Infection involving the spinal cord and cauda equina are much less common than intracranial infection. Among the above, bacterial infection in spinal epidural space are relatively uncommon but well recognized entity in adult and children. More than 300 cases with spinal epidural abscess are described in the literatures. Because of its rarity, there is delay in diagnosis and irreversible neurological sequelae in high percentage of cases. Infection of the spinal epidural space are accompanied by fever, tachycardia, headache, pain and tenderness in the back, weakness of the lower extremities and finally a complete paraplegia. The modes of infection are 1) direct extension from inflammatory process in adjacent tissues 2) perforating wounds or lumbar puncture 3) hematogenous route from the remote origin. The most frequent causative organism is staphylococcus aureus always, but pneumococcus, streptococcus, pseudomonas, typhoid bacillus, pyocyanus, oidium coccidioides and fungus are causative organisms occasionally. In spinal epidural abscess with complete paraplegia, the neurologic sequelae are permanent and unhappy. So the spinal epidural abscess is neurosurgical emergency in which early diagnosis and prompt surgery are necessary to avert permanent cord damage. Recently, the spinal epidural abscess has increasing tendency. We have treated 5 cases with spinal epidural abscesses from Nov. 1974 to Apr. 1976. The followings are results ; 1) Sex incidence showed male 2, female 3 and age incidence ranged from 21 years to 38 years, but 4th decade was most common. 2) Most common mode of infection was unknown though all cases have been applied the acupunture for the back pain several times. 3) Most avaliable procedures of diagnosis were the usual infectious symptoms, leukocytosis, increased erythrocyte sedimentation rate, obstructive responce by Queckenstedt test and findings of myelography, including increased protein and pleocytosis in cerebrospinal fluid. 4) All 5 cases had been performed total laminectomy from T3-L3, according to the lesions commonly in thoracic spine with spinal epidural abscess and had been treated with penicillin G, Methicillin and Geopen. 5) The prognosis was poor in 4 cases with complete paraplegia but 1 case with incomplete paralysis recovered completely.
Adult ; Bacillus ; Back Pain ; Bacterial Infections ; Blood Sedimentation ; Carbenicillin ; Cauda Equina ; Cerebrospinal Fluid ; Child ; Coccidioides ; Diagnosis ; Early Diagnosis ; Emergencies ; Epidural Abscess* ; Epidural Space ; Female ; Fever ; Fungi ; Headache ; Humans ; Incidence ; Laminectomy ; Leukocytosis ; Lower Extremity ; Male ; Methicillin ; Myelography ; Paralysis ; Paraplegia ; Penicillin G ; Prognosis ; Pseudomonas ; Spinal Cord ; Spinal Puncture ; Spine ; Staphylococcus aureus ; Streptococcus ; Streptococcus pneumoniae ; Tachycardia ; Typhoid Fever ; Wounds and Injuries

No abstract available.
Catheters

The 46, XX male syndrome is rare disease that is characterized by a phenotypic male who has a 46, XX female karyotype. Since the first report by de la Chapelle and associates in 1964, several cases have been reported, but it is still a rare entity. Recently we examined a 20-year-old XX male who had the symptoms of gynecomastia, an infantile appearance of the external genitalia, scanty pubic hair, no Adams apple, and no axillary hair. We presently describe a patient with the 46, XX male syndrome who showed a 46, XX karyotype on chromosomal study and review the literatures.
46, XX Testicular Disorders of Sex Development* ; Female ; Genitalia ; Gynecomastia ; Hair ; Humans ; Karyotype ; Male ; Rare Diseases ; Young Adult

Cushing's syndrome in pregnant women is rare and difficult to be diagnosed because of the syndrome's association with oligomenorrhea or amenorrhea and the changes in cortisol metabolism during normal pregnancy. Cushing syndrome in pregnancy is usually confused with complicated pregnancy, such as preeclampsia or gestational diabetes, and its rarity leads to a low degree of clinical suspicion, often delaying diagnosis. We experienced a case of Cushing's syndrome in pregnancy, which had been considered as the severe preeclampsia and gestational diabetes due to uncontrolled hypertension and hyperglycemia. The pregnancy was terminated with an emergency cesarean operation at 30 weeks of gestation because of severe preeclampsia. In consequence of the evaluation about the Cushing's syndrome after delivery, the adrenal cortical adenoma of right adrenal gland was diagnosed and laparoscopic adrenalectomy was performed.
Adenoma, Adrenal Cortical/*complications/radiography/surgery ; Adrenal Cortex Neoplasms/*complications/radiography/surgery ; Adrenalectomy ; Adult ; Cushing Syndrome/*etiology/radiography/surgery ; Female ; Human ; Pregnancy ; Pregnancy Complications, Neoplastic/*radiography ; Pregnancy Outcome

BACKGROUND/AIMS: Cat-scratch disease (CSD), caused by Bartonella henselae is one of the most common zoonosis. However, only several cases of B. henselae infection have been reported in Korea. This study investigated the seroprevalence of B. henselae in healthy adults and related risk factors. METHODS: Serum samples from 300 healthy participants were analyzed using an immunoglobulin G immunof luorescence assay (IFA) for B. henselae isolated in Korea. Surveys on the risk factors for B. henselae infection were conducted simultaneously. RESULTS: Of the participants, 47.7% and 15.0% raised dogs and cats, respectively. The overall seroprevalence of B. henselae was 15.0% (IFA titer ≥ 1:64). Participants who had raised cats showed 22.2% seropositivity against B. henselae, and those with no experience with cats showed 13.7% seroprevalence (p = 0.17). Participants who had cats as pets or been scratched by cats, showed 9.8% seropositivity against B. henselae (IFA titer ≥ 1:256). However, those who had not raised or been scratched by a cat showed 2.0% seropositivity (p = 0.015). CONCLUSIONS: In Korea, the seroprevalence of B. henselae is higher than expected, suggesting that Bartonella infection due to B. henselae is not uncommon. Cats are proposed to play a more important role than dogs in transmission of CSD.
Adult* ; Animals ; Bartonella henselae* ; Bartonella Infections ; Bartonella* ; Cat-Scratch Disease ; Cats ; Dogs ; Healthy Volunteers ; Humans ; Immunoglobulin G ; Korea* ; Risk Factors ; Seroepidemiologic Studies*

BACKGROUND/AIMS: Cat-scratch disease (CSD), caused by Bartonella henselae is one of the most common zoonosis. However, only several cases of B. henselae infection have been reported in Korea. This study investigated the seroprevalence of B. henselae in healthy adults and related risk factors. METHODS: Serum samples from 300 healthy participants were analyzed using an immunoglobulin G immunof luorescence assay (IFA) for B. henselae isolated in Korea. Surveys on the risk factors for B. henselae infection were conducted simultaneously. RESULTS: Of the participants, 47.7% and 15.0% raised dogs and cats, respectively. The overall seroprevalence of B. henselae was 15.0% (IFA titer ≥ 1:64). Participants who had raised cats showed 22.2% seropositivity against B. henselae, and those with no experience with cats showed 13.7% seroprevalence (p = 0.17). Participants who had cats as pets or been scratched by cats, showed 9.8% seropositivity against B. henselae (IFA titer ≥ 1:256). However, those who had not raised or been scratched by a cat showed 2.0% seropositivity (p = 0.015). CONCLUSIONS: In Korea, the seroprevalence of B. henselae is higher than expected, suggesting that Bartonella infection due to B. henselae is not uncommon. Cats are proposed to play a more important role than dogs in transmission of CSD.
Adult* ; Animals ; Bartonella henselae* ; Bartonella Infections ; Bartonella* ; Cat-Scratch Disease ; Cats ; Dogs ; Healthy Volunteers ; Humans ; Immunoglobulin G ; Korea* ; Risk Factors ; Seroepidemiologic Studies*

Autoimmune hypoglycemia is characterized by hyperinsulinemia, fasting hypoglycemia, and the presence of insulin auto- antibodies without previous exposure to exogenous insulin. We experienced a case of autoimmune hypoglycemia without diabetes mellitus or any evidence of insulinoma. The insulin auto-antibody and insulin receptor auto-antibody were present. We diagnosed the patient as having autoimmune hypoglycemia and treated with glucocorticoid. After treatment, the hypoglycemic symptoms were resolved. However, four months later, the patient was readmitted with transient diabetic ketoacidosis. After recovery, he showed no signs of diabetes mellitus. We believe that insulin auto-antibodies may play a role in autoimmune hypoglycemia and diabetic ketoacidosis, but its role and mechanism are not precisely known. Further studies are needed to define the action mechanisms and the functions of insulin auto-antibodies: here we present case with a relevant literature.
Diabetic Ketoacidosis/*complications/*immunology/pathology ; Human ; Hypoglycemia/*complications/*immunology/pathology ; Insulin Antibodies/*blood ; Magnetic Resonance Imaging ; Male ; Middle Aged

Rifampin, when given in usual doses, is well tolerated with less than 4% of patients having significant adverse reactions. The patient had did not have any adverse reaction to rifampin in the first place. After 10 years, however, the patient was presented with hypotension, shortness of breath, wheezing and deterioration of consciousness in 10 minutes after taking rifampin. All abnormal symptoms and signs of anaphylaxis were normalized in 24 hours after administration of normal saline, glucocorticosteroid, and antihistamine. Skin prick test with rifampin showed positive reaction to gradual concentration of rifampin in dose dependent manner. The wheals by rifampin developed in 30 minutes and maximized in 2 hours, while normal saline and histamine controls showed expected negative and positive response in 10 minutes, respectively. Recently we expererienced a rare case of anaphylaxis after single oral administration of rifampin (450mg), who had been treated with antituberculous drug including rifampin, ca 10 years ago.
Administration, Oral ; Anaphylaxis* ; Consciousness ; Dyspnea ; Histamine ; Humans ; Hypotension ; Respiratory Sounds ; Rifampin* ; Skin

Cerebral aspergillosis accounts for about 10% of all the cases of invasive aspergillosis. The brain is the only infected site in less than 10% of cases. The patients at high risk for of aspergillosis are immunocompromised patients such as those in a neutropenic state after chemotherapy, AIDS and etc. We experienced a case of cerebral aspergillosis in a patient with acute leukemia that was in complete remission. The patient visited our hospital's ER due to nasal bleeding, and then he was quickly diagnosed as having acute promyelocytic leukemia. After the first induction chemotherapy, he achieved a complete remission. Loss of consciousness developed on day 31 after chemotherapy. High signal intensity in the right temporooccipital lobe and multiple nodular lesions in both cerebral hemispheres were observed on the brain MRI. Stereotaxic biopsy showed septate aspergillus hyphae in the brain specimen. Despite of the use of amphotericin B deoxycholate, the patient died of recurrent grand mal seizure and multiple organ failure.
Amphotericin B ; Aspergillosis* ; Aspergillus ; Biopsy ; Brain ; Brain Infarction ; Cerebrum ; Deoxycholic Acid ; Drug Therapy ; Epistaxis ; Humans ; Hyphae ; Immunocompromised Host ; Induction Chemotherapy ; Leukemia ; Leukemia, Promyelocytic, Acute* ; Magnetic Resonance Imaging ; Multiple Organ Failure ; Seizures ; Unconsciousness

Cryptococcus neoformans commonly causes opportunistic infection in other immunocompromised patients as well as in AIDS. Among cryptococcosis, cryptococcal meningitis is a relatively frequent manifestation and causes serious morbidity and mortality. It needs urgent diagnosis and effective antifungal therapy. We experienced cryptococcal meningitis in a 25-year-old female patient with autoimmune hemolytic anemia. She was admitted because of autoimmune hemolytic crisis. Her anemic symptoms were controlled by steroid and red cell transfusions. However, she was suddenly readmitted with decreased mentality. Seven days later, she was diagnosed as cryptococcal meningitis and cryptococcemia resulting from culture studies of CSF and blood. Since treated with amphotericin B and flucytosine and maintained with prudent fluconazole therapy, her symptoms and general conditions were improved. We report an unusual case of cryptococcal meningitis developed in a patient with autoimmune hemolytic anemia in spite of short-term steroid therapy.
Adult ; Amphotericin B ; Anemia ; Anemia, Hemolytic, Autoimmune* ; Cryptococcosis ; Cryptococcus neoformans ; Diagnosis ; Female ; Fluconazole ; Flucytosine ; Humans ; Immunocompromised Host ; Meningitis ; Meningitis, Cryptococcal* ; Mortality ; Opportunistic Infections ; Steroids