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

We studied local cerebral blood flow with Tc-99m HMPAO SPECT in 15 patients with olivopontocerebellar atrophy(OPCA) and 15 age-matched control subjects without neurological desease. The diagnosis of OPCA was based upon the history and physical findings and upon the exclusion of other cerebellar ataxia by means of laboratory investigations. Computed tomographic scan and MRI revealed some degree of atrophy of the cerebellum in most patient with OPCA, and many also had atrophy of the brain stem. SPECT studies in these patients revealed decreased cerebral blood flow in the cerebellum in comparison with the normal control subjects(p<0.001). Two patients with minimal atrophy or no structural changes in the cerebellum also showed decreased perfusion. Tc-99m HMPAO SPECT may be useful as a diagnostic test in patients with OPCA. Some instances suggest that Tc-99m HMPAO SPECT may show abnormal finding earlier than other neuroimaging methods.
Atrophy ; Brain Stem ; Cerebellar Ataxia ; Cerebellum ; Diagnosis ; Diagnostic Tests, Routine ; Humans ; Magnetic Resonance Imaging ; Neuroimaging ; Olivopontocerebellar Atrophies* ; Perfusion ; Technetium Tc 99m Exametazime* ; Tomography, Emission-Computed, Single-Photon*

A rat model of focal cerebral ischelma has been established by mhe tecbnique of elecvrocamtery for me middle oerebral artery occlusion (MCAO). We investigated mhe effect of naloxone pretreatment on the size of infarction and the regional cerebral blood flow (rCBF) Another purpose of this study was to determine the effecbve dose (high-or lowdose) in focal cerebral ischemia. The rats were given Img/Kg I.v. (low-dose), 4mg/Kg I.v. (high-dose) of naloxone 30 min before MCAO and infused continuously with 0.5mg/Kg/hr (low dose) or 2mg/Kg/hr (high-dose) over next I hour by am infusion pump. The control group was given normal salin of the same amount by the same method. Dunng the peDod of saline amd naloxone infusion, mean arterial blood pressure was monitored. Arterial blood gas analysis and blood glucose measuremert were performed just after MCAO. The rectal temperature of rat was maintained within 37)0.5C by a heating lamp. Twenty-fow hours after MCAO, eight 2mm-thick coronal sections of one rat brain were stained by TTC solution and the size of infarction was described as the percentage of ipsilateral hemisphere. The rCBFs were measured by an autoradiography using 14C-iodoantipyrine and the chamges of rCBFs were analyzed by three methods of (1) rCBF ratio, (2) 1 mm-serial rCBF measurement of cerebral cortex, and (3) areas of rCBF below critical values(<25, 25-50, <50ml/100g/min). The results were as follows; 1. There was no significamt chamge of blood pressure during the infusion of saline. Iow-dose and high-dose naloxones 2. Arterial blood gas amalysis amd blood glucose measurement showed that there were no significant differences of pH, PC02, PO2 and blood glucose between saline and low dose and high-dose naloxone groups 3. High-dose naloxone pretreatment reduced significantly the size of infarction(p<0.05 vs saline-treated group by Mann-Whitney U test). 4. High-dose naloxone pretreatment improved significantly the rCBF ratios of caudate head and CA 3 area (p<0.05 vs. saline-treated group by Mann-Whitney U test) There was no significant improvement of rCBF ratios in the low-dose naloxone treated group. 5. One-mm serial rCBF measurement of cerebral cortex indicated that while low-dose naloxone group showed no improvement of rCBF of cerebral cortex, high-dose nalox one pretreatment produced an improvement of rCBF in penumbra and its neighboring area 6. The area below 25ml/100g/min or rCBF was reduced significantly by high-dose naloxone pretreatment(high-dose naloxone group: 15.0+4.1mm2, saline group:23.3)5.3 mm2, p <0.05). In summary these results indicate that high-dose naloxone pretreatment reduced the size of infarction and improved the rCBFs in the focal cerebral ischemia of rats.
Animals ; Arterial Pressure ; Arteries ; Autoradiography ; Blood Gas Analysis ; Blood Glucose ; Blood Pressure ; Brain ; Brain Ischemia* ; Cerebral Cortex ; Head ; Heating ; Hot Temperature ; Hydrogen-Ion Concentration ; Infarction* ; Infusion Pumps ; Models, Animal ; Naloxone* ; Rats*

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*