Thrombosis of the dural sinus in the fetal period is an extremely rare congenital cerebrovascular condition. The exact etiologies and prognosis of dural sinus thrombosis in the fetal period are still unknown due to the extremely limited clinical information available. Therefore, we present a case of dural sinus thrombosis diagnosed by prenatal ultrasound and fetal magnetic resonance imaging that spontaneously regressed, with a brief review of the relevant literature.
Magnetic Resonance Imaging ; Prenatal Diagnosis ; Prognosis ; Sinus Thrombosis, Intracranial ; Thrombosis

Increasingly aggressive chemotherapy regimens, advances in transplantation technology, and the acquired immunodeficiency syndrome have resulted in a growing number of immunocompromised patients. Infections are a major cause of morbidity and mortality in this population. One of the most ominous complications is the development of typhlitis in this immunocompromised patients. Treatment of this process is controversial, and no consensus has emerged. We report a case of typhlitis who complicated agranulocytosis after exposure to drugs to treat "flu" like illness and recovered completely after two operations of appendectomy and ileocolectomy. Reviewing articles and this case, the favorable outcome seemed to be related to following three factors recognition of the acute surgical abdomen by abdominal CT scan, a prompt return of normal circulating white cells by the use of Granulocyte Colony Stimulating Factor and discontinuation of causative drugs, and an appropriately timed surgical intervention.
Abdomen ; Acquired Immunodeficiency Syndrome ; Agranulocytosis* ; Appendectomy ; Colony-Stimulating Factors ; Consensus ; Drug Therapy ; Granulocytes ; Immunocompromised Host ; Mortality ; Tomography, X-Ray Computed ; Typhlitis*

The authors describe their experience with the CANS navigator, which has been in use since January 1997. The device uses magnetic field modulation technology for intraoperative localization: using a built-in scanner, a preoperative image with fiducial markers is input to a computer, and intraoperative localization uses a suctiontube integrated probe. During the previous ten months, we have used the device to perform surgery in 60 cases of brain lesion, mostly tumors. In five early cases, precise intraoperative localization was not successful, probably due to error in image input or registration, but after 2 months, there were only two failures, and for surgery, the device was very helpful: it was useful in the dessign of scalp incisionand bone flap, and for assessing the extent of resection in tumors, especially in cases in which surrounding brain tissue was poorly demarcated. It was also helpful in skull base surgery, in which precise localization of the work area is critical. The CANS navigator uses a magnetic field for localization, but except for the skull clamp, there was no problem in using metallic surgical instruments: there was no interference with laser, CUSA, or monitoring devices, and no complication attributable to its use. We suggest that for neurosurgery, the CANS navigator is a useful device: it is helpful for performing minimally invasive surgery.
Brain ; Brain Neoplasms ; Fiducial Markers ; Magnetic Fields ; Neurosurgery ; Scalp ; Skull ; Skull Base ; Surgery, Computer-Assisted* ; Surgical Instruments ; Surgical Procedures, Minimally Invasive

PURPOSE: Right middle lobe syndrome is defined as chronic atelectasis of the middle lobe of the right lung. The purpose of this study was to analyze the etiologies, radiologic findings, bronchoscopic findings, and clinical manifestations of right middle lobe syndrome in children. METHODS: We retrospectively reviewed the medical records of 28 children, who were admitted to the Samsung Medical Center from June 1998 to January 2003. These children had persistent atelectasis in the right middle lobe in plain chest radiography for more than a month. RESULTS: In 28 children, the most common etiology was pneumonia, followed by tuberculosis, bronchiectasis, and asthma. Most of the patients manifested nonspecific respiratory symptoms, such as coughing. The computerized tomography showed various findings including atelectasis, air bronchogram, or bronchietasis. While normal patent airway was found in 50% of the patients by bronchoscopy, narrowing of bronchus, large amount of secretion, and granulation nodules were noted in another half of the patients. In comparison with tuberculosis, atelectasis caused by pneumonia was relived more frequently by bronchoscopic therapeutic intervention (P=0.008), but there was no significant difference between them after approximately 2 years of follow-up. (P=0.232) Final outcomes in patients whose duration of atelectasis was 2 months or less tended to be better than 12 months or more, but it was not statistically significant. (P= 0.067) CONCLUSION: Common causes of right middle lobe syndrome in Korean children are pneumonia and tuberculosis. A high index of suspicion is required for early diagnosis and proper treatment which leading to better outcomes.
Asthma ; Bronchi ; Bronchiectasis ; Bronchoscopy ; Child* ; Cough ; Early Diagnosis ; Follow-Up Studies ; Humans ; Lung ; Medical Records ; Middle Lobe Syndrome* ; Pneumonia ; Pulmonary Atelectasis ; Radiography ; Retrospective Studies ; Thorax ; Tuberculosis

We present two cases of acute interstitial pneumonia (AIP) during the second trimester of pregnancy managed by mechanical ventilation, high dose corticosteroids. We described clinical course, laboratory data and imaging studies. Case 1) A 29-year-old woman, G1P1, was referred for aggravated continuous coughing, sputum and dyspnea, pleuritic chest pain and mild fever for 3 weeks at 24(+3) weeks of gestation. There were coarse breathing sounds with crackles on the both lung field. Her chest X-ray showed diffuse haziness in both lungs with suspicious nodular opacities and suggested pneumonia. HRCT showed diffuse ground glass opacities with interstitial thickening and suspicious fine nodular infiltration in both lungs suggesting acute interstitial pneumonia combined with ARDS. Because her symptoms were more aggravated, she was performed mechanical ventilation treatment. After that, she was performed cesarean hysterotomy and delivered a dead male 850grams. After her symptoms were much more improved. All antibiotics were stopped and reduced the doses of steroids, she was discharged with t-tube capped state. Case 2) A 33-year-old woman, G1P1, was referred for continuous coughing, sputum and dyspnea for 3 months and low abdominal discomfort at 24(+4) weeks of gestation. There were coarse breathing sounds with rales on the both lung field. Her chest X-ray showed diffuse haziness in both lungs with suspicious nodular opacities and suggested interstitial pneumonia. HRCT showed diffuse ground glass opacities with some intralobular and interlobular interstitial thickening and suspicious fine nodular infiltration in both lungs suggesting acute interstitial pneumonia or miliary TBc combined with ARDS. She was treated with antibiotics, oxygen, high dose corticosteroids, and tocolytics. There was no evidence of TBc in the bronchoscopy. She showed decreased mentality and decreased O2 saturation below 90% in spite of mechanical ventilation, high dose steroids and IVGV therapy. She delivered a boy of 870 g (Apgar score 1/5). After delivery, she was expired due to combined aggravating DIC. Her baby was expired at the next day, too. The outcome of AIP is fatal, reporting 59~100% mortality rate. The clinical course, laboratory data and treatment are not well established due to rarity of this disease entity. Chest X-ray and HRCT may be helpful in diagnosis and high dose steroid and immunosuppressive agents usually used but the efficacy is not guaranteed.
Adrenal Cortex Hormones ; Adult ; Anti-Bacterial Agents ; Bronchoscopy ; Chest Pain ; Cough ; Dacarbazine ; Diagnosis ; Dyspnea ; Female ; Fever ; Glass ; Humans ; Hysterotomy ; Immunosuppressive Agents ; Lung ; Lung Diseases, Interstitial* ; Male ; Mortality ; Oxygen ; Pneumonia ; Pregnancy ; Pregnancy Trimester, Second* ; Pregnancy* ; Respiration, Artificial ; Respiratory Sounds ; Sputum ; Steroids ; Thorax ; Tocolytic Agents

BACKGROUND: There have been recent reports that the fat distribution within skeletal muscle and the amount of muscle mass are associated with insulin resistance and the development of type 2 diabetes mellitus (T2DM). This study evaluated the impacts of visceral fat and thigh muscle from patients with T2DM and healthy subjects on atherosclerosis and insulin resistance. METHODS: Forty-two patients with newly-developed T2DM and 11 healthy subjects were selected for the study. The diabetic patients were subdivided into two groups, those under 40 years of age, as the young T2DM (n=21) group, and 40 years-old or greater, as the old T2DM (n=21) group. CT scans were obtained for all patients at the L4-L5 level and at the mid-portion between the greater trochanter and upper margin patella. The carotid intima-media thickness (IMT) was also measured using high resolution B-mode ultrasonography. RESULTS: The mean visceral fat area (VFA) in the old T2DM group was 169.4+/-13.2cm2, which was significantly greater than that found in the healthy subjects (67.9+/-7.92cm2, P<0.001) and young T2DM group (127.1+/-10.4cm2, P<0.05). The mean visceral fat to normal density muscle area ratio (VMNR) in the old T2DM group was 1.50+/-0.19, which was greater than in the healthy subjects (0.46+/-0.52, P<0.001) and young T2DM group (1.01+/-0.10, P<0.05). The total thigh muscle areas in the young and old T2DM groups were smaller than that in the healthy subjects, but without statistical significance. VMNR showed a positive correlation with the IMT and HOMA-IR. However, the total thigh muscle area was negatively correlated with the IMT. The normal density muscle area also showed significant negative correlations with the IMT and HOMA-IR. In a multiple regression analysis, age and VMNR were the most important independent risk factors of an increased carotid IMT. CONCLUSION: This study showed that the role of thigh muscle, as well as that of visceral fat, played a very important role in the occurrence of atherosclerosis. VMNR was found to be an especially important independent factor for an increased carotid IMT.
Adult ; Atherosclerosis ; Carotid Arteries* ; Carotid Intima-Media Thickness ; Diabetes Mellitus, Type 2 ; Femur ; Humans ; Insulin Resistance* ; Insulin* ; Intra-Abdominal Fat ; Muscle, Skeletal ; Patella ; Risk Factors ; Thigh* ; Tomography, X-Ray Computed ; Ultrasonography

Salvia plebeia R. Br. is a plant which has been used as an edible crop and traditional medicine in Asian countries. In this study, HPLC-PDA analysis and countercurrent chromatography (CCC) coupled with reversed-phase (RP) HPLC method were applied to isolate ten isolates from 3.3 g of n-butanol soluble extract from hot-water extract of S. plebeia. The use of CCC enabled us to efficiently fractionate the starting material with less sample loss and facilitate the isolation of compounds from S. plebeia extract using RP-HPLC. The isolates were determined to be caffeic acid (1), 6-hydroxyluteolin 7-O-β-D-glucoside (2), eudebeiolide B (3), (R)-rosmarinic acid (4), homoplantaginin (5), eudebeiolide D (6), plebeiolide C (7), salpleflavone (8), eupafolin (9) and hispidulin (10) based on the spectroscopic evidence.

PURPOSE: This study was designed to determine the influencing factors and clinical course of pathologically proven cases of radiation-induced brain injury (RIBI). MATERIALS AND METHODS: The pathologic records of twelve patients were reviewed; these patients underwent surgery following radiotherapy due to disease progression found by follow-up imaging. However, they were finally diagnosed with RIBI. All patients had been treated with 3-dimensional conventional fractionated radiotherapy and/or radiosurgery for primary or metastatic brain tumors with or without chemotherapy. The histological distribution was as follows: two falx meningioma, six glioblastoma multiform (GBM), two anaplastic oligodendroglioma, one low grade oligodendroglioma, and one small cell lung cancer with brain metastasis. RESULTS: Radiation necrosis was noted in eight patients and the remaining four were diagnosed with radiation change. Gender (p = 0.061) and biologically equivalent dose (BED)3 (p = 0.084) were the only marginally influencing factors of radiation necrosis. Median time to RIBI was 7.3 months (range, 0.5 to 61 months). Three prolonged survivors with GBM were observed. In the subgroup analysis of high grade gliomas, RIBI that developed <6 months after radiotherapy was associated with inferior overall survival rates compared to cases of RIBI that occurred > or =6 months (p = 0.085). CONCLUSION: Our study demonstrated that RIBI could occur in early periods after conventional fractionated brain radiotherapy within normal tolerable dose ranges. Studies with a larger number of patients are required to identify the strong influencing factors for RIBI development.
Brain ; Brain Injuries ; Brain Neoplasms ; Disease Progression ; Follow-Up Studies ; Glioblastoma ; Glioma ; Humans ; Meningioma ; Necrosis ; Oligodendroglioma ; Radiation Injuries ; Radiosurgery ; Retrospective Studies ; Small Cell Lung Carcinoma ; Survival Rate ; Survivors

Obstructive jaundice is most commonly attributed to a malignancy or stones affecting the common bile duct. Biliary tuberculosis and lymphadenitis around the periportal area have also been implicated but cases are quite rare. A 24 year old man presented with jaundice and abdominal pain for 3 days. Abdominal CT and ERCP revealed a stricture of the extrahepatic bile duct with multiple enlarged lymph nodes showing necrotic foci located at the periportal area. The colonoscopic biopsy showed evidence of M. tuberculosis. The patient was treated with ERBD insertion and oral anti-tuberculosis therapy. However, the abdominal pain recurred and there was progressive stenosis of the common bile duct. A bile duct resection with choledochojejunostomy was subsequently performed. Frozen sections revealed granulomatous inflammation with caseation necrosis, which was consistent with tuberculosis. We report a case of tuberculous cholangitis and lymphadenitis with obstructive jaundice that was managed surgically due to the progressive stricture of the bile duct.
Abdominal Pain ; Bile Ducts* ; Bile Ducts, Extrahepatic ; Bile* ; Biopsy ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis* ; Choledochostomy ; Common Bile Duct ; Constriction, Pathologic* ; Frozen Sections ; Humans ; Inflammation ; Jaundice ; Jaundice, Obstructive* ; Lymph Nodes ; Lymphadenitis* ; Necrosis ; Tomography, X-Ray Computed ; Tuberculosis ; Tuberculosis, Lymph Node ; Young Adult

OBJECTIVE: To determine whether polymorphisms of the Vitamin D receptor (VDR)gene,known to be associated with osteoporosis and/or osteoarthritis (OA) in Caucasians,might also relate to the risk of OA and osteoporosis in Korean postmenopausal women METHODS: A population of 130 postmenopausal women,including 76 healthy controls and 54 knee OA patients,were studied using anteroposterior radiographs of the knee,which were graded for OA according to the Kellgren classification system.The VDR genotype was determined by using polymerase chain reaction and by digestion with the three restriction enzymes Taq I,Bsm I,and Apa I.Femoral neck bone mineral density (BMD)was assessed in all participants by dual energy X-ray absorptiometry . RESULTS: VDR genotype frequency distributions in Koreans were much different from Caucasian's both in the OA group and the control group.Especially, "t t", "B B" and "A A" genotype were very rare,prominently differentiating from Caucasians.But within Koreans,no significant differences in VDR genotype frequencies were observed between OA cases and controls.VDR genotype was not significantly associated with the radiographic grades of OA.And there were no significant relationships of VDR genotype with BMD scores in each group. CONCLUSION: In Korean postmenoposal women,the VDR gene polymorphisms do not significantly contribute to an increased prevalence of knee OA or to differences in BMD.VDR genotype analysis would not be helpful for assessing the risk of knee OA in Koreans because :(1)there is no correlation of VDR genotypes with the radiographic severity of OA ;and (2)there is a more skewed distribution of VDR genotypes in Korean population compared to the Caucasian's .
Absorptiometry, Photon ; Bone Density ; Classification ; Digestion ; Female ; Genotype ; Humans ; Knee* ; Neck ; Osteoarthritis* ; Osteoporosis ; Polymerase Chain Reaction ; Prevalence ; Receptors, Calcitriol