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

OBJECTIVE: The objective of this study was to evaluate and compare the diagnostic value of the open biopsy technique and the percutaneous biopsy techniques in lumbar spondylodiscitis. METHODS: Between January 2004 and December 2009, we retrospectively reviewed the medical records of 57 patients with infectious lumbar spondylodiscitis. The etiologic diagnosis of the infectious spondylodiscitis was obtained by two methods. Of 57 cases, twenty-seven patients underwent open biopsy and thirty patients underwent percutaneous needle biopsy including computed tomography (CT) - guided and fluoroscopy-guided needle aspiration. All biopsies were performed by experienced two neurosurgeons and one interventional radiologist. RESULTS: Of the 57 cases radiologically consistent with spinal infection, 29 (50.9%) biopsy specimens resulted in positive cultures and 28 (49.1%) returned negative cultures. According to the type of biopsy techniques, the culture-positive rate was higher (p=0.005) in the open biopsy group than the percutaneous needle biopsy group. 19 (70.4%) of 27 biopsy specimens were positive in the open biopsy group, and 10 (33.3%) of 30 biopsy specimens were positive in the percutaneous needle biopsy group. Furthermore, the open biopsy showed higher positive culture rate than the percutaneous needle biopsy in cases with administration of empirical antibiotics although there was no statistically significant (p=0.137). CONCLUSIONS: Open biopsy should be considered for administration of organism-specific antibiotics for the successful treatment when percutaneous needle yield negative result. Furthermore, empirical antibiotics should be delayed until results of cultures unless the patient is severely septic, critically ill, neutropenic or neurologically compromised.
Anti-Bacterial Agents ; Biopsy ; Biopsy, Needle ; Critical Illness ; Discitis ; Humans ; Medical Records ; Needles ; Retrospective Studies

No abstract available.
Kidney Failure, Chronic*

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

We experienced 2 cases of cauda equina syndrome with lumbar and lumbosacral disc herniations. They have symptoms of motor paralysis, decreased deep tendon reflex, sensory change on the corresponding dermatome or saddle area, and bladder dysfunction. We had performed neurologic examination, simple spine radiography, lumbosacral myelography, computed tomography, and cystometry for diagnosis. Patients were received operations of laminectomy and discectomy, and revealed significant degree of recovery on motor or sensory change but, not for the bladder dysfunction.
Cauda Equina* ; Diagnosis ; Diskectomy ; Humans ; Laminectomy ; Myelography ; Neurologic Examination ; Paralysis ; Polyradiculopathy* ; Radiography ; Reflex, Stretch ; Spine ; Urinary Bladder

In hypertrophic cardiomyopathy, the distribution and extent of left ventricular hypertrophy is known to be variable. Among the subtypes of hypertrophic cardiomyopathy, midventricular obstruction is a rare variant of obstructive hypertrophic cardiomyopathy. This variant is at higher risk of apical wall motion abnormality and/or infarction. We report 4 patients with midventricular obstructive hypertrophic cardiomyopathy who presented with chest pain. Significant systolic pressure gradients between basal and apical chamber of left ventricle were documented by cardiac catheterization and Doppler echocardiography in all patients, and left ventricular apical infarction was noted in one of them. During mean follow-up period of 32 months(21 months to 5 years), one patient with apical infarction died of malignant ventricular arrhythmia.
Arrhythmias, Cardiac ; Blood Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Cardiomyopathy, Hypertrophic* ; Chest Pain ; Echocardiography, Doppler ; Follow-Up Studies ; Heart Ventricles ; Humans ; Hypertrophy, Left Ventricular ; Infarction

In hypertrophic cardiomyopathy, the distribution and extent of left ventricular hypertrophy is known to be variable. Among the subtypes of hypertrophic cardiomyopathy, midventricular obstruction is a rare variant of obstructive hypertrophic cardiomyopathy. This variant is at higher risk of apical wall motion abnormality and/or infarction. We report 4 patients with midventricular obstructive hypertrophic cardiomyopathy who presented with chest pain. Significant systolic pressure gradients between basal and apical chamber of left ventricle were documented by cardiac catheterization and Doppler echocardiography in all patients, and left ventricular apical infarction was noted in one of them. During mean follow-up period of 32 months(21 months to 5 years), one patient with apical infarction died of malignant ventricular arrhythmia.
Arrhythmias, Cardiac ; Blood Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Cardiomyopathy, Hypertrophic* ; Chest Pain ; Echocardiography, Doppler ; Follow-Up Studies ; Heart Ventricles ; Humans ; Hypertrophy, Left Ventricular ; Infarction

PURPOSE: Congenital spinal dermal sinus tract is a rare lesion connecting skin to deeper structures including neural tissue. It results from the failure of the neuroectoderm to separate from the cutaneous ectoderm in the third to fifth week of gestation. The common locations are the lumbosacral and occipital regions. Sometimes it extends to spinal canal. In this paper we report a case of congenital spinal dermal sinus tract in the coccyx. METHODS: A 21-month-old male child born after an uncomplicated full-term pregnancy was admitted to our institute with a midline dermal sinus and a cartilaginous protrusion in the coccygeal region. There were no signs of infection. Neurologic examination showed no functional deficit in both lower limbs. He was treated with complete excision of the tract and an underlying accessory cartilage. RESULTS: The spinal dermal sinus tract was extended from the skin to the coccyx. The stalk was loosely attached to the accessory cartilage of coccyx. At that point, it was dissected from the accessory cartilage and resected. The accessory cartilage was also resected at the bone and cartilage junction. During the follow-up period of 6 months, the wound healed well without any complication nor recurrence. CONCLUSION: Congenital spinal dermal sinus tract is known as a form of spinal dysraphism. In order to prevent complications, timely surgical intervention including complete resection of sinus tract with correction of associated abnormalities is of utmost importance.
Cartilage ; Child ; Coccyx ; Ectoderm ; Follow-Up Studies ; Humans ; Infant ; Lower Extremity ; Male ; Neural Plate ; Neurologic Examination ; Pregnancy ; Recurrence ; Sacrococcygeal Region ; Skin ; Spina Bifida Occulta ; Spinal Canal ; Spinal Dysraphism