Acute necrotizing encephalopathy is a recently established disease entity, proposed by Mizuguchi et al in 1995, that shows a characteristic symmetric and multifocal involvement of both thalamus, brainstem tegmentum, cerebral periventricular white matter, and cerebellar medulla. It is known to be prevalent in Japan and other Far Ease countries. The etiology of the acute necrotizing encephalopathy remains unknown. The typical course of acute necrotizing encephalopathy is the development of the irreversible neurologic symptoms related to brain lesions. The diagnosis can be made on the basis of the combination of a typical clinical profile and characteristic radiologic findings. We experienced a first case of acute necrotizing encephalopathy in a 9 month old boy in Korea. We report this case with the brief review of related literatures.
Brain ; Brain Stem ; Diagnosis ; Humans ; Infant ; Japan ; Korea ; Male ; Neurologic Manifestations ; Thalamus

No abstract available.
Pierre Robin Syndrome*

Nontyphoidal Salmonella are gram negative bacilli organism, which may induce systemic infection such as febrile enteritis, bacteremia, and osteomyelitis. Main route of infection is known as food but also possible through reptile, amphibian, and fish raised as pets in the house. There is no known cases report of Salmonella infection through pets in Korea and also rare in the overseas. We report 2 patients who visited Severance children's hospital with chief complaint of fever and diagnosed as nontyphoidal salmonellosis. Each case had a history of raising turtle or tropical fish with possibility of Salmonella infection through these pets. Increasing incidence of raising pet reptile and fish lately, contact precaution and proper prevention and control of Salmonella infection of these pets especially in children under 5 years old are necessary due to higher risk of serious complications of salmonellosis.
Amphibians ; Bacteremia ; Child ; Enteritis ; Fever ; Fishes ; Humans ; Incidence ; Korea ; Osteomyelitis ; Reptiles ; Salmonella ; Salmonella Infections ; Turtles

In 1988, a new fascioutaneous flap, the Lateral supramalleolar flap, was introduced by Masquelet and Roman. The flap is designed on the lower third of the aspect of leg, and supplied by a cutaneous branch from the perforating branch of the peroneal artery. This perforating branch continues distally deep to the fascia along the anterior ankle and into the foot. This can be use as either proximally based rotation flap or distally based reversed pedicle island flap giving the flap an arc of rotation that allows coverage of the dorsal, lateral and plantar aspects of the foot, the posterior heel and the lower medial portion of the leg. The authors have recently used this flap for 13 cases of foot and ankle soft tissue defect reconstruction and all the cases, except two partial marginal necrosis, good postoperative course. In our opinion, this flap is useful for reconstruction of foot and ankle soft tissue defect which does not need nerve innervation. The main advantages of the flap are as follows 1. It may be a rather large flap(15× 9cm2 ). 2. The pedicle is long(8cm) and easy to dissect. 3. The pivot of the pedicle is distal(sinus tarsi) and allows great local possibilities of coverage. 4. It does not require the sacrifice of a main artery.
Ankle ; Arteries ; Fascia ; Foot ; Heel ; Leg ; Necrosis

PURPOSE: Transcranial electromagnetic stimulation(TMS) is a noninvasive method which stimulates the central nervous system through pulsed magnetic fields without direct effect on the neurons. Although the neurobiologic mechanisms of magnetic stimulation are unknown, the effects on the brain are variable according to the diverse stimulation protocols. This study aims to observe the effect of the magnetic stimulation with two different stimulation methods on the cultured hippocampal slices. METHODS: We obtained brains from 8-days-old Spague-Dawley rats and dissected the hippocampal tissue under the microscope. Then we chopped the tissue into 450 micrometer thickness slices and cultured the hippocampal tissue by Stoppini's method. We divided the inserts, which contained five healthy cultured hippocampal slices respectively, into magnetic stimulation groups and a control group. To compare the different effects according to the frequency of magnetic stimulation, stimulation was done every three days from five days in vitro at 0.67 Hz in the low stimulation group and at 50 Hz in the high stimulation group. After N-methyl-D-aspartate exposure to the hippocampal slices at 14 days in vitro, magnetic stimulation was done every three days in one and was not done in another group. To evaluate the neuronal activity after magnetic stimulation, the NeuN/beta-actin ratio was calculated after western blotting in each group. RESULTS: The expression of NeuN in the magnetic stimulation group was stronger than that of the control group, especially in the high frequency stimulation group. After N-methyl-D-aspartate exposure to hippocampal slices, the expression of NeuN in the magnetic stimulation group was similar to that of the control group, whereas the expression in the magnetic non-stimulation group was lower than that of the control group. CONCLUSION: We suggest that magnetic stimulation increases the neuronal activity in cultured hippocamal slices, in proportion to the stimulating frequency, and has a neuroprotective effect on neuronal damage.
Animals ; Blotting, Western ; Brain ; Central Nervous System ; Magnetic Fields ; Magnets* ; N-Methylaspartate ; Neurogenesis* ; Neurons* ; Neuroprotective Agents ; Rats*

BACKGROUND: The major risk factors such as hypercholesterolemia, hypertension, diabetes melitus and cigarrete smoking have not been studied in an attempt to provide a composition of major risk factors in Korea. Also we have met with some patients without major risk factors. METHODS: A Retrospective Study was done on 160 patients of acute myocardial infarction who had been admitted to National Medical Center within 48 hours from onset, from January 1948 to December 1992 and studied on major risk factors of acute myocardial infarction. RESULTS: 1) Among major risk factors, smoking was found in 50%, hypertension in 49%, diabetes in 25% and hypercholesterolemia in 21%. 2) The percentage of patients without major risk factors was 19%. 3) Among major risk factors, hypertension, hypercholesterolemia and diabetes were increasing tendencies, recentely. CONCLUSION: Some patients with acute myocardial infarction don't have any major risk factors. Also hypertension, hypercholesterolemia and diabetes were increasing tendencies. So further study for other risk factors is needed and preventive management should require a commitment to behavior modification and alteration in life-style.
Behavior Therapy ; Humans ; Hypercholesterolemia ; Hypertension ; Korea ; Myocardial Infarction* ; Retrospective Studies ; Risk Factors* ; Smoke ; Smoking

Hydroxyapatite is generally used as an orbital implant which is biocompatible. It is considered esthetically and functionally better than traditional measure. We performed hydroxyapatite implantation using autogenous temporalis muscle fascia for 4 eyes of 4 phthisis patients by truma. Hydroxyapatite implants wrapped with autogenous temporalis muscle fascia were inserted into all eyes after enucleation. Follow-up for 12-15 months [mean:13.4 months] showed less inflammatory reaction. There were has no wound dehiscence, implant protrusion and migration. MRI showed a goodfibrovascular proliferation at 4-5 months postoperatively, so we performed drilling. Temporalis muscle fascia is easily obtained and there is no esthetic problem because scar at scalp is covered by hair.
Cicatrix ; Durapatite* ; Fascia* ; Follow-Up Studies ; Hair ; Humans ; Magnetic Resonance Imaging ; Orbital Implants ; Scalp ; Wounds and Injuries

PURPOSE: Complete resection of the tumor nodule(mural nodule or solid portion of the tumor) is the essential goal of surgical treatment for heman-gioblastoma. The purpose of this study was to classify the morphologic types of intracranial hemangioblastoma on MRI and to compare the location and contour of tumor nodule on MRI with those on angiography. MATERIALS AND METHODS: The MRI findings of 34 lesions(38 lesions if 4 spinal cord lesions were included) in 26 patients(17 males and 9 females, range of age, 18-67 years, mean, 39 years) with surgically and histopathologically proved intracranial hemangioblastomas were reviewed. Seventeen patients underwent CT scanning in a short interval. Contrast-enahnced T1 -weighted imaging pa- tterns of hemangioblastoma were classified according to Ho's morphologic types. The location and contour of tumor nodule were compared between MRI and angiography in 15 patients(24 lesions). RESULTS: By location, cerebellar hemisphere was predominated(55%), followed by cerebellar vermis(26%), supratentorial region(5%), and medulla oblongata (3%). Spinal cord lesions(11%) were seen in 3 patients of 5 von HippeI-Lindau diseases. The frequency of morphologic types was as follows; Type 1 (purely cystic), 3%, Type 2(mural nodule), 50%, Type 3(cyst with wall enhancement), 3%, Type 4 (cystic nodule), 15%, Type 5(solid with internal cyst), 9%, and Type 6(solid), 20%. All tumor nodules(33 lesions) enhanced intensely with intravenous contrast material on MRI, of which 24 lesions(in 15 patients) revealed hypervascular masses fed by pial arteries on angiography. They were superficial and abutted pia mater partially or in large portion on both MR I and angiography. CONCLUSION: Over 70% of intracranial hemangioblastomas had a surrounding cyst, and superficial, pial-based location and number of the tumor nodules on MRI was correlated well with those on angiography. MRI is the examination of choice for preoperative evaluation of intracranial hemangioblastoma.
Angiography ; Arteries ; Female ; Hemangioblastoma* ; Humans ; Magnetic Resonance Imaging* ; Male ; Medulla Oblongata ; Pia Mater ; Spinal Cord ; Tomography, X-Ray Computed

PURPOSE: Traumatic subarachnoid hemorrhage (TSAH) is frequently found after traumatic brain injury (TBI) and its presence is a powerful predictor for the computed tomography (CT) assessed progression of intracranial lesions. The initial CT findings of progressing intracranial lesions in patients with tSAH are poorly understood. The aim of this study was to identify the factors that may predict the progression of lesions on the initial CT scans of patients with tSAH. METHODS: We evaluated 224 patients with tSAH and who were consecutively admitted from January 1, 2004 to December 31, 2008. The CT progression, the amount of SAH, the site of SAH, the presence and volume of associated intracranial lesion and the bilaterality of lesions were examined to identify the factors to predict CT progression of lesion. The initial and "worst" CT scans were compared. The CT scan changes were classified as "any CT progression" or "significant CT progression" (changes in the Marshall score). RESULTS: Eighty-two patients with tSAH (36.6%) had some CT progression and thirty-seven patients with tSAH (16.5%) had significant CT progression among the patients with tSAH. The initial CT findings according to the Marshall classification, the amount of SAH, the site of SAH and the associated intracranial lesions were significantly related to CT progression (p<0.05). The prognostic model to predict CT evolution, which consisted of the four initial CT findings described above, had high sensitivity (96.6~100%) and a high negative predictive value (94.1~100%). The area under the receiver operating characteristic (ROC) curve for the predictive model to predict the CT assessed evolution of SAH lesions was 0.701 (95% CI, 0.633~0.770). CONCLUSION: The prognostic model to predict CT progression of SAH lesions can help emergency medicine physicians decide when to perform repeat head CT scans in patients with tSAH.
Brain Injuries ; Disease Progression ; Emergency Medicine ; Head ; Humans ; ROC Curve ; Subarachnoid Hemorrhage, Traumatic ; Tomography, X-Ray Computed

Cataract extraction, intraocular lens implantation, and pars plana vitrectomy combined in a one-stage procedure(posterior segment triple surgery) are effective operation method for complications of diabetic retinopathy and uveitis. We performed posterior segment triple surgeries in 12 eyes(12 patients) with traumatic eye injuries. After a follow up of at least 3 months, eleven eyes(92%) had a visual acuity f 20/200 or more: seven eyes(58%), 20/40 or morel. The result suggest that posterior segment triple surgery is effective in traumatic eye injuries for the fast visual rehabilitation.
Cataract Extraction ; Diabetic Retinopathy ; Eye Injuries ; Follow-Up Studies ; Humans ; Lens Implantation, Intraocular ; Rehabilitation ; Uveitis ; Visual Acuity ; Vitrectomy