Total anomalous pulmonary venous return(connection) is a congenital heart disease. Especially, the reports of the patients with double connections of all pulmonary veins were rare. An infant who underwent operation for total anomalous pulmonary venous return had double drainge of all pulmonary veins to both left vertical vein and anomalous descending vein. This second lesion was not diagnosed preoperatively, but in operative field. Operative treatments were performed by ligation of left vertical vein and central pulmonary vein-to-left atrium anastomosis without ligation of the descending anomalous vein. For these less common variants fo total anomalous pulmonary venous return,a more detailed and precise understanding of morphology can facilitate accurate surgical repair. And also, early detection of the disease is an another issue for a good prognosis.
Heart Defects, Congenital ; Humans ; Infant ; Ligation ; Prognosis ; Pulmonary Veins ; Scimitar Syndrome* ; Veins

BACKGROUND: Cardiogenic pulmonary edema increases nonspecific airway responsiveness in humans and animals. Increased extravascular lung water from overt pulmonary edema to subclinical interstitial edema is a common finding in patients with chronic renal failure. Several studies carried out to assess pulmonary function disturbances in this condition have documented a reduction in forced expiratory volume that usually reverses after hemodialysis, suggesting airway edema as the underlying mechanism. This interstitial edema may also lead to nonspecific bronchial hyperre- sponsiveness. We hypothesized that patients with chronic renal failure may present nonspecific bronchial hyperresponsiveness due to subclinical interstitial pulmonary edema. METHODS: We studied 18 chronic renal failure undergoing regular hemodialysis 3 times a week (New York Heart Association Class II) without concomittent disease. These patients were checked pulmonary function test and metacholine provocation test before hemodialysis and same procedure was repeated if responsive, after hemodialysis. RESULTS: 1) 12 out of 18 patients before hemodialysis were reactive in metacholine provocation test (66.7%) before hemodialysis. This airway hyperresponsiveness were decreased after hemodialysis. 2) Pulmonary function was improved after hemodialysis and change in FEV1 was correlated with change in weight(r= -0.62, p<0.01). 3) There was a close correlation between log PD20 and FEF25, which is one of the variables of the peripheral airways(r=0.58, p<0.05). CONCLUSION: We speculated interstitial pulmonary edema may play a significant role in bronchial hyperresponsiveness and lung function impaired in patients with chronic renal failure.
Animals ; Edema ; Extravascular Lung Water ; Forced Expiratory Volume ; Heart ; Humans ; Kidney Failure, Chronic* ; Lung ; Pulmonary Edema ; Renal Dialysis* ; Respiratory Function Tests

No abstract available.
Animals ; Inositol* ; Kidney* ; Liver* ; Phospholipases* ; Rats* ; Type C Phospholipases*

Cutaneous horn is a clinica) diagnosis based upon the presence of a large protuberant mass of keratin. We report a case of cutaneous horn arising from keratoacanthoma in a 76-year old woman. The patient showed a dome-shaped nodule 2n in diameter with a central crater on thc right temple area. A yellow brown colored cornical hyperkeratotic protruding lesion(0.7* 0.7cm size) from the central crater of the nodule was also observed. Histopathological findings of the lesions showed charaeteristic findings of keratoacanfhoma and cutaneous horn. The lesion was removed by surgical excision.
Aged ; Animals ; Diagnosis ; Dronabinol ; Female ; Horns* ; Humans ; Keratoacanthoma*

To evaluate the risk and factors associated with seizure recurrence in children with epilepsy while receiving the adequate anticonvulsant treament, we studied 58 patients with newly diagnosed epilepsy who were followed prospectively for a median of 26 months (range 7 to 54). The results were as follows: 1) Forty-four of the 58 patients (75.9%) had recurrence of seizure. 2) The rate of recurrence according to type of seizure was observed to be 22 patients (68.8%) in generalized tonic-clonic seizure, 6 patients (85.7%) in simple partial seizure, 5 patients (83.3%) in complex partial seizure, 3 patients (100%) in mixed seizure, 2 patients (100%) in absence, 3 patients (100%) in infantile spasm, 1 patient (100%) in atonic seizure, 2 patients (50%) in secondary generalized seizure. There was no significant difference in the risk of recurrence observed among these seizure types. 3) The risk of recurrence varied according to the history of seizure, seizure recurrence was observed in 100% of the cases with history of neonatal seizure, 72.7% of the cases with febrile convulsion, and 73.3% of the cases with non-specific history. No significant difference was observed among these past history of seizure. 4) The rate of seizure recurrence according to electroencephalographic abnormalities did not differ significantly. Seizure recurrence was noted in 13 of the 18 patients with mildly disordered tracings (72.2%), 15 of the 20 patients with moderate abnormality (75.0%), and 12 of the 16 patients with severe abnormality (75.0%). 5) Recurrence rate according to cause of seizure was more significantly frequent in those with symptomatic epilepsy than in those with idiopathic type (100% vs 70.2%, p<0.05). 6) The frequency percentage of seizure recurrence by age groups of below 1 year, 1 to 3 years, 4 to 6 years, and above 6 years at onset of seizure were 100, 66.7, 57.1, and 72.7, respectively. The rate of seizure recurrence was significantly highest in patients aged below 1 year at onset of seizure. 7) There was significant difference in seizure recurrence between those with and without abnormalities as shown by neurologic examination (100% vs 70.8%, p<0.05). 8) There was no consistent difference in valproic acid serum levels between those who had a recurrence and those who did not. The patients receiving phenobarbital had significantly high serum levels of the phenobarbital in recurrent groups than those who had no recurrence. In conclusion, factors associated with an increased risk of seizure recurrence were early age at onset of epilepsy, symptomatic epilepsy, and neurologic abnormalities. We found no associations between risks of recurrence and types of epilepsy, or electroencephalographic abnormalities.
Anticonvulsants* ; Child ; Epilepsy ; Humans ; Infant ; Infant, Newborn ; Neurologic Examination ; Phenobarbital ; Prospective Studies ; Recurrence* ; Risk Factors ; Seizures* ; Seizures, Febrile ; Spasms, Infantile ; Valproic Acid

Cell-mediated immunity frequently becomes impaired after major trauma. To investigate the immune response of the head injury, the authors measured the level of the serum neopterin, which represents the index of macrophage activation, in 53 head-injured patients. In the injured group the serum neopterin level was 5.4+/-3.1 nmol/l and slightly higher than that of the normal control group, 4.4+/-1.0 nmol/1. In the group of the patients with the Glasgow Coma Scale(GCS) 3-9, the level was significantly higher than the group GCS 10-15. The differences were not significantly related to the age or the presence of intracranial hematoma. It is conceivable that head injury will change the patient's immune response and it may be influenced by neural control.
Coma ; Craniocerebral Trauma* ; Head* ; Hematoma ; Humans ; Immunity, Cellular ; Macrophage Activation ; Neopterin*

Several different methods of posterior wiring and fusion have been advocated for treatment of the odontoid process fractures, regardless of direction of displacement. Between 1983 and 190, 8 cases of type II odontoid process fracture underwent posterior wiring and fusion at Kyungpook National University Hospital. Among them, three cases were posteriorly displaced fractures. For these three cases, the authors modified wiring method and applied acrylic resin. The authors thought this procedure is not complex and a good method for posteriorly displaced type II fractures in which conventional posterior wiring may actually create a tration effect that further displaces the fractured odontoid into the spinal canal.
Gyeongsangbuk-do ; Odontoid Process* ; Spinal Canal

Of the 68 cervical spondyltic patients showing symptoms of radiculomyelopathy, assessments were made on 29 patients who underwent neural decompressive surgery with cervical laminectomy through posterior approach for the results of surgery. Analyses were also made on the anterior-posterior diameters of cervical canal on the plain film of cervical spine. The mean values of anterior-posterior diameters measured on the levels of cervical C3-7 were 16.5+/-1.83 mm in the normal adult and 7.3+/-1.08 mm in the cervical spondylotic patients with radiculomyelopathy, which is far narrower than that of the normal. In cervical spondylotic patients, the anterior-posterior diameters of directly upper and lower parts of the lesions were 11.9+/-1.20 mm and 12.1+/-1.61 mm respectively, also much narrower mean values than those of the normal control group. The results of the 29 patients who received cervical laminectomy by posterior approach were much improved for 51.7% and improved for 44.8%.
Adult ; Humans ; Laminectomy ; Spine ; Spondylosis*

Ventriculitis is one of the most serious complication of the ventriculoperitoneal shunt, which may cause intelligence deterioration in children. The purpose of this study is to investigate the mechanism of the neural damage in lipopolysacciride(LPS)-induced ventriculitis in rat. Ventriculitis was induced by intraventricular injection of 1mg/Kg LPS in rat. H & E and Tunel stains were done on the day 1, 2 and 14 to access the microscopic changes of the periventricular tissue and apoptosis, respectively. TNF-alpha and IL-1beta mRNA expressions were studied using RT-PCR. HRP was injected into the femoral vein and electron microscopic examinations were performed to access the BBB changes. Light microscopic examination one day after LPS injection revealed neutrophilic infiltration, which diminished on day 4, and disappeared on 14. Tunel stain revealed apoptosis on day 1 and 4. TNF-alpha and IL-1beta were expressed on day 1, and diminished progressively thereafter. HRP histochemical electron microscopic examination revealed accumulation of HRP reaction in the interstitial space around the brain parenchyma. These findings suggest the opening of the BBB and increased capillary permeability in the periventricular tissue in the LPS induced ventriculitis. This can possibly damage the periventricular neural tissue. TNF-alpha and IL-1beta seemed to play an important role in the opening of the BBB.
Animals ; Apoptosis ; Blood-Brain Barrier ; Brain ; Capillary Permeability ; Child ; Coloring Agents ; Femoral Vein ; Humans ; In Situ Nick-End Labeling ; Injections, Intraventricular* ; Intelligence ; Interleukin-1 ; Neutrophils ; Rats ; RNA, Messenger ; Tumor Necrosis Factor-alpha ; Ventriculoperitoneal Shunt

The segmental spread of epidural analgesia was measured in seventeen surgical patients aged between 17 and 52 years, and in fourteen patients between 60 and 77 years. The upper level in the young was 6.29(+/-1.56) thoracic vertebra level, but in the elderly was 4 (+/-0.65_ thoracic vertebra level at 20 minutes after epidural injection of 1.5% lidocaine 20 ml. A given volume of solution spreads to 0.9, 1.07, 1.54, 2.29 segments greater upper extent at 5, 10, 15, 20 minutes after epidural injection and 0.57, 1.07 segments greater lower extent at 5, 10 minutes in the elder than young. So with increasing age relatively small amounts of solution are required, to produce the same extent of anesthesia in the young.
Aged* ; Analgesia, Epidural* ; Anesthesia ; Humans ; Injections, Epidural ; Lidocaine ; Spine