When a soft tissue mass in the bony wall of the paranasal sinus is present, it is difficult to make a distinction between tumor and inflammatory mass on CT. Fungal sinusitis may have soft tissue attenuation on the bony wall of the sinus, bony sclerosis, focal bony destruction, and calcific area on CT. This is a report of four proven cases of fungal sinusitis, asperogillosis in 3 cases and mucormycosis in 1 case, All 4 patients had CT and one patient had MRI, On CT, bony sclerosis and destruction were well visualized in all cases. On MRI, mycetoma in the maxillary sinus was hypointense on T1 weighted images and more hypointense on T2 weighted images. Although CT appears to be the best modality for initial examination of the patient with sinusitis, the differentiation of fungal sinusitis from tumor mass or other entity may be better accomplished with MRI.
Humans ; Magnetic Resonance Imaging ; Maxillary Sinus ; Mucormycosis ; Mycetoma ; Sclerosis ; Sinusitis

PURPOSE: The purpose of this study was to compare the effectiveness of a structured preoperative PCA education to that of the usual informal teaching provided by hospital staff in alleviating postoperative pain through more effective use of PCA therapy. METHOD: As an advanced research, the knowledge about the use of PCA therapy and the attitude about the use of the pain medicine were estimated, and then as a later research, the knowledge about the use of PCA therapy, the attitude about the use of the pain medicine, and the score of the pain were estimated. RESULT: The experimental group those who received structured preoperative PCA education had statistically significant higher knowledge regarding the use of PCA therapy(p=0.026) and more positive attitudes toward using pain medicine(p=0.004). The experimental group those who received structured preoperative PCA education reported better pain control 4(p= 0.002), 8(p=0.014) and 24 hours(p=0.018) after the operation. CONCLUSION: The structured preoperative PCA education increases the knowledge for the use of patient's PCA therapy and changes their attitude toward the use of the pain medicine positively and consequently enable the use of PCA therapy to be more effective and then finally reduced the patient's pain after the operation.
Education* ; Pain, Postoperative* ; Passive Cutaneous Anaphylaxis* ; Patient Education as Topic

We report a case of neuroblastoma with multiple skin metastases as a chief complaint in a 2-month-old girl. the skin lesions were rnultiple, pea-sized, bluish, nontender, moable subcutaneous nodules on abdomen, back and scalp. Histopathology showed small round or poly gonal tumor cells which have deeply stained, basophilic, hyperchromatic nuclei with some mitoses. Th.se tumor cells showed clumping tendency which is one of early menifestations of rosette formation. Immunohistochemically positive reaction was demonstrated by anti-NSE(neuron specific enolase) antilody but negative reaction by anti-NFP (neurofilament proteiin ) antibody. She has been succesfully treated with combined chemotherapy for 10 months without relapse.
Abdomen ; Basophils ; Drug Therapy ; Female ; Humans ; Infant ; Mitosis ; Neoplasm Metastasis* ; Neuroblastoma* ; Phosphopyruvate Hydratase ; Recurrence ; Rosette Formation ; Scalp ; Skin*

BACKGROUND: Experimental data indicate that low-flow reperfusion following prolonged cardiocirculatory arrest may aggravate early cerebral microcirculatory repefusion disorders. We investigated the influence of cerebral repefusion flow change to the ischemic histopathologic damage of brain tissue after incomplete forebrain ischemia in rats. MATERIALS AND METHOD: Anesthetized Sprague-Dawley rats were undergone ligation of both infernal carotid artery by microvascular clamp for 10 minutes. After release of the clamp, reperfusion was started with several different flow levels (0, 10, 20, 30, 50, and 100%) of infernal carotid artery comparing to pre-clamping phase using flowmeter. After 15minutes of reperfusion, rat brains were prepared by perfusion-fixation with 3% formaldehyde. Under light microscopic examination of Hematoxylin-Eosin stained tissue slide, histopathologic damage was examined at cortex, putamen, and hippocampus regions. Categorical hisotopathologic damage scores were derived in each regions by manual counts of ischemic neurons. RESULT: The histopathologic damage scores were 0, 10. 2+/-0.5, 7.6+/-1.5, 5.9+/-1.4, 5.0+/- 2.8, 3.5+/-0.7, and 1.0+/-0.0 in control, 0, 10, 20, 30, 50, and 100% reperfusion groups, respectively(p<0.05). CONCLUSION: Our insults showed significant increment of brain histopathologic damage scores along with decreasing amount of cerebral reperfusion know after incomplete forebrain ischemia. We believe restoration of repefusion flow to pre-ischemic level would be a critical component in attenuation of brain ischemic damage.
Animals ; Brain ; Carotid Arteries ; Flowmeters ; Formaldehyde ; Hippocampus ; Ischemia* ; Ligation ; Models, Animal* ; Neurons ; Prosencephalon* ; Putamen ; Rats* ; Rats, Sprague-Dawley ; Reperfusion*

Objectives: . To determine the appropriate anatomical borders of implantation on the temporal bone in a cadaver study, and to develop a simplified surgical technique for Baha Attract implantation through a small incision along the hairline using anatomical evidence and a navigation system. Methods: . In a cadaver study, 20 human adult dry skulls were used to find flat areas of the temporal bone for Baha Attract magnet implantation. Four borders of the “optimal surgical site” were defined: Asterion line, occipitomastoid suture line, sigmoid sinus line, and digastric groove line. In three patients, we implanted the Baha Attract according to the newly developed surgical procedure and validated the feasibility of this technique with a navigation system. Results: . We identified the appropriate position of the implant on the temporal bone, suggesting a simplified surgical technique for Baha Attract with a small incision. We determined the spot of implantation, and the implants were inserted through a small surgical incision (<2.5 cm) under local anesthesia; the procedure lasted approximately 30 minutes. Conclusion . The optimal surgical site of the temporal bone is a safe and easily accessible location for implantation of the Baha Attract.

OBJECTIVE: After drawing and stacking contour of structures, which are identifed in the serially sectioned images, three-dimensional (3D) images can be made by surface reconstruction. The 3D images can be selected and rotated in a real time. The purpose of this research is to compose software of automatic surface reconstruction for making 3D images. METHODS: Contours of 55 structures in the 613 magnetic resonance images of whole body were drawn to make segmented images. We composed automatic software for stacking contours of a structure, for converting the contours into polygons, and for connecting vertices of the neighboring polygons to fill gaps between polygons with triangular surfaces. The surface reconstruction software was excuted to make 3D images of 55 structures. RESULTS: Virtual dissection software, on which 3D images could be selected and rotated, was composed. CONCLUSION: For other research, this like program can be composed for automatic surface reconstruction; several kinds of commercial software can be used for manual or automatic surface reconstruction. Investigators might choose one of the methods in consideration of their only circumstances.
Humans ; Imaging, Three-Dimensional ; Research Personnel

OBJECTIVE: Cadaver's sectioned images with high resolution and real color could be used as the source of realistic three-dimensional images. If the sectioned images are registered to a patient's MRIs, three-dimensional images with high resolution and real color that fit the patient, can be produced; the three-dimensional images enable realistic virtual surgery for the patient. The objective of this study was to verify the registration of a cadaver's sectioned images to a patient's head MRIs. METHODS: The sectioned images of the heads of cadaver were associated with segmented images selected at 3 mm intervals. The patient had his head MR scanned at 3 mm intervals; the MRIs were segmented. Software to register the cadaver's sectioned images to the patient's MRIs was developed. On this software, the corresponding dots were identified on both the sectioned images and the MRIs either manually or automatically using segmented images. RESULTS: The registered sectioned images corresponded to the patient's MRIs. Both manual and automatic registrations were satisfied. CONCLUSION: Further study is needed for registering sectioned images to actual patients.
Cadaver ; Head ; Humans ; Imaging, Three-Dimensional

Authors had prepared the high-quality sectioned images of a cadaver head. For the delineation of each cerebral gyrus, three-dimensional model of the same brain was required. The purpose of this study was to develop the segmentation protocol of cerebral gyri by referring to the three-dimensional model on the personal computer. From the 114 sectioned images (intervals, 1 mm), a cerebral hemisphere was outlined. On MRIcro software, sectioned images including only the cerebral hemisphere were volume reconstructed. The volume model was rotated to capture the lateral, medial, superior, and inferior views of the cerebral hemisphere. On these four views, areas of 33 cerebral gyri were painted with colors. Derived from the painted views, the cerebral gyri in sectioned images were identified and outlined on the Photoshop to prepare segmented images. The segmented images were used for production of volume and surface models of the selected gyri. The segmentation method developed in this research is expected to be applied to other types of images, such as MRIs. Our results of the sectioned and segmented images of the cadaver brain, acquired in the present study, are hopefully utilized for medical learning tools of neuroanatomy.
Aged ; Cerebrum/*anatomy & histology ; Humans ; Imaging, Three-Dimensional ; Male ; *Models, Anatomic ; Software

Henoch-Schonlein Purfrura is a generalized small vessel vasculitis of hypersensitivity type characterized primarily by a purpuric skin lesion, renal involvementwith hematuria and proteinuria, arthralgia, and colicky abdominal pain. A possible neurologic involvement was recognized in 1914 by Osler. A case of a 7 1/2-year-old male patient with Henoch-Schonlein purpura developed neurologic manifestations including seizure and mental status change. The cranial CT demonstrated a occipital hemorrhage of right side and cerebral edema with contrast enhancing scattered dilated vessels. The EEGchanges were slow wave activities in acute stage. The follow-up EEG shows that the slow wave activities were more improved than previous and that multiple spike waves were recorded at bothfronto-temporo-parietal areas with phase reversals. The vasculitis of HenochSch6nlein purpura can involve the nervous system.
Abdominal Pain ; Arthralgia ; Brain Edema ; Cerebrum* ; Electroencephalography ; Follow-Up Studies ; Hematuria ; Hemorrhage ; Humans ; Hypersensitivity ; Male ; Nervous System ; Neurologic Manifestations ; Proteinuria ; Purpura ; Purpura, Schoenlein-Henoch* ; Seizures ; Skin ; Vasculitis

Necrotizing fasciitis (NF) is an uncommon, life-threatening infection of the subcutaneous tissue and superficial fascia. The clinical course of NF is rapid and progressive, and it is often fatal despite the appropriate therapy. The prognosis of NF depends on a timely diagnosis and then proper treatment. At onset it may not be possible to clearly distinguish NF from minor soft-tissue infections. Although infection are common due to the use of steroids and immunosuppressive agents in patients with systemic lupus erythematous (SLE), it is interesting that NF has rarely been reported with SLE. Here, we present two cases of NF with SLE.
Fasciitis, Necrotizing ; Humans ; Immunosuppressive Agents ; Prognosis ; Steroids ; Subcutaneous Tissue