Prognostic Factors of Invasive Fungal Sinusitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Fulminant invasive fungal sinusitis (IFS) is an aggressive, destructive disease most commonly affecting the immunocompromised hosts. This study aimed to investigate the clinical features of invasive fungal sinusitis and to determine its prognostic factors. MATERIALS AND METHOD: Fifteen cases of invasive fungal sinusitis were retrospectively reviewed. Prognosis was analyzed according to predisposing factors including the underlying disease, the extent of disease, the mycotic species, and treatment modalities. RESULTS: Overall 5-year survival rate of the patients with IFS was 60%. There was significant survival gain in the group for which underlying disease was well controlled (p=0.04). There was no difference in survival in terms of mycotic species and extent of disease at presentation. No statistically significant difference in survival was observed between the conservative surgery and the radical surgery group. CONCLUSION: Survival is usually determined at the very early period of treatment. The most important prognostic factor is not the surgical modalities including wide surgical resection or conservative debridement, but the optimal control of underlying disease.

A Case of Orbital Cavernous Hemangioma with Multiple Intra c ranial Lesions

Cavernous hemangioma is the most common primary orbital tumor in adults. This tumor is usually unilateral and single.The authors experienced a young male patient who complained of postural variations of proptosis and was diagnosed as an orbital cavernous hemangioma associated multiple intracranial lesions. The diagnosis was based on histopathological examination and various radiologic studies including computed tomography (CT), magnetic resonance imaging (MRI), and single photon emission computed tomography (SPECT). So we report a rare case of cavernous hemangioma which occurred multiplly with a brief review of the literature.

Nontraumatic Cerebrospinal Fluid Rhinorrhea(via the Middle Cranial Fossa and Sphenoid Sinus): A Case Report

We describe a rare case of nontraumatic normal pressure cerebrospinal fluid rhinorrhea. A 33-year-old male was admitted to our hospital due to continuous rhinorrhea but without a history of specific trauma. We performed various radiological evaluations, and on bone-window CT, detected severe bilateral extension of the sphenoid sinus into the greater wing. MRI and CT cisternography revealed that contrast media and cerebrospinal fluid had leaked from the middle cranial fossa to the sphenoid sinus. Transethmoidal sphenoid approach and sphenoid sinus fat obliteration was successfully performed by an otolaryngologist. On postoperative day 2, however, the patient's mental condition deteriorated and CT showed the development of acute obstructive hydrocephalus. Ventriculo-peritoneal shunt was then successfully performed and the patient was discharged. Nontraumatic normal pressure cerebrospinal fluid rhinorrhea involving leakage through the middle cranial fossa is very rare, this report discussed the etiological, anatomical and surgical considerations of this case.

Osseous Choristoma within an Epibulbar Complex Choristoma

Episcleral osseous choristoma is a rare isolated bony nodule occurring in the conjunctival or episcleral connective tissue in eyes which are otherwise normal. They are present at birth. This congenital lesion is usually about the size of a pea and typically located in the superotemporal quadrant, some 5 to 10mm from the limbus. Of the 40 reported cases in the literature, none had associated ocular abnormalities. The diagnosis has seldom been suspected preoperatively. Our patient was 3-month-old healthy male baby. For the cosmetic purpose, we had done excisional biopsy. In the histopathologic study, the mass was a dermoid covered with skin and contained fat, hair follicle and osseous tissue at its center. The mass was confirmed to be a complex choristoma, especially osseous choristoma. We report this case because of the rarity of osseous chroistomas combined with complex choristoma.

Evaluation of Extraocular Muscle Contractibility after Recession and resection by EMG in Rabbit

For evaluating the change of strength of extraocular muscle after strabismus surgery, ten rabbits had been performed resection of lateral rectus muscle in right eye and recession of lateral rectus muscle in left eye, and then performed EMG(electromyography). We performed EMG before surgery, at immediate post-op,after 1 day,1,2,3,4,6,8 weeks. In case of resection of lateral rectus muscle, EMG value increased at immediate post-op then stabilized after 6 weeks. In case of recession of lateral rectus muscle, EMG value decreased at immediate post-op, then stabo; ozed after 6 weeks. Therefore, EMG is the useful method in evaluating the change of strength of EOM. Especially, during 6 weeks after surgery is the important peeriod for follow-up.

A Clinical Study on the Incompetent Internal Os of the Cervix / 대한주산의학회잡지

This study was undertaken for the clinical analysis and evaluation on 121 patients with incompetent internal os of the cervix, who were admitted and treated with McDonald operation or Shirodkar operation at the Soonchounhyang Medical Center from January 1991 to December 1995. The results of this study were as follows : 1. The incidence of this IIOC was 1.1% of 11,116 cases of total delivery. 2. The mean age of IIOC was 31.7 years old. 3. The average number of gravida was 3.2. 4. The most common contributary factor was previous history of artificial abortion (51.2 %), and midtrimester abortion (17.4 %), cervical laceration due to previous vaginal delivery (8.3 %) etc. was followed. 5. The success rate of operation was 76 %, and the highest success rate (85.7 %) was reveald with period from 15th weeks to 16th weeks of gestation. 6. When cervical dilatation was abscent or small, the success rate of operation was high. 7. The factors of failed operation were preterm labor (58.7 %), PROM (34.5 %), and PIH, bleeding. 8. The delivery method after operation was vaginal delivery in 83 cases (68.6%) and cesarean section in 38 cases (31.4 %).

A Case of the Development of Acute Lymphocytic Leukemia druing Pregnancy / 대한주산의학회잡지

The development of leukemia during pregnancy is rare and difficult to diagnosis and treatment. Acute leukemias are among the most common malignant neoplasms of young women, but paradoxically, their incidence complicating pregnancy is cited to be 0.9 to 1.2 cases per 100,000. l'he signs and symptoms of acut:e leukemia may mask the signs and symptoms of early pregnancy. 'I'he occurrence of acute leukemia during pregnancy raises many therapeut,ic and ethical dilemmas because of the potential tetatogenic effects of chemotherapy and the danger of fetal wastage, in addition to the well-known problem of marrow suppression in the mother. We experienced a case where diagnosis of a woman at the 15 gestational weeks revealed acute lymphocytic leukemia and immediate treatment. as well as termination of pregnancy was made to prevent abnormal neonatal birth. We present this case with review of related literatures.

MRI Findings of Miliary Tuberculosis of the Brain

PURPOSE: To evaluate MRI(Magnetic Resonance Imaging) findings of miliary tuberculosis of the brain. MATERIALS AND METHODS: Six patients with miliary tuberculosis of the brain diagnosed by characteristic clinical or laboratory findings were studied with spin echo MRI before and after contrast enhancement. We retrospectively evaluated MRI findings acording to the appearance, distribution, location, and enhancement pattern of the granulomas as well as associated other abnormalities. RESULTS: In six patients, contrast-enhanced MRI of thebrain showed numerous punctate, contrast enhancing lesions scattered throughout the brain. Unenhanced MRI failed to demonstrate small granulomas except a few small foci of high signal intensity on T2-weighted images. The shapes of enhancing granulomas were homogeneous nodular enhancement in 86% of cases and small ring enhancement in 14%.98% of granulomas were smaller than 3-mm and 2% were larger. Although several lesions were located in the basalganglia, thalamus, and brain stem, the majority were located in the subpial and subarachnoid space. There was no significant difference in distribution of granulomas between the supratentorial and the infratentorial areas. Other associated abnormalities were focal meningitis in five cases and focal cerebritis in one. On chest radiograph, all patients had miliary tuberculosis in the lungs. CONCLUSION: Contrast-enhanced T1-weighted MRimaging showed numerous round, very small enhancing lesions scattered throughout the brain. The majority of lesions were located in the subpial and subarachnoid space. Contrast-enhanced T1-weighted images are helpful inthe detection and diagnosis of miliary disseminated tuberculous granulomas and meningitis.

A study of the relationship between health risk factors and family function

No abstract available.

Vitamin K-Deficient Hemorrhagic Disease in Infants with Acute Subdural Hematoma

We had experienced 2 cases of acute subdural hematoma due to vitaimin K(vit. K) deficiency. They were 44-and 42-day-old. After the adminstration of vit.K1, prolonged prothrombin time(PT) and activated partial thromboplastin time(APTT) were corrected, so the surgical treatment ws performed. We supposed the predisposing factors were breast feeding and unknown hepatic pathology. No complication remained to one infant but the other multiple cerebral infarctions. The etiology, pathogenesis, diagnosis, prevention are discussed. We insist on neonatal administration of vit. K1 for the prevention of bleeding tendency. If intracranial hemorrhage develops, we must keep in mind that the early neurosurgical intervention may be needed.

A Subgaleal Hematoma Accompanying Exophthalmos

A case of subgaleal hematoma accompanying ipsilateral exophthalmos is reported. The exophthalmos is due to orbital extension of subgaleal hematoma through potential gap between orbital septum and the lateral horn of the levator palpebral aponeurosis. We must remember that exophthalmos is able to occur after subgaleal hematoma.

Effect of Nicardipine on Pressor Response to Raised Intracranial Pressure and alpha-Adrenoceptor Agonist

The effect of nicardipine was investigated on hypertension due to raised intracranial pressure, pressor response of alpha-adrenoceptor agonists in the dissected thoracic aorta. Intracerebroventricular(icv) and intravenous(iv) nicardipine produced dose-dependent depressor response and bradycardiac effect, especially marked response was observed following iv injection. The pressor response to raised intracranial pressures was potentiated following iv injection of 50 microgram/kg nicardipine but was markedly inhibited following iv 100 microgram/kg injection, and was not affected following icv 50 microgram/kg administration but was markedly inhibited following icv administration of 100-200 microgram/kg nicardipine. The nicardipine inhibited contractile effect of KCI 35 mM in a dose-dependent fashion but did not affect that of Ne and ME. These data suggest that nicardipine caused hypotensive effect by blocking calcium influx in the peripheral vessels and that direct effect of nicardipine on central nervous system involves the hypotensive action. Conclusively, the inhibitory effect of nicardipine on the pressor response to the intracranial pressure elevation may be induced by these two mechanisms.

Intracerebral Hemorrhage in Newborn Infants Secondary to Vitamin K Deficiency

Intracerebral hemorrhage secondary to vitamin K deficiency is presented in three newborn infants: 4 days, 28 days and 21 days of age respectively. After the administration of vitamin K(5-10 mg) either intravenously or intramusculary, prolonged prothrombin time(PT) and partial thromboplastin time(PTT) were corrected promptly. Vitamin K dependent coagulation factor deficiency due to vitamin K deficiency is accounted for the pathogenesis of hemorrhage. The possible causes of vitamin K deficiency, diagnostic methods and treatment of this disease entity are reviewed. Neurosurgeons as well as pediatricians should remain alert for the development of intracerebral hemorrhage caused by vitamin K deficiency in neonatal period.