Rupture of spontaneous dissecting aneurysms of the middle cerebral artery (MCA) is rare and its etiology remains obscure, although the risk of rebleeding is greater than with saccular aneurysms. Most reports concerning the treatment of a ruptured dissecting aneurysm of the anterior circulation involve surgical trapping or wrapping. Here, we report on a case of an MCA dissecting rupture treated with endovascular procedures. A 22-year-old female presented with sudden stuporous mental change following severe headache and left side hemiparesis. A computed tomography scan showed a diffuse subarachnoid hemorrhage and diffusion MR showed diffusion restriction at the right putamen and internal capsule. A 3-hour follow-up digital subtraction angiography (DSA) showed a dissecting aneurysm, which was not seen on an initial DSA. A stent assisted coil embolization was performed and double stents were applied to achieve flow diversion effects. A small remnant area of the dissecting aneurysm had disappeared at 60-day and was not observed on 12-month follow-up DSA.
Aneurysm ; Aneurysm, Dissecting ; Angiography, Digital Subtraction ; Diffusion ; Embolization, Therapeutic ; Endovascular Procedures ; Female ; Follow-Up Studies ; Headache ; Humans ; Internal Capsule ; Middle Cerebral Artery* ; Paresis ; Putamen ; Rupture ; Stents ; Stupor ; Subarachnoid Hemorrhage ; Young Adult

Condyloma acuminata, an uncommon disease in the pediatric patients, is being reported with increasing frequency in both adults and children. During the last 10 years, we had the opportunity to treat 11 children with condyloma acuminata in anogenital area. Patient age at presentation varied from 9 months to 11 years, and boys were outnumbered girls by a ratio of 2 : 1. The lesions were found in the perianal area in 9 patients, while the remaining had lesions localized to the genitalia. No history of sexual contact or abuse could be elicited. Although the exact mode of transmission of human papillomavirus (HPV) couldn't be defined, maternal-infant transmission at birth and close nonsexual family contact were the main possible causes of HPV infection in our patients. Our experience suggest that fulguration of the warts and concomitant scissors excision for the larger ones are the satisfactory method of treatment in children. However, based on our data we feel that condyloma acuminata has a high recurrence rate despite treatment. Viral typing and careful epidemiological investigation on a larger series of patients may further clarify the causal factors and effective modalities of treatment in childhood anogenital condyloma acuminata.
Adult ; Child* ; Female ; Genitalia ; Humans ; Parturition ; Recurrence ; Warts

A case of ependymoma originated in pelvic cavity is reported. Metastasis to regional lymph nodes and abdominal cavity developed. This tumor is thought to arise from heterotopic ependymal rests. The patient was 32 year old woman. A 10.0x7.0x7.0 cm sized mass was located between the uterus and rectum, which was attached to the rectal wall. It was a well circumscribed tumor with massive hemorrhage and necrosis. Histologically, tumor showed variegated appearance. Plump oval or round cells were arranged oval of elongated cells with fibrillary cytoplasmic process. Occasionally perivascular pseudorosette and ependymal rosette were seen. Immunohistochemical staining for GFAP showed intense positivity. Ultrastructural examination showed intracytoplasmic microfilaments, cilia, microvilli, and blepharoplasts.
Female ; Humans ; Neoplasm Metastasis

Rhizome of Alisma orientale has been used as a traditional medicine for treating kidney diseases in East Asian countries. Its inhibitory effects on hypersensitivity responses have been reported for methanol extracts, with alisol B 23-acetate (AB23Ac) being the most active constituent among six terpenes in inhibiting the direct passive Arthus reaction. However, whether AB23Ac has efficacy against allergic asthma has not been tested to date. The in vivo efficacy of AB23Ac in an ovalbumin (OVA)-induced allergic asthma mouse model was evaluated by administrating AB23Ac before OVA sensitization or OVA challenge in BALB/c mice. AB23Ac suppressed antigen-induced degranulation of RBL-2H3 mast cells in a concentration-dependent manner. The administration of AB23Ac both before OVA sensitization and OVA challenge greatly lowered pulmonary resistance and the increase in immune cell counts and inflammatory responses around the peribronchial and perivascular regions. In addition, the inflammatory cytokine levels of Th1/Th2/Th17 cells in the bronchoalveolar lavage fluid decreased in the AB23Ac-treated groups. AB23Ac reduced the number of PAS-stained cells in the lungs. Furthermore, a computer modeling study indicated that AB23Ac can bind tightly to spleen tyrosine kinase (Syk). These results suggest that AB23Ac may ameliorate allergic asthma by suppressing immune responses in dendritic cells during sensitization and in mast cells during challenge periods.

PURPOSE: To evaluate the stability, activity level and clinical results of an autologous hamstring and Bone-patellar tendon-bone (BPTB) graft in an Anterior cruciate ligament (ACL) reconstruction. MATERIALS AND METHODS: Between September 1997 and January 2003, 22 patients with an ACL reconstruction with an autologous four strand hamstring tendon, and 30 patients with a BPTB autograft were enrolled in this study. At the time of the final follow-up, the patients were evaluated by stress radiographs using a Telos instrument, the Lysholm score, Tegner activity score, IKDC activity grades, and anterior kneeling pain. RESULTS: An evaluation of the anterior laxity using the Telos instrument revealed no significant difference in the hamstring and BPTB groups: side to side difference 2.6 mm in the hamstring group vs 2.3 mm in the BPTB groups (p>0.05). The Lysholm score improved from a preoperative score of 58 to a postoperative score of 88 in the hamstring groups and from 56 to 91 in the BPTB groups. The Tegner score for the hamstring groups was 2.4 preoperatively and 5.8 at the final follow up, and the Tegner score for the BPTB groups were 2.3 and 6.2 preoperatively and after the last follow-up, respectively. The Tegner score was similar in the two treatment groups (p>0.05). According to the IKDC rating system, 9% were normal and 64% were almost normal in the hamstring group. In the BPTB group, 10% were normal and 67% were almost normal. Anterior kneeling pain after a reconstruction with the hamstring tendon autograft (13%) was significantly less common than with the patellar tendon autograft (37%)(p<0.05). CONCLUSION: The hamstring autograft for an ACL reconstruction decreased the incidence of anterior kneeling pain and produced equivalent clinical results to the BPTB autograft.
Anterior Cruciate Ligament Reconstruction* ; Anterior Cruciate Ligament* ; Autografts ; Bone-Patellar Tendon-Bone Grafts* ; Follow-Up Studies* ; Humans ; Incidence ; Patellar Ligament ; Tendons ; Transplants

PURPOSE: The purpose of this study was to evaluate the clinical and abdominal ultrasonogra- phic (US) features of spontaneously reduced transient small bowel intussusception in chlidren. METHODS: We retrospectively reviewed the clinical and US findings of 98 children with intussusception who were admitted to the Pediatric Department of Ulsan Dong-Kang General Hospital from Mar. 1999 to Feb. 2000. RESULTS: 1) Among 98 cases, there were 12 cases (12.3%) of transient small bowel intussusception (TSBI) and 86 cases (87.7%) of classic intussusception (CI). 2) The peak incidence of age in TSBI was over 3 years, which was older than that in CI. With regard to sex distribution, male predominated in both type. 3) Clinical symptoms and signs including cyclic irritability, vomiting, bloody stool, and abdominal mass in TSBI group were less common than those in CI group (41.7%, 33.4%, 0.0%, 0.0% vs 91.9%, 59.3%, 41.9%, 26.7%, respectively) but persistent abdominal pain was more common in TSBI group than in CI group (58.5% vs 11.2% ). 4) The size of total target sign and surrounding peripheral hypoechoic rim of TSBI group on US were smaller than those of CI group (11.9±2.61 mm, 2.08±1.15 mm vs 26.91±5.98 mm, 7.86±2.77 mm, respectively). 5) Concomittant illness was found more frequently in TSBI group than in CI group (66.7% vs 26.7%). 6) All case of TSBI group were reduced spontaneouly, which were confirmed by US, but none of CI group. CONCLUSION: Transient small bowel intussusception is probably more common than generally thought and its clinical and US findings is quite different from classical obstructing intussus-ception. Because all of our cases resulted in spontaneous reduction, we recommend careful observation and repeat examination rather than an immediate operation in transient small bowel intussusception.
Abdominal Pain ; Child ; Hospitals, General ; Humans ; Incidence ; Intussusception ; Male ; Retrospective Studies ; Sex Distribution ; Ulsan ; Ultrasonography ; Vomiting

We report here on a rare case of a ruptured basilar tip aneurysm that was successfully treated with coil embolization in the bilateral cervical internal carotid artery (ICA) occlusions with abnormal vascular networks from the posterior circulation. A 43-year old man with a familial history of moyamoya disease presented with subarachnoid hemorrhage. Digital subtraction angiography demonstrated complete occlusion of the bilateral ICAs at the proximal portion and a ruptured aneurysm at the basilar artery bifurcation. Each meningeal artery supplied the anterior cranial base, but most of both hemispheres were supplied with blood from the basilar artery and the posterior cerebral arteries through a large number of collateral vessels to the ICA bifurcation as well as the anterior cerebral and middle cerebral arteries. The perfusion computed tomography (CT) scans with acetazolamide (ACZ) injection revealed no reduction of cerebral blood flow and normal cerebrovascular reactivity to ACZ. An abdominal CT aortogram showed no other extracranial vessel abnormalities. A ruptured basilar tip aneurysm was successfully treated with coil embolization without complications. Endovascular embolization may be a good treatment option with excellent safety for a ruptured basilar tip aneurysm that accompanies proximal ICA occlusion with vulnerable collateral flow.
Acetazolamide ; Aneurysm ; Aneurysm, Ruptured ; Angiography, Digital Subtraction ; Basilar Artery ; Carotid Artery, Internal ; Collateral Circulation ; Glycosaminoglycans ; Meningeal Arteries ; Middle Cerebral Artery ; Moyamoya Disease ; Perfusion ; Posterior Cerebral Artery ; Skull Base ; Subarachnoid Hemorrhage

BACKGROUND AND OBJECTIVES: A mouse has a great potential to be used in studying genetics and inflammatory process of the rhinosinusitis. The aim of this study was to observe effects of experimentally induced chronic rhinosinusitis on histopathology of the sinonasal mucosa in a mouse and to develop a chronic form of rhinosinusitis. MATERIALS AND METHOD: Thirty five, six-week old male C57BL/6 mice were used as follows: 7 normal controls without intervention, 7 Sham operated controls, 7 animals with ostial obstruction alone using Merocel, 7 animals implanted with Merocel plus 106 colony forming unit (CFU)/mL of Streptococcus pneumoniae and 7 animals implanted with Merocel plus 10(8) CFU/mL of S. pneumoniae. Six weeks after intervention, the animals were sacrificed and serially sectioned at 1 mm intervals and stained with Hematoxylin and Eosin. RESULTS: Increased epithelial thickness, goblet cell hyperplasia, epithelial disarray and inflammatory infiltration were observed in the experimental sinuses packed with Merocel alone or Merocel with bacterial inoculation, especially at the nasal septal area. However, there were no significant differences between the Merocel only inserted group and Merocel and bacteria inoculated group. CONCLUSION: Maxillary sinus ostial obstruction or ostial obstruction with S. pneumoniae inoculation induced chronic rhinosinusitis in C57BL/6 mice as indicated by the histologic change. This study could be used as a model of chronic rhinosinusitis for further study.
Animals ; Bacteria ; Eosine Yellowish-(YS) ; Genetics ; Goblet Cells ; Hematoxylin ; Humans ; Hyperplasia ; Male ; Maxillary Sinus ; Mice* ; Mucous Membrane ; Pneumonia ; Septum of Brain ; Sinusitis ; Stem Cells ; Streptococcus pneumoniae* ; Streptococcus*

Cutaneous sinus tract of dental origin is a syndrome rather than a disease entity, and is composed of a periapical abscess, sinus tract and granulomatous skin change at the opening of the tract. The presence of an intermittently-draining, granulomatous lesion on the face or neck should alert clinicians to the necessity of a routine dental examination, including radiographic studies. Early correct diagnosis and appropriate dental treatment can prevent unnecessary and ineffective antibiotic therapy or surgical treatment. We report a case of a 68 year-old woman with a cutaneous sinus tract on the right nasolabial fold, secondary to infection of eight maxillary remnant teeth.
Aged ; Diagnosis ; Female ; Humans ; Nasolabial Fold ; Neck ; Periapical Abscess ; Skin ; Tooth

PURPOSE: The goal of this study was to identify a patient subgroup with a positive SLN where exposure to the morbidity and cost associated of an axillary lymph node dissection (ALND) is not required. To achieve this goal, we subdivided SLNs according to their isotope counts, and then assessed whether the number of positive SLNs and subdivided status were related to the axillary NSLN status. METHODS: During SLN biopsies, the ex vivo isotope counts were measured for each SLN. Each SLN was labeled as S1, S2 or S3, and so on, in descending count order. An SLN biopsy was performed until the isotope counts of the axilla equaled that of the background. If SLNs were positive, a completion ALND (cALND) was performed. The pathological report was also reviewed and analyzed. RESULTS: SLNs were successfully identified in 243 (99.6%) of 244 patients, with metastases in SLNs identified in 28.0% of patients. An SLN was the only positive lymph node in 52.9% (36/68) of patients, with a positive SLN followed by a cALND. NSLNs metastases were found in 32/68 cases (47.1%). The rate of NSLN metastasis was positively correlated with the number of positive SLN (P=0.017). In SLN positive patients, the NSLN metastasis rate was 60.9% (28/46) in patient with a tumor-harboring last-order SLN (SLN with least isotope counts), but only 18.2% (4/22) in patients with a tumor-free SLN (P=0.001). Similar results were found in patients with either two or more metastatic SLNs (P=0.023). CONCLUSION: In patients with a positive SLN, the number of metastatic SLNs and their isotope counts can be useful in the prediction of NSLNs metastasis. Further investigation will be necessary to confirm these results.
Axilla ; Biopsy ; Breast Neoplasms* ; Breast* ; Classification* ; Humans ; Lymph Node Excision ; Lymph Nodes* ; Neoplasm Metastasis*