Isolated angiitis of the central nervous system is characterized by necrotizing vascular inflammation confined to the brain or spinal cord. The present report described a 22 year old female patient who experienced abruptly developing headache, dysarthria, swallowing difficulty, quadriparesis, and mental changes. The laboratory test of her blood, urine, and cerebrospinal fluid are all within normal range. Bliateral multiple small areas of low density were noted in the deep brain, cerebellun, and brainstem on brain C-T scan. There is no specific abnormal finding on the cerebral angiogram. The steroid treatment, 3 days of the 'pulse theraphy' followed by oral administration of prednisolone, dramatically ameliorated almost all symptoms and signs at first, but her symptoms were relapsed during tapering of oral prednisolone soon after. The second trial of the steroid treatment was not effective but there was a good response to the combined treatment of cyclophosphamide (Cytoxan) and prednisolone. The repeated brainstem auditary evoked potentials (BAEP) and somatosensory evoked potentials (SSEP) were helpful to determine the clinical course, as well as fluctuating abnormalities on brain CT scans.
Administration, Oral ; Brain ; Brain Stem ; Central Nervous System* ; Cerebrospinal Fluid ; Cyclophosphamide ; Deglutition ; Dysarthria ; Evoked Potentials ; Evoked Potentials, Somatosensory ; Female ; Headache ; Humans ; Inflammation ; Prednisolone ; Quadriplegia ; Reference Values ; Spinal Cord ; Tomography, X-Ray Computed ; Vasculitis* ; Young Adult

BACKGROUND: During a 1-month period in 2005 , a series of 4 Leclercia adecarboxylata and 8 Pseudomonas aeruginosa bacteremias were reported from patients admitted to the emergency room. METHODS: An outbreak of L. adecarboxylata and P. aeruginosa bacteremia that occurred from February to March 2005 was investigated. The infection control nurse reviewed medical records and observed the procedures of blood cultures at the clinical microbiology laboratory. Specimens were obtained for investigational cultures from alcohol sponge, tray, sink, water of sink, saline cotton, microscope, computer, and telephone. RESULTS: L. adecarboxylata was isolated from 4 patients and P. aeruginosa from 8 patients during a 1-month period. Observation of the culture procedure revealed that saline cotton was used to prevent betadin skin discoloration. The culture of the saline solution yielded a heavy growth of P. aeruginosa, which was not isolated from any other specimens. CONCLUSIONS: This was a pseudoepidemic caused by contaminated saline cotton. The use of the saline cotton was stopped, and during the follow-up period of 3 months, no additional L. adecarboxylata or P. aeruginosa bacteremia were reported.
Bacteremia ; Emergency Service, Hospital ; Enterobacteriaceae* ; Follow-Up Studies ; Humans ; Infection Control ; Medical Records ; Porifera ; Pseudomonas aeruginosa ; Skin ; Sodium Chloride ; Telephone ; Water

BACKGROUND: Reperfusion of ischemic myocardium has been postulated to result in a specific oxygen radical mediated tissue injury. Iron may liberate during ischemia and we hypothesized that administration of the iron chelator, deferoxamine during ischemia would result in improved recovery after postischemic reperfusion. PURPOSE: To test whether iron-catalyzed processes contribute to myocardial necrosis during ischemia and reperfusion, deferoxamine was administered to block iron catalyzed hydroxyl radical formation in rabbits. METHODS: Eleven rabbits were divided into two groups: control group (n=5) and deferoxamine pretreatment group (n=6). the left circumflex coronay artery was ligated for 30 minutes and reperfused for 180 minutes. Area at risk (AR) was measured by non-stained area with ethylene blue injection into left atrium after left circumflex coronary artery ligation. Infarct size was measured by weighing after tripheyltetrazolium chloride staining. Heart rate was measured using electrocardiographic recording and systemic blood pressure was monitored by pressure transducer connected to the catheter in the left ventricle. RESULTS: 1. There was no significant difference of heart rate and blood pressure in deferoxamine pretreatment group compared with control group. 2. There was significant decrease of serum iron concentration after continuous infusion of deferoxamine compared with serum iron concentration before ligation of coronary artery (P<0.05). 3. There was no significant difference of area at risk between control and deferoxamine pretreatment group. 4. Area at necrosis to area at risk was significantly reduced in deferoxamine pretreatment group compared with control group (P<0.05) The results suggest that deferoxamine infusion prior to coronary artery occlusion has a significant benefit in reducing infarct size in this model.
Arteries ; Blood Pressure ; Catheters ; Coronary Vessels ; Deferoxamine* ; Electrocardiography ; Heart Atria ; Heart Rate ; Heart Ventricles ; Hydroxyl Radical ; Iron ; Ischemia ; Ligation ; Myocardial Infarction* ; Myocardium ; Necrosis ; Oxygen ; Rabbits ; Reperfusion ; Transducers, Pressure

A 39-year-old hairdresser developed sodium bromate poisoning after drinking a cup of hair neutralizer in a suicide attempt. This is the first case of visual loss afteringestion of sodium bromate. Only few cases are as a cause of acute renal failure reported in medical literature. She presented 1 day later with anuria, required hemodialysis. Sensorineural hearing loss, often a characteristic finding, was developed.
Acute Kidney Injury* ; Adult ; Anuria ; Deafness* ; Drinking ; Hair ; Hearing Loss, Sensorineural ; Humans ; Poisoning* ; Renal Dialysis ; Sodium* ; Suicide

We experienced two cases of Boerhaave syndrome (spontaneous esophageal rupture). The first patient was a 62-year-old male who presented epigastric pain after several violent vomitings associated with alcohol ingestion. Diagnosis was done early and promptly in our emergency center and then definitive treatment was done only after 12hrs from onset of his symptom and he was discharged in relatively good condition 256ays after his admission. The second patient was a 44-year-old male who was transfered to our emergency center with chest pain, dyspnea and fever after vomitings associated with autobicycle accident. Diagnosis was delayed due to initial trauma oriented evaluation and incidious develpement of typical clinical findings and then he was managed conservatively but he died of multiple organ failure due to sepsis. We report these cases with literature review.
Adult ; Chest Pain ; Diagnosis ; Dyspnea ; Eating ; Emergencies ; Esophageal Perforation* ; Fever ; Humans ; Male ; Middle Aged ; Multiple Organ Failure ; Sepsis

No abstract available.
Intracranial Hypotension*

No abstract available.

No abstract available.

Of eighty-two patients who were hospitalized for acute cervical injuries, seventy five lived, seven died within 5 months of injury, and one was lost to follow-up. These patients were grouped by injury mechanism, level of vertebral injury, level and type of cord injury, and management. Degree of injuries and prognosis were classified by modified Frankel's classification. The ratio of male to female was 3.3 to 1. The causes of traumas were traffic accidents, falling down, sports, diving, slip down. Traffic accident was the most common cause of trauma, and passenger injury was the most frequent cause among that. The most common level of dislocation was C5-6 followed by C4-5 level. The C5 vertebra was most commonly fractured. Injury mechanisms divided into 4 groups(compressive or disruptive flexion, compressive or disruptive extenstion. Disruptive extension was less common than other three groups. Vertebral fractures were more common in flexion mechanism than in the extension mechanism. Cord injuries were more common in the compressive injury groups than disruptive one. Spinal cord was frequently injured by compressive flexion mechanism(p<0.005). Complete cord injury was the most common type of cord injury. And complete cord injuries were most frequently ocured by compressive flexion mechanism(p<0.005). On the other hand, forty one cases of asymtomatic spinal column injuries were frequently seen in disruptive flexion mechanism group(p<0.005). Of twenty four patients were operated, forty one were fused posteriorly, one anteriorly, one was performed discectomy, and one was fused anteriorly and posteriorly. Operations were more frequently applied in the compressive mechanism groups(p<0.005). The rate of neurologic improvement was 76.2%, 91.3%, 73.9% and 75% in compressive flexion, disruptive flexion, compressive extension and disruptive extension group respectively. The rate of neurological improvement in the operated group was 83.3%, and 73.7% in the non-operated group. Common complications were urinary tract infection, pneumonia, bed sore, gastrointestinal bleeding. The more frequent complications were urinary tract infection and pneumonia. The rate of complications was more common when the initial neurologic status was worse(p<0.005). Expire rate was high in the compressive flexion mechanism group. When the initial neurologic statue was A, when cord injury was at C6 or higher levels. The most common cause of was pulmonary problem.
Accidents, Traffic ; Classification ; Diskectomy ; Dislocations ; Diving ; Female ; Hand ; Hemorrhage ; Humans ; Lost to Follow-Up ; Male ; Pneumonia ; Pressure Ulcer ; Prognosis ; Spinal Cord ; Spine* ; Sports ; Urinary Tract Infections

A case of primary choroid plexus papilloma of the cerebellopontine angle with spinal leptomengeal seeding is reported, and the literature pertinent to this subject reviewed. CT scan revealed a well-demarcated elliptical homogeneousely high density lesion with definite contrast enhancement within right cerebellopontine angle, which could hardly be differentiated from that of acoustic neurinoma.
Cerebellopontine Angle* ; Choroid Plexus* ; Choroid* ; Neuroma, Acoustic ; Papilloma, Choroid Plexus* ; Tomography, X-Ray Computed