PURPOSE: To review the results of resections of heterotopic ossification around the hip in patients with central nervous system injuries. MATERIALS AND METHODS: Heterotopic ossification was resected in ten hips of eight patients and followed for at least one year. Average age was 38.1 years (range, 21-56 years). We reviewed the charts and the radiographs for overall patient function, location of the lesion, radiographic evidence of maturation and any recurrence. Heterotopic ossification was resected regardless of the result of bone scan. RESULTS: All patients showed improved function. Three minimal recurrences and one moderate recurrence were identified at the last follow-up radiography, but the range of motion had not decreased due to recurrence. CONCLUSION: Severe heterotopic ossification around the hip in patients with spastic paralysis was resected, and it was found that the range of motion was improved in all patients and that the chance of recurrence was minimal, even though the bone scan showed hot uptake on the bone scan.
Adult* ; Central Nervous System ; Follow-Up Studies ; Hip Joint ; Hip* ; Humans ; Muscle Spasticity* ; Ossification, Heterotopic* ; Paralysis ; Radiography ; Range of Motion, Articular ; Recurrence

No abstract available.
Animals ; Cytochrome P-450 Enzyme System* ; Cytochromes* ; Gene Expression* ; Mice*

Pyruvate dehydrogenase complex deficiency (PDCD) is one of the most common neurodegenerative disorders associated with abnormal mitochondrial metabolism. Pyruvate dehydrogenase complex plays an important role in glucose metabolism and generation of energy from carbohydrates. Potential therapies for PDCD, include thiamine and ketogenic diet (KD), have been used with varying degrees of success. However, the KD is too restrictive, and its serious complications, particularly in early age of neonate or infancy are important drawbacks. Recently, the modified Atkins diet (MAD) for intractable epilepsy has provided balanced nutrients. The complications can be expected to be less frequent and well controlled. In this report, we describe an infant with PDCD confirmed by PDHA1 gene mutation through high-throughput sequencing technique of whole exome sequencing, who failed to continue the KD, but made good progress on MAD.

BACKGROUND AND PURPOSE: The advances in the diagnosis and treatment of acute stroke increase the importance of providing these patients with timely medical attention. This study was designed to assess time delays in neurological evaluation and neuroimaging and to determine whether they are important obstacles to performing thrombolytic therapy. METHODS: Data were obtained between May 2004 and September 2006 from 195 consecutive patients who were admitted to Cheju National University Hospital for acute ischemic stroke within 24 hours of the onset of symptoms. We determined the time of the onset of symptoms, arrival time at the emergency department (ED), and times of neurology notification, neurology evaluation, and neuroimaging using interviews and by reviewing the medical record. RESULTS: Short onset-to-door time, performing computed tomography rather than magnetic resonance imaging, presence of aphasia or motor weakness, and severe initial neurological deficit were significantly associated with reduced in-hospital delays. Seventeen (20%) of the 85 patients who arrived within 3 hours of the onset of symptoms received intravenous thrombolysis. Mild neurological deficit, rapidly improving symptoms, and insufficient time to workup were the main causes of the nonreceipt of thrombolytic therapy in these patients. Only one patient did not receive thrombolytic therapy due to delay in neurology consultation. CONCLUSIONS: Whilst in-hospital delays were not major obstacles to performing thrombolytic therapy in this study, there is still a high probability of missing patients with mild-to-moderate stroke symptoms. More effective in-hospital organization is required for the prompt evaluation and treatment of patients with acute ischemic stroke.
Aphasia ; Cerebrovascular Disorders ; Diagnosis ; Emergency Service, Hospital ; Humans ; Jeju-do ; Magnetic Resonance Imaging ; Medical Records ; Neuroimaging ; Neurology ; Stroke* ; Thrombolytic Therapy* ; Time Factors

PURPOSE: We evaluated the impact of renal tumor size on the oncologic and surgical efficacy of laparoscopic renal cryosurgery (LRC) according to our intermediate-term experience in Korea. MATERIALS AND METHODS: From June 2005 to October 2008, we enrolled 37 patients who underwent LRC for 40 renal tumors. Patients were stratified into four groups according to renal tumor size. Patients who presented with a maximum tumor diameter (MTD) of at least 1 cm but less than 2 cm were assigned to Group 1, those with an MTD equal to or greater than 2 but less than 3 cm were assigned to Group 2, those with an MTD equal to or greater than 3 but less than 4 cm were assigned to Group 3, and those with an MTD equal to or greater than 4 cm were assigned to Group 4. Oncologic and clinical outcomes in each group were compared. RESULTS: The four groups showed no statistically significant differences in preoperative variables, including age, sex, body mass index, American Society of Anesthesiologists scores, baseline renal function and hemoglobin, and length of hospital stay. Regarding surgical aspects, however, operation time, estimated blood loss, and postoperative complications were significantly increased in patients with larger tumors. Three patients in Group 3 required postoperative transfusions, and 1 patient in Group 4 required conversion to open renal cryosurgery. During the mean follow-up period of 31.6 months, radiologic evidence of tumor recurrence was found in only 2 patients in Group 4. CONCLUSIONS: In this series, LRC for renal tumors smaller than 3 cm was conducted safely without radiologic evidence of tumor recurrence during intermediate-term follow-up. For tumors larger than 3 cm, however, the transfusion rate increased, and for renal tumors larger than 4 cm, the tumor recurrence rate increased significantly.
Body Mass Index ; Carcinoma, Renal Cell ; Cryosurgery ; Follow-Up Studies ; Hemoglobins ; Humans ; Korea ; Laparoscopy ; Length of Stay ; Postoperative Complications ; Recurrence

OBJECTIVES: Many patients diagnosed with cancer suffer from various psychiatric symptoms such as depression, anxiety and insomnia as well as cancer itself. Patients with cancer are more vulnerable to possible adverse events of psychotropic medications. Although antidepressants are widely used among cancer patients, there is little information about tolerability of antidepressants. This study was conducted to compare tolerability of antidepressants in cancer patients referred for psychiatric consultation. METHODS: The participants were cancer patients who had been referred to psychiatrist for their psychiatric symptoms. We retrospectively analyzed the data of patients diagnosed with cancer from 9 general hospitals in Korea. The discontinuation rate for a 6 months period after treatment initiation for three antidepressants(Escitalopram, Mirtazapine, Paroxetine) were compared. RESULTS: Antidepressants were prescribed for 96.3% of subjects and Escitalopram 150(47.2%), Mirtazapine 92 (28.9%) and Paroxetine 76(23.9%) were prescribed frequently in order There were no significant differences in discontinuation rates among the three antidepressants during the 6 month period after initiation of pharmacotherapy. But there was a difference in discontinuation rates between inpatients versus outpatients(p<0.0001). CONCLUSIONS: In a naturalistic setting for the antidepressant treatment for cancer patients, it seems that there are no differences in discontinuation rates among these three antidepressants. It is therefore essential that such interactions are carefully considered when treating patients of antidepressants who already have cancer.
Antidepressive Agents ; Anxiety ; Citalopram ; Depression ; Hospitals, General ; Humans ; Inpatients ; Korea ; Mianserin ; Paroxetine ; Psychiatry ; Retrospective Studies ; Sleep Initiation and Maintenance Disorders

One of the most common symptoms of multiple sclerosis is visual loss. But the most previous reported cases are unilaterai visual loss due to optic neuritis or retrobulbar optic neuritis or visual field defect due to chiasmal or optic tract lesion. We report a 34 year old female patient who had developed sudden onset of blindenss because of optic chiasm and optic tract lesion. She also complained of involuntary right hand movement and mild left hemiparesis. On T2-weighted image of MRI we found abnormal high sigmal intensities on the optic chiasm, bilateral optic tract, internal capsule and periventricular white matter. Her total blindness has not recovered until the last follow nine months after the initial event.
Adult ; Blindness ; Female ; Hand ; Humans ; Internal Capsule ; Magnetic Resonance Imaging ; Multiple Sclerosis* ; Optic Chiasm* ; Optic Neuritis ; Paresis ; Visual Fields ; Visual Pathways*

To find out whether the susceptibility to Hansen's disease are associated with HLA genes, serological and nucleotide typing of HLA-A, B, and DRB1 alleles have been conducted in 301 Hansen's disease patients[190 Multibacillary cases(MB, LL/BL), 111 Paucibacillary cases(PB, TT/BT) confirmed at the time of diagnosis, almost of them were treated with Multidrug therapy] and 928 healthy controls from a population in Seoul and Northern area of Han River in Kyunggi Province, Korea. HLA-A30[relative risk(RR) 1.58, chi-square=4.89, P=0.04] was significantly associated with Hansen's disease. In contrast to HLA-B27(RR 0.20, chi-square=11.34, P=0.0002), which was negatively associated with Hansen's disease as a whole, in MB and PB separately, HLA-B52(RR 1.97, chi-square=6.89, P=0.002) and B46(RR 1.63, chi-square=4.84, P=0.04) were significantly increased in Hansen's disease. DRB1*02 was associated with MB(LL/BL)[RR 1.96, chi-square=13.47, P=0.0004] but not with PB(TT/BT). Further works about oligonuceotide typing of DQA,B, and DPB1 are ongoing. High resolution study to define DRB1*02 alleles will be performed.
Alleles ; Diagnosis ; Gyeonggi-do ; HLA-A Antigens* ; Korea ; Leprosy* ; Rivers ; Seoul

BACKGROUND: In searching for a differential spinal block between dependent and nondependent sides, we evaluated the influence of the duration of lateral decubitus on the spread of hyperbaric bupivacaine during spinal anesthesia. METHODS: Spinal anesthesia with 1.2 ml of hyperbaric 0.5% bupivacaine (6 mg) was administered with a 25-gauge Whitacre unidirectional needle to 50 ASA 1 patients undergoing unilateral knee arthroscopy. The patients were allocated randomly to three groups according to the duration of lateral decubitus after spinal injection in the lateral position operation side dependent: Group 1, 10 min in lateral decubitus then supine; Group 2, 20 min in lateral decubitus then supine; Group 3, 30 min in lateral decubitus then supine. Sensory and motor block (pinprick/modified Bromage scale) as well as skin temperature were compared between the dependent and nondependent sides. Circulatory variables were recorded for 10 min after being turned supine. RESULTS: The sensory block between dependent and nondependent sides were significantly different in Group 3. In Group 1, the level of maximum sensory block was higher than Group 3 on nondependent side. There was no difference in the number of patients having achieved Grade 3 and 0 motor block among three groups on dependent and nondependent sides. The skin temperature in lateral decubitus was significantly higher on the dependent side than nondependent side in three groups. In Groups 1 and 2, the skin temperatures of nondependent side were increased after turned supine, but that was maintained during supine position in Group 3. The circulatory variables were stable in all 50 patients. CONCLUSIONS: We conclude that when a small dose of 0.5% hyperbaric bupivacaine is injected into patients in the lateral position, complete unilateral spinal anesthesia is achieved when the patients arekeep in a lateral position for more than 30 min after spinal injection.
Anesthesia, Spinal* ; Arthroscopy ; Bupivacaine* ; Humans ; Injections, Spinal ; Knee ; Needles ; Skin Temperature ; Supine Position

Hemobilia is defined as hemorrhage into the biliary tract as a result of a communication between the biliary tract and arteriovenous circulation. A classical triad of symptoms and signs are upper abdominal pain, gastrointestinal bleeding, and jaundice. Hemobilia is a rare condition that may be difficult to recognize; it is, nevertheless, important to include it in the differential diagnosis of gastrointestinal bleeding. The causes include accidental and iatrogenic trauma, gallstones, inflammation, vascular malformation, and tumors. Due to the frequent use of diagnostic and therapeutic procedures involving hepatobiliary and portal systems, there has been an increase in the incidence of iatrogenic hemobilia during the last two decades. Like hematuria and epistaxis, hemobilia may also occur in coagulopathy, but acquired coagulopathy with anticoagulation therapy is very rarely associated with this condition. We present a case of acquired coagulopathy following warfarin therapy that resulted in spontaneous hemobilia complicating acalculous cholecystitis and cholangitis.
Abdominal Pain ; Acalculous Cholecystitis ; Biliary Tract ; Cholangitis ; Diagnosis, Differential ; Epistaxis ; Gallstones ; Hematuria ; Hemobilia* ; Hemorrhage ; Incidence ; Inflammation ; Jaundice ; Portal System ; Vascular Malformations ; Warfarin*