During a period of four years the authors experienced eighteen cases of focal seizure disorder, showing small ring or nodular enhancement with surrouding low density on CT scans. In fifteen cases, the epileptogenic lesions decreased in size or resolved completely on serial CT scans. Three cases were explored surgically. Males and famales were equally affected. Their age ranged from six to fourtyfive years and fifteen patients were under the age of thirty years. The principal symptoms and signs consisted of focal siezures (17 cases), generalized seizure during sleep (1 case), focal neurological deficits (14 cases), and intracranial hypertension (4 cases). The lesions of CT scans were found frequently in the parietal and frontal lobes. The clinical course of this self-limited disorder was variable and well correlated with the change of CT findings. The histological findings were the typical tuberculoma and the caseating gramuloma containing calcium in two cases. In one case the enhancing nodule of CT scan was not resected and the tissue specimen around the nodule revealed nonspecific inflammation. The cause of this disorder might be tuberculoma, but in some cases we could not rule out cysticercosis.
Calcium ; Cysticercosis ; Epilepsies, Partial* ; Frontal Lobe ; Humans ; Inflammation ; Intracranial Hypertension ; Male ; Rabeprazole ; Seizures* ; Tomography, X-Ray Computed ; Tuberculoma

No abstract available.
Primary Myelofibrosis*

The orbitozygomatic area occupies a key anatomic position in midface, is prone to injury, and plays a prominent role in facial aesthetics. So the facial appearance including orbital shape can be altered by complications of orbitozygomatic fractures. Most possible initial complications include blindness, hyphema, retinal detatchment, and paralysis or entrapment of extraocular muscles. Long term sequelaes include infraorbital nerve dysfunction, loss of malar projection, enophthalmos, and dystopia. Accurate anatomic reduction and rigid fixation is essential for management of orbitozygomatic fractures to minimize those late sequelaes. Conventional fixation devices to fix displaced fracture of facial bone are interosseous wire and miniplate. But interosseous wirings are unstable for primary bone healing and time consuming. Miniplates have great deal in rigid fixation but their high profile and palpability are the main complaints in many patients, especially in orbital rim area. In this article, we reviewed the 30 cases of zygomamaxilla complex fractures with orbital rim fracture fixed with microplates, and discussed the stability of microplate and superiorities in final aesthetics result. The use of microplates in these area permits enough stability of fracture segment with ease of procedures and superiorities in final results without any palpability.
Blindness ; Enophthalmos ; Esthetics ; Facial Bones ; Humans ; Hyphema ; Muscles ; Orbit* ; Paralysis ; Retinaldehyde

The computed tomographic (CT) and clinical findings in 9 patients with serologically confirmed Japanese encephalitis were reviewed. In 6 patients with prominent pyramidal and extrapyramidal symptoms and signs, the main CT finding was low density areas in the thalamus, internal capsule, basal ganglia, and midbrain. Low density areas were compatible with the anatomical distribution of pathologic lesions in Japanese encephalitis. Diffuse low density in the periventricular white matter was evident in 5 of 6 cases, with ventricular compression in 2 cases, between the 1st and 7th day of illness. There was enlargement of the third and lateral ventricles and cortical sulci dilatation in 3 cases on or after the 21st day of illness. In once CT scan obtained on the 10th day of illness, diffuse low density in the periventricular white matter was observed with enlargement of lateral ventricles and cortical sulci dilatation. Gyral enhancement was noted in 3 of 4 cases within 4 days after the onset of symptoms. There was a limited correlation between the clinical and CT findings.
Asian Continental Ancestry Group* ; Basal Ganglia ; Dilatation ; Encephalitis, Japanese* ; Humans ; Internal Capsule ; Lateral Ventricles ; Mesencephalon ; Thalamus ; Tomography, X-Ray Computed

The authors encountered 2 siblings who showed progressive ophthalmoplegia and bulbar palsy. The patients were studied with various laboratory aids and thought to be as oculopharyngeal muscular dystrophy. The oculopharyngeal muscular dystrophy is a rare form of muscular dystrophy. The authors present the cases as familial oculopharyngeal muscular dystrophy.
Bulbar Palsy, Progressive ; Humans ; Muscular Dystrophies ; Muscular Dystrophy, Oculopharyngeal* ; Ophthalmoplegia ; Siblings

Authors reviewed clinical recordings of 102 patients who were diagnosed as Guillain-Barre syndrome from 1979 to 1983 at Seoul National University Hospital. Among them, eighty-five cases were selected for the clinical study of Guillain-Barre syndrome through application of strict diagnostic criteria. And the following results were obtained. 1) There was a male preponderance (2.5:1) and an apparent predilection for the first and the second decades in this series. 2) Seasonal predilection was in summer and fall over five years. As judged from the uneven monthly incidence rate in each year, some epidemic tendency is likely to be in Guillain-Barre syndrome. 3) Sixty cases (71%) of this series had a history of antecedental events. The onset of neuritic symptoms occurred within one week from the preceding events in twenty-nine cases and one to two weeks in twenty cases. 4) The neuritic symptoms started from lower limbs in fifty cases (59%), upper limbs in eighteen (21%), cranial nerve distribution in six (7%) and developed nearly simultaneously in eleven (13%). 5) Most of the disabilities of the patients were devided into flaccid paralysis of limbs, cranial nerve dysfunction, autonomic dysfunction, respiratory difficulty and sensory abnormalities (paresthesia and myalgia). Autonomic dysfunction was observed in nine cases (11%), respiratory difficulty in thirty-one (37%), sensory abnormality in thirty-two (38%), and cranial nerve dysfunction in forty-seven (55%). 6) Authors devided the crainal nerve dysfunction into facial diplegia which was the most frequent form, bulbar palsy the next, masticatory muscle weakness the third, and ocular paresis the least. 7) There were two cases of Fisher syndrome (2.4%), three cases of polyneuritis cranialis (3.5%), and two cases of recurrence (2.4%) in this series. 8) Two cases (2.4%) died of respiratroy and bulbar dysfunction. Five cases (6%) had residual disability in motor function till six months follow-up.
Bulbar Palsy, Progressive ; Cranial Nerves ; Extremities ; Follow-Up Studies ; Guillain-Barre Syndrome ; Humans ; Incidence ; Lower Extremity ; Male ; Masticatory Muscles ; Miller Fisher Syndrome ; Neuritis ; Paralysis ; Paresis ; Recurrence ; Seasons ; Seoul ; Upper Extremity

Peutz-Jeghers syndrome (PJS) is a very rare genetic disorder. PJS carries a high risk of developing gastrointestinal (GI) cancer or non-GI cancer with advancing years. However, major symptoms of PJS in childhood are obstruction, intussusception, and bleeding from hamartomatous intestinal polyps which in majority of cases are not related to cancer. Generally, first GI symptom develops by 20 years in one half of children diagnosed with PJS. Children under two years of age who had PJS polyp-related intestinal symptoms are rare, and there have been no published report on intestinal carcinoma development, adenomatous change or dysplasia of polyps in Korean children with PJS. Recently, the authors have experienced a case PJS with adenomatous polyp change in a 15-month-old boy who had STK11 gene mutation. Therefore, early evaluation could be necessary and considered in children with PJS.
Adenoma/*diagnosis/pathology ; Base Sequence ; Colonoscopy ; Heterozygote ; Humans ; Infant ; Male ; Peutz-Jeghers Syndrome/*diagnosis/genetics/pathology ; Polymorphism, Single Nucleotide ; Polyps/pathology ; Protein-Serine-Threonine Kinases/chemistry/genetics

No abstract available.
Basal Ganglia* ; Pseudohypoparathyroidism*

This case involved a pulmonary thromboembolism, which originated from the lower extremity. A 68-year-old female, with a femur neck fracture, underwent spinal anesthesia with 0.5% heavy bupivacaine 11 mg for total hip arthroplasty. Ten minutes after the induction of spinal anesthesia, dyspnea, tachycardia and hypotension appeared. Under the impression of a pulmonary embolism, intubation was done and dopamine and epinephrine were infused. The operation stopped and she was sent to the intensive care unit. On the spiral CT chest angiogram, a pulmonary embolism was found. Deep venous thrombosis was detected in the left lower extremity on the venogram. Heparin therapy was started at a rate of 800 U/hour with a bolus of 5000 U. A consultative operation for the removal of deep vein thrombosis was performed by a chest surgeon, and total hip arthroplasty was performed successfully under spinal anesthesia.
Aged ; Anesthesia, Spinal* ; Arthroplasty, Replacement, Hip ; Bupivacaine ; Dopamine ; Dyspnea ; Epinephrine ; Female ; Femoral Neck Fractures* ; Femur Neck* ; Femur* ; Heparin ; Humans ; Hypotension ; Intensive Care Units ; Intubation ; Lower Extremity ; Pulmonary Embolism* ; Tachycardia ; Thorax ; Tomography, Spiral Computed ; Venous Thrombosis

With the growing interests in the treatment of osteoporosis. percutaneous Vertebroplasty aimed at stabilizing and preventing progressiv eosteoporotic vertebral compression fracture has been tried. We analyzed 60 cases of vertebroplasty for senile osteporotic vertebvral compression fractures performed from April to August, 1999 at Wooridul Spine Hospital. We observed dramatic pain relief in almost cases within 6~72 hours(mean, 36 hours). Mean value of the Visual Analogue Scale(VAS) decreased from 8.3 to 2.8 after the procudure. The Operative complications were as follows ; epidural leakage(70 levels). Paraparesis(2 cases), Paravertebral venous leakage, Intradiscal leakage, foraminal leakage transient hypotension and transient apnea. This procedure is relatively safe and effective treatment modality for osteoporotic compression fracture. But much attention is required in selection of the cases such as severe crushing fracture, suspicions cortical fracture of the endplate and bursting fracture. The viscosity of the material and avoidance of rapid injection were important in preventing complications.
Aged* ; Apnea ; Fractures, Compression ; Humans ; Hypotension ; Osteoporosis ; Spine ; Vertebroplasty* ; Viscosity