Follow-Up Studies ; Humans ; Mouth ; Osteotomy, Sagittal Split Ramus ; Prognathism ; Recurrence ; Research Personnel ; Skull Base

Craniosysostosis is a congenital anomaly which should be corrected at an early age. The correction should be both for shape as well as to assure normal growth of the brain. In the past, many patients of craniosysostosis underwent corrective suturectomy only for the purpose of removing constructive forces on the brain. However, recurrence is frequent and further deformity in the shape of the skull and face often develop. The particular patient in this article had undergone a simple suturectomy in the neurosurgery department. For 12 years, he had suffered from not only the deformed shape of the skull but also from medical refractory epileptic convulsions. Therefore, the patient underwent total cranial remodeling for correction of a deformed forehead and skull following correction of the bone contour. Unexpectedly, the epileptic convulsions of the patient markedly improved with the new shape. Based upon these results, the authors suggest that secondary total cranial remodeling can improve the convulsions by affecting the epileptic focus which may have been caused by previous operational scars on the dura.
Brain ; Cicatrix ; Congenital Abnormalities ; Craniosynostoses* ; Forehead ; Humans ; Neurosurgery ; Recurrence ; Seizures* ; Skull

The objective of this paper is to introduce the schematic protocol of radiofrequency (RF) ablation for the treatment of varicose veins. Indication: anatomic or pathophysiologic indication includes venous diameter within 2-20 mm, reflux time > or =0.5 seconds and distance from the skin > or =5 mm or subfascial location. Access: it is recommended to access at or above the knee joint for great saphenous vein and above the mid-calf for small saphenous vein. Catheter placement: the catheter tip should be placed 2.0 cm inferior to the saphenofemoral or saphenopopliteal junction. Endovenous heat-induced thrombosis > or =class III should be treated with low-molecular weight heparin. Tumescent solution: the composition of solution can be variable (e.g., 2% lidocaine 20 mL+500 mL normal saline+bicarbonate 2.5 mL with/without epinephrine). Infiltration can be done from each direction. Ablation: two cycles' ablation for the first proximal segment of saphenous vein and the segment with the incompetent perforators is recommended. The other segments should be ablated one time. During RF energy delivery, it is recommended to apply external compression. Concomitant procedure: It is recommended to do simultaneously ambulatory phlebectomy. For sclerotherapy, it is recommended to defer at least 2 weeks. Post-procedural management: post-procedural ambulation is encouraged to reduce the thrombotic complications. Compression stocking should be applied for at least 7 days. Minor daily activity is not limited, but strenuous activities should be avoided for 2 weeks. It is suggested to take showers after 24 hours and tub baths, swimming, or soaking in water after 2 weeks.
Baths ; Catheter Ablation* ; Catheters ; Consensus* ; Heparin ; Knee Joint ; Lidocaine ; Saphenous Vein ; Sclerotherapy ; Skin ; Stockings, Compression ; Swimming ; Thrombosis ; Varicose Veins* ; Walking

Abrupt increase in the size of cervico-mediastinal tumor due to infection or spontaneous hemorrhage into cyst can induce severe tracheal compression and therefore sudden death. A 5 year old boy, who had a history of URI, had an enlarging cystic hygroma on the right side of the neck and anterior mediastinum. Under diagnosis of the cervico-mediastinal cystic hygroma, surgical removal was scheduled. After induction of anesthesia, intubation was done without any difficulty. A few minutes later, signs of partial airway obstruction were appeared. And within a very short period, total airway occlusion occurred. The tracheal tube was removed and manual ventilation was performed with positive airway pressure, but ineffective. We attempted to puncture cricothyroid membrane with 14 Gauge needle in order to ventilate manually. As soon as we puncture cricothyroid membrane, straw-colored fluid, not air, gushed out through a needle. After aspiration of about 200ml of cystic fluid, the obstructive signs disappeared and the patency of the airway was maintained. Intraoperatively, no more airway problems occured and vital signs were stable. And postoperatively, patient had no specific complications and discharged on the 7th day after operation.
Airway Obstruction* ; Anesthesia ; Child, Preschool ; Death, Sudden ; Diagnosis ; Hemorrhage ; Humans ; Intubation ; Intubation, Intratracheal* ; Lymphangioma, Cystic* ; Male ; Mediastinum ; Membranes ; Neck ; Needles ; Punctures ; Ventilation ; Vital Signs

No abstract available.
Extremities* ; Sarcoma*

Progressive idiopathic atrophoderma of Pasini and Pierini is an asymptomatic atrophic disorder of the skin characterized by sharply demarcated, slightly depressed and slate-gray to brownish patches. The affected skin may be thin but of normal consistency. We herein described a 32-year-old female who showed on the trunk and extremities well-defined, brownish and atrophic areas without induration, but the central portion of the abdominal lesion was slightly thickened. Histopathologic findings showed slight thinning of the epidermis and dermis with mild perivascular infiltrate, however, the central portion of the abdominal lesion showed a focal, slightly sclerotic change of the collagen fibers.
Adult ; Collagen ; Dermis ; Epidermis ; Extremities ; Female ; Humans ; Skin

A 53-year-old man had skin-colored linear serpiginous plaque within brownish patch on his left thigh for one year. He habitually drank natural spring water for 3 years. We diagnosed this case as sparganosis infiltrated within dermis by histologic and parasitologic diagnosis. The skin lesion mimicked the cutaneous larva migrans by showing dermal migration of sparganum to pro-duce itchy linear serpiginous plaque. We report an interesting case of sparganosis mimicking cutaneous larva migrans.
Dermis ; Diagnosis ; Humans ; Larva Migrans* ; Middle Aged ; Natural Springs ; Skin ; Sparganosis* ; Sparganum ; Thigh ; Water

The pleomorphic xanthoastrocytoma is considered as a special subgroup of gliomas because of its distinctive characteristics regarding age, gross and microscopic features, and perhaps, most importantly, the relatively favorable prognosis despite of pleomorphism and bizarre giant cells in the microscopic picture. Because of rarity of this disease entity, we report a case of pleomorphic xanthoastrocytoma with a review of literature.
Giant Cells ; Glial Fibrillary Acidic Protein ; Glioma ; Prognosis

The epidural space is located along the entire spinal column hetween the dural mater and the external dural (periosteal) layer. It contains fat, connective tissue and numerous vessels, primarily veins. It is known that epidural pressure is negative. Negative intrathoracic pressure is thus transfered via the paravertebral spaces to the thoracic epidural spaces and to a diminishing extent to the cervical and lumbar regions. The spread of the anesthetic solution within the epidural spacea is variable according to the patient's physical characteristics such as age, arteriosclerosis according to the patients physical character-sitics such as age, arteriosclerosis, pregnancy, venous circulation and extradural fat. Other factors are under the direct control of the anesthesiologist such as positioning the patient, choosing the site of epidural puncture, orientation of the needle bevel and determining the speed of injection, volume and concentration of anesthetic solution. The epidural pressure (initial negative pr flexion pr., pr. after 10ml lidocaine injection) was measured at the lumbar 3-4 interspace by the hanging drop method. The results were summarized as follows: 1) The negative pressure was meassured in 70 cases and was observed in 95.7 percent. The lowest value was -21 cm. of water in one case and no negative pressures were observed in 2 cases. 2) The pressures after 10 ml injection exhibited three successive components: the peak, the descent and the residual values which were scattered from the injection and were observed more frequently in patients under the age of 50. A slower rate of descent and higher residual pressures were found in older patients. 3) The relationship between height, weight and epidural pressure was not observed. 4) In older patients it was observed that epidural pressures were pulsated along with the heart beats and were moved up and down with the respiratory movement.
Arteriosclerosis ; Connective Tissue ; Epidural Space ; Heart ; Humans ; Lidocaine ; Lumbosacral Region ; Needles ; Pregnancy ; Punctures ; Spine ; Veins ; Water

OBJECTIVES: To determine whether the body weight, body mass index (BMI), and basal serum level of LH, FSH, testosterone (T), dehydroepiandrosterone sulfate (DHEA-S) are related to the ovarian response to clomiphene citrate (CC) in patients with polycystic ovarian syndrome (PCOS). MATERIALS AND METHOD: From January 1996 to June 1997, total 57 patients with PCOS were enrolled in the present study. Women who had other infertility factors were excluded from our study. The ovulation induction using CC was used in all patients. The patients were grouped into 50 mg group, 100 mg group, and 150 mg group according to their daily CC dose. The patients were also grouped to ovulatory and non-ovulatory group. The body weight, BMI, arid basal serum level of LH, FSH, T, DHEA-S were measured in all patients on the 2nd or 3rd day of the menstrual cycle. Results were analysed with Student's t-test and Fisher's exact test. RESULTS: The body weight and BMI of the nonovulating group were significantly higher than those of the ovulating group in all groups (50, 100, 150 mg of CC). However, there were no significant differences of the level of LH and FSH between ovulating and nonovulating groups in all CC groups (50, 100, 150 mg). The level of T of nonovulating group was significantly higher in 50 and 100 mg of CC groups, but not in 150 mg group. The level of DHEA-S of the non-ovulating group is significantly higher in 50 mg group, but not in 100 and 150 mg groups. CONCLUSION: The body weight and BMI could be useful predictors of ovarian response to CC in patients with PCOS, and basal T and DHEA-S also might be useful in cases of low-dose CC treatment.
Body Mass Index ; Body Weight ; Clomiphene* ; Dehydroepiandrosterone Sulfate ; Female ; Humans ; Infertility ; Menstrual Cycle ; Ovulation Induction ; Polycystic Ovary Syndrome* ; Testosterone