Fetal cystic hygroma is a rare congenital malformation of the lymphatic system appearing as a single or multiloculated fluid-filled cavity, most often in the neck. A case of fetal nuchal cystic hygroma was diagnosed by Ultrasonography at 22 weeks of gestation and the diagnosis was confirmed at autopsy. We present the case with a brief review of literature.
Autopsy ; Diagnosis ; Lymphangioma, Cystic* ; Lymphatic System ; Neck ; Pregnancy ; Ultrasonography

STUDY DESIGN: A case report is presented of a symptomatic sacral perineural cyst with lumbar disc herniation that has reported a few case in the literature. We report the case of symptomatic perineural cyst with lumbar disc herniation. SUMMARY OF LITERATURE REVIEW: Symptomatic sacral perineural cyst is rare and some cases of sacral perineural cyst associated with disc herniation were reported. But it is not well known that the correlation between clinical symptoms caused by mass itself and concomittant lumbar disc herniation. METHODS: A 34-year-old male presented with low back pain, both leg dysesthesia and bilateral radiating pain. Clincal sign and symptom, physical examination, diagnostic imaging studies including MRI, myelography and pathologic findings of surgical specimens were evaluated. RESULTS: After the decompressive partial laminectomy and discectomy, the patient who had diapnosed with herniated nucleus pulposus of L4-5 and L5-S1 complained residual both leg paesthesia and hypoesthesia. Patient's clinical symptom was correlated with sacral perineural cyst. So we removed the cyst. Postoperatively neurologic symptoms and signs were completely relieved. Pathologically, Sacral perineural cyst composed of meningoepithelial cell and neural tissue within cystic wall were confirmed. CONCLUSION: We could find that sacral perineural cyst sufficiently evoked a clinical symptom. So, careful observation was needed in that case of sacral perineural cyst associated with disc herniation.
Adult ; Diagnostic Imaging ; Diskectomy ; Humans ; Hypesthesia ; Laminectomy ; Leg ; Low Back Pain ; Magnetic Resonance Imaging ; Male ; Myelography ; Neurologic Manifestations ; Paresthesia ; Physical Examination ; Tarlov Cysts*

A series of 41 patients in a vegetative state after severe head injury in presented. The patients selected were those who were in comatose state at least 2 weeks and observed more than 6 months. The vegetative state was more common before the age of 40(75.6%). The most common types of lesion causing vegetative state were subdural hematoma and epidural hematoma(56.1%). Twentyeight patients(68.1%) had a Glasgow coma score of 3 to 5. The two most frequent complications were urinary tract infections(80.5%) and bed sores(65.9%), but the most common cause of death was respiratory complication(60.0%). CT scans taken in the vegetative state showed variable evidences of cerebral atrophy, which were considered to be the results of the injury and had little value in predicting the outcome. At 6 months, the outcome was as follows : good recovery 4(9.8%) ; moderate disability 7(17.1%) ; severe disability 12(29.3%) ; vegetative state 10(24.4%) ; and dead 8(19.5%). Twenty-three patients(56.1%) came out of the vegetative state during a 6 month follow-up period. Vegetative state is not always permanent. Therefore, it seems necessary to distinguish perisstent vegetative state from vegetative state. The term, "persistent", means that the patient, if ever, came out of the vegetative state and in the event he did he usually remained in severe disability. 15 out of the 23 improved within 2 months, 14 out of the 15 improved to at least moderate disability. 8 out of the 23 improved after 2 months but all remained in severe disability. From these results we propose that the term "persitent" be applied to patients who remain in a vegetative state for more than 2 months.
Atrophy ; Cause of Death ; Coma ; Craniocerebral Trauma* ; Follow-Up Studies ; Head* ; Hematoma, Subdural ; Humans ; Persistent Vegetative State* ; Tomography, X-Ray Computed ; Urinary Tract

PURPOSE: Peripheral T-cell lymphomas(PTCL) show diverse clinical and histological characteristics and should be understood as mixtures of heterogeneous entities. Although many clinical and biological parameters have been proposed for classifying PTCL into different prognostic groups, few parameters have turned out to be appropriate for classification. To investigate the clinical significance of FUO presentation in PTCL, comparisons of clinical parameters were performed using non-FUO presentation as a control. MATERIALS AND METHODS: 66 cases of Korean PTCL were divided into FUO group and non-FUO group according to the presentation and compared with each other. RESULTS: Among 66 patients of PTCL, 19 patients presented with FUO. Compared with non-FUO group, FUO group showed no significant age and sex ratio differences. FUO group showed more advanced stage, worse performance status than non-FUO group. Predominant sites of definite diagnosis were skin, gastrointestinal tract and liver in FUO group and nasal cavity and paranasal sinus in non-FUO group. There were no significant differences between histologic classifications of both groups. Survival analysis revealed significant differences between both groups. FUO group showed significantly shorter survival. Prognostic factor analysis(multivariate) was done with stage, LDH level, performance status, and FUO status. FUO status, stage and performance status were significant determinants of survival, but LDH level proved to have no prognostic implication. CONCLUSION: PTCL with FUO presentation showed such distinct characteristics that the authors propose fever of unknown origin(FUO) as a clinical parameter for classifying PTCL. Further studies are needed to identify biological parameters which characterize PTCL with FUO presentation.
Classification ; Diagnosis ; Fever of Unknown Origin* ; Fever* ; Gastrointestinal Tract ; Humans ; Liver ; Lymphoma* ; Nasal Cavity ; Prognosis ; Sex Ratio ; Skin ; T-Lymphocytes

Metabolic acidosis (MA) is associated with increased proteolysis, increased osteoclast activity and blunted cardiac muscle response, but the effect of MA on various clinic al parameters in CAPD patients is not well known. To evaluate the effects of MA on serum albumin level and other nutritional parameters in CAPD patients, we studied 106 CAPD patients retrospectively who have had monthly biochemical measurement and urea kinetic studies every 6 months for more than 2 years. The patients were divided into three groups according to their mean total CO2 (tCO2) level of the 2-year follow-up (Group l; mean tCO2 < 22mM/L, Group ll; 22mM/L < or = mean tCO2 < 26mM/L, and Group lll; mean tCO2 > or = 26mM/L), and the clinical, biochemical, and urea kinetic data were compared among the three groups. 1)The mean age of the subjects was 46.9+/-12.2 years with a sex ratio of 1.2:1, the mean CAPD duration 28.3+/-21.8 months, mean body weight (Bwt) 59.0+/-8.9kg, %Bwt/IBW 104.1+/-11.5%, %LBM/Bwt 75.5+/-11.1% and well-nourished patients by subjective global assessment (SGA) were 65%. 2)The mean BUN, creatinine, total protein and albumin of all patients were 55.6+/-13.6mg/dL, 12.3+/-3.5mg/dL, 6.6+/-0.7g/dL and 4.0+/-0.4g/dL, respectively. In urea kinetic study, the mean NPCR, weekly Kt/ Vurea, SCCr and RRF were 0.96+/-0.16g/kg/day, 2.02+/-0.37, 63.7+/-18.4L/week/1.73m2, and 0.99+/-1.32ml/ min, respectively. 3)The mean age was significantly higher in group l (51.0+/-10.8) than those of group ll (47.0+/-12.4) and lll (42.6+/-11.4) (P<0.05). %Bwt/IBW of group l (114.4+/-15.8%) was also significantly higher than those of group ll (104.6+/-12.6%) and lll (103.5+/-13.7 %) (P<0.05), but there were no significant differences in sex ratio, CAPD duration, %LBM/Bwt, and SGA among the three groups. 4)The mean tCO2 in group l, group ll, and group lll were 20.6+/-1.2mM/L, 23.9+/-1.1mM/L, and 27.3+/-0.8mM/L, respectively. Compared to group lll, group l had significantly higher BUN (61.1+/-14.3 vs. 46.1+/-7.2mg/dL, P<0.05) and serum albumin (4.04+/-0.31 vs. 3.75+/-0.39g/dL, P<0.05), in spite of comparable dialysis dose and albumin loss into dialysate. 5)NPCR (1.02+/-0.21g/kg/day vs. 0.88+/-0.14g/kg/ day, P<0.05) and ultrafiltration volume (1.4+/-0.4 vs. 1.0+/-0.3, P<0.05) were significantly higher in group l than those of group lll. But there were no significant differences in Kt/Vurea, SCCr, RRF, and 24-hour dialysate loss of protein/albumin among the three groups. 6)No differences were observed among the three groups in the changes of body weight, %Bwt/IBW, %LBM/Bwt, BUN, albumin, NPCR, and RRF from the baseline values after the 2-year follow-up. 7)There were significant inverse correlations between the mean tCO2 level and NPCR (r=-0.33, P<0.001), %Bwt/IBW (r=-0.32, P<0.001), RRF (r=-0.29, P<0.005), and serum albumin level (r=-0.24, P<0.05). But, creatinine, %LBM/Bwt, and Kt/Vurea did not show any correlation with the mean tCO2 level. 8)Using stepwise multiple regression analysis, NPCR (beta=-0.3491, P<0.001), %Bwt/IBW (beta=-0.046, P<0.001), and ultrafiltration volume (beta=-0.0012, P< 0.005) were independent factors affecting the mean tCO2 level. In conclusion, low total CO2 level in long-term CAPD patients may reflect increased protein intake and mild to moderate degree of metabolic acidosis may not affect the nutritional status of well-dialyzed CAPD patients.
Acidosis* ; Body Weight ; Creatinine ; Dialysis ; Follow-Up Studies ; Humans ; Myocardium ; Nutritional Status ; Osteoclasts ; Peritoneal Dialysis, Continuous Ambulatory* ; Proteolysis ; Retrospective Studies ; Serum Albumin* ; Sex Ratio ; Ultrafiltration ; Urea

OBJECTIVE:The purpose of this study is to evaluate the CT findings of the carcinoma of the ampulla of Vater and to differentiate from other periampullary carcinoma including the carcinoma of the distal common bile duct and pancreas head. MATERIALS AND METHODS: We retrospectively reviewed the CT findings of 13 cases of the carcinoma of the ampulla of Vater, 20 cases of the carcinoma of the distal common bile duct and 20 cases of the carcinoma of the pancreas head confirmed by pathology. Five millimeter consecutive settings of CT scan were performed in all cases on ampulla level with supine position. The CT findings were retrospectively evaluated in view of common bile duct dilatation, pattern of termination of bile duct, pancreatic duct dilatation, protruding mass in duodenal lumen, and regional lymph node metastasis. RESULTS: All case of the carcinoma of the ampulla of Vater(13/13) and distal common bile duct(20/20) showed common bile duct dilatation with abrupt termination. Among the 10 cases of the carcinoma of the pancreas head with common bile duct dilatation, five cases each had is abrupt termination(5/20) and gradual stenosis of bile duct(5/20). Five cases of the carcinoma of the ampulla of Vater(5/13) and four cases of the carcinoma of distal common bile duct(4/20) showed pancreatic duct dilatation and all cases of the carcinoma of pancreas head show pancreatic duct dialtation(20/20). Twenty cases of the carcinoma of the ampulla of Vater showed protruding mass in the medial wall of the second portion of the duodenum(12/13) but only one case of the carcinoma of the distal common bile duct(I/20) and five cases of the carcinoma of the pancreas head (5/20) had protruding mass in the duodenal lumen. Only one case of the carcinoma of the ampulla of Vater showed(1/13) regional lymph node metastasis but three cases of the carcinoma of the distal common bile duct(3/20) and 18 cases of the carcinoma of the pancreas head(18/20) showed regional lymph node metastasis. CONCLUSION: Common bile duct dilatation with abrupt termination, protruding mass in the duodenal lumen and rare lymph node metastasis in CT may suggest the carcinoma of the ampulla of Vater.
Ampulla of Vater* ; Bile ; Bile Ducts ; Common Bile Duct ; Constriction, Pathologic ; Dilatation ; Head ; Lymph Nodes ; Neoplasm Metastasis ; Pancreas ; Pancreatic Ducts ; Pathology ; Retrospective Studies ; Supine Position ; Tomography, X-Ray Computed

PURPOSE: Recently, allergic disorders in children have increased. The cause of allergic disorders made not clear. Therefore study in aspect of food and nutrition was required to prevent allergic disorders in children, show guide of dietary management. METHODS: This study was done in 78 children with allergy from July, 1997 to September, 1997, investigated family history of allergy and general environment with questionnaire, besides growth levels of children with allergic symptoms, nutrient intakes, eating behavior, and allergy-inducing foods. RESULTS: The results of this study are summarized as follows. 1) Allergic symptoms with a age 2-3 years old were asthma (46%), dermatitis (39%), hypersensitivity skin (7%), urticaria (5%) and rhinitis (5%). At age 4-6 years, asthma was 54%, dermatitis 44%, rhinitis 28%, hypersensitivity skin 10%, and urticaria 3%. Most of the dermatits was caused by unknown etiology, temperature change and house dust mite. Asthma was caused by house dust mite and temperature change. Urticaria was caused by foods and rhinitis was caused by house dust mite. 2) Tomato was the most common food as a cause of allergic disease and peach, mackerel, yoghurt, cheese, and egg were included. Urticaria was provoked mainly by tomato and peach, diarrhea was induced by milk, yoghurt and cheese, vomiting by quail eggs, and swelling lip was induced by tomato. 3) The average daily calory intake was 80% of the RDA at the age of 2-3 years old, 66% at the age of 4-6 year old. Protein and fat intake were similar as RDA. The other nutrients intake at the age of 2-3 and 4-6 years old were 106% and 71% for calcuim, 49% and 52% for iron, 30% and 31% for zinc, respectively. The amount of vitamin intake also lower than RDA for both age groups. CONCLUSION: The average calory intake and other nutrients intake for the children with allergic symptoms were lower than RDA. But they showed relatively normal growth pattern compared with the Korean growth standard. It is necessary to findout the food that provoke the allergic symptoms and make guideline for diet therapy for the children with a various allergic symptoms.
Asthma ; Cheese ; Child* ; Dermatitis ; Diarrhea ; Diet Therapy ; Eggs ; Feeding Behavior ; Humans ; Hypersensitivity ; Iron ; Lip ; Lycopersicon esculentum ; Milk ; Ovum ; Perciformes ; Prunus persica ; Pyroglyphidae ; Quail ; Surveys and Questionnaires ; Rhinitis ; Skin ; Urticaria ; Vitamins ; Vomiting ; Yogurt ; Zinc

Retroperitoneal cystic lymphangioma is a rare benign tumor which had previously been difficult to diagnose preoperatively by conventional radiographic technique(1). Recent reports describe the computed tomographic and ultrasonographic findings in cystic lymphangioma(1,2). We report a case of retroperitoneal cystic lymphangioma, accurately diagnosed by lymphography, with computed tomographic findings and percutaneous drainage findings. To the best of out knowledge, this is the most aged case of retroperitoneal cystic lymphangioma of preoperatively diagnosed.
Drainage ; Lymphangioma, Cystic* ; Lymphography

BACKGROUND AND OBJECTIVES: Pulmonary arterial hypertension (PAH) is a life threatening disease characterized by progressive pulmonary arterial occlusion which may ultimately result in death. Currently, the available treatments are diverse, but no therapy alone can reverse the disease process although they may have some clinical benefits. This study was designed to investigate single and combination therapy of simvastatin and sildenafil, which have different mechanisms of action, in monocrotaline (MCT)-induced PAH. METERIALS AND METHODS: Rats were randomized to receive saline (control, n=8) or MCT treatment (n=32). MCT treated rats were randomized to vehicle, simvastatin (2 mg/kg/day), sildenafil (25 mg/kg/day) and a combination simvastatin and sildenafil (n=8, respectively). Three weeks later, hemodynamic study and histologic changes of pulmonary arterioles were measured. Proliferating cell nuclear antigen (PCNA) as well as Western blot for endothelial nitric oxide synthase (eNOS) were performed. RESULTS: Systolic right ventricular pressure was significantly decreased in monotherapy groups (simvastatin and sildenafil) and the combination group compared to MCT group (p<0.05). Right ventricular hypertrophy and medial wall thickness of pulmonary arterioles were significantly attenuated with sole and combination therapy (p<0.05). However, combination therapy did not confer additive benefits over monotherapy. Altered PCNA or eNOS in lung tissue was normalized by either monotherapy or combination therapy. CONCLUSION: The results suggest that either simvastatin or sildenafil has the therapeutic potential in MCT-induced PAH, although combination therapy of these two drugs has failed to show greater benefits in the study.
Animals ; Arterioles ; Blotting, Western ; Hemodynamics ; Hypertension ; Hypertension, Pulmonary ; Hypertrophy, Right Ventricular ; Lung ; Monocrotaline ; Nitric Oxide Synthase Type III ; Piperazines ; Proliferating Cell Nuclear Antigen ; Pulmonary Circulation ; Purines ; Rats ; Simvastatin ; Sulfones ; Ventricular Pressure ; Sildenafil Citrate

BACKGROUND: Infants are very different from children and adults in the point of anatomy, physiology, pharmacology and psychology. The mortality rate of infant anesthesia is higher than that of child and adult. So that this study is to analyze the infant's operation and to recognize the tendency and problems of infant's anesthesia and also to improve the outcome. METHODS: A retrospective analysis was performed on 1436 infants who had operations from april 1987 to february 1995 according to age, sex, department, disease, operation time, postoperative complications, mortality rate and anesthetic method. RESULTS: Total number of operation tend to increase annually. The male to female ratio was 67.5% to 32.5%. The distribution of patients by department was 60.6% of general surgery, 21.0% of plastic surgery and small percentage of other department. The distribution of disease was the following : inguinal hernia - the most common; cleft lip and palate, intussusception and others. The postoperative complications developed in 98 of 1436. The most common complication was the respiratory problems, the others were sepsis, electrolyte unbalance, gastrointestinal and CNS problems. The total mortality rate was 3.6%. The emergency operation case was 17.9%. CONCLUSIONS: The most common distribution of age was neonate and the most commm department was general surgery and the most common disease was inguinal hernia. The most common postoperative complication was respiratory problems and the second was infection and sepsis. The mortality rate in preterm infant, neonate, emergency operation and long duration operation was higher than total motality rate.
Adult ; Anesthesia* ; Child ; Cleft Lip ; Emergencies ; Female ; Hernia ; Hernia, Inguinal ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Intussusception ; Male ; Mortality ; Palate ; Pharmacology ; Physiology ; Postoperative Complications ; Psychology ; Retrospective Studies* ; Sepsis ; Surgery, Plastic