PURPOSE: Neonatal seizures are mostly symptomatic and have variable atypical clinical features with very different EEG findings from those of post-neonatal period. This study was performed to determine the common types of epileptiform discharges and their relationship with abnormalities in imaging study in neonates with seizures. METHODS: Fourty one neonates under 7 days of age who had been hospitalized at the Hanyang university hospital from June 1993 to May 1997 were studied retrospectively. Their medical records, results of EEG and brain imaging study were reviewed. RESULTS: 1) The types of neonatal seizures were subtle, generalized tonic, multifocal clonic, focal clonic, myoclonic in order of frequency. 2) The most common epileptiform discharge was excessive sharp transients recorded in 28 cases and the rest showed multifocal spikes, sharp waves, repetitive alpha, repetitive theta in order. Epileptiform discharges appeared on the both hemisphere in 24 cases, right hemisphere in 9 cases and left hemisphere in 8 cases. 3) Imaging study showed no abnormal findings in 27 cases and abnormal findings in 14 cases such as brain edema, intracranial hemorrhage, leukomalacia, subarachnoid hemorrhage, cephalhematoma, craniosynostosis. 4) Among 14 cases with radiological abnormalities, 5 cases had localized abnormalities and 3 of them had the abnormal EEG discharges on the same area concomittantly. But in total only 3 cases of 17 cases with localized epileptiform discharges had abnormalities in imaging study on the same site and so significant relationship between two studies was not observed. 5) As for the prognosis of seizures, subsided in 23 cases without any antiepileptic drugs, 13 cases had no seizure after taking medicine for few days and 5 cases needed continuous antiepileptic drug. CONCLUSION: This study showed no meaningful relationship between abnormal EEG findings and localization by imaging study in neonatal seizure but we concluded that brain imaging study was needed to determine degree of encephalopathy in neonatal seizures.
Anticonvulsants ; Brain Edema ; Craniosynostoses ; Electroencephalography ; Humans ; Infant, Newborn* ; Intracranial Hemorrhages ; Medical Records ; Neuroimaging ; Prognosis ; Retrospective Studies ; Seizures* ; Subarachnoid Hemorrhage

Endotracheal obstruction may cause serious complications, including cardiovascular instability, pneumothorax, pulmonary edema and even brain death. A 21-year-old man was scheduled to undergo an open reduction for an orbital fracture. The patient had tracheostomy with an 8.0 mm tracheostomy tube 3 weeks ago and was breathing well spontaneously. When the cuff of tracheostomy tube was inflated for assisted manual ventilation and the induction of anesthesia, signs of partial endotracheal obstruction were observed, including high airway pressure, low tidal volume and high ETCO2. Large dried mucous plug was impacted in the tracheostomy tube. After removing this plug with a sterile surgical forcep, effective ventilation was recovered without complications. The case like this nearly fatal obstruction by large dried mucous plug was rarely reported, but it should be considered cautiously when a patient uses tracheostomy tube as an airway before general anesthesia.
Airway Obstruction ; Anesthesia ; Anesthesia, General ; Brain Death ; Humans ; Orbital Fractures ; Pneumothorax ; Pulmonary Edema ; Respiration ; Surgical Instruments ; Tidal Volume ; Tracheostomy ; Ventilation ; Young Adult

Simultaneous or subsequent bilateral thalamic hemorrhagic events have ranged from 12 to 19 in prior reports, with a time lag between bilateral thalamic hemorrhage of up to two days. Herein, we report the first case of delayed (17 days) consecutive contralateral thalamic hemorrhage after spontaneous first thalamic hemorrhage. A 65-year-old female initially presented with a drowsy mentality with a left-side motor weakness (grade II/III). Brain computed tomography (CT) demonstrated right side thalamic and intraventricular hemorrhage. She regained alertness with mild residual motor weakness (grade III/IV) under medical management. Seventeen days later, a sudden and generalized tonic-clonic seizure developed. Brain CT scans revealed a new contralateral thalamic hemorrhage coincident with microbleeds. Neurologic status remained unchanged, consisting of a stuporous mentality with quadriparesis of grade II/II. We report the first case of delayed consecutive contralateral thalamic hemorrhage up to 17 days after first thalamic hemorrhage. The case highlights the need for close monitoring of patients with thalamic hemorrhage who experience microbleeds on the contralateral side, due to the possibility of delayed hemorrhage.
Aged ; Brain ; Female ; Hemorrhage* ; Humans ; Hypertension ; Intracranial Hemorrhages ; Quadriplegia ; Seizures ; Stupor ; Thalamus ; Tomography, X-Ray Computed

Simultaneous or subsequent bilateral thalamic hemorrhagic events have ranged from 12 to 19 in prior reports, with a time lag between bilateral thalamic hemorrhage of up to two days. Herein, we report the first case of delayed (17 days) consecutive contralateral thalamic hemorrhage after spontaneous first thalamic hemorrhage. A 65-year-old female initially presented with a drowsy mentality with a left-side motor weakness (grade II/III). Brain computed tomography (CT) demonstrated right side thalamic and intraventricular hemorrhage. She regained alertness with mild residual motor weakness (grade III/IV) under medical management. Seventeen days later, a sudden and generalized tonic-clonic seizure developed. Brain CT scans revealed a new contralateral thalamic hemorrhage coincident with microbleeds. Neurologic status remained unchanged, consisting of a stuporous mentality with quadriparesis of grade II/II. We report the first case of delayed consecutive contralateral thalamic hemorrhage up to 17 days after first thalamic hemorrhage. The case highlights the need for close monitoring of patients with thalamic hemorrhage who experience microbleeds on the contralateral side, due to the possibility of delayed hemorrhage.
Aged ; Brain ; Female ; Hemorrhage* ; Humans ; Hypertension ; Intracranial Hemorrhages ; Quadriplegia ; Seizures ; Stupor ; Thalamus ; Tomography, X-Ray Computed

To expand the epidemiological understanding of Newcastle disease in Jeju Province, Korea, active surveillance was extensively performed through a virological examination for poultry farms and wild birds in Jeju Province during 2007~2008. Samples (swabs or fresh feces) were collected from a total of 6,485 birds including 6,405 domestic birds (chickens, ducks, pheasants, geese, quails, turkeys, and ostriches) and 80 wild birds. A total of 24 hemagglutinating agents were isolated from domestic birds on fourteen farms including five Korean native chicken, one layer chicken, two broiler chicken, four duck and two pheasant farms. The hemagglutinating agents were all identified as lentogenic NDV based on the reverse transcriptase polymerase chain reaction, sequence analysis of amino acids on the F cleavage site and mean death time in chicken embryos. The F gene-based phylogenetic analysis revealed that the NDV isolates were classified into genotypes 1 or 2 of class II. These lentogenic viruses were closely related to NDV vaccine strains used in Jeju Province. Active surveillance conducted for Newcastle disease indicates no scientific evidence of virulent NDV infection in chickens in Jeju Province, Korea since 2005.
Amino Acids ; Animals ; Birds ; Chickens ; Ducks ; Embryonic Structures ; Geese ; Genotype ; Korea ; Newcastle Disease ; Newcastle disease virus ; Poultry ; Quail ; Reverse Transcriptase Polymerase Chain Reaction ; Sequence Analysis ; Turkeys

PURPOSE: The purpose of this study was to evaluate the accuracy of each method of counting ribs on chest CT and to propose a new method: the anterior approach with using the sternocostal joints. MATERIALS AND METHODS: CT scans of 38 rib lesions of 27 patients were analyzed (fracture: 25, metastasis: 11, benign bone disease: 2). Each lesion was independently counted by three radiologists with using three different methods for counting ribs: the sternoclavicular approach, the xiphisternal approach and the modified sternomanubrial approach. The rib lesions were divided into three parts for evaluation of each method according to the location of the lesion as follows: the upper part (between the first and fourth thoracic vertebra), the middle part (between the fifth and eighth) and the lower part (between the ninth and twelfth). RESULTS: The most accurate method was a modified sternomanubrial approach (99.1%). The accuracies of a xiphisternal approach and a sternoclavicular approach were 95.6% and 88.6%, respectively. A modified sternomanubrial approach showed the highest accuracies in all three parts (100%, 100% and 97.9%, respectively). CONCLUSION: We propose a new method for counting ribs, the modified sternomanubrial approach, which was more accurate than the known methods in any parts of the bony thorax, and it may be an easier and quicker method than the others in clinical practice.
Bone Diseases ; Humans ; Neoplasm Metastasis ; Ribs* ; Sternocostal Joints ; Thorax* ; Tomography, X-Ray Computed*

Natural killer (NK) cell neoplasms are a group of rare but highly malignant tumors. We report here one case of NK cell leukemia. A 54-yr-old woman presented with a 2-month history of progressive left neck mass. Based on the positive result of tissue PCR for Mycobacterium tuberculosis, she was at first diagnosed with tuberculous lymphadenopathy. After two weeks, she developed generalized lymphadenopathy, hepatosplenomegaly, fever and anemia. Subsequent evaluation was performed including bone marrow aspiration and biopsy. Peripheral blood smear showed leukoerythroblastic features with 31% blasts. Bone marrow was packed with agranular blastoid cells, which were periodic acid-Schiff (PAS) positive and myeloperoxidase (MPO) negative. Immunophenotyping showed that these cells were positive for CD45 and HLA-DR, whereas negative for CD3, CD5, CD7, CD10, CD13, CD14, CD19, CD20, CD22, CD33, CD34, and CD61. Because of the absence of the markers of T-cell, B-cell, and myeloid lineage-specific antigens, we added CD16/56 for the immunophenotyping and the blasts were positive (94%). The tumor cells of biopsied lymph node were only positive for CD56, consistent with NK cell lymphoma. Epstein-Barr virus (EBV) was not detected by RNA in situ hybridization. Culture for M. tuberculosis was negative. Thus this patient was diagnosed with blastic NK cell lymphoma/leukemia involving bone marrow and lymph node.
Antigens, CD45/metabolism ; Bone Marrow/pathology ; Female ; HLA-DR Antigens/metabolism ; Humans ; Killer Cells, Natural/immunology/*pathology ; Leukemia/*diagnosis/immunology/pathology ; Middle Aged ; Tuberculosis, Lymph Node/diagnosis

Xanthogranulomatous cholecystitis is an uncommon inflammatory disease of the gall baldder characterised by a focal or diffuse destructive inflammatory process. The pathogenesis is uncertain, but an inflammatory response to extravasated bile due to acute inflammation and obstruction is likely. Macroscopically, the gall bladder wall is invariably thickened, and extensive adhesions to adjacent organs are frequent. Clinically, xanthogranulomatous cholecystitis can mimic gall bladder carcinoma and radiologic differential diagnosis is extremely difficult. Fistula to skin and duodenum was reported. We report the first case of cholecysto-colonic fistula due to xanthogranulomatous cholecystitis.
Bile ; Cholecystitis* ; Diagnosis, Differential ; Duodenum ; Fistula* ; Inflammation ; Skin ; Urinary Bladder

Hand-foot syndrome is also known as palmar-plantar erythrodysesthesia, and it is a side effect that mostly occurs with chemotherapy or biologic therapy. It is characterized by a painful erythema and edema, which may be followed by dry or moist desquamation of the palms and soles. Mizoribine (MZR) is an imidazole nucleoside that blocks purine biosynthesis. It was found to inhibit both humoral and cellular immunity by selectively inhibiting proliferation of lymphocytes. MZR has been used for preventing renal transplant rejection and treating rheumatoid arthritis, nephritic syndrome and lupus nephritis. The principal adverse reactions are leukopenia, abnormal hepatic function and hyperuricemia. The cutaneous side effects are skin rash, prurigo and epilation, with an incidence of about 1.32%, 0.77% and 0.55%, respectively. To the best of our knowledge, no case of hand-foot syndrome associated with MZR has ever been published. Herein, we report that MZR, which has been widely used, may induce drug-induced hand-foot syndrome.
Arthritis, Rheumatoid ; Biological Therapy ; Edema ; Erythema ; Exanthema ; Graft Rejection ; Hair Removal ; Hand-Foot Syndrome ; Hyperuricemia ; Imidazoles ; Immunity, Cellular ; Incidence ; Leukopenia ; Lupus Nephritis ; Lymphocytes ; Prurigo ; Purines ; Ribonucleosides