Neuroleptic malignant syndrome(NMS) is an uncommon but potentially fatal idiosyncratic reaction to neuroleptics, characterized by muscular rigidity, fever, autonomic dysfunction, and altered consciousness. The major theories to explain NMS is central dopaminergic blockade, but it is unclear. Risperidone is a new antipsychotic drug, a benzisoxazole derivative that blocks dopamine D2 receptor and serotonin type 2 receptor. The comparatively greater serotonin-blocking activity is believed to give risperidone the specific property of not causing any more extrapyramidal side effects than conventional antipsychotics at the optimal dose of 4-8mg/day. It is postulated that risperidone is unlikely to cause NMS. Here, we report a case of risperidone induced neuroleptic malignant syndrome.
Antipsychotic Agents ; Consciousness ; Fever ; Muscle Rigidity ; Neuroleptic Malignant Syndrome* ; Receptors, Dopamine D2 ; Risperidone ; Serotonin

No abstract available.

The Fracture of the os calcis is quite common in relation to fracture in other tarsal bone, and fractures involving the subtalar joint may cause serious and persistant disabilities. The treatment of these calcaneal fractures remains controversial So there is no universal agreement in the treatment of these fractures, especially involving the subtalar joint. Twenty displaced intraarticular fractures of calcaneus in 15 patients were treated by open reduction and internal fixation with a plate and screws and bone graft through a lateral approach to elevate the depressed lateral portion of the posterior facet at the Inchon Chritian Hospital from Jan., 1990 to Dec, 1991. Twenty feet in 15 patients of calcaneal fractures involving the subtalal joint were treated and were clinically analysed and following result were obtained. 1. The 20 cases were classified according to the Sanders classification, 9 in type II, 9 in type III and 2 in type IV. 2. The 20 cases were treated by open reduction andinteranl fixation with plate and screws and iliac bone graft through an Sanders lateral approach. The bone graft is packed under the elevated posterior to prevent late collapse of the central fragment and to supply structral stability. 3. The preoperative average Böhler's angle was 0.4°. The post operative average Böhler's angle was 23.4° which was increased significantly. 4. Based on assessment of result of Salama, excellenwas 6, good was 7, fair was 4 and poor was 3. 5. The most common complication after treatment was persistant pain, especially beneath the lateral malleolus.
Calcaneus ; Classification ; Foot ; Humans ; Incheon ; Intra-Articular Fractures ; Joints ; Subtalar Joint ; Tarsal Bones ; Transplants

Myotonic dystrophy is a multisystemic disorder inherited as an autosomal dominant trait. The characteristic clinical features include the presence of myotonia, atrophy of the muscles of the face and the sternocleidomastoids and numerous nonmusclar manifestations such as cataracts, frontal baldness, gonadal dysfunctions and cardiac abnormalities. We experienced one case of myotonic dystrophy with prolonged atrial flutter in 30-year-old male who was admitted because of palpitation. We present this case with reviewing literatures.
Adult ; Alopecia ; Atrial Flutter* ; Atrophy ; Cataract ; Gonads ; Humans ; Male ; Muscles ; Myotonia ; Myotonic Dystrophy*

PURPOSE: To report three various cases of retinal hemorrhages caused by Plasmodium vivax malaria. CASE SUMMARY: Two 55-year-old male patients and a 52-year-old male patient with cyclic high fever were admitted to the department of internal medicine. Three of the patients were diagnosed with malaria caused by P. vivax based on a peripheral blood smear. The patients were treated with hydroxychloroquine and premaquine but complained of decreased visual acuity. The patients were examined with funduscopy, fluorescein angiography, and optical coherence tomography. The first case showed 2 areas of retinal hemorrhages on the macular in the right eye and 1 area of retinal hemorrhage in the left eye. The second case showed many cotton-wool spots along with a number of small retinal hemorrhages and tortuous blood vessels in both eyes. The third case showed 1 area of retinal hemorrhage in the right eye and many cotton-wool spots in both eyes. CONCLUSIONS: P. vivax malaria rarely causes retinal hemorrhage. Manifestations of retinal hemorrhage and degree of visual acuity loss may vary among patients. P. vivax malaria should be considered when patients with unexplained high fever present with retinal hemorrhage, even without a history of overseas travel.
Blood Vessels ; Eye ; Fever ; Fluorescein Angiography ; Humans ; Hydroxychloroquine ; Internal Medicine ; Malaria ; Malaria, Vivax ; Male ; Middle Aged ; Plasmodium ; Plasmodium vivax ; Retinal Hemorrhage ; Retinaldehyde ; Tomography, Optical Coherence ; Visual Acuity

No abstract available.
Diabetes Insipidus* ; Pregnancy*

We report a case of coincidental pituitary adenoma and sphenoid meningioma. Computed tomographic scan had shown a large intrasellar rim enhancing mass and another well-enhancing mass with reactive bony thickening on the medial sphenoidal ridge. Magnetic resonance image revealed a snow-man shaped, expansile intrasellar mass, with small supra-sellar component, and a small enplaque-type enhancing dural thickening on the right medial sphenoidal ridge. Histopathologically, the intrasellar mass was diagnosed as pituitary adenoma and the other mass as secretory meningioma. We present clinical, radiological, and histopathological findings and review the reported cases of coincidental pituitary adenoma and meningioma without irradiation or trauma.
Brain Neoplasms ; Meningioma* ; Pituitary Neoplasms* ; Sphenoid Bone

Mitral ring motion and indices of left ventricular diastolic filling were measured by M-mode and Doppler echocardiography in apical 4 chamber view in 11 dilated cardiomyopathy patients and 9 normal subjects without clinical evidence of heart disease. The mean age of patients was 52 years and average heart rate was 76 beats/min. The parameters of mitral annulus motion include earley relaxation amplitude(ER), late atrial contraction amplitude(AC) and A2-peak excursion(A2-PE). Transmitral flow velocity parameters include peak flow velocity of early diastolic flow velocity(PFVE), peak flow velocity of late atrial contraction(PFVA), the ratio between early and late peak flow velocity(PFVE/PFVA), Acceleration rate of early diastolic peak flow(AR), deceleration rate of early diastolic peak flow(DR), time velocity integral of early diastolic flow velocity(TVIE), time velocity integral of late atrial contraction flow velocity(TVIA) and ratio between early diastolic and late atrial flow velocity integral(TVIE/TVIA). In patients with dilated cardiomyopathy, ER(4.5+/-2.3mm) and AC(2.3+/-1.6mm) were significantly decreased than normal(10.7+/-2.6mm, 6.6+/-1.6mm, p<0.01, p<0.01, respectively), whereas ER/AC(1.7+/-0.7) was not significantly different than normal subjects(1.6+/-0.5). A2-PE(100+/-80 msec) was significantly delayed in dilated cardiomyopathy patients than normal subjects(35+/-25 msec, p<0.01). In analysis of transmitral flow velocities, PFVE, PFVA and PFVE/PFVA, etc were not significantly different compared to normal subjects in patients with dilated cardiomyopathy. Mitral ring motion amplitude was decreased and A2-peak excursion time interval(A2-PE) was delayed in patients with dilated cardiomyopathy, but transmitral flow velocities were not significantly different from normal subjects in patients with dilated cardiomyopathy. These results reflect the facts that early diastolic relaxation amplitude is decreased by the change of compliance of LV and late atrial contractin amplitude is decreased by decrease of atrial contractility and increased stiffness of LA and LV. Despite of decreased mitral ring motion, transmitral flow velocity is not significantly different compared to normal subjects in patients with dilated cardiomyopathy. From these evidences, not only transmitral flow velocity affected by multiple factors but also mitral ring motion affected by LA and LV function are considered in assessment of LV diastolic dysfuction.
Acceleration ; Blood Flow Velocity* ; Cardiomyopathy, Dilated* ; Compliance ; Deceleration ; Echocardiography, Doppler ; Heart Diseases ; Heart Rate ; Humans ; Relaxation

A 64-year-old female presented with unconscious state after sudden onset headache, nausea and vomiting. Computed tomography showed acute subdural hematoma (SDH) over the left convexity without subarachnoid hemorrhage. 3D-CT angiogram showed a saccular aneurysm at the junction of A2-A3 of the left anterior cerebral artery. Surgery for decompressive craniotomy and aneurysmal neck clipping was performed. In operative field, the left distal anterior cerebral artery was abnormally elongated toward the frontal pole and located not in the pericallosal cistern but on the cortical surface and the rupturing point was located in the adhesive portion of aneurysmal sac and arachnoid membrane near the falx. Pure acute SDH without subarachnoid hemorrhage (SAH) caused by ruptured aneurysm is extremely rare. Rupture of an aneurysm adhered to either the dura or falx and located in the subdural space may cause pure SDH. In our case, abnormally elongated location of artery may be related to this adhesion and rupture of aneurysm to subdural space. Therefore, ruptured intracranial aneurysm should be considered as a cause of non-traumatic SDH. Immediate removal of the SDH and aneurysmal clipping is recommended in such patients, even those in poor neurological condition.
Adhesives ; Aneurysm ; Aneurysm, Ruptured ; Anterior Cerebral Artery* ; Arachnoid ; Arteries ; Craniotomy ; Female ; Headache ; Hematoma, Subdural, Acute* ; Humans ; Intracranial Aneurysm* ; Membranes ; Middle Aged ; Nausea ; Neck ; Rupture* ; Subarachnoid Hemorrhage ; Subdural Space ; Unconsciousness ; Vomiting

OBJECTIVES: The purposes of this study were to examine the health-related quality of life(HRQoL) and to identify its related factors for a group of rural adults. METHODS: The study subjects were 1,901 adults who were aged 40-70 years and who were living in Naju City, Jeollanamdo. The sociodemographic characteristics, health-related behavior, health status and global self-rated health were collected for statistical analysis. The healthrelated quality of life was measured by the Euroqol EQ-5D instrument. The differences on the EQ-5D index between the groups were assessed with t-test, ANOVA and hierarchical multiple regression analysis. RESULTS: Overall, the mean value of the EQ-5D index was 0.884+/-0.140 and this score was significantly different according to the socioeconomic characteristics, the healthrelated behavior, the health status and the global self-rated health. According to the results from the hierarchical multiple regression analysis, the HRQoL was significantly reduced for females, older subjects, and other subjects with no spouse and the subjects with osteoporosis, obesity, mental distress or poorer global self-rated health. CONCLUSIONS: The HRQoL for rural adults was related to the socioeconomic characteristics, the health status and the global self-rated health. A better understanding of the factors related to the HRQoL would help to improve the rural adults' quality of life.
Aged ; Female ; Health Behavior ; *Health Status ; Humans ; Korea ; Male ; Middle Aged ; *Quality of Life ; Questionnaires ; Risk Factors ; *Rural Population ; Social Class