Objective: To identify the CT findings associated with treatment failure after antibiotic therapy for acute appendicitis. Materials and Methods: Altogether, 198 patients who received antibiotic therapy for appendicitis were identified by searching the hospital’s surgery database. Selection criteria for antibiotic therapy were uncomplicated appendicitis with an appendiceal diameter equal to or less than 11 mm. The 86 patients included in the study were divided into a treatment success group and a treatment failure group. Treatment failure was defined as a resistance to antibiotic therapy or recurrent appendicitis during a 1-year follow-up period. Two radiologists independently evaluated the following CT findings: appendix–location, involved extent, maximal diameter, thickness, wall enhancement, focal wall defect, periappendiceal fat infiltration, and so on. For the quantitative analysis, two readers independently measured the CT values at the least attenuated wall of the appendix by drawing a round region of interest on the enhanced CT (HUpost) and non-enhanced CT (HUpre). The degree of appendiceal wall enhancement (HUsub) was calculated as the subtracted value between HUpost and HU pre. A logistic regression analysis was used to identify the CT findings associated with treatment failure. Results: Sixty-four of 86 (74.4%) patients were successfully treated with antibiotic therapy, with treatment failure occurring in the remaining 22 (25.5%). The treatment failure group showed a higher frequency of hypoenhancement of the appendiceal wall than the success group (31.8% vs. 7.8%; p = 0.005). Upon quantitative analysis, both HU post (46.7 ± 21.3 HU vs. 58.9 ± 22.0 HU; p = 0.027) and HUsub (26.9 ± 17.3 HU vs. 35.4 ± 16.6 HU; p = 0.042) values were significantly lower in the treatment failure group than in the success group. Conclusion Hypoenhancement of the appendiceal wall was significantly associated with treatment failure after antibiotic therapy for acute appendicitis.

PURPOSE: Wilms' tumor typically affects young children, with more than 80% of patients identified before 5 years of age. We evaluated the clinical features of Wilms' tumor according to age. MATERIALS AND METHODS: According to their age, 27 patients with Wilms' tumor who underwent radical nephrectomy were classified into group I (under 24 months: n=15), group II (24-48 months: n=4), and group III (over 48 months: n=8), respectively. We retrospectively reviewed tumor size, pathologic features, renal vein invasion, renal capsule invasion, bilaterality, lymphovascular invasion, stage, complete resection, and survival rate. RESULTS: The mean age of groups I, II, and III was 12.5+/-7.0 (range, 1-20), 33.3+/-5.7 (range, 24-39) and 126.9+/-89.1 (range, 54-300) months, respectively. Bilaterality (p<0.001) and male sexuality (p=0.039) were significantly related to early diagnostic age. Tumor stage (p=0.036) and blastema component (p=0.027) increased with age. Bilaterality and incomplete resection of Wilms' tumor were related to larger size (p<0.001) and vessel/lymph node invasion (p=0.02), respectively. There were no significant differences in tumor volume, anaplasia, capsule invasion, lymph node invasion, vessel invasion, complete resection, laterality, or recurrence according to age. There was also no significant difference in the survival rate according to age. CONCLUSIONS: Tumor stage and blastema component of Wilm's tumor increased with age. Bilaterality and male sexuality were related to an early diagnostic age. There was no significant difference in the survival rate according to age.
Age of Onset ; Anaplasia ; Child ; Glycosaminoglycans ; Humans ; Lymph Nodes ; Male ; Nephrectomy ; Recurrence ; Renal Veins ; Retrospective Studies ; Sexuality ; Survival Rate ; Tumor Burden ; Wilms Tumor

BACKGROUND: Phadiatop test has been introduced as a single test for screening the atopics who were sensitized to common inhalant allergens. MATERIAL AND METHOD: We compared the clinical efficiency of Phadiatop test and total IgE level for defining presence of atopy in 136 asthmatic subjects. The presence of atopy was defined by skin prick test done with 10 common inhalant allergens. More than 2+ skin reactivity was defined as having atopy. Phadiatop test and total IgE level in serum were measured using Pharmacia CAP systems. RESULT: 109 out of 136 subjects had more than 2+ skin reactivity to at least one allergen and another 27 subjects had 1+ or negative skin reactivity to allergens. The performance characteristics of Phadiatop test for screening atopy was superior than total IgE level, with sensitivity(91.7% vs. 82.6%), positive predictive value(94.3% vs. 86.5%) and concordance rate(89.0 % vs. 75.7% ). Specificity and negative predictive value of the Phadistop test were acceptable and higher than that of total IgE level. CONCLUSION: These results suggested that Ph adiatop may be simple and useful for screening atopic status in Korean asthmatic subjects.
Allergens ; Hydrogen-Ion Concentration ; Immunoglobulin E ; Mass Screening* ; Sensitivity and Specificity ; Skin

OBJECTIVES: We sought to examine the diverse factors associated with aneurysms of the posterior circulation. In addition, the results of conventional craniotomy were compared with those of endovascular treatment. METHODS: One hundred and one patients with posterior circulation aneurysms were selected for study inclusion. The factors that might affect the clinical outcomes were studied , such as the initial Hunt-Hess (H-H) grade, aneurysm location, size of the aneurysm, and therapeutic modalities. In addition, the morbidity and mortality rates were analyzed. The treatment outcomes were evaluated using the Glasgow Outcome Scale (GOS) 6 months after the initial insult. RESULTS: The patient population consisted of 67 women and 34 men, with a mean age of 52 (range 28-81 years). The overall morbidity and mortality rates at 6 months were 13.9% (14/101) and 17.8% (18/101), respectively. Sixty-one operations (60.3%) were performed, and 32 patients were treated with endovascular therapy. Forty-two (85.7%) of the 49 patients that had initial H-H grades of I and II had a better prognosis (GOS more than 4) than those with poor H-H grades (P<0.001). Patients that underwent endovascular treatment had better outcomes than those that had clipping (P=0.032). There was no significant difference in outcome according to the size of the aneurysm, location of the aneurysm, or the age of the patients. CONCLUSIONS: The results of this study showed that the factors affecting the prognosis were the initial HH grade and treatment modality. Considering the very high mortality rate in patients with rebleeding, early management may help improve the prognosis of patients with posterior circulation aneurysms. Endovascular therapy should be considered the primary treatment modality in patients with posterior circulation aneurysms.
Aneurysm ; Craniotomy ; Female ; Glasgow Outcome Scale ; Humans ; Intracranial Aneurysm ; Male ; Prognosis

Neurosyphilis is a rare infection of the brain and spinal cord caused by a spirochete named Treponema pallidum. We describe the magnetic resonance imaging of a 53-year-old man with syphilis who manifested as both meningovascular, and spinal meningomyelitic types, which involved the optic, trigeminal, facial and vestibulocochlear nerves, both middle and left posterior cerebral arteries, thoracic spinal cord and meninges of the lumbar spine. This case report suggests that neurosyphilis should be considered as a possible diagnosis in patients showing complex brain and spinal imaging features. These features include enhancing meningeal lesions with multiple cranial nerve involvement, stenoses in large to medium size cerebral arteries, and intramedullary and meningeal lesions of spine.
Brain ; Cerebral Arteries ; Cerebral Infarction* ; Constriction, Pathologic ; Cranial Nerve Diseases* ; Cranial Nerves ; Diagnosis ; HIV* ; Humans ; Magnetic Resonance Imaging* ; Meninges ; Meningitis ; Middle Aged ; Neurosyphilis* ; Posterior Cerebral Artery ; Spinal Cord ; Spine ; Spirochaetales ; Syphilis ; Tabes Dorsalis ; Treponema pallidum ; Vestibulocochlear Nerve

Fibrovascular polyps are rare benign intraluminal tumors that usually arise from the cervical esophagus. These often present as very large sized pedunculated polyps and cause symptoms including dysphagia and respiratory distress. Generally, large polyps are surgically excised, while endoscopic resection is limited to smaller polyps. Herein, we present a giant fibrovascular polyp of the esophagus treated successfully by endoscopic resection.
Deglutition Disorders ; Esophagus* ; Polyps*

Although congenital renal tumors are rare, congenital mesoblastic nephroma (CMN) is the most common renal tumor in early infancy. It is non-metastatic, well differentiated, amenable to surgical removal, and carries a good prognosis. Polyhydramnios has been detected in most of the published cases of CMN. However, we experienced a rare case of fetal CMN associated with oligohydramnios. A 28-yr old woman at 34 weeks of gestation was referred to our hospital for oligohydramnios and a fetal abdominal mass. An ultrasonography revealed a huge, well-encapsulated mass arising from the right kidney. An emergency cesarean section was performed due to fetal distress. After birth, despite intensive neonatal care, the baby died because of renal failure, disseminated intravascular coagulopathy, pulmonary edema, together with other problems.
Pregnancy ; Oligohydramnios/*diagnosis/therapy ; Nephroma, Mesoblastic/*diagnosis/therapy ; Kidney Neoplasms/*diagnosis/therapy ; Infant, Newborn ; Humans ; Fetal Diseases/etiology/prevention & control ; Female ; Fatal Outcome ; Cesarean Section ; Adult

Background: Although neuromyelitis optica spectrum disorder (NMOSD) is known to be a rare disease, its prevalence and incidence have not yet been studied in Korea. We performed a population-based study to examine the prevalence and incidence of NMOSD in Korea using data from the Korean National Health Insurance (NHI) claims database. Methods: Data from 2013 to 2017 were obtained, with a washout period set as 2013 and 2014. The prevalence and incidence of NMOSD in 2016 and 2017 were calculated using population census data. Subjects were divided into 5 groups at 15-year intervals, depending on the age at which the diagnostic code was entered. The relative risk (RR) for each age group was compared with the oldest (≥ 60 years) age group. Results: The overall prevalence was estimated to be 3.36 and 3.56 per 100,000 individuals, with an incidence of 0.41 and 0.65 per 100,000 individuals-year in 2016 and 2017, respectively. The mean age was 43.08 (standard deviation, 14.56) years, and the ratio of male to females was 1:4.7. The incidence was higher in female individuals aged between 30 and 59 years (RR, 2.8–3.05; P < 0.05). Conclusion Nationwide prevalence of NMOSD in Korea was 3.36 and 3.56/100,000 and its incidence was 0.41 and 0.65/100,000-year in 2016 and 2017 respectively.

Cri-du-Chat syndrome, also called the 5p-syndrome, is a rare genetic abnormality, and only few cases have been reported on its brain MRI findings. We describe the magnetic resonance imaging findings of a 1-year-old girl with Cri-du-Chat syndrome who showed brain stem hypoplasia, particularly in the pons, with normal cerebellum and diffuse hypoplasia of the cerebral hemispheres. We suggest that Cri-du-Chat syndrome chould be suspected in children with brain stem hypoplasia, particularly for those with high-pitched cries.
Brain Stem/*pathology ; Cri-du-Chat Syndrome/*complications/diagnosis ; Diagnosis, Differential ; Female ; Humans ; Infant ; Magnetic Resonance Imaging/*methods ; Pons/pathology

PURPOSE: To quantitatively and qualitatively compare fat-suppressed MRI quality using iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL) with that using frequency selective fat-suppression (FSFS) T2- and postcontrast T1-weighted fast spin-echo images of the head and neck at 3T. MATERIALS AND METHODS: The study was approved by our Institutional Review Board. Prospective MR image analysis was performed in 36 individuals at a single-center. Axial fat suppressed T2- and postcontrast T1-weighted images with IDEAL and FSFS were compared. Visual assessment was performed by two independent readers with respect to; 1) metallic artifacts around oral cavity, 2) susceptibility artifacts around upper airway, paranasal sinus, and head-neck junction, 3) homogeneity of fat suppression, 4) image sharpness, 5) tissue contrast of pathologies and lymph nodes. The signal-to-noise ratios (SNR) for each image sequence were assessed. RESULTS: Both IDEAL fat suppressed T2- and T1-weighted images significantly reduced artifacts around airway, paranasal sinus, and head-neck junction, and significantly improved homogeneous fat suppression in compared to those using FSFS (P < 0.05 for all). IDEAL significantly decreased artifacts around oral cavity on T2-weighted images (P < 0.05, respectively) and improved sharpness, lesion-to-tissue, and lymph node-to-tissue contrast on T1-weighted images (P < 0.05 for all). The mean SNRs were significantly improved on both T1- and T2-weighted IDEAL images (P < 0.05 for all). CONCLUSIONS: IDEAL technique improves image quality in the head and neck by reducing artifacts with homogeneous fat suppression, while maintaining a high SNR.
Artifacts* ; Ethics Committees, Research ; Head* ; Lymph Nodes ; Magnetic Resonance Imaging* ; Mouth ; Neck* ; Pathology ; Prospective Studies ; Signal-To-Noise Ratio ; Water