No Abstract available.
Cross Infection* ; Korea*

It has been known that right ACA occlusions can cause callosal disconnection syndrome. A 61-year old right-handed man was admitted because of a left ACA occlusion. MRI showed infarction of the medial frontal cortex and the anterior two-thirds of the corpus callosum. He presented with weakness and gait initiation failure in the right leg with grasp reflex, suspicious alien hand sign, and tactile anomia in the right hand. He was diagnosed with transcortical motor aphasia. He was unable to successfully complete written tasks in response to dictations and writing down spontaneous answers. He wrote down incorrect words and demonstrated paragraphism with his left hand. He could copy simple items but not written words and complex items with his left hand. Finally, he had difficulties in writing answers in response to complex verbal and written commands with his left hand, but preserved the ability to simple verbal commands, somato-sensory, and visually guided tasks. We attribute these results to the anterior callosal disconnection of the right sensorimotor cortex from the left language area.
Anomia ; Anterior Cerebral Artery ; Aphasia, Broca ; Corpus Callosum ; Emigrants and Immigrants ; Gait ; Hand ; Hand Strength ; Humans ; Infarction ; Leg ; Magnetic Resonance Imaging ; Middle Aged ; Reflex ; Writing

BACKGROUND: Enterococci are important cause of nosocomial infections. Recently, vancomycin-resistant enterococci (VRE) has been increasingly reported as significant nosocomial pathogens. Therefore, accurate identification of enterococcal species is a prerequisite step for the appropriate antibiotic treatment and epidemiologic surveillance. We wanted to know the usefulness of PCR method compared with Vitek automatic identification system. METHODS: Totally 105 isolates were identified on the species level by Vitek (GPI card and software version R06.1), methyl-alpha-D-glucopyranoside test, and PCR methods. RESULTS: Among 105 enterococcal isolates, 59 were identified as E. faecium, 11 E. faecalis, 6 E. gallinarum by Vitek. But 29 isolates (28%) were unidentified. Subsequently all of these isolates were analyzed by PCR, the results of which were as follows: 17 E. faecium, 5 E. casseliflavus, 7 E. gallinarum. Two isolates identified as E. gallinarum by Vitek were reidentified as E. casseliflavus by PCR and other methods for phenotypic characterization. CONCLUSOIN: PCR method was more accurate and sensitive than Vitek for the identification of enterococci species.
Cross Infection ; Epidemiological Monitoring ; Polymerase Chain Reaction*

Posttraumatic enophthalmos is one of the common complications of facial bone fracture, leading to serious functional and esthetic sequele. However, the correction of this complication is a challenging procedure. A 62-year old patient was injured in a traffic accident, resulting in enophthalmos of the right orbit, which had been uncorrected by a previous correction surgery. The patient showed prominent enophthalmos, ptosis of right orbit, and temporal area depression without complaining diplopia. Under general anesthesia, the correction of enophthalmos of right orbit was done using diced coastal cartilage and an absorbable mesh plate. The depressed right temporal and the frontal area were reinforced using harvested abdominal fat. Three months after the surgery, additional fat injection was introduced to supplement under local anesthesia. Currently, 12 months after the surgery, the patient is in stable state without any complications.
Abdominal Fat ; Accidents, Traffic ; Anesthesia, General ; Anesthesia, Local ; Cartilage* ; Depression* ; Diplopia ; Enophthalmos* ; Facial Bones ; Humans ; Orbit ; Ribs* ; Transplantation, Autologous

No abstract available.
Cord Blood Stem Cell Transplantation* ; Fetal Blood* ; Humans ; Leukemia* ; Siblings*

BACKGROUND: Although relapses are known to be common in optic neuritis, there are only a few follow-up studies concerning recurrent optic neuritis. The aim of this study is to characterize the difference between monophasic and recurrent optic neuritis by analyzing clinical and laboratory spectrums of index event. METHODS: We performed a partially retrospective and prospective cohort study of patients with optic neuritis. The patients with optic neuritis were included by review of their medical records and neuroimaging studies and then followed up for the relapses of optic neuritis. Excluded were those who showed any evidence of multiple sclerosis, and those with prior demyelinating attacks. RESULTS: Thirteen of 43 enrolled patients had a recurrent optic neuritis during a mean (SD) follow up period of 58.0 (21.2) months, yielding a 5-year cumulative rate of recurrence of 39.5 percent. The patients who had CSF pleocytosis were more likely to develop a recurrent attacks (P<0.05), but neither clinical findings nor the other laboratory results appeared to influence recurrence. CONCLUSIONS: We suggest that this disorder have a distinctive feature in terms of relapse and CSF pleocytosis compared with monophasic optic neuritis.
Cohort Studies ; Follow-Up Studies ; Humans ; Leukocytosis ; Medical Records ; Multiple Sclerosis ; Neuroimaging ; Optic Neuritis* ; Prospective Studies ; Recurrence ; Retrospective Studies

A 42-year-old woman who had undergo a subtotal gastrectomy for stomach cancer, developed transient bilateral cortical blindness and hemiplegia after the removal of a subclavian vein catheter. A brain MRI, transcranial doppler sonogram and visual evoked potentials revealed no abnormalities. She returned to normal neurologic status 4 days after onset. There have been a few cases of transient cortical blindness after an insertion or removal of the subclavian vein catheter. However, caution should be taken for this possibility whenever the subclavian catheter is inserted or removed.
Adult ; Blindness, Cortical* ; Brain ; Catheters* ; Evoked Potentials, Visual ; Female ; Gastrectomy ; Hemiplegia ; Humans ; Magnetic Resonance Imaging ; Stomach Neoplasms ; Subclavian Vein*

It is generally believed that tumor necrosis factor alpha (TNF a) plays an crucial role in the pathogenesis of bacterial meningitis through various mechanisms such as endothelial damage, induction of adhesion molecule on the endothelial cell, recruitment of leukocytes in the cerebrospinal fluid(CSF). We performed this study to analyze the relationship of TNF alpha level with the severity of inflammation in the CSF. In a rabbit meningitis model, we attempted to evaluate whether antibiotics induced bacteriolysis can induce the elevation of the TNF alpha level and pleocytosis in CSF, and whether dexamethasone can suppress this elevation of TNF alpha. We also tried to assess the effective administation timing of dexamethasone. Meningitis was induced by intracistemal inoculation of Streptococcus pneumoniae. We designed four groups : Group 1. Untreated conrol (N=5); Group 2. Lone ceftriaxone at 6 hours after inoculation (N=5) ; Group 3. Dexamethasone at 30 minutes before ceftriaxone treatment (N=5); Group 4. Dexamethasone at 30 min. after ceftriaxone treatment (N=5). CSF TNF alpha level and cell count was assessed with regular time interval. The results were as follows: First, the CSF bacterial counts (measured by colony forming units) of group 1 was significantly higher than the other groups after ceftriaxone treatment (P<0. 05). Second, the CSF WBC counts of group 3 and 4 were significantly lower than those of group 1 and 2 at 6 and 14 hours after ceftriaxone treatment (P<0.05). Third, the CSF TNF alpha titers of group 1 and 3 were significantly lower than those of group 2 and 4 at 2 hours after ceftriaxone treatment (P<0.05). Fourth, after 14 hours, the CSF TNF alpha titers of group 1 kept on rising and became significantly higher than those of other groups (P Anti-Bacterial Agents ; Bacterial Load ; Bacteriolysis ; Ceftriaxone ; Cell Count ; Dexamethasone* ; Endothelial Cells ; Inflammation* ; Leukocytes ; Leukocytosis ; Meningitis ; Meningitis, Bacterial ; Meningitis, Pneumococcal* ; Streptococcus pneumoniae ; Tumor Necrosis Factor-alpha

Flumazenil, an imidazobenzodiazepine, is the first benzodiazepine antagonist and is being used to reverse the adverse pharmacological effects of benzodiazepine. There have been a few reports on the central nevous system side effects with its use. We report a patient with generalized ballism following administration of flumazenil. The mechanism through which flumazenil induced this symptom is unknown. It is conceivable that flumazenil may antagonize the GABA-benzodiazepine receptor complex and induce dopamine hypersensitivity, thus induce dyskinesic symptoms.
Diagnosis, Differential ; Dyskinesias/etiology* ; Female ; Flumazenil/adverse effects* ; GABA Modulators/adverse effects* ; Human ; Middle Aged

Dermatofibrosarcoma protuberance is a relatively rare malignant soft tissue tumor which is locally invasive and looks like a protruded hardened plaque composed of multiple nodules. It seldom occurs on the scalp and the occurrence rate is less than 5%. Nowadays there is a tendency to choose Mohs surgery as a primary treatment instead of a wide excision, because Mohs surgery can reduce cases of recurrence. We report a case of multiple dermatofibrosarcoma protuberans on the scalp of a 32-year-old man. We planned a delayed operation using tissue expanders. We inserted two skin expanders and successfully expanded scalp tissue more than 150% after 7 months. Mohs surgery was performed with a 4 cm distance from borderline of lesions and then the large scalp skin defect was covered by the expanded skin which had been prepared by tissue expanders. It has been 9 months since the operation was performed and there have been no signs of recurrence.
Adult ; Dermatofibrosarcoma* ; Humans ; Mohs Surgery* ; Recurrence ; Scalp* ; Skin ; Tissue Expansion Devices ; Tissue Expansion*