Pancreatic islet cell adenoma is a benign tumor of pancreatic beta-cell and a rare cause of hyperinsulinemic hypoglycemia in children. The authors experienced a case of pancreatic islet cell adenoma(Insulinoma)in a 11 year and 8 month old male who had frequent loss of consciousness and seizure. Enucleation was done after localization of tumor by selective celiac artery angiography and abdominal computed tomography. Diagnosis was confirmed by histologic findings as pancreatic-adenoma, gyriform growth pattern. A brief review of related literature was made.
Adenoma* ; Angiography ; Celiac Artery ; Child ; Diagnosis ; Humans ; Hyperinsulinism ; Hypoglycemia ; Infant ; Islets of Langerhans ; Male ; Seizures ; Unconsciousness

No abstract available.
DNA* ; Flow Cytometry* ; Gestational Trophoblastic Disease*

A case of metastatic adrenal cortical carcinoma in which partial remission was achieved with transarterial embolization is presented as probably the first reported case in the literature to date. A 29-year-old woman was admitted because of adrenal cortical carcinoma which had not responded to mitotane. A left adrenalectomy with segmentectomy of the involved liver had been done previously. Abdominal computerized tomography demonstrated multiple large metastatic tumors in the liver. Transarterial embolization with Gelfoam and 20 mCi of 131I-labeled lipiodol was performed and resulted in a decrease in tumor size and biochemical parameters. Transarterial embolization can be one of the therapeutic modalities for metastatic adrenal cortical carcinomas.
Adrenal Cortex Neoplasms/metabolism/*therapy ; Adult ; *Embolization, Therapeutic ; Female ; Gelatin Sponge, Absorbable ; Hepatic Artery ; Humans ; Hydrocortisone/metabolism ; Iodine Radioisotopes ; Iodized Oil ; Liver Neoplasms/metabolism/*secondary/*therapy

A totally implanted venous access system was inserted in 19 children with cancer. The devices were utilized for the administration of antineoplastic drugs, parenteral fluids, antibiotics, and blood products. Total duration of implantation was 4,046 days for 23 implanted system (range 7-445 days). Complications included cather infection (0.247/100 catheter days), occlusion (0.692/100 catheter days), and dislodgement of needle (0.643/100 catheter days). There were major complications that necessitated removal of catheters, including systemic infections (0.09/100 catheter days) and complete occlusions (0.09/100 catheter days). The system was thought to be safe and convenient in chemotherapy, and permitted full physical activity.
Anti-Bacterial Agents ; Antineoplastic Agents ; Catheters ; Child* ; Drug Therapy ; Humans ; Motor Activity ; Needles ; Prospective Studies*

Bell's palsy is a relatively common, unilateral facial paralysis of unknown etiology. The purpose of this study was to evaluate the prognostic value of several electrophysiologic tests in Bell's palsy. Blink reflex (BR), side-to-side compound muscle action potential (CMAP) amplitude comparison, and side-to-side nerve excitability test (NET) threshold differ once have been studied during the first 2 weeks in 66 patients with Bell's palsy. According to the early response of BR(Rl), the patients were divided into 3 groups: Rl< or = 13ms(17cases) ; Rl>13ms(22cases), and absent BR(27cases). There was a remarkable tendency towards a satisfactory recovery from paralysis if BR occurred during the first 2 weeks from onset(p<0.001). In patients with normal BR, 88.2% had a satisfactory recovery, when the reflex was absent a bad prognosis was given in 59.3% of the patients. According to side-to-side CMAP amplitude comparison, the patients were divided into 2 groups; CMAP amplitude comparison > or = 25% (35cases), and CMAP amplitude comparison <25% (31cases). There was a tendency towards a satisfactory recovery from paralysis if side-to-side CMAP amplitude comparison was more than 25% (p < 0,003). In patients with more than 25% of CMAP amplitude comparison, 82.9% of the patients had a satisfactory recovery, but in patients with less than 25% of CMAP amplitude comparison, 51.6% of the patients had a bad prognosis. According to side-to-side NET threshold difference, the patients were divided into 2 groups, NET threshold difference < or = 3.5mA(43cases), and NET threshold difference >3.5mA (23cases). When the threshold of electrical excitability on both sides differs 3.5mA or more an unsatisfactory recovery has strongly to expected(p<0.001). In patients with less than 3.5mA of NET threshold, 81.4% had a satisfactory recovery, but in patients with more than 3.5mA of NET threshold, 60.9% had a bad prognosis. BR, side-to-side CMAP amplitude comparison, and side-to-side NET threshold difference seem to be useful independent indices for predicting the prognosis an early stage of the paralysis.
Action Potentials ; Bell Palsy* ; Blinking ; Facial Paralysis ; Humans ; Paralysis ; Prognosis ; Reflex

Hereditary spastic ataxia is a familial neurological disorder which exhibit the features of a progressive combined pyramidal tract and cerebellar deficiency. The main features are progressive gait disturbance, incoordination, nystagmus, visual impairment, hyperreflexia, extensor plantar response, peripheral neuropathy, and pes cavus. A 27-year-old male patient with spastic ataxic gait was evaluated. He showed characteristic features of hereditary spastic ataxia. There were another twelve affected members in four generations of his family which may be inherited by autosomal dominant pattern. One of them is reported with review of the literature on familial spastic ataxia.
Adult ; Ataxia* ; Family Characteristics ; Foot Deformities ; Gait ; Humans ; Male ; Muscle Spasticity* ; Nervous System Diseases ; Peripheral Nervous System Diseases ; Pyramidal Tracts ; Reflex, Abnormal ; Reflex, Babinski ; Vision Disorders

The spontaneous hematomyelia is an uncommon event and its predisposing conditions are vascular malformation, syringomyelia, pregnancy and delivery, angioma, hemophilia, anticoagulant therapy, etc. We have recently experienced the patient with spontaneous onset and resolving hematomyelia in the cervical spinal cord. A 30-year-old male patient with non-traumatic spinal shock was evaluated. On MRI, a hematomyelia along cervical spi-nal cord was revealed. A suspicious AV malformation was noticed at C3-4 level. Fol-low-up MRIs showed spontaneous resolution of the hematoma.
Adult ; Hemangioma ; Hematoma ; Hemophilia A ; Humans ; Magnetic Resonance Imaging ; Male ; Pregnancy ; Shock ; Spinal Cord ; Spinal Cord Vascular Diseases* ; Syringomyelia ; Vascular Malformations

Congenital lobar emphysema is a rare disease and a cause of respiratory distress in early infancy. The most common location of pulmonary involvement is the left upper lobe. We diagnosed a case of congenital lobar emphysema in a 5-month-old female infant, who had a complex heart disease using flexible bronchoscopy. In spite of palliative heart surgery, respiratory difficulty and cyanosis did not improve and weaning from artificial ventilation was not possible. Chest X-ray and CT scan showed persistent hyperinflation in the left upper lobe. So, we performed flexible bronchoscopy. The findings showed no cartilage and patent bronchus during inspiration, but complete collapse during expiration due to a check valve effect in the left upper lobar bronchus. After excision of the involved lobe, the patient improved from respiratory distress. The observed airway patency during inspiration, and dynamic airway collapse on expiration suggest that bronchomalacia contributed to lung overinflation in this case.
Bronchi ; Bronchomalacia ; Bronchoscopy ; Cartilage ; Cyanosis ; Emphysema* ; Female ; Heart Diseases ; Humans ; Infant ; Lung ; Rare Diseases ; Thoracic Surgery ; Thorax ; Tomography, X-Ray Computed ; Ventilation ; Weaning

BACKGROUND: Bispectrum and bicoherence analysis that is the frequency domain methods of EEG analysis was examined to elucidate the correlation with the depth of anesthesia. METHODS: 25 patients under the gynecological surgery were studied. EEG was surveyed by PhysioLab 400. Analysis of EEG was done according to the progress of anesthesia, normal state before anesthesia, before incision of skin, operation 1, operation 2, awake and post-anesthesia. EEG is applied to filtering of signal, base line correction, linear detrend removal to get more reliable analysis. The appearance rate of bispectrum peaks are calculated by bispectrum operation. And bicoherences are calculated by bispectrum and power spectrum of AR model. RESULTS: In awaking state of patient in pre-anesthesia and post anesthesia, appearance rate of bispectral coupling was observed that a strong appearance rate was represented in all area (0-35 Hz). During the anesthesia, the low frequency area (3-15 Hz) revealed a strong appearance. Also the 2D map of a appearance rate is divided into four sections for more objectivity. Of four sections Bipara#4 is considered that the best parameter which showed progress of anesthesia (P < 0.01). In bicoherence study, in awake state which patient is in pre-anesthesia and post anesthesia, appearance rate of bicoherence value was observed that a strong appearance rate was represented in high frequency range (15-30 Hz). However, under the anesthesia of patients, the low frequency area (0-10 Hz) revealed a strong appearance. And, of four sections Bicpara#2 and Bicpara#4 are considered that the best parameter which showed progress of anesthesia effectively (P < 0.01). CONCLUSIONS: The analysis of the peak appearance of bispectrum and bicoherence is useful monitoring for the depth of anesthesia.
Anesthesia ; Electroencephalography ; Female ; Gynecologic Surgical Procedures ; Humans ; Skin

BACKGROUND: In patients with variant angina, previous data have been inconclusive as to whether basal coronary artery tone is elevated at the spastic sites and nonspastic sites. The purpose of this study was to assess the basal coronary artery tone and to evaluate the responsiveness to acetylcholine and ergonovine in patients with variant angina. METHODS: Basal coronary artery tone was assessed by obtaining the percent increase in coronary artery diameter induced by nitroglycerin in 66 patients with variant angina and 26 control subjects. We also compared the basal coronary tone and the constrictive responses to acetylcholine and ergonovine between the 31 patients with variant angina whom spasm was provoked by the low doses of acetylcholine(Ach; intracoronary, 20microg) or ergonovine(Erg; intravenous, 50microg)(Group 1) and the 35 patients provoked by higher doses of acetylcholine(intracoronary, 100microg) or ergonovine(intravenous cumulative dose of 350microg)(Group 2). RESULTS: Patients with variant angina whom spasm was provoked by low doses of acetylcoline and ergonovine, have a more tendency of combine fixed disease(mix disease), multivessel spasm and high disease activity. Basal coronary artery tone at the spastic sites was significantly elevated in the Group 1 in whom spasm was provoked by low doses of acetycholine and ergonovine than that in Group 2(44+/-17 vs 13+/-11%, respectively, p<0.05). Basal coronary artery tone of spasm-related artery, but not nonspasm related artery, at the non spastic site was greater in the Group 1 than that in Group 2 (26+/-14 vs 16+/-10%, respectively, p<0.05). In the patients with variant angina in whom spasm was provoked by higher dose of acetylcholine or ergonovine, basal coronary artery was comparable at the spastic and nonspastic sites and was not different from that in the control subjects. The magnitude of vasoconstrictive responses to acetylcoline and ergonovine, at the nonspastic sites, were also greater in Group 1 than those in Group 2 and the control groups(Ach; 40+/-20 vs 26+/-11. 27+/-12% : Erg ; 37+/-18 vs 12+/-8, 13+/-10%, respectively, p<0.05). CONCLUSION: These findings suggest that elevated basal coronary artery tone of the spastic sites and nonspastic sites of spasm-related artery in patients with variant angina may be related to occurrence of coronary spasm.
Acetylcholine* ; Arteries ; Coronary Vessels* ; Ergonovine* ; Humans ; Muscle Spasticity ; Nitroglycerin ; Spasm*