BACKGROUND AND PURPOSE: 123I cardiac meta-iodobenzylguanidine (MIBG), an analogue of norepinephrine, has been used to estimate myocardial sympathetic nerve function. We investigate whether cardiac-MIBG SPECT is clinically applicable in the differentiation of Parkinson's disease (PD) from parkinsonian syndromes. METHODS: Cardiac-MIBG scintigraphy was performed in 27 controls, in 40 patients with PD and in 52 patients with other parkinsonian syndromes comprising 23 with multiple system atrophy (MSA), 26 with drug-induced parkinsonism (DIP), and 3 with corticobasal degeneration (CBD). The heart to mediastinum (H/M) uptake ratio was calculated for each subjects. Patients who either had medical conditions that confused the MIBG SPECT results or who took medications that interfere with MIBG accumulation were excluded from the study. RESULTS: Both early and delayed H/M ratios were in patients with PD significantly lower than in controls (early, 1.34+/-0.15 vs 1.79+/-0.19; delayed, 1.29+/-0.15 vs 2.06+/-0.29, p<0.001). In patients with PD, both early and delayed H/M ratios were significantly lower than those in patients with MSA (early, 1.68+/-0.23; delayed, 1.80+/-0.34, p<0.001), DIP (early, 1.83+/-0.24; delayed, 2.07+/-0.4, p<0.001), or CBD (early, 1.85+/-0.01; delayed, 1.99+/-0.19, p<0.001). Two patients with DIP, who were within the range of patients with PD, showed clinically similar courses of PD. CONCLUSIONS: This study demonstrates that cardiac-MIBG is a clinically powerful tools to differentiate PD from other parkinsonian syndromes.
3-Iodobenzylguanidine ; Heart ; Humans ; Mediastinum ; Multiple System Atrophy ; Norepinephrine ; Parkinson Disease ; Parkinsonian Disorders* ; Radionuclide Imaging ; Tomography, Emission-Computed, Single-Photon*

BACKGROUND AND PURPOSE: Elucidating the factors that predict the quality of life (QOL) in stroke patients is important. However, the residual sensory symptoms that are common in stroke patients have not usually been included as factors that influence the QOL. The purpose of the present study was to elucidate the factors that predict the QOL of chronic-stage patients with special attention to residual sensory symptoms. METHODS: We examined 214 patients who had experienced a first-time stroke during the subacute (i.e., approximately 3 months poststroke) stage; 151 patients from this group were followed up by telephone interview during the chronic (i.e., approximately 3 years poststroke) stage. Physical disabilities, including motor dysfunction, sensory symptoms that included central poststroke pain (CPSP, described using a standardized questionnaire with a visual analogue scale), activities of daily living (ADL, measured by the Barthel index score), as well as the presence of depression (using the DSM IV criteria), were assessed during both the subacute and chronic stages. Economic and job statuses during the chronic stage were also assessed. QOL ratings were determined by the World Health Organization QOL scale. RESULTS: The following factors at 3 months poststroke were related to low QOL at 3 years poststroke: dependency in ADL, motor dysfunction, depression, and CPSP. At 3 years poststroke, dependency in ADL, depression, CPSP, poor economic status, and unemployment were all factors that were related to low QOL. Multiple regression analysis showed that dependency in ADL (19%), presence of CPSP (12%), and poor economic status (10%) were important explanatory factors for overall QOL. In the analysis of QOL subdomains, the most important explanatory factors were CPSP for both physical and psychological domains, dependency in ADL for both independence and social-relationships domains, economic status for the environmental domain, and female sex for the spiritual domain. CONCLUSIONS: We conclude that dependency in ADL, depression, low socioeconomic status, and the presence of CPSP either at 3 months or 3 years poststroke are factors that are related to a low QOL at 3 years poststroke. The recognition of these factors may allow strategies to be developed to improve the QOL for stroke patients.
Activities of Daily Living ; Depression ; Female ; Humans ; Interviews as Topic ; Quality of Life* ; Social Class ; Stroke ; Unemployment ; World Health Organization ; Surveys and Questionnaires

BACKGROUND AND PURPOSE: Intracranial atherosclerosis (ICAS) is one of the major risk factors for ischemic stroke, particularly in Asian populations. We investigated the prevalence and risk factors of ICAS in asymptomatic subjects. METHODS: We prospectively evaluated 835 asymptomatic Korean adults who voluntarily visited a tertiary referral hospital for a health screening examination that included brain magnetic resonance angiography. The subjects had no history of stroke or transient ischemic attacks; those who had potential cardiac sources of emboli were excluded. ICAS and extracranial atherosclerosis were defined as a reduction in luminal diameter of at least 50%. Vascular risk factors were screened through questionnaires, interviews, and examinations. RESULTS: ICAS was found in 25 subjects (3.0%) and extracranial atherosclerosis was found in 4 patients (0.5%). No patient had combined lesions. ICAS was distributed in 31 arteries in 25 subjects: anterior cerebral arteries (5 subjects, 16%), middle cerebral arteries (16 subjects, 52%), posterior cerebral arteries (8 subjects, 26%), and distal internal carotid arteries (2 subjects, 7%). The ratio of ICAS of the anterior circulation (23 of 31 arteries with ICAS, 74%) to that of the posterior circulation (8 of 31 arteries with ICAS, 26%) was 3:1. The ratio of ICAS (23 of 27 arteries with atherosclerosis in the anterior circulation, 85%) to extracranial atherosclerosis (4 of 27 arteries with therosclerosis in the anterior circulation, 15%) was 6:1. An older age [odds ratio (OR)=1.05, 95% confidence interval (CI)=1.00-1.10] and hypertension (OR=2.41, 95% CI=1.01-5.72) were independent risk factors for ICAS. CONCLUSIONS: ICAS is more prevalent than extracranial atherosclerosis among neurologically asymptomatic Korean adults. Subjects with ICAS are significantly older and have an increased frequency of hypertension compared to those subjects without atherosclerotic stenosis.
Adult ; Anterior Cerebral Artery ; Arteries ; Asian Continental Ancestry Group ; Atherosclerosis ; Brain ; Carotid Artery, Internal ; Constriction, Pathologic ; Humans ; Hypertension ; Intracranial Arteriosclerosis* ; Ischemic Attack, Transient ; Magnetic Resonance Angiography ; Mass Screening ; Middle Cerebral Artery ; Phenobarbital ; Posterior Cerebral Artery ; Prevalence* ; Prospective Studies ; Risk Factors* ; Stroke ; Tertiary Care Centers ; Surveys and Questionnaires

Atherothromboembolism and intracranial small vessel disease are considered to be the main causes of cerebrovascular injury, which may lead to cognitive impairment and vascular dementia (VaD). VaD appears to be the second most common type of dementia with prevalence estimates of 10-15%. Cortical or multi-infarct dementia and subcortical vascular dementia (SVD) are suggested to be the two main forms of VaD. The main clinical features of SVD comprise decreased motor performance, early impairment of attention and executive function with slowing of information processing. SVD results from lacunar infarcts or multiple microinfarcts in the basal ganglia, thalamus, brainstem and white matter and are associated with more than 50% of the VaD cases. White matter changes including regions of incomplete infarction are usually widespread in VaD but their contribution to impairment of subcortical regions is unclear. While most of VaD occurs sporadically only a small proportion of cases bear clear familial traits. CADASIL is likely the most common form of hereditary VaD, which arises from subcortical arteriopathy. SVD needs unambiguous definition to impact on preventative and treatment strategies, and critical for selective recruitment to clinical trials.
Automatic Data Processing ; Basal Ganglia ; Brain Stem ; CADASIL ; Dementia ; Dementia, Multi-Infarct ; Dementia, Vascular* ; Executive Function ; Infarction ; Prevalence ; Stroke ; Stroke, Lacunar ; Thalamus

PURPOSE: 1) to construct cohorts according to risk scores calculated with the Gail Breast Cancer Risk Assessment Tool (Gail et al., 1989) (Gail) and the Breast Cancer Risk Appraisal (Lee et al,. 2003) (Lee) 2) to identify the distribution of risk factors and preventive behavior stages between the cohorts 3) to identify abnormal breast conditions in risk cohort. METHOD: Using convenience sampling, 775 rural women were selected. Risk appraisal was scored using Gail and Lee. Preventive behavior stages for BSE (Breast self examination) and mammography were measured using 4 stages of the Transtheoretical Model (Prochaska & DiClemente, 1983). RESULTS: 1) The risk cohort according to Gail was 12.3% (n=95), and Lee, 3.1% (n=24). 2) There were significant differences in the distribution of risk factors (age, family history, age at 1st live birth, age at menarche, number of breast biopsy, history of breast disease, and breast-feeding) between cohorts. 3) There was a significant difference in the distribution of the stage of BSE according to Lee. 4) Six women in the risk group detected masses or nodules and physician consultation and ultrasonography were recommended. CONCLUSION: On the basis of the constructed cohorts, further longitudinal studies of cohorts are recommended with interventions according to characteristics of cohorts.
Biopsy ; Breast Diseases ; Breast Neoplasms* ; Breast* ; Cohort Studies* ; Female ; Humans ; Live Birth ; Mammography ; Menarche ; Risk Assessment ; Risk Factors ; Ultrasonography

PURPOSE: This study was performed to identify relationships among stress, hardiness, and the level of self-care in kidney transplant patients and use the results of this study as baseline data for developing self-care promotion programs. METHOD: Subjects were 41 patients who undergone a kidney transplantation surgery at least one month before and were receiving regular follow-up care via OPD. Four researchers interviewed each subjects by filling out questionnaires. RESULTS: The mean score of the level of stress was 2.32(SD=0.54) on a 4 point scale and the mean score of hardiness was 4.68(SD=0.62) on a 6 point scale. The mean score of self-care among the subjects was 3.83(SD=0.55). There was statistically a significant positive relationship between self-care and hardiness(r=0.42). Especially, relationships between self-care and commitment (r=.51) and control(r=.36) as the sub- dimensions of hardiness were significant. The item suggested as most stressful was economic burden and the item suggested as least stressful was sexual activity. CONCLUSION: Although transplant patients have various stressors, the positive self-care activities of the patients could be increased if the commitment and control were enhanced by proper intervention programs.
Follow-Up Studies ; Humans ; Kidney Transplantation ; Kidney* ; Self Care* ; Sexual Behavior ; Surveys and Questionnaires

Oral or rectal sodium phosphate(NaP) preparation is commonly used for the colonic cleansing. Since the sole route of excretion of absorbed phosphate is renal, diminished renal function will limit the ability to excrete a sudden phosphate load. To date, about 20 adult cases of hyerphosphatemia associated with oral or rectal sodium phosphate solution have been reported, but not a single case in Korea to our knowledge. We report two cases of hyperphosphatemia and hypocalcemia after the administration of NaP(Colclean(R)) to reemphasizes the potential hazard of sodium phosphate bowel preparation in patients with compromised renal function.
Adult ; Colon ; Humans ; Hyperphosphatemia* ; Hypocalcemia* ; Kidney Failure, Chronic* ; Korea ; Laxatives* ; Sodium

A 64-year-old woman with ischemic heart disease was admitted to our hospital because of both leg pain and difficulty to walk for 5 days. She had taken cerivastatin and gemfibrozil for atherosclerosis and ischemic heart disease. One year ago, she had been admitted to our hospital because of acute renal failure due to rhabdomyolysis of unknown origin and was improved after conservative therapy. Laboratory studies revealed serum creatinine 1.2 mg/dL, creatine kinase 23,700 IU/L, serum myoglobin >500 ng/mL, urine myoglobin >3,000 ng/mL. (99m)Tc-HDP whole body Bone scan showed multiple increased uptakes of the soft tissue, especially both calf. With supportive care, she was recovered and discharged with normal creatinine(0.8 mg/dL) and creatine kinase(260 IU/L).
Acute Kidney Injury ; Atherosclerosis ; Creatine ; Creatine Kinase ; Creatinine ; Female ; Gemfibrozil ; Humans ; Leg ; Middle Aged ; Myocardial Ischemia ; Myoglobin ; Rhabdomyolysis*

An 51-year-old woman presented with microscopic hematuria without protenuria for long time. Laboratory studies demonstrated the presence of red blood cells in urine, a normal serum IgM level, the absence of antinuclear antibodies, and a normal complement level. Renal biopsy revealed that some glomeruli are enlarged with endocapillary cell proliferation and a few glomeruli exhibit prominent vascular pole of the tufts and segmental increase in mesangial cell and matrix. Immunofluorescence studies demonstrated segmental granular deposits for IgM. Electron microscopy showed well-preserved foot process associated with focal effacement. Biopsy findings were consistent with IgM nephropathy. We present this case to promote understanding of the pathogenesis of IgM nephropathy.
Antibodies, Antinuclear ; Biopsy ; Cell Proliferation ; Complement System Proteins ; Erythrocytes ; Female ; Fluorescent Antibody Technique ; Foot ; Hematuria ; Humans ; Immunoglobulin M* ; Mesangial Cells ; Microscopy, Electron ; Middle Aged ; Proteinuria*

We have described a male patient with a episode of acute renal failure after strenuous exercise. He was found to have low serum uric acid(0.6 mg/dL, after recovery) and normal 24 hour urinary excretion in the steady state. The possibility of other diseases that cause hypouricemia could be excluded, acute renal failure associated with idiopathic renal hypouricemia was diagnosed in this case. A renal computed tomography showed the delayed wedge shaped contrast enhancement, these findings suggested that the cause of acute renal failure could be renal vasoconstriction rather than obstruction by uric acid crystals. Hypouricemia appear to play a crucial role in this reperfusion oxygen free radical induced acute renal failure. We have suggested that the renal hypouricemia should be suspected in the case of acute renal failure associated with exercise when the patient's uric acid level was within or slight alone normal range at the time of acute renal failure.
Acute Kidney Injury* ; Humans ; Male ; Oxygen ; Reference Values ; Reperfusion ; Uric Acid ; Vasoconstriction