BACKGROUND AND PURPOSE: Freezing of gait (FOG) is a frustrating problem in Parkinson's disease (PD) for which there is no effective treatment. Our aim was to find brain stimulation areas showing greater responses for reducing FOG. METHODS: Twelve PD patients with FOG were selected for inclusion. We explored the therapeutic effect of repetitive transcranial magnetic stimulation (rTMS) in the supplementary motor area (SMA) and the motor cortex (MC). We measured the number of steps, completion time, and freezing episodes during the stand-walk-sit test before and after rTMS treatment. We also tested freezing episodes in two FOG-provoking tasks. RESULTS: There was a trend for a greater reduction in freezing episodes with SMA stimulation than MC stimulation (p=0.071). FOG was significantly improved after SMA stimulation (p < 0.05) but not after MC stimulation. CONCLUSIONS: Our study suggests that the SMA is a more-appropriate target for brain stimulation when treating PD patients with FOG. This study provides evidence that stimulating the SMA using rTMS is beneficial to FOG, which might be useful for future developments of therapeutic strategies.
Brain ; Freezing* ; Gait* ; Humans ; Motor Cortex* ; Parkinson Disease* ; Transcranial Magnetic Stimulation ; Weather

Spinal hemangioblastomas at the filum terminale are rare. Only a few reports present immunohistopathological features of spinal hemangioblastomas. A 55-year-old woman presented with sustained low back pain and intermittent numbness in both lower extremities. She already had a decompressive surgery for a left L5-S1 extraforaminal lesion 7 months ago. Her incidental mass lesion had been slightly enlarged for 7 months and concordant symptoms had also been prolonged. Her tumor was removed en bloc with a unilateral hemilaminotomy and bilateral decompression technique. The patient's symptoms improved immediately after the surgery. In immunohistochemical stains, the stromal cells were positive for inhibin-alpha, neuron specific enolase (NSE), and the endothelial cells were positive for CD31, CD34, and factor VIII related antigen in confirming the diagnosis of hemangioblastoma. We report a rare case of intradural extramedullary spinal hemangioblastoma at the filum terminale. Complete en bloc resection was achieved with no morbidity. The immunohistopathological staining include inhibin-alpha confirmed an accurate diagnosis of the hemangioblastoma distinguishing from other vascular tumors.
Cauda Equina ; Coloring Agents ; Decompression ; Endothelial Cells ; Female ; Hemangioblastoma ; Humans ; Hypesthesia ; Low Back Pain ; Lower Extremity ; Middle Aged ; Phosphopyruvate Hydratase ; Stromal Cells ; von Willebrand Factor

Intraspinal synovial cysts are commonly found in the lumbar spine and occur less commonly in the cervical spine. Occurrence of a cyst in the thoracic spine causing myelopathy is extremely rare. We report here the radiological findings of a case of a thoracic intraspinal synovial cyst that caused myelopathy at the T2-3 level with an accompanying review of the clinical literature.
Spinal Cord Diseases ; Spine ; Synovial Cyst

Currently finger pricking is the common method of blood glucose measurement in patients with diabetes mellitus. However, diabetes patients have proven to be reluctant to check their glucose profiles regularly because of the discomfort associated with this technique. Recently, a non-invasive and continuous Reverse Iontophoresis based Glucose Monitoring Device (RIGMD) was developed in Korea. The study was conducted during the period November 2003-January 2004 on 19 in-patients. Glucose measurements were performed using RIGMD between 10 a.m. and 4 p.m. Concurrent plasma glucose levels were checked hourly and subsequently compared with RIGMD data. The mean error of RIGMD measurements was -3.45+/-52.99 mg/dL with a mean absolute relative error of 20+/-15.16%. Measurements obtained by RIGMD were correlated with plasma glucose levels (correlation coefficient; 0.784 (p<0.05)) and this correlation was independent of time of data collection. However, after excluding confounding variables this correlation coefficient exhibited a tendency to increase. 98.9% of the results were clinically acceptable by Clarke error grid analysis. We concluded that RIGMD does not have the reliability and accuracy required to wholly replace conventional methods. However, further technical advancements that reduce its shortcomings would make this device useful for the management of diabetes.
Middle Aged ; Male ; Linear Models ; *Iontophoresis ; Humans ; Female ; Blood Glucose Self-Monitoring/adverse effects/*instrumentation ; Aged ; Adult

Pure epidural cavernous hemangioma of the spine without vertebral involvement is rare. Due to the slow growth of this lesion, the most common symptoms are chronic pain, myelopathy, and radiculopathy. In our case, the patient complained of an acute onset sensory deficit of the C4 dermatome. An MRI revealed an epidural mass with an acute hematoma. Here, we report a case of a pure epidural cavernous hemangioma that presented with acute neurologic symptoms caused by intralesional hemorrhage and an acute epidural hematoma, which were demonstrated on the patient's MRI.
Tomography, X-Ray Computed ; Middle Aged ; Male ; Hyperesthesia/*diagnosis/etiology ; Humans ; Hematoma, Epidural, Spinal/complications/*diagnosis/radiography ; Hemangioma, Cavernous, Central Nervous System/complications/*diagnosis/radiography ; Epidural Space/radiography ; Epidural Neoplasms/complications/*diagnosis/radiography ; Cervical Vertebrae

Pure epidural cavernous hemangioma of the spine without vertebral involvement is rare. Due to the slow growth of this lesion, the most common symptoms are chronic pain, myelopathy, and radiculopathy. In our case, the patient complained of an acute onset sensory deficit of the C4 dermatome. An MRI revealed an epidural mass with an acute hematoma. Here, we report a case of a pure epidural cavernous hemangioma that presented with acute neurologic symptoms caused by intralesional hemorrhage and an acute epidural hematoma, which were demonstrated on the patient's MRI.
Tomography, X-Ray Computed ; Middle Aged ; Male ; Hyperesthesia/*diagnosis/etiology ; Humans ; Hematoma, Epidural, Spinal/complications/*diagnosis/radiography ; Hemangioma, Cavernous, Central Nervous System/complications/*diagnosis/radiography ; Epidural Space/radiography ; Epidural Neoplasms/complications/*diagnosis/radiography ; Cervical Vertebrae

BACKGROUND: Self monitoring of blood glucose plays an important role in the management of diabetes. However, traditional finger prick testing causes pain and so compliance with self monitoring of blood glucose is usually poor. Using an alternative site for sampling may reduce the level of pain and be beneficial for improving the compliance of diabetic patients. We evaluated the accuracy and acceptability of blood glucose testing from the forearm by analyzing the performance of the CareSens(R) (i-Sens, Inc. Korea) device for diabetic patients. METHODS: We measured the glucose level at the forearm by use of CareLance(R) (vaccum assisted lancing device) and also at the finger tip simultaneously by use of the CareSens(R) device at fasting and postprandial 2 hours, respectively. At the same time, the glucose levels of venous samples were checked by the laboratory method (BIOSEN 5030, EKF, Germany) and compared with those glucose level measured by the CareSens(R) device. We also checked the ease of use of the CareLance(R) and the associated pain of the patients by means of a visual analogue scale (VAS) at the time of blood sampling. RESULTS: The glucose level obtained from the forearm and finger tip correlated well with that from the laboratory method, respectively. Error grid analysis showed that 100% of the measurements were clinically acceptable; forearm blood glucose testing by use of CareLance(R) was less painful and it was as easy to use as the finger prick (P < 0.05 and P = 0.04, respectively). CONCLUSION: Forearm testing is an acceptable alternative to finger prick testing for measuring blood glucose in diabetic patients.
Blood Glucose ; Blood Glucose Self-Monitoring ; Compliance ; Diabetes Mellitus ; Fasting ; Fingers ; Forearm* ; Glucose* ; Humans

BACKGROUND: Self monitoring of blood glucose plays an important role in the management of diabetes. However, traditional finger prick testing causes pain and so compliance with self monitoring of blood glucose is usually poor. Using an alternative site for sampling may reduce the level of pain and be beneficial for improving the compliance of diabetic patients. We evaluated the accuracy and acceptability of blood glucose testing from the forearm by analyzing the performance of the CareSens(R) (i-Sens, Inc. Korea) device for diabetic patients. METHODS: We measured the glucose level at the forearm by use of CareLance(R) (vaccum assisted lancing device) and also at the finger tip simultaneously by use of the CareSens(R) device at fasting and postprandial 2 hours, respectively. At the same time, the glucose levels of venous samples were checked by the laboratory method (BIOSEN 5030, EKF, Germany) and compared with those glucose level measured by the CareSens(R) device. We also checked the ease of use of the CareLance(R) and the associated pain of the patients by means of a visual analogue scale (VAS) at the time of blood sampling. RESULTS: The glucose level obtained from the forearm and finger tip correlated well with that from the laboratory method, respectively. Error grid analysis showed that 100% of the measurements were clinically acceptable; forearm blood glucose testing by use of CareLance(R) was less painful and it was as easy to use as the finger prick (P < 0.05 and P = 0.04, respectively). CONCLUSION: Forearm testing is an acceptable alternative to finger prick testing for measuring blood glucose in diabetic patients.
Blood Glucose ; Blood Glucose Self-Monitoring ; Compliance ; Diabetes Mellitus ; Fasting ; Fingers ; Forearm* ; Glucose* ; Humans

Spontaneous epidural hematomas (SEHs) of the lumbar spine are rare. The pathogenesis is not entirely clear, but several reports have suggested that bleeding originating in the venous epidural plexus is the cause. This is the second report of a SEH thought to be the result of facet joint hemorrhage with no previous synovial cyst formation. A magnetic resonance image revealed a mass beginning in the left epidural space and continuing through to the left L5-S1 facet joint. Surgically, the epidural hematoma, which was covered by a very thin translucent membrane, was visualized directly. A histopathological examination revealed the wall of the epidural hematoma to be composed of very thin fibrous connective tissue with no synovium lining. The purpose of this study was to report a case of an epidural hematoma originated from lumbar facet joint, diagnosed by radiological examination, and to present a review of the subject literature.
Connective Tissue ; Epidural Space ; Hematoma* ; Hemorrhage ; Membranes ; Spine ; Synovial Cyst ; Synovial Membrane ; Zygapophyseal Joint*

The purpose of this preliminary study is to elucidate that vascular endothelial growth factor (VEGF) influences contrast enhancement of hepatic tumors on computed tomography (CT). Fourteen patients with hepatic tumors (11 hepatocellular carcinomas; 3 metastatic cancers) underwent a dual-phase dynamic helical CT or computed tomographic hepatic arteriography. The attenuation of each mass was determined as hyperattenuation, isoattenuation or hypoattenuation with respect to the adjacent nontumorous parenchyma. Gun-needle biopsy was done for each tumor, and paraffin sections were immunostained with anti- VEGF antibody by the avidin-biotin-peroxidase complex method. The pathologic grade was made by intensity (1 +, 2+, 3+) and area (+/-, 1 +, 2+). The tumor ranged 2.0-14.0 cm in size (mean, 5.8 cm). In arterial phase, the intensity was not correlated with the degree of enhancement (p=0.086). However, the correlation between the attenuation value of hepatic arterial phase and the area of positive tumor cells was statistically significant (p=0.002). VEGF may be the factor that enhances the hepatic mass with water-soluble iodinated contrast agent in CT.
Adult ; Aged ; Capillary Permeability ; Endothelial Growth Factors/physiology* ; Endothelial Growth Factors/analysis ; Female ; Human ; Liver Neoplasms/radiography* ; Liver Neoplasms/blood supply ; Lymphokines/physiology* ; Lymphokines/analysis ; Male ; Middle Age ; Prospective Studies ; Radiographic Image Enhancement* ; Tomography, X-Ray Computed