Thrombotic thrombocytopenic purpura (TTP) is an uncommon disorder, frequently fatal, characterized by a pentad of thrombocytopenia, microangiopathic hemolytic anemia, fluctuating neurologic symptoms, fever, and renal disease. TTP is characterized by widespread noninflammatory thrombotic occlusions of arterioles and capillaries with material containing fibrin and platelets. Generally, gross infarct is rare in the patient with TTP. We present a case of TTP with multiple gross infarcts on brain CT scan. A 53-year-old-man was presented with left hemiparesis and confused mentality. On laboratory study, he had microangiopathic hemolytic anemia & thrombocytopenia. Brain CT showed multiple gross infarct areas in the right basal ganglia, right parietal lobe and right cerebellar hemisphere. When managing the patient with acute stroke syndrome, we should consider TTP as a diagnostic possibility for early proper treatment, even if CT scan of brain show multiple gross infarctions.
Anemia, Hemolytic ; Arterioles ; Basal Ganglia ; Brain ; Capillaries ; Fever ; Fibrin ; Humans ; Infarction* ; Neurologic Manifestations ; Paresis ; Parietal Lobe ; Purpura, Thrombotic Thrombocytopenic ; Stroke ; Thrombocytopenia ; Tomography, X-Ray Computed

PURPOSE: The purpose of this study was to identify the factors that affect quality of life in elderly people with dementia. METHODS: The participants for this descriptive correlational study were 97 elderly patients with dementia who were attending a daycare center or were being cared for at home. Data were collected from the participants using the Mini-Mental Status Examination-Dementia Scale, the Geriatric Depression Scale (Short Form), Activity of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) Scale. RESULTS: There were statistically significant differences in quality of life of elders with dementia according to mobility, using dementia day-care center, and cohabitation. In multiple regression analysis, depression, activity of daily of living, using dementia day-care centers and cohabitation were significant predictors of quality of life and the four variables explained 60% of the variance in quality of life. CONCLUSION: Findings indicate that to enhance the quality of life for elders with dementia, depression needs to be decreased and regular use of daycare service recommended. Further, various programs enhancing physical ability need to be developed and used with these elders.
Activities of Daily Living ; Aged* ; Dementia* ; Depression ; Humans ; Quality of Life*

BACKGROUND: Pleural eosinophilia is rare and commonly considered to be an indicator of good prognosis. The diagnostic significance of eosinophilic pleural effusions remains controversial despite a century of observation and discussion. This study was conducted to assess the prevalence of eosinophilia in 446 consecutive samples of pleural fluid, to review the cause of eosinophilic pleural effusion and to determine whether the presence of eosinophils increases the likehood of benign conditions. METHOD: A retrospective analysis was performed upon patients that underwent first thoracentesis due to pleural effusion between January 1999 and December 1999. RESULTS: Eosinophilic pleural effusions were identified in 24 of the 446 patients (5.4%). Malignancy, parapneumonic effusion and tuberculosis were determined the major causes of pleural effusion (80.6%). Malignancy was diagnosed as frequently in eosinophilic effusions as in non-eosinophilic effusions (54.2% vs 50.5%, p=0.725). No difference was found in the prevalence of eosinophilic and non-eosinophilic effusion according to the etiology. The mean blood eosinophil ratio in patients with eosinophilic pleural effusion was 5.4% and no significant correlation existed between the blood and pleural eosinophilic count. CONCLUSION: Pleural eosinophilia is not helpful for differentiating benign and malignant etiology and is not related with blood eosinophilia or repeated tapping.
Eosinophilia ; Eosinophils* ; Humans ; Pleural Effusion* ; Prevalence ; Prognosis ; Retrospective Studies ; Tuberculosis

The blink reflex is an electrically induced glabella response that has long been used in clinical neurology. The blink reflex is now known to be a polysynaptic reflex with an afferent arc through sensory fibers of the trigerminal nerve and with an c,fferent arc through the motor fibers of the facial nerve. This study was performed to determine the relationship of latency and amplitude to ethnic groups sex and age and to obtain the normal data of korean in the blink reflex(BR) and direct facial nerve stimulation test(DFNS). BR and DFNS were recorded in 103 normal korean adults that consisted of 52 men and 51 women and the age ranged 22 to 77 years. The results are as follows: (1) the Rl wave was more stable than R2 and contralateral R2 wave, (2) there seerns to be no significant difference of latency and amphtude between ethnic groups, (3) the latency of Rl wave was shorter and the amplitude of CMAP was larger m men compared with women and (4) the latency of Rl wave was increased by aging.
Adult* ; Aging ; Blinking* ; Ethnic Groups ; Facial Nerve* ; Female ; Humans ; Male ; Neurology ; Reflex

An alveolar soft part sarcoma(ASPS) is a rare malignant soft tissue tumor, which metastasizes to the lung, bone and brain. Recently, we encountered an unusual case of a metastatic ASPS to the bilateral breasts in a 27-year-old woman. She had undergone surgery for an ASPS in her right thigh two years ago, which metastasized to the breast on three occasions, 15 months, 20 months and two years after surgery.
Adult ; Brain ; Breast ; Female ; Humans ; Immunohistochemistry ; Lung ; Neoplasm Metastasis* ; Sarcoma, Alveolar Soft Part* ; Thigh ; Viperidae

Although laryngomalacia is the most common cause of congenital stridor in infancy, it is a benign, self-limited disease which usually resolves by the age of 18 months with no long- term sequelae. Nevertheless, infants who suffered from recurrent stridor and respiratory distress should be evaluated for other causes of stridor such as cardiopulmonary anomalies. We report 3 cases of infants who had recurrent stridor and respiratory distress from their early infancy. Case 1 had a double aortic arch and a tracheomalacia, case 2 had a hypoplasia of the right lung, and case 3 had a horseshoe lung as well as scimitar syndrome. Physicians should be alert for the possibility of the congenital cardiopulmonary abnormalities in infants with recurrent stridor and/or respiratory distress.
Aorta, Thoracic ; Dyspnea ; Humans ; Infant ; Laryngomalacia ; Lung ; Respiratory Sounds ; Scimitar Syndrome ; Tracheomalacia

Myasthenia gravis (MG) is regarded as autoimmune disorder of neuromuscular transmission and apparently is due to formation of humoral antibody that cross-link to acetylcholine receptor at skeletal muscle end plate. Patients with autoimmune diseases often have circulating antibodies to a variety of different autoantigens and show a variety of manifestations of autoimmune diseases in more than one organ. Therefore, MG patients frequently have manifestations of autoimmune diseases such as thyroid disease, rheumatoid arthritis and systemic lupus erythematosus. But MG in association with premature ovarian failure (POF) rarely has been described. A case of MG with POF and thyroid autoantibodies was experienced and presented with a brief review of literature.
Acetylcholine ; Antibodies ; Arthritis, Rheumatoid ; Autoantibodies ; Autoantigens ; Autoimmune Diseases ; Humans ; Lupus Erythematosus, Systemic ; Muscle, Skeletal ; Myasthenia Gravis* ; Primary Ovarian Insufficiency* ; Thyroid Diseases ; Thyroid Gland*

A series of 61 cases of primary hemifacial spasm have been evaluated by means of blink reflex and needle electromyography and their result compared with unaffected site. The R1 and R2 response and late acti-ity. After activity in blink reflex. And electrical activity in EMG at rest were observed. The results of study were as in the followings: 1) The arnplitude of large R1 and R2 responses were increased in affected side in contrast to unaffected side. 2) late activity(72.2%) and after activity(83.6%) were observed in only affected side at rela-ti-ely Iong duration, as well as regular interval spontaneous repetivive discharges in EMG at rest. This result of large R1 and R2 responses could be compatible with ephaptic ransmission, but late activity, after activity, and spontaneous repetitive MUPs could be explained hyperexcitability of the facial motor nucleus rather than autoexcitation of peripheral facial nerve. Additionally the authors thought that the use of conventional blink reflex as well as specialized blink reflex tests could be very useful for the diagnosis of hemifacial spasm and for the evaluation of it's course.
Blinking* ; Diagnosis ; Electromyography* ; Facial Nerve ; Hemifacial Spasm* ; Needles

Gastrointestinal hemangiomas are not common and congenital lesion. Intestinal bleeding is the most common symptom of it. Hemangiomas were classified with capillary, cavernous and mixed type. Cavernous hemangioma is most common. Colonic cavernous hemangioma is rare and are usually arising in the sigmoid colon or/and rectum. Transverse colonic cavernous hemangioma are very rare. Gastrointestinal hemangioma is commonly developed in childhood and in young adults. Fifty eight-year-old man who complained of hematochezia was admitted. Physical examination was unremarkable. Stool occult blood was positive. Abdominal computerized tomography show normal finding. Colonoscopic examination showed giant and bluish-purple colored vascular malformation, 15 cm in length with tough bleeding, on the transverse colon. The patient underwent segmental resection of transverse colon for confirmatory diagnosis and treatment. The final pathologic diagnosis of the resection lesion was cavernous hemangioma of the transverse colon. We report a case of giant hemangioma of the transverse colon associated with hematochezia, with review of relevant literature.
Capillaries ; Colon ; Colon, Sigmoid ; Colon, Transverse* ; Diagnosis ; Gastrointestinal Hemorrhage* ; Hemangioma ; Hemangioma, Cavernous* ; Hemorrhage ; Humans ; Occult Blood ; Physical Examination ; Rectum ; Vascular Malformations ; Young Adult