Although deep brain stimulation (DBS) has been reported to be effective to ameliorate motor and non-motor dysfunctions, freezing of gait (FoG) is often resistant to DBS in patients with Parkinson's disease (PD). Transcranial direct current stimulation (tDCS) has been reported as an alternative therapeutic strategy to ameliorate FoG in PD patients. In this case report, we describe the effects of cumulative tDCS over the primary motor cortex of the lower leg to reduce FoG in 2 cases of PD patients with DBS. Two PD patients who had undergone DBS of the subthalamic nucleus visited the rehabilitation medicine department for refractory FoG. Each patient received cumulative tDCS over the primary motor cortex of the lower leg over to reduce FoG. Neither patient required change in dose of dopaminergic medication during the tDCS period nor a significant side effect during and after tDCS.Although the FoG-questionnaire (FoG-Q) in case 1 showed no change after 10 tDCS treatments, the patient in case 2 reported a significant improvement of FoG-Q from 11 to 3 after 5 days of tDCS. We present the safety and feasibility of tDCS in PD patients with DBS who showed refractory FoG.

Although deep brain stimulation (DBS) has been reported to be effective to ameliorate motor and non-motor dysfunctions, freezing of gait (FoG) is often resistant to DBS in patients with Parkinson's disease (PD). Transcranial direct current stimulation (tDCS) has been reported as an alternative therapeutic strategy to ameliorate FoG in PD patients. In this case report, we describe the effects of cumulative tDCS over the primary motor cortex of the lower leg to reduce FoG in 2 cases of PD patients with DBS. Two PD patients who had undergone DBS of the subthalamic nucleus visited the rehabilitation medicine department for refractory FoG. Each patient received cumulative tDCS over the primary motor cortex of the lower leg over to reduce FoG. Neither patient required change in dose of dopaminergic medication during the tDCS period nor a significant side effect during and after tDCS.Although the FoG-questionnaire (FoG-Q) in case 1 showed no change after 10 tDCS treatments, the patient in case 2 reported a significant improvement of FoG-Q from 11 to 3 after 5 days of tDCS. We present the safety and feasibility of tDCS in PD patients with DBS who showed refractory FoG.

Meningiomas are the most common benign intracranial tumors and make up 13-26% of all primary intracranial tumors. Clinical presentation of hemorrhage is rare in these tumors occurring in approximately 1.3% of cases and subdural hemorrhages are even more uncommon. The mechanism of hemorrhage is still unclear and may vary according to histologic type, location and the type of hemorrhage. We experienced a case of 61-year-old woman with a benign meningioma presenting as a subdural hemorrhage. She developed sudden onset of headache right after aggressively coughing. Her headache persisted for a week before she was admitted to the emergency room of National Cancer Center. She had a past medical history of ovarian cancer which had been treated and was allegedly recurrence-free for 2 years. At the time of admission, a headache was the only symptom and imaging studies showed a right frontal hemorrhagic subdural mass lesion accompanying an ipsilateral subdural hematoma. Elective surgery was performed and intraoperative findings revealed the hallmark characteristics of a meningioma with mixed stage diffuse subdural hematoma. Permanent pathology result determined it was a conventional meningioma (World Health Organization grade I). From this case, we discuss the rare presentation of subdural hemorrhage in meningioma and related points by reviewing the literature of previous studies.
Cough ; Emergency Service, Hospital ; Female ; Headache ; Hematoma, Subdural* ; Hemorrhage ; Humans ; Meningioma* ; Middle Aged ; Ovarian Neoplasms ; Pathology ; World Health Organization

We present a case of dural arteriovenous fistula (dAVF) within the wall of the superior sagittal sinus(SSS) presenting with chronic headache. Transfemoral arterial embolization was tried but failed because of tortuous middle meningeal artery (MMA) feeders preventing the microcatheter from reaching the fistula closely enough. A small craniectomy was performed to directly puncture the feeder close to the SSS, and then glue occlusion of the dAVF through the directly catheterized MMA was successfully accomplished.
Adhesives ; Catheters ; Central Nervous System Vascular Malformations* ; Fistula ; Headache Disorders ; Meningeal Arteries ; Punctures ; Superior Sagittal Sinus*

During the neutropenic phase, leukemia patients receiving chemotherapy are prone to bacterial and, fungal infections; occasionally mycobacterial, viral and protozoal organisms may also cause infections. Mycobacterium tuberculosis infection was reported very rarely in these patients. This report describes four patients with M. tuberculosis infection identified from 185 adult patients who were diagnosed myelogenous leukemia between January 2003, and December 2004. There was no patient with M. tuberculosis infection from 44 lymphoid leukemia and 11 acute biphenotypic leukemia patients. Sites of infection were all lymph nodes. Three among four patients were presented with lymphadenopathy at initial diagnosis of leukemia, and the other one presented with lymphadenopathy after induction chemotherapy. There was no patient presented with lymphadenopathy during the neutropenic phase. Tuberculous lymphadenitis was presented in a patient with three acute myelogenous leukemia (FAB class 2 M4, 1 M2) and a chronic myelogenous leukemia, accelerated phase. An acute myelogenous leukemia patient had a leukemic cell and tubercle bacilli in the same lymph node. Tuberculosis should also be included as a differential diagnosis in myelogenous leukemia patient with lymphadenopathy, especially in the countries in which the disease is endemic.
Adult ; Diagnosis ; Diagnosis, Differential ; Drug Therapy ; Humans ; Induction Chemotherapy ; Leukemia ; Leukemia, Biphenotypic, Acute ; Leukemia, Lymphoid ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Leukemia, Myeloid* ; Leukemia, Myeloid, Acute ; Lymph Nodes ; Lymphatic Diseases ; Mycobacterium tuberculosis ; Tuberculosis ; Tuberculosis, Lymph Node*

During the neutropenic phase, leukemia patients receiving chemotherapy are prone to bacterial and, fungal infections; occasionally mycobacterial, viral and protozoal organisms may also cause infections. Mycobacterium tuberculosis infection was reported very rarely in these patients. This report describes four patients with M. tuberculosis infection identified from 185 adult patients who were diagnosed myelogenous leukemia between January 2003, and December 2004. There was no patient with M. tuberculosis infection from 44 lymphoid leukemia and 11 acute biphenotypic leukemia patients. Sites of infection were all lymph nodes. Three among four patients were presented with lymphadenopathy at initial diagnosis of leukemia, and the other one presented with lymphadenopathy after induction chemotherapy. There was no patient presented with lymphadenopathy during the neutropenic phase. Tuberculous lymphadenitis was presented in a patient with three acute myelogenous leukemia (FAB class 2 M4, 1 M2) and a chronic myelogenous leukemia, accelerated phase. An acute myelogenous leukemia patient had a leukemic cell and tubercle bacilli in the same lymph node. Tuberculosis should also be included as a differential diagnosis in myelogenous leukemia patient with lymphadenopathy, especially in the countries in which the disease is endemic.
Adult ; Diagnosis ; Diagnosis, Differential ; Drug Therapy ; Humans ; Induction Chemotherapy ; Leukemia ; Leukemia, Biphenotypic, Acute ; Leukemia, Lymphoid ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Leukemia, Myeloid* ; Leukemia, Myeloid, Acute ; Lymph Nodes ; Lymphatic Diseases ; Mycobacterium tuberculosis ; Tuberculosis ; Tuberculosis, Lymph Node*

BACKGROUND: The outcome of hematopoietic stem cell transplantation (HSCT) for patients with severe aplastic anemia (SAA) in Seoul National University Hospital was analyzed retrospectively. METHODS: Between January, 1990 and March, 1999, 25 patients with SAA underwent HSCT. Their medical records were reviewed. Statistical analyses were done about survival and complication after HSCT. RESULTS: The median age of patients was 22 (range, 14~43) and male to female ratio was 18 : 7. Twenty two were HLA matched non- identical siblings. Three were one identical twin, one one-locus mismatched father and one HLA matched unrelated donor, respectively. Conditioning regimens were CY/TLI (cyclophosphamide, total lymphoid irradiation) for 18 patients, CY/ATG (CY, antithymocyte globulin) for 3, CY/ buffy (CY, unirradiated buffy- coat) for 2, CY/ ATG/TLI for 1, BU/CY (busulfan, CY) for 1. For prophylaxis of graft-versus-host disease (GVHD), cyclosporine and methotrexate were used in all patients except for identical twin. The median nucleated cell dose given to patients was 4.5x108/kg (range, 2.0~5.9). All evaluable patients achieved absolute neutrophil count of 500/microliter after median 17 days of HSCT (range, 12~27) and untransfused platelet count over 20,000/microliter after median 21 days of HSCT (range, 13~67). Six patients (24%, grade I : 3, II : 1, III : 1, IV : 1) developed acute GVHD and 8 (32%, limited : 4, extensive : 4) developed chronic GVHD. Hepatic venoocclusive disease (VOD) occurred in 2 patients (8%). Rejection occured in 4 patients (16 %), but among 22 allogeneic transplant recipients from HLA matched siblings, only one (5%) lost graft. After a median follow-up of 32 months (range 9~120 months), 5 year overall survival of all patients was 87%, and that of 22 allogeneic recipients from HLA matched sibling donors was 95%. Four patients (16%) died. Causes of death were VOD in one case, rejection with pneumonia one, acute GVHD one. One died from traffic accident in a cured state. CONCLUSION: Experiences from our center suggest that HSCT is an effective treatment for patients with severe aplastic anemia. Long- term survival is especially excellent for patients who have matched related donors.
Accidents, Traffic ; Anemia, Aplastic* ; Cause of Death ; Cyclosporine ; Fathers ; Female ; Follow-Up Studies ; Graft vs Host Disease ; Hematopoietic Stem Cell Transplantation* ; Hematopoietic Stem Cells* ; Humans ; Male ; Medical Records ; Methotrexate ; Neutrophils ; Platelet Count ; Pneumonia ; Retrospective Studies ; Seoul ; Siblings ; Tissue Donors ; Transplantation ; Transplants ; Twins, Monozygotic ; Unrelated Donors

Eosinophilic cystitis is an uncommon disease which is characterized by eosinophilic infiltration into all layers of bladder. It was first described in 1959 by Brown and 50 cases have been reported in the literature. The presenting symptoms are frequency, urgency, dysuria and hematuria. It is chronic disease with remission and exacerbation and mimics other forms of chronic cystitis, such as interstitial cystitis, tuberculosis and bladder neoplasm. Diagnosis is made by biopsy. Treatment consists of removal of inciting allergens, corticosteroids, antihistamines, and antibiotics for secondary bacterial infection. Most women and children with eosinophilic cystitis had the history of allergic disease or asthma and most male patients had bladder or prostatic disorders, such as benign prostatic hypertrophy, bladder carcinoma, and congenital anomalies. But eosinophilic cystitis has not been found in diabetic patients yet. We report a case of eosinophilic cystitis in a 59- year-old diabetic patient with brief review of the literature.
Adrenal Cortex Hormones ; Allergens ; Anti-Bacterial Agents ; Asthma ; Bacterial Infections ; Biopsy ; Child ; Chronic Disease ; Cystitis* ; Cystitis, Interstitial ; Diabetes Mellitus* ; Diagnosis ; Dysuria ; Eosinophils* ; Female ; Hematuria ; Histamine Antagonists ; Humans ; Male ; Prostatic Hyperplasia ; Tuberculosis ; Urinary Bladder ; Urinary Bladder Neoplasms

BACKGROUND: Acute myelogenous leukemia (AML) is the most common cause of leukemia in adults. Allogeneic bone marrow transplantation (BMT) for the treatment of AML is done worldwide now. METHODS: Between November 1987 and June 1998, we performed allogeneic BMT for 27 patients with AML from HLA-identical sibling donors. We reviewed medical records of these patients. RESULTS: The median age of patients was 31 (range, 15~43) and male to female ratio was 18 : 9. Conditioning regimens were BU/CY (busulfan, cyclophosphamide) for 22 patients, TBI/CY (total body irradiation, cyclophosphamide) for 3 patients, and TBI/VP/CY (TBI, VP-16, cyclophosphamide) for 2 patients. Cyclosporine and methotrexate were used in 18 patients for prophylaxis of graft-versus-host disease (GVHD), and cyclosporine and methyl-prednisolone were used in 9 patients. The median nucleated cell dose given to patients was 4.1x108 /kg. All evaluable patients achieved absolute neutrophil count of 500 /microliter after median 15 days after BMT (range, 11~45 days). Twenty-five percent of patients developed acute GVHD (> or = grade II) and there was no patient with grade IV acute GVHD. Twenty-nine percent developed chronic GVHD. Hepatic venoocclusive disease (VOD) occurred in 7 patients (26%). At the time of BMT, 16 patients were in the first remission status and 11 patients were in the advanced disease status. After a median follow-up of 27 months (range 7~127 months), the actuarial disease-free survival at 5 years was significantly higher in the first remission group than the others (44% vs. 9%; P=0.05). The difference of 5 year overall survival between these two groups approached statistical significance (50%for the first remission group and 12% for the others; P=0.13). There were 17 deaths. The causes of death were relapse (8 patients, 47%), VOD (3 patients, 18%), sepsis (2 patients, 12%), interstitial pneumonia (2 patients, 12%), chronic GVHD (1 patient, 6%), and drug-toxicity (1 patient, 6%). Eary deaths (<100 days) occurred in 6 patients (22%). CONCLUSION: Allogeneic BMT for patients with AML was most successful when done during the first remission. Clinical features of patients with AML treated with allogeneic BMT were similar to those from Western countries, but the incidence and severity of acute GVHD seem to be lower.
Adult ; Bone Marrow Transplantation* ; Bone Marrow* ; Cause of Death ; Cyclosporine ; Disease-Free Survival ; Etoposide ; Female ; Follow-Up Studies ; Graft vs Host Disease ; Humans ; Incidence ; Leukemia ; Leukemia, Myeloid, Acute* ; Lung Diseases, Interstitial ; Male ; Medical Records ; Methotrexate ; Neutrophils ; Recurrence ; Retrospective Studies* ; Sepsis ; Siblings ; Tissue Donors

Kimura's disease is a granulomatous disease which develops in the skin, subcutaneous tissues and lymph nodes and is characterized histologically by the presence of lymphoid follicles, vascular proli- feration and infiltration with eosinophils. The disease shows geographical predilection to Japan, China and South East Asia. The exact etiology and pathogenesis remain uncertain. Some patients had proteinuria or nephrotic syndrome. We have recently experienced the superimposed oliguric acute renal failure associated with Kimura's disease in a male patient with chronic renal failure who had been managed conservatively. Inguinal lymph node biopsy revealed Kimura's disease. He recovered from acute renal failure after being treated with hemodialysis and prednisolone. Lymphadeno- pathy and fever subsided with steroid treatment. We report a case of Kimura's disease which was complicated by acute renal failure in the patient with chronic renal failure.
Acute Kidney Injury* ; Biopsy ; China ; Eosinophils ; Far East ; Fever ; Humans ; Japan ; Kidney Failure, Chronic* ; Lymph Nodes ; Male ; Nephrotic Syndrome ; Prednisolone ; Proteinuria ; Renal Dialysis ; Skin ; Subcutaneous Tissue