The posterior fossa, which contains about one fourth of the intracranial contents, is the site of known about two thirds of pediatric intracranial tumors. In about such tumors are less common and the prognosis may bevery poor. However, it is important to recognize the earliest symptoms because of the relatively high ease rate of operable management and the possibility for a high cure rate in some cases. A series of 51 pathologically verified posterior fossa tumors seen at the Department of Neurosurgery, Yonsei University, Severance Hospital over several years were studied. These tumors were explored surgically, and the diagnosis being made through histological examination. The cases were reviewed as to history, development and progression of the neurological features, laboratory findings, roentgenograms, differential diagnosis, operative methods and findings, and pathology. The authors emphasized some interesting points which are illustrated as follows; 1. Among 51 cases of posterior fossa tumors, 25 cases of acoustic neuroma, 9 cases of astrocytoma, 9 cases of medulloblastoma, 2 cases of ependymoma, 3 cases of pontine glioma and 3 cases of cysticercosis in the fourth ventricle were found, comprising 21 males and 30 females. 2. The 25 operated cases of acoustic neuroma were between the age of 20 and 60. Eighteen cases(69.2%) of the remaining posterior fossa tumors were below the age of 15. 3. The author was able to make the correct plain film diagnosis of acoustic neuroma in 13 cases(51%) of 25 cases. The prominent angiographic and ventriculographic finding of posterior fossa tumors was ventricular dilatation. 4. Vntriculogram was very important in the diagnosis of the fourth ventricle tumors. The Conray ventriculogram had the special benefit in accurately outlining and demonstrating the invasive pattern of fourth ventricle tumors. The Conray showed C.S.F. flow in malignant and other large tumors in the fourth ventricle better than was shown by previous pneumo-ventriculograms. 5. The Electroencephalogram showed an abnormal pattern in 62.2 per cent of 29 posterior fossa tumors.
Astrocytoma ; Cysticercosis ; Diagnosis ; Diagnosis, Differential ; Dilatation ; Electroencephalography ; Ependymoma ; Female ; Fourth Ventricle ; Glioma ; Humans ; Infratentorial Neoplasms* ; Male ; Medulloblastoma ; Neuroma, Acoustic ; Neurosurgery ; Pathology ; Prognosis

When a soft tissue mass in the bony wall of the paranasal sinus is present, it is difficult to make a distinction between tumor and inflammatory mass on CT. Fungal sinusitis may have soft tissue attenuation on the bony wall of the sinus, bony sclerosis, focal bony destruction, and calcific area on CT. This is a report of four proven cases of fungal sinusitis, asperogillosis in 3 cases and mucormycosis in 1 case, All 4 patients had CT and one patient had MRI, On CT, bony sclerosis and destruction were well visualized in all cases. On MRI, mycetoma in the maxillary sinus was hypointense on T1 weighted images and more hypointense on T2 weighted images. Although CT appears to be the best modality for initial examination of the patient with sinusitis, the differentiation of fungal sinusitis from tumor mass or other entity may be better accomplished with MRI.
Humans ; Magnetic Resonance Imaging ; Maxillary Sinus ; Mucormycosis ; Mycetoma ; Sclerosis ; Sinusitis

PURPOSE: Introduction of low osmolality contrast agent(LOCA) has allowed safer, more comfortable contrast-enhanced CT examination, but there has been significant increase in image degradation when evaluating the kidneys due to streaky artifact. The authors reviewed findings of contrast-enhanced abdominal and pelvic computed tomography(CT) to know the difference of renal streaky artifact between a high osmolality contrast agent (HOCA) and LOCA. MATERIALS AND METHODS: This study included two hundred contrast-enhanced CT in 200 patients, 100 performed with HOCA(meglumine ioglicate, 150ml) and 100 performed with LOCA (iopromide, 150ml). The severity of renal streaky artifact was compared between HOCA and LOCA groups. RESULTS: Of the scans performed with HOCA, 40 had no artifact, 52 had grade I artifact, 6 had grade II artifact, and 2 had grade III artifact Of the scans performed with LOCA, 23 had no artifact, 44 had grade I artifact, 29 had grade II artifact, and 4 had grade III artifact. There was significant difference in the degree of the streaky artifact depending upon the osmolality of the contrast media used(by {{{{x^2}}}}-test, P=.0001). CONCLUSION: The results of this study revealed a statistically significant increased incidence of artifacts and distortions of renal image with LOCA when compared with HOCA.
Artifacts* ; Contrast Media* ; Humans ; Incidence ; Kidney ; Osmolar Concentration* ; Tomography, X-Ray Computed

In order to elucidate the biological effects of pulsating magnetic field in in vitro culture system we designed a pulsating magnetic apparatus using 120 Hertz, 24 Volt direct current. It can generate 63~225 Gauss in the experimental area of 90 mm petri dish, and has little thermal effect on the culture media in 37.5oC, 5% CO2. Human osteogenic sarcoma (HOS) cells were cultured in the pulsating magnetic field and the nuclear changes of cultured cells were observed routinely by hematoxylin staining, and apoptotic change was detected by ApopTag staining using both peroxidase and fluorescein labelings. Compared to the control group which formed well organized whorling pattern of HOS cell line in 3 days culture, the HOS cells cultured in the pulsating magnetic field for 12 hours or 24 hours grew irregularly and showed increased number of apoptotic cells. When the flow of pulsating magnetic field was interrupted by insertion of strong permanent magnetic bar (1000 Gauss, 5530 mm) beneath the petri dish during in vitro culture, the area of sparse pulsating magnetic field showed active proliferation and aggregation of HOS cells even in 24 hour exposure group. These data suggest that the pulsating magnetic field may play a role in inducing growth retardation and apoptosis of HOS cells. Furthermore, the hazardous effects of pulsating magnetic field can be lessened or nullified by the interruption of pulsating magnetic field with a strong permanent magnetic bar.
Apoptosis ; Cell Line* ; Cells, Cultured ; Culture Media ; Fluorescein ; Hematoxylin ; Humans* ; Magnetic Fields* ; Osteosarcoma* ; Peroxidase

The diagnosis of soft tissue osteochondroma should be considered when a well-defined osseous mass is located in the soft tissues. The differential diagnosis includes myositis ossificans, tumoral calcinosis, synovial chondromatosis, and soft tissue osteosarcoma, true osteochondroma which arises from bone. One case of soft tissue osteochondroma in the knee, a lesion of uncertain pathogenesis is reported.
Calcinosis ; Chondromatosis, Synovial ; Diagnosis ; Diagnosis, Differential ; Knee ; Myositis Ossificans ; Osteochondroma* ; Osteosarcoma

No abstract available.
Fibroma, Desmoplastic* ; Fibula*

BACKGROUND: Head injury is one of the most common causes of emergency department visits and hospital admission in the pediatric populations, and most injuries are mild. In mild head injury, grading of severity and decision of hospital admission are difficult in the emergency department. Recent studies have suggested that patients with a normal head CT scan and neurologic exam following head injury can be safely discharged from the emergency department. However, previous studies have relied on incomplete patient follow-up and been limited for the most part to adult population. So we performed this study to assess clinical course and the incidence of significant CNS sequelae in children with a normal head CT scan and no focal neurologic sign after mild head injuries during hospital admission and follow-up for 1 month. METHODS: We reviewal the records of children(n=209) admitted to the department of emergency medicine with closed head injuries from Jan. 1, 1996 to Dec. 31, 1996, who's initial Glasgow Coma Scale was 13 to 15, and have no focal neurologic sign and a normal head CT scan. RESULT: 209 patients were studied with a mean age of 6.8(range 3 months to 15years), and 66.5% were male. The most common mechanisms of injury were pedestrian T.A(50.2%) and fall(11.5%). Patients had a mean Glasgow coma scale of 14.8 and mean Abbreviated Injury Score of 1.3. Patients had clinical symptoms of headache(49.3%), vomiting(44.5%), loss of consciousness(LOC)(29.6%), amnesia(10.0%), sleepiness(8.6%), irritability(8.6%), confusion(2.9%) and seizure(1.9%). The mean duration of admission was 4.3 days(range: 6 hours-20 days) and the mean duration of symptom was 36.4 hours. No child developed significant CNS sequelae during hospital admission. However, during hospital admission, aye children(all were preschooler) had psychologic complication ; one child developed post-traumatic stress disorder requiring psychologic treatment for 3 months. Three children developed enuresis and two children developed night terror. During 1 month fallow-up, one child developed a symptomatic hemorrhagic contusion 5 days after the head injury, not requiring neurosurgical treatment. CONCLUSION: Among children with an initial Glasgow Coma Scale of 13 to 15, a normal head CT scan and no focal neurologic sign after mild head injuries, delayed intracranial sequelae are extremely uncommon. So these patient may be discharged home with parental supervision and education for dose observation.
Adult ; Child* ; Contusions ; Craniocerebral Trauma* ; Education ; Emergencies* ; Emergency Medicine* ; Emergency Service, Hospital ; Enuresis ; Follow-Up Studies ; Glasgow Coma Scale ; Head Injuries, Closed ; Head* ; Humans ; Incidence ; Male ; Neurologic Manifestations ; Organization and Administration ; Parents ; Stress Disorders, Post-Traumatic ; Tomography, X-Ray Computed

Down syndrome is perhaps the most common genetic condition associated with mental retardation. In cytogenetic examination, trisomy 21 is in 95% of Down syndrome, and the others are mosaicism, translocation or deletion. There are many associated diseases with Down syndrome such as, thyroid function abnormality, congenital heart disease, intestinal blockage, and so on. Hypothyroidism appeared in 15% before adolescent in Down syndrome patients. In Korea, there were several reports of Down syndrome with hypothyroidism in childhood but not in adulthood. And we had three cases of hypothyroidism with Down syndrome in adulthood. Cytogenetic examination revealed trisomy 21 in the 2 cases and 1 case of mosaicism. Antithyroid antibody was positive in one case. None of these cases was admitted due to symptoms of hypothyroidism. It is very difficult to make the diagnosis of hypothyroidism in Down syndrome because of similarity in symptoms between Down syndrome and hypothyroidism. Thus, periodic thyroid function test should be made in Down syndrome, and this could be a part of improving quality of life in Down syndrome.
Adolescent ; Adult* ; Congenital Abnormalities ; Cytogenetics ; Diagnosis ; Down Syndrome* ; Heart Diseases ; Humans ; Hypothyroidism* ; Intellectual Disability ; Korea ; Mosaicism ; Quality of Life ; Thyroid Function Tests ; Thyroid Gland

BACKGROUND: Ross procedure is the pulmonary valve autograft in the aortic valve disease, and its use trends to increase after introduced by Ross in 1967, firstly. The most important point is that it is a permanent valve replacement. It is to be ideal method to the young patient because the graft is a viable tissue to be able to grow, and hemodynamically, most similar to the normal aortic valve, and doesn't need to do anticoagulation therapy due to not having the thromboembolism, but not popular because it has a lot of technical problem and doesn't have the long-term follow-up METHODS: The patients were 8 admitted between October 1997 and October 1998, the age from 15 to 39 ; 6 males and 2 females. The causes of disease were 4 patients of rheumatic disease, 1 of a infective endocarditis with the aortic annular abscess,1 of recurred severe aortic insufficiency 2 years after replacement. Two patients used the homograft and 6 patients switched a diseased aortic valve with the pulmonary autograft. RESULTS: There were no death and the preoperative dyspnea nearly disappeared (NYHA FC III-IV -> I-II). The diastolic diameter of left ventricle decreased significantly when we compared to the previous echocardiography 1 month after the operation, and we observed the mild aortic valve insufficiency in 3 patients, severe in 4, mild pulmonary valve insufficiency in 4, severe in 1, and mild pulmonary valve stenosis in 4. CONCLUSION: The operative death rate of Ross procedure in the aortic valve disease was not higher than the artificial valve replacement. Therefore, if we find the appropriate indication of operation, we can expect better results and think that we should have the long-term follow-up furthermore.
Allografts ; Aortic Valve ; Aortic Valve Insufficiency ; Autografts* ; Dyspnea ; Echocardiography ; Endocarditis ; Female ; Follow-Up Studies ; Heart Ventricles ; Humans ; Male ; Mortality ; Pulmonary Valve ; Pulmonary Valve Insufficiency ; Pulmonary Valve Stenosis ; Rheumatic Diseases ; Thromboembolism ; Transplantation, Autologous ; Transplants

BACKGROUND: Elafin is a potent anti-elastase in human saliva, and is supposed to play a role in preventing oral ulceration. The expression of elafin was observed in the oral lichen planus (OLP), one of the most common noninfectious oral mucosal diseases, which frequently manifests as extensive ulceration on the involved oral mucosa. METHODS: 50 OLP, 10 oral leuko-plakia, 3 inflammatory oral ulcers, and 3 normal oral mucosa cases were fixed with 10% buffered formalin, and immunohistochemically stained with monoclonal elafin antibody. Representative specimens were fixed with 4% paraformaldehyde, and RNA in situ hybridization, with an elafin RNA probe, was performed. RESULTS: With both the immunohistochemistry and RNA in situ hybridization the expression of elafin was more decreased in the OLP compared to the normal mucosa, while in the hyperplastic epithelium of the leukoplakia and inflammatory ulcers the expressions of elafin was more intense. In the thin epithelia of the reticular and atrophic OLPs the expressions of elafin were reduced compared to the normal mucosa, and became almost negative in the epithelium of the erosive OLP. CONCLUSIONS: These data suggested that the extensive ulceration of the OLP was closely relevant to the reduced expression of elafin in the involved epithelium
Elafin* ; Epithelium ; Formaldehyde ; Humans ; Immunohistochemistry ; In Situ Hybridization ; Leukoplakia ; Lichen Planus ; Lichen Planus, Oral* ; Mouth Mucosa ; Mucous Membrane ; Oral Ulcer ; RNA ; Saliva ; Ulcer