Changes in the Hippocampal Volume and Shape in Early-Onset Mild Cognitive Impairment

OBJECTIVE: The aim of this study was to examine the change in the hippocampal volume and shape in early-onset mild cognitive impairment (EO-MCI) associated with the APOE ε4 carrier state. METHODS: This study had 50 subjects aged 55–63 years, all of whom were diagnosed with MCI at baseline via the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet. The EO-MCI patients were divided into the MCI continued (MCIcont) and Alzheimer's disease (AD) converted (ADconv) groups 2 years later. The hippocampal volume and shape were measured for all the subjects. The local shape analysis (LSA) was used to conduct based on the 2-year-interval magnetic resonance imaging scans. RESULTS: There was a significant correlation between APOE ε4 allele and hippocampal volume atrophy. Over two years, the volume reduction in the left hippocampus was found to be faster than that in the right hippocampus, especially in the APOE ε4 carriers. LSA showed that the 2 subfields were significantly affected in the left hippocampus. CONCLUSION: These results suggest that the possession of APOE ε4 allele may lead to greater predilection for left hippocampal atrophy in EO-MCI, and some specific subfields of the hippocampus may be more prominently involved.

Impulsive Behavior and Recurrent Major Depression Associated with Dandy-Walker Variant

Reported herein is a case of recurrent major depression with impulse control difficulty in a 33-year-old man with Dandy-Walker variant. He was diagnosed as having major depressive disorder a year before he presented himself to the authors' hospital, and had a history of three-time admission to a psychiatric unit in the previous 12 months. He was readmitted and treated with sodium valporate 1,500 mg/day, mirtazapine 45 mg/day, and quetiapine 800 mg/day during the three months that he was confined in the authors' hospital, and the symptoms were reduced within three months but remained thereafter. This is the only case so far reporting recurrent depression with impulse control difficulty associated with Dandy-Walker variant. This case implies that any cerebellar lesion may cause the appearance of recurrent depression with impulse control difficulty in major depressive disorder.

Sonographic Imaging of a Hydrocele of the Spermatic Cord

PURPOSE: The US examination has been used to evaluate the infant and child having an inguino-scrotal bulge or mass for the non-invasive diagnostic work up to exclude neoplasm, cryptorchidism, lymphadenopathy, hydrocele of spermatic cord, etc. We performed this study to determine the characteristic ultrasound features of hydrocele of spermatic cord in children. MATERIALS AND METHODS: From February 2002 to March 2007, 213 pediatric patients with swelling or palpable mass of the inguino-scrotal area, or suspected cryptorchidism underwent ultrasonography for evaluation of accurate diagnosis. Ninetythree of 213 patients had a cystic lesion of the inguino-scrotal area. Among 93 patients, the sonographic images of 28 patients, who were confirmed as having hydrocele of the spermatic cord, were collected on a retrospective basis. The age of the patients ranged from 15 days to 11 years. The ultrasound images of the patients were subsequently reviewed to analyze the typical features in the diagnostic workup of hydrocele of spermatic cord. Eight patients were confirmed by surgery. Twenty patients who were less than one year old were clinically followed up. RESULTS: The most common finding was testicular hydrocele, which was found in 44 patients of the 93 patients that had a cystic lesion of the inguino-scrotal area. Of the 28 patients who had a hydrocele of spermatic cord, 10 patients had the lesions on the left side and 17 patients on the right side. One patient has bilateral hydrocele of spermatic cord. Well-defined elongated or elliptical-shaped cystic lesions were noted in the 24 of 29 cases (one patient had bilateral hydrocele of the spermatic cord). One patient had septations within elongated cystic lesion was seen and round shape in one case; tear drop shape was found in three cases. CONCLUSIONS: The most common ultrasound imaging of spermatic cord hydrocele is well-defined, elongated cystic mass separating the testes.

Image Spectrum of Anal Ultrasound in Patients with Peri Anal Disease

Endoanal ultrasonography has recently emerged as a popular diagnostic modality for mapping and imaging the anal sphincter. This procedure can be performed as an outpatient procedure; it is relatively quick and virtually painless. The imaging typically is performed in a proximal to distal manner with defining a variety of levels of the anal canal as it progresses. Anal ultrasond can provide a detailed image of the anal sphincter musculature. The internal anal sphincter appears endosonographically as a hypoechoic circular band that is most prominently seen at the level of the mid-anal canal. The external anal sphincter appears as a thicker circular mixed echogenic band outside of the hypoechoic internal sphincter. Anal ultrasond can be used to evaluate patients with anal fistulas with or without abscess. Imaging is performed and the fistulous tracts or abscesses are identified by hypoechogenicity within the external sphincter muscle or the ischiorectal fossa. Its ability to clearly image the anal sphincters has allowed its use for the evaluation of anal fistulas. Moreover, anal ultrasound has emerged as the technique of choice for imaging the anal sphincters and for evaluating incontinence. Each of the individual physiologic tests offers valuable information that is relevant to the continence mechanism, and the ultrasound yields results that are complementary to other tests. Ultrasound serves as a surveillance tool to monitor the results after sphincterplasty. We illustrate the endo-anal sonographic features of various anal diseases and the ultrasound-anatomic correlation for the anus.

Small bowel obstruction in early pregnancy: A case report / 대한산부인과학회지

Intestinal obstruction occurs rarely as a cause of acute abdominal pain during pregnancy. It is very difficult to make diagnosis, as nausea, vomiting and abdominal pain are commonly associated with pregnancy, and X-rays are avoided if possible. However, delayed diagnosis can cause intestinal strangulation, which results in a high incidence of maternal morbidity, mortality, premature labor, and fetal loss. The incidence of intestinal obstruction seems to increase at the time of rapid uterine size changes such as between 16~20 weeks, 32~36 weeks or even in the puerperium. The possibility of intestinal obstruction must always be kept in mind when a pregnant woman with an operation scar on her abdomen develops abdominal pain. We present a case of small bowel obstruction during early pregnancy with a brief review of the literature who had the history of right salpingo-oophorectomy and appendectomy operation

Acute Rhabdomyolysis : Importance of MRI and Bone Scintigraphy

Rhabdomyolysis is a potentially life-threatening disease which may result from a variety of causes. We describe the features of magnetic resonance imaging(MRI) and bone scintigraphy, and their importance for diagnosis and treatment of a patient with rhabdomyolysis.

CT and MR Imaging Analysis of Calcification Suspensions of Different Types and Concentrations

BACKGROUND: High-density calcifications on CT images can appear as high signals on T1-weighted MR images, but with differing extents and degrees. This study investigated CT and MR images of calcifications of various types and concentrations. METHODS: We analyzed CT and MR images of two cases of bilateral basal ganglia calcifications and experimental suspensions of calcifications of different types and concentrations. RESULTS: The density of CT calcifications increased in proportion to their concentration regardless of their type. However, the MR signals differed with the types and concentrations of calcification. A high signal was one of the most noticeable signs on T1-weighted MR images for calcium phosphate, and it increased for concentrations up to 0.2 g/mL before leveling off. The signal for all types of calcification decreased on T2-weighted and especially fluid-attenuated inversion recovery (FLAIR) images. CONCLUSIONS: High signals are characteristic of calcification on T1-weighted MR images, and are often stronger than those on CT images. A low signal appears consistently on FLAIR MR images regardless of the calcification type. These findings might be helpful in evaluating calcifications apparent in MR images.

Relationship between the depth of cingulate sulcus on neonatal high resolution cranial ultrasound and gestational age / 소아과

PURPOSE: It is critical that the exact gestational age of a newborn baby, especially premature baby, be determined to evaluate the status of a disease and its management and to estimate the prognosis of a patient. This study aimed to investigate an easy and accurate method to estimate gestational age on cranial ultrasound, requiring minimal additional time and equipment. METHODS: A high-resolution coronal sonographic image was obtained via the anterior fontanel with a 5-12 Mhz linear probe after the usual cranial sonographic examination. We measured the depth of cerebral hemisphere, thickness of corpus callosum, and depth of cingulate sulcus and obtained the correlations between these factors and gestational age. RESULTS: Depth of cingulate sulcus had the highest correlation coefficiency with gestational age (r=0.878, P=0.000). All the cases, except for 2 cases, had a gestational age of more than 37 weeks, when the depths of cingulate sulcus were more than 0.55 cm, and had a gestational age less than 34 weeks, when the depths of cingulate sulcus were less than 0.35 cm. CONCLUSION: Measurement of the depth of cingulate sulcus was a simple and accurate method to estimate the gestational age on cranial ultrasound. The gestational age is more than 37 weeks, when the depth of cingulate sulcus is more than 0.55 cm, and is less than 34 weeks, when the depth of cingulate sulcus is less than 0.35 cm.

A case of newly developed pulmonary lesion during the antitubercular agents in tuberculous pleurisy : A paradoxical response / 소아과

Paradoxical response refers to the enlargement of old lesions or unexpected appearance of new lesions after initial improvement following treatment with antitubercular agents. Various types of paradoxical responses have been reported in the world, but they are rarely reported in Korean children. We report the case of a 17-year-old boy who was diagnosed with tuberculous pleurisy and was treated appropriately. Although the tuberculous pleurisy initially responded to medication with resolution of the pleural fluid, a new pulmonary lesion subsequently developed 3 weeks after the initiation of treatment that eventually cleared with continuation of the original drug regimen.

A case of lung abscess caused by Burkholderia cepacia in healthy child / 소아과

Burkholderia cepacia is a Gram-negative aerobic bacillus known to cause opportunistic infections in the immune-compromised hosts. This microorganism is strongly virulent and causes a necrotising invasive infection that may lead to death. As B. cepacia is highly resistant to various antimicrobials, combination antimicrobial therapy must be used instead of monotherapy. We report a successful treatment of lung abscess that was naturally caused by B. cepacia in a healthy child, through combination antimicrobial therapy of meropenem and trimethoprim/sulfamethoxazole and operative management.

Fine Needle Aspiration of Focal Lung Lesion under CT Fluoroscopic Guidance

PURPOSE: We wanted to assess the efficacy of using CT fluoroscopy during Fine Needle Aspiration (FNA) for focal lung lesion. MATERIALS AND METHODS: We retrospectively reviewed 22 patients who had undergone FNA under CT fluoroscopic guidance. The final diagnosis of focal lung lesion was based on surgery, the results of biopsy taken from another site or the clinical diagnosis with imaging follow-up. We reviewed the imaging and recorded the location of the lesion, the lesion size and the depth from the puncture site. RESULTS: In 24 cases of 22 patients, 16 lesions were benign and 8 were malignant. The sensitivity and specificity for malignant lesions were 100%, and 75%, respectively. The mean size of the malignant lesions was 3.75+/-1.68 cm, and that of the benign lesion was 3.05+/-2.98 cm. The mean depth of the lesion divided by the size was 1.85+/-1.09 for 20 lesions of the correct result group and 3.13+/-1.73 for 4 lesions of the incorrect result group; the difference between the two groups was statistically different (p=0.030). The complications after FNA were pneumothoraces in three cases and parenchymal hemorrhage in one case, but no significant complication was noted after the procedures. CONCLUSION: We could perform the FNA accurately and safely under CT fluoroscopy guidance, so this technique can be used for FNA of focal lung lesion for obtaining a correct result with fewer complications.

A Case of Chylous Mesenteric Cyst in a Neonate / 소아과

Mesenteric cysts are one of the least common intraabdominal lesions, which are very rare in neonates. Among mesenteric cysts, a chylous cyst is the rarest one of all. This entity can be found anywhere in the gastrointestinal tract from the duodenum to the rectum. Mesenteric cysts may be asymptomatic and found on routine examinations, or can present with symptoms such as abdominal pain, palpable mass, abdominal distension and intestinal obstruction. We report a rare case of chylous mesenteric cyst in a neonate, who presented with symptoms of the intestinal obstruction along with the review of the literature.

Wilson-Mikity Syndrome in a Newborn: Findings of Initial and Follow-up High-Resolution CT

Wilson-Mikity Syndrome, a form of chronic lung disease, is rarely developed with the widespread use of mechanical ventilaton. There has always been difficulty distinguishing it from bronchopulmonary dysplasia. The etiology and pathogenesis of this disease are still unknown. There are no reports in Korean literature about high-resolution (HR) CT follow-up of this disease. Diffuse interstitial thickening, which was noted on the initial examination, decreased, but some focal hyperinflations remained on follow-up HRCT. Further studies with HRCT will help to understand the progression of the disease, and will help to develop treatment and management programs.

Positioning of Lumbar Facet Joints by Analysis of Surface Anatomy in Korean Adults

OBJECTIVE: To determine the Korean adult standard of mean length and depth from spinous process which is palpable landmark of back to each facet joint. METHOD: The horizontal line was made between the posterior end of each facet joint, and the rectangular line was made on the horizontal line at the level of spinous process, respectively. We measured the length from the point of intersection to the posterior end of each facet joint (SFL), and the depth from the tip of spinous process to the point of intersection (SFD). All parameters were measured in 30 volunteers (Exp. 1) using computed tomography and in 30 cadavers (Exp. 2). RESULTS: The lower lumbar spine revealed the longer SFL (p0.05). There was no correlation with height and weight, either (r<0.04). CONCLUSION: We measured the standard for SFL and SFD in Korean. We suggest that these results will be useful in clinical practice including blind approach of spinal intervention to the facet joints.

Solitary Juvenile Polyp with Adenomatous Change Presenting as Colonic Intussusception / 대한소화기내시경학회지

Solitary juvenile polyps are the most common benign hamartomatous polyps in childhood presenting with painless rectal bleeding. It is rare in solitary juvenile polyps with adenomatous change which is associated with increased risk for gastrointestinal cancer. We report a rare case of a solitary juvenile polyp with adenomatous change and causing colonic intussussection in a 6 year old girl, who presented symptoms of lower abdominal pain, vomiting, and hematochezia. The colonic intussussception was reduced during the colon barium study and a polypoid round mass shadow at the splenic flexure was formed. On colonoscopy, it was seen as a single huge polyp impacted to the splenic flexure lumen. Endoscopic polypectomy was performed. The histologic evaluation revealed the characteristic features of a juvenile poloyps with adenomatous change.

A Dead Body with Extremely Abnormal Posture / 대한법의학회지

A 38-year-old female dead body was found in extremely abnormal posture on a chair at an inn. The posture of the dead body was in a state of hyperextension and rotation of the head. The postmortem investigation revealed no evidence of homicide or struggle. The external examination showed facial excoriations formed by pressure with wall. The judicial autopsy revealed liquid heart blood, a few petechia on epicardium and congestion of internal organs. Author supposed two ways of possibility that the dead body's posture. One is due to sudden loss of consciousness by acute heart failure. The other is due to slip of both hands from elbowrest of armchair to move his position. The possibility favors the latter to the former. Author reproduced similar posture with the dead body to explain the mechanism of the death. Conclusion was as follows: the death was due to respiratory insufficiency by phrenic nerve damage, compressional damage of cervical vertebrae and pain shock etc.

Functional Investigation with Use of Anorectal Physiology in the Patients with Fecal Incontinence

BACKGROUND: A large amount of attention in anorectal physiologic studies has been devoted to the diagnosis of fecal incontinence. The current study was designed firstly to assess the physiologic characteristics of fecal incontinence and secondly to analyze how the physiologic findings correlate with each other. METHODS: The physiologic findings of 47 patients (24 men and 23 women) were analyzed, retrospectively. Studies included anal manometry (n=38), anal electromyography/pudendal nerve terminal motor latency (PNTML) (n=30), and endoanal ultrasound (n=37). The degrees of continence were estimated by using continence grading scores (CGS) that ranged from 0 to 20 points based on the type and the frequency of incontinence. Control data were obtained from volunteers (n=23). RESULTS: The patients were categorized as having neurogenic (group I, n=25) or myogenic (group II, n=17) incontinence. Despite intensive investigations, unknown etiology was noted in 5 patients (10.4%). The CGS was not different between groups I and II. Pudendal neuropathy was found in 96% of group I and 37.5% of group II patients. Group I showed a higher value of PNTML than that of group II (2.96 1.0 msec vs. 2.07 0.48 msec, p=0.003). The CGS was proportional to the value of the PNTML in group I (r=0.476, p=0.01). However, no correlation was found between the mean PNTML and the CGS in group II. In the manometric parameters, there were no statistical differences between the values of the mean resting pressure (RP), the maximum RP, and the maximum voluntary contraction (MVC) between groups I and II. The MVC was inversely proportional to the CGS in group I (r= 0.616, p=0.02) and in group II (r= 0.664, p=0.02). No correlation was found between the PNTML and the manometric parameters. When we consider the presence of a defect or a scar as an abnormal anal ultrasound finding, such findings were more frequent in group II than in group I (group I, 20% vs. group II, 88%, p<0.001, Fisher's exact test). CONCLUSIONS: The value of the PNTML had relevance to the degree of symptoms in the patients with neurogenic incontinence. Specifically, the squeeze profiles of the manometric parameters were inversely related to the grade of incontinence. No correlation between the PNTML and the manometric parameters could be independently specified based on the etiology. Complementary examination by using the PNTML and anal ultrasound provided the only useful information to discriminate the etiology of incontinence.

Postoperative Changes of Ultrasonographic Pyloric Mass in Infantile Hypertrophic Pyloric Stenosis

BACKGROUND: Infantile hypertrophic pyloric stenosis (IHPS) is a well-recognized cause of vomiting in infancy and is easily cured by a Ramstedt pyloromyotomy. However there have been no reports on the postoperative appearance of a pyloric mass in Korea. METHODS: Twenty infants with IHPS and 20 control infants were studied ultrasonographically during the first year of life at a regular interval. According to examination intervals, the IHPS infants (n=20) were divided into three groups: Group A (3 months, n=6), B (6 months, n=7), and C (12 months, n=7). At each examination, measurements were obtained concerning the length of the pyloric canal and the muscular thickness. RESULTS: The mean preoperative length of the pylorus of the IHPS group was 19.4+/-3.64 mm, ranging from 17 to 30 mm (control: 7.73+/-2.67 mm) (p<0.0001). The mean pyloric muscle thickness of the IHPS group was 5.08+/-0.67 mm, ranging from 3.5 to 6 mm (control: 2.37+/-0.58 mm) (p<0.0001). The preoperative and postoperative measurements were subsequently compared. Postoperatively, the length of the pylorus averaged 22.0+/-2.66 mm, and the muscular thickness was 6.53+/-1.68 mm (p<0.0001). The reduction rates in pyloric length were 23.5%, 46.3%, and 53.4% for the respective groups. Also, the muscle-thickness reduction rates were 31.8%, 48.9%, and 57.8% respectively. At 6 months after the operation, the pyloric muscular thickness was in the normal control range, and the pyloric length was reduced to the normal range after 12 months. CONCLUSIONS: This prospective study suggests that the pyloric mass undergoes a rapid reduction in size in the first 6 months, followed by a more gradual reduction to a normal value by 12 months after a pyloromyotomy.

Effect of Postures on Residual Urine Following Catheterization in Spinal Cord Injured Patients

Intermittent catheterization has reduced the frequency of urinary tract infection(UTI), calculus formation and vesicourethral reflux in spinal cord injured(SCI) patients. Still the residual urine (RU) following catheterization has been suggested as one of the possible causes of UTI. The purpose of this study was to identify the effect of postures on RU following catheterization, for the rehabilitation of neurogenic bladder in SCI patients. The inclusion criteria were: SCI patients with neurogenic bladder; completion of bladder rehabilitation program; good sitting balance and intact hand function. twelve SCI patients fulfilled the criteria and completed ultrasonographic RU measurement in sitting and supine posture following catherterization, respectively. We also studied the frequency of UTI, the functional type of neurogenic bladder and the postures during bladder evacuation at home. All patients had ultrasonographical evidence of RU following catheterizations both in sitting and supine postures. Residual urine volume following catheterization was significantly smaller in sitting posture than in supine posture(p<0.05). Frequency of UTI was significantly lower in the patients who performed catheterizations in sitting posture than in supine posture(p<0.05). In conclusion, bladder training in sitting posture would be better than in supine posture to minimize RU in SCI patients with good sitting balance and intact hand function.

MRI Findings of Cervical Lymphadenopathy: Preliminary Study

PURPOSE: The purpose of this study is to evaluate findings in MRI which maybe useful in differential diagnosis of cervical lymph node enlargement. MATERIALS AND METHODS: We retrospectively analyzed the MRI findings of cervical lymph node enlargement in surgically proven 13 patients. We analyzed the location, size and shape, signal intensity, margin between node and surrounding structures degree and patterns of contrast enhancement RESULTS: No disease specificity in location and size of lymphadenopathy. was demonstrated in MRI. Most lymph nodes shows isointensity or slightly increased signal intensity to adjacent muscle on T1WI and high signal intensity on T2WI. Most of the cases showed contrast enhancement with metastatic lymph nodes showing ring-like and/or patchy enhancement. Tuberculous lymphadenopathy showed homogeneous or rather thick walled ring-like enhancement and one or multiple central nonenhancing portions of eccentrical location in the node. Relatively homogeneous enhancements were noted on reactive lymphold hyperplasia, Lymphoma and Castleman's disease. CONCLUSION: MR imaging was helpful in differentiation of cervical lymph node enlargements. Tuberculous lymphadenopathy showed characteristic findings of rather spherical shaped, thick walled ring enhancement and multiple eccentrically located central nonenhancing portions.