Rupture of anterior communicating artery aneurysm is one of the most important casuses of subarachnoid hemorrhage. Subarachnoid hemorrhage due to ruptured anterior communicating artery aneurysm shows characteristic CT findings, such as forntal hematoma or septum pellucidum hematoma. In some patients with the ruptured aneurysm, direct carotid angiography may be needed. particularly when transfemoral approach is not possible. However, not much have been known about the puncture site selection between the two carotid arteries in relation to the location of hematoma in CT scans. To determine the ideal puncture site of the direct carotid angiography, seventy-five cases of anterior communicating artery aneurysm confirmed by operation from May 1988 to April 1992, were analyzed in terms of relationship between location of hematoma on CT, direction of aneurysm and A1 artery on angiograms. Frontal lobar hematoma was more prevalent than septal hematoma, and was more common on the right side. In cases of lobar hematoma, aneurysm was directed to the ipsilateral side of the hematoma (67%) and was most commonly fed by contralateral A1 artery(75%). Septal bematoma consisted 36% of the cases and among there, midline directed aneurysm was most common, frequently fed by left A1 artery. In conclusion, when performing direct carotid angiography in patients with anterior communicating artery aneurysm, if forntal hematoma is observed on CT, it may be beneficial to puncture contralateral carotid artery. Meanwhile, if hemorrhage of septum pellucidum is observed, it may be better to puncture left carotid artery.
Aneurysm ; Aneurysm, Ruptured* ; Angiography ; Arteries* ; Carotid Arteries ; Hematoma ; Hemorrhage ; Humans ; Intracranial Aneurysm ; Punctures ; Rupture ; Septum Pellucidum ; Subarachnoid Hemorrhage ; Tomography, X-Ray Computed

Syringomyelia was described by Etienne et al in 1954 and was named by Ollivier in 1827 by reason of the pathologic cavitation of cord. Also it is considered a very chronic and irregulary progressive disease of the spinal cord of unknown cause which has predilection for the cervical and lumbar enlargements. The patient of 19 years old male had been suffered from the painless, severe swelling and instability of right elbow after trauma on right elbow, aud had complained of the sensory and temperature dissociation, muscle weakness with clawing hand in right upper extremity and scoliosis of mild degree. These symptoms and findings were same as those of the classic syringomyelia. Therefore the syningomyelia which is relatively rare in incidence will be reviewed by this report with the references.
Animals ; Elbow ; Hand ; Hoof and Claw ; Humans ; Incidence ; Male ; Muscle Weakness ; Scoliosis ; Spinal Cord ; Syringomyelia ; Upper Extremity

PURPOSE: An atrophic renal scar(RS) is one of the underlying causes for childhood hypertension and chronic renal failure. The risk factors for atrophic renal scar were evaluated. METHODS: 41 children, who presented with first febrile urinary tract infection at the Ewha Womans University Hospital between 1995 and 2003 and had generalized atrophic RS on 99mTc-DMSA renal scan, were retrospectively studied. Atrophic RS was divided into severe atrophic RS(n=14) if relative uptake on renal scan was below 10%, or mild atrophic RS(n= 27) if relative uptake on renal scan was between 10-35%. RS was defined as congenital if the scar was detected on the first renal scan, and as acquired if the scar developed on the follow-up renal scan from acute pyelonephritis of the first renal scan. The control group was consisted of randomly selected 41 children with segmental RS. The risk factors for atrophic RS such as the generation time, VUR, gender and ACE gene polymorphism were evaluated. RESULTS: The age distribution of atrophic RS and segmental RS did not differ significantly (P>0.05). The rate of congenital RS in atrophic RS was 61.0%(25/41), which was significantly higher than 9.8%(4/41) of segmental RS(P<0.01). Atrophic RS developed more frequently in male children(M:F 68.3%:31.7%) than segmental RS(M:F 41.4%:58.6%)(P<0.05). Vesicoureteral reflux(VUR) was found in 92.7%(38/41) of the atrophic RS, which was significantly higher than 53.7%(22/41) of segmental RS(P<0.05). In children without VUR, the male to female ratio did not differ between atrophic RS and segmental RS(P>0.05). But in children with VUR, there was a higher proportion of males with severe atrophic RS than segmental RS(85.7%:45.5%). ACE gene polymorphism did not differ between the atrophic and segmental RS groups, irrespective of the presence of VUR(P>0.05). CONCLUSION: Most atrophic RSs were congenital which could not be preventable postnatally and the major risk factors were VUR and the male gender. ACE gene polymorphism was not the significant risk factor for an atrophic RS.
Age Distribution ; Child ; Cicatrix* ; Female ; Follow-Up Studies ; Humans ; Hypertension ; Kidney Failure, Chronic ; Male ; Pyelonephritis ; Retrospective Studies ; Risk Factors* ; Technetium Tc 99m Dimercaptosuccinic Acid ; Urinary Tract Infections ; Vesico-Ureteral Reflux

Spontaneous herniation of the spinal cord is a rare disease entity in which spinal cord substance is herniated through a previously uninjured and/or untouched dura. It is a cause of myelopathy that is treatable but difficult to diagnose. We report the CT and MR findings of a case of spontaneous thoracic spinal cord herniation manifesting as ventrolateral protrusion of thoracic spinal cord through a dural defect.
Rare Diseases ; Spinal Cord Diseases ; Spinal Cord*

A ganglion cyst is a tumor-like lesion that contains mucous or myxoid material in the fibrous capsule. We report a case of ganglion cyst located in the lumbar anterior epidural space and causing lumbar radiculopathy. Computed tomography and magnetic resonance imaging revealed the cyst as a cystic lesion with wall en-hancement. Myelography showed that it was not filled with contrast medium and not connected with the dura, nerve root, or facet joint.
Epidural Space* ; Ganglion Cysts* ; Magnetic Resonance Imaging ; Myelography ; Radiculopathy ; Spinal Canal ; Zygapophyseal Joint

Transfer of large quantities of fetal blood across the placental barrier to the maternal circulation is a rare occurrence which results in severe anemia in the newborn infants. This phenomenon is believed to occur most often during labor and delivery and apparently, is more frequent when abnormal obstetric conditions are present. However, fetal erythrocytes have been identified in the naternal circulation throughout most of pregnancy indicating some degree of constant or intermittent transplacental transfusion. We experienced a case of stillbirth due to large amount of fetomaternal transfusion. Acid elutionl test of maternal blood was positive and direct and indirect Coombs test was negative. Ultrasonographic finding on abdomen and cranium to rule out the internal hemorrhage was normal. We report a case of stillbirth due to fetomaternal transfusion with a brief review of related literatures.
Abdomen ; Anemia ; Coombs Test ; Erythrocytes ; Female ; Fetal Blood ; Fetomaternal Transfusion* ; Hemorrhage ; Humans ; Infant, Newborn ; Pregnancy ; Skull ; Stillbirth*

BACKGROUND: Intravenous immunoglobulin (IVIg) has been widely used in the management of patients with various autoimmune neurological diseases, however, its action mechanisms have not fully been elucidated yet. This study focused on the effects of IVIg on the production of interleukin-6 (IL-6), one of major proinflammatory cytokine, using a human skeletal muscle cell line (HM4). METHODS: After HM4 cells were cultured in Dulbecco's modified eagle's medium (DMEM) containing 5% fetal bovine serum for 24 h, the culture medium was changed with serum-free media. TNF-alpha (tumor necrosis factor-alpha, 100 ng/mL) and IVIg (5 mg/mL) were treated alone or in combination and cultured for various time. RT-PCR and ELISA kit were employed for mRNA expression and secretion of IL-6, respectively. RESULTS: Treatment with TNF-alpha or/and IVIg significantly induced IL-6 mRNA expression (p<0.001). Although IL-6 production was markedly increased by TNF-alpha (p<0.001), IVIg treatment alone or in combination with TNF-alpha had no effect on the production of IL-6 except at 6 h after the treatment. CONCLUSIONS: IVIg seems not to have a significant effect on IL-6 production as an action mechanism of its immunomodulatory capabilities, at least in the HM4 cell line.
Cell Line* ; Culture Media, Serum-Free ; Enzyme-Linked Immunosorbent Assay ; Humans* ; Immunoglobulins ; Immunoglobulins, Intravenous ; Interleukin-6* ; Muscle, Skeletal* ; Necrosis ; RNA, Messenger ; Tumor Necrosis Factor-alpha

Methemoglobin (MetHb) is an oxidation product of hemoglobin in which the sixth coordination position of ferric iron is bound to a water molecule or to a hydroxyl group. The most common cause of acquired MetHb-emia is accidental poisoning which usually is the result of ingestion of water containing nitrates or food containing nitrite, and sometimes the inhalation or ingestion of butyl or amyl nitrite used as an aphrodisiac. We herein report a case of MetHb-emia after ingestion of an aphrodisiac, later identified as dapsone by gas chromatograph/mass selective detector (GC/MSD). A 24-year old male was admitted due to cyanosis after ingestion of a drug purchased as an aphrodisiac. On arterial blood gas analysis, pH was 7.32, PaCO2 26.8 mmHg, PaO2 75.6 mmHg, and bicarbonate 13.9 mmol/L. Initial pulse oxymetry was 89%. With 3 liter of nasal oxygen supplement, oxygen saturation was increased to 90-92%, but cyanosis did not disappear. Despite continuous supplement of oxygen, cyanosis was not improved. On the fifth hospital day, MetHb was 24.9%. Methylene blue was administered (2 mg/kg intravenously) and the patient rapidly improved. We proved the composition of aphrodisiac as dapsone by the method of GC/MSD.
Administration, Oral ; Adult ; Antidotes/therapeutic use ; Aphrodisiacs/adverse effects* ; Case Report ; Cyanosis/drug therapy ; Cyanosis/chemically induced ; Cyanosis/blood ; Dapsone/adverse effects* ; Human ; Male ; Methemoglobinemia/drug therapy ; Methemoglobinemia/chemically induced* ; Methylene Blue/therapeutic use

Bilateral cortical necrosis accounts for up to 2% of cases of acute renal failure. More than half of cases of bilateral renal cortical necrosis occure in association with pregnancy complicated by antipartum or postpartum hemorrhage. Other causes including severe bacterial infections, hemolytic uremic syndrome, trauma, postoperative shock, burns, Acute pancreatitis, diabetic ketoacidosis, snake venoms, and phosphorus poisoning. A 53-year-old woman presented with acute pancreatitis and acute renal failure. Diffuse bilateral renal cortical necrosis was diagnosed by renal biopsy and computed tomography. The patient recovered from the attack of pancreatitis but remained anuric. Then, we report this case of acute renal cortical necrosis associated with acute pancreatitis.
Acute Kidney Injury ; Bacterial Infections ; Biopsy ; Burns ; Diabetic Ketoacidosis ; Female ; Hemolytic-Uremic Syndrome ; Humans ; Kidney Cortex Necrosis* ; Middle Aged ; Necrosis ; Pancreatitis* ; Phosphorus ; Poisoning ; Postpartum Hemorrhage ; Pregnancy ; Shock ; Snake Venoms

Bilateral cortical necrosis accounts for up to 2% of cases of acute renal failure. More than half of cases of bilateral renal cortical necrosis occure in association with pregnancy complicated by antipartum or postpartum hemorrhage. Other causes including severe bacterial infections, hemolytic uremic syndrome, trauma, postoperative shock, burns, Acute pancreatitis, diabetic ketoacidosis, snake venoms, and phosphorus poisoning. A 53-year-old woman presented with acute pancreatitis and acute renal failure. Diffuse bilateral renal cortical necrosis was diagnosed by renal biopsy and computed tomography. The patient recovered from the attack of pancreatitis but remained anuric. Then, we report this case of acute renal cortical necrosis associated with acute pancreatitis.
Acute Kidney Injury ; Bacterial Infections ; Biopsy ; Burns ; Diabetic Ketoacidosis ; Female ; Hemolytic-Uremic Syndrome ; Humans ; Kidney Cortex Necrosis* ; Middle Aged ; Necrosis ; Pancreatitis* ; Phosphorus ; Poisoning ; Postpartum Hemorrhage ; Pregnancy ; Shock ; Snake Venoms