Invasive pulmonary aspergillosis (IPA) has been known to occur in immunocompromised patients, but has been rarely reported in immunocompetent patients. In immunocompetent patients, pulmonary fungal infections are not initially considered. This results in diagnosis and treatment delays, as well as poor prognosis. We report a case and serial CT findings of IPA in an immunocompetent 29-year-old male after congenital heart disease surgery.

PURPOSE: Hematopoietic stem cells from umbilical cord blood are one of the useful resources for stem cell transplantation in the various adult and childhood diseases. Immunologic complications of transplantation, e.g., graft-vs-host disease, occur much less with transplantation of cord blood stem cells. Cord blood-derived dendritic cells (CB-DCs) are known to be different from adult peripheral blood-derived dendritic cells (PB-DCs) in immunologic characteristics. These phenomena might be related to the characteristics of hematopoietic cells in cord blood. Therefore, we analysed characteristics of dendritic cells, which are well-known immune-provoking cells, derived from cord blood precursors. METHODS: Dendritic cells were differentiated from plastic-adherent cord blood monocytes in the presence of GM-CSF and IL-4. Immunophenotype was analysed by flow cytometry and expression of IDO (indoleamine 2, 3-dioxygenase), an enzyme expressed in immune-regulating or tolerogenic DCs, IL-12, IL-10 and IL-6 was measured by RT-PCR along in vitro differentiation. Changes in expression of cytokines and IDO after antibody engagement were also analysed. RESULTS: CB-DCs were very similar to PB-DCs in immunophenotype and expression of cytokines. But CB-DCs expressed IDO transcripts much earlier than PB-DCs during differentiation from precursors. Engagement of CB-DCs with DU-1 mAb induced upregulation of IDO and downregulation of IL-6. CONCLUSION: Although immunophenotype and cytokine expression pattern of CB-DCs were quite similar to those of PB-DCs, CB-DCs expressed IDO earlier than PB-DCs. This might be related to the phenomena that CB-DCs are less immunogenic or, sometimes, tolerance-inducing.
Adult ; Cytokines ; Dendritic Cells* ; Down-Regulation ; Fetal Blood ; Flow Cytometry ; Graft vs Host Disease ; Granulocyte-Macrophage Colony-Stimulating Factor ; Hematopoietic Stem Cells ; Humans ; Interleukin-10 ; Interleukin-12 ; Interleukin-4 ; Interleukin-6 ; Monocytes ; Stem Cell Transplantation ; Stem Cells ; Up-Regulation

No abstract available.
Hypoglycemia ; Paresis*

In this case study, we investigated the effects of robot-assisted gait training on the plasticity of motor system in a stroke patient using functional MRI. A patient who suffered from the left hemiparesis following the right MCA infarction performed gait training with a robot-assisted gait orthosis. Before and after gait training, motor performances were assessed and functional MRIs were acquired with motor activation task of affected lower limb. After gait training with a robot-assisted orthosis, the patient's motor performances were improved and cortical activities were changed. Activation in the ipsilesional primary sensorimotor cortex was increased and cortical reorganization was induced in a way that nearby regions were recruited for the movement of affected lower limb. The results of this study showed that gait training with a robot-assisted orthosis induced cortical reorganization of the motor network that resulted in enhancement of motor performance of the lower limb.

The therapeutic efficacy and significance of intraprostatic fosfomycin injection in treating patients with chronic prostatitis were reviewed. During the last 6 years, 350 patients were treated with intraprostatic fosfomycin injection for chronic prostatitis, and among them, 218 patients who could be followed up at least for 3 months were analysed. As for chronic prostatitis, when a patient's WBC count of EPS per high power field remains invariable below 15 for at least 3 months, he is said to be cured. Intraprostatic injection was performed once or twice in all patients and 153 (70.2%) cases were responsive to this treatment. But eleven patients recurred immediately within 3 months after the response. Therefore, final cure rate reached 65.1% (142/218): Adverse effects were rare, if any, they were just trivial symptoms such as mild suprapubic pain or discomfort, transient hematuria and hemospermia. These facts demonstrate that intraprostatic fosfomycin injection has much advantage in patients with chronic prostatitis as treatment modality compared with ordinary method.
Fosfomycin* ; Hematuria ; Hemospermia ; Humans ; Prostatitis*

BACKGROUND & OBJECTIVES: It was well known that benign paroxysmal positional vertigo(BPPV) was caused by the involvement of the posterior semicircular canal, but there were a few reports about horizontal canal variant of BPPV. We studied the clinical features electronystagmographic (ENG) findings and the possible mechanism of BPPV of the horizontal canal(HBPPV). METHODS: We examined 10 cases of HBPPV with episodic vertigo and intense horizontal geotropic nystagmus provoked by rotation of the head in a supine position. Six patients underwent ENG and we recorded four patients' nystagmus, provoked by rotating head from extreme lateral, mid and nose-up position to extreme contralateral direction in supine position. RESULTS: All observed horizontal nystagmus beated towards the ground on both sides and were more pronounced when head was rotated to pathological side. In rotating to pathological side, nystagmus had mean latency of 2.6+/-1.8 seconds, peak velocity of slow phase of 66,8+/-19.7 degree/second and mean duration of 24.7+/-3.4 seconds. In rotating to healthy side the nystagmus had 3. 7+/- 2.9, 38.0+/-11.5 and 22.5+/-4. Secondary phase nystagmus occurred in 2 patients and fatigue was observed in 4 patients. The slow phase velocity of nystagmus was relative to the distance of head rotation. The duration of attack is 3 to 17 days(6.9+/-5.2days). Liberatory manuever had relatively a good effect. CONCLUSION: HBPPV represents the origin of horizontal semicircular canal and has a good prognosis Above findings support that mechanism of horizontal BPPV is canalolithiasis.
Fatigue ; Head ; Humans ; Nystagmus, Pathologic ; Prognosis ; Semicircular Canals* ; Supine Position ; Vertigo*

We present a case of a fetal adrenal hemorrhage, a rare disease in fetal life, detected prenatally at 36 weeks' gestation by ultrasound. Routine ultrasound examination at 36 weeks' gestation by primary obstetrician showed a cyst on the fetal suprarenal area. Initially, the suspected diagnosis was a fetal adrenal hemorrhage, but we should diagnose differently from neuroblastoma. Subsequent ultrasound examination at 38 and 39 weeks' gestation showed increase of the cyst in size. A 3.34-kg-male neonate was born by spontaneous vaginal delivery at 39 weeks' gestation. The diagnosis of adrenal hemorrhage was confirmed by postnatal follow-up sonograms and magnetic resonance imaging. Course and sonographic signs were typical for adrenal hemorrhage and the neonate was therefore managed without surgical exploration.
Diagnosis ; Follow-Up Studies ; Hemorrhage* ; Humans ; Infant, Newborn ; Magnetic Resonance Imaging ; Neuroblastoma ; Pregnancy ; Prenatal Diagnosis* ; Rare Diseases ; Ultrasonography

PURPOSE: Cystic neoplasms of the pancreas are rare tumors that occurs in approximately 10~15% of all cystic lesions of the pancreas. A recent trend has been to resect all cystic neoplasms, without any attempt to preoperatively determine the exact histologic subtype. METHODS: We retrospectively reviewed the clinical records of fifteen patients with cystic neoplasms and intraductal papillary mucinous neoplasms of the pancreas who were treated surgically between January, 1991 and May, 2001. RESULTS: Patient ages ranged from 14 to 69 years with a mean of 53.4. Sixty percent of patients were women. There were 4 cases of mucinous cystic neoplasms, 7 solid pseudopapillary tumors, 3 intraductal papillary mucinous neoplasms, and 1 serous cystadenoma. The most prominant symptom was an abdominal mass. Pancreaticoduodenectomy was performed in six cases, distal pancreatectomy in five cases, excision of cyst in three cases and median segmental pancreatectomy in one case. The mortality rate from surgery was 0%, and the overall perioperative complication rate was 40%. The mean follow-up was 24 months (range from 2 months to 63 months). Two patients, both displaying intraductal papillary mucinous neoplasms, died at 9 and 14 months postoperatively. CONCLUSION: We suggest that cystic neoplasms of the pancreas including intraductal papillary mucinous neoplasm should be resected because they are malignant or pre-malignant. Endoscopic retrograde cholangiopancreatography is the imaging modality of choice for the diagnosis of intraductal papillary mucinous neoplasm. We conclude that the prognosis for resected cystic neoplasms of the pancreas is good.
Cholangiopancreatography, Endoscopic Retrograde ; Cystadenoma, Serous ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Mortality ; Mucins* ; Pancreas* ; Pancreatectomy ; Pancreaticoduodenectomy ; Prognosis ; Retrospective Studies

BACKGROUND & OBJECTIVES: Although benign childhood epilepsy with controtemporal spikes (BCECT) has been well characterized and extensively studied, the clinical findings and prognosis of benign childhood epilepsy with occipital paroxysms (BCEOP) have been less well understood. The purpose of this study was to evaluate clinical manifestations, responses to antiepileptic drugs, and longterm. Prognosis of BCEOP. METHODS AND SUBJECTS: We studied 10 BCEOP patients seen between 1985 and 1995 and followed up from 2 to 14 years(7.2+/-2.9). RESULTS: In 10 patients, there were 7 females and 3 males. The age of onset ranges from 4 to 9 year-old(6.4+/-1.5). In the cases whose age of onset was below 6 year-old, the main clinical manifestations were tonic deviation of eye bal1, ictal vomiting and frequent development of status epilepticus in the sleep. In the cases whose age of onset was above 7 year-old, the main clinical manifestations were visual symptoms (blurring or blindness) associated with ictal vomiting/headache and complex visual hallucination evolved to automatism. The typical EEG findings were occipital paroxysms, characterized by repetitive high amplitude spike or sharp and slow wave complexes in the occipital area, mainly when the eyes were closed. Except one patient, the seizures responded well to anticonvulsant therapy and did not occur after the age of 11. CONCLUSION: Although the number of cases was small and the follow-up period was not long enough, our data indicated that BCEOP had a good prognosis and showed diverse clinical manifestations, which might be dependent on the age of onset.
Age of Onset ; Anticonvulsants ; Automatism ; Child ; Electroencephalography ; Epilepsy* ; Female ; Follow-Up Studies ; Hallucinations ; Humans ; Male ; Prognosis ; Seizures ; Status Epilepticus ; Vomiting

Genitourinary gangrene is an uncommon, potentially lethal disorder characterized by the abrupt onset of a rapidly progressive necrotizing soft tissue infection caused by the synergistic action of various organisms that spread along fascial planes, causing subfascial soft tissue necrosis and destruction. Many factors, debilitating condition such as carcinoma, diabetes and alcoholism, contribute to the development and perpetuate the course of Fournier's gangrene. In our two cases , predisposing causes were as follow ; chronic liver disease, diabetes mellitus, chronic alcoholism, perianal abscess. The patients were hemodynamically unstable and extensive necrosis was noted. After aggressive debridement of the wound and triple antibiotic therapy, general condition became improved and then we performed split thickness skin grafts and the results of reconstructive surgery were satisfactory.
Abscess ; Alcoholism ; Debridement ; Diabetes Mellitus ; Fournier Gangrene* ; Gangrene ; Humans ; Liver Diseases ; Necrosis ; Skin ; Soft Tissue Infections ; Transplants ; Wounds and Injuries