No abstract available.
Myocutaneous Flap* ; Pressure Ulcer*

No abstract available.
Cleft Lip*

Two cases of malignant histiocytosis, in which skin involvement was a prominent finding at initial clinical presentation, are reported. 1nteresting histopathologic findings, including Langerhans granule in one case and numerous eosinophils in another, were observed. In one case remission was achieved with BACOP chemotherapy (Bleomycin, Adriamycin, Cyclophosphamide, Vincristine, and Prednisone). In the other case, the patient died nine months after the onset of the disease without any treatment.
Cyclophosphamide ; Doxorubicin ; Drug Therapy ; Eosinophils ; Histiocytic Sarcoma* ; Humans ; Skin ; Vincristine

The effects of sodium hypochlorite for the destruction of P. aeruginosa, E. coli, K. pneumonias and S. anreas and for the prevention of contamination of irrigation fluid, which is either exposed to ICU environment or used for cleansing oral or trachea catheter tips, were tested and the following results were obtained. 1) The sodium hypochlorite solution 1: 800 destroyed P. aeraginosa, E. coli, K. pneomoniue and S. aweas in 5 minutes. This bactericidal effect was observed to be retained after the solution had stood 24 hours. 2) Viable P. aeraginosa was not detected immediately, 5 minutes and 10 minutes after exposure to 1: 500, 1: 800 and 1: 1000 sodium hypochloride solutions respectively. 3) The sodium hypochlorite solution 1: 800 prevented contamination of the irrigation fluids during a 24 hour exposure to the ICU environment. 4) P. aeraginosa and other gram-negative bacilli were frequently isolated from the plain fluid used for irrigating and holding the suction tips which had been used for patients. However, no organisms were isolated from fluid containing sodium hypochlorite 1: 800 even after 24 hour usage. It is concluded that the use of fluid containing sodium hypochlorite for the irrigation of catheter tips can reduce development of infections in the ICU patients.
Catheters ; Humans ; Infection Control* ; Pneumonia ; Sodium Hypochlorite* ; Sodium* ; Suction ; Trachea

No abstract available.
Brain* ; Epilepsy, Frontal Lobe* ; Frontal Lobe*

PURPOSE: As mesial temporal lobe epilepsy (TLE) shows hypometabolism of medial and lateral tempora lobe, we investigated whether symmetric uptake of F-18-FDG in medial temporal lobes can differentiat mesial from lateral TLE. MATERIALS AND METHODS: In 113 patients (83 mesial TLE, 30 lateral TLE) wh underwent anterior temporal lobectomy and/or corticectomy with good surgical outcome, we performe F-18-FDG PET and compared F-18-FDG uptake of medial and lateral temporal lobes. All the patients wi mesial TLE had hippocampal sclerosis except one congenital abnormal hippocampus. Patients with latera TLE revealed cerebromalacia, microdysgenesis, arteriovenous malformation, old contusion, and cortical dys plasia. RESULTS: Sensitivity of F-18-FDG PET and MR for mesial TLE was 84% (70/83) and 73% (61/83 respectively. Sensitivity of F-18-FDG PET and MR for lateral TLE was 90% (27/30) and 66% (20/30 respectively. Twelve patients were normal on F-18-FDG PET. 101 patients had hypometabolism of latera temporal lobe. Among 88 patients who showed hypometabolism of medial temporal lobe as well as later temporal lobe, 70 were mesial TLE patients and 18 were lateral TLE on pathologic examination. Positive predictive value of medial temporal hypometabolism for mesial TLE was 80%. Among 13 patients wh showed hypometabolism of only lateral temporal lobe, 4 were mesial TLE and 9 were lateral TLE. Positive predictive value of hypometabolism of lateral temporal lobe for the diagnosis of lateral TLE was 69% ( 13). Normal MR findings stood against medial TLE, whose negative predictive value was 66%. Conclusion Lateral temporal lobe epilepsy should be suspected when there is decreased F-18-FDG uptake in latera temporal lobe with normal uptake in medial temporal lobe.
Anterior Temporal Lobectomy ; Arteriovenous Malformations ; Contusions ; Diagnosis ; Electrons* ; Encephalomalacia ; Epilepsy, Temporal Lobe* ; Hippocampus ; Humans ; Magnetic Resonance Imaging* ; Positron-Emission Tomography* ; Sclerosis ; Temporal Lobe*

Bow hunter's stroke is a rare symptomatic vertebrobasilar insufficiency in which vertebral artery (VA) is mechanically occluded during head rotation. Various pathologic conditions have been reported as causes of bow hunter's stroke. However, bow hunter's stroke caused by facet hypertrophy of C1-2 has not been reported. A 71-year-old woman presented with symptoms of vertebrobasilar insufficiency. Spine computed tomography showed massive facet hypertrophy on the left side of C1-2 level. A VA angiogram with her head rotated to the right revealed significant stenosis of left VA. C1-2 posterior fixation and fusion was performed to prevent serious neurologic deficit from vertebrobasilar stroke.
Aged ; Constriction, Pathologic ; Female ; Head ; Humans ; Hypertrophy ; Neurologic Manifestations ; Spine ; Stroke ; Vertebral Artery ; Vertebrobasilar Insufficiency ; Zygapophyseal Joint

OBJECTIVE: Parietal lobe epilepsy(PLE) is neither common nor easily diagnosed because of its variable clinical features. To elucidate its characteristics and surgical outcome, the authors review their surgical experiences. METHODS: Between September 1994 and August 2001, 38 patients with parietal lobe epilepsy received surgical treatment at our Hospital. All patients underwent resection, mainly involving the parietal lobe. In most patients, preoperative evaluation included interictal and ictal electroencephalography, magnetic resonance image, positron emission tomography, and interictal and ictal single photon emission computed tomography. The male to female ratio was 23: 15. Age at surgery ranged from 4 to 38 years (median, 25). RESULTS: Preoperatively over 60% were considered not to be PLE, even though PLE was the most common (15/38, 39.8 %). The most common seizure type was complex partial seizure (26/38, 68.4%) rather than simple partial seizure (3/38, 7.9%). Invasive study was performed in 37 of the 38 patients. Monitoring duration was from 4 to 18 days (median, 8 days). Awake operations under regional anesthesia were performed in 20 patients (52.6%). Follow-up periods ranged from 14 to 81 months (mean, 50.7). Seizure disappeared in 15 (Engel's classification I, 39.5%), and rare seizure remained in 5 (Engel II, 13.2%). Thirteen patients showed a worthwhile improvement (Engel III, 34.2%) and 5 no worthwhile improvement (Engel IV, 13.2%). Pathologies were diverse, the most common being cortical dysplasia (94.3%). CONCLUSION: Since PLE is difficult to diagnose preoperatively, an invasive study covering the parietal lobe is mandatory, if PLE is suspected. Cortical dysplasia was the most common etiology, thus awake operation under regional anesthesia and intraoperative brain mapping is helpful during extensive resection in order to spare the eloquent cortex. Using this protocol, PLE can be controlled surgically with a satisfactory result and a reasonably low level of complications.
Anesthesia, Conduction ; Brain Mapping ; Classification ; Electroencephalography ; Epilepsy* ; Female ; Follow-Up Studies ; Humans ; Male ; Malformations of Cortical Development ; Parietal Lobe* ; Pathology ; Positron-Emission Tomography ; Rabeprazole* ; Seizures ; Tomography, Emission-Computed, Single-Photon

The authors analyzed 11 patients of hypertensive intracerebral hematoma who had undergone the delayed CT guided stereotaxic evacuation. this delayed stereotaxic evacuation seemed to be highly effective in improving the motor weakness rather than mental state. Such effect was appeared immediately after the procedures in most of the patients, even in very small amount of hematoma. In addition, we could shorten the total hospital periods. The most effective time of this delayed stereotaxic evacuation was seemed to be in around 2 weeks after the hemorrhage.
Hematoma* ; Hemorrhage ; Humans ; Hypertension

We tried to investigate the incidence and the clinical profile of intractable epilepsy with hippocampal atrophy and ictal onset zones located in areas other than the hippocampus (extra-medial-temporal epilepsy; EMTE). We included patients who had hippocampal atrophy confirmed by MRI but with extra-medial-temporal ictal onset zones as verified by invasive intracranial electrodes or video-EEG monitoring. The case histories, interictal EEG, ictal semiology, other MRI findings in addition to hippocampal atrophy, and results of ictal SPECT and PET scans were evaluated. Results were compared with those of surgically proven medial temporal lobe epilepsy with hippocampal atrophy recruited during the same period. 8.5% of the intractable epilepsy patients with hippocampal atrophy had extra-medial temporal epileptogenic zones. A history of encephalitis and hemiconvulsion-hemiparesis were significantly common in the EMTE group. Most of the interictal EEGs of EMTE patients showed extratemporal irritative zones. MRI, ictal SPECT, and FDG-PET seemed to be helpful at localizing the true epileptogenic zones. The predominant EMTE seizure type was focal motor seizure with secondary generalization. Some portion of intractable epilepsy patients with hippocampal atrophy had extra-medial-temporal epileptogenic foci and careful analysis of semiology and neuroimagings could yield clues to correct diagnosis.
Adult ; Atrophy ; Electroencephalography ; Epilepsy/physiopathology ; Epilepsy/epidemiology* ; Epilepsy/diagnosis ; Epilepsy, Temporal Lobe/epidemiology ; Hippocampus/pathology* ; Human ; Incidence ; Magnetic Resonance Imaging ; Retrospective Studies ; Tomography, Emission-Computed ; Tomography, Emission-Computed, Single-Photon