Hypoglycemia sometimes manifests as focal neurologic deficits simulating cerebrovascular disease. Symptoms are usually resolved by glucose infusion, but persistent hemiplegia is rarely reported. A 68-year-old diabetic woman on oral hypoglycemic agent(OHA) was admitted with right hemiplegia and global aphasia. Blood glucose level was 29 mg/dl on admission. No evidence of cerebral infarct or underlying brain disease could be found on initial brain CT and follow up MRI. Focal stenosis or occlusion was also absent on MR angiography. Hemiplegia and aphasia were not improved despite adequate therapy. Hypoglycemic hemiplegia should be suspected in all diabetic patients using insulin or OHA with stroke-like episode, and we suggest that prolonged hypoglycemia may be related to persistence of neurologic deficits.
Aged ; Angiography ; Aphasia ; Blood Glucose ; Brain ; Brain Diseases ; Constriction, Pathologic ; Female ; Follow-Up Studies ; Glucose ; Hemiplegia* ; Humans ; Hypoglycemia ; Insulin ; Magnetic Resonance Imaging ; Neurologic Manifestations

Transesophageal echocardiography(TEE) was performed during pharmacologic stress with dobutamine for evaluation of coronary artery disease in 15 patients (12 men, 3 women ; mean age, 70 years) with inadequate transthoracic echocardiographic images. In five patients, additional indications for TEE were present. Dobutamine was administered according to a standard protocol with a maximum dose of 40microg/kg per minute. Angina and an increase in simple ventricular ectopy were noted in one patient each, but no other complication or side effect was noted. Images (midesophageal four-and two-chamber views ad transgastric short-and long-axis views) were satisfactory for interpretation in 14 patients. In one patient, the apex could not be optimally visualized. Five patients (33%) had resting wall motion abnormalities. Wall motion abnormality developed in three patients(20%) and worsened in two(13%). Dobutamine stress TEE findings were normal in eight patients. Coronary angiography in two patients revealed significant stenosis corresponding to stress-induced wall motion abnormalities. Dobutamine stress TEE is a safe, feasible, well-toerated alternative to conventional stress echocardiography for detecting myocardial ischemia.
Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Dobutamine* ; Echocardiography ; Echocardiography, Stress ; Echocardiography, Transesophageal* ; Feasibility Studies* ; Female ; Humans ; Male ; Myocardial Ischemia

OBJECTIVE: To correlate the MRI findings in acute and chronic stage of Wemicke encephalopathy with the well-known clinical and pathologic findings. Background. Wemicke encephalopathy is an acute phase of Wemicke-Korsakoff syndrome. Pathologic findings change between acute and chronic phases. Only a few MRI studies have been done in this disease to date. METHODS: Ten consecutive patients with Wemicke encephalopathy were evaluated with MRI; seven within 24 hours of thiamine treatment, and three between 2 and 4 days. They presented with confusion, ophthalmoplegia and gait ataxia which improved with intravenous thiamine. Korsakoff psychosis became evident on followup. Tl-, proton- and T2-weighted axial images were obtained with additional 5 mmthick Tl-weighted sagittal and coronal images to evaluate the morphology and size of the mammillary body. RESULTS: Increased T2 signal was seen in the periaqueductal area in seven(sometimes involving superior colliculus); medial thalamus in five; and splenium of the corpus callosum in two. Among the seven patients with T2 signal abnormalities, five had follow-up MRI in 2 to 70 days, which showed complete resolution of the abnormalities. Seven patients showed atrophy of mammillary body on the initial MRI. In the three patients who had normal mammillary body in size on initial scan, follow up MRI revealed atrophic change of mammillary body. Tlweighted sagittal image showed superior cerebellar vermis atrophy in seven. Four patients revealed dilatation of the third ventricle. CONCLUSION: MRI findings of Wernicke encephalopathy appear diagnostic in acute stage and may reflect the pathological evolution in acute and chronic phases of Wernicke-Korsakoff syndrome.
Atrophy ; Corpus Callosum ; Dilatation ; Follow-Up Studies* ; Gait Ataxia ; Humans ; Korsakoff Syndrome ; Magnetic Resonance Imaging* ; Mamillary Bodies ; Ophthalmoplegia ; Thalamus ; Thiamine ; Third Ventricle ; Wernicke Encephalopathy*

Background: Lessons learned from the Household Humidifier Disinfectant Tragedy (HHDT) in Korea, which poisoned thousands of citizens over a period of years, necessitated an examination of national poison prevention and surveillance systems. The objectives of this study are to identify essential changes needed in chemical poisoning prevention regulations and surveillance systems for effective poison control by comparing recent trends in international poison control center (PCC) operations, and to delineate the critical elements for establishing a state-of-the-art poison control surveillance system in Korea based on recent advances in PCCs with toxicovigilance. Methods: A comprehensive review of Korea’s regulatory and surveillance systems for chemical health hazards, with a focus on household products under the HHDT, was conducted. A review of toxicovigilance systems in major countries shows that creating an effective national PCC requires key elements: a centralized database of toxic substances and poisoning cases, mandatory or voluntary reporting of poisoning cases, real-time alerts, collaboration among health organizations, and targeted follow-up of poisoned individuals. Results: Significant deficiencies in Korea’s legislation, toxicological data management, and poisoning surveillance systems, explained the inadequate response of the Korean government to the HHDT for nearly 17 years until the end of 2011. Based on a review of PCC toxicovigilance systems in major countries, a national framework with five core components is recommended for establishing a modern comprehensive Korea PCC system with toxicovigilance capacity. The core components include establishment of a centralized database of toxic substances information and clinical poisoning cases, implementation of mandatory or permissive reporting of poisoning cases, real-time alert mechanisms, collaborative systems among health-related organizations, and clinical follow-up of poisoned sub-groups. Conclusion A rationale and framework for a state-of-the-art national Korean PCC with toxicovigilance is justified and offered. This proposed system could assist neighboring countries in establishing their own sophisticated, globally integrated PCC networks.

OBJECTIVES: During the past few years, the development of functional brain imaging techniques has allowed to describe brain impairment in cognitive disorders. Among them, based on the observation of bilateral parietotemporal hypoperfusion in Alzheimer's disease(AD), single photon emission computed tomography(SPECT) is advocated by some as powerful diagnostic tool in the evaluation of demented patients. The aim of this study is to investigate the usefulness of SPECT in the diagnosis of AD and to clarify the associated factors of parietotemporal hypoperfusion, the typical SPECT pattern of Alzheimer's disease(AD). METHODS: We reviewed the SPECT scans of 26 patients fulfilling NINCDS-ADRDA criteria for probable AD, 14 with typical pattern of SPECT and 12 with atypical pattern of SPECT. Dementia severity was assessed by the Mini-Mental State Examination. Image interpretation was done visually by the consensus opinion of 2 experienced nuclear medicine physicians who were blind to clinical information. To estimate the association of typical pattern of SPECT with other variables of interest, discriminant function analysis was done. RESULTS: Though the overall diagnostic sensitivity of SPECT in AD was 53.8%, it was 76.9%, in early-onset AD patients. Typical pattern of SPECT was more frequent in the patients with early onset of the symptoms. Duration of symptoms, duration of education, sex, severity of disease was not associated with this SPECT pattern. CONCLUSION: These findings may be useful in the clinical setting and point to heterogeneity of AD according to age at onset.
Alzheimer Disease* ; Brain* ; Consensus ; Dementia ; Diagnosis ; Functional Neuroimaging ; Humans ; Nuclear Medicine ; Population Characteristics ; Sex Education ; Tomography, Emission-Computed, Single-Photon*

This study aimed to estimate the medical cost of cancer in the first five years of diagnosis and in the final six months before death in people who developed cancer after human immunodeficiency virus (HIV) infection in Korea. The study utilized the Korea National Health Insurance Service-National Health Information Database (NHIS-NHID). Among 16,671 patients diagnosed with HIV infection from 2004 to 2020 in Korea, we identified 757 patients newly diagnosed with cancer after HIV diagnosis. The medical costs for 60 months after diagnosis and the last six months before death were calculated from 2006 to 2020. The mean annual medical cost due to cancer in HIV-infected people with cancer was higher for acquired immunodeficiency syndrome (AIDS)-defining cancers (48,242 USD) than for non-AIDS-defining cancers (24,338 USD), particularly non-Hodgkin’s lymphoma (53,007 USD), for the first year of cancer diagnosis. Approximately 25% of the cost for the first year was disbursed during the first month of cancer diagnosis. From the second year, the mean annual medical cost due to cancer was significantly reduced. The total medical cost was higher for non-AIDS-defining cancers, reflecting their higher incidence rates despite lower mean medical costs. The mean monthly total medical cost per HIV-infected person who died after cancer diagnosis increased closer to the time of death. The estimated burden of medical costs in patients with HIV in the present study may be an important index for defining healthcare policies in HIV patients in whom the cancer-related burden is expected to increase.

BACKGROUND: It is very important to determine an accurate staging of the non-small cell lung cancer(NSCLC) for an assessment of operability and it's prognosis. However, it is difficult to evaluate tumor involvement of mediastinal lymph nodes accurately utilizing noninvasive imaging modalities. PET is one of the sensitive and specific imaging modality. Unfortunately PET is limited use because of prohibitive cost involved with it's operation. Recently hybrid SPECT/PET (single photon emission computed tomography/positron emission tomography) camera based PET imaging was introduced with relatively low cost. We evaluated the usefulness of coincidence detection (CoDe) PET in the detection of metastasis to the mediastinal lymph nodes in patients with NSCLC. METHODS: Twenty one patients with NSCLC were evaluated by CT or MRI and they were considered operable. CoDe PET was performed in all 21 patients prior to surgery. Tomographic slices of axial, coronal and sagittal planes were visually analysed. At surgery, mediastinal lymph nodes were removed and histological diagnosis was performed. CoDe PET findings were correlated with histological findings. RESULTS: Twenty of 21 primary tumor masses were detected by the CoDe PET. Thirteen of 21 patients was correctly diagnosed mediastinal lymph node metastasis by the CoDe PET. Pathological NO was 14 cases and the specificity of NO of CoDe PET was 64.3%. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of N1 node was 83.3%, 73.3%, 55.6%, 91.7%, and 76.2% respectively. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of N2 node was 60.0%, 87.5%, 60.0%, 87.5%, and 90.0% respectively. There were 3 false negative cases but the size of the 3 nodes were less than 1cm. The size of true positive nodes were 1.1cm, 1.0cm, 0.5cm respectively. There were 1 false positive among the 12 lymph nodes which were larger than 1cm. False positive cases consisted of 1 tuberculosis case, 1 pneumoconiosis case and 1 anthracosis case. CONCLUSION: CoDe PET has relatively high negative predictive value in the enlarged lymph node in staging of mediastinal nodes in patients with NSCLC. Therefore CoDe PET is useful in ruling out metastasis of enlarged N3 nodes. However, further study is needed including more number of patients in the future.
Anthracosis ; Carcinoma, Non-Small-Cell Lung* ; Diagnosis ; Electrons* ; Humans ; Lung ; Lymph Nodes ; Magnetic Resonance Imaging ; Neoplasm Metastasis ; Pneumoconiosis ; Positron-Emission Tomography* ; Prognosis ; Tuberculosis

Increasing concern is being given to the association between risk of cancer and exposure to low-dose bisphenol A (BPA), especially in young-aged population. In this study, we investigated the effects of repeated oral treatment of low to high dose BPA in juvenile Sprague-Dawley rats. Exposing juvenile rats to BPA (0, 0.5, 5, 50, and 250 mg/kg oral gavage) from post-natal day 9 for 90 days resulted in higher food intakes and increased body weights in biphasic dose-effect relationship. Male mammary glands were atrophied at high dose, which coincided with sexual pre-maturation of females. Notably, proliferative changes with altered cell foci and focal inflammation were observed around bile ducts in the liver of all BPA-dosed groups in males, which achieved statistical significance from 0.5 mg/kg (ANOVA, Dunnett’s test, p<0.05). Toxicokinetic analysis revealed that systemic exposure to BPA was greater at early age (e.g., 210-fold in C(max), and 26-fold in AUC at 50 mg/kg in male on day 1 over day 90) and in females (e.g., 4-fold in C(max) and 1.6-fold in AUC at 50 mg/kg vs. male on day 1), which might have stemmed from either age- or gender-dependent differences in metabolic capacity. These results may serve as evidence for the association between risk of cancer and exposure to low-dose BPA, especially in young children, as well as for varying toxicity of xenobiotics in different age and gender groups.
Animals ; Area Under Curve ; Bile Ducts* ; Bile* ; Body Weight ; Child ; Female ; Humans ; Inflammation ; Liver Neoplasms* ; Liver* ; Male ; Mammary Glands, Human ; Rats* ; Rats, Sprague-Dawley ; Toxicokinetics ; Xenobiotics

OBJECTIVE: To comprehensively analyze the spectrum of imaging features of the primary tumors and metastatic patterns of the Extraskeletal Ewing sarcoma family of tumors (EES) in adults. MATERIALS AND METHODS: We performed a computerized search of our hospital's data-warehouse from 1996 to 2013 using codes for Ewing sarcoma and primitive neuroectodermal tumors as well as the demographic code for > or = 18 years of age. We selected subjects who were histologically confirmed to have Ewing sarcoma of extraskeletal origin. Imaging features of the primary tumor and metastatic disease were evaluated for lesion location, size, enhancement pattern, necrosis, margin, and invasion of adjacent organs. RESULTS: Among the 70 patients (mean age, 35.8 +/- 15.6 years; range, 18-67 years) included in our study, primary tumors of EES occurred in the soft tissue and extremities (n = 20), abdomen and pelvis (n = 18), thorax (n = 14), paravertebral space (n = 8), head and neck (n = 6), and an unknown primary site (n = 4). Most primary tumors manifested as large and bulky soft-tissue masses (mean size, 9.0 cm; range, 1.3-23.0 cm), frequently invading adjacent organs (45.6%) and showed heterogeneous enhancement (73.7%), a well-defined (66.7%) margin, and partial necrosis/cystic degeneration (81.9%). Notably, 29 patients had metastatic disease detected at their initial diagnosis. The most frequent site of metastasis was lymph nodes (75.9%), followed by bone (31.0%), lung (20.7%), abdominal solid organs (13.8%), peritoneum (13.8%), pleura (6.9%), and brain (3.4%). CONCLUSION: Primary tumors of EES can occur anywhere and mostly manifest as large and bulky, soft-tissue masses. Lymph nodes are the most frequent metastasis sites.
Adolescent ; Adult ; Aged ; Asian Continental Ancestry Group ; Bone Neoplasms/*pathology/radiography ; Brain Neoplasms/pathology/radiography ; Female ; Humans ; Lymph Nodes/pathology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neoplasm Metastasis ; Neuroectodermal Tumors, Primitive/pathology/radiography ; Positron-Emission Tomography ; Sarcoma, Ewing/*pathology/radiography ; Tomography, X-Ray Computed ; Young Adult

Objective: The International Cooperative Ataxia Rating Scale (ICARS) is a semiquantitative clinical scale for ataxia that is widely used in numerous countries. The purpose of this study was to investigate the validity and reliability of the Korean-translated version of the ICARS. Methods: Eighty-eight patients who presented with cerebellar ataxia were enrolled. We investigated the construct validity using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). We also investigated the internal consistency using Cronbach’s α and intrarater and interrater reliability using intraclass correlation coefficients. Results: The Korean-translated ICARS showed satisfactory construct validity using EFA and CFA. It also revealed good interrater and intrarater reliability and showed acceptable internal consistency. However, subscale 4 for assessing oculomotor disorder showed moderate internal consistency. Conclusion This is the first report to investigate the validity and reliability of the Korean-translated ICARS. Our results showed excellent construct and convergent validity. The reliability is also acceptable.