The meningitis occur within a closed anatomic space, so they have many similar clinical features and characteristic CSF abnormalities. But the temporal profile of many meningitis is distinctive from aseptic meningitis with spontaneous remission to bacterial or tuberculous meningitis with fatal outcome without treatment. Therefore early accurate differential diagnosis is required. The development of diagnostic tools and treatment, and increase of immunodeficient state and resistant pathogens have changed the distribution of main pathogens of meningitis from the past. Therefore we analyzed 241 medical records with final diagnosis as 'infectious meningitis' to evaluate the distribution of pathogens in Korea and any differential points of clinical, laboratory, and radiologic, profile according to etiology. 1. The etiologic distributions were followings, Aseptic meningitis in 100 patient(41.5%), tuberculous meningitis in 58 patients(24.1%), bacterial meningitis in 48 patients(19.9%), and fungal in 16 patients(6.6%). 2. The intense seasonal occurrence was noted in aseptic meningitis with summer. 3. Fever and headache were noted in almost all patients Altered mental status were noted in 39.6% of bacterial meningitis, 53.41% of tuberculous meningitis but not in fungal and aseptic meningitis. Meningeal irritation signs were noted in less patients(25%) with fungal meningitis but in more with aseptic, bacterial or tuberculous meningitis m 52-66.7%. Most of all focal neurologic signs were present in bacterial or tuberculous meningitis. 4. Many immunocompromized patients had fungal meningitis, three of which showed normal CSF leukocyte counts And it pointed up the importance of intensive etiologic evaluation in immunodeficient patients with clinically suspected symptoms of meningitis. 5. CSF findings at admission were following. CSF leukocytes were mean 206-258/yL in aseptic, tuberculous or fungal meningitis. But in bacterial meningitis leukocyte counts were greater than 1,000/mL in mom than half of patients. The differential counts of leukocytes were monocyte predominant except in bacterial meningitis. The reductions of CSF sugar were noted in bacterial, tuberculous, or fungal meningitis. Characteristically all patients with extremely low CSF sugar(less than 10mg/dL) had bacterial meningitis. 6. The most frequent pathologic findings in neuroimaging study were hydrocephalus(20patients: 9.1%) and meningeal enhancement(19patient,: 8.6%). Small enhancing mass(8patients: 3.6%.) and focal infarction(8patients: 3.6%) were noted less frequently. These abnormal radiologic findings were noted in 2 patients(2.0%) with aseptic meningitis, 15 patients(38.7%) with bacterial meningitis, 29 patients(50.0%) with tuberculous meningitis and 5 patients(35.7%) with fungal meningitis.
Adult* ; Diagnosis ; Diagnosis, Differential ; Fatal Outcome ; Fever ; Headache ; Humans ; Korea ; Leukocyte Count ; Leukocytes ; Medical Records ; Meningitis* ; Meningitis, Aseptic ; Meningitis, Bacterial ; Meningitis, Fungal ; Monocytes ; Neuroimaging ; Neurologic Manifestations ; Remission, Spontaneous ; Seasons ; Tuberculosis, Meningeal

We studied 55 patients with static brain lesions who developed delayed-onset movement disorders. Of these, 29(52.7%) had pakinsonism, 17(30.9%) dystonia, 6(10.9%) chorea, 2(3.6%) tremor, and I(I.8%) myoclonus. The precipitating insults included carbon mono-oxide, poisoning in 32(58.2%), 6(10.9%), encephalitis in 5(9.1%)head injury, stoke and hypoxia, in 6(10.9%) patients each. Among the four Patients with initial insult occurring at age 2years or younger(infant group), all had dystonia. Distribution of dystonia was focal in one(25%), segmental in two(50%), and unilateral in one patient(25%). The mean latency between the original injury and the onset of movement disorder was 378.03+277.13 weeks. Among the 11 patient initial insults occurring between ages 5 and 17(childhood group), 7 had dystonia, 3 parkinsonism, 1chorea. The distribution of dystonia was focal in one, segmental in five, and unilateral in one patient; the mean latency between the original injury and the onset of movement disorder was 91.3+,230.1 weeks. Among the 40patients with initial insults occurring at ages 23 or older (adult group), 26(65.0%) had parkinsonism, 6(15.0%) dystonia, 5(12.5%) chorea, 2(5.0%) tremor, 1(2.5%) myoclonus. The distribution of dystonia in patient was focal in two(33.0%), and segmental in four(67.7%) patients. The mean latency of movement disorder onset in the 40 patients, of the adult group was 17.25+43.67weeks. Brain injury at a young age was associated with a longer latency to onset of subsequent movement disorder. Among the 45 initial brain computed tomography, 28 (62.2%) had abnormal findings; 14(31.1%) low density lesion in the basal ganglia, 7(15.6%) low density lesions in the cerebral white matter, 2(4.4%) low density lesion in the cerebral white matter and basal ganglia, and 5(l1.1%) cortical atrophy. Seventeen (37.8%) had normal neuroimaging finding. Many, but not all, patients had lesionon on brain imaging, but there was no clear correlation between the sites of damage on imaging and the clinical manifestation.
Adult ; Anoxia ; Atrophy ; Basal Ganglia ; Brain Injuries ; Brain* ; Carbon ; Chorea ; Dystonia ; Encephalitis ; Humans ; Movement Disorders* ; Myoclonus ; Neuroimaging ; Parkinsonian Disorders ; Poisoning ; Tremor

BACKGROUND: Presently, it is well known that there are neurological and systemic complications after carbon monox-ide (CO) intoxication. Until recently, delayed-onset movement disorders after CO intoxication were rarely reported. We analyzed 32 patients with delayed onset movement disorders after CO intoxication. METHODS: We reviewed the medical records of 242 patients admitted to the Yonsei University Medical Center from January 1986 to December 1996 due to CO intoxication. Patients were analyzed with respect to movement disorders, onset, latency, and radiological findings. RESULTS: Among the 242 patients of CO intoxication, 32 (13.2%) patients had delayed-onset movement disorders. Of these, 23 (71.9%) had parkinsonism, 5 (15.6%) had dystonia, 3 (9.4%) had chorea, and 1 (3.1%) had myoclonus. The mean age of the patients was 46.66 +/-16.91 years. Among the 4 patients with CO intoxication occuring at age 17 or younger (Childhood group), 2 had parkinsonism and 2 had focal dystonia. The mean age of the Childhood group was 1 7 . 7 5 +/-6.99 years. Among the 28 patients with CO intoxication occuring at age 18 or older (Adult group), 21 (75%) had parkinsonism, 3(10.7%) dystonia, 3(10.7%) chorea, and 1(3.6%) myoclonus. Among the 3 patients with dystonia in the Adult group, 1 had focal dystonia and 2 had segmental dystonia. The mean age of the adult group was 50.79 +/-1 3 . 4 6 years. The mean latency between CO intoxication and the onset of movement disorders was 27.20 +/-27.94 weeks in the Childhood group and 9.60 +/-14.97 weeks in the Adult group. The mean latency between CO intoxication and the onset of movement disorders was 6.44 +/-6.76 weeks in parkinsonism, 41.76 +/-27.99 weeks in dystonia, 4.0 weeks in chorea, and 8.0 weeks in myoclonus. The mean latency in dystonia was longer than in the others. Among the 23 patients who underwent brain computed tomography, 12 (52.2%) had abnormal findings. Low density lesions were found in the globus pallidus (13.0%), cerebral white matter (13.0%), and both globus pallidus and cerebral white matter (17.4%). One (14.3%) patient showed cortical atrophy while another patient showed both cortical atrophy and low density in cerebral white matter. CONCLUSIONS: The development of a delayed-onset movement disorder after CO intoxication is not rare. In our research, the radiological findings of patients with delayed-onset movement disorders after CO intoxication were inconsistant. The findings revealed no correlations with the various types of delayed-onset movement disorders.
Academic Medical Centers ; Adult ; Atrophy ; Brain ; Carbon Monoxide* ; Carbon* ; Chorea ; Dystonia ; Dystonic Disorders ; Globus Pallidus ; Humans ; Medical Records ; Movement Disorders* ; Myoclonus ; Parkinsonian Disorders

A 63-year-old man complained of intermittent motor weakness of his arm. The magnetic resonance image (MRI) of his brain displayed a high signal lesion in right cingulate gyrus on T2 weighted image. One year later, he showed a stuporous mental status with repeated seizures, and the follow-up brain MRI showed heterogeneously enhanced mass associated with bleeding. He was treated with surgery and radiotherapy for secondary glioblastomas in right cingulate gyrus. One year more later, a mass recurred on the left frontal base, and gliosarcoma was diagnosed. After tumor resection, ventriculoperitoneal shunt, chemotherapy, and re-radiation therapy, all brain lesions were stable. Fourteen months after the diagnosis of gliosarcoma, he complained of dyspnea and back pain. Torso positron emission tomography/computed tomography revealed multiple metastatic lesions in both lungs, pericardium, pleura, liver, lymph nodes, and bones, and metastatic gliosarcoma was diagnosed. One month later, the patient died because of the systemic metastases. We present an unusual case of secondary gliosarcoma with stable brain lesions and extensive systemic metastases.
Arm ; Back Pain ; Brain ; Brain Neoplasms ; Diagnosis ; Drug Therapy ; Dyspnea ; Electrons ; Follow-Up Studies ; Glioblastoma ; Gliosarcoma* ; Gyrus Cinguli ; Hemorrhage ; Humans ; Liver ; Lung ; Lymph Nodes ; Magnetic Resonance Imaging ; Middle Aged ; Neoplasm Metastasis* ; Pericardium ; Pleura ; Radiotherapy ; Seizures ; Stupor ; Torso ; Ventriculoperitoneal Shunt

OBJECTIVE: The measurement of liver size can be used for the diagnosis of the fetal growth abnormality (FGR, macrosomia etc.). The purpose of this study was to evaluate a mathematical relationship between the fetal liver size(liver length or volume) and the gestational age in the normal pregnancies. Brief comparisons were also tried on the base of the degree of the correlation between liver length and its volume. METHODS: We collected 54 singleton pregnancies of 20 to 36weeks of gestation for measuring fetal liver length and 57 singleton pregnancies for measuring fetal liver volume. We used Combison 530 utrasonic machine(Kreztechnik AG, Zipf, Austria). RESULTS: There was significant correlation between liver size( length and volume) and gestation age. And the liver volume better correlated with gestational age than liver length(r=0.93 : r=0.78, p<0.0001, p<0.0001). CONCLUSION: Ultrasonic measurement of fetal liver size is a reliable indicator of fetal growth, especially liver volume. Therefore these data may have a potential value for the prediction of abnormal fetal growth(FGR, macrosomia).
Diagnosis ; Fetal Development ; Gestational Age* ; Liver* ; Pregnancy* ; Ultrasonics

Aseptic meningitis may rarely occur with the use of OKT3 murin monoclonal antibody, which is an immunosuppressive agent for the prevention and treatment of acute rejection in solid transplantation. We present a patient with aseptic meningitis, developed during OKT3 therapy, who shows characteristic clinical features and CSF findings consistent with OKT3 associated aseptic meningitis.
Humans ; Meningitis, Aseptic* ; Muromonab-CD3*

No abstract available.
Humans ; Perfusion* ; Prenatal Diagnosis*

Twenty-six primary hip prostheses were implanted in nineteen patients with a diagnosis of aplastic anemia between January 1990 and December 1992. The preoperative diagnosis were osteonecrosis of the femoral head in twenty-five hips and femoral neck fracture in one. The duration of follow-up was minimum of fours years. Preoperatively, the average Harris hip score was 56. At four years postoperatively, the average score reached 87. At this time, twelve hips were rated excellent, eleven good, two fair, and one poor. One patient who received a bipolar arthroplasty showed an intrapelvic protrusion of the acetabular component. Another bipolar fixed with Boneloc cement was performed due to femoral neck fracture. There was no migration of component, subsidence, radiolucency or osteolysis in three hips with hybrid fixation. No sign of migration of acetabular component was seen with uncemented prosthesis. Two hips with HA coated acetabular components showed a progressive radiolucent line. Progressive retroacetabular osteolysis was found in one hip at zone I and II. There were neither cases of infection nor hemorrhage complications. Two patients died of pneumonia and sepsis, respectively, at fifty-three and fifty-seven months postoperatively. It appears that fatty marrow conversion of proximal femur and pelvis does not affect the survival of cemented and uncemented fixation, but long-term follow-up is needed to validate our view. We have demonstrated that the hip arthroplasty in most patients with aplastic anemia can be successful despite the fact that hematologic characteristics of aplastic anemia seem to indicated a high risk for hemorrhagic complication and infection. In conclusion, we strongly recommend hip arthro-plasty if the patients has a painful hip joint, regardless of severity of aplastic anemia whose prognosis may be disappointing.
Acetabulum ; Anemia, Aplastic* ; Arthroplasty* ; Bone Marrow ; Diagnosis ; Femoral Neck Fractures ; Femur ; Follow-Up Studies ; Head ; Hemorrhage ; Hip Joint ; Hip Prosthesis ; Hip* ; Humans ; Osteolysis ; Osteonecrosis ; Pelvis ; Pneumonia ; Prognosis ; Prostheses and Implants ; Sepsis

No abstract available.
Gangwon-do* ; Humans ; Norovirus* ; Sequence Analysis*

PURPOSE: To evaluate the effectiveness of a blocking screw in intramedullary nailing at the tibia proximal shaft fracture. MATERIALS AND METHODS: 63 tibia proximal shaft fractures from January 2000 to December 2002 treated with only intramedullary nailing were referred to as group I, and 8 fractures from January 2003 to December 2003 treated with both intramedullary nailing and the blocking screw were referred to as group II. Retrospective studies were done for group I and II. The incidence of nonunion and the postoperative angular alignments were compared. Malalignment was defined as an angle of 5 degrees anteroposteriorly or mediolaterally. RESULTS: There were 7 nonunion (11%) in group I in compare with none in group II. There were 21 angular malalignments (33%) in group I and 1 in group II (12%) and most of them had valgus deformity or anterior anglulation. No complications were directly due to the use of the Blocking screw. CONCLUSION: The technique of the blocking screw used to be one of the option for proximal tibial nailing at tibial proximal shaft fracture helps to overcome angular malalignments of bones.
Congenital Abnormalities ; Fracture Fixation, Intramedullary ; Incidence ; Retrospective Studies ; Tibia ; Tibial Fractures*