No abstract available.
Myelitis* ; Polyneuropathies*

Pyridoxine deficiency and excess have both been implicated as causes of peripheral neuropathy. A 74-year-old man presented with paresthesia in both legs that first appeared 2 months previously. A nerve conduction study revealed axonal sensory polyneuropathy. He had consumed 100 milligrams of pyridoxine every day for 1 year, in the form of vitamin tablets. His blood levels of vitamin B6 were markedly elevated to above 250 nmol/L. This case indicates that the consumption of high-dose pyridoxine can cause sensory polyneuropathy.
Aged ; Axons ; Humans ; Leg ; Neural Conduction ; Paresthesia ; Peripheral Nervous System Diseases ; Polyneuropathies* ; Pyridoxine* ; Tablets ; Vitamin B 6 ; Vitamin B 6 Deficiency ; Vitamins

Spontaneous spinal subdural hematoma (SDH) is very rare. Furthermore, intracranial vasospasm (ICVS) associated with spinal hemorrhage has been very rarely reported. We present an ICVS case without intracranial hemorrhage following SDH. A 41-year-old woman was admitted to our hospital with a complaint of severe headache. Multiple intracranial vasospasms were noted on a brain CT angiogram and transfemoral cerebral angiography. However, intracranial hemorrhage was not revealed by brain MRI or CT. On day 3 after admission, weakness of both legs and urinary incontinence developed. Spine MRI showed C7~T6 spinal cord compression due to hyperacute stage of SDH. After hematoma evacuation, her symptoms gradually improved. We suggest that spinal cord evaluation should be considered in patients with headache who have ICVS, although intracranial hemorrhage would not be visible in brain images.
Adult ; Brain ; Cerebral Angiography ; Female ; Headache ; Hematoma ; Hematoma, Subdural, Spinal* ; Hemorrhage ; Humans ; Intracranial Hemorrhages* ; Leg ; Magnetic Resonance Imaging ; Spinal Cord ; Spinal Cord Compression ; Spine ; Subarachnoid Hemorrhage ; Urinary Incontinence ; Vasospasm, Intracranial*

BACKGROUND/AIMS: Spontaneous HBeAg seroconversion occurs frequently in the immune reactive phase in HBeAg-positive chronic hepatitis B (CHB). Therefore, observation for 3-6 months before commencing antiviral therapy is recommended in patients with alanine aminotransferase (ALT) levels that exceed twice the upper limit of normal (ULN). However, HBeAg seroconversion occurs infrequently in patients infected with hepatitis B virus (HBV) genotype C. The aim of the present study was to determine whether the waiting policy is necessary in endemic areas of HBV genotype C infection. METHODS: Ninety patients with HBeAg-positive CHB were followed prospectively without administering antiviral therapy for 6 months. Antiviral therapy was initiated promptly at any time if there was any evidence of biochemical (i.e., acute exacerbation of HBV infection or aggravation of jaundice) or symptomatic deterioration. After 6 months of observation, antiviral therapy was initiated according to the patient's ALT and HBV DNA levels. RESULTS: Only one patient (1.1%) achieved spontaneous HBeAg seroconversion. Biochemical and symptomatic deterioration occurred before 6 months in 17 patients (18.9%) and 5 patients, respectively. High ALT and HBV DNA levels were both independent risk factors for biochemical deterioration. Of 15 patients with HBV DNA > or =5.1x107 IU/mL and ALT > or =5xULN, biochemical deterioration occurred in 7 (46.7%), including 1 patient receiving liver transplantation due to liver failure. CONCLUSIONS: Spontaneous HBeAg seroconversion in patients with HBeAg-positive CHB is rare within 6 months. Biochemical deterioration was common and may lead to liver failure. Immediate antiviral therapy should be considered, especially in patients with high ALT and HBV DNA levels in endemic areas of genotype C infection.
Adult ; Alanine Transaminase/blood ; Antiviral Agents/*therapeutic use ; DNA, Viral/blood ; Female ; Follow-Up Studies ; Genotype ; Guanine/analogs & derivatives/therapeutic use ; Hepatitis B e Antigens/*blood ; Hepatitis B virus/*genetics ; Hepatitis B, Chronic/*drug therapy ; Humans ; Male ; Middle Aged ; Prospective Studies ; Risk Factors

PURPOSE: Cinacalcet is effective for treating refractory secondary hyperparathyroidism (SHPT), but little is known about the response rates and clinical factors influencing the response. MATERIALS AND METHODS: A prospective, single-arm, multi-center study was performed for 24 weeks. Cinacalcet was administered to patients with intact parathyroid hormone (iPTH) level greater than 300 pg/mL. Cinacalcet was started at a dose of 25 mg daily and titrated until 100 mg to achieve a serum iPTH level <300 pg/mL (primary end point). Early response to cinacalcet was defined as a decrease of iPTH more than 50% within one month. RESULTS: Fifty-seven patients were examined. Based on the magnitude of iPTH decrease, patients were divided into responder (n=47, 82.5%) and non-responder (n=10, 17.5%) groups. Among the responders, 38 achieved the primary end point, whereas 9 patients showed a reduction in serum iPTH of 30% or more, but did not reach the primary end point. Compared to non-responders, responders were significantly older (p=0.026), female (p=0.041), and diabetics (p<0.001). Additionally, early response was observed more frequently in the responders (30/47, 63.8%), of whom the majority (27/30, 90.0%) achieved the primary end point. Multivariate analysis showed that lower baseline iPTH levels [odds ratio (OR) 0.96, 95% confidence interval (CI) 0.93-0.99], the presence of diabetes (OR 46.45, CI 1.92-1125.6) and early response (OR 21.54, CI 2.94-157.7) were significant clinical factors affecting achievement of iPTH target. CONCLUSION: Cinacalcet was effective in most hemodialysis patients with refractory SHPT. The presence of an early response was closely associated with the achievement of target levels of iPTH.
Adult ; Aged ; Biomarkers, Pharmacological/blood ; Calcium/blood ; Female ; Humans ; Hyperparathyroidism, Secondary/*drug therapy ; Male ; Middle Aged ; Naphthalenes/adverse effects/*therapeutic use ; Parathyroid Hormone/*blood ; *Renal Dialysis ; Treatment Outcome

BACKGROUND: Conventional nerve conduction studies (NCS) are used in the diagnosis of carpal tunnel syndrome (CTS). The median terminal latency index (TLI) and median residual latency (RL) are parameters calculated to identify abnormalities in distal segments of the median motor nerve. The objective of this study was to determine the sensitivity and specificity of TLI and RL together with NCS in the diagnosis of CTS. METHODS: This prospective study involved 83 hands of 47 patients with suspected CTS. Conventional NCS were performed using Oh's method. Control data were obtained from the 68 hands of 40 healthy volunteers. The diagnostic sensitivity and specificity of TLI and RL were calculated and compared with those of conventional NCS. We divided the CTS patients into four groups based on their electrophysiological severity, and compared the TLI and RL values between these groups. RESULTS: TLI and RL were 0.20+/-0.03 (mean+/-SD) and 3.62+/-0.90, respectively, in the patients, while the corresponding values, in the healthy control, were 0.29+/-0.03 and 2.08+/-0.30. The sensitivities of TLI and RL in diagnosing CTS were 75.9% and 86.3%, respectively. Compared with median motor terminal latency, the sensitivities of TLI and RL in diagnosing CTS was found to be higher. Moreover, the diagnostic sensitivities of TLI and RL were significant better for the severe group than for the mild and moderate severity group. CONCLUSIONS: We conclude that measuring TLI and RL of the median nerve may increase the sensitivity in diagnosing CTS and also provide information about its electrophysiological severity.
Carpal Tunnel Syndrome* ; Diagnosis* ; Hand ; Healthy Volunteers ; Humans ; Median Nerve ; Neural Conduction ; Prospective Studies ; Sensitivity and Specificity*

BACKGROUND: Conventional nerve conduction studies (NCS) are used in the diagnosis of carpal tunnel syndrome (CTS). The median terminal latency index (TLI) and median residual latency (RL) are parameters calculated to identify abnormalities in distal segments of the median motor nerve. The objective of this study was to determine the sensitivity and specificity of TLI and RL together with NCS in the diagnosis of CTS. METHODS: This prospective study involved 83 hands of 47 patients with suspected CTS. Conventional NCS were performed using Oh's method. Control data were obtained from the 68 hands of 40 healthy volunteers. The diagnostic sensitivity and specificity of TLI and RL were calculated and compared with those of conventional NCS. We divided the CTS patients into four groups based on their electrophysiological severity, and compared the TLI and RL values between these groups. RESULTS: TLI and RL were 0.20+/-0.03 (mean+/-SD) and 3.62+/-0.90, respectively, in the patients, while the corresponding values, in the healthy control, were 0.29+/-0.03 and 2.08+/-0.30. The sensitivities of TLI and RL in diagnosing CTS were 75.9% and 86.3%, respectively. Compared with median motor terminal latency, the sensitivities of TLI and RL in diagnosing CTS was found to be higher. Moreover, the diagnostic sensitivities of TLI and RL were significant better for the severe group than for the mild and moderate severity group. CONCLUSIONS: We conclude that measuring TLI and RL of the median nerve may increase the sensitivity in diagnosing CTS and also provide information about its electrophysiological severity.
Carpal Tunnel Syndrome* ; Diagnosis* ; Hand ; Healthy Volunteers ; Humans ; Median Nerve ; Neural Conduction ; Prospective Studies ; Sensitivity and Specificity*

Aged ; Carcinoma ; Carcinoma, Squamous Cell ; Gingiva ; Head ; Humans ; Lymph Nodes ; Male ; Neck ; Neck Dissection ; Neoplasm Metastasis ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy

Recent studies suggest that liver cirrhosis is reversible after administering oral nucleos(t)ide analogue therapy to patients with hepatitis B virus (HBV) infection. However, few studies have addressed whether esophageal varices can regress after such therapy. We report a case of complete regression of esophageal varices during entecavir therapy in patients with HBV-related liver cirrhosis, suggesting that complications of liver cirrhosis such as esophageal varices can regress after the long-term suppression of HBV replication.
Abdomen/diagnostic imaging ; Antiviral Agents/*therapeutic use ; DNA, Viral/blood ; Esophageal and Gastric Varices/complications/prevention & control ; Guanine/*analogs & derivatives/therapeutic use ; Hepatitis B virus/genetics ; Hepatitis B, Chronic/complications/*drug therapy/virology ; Humans ; Liver Cirrhosis/*diagnosis/etiology ; Male ; Middle Aged ; Polymerase Chain Reaction ; Ultrasonography

Purpose: This study aimed to evaluate the real-world efficacy of immune checkpoint inhibitors (ICIs), and to identify clinicolaboratory factors to predict treatment outcomes in patients with advanced esophageal squamous cell carcinoma (ESCC) receiving ICIs. Materials and Methods: Sixty patients with metastatic or unresectable ESCC treated with nivolumab (n=48) or pembrolizumab (n=12) as ≥ second-line treatment between 2016 and 2019 at Asan Medical Center were included. Results: The median age of the patients was 68 years (range, 52 to 76 years), and 93.3% were male. Most patients had metastatic disease (81.7%) and had been previously treated with fluoropyrimidines, platinum, and taxane. In 53 patients with measurable disease, the overall response rate and disease control rate were 15.1% and 35.8%, respectively. With a median follow-up duration of 16.0 months, the median progression-free survival (PFS) and overall survival (OS) were 1.9 months (95% confidence interval [CI], 1.54 to 2.19) and 6.4 months (95% CI, 4.77 to 8.11), respectively. After multivariate analysis, recent use of antibiotics, low prognostic nutrition index (< 35.93), high Glasgow Prognosis Score (≥ 1) at baseline, and ≥ 1.4-fold increase in neutrophil-to-lymphocyte ratio after one cycle from baseline were significantly unfavorable factors for both PFS and OS. Younger age (< 65 years) was a significant factor for unfavorable PFS and hyponatremia (< 135 mmol/L) for unfavorable OS. Conclusion The use of ICIs after the failure of chemotherapy showed comparable efficacy in patients with advanced ESCC in real practice; this may be associated with host immune-nutritional status, which could be predicted by clinical and routine laboratory factors.