PURPOSE: Neonatal seizures are mostly symptomatic and have variable atypical clinical features with very different EEG findings from those of post-neonatal period. This study was performed to determine the common types of epileptiform discharges and their relationship with abnormalities in imaging study in neonates with seizures. METHODS: Fourty one neonates under 7 days of age who had been hospitalized at the Hanyang university hospital from June 1993 to May 1997 were studied retrospectively. Their medical records, results of EEG and brain imaging study were reviewed. RESULTS: 1) The types of neonatal seizures were subtle, generalized tonic, multifocal clonic, focal clonic, myoclonic in order of frequency. 2) The most common epileptiform discharge was excessive sharp transients recorded in 28 cases and the rest showed multifocal spikes, sharp waves, repetitive alpha, repetitive theta in order. Epileptiform discharges appeared on the both hemisphere in 24 cases, right hemisphere in 9 cases and left hemisphere in 8 cases. 3) Imaging study showed no abnormal findings in 27 cases and abnormal findings in 14 cases such as brain edema, intracranial hemorrhage, leukomalacia, subarachnoid hemorrhage, cephalhematoma, craniosynostosis. 4) Among 14 cases with radiological abnormalities, 5 cases had localized abnormalities and 3 of them had the abnormal EEG discharges on the same area concomittantly. But in total only 3 cases of 17 cases with localized epileptiform discharges had abnormalities in imaging study on the same site and so significant relationship between two studies was not observed. 5) As for the prognosis of seizures, subsided in 23 cases without any antiepileptic drugs, 13 cases had no seizure after taking medicine for few days and 5 cases needed continuous antiepileptic drug. CONCLUSION: This study showed no meaningful relationship between abnormal EEG findings and localization by imaging study in neonatal seizure but we concluded that brain imaging study was needed to determine degree of encephalopathy in neonatal seizures.
Anticonvulsants ; Brain Edema ; Craniosynostoses ; Electroencephalography ; Humans ; Infant, Newborn* ; Intracranial Hemorrhages ; Medical Records ; Neuroimaging ; Prognosis ; Retrospective Studies ; Seizures* ; Subarachnoid Hemorrhage

Simultaneous or subsequent bilateral thalamic hemorrhagic events have ranged from 12 to 19 in prior reports, with a time lag between bilateral thalamic hemorrhage of up to two days. Herein, we report the first case of delayed (17 days) consecutive contralateral thalamic hemorrhage after spontaneous first thalamic hemorrhage. A 65-year-old female initially presented with a drowsy mentality with a left-side motor weakness (grade II/III). Brain computed tomography (CT) demonstrated right side thalamic and intraventricular hemorrhage. She regained alertness with mild residual motor weakness (grade III/IV) under medical management. Seventeen days later, a sudden and generalized tonic-clonic seizure developed. Brain CT scans revealed a new contralateral thalamic hemorrhage coincident with microbleeds. Neurologic status remained unchanged, consisting of a stuporous mentality with quadriparesis of grade II/II. We report the first case of delayed consecutive contralateral thalamic hemorrhage up to 17 days after first thalamic hemorrhage. The case highlights the need for close monitoring of patients with thalamic hemorrhage who experience microbleeds on the contralateral side, due to the possibility of delayed hemorrhage.
Aged ; Brain ; Female ; Hemorrhage* ; Humans ; Hypertension ; Intracranial Hemorrhages ; Quadriplegia ; Seizures ; Stupor ; Thalamus ; Tomography, X-Ray Computed

Simultaneous or subsequent bilateral thalamic hemorrhagic events have ranged from 12 to 19 in prior reports, with a time lag between bilateral thalamic hemorrhage of up to two days. Herein, we report the first case of delayed (17 days) consecutive contralateral thalamic hemorrhage after spontaneous first thalamic hemorrhage. A 65-year-old female initially presented with a drowsy mentality with a left-side motor weakness (grade II/III). Brain computed tomography (CT) demonstrated right side thalamic and intraventricular hemorrhage. She regained alertness with mild residual motor weakness (grade III/IV) under medical management. Seventeen days later, a sudden and generalized tonic-clonic seizure developed. Brain CT scans revealed a new contralateral thalamic hemorrhage coincident with microbleeds. Neurologic status remained unchanged, consisting of a stuporous mentality with quadriparesis of grade II/II. We report the first case of delayed consecutive contralateral thalamic hemorrhage up to 17 days after first thalamic hemorrhage. The case highlights the need for close monitoring of patients with thalamic hemorrhage who experience microbleeds on the contralateral side, due to the possibility of delayed hemorrhage.
Aged ; Brain ; Female ; Hemorrhage* ; Humans ; Hypertension ; Intracranial Hemorrhages ; Quadriplegia ; Seizures ; Stupor ; Thalamus ; Tomography, X-Ray Computed

Endotracheal obstruction may cause serious complications, including cardiovascular instability, pneumothorax, pulmonary edema and even brain death. A 21-year-old man was scheduled to undergo an open reduction for an orbital fracture. The patient had tracheostomy with an 8.0 mm tracheostomy tube 3 weeks ago and was breathing well spontaneously. When the cuff of tracheostomy tube was inflated for assisted manual ventilation and the induction of anesthesia, signs of partial endotracheal obstruction were observed, including high airway pressure, low tidal volume and high ETCO2. Large dried mucous plug was impacted in the tracheostomy tube. After removing this plug with a sterile surgical forcep, effective ventilation was recovered without complications. The case like this nearly fatal obstruction by large dried mucous plug was rarely reported, but it should be considered cautiously when a patient uses tracheostomy tube as an airway before general anesthesia.
Airway Obstruction ; Anesthesia ; Anesthesia, General ; Brain Death ; Humans ; Orbital Fractures ; Pneumothorax ; Pulmonary Edema ; Respiration ; Surgical Instruments ; Tidal Volume ; Tracheostomy ; Ventilation ; Young Adult

To expand the epidemiological understanding of Newcastle disease in Jeju Province, Korea, active surveillance was extensively performed through a virological examination for poultry farms and wild birds in Jeju Province during 2007~2008. Samples (swabs or fresh feces) were collected from a total of 6,485 birds including 6,405 domestic birds (chickens, ducks, pheasants, geese, quails, turkeys, and ostriches) and 80 wild birds. A total of 24 hemagglutinating agents were isolated from domestic birds on fourteen farms including five Korean native chicken, one layer chicken, two broiler chicken, four duck and two pheasant farms. The hemagglutinating agents were all identified as lentogenic NDV based on the reverse transcriptase polymerase chain reaction, sequence analysis of amino acids on the F cleavage site and mean death time in chicken embryos. The F gene-based phylogenetic analysis revealed that the NDV isolates were classified into genotypes 1 or 2 of class II. These lentogenic viruses were closely related to NDV vaccine strains used in Jeju Province. Active surveillance conducted for Newcastle disease indicates no scientific evidence of virulent NDV infection in chickens in Jeju Province, Korea since 2005.
Amino Acids ; Animals ; Birds ; Chickens ; Ducks ; Embryonic Structures ; Geese ; Genotype ; Korea ; Newcastle Disease ; Newcastle disease virus ; Poultry ; Quail ; Reverse Transcriptase Polymerase Chain Reaction ; Sequence Analysis ; Turkeys

Hand-foot syndrome is also known as palmar-plantar erythrodysesthesia, and it is a side effect that mostly occurs with chemotherapy or biologic therapy. It is characterized by a painful erythema and edema, which may be followed by dry or moist desquamation of the palms and soles. Mizoribine (MZR) is an imidazole nucleoside that blocks purine biosynthesis. It was found to inhibit both humoral and cellular immunity by selectively inhibiting proliferation of lymphocytes. MZR has been used for preventing renal transplant rejection and treating rheumatoid arthritis, nephritic syndrome and lupus nephritis. The principal adverse reactions are leukopenia, abnormal hepatic function and hyperuricemia. The cutaneous side effects are skin rash, prurigo and epilation, with an incidence of about 1.32%, 0.77% and 0.55%, respectively. To the best of our knowledge, no case of hand-foot syndrome associated with MZR has ever been published. Herein, we report that MZR, which has been widely used, may induce drug-induced hand-foot syndrome.
Arthritis, Rheumatoid ; Biological Therapy ; Edema ; Erythema ; Exanthema ; Graft Rejection ; Hair Removal ; Hand-Foot Syndrome ; Hyperuricemia ; Imidazoles ; Immunity, Cellular ; Incidence ; Leukopenia ; Lupus Nephritis ; Lymphocytes ; Prurigo ; Purines ; Ribonucleosides

Newcastle disease (ND) caused by virulent Newcastle disease virus (NDV) is a highly contagious viral disease of poultry. Virulent NDVs characteristically have a multibasic amino acid sequence (virulence motif) such as (112)RRQKRF(117) at the cleavage site of the precusor fusion (F0) protein. The antigenic and immunogenic characteristics of the virulence motif (112)RRQKRF(117) in the F0 protein of virulent NDVs were investigated. Epitope mapping analysis revealed that a RRQKRF-specific monoclonal antibody 4G2 recognized the KRF section of the motif. A synthetic peptide bearing the RRQKRF motif reacted strongly with sera from virulent NDV (with RRQKRF motif)-infected chickens. These sera also showed reactivity to peptides bearing other virulence motifs ((112)KRQKRF(117), (112)RRQRRF(117) and (112)RRRKRF(117)) but not an avirulence motif ((112)GRQGRL(117)) by ELISA. The synthetic bearing RRQKRF motif reacted with 60% to 91% of sera taken from surviving chickens on ND outbreak farms but not with sera from vaccinated birds, even though most of the sera had antibody to NDV due to vaccination. This indicates that the virulence motif has the potential to differentiate virulent NDV infected birds from vaccinated birds.
Amino Acid Motifs/*immunology ; Amino Acid Sequence ; Animals ; Chickens ; Enzyme-Linked Immunosorbent Assay/veterinary ; Epitope Mapping/veterinary ; Newcastle Disease/*immunology ; Newcastle disease virus/*genetics/pathogenicity ; Poultry Diseases/*immunology/*virology ; Serologic Tests/veterinary ; Viral Fusion Proteins/*genetics/immunology ; Virulence/genetics

BACKGROUND: The relatively recently developed I-gel (Intersurgical Ltd., Workingham, England) is a supraglottic airway device designed for single-use that, unlike conventional LMAs, does not require an inflatable cuff. In addition, the I-gel, much like the Proseal LMA (PLMA), has a gastric drainage tube associated with an upper tube for decompression of the stomach, thereby avoiding acid reflux and decreasing the risk of pulmonary absorption. The purpose of this study was to compare PLMA and I-gel devices in patients undergoing gynecological laparoscopy based on sealing pressure before and during pneumoperitoneum, insertion time, and gas exchange. METHODS: Following Institutional Review Board approval and written informed consent, 30 adult patients were randomly allocated to one of two groups (the PLMA or I-gel group). In each case, insertion time and number of attempts were recorded. After successful insertion, airway leak pressure was measured. RESULTS: Successful insertion and mechanical ventilation with both supraglottic airway devices was achieved on the first attempt in all 30 patients, and there were no significant differences with respect to insertion time. Likewise, leak pressure did not vary significantly either between or within groups after CO2 insufflation. In addition, differences between leak volume and leak fraction between groups were not significant. CONCLUSIONS: The results of our study indicate that the I-gel is a reasonable alternative to the PLMA for controlled ventilation during laparoscopic gynecologic surgery.
Absorption ; Adult ; Decompression ; Drainage ; Equipment Design ; Ethics Committees, Research ; Female ; Gynecologic Surgical Procedures ; Humans ; Informed Consent ; Insufflation ; Laparoscopy ; Pneumoperitoneum ; Respiration, Artificial ; Stomach ; Ventilation

PURPOSE: We assessed the repeatability and reproducibility of abutment teeth dental impressions, digitized with a blue light scanner, by comparing the discrepancies in repeatability and reproducibility values for different types of abutment teeth. MATERIALS AND METHODS: To evaluate repeatability, impressions of the canine, first premolar, and first molar, prepared for ceramic crowns, were repeatedly scanned to acquire 5 sets of 3-dimensional data via stereolithography (STL) files. Point clouds were compared and the error sizes were measured (n=10, per type). To evaluate reproducibility, the impressions were rotated by 10-20° on the table and scanned. These data were compared to the first STL data and the error sizes were measured (n=5, per type). One-way analysis of variance was used to assess the repeatability and reproducibility of the 3 types of teeth, and Tukey honest significant differences (HSD) multiple comparison test was used for post hoc comparisons (α=.05). RESULTS: The differences with regard to repeatability were 4.5, 2.7, and 3.1 µm for the canine, premolar, and molar, indicating the poorest repeatability for the canine (P<.001). For reproducibility, the differences were 6.6, 5.8, and 11.0 µm indicating the poorest reproducibility for the molar (P=.007). CONCLUSION: Our results indicated that impressions of individual abutment teeth, digitized with a blue light scanner, had good repeatability and reproducibility.
Bicuspid ; Ceramics ; Crowns ; Molar ; Tooth