Deep Brain Stimulation(DBS) analgesia is known to be an effective method of otherwise intractable chronic pain. The authors report a case of thalamic DBS for the relief of recurred deafferentation pain after DREZotomy. The patient was a 53-year-old female who had presented with neuropathic pain on right shoulder and upper extremity, owing to previous brachial plexus injury. She underwent DREZotomy on C3-C5 level with resultant pain relief, but symptom recurred 3 months after surgery. The authors performed left VPL nucleus stimulation, and good relief of the pain was achieved. We reviewed the pertinent literature, and discussed pathophysiology, clinical result of the DBS on deafferentation pain.
Analgesia ; Brachial Plexus ; Brain ; Causalgia* ; Chronic Pain ; Deep Brain Stimulation* ; Female ; Humans ; Middle Aged ; Neuralgia ; Shoulder ; Upper Extremity

No abstract available.
Orientia tsutsugamushi* ; Rickettsia* ; Ulsan*

BACKGROUND: The in-hospital 'Utstein style' is international recommended guidelines for reporting outcome data from in-hospital resuscitation events. This study was designed to evaluate the current status of in-hospital cardiopulmonary resuscitation(CPR), and to provide basic data far the unified reporting guideline of resuscitation in Korea. METHODS: The patients who had received CPR in a university hospital were searched during one year period from March 1997. The variables according to the Utstein style were evaluated with review of the medical records. RESULTS: During the period, 428 patients had received CPR. Excluding the patients of out-of-hospital arrest and less than 8 years, 242 were enrolled. Their initial ECG rhythms were 55 of asystole, 148 of pulseless electrical activity, and 39 of ventricular fibrillation, The spontaneous circulation was returned in 118(49%, and 48(20% were maintained more than 24 hours. Twenty-two patients(9%) were discharged with spontaneous respiration. Among the survivors, 17 had the Cerebral Performance Category of 1. CONCLUSION: We recommend the Utstein style to report the outcome of in-hospital CPR.
Cardiopulmonary Resuscitation ; Electrocardiography ; Heart Arrest* ; Humans ; Korea ; Medical Records ; Respiration ; Resuscitation ; Survivors ; Ventricular Fibrillation

Richer's syndrome is a development of a high grade malignant lymphoma in a patient with preexisting chronic 1ymphocytic leukemia, small lymphocytic lymphoma or Waldenstrom's macroglobulinemia. A rare case of Richer's syndrome arising in the spleen of a 35-year-old-man was studied by morphology, immunohistochemistry and gene rearrangement study. He has had weight loss and night sweat for last 6 months. Hepatosplenomegaly and abdominal lymphadenopathy were noted on CT scanning. Especially an ovoid radiolucent mass was found within the image of splenomegaly. Lymph nodes and liver biopsy, bone marrow aspiration and splenectomy were done. In the lymph nodes, liver and bone marrow, well differentiated small lymphocytic infiltrations were found but, in the spleen, pleomorphic, large cells with occasional multinucleated giant cells formed a nodular mass surrounded by diffuse, extensive infiltration of small well differentiated lymphocytes. The two distinctive areas in the spleen had positive staining for B-cell marker (HLA-DR and L26), negative staining for T-cell marker (UCLH1), and positive staining for IgM heavy chain and kappa light chain by immuohistochemical study. so this case was diagnosed as a diffuse large cell 1ymphoma transformed from small lymphocytic lymphoma. We made an another effort to clarify their clonality. Gene rearrangement method usingcomplementarity.determining region 3(CDR3) of immunoglobulin heavy chain (IgH) gene and T-cell receptor gamma (TCRgamma) gene by polymerase chain reaction (PCR) technique was done. The two lymphomas in the spleen demonstrated the same rearrangement pattern in both IgH and TCRgamma gene. We think these findings strongly suggest that the large cell lymphoma has the same clonality with that of the small lymphocytic lymphoma.
Male ; Humans

Amicrobial pustulosis of the folds (APF) is a rare pustular eruption, which predominantly involves the cutaneous folds, including the external auditory canals, scalp, and palms. It occurs in patients with a wide spectrum of autoimmune abnormalities. Systemic lupus erythematosus is the autoimmune disorder observed most commonly in patients with APF. The etiology of APF is unclear, but all reported cases have involved women of reproductive age when the eruptions first occurred. This report describes a 34-year-old woman who presented with an acute pustular rash. Her medical history was unremarkable, except for transitory dry eyes, dry mouth, and polyarthralgia for 1 year. Coalescing pustular lesions arising on erythematous skin, forming crusted and eroded plaques, were observed, which predominantly affected the anterior chest, mainly the cutaneous folds. The periorificial regions were also involved, including the nasal alae, mouth angles, and external auditory canals. Our patient had the characteristic clinical and histopathological features of APF, in association with primary Sjogren's syndrome (pSS). In conclusion, we present a patient having APF associated with pSS.
Adult ; Arthralgia ; Cytochrome P-450 CYP1A1 ; Ear Canal ; Exanthema ; Eye ; Female ; Humans ; Lupus Erythematosus, Systemic ; Mouth ; Scalp ; Sjogren's Syndrome ; Skin ; Thorax

Narcolepsy is characterized by excessive daytime sleepiness, cataplexy, sleep paralysis and hypnagogic hallucinations. Only a few studies have focused on non-rapid eye movement (NREM) and REM parasomnias in narcolepsy. We report a narcolepsy without cataplexy patient presenting parasomnia as an initial symptom. A 18-year-old boy was admitted to hospital for abnormal behavior of sitting up during sleep over 2 years. He had a symptom of lethargy without cataplexy and subjective excessive daytime sleepiness, but his family found him often asleep during daytime. He underwent 3 times of polysomnography (PSG) including 1 multiple sleep latency test (MSLT) after the last PSG. The last PSG showed 1 episode of abrupt sitting. Three sleep REM onset period was observed in MSLT which was not detect in PSG. Parasomnia as an initial symptom of narcolepsy is a rare clinical entity. The MSLT may be useful in the evaluation of patients with parasomnia and unexplained hypersomnia.
Adolescent ; Cataplexy ; Disorders of Excessive Somnolence ; Eye Movements ; Hallucinations ; Humans ; Lethargy ; Male ; Narcolepsy ; Parasomnias ; Polysomnography ; Sleep Arousal Disorders ; Sleep Paralysis

PURPOSE: The purpose of this retrospective study is to evaluate the prognostic significance of lymph node dissection in gastric cancer surgery. MATERIALS AND METHODS: We analysed the survival curves of 1661 cases of gastric cancer patients who received gastric resection from 1987 to 1991, in whom the number of dissected lymph nodes is more than 9 (to minimize stage migration). We used modified TNM system with numeric classification. RESULT: The average number of resected lymph nodes of the study group was 31.5 and there was no significant difference in the average number of resected lymph nodes during the study period. In stage I, IIa, IIb and IV, there was no significant difference in survival curves according to the number of resected lymph nodes (25, 35 or 45). However, in stage IIIa, the 5-year survival rate (5YSR) was better in the patients (n=171) of more than 25 lymph nodes than in the patiens (n=104) of less than 26 resected lymph nodes (64.1% vs. 59.9%, p=0.031). In stage IIIb, 5YSR was better in the patients (n=206) of more than 35 lymph nodes than in the patients (n=307) of less than 36 lymph nodes (33.2% vs. 18.3%, p=0.029). In multivariate analysis, number of dissected lymph node was an independent prognostic factor. CONCLUSION: Survival benefit of extended lymph node dissection in the gastric cancer surgery is limited in the stage IIIa and IIIb and the recommended number of dissection is more than 35. This study also suggests a positive correlation between tumor stage and required quantity of lymph node dissection for better survival (>25 for stage IIIa and >35 for stage IIIb).
Classification ; Humans ; Lymph Node Excision* ; Lymph Nodes* ; Multivariate Analysis ; Prognosis ; Retrospective Studies ; Stomach Neoplasms* ; Survival Rate

A 56-year-old male with a gastrointestinal stromal tumor (GIST) underwent surgical resection of the tumor. Nine months after surgery, imatinib therapy was initiated because of the discovery of metastatic tumors in the left adrenal gland and in a lymph node of the peritoneum. Seventeen months later, the patient achieved complete remission (CR) and imatinib therapy was continued. However, 48 months after initiation of imatinib therapy, computed tomography scans revealed a left adrenal gland metastasis and the patient underwent left adrenalectomy. Immunohistochemical staining indicated that the spindle-shaped cells of the resected tumor were positive for C-kit, thus confirming metastasis of the GIST. This is the first report from Korea of an adrenal gland metastasis from a GIST. Worldwide, only two such cases have been reported. Here, we describe the first case of a distant recurrence of a GIST in the left adrenal gland after CR had been achieved with the aid of surgical resection and imatinib therapy.
Adrenal Glands* ; Adrenalectomy ; Gastrointestinal Stromal Tumors* ; Humans ; Imatinib Mesylate ; Korea ; Lymph Nodes ; Male ; Middle Aged ; Neoplasm Metastasis* ; Peritoneum ; Recurrence

Constipation is a prevalent, often chronic, gastrointestinal motility disorder. Bisacodyl, a stimulant laxative, is widely used to treat constipation in adults and children. This drug is usually safe, but it has some side effects including diarrhea, abdominal pain, colitis, and proctitis. There have been reports that rectal administration of bisacodyl could cause injury to the rectal mucosa by mechanical and chemical mechanisms. However, there has been no report of severe proctitis with rectal ulcers in patients taking oral bisacodyl. In this report, we describe the case of an 80-year-old woman with severe rectal ulcers and proctitis after taking oral bisacodyl for several days, and review the literature.
Abdominal Pain ; Administration, Rectal ; Adult ; Aged, 80 and over ; Bisacodyl* ; Child ; Colitis ; Constipation ; Diarrhea ; Female ; Gastrointestinal Motility ; Humans ; Mucous Membrane ; Proctitis* ; Rectum ; Ulcer*

PURPOSE: Determining an appropriate thresholding is crucial for PDG PET analysis since strong control of Type I error could fail to find pathological differences between early Alzheimer' disease (AD) patients and healthy normal controls. We compared the SPM results on FDG PET imaging of early AD using uncorrected p-value, random-field based corrected p-value and false discovery rate (FDR) control. MATERIALS AND METHODS: Twenty-eight patients (66+/-7 years old) with early AD and 18 age-matched normal controls (68+/-6 years old) underwent FDG brain PET. To identify brain regions with hypo-metabolism in group or individual patient compared to normal controls, group images or each patient's image was compared with normal controls using the same fixed p-value of 0.001 on uncorrected thresholding, random-field based corrected thresholding and FDR control. RESULTS: The number of hypo-metabolic voxels was smallest in corrected p-value method, largest in uncorrected p-value method and intermediate in FDG thresholding in group analysis. Three types of result pattern were found. The first was that corrected p-value did not yield any voxel positive but FDR gave a few significantly hypometabolic voxels (8/28, 29%). The second was that both corrected p-value and FDR did not yield any positive region but numerous positive voxels were found with the threshold of uncorrected p-values (6/28, 21%). The last was that FDR was detected as many positive voxels as uncorrected p-value method (14/28, 50%). CONCLUSIONS: FDR control could identify hypo-metabolic areas in group or individual patients with early AD. We recommend FDR control instead of uncorrected or random-field corrected thresholding method to find the areas showing hypometabolism especially in small group or individual analysis of FDG PET.
Brain ; Dementia* ; Humans