Even though the nonketotic hyperglycemia is a metabolic disorder, it complicates hemic- horea-hemiballism rarely. Moreover, generalized chorea-ballism associated with nonketotic hyperglycemia in diabetes mellitus is very rare, so it has not been reported in Korean literature. Although the precise pathophysiologic mechanisms of these disorders are still poorly understood, deficiency of gamma aminobutyric acid (GABA) in nonketotic hyperglycemia or reduced GABAnergic inhibition by striatal lesion may increase inhibitory output to subthalamic nucleus. These result loss of pallidal inhibition and produce contralateral hemichorea-hemiballism. The striatal lesions, such as transient ischemia with reactive astrocytosis or small amount of petechial hemorrhage, are related with changes of magnetic resonance image (MRI) findings presumably. We report a diabetic old woman who developed generalized chorea-ballismus as a very rare complication of nonketotic hyperglycemia. Her brain MRI showed high signal intensity in left lentiform nucleus and right pallidum on T1 weighted images and low signal intensity in bilateral putamen on T2 weighted images with highly enhanced corresponding lesions on T1 weighted enhancement images.
Brain ; Corpus Striatum ; Diabetes Mellitus* ; Female ; gamma-Aminobutyric Acid ; Gliosis ; Hemorrhage ; Humans ; Hyperglycemia* ; Ischemia ; Magnetic Resonance Imaging ; Putamen ; Subthalamic Nucleus

No abstract available.

Coronary artery calcification(CAC) is found frequently in the atheromatous plaques CAC is known to have increased frequency above 40 years. CAC without evidence of atherosclerosis in young adults is quite rare, however, CAC combined with aneurysms in young adults have been infrequently reported in patients with a past history of a Kawasaki disease in child. We report an autopsy case showing CAC and aneurysm in the absence of macroscopically identified atherosclerotic lesions in a healthy 23-year-old man. The autopsy examination revealed aneurysmal dilatation of the right coronary artery which was connected with calcified lesion. A calcified lesion of the left anterior descending coronary artery was aslo noted. Microscopically, aneurysmal wall was non-specific except for hyalinized wall and foci of calcification. A striking histologic finding of calcified mass was ring calcification along the wall of the coronary artery. Antecedent Kawasaki disease in the past was suggestive as other reports.
Aneurysm* ; Atherosclerosis* ; Autopsy ; Child ; Coronary Vessels* ; Dilatation ; Humans ; Hyalin ; Mucocutaneous Lymph Node Syndrome ; Plaque, Atherosclerotic ; Strikes, Employee ; Young Adult*

Aortic dissection may be considered the result of a discrepancy between the strength of the aortic wall and the intramural pressure. And factors that predispose to aortic dissection may include systemic hypertension, cystic medial necrosis, Marfan's syndrome, atherosclerosis, disease of aortic valve, pregnancy, giant cell arteritis, hyperthyrosis, disease of aortic valve, pregnancy, giant cell arteritis, hyperthyroidism, and blunt chest trauma. A few of aortic dissection may extend retrograde toward the aortic valve and involve the coronary arteries. Coronary artery occlusions due to mural dissection are an uncommon but well documented cause of myocardial infarction. Although rare, extramural hematoma compressing the coronary artery is another cause of myocardial infarction. At autopsy of 43 years old male who had no critical external wound, pericardial sac was distended and contained 400ml of dark red and clotted blood. Examination of the aorta revealed only minute atherosclerosis, intact aortic valve, and patent coronary ostia. 0.5cm sized aortic rupture was noted at the 3.5cm distal to the aortic valve. DeBakey type II aortic dissection was found to involve the ascending aorta and brachiocephalic trunk. Three intimal tears were 1.5cm, 8cm. 11.5cm distal to the aortic valve and two false lumens which had intact area between them extended 3.5cm distal to the third intimal tear and proximally in a retrograde fashion to the aortic root. Microscopically, sections of aorta showed relatively intact arrangement of smooth muscle and elastic fibers, except mild vascular ectasia and scattered several foci of the small sized aggregation of foamy histiocytes, and there was no evidence of cystic medial degeneration in aorta. Sections of both coronary arteries did not show mural dissection or atherosclerosis. Sections of right atrium and sinus node showed inflammatory reaction, extensive replacement of myocardium by active fibrous tissue consistent with infarction. There was no histologic evidence of myocardial infarction in the walls of other chambers or septum of the heart. We believe that extramural compression of the artery to sinus m\node by the dissecting hematoma was the cause of myocardial infarction involving the right atrium and the sinus node.
Adult ; Aorta ; Aortic Rupture ; Aortic Valve ; Arteries ; Atherosclerosis ; Autopsy ; Brachiocephalic Trunk ; Coronary Vessels ; Dilatation, Pathologic ; Elastic Tissue ; Giant Cell Arteritis ; Heart ; Heart Atria ; Hematoma ; Hemodynamics* ; Histiocytes ; Humans ; Hypertension ; Hyperthyroidism ; Infarction ; Male ; Marfan Syndrome ; Muscle, Smooth ; Myocardial Infarction* ; Myocardium ; Necrosis ; Pregnancy ; Sinoatrial Node ; Thorax ; Wounds and Injuries

Flap survival is critical to the success in reconstructive surgery, there have been many investigations to increase the blood supply to the flaps such as surgical delay and pharmacologic delay. Prostaglandin(PG) is released from various tissues including blood vessel in response to physical stimulus. Among the Prostaglandins, PGE1 has been proven to be a vasodilatation property and many authors have demonstrated its effect to increase blood supply after random cutaneous flap surgery. Clinically, however, muscle flap or musculocutaneous flap is more significantly used in reconstructive surgery and hemodynamic effects of PGE1 of this type of flap are still not documented. The authors designed the random muscle flap to study the hemodynamic effects of PGE1 of the muscle flap. Superior based rectus muscle flap was elevated from rats and the superior epigastric artery, its major vascular pedicle, was ligated to create the random-type muscle flap. Twenty two rats were divided into two experimental groups and each group had 11 rats; Group I: No drugs Group II: PGE1 injection group for 7 postoperative days intraperitoneally The average muscle flap survival rate of group I was 46+/-3.0 precent and it had a higher survival rate than the control group(23+/-4.3%). The muscle flap survival rates showed significant differences between the two groups (p< 0.005) This study shows that the administration of the PGE1, in clinical usage of the rare random muscle flap with a pedicle injury or musculocutaneous flap with the risk of distal cutaneous flap necrosis, such as TRAM flap, which might be much safer and popular.
Alprostadil ; Animals ; Blood Vessels ; Epigastric Arteries ; Hemodynamics ; Myocutaneous Flap ; Necrosis ; Prostaglandins ; Rats* ; Rectus Abdominis* ; Survival Rate ; Vasodilation

PURPOSE: DNA mismatch repair gene is responsible for hereditary nonpolyposis colorectal cancer. But it is not well known its role in sporadic colorectal cancer patients. We analysed normal hMSH2, hMLH1 protein expression in colorectal adenocarcinoma tissues and corresponding normal tissues to find out the role of mismatch repair gene in sporadic colorectal cancer by Western blotting. METHODS: Normal hMSH2 and hMLH1 protein expression was studied on 25 colorectal cancer and corresponding normal tissue by Western blot with hMSH2 and hMLH1 monoclonal antibody. Normal protein band was expressed on 100 kD in hMSH2 and 87 kD in hMLH1. SW480 and LoVo cell line was used as positive and negative control for hMSH2 and LoVo and SW480 as positive and negative for hMLH1. And we analysed the relation between the hMSH2, hMLH1 protein expression and clinicopathological parameters. RESULTS: It was 2 cases (8%) that both hMSH2 and hMLH1 protein expression was not observed. Three cases (12%) were negative for hMSH2 and 2 cases (8%) for hMLH1. One or both hMSH2, hMLH1 protein expression was not observed in 7 cases (28%) in total. There was no correlation for proximal occurrence (25% vs 35%), young age (37.5% vs 23.5%) and lymph node metastasis (50% vs 47%). But poorly and mucinous differentiation was regarded as having relation with negative expression of hMSH2 and hMLH1 (50% vs 17.6%) but not significant statistically. CONCLUSION: Sporadic colorectal cancer with negative expression of normal hMSH2 and hMLH1 protein showed no relation to younger age, proximal site preference and lymph node metastasis. But it was suggested that mismatch repair gene protein was involved in cancer cell differentiation in sporadic colorectal cancer.
Adenocarcinoma ; Blotting, Western ; Cell Differentiation ; Cell Line ; Colorectal Neoplasms* ; Colorectal Neoplasms, Hereditary Nonpolyposis ; DNA Mismatch Repair ; Humans ; Lymph Nodes ; Mucins ; Neoplasm Metastasis

PURPOSE:Idiopathic ketotic hypoglycemia (IKH) is an important cause of hypoglycemia in children. The purpose of this study was to determine the prevalence of ketotic hypoglycemia and to describe the clinical manifestation. METHODS:We conducted a retrospective chart review of children presenting hypoglycemia to the emergency department (ED) of Ewha Womans University Hospital between January 1995 and June 2004. Information recorded for subject included age, gender, weight, time of presentation, presenting symptoms, and laboratory data. RESULTS:Eighty two children were identified for hypoglycemia during the study period. IKH was the ultimate diagnosis for 66 patients (80.5%). Other diagnoses included hyperinsulinism (2.4%), drug adverse event (1.2%), sepsis (1.2%), and other disorder. The mean age for presentation of IKH was 37.9+/-18.6 months. Thirty eight boys and twenty eight girls were identified. The median time of presentation was 9:48 a.m. Of the 66 subjects, body weight of 46.9% patients was below 25th percentile for age. The average blood glucose was 41.4+/-14.2 mg/dL. Symptoms at presentation included lethargy (24.2%), mental change (16.7%) and vomiting (16.7%). 49 patients (74.2%) were described as having a concomitant illness. CONCLUSION: IKH was responsible for 80.4% of cases of hypoglycemia in pediatric ED and it had usually concomitant intercurrent illness which resulting in poor oral intake. Awareness of IKH, and its presenting characteristics, will be helpful in the ED when taking care of hypoglycemic children.
Blood Glucose ; Body Weight ; Child ; Diagnosis ; Emergency Service, Hospital ; Female ; Humans ; Hyperinsulinism ; Hypoglycemia* ; Lethargy ; Prevalence* ; Retrospective Studies ; Sepsis ; Vomiting

No abstract available.

PURPOSE: The aim of this study was to examine the relationship between tooth loss and sub-clinical atherosclerosis in Korean adults. MATERIALS AND METHODS: The subjects were part of a cohort study conducted in Ansan city by the Korea University medical school as part of the Korean Genome project. 749 subjects over than 40 years old were evaluated. After taking panoramic radiography, the amount of tooth loss was calculated. The intima-media thickness (IMT) was assessed by using ultrasonography at the common carotid artery. Traditional cardiovascular risk factors for atherosclerosis were also evaluated. The relationship between tooth loss and the IMT was evaluated using ANOVA with Scheffe's multiple comparison method in univariate analysis. Multiple regression analysis was also performed to determine the significance between the IMT and tooth loss. RESULTS: With age, tooth loss increased, but there was no significant increase in other traditional cardiovascular risk factors. Univariate analysis revealed the IMT to be positively related with the amount of tooth loss. Regression analysis of the IMT in the anterior and posterior tooth loss revealed that only the posterior tooth loss was significantly related with the IMT at all sites of the common carotid artery (right far wall, P = .015; left far wall, P = .008; right near wall, P < .001; left near wall, P = .001). CONCLUSION: This study verified the positive relationship between the increased tooth loss at the posterior area and the accumulation of atheroma in arteries.
Adult ; Arteries ; Atherosclerosis ; Carotid Artery, Common ; Carotid Intima-Media Thickness ; Cohort Studies ; Genome ; Humans ; Korea ; Plaque, Atherosclerotic ; Radiography, Panoramic ; Risk Factors ; Schools, Medical ; Tooth ; Tooth Loss

Purpose: This study examined the acute effects of static and dynamic stretching on the flexibility of the hamstring, dynamic balance ability, and function of the lower extremities in healthy adults. Methods: Thirty participants were assigned randomly to three groups: static stretching group (SSG), basic dynamic stretching group (BDSG), and 5 sec dynamic stretching group (5DSG). SSG performed three sets of 30 seconds of static stretching. BDSG performed a single-leg deadlift (SLD) at the same time as SSG, and 5DSG performed SLD held for five seconds. Hamstring flexibility, dynamic balance ability, and lower extremity function were evaluated before and after intervention. Results: The hamstring flexibility significantly improved in all groups (p<0.05). The dynamic balance ability improved significantly after intervention in all groups except BDSG in the anterior direction (p<0.05). There were significant differences in the posterolateral and posteromedial direction in all groups. The function of the lower extremity showed significant improvement over time only in BDSG (p<0.05). Conclusion This study suggested that basic dynamic stretching and 5 sec dynamic stretching positively affect the hamstring flexibility, dynamic balance ability, and lower extremity function. Therefore, it is recommended to include dynamic stretching in a program for improving the hamstring flexibility, dynamic balance ability, and the lower extremity function. In addition, it is recommended to apply it at different times depending on the purpose.