From June, 1988 to Feb, 1989 a total of 47 cases of percutaneous mitral valve balloon valvuloplasty(PMV) and 4 cases of aortic valve balloon valvuloplasty(PAV) were done at the Guro Hospital of the Korea University. Among these patients first 18 patients of PMV are the subjects of this study. 1) Among a total of 28 patients,10 patients were male and 18 patients were female patients. The age of the patients were between 21 and 59 years with the mean age of 40.9+/-12.2 Aortic Valve ; Atrial Fibrillation ; Balloon Valvuloplasty* ; Blood Pressure ; Cardiac Output ; Cardiac Tamponade ; Catheters ; Drainage ; Electrocardiography ; Embolism ; Female ; Humans ; Korea ; Male ; Middle Cerebral Artery ; Mitral Valve Insufficiency ; Mitral Valve Stenosis* ; Mitral Valve* ; Sepsis ; Thrombosis ; Vascular Resistance

Non-ketotic hyperglycemia (NKH) is recognized both as a direct cause of a precipitating factor of many types of epileptic seizure, including simple partial motor, complex partial as well as reflex motor seizure, choreoathetosis and ballismus. Its association with isolated visual alteration is less known. A 74-year-old diabetic woman with visual complaints manifested as flashing colorful lights (red, yellow and blue) in both visual field with progressive increase in frequency. Among the laboratory tests, NKH of 508mg/dL stood out. Slow waves from the right occipital region maximum at O2 associated with visual symptom were recorded in EEG. Brain MRI showed subcortical T2WI and FLAIR hypointensities in the right occipital lobe with scanty enhancement. Patient was treated with hydration and insulin and her symptoms disappeared after hyperglycemia was corrected. We stress that isolated visual episodes may be initial manifestation of occipital lobe simple partial seizure associated with NKH.
Aged ; Brain ; Dyskinesias ; Electroencephalography ; Epilepsies, Partial ; Epilepsy ; Female ; Humans ; Hyperglycemia ; Insulin ; Light ; Occipital Lobe ; Precipitating Factors ; Reflex ; Seizures ; Visual Fields

BACKGROUND: We investigated the prevalence of dementia and mild cognitive impairment (MCI) and their risk factors in an urban community-dwelling elderly people over 65 years old. METHODS: A two-phase investigation was performed from January 2010 to December 2011. In Phase I, all subjects (n=9,485) responded to the Korean version of the Mini-Mental State Examination (K-MMSE). Based on the K-MMSE score the subjects were classified into two groups ('Normal' and 'Cognitive decline'). In Phase II, cognitive decline subjects were diagnosed as dementia or MCI according to the neuropsychological tests and doctor's interview. We also surveyed the socioeconomic and medical factors in Normal, Dementia and MCI groups. And we compared and analyzed the socioeconomic and medical risk factors by multiple logistic regressions in Dementia and MCI group. RESULTS: The prevalence of dementia and MCI was obtained 5.4% and 4.3%, respectively. Old age, alcohol intake, living together, low economic status, jobless in the past, diabetes mellitus, previous stroke, lower BMI and family history of dementia were associated with the increased dementia risk. Higher education, hypertension and physical activity were associated with the decreased dementia risk. And old age, alcohol intake, higher education, previous stroke, lower BMI and physical activity were common risk factors in MCI group. CONCLUSIONS: The prevalence of dementia and MCI was obtained much lower than previous reports. Dementia and MCI patients had common socioeconomic and medical risk factors. It is also important to control the risk factors earlier to prevent the increase of patients in dementia. And in order to prove the hypothesis that early control of the risk factors can decrease the occurrence of dementia, the further prospective studies are needed.
Aged* ; Dementia* ; Diabetes Mellitus ; Education ; Humans ; Hypertension ; Logistic Models ; Mild Cognitive Impairment ; Motor Activity ; Neuropsychological Tests ; Prevalence* ; Risk Factors* ; Stroke

10~25% of all cases of lymphoma involves the nervous system. Neurolymphomatosis, one of the complications of lymphoma, is rare clinical disorder with signs of peripheral neuropathy. It is also a rare cause of painful neuropathy and usually presents with sensorimotor polyneuropathy in nerve conduction studies. We report a case of neurolymphomatosis that had originated from a nasal type NK/T cell lymphoma with clinical and electrophysiological evidences of peripheral neuropathy, confirmed by histopathologic evidences of lymphomatous infiltration.
Animals ; Lymphoma* ; Marek Disease* ; Nervous System ; Neural Conduction ; Peripheral Nervous System Diseases ; Polyneuropathies

Toe deformities occurring after tibial shaft fracture can result from compartment syndrome or adhesion of muscle to tendon. Claw toes or checkrein deformity caused by injury of posterior compartment muscles has been reported relatively often. But, a deformity due to injury of the anterior compartment muscles is very rare. We observed the two cases of an extension deformity at the metatarsophalangeal joint of the hallux following intramedullary nailing of a tibial shaft fracture. There was no evidence of compartment syndrome. Extension deformity of the hallux was decreased with dorsiflexion of the ankle and increased with plantar flexion. Contracture of the extensor hallucis longus tendon was diagnosed, and Z-lengthening of that tendon was performed. Satisfactory results were obtained without a recurrence of deformity. We report these rare cases of toe deformities occurring after a tibial shaft fracture, with a brief review of the literature.
Animals ; Ankle ; Compartment Syndromes ; Congenital Abnormalities ; Contracture ; Fracture Fixation, Intramedullary ; Hallux ; Hammer Toe Syndrome ; Metatarsophalangeal Joint ; Muscles ; Recurrence ; Tendons ; Tibia ; Tibial Fractures ; Toes

Hypertensive brainstem encephalopathy (HBE) is a variant of hypertensive encephalopathy characterized by brainstem and cerebellar involvement. Simultaneous supratentorial involvement in HBE is rarely reported as a vasogenic edema in subcortex and/or periventricular white matter. A 36-year-old woman visited hospital due to headache lasting 7 days before admission. Initial blood pressure was 270/170mmHg. T2-weighted and fluid-attenuated inversion recovery magnetic resonance imaging revealed multifocal high signal intensity lesions in upper medulla, pons, midbrain and cerebellar hemisphere. Especially, atypical periventricular lesions were shown as perpendicular fingers to the lateral ventricle like multiple sclerosis. Her clinical symptoms and radiological lesions were subsided with lowering blood pressure. We herein report a HBE with unusual supratentorial involvement mimicking multiple sclerosis.
Blood Pressure ; Brain Stem ; Edema ; Female ; Fingers ; Headache ; Humans ; Hypertensive Encephalopathy ; Lateral Ventricles ; Magnetic Resonance Imaging ; Mesencephalon ; Multiple Sclerosis ; Pons ; Posterior Leukoencephalopathy Syndrome

No abstract available.
Movement Disorders

BACKGROUND: Chronic kidney disease (CKD) is known to be associated with atherosclerosis and silent small-vessel occlusion, but there is scant information regarding the association between CKD and acute stroke. The aim of this study was to establish whether CKD influences the outcome and mortality rate after acute ischemic stroke. METHODS: From January 2005 to June 2008, patients with CKD and with normal kidney function were identified from the entire population of patients presenting with acute ischemic strokes at Soonchunhyang university hospital. We analyzed the baseline demographics, risk factors, stroke severity, functional outcome, mortality rate, and the prognostic factors affecting mortality in the two groups, and investigated the causes of death. RESULTS: Totals of 541 patients with normal kidney function (age 67.0/12.6 years; mean/SD) and 66 patients with CKD (age 70.8/11.9 years) were recruited. Hypertension and diabetes were more prevalent in the CKD group. National Institutes of Health Stroke Survey scores at admission (8.3/8.5 vs 5.5/6.0, p=0.001) and Modified Rankin Scale (mRS) scores at discharge (2.32/1.5 vs 1.92/1.5, p=0.067) were higher in the CKD group than in that with normal kidney function. Patients with CKD had a higher case-fatality rate (median survival time 13.9/13.6 months) than those without CKD (median survival time 19.2/13.2 months) and CKD was an independent prognostic factor for mortality after acute ischemic stroke. Cox proportional hazard analysis leukocytosis (hazard ratio, HR=4.46; 95% confidence interval, CI=1.28-15.52), high cardioembolic risk (HR=7.68; 95% CI=1.59-37.08), and poor (mRS> or =3) functional outcome at discharge (HR=8.67, 95% CI=2.19-34.33) were significant influencing factors on mortality in the CKD group. CONCLUSIONS: Compared with the normal kidney function condition, CKD is associated with a higher mortality after acute ischemic stroke. Leukocytosis, high cardioembolic risk, and poor functional outcome may be important prognostic factors of mortality from acute ischemic stroke with CKD.
Atherosclerosis ; Cause of Death ; Demography ; Humans ; Hypertension ; Kidney ; Leukocytosis ; National Institutes of Health (U.S.) ; Renal Insufficiency, Chronic ; Risk Factors ; Stroke

PURPOSE: Marjolin's ulcer is rare but highly aggressive malignant cancer that is associated with chronic, nonhealing wounds such as burn wound. There are no confirmed effective protocols for treatment of this disease. This study was conducted to describe the clinical presentation and treatment modalities of Marjolin's ulcer in our hospital. METHODS: This was a retrospective study of Marjolin's ulcer. 20 cases were histologically confirmed malignant skin cancer seen at Chonbuk National University Hospital from January 2000 to December 2011. Data were retrieved from patients' medical records and photographs. RESULTS: The total 20 cases of Marjolin's ulcer were studied. Squamous cell carcinoma was the most common pathological type in 20 patients (100%). Lymph node metastasis at the time of diagnosis was recorded in 3 patient (15%). Wide excision was the most common surgical procedure performed in 17 patients (85%) of cases. The reconstruction modalities were various as free flap 3 patients (15%), skin graft 13 patients (65%), local advancement flap 2 patients (10%) and regional flap 1 patient (5%). Local recurrence was noted in 3 patients (15%) who had surgical treatment. And one patient (5%) expired in hospital. CONCLUSION: Marjolin's ulcer is an infrequent lesion. Unfortunately the diagnosis and treatment are often delayed. If the wound was histologically confirmed, aggressive excision and reconstruction is warranted in these highly malignant skin cancer. Early recognition and aggressive treatment of Marjolin's ulcers are essential to improve outcomes.
Burns ; Carcinoma, Squamous Cell ; Free Tissue Flaps ; Humans ; Lymph Nodes ; Medical Records ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies ; Skin ; Skin Neoplasms ; Transplants ; Ulcer

BACKGROUND: Creutzfeldt-Jakob disease (CJD) shares common clinical features with Hashimoto's encephalopathy (HE). The 14-3-3 protein is a relatively sensitive and specific marker of CJD but is not commonly detected in HE. We report the case of a patient with HE with unusual features including positive 14-3-3 protein in the cerebrospinal fluid (CSF) and an atypical course mimicking that of CJD. CASE REPORT: A 64-year-old male was admitted due to acute-onset cognitive dysfunction. HE was suspected based on increased titers of anti-thyroid microsomal antibody and an excellent response to steroid. However, 14-3-3 protein was detected in the CSF and a recurrent attack with progressive cognitive decline, pyramidal symptoms and myoclonus mimicking CJD occurred. Cognitive dysfunction showed progressive worsening and the response to steroid treatment was decreased. CONCLUSIONS: 14-3-3 protein could be considered a general marker of neuronal destruction and not specific to CJD. The clinical manifestations of HE are variable and its diagnosis is difficult due to the lack of a specific phenotype and reliable diagnostic criteria. We recommend that patients with clinical features of CJD and antithyroid antibodies should be considered for empirical steroid treatment for HE, despite a positive result for 14-3-3 protein.
14-3-3 Proteins* ; Antibodies ; Cerebrospinal Fluid* ; Creutzfeldt-Jakob Syndrome* ; Diagnosis ; Humans ; Male ; Middle Aged ; Myoclonus ; Neurons ; Phenotype