BACKGROUND: Guillain-Barre syndrome (GBS) is defined as a recognizable clinical entity that is characterized by rapidly evolving symmetric limb weakness, loss of tendon reflexes, absent or mild sensory signs, and variable autonomic dysfunctions. Recently, GBS has been classified as a classical demyelinating (acute imflammatory demyelinating polyradiculoneuropathy, AIDP) and two axonal (acute motor axonal neuropathy, AMAN, and acute motor sensory axonal neuropathy, AMSAN) forms. The clinical pattern and prognosis according to type is not clear. METHODS: Forty-one patients clinically diagnosed as GBS were enrolled and classified as AIDP, AMAN, and AMSAN according to electrodiagnostic criteria. We analyzed the clinical data of each subgroup; age, sex, seasonal distribution, history of previous illness, cranial nerve involvement, respiratory involvement, and motor weakness. RESULTS: Forty-one patients with GBS were comprised of 19 patients (46.3%) with AIDP, 12 patients (29.2%) with AMAN, and 10 patients (24.3%) with AMSAN. AIDP was found more frequently in males and in winter (42.1%) while axonal forms of GBS showed neither gender nor seasonal predominance. Frequency of cranial nerve involvement was not different between the sub-groups of GBS, whereas respiratory involvement was more frequent in AMSAN (50%). Upper limbs were weaker in axonal than in demyelinating types of GBS. CONCLUSIONS: Axonal forms of GBS showed some clinical characteristics distinctive from the demyelinating forms, which might be useful in the differential diagnosis of subgroups of GBS. (J Korean Neurol Assoc 19(5):503~508, 2001)
Amantadine ; Axons ; Cranial Nerves ; Diagnosis, Differential ; Extremities ; Guillain-Barre Syndrome* ; Humans ; Male ; Polyradiculoneuropathy ; Prognosis ; Reflex, Stretch ; Seasons ; Upper Extremity

STUDY DESIGN: Twenty-nine patients with spinal tuberculousis were evaluated according to the surgical treatment methods using posterior spinal instrumentation and conventional anterior excision and interbody fusion methods without posterior spinal instrumentation. OBJECTIVE: To confirm the effectiveness of the surgical treatment methods using posterior spinal instrumentation (combined with anterior radical excision and anterior interbody fusion ) in tuberculous spondylitis. SUMMARY OF BACKGROUND DATA: Relatively good results(maintaining corrected kyphotic angle , short fusion time, rapid rehabilitation etc.)were obtained in posterior spinal instrumetnation group, especially at thoracic and thoracolumbar spine, but no specific benefits of posterior instrumentation at low lumbar spine during follow-up period. METHODS: Twenty-nine patients with tuberculous spondylitis were divided into two groups depending on their use of posterior spinal instrument in surgical treatment methods ; one group consisted of 18 cases which were treated by anterior radical excision of involved body and anterior interbody fusion with posterior spinal instrumentation(Group I), and the other groups consisted of 11 cases which were treated by anterior radical excision of involved body and anterior interbody fusion(Group II). Change of corrected kyphotic angle according to the level of lesion, number of involved body and complications were measured using pre-, post-operative, and follow-up radiographs and chart review. RESULTS: Comparing the two groups, relatively short fusion time, less kyphotic angle loss, and low complication rates were obtained in posterior spinal instrumentation group(Group I) during the follow up period, especilally, at thoracic and thoracolumbar spine. However, there were no significant postoperative and follow-up results in both groups at low lumbar spine. CONCLUSIONS: Tuberculous spondylitis can be treated, and correction can be maintained with anterior radical excision of involved body and anterior interbody fusion with posterior spinal instrumentation during follow up period.
Follow-Up Studies ; Humans ; Rehabilitation ; Spine ; Spondylitis*

Bleeding and thrombocytopenia are important adverse effects of abciximab. The incidence of abciximab-induced acute profound thrombocytopenia (APT) is low. APT is defined as an abrupt drop in platelet count to <20,000/microL that occurred within 24 hours of administration of an abciximab. This is distinct from all other types of drug-induced thrombocytopenia, which requires a period of drug administration to induce sensitization. If APT occurs and is left untreated, it can cause serious hemorrhage and ischemia that may be fatal. In this case, a 45-year-old man with acute myocardial infarction was administered a bolus intravenous injection of abciximab (0.25 mg/kg), followed by a 12-hour continuous infusion (10 microgram/min) during primary coronary angioplasty. We report a case of APT that was recognized at 2 hours after the initiation of abciximab infusion and was corrected without serious complications.
Angioplasty ; Hemorrhage ; Humans ; Incidence ; Injections, Intravenous ; Ischemia ; Middle Aged ; Myocardial Infarction ; Platelet Count ; Thrombocytopenia*

PURPOSE: To find out the problem of modified Bosworth method and improve the method of operation. MATERIALS AND METHODS: 21patients treated with modified Bosworth method were evaluated after a minium follow-up period of two years. The results were analysed clinically and reontgenographically. RESULTS: In postoperative X-ray evaluation, the coracoclavicular interval of the operated side was decreased by an average of 0.8 mm compared with that of the normal side. There was no significant difference in coracoclavicular interval between after screw removal and last follow-up. Loosening of the screw was seen in 3 of the 5 cases overcorrected by more than 2 mm and the result was fair in two of them. A satisfactory result was obtained in 17 (81.1%) of the 21 cases. CONCLUSION: Modified Bosworth method for acute complete acromioclavicular dislocation yields better results provided the overcorrection and anterior displacement of the clavicle are appropriately protected.
Acromioclavicular Joint ; Clavicle ; Dislocations* ; Follow-Up Studies

TRPM7, a cation channel protein permeable to various metal ions such as Mg2+, is ubiquitously expressed in variety of cells including lymphocytes. The activity of TRPM7 is tightly regulated by intracellular Mg2+, thus named Mg2+-inhibited cation (MIC) current, and its expression is known to be critical for the viability and proliferation of B lymphocytes. In this study, the level of MIC current was compared between immature (WEHI-231) and mature (Bal-17) B lymphocytes. In both cell types, an intracellular dialysis with Mg2+-free solution (140 mM CsCl) induced an outwardly-rectifying MIC current. The peak amplitude of MIC current and the permeability to divalent cation (Mn2+) were several fold higher in Bal-17 than WEHI-231. Also, the level of mRNAs for TRPM7, a molecular correspondence of the MIC channel, was significantly higher in Bal-17 cells. The amplitude of MIC was further increased, and the relation between current and voltage became linear under divalent cation-free conditions, demonstrating typical properties of the TRPM7. The stimulation of B cell receptors (BCR) by ligation with antibodies did not change the amplitude of MIC current. Also, increase of extracellular [Mg2+]c to enhance the Mg2+ influx did not affect the BCR ligation-induced death of WEHI-231 cells. Although the level of TRPM7 was not directly related with the cell death of immature B cells, the remarkable difference of TRPM7 might indicate a fundamental change in the permeability to divalent cations during the development of B cells.
Antibodies ; B-Lymphocytes* ; Cations, Divalent ; Cell Death ; Dialysis ; Ions ; Ligation ; Lymphocytes ; Permeability ; Precursor Cells, B-Lymphoid ; RNA, Messenger

STUDY DESIGN: A case report. OBJECTIVES: To report and discuss an extremely uncommon cause of lumbar plexopathy seat belt injury. SUMMARY OF LITERATURE REVIEW: For patients who undergo traffic accidents, most cases of seat belt injury cause trauma to the lower torso. Seat belt injury is associated with variable clinical problems such as vascular injury, intestinal injury (perforation), vertebral injury (flexion-distraction injury), chest wall injury, diaphragmatic rupture/hernia, bladder rupture, lumbosacral plexopathy, and other related conditions. MATERIALS AND METHODS: A 38-year-old male truck driver (traffic accident victim) who suffered monoplegia of his right leg due to lumbar plexus injury without spinal column involvement. Injury to a lumbar plexus and the internal vasculatures originated from direct compression to internal abdominal organs (the iliopsoas muscle and internal vasculatures anterior to the lumbar vertebrae) caused by the seat belt. We have illustrated an extremely uncommon cause of a neurologic deficit from a traffic accident through this case. RESULTS: Under the impression of traumatic lumbar plexopathy, we managed it conservatively, and the patient showed signs of recovery from neurologic deficit. CONCLUSIONS: We need to review the lumbar plexus pathway, in patients with atypical motor weakness and sensory loss of the lower extremities which are not unaccompanied by demonstrable spinal lesions. Therefore, close history taking, physical examination and comprehension of injury mechanism are important in the diagnosis.
Accidents, Traffic ; Adult ; Comprehension ; Diagnosis ; Hemiplegia ; Humans ; Leg ; Lower Extremity ; Lumbosacral Plexus ; Male ; Motor Vehicles ; Neurologic Manifestations ; Physical Examination ; Rupture ; Seat Belts* ; Spine ; Thoracic Wall ; Torso ; Urinary Bladder ; Vascular System Injuries

BACKGROUND: Primary focal segmental glomerulosclerosis (FSGS) is a cause of nephrotic syndrome in adult. Although primary FSGS has been known to be refractory to treatment, recent studies reveal higher remission rate and better prognosis. And it has been reported that some clinical and histopathologic parameters are significant to prognosis. But, confirmative prognostic indices remain to be defined. In order to further clarify the prognostic factors for therapeutic response and risk factors for progression to chronic renal failure (CRF), we reviewed the medical records of primary adult FSGS patients. METHODS: Forty-adult patients diagnosed as primary FSGS between 1991 to 2002 were enrolled. We retrospectively analyzed the clinical and histopathological parameters of all patinents at the time of renal biopsy. In addition, the therapeutic responses to immunosuppressants and the renal survival were analyzed. RESULTS: At the time of renal biopsy, 26 patients (65%) had proteinuria of the nephrotic range and 14 patients (35%) had proteinuria of the non-nephrotic range. The serum creatinine level was higher in nephrotic-ranged patients than that in non nephrotic-ranged patients (p<0.05). The other parameters were not significantly different between two groups. Twenty-seven patients were treated with immunosuppressants and 15 patients (55.6%) responded to the treatment. There was no significant difference in clinical or histopathological variables between the responders and the non-responders. High serum creatinine level at diagnosis and responsiveness to treatment appeared to be significant as risk factors for progression to CRF (p<0.05). The patients treated with immunosuppressants had longer survival period, compared with those without treatment. And the responders had significantly longer survival period compared with the non-responders (p<0.05). CONCLUSION: The patients with initial impairment of renal function or poor response to therapy may have worse prognosis, and the intense treatment with regular follow-up of renal function should be recommended for these patients.
Adult* ; Biopsy ; Creatinine ; Diagnosis ; Follow-Up Studies ; Glomerulosclerosis, Focal Segmental* ; Humans ; Immunosuppressive Agents ; Kidney Failure, Chronic ; Medical Records ; Nephrotic Syndrome ; Prognosis ; Proteinuria ; Retrospective Studies ; Risk Factors

BACKGROUND: Systolic and diastolic dysfunction frequently coexist in heart failure. The purpose of this study is to evaluate combined systolic and diastolic function in heart failure using new index presented by Dr. Tei. A new index: [(ICT+IRT)/ET] defined as the sum of isovolemic contraction time(ICT) and isovolemic relaxation time(IRT) divided by ejection time(ET). METHOD: Study patients consisted of 71 subjects. 20 normals, 23 patients in NYHA class II, 22 patients in NYHA class III and 6 patients in NYHA class IV. Left ventricular end-systolic and end-diastolic dimension, FS(fractional shortening) were measured by conventional echocardiography. ICT, IRT, ET, ICT/ET, deceleration time of mitral E wave and E/A of mitral flow were also measured.(ICT+IRT)/ET was easily obtained by subtracting ET from the interval between cessation and onset of the mitral inflow to give the sum of ICT and IRT. Cardiac output was calculated by left ventriculography in 10 normals and 19 patients. RESULTS: The mean value of (ICT+IRT)/ET was significantly different between group IV(0.88 +/-0.03) and group I(0.50+/-0.04) and II(0.50+/-0.03)(p<0.01). also, was significant between group IV and group III(0.63+/-0.04)(p<0.05). FS and deceleration time of mitral E wave were also significant between group III and group IV(p<0.05). Cardiac output calculated by left ventriculography was significantly correlated with(ICT+IRT)/ET(n=29, r=-0.463, p<0.05). CONCLUSION: (ICT+IRT)/ET is a new and simple Doppler index of combined systolic and diastolic left ventricular function in patient with heart failure.
Cardiac Output ; Deceleration ; Echocardiography* ; Heart Failure ; Humans ; Relaxation ; Ventricular Function, Left*

BACKGROUND: As the result of renal transplantation improving, also increasing the number of graft failure which will be a candidate for second renal transplantation. The purpose of this study is to evaluate the factors that influence the survival of retransplanted kidney. METHODS: Among 775 renal transplantations that have been performed in Dongsan Medical Center until August 2007, 225 cases were failed their graft function and 59 of them were retransplanted during their follow up period. Graft survival of retransplanted kidney was compared with primary renal transplantation and factors that affecting the survival of kidney retransplantation were evaluated. RESULTS: Main causes of graft failure of first kidney transplantation were chronic rejection, followed by recurrence of original disease of recipient and acute vascular rejection. Mean survival time was 72.6 months (15 days~161 months). One and 5 years graft survivals were 94.6%, 90.7%, and patient survivals were 100.0%, 97.8%, respectively. Among the factors which showed significance in univariate analysis, short interval between failure of first transplantation and retransplantation, and graft failure due to chronic rejection were statistically significant unfavorable factors for survival of retransplanted kidney. CONCLUSIONS: Kidney retransplantation showed similar graft and patient survival compare to the first one. However, retransplantation should be performed after enough time after graft failure and should be cautious in a patient who lost their graft due to chronic rejection.
Follow-Up Studies ; Graft Survival ; Humans ; Kidney ; Kidney Transplantation ; Recurrence ; Rejection (Psychology) ; Survival Rate ; Transplants

Primary leptomeningeal melanomas(PLMs) are rare aggressive central nervous system(CNS) tumors without systemic foci. It can be very difficult, however, to clearly distinguish PLMs from those that have metastasized. We report a case of malignant leptomenigeal melanoma occurring in the right temporal convexity of a 77-yearold woman. Almost all malignant CNS melanomas in the old are secondary to the cutaneous melanoma and can cause diverse neurological manifestations; certain clinical findings of the presented case-namely, the patient's age, vague neurologic findings and absence of cutaneous lesions -are therefore interesting. Thorough clinical checkups, including whole-body bone scan, whole spine MRI, abdominal ultrasound, and tumor marker studies to find extracranial lesions revealed no abnormalities. Based on these clinical findings, we suppose-though are not certain-that the tumor of the presented case is a PLM.
Female ; Humans ; Magnetic Resonance Imaging ; Melanoma* ; Neurologic Manifestations ; Spine ; Ultrasonography