PURPOSE: To illustrate frequently encountered anatomic variations on PNS computed tomography(CT) and to assess their clinical significance. MATERIALS AND METHODS: CT findings of 1523 patients, who underwent PNS CT with no history of sinus surgery, were reviewed, and prevalence of each anatomic variation and its relationship with mucociliary clearance pathway was evaluated. RESULTS: Two categories of anatomic variations were encountered. The first group included variations of the turbinates, such as concha bullosa(28.6% ), paradoxical middle turbinate(31.5%), of the uncinate process, such as medially bent or folded(36.3%), laterally bent(3.7%) or uncinate bulla(0.5%), of the ethmoidal sinus, such as Haller's ce11(28.2%), large agger nasi ce11(9.6%) or large ethmoidal bulla(23.5%) and nasal septal deviation(24. 1%), which might cause obstruction of mucociliary clearance pathway and thus give rise to secondary obstructive sinusitis. The second group included Onodi ce11(1.4%) and medial depression of the lamina papyracea (3.5%), which were not related with obstructive sinusitis. 87 cases of large agger nasi cell were associated with obstruction of nasofrontal recess. Large ethmoidal bulla(452 cases), Haller's ce11(245 cases) and true concha bullosa (25 cases) contributed to narrowing of the infundibulum. Medially bent uncinate process(220 cases), concha bullosa(157 cases), paradoxical middle turbinate(126 cases) and nasal septal deviation(93 cases) were observed in middle meatal obstruction and supreme concha (3 cases) accompanied sphenoethmoidal recess obstruction. CONCLUSION: Recognition of anatomic variations on PNS CT is important to build a treatment plan in patients with obstructive sinusitis as they may represent causes of the disease, and to avoid critical complications during functional endoscopic sinus surgery.
Anatomic Variation ; Depression ; Humans ; Mucociliary Clearance ; Prevalence ; Sinusitis ; Turbinates

OBJECTIVES: To report two cases of neuropathy due to methyl bromide intoxication. METHODS: Workers, engaged in the fumigating process, complained fatigue, general weakness, ataxia, and hypersomnia. We evaluated them with blood tests, neurophysiologic studies and MRI and investigated their occupational history. RESULTS: Increased signal intensities were found in the medulla oblongata and paraver mian of cerebellum in MRI and after 11 days, high signal intensities were reduced in the following MRI. In the other case, polyneuropathy and rlght lower brainstem lesion were observed In the NCV and BAEP studies. CONCLUSIONS: We confirmed that worker's symptoms were related to methyl bromide exposure in the fumigation. It is necessary that we should evaluate present condition of fumigating process and prepare appropriate methods to protect workers engaged in the fumigation.
Ataxia ; Brain Stem ; Cerebellum ; Disorders of Excessive Somnolence ; Fatigue ; Fumigation* ; Hematologic Tests ; Magnetic Resonance Imaging ; Medulla Oblongata ; Polyneuropathies

In order to examine the usefulness of the sympathetic skin response(SSR) as an indicator of autonomic dysfunction, we measured the amplitudes and latencies of the SSR in 64 consecutive non-insulin dependent diabetic patients, which were compared with those of 54 normal controls. The SSR on stimulation of median and posterior tibial nerves with EMG electrographer were correlated with nerve conductoin velocity(NCV) findings of median, posterior tibial and sural nerves and with beat-to-beat variation, measured as difference beeen maximum and minimum heart rate during deep breathing. Diabetic patients were also divided into 5 subgroups according to the symptoms of peripheral neuropathy, autonomic neuropathy and NCV findings for further comparisons. The results were as follows: 1. The shapes of the SSR were similar in the hand and the foot, but the amplitude was consistently greater in the hand than in the foot(p<0.001). The latency was shorter in the hand than in the foot(P<0.001). 2. The latencies of the foot and hand SSR in the diabetic patients were not significantly different from the normal controls. On the other hands, the amnplitude of the hand and foot SSR was significantly reduced compared to the control(p<0.001). 3. Of the patients with absent foot SSR, 20(59%) had two or more symptoms of autonomic involvement, whereas 14(14%) had no autonomic symptoms. These difference were significant(p Diabetes Mellitus ; Diabetic Neuropathies ; Extremities ; Foot ; Hand ; Heart Rate ; Humans ; Peripheral Nervous System Diseases ; Respiration ; Skin* ; Sural Nerve ; Tibial Nerve

The etiology of the postoperative discitis is not fully known, but most likely, the cause seems to be of a low grade infection and chemical and mechanical injuries. The incidence of these complication is from 0.12% to 2.6% of all cases. The characteristics of this disease are recurrence of severe lower back and gluteal pain, spasm of lumbar paravertebral muscle and elevated E.S.R. following the asymptomatic post-operative period, a roentgenogram showed an early destructive change in the adjacent vertebra, the narrowing of the intervertebral disc space, sclerotic changes in the vertebral bone and occasional fusion of the spine, and relatively good prognosis. We present a case of recurrent postoperative discitis with E.S.R. change and roentgenographic change.
Discitis* ; Incidence ; Intervertebral Disc ; Prognosis ; Recurrence ; Spasm ; Spine

OBJECTIVE: To evaluate the shapes and sizes of nasopharyngeal airways by using cone-beam computed tomography and to assess the relationship between nasopharyngeal airway shape and adenoid hypertrophy in children. METHODS: Linear and cross-sectional measurements on frontal and sagittal cross-sections containing the most enlarged adenoids and nasopharyngeal airway volumes were obtained from cone-beam computed tomography scans of 64 healthy children (11.0 +/- 1.8 years), and the interrelationships of these measurements were evaluated. RESULTS: On the basis of frontal section images, the subjects' nasopharyngeal airways were divided into the following 2 types: the broad and long type and the narrow and flat type. The nasopharyngeal airway sizes and volumes were smaller in subjects with narrow and flat airways than in those with broad and long airways (p < 0.01). Children who showed high adenoid-nasopharyngeal ratios on sagittal imaging, indicating moderate to severe adenoid hypertrophy, had the narrow and flat type nasopharyngeal airway (p < 0.01). CONCLUSIONS: Cone-beam computed tomography is a clinically simple, reliable, and noninvasive tool that can simultaneously visualize the entire structure and a cross section of the nasopharyngeal airway and help in measurement of adenoid size as well as airway volume in children with adenoid hypertrophy.
Adenoids ; Child ; Cone-Beam Computed Tomography ; Humans ; Hypertrophy

PURPOSE: To evaluate changes in total cerebral blood flow (tCBF) with aging, parenchymal volume changes and vascular abnormalities, using 2 dimensional (D) phase-contrast magnetic resonance imaging (PC MRI). MATERIALS AND METHODS: Routine brain MRI including T2 weighted image, time-of-flight (TOF) MR Angiography (MRA) and 2D PC MRI were performed in 73 individuals, including 12 volunteers. Normal subjects (12 volunteers, and 21 individuals with normal MRI and normal MRA) were classified into groups according to age (18 -29, 30 -49 and 50 -66 years). For the group with abnormalities in brain MRIs, cerebral parenchymal volume changes were scored according to the T2 weighted images, and atherosclerotic changes were scored according to the MRA findings. Abnormal groups were classified into 4 groups: (i) mild reduction in volume, (ii) marked reduction in volume by parenchymal volume and atherosclerotic changes, and (iii) increased volume and (iv) Moya-moya disease. Volumetric flow was measured at the internal carotid artery (ICA) and vertebral artery bilaterally using the velocity-flow diagrams from PC MRI, and combined 4 vessel flows and tCBF were compared among all the groups. RESULTS: The age-specific distribution of tCBFs in normal subjects were as follows: 12.0 +/- 2.1 ml/sec in 18 -29 years group, 11.8 +/- 1.9 ml/sec in 30 -49 years group, 10.9 +/-2.2 ml/sec in 50 -66 years group. The distribution of tCBFs in the different subsets of the abnormal population were as follows: 9.5 +/-2.5 ml/sec in the group with mild reduction in volume, 7.6 +/-2.0 ml/sec in the group with marked reduction in volume, and 7.3 +/-1.2 ml/sec and 7.0 +/- 1.1 ml/sec in the increased parenchymal volume and Moya-moya disease groups respectively. CONCLUSION: Total cerebral blood flow decreases with increasing age with a concomitant reduction in parenchymal volumes and increasing atherosclerotic changes. It is also reduced in the presence of increased parenchymal volume and Moya-moya disease. 2D PC MRI can be used as a tool to evaluate tCBF with aging and in the presence of various conditions that can affect parenchymal volume and cerebral vasculature.
Aging* ; Angiography ; Brain ; Carotid Artery, Internal ; Magnetic Resonance Imaging* ; Moyamoya Disease ; Vertebral Artery ; Volunteers

Familial hypokalemic periodic paralysis (hypoPP) is a rare inherited channelopathy that often presents with episodic weakness accompanied by hypokalemia. Thus far, mutations in the gene encoding two ion channels (CACNL1A3, L-type calcium channel alpha-1 subunit and SCN4A, a sodium channel type IV alpha subunit) have been identified. Several cases of familial hypoPP in children have been reported in Koreans, but there are only a few cases with identified mutations. We report a 12-year-old boy and his affected mother with hypoPP who has a heterozygous G to A substitution at codon 1239 in exon 30 of the CACNL1A3 gene that causes a change from arginine to histidine (Arg1239His, CACNL1A3). This mutation is common among Caucasians; however, it has not yet been reported in Koreans. The patients were treated with oral acetazolamide and potassium replacement and were instructed to avoid precipitating factors. After the medication and lifestyle modification, the paralytic attacks significantly decreased.
Acetazolamide ; Arginine ; Calcium Channels, L-Type ; Channelopathies ; Child ; Codon ; Exons ; Histidine ; Humans ; Hypokalemia ; Hypokalemic Periodic Paralysis ; Ion Channels ; Life Style ; Mothers ; Potassium ; Precipitating Factors ; Sodium Channels

Paragonimiasis is a parasitic infection that occurs following the ingestion of infectious Paragonimus metacercariae from crabs or crayfish. Pulmonary paragonimiasis is the most common clinical manifestation of this infection, but several ectopic paragonimiasis cases have also been reported. Among them, cases of subcutaneous paragonimiasis are rare, especially in children. We report a case of subcutaneous paragonimiasis of the right abdominal wall with pleural effusion with hepatic involvement and without abnormal pulmonary infiltration in a boy aged 2 years and 5 months. He had eaten soybean sauce-soaked freshwater crabs (kejang) 6 months prior to complaining of right abdominal wall distension. On evaluation, right pleural effusion without abnormal pulmonary infiltration was detected, as well as blood eosinophilia, an elevated serum IgE level, pleural fluid eosinophilia and a positive enzyme-linked immunosorbent assay that detected P. westermani antibody in the serum. Thoracentesis, praziquantel administration, and excision of subcutaneous lesions were performed. After treatment, the eosinophil count and serum IgE level were decreased, and the subcutaneous lesions did not recur. The frequency of paragonimiasis has decreased recently, but it is still prevalent in Korea. Paragonimiasis should be suspected if pleural fluid eosinophilia is associated with blood hypereosinophilia and a high level of serum IgE; however clinicians should obtain a thorough history of travel and food habits.
Abdominal Wall ; Aged ; Astacoidea ; Child ; Eating ; Enzyme-Linked Immunosorbent Assay ; Eosinophilia ; Eosinophils ; Food Habits ; Fresh Water ; Humans ; Immunoglobulin E ; Korea ; Metacercariae ; Paragonimiasis ; Paragonimus ; Paragonimus westermani ; Pleural Effusion ; Praziquantel ; Soybeans

BACKGROUND: Headache is one of the most common symptoms having experienced by many people. High school girls are expected to experience headache very often. Their proper treatment and adequate medical service is doubtful, and stressful environment of the Korean high school will augment the chronicity of headache. Knowing the forms of headache and categorizing the headache according to headache classification system is important for proper treatment of headache. Types of headache in high school girls have been categorized using International Headache Society (IHS) system. The relationships of headache with Beck Depression Inventory (BDI) and Family APGAR score of the headache groups and control group are investigated. Thus, the purpose of this study was to attribute to the treatment of the headache in female youths. METHODS: The questionnaires .on headache, under direct interviews, was given to each high school girls in Seoul, from March 1 to 31, 1999. The headache group was subclassified into migraine group, tension headache group and other headache group, using IHS system. Furthermore, the migraine group was subclassified into migraine with aura (classic migraine), migraine without aura (common migraine) and other migronous disorder. The students who had not experienced any headaches during the recent one year have been selected as the normal group. The normal group was compared with the headache group, i.e., tension headache and migraine. Depressed tendency was assessed using the BDI; and family function was evaluated by Family APGAR. The data are analyzed using SPSS 8.0. RESULTS: Among the subjects, 304 (60.4%) high school girls had experienced a headache during the previous one year. The girls with migraine, tension headache, and other types of headache were 110 (38%), 81 (27%) and 113 (35%), respectively. The migraine group showed higher BDI scores (p<0.01). Also, the migraine group showed more depressiveness than the normal group (p<0.01), according to the scores on the BDI which were greater than the cutting score of 21. In the Family APGAR, there was no significant difference between the headache groups and the normal group.(P>0.05) CONCLUSIONS: When the headache in high school girls was classified by using IHS system, headache in the migraine group was more prevalent than in the tension headache group and normal group. And the migraine group had more depressive tendency. When physicians deal with the headache in high school girls, they need to be aware of migraine headache and associated depressive tendency.
Adolescent ; Apgar Score ; Classification ; Depression ; Female* ; Headache* ; Humans ; Migraine Disorders ; Migraine with Aura ; Migraine without Aura ; Seoul ; Tension-Type Headache ; Surveys and Questionnaires

PURPOSE: Neurologic complications(NC) after hematopoietic stem cell transplantation(HSCT) are important because of high mortality and severe sequelae. We analyzed the incidence, manifestation and risk factors of NC in 61 children undergoing HSCT. METHODS: We retrospectively analyzed NC in 61 cases(42 male and 19 female, aged one to 16 years) given HSCT between 1996 and 2003 due to hematologic malignacies, solid tumors, or other hematologic diseases. RESULTS: NC were seen in 22 children(36.0%). Herpes zoster was the most frequent one(n=17, 27.9 %), followed by seizure(n=8, 13.1%), CNS infection(n=3, 4.9%), cyclosporin toxicity(n=3, 4.9%), CVA (n=2, 3.3%), and chemotherapy injury(n=1, 1.6%). Among the 22 cases, 12 developed herpes zoster only and 10 developed other NC in addition to herpes zoster. Two patients died of NC. The incidence of NC was not affected by various factors, including type and source of HSCT or previous cranial radiation. CONCLUSION: NC were frequent in children who underwent HSCT. We should acknowlege the occurrence of various NC after HSCT. Further study is needed to develop measures to minimize these complications.
Child ; Male ; Female ; Humans ; Incidence ; Mortality ; Risk Factors