BACKGROUND AND OBJECTIVES:Traditionally, down beat nystagmus is regarded as a sign of central nervous system dysfunction. But, several years has passed since Herdman et al reported the down beat nystagmus developed during treatment maneuvers for posterior semicircular canal benign paroxysmal positional vertigo(BPPV). We undertook this study to evaluate the character and clinical analysis of the positional or positioning down beat nystagmus, to discuss the clinical significance of positional or positioning down beat nystagmus as a diagnostic criteria of superior semicircular canal BPPV, and to propose the new treatment method. MATERIALS AND METHOD:From November 1999 to March 2004, we sampled the 103 patients with positional or positioning down beat nystagmus. Of these patients, we selected 16 patients except for the patients with central nervous system dysfunction, nonspecific or artifact result, idiopathic origin. RESULTS:All of 16 patients had no sign and radiologic result of central nervous system disorder. 10 patients was reported or suspected the diagnosis of posterior semicircular canal BPPV. Fatigability was reported in 9 patients and reversibility was reported in 1 patient. Average latency was checked less than 2 seconds. CONCLUSION:Although the diagnostic criteria of superior semicircular canal BPPV that we reported was not controversial, we expect that this criteria is useful in diagnosis for patients with atypical positional or positioning down beat nystagmus. And the new treatment method that we reported will has the better results than previous method.
Artifacts ; Central Nervous System ; Diagnosis ; Humans ; Semicircular Canals ; Vertigo*

No abstract available.
Fallopian Tubes* ; Female

In carpal injury, a good functional end result seems to correlate with final anatomic alignment of carpus after treatment. Some cases are often misdiagnosed and result in inadequate treatment. Forty six cases of carpal injuries were analysed which were treated for 9 years from 1975 to 1984 at the Department of Orthopedic Surgery, Seoul National University Hospital. The observations can be summarized as follows. 1. The male to female ratio was 3.5: 1 and 82% of total cases were in the third and fourth decades. 2. The most frequent cause of injury was fall from height with outstretched hand. 3. Trans-scaphoid perilunar dislocation and its variant were the most common diagnosis in this analysis. 4. All of the scapho-lunate dissociation showed volar flexion intercalated segmental instability with scapho-lunate gap more than 2 mm in our series. 5. In 11 cases of trans-scaphoid perilunar dislocation and its variant, carpal collapse was found in 10 cases. In 5 cases dorsiflexion intercalated segmental instability pattern and in one case volar flexion intercalated segmental instability pattern were found to be present. 6, There was an increase in scapho-lunate angle in all cases of dorsiflexion intercalated segmental instability, but a decrease in scapho-lunate angle is not a consistent finding in volar flexion intercalated segmental instability. 7. In 24 cases more than 6 months follow-up, excellent and good results were obtained in 20 cases. 8. As a result of above findings, authors conclude that scapho-lunate gap more than 2mm has diagnostic value in scapho-lunate dissociation but that dorsiflexion intercalated segmental instability or volar flexion intercalated segmental instability only means the changes in the relationship between carpal bones and does not have definite or specific diagnostic value for a specific carpal injury.
Carpal Bones ; Diagnosis ; Dislocations ; Female ; Follow-Up Studies ; Hand ; Humans ; Male ; Orthopedics ; Seoul ; Wrist

PURPOSE: To assess the usefulness of the ultrasound-guided subclavian vein catheterization in difficult patients. MATERIALS AND METHODS: We tried subclavian vein catheterization in 18 patients in which conventional blind technique failed(N=9) :or was complicated by hemothorax or pneumothorax(N=3) :or was prohibited by respirator care(N=4) and severe thoracic deformity(N=2). Initially, the patency of subclavian vein was evaluated with ultrasonography, and then, the puncture of the subclavian vein was performed under the guidance of ultrasonography. Under the fluoroscopy, the patency of the proximal subclavian vein and the superior vena cava was evaluated after contrast-media injection and a catheter was inserted into the subclavian vein and accurately positioned at the superior vena cava. RESULTS: Successful catheterization was performed in 17 patients. In the remaining one patient, we did not perform catheterization because of bilateral subclavian vein thrombosis detected during the procedure. There were no procedure-related complications. CONCLUSION: Ultrasound-guided subclavian vein catheterization is an easy and safe method even in difficult cases.
Catheterization* ; Catheters* ; Fluoroscopy ; Hemothorax ; Humans ; Punctures ; Subclavian Vein* ; Thrombosis ; Ultrasonography ; Vena Cava, Superior ; Ventilators, Mechanical

Chemotherapy offers palliative treatment to patient with advanced nonresectable hepatoma. The usefulness of systemic chemotherapy is limited becaused of serious side reaction and low concentration of drug at tumor. Butthis problem may be overcome by intraarterial infusion. Nonsurgical percutaneous hepatic arteiral catheterizationwas done in 21 patients with primary hepatoma, and infusion chemotherapy was done in 19 patients who were successful in catherization. The results were as follows; 1. Selective catheterization of hepatic artery proper,common hepatic artery, and celiac artery were seccessful in 4, 9 and 4 patients, respectively. The success rate ofselective catheterization is 80.9% including celiac artery among 21 patients with hepatoma. 2. Simple catherization method was applied in 14 patients, and catheter exchange and Loop methods were applied in 2 and 1patient respectively. 3. Complications related to catheterization, such as infection and bleeding on punctured site, intimal injury and dislodgement of catheter were not serious. 4. Drugs were well tolerated without serioustoxicity or complication. 5. 3 patients showed objective response and median survival time of treated patients is 2.5 months.
Carcinoma, Hepatocellular ; Catheterization ; Catheters ; Celiac Artery ; Drug Therapy ; Hemorrhage ; Hepatic Artery ; Humans ; Infusions, Intra-Arterial ; Methods ; Palliative Care

Intravascular lymphomatosis (IL) is a variant of non-Hodgkin's lymphoma with an predilection for the CNS. Most cases are not diagnosed until postmortem. IL is characterized by neoplastic proliferation of lymphoid cells within the lumen of small veins and arteries with minimal involvement of the parenchyma. We experienced a 62-year-old woman who presented with seizure and fever associated with anemia, elevated LDH and beta 2-microglobulin without systemic involvement. This report illustrates the diagnostic challenge of this rare disorder with a grave prognosis. (J Korean Neurol Assoc 19(4):413~416, 2001)
Anemia ; Arteries ; beta 2-Microglobulin ; Central Nervous System* ; Female ; Fever ; Humans ; L-Lactate Dehydrogenase ; Lymphocytes ; Lymphoma, Non-Hodgkin ; Middle Aged ; Prognosis ; Seizures ; Veins

PURPOSE: Chronic prostatitis displays various pathophysiologies due to various causes, and is a life time affliction, but the diagnosis and treatment are still unclear. Therefore, it is important to find if some elements influence the incidence and progress of the disease; attempts were made to recognize the risk factors for chronic prostatitis. MATERIALS AND METHODS: 184 chronic prostatitis patients were selected, and divided, after treatment, into the improvement (IG; n=147) and non-improvement groups (NIG; n=37). 40 healthy men were chosen as the control group (CG) for a comparative analysis. Subjects were investigated for their professional stati and form of work, driving, motorcycle or bicycle utilization, drinking, smoking, sex and their style of diet. RESULTS: The ratio of sedentary desk workers in the NIG (73.0%) was higher than in the other groups. The ratio of those that drove for more than 1 hour was much high in the NIG by 54.1%. The ratio of the people who ejaculated more than once a week, either through sexual intercourse or masturbation, was lower in the NIG by 56.5%, but that of people who ejaculated every day was higher in the NIG (13.5%). People drinking more than once a week was greater in the NIG (67.6%), and those who drank more than 1 bottle of Korean wine, Soju, were showed an expressively higher ratio in the NIG (72.0%). In relation to dietary behavior, the NIG showed a high ratio (73.0%) for a preference for salty food only. CONCLUSIONS: Factors that may influence the prognosis of chronic prostatitis are thought to be the form of profession, number ejaculations, frequency and amount of drinking, an a habit of eating salty food. Therefore, these factors should be considered together when looking for a cure for chronic prostatitis.
Coitus ; Diagnosis ; Diet ; Drinking ; Eating ; Ejaculation ; Humans ; Incidence ; Male ; Masturbation ; Motorcycles ; Prognosis ; Prostatitis* ; Risk Factors* ; Smoke ; Smoking ; Wine

OBJECTIVES: The objective of this study is to measure and to compare the rate of depression, anxiety, self-esteem and the quality of life of the patients with chest pain. Based on the result of this study, the necessity of the psychiatric assessment and treatment of the patients with chest pain is emphasized. This study is a preliminary research for a larger scale investigation to be carried out in the future. METHODS: Thirty nine patients with chest pain who visited Cardiovascular Division of Dept. of Internal Medicine Pusan National University Hospital and fourty normal control group(NC) were included in this study. The patients were classified into typical chest pain group(TCP, N=19) and atypical chest pain group(ACP, N=20) based on the cause of the pain. The cause was determined by cardiac computed tomography, exercise stress test, coronary angiography, and questionaires by a cardiology specialist. The patients were assessed with Beck Depression Inventory(BDI), State-Trait Anxiety Inventory(STAI), Rosenberg Self-Esteem Scale(RSES) and Korean version of the Smith Klein Beecham 'Quality of Life' scale(KvSBQOL). RESULTS: 1) When the risk factors of cardiac disease is compared, most of the factors(Hypertension, Diabetes, Hyperlipidemia, Cerebral infarction) did not differ significantly among the two chest pain groups, except for the family history, for which TCP group showed higher risk than ACP group did. 2) As for the self-report questionaires scores, BDI score, which indicates the rate of depression, of both ACP group and TCP group was significantly higher than that of NC group in BDI for depression. STAI score, which measures anxiety, was also significantly high in both groups. Especially, STAI score was significantly higher in ACP group than TCP group. 3) In the aspect of self-esteem and quality of life, ACP group scored significantly lower than TCP group and NC group. The scores for TCP group and NC group did not differ significantly. CONCLUSIONS: The patients with chest pain showed more depression and anxiety than normal control group, regardless of the cause of the pain. However, TCP group did not show significantly larger drop in self-esteem and quality of life than ACP group did. This result implies that early psychiatric assessment and treatment is needed for the patients with such chest pain, since it is highly likely that the pain would lead to lower quality of life of the patients.
Anxiety ; Cardiology ; Chest Pain ; Coronary Angiography ; Depression ; Exercise Test ; Heart Diseases ; Humans ; Hyperlipidemias ; Internal Medicine ; Quality of Life ; Risk Factors ; Specialization ; Thorax

Multifocal fibrosclerosis, a rare disorder, has no known etiology and is considered to be a systemic illness manifested by combinations of fibrosing process of multiple areas such as mediastinal fibrosis, retroperitoneal fibrosis, orbital pseudotumor, sclerosing cholangitis, and Reidel's thyroiditis. We have experienced a 49-year-old man with pseudotumor of the orbit, sclerosing cholangitis, and CNS involvements included unrecognized meningitis and suspicious CNS vasculitis. The patient showed clinical improvement with corticosteroid therapy.
Cholangitis, Sclerosing ; Fibrosis ; Humans ; Meningitis ; Middle Aged ; Orbit ; Orbital Pseudotumor ; Retroperitoneal Fibrosis ; Thyroid Gland ; Thyroiditis ; Vasculitis, Central Nervous System

PURPOSE: To evaluate the diagnostic value of radiologic studies in the Cushing's disease MATERIALS AND METHODS: We analyzed retrospectively the CT(n=19, dynamic CT was not perfomed), MR (n=23, dynamic MR in 2 cases), and the results of inferior petrosal sinus sampling(IPSS)(n=13) in 25 patients(19 women, 6men, age range 16-58, mean 32.2) with pathologically-confirmed ACTH secreting pituitary adenoma. We analyzed the radiologic findings and determined how accurately each method could detect and lateralize the lesion within the pituitary gland. The results were compared with the surgical findings and with each other. RESULTS: Seven patients(28%) out of 25 had macroadenomas and the lesions were detected and correctly diagnosed by CT and MR in all. Eighteen patients(72%) had microadenoma. In patients with microadenoma the sensitivity was 38.5%(5/13) in CT, 64.7%(11/17) in MR, 90.9%(10/11) in IPSS. In two patients with dynamic MR, in whom the conventional Gd-enhanced MR showed false negative results, the lesions were detected as low signal intensity mass and correctly lateralized. Considering the results of both MR and IPSS, the sensitivity increased up to 94.1%(17/18). CONCLUSION: Considering the invasiveness of IPSS, Gd-enhanced MR, preferably dynamic, seems to be an imaging modality of choice in Cushing's disease. Combined use of IPSS in selected patients further increases the accuracy of diagnosis and lateralization.
ACTH-Secreting Pituitary Adenoma ; Diagnosis ; Female ; Humans ; Pituitary Gland ; Retrospective Studies