Purpose: We report a case of idiopathic chiasmal optic neuritis in a pediatric patient.Case summary: A 13-year-old boy with no history of systemic disease was referred to our ophthalmology clinic because of visual disturbance in both eyes of 5 days in duration. The best-corrected visual acuity was 0.08 in the right eye and finger counting at 30 cm in the left eye; mild blurring of the disc margins (both eyes) was evident on fundus examination, as were temporal hemianopsia in the right eye and diffuse field loss in the left eye. Brain magnetic resonance imaging revealed focal nodular enhancement in the optic chiasm. Blood and cerebral fluid analysis yielded no evidence of infection or autoimmune disease. Therefore, we diagnosed isolated idiopathic chiasmal optic neuritis and commenced a systemic steroid. After 5 days, the visual acuity began to improve, and the field defect was almost eliminated (except for a small central scotoma) at 1 month. He has remained stable to the time of writing (4 months after treatment) and his visual acuity has normalized. Conclusions Isolated idiopathic chiasmal optic neuritis developed in a pediatric patient and the visual function improved after steroid treatment. Although there was no evidence of systemic demyelinating disease, regular observation is scheduled given the possibility of late-onset disease.

PURPOSE: To demonstrate the incidence and variation of the meniscofemoral ligament in Koreans. MATERIALS AND METHODS: A total of 100 MR studies of 95 patients were reviewed with special attention to the appearance and incidence of the meniscofemoral ligaments. The ligament of Wrisberg was classified according to proximal insertion: type I, insertion at the posterofemoral condyle ; type II, insertion at the distal portion of the posteriorcruciate ligament ; type III, insertion at the distal portion of the posterior cruciate ligament. On T2-weighted images, the high signal at the meniscal insertion of the meniscofemoral ligament was classified according to itsshape. RESULTS: The ligament o Humprey was observed in 17 cases and the ligament of Wrisberg was in 90:type I in41 cases;type II, 19 cases;type III, in 28 cases; unclassified, in 2 cases. In 77 cases, the cleft with high signal intensity was seen between the meniscofemoral ligament and the posterior cruciate ligament. CONCLUSION: From our results, the incidence of the ligament of Wrisberg on MRI was moe prevelant than the ligament of Humprey. An exact knowledge of the meniscofemoral ligament could be helpful in distinguishing it from pathologic lesions.
Classification* ; Humans ; Incidence* ; Knee ; Ligaments* ; Magnetic Resonance Imaging* ; Posterior Cruciate Ligament

BACKGROUND AND OBJECTIVES: An understanding of the cross-sectional structures and histological features of experimental animals is necessary for conducting the research of rhinosinusitis in experimental animals. The aim of this study is to determine the most suitable cross-sectional level of rhinosinusitis in a rat model. MATERIALS AND METHODS: The study examined the histological features of the mucosal epithelium, gland, lymphoid tissue, and vomeronasal organs using 4 week-old male rats weighing 60-70 g as test subjects. Whole mounted sinus-nose complexes were divided into four levels of areas which were sectioned according to the coronal plane and each section was stained with hematoxylin-eosin and observed under light microscopy. RESULTS: Level I revealed the nasal turbinate, maxilloturbinale, and nasolacrimal duct. Level II revealed the nasal turbinate, maxilloturbinale, vomeronasal organ, and nasolacrimal duct. Level III revealed the ectoturbinale I, II, endoturbinale II, III, maxillary sinus, Steno's gland, maxillary sinus gland, and nasal associated lymphoid tissue (NALT). Level IV revealed the ectoturbinale II, endoturbinale III, IV, pharyx respiratorius, and NALT. The lining epithelia were squamous, respiratory and olfactory. However, the squamous epithelium was not observed in level III and IV. CONCLUSION: The Level III appears to be the most suitable for the rhinosinusitis animal rat model since we can observe the respiratory epithelium lined sinonasal airspace including the maxillary sinus and NALT.
Animals ; Epithelium ; Humans ; Lymphoid Tissue ; Male ; Maxillary Sinus ; Microscopy ; Models, Animal ; Nasal Cavity* ; Nasolacrimal Duct ; Nose ; Paranasal Sinuses* ; Rats* ; Respiratory Mucosa ; Turbinates ; Vomeronasal Organ

Penetrating injuries of the neck are diagnostic and therapeutic challenges to emergency physicians or surgeons. The neck is unique in that it contains a dense concentration of vital structures in a small anatomic space. Two treatment strategies have emerged over time. First, exploration of all penetrating neck injuries, and second, selective approach based in clinical and diagnostic work-up. We present a previously unreported case in the Korean literature, a zone III neck injury caused by a metal stick penetrating through the neck.
Emergencies ; Neck Injuries* ; Neck*

BACKGROUND AND OBJECTIVES: Orbital complications of sinusitis are uncommon but can result in significant morbidity if not appropriately managed. We have experienced 8 cases of orbital subperiosteal absces- ses (SPA) as a complication of acute sinusitis. The purposes of our study are to assess the clinical features, diagnosis, isolated bacteria, and therapeutic results. MATERIALS AND METHOD: Eight patients with acute rhinosinusitis and orbital SPA who had been treated between April 1989 and September 2002 were retrospectively studied with medical records and CT. RESULTS: The most common symptoms and signs were proptosis and opthalmoplegia, and five patients (62%) complained of ocular pain or periorbital erythema. Seven patients (87%) complained of diplopia. We carried out medical treatment in 4 cases and surgical intervention in 4 cases. All patients were cured without complications. Streptococcus intermedius was isolated from 1 case and peptostreptococcus species from another but there was no growth of bacteria in 2 cases. CONCLUSION: Conservative treatment with intravenous antibiotics, topical nasal decongestants are the appropriate initial management in orbital SPA. In cases of medially located SPA of orbit, we recommend endoscopic surgical drainage because it does not require an external incision and has less postoperative edema.
Abscess* ; Anti-Bacterial Agents ; Bacteria ; Diagnosis ; Diplopia ; Drainage ; Edema ; Erythema ; Exophthalmos ; Humans ; Medical Records ; Nasal Decongestants ; Orbit* ; Peptostreptococcus ; Retrospective Studies ; Sinusitis* ; Streptococcus intermedius

The urinary tract infection(UTI) is a very common complication of rehabilitation patients with neurogenic bladder. Proper diagnosis and early treatment are very important for the long term rehabilitation outcomes. Many reports are available in the literature on the characteristics of UTI in spinal cord injury(SCI) patients, however only few reports appear on non-SCI patients. We have done comprehensive chart reviews of 1,251 patients with neurogenic bladder who were admitted to the rehabilitation medicine department, PMC from January 1982 to August 1996. Patients were divided into 4 groups: patients with stroke, spinal cord injury, traumatic brain injury and other neurologic diseases, and we have studied: incidence of UTI, commonly cultured organisms, antibiotic sensitivities, urinary pH, voiding methods, and residual urine volumes. The incidences of UTI are 50.9% for all patients, 48.1% in Stroke, 72.3% in Spinal cord injury, 38.9% in Traumatic brain injury, and 34.1% in other neurologic diseases. There has been increase of Gram(+) cocci and decrease of Gram(-) rod during study period. Commonly cultured organisms are Escherichia coli(E. coli), Pseudomonas, Klebsiella. The decreased antibiotic sensitivities are noted in almost all organisms. Positive correlations are found between the incidence of UTI, high urine pH, high residual urine volumes, and use of catheters. In conclusion, despite of many variable factors, the trends of UTI in each groups show no significant difference.
Brain Injuries ; Catheters ; Diagnosis ; Escherichia ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Klebsiella ; Pseudomonas ; Rehabilitation ; Spinal Cord ; Spinal Cord Injuries ; Stroke ; Urinary Bladder, Neurogenic* ; Urinary Tract Infections* ; Urinary Tract*

BACKGROUND AND OBJECTIVES: With the recent development of endoscopic nasal surgery, endoscopic sphenopalatine artery ligation allows for secure control of posterior epistaxis with considerably low recurrence and complications. Surgical approaches to the sphenopalatine foramen to ligate the sphenopalatine artery are transantral, intranasal, and transseptal. However, the procedures have considerable limitations. Therefore, we have revised the transturbinal approach, which was described by Togawa for intranasal vidian neurectomy in 1977, to ligate the sphenopalatine artery in two patients of intractable posterior epistaxis, and describe our technique of the trans-inferior turbinate approach for endoscopic sphenopalatine artery ligation. SURGICAL TECHNIQUE: A longitudinal incision is made along the lower border of the inferior turbinate, and the mucoperiosteal flaps are developed to the lateral nasal wall. The posterior two-thirds of the inferior turbinate bone is removed from the lateral nasal wall. The posterior lateral nasal artery on the upper flap is positively identified, and followed to the posterior end of the middle turbinate bone. The sphenopalatine foramen can be localized after removing the posterior end of the middle turbinate bone, and the sphenopalatine artery is ligated with hemoclips or divided with bipolar electrocautery. RESULTS: With the trans-inferior turbinate approach, it was possible to identify and ligate the sphenopalatine artery and its branches in the sphenopalatine foramen with no immediate or delayed complications. CONCLUSION: The trans-inferior turbinate approach provides unobscured surgical access to the posterior nasal cavity, and enough working space for endoscopic manipulation. The posterior lateral nasal artery is a reliable surgical landmark leading to the sphenopalatine foramen.
Arteries* ; Electrocoagulation ; Epistaxis ; Humans ; Ligation* ; Nasal Cavity ; Nasal Surgical Procedures ; Recurrence ; Turbinates*

BACKGROUND AND OBJECTIVES: Isolated sphenoid lesion (ISL) is rare due to its anatomic location in the nasal cavity. The recent advances in the diagnosis with CT and MRI make it easier to diagnose ISL. We experienced 15 cases of ISL and reviewed their clinical characteristics. MATERIALS AND METHODS: Patients with ISL admitted from January 1998 through April 2004 were retrospectively reviewed. Patients' clinical symptoms, endoscopic and radiologic findings, treatment modalities, postoperative diagnosis, and the outcomes were analyzed. RESULTS: The most common symptom was headache presented in 9 patients, followed by nasal symptoms in 4 patients. Five of 15 cases were acute sphenoiditis which was improved with antibiotic trials. The other 10 cases were treated by endoscopic sphenoidotomy. Postoperative pathology showed 4 cases of fungal ball, and 3 cases of mucocele, 3 cases of chronic sphenoiditis. CONCLUSION: Headache and orbital symptom were the most common presentation in patients with ISL. Endoscopic and radiologic findings were not pathognomonic to diagnose ISL in most cases. Antibiotic trials should be preceded, and then followed by endoscopic sphenoidotomy in the refractory cases. Loss of vision or light reflex may predict a poor rognosis.
Diagnosis ; Endoscopy ; Headache ; Humans ; Magnetic Resonance Imaging ; Mucocele ; Nasal Cavity ; Orbit ; Pathology ; Reflex ; Retrospective Studies ; Sphenoid Sinus*

OBJECTIVES: It has been proposed that microbial persistence, superantigen (SA) production, and host T-cell response may be involved in the development of chronic rhinosinusitis. According to the SA hypothesis, a single intranasal application of SA such as staphylococcal enterotoxin B (SEB) may induce chronic eosinophilic rhinosinusitis. This study aimed to develop a rat model of rhinosinusitis induced by intranasally applied SEB. METHODS: Forty microliter of SEB (100 microgram/mL) or phosphate buffered saline was applied intranasally through each naris in 4 weekold Sprague-Dawley test rats (N=36) and controls (N=16), respectively. Following sacrifice at 1, 5, 14, and 28 days, the obtained nasal cavity and sinuses were prepared for histologic investigation. The histologic sections were examined in a blind manner for the ratio of the sinus spaces occupied by inflammatory cell clusters and the number of inflammatory cells in the lamina propria. RESULTS: Infiltration of neutrophils in the lamina propria and appearance of neutrophil clusters in the sinus spaces were observed in the SEB-applied rats. The ratio of the sinus spaces occupied by neutrophil clusters and the number of neutrophils infiltrated in the lamina propria increased significantly at day 1 as compared with the control rats. CONCLUSION: Intranasally applied SEB induces acute neutrophilic rhinosinusitis in rats. Eosinophilic inflammation was not demonstrated. The mere presence of SA in the nose does not necessarily induce SA-induced inflammation, as suggested by the SA hypothesis.
Animals ; Enterotoxins ; Eosinophils ; Inflammation ; Mucous Membrane ; Nasal Cavity ; Neutrophils ; Nose ; Rats ; Sinusitis ; T-Lymphocytes

OBJECTIVES: It has been proposed that microbial persistence, superantigen (SA) production, and host T-cell response may be involved in the development of chronic rhinosinusitis. According to the SA hypothesis, a single intranasal application of SA such as staphylococcal enterotoxin B (SEB) may induce chronic eosinophilic rhinosinusitis. This study aimed to develop a rat model of rhinosinusitis induced by intranasally applied SEB. METHODS: Forty microliter of SEB (100 microgram/mL) or phosphate buffered saline was applied intranasally through each naris in 4 weekold Sprague-Dawley test rats (N=36) and controls (N=16), respectively. Following sacrifice at 1, 5, 14, and 28 days, the obtained nasal cavity and sinuses were prepared for histologic investigation. The histologic sections were examined in a blind manner for the ratio of the sinus spaces occupied by inflammatory cell clusters and the number of inflammatory cells in the lamina propria. RESULTS: Infiltration of neutrophils in the lamina propria and appearance of neutrophil clusters in the sinus spaces were observed in the SEB-applied rats. The ratio of the sinus spaces occupied by neutrophil clusters and the number of neutrophils infiltrated in the lamina propria increased significantly at day 1 as compared with the control rats. CONCLUSION: Intranasally applied SEB induces acute neutrophilic rhinosinusitis in rats. Eosinophilic inflammation was not demonstrated. The mere presence of SA in the nose does not necessarily induce SA-induced inflammation, as suggested by the SA hypothesis.
Animals ; Enterotoxins ; Eosinophils ; Inflammation ; Mucous Membrane ; Nasal Cavity ; Neutrophils ; Nose ; Rats ; Sinusitis ; T-Lymphocytes