Diagnosis of tuberculous meningitis by detection of immunoglobulin G antibodies to purified protein derivative and lipoarabinomannan antigen in cerebrospinal fluid

Enzyme-linked immunosorbent assay of immunoglobulin G (IgG) activity in cerebrospinal fluid (CSF) and sera was conducted prospectively in 27 patients with tuberculous meningitis (TBM) by using purified protein derivative (PPD) and lipoarabinomannan (LAM) antigens, from January 1989 to August 1990. 29 patients with aseptic meningitis and 49 patients with non-inflammatory neurological illnesses served as controls. All patients had a computed tomography (CT) scan of the head before a lumbar puncture. The IgG antibodies to the antigens were significantly elevated in TBM, and the reactivity was more frequently positive in the CSF than in the sera, suggesting a local synthesis of IgG in the central nervous system (CNS). The sensitivity and the specificity for the diagnosis of TBM were 59.2% and 93.9% for PPD antigen, and 85.2% and 95.9% for LAM antigen, respectively. Assay of IgG reactivity to LAM antigen was clinically very useful for the early diagnosis of TBM and was superior to PPD for detecting the serological evidence of TBM.

[Identification of enterotoxin-producing Clostridium perfringens by the polymerase chain reaction]

Polymerase chain reaction was applied to identify enterotoxin-producing Clostridium perfringens by amplifying a segment of the C. perfringens enterotoxin gene. All of the four enterotoxin-positive reference strains tested were PCR positive while an enterotoxin-negative strain was PCR positive. All 17 clostridial strains (16 species) other than C. perfringens were PCR negative. With clinical strains isolated from various clinical specimens in Japan, Korea, and Thailand, all three enterotoxin-positive isolates were PCR positive and all 82 enterotoxin-negative isolates were PCR negative. PCR results for amplifying a region containing the initiation codon of the C. perfringens enterotoxin gene also demonstrated complete agreement with enterotoxin producibility. These results suggested that the PCR assay is a rapid and simple test for identifying the enterotoxin-producing C. perfringens without using any cultures and spore treatments.

The attenuation effect in brain SPECT

False perfusion defects simulating Alzheimer's disease can be attributed to skull thickness and head holders of a SPECT scan table. Brain phantom SPECT was performed using a different type of head holder in order to evaluate the effect of attenuation due to head holders and skull thickness on brain SPECT. Skull thickness was measured in 10 normal or non-Alzheimer's patients and 10 patients with suspected Alzheimer's disease. Visual and quantitative analysis of regional perfusion showed a 19% count loss due to attenuation by commercially available head holders and average skull thickness, less than 18% count difference between frontal-temporal and parietal-occipital skull in non-Alzheimer's disease patients, and more than 22% count difference observed in suspected Alzheimer's patients.

The expression of p53 antigen in primary malignant epithelial tumors of the liver: an immunohistochemical study

We examined the expression of mutant p53 gene products in primary malignant epithelial tumors of the liver. Fourteen of 68 hepatocellular carcinomas, one of seven hepatoblastomas and one of nine intrahepatic cholangiocarcinomas showed nuclear staining for p53 proteins. None of the surrounding non-tumorous tissues expressed nuclear staining. The detection of p53 proteins in tumor cells was significantly higher in hepatocellular carcinomas of Oriental patients (31.6%) compared to non-Orientals (6.7%, p < 0.015). No significant differences were seen in p53 antigen expression between hepatitis B and non-hepatitis B associated hepatocellular carcinomas in Oriental patients. These results suggest a role for other environmental factors, such as aflatoxin, in the etiology of p53 mutation in hepatocellular carcinoma in Oriental patients.

Distribution of HLA class I alleles and haplotypes in Korean

The antigen (phenotype), gene (allele) and haplotype frequencies of HLA class I were analysed in 4,622 Koreans. With allele frequencies of over 0.05, the most frequent HLA-A,-B and -C antigens were A2, A24, A33, A11, A26, A31; B62, B51, B44, B54, B61, B35, B58, B60; Cw3, Cw1, Cw4, Cw7. Of these A2, A24, Cw1 and Cw3 were present in very high frequencies, respectively (0.3211, 0.2200, 0.2204, and 0.3737). The most common haplotypes with frequencies larger than 0.02 were A2-Blank, A33-B44, A33-B58, A11-B62, A24-B51, A24-B54, A2-B27, B54-Cw1, B58-Cw3, B51-Blank, B61-Cw3, B62-Cw4, B35-Cw3, B44-Blank, B60-Cw3, B27-Cw1, A2-Cw3, A2-Cw1, A24-Cw1, A33-Cw3, A26-Cw3, and A11-Cw4. A significant negative linkage disequilibrium was found for the haplotypes of A2-B7, A2-B44, A2-B58, A24-B13, A24-B27, A33-B54 and A33-B62, of which frequencies were larger than 0.003. The B-C and A-C haplotypes which showed the significant negative linkage disequilibrium were B44-Cw1, B51-Cw1, B44-Cw3,B62-Blank, A2-Cw4, A2-Blank, A11-Cw3, A11-Blank and A33-Cw1 and had frequencies higher than 0.01. The findings presented here could be used per se to estimate the populational relationships or as the control data for HLA-disease investigation. Furthermore they could provide the scope for the definition of new antigens.

Brain SPECT in a patient with post-stroke hallucination

A patient developed visual hallucinations following a left-sided cerebrovascular accident (CVA). Brain SPECT using Tc-99m HMPAO demonstrated increased perfusion at the biparieto-occipital lobes. Following antiepileptic medication, repeat brain SPECT showed interval decrease in perfusion in the same areas with the symptomatic relief of hallucinatory episode. While it is possible that the interval decrease is due to natural resolution, the authors believe that it is likely due to drug treatment.

Scintigraphic recognition of papillary muscles and papillary muscle ischemia

During stress thallium imaging, papillary muscles (anterolateral and posteromedial) appear scintigraphically as focal regions of enhanced activity in sites corresponding to their anatomic position. In the normal case, enhancement after exercise is greater than or equal to enhancement at rest. With papillary muscle ischemia, the involved papillary muscle demonstrates more enhanced activity at rest than at postexercise. This pattern change with papillary muscle ischemia was observed in four patients. Three cases demonstrated complete reversal of those ischemic changes after angioplasty and the remaining case failed to show any significant improvement after angioplasty.

Clinical, laboratory, and scintigraphic manifestations of subacute and chronic thyroiditis

The term "thyroiditis" refers to several syndromes of differing etiology. Chronic or Hashimoto's thyroiditis (HT), an autoimmune disorder that is manifested by goiter and hypothyroidism, is by far the most common of these syndromes. Subacute thyroiditis (SAT) encompasses two distinct syndromes: subacute granulomatous thyroiditis (SAGT) and subacute lymphocytic thyroiditis (SLT). SAGT is viral in origin and usually presents with neck tenderness and hyperthyroid symptoms, while SLT, which is likely to be an autoimmune entity, results in goiter and transient hyperthyroidism. SLT is often seen in the postpartum period and is referred to as postpartum thyroiditis (PPT). Less common forms of thyroiditis include Riedel's struma, which is characterized by extensive fibrosis of the thyroid gland, and acute suppurative thyroiditis, which is a bacterial infection. Twenty patients with goiter were evaluated by thyroid scintigraphy. They were ultimately diagnosed as having either HT (14), SAGT (3), SLT (1), or PPT (2). Their scan findings were correlated with both clinical presentations as well as in vitro laboratory analysis.

Serum antibody response elicited by a casein diet is directed to only limited determinants of alpha s1-casein

Feeding mice with bovine whole casein as a diet constituent elicited an anti-alpha s1-casein (alpha s1-CN) systemic humoral response. The mice fed with the casein (CN) diet responded poorly to subsequent parenteral immunization with the antigen, indicating that oral tolerance was induced in the animals. The serum antibodies elicited by feeding CN were tested for binding to a panel of synthetic peptides and are shown to recognize only a limited number of potential antigenic determinants on alpha s1-CN. Our results suggest that a similar mechanism may be involved in the onset of milk allergy.

Tc-99m DTPA diffuse pulmonary uptake in patients with coronary artery disease and renal insufficiency

Diffuse bilateral lung uptake was observed in 10 patients undergoing Tc-99m DTPA renal scanning, referred for the evaluation of rising serum creatinine levels. All 10 patients demonstrated renal insufficiency (RI) as shown by both decreased bilateral renal tracer concentration and elevated background activity. Nine of the patients were known to have coronary artery disease (CAD) and six of these nine patients were in congestive heart failure (CHF), at or around the time of scanning. However, Tc-99m DTPA lung uptake was not observed in five other patients whose scans demonstrated RI, in whom there was no CAD or other cardiac disease. Diffuse lung uptake of Tc-99m DTPA in patients with RI therefore is highly suggestive of cardiac dysfunction (i.e. CAD and/or CHF).

Surgical treatment of periampullary cancer--review of 766 surgical experiences of 8 hospitals

The incidence of periampullary cancer has been steadily rising in Korea. In the present study, we have reviewed 766 cases of surgically treated periampullary cancers, including 122 cases of our own, which were published in the Korean literature from 1984 to 1992. The 6th decade was the most prevalent age group, occupying 38% of the patients. The ratio of male of female was 1.7 to 1. Approximately 60% of lesion located at the head of the pancreas. Computed tomography which had 85% sensitivity was the most commonly employed modality for a diagnosis. The diagnostic sensitivity of percutaneous transhepatic cholangiography was 72%, of endoscopic retrograde cholangiopancreatography was 71%, and of ultrasonography was 54% in order of frequency. Tumor markers such as CA-19, CEA, and CA-125 were also studied in pancreatic cancer. The combinations of these markers recorded a higher positivity than using solely. The resection rate for lesions at the head of the pancreas was 21%, and that of distal common bile duct, ampulla of vater, and duodenum were 37%, 85%, and 50%, respectively. The morbidity and mortality rates after pancreatoduodenectomy were 44% and 12%, respectively. TNM staging revealed 66% of patients were in stage III, 26% in stage I, and 8% in stage II. The actual 5-year survival rates for cancer of the head of the pancreas was 11%, and that of duodenal cancer, distal choledochal cancer, and ampullary cancer were 21%, 18%, and 15%, respectively. In nonresected group, none survived over 18 months after treatment. Relatively high portion of lymph node metastatic patients may explain the poor survival observed in our series.

Diabetic nephropathy: duplex Doppler ultrasound findings

To evaluate the correlations among Doppler sonographic findings, morphologic sonographic findings, and laboratory findings representing renal functional status, duplex Doppler sonography of the kidney was performed in 32 patients with diabetes mellitus. Resistive indices obtained in the region of the arcuate or the interlobar arteries in patients with elevated serum creatinine levels were significantly higher than those in patients with normal serum creatinine levels (P < 0.05). Also, there was a significant correlation between the resistive indices and creatinine clearance levels (correlation coefficient, -0.828). There was a significant difference between the serum creatinine levels of patients with normal renal cortical echogenicity and those with increased cortical echogenicity (P < 0.05). Analysis of the Doppler spectrum of the intrarenal arteries in conjunction with careful evaluation of the renal cortical echogenicity may be helpful in sonographic prediction of the renal functional status in patients with diabetes mellitus.

Reverse crossed cerebellar diaschisis in partial complex seizures related to herpes simplex encephalitis

Tc-99m HMPAO brain SPECT was performed in a patient who had partial complex seizures for 1 year after successful acyclovir treatment of biopsy-proven herpes simplex encephalitis 2 years earlier. In spite of antiepileptic medications, her seizures were intractable and occurred daily. Tc-99m HMPAO was administered intravenously while she was having subclinical seizures, and brain SPECT demonstrated an area of hyperperfusion in the right temporal lobe medially and in the contralateral cerebellum. This reverse of the crossed cerebellar diaschisis phenomenon in epileptic disorders has not previously been documented.

Dual isotope SPECT in the evaluation of recurrent brain tumor

Dual isotope brain SPECT was performed in a patient with recurrent brain tumor (grade II astrocytoma). In this case, a good coregistration of brain perfusion and tumor images was obtained because Tc-99m HMPAO and the Tl-201 chloride imaging were done simultaneously using a Triad SPECT unit. This method might play an important clinical role in the evaluation of patients with recurrent brain tumors.

Nonpustular psoriatic lesions detected by Tc-99m HMPAO labeled granulocytes

A patient with a fever of unknown origin was evaluated by abdominal SPECT using Tc-99m HMPAO labeled granulocytes and a triple detector camera. Although no abscesses were located, nonpustular psoriatic skin lesions were demonstrated incidentally on the reprojectional images. Psoriatic scales contain a chemotactic factor for leukocytes, and this is a likely explanation for the increased uptake of the radiotracer by psoriatic lesions.

Present status of periampullary cancer treatment in Korea

The incidence of periampullary cancer has been steadily risen in Korea. In the present study, we have reviewed 766 cases of surgically treated periampullary cancers, including 122 cases of our own, that were published in the Korean literatures in last ten years. The 6th decade was the most common age group, occupying 37.9% of the patients. Male to female, ratio was 1.7 to 1. C-T scan was the principal modality available for diagnosis and preoperative staging, and recorded 84% of diagnostic accuracy. The accuracy rate of PTC was 72%, ERCP of 68%, and USG of 51%, in order of frequency. For the screening of pancreatic cancer, diagnostic serologic test using serum markers such as CA 19-9, CEA, CA 125, and various combinations were studied. The combinations of these markers recorded higher positivity. Overall resectability was 36.2%. Preoperative C-T scan with antigraphy correlated with better discrimination of the resectable lesion preoperatively than C-T scan alone was performed (63% VS 46%). The morbidity and mortality after pancreaticoduodenectomy were 46% and 13.2%, and 1, 3, and 5-year survival rates after the resection were 68, 25, and 15%, respectively. In non-resected group, none survived at 18 months after treatment. To improve resectability; early detection, precise preoperative staging, and improved surgical approach are imperative. Future studies will be necessary to find a better multimodality therapy.

Scintigraphic diagnosis of right ventricular ischemia

We present a patient with exercise induced right ventricular ischemia demonstrated on stress TI-201 myocardial scintiscan. The patient underwent cardiac catheterization, and subtotal occlusion was found at the proximal right coronary artery. Repeat stress TI-201 scan became normal following the successful percutaneous transluminal coronary angioplasty.

Two cases of mitochondrial myopathy with predominant respiratory dysfunction

Although it is well known that the respiratory failure is a major cause of death in most patients with chronic neuromuscular disease, predominant respiratory dysfunction without severe involvement of limb muscles is an unusual complication of mitochondrial myopathy in adult age. We experienced two cases of mitochondrial myopathy with severe involvement of respiratory function and only mild involvement of limb muscles. One is a 16 year old female and another is a 22 year old male. The diagnosis is based on morphologic characteristics of "ragged red fibers" under the light microscope and abnormal mitochondrias on the electron microscope in the muscle biopsy.

Malignant glomus tumor originating in the superior mediastinum--an immunohistochemical and ultrastructural study

An extremely rare case of malignant glomus tumor originating in the superior mediastinum was evaluated immunohistochemically and ultrastructurally. A 78-year-old woman who had been suffering from dysphagia and dyspnea had poorly-defined soft tissue mass, 4.5 x 2.5cm, in the superior mediastinum with direct invasion into the esophagus, trachea, and bilateral thyroid glands. This case is believed to be unique in several respects. There were neither recognizable findings of benign glomus tumor nor sarcomatous areas, in contrast to the previously reported cases. A definite direct invasion into the surrounding organs was identified. We therefore interpreted this case as primary malignant glomus tumor, not as glomangiosarcoma arising in a benign glomus tumor.

Solitary myeloma with massive extracellular crystalline structures--a case report

We describe a case of solitary myeloma showing cystic change filled with massive crystalline structures in a 54-year-old woman. A bone X-ray showed a solitary cystic osteolytic lesion in the right iliac bone. Serum and urine protein electrophoresis showed no demonstrable M-protein, and bone-marrow aspirates did not show any myeloma cells. Histologic examination of the tumor revealed aggregation of plasma cells with massive extracellular infiltration of the rhomboid-shaped crystalline structures. In immunoperoxidase staining, both these crystalline structures and the cytoplasms of the myeloma cells demonstrated a positive reaction for lambda light chain. By electron microscope, the large extracellular crystalline structures were observed, and we found unique rhomboid or rectangular-shaped crystalline structures in the cytoplasms of the myeloma cells.

Evaluation of plantar fasciitis by three-phase bone scintigraphy

Fifteen patients complaining of chronic heel pain underwent three-phase Tc-99m MDP bone scintigraphy. Ten patients demonstrated abnormal scan findings consistent with plantar fasciitis (PF) and had responded to conventional therapy. Two patients were found to have calcaneal stress fractures, and one patient demonstrated a calcaneal spur that required no treatment. The remaining two patients had normal scans and did not appear clinically to have PF. The three-phase bone scan is therefore very useful in diagnosing PF and in distinguishing it from other etiologies of the painful heel syndrome.

Benign brainstem hemorrhage simulating transient ischemic attack

A 48-year-old hypertensive man had sudden onset of symptoms suggesting vertebrobasilar insufficiency, which were transient in nature lasted for only 4 hours. Brain computed tomography revealed a small hematoma in the pontomedullary junction. This is an uncommon presentation of benign brainstem hemorrhage simulating transient ischemic attack. We propose that computed tomographic scan using thin slices of 3mm to 5mm thickness at the level of brainstem is required before starting anticoagulation therapy for vertebrobasilar transient ischemic attack.

Gallium uptake in tryptophan-related pulmonary disease

We describe a patient who developed fever, fatigue, muscle weakness, dyspnea, skin rash, and eosinophilia after taking "high doses" of tryptophan for insomnia for two years. A gallium-67 scan revealed diffuse increased uptake in the lung and no abnormal uptake in the muscular distribution. Bronchoscopy and biopsy confirmed inflammatory reactions with infiltration by eosinophils, mast cells, and lymphocytes. CT scan showed an interstitial alveolar pattern without fibrosis. EMG demonstrated diffuse myopathy. Muscle biopsy from the right thigh showed an inflammatory myositis with eosinophilic and lymphocytic infiltrations.

Rapid resolution of pulmonary embolism by tissue plasminogen activator

A case of multiple bilateral pulmonary emboli demonstrating complete resolution 48 hours after the intravenous administration of tissue plasminogen activator is presented.

Two cases of anterior choroidal artery territory infarction

Occlusion of the anterior choroidal artery (AChA) can cause infarction in the posterior limb of the internal capsule. Infarction is less frequently observed in the thalamus, midbrain, temporal lobe, and lateral geniculate body (LGB) territories of the AChA. The most common clinical finding is hemiparesis. Hemianesthesia may be severe at onset but is usually transient. Homonymous hemianopia, upper-quadrant anopia, or upper- and lower-quadrant sector anopia can be present. Occasionally these patients are reported to have transient abnormalities of higher cortical function. The most common stroke mechanism is known to be small-vessel occlusive disease, predominantly found in hypertensive and diabetic patients. Vasospasm due to ruptured aneurysm or intraoperative mechanical manipulation, and cardiac origin the AChA territory. The infarct lesion is usually recognized and diagnosed by computed tomography. The best treatment is still unknown.

Thallium-201 imaging in anomalous left coronary artery originating from pulmonary trunk

A 3-month-old infant with anomalous origin of the left main coronary artery (LMCA) from the pulmonary trunk was evaluated using resting thallium imaging. The imaging findings were consistent with myocardial scar and ischemia of the anterolateral and posterolateral walls in the distribution of the LMCA.

Redistribution of crossed cerebellar diaschisis

Crossed cerebellar diaschisis refers to a functional decrease in blood flow to the cerebellar hemisphere contralateral to the infarcted or ischemic cerebral hemisphere. This phenomenon can be depicted using PET as well as using SPECT. This condition, seen on early I-123 IMP brain scans, can show redistribution on the three hour delayed scan, presumably due to normal non-specific amine receptor sites of the affected cerebellum. One such case is reported.

Scintigraphic evaluation of regional migratory osteoporosis

Three patients with regional migratory osteoporosis (RMO) of the lower extremity were observed over a period of time with clinical and scintigraphic follow-up. The diagnosis of RMO is clinically and radiographically difficult, but a three-phase bone image is very helpful in diagnosing patients with RMO.

Antibody response of three different strains of mice to alpha s1-casein analyzed by using proteolytic and synthetic peptides

The location of immunodominant regions on bovine alpha s1-casein (alpha s1-CN) was compared among three strains of mice (BALB/c, C3H/He and C57BL/6). Anti-alpha s1-CN antisera were separated 5 weeks after the first immunization. Thirty-seven kinds of peptides were obtained from alpha s1-CN by proteolysis, and the segmental 19- to 20-residue peptides overlapping with their adjacent neighbors by 5 residues were synthesized over the entire polypeptide chain of alpha s1-CN. The ability of the anti-alpha s1-CN antibody to bind peptides was tested by an enzyme-linked immunosorbent assay, in which the peptides were adsorbed to the solid phase. All the strains responded highly to alpha s1-CN. The immunodominant antigenic regions of alpha s1-CN were not common to the three strains of mice, the H-2 haplotypes being different from each other (BALB/c, regions 1, 3, 5, 6 and 7; C3H/He, regions 2, 3, 5, 6, 6', 7 and 7'; and C57BL/6, regions 2, 4, 5, 6 and 7).

Pure signet ring cell type early gastric carcinoma with extensive lymph node metastases--a case report

A 42-year old man was admitted with indigestion and left upper quadrant pain. A gastrofiberscopic examination revealed a depressed, discolored lesion (1.5 × 1.5 cm) with converging irregular radiating folds in the antral portion, suggestive of early gastric cancer (type IIc). Histologically, signet ring cell carcinoma was seen. A subtotal gastrectomy was performed and the opeartive findings showed a shallow depression in the anterior wall of the greater curvature side in the antrum and multiple perigastric lymph node enlargment. On microscopic examination, the authors observed pure signet ring cell carcinoma confined to the mucosa but with widespread lymph node metastases.

Platelet sequestration in widespread pulmonary hemangiolymphangiectasia. Demonstration by indium-111 labeled platelets

A thrombocytopenic patient with pulmonary hemangiolymphangiectasia proven by biopsy, was studied for platelet sequestration with In-111-labeled autologous platelets. The 24-hour scan showed diffuse increased uptake throughout both lung fields, indicating platelet sequestration by the diffuse pulmonary hemangiolymphangiectasia.

Stress fracture of the pubic ramus in a swimmer

Stress fracture is common in military recruits, joggers, and runners. Stress fracture in the pubic ramus is not common, and it constitutes only 1.25% of all stress fractures. A stress fracture, avulsion type of the pubis at the insertion of adductor magnus on an active swimmer is reported here.

Pathognomonic scintigraphic finding of hepatic cavernous hemangioma

Hemangioma is the most common benign tumor of the liver. An accurate diagnosis of such tumor is essential for proper management of patients with hepatic cavernous hemangioma (HCH). Noninvasive diagnosis of HCH can be made using sequential Tc-99m RBC scintigraphy by demonstrating a "perfusion-blood pool mismatch." In addition, a case of HCH was observed which demonstrated peripheral enhancement with subsequent central enhancement on a sequential Tc-99m RBC blood pool scintigraphy. It is felt that this scintigraphic finding is pathognomonic for HCH.

The primary structure of porcine Cu-Zn superoxide dismutase. Evidence for allotypes of superoxide dismutase in pigs

Cu-Zn superoxide dismutase was purified to homogeneity from mixed pig blood and from a single pig. The isolated product had an absorption ratio 280/260 nm of 0.91, a specific activity of 3 000 +/- 200 units (cytochrome c reduction test), and an isoelectric point of 7.5 (chromatofocusing) or 7.25 (isoelectric focusing), respectively. Sequence determination was performed by automated solid-phase Edman degradation of fragments of the reduced S-carboxymethylated proteins obtained by digestion with trypsin or Staphylococcus aureus proteinase V8 or treatment with cyanogen bromide. Acetylation of the N-terminus was confirmed by comparing high performance liquid chromatography retention times of N-terminal peptides with those of authentic samples. Sequencing of the superoxide dismutase of mixed porcine blood revealed heterogeneity (70% Leu; 30% Val at position 29), whereas the sample derived from a single French pig proved to be homogeneous (100% Leu at position 29). The complete sequence of pig superoxide dismutase comprised 152 amino-acid residues, which corresponds to a theoretical molecular mass of 15 800 Da per subunit, and exhibited the expected high homology with those of other mammals. The aspartate and all 7 histidine residues known to complex the metal ions in bovine superoxide dismutase are conserved in the porcine sequence at the homologous positions Asp82 and His45, His47, His62, His70, His79, His119, respectively.

Prevention of perinatal transmission of hepatitis B virus: a comparison between the efficacy of passive and passive-active immunization in Korea

In a study to compare the prophylactic efficacy of passive and passive-active immunization against hepatitis B virus (HBV) among newborn infants of HBV carrier mothers positive for hepatitis B e in Korea, both regimens resulted in effective protection against development of hepatitis B surface antigen (HBsAg): 10 of 12 recipients of hepatitis B immune globulin (HBIG) and 25 of 29 recipients of HBIG and vaccine during nine months of follow-up. Among untreated controls in the same population just before the present study, 12 of 16 developed HBsAg within nine months of birth. Seven recipients of HBIG and vaccine and four untreated infants who had HBsAg in their blood at birth were excluded. The declining antibody levels in infants who received only HBIG as compared with the rising antibody levels in infants who received HBIG followed by three doses of HBV vaccine suggest that long-term protection will be seen only in the latter group.

Isolated proximal musculocutaneous nerve palsy: case report

Isolated musculocutaneous nerve injury is extremely rare. The few reported cases were associated with heavy exercises and violent extension of the forearm. The lesions in those cases were below the coracobrachialis muscle, involving the biceps, brachialis, and cutaneous nerves of the forearm. This patient's lesion was unique, located proximal to the coracobrachialis. There was no antecedent trauma. At follow-up six weeks and four months after onset of symptoms, significant improvement was noted both clinically and electrophysiologically. Musculocutaneous nerve palsy is important to distinguish in certain differential diagnoses, particularly with C5 or C6 radiculopathy and brachial plexus injury.