Ocular disturbances related to cranial nerve lesion or increased intracranial pressure are well known in cryptococcal meningitis, but internuclear ophthaloplegia is very rare and only two cases have been reported to our knowledge. We report the third patient of internuclear ophthalmoplegia in cryptococal meningitis. The internuclear ophthalmoplegia in our case persisted for one year with a demonstrable lesion in brain MRI, in contrast to the other cases in which intranuclear ophthalmoplegia was transient and no responsible lesion was observed.
Brain ; Cranial Nerves ; Cryptococcosis* ; Humans ; Intracranial Pressure ; Magnetic Resonance Imaging ; Meningitis ; Meningitis, Cryptococcal ; Ocular Motility Disorders ; Ophthalmoplegia

BACKGROUND: Patients with Parkinson's disease and mild cognitive impairment (PD-MCI) and patients with subcortical vascular mild cognitive impairment (svMCI) are known to have cognitive dysfunction. The aim of this study was to determine the cognitive characteristics that can be used to differentiate these two conditions. METHODS: Twenty-two PD-MCI and 22 svMCI patients seen in our neurodegenerative disease clinic, and 22 normal controls were recruited. These three groups were matched in terms of age, gender, and education level. Mild cognitive impairment was diagnosed according to the criteria of Petersen. svMCI should meet the criteria modified from those of Erkinjuntti. RESULTS: Analysis of covariance revealed that frontal executive dysfunction was prominent in both the PD-MCI and svMCI groups after adjusting for depression. The scores in word fluency and the Stroop test were lower in the svMCI group than in the PD-MCI group. Both groups exhibited decreased performance in verbal and visuospatial memory tests. The score in the verbal recognition test was lower in the PD-MCI group than in the svMCI group, which exhibited comparatively reduced visuospatial memory. The depression level was higher in the PD-MCI group than in the svMCI group, as assessed using the Geriatric Depression Scale. CONCLUSIONS: The impairment in frontal executive function was more severe in the svMCI group than in the PD-MCI group, which displayed severe impairment in verbal memory function. These differences in cognitive function may help to differentiate PD-MCI from svMCI, and to further the understanding of their pathophysiologies. PD-MCI patients also exhibited severe depressive mood, which raises the possibility of cognitive improvement through therapy.
Cognition ; Dementia, Vascular ; Depression ; Executive Function ; Humans ; Memory ; Mild Cognitive Impairment ; Neurodegenerative Diseases ; Parkinson Disease ; Stroop Test

Objective: : This study aimed to validate the Korean version of the Repeatable Battery for the Assessment of Neuropsychological Status Update (K-RBANS). Methods: : We performed a retrospective analysis of 283 psychiatric and neurosurgery patients. To investigate the convergent validity of the K-RBANS, correlation analyses were performed for other intelligence and neuropsychological test results. Confirmatory factor analysis was used to test a series of alternative plausible models of the K-RBANS. To analyze the various capabilities of the K-RBANS, we compared the area under the receiver operating characteristic (ROC) curves (AUC). Results: : Significant correlations were observed, confirming the convergent validity of the K-RBANS among the Total Scale Index (TSI) and indices of the K-RBANS and indices of intelligence (r=0.47–0.81; p<0.001) and other neuropsychological tests at moderate and above significance (r=0.41–0.63; p<0.001). Additionally, the results testing the construct validity of the K-RBANS showed that the second-order factor structure model (model 2, similar to an original factor structure of RBANS), which includes a first-order factor comprising five index scores (immediate memory, visuospatial capacity, language, attention, delayed memory) and one higher-order factor (TSI), was statistically acceptable. The comparative fit index (CFI) (CFI, 0.949) values and the goodness of fit index (GFI) (GFI, 0.942) values higher than 0.90 indicated an excellent fit. The root mean squared error of approximation (RMSEA) (RMSEA, 0.082) was considered an acceptable fit. Additionally, the factor structure of model 2 was found to be better and more valid than the other model in χ2 values (Δχ2=7.69, p<0.05). In the ROC analysis, the AUCs of the TSI and five indices were 0.716–0.837, and the AUC of TSI (AUC, 0.837; 95% confidence interval, 0.760–0.896) was higher than the AUCs of the other indices. The sensitivity and specificity of TSI were 77.66% and 78.12%, respectively. Conclusion : The overall results of this study suggest that the K-RBANS may be used as a valid tool for the brief screening of neuropsychological patients in Korea.

PURPOSE: To evaluate the patterns of injuries and frequency of associated findings on MR imaging in patients with both anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) tears; to compare the associated findings, as seen on MR imaging, in cases with both ACL and PCL tears with those with ACL or PCL tears. MATERIALS AND METHODS: Ten patients with combined ACL and PCL tears, 16 with ACL tears and 18 with PCL tears, all confirmed by arthroscopy or open surgery, were involved in this study. To identify the associated knee injuries, MR images were retrospectively evaluated. RESULTS: In ten patients with combined ACL and PCL tears, open surgery led to the identification of six complete ACL tears (60%), four partial ACL tears (40%), eight complete PCL tears (80%) and two partial PCL tears (20%). Injuries associated with these combined tears, and revealed by MR imaging, comprised six medial collateral ligament injuries (60%), six lateral collateral ligament injuries (60%), five medial meniscal injuries (50%), three lateral meniscal injuries (30%), nine bony injuries (90%), two posterior capsular injuries (20%), and three popliteus muscle injuries (30%). The frequency of popliteus muscle injury was significantly different (p<0.05, Fisher's exact test) between the group with both ACL and PCL tears and that with ACL or PCL tears. CONCLUSION: Associated findings in patients with combined ACL and PCL tears are more frequentthan in those with ACL or PCL tears. In cases involving combined ACL and PCL tears, associated findings-as seen on MR images-should thus be carefully examined.
Anterior Cruciate Ligament ; Arthroscopy ; Collateral Ligaments ; Humans ; Knee Injuries ; Lateral Ligament, Ankle ; Magnetic Resonance Imaging* ; Posterior Cruciate Ligament* ; Retrospective Studies

The purpose of the present study is to determine whether lumbrokinase has an in vivo thrombolytic effect in a rabbit cerebral embolism model. In our previous studies, we found that lumbrokinase, an extract from Korean earth worms, has a strong in vitro fibrinolytic effect without the presence of plasminogen and significant in vivo thrombolytic effects of lumbrokinase in a rat human-clot-induced cerebral embolism model. We established the cerebral embolism model in rabbits by injecting a piece of human clot into the internal carotid artery via the external carotid artery and confirmed the occlusion with angiography. Twenty one rabbits were divided into three groups and 5cc of saline, urokinase of 50,000 u/ml, and equipotent LK were injected intraarterially for 30 minutes into each group of 7 animals. Ten minutes after the end of infusion, an angiogram was performed to confirm the recanalization. Clot lysis occurred in one, six, and one animals in the saline, urokinase and lumbrokinase treated groups respectively. With regard to its in vitro effect, lumbrokinase is not as potent in vivo. Further investigation should be performed to determine the cause of its weakened in vivo effect and to develop a method to potentiate it.
Animals ; Endopeptidases/*therapeutic use ; Fibrinolytic Agents/*therapeutic use ; Intracranial Embolism and Thrombosis/*drug therapy ; Rabbits ; *Thrombolytic Therapy ; Urokinase-Type Plasminogen Activator/*therapeutic use

BACKGROUND: It is well recognized that thyroid hormone stimulates bone turnover, increasing bone resorption, thus affecting bone mineral density, but few data are available on untreated subclinical hypothyroidism. The aim of this study was to examine whether bone mineral density is increased in postmenopausal subclinical hypothyroidism patients compared with postmenopausal normal thyroid function women, and to evaluate the relationship between thyroid hormones (TSH, FT(4)) and bone mineral density or various biochemical markers of bone metabolism. METHODS: This was a cross sectional study of 132 postmenopausal women aged from 51 to 70 who undertook health screening program in Pundang CHA general hospital from 1996 to 2001. They were divided into two groups; subclinical hypothyroidism group (n=52) and normal thyroid function group (n=80) matched by age. RESULTS: The total bone mineral density was significantly increased in the subclinical hypothyroid group than in the normal group (P<0.05). The serum osteocalcin was lower in the subclinical hypothyroidism group (P<0.05), but neither the alkaline phosphatase nor the deoxypyridinoline showed any significance. For all participants in this study, TSH, but not FT(4), exhibited significant correlation with the total bone mineral density (r=0.188, P<0.05), and with the osteocalcin (r=-0.191, P<0.05). Multiple regression analysis identified the TSH as an independent predictor of the total bone mineral density (beta=0.0410; P< 0.05). CONCLUSION: This study indicated that subclinical hypothyroidism is one of the factors which can elevate bone mineral density in postmenopausal women.
Aged ; Alkaline Phosphatase ; Amino Acids ; Biomarkers ; Bone Density ; Bone Resorption ; Female ; Hospitals, General ; Humans ; Hypothyroidism ; Mass Screening ; Osteocalcin ; Thyroid Gland ; Thyroid Hormones

BACKGROUND: Impaired verbal fluency in Alzheimer's disease (AD) has been well documented. Furthermore, crosssectional studies suggest that semantic fluency is disproportionately impaired relative to phonemic fluency in AD. The aim of this study was to determine the ability of fluency measures as follow-up screening tool for mild to moderate AD. METHODS: Participants were recruited from AD patients in mild to moderate stages. We annually evaluated semantic (animal, supermarket) and phonemic (giyeok, siot, ieung) fluency and tested other extensive neuropsychological measures for two years. RESULTS: A total of 33 AD patients were included at baseline and 1-year follow-up, who were aged 70.18+/-5.97 years at baseline. Eleven patients completed a 2-year follow-up. Phonemic fluency total score was not significantly changed during the study period. However, semantic fluency total score tended to decline annually, and significantly declined at 2-year follow-up compared to baseline. In addition, difference score (semantic fluency minus phonemic fluency) was significantly decreased at every follow-up compared to previous year. In Pearson correlation analyses between changes of verbal fluency and other neuropsychological measures, changes of semantic fluency appeared to be significantly correlated with neuropsychological measures much more than changes of phonemic fluency. CONCLUSIONS: Significant longitudinal declines in semantic fluency compared to phonemic fluency seem to be consistent with previous cross-sectional studies. These patterns of changes in verbal fluency were observed even at an interval of one year follow-up in our study. The verbal fluency might be useful follow-up screening test for mild to moderate AD in the memory clinic setting.
Aged ; Alzheimer Disease ; Follow-Up Studies ; Humans ; Longitudinal Studies ; Mass Screening ; Memory ; Semantics

Brevibacterium spp. are gram-positive rods that are considered to be strictly nonpathogenic, and a very few cases of their infection in humans have been reported. In this study, we report a case of otitis caused by Brevibacterium otitidis. A 53-year-old woman, who visited the hospital, complained of symptoms, such as otorrhea from both ears, ear fullness, tinnitus, and hearing impairment, for several months. Ear discharge was cultured on blood agar for pathogen identification. Bacteria from the isolated colony were initially identified as Actinomyces odontolyticus by VITEK 2 (bioMerieux, France), whereas VITEK® MS (bioMerieux, France) identified them as Brevibacterium luteolum. Subsequently, bacteria from the isolated colony were confirmed as B. otitidis by 16S rRNA sequencing. Antimicrobial susceptibility testing confirmed their sensitivity to vancomycin and linezolid and resistance to clindamycin and penicillin. To our knowledge, this is the first reported case of otitis caused by B. otitidis in Korea.
Actinomyces ; Agar ; Bacteria ; Brevibacterium ; Clindamycin ; Ear ; Female ; Gram-Positive Rods ; Hearing Loss ; Humans ; Korea ; Linezolid ; Middle Aged ; Otitis ; Penicillins ; RNA, Ribosomal, 16S ; Tinnitus ; Vancomycin

The KMT2A (formerly MLL) gene is associated with at least 10% of all cases of acute leukemia. More than 80 translocation partner genes of KMT2A have been discovered to date, six of which have been identified on the long arm of chromosome 17. Among these, the MLLT6 (formerly AF17) gene is located at 17q12 and fuses with the KMT2A gene in rare cases of acute leukemia. We report here a case of AML with a KMT2A/MLLT6 fusion that was confirmed using molecular genetic methods. According to a literature review, this is the first reported case of AML with a KMT2A/MLLT6 fusion in Korea.
Arm ; Chromosomes, Human, Pair 17 ; Korea ; Leukemia ; Leukemia, Monocytic, Acute ; Molecular Biology

BACKGROUND: Therapeutic plasma exchange (TPE) is used to remove pathologic substances involved in various disease etiologies. The use of TPE is increasing steadily in a variety of disease. This study analyzed the incidence, type and severity of adverse events (AE) according to the initial TPE of each patient in a single center. The risk factors for AE of TPE were also elucidated. METHODS: The medical and laboratory records of patients, who received TPE from January 2014 to December 2018, were reviewed retrospectively. The signs or symptoms during and after TPE were analyzed. RESULTS: TPE sessions were performed on 95 patients. The mean age was 53.3 years and men comprised 63.2%. The most common indication for TPE was desensitization for ABO-incompatible liver transplantation (ABO-i LT) (N=56, 58.9%). A total of 27 patients (28.4%) experienced AE during the initial TPE. The types of AE were allergic reactions (N=14, 14.7%), anaphylactic reaction (N=3, 11.1%), hypotension (N=5, 5.3%), hypocalcemic reaction (N=4, 4.2%), and febrile nonhemolytic reaction (N=1, 1.1%). The severities of AE were evaluated as mild in eight procedures (8.4 %), moderate in seventeen (17.9 %), and severe in two (2.1 %). Multivariable logistic regression analysis showed that the desensitization for ABO-i LT (odds ratio (OR), 2.08; 95% CI, 1.03~4.22) and the amount of FFP (OR, 1.07; 95% CI, 1.01~1.09) were associated with a higher incidence of AE. CONCLUSION: TPE can be performed under careful patient monitoring to provide prompt intervention, particularly in patients with desensitization of ABO-i LT using FFP.
Anaphylaxis ; Humans ; Hypersensitivity ; Hypotension ; Incidence ; Liver Transplantation ; Logistic Models ; Male ; Monitoring, Physiologic ; Plasma Exchange ; Plasma ; Retrospective Studies ; Risk Factors