Liver transplantation (LT) for hepatitis C virus (HCV)-related liver diseases has been increasing in Korea. HCV recurrence, a serious complication after LT, can accelerate liver cirrhosis and fatal graft loss. Therefore, the prevention and appropriate treatment for HCV recurrence can improve a LT patient's quality of life and survival. In considering the relationship between immunosuppressants and HCV recurrence, there is no clear difference in HCV recurrence between the immunosuppressant tacrolimus or cyclosporine, and the use of steroids for patients with HCV is still under debate. In the management of HCV recurrence, direct-acting antivirals, such as protease inhibitors, polymerase inhibitors, or other nonstructural protein inhibitors will open a new era in HCV treatment. However, their safety and drug interactions with immunosuppressants should be evaluated for patients after LT.
Antiviral Agents ; Cyclosporine ; Drug Interactions ; Hepacivirus ; Humans ; Immunosuppression ; Immunosuppressive Agents ; Korea ; Liver ; Liver Cirrhosis ; Liver Diseases ; Liver Transplantation ; Protease Inhibitors ; Quality of Life ; Recurrence ; Steroids ; Tacrolimus ; Transplants

Restless legs syndrome (RLS) is a common neurological condition characterized by uncomfortable and unpleasant sensations experienced primarily in the legs. Several clinical reports have indicated that many patients with RLS also have the same symptoms in their arms. We report contralateral arm and leg restlessness on resting after acute internal capsular infarction, which resulted in sleep-onset insomnia and disappeared after administering a dopamine receptor agonist. These observations could provide clues to the mechanism underlying the pathophysiology of RLS.
Arm ; Dopamine Agonists ; Humans ; Infarction ; Leg ; Psychomotor Agitation ; Restless Legs Syndrome ; Sensation ; Sleep Initiation and Maintenance Disorders

Cryptococcosis is a global invasive mycosis associated with significant morbidity and mortality. Fever, headache and vomiting are common clinical presentations of the cryptococcal meningitis. But ischemic stroke and cranial nerve impairment are rare neurologic complications. We report a case of cryptococcal meningoencephalitis presenting as cerebral infarction and multiple cranial nerve palsies.
Cerebral Infarction ; Cranial Nerve Diseases ; Cranial Nerves ; Cryptococcosis ; Fever ; Headache ; Meningitis, Cryptococcal ; Meningoencephalitis ; Stroke ; Vomiting

Polychlorinated biphenyls (PCBs) are accumulated in our body through food chain and cause a variety of adverse health effects including neurotoxicities such as cognitive deficits and motor dysfunction. In particular, neonates are considered as a high risk group for the neurotoxicity of PCBs exposure. The present study attempted to analyze the structure-activity relationship among PCB congeners and the mechanism of PCBs-induced neurotoxicity. We measured total protein kinase C (PKC) activities, PKC isoforms, reactive oxygen species (ROS), and induction of neurogranin (RC-3) and growth associated protein-43 (GAP-43) mRNA in cerebellar granule cells of neonatal rats with phorbol 12, 13-dibutyrate ([3H]PDBu) binding assay, western blot, ROS assay, and reverse transcription PCR (RT-PCR) analysis respectively following the different structural PCBs exposure. Only non-coplanar PCBs showed a significant increase of total PKC-alpha and betaII activity as measured with [3H]PDBu binding assay. ROS were more increased with non-coplanar PCBs than coplanar PCBs. The mRNA levels of RC-3 and GAP-43 were more induced with non-coplanar PCBs than coplanar PCBs, indicating that these factors may be useful biomarkers for differentiating non-coplanar PCBs from coplanar PCBs. Non-coplanar PCBs may be more potent neurotoxic congeners than coplanar PCBs. This study provides evidences that non-coplanar PCBs, which have been neglected in the risk assessment processes, should be added in the future to improve the quality and accuracy of risk assessment on the neuroendocrinal adverse effects of PCBs exposures.
Animals ; Blotting, Western ; Food Chain ; GAP-43 Protein ; Humans ; Infant, Newborn ; Nerve Growth Factor ; Neurogranin ; Neurons ; Neurotoxicity Syndromes ; Phorbols ; Polychlorinated Biphenyls ; Polymerase Chain Reaction ; Protein Isoforms ; Protein Kinase C ; Rats ; Reactive Oxygen Species ; Reverse Transcription ; Risk Assessment ; RNA, Messenger ; Structure-Activity Relationship ; Biomarkers

PURPOSE: To evaluate the use of prophylactic antibiotics in glaucoma surgery and the prevalence of postoperative endophthalmitis. METHODS: Retrospective medical record review was performed on 136 eyes which underwent glaucoma operation by one surgeon from March 2008 to February 2010 and were followed at least till 6 months postoperatively (glaucoma drainage device implantation; 95 eyes, trabeculectomy; 41 eyes). RESULTS: For intravenous antibiotics injection, 10 eyes used 3rd generation cephalosporin, 54 eyes used 4-fluoroquinolone, 72 eyes used 2nd generation cephalosporin. For oral antibiotics, 125 eyes used 3rd generation cephalosporin, 1 case used 4-fluoroquinolone, and other 10 cases did not use oral antibiotics after the surgery. Total period of systemic antibiotics use showed various distributions with 14 eyes more than 5 days, 115 eyes 4-5 days, and 8 cases less than 4 days. Six eye which used 4-fluoroquinolone and 3 eyes which used cephalosporin showed side effect such as skin lesion and nausea. There has been no single occurrence of endophthalmitis. CONCLUSIONS: Various kinds of prophylactic antibiotics were used for glaucoma surgery and the period of antibiotics use was different among patients. However, there has been no single occurrence of endophthalmitis till 6 months postoperative follow up.
Anti-Bacterial Agents ; Drainage ; Endophthalmitis ; Eye ; Follow-Up Studies ; Glaucoma ; Humans ; Medical Records ; Nausea ; Prevalence ; Retrospective Studies ; Skin

PURPOSE: The aim of this study was to investigate factors associated with the signal strengths (SS, image quality scores) of optic disc and macular images obtained using Cirrus spectral domain optical coherence tomography (OCT). METHODS: Ninety-two glaucomatous eyes were imaged using the Cirrus OCT macular and optic disc cube modes after pupil dilation. The influences of patient age, spherical equivalent, cataract presence, and cataract and glaucoma severity (visual field mean deviation), on the SS of images obtained using the two cube modes were compared between patients whose images showed high SS (SS > or =7) and low SS (SS <7). RESULTS: The signal strength was significantly higher in images obtained using the macular cube compared to the optic disc cube mode (7.8 +/- 1.3 vs. 6.9 +/- 1.1, respectively; p = 0.001). Age and visual acuity of patients differed significantly between the high- and low-SS groups when data acquired using the optic disc (p = 0.027 and 0.012, respectively) and macular cube modes (p = 0.046 and 0.014, respectively) were analyzed. When the optic disc cube mode was employed, the extent of cataracts was significantly related to SS, whereas when the macular cube mode was used, none of the factors analyzed was significantly associated with SS. CONCLUSIONS: Age, visual acuity, and the extent of cataracts were significantly associated with images of higher SS when the Cirrus OCT optic disc cube mode was employed.
Cataract/complications/pathology ; Female ; Glaucoma/complications/*pathology ; Humans ; Macula Lutea/*pathology ; Male ; Middle Aged ; Nerve Fibers/*pathology ; Reproducibility of Results ; Retinal Ganglion Cells/*pathology ; Retrospective Studies ; Tomography, Optical Coherence/methods

BACKGROUND: The ankle brachial index (ABI) is a useful screening tool for peripheral arterial disease. It has been documented that the cerebral atherosclerosis is more frequent in stroke patients with abnormal ABI than in those with normal ABI. The present study compared the different calculation methods of ABI for coexistent intracranial and extracranial arterial stenosis (IECAS) in ischemic stroke. METHODS: We reviewed the data of patients admitted for acute ischemic stroke or transient ischemic attack. The following four distinct ABIs were calculated: the ratio of the higher (ABI-H), lower (ABI-L), or either of the systolic blood pressures (SBPs) of the posterior tibial (ABI-PT) and dorsalis pedis (ABI-DP) arteries relative to the higher of the brachial SBP. We compared the values of these four ABI measures relative to the presence of any IECAS using receiver operating characteristic (ROC) curve analysis. RESULTS: ABI-H, ABI-L, ABI-PT, and ABI-DP were abnormal (≤ 0.9) in 19 (13.1%), 36 (24.8%), 29 (20%), and 30 (20.7%) of 145 patients, respectively. The area under the ROC curve was significantly larger for ABI-H, ABI-L, and ABI-DP than for ABI-PT for any type of IECAS. The extracranial stenosis was more frequent when any of the four ABIs was abnormal, while intracranial stenosis was not correlated with the four ABIs. The IECAS was more frequent for abnormal ABI-H and ABI-DP than for normal ABIs. CONCLUSIONS: Our studies suggested that ABIs based on a higher SBP of the PT or DP (i.e., ABI-H) are more strongly associated with the presence of IECAS than are those using the SBP of the PT (ABI-PT). Extracranial artery stenosis seems to be more strongly associated with ABI than is intracranial stenosis.
Ankle Brachial Index* ; Ankle* ; Arteries* ; Atherosclerosis ; Constriction, Pathologic* ; Humans ; Intracranial Arteriosclerosis ; Ischemic Attack, Transient ; Mass Screening ; Methods* ; Peripheral Arterial Disease ; ROC Curve ; Stroke*

PURPOSE: To evaluate the correlations between central corneal thickness (CCT) and optic disc and retinal nerve fiber layer (RNFL) parameters determined by spectral domain optical coherence tomography (SD OCT) and visual field (VF) global indices. METHODS: The present study included 151 eyes diagnosed with open-angle glaucoma (OAG) and 135 glaucoma suspect (GS) eyes. The CCT, RNFL thickness, optic disc parameters, and VF global indices were measured. The relationships between CCT and RNFL thickness, optic disc parameters, and VF global indices were assessed by linear regression analysis. RESULTS: Intraocular pressure (IOP, p < 0.001) and VF mean deviation (p = 0.005) in all participants, age (p = 0.017) and IOP (p = 0.003) in the GS group, and IOP (p = 0.002) and inferior RNFL thickness (p = 0.017) in the OAG group were significantly associated with CCT. Among the optic disc parameters, rim area, average cup/disc ratio, and vertical cup/disc ratio were significantly associated with CCT in all participants in the univariate but not multivariate analysis. CONCLUSIONS: Optic disc parameters obtained by SD OCT were not correlated with CCT in the OAG or GS group, while RNFL thickness and VF mean deviation showed associations.
Eye ; Glaucoma ; Glaucoma, Open-Angle ; Intraocular Pressure ; Linear Models ; Nerve Fibers ; Retinaldehyde ; Tomography, Optical Coherence ; Visual Fields

PURPOSE: To compare the performance of glaucoma diagnosis according to the macular and peripapillary retinal nerve fiber layer (RNFL) thicknesses, as determined by spectral domain optical coherence tomography (OCT). METHODS: Ninety-six normal, 63 early glaucoma and 37 moderate to advanced glaucomatous eyes were imaged by Cirrus OCT. The areas under the receiver operating characteristics curves (AUCs) of macular and RNFL thicknesses were calculated for discrimination of normal and glaucomatous eyes. The sensitivity and specificity of normative classification of each parameter were assessed. RESULTS: The glaucoma diagnostic capability determined by AUC was greater when based on the peripapillary RNFL than the macular thickness (0.914, 0.775, p<0.001). Both the early and the moderate-to-advanced group showed higher AUCs in peripapillary RNFL thickness (early glaucoma group; 0.870, 0.670, p<0.001, moderate to advanced glaucoma group; 0.990, 0.954, p=0.03). The inferior outer sector of macular thickness showed highest sensitivity among the parameters (58%). CONCLUSIONS: Although Cirrus OCT applied to determine macular thickness did not outperform that applied to determine peripapillary RNFL thickness in glaucoma diagnosis, applying Cirrus OCT to determine both thicknesses in diagnosis may help in understanding a patient's status.
Area Under Curve ; Discrimination (Psychology) ; Eye ; Glaucoma ; Nerve Fibers ; Retinaldehyde ; ROC Curve ; Sensitivity and Specificity ; Tomography, Optical Coherence

Hemichorea is caused by various diseases but stroke is the most common cause. The usual lesions of the stroke related hemichorea are the contralateral subthalamus or basal ganglia. Few cases with cortical lesion have been reported. But hemichorea with primary somatosensory cortical lesion has not yet been reported. We report a case with hemichorea after acute infarction of the contralateral primary somatosensory cortex.
Basal Ganglia ; Cerebral Infarction ; Chorea ; Infarction ; Somatosensory Cortex ; Stroke ; Subthalamus