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

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

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

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

Pharyngeal dysphagia can be caused by structural abnormalities or neurological disorders such as stroke, meningitis, and other conditions. Herpes zoster (HZ), caused by the varicella-zoster virus (VZV), is a rare cause of pharyngeal dysphagia. The symptoms of HZ usually involve a painful rash with vesicles along the dermatome area, but it can also affect the cranial nerves (CN), such as CN VII (Ramsay-Hunt syndrome), and less commonly, other CN. A 69-year-old man presented with a sore throat and dysphagia symptoms. A laryngoscopy revealed multiple ulcerative mucosal lesions on the right soft palate and lateral pharynx. The patient was treated with oral valacyclovir, and although the lesions disappeared, the dysphagia symptoms remained. While dysphagia associated with a VZV infection is rare, it can occur with the additional symptoms of vocal cord paralysis. This paper reports a rare case of pharyngeal dysphagia caused by a VZV infection, and the patient presented only with the initial symptoms of sore throat and dysphagia without skin lesions or signs of vocal cord paralysis.

Pharyngeal dysphagia can be caused by structural abnormalities or neurological disorders such as stroke, meningitis, and other conditions. Herpes zoster (HZ), caused by the varicella-zoster virus (VZV), is a rare cause of pharyngeal dysphagia. The symptoms of HZ usually involve a painful rash with vesicles along the dermatome area, but it can also affect the cranial nerves (CN), such as CN VII (Ramsay-Hunt syndrome), and less commonly, other CN. A 69-year-old man presented with a sore throat and dysphagia symptoms. A laryngoscopy revealed multiple ulcerative mucosal lesions on the right soft palate and lateral pharynx. The patient was treated with oral valacyclovir, and although the lesions disappeared, the dysphagia symptoms remained. While dysphagia associated with a VZV infection is rare, it can occur with the additional symptoms of vocal cord paralysis. This paper reports a rare case of pharyngeal dysphagia caused by a VZV infection, and the patient presented only with the initial symptoms of sore throat and dysphagia without skin lesions or signs of vocal cord paralysis.

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.

Pharyngeal dysphagia can be caused by structural abnormalities or neurological disorders such as stroke, meningitis, and other conditions. Herpes zoster (HZ), caused by the varicella-zoster virus (VZV), is a rare cause of pharyngeal dysphagia. The symptoms of HZ usually involve a painful rash with vesicles along the dermatome area, but it can also affect the cranial nerves (CN), such as CN VII (Ramsay-Hunt syndrome), and less commonly, other CN. A 69-year-old man presented with a sore throat and dysphagia symptoms. A laryngoscopy revealed multiple ulcerative mucosal lesions on the right soft palate and lateral pharynx. The patient was treated with oral valacyclovir, and although the lesions disappeared, the dysphagia symptoms remained. While dysphagia associated with a VZV infection is rare, it can occur with the additional symptoms of vocal cord paralysis. This paper reports a rare case of pharyngeal dysphagia caused by a VZV infection, and the patient presented only with the initial symptoms of sore throat and dysphagia without skin lesions or signs of vocal cord paralysis.