The mortality of patients with brain abscess has decreased significaltly. This has been attributed to improved diagnostic imaging, the evolution of neurosurgical techniques and understanding of intracranial pressure pathophysiology, greater critical care understanding, and newer antibiotics. However, the mortality associated with intraventricular rupture of brain abscess remained consistently high at or above 80% once identified. A case of intraventicular rupture of thalamic abscess with good quality of survival is presented based on aggressive 4-component therapeutic plan used. The four components are 1) extraventricular drainage for 6 weeks, 2) lavage of the ventricular system using closed irrigation system, 3) intravenous antibiotics, 4) intraventricular gentamicin and vancomycin, twice and once daily, respectively.
Abscess* ; Anti-Bacterial Agents ; Brain Abscess ; Critical Care ; Diagnostic Imaging ; Drainage ; Gentamicins ; Humans ; Intracranial Pressure ; Mortality ; Rupture* ; Thalamus ; Therapeutic Irrigation ; Vancomycin

PURPOSE: Acute pyelonephritis (APN) is mostly caused by ascending infection. Based on clinical and experimental studies, it is known that APN is caused by bacteria that ascends from the bladder through the ureter to the renal pelvis and parenchyma. Urinary reflux, bacterial virulence factors, and decreased ureteral peristalsis are some of the causes of ascending infection. We have tried to evaluate the significance of reflux in adult uncomplicated APN. MATERIALS AND METHODS: Voiding cystourethrogram (VCUG) was performed in 71 female patients with APN who showed no structural abnormalities on either intravenous urogram or ultrasonogram from April 1998 to May 2000. VCUG was performed at cure phase (29.7+/-9.18 days, 20 patients) in the early days of the study and the date of performing VCUG was shortened gradually to resolved phase (13.8+/-2.13 days, 10 patients), subacute phase (6.60+/-1.84 days, 10 patients), and acute phase (2.42+/-0.51 days, 31 patients). RESULTS: There were only 2 (2.8%) cases with vesicoureteral reflux among 71 female patients with uncomplicated APN. 1 ipsilateral grade 2 reflux was found among the 20 patients who underwent VCUG at cure phase. 1 case with ipsilateral grade 1 reflux was found at resolved phase. Reflux was not found in the groups where study was performed at subacute and acute phase. The cause of infection was found to be E. coli (55 patients, 77.5%), Enterococcus faecalis (3 patients, 4.2%), Klebsiella pneumoniae (2 patients, 2.8%), and S. aureus (1 patients, 1.4%). CONCLUSIONS: These results suggest that reflux may not be a significant factor causing ascending infection that leads to APN. More study on the pathophysiology of ascending infection to the upper urinary tract is warranted.
Adult* ; Bacteria ; Enterococcus faecalis ; Female ; Humans ; Kidney Pelvis ; Klebsiella pneumoniae ; Peristalsis ; Pyelonephritis* ; Ultrasonography ; Ureter ; Urinary Bladder ; Urinary Tract ; Vesico-Ureteral Reflux* ; Virulence Factors

PURPOSE: We assessed the accuracy of a portable ultrasound device (BladderScan(TM) BVI 3000) used to measure the postvoid residual urine volume (PVR). MATERIALS AND METHODS: We prospectively measured the volume of residual urine in 160 patients with lower urinary tract symptoms between August 2000 and April 2001. After voiding, PVR measurements were performed immediately using ultrasound bladder scanning, followed by Nelaton catheterization, with the patient was in the supine position, and compared the results of the two techniques. RESULTS: The ultrasound bladder scanning correlated well with the catheterization for measuring the PVR (r=0.946). The ultrasound bladder scanning had a sensitivity and specificity of 95.4 and 100%, respectively, in detecting a PVR>or=100ml, and 83.4 and 91.5%, respectively, in cases where the PVR was less than 50ml. A multiple regression analysis, and a two sample t-test, showed that the difference was not related to: age, sex, weight, height, body mass index (BMI) or related diseases (p>0.05). Age, weight, height, BMI were not significant variables when comparing the sexes (p>0.05). There was a significant difference in patient's satisfaction and the required time of the procedure between bladder scanning and catheterization (p<0.01). CONCLUSIONS: Portable ultrasound bladder scanning is quick, easy to use, non-invasive, readily repeatable, and specific for determining the PVR. Therefore, portable ultrasound bladder scanning can be used as an alternative to catheterization in the determination of residual urine volume.
Body Height ; Catheterization ; Catheters ; Humans ; Lower Urinary Tract Symptoms ; Prospective Studies ; Sensitivity and Specificity ; Supine Position ; Ultrasonography* ; Urinary Bladder

PURPOSE: Improvement in the prognosis of multiple primary malignant neoplasm may be attained by early discovery and awareness of the secondary tumor. This study aimed to determine the characteristics of multiple primary neoplasms involving the urinary tract in Korea. MATERIALS AND METHODS: Of 1,406 patients treated for urologic cancers, 76 patients with multiple primary neoplasms also involving other than the genitourinary system were analyzed. We studied the occurrence rate and distribution of tumors. RESULTS: Of the 76 cases, 33 cases were synchronous and 43 cases were metachronous. Average time interval between the diagnosis of first and second tumor was 48 months. Tumors of the gastrointestinal tract, particularly stomach cancer, among non-urologic cancers and tumors of the bladder among urologic cancers were predominantly involved followed by renal and prostate tumors. However, renal tumor was the most common urologic tumor in synchronous cancers. Eighty-one percent of the metachronous urinary tumors occurred as second tumors. CONCLUSIONS: Our present findings show that the occurrence of multiple primary neoplasms involving the urinary tract is not rare and that the incidence of organ involvement is different from the western countries.
Diagnosis ; Gastrointestinal Tract ; Humans ; Incidence ; Korea ; Neoplasms, Multiple Primary ; Prognosis ; Prostate ; Stomach Neoplasms ; Urinary Bladder ; Urinary Tract* ; Urogenital System ; Urologic Neoplasms

Recurrent episodes of venoocclusive priapism have been described previously in patients who have had repeated exposure to a recognized stimulus such as intracavernosal injections of vasoactive agents, or pathologic conditions such as spinal stenosis or hematological disorders. Three patients were referred for evaluation of an unusual sequoia of an initial episode of idiopathic venoocclusive priapism, occurred with a frequency ranging from several times per month to once per year and were symptomatically disabling. We reviewed the characteristics and the possible pathophysiology of this syndrome and some therapeutic options in the management of these patients.
Humans ; Priapism* ; Sequoia ; Spinal Stenosis

Dermoid tumors of tbe corneal limbus are failYly common congenital lesions. They are noted -at birth and may grow slowly in size and encroach upon the pupillary area occupying a site partly over the cornea and partly over the sclera. The tumors are yellowish, elevated and variable in size. Histologically the tumor consists of fibrofatty tissue covered by epidermoid epithelium and are invaded by ectodermal derivatives such as hair follicle, sebaceous and sweat glands. Trauma, irritation and puberty may hasten their growth. About 30% of patients with. corneal dermoid exhibit other congenital anomalies of ocular tissue, face, teeth, jaw, ear, spine, skull, and so on. Recently two cases of limbal dermoids were seen in our clinic. Histologically hair follicles and sebaceous glands are shown in one specimen, and cartHage and sebaceous glands in the other specimen.
Adolescent ; Cornea ; Dermoid Cyst* ; Ear ; Ectoderm ; Epithelium ; Hair Follicle ; Humans ; Jaw ; Limbus Corneae ; Parturition ; Puberty ; Sclera ; Sebaceous Glands ; Skull ; Spine ; Sweat Glands ; Tooth

No abstract available.
Adrenocortical Carcinoma*

BACKGROUND: Poly(L-lactic acid) (PLLA) is a biodegradable polymer (BP) that replaces conventional petroleumbased polymers. The hydrophobicity of biodegradable PLLA periodontal barrier membrane in wet state can be solved by alloying it with natural polymers. Alloying PLLA with gelatin imparts wet mechanical properties, hydrophilicity, shrinkage, degradability and biocompatibility to the polymeric matrix. METHODS: To investigate membrane performance in the wet state, PLLA/gelatin membranes were synthesized by varying the gelatin concentration from 0 to 80 wt%. The membrane was prepared by electrospinning. RESULTS: At the macroscopic scale, PLLA containing gelatin can tune the wet mechanical properties, hydrophilicity, water uptake capacity (WUC), degradability and biocompatibility of PLLA/gelatin membranes. As the gelatin content increased from 0 to 80 wt%, the dry tensile strength of the membranes increased from 6.4 to 38.9 MPa and the dry strain at break decreased from 1.7 to 0.19. PLLA/gelatin membranes with a gelatin content exceeding 40% showed excellent biocompatibility and hydrophilicity. However, dimensional change (37.5% after 7 days of soaking), poor tensile stress in wet state (3.48 MPa) and rapid degradation rate (73.7%) were observed. The highest WUC, hydrophilicity, porosity, suitable mechanical properties and biocompatibility were observed for the PLLA/40% gelatin membrane. CONCLUSION PLLA/gelatin membranes with gelatin content less than 40% are suitable as barrier membranes for absorbable periodontal tissue regeneration due to their tunable wet mechanical properties, degradability, biocompatibility and lack of dimensional changes.

OBJECTIVES: Protein-calorie malnutrition has been shown to be prevalent among patients on chronic dialysis, And assessment of nutritional status of continuous ambulatory peritoneal dialysis(CAPD) patients has assumed greater importance because of the association of protein-calorie malnutrition with increasing morbidity and mortality. So we observed the incidence and clinical effect of protein-calorie malnutrition, and we compared the indices of nutrition with dialysis adequacy utilizing urea kinetic modeling and cretinine clearance in CAPD patients. METHODS: We performed a cross-sectional study in which eight parameters, based on anthropometry, blood chemistry and subjective symptoms, were scored according to the degree of abnormalities in 82CAPD patients. A malnutrition index was derived from these scores. We also performed comparative analysis to identify significant correlations of the indices of urea kinetic modeling and creatinine clearance with the other parameters of nutritional status. RESULTS: The malnutrition index classified 47(57%) patients as normal, 30(37%) intermediately malnourished, and 5(6%) as severely malnourished. Malnutrition index showed a significant correlation with the body mass index(BMI), triceps skinfold thickness(TSF), mid-arm circumference(MAC), mid-arm muscle area (MAMA), duration of CAPD, subjective symptoms, serum albumin, transferrin, cholesterol, and triglyceride. The malnutrition index also showed a significant correlation with residual renal function(RRF), and standardized creatinine clearance(SCCr). The TWR-Kt/V(total Kt/Vurea per week with consideration of residual renal urea clearance) was significantly lower in the severely malnourished group than in the normal group. Serum alkaline phosphatase and BUN levels were higher in the severely malnourished group than in the normal and inter-mediate groups. CONCLUSION: In assessing the nutrition status of CAPD patients, body weight, TSF, MAC, MAMA, subjective symptoms, serum albumin, transferrin, cholesterol, triglyceride, urea nitrogen, and alkaline phosphatase were considered useful parameters. There was a trend of increased BUN and decreased TWR-Kt/V in severely malnourished patients, and the value of SCCr was significantly lower in malnourished patients. However, no meaningful relationships between TW-Kt/V and malnutrition index or between NPCR(normalized protein catabolic rate) and malnutrition index were found m this cross-sectional study. As the number of patients with longer duration of CAPD or negligible RRF has increased in the malnourished patients, regular monitoring of these parameters, especially TWR-Kt/V and SCCr, may be helpful to assess dialysis adequacy to keep good nutritional status of each CAPD patient.
Alkaline Phosphatase ; Anthropometry ; Body Weight ; Chemistry ; Cholesterol ; Creatinine* ; Cross-Sectional Studies ; Dialysis ; Humans ; Incidence ; Malnutrition ; Mortality ; Nitrogen ; Nutritional Status ; Peritoneal Dialysis, Continuous Ambulatory* ; Protein-Energy Malnutrition ; Serum Albumin ; Transferrin ; Triglycerides ; Urea*

Cervical spondylolysis is a rare condition, and less than 100 cases have been reported in the world literature. Cervical spondylolysis is defined as a well corticated defect in the posterior element of a cervical vertebra. Although the etiology of cervical spondylolysis is unknown, its association with dysplastic changes and spina bifida occulta suggest that the lesion is congenital. Here, we describe the radiographs and CT images of cervical spondylolysis involving four levels in a 9 year old boy.
Child* ; Humans ; Male ; Spina Bifida Occulta ; Spine ; Spondylolysis*