No abstract available.

The Kallmanns syndrome is the most common form of isolated hypogonadotropic hypogonadism in which anosmia or hyposmia resulting from agenesis of hypoplasia of the olfactory lobes is associated with LHRH deficiency, This syndrome is genetically heterogeneous and can be trans-mitted as an X-linked, autosomal dominant or autosomal recessive trait. The hypogonadotropic hypogonadism results in absent or incomplete pubertal development and may be associated with anosmia or hyposmia, mid-line defect(color blindness, cleft-lip or
Blindness ; Cryptorchidism ; Epiphyses ; Femur Neck ; Gonadotropin-Releasing Hormone ; Growth Plate ; Head ; Humans ; Hypogonadism ; Kallmann Syndrome ; Male ; Olfaction Disorders ; Olfactory Cortex ; Slipped Capital Femoral Epiphyses

Purpose: We performed three-dimensional (3D) dose reconstruction-based pretreatment verification to evaluate gamma analysis acceptance criteria in volumetric modulated arc therapy (VMAT) for prostate cancer. Materials and Methods: Pretreatment verification for 28 VMAT plans for prostate cancer was performed using the COMPASS system with a dolphin detector. The 3D reconstructed dose distribution of the treatment planning system calculation (TC) was compared with that of COMPASS independent calculation (CC) and COMPASS reconstruction from the dolphin detector measurement (CR). Gamma results (gamma failure rate and average gamma value [GFR and γAvg]) and dose-volume histogram (DVH) deviations, 98%, 2% and mean dose-volume difference (DD98%, DD2% and DDmean), were evaluated. Gamma analyses were performed with two acceptance criteria, 2%/2 mm and 3%/3 mm. Results: The GFR in 2%/2 mm criteria were less than 8%, and those in 3%/3 mm criteria were less than 1% for all structures in comparisons between TC, CC, and CR. In the comparison between TC and CR, GFR and γAvg in 2%/2 mm criteria were significantly higher than those in 3%/3 mm criteria. The DVH deviations were within 2%, except for DDmean (%) for rectum and bladder. Conclusions The 3%/3 mm criteria were not strict enough to identify any discrepancies between planned and measured doses, and DVH deviations were less than 2% in most parameters. Therefore, gamma criteria of 2%/2 mm and DVH related parameters could be a useful tool for pretreatment verification for VMAT in prostate cancer.

We report a 77-year-old woman with bilateral pons infarction who presented with severe trismus, which was responsive to botulinum toxin-A injection. She was unable to open her mouth and showed anterior displacement of her temporo-mandibular (TM) joint on MRI findings. She was fed via nasogastric tube because of mouth opening limitation. There was no improvement of her mouth opening after range of motion exercise. She underwent closed reduction of the TM joints under general anesthesia but there was no significant improvement. Electromyography studies revealed continuous muscle activities on masseter and temporalis muscles during mouth opening. Botulinum toxin-A (Botox(R)) was injected into both the masseter and left temporalis muscles under ultrasonographic guidance. There was some improvement in mouth opening at post-injection 5 days. The inter-incisal distance improved gradually, and she could start oral feeding after 18 days. She could maintain an inter-incisal distance of 1.8 cm with favorable response during post-injection 4 months.
Aged ; Anesthesia, General ; Botulinum Toxins ; Displacement (Psychology) ; Electromyography ; Female ; Humans ; Infarction ; Joints ; Mouth ; Muscles ; Pons ; Range of Motion, Articular ; Trismus

Even a single brain infarct can cause dementia when it occurs in functionally critical areas of the brain. A 71- year-old female developed sudden cognitive impairment without any other focal neurologic deficits. A brain MRI revealed a bilateral anterior fornix infarction. Neuropsychological evaluation revealed verbal and visual memory deficits, visuospatial dysfunction, and frontal executive dysfunction. The cognitive impairment did not improve for 3 months and the patient showed impairments in daily activities. We report a patient who demonstrated strategic infarct dementia after a bilateral anterior fornix infarction.
Brain ; Dementia* ; Dementia, Vascular ; Female ; Fornix, Brain ; Humans ; Infarction* ; Magnetic Resonance Imaging ; Memory Disorders ; Neurologic Manifestations

OBJECTIVE: To assess the clinical usefulness of ultrasonography for the diagnosis of mild and very mild carpal tunnel syndrome. METHOD: Ultrasonographic evaluation was performed in 39 hands of 29 patients with mild and very mild carpal tunnel syndrome according to Bland's neurophysiologic grading scale. Controls included 41 hands of 34 subjects without electrophysiologic evidence of carpal tunnel syndrome. Ultrasonographic findings were evaluated quantitatively with regard to the cross-sectional area, the flattening ratio, the swelling ratio of the median nerve, and palmar displacement of the flexor retinaculum. The analysis of differences between controls and patients group were done by independent t-test. Cut-off values using receiver operation characteristic, were calculated. RESULTS: Patients had significantly increased cross sectional area and flattening ratio of the median nerve at proximal carpal area, palmar displacement of the flexor retinaculum at proximal carpal area. A critical value of equal or higher to 8.5 mm(2) for cross-sectional area at the pisiform level showed a sensitivity 79.5%, a specificity of 95.1%, which had most diagnostic value compared with the value of cross-sectional area at the distal radius level, flattening ratio at the pisiform level and palmar displacement. CONCLUSION: Ultrasonography was useful in the diagnosis of mild and very mild carpal tunnel syndrome.
Carpal Tunnel Syndrome ; Displacement (Psychology) ; Hand ; Humans ; Median Nerve ; Radius ; Sensitivity and Specificity

In this study, the prevalence of Hepatitis B virus(HBV) DNA in the needle biopsied paraffin embedded liver tissues of chronic hepatitis B patients by rapid nested PCR was examined. DNA was extracted by NaOH with boiling, and amplified by rapid air thermocycler with glass capillary tubes and nested PCR with two primer sets specific for the surface and the core genes of HBV. The PCR results were compared to that of serum HBeAg, serum HBV DNA by dot blot hybridization with a radioactive DNA probe, and tissue immunohistochemical (HBsAg/ HBcAg) studies. Among 44 patients with chronic hepatitis with serum HBsAg positivity, HBV DNA could be detected by PCR in 43 liver tissues (98%). This results were comparable to the positive rates of 94%(31/33) for serum HBV DNA, 80%(35/44) for serum HBeAg, and 59%(26/44) and 75%(33/44) for tissue HBsAg and HBcAg, respectively. The accordance rate between tissue PCR and serum DNA probe testing was 91%. The results indicate that HBV DNA detection by rapid nested PCR of paraffin embedded liver tissues by needle biopsy is a more sensitive method to detect the HBV DNA carrier than the serum HBeAg or tissue HBsAg/HBcAg status, and is well correlated with the result of serum HBV DNA probe testing. Therefore this method is a practical indicator for the diagnosis and replication status in retrospective analysis.
Biopsy

Craniopharyngiomas exhibit benign histologic features. However, such tumors have a relatively high incidence of recurrence after surgical removal, In order to device reliable and efficient methods in identifying craniopharyngiomas with increased risk for recurrence after surgical removal, proliferating cell nuclear antigen(PCNA) expressions as well as histological characteristics of the tumor were analyzed. There were 43 patients who had been surgically confirmed and had paraffin-embedded tissue from June, 1984 to May, 1993 available for analysis from our department. Of the 43 patients, eighteen cases were in children(age of 15 years of less) and 25 cases were in adults. The mean follow-up period was 42.7 months. The histologic types were adamantinomatous in 30 cases, squamous papillary in 9 cases and mixed in 4 cases. There was no case of tumor recurrence in the squamous papillary group, while the recurrence rate was about 55% in the adamantinous group after surgical removal alone. The mean age of the admantinous group was younger than that of the squamous papillary group(17.5 vs. 37.9 years old. p=0.0012), and the squamous papillary type was found only in adults(age over 20). In the group of 30 patients treated by surgical removal without radiation, the PCNA labelling index, calculated by counting the basal cell layer only, was significantly higher in the group with recurrence than without recurrence(9.51 vs. 6.58. p=0.001). However, the PCNA labelling index obtained by counting all cells in the four high-power(x400) fields failed to demonstrate any correlation with tumor recurrence. With a reference value of 8, PCNA index of the basal cell layer demonstrated the predictive sensitivity of 81.8% and specificity of 84.2% for tumor recurrence. There was no significant difference in PCNA labelling indices between adamantinous and squamous papillary types. As PCNA labelling index of the basal cell layer, as well as the histologic type, are sensitive indicators for prediction of tumor recurrence after surgical removal of craniopharyngiomas, therefore they should be considered as an index for biologic behavior of the tumor.
Adult ; Craniopharyngioma* ; Follow-Up Studies ; Humans ; Incidence ; Proliferating Cell Nuclear Antigen* ; Recurrence ; Reference Values ; Sensitivity and Specificity ; Treatment Outcome*

Central pontine myelinolysis (CPM) is well-recognized osmotic demyelination syndrome that is related to various conditions such as rapid correction of hyponatremia and chronic alcoholism. Acute ataxia as a sole clinical sign in CPM is rare. We report a case of a 59-year-old man with dysarthria, intention tremor, and a significant gait ataxia starting after alcohol withdrawal, with radiological evidence of CPM. CPM should be included in the differential diagnosis of alcoholic patients who develop a sudden ataxia. Chronic alcohol abuse is one of the most commonly encountered predisposing factors. Alcohol withdrawal represents an additional vulnerability factor, being responsible for electrolyte imbalances which are not always demonstrable but are certainly involved in the development of CPM.
Alcoholics* ; Alcoholism ; Ataxia ; Causality ; Demyelinating Diseases ; Diagnosis, Differential ; Dysarthria ; Gait Ataxia ; Humans ; Hyponatremia ; Middle Aged ; Myelinolysis, Central Pontine* ; Tremor

Hemichorea have been reported in patients with nonketotic hyperglycemia. Usually, hemichorea and hyperglycemia are concomitant. A 73-year-old woman was admitted for investigation of an acute hemichorea. T1-weighted brain magnetic resonance imaging showed hyperintensity in the right putamen. Although she was a diabetic patient, she had no hyperglycemia. Interestingly, 4 weeks earlier, the patient was admitted due to nonketotic hyperglycemia. However, there were no hemichorea at that time. Although pathophysiologically controversial, a delayed hemichorea without nonketotic hyperglycemia should be considered as one of many different causes when evaluating acute hemichorea in diabetic patients.
Aged ; Brain ; Chorea ; Female ; Humans ; Hyperglycemia* ; Magnetic Resonance Imaging ; Putamen