Zonisamide was administered to 20 patients with refractory epileptic seizures. The mean duration of the administration was 6 months, and the mean dosage was 7.2 mg/kg/day. The efficacy of zonisamide was rated remarkable in 15% of the cases, improvement in 40%, and no change in 45%. The response rates of zonisamide were 62.5% for myoclonic seizures, 50% for tonic-clonic seizures, 80% for atonic seizures and 33.3% for atypical absence seizures. There was no correlation between the clinical response and dose or serum concentration of the drug. The adverse effects were observed in 35% of the cases which were drowsiness, dizziness, ataxia, nausea, and vomiting. In all cases, however, the administration of zonisamide could be continued.
Ataxia ; Child* ; Dizziness ; Epilepsy* ; Epilepsy, Absence ; Humans ; Nausea ; Seizures ; Sleep Stages ; Vomiting

Leiomyosarcoma arising in the skin is rare tumor, and diagnosis usually is made microscopically. After local excision, these lesions recur in large proportion of pat ients. The authors herein report a 53-year-old male with leiomyosarcoma appeared in the skin of the right forearm and presenting as a dark reddish colored, 5*6cm in diameter, superficial ulcerated single firm nodule with intermittent pain. Histopathological examination showed poorly circumscribed tumor consisting of interlacing bundles of spindle shaped smooth muscle cells in the middle and lower parts of the dermis. The nuclei were hyperchromatic, large, vacuolated, and irregular in shape. Electron microscopic findings revealed cytoplasmic organelles such as rough endoplasmic reticulum and mitochondria of malignant smooth muscle cells in the paranuclear area, Characteristic subsarcoelmmal caveolae and dense plaque were noted and myofilaments were distributed in the peripheral cytoplasm. The tumor did not recur in 10 months' follow-up.
Caveolae ; Cytoplasm ; Dermis ; Diagnosis ; Endoplasmic Reticulum, Rough ; Follow-Up Studies ; Forearm ; Humans ; Leiomyosarcoma* ; Male ; Middle Aged ; Mitochondria ; Myocytes, Smooth Muscle ; Myofibrils ; Organelles ; Skin* ; Ulcer

No abstract available.

To evaluate the progress of clinical and histopathological changes of dermat ophytosis caused by M. gypseum, its inoculation study was done in 16 male New Zealand white rabbits(control: 4, innoculation : l2). The results were as follows . Clinically Initial erythema, scales, and crusts developed in 1 week after inoculation. They reached maximum severity on the 14th to 18th day and disappeared on the 25th to 44th day after inoculation. I-Iist,opathologically : The earliest findings were mild focal acanthosis and for al vascular ilatations and cellular infiltrations of the papillary dermis on the 4th day after inoculation. Their severity increased to the moderate degree until the. 8th day when mild hyperkeratosis was notec1, and lasted to the 13th day, Maximum degree of the findings including parakiratosis, intraepidermal microabscesses and middermal changes was seen on the 16th to 22nd day, and disapveared gradually between the 25th day and the 46th day. Hyphae and spores were founil on the PAS stainings until the 22nd clay. M. gypseum was not cultured from the lesions after the 25th day. seven of 10 rabbits injected intradermally with trichophytons became positive in 2 to 4 weeks after inoculation. All these findings suggest that the maximum inflammatory response is the result of immunologic reaction and the increased epidermal turnover rate may play a. major role in the shedding of remained fungi of the horny layer.
Dermis ; Erythema ; Fungi ; Humans ; Hyphae ; Male ; Microsporum* ; New Zealand ; Rabbits* ; Spores ; Trichophyton ; Weights and Measures

No abstract available.
Drainage* ; Prognosis*

Percutaneous endoscopic surgery for the treatment of upper urinary tract stone or stricture has proved less invasive, reliable and safe with results comparable to open surgery. Because this contains many procedures, however, one can expect complications at some extents. Between 1987 and 1994, 410 percutaneous endoscopic procedures - PNL (330 cases), endopyelotomy (40 cases), endoinfundibulotomy (24 cases), endoureterotomy (10 cases), nephropexy (6 cases) - were performed by three operators in one hospital. The incidence of complication was evaluated and compared statistically. Overall complication rates were 23.6% and there was no mortality. Bleeding necessitating transfusion (7.6%) and fever (7.1%) were the most frequent complications. Other complications included renal pelvis or ureteral perforation (6.8%), paralytic ileus (2.9%), sepsis (0.7%), pneumothorax (0.7%), stent migration (0.7%), atelectasis (0.2%), ureteral stricture (0.2%), colon perforation (0.2%). Surgical interventions for the management of complication included nephrectomy (2 cases) for uncontrolled bleeding, and open repair for colon perforation (1 case). Renal artery embolization stopped the delayed bleeding in one case. Data on complications occurring before and after the first 50 cases indicated a statistically significant decrease in complications (p<0.005). These complications could be attributed to inexperience, improper technique, underlying pathologic conditions, and anatomic variants. As might be expected, the complication rate was much lower on later cases according to the increasing experience and improved technique. Based on our accumulated experience, the experience with more than 50 procedures could be needed to minimize complications.
Colon ; Constriction, Pathologic ; Endoscopy ; Fever ; Hemorrhage ; Incidence ; Intestinal Pseudo-Obstruction ; Kidney Pelvis ; Mortality ; Nephrectomy ; Pneumothorax ; Pulmonary Atelectasis ; Renal Artery ; Sepsis ; Stents ; Ureter ; Urinary Calculi

PURPOSE: Traumatic brain injury is a multifaceted injury that involves direct mechanical damage, intraparenchymal and subarachnoid hemorrhage, breakdown of the blood-brain barrier, excitotoxicity, and ischemia. Even though much investigations were performed, acceptable mechanical informations were rare. The aim of this study was to reveal the expression pattern of intermediate filament proteins associated with gliotic scars in cerebral cortex of rats after cryoinjury. METHODS: A total of 18 male Sprague-Dawley rats weighing 300 g, 2 months old, were used throughout the experiments. To injure the brain, rats were anesthetized for surgery with 3.5% chloral hydrate(1 mL/100 g, intraperitoneally); the frontal bones were exposed by elevating the skin; and craniectomies were performed adjacent to the central suture, midway between lambda and bregma. A cryoinjury was then created by applying a cold probe(3-mm-diameter steel rod chilled in liquid nitrogen) to the left frontal cortex(ipsilateral cortex) for 1 min. Rats were sacrificed at 1, 4, 7 and 14 days postsurgery(n=3, per time point), and three rats were sacrificed as normal controls. Serial brain cryosections were made by cryostat. For immunohistochemistry, brain tissue sections were allowed to react with mouse anti-rat GFAP antibody(1:200), mouse anti-rat vimentin antibody(1: 200), and mouse anti-rat nestin antibody(1:200). RESULTS:Reactive astrocytes expressing GFAP, vimentin and nestin appeared for the first time at 6 hours after cryoinjury. Proliferation of GFAP and nestin positive cells started at 1 day after cryoinjury, reached its maximum on day 4, and returned to normal level after the 7th post-injured day. Proliferation of vimentin positive cells started at 1 day after cryoinjury, reached its maximum on day 4, and returned to normal level after the 14th post-injured day. Characteristic morphological changes in reactive astrocytes were seen at 4 days after cryoinjury. CONCLUSION: The above results suggest that GFAP, vimentin and nestin positive cells attend in the formation of gliotic scars.
Animals ; Astrocytes ; Blood-Brain Barrier ; Brain ; Brain Injuries ; Cerebral Cortex ; Chloral Hydrate ; Cicatrix ; Cold Temperature ; Frontal Bone ; Humans ; Immunohistochemistry ; Intermediate Filament Proteins ; Intermediate Filaments ; Ischemia ; Male ; Mice ; Nerve Tissue Proteins ; Rats ; Rats, Sprague-Dawley ; Steel ; Subarachnoid Hemorrhage ; Sutures ; Vimentin

No abstract available.
Extremities* ; Osteogenesis* ; Ultrasonography*

PURPOSE: Hypothalamic hamartomas are non-neoplastic malformations which are composed of hyperplastic neuronal tissue of varying size. Clinically, they are characterized by gelastic seizure, precocious puberty, and behavioral and psychiatric disorders. This study was performed to examine the various features of hypothalamic hamartomas such as neurologic manifestations, other clinical manifestations, and EEG and brain MRI findings. Response to AEDs or outcome of operation on hypothalamic hamartoma was evaluated. METHODS: Eleven patients who were admitted to Seoul National University Children's Hospital from July 1986 to January 1997 and diagnosed as hypothalamic hamartoma by brain MRI or CT were enrolled in this study. Clinical manifestations and EEG were reviewed retrospectively through the medical records. The size and type of the hypothalamic hamartoma on brain MRl were analyzed. RESULTS: 1) The range of age at visit was 1yr 9mo to 17yr 2mo (mean 10yr 8mo), and the age at onset was 1yr 1mo to 14yr to 2mo (mean 5yr 8mo). Six patients were male and five were female. 2) The clinical manifestations included gelastic seizure (n=9), behavioral and psychiatric disorders (n=9), other types of seizure (n=8), and precocious puberty (n=6). Other types of seizure were complex partial seizure (n=3), generalized tonic seizure(n=3), and infantile spasm (n=2). 3) The interictal EEG findings included focal spike discharges (n=8), diffuse delta slowings (n=1), hypsarrhythmia (n=1), and normal record (n=1). The focal spike discharges originated from the temporal (n=2), fronto-temporal (n=1), occipital (n=3), or frontal area(n=2). 4) The brain MRI showed that the size of the hypothalamic hamartomas was 2.47+/-1.12cm, and the origin of the tumors was tuber cinereum (n=6) or tuber cinereum and mamillary body (n=5). All lesions were isointense on T1-weighted image relative to normal gray matter, with a sessile attachment to the hypothalamus, and were not enhanced by Gadolinium. 5) Operations were done in 5 cases, those were subtotal removal of the tumor (n=4), and gamma knife radiosurgery (n=1). Seizures were not completely controlled in all but one case on which gamma knife radiosurgery was done. CONCLUSIONS: The hypothalamic hamartomas presented variable clinical pictures including gelastic seizure, precocious puberty, and behavioral and psychiatric disorders. The gelastic and other types of seizure associated with hypothalamic hamartomas were refractory to medication and might be controlled by total removal of the tumor.
Brain ; Electroencephalography ; Female ; Gadolinium ; Hamartoma* ; Humans ; Hypothalamus ; Infant ; Infant, Newborn ; Magnetic Resonance Imaging* ; Male ; Mamillary Bodies ; Medical Records ; Neurologic Manifestations ; Neurons ; Puberty, Precocious ; Radiosurgery ; Retrospective Studies ; Seizures ; Seoul ; Spasms, Infantile ; Tuber Cinereum

Meniscal tears are a common source of knee pain in military personnel. We aimed to investigate the arthroscopic findings of isolated meniscal tears in soldiers younger than 30 years of age. Between May 2011 and April 2014, a total of 36 soldiers with 37 knees who underwent arthroscopic surgeries for isolated meniscal tears were included in this study. All patients were male soldiers and average age was 22 years (range, 19 to 30 years). Thirty patients (83%) were identified as having trauma in sports activity or military training, but no definite trauma was documented in six patients. We analyzed whether medial or lateral meniscus, the location and type of tear according to the arthroscopic findings. The incidence of meniscal tears was nearly same for both knees (right 18 and left 19). Twenty-six of 37 tears (70%) were found in the lateral meniscus and 11 (30%) in the medial meniscus. Twenty-five tears (68%) were located in mid body and traumatic vertical type tears (65%) were more common than degenerative horizontal type tears (35%). Although our study based on relatively small cohort, isolated meniscal tears in young soldiers were usually resulted from trauma such as sports or ranger training and commonly located in lateral meniscus. Regarding the type of tear, traumatic vertical type was more common than degenerative horizontal type.
Arthroscopy ; Cohort Studies ; Humans ; Incidence ; Knee ; Male ; Menisci, Tibial ; Military Personnel* ; Sports ; Tears*