Akinetic mutism is a syndrome caused by various etiologies, and characterized by silent immobility and preserved alertness. The repetitive ventriculoperitoneal shunt for the recurrent hydrocephalus can be a forerunner of that. We present a man with akinetic mutism following two times of ventriculoperitoneal shunt revision. Akinetic mutism of the patient may be caused by the damage on the ascending dopaminergic projections. Symptoms were not alleviated by the normalization of ventricular size but by a large dose of bromocriptine.
Akinetic Mutism* ; Bromocriptine ; Cerebral Ventricles* ; Humans ; Hydrocephalus ; Ventriculoperitoneal Shunt

BACKGROUND/AIMS: Uninsured individuals have lower rates of screening colonoscopy (SC), and little is known regarding the pathology results obtained when they undergo colonoscopies. Since 2004, we have participated in a program that offers SC to uninsured New Yorkers; herein, we report our findings. METHODS: Uninsured, average-risk patients who were at least 50 years of age underwent SC at our institution between April 2004 and June 2011. We analyzed polyp pathology, location, size, incidence of adenomas, and incidence of adenomas with advanced pathology (AAP) with respect to ethnicity, gender, and age. RESULTS: Out of 493 referrals, 222 patients completed the colonoscopies. Polyps were identified in 21.2% of all patients; 14% had adenomas, and 4.5% had AAP. The rates of adenomas among African-Americans, Hispanics, and Whites were 24.3%, 12.1%, and 11.6%, respectively, and the corresponding rates of AAP were 10.8%, 3.5%, and 2.3%. Differences in the polyp type, location, and AAP did not reach statistical significance with respect to ethnicity or gender. Patients aged 60 and older were found to have a higher rate of advanced adenomas compared with younger patients (8.6% vs 2.6%, p=0.047). CONCLUSIONS: Further efforts to fund screening colonoscopies for uninsured individuals will likely result in the identification of advanced lesions of the colon before they progress to colorectal cancer.
Adenoma/diagnosis/epidemiology ; African Americans/statistics & numerical data ; Age Factors ; Aged ; Colon/pathology ; Colonic Neoplasms/diagnosis/epidemiology ; Colonic Polyps/diagnosis/epidemiology ; Colonoscopy/*statistics & numerical data ; European Continental Ancestry Group/statistics & numerical data ; Female ; Hispanic Americans/statistics & numerical data ; Humans ; Incidence ; Male ; Mass Screening/*statistics & numerical data ; Medically Uninsured/*statistics & numerical data ; Middle Aged ; Minority Groups/*statistics & numerical data ; New York City/epidemiology ; Program Evaluation ; *Urban Population

PURPOSE: Liver, unlike heart or skin, allografts transplanted between MHC-disparate mouse strains are spontaneously accepted without any immunosuppressive therapy. Despite the allograft acceptance, the recipients continue to exhibit donor-specific immune responses in vitro (MLR and generation of CTL). High levels of CTL apoptosis evident within tolerated liver grafts have been postulated as a mechanism underlying this 'split' tolerance. METHODS and RESULTS: By using radiometric DNA fragmentation test ("JAM" assay) and TUNEL staining, we present the evidence here that liver nonparenchymal cells (NPC) are quite strong inducers of activated T cell apoptotic death in allogeneic mice. This phenomenon occurs the similar level in activated T cells of syngeneic or third-party mice. Liver cells from gld (FasL-deficient) mice exert similar apoptosis-inducing effect on activated T cells from normal mice. Tumor necrosis factor receptor (TNFR): Fc fusion protein, and concanamycin A, an inhibitor of perforin pathway, fail to inhibit the apoptotic activity. CONCLUSION: These data indicate that liver NPC play important role in causing active apoptosis in graft-infiltratingCTL which favors liver graft acceptance, and liver-induced activated T cell apoptosis may not mediated by Fas, TNF or perforin pathways.
Allografts ; Animals ; Apoptosis* ; DNA Fragmentation ; Heart ; Immune Tolerance ; In Situ Nick-End Labeling ; Liver* ; Mice ; Perforin ; Receptors, Tumor Necrosis Factor ; Skin ; T-Lymphocytes* ; Transplantation ; Transplants

OBJECTIVE: To investigate the clinical applicability of the somatosensory evoked potentials (SEPs) study in early detection of diabetic neuropathy, and compare the results in different degrees of the disease. METHOD: The study was performed retrospectively with prospective data collection. The Toronto clinical scoring system was taken as well as nerve conduction study, needle electromyography, and SEPs study with median and posterior tibial nerve stimulations in thirty-eight diabetic patients and twenty non-diabetic adults. The subjects were divided into the non-neuropathy group and the neuropathy group, and the latter was divided into three subgroups (suspected, probable, and definite) according to the degree of neuropathy. Statistical analysis was performed with height and age-related correction of reference values of the latency of SEPs with posterior tibial nerve stimulation. RESULTS: The Toronto clinical scoring system showed concordance with the degree of the diabetic neuropathy (p<0.05, correlation coefficient=0.827). SEPs study with posterior tibial nerve stimulations showed statistically significant latency delay, not only in the neuropathy group, but also in the non-neuropathy group, compared with the non-diabetic group (p<0.05). Moreover, the latency delay was noted in proportion to the degree of the diabetic neuropathy within the neuropathy group. Interpretation of the data with height and age-corrected reference values of latency of posterior tibial SEPs had stronger correlation. CONCLUSION: The SEPs study is useful in the early diagnosis of diabetic neuropathy. However, application of the SEPs to clinical use needs to go through height and age correction.
Adult ; Data Collection ; Diabetic Neuropathies ; Early Diagnosis ; Electromyography ; Evoked Potentials, Somatosensory ; Humans ; Needles ; Neural Conduction ; Prospective Studies ; Reference Values ; Retrospective Studies ; Tibial Nerve

OBJECTIVE: To assess the usefulness of the somatosensory evoked potentials in correlating with various clinical features and in predicting the functional outcome in patients with stroke. METHOD: The subjects were 57 patients with first stroke. Somatosensory evoked potential study was performed at the time of transfer to the rehabilitation department. Data of somatosensory evoked potential with median and tibial nerve stimulations were obtained and classified as normal (group 1), abnormal (group 2), and no response group (group 3). Modified Barthel index (MBI), motor and sensory functions were evaluated at the time of transfer and discharge. RESULTS: MBI score was statistically different among the 3 groups based on the findings of median and tibial nerve SSEP at the time of transfer, but not different at the time of discharge. Motor function was statistically different among the 3 groups at the time of transfer and discharge. Sensory function was statistically different among the 3 groups at the time of transfer, but not different at the time of discharge. CONCLUSION: Even though SSEP study reflects the functional status of the patients and correlates well with the findings of brain image, it has limitation in predicting outcome of the patients with stroke.
Brain ; Evoked Potentials, Somatosensory* ; Humans ; Rehabilitation ; Sensation ; Stroke* ; Tibial Nerve

OBJECTIVE: To investigate the frequency of carpal tunnel syndrome (CTS) according to the severity of diabetic polyneuropathy. METHOD: Electrophysiologic study was performed in 456 patients (male 222, female 233, average age 58) with diabetes mellitus. Electrophysiologically diagnosed diabetic neuropathy was classified as suspected, probable or definite. CTS was also diagnosed both in cases with and without underlying diabetic peripheral neuropathy. The ANOVA test was used for statistical analysis. RESULTS: Out of 456 diabetic patients, 228 patients were diagnosed as diabetic peripheral neuropathy. The patients with diabetic neuropathy consisted of 107 cases (23.5%) of sus pected group, 95 cases (20.8%) of probable group and 26 cases (5.7%) of definite group. The frequencies of concomitant CTS were 49 cases (21.5%) in 228 diabetic patients without diabetic polyneuropathy, 31 cases (29%) in suspected group and 30 cases (31.6%) in probable group. These were statistically significant. However, only one case showed concomitant CTS in 26 cases of definite group. CONCLUSION: The frequency of CTS was higher in probable group compared to suspected group. However the frequency decreased in definite group because there is a difficulty in the differential diagnosis of two disease in the cases of advanced peripheral neuropathy.
Carpal Tunnel Syndrome* ; Diabetes Mellitus ; Diabetic Neuropathies* ; Diagnosis, Differential ; Female ; Humans ; Peripheral Nervous System Diseases

Purpose: This study aimed to determine the effects of a 12-week metabolic syndrome BeHaS (Be Happy and Strong) program in elderly people with metabolic syndrome living alone, based on a community-based participatory research (CBPR). Methods: A nonequivalent control group pre-posttest design was used, and the participants were 43 elderly people living alone (experimental group 24, control group 19). The experimental group received a one-hour program per week and two individual health consultations during 12 weeks. The control group received two sessions about the metabolic syndrome and two individual health consultations. The effects of health behavior, blood pressure, blood sugar levels, abdominal circumference, triglycerides, and self-esteem were evaluated. The data were analyzed using the independent t-test and Mann-Whitney U test. Results: The health behavior with respect to the metabolic syndrome in the experimental group increased significantly (t = - 3.19, p = .002). Both diastolic blood pressure and abdominal circumference decreased in the experimental group (t = 2.00, p = .028 and t = 3.91, p < .001). No significant differences were observed between the groups in systolic blood pressure, fasting blood sugar levels, triglycerides, and self-esteem. Conclusion The 12-week metabolic syndrome BeHaS program using community resources improves the health of elderly people with metabolic syndrome living alone. Based on these findings, further studies on the effectiveness of the metabolic syndrome BeHaS program and the experiences of those who participated in the CBPR are warranted.

No abstract available.
Distal Myopathies*

Purple glove syndrome is a complication of the intravenous infusion of phenytoin. It is characterized by progressive distal edema, discoloration and pain. The mechanism of purple glove syndrome is poorly understood, but the chemical properties of intravenous phenytoin and the extravasation of that are possible causes. We present a woman with purple glove syndrome, whose symptoms were subsided gradually with conservative management.
Edema ; Female ; Humans ; Infusions, Intravenous ; Phenytoin

A 30-year-old man was admitted due to decreased mentality. He was diagnosed as a diabetic ketoacidosis by hyperglycemia, metabolic acidosis, and positive urinary ketone bodies. Two weeks later, despite the improved state of ketoacidosis, he complained of dysphagia, quadriparesis, and respiratory difficulty. Cerebrospinal fluid analysis showed albumino-cytologic dissociation. Nerve conduction study revealed axonal motor neuropathy. His neurological deficit was rapidly improved by intravenous immunoglobulin. We report a case of Guillain-Barre syndrome just after a ketoacidosis.
Acidosis ; Adult ; Axons ; Cerebrospinal Fluid ; Deglutition Disorders ; Diabetic Ketoacidosis* ; Guillain-Barre Syndrome* ; Humans ; Hyperglycemia ; Immunoglobulins ; Ketone Bodies ; Ketosis ; Neural Conduction ; Quadriplegia