PURPOSE: To assess the MR findings of Tolosa-Hunt syndrome and to evaluat differential point of cavernous sinus lesions. MATERIALS AND METHODS: Eleven cases of Tolosa-Hunt syndrome were evaluated by MRI with specific regard to the shape of cavernous sinus, signal intensity, and pattern of enhancement. Other associated findings were also anlaysed. RESULTS: Two patients had normal MR features of the cavernous sinus. When compared with the contralateral normal cavernous sinus, the involved cavernous sinus was enlarged in six of the nine patients. The outer dural margin was convex and bulged laterally in 6 cases, flat in 2 cases, and concave in 1 case. Of the nine patients, five had iso-signal intensity and four had low signal intensity relative to gray matter on short TR/short TE. Three had isosignal intensity and 6 were not detectale on long TR/short and long TE pulse sequence. Contrast enhancement was seen in 8 cases ;7 cases showed homogeneous enhancement, 1 case heterogeneous enhancement. CONCLUSION: In the appropriate clinical setting of painful ophthalmoplegia, MR findings of cavernous sinus abnormality that consist of iso to low signal intensity on short TR/short TE images and isointense or undetectale mass on long TR/short TE or long TR/Iong TE images may suggest the dignosis of Tolosa-Hunt syndrome.
Cavernous Sinus ; Humans ; Magnetic Resonance Imaging ; Ophthalmoplegia ; Tolosa-Hunt Syndrome*

Glycogen storage diseases are inherited disorders of carbohydrate metabolism caused by a deficiency of enzymes that are involved in degradation of glycogen in the liver. The accumulation of glycogen occurs in the liver and other organs. Type Ia is the most common form and clinically may manifest of glycogen storage disease itself rather than growth hormone deficiency. But in this case the patient showed exceptional extreme growth retardation. Growth hormone stimulation test with clonidine and L-dopa revealed that the patient had growth hormone deficiency. Therefore, we report of a case of glycogen storage disease type Ia with the presence of GH deficiency with review of literature. A 16-year-old male was admitted for the evaluation of hepatomegaly and extreme short stature. The height was 113.5cm, less than third percentile of same age group, and compatible with fiftieth percentile of height of 6 years of age. After laboratory work up including liver biopsy, he was diagnosed with type I glycogen storage disease. The patient was presented with metabolic acidosis, hyperuricemia, and hypoglycemia. Hypoglycemia was managed with frequent feeding with high starch diet and intravenous glucose infusion. Metabolic acidosis was treated with sodium bicarbonate. Secondary hyperuricemia was treated with allopurinol. The patient is being followed at out-patient clinic with clinical improvement after of GH administration.
Acidosis ; Adolescent ; Allopurinol ; Biopsy ; Carbohydrate Metabolism ; Clonidine ; Diet ; Glucose ; Glycogen Storage Disease* ; Glycogen* ; Growth Hormone ; Hepatomegaly ; Humans ; Hyperuricemia ; Hypoglycemia ; Levodopa ; Liver ; Male ; Outpatients ; Sodium Bicarbonate ; Starch

Actinomycosis causes a chronic suppurative, granulomatous disease which is characterized by extensive abscess formation, and sulfur granule formation. Actinomycosis may present different clinical forms: cervicofacial, thoracic, abdominal and cerebral actinomycosis. The diagnosis can only be made after surgery. In general, patients with abdominal actinomycosis have undergone abdominal surgery. We report four cases of primary appendiceal actinomycosis presenting as acute appendicitis without history of abdomen surgery.
Abdomen ; Abscess ; Actinomycosis* ; Appendicitis* ; Diagnosis ; Humans ; Sulfur

PURPOSE: To gain insight on transcriptional repression of Topo II a in HL-60 cells arrested to G2/M and M phase, the levels of Topo IIa mRNA and the binding activity of ATF have been investigated with Northern blot hybridization and DNA mobility shift assay, respectively. MATERIALS AND METHODS: HL-60 cells were grown in RPMI 1640 medium supplemented with 10% heat-mactivated fetal bovine serum and antibiotics in a humidified 5% CO2 at 37C degree. Total RNA was prepared by a modification of the method of Karlinsey et al. Northern blot hybridization was performed by the method of Virca et al. A Xho I-Mlu I fragment of phTOP2 was used as probe for Northern blot analysis of Topo II a mRNA. DNA mobility shift assay was performed by the method of Lim et al. End labeled DNA oligomer (upper strand, 5-TCTCCGCTATGACGCCGAGTGGTG-3) for ATF binding activity was mixed with nuclear extracts in a 20 pl reaction volume containing 60 mM KC1, 12 mM HEPES, pH 7.9, 5 mM MgCl2, 0.2 mM EDTA, 0.2 mM DTT, 12% glycerol, and 2 ug of poly [dI-dC]. RESULTS: HL-60 cells were arrested at G2/M phase and M phase after taxol or nocodazole treatment. The levels of Topo II a mRNA were reduced at 24 hours after exposure with nocodazole or taxol but the unknotting activities were not changed. DNA mobility shift assay using oligonucleotide containing the ATF binding site showed that ATF binding activity was reduced after pretreatment of nododazole or taxol. CONCLUSIONS: These results suggest that the reduction of ATF binding activity may be important to transcriptional repression of Topo II a gene by nocodazole and taxol in HL- 60 cells.
Anti-Bacterial Agents ; Binding Sites ; Blotting, Northern ; Cell Division* ; DNA Topoisomerases, Type I* ; DNA Topoisomerases, Type II* ; DNA* ; Edetic Acid ; Electrophoretic Mobility Shift Assay ; Genes, vif ; Glycerol ; HEPES ; HL-60 Cells ; Humans ; Hydrogen-Ion Concentration ; Magnesium Chloride ; Nocodazole ; Paclitaxel ; Repression, Psychology ; RNA ; RNA, Messenger

PURPOSE: To evaluate a recently developed technique to place a medium-duration(weeks to months) central venous access. MATERIALS AND METHODS: Within three-year period, 635 patients were referred to interventional radiology suite for placement of peripherally inserted central catheter(PlCC). Contrast medium was injected into the peripheral intravenous line and a puncture was made into the opacified vein near the junction of the middle and upper thirds of the upper arm, either the brachial or basilic vein under fluoroscopic guidance. A 5.5-French peel-away sheath was inserted into the vein and a 5- French silicone catheter was introduced with its distal tip to the junction of the right atrium and superior vena cava. RESULTS: Catheter placement was successful in all patients unless there was a central venous obstruction. Catheters were maintained from 2 days to 5 months with a mean of 3 weeks. Complications included infection requiring removal of the PICC in 16 patients(2.5%), acute thrombosis of the subclavian vein in 3(0.5%). Occluded catheters in 4 patients were easily cleared with urokinase in place. CONCLUSION: The PICC system is an excellent option for medium-duration cen- tral venous access. Patients were able to carry on normal activities with the catheters in place.
Arm* ; Catheters* ; Heart Atria ; Humans ; Ocimum basilicum ; Punctures ; Radiology, Interventional ; Silicones ; Subclavian Vein ; Thrombosis ; Urokinase-Type Plasminogen Activator ; Veins ; Vena Cava, Superior

PURPOSE: To evaluate a recently developed technique to place a medium-duration(weeks to months) central venous access. MATERIALS AND METHODS: Within three-year period, 635 patients were referred to interventional radiology suite for placement of peripherally inserted central catheter(PlCC). Contrast medium was injected into the peripheral intravenous line and a puncture was made into the opacified vein near the junction of the middle and upper thirds of the upper arm, either the brachial or basilic vein under fluoroscopic guidance. A 5.5-French peel-away sheath was inserted into the vein and a 5- French silicone catheter was introduced with its distal tip to the junction of the right atrium and superior vena cava. RESULTS: Catheter placement was successful in all patients unless there was a central venous obstruction. Catheters were maintained from 2 days to 5 months with a mean of 3 weeks. Complications included infection requiring removal of the PICC in 16 patients(2.5%), acute thrombosis of the subclavian vein in 3(0.5%). Occluded catheters in 4 patients were easily cleared with urokinase in place. CONCLUSION: The PICC system is an excellent option for medium-duration cen- tral venous access. Patients were able to carry on normal activities with the catheters in place.
Arm* ; Catheters* ; Heart Atria ; Humans ; Ocimum basilicum ; Punctures ; Radiology, Interventional ; Silicones ; Subclavian Vein ; Thrombosis ; Urokinase-Type Plasminogen Activator ; Veins ; Vena Cava, Superior

The effect of sodium nitroprusside(SNP) on arterial oxygen tension in 20 neurosurgical patients with normal lung function was studied under general anesthesia. Blood gas, heart rate, mean arterial pressure and central venous pressure were measured before, during and after SNP infusion. The results were as follows:1) Arterial oxygen tension significantly decreased from 177+/-40.6 mmHg before SNP to 138+/-50.1 mmHg during SNP(p<0.005), and increased again to 168+/-44.4 mmHg after SNP. 2) Mixed venous oxygen tension decreased 47+/-8.2 mmHg to 40+/-7.3 mmHg(p<0.005), and increased again to 44+/-10.3 mmHg. 3) Heart rate significantly increased from 92+/-24.6 beats/min to 118+/-27.4 beats/min(p<0.005), and decreased again to 94+/-18.6 beats/min. The above findings have shown a marked reduction in PaO2 when SNP was administered during general anesthesia. After SNP, PaO2, returned to the previous values. It is suggested that the reduction in PaO2, is the result of an increased scatter of ventilation/perfusion relationships in the lung and inhibition of hypoxic pulmonary vasoconstriction by SNP. These results provide evidence that SNP induced hypotension may cause significant impairment in pulmonary gas exchange in patients with normal lung function.
Anesthesia, General ; Arterial Pressure ; Central Venous Pressure ; Heart Rate ; Humans ; Hypotension* ; Lung ; Nitroprusside* ; Oxygen* ; Pulmonary Gas Exchange ; Sodium* ; Vasoconstriction

PURPOSE: The aim of this study was to investigate the effect of perinatal risk factors on brain maturation and the relationship of brain maturation and neurodevelopmental outcomes with brain maturation scoring system in brain MRI. METHODS: ELBWI infants born at the Seoul National University Children's Hospital from January 2006 to December 2010 were included. A retrospective analysis was performed with their medical record and brain MR images acquired at near full term. We read brain MRI and measured maturity with total maturation score (TMS). TMS is a previously developed anatomic scoring system to assess brain maturity. The total maturation score was used to evaluate the four parameters of maturity: (1) myelination, (2) cortical infolding, (3) involution of glial cell migration bands, and (4) presence of germinal matrix tissue. RESULTS: Images from 124 infants were evaluated. Their mean gestational age at birth was 27.1+/-2.1 weeks, and mean birth weight was 781.5+/-143.9 g. The mean TMS was 10.8+/-2.0. TMS was significantly related to the postmenstrual age (PMA) of the infant, increasing with advancing postmenstrual age (P<0.001). TMS showed no significance with neurodevelopmental delay, and with brain injury, respectively. CONCLUSION: TMS was developed for evaluating brain maturation in conventional brain MRI. The results of this study suggest that TMS was not useful for predicting neurodevelopmental delay, but further studies are needed to make standard score for each PMA and to re-evaluate the relationship between brain maturation and neurodevelopmental delay.
Birth Weight ; Brain ; Gestational Age ; Humans ; Infant ; Infant, Extremely Low Birth Weight ; Infant, Newborn ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets ; Medical Records ; Myelin Sheath ; Neuroglia ; Parturition ; Premature Birth ; Retrospective Studies ; Risk Factors