We report a case of esthesioneuroblastoma with intracranial extension treated with surgical resection and chemotherapy. A 5-year-old child presented with visual disturbance, and was subsequently found to have a huge sized mass in the anterior skull base, suprasellar region and lateral ventricle. A bifrontal craniotomy with excision of the tumor through subfrontal and interhemispheric approach was performed. The patient received postoperative chemotherapy according to Tandem protocol. A follow-up magnetic resonance(MR) image showed that the tumor showed partial regression, however, there was no change in tumor size in lateral ventricle. Second operation with excision of remnant mass through a transcallosal approach was performed. MR image, 9 months after first operation showed the postoperative change in frontal area without enhancing mass. By employing staged operation and chemotherapy, the authors obtained good results in the treatment of esthesioneuroblastoma with intracranial extension.
Child ; Child, Preschool ; Craniotomy ; Drug Therapy ; Esthesioneuroblastoma, Olfactory* ; Follow-Up Studies ; Humans ; Lateral Ventricles ; Skull Base

PURPOSES: The purposes of this study were to identify factors related to burden and well-being in primary caregivers of patients who have had a stroke and examine the correlation between burden and well-being of the caregivers. METHODS: Between April 2006 to June 2007 data were collected using self-report questionnaires and interviews with 85 primary caregivers of stroke patients in C University Hospital. Data were analyzed using t-test, ANOVA, Duncan test and Pearson's correlation with SPSSWIN 15.0. RESULTS: Factors related to burden of primary caregivers were sex and activities of daily living of the patients, and age, education level and satisfaction with income of the caregivers. The factors related to well-being of primary caregivers were sex of patients, and age and education level of caregivers as well as cohabitation with the patient. A negative correlation was found between burden and well-being of the caregivers (r= -.393, p<.001). CONCLUSION: These results indicate a need to develop a nursing intervention program for caregivers and education program for other family members to reduce caregiver burden. These programs should lead to improvements in the well-being of the caregiver.
Activities of Daily Living ; Caregivers ; Humans ; Surveys and Questionnaires ; Stroke

PURPOSE: The purpose of this study was to evaluate the effect of testosterone deficiency and osteopenia on fracture healing using orchiectomized adult rats. MATERIALS AND METHODS: Fifty-two 3 month old male rats were used. Animals were divided into 3 groups. Group 1 received sham operations and groups 2 and 3 were orchiectomized. At 4 weeks, right tibial shaft fractures were administered in all animals. Afterwards in group 3, testosterone was injected intra-peritoneally for 4 weeks. After 8 weeks of breeding, animals were sacrified for morphometrical, histopathological and biomechanical testing. RESULTS: No nonunion or delayed union was observed. Differences in tibial volumes and circumferences between the fracture site and the corresponding contralateral site were less in groups 2 and 3 than in group 1, with statistical significance. The yield strength and the trabecular area of the fractured tibiae were significantly lower in group 2, but group 3 and group 1 were similar. CONCLUSION: Even though there was no evidence of compromised fracture healing, both of the androgen deficiency and osteopenia induced by orchiectomy negatively influenced callus volume and strength. But osteopenia did not influece callus strength. The above results demonstrate the positive effect of testosterone injection on fracture healing.
Adult ; Animals ; Bone Diseases, Metabolic* ; Bony Callus ; Breeding ; Fracture Healing* ; Humans ; Infant ; Male ; Orchiectomy ; Rats* ; Testosterone ; Tibia

Anti-Ma2-associated encephalitis is one of the paraneoplastic neurological syndromes. It has been shown to be associated with various neoplasms, mainly testicular, lung, and breast cancers. Most patients with anti-Ma2-associated encephalitis present limbic-diencephalic-brainstem dysfunctions such as seizure, mood disorder, excessive daytime sleepiness, and ophthalmoparesis. Some patients develop symptoms indicating the multifocal involvement of the limbic system, diencephalon, or brainstem. However, there are few case studies of anti-Ma2-associated encephalitis presenting as isolated hypersomnia. We report a case of anti-Ma2-associated encephalitis presenting as hypersomnia.
Brain Stem ; Breast ; Diencephalon ; Disorders of Excessive Somnolence* ; Encephalitis* ; Humans ; Limbic System ; Lung ; Mood Disorders ; Ophthalmoplegia ; Paraneoplastic Syndromes ; Seizures

PURPOSE: This is a descriptive study conducted in order to survey sleep patterns and factors responsible for sleep disturbance among adolescent cancer patients after hospital admission. METHODS: The study group included 46 adolescent cancer patients aged 10 to 19 who received admission care in multi-bed hospital rooms from March to June 2016. Data on patterns and quality of sleep, and factors causing sleep disturbance were recorded using the Verran and Snyder-Halpern (VSH) Sleep Scale, the Pittsburgh Sleep Quality Index (PSQI), and a sleep disturbance questionnaire. RESULTS: There was no difference in patterns and quality of sleep prior to and after hospital admission in the study group. However, patients experienced sleep disturbance, as defined by PSQI > 5, both before (5.43) and after (6.30) admission. The most important physical, emotional and environmental factors causing sleep disturbance after admission were nocturnal diuresis, monotony of admission care, and crying of younger patients respectively. CONCLUSION: This study focused on sleep patterns and factors causing sleep disturbance after hospital admission for adolescent cancer patients. Future studies should aim to develop nursing interventions resulting in an environment that improves sleep quality. Additional studies should focus on developing daytime programs to determine the impact of admission care on other quality of life parameters.
Adolescent* ; Crying ; Diuresis ; Humans ; Nursing ; Quality of Life ; Sleep Wake Disorders

A pancreatic arteriovenous malformation (AVM) is a very rare disease entity that is usually asymptomatic; however, it may present with a massive gastrointestinal hemorrhage. Recent advances in cross-sectional imaging and the widespread availability of angiography have contributed to the diagnosis of this condition. A patient was transferred to our clinic due to unknown origin gastrointestinal bleeding and upper abdominal pain. Double balloon enteroscopy and duodenoscopy revealed a bleeding pancreatico-cholangio-duodenal fistula. We were able to diagnose an arteriovnous malformation with a pancreatico-cholangio-duodenal fistula by the use of angiography and from the post-operative pathological findings.
Abdominal Pain ; Angiography ; Arteriovenous Malformations* ; Diagnosis ; Double-Balloon Enteroscopy ; Duodenoscopy ; Fistula ; Gastrointestinal Hemorrhage ; Hemorrhage* ; Humans ; Pancreas ; Rare Diseases

Vitamin D hydroxylation-deficient rickets type 1A (VDDR1A, OMIM 264700) is a rare autosomal recessive inherited disorder. Pathogenic variants in the CYP27B1 gene lead to loss of 1α-hydroxylase activity. We report the case of a 22-month-old toddler who presented with growth retardation and delayed development. The patient exhibited the typical laboratory findings of VDDR1A, including hypocalcemia (calcium: 5.2 mg/dL), elevated serum level of alkaline phosphatase (2,600 U/L), elevated serum level of intact-parathyroid hormone (238 pg/mL), low 1,25(OH)₂D₃ level (11.2 pg/mL), and normal 25(OH)D₃ level (40.7 ng/mL). His height and weight were 76.5 cm and 9.5 kg, respectively (both <3rd percentile). The Bayley Scales of Infant and Toddler Development II indicated significantly delayed development (mental development index <50, psychomotor development index <50). The patient was a compound heterozygous for two novel pathogenic variants in the CYP27B1 gene: c.57_69del (p.Glu20Profs*2) and c.171dupG (p.Leu58Alafs*275), inherited from his mother and father, respectively. The patient showed remarkable improvement after treatment with calcitriol and calcium carbonate.
25-Hydroxyvitamin D3 1-alpha-Hydroxylase ; Alkaline Phosphatase ; Calcitriol ; Calcium Carbonate ; Databases, Genetic ; Fathers ; Humans ; Hypocalcemia ; Infant ; Mothers ; Rickets ; Vitamin D ; Vitamins ; Weights and Measures

Paraduodenal hernia is by far the most common form of congenital internal hernia. Chylous ascites is an accumulation of lymphatic fluid in the peritoneal cavity. It develops when the lymphatic system is disrupted due to traumatic injury or obstruction. A 40-year-old, woman showed up to the Emergency Department with severe, colicky abdominal pain. Tenderness and rebound tenderness were observed at the left abdomen. Abdominal CT confirmed a cluster of dilated proximal small bowel loops with ischemic change, without ascites. The patient underwent an emergency surgery to relieve bowel ischemia. As soon as the peritoneum was exposed, 1.5 L of chylous fluid was found. A hernial sac was found along the posterior side of the mesentery of the inferior mesenteric artery. We resected the hernial sac and pulled out the herniated small bowel. On the sixth day after the surgery, she was discharged without any complication.
Abdomen ; Abdominal Pain ; Adult ; Ascites ; Chylous Ascites* ; Emergencies ; Emergency Service, Hospital ; Female ; Hernia* ; Humans ; Ischemia ; Lymphatic System ; Mesenteric Artery, Inferior ; Mesentery ; Peritoneal Cavity ; Peritoneum ; Tomography, X-Ray Computed

Gastric tuberculosis is rare even in the endemic areas of tuberculosis, and can mimic neoplasm by causing elevation of the mucosa with or without ulceration. Here, we report a case in which a 54-year-old female patient admitted for resection of early gastric cancer was found to have coexisting histopathologically and bacteriologically confirmed gastric cancer and tuberculosis.
Female ; Humans ; Hydrazines ; Mucous Membrane ; Stomach Neoplasms ; Tuberculosis ; Tuberculosis, Gastrointestinal ; Ulcer