This is a case report of multiple coil embolization for the diffuse pulmonary arteriovenous malformations(PAVM). PAVMs are direct communications between pulmonary arteries and pulmonary veins, resulting in an anatomic right-to-left shunt that may cause paradoxical embolization to may occur, resulting in neurologic complications such as stroke or cerebral abscess. The treatment of choice for solitary PAVMs was limited to surgical resection or ligation of the PAVM but, multiple PAVMs present a difficult management problem, since surgical resection is not feasible in most instances. The coil embolization is a safe and effective treatment of multiple PAVMs. Our exprience was of a 5-year-old boy who had cyanosis and clubbing of his finger, and was diagnosed with multiple PAVMs by chest CT and pulmonary angiography. The coil embolization was peformed, thirteen vessels were successfully occluded and no complication in placement of coils occured. Embolization therapy should be performed in all cases of PAVMs to prevent neurologic complications.
Angiography ; Arteriovenous Malformations* ; Brain Abscess ; Child, Preschool ; Cyanosis ; Embolization, Therapeutic* ; Fingers ; Humans ; Ligation ; Male ; Pulmonary Artery ; Pulmonary Veins ; Stroke ; Tomography, X-Ray Computed

PURPOSE: The purpose of this study was to evaluate the morphologic changes of the injured hepatic acini following ligation of common bile duct and to investigate the pathophysiologic process of hepatic failure and biliary liver cirrhosis in the extrahepatic cholestasis. MATERIALS AND METHODS: The common bile ducts of 18 rabbits were ligated partially. The rabbits were killed and selective microangiography was carried out with infusion of barium suspension via portal vein 4 to 24 weeks after ligation. Selective microangiography was also carried out in two normal rabbits. The microangiographic findings were evaluated and correlated with histopathologic features. RESULTS: The sinusolds of the liver acinus showed distortion, varying degrees of luminal widening, and irregularities in architecture. Terminal branches of the portal vein (TPV) showed increased number of branches, luminal narrowing, tortuosity, distortion, and beaded appearance. Peribiliary plexi were found as thin curvilinear, barium-filled structures along the wall of the dilated bile duct. The microangiographic findings were well correlated with histopathologic findings. The grades of microangiographic and histopathologic findings were poorly correlated with the duration of the ligation of CBD. CONCLUSION: Changes in microvasculature of the liver acinus following partial ligation of common bile duct were demonstrated by microangiography. Although the microvascular changes were evoked secondary to the injury, they might have some active roles in the pathophysiologic process in the liver.
Barium ; Bile Ducts ; Cholestasis, Extrahepatic ; Common Bile Duct* ; Ligation* ; Liver Cirrhosis ; Liver Failure ; Liver* ; Microvessels ; Phenobarbital ; Portal Vein ; Rabbits

Clinical and Bacteriological studies were carried out on 57 cases of infants and children with shigellosis who were cared from January, 1976 to December, 1980 in our hospital. The results were as follows: 1. The age distribution revealed the range between 6 months and 5 years(85% of all) with sex ratio of 30(53%) of male and 27(47%) of female, 1.1:1. 2. The peak incidence was noted in summer, althought there were occurrence throughout the year, even in winter. 3. On bacteriological studies, Shigellan flexneri was isolated most frequenty(90%) and Shigella sonnei was the next(8.8%). 4. Only 8.3% of Shigella strains were resistant to ampicillin between 1976 and 1977 but resistance increased to 76.7% in 1980. Gentamicin and Kanamycin which are aminoglycosiides were quite effectived but their use was limited becauseof their nephrotoxicity. 5. The average duration from the onset to the clinical improvement including stool character in the 32 ampicillin treated patients was 3.6 days and in the 25 rifampin treated patients was 2.2 days. Rifampin was effective in eradicating the shigella stralins and stool cultures taken at 7th therapeutic day remained negative in all 25 rifampin treated patients but yielded growth of shigella strains in 13 ampicillin treated patients. There was no doubt that rfaimpin was superior to ampicillin for bacillary dysentry. 6. One of these 57 cases was expired and motality rate was 1.8%.
Age Distribution ; Ampicillin ; Child ; Dysentery, Bacillary* ; Female ; Gentamicins ; Humans ; Incidence ; Infant ; Kanamycin ; Male ; Rifampin ; Sex Ratio ; Shigella ; Shigella sonnei

Reversible airway obstruction and wheezing are typical features of bronchial asthma, but these features may also be observed in other conditions. However, the inclusion of these conditions in the differential diagnosis of asthma-like symptoms in adults is often neglected, resulting in a correct diagnosis being made after months of unsuccessful treatment for asthma. We report two cases of an upper airway obstruction masquerading as asthma. In case one, adenoid cystic carcinoma was identified in the trachea of a patient showing asthma-like symptoms, positive response to allergic skin test and methacholine inhalation challenge. In the other case, aspirated foreign body was misdiagnosed and treated as asthma for more than one year. A high degree of suspicion and a thorough medical evaluation censisting of history, physical examination and pulmonary function test including shapes of spirogram are essential to the differential diagnosis of asthma-like symptoms
Adenoids* ; Adult ; Airway Obstruction* ; Asthma* ; Carcinoma, Adenoid Cystic* ; Diagnosis ; Diagnosis, Differential ; Foreign Bodies* ; Humans ; Inhalation ; Methacholine Chloride ; Physical Examination ; Respiratory Function Tests ; Respiratory Sounds ; Skin Tests ; Trachea

We report a 16-month-old male with a primitive neuroectodermal tumor of the cerebellar hemisphere. This tumor consisted of undifferentiated cells resembling germinal or matrix cells of the embryonic neural tube and prominent mesenchymal component.
Cerebellum* ; Humans ; Infant ; Male ; Neural Tube ; Neuroectodermal Tumors, Primitive*

An anomalous systemic arterial supply to the normal basal segments of the left lower lobe without sequestration is a rare congenital anomaly. It differs from classical bronchopulmonary sequestration in that the involver lung retains a normal connection to the bronchial tree, although some place this entity exists within the broad framework of pulmonary sequestration. We experienced a case of a woman who presented with a nodular lesion on a chest X-ray. Contrast-enhanced CT diagnosed her as having an anomalous systemic arterial supply to the normal basal segments of the left lower lobe. This case is reported with a brief literature review.
Bronchopulmonary Sequestration ; Female ; Humans ; Lung* ; Thorax ; Tomography, X-Ray Computed ; Trees

OBJECTIVE: The objective of this study was to investigate the morphologic characteristics between the vertebral body and the regions of the cervical and thoracic spinal cords where each rootlets branch out. METHODS: Sixteen adult cadavers (12 males and 4 females) with a mean age of 57.9 (range of 33 to 70 years old) were used in this study. The anatomical relationship between the exit points of the nerve roots from the posterior root entry zone at each spinal cord segment and their corresponding relevant vertebral bodies were also analyzed. RESULTS: Vertical span of the posterior root entry zone between the upper and lower rootlet originating from each spinal segment ranged from 10-12 mm. The lengths of the rootlets from their point of origin at the spinal cord to their entrance into the intervertebral foramen were 5.9 mm at the third cervical nerve root and increased to 14.5 mm at the eighth cervical nerve root. At the lower segments of the nerve roots (T3 to T12), the posterior root entry zone of the relevant nerve roots had a corresponding anatomical relationship with the vertebral body that is two segments above. The posterior root entry zones of the sixth (94%) and seventh (81%) cervical nerve roots were located at a vertebral body a segment above from relevant segment. CONCLUSION: Through these investigations, a more accurate diagnosis, the establishment of a better therapeutic plan, and a decrease in surgical complications can be expected when pathologic lesions occur in the spinal cord or vertebral body.
Adult ; Cadaver ; Humans ; Male ; Spinal Cord

OBJECTIVE: Terson's syndrome, a complication of visual function, has occasionally been reported in patients with aneurysmal subarachnoid hemorrhage (SAH), however the factors responsible for Terson's syndrome in aneurysmal SAH patients have not yet been fully clarified. In this study, we report on potential risk factors for prediction and diagnosis of Terson's syndrome in the earlier stage of the disease course in patients with aneurysmal SAH. MATERIALS AND METHODS: The authors retrospectively analyzed the data of 322 consecutive patients who suffered from aneurysmal SAH in a single institution between Jan. 2007 and Dec. 2013. Medical records including demographics, neurologic examination, and radiologic images were collected to clarify the risk factors of Terson's syndrome. Patients with visual problem were consulted to the Department of Ophthalmology. RESULTS: Among 332 patients with aneurysmal SAH, 34 patients were diagnosed as Terson's syndrome. Four individual factors, including World Federation of Neurosurgical Societies (WFNS) grade at admission, aneurysm size, method of operation, and Glasgow outcome scale showed statistically significant association with occurrence of Terson's syndrome. Of these, WFNS grade at admission, aneurysm size, and method of operation showed strong association with Terson's syndrome in multivariate analysis. Terson's syndrome accompanied by papilledema due to increased intracranial pressure led to permanent visual complication. CONCLUSION: In patients with aneurysmal SAH, the patients' WFNS grade at admission, the size of the aneurysms, particularly the diameter of the aneurysm dome, and the method of operation might influence development of Terson's syndrome.
Aneurysm* ; Demography ; Diagnosis ; Glasgow Outcome Scale ; Humans ; Incidence* ; Intracranial Pressure ; Medical Records ; Multivariate Analysis ; Neurologic Examination ; Ophthalmology ; Papilledema ; Retrospective Studies* ; Risk Factors* ; Subarachnoid Hemorrhage* ; Vitreous Hemorrhage

OBJECTIVE: Terson's syndrome, a complication of visual function, has occasionally been reported in patients with aneurysmal subarachnoid hemorrhage (SAH), however the factors responsible for Terson's syndrome in aneurysmal SAH patients have not yet been fully clarified. In this study, we report on potential risk factors for prediction and diagnosis of Terson's syndrome in the earlier stage of the disease course in patients with aneurysmal SAH. MATERIALS AND METHODS: The authors retrospectively analyzed the data of 322 consecutive patients who suffered from aneurysmal SAH in a single institution between Jan. 2007 and Dec. 2013. Medical records including demographics, neurologic examination, and radiologic images were collected to clarify the risk factors of Terson's syndrome. Patients with visual problem were consulted to the Department of Ophthalmology. RESULTS: Among 332 patients with aneurysmal SAH, 34 patients were diagnosed as Terson's syndrome. Four individual factors, including World Federation of Neurosurgical Societies (WFNS) grade at admission, aneurysm size, method of operation, and Glasgow outcome scale showed statistically significant association with occurrence of Terson's syndrome. Of these, WFNS grade at admission, aneurysm size, and method of operation showed strong association with Terson's syndrome in multivariate analysis. Terson's syndrome accompanied by papilledema due to increased intracranial pressure led to permanent visual complication. CONCLUSION: In patients with aneurysmal SAH, the patients' WFNS grade at admission, the size of the aneurysms, particularly the diameter of the aneurysm dome, and the method of operation might influence development of Terson's syndrome.
Aneurysm* ; Demography ; Diagnosis ; Glasgow Outcome Scale ; Humans ; Incidence* ; Intracranial Pressure ; Medical Records ; Multivariate Analysis ; Neurologic Examination ; Ophthalmology ; Papilledema ; Retrospective Studies* ; Risk Factors* ; Subarachnoid Hemorrhage* ; Vitreous Hemorrhage

To identify the corresponding cord segment for each root at the level of conus medullaris, a dissecting microscopic study was carried out on the spinal cord of 14 adult cadavers. We measured following contents:1) the longitudinal extent of the medullary segment of origin of each root:2) the distance from the lowest rootlet of the conus to the highest portion of the medullary segment of each root:3) the distance from the conus tip to the lowest portion of the medullary segment of each root:4) the morphological features of root-spinal cord juncton, intrathecal anastomoses, and others. We measured on the basis of the last rootlet ecause of no clear distinction between the conus and filum terminale. Our values showed considerable variation from one case to another. The average length of the whole lumbar and sacral segment was 50 mm and 30 mm, respectively. The S-1 root was the largest. Intrathecal intersegmental anastomoses were found in all cases examined, and usually consisted of small caliber rootlets connecting the spinal roots of adjacent segments. We emphasize the importance of microsurgical structure of conus medullaris when performing an operation of dorsal root entry zone or myelotomy for the relief or spasticity or intractable pain of lower extremities.
Adult ; Cadaver ; Cauda Equina ; Conus Snail* ; Humans ; Lower Extremity ; Muscle Spasticity ; Pain, Intractable ; Spinal Cord ; Spinal Nerve Roots