Cholesteatoma of the middle ear and mastoid sometimes destroys the posterior wall of the external auditory canal(EAC), and this phenomenon is termed as "automastoidectomy". During the past two years the authors reviewed the CT features of automastoidectomy in eight patients with middle ear cholesteatoma. There was a variable amount of the cholesteatomatous mass or debris within the mastoid cavity in all patients, of whom air collection was found in four. Interestingly, the site and pattern of the erosion of the EAC were nearly, identical between patients with air in the mastoid cavity and those without it . Air in the mastiod cavity was the only clue of the expulsion of the cholesteatoma. So, we think that the expulsion of the cholesteatoma might be predicted when the erosion of the EAC is present in patients with cholesteatoma in the mastoid cavity. CT clearly depicted associated complications caused by the cholesteatoma, such as ossicular destruction (n=8), the eroion of the facial nerve canal (n=2), the erosion of the lateral semicircular canal (n=2), the erosion of the tegmen (n=1), the erosion of the sigmoid sinus plate(n=1), the erosion of the superior esmicircular canal (n=1), and the erosion of the vestibule (n=1). Although much of the natural history of the middle ear cholesteatoma still remains to be determined, we think that careful evaluation of one type of possible progression of the disease will help us understand its clinical course. Moreover, our findings strongly support the use of CT for evaluation of "automustetomy" seen in many cases of cholesteatoma.es of cholesteatoma.
Cholesteatoma ; Cholesteatoma, Middle Ear ; Colon, Sigmoid ; Ear, Middle ; Facial Nerve ; Humans ; Mastoid ; Natural History ; Semicircular Canals

No abstract available.
Neck*

To evaluate the normal development of the paranasal sinuses in children with CT, authors prospectively studied with brain CT scans of 260 children without known sinus diseases, ranging in age from 7 days to 16 years. Maximal anteroposterior and transverse diameters(mm) and maximal cross-sectional area(mm2) of both sides of the maxillary sinus were measured with the aid of computer device. As to the ethmoidal and sphenoidal sinuses, we simply documented the presence of the aplastic ethmoidal sinus and calculated the age-incidence of the sphenoidal sinus pneumatization, respectively. There noted three phases in the development of the maxillary sinus. The anteroposterior and transverse diameters of the maxillay sinus increased nearly in parallel. The former was always greater than the latter. In no cases was the ethmoidal sinus aplastic and almost all sinuses were pneumatized even in infants as early as 7 days old. CT identified the conchal pattern of sphenoidal sinus pneumatization in infants as early as 11 days old. Sphenoidal sinus pueumatization was seen in 38% of the children under the age of 1 year, 82% of the children between the age of 1 and 2 years, and almost all children older than 2 years. The anteroposterior and transverse diameters of the maxillary sinus seem to reach the adult size by 8 years of age, and the conchal pattern of sphenoidal sinus pneumatization can be recognized earlier with CT than on the plain radiographs.
Adult ; Brain ; Child* ; Humans ; Infant ; Maxillary Sinus ; Paranasal Sinuses* ; Prospective Studies ; Tomography, X-Ray Computed

No abstract available.
Neck*

The morphologic change of the mouse brain after exposure to magnetic field is studied. Our magnetic field model was a pulsed unipolar magnetic field with the flux density of 0.2 - 0.3 tesla and the frequency of 60 hertz. Twelve adult male mice were exposed to the magnetic field for 2, 4, 8, 12, 18 and 24 hours. After the exposure to the magnetic field mice were anesthetized with chloral hydrate, and paraformaldehyde was infused through the left ventricle for fixation. During exposure to the magnetic field, behavioral and weight changes of mice were observed. Mice became irritable and restless, especially during first 2 hours of the exposure. Microscopic and ultrastructural examination on the brain revealed nuclear chromatin clumping of the neuron in mice exposed to the magnetic field for more than four hours. The change was proportional to the exposed time and more prominent in the cerebral cortex. An immunohistochemical study for amyloid precursor protein (APP) was also performed. There was an increased expression of APP in the neuronal cytoplasm of the mouse brain exposed to the magnetic field for 4 hours or more. But the reaction was not proportional to the exposure time and reactive neuron was diffusely distributed through the whole brain. Anti-APP antibody reactivity was not correlated with the chromatin clumping. The mechanism of APP induction was postulated as stress-induced APP-gene induction, and the role of APP was presumed to protect the neuron against hazardous environment.
Adult ; Male ; Female ; Humans ; Mice ; Animals

PURPOSE: To classify the type of transient synovitis and determine a treatment plan using MRI. MATERIALS AND METHODS: From March 1985 to October 1998, 37 hips in 33 children with clinical symptoms of transient synovitis were evaluated with MRI. The average age of the patients was 7.5 years (range, 3.5-15 years) . The mean follow-up period was 18 months (range, 12-36 months) . The 37 hips were classified as grade l, ll, lll, or lV according to the amount of accumulated joint fluid on MRI. RESULTS: Of 37 hips with transient synovitis, 36 hips had no involvement of epiphysis and metaphysis and one hip had a cyst and bone marrow edema in the metaphysis on MRI scans. The amount of joint fluid was classified as seen on MRI scans: grade 1 in 2 hips, grade 2 in 14 hips, grade 3 in 5 hips, and grade 4 in 16 hips. CONCLUSION: MRI is a very useful diagnostic tool to classify and determine the treatment plan for transient synovitis. In patients with grade 3 and 4 joint fluid, the risk of vascular compromise of the femoral epiphysis could be higher. These patients should be hospitalized and immobilized in flexed position of the hip. Patients with grade 1 and 2 joint fluid can be treated at home with immobilization.
Bone Marrow ; Child ; Classification* ; Edema ; Epiphyses ; Follow-Up Studies ; Hip ; Humans ; Immobilization ; Joints ; Magnetic Resonance Imaging* ; Synovitis*

Achalasia is a primary esophageal motor disorder, which is a rare disease with an estimated prevalence of 0.5-1 per 100,000 general population. The typical symptoms are vomiting, dysphagia and weight loss, but the respiratory symptoms are often presented in the 20-30% of the patients. The respiratory symptoms are known to be caused by the regurgitation or aspiration of the undigested food. Choking, recurrent pneumonia nocturnal cough are common and bronchiectasis, lung abscess and atelectasis also have been reported. The treatment of achalasia aimed at improving esophageal peristalsis by reducing pressure at the lower esophageal sphincter. We experienced a case of esophageal achalasia coincidentally found in a 10-year-old girl who was admitted with the exacerbation of asthma. She had pneumatic dilatation and her asthma symptoms including nocturnal cough much improved.
Airway Obstruction ; Asthma ; Bronchiectasis ; Child ; Cough ; Deglutition Disorders ; Dilatation ; Esophageal Achalasia ; Esophageal Sphincter, Lower ; Humans ; Lung Abscess ; Peristalsis ; Pneumonia ; Prevalence ; Pulmonary Atelectasis ; Rare Diseases ; Vomiting ; Weight Loss

Pituitary adenylate cyclase activating polypeptide (PACAP) was first isolated from ovine hypothalamus and was known to stimulate the release of growth factor in various cells. Recently, we reported the cellular localization of PACAP and its type I (PAC1 ) receptor in rat placenta during pregnancy. Placenta is a critical organ that synthesizes several growth factors and angiogenic factors for the fetal development and its own growth. However, there is little information regarding the cellular localization of PACAP and its receptor in human placenta at various gestations. The aim of the present study was to define the expression and distribution of PACAP and PAC1 receptor mRNAs in the human placenta during the pregnancy period. PACAP and PAC1 receptor mRNAs were expressed in stroma cells of stem villi and terminal villi. At the early stage, on 7 and 14 weeks, PACAP and PAC1 receptor genes were moderately expressed in stroma cells surrounding the blood vessels within stem villi. These genes were strongly expressed in stroma cells of stem villi and terminal villi on 24 and 38 weeks. The expression of these genes was increased as gestation advanced, and localized in the same areas. Localization of PACAP and PAC1 receptor demonstrate the evidence that PACAP may play an important role, as an autoregulator or pararegulator via its PAC1 receptor. In conclusion, our findings strongly suggest that PACAP may have a critical role in physiological function of the placenta for gestational maintenance and fetal growth.
Chorionic Villi/metabolism ; Female ; Gene Expression ; Humans ; Nerve Growth Factors/*biosynthesis ; Neuropeptides/*biosynthesis ; Neurotransmitter Agents/*biosynthesis ; Pituitary Adenylate Cyclase-Activating Polypeptide ; Placenta/*metabolism ; Pregnancy ; Pregnancy Trimester, First ; Pregnancy Trimester, Second ; RNA, Messenger ; Receptors, Cell Surface/*biosynthesis ; Receptors, Pituitary Adenylate Cyclase-Activating Polypeptide ; Receptors, Pituitary Adenylate Cyclase-Activating Polypeptide, Type I

Uterine serous adenocarcinoma (USC) is rare and invasive cancer. This cancer is more often reported in the ovary, the fallopian tube, and the endometrium than uterine cervix. No matter where the tumor is located, the tumor exhibits similar histological characteristics. So when uterine cancer is proven to be serous adenocarcinoma, it is necessary to see if the tumor originated from ovary or endometrium and invaded the cervix. We report a case of a 73-year-old postmenopausal woman with USC arising near the internal os of endocervical canal, clinically misdiagnosed as uterine cervix cancer.
Adenocarcinoma* ; Aged* ; Cervix Uteri* ; Endometrium ; Fallopian Tubes ; Female ; Humans ; Ovary ; Uterine Cervical Neoplasms ; Uterine Neoplasms ; Uterus

STUDY DESIGN: A retrospective study was designed to evaluate the clinical result and difference between short segment and long segment fixation, which was undertaken by posterior approach for thoracic and lumbar spine fractures. OBJECTIVE: To determine and compare the mechanical maintenance and ability of correction, and clinical and neurologic recov-ery between short segment and long segment fusion group. SUMMARY OF BACKGROUND DATA: The long segment instrumentation is a cause of decrease of motion segment in thoracic and lumbar spine. In short segment fusion, screw failures were reported. MATERIALS AND METHODS: From 1989 thorough 1997, 54 patients who had been operated on by the posterior approach with transpedicular screw fixation for spine injuries were divided into two groups. The authors applied the short segment transpedic-ular instrumentation including fractured vertebra. Short segment group included 35 cases, and long segment group, 19 cases. The mean follow-up period was one year and eight months for short segment group, two years and seven months for long segment one. The results were evaluated by comparing the anterior vertebral height, sagittal index in simple roentgenogram and neurologic recovery. RESULTS: The average of anterior vertebral height which was 50.7% at preoperation, became 78.7% after the operation and measured 74.9% at final follow-up in long segment fusion group, while in short segment fusion group it was 59.7%, 79.3% and 77.7%, respectively. The average of sagittal index of 17.5degreeat preoperation became 6.7degreeafter the operation, and measured 8degreeat final follow-up in long segment fusion group, while in short segment fusion group it was 19.9degree, 10.4degree, and 12.1degree, respectively. Overall clinical results had no statistical significant difference between two groups. Of the thirty-six patients with neurologic deficits, twenty-two improved by over the one Frankel grade. CONCLUSIONS: The authors conclude that the short segment transpedicular instrumentation including fractured vertebra is a successful method of thoracolumbar and lumbar burst fractures.
Follow-Up Studies ; Humans ; Neurologic Manifestations ; Retrospective Studies ; Spine