No abstract available.
Hypereosinophilic Syndrome*

No abstract available.
Dacryocystorhinostomy*

No abstract available.
Carcinoma in Situ* ; Cervix Uteri* ; Female

A delayed hemolytic transfusion reaction (DHTR) is the result of delayed anamnestic alloantibody response four to fourteen days after transfusion of apparently compatible blood. Most DHTRs are very mild and may not be recognized clinically. Some are manifested only by anemia. Only a few cases are severe enough to induce a massive hemolytic reaction followed by frank renal failure. Recently, we experienced a case of DHTR with acute renal failure (ARF) due to anti-E. A 21-year-old woman received compatible four units of packed red cells after right artificial total hip replacement arthroplasty due to juvenile rheumatoid arthritis. She had a history of transfusion 4 years ago. Fourteen days after the transfusion, she showed a fall in hematocrit, hemoglobinuria and a positive indirect antiglobulin test, and accompanied by ARF. Anti-E was identified in the patient's serum by antibody screening and identification test at that time. She recovered from ARF after hemodialysis with conservative management. However, eventually, she died due to disseminated intravascular coagulopathy.
Acute Kidney Injury* ; Anemia ; Arthritis, Juvenile ; Arthroplasty ; Arthroplasty, Replacement, Hip ; Blood Group Incompatibility* ; Coombs Test ; Female ; Hematocrit ; Hemoglobinuria ; Humans ; Mass Screening ; Renal Dialysis ; Renal Insufficiency ; Young Adult

OBJECTIVE: Chronic hydrocephalus is one of the major complications following aneurysmal subarachnoid hemorrhage(SAH). However the incidence and predicting factors requiring shunting after SAH is not precisely known. The authors investigated the incidence of chronic hydrocephalus, timing of shunting procedure, and factors to predict the need for shunting in patients with aneurysmal SAH. PATIENTS AND METHODS: A series of 209 patients admitted to our institute from January 1993 to December 1997, who presented with SAH and underwent craniotomy for aneurysm clipping were studied retrospectively. Chronic hydrocephalus was defined as clinically and radiographically demonstrated hydrocephalus that lasted 2 weeks or longer after initial hemorrhage and that required shunting. The author divided study group into shunt group(SG, n=20) and non-shunt group(NSG, n=189). Patients were evaluated based on following factors: age, sex, history of hypertension and diabetes mellitus, consciousness at admission, Hunt-Hess grade, the presence of intracranial hemorrhage, Graeb's score, bifrontal index(BFI), Fisher grade, amount of SAH, location of aneurysm, time of aneurysm clipping, rebleeding, and vasospasm. RESULTS: The incidence of chronic hydrocephalus was 9.6%(20/209). The timing of the shunting procedure ranged from 16 days to 150 days after initial hemorrhage with the average being 77(+/-37)days. In a univariate analysis with chi-square test, age, consciousness, Hunt-Hess grade, amount of SAH, BFI, Fisher grade, and Graeb's score were significantly related with the need for shunting(p<0.05). In a multivariate logistic regression analysis, odds ratio was calculated for each variables. If the odds ratio of below 60 year of age was 1.0 then that of above 61 was 5.4(p<0.001). If the odds ratio of alert/drowsy was 1.0 then that of stupor/coma was 4.4(p<0.05). If the odds ratio of 0 of Graeb's score was 1.0 then that of 1-10 was 4.3(p<0.05). If the odds ratio of amount of SAH below score 3 was 1.0 then that of above score 4 was 1.8. If the odds ratio of BFI below 30 was 1.0 then that of above 31 was 1.1. CONCLUSION: The development of chronic hydrocephalus after aneurysmal SAH is multifactorial, but should be strongly suspected in patients with older age, decreased level of consciousness or IVH at admission. The patients require a shunt from 2 weeks to 5 months from the time of their initial hemorrhage.
Aneurysm* ; Consciousness ; Craniotomy ; Diabetes Mellitus ; Hemorrhage ; Humans ; Hydrocephalus ; Hypertension ; Incidence ; Intracranial Hemorrhages ; Logistic Models* ; Odds Ratio ; Retrospective Studies ; Subarachnoid Hemorrhage*

Lasers have used safely to and in the resection of highly vascular tumors or arteriovenous malformation. As far as blood vessel coagulation, arteries up to 2mm in diameter and veins up to 3mm in diameter can be reliably sealed with the Nd-YAG laser, and lesser size of vessels can be coagulated with the CO2 laser. Another advantage of laser is to be a useful tool for small vessel repair or anastomosis without microsuture technique. The aim of this experiment was to investigate intensity and duration of exposure with the CO2 laser for vessel coagulation and repair. 36 rats weighing 200 to 250 gm, were used in this study. For vessel coagulation of extracranial arteries and veins, power density between 10 and 50 watts/cm2(W) was applied with handpiece, and for vessel repair or anastomosis 2 W was applied with micromanipulator. The results obtained were as follows : 1) The artery was perforated immediately over 10 W with 0.5 seconds of exposure of smaller focal beam. 2) The artery was constricted in its diameter in defocused beam with 30-40 W, and perforated with 50 W. 3) The lower limit of venous coagulation was 15 W, 0.5 sec. of exposure and 2 mm of focal beam diameter. 4) The lower limit or arterial coagulation was 10 W, 5 sec. of exposure, 4 mm of focal beam diameter, and exposure time was reduced to 3 sec. at 20 W. 5) The repair or anastomosis of artery was accomplished with 2 W, 0.05 sec. of exposure of 0.2 mm of focused beam by 6 times of delivery, and the delivery times could be successfully reduced to half under the overlying thin blood clot film on the anastomosis site of the artery. 6) In the histological examination, the entire layer of coagulated vessel wall on the laser delivered side disclosed marked constriction and destruction. On the anastomosis site, re-endothelialization began from 3 days, and completed by 2 weeks after operation.
Animals ; Arteries ; Arteriovenous Malformations ; Blood Vessels* ; Constriction ; Lasers, Gas* ; Lasers, Solid-State ; Rats ; Veins

It is important to obtain a good exposure of the root exit zone(REZ) of the facial nerve during microvascular decompression(MVD) for hemifacial spasm(HFS). For this purpose, authors dissected cerebellar cortical artery in addition to exposing the proximal portion of lower cranial nerves. During MVD for HFS, surgeons frequently meet a cerebellar cortical artery along the inferolateral aspect of cerebellar hemisphere. It is usually hemispheric branch of anterior inferior cerebellar artery(AICA) or posterior inferior cerebellar artery(PICA). It is reason that authors have dissected the outside arachnoid membrane attached pia mater of cerebellar cortical artery with a arachnoid knife or microscissor but preserve the inside arachnoid membrane attached dura mater. Microsurgical retractor is placed inferolaterally between cerebellar cortical artery and cerebellar hemisphere and elevated from the floor of the posterior fossa. The subarachnoid cisterns over the lower cranial nerves are opened with sharp dissector and wide operative fields and good exposure of REZ of facial nerve is obtained.
Arachnoid ; Arteries* ; Cranial Nerves ; Dura Mater ; Facial Nerve ; Hemifacial Spasm* ; Membranes ; Microvascular Decompression Surgery* ; Pia Mater

This study includes 398 cases of cerebral contusion among 1137 cases of craniocerebral injury diagnosed by neurological finding and CT brain scan, who were admitted from January 1983 to June 1985 in our neurological department. 68 cases showed abnormalities on CT scanning, among these 48 cases were heterogenous hyperdensity with surrounding irregular marginated hypodensity, 26 cases midline shift, 13 cases local increased density, 9 cases recurrence of new lesion. The authors studied comparison and correlation of clinical course and CT finding of cerebral contusion.
Brain ; Contusions* ; Craniocerebral Trauma ; Recurrence ; Tomography, X-Ray Computed

Yakovlev demonstrated that the Schizencephalies appear to result from injury to developing cerebral vesicles in the second month of intrauterine life. There is a total loss of neurons in restricted symmetrical zones of each developing hemisphere and on either side of the resulting cleft-shaped defects are evidences of subtotal injury to developing neuroblasts. A case of a 4 years old male with Schizencephaly is reported.
Child, Preschool ; Humans ; Male ; Malformations of Cortical Development* ; Neurons

No abstract available.
Alagille Syndrome* ; Cholestasis ; Xanthomatosis*