85 cases of neurosyphilis were observed in Seoul National University Hospital over 6-year period (1979-1984). They were analyzed with respect to clinical symptoms and signs in individual types, serological data in both blood and CSF, changes of cytochemical compositions in CSF, and other significant findings. And some coparisons with other reports were made. They ranged from 22 to 66 years in age with the peak incidence in the forties (41%). Ratio of male to female was observed to be 4.3:1. There were 27 cases of asymptomatic neurosyphilis (NS) (32%), 14 cases of tabes dorsalis (16%), 18 cases of general paresis (21%), 2 cases of taboparesis (2%), 7cases of vascular NS (8%), 6 cases of meningeal NS (7%), 4 cases of syphilitic eight nerve involvement (5%), 4 cases of late syphilitic ocular involvement including optic atrophy (5%), and 3 cases of spinal form (4%). Except in 4 self-referral cases, alimentary system symptoms or illnesses were the main prolbems in asymptomatic neurosyphilitics (48%). Most symptomatic cases had the similar clinical pictures as described in the previous reports but some cases appeared to be combined with symptoms and signs of different types. In tabes dorsalis, patients presented paresthesia and hypoactive DTRs in lower limbs as the most frequent features. According to predominant manifestations, there were 4 cases of dementic form and 14 cases of psychotic form in general paresis but in most cases both features overlapped each other. In 8 cases of general paresis brain CT scans were performed, which revealed diffuse cerebral atrophy in five. Focal abnormalities of vascular NS were most frequently found in temporal areas (4 in 7 cases). Meningeal irritation signs were observed only in one among 6 cases 6 meningeal NS. All cases of eighth nerve involvement showed sensorineural hearing loss at high-tone level. Compared with TPHA, which was used as a criterion for the patient selection, VDRL reactivity was 98% in serum and 49% in CSF. It is notable that as for general paresis and meningeal NS, higher reactivity and elevated titers of CSF VDRL were associated with increase of cells and total protein in CSF, suggesting higher disease activity in both types. Unlike those from other countries, the domestic studies including this report show that general paresis occupies a relatively higher proportion than tabes dorsalis in Korea.
Atrophy ; Brain ; Digestive System ; Female ; Hearing Loss, Sensorineural ; Humans ; Incidence ; Korea ; Lower Extremity ; Male ; Neurosyphilis* ; Optic Atrophy ; Paresthesia ; Patient Selection ; Seoul ; Tabes Dorsalis ; Tomography, X-Ray Computed

Acetazolamide, a selective-inhibitor of carbonic anhydrase. Has been shown to induce a rapid increase in cerebral blood flow by acidifying cerebral extracellular tluid in large doses. In order to assess the cerebral blood flow reserve, we investigated 14 patients with ischemic cerebrovascular disease using Tc-99m HMPAO SPECT before and after administration of acetazolamide.The patients after acetazolamide challenge showed variable pattems of vasodilating capacity which were classified as follows: group I. Accentuation of abnormal perfusion pattem; group II, no change in abnormal perfusion pattern: and group III. Blunting of abnormal perfusion pattern. Thirty-six percent of the patients studied qualified for group I. The p?tients in group I seem to have decreased vasodilating reserve in the area of cerebral ischemia. They are most likely to benefit by medical or surgical efforts to augment CBF delivery. Tc-99m HMPAO-SPECT with acetazolamide flow challenge may serve as an objective. Clinically accessible method for assessing blood flow reserve and as a kind of guide for the therapeutic strategy.
Acetazolamide* ; Brain Ischemia ; Carbonic Anhydrases ; Humans ; Perfusion ; Technetium Tc 99m Exametazime ; Tomography, Emission-Computed, Single-Photon

PURPOSE: We evaluated the effectiveness of intrarectal lidocaine-gel and periprostatic nerve block, or the combined method, on the reduction of pain during repeated transrectal prostate biopsy. MATERIALS AND METHODS: 61 patients with a negative pathology after an initial sextant biopsy, with no sedatives or analgesia, were rebiopsied using the 12 extended biopsy technique. The patients scheduled for a repeat prostate biopsy were randomized to the combination method (group 1, 19 patients), periprostatic nerve block (group 2, 23 patients) or intrarectal lidocaine-gel (group 3, 19 patients). After the repeat biopsy, the rectal pain during probe insertion, pain intensity during prostate biopsy and complication rates were recorded. Pain was evaluated by a 10-point linear visual analogue scale (VAS). An ANOVA test was used as the statistical analysis for the assessment of VAS, with p<0.05 considered significant. RESULTS: No significant difference was found in mean patient age, prostate specific antigen level, prostate volume and complication rates between the groups. The VAS during probe insertion were significantly lower in group 1 and 3 (mean 1.74 and 1.84) than in group 2 (mean 3.96, p<0.001). The VAS during biopsy was significantly lower in group 1 (mean 3.05) than group 3 (mean 4.63, p<0.001). CONCLUSIONS: Periprostatic nerve block decreased pain during the repeated prostate biopsy, but had no effect on the pain felt during transrectal probe insertion. Intrarectal lidocaine-gel decreased the pain only during probe insertion. However, the combination of intrarectal lidocaine-gel and periprostatic nerve block was effective in reducing the pain, both at biopsy and during probe insertion, in the repeated 12 core biopsy.
Analgesia ; Anesthesia ; Biopsy* ; Humans ; Hypnotics and Sedatives ; Lidocaine* ; Nerve Block ; Pathology ; Prostate* ; Prostate-Specific Antigen

No abstract available.
Parkinson Disease* ; Technetium Tc 99m Exametazime* ; Tomography, Emission-Computed, Single-Photon*

Endoscopic variceal ligation(EVL) is newly developed method to manage esophageal variceal bleeding. This study asse initial control rate of active variceal bleeding, incidence of rebleeding and complications in EVL. From June in l992 to December in 1994, this study was performed on 70 patients who had visited to our medical center for melena or hematemesis by acute esophageal variceal bleeding. In all of 70 cases, eradication of esophageal varix was performed and variceal bleeding was controlled well. And first session was performed successfully with EVL. But rebleeding was occured in 12 cases(11 cases caused by esoyhageal varix and 1 case caused by esophageal ulcer) during follow-up period, so EVL therapy was performed repeatedly and 8 cases were eradicated and 4 cases were uncontrolled and died, and then 94% hemostatic effect was achieved during follow-up period. Complications of EVL therapy were mild(substernal discomfort in 12 cases, substernal pain in 4 cases, fever in 3 cases, mild dysphagia in 2 cases) and well controlled. Superficial esaphageal ulcer was shown in 18 cases by follow-up endoscopy after 1 week. These results show that EVL is a good therapeutic method to control active variceal bleeding and eradication of varix with repeat treatment. In conclusion, EVL is an effective and safe method of treatment and prevention for esophageal variceal bleeding.
Deglutition Disorders ; Endoscopy ; Equidae ; Esophageal and Gastric Varices* ; Fever ; Follow-Up Studies ; Hematemesis ; Humans ; Incidence ; Ligation* ; Melena ; Ulcer ; Varicose Veins

We performed 3 kinds of memory tests and cognitive evoked potential study, P300, in 13 patients with memory disturbance and 19 control free of neurologic symptoms or history of neurological impairment; to determine correlation of each memory test with P300 and possibility of clinical application of P300 as a quantitative test of cognitive function. Patients and control younger than 40 years of age were selected to minimize the aging effect on the cognitive function tests. Those who marked 30 points in Mini-mental state examination were chosen as control. 11 of 13 patients had brrain lesions including temporal lobe. Comparing with tests in control group, the declarative ant the procedural memory of patients were significantly impaired (p<0.05, p<0.025, respectively), and P300 latency was significantly prolonged (p<0.001). In control group, among declarative memory tests Rey-Osterreith complex figure test and enhanced cued recall had significant correlation with P300 latency (p<0.05, p<0.05, respectively), while the Tower of Toronto test which was known to evaluate precedural memory did not. In patient group there was no significant correlation between any kind of memory test and P300 latency. These results not only are consistent with previous studies which detected temporal lobe as the origin of P300 wave, but implicate that brain loci other than temporal lobe might originate P300 wave. To apply P300 as a quantitative test of cognitive function, further extensive studies using age and IQ matched control will be needed.
Aging ; Ants ; Brain ; Evoked Potentials* ; Humans ; Memory* ; Neurologic Manifestations ; Temporal Lobe

Two patients of a family, suffenng from frequent periodic paralysis, were evaluated. Their family history reveals seven affected members in three generations, with autosomal dominance pattern. Their earliest symptoms were noticed between 10-13 years of age. The serum potassium level fell during the attack. EMG demonstrated progresslve reduction in numer of motor units and drop off in the response of muscle fibers to stimuli. These findings were consistent with familial hypokalemic periodic paralysis. The clinical features, electron microscoscopic findings, and pathogenesis were also described.
Family Characteristics ; Humans ; Hypokalemic Periodic Paralysis* ; Paralysis ; Potassium

Adie's tonic pupil usually consists of mydriasis, defect in accommodation. Poor or absent light reflex, and tonic near reflex, It is usually unilateral, but rarelY observed bilaterally. The pupillary abnormalities often accompany areflexia, which is called Adie syndrome collechvely, Other autonomic dysfunction especially hypohidrosis. Are rarely reported in association with Adie syndrome. We recently experienced 2 cases of bilateral Adie's pupils in 2 women, one of whom had hypohidrosis, and the other had areflexia. So we report 2 cases with bilateral Adie's pupils with a review of literature.
Adie Syndrome ; Female ; Humans ; Hypohidrosis ; Mydriasis ; Reflex ; Tonic Pupil*

Brainstem auditory evoked potentials (BAEPs) were evaluated in 22 patients with tuberculous meningitis to determine the incidence of abnormal BAEPs in tuberculous meningitis and the possible effect of variable factors on the incidence of abnormal BAEPs. Of 22 patients tested, 19 (86.4%) had abnormal interpeak latencies in one or both ears. I-III interpeak latenies were increased in 14 patients (63.6%) and III-V interpeak latencies in 7 patients (31.8%). Meningeal enhancement in brain CT or MRI was significantly correlated with abnormal BAEPs, especially with I-III interpeak latencies.
Brain ; Brain Stem* ; Ear ; Evoked Potentials, Auditory, Brain Stem* ; Humans ; Incidence ; Magnetic Resonance Imaging ; Tuberculosis, Meningeal*

Visual evoked potentials (VEP's) were studied in 19 children with surgically verified sellar or parasellar masses (7 craniopharyngioma, 3 optic chiasmal glioma, 3 granuloma, 1 hematoma, 1 arachnoid cyst, 1 medulloblastoma, 1 pituitary adenoma, 1 Rathke's cleft cyst and 1 germ cell tumor). Abnormalities consistent with visual pathway dysfunction were recorded in 17 patients (89%). Absent responses or poor wave formations were noted in 7 patients and delayed P1 latency in 10 patients. Two patients, one with intrasellar Langerhans' cell granuloma and the other with pituitary adenoma, had normal evoked potentials. The incidence and the degree of abnormalities in VEP's roughly correlated with the visual acuity. Postoperative VEP's were recorded in 5 patients and showed improvement in 4 patients. VEP's might be helpful for postoperative follow-up in children with sellar or parasellar masses.
Arachnoid ; Child* ; Craniopharyngioma ; Evoked Potentials ; Evoked Potentials, Visual* ; Follow-Up Studies ; Germ Cells ; Glioma ; Granuloma ; Hematoma ; Humans ; Incidence ; Medulloblastoma ; Optic Chiasm ; Pituitary Neoplasms ; Visual Acuity ; Visual Pathways