PURPOSE: Hypothalamic hamartomas are non-neoplastic malformations which are composed of hyperplastic neuronal tissue of varying size. Clinically, they are characterized by gelastic seizure, precocious puberty, and behavioral and psychiatric disorders. This study was performed to examine the various features of hypothalamic hamartomas such as neurologic manifestations, other clinical manifestations, and EEG and brain MRI findings. Response to AEDs or outcome of operation on hypothalamic hamartoma was evaluated. METHODS: Eleven patients who were admitted to Seoul National University Children's Hospital from July 1986 to January 1997 and diagnosed as hypothalamic hamartoma by brain MRI or CT were enrolled in this study. Clinical manifestations and EEG were reviewed retrospectively through the medical records. The size and type of the hypothalamic hamartoma on brain MRl were analyzed. RESULTS: 1) The range of age at visit was 1yr 9mo to 17yr 2mo (mean 10yr 8mo), and the age at onset was 1yr 1mo to 14yr to 2mo (mean 5yr 8mo). Six patients were male and five were female. 2) The clinical manifestations included gelastic seizure (n=9), behavioral and psychiatric disorders (n=9), other types of seizure (n=8), and precocious puberty (n=6). Other types of seizure were complex partial seizure (n=3), generalized tonic seizure(n=3), and infantile spasm (n=2). 3) The interictal EEG findings included focal spike discharges (n=8), diffuse delta slowings (n=1), hypsarrhythmia (n=1), and normal record (n=1). The focal spike discharges originated from the temporal (n=2), fronto-temporal (n=1), occipital (n=3), or frontal area(n=2). 4) The brain MRI showed that the size of the hypothalamic hamartomas was 2.47+/-1.12cm, and the origin of the tumors was tuber cinereum (n=6) or tuber cinereum and mamillary body (n=5). All lesions were isointense on T1-weighted image relative to normal gray matter, with a sessile attachment to the hypothalamus, and were not enhanced by Gadolinium. 5) Operations were done in 5 cases, those were subtotal removal of the tumor (n=4), and gamma knife radiosurgery (n=1). Seizures were not completely controlled in all but one case on which gamma knife radiosurgery was done. CONCLUSIONS: The hypothalamic hamartomas presented variable clinical pictures including gelastic seizure, precocious puberty, and behavioral and psychiatric disorders. The gelastic and other types of seizure associated with hypothalamic hamartomas were refractory to medication and might be controlled by total removal of the tumor.
Brain ; Electroencephalography ; Female ; Gadolinium ; Hamartoma* ; Humans ; Hypothalamus ; Infant ; Infant, Newborn ; Magnetic Resonance Imaging* ; Male ; Mamillary Bodies ; Medical Records ; Neurologic Manifestations ; Neurons ; Puberty, Precocious ; Radiosurgery ; Retrospective Studies ; Seizures ; Seoul ; Spasms, Infantile ; Tuber Cinereum

This study was performed to review the transition of infection rate and major factor in decreasing pattern of intestinal parasites infection in Korea. The results of this review study are as follows: 1) The first study on the intenstinal parasites of Korean was performed by Muta(1913): he reported egg positive rate of A.lumbricodies 80%; that of T.trichiura 93%; that of Hookworm 65%. 2) After then the egg positive rates of A.lumbriciodes among Korean people has been higher thant 80% until and after Korean war. Owing to the biannual mass chemotherapy for 20 years be K.A.P.E.(Korea Association for Parasite Eradication), a decreasing pattern was recognized after 1960's. 3) The nationwide egg positive rate of A.lumbricodies was estimated by M.H.S.A.(Ministry of Health and Social Affairs) and K.A.P.E.(1971, 1976, 1981, 1986) to be 54.89%, 41.0%, 13.0%, 2.1%. 4) The causal agents in decreasing pattern of intestinal parasites in Korea are multifactorial such as mass chemotherapy, environmental sanitation, public education, improvement in socio-economic status, development in antihelminths, increase in use of chemical fertilizer, acceleration in national industrialization and so forth. 5) The infection rate of Korea is still higher than that of Japan and Taiwan but lower than any other countries in Southeast Asia. Nevertheless it is apparent that the present situation is not satisfactory and in this sense more effective and efficient control program is desirable.
English Abstract ; History of Medicine, 20th Cent. ; Human ; Intestinal Diseases, Parasitic/*history ; Korea ; Parasitology/*history ; Public Health/history

OBJECTIVE: The positive rates of hepatitis B virus (HBV) markers differ according to age, sex, race, locality, sexual behavior, socioeconomic conditions, immunologic and genetic factors. It is a well-known fact that Korea is one of the endemic areas of HBV infection in the world. Past many reports have presented that the positive rates of HBsAg and anti-HBs in Korea were about 6~14% and 30~62%, respectively. However there were a few epidemiological surveys of rural communities on the positive rates of HBV markers. The present study undertook to determine the positive rates of HBsAg and anti-HBs in Hwasun county, a rural area of Korea. METHODS: We performed Population-based cross- sectional study by random cluster sampling of registered residents in Hwasun county. Out of the 2,920 subjects (4.1%) scheduled for the survey, 1,913 residents underwent the actual examination. We tested HBsAg and anti- HBs by reversed passive hemagglutination (RPHA) and passive hemagglutination (PHA), respectively. RESULTS: The positive rates of HBsAg and anti-HBs in all subjects were 5.6% and 20.8%, respectively, and those were 5.4% and 20.4% in 168 pregnant women, respectively. The positive rate of HBsAg was significantly higher in male (8.2%) than in female (4.0%) (p< 0.01). The positive rate of anti-HBs was 21.4% in female, but it was not significanly higher than in male (19.6%). There were no significant differences according to age groups in the positive rates of HBsAg and anti-HBs. CONCLUSION: There are no significant changes in the positive rates of HBsAg and anti-HBs between the present study for Hwasun county and past many reports in Korea. Although the rate of hepatitis B vaccination increased significantly, it was not effective because that the vaccinated total numbers in the rural area of Korea were probably small. So it is very important to undertake a nationwide program of hepatitis B immunization and to educate the residents in rural areas of Korea.
Continental Population Groups ; Female ; Hemagglutination ; Hepatitis B ; Hepatitis B Surface Antigens* ; Hepatitis B virus ; Humans ; Immunization ; Korea* ; Male ; Pregnant Women ; Rural Population ; Sexual Behavior ; Vaccination

The triggering receptor expressed on myeloid cells (TREM) family, which is abundantly expressed in myeloid lineage cells, plays a pivotal role in innate and adaptive immune response. In this study, we aimed to identify a novel receptor expressed on hematopoietic stem cells (HSCs) by using in silico bioinformatics and to characterize the identified receptor. We thus found the TREM-like transcript (TLT)-6, a new member of TREM family. TLT-6 has a single immunoglobulin domain in the extracellular region and a long cytoplasmic region containing 2 immunoreceptor tyrosine-based inhibitory motif-like domains. TLT-6 transcript was expressed in HSCs, monocytes and macrophages. TLT-6 protein was up-regulated on the surface of bone marrow-derived and peritoneal macrophages by lipopolysaccharide stimulation. TLT-6 exerted anti-proliferative effects in macrophages. Our results demonstrate that TLT-6 may regulate the activation and proliferation of macrophages.
Adaptive Immunity ; Computational Biology ; Computer Simulation ; Cytoplasm ; Hematopoietic Stem Cells ; Humans ; Immunoglobulins ; Macrophages* ; Macrophages, Peritoneal ; Monocytes ; Myeloid Cells*

Age-related vertebral fractures occur frequently in the elderly recently. An epidural block has been introduced as an effective management for the treatment of pain with vertebral compression fractures. While an epidural block is considered to be reasonably safe, serious complications may occur even when this invasive procedure is related to pain. Vasovagally mediated episodes of hypotension and bradycardia are thought to be a common cause of recurrent unexplained syncope. Precipitating factors include pain, trauma, fatigue, blood loss, or prolonged motionless standing. We report one case of vasovagal syncope associated with severe bradycardia and hypotension in a 78 year-old male patient with vertebral fractures. Syncopal attacks occurred during a caudal epidural block. The patient was resuscitated successfully and recovered without any adverse effects.
Aged ; Bradycardia ; Fatigue ; Fractures, Compression ; Humans ; Hypotension ; Male ; Precipitating Factors ; Syncope ; Syncope, Vasovagal*

Subclavian steal syndrome is understood to be an occlusion or stenosis of the subclavian artery proximal to the origin of the vertebral artery with a retrograde flow of blood through the ipsilateral vertebral artery. It is characterized most prominently and most consistently by unequal blood pressures of both arms. In this case, we found incidentally unequal arm pressures during emergence. After the surgery, the 95% stenosis of left anterior descending coronary artery and total occlusion of subclavian artery was proved angiographically. This patient had the risk factors of atherosclerosis such as male, DM, hypertension, smoking and hyperlipidemia. In conclusion, pressures should be taken from both arms during initial visit, when the patient has the risk factors of atherosclerosis.
Arm* ; Atherosclerosis ; Constriction, Pathologic ; Coronary Vessels ; Humans ; Hyperlipidemias ; Hypertension ; Male ; Risk Factors ; Smoke ; Smoking ; Subclavian Artery ; Subclavian Steal Syndrome* ; Vertebral Artery

Uterine anomalies have been reported in 4% of women with infertility and in up to 15% of those with recurrent abortion. One of the major intrauterine disorder associated with infertility and recurrent abortions is intrauterine septum, The reproductive outcome of 41 patients of intrauterine septum (7 complete, 34 incomplete) with repeated abortions or infertility was assessed after the uterine septotomy. 5 of 7 patients with comlete uterine septum undergone uterine septotomy (3; hysteroscopic metroplasty, 2; abdominal metroplasty) had total 6 pregnancies and all of them had live biths. 28 patients with incomplete uterine septum got the hysteroscopic intrauterine septotomy and the viable pregnancy rate was 62% (3 ongoing pregnancies, 13 live biths of total 26 pregnancies). 6 patients with incomplete uterine septum had not the operation and 5 patients had 5 live births after total 6 pregnancies with 1 spontaneus abortion. Even though, the number of cases were small, the live birth rate in the group of septotomy of the patients of complete uterine septum (100%, 6/6) was higher than that in the group of not-done (50%, 1/2). The live birth rate in the group of not-done of the patients with incomplete uterine septum (83%, 5/6) was higher than that in the group of hysteroscopic uterine septotomy (62%, 16/26), but 5 of 6 had short uterine septal length (<1 cm), 1 had 1.5 cm septal length in the group of not-done. All the patients with successful pregnancy outcome had no other co-factors at the diagnostic laparoscopy, but the 5 primary infertility patients with no live birth even after treatment (all were with incomplete septum; 3 undergone hysteroscopic septotomy, 2 not-done with one abortion) had other co-factors such as endometriosis, peritoneal or tubal facor. In conclusion, hysteroscopic uterine septotomy would be useful for the patients with habitutal abortion or infertility and more advanced managemnet protocols should be applied to the patients having other co-factors if there was no pregnancy even after the uterine septotomy.
Abortion, Habitual* ; Endometriosis ; Female ; Humans ; Hysteroscopy* ; Infertility* ; Laparoscopy ; Live Birth ; Pregnancy ; Pregnancy Outcome ; Pregnancy Rate

PURPOSE: Renal blood oxygen level-dependent (BOLD) MRI has been used in the evaluation of renal oxygenation. We tried to provide the normal R2* value of the human kidney with 3.0 T, and evaluated the differences in R2* values according to gender and location. MATERIALS AND METHODS: Twenty-four healthy volunteers underwent BOLD MRI at 3.0 T. Multi gradient echo-echo planar imaging sequence with seventeen echoes was used. After generation of the T2* map, the R2* was calculated. The statistical differences in R2* values between the cortex and medulla, males and females, and the right and left kidney were analyzed. The regional differences of R2* within the both kidneys were evaluated respectively. RESULTS: BOLD MRI was successful in all participants. No gross artifact interfered with R2* measurement. The mean R2* at 3.0 T was 17.1 +/- 2.60 s-1 in the cortex and 27.7 +/- 4.83 s-1 in the medulla (p < 0.001). The R2* value in the medulla was significantly higher in the male than female volunteers (p = 0.025). There were no statistical differences of R2* according to the side and location in the kidney (p = 0.197). CONCLUSION: Renal BOLD MRI can be efficiently performed with 3.0 T MRI. Renal medullary hypoxia is present in normal volunteers. Our results may be used as reference values in the evaluation of pathologic conditions using BOLD MRI.
Anoxia ; Artifacts ; Female ; Humans ; Kidney ; Male ; Oxygen ; Reference Values

Malignant fibrous histiocytoma (MFH) is an aggressive and most common soft tissue sarcoma that occurs in the skeletal muscle of the extremities, trunk or retroperitoneum of late adult life. But the disease course, prognostic factors and outcome in younger patients have not been well described, because MFH rarely occurs in children. We report a case of MFH presenting on the left thoracic back in a 12 year-old boy with systemic metastasis of liver, kidney, bone and adrenal gland.
Adrenal Glands ; Adult ; Child ; Extremities ; Histiocytoma, Malignant Fibrous* ; Humans ; Kidney ; Liver ; Male ; Muscle, Skeletal ; Neoplasm Metastasis* ; Sarcoma

OBJECTIVE: Ovarian hyperstimulation syndrome (OHSS) is one of the well known complication of conttolled ovarian hyperstimulation. Though there have been numerous protocols for the prevention of OHSS, it has not been completely preventable until now. This study was performed to identify clinical predictors for early and late OHSS. METHODS: A retrospective analysis of all IVF cycles in 1993 up to June 1996 was performed. OHSS was diagnosed using the criteria of Rabau modified by Schenker. All cases of OHSS reported in this study presented with marked ovarian enlargement, ascites, oliguria, hemoconcentration and electrolyte disturbance. Ovarian stimulation was carried out using a combination of gonadotrophin releasing hormone-agonist, follicle-stimulation hormone and human menopausal gonadotrophin. 27 patients has moderate or severe OHSS presenting 3-7 days post-human chorionic gonadotrophin (hCG), and 21 patients had severe OHSS presenting 12-17 days post-hCG. RESULTS: No patient with early OHSS went onto develop late OHSS, and no patient with late OHSS had demonstrated early OHSS. Logistic regression showed that early OHSS was predicted by the number of oocytes retrieved and the estradiol concentration on the day hCG injection (P<0.05). Late OHSS was predicted by the transferred embryos, B-hCG on 14 day after hCG injection (P<0.05). CONCLUSION: Early OHSS was an acute effect of the hCG administered prior to egg retrieval in women with high estradiol and large number of retrieved oocytes. Our analysis of the risk factors for early OHSS indicates that cryopreservation of all embryos will not alter the risk of early OHSS even though it should prevent late OHSS. Late OHSS was induced by the rising serum concentration of hCG produced by the early pregnancy, the number of transferred embryos must be adjusted carefully, since it was associated with multiple gestation.
Ascites ; Chorion ; Cryopreservation ; Embryonic Structures ; Estradiol ; Female ; Humans ; Logistic Models ; Oliguria ; Oocytes ; Ovarian Hyperstimulation Syndrome ; Ovulation Induction ; Ovum ; Pregnancy ; Retrospective Studies ; Risk Factors