We analyzed 177 diabetic patients(80 males, 97 females) with the nerve con duction study (NCS) performed twice or more at the interval of more than one year in Severance Hospital from Jan 1, 1984 through Dec 31, 1994. We conclude as follows: 1)The NCS follow-ups showed that diabetic polyneuropathy was getting worsened electrophysiologically as time goes by. 2)The NCS revealed that the earlier change was noticed on the distal portion of sensory nerve fiber, though diabetes was known to cause a damage to both sensory and motor nerve fibes. 3)Considering that the NCS follow-ups revealed earlier and more marked changes in amplitude than in nerve conduction velocity, axonal degeneration seems to be more responsible for the pathogenesis of diabetic polyneuropathy rather than segmental demyelination.
Axons ; Demyelinating Diseases ; Diabetic Neuropathies ; Follow-Up Studies* ; Humans ; Male ; Nerve Fibers ; Neural Conduction*

OBJECTIVE: Study was designed preliminarily to observe the accordance of caregivers strain and depression with other factors such as sex of the patient, caregiver, lesion side, Mini Mental Status Examination (MMSE) score and Beck's Depression Index (BDI). METHOD: We composed a questionnaire with BDI, and the Sense of Competence Questionnaire (SCQ) in order to evaluate the amount of stress and depression of caregivers. Evaluation of the patient was done by interviewing them along with reviewing their medical records and obtaining scores such as the MMSE, Functional Inependence Index (FIM) and the Geriatric Depression Scale (GDS). RESULTS: BDI of the caregivers showed a negative correlation with the patients' age. Lesion side nor age, nor the prevalence of hemiplegia of patients did not show statistical relevance with the strain that the caregiver felt. The first subscale of SCQ showed a positive correlation with the caregiving time that the caregiver gave. In accordance to the sex of the caregiver, females showed to spend more time with the patient, showed to be more unsatisfied with the patient but showed a tendency of lesser SCQ score. CONCLUSION: Depression, strain and burden that the caregivers went through showed to have slight correlation with the patient and caregiver factors.
Caregivers* ; Depression* ; Female ; Hemiplegia ; Humans ; Medical Records ; Mental Competency ; Prevalence ; Surveys and Questionnaires

The myoclonic epilepsies of infancy and early childhood pose the most difficult problems in the diagnosis and classification of epilepsies because they are often confused with the Lennox-Gastaut syndrome sharing a number of common features. However, their correct differentiation is easily justifiable because some of the myoclonic epilepsies of early childhood have better prognosis than the Lennox-Gastaut syndrome. We experienced and treated a 4-year-old boy who had normal intellectual function but frequent myoclonic and generalized clinic-tonic-clinic seizures, which were successfully controlled by anti-epileptic drugs. Hence we report a case with brief review of literatures.
Child, Preschool ; Classification ; Diagnosis ; Epilepsies, Myoclonic* ; Epilepsy ; Humans ; Male ; Prognosis ; Seizures

Diagnostic peritoneal lavage is a accurate and safe method confirming the intraabdominal injury with head trauma, unstable multiple injuried patients. But the development of imaging technique and the trend in noninvasive diagnostic value is decreasing now. In the emergency room, the emergency physicians are required the rapidity and accuracy' in intial assessment and the decisions for the operation or not. So emergency physicians have been investigating the diagnostic method for intraabdomial injury that is more rapid, safe and accurate. Many diagnostic tools are developed and now accepted and used widely, among them the diagnostic peritoneal lavage is still the best method for unsatble or head injuries patients. But the positive diagnostic criterias are variable by many authors and still remain imperfectly. So our study was reviewed by medical record of patients who were undertaken the diagnostic peritoneal lavage for the diagnosis intraabdominal injury and statistical analyasis was done compared with many criteria of red blood cell and white blood cell for the more actuate way. A retrospective study of diagnostic peritoneal lavage was done of 90 patients with blunt abdominal trauma during 2 years from January, 1996 to December, 1997 and summerized our experience. The results were as follows; 1) There are 73 males and 17 females in sex. The most common type of injury was the traffic accident. 2) With many variable criteria of RBC and WBC, the accuracy and the false positive and false negative were not different in statistical results. The average accuracy was 80.1%. 3) The operations were done in 30(33.3%) cases, and the most frequent injuried organ was the small bowel, 20 cases(66.7%).
Accidents, Traffic ; Craniocerebral Trauma ; Diagnosis ; Emergencies ; Emergency Service, Hospital ; Erythrocytes ; Female ; Humans ; Leukocytes ; Male ; Medical Records ; Peritoneal Lavage* ; Retrospective Studies

Distal myopathy with rimmed vacuoles is a rare muscle disease and, so far as we know, it has not been reported in Korea as yet. This disorder is known to be inherited as autosomal recessive trait and to have no specific treatment. Hereby, we report 3 patients of distal myopathy with rimmed vacuoles in a family. The clinical characteristics of these patients were slowly progressive symmetrical muscle weakness and wasting of all 4 extremities, worse in distal legs. The pretibial muscles were involved more markedly than the calf muscles. Serum muscle enzymes were increased. The prominent EMG findings were myopathic changes, but reduced recruitment was occasionally found in some distal muscles The muscle biopsies of right biceps brachii muscle were performed in two patients, which showed the characteristic rimmed vacuoles by light microscope. Membranous whorls and randomly oriented intracytoplasmic filaments were found by electron microscope. The severity of pathological abnormalities were related to the clinical status of the patient. One had been treated with steroid(prednisolone) for several years but with no improvement.
Biopsy ; Distal Myopathies* ; Extremities ; Humans ; Korea ; Leg ; Muscle Weakness ; Muscles ; Vacuoles*

Many authors have been reported that the abdominal trauma, especially injury of the liver and spleen, is frequently found with lower rib fractures, below the ninth rib fractures and the incidence was about 20 to 30%. In cases of rib fractures, Intra- abdominal organs may be injured in the higher rib fractures than the ninth because the diaphragm is elevated at the level of filth intercostal space in expiration period and the intra-abdominal lesions are often delayed evaluated due to the pain of the fractures and masked by the other injuries of the head and the extremities. So above reasons, we were often questioned what the level of rib fracture we must evaluate the intra-abdominal injury was? So we investigated 452 patients with rib fractures who visited our emergency medical center from 1995, January to 1996, December and divided into two groups according to the prescience of intra-abdominal organ injuries by each the level of rib fractures. The number of patients with intra-abdominal organ injuries were 75(16.6%) and the most frequently damaged organ was the liver(25 cases, 33.3%). We calculated the statistical values of each level of rib fractures by the Chi-Square method and got a result that the level of rib fracture we must evaluate the intra-abdominal injuries was the sixth rib fracture. Therefore, if we will meet the patients with rib fracture below the sixth, we must have attentions to the intra-abdominal injuries and evaluate the abdomen closely with various diagnostic methods.
Abdomen ; Attention ; Diaphragm ; Emergencies ; Extremities ; Head ; Humans ; Incidence ; Liver ; Masks ; Rib Fractures* ; Ribs* ; Spleen

Essential thrombocythemia is one type of the related chronic myeloproliferative disorders that also include poly-cythemia vera, chronic myelogenous leukemia, and idiopathic myelofibrosis. It is a rare disorder of unknown origin characterized by thrombocytosis, excessive megakaryocytes, hemorrhage, and thrombotic complication. Several cases of ischemic stroke in essential thrombocythemia have been reported, but cerebral infarction combined with cerebral hemorrhage has been very rare and has not been reported in Korea. We report a case of cerebral infarction and chronic subdural hematoma in a pateint with essential thrombocythemia. A 59-year-old woman with essential thrombocythemia was admitted with mild left hemiparesis that developed 3 days prior. She had a history of minor trauma 15 days prior. A brain MRI showed an infarction in the right temporal lobe and a chronic subdural hematoma in the right frontoparietal area. A cerebral angiography revealed an occlusion of the M2 portion of the right middle cerebral artery.
Brain ; Cerebral Angiography ; Cerebral Hemorrhage ; Cerebral Infarction* ; Female ; Hematoma, Subdural, Chronic* ; Hemorrhage ; Humans ; Infarction ; Korea ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Magnetic Resonance Imaging ; Megakaryocytes ; Middle Aged ; Middle Cerebral Artery ; Myeloproliferative Disorders ; Paresis ; Primary Myelofibrosis ; Stroke ; Temporal Lobe ; Thrombocythemia, Essential* ; Thrombocytosis

Moyamoya disease is characterized by a bilateral progressive narrowing of the distal internal carotid and proximal portions of the anterior and middle cerebral arteries. The cerebral vessels of the 11 to 14 mm embryonic period are extremely similar to these moyamoya vessels. The vertebral arteries unite with a contralateral homologue to form the basilar artery during embryonic development and rarely, the failure of complete fusion results in duplication of these arteries. It is well known that moyamoya disease sometimes is accompanied by persistent primitive arteries, cerebral aneurysm, or rarely arteriovenous malformation. However, no case of the moyamoya disease with complete duplication of basilar artery has been previously reported. These two types of vascular abnormality are probably associated in certain developmental period, and moyamoya disease causes hemodynamic load in the basilar artery system as a collateral pathway and these effects are also involved in duplication of basilar artery. The relationship between these two varieties of vascular abnormality and possible pathogenesis of the moyamoya disease are discussed.
Aneurysm ; Arteries ; Arteriovenous Malformations ; Basilar Artery* ; Cerebral Arteries ; Embryonic Development ; Female ; Hemodynamics ; Middle Cerebral Artery ; Moyamoya Disease* ; Pregnancy ; Vertebral Artery

BACKGROUND: The circadian rhythm of circulating melatonin is regulated by the endogenous oscillators, the suprachi-asmatic nuclei, and entrained by the light-dark cycle of the environment, but it seems that the rhythm can be affected by variable lesions outside the retina-pineal pathway. We intended to know how acute cerebral infarction affects on the cir-cadian rhythm of plasma melatonin secretion. METHODS: Plasma melatonin level was measured from 64 patients with acute cerebral infarction. On admission, blood samples were collected by venipuncture at 2AM, 4AM, 10AM, and 2PM and melatonin level was measured by radioimmunoassay. The state of consciousness of each patient was assessed clini-cally and the infarction site and size were evaluated clinically and radiographically. RESULTS: Among 64 patients with acute cerebral infarction, dramatic blunting or obliteration of nocturnal melatonin surge in the blood was found in 29 patients. The circadian rhythm of melatonin secretion was absent in 12 of 35 alert patients, in 10 of 20 drowsy patients, and in 5 of 7 stuporous patients. Melatonin secretion into plasma was markedly decreased in all 2 comatose patients. Of 14 patients with brainstem lesions, 8 patients showed decreased melatonin levels with the absence of a nocturnal rise, although most of them were alert. CONCLUSIONS: This study suggests that brainstem and the initial mental state might contribute to the regulation of the circadian rhythm of plasma melatonin even though the lesion does not involve the retina-pineal pathway, but further extensive study is required to elucidate it. (J Korean Neurol Assoc 19(4):359~363, 2001)
Biological Clocks ; Brain Stem ; Cerebral Infarction* ; Circadian Rhythm* ; Coma ; Consciousness ; Humans ; Infarction ; Melatonin* ; Phlebotomy ; Photoperiod ; Pineal Gland ; Plasma ; Radioimmunoassay ; Stupor

In 17 myotonic cases (16 of myotonic muscular dystrophy and 1 of congenital myotonia), 13 cases showed significant decremental responses on RNS study. The decremental responses had the tendency of more prominence on faster stimulating rate, and in the proximal limb muscles. This result suggests that the RNS test is useful but not specific for the disorder of neuromuscular junction.
Extremities ; Humans ; Muscles ; Muscular Dystrophies ; Neuromuscular Junction