1.Eosinophilic granulomatosis with polyangiitis presenting with acutepolyneuropathy mimicking Guillain-Barré syndrome: A case report
Jee Seon KIM ; June Hong AHN ; Hyun Jung JIN
Allergy, Asthma & Respiratory Disease 2018;6(1):72-76
Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare systemic vasculitis that commonly affects the peripheral nervous system. EGPA rarely presents with acute polyneuropathy resembling Guillain-Barré syndrome (GBS). A 51-year-old female patient with a history of asthma suddenly developed bilateral lower extremityparesthesia that progressed to asymmetric ascending paralysis within 10 days of onset. Nerve conduction study results were compatible with acute motor sensory axonal neuropathy, consistent with a GBS subtype. A clinical and neurophysiological diagnosis of GBS was made, and high-dose intravenous immunoglobulins were administered. However, the patient's painful motor weakness persisted. Furthermore, she had newly developed skin lesions on her back, face, and arms. Her blood test revealed marked eosinophilia (>60%). In addition, antineutrophil cytoplasmic antibodies were reported positive. A Water's view radiographic image showed bilateral maxillary sinusitis. Considering the history of asthma, we suspected EGPA-associated polyneuropathy and started steroid treatment. The patient's strength and eosinophilia improved rapidly and dramatically. EGPA can mimic GBS and should be differentiated because of different treatment strategies. Early diagnosis and prompt treatment help achieve a good outcome.
Antibodies, Antineutrophil Cytoplasmic
;
Arm
;
Asthma
;
Axons
;
Diagnosis
;
Early Diagnosis
;
Eosinophilia
;
Eosinophils
;
Female
;
Granulomatosis with Polyangiitis
;
Guillain-Barre Syndrome
;
Hematologic Tests
;
Humans
;
Immunoglobulins, Intravenous
;
Maxillary Sinus
;
Maxillary Sinusitis
;
Middle Aged
;
Neural Conduction
;
Paralysis
;
Peripheral Nervous System
;
Polyneuropathies
;
Skin
;
Systemic Vasculitis
2.Lumbar Internal Disc Derangement in Patients with Chronic Low Back Pain: Diagnostic Value of the MR Imaging Findings as Compared with Provoked Discography as the Standard.
Hyeon Seon PARK ; Jee Young PARK ; Sang Ho LEE ; Yong AHN ; Sang Yeun LEE
Journal of the Korean Radiological Society 2006;54(4):301-307
PURPOSE: The aim of this study was to evaluate the diagnostic value of the MR Imaging findings with provoked discography used as the standard for painful lumbar disc derangement. MATERIALS AND METHODS: Two hundred patients (412 discs), (age range: 21-77 years), with chronic low back pain underwent MRI and provoked discography. We evaluated the MRI T2-WI findings such as disc degeneration, high-Intensity zones and endplate abnormalities. Subsequently, provocative discography was independently performed with using MR imaging, and a painful disc was defined when moderate to severe and concordant pain was provoked. We calculated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the MRI findings with using provoked discography as the standard. RESULTS: 400 discs showed abnormal findings such as disc degeneration, HIZ and endplate abnormalities on the T2-WI images. 12 discs showed normal findings. HIZ or endplate abnormalities were always combined with disc degeneration. The prevalence of each findings were disc degeneration (400 discs: 97.1%), HIZ (111 discs: 26.9%), type I endplate abnormalities (34 discs: 8.3%), type II endplate abnormalities (75 discs: 18.2%), the combined findings of HIZ and type I endplate abnormalities (2 discs: 0.5%) and the combined findings of HIZ and type II endplate abnormalities (7 discs: 1.7%). The disc degeneration showed high sensitivity (99.5%) and low specificity (5.0%), so only the NPV (91.7%) was significant, and not the PPV (47.8%). Each findings of HIZ (sensitivity, 36.5%; specificity, 81.4%; PPV, 63.18%; NPV, 59.5%), type I endplate abnormalities (11.0%, 94.1%, 61.8% and 54.8%, respectively), type II endplate abnormalities (19.8%, 83.2%, 50.7% and 54.3%, respectively), the combined findings of HIZ and type I endplate abnormalities (0.5%, 99.6%, 50.0% and 53.4%, respectively) and the combined findings of HIZ and type II endplate abnormalities (26.0%, 99.1%, 71.4% and 53.8%, respectively) show high specificity, but low sensitivity, so the PPV and NPV were also not significant. CONCLUSION: For diagnosing painful lumbar disc derangement, the MR imaging findings seem to be inadequate as predictive factors when provoked discography was used as the standard.
Humans
;
Intervertebral Disc Degeneration
;
Low Back Pain*
;
Magnetic Resonance Imaging*
;
Prevalence
;
Sensitivity and Specificity
3.Human CD36 overexpression in renal tubules accelerates the progression of renal diseases in a mouse model of folic acid-induced acute kidney injury.
Jong Hwan JUNG ; Jee Eun CHOI ; Ju Hung SONG ; Seon Ho AHN
Kidney Research and Clinical Practice 2018;37(1):30-40
BACKGROUND: Acute kidney injury (AKI) is a risk factor for progression to chronic kidney disease, with even subclinical AKI episodes progressing to chronic kidney disease. Several risk factors such as preexisting kidney disease, hyperglycemia, and hypertension may aggravate renal disease after AKI. However, mechanisms underlying the progression of AKI are still unclear. This study identified the effect of human cluster of differentiation 36 (CD36) overexpression on the progression of folic acid-induced AKI. METHODS: Pax8–rtTA/tetracycline response element–human CD36 transgenic mice were used to elucidate the effect of human CD36 overexpression in the proximal tubules on folic acid-induced AKI. RESULTS: Results of histological analysis showed severely dilated tubules with casts and albuminuria in folic acid-treated transgenic mice overexpressing human CD36 compared with folic acid-treated wild-type mice. In addition, analysis of mRNA expression showed a significant increase in the collagen 3a1 gene in folic acid-treated transgenic mice overexpressing human CD 36 compared with folic acid-treated wild type mice. CONCLUSION: Human CD36-overexpressing transgenic mice showed severe pathological changes and albuminuria compared with wild-type mice. Moreover, mRNA expression of the collagen 3a1 gene increased in folic acid-treated transgenic mice. These results suggest that human CD36 overexpression is a risk factor of AKI and its progression to chronic kidney disease.
Acute Kidney Injury*
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Albuminuria
;
Animals
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Collagen
;
Fibrosis
;
Folic Acid
;
Humans*
;
Hyperglycemia
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Hypertension
;
Kidney Diseases
;
Mice*
;
Mice, Transgenic
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Renal Insufficiency
;
Renal Insufficiency, Chronic
;
Risk Factors
;
RNA, Messenger
4.Movement-Related Potentials Associated with Motor Timing Errors as Determined by Internally Cued Movement Onset
Jee Seon AHN ; Jun Ho YOON ; Jae-Jin KIM ; Jin Young PARK
Psychiatry Investigation 2021;18(7):670-678
Objective:
Accurate motor timing is critical for efficient motor control of behaviors; however, the effect of motor timing abilities on movement-related neural activities has rarely been investigated. The current study aimed to examine the electrophysiological correlates of motor timing errors.
Methods:
Twenty-two healthy volunteers performed motor timing tasks while their electroencephalographic and electromyographic (EMG) activities were simultaneously recorded. The average of intervals between consecutive EMG onsets was calculated separately for each subject. Motor timing error was calculated as an absolute discrepancy value between the subjects’ produced and given time interval. A movement-related potential (MRP) analysis was conducted using readings from Cz electrode.
Results:
Motor timing errors and MRPs were significantly correlated. Our principal finding was that only Bereitschaftpotential (BP) and motor potential (MP), not movement monitoring potential, were significantly attenuated in individuals with motor timing errors. Motor timing error had a significant effect on the amplitude of the late BP and MP.
Conclusion
The findings provide electrophysiological evidence that motor timing errors correlate with the neural processes involved in the generation of self-initiated voluntary movement. Alterations in MRPs reflect central motor control processes and may be indicative of motor timing deficits.
5.Incidence and Procedure-Related Risk Factors of Delirium in Patients Admitted to an Intensive Care Unit
Jee Seon AHN ; Jooyoung OH ; Jaesub PARK ; Jae Jin KIM ; Jin Young PARK
Korean Journal of Psychosomatic Medicine 2019;27(1):35-41
OBJECTIVES: Although delirium is a common complication among patients hospitalized in intensive care units(ICUs), little is known about the roles that diagnostic and therapeutic procedures play in its development. This study investigates the procedure-related risk factors of delirium in ICU patients. METHODS: All the consecutive patients admitted to the ICU between June 2016 and May 2017 were routinely evaluated for delirium by psychiatrists. In total, 1156 patients met the inclusion criteria and were retrospectively analyzed. A multiple logistic regression analysis was conducted to investigate independent risk factors of delirium development while adjusting for other characteristics. RESULTS: The age, Acute Physiology and Chronic Health Evaluation (APACHE II) score, proportion of patients who had undergone an operation, and proportion of patients who were foley catheterized, mechanically ventilated, and physically restrained were higher in the delirium group. The multiple logistic regression analysis confirmed that the use of restraint was an independent risk factor of delirium (odds ratio : 10.006 ; 95% confidence interval : 6.120–16.360 ; p<0.001). The patient factors independently associated with delirium were an advanced age and a higher APACHE II score. The incidence of delirium was 15.3%. CONCLUSIONS: There is a high prevalence of delirium influenced by potentially harmful procedures in patients in ICU settings. The use of physical restraint had the strongest association with the development of delirium. These findings advocate the need to target procedure-related risk factors such as the use of restraints as preventive intervention measures for ICU delirium.
APACHE
;
Catheters
;
Critical Care
;
Delirium
;
Humans
;
Incidence
;
Intensive Care Units
;
Logistic Models
;
Prevalence
;
Psychiatry
;
Restraint, Physical
;
Retrospective Studies
;
Risk Factors
6.Movement-Related Potentials Associated with Motor Timing Errors as Determined by Internally Cued Movement Onset
Jee Seon AHN ; Jun Ho YOON ; Jae-Jin KIM ; Jin Young PARK
Psychiatry Investigation 2021;18(7):670-678
Objective:
Accurate motor timing is critical for efficient motor control of behaviors; however, the effect of motor timing abilities on movement-related neural activities has rarely been investigated. The current study aimed to examine the electrophysiological correlates of motor timing errors.
Methods:
Twenty-two healthy volunteers performed motor timing tasks while their electroencephalographic and electromyographic (EMG) activities were simultaneously recorded. The average of intervals between consecutive EMG onsets was calculated separately for each subject. Motor timing error was calculated as an absolute discrepancy value between the subjects’ produced and given time interval. A movement-related potential (MRP) analysis was conducted using readings from Cz electrode.
Results:
Motor timing errors and MRPs were significantly correlated. Our principal finding was that only Bereitschaftpotential (BP) and motor potential (MP), not movement monitoring potential, were significantly attenuated in individuals with motor timing errors. Motor timing error had a significant effect on the amplitude of the late BP and MP.
Conclusion
The findings provide electrophysiological evidence that motor timing errors correlate with the neural processes involved in the generation of self-initiated voluntary movement. Alterations in MRPs reflect central motor control processes and may be indicative of motor timing deficits.
7.A Case of Newly Detected Ectopic Mediastinal Parathyroid Gland in Chronic Renal Failure Patient after Parathyroidectomy.
Duk Eun JUNG ; Jee Eun CHOI ; Kang Won LEE ; Yu Min LEE ; Ji Eun LEE ; Hyun Jung KIM ; Seon Ho AHN ; Ju Hung SONG
Korean Journal of Nephrology 2009;28(6):704-707
Hyperparathyroidism is one of the most serious complications for hemodialysis patients. Parathyroidectomy is indicated in patients with severe hyperparathyroidsm refractory to medical treatment. An 39- year-old man who were maintained by hemodialysis underwent parathyroidectomy due to tertiary hyperparathyroidism. The level of intact PTH fell after parathyroidectomy but subsequently rose. We checked up the parathyroid gland by MIBI scan and CT. As a result, a mass was found in the anterior mediastinum. So it is important to suspect the ectopic parathyroid gland when the PTH level elevation is persistent after parathyroidectomy in chronic renal failure patient.
Humans
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Hyperparathyroidism
;
Kidney Failure, Chronic
;
Mediastinum
;
Parathyroid Glands
;
Parathyroidectomy
;
Renal Dialysis
8.A Case of IgG4-Related Lung Disease Presenting as Interstitial Lung Disease.
Jee Hwan AHN ; Sun In HONG ; Dong Hui CHO ; Eun Jin CHAE ; Joon Seon SONG ; Jin Woo SONG
Tuberculosis and Respiratory Diseases 2014;77(2):85-89
Intrathoracic involvement of immunoglobulin G4 (IgG4)-related disease has recently been reported. However, a subset of the disease presenting as interstitial lung disease is rare. Here, we report a case of a 35-year-old man with IgG4-related lung disease with manifestations similar to those of interstitial lung disease. Chest computed tomography showed diffuse ground glass opacities and rapidly progressive pleural and subpleural fibrosis in both upper lobes. Histological findings showed diffuse interstitial lymphoplasmacytic infiltration with an increased number of IgG4-positive plasma cells. Serum levels of IgG and IgG4 were also increased. The patient was diagnosed with IgG4-related lung disease, treated with anti-inflammatory agents, and showed improvement. Lung involvement of IgG4-related disease can present as interstitial lung disease and, therefore, should be differentiated when evaluating interstitial lung disease.
Adult
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Anti-Inflammatory Agents
;
Fibrosis
;
Glass
;
Humans
;
Immunoglobulin G
;
Immunoglobulins
;
Lung
;
Lung Diseases*
;
Lung Diseases, Interstitial*
;
Plasma Cells
;
Thorax
9.Clinical Features of Acute Aortic Dissection Patients Initially Diagnosed with ST-segment Elevation Myocardial Infarction.
Min Jee LEE ; Young Sun PARK ; Shin AHN ; Chang Hwan SOHN ; Dong Woo SEO ; Jae Ho LEE ; Yoon Seon LEE ; Kyung Soo LIM ; Won Young KIM
Journal of the Korean Society of Emergency Medicine 2016;27(1):30-35
PURPOSE: Acute myocardial infarction (AMI) concomitant with acute aortic syndrome (AAS) is rare but prompt recognition of concomitant AAS is critical, particularly in patients with ST-segment elevation myocardial infarction (STEMI) because misdiagnosis with early thrombolytic or anticoagulant treatment may result in catastrophic consequences. This study examined the clinical features of patients of STEMI concomitant with AAS that may be a diagnostic clue. METHODS: Between January 1, 2010 and December 31, 2014, 22 patients who had the initial diagnosis of acute coronary syndrome (AMI and unstable angina) and AAS (aortic dissection, intramural hematoma, and ruptured thoracic aneurysm) in our emergency department were reviewed. Among them, 10 patients who were transferred from other hospitals and 4 patients with non-STEMI were excluded, leaving 8 patients of STEMI concomitant with AAS for analysis. RESULTS: The mean age of study patients was 57.5+/-16.31 years and five patients were Stanford type A and three patients were type B aortic dissection. Six patients had ST-segment elevation in anterior leads and 2 patients in inferior leads. Most patients had acute onset and severe chest pain, but none had dissecting nature chest pain. Serum troponin I was elevated in three patients but all patients had Ddimer elevation. Aortic regurgitation or regional wall motion abnormality was detected in four patients, and widened mediastinum was observed in all study patients. CONCLUSION: Concomitant AAS might be suspected in patients with STEMI who have elevated D-dimer and widened mediastinum.
Acute Coronary Syndrome
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Aortic Valve Insufficiency
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Chest Pain
;
Diagnosis
;
Diagnostic Errors
;
Emergency Service, Hospital
;
Hematoma
;
Humans
;
Mediastinum
;
Myocardial Infarction*
;
Troponin I
10.Etiology of Pleural Effusions in Cancer Patients.
Min Jee LEE ; Yoon Seon LEE ; Youn Jung KIM ; Shin AHN ; Chang Hwan SOHN ; Dong Woo SEO ; Jae Ho LEE ; Won Young KIM ; Kyung Soo LIM
Journal of the Korean Society of Emergency Medicine 2016;27(1):15-21
PURPOSE: The purpose of this study is to examine the causes of Pleural effusion (PE) in cancer patients and to compare the clinical characteristics between malignant PE (MPE) and non-MPE. METHODS: All consecutive cancer patients with PE who underwent diagnostic thoracentesis from January 1, 2008 to March 31, 2011 were analyzed retrospectively. RESULTS: A total of 719 patients were included; mean age was 58.4+/-13.6 years and 44.5% were female. The most common cause of PE was MPE (57.7%), followed by parapneumonic or empyema in 16.3%. However, the etiology was significantly different according to primary tumor origin and subtypes of lung cancer. While MPE was most common in lung, breast, and gynecologic cancer, hepatic hydrothorax was the main cause in Hepatocellular carcinoma (HCC). MPE accounted for 85.2% in adenocarcinoma, and 30.2% and 58.8% in squamous cell and small cell carcinomas, respectively. Patients with MPE were younger (57.0 vs. 60.2 years) and female-dominant (55.4% vs. 29.6%) compared to those with non-MPE. MPE had the large size (53.5% vs. 34.9%) and left location of PE (31.3% vs. 19.4%) more frequently than non-MPE, and fewer neutrophils (15.4% vs. 30.6%) and more lymphocytes (32.2% vs. 28.2%), higher levels of pH (7.33 vs. 7.29), and lower levels of glucose (111.5 vs. 129.7 mg/dL) than non-MPE (p<0.001 for all). CONCLUSION: Overall, MPE was the most common cause of PE in cancer patients. However the etiology of PE was significantly different according to primary tumor origin and subtypes of lung cancer. A difference in age, gender, size and location of PE, cell count, pH, and glucose was observed between MPE and non-MPE.
Adenocarcinoma
;
Breast
;
Carcinoma, Hepatocellular
;
Carcinoma, Small Cell
;
Cell Count
;
Empyema
;
Female
;
Glucose
;
Humans
;
Hydrogen-Ion Concentration
;
Hydrothorax
;
Liver Neoplasms
;
Lung
;
Lung Neoplasms
;
Lymphocytes
;
Neutrophils
;
Pleural Effusion*
;
Retrospective Studies