Acute infarction in the whole territory of the middle cerebral artery (MCA) can lead to massive cerebral edema, raised intracranial pressure and cerebral herniation which may result in come and death ultimately. There are same reports which mentioned that craniectomy or stroketomy was an effective life-saving procedure and favorable outcome would be expected after the procedure. In this study, the effect of decompressive partial temporal lobectomy was evaluated in twelve patients of extensive panhemispheric infarction of middle cerebral artery(MCA). We investigated radiologically proven patients of extensive panhemispheric infarction of MCA with impending herniation process, who were admitted to our hospital from March 1991 to June 1996, prospectively and retrospectively. Decompressive partial temporal lobectomy was performed in twelve patients and eighteen patients were treated by only conventional medical treatment(control group). Prognosis were compared between two groups to analyse the effect of the decompressive lobectomy. Fourteen out of the 18 controls(78%) and five out of 12 patients who were treated by decompressive lobectomy(41%) expired due to herniation process. The mortality between two groups was significantly different(P(0.05). Four patient had relatively good outcome(by Barthel index score) and all of them belonged to the decompressive lobectomy group. These results suggest that the decompressive lobectomy be an effective life saving procedure for malignant cerebral edema after a total MCA infarction.
Brain Edema ; Humans ; Infarction* ; Infarction, Middle Cerebral Artery ; Intracranial Pressure ; Middle Cerebral Artery* ; Mortality ; Prognosis ; Prospective Studies ; Retrospective Studies

Small incision cataract surgery using phacoemulsification, self sealing, small diameter optics and foldable intraocular lenses has been developed. These small incisions are designed to minimize the astigmatism induced by the surgery. The 3.5mm clear corneal incision for the implantation of foldable silicone lense has been widely used. However, the implantation of a PMMA lense has been tried in spite of the longer incision required for the unfoldable PMMA lense. Generally, longer incision was believed to increase the risk of infection and induced asigmatism. In this study, we analyzed the results of clear corneal incision between injectable silicone IOLs and 5mm optic PMMA IOLs. In the early postoperative period(to 3 months) vector analysis showed less induced astigmatism in the 3.5mm group than that in the 5.1mm group. The corrected visual acuity during the postoperative period was not diffrent between two groups. The posterior capsular fibrosis in 3.5mm silicone IOLs was more common than that in 5mm PMMA IOLs.
Astigmatism ; Cataract* ; Fibrosis ; Lenses, Intraocular ; Phacoemulsification ; Polymethyl Methacrylate ; Postoperative Period ; Silicones ; Visual Acuity

The adenoid cystic carcinoma in the orbit is rare, but is the most common in the malignancy of the orbit. The clinical signs are proptosis with displacement of the globe downward and inward, limitation of ocular movements and diplopia. The diplopia and ocular pain is due to the tumor metastasis to the extraocular mescle and nerve sheath. The authors have experienced a case of adenoid cystic carcinoma in the right orbit in a 72-year-old man.
Adenoids* ; Aged ; Carcinoma, Adenoid Cystic* ; Diplopia ; Exophthalmos ; Humans ; Neoplasm Metastasis ; Orbit*

Medication-related osteonecrosis of the jaw (MRONJ) is a severe complication associated with antiresorptive or anticancer agents.Surgical intervention is generally recommended for advanced stages, but some patients may be ineligible for surgery due to systemic conditions or anatomical limitations. We present two patients who had been treated for osteoporosis with bisphosphonates and were diagnosed with stage 2 MRONJ. Their chief complaints included refractory pain, purulent discharge, and exposed bone following tooth extraction. Despite conservative treatment, the MRONJ worsened, prompting the initiation of teriparatide therapy. After teriparatide administration, the patients experienced symptom improvement, spontaneous sequestrum removal, and significant bone regeneration of vertical osteolysis. Teriparatide, a bone anabolic agent, is typically recommended as adjuvant therapy alongside surgical treatment for MRONJ. This case report illustrates the effectiveness of teriparatide monotherapy in the absence of surgical intervention, particularly for patients who cannot discontinue antiresorptive agents due to low bone mineral density.

Medication-related osteonecrosis of the jaw (MRONJ) is a severe complication associated with antiresorptive or anticancer agents.Surgical intervention is generally recommended for advanced stages, but some patients may be ineligible for surgery due to systemic conditions or anatomical limitations. We present two patients who had been treated for osteoporosis with bisphosphonates and were diagnosed with stage 2 MRONJ. Their chief complaints included refractory pain, purulent discharge, and exposed bone following tooth extraction. Despite conservative treatment, the MRONJ worsened, prompting the initiation of teriparatide therapy. After teriparatide administration, the patients experienced symptom improvement, spontaneous sequestrum removal, and significant bone regeneration of vertical osteolysis. Teriparatide, a bone anabolic agent, is typically recommended as adjuvant therapy alongside surgical treatment for MRONJ. This case report illustrates the effectiveness of teriparatide monotherapy in the absence of surgical intervention, particularly for patients who cannot discontinue antiresorptive agents due to low bone mineral density.

Medication-related osteonecrosis of the jaw (MRONJ) is a severe complication associated with antiresorptive or anticancer agents.Surgical intervention is generally recommended for advanced stages, but some patients may be ineligible for surgery due to systemic conditions or anatomical limitations. We present two patients who had been treated for osteoporosis with bisphosphonates and were diagnosed with stage 2 MRONJ. Their chief complaints included refractory pain, purulent discharge, and exposed bone following tooth extraction. Despite conservative treatment, the MRONJ worsened, prompting the initiation of teriparatide therapy. After teriparatide administration, the patients experienced symptom improvement, spontaneous sequestrum removal, and significant bone regeneration of vertical osteolysis. Teriparatide, a bone anabolic agent, is typically recommended as adjuvant therapy alongside surgical treatment for MRONJ. This case report illustrates the effectiveness of teriparatide monotherapy in the absence of surgical intervention, particularly for patients who cannot discontinue antiresorptive agents due to low bone mineral density.

Medication-related osteonecrosis of the jaw (MRONJ) is a severe complication associated with antiresorptive or anticancer agents.Surgical intervention is generally recommended for advanced stages, but some patients may be ineligible for surgery due to systemic conditions or anatomical limitations. We present two patients who had been treated for osteoporosis with bisphosphonates and were diagnosed with stage 2 MRONJ. Their chief complaints included refractory pain, purulent discharge, and exposed bone following tooth extraction. Despite conservative treatment, the MRONJ worsened, prompting the initiation of teriparatide therapy. After teriparatide administration, the patients experienced symptom improvement, spontaneous sequestrum removal, and significant bone regeneration of vertical osteolysis. Teriparatide, a bone anabolic agent, is typically recommended as adjuvant therapy alongside surgical treatment for MRONJ. This case report illustrates the effectiveness of teriparatide monotherapy in the absence of surgical intervention, particularly for patients who cannot discontinue antiresorptive agents due to low bone mineral density.

PURPOSE: The aim of this study was to compare the short and long-term outcomes following carotid endarterectomy (CEA) with either primary closure (PC) or patch angioplasty (PAT) performed by single center vascular surgeons. METHODS: Between November 1994 and March 2008, a total of 366 patients underwent 401 consecutive primary CEA procedures at our institution. We retrospectively reviewed patients' medical records. Two vascular surgeons prefer routine PC and one vascular surgeon prefer routine patch closure using bovine pericardial patch. Postoperative neurologic complications were determined by clinical neurologists. Restenosis was defined as >50% stenosis on follow-up duplex scan. Data was analyzed to compare the early (< or =30 days) and late results of CEA between PC group and PAT group. RESULTS: The mean follow-up duration was significantly longer in the PC group than that in the PAT group (61.7 months vs. 41.2 months, P<0.001). Coronary artery disease and combined CEA with coronary artery bypass were more common in the PAT group (39% vs. 55%, P<0.002; 4% vs. 12%, P<0.004). Perioperative ipsilateral TIA/stroke rates in the PC and PAT groups were 1.5% and 0.7% (PC=4/270 vs. PAT=1/131, P=0.564). Regarding late outcomes, Kaplan-Meier analysis failed to show any difference between 2 groups on freedom from ipsilateral transient ischemic attack (TIA)/stroke, freedom from restenosis and TIA/stroke-free survival (P=0.851, P=0.232, P=0.103, log-rank test). CONCLUSION: Our results suggest that PC following CEA is not necessarily inferior to PAT for experienced surgeons.
Angioplasty ; Constriction, Pathologic ; Coronary Artery Bypass ; Coronary Artery Disease ; Endarterectomy, Carotid ; Follow-Up Studies ; Freedom ; Humans ; Ischemic Attack, Transient ; Kaplan-Meier Estimate ; Medical Records ; Retrospective Studies

Ticlopidine is an antiplatelet agent used as a drug to prevent the recurrence of cerebral infarction or ischemic heart disease. Close attention has recently been paid to the superiority of this drug to aspirin in the prevention of stroke. Its mechanism of action differs from aspirin, dipyridamole, and sulfinpyrazone. Inhibition of the adenosine diphosphate induced pathway of platelet aggregation, along with the activation of adenylate cyclase and suppression of platelet-activating factor and thromboxane A2, are the postulated mechanisms of action of ticlopidine. Because ticlopidine causes neutropenia and agranulocytosis in roughly 1% of treated patients, usually within the first 3 months of treatment, this drug has been reserved for patients intolerant to aspirin therapy. We reported two cases of ticlopidine-induced neutropenia and one patient hospitalized with severe neutropenia and pneumonia.
Adenosine Diphosphate ; Adenylyl Cyclases ; Agranulocytosis ; Aspirin ; Cardiovascular Diseases* ; Cerebral Infarction ; Dipyridamole ; Humans ; Myocardial Ischemia ; Neutropenia* ; Platelet Aggregation ; Pneumonia ; Recurrence ; Stroke ; Sulfinpyrazone ; Thromboxane A2 ; Ticlopidine

Ticlopidine is an antiplatelet agent used as a drug to prevent the recurrence of cerebral infarction or ischemic heart disease. Close attention has recently been paid to the superiority of this drug to aspirin in the prevention of stroke. Its mechanism of action differs from aspirin, dipyridamole, and sulfinpyrazone. Inhibition of the adenosine diphosphate induced pathway of platelet aggregation, along with the activation of adenylate cyclase and suppression of platelet-activating factor and thromboxane A2, are the postulated mechanisms of action of ticlopidine. Because ticlopidine causes neutropenia and agranulocytosis in roughly 1% of treated patients, usually within the first 3 months of treatment, this drug has been reserved for patients intolerant to aspirin therapy. We reported two cases of ticlopidine-induced neutropenia and one patient hospitalized with severe neutropenia and pneumonia.
Adenosine Diphosphate ; Adenylyl Cyclases ; Agranulocytosis ; Aspirin ; Cardiovascular Diseases* ; Cerebral Infarction ; Dipyridamole ; Humans ; Myocardial Ischemia ; Neutropenia* ; Platelet Aggregation ; Pneumonia ; Recurrence ; Stroke ; Sulfinpyrazone ; Thromboxane A2 ; Ticlopidine