No abstract available.
Cerebral Hemorrhage* ; Mucormycosis*

Only a few reports have focused on ocular motor paralysis in herpes zoster ophthalmicus. We report a case of ocular motor paralysis resulting from herpes zoster. The patient, an 80-yr-old woman, presented with grouped vesicles, papules, and crusting in the left temporal area and scalp, with diplopia, impaired gaze, and severe pain. Her cerebrospinal fluid analysis was positive for varicellar zoster virus IgM. Magnetic resonance imaging was performed to rule out other diseases causing diplopia; there were no specific findings other than old infarctions in the pons and basal ganglia. Therefore, she was diagnosed of abducens nerve palsy caused by herpes zoster ophthalmicus. After 5 days of systemic antiviral therapy, the skin lesions improved markedly, and the paralysis was cleared 7 weeks later without extra treatment.
Abducens Nerve Diseases/*complications/*diagnosis/therapy ; Acyclovir/*therapeutic use ; Aged, 80 and over ; Antiviral Agents/therapeutic use ; Female ; Herpes Zoster/*complications/*diagnosis/therapy ; Herpes Zoster Ophthalmicus/complications/diagnosis ; Humans ; Skin Diseases, Viral/complications/diagnosis/therapy ; Treatment Outcome

BACKGROUND/OBJECTIVES: Iron deficiency in early life is associated with developmental problems, which may persist until later in life. The question of whether iron repletion after developmental iron deficiency could restore iron homeostasis is not well characterized. In the present study, we investigated the changes of iron transporters after iron depletion during the gestational-neonatal period and iron repletion during the post-weaning period. MATERIALS/METHODS: Pregnant rats were provided iron-deficient (< 6 ppm Fe) or control (36 ppm Fe) diets from gestational day 2. At weaning, pups from iron-deficient dams were fed either iron-deficient (ID group) or control (IDR group) diets for 4 week. Pups from control dams were continued to be fed with the control diet throughout the study period (CON). RESULTS: Compared to the CON, ID rats had significantly lower hemoglobin and hematocrits in the blood and significantly lower tissue iron in the liver and spleen. Hepatic hepcidin and BMP6 mRNA levels were also strongly down-regulated in the ID group. Developmental iron deficiency significantly increased iron transporters divalent metal transporter 1 (DMT1) and ferroportin (FPN) in the duodenum, but decreased DMT1 in the liver. Dietary iron repletion restored the levels of hemoglobin and hematocrit to a normal range, but the tissue iron levels and hepatic hepcidin mRNA levels were significantly lower than those in the CON group. Both FPN and DMT1 protein levels in the liver and in the duodenum were not different between the IDR and the CON. By contrast, DMT1 in the spleen was significantly lower in the IDR, compared to the CON. The splenic FPN was also decreased in the IDR more than in the CON, although the difference did not reach statistical significance. CONCLUSIONS: Our findings demonstrate that iron transporter proteins in the duodenum, liver and spleen are differentially regulated during developmental iron deficiency. Also, post-weaning iron repletion efficiently restores iron transporters in the duodenum and the liver but not in the spleen, which suggests that early-life iron deficiency may cause long term abnormalities in iron recycling from the spleen.
Animals ; Diet ; Duodenum ; Hematocrit ; Hepcidins ; Homeostasis ; Iron* ; Iron, Dietary ; Liver ; Rats* ; Recycling ; Reference Values ; RNA, Messenger ; Spleen ; Weaning

Salmonella typhi splenic abscesses are a very rare complication of typhoid fever. Splenectomy is the standard surgical treatment for these lesions. But these days, with improvements in imaging techniques, percutaneous drainage of splenic abscesses has been demonstrated to be one of the alternative treatment in selected cases. We report the case of a 7 year-old male, who presented with Salmonella typhi in blood and urine cultures, and a 1: 320 in O titer of Widal test. Ultrasound and computed tomography showed a single splenic abscess, 3 cm in diameter. He was treated with antibiotics, but the symptoms were not relieved. Thus we performed the percutaneous drainage of the splenic abscess under ultrasound guidance. A culture of the aspirated material was positive for Salmonella typhi, and the boy's condition improved. We think that percutaneous drainage of a single lesion was an excellent alternative to surgery, particularly because our patient was young and spleen conservation was desirable.
Abscess/*therapy ; Case Report ; Child ; Drainage ; Human ; Male ; Splenic Diseases ; Typhoid Fever/*complications

We treated a total of 4 patients with midfacial hypoplasia, aged 12 to 19 years, using distraction osteogenesis between January 1998 and June 1999. In 3 patients with severe maxillary hypoplasia, we used rigid external distraction device developed by Dr. Polley. The distraction was performed from 5 days after Le Fort I osteotomy at a rate of 1 mm/day for 10 to 15 days. After distraction was completed, the device was left in place for another 6 weeks for bony consolidation. And then, an orthodontic face mask was used with elastic traction for 2 months. In one patient with partial hypoplasia of the midface, the osteotomized zygoma and a part of the maxilla was distracted selectively using rigid external distraction device a total of 15 mm. In the degree of SNA, mean value improved from 75.0(75.5, 75.0, 74.5) to 81.8(81.5, 83.0, 81.0) after 6 months later. In relapse rate, distracted length decreased from 10 mm to 6 mm, 15 mm to 8 mm, 13mm to 7 mm at 6 months later resulting in relapse rate of 44.3%. The follow-up period was from 7 to 26 months. Advantages of rigid external distraction device are highly effective technique of maxillary distraction, easy control of vector of distraction and no additional surgical procedure for removal of the device. In conclusion, the external distraction device is very useful for midface distraction.
Follow-Up Studies ; Humans ; Masks ; Maxilla ; Osteogenesis, Distraction ; Osteotomy ; Recurrence ; Traction ; Zygoma

The purpose of this study is to investigate the effect of artificial dermis(Terudermis(R)) on cartilage induction from perichondrium. A total of 24 rabbits were used and divided into control(n = 12) and experimental groups(n = 12). Each group was divided into 2 weeks(n = 6) and 4 weeks subgroups(n = 6). The dorsal skin of the rabbit ear was incised in reverse L-shape and the perichondrium was exposed. The silicone membrane from the Terudermis(R) , 1 x 1 cm sized,was removed. The Terudermis(R) was grafted on the exposed perichondrium in the experimental group. However, Terudermis(R) was not grafted in the control group. At 2 and 4 weeks after the surgery, the specimen was obtained and studied by histologic study. The results are as follows: 1. In control group at 2 weeks after surgery, the appearance of perichondrocytes and chondrocytes were not different from those of normal tissue. 2. In control group at 4 weeks after surgery, the extent of chondroblast differentiation and cartilage regeneration was insignificant compared to experimental group. 3. In experimental group at 2 weeks after surgery, we examined the active differentiation process of chondroblast beneath the perichondrium. The mean thickness of the neocartilage layer was 0.11+/-0.04 mm. 4. In experimental group at 4 weeks after surgery, there was an active regenerated new cartilage layer eneath the perichondrium, but the neocartilage layer was immature. The mean thickness of neocartilage layer was 0.33+/-0.10 mm. In conclusion, this study suggested that the grafted Terudermis(R) has an effect on chondrogenetic induction by activating the perichondrium.
Cartilage ; Chondrocytes ; Chondrogenesis* ; Dermis* ; Ear ; Membranes ; Rabbits ; Regeneration ; Silicones ; Skin ; Transplants

The face is a variable part of the body and characterized not only by each part but also by the interrelation of the parts. Because facial image is very complex, it is very difficult to standardize the facial profile. However, it is necessary to establish the facial anthropometry in the infant. We perforrned an anthropometric study of the linear length of soft tissue in 13 places of the nasolabial area using a spreading caliper and ruler for the purpose of establishing normal interrelationship of regional profile in newborns and 2, 4, 6 month old babies. Each age group was composed of 40 normal babies. Followings are our results in the order of newborn, 2, 4, 6 months old. Widths of columella were 3.2 mm, 3.5 mm, 3.7 mm, 3.8 mm, respectively. Heights of columella were 4.7 mm, 4.9 mm, 5.2 mm, 5.3 mm. Distances between medial alar bases were 13.7 mm, 14.4 mm, 17.4 mm, 17.6 mm. Lengths from alar to tip of Cupid's bow were 9.5 mm, 10.0 mm, 10.5 mm, 10.6 mm. Lengths from columella base to tip of Cupid's bow were 8.4 mm, 9.9 mm, 10.2 mm, 10.5 mm. Lengths from columella base to center of Cupid's bow were 8.3 mm, 9.5 mm, 9.8 mm, 9.9 mm. Lengths of one limb of Cupid's bow were 2.7 mm, 3.1 mm, 3.4 mm, 3.5 mm. Lengths from tip of Cupid's bow to commissure were 13.4 mm, 14.7 mm, 16.4 mm, 16.9 mm. Intercommissural distances were 26.8 mm, 30.3 mm, 30.8 mm, 32.5 mm. Widths of philtral column at columella base were 3.1 mm, 3.6 mm, 3.7 mm, 4.0 mm. Distances between philtral columns(mid portion) were 3.7 mm, 4.6 mm, 4.6 mm, 4.6 mm. Heights of nasal tip protrusion were 8.7 mm, 11.0 mm, 11.7 mm, 12.1mm. Widths of nose were 20.7 mm, 23.7 mm, 25.3 mm, 25.9 mm. As the treatment of cleft lip should be performed within 6 months of age, the exact data for the face are very important, especially in the nasolabial area. We expect our data to be useful as a guideline for the management of cleft lip patient under one year old.
Anthropometry ; Cleft Lip ; Extremities ; Humans ; Infant* ; Infant, Newborn ; Lip* ; Nose*

We treated 9 patients with hemifacial microsomia or facial asymmetry between April 1998 and November 1999. The age of patients ranged from 21 to 45 years(mean 24.6). Six were women, 3 were men. The follow up period was 6 to 24 months(mean 15.3 months). The operative procedure was based on the Ortiz Monasterio's simultaneous mandibuiar and maxillary distraction technique. Ortiz Monasterio only freed the pterygomaxillay junction of the affected side, leaving the nasal septum and pterygomaxillary junction of the unaffected side intact. They also used external corticotomy on mandible. We modified the original Ortiz Monasterio's method by using complete Le Fort I osteotomy with complete separation of both pterygomaxillary junction and mandibular osteotomy to avoid the resistance during the distraction. In one patient of scleroderma with severe atrophy of the mandible and soft tissue on the right face, a free scapular osteocutaneous flap was done. One month later, simultaneous distraction of the maxilla, the transferred scapula bone and the mandible was performed. Among the 9 patients, bidirectional distraction was done in one patient, and intraoral device was applied in 3 patients. After 5 days of latent period, distraction was performed at a rate of 1 mm per day. After 6 to 8 weeks of consolidation period, intermaxillary fixation and distraction device were removed. Preoperatively, the deviation of occlusal plane ranged from 8 to 13 (mean 10.5 ). The length of distraction ranged from 7 mm to 20 mm(mean 13 mm). In 2 patients, there were radiologic evidences of relapse 6 months after distraction, but no significant change of facial appearance was found. Seven patients have maintained stable preoperative occlusion of of teeth as previous conditions and preoperative lateral open bite was improved postoperatively in 2 patients. Postoperative occlusal plane ranged from 0 to 1.
Adult* ; Atrophy ; Dental Occlusion ; Facial Asymmetry* ; Female ; Follow-Up Studies ; Goldenhar Syndrome ; Humans ; Male ; Mandible ; Mandibular Osteotomy ; Maxilla ; Nasal Septum ; Open Bite ; Osteotomy ; Recurrence ; Scapula ; Surgical Procedures, Operative ; Tooth

PURPOSE: The purpose of this study was to investigate the value of the alveolar-arterial (A-a) oxygen gradient for patients with community-acquired pneumonia (CAP) in the emergency department (ED). METHODS: A prospective study of patients with CAP in the ED was performed. Patients with clinical and a radiographic diagnosis of CAP were enrolled. Inflammatory biomarkers, such as WBC (white blood cell) count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and A-a oxygen gradient were measured. The severity of CAP was assessed by three prediction rules: The Pneumonia Severity Index (PSI), CURB65 (confusion, blood urea nitrogen, respiratory rate, blood pressure and age> or =65 yrs), and the Infectious Disease Society of America (IDSA) and American Thoracic Society (ATS) rules. The value of each biomarker (WBC, CRP, ESR) and A-a oxygen gradient for the prediction of mortality and CAP severity were assessed. RESULTS: A total of 126 patients with CAP were included. Sixteen patients, older and in the high-risk group, died within 30 days. Non-survivors had a significantly increased A-a oxygen gradient compared to survivors (91.20 vs. 46.71 mmHg, respectively; p<.01) and a high-sensitivity to C-reactive protein (158.57 vs. 91.28 mg/dL, respectively; p<.01). The median A-a oxygen gradient was significantly higher with severe disease based on the three prediction rules. In regression logistic analyses, the area under the receiver operating characteristic curve of the alveolar-arterial oxygen gradient was 0.807(95% confidence interval, 0.727-0.872). The addition of A-a oxygen gradient to the three prediction rules significantly increased the area under the receiver operating characteristic curve. CONCLUSION: These results suggest that A-a oxygen gradient is useful for the prediction of mortality and disease severity among CAP patients in the ED. The A-a oxygen gradient, as an adjunct to CAP prediction rules, may be worth while for the assessment of prognosis and severity.
Americas ; Biomarkers ; Blood Pressure ; Blood Sedimentation ; Blood Urea Nitrogen ; C-Reactive Protein ; Communicable Diseases ; Diagnosis ; Emergencies ; Humans ; Mortality ; Oxygen* ; Pneumonia* ; Prognosis ; Prospective Studies ; Respiratory Rate ; ROC Curve ; Survivors

PURPOSE: The purpose of this study was to investigate the value of the alveolar-arterial (A-a) oxygen gradient for patients with community-acquired pneumonia (CAP) in the emergency department (ED). METHODS: A prospective study of patients with CAP in the ED was performed. Patients with clinical and a radiographic diagnosis of CAP were enrolled. Inflammatory biomarkers, such as WBC (white blood cell) count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and A-a oxygen gradient were measured. The severity of CAP was assessed by three prediction rules: The Pneumonia Severity Index (PSI), CURB65 (confusion, blood urea nitrogen, respiratory rate, blood pressure and age> or =65 yrs), and the Infectious Disease Society of America (IDSA) and American Thoracic Society (ATS) rules. The value of each biomarker (WBC, CRP, ESR) and A-a oxygen gradient for the prediction of mortality and CAP severity were assessed. RESULTS: A total of 126 patients with CAP were included. Sixteen patients, older and in the high-risk group, died within 30 days. Non-survivors had a significantly increased A-a oxygen gradient compared to survivors (91.20 vs. 46.71 mmHg, respectively; p<.01) and a high-sensitivity to C-reactive protein (158.57 vs. 91.28 mg/dL, respectively; p<.01). The median A-a oxygen gradient was significantly higher with severe disease based on the three prediction rules. In regression logistic analyses, the area under the receiver operating characteristic curve of the alveolar-arterial oxygen gradient was 0.807(95% confidence interval, 0.727-0.872). The addition of A-a oxygen gradient to the three prediction rules significantly increased the area under the receiver operating characteristic curve. CONCLUSION: These results suggest that A-a oxygen gradient is useful for the prediction of mortality and disease severity among CAP patients in the ED. The A-a oxygen gradient, as an adjunct to CAP prediction rules, may be worth while for the assessment of prognosis and severity.
Americas ; Biomarkers ; Blood Pressure ; Blood Sedimentation ; Blood Urea Nitrogen ; C-Reactive Protein ; Communicable Diseases ; Diagnosis ; Emergencies ; Humans ; Mortality ; Oxygen* ; Pneumonia* ; Prognosis ; Prospective Studies ; Respiratory Rate ; ROC Curve ; Survivors