Intracranial vasculitis is a rare and disastrous complication of tuberculous meningitis if not treated properly. Focal neurologic deficits according to the vessels involved are common manifestation. Here, we report a 29-year-old man who suffered abrupt, bizarre behavioral changes caused by vasculitis complicating tuberculous meningoencephalitis. The diagnosis of tuberculous meningitis is based upon both the CSF findings and a chest X-ray. His systemic symptoms disappeared by after being administered antituberculous medication but various psychotic features such as hypersomnia, hyperphagia and aggressivebehavior continued. A brain MRI showed multiple small parenchymal tuberculous nodules, and the brain MR angiography revealed a narrowing of the proimal middle cerebral arteries and a reduced visualization of the cerebral vessels, suggesting widespread vasculitis. Intravenous dexamethasone successfully ameliorated his behavioral changes. In addition both the follow up brain MRI and angiography showed a normalization of the previous findings.
Adult ; Angiography ; Brain ; Dexamethasone ; Diagnosis ; Disorders of Excessive Somnolence ; Follow-Up Studies ; Humans ; Hyperphagia ; Magnetic Resonance Imaging ; Meningoencephalitis* ; Middle Cerebral Artery ; Neurologic Manifestations ; Thorax ; Tuberculosis ; Tuberculosis, Meningeal ; Vasculitis

Skin atrophy is one of the most common side effects of topical steroid use and results from decreased skin proalphaI collagen mRNA production due to specific alterations in collagen gene transcription or from reduced collagen mRNA stability. This report describes a case of a 8 year-old-girl who visited our hospital with a complaint of ambiguous genitalia. She was observed to have atrophic labia majora and atrophic striae resembling scrotal rugae. However, her serum levels of FSH, LH, 17-KS, 17-OHCS, 5-DHT, DHT and DHEA-S were all in normal range and her karyotype was 46,XX. Abdominal and pelvic ultrasonogram showed a normal uterus and ovaries. Careful history taking revealed frequent use of steroid ointment due to vulvar pruritus for 2 years and she was finally diagnosed to have atrophy of external genitalia induced by long-term use of topical steroid.
Atrophy* ; Collagen ; Disorders of Sex Development ; Female ; Genitalia* ; Karyotype ; Ovary ; Pruritus ; Reference Values ; RNA Stability ; RNA, Messenger ; Skin ; Ultrasonography ; Uterus

No abstract available.

This article was published with an incorrect unit in Table 1.

BACKGROUND: Cardiopulmonary exercise test is a useful test for the evaluation of the cardiovascular and respiratory systems. Obese subjects have an increased resting metabolic rate (VO2) compared to non-obese subjects and the increase is more marked during dynamic exercise, which results in the limitation of maximal exercise in obese subjects. In this study, the influence of the obesity and fat distribution on the maximal exercise capacity were evaluated. METHODS: Maximal exercise capacity was represented by maximam maximum oxygen uptake and VO2 max in the cardiopulmonary test. Obesity, total fat content and abdominal obesity(waist to hip ratio, WHR) were measured by bioelectrical impedence method. Total of 42 volunteers(male 22, female 20) were evaluated. RESULTS: 1) Weight to height ratio(mean±SD) was 110%±14.9% in men and 100±11.1% in women. 2) Fat ratio(mean±SD) was 23.3±5.2% in men and 27.55±3.9% in woman. 3) Waist to hip ratio(mean±SD) was 0.85±0.04 in men and 0.8±0.03 in woman. 4) In men, VO2max/min/Kg was negatively correlate with obesity, fat ratio, and abdominal fat distribution. 5) In woman, VO2max/Kg was negatively correlated with obesity and fat ratio, but did not show significant relationship with abdominal fat distribution. CONCLUSION: Obesity was a limiting factor for maximal exercise in both men and women. Abdominal obesity was a limiting factor for maximal exercise in men but its implication to women needs further evaluation.
Abdominal Fat ; Exercise Test* ; Female ; Hip ; Humans ; Male ; Obesity ; Obesity, Abdominal ; Oxygen ; Respiratory System

No abstract available.
Heel* ; Melanoma, Amelanotic* ; Ulcer*

Primary lateral sclerosis (PLS) is a rare upper motor neuron disease characterized by selective degeneration of corticospinal and corticobulbar tracts. It is important to rule out other diseases presenting as progressive spastic paraparesis, such as multiple sclerosis (MS) or amyotrophic lateral sclerosis (ALS). Though that is not so difficult as the development of imaging technique and neurophysiological tool, if one shows slow progressive spastic paraparesis clinically, and there is no abnormal CSF or EMG findings, it is not easy to differentiate between primary progressive MS and PLS. In fact, PLS is so rare that it has long been debated whether PLS is a disease entity or syndrome or a nothing. But we present a PLS patient whose brain MRI shows diffuse signal change along the bilateral corticospinal tracts and the hypoperfusion of frontal motor cortex is proved by brain SPECT.
Amyotrophic Lateral Sclerosis ; Brain ; Humans ; Magnetic Resonance Imaging* ; Motor Cortex ; Motor Neuron Disease* ; Multiple Sclerosis ; Paraparesis, Spastic ; Pyramidal Tracts ; Tomography, Emission-Computed, Single-Photon

Thrombomodulin (TM) is thrombin receptor present on the luminal surface of endothelial cells. Because the thrombin-TM complex acts as an anticoagulant, the functional variants or deficiency of TM may lead to increment of thrombotic tendency. In this study, we screened the genetic variants of the TM gene in patients with myocardial infarction (MI) and analyzed the genotype to elucidate the effects of genetic variations of TM gene on the development of the MI. We screened a promoter region and coding sequence of the TM gene using single strand conformation polymorphism-heteroduplex analysis and identified three common genetic variants: those were TM G-33A, TM Ala455Val, and TM C1922T. The genotype frequencies were investigated in the patients with MI (n=234) and control subjects (n=291) by the method of allele-specific oligomer hybridization. The frequencies of mutant genotypes (TM -33A, TM 455Val, and TM 1922T) were higher in patient group compared to the control subjects in males while there were no significant differences in females. In the multiple logistic regression analysis, TM 455Val and TM 1922T alleles were independent risk factors for MI (OR[95% CI: 1.799[1.125-2.878] p=0.014 and 5.624[1.019-31.025], p=0.048, respectively) in males. However, the genetic variations were not independent risk factors for MI in females. There were significant linkage disequilibriums among three genetic variants. These linkage disequilibriums explain the similar effects of three genetic variants on the development of MI. To investigate the effect of the TM G-33A mutation on TM promoter activity, the two TM promoter constructs (pTM-355 and pTM-125, bearing TM -33G or TM -33A) containing of firefly luciferase gene were transfected into HepG2, BAE, and CHO cells. The promoter activities were higher in the promoter constructs with TM -33G compared to the constructs with TM -33A in pTM-355. These results suggest the possibility of the positive predisposing effect of TM -33A allele on MI in males. The functional study for TM Ala455Val and TM C1922T should be followed to elucidate the genotype effects of these mutations on the development of MI. In this study, we identified three genetic variants of TM gene and showed the significant associations between genetic variants and MI in males. These results proposed that TM gene is an attractive candidate for genetic risk factor for MI in Koreans.
Alleles ; Animals ; CHO Cells ; Clinical Coding ; Cricetinae ; Endothelial Cells ; Female ; Fireflies ; Genetic Variation ; Genotype ; Humans ; Linkage Disequilibrium ; Logistic Models ; Luciferases ; Male ; Myocardial Infarction* ; Phenobarbital ; Promoter Regions, Genetic ; Receptors, Thrombin ; Risk Factors* ; Thrombomodulin

Spinal cord infarction as a complication of spine surgery occurs rarely. Herein, a case of spinal cord infarction, which developed in a 69 year old woman following posterior decompression and internal fixation for a T11 bursting fracture, is descirbed. The anesthetic induction and intraoperative course were uneventful, except at the end of the procedure, where her blood pressure suddenly dropped from 130/90 to 90/60 mmHg. The patient was aggressively treated with a transfusion and vasopressor, the blood pressure then returned to its usual value within 10 minutes. However, during a physical examination in the recovery room, the patient was found to have flaccid lower limbs, with impaired sensory function below the T8 level. Her cord diameter had increased, and a high signal lesion was observed within the thoracic spinal cord, from T9 to T12 level on T2-weighted MR images, which was diagnosing as a spinal cord infarction, was and showed no improvement despite the immediate and aggressive treatment.
Aged ; Blood Pressure ; Decompression ; Female ; Humans ; Infarction* ; Lower Extremity ; Physical Examination ; Recovery Room ; Sensation ; Spinal Cord* ; Spine*

OBJECTIVE: Elevated serum progesterone (P) levels on triggering day have been known to affect the pregnancy rate of in vitro fertilization (IVF). This study aimed to identify the possible factors influencing serum P levels on triggering day in stimulated IVF cycles. METHODS: Three hundred and thirty consecutive fresh IVF cycles were included in the study. All cycles were first attempts and were performed in a single infertility center. The indications for IVF were male factor infertility (n=114), ovulatory infertility (n=84), endometriosis (n=61), tubal infertility (n=59), unexplained infertility (n=41), and uterine factor infertility (n=39). A luteal long protocol of a gonadotropin-releasing hormone (GnRH) agonist (n=184) or a GnRH antagonist protocol (n=146) was used for pituitary suppression. Ovarian sensitivity was defined as the serum estradiol level on triggering day per 500 IU of administered gonadotropins (OS[a]) or the retrieved oocyte number per 500 IU of administered gonadotropins (OS[b]). RESULTS: Univariate analysis revealed that the serum P level on triggering day was associated with the serum estradiol level on triggering day (r=0.379, p<0.001), the number of follicles > or =14 mm (r=0.247, p<0.001), the number of retrieved oocytes (r=0.384, p<0.001), and ovarian sensitivity (OS[a]: r=0.245, p<0.001; OS[b]: r=0.170, p=0.002). The woman's age, body mass index, antral follicle count, and basal serum follicle stimulating hormone and estradiol levels were not associated with serum P level on triggering day. The serum P level on triggering day did not show significant variation depending on the type or cause of infertility, pituitary suppression protocol, or the type of gonadotropins used. CONCLUSION: The serum P level on triggering day was closely related to the response to ovarian stimulation.
Body Mass Index ; Endometriosis ; Estradiol ; Female ; Fertilization in Vitro* ; Follicle Stimulating Hormone ; Gonadotropin-Releasing Hormone ; Gonadotropins ; Humans ; Infertility ; Male ; Oocytes ; Ovulation Induction ; Pregnancy Rate ; Progesterone*