Despite the advent of new antimicrobial drugs and mordern imaging techniques, mortality and morbidity of bacterial meningitis remain high. The unfavorable clinical outcomes are due to intracranial complications such as cerebrovascular complications, hydrocephalus, cerebral edema, intracerebral hemorrhage, brain abscess, and convulsion. Prompt identification and treatment of each are essential to mininize unfavorable outcomes. We report two cases of cerebral infarctions complicated by Streptococcus pneumoniae meningitis with a brief review of related literatures.
Brain Abscess ; Brain Edema ; Cerebral Hemorrhage ; Cerebral Infarction* ; Hydrocephalus ; Meningitis, Bacterial ; Meningitis, Pneumococcal* ; Mortality ; Seizures ; Streptococcus pneumoniae* ; Streptococcus* ; Thrombosis

No abstract available.
Coronary Vessels* ; Dilatation* ; Edema* ; Meningitis, Aseptic* ; Mucocutaneous Lymph Node Syndrome*

No abstract available.
Ankle* ; Chondromatosis, Synovial*

PURPOSE: The purpose of this study is to help determine the optimal time and method for operation of pulmonary atresia(PA) with ventricular septal defect(VSD). METHODS: Seventy patients who were diagnosed as PA with VSD in the Pediatric Department of Cardiology, Severance Hospital between May, 1991 and April, 1995, were included in our study. Subjects were divided into two groups depending on the presence of major aorto-pulmonary collateral arteries(MAPCAs). In patients with MAPCAs, the distribution of MAPCAs concerning its relationship with central PA were analyzed, while in patients without them, morphologic changes of PA after performing conventional modified Blalock-Taussig(B-T) shunt were studied. RESULTS: After performing modified B-T shunts, the number of cases of PA stenosis and interruption increased from 26 to 37. Fifteen cases of advanced stenosis and six cases of interrupted PA were also observed. After performing modified B-T shunt, CSAI of both PA was increased from 197+/-101 to 311+/-138, more remarkably in cases without progression of PA stenosis. Among the patients with MAPCAs, 12 cases showed PDA, while 16 cases showed confluent PA. On average, MAPCAs were present in 2.5 cases. Concerning the types of MAPCAs, 14 cases were unifocal, while 36 cases were multifocal and most of them originated from descending aorta. CONCLUSION: In cases where pulmonary flow is maintained by PDA, stenosis of central PA is common, and can result in retarded pulmonary arterial development or increased stricture after modified B-T shunt, so careful attention is needed during follow-up. In cases with dominant MAPCAs, confluent PA is common, and multifocal pulmonary supply renders surgery difficult, so careful analysis of pulmonary supplies to each pulmonary segments, their shapes and relationships, are indicated preoperatively.
Aorta, Thoracic ; Cardiology ; Classification* ; Constriction, Pathologic ; Equipment and Supplies ; Follow-Up Studies ; Heart Defects, Congenital ; Heart Septal Defects, Ventricular* ; Humans ; Pulmonary Artery* ; Pulmonary Atresia*

Hemorrhagic disease of newborn by combined blood clotting factor deficiencies is very rare. Combined deficiency of factor V and factor VIII is the most common form among these cases, and inherited by autosomal recessive trait. Clinical findings are easy bruising, post-traumatic bleeding and bleeding after tooth extractions, and the main laboratory findings are prolonged partial thromboplastin time (PTT) and prothrombin time (PT) that are different from hemophilia A only with prolonged PTT. We experienced a case of combined congenital deficiency of factor V and factor VIII in a 1-day-old boy. We report the case with brief review of literature.
Blood Coagulation ; Factor V Deficiency ; Factor V* ; Factor VIII* ; Hemophilia A ; Hemorrhage ; Humans ; Male ; Partial Thromboplastin Time ; Prothrombin Time ; Tooth Extraction ; Vitamin K Deficiency Bleeding

OBJECTIVE: To determine whether a routine ultrasonography (US) is necessary for diagnosis of developmental dysplasia of hip (DDH), presenting with congenital muscular torticollis (CMT). METHODS: Cases of 133 patients (81 males, 52 females) diagnosed as CMT were reviewed, retrospectively. We reviewed the medical charts and diagnostic examination. We also assessed the coincidence of CMT and DDH, and investigated the clinical features of CMT related to DDH. RESULTS: Twenty (15.0%) patients out of 133 CMT patients were diagnosed as having DDH by US. Of whom, 8 patients were radiographically positive and 4 patients were both clinically and radiographically positive. Nine patients were treated with a harness and 1 of them needed closed reduction and casting. Out of 9 patients treated with a harness, only 4 were clinically positive. The difference and ratio of the sternocleidomastoid (SCM) muscle thickness between the normal and abnormal side was significantly greater in DDH patients (p=0.014). Further, receiver operating characteristic analysis showed when the SCM ratio is greater than 2.08 and the SCM difference is greater than 6.1 mm, the efficiency of US for the diagnosis of the DDH was found to be the best (p<0.05). CONCLUSION: To evaluate DDH, physical examination showed low sensitivity and radiologic study has limitation for the child before 4 to 6 months of age. Therefore, we recommend that hip is screened by US for the diagnosis of DDH associated with CMT when physical examination is positive or CMT patients with large SCM difference and high SCM ratio.
Child ; Hip ; Hip Joint ; Humans ; Male ; Muscles ; Physical Examination ; Retrospective Studies ; ROC Curve ; Torticollis

Pneumonia is one of important complications after allogeneic bone marrow transplantation (BMT). It is essential to disclose the cause of pneumonia because the treatment depends on the cause. The cause of pneumonia which BMT recipients develop can be infectious as well as noninfectious in origin. Acute eosinophilic pneumonia is a very rare cause of noninfectious pneumonia after BMT. We here report a 42-year-old woman with acute myelogenous leukemia (AML, M4) who developed acute eosinophilic pneumonia on 160 days after unrelated BMT. She was diagnosed by bronchoalveolar lavage and was dramatically improved after steroid treatment.
Adult ; Bone Marrow Transplantation* ; Bone Marrow* ; Bronchoalveolar Lavage ; Eosinophils* ; Female ; Humans ; Leukemia, Myeloid, Acute ; Pneumonia ; Pulmonary Eosinophilia*

Langerhans cell histiocytosis can cause central diabetes insipidus. Here, a case of Langerhans cell histiocytosis invading the pituitary stalk was experienced. The patient was 15 years old boy, with complaint of polydipsia and polyuria. A water deprivation test was carried out, and the urine osmolarity was increased from 165 to 469 mosm/kg following an injection of AVP to confirm the diagnosis of central diabetes insipidus. A pituitary function stimulation test gave a normal response. A sellar MRI was performed, which showed a thickened pituitary stalk mass (about 5.7mm), with an increased size, 6.9 mm, on a second MRI 2 month later. A tissue biopsy was performed, which showed aggregates of histiocytes and inflammatory cells, with prominent eosinophils (H&E), and also revealed strong reactivity to anti-CD1a antibody on the immunohistochemistry. After confirmative tissue diagnosis, the patient received radiotherapy (900 cGy). The thickened mass of the pituitary stalk disappeared on the MRI following the radiotherapy. The patient was managed with DDAVP nasal spray, after which the polyuric symptoms were completely relieved.
Adolescent ; Biopsy ; Deamino Arginine Vasopressin ; Diabetes Insipidus, Neurogenic* ; Diagnosis ; Eosinophils ; Histiocytes ; Histiocytosis, Langerhans-Cell* ; Humans ; Immunohistochemistry ; Magnetic Resonance Imaging ; Male ; Osmolar Concentration ; Pituitary Gland ; Polydipsia ; Polyuria ; Radiotherapy ; Water Deprivation

PURPOSE: We reviewed the therapeutic results of various Duct-Occlud coils(pfm AG, Koln, Germany) to evaluate the efficacy of the most-recently modified Duct-Occlud coil(Nit-Occlud) in the transcatheter closure of patent ductus arteriosus(PDA), including large defects more than 4 mm in diameter. METHODS: Two hundred and five patients who underwent percutaneous PDA occlusion using Duct- Occlud devices from March 1996 to December 2003 were enrolled and four types of Duct-Occlud [Standard(S), Reinforced(R), Reinforced reverse cone(RR) and Nit-Occlud(N)] were used in this study. The patients were followed up by echocardiogram and physical examination before discharge, one month, six months and 12 months after the procedure. RESULTS: The rate of residual shunt according to the type of Duct-Occlud were as follows: S-54%, R-72%, RR-50%, N-14%(P<0.05 compared with other devices) at one month, S-25%, R-44%, RR- 37%, N-0%(P<0.05 compared with other devices) at six months, S-8%, R-8%, RR-4%, N-0%(P< 0.05 compared with S and R) at 12 months and later. Nit-Occlud coil showed the complete occlusion of PDA after six months of follow-up, even in 12 patients with relatively large PDA(>4 mm). CONCLUSION: The transcatheter closure of PDA using Duct-Occlud was an effective treatment and our study revealed that a Nit-Occlud coil which showed higher rate of occlusion even in PDA with large diameters over than 4 mm, was a more effective modality compared to previous devices.
Ductus Arteriosus, Patent* ; Follow-Up Studies ; Humans ; Physical Examination

OBJECTIVE: To clarify specific serum beta-human chorionic gonadotropin (beta-hCG) levels on 11 days after intrauterine insemination (IUI) and in vitro fertilization-embryo transfer (IVF-ET) that could predict live birth. METHODS: Three hundred ninety-two pregnancies resulting from IUI and IVF-ET procedures between January 1, 1997 and December 31, 2000 were evaluated. Serum quantitative beta-hCG levels were measured 11 days after IUI or ET using standard immunoradiometric assays. Pregnancy outcomes were categorized as spontaneous abortion, biochemical pregnancy, ectopic pregnancy, singleton live birth, or multiple live birth. Statistical analyses were performed by analysis of variances, and Student's t-test. The sensitivity and specificity of serum beta-hCG level for predicting live birth were plotted using receiver-operator-characteristic (ROC) curve. RESULTS: The multiple live birth group has significantly higher serum beta-hCG level among the different pregnancy outcome groups. The beta-hCG level on the eleventh day after IUI and IVF-ET was significantly higher in the live birth group than the non viable pregnancy group. At a threshold level of 65 mIU/ml, the serum beta-hCG level on the eleventh day after IUI had a positive predictive value of 78.9% in predicting live birth with 95% specificity. At a threshold level of 115 mIU/ml, the serum beta human chorionic gonadotropin level on the eleventh day after ET had a positive predictive value of 92.1% with 95% specificity. CONCLUSION: These data suggest that serum beta-hCG level on 11 days after IVF-ET could be a reliable indicator predicting pregnancy outcome.
Abortion, Spontaneous ; Chorionic Gonadotropin* ; Female ; Humans* ; Immunoradiometric Assay ; Insemination* ; Live Birth ; Pregnancy Outcome ; Pregnancy* ; Pregnancy, Ectopic ; Sensitivity and Specificity