BACKGROUND AND OBJECTIVES: It had been well known that Lipoprotein(a) had proatherogenic and thrombogenic action because of structural similarity with plasminogen. However the role of Lipoprotein (a) (Lp(a)) in the development of ischemic cerebrovascular disease had not sufficiently clarified. The aim of this study was to evaluate the effect of diabetes mellitus (DM) and hypertension (HBP) to the role of Lp(a) as a risk factor of ischemic cerebrovascular disease. METHOD: For comparing Lp(a) and the lipid profile of ischemic stroke group (5, N=232) with those of control group (C, N=158), we divided each group into four subgroups according to the existance of DM and HBP: stroke patients and control subjects with DM only(DMS, N=27; DMC, N=44), those with HBP only(HBPS, N=94; HBPC, N=44), those with both of DM and HBP (DMHBPS, N=46; DMHBPC, N=29), and those with none of DM and HBP(NS, N=65; NC, N=41). We evaluated Lp(a) and the lipid profile measured less than 72 hour after onset of stroke and 3 month later in 33 ischemic stroke patients. Also we divided the stroke group into two subgroups according to the type (large artery thrombotic vs small artery perforating) and the age of onset (below 50 year-old vs above 50 year-old), and compared Lp(a) and the lipld profile in each subgroups. RESULT: 1. In control group, the Lp(a) in DMC was significantly higher t that in NC. 2. The Lp(a) compared between HBPC & HBPS and between & NS were statistically significant. 3. The Lp(a) in DMS revealed no significant difference compared with that in DMC. 4, The type of ischemic stroke did not give specific Lp(a) level. 5. The Lp(a) in the young age onset revealed no significant difference compared with that in the old age onset. CONCLUSION: The Lp(a) is likely to contribute to the ischemic stroke at independent risk factor, However it is seemed that the role of Lp(a) as a risk factor of the ischemic stroke is evaluated after being subdivided according existence of DM.
Age of Onset ; Arteries ; Diabetes Mellitus ; Humans ; Hypertension* ; Lipoprotein(a) ; Middle Aged ; Plasminogen ; Risk Factors* ; Stroke

Since cyanide poisoning is almost always fatal, reports of surviving patients to develop neurologic signs are rare. Systemic hypoxemia was not documented with arterial blood gases : however, significant tissue hypoxia most likely occurred from the action of cyanide. A38-year-old man ingested cyanide in a suicidal attempt. He was treated and survived the poisoning episode. But one week later, he showed classic extrapyramidal symptoms and signs, characterized by pit disturbance, bradykinesia, increased muscle tone, micrographia, tremor, apraxia of eyelid opening, palilalia. These symptoms and signs continued to progress, and response to levo-dopa and anticholinergics was poor, except apraxia of eyelid opening. About 3 months later, brain MRI showed abnormal signals (increas ed signal intensity on T2WI, decreased signal intensity on TIWI) in both globus pallidus and a part of putamen, but hippocompus and substantia nigra was normal. After 16 months, follow-up brain MRI showed the same findings. Although brainstem auditory evoked potential(BAEP) was normal, motor evoked potential(MEP) showed prolongation of central motor conduction time(CMCT) in right upper and lower extremities, then wecould suspect subtle changes in pyramidal tract. We report a patient as cyanide-induced parkinsonism by history, neuroimaging finding, and clinical parkinsonian symptoms and signs.
Anoxia ; Apraxias ; Brain ; Brain Stem ; Cholinergic Antagonists ; Eyelids ; Follow-Up Studies ; Gases ; Globus Pallidus ; Humans ; Hypokinesia ; Lower Extremity ; Magnetic Resonance Imaging ; Neuroimaging ; Neurologic Manifestations ; Parkinsonian Disorders* ; Poisoning ; Putamen ; Pyramidal Tracts ; Substantia Nigra ; Tremor

Theophylline has been used for more than 50 years to treat bronchial asthma, and theophylline toxicity continues to be an encountered clinical problem. With suicidal intention, a 61-year-old depressive male patient was sent to the hospital after ingestion of overdose theophylline. He had been followed up for bronchial asthma with about 10 microgram/ mL average plasma theophylline level. On arrival, he complained of dyspnea, palpitation and the plasma theophylline level was 252 microgram/mL. After 2 hours of ingestion, hypotension and tachycardia developed (Systolic blood pressure 50 mmHg, heart rate 190/ min). Other symptoms and signs were stuporous mental state and hypoxemia. Patient's peak plasma theophylline level reached 402 microgram/mL after 3 hours. beta-blocker, dopamine and midazolam were used for control of tachycardia, hypotension and prevention of seizure respectively. After Gastric lavage and administration of charchoal, he was treated with hemoperfusion for 3.5 hours, and serum level decreased. The patient was discharged in good health after 17 days.
Anoxia ; Asthma ; Blood Pressure ; Dopamine ; Dyspnea ; Eating ; Gastric Lavage ; Heart Rate ; Hemoperfusion* ; Humans ; Hypotension ; Intention ; Male ; Midazolam ; Middle Aged ; Plasma ; Seizures ; Stupor ; Tachycardia ; Theophylline*

BACKGROUND: Type 2 diabetes develops because of defects in both insulin secretion and action. The half-life of insulin in uremia is prolonged because the metabolic clearance rate of insulin in diabetic end stage renal disease (ESRD) patients is reduced with consequence that the dose of insulin and/or oral hypoglycemic agent (OHA) administered in normal renal function make them increase the risk of hypoglycemia. Therefore, we should usually reduce the dose of insulin and/or OHA, or stop administration of insulin and/or OHA if type 2 diabetic patients are progressed to ESRD. But in some patients, that is not true. The aim of this study was to test the hypothesis that insulin resistance plays an important role in (re)evaluation of optimal insulin and/or OHA dose for glycemic control after type 2 diabetic patients are progressed to ESRD. METHODS: Insulin resistance was examined in 23 type 2 diabetic ESRD patients with tight control of glycemia using the K index of the insulin tolerance test (Kitt). We divided 23 patients into three groups. Group 1 (n=10) was defined as patients who were administered neither insulin nor OHA after ESRD. Group 2 (n=9) was defined as patients who were changed from insulin to OHA as drug for glycemic control after ESRD. Group 3 (n=4) was defined as patients in whom insulin or OHA was continuously administered after ESRD without a change of them for glycemic control. We compared the degree of insulin resistance among these three groups. RESULTS: Insulin resistance determined by Kitt was significantly different between group 1 (Kitt, 2.1422/0.94-4.01%/min), group 2 (Kitt, 1.3811/0.79- 3.90%/min) and group 3 (Kitt, 0.8550/0.44-1.81%/min) by using Kruskal-Wallis test (p=0.048). Kitt in group 3 was significantly lower than in group 1 by using Mann-Whitney test (p=0.016). CONCLUSION: Although metabolic clearance of insulin is reduced by renal failure, demand of insulin/ OHA for optimal glycemic control is not reduced in higher insulin-resistant type 2 diabetic ESRD patients on hemodialysis. Insulin resistance plays an important role in determination of optimal insulin/ OHA dose for glycemic control after type 2 diabetic patients are progressed to ESRD.
Half-Life ; Humans ; Hypoglycemia ; Insulin Resistance* ; Insulin* ; Kidney Failure, Chronic* ; Metabolic Clearance Rate ; Renal Dialysis* ; Renal Insufficiency ; Uremia

OBJECTIVE: To investigate the incidence of vocal cord palsy (VCP) in acute ischemic stroke patients and its influence on aspiration risk. METHOD: Fifty patients with first-ever acute stroke were enrolled. The mean age was 68.3 years and there were 21 men and 29 women. Based on clinical and neuroimaging findings, their stroke subtype was categorized into cortical/ subcortical (Group A), lateral medulla (Group B) and other brainstem (Group C). We examined them by using flexible fiberoptic rhinolaryngoscope and videofluroscopic swallowing study (VFSS) within 2 weeks after stroke onset. The Penetration - Aspiration Scale (PAS) was used to score each VFSS. RESULTS: Among the 50 patients, VCP was found in 15 (30%): 15.8% of group A, 100% of group B and 40% of group C. VCP was contralateral to the brain lesion in group A and ipsilateral in 85.7% of group B. Aspiration risk was found in 38% of the all patients and 53% of VCP had aspiration risk. No differences in the incidence of aspiration risk were noted according to VCP (chi-square=2.138, p=0.144). CONCLUSION: There was no relationship between VCP and aspiration risk in acute ischemic stroke patients. Although VCP is a known risk factor for aspiration, other factors are important in determining an effective swallowing.
Brain ; Brain Stem ; Deglutition ; Deglutition Disorders ; Female ; Humans ; Incidence ; Male ; Neuroimaging ; Risk Factors ; Stroke ; Vocal Cord Paralysis ; Vocal Cords

OBJECTIVES: To investigate the effect of the occupational exposure to organic solvent on the olfactory function of shipyard painters; we measured the prevalence of olfactory function impairment between the exposure group and the controls by using the Korean Version of the Sniffin'Stick (KVSS) test through smell, and by analyzing factors related to olfactory alteration. METHODS: The olfactory function of 245 painters exposed to organic solvents was compared to that of 122 unexposed controls. A total of 367 shipyard subjects underwent questionnaire study and the olfactory function test was performed by KVSS test I from April to August 2007. Suspected subjects of abnormal findings were referred to an otorhinolaryngologist. In addition, the Biologic Exposure Index (BEI) and industrial hygiene laboratory data were collected as well as analyzed by job title in the exposure group. RESULTS: The difference in the result of KVSS test I was significantly different from the exposure group and the controls (P<0.05). For the exposure group, reduced olfaction and exposure group were correlated with statistical significance when compared to the controls (P<0.01). Adjusting for work duration, smoking, rhinitis or sinusitis history, exposure of the organic solvent (OR 1.76, 95% CI=1.05-2.96) had a statistically meaningful relationship with decreased olfaction. The data on BEI for the exposure group were collected; the difference in methylhippuric acid was significant between spray workers and others, but did not correlate well with decreased olfaction. CONCLUSION: Occupational exposure to organic solvents in shipyard painters may affect the olfactory function. Therefore, shipyard painters should be monitored on a periodic bases by the quantitative test such as KVSS test. There is no other quantitative testing method or standardized procedure that can objectively diagnose the neurotoxic effect, further enhanced quality research in this field is necessary.
Occupational Exposure ; Occupational Health ; Paintings ; Prevalence ; Questionnaires ; Rhinitis ; Sinusitis ; Smell ; Smoke ; Smoking ; Solvents

BACKGROUND: With increasing industrial development, opportunities are growing to contact electricity in the workplace or home. Therefore, the risk of electrical accident has been increased gradually. In general, electrical injuries involve the extremities and result in amputation or severe disability of limbs. Delayed spinal cord injury and peripheral neuropathies following electrical accidents are extremely rare. CASE REPORT: A 32-year-old man with 10 years working experience at a CRT-monitor manufacturer with repetitive exposures to high voltage current visited our hosipital. He complained of left leg weakness and atrophy, and intermittent pain. The symptoms were progressive. Other symptoms occurred such as nocturia, hesitancy, and weak urinary stream. We examined the patient and conducted EMG, L-spine MRI, neurometer test, isokinetic strength test, and physical examination. The results showed neural injuries due to anterior horn lesions or compression of the left femoral nerve pathway, with a consequent diagnosis of neurogenic bladder.
Adult ; Amputation ; Animals ; Atrophy ; Diagnosis ; Electricity ; Extremities ; Femoral Nerve ; Horns ; Humans ; Leg ; Magnetic Resonance Imaging ; Muscular Atrophy ; Nocturia ; Peripheral Nervous System Diseases* ; Physical Examination ; Rivers ; Spinal Cord Injuries ; Urinary Bladder, Neurogenic

OBJECTIVE: It is controversial whether routine or selective iron supplementation during gestation is needed. The aim of this study is to evaluate whether screening with serum ferritin during the first trimester of pregnancy could be identify women who need prophylactic iron supplementation. METHODS: According to the serum ferritin level of cut-off point of 30 microgram/L during the first trimester of pregnancy and the presence of iron supplementation during gestation, the subject was divided into 4 group that were as follows: serum ferritin level of 30 microgram/L and iron- supplemented group (n=40), serum ferritin level of >30 microgram/L and non iron-supplemented group (n=15). Maternal serum ferritin, TIBC, iron, hemoglobin, hematocrit, red cell indices (MCV, MCH, MCHC, RDW) were measured before 14 weeks of gestation and after 34 weeks of gestation. RESULTS: All hematologic and biochemical markers indicated more severe anemic status in the late pregnancy than during the first trimester of pregnancy. The effect of iron supplementation was profounder on the pregnant woman whose ferritin levels were below 30 microgram/L during the first trimester of pregnancy. Regardless of iron supplementation, the group (ferritin >30 microgram/L during the first trimester of pregnancy) showed relatively higher ferritin level in late pregnancy. CONCLUSION: The screening with serum ferritin level of cut-off point of 30 microgram/L during the first trimester of pregnancy may be useful to identify women who need prophylactic iron supplementation.
Biomarkers ; Erythrocyte Indices ; Female ; Ferritins ; Hematocrit ; Humans ; Iron* ; Mass Screening ; Pregnancy Trimester, First ; Pregnancy* ; Pregnant Women

PURPOSE: To assess the usefulness of diffusion-weighted MR imaging in patients with intracranial tumors. MATERIALS AND METHODS: Using the single-shot spin echo EPI technique on a 1.5T unit and two gradient steps(b values of 0, 900 s/mm2), diffusion-weighted MR images (DW-MRI) of 76 patients with various intracranial tumors including high-grade glioma (n=20), meningioma (n=15), metastasis(n=14), lymphoma (n=6), low-grade glioma (n=5), schwannoma (n=4), cerebellar hemangioblastoma (n=3), - and others- were obtained. The signal intensity of each tumor was visually assessed as one of four grades, and this and apparent diffusion coefficient(ADC) were analyzed in the solid and cystic portions of tumors, normal gray matter, white matter and CSF. RESULTS: Lymphomas, metastases, meningiomas, and high- and low-grade gliomas showed low ADC values in increasing order. Tumors showing high signal intensity on DW-MRI had low ADC values. Visual assessment whowed that solid portions of high-grade gliomas were significantly more hyperintense than those of low-grade gliomas. There was, however, no significant difference in ADCs between high- and low-grade gliomas. Lymphoma a and metastases showed significantly higher signal intensities on DW-MRI and lower ADCs than did high-grade gliomas. There were significant differences in signal intensities, as seen on DW-MRI, and in ADCs, between metastatic adenocarcinomas and non-adenocarcinomas. Schwannomas and cerebellar heman-gioblastomas showed low signal intensities and high ADC values. CONCLUSION: DW-MRI appears to provide an additional means of examining intracranial tumors, not available with conventional MRI, and may thus be helpful in the grading of gliomas and the differential diagnosis of some intracranial tumors.
Adenocarcinoma ; Brain Neoplasms ; Diagnosis, Differential ; Diffusion* ; Glioma ; Hemangioblastoma ; Humans ; Lymphoma ; Magnetic Resonance Imaging* ; Meningioma ; Neoplasm Metastasis ; Neurilemmoma

BACKGROUND/AIMS: Fabry disease is an X-linked recessive and progressive disease caused by alpha-galactosidase A (alpha-GaL A) deficiency. We sought to assess the prevalence of unrecognized Fabry disease in dialysis-dependent patients and the efficacy of serum globotriaosylceramide (GL3) screening. METHODS: A total of 480 patients of 1,230 patients among 17 clinics were enrolled. Serum GL3 levels were measured by tandem mass spectrometry. Additionally, we studied the association between increased GL3 levels and cardiovascular disease, cerebrovascular disease, or left ventricular hypertrophy. RESULTS: Twenty-nine patients had elevated serum GL3 levels. The alpha-GaL A activity was determined for the 26 patients with high GL3 levels. The mean alpha-GaL A activity was 64.6 nmol/hr/mg (reference range, 45 to 85), and no patient was identified with decreased alpha-GaL A activity. Among the group with high GL3 levels, 15 women had a alpha-GaL A genetics analysis. No point mutations were discovered among the women with high GL3 levels. No correlation was observed between serum GL3 levels and alpha-GaL A activity; the Pearson correlation coefficient was 0.01352 (p = 0.9478). No significant correlation was observed between increased GL3 levels and the frequency of cardiovascular disease or cerebrovascular disease. CONCLUSIONS: Fabry disease is very rare disease in patients with end-stage renal disease. Serum GL3 measurements as a screening method for Fabry disease showed a high false-positive rate. Thus, serum GL3 levels determined by tandem mass spectrometry may not be useful as a screening method for Fabry disease in patients with end stage renal disease.
Adult ; Aged ; Fabry Disease/blood/*diagnosis ; Female ; Humans ; Kidney Failure, Chronic/blood/*therapy ; Male ; Middle Aged ; *Renal Dialysis ; Trihexosylceramides/*blood ; alpha-Galactosidase/genetics/metabolism