Neurological Complications Resulting from Non-Oral Occupational Methanol Poisoning

Methanol poisoning results in neurological complications including visual disturbances, bilateral putaminal hemorrhagic necrosis, parkinsonism, cerebral edema, coma, or seizures. Almost all reported cases of methanol poisoning are caused by oral ingestion of methanol. However, recently there was an outbreak of methanol poisoning via non-oral exposure that resulted in severe neurological complications to a few workers at industrial sites in Korea. We present 3 patients who had severe neurological complications resulting from non-oral occupational methanol poisoning. Even though initial metabolic acidosis and mental changes were improved with hemodialysis, all of the 3 patients presented optic atrophy and ataxia or parkinsonism as neurological complications resulting from methanol poisoning. In order to manage it adequately, as well as to prevent it, physicians should recognize that methanol poisoning by non-oral exposure can cause neurologic complications.

Reversible Lesion in The splenium of The Corpus Callosum Induced by Topiramate in a Patient with Migraine

Reversible lesion in the splenium of the corpus callosum in patients with epilepsy is often associated with some antiepileptic drugs. However, topiramate has never been reported as a possible inducer of the focal lesion. We report a case of reversible splenial lesion of the corpus callosum presumed to be induced by low dose topiramate in a patient with chronic migraine.

The Correlation Study between Plasma Aβ Proteins and Cerebrospinal Fluid Alzheimer's Disease Biomarkers

BACKGROUND AND PURPOSE: Alzheimer's disease (AD) is characterized by the accumulation of amyloid-β proteins (Aβ). In this study we explored the correlation of plasma Aβ40 and Aβ42 concentrations with Aβ42, total tau (tTau) and phosphorylated tau 181 (pTau181) levels in cerebrospinal fluid (CSF) in AD and control subjects to further understand the characteristics of plasma Aβ proteins levels. METHODS: The consecutive subjects (44 AD and 47 controls) in this study were recruited. The plasma levels of Aβ40 and Aβ42 were measured using a commercially available sandwich enzyme-linked immunosorbent assay (ELISA) kits. And the corresponding CSFs were analyzed in terms of Aβ42, tTau and pTau181 concentrations using INNOTEST ELISA kits. Further, the albumin levels were measured both in serum and CSF and albumin ratio was obtained to check the integrity of blood-brain barrier. RESULTS: CSF Aβ42 concentrations were significantly decreased while tTau and pTau181 levels were significantly increased in AD subjects. The plasma levels of Aβ42 were significantly lower (p=0.007), while the Aβ40/Aβ42 ratio was significantly higher (p<0.001) in AD patients than in controls. The overall plasma Aβ42 levels showed a positive correlation with those of CSF Aβ42 (p=0.001), but not with the others in CSF. In subgroup analysis, the CSF Aβ42 demonstrated positive correlation with not only plasma Aβ42 but also Aβ40 levels in controls. However, no significant relationship was noted between plasma and CSF Aβ proteins in AD group. CONCLUSIONS: The plasma Aβ42 and Aβ40 concentrations were shown to have a close relationship with CSF Aβ42 levels in controls, but not in AD subjects. Our results suggest that the correlation between plasma Aβ40 and CSF Aβ42 levels is perturbed in AD.

Atypical Early-Onset Alzheimer's Disease Dementia Diagnosed by Biomarker Study

BACKGROUND: The described clinical characteristics of early-onset Alzheimer's disease (EOAD) are distinct from that of late-onset AD. We reported a patient with atypical EOAD. CASE REPORT: A 54-year-old, truck driver developed gradual visuospatial, language and calculation deficits for 3 months. The neuropsychological impairments were extensive. Brain MRI revealed asymmetric atrophy in left medial temporal lobe along with distinct widening of sylvian fissure. (18)F-florbetapir-positron emission tomography (PET) showed a high uptake in the cortex. Further, the profiles of cerebrospinal fluid (CSF) biomarker were compatible with AD. CONCLUSIONS: We diagnosed the patient as EOAD based on the result of biomarker study. Increased Abeta burden was identified through amyloid PET imaging and decreased CSF Abeta level. The high rise of CSF Tau proteins was in agreement with the patient's extensive and rapid cognitive decline. This case report demonstrates the importance of AD biomarker study in confronting early-onset dementia with atypical clinical presentation.

Systemic Air Embolism after CT-guided Transthoracic Needle Biopsy

Systemic air embolism is rare event that occurs when air bubbles enter into the multiple organs through blood circulation. We report a case of a 76-year-old man who developed systemic embolism in cerebral, coronary and renal artery after computed tomography guided trans-thoracic needle biopsy. It is assumed that cerebral infarction in the inferior branch of right middle cerebral artery and renal artery infarction might be occurred because of both the procedure performed in prone position and the physical characteristics of the air.

The Clinical Characteristics according to the Educational Level in the Elderly Patients with Mild Alzheimer's Disease Dementia

BACKGROUND AND PURPOSE: Cognitive reserve is important for the individual susceptibility to dementia. Among the various determinants of cognitive reserve, the number of years of formal education would be of prime importance. We performed this study to explore its contribution to the clinical characteristics of dementia. METHODS: We included consecutive mild Alzheimer's disease (AD) dementia patients (clinical dementia rating, CDR=0.5 or 1) who visited our memory clinic and were older than 70 years at the evaluation from October 2013 to September 2015. According to the number of years of education, the corresponding subjects was grouped into two extreme educational groups, low education (illiterate or partially illiterate, LE, n=43) vs. high education (more than 9 years of education, HE, n=34). Among these patients, we compared various demographic, neuropsychological and neuroimaging characteristics. RESULTS: The groups were comparable in terms of age, frequency of hypertension and diabetes, and CDR and its sum of box. However, female gender was more frequent in the LE group (p=0.000). Also this group showed a more depressive mood on the geriatric depression scale (p=0.007). The raw scores on Korean Version of Mini-Mental State Examination and well-validated neuropsychological tests were lower in the LE group. However, the cognitive performance was found to be more preserved in the LE group than in the HE group when assessed using the z-score in certain specified tests on univariate and multivariate analyses (p<0.05). The Schelten's grade of medial temporal atrophy was similar between the two educational groups. Also, the degree of combined ischemic burden did not differ between the two groups. CONCLUSIONS: We identified that the prevalence of depressive mood and the extent of decline from the corresponding norm in a particular neuropsychological performance differ according to the educational level of mild AD patients.

Endoscopic snare resection for tumors of the ampulla of Vater

Though surgical resection has been the traditional treatment for tumors of the ampulla of Vater, endoscopic maneuvers such as snare resection, laser photodestruction and electrofulguration have recently been introduced to avoid operation-related morbidity and mortality. From 1994 to 1996, 6 patients with ampullary tumor were managed by endoscopic snare resection and regularly followed. Endoscopic snare resection of the ampullary tumor was technically feasible in all patients and each procedure was performed in a single session. Histologic diagnoses of the resected specimens were adenoma in 4 patients and adenoma with coexistent adenocarcinoma in 2 patients. Resection margins were negative in all patients except 1 with coexistent adenocarcinoma and a radical pancreaticoduodenectomy was performed in that case. For the other patient with adenocarcinoma foci, no further treatment was persued since he was 72-year-old and refused operation. Acute pancreatitis developed in 2 patients after endoscopic therapy, but was resolved with conservative management. There was no procedure-related death. Surveillance duodenoscopy performed at 1 and 6 months after endoscopic resection revealed no evidence of recurrent tumor in 4 patients with adenoma. Among them, 3 patients are alive without evidence of recurrence at 16-37 months after resection, but 1 patient was lost after 9 months of follow-up. The patient with adenocarcinoma in whom a pancreaticoduodenectomy was performed, has been alive without recurrence for 12 months. Oral 5-fluorouracil was administered for the other patient with adenocarcinoma foci. Though he experienced local recurrence at 13 months after the procedure, he has been alive for 28 months after resection. In conclusion, endoscopic snare resection may be applied as a viable alternative to surgery in selected patients with small ampullary tumors.

A Case with Gastric Anisakiasis Presented with a Submucosal Tumor / 대한소화기내시경학회지

Anisakiasis is a parasitic infestation caused by nematode larvae belonging to the subfamily Anisakinae when a raw or inadequately cooked fish is ingested. The clinical symtoms are severe cramping abdominal pain, nausea, vomiting, epigastric fulling sensation, but hematemesis or melena is very rare. We report a case of a 60-year-old male patient who developed melena one day after eating raw sea-fish. An esophagogastroduodenoscopy revealed a submucosal tumor with an ulceration located in the gastric fundus and subsequently an explolaparotomy and mass excision was performed due to massive bleeding. An anisakis larva was found in the resected mass, which was thought to be gastric anisakiasis.

Factors Affecting Insertion Time during Colonoscopy / 대한소화기내시경학회지

BACKGROUND AND AIMS: The goal of this study was to examine whether certain variables are associated with insertion time during colonoscopy. METHODS: A total of 703 consecutive subjects underwent colonoscopy by a single endoscopist from April of 1998 to August of 1998. The insertion time during colonoscopy was checked and the factors that may affect insertion time were analyzed. RESULTS: The indications for colonoscopy were bowel habit change (34.8%), the diagnosis of and follow up for colonic neoplastic disease (31.6%), abdominal pain (22.8%), thin stool caliber (19.2%), hematochezia (16.1%), routine examination (10.7%), inflammatory bowel disease (9.4%), tenesmus (8.8%) and a family history of colonic disease (3.1%). Of 703 subjects, complete colonoscopy was possible in 678 (96.4%). Reasons for incomplete insertion included inadequate bowel cleaning (n=11), pain (n=6), a history of operations (n=3), and others (n=5). Therefore, the adjusted completion rate was 97.9% (678/692). The mean insertion time in complete colonoscopy was 7.07 4.26 min (range; 2~35 min). Multivariable analysis revealed that inadequacy of bowel preparation was significantly associated with prolonged (>10 min) insertion time (p=0.005), whereas the history of colorectal resection was inversely associated with prolonged insertion time (p=0.010). CONCLUSIONS: Among the factors affecting insertion time during colonoscopy, cleanness of the bowels is the only correctable factor.

Endoscopic Ampullectomy for Tumors of the Ampulla of Vater: Long-term Follow-up Results / 대한소화기내시경학회지

BACKGROUND/AIMS: The resectability rate and prognosis of tumors of the ampulla of Vater are significantly better than for other periampullary tumors. Treatment for ampullary tumors has traditionally been surgical resection. However, endoscopic ampullectomy has been reported in patients with benign ampullary tumors. This study is being conducted to evaluate the availability of endoscopic ampullectomy. METHODS: Between 1994 and 1996, 6 cases (M: F=5: 1) with ampullary tumors were treated by endoscopic ampullectomy. Clinical presentations, complications, pathologic findings, and follow-up information were reviewed. RESULTS: Complete resection was perfomed in 5 cases. Pancreatitis after this procedure occurred in 2 cases, but were resolved by conservative care. Pathologic findings of resected specimens were adenama in 4 cases and adenocarcinoma in 2 cases. There was no recurrence in adenoma during the follow-up period (9-37 months) except in one case, which the patient was lost after 9 months. In one case with adenocarcinoma, the patient refused the operation, and consequently had the tumor recurrence 13 months later. CONCLUSIONS: Endoscopic ampullectomy was considered safe and effective treatment for removing benign ampullary tumors as well as malignant tumors, the latter of which are not considered suitable for operation.

A Case of Bilateral Sacroiliitis in Systemic Lupus Erythematosus / 대한류마티스학회지

Sacroiliitis is a prototyical feature of the seronegative spondyloarthropathies. It has been reported rarely in patients with systemic lupus erythematosus. We report a case of bilateral sacroiliitis in a 26 year-old female who presented 5 out of 11 ARA criteria for systemic lupus erythematosus. She complained of right low back pain since 1 week after delivery. Plain roentgenogram, computed tomogram and magnetic resonance imaging revealed no evidence of subluxation or pyogenic infection that may be possibly related to delivery, but bilateral sacroiliitis especially more severe in the right side that showed concordantly increased uptake on bone scan. Also she had neither HLA DR-3 nor B-27 antigens and had no other clinical findings of limitation of motion of spine and chest expansion, which suggest that there is a less likelihood of coexistent ankylosing spondylitis. In this case, we suggested that sacroiliitis may be a infrequent manifestation of systemic lupus erythematosus.

A Phase I/II Trial of DA3030 in Chemotherapy Induced Neutropenia / 대한암학회지

PURPOSE: We planned to evaluate the toxicity and efficacy of DA-3030 to determine the recommended dose for phase III clinical trial based on the biologically active doses from phase I/II clinical trial. MATERIALS AND METHODS: Open non-randomized phase I/II study was carried out in 64 cancer patients with chemotheray-induced myelosuppression. After 1 cycle of control period (chemotherapy without DA-3030), DA-3030 was started 24 hours after the second cycle of chemotherapy to 4 groups of patients with the doses of 50 microgram/m2/day (step I), 100 microgram/m2/day (step II), 150 microgram/m2/day (step III), 200microgram/m2/day (step IV) by once-a-day subcutaneous administration for 10 days. RESULTS: Of the 64 enrolled patients, 46 patients were evaluable. Tmax reached after 2 hours of injection in step I and 4 hours in step II-IV. Terminal half life was 1.8 hours in step I and 3.2 hours in step II, 3.3 hours in step III, 3.0 hours in step IV. Area under the curve (AUC) and AUMC increased dose dependently from step I through step IV. Total clearance rate decreased in a dose dependent manner but the volume of distribution showed no differences between the steps.The mean nadir count of total WBC and neutrophil increased in all 4 steps of DA-3030 administration. Also the duration of leukopenia, equal to or less than 2,000/uL or neutropenia and the recovery time of WBC or neutrophil from nadir decreased with DA-3030 administration in all 4 steps. But no differece of DA-3030 effect was found among 4 steps. When we compared the clinical efficacy of DA-3030 with total WBC and neutrophil criteria, it was 58.3% and 58.3% in step I, 90.0% and 80.0% in step II, 91.7% and 91.7% in step III, 75.0% and 70.0% in step IV. Although the duration of antibiotics administration showed no difference between control and DA-3030 administration period in step I, it decreased with DA-3030 administration in step II-IV. Infection was found only in step I. Life-threatening side effect was not found in all steps. Only mild myalgia was found without any dose relationship. CONCLUSION: When we considered the efficacy, toxicity and pharmacokinetic parameters, we suggest that 100microgram/m2 is an appropriate dosage for the phase III clinical trial.

P53 overexpression in gastric adenocarcinoma with Helicobacter pylori infection

Gastric carcinogenesis has been studied in various aspects. Helicobacter pylori (Hp) infection and mutation of the p53 tumor suppressor gene have recently been argued to be important factors of gastric carcinogenesis. There have been many studies to determine the precise mechanism of how Hp is related to gastric cancer, but it is so far still unknown. We studied the relationship of Hp infection and p53 overexpression and tried to discover some significance in clinicopathologic factors such as age, sex, stage, site, differentiation and gross morphology. Ninety-six patients who were diagnosed with gastric cancer at Severance Hospital, Yonsei University Medical College from November 1995 to March 1996, and 96 control patients of non-ulcer dyspepsia (NUD) were studied by endoscopic biopsy of normal gastric tissue and cancer tissue. They also underwent the CLO (Delta West, Melbourne, Western Australia) test for Hp positivity and p53 immunohistochemical stain for p53 positivity. These data were analyzed for comparison with the clinicopathologic characteristics of gastric cancers. In conclusion, the differentiated group cancer had a significantly high Hp positivity and p53 positivity. There is a possibility that Hp infection and p53 tumor suppressor gene mutation might be significantly related in the gastric carcinogenic process of well- and moderately-differentiated adenocarcinomas, but further study is necessary to determine more direct clues on the carcinogenic roles of these factors.

A Case of Epithelioid Hemangioendothelioma Involving the Lung and Liver / 결핵

Epithelioid Hemangioendothelioma(EH) is a rare vascular tumor, originating from endothelial cells. The principal locations are lung, soft tissue, bone and liver. This tumor is of borderline malignancy, relatively benign course. In the lung, the tumor is often multifocal, bilateral and frequently lead to the mistaken diagnosis of metastatic carcinoma. Although EH of the lung is relatively slow growing tumor, extensive pulmonary involvement, systemic metastasis, mainly to the liver have been documented. A 26-year-old man with EH involving the lung and liver was reported. Chest X-ray and chest CT showed multiple nodules in both lung fields and Abdominal CT multiple round low densities in liver. Transbronchial lung biopsy was performed. The patient diagnosed as EH by light microscopic finding and immunohistochemical study for Factor VIII-related antigen.

Secondary Intraocular Lens Implantation in Aphakia

The secondary implantation has gradually increased year by year. The authors conducted a study on eighty-two patients(92 eyes) recieving secondary intraocular lens implantation from Jan 1989 to Jan 1993. Sulcus fixation of posterior chamber IOL implantation was done in cases of intact or small posterior capsule rupture(56 cases). Anterior chamber intraocular lens(8 cases) and posterior chamber intraocular lens implantation by scleral fixation(28 cases) was done in eyes with large posterior capsule rupture or no zonular support. Final postoperative visual acuity of 0.5 or better was acquired in 77 eyes(83.7%) and didn't show statistically significant difference in three groups. The postoperative complications induced IOL decent ration(9.8%), uveitis(6.7%), cystoid macular edema(3.3%), vitreous hemorrhage(3.3%), and retinal detachment(3.3%). The causes of postoperative decreased visual acuity were cystoid macular edema(2.2%), fibrous membrane on IOL(2.2%), IOL decentration(1.1%) and IOL dislocation(1.1%), No statistically significant difference was noted in postoperative central corneal endothelial cell loss in three groups.

Effect of Corticosteroid on Orbital Pseudotumor Caused by Orbital Myositis

Idiopathic orbital myositis, a subgroup of inflammatory orbital pseudotumor may occur with acute-onset periorbital pain, diplopia, and, in most cases, eyelid swelling. Proptosis, extraocular muscle motility restrictions, and response to oral prednisolone administration were characteristic. Although the CT appearance of orbital myositis is often helpful, the findings are not pathognomonic: correlation with history, clinical finding, and therapeutic response must be considered in making the diagnosis. The results of corticosteroid therapy on the orbital pseudotumor caused by orbital myositis were as follows: 1. The effect of corticosteroid was more effective in single extraocular muscle involvement than in that of a multiple extraocular muscle. 2. Early age of onset and early treatment after symptom increased the effectiveness of corticosteroid therapy.

A Clinical Study of Retinal Vein Occlusion

Following diabetic retinopathy, retinal vein occulusion is probably the most common retinal vascular disorder. Author studied 47 cases of occlusion of the retinal vein in aspects of sex, age, laterality, change of visual acity, associated diseases and location of the affected vein. The results were as follows; 1. There was no significant difference in mobidity rate of retinal vein occlusion between male and female or right and left. 2.73% of BRVO affected superior temporal branch of retinal vein. 3. The incidence of BRVO is 2.2 times of that of CRVO. 4. The visual acuities of initial visit were below 0.1 in 73% of CRVO and 46% of BRVO. 5. 40% of CRVO retained or regained vision of 0.1 or better. 6. The most common associated disease was systemic hypertension.

Nasolacrimal Duct Reconstruction with Pyrex Glass Tube

From March, 1988 to August, 1989, the authors performed nasolacrimal duct reconstruction with Pyrex glass tube without bony perforation in 26 eyes of 25 patients who has chronic dacryocystitis with nasolacrinal duct obstruction. This method is implantation of permanent indwelling pyrex glasstube from base of the sac through the interosseous canal into the vault of inferior nasal meatus and there are several advantages in this method; The technique is more simple and less traumatic than other dacryocystorhinostomy, tear drainage inferioly prevents pooling of tear in inferior portion of lacrimal sac after surgery, normal anatomic relationships are retained and less postoperative care is required. The results were as follows: 1. Success was achieved in 24 of 26 cases including partial success. 2. Postoperative complications were developed that hypertrophic scar 2 cases, superficial punctate keratitis 1 case, wound infection 1 case, nasal bleeding 1 case.