Claude syndrome is a well known midbrain syndrome which is characterized by ipsilateral oculomotor nerve palsy and contralateral cerebellar ataxia by the lesion of the red nucleus. Although this syndrome was reported as early as in 1924 by Claude, only a few cases have been reported. Moreover, the midbrain infarction as a cause of Claude syndrome has quite rarely been described. Firstly, we report a 61-year-old patient with partial oculomotor nerve palsy and contralateral cerebellar ataxia who demonstrated an infarction just caudal to the red nucleus on MRI. Secondly, we also discuss the probable vertical fascicular arrangement of the oculomotor nerve in the midbrain.
Brain Stem Infarctions* ; Cerebellar Ataxia ; Humans ; Infarction ; Magnetic Resonance Imaging ; Mesencephalon* ; Middle Aged ; Oculomotor Nerve ; Oculomotor Nerve Diseases ; Red Nucleus

PURPOSE: Flow interruptor high frequency ventilator(HFV) on neonatal respiratory failure caused by various disorders has been applied in order to assess its therapeutic effect and safety. METHODS: Premature babies below 1.8kg with respiratory failure from 1991 to 1997 in the Fatima neonatal intensive care unit(NICU) for 6 year and 4 months are included. Flow interruptor HFV with low intermittent mandatory ventilation(IMV) has been applied in 74 cases. If clinical symptom and arterial blood gas analysis(ABGA) became stable for 6-12 hrs, we started weaning aggressively. RESULTS: Mean duration of HFV with low IMV was 5.4 4 days. Initial success rate of weaning was 63 cases(85.1%). Weaning failure rate was 11 cases(14.9%). Six cases was due to underlying sepsis. Four cases was caused by pneumothorax and one case resulted from patent ductus arteriosus(PDA) with congestive heart failure(CHF). Complication of HFV with combined low IMV was 5 cases of pneumothorax, 4 cases of grade III intraventricular hemorrhage and one case of bronchopulmonary dysplasia(BPD). Eleven cases of stage III or more retinopathy of prematurity(ROP) and 5 cases of periventricular leukomalasia(PVL) were confirmed. CONCLUSION: Flow interruptor HFV with low IMV can be used safely as conventional mechanical ventilators in the case of respiratory failure caused by various disorders. If MAP has been adjusted appropriately, incidence of pneumothorax and BPD are expected to diminish by aggressive weaning as clinical symptom become stable.
Estrogens, Conjugated (USP) ; Heart ; Hemorrhage ; High-Frequency Ventilation* ; Incidence ; Infant, Newborn ; Intensive Care, Neonatal ; Pneumothorax ; Respiratory Insufficiency* ; Sepsis ; Ventilators, Mechanical ; Weaning

PURPOSE: Early surfactant therapy with either gentle ventilation, high-frequency ventilation or aggressive weaning of mechanical ventilation are principles for the treatment of respiratory distress syndrome(RDS). We studied to determine the accessibility of noninvasive nasal continuous positive airway pressure(CPAP) rather than mechanical ventilation by invasive intubation after early surfactant therapy. METHODS: The study group consisted of 14 infants who were born and diagnosed with moderate respiratory distress syndrome and received early surfactant therapy with nasal CPAP of PEEP 5-6 cm H2O within two hours after birth in the Fatima neonatal intensive care unit for two years from January 1999 to August 2001. The control group consisted of 15 infants who were diagnosed with the disease and could be weaned from mechanical ventilator within five days after birth during the same period. RESULTS: The characteristics, the severity of clinical symptoms and laboratory findings in the two groups at birth showed no significant difference. Neither did the interim analysis of laboratory data in two groups. Of 14 infants in the study group who received nasal CPAP after early surfactant therapy, only two infants showed weaning failure with this therapy. In the response cases, duration of CPAP was five days and mean airway pressure was 5.4+/-0.5 cm H2O. Two had the complication of CPAP with abdominal distension. Final complications and outcomes in the two groups showed no signifcant difference(p>0.05). CONCLUSION: The clinical courses in the two groups showed no significant difference. Therefore, we suggest that early surfactant therapy with noninvasive nasal CPAP is a simple and safe method rather than aggressive weaning after invasive mechanical ventilation in moderate respiratory distress syndrome.
Continuous Positive Airway Pressure* ; High-Frequency Ventilation ; Humans ; Infant ; Infant, Newborn ; Intensive Care, Neonatal ; Intubation ; Parturition ; Respiration, Artificial ; Ventilation ; Ventilators, Mechanical ; Weaning

PURPOSE: This study was conducted to determine the correlation between the incidence of chronic lung disease and the combined use of gentle ventilation and high-frequency ventilation. METHODS: The subject group consisted of 63 very low birthweight infants of less than 1500gm who were born and survived through ventilator treatment in the Fatima neonatal intensive care unit for four years from January 1995 to December 1998. The analysis was performed retrospectively with medical records. Ventilator treatment was based on the combined use of gentle ventilation and high-frequency ventilation by means of the flow interruptor type of Infant star. High- frequency ventilation was carried out for 24 hours after surfactant replacement, when PaCO2 exceeded 60mmHg, or if the period of gentle ventilation exceeded one week. When the results of arterial blood gas analysis and the state of the body became stable, the aggressive weaning was performed. RESULTS: For 49(77.8%) of 63 infants, the weaning was possible within seven days. The other 14 infants(22.2%) needed ventilator treatment for more than seven days. The mean duration of ventilator treatment was 12.3 days. The causes of weaning failure included sepsis, patent ductus arteriosus, chronic lung disease, and intraventricular hemorrhage. Two infants who had received ventialtor treatment for more than two weeks were found to have incidence of chronic lung disease. CONCLUSION: It is suggested that the combined use of gentle ventilation and high-frequency ventilation can help reduce pulmonary damage, and it will be important to shorten the period of ventilator treatment.
Blood Gas Analysis ; Ductus Arteriosus, Patent ; Hemorrhage ; High-Frequency Ventilation ; Humans ; Incidence* ; Infant ; Infant, Newborn ; Intensive Care, Neonatal ; Lung Diseases* ; Lung* ; Medical Records ; Retrospective Studies ; Sepsis ; Ventilation* ; Ventilators, Mechanical ; Weaning

PURPOSE: Surgery remains the only curative option for patients with extrahepatic bile duct cancer (EHBD Ca). But, long-term survival is typically not good because of the advanced stage of disease at the time of diagnosis and frequent disease recurrence after surgical resection. The purpose of this study was to evaluate factors that influence survival and recurrence after surgical resection of EHBD Ca. METHODS: A retrospective analysis of 113 patients who had received surgical resection for EHBD Ca between 2004 and 2009 was done. We investigated histopathological features, and survival and recurrence rates, and evaluated prognostic factors affecting survival and disease recurrence after surgical resection. RESULTS: Overall survival rates for 1, 3 and 5 years were 73.2%, 42.8%, and 36.0% respectively. In univariate analysis, prognostic factors influencing survival were histologic differentiation, T stage, lymph node (LN) metastasis, TNM stage, perineural invasion (PNI), lymphovascular invasion (LVI) and resection margin state. Among them, LN metastasis, PNI and resection margin state were found to be independent prognostic factors for overall survival in multivariate analysis. Recurrence occurred in 44 patients (48.9%) and disease-free survival rates were 50.6% at 1 year and 38.3% at 3 year. Univariate analysis revealed that histologic differentiation, T stage, LN metastasis, TNM stage, PNI and LVI were significantly associated with recurrence. In multivariate analysis, only LN metastasis was found to be a significant independent predictor of recurrence. CONCLUSION: LN metastasis, PNI and positive resection margin were significant prognostic factors affecting survival. LN metastasis was found to be a significant independent predictor of recurrence in surgical resection of EHBD Ca.
Bile ; Bile Duct Neoplasms ; Bile Ducts ; Bile Ducts, Extrahepatic ; Disease-Free Survival ; Humans ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies ; Survival Rate