To make guideline to the diagnosis and treatment and of the intracranial nodular lesions, the authors made a clinical analysis on 81 pediatric patients who had showed nodular lesions on brain CT scan at Severance Hospital from Mar. 1979 to Feb. 1989 and the results were summarized as follows. 1) The peak incidence of intracranial nodular lesions was found in the 2nd decade(61.7%). There was no sexual difference. 2) The most common clinical symptom was seizure(92.6%) and the predilection site was parietal area. The nodular enhancing type on brain CT scan showed not only the most common type but also the most favorable clinical course. 3) As the etiology of the intracranial nodular lesions, tuberculosis, paragonimiasis, cysticercosis, tumor(meningioma), and aspergillosis were confirmed or suspected, but tuberculosis was the most common. CSF routine examination, chest PA, PNS X-rays, skin test for paragonimiasis and tuberculosis, CSF ELISA test for cysticercosis and paragonimiasis should be routine as the diagnostic studies. 4) We made treatment principle for intracranial nodular lesions. In cases that initial brain CT scan show low density or calcified density without contrast enhancement, we treat those patients with anticonvulsants and steroid with regular check-up. If the lesion increases in size or new enhancement develops on follow up CTY scan, medications for the suspected etiology should be added. In cases that initial brain CT scan show enhancing lesions, treatment is started with anticonvulsants and medications for the etiology with regular check up. If the lesion increase in size on follow up CT scan or seizure is uncontrolled. Surgery should be considered.
Anticonvulsants ; Aspergillosis ; Brain* ; Child* ; Cysticercosis ; Diagnosis ; Enzyme-Linked Immunosorbent Assay ; Follow-Up Studies ; Humans ; Incidence ; Meningioma ; Paragonimiasis ; Rabeprazole ; Seizures ; Skin Tests ; Thorax ; Tomography, X-Ray Computed* ; Tuberculosis

PURPOSE: Early diagnosis of congenital hearing loss through the neonatal hearing screening test minimizes language defect. This research intends to identify frequency of congenital hearing loss in infants through neonatal hearing screening test with the aim of communicating the importance of hearing test for infants. METHODS: From May 20, 2003 to May 19, 2004, infants were subjected to Automated Auditory Brainstem Response test during one month of birth to conduct the test with 35 dB sound. Infants who passed the 1st round of hearing test, were classified into 'pass' group whereas those who did not were classified into 'refer' group. Infants who did not 'pass' in the hearing test conducted within one month of birth were subjected to re-test one month later, and if classified as 'refer' during the re-test, they were subjected to the diagnosis for validation of hearing loss by requesting test to the hearing loss clinic. RESULTS: There was no difference among the 'pass' and 'refer' group in terms of form of childbirth, weight at birth and gestational age. In the 1st test, total of 45 infants were classified into 'refer' group. Six among 35 who were subjected to re-test (17%) did not pass the re-test, and all were diagnosed with congenital hearing loss. This corresponds to 0.35% (3.5 per 1, 000) among total number of 1, 718 subjects. CONCLUSION: In our study the congenital hearing loss tends to be considerably more frequently than congenital metabolic disorder. Accordingly, newly born infants are strongly recommended to undergo neonatal hearing screening test.
Diagnosis ; Early Diagnosis ; Evoked Potentials, Auditory, Brain Stem ; Gestational Age ; Hearing Loss* ; Hearing Tests ; Hearing* ; Humans ; Infant ; Mass Screening* ; Parturition

Transradial access is a widely accepted method for percutaneous coronary diagnostic and interventional procedures, and it has dramatically reduced access site vascular complications compared to transfemoral access. Arteriovenous fistula formation at the access site is an especially rare complication in transradial access. We report an extremely rare case of delayed radial arteriovenous fistula that developed one year after transradial coronary angiography, which was successfully treated by surgical repair.
Angiography ; Arteriovenous Fistula ; Cardiac Catheterization ; Coronary Angiography ; Vascular Diseases

Pleomorphic xanthoastrocytoma is known as a rare specialized type of cerebral astrocytoma. Clinical and pathological characteristics are summarized as follows: 1) Clinically-young patients, presentation with seizure and increased intracranial pressure symptoms, and relatively favorable clinical courses. 2) Pathologically-predilection for temporal and parietal lobes, superficial location involving leptomeninges but not dura mater, circumscribed nature, marked pleomorphism with spindle cells, multinucleated giant cells, and lipid laden xanthomatous cells, few mitoses, no necrosis, rich reticulin networks, and demonstration of glial fibrillary acidic proteins. Its optimal treatment is considered to be a complete surgical excision and the value of radiotherapy is uncertain. Three cases of supratentorial intrinsic brain tumor and a case of spinal cord tumor full filling the above clinical and histological characteristics are presented.
Astrocytoma ; Brain Neoplasms ; Dura Mater ; Giant Cells ; Glial Fibrillary Acidic Protein ; Glioma ; Humans ; Intracranial Pressure ; Mitosis ; Necrosis ; Parietal Lobe ; Radiotherapy ; Reticulin ; Seizures ; Spinal Cord Neoplasms

Author analyzed 117 patients with traumatic lesions in posterior cranial fossa who had been treated at the Department of Neurosurgery in Jeonju Presbyterian Medical Center from January 1982 to December 1985. Results are summarized as follows: 1) The traumatic lesions in posterior cranial fossa were 4.97% of all head injuries. 2) 73 out of 117 patients were male and female were 44 cases. 75.2% of cases were found below age of 40. 3) The most common cause of injuries was traffic accident with motor vehicle(50%). 4) Occipital skull fractures were found in 69 cases(50.4%). Most of them were linear type. There were 15 epidural hematoma(12.8%), 6 cerebellar hematoma, 4 pontine hematoma, 1 subdural hematoma. 5) 67 cases of all patients were on Grady coma scale grade 1 and 2. 48 cases were on Grady coma scale grade 3 and 4. 2 cases were on Grady coma scale grade 4 and 5 on admission. 6) 13 cases with traumatic hematomas in posterior cranial fossa were treated surgically and 13 cases conservatively. 3 of them were expired. 7) There were 61 cases associated injuries(52.1%). Commonly associated injuries were the fracture of rib, clavicle and femur. 8) 50 out of 117 cases showed sequelae:Motor weakness and cranial nerve palsies were main deficits. 9) The total mortality of traumatic posterior fossa lesions was 12.8%(15 cases) and the operative mortality was 15.4%(2 cases).
Accidents, Traffic ; Clavicle ; Coma ; Cranial Fossa, Posterior* ; Cranial Nerve Diseases ; Craniocerebral Trauma ; Female ; Femur ; Hematoma ; Hematoma, Subdural ; Humans ; Jeollabuk-do ; Male ; Mortality ; Neurosurgery ; Protestantism ; Ribs ; Skull Fractures

Author analyzed 117 patients with traumatic lesions in posterior cranial fossa who had been treated at the Department of Neurosurgery in Jeonju Presbyterian Medical Center from January 1982 to December 1985. Results are summarized as follows: 1) The traumatic lesions in posterior cranial fossa were 4.97% of all head injuries. 2) 73 out of 117 patients were male and female were 44 cases. 75.2% of cases were found below age of 40. 3) The most common cause of injuries was traffic accident with motor vehicle(50%). 4) Occipital skull fractures were found in 69 cases(50.4%). Most of them were linear type. There were 15 epidural hematoma(12.8%), 6 cerebellar hematoma, 4 pontine hematoma, 1 subdural hematoma. 5) 67 cases of all patients were on Grady coma scale grade 1 and 2. 48 cases were on Grady coma scale grade 3 and 4. 2 cases were on Grady coma scale grade 4 and 5 on admission. 6) 13 cases with traumatic hematomas in posterior cranial fossa were treated surgically and 13 cases conservatively. 3 of them were expired. 7) There were 61 cases associated injuries(52.1%). Commonly associated injuries were the fracture of rib, clavicle and femur. 8) 50 out of 117 cases showed sequelae:Motor weakness and cranial nerve palsies were main deficits. 9) The total mortality of traumatic posterior fossa lesions was 12.8%(15 cases) and the operative mortality was 15.4%(2 cases).
Accidents, Traffic ; Clavicle ; Coma ; Cranial Fossa, Posterior* ; Cranial Nerve Diseases ; Craniocerebral Trauma ; Female ; Femur ; Hematoma ; Hematoma, Subdural ; Humans ; Jeollabuk-do ; Male ; Mortality ; Neurosurgery ; Protestantism ; Ribs ; Skull Fractures

OBJECTIVE: Post-traumatic cerebral infarction (PTCI) is one of the most severe secondary insults after traumatic brain injury (TBI), and is known to be associated with poor outcome and high mortality rate. We assessed the practical incidence and risk factors for the development of PTCI. METHODS: We conducted retrospective study on 986 consecutive patients with TBI from the period May 2005 to November 2012 at our institution. The definition of PTCI was made on non-enhanced CT scan based on a well-demarcated or fairly discernible region of low attenuation following specific vascular territory with normal initial CT. Clinical and radiological findings that related to patients' outcome were reviewed and statistically compared. RESULTS: PTCI was observed in 21 (2.1%) patients. Of various parameters, age (p=0.037), initial Glasgow coma scale score (p<0.01), brain herniation (p=0.044), and decompressive craniectomy (p=0.012) were significantly higher in patients with PTCI than patients who do not have PTCI. Duration between accident and PTCI, patterns of TBI and vascular territory of PTCI were not specific. The mortality rates were significantly higher in patients with PTCI than without PTCI. CONCLUSION: The development of PTCI is rare after TBI, but it usually results in serious outcome and high mortality. Early recognition for risks and aggressive managements is mandatory to prevent PTCI.
Brain ; Brain Injuries* ; Cerebral Infarction* ; Craniocerebral Trauma ; Decompressive Craniectomy ; Glasgow Coma Scale ; Hernia ; Humans ; Incidence* ; Mortality ; Retrospective Studies ; Risk Factors* ; Tomography, X-Ray Computed

Acute fatty liver of pregnancy is a rare, clinically distinct cause of jaundice occuring during the third trimester of pregnancy, with maternal death as the usual outcome and first described in 1,940 by Sheehan, which may be characterized by nausea, vomiting, epigastric pain, jaundice and confirmed by liver biopsy. We have experienced a case of acute fatty liver at 38 weeks of gestation in 30 year-old primigravida woman and reproted with a brief review of related literatures.
Adult ; Biopsy ; Fatty Liver* ; Female ; Humans ; Jaundice ; Liver ; Maternal Death ; Nausea ; Pregnancy Trimester, Third ; Pregnancy* ; Vomiting

PURPOSE: To assess the incidence of neonatal hearing loss in a neonatal intensive care unit and the relative importance of risk factors for hearing imparement in a neonatal intensive care unit which the Joint Committee on Infant Hearing(JCIH) had recommended. METHODS: One thousand, two hundred and one newborns admitted to the Good Moonhwa Intensive Care Unit from May 2003 to December 2005 were assesed using the automated auditory brainstem response(AABR). The screening was performed on those aged more than 36 weeks and weighing more than 2,200 g. We divided the infants into two groups, 'pass' and 'refer'. The 'refer' group were retested one month later, and if classified as 'refer' during the retest, were referred to a hearing impairment clinic. RESULTS: From the 1,201 neonates, 1,187(98.8 percent) passed the test and 14(1.2 percent) failed. 293(24.4 percent) of the 1,201 neonates had a risk factor for hearing impairment; 282(96.2 percent) passed the test and 11(3.8 percent) failed. The group with risk factors were shown to have a higher incidence of hearing loss(P<0.001). The neonates in the refer group were shown to have a higher incidence of ototoxic drugs(P<0.001), low birth weight(<1,500 g)(P<0.001) and craniofacial anomalies(P=0.007). On the other hand, there were no statistical differences between the pass and refer groups in congenital infection, hyperbilirubinemia, bacterial meningitis, low Apgar scores, prolonged mechanical ventilation and syndromes known to include hearing loss. CONCLUSION: In order to identify hearing-impaired infants within an appropriate period, neonatal hearing screening tests and identification of the risk factors for neonatal hearing loss are important.
Brain Stem ; Equidae ; Hand ; Hearing Loss* ; Hearing* ; Humans ; Hyperbilirubinemia ; Incidence* ; Infant ; Infant, Newborn ; Intensive Care Units ; Intensive Care, Neonatal* ; Joints ; Mass Screening ; Meningitis, Bacterial ; Parturition ; Respiration, Artificial ; Risk Factors*

BACKGROUND: Primary focal segmental glomerulosclerosis (FSGS) is a cause of nephrotic syndrome in adult. Although primary FSGS has been known to be refractory to treatment, recent studies reveal higher remission rate and better prognosis. And it has been reported that some clinical and histopathologic parameters are significant to prognosis. But, confirmative prognostic indices remain to be defined. In order to further clarify the prognostic factors for therapeutic response and risk factors for progression to chronic renal failure (CRF), we reviewed the medical records of primary adult FSGS patients. METHODS: Forty-adult patients diagnosed as primary FSGS between 1991 to 2002 were enrolled. We retrospectively analyzed the clinical and histopathological parameters of all patinents at the time of renal biopsy. In addition, the therapeutic responses to immunosuppressants and the renal survival were analyzed. RESULTS: At the time of renal biopsy, 26 patients (65%) had proteinuria of the nephrotic range and 14 patients (35%) had proteinuria of the non-nephrotic range. The serum creatinine level was higher in nephrotic-ranged patients than that in non nephrotic-ranged patients (p<0.05). The other parameters were not significantly different between two groups. Twenty-seven patients were treated with immunosuppressants and 15 patients (55.6%) responded to the treatment. There was no significant difference in clinical or histopathological variables between the responders and the non-responders. High serum creatinine level at diagnosis and responsiveness to treatment appeared to be significant as risk factors for progression to CRF (p<0.05). The patients treated with immunosuppressants had longer survival period, compared with those without treatment. And the responders had significantly longer survival period compared with the non-responders (p<0.05). CONCLUSION: The patients with initial impairment of renal function or poor response to therapy may have worse prognosis, and the intense treatment with regular follow-up of renal function should be recommended for these patients.
Adult* ; Biopsy ; Creatinine ; Diagnosis ; Follow-Up Studies ; Glomerulosclerosis, Focal Segmental* ; Humans ; Immunosuppressive Agents ; Kidney Failure, Chronic ; Medical Records ; Nephrotic Syndrome ; Prognosis ; Proteinuria ; Retrospective Studies ; Risk Factors