Parkinson's Syndrome Caused by Organophosphate Intoxication: A case report

Organophosphate intoxication causing the extrapyramidal symptom is not frequent. A case of Parkinson's syndrome caused by organophosphate intoxication was observed, of which is reported with the quantitative measurement of tremor using Tri-axial accelerometry. A fifty nine year-old male was admitted to Wonju Christian Hospital after the intake of organophosphate for the purpose of suicide and three days after the accident, involuntary movements were detected. The encephalography and MRI showed no abnormality. With Tri-axial accelerometry, we detected less than 4 Hz resting tremor. The tremor did not response to L-dopa, and in the follow up examination performed 149 days after the accident, an increase in amplitude was detected. Gait disturbance and dysarticulation became more severe. In a case of the organophosphate intoxication patient, very rare Parkinson's syndrome findings were detected, and the tremor during the resting period was measured quantitatively by electromyography and Tri-axial accelerometry.

Percutaneous Balloon Compression of Trigeminal Ganglion for the Treatment of Idiopathic Trigeminal Neuralgia : Experience in 50 Patients

OBJECTIVE: We assessed the surgical results of percutaneous balloon compression in 50 patients with idiopathic trigeminal neuralgia. METHODS: Fifty patients with follow-up period of more than 12 months were retrospectively analyzed. The mean follow-up period was 42 months (range, 12-82). The mean age was 65.8 years (range, 27-83). Seventeen patients (34%) had other previous surgical procedures. The balloon was inflated by injecting radio-contrast media under brief general anesthesia according to Mullan's technique. The mean inflating time was 88 seconds (range, 60-120). The whole procedure took about 20 minutes. RESULTS: We reported excellent and good results in 70% of the cases, poor in 6% as annoying dysesthesia, recurrence in 16%, and 8% failure due to technical deficiencies. Forty-six patients (92%) were initially relieved of their pain. There were permanent motor weakness of the masseter muscle in 4% of patients and transitory diplopia in 8%. Neither anesthesia dolorosa nor keratitis occurred. Almost all patients (92%) were discharged postoperatively within two days. CONCLUSION: These results indicate that balloon compression would be an effective method with acceptable morbidity, technically, it can be performed rapidly and simply in the treatment of idiopathic trigeminal neuralgia.

Lateral Third Infraclavicular Implantation of the Vagal Nerve Stimulation Generator Through Axillary Incision

OBJECTIVE: This report describes the clinical study of the surgical method of lateral third infraclavicular implantation of vagal nerve stimulation (VNS) generator through the axillary wrinkle incision. METHODS: In a retrospective study, the data for 20 patients with medically intractable epilepsy treated by this approach were examined. The mean age was 31.4 years (range : 14-50), and the mean follow-up period was 12.15 months (range : 4-21 months). The male to female ratio was 2.3 : 1. The subcutaneous pocket for the generator was located in the lateral third infraclavicular area through the axillary wrinkle. Our method was a modification of the standard VNS generator implantation in the mid-infraclavicular pocket through anterior axillary incision. RESULTS: There were the excellent or good cosmetic satisfaction in 95% of the cases and fair in 5%. The generator was located outside the lung field in 15%, periphery of the lung field in 45%, and crossed over the lung field in 40%. Discomfort from shoulder motion occurred transiently in 35% of cases. Other complications were minimal. CONCLUSION: These results demonstrate that the lateral third infraclavicular apporach will offers cosmetic benefits and reduction of obscuration of the lung field without serious complications. Thus, this technique provides an attractive alternative among the surgical techniques for the vagal nerve stimulation.

Effects of Electrical Stimulation of Transcutaneous Electrical Nerve and Acupuncture Stimulation in Patients with Myofascial Pain Syndrome

OBJECTIVE: To evaluate the effective stimulating mode of transcutaneous electrical nerve stimulation (TENS) and acupuncture for pain relief. METHOD: The subjects were 40 patients with MPS. In 20 patients, TENS were applied to the trigger point. In other 20 patients, acupuncture mode electrical stimulation were applied to the acupuncture site by measuring skin impedance of affected muscle. RESULTS: The visual Analogue Scale (VAS) decreased 20.48 (19.15%) in the group applied TENS mode and 30.08 (16.97%) in the group applied acupuncture mode after 1 week. The VAS decreased 33.19 (25.76%) in the groupapplied TENS mode and 46.48(17.76%) in the group applied acupuncture mode after 2 week (p<0.05). The pressure threshold was increased 16.07 (17.45%) in the group applied TENS mode and 26.09 (22.20%) in the group applied acupuncture mode after 1 week. The pressure threshold increased 24.88 (23.25%) in the group applied TENS mode and 41.11 (27.35%) in the group applied acupuncture mode after 2 week. CONCLUSION: Acupuncture mode was more effective treatment modality in MPS for pain relief than TENS mode.

Rehabilitation for Ambulation of Triple Amputee: A case report

Triple amputee is an uncommon impairment and has been rarely reported. We reported a case of success in independent bipedal ambulation of a triple amputee with bilateral lower limb prostheses. We selected a thirty five-year-old male who underwent a left shoulder disarticulation and a left very short transfemoral amputation and a right transfemoral amputation due to trauma. After program of gait training for eight weeks, he could walk independently, donning right hip disarticulation prosthesis and left transfemoral prosthesis and left shoulder disarticulation prosthesis with right Lofstrand forearm orthosis. We measured the amountof oxygen consumption of the patient before and after rehabilitation program done, of which all parameters including oxygen consumption were more improved than before that program. The patient preferred to walk by himself and got a feeling of full achievement. Nevertheless higher energy consumption, young active triple amputees need fitting prostheses with intensive rehabilitation training program for bipedal ambulation to prevent deterioration of physical function and mental health due to immobilization.

The Change of Skin Temperature after Thoracic Sympathectomy in Patients with Palmar Hyperhidrosis

OBJECTIVE: The purposes of this study were to evaluate the change of temperature before and after thoracic sympathectomy in patients with palmar hyperhidrosis and to find the usefulness of infrared thermography for the assessment of effects of thoracic sympathectomy. METHOD: The skin temperature was measured before, one day and 30 days after sympathectomy in 28 patients with palmar hyperhidrosis. Temperature was recorded on forehead, cheek, neck, axilla, umbilicus and 6 sites of each hand and foot by infrared thermography and thermometer. Patient's satisfaction with operation was assessed by 10 point scale. RESULTS: All patient who had undergone sympathectomy showed significantly decreased discomfort owing to hyperhidrosis by 10 point scale (p<0.05). The temperature significantly elevated on postoperative 1 day and 30 days on both palms as compared with preoperative state, bilaterally (p<0.05). There were no significant differences of sole temperatures among preoperative, postoperative 1 day and postoperative 30 days, bilaterally. CONCLUSION: We proved significant effect of thoracic sympathectomy to the patients with palmar hyperhidrosis objectively, and we also quantified the elevation of palm temperature after sympathectomy.

Squamous Cell Carcinoma of Oral Cavity and Metachronously Developed Hepatocellular Carcinoma Arising from Fanconi's Anemia

Fanconi's anemia (FA) is a rare familiar form of aplastic anemia (AA) that is associated with increased chromosomal instability and defective DNA repair, and it characterized by progressive pancytopenia, skeletal abnormalities, hyperpigmentation, and an increased risk of leukemia, hepatocellular carcinoma (HCC) and squamous cell carcinoma (SCC), including head and neck SCC. We reported a 31-year-old man who had AA for 17 years and who developed SCC of oral cavity and then metachronously developed HCC. For treatment of his AA, he was given cyclosporin, steroid and androgen in addition to frequent blood transfusion. At the age of 27, he presented with SCC of the maxilla and the right maxillectomy was performed. Four years later in 2003, hepatic resection of the left medial segment of the liver was performed due to hepatocellular carcinoma. Confirmation of FA was done by cytogenetic analysis. The patient died in 2005 of subdural hemorrhage and pneumonia without involvement of the SCC and HCC.

Intrahepatic Cholangiocarcinoma with Sarcomatous Change: Case Report

Cholangiocarcinomas have several histologic types, but intrahepatic cholangiocarcinoma with sarcomatous change is rare. A 71-year-old man was admitted to our hospital because of fever which had lasted two months. Ultrasonography (US) of the upper abdomen demonstrated a huge hepatic mass with central solid and peripheral cystic portions, and computed tomography (CT) revealed a heterogeneous hepatic mass with a central area in which enhancedment was delayed. Magnetic resonance imaging (MRI) disclosed a huge mass of predominantly low signal intensity at T1WI, and peripheral portions of high signal intensity and a central portion of intermediate signal intensity at T2WI. The pathologic diagnosis was cholangiocarcinoma with sarcomatous change.

Hepatoblastoma in a Patient with Familial Adenomatous Polyposis: Case Report

Familial adenomatous polyposis and hepatoblastoma are rare conditions; the latter is closely related to the FAP gene. We describe the imaging findings of hepatoblastoma in a patient with polyposis coli.

Three Cases of Conservative Management of Ectopic Pregnancy Implanting in The Previous Cesarean Section Scar / 대한산부인과학회잡지

Ectopic pregnancy developing in the previous cesarean section scar is the rarest forms of ectopic pregnancy and very dangerous because of the risk of uterine rupture and hemorrhage. Hysterectomy was usually done in the management but, conservative treatment is desirable for young women who want to maintain her fertility. We present three cases of ectopic pregnancy developing in the previous cesarean section scar in which successfully treated with conservative management.