BACKGROUND: It is important to consider leprosy as a cause of peripheral neuropathy, as it is readily treatable. We analyzed clinical and electrodiagnostic characteristics of leprosy patients with peripheral nerve involvement. METHODS: This study was a retrospective analysis of nerve conduction studies (NCS) and the medical records of 10 patients with leprosy were confirmed by a skin or nerve biopsy. NCS using a conventional surface technique were performed in 15 upper extremities and 14 lower extremities. RESULTS: Among ten patients, three patients presented with mononeuropathy, and the others with mononeuropathy multiplex. Five patients had medical histories of leprosy treatment. The patterns of peripheral neuropathies were mononeuropathy multiplex except for one who had an ulnar mononeuropathy. On motor NCS, low or absent CMAPs were most common abnormalities followed by slow conduction velocity and prolonged terminal latency. Sensory NCS also showed changes of amplitudes rather than in conduction velocity. The conduction block of CMAPs with or without dispersion were observed in 5 patients usually on the ulnar nerve at the forearm. CONCLUSIONS: In most instances, leprous patients with neuropathy presented with mononeuropathy multiplex affecting the sensory and motor nerves. NCS showed more likely axonal than demyelinating changes, but the conduction blocks were also found frequently at the forearms.
Axons ; Biopsy ; Forearm ; Humans ; Leprosy ; Lower Extremity ; Medical Records ; Mononeuropathies ; Neural Conduction ; Peripheral Nerves ; Peripheral Nervous System Diseases ; Retrospective Studies ; Skin ; Ulnar Nerve ; Upper Extremity

OBJECTIVE: The goal of this study was to examine the colposcopic findings underlying referred cytologic abnormalities classified according to the Bethesda system. Further determine the strength of correlations between the referral smear performed at colposcopy, and the histologic diagnosis. METHODS: The charts of 462 patients who had referred to our hospital due to abnormal cytology at another hospitals from Jan. 1997 to Dec. 2001 at Soonchunhyang University Chunan Hospital were retrospectively reviewed. According to the necessities, repeat Pap, colposcopy-guided biopsy and conization was done. Results were compared both with referral Pap. One way ANOVA and chi-square test were used for statistical analysis. RESULTS: The results were as follows. 1. Mean age of the patients was 46.3 +/- 3.7 years. 2. Mean interval between referral smear and repeat smear or colposcopy was 3-82 days. 3. The agreement between referral and repeat Pap smears was 48.4%, no AGUS smears were conformed by repeat cytology and abnormal referral smears reverted to negative in 36.7%: 28.6% for the women with ASCUS, 50% with AGUS, 60% with LSIL, 36.4% with HSIL, and 13% with cancer. 4. The likelihood of a negative colposcopy guided biopsy of referral Pap smears was 14.3% for the women with ASCUS, 50% with AGUS, 25% with LSIL, 15.4% with HSIL, and 0% with cancer and more severe lesion than LSIL was found in 71.4% with ASCUS, 100% with AGUS, 68.8% with LSIL, 84.6% with HSIL, 100% with cancer. 5. The likelihood of a negative colposcopy guided biopsy of repeat Pap smears was 9.1% for the women with ASCUS, 50% with LSIL, 9.5% with HSIL, and 0% with cancer and more severe lesion than LSIL was found in 90.9% with ASCUS, 50% with LSIL, 90.5 with HSIL, 100% with cancer. 6. The likelihood of a negative conization of referral Pap smears was 12.5% for the women with ASCUS, 33.3% with AGUS, 0% with LSIL, 16.4% with HSIL, and 0% with cancer and more severe lesion than LSIL was found in 87.5% with ASCUS, 66.6% with AGUS, 100% with LSIL, 83.6% with HSIL, 100% with cancer. CONCLUSION: The agreement of referral smears with colposcopic biopsy and conization was 54.3% and 51.9%, respectively. Since the cytology classified according to the Bethesda system does not accurately predict histologic diagnosis, cytologic findings should not be used to determine treatment. Further we should use other methods as colposcopy, punch biopsy and conization to determine treatment.
Biopsy* ; Chungcheongnam-do ; Colposcopy ; Conization ; Diagnosis ; Female ; Humans ; Referral and Consultation ; Retrospective Studies

OBJECTIVE: Cervical cancer is the most common malignancy of the female genital tract in Korea. Recognized prognostic factors include FIGO stage, histologic grade, depth on invasion, primary cancer screening and age. However, prognosis of pregnant woman with cervical cancer is unclear. We reviewed our patients in an attempt to identify the best management options which resulted in long term survival for the mother. METHODS: We retrospectively investigated the results of 11 patients with CIS and cervical cancer in pregnant patients who had been diagnosed and treated at Soonchunhyang University Medical center from January 1990 to December 2002. RESULTS: The age range was 23-41 years. Six patients were CIS and performed LEEP conization during pregnancy. One patient had stage Ia disease and 3 patients had stage Ib with radical hysterectomy after Cesarean section. 4 cases were diagnosed as squamous cell cancer. One patient with stage Ib had been referred to our hospital at 28 gestational weeks. Another one patient with high risk histology (mucinous adenocarcinoma) pointed out polypectomy at 26 gestational weeks. One year later, the case died after treatment. All of 11 patients were treated surgically and two patients achieved pregnancy again with three live births. Preterm delivery after conization occured in one case at 34 gestational weeks. HPV infection was diagnosed in 82% of patients. The HPV type 16 was infected 4 patients, type 18 was one patient, type 58 was one patient, and mixed another type were 2 patients. CONCLUSION: We conclude that all pregnant women should have a Pap smear performed antenatally. Cone biopsy can be safely performed in pregnant women and may be adequate treatment for CIS. When cervical cancer complicates with pregnancy, decisions, management must include maternal and fetal consideration.
Academic Medical Centers ; Biopsy ; Carcinoma in Situ* ; Cesarean Section ; Conization ; Early Detection of Cancer ; Female ; Humans ; Hysterectomy ; Korea ; Live Birth ; Mothers ; Neoplasms, Squamous Cell ; Pregnancy* ; Pregnant Women ; Prognosis ; Retrospective Studies ; Uterine Cervical Neoplasms*

Bilateral hypoglossal nerve palsy is a rare clinical presentation. We report a case of central skull base osteomyelitis (SBO) presenting with complete tongue paralysis in a 53-year-old man who was not diabetic or immunocompromised. Magnetic resonance imaging demonstrated characteristic features including abnormal contrast enhancement in the clivus (T1-weighted images). Blood tests revealed elevated acute-phase reactants and leukocytosis, which prompted prolonged antibiotic treatment. He responded well to the antibiotics, which together with typical clinical and imaging findings led to the diagnosis of bacterial SBO.
Acute-Phase Proteins ; Anti-Bacterial Agents ; Cranial Fossa, Posterior ; Hematologic Tests ; Humans ; Hypoglossal Nerve ; Hypoglossal Nerve Diseases ; Leukocytosis ; Magnetic Resonance Imaging ; Middle Aged ; Osteomyelitis ; Paralysis ; Skull ; Skull Base ; Tongue

BACKGROUND: Coronary artery disease are increasing in recent years among Korean due to change of dietary pattern. We conducted a cross sectional study to analyze various factors for low HDL cholesterol knowns as a independent risk factor for coronary artery disease. METHODS: At the health care center of Asan Medical Center in 1999, 7259 people without cardiovascular disease, cerebrovascular disease, hyperlipidemia were selected. They were exmined weight, height, blood pressure. Other data was drawn from questionnaire, blood chemistry. SPSS (version 7.5) was used for analysis of this data. RESULTS: 1) The means of HDL cholesterol level was higher in women than men. 2) The means of HDL cholesterol of men was lower in subgroup of age below 45 years old, obesity, lower total cholesterol(< 240 mg/dL), higher triglyceride (> OR =200 mg/dL), current smoking, sedantary life style than others. In women, it was lower in subgroup of over 55 years old, obesity, diabetes, hypertention, lower total cholesterol(< 240 mg/dL), higher triglyceride (> OR =200 mg/dL) than others. By multilple logistic analysis, obesity, triglyceride, current smoking, moderate alcohol drinking were significant factors associated with low HDL cholesterol (< 42 mg/dL, 25 percentile of study paricipants). CONCLUSION: These resluts suggest that obesity, high triglyceride, current smoking are independent risk factors and moderate alcoholic drinking is a negative risk factor of low HDL cholesterol in this study participants.
Adult* ; Alcohol Drinking ; Alcoholics ; Blood Pressure ; Cardiovascular Diseases ; Chemistry ; Cholesterol, HDL* ; Chungcheongnam-do ; Coronary Artery Disease ; Delivery of Health Care ; Drinking ; Female ; Humans ; Hyperlipidemias ; Life Style ; Male ; Middle Aged ; Obesity ; Risk Factors ; Smoke ; Smoking ; Triglycerides ; Surveys and Questionnaires

Many monogenic neurodevelopmental disorders have been newly identified in recent years owing to the rapid development of genetic sequencing technology. These include variants of the epigenetic machinery – up to 300 known epigenetic factors of which about 50 have been linked to specific clinical phenotypes. Chromodomain, helicase, DNA binding 1 (CHD1) is an ATP-dependent chromatin remodeler, known to be the causative gene of the autosomal dominant neurodevelopmental disorder Pilarowski-Bjornsson syndrome. Patients exhibit various degrees of global developmental delay, autism, speech apraxia, seizures, growth retardation, and craniofacial dysmorphism. We report the first case of Pilarowski-Bjornsson syndrome in Korea, due to a de novo missense variant of the CHD1 gene (c.862A>G, p.Thr288Ala) in a previously undiagnosed 17-yearold male. His infantile onset of severe global developmental delay, intellectual disability, speech apraxia, and failure to thrive are compatible with Pilarowski-Bjornsson syndrome. We also noted some features not previously reported in this syndrome such as skeletal dysplasia and ichthyosis. Further studies are needed to discover the specific phenotypes and pathogenic mechanisms behind this rare disorder.

Purpose: The aim of this study was to develop a neural network that accurately and effectively segments the median nerve in ultrasound (US) images. Methods: In total, 1,305 images of the median nerve of 123 normal subjects were used to train and evaluate the model. Four datasets from two measurement regions (wrist and forearm) of the nerve and two US machines were used. The neural network was designed for high accuracy by combining information at multiple scales, as well as for high efficiency to prevent overfitting. The model was designed in two parts (cascaded and factorized convolutions), followed by selfattention over scale and channel features. The precision, recall, dice similarity coefficient (DSC), and Hausdorff distance (HD) were used as performance metrics. The area under the receiver operating characteristic curve (AUC) was also assessed. Results: In the wrist datasets, the proposed network achieved 92.7% and 90.3% precision, 92.4% and 89.8% recall, DSCs of 92.3% and 89.7%, HDs of 5.158 and 4.966, and AUCs of 0.9755 and 0.9399 on two machines. In the forearm datasets, 79.3% and 87.8% precision, 76.0% and 85.0% recall, DSCs of 76.1% and 85.8%, HDs of 5.206 and 4.527, and AUCs of 0.8846 and 0.9150 were achieved. In all datasets, the model developed herein achieved better performance in terms of DSC than previous U-Net-based systems. Conclusion The proposed neural network yields accurate segmentation results to assist clinicians in identifying the median nerve.

No abstract available.
Asian Continental Ancestry Group ; Encephalitis, Japanese ; Humans ; Temporal Lobe

In clinical practice, primary healthcare physicians commonly encounter patients with alcohol-related problems. This review article introduces the concept of an alcohol clinic for treating patients with these issues at primary healthcare clinics.Current Concepts: Alcohol-related problems often give rise to health problems, which prompts primary healthcare physicians to be required to develop screening, treatment, and counseling skills. Primary healthcare clinics should actively screen for alcohol-related problems. Screening involves questions regarding the frequency, quantity, and maximum consumption of alcohol to determine risk levels. For Koreans, moderate alcohol consumption is defined as ≤8 drinks per week (1 drink=14 g of alcohol) for men aged up to 65 years, and ≤4 drinks per week for men over 65 years; consumption for women is set at half of the amount defined for men. Individuals experiencing facial flushing after alcohol consumption are advised to limit their alcohol intake to half the amount consumed by those who do not experience flushing.Discussion and Conclusion: The focus for these patients should be on their environment, particularly when implementing a family-oriented approach. The decision to initiate drug treatment should be based on the symptoms of the patient, with follow-up evaluations performed at appropriate time points. The “FRAMES Motivational Enhancement Interview” and “Insight Enhancement Counseling” are recommended for an effective counseling of patients.

Tubal leiomyoma during pregnancy is rare. Fewer than 100 cases of leiomyoma of the fallopian tube have been described in the literature. Most of them are asymptomatic. The diagnosis is incidentally if there is a primary tubal lesion such as ectopic pregnancy or during the general gynecologic operation. The tube must be entirely sectioned and completely examined whether there is primary tubal adenocarcinoma, if rare. We experienced a case of tubal leiomyoma in woman at 38+5 weeks gestation with previous primary cesarean section diagnosed after repeat cesarean delivery and bilateral tubal ligation with a brief review of literature.
Adenocarcinoma ; Cesarean Section ; Diagnosis ; Fallopian Tubes ; Female ; Humans ; Leiomyoma* ; Pregnancy* ; Pregnancy, Ectopic ; Sterilization, Tubal