STUDY DESIGN: Retrospective study. OBJECTIVES: To analyze the outcomes of conservative management in elderly patients over 65 years of age who were diagnosed with pyogenic spondylitis. SUMMARY OF LITERATURE REVIEW: The surgical treatment of pyogenic spondylitis can lead to complications in elderly patients in a poor general condition or with underlying diseases. MATERIALS AND METHODS: We performed a retrospective review of 32 patients who were diagnosed with pyogenic spondylitis and had a minimum of 12 months of follow-up. Age, sex, comorbidities, clinical symptoms, and the involved segments were analyzed retrospectively. The diagnosis was assessed using clinical, laboratory, and radiologic findings. Antibiotic therapy was either specific (if positive culture results were found) or broad-spectrum cephalosporin (when the pathogenic agent was not isolated). Outcomes were assessed using residual pain and neurologic deficits. RESULTS: The mean onset time was 23.5 days (range, 3-90 days). The mean period of intravenous antibiotic therapy was 36.3 days (range, 10-90 days). All cases underwent conservative management, and 4 patients with progressive neurologic deficits due to epidural abscess underwent posterior laminectomy and abscess drainage. In all cases, the infection was successfully treated, although 12 cases reported residual lower back pain and 2 continued to exhibit minor neurologic deficits. CONCLUSIONS: In elderly patients with pyogenic spondylitis, satisfactory results were obtained with conservative management using antibiotics and orthosis after an early diagnosis, unless progressive neurologic symptom instability or spine deformities were noted.
Abscess ; Aged* ; Anti-Bacterial Agents ; Comorbidity ; Congenital Abnormalities ; Diagnosis ; Drainage ; Early Diagnosis ; Epidural Abscess ; Follow-Up Studies ; Humans ; Laminectomy ; Low Back Pain ; Neurologic Manifestations ; Orthotic Devices ; Retrospective Studies ; Spine ; Spondylitis*

PURPOSE: The purpose of our study is to evaluate characteristic features of 4th ventricular tumors in CT and MRI. MATERIALS AND METHODS: Pathologically proved 9 patients with 4th ventricular tumor were examined by CT and/or MRI. 4th ventricular tumors were epedymoma(4 cases), medulloblastoma(2 cases), choroid plexus papilIoma(2 cases), and oligodendroglioma(1 case). Included in our study were only those mass lesions that were located at surgery predominently within 4th ventricle with or without ventricular expansion. RESULTS: The origin of 4th ventricular tumor was the roof (epedymoma 3 cases, medulloblastoma 2 cases), the floor (epedymoma 1 case), and the undetermined(remaining 3 cases). On MRI, all tumors were hypointense exept ependymoma(3 cases) showing isointensity on T1WI. All tumors were hyperintense on PDWI and T2WI. On Gd-DTPA enhanced T1WI, strong enhancement was seen in all but epedymoma(1 case) which showed mild enhancement. On CT, as compared with MR images, various density on precontrast and postcontrast images were seen. Calcification was seen in choroid plexus papilloma(1 case) and oligodendroglioma(1 case). Hydrocephalus is seen in all cases exept ependymoma(2 cases) and oligodendroglioma(1 case). Hemorrhage within tumor was present only in epedymoma(2 cases). Cystic change or necrosis of tumor was seen in ependymomma(3 cases), choroid plexus papilloma(1 case), and oligodendroglioma(1 case). Peritumoral edema was seen in medulloblastoma(1 case). Extension through the foramen Luschka and the Magendie was seen in ependymoma(2 cases), choroid plexus papilloma(2 cases), and medulloblastoma(1 case). Seeding along the CSF pathway was seen only in ependymoma(2 cases). CONCLUSION: The results of our study may suggest that specific diagnosis of 4th ventricular tumor can be suggested preoperatively by analysing the origin in 4th ventricle, difference of CT density or MRI signal inten. sity, presence of extension or seeding through cerebrospinal fluid of the lesion.
Cerebrospinal Fluid ; Choroid Plexus ; Diagnosis ; Edema ; Gadolinium DTPA ; Hemorrhage ; Humans ; Hydrocephalus ; Magnetic Resonance Imaging* ; Medulloblastoma ; Necrosis

PURPOSE: Spontaneous subarachnoid hemorrhage(S-SAH) is a relatively rare disease with good clinical course and prognosis. The purpose of this study is to evaluate the cisternal blood distribution on CT in patient with S-SAH. MATERIALS AND METHODS: Out of 406 patients with subarachnoid hemorrhage on brain CT scan, 11 patients confirmed to be S-SAH by angiography and clinical follow-up were examined. We analysed the CT findings of these 11 cases retrospectively. RESULTS: Five patients had only perimesencephalic distribution of hemorrhage:the prepontine, the interped- uncular, and the suprasellar cisterns were involved in 4 cases each, the basal sylvian cistern in 3 cases, and the ambient cistern in 2 cases. The quadrigeminal and a portion of the lateral sylvians were also involved in 1 case each. Six patients revealed cisternal hemorrhage extending beyond the perimesencephalic cistern into the ventricles, cortical sulci, and lateral sylvian fissure. Intraventricular hemorrhage was noted in 3 cases of these 6 patients. CONCLUSION: Our study suggests that uncomplicated clinical course and normal anglographic finding are more important than CT distribution of cisternal hemorrhage in diagnosing S-SAH.
Angiography ; Brain ; Follow-Up Studies ; Hemorrhage ; Humans ; Prognosis ; Rare Diseases ; Retrospective Studies ; Subarachnoid Hemorrhage* ; Tomography, X-Ray Computed

No abstract available.
Adult ; Colonic Diseases/*diagnosis/etiology/surgery ; Colonoscopy ; Humans ; Intussusception/*diagnosis/etiology/surgery ; Lipoma/complications/*diagnosis/pathology ; Male ; Tomography, X-Ray Computed

Self-healing juvenile cutaneous mucinosis (SHJCM) is a rare disorder of unknown origin that affects healthy children. It is characterized by multiplication of transient papules and nodules on the head and periarticular area. Histopathologically, lesions show mucin deposition in the dermis or subcutis. A 9-year-old male patient presented with multiple skin-colored papules and nodules on the face and both hands. These papules and nodules had appeared over the preceding months and had been increasing in number. He was otherwise healthy and had no underlying systemic disorders. Skin biopsy in the right thenar nodule revealed deposition of amorphous material stained positively with Alcian blue (pH 2.5) within the dermis and subcutis. Spontaneous resolution occurred over several months without sequelae.
Alcian Blue ; Biopsy ; Child ; Dermis ; Hand ; Head ; Humans ; Male ; Mucinoses* ; Mucins ; Skin

Wells' syndrome or eosinophilic cellulitis is usually observed in adults who present with pruritic, erythematous and edematous plaques associated with papules or vesicles. It is a rare inflammatory dermatosis of unknown etiology showing an eosinophil-mediated immune response. Classical histopathological features observed in patients are eosinophil-predominant inflammatory infiltration and marked dermal edema, along with ‘flame figures’. An 11-year-old boy presented with edematous plaques surmounted by vesicles on his abdomen and lower extremities. A month prior to presentation, these skin lesions occurred on other parts of his abdomen; however, they resolved spontaneously within a week. Skin biopsies from the recurrent lesions showed features consistent with Wells' syndrome and a few molluscum bodies in the epidermis. Laboratory tests showed peripheral eosinophilia. We concluded that Wells' syndrome in this young patient was caused by preceding molluscum contagiosum infection.
Abdomen ; Adult ; Biopsy ; Cellulitis ; Child* ; Edema ; Eosinophilia ; Eosinophils ; Epidermis ; Humans ; Lower Extremity ; Male ; Molluscum Contagiosum* ; Skin ; Skin Diseases

Background: Direct insertion of a double-lumen tube (DLT) using a flexible fiberoptic bronchoscope (FOB) is an option for DLT intubation. The difficult process of fiberoptic intubation is that the different properties of polyvinyl chloride and silicone DLTs may affect railroading differently. Therefore, we aimed to compare intubation using polyvinyl chloride and silicone DLTs over an FOB. Methods: Patients aged 19–75 years who required one-lung ventilation under general anesthesia were enrolled in this study. After induction of anesthesia, the anesthesiologist intubated the DLT using FOB. The primary outcome was the difficulty of railroading over the flexible FOB scaled into five grades (I, II-1, II-2, III, and IV). Additionally, the intubation time and mucosal damage were recorded. Results: A total of 46 patients participated in this study, 23 each in the silicone and polyvinyl groups. The difficulty of railroading over the FOB was significantly different between the two groups (P < 0.001). In the silicone group, the grades of difficulty in railroading were limited to I and II-1; 20 patients (87%) presented no difficulty in advancing the tube. In contrast, in the polyvinyl group, 13 patients (57%) had scores of II-2 and III. Both the intubation time and mucosal damage were significantly better in the silicone group than in the polyvinyl group. Conclusions Intubation using a silicone DLT over an FOB was easier and faster than that with a polyvinyl chloride DLT with lesser trauma around the glottis.

Objective: To develop a computerized visuomotor integration system for assessment and training of visual perception impairments and evaluate its safety and feasibility in patients with a stroke. Visual field defects and spatial neglect lead to substantial poststroke impairment. Most diagnostic assessments are anchored in traditional methods, and clinical effects of rehabilitation treatments are limited. Methods: The CoTras Vision system included two evaluations and four training modules. The evaluation modules were based on the Albert’s test and Star cancellation test, and training modules were based on visual tracking, central-peripheral integration, and visuomotor perception techniques. Bland–Altman plots for agreement with the traditional paper-and-pencil test were performed, and the modified Intrinsic Motivation Inventory, Patient Satisfaction Questionnaire, and Simulator Sickness Questionnaire were conducted. Results: Ten patients with acute stroke completed the study. Bland–Altman plots revealed good agreements for Albert’s test (mean difference, -0.3±4.5) and Star cancellation test (mean difference, 0.3±0.7). The mean±standard deviation scores of the modified Intrinsic Motivation Inventory, Patient Satisfaction Survey, and Simulator Sickness Questionnaire were 84.7±30.6, 40.5±7.9, and 34.0±34.5 respectively. Conclusion The CoTras Vision system is feasible and safe in patients with stroke. Most patients had a high degree of motivation to use the system and did not experience severe adverse events. Further studies are needed to confirm its usefulness in stroke patients with visual field defects and hemineglect symptoms. Furthermore, a large, well-designed, randomized controlled trial will be needed to confirm the treatment effect of the CoTras Vision system.

Encephalopathy is a disorder characterized by altered brain function, which can be attributed to various causes. Encephalopathy associated with metronidazole administration occurs rarely and depends on the cumulative metronidazole dose, and most patients with this condition recover rapidly after discontinuation of therapy. Because metronidazole is metabolized in the liver and can be transported by the cerebrospinal fluid and cross the blood-brain barrier, it may induce encephalopathy even at a low cumulative dose in patients with hepatic dysfunction. We experienced a patient who showed ataxic gait and dysarthric speech after receiving metronidazole for the treatment of hepatic encephalopathy that was not controlled by the administration of lactulose. The patient was diagnosed as metronidazole-induced encephalopathy, and stopping drug administration resulted in a complete recovery from encephalopathy. This case shows that caution should be exercised when administering metronidazole because even a low dose can induce encephalopathy in patients with liver cirrhosis.
Anti-Infective Agents/*adverse effects/therapeutic use ; Brain Diseases/*chemically induced/diagnosis ; Hepatic Encephalopathy/*drug therapy/etiology ; Humans ; Liver Cirrhosis/*complications ; Magnetic Resonance Imaging ; Male ; Metronidazole/*adverse effects/therapeutic use ; Middle Aged ; Tomography, X-Ray Computed

Cutaneous and systemic plasmacytosis (CSP) is a rare disorder of unknown etiology characterized by cutaneous polyclonal plasma cell infiltrates associated with various extracutaneous involvement and polyclonal hypergammaglobulinemia. Here, we report on a 54-year-old male patient with chronic renal insufficiency who presented with disseminated reddish-brown macules and plaques on the face and trunk. In our evaluation, he was found to have lymphadenopathy, polyclonal hypergammaglobulinemia; benign plasma cell infiltration involving the skin, bone marrow, and retroperitoneal area; and renal amyloidosis. To the best of our knowledge, this is the first reported case of CSP associated with renal amyloidosis.
Amyloidosis* ; Bone Marrow ; Humans ; Hypergammaglobulinemia ; Lymphatic Diseases ; Male ; Middle Aged ; Plasma Cells ; Renal Insufficiency, Chronic ; Skin