PURPOSE: Neurofibromatosis(NF) is an autosomal- dominant systemic disease. Up to fifty percent of patients with NF are reported to have concomitant vascular abnormalities. In the resection of a larger NF, the risk of uncontrolled hemorrhage is much higher due to the difficulty of hemostasis of large vessels within the tumor. We ligated the base of the giant NF with a simple loop- shaped ligation before removal of the giant NF in both buttocks. And then we successfully reduced the amount of hemorrhage during the operation. METHODS: A 46-year-old female patient presented for giant masses of both gluteal area, which has been growing slowly for the last ten years. Each mass was about 30x20 cm in size. After designing the elliptical resection margin, we tightened the tumor base by using continuous loop- shaped suture ligation(weaving the thread up and down in a loop-shaped pattern, leaving a space of 2cm between each loop) with a straight needle and prolene 2-0. After skin incision, we proceeded the dissection toward the central and inferior side of the mass obliquely while we avoided breaking large vascular sinuses. We resected the tumor in a wedged-shape. Subcutaneous tissue was sutured layer by layer and skin was closed by vertical mattress and interrupted suture. The loop-shaped ligation of the base was removed and compressive dressing was done with gauzes and elastic bandages. RESULTS: Postoperative complications such as infection, hemorrhage, hematoma, and dehiscence did not occur. Perioperatively the patient was sufficiently transfused with five units of blood and two units of fresh frozen plasma. During the subsequent 1 year follow-up, the functional and cosmetic results were excellent. CONCLUSION: A continuous loop-shaped suture ligation procedure along the base of the giant NF effectively reduced the amount of hemorrhage during the operation, made dissection and ligation of vessels easily and quickly, and shorten the operating time and postoperative recovery time.
Bandages ; Buttocks ; Cosmetics ; Female ; Follow-Up Studies ; Hematoma ; Hemorrhage ; Hemostasis ; Humans ; Ligation ; Middle Aged ; Needles ; Neurofibroma ; Plasma ; Polypropylenes ; Postoperative Complications ; Skin ; Subcutaneous Tissue ; Sutures

PURPOSE: Febrile convulsion is a common clinical problem in young children. In spite of their frequent occurrence, there is little information available about the value of investigation with febrile convulsion. Recent studies found a correlation between low serum sodium levels and risk of febrile convulsions. We carried out a study to evaluate the role of inappropriate ADH secretion in hyponatremia in relation to febrile convulsions. METHODS: This study used seventy cases(46 boys, 24 girls) with febrile convulsion, that were treated at the pediatric department of Korea University Medical Center Ansan hospital from Jan. 1998 to Aug. 1999. During the same period, thirty one cases(19 boys, 12 girls) with fever but without convulsion(control group I) and twenty four cases(16 boys, 8 girls) with convulsion but without fever(control group II) were evaluated in comparison with febrile convulsion group. Serum sodium, osmolality, vasopressin and urine osmolality of each group were measured on admission and analyzed by ANOVA. RESULTS: The mean serum sodium concentration of febrile convulsion group, control group I and control group II were 134.3+/-2.4mmol/L, 136.4+/-2.0mmol/L, and 136.0+/-2.2 mmol/L respectively. The serum sodium level of patient group was significantly lower than those of control group I and II(P<0.05). The case of the serum levels less than 135mmol/L was 54.3%(38/70) in patient group, 16.1%(5/31) in control group I and 12.5% (3/24) in control group II. Serum osmolality, uine osmolality of patients group were not significantly different from those of each control group. Vasopressin level of febrile convulsion group was higher than that of each control group. The risk of recurrent convulsion approaches 60%(15/25) of cases with hyponatremia less than 135mmol/L. CONCLUSION: We conclude that febrile convulsions are not mediated by hyponatremia but induce the changes in serum vasopressin and sodium level.
Academic Medical Centers ; Child ; Control Groups ; Fever ; Gyeonggi-do ; Humans ; Hyponatremia* ; Korea ; Osmolar Concentration ; Seizures ; Seizures, Febrile* ; Sodium ; Vasopressins

PURPOSE: Interleukin-1beta(IL-1beta) and Tumor necrosis factor-alpha(TNF-alpha) are multifunctional cytokines that may play important roles both in the normal development of central nervous system and in the response of brain to diverse forms of injury. IL-1beta and TNF-alpha have potent proinflammatory action and the potential to modulate cell growth. Cerebral hypoxia-ischemia selectively stimulates IL-1beta and TNF-alpha gene expression in brain regions susceptible to irreversible injury in perinatal rats. Pentoxifylline, a cAMP phosphodiesterase inhibitor, attenuates hypoxic-ischemic brain injury in immature rats and inhibits TNF-alpha expression at the transcription level. We hypothesize that pentoxifylline would attenuate the expression of IL-1beta and TNF-alpha mRNA gene expression on hypoxic-ischemic brain injury in immature rats. METHODS: To elicit focal hypoxic-ischemic brain injury, 7-d-old(P7) rats underwent right carotid artery ligation, followed by 3 hr of hypoxia(fractional concentration of inspired O2=0.08). In 3 rats, pentoxifylline(40mg/kg) was injected into the intraperitoneal cavity immediately before and after hypoxia. The other 4 rats were given PBS solutions. IL-1beta and TNF-alpha mRNA content were measured by reverse transcription followed by polymerase chain reaction amplification(RT-PCR) in the samples prepared from the lesioned and contralateral hemispheres killed 4 hr post-hypoxia. cDNA were amplified with primers specific for IL-1beta and TNF-alpha. and also amplified with GAPDH primers which served as an internal control. RESULTS: In control group, hypoxia-ischemia induced IL-1beta and TNF-alpha mRNA expression from the lesioned hemisphere in immature rat brain. In pentoxifylline treated group, IL-1beta and TNF-alpha mRNA expression were attenuated at 4 hr post hypoxia- ischemia. CONCLUSION: Preteatment with pentoxifylline decreased incidence and severity of hypoxic-ischemic injury in immature rat brain. Pentoxifylline attenuated the expression of IL-1beta and TNF-alpha gene on hypoxic-ischemic injury in immature rat brain. IL-1beta and TNF-alpha may play important roles in the response of the developing brain to acute hypoxic-ischemic injury.
3',5'-Cyclic-AMP Phosphodiesterases ; Animals ; Anoxia ; Brain Injuries* ; Brain* ; Carotid Arteries ; Central Nervous System ; Cytokines ; DNA, Complementary ; Gene Expression* ; Hypoxia-Ischemia, Brain ; Incidence ; Ischemia ; Ligation ; Necrosis ; Pentoxifylline* ; Polymerase Chain Reaction ; Rats* ; Reverse Transcription ; RNA, Messenger* ; Tumor Necrosis Factor-alpha*