Primary cutaneous aspergillosis is rare. In this report we describe primary skin infection by Aspergillus in 9 children with leukemia. The skin lesion was characterized clinically by erythematous macule and papule associated with pain and itching, followed by a rapid progression to ulcer and central black eschars with raised erythematous border at the site of venipuncture, insertion of intravenous cannula, or where arm boards had been taped to extremities. Diagnosis was confirmed by skin biopsy and wound culture. Positive revealed in 6 patients, including A. glaucus in 2 cases, A. flavus in 1 case. Treatment consisted of temporary withdrawl of anticancer chemotherapy, intravenous amphotericin B, oral flucytosine, itraconazole and/or rifampin. One patient recovered completely without antifungal medication with resolution of leukopenia. Six of eight treated patients recovered. One patient discharged against medical advice, while cutaneous aspergillosis was improving. One patient died with persistent skin lesion and neutropenia. We conclude that primary cutaneous aspergillosis is increasingly recognized in association with intravenous cannula, intravenous puncture or prolonged contact with arm boards in immunocompromised patients, and that this serious disease can be treated successfully with appropriate management.
Amphotericin B ; Arm ; Aspergillosis* ; Aspergillus ; Biopsy ; Catheters ; Child* ; Diagnosis ; Drug Therapy ; Extremities ; Flucytosine ; Humans ; Immunocompromised Host ; Itraconazole ; Leukemia ; Leukopenia ; Neutropenia ; Phlebotomy ; Pruritus ; Punctures ; Rifampin ; Skin ; Ulcer ; Wounds and Injuries

Central pontine myelinolysis (CPM) is well-recognized osmotic demyelination syndrome that is related to various conditions such as rapid correction of hyponatremia and chronic alcoholism. Acute ataxia as a sole clinical sign in CPM is rare. We report a case of a 59-year-old man with dysarthria, intention tremor, and a significant gait ataxia starting after alcohol withdrawal, with radiological evidence of CPM. CPM should be included in the differential diagnosis of alcoholic patients who develop a sudden ataxia. Chronic alcohol abuse is one of the most commonly encountered predisposing factors. Alcohol withdrawal represents an additional vulnerability factor, being responsible for electrolyte imbalances which are not always demonstrable but are certainly involved in the development of CPM.
Alcoholics* ; Alcoholism ; Ataxia ; Causality ; Demyelinating Diseases ; Diagnosis, Differential ; Dysarthria ; Gait Ataxia ; Humans ; Hyponatremia ; Middle Aged ; Myelinolysis, Central Pontine* ; Tremor

No abstract available.
Hodgkin Disease*

No abstract available.
Brain Neoplasms* ; Brain* ; Drug Therapy ; Medulloblastoma ; Neoplasm Metastasis* ; Neuroectodermal Tumors, Primitive

No abstract available.
Chickenpox ; Herpesvirus 3, Human*

Congenital hepatic fibrosis is a relatively rare liver disease in children and young adults,that is characterized by stony hard hepatomegaly and portal hypertension with relative preservation of liver function and underlying architecture. Since this Condition was first delineated by Kerr et al in 1961, approximately over 150 cases have been reported in the literature. However, congenital hepatic fibrosis was not described in our country, except for 4cases of portal fibrosis seen in adults. Recently we have experinced a case of congenital hepatic fibrosis in a 4-year-old girl. At the time of admission this patient showed growth retardation, accompanied by marked hepatosplenomegaly. The liver was stony hard and relatively smooth on palpation, however, the liver function test being with in normal limits. There was evidence of esophageal varices on esophagography. PathologicaIly liver wedge biopsy showed an extremely hard gray white liver tissue with a thickened capsule and even surface. Microscopically the liver was characterized by broad bands of mature fibrous tissue with relatively normal lobular architectures in between. These fibrous septa contained numerous well-formed bile ducts and were slightly :infiltrated with chronic inf1ammatory cells. Most bile ducts were small and were empty. Reduction in the number of portal branches or abnormal arterial branches were not seen. Liver needle biopsy done one year prior to the present wedge biopsy showed only moderate portal fibrosis and small round cell infiltration with minimal bile duct proliferation.
Adult ; Bile Ducts ; Biopsy ; Biopsy, Needle ; Child ; Child, Preschool ; Esophageal and Gastric Varices ; Female ; Fibrosis* ; Hepatomegaly ; Humans ; Hypertension, Portal ; Liver ; Liver Diseases ; Liver Function Tests ; Palpation

The cell surface molecule identified by a monoclonal antibody(TE-1) to human thymic epithelial cell showed the specificity for thymic epithelial cells of both the cortex and medulla. TE-1 reacted with the epithelial cells of normal thymus and thymoma in fresh frozen tissues. The antigen recognized by TE-1 was mostly confined to the cell surface membrane and arranged in reticular network with long processes between thymocytes. On immunohistochemical analysis, TE-1 did not recognize normal epithelial cells of the uterine cervix, skin and stomach, and neoplastic cells of squamous cell carcinoma and gastric adenocarcinoma, all of which were stained with anti-cytokeratin monoclonal antibody. Among the tumor cell lines tested with flow cytometry, most of epithelial and all of hematopoietic cell origin were not labeled with TE-1. In summary, TE-1 appears to be a monoclonal antibody against a surface antigen of human thymic epithelial cell that is immunohistologically different from known epithelial cell surface antigens reported so far.
Animals ; Antibodies, Monoclonal/biosynthesis/*immunology ; Antibody Specificity ; Antigens, Surface/*immunology ; Epithelium/immunology ; Fluorescent Antibody Technique ; Humans ; Immunoenzyme Techniques ; Immunoglobulin G/immunology ; Immunoglobulin Isotypes/immunology ; Mice ; Mice, Inbred BALB C ; Neoplasms/immunology ; Thymoma/immunology ; Thymus Gland/*immunology ; Thymus Neoplasms/immunology ; Tumor Cells, Cultured

No abstract available.
Brain* ; Conus Snail* ; Dermoid Cyst* ; Magnetic Resonance Imaging ; Rupture

PURPOSE: The objective of this phase II study was to assess the clinical antitumor activity and toxicities of docetaxel and cisplatin chemotherapy, in patients with locally advanced and metastatic, recurrent squamous cell carcinomas of the head and neck (SCCHN). MATERIALS AND METHODS: All eligible patients with locally advanced and metastatic, recurrent SCCHN had received two courses of chemotherapy followed by repeated head and neck examinations and computed tomography. Patients who had received prior chemotherapy with taxanes were ineligible. If the patients achieved a response (either CR or PR), they received one more course of chemotherapy prior to undergoing definitive local treatment. The combination chemotherapy consisted of docetaxel, 70 mg/m2, and cisplatin, 75 mg/m2, on day 1, with the cycles repeated every 3~4 weeks. RESULTS: All 32 patients were assessable for response and toxicity analyses. The most common grade 3/4 adverse event was neutropenia, which occurred in 11% of cases. No febrile neutropenia was noticed. The other grade 3/4 adverse events included: anemia (2%) and stomatitis (3%). The response rate in patients with locally advanced cancer was 19/21 (90%). Fifteen patients (71%) achieved a CR and 4 (19%) a PR. Out of the 4 patients presenting with a distant metastatic disease, 1 each achieved CR and PR, with 2 stable disease (SD). Out of the 7 patients with a recurrence at a distant site, 1 each achieved PR and SD, and 5 (71%) had a progression of the disease (PD). The overall response rate was 22/32 (69%). CONCLUSION: Docetaxel plus cisplatin is an effective regimen with an acceptable toxicity profile. This regimen may offer high antitumor activity on short outpatient administration, with a low incidence of severe toxicity.
Anemia ; Carcinoma, Squamous Cell* ; Cisplatin* ; Drug Therapy ; Drug Therapy, Combination* ; Febrile Neutropenia ; Head* ; Humans ; Incidence ; Neck* ; Neutropenia ; Outpatients ; Recurrence ; Stomatitis ; Taxoids

BACKGROUND: Even though the effect of prehydration on the spinal anesthesia-induced hypotension has not yet been concluded, prehydration prior to spinal anesthesia is recommended in order to reduce the incidence and severity of hypotension. We investigated the effects of prehydration on hemodynamic change during spinal anesthesia with isobaric 0.5% tetracaine. METHODS: We prospectively performed this study on 96 patients who underwent elective transurethral surgery from October 2002 to January 2004. Patients were randomly allocated to receive either no prehydration or 10 ml/kg crystalloids administered over 10 15 min prior to spinal anesthesia. We compared dermatomal spreads of spinal anesthesia, hemodynamic parameters (blood pressure, heart rate), incidences of hypotension and bradycardia between two groups. RESULTS: Hemodynamic parameters, incidences of hypotension and bradycardia showed no statistically significant differences during spinal anesthesia between two groups. There were statistically significant differences in the dermatomal spread of sensory levels between two groups from 5 to 90 min after spinal anesthesia. Sensory block levels in prehydration group were statistically lower than no prehydration group. CONCLUSION: We hypothesized that prehydration can be one of factors that influence on dermatomal spread of local anesthetics in isobaric spinal anesthesia. The difference of dermatomal spread between two groups may be caused by brain blood barrier (BBB)-freely passing crystalloids, which may influence on the volume and density of cerebrospinal fluids. To verify this phenomenon found in our study, further investigation is still warranted.
Anesthesia, Spinal* ; Anesthetics, Local ; Blood-Brain Barrier ; Bradycardia ; Cerebrospinal Fluid ; Heart ; Hemodynamics ; Humans ; Hypotension ; Incidence ; Prospective Studies ; Tetracaine