Acute cerebral infarctions are rare in children, however, they can occur as a complication of a Mycoplasma pneumoniae (MP) infection due to direct invasion, vasculitis, or a hypercoagulable state. We report on the case of a 5-year-old boy who had an extensive stroke in multiple cerebrovascular territories 10 days after the diagnosis of MP infection. Based on the suspicion that the cerebral infarction was associated with a macrolide-resistant MP infection, the patient was treated with levofloxacin, methyl-prednisolone, intravenous immunoglobulin, and enoxaparin. Despite this medical management, cerebral vascular narrowing progressed and a decompressive craniectomy became necessary for the patient's survival. According to laboratory tests, brain magnetic resonance imaging, and clinical manifestations, the cerebral infarction in this case appeared to be due to the combined effects of hypercoagulability and cytokineinduced vascular inflammation.
Brain ; Cerebral Infarction* ; Child ; Child, Preschool ; Decompressive Craniectomy ; Diagnosis ; Enoxaparin ; Humans ; Immunoglobulins ; Inflammation ; Levofloxacin ; Magnetic Resonance Imaging ; Male ; Mycoplasma pneumoniae* ; Mycoplasma* ; Pneumonia, Mycoplasma* ; Stroke ; Thrombophilia ; Thrombosis ; Vasculitis

No abstract available.
Growth Plate*

No abstract available.
Infectious Mononucleosis*

Granulocytic sarcoma is an uncommon extramedullary localized tumor composed of granulocytic precursor cells. The majority of cases have been reported in association with acute myeloid leukemia(AML) especially in children, but infrequently may occur in patients with myeloproliferative disorders or myelodysplastic syndromes. Most common sites of involvement were bone, soft tissue, lymph nodes and skin, but gastrointestinal tract, testis, central nervous system are also involved rarely. We present an unusual case of granulocytic sarcoma of the intracranium and the retro-orbital soft tissue occurring in a patient with concurrent myelodysplastic syndrome, diagnosed by brain magnetic resonance images and ultrasound guided needle biopsy.
Biopsy, Needle ; Brain ; Central Nervous System ; Child ; Gastrointestinal Tract ; Granulocyte Precursor Cells ; Humans ; Lymph Nodes ; Myelodysplastic Syndromes* ; Myeloproliferative Disorders ; Sarcoma, Myeloid* ; Skin ; Testis ; Ultrasonography

No abstract available.
Resuscitation* ; Shock, Hemorrhagic*

BACKGROUND: Morphine for the intravenous patient controlled analgesia (IV-PCA) provides effective postoperative pain control, but it has side effects such as itching, nausea and vomiting. Meanwhile, butorphanol, a synthetic potent agonist-antagonist narcotic with low incidence of adverse side effects and minimal addiction, produce adequate analgesia for postoperative pain. The purpose of this study was to compare the suitability of butorphanol combining with or without morphine with that of morphine in terms of relieving postoperative pain and incidence of side effects. METHODS: Sixty ASA physical status I or II female patients undergoing total abdominal hysterectomy were randomly allocated into one of three groups according to type of drug used (n=20 for each group). The groups were divided to group M (morphine 100 mg), group M B (morphine 50 mg+butorphanol 10 mg) and group B (butorphanol 20 mg). Drugs for each group mixed with 90 ml of normal saline (total amount: 100 ml) for infusion. Loading dose, PCA dose, lockout interval, mode of infusion was 0.05 ml/kg, 0.02 ml/kg, 8 minute, and PCA only, respectively. In each group, visual analog scale (VAS), pain score, sedation score, degree of satisfaction, total amount of drug used, history of attempt/injetion and incidence of side effects were checked. RESULTS: There were no significant differences in analgesic effects and degree of satisfaction among three groups, but incidence of side effects (especially pruritis) were less in group M+B and B compared with group M (p<0.05). CONCLUSIONS: Butorphanol showed comparable postoperative pain relief and marked less side effects compared with morphine. Butorphanol was considered as a useful drug for postoperative pain relief using IV-PCA.
Analgesia ; Analgesia, Patient-Controlled* ; Analgesics ; Butorphanol* ; Female ; Humans ; Hysterectomy ; Incidence ; Morphine* ; Nausea ; Pain, Postoperative* ; Passive Cutaneous Anaphylaxis ; Pruritus ; Visual Analog Scale ; Vomiting

Cosmetic lateral canthoplasty, in which the size of the eye is increased by extending the palpebral fissure and decreasing the degree of the eye slant, has become a prevalent procedure for East Asians. However, it is not uncommon for there to be complications or unfavorable results after the surgery. With this in mind, the authors have designed a surgical method to reduce complications in cosmetic lateral canthoplasty by preserving the lateral canthal angle. We discuss here the anatomy required for surgery, the surgical methods, and methods for reducing complications during cosmetic lateral canthoplasty.
Asian Continental Ancestry Group ; Humans ; Lacrimal Apparatus ; Methods

PURPOSE: Recurrent stone formers are usually presented with calculi on the ipsilateral side. It has been postulated that sleep posture may alter renal hemodynamics and urinary flow during sleep and promote stone formation. We investigated the correlation of sleep posture with unilateral stone formation and the influence of body position on renal hemodynamics and urinary flow. MATERIALS AND METHODS: We prospectively evaluated the sleep posture of 106 patients with unilateral urolithiasis. A questionnaire was used to evaluate sleep posture of the patients. Sixteen normal volunteers were studied. They were evaluated in the supine, left and right lateral decubitus positions with separate diuretic renograms spaced one week apart. Renal scans were obtained using diethylenetriamine-pentaacetic acid (99mTc- DTPA) after the patient was equilibrated in the specific body position for 30 minutes. RESULTS: Of the patients, 66 slept consistently with 1 side in a dependent position, and the side of the stone was identical to the dependent sleep side in 80.2% (p<0.01). Renal perfusion and the T1/2 for clearances in the dependent kidney in the left and right decubitus positions were significantly increased when compared to the same kidney in the supine position (p<0.01). CONCLUSIONS: Specific sleeping position has significant effects on renal perfusion and urinary flow as measured by nuclear renal scintigraphy. This finding may help explain the correlation of sleep posture with unilateral urolithiasis. Even though this observation needs further investigation, it should be factored into the evaluation and prevention of unilateral stone disease.
Calculi ; Healthy Volunteers ; Hemodynamics ; Humans ; Kidney ; Perfusion ; Posture* ; Prospective Studies ; Surveys and Questionnaires ; Radionuclide Imaging ; Supine Position ; Urinary Calculi* ; Urinary Tract* ; Urolithiasis

PURPOSE: We compared estimates of ejection fraction (EF) determined by gated Tl-201 perfusion SPECT (g-TI-SPECT) with those by gated blood pool (GBP) scan. MATERIALS AND METHODS: Eighteen subjects underwent g-TI-SPECT and GBP scan. After reconstruction of g-TI-SPECT, we measured EF with Cedars software. The comparison of the EF with g-TI-SPECT and GHP scan was assessed by correlation analysis and Bland Altman plot. RESULTS: The estimates of EF were significantly different (p<0.05) with g-TI-SPECT (40%+/-14%) and GBP scan (43%+/-14%). There was an excellent correlation of EF between e-TI-SPECT and GBP scan (r=0.94, p<0.001). The mean difference of EF between GRP scan and g-TI- SPECT was +3.2%, Ninety-five percent limits of agreement were +9,8%. EF between g-TI-SPECT and GBP scan were in poor agreement. CONCLUSION: The estimates of EF by g-TI-SPECT was well correlated with those by GBP scan. However, EF of g-TI-SPECT doesn't agree with EF of GBP scan. EF of g-TI-SPECT cant be used interchangeably with EF of GBP scan.
Perfusion* ; Tomography, Emission-Computed, Single-Photon*

BACKGROUND: Recent reports suggest that the intake of vitamin D and calcium may influence insulin resistance. The aim of this study was to assess the effects of vitamin D and calcium intervention on the improvement of blood glucose and insulin resistance in patients with type 2 diabetes mellitus (DM). METHODS: Fasting blood glucose, glycosylated hemoglobin A1c (HbA1C), serum 25(OH)D3, serum lipid levels, insulin secretion, and activity and dietary surveys were analyzed in type 2 DM patients both before and after a 12-week vitamin D and calcium intake intervention. RESULTS: The serum 25(OH)D3 level was found to be negatively correlated with insulin resistance and fasting blood glucose. Calcium intake level was also negatively correlated with insulin resistance. Fasting blood glucose, HbA1C, and HOMA-IR decreased significantly (P <0.05) following vitamin D and calcium intake intervention in the medical nutrition therapy (MNT) group, while there was no such change observed in the control group. Dietary calcium and vitamin D intakes were significantly (P <0.05) higher in the MNT group than in the control group. The concentrations of serum 25(OH)D3 and insulin secretion increased slightly in the MNT group following the 12-week intervention; however, these results did not reach statistical significance. CONCLUSION: The results of the present study indicate that calcium and vitamin D intervention may be helpful in improving fasting blood glucose, HbA1C, serum 25(OH)D3 and HOMA-IR in patients with type 2 DM who have insufficient serum 25(OH)D3 concentrations.
Blood Glucose ; Calcium ; Calcium, Dietary ; Diabetes Mellitus, Type 2 ; Fasting ; Hemoglobin A, Glycosylated ; Humans ; Insulin ; Insulin Resistance ; Nutrition Therapy ; Vitamin D ; Vitamins