Seventeen volunteers with cutaneous dermatophytosis were enrolled in a clinical trial to evaluate the effectiveness of oral ketoconazole. The group included six patients with tinea cruris(6 malcs), four with tinea corporis, including one with tinea faciai, (3 males, 1 female), three with tinea versicolor(3 males) and four with tinea capitis(3 males, 1 female). The oral ketoconazole was taken within 10 minutes after a meal. The patients under the age of 10 received 100mg of ketoconazole per day, whereas those aged over 11 received 200mg of ketoconazole until the skin lesions are cured. Seventeen patients had complete clinical and mycologic cure, one responded clinically. It required one to four weeks to become culturally negative for tinea cruris, four to seven weeks for tinea corporis, three to eight weeks for tinea capitis. For tinea versicolor it required three to five weeks to become negative by scotch tape method. Adverse reactions to ketoconazole were absent and no patients required discontinuation of the drug. The results indicate that ketoconazole is a safe and effective drug for the treatment of dermatophytosis.
Humans ; Ketoconazole* ; Male ; Meals ; Skin ; Tinea Capitis ; Tinea Versicolor ; Tinea* ; Volunteers

Antiphospholipid syndrome is a disorder characterized by the presence of antiphospholipid antibodies, recurrent arterial and/or venous thromboembolism, and spontaneous abortion. Deep vein thrombosis, pulmonary thromboembolism, and cerebral infarction are major thrombotic event, but portal vein thrombosis, especially in young age male, is rarely reported. A 27-year- old man, without prior thrombotic event, presented with severe abdominal pain for 4 days. Extensive portal vein thrombosis was noted on abdominal CT scan and MR angiography. Lupus anticoagulant was suspected and was confirmed according to the guidelines of the International Society on Thrombosis and Hemostasis and the patient was diagnosed as having primary antiphospholipid syndrome associated with portal vein thrombosis. Intravenous heparin infusion was initiated and switched to warfarin upon discharge. Now the patients is being followed in outpatient clinic and treated with warfarin without any evidence suggesting the recurrence of thrombotic event.
Abdominal Pain ; Abortion, Spontaneous ; Ambulatory Care Facilities ; Angiography ; Antibodies, Antiphospholipid ; Antiphospholipid Syndrome* ; Cerebral Infarction ; Female ; Hemostasis ; Heparin ; Humans ; Lupus Coagulation Inhibitor ; Male ; Portal Vein* ; Pregnancy ; Pulmonary Embolism ; Recurrence ; Thrombosis ; Tomography, X-Ray Computed ; Venous Thromboembolism ; Venous Thrombosis* ; Warfarin

Magnet compression anastomosis is a nonsurgical method that uses two magnets to treat bilio-biliary and bilio-enteric anastomotic strictures after a living donor transplantation. The compression pressure of the two magnets induces ischemic necrosis at the anastomostic stricture and creates a fistula at the stricture site. A choledochal cyst is an uncommon congenital anomaly characterized by dilatation of the biliary tree and can cause obstructive jaundice, cholangitis, biliary stones, and cholangiocelluar carcinoma. Treatment for choledochal cyst is essentially surgical including total excision of the cyst with hepaticoenterostomy, but there can be complications such as postoperative intrahepatic stones and recurrent cholangitis due to a stricture at the site of the anastomosis. Endoscopic and fluoroscopy-guided radiologic interventions can be applied to resolve the anastomotic stricture, and re-operation is possible as the method of last resort. We report here a first case, trial magnet compression anastomosis in Korea of a bilioenteric anastomotic stricture after excision of a choledochal cyst and hepaticojejunostomy.
Biliary Tract ; Cholangitis ; Choledochal Cyst ; Constriction, Pathologic ; Dilatation ; Fistula ; Health Resorts ; Humans ; Jaundice, Obstructive ; Korea ; Living Donors ; Magnets ; Necrosis ; Transplants

Splenosis is an ectopic implantation of splenic tissue after splenic injury or splenectomy. These splenic implants may be located throughout the abdominal cavity and may be misdiagnosed as a malignancy or tumorous condition. Here, we report a case of splenosis that was initially diagnosed as carcinomatosis from colon cancer in a patient with colon polyps that had undergone explo-laparotomy.
Abdominal Cavity ; Carcinoma ; Colon ; Colonic Neoplasms ; Colonic Polyps ; Humans ; Polyps ; Splenectomy ; Splenosis

OBJECTIVE: The purpose of this study was to differentiate true progression from pseudoprogression of glioblastomas treated with concurrent chemoradiotherapy (CCRT) with temozolomide (TMZ) by using histogram analysis of apparent diffusion coefficient (ADC) and normalized cerebral blood volume (nCBV) maps. MATERIALS AND METHODS: Twenty patients with histopathologically proven glioblastoma who had received CCRT with TMZ underwent perfusion-weighted imaging and diffusion-weighted imaging (b = 0, 1000 sec/mm2). The corresponding nCBV and ADC maps for the newly visible, entirely enhancing lesions were calculated after the completion of CCRT with TMZ. Two observers independently measured the histogram parameters of the nCBV and ADC maps. The histogram parameters between the true progression group (n = 10) and the pseudoprogression group (n = 10) were compared by use of an unpaired Student's t test and subsequent multivariable stepwise logistic regression analysis to determine the best predictors for the differential diagnosis between the two groups. Receiver operating characteristic analysis was employed to determine the best cutoff values for the histogram parameters that proved to be significant predictors for differentiating true progression from pseudoprogression. Intraclass correlation coefficient was used to determine the level of inter-observer reliability for the histogram parameters. RESULTS: The 5th percentile value (C5) of the cumulative ADC histograms was a significant predictor for the differential diagnosis between true progression and pseudoprogression (p = 0.044 for observer 1; p = 0.011 for observer 2). Optimal cutoff values of 892 x 10-6 mm2/sec for observer 1 and 907 x 10-6 mm2/sec for observer 2 could help differentiate between the two groups with a sensitivity of 90% and 80%, respectively, a specificity of 90% and 80%, respectively, and an area under the curve of 0.880 and 0.840, respectively. There was no other significant differentiating parameter on the nCBV histograms. Inter-observer reliability was excellent or good for all histogram parameters (intraclass correlation coefficient range: 0.70-0.99). CONCLUSION: The C5 of the cumulative ADC histogram can be a promising parameter for the differentiation of true progression from pseudoprogression of newly visible, entirely enhancing lesions after CCRT with TMZ for glioblastomas.
Adult ; Aged ; Brain Neoplasms/*pathology/physiopathology/therapy ; Cerebrovascular Circulation/*physiology ; Combined Modality Therapy ; Diagnosis, Differential ; Diffusion Magnetic Resonance Imaging/*methods ; Disease Progression ; Female ; Glioblastoma/*pathology/physiopathology/therapy ; Humans ; Male ; Middle Aged ; Prognosis ; ROC Curve ; *Regional Blood Flow ; Reproducibility of Results ; Retrospective Studies

Animals ; Axons ; Brain-Derived Neurotrophic Factor ; Cell Separation ; Ganglia, Spinal ; Intercellular Signaling Peptides and Proteins ; Neurons ; Peripheral Nerves ; Peripheral Nervous System ; Rats ; Regeneration ; Spinal Nerve Roots

PURPOSE OF STUDY: Peripheral nerve regeneration depends on neurotrophism of distal nerve stump, recovery potential of neuron, supporting cell like Schwann cell and neurotrophic factors such as BDNF. Peripheral nerve regeneration can be enhanced by the conduit which connects the both sides of transected nerve. The conduit maintains the effects of neurotrophism and BDNF produced by Schwann cells which can be made by gene therapy. In this study, we tried to enhance the peripheral nerve regeneration by using calcium phosphate coated porous conduit and BDNF-Adenovirus infected Schwann cells in sciatic nerve of rats. MATERIALS AND METHODS: Microporous filter which permits the tissue fluid essential for nerve regeneration and does not permit infiltration of fibroblasts, was made into 2mm diameter and 17mm length conduit. Then it was coated with calcium phosphate to improve the Schwann cell adhesion and survival. The coated filter was evaluated by SEM examination and MTT assay. For effective allogenic Schwann cell culture, dorsal root ganglia of 1-day old rat were extracted and treated with enzyme and antimitotic Ara-C. Human BDNF cDNA was obtained from cDNA library and amplified using PCR. BDNF gene was inserted into adenovirus shuttle vector pAACCMVpARS in which E1 was deleted. We infected the BDNF-Ad into 293 human mammary kidney cell-line and obtained the virus plaque 2 days later. RT-PCR was performed to evaluate the secretion of BDNF in infected Schwann cells. To determine the most optimal m.o.i of BDNF-Ad, we infected the Schwann cells with LacZ adenovirus in 1, 20, 50, 75, 100, 250 m.o.i for 2 hours and stained with beta-galactosidase. Rats(n=24) weighing around 300g were used. Total 14mm sciatic nerve defect was made and connected with calcium phosphate coated conduits. Schwann cells(1x10(6)) or BDNF-Ad infected Schwann cells(1x10(6)) were injected in conduit and only media(MEM) was injected in control group. Twelve weeks after surgery, degree of nerve regeneration was evaluated with gait analysis, electrophysiologic measurements and histomorphometric analysis. RESULTS: 1. Microporous Millipore filter was effective conduit which permitted the adhesion of Schwann cells and inhibited the adhesion of fibroblast. We could enhance the Schwann cell adhesion and survival by coating Millipore filter with calcium phosphate. 2. Schwann cell culture technique using repeated treatment of Ara-C and GDNF was established. The mean number of Schwann cells obtained 1 and 2 weeks after the culture were 1.54+/-4.0*10(6) and 9.66+/-9.6*10(6). 3. The mRNA of BDNF in BDNF-Ad infected Schwann cells was detected using RT-PCR. In Schwann cell 0.69 microgram/microliter of DNA was detected and in BDNF-Adenovirus transfected Schwann cell 0.795 microgram/microliter of DNA was detected. The most effective infection concentration was determined by LacZ Adenovirus and 75 m.o.i was found the most optimal. CONCLUSION: BDNF-Ad transfected Schwann cells successfully regenerated the 14mm nerve gap which was connected with calcium phosphate coated Millipore filter. The BDNF-Ad group showed better results compared with Schwann cells only group and control group in aspect to sciatic function index, electrophysiologic measurements and histomorphometric analysis.
Adenoviridae ; Animals ; beta-Galactosidase ; Brain-Derived Neurotrophic Factor* ; Calcium* ; Cell Adhesion ; Cell Culture Techniques ; Cytarabine ; DNA ; DNA, Complementary ; Fibroblasts ; Gait ; Ganglia, Spinal ; Gene Library ; Genetic Therapy ; Genetic Vectors ; Glial Cell Line-Derived Neurotrophic Factor ; Humans ; Kidney ; Micropore Filters ; Nerve Growth Factors ; Nerve Regeneration ; Neurons ; Peripheral Nerves ; Polymerase Chain Reaction ; Rats* ; Regeneration* ; RNA, Messenger ; Schwann Cells ; Sciatic Nerve*

Involvement of central nervous system is a well- known compication in uremic patients. However, development of acute extrapyramidal symptoms with bilateral basal ganglia involvement (acute basal ganglia syndrome), especially in non-diabetic hemodialysis patient is very rare. We report a case of acute basal ganglia syndrome in a non-diabetic hemodialysis patient. A 45-year-old man with autosomal dominant polycystic kidney disease (ADPKD) on chronic hemodialysis treatment for the last 4 years was admitted due to generalized myalgia. On admission, the patient was found to have rhabdomyolysis and intractable metabolic acidosis. Nine days after admission, he suddenly developed dysarthria, lateralizing ataxia, and bradykinesia. Brain MRI demonstrated low and high signals in bilateral basal ganglia and cerebellar vermis in T1-weighted and T2-weighted images, respectively. Intensified hemodialysis treatment combined with general supportive therapy resolved the severe metabolic acidosis and the neurologic manifestations gradually improved. Follow up brain CT scan taken 3 months later showed decreased size of initial low attenuation lesions in bilateral basal ganglia and cerebellar vermis. Although no definite pathophysiology is yet established, severe metabolic disorder is believed to play an important role in development of acute basal ganglia syndrome. Correction of metabolic acidosis and hypoglycemia in our patient lead to improvement in neurologic manifestations and organic brain lesions. Our case suggests that severe metabolic acidosis and hypoglycemia in uremic patient may act as risk factors for acute basal ganglia syndrome even in non-diabetic patient.
Acidosis ; Ataxia ; Basal Ganglia* ; Brain ; Central Nervous System ; Dysarthria ; Follow-Up Studies ; Humans ; Hypoglycemia ; Hypokinesia ; Magnetic Resonance Imaging ; Middle Aged ; Myalgia ; Neurologic Manifestations ; Polycystic Kidney, Autosomal Dominant ; Renal Dialysis* ; Rhabdomyolysis ; Risk Factors ; Tomography, X-Ray Computed