A perilymphatic fistula (PLF) is defined as leakage of perilymph with several possible causes such as superior canal dehiscence through trauma, temporal bone fracture, or sudden pressure change (e.g., skydiving or scuba diving). Pneumolabyrinth can result from temporal bone fracture after trauma, or sudden pressure change in the middle ear or cerebrospinal fluid, such as excessive nose blowing or Valsalva maneuver. A PLF and pneumolabyrinth may occur without trauma, associated with a sudden pressure change in the middle ear. We report two cases of PLF followed by pneumolabyrinth and one case of suspicious PLF without pneumolabyrinth after excessive nose blowing. All three cases were diagnosed as having sensorineural hearing loss and the patients recovered completely after conservative treatment. We report various CT findings of pneumolabyrinth and PLF, from normal CT findings to air pockets in the labyrinth and soft tissue density around the stapes.

Objective: : The goal of this study was to analyze the clinical outcomes of endoscopic third ventriculostomy (ETV) and endoscopic septostomy when shunt malfunction occurs in a patient who has previously undergone placement of a ventriculoperitoneal shunt. Methods: : From 2001 to 2020 at Seoul National University Children's Hospital, patients who underwent ETV or endoscopic septostomy for shunt malfunction were retrospectively analyzed. Initial diagnosis (etiology of hydrocephalus), age at first shunt insertion, age at endoscopic procedure, magnetic resonance or computed tomography image, subsequent shunting data, and follow-up period were included. Results: : Thirty-six patients were included in this retrospective study. Twenty-nine patients, 18 males and 11 females, with shunt malfunction underwent ETV. At the time of shunting, the age ranged from 1 day to 15.4 years (mean, 2.4 years). The mean age at the time of ETV was 13.1 years (range, 0.7 to 29.6 years). Nineteen patients remained shunt revision free. The 5-year shunt revisionfree survival rate was 69% (95% confidence interval [CI], 0.54–0.88). Seven patients, three males and four females, with shunt malfunction underwent endoscopic septostomy. At the time of shunting, the age ranged from 0.2 to 12 years (mean, 3.9 years). The mean age at the time of endoscopic septostomy was 11.9 years (range, 0.5 to 29.5 years). Four patients remained free of shunt revision or addition. The 5-year shunt revision-free survival rate was 57% (95% CI, 0.3–1.0). There were no complications associated with the endoscopic procedures. Conclusion : The results of our study demonstrate that ETV or endoscopic septostomy can be effective and safe in patients with shunt malfunction.

OBJECTIVE: The purpose of this study is to determine the effects of the methods of anesthesia on fetal acidemia following elective cesarean delivery among uncomplicated healthy parturients at term, with a single fetus and is to see the correlation of that results with maternal age, Apgar score. MATERIALS AND METHODS: The gestational age more than 37 weeks, singleton, estimated birth weight more than 2.5 kg with ultrasonographic profiles, 98 cases of uncomplicated parturients were included. Three methods of anesthesia - general, epidural, spinal - were chosen randomly. Umbilical artery blood samples just after delivery were obtained from a double clamped segment of cord using a 3 ml syringe that had been flushed with heparin, then transported in ice to the laboratory. RESULTS: There was no statistically significant difference between the three anesthesia groups in regarding to maternal age, birth weight, and Apgar score. The incidence of fetal acidemia was more prevalent in the epidural anesthesia group than the others, and less in the general anesthesia group. No clinically pathologic neonatal outcome was happened even one case of pathologic fetal acidemia among the spinal anesthesia group. The average PO2 of umbilical artery was 19.7 mmHg, and there was no statistically significant difference between the three anesthesia groups. The average PCO2 of umbilical artery was statistically high in the epidural anesthesia group. CONCLUSION: This study shows that the fetal acidemia can occur in three methods of anesthesia. Because there is no difference between the three methods of anesthesia with regarding to 1-minute, 5-minute Apgar scores and there is no specific finding for postpartum follow up of 1month. In conclusion, any method of anesthesia can be used safely in the view of neonatal outcome for elective cesarean delivery.
Anesthesia* ; Anesthesia, Epidural ; Anesthesia, General ; Anesthesia, Spinal ; Apgar Score ; Birth Weight ; Fetus ; Follow-Up Studies ; Gestational Age ; Heparin ; Ice ; Incidence ; Maternal Age ; Postpartum Period ; Syringes ; Umbilical Arteries

OBJECTIVE: The purpose of this study is to determine the effects of the methods of anesthesia on fetal acidemia following elective cesarean delivery among uncomplicated healthy parturients at term, with a single fetus and is to see the correlation of that results with maternal age, Apgar score. MATERIALS AND METHODS: The gestational age more than 37 weeks, singleton, estimated birth weight more than 2.5 kg with ultrasonographic profiles, 98 cases of uncomplicated parturients were included. Three methods of anesthesia - general, epidural, spinal - were chosen randomly. Umbilical artery blood samples just after delivery were obtained from a double clamped segment of cord using a 3 ml syringe that had been flushed with heparin, then transported in ice to the laboratory. RESULTS: There was no statistically significant difference between the three anesthesia groups in regarding to maternal age, birth weight, and Apgar score. The incidence of fetal acidemia was more prevalent in the epidural anesthesia group than the others, and less in the general anesthesia group. No clinically pathologic neonatal outcome was happened even one case of pathologic fetal acidemia among the spinal anesthesia group. The average PO2 of umbilical artery was 19.7 mmHg, and there was no statistically significant difference between the three anesthesia groups. The average PCO2 of umbilical artery was statistically high in the epidural anesthesia group. CONCLUSION: This study shows that the fetal acidemia can occur in three methods of anesthesia. Because there is no difference between the three methods of anesthesia with regarding to 1-minute, 5-minute Apgar scores and there is no specific finding for postpartum follow up of 1month. In conclusion, any method of anesthesia can be used safely in the view of neonatal outcome for elective cesarean delivery.
Anesthesia* ; Anesthesia, Epidural ; Anesthesia, General ; Anesthesia, Spinal ; Apgar Score ; Birth Weight ; Fetus ; Follow-Up Studies ; Gestational Age ; Heparin ; Ice ; Incidence ; Maternal Age ; Postpartum Period ; Syringes ; Umbilical Arteries

Mycoplasma pneumoniae is a common cause of respiratory tract infections and typically causes mild disease. Extrapulmonary manifestations of M. pneumoniae infection are also common, but rhabdomyolysis is a rare complication. Here, we describe the case of a previously healthy 23-year-old male who displayed the simultaneous onset of rhabdomyolysis and severe pneumonia requiring mechanical ventilation. Both conditions were resolved by a 10-day course of antimicrobial treatment and the patient was discharged without complication.
Humans ; Male ; Mycoplasma ; Mycoplasma pneumoniae ; Pneumonia ; Pneumonia, Mycoplasma ; Respiration, Artificial ; Respiratory Tract Infections ; Rhabdomyolysis ; Young Adult

Lamotrgine is an antiepileptic drug that is effective for multiple types of seizure and has side-effects such as headache, nausea, dizziness, diplopia, ataxia, cutaneous lesions, and anticonvulsant hypersensitivity syndrome. Anticonvulsant hypersensitivity syndrome consists of the hallmark features of fever, rash, lymphadenopathy and internal organ involvement, induced by aromatic anticonvulsants, for example phenytoin, phenobarbital, carbamazepine, and lamotrigine. We report a case of 13-year-old girl who had a fever, generalized erythematous skin eruption, facial edema, eosinophilia, and elevated liver enzyme induced by lamotrigine and resolved with discontinuation of medication and intravenous steroid and immunoglobulin.
Adolescent ; Anticonvulsants ; Ataxia ; Carbamazepine ; Diplopia ; Dizziness ; Edema ; Eosinophilia ; Exanthema ; Female ; Fever ; Headache ; Humans ; Hypersensitivity* ; Immunoglobulins* ; Liver ; Lymphatic Diseases ; Nausea ; Phenobarbital ; Phenytoin ; Seizures ; Skin

The simultaneous existence of intrauterine and extrauterine pregnancies is known as a heterotopic pregnancy. Spontaneous heterotopic pregnancy is a rare event although its incidence has increased since the recent development of treatment of infertile women with ovulation induction or in-vitro fertilization and embryo transfer(IVF-ET).The theoretical rate of this condition was estimated to be approximately 1 in 30,000 pregnancies. The early diagnosis of heterotopic pregnancy is very difficult . So there is a high maternal morbidity and fetal loss. We reported a IVP - ET patient resulting in the successful delivery of live infant at 35weeks of gestational age from intrauterine pregnancy following surgical removal of ruptured concurrent extrauterine pregnancy.
Early Diagnosis ; Embryonic Structures ; Female ; Fertilization ; Gestational Age ; Humans ; Incidence ; Infant ; Ovulation Induction ; Pregnancy ; Pregnancy, Heterotopic*

PURPOSE: Non-alcoholic fatty liver disease (NAFLD) in children has become an important public health issue because of its high prevalence and severity. Several noninvasive methods for estimating NAFLD are under investigation. We aimed to evaluate the usefulness of serum ferritin as a biomarker of severity of pediatric NAFLD patients. METHODS: A total of 64 NAFLD patient were enrolled from Severance Children's Hospital from March 2010 to February 2013. Serum ferritin levels, liver related laboratory tests, liver magnetic resonance imaging (MRI) (2-dimensional [2D] proton density-fat fraction) and NAFLD severity markers were compared between obese group and overweight group. Correlation analyses were performed between serum ferritin and laboratory values including NAFLD severity markers. RESULTS: In obese group, serum ferritin, alanine aminotransferase (ALT), total bilirubin, international normalized ratio (INR), MRI 2D proton density-fat fraction, aspartate aminotransferase (AST) to platelet ratio index (APRI) and fibrosis-4 (FIB-4) (an index score calculated from platelet count, ALT, AST and age) were significantly higher than those of overweight group. NAFLD severity markers, APRI and FIB-4, and liver specific important laboratory values, AST, ALT, INR, cholesterol, triglyceride and low density lipoprotein show significant correlation with serum ferritin in NAFLD patients. CONCLUSION: Serum ferritin concentrations could be a candidate of useful severity marker in the pediatric NAFLD patients.
Alanine Transaminase ; Aspartate Aminotransferases ; Bilirubin ; Biomarkers ; Blood Platelets ; Child ; Cholesterol ; Fatty Liver* ; Ferritins* ; Humans ; International Normalized Ratio ; Lipoproteins ; Liver ; Magnetic Resonance Imaging ; Obesity ; Overweight ; Platelet Count ; Prevalence ; Protons ; Public Health ; Triglycerides

A congenital ureteral valve is a rare disease, with the first case presented in 1887, since when, only 42 cases have subsequently been reported. From a review of the reported cases, this abnormality was often found to be associated with other urological disorders, such as vesicoureteral reflux, ectopic ureter, complete and incomplete duplication of the kidney, and contralateral renal atrophy. Here, the case of an adult patient with multiple congenital ureteral valves and renal atrophy is reported.
Adult* ; Atrophy ; Constriction, Pathologic ; Humans ; Kidney ; Rare Diseases ; Ureter* ; Vesico-Ureteral Reflux

The spinocerebellar ataxia type 2 (SCA 2) is an autosomal dominant cerebellar ataxia that commonly presents with cerebellar ataxia, hyporeflexia, and slow saccades. Recent clinical series described movement disorder in the SCA 2 such as Parkinsonism or dystonia. Dystonia can be observed in and even be the presenting feature of the SCA 2. We report two patients with genetically confirmed SCA 2 displaying a slowly progressive syndrome combined with cerebellar ataxia and craniocervical segmental dystonia.
Cerebellar Ataxia ; Dystonia* ; Humans ; Movement Disorders ; Parkinsonian Disorders ; Reflex, Abnormal ; Saccades ; Spinocerebellar Ataxias*