We report a case of primary central nervous system vasculitis (PCNSV) mimicking a cortical brain tumor. A 25-year-old woman presented with a 2-week history of headache and transient right hemiparesis. Brain magnetic resonance imaging (MRI) revealed a cortical-involving lesion on the left frontal lobe. The 6-cm sized lesion showed low signal intensity on T1-weighted images and high signal intensity on T2-weighted images. The lesion had continual linear enhancement on the subcortical white matter and leptomeninges. There was no evidence of hemorrhage on susceptibility-weighted images and no diffusion restriction on diffusion-weighted images. The regional cerebral blood volume was decreased on the MR perfusion images, and spectroscopy showed increased lactate and lipid peaks. The symptoms were aggravated by fever and seizures. Biopsy was performed to rule out tumorous or inflammatory lesions. Pathologically, lymphocytes were infiltrated on the vessels, and the arachnoid membrane was thickened with inflammatory cells. The patient did not have any underlying diseases, including immune disorders. After high-dose steroid administration, her symptoms improved. Two months later, brain MRI showed a reduction in the infiltration of the T2 hyperintensity lesion with subtle subcortical enhancement. We present a case of PCNSV involving the left frontal lobe, showing vasogenic edema, mass effect, and subcortical linear contrast enhancement without hemorrhage or infarction.
Adult ; Arachnoid ; Biopsy ; Blood Volume ; Brain Neoplasms* ; Brain* ; Central Nervous System ; Diffusion ; Edema ; Female ; Fever ; Frontal Lobe ; Headache ; Hemorrhage ; Humans ; Immune System Diseases ; Infarction ; Lactic Acid ; Lymphocytes ; Magnetic Resonance Imaging ; Membranes ; Paresis ; Perfusion ; Seizures ; Spectrum Analysis ; Steroids ; Vasculitis ; Vasculitis, Central Nervous System* ; White Matter

No abstract available.
Ligaments* ; Pelvic Organ Prolapse*

Intravascular papillary endothelial hyperplasia (IPEH) is a rare vascular benign lesion that rarely involves the central nervous system with or without skull invasion. We report a rare case of IPEH on the skull bone, which displayed destructive radiologic development associated with hemorrhage. A 14-year-old male presented with an incidentally detected a small enhancing, left frontal osteolytic lesion. Previously, he underwent operation and received adjuvant chemoradiation therapy for cerebellar medulloblastoma. Follow-up magnetic resonance imaging revealed a left frontal bone lesion, which expanded to an approximately 2 cm-sized well-circumscribed osteolytic lesion associated with hemorrhage for 20 months. Frontal craniectomy and cranioplasty were performed. Destructive change was detected on the inner table and diploic space of the skull. The mass had a cystic feature with hemorrhagic content without dural attachment. Pathologic examination showed the capsule consisted of parallel collagen lamellae representing a vascular wall, vascular lumen, which was pathognomonic for IPEH. Immunohistochemical staining revealed that the capsule was positive for CD34 and factor VIII, which favor the final diagnosis of IPEH. This was the first case of intracalvarial IPEH.
Adolescent ; Central Nervous System ; Collagen ; Factor VIII ; Follow-Up Studies ; Frontal Bone ; Hemorrhage ; Humans ; Hyperplasia ; Magnetic Resonance Imaging ; Male ; Medulloblastoma ; Skull

The reports of all amniocentesis samples received in our cytogenetic laboratory from 1986 to 1998 were reviewed to identify cases in which culture failure of amniocytes occurred. Medical records were then reviewed for the prenatal ultrasonographic findings, karyotype when available, and clinical outcome. We investigated the clinical aspects associated with second trimester amniotic fluid cell culture failure. During the study period, 5,325 second trimester amniotic fluid samples were processed, of which 42(0.8%) failed to yield a result. Ninety-seven percent of the samples were obtained before 24 weeks' gestation, mainly because of advanced maternal age. Three percent of the samples were obtained after 24 weeks' gestation. Culture failure was more common in samples obtained after or at 24 weeks' gestation(11.8%) than in those obtained before 24 weeks(0.44%)(p<0.05, chi-square test). This difference was also observed when the results were analysed according to the cases with known normal or abnormal karyotypes, The frequency of culture failure did not differ significantly between the groups with normal and abnormal karyotypes. We conduded that amniotic fluid cell culture failure is more common in advanced pregnancy and is not associated with a higher incidence of chromosomal abnormalities.
Abnormal Karyotype ; Amniocentesis ; Amniotic Fluid ; Cell Culture Techniques* ; Chromosome Aberrations ; Cytogenetics ; Female ; Humans ; Incidence ; Karyotype ; Maternal Age ; Medical Records ; Pregnancy ; Pregnancy Trimester, Second

Purpose: This study aimed to identify independent predictors of favorable outcomes associated with emergent carotid artery stenting (CAS) in patients with acute anterior circulation stroke. Materials and Methods: This study included 93 patients with acute stroke who underwent emergent CAS to treat stenoocclusive lesions in the cervical internal carotid artery (ICA) within 6 hours of the onset of the associated symptoms. Data were compared between patients with and without favorable outcomes. The independent predictors of a favorable outcome were determined via logistic regression analysis (modified Rankin Scale 0–2 at 90 days). Results: Intracranial tandem occlusion was noted in 81.7% of patients (76/93) among which (76/93), 55 of whom underwent intracranial recanalization therapy. Intracranial reperfusion was successful in 74.2% (69/93) and favorable outcomes were noted in 51.6% of patients (48/93). The mortality rate was 6.5% (6/93). In logistic regression analysis, diffusion-weighted imaging-Alberta Stroke Program Early CT Score [odds ratio (OR), 1.487; 95% confidence interval (CI), 1.018–2.173, p = 0.04], successful reperfusion (OR, 5.199; 95% CI, 1.566–17.265, p = 0.007), and parenchymal hemorrhage (OR, 0.042; 95% CI, 0.003–0.522, p = 0.014) were independently associated with a favorable outcome. Conclusion Baseline infarct size, reperfusion status, and parenchymal hemorrhage were independent predictors of favorable outcomes after emergent CAS to treat stenoocclusive lesions in the cervical ICA in patients with acute anterior circulation stroke.

Objective: : A primary degenerative sagittal imbalance has been considered because of unique lifestyles such as the prolonged crouched posture during agricultural work and performing activities of daily living on the floor. Previous papers have reported that sagittal imbalance disease is often seen distinctly in the farming districts of “oriental” countries such as Korea and Japan. However, this finding was only evaluated with the use of X-ray, and other factors such as magnetic resonance imaging (MRI), muscle volume, compression fracture, and laboratory results were not considered. Thus, using these, we evaluate the agricultural work-associated factors for Korean elderly spinal sagittal imbalance. Methods: : We recruited 103 Korean participants who had a sagittal vertical axis (SVA) of >5 cm in this Korean Elderly Sagittal Imbalance Cohort Study. The following were evaluated : radiological parameters, MRI, compression fracture, vitamin D, parathyroid hormone, C-telopeptide, osteocalcin, bone mineral density and muscle fatty change, muscle volume, and health-related quality of life from patients’ survey. Moreover, in this survey, the farmers’ annual working hours were investigated. Subsequently, we analyzed the associated factors for spinal sagittal imbalance depending on occupation. Results: : A total of 46 participants were farmers, and the others were housewives, sellers, and office workers. The farmer group had more SVA (141 vs. 99 mm, p=0.001) and pelvic tilt (31° vs. 24°, p=0.004) and lesser lumbar lordosis (20° vs. 30°, p=0.009) and thoracic kyphosis (24° vs. 33°, p=0.03) than non-farmer group. A significantly positive correlation was noted between the working hour and SVA in the farmer group (p=0.014). The visual analogue scale score for back pain (8.26 vs. 6.96, p=0.008) and Oswestry Disability Index (23.5 vs. 19.1, p=0.003) in the farmer group were higher than that in the non-farmer group, but the Short Form-36 score was not significantly different between the two groups. The Mini-Mental State Exam score was significantly lower in the farmer group than in the non-farmer group (24.85 vs. 26.98, p=0.002). Conclusion : The farmer group had more sagittal imbalance and back pain in proportion to the working hours even though the muscle and bone factors and general laboratory condition were not significantly different between the two groups. These results supported that the long hours spent in the crouched posture while performing agricultural work were a risk factor for severe sagittal imbalance.

OBJECTIVE: Cervical carcinoma of the uterus, the most common maliganacy among women in Korea, which its etiology and pathogenesis are not yet determined. Recently, since it has been found about the function of the growth factor and its receptor, involved in the regulation of cellular growth and differentiation, many studies have been undertaken about the role of growth factors and its receptors in the growth and differentiation of the tumor cell. METHODS: In this study, we examined the expression of EGFR, TGF-alpha and Ki-67 in 50 CINs and 20 invasive cervical cancers using immunohistochemical stain. RESULTS: Positive rate of EGFR was 92% in CIN, 80% in invasive cancer, negative rate of TGF-alpha was 74% in CIN, 80% in invasive cancer and Ki-67 labelling index(LI) in normal basal cell, CIN I-II, CIN III were 5+/-0.7, 13+/-2.5, 65+/-5.4 repectively and in invasive cancer, LI was over 90. from this result as cervical carcinoma progresses, the expression of EGFR and Ki-67 increase while that of TGF-alpha decreases. CONCLUSION: As cervical carcinoma progress, the expression of EGFR and Ki-67 increase while that of TGF-alpha decreases. Further studies on the expression of EGFR and TGF-alpha and its growth-stimulation mechanism in cervical carcinoma are warranted to establish the pathogenesis of the cervical carcinoma.
Female ; Humans ; Intercellular Signaling Peptides and Proteins ; Korea ; Transforming Growth Factor alpha* ; Uterus

Chlorfenapyr is a widely used, moderately hazardous pesticide. Previous reports have indicated that chlorfenapyr intoxication can be fatal in humans. We reported the first non-fatal case of chlorfenapyr-induced toxic leukoencephalopathy in a 44-year-old female with resolution of extensive and abnormal signal intensities in white matter tracts throughout the brain, brain stem, and spinal cord on serial magnetic resonance imaging.
Adult ; Brain/*radiography ; Brain Stem/radiography ; Female ; Humans ; Insecticides/*toxicity ; Leukoencephalopathies/*etiology/radiography ; *Magnetic Resonance Imaging ; Pyrethrins/*toxicity ; Spinal Cord/*radiography ; White Matter/radiography

OBJECTIVE: We evaluated the usefulness of a polyetheretherketone (PEEK) cage filled with demineralized bone matrix (DBM) and plate fixation in anterior interbody fusions for subaxial cervical spine injuries. METHODS: A retrospective review of 98 patients (58 women, 40 men; mean age, 49.7 years; range, 17–78 years) who underwent single-level anterior cervical discectomy and fusion (ACDF) using a PEEK cage filled with DBM and plate fixation for subaxial cervical spine injuries from March 2005 to June 2018 was conducted. Bone fusion, interbody height (IBH), segmental lordosis, and adjacent segment degeneration (ASD) development were assessed with plain radiographs and computed tomography. Clinical outcomes were assessed using a visual analog scale (VAS) for pain and the Frankel grade for neurologic function. RESULTS: The mean follow-up period was 27.6 months (range, 6–142 months). Twenty-one patients (21.4%) had an improvement of at least one Frankel grade. The mean preoperative and final follow-up neck pain VAS scores were 8.3±0.9 and 2.6±1.5 (p < 0.05). All patients showed solid fusion at the final follow-up. The mean preoperative and final Cobb's angles were −3.7±7.9° and 1.9±5.1° (p < 0.05). The mean preoperative and final IBHs were 36.9±1.7 mm and 38.2±1.8 mm (p < 0.05). Five patients (5%) showed ASD. CONCLUSION: ACDF using a PEEK cage filled with DBM and plate fixation yielded high fusion rates and satisfactory clinical outcomes without donor-site morbidity. This procedure is safe and effective for single-level subaxial cervical spine injuries.
Animals ; Bone Matrix* ; Diskectomy ; Female ; Follow-Up Studies ; Humans ; Lordosis ; Male ; Neck Pain ; Retrospective Studies ; Spine* ; Visual Analog Scale