Background: The clinical manifestations of metastatic brachial plexopathy include pain, sensory loss, paresthesia, weakness, and reduced range of motion. These symptoms closely resemble those of shoulder disorders and peripheral nerve entrapment, which are commonly diagnosed in pain clinics, increasing the risk of misdiagnosis or delayed diagnosis, particularly in patients with a history of malignancy.Case: A 51-year-old woman with a history of breast cancer in complete remission for 19 years presented with shoulder pain, arm weakness, and tingling in the fingers. Initial treatments for suspected cervical radiculopathy, shoulder disorders, and nerve entrapment were ineffective. Electromyography and nerve conduction studies revealed electrophysiological abnormalities consistent with left brachial plexopathy. Magnetic resonance imaging of the brachial plexus confirmed metastatic involvement. The patient is currently undergoing chemotherapy. Conclusions Clinicians must be vigilant of the possibility of malignancy in patients with a history of cancer and should pursue comprehensive diagnostic evaluations to exclude cancer recurrence.

PURPOSE: The purpose of this study was to analyze the radiological and clinical outcomes in elderly patients with unstable intertrochanteric femur fractures in accordance with the length of intramedullary nail. MATERIALS AND METHODS: Between August 2009 and December 2014, a total of 139 patients–older than 65 years of age with AO/OTA classification of 31-A2 unstable intertrochanteric femur fracture–who has been followed-up for at least 1 year after the treatment with internal fixation by using an intramedullary nail were enrolled for this retrospective control study. The subjects were classified into two groups according to the length of intramedullary nail: 106 patients in the short group (group I) and 33 patients in the long group (group II). For radiological assessments, the reduction state, time to union, and implant related complications were examined. The clinical outcomes were assessed by preoperative hemoglobin, operating time, intraoperative bleeding amount, blood transfusion rate, hospitalization period, and Charnley hip pain scoring system at the final follow-up. RESULTS: The postoperative radiographs showed good or acceptable reduction in all cases. The mean time of radiologic bone union was 4.8 months, and there was no difference between the two groups. With respect to surgical time, the group II was found to take longer (57.87 minutes) than the group I (45.65 minutes) (p=0.003). The bleeding amount during surgery of the group II was greater (288.78 ml) than that of the group I (209.90 ml) (p=0.046). The clinical results at the final follow-up were found to be satisfactory in both groups. CONCLUSION: In cases of good reduction of the fracture from the treatment of unstable intertrochanteric femur fracture accompanying the posteromedial fragment in elderly patients, both groups–long and short intramedullary nails–showed satisfactory radiological and clinical outcomes.
Aged* ; Blood Transfusion ; Classification ; Femoral Fractures* ; Femur ; Follow-Up Studies ; Fracture Fixation, Intramedullary* ; Hemorrhage ; Hip ; Hip Fractures ; Hospitalization ; Humans ; Operative Time ; Retrospective Studies

BACKGROUND/AIMS: In 2010, the American Diabetes Association (ADA) adopted glycated hemoglobin (HbA1c) as a new diagnostic criterion for diabetes mellitus. However, HbA1c values may differ among races. We determined whether this criterion could be applied to Korean diabetics. METHODS: Between January 2000 and January 2010, 1,862 patients among Konyang University Hospital visitors in which the 75 g oral glucose tolerance test (OGTT) and HbA1c were checked at the same time were enrolled. We excluded patients with acute disease, an Hb < or = 10 g/dL, a Cr > or = 2 mg/dL, those prescribed oral hypoglycemic agents or insulin, and those who were pregnant. RESULTS: After applying the exclusion criteria, 1,474 Korean patients were enrolled. All had common features of Korean diabetics for body mass index and homeostatic model assessment of insulin resistance values. Using the 0 and 120 minute glucose levels of the OGTT from the receiver operating characteristic curve, the HbA1c cutoff value was 6.25%. The cutoff value to diagnose diabetes with the presence of diabetic retinopathy was 6.75%. CONCLUSIONS: Our study showed a difference between the HbA1c values for diagnosing diabetes and the new diagnostic criterion from the ADA. Considering that the HbA1c characteristics may be influenced by race or culture, larger studies on diabetes complications are needed to identify the appropriate HbA1c value for Korean diabetics.
Acute Disease ; Body Mass Index ; Continental Population Groups ; Diabetes Complications ; Diabetes Mellitus ; Diabetic Retinopathy ; Glucose ; Glucose Tolerance Test ; Hemoglobins ; Humans ; Hypoglycemic Agents ; Insulin ; Insulin Resistance ; Korea ; ROC Curve

Leptospirosis is a zoonotic disease of worldwide distribution that is caused by spirochetes known as Leptospira; more than 20 serogroups and more than 200 serovars are known. The disease has seasonal incidence occurring in the late summer or early fall. The typical severe case of leptospirosis is known as Weil's disease; it is characterized by hepatic and renal involvement and is common in Korea. Elevated amylase can be seen when ARF is associated but true acute pancreatitis is an uncomon complication of leptospirosis and only seven cases of well documented pancreatitis have been described abroad, with there was no case report in Korea yet. We experienced a 55-year old male patient who had Weil's disease associated with acute pancreatitis which was confirmed by elevated amylase and lipase with pancreatic swelling and peripancreatic fat infiltration on abdomen CT.
Abdomen ; Amylases ; Humans ; Incidence ; Korea ; Leptospira ; Leptospirosis ; Lipase ; Male ; Middle Aged ; Pancreatitis* ; Seasons ; Spirochaetales ; Weil Disease* ; Zoonoses

Leptospirosis is a zoonotic disease of worldwide distribution that is caused by spirochetes known as Leptospira; more than 20 serogroups and more than 200 serovars are known. The disease has seasonal incidence occurring in the late summer or early fall. The typical severe case of leptospirosis is known as Weil's disease; it is characterized by hepatic and renal involvement and is common in Korea. Elevated amylase can be seen when ARF is associated but true acute pancreatitis is an uncomon complication of leptospirosis and only seven cases of well documented pancreatitis have been described abroad, with there was no case report in Korea yet. We experienced a 55-year old male patient who had Weil's disease associated with acute pancreatitis which was confirmed by elevated amylase and lipase with pancreatic swelling and peripancreatic fat infiltration on abdomen CT.
Abdomen ; Amylases ; Humans ; Incidence ; Korea ; Leptospira ; Leptospirosis ; Lipase ; Male ; Middle Aged ; Pancreatitis* ; Seasons ; Spirochaetales ; Weil Disease* ; Zoonoses

Transient monocular blindness (TMB) may occur in patients with systemic lupus erythematosus (SLE). Several mechanisms have been suspected as the causes of such TMBs. A 32-year-old female patient with SLE presented recurrent monocular altitudinal visual field defects lasting for several minutes and occurring less than six times per day. Her anticardiolipin antibody level was persistently positive. All cerebrovascular imagings were normal. We report a case of recurrent TMBs in SLE with antiphospholipid antibody syndrome, which may have been induced by vasospasm.
Adult ; Amaurosis Fugax* ; Antibodies, Anticardiolipin ; Antibodies, Antiphospholipid* ; Antiphospholipid Syndrome* ; Female ; Humans ; Lupus Erythematosus, Systemic* ; Visual Fields

PURPOSE: Gingko biloba extract (GBE), a natural product extracted from Gingko leaves, is known to increase the radiosensitivity of tumors. This radiosensitization probably arises from the increase in the peripheral blood flow by decreasing the blood viscosity and relaxing the vasospasm. The influence of a GBE on the metabolic status in fibrosarcoma II (FSaII) of a C3H mouse was investigated using 31P magnetic resonance spectroscopy (MRS). MATERIALS AND METHODS: Eighteen C3H mice with fibrosarcoma II (from 100 mm3 to 130 mm3) were prepared for this experiment. The mice were divided into 2 groups; one (9 mice) without a priming dose, and the other (9 mice) with a priming dose of GBE. The GBE priming dose (100 mg/kg) was administered by an intraperitoneal (i.p.) injection 24 hours prior to the measurement. First 31P MRS spectra were measured in the mice from each group as a baseline and test dose of GBE (100 mg/kg) was then administered to each group. One hour later, the 31P MRS spectra were measured again to evaluate the change in the energy metabolic status. RESULTS: In the group without the priming dose, the mean pH, PCr/Pi, PME/ATP, Pi/ATP, PCr/(Pi+ME) values 1 hour after the test dose were not changed significantly compared to the values at the baseline. However, in the group with the priming dose, the mean PCr/Pi, Pi/ATP, PCr/(Pi+PME) values 1 hour after the test dose changed from the baseline values of 0.49, 0.77, 0.17 to 0.74, 0.57, 0.28 respectively. According to the paired t-test, the differences were statistically significant. CONCLUSION: The above findings suggest that the metabolic status is significantly improved after administering GBE if the priming dose is given 24 hours earlier. This shows that the radiosensitizing effect of GBE is based on the increase of tumor blood flow and the improvement in the metabolic status.
Animals ; Blood Viscosity ; Energy Metabolism ; Fibrosarcoma* ; Ginkgo biloba* ; Hydrogen-Ion Concentration ; Magnetic Resonance Spectroscopy* ; Mice ; Mice, Inbred C3H* ; Radiation Tolerance ; Radiation-Sensitizing Agents

Nocturnal enuresis has been recognized as an adverse effect of clozapine treatment. We reported 3 chronic schizophrenic patients who had showed nocturnal enuresis following clozapine treatment. Oxybutynin hydrochloride on clozapine-induced enuresis was very effective in 3 patients. The dose in our patients was 5 to 10mg/day. This medication was well tolerated. It is suggested that oxybutynin hydrochloride is a effective therapeutic option in clozapine-induced nocturnal enuresis.
Clozapine* ; Enuresis ; Humans ; Nocturnal Enuresis* ; Schizophrenia

BACKGROUND: The cause of autoimmune thyroid diseases (AITD), including Graves disease and Hashimotos thyroiditis, is largely unknown. To identify the genes responsible, most attention has been focussed on the HLA regions in the early studies. However, these studies have repeatedly shown a weak association between AITD and the HLA-DR3 in Caucasians. To understand and find out the mechanisms underlying the development of AITD, a search for non-HLA linked susceptibility genes is important. A recent study from American population have indicated an association between a polymorphism of CILA-4 gene and Graves disease. To clarify the relationship of the CTLA-4 polymorphism and AITD, the allele frequency of CTLA-4 gene from the patients with Graves disease and with Hashimotos thyroiditis in Korean papulation were analysed. METHODS: The CTLA-4 exon 1 polymorphism (49, A/G) was analysed by PCR-based, RFLP (Restriction Fragment Length Polymorphism) from 92 women and 37 men with Graves disease and 50 women and 9 men with Hashimotos thyroiditis diagnosed. Also, 287 healthy controls including 155 women and 132 men with no clinical evidence or family history of thyroid disease were enrolled. RESULTS: 1) In the group of Graves disease, there was significantly more patients with alanine homozygote (GG) than in control group (P<0.0005, RR=1.40). However, there was not significant with threonine homozygote (AA) between two groups (P=0.052). In the group of Hashimotos thyroiditis, no significant differences were found between all homozygotes and heterozygote. 2) In the group of Graves disease, there were significantly more patients with alanine homozygote (GG) (P<0.0001, RR=1.85) and significantly fewer patients with threonine homozygote (AA) than in the group of Hashimoto's thyroiditis (P<0.005, RR 0.25). CONCLUSION: Regardless of sex difference, alanine homozygote (GG) at exon 1 (codon 17) of CTLA-4 is associated with Graves disease in Korean population, which suggests genetic susceptibility is some role in the pathogenesis of Graves disease.
Alanine ; Exons ; Female ; Gene Frequency ; Genetic Predisposition to Disease ; Graves Disease ; Heterozygote ; HLA-DR3 Antigen ; Homozygote ; Humans ; Lymphocytes* ; Male ; Polymorphism, Restriction Fragment Length ; Sex Characteristics ; Threonine ; Thyroid Diseases* ; Thyroid Gland* ; Thyroiditis

The authors have clinically analysed the patients who required the reoperations after the aneurysmal clippings with intention to decrease the rate of reoperation as predicting the risk factors causing the postoperative complications or sequelae of subarachnoid hemorrhage. Between 1991 and 1996, we have performed total operation on 691 patients with aneurysmal subarachnoid hemorrhage. Among these, 72 patients(10.4% of total) required to be reoperated due to various causes. The shunt for hydrocephalus which was the most common cause of reoperation, performed in 57 patients(79.2% of the reoperated), and next, trephination for the subdural hygroma in 12 cases (16.7%), removal of the intracranial hematoma on the operated site in 7 cases(9.7%), reclipping of aneurysms for the regrowing of aneurysm rest or undiscovered aneurysm preoperatively in 5 cases(7%), and decompressive surgery for postoperative brain swelling and vasospasm in 2 cases(2.8%). The authors suggest that the perfect aneurysmal clipping and the detailed evaluation to decrease these complications of aneurysmal surgery, and careful attention should be given to find out the hidden or regrowing of aneurysmal rest are needed on pre-, postoperatively, and during the operation procedure.
Aneurysm* ; Brain Edema ; Hematoma ; Humans ; Hydrocephalus ; Intention ; Postoperative Complications ; Reoperation ; Risk Factors ; Subarachnoid Hemorrhage ; Subdural Effusion ; Trephining