Therapeutic irradiation may produce a variety of adverse side effects on the central and the peripheral nervous systems. These adverse effects are divided into two main groups; transient and permanent. Four major clinical syndromes have been described in relation to permanent radiation injury of the nervous system: encephalopathy, cranial neuropathy, myelopathy, and peripheral neuropathy. Among them, delayed encephalopathy represents the major hazard in CNS irradiation. The characteristic MR imaging pattern of radiation induced delayed necrotizing leukoencephalopathy is symmetric, high-signal foci on T2WI in the periventricular white matter. We report a case of suspected post-irradiation leukoencephalopathy showed progressive mental change, quadriparesis, and urinary incontinence with characteristic MR findings who had taken therapeutic irradiation 12 months ago.
Cranial Nerve Diseases ; Leukoencephalopathies* ; Magnetic Resonance Imaging ; Nervous System ; Peripheral Nervous System ; Peripheral Nervous System Diseases ; Quadriplegia ; Radiation Injuries ; Spinal Cord Diseases ; Urinary Incontinence

BACKGROUND: Quinidine appeared to increase serum digoxin levels when given with quinidine. Therefore elevated serum digoxin concentrations and clinical toxicity have been reported in patient receiving quinidine. Currently, Bayesian method which estimates the most probable parameters of the drug for each patient from population parameters data is useful approach for adjusting digoxin dosage. To increase the accuracy of Bayesian method, it is desirable to use population parameters of Korean. Therefore we evaluated the effect of quinidine on digoxin clearance in Korea. METHOD: Patient's records from 19 adult cardiac disease without CHF having normal renal and liver function from Seoul National University of Hospital respectively wre evaluated. Digoxin pharmacokinetic parameters, CL and Vd, were obtained from serum concentration of digoxin of single and combined therapy at each steady-state by using bayesian method. RESULTS: This study show that quinidine reduced the total body clearance of digoxin from 2.39+/-0.17 to 1.51+/-0.08ml/min/kg(p<0.05) and reduced the digoxin volume of distribution from 8.57+/-0.29 to 4.98+/-0.19L/kg(p<0.05). This results show that digoxin dosage reduced to 40-50% in Korean, if quinidine therapy is initiated.
Adult ; Bayes Theorem ; Digoxin* ; Drug Interactions ; Heart Diseases ; Humans ; Korea ; Liver ; Pharmacokinetics ; Quinidine* ; Seoul

BACKGROUND & OBJECTIVES: There are few reports of affecting factors of the longterm prognosis after acute ischemic stroke. The aim of this prospective study was to determine which variables, of those easily measurable during the first 24 hours after stroke onset, would be predictors of longterm outcome. METHOD: Ninety-eight patients with an acute ischemic stroke were evaluated within 24 hours after symptom onset. The following potential affecting factors of outcome were prospectively collected : demographic datas, socioeconomic factors, risk factors of cerebrovascular accidents, clinical f indings as measured by the National Institute of Health (NIH) scale, laboratory findings and premorbid varibles rated according to modified Rankin score (mRS). We evaluated the outcome, assessed with mRS as good (mRS 3 or less) and poor (mRS 4, 5 or death) and follow up was undertaken at 6, 12, 18 and 24 months after onset. The statistical analysis was performed by means of SPSS/PC+package to determine the longterm prognostic factors. RESULTS: The multiple stepwise regression analysis revealed that the outcome depend on NIH scale(p<0.001), age (p<0.01), previous stroke(p<0.01), loss of consciousness (LOC) at onset (p Follow-Up Studies ; Humans ; Paresis ; Prognosis ; Prospective Studies ; Risk Factors ; Socioeconomic Factors ; Stroke ; Unconsciousness

We report a 18 years old man of brainstem encephalitis with acute ataxia, areflexia and gaze evoked vertical and horizontal nystagmus which is mimicking Miller Fisher syndrome. He had evidences of both peripheral neuropathy in nerve conduction studies and a brainstem encephalitis in MR findings. The possible relationship of the Miller Fisher syndrome and brainstem encephalitis are discussed with brief review of literature.
Adolescent ; Ataxia ; Brain Stem* ; Encephalitis* ; Humans ; Miller Fisher Syndrome* ; Neural Conduction ; Nystagmus, Pathologic ; Peripheral Nervous System Diseases

High dose intravenous immunoglobulin (IVIg) therapy can improve the clinical course of several immune mediciated diseases. We evaluated clinical effects and side effects of IVIg in Guillain-Barre syndrome (GBS). 19 Patients with GBS were studied prospectively in a placebo-controlled trial. 11 Patients were received high dose IVIg (400mg/kg for 5 days) and controls received only conservative treatment. The disability scores using modified Rankin scores before and after treatment of each group were compared. Four weaks later, mean Rankin Score of IVIg group was 2.5 + 0.7 and control group was 3.3+ 0.5which showed significant difference(p<0.05). There were no serious advers effer of promote early improvement with safety in acute phase of Guillan-Barre syndrome.
Guillain-Barre Syndrome* ; Humans ; Immunization, Passive* ; Immunoglobulins* ; Immunoglobulins, Intravenous ; Prospective Studies

Central pontine myelinolysis (CPM) is characterized by regions of demyelination throughout the brain but most prominent in the pons. The symptoms of CPM include rapidly evolving quadriplegia, pseudobulbar palsy and varying degree of altered consciousness. The exact pathogenesis is unknown. We report a rare case of extrapontine myelinolysis (EPM) without CPM; A 49-year-old man with chronic alcoholism and chronic type B hepatitis were presented with clinical symptoms of rapidly progressive quadriplegia and pseudobulbar palsy preeded by hyponatremia. Magnetic resonance imaging in this patient showed bilateral increased T2-weighted signals in the caudate nucleus and the putamen.
Alcoholism ; Brain ; Caudate Nucleus ; Consciousness ; Demyelinating Diseases ; Hepatitis ; Humans ; Hyponatremia* ; Magnetic Resonance Imaging ; Middle Aged ; Myelinolysis, Central Pontine* ; Pons ; Pseudobulbar Palsy ; Putamen ; Quadriplegia

We describe a 28 year-old woman who had fever, general myalgia, tender erythematous subcutaneous nodules on whole body skin, and acute pleuritis after influenza vaccination. Temporal association between vaccination and her symptoms and skin biopsy result are in agreement with our diagnosis as leukocytoclastic vasculitis. A review found that there were a few similar cases involving the skin, kidney, and rarely nervous system, mostly with good prognoses. Our patient was treated by a short course of corticosteroid and no recurrence has been observed for five months. Although there is a possibility of an infection, the temporal association, the false-positive HCV ELISA test, and the increased serum IgE were interesting findings, which might account for this leukocytoclastic vasculitis after influenza vaccination.
Adult ; Biopsy ; Diagnosis ; Enzyme-Linked Immunosorbent Assay ; Female ; Fever ; Humans ; Immunoglobulin E ; Influenza, Human* ; Kidney ; Myalgia ; Nervous System ; Pleurisy ; Prognosis ; Recurrence ; Skin ; Vaccination* ; Vasculitis*

For the purpose of investigation of prevalence, etiology and its related factors of the dementia in the rural elderly, the author examined 650 elderly people aged 60 years or more via cluster sampling by using a door to door 2 phase design from June 1992 to July 1992. The cognitive impairment was assessed by MMSEK in the first screening phase, and in the second phase 252 people in the dementia suspected group (MMSEK score < 23) and 34 in the control group (MMSEK score > 24) were taken to the clinical examination for the diagnosing dementia. The results were as follows; 1. The prevalence rate of dementia was 21.3% in the rural elderly, and was higher in females (31.1%) than in males (10.7%) (p<0.01). 2. The prevalence rates of dementia in males aged 60-69, 70-79 and over 80 were 4.1%, 16.7% and 50.0% respectively and those in female were 8.7%, 49.3%, 72.2% respectively. The rates increased significantly with increasing age in both sexes (p<0.01). 3. The prevalence rates of the mild, moderate and severe dementia were 8.4%, 9.3% and 3.6% respectively and increased significantly with increasing age in females (p<0.001). 4. The proportional distribution of dementia type by etiological classification was 63.6% senile dementia of Alzheimer's type, 17.7% vascular dementia, 10.4% mixed dementia, 4.2% alcoholic dementia, 1.0% posttraumatic dementia and 3.1% for others. 5. In multiple logistic regression analysis for affecting factors of the dementia, the significant variables were level of physical activity, age, education and sex. The Odds ratios in factors were low level of physical activity 6.0 x (95% CI 2.4-15.1), age over 70 4.8 x (95% CI 2.2-10.7), no formal education 3.9 x (95% CI 1.1-13.8), and female sex 2.2 x (95% CI 1.0-5.0).
Aged* ; Alcoholics ; Alzheimer Disease ; Classification ; Dementia* ; Dementia, Vascular ; Education ; Female ; Humans ; Logistic Models ; Male ; Mass Screening ; Motor Activity ; Odds Ratio ; Prevalence*

AIMS: In this paper we have investigated the detection rate of each H. pylori test in the antrum and in the body for patients with nonulcer dyspepsia (NUD), duodenal ulcer (DU), benign gastric ulcer (BGU), and stomach cancer. In addition, we examined whether or not there is any relationship between the decrease of H. pylori detection rate and intestinal metaplasia in the antrum. METHODS: Three different test methods for identifying H. pylori infection-CLOtest, Gram stain, H&E stain-were taken in the antrum and in the body. RESULTS: 1) The detection rates of CLOtest, Gram stain, and H&E stain for NUD group were 88%, 75%, and 64% (mean: 76%) in the antrum, and 89%, 78%, and 67% (mean: 78%) in the body, respectively, and those of DU group were 95%, 95% and 81% (mean: 90%) in the antrum, and 97%, 87% and 64% (mean: 83%) in the body, respectively. Those of BGU group were 86%, 74%, 53% (mean: 71%) and 98%, 82%, 58% (mean: 79%), respectively, and those of stomach cancer group were 80%, 88%, 58% (mean: 75%) in the antrum, and 100%, 96%, 83% (mean: 93%) in the body, respectively. The B/A detection ratio which means the ratio of mean H. pylori detection rate of body to that of antrum was 1.03 in NUD, 0.93 in DU, 1.11 in BGU, and 1.24 in stomach cancer group. 2) The rate of intestinal metaplasia in the antrum was 12% for NUD, and 15% for DU group. Those of BGU and stomach cancer group were 47% and 72%, respectively. 3) The correlation etween B/A detection ratio and intestinal metaplasia in the antrum was good (correlation coefficient(r)=0.93). CONCLUSIONS: The result that body is more adequate for H. pylori detection in BGU and stomach cancer patients rather than antrum can be explained by the high rate of intestinal metaplasia in the antrum which is hostile surrounding for H. pylori.
Duodenal Ulcer ; Dyspepsia ; Humans ; Metaplasia* ; Stomach Neoplasms ; Stomach Ulcer

The incidence of abdominal trauma has increased in recent decades as the frequency of traffic accidents increased. Early symptoms and signs of blunt abdominal trauma may be absent and associated injuries frequently detract physicians from early diagnosis of abdominal trauma. Delayed diagnosis has been shown to be associated with higher morbidity and mortality. Gastrointestinal tract is the third most commonly injured organ from blunt abdominal trauma. Gastric ruptures after blunt abdominal trauma were reported occasionally, but reports of upper gastrointestinal bleeding by gastric mucosal tear were very rare. Four cases of upper gastrointestinal bleeding due to gastric mucosal tear after blunt abdominal trauma are herein reported with a review of related literatures.
Accidents, Traffic ; Delayed Diagnosis ; Early Diagnosis ; Gastrointestinal Tract ; Hemorrhage ; Incidence ; Mortality ; Stomach Rupture