Subdural empyema is a fulminating, purulent, bacterial infection located between the dura and arachnoidal membrane. Early diagnosis, adequate antibiotic therapy and surgical treatment played important roles in the successful management of subdural empyema. Subdural empyema can develop secondary to sinusitis, otitis media, meningitis, trauma or craniotomy. Subdural empyema in infants commonly develops secondary to infected subdural effusion associated with purulent meningitis. The incidence of this complication of meningitis in infants is approximately 2%. We report a case of subdural empyema concomitant with bilateral subdural effusion, which was successfully treated with surgical intervention and antibiotic therapy.
Arachnoid ; Bacterial Infections ; Craniotomy ; Early Diagnosis ; Empyema, Subdural* ; Humans ; Incidence ; Infant* ; Membranes ; Meningitis* ; Otitis Media ; Sinusitis ; Subdural Effusion*

We reviewed 178 patients with hypertensive intracerebral hematoma(HICH), which were treated with computed tomography(CT) guided stereotactic aspiration from Aug. 1986 to Dec. 1993(166 CT guided U-loop and 12 Leksell system). Our series consisted of 82 males and 96 females. The hemorrhages were located in putamen in 67.4%, thalamus in 20.2%, subcortex in 9% and cerebellum in 3.4%. Mean removal rate of hematoma was 55.3%. The results for the 178 cases who underwent stereotactic aspiration were good recovery in 45.5%, moderate disability in 28.0%, severe disability in 9.0% and vegetative state in 4.0%. The infection rate and rebleeding rate of all cases were 1.7% and 6.8% respectively. The mortality rate of all cases was 13.5%. We analysed the factors affecting the prognosis in 178 patients. Factors affecting good prognosis were high initial GCS, less amount of initial hematoma and no presence of intraventricular hemorrhage. Stereotactic aspiration by CT-guided U-loop and Leksell system is simple, safe and can minimize the brain damage. This method can e performed under local anesthesia.
Anesthesia, Local ; Brain ; Cerebellum ; Female ; Hematoma ; Hemorrhage ; Humans ; Male ; Mortality ; Persistent Vegetative State ; Prognosis ; Putamen ; Thalamus ; Urokinase-Type Plasminogen Activator

It is highly desirable to achieve optimal reproductive performance, reliable morphological and physiological basic data of the reproductive organs. Therefore, seasonal changes in serum testosterone, LH, and FSH concentrations, and morphological changes in testicular epithelial cells were studied in the Korean native pheasant throughout the annual cycle. Mature male pheasants[14-16 months after hatching] were used in this study. The general morphological changes of the epithelia of the seminiferous tubules were observed by dibasic stain, and semithin section from Epon blocks with a phase contrast microscopy. The ultrastructural changes of the the epithelia of the seminiferous tubules were investigated by ultrathin section with transmission electron microscope. The changes in the profiles of the serum FSH, LH, and testosterone concentratioins were measured by RIA[radioimmunoassay]. The results obtained are summarized as follows : 1. There was little variation in the average diameter of the seminiferous tubules from autumn[67.13+/-5.95micrometer] to winter[68.59+/-6.07micrometer], but the highest levels were reached in spring[192.78+/-41.58micrometer]. Thereafter, the diameter decreased slowly in summer[146.57+/-43.68micrometer], then decreased significantly in autumn[67.13+/-5.95micrometer]. 2. Serum testosterne concentration was low from autumn[13.+/-7.21ng/100ml] to winter[17.39+/-13.75ng/100ml], but the highest levels were reached in spring[127.72+/-66.47 ng/100ml]. Thereafter, the concentration was lowest in autumn[13.+/-7.21ng/100ml]. 3. Serum LH concentration increased slowly and linealy from autumn[5.04+/-1.04ng/100ml] to winter[6.23+/-1.08ng/100ml], but the highest levels were reached in spring[11.3+/-3.6 ng/100ml]. Thereafter, the concentration reached the lowest level in autumn[5.04+/-1.04 ng/100ml]. 4. Serum FSH concentration was low from autumn[4.65+/-0.63ng/100ml] to winter[4.2+/-0.98ng/100ml], but the highest levels were reached in spring[17.41+/-8.35ng/100ml]. Thereafter, concentration was the lowest in autumn[4.65+/-0.63ng/100ml]. 5. The seminiferous tubules showed the onset of the spermatongenic cycle in spring but the seminiferous tubules collected in summer exhibited partially degenerative changes. 6. The cytoplasmic process of Sertoli cells of the seminiferous tubules of the pheasant were collected in summer. Many vesicles and degeneratiye changes were included but many number of spermatozoa were embedded partially in the multivesicular bodies in these processes. 7. The diameter of the seminiferous tubules of the pheasant narrowed markedly in autumn, and atrophied in winter. The spermatogonia and Sertoli cells were arranged in monolayer. 8. The myelin figures in the cytoplasmic process of Sertoli cells of the seminiferous tubules of the pheasant in autumn. The nucleus of the Sertoli cells were of a round configuration elongated and oriented perpendicularly to the basement membrane. The results obtained provide basic data for reproductive physiology and are useful for studying the male genital organs of the Korean native pheasant. Structural changes of the seminiferous epithelial cells significantly and postively correlated with serum FSH, LH. The correlation of changes in the hormonal status with alterations of Sertoli cell organells precedes the breeding season.
Basement Membrane ; Breeding ; Cytoplasm ; Epithelial Cells ; Epithelium* ; Genitalia, Male ; Humans ; Male ; Microscopy, Phase-Contrast ; Multivesicular Bodies ; Myelin Sheath ; Physiology ; Seasons* ; Seminiferous Tubules* ; Sertoli Cells ; Spermatogonia ; Spermatozoa ; Testosterone*

BACKGROUND AND OBJECTIVES: Flow-mediated brachial artery vasoactivity has been proposed as a noninvasive means for assessing endothelial function. The present study is designed to assess the influence of aging on endothelial function and when vasoactivity developed initially, peaked. MATERIALS AND METHOD: We measured brachial artery diameter for 60 seconds continuously using 7.5 MHz ultrasound following 5 minutes of lower arm occlusion in 22 normal volun-teers (young group: 10 volunteers, 26.5+/-1.9 years; old group: 12 volunteers, 55.9+/-3.3 years). After sublingual administration of 0.6 mg nitroglycerine, 240 seconds continuously. And then we measure vasoactivity every 3 seconds. RESULTS: Flow-mediated vasodilation (FMD) was started earlier in young group (24.3+/-2.8 sec; old group 28.8+/-3.6 sec, p=0.017). After release of occlusion, peak vasoacitivity time was at 35.5+/-4.7 seconds and peak vasoactivity was 8.4+/-1.7% in young group (old group 6.9+/-1.5%, p=0.099). Endothelial independent vasodilation (EID) was started at 80.7+/-13.3 seconds after sublingual nitroglycerine in young group (vs 80.0+/-19.0 sec), peaked at 177.5+/-16.9 seconds (vs 171.3+/-13.8 sec). Peak vasoactivity was higher in young group (19.1+/-3.1%; old group 15.9+/-2.5%, p=0.033). CONCLUSION: We conclude that 1) Aging has influence on endothelial function about initiating time of vasoactivity as well as peak vaso- activity. 2) FMD can be measured around 50 seconds after release of brachial artery occlusion and EID at 180 seconds after application of sublingual nitroglycerine. 3) The initiating time of vasoactivity (under 30 seconds) can be used for evaluation of endothelial function.
Administration, Sublingual ; Aging* ; Arm ; Brachial Artery ; Nitroglycerin ; Ultrasonography* ; Vasodilation ; Volunteers

Rhabdomyosarcoma is the most common soft tissue sarcoma occurring in children, though retroperitoneal rhabdomyosarcoma is rare. We experienced a case of embryonal rhabdomyosarcoma of the retroperitoneum in a 43-month-old child, and describe the CT , MRI and pathologic findings.
Child* ; Child, Preschool ; Humans ; Magnetic Resonance Imaging ; Myosarcoma ; Rhabdomyosarcoma ; Rhabdomyosarcoma, Embryonal* ; Sarcoma

OBJECTIVE: Anterior cervical fusion is widely used with many kinds of plate systems. The purpose of this study is to evaluate the rate and influencing factor of instrument failure. METHODS: The authors reviewed 101 consecutive patients who underwent anterior interbody fusion used Caspar, PCB(Cervical Plate Cage System), Orion and Atlantis plate system during the period of January 1991 to December 2000. The cases of trauma were 49, tumor 2 and degenerative disorder 50. The average length of follow up was 12.2 months. RESULTS: There were 10 cases of instrument related complications and 18 cases of non-instrument related complications. Among 10 cases of instrument related complication, eight patients showed screw loosening and two patients showed bone graft displacement. The nine cases of hardware failure occurred within 3 months. The rate of instrument failure was higher in trauma, unlocking plate and multi-level than non-trauma, locking plate and one-level. There were no injuries to tracheoesophageal or neurovascular structures as a results of instrument failure. CONCLUSION: We conclude that anterior cervical plating can be carried out with acceptable complication rate. The incidence of prominent instrument failure that endangers tracheoesophageal structures is minimal.
Follow-Up Studies ; Humans ; Incidence ; Transplants

PURPOSE: We compared the reproducibility of 201Tl and 99mTc-sestamibi (MIBI) gated SPECT measurement of myocardial function using the Germano algorithm. MATERIALS AND METHODS: Gated SPECT acquisition was repeated in the same position in 30 patients who received 201Tl and in 26 who received 99mTc-MIBI. The quantification of end-diastolic volume (EDV), end-systolic volume (ESV), and ejection fraction (EF) on 201Tl and 99mTc-MIBI gated SPECT was processed independently using Cedars quantitative gated SPECT software. The reproducibility of the assessment of myocardial function on 201Tl gated SPECT was compared with that of 99mTc-MIBI gated SPECT. RESULTS: Correlation between the two measurements for volumes and EF was excellent by the repeated gated SPECT studies of 201Tl (r=0.928 to 0.986; p<0.05) and 99mTc-MIBI (r=0.979 to 0.997; p<0.05). However, Bland Altman analysis revealed the 95% limits of agreement (2 SD) for volumes and EF were tighter by repeated 99mTc-MIBI gated SPECT (EDV: 14.1 ml, ESV: 9.4 ml and EF: 5.5%) than by repeated 201Tl gated SPECT (EDV: 24.1 ml, ESV: 18.6 ml and EF: 10.3%). The root mean square (RMS) values of the coefficient of variation (CV) for volumes and EFs were smaller by repeated 99mTc-MIBI gated SPECT (EDV: 2.1 ml, ESV: 2.7 ml and EF: 2.3%) than by repeated 201Tl gated SPECT (EDV: 3.2 ml, ESV: 3.5 ml and EF: 5.2%). CONCLUSION: 99mTc-MIBI provides more reproducible volumes and EF than 201Tl on repeated acquisition gated SPECT. 99mTc-MIBI gated SPECT is the preferable method for the clinical monitoring of myocardial function.
Humans ; Perfusion* ; Technetium Tc 99m Sestamibi ; Tomography, Emission-Computed, Single-Photon*

Multiple primary brain tumors of different cell types are rare, accounting for 0.4% of all the primary brain tumors. Phakomatosis, irradiation, trauma and other factors have been associated with multiplicity of brain tumors. When these tumors are close or intermixed, the term "collision" has been used, and in these cases an explanation might be that one tumor stimulating the other. We report a patient with collision tumor of meningioma and anaplastic astrocytoma, who did not have a history of trauma, irradiation, or phakomatosis.
Astrocytoma* ; Brain Neoplasms ; Humans ; Meningioma* ; Neurocutaneous Syndromes