Alzheimer's disease (AD) is an age-related disorder. Both the prevalence and the incidence of AD double approximately every 5 years after the age of 60. This is a particularly serious problem considering that the Korean elderly population is rapidly growing. We present three illustrative cases of AD in mild, moderate, and advanced stages, respectively. Their initial symptoms were memory impairment which was followed by language disturbance and visuospatial dysfunction. Abnormal behaviors such as delusion and aggression occurred in moderate and severe cases. The presence and severity of dementia in these cases were established by history taking, neurological examination, standardized mental status assessment, and neuropsychological test. Laboratory investigations showed no abnormalities that could account for the cognitive deficits. Brain CT or MRI findings of the patients wee not remarkable except for a diffuse atrophy demonstrated by increased ventricular volume, narrowed gyri, and widened sulci, As an addendum, risk factors, clinical symptoms, clinical diagnosis, and natural history of AD were reviewed.
Aged ; Aggression ; Alzheimer Disease* ; Atrophy ; Brain ; Cognition Disorders ; Delusions ; Dementia ; Diagnosis ; Humans ; Incidence ; Magnetic Resonance Imaging ; Memory ; Natural History ; Neurologic Examination ; Neuropsychological Tests ; Prevalence ; Risk Factors

Bacterial endogenous endophthalmitis is a rare, but devastating complication of septicemia.It has occurred in the process of systemic infection and its underlying conditions are Diabetes Mellitus, advanced liver disease and immunosuppressive state or drug abuse. Klebsiella endogenous endophthalmitis is especially rapidly progressive and visual outcome is typically poor. To evaluate the clinical aspect of this disease, particularly predisposing factors, causative microorganism, outcome of therapeutic modality and initial time of therapy, we performed a retrospective study on 9 eyes of 9 patients who had been treated with this diagnosis from September 1988 to January 1999 at Kyung-Hee Medical Center. Mean time between the onset of disease and the initiation of therapy was 4.33 days. Underlying systemic diasease consist of Daibetes Mellitus, advanced liver disease and chronic renal failure [5 patients:DM with advanced liver disease, 3 patients:DM alone, 1 patient:DM with CRF].The visual outcome was poor but it turned out better in two patients compared with initial visual acuity, no change in one patient and worse in six patients. We found that Diabetes Mellitus and advanced liver disease were leading underlying predisposing factors of Klebsiella Pneumoniae and visual outcome was poor despite the various intensive treatments.High index of suspicion and aggressive diagnostic and therapeutic approach might improve visual outcome.
Causality ; Diabetes Mellitus ; Diagnosis ; Endophthalmitis* ; Humans ; Kidney Failure, Chronic ; Klebsiella ; Klebsiella pneumoniae ; Liver Diseases ; Retrospective Studies ; Substance-Related Disorders ; Visual Acuity

BACKGROUND: Massive bleeding, inability to identify important landmarks and structures, and necessity for a blood transfusion have been the usual problems of hemangioma excision. OBJECTIVE: We introduce a CO2 laser excision technique as a surgical method for the treatment of hemangioma of the lips and demonstrate its benefits. METHODS: In 4 patients with nevus flammeus of hemiface and accompanying hemangioma of the lips, excision of the hemangioma was performed using a focused beam from a CO2 laser under local anesthesia. RESULTS: Excellent to good results were achieved with minimal blood losses in all patients. No or minimal post-operative pain and edema and no significant complications were observed. CONCLUSION:The CO2 laser excision technique is recommended since it renders less textural change, greater volume reduction, hemostasis and an overall good cosmetic outcome than defocused modes or conventional scalpel surgery.
Anesthesia, Local ; Blood Transfusion ; Edema ; Hemangioma* ; Hemorrhage ; Hemostasis ; Humans ; Lasers, Gas* ; Lip* ; Port-Wine Stain

No abstract available.
Biopsy, Fine-Needle* ; Salivary Glands*

PURPOSE: Bacterial meningitis in childhood carries significant mortality and morbidity, so accurate and rapid diagnosis is important. Cerebrospinal fluid (CSF) latex agglutination test has been used for rapid diagnosis of bacterial meningitis. However, urine may be the best specimen for a latex test, because bacterial antigens are concentrated in the urine. The study tried to determine the diagnostic value of urine latex test in bacterial meningitis. METHODS: We evaluated 219 patients who were suspected with bacterial meningitis and examined CSF Gram stain, CSF culture, CSF latex test and urine latex test. And 17 patients with bacterial meningitis were followed up at post-antibiotics 3, 7, 14, 21, 28 days. RESULTS: Sensitivity and specificity of urine latex test in bacterial meningitis were 82.4% and 99.4%. In H. influenzae type b meningitis, the sensitivity and specificity of urine latex test were 100% and 99.4%. The positive rates of urine latex tests after antibiotics treatment persisted significantly longer than the positive rates of CSF culture, smear and latex test. CONCLUSOIN: Urine latex test was as useful as CSF smear and CSF latex test during the early diagnosis of bacterial meningitis. The urine latex test was more valuable than CSF smear, latex, and culture in partially treated bacterial meningitis, because of persistent positivity after antibiotics treatment.
Anti-Bacterial Agents ; Antigens, Bacterial ; Cerebrospinal Fluid ; Diagnosis ; Early Diagnosis ; Humans ; Influenza, Human ; Latex Fixation Tests ; Latex* ; Meningitis ; Meningitis, Bacterial* ; Mortality ; Sensitivity and Specificity

No abstract available.
Cytomegalovirus Infections* ; Cytomegalovirus*

The Dandy-Wlaker syndrome is a developmental disoeder characterized by cystic dilatation of the fourth ventricle and agenesis or hypoplasia of the cerebellar vermis and is usually associated with hydrocephalus. This syndrome is also associated with intracranial malformations such as agenesis of corpus callosum, and extracranial malformations such as facial anormalies (cleft palate, cleft lip, and ocular anomalies), polycystic kidney, and cardiac anormalies. Reported associated ophthalmic anomalies are microphthalmos, coloboma, and congenital cataract.We experienced a case of infantile esotropia in abnormal insertion and direction of lateral rectus muscle as a variant of the Dandy-Walker syndrome accompanied by cleft palate and cleft lip in a 19-month-old male infant. Subsequent treatment of the 30delta esodeviation and left inferior oblique muscle overaction, including resection of the lateral rectus muscle in both eyes and the myectomy of the inferior oblique muscle in the left eye, yielded satisfactory results, so we report this case, with a review of the pertinent literature, as the first case of Dandy-Walker syndrome associated with esotropia with abnormal course of lateral rectus muscle in Korea.
Agenesis of Corpus Callosum ; Cleft Lip ; Cleft Palate ; Coloboma ; Dandy-Walker Syndrome* ; Dilatation ; Esotropia* ; Fourth Ventricle ; Humans ; Hydrocephalus ; Infant ; Korea ; Lip ; Male ; Microphthalmos ; Polycystic Kidney Diseases

Cytomegalovirus (CMV) is a ubiquitous virus and its infections occur commonly after renal transplantation and immunosuppressive therapy. Early and accurate laboratory diagnosis of CMV infection in renal transplant is necessary but often difficult. To find optimal diagnostic methods for CMV infection, we compared shell vial culture and polymerase chain reaction (PCR) and Southern blot of PCR products. A total of 301 specimens of urine, blood neutrophils, tissues, or body fluids were obtained from 75 renal transplant recipients and were submitted to shell vial culture for CMV as well as DNA PCR using primers for immediate early(IE) gene of CMV. The human fibroblast cell line (MRC-5) was used to culture CMV and were examined with immunofluorescence staining using monoclonal antibody to the early antigen of CMV. The PCR products (274 and 379 bp) were detected by gel electrophoresis and ethidium bromide staining. When PCR products were not clearly visible on electrophoresis, PCR products were analyzed by Southern blot using IE gene probe. Sixty four(85.3%) of 75 renal transplant recipients showed CMV infection as analyzed by PCR and Southern blot as well as shell vial culture. On shell vial culture, CMV were detected in 81 specimens from 30(40%) renal transplant recipients in viremic state. On PCR and Southern blot analysis CMV were detected in 55 and 26 specimens, respectively from 59 patients. The sensitivity of culture and PCR to detect CMV infection were 42.4% and 83.3%, respectively. The results of two studies were concordant in 48%. PCR and Southern blot did not detect CMV in 10 and 5 culture proven CMV positive samples, respectively. Mutant CMV were found in 3 patients which showed 5-10 bp deletion in IE gene. Moreover, DNA sequencing analysis showed 5 mutant strains among 11 strains which appeared same by PCR prodcut. These results suggest that PCR followed by Southern blot may be more sensitive, but less specific than shell vial culture in the diagnosis of CMV disease. PCR followed by Southern blot may not detect mutant CMV. Combined analysis using both shell vial culture and PCR followed by Southern blot may be necessary to diagnose CMV infection in renal transplant recipients.
Blotting, Southern ; Body Fluids ; Cell Line ; Clinical Laboratory Techniques ; Cytomegalovirus Infections* ; Cytomegalovirus* ; Diagnosis ; DNA* ; Electrophoresis ; Ethidium ; Fibroblasts ; Fluorescent Antibody Technique ; Humans ; Kidney Transplantation ; Neutrophils ; Polymerase Chain Reaction ; Sequence Analysis, DNA ; Transplantation*

PURPOSE: Low-dose dopamine (0.5-3 microgram/kg/min) increases renal blood flow, glomerular filtration rate and natriuresis and has protective and therapeutic effects on oliguric renal failures. Asphyxia is the most common cause of acute renal failure in neonates. But the protective effects of dopamine have never been reported in asphyxiated neonates. So we reported the effects of low-dose dopamine on the renal function of asphyxiated neonates. METHODS: Twenty-seven asphyxiated neonates who were admitted to the neonatal intensive care unit of Ewha Womans University hospital, from September, 1995 to June, 1997, were randomized to dopamine group (N=14, dopamine 0.5-3 microgram/kg/min) and control group (N=13). Serum creatinine (Pcr) and Na (PNa), urine creatinine (Ucr) and Na (UNa), urine output, creatinine clearance rate (Ccr), fractional excretion of Na (FENa) of two groups were compared on postnatal day 1, 3, 5. Incidences of acute renal failure and neonatal complications were also checked. RESULTS: The postnatal changes of Pcr (mg/dL), Ccr (mL/min/1.73m2) and FENa (%), on lst, 3rd & 5th days were not significnatly diffrent between dopamine group and control group. The postnatal changes of UNa (mmol/day) and urine output (ml/kg/hr) in dopamine group on 1st, 3rd & 5th days were significantly higher than those of control group (P<0.05). The incidence of acute renal failure, intraventricular hemorrhage, bronchopulmonary dysplasia, patient ductus arteriosus, sepsis and necrotizing enterocolitis were not significantly different between two groups. CONCLUSION: Low-dose dopamine, which was prophylactically given after birth in asphyxiated neonates, showed natriuretic and diuretic effects without significant increase of glomerular function.
Acute Kidney Injury ; Asphyxia ; Bronchopulmonary Dysplasia ; Creatinine ; Diuretics ; Dopamine* ; Ductus Arteriosus ; Enterocolitis, Necrotizing ; Female ; Glomerular Filtration Rate ; Hemorrhage ; Humans ; Incidence ; Infant, Newborn* ; Intensive Care, Neonatal ; Natriuresis ; Parturition ; Polymerase Chain Reaction ; Renal Circulation ; Renal Insufficiency ; Sepsis

A diagnosis of gout is often straightforward because gout has well known clinical presentations, laboratory analyses, and radiologic features. On the other hand, gout can mimic other diseases by showing a range of atypical clinical manifestations. This paper reports a 35-year-old male with no prior history of gout who developed tophaceous gout at his previously repaired Achilles tendon 11 years after surgery. He was initially misdiagnosed with cellulitis because of his atypical clinical features. This case is presented with a review of the relevant literature.