No abstract available.
Reference Values*

Although urinary tract infections are common in adults, pyelonephritis is rarely considered in the differential diagnosis of acute renal failure. Acute pyelonephritis without urinary tract obstruction, previous renal diseases or septic shock is a rare cause of acute renal failure. Despite appropriate antibiotic therapy, recovery of renal function could be slow and incomplete. We experienced a 45 year-old woman with diabetes who developed bilateral acute pyelonephritis followed by acute renal failure. The renal biopsy revealed diffuse edematous and focal fibrotic inters- titium with infiltration of lymphocytes compatible with interstitial nephritis. Although her renal function improved gradually with antimicrobial treatment, the process was incomplete and renal dysfunction persisted at about 10-month follow-up, suggesting permanent renal damage. Therefore, we report this case with brief review of related literature.
Acute Kidney Injury* ; Adult ; Biopsy ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Humans ; Lymphocytes ; Middle Aged ; Nephritis, Interstitial ; Pyelonephritis* ; Shock, Septic ; Urinary Tract ; Urinary Tract Infections

We present a rare case of a pituitary adenoma revealing a sedimentation level on MRI, which has not been previously documented. This 55-year-old woman was referred with the diagnosis of craniopharyngioma. She presented with four-month history of progressive headache and visual dimness. Neurological examination revealed a bitemporal hemianopsia and decreased visual acuity. Laboratory data including endocrine examination were unremarkable. An additional three-dimensional MRI was taken for further evaluation, and demonstrated a sedimentation level within the tumor. The patient underwent transcranial removal of the tumor. About 12cc of dark-red blood was aspirated from the tumor. Histological examination revealed a pituitary adenoma with hemorrhage. Postoperatively, the patient showed gradual improvement of visual function. Considering that the pituitary adenoma is one of more common tumors that cause tumoral bleeding, a cystic sellar tumor that has a sedimentation level should be sought first for a pituitary adenoma rather than a craniopharyngioma. This may have an important impact when deciding surgical approach.
Craniopharyngioma ; Diagnosis ; Female ; Headache ; Hemianopsia ; Hemorrhage ; Humans ; Magnetic Resonance Imaging* ; Middle Aged ; Neurologic Examination ; Pituitary Apoplexy ; Pituitary Neoplasms* ; Visual Acuity

No abstract available.
Astrocytoma* ; Tuberous Sclerosis*

No abstract available.
Arteriovenous Malformations* ; Hematoma*

Anterior cervical fusion has enjoyed an increasing acceptance and frequency of utilization in the treatment of symptomatic degenerative, traumatic, and neoplastic disorders. Since the introduction of plate systems, cervical fusion with fixation has become popularized. We present our experiences of 152 cases of cervical fusion in degenerative and traumatic lesions, focusing on their surgical results and complications, along with our opinions about the various plate systems we used. Between March 1993 and May 1996, 152 patients with symptomatic degenerative and traumatic cervical lesions between C3-4 and C7-T1 levels were treated with anterior cervical fusions. These patients were retrospectively studied according to their medical records and radiological studies. A comparison between various plate systems were also done. There were 110 men and 42 women, aged from 21 to 77 years. Mean follow up period was 17 months. Mean fused segments were 1.4. Various plate systems were used: Caspar plate system in 14 patients; Top plate in 102; Orion plate in 21; and none in 15. Dislodgement of bone graft, screw loosening, and fusion failure that required reoperation were occurred in 8 cases. None of them were initially treated with unicortical type screws. Asymptomatic esophageal perforation was developed in one case among them. In conclusion, anterior cervical fusion with screw plate system can be carried out with acceptable complication rate. Although relative follow up period was short, we concluded that the locking type screw plate system was superior than the classic bicortical screw system in their procedural simplicity, unnecessary penetration of posterior cortex, and elimination of the fear for the neurological complication.
Esophageal Perforation ; Female ; Follow-Up Studies ; Humans ; Male ; Medical Records ; Reoperation ; Retrospective Studies* ; Transplants

OBJECTIVE: For the treatment of the hypertensive intracerebral hemorrhage, stereotactic catheter drainage of hematoma has been widely used as a less invasive and effective therapeutic modality. However stereotactic catheter drainage method occasionally can not be available. Here, we introduce C-arm fluoroscopic guided catheter drainage of hematoma as an alternative method. The authors compared the two methods and report the result with review of the literatures. METHODS: A total of 62 patients with hypertensive intracerebral hemorrhage who underwent catheter drainage between February 1996 and December 1999 were reviewed. The patients were divided into two groups according to the method of catheter insertion. The two groups were compared with respect to pre- and post-operative changes of hematoma volume and neurological deficit, hematoma drainage rate, duration of catheter placement, complication, and short term prognosis. RESULTS: The pre-operative hematoma volume was slightly large in the C-arm fluoroscopic guided method group. But post-operative hematoma volume, pre- and post-operative neurological deficit, hematoma drainage rate, duration of catheter placement, post-operative complication and short term prognosis were not different statistically between the two groups. The preparation time for operation was short in C-arm fluoroscopic guided group. CONCLUSION: C-arm fluoroscopic guided catheter drainage of intracerebral hematoma can be an alternative to the stereotactic guided method in the urgent situation or when the stereotactic system is not available
Catheters* ; Drainage* ; Hematoma* ; Humans ; Intracranial Hemorrhage, Hypertensive ; Prognosis

Hepatoblastoma is a hepatic tumor predominantly occurring in children. The usual site of metastasis is the lung. There are only several reports worldwide on the distant metastasis of hepatoblastoma to the central nervous system in children. Only one reported case showed survival of a patient after multiple resections of a recurrent brain lesion. Involvement of the cardiovascular system has been reported in the medical literature. Lesions almost always involve the right-side of the heart. We report a case of recurrent hepatoblastoma at multiple sites, including brain, left atrium of the heart and lung in a 6-year-old girl who was partially treated in the past at the age of 1.5 years; the patient had been event-free for four and a half years.
Brain* ; Cardiovascular System ; Central Nervous System ; Child ; Female ; Heart Atria ; Heart* ; Hepatoblastoma* ; Humans ; Lung* ; Neoplasm Metastasis*

In order to define the prognostic implications of cervical myelopathy, we conducted a morphometrical analysis of spinal cords in patients suffering from this condition. Twenty patients who had undergone laminoplasty for their cervical myelopathy were the subject of this study. Cervical spondylosis was diagnosed in 14 patients and ossification of the posterior longitudinal ligament in six. Signal change of the spinal cord, its anteroposterior diameter, and the number of stenotic segments were determined by pre- and postoperative magnetic resonance imaging and simple X-ray. The patients' neurological status before and after surgery was evaluated by the Neurosurgical Cervical Scale. Patients whose cord revealed no signal change had better recovery rates than those who showed change (77.5% vs. 60.5%). The wider the diameter of the cord, the better the outcome of surgery(p<0.05 on one-way ANOVA). The number of stenotic segments was not significantly related to recovery rate. In conclusion, focal morphological changes of the spinal cord, regardless of the general stenotic area, are the main factors determining the outcomes of surgery.
Humans ; Longitudinal Ligaments ; Magnetic Resonance Imaging ; Spinal Cord ; Spinal Cord Diseases* ; Spondylosis

OBJECTIVE:To evaluate the normal figure of intracranial and intraspinal cerebrospinal fluid(CSF) dynamics, we report the results of the various parameters of cine phase contrast(PC) magnetic resonance(MR) CSF flow images throughout the whole neuraxis. METHODS: The MR images were obtained with 1.5T unit using the cine PC sequence with cardiac gating and gradient echo imaging in 10 normal persons(mean age, 30.4 years). The temporal velocity information from the anterior and posterior cervical pericord subarachnoid spaces, third and fourth ventricles, aqueduct, and lumbar cistern were plotted as wave forms. The wave forms were analyzed for configurations, amplitude parameters, and temporal parameters. The statistical significance of each parameter was examined with paired t-test. RESULTS: The actual flow of CSF were clearly visible with cine MR images. Throughout the whole neuraxis, the distinct reproducible configuration features were not obtained at ventricular or lumbar cistern, but at aqueduct and cervical pericord spaces. The temporal parameters were more important than the amplitude parameters. CONCLUSION: In this study, the authors demonstrated normal CSF dynamics and obtained further precision by plotting the temporal velocity information from the images as a waveform. This important basic information may be useful for understanding altered physiology in disease states such as syringomyelia and hydrocephalus.
Cerebrospinal Fluid* ; Fourth Ventricle ; Hydrocephalus ; Magnetic Resonance Imaging ; Physiology ; Subarachnoid Space ; Syringomyelia