Authors presented the serial changes of brain MRI findings in two cases of cryptococcal meningitis. The MRI findings of the first patient (53-year-old female) consisted of dilated Virchow-Robin spaces, leptomeningeal enhancement, cryptococcomas and hydrocephalus. Dilated Virchow-Robin spaces were noted on the first MR obtained 33 days after symptom onset. The size and number of dilated Virchow-Robin space gradually decreased since 119 days after symptom onset (62 days after treatment). Faint leptomeningeal enhancement was found at cerebellar region on the first MRI, which became more distinct and intense on the day 119, probably due to improper treatment. The leptomeningeal enhancement decreased on the day 156. Mild hydrocephalus was noted on MRI obtained 70 days after symptom onset, which markedly aggravated on the day 119. It decreased after steroid therapy alone. Enhancing crytococcomas of variable size were noted at the right temporal lobe and cerebellum on MRI of the day 119, which decreased in size and number on the day 156. On the day 295 MRI showed nearly disppearance of the dilated Virchow-Robin space, but faint leptomeningeal enhancement, cerebellar crytococcomas and hydrocephalus still remained. The MRI findings of the second patient (36-year-old female) showed the findings similar to those of the first patient. Initial MRI obtained 18 days after symptom onset showed no abnormal findings. Dilated Virchow-robin spaces were noted on the day 36 (13 days after treatment onset), which nearly disappeared on the day 109. Enhancing cryptococcomas in both basal ganglia and cerebral cortex and leptomeningeal enhancement were noted on MRI of the day 136. Both cryptococcomas and leptomeningeal enhancement decreased in size and enhancing degree on the day 157. Hydrocephalus was noted on the day 109.
Basal Ganglia ; Brain ; Cerebellum ; Cerebral Cortex ; Follow-Up Studies* ; Humans ; Hydrocephalus ; Magnetic Resonance Imaging* ; Meningitis, Cryptococcal ; Temporal Lobe

Authors presented the serial changes of brain MRI findings in two cases of cryptococcal meningitis. The MRI findings of the first patient (53-year-old female) consisted of dilated Virchow-Robin spaces, leptomeningeal enhancement, cryptococcomas and hydrocephalus. Dilated Virchow-Robin spaces were noted on the first MR obtained 33 days after symptom onset. The size and number of dilated Virchow-Robin space gradually decreased since 119 days after symptom onset (62 days after treatment). Faint leptomeningeal enhancement was found at cerebellar region on the first MRI, which became more distinct and intense on the day 119, probably due to improper treatment. The leptomeningeal enhancement decreased on the day 156. Mild hydrocephalus was noted on MRI obtained 70 days after symptom onset, which markedly aggravated on the day 119. It decreased after steroid therapy alone. Enhancing crytococcomas of variable size were noted at the right temporal lobe and cerebellum on MRI of the day 119, which decreased in size and number on the day 156. On the day 295 MRI showed nearly disppearance of the dilated Virchow-Robin space, but faint leptomeningeal enhancement, cerebellar crytococcomas and hydrocephalus still remained. The MRI findings of the second patient (36-year-old female) showed the findings similar to those of the first patient. Initial MRI obtained 18 days after symptom onset showed no abnormal findings. Dilated Virchow-robin spaces were noted on the day 36 (13 days after treatment onset), which nearly disappeared on the day 109. Enhancing cryptococcomas in both basal ganglia and cerebral cortex and leptomeningeal enhancement were noted on MRI of the day 136. Both cryptococcomas and leptomeningeal enhancement decreased in size and enhancing degree on the day 157. Hydrocephalus was noted on the day 109.
Basal Ganglia ; Brain ; Cerebellum ; Cerebral Cortex ; Follow-Up Studies* ; Humans ; Hydrocephalus ; Magnetic Resonance Imaging* ; Meningitis, Cryptococcal ; Temporal Lobe

BACKGROUND: Paradoxical puborectalis syndrome (PPS) is a complex and poorly understood entity characterized by contraction rather than relaxation of the pelvic floor muscles during attempted evacuation. Anal electromyography (EMG) and cinedefecography (CD) are the most commonly used tests for the diagnosis of PPS. Therefore, the aim of this study was to prospectively assess the correlation of EMG and CD in the diagnosis of PPS. METHODS: All patients with symptoms of obstructed evacuation who underwent EMG and CD between September 1998 and February 1999, were evaluated. The clinical criteria for PPS included incomplete or difficult evacuation, straining, tenesmus, and the need for an enema or digitation. The EMG criteria included failure to achieve a significant decrease in the electrical activity of the puborectalis during attempted evacuation. The CD criteria included either paradoxical contraction or failure of the puborectalis to relax along with incomplete evacuation. RESULTS: Twenty-nine (29) patients had clinical evidence of PPS, 8 males and 21 females with a mean age of 42.6 years (range, 19-75 years), and underwent CD and EMG. The mean duration of symptoms was 7.2 years (range, 3 months-30 years). Nineteen patients (65.5%) had evidence as having PPS on CD and/or EMG. Of these patients, six patients (20.7%) were diagnosed as having PPS on both tests, five patients (17.2%) were only diagnosed on CD, and eight patients (27.6%) were only diagnosed on EMG. The remaining ten patients had normal puborectalis muscle relaxation on CD and EMG. Therefore, the correlation rate between the two tests was 55.2%. If EMG was considered as the ideal test for the diagnosis of PPS, CD had a sensitivity of 42.9% and a specificity of 66.7%. Conversely, if CD was considered as the ideal test, EMG had a sensitivity of 54.5% and a specificity of 55.6%. CONCLUSIONS: The sensitivity and the specificity values of EMG and CD for the diagnosis of PPS are suboptimal, and a low correlation existed between the two tests. This result suggests that the diagnosis of PPS should not be based upon only one test.
Constipation ; Diagnosis* ; Electromyography* ; Enema ; Female ; Humans ; Male ; Muscle Relaxation ; Muscles ; Pelvic Floor ; Prospective Studies ; Relaxation ; Sensitivity and Specificity

Epileptic seizures of nystagmoid character with the fast -beat to the opposite side of the epileptogenic focus have been described as oculoclonic seizures and epileptic nystagmus. Epileptic nystagmus, especially horizontal, most commonly results from seizure activity involving the occipital cortex, although participation of adjoining portions of the parietal and temporal cortex is possible. The frequency of ictal nystagmus was less than 10% of patients with occipital lobe epilepsy. Although forty-six cases were already reported at the litherature, there was no report in korea. We reported a 20-year old patient who had history of recurrent paroxysmal attacks of epileptic nystagniu, associated with oscillopsia and followed by episodic bilateral blindness and eyelid flutter. Standard and extra occipital electrodes visualized more exact left occipital foci at the videomonitored EEG examination when the patient showed epileptic nystagmus. The ictal Brain SPECT, with the use of 99mTc-HMPAO also localized the seizures to left occipital lobe.
Blindness ; Brain ; Electrodes ; Electroencephalography ; Epilepsies, Partial* ; Epilepsy ; Eyelids ; Humans ; Korea ; Occipital Lobe* ; Rabeprazole ; Seizures ; Technetium Tc 99m Exametazime ; Tomography, Emission-Computed, Single-Photon ; Young Adult

Intestinal lymphangiectasia is characterized by protein- losing enteropathy, and is diagnosed by a small bowel biopsy demonstrating dilated lymphatics in the mucosa, submucosa and serosa in the absence of coexistent inflammation. We report a case of primary intestinal lymphangiectasia that occurred in a 2-year-6-month-old girl who was treated successfully with antiplasmin and octreotide. Initially, the patient was treated with a lipid restriction diet with medium chain triglyceride oil, but her symptoms were not relieved. This case shows that antiplasmin and octreotide therapy might be useful for treating refractory primary intestinal lymphangiectasia.
Biopsy ; Diet ; Female ; Humans ; Inflammation ; Mucous Membrane ; Octreotide* ; Serous Membrane ; Triglycerides

Herpes simplex virus type I (HSV-I) causes an acute necrotizing encephalitis that selectively affects tempioral and frontal lobes. The sequelae and mortality of herpes simplex encephalitis(HSE) may be reduced by available antiviral therapy and therefore early diagnosis of HSE is essential. We have assessed the potential of brain perfusion scintigraphy using Tc-99m-HMPAO single photon emission computed tomoglaphy(SPECT) in HSE. Nine Tc-99m-HMPAO SPECTs were performed in eight patients with clinically suspected herpes simplex encephalitis. The examinations were made between 18 days and 10 months after onset of encephalitic symptoms The SPECT images in seven patients revealed decreased accumulation ol radioactivity in the affected temporal, frontal or parietal lobes. In a 30 yr-old female patient, two SPECT images were obtained on 18th day after the onset of symptoms and 3 months later. Her initial SPECT showed increased accumulation of radioactivity in the affected temporal and inferior frontal lobes. 3 month later follow-up SPECT image revealed the decreased radioactivity in the affected temporal, inferior frontal, and inferior parietal lobes. We found that the SPECT done at early stage of HSE may show increased cerebral perfusion due to inflammatory or other pathologic mechanism and the later stage SPECT may show decreased cerebral perfusion due to decreased cerebral metabolism caused by neuronal death We suggest that Tc-99m-HMPAO SPECT may support the clinical diagnosis of HSE.
Brain ; Diagnosis ; Early Diagnosis ; Encephalitis, Herpes Simplex ; Female ; Follow-Up Studies ; Frontal Lobe ; Herpes Simplex ; Humans ; Leukoencephalitis, Acute Hemorrhagic ; Metabolism ; Mortality ; Neurons ; Parietal Lobe ; Perfusion ; Perfusion Imaging ; Radioactivity ; Simplexvirus ; Tomography, Emission-Computed, Single-Photon*

Purpose: Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors have greatly improved survival in EGFR-mutant (EGFRm) non–small cell lung cancer (NSCLC); however, their effects on the tumor microenvironment (TME) are unknown. We assessed the changes induced by neoadjuvant erlotinib therapy (NE) in the TME of operable EGFRm NSCLC. Materials and Methods: This was a single-arm phase II trial for neoadjuvant/adjuvant erlotinib therapy in patients with stage II/IIIA EGFRm NSCLC (EGFR exon 19 deletion or L858R mutations). Patients received up to 2 cycles of NE (150 mg/day) for 4 weeks, followed by surgery and adjuvant erlotinib or vinorelbine plus cisplatin therapy depending on observed NE response. TME changes were assessed based on gene expression analysis and mutation profiling. Results: A total of 26 patients were enrolled; the median age was 61, 69% were female, 88% were stage IIIA, and 62% had L858R mutation. Among 25 patients who received NE, the objective response rate was 72% (95% confidence interval [CI], 52.4 to 85.7). The median disease-free and overall survival (OS) were 17.9 (95% CI, 10.5 to 25.4) and 84.7 months (95% CI, 49.7 to 119.8), respectively. Gene set enrichment analysis in resected tissues revealed upregulation of interleukin, complement, cytokine, transforming growth factor β, and hedgehog pathways. Patients with upregulated pathogen defense, interleukins, and T-cell function pathways at baseline exhibited partial response to NE and longer OS. Patients with upregulated cell cycle pathways at baseline exhibited stable/progressive disease after NE and shorter OS. Conclusion NE modulated the TME in EGFRm NSCLC. Upregulation of immune-related pathways was associated with better outcomes.