Fungal infection of the central nervous system tends to occur in immunosuppressed patients. In the pediatric population, it is usually seen in severely immunocompromised patients, particulary in children with chronic granulomatous disease, hematopoietic malignancies, and those receiving chemotherapy or corticosteroid therapy. Literature indicates rare survivors from neonatal aspergillosis. We report a case of multiple brain abscess caused by Aspergillus in a 15-day-old male neonate, who had suffered from high fever, generalized seizure, severe dehydration, and azotemia. The patient was immunologically competent and successfully treated with surgical removal and antifungal agents.
Abscess* ; Antifungal Agents ; Aspergillosis ; Aspergillus* ; Azotemia ; Brain Abscess ; Central Nervous System ; Child ; Dehydration ; Drug Therapy ; Fever ; Granulomatous Disease, Chronic ; Hematologic Neoplasms ; Humans ; Immunocompromised Host ; Infant, Newborn* ; Male ; Seizures ; Survivors

Fungal infection of the central nervous system tends to occur in immunosuppressed patients. In the pediatric population, it is usually seen in severely immunocompromised patients, particulary in children with chronic granulomatous disease, hematopoietic malignancies, and those receiving chemotherapy or corticosteroid therapy. Literature indicates rare survivors from neonatal aspergillosis. We report a case of multiple brain abscess caused by Aspergillus in a 15-day-old male neonate, who had suffered from high fever, generalized seizure, severe dehydration, and azotemia. The patient was immunologically competent and successfully treated with surgical removal and antifungal agents.
Abscess* ; Antifungal Agents ; Aspergillosis ; Aspergillus* ; Azotemia ; Brain Abscess ; Central Nervous System ; Child ; Dehydration ; Drug Therapy ; Fever ; Granulomatous Disease, Chronic ; Hematologic Neoplasms ; Humans ; Immunocompromised Host ; Infant, Newborn* ; Male ; Seizures ; Survivors

OBJECTIVE: PTEN is a novel tumor-suppressor gene located on chromosomal band 10q23. Loss of PTEN function has been implicated in the progression of several types of cancer, including glial tumors. This study is performed to evaluate the difference of PTEN expression between the low grade glial tumors and the high grade one. METHODS: Formalin fixed and paraffin embedded tissues from 15 patients with low grade astrocytoma and oligodendroglioma, and 26 patients with glioblastoma, anaplastic astrocytoma, anaplastic oligodendroglioma and malignant mixed glial tumor were evaluated for PTEN expression by immunohistochemical method. RESULTS: Eleven(73%) of 15 cases of low grade glial tumors revealed PTEN expression and eight(31%) of 26 cases of high grade glial tumors, including glioblastoma, revealed PTEN expression. CONCLUSION: The present study suggests that loss of PTEN expression is related with tumor progression from the low grade glial tumor to glioblastoma.
Astrocytoma ; Brain* ; Formaldehyde ; Glioblastoma ; Humans* ; Oligodendroglioma ; Paraffin

Distal thrombosed aneurysm of the superior cerebellar artery (SCA) is extremely rare and is often associated with cerebellar infarction or subarachnoid hemorrhage. We report herein on a case involving a patient with a ruptured thrombosed distal SCA aneurysm which was treated successfully through the endovascular approach.
Aneurysm ; Arteries ; Humans ; Infarction ; Subarachnoid Hemorrhage

BACKGROUND: Left ventricular hypertrophy is common in chronic renal failure patients and may contribute increased risk of cardiovascular morbidity and mortality. We evaluated the left ventricular morphology and function in renal transplant recipients to find the relationship between hemodynamic changes and morphologic and functional improvement after transplantation. METHODS: Serial echocardiographic evaluations were performed in 27 adults(20 men and 7 women) at the time of transplantaion and posttransplantation 1 month and 4 months. The average duration of hemodialysis was 16+/-24 months(mean+/-S.D.). RESULTS: At the time of transplantation, the hematocrit level was 21+/-6% and posttransplantation 1 month and 4 months, that was increased to 39+/-5% and 42+/-7%, respectively(p<0.001). Left ventricular mass index by echocardiography was decreased significantly from 246+/-87g/m2(pre-KT) to 169+/-38g/m2(post-KT 1 month) and 153+/-40g/m2(post-KT 4 months), respectively (p<0.001). Interventricular septal thickness and left ventricular posterior wall thickness were decreased significantly after 4 months of transplantation. Left ventricular systolic and diastolic dimensions were also decreased significantly after 1 month and 4 months of transplantation. Left ventricular volumes and cardiac output were also decreased significantly. But A/E ratio, ejection fraction and fractional shortening did not change significantly. CONCLUSION: These findings showed that pretransplant high output state was resolved radipidly(within 1 month) but the diastolic function did not improved after transplantation 1 month and 4 months.
Cardiac Output ; Echocardiography* ; Hematocrit ; Hemodynamics ; Humans ; Hypertrophy, Left Ventricular ; Kidney Failure, Chronic ; Kidney Transplantation ; Male ; Mortality ; Renal Dialysis ; Transplantation*

BACKGROUND: Anesthesia induction time is related to speed of injection, injected volume, and Keo. In the case of target controlled infusion, induction time can be controlled by adjusting the induction time mode. The aim of this study was to estimate the effect of induction time mode on variable parameters and vital signs during anesthesia induction with propofol using a target controlled infusion (TCI). METHODS: Sixty unpremedicated adult patients (ASA class I or II, 18 55 yrs) scheduled for elective surgery were randomly allocated to four groups according to induction mode. Group 1 was assigned a flash induction mode, and groups 2, 3 and 4 were assigned 2, 3 and 4min respectively. The end point of anesthesia induction was loss of eyelash reflex. Various parameters including induction time, infused volume, current/effect concentration at induction, and vital signs were compared. RESULTS: As the induction time mode was prolonged, induction time was delayed, but there was no difference in infused volume. Also, the current concentration decreased gradually, but the effect concentration did not show any difference. The vital signs were more stable in groups 3 and 4 compared with groups 1 and 2. CONCLUSIONS: For anesthesia induction, a rapid induction mode showed more rapid induction and low current concentration, but vital signs were relatively unstable and the effect concentration at induction showed no difference. For critically ill patients or patients with unstable hemodynamics, a more gradual induction mode for anesthesia induction in propofol TCI is recommended.
Adult ; Anesthesia* ; Critical Illness ; Hemodynamics ; Humans ; Propofol* ; Reflex ; Vital Signs*

Most common cause of brisk hematochezia is diverticular bleeding in Western countries. It occurs in 15% of patients with diverticulosis and one-third of them appear to be massive. Most of diverticulosis in Western countries occur in the left colon but the right colon is more common in Korea. Especially, the reports of diverticular bleeding on left colon are rare in Korea. We report a case presenting with multiple diverticuli complicated by recurrent massive bleeding restricted to the left colon. 75-year-old female was admitted due to hematochezia and dizziness. On past history, two years and two weeks ago respectively, she was treated of diverticular bleeding with and without diverticulitis. Hemoglobin level was 9.8 g/dL. On Colonoscopy, numerous diverticuli were seen at sigmoid colon upto splenic flexure which showed fresh blood clots in the lumen. We diagnosed her as recurrent massive diverticular bleeding on the sigmoid colon. She received elective laparoscopic left hemicolectomy.
Aged ; Colonoscopy ; Diagnosis, Differential ; Diverticulosis, Colonic/complications/*diagnosis/surgery ; Female ; Gastrointestinal Hemorrhage/*diagnosis/etiology/therapy ; Humans ; Recurrence ; Sigmoid Diseases/*diagnosis/etiology/therapy ; Tomography, X-Ray Computed

BACKGROUND: The bispectral index (BIS) has been designed to objectively measure the degree of sedation and hypnosis for several anesthetics. The aim of this study was to evaluate the changes of the BIS during desflurane-N2O-O2 anesthesia. METHODS: With Institutional Review Board approval and informed consent, forty premedicated (atropine 0.5 mg, IM) male and female adult patients (ASA class 1 or 2, 18 55 yrs) scheduled for elective surgery were studied. After intubation with the aid of propofol (2.0 mg/kg) and vecuronium (0.15 mg/kg), anesthesia was maintained with desflurane in combination with 50% N2O and 50% O2. Several transitions between 3.0 and 12.0 vol% were performed. During anesthesia, the BIS was checked at least 30 min after induction to avoid the residual effect of propofol and after 15 min maintenance of a certain inhaled concentration for equilibration. RESULTS: The values of BIS were correlated closely with the desflurane concentrations (r = 0.88). Steep changes in the BIS were shown between 1.5 6.0 vol% and a ceiling effect regarding the BIS over 6.0 vol% was observed. CONCLUSIONS: The BIS is valuable for measuring the degree of sedaton and hypnosis in desflurane anesthesia. Above 6.0 vol%, desflurane showed a ceiling effect regarding the BIS.
Adult ; Anesthesia ; Anesthetics ; Ethics Committees, Research ; Female ; Humans ; Hypnosis ; Informed Consent ; Intubation ; Male ; Propofol ; Vecuronium Bromide

BACKGROUND: Bispectral index (BIS) has been designed to measure objectively the degree of sedation and hypnosis for several anesthetics. It is predicted that sedation and hypnosis during nitrous oxide inhalation affect BIS in an unusual manner due to a different mechanism compared to usual hypnotics. The aim of this study was to evaluate the effect of different concentration of nitrous oxide inhalation on BIS and sedation score. METHODS: Forty unpremedicated ASA physical status I or II patients scheduled for lower extremity surgery were studied. After performing epidural anesthesia, patients inhaled gradually increasing concentrations of nitrous oxide from 0 to 67% (15 minutes for each concentration) via a tightly sealed face mask. At the end of each inhalation, BIS and OAA/S scale (Observers's Assessment of Alertness/ Sedation scale) were assessed. RESULTS: The increasing concentrations of inhaled nitrous oxide resulted in significant reduction of the OAA/S scale but in no change of BIS. Concentrations of nitrous oxide exceeding 50% affected behavior or emotion of the patients. CONCLUSIONS: Following increasing concentrations of inhaled nitrous oxide, sedation score was reduced significantly but BIS was not affected.
Anesthesia, Epidural ; Anesthetics ; Humans ; Hypnosis ; Hypnotics and Sedatives ; Inhalation ; Lower Extremity ; Masks ; Nitrous Oxide*