We have had an opportunity to study a patient with acute sensory neuronopathy. The patient was a 32-yearold housewife; the rapidly spreaded tingling sensation along both arms and legs developed, rendering her severely ataxic. There was no history of antecedent illness, familial neurological disease, or exposure to toxins and special drugs. On examinations, there was no abnormality in her mental and cranial nerve function. There was no motor weakness. She showed the profound loss of kinesthetic sense which was acutely progressive and associated with severe sensory ataxia and pseudoathetosis. All tendon reflexes were absent. However, cutaneous senses were preserved. There was no significant abnormal laboratory finding except elevated CSF protein content. On electrophysiologic findings, the decrease in the amplitude of action potentials with only mild slowing of conduction velocities of sensory nerves were found even though motor nerve conduction studies were normal. Median and tibial somatosensory evoked potentials could be elicited, although the median N19 scalp response and tibial N45 waveforms were prolonged in latency. Plasmapheresis were provided; clinical features improved. However, the electrophy-siological abnormalites remained. Thus we wish to report an additional case of woman suffering from the acute sensory neuronopathy, complementing the cases described by Stemm, Schaumburg and Asbury.
Action Potentials ; Arm ; Ataxia ; Complement System Proteins ; Cranial Nerves ; Evoked Potentials, Somatosensory ; Female ; Humans ; Kinesthesis ; Leg ; Neural Conduction ; Plasmapheresis ; Reflex, Stretch ; Scalp ; Sensation

Accurate diagnosis and management of a femoral vascular injury is important as it is a life-threatening injury with high morbidity and mortality. This is the case of a 75-year-old man admitted to the emergency room with trauma to the right groin due to a horse fall. Computed tomography showed active bleeding of the femoral artery without pelvic or femoral fracture. We inserted a stent-graft, but hypotension persisted. Exploration of the groin was completed, and the bleeding from the external iliac vein was identified and repaired. In conclusion, vascular injury is rare in groin trauma without associated fracture, however, arterial and venous injury should not be completely ruled out. Endovascular therapy is worth recommending as a quicker and safer management than surgery in patients with active bleeding in the femoral artery. However, the possibility of combined injury of the femoral vein should be suspected in case of ongoing hemodynamic instability.

PURPOSE: To evaluate the refractive outcomes of small incision lenticule extraction (SMILE) in high myopia patients compared with mild to moderate myopia patients. METHODS: This study included 332 eyes of 166 myopic patients treated with SMILE using Visumax 500 kHz femtosecond laser. Treated eyes were divided into 2 groups according to preoperative spherical equivalent (SE): mild to moderate myopia (A group, <-6.0 D) and high myopia (B group, > or =-6.0 D). Follow-up visits were at 1 day, 1 week, 1 month, 3 months, and 6 months. The outcome measures included uncorrected distance visual acuity (UDVA), best corrected distance visual acuity (BDVA), postoperative SE, efficacy index, safety index and predictability. RESULTS: Preoperative SE was -4.85 +/- 0.86 D in the A group and -7.70 +/- 1.0 D in the B group. No differences were observed between -0.04 +/- 0.29 D in the A group and -0.30 +/- 0.37 D in the B group at 6 months postoperatively (p = 0.062). At 6 months postoperatively, 98.3% and 97.3% had UDVA of 20/25 or better in the A group and B group, respectively. In the A group, 97.3% and 100% were within +/-0.5 D and +/-1.0 D of intended correction and in the B group, 91.7% and 96.9% were within +/-0.5 D and +/-1.0 D, respectively. Efficacy indices were 1.02 +/- 0.19 in the A group and 0.99 +/- 0.18 in the B group. Safety indices were 1.16 +/- 0.16 in the A group and 1.14 +/- 0.16 in the B group. The efficacy and safety indices were not significantly different between the A and B groups at 6 months postoperatively (p = 0.09, p = 0.695, respectively). CONCLUSIONS: This study showed that SMILE is effective and safe for correcting high myopia as well as mild to moderate myopia.
Follow-Up Studies ; Humans ; Myopia* ; Outcome Assessment (Health Care) ; Visual Acuity

PURPOSE: Tumor necrosis factor-alpha(TNF-alpha) is a pro-inflammatory cytokine that has been implicated in the pathogenesis of cardiovascular disease. Serum levels of TNF-alpha are elevated in many human cardiac related pathogenic conditions, including heart failure. It is well known that TNF-alpha inhibits myocardial contractility and induces apoptosis of adult rat cardiomyocytes via stimulation of TNF receptor 1. But pathophysiologically relevant low levels of TNF-alpha can not induce apoptosis of neonatal cardiomyocytes. So, we evaluated the effects of different concentrations of TNF-alpha in cultured rat neonatal cardiomyocytes : apoptosis or necrosis. METHODS: Neonatal ventricular myocytes were isolated from 3-day-old rats by stepwise collagenase dissociation, and the cells were cultured for 3 days. After that, cardiomyocytes were treated with low(25 ng/mL) and high(250 ng/mL) concentration of TNF-alpha for 48 hours. Apoptosis was determined by terminal deoxynucleotidyl transfer-mediated end labelling(TUNEL) staining, and cell viability was evaluated by lactate dehydrogenase(LDH) measurements using cell culture supernatants. RESULTS: Low dose TNF-alpha did not induce apoptosis compared with controls(10.5 +/- 3.5% : 10.4 +/- 4.3%). And high dose TNF-alpha also did not induce significant apoptosis(10.2 +/- 3.6% : 10.4 +/- 4.3%). There was no detectable morphological changes of cardiomyocytes after low and high concentration of TNF-alpha treatment. LDH levels after TNF-alpha treatment was not significant compared with control(control : low : high, 3.2 +/- 0.1% : 3.1 +/- 0.2% : 3.3 +/- 0.3%). CONCLUSIONS: Our results suggest that high concentration of TNF-alpha alone can not induce apoptosis and significant cytotoxicity in neonatal rat cardiomyocytes.
Adult ; Animals ; Apoptosis ; Cardiovascular Diseases ; Cell Culture Techniques ; Cell Survival ; Collagenases ; Heart Failure ; Humans ; Lactic Acid ; Muscle Cells ; Myocytes, Cardiac* ; Necrosis ; Rats* ; Receptors, Tumor Necrosis Factor ; Tumor Necrosis Factor-alpha*

Huntington's disease(HD) is an autosomal dominantly inherited neurodegenerative disease, which is characterized by choreic movement and progressive dementia. HD is a disease caused by CAG repeat expansion of huntintin gene and definitely diagnosed or is excluded by molecular genetic analysis. Juvenile HD, of which onset is in children or young adult, is the most severely disabled type and shows several distinct clinical and genetic features in contrast to usual late-onset type. We report a 10 year-old girl who presented with involuntary movement, seizure and moderate dysarthria confirmed by molecular genetic analysis.
Child ; Chorea ; Dementia ; Dysarthria ; Dyskinesias ; Female ; Humans ; Molecular Biology ; Neurodegenerative Diseases ; Seizures ; Young Adult

Pure sensory stroke (PSS), first described by Fisher in 1965, is a clinical condition characterized by numbness and paresthesia of the face, arm and trunk on one side, in absence of other neurologic deficit. PSS could arise anywhere along the sensory system from the cerebral cortex to the medulla. The authors experienced 5 patients with PSS: one patient had a hemorrhage on the thalamocortical pathway including the internal capsule and the corona radiata. Two another had thalarnic lesions. The fourth had a pontine hemorrhage with perioral onionpeel distributed face sensor- involvement. And the last had a pontine lacune involving crossed trigeminothalamic tract and lateral spinothalamic tract.
Arm ; Cerebral Cortex ; Hemorrhage ; Humans ; Hypesthesia ; Internal Capsule ; Neurologic Manifestations ; Paresthesia ; Spinothalamic Tracts ; Stroke*

Arteriovenous fistulae(AVF) are well documented complications of percutaneous renal biopsy. Between August 1995 and April 1997, we prospectively studied 280 consecutive ultransound-guided percutaneous renal biopsies to evaluate the incidence of post-biopsy AVF and its natural course. All biopsies patients were monitored through a routine follow-up echo-color popple sonography at post-biopsy 1, 7, 14 and 30 days. The 28 patients(10%) out of 280 consecutive percutaneous renal biopses were diagnosed to have AVF. There was no differences in the incidence of AVF between native and transplanted kidney biopsy. Most AVF were small(<2cm) and caused minimal or no symptoms. AVF was accompanied with large hematoma(thickness above 2cm) was observed in 9 cases(53%) of 17 native kidneys and none in 10 transplanted kidneys. This difference was statistically significant(P=0.008). At follow-up, AVF resolved spontaneously in 24 cases(87%). In two patients(7.1%) required superselective arterial embolization, one develoved spontaneous rupture of AVF, and one had persistence of AVF over 12 months. We concluded that color Doppler sonography provides a good, non-invasive and safe method for diagnosis and follow up of post-biopsy AVF.
Arteriovenous Fistula ; Biopsy ; Diagnosis ; Fistula* ; Follow-Up Studies ; Humans ; Incidence* ; Kidney ; Prospective Studies ; Rupture, Spontaneous

Amelanotic melanoma is a subtype of malignant melanoma that lacks clinically visible pigmentation. The absence of recognizable pigmentation obscures the clinical hallmark of the more typical form of malignant melanoma. Because it mimics various non-pigmented benign and malignant skin diseases, clinicians have difficulty diagnosing this lesion. An incorrect or delayed diagnosis can result in a worse outcome because the prognosis of melanoma depends on the tumor thickness and tissue invasion at the time of diagnosis. Therefore, early diagnosis is crucial for treating amelanotic melanoma. Dermoscopy is a useful non-invasive technique for diagnosing not only pigmented skin lesions, but also non-pigmented skin lesions because this modality can visualize vascular structures that are not discernible to the naked eye. Analyzing the dermoscopic vascular structures of amelanotic melanoma helps make an early diagnosis. We report here on a case of amelanotic melanoma for which the diagnosis was aided by performing dermoscopy as an adjuvant tool.
Delayed Diagnosis ; Dermoscopy ; Early Diagnosis ; Eye ; Melanoma ; Melanoma, Amelanotic ; Pigmentation ; Prognosis ; Skin ; Skin Diseases

BACKGROUND AND OBJECT: Cheiro-oral syndrome (COS) is characterized by a sensory disturbance in the unilateral hand and ipsilateral mouth corner. It is usually due to a lesion in the parietal cortex, thatamocortical projections, thalamus, or rarely brain stem. However, the syndrome is relatively unknown and rarely mentioned in most neurological textbooks. We presented ten cases of COS with a review of the clinical symptoms and signs and the neuroradiological methods used to demonstrate the responsible site. METHODS AND RESULTS: We studied 10 patients with stroke who showed restricted sensory disturbance on the one hand and ispilateral mouth. The study forms consisted of clinical manifestaion, neurological examination, electrophysiological, and neuroradiologic studies. Computed tomography and/or magnetic resonance imaging identified lesion in the thalamus in 5, brain stem in 3, and corona radiata in 1 patient. But, the anatomical responsible site for one case was not founded. Infarction had occurred in nine cases and hemorrhage in one. Seven of the 10 patients showed sensory disturbances restricted to the perioral area, hands, fingers when they were first examined; the remaining patients complained more diffuse sensory disturbances at first, but it had become restricted to perioral and fingers, usually within 2-3 weeks. The durations of symptom varied from 5 days to more than 15 months and these symptoms were improved within 2-3 weeks to 4 months in treated patients. CONCLUSION: When the symptoms and signs of the COS were presented, especially if a history of migraine is lacking, neuroradiological methods such as CT or MRI should be undertaken to localize and diffentiate the nature of lesion.
Brain Stem ; Fingers ; Hand ; Hemorrhage ; Humans ; Infarction ; Magnetic Resonance Imaging ; Migraine Disorders ; Mouth ; Neurologic Examination ; Rabeprazole ; Stroke ; Thalamus

Glanzmann's thrombasthenia is a rare autosomal recessive hemorrhagic disorder of platelet function with missing or abnormal platelet plasma membrane glycoprotein IIb-IIIa, which functions as a receptor for fibrinogen. We have experienced a case of thrombasthenia in a 6-year-old female whose chief complaints were easy bruising, frequent epistaxis, arthralgia and swelling of the right ankle joint. Bleeding time was prolonged in the presence of normal platelet levels and the platelet aggregation test showed lack of aggregation after exposure to ADP, epinephrine and collagen, but showed an aggregation response to ristocetin. Platelet analysis by flow cytometry is a successful alternative rapid diagnostic technique for Glanzmann's thrombasthenia patients as well as for carriers of this disease. Flow cytometry technique provides an effective tool for investigating platelet function defects caused by altered expression or deficiency of platelet surface proteins.
Adenosine Diphosphate ; Ankle Joint ; Arthralgia ; Bleeding Time ; Blood Platelets ; Cell Membrane ; Child ; Collagen ; Epinephrine ; Epistaxis ; Female ; Fibrinogen ; Flow Cytometry* ; Glycoproteins ; Hemorrhagic Disorders ; Humans ; Membrane Proteins ; Platelet Aggregation ; Ristocetin ; Thrombasthenia*