No abstract available.

PURPOSE: To report a case of bacterial keratitis caused by Hafnia alvei after using a contact lens in a patient with graft-versus-host disease. CASE SUMMARY: A 47-year-old male patient presented with a corneal ulcer. The patient had been wearing a therapeutic contact lens for a month because of severe dry eye syndrome and filament removal due to filamentary keratitis. The patient had been taking moxifloxacin to prevent infection, but had not for the previous 7 days. The corneal ulcer occurred at the 11 o'clock direction in the peripheral cornea accompanied by corneal epithelial defect and stromal infiltration. The corneal scraping and culture yielded Hafnia alvei, which is susceptible to ceftazidime, levofloxacin and moxifloxacin. There was no systemic signs or symptoms to suspect systemic infection. After treatment with a topical antibiotic agent, the patient's eye condition improved with only mild corneal opacity remaining. CONCLUSIONS: Hafnia alvei infection rarely occurs in humans but should be considered as a potential causal pathogen in immunosuppressed patients.
Aza Compounds ; Ceftazidime ; Cornea ; Corneal Opacity ; Corneal Ulcer ; Dry Eye Syndromes ; Eye ; Graft vs Host Disease ; Hafnia ; Hafnia alvei ; Humans ; Keratitis ; Male ; Middle Aged ; Ofloxacin ; Quinolines

PURPOSE: To evaluate the association between multidrug resistance (MDR) gene and prognosis of acute lymphoblastic leukemia (ALL), several parameters were compared according to the expression status of MDR associated P-glycoprotein. METHODS: 40 bone marrow samples from 36 children of acute lymphoblastic leukemia were analyzed with immunohistochemical stain by C219 monoclonal antibody. RESULTS: 1) The expression of MDR associated P-glycoprotein was positive in 47% at the time of initial diagnosis & 66.7% at relapse. 2) There are no stastical difference between two groups in complete remission rate, relapse rate, mean 2 years survival rate. 3) Event free survival duration was 11.3 months (+/-8.5 months) in P-glycoprotein positive group, while 20 months (+/-7.3months) in P-glycoprotein negative group (P<0.05). 4) There are no stastical difference between two groups in the mean age, sex ratio, initial WBC and immunophenotype of subjects. CONCLUSION: These results suggested the possibility of adopting MDR associated P-glycoprotein in the design of therapeutic regimen and prognostification of childhood acute lymphoblastic leukemia. However, a prospective, randomized study incorporating a larger population should precede before a firm conclusion of significance would draw regarding the prognostic and the therapeutic implication of P-glycoprotein in childhood acute lymphoblastic leukemia.
Bone Marrow ; Child* ; Diagnosis ; Disease-Free Survival ; Drug Resistance, Multiple* ; Humans ; P-Glycoprotein* ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Prognosis ; Prospective Studies ; Recurrence ; Sex Ratio ; Survival Rate

PURPOSE: To determine the relation between the initial plasma cytokine response and the neurological prognosis in term infants with severe fetal distress. METHODS: Infants with severe fetal distress at birth (n=23) were studied prospectively. Cytokine concentrations were measured from umbilical cord blood at 3 and 12 hours of life by enzyme-linked immunosorbent assays for interleukin (IL)-1beta, IL-6, and IL-18. The study groups were divided into good (n=14) or poor prognostic group (n=9) according to survival and presence of cerebral palsy (CP) later and correlations with afore mentioned cytokine levels were determined. RESULTS: Cord blood IL-1beta and IL-18 concentrations were similar in both groups. However, infants with poor prognosis had significantly higher median (range) IL-6 concentration than infants with good prognosis at 3 hours [323.6 (32.6-812.8) vs. 38.4 (6.3- 322.7) pg/mL] (P=0.001), and 12 hours of life [287.1 (16.4-769.1) vs. 66.2 (8.8-757.8) pg/mL] (P<0.05). Significant higher IL-6 levels greater than 200 pg/mL were observed at 3 hours (P=0.005) and at 12 hours of life (P=0.023) for poor prognosis group. CONCLUSION: There was a significant correlation between neurologic outcome and plasma IL-6 levels. Higher concentrations of IL-6 (>200 pg/mL) may be a useful indicator of poor neurological outcome in infants with severe fetal distress.
Cerebral Palsy ; Enzyme-Linked Immunosorbent Assay ; Fetal Blood ; Fetal Distress* ; Humans ; Infant ; Infant, Newborn* ; Interleukin-18 ; Interleukin-6 ; Interleukins ; Parturition ; Plasma ; Prognosis ; Prospective Studies

A 68-year-old man developed mild quadriparesis 1 month prior to presentation. At 4 days before presentation, he developed dysarthria and more severe quadriparesis, predominantly on the left side of the body. MRI revealed edematous lesions in the medulla and throughout the spinal cord. Angiography showed a right tentorial dural arteriovenous fistula (DAVF). Despite successful treatment achieved by endovascular embolization, there was no improvement in the weakness of either leg. Early diagnosis of tentorial DAVF is important to prevent neurological complications such as encephalomyelopathy and hemorrhage.
Aged ; Angiography ; Central Nervous System Vascular Malformations* ; Dysarthria ; Early Diagnosis ; Hemorrhage ; Humans ; Leg ; Magnetic Resonance Imaging ; Quadriplegia ; Spinal Cord

Lymphangioma of the large bowel is a rare benign tumor which is composed of numerous small or large thin-walled lymphatie spaces contained fibrous tissue, smooth muscle and aggregates of lymphoid tissue. Lymphangioma never demonstrated any potential for malignant degeneration. There are three types; l. simple capillary lymphangioma, 2 cavernous lymphangioma and 3 cystic lymphangioma. Endoscopically, lymphangioma appears as a compressible smooth, round, or oval submucosal tumor covered with pale intact mucosa. The surfaces is smooth and the superficial color is the same as the surrouding mucosa or slightly more yellowish. There are change of dimension and shape during propagation of the peristaltic wave and on compression. Recently, authors experienced 4 cases of lymphangioma of large intestine which has been revealed by typical colonoscopic findings and/or endoscopic ultrasound, and confirmed by surgical resection and colonscopic snare polypectomy. 3 of 4 cases show cystic lymphangioma and one case shows carvenous lymphangio~rna. We report these cases with review of literatures.
Capillaries ; Colon* ; Intestine, Large ; Lymphangioma* ; Lymphangioma, Cystic ; Lymphoid Tissue ; Mucous Membrane ; Muscle, Smooth ; SNARE Proteins ; Ultrasonography

BACKGROUND/AIMS: Viral breakthrough has been considered a major limitation of lamivudine in the treatment of hepatitis B virus related chronic liver disease. Its clinical meaning has not been thoroughly assessed. METHODS: 64 patients who showed viral breakthrough during lamivudine treatment were retrospectively reviewed. We evaluated the rate of HBeAg seroconversion and hepatic decompensation after viral breakthrough. RESULTS: After viral breakthrough, serum alanine transaminase (ALT) elevation more than 1.2X upper limit of normal (ULN) was noticed in 40 patients (62.5%). Acute flare (serum ALT elevation >X5 ULN, or serum bilirubin >3 mg/dL) occured in 15 patients (23.4%). During the period of follow up (15.0 +/- 9.7 months; range, 0-31 months) since viral breakthrough, decreased serum HBV-DNA level to below the detection limit and serum ALT normalization was seen in 15 patients (23.4%). HBeAg seroconversion was noticed in 7 (13.7%) of a total of 51 HBeAg positive patients at base line; in 4 (15.4%) of 26 patients with non-hepatic failure (chronic hepatitis or Child-Pugh class A liver cirrhosis) at base line; and in 2 (40.0%) of 5 patients with non-hepatic failure at base line and acute flare after viral breakthrough. During this period, terminal hepatic decompensation (Child-Pugh class C) or death was noticed in 9 (90.0%) of 10 patients who had hepatic decompensation (Child-Pugh class B or C) at baseline and acute flare after viral breakthrough. CONCLUSIONS: Acute flare after viral breakthrough seemed to continue during HBeAg seroconversion and rarely developed into terminal hepatic decompensation or death in patients with non-hepatic decompensation at baseline. Its incidence is not only high but lethal to most patients with hepatic decompensation at baseline.
Acute Disease ; Adult ; Aged ; Antiviral Agents/*therapeutic use ; DNA, Viral/blood ; English Abstract ; Female ; Hepatitis B e Antigens/blood ; Hepatitis B virus/genetics/isolation & purification ; Hepatitis B, Chronic/complications/drug therapy/*virology ; Humans ; Lamivudine/*therapeutic use ; Male ; Middle Aged ; Reverse Transcriptase Inhibitors/*therapeutic use

No abstract available.
Humans ; Pericardial Effusion*

OBJECTIVE: Two-dimensional fluoroscopy-based computerized navigation for the placement of pedicle screws offers the advantage of using stored patient-specific imaging data in providing real-time guidance during screw placement. The study aimed to describe the accuracy and reliability of a fluoroscopy-based navigation system for pedicle screw insertion. METHODS: A total of 477 pedicle screws were inserted in the lower back of 96 consecutive patients between October 2007 and June 2012 using fluoroscopy-based computer-assisted surgery. The accuracy of screw placement was evaluated using a sophisticated computed tomography protocol. RESULTS: Of the 477 pedicle screws, 461 (96.7%) were judged to be inserted correctly. Frank screw misplacement [16 screws (3.3%)] was observed in 15 patients. Of these, 8 were classified as minimally misplaced (< or =2 mm); 3, as moderately misplaced (2.1-4 mm); and 5, as severely misplaced (>4 mm). No complications, including nerve root injury, cerebrospinal fluid leakage, or internal organ injury, were observed in any of the patients. CONCLUSION: The accuracy of pedicle screw placement using a fluoroscopy-based computer navigation system was observed to be superior to that obtained with conventional techniques.
Cerebrospinal Fluid ; Humans ; Surgery, Computer-Assisted

A pure extradural spinal arteriovenous malformation, in the absence of a vertebral body hemangioma, is extremely rare. 33-year-old male presented with spinal extradural arteriovenous malformation(AVM) that caused compressive radiculo- pathy of the L4 nerve root in the left side. The initial symptoms were presented to pain in the left leg and low back pain. Neurological examination showed paresthesia and hyperalgesia in the anterolateral aspect of the left thigh and in the medial to lateral aspect of the left lower leg as like a case of L4 root compression of suspiciously acute disc herniation. MRI showed a mass like a central protruding disc at L3-4 combined with a cystic mass with no specific findings in the vertebral body, and no evidence of vascular abnormality. The spinal extradural AVM was excised with laminectomy. The patient recovered completely from the initial signs and symptoms.
Arteriovenous Malformations ; Hemangioma ; Humans ; Hyperalgesia ; Intervertebral Disc ; Laminectomy ; Leg ; Low Back Pain ; Male ; Neurologic Examination ; Paresthesia ; Radiculopathy ; Thigh