A 2.5-year-old female patient who has a prior history of partial seizures was admitted by generalized tonic-clonic status epilepticus secondary to tapering of phenobarbital. Tonic-clonic status epilepticus was refractory to phenytoin, phenobarbital, valproic acid, diazepam, and pentobarbital. After 4 days of unsatisfactory control of seizure activity, isoflurane was administered for 4 hours. Inspired isoflurane concentration of 1.3% were required to control seizures. Heart rate and blood pressure were supported with infusions of dopamine and fluid. After discontinuation of isoflurane, the patient developed partial seizures but seizure activity was controlled with anticonvulsants. She was discharged alive from the hospital after weaning of the ventilator.
Anesthesia, General* ; Anticonvulsants ; Blood Pressure ; Diazepam ; Dopamine ; Female ; Heart Rate ; Humans ; Isoflurane ; Pentobarbital ; Phenobarbital ; Phenytoin ; Seizures ; Status Epilepticus* ; Valproic Acid ; Ventilators, Mechanical ; Weaning

Global aphasia without other focal neurologic lateralizing signs (GWLS) is an uncommon stroke syndrome. The pathogenesis of GWLS has been thought as the result of multiple cardioembolism. However, a few cases of GWLS with a single lesion have been reported. We report an unusual case of GWLS with a single left superior temporal infarction. A 73-year-old right handed man was admitted with receptive and expressive language impairment without other focal neurologic lateralizing signs. The patient's global aphasia symptom has being 4 weeks after symptom onset. Brain CT showed only one lesion of left superior temporal lobe. Our case notes that the multiple lesions of the speech area are not only necessary to produce GWLS, and it is not necessarily imply a double lesion or an embolic causes.
Aged ; Aphasia* ; Brain ; Hand ; Humans ; Infarction ; Stroke ; Temporal Lobe

BACKGROUND/AIMS: It has been reported that the difference in the hepatitis C virus (HCV) genotype due to genetic heterogeneity of HCV influence the clinical features, prognosis of HCV associated liver disease and response to interferon therapy. Prevalence of different genotypes of HCV may also vary between geographic areas. The aim of this study was to examine the relationship between the response to interferon alpha (IFN-a) therapy and HCV genotypes in patients with chronic HCV infection in Taegu and its environs. METHODS: One hundred seventy six patients known to be HCV antibody and HCV-NA positive were evaluated for HCV genotypes by restriction fragment length polymorphism. Among patients who had elevated ALT levels, 67 patients have been investigated for the role of the HCV genotype on disease outcome and the response of IFN-a therapy. RESULTS: Genotype 1b were found in 59.0% of patients (103/176), genotype 2a in 37.5% (66/176). The mode of transmission of HCV infection was guessed as transfusion in genotype 1b, but as parenteral infection in genotype 2a. According to their response to IFN-a therapy, 73 patients were divided into three groups, complete response, 18 (60%) of 30 patients with genotype 2a and 21 (48.8%) of 43 patients with genotype 1b: partial response, 5 (16.7%) of 30 patients with genotype 2a and 7 (16.2%) of 43 patients with genotype 1b: no response, 7 (23.3%) of 30 patients with genotype 2a and 15 (34.9%) of 43 patients with genotype 1b. Good response to IFN-a therapy was observed among patients group showing normal platelet count in patients with genotype 1b and normal GGT in patients with genotype 2a. CONCLUSIONS: The most frequently identified genotype was genotype 1b in Taegu and its environs, followed by genotype 2a. The HCV genotype was not a reliable predictor of response to IFN-a therapy. When a standardized regimen of IFN-a was administered, pretreatment serum platelet counts and GGT level seem to be useful predictor of IFN-a therapy in HCV infection. Further investigations are required in order to establish a correlation between viral factors and therapeutic responses.
Daegu* ; Genetic Heterogeneity ; Genotype* ; Hepacivirus* ; Hepatitis C* ; Hepatitis* ; Humans ; Interferon-alpha ; Interferons ; Liver Diseases ; Platelet Count ; Polymorphism, Restriction Fragment Length ; Prevalence ; Prognosis

Carcinoma of the prostate is a common malignancy affecting elderly men. Lung metastasis from prostate cancer occurs frequently, but tumor metastasis to the central bronchi that clinically mimics primary bronchogenic carcinoma are very rare. We report a 73-year old man with endobronchial metastasis from prostatic carcinoma presented with respiratory symptom cough. Diagnosis of issues taken from materials which were used for bronchoscopic biopsy and prostate biopsy and immunohistochemical staining for prostate specific antigen(PSA) confirmed a case of endobronchial metastasis from prostatic carcinoma. Hormonal therapy(LHRH agonist) was applied to this patient.
Aged ; Biopsy ; Bronchi ; Carcinoma, Bronchogenic ; Cough ; Diagnosis ; Humans ; Lung ; Male ; Neoplasm Metastasis* ; Prostate ; Prostatic Neoplasms

OBJECTIVES: It was revealed that autonomic dysfunction, especially decreased parasympathetic functions, seems to be one of the major etiological factors in functional gastrointestinal disorders(FGID) The physiological characteristics of sympathetic and parasympathetic functions are externally similar to the features of Yin and Yang based on oriental medicine theory. And it was also revealed that gastrointestinal symptoms are prevalent in Lesser Yin constitutional type riginated from four types of constitution shown in Sasang constitutional theory. If we obtain the findings on the similarities or compatibilities between autonomic nervous functions and physical constitutional features in functional gastrointestinal disorders, we could apply various oriental treatment modalities to the patients with functional disorders, especially according to Yin-Yang constitutional concept. METHODS: We investigated the correlations between characteristics of physical constitution(Yin and Yang)and imbalance of the autonomic functions in patients with FGID. Subjects consisted with three groups: 27 patients with FGID (including irritable bowel syndrome, functional dyspepsia, functional abdominal pain syndrome according to the Rome criteria) 28 patients with somatoform disorders who had symptoms other than abdominal symptoms (other somatoform disorders) and 26 normal healthy controls. Characteristics of constitutions were evaluated and divided into two major groups, i.e., Lesser Yin constitution and other constitutions (Greater Yin & Yang and Lesser Yang included)according to the Je-Ma Lee's Classification Questionnaire for Four Constitutional Types (Song et al. 1993) For evaluating the autonomic functions, three parasympathetic functions and two sympathetic functions were measured. Levels of anxiety and depression were also evaluated to be used as a covariant controlling the autonomic functions. RESULTS: 1)FGID group showed significantly lower parasympathetic functions compared to healthy controls, however, there was no differences between FGID and other somatoform disorder groups. 2)Lesser Yin constitutional type was not so prevalent in FGID group. 3)When FGID and other somatoform disorder groups were combined and compared with normal healthy controls, the former group showed significantly lower parasympathetic functions than the latter group. CONCLUSIONS: According to these results, Lesser Yin constitutional type do not seem to be closely related with FGID. However, it was suggested that decreased parasympathetic functions were partly associated with this group. We could not find any correlations or compatibilities between two constitutional characteristics and autonomic dysfunction in FGID. This means that functional symptoms of FGID when those were deducted as Yin and Yang characteristics based on oriental medicine could not be understood as two oppositional and co-operative functions such as autonomic functions. Further research with more restricted symptoms selected in the functional disorders and with other physiological cues applied would be needed.
Abdominal Pain ; Anxiety ; Classification ; Constitution and Bylaws ; Cues ; Depression ; Dyspepsia ; Gastrointestinal Diseases* ; Humans ; Irritable Bowel Syndrome ; Medicine, East Asian Traditional ; Psychophysiologic Disorders ; Surveys and Questionnaires ; Somatoform Disorders ; Yin-Yang*

Selective cervical nerve root block is executed for patients who have symptoms of cervical radiculopathy for diagnostic and therapeutic purposes. However several catastrophic complications caused by this procedure have been reported including neurological complications. A 43-year-old male received a C5 selective cervical nerve root block procedure due to continuous radiating pain even after cervical discectomy and interbody fusion was performed. At the time of the procedure, the contrast outline revealed reflux of the nerve root and epidural space. But after the procedure was performed, the patient experienced decreased sensation in the upper and low extremities as well as motor paralysis of both extremities. Our sspecting diagnosis was anterior spinal artery syndrome but both sensory and motor functions were subsequently recovered within a few hours after the procedure was completed. Due to the difficult nature of this case, we reported these complications and reviewed current literature related to this study.
Adult ; Anterior Spinal Artery Syndrome ; Diskectomy ; Epidural Space ; Extremities ; Humans ; Injections, Spinal ; Male ; Paralysis ; Quadriplegia ; Radiculopathy ; Sensation ; Spinal Nerve Roots

OBJECTIVES: Patients with poor insight are commonly observed among schizophrenics and they show poor drug compliance and prognosis. This study aimed at examining the characteristics of psychopathology in patients with schizophrenia who have no insight. Understanding the features of inner psychopathology in schizophrenic patients with poor insight, we assumed, could lead to insight-promoting clues. METHODS: The subjects consisted of 69 patients with schizophrenia diagnosed by DSM-IV criteria. For identifying insight level in the patients, Scale to Assess Unawareness of Mental Disorder(SUMD) was applied. After subjects were divided into two groups depending upon insight level, psychopathological differences were evaluated by Kyung Hee-Frankfruter Beschwerde Fragebogen(K-FBF), which was known as one of the subjective psychological tests for the schizophrenics. RESULTS: There was no significant differences in demographic variables, duration of illness, and dose of medication between two groups. However, significantly high rate of involuntary admission and tendency of high frequency of admission were revealed in schizophrenic patients with poor insight. And, also poor insight group showed significantly high scores in the factors of sensorimotor disorder(subscales of psychomotor disorder, perceptual disorder and blocking symptoms included) and in language-cognitive disorder factor(subscales of language disorder and cognitive floating included) compared with patients who have insight. CONCLUSION: We was assumed that lack of insight in schizophrenics could include one of the symptoms based on neuropsychological or neurobiological abnormalities in brain. Moreover, it was revealed that patients with poor insight evaluated themselves as having more serious psychopathologies than patients who had insight. It has been already known that schizophrenic patients who lack in insight are reluctant to taking psychiatric care and lack in awareness of their illness. However, this study suggests that their inner psychopathology associated with insight can be understood with the use of subjective psychological test, i.e. K-FBF. For understanding the schizophrenic patients who lack in insight, not only checking the insight but also applying the subjective test such as K-FBF seems to be helpful.
Brain ; Compliance ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Language Disorders ; Perceptual Disorders ; Prognosis ; Psychological Tests ; Psychopathology* ; Schizophrenia

A severe or prolonged drop in blood pressure caused by syncope can lead to border-zone infarction in the absence of coexisting large artery disease. Syncope due to defecation represent special cases of reflex syncope for which the mechanisms are poorly understood and probably multifactorial. We experienced a 56-year-old woman was recurrent loss of consciousness duration defecation. Brain MRI revealed multifocal high signals in T2WI and FLAIR image on both end-artery border zone, but brain MRA revealed normal finding. Thus, We report a rare case of an old woman patient with end-artery border zone infarction due to prolonged hypoperfusion that was caused by defecation syncope.
Arteries ; Blood Pressure ; Brain ; Defecation* ; Female ; Humans ; Infarction* ; Magnetic Resonance Imaging ; Middle Aged ; Reflex ; Syncope* ; Unconsciousness

Pulmonary atelectasis is a common complication following surgery under general anesthesia. However, collapse during anesthesia and surgery is rare, and usually is not diagnosed until the surgical procedure is well under way. Total or segmental lung collapses are usually resulted from the obstruction of bronchial pathway by secretions such as mucus, blood and pus etc. We experienced acute lung collapse of right upper lobe during left thoracotomy. We assumed that the cause of the atelectasis was an obstruction of right superior lobar bronchus by mucus. The possible cause of lung collapse is described.
Anesthesia ; Anesthesia, General ; Anesthesia, Inhalation* ; Bronchi ; Inhalation* ; Lung ; Mucus ; Pulmonary Atelectasis* ; Suppuration ; Thoracotomy*

Acute airway obstruction during endotracheal anesthesia is embarrassing and critical situation which requires early diagnosis and immediate management. A 57-year-old man was scheduled for right pneumonectomy for a destroyed lung by fibroatelectatic changes and pleural calcification of right lung. We experienced high arterial PCO2 and inspiratory resistance during Left - Sided Double Lumen Endobronchial anesthesia in the left decubitus position. We exchanged tube after failure of suction and found airway obstruction due to mucous plug attached to the bevel of the endobronchial lumen.
Airway Obstruction* ; Anesthesia ; Anesthesia, Inhalation* ; Early Diagnosis ; Humans ; Inhalation* ; Lung ; Middle Aged ; Pneumonectomy ; Suction