No abstract available.
Extracorporeal Circulation* ; Plasma*

Surgical approaches to blowout fracture have been made through a skin inci-sion in the lower eyelid placed just below the eyelashes[a subciliary pproach], a conjunctival approach, a transantral approach, or a combined approach. Authors repaired the orbital floor fracture through the transconjunctival and transantral approaches simultaneously in 4 patients confirmed orbital floor fracture on CT scan from April to September 1998. Transconjunctival approach could avoid ectropion, lower eyelid retraction and transantral endoscopic orbital floor exploration could allow precise determination of fracture size, location, and replacement of prolapsed tissue and placement of implant over the bony defect. So it was possible to repair with a minimal size of implant and could avoid the complications caused by a too large implant in the posteriorly located orbital floor fracture.
Ectropion ; Endoscopy ; Eyelids ; Humans ; Orbit* ; Orbital Implants* ; Skin ; Tomography, X-Ray Computed

The claw-foot deformity is only a symptom of some primary lesion, not an entity in itself. The treatment of claw-foot usually depends on the type and severity of the deformity. In the past two years, authors have treated 7 cases of claw-foot, 3 of which were treated by Cole's anterior tarsal wedge osteotomy and 4 cases by Japas “V”-osteotomy of tarsus. In all 7 cases, Steindler's plantar fasciotomy for cavus deformity were combined and 1 case was combined with Achilles tendon lengthening. The followings were noted. 1. AlI patients were military personals and the ages were between 21 to 27 years old male. 2. Two patients were bilateral claw-foot deformity and both sides were operated. 3. The causes were secondary to poliomyelitis in one case and the others were idiopathic. 4. Postoperative complications were skin necrosis in one case and sensory disturbance on the dorsum of the first web space of the foot in 3 cases. 5. All patients can walk and run without pain after average 1 year follow-up period.
Achilles Tendon ; Ankle ; Congenital Abnormalities ; Follow-Up Studies ; Foot ; Foot Deformities ; Humans ; Male ; Military Personnel ; Necrosis ; Osteotomy ; Poliomyelitis ; Postoperative Complications ; Skin

Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are rare, life-threatening mucocutaneous diseases, usually attributable to drugs and infections. Corticosteroids have been used in the management of TEN for the last 30 years. This remains controversial and is still much debated. TEN can occur despite administration of high doses of systemic corticosteroids. The psychiatric side effects of corticosteroids can include headache, insomnia, depression, and mood disorders with or without psychotic episodes. Steroid-induced psychosis is dealt with by tapering or discontinuing the steroid; antipsychotics are also sometimes used. We report a case of an 11-year-old boy who was admitted with TEN. He had also been diagnosed as having nephrotic syndrome in the past. Remission was achieved through induction therapy and by maintaining the use of steroids. After a full-dose intravenous dexamethasone for TEN, he showed psychotic symptoms. We diagnosed him as having steroid-induced psychosis. We tapered the steroid use and initiated an atypical antipsychotic medication, olazapine and intravenous immunoglobulin (IV-IG). His symptoms dramatically improved and he was discharged.
Adrenal Cortex Hormones ; Antipsychotic Agents ; Child ; Depression ; Dexamethasone ; Epidermal Necrolysis, Toxic ; Headache ; Humans ; Immunoglobulins ; Mood Disorders ; Nephrotic Syndrome ; Psychotic Disorders ; Sleep Initiation and Maintenance Disorders ; Steroids ; Stevens-Johnson Syndrome

We report on a 2-year-old girl who developed autoimmune hemolytic anemia, which occurred with minimal change nephrotic syndrome 3 months after umbilical cord blood transplantation for acute megakaryocytic leukemia. Because the disease is regarded as chronic graft versus host disease and developed while taking cyclosporine medication, she was treated with methylprednisolone 2 mg/kg/day. However, hemolysis and proteinuria were refractory to steroid treatment. One week after starting methylprednisolone, mycophenolate mofetil was added. Hemolysis and proteinuria showed improvement after 2 weeks of mycophenolate mofetil medication.
Anemia, Hemolytic, Autoimmune* ; Child, Preschool ; Cord Blood Stem Cell Transplantation ; Cyclosporine ; Female ; Fetal Blood* ; Graft vs Host Disease ; Hemolysis ; Humans ; Leukemia, Megakaryoblastic, Acute ; Methylprednisolone ; Nephrosis, Lipoid ; Nephrotic Syndrome* ; Proteinuria

No abstract available.
Brain* ; Hydrocephalus*

Objective: To compare Octopus multipurpose (MP) electrodes, which are capable of saline instillation and direct tissue temperature measurement, and conventional electrodes for radiofrequency ablation (RFA) in porcine livers in vivo. Materials and Methods: Sixteen pigs were used in this study. In the first experiment, RFA was performed in the liver for 6 minutes using Octopus MP electrodes (n = 15 ablation zones) and conventional electrodes (n = 12 ablation zones) to investigate the effect of saline instillation. The ablation energy, electrical impedance, and ablation volume of the two electrodes were compared. In the second experiment, RFA was performed near the gallbladder (GB) and colon using Octopus MP electrodes (n = 12 ablation zones for each) with direct tissue temperature monitoring and conventional electrodes (n = 11 ablation zones for each). RFA was discontinued when the temperature increased to > 60°C in the Octopus MP electrode group, whereas RFA was performed for a total of 6 minutes in the conventional electrode group. Thermal injury was assessed and compared between the two groups by pathological examination. Results: In the first experiment, the ablation volume and total energy delivered in the Octopus MP electrode group were significantly larger than those in the conventional electrode group (15.7 ± 4.26 cm3 vs. 12.5 ± 2.14 cm3 , p = 0.027; 5.48 ± 0.49 Kcal vs. 5.04 ± 0.49 Kcal, p = 0.029). In the second experiment, thermal injury to the GB and colon was less frequently noted in the Octopus MP electrode group than that in the conventional electrode group (16.7% [2/12] vs. 90.9% [10/11] for GB and 8.3% [1/12] vs. 90.9% [10/11] for colon, p < 0.001 for all). The total energy delivered around the GB (2.65 ± 1.07 Kcal vs. 5.04 ± 0.66 Kcal) and colon (2.58 ± 0.57 Kcal vs. 5.17 ± 0.90 Kcal) were significantly lower in the Octopus MP electrode group than that in the conventional electrode group (p < 0.001 for all). Conclusion RFA using the Octopus MP electrodes induced a larger ablation volume and resulted in less thermal injury to the adjacent organs compared with conventional electrodes.

We have experienced a case of aortic dissecting aneurysm in pregnant woman. She felt initially severe chest pain which was radiated to the neck on the 3days before delivery. Thereafter dyspnea and generalized edema were developed for 1 month after delivery. She was diagnosed as aortic dissectLn, Debakey type-II. During cardiopulmonary bypass, the selective cerebral perfusion was done through the right and left commom carotid arteries. Aortic replacement with Hemashield vascular graft and reimplantation of innominate artery, resuspension of aortic valve, repair of intimal tear were performed. The postoperative course was uneventful.
Aneurysm, Dissecting ; Aortic Valve ; Brachiocephalic Trunk ; Cardiopulmonary Bypass ; Carotid Arteries ; Chest Pain ; Dyspnea ; Edema ; Female ; Humans ; Neck ; Perfusion ; Pregnant Women* ; Replantation ; Tears ; Transplants

OBJECTIVE: The introduction and development of the embolic protecting device (EPD) has resulted in a decreased rate of stroke after carotid artery stenting (CAS). The authors performed a retrospective study to investigate the risk factors for developing large emboli after CAS which can lead to ischemic events. METHODS: A total of 35 consecutive patients who underwent CAS between January 2009 and March 2012 were included in this study. Patients were divided into two groups including those with small emboli (group A; grade 1, 2) and those with large emboli (group B; grade 3, 4). The size and number of emboli were assigned one of four grades (1=no clots, 2=1 or 2 small clots, 3=more than 3 small clots, 4=large clots) by microscopic observation of the EPD after CAS. We compared demographic characteristics, medical history, and angiographic findings of each group. RESULTS: Thirty-five patients underwent CAS, and technical success was achieved in all cases. Twenty-three patients were included in group A and 12 patients in group B. Our results demonstrated that advanced age [odds ratio (OR) 1.24; 95% confidence interval (CI) 1.01-1.52; p=0.044] and smoking (OR 42.06; CI 2.828-625.65, p=0.006) were independent risk factors for developing large emboli after CAS. CONCLUSION: In patients with carotid artery stenosis treated with CAS, advanced age and smoking increased the number and size of emboli. Although use of an EPD is controversial, it may be useful in CAS in patients with risk factors for large emboli in order to reduce the risk of ischemic events.
Carotid Arteries ; Carotid Stenosis ; Embolic Protection Devices ; Humans ; Retrospective Studies ; Risk Factors ; Smoke ; Smoking ; Stents ; Stroke

Objective: : To evaluate the stent apposition of a low-profile visualized intraluminal support (LVIS) device in distal internal carotid artery (ICA) aneurysms, examine its correlation with clinical and angiographic outcomes, and determine the predictive factors of ischemic adverse events (IAEs) related to stent-assisted coiling. Methods: : We retrospectively analyzed a prospectively maintained database of 183 patients between January 2017 and February 2020. The carotid siphon from the cavernous ICA to the ICA terminus was divided into posterior, anterior, and superior bends. The anterior bends were categorized into angled (V) and non-angled (C, U, and S) types depending on the morphology and measured angles. Complete stent apposition (CSA) and incomplete stent apposition (ISA) were evaluated using unsubtracted angiography and flat-panel detector computed tomography. Dual antiplatelet therapy with aspirin 200 mg and clopidogrel 75 mg was administered. Clopidogrel resistance was defined as fewer responders (≥10%, <40%) and non-responders (<10%) based on the percent inhibition (%INH) of the VerifyNow system. These were counteracted by a dose escalation to 150 mg for fewer responders or substitution with cilostazol 200 mg for non-responders. IAEs included intraoperative in-stent thrombosis, transient ischemic attack, cerebral infarction, and delayed in-stent stenosis. A multivariate logistic regression analysis was used to determine the predictive factors for ISA and IAEs. Results: : There were 33 ISAs (18.0%) and 27 IAEs (14.8%). The anterior bend angle was narrower in ISA (-4.16°±25.18°) than in CSA (23.52°±23.13°) (p<0.001). The V- and S-types were independently correlated with the ISA (p<0.001). However, treatment outcomes, including IAEs (15.3% vs. 12.1%), aneurysmal complete occlusion (91.3% vs. 88.6%), and recanalization (none of them), did not differ between CSA and ISA (p>0.05). The %INH of 27 IAEs (13.78%±14.78%) was significantly lower than that of 156 non-IAEs (26.82%±20.23%) (p<0.001). Non-responders to clopidogrel were the only significant predictive factor for IAEs (p=0.001). Conclusion : The angled and tortuous anatomical peculiarity of the carotid siphon caused ISA of the LVIS device; however, it did not affect clinical and angiographic outcomes, while the non-responders to clopidogrel affected the IAEs related to stent-assisted coiling.