Lateral medullary syndrome is famous for its unique symptom complex such as crossed sensory change or Homer syndrome, and thus hardly can be misdiagnosed. Though this syndrome has been reported to be able to accompany ipsilateral motor weakness, the sensory change of extremities is known to be almost always contralateral to the lesion. We recently experienced one case presented with weakness and dysmetria on the right associated with ipsilateral sensory change. But few days later, he showed additional neurologic signs compatible with right lateral medullary syndrome. Brain MRI showed rostro-caudally elongated lesion extending from right lateral medulla to the upper cervical cord. Here we suggest the probable neuroanatomical substrate for this symptom and clinico-radiologic relationship with previous literature.
Brain ; Cerebellar Ataxia ; Extremities ; Lateral Medullary Syndrome* ; Magnetic Resonance Imaging ; Neurologic Manifestations ; Stroke*

Background & Objective: Sex differences in cerebral atherosclerosis and subsequent stroke have not been thoroughly investigated and conflicting data exist. The aim of this study was to investigate sex differences in the risk factors and distribution of large artery atherosclerotic stroke in a Korean population. Methods: We included consecutive acute ischemic stroke patients with symptomatic extracranial atherosclerosis (ECAS) or intracranial atherosclerosis (ICAS) based on brain and vascular imaging who presented at our hospital between January 2011 and December 2015. We then compared risk factor profiles and the proportion of symptomatic ECAS and ICAS between men and women. Results: Eight hundred and forty four patients were enrolled during the study period. The proportion of ECAS in men was notably higher than in women (19.4% in men vs. 9.3% in women; p < 0.001). A multiple regression analysis showed that male gender was a factor favoring ECAS (vs. ICAS, odds ratio [OR], 3.554; 95% confidence interval [CI], 2.175-5.808; p < 0.001). Age (OR, 1.051; 95% CI, 1.031-1.072; p = 0.001) and hyperlipidemia (OR, 2.330; 95% CI, 1.538-3.529; p < 0.001) were also factors favoring ECAS. However, after stratification by sex, the association was only significant in men. Conclusions: There is a sex difference in the distribution of atherosclerotic stroke. Sex may be an effect modifier of the association between atherosclerotic risk factors and atherosclerotic distribution.
Stroke

We examined the p53 protein overexpression and evaluated its correlation with pathobiological variables, including: (1) patient age, sex, tumor size, histological type and grade, invasion depth, vascular invasion, perineural invasion and lymph node status; (2) the Ki-67 labeling index in 100 gastric carcinomas; and (3) the DNA ploidy pattern, S phase fraction (SPF), and the proliferation index (PI) in 84 cases using flow cytometry. The positive rate of p53 staining was 48% and the p53 immunoreactivity was independent of variable clinicopathologic factors. No correlation was made between the Ki-67 labeling index with p53 immunostaining and DNA ploidy parameters. Aneuploidy rate was slightly higher in the p53 positive group (55.6%) than the p53 negative group (44.4%)(p=0.097). The mean values of SPF and PI were significantly higher in the p53 protein positive group. Aneuploidy was more often observed in the intestinal type (p=0.038), advanced gastric carcinoma (p=0.015) and lymph node positive group(p=0.039). The above results suggest that although the p53 protein overexpression has no significant correlation with pathological factors and the Ki-67 labeling index, it may play an important role in tumor cell proliferation. Since p53 protein overexpression was slightly higher in the aneuploidy group showing significant correlation with poor prognostic parameters, it is thought that re-evaluation of the p53 mutation by molecular biological study is needed.
Aneuploidy ; Cell Proliferation ; DNA* ; Flow Cytometry ; Humans ; Lymph Nodes ; Ploidies* ; S Phase

OBJECTIVE: The negative symptoms of schizophrenia usually are not responsive to drug therapy to persist and make schizophrenics more difficult in their rehabilitation. The authors investigated the therapeutic effect of token economy(TET) for negative symptoms of schizophrenic patients, and attempted to develop a TET program f3r psychiatric wards in general hospital. METHODS: Negative subscale of PANSS was rated for 35 schizophrenics with negative symptoms as their main problems before and after short-term TET(less than 3 months). Therapeutic factors were identified by comparing patient and program variables between the achieved and the non-achieved group of each level of target behaviors. RESULTS: 1) Subtotal of negative subscale of PANSS was decreased from 31.57+/-4.32 at baseline to 20.66+/-4.63 artier treatment. With TET, symptoms of difficulty in abstract thinking' and 'stereotypic thinking' were less responsive than the other 5 items of the scale Also the dose of antipsychotics prescribed was reduced to 291.21+/-287.74mg/day from 487.58+/-372.79mg/day. 2) The achievement rate of level I (self-help) was 75%, level II (ward-activity) 78%, and level III (social activity/occupation) 68%, resulting in average 74% for all target behaviors. 3) On level II, dose of antipsychotics was lower, and on level III, number of admission was lower and female sex was more frequent in achieving patient group than nonachieving group. The rate of achievement was higher in case of special flood, reception, and outing with family applied as a reinforcer on level I, and reception on level II . CONCLUSION: These results showed that TET was effective for schizophrenic patients with negative symptoms in psychiatric ward. Further investigations to refine the individual program of TET will be needed far enhancement of it s therapeutic efficacy and smart application of it.
Antipsychotic Agents ; Drug Therapy ; Female ; Hospitals, General ; Humans ; Rehabilitation ; Schizophrenia ; Token Economy*

BACKGROUND: In anesthesia for cesarean section, there is an increased incidence of maternal awareness because a light plane of general anesthesia is chosen for fetal safety and rapid recovery. Propofol may be the choice if smooth induction and rapid maternal recovery are desired. Authors tried to know that propofol has properties which suggest that it might be useful alternative to thiopental and enflurane. METHODS: Forty patients in ASA class I or II scheduled for cesarean section were allocated randomly to either propofol (n=20) (P) or thiopental-enflurane (n=20) (T-E) group. Anesthesia was induced with propofol 2 mg/kg IV and maintained by continuous infusion of propofol 8 mg/kg/hr in P group and was induced with thiopental 4 mg/kg IV and maintained by inhalation of 1 vol% enflurane in T-E group. All patients received vecuronium 0.1 mg/kg and 50% N2O-O2. Blood pressure, heart rate, Apgar score, umbilical arterial blood gas analysis and the incidence of maternal awareness using the isolated forearm technique (IFT) were evaluated. RESULTS: Diastolic pressure was decreased in P group than T-E group at 10 min after delivery. Heart rate was increased in P group than T-E group at immediate after extubation (p<0.05). For apgar score, umbilical artery gas analysis and maternal awareness there were not significant differences between two groups. CONCLUSIONS: In comparison with thiopental-enflurane, propofol infusion (8 mg/kg/hr) coupled with N2O was proved to be clinically satisfactory anesthesia for cesarean section with no adverse effects on both mother and neonate.
Anesthesia* ; Anesthesia, General ; Apgar Score ; Blood Gas Analysis ; Blood Pressure ; Cesarean Section* ; Enflurane ; Female ; Forearm ; Heart Rate ; Humans ; Incidence ; Infant, Newborn* ; Inhalation ; Mothers ; Pregnancy ; Propofol ; Thiopental ; Umbilical Arteries ; Vecuronium Bromide

BACKGROUND/AIMS: In HCC with low AFP. we have to use repeated imaging study to evaluate residual viable rumor or recurrence after TACE ( transarterial chemoembolization). We performed the study to know that sICAM-1 in HCC can be a tumor marker of diagnosis and has cor relation with tumor size or clinical staging. The results were compared with PIVKA- , an another tumor marker of HCC. METHODS: Previously untreat ed 39 pat ients with HCC were evaluated. Serum sICAM- 1, AFP and PIVKA-II were measured by EIA, immunoradiometric assay and EIA, respectively. Tumor size were meas ured by abdominal CT and angiogr aphy. RESULTS: Range of sICAM- 1 levels with HCC patients were 189.0 to 983.6 ng/ mL, and mean value was 668.3+- 254.4 ng/ mL. Thirty four of the 39 patients (87.2%) with HCC showed sICAM- 1 levels higher than 306.4 ng/ mL (mean of 131 healt hy controls + 2SD level). Range of PIVKA-II level with HCC patients were 25.3 to 2,779.3mAU/nL, and mean value was 1,340.1+-1,091.1mAU/mL. seven of the 39 patients(94.9%) with HCC showde PIVKA-II levels higher than 40mAU/mL. Range of AFP levels with HCC patients were 4.2 to 57,520ng/mL, and mean value was 4,215.6+-10,807.2ng/mL. 10 patients (26%) showed AFP lower than 20ng/mL, and 17 patients(44%) were AFP lower than 100ng/mL. All of the 17 patients with alphaFP lower than 100ng/mL had s ICAM-1 levels more than reference range (mean of 131 healt hy cont r ols + 2 SD level), and PIVKA-II levels also more than reference range. Positive correlation was observed between PIVKA-II level and tumor size in 18 patients without vascular invasion. Accor ding t o HCC clinical staging, 10 patients (25.6%) belonged clinical stage II. 5 pat ients (12.8%) III, 24 pat ients (61.5%) IV. Both of PIVKA-II and sICAM-1 levels of stage showed significantly higher than stage II. PIVKA-II showed more positive correlation with tumor size and clinical stage than sICAM- 1. No correlation was found between AFP and sICAM-1, and positive correlation was AFP and PIVKA-II. CONCLUSION: In HCC patients with low AFP, sICAM-1 and PIVKA-II correlated with tumor size and clinical stage. sICAM-1 and PIVKA-II may be a useful marker of diagnosis. So, we need to further study to evaluate whether sICAM- 1 and PIVKA-II can be used as a marker of disease progression or prognosis.
Carcinoma, Hepatocellular* ; Diagnosis ; Disease Progression ; Humans ; Immunoradiometric Assay ; Intercellular Adhesion Molecule-1* ; Prognosis ; Recurrence ; Reference Values ; Tomography, X-Ray Computed

Crohn's disease of the perineum is notably resistant to treatment. We describe our experiences of tacrolimus ointment application in three patients with intractable perianal Crohn's disease. At the time of diagnosis patients showed anal fissure with ulcer, anal fistula, or perianal abscess, respectively. These lesions did not respond to steroid, metronidazole, mesalazine, or azathioprine, though the pediatric Crohn's disease activity index was markedly improved during the treatment period (4 to 12 months). Topical tacrolimus was applied and resulted in marked healing and a rapid granulation of cavity edges within 6 weeks to 3 months. Topical tacrolimus at a low dose shows a promise for the management of childhood perianal Crohn's disease. Further controlled studies are required to assess the efficacy and safety of this treatment.
Abscess ; Azathioprine ; Child ; Crohn Disease* ; Diagnosis ; Fissure in Ano ; Fistula ; Humans ; Mesalamine ; Metronidazole ; Perineum ; Tacrolimus*

We have noticed an inadvertent error in our article. In Figure 1, an abbreviation is misspelled.

The double pylorus-is a fistulous communication between the gastric antrum and duodenal bulb, usually extending from the lesser curvature of the stomach to the superior aspect of the duodenal bulb, and seperated by septum or bridge of normal mucosa. Although its incidence is rare, reports concerning double pylorus are increasing with the recent development of upper gastrointestinal endoscopy and more awareness of this abnormality. We recently experienced two cases of double pylorus; an aquired one in 72-year old male who had an another opening with healing ulcer at the superior aspect of the original pyloric channel, central erosion with clubbing and fusion of mucosal folds at the greater curvature of the lower body and a 3 x 4 cm sized ulcer at the lesser curvature of the lower body, and the other congenital one in 53-year old male who had an another opening at the superior aspect of the original pyloric channel with histologically intact muscularis mucosa in the pyloric septum with no evidence of chronic peptic ulcer scarring. We report here two cases of double pylorus, one-acquired, and the other-congenital, with a review of the literature.
Aged ; Cicatrix ; Endoscopy, Gastrointestinal ; Humans ; Incidence ; Male ; Middle Aged ; Mucous Membrane ; Peptic Ulcer ; Pyloric Antrum ; Pylorus ; Stomach ; Stomach Ulcer ; Ulcer

Meningeal irritation signs sometimes develop after myelography due to bacterial infection by contamination during the procedure or chemical irritiation by contrast media itself. CSF profiles of chemical meningitis often mimick those of bacterial meningitis, sometimes causing difficulty in differentiation, but in that case clinical course soon reverse in short time without any complication. Postmyelography chemical meningitis by metrizamide (AmipaqueR) has been well described but iohexol (OmnipaqueR) has rarely been reported to cause chemical meningitis. We experienced a patient of chemical meningitis by iohexol and here descibe the case.
Bacterial Infections ; Contrast Media ; Humans ; Iohexol ; Meningitis* ; Meningitis, Bacterial ; Metrizamide ; Myelography*