Pseudohypoparathyroidism (PHP) is a rare clinical syndrome characterized by hypocalcemia, hyperphosphatemia and increase of serum parathyroid hormone in association with unique clinical features. We recently experienced a typical PHP type Ia patient who presented with recurrent seizure and muscle spasms and electroencephalogram (EEG) showed generalized spike-and-wave discharges. With the correction of hypocalcemia, seizures did not recur and epileptiform discharges disappeared. We suggest that the possibility of PHP should be considered in patients with seizures showing hypocalcemia and hyperphosphatemia.
Electroencephalography ; Humans ; Hyperphosphatemia ; Hypocalcemia ; Parathyroid Hormone ; Pseudohypoparathyroidism ; Seizures ; Spasm

BACKGROUND AND PURPOSE: Hyperglycemia after acute ischemic stroke (AIS) is associated with poor outcomes. However, there is no consensus as to the optimal method for glycemic control. We designed an insulin infusion protocol for aggressive glucose control and investigated its efficacy and safety. METHODS: We applied our protocol to patients within 48 hours after AIS or transient ischemic attack (TIA) with an initial capillary glucose level of between 100 and 399 mg/dL (5.6-22.2 mmol/L). An insulin solution comprising 40 or 50 U of human regular insulin in 500 mL of 5% dextrose was administered for 24 hours. Capillary glucose was measured every 2 hours and the infusion rate was adjusted according to a nomogram with a target range of 80-129 mg/dL (4.4-7.2 mmol/L). Changes in glucose and overall glucose levels during insulin infusion were analyzed according to the presence of diabetes or admission hyperglycemia (admission glucose >139 mg/dL or 7.7 mmol/L) by the generalized estimating equation method. RESULTS: The study cohort comprised 115 consecutive patients. Glucose was significantly lowered from 160+/-57 mg/dL (8.9+/-3.2 mmol/L) at admission to 93+/-28 mg/dL (5.2+/-1.6 mmol/L) during insulin infusion (p<0.05). Laboratory hypoglycemia (capillary glucose <80 mg/dL or 4.4 mmol/L) occurred in 91 (71%) patients, 11 (10%) of whom had symptomatic hypoglycemia. Although glucose levels were significantly lowered and maintained within the target range in all patients, overall glucose levels were significantly higher in patients with diabetes or hyperglycemia (p<0.05). CONCLUSIONS: Our insulin-infusion protocol was effective in glycemic control for patients with AIS or TIA. Further modification is needed to improve the efficacy and safety of this procedure, and tailored intervention should be considered according to glycemic status.
Capillaries ; Cohort Studies ; Consensus ; Glucose ; Humans ; Hyperglycemia ; Hypoglycemia ; Insulin ; Ischemic Attack, Transient ; Nomograms ; Stroke

Hashimoto's encephalopathy (HE) is a rare autoimmune disorder characterized by a nonspecific encephalopathy with high titers of serum anti-thyroid antibody in the absence of other defined causes. A 54-year-old woman was admitted due to recurrent seizures and confusion. Her serum anti-thyroid antibody level was elevated, and brain MRI showed multiple instances of vasogenic edema. Her symptoms disappeared after treatment with high-dose steroids and antiepileptic drugs. We propose that HE should be considered in the differential diagnosis of multiple vasogenic edema on brain imaging.
Anticonvulsants ; Brain* ; Diagnosis, Differential ; Edema* ; Female ; Humans ; Magnetic Resonance Imaging* ; Middle Aged ; Neuroimaging ; Seizures ; Steroids

Hashimoto's encephalopathy (HE) is a rare autoimmune disorder characterized by a nonspecific encephalopathy with high titers of serum anti-thyroid antibody in the absence of other defined causes. A 54-year-old woman was admitted due to recurrent seizures and confusion. Her serum anti-thyroid antibody level was elevated, and brain MRI showed multiple instances of vasogenic edema. Her symptoms disappeared after treatment with high-dose steroids and antiepileptic drugs. We propose that HE should be considered in the differential diagnosis of multiple vasogenic edema on brain imaging.
Anticonvulsants ; Brain* ; Diagnosis, Differential ; Edema* ; Female ; Humans ; Magnetic Resonance Imaging* ; Middle Aged ; Neuroimaging ; Seizures ; Steroids

BACKGROUND: Prehospital delay is a major obstacle for successful treatment of acute stroke. We investigated the annual change of prehospital delay and related factors in patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA). METHODS: From prospective patient registry, demographic and clinical characteristics of patients who presented within 48 hours of symptom onset after AIS or TIA from 2005 to 2008 were analyzed. We compared the annual change of prehospital delay (time from symptom onset to hospital arrival) and the proportion of early arrival (EA-3, prehospital delay<3 h; EA-6, prehospital delay<6 h). We also investigated factors associated with prehospital delay and early arrival. RESULTS: Of 612 patients, 623 events of AIS or TIA were analyzed. The adjusted geometric mean (95% CI) of prehospital delay (hours) was 7.42 (6.07-9.06) in 2005, 8.18 (6.76-9.89) in 2006, 4.39 (3.50-5.51) in 2007, and 4.02 (3.10-5.22) in 2008 (p<0.01). The proportion of early arrival (year) was 23.6% (2005), 31% (2006), 58% (2007), 54% (2008) for EA-3 (p<0.001) and 38.8% (2005), 32.5% (2006), 51.6% (2007), 75% (2008) for EA-6 (p<0.001). Compared with 2006, the adjusted odds (95% CI) for early arrival were 1.54 (0.87-2.71) in 2005, 1.91 (1.11-3.30) in 2007, 2.29 (1.31-4.01) in 2008 for EA-3 and 1.37 (0.84-2.25) in 2005, 1.73 (1.06-2.81) in 2007, 2.03 (1.23-3.36) in 2008 for EA-6. Younger age, severe neurologic deficit, admission through emergency department, cardioembolic stroke, and TIA were also independently associated with early arrival. CONCLUSIONS: From 2005 to 2008, prehospital delay decreased and potential candidates for thrombolytic therapy increased significantly.
Emergencies ; Humans ; Ischemic Attack, Transient ; Neurologic Manifestations ; Stroke ; Thrombolytic Therapy

Vitamin K, a cofactor of coagulation cascade, is used for hemostasis in patients with abnormal coagulation status. However, it is uncertain whether administration of vitamin K elevates the risk of thrombotic events. We present a patient with trauma who developed acute multiple cerebral infarctions after receiving intravenous vitamin K for several days. We presume that vitamin K can be a contributing factor for embolism in a patient with trauma.
Cerebral Infarction ; Embolism ; Hemostasis ; Humans ; Vitamin K ; Vitamins

BACKGROUND: Three-dimensional (3D) in vitro cultures recapitulate the physiological microenvironment and exhibit high concordance with in vivo conditions. Improving co-culture models with different kind of cell types cultured on a 3D scaffold can closely mimic the in vivo environment. In this study, we examined the osteogenic response of pre-osteoblast MC3T3-E1 cells and Raw264.7 mouse monocytes in a 3D-encapsulated co-culture environment composed of the Cellrix®3D culture system, which provides a physiologically relevant environment. METHODS: The Cellrix® 3D Bio-Gel scaffolds were used to individually culture or co-culture two type cells in 3D microenvironment. Under 3D culture conditions, osteoblastic behavior was evaluated with an ALP assay and staining. ACP assay and TRAP staining were used as osteoclastic behavior indicator. RESULTS: Treatment with osteoblastic induction factors (?3F) and RANKL had on positively effect on alkaline phosphatase activity but significantly inhibited to acid phosphatase activity during osteoclastic differentiation in 3D coculture. Interestingly, alkaline phosphatase activity or acid phosphatase activity in 3D co-culture was stimulated with opposite differentiation factors at an early stage of differentiation. We guess that these effects may be related to RANK– RANKL signaling, which is important in osteoblast regulation of osteoclasts. CONCLUSION In this study, the osteogenic response of 3D encapsulated pre-osteoblast MC3T3-E1 cells and mouse monocyte Raw264.7 cells was successfully demonstrated. Our 3D culture conditions will be able to provide a foundation for developing a high-throughput in vitro bone model to study the effects of various drugs and other agents on molecular pathways.

BACKGROUND: Three-dimensional (3D) in vitro cultures recapitulate the physiological microenvironment and exhibit high concordance with in vivo conditions. Improving co-culture models with different kind of cell types cultured on a 3D scaffold can closely mimic the in vivo environment. In this study, we examined the osteogenic response of pre-osteoblast MC3T3-E1 cells and Raw264.7 mouse monocytes in a 3D-encapsulated co-culture environment composed of the Cellrix®3D culture system, which provides a physiologically relevant environment. METHODS: The Cellrix® 3D Bio-Gel scaffolds were used to individually culture or co-culture two type cells in 3D microenvironment. Under 3D culture conditions, osteoblastic behavior was evaluated with an ALP assay and staining. ACP assay and TRAP staining were used as osteoclastic behavior indicator. RESULTS: Treatment with osteoblastic induction factors (?3F) and RANKL had on positively effect on alkaline phosphatase activity but significantly inhibited to acid phosphatase activity during osteoclastic differentiation in 3D coculture. Interestingly, alkaline phosphatase activity or acid phosphatase activity in 3D co-culture was stimulated with opposite differentiation factors at an early stage of differentiation. We guess that these effects may be related to RANK– RANKL signaling, which is important in osteoblast regulation of osteoclasts. CONCLUSION In this study, the osteogenic response of 3D encapsulated pre-osteoblast MC3T3-E1 cells and mouse monocyte Raw264.7 cells was successfully demonstrated. Our 3D culture conditions will be able to provide a foundation for developing a high-throughput in vitro bone model to study the effects of various drugs and other agents on molecular pathways.

PURPOSE: Alcohol related seizures (ARS) are common problems in community. We reviewed the clinical characteristics of ARS in chronic alcoholics and evaluated the predictors of delirium tremens and recurrence of seizures. METHODS: We thoroughly reviewed all medical records of patients with alcohol related seizures at admission and some outpatient records for follow-up data. For the patients who had been lost during follow-up, telephone interviews were performed. We described the clinical characteristics of ARS during admission and analyzed the correlation between initial findings of ARS. RESULTS: Forty eight patients with ARS were admitted and followup data were available in 33 patients by out-patient records or telephone interviews. Forty-four patients were male and the mean age was 47.4+/-10.4 years old. Nine out of 33 patients became completely abstinent after discharge. Ten out of 24 current drinkers developed recurrent seizures and 20 out of 48 patients developed delirium tremens (DT) during admission. The number of seizures and age ofpatients were significantly related with DT. Patients with much weekly- consumption of alcohol were prone to develop recurrent seizures. CONCLUSIONS:These results suggest that careful attention should be paid to the patients with older age and multiple seizures at each event about the development of DT and to the patients with much weekly-consumption of alcohol about the recurrence of seizures during follow-up.
Alcohol Withdrawal Delirium ; Alcoholics ; Follow-Up Studies ; Humans ; Interviews as Topic ; Male ; Medical Records ; Outpatients ; Recurrence ; Seizures

No abstract available.
Alzheimer Disease ; Eating ; Humans ; Seizures