PURPOSE: Malformation of cortical development(MCD) constitutes an important etiology of intractable epilepsy and is considered an indication for surgical treatments, though their efficacy is limited and variable depending on MCD's location or distribution. Ketogenic diets are widely known to be effective, but as little study has been made concerning their efficacy on epilepsy with MCD, we evaluated the efficacy of ketogenic diets on MCD patients compared with that of epileptic surgery, which is more invasive. METHODS: We performed retrospective studies and analyse on 30 patients with MCD diagnosed by brain MRI and treated with ketogenic diets for intractable epilepsy since 1998, checking decreases in their seizure episodes after starting the diets. RESULTS: Cortical dysplasia was observed in 24(80.0 percent) patients as the most common type of MCD. Also, MCD was observed in unilateral hemisphere most commonly, in 23(76.7 percent) patients; it was observed in both hemispheres in 7(23.3 percent) patients. Nine(30.0 percent) out of 30 patients became seizure-free after starting ketogenic diets, and 14(46.7 percent) patients experienced 50 percent seizure reductions as well. Age of starting the diet or the duration of epilepsy period before starting showed no statistical relationship with the efficacy of the diet. Though the younger the patient and the longer the treatment the more effective the diet seemed to be, there was no statistical correlation between them. The location of MCD showed no significance neither. CONCLUSION: Considering various limits and invasiveness of surgical treatment, a ketogenic diet could be a good tool in treating children with intractable epilepsy with MCD.
Brain ; Child ; Diet ; Epilepsy* ; Humans ; Ketogenic Diet* ; Magnetic Resonance Imaging ; Malformations of Cortical Development ; Retrospective Studies ; Seizures

OBJECTIVE: To evaluate the effects of the videofluoroscopic swallowing study (VFSS) timing after the nasogastric tube (NGT) removal on swallowing function of the patients with dysphagia. METHODS: This study was conducted on 40 NGT-fed patients with dysphagia. To assess the patients' swallowing function, VFSS was performed twice using a 5-mL 35% diluted barium solution. For the initial examination, VFSS was performed immediately after the NGT removal (VFSS 1). For the second examination, VFSS was performed five hours after the NGT removal (VFSS 2). We used the functional dysphagia scale (FDS) to assess swallowing function. In the FDS, a significant difference in the four items in the oral phase, seven items in the pharyngeal phase, and total scores were assessed (p<0.05). We also used modified penetration-aspiration scale (mPAS) to compare the two examinations (p<0.05). RESULTS: A paired t-test was performed to confirm the statistical significance of the two examinations (p<0.05). The overall swallowing function was assessed as better in VFSS 2 than in VFSS 1. In the FDS, significant differences in the residue in valleculae (p=0.002), the residue in pyriform sinuses (p=0.001), the coating of pharyngeal wall after swallow (p=0.001), and the total scores (p<0.001) were found between the two examinations. Also, in the mPAS that assessed the degree of penetration-aspiration, a significant difference was found between the two examinations (p<0.001). CONCLUSION: The results of this study confirmed that the timing of the VFSS after the NGT removal affects the swallowing function. Thus, to accurately assess the swallowing function, VFSS must be performed in NGT-fed patients after they have rested for a certain period following the removal of their NGT.
Barium ; Deglutition Disorders* ; Deglutition* ; Enteral Nutrition ; Humans ; Pyriform Sinus

The urogenital tract manifestations of acquired immune deficiency syndrome (AIDS) include the entire array of voiding symptoms; infections, neurogenic bladder problems, impotence, infertility, neoplasma and AIDS associated renal syndromes. Tuberculosis occurs in approximately 4% of patients with AIDS, and involves at least one extrapulmonary site in nearly 50% of cases. However, tuberculous infection of the testicle in AIDS is rarely seen. Herein, we report a case of tuberculosis epididymoorchitis, which developed as a result of reactivation in an AIDS patient. To the best of our knowledge, this is the first reported case of AIDS presenting as tuberculous epididymoorchitis in Korea.
Acquired Immunodeficiency Syndrome* ; Erectile Dysfunction ; Humans ; Infertility ; Korea ; Male ; Testis ; Tuberculosis ; Urinary Bladder, Neurogenic

We retrospectively reviewed the medical records of 189 children who were admitted to the Pediatric Neurology Department at Yonsei University College of Medicine with status epilepticus (SE) between April, 1994 and April, 2003. The children were followed up for a mean duration of 17 months. We analyzed the clinical findings and the relationships between neurologic sequelae, recurrence, age of onset, presumptive causes, types of seizure, seizure duration and the presence of fever. Mean age at SE onset was 37 months. Incidences by seizure type classification were generalized convulsive SE in 73.5%, and non-convulsive SE in 26.5%. The incidences of presumptive causes of SE were idiopathic 40.7%, epilepsy 29.1%, remote 16.4% and acute symptomatic in 13.3%. Among all the patients, febrile episodes occurred in 35.4%, especially in patients under 3 year old, and 38.4% of these were associated with febrile illness regardless of presumptive cause. Neurologic sequelae occurred in 33% and the mortality rate was 3%. Neurologic sequelae were lower in patients that presented with an idiopathic etiology and higher in generalized convulsive SE patients. The recurrence of SE was higher in patients with a remote symptomatic epileptic etiology, and generalized convulsive SE showed higher rates of recurrence. Based on this retrospective study, the neurologic outcomes and recurrence of SE were found to be strongly associated with etiology and seizure type. Age, seizure duration and the presence of febrile illness were found to have no effect on outcome.
Age Distribution ; Child ; Child, Preschool ; Female ; Humans ; Incidence ; Infant ; Male ; Prognosis ; Recurrence ; Sex Distribution ; Status Epilepticus/etiology/*mortality

No abstract available.
Humans ; Paraquat* ; Poisoning*

OBJECTIVE: To investigate the cases of intracranial abnormal brain MRI findings even in the negative brain CT scan after mild head injury. METHODS: During a 2-year period (January 2009-December 2010), we prospectively evaluated both brain CT and brain MRI of 180 patients with mild head injury. Patients were classified into two groups according to presence or absence of abnormal brain MRI finding even in the negative brain CT scan after mild head injury. Two neurosurgeons and one neuroradiologist validated the images from both brain CT scan and brain MRI double blindly. RESULTS: Intracranial injury with negative brain CT scan after mild head injury occurred in 18 patients (10.0%). Headache (51.7%) without neurologic signs was the most common symptom. Locations of intracranial lesions showing abnormal brain MRI were as follows; temporal base (n=8), frontal pole (n=5), falx cerebri (n=2), basal ganglia (n=1), tentorium (n=1), and sylvian fissure (n=1). Intracranial injury was common in patients with a loss of consciousness, symptom duration >2 weeks, or in cases of patients with linear skull fracture (p=0.00013), and also more frequent in multiple associated injury than simple one (35.7%>8.6%) (p=0.105). CONCLUSION: Our investigation showed that patients with mild head injury even in the negative brain CT scan had a few cases of intracranial injury. These findings indicate that even though the brain CT does not show abnormal findings, they should be thoroughly watched in further study including brain MRI in cases of multiple injuries and when their complaints are sustained.
Basal Ganglia ; Brain ; Craniocerebral Trauma ; Head ; Headache ; Humans ; Magnetic Resonance Imaging ; Magnetics ; Magnets ; Multiple Trauma ; Neurologic Manifestations ; Prospective Studies ; Skull Fractures ; Unconsciousness

Primary omental torsion is a rare condition and its etiology and pathogenesis remain unknown. It is very difficult even for general surgeon to differentiate this from other acute abdominal diseases, and so the most common preoperative diagnosis is acute appendicitis and the treatment of choice is resection of the affected organ. The authors experienced 7 cases of primary omental torsion at Holy Family Hospital since 1990 and review them retrospectively with other literatures. We conclude that omental torsion must be tried to find if there is serosanguious fluid or undescended omentum without pathology in peritoneal cavity during the emergency operation.
Appendicitis ; Diagnosis ; Emergencies ; Humans ; Omentum ; Pathology ; Peritoneal Cavity ; Retrospective Studies

Sleeve pneumonectomy can be a method of treatment in a selected patient with bronchogenic carcinoma involving carina. A 64 years old male with a history of mitral valve replacement via midsternotomy 13 years ago and resection of papilloma of the vocal cord 2 years ago. The patient was admitted due to blood-tinged sputum. Bronchoscopy and computerized tomogram of the chest revealed 3.5 cm mass at lower margin of the trachea and totally obstructing the left main bronchus. A biopsy revealed squamous cell carcinoma. He underwent left sleeve pneumonectomy through sequential bilateral thoracotomy without cardiopulmonary bypass, and the pathologic stage was T4N0M0 stage IIIB. The patient is being followed through the outpatient clinic in good general condition.
Ambulatory Care Facilities ; Biopsy ; Bronchi ; Bronchoscopy ; Carcinoma, Bronchogenic ; Carcinoma, Squamous Cell* ; Cardiopulmonary Bypass ; Humans ; Lung Neoplasms ; Male ; Middle Aged ; Mitral Valve ; Papilloma ; Pneumonectomy* ; Sputum ; Thoracotomy* ; Thorax ; Trachea ; Vocal Cords

PURPOSE: Acute disseminated encephalomyelitis(ADEM) is a neurological disease that is commonly associated with previous history of infection or vaccination. It is mediated through immunological mechanisms, resulting in inflammatory demyelination of the central nervous system. The authors investigated the clinical, radiological features and disease progress of patients diagnosed with ADEM. METHODS: We have retrospectively reviewed 25 patients diagnosed with ADEM through neurological symptoms and brain MRI findings from July 1992 to July 2003. Patients were divided into three groups; patients treated with dexamethasone(group I), those with dexamethasone and immune globulin(group II), and those with methylprednisolone and immune globulin(group III). The neurological symptoms, time taken for recovery, recurrence rates and presence of neurologic residues were statistically analyzed. RESULTS: All 25 patients were treated with steroid, and 18 patients received immune globulin at the same time. Symptomatic improvements occurred 1 to 14 days with a mean of 6.9+/-4.0 days after administration of steroids. 6 patients displayed long-lasting sequelae, including 2 patients who relapsed. The average time taken for clinical improvements in various treatment groups were as follows; 7.5+/-2.1 days for group I(N=4), 7.3+/-5.1 days for group II(N=9), and 5.3+/-2.8 days for group III(N=4). Group III showed most rapid recovery without statistical significance. Differences in the rates of relapse and prevalence of neurological sequelae among those groups were statistically insignificant. CONCLUSION: The image detected on MRI and the clinical features of the patients did not differ from these of previously reported studies. The size of the sample was too small to acquire statistically significant results, but the patients who received methylprednisolone and immune globulin showed shortest recovery time, which might necessiate further studies.
Brain ; Central Nervous System ; Child* ; Demyelinating Diseases ; Dexamethasone ; Encephalomyelitis, Acute Disseminated* ; Humans ; Magnetic Resonance Imaging ; Methylprednisolone ; Prevalence ; Recurrence ; Retrospective Studies ; Steroids ; Vaccination

PURPOSE: To evaluate the efficacy and safety of laparoscopic renal cryoablation (LRC) of small endophytic renal cell carcinoma, for which surgical treatment is technically difficult. MATERIALS AND METHODS: We enrolled patients with endophytic tumors from a prospectively collected database of 45 renal tumors in 39 patients who had undergone LRC from June 2005 to May 2009. An endophytic tumor was defined as less than 40% of the lesion extending off the surface of the kidney. We evaluated surgical and oncological outcomes. RESULTS: Among the treated tumors, 17 tumors (37.8%) were defined as endophytic tumors and 15 tumors from 14 patients were confirmed as renal cell carcinoma (RCC) in the pathologic examination of the tissue biopsy that was conducted at the time of LRC. The mean American Society of Anesthesiologists (ASA) score of the whole patient group was 2.9 (range, 1-4), and 85.7% (12/14) of the patients had an ASA physical status score over 3. The mean tumor size was 2.8 cm (range, 1.7-3.7 cm). The layout of the cryoprobe was carefully planned preoperatively on the basis of radiologic evaluation in all tumors. Multiple cryoprobes (mean, 3.2; range, 2-5) were used. No major complications, including open surgical conversion and nephrectomy due to bleeding, occurred. No patient experienced clinical symptoms of collecting system injuries. During the mean follow-up of 32.6 months (range, 12-51 months), radiologic evidence of tumor recurrence was found in one patient (6.7% for RCC). With the exception of this patient, all other patients have remained free of recurrence or metastasis, as determined by periodic radiologic workups. CONCLUSIONS: In this series of patients with intermediate-term follow-up, LRC for endophytic renal cell carcinoma showed acceptable oncological and surgical outcomes without sequelae in the collecting system.
Biopsy ; Carcinoma, Renal Cell ; Cryosurgery ; Follow-Up Studies ; Hemorrhage ; Humans ; Kidney ; Neoplasm Metastasis ; Nephrectomy ; Prospective Studies ; Recurrence