Mirror writing is script that runs in the direction opposite to normal, with individual letters also reversed. A Right handed woman suddenly developed mirror-writing. After traumatic brain injury without definitive lesions on MRI, she could not discriminate between right and left by herself. Several theories, including motor, visual dominance, spatial disorientation and supplementary motor hypotheses, have been proposed to explain such. We believe that availability of mirror engrams induce reversal of normal left-to-right writing pattern including mirror-writings.
Brain Injuries ; Female ; Functional Laterality ; Hand ; Humans ; Magnetic Resonance Imaging* ; Writing

No abstract available.
Humans ; Spastic Paraplegia, Hereditary*

BACKGROUND: Legionella pneumophila has been recognized as an important cause of community-acquired pneumonia(CAP) requiring hospitalization. However, epidemiological data on the occurrence of legionella-related pneumonia is unavailable in Korea. The purpose of this study was to evaluated the etiological imprtance of legionella pneumophila serogroup 1 in patients hospitalized with CAP. METHOD: The CAP patient over 16 year-old were recruited from July 1999 to June 2000 at the Chunchon Sacred Heart Hospital. Fifty four patients (male 29, female 25, average age 63.8±15.3) were included in this study. A diagnosis of a legionella pneumophila infection was based on a urinary antigen test using the Binax Company enzyme immunoassay. The severity of pneumonia was assessed using the Fine's PORT scoring system. RESULT: The average Fine's PORT score was 99.7(±44.9). According to the risk classification proposed by the Infectious Disease Society of America, the number of patients in each class(from class I to class V) were 6(11.1%), 13(24.1%), 9(16.7%), 14(25.8%), and 12(22.2%), respectively. Thirty two patients(59.3%) were initially admitted to the intensive care unit. The mortality rate was 16.7%(9 in 54). In all patients, urinary antigens to Legionella pneumophila serogroup 1 were not detected. CONCLUSION: Legionella pneumophila may play little role in causing adult CAP in Korea. Therefore, the routine use of macrolide in the empirical treatment of the CAP patients based upon the ATS guidelines(1993) in Korea should be reevaluated.
Adult ; Americas ; Classification ; Communicable Diseases ; Diagnosis ; Female ; Gangwon-do ; Heart ; Hospitalization ; Humans ; Immunoenzyme Techniques ; Intensive Care Units ; Korea* ; Legionella pneumophila* ; Legionella* ; Legionnaires' Disease ; Mortality ; Pneumonia*

INTRODUCTION: The planning of implant surgery is an important factor for the implant prosthesis. Stereolithographic (SLA) surgical stents based on a computer simulation are quite helpful for clinicians to perform the surgery as planned. Although many clinical and technical trials have been performed for computed tomography (CT)-guided implant stents to improve the surgical procedures and prosthetic treatment, there are still many problems to solve. We developed a system of a surgical guide based on 3 dimensional (3D) CT for implant therapy and achieved satisfactory results in the terms of planning and operation. MATERIALS AND METHODS: Fifteen patients were selected and 30 implant fixtures were installed. The preoperative CT data for surgical planning were prepared after obtaining informed consent. Surgical planning was performed using the simulation program, Ondemend3D In2Guide. The stents were fabricated based on the simulation data containing information of the residual bone, the location of the nerve, and the expected design of the prostheses. After surgery with these customized stents, the accuracy and reproducibility of implant surgery were evaluated based on the computer simulation. The data of postoperative CT were used to confirm this system using the image fusion technique and compare the implant fixtures between the planned and implanted. RESULTS: The mean error was 1.18 (+/-0.73) mm at the occlusal center, 1.23 (+/-0.67) mm at the apical center, and the axis error between the two fixtures was 3.25degrees (+/-3.00). These stents showed superior accuracy in maxilla cases. The lateral side error at the apical center was significantly different from the error at the occlusal center but there were no significant differences between the premolars, 1st molars and 2nd molars. CONCLUSION: SLA surgical stents based on a computer simulation have the satisfactory accuracy and are expected to be useful for accurate planning and surgery if some errors can be improved.
Axis, Cervical Vertebra ; Bicuspid ; Computer Simulation ; Humans ; Informed Consent ; Maxilla ; Molar ; Prostheses and Implants ; Stents

A 5-year-old girl was admitted because of an acute onset of weakness in her extremities. She had experienced a similar episode before but had recovered spontaneously. She had previously been diagnosed with distal renal tubular acidosis(RTA) at the age of 2 months. During the period of acute paralysis, her serum potassium level was 1.8 mmol/L and the muscle enzymes were markedly raised suggesting massive rhabdomyolysis. Although hypokalemia is common in renal tubular acidosis, acute paralytic presentation is uncommon and is rarely described in children. We report a case of distal RTA complicated with hypokalemic paralysis with a brief review of related literatures.
Acidosis, Renal Tubular* ; Child ; Child, Preschool ; Extremities ; Female ; Humans ; Hypokalemia ; Paralysis* ; Potassium ; Rhabdomyolysis

The nephrotic syndrome is characterized by generalized edema, hypoproteinemia(<2 g/dL), proteinuria(>40 mg/m2/hr), and hypercholesterolemia(>200 mg/dL). It is reported that hypoalbuminemia, which is one of the four diagnostic criteria of the nephrotic syndrome, is associated with gallbladder wall thickening. An explanation for the thickened wall in hypoalbuminemic states is the accumulation of fluid in the subserosal layer of the gallbladder wall which contains the most areolar tissue. This report describes a patient who was initially diagnosed with the nephrotic syndrome at the age of 4 and subsequently developed acute acalculous cholecystitis at the age of 5.8 with an albumin level of 1.3 g/dL. The patient responded to fluid therapy, nasogastric suction, and broad spectrum antibiotics.
Acalculous Cholecystitis* ; Anti-Bacterial Agents ; Edema ; Fluid Therapy ; Gallbladder ; Humans ; Hypoalbuminemia ; Nephrotic Syndrome* ; Suction

A 69-year old man presented with severe epigastric pain for 1 day. He had early gastric cancer at the antrum and underwent a distal subtotal gastrectomy and Billorth II gastrojejunostomy one month later without any post-operative complications. Radiologic examination revealed a large amount of retroperitoneal free air formation. Because of unremitting pain and unstable vital sign, exploratory laparotomy was followed. During the operation, a perforated duodenal diverticulum at the posterior wall of the 2nd portion of the duodenum was identified. He underwent diverticulectomy and primary closure. He was discharged on the 18th post operative day and has been followed up without any evidence of comlpication for several months.
Aged ; Diverticulum* ; Duodenum ; Gastrectomy* ; Gastric Bypass* ; Humans ; Laparotomy ; Stomach Neoplasms ; Vital Signs

Interstitial lung disease, mostly chronic lung disorder, is usually characterized by diffuse infiltrates and disordered gas exchange, is a very rare disease in children. Chronic pneumonitis of infancy (CPI) is a recently described entity representing a distinct form of interstitial lung disease affecting infants and young children. The histologic findings suggest marked alveolar septal thickening, striking alveolar pneumocyte hyperplasia, and alveolar exudates containing numerous macrophages and foci of eosinophilic debris. A 3-year-old boy visited a local clinic with cough and tachypnea for a duration of 3 weeks. His clinical symptoms were aggravated and he was referred to our hospital. He was diagnosed with chronic pneumonitis of infancy after undergoing open lung biopsy. We herein present the case with review of literature.
Biopsy ; Child ; Child, Preschool* ; Cough ; Eosinophils ; Exudates and Transudates ; Humans ; Hyperplasia ; Infant ; Lung ; Lung Diseases, Interstitial ; Macrophages ; Male* ; Pneumocytes ; Pneumonia* ; Rare Diseases ; Strikes, Employee ; Tachypnea

Sedation can resolve anxiety and fear in patients undergoing endoscopy. The use of sedatives has increased in Korea. Appropriate sedation is a state in which the patient feels subjectively comfortable while maintaining the airway reflex for stable spontaneous breathing. The patient should maintain a state of consciousness to the extent that he or she can cooperate with the needs of the medical staff. Despite its benefits, endoscopic sedation has been associated with cardiopulmonary complications. Such cardiopulmonary complications are usually temporary, and most patients recover without sequelae. However, these events may progress to serious complications, such as cardiovascular collapse. Therefore, it is essential to screen high-risk patients before sedation and reduce complications by meticulous monitoring. Additionally, physicians should be familiar with the management of emergencies. The first Korean clinical practice guideline for endoscopic sedation was developed based on previous worldwide guidelines for endoscopic sedation using an adaptation process. The guideline consists of nine recommendations based on a critical review of currently available data and expert consensus when the guideline was drafted. These guidelines should provide clinicians, nurses, medical school students, and policy makers with information on how to perform endoscopic sedation with minimal risk.

Sedation can resolve anxiety and fear in patients undergoing endoscopy. The use of sedatives has increased in Korea. Appropriate sedation is a state in which the patient feels subjectively comfortable while maintaining the airway reflex for stable spontaneous breathing. The patient should maintain a state of consciousness to the extent that he or she can cooperate with the needs of the medical staff. Despite its benefits, endoscopic sedation has been associated with cardiopulmonary complications. Cardiopulmonary complications are usually temporary. Most patients recover without sequelae. However, they may progress to serious complications, such as cardiovascular collapse. Therefore, it is essential to screen high-risk patients before sedation and reduce complications by meticulous monitoring. Additionally, physicians should be familiar with the management of emergencies. The first Korean clinical practice guideline for endoscopic sedation was developed based on previous worldwide guidelines for endoscopic sedation using an adaptation process. The guideline consists of nine recommendations based on a critical review of currently available data and expert consensus when the guideline was drafted. These guidelines should provide clinicians, nurses, medical school students, and policy makers with information on how to perform endoscopic sedation with minimal risk.