Pulmonary paragonimiasis mimicking lung cancer in a tertiary referral centre in Korea.

OBJECTIVE AND DESIGN: To determine how pulmonary paragonimiasis may be confused with lung cancer, we retrospectively analysed the clinical and radiological characteristics of 47 patients (27 males, median age 55 years; interquartile range 49-61) with serologically or histopathologically confirmed pulmonary paragonimiasis seen between October 2004 and December 2009. RESULTS: Respiratory symptoms were present in 29 (62%) patients; the remaining 18 (38%) were asymptomatic. Chest radiography (CXR) revealed intrapulmonary parenchymal lesions (n = 35, 75%) more frequently than pleural lesions (n = 11, 23%). Of the 47 patients, 28 (60%) were referred for suspected lung cancer. The majority of these patients had no symptoms, and 22 (79%) patients with suspected lung cancer had nodular or mass lesions on CXR. As a result, additional diagnostic procedures were performed to make an accurate diagnosis in these patients, including bronchoscopy in 20, transthoracic lung biopsy in 11 and fluorodeoxyglucose positron emission tomography in seven. Surgical lung resection was performed unnecessarily in six patients. CONCLUSIONS: Pulmonary paragonimiasis presenting with nodular or mass lesions on CXR is common. Clinicians should therefore include pulmonary paragonimiasis in the differential diagnosis of asymptomatic nodular lesions in the lung in patients who have lived in or travelled to paragonimiasis-endemic areas.

Combined direct and indirect reconstructive vascular surgery on the fronto-parieto-occipital region in moyamoya disease.

Between January 1992 and December 1995, eight patients with Moyamoya disease, aged from 2 to 39 years, underwent encephalo-duro-arterio-myo-synangiosis (EDAMS) on the frontal region, superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis combined with encephalo-myo-synangiosis (EMS) on the parietal region and encephaloduro-arterio-synangiosis (EDAS) on the occipital region using the frontal and parietal branch of the STA and the occipital artery, respectively. The development of postoperative collateral formation was assessed by carotid angiography and the improvement of clinical symptoms was evaluated for over 1 year after the bypass surgery. Of the 13 sides which underwent EDAMS and STA-MCA anastomosis with EMS, 11 sides resulted in extensive revascularization on the frontoparietal region and two sides showed localized collaterals, whereas EDAS on the occipital region demonstrated extensive and localized revascularization in each four sides and no evidence of revascularization in two sides among ten sides which underwent the EDAS. The clinical improvement due to the combined reconstructive surgery was very excellent in the reduction of the incidence of transient ischemic attacks (TIA) and reversible ischemic neurologic deficits (RIND).

Adrenal medullary transplantation for Parkinson's disease.

Autotransplantation of adrenal medullary tissue to the right caudate nucleus was performed in 8 patients (6 men and 2 women) with Parkinson's disease demonstrating mainly rigidity and bradykinesia. Their mean age was 52 years. The mean duration of Parkinson's disease was 7 years. Left adrenalectomy and open craniotomy were done to implant medullary tissue into the right caudate nucleus. The 6-month clinical findings were evaluated. 5 cases showed improvement, 2 cases remained unchanged and 1 was worse. There was no operative mortality, but 1 patient developed right frontal infarction postoperatively and 2 patients demonstrated subdural hygroma.

Intraventricular or epidural injection of morphine for severe pain.

Intraventricular or epidural injection of morphine through implantable infusion devices was used for severe pain in 50 patients with advanced cancer, arachnoiditis, or spinal injury. Intraventricular catheter was inserted for injection of morphine in 21 patients, 29 were treated through epidural infusion. For the evaluation of results the multimodal evoked potential (MEP) has been obtained before and after each treatment. 80% of the patients experienced good results. No significant side effects have been noted in patients with either epidural or intraventricular injection of morphine. These may be excellent methods for pain control in well selected patients.

Traumatic isolated intracerebral hemorrhage in children.

Among 314 children with craniocerebral injury, 21 were diagnosed as having traumatic, isolated intracerebral hemorrhage (TIICH) by computed tomography (CT) from 1980 to 1986 (basal ganglia, 7; frontal, 8; parietal, 2; frontoparietal, 1; temporoparietal, 1; intraventricular, 1; midbrain, 1). The level of consciousness was assessed according to the Children's Coma Score (CCS) and CT scan was subsequently repeated to evaluate the change in TIICH. The patients were classified into three types according to their clinical courses and CT findings: type I (4 cases), type II (14 cases), and type III (3 cases). Of the 21 cases, conservative treatment was given in 15 and surgical treatment in 6. The outcome showed: good recovery in 1, fair recovery in 7, poor recovery in 2, and death in 2. Type III had a poor prognosis. We discuss the mechanism of the formation of TIICH and speculate that impact to the head caused shear strain in the small perforating vessels and at the junction between white and gray matter which, in turn, caused vascular rupture.

Results of the management of craniopharyngioma in children. An endocrinological approach to the treatment.

The treatment results of 21 (1972-1982) patients with craniopharyngioma are reported who were treated either by surgery alone or by surgery and radiation therapy. The authors reviewed 14 patients (67%) who were less than 18 years of age at the time of surgery. The eradication was thought to be total in 7 children and subtotal in 7. Radiation was given as part of the initial therapy to 5 children after total excision and to 3 after subtotal removal. There were 2 postoperative deaths. All of the children suffered postoperative hormonal deficiencies. The results of this study indicate that total and subtotal removal followed by RT is an acceptable treatment for craniopharyngioma. Endocrine-deficient children, if treated properly, do well in terms of survival.

Effects of tethering on regional spinal cord blood flow and sensory-evoked potentials in growing cats.

The spinal cords of 2-week-old kittens were tethered by fixing the end of the filum terminale to the lower sacrum, to study the effects of tethering and untethering on regional spinal cord blood flow (rSCBF), sensory-evoked potentials (SEPs) and clinical features. Progressive sensorimotor deficits and incontinence were observed in all the tethered cats. Cord tethering induced a reduction of rSCBF in the distal spinal cord close to the tethering (L3) by 32% of the normal flow 2 weeks after tethering and by 67% 10 weeks after tethering. Untethering of the cord resulted in an increase of rSCBF, restoring it to the normal level in the group untethered 2 weeks after tethering, but rSCBF did not increase in the group untethered 8 weeks after tethering. The changes in SEPs were observed whenever rSCBF was below 14 ml/100 g per minute. Suppression of the early components of SEPs was observed 2 weeks after tethering and the components were progressively altered in amplitude and latency during the experimental period. It is assumed that early untethering can improve the spinal cord blood flow as well as the function of the cord.