The clear cell variant of ependymoma is a rare, recently described, intracranial tumor which is composed of clear neoplastic ependymal cells. Clear cell ependymomas may share characteristic histologic features of oligodendrogliomas or central neurocytomas; striking nuclear uniformity, perinuclear halos, and numerous angulated capillaries. In contrast to oligodendrogliomas, however, clear cell ependymomas are noninfiltrating tumors with sharp boundaries. Perivascular pseudorosette formation is frequent. Oligodendrogliomas are usually nonreactive for GFAP compared to diffuse immunoreactivity of clear cell ependymoma. Central neurocytomas may also be differentiated by their immunoreactivity for synaptophysin. This is a case of clear cell ependymoma in a 40-year-old man. By computed tomography and magnetic resonance imaging scans, a well circumscribed cystic tumor with mural nodule was demonstrated in the right frontal lobe. It was 6cm in diameter and well enhanced. Histologically, it was sharply demarcated from the brain parenchyma. The cystic wall was lined by atypical ependymal cells, which "transformed" to clear cells in the solid area. The cells had uniform nuclei and perinuclear halos. Mitotic figures and necrotic foci were focally present. The cells were immunoreactive for glial fibrillary acidic protein (GFAP), while synaptophysin was negative. Electron microscopy revealed densely packed polyheadral cells with scant organelles and well developed intercellular junctions.
Adult ; Brain ; Capillaries ; Ependymoma* ; Frontal Lobe ; Glial Fibrillary Acidic Protein ; Humans ; Intercellular Junctions ; Magnetic Resonance Imaging ; Microscopy, Electron ; Neurocytoma ; Oligodendroglioma ; Organelles ; Strikes, Employee ; Synaptophysin

No abstract available.
Colonoscopy* ; Humans ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis*

No abstract available.
Humans ; Outpatients*

Hypodipsic hypernatremia is characterized by chronic or recurrent episodes of severe hypernatermia associated with dehydration and a lack of thirst. This constellation of deficits suggests that the syndrome is due to hypodipsia of destruction of the hypothalamic osmoreceptors that regulate thirst and ADH secretion. We report a child with abnormalities of the central nervous system who had hypernatremia and a lack of thirst without detectable abnormalities in the osmoregulation of ADH secretion. The patient was a 11 month old female and her chief complaints were poor oral intake and weight gain. There were recurrent hypernatremia with hyperosmosis and normal level of plasma ADH. With intravenous rehydratin, oral intake was improved and plasma sodium level decreased.
Central Nervous System ; Child ; Dehydration ; Female ; Humans ; Hypernatremia* ; Infant ; Osmoregulation ; Plasma ; Sodium ; Thirst ; Weight Gain

Epilepsy surgery can be a safe, effective treatment for individuals with intractable partial epilepsy. There is increasing evidence that brain abnormalities in focal epilepsy are not restricted to a single area. The longstanding debate around the relationship between structural lesions and the epileptic zone remains unresolved. Patients with DNT (dysembryoplastic neuroepithelial tumor), which is an essentially benign tumor, can be cured by epilepsy surgery-oriented approach. Cortical dysplasia is frequently associated with DNT and seems to contribute to epileptogenic activity of DNT. Surgical treatment should be aimed at removal of the associated cortical dysplasia as well as DNT itself for ideal treatment of the disease. Simple lesionectomy of cavernous angioma would relieve seizures significantly, but not always. The concept of epilepsy surgery needs to be recruited in the treatment of cavernous angioma with seizures because diffusion of hemosiderin into the surrounding brain tissue and formation of cortical scars can make epileptogenic areas. Cortical dysplasia is a highly epileptogenic lesion constituting an important cause of medically intractable epilepsy and surgery is a treatment of choice in a selected group of patients. Identification and complete resection of the lesion and ictal onset zone are necessary to achieve a good surgical results. Intractable epilepsy accompanied by benign brain lesions can be treated surgically using the entire armamentarium of presurgical investigations. Deliberate resective procedures aimed at complete removal of dysplastic tissue and epiletogenically active areas on and around the lesion ensure excellent seizure control without permanent neurologic deficit.
Brain* ; Cicatrix ; Diffusion ; Epilepsies, Partial ; Epilepsy* ; Hemangioma, Cavernous ; Hemosiderin ; Humans ; Malformations of Cortical Development ; Neurologic Manifestations ; Seizures

Aplastic anemia is characterized by a failure of blood cell production resulting in varying degrees of pancytopenia with a markedly hypocellular bone marrow. Most cases of aplastic anemia are acquired, but the disease may also occur as the result of inherited abnormalities. In 50-65% of cases, however, the etiology is unknown. For acquired forms of aplastic anemia, a variety of causative factors, including radiation, viruses, chemicals and drugs, have been implicated. Antithyroid drugs(Carbimazole, Methimazole, Propylthiouracil) are usually listed among agents associated with the development of agranulocytosis, but aplastic anemia rarely follows their use. The first case of aplastic anemia followmg propylthiouracil was reported by Marte~lo et al. in 1967 and the second case was by Aksoy and Erdem in 1968. Recently, we experienced two cases of aplastic anemia following propylthiouracil therapy due to Graves disease, so we report here these cases with literature review.
Agranulocytosis ; Anemia, Aplastic* ; Blood Cells ; Bone Marrow ; Graves Disease ; Methimazole ; Pancytopenia ; Propylthiouracil*

No abstract available.
Humans ; Peritoneal Dialysis, Continuous Ambulatory* ; Pregnancy*

OBJECTIVE: This study was designed to investigate 1) sleep changes after antidepressant(dothiepin) treatment, and 2) sleep variables which seem to be associated with clinical response in the depressed patients. METHODS: The subjects consisted of 16 patients who fullfilled the criteria for major depression by the Diagnostic and Statistical Manual,(4th edition). Their sleep was recorded using polysomnography at the baseline and after one week and three weeks of dothiepin treatment. All subjects were further interviewed using Hamilton Rating Scale for Depression (HRSD) to rate the severity of their depression. High response to the drug was defined as a reduction of more than 50% of the HRSD score. Result : The results were as follows : 1) Depressed patients after dothiepin treatment showed more total sleep time(p=0.019), shorter sleep latency(p=0.05), less awake time(p=0.033), more sleep efficiency(p=0.018), more stage 2 sleep(p=0.002), less REM time(p=0.000), and longer REM sleep latency(p=0.004) than before treatment. 2) There were no differences in sleep variables between those who received 1 week and 3 weeks of dothiepin treatment except of th shortening of sleep latency after 3 weeks(p<0.05). 3) Depressive symptom scores on HRSD were reduced after 1 week and 3 weeks of dothiepin treatment as compared with the baseline. 4) High responers showed a tendency of increased wake time(p=0.054), while their stage 4 sleep decreased after 1 week of dothiepin treatment as compared with the low responders(p=0.0136). Conclusions : These results suggest that sleep of the depressed patients after dothiepin treatment tends to be nomalized and sleep chages seem to appear early in the treatment phase. In addition, clinical response might be associated with greater wake time at the baseline and lesser atage 4 sleep 1 week of dothiepin treatment.
Depression ; Dothiepin ; Humans ; Polysomnography ; Sleep, REM

No abstract available.
Aortic Coarctation*

PURPOSE: The replacement of functional genes into cells that lack genes or mutant genes is the basis of gene therapy. In cancer, where cells often have multiple genetic defects, the replacement of critical genes may suffice to suppress cell growth or induce cell death. In malignant brain tumors, p53 mutation are among the most frequently observed genetic findings and inactivation p53 suggests that p53 plays a critical role in carcinogenesis and tumor progression. Therefore, we study the successful transfer of the wild-type p53 gene using a replicative deficient adenovirus vector into human glioma and medulloblastoma c~ell lines. Meterials and Methods: The human glioma cell line T-98G, U-87MG, U-373MG were used. To determine the efficiency of the adenovirus vector, cell lines were transfected with the Ad-p gal and analysed with X-Gal staining. Cell viability was determined by trypan blue exclusion every day after infection and Westem blot analysis was used to conform the expression of the exogenous p53 protein. RESULTS: Cell growth of the Ad-CMV-p53 infected U-373MG, and U-87MG was significantly suppressed. It appeared that exogenous p53 protein expression had an earlier ad more profound suppressive effect on U-373MG having a mutated p53 gene than on U-87MG having a wild-type p53. The expression of the exogenous p53 was more than 10 times higher than the expression of the endogenous p53. To examine the decreased viability, U-373MG was stained with Hochest 33258 and detected nuclear condensation and apoptic body. Staining results suggest that cells undergo apoptosis. CONCLUSION: The replicative deficient adenoviral vector can transfer and express p53 in human glioma cell lines in vitro, restoring wild-type p53 tumor suppressor functions. The restoration of normal p53-encoded protein in the mutant ceil lines induced cell death. The high expression of the newly transduced protein had different effects on the growth rate of the infected cell lines depending on the p53 status of the cells.
Adenoviridae* ; Apoptosis ; Brain Neoplasms ; Carcinogenesis ; Cell Death ; Cell Line* ; Cell Survival ; Genes, p53 ; Genetic Therapy ; Glioma* ; Humans ; Medulloblastoma ; Trypan Blue