We report two cases of murine typhus diagnosed by indirect immunofluorescent test. The patients showed cardinal symptoms and signs such as fever and chill, general myalgia, intractable headache and typical rash. Laboratory values and histopathologic findings were compatible with murine typhus. The oral administration of doxycycline improved dramatically the clinical manifestations of the two CCLSPS.
Administration, Oral ; Doxycycline ; Exanthema ; Fever ; Headache Disorders ; Humans ; Myalgia ; Typhus, Endemic Flea-Borne*

Forty patients(9 male and 31 female) with tsutsugamushi disease were evaluated clinically. The diagnosis of tsutsugamushi disease was confirmed by indirect immunofluoresent test or isolation of causative agent. More than 77% of patients were over 40 years of age. After the incubation period(5 to 13 days, average 8 days) symptoms developed suddenly. The frequent symtoms were fever(100%), chill(100%), headache(100%), rnalaise(97%), and myalgia(95%). On physical exammination the rash, eschar, and lymphadenopathy were found in 97%, 82%, and 67% respectively. Eschar was observed in the trunk, especially axillary, abdominal and inguinal area. Serum transarninase(SGOT snd SGPT) was elevated(89 and 87%). Urinalysis revealed proteinuria in 35%(12/34) and hematuria in 19%(7/36). Chest roentgram and ECG demonstrated abnormalities in 39%(14/36) and 73%(26/36) respectively, The treatment with doxycycline was very effective in all cases.
Diagnosis ; Doxycycline ; Electrocardiography ; Exanthema ; Hematuria ; Humans ; Lymphatic Diseases ; Male ; Proteinuria ; Scrub Typhus* ; Thorax ; Urinalysis

No abstract available.
Homocystine ; Homocystinuria*

No abstract available.
Diabetes Insipidus ; Holoprosencephaly

The N-terminal sequence of HIV1 gp41 (amino acid residues 584-623) was known to be the immundominant region of HIV1 gp41 protein. In order to determine epitope for gp41 protein of Korean anti-HIV1 positive sera, multiple antigenic peptides (MAPs) for the sequences corresponding to 584-604, 590-612, 604-623 and 584-618 of HIV1 gp41 were synthesized by solid phase method using Fmoc-Lys (Fmoc)-OH and used as coating antigens for ELISA. The reactivities of the synthetic peptides with Korean HIV1 positive (21 samples) and anti-HIV1 negative sera (22 samples) obtained from healthy blood doner were estimated by an indirect ELISA. MAPs for 584-604, 590-612 and 604-623 of gp41 reacted with 62 %, 100 % and 81 % of Korean anti-HIV1 positive sera tested, respectively. The results suggest that the epitope for HIV1 gp 41 for Korean anti-HIV1 positive sera is located in the region of amino acid 590-612 of gp41. MAP for gp41 (584-618) reacted with all (100 %) of anti-HIV1 positive sera tested, but did not react with anti-HlV1 negative sera. In addition, this MAP reacted stronger with seven samples of anti-HIV1 positive sera of anti-HIV1/2 combo performance panel than the mixture of 584-604, 590-612 and 604-623 of gp41, but did not react with anti-HIV negative serum. The high sensitivity and selectivity of MAP of gp41 (584-618) suggest that this peptide as a coating antigen in an ELISA system will be useful for antibody detection of HIV1.
Enzyme-Linked Immunosorbent Assay ; Epitope Mapping* ; Immune Sera* ; Peptides*

BACKGROUND AND OBJECTIVES: The purpose of this research was to evaluate physiological significances of expression of immediate early gene proteins in the vestibular nuclear complex by change of arterial pressure (AP) in adult Sprague-Dawley rats. MATERIALS AND METHOD: Record AP and inject either sodium nitroprusside (SNP) or phenylnephrine to change AP. Either fast or slow removal of blood from the femoral artery was made to induce different rapidity in reduction of AP. Blood supply to the inner ear was temporally blocked by clamping anterior inferior cerebellar artery (AICA). Immunohistochemical staining and image analysis for cFos, FosB, Krox, and JunB proteins were performed 2, 6, 12 hours after change of AP. RESULTS: The selective expression of cFos protein was observed in the medial vestibular nucleus (MVN) following reduction of AP. The number of cFos positive neurons peaked at 2 hours and then rapidly reduced, returning to the normal value 24 hours after SNP injection. And cFos protein expression was also well correlated with that of AP reduction at 2 hours of SNP injection. The rapid falling of AP caused a significant expression of cFos protein but slow withdrawal of blood did a minimal change of cFos protein expression. In addition, there was a significant expression of cFos protein following the increase of AP by single injection of phenylnephrine. Unilateral occlusion of AICA resulted in the significant expression of cFos protein in bilateral MVN. Furthermore, bilateral ablation of vestibular endorgans resulted in significant reduction of cFos expression by AICA occlusion in MVN. CONCLUSION: These results suggest that cFos protein is a marker for neuronal excitation in vestibular complex in response to rapid changes in the arterial blood pressure and that medial vestibular nuclei plays an important role in signaling the process of cardiovascular information coming from the peripheral vestibular apparatus.
Adult* ; Animals ; Arterial Pressure* ; Arteries ; Blood Pressure ; Constriction ; Ear, Inner ; Femoral Artery ; Humans ; Neurons ; Nitroprusside ; Proteins ; Rats* ; Rats, Sprague-Dawley ; Reference Values ; Vestibular Nuclei ; Vestibule, Labyrinth

Surgical treatment of cerebral arteriovenous malformations(AVM's) that are high flow and large remain particularly difficult to manage. It has been reported that normal perfusion pressure breakthrough(NPPB) syndrome occur more frequently in such AVM's and managing such AVM's by staged treatment may help to avoid the occurrence of this complication. The authors report our experience with one case of high flow, large AVM that would pose a great operative difficulty if it was to be managed by surgical resection alone. The patient was treated by a staged procedure in which a preoperative embolization was followed by a complete microsurgical excision. The staged, complementary approach proved to be quite useful and safe for the treatment of high flow, large AVM.
Arteriovenous Malformations ; Humans ; Intracranial Arteriovenous Malformations* ; Microsurgery* ; Perfusion

No abstract available.

We report an unusual case of primary extranodal non-Hodgkin's lymphoma combined with sinusitis in an AIDS patient. A 39-year-old male presented with sinusitis as initial manifestation. A nasal endoscopy revealed nasal polyposis with mucopurulent discharge in both middle meatus and paranasal sinus (PNS) CT scans demonstrated pansinusitis without lamina papyracea or skull base defect. He received antiretroviral and antibiotics therapy due to low CD4 count representing immunocompromised state. The patient was not followed up for observation and he returned with reduced right visual acuity and diplopia, and proptosis after 6 months. A PNS CT scan showed bilateral sinonasal polyposis with pansinusitis and soft tissue density in the right orbit and frontal lobe through bone defect of lamina papyracea and skull base. Endoscopic sinus surgery for orbital decompression and biopsy of intraorbital mass was performed under general anesthesia. The mass was infiltrated into orbital contents and was confirmed as an diffused large B-cell lymphoma with anaplastic variant. The patient received radiotherapy because his general condition was poor. Proptosis and ocular pain were decreased; however, he complained of a persistent headache. Brain CT and MRI showed diffused parenchymal edema around brain abscess in the right frontal lobe. Stereotactic evacuation of the right brain abscess was performed. He has no specific complaints for the last 14 months and antiretroviral therapy is concluded at the present.
Acquired Immunodeficiency Syndrome ; Adult ; Anesthesia, General ; Anti-Bacterial Agents ; B-Lymphocytes* ; Biopsy ; Brain ; Brain Abscess ; CD4 Lymphocyte Count ; Decompression ; Diplopia ; Edema ; Endoscopy ; Exophthalmos ; Frontal Lobe ; Headache ; Humans ; Lymphoma, B-Cell* ; Lymphoma, Large B-Cell, Diffuse ; Lymphoma, Non-Hodgkin ; Magnetic Resonance Imaging ; Male ; Orbit ; Radiotherapy ; Sinusitis* ; Skull Base ; Tomography, X-Ray Computed ; Visual Acuity

BACKGROUND AND OBJECTIVES: Glomus tumors are benign, slow-growing tumors which cause various symptoms such as pulsatile tinnitus and hearing loss. The aim of this study was to analyze the clinical manifestation and surgical outcomes of the glomus tumors in the temporal bone and skull base. SUBJECTS AND METHOD: Medical records of 17 patients who were surgically managed for glomus tumors of the temporal bone and skull base from 1997 to 2013 were retrospectively reviewed. The location and the size of the tumor were analyzed by CT and MRI, and the Fisch classification method was used to classify the tumor. Pre- and postoperative facial function measured by House-Brackmann (H-B) grade and lower cranial nerve (LCN) function were collected. RESULTS: The mean age of 17 patients was 50.6 (18-83) years, and male to female ratio was 4:13. The most common symptom of glomus tumors was pulsatile tinnitus, and this symptom disappeared or changed naturally postoperatively. The majority of patients with glomus jugulare showed various degrees of immediate postoperative facial nerve palsy, and 8 out of 9 patients showed improvement of facial nerve function to H-B grade I in 3 months. LCN palsy occurred in 5 out of 9 patients immediately following the operation and remained in 3 patients with Fisch type C2 tumor. CONCLUSION: Glomus tumors of the temporal bone and skull base were successfully removed by surgery. The surgical outcome of glomus jugulare shows that facial nerve function is acceptable and the incidence of lower cranial nerve palsy may be related to the classification of tumor.
Classification ; Cranial Nerve Diseases ; Cranial Nerves ; Facial Nerve ; Female ; Glomus Jugulare ; Glomus Tumor* ; Hearing Loss ; Humans ; Incidence ; Magnetic Resonance Imaging ; Male ; Medical Records ; Paralysis ; Retrospective Studies ; Skull Base* ; Temporal Bone* ; Tinnitus