Coiling of intracranial aneurysms is a generally safe treatment. However, despite increasing clinical experience and technological improvements, endovascular treatment still has inherent risks of morbidity and mortality. Recently, we have experienced two cases of delayed complications that developed after uneventful coil embolization of unruptured aneurysms.
Aneurysm ; Intracranial Aneurysm

PURPOSE: This study was performed to characterize sepsis with thrombocytopenia in premature infants to determine if thrombocytopenia is a prognostic factor in sepsis in premature infants. METHODS: We retrospectively analyzed the medical records of sepsis in premature infants admitted to the neonatal intensive care unit(N=41) at the Hallym University Sacred Heart Hospital from January 1999 to December 2002. The incidence, risk factors, symptoms, hematologic and bacteriologic findings were analyzed during episodes of sepsis. RESULTS: Of the 41 cases, 29(72%) were associated with thrombocytopenia. The ratio of male to female was 1.2 : 1. The vast majority(98%) were late-onset sepsis. The risk factors of the thrombocytopenic group were low birth weight and low gestational age. Major symptoms were poor activity (72%), apnea/tachypnea(52%), but were not significantly different between two groups. In the thrombocytopenic group(N=29), low total WBC count and high CRP level were discovered(P=0.03, P<0.01). The mean platelet count was 70.17(x103/mm3) at diagnosis of sepsis, and a mean platelet nadir was 43.10(x103/mm3). The severe thrombocytopenia(below 50x103/mm3) in the thrombocytopenic group was discovered in 69% and the duration of thrombocytopenia was about eight days. The majority of pathogens were gram-negative bacteria and candida. The thrombocytopenic group showed a pro longed length of stay and a high mortality rate. According to comparisons between the survived and expired groups, low birth weight, low gestational age, neutropenia and thrombocytopenia were significantly correlated with mortality(P<0.05). CONCLUSION: The sepsis with thrombocytopenia in premature infants showed late-onset sepsis and high morbidity and mortality, although differences were not significant statistically. Especially, low birth weight and low gestational aged infants should be cautiously treated and monitored.
Blood Platelets ; Candida ; Diagnosis ; Female ; Gestational Age ; Gram-Negative Bacteria ; Heart ; Humans ; Incidence ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature* ; Intensive Care, Neonatal ; Length of Stay ; Male ; Medical Records ; Mortality ; Neutropenia ; Platelet Count ; Retrospective Studies ; Risk Factors ; Sepsis* ; Thrombocytopenia*

PURPOSE: Children with acute colonic diverticulitis(ACD), can be misdiagnosed with acute appendicitis. METHODS: We reviewed 15 cases of ACD during five years, from January 1998 to June 2002 retro spectively. RESULTS: Most patients(80%) with ACD in children presented with right lower quadrant pain. The primary diagnosis on admission was mostly acute appendicitis(87%), and all ACD in children occurred in the right colon. Fourteen patients were managed by conservative treatment including antibiotics. A follow-up study was performed in 15 patients. There were symptomatic recurrences in two patients, but no significant complication was noted. The frequency of ACD was 11.7 per 1000 acute appendicitis. CONCLUSION: ACD in children can mostly be cured by conservative treatment. It is prudent to choose the management through the diagnostic work up, including abdominal sonography and computed tomography, because there was no significant difference of clinical findings between ACD and acute appendicitis.
Anti-Bacterial Agents ; Appendicitis ; Child* ; Colon* ; Diagnosis ; Diverticulitis ; Diverticulitis, Colonic* ; Follow-Up Studies ; Humans ; Recurrence

PURPOSE: To raise awareness of the clinical importance of, and the need for proper management of acute focal bacterial nephritis(AFBN), we analyzed 22 AFBN patients and 22 other upper urinary tract infection patients by use of comparative studies. METHODS: From January 2000 to May 2002, 22 AFBN patients aged from 1 month to 12 months were selected. As a control group, 22 UTI patients with no radiologic abnormalities were selected and matched by age and sex. RESULTS: The incidence of AFBN was more common in boys than in girls. Since both groups had similar symptoms, it was difficult to diagnose AFBN by clinical presentations alone. ESR and CRP were significantly higher in AFBN patients. The most common causative organism was E. coli in both groups. On the sonographic findings, the most lesions were seen on the upper lobe of the kidney; more frequently, on left kidney. The lesions showed globular or wedge-shaped increased echogenecity. 99mTc-DMSA scan showed the complete coincidence of the location, size and shape in all cases compared to the findings of renal sonography. CONCLUSION: The roles of renal sonography and DMSA scan were very important, and ultrasonography was an excellent initial tool in diagnosing AFBN. Since the degree of infection in AFBN is more severe than other urinary tract infections and evollution into a renal abscess is possible, early diagnosis and appropriate antibiotics therapy is essential.
Abscess ; Anti-Bacterial Agents ; Child* ; Early Diagnosis ; Female ; Humans ; Incidence ; Kidney ; Nephritis* ; Succimer ; Technetium Tc 99m Dimercaptosuccinic Acid ; Ultrasonography ; Urinary Tract Infections

OBJECTIVE: Unruptured intracranial aneurysms (UIA) accompanied by ischemic cerebrovascular disease (CVD), will be an increasing problem for neurosurgeons in the future, as the population ages. These patients are a high-risk group of treatment. UIA associated with ischemic CVD in seventeen patients were analyzed and their managements are discussed. METHODS: In the past four years, one hundred seventy seven cases of UIAs were treated in our hospital. Among them, seventeen patients suffered from ischemic CVD before treatment of aneurysm. The age of patients varied from 40 to 78 (mean 63.2) years old. The associated ischemic CVD was that transient ischemic attack (TIA) was nine, minor completed stroke in eight patients. There was permanent neurological deficit in two patients. Microsurgical treatment underwent for ten patients and seven patients were treated with endovascular technique. RESULTS: Fourteen patients were fully recovered from surgical and endovascular management. In clipping group, hemiparesis event occurred in one patient after the surgery. The patient suffered from ischemia-related permanent neurological worsening. There were two patients who developed neurological deficit following endovascular treatment for UIA in seven patients of coiling group. One patient was recovered after rehabilitation but the other patient didn't improve left hemiparesis until discharge. This patient had bilateral paraclinoid aneurysms. We treated these lesions simultaneously and coil embolization for the aneurysm was uneventful. However, left side weakness developed after the procedure. Angiography revealed occlusion of cortical branches of middle cerebral artery and MRI scan showed hyperintense areas in the right motor cortex. CONCLUSION: Our results suggest that surgical treatment of unruptured cerebral aneurysm is not contraindicated in patients with CVD. However, the treatment of UIA accompanied by CVD should be performed only after careful examination of the factors involved in the particular ischemic episodes. Careful case selection and perioperative management are mandatory for preventing surgical complications.
Aneurysm ; Angiography ; Endovascular Procedures ; Humans ; Intracranial Aneurysm ; Ischemic Attack, Transient ; Magnetic Resonance Imaging ; Middle Cerebral Artery ; Motor Cortex ; Paresis ; Stroke

PURPOSE: To investigate the characteristics of the sliding pattern of the proximal fragment (head and neck) in unstable intertrochanteric fractures, which were fixed with a dynamic hip screw (DHS) with anterior to posterior or posterior to anterior insertion angle in the axial view. MATERIALS AND METHODS: AO type A2.1 intertrochanteric fracture was reproduced in 10 proximal femur model (Synbone, Malans, Switzerland). Five fractured models were reduced and fixed using DHS with anterior to posterior insertion angle (group 1) and five models were fixed with posterior to anterior angle (group 2). Load of 500 N (30 cycles) was applied to the fracture fragment-plate complex using Instron 6022. Data on the distance of sliding and the angle of rotation of the proximal fragment were collected and analyzed. RESULTS: No significant difference was noted statistically in the distance of sliding between the two groups (p=0.92). However, the mean angle of rotation was 13.4degrees and 8.0degrees in group 1 and 2, respectively and the difference was statistically significant (p=0.012). Anterior cortical fracture of distal fragment was noted in 3 cases of group 1. There was no fracture of the anterior cortex in group 2. CONCLUSION: In unstable intertrochanteric fracture, the insertion angle of the lag screw in axial view does seem to play a role in the fate of bone-plate complex. Early eccentric contact of both fragments caused rotation of the proximal fragment in all cases and anterior cortical fracture of the distal fragment in 3 cases of group 1.
Femur ; Hip ; Hip Fractures*

Prader-Willi syndrome is a disease of chromosome 15, which is characterized by severe hypotonia and feeding difficulty in neonates, followed by development of obesity, mental retardation, and hypogonadism. Approximately 70% of the patients have a paternal deletion on chromosome 15q11-13, which is mainly a microdeletion, and a large deletion due to an unbalanced structural translocation of the proximal long arm of chromosome 15 to several other chromosomes is rarely found. We encountered a neonatal case with Prader-Willi syndrome who had sustained hypotonia and feeding difficulty. On high-resolution chromosome analysis, deletion of the short arm and the proximal part of the long arm of chromosome 15, with unbalanced translocation of the remaining part of chromosome 15(q13-qter) to the terminal part q37 of chromosome 2, was shown to be <45,XX, -15, der(2) t(2;15) (q37:q13)>. Through FISH (Fluorescence in situ hybridization) and methylation-specific DNA PCR, we confirmed the deleted q11-13 was derived from the father.
Arm ; Chromosomes, Human, Pair 15 ; Chromosomes, Human, Pair 2* ; DNA ; Fathers ; Humans ; Hypogonadism ; Infant, Newborn ; Intellectual Disability ; Muscle Hypotonia ; Obesity ; Polymerase Chain Reaction ; Prader-Willi Syndrome*

With increasing survival of smaller, more immunocompromised preterm infants, the incidence of invasive fungal infection is increasing among NICU patients, with highly associated morbidity and mortality. The most common site of end organ dissemination in premature infants with fungemia is the renal system. Renal fungal infection is followed by acute pyelonephritis and renal cortical abscess, and leads to obstructive nephropathy and renal failure. We recently experienced a case of VLBW infant who was dignosed as both hydronephrosis and obstructive uropathy due to Candida albicans that was treated intravenous amphotericin B combined with direct daily irrigation into the renal pelvis via percutaneous nephrostomy catheter.
Abscess ; Amphotericin B ; Candida albicans ; Catheters ; Fungemia ; Humans ; Hydronephrosis* ; Incidence ; Infant* ; Infant, Newborn ; Infant, Premature ; Kidney Pelvis ; Mortality ; Nephrostomy, Percutaneous* ; Pyelonephritis ; Renal Insufficiency

BACKGROUND: To determine the natural progression of conservatively treated rotator cuff tears, we evaluated changes in radiologic and clinical parameters in patients whose recalcitrant tears were neglected after conservative treatment. METHODS: A total of 73 patients with recalcitrant rotator cuff tears in spite of conservative treatment were included in this study. We measured changes in tear size and in the extent of fatty infiltration of the rotator cuff by comparing the initial and final follow-up magnetic resonance imagings (MRIs). To determine factors influencing the change in tear size, we collected the medical history of patients taken at the time of initial admission. RESULTS: The average follow-up period was 20.1 months, and the average increase in tear size across this period was 6.2 mm. In terms of steroid injection, we found that the increases in tear size of the steroid injection group (p=0.049) and of the sub-group that had received more than three steroid injections (p=0.010) were significantly greater than that of the non-steroid injection group. CONCLUSIONS: We found that the increase in cuff tear size was on average 6.2 mm across the follow-up period, indicating that neglecting cuff tears may cause them to progress into more severe tears. We also observed that a history of steroid injection might be a possible risk factor for a worse prognosis of cuff tears. Therefore, we suggest that patients with rotator cuff tears and a history of steroid injection are recommended aggressive modes of treatment such as surgery.
Follow-Up Studies ; Humans ; Magnetic Resonance Imaging* ; Prognosis ; Retrospective Studies* ; Risk Factors ; Rotator Cuff* ; Tears*

Neonatal hydrometrocolpos is the cystic dilatation of the vagina and uterus, which is caused by the combination of vaginal obstruction such as imperforate hymen, transverse vaginal septum, or vaginal atresia, and glandular secretion by maternal estrogenic stimulation. Although hydrometrocolpos is a rare congenital abnormality unlike pubertal hematocolpos, it is one of the relatively common abdominal masses in neonates. In typical cases the diagnosis may be determined easily by the combination of a pelvic mass, upper urinary tract dilatation and a bulging membrane in the vaginal introitus. The presense of a lower abdominal mass in a female infant should always arouse suspicion of hydrometrocolpos and lead to careful examination of the vagina. We report a case of neonatal hydrometrocolpos due to imperforate hymen which was initially presented as a large abdominal mass and a bulging membrane in the vaginal introitus. For 72 hrs, the abdominal mass increased rapidly, accompanied by urinary tract obstruction. It was relieved by a simple incision of the imperforate hymen and drainage of 300 cc of whitish mucoid vaginal fluid, and by Foley catheter drainage of 750 cc urine. No other anomaly was observed.
Catheters ; Congenital Abnormalities ; Diagnosis ; Dilatation ; Drainage ; Estrogens ; Female ; Hematocolpos ; Humans ; Hymen ; Infant ; Infant, Newborn ; Membranes ; Urinary Tract* ; Uterus ; Vagina