No abstract available.

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

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

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.
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*

Neurologic complications after open-heart surgery are not only relatively common but also often fatal. In order to know the clinical characteristics and causative risk factors, we carried out the retrospective study on 655 patients who had been admitted and undergone OHS at Seoul National University Children's Hospital during 2-year period from July 1990 to June 1992. The results were as follows; 1) The incidence of neurologic complications after OHS was 4.7% (31 cases) of the total 655 cases. 2) In the viewpoint of the pre-op diagnosis, neurologic complications developed in 20 cases (7.8%) among cyanotic congenital heart disease and in 11 cases (2.9%J among acyanotic CHD. 3) In the viewpoint of the type of operation, the incidence of neurologic complications was 33.3% in Jatene procedure and 12.1% in Fontan procedure. 4) Compared with the group who didn't develp neurologic complications (624 cases), cardiopulmonary bypass time, aorta cross clamp time, and total arrest time were longer and the degree of hypothermia was lower in the group who had neurologic complications (31 cases), which are statistically significant each other(p<0.01). 5) In 25 cases (80.6%), neurologic complications occurred within 72 hours after OHS. 6) Clinical manifestations of neurologic complications were seizures (26 cases, 84%), consciousness change (13 cases, 42%), hemiplegia (1 case), and decreased muscle tone (1 case). 7) Of the 31 cases, 16 cases showed more than one abnormal finding among EEG, Brain CT, or Brain MRI. 8) The possible etiologies of neurologic complications were diffuse hypoxic ischemic encephalopathy (16 cases, 51.6%), focal or multiple ischemic stoke that was thought to be due to microembolisms (3 cases, 9.7%), electrolyte or acid-base imbalance (8 cases, 25.8%), and the remainders were unknown (4 cases. 12.9%) 9) In the course of neurologic complications, 11 cases (35.5%) expired, 14 cases(45.2%) recovered at discharge, 3 cases (9.7%) were controlled at discharge, and 2 cases (6.5%) had long-term sequela(one spastic quadriplegia and one hemiparesis). 10) The cause of death among mortality cases were mainly due to brain damage (7 cases), while 4 cases had other direct causes such as heart failure, respiratory failure, or sepsis.
Acid-Base Imbalance ; Aorta ; Brain ; Cardiopulmonary Bypass ; Cause of Death ; Child* ; Consciousness ; Diagnosis ; Electroencephalography ; Fontan Procedure ; Heart Defects, Congenital ; Heart Failure ; Hemiplegia ; Humans ; Hypothermia ; Hypoxia-Ischemia, Brain ; Incidence ; Magnetic Resonance Imaging ; Mortality ; Muscle Hypotonia ; Quadriplegia ; Respiratory Insufficiency ; Retrospective Studies ; Risk Factors ; Seizures ; Seoul ; Sepsis

PURPOSE: Percutaneous nephroureterolithotripsy is one of alternative methods for the treatment of upper ureteral stones which are impacted in ureter or unresponsive to repeated extracorporeal shock wave lithotripsy(SWL). We evaluated the factors influencing the success rate of percutaneous nephroureterolithotripsy based on clinical data. MATERIALS AND METHODS: 107 patients(2 with bilateral) were included in this study. We reviewed the medical records and analyzed the factors ; stone size, laterality, location, site of percutaneous puncture, presence of pyuria, body weight, previous procedure(open surgery or SWL), and the experience of operator. RESULTS: The overall success rate of percutaneous nephroureterolithotripsy was 85.3%(93 of 109 cases). The location of stone and the experience of operator influenced the success rate of operation. The stones located above the lower pole level were obviously more successful than those located below it(57/62, 91.9% versus 36/47, 76.6%, p<0.05). In the late period of the operator`s experience, the success rate was significantly increased than that in the early period(51/58, 87.9% versus 40/51, 78.4%, p<0.05). But the stone size, laterality, site of percutaneous puncture, presence of pyuria, body weight and previous procedure didn`t influence the success rate. The average operation time was 93 minutes, average radiation exposure time was 2.2 minutes, and average hospital stay was 5.4 days. Most of the complications such as bleeding, urinary tract infection and pneumothorax were managed successfully with conservative treatments. CONCLUSIONS: Upper ureteral stones, which are impacted in ureter or unresponsive to repeated SWL can be successfully managed with percutaneous procedures. The stone location and the experience of operator are considered to be the major factors influencing the success rate.
Body Weight ; Hemorrhage ; Length of Stay ; Medical Records ; Pneumothorax ; Punctures ; Pyuria ; Shock ; Ureter ; Urinary Tract Infections