Cerebral palsy is the most common motor disorder in childhood. In cerebral palsy, spasticity can be a very disabling feature: limited locomotor abilities, contracture and gait difficulty. We present two cases of cerebral palsy patients who had treated with oral medication and chemodenervation with the Botulinum toxin A or alcohol but could not walk independently. We performed percutaneous selective radiofrequency thermocoagulation in the tibial motor nerve branch under the general anesthesia. The degree of spasticity, which was measured with modified Ashworth scale and modified Tardieu scale, was reduced and recurrence of the spasticity wasn't seen untill 6 months. Percutaneous selective radiofrequency thermocoagulation could be a treatment option for spasticity of cerebral palsy with little adverse effect.
Anesthesia, General ; Botulinum Toxins ; Cerebral Palsy ; Contracture ; Electrocoagulation ; Gait ; Humans ; Muscle Spasticity ; Nerve Block ; Recurrence

OBJECTIVE: To compare the therapeutic effects between radiofrequency thermocoagulation and phenol motor branch block in treatment of spasticity of child with cerebral palsy. METHOD: Thirteen patients with spastic cerebral palsy were randomly divided into two groups. One group received percutaneous selective radiofrequency thermocoagulation on tibial nerve motor branch and the other group received phenol motor branch block to the gastrocnemius muscle. Therapeutic effects were assessed before and after treatment for 6 months in each group. The severity of ankle spasticity was assessed with the modified Ashworth scale (MAS), the modified Tardieu scale (MTS), and the passive range of motion (PROM) of ankle joint. RESULTS: In both groups, the MAS and MTS decreased, and radiofrequency thermocoagulation group showed more significant reduction of the spasticity (p<0.05). There was a significant increase in PROM on knee flexion and extension in a radiofrequency thermocoagulation group (p<0.05). CONCLUSION: Percutaneous selective radiofrequency thermocoagulation could be a treatment option for relieving the localized spasticity of ankle in spastic cerebral palsy with little adverse effect.
Animals ; Ankle ; Ankle Joint ; Cerebral Palsy ; Child ; Electrocoagulation ; Humans ; Knee ; Muscle Spasticity ; Muscle, Skeletal ; Phenol ; Range of Motion, Articular ; Tibial Nerve

A 53-year-old woman had a 1.7 cm left adrenal mass on an abdominal computed tomography (CT) scan. She presented with paroxysmal headache, palpitation, sweating, and hypertension. The patient was highly suspected of having a pheochromocytoma, but measurements of 24-hour urinary metanephrine, catecholamines, and vanillylmandelic acid were normal. Plasma and urine catecholamine levels were within the normal range even during paroxysmal episodes. A scintigraphic study with 131I-metaiodobenzylguanidine (MIBG) revealed selective concentration of the radiotracer, corresponding to the CT mass. The patient underwent a left adrenalectomy and the pathological examination confirmed the diagnosis of pheochromocytoma. In this report, we describe a rare case of a symptomatic pheochromocytoma with normal catecholamine levels. Our case illustrates that routine nuclear scintigraphy, such as 131I-MIBG, should be performed even in cases with normal hormonal testing for all patients with high clinical suspicion of pheochromocytoma.
3-Iodobenzylguanidine ; Adrenalectomy ; Catecholamines ; Female ; Headache ; Humans ; Hypertension ; Metanephrine ; Middle Aged ; Pheochromocytoma ; Plasma ; Reference Values ; Sweat ; Sweating ; Vanilmandelic Acid

PURPOSE: Carcinomas arising in the gall bladder (GB) or extrahepatic biliary ducts are uncommon and generally have a poor prognosis. The overall 5- year survival rates are less than 10%. Early experiences with the external radiation therapy demonstrated a good palliation with occasional long-term survival. The present report describes our experience over the past decade with irradiation of primary carcinomas of the gallbladder and extrahepatic biliary duct. MATERIALS AND METHODS: From Feb. 1984 to Nov. 1995, thirty-three patients with carcinoma of the GB and extrahepatic biliary duct were treated with external beam radiotherapy with curative intent at our institution. All patients were treated with 4-MV linear accelerator and radiation dose ranged from 31.44Gy to 54.87Gy (median 44.25Gy), and three patients received additional intraluminal brachytherapy (range, 25Gy to 30Gy). Twenty-seven patients received a postoperative radiation. Among 27 patients, Sixteen patients underwent radical operation with curative aim and the rest of the patients either had bypass surgery or biopsy alone. In seventeen patients, adjuvant chemotherapy was used and eleven patients were treated with 5-FU, mitomycin and leucovorin. RESULTS: Median follow up period was 8.5 months (range 2-97 months). The overall 2-year and 5-year survival rates in all patients were 29.9% and 13.3% respectively. In patients with GB and extrahepatic biliary duct carcinomas, the 2-year survival rates were 34.5% and 27.8% respectively. Patients who underwent radical operation showed better 2-year survival rates than those who underwent palliative operation (43.8% vs. 20.7%). albeit, statistically insignificant (P>0.05). The 2-year survival rates in Stage I and II were higher than in Stage III and IV with statistical significance (P<0.05). Patients with good performance status in the beginning showed significantly better survival rates than those with worse status (P<0.05). The 2-year survival rates in combined chemotherapy group and radiation group were 40.5% and 22.6% respectively. There was no statistical differences in two groups (P>0.05). CONCLUSION: The survival of patients with relatively lower stage and/or initial good performance was significantly superior to that of others. We found an statistically insignificant trend toward better survival in patients with radical operation and/or chemotherapy. More radical treatment strategies, such as total resection with intensive radiation and/or chemotherapy may offer a better chance for cure in selective patients with carcinoma of gall bladder and extrahepatic biliary ducts.
Biopsy ; Brachytherapy ; Chemotherapy, Adjuvant ; Drug Therapy ; Fluorouracil ; Follow-Up Studies ; Gallbladder ; Humans ; Leucovorin ; Mitomycin ; Particle Accelerators ; Prognosis ; Radiotherapy* ; Retrospective Studies* ; Survival Rate ; Urinary Bladder*

OBJECTIVE: The purpose of this study was to compare the efficacy of intravaginal misoprostol and that of intravenous sulprostone for termination of second-trimester pregnancy. METHODS: Fouty-six patients were randomly assigned to misoprostol and sulprostone group, and the misoprostol group was further divided into two groups according to gestational age. In the misoprostol group, the patients at or before 20 weeks of gestation received 400 microgram of intravaginal misoprostol every 4 hours until labor pain was established, 200 microgram every 6 hours after 20 weeks of gestation. In the sulprostone group, intravenous sulprostone was infused at the speed of 100 microgram/hr regardless of gestational age. RESULTS: At or before 20 weeks of gestation, the mean time from induction to completion of termination was shorter, and the success rate within 24 hours was higher in the misoprostol group than in the sulprostone group (9.0 vs. 20.2 hours; 86% vs 50%). After 20 weeks, the mean induction time was longer at misoprostol group than sulprostol group but, there was no significant difference in success rate within 24 hours (14.7 vs. 7.1 hours; 83% vs. 86%). There was no significant difference in the prevalence of complication between two groups. CONCLUSION: Misoprostol is superior to sulprostone for termination of pregnancy at or before 20 weeks of gestation, but both have almost equal effectiveness after 20 weeks of gestation. Considering less cost and complication, the efficacy of misoprostol should be further investigated for termination of second-trimester pregnancy.
Female ; Gestational Age ; Humans ; Labor Pain ; Misoprostol* ; Pregnancy* ; Prevalence

Human herpes virus-8 (HHV-8)-negative primary effusion lymphoma (PEL) is frequently observed in patients with chronic liver disease. We describe herein a case of PEL in a patient with chronic kidney disease. A 59-year-old woman presented with dyspnea. The patient had a history of uncontrolled pleural effusion. The pleural effusion revealed a malignant cell-dominant exudate. Serological tests were negative for human immunodeficiency virus (HIV). Initial chest and abdomen computed tomography showed bilateral pleural effusion; however, no evidence of a tumor mass or lymph node enlargement was found. A malignant lymphoma of diffuse large B-cell type was confirmed by pleural fluid cytology. Immunohistochemical staining of malignant cells was negative for HHV-8. She was treated with rituximab and CHOP (cyclophosphamide, adriamycin, vincristine, prednisolone) chemotherapy. We report a case of PEL in a patient with chronic kidney disease that may be a plausible predisposing factor for HHV-8-negative PEL.
Abdomen ; Antibodies, Monoclonal, Murine-Derived ; B-Lymphocytes ; Doxorubicin ; Dyspnea ; Exudates and Transudates ; Female ; Herpesvirus 8, Human ; HIV ; Humans ; Liver Diseases ; Lymph Nodes ; Lymphoma ; Lymphoma, Primary Effusion ; Middle Aged ; Pleural Effusion ; Renal Insufficiency, Chronic ; Serologic Tests ; Thorax ; Vincristine ; Rituximab

Crohn 's disease is characterized by a chronic relapsing inflammation of the bowel in which pro-inflammatory cytokines play an important role. Rebamipide is an anti-gastric ulcer drug with anti-inflammatory properties in vivo and in vitro. The effects of rebamipide on Crohn 's disease have not been carefully evaluated. This study investigated the potential of rebamipide to protect Crohn 's disease using a murine model of colitis induced by trinitrobenzene sulfonic acid (TNBS). Rebamipide dramatically improved histopathological symptom involving myeloperoxidase (MPO)activation and increase of microscopic damage score in TNBS induced colitis. Rebamipide suppressed IL-8 secretion, ICAM-1 induction and nuclear factor-kappaB (NF-kappaB) activation by TNF-alpha and induced heme oxygenase-1(HO-1)in HT-29 cells. HO-1 inducer cobalt protoporphyrin IX (CoPPIX)suppressed NF-kappaB activation by TNF-alpha in HT-29 cells like rebamipide, and mimicked the protective effects of rebamipide on TNBS induced colitis. This suggests that rebamipide exerts anti-inflammatory effects by down-regulating NF-kappaB activity via inducting HO-1 expression. In conclusion, this study suggests that rebamipide represents a potential therapeutic agent and HO-1 is an important therapeutic target for the treatment of Crohn's disease.
Cobalt ; Colitis ; Colon* ; Crohn Disease ; Cytokines ; Down-Regulation* ; Heme Oxygenase (Decyclizing)* ; Heme* ; HT29 Cells ; Humans ; Inflammation ; Intercellular Adhesion Molecule-1 ; Interleukin-8 ; NF-kappa B* ; Peroxidase ; Tumor Necrosis Factor-alpha ; Ulcer

Background: The objective of this study was to investigate whether alcohol consumption might affect the quality of life (QOL), depressive mood, and metabolic syndrome in patients with obstructive lung disease (OLD). Methods: Data were obtained from the Korean National Health and Nutrition Examination Survey from 2014 and 2016. OLD was defined as spirometry of forced expiratory volume in 1 second/forced vital capacity <0.7 in those aged more than 40 years. QOL was evaluated using the European Quality of Life Questionnaire-5D (EQ-5D) index. Patient Health Questionnaire-9 (PHQ-9) was used to assess the severity of depressive mood. Alcohol consumption was based on a history of alcohol ingestion during the previous month. Results: A total of 984 participants with OLD (695 males, 289 females, age 65.8±9.7 years) were enrolled. The EQ-5D index was significantly higher in alcohol drinkers (n=525) than in non-alcohol drinkers (n=459) (0.94±0.11 vs. 0.91±0.13, p=0.002). PHQ- 9 scores were considerably lower in alcohol drinkers than in non-alcohol drinkers (2.15±3.57 vs. 2.78±4.13, p=0.013). However, multiple logistic regression analysis showed that alcohol consumption was not associated with EQ-5D index or PHQ-9 score. Body mass index ≥25 kg/m2, triglyceride ≥150 mg/dL, high-density lipoprotein <40 mg/dL in men and <50 mg/dL in women, and blood pressure ≥130/85 mm Hg were significantly more common in alcohol drinkers than in non-alcohol drinkers (all p<0.05). Conclusion Alcohol consumption did not change the QOL or depressive mood of OLD patients. However, metabolic syndrome-related factors were more common in alcohol drinkers than in non-alcohol drinkers.

A 66-years-old man was refered to our hospital because of cough, sputum, chill and fever. Enlargement of the trachea and main bronchi on radiography and bronchoscopy is compatible with Mounier-Kuhn syndrome. Mounier-Kuhn syndrome or tracheobronchomegaly is a rare disorder of uncertain etiology, characterized by marked dilatation of the trachea and major bronchi. This syndrome is associated with tracheal diverticulosis, bronchiectasis and recurrent respiratory tract infection. We report a rare case of Mounier-Kuhn syndrome with pneumonia and literature reviews.
Bronchi ; Bronchiectasis ; Bronchoscopy ; Cough ; Dilatation ; Diverticulum ; Fever ; Pneumonia* ; Radiography ; Respiratory Tract Infections ; Sputum ; Trachea ; Tracheobronchomegaly*

We describe a patient with hyponatremia induced by the use of angiotensin-converting enzyme (ACE) inhibitor; imidapril HCl. Although the mechanism of severe hyponatremia due to ACE inhibitor is not clear, it is conceivable that ACE inhibitor therapy may complicate the syndrome of inappropriate secretion of antidiuretic hormone and induce hyponatremia. In addition, the possibility should be considered that hyponatremia in our patient is a presumptive interaction between oxcarbazepine and imidapril HCl.
Angiotensins* ; Humans ; Hyponatremia* ; Peptidyl-Dipeptidase A*