Multiloculated hydrocephalus (MLH) is a condition in which patients have multiple, separate abnormal cerebrospinal fluid collections with no communication between them. Despite technical advancements in pediatric neurosurgery, neurological outcomes are poor in these patients and the approach to this pathology remains problematic especially given individual anatomic complexity and cerebrospinal fluid (CSF) hydrodynamics. A uniform surgical strategy has not yet been developed. Current treatment options for MLH are microsurgical fenestration of separate compartments by open craniotomy or endoscopy, shunt surgery in which multiple catheters are placed in the compartments, and combinations of these modalities. Craniotomy for fenestration allows better visualization of the compartments and membranes, and it can offer easy fenestration or excision of membranes and wide communication of cystic compartments. Hemostasis is more easily achieved. However, because of profound loss of CSF during surgery, open craniotomy is associated with an increased chance of subdural hygroma and/or hematoma collection and shunt malfunction. Endoscopy has advantages such as minimal invasiveness, avoidance of brain retraction, less blood loss, faster operation time, and shorter hospital stay. Disadvantages are also similar to those of open craniotomy. Intraoperative bleeding can usually be easily managed by irrigation or coagulation. However, handling of significant intraoperative bleeding is not as easy. Currently, endoscopic fenestration tends to be performed more often as initial treatment and open craniotomy may be useful in patients requiring repeated endoscopic procedures.
Brain ; Catheters ; Cerebrospinal Fluid ; Craniotomy* ; Endoscopy* ; Hematoma ; Hemorrhage ; Hemostasis ; Humans ; Hydrocephalus* ; Hydrodynamics ; Length of Stay ; Membranes ; Neurosurgery ; Pathology ; Subdural Effusion

The endophytic fungi from root, main stem, branch and leaf of Scrophularia ningpoensis were isolated and identified from Wulong and Chongqing, and the population diversity analysis and phylogenetic analysis were followed. The result indicated that, as to population diversity index, S. ningpoensis from Wulong： leaf>main stem=branch>root, branch from Chongqing>branch from Wulong. Fifty-eight endophytic fungi were obtained, most of which were the pathogens of the plant. Colletotrichum was the prevailing genus, of which C. gloeosporioides and C. boninense were the prevailing strains. Leaf and seedlings might be the main path of infection. Endophytic fungi and pathogen might convert to each other, influenced by such factors as environment, genotype et al.

OBJECTIVE: Craniotomy (CO) and decompressive craniectomy (DC) are two main surgical options for acute subdural hematomas (ASDH). However, optimal selection of surgical modality is unclear and decision may vary with surgeon's experience. To clarify this point, we analyzed preoperative findings and surgical outcome of patients with ASDH treated with CO or DC. METHODS: From January 2010 to December 2014, data for 46 patients with ASDH who underwent CO or DC were retrospectively reviewed. The demographic, clinical, imaging and clinical outcomes were analyzed and statistically compared. RESULTS: Twenty (43%) patients underwent CO and 26 (57%) patients received DC. In DC group, preoperative Glascow Coma Scale was lower (p=0.034), and more patient had non-reactive pupil (p=0.004). Computed tomography findings of DC group showed more frequent subarachnoid hemorrhage (p=0.003). Six month modified Rankin Scale showed favorable outcome in 60% of CO group and 23% of DC group (p=0.004). DC was done in patient with more unfavorable preoperative features (p=0.017). Patients with few unfavorable preoperative features (<6) had good outcome with CO (p<0.001). CONCLUSION: In selective cases of few unfavorable clinical findings, CO may also be an effective surgical option for ASDH. Although DC remains to be standard of surgical modality for patients with poor clinical status, CO can be an alternative considering the possible complications of DC.
Coma ; Craniotomy* ; Decompressive Craniectomy* ; Hematoma, Subdural, Acute* ; Humans ; Pupil ; Retrospective Studies ; Subarachnoid Hemorrhage ; Treatment Outcome

OBJECTIVES: Voice and speech alternations that can occur after total thyroidectomy are usually due to recurrent or superior laryngeal nerve injury. These alterations may also be associated with other extralaryngeal factors, such as neck muscle dysfunction and scar contracture of the neck. We performed a prospective acoustic analysis on speech changes after surgery, in the absence of laryngeal nerve injury. METHODS: Patients aged 19 to 58 years undergoing total thyroidectomy, in the absence of laryngeal/pulmonary disease, previous neck surgery, or other malignant diseases, were recruited prospectively. For the running speech analysis, the speaking fundamental frequencies (SFo), range of SFo and speaking intensity were evaluated before surgery, 7 days, and 1 and 3 months after surgery. For consonant analysis, the acoustic distinctions of stop consonant, the voice onset time (VOT), vowel duration and closure duration were evaluated at the same periods. RESULTS: SFo and range of SFo were specifically diminished after surgery, while speaking intensities were not changed significantly after surgery. The thyroidectomized speakers displayed systematically varied VOT for the consonant production, which was phonetically representative. However, VOT after surgery could be longer in the strong aspirated and glottalized stops, but not in the lax stop than before surgery. The vowel and closure durations were not affected before and after surgery. CONCLUSION: Patients with thyroidectomy have some difficulty of pitch control and consonant articulation during speaking. VOT is also one of the meaningful acoustic parameters and provide a reference for comparing acoustic measures before and after thyroidectomy.
Acoustics ; Cicatrix ; Contracture ; Humans ; Laryngeal Nerve Injuries ; Laryngeal Nerves ; Neck ; Neck Muscles ; Prospective Studies ; Running ; Thyroidectomy* ; Voice

We demonstrated that a mineral aqueous solution (MAS) administered to mice functionally and histologically protected against cisplatin-induced acute renal failure (ARF) and CCl4-induced acute liver failure (ALF). In ARF model, 0.4 and 0.2% MAS decreased mortality and the serum concentrations of blood urea nitrogen (BUN) and creatine in mice. Additionally, 0.4 and 0.2% MAS reduced contraction of distal convoluted tubules and suppressed expression of the proinflammatory cytokines interlukein-6 (IL-6) and tumor necrosis factor (TNF-alpha) in the kidney. In ALF model, 0.4 and 0.2% MAS decreased serum concentrations of alanine aminotransferase and aspartate aminotransferase in mice. Additionally, 0.4 and 0.2% MAS reduced necrotic areas and suppressed expression of IL-6 and TNF-alpha in the liver. These results indicate that a MAS might have protective effects against ARF and ALF.
Acute Kidney Injury ; Alanine Transaminase ; Animals ; Aspartate Aminotransferases ; Blood Urea Nitrogen ; Contracts ; Creatine ; Cytokines ; Interleukin-6 ; Kidney* ; Liver Failure, Acute ; Liver* ; Mice* ; Mortality ; Silicon ; Tumor Necrosis Factor-alpha

Situs inversus totalis (SIT) is a rare congenital condition in which the viscera are transposed as a mirror of normal physiologic arrangement. We describe a rare case of lingual thyroid associated with SIT. A 64-year-old female who was diagnosed with SIT, visited our clinic due to pharyngeal foreign body sensation. Physical examination revealed a 2.5x2.5x2.0 cm sized, pinkish, round mass in the base of the tongue. Computed tomography suggested the diagnosis of lingual thyroid. She has been on regular follow up with levothyroxine therapy. To our best knowledge, this is the first case of lingual thyroid (LT) associated with SIT. The literature is reviewed and clinical features about LT and SIT are presented.
Diagnosis ; Female ; Follow-Up Studies ; Foreign Bodies ; Humans ; Lingual Thyroid* ; Middle Aged ; Physical Examination ; Sensation ; Situs Inversus* ; Thyroxine ; Tongue ; Viscera

OBJECTIVE: To determine and verify the correlation formula of age estimation using the content of signal joint T-cell receptor excision DNA circle (sjTREC) in human peripheral blood and to discuss its application value in forensic biological practice. METHODS: The samples of peripheral blood stains were collected from 30 healthy unrelated individuals whose ages were known. The DNAs were extracted from the samples stored at room temperature after 4 weeks. The content of sjTREC was measured by real-time fluorescent quantitative PCR technique, and the TATA box binding protein (TBP) was selected as reference genes. The age of each sample was predicted with the formula which was Age = -7.181 5 Y-42.458 +/- 9.42 (Y = dCtTBP-sjTREC), and the result was compared with the real age of each individual to determine the accuracy of the formula. RESULTS: sjTREC and TBP gene were detectable in all 30 samples of peripheral blood. The contents of sjTREC in human peripheral blood showed a decreasing tendency with aging. The accuracy rate for the age estimation by this method was 76.67%. CONCLUSION The method for the age estimation with the content of sjTREC was simple, fast, sensitive, and good species specific with important potential application prospect.
Adolescent ; Adult ; Aged ; Aging/blood* ; Blood Stains ; Child ; Child, Preschool ; DNA/genetics* ; DNA Primers/genetics* ; Female ; Forensic Genetics/methods* ; Gene Rearrangement, T-Lymphocyte/genetics* ; Humans ; Infant ; Male ; Middle Aged ; Real-Time Polymerase Chain Reaction/methods* ; Sensitivity and Specificity ; TATA-Box Binding Protein/genetics* ; Young Adult

A 59-year-old male patient presented with sudden onset of vertigo and hearing loss. Labyrinthitis due to lateral semicircular canal fistula caused by cholesteamatous otitis media was suspected from temporal bone computed tomography (CT) and clinical symptoms. The patient was treated with canal wall down mastoidectomy with removal of the cholesteatoma and lateral semicircular canal occlusion. Preoperative gadolinium-enhanced magnetic resonance imaging (MRI) images of the inner ear revealed increased signal in the cochlea as well as vestibule. Correlation of the MRI findings and the inner ear involvement in labyrinthine fistula is discussed.
Cholesteatoma ; Cochlea ; Ear, Inner ; Fistula ; Hearing Loss ; Humans ; Labyrinthitis ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Otitis Media ; Semicircular Canals ; Temporal Bone ; Vertigo

Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired clonal disorder of the hematopoietic stem cells characterized by chronic intravascular hemolysis, venous thrombosis, deficient hematopoiesis. Kidney involvement is usually benign and secondary to chronic deposition of hemosiderin. However, acute kidney injury may rarely occur in association with a hemolytic crisis or thrombotic complication. Hemolytic crisis is precipitated by nonspecific factors, such as infection, surgery and transfusion. A 35-year-old woman, who developed hemolytic crisis and acute kidney injury was admitted to our hospital presenting with acute gastroenteritis. After being treated by hemodialysis and oral low dose steroid, she was discharged with recovered renal function. Renal biopsy demonstrated acute tubular necrosis with considerable hemosiderin deposition without evidence of vascular thrombosis. A review of Korean cases showed that most of the cases featured severe renal dysfunction to such an extent to require a hemodialysis although there were no definite etiologies other than the deposition of blood iron due to massive hemolysis unlike the foreign cases. It also showed that the disease duration was longer. It can therefore be inferred that the early diagnosis and active treatment will be mandatory for the treatment of Korean patients with PNH. We reported a case of PNH with acute kidney injury and hemolytic crisis and documented by renal biopsy with review of Korean literature.
Acute Kidney Injury ; Adult ; Biopsy ; Early Diagnosis ; Female ; Gastroenteritis ; Hematopoiesis ; Hematopoietic Stem Cells ; Hemoglobinuria, Paroxysmal ; Hemolysis ; Hemosiderin ; Humans ; Iron ; Kidney ; Korea ; Necrosis ; Renal Dialysis ; Thrombosis ; Venous Thrombosis

PURPOSE: The optimal interval at which to repeat prostate-specific antigen (PSA) measurement is controversial. We evaluated the probability of the serum PSA value increasing above specific cutoff values (4.0 ng/ml, 3.0 ng/ml, and 2.5 ng/ml) on annual follow-up visits in men with a lower baseline PSA than each cutoff value. MATERIALS AND METHODS: Between 2002 and 2006, a total of 14,459 men aged 40 to 79 years who underwent serum PSA determinations at least twice during health examinations at 11 medical centers were enrolled in this study. To reduce probable bias, we excluded men with pyuria, those with a baseline or follow-up PSA level of 10.0 ng/ml or more, and those with a history of medication with 5 alpha-reductase inhibitors. Serum PSA underwent logarithmic conversion to work out the normal distribution. The cumulative rate of freedom from increase in PSA above 4.0 ng/ml, 3.0 ng/ml, and 2.5 ng/ml was estimated with the Kaplan-Meier method according to baseline PSA range and age. The significance level was 1%. RESULTS: The rate of increase in PSA was lower in men who had a baseline PSA value in the low range and whose age was in the 40s or 50s. However, the cumulative rate of freedom from increase in PSA decreased as the PSA cutoff value was lowered. The optimal screening interval for men in their 40s and 50s whose baseline serum PSA level was 1.0 ng/ml or lower was 3 years when the significance level for PSA rising above 4.0 ng/ml was 1%. It was 2 years and 1 year, respectively, when the cutoff value was lowered to 3.0 ng/ml or 2.5 ng/ml. An annual PSA screening interval was recommended in men older than their 60s. CONCLUSIONS: The PSA test interval should be individualized according to baseline PSA, age, and PSA cutoff value.
Aged ; Bias (Epidemiology) ; Cholestenone 5 alpha-Reductase ; Follow-Up Studies ; Freedom ; Humans ; Male ; Mass Screening ; Prostate-Specific Antigen ; Pyuria