PURPOSE: To analyze the variable MRI features and clinical significance of intracranial cavernous realformation. MATERIALS AND METHODS: Forty patients(mean age 35.4) with cavernous malformation were evaluated by MRI. Eleven patients were surgically confirmed. Cavernous malformations were divided into four categories on the basis of the MR imaging characteristics, especially on T2-weighted image. Type I lesion was defined as an extralesional subacute hemorrhage outside the low signal rim, type II as an intralesional hemorrhage surrounded by low signal rim, type III lesion as an intralesional thrombosis with variegated central core surrounded by low signal rim, and type IV lesion as a focal old hemorrhagic core with small low signal intensity. Type IV was further divided into IVa and IVb, whether the lesion has small iso- or hypersignal central core (IVa) or not (IVb). Follow-up MRI was evaluated in 12 patients who were managed conservatively. Follow-up intervals ranged from 2 weeks to 29 months (mean 6months). RESULTS: Total 80 lesions were detected in 40 patients. Multiple lesions were noted in 10 patients. The topography of the cavernous malformations was supratentorial in 75% and infratentorial in 23%. There were 10 lesions in type I, 15 in type 11, 21 in type III, 14 in type IVa, and 20 in type IVb. Type I lesions mainly showed mass effect and edema. Type III lesions showed minimal contrast enhancements in 7 lesions on delayed images. Type II lesions showed the characteristics of both type I and type III lesions. On follow up images, decrease in size in 5, change of type in 7, rebleeding in 2 and no change in 12 lesions were demonstrated. Hemorrhage, edema and mass effect were combined in the cases of rebleeding. On follow-up study, the estimated risk of bleeding was 32.3%/person-year and 13.7%/lesion-year. CONCLUSION: Cavernous realformations show as variable appearance, on MR imaging suggesting variable stages of evolution. The MR morphologic classification and evaluation of secondary findings are helpful to predict natural course and possibility of rebleeding of the lesion.
Classification ; Edema ; Follow-Up Studies ; Hemorrhage ; Humans ; Magnetic Resonance Imaging* ; Thrombosis

The effect of a secretory proteinase from the pathogenic amoebae Acanthamoeba castellanii on hosts defense-oriented or regulatory proteins such as immunoglobulins, interleukin-1, and protease inhibitors was investigated. The enzyme was found to degrade secretory immunoglobulin A (sIgA), IgG, and IgM. It also degraded interleukin-1alpha (IL-1alpha) and IL-1beta. Its activity was not inhibited by endogenous protease inhibitors, such as alpha2-macroglobulin, alpha1-trypsin inhibitor, and alpha2-antiplasmin. Furthermore, the enzyme rapidly degraded those endogenous protease inhibitors as well. The degradation of hosts defense-oriented or regulatory proteins by the Acanthamoeba proteinase suggested that the enzyme might be an important virulence factor in the pathogenesis of Acanthamoeba infection.
Acanthamoeba/*enzymology/pathogenicity ; Animals ; Endopeptidases/*physiology ; Immunoglobulins/*metabolism ; Interleukin-1/*metabolism ; Protease Inhibitors/*metabolism ; Support, Non-U.S. Gov't ; Virulence

PURPOSE: It has been customary to perform brain ultrasonogram (brain US) for the early detection of intraventricular hemorrhage (IVH) during intensive care of neonates. On the other hand magnetic resonance imaging (MRI) has been greatly restrictioned due to its complicated procedures. This study was conducted to identify changes in neonates' brain structure and to gain basic data for the long-term follow-up of neurologic sequelae in the future. For this purpose, the findings obtained from both brain US performed within one postnatal week and MRI at the time of discharge were compared and analysed. METHODS: Brain US within one postnatal week and MRI at discharge were carried out on 67 neonates who were discharged from the neonatal intensive care unit of Fatima Hospital from July 01, 1996 to June 30, 1998. We compared and analysed IVH found in the brain US, and focal parenchymal hemorrhage, periventricular leukomalacia (PVL), basal ganglia hemorrhage, and encephalomalacia revealed the MRI performed at discharge. RESULTS: It was found that out of 67 cases from the brain US, there were 13 with IVH of Grade l & ll, 11 with IVH of Grade lll or higher, one with focal parenchymal hemorrhage, and three with PVL. Also the MRI found seven with focal parenchymal hemorrhage, one with basal ganglia hemorrhage, six with PVL, three with encephalomalacia, and one with ventricular dilatation. CONCLUSION: For infants with IVH of Grade lll or higher, MRI performed at discharge is considered to be very useful in identifying structural parenchymal abnormality and the presence or absence of its associated lesions as well as in carrying out long-term follow-up.
Basal Ganglia Hemorrhage ; Brain* ; Dilatation ; Encephalomalacia ; Follow-Up Studies ; Hand ; Hemorrhage ; Humans ; Infant ; Infant, Newborn ; Infant, Premature* ; Critical Care ; Intensive Care, Neonatal ; Leukomalacia, Periventricular ; Magnetic Resonance Imaging* ; Ultrasonography*

No abstract available.
Cerebral Palsy* ; Equinus Deformity* ; Heel* ; Muscle Spasticity*

Most cases of spondylolisthesis are asymptomatic and successfully managed with conservative treatment. Operation was performed in 20% of symptomatic cases having severe back pain, neurological symptoms and/or progressive slipping. Although surgical treatments are divided into decompression and fusion, various methods were tried from simple Gill's resection to posterior and/or anterior fusion with instrumentation in case of severe slipping. The authors reviewed 54 cases of symptomatic spondylolisthesis, who were surgically treated, and had follow up evaluations our institution during past 6 years from March, 1990, to March, 1996. 1) The age distribution was from 19 to 64 years of age and the highest prevalent decade was at the 5th. 2) There were 14 male and 40 female patients with female preponderance about 3 to 1 ratio. 3) Thirty one cases were isthmic type and 23 cases were degenerative type. The ratio between isthmic type and degenerative type was about 2:1. 4) The displacement between L4 and L5 was 25 cases and the displacement between L5 and sacrum was 18 cases, and others were L3 and L4, L4 and sacrum, L5 and L6. 5) Overall results are excellent in 7 cases(13%), good 35 cases(65%), fair 10 cases(19%), and poor 2 cases(4%). 6) There were no changes in slipping in 23 cases(42.6%). Occurred in partial reduction were possible in 30 cases (55.5%), and further slipping developed was 1 case(1.9%).
Age Distribution ; Back Pain ; Decompression ; Female ; Follow-Up Studies ; Humans ; Male ; Sacrum ; Spondylolisthesis*

Extraskeletal Ewing's sarcoma is a rare primary malignant soft tissue tumor that has the same pathological characteristics of skeletal Ewing's sarcoma. It is known that the differential diagnosis of Ewing's sarcoma from undifferentiated rhabdomyosarcoma, neuroblastoma, reticulum cell sarcoma, and malignant lymphoma by the histologic studies only are not easy because their histologic findings are nearly similar each other. Therefore, immunohistochemical method, electron microscopic examination, cytogenetic study, or molecular gene study are used together to confirm the diagnosis. It chiefly involves the lower extremity, soft tissues of the paravertebral region, and adjacent chest wall. We recently experienced a case of extraskeletal Ewing's sarcoma of duodenum in a 21-year old female. The patient underwent Whipple's operation and postoperative combined chemotherapy were done.
Cytogenetics ; Diagnosis ; Diagnosis, Differential ; Drug Therapy ; Duodenum* ; Female ; Humans ; Lower Extremity ; Lymphoma ; Lymphoma, Non-Hodgkin ; Neuroblastoma ; Rhabdomyosarcoma ; Sarcoma* ; Sarcoma, Ewing ; Thoracic Wall ; Young Adult

Fibrolipomatous harmatomas are rare, benign, fibrolipomatous process of peripheral nerves. It usually manifests as a soft slowly growing mass consisting of proliferating fibrofatty tissue surrounding and infiltrating major nerves and their branches. The median nerve is affected in the great majority of cases. Intradural spinal cases are extremely rare. The authors present a very rare case of a fibrolipomatous harmatoma involving the intradural space of lumbar spine with review of pertinent literature.
Hamartoma* ; Median Nerve ; Peripheral Nerves ; Spine

BACKGROUND: This study was performed to compare the analgesic effects of the systemic versus local administration of ketamine and observe the effects of an NMDA receptor agonist on its peripheral analgesia using the rat formalin test. METHODS: Rats undergoing peripheral analgesia were divided into three groups; the administration of a subcutaneous (s.c.) injection of 0.1 ml of normal saline (Control), and intraperitoneal (i.p.) (Keta/IP) and s.c. (Keta/LO) injections of 2.5 mg/0.1 ml of ketamine administered 5 min before a s.c. injection of 50 ul of 5% formalin. All s.c. injections were performed at the same site: the right hind paw of the rat. To observe the effects of an NMDA receptor agonist, five groups were compared. In addition to the control and Keta/LO groups described above, following three groups with 1-Aminocyclopropanecarboxylic acid (ACPC), an NMDA receptor agonist, in addition to the Keta/LO group; local infiltration with 0.1 mM/0.1 ml ACPC 10 min before or after the administration of ketamine, and an i.p. injection 10 min before the administration of ketamine followed by a s.c. injection of formalin 5 min later. The pain behavior was compared according to the number of flinches during phase 2. RESULTS: All the ketamine groups showed fewer flinches compared to the control (P < 0.01). The Keta/Lo group showed fewer flinches than that of the Keta/IP group (P < 0.01). The analgesic effect of locally administered ketamine was reversed by pretreatment with either s.c. or i.p. ACPC, but not by post-treatment. CONCLUSIONS: These data suggest that locally administered ketamine has a potent peripheral analgesic effect, but the administration of ACPC prior to ketamine decreases the analgesic effect of ketamine.
Analgesia ; Animals ; Formaldehyde* ; Ketamine* ; N-Methylaspartate ; Pain Measurement* ; Rats*

PURPOSE: Sleep disorder is common in childhood and adolescence with prevalence of 27-62%, and the patients could have trouble with their daily life due to fatigue and headache; and it can also cause developmental disability, learning disorder, anxiety disorder, and depressive disorder. We studied the prevalence of anxiety and depressive disorder in childhood and adolescence with sleep disorder. METHODS: We studied 34 cases of patients under twenty-year-old who took a sleep polysomnography test at Sleep Center of Keimyung University Dongsan Medical Center and who could answer sleep survey questionnaires; and we used testing methods of Questionnaire for insomnia, Epworth sleepness scale, Hospital Anxiety Depression Scale, and Back Depression Inventory. We studied sleep disorder as two categories of sleep apnea and other sleep disorders and also the relationships of sleep and anxiety and depressive disorder with chi-square test. RESULTS: 29.4% of sleep disorder patients had anxiety disorder, and 47.1% depressive disorder. Considering the two categories of sleep disorder, anxiety disorder was significantly higher(P<0.005) in sleep apnea group with 43.5% than in other sleep disorder group with 9.1%. Depressive disorder was also significantly higher(P<0.05) in sleep apnea group with 65.6% than in other sleep disorder group with 36.4%. CONCLUSION: The patients with sleep disorder also had a tendency of having mood disorder, with prevalence of 29.4% of anxiety disorder and 47.1% of depressive disorder; especially in the group of sleep apnea, mood disorders was significantly higher than other sleep disorder group, which means more aggressive diagnosis and treatment are needed for the combined condition of sleep and mood disorder.
Adolescent ; Anxiety ; Anxiety Disorders ; Depression ; Depressive Disorder ; Developmental Disabilities ; Fatigue ; Humans ; Learning Disorders ; Mood Disorders ; Polysomnography ; Prevalence ; Surveys and Questionnaires ; Sleep Apnea Syndromes ; Sleep Wake Disorders ; Sleep Initiation and Maintenance Disorders

The encapsulated hepatocellular (HCC) is a pathologic subtype of HCC. It is a well defined tumor that tends to grow slowly, and has a better prognosis than any other gross forms of HCC. Twenty surgically resected HCC were evaluated retropectively to correlate the thickness of pseudocapsules in pathology with those in computed tomography and ultrasound. At a histologic examination, pseudocapsules of seven cases were composed of two layers, an inner compact fibrous zone and outer loose fibrous zone interlaced with compressed liver parenchyma containing small vessels and newly formed bile ducts. Sonographic thickness and pathologic measurements of pseudocapsule relatively well correlated, but the former slightly overestimated the thickness of pathologic pseudocapsule (r=0.825, y=2.56x-1.23, P<0.05). On the other hand, thickness in CT and pathologic measurement did not correlate well. Thirteen cases showed one layer of pseudocapsule in which two cases were composed of thin layer of compact fibrosis and eleven cases composed of loose fibrosis. There were poor correlations in this group between thickness of pseudocapsules in pathology and those in images. Image overtly overestimated the thickness of the pseudocapsules in pathology. In conclusion, radiologic pseudocapsule of HCC may represent the compressed liver parenchyma as well as the fibrous pseudocapsule.
Bile Ducts ; Carcinoma, Hepatocellular* ; Fibrosis ; Hand ; Liver ; Pathology ; Prognosis ; Ultrasonography