No abstract available.

Ramsay Hunt syndrome(RHS or herpes zoster oticus) is caused by reactivation of latent varicella-zoster virus(VZV) in the geniculate ganglion of the seventh cranial nerve. Unilateral facial paralysis is accompanied by herpetic vesicles on the external auditory canal or in the mouth. The prognosis is not good as that of idiopathic facial palsy. Aggressive treatment with acyclovir, in combination with steroids, is recommended. RHS is thought to affect adults primarily, but a few cases of children with RHS have been reported. We present a case of RHS combined with aseptic meningitis in a previously healthy 10-year-8-month-old boy. He showed a complete peripheral facial palsy on the right side with CSF pleocytosis. Eight days after the onset of the facial palsy, the characteristic herpetic vesicles appeared on the pinna of the right side. The analysis of sera confirmed the clinical diagnosis of RHS with a positive IgG and IgM-ELISA antibody titer of VZV. Although we administered acyclovir and prednisolone adequately to the patient, he has shown an incomplete recovery of the facial palsy on a follow-up visit. The physicians should be prudent in the diagnosis of idiopathic facial palsy or RHS, and must watch for the appearance of vesicles in children with facial palsy.
Acyclovir ; Adult ; Child ; Diagnosis ; Ear Canal ; Facial Nerve ; Facial Paralysis ; Follow-Up Studies ; Geniculate Ganglion ; Herpes Zoster ; Herpes Zoster Oticus* ; Herpesvirus 3, Human ; Humans ; Immunoglobulin G ; Leukocytosis ; Male ; Meningitis, Aseptic* ; Mouth ; Prednisolone ; Prognosis ; Steroids

The purpose of this study was to evaluate the efficacy of adenosine triphosephate (ATP) in comparison to sodium nitroprusside (SNP) in reducing left ventricular afterload in 20 patients, ASA physical status I, during ethrane-N2O anesthesia. Hemodynamic effects of intravenous ATP (30~250 ug/kg/min) were compared with those of SNP (0.3~2.5 ug/kg/min) in group 1 (n=10). In group 2 (n=10), hemodynamic and intrapulmonary shunt effects of dobutamine (1 ug/kg/min) alone and in combination with ATP or SNP, required to maintain mean arterial pressure around 70 mmHg, were compared. The results were as follows. 1) Both ATP and SNP reduced arterial pressure rapidly resulting from a marked decrease in systemic vascular resistance in a dose-related manner. 2) Cardiac index increased from 3.31+/-0.201/min/m2 to 4.04+/-0.281/min/m2 (p<0.01) following dobutamine alone, and increased further to 5.71+/-0.38 1/min/m2 (p<0.001) and decreased to 3.77+/-0.28 1/min/m (NS) in combination with ATP and SNP, respectively. 3) At equivalent decrease in mean arterial pressure, ATP increased heart rate significantly less than SNP. 4) Hypotensive response was more stable during ATP infusion than during SNP infusion. 5) Arterial oxygen tension was significantly higher during dobutamine/ATP infusion than during dobutamine/SNP infusion (268+/-6 vs 256+/-9 mmHg, p<0.05). 6) Intrapulmonary shunt fraction increased from 4.49+/-0.65% to 5.51+/-0.71% (p<0.05) following dobutamine alone, and increased further to 9.92+/-1.13 (p<0.001) and to 7.21+/-0.77% (p<0.01) in combination with ATP and SNP, respectively. These results suggest, although ATP increases intrapulmonary shunt fraction more than does SNP, ATP has significant advantage over SNP, either alone or in combination with dobutamine, in improving cardiac performance in patients with low output states due to high peripheral vascular resistance.
Adenosine Triphosphate* ; Adenosine* ; Anesthesia ; Arterial Pressure ; Dobutamine* ; Heart Rate ; Hemodynamics* ; Humans ; Lung ; Nitroprusside* ; Oxygen ; Pharmacology ; Sodium* ; Sympathetic Nervous System ; Vascular Resistance

PURPOSE: We evaluated the indications of operation and radiologic findings in 12 operated DeBakey type III aortic dissections. MATERIAL AND METHODS: We retrospectively reviewed radiologic findings of 12 operated DeBakey type III aortic dissections, using CT, MRI, or aortography, and correlations were made with clinical course of the patients. RESULTS: Three cases were uncomplicated dissections. There were aneurysm rupture in 4 cases, impending rupture in 4 cases, occlusion of common lilac artery in 2 cases, occlusion of renal artery in 1 case, and compression of bronchus and esophagus by dilated aorta in 1 case. Associated clinical sign and symptoms were chest and back pain in 12 cases, claudication in 3 cases, dyspnea and dysphagia in 1 case, hoarseness in 1 case, and hemoptysis in 1 case. Post-operative complications were death from aneurysm rupture in 1 case, paraplegia in 2 cases, acute renal failure in 3 cases, and hemopericardium in 1 case. CONCLUSION: Although medical therapy is preferred in management of DeBakey type Ill aortic dissection, surgical treatment should be considered in patients with radiological findings of aortic rupture, impending rupture, occlusion of aortic major branches.
Acute Kidney Injury ; Aneurysm ; Aorta ; Aortic Aneurysm* ; Aortic Rupture ; Aortography ; Arteries ; Back Pain ; Bronchi ; Deglutition Disorders ; Dyspnea ; Esophagus ; Hemoptysis ; Hoarseness ; Humans ; Magnetic Resonance Imaging ; Paraplegia ; Pericardial Effusion ; Renal Artery ; Retrospective Studies ; Rupture ; Thorax

No Abstract Available.
Female ; Hormone Replacement Therapy* ; Humans ; Life Style* ; Osteoporosis*

PURPOSE: To compare the findings of fluid-attenuated inversion recovery(FLAIR) MR imaging in the detection of subarachnoid hemorrhage(SAH), with those of precontrast CT and T1-weighted MR imaging. MATERIALS AND METHODS: In 13 patients (14 cases) with SAH, FLAIR MR images were retrospectively analyzed and compared with CT(10 patients, 11 cases) and T1-weighted MR images(9 cases). SAH was confirmed on the basis of high density along the subarachnoid space,as seen on precontrast CT, or lumbar puncture. MR imaging was performed on a 1.0T unit. FLAIR MR and CT images were obtained during the acute stage(less than 3 days after ictus) in 10 and 9 cases, respectively, during the subacute stage(4 -14 days after ictus) in two cases and one, respectively, and during the chronic stage(more than 15 days after ictus) in two cases and one, respectively. CT was performed before FLAIR MR imaging, and the interval between CT and FLAIR ranged from 24hours(6 cases) to 2 -3 (2 cases) or 4 -7 days(3 cases). In each study, the conspicuity of visualization of SAH was graded as excellent, good, fair, or negative at five locations(sylvian fissure, cortical sulci, anterior basal cistern, posterior basal cistern, and perimesencephalic cistern). RESULTS: In all cases, subarachnoid hemorrhages were demonstrated as high signal intensity areas on FLAIR images. The detection rates for SAH on CT and T1-weighted MR images were 100 %(11/11) and 89%(8/9), re-spectively. FLAIR was superior to T1-weighted imaging in the detection of SAH at all sites except the anterior basal cistern (p<0.05) and superior to CT in the detection of SAH at the cortical sulci(p<0.05). CONCLUSION: On FLAIR MR images, subarachnoid hemorrhages at all stages are demonstrated as high signal intensity areas; the FLAIR MR sequence is thus considered useful in the detection of SAH. In particular, FLAIR is more sensitive than CT for the detection of SAH in the cortical sulci.
Brain ; Hemorrhage ; Humans ; Magnetic Resonance Imaging* ; Retrospective Studies ; Spinal Puncture ; Subarachnoid Hemorrhage*

Labial adhesions are postnatal fusion of the labia minora in the midline of varying degrees. They are postulated to be the result of low estrogen levels in the prepubertal child and possibly of a chronic inflammatory process. Topical treatment with conjugated estrogens has been the mainstay of therapy. We experienced one case of labial adhesion in an infant who was treated with estrogen cream for three weeks without any complication. Here we present this case with a brief review of the literature.
Child ; Estrogens ; Estrogens, Conjugated (USP) ; Humans ; Infant

PURPOSE: To evaluate the findings and role of contrast-enhanced fat suppression MR imaging in avascular necrosis(AVN) of the femoral head. MATERIALS AND METHODS: In 15 patients with AVN of the femoral head, MR T1-weighted and T2-weighted images and contrast-enhanced fat-suppression T1-weighted images were obtained, and the findings were re-viewed. Early and advanced groups were classified on the basis of clinical findings and imaging, and the en-hancement pattern was classified as either type I, rim enhancement; type II, surrounding diffuse enhance-ment; type III, intralesional enhancement; or type IV, II + III. RESULTS: Twenty-four cases of AVN of the femoral head were detected; in nine patients, lesions were bilateral. Eight cases occurred in the early group and 16 in the advanced. All eight in the early group showed the "double line sign" on T2-weighted images, with a type-I enhancement pattern. In the advanced goup, type II(8/16) and type IV(8/16) enhancement patterns were seen. Among the cases showing the type-IV pattern, the intrale-sional enhancing area showed low signal intensity on T1-weighted images and isosignal intensity on T2 weighted in one case, and low signal intensity on T1-weighted images and high signal intensity on T2-weight-ed in the other cases. There was no difference in the extent of the disease before and after enhancement. CONCLUSION: Contrast-enhanced fat-suppression MR images may be helpful in evaluating the extent of AVN of the femoral head and predicting the histopathologic findings of the disease
Head* ; Humans ; Magnetic Resonance Imaging* ; Necrosis*

OBJECTIVES: The aims of this study were to know the frequency of cognitive dysfunction among patients with autoimmune thyroid disorders, and to reveal influencing factors on it, especially to clarify association with autoimmune thyroid antibodies. METHODS: From sixty-five female patients with autoimmune thyroid disorders, demographic data were obtained by structured interview. Their cognitive funtions were measured using the MMSE-K and the MoCA-K tests. Depression was evaluated by the K-HDRS. RESULTS: 1) Among patients with autoimmune thyroid disorders, 7.69% of them were below 24 on the MMSE-K, while 10.77% were below 22 on the MoCA-K. The frequency of cognitive deficit was not significantly different according to having positivity to antimicrosomal antibodies or not. 2) The antimicrosomal antibody-positive patients had significantly higher antithyroglobulin antibody titers, antimicrosomal antibody titers, and TSH concentration, while had significantly lower free T4 levels(p<0.05, respectively). 3) The total scores of the MMSE-K and the MoCA-K had significant correlation with age, marital status, antithyroglobulin antibody titers and K-HDRS(p<0.05, respectively). 4) The regression analysis revealed that variables such as age, education, autoimmune thyroid antibodies, thyroid function and depression did not influence on cognitive function of patients with autoimmune thyroid disorders. CONCLUSIONS: Our results could not support that cognitive function of patients with autoimmune thyroid disorders had correlation with autoimmune thyroid antibodies.
Antibodies ; Cognition ; Cognition Disorders ; Depression ; Education ; Female ; Humans ; Marital Status ; Thyroid Gland*

BACKGROUND: Surgical endarterectomy had been known to be the standard treatment modality in management of carotid stenosis. However, endarterectomy had several limitations in high-risk patients, particulary with coronary artery disease. Carotid angioplasty and stenting has been suggested to be a safer and more cost-effective alternative to carotid endarterectomy in the management of symptomatic carotid artery disease. The purpose of this study is to evaluate the feasibility and safety of elective carotid artery stent implantation in patients with carotid artery stenosis. METHOD: We treated 19 patients with symptomatic and asymptomatic stenosis of >60% in 19 carotid arteries with balloon angioplasty followed by elective stent implantation. Of all carotid stenting procedures, 18 stents were implanted in obstructing atherosclerotic plaques and in one for Takayasu's arteritis. Of all patients, 10 patients were symptomatic with a history of stroke or transient ischemic attacks which were ipsilateral to the treated carotid artery. 12 patients represented a high-risk subset with myocardial infarction, previous coronary artery bypass graft and coronary artery stenosis. 6 months follow up angiogram was done in 7 patients, a patient(Takayasu's arteritis) showed restenosis. Result: Angiographic and procedural success rate were 100%, and there were no acute or subacute stent thrombosis. Immediately after initial carotid stenting, the mean(+/-SD) stenosis was reduced from 74.9+/-13.6% to 10.2+/-8.7% and the minimal luminal diameter was increased from 1.4+/-0.8mm to 5.3+/-1.0mm corresponding to an acute gain of 3.9mm. There were no major or minor stokes during follow-up. CONCLUSION: Percutaneous carotid angioplasty with stenting is a safe and feasible procedure. It is associated with high immediate success rates and relatively low complications in the management of carotid artery stenosis. Carotid stenting seems to be a reasonable alternatives to medical management for the treatment of carotid stenosis in patients deemed to be poor candidates for standard carotid endarterectomy.
Angioplasty ; Angioplasty, Balloon ; Carotid Arteries* ; Carotid Artery Diseases ; Carotid Stenosis* ; Constriction, Pathologic ; Coronary Artery Bypass ; Coronary Artery Disease ; Coronary Stenosis ; Endarterectomy ; Endarterectomy, Carotid ; Follow-Up Studies ; Humans ; Ischemic Attack, Transient ; Myocardial Infarction ; Phenobarbital ; Plaque, Atherosclerotic ; Stents* ; Stroke ; Takayasu Arteritis ; Thrombosis ; Transplants