Distinguishing epileptic seizure from non-epileptic seizure is a common diagnostic problem. Neurogenic or cardiac syncope can appear similar to atonic and even convulsive seizures. Classic migraine and transient ischemic attacks may also resemble epileptic seizures. Sleep disorders including REM sleep behavior disorder, nocturnal paroxysmal dystonia, and narcolepsy likewise simulate an epileptic seizure. Movement disorders such as paroxysmal dyskinesia can be misinterpreted as epileptic seizures (reflex epilepsy or myoclonic seizures). Psychogenic seizures are often misdiagnosed as an intractable epilepsy. Prior to the definitive diagnosis of epilepsy, possible non-epileptic seizures should be excluded. For the correct decision, a thorough and systematic history taking is important. In addition, EEG, pseudoseizure induction test, head-up tilt test, EKG, sleep studies, and video-EEG monitoring may be necessary. Misdiagnosis of non-epileptic seizures as epilepsy may result in unnecessary anti-epileptic drug use. At the same time, we should let the patients understand what the epilepsy is and that epilepsy is a treatable disease.
Chorea ; Diagnosis ; Diagnostic Errors ; Drug Resistant Epilepsy ; Electrocardiography ; Electroencephalography ; Epilepsy* ; Humans ; Ischemic Attack, Transient ; Linear Energy Transfer ; Migraine with Aura ; Movement Disorders ; Narcolepsy ; Nocturnal Paroxysmal Dystonia ; REM Sleep Behavior Disorder ; Seizures* ; Sleep Wake Disorders ; Syncope

Successful percutaneous transluminal angioplasty (PTA) of an internal mammary artery graft was performed in a 40 year old male patient who had recurrent angina soon after bypass surgery. Coronary angiography showed total occlusion of proximal portion of the left anterior descending artery and normal right coronary artery. Angiography of the left internal mammary artery graft revealed a tight stenosis (90% diameter narrowing) in the mammary artery at its insection into the left anterior descending artery.Angiography after the angioplasty demonstrated a widely patent graft (residual stenosis 10%) and translesional pressure gradient was 10 mmHg.
Adult ; Angiography ; Angioplasty* ; Arteries ; Constriction, Pathologic* ; Coronary Angiography ; Coronary Vessels ; Humans ; Insects ; Male ; Mammary Arteries* ; Transplants*

OBJECTIVE: To compare the safety and efficacy of intravaginal misoprostol versus intracervical dinoprostone (prostaglandin E2 gel) for cervical ripening and labor induction. METHODS: 60 patients with indication for labor induction and unfavorable cervices were randomly assigned to receive either intravaginal misoprostol or intracervical dinoprostone. 50 microgram tablets of misoprostol were placed in the posterior vaginal fornix every 4 hours for a maximum of 3 doses or dinoprostone 0.5mg was placed into the endocervix every 6 hours for a maximum of 2doses. No more medication was given after either spontaneous rupture of membranes or beginning of active labor. RESULTS: Among 60 patients enrolled, 30 received misoprostol and 30 received dinoprostone. The average interval from start of induction to active labor was shorter in misoprostol group (6.5+/-3.2 hours) than in the dinoprostone group (10.7+/-7.3 hours) (p<0.05). Oxytocin augmentation of labor occurred more often in the dinoprostone group (36.7%) than in the misoprostol group (10.0%) (p<0.05). There was a higher prevalence of fetal distress (23.3% versus 3.3%) and tachysystole (16.6% versus 6.6%) in the misorprostol group than in the dinoprostone group(p<0.05). CONCLUSIONS: Vaginally administered misoprostol is an effective agent for cervical ripening and induction of labor. Furthermore, the cost of misoprostol ( 360/200microgram) is much less than that of dinoprostone ( 42,000/0.5mg). Cost benefits from administration of misoprostol are evident, especially in clinics under system of diagnosis-related group (DRG) : however when given at this dosage, it is associated with a higher prevalence of fetal distress and tachysystole than dinoprostone. Further studies to compare the safety of misoprostole to that of dinoprostone and to delineate an optimal dosing regimen for misoprostol are needed.
Cervical Ripening* ; Cost-Benefit Analysis ; Diagnosis-Related Groups ; Dinoprostone* ; Female ; Fetal Distress ; Humans ; Membranes ; Misoprostol* ; Oxytocin ; Pregnancy ; Prevalence ; Prospective Studies* ; Rupture, Spontaneous ; Tablets

No abstract available.
Diabetic Neuropathies*

PURPOSE: The ictal perfusion patterns of cerebellum and basal ganglia have not been systematically investigated in patients with temporal lobe epilepsy (TLE). Their ictal perfusion patterns were analyzed in relation with temporal lobe and frontal lobe hyperperfusion during TLE seizures using SPECT subtraction. MATERIALS AND METHODS: Thirty-three TLE patients had interictal and ictal SPECT, video-EEG monitoring, SPGR MRI, and SPECT subtraction with MRI co-registration. RESULTS: The vermian cerebellar hyperperfusion (CH) was observed in 26 patients (78.8%) and hemispheric CH in 25 (75.8%). Compared to the side of epileptogenic temporal lobe, there were seven ipsilateral hemispheric CH (28.0%), fifteen contralateral hemispheric CH (60.0%) and three bilateral hemispheric CH (12.0%). CH was more frequently observed in patients with additional frontal hyperperfusion (14/15, 93.3%) than in patients without frontal hyperperfusion (11/18, 61.1%). The basal ganglia hyperperfusion (BGH) was seen in 11 of the 15 patients with frontotemporal hyperperfusion (73.3%) and 11 of the 18 with temporal hyperperfusion only (61.1%). In 17 patients with unilateral BGH, contralateral CH to the BGH was observed in 14 (82.5%) and ipsilateral CH to BGH in 2 (11.8%) and bilateral CH in 1 (5.9%). CONCLUSION: The cerebellar hyperperfusion and basal ganglia hyperperfusion during seizures of TLE can be contralateral, ipsilateral or bilateral to the seizure focus. The presence of additional frontal or basal ganglia hyperperfusion was more frequently associated with contralateral hemispheric CH to their sides. However, temporal lobe hyperperfusion appears to be related with both ipsilateral and contralateral hemispheric CH.
Basal Ganglia* ; Cerebellum* ; Epilepsy, Temporal Lobe* ; Frontal Lobe ; Humans ; Magnetic Resonance Imaging ; Perfusion ; Seizures ; Temporal Lobe* ; Tomography, Emission-Computed, Single-Photon

No abstract available.

Profound reduction of anterograde coronary flow with concomitant ischemia is seen occasionally during percutaneous coronary intervention despite technically successful procedure. We found interesting coronary flow pattern in a patient with acute myocardial infarction, showing angiographic no reflow phenomenon after direct PTCA. The coronary blood flow pattern of the angiographic no-reflow phenomenon in this case was characterized by minimal systolic flow and sharp deceleration of diastolic flow. Coronary flow reserve calculated by the ratio of adenosine induced maximal hyperemic velocity and basal velocity was reduced. The Dopplertipped guide wire was useful for observation of phasic coronary flow pattern of angiographic no-reflow phenomenon.
Adenosine ; Deceleration ; Humans ; Ischemia ; Myocardial Infarction* ; No-Reflow Phenomenon ; Percutaneous Coronary Intervention

An isolated avulsion fracture of the subscapularis from the lesser tuberosity of the proximal humerus is rare in the pediatric population and only a couple of cases have been described in literature. A 12-yearold right-handed boy, was admitted to the hospital with left shoulder pain after falling down the previ-ous day. Physical examination revealed tenderness on the lesser tuberosity and intertubercular groove of the humerus and a limited range of motion. Ultrasonography, computed tomography, and magnetic resonance imaging showed an isolated avulsion fracture of the subscapularis tendon from the lesser tuberosity of the humerus, accompanied by medial subluxation of the long head of the biceps tendon.In this case, a subscapularis avulsion fracture which is rare in this age group was detected at an early stage, and surgical treatment resulted in positive outcomes. Subscapularis avulsion fractures in children are difficult to diagnose in the early stages, and if not treated on time, the symptomatic improvement may be delayed. Timely and accurate diagnosis and treatment can help faster return to normal activi-ties. We would therefore like to report this case with a literature review.

BACKGROUND: We assessed the effectiveness of arthroscopic capsular release for the treatment of adhesive capsulitis. Further, we tried to ascertain the clinical benefits, if any, of pancapsular release over selective capsular release, where the two differ by performing or not performing a posterior capsular release, respectively. METHODS: Thirty-five consecutive patients with either primary or secondary adhesive capsulitis who failed conservative treatment for more than 6 months were enrolled in the study. A total of 16 patients allocated in group 1 received a pancapsular release that comprises the release of the rotator interval, anteroinferior capsular, and the posterior capsular release, whereas 19 patients in group 2 received a selective capsular release that comprises only the release of the rotator interval release and anteroinferior capsular release. The clinical outcomes, visual analogue scale (VAS) score, Constant score, and range of motion, were assessed preoperative and postoperatively. RESULTS: In both groups, the preoperative VAS score, Constant score, and ROM showed a significant improvement by the 6-month follow-up. We found that the immediate postoperative internal rotation was significantly higher in group 1 than group 2. Despite significant differences seen between the two groups at the initial postoperative period, there were no significant differences in Constant score, VAS score, and the ROM at all the subsequent follow-ups between the two groups. CONCLUSIONS: Arthroscopic capsular release for the treatment of adhesive capsulitis is very effective. However, pancapsular release did not show any advantage over selective capsular release in terms of overall clinical outcome.
Bursitis* ; Follow-Up Studies ; Humans ; Joint Capsule Release* ; Postoperative Period ; Range of Motion, Articular

BACKGROUND: Insulin resistance syndrome shows extreme insulin resistance and is associated with acanthosis nigricans. We can differentiate it into type A insulin resistance that has insulin receptor defect, and type B insulin resistance due to insulin receptor autoantibody. Type B insulin resistance was firstly described by Kahn in 1976. It was often found in adult female and showed autoimmune characteristics. As clinical characteristics, there are hyperglycemia, hypoglycemia, hyperinsulinemia, extreme insulin resistance and acanthosis nigricans. METHODS: We investigated 17 insulin receptor autoantibody positive cases and 8 cases of normal control who had visited Wonju Christian Hospital from October 1994 to December 1995. Among insulin receptor autoantibody positive subject, male was 4 cases and female 13 cases. Their mean age was 42.2. We compared patients who had insulin receptor antibody positive acanthosis nigricans(IRA) with normal controls. IRA patients were 6 cases(35.3%) of nomal glucose tolerance, 11 cases(64.7%) of abnormal glucose tolerance including overt diabetes mellitus. RESULTS: The 11 cases(64.7%) among IRA patrents were obese and 13 cases(76.5%) had hyperininsulinemia. In IRA patients, mean serum insulin concentration during oral glucose tolerance test was 202.1mU/mL and it was greater than 46.3 of normal controls. Insulin sensitivity in 1.79mg/L * mM * xmU * min normal controls was higher than 0.74mg/L * mM * min of IRA patients. CONCLUSION: IRA patients showed abnormal glucose tolerance including overt diabetes millitus, severe insulin resistance, hyperinsulinemia and obesity.
Acanthosis Nigricans* ; Adult ; Diabetes Mellitus ; Female ; Gangwon-do ; Glucose ; Glucose Tolerance Test ; Humans ; Hyperglycemia ; Hyperinsulinism ; Hypoglycemia ; Insulin Resistance ; Insulin* ; Male ; Obesity ; Receptor, Insulin*