The meningitis occur within a closed anatomic space, so they have many similar clinical features and characteristic CSF abnormalities. But the temporal profile of many meningitis is distinctive from aseptic meningitis with spontaneous remission to bacterial or tuberculous meningitis with fatal outcome without treatment. Therefore early accurate differential diagnosis is required. The development of diagnostic tools and treatment, and increase of immunodeficient state and resistant pathogens have changed the distribution of main pathogens of meningitis from the past. Therefore we analyzed 241 medical records with final diagnosis as 'infectious meningitis' to evaluate the distribution of pathogens in Korea and any differential points of clinical, laboratory, and radiologic, profile according to etiology. 1. The etiologic distributions were followings, Aseptic meningitis in 100 patient(41.5%), tuberculous meningitis in 58 patients(24.1%), bacterial meningitis in 48 patients(19.9%), and fungal in 16 patients(6.6%). 2. The intense seasonal occurrence was noted in aseptic meningitis with summer. 3. Fever and headache were noted in almost all patients Altered mental status were noted in 39.6% of bacterial meningitis, 53.41% of tuberculous meningitis but not in fungal and aseptic meningitis. Meningeal irritation signs were noted in less patients(25%) with fungal meningitis but in more with aseptic, bacterial or tuberculous meningitis m 52-66.7%. Most of all focal neurologic signs were present in bacterial or tuberculous meningitis. 4. Many immunocompromized patients had fungal meningitis, three of which showed normal CSF leukocyte counts And it pointed up the importance of intensive etiologic evaluation in immunodeficient patients with clinically suspected symptoms of meningitis. 5. CSF findings at admission were following. CSF leukocytes were mean 206-258/yL in aseptic, tuberculous or fungal meningitis. But in bacterial meningitis leukocyte counts were greater than 1,000/mL in mom than half of patients. The differential counts of leukocytes were monocyte predominant except in bacterial meningitis. The reductions of CSF sugar were noted in bacterial, tuberculous, or fungal meningitis. Characteristically all patients with extremely low CSF sugar(less than 10mg/dL) had bacterial meningitis. 6. The most frequent pathologic findings in neuroimaging study were hydrocephalus(20patients: 9.1%) and meningeal enhancement(19patient,: 8.6%). Small enhancing mass(8patients: 3.6%.) and focal infarction(8patients: 3.6%) were noted less frequently. These abnormal radiologic findings were noted in 2 patients(2.0%) with aseptic meningitis, 15 patients(38.7%) with bacterial meningitis, 29 patients(50.0%) with tuberculous meningitis and 5 patients(35.7%) with fungal meningitis.
Adult* ; Diagnosis ; Diagnosis, Differential ; Fatal Outcome ; Fever ; Headache ; Humans ; Korea ; Leukocyte Count ; Leukocytes ; Medical Records ; Meningitis* ; Meningitis, Aseptic ; Meningitis, Bacterial ; Meningitis, Fungal ; Monocytes ; Neuroimaging ; Neurologic Manifestations ; Remission, Spontaneous ; Seasons ; Tuberculosis, Meningeal

We studied 55 patients with static brain lesions who developed delayed-onset movement disorders. Of these, 29(52.7%) had pakinsonism, 17(30.9%) dystonia, 6(10.9%) chorea, 2(3.6%) tremor, and I(I.8%) myoclonus. The precipitating insults included carbon mono-oxide, poisoning in 32(58.2%), 6(10.9%), encephalitis in 5(9.1%)head injury, stoke and hypoxia, in 6(10.9%) patients each. Among the four Patients with initial insult occurring at age 2years or younger(infant group), all had dystonia. Distribution of dystonia was focal in one(25%), segmental in two(50%), and unilateral in one patient(25%). The mean latency between the original injury and the onset of movement disorder was 378.03+277.13 weeks. Among the 11 patient initial insults occurring between ages 5 and 17(childhood group), 7 had dystonia, 3 parkinsonism, 1chorea. The distribution of dystonia was focal in one, segmental in five, and unilateral in one patient; the mean latency between the original injury and the onset of movement disorder was 91.3+,230.1 weeks. Among the 40patients with initial insults occurring at ages 23 or older (adult group), 26(65.0%) had parkinsonism, 6(15.0%) dystonia, 5(12.5%) chorea, 2(5.0%) tremor, 1(2.5%) myoclonus. The distribution of dystonia in patient was focal in two(33.0%), and segmental in four(67.7%) patients. The mean latency of movement disorder onset in the 40 patients, of the adult group was 17.25+43.67weeks. Brain injury at a young age was associated with a longer latency to onset of subsequent movement disorder. Among the 45 initial brain computed tomography, 28 (62.2%) had abnormal findings; 14(31.1%) low density lesion in the basal ganglia, 7(15.6%) low density lesions in the cerebral white matter, 2(4.4%) low density lesion in the cerebral white matter and basal ganglia, and 5(l1.1%) cortical atrophy. Seventeen (37.8%) had normal neuroimaging finding. Many, but not all, patients had lesionon on brain imaging, but there was no clear correlation between the sites of damage on imaging and the clinical manifestation.
Adult ; Anoxia ; Atrophy ; Basal Ganglia ; Brain Injuries ; Brain* ; Carbon ; Chorea ; Dystonia ; Encephalitis ; Humans ; Movement Disorders* ; Myoclonus ; Neuroimaging ; Parkinsonian Disorders ; Poisoning ; Tremor

BACKGROUND: Presently, it is well known that there are neurological and systemic complications after carbon monox-ide (CO) intoxication. Until recently, delayed-onset movement disorders after CO intoxication were rarely reported. We analyzed 32 patients with delayed onset movement disorders after CO intoxication. METHODS: We reviewed the medical records of 242 patients admitted to the Yonsei University Medical Center from January 1986 to December 1996 due to CO intoxication. Patients were analyzed with respect to movement disorders, onset, latency, and radiological findings. RESULTS: Among the 242 patients of CO intoxication, 32 (13.2%) patients had delayed-onset movement disorders. Of these, 23 (71.9%) had parkinsonism, 5 (15.6%) had dystonia, 3 (9.4%) had chorea, and 1 (3.1%) had myoclonus. The mean age of the patients was 46.66 +/-16.91 years. Among the 4 patients with CO intoxication occuring at age 17 or younger (Childhood group), 2 had parkinsonism and 2 had focal dystonia. The mean age of the Childhood group was 1 7 . 7 5 +/-6.99 years. Among the 28 patients with CO intoxication occuring at age 18 or older (Adult group), 21 (75%) had parkinsonism, 3(10.7%) dystonia, 3(10.7%) chorea, and 1(3.6%) myoclonus. Among the 3 patients with dystonia in the Adult group, 1 had focal dystonia and 2 had segmental dystonia. The mean age of the adult group was 50.79 +/-1 3 . 4 6 years. The mean latency between CO intoxication and the onset of movement disorders was 27.20 +/-27.94 weeks in the Childhood group and 9.60 +/-14.97 weeks in the Adult group. The mean latency between CO intoxication and the onset of movement disorders was 6.44 +/-6.76 weeks in parkinsonism, 41.76 +/-27.99 weeks in dystonia, 4.0 weeks in chorea, and 8.0 weeks in myoclonus. The mean latency in dystonia was longer than in the others. Among the 23 patients who underwent brain computed tomography, 12 (52.2%) had abnormal findings. Low density lesions were found in the globus pallidus (13.0%), cerebral white matter (13.0%), and both globus pallidus and cerebral white matter (17.4%). One (14.3%) patient showed cortical atrophy while another patient showed both cortical atrophy and low density in cerebral white matter. CONCLUSIONS: The development of a delayed-onset movement disorder after CO intoxication is not rare. In our research, the radiological findings of patients with delayed-onset movement disorders after CO intoxication were inconsistant. The findings revealed no correlations with the various types of delayed-onset movement disorders.
Academic Medical Centers ; Adult ; Atrophy ; Brain ; Carbon Monoxide* ; Carbon* ; Chorea ; Dystonia ; Dystonic Disorders ; Globus Pallidus ; Humans ; Medical Records ; Movement Disorders* ; Myoclonus ; Parkinsonian Disorders

We reviewed a total of 36 cases of gastrointestinal carcinoid tumors during a period of ten and a half years at Seoul National University Hospital, looking at their histologic and ultrastructural features, as well as immunohistochemical results, then we correlated these with location. The primary sites of carcinoid tumors were rectum(39%), stomach(25%), appendix(22%), small intestine(8%) and colon(6%), in order of frequency. The predominant histologic types by organ were mixed and solid(A) types in all location, the solid type(type A) in the stomach, and tubular type(type C) in the rectum. Six out of 8 cases of appendiceal carcinoid were type A and the other two cases were mucinous carcinoid. Tubular adenoma or adenocarcinoma was associated with 36% of the rectal carcinoids, with one case of carcinoid in the small intestine, and one(11%) of the gastric carcinoids was found near an adenocarcinoma. Metastasis was found in one case of ileal carcinoid(100%), one case of cecal carcinoid, 3 of gastric carcinoid(33%) and 2 of rectal carcinoid(14%). Primary tumor size ranged from 1 to 7 cm. Tumor necrosis and endolymphatic tumor emboli were found in 57% and 43% of the metastatic carcinoids, respectively. PCNA index showed a borderline significant difference between metastatic and nonmetastatic groups(P value=0.063). The low prevalence of appendiceal carcinoid and the relatively high prevalence of gastric-rectal carcinoid may reflect a low chance of incidental appendectomy and frequent detection of gastrointestinal endoscopy.
Adenocarcinoma ; Adenoma ; Neoplasm Metastasis

No abstract available.
Hearing*

The degenerative spondylolisthesis is one of the most common causes of the prominent central and recess stenosis which are produced by the hypertrophy of the facet joints and anterior slipping of the posterior arch. The resulting neurogenic symptoms in the legs are the major causes of the surgical treatment in the degenerative spondylolisthesis and the complete decompression is indicated for these types of spinal stenosis. The decompression procedures performed in the degenerative spondylolisthesis makes more unstable and induce the late instability and the post
Clinical Study ; Constriction, Pathologic ; Daegu ; Decompression ; Decompression, Surgical ; Hypertrophy ; Korea ; Leg ; Lumbar Vertebrae ; Nerve Compression Syndromes ; Spinal Stenosis ; Spine ; Spondylolisthesis ; Zygapophyseal Joint

Aseptic meningitis may rarely occur with the use of OKT3 murin monoclonal antibody, which is an immunosuppressive agent for the prevention and treatment of acute rejection in solid transplantation. We present a patient with aseptic meningitis, developed during OKT3 therapy, who shows characteristic clinical features and CSF findings consistent with OKT3 associated aseptic meningitis.
Humans ; Meningitis, Aseptic* ; Muromonab-CD3*

Eosinophilic myelitis (EM) or atopic myelitis is a rare disease characterized by a myelitic condition in the spinal cord combined with allergic process. This disease has specific features of elevated serum IgE level, active reaction to mite specific antigen and stepwise progression of mostly the sensory symptoms. Toxocariasis can be related with a form of EM. This report describes two cases of cervical eosinophilic myelitis initially considered as intramedullary tumors. When a differential diagnosis of the intramedullary spinal cord lesion is in doubt, evaluation for eosinophilic myelitis and toxocariasis would be beneficial.
Diagnosis, Differential ; Eosinophils ; Hypersensitivity ; Immunoglobulin E ; Mites ; Myelitis ; Rare Diseases ; Spinal Cord ; Toxocariasis

Twenty seven patients with known rectal cancer were evaluated with CT and CT findings were correlated with surgical and pathologic results on the aspect of perirectal fat infiltration and lymph node involvement. The accuracy in assessment of perirectal fat infiltration was 77.8% (21 of 27); sensitivity, 73.3% (11 of 13); specificity, 83.3% (10 of 12). In the detection of lymph node involvement, lymph nodes were divided into five groups according to the arterial teritories. Overall accuracy in the evaluation of lymph node involvement was 86.7%. Accuracy of peritumoral lymph node involvement was 51.9% (14 of 27); sensitivity, 42.9%(9 of 21); specificity 83.3% (5 of 6). Accuracy of internal iliac lymph node involvement was 88.9% (24 of 27); sensitivity, 85.7% (6 of 7); specificity, 90.0% (18 of 20). Of the common and external iliac lymph node, accuracy was 100% (27 of 27); sensitivity, 100% (2 of 2); specificity, 100% (25 of 25). Of the aortic bifurcation and mid sacral lymph node, accuracy was 92.6% (25 of 27); sensitivity, 50% (2 of 4); specificity, 100% (23 of 23). In regard to the inferior mesenteric lymph node, no lymphadenopathy was found on CT and pathologic results. In conclusion, CT has limited value in evaluating rectal cancer but with the satisfactory outcome in assessment of perirectal fat infiltration and lymph node, involvement except peritumoral node preoperative CT is useful in the evaluation of rectal cancer.
Humans ; Lymph Nodes* ; Lymphatic Diseases ; Rectal Neoplasms* ; Sensitivity and Specificity

Pulmonary blastoma is a rare lung tumor resembling fetal lung tissue. Pathologically the tumor can be classified to 2 groups, well-differentiated fetal adenocarcinoma(WDFA) and biphasic blastoma. WDFA has more favorable prognosis with fewer metastasis at initial presentation and fewer recurrence after treatment. We experienced a case of pulmonary blastoma in 32-year-old female patient. The patient was referred to our hospital because of abnormal mass shadow in right middle lobe. The diagnosis of pulmonary blastoma(WDFA type, Stage I T2NOMO) was confirmed after right middle lobectomy. We followed up 22 months without an evidence of recurrence.
Adult ; Diagnosis ; Female ; Humans ; Lung ; Neoplasm Metastasis ; Prognosis ; Pulmonary Blastoma* ; Recurrence