No abstract available.

In spite of the appropriate antibiotic treatment and the development of newer antibiotics, bacterial meningitis still has a high risk of complications. Especially, vascular involvements of meningitis, including vasospasms and infarctions, frequently result in neurologic sequelae. Here, we report a case of bacterial meningitis complicated by arterial vasospasms and multiple infarctions during a clinically improving course. This case suggests that in the management of bacterial meningitis, early evaluation and monitoring of vasculitis by TCD and its management could prevent fatal outcomes.
Anti-Bacterial Agents ; Cerebral Infarction* ; Fatal Outcome ; Infarction ; Meningitis ; Meningitis, Bacterial* ; Vasculitis

A 31-year-old woman was referred to our pain clinic department under the diagnosis of an adult onset Still's disease. She had been suffering from high fever, skin rash, multiple arthralgia, morning stiffness and lymph node enlargement for 16 months. She had taken conventional medication with steroid and NSAIDs, but the symptoms were a remittent nature. And also, she complained of systemic side effects of corticosteroids. Stellate ganglion block with 0.25% bupivacaine was performed 67 times for the treatment of adult onset Still's disease and then, her symptoms were improved eventually. We could discontinue steroid and NSAIDs, laboratory data were satisfactory. As we experienced an adult onset still's disease improved with stellate ganglion block, we report this case with a review of the literature.
Adrenal Cortex Hormones ; Adult* ; Anti-Inflammatory Agents, Non-Steroidal ; Arthralgia ; Bupivacaine ; Diagnosis ; Exanthema ; Female ; Fever ; Humans ; Lymph Nodes ; Pain Clinics ; Stellate Ganglion* ; Still's Disease, Adult-Onset*

PURPOSE: Although Henoch-Sch nlein purpura(HSP) has been described in detail, there is a paucity of information describing scrotal involvement and risk factors for renal involvement. This study was performed to evaluate the incidence of scrotal involvement and the relationship between renal and nonrenal involvement, including scrotal involvement. METHODS: We retrospectively reviewed medical records of 164 male children who were diagnosed as HSP at the Department of Pediatrics, Korea University Guro Hospital between January 1985 and December 1997. RESULTS: The incidence of scrotal involvement was 13.4%(22/164), and the mean age of the group of scrotal involvement was significantly younger(5.6+/-1.9 year) than that of the others (P<0.05). One patient was initially seen with scrotal involvement without any other symptoms, another patient, who presented with acute scrotal pain and swelling, turned out to have testicular torsion through laparotomy. Those with scrotal and gastrointestinal symptoms were more likely to be related to renal involvement at acute stage, but there was no statistical difference. Those with scrotal symptoms at acute stage developed nephritis more frequently after 6 months(P<0.05). CONCLUSION: Those with scrotal symptoms at acute stage of HSP should be followed up for at least 6 months.
Child ; Humans ; Incidence ; Korea ; Laparotomy ; Male ; Medical Records ; Nephritis ; Pediatrics ; Purpura* ; Retrospective Studies ; Risk Factors ; Spermatic Cord Torsion

Persistent cloaca is a very rare congenital anomaly with a single common perineal opening for the genital urinary and gastrointestinal tract, which is caused by abnormal formation of the urorectal septum. It has an incidence of 1 in 50,000 to 1 in 125,000 births and is much more common in females and in twin pregnancies. Pathologic findings of persistent cloaca include dilated bowel, hydrocolpos, urethral obstruction, hydronephrosis and oligohydramnios caused by obstruction of the bladder, vagina and intestine. Failure of the paired m llerian ducts to fuse also usually results in duplication of the uterus and vagina. Currently, the diagnosis depends on the prenatal sonography but the diagnosis may be very difficult due to the complex nature of the anomaly and variable appearances. We present a case of persistent cloaca with one opening confirmed by autopsy after therapeutic termination which was initially diagnosed by prenatal sonography.
Autopsy ; Cloaca* ; Diagnosis ; Female ; Gastrointestinal Tract ; Humans ; Hydrocolpos ; Hydronephrosis ; Incidence ; Intestines ; Oligohydramnios ; Parturition ; Pregnancy ; Pregnancy, Twin ; Urethral Obstruction ; Urinary Bladder ; Uterus ; Vagina

The role of neuropeptides in the central nervous system (CNS) has received increasing attention. Numerous peptide molecules are found in the mammalian CNS and many of them are thought to act as either neurotransmitters or neuromodulators. The neuropeptides found in high concentration in the hypothalamus include vasopressin (VP), vasoactive intestinal polypeptide, somatostatin, and oxytocin. The main approches to assess the involvement of neuropeptides can be focused on functions affecting the aging of the brain. Morphological aging of the CNS has been characterized by degenerative changes of fiber connections and cell loss, although degeneration does not always occur to the same extent throughout various parts of the brain and, moreover, varies for different cell types. Despite of many studies in VP containing neurons , there exist discrepancies in results about the changes of aged rat brain. The aim of the present study is, therefore, to investigative possible changes in the number and morphology of VPimmunoreactive neurons with aging in each area of the hypothalmus of the aged rats. As a result, the number of VP-immunoreactive neurons was decreased in hypothalamus nucleus of aged group. Especially, in VP-immunoreactive neurons of hypothalamus, the size of neuronal cell body and nuclei in aged group is larger than in young group and the fiber density of immunoreactivity neurons of median eminance (ME) in aged group is stronger than in young group. But, the total number of VP-immunoreactive neurons in the suprachiasmatic nucleus (SCN) of the aged group is larger than in the young group. These studies indicate the involvement of VP-immunoreactive neurons in aging process of hypothalamus, and aging process may affect the synthesis of VP in the neurons of hypothalamic nuclei. Whereas, in VP expression, aging process induces an enlargement of the cell size of surviving neurons to compensate.
Aging ; Animals ; Brain ; Cell Size ; Central Nervous System ; Hypothalamus* ; Neurons* ; Neuropeptides ; Neurotransmitter Agents ; Oxytocin ; Paraventricular Hypothalamic Nucleus ; Rats* ; Somatostatin ; Suprachiasmatic Nucleus ; Supraoptic Nucleus ; Vasoactive Intestinal Peptide ; Vasopressins

BACKGROUND: Although the elderly patients who need coronary revascularization are increasing, the effecti- veness and benefit of percutaneous coronary intervention(PCI) or coronary artery bypass surgery(CABG) in the elderly patients have not been evaluated by using comprehensive geriatric assessment. METHODS: From January 2007 to May 2007, 47 patients aged 65 years or older, who had stable angina with more than one coronary artery stenosis, were included in the current study. Comprehensive geriatric assess- ment, including medical, psychosocial, and functional evaluation, was performed by geriatric team. Patients were managed by medical treatment, PCI or CABG according to the decision of attending physician. One year clinical and laboratory evaluations were performed in all the study patients. RESULTS: Baseline characteristics were not significantly different among the medical treatment, PCI, or CABG group, except the extent of coronary artery disease(p=0.007). In addition, comprehensive geriatric assess- ment showed no difference in the three groups. During the follow-up period, major adverse cardiac events (MACE) were observed in 9 patients including 2 cases of cardiac death. Compared with medical treatment and PCI group, CABG group showed impaired ADL status. ADL independency was significantly impaired in CABG group; medical treatment group(84.6%-->91.7%), PCI group(85.2%-->76.9%), and CABG group(71.4%-->33.3%)(p=0.025). However, there was no other difference in cognition, depression, and nutritional status among the groups. CONCLUSION: Compared with medical treatment and PCI group, patients treated by CABG appeared functional dependency in the elderly patients. Effort to identify the risk factor and vulnerable patients should be emphasized especially in the elderly patients who need CABG.
Activities of Daily Living ; Aged ; Angina, Stable ; Cognition ; Coronary Artery Bypass ; Coronary Artery Disease ; Coronary Stenosis ; Coronary Vessels ; Death ; Dependency (Psychology) ; Depression ; Follow-Up Studies ; Geriatric Assessment ; Humans ; Nutritional Status ; Risk Factors

PURPOSE: This study was undertaken to determine the preoperative predictors of mortality and morbidity after lung cancer resection. METHOD: During the period from October 1, 1995 to August 31, 1996, a prospective study was conducted in 92 lung resection candidates diagnosed as lung cancer. For preoperative predictors of nonpulmonary factors, we considered age, sex, weight loss, hematocrit, serum albumin, EKG and concomitant illness, and f or those of pulmonary factors, smoking history, presence of pneumonia, dyspnea scale(1 to 4), arterial blood gas analysis with room air breathing, routine pulmonary function test. And predicted postoperative(ppo) pulmonary factors such as ppo-FEV1, ppo-diffusing capacity(DLco), predicted postoperative product(PPP) of ppo-FEV1 % x ppo-DLco% and ppo-maximal O2 uptake(VO2max) were also considered. RESULTS: There were 78 men and 14 women with a median age of 62 years(range 42 to 82) and a mean FEV1 of 2.37+/-0.06L. Twenty nine patients had a decreased FEV1 less than 2.0L. Pneumonectomy was performed in 26 patients, bilobectomy in 12, lobectomy in 54. Pulmonary complications developed in 10 patients, cardiac complications in 9, other complications(empyema, air leak, bleeding) in 11, and 16 patients were managed in intensive care unit for more than 48hours. Three patients died within 30 days after operation. The ppo-O2max was less than 10ml/kg/min in these three patients, but its statistical significance could not be determined due to small number of patients. In multivariate analysis, the predictor related to postoperative death was weight loss (p<0.05), and as for pulmonary complications, weight loss, dyspnea scale, ppo-DLco and extent of resection(p<0.05). CONCLUSIONS: Based on this study, preoperative nonpulmonary factors such as weight loss and dyspnea scale are more important than the pulmonary factors in the prediction of postoperative mortality and/or morbodity in lung resection candidates, but exercise pulmonary fuction test may be useful. Our study suggests that ppo-VO2max value less than 10ml/kg/min is associated with death after lung cancer resection but further studies are needed to validate this result.
Blood Gas Analysis ; Dyspnea ; Electrocardiography ; Female ; Hematocrit ; Humans ; Intensive Care Units ; Lung Neoplasms* ; Lung* ; Male ; Mortality* ; Multivariate Analysis ; Pneumonectomy ; Pneumonia ; Prospective Studies* ; Respiration ; Respiratory Function Tests ; Serum Albumin ; Smoke ; Smoking ; Weight Loss

PURPOSE: Multiple symmetric lipomatosis (MSL) is a relatively rare disorder characterized by presence of multiple, symmetric, nonencapsulated fat masses in face, neck, shoulder and other areas. There has been only a few cases reported in Korea. The main purpose of this research is to examine the Korean patients to see what kinds of special characteristics occurred due to this disease and to decide the proper treatment. METHODS: A total of 16 patients were evaluated retrospectively. 5 patients were treated at our hospital. The other patients were reviewed from literature. We analyzed the biological characters of patients, location of fat deposit, morphologic characters of patients, clinical evidence of neuropathy, associated metabolic disorders and treatment modality. RESULTS: All cases were male patient. The mean age of onset was 47.43 years. All patients were moderate to heavy alcoholics. The most common location of fat deposition was posterior neck and abdomen. In neurologic exam of 9 patients, 5 patients showed muscle weakness, tremor, pain and autonomic nerve dysfunction. In metabolic studies of 9 patients, total cholesterol values were higher in 1 patient. A glucose tolerance test was abnormal in 1 patient. In treatment modality, 14 patients were treated with surgical resection, 1 patient was treated with liposuction and surgical excision, 1 patient was treated only with liposuction. CONCLUSION: To treat MSL patients successfully, we should concentrate not only on the removal of the fatty tissue but also on neurologic abnormities, metabolic disorders and associated diseases.
Abdomen ; Adipose Tissue ; Age of Onset ; Alcoholics ; Autonomic Pathways ; Cholesterol ; Glucose Tolerance Test ; Humans ; Korea ; Lipectomy ; Lipomatosis, Multiple Symmetrical* ; Male ; Muscle Weakness ; Neck ; Retrospective Studies ; Shoulder ; Tremor

PURPOSE: The aim of this study is to assess the specific patterns of regional cerebral blood flow (rCBF) in patients with the early stage of subcortical vascular dementia (SVaD) and Alzheimer's disease (AD) using Tc-99m HMPAO SPECT, and to compare the differences between the two conditions. MATERIALS AND METHODS: Sixteen SVaD, 46 AD and 12 control subjects participated in this study. We included the patients with SVaD and AD according to NINCDS-ADRDA and NINDS-AIREN criteria. They were all matched for age, education and clinical dementia rating scores. Three groups were evaluated by Tc-99m HMPAO SPECT using statistical parametric mapping (SPM) for measuring rCBF. The SPECT data of patients with SVaD and AD were compared with those of normal control subjects and then compared with each other. RESULTS: SPM analysis of the SPECT image showed significant perfusion deficits on the right temporal region and thalamus, left insula and superior temporal gyrus, both cingulate gyri and frontal subgyri in patients with SVaD and on the left supramarginal gyrus, superior temporal gyrus, postcentral gyrus and inferior parietal lobule, right fugiform gyrus and both cingulate gyri in AD compared with control subjects (uncorrected p<0.01). SVaD patients revealed significant hypoperfusion in the right parahippocampal gyrus with cingulated gyrus, left insula and both frontal subgyral regions compared with AD (uncorrected p<0.01). CONCLUSION: Our study shows characteristic and different pattern of perfusion deficits in patients with SVaD and AD, and these results may be helpful to discriminate the two conditions in the early stage of illness.
Alzheimer Disease* ; Dementia ; Dementia, Vascular* ; Education ; Humans ; Parahippocampal Gyrus ; Perfusion ; Rabeprazole ; Technetium Tc 99m Exametazime* ; Thalamus ; Tomography, Emission-Computed, Single-Photon*