Wernickes encephalopathy is an illness characterized by mental disturbance, paralysis of eye movements and ataxia of gait. The specific factor for most, if not all, of these symptoms is a deficiency of thiamine. Wemicke's encephalopathy mostly occurs in developing countries when the patient is in a state such as nutritionally deprived state, anorexia nervosa, stomach cancer, long duration of parenteral nutrition. Wernickes encephalopathy was recognized as a complication of hyperemesis of pregnancy in 1914. Unfortunately, cases continue to occur. We present here a case of Wernickes encephalopathy in a 36-year-old pregnant woman. We discuss the clinical picture, histopathology, radiology, therapeutic management and prognosis with review of the literature.
Adult ; Anorexia Nervosa ; Developing Countries ; Eye Movements ; Female ; Gait Ataxia ; Humans ; Hyperemesis Gravidarum* ; Hyperthyroidism* ; Paralysis ; Parenteral Nutrition ; Pregnancy ; Pregnant Women ; Prognosis ; Radiation Oncology ; Stomach Neoplasms ; Thiamine ; Wernicke Encephalopathy*

A nineteen year-old boy with progressive enlargement of the joints and distal extremities, clubbing, coarse facial features and hyperhidrosis was investigated. In physical examination, thickening of the scalp with furrowing (cutis verticis gyrata) and greasy thickening of skin (pachyderma) was prominent. His endocrine profile was normal. Radiological studies demonstrated bilateral symmetrical periosteal new bone formation with acroosteolysis and incidental microadenoma of pituitay gland. After extensive investigation to exclude systemic and endocrine causes, the patient was diagnosed as pachydermoperiostosis (PDP). PDP is a rare syndrome manifested clinically by finger clubbing, extremity enlargement, hypertrophic skin changes, and periosteal bone formation. The pathogenesis of the disorder has not been clarified though few endocrine abnormalities were seen. To aware of these clinical phenotype would help to differentiate PDP from acromegaly.
Acro-Osteolysis ; Acromegaly ; Extremities ; Fingers ; Humans ; Hyperhidrosis ; Joints ; Male* ; Osteoarthropathy, Primary Hypertrophic* ; Osteogenesis ; Phenotype ; Physical Examination ; Scalp ; Skin ; Young Adult*

PURPOSE: CD24 is a small heavily glycosylated glycosylphosphatidylinositol-linked cell surface protein, which is expressed in hematological malignancies as well as a large variety of solid tumors. The authors aimed to evaluate the CD24 protein expression in fibroadenomas and adenocarcinomas of the breast and its correlation to clinicopathological data. METHODS: Immunohistochemical staining for CD24 was performed on 28 mammary neoplasia, diagnosed as either adenocarcinomas (22 cases) or fibroadenomas (6 cases), to examine the relationship with clinicopathological parameters. The results of the immunohistochemical staining were evaluated by the stainability (negative, weak-, moderate-, strong-positive) and staining patterns (membranous vs. intracytoplasmic) for statistical analyses. RESULTS: The present study clearly demonstrates that CD24 was abundantly expressed in adenocarcinoma, compared to in fibroadenomas of the breast (P<0.001). Intracytoplasmic staining was noted in the adenocarcinomas only but this was not statistically significant between the adenocarcinoma and fibroadenoma groups. No significant correlations of the CD24 stainability or staining pattern were detected with the nodal status, tumor histological grade or histological subtypes. CONCLUSION: Our data suggest that abundant membranous expression or intracytoplasmic expression of CD24, as detected by immunohistochemistry, is an important tissue marker for a mammary epithelial neoplasm, which could help to define adenocarcinomas from fibroadenomas.
Adenocarcinoma ; Breast ; Fibroadenoma ; Hematologic Neoplasms ; Immunohistochemistry ; Neoplasms, Glandular and Epithelial

No abstract available.
Conjunctiva* ; Melanoma*

No abstract available.
Bacteriolysis* ; Galactose* ; Lipopolysaccharides* ; Salmonella typhi* ; Salmonella*

PURPOSE: The purpose of this study was to evaluate the spectrum of MR characteristics of cystic acoustic neurinomas and to correlate with pathologic findings. MATERIALS AND METHODS: We retrospectively reviewed the MR findings of 12 patients with cystic acoustic neurinomas. The signal intensity and enhancement pattern of the cystic components as well as the location relative to the tumors were analyzed. RESULTS: A total of 30 cysts were found in 15 acoustic neurinomas;28 were intratumoral cysts and the remaining two were extratumoral cysts. The signal intensity of all 28 intratumoral cysts was higher than that of CSF on Tl-weighted images, and isointense to CSF on T2-weighted images, while the signal intensity of the two extratumoral cysts was same as CSF on both Tl-weighted and T2-weighted images. Rim enhancement was seen in 27 of 28 intratumoral cysts but in none of the two extratumoral cysts. CONCLUSION: We concluded that intratumoral cyst was due to tumoral necrosis, hemorrhage or degenerative change and extratumoral cyst due to secondary arachnoid cyst formation.
Acoustics* ; Arachnoid ; Hemorrhage ; Humans ; Necrosis ; Neuroma, Acoustic* ; Retrospective Studies

We have experienced 113 cases of neonatal sepsis comfirmed by clinical manifestations and blood cultures from Jan. 1988 to Dec. 1992 at the Neonatal Intensive Care Unit of Ulsan Dong-Kang Hospital and observed the incidence, predisposing perinatal factors, clinical manifestations, associated illnesses, laboratory findings, isolated microorganisms, antibiotics sensitivity test and mortality rate of neonatal sepsis according to onset of disease. The result were as follows: 1) The incidence of neonatal sepsis was 1.39% and male to female ration was 1.38:1. The incidence and sex difference between early onset and late onset disease were not significant. 2) Neonatal sepsis was more prevalent in premature infants (2.47%) than in fullterm infants (1.28%) and nore prevalent in low birth weight infants(3.01%) than in normal birth weight infants (1.25%). In premature infants, neonatal sepsis was more prevalent in early onset (63.2%) than in late onset diease (36.8%). In low birth weight infants, neonatal sepsis was more prevalent in early onset (64.8%) than in late onset dieases (35.7%P). 3) Predisposing perinatal factors, such as meconium staining, birth asphyxia, difficult delivery, premature rupture of membrane, maternal infection, toxemia and postpartum bleeding were slightly frequent in early onset disease. 4) Among the clinical manifestations, jaundice, respiratory symptoms, pallor, lethargy, poor feeding and hepatosplenonegaly were slightly frequent in early onset disease, but temperature instability and gastrointestinal symptoms were slightly frequent in late onset disease. 5) Among the associated illness, pneumonia, disseminated intravascular coagulopathy, amnionitis, hyaline membrane disease and osteomyelits were more common in early onset disease, but gastroenteritis, urinary tract infection, necrotizing enterocolitis, wound infection and meningitis were mors common in late onset disease. 6) The difference of laboratory findings between early onset and late onset disease was not significant. 7) Causative organisms were gram positive organisms in 87 cases(77.0%), gram negative organisms in 22 cases (18.6%) and mixed infections in 5 cases (4.4%). Among them, coagulase negative staphylococcus was the most common one and staphylococcus aureus was the second. The incidence of infections caused by coagulase negative staphylococcus and staphylococcus aureus, between early onset and late onset disease, was not significantly different. Streptococcal infection was more prevalent in early onset disease, especially all group B streptococcus caused early onset disease. 8) Gram positive organisms ware sensitive to Cephalothin (92.9%), Chloramphenicol (90.0%) and Ceftriaxone (88.9%). Gram negative organisms were sensitive to Amikacin (91.3%) and Colistin (82.6%). The difference of antibiotics sensitivity for organisms causing early onset and late onset diease were not significant. Gram negative organisms causing early onset disease were resistant to gentamicin and terramycin, but those organisms causing late onset disease were more sensitive to gentamicin (88.9%) and tobramycin (77.8%). 9) The mortality rate was 7.96%. It was higher in gram negative infections (23.8%) than in gram positive infections (4.6%). No significant difference of mortality rate between early onset and late onset disease was found.
Amikacin ; Amnion ; Anti-Bacterial Agents ; Asphyxia ; Birth Weight ; Ceftriaxone ; Cephalothin ; Chloramphenicol ; Chorioamnionitis ; Coagulase ; Coinfection ; Colistin ; Enterocolitis, Necrotizing ; Female ; Gastroenteritis ; Gentamicins ; Hemorrhage ; Humans ; Hyaline Membrane Disease ; Incidence ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Intensive Care, Neonatal ; Jaundice ; Lethargy ; Male ; Meconium ; Membranes ; Meningitis ; Mortality ; Oxytetracycline ; Pallor ; Parturition ; Pneumonia ; Postpartum Period ; Pregnancy ; Rupture ; Sepsis* ; Sex Characteristics ; Staphylococcus ; Staphylococcus aureus ; Streptococcal Infections ; Streptococcus ; Tobramycin ; Toxemia ; Ulsan ; Urinary Tract Infections ; Wound Infection

OBJECTIVE: The laparoscopic appendectomy was developed as an alternative procedure to be used in acute appendicitis. Some surgeons dispute the advantages of laparoscopic procedures for acute appendicitis. Specifically, there are many controversies associated with perforated appendicitis. We reviewed the results of appendectomies to assess the feasibility of a laparoscopic appendectomy in acute appendicitis that included perforated appendicitis. METHODS: Three hundred thirty-nine consecutive patients with laparoscopic appendectomies, which include 27 patients with perforated appendicitis, were analysed. This study considered the lengths of the operation and the hospital stay. Differences in complications between non-perforated and perforated appendicitis were also evaluated. RESULTS: A total of 388 patients underwent appendectomies, 339 patients with laparoscopy and 49 patients with conventional open appendectomies, from April 1994 to June 1996. The mean duration of laparoscopic appendectomies was 48.9 minutes. This was slightly longer than that of open appendec tomies (44.9 minutes) in the same hospital. The duration of hospital stay was on the average of 4.9 days. Six patients (1.8%) were converted to conventional surgery because of difficult mobilization in 4 patients and uncontrollable bleeding in the remaining two. The surgeries on patients who were converted to conventional surgery were performed by rotating residents without staff supervision. Minor complications developed in eight patients (2.4%). In comparing the results between non-perforated and perforated appendicitis, durations of operation (47.3 vs. 78.3 minutes) and the hospital stay (4.6 vs. 8.6 days) were longer in perforated appendicitis. However, the complication rate (2.6 vs. 0%) was unexpectedly found to be lower in perforated appendicitis. CONCLUSIONS: The laparoscopic appendectomy is a safe, feasible procedure for acute appendicitis. It is an excellent procedure for perforated appendicitis and has minor complications compared to an open appendectomy with its large incision that is followed by a high rate of wound infection and/or post operative adhesion. There aree various reports on prospective randomized studies evaluating the benefits of a laparoscopic appendectomy compared to a conventional open appendectomy. The reports by laparo scopic surgeons in various centers are different with regard to operative time, postoperative recovery, morbidity, and postoperative complications. For complicated appendicitis, most surgeons are not in agree ment with the laparoscopic approach. We obtained excellent results with laparoscopic appendectomies in perforated appendicitis which included periappendiceal abscesses.
Abscess ; Appendectomy* ; Appendicitis ; Dissent and Disputes ; Hemorrhage ; Humans ; Laparoscopy ; Length of Stay ; Operative Time ; Organization and Administration ; Postoperative Complications ; Prospective Studies ; Wound Infection

The application of stereotactic radiosurgery for cerebrovascular malformations began in the early 1970s. Despite pooly documented response of vascular malformations to externally fractionated radiotherapy, single fraction, high dose, small-field, focused irradiation of small vascular malformations were found to be effective and non-invasive method to obliterate vascular malformations. During last thirty years, overall role of stereotactic radiosurgery has been established in the management of carefully selected vascular malformations. By 1998 world-wide, more than 20,000 patients had undergone Gamma Knife radiosurgery for arteriovenous malformations. In comparison to other forms of nonsurgical management or surgical excision, stereotactic radiosurgery has number of advantages. In properly selected, small volume AVMs, the total obliteration rate at two years appears to be acceptably high(more than 80%), and is associated with low morbidity(less than 2-3%). In contrast to open surgical removal, radiosurgery is associated with none of the risk of microsurgical resection such as blood loss, infection, acute neurological deficits and operative mortality. And yet, major problem of radiosurgery is that it is still exposed to any potential risk of bleeding during latent period before complete obliteration of arteriovenous malformations. Continuous study and researches are recommended for radiobiological clearance. To solve this problem and to enhance the effectiveness of treatment, new energy source should be developed to reduce latent period until complete obliteration would be secured, while reducing the chance of risk by irradiation. Presently, radiosurgery is applied to other vascular malformations such as cavernous angioma or venous angioma, yet, the result is still subject to controversy. Thus, more rigorous research, clinical experience, and enhanced treatment plan should be sought.
Arteriovenous Malformations ; Hemangioma ; Hemangioma, Cavernous ; Hemorrhage ; Humans ; Mortality ; Radiosurgery ; Radiotherapy ; Vascular Malformations

In this report we describe twenty-two cases of intracranial tumors studied with an MR imager operating at a field strength of 0.064 T for evaluation of the clinical utility of low tesla MRI. The comfirmed diagnoses were meningioma(9 cases), astrocytoma(4 cases), glioblastoma multiforme(1 case), craniopharyngioma(2 cases), intracranial metastasis(1 case). pituitary microadenoma (1 case), hemangioblastoma (1 case), and trigerminal neurilemmoma(1 case). Meningiomas appeared as well-marginated, homogenous signal intensity masses(67%) in most cases. Most meningiomas showed iso-signal intensity(78%) on T1-weighted images, and high signal intensity on T2-weighted images. After Gd-DTPA enhancement, diffuse homogeneous contrast enhancement(75%) was well see. The multiple hemorrhagic foci within the glioblastoma multiforme were identified, which shoed high signal intensity on T1-weighted images and low signal intensity on T2-weighted images(intracellular methemoglobin), or high signal intensity on both T1 and T2-weighted images(extracellular methemoglobin). One case of cerebellar hemangioblastoma was a well-defined cystic mass with contrast enhanced mural nodule but no identification of characteristic signal void vessels. The remianing tumors showed low signal intensity on T1-weighted images, and high signal intensity on T2-weighted images. Gd-DTPA enhancement was helpful in separating the lesion from the surrounding edema or normal tissue, but had limited diagnostic value in characterizing the nature of the mass. The advantages of low tesla MRI are as follows on requirement of cooling water or electricity, open design, shorter T1 relaxation time compared with high tesla unit that increases the difference of T1-relaxation time between tissues, ease of installation, and cost effectiveness. In conclusion, the low tesla MRI is useful for the detection and evaluation of the brain tumors.
Brain Neoplasms ; Cost-Benefit Analysis ; Diagnosis ; Edema ; Electricity ; Gadolinium DTPA ; Glioblastoma ; Hemangioblastoma ; Magnetic Resonance Imaging ; Meningioma ; Relaxation ; Water