Persistent pupillary membrane ia a congenital anomaly which waa resulted from incomplete atrophy of the fetal vascular arcades and its associated mesodermal tissue derived from the primitive annular vessels. Authors experienced a case (female, 17 years old) of thick persistent pupillary membrane of both eyes which were required complete removal of these membranes under operating microscope. Her corrected vision has improved up to 0.5 (Rt. eye) from 0.1 and 0.7 (Lt eye) from 0.2 without diplopia after operation.
Atrophy ; Diplopia ; Membranes* ; Mesoderm

The omentum has been used over the years for a variety of clinical problems. Recently it has shown that placing the omemtum on the brain and spinal cord can lead to an extensive development of vascular connections at the omental/CNS interface. Success with omental transposition to the human brain has led to increasing intreast in placing the omentum onto the human spinal cord. One paraplegic patient was chosen to enter into a feasibility study to see if omental transposition to their spianl cord might result in clinical benefit. The length of time from injury was about 21 months respecively. This patient had little, if any, motor and sensory function below umbilicus level. The operation required surgical lengthening of the pedicled omentum followed by its placement into a subcutaneous tunnel created backward along the lateral chest wall up to T-10, 11 level. An extensive thoracic laminectomy was then performed followed bya wide opening of the dura. In our case the cord showed segmental shrinkage of the spinal cord consistent with previous trauma. The omentum was laid directly onto the underlying spinal cord. Our observation for five months has shown that placement of the omentum onto the chronically injured spinal cord allowed for subsequent improvement in neuroelectrical activity, as manifested by reproducible somatosensory evoked potentials, and, more importantly, in moter function. It is considered that placing the omentum directly upon the brain or spinal cord may have the effect of either improving local vascular perfusion or, possibly, exerting some biochemicals(neurotransmitter), or as yet unknown, influence. But further observation is warranted to determine whether this improvement will be continued and will be observed in another cases.
Brain ; Evoked Potentials, Somatosensory ; Feasibility Studies ; Humans* ; Laminectomy ; Neurotransmitter Agents ; Omentum ; Perfusion ; Sensation ; Spinal Cord ; Spinal Cord Injuries ; Thoracic Wall ; Umbilicus

Cleft Lip ; Congenital Abnormalities ; Humans ; Palate ; Rhinoplasty

PURPOSE: This study aims to investigate preexposure prophylaxis and postexposure prophylaxis of rabies that the National Medical Center (NMC) handled and to check whether appropriate measures were performed according to the recent domestic and overseas guidelines after animal bites. METHODS: This study surveyed 41 people who were 18 years or under and received preexposure and postexposure prophylaxis of rabies at the NMC from November 2006 to December 2011. Their medical records were reviewed for their age, gender, the reason for preexposure prophylaxis, the body sites of animal bite, the kind of the animal that bit children, the region where the biting occurred and rabies vaccination and inoculation of immunoglobulin. RESULTS: Eleven children took rabies vaccination for preexposure prophylaxis and 30 children received post exposure prophylaxis of rabies. Of patients who were bitten by unvaccinated animals including wild animals or by animals which were not certain to be vaccinated, 50% (13 of 26 children) received postexposure prophylaxis, while 75% (3 of 4 children) of patients who were bitten by vaccinated animals received postexposure prophylaxis of rabies. Ten of 30 bitten patients knew whether or not the biting animals had received rabies vaccination. Of them, four people (40%) were bitten by animals which had received rabies vaccination. CONCLUSION: To prevent the occurrence of rabies, people and health care providers need to correctly understand latest guideline for rabies preexposure and postexposure prophylaxis and the information for bitten patient, biting animal and area at bitten by animal should be accurately recorded.
Animals ; Animals, Wild ; Bites and Stings ; Child ; Child Health ; Health Personnel ; Humans ; Isothiocyanates ; Medical Records ; Post-Exposure Prophylaxis ; Rabies ; Vaccination

Malignant melanoma of the spinal cord is a rare tumor 3,8,9,12 The melanomas that originate in the meninges bear a general structural resemblance to those arising elsewhere, but it is questionable whether they ever metastasis outside the central nervous system7. If can be also argued that the primary central nervous system melanoma could actually be a metastasis from an occult primary site in the skin, esophagus, rectum or other sites6. We are reporting a case of malignant melanoma involving the cervical spinal meninges and hard palate.
Central Nervous System ; Esophagus ; Melanoma* ; Meninges ; Neoplasm Metastasis ; Palate, Hard ; Rectum ; Skin ; Spinal Cord*

Most popular incisions for open reduction of mandibular condylar fractures are submandibular approach, preauricular approach, Risdon approach, and retromandibular approach etc. These methods are selected according to the location of condylar fracutre, condylar segments displacement, and preference of the surgeon. We performed the open reduction and rigid fixation by means of retromandibular approach for the treatement of mandibular condyle fracture in the 9 patients (8 cases were performed by direct reduction and rigid fixation, and 1 case was performed by Dr. Nam's method). The retromandibular approach has many advantages. This is more easier approach to the fracture site, better visibility and accessibility, less wound exposure, less muscle retraction, and more comfortable to patient because lesser sensory and motor nerve injury.
Humans ; Mandibular Condyle* ; Wounds and Injuries

BACKGROUND: Intravenous anesthetics such as propofol and ketamine have been known to have neuroprotective effects. However, the combination of these drug is not known. This study was conducted to determine the neuroprotective effects of propofol, ketamine or both after transient forebrain ischemia. METHODS: Twenty Sprague-Dawley rats (250-300 gm) were used. Anesthesia was induced with 4% isoflurane in oxygen and then maintained with 1 - 2% isoflurane in oxygen. Ischemic injury was induced by 10 minutes of both common carotid artery ligation and hypotension (MAP < 50 mmHg). All rats were randomly divided into four groups: group I; control group; group II; ketamine 10 mg/kg was administered 10 minutes before injury; group III; propofol (1 mg/kg/min) was administered until EEG isoelectricity; and group IV; ketamine 10 mg/kg and propofol 1 mg/kg/min was administered. The Rectal temperature was maintained at 38oC. After forebrain ischemia, neurologic scores were estimated at 1 hr, 2 hrs, 1 day and 2 days after recovery. The brain was removed 3 days after and stained with H-E stain. RESULTS: Neurologic and histologic scores of group II, III, IV were significantly lower than that of group I. However, there were no significant difference between group II, III and IV. CONCLUSIONS: Ketamine and propofol have neuroprotective effects in transient forebrain ischemia in rats. However, the combination of propofol and ketamine did not show any synergistic or additive effects.
Anesthesia ; Anesthetics, Intravenous ; Animals ; Brain ; Carotid Artery, Common ; Electroencephalography ; Hypotension ; Ischemia* ; Isoflurane ; Ketamine* ; Ligation ; Neuroprotective Agents* ; Oxygen ; Propofol* ; Prosencephalon* ; Rats* ; Rats, Sprague-Dawley

This report describes three cases of large arteriovenous malformation which were removed totally with two stage operation. When a large arteriovenous malformtaion had to be removed, prediction of profuse bleeding and brain swelling could be made. We clipped large feeding arteries and arteires and made a cleft around the AVM during the first operation, and the progressive reduction of the shunt flow by clipping the dominant peduncles on after the other diminished the risk of profuse bleeding and brain swelling. 7 to 10 days later, we removed AVM totally as the second operation. All three lesions were resected by microsurgical techniques, and the results were excellent. The rationale for the two stage operation for large cerebral AVM is discussed.
Arteries ; Arteriovenous Malformations ; Brain Edema ; Hemorrhage ; Intracranial Arteriovenous Malformations*

BACKGROUND: The long-term survival after operation of patients with lung cancer invading the chest wall is known to be related to regional nodal involvement, completeness of resection and depth of chest wall involvement. In this study results of complete resection are reviewed to determine survival charateristics. MATERIAL AND METHOD: Of 680 consecutive patients who were operated on for primary non-small cell carcinoma between 1988 and 1998, we retrospectively reviewed 55 patients(8.0%) who had complete resection for lung cancer invading the chest wall or parietal pleura. RESULT: Resection of the chest wall was en bloc in 29 patients(47.3%), and extrapleural in 26(52.7%). In the patients undergoing extrapleural resection, the depth of chest wall invasion was confined to the parietal pleura in all patients(100%). In the patients underging en bloc resection, the pathologic depth of invasion was into the parietal pleura alone in 9(31.0%) and into the chest wall in 20(69.0%). The follow-up rate of these patients was 100%. Hospital mortality was 5.4%(n=3). The actuarial 5-year survival rate was 26% for all hospital survivors(n=52). The actuarial 5-year survival rate of patients with T3N0M0 disease(29%) was better than that of T3N2M0 disease(18%), however, there was no significant(p=0.30) difference. The depth of chest wall invasion had no statistically significant effect on survival in our series, neither for patients with involved lymphatic metastasis nor for those without(p=0.99). CONCLUSION: These observations indicate that the good five year survival in patients with T3 NSCLC invading the chest wall resulted from complete resection. Survival of patients with lung cancer invading the chest wall after complete resection is dependent on the extent of nodal involvement and much less so on the depth of chest wall invasion.
Carcinoma, Non-Small-Cell Lung* ; Follow-Up Studies ; Hospital Mortality ; Humans ; Lung Neoplasms ; Lymphatic Metastasis ; Pleura ; Retrospective Studies ; Survival Rate ; Thoracic Wall* ; Thorax*

OBJECTIVE: Hydrocephalus is a common sequelae of aneurysmal subarachnoid hemorrhage (SAH) and patients who develop hydrocephalus after SAH typically have a worse prognosis than those who do not. This study was designed to identify factors predictive of shunt-dependent chronic hydrocephalus among patients with aneurysmal SAH, and patients who require permanent cerebrospinal fluid diversion. METHODS: Seven-hundred-and-thirty-four patients with aneurysmal SAH who were treated surgically between 1990 and 2006 were retrospectively studied. Three stages of hydrocephalus have been categorized in this paper, i.e., acute (0-3 days after SAH), subacute (4-13 days after SAH), chronic (> or =14 days after SAH). Criteria indicating the occurrence of hydrocephalus were the presence of significantly enlarged temporal horns or ratio of frontal horn to maximal biparietal diameter more than 30% in computerized tomography. RESULTS: Overall, 66 of the 734 patients (8.9%) underwent shunting procedures for the treatment of chronic hydrocephalus. Statistically significant associations among the following factors and shunt-dependent chronic hydrocephalus were observed. (1) Increased age (p < 0.05), (2) poor Hunt and Hess grade at admission (p < 0.05), (3) intraventricular hemorrhage (p < 0.05), (4) Fisher grade III, IV at admission (p < 0.05), (5) radiological hydrocephalus at admission (p < 0.05), and (6) post surgery meningitis (p < 0.05) did affect development of chronic hydrocephalus. However the presence of intracerebral hemorrhage, multiple aneurysms, vasospasm, and gender did not influence on the development of shunt-dependent chronic hydrocephalus. In addition, the location of the ruptured aneurysms in posterior cerebral circulation did not correlate with the development of shunt-dependent chronic hydrocephalus. CONCLUSION: Hydrocephalus after aneurysmal SAH seems to have a multifactorial etiology. Understanding predisposing factors related to the shunt-dependent chronic hydrocephalus may help to guide neurosurgeons for better treatment outcomes.
Aneurysm ; Aneurysm, Ruptured ; Animals ; Cerebral Hemorrhage ; Hemorrhage ; Horns ; Humans ; Hydrocephalus ; Meningitis ; Prognosis ; Retrospective Studies ; Subarachnoid Hemorrhage ; Ventriculoperitoneal Shunt