PURPOSE: To evaluate US and CT characteristics of small renal cell carcinomas with diameter less than 3cm. MATERIALS AND METHODS: We retrospectively analysed US and CT findings of the small renal cell carcinomas which were surgically confirmed. We analysed echogenicity, peritumoral hypoechoic rim, intratumoral cysts on US. We analysed CT with viewpoints of tumor margin, growth pattern, renal contour change, attenuation on pre- and postcontrast scan, homogeneity, and perirenal changes. RESULTS: The US characteristics of the small renal cell carcinomas were hyperechogenicity(89%), peritumoral hypoechoic rim(66%) and intratumoral cysts(44%). They had relatively well-defined margin(90%), smooth and round contour(90%), endophytic growth pattern(65%), and outward bulging of renal contour(75%) on CT. They had iso- or high attenuation(87%) on precontrast CT, and were relatively homogeneous low-attenuated on postcontrast CT. CONCLUSION: The constellation of US and CT findings may be helpful in the diagnosis and understanding of the internal architecture of the small renal cell carcinomas.
Carcinoma, Renal Cell* ; Diagnosis ; Retrospective Studies

We performed pars plana vitrectomy combined with anterior capsule-sparing lensectomy on forty three eyes WJth coexisting cataract and vitreoretinal disease and followed up more than 6 months. Preoperative vitreoretinal diseases consisted of nondiabetic vitreous hemorrhage (thirteen eyes), retained metallic intraocular foreign bodies (nine eyes), posterior uveitis (nine eyes), proliferative diabetic retinopathy (seven eyes) and rhegmatogenous retinal detachment (five eyes) . Thirty six eyes (84%) revealed the visual acuity of 0.1 or less before operation. Thirty eight eyes (88%) could get a better visual acuity after operation than before operation. Posterior chamber intraocular lenses were implanted to thirty eight eyes. The severity of anterior capsular opacity showed a statistically significant difference between the eyes with injection of intraocular gas or silicone oil and them without injection of that (p=0.004). In this study, we can find that the technique of pars plana vitrectomy combined with anterior capsule-sparing lensectomy would be recommendable and the anterior capsular opacity may have relation with intraocular gas or silicone oil.
Cataract ; Diabetic Retinopathy ; Foreign Bodies ; Lenses, Intraocular ; Retinal Detachment ; Silicone Oils ; Uveitis, Posterior ; Visual Acuity ; Vitrectomy* ; Vitreous Hemorrhage

CHAP syndorme consists of choreoathetosis, orofacial dyskinesia, affective change, hypotonia, and pseudobulbar signs. CHAP syndrome was firstly des- cribed with onset 1 to 7 days after induced profound hypothermia and complete circulatory arrest for con- genital heart lesion repair. Since then, only a few cases have been reported until now. Case We report a patient who demonstrated all of the elements of the CHAP syndrome in severe cachexic state. Brain SPECT(99mTC-ECD) shows decreased perfusion in left fronto-parieto-temporal lobe. Comments The pathogenesis of CHAP syndrome is obscure. However our case led us to suggest that more essential component pre- disposing to the CHAP syndrome is hypoxia rather than hypothermia. Furthermore, it seems to be related with circulatory insufficiency in extrapyramidal nervous systems.
Anoxia ; Brain ; Heart ; Humans ; Hypothermia ; Movement Disorders ; Muscle Hypotonia ; Nervous System ; Perfusion

BACKGROUND AND OBJECTIVE: Transient global amnesia(TGA) is a neurological syndrome affecting preferentially middle-aged or elderly people and characterized by sudden onset of transient impairment of antegrade amnesia with variably retrograde amnesia. TGA was defined over 30 years ago, but the etiology remain unclear. Several mechanisms have been proposed, including arterial thromboembolic ischemic attacks in both posterior cerebral artery territories, epilepsy, and migraine. Although many studies have reported TGA, only a few reported cerebral perfusion studies using SPECT because of the brief duration of the episode. Technetium-99m-ethyl cysteinate dimmer(ECD) is superior to sensitivity of lesion detection and lesion to normal contrast, probably due to lower back diffusion from the brain to the blood and its excellent radiochemical stability. So we evaluate pathophysiologic mechanism of TGA by using 99mTC-ECD SPECT with or without acetazolamide(ACZ) stress. METHODS: We evaluated six patients with transient global amnesia, four women and two men, age ranges 56 to 78 years, mean 62.2 years. Measurements of CBF and vascular reserve using 99mTC-ECD with or without ACD stress were performed during or after TGA episode. RESULTS: One patient, who was evaluated in TGA episode showed that regional cerebral blood flow was decreased in both anteroinferior frontal, both temporal, right thalamus, both inferior parietal and left parietal region with impaired vascular reserve in left inferior temporal and right thalamus. Others, who were evaluated more than 6days in TGA episode showed that regional cerebral blood flow was decreased in left temporal (4), both temporal region (1), left thalamus (2) and both basal ganglia (1) with preserved vascular reserve except one, showed impaired vascular reserve in left thalamus. CONCLUSION: This result show that severe hypoperfusion of bilateral temporal region and impaired vascular reserve in left temporal region in TGA episode. Other patients who were recovered from TGA showed hypoperfusion of left temporal region and preserved vascular reserve. 99mTc-ECD with acetazolamide SEPCT that sensitively detects localized impaired cerebraovascular reserve should help elucidate these processes. But further study with more cases is necessary for evaluation of pathophysiology of TGA.
Acetazolamide ; Aged ; Amnesia ; Amnesia, Retrograde ; Amnesia, Transient Global* ; Basal Ganglia ; Brain ; Diffusion ; Epilepsy ; Female ; Humans ; Male ; Migraine Disorders ; Perfusion ; Posterior Cerebral Artery ; Rabeprazole ; Technetium* ; Thalamus ; Tomography, Emission-Computed, Single-Photon*

Post-traumatic encephalopathy is characterized by the combination of upper motor neurons, basal ganglia, cerebellar, and psychiatric disturbances. A "striatal" variant, with predominant parkinsonism, is uncommon and may be difficult to distinguish from idiopathic Parkinson's disease. A 38-year-old man, who had history of head injuries associated with brief losses of consciousness, developed a resting tremor and rigidity of the left lower extremity. Upon admission, he showed masked face and bradykinesia without dementia or other neurologic abnormalities. Brain MRI and SPECT studies showed no abnormalities. A BAEP study revealed an abnormal prolongation of inter-peak latencies between wave III and V.
Adult ; Basal Ganglia ; Brain ; Brain Injuries ; Consciousness ; Craniocerebral Trauma* ; Dementia ; Head* ; Humans ; Hypokinesia ; Lower Extremity ; Magnetic Resonance Imaging ; Masks ; Motor Neurons ; Parkinson Disease ; Parkinsonian Disorders* ; Tomography, Emission-Computed, Single-Photon ; Tremor

Post-traumatic encephalopathy is characterized by the combination of upper motor neurons, basal ganglia, cerebellar, and psychiatric disturbances. A "striatal" variant, with predominant parkinsonism, is uncommon and may be difficult to distinguish from idiopathic Parkinson's disease. A 38-year-old man, who had history of head injuries associated with brief losses of consciousness, developed a resting tremor and rigidity of the left lower extremity. Upon admission, he showed masked face and bradykinesia without dementia or other neurologic abnormalities. Brain MRI and SPECT studies showed no abnormalities. A BAEP study revealed an abnormal prolongation of inter-peak latencies between wave III and V.
Adult ; Basal Ganglia ; Brain ; Brain Injuries ; Consciousness ; Craniocerebral Trauma* ; Dementia ; Head* ; Humans ; Hypokinesia ; Lower Extremity ; Magnetic Resonance Imaging ; Masks ; Motor Neurons ; Parkinson Disease ; Parkinsonian Disorders* ; Tomography, Emission-Computed, Single-Photon ; Tremor

Although tuberculous meningitis (TBM) rarely complicates pregnancy and seldom occurs in puerperal women, the prognosis for such patients has been surprisingly poor. The neurologic complications of TBM are tuberculoma, syringomyelia, epidural abscess of spinal cord, abscess of brain and internuclear opthalmoplegia. Most reports about TBM in pregnant women are describing prognosis and treatment, and have no concern with complication except hemiplegia. Tuberculous radiculomyelitis (TBRM) is a rare complication of tuberculosis in nervous system. TBRM is characterized by the subacute onset of paraparesis. Symptoms include root pain, paresthesias, bladder disturbance, and muscle wasting. MRI and CT scan are important for diagnosis. We described a 27-year-old pregnant woman, who developed TBM. Durng the treatment of TBM, she developed motor weakness of lower extremities, muscle atrophy, impairment of sensation, voiding disturbance and loss of tendon reflex. CSF evaluation showed an active inflammatory response with a high protein level. The MRI scan of spinal cord demonstrated TBRM. She showed clinical improvement with addictive steroid therapy.
Abscess ; Adult ; Brain ; Diagnosis ; Epidural Abscess ; Female ; Hemiplegia ; Humans ; Lower Extremity ; Magnetic Resonance Imaging ; Muscular Atrophy ; Nervous System ; Paraparesis ; Paresthesia ; Pregnancy ; Pregnant Women* ; Prognosis ; Reflex, Stretch ; Sensation ; Spinal Cord ; Syringomyelia ; Tomography, X-Ray Computed ; Tuberculoma ; Tuberculosis ; Tuberculosis, Meningeal* ; Urinary Bladder

No abstract available.
Anesthesia, Spinal* ; Myoclonus*

Isaacs' syndrome is a rare and heterogeneous syndrome of continuous muscle fiber activity that originates from peripheral nerves. We report a 56-year-old male patient who showed symptoms of Isaacs' syndrome after the removal of a malignant thymoma. Needle electromyography revealed spontaneously occurring repetitive myokymic discharge in the affected muscles. Acetylcholine receptor (AChR) antibodies were significantly elevated, but clinical and electrophysiologic findings did not indicate the presence of myasthenia gravis. We deduce that in Isaacs' syndrome, raised AChR antibodies may facilitate rather than inhibit cholinergic action.
Acetylcholine ; Antibodies ; Electromyography ; Humans ; Isaacs Syndrome ; Male ; Middle Aged ; Muscles ; Myasthenia Gravis ; Needles ; Peripheral Nerves ; Thymoma

BACKGROUND: Methyl bromide is toxic to the central and peripheral nervous systems. Two patients with occupational exposure to this agent are described. CASE: Two cases of previously healthy young men were involved. They had worked in a fumigating plant spraying fruits using methyl bromide for several months before admission. They showed general weakness, severe ataxia, bilateral dysmetria and bilateral lateral gaze limitation. And gaze-evoked nystagmus was observed in one of them. Brain MRI showed symmetrically increased signal intensity lesions including the brainstem, cerebellum and splenium of corpus callosum. After conservative treatment, they gradually improved over the next few weeks. CONCLUSIONS: Symmetry and topography of our patients??clinical and radiographic abnormalities support the proposal that methyl bromide exposure can produce symptoms similar to Bickerstaff's brainstem encephalitis.
Ataxia ; Brain ; Brain Stem ; Cerebellar Ataxia ; Cerebellum ; Corpus Callosum ; Encephalitis ; Fruit ; Humans ; Hydrocarbons, Brominated ; Male ; Occupational Exposure ; Peripheral Nervous System ; Plants