PURPOSE: To test the hypothesis that chronic subdural hematoma (CSDH) enlarges by the causative factors, this study has performed. METERIALS AND METHODS: In 10 patients with CSDH, coagulation factors in venous blood taken at the time of surgery and hematomic contents aspirated from the CSDH were studied, using both laboratory assays and microscopy. RESULTS: When compared to the range of normal plasma, the hematoma fluids demonstrated a marked reduction in factor II, V, VII, VIII, and X, moderate reduction of factors IX and XI, and slight reduction of factor XII. Activated protein C and antithrombin III levels were decreased. The FDP (Fibrinogen Degradation Product) levels in chronic subdural hematoma were extremely high. The endothelial cells of the macrocapillaries (also called "sinusoid") showed numerous gap junctions between adjacent endothelial cells and a thinness or absence of the basement membrane, suggesting that the macrocapillaries are very fragile and susceptible to bleeding. CONCLUSION: Excessive coagulation in the hematoma, predominantly via the extrinsic clotting pathway, local hyperfibrinolysis, transmitted pulsations, and characteristics of the macrocapillaries play an important role in the leakage of blood and the enlargement of CSDH.

OBJECTIVE: There are few published studies which have documented psychopathological abnormalities in patients with of adolescent idiopathic scoliosis (AIS) The aim of this study was to evaluate the psychopathological influence of AIS in Korean 19-year-old males. METHODS: The authors compared the Korean military multiphasic personal inventory (KMPI) military profiles of 105 AIS cases (more than 10 degrees of Cobb's angle without surgical treatment) with the KMPI profiles of 108 normal controls. The AIS group was split depending on Cobb's angle to further evaluate this relation by the severity of AIS. RESULTS: A significantly decreased result on the faking-good response scale and an significantly increased result on the faking-bad response were observed in the AIS group compared to the control (p<0.012). The neurosis scale results, including anxiety, depression and somatization symptoms, were significantly increased in the AIS group compared to the control (p<0.010). The severity level of personality disorder and schizophrenia were also significantly increased in the AIS group (p<0.010). Differences in KMPI scale scores were not related to the severity of AIS. CONCLUSION: Young males with AIS tend to have abnormal results on the multiphasic personal inventory test compared to normal volunteers, suggesting that AIS may be related to psychopathology in the young male group in Korea. Although these psychopathology in AIS were differently observed compared to normal controls, but not interfered with military life. Clinicians are recommended to pay attention the psychopathological traits of patients with AIS.
Adolescent ; Anxiety ; Depression ; Humans ; Korea ; Male ; Military Personnel ; Personality Disorders ; Psychopathology ; Schizophrenia ; Scoliosis

Optic neuritis is a rare extraintestinal manifestation of inflammatory bowel disease. Antitumor necrosis factor alpha (anti-TNF-α) agents are essential treatment options in inflammatory bowel diseases. However, anti-TNF-α agents can implicate optic neuritis and other demyelinating diseases as complications of these agents. We report a patient of infliximab-induced optic neuritis in a patient with ulcerative colitis who was treated with high-dose steroids after discontinuation of infliximab.

BACKGROUND: Infections are still a frequent cause of morbidity and mortality in patients with hematologic malignancies. Antimicrobial prophylaxis in neutropenic patients has been practised for several decades. But, recently the rates of occurrence for pathogens have significantly changed (from predominance of gram-negative to gram-positive species) under selective pressure of antimicrobial prophylaxis, and novel resistance mechanisms have emerged. We investigated this study to assess the effectiveness of selective bowel decontamination for preventing infections in granulocytopenic patients who are receiving chemotherapy for acute myelogenous leukemia. METHODS: In a prospective, randomized trial, we evaluated the efficacy of oral ciprofloxacin (250 mg p.o. twice a day), roxithromycin (150 mg p.o. twice a day), fluconazole (50 mg p.o.) in 95 adult patients with acute myelogenous leukemia who undergone intensive chemotherapy. Prophylaxis was begun within 72 hours of initiation of the chemotherapy and continued until the onset of fever, signs or symptoms of infection, serious adverse effect, or recovery of the leukocyte count to > or = 1,000/mm3. RESULTS: 46 decontamination regimen treated patients and 49 control patients were assessable for efficacy. No difference was noted between the two groups in occurrence of fever during neutropenia, time to onset of first fever, sites of infection, duration of using systemic antimicrobials, overall infection rates, infection-related mortality, or hospitalization day. Decontamination regimen reduced the gram-negative infections, but increased the gram-positive infections. Among those who received decontamination regimen, the incidence of resistance to ciprofloxacin was 100% for gram-negative species. And resistance to erythromycin for gram-positive species, irrespective of decontamination, was very much high (90-100%). CONCLUSION: The approach of selective decontamination has not led to fewer febrile episodes or to a lower mortality in neutropenia after chemotherapy for acute myelogenous leukemia. It should be considered that we had better not prescribe decontamination regimen because of increment of infection due to gram-positive species and high resistance rate to fluoroquinolone and macrolide. Additional trials are needed to establish the efficacy of decontamination for other malignancies, aplastic anemia, or bone marrow transplantation.
Adult ; Anemia, Aplastic ; Bone Marrow Transplantation ; Ciprofloxacin ; Decontamination* ; Drug Therapy ; Erythromycin ; Fever ; Fluconazole ; Hematologic Neoplasms ; Hospitalization ; Humans ; Incidence ; Leukemia ; Leukemia, Myeloid, Acute* ; Leukocyte Count ; Mortality ; Neutropenia ; Prospective Studies* ; Roxithromycin

Superficial siderosis (SS) in central nervous system is a rare, slowly progressive disease and usually misdiagnosed or diagnosed too late when the patient is chronically devastated. A 55-year-old man with deafness and gait disturbance for ten years was referred from otorhinologist for evaluation of brain. Magnetic resonance image (MRI) showed symmetric hypointense rim partially delineated the bilateral hemisphere on gradient-recalled-echo T2-weighted image, and it was diagnosed as hemosiderin deposition in subarachnoid and subpial meningeal layer. The correct diagnosis of cerebral superficial siderosis can be achieved by careful neurological examination and MRI because computed tomography findings and symptoms are ambiguous. Serial follow-up of imaging study and education for patient are necessary to prevent progression of SS.
Brain ; Central Nervous System* ; Deafness ; Diagnosis ; Education ; Follow-Up Studies ; Gait ; Hearing Loss, Sensorineural ; Hemosiderin ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Neurologic Examination ; Siderosis*

Superficial siderosis (SS) in central nervous system is a rare, slowly progressive disease and usually misdiagnosed or diagnosed too late when the patient is chronically devastated. A 55-year-old man with deafness and gait disturbance for ten years was referred from otorhinologist for evaluation of brain. Magnetic resonance image (MRI) showed symmetric hypointense rim partially delineated the bilateral hemisphere on gradient-recalled-echo T2-weighted image, and it was diagnosed as hemosiderin deposition in subarachnoid and subpial meningeal layer. The correct diagnosis of cerebral superficial siderosis can be achieved by careful neurological examination and MRI because computed tomography findings and symptoms are ambiguous. Serial follow-up of imaging study and education for patient are necessary to prevent progression of SS.
Brain ; Central Nervous System* ; Deafness ; Diagnosis ; Education ; Follow-Up Studies ; Gait ; Hearing Loss, Sensorineural ; Hemosiderin ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Neurologic Examination ; Siderosis*

PURPOSE: To assess the therapeutic value of two different drainage catheters in treating chronic subdural hematoma (CSDH). MATERIALS AND METHODS: Two types of drainage catheters can be used to treat CSDH according to the position of holes in the catheter: open-type or closed-type catheter. In this retrospective study, 199 total patients with CSDH were reviewed according to catheter type. Among them, 84 patients were and 113 in the closed-type group (holes positioned within the distal-most 1 cm of the catheter). The surgeon selected the catheter type. Total drainage volume, initial drainage volume within 2 days, percentage of initial drainage volume per total drainage volume, duration of catheter insertion, and reoperation rate were compared. RESULTS: Total drainage volume was not different between the two groups (p=0.333). The initial drainage volume within 2 days was larger in the open-type group than closed-type group (p=0.024), but the percentage of initial drainage volume per total drainage volume was not different (p=0.354). The duration of catheter insertion was shorter in the open-type group than closed-type group (p=0.015). The reoperation rate of CSDH was also higher in the open-type group than closed-type group (p=0.004). CONCLUSION: CSDH drainage with an open-type catheter is faster compared with a closed-type catheter, but total drainage volume is similar and reoperation rate is higher. Therefore, the open-type catheter for CSDH drainage has limited clinical value.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Catheters/*adverse effects ; Child ; Child, Preschool ; Drainage ; Equipment Design ; Female ; Hematoma, Subdural, Chronic/surgery/*therapy ; Humans ; Infant ; Male ; Middle Aged ; Retrospective Studies