We treated the persistent ruminative vomiting of a 13-year-old autistic boy by using a behavioral and psychopharmacological approach in a closed ward. Before the interventions, the patient had lost about 10kg of body weight due to very high-frequency ruminative vomiting. Together with psychopharmacological trials, the psychiatric treatment included a combination of a behavioral approach and food regulation that emphasized food restrictions, and we provided regular light meals. There was a considerable reduction of the ruminative vomiting and 2kg weight gain was achieved during the admission. These therapeutic gains were maintained at the 4-month follow-up assessment and the vomiting symptom reached a near-zero level and the weight loss were recovered by about 8kg. The issues related to the treatment approaches for ruminative vomiting with autism are discussed.
Adolescent ; Autistic Disorder ; Body Weight ; Follow-Up Studies ; Humans ; Light ; Meals ; Vomiting ; Weight Gain ; Weight Loss

Short umbilical cord syndrome, also known as the limb-body wall malformation complex and the body stalk anomaly, is a poorly defined sporadic group of congenital anomaly charaterized by a complex set of disruptive abnormalities having in common the failured closure of the ventral body wall. This disorder is charaterized by a short or absent umbilical cord and disruption of the lateral body wall, spine, limbs, face, and cranium, isolated or in combination. Recently, we present a case of short umbilical cord syndrome which found in a term baby, so we report a case of short umbilical cord syndrome with brief review of literature.
Extremities ; Skull ; Spine ; Umbilical Cord*

No abstract available.
Animals ; Peripheral Nerve Injuries* ; Peripheral Nerves* ; Rats* ; Sciatic Nerve*

Background & Objective: Hiccups is a disabling condition of lateral medullary infarction (LMI). Unlike other symptoms of LMI, the anatomical lesions of hiccups are not well known. Few studies have evaluated the relationship between the lesional location of LMI and hiccups. We performed this study to correlate hiccups and magnetic resonance imaging (MRI)-based lesional location in pure LMI. Methods: Between January 1997 and February 2013, we identified 24 patients with pure LMI who presented with hiccups in addition to typical lateral medullary syndrome. Sixty six pure LMI patients without hiccups were included as a control group. Clinical and radiologic findings were compared between the two groups. MRI-identified lesions were classified rostrocaudally as rostral, middle and caudal, and horizontally as typical, ventral, large, lateral and dorsal. Results: The pure LMI patients with hiccups had significantly more frequent aspiration pneumonia (P = 0.001) and longer hospital stay (P = 0.03). The patients with hiccups significantly more often had dorsal rather than ventral lesion at horizontal levels (P = 0.012). But, there were no rostro-caudal differences at vertical levels (P = 0.162). Conclusions: We suggest that pure LMI associated with hiccups often locates in the dorsal medulla at horizontal correlation. This MRI-based comparative study has advanced the understanding of the neural substrate for hiccups in LMI, and indicates that hiccups become predictable when specific lesional locations in the lateral medulla are considered.

No abstract available.
Facial Nerve* ; Magnetic Resonance Imaging* ; Paralysis*

Tuberculosis is still remains an important cause of morbidity and mortality throughout the world. Calvarial tuberculosis is a rare entity and when the primary lesion is in the calvarium without any detectable pulmonary lesion, it is even exeedingly rare. The authors present a case of a 60-year-old female patient presenting with headache and an area of painful protrusion in the left parietal scalp. Plain skull radiographs, computerized tomography(CT) scan and magnetic resonance(MR) image of the brain revealed an osteolytic lesion in the left parietal bone with an outward growth of the outer table. Chest radiograph was normal. At operation, the osteolytic lesion of the skull and the abnormal soft tissue were removed completely. Histopathological report on the surgical specimen confirmed the tuberculosis of the calvarium.
Brain ; Female ; Headache ; Humans ; Middle Aged ; Mortality ; Parietal Bone ; Rabeprazole ; Radiography, Thoracic ; Scalp ; Skull ; Tuberculosis*

PURPOSE: To describe the MR findings for the three phases of eosinophilic granuloma, as defined by Mirra 'sconventional radiographic criteria. MATERIALS AND METHODS: Eighteen lesions in 14 patients with proveneosinophilic granuloma were retrospectively analyzed. Among this total, three vertebral lesions were excluded,and the remaining is were classified as early, middle, or late phase on the basis of Mirra's radiographiccriteria. For each phase, we compared MR findings with regard to signal intensity, homogeneity, contrastenhancement, perilesional marrow edema, and soft tissue change. For the three vertebral lesions excluded becausethe application of radiographic criteria was difficult, MR findings for paravertebral soft tissue reaction anddegree of cord compression were compared. RESULTS: Of the fifteen cases classified, eight were early phase, fivewere mid phase, and two were late phase. During each phase, all lesions except one, as seen on T1-weightedimages(T1W1), showed iso-signal intensity. On T2WI, all lesions showed high signal intensity. Contrast studydemonstrated marked contrast enhancement. Thus, no remarkable differences were found in the signal intensitydegree of contrast enhancement of each phase. With regard to heterogeneity, this was demonstrated in most earlyphase lesions, reflecting necrosis and hemorrhage of those lesions. Soft tissue swelling was more severe duringthe early phase than the mid or late phase, but marrow edema was similar in each of the three phase. One of threepatients with vertebra plana showed para-vertebral soft tissue swelling and cord compression, but this was notseen in the two other cases. CONCLUSION: For evalvating the extent of eosinophilic granuloma and its relationshipwith surrounding structures, MRI was superior to conventional radiography. During the early phase of the disease,lesions showed greater inhomogeneity and more aggressive soft tissue reaction than during the mid and late phase.The use of MRI for the evalvation of eosinophilic granuloma can help decide a therapeutic plan of action andfollow up evaluation.
Bone Marrow ; Edema ; Eosinophilic Granuloma* ; Eosinophils* ; Granuloma ; Hemorrhage ; Histiocytosis ; Humans ; Magnetic Resonance Imaging ; Necrosis ; Population Characteristics ; Radiography ; Retrospective Studies ; Spine

OBJECTIVE: Bronchopulmonary dysplasia (BPD) is one of the most frequent and clinically significant complications of prematurity and it has been widely accepted that immaturity, barotrauma, and oxygen toxicity are major factors in the etiology of BPD. However, recent studies showed that infection may also play a role in the pathogenesis of BPD and exposure to a prenatal inflammatory process may lead to lung injury and predispose to the subsequent development of BPD. The purpose of this study was to test the hypothesis that neonates with BPD had higher incidence of histologic chorioamnionitis than those in whom BPD does not develop. METHODS: A retrospective study was conducted to examine the relationship between histologic chorioamnionitis and the occurrence of BPD in neonate. We reviewed the hospital charts of 363 women and their neonates whose gestational age at birth were between 24 weeks and 35 weeks and recorded their pregnancy outcomes, the results of placental Biopsy, perinatal outcomes including the occurrence of BPD. RESULTS: 1. Neonates who developed BPD showed higher incidence of acute histologic chorioamnionitis. The relationship remained significant even after the adjustment for gestational age (odds ratio, 3.2: 95% confidence interval, 1.6-11.3: P<0.05). 2. Higher maternal serum CRP was also associated with increased incidence of histologic chorioamnionitis and BPD (P<0.05). 3. Neonates who developed BPD also had higher incidence of infectious morbidity such as early neonatal pneumonia and sepsis (P<0.05). CONCLUSION: These results suggest that histologic chorioamnionitis is closely related to the occurrence of BPD. This support the hypothesis that intrauterine infection may cause fetal lung injury and subsequent development of BPD.
Barotrauma ; Biopsy ; Bronchopulmonary Dysplasia* ; Chorioamnionitis* ; Female ; Gestational Age ; Humans ; Incidence ; Infant, Newborn ; Lung Injury ; Oxygen ; Parturition ; Pneumonia ; Pregnancy ; Pregnancy Outcome ; Retrospective Studies ; Sepsis

Mesenchymal chondrosarcoma is a rare tumor occurring in both bone and soft tissues and exhibits characteristic of a malignant nature. The authors experienced a case of mesenchymal chondrosarcoma occurring in a 23-year-old woman which had invaded the cervical spine. The patient presented with severe both shoulder pain, left upper extremity weakness(Grade IV) and paresthesia at admission. Radiologic studies of the cervial spine showed an aggressive osteolysis of C4 vertebral body, pedicle and lamina with compression of the spinal cord posteriorly on C3, C4, C5 levels. The tumor was totally removed by a combined anterior and posterior approach. The removed vertebral body was replaced with autogenous bone and stabilized by Codman locking plate symtem. The pathological examination showed characteristic of mesenchymal chondrosarcoma.previous symptoms well improved postoperatively. The authors present a case of mesenchymal chondrosarcoma with review of literature.
Chondrosarcoma, Mesenchymal* ; Female ; Humans ; Osteolysis ; Paresthesia ; Shoulder Pain ; Spinal Cord ; Spine* ; Upper Extremity ; Young Adult

Repeated surgery of the lumbar spine after lumbar discectomy was not uncommon. Total 817 cases of lumbar disorders were carried out surgical intervention in author's clinic from Jan. 1993. to May 1997. Among them, 82 cases were reoperated cases after lumbar disc surgery. The causes, methods and outcome of reoperation were reviewed. The most common causes of reoperation was epidural adhesion, and the most frequent method of reoperation was the interbody fusion with adhesiotomy. Epidural fibrosis was the major problem and must be studied forward for preventing reoperaion.
Diskectomy ; Fibrosis ; Reoperation* ; Spine