An isolated ventricular abscess is a rare event, and its treatment is a real challenge. We report such case in a 52-year-old man that was successfully managed with aid of occipital approach and ventricular access device. This patient presented with the chief complaint of headache and fever of 3-day duration. Magnetic resonance imaging showed fluid-filled layering within the posterior horns of the lateral ventricle without contrast enhancement. Blood test and cerebrospinal fluid analysis was consistent with acute bacterial ventriculitis. Using stereotactic technique guided by electromagnetic navigation, the occipital horns were bilaterally targeted and catheter-ized, and then the abscess and debris was evacuated. The Ommaya reservoir implanted at the left entry was intermittently punctured for preventing the recollection. The pus culture was positive for Streptococcus pneumoniae . He received an antibiotic therapy and the reservoir aspiration leading to rapid recovery and remission of clinical manifestations. There was no evidence of the recurrence within the ventricles on follow-up scans after discharging. This modification, occipital approach and reservoir placement, is effective treatment for improving the cure rate in the selected cases with intraventricular cerebral empyema.
{"title":"Treatment of Primary Cerebral Ventricular Abscess: Use of Dual Catheters and Ommaya Reservoir","authors":"J. Byun, El Kim","doi":"10.46308/kmj.2023.00080","DOIUrl":"https://doi.org/10.46308/kmj.2023.00080","url":null,"abstract":"An isolated ventricular abscess is a rare event, and its treatment is a real challenge. We report such case in a 52-year-old man that was successfully managed with aid of occipital approach and ventricular access device. This patient presented with the chief complaint of headache and fever of 3-day duration. Magnetic resonance imaging showed fluid-filled layering within the posterior horns of the lateral ventricle without contrast enhancement. Blood test and cerebrospinal fluid analysis was consistent with acute bacterial ventriculitis. Using stereotactic technique guided by electromagnetic navigation, the occipital horns were bilaterally targeted and catheter-ized, and then the abscess and debris was evacuated. The Ommaya reservoir implanted at the left entry was intermittently punctured for preventing the recollection. The pus culture was positive for Streptococcus pneumoniae . He received an antibiotic therapy and the reservoir aspiration leading to rapid recovery and remission of clinical manifestations. There was no evidence of the recurrence within the ventricles on follow-up scans after discharging. This modification, occipital approach and reservoir placement, is effective treatment for improving the cure rate in the selected cases with intraventricular cerebral empyema.","PeriodicalId":166951,"journal":{"name":"Keimyung Medical Journal","volume":"217 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134104839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Meningitis is a rare and potentially serious complication in children with temporal bone fractures. We present an unusual case of a 7-year-old girl with pneumococcal meningitis complicated by cerebrospinal fluid (CSF) leakage following transverse fracture in the left temporal bone. She had an otorrhea resolved spontaneously in the early stage of hospitalization. At 4 days post-discharge, the patient returned with headache, fever, neck stiffness, voiding difficulty, and bilateral abducens nerve palsy. Magnetic resonance images demonstrated an intense uniform contrast enhancement in the cerebral cisterns and the sacral nerve roots. Laboratory analysis and culture diagnosed meningitis caused by Streptococcus pneumonia . She was discharged home after getting intravenous ceftriaxone for 5 weeks. Follow-up for the patient required constant vigilance and included a multidisciplinary approach. At 7 months after head trauma, the child was well with no neurological and auditory deficits. This case illustrates a previously unreported complication in pediatric patient of temporal bone fracture associated with CSF otorrhea.
{"title":"Pneumococcal Cerebrospinal Meningitis: A Rare Complication of Pediatric Temporal Bone Fracture","authors":"J. Byun, El Kim","doi":"10.46308/kmj.2023.00059","DOIUrl":"https://doi.org/10.46308/kmj.2023.00059","url":null,"abstract":"Meningitis is a rare and potentially serious complication in children with temporal bone fractures. We present an unusual case of a 7-year-old girl with pneumococcal meningitis complicated by cerebrospinal fluid (CSF) leakage following transverse fracture in the left temporal bone. She had an otorrhea resolved spontaneously in the early stage of hospitalization. At 4 days post-discharge, the patient returned with headache, fever, neck stiffness, voiding difficulty, and bilateral abducens nerve palsy. Magnetic resonance images demonstrated an intense uniform contrast enhancement in the cerebral cisterns and the sacral nerve roots. Laboratory analysis and culture diagnosed meningitis caused by Streptococcus pneumonia . She was discharged home after getting intravenous ceftriaxone for 5 weeks. Follow-up for the patient required constant vigilance and included a multidisciplinary approach. At 7 months after head trauma, the child was well with no neurological and auditory deficits. This case illustrates a previously unreported complication in pediatric patient of temporal bone fracture associated with CSF otorrhea.","PeriodicalId":166951,"journal":{"name":"Keimyung Medical Journal","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128031472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Subcutaneous panniculitis-like T-cell lymphoma (SPLTCL) which is similar to lobular panniculitis is a subtype of skin lymphoma that is characterized by pleomorphic T cells and benign macrophages. The simultaneous presence of hemophagocytic lymphohistiocytosis (HLH) is the most important and adverse prognostic factor in SPLTCL. SPLTCL is a rare disease with no well-established standard treatment. We report a child with SPLTCL and HLH, who were successfully treated with the modified NHL (non-Hodgkin lymphoma)-BFM(Berlin-Frankfurt-Münster)-90 and HLH-2004 protocols. Patient had persistent fever and subcutaneous masses. SPLT-CL with HLH was diagnosed by immunohistochemistry, radiology and laboratory results. SPLTCL with HLH has shown high mortality when treated with a combination of intensive anticancer drugs. Thus, we first administered dexamethasone and etoposide. After this, when we used the modified protocol of NHL-BFM-90 and HLH-2004, patient showed complete resolution of the subcutaneous masses and features of HLH, except for persistent hyperferritinemia. We tried etanercept to reduce high serum ferritin with some effects. In children with diagnosis of SPLTCL with HLH, initiation of immediate and appropriate treatment affects prognosis. Thus, prompt initiation of the agents that can simultaneously control underlying disease as well as secondary HLH could have lead to successful results.
皮下潘膜炎样T细胞淋巴瘤(SPLTCL)与小叶潘膜炎相似，是一种以多形性T细胞和良性巨噬细胞为特征的皮肤淋巴瘤亚型。同时存在噬血细胞性淋巴组织细胞增多症(HLH)是SPLTCL最重要的不良预后因素。SPLTCL是一种罕见的疾病，没有完善的标准治疗方法。我们报告了一个患有SPLTCL和HLH的儿童，他们成功地接受了改良的NHL(非霍奇金淋巴瘤)-BFM(berlin - frankfurt - m nster)-90和HLH-2004方案的治疗。患者有持续发热和皮下肿块。通过免疫组织化学、放射学和实验室检查诊断SPLT-CL合并HLH。SPLTCL合并HLH在联合强化抗癌药物治疗时显示出高死亡率。因此，我们首先给药地塞米松和依托泊苷。在此之后，当我们使用修改后的NHL-BFM-90和HLH-2004方案时，除了持续的高铁素血症外，患者的皮下肿块和HLH特征完全消退。我们尝试依那西普降低高血清铁蛋白有一定效果。在诊断为SPLTCL合并HLH的儿童中，立即开始适当的治疗会影响预后。因此，及时启动能够同时控制潜在疾病和继发性HLH的药物可能会导致成功的结果。
{"title":"Modifying NHL-BFM-90 and HLH-2004 Protocols for a Child with SPLTCL and HLH; Prompt Initiation of Dexamethasone and Etoposide","authors":"Kwi Han Ko, Minsu Kim, J. Hah","doi":"10.46308/kmj.2023.00073","DOIUrl":"https://doi.org/10.46308/kmj.2023.00073","url":null,"abstract":"Subcutaneous panniculitis-like T-cell lymphoma (SPLTCL) which is similar to lobular panniculitis is a subtype of skin lymphoma that is characterized by pleomorphic T cells and benign macrophages. The simultaneous presence of hemophagocytic lymphohistiocytosis (HLH) is the most important and adverse prognostic factor in SPLTCL. SPLTCL is a rare disease with no well-established standard treatment. We report a child with SPLTCL and HLH, who were successfully treated with the modified NHL (non-Hodgkin lymphoma)-BFM(Berlin-Frankfurt-Münster)-90 and HLH-2004 protocols. Patient had persistent fever and subcutaneous masses. SPLT-CL with HLH was diagnosed by immunohistochemistry, radiology and laboratory results. SPLTCL with HLH has shown high mortality when treated with a combination of intensive anticancer drugs. Thus, we first administered dexamethasone and etoposide. After this, when we used the modified protocol of NHL-BFM-90 and HLH-2004, patient showed complete resolution of the subcutaneous masses and features of HLH, except for persistent hyperferritinemia. We tried etanercept to reduce high serum ferritin with some effects. In children with diagnosis of SPLTCL with HLH, initiation of immediate and appropriate treatment affects prognosis. Thus, prompt initiation of the agents that can simultaneously control underlying disease as well as secondary HLH could have lead to successful results.","PeriodicalId":166951,"journal":{"name":"Keimyung Medical Journal","volume":"249 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115633930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Medical Humanities Course Development Experience in Medical School","authors":"Seon-Kyoung Kim, J. Bae, Jae-Ho Lee","doi":"10.46308/kmj.2023.00045","DOIUrl":"https://doi.org/10.46308/kmj.2023.00045","url":null,"abstract":"","PeriodicalId":166951,"journal":{"name":"Keimyung Medical Journal","volume":"83 3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121214797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
B. Youn, Seongwan Hong, Dae-Wook Kim, J. Ha, Insung Chung
{"title":"Characteristics of Pulmonary Nodules in Current Smoker","authors":"B. Youn, Seongwan Hong, Dae-Wook Kim, J. Ha, Insung Chung","doi":"10.46308/kmj.2023.00066","DOIUrl":"https://doi.org/10.46308/kmj.2023.00066","url":null,"abstract":"","PeriodicalId":166951,"journal":{"name":"Keimyung Medical Journal","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127973356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Hemodynamic Improvement after Surgical Intervention for Pannus in Prosthetic Mitral Valve","authors":"Kyung-Suk Song, Y. Kim, W. Jang","doi":"10.46308/kmj.2023.00038","DOIUrl":"https://doi.org/10.46308/kmj.2023.00038","url":null,"abstract":"","PeriodicalId":166951,"journal":{"name":"Keimyung Medical Journal","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117032199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Initial Experiences of Left Bundle Branch Area Pacing in Daegu, South Korea – New Procedure with Familiar Tools","authors":"","doi":"10.46308/kmj.2023.00052","DOIUrl":"https://doi.org/10.46308/kmj.2023.00052","url":null,"abstract":"","PeriodicalId":166951,"journal":{"name":"Keimyung Medical Journal","volume":"604 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126755633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Radiofrequency thermocoagulation (RFT) via trans-oval approach is effective treat-ment modalities for trigeminal neuralgia. Clear identification of the foramen ovale (FO) is the most important initial step for successful percutaneous procedures. The purpose of this study was to verify whether the medial end of the temporomandibular joint and the distance between the mandibular angle and the occipital inner line can be used as a fluoroscopic landmark to determine the proper angulation of the C-arm. Analysis of previously saved fluoroscopic FO images during RFT was performed. As a fluoroscopic landmark to guide a proper lateral and axial oblique rotation of the C-arm, the position of the medial end of the temporomandibular joint and the vertical distance between the mandibular angle and the occipital inner line were evaluated. When the FO was located at the most central point within the H-fig-ure, the medial end of TMJ was always located within the mandibular notch. The maximum view of the FO was defined when the FO showed maximal short axis to long axis ratio. The FO showed the best view when the vertical distance between the mandibular angle and occipital inner line was 20.04 (5.1) mm. This study demonstrated that the medial end of the temporomandibular joint and the vertical distance between the mandibular angle and occipital inner line as a fluoroscopic landmark for obtaining the optimal view of the FO.
{"title":"Fluoroscopic Landmark to Optimize the View of the Foramen Ovale Using the Neighboring Structure","authors":"Ji-Hee Hong, Se Nyung Huh, Ki Beom Park","doi":"10.46308/kmj.2023.00024","DOIUrl":"https://doi.org/10.46308/kmj.2023.00024","url":null,"abstract":"Radiofrequency thermocoagulation (RFT) via trans-oval approach is effective treat-ment modalities for trigeminal neuralgia. Clear identification of the foramen ovale (FO) is the most important initial step for successful percutaneous procedures. The purpose of this study was to verify whether the medial end of the temporomandibular joint and the distance between the mandibular angle and the occipital inner line can be used as a fluoroscopic landmark to determine the proper angulation of the C-arm. Analysis of previously saved fluoroscopic FO images during RFT was performed. As a fluoroscopic landmark to guide a proper lateral and axial oblique rotation of the C-arm, the position of the medial end of the temporomandibular joint and the vertical distance between the mandibular angle and the occipital inner line were evaluated. When the FO was located at the most central point within the H-fig-ure, the medial end of TMJ was always located within the mandibular notch. The maximum view of the FO was defined when the FO showed maximal short axis to long axis ratio. The FO showed the best view when the vertical distance between the mandibular angle and occipital inner line was 20.04 (5.1) mm. This study demonstrated that the medial end of the temporomandibular joint and the vertical distance between the mandibular angle and occipital inner line as a fluoroscopic landmark for obtaining the optimal view of the FO.","PeriodicalId":166951,"journal":{"name":"Keimyung Medical Journal","volume":"93 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121120321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Trajectory of Loneliness among Adolescent Game Players","authors":"","doi":"10.46308/kmj.2022.00185","DOIUrl":"https://doi.org/10.46308/kmj.2022.00185","url":null,"abstract":"","PeriodicalId":166951,"journal":{"name":"Keimyung Medical Journal","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125220852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Effect of Intravitreal Bevacizumab Injection in Wet Age-Related Macular Degeneration Patients with Cataract Surgery","authors":"J. An, Y. Kim, K. T. Kang","doi":"10.46308/kmj.2022.00234","DOIUrl":"https://doi.org/10.46308/kmj.2022.00234","url":null,"abstract":"","PeriodicalId":166951,"journal":{"name":"Keimyung Medical Journal","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133763526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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