Lymphangioma is composed of lymphatic tissue and filled with clear or chylous fluid that develops most often in the skin and subcutaneous tissue of neck but relatively rare in extremities. It is perhaps a congnital malformation rather than a true neoplasm, and so most of these lesions are usually present at birth and have a tendency to grow very slowly. If it is developed with a cavernous type of lymphangioma, it will have more aggressive and infiltrative tendency because their margin is usually adhesive with adjacent normal tissue. A case of cavernous lymphangioma on the right wrist of an eight month old female infant, treated by surgical excision is followed up over one year and presented here with a review of the literature.
Adhesives ; Extremities ; Female ; Humans ; Infant ; Lymphangioma ; Lymphoid Tissue ; Neck ; Parturition ; Skin ; Subcutaneous Tissue ; Wrist

Postoperative hypoxemia has been well known is adults but not in infants and children, although they are potentially more susceptible to airway closure and to disturbances in pulmonary gas exchange. We measured blood gas parameters of capillary blood in 30 cases of ASA physical status class l infants and children breathing room air, before and after general anesthesis for superficial surgical procedures. The blood samples were taken preoperatively, on arrival and 4~6 minutes later in the recovery room. The results are as follows: 1) The blood gas parameters on arrival in the recovery room showed significant change in pH nad PCO2(p<0.01) and increased PCO2(p<0.01) in comparison with preoperative gases. 2) The blood gas parameters checked at 4~6 minutes later in the recovery room showed insignificant differences from preoperative values of PO2 and SO2, but significantly increased PCO2 and decreased pH(p<0.01). 3) As a results of this study, it is suggested that for the safe management of patients, supplementary oxygen be provided for at least 10 minutes in the early recovery period to all pediatric patients.
Adult ; Anesthesia, General* ; Anoxia* ; Blood Gas Analysis ; Capillaries ; Child* ; Gases ; Humans ; Hydrogen-Ion Concentration ; Infant ; NAD ; Oxygen ; Pulmonary Gas Exchange ; Recovery Room ; Respiration

We report a case of acute transient encephalopathy with mental alteration, myoclonic jerks, and periodic triphasic wave electroencephalographic patterns caused by a therapeutic dose of baclofen. The clinical and electroencephalo-graphic abnormalities improved to a normal range shortly after baclofen was discontinued. We discuss the pathogenesis and review the literature about baclofen-induced encephalopathies.
Baclofen ; Myoclonus ; Reference Values

STUDY DESIGN: Thirty-seven patients with spinal tuberculosis were evaluated according to surgical method. OBJECTIVES: To evaluate the effectiveness of posterior spinal instrumentation in the surgical treatment of patient with tuberculous spondylitis. SUMMARY OF LITERATURE REVIEWS: There are many debates about the effectiveness of posterior spinal instrumentation combined with anterior interbody fusion in tuberculous spondylitis. MATERIALS AND METHODS: From January 1995 to June 2000, 37 patients were divided into two groups depending on their use of posterior spinal instrumentation. Group I consist of thirteen patients who were treated with conventional anterior corpectomy and anterior interbody fusion using autogenous strut bone graft. Group II was composed of twenty-four patients who were treated with conventional anterior corpectomy and anterior interbody fusion combined with posterior spinal instrumentation. Changes of corrected kyphotic angle and complication were measured using pre-, post-operative and follow-up radiographs and chart review. RESULTS: In group I, six cases (46.2%) showed loss of corrected kyphotic angle. Of these six cases, five cases had initial kyphotic angle of more than 20 dgree and three cases had involvement of two or more vertebrae. All six cases had thoracic or thoracolumbar involvement. Comparing two groups, maintaining corrected kyphotic angle and low complication rates were obtained in group II during follow-up period. The change of deformity as followed. In thoracic area, the mean kyphotic angle of 26.5 dgree was reduced to 18 dgree postoperatively, At the most recent follow-up, the mean kyphotic angle was 31.5 dgree in group I, a loss of correction of 13.5 dgree . In group II, the mean kyphotic angle was corrected from 27 dgrees to 13.5 dgree after surgery. At the most recent follow-up, the mean kyphotic angle was 17.5 dgrees, a loss of correction of 4 dgree . CONCLUSION: Posterior spinal instrumentation combined with conventional anterior corpectomy and anterior interbody fusion were found to be effective for preventing loss of kyphotic angle and for maintaining stable bone fusion in patients with mean
Congenital Abnormalities ; Follow-Up Studies ; Humans ; Spine ; Spondylitis* ; Transplants ; Tuberculosis, Spinal

BACKGROUND: Persistent auras after temporal lobectomy may be bothersome to the patients even though they are seizure free. But most authors specifically are concerned about the seizure outcome itself. The aim of the present study was to investigate which factors are related to persistent auras in patients with temporal lobe epilepsy(TLE) after temporal lobectomy. METHODS: We have retrospectively analysed many factors in 38 TLE patients with aura. All patients underwent anterior temporal lobectomy with amygdalo-hippocampectomy. Twenty three patients were seizure and aura free (completely seizure-free) and 15 patients had persistent auras(persistent auras) in spite of seizure-free. Characteristics of auras, past medical history, presence of secondary GTC, seizure frequency, age of surgery, age of onset, duration of habitual seizure, ictal EEG pattern, and pre- and postoperative MRI findings were compared between group with completely seizure-free and group with persistent aura. RESULTS: Characteristics of aura, past medical history, presence of secondary GTC, seizure frequency, ictal EEG pattern, age of onset, and age of surgery had no statistical differences between both groups. Seizure duration of group with persistent aura seemed to be longer than that of group with completely seizure-free(13.6 years vs 17.0 years, median test, p=0.10) and remained hippocampus in postsurgical MRI seemed to be related to persistent auras(Fisher's exact test, p=0.06). CONCLUSIONS: We found that there were suggestive differences in seizure duration and remained hippocampus between the two groups.
Age of Onset ; Anterior Temporal Lobectomy ; Electroencephalography ; Epilepsy* ; Epilepsy, Temporal Lobe ; Hippocampus ; Humans ; Magnetic Resonance Imaging ; Prognosis ; Retrospective Studies ; Seizures ; Temporal Lobe

PURPOSE: Ebersole and Pacia recently introduced a classification of scalp ictal EEG in temporal lobe epilepsy (TLE). So we investigated whether scalp ictal EEG without sphenoidal electrode can differentiate mesial TLE from neocortical TLE and can be predictive of surgical outcome after temporal lobectomy. METHODS: A consecutive 77 patients (male 43, female 34) with TLE were included who had temporal lobectomy after the comprehensive presurgical evaluation. The patients with mesial TLE were 59 and those with neocortical TLE 18. The total 358 seizures were analyzed using bipolar and monopolar montage without sphenoidal electrodes. Scalp ictal EEGs were categorized into 3 types based on Ebersole and Pacia's classification and then were evaluated with regard to the differentiation of TLE and its correlation with surgical outcome. RESULTS: 1) Out of the total 77 patients, type 1 pattern was observed in 23 (30%), type 2 in 51 (65%), and type 3 in 3 (5%). The number of patients with mesial TLE were 17 (74%) out of 23 with type 1, 41 (80%) out of 51 with type 2, 1 out of 3 with type 3. Type 1 pattern was relatively specific (74%) but not sensitive (30%) for mesial TLE. Also the lesion location of neocortical TLE with type 1 onset was not limited to medial temporal area. 2) Scalp ictal EEG patterns were significantly correlated with surgical outcome only in the subgroup of mesial TLE (p=0.006) but not in neocortical TLE. Type 1 onset pattern in mesial TLE was associated with favorable outcome comparing to type 2 onset. CONCLUSIONS: Scalp ictal EEG onset pattern cannot accurately differentiate mesial TLE from neocortical TLE. However, its onset pattern can be predictive of surgical outcome.
Classification ; Electrodes ; Electroencephalography* ; Epilepsy, Temporal Lobe* ; Female ; Humans ; Scalp* ; Seizures ; Temporal Lobe*

BACKGROUND: Depth and subdural electroencephalographic (EEG) recordings are often required to identify an area of the brain for epileptic surgery. We simultaneously compared bilaterally placed depth and subdural electrode EEGs to determine the site of seizure origins from the temporal lobes. METHODS: We included nine consecutive patients with medically refractory temporal lobe epilepsy, whose noninvasive evaluations such as magnetic resonance imaging, scalp and sphenoidal EEG, and other tests had not proved consistent lateralization. All patients had bilateral temporal depth electrodes, anterior and lateral temporal subdural strip electrodes. Thirty-eight clinical seizures and 3 subclinical seizures were evaluated. RESULTS: Seven out of 9 patients (78%) had unitemporal seizures, one patient had bilateral seizures, and the other had lateral temporal seizures in an invasive study. Ictal onset was localized by depth electrodes in 8 patients, and subdural strip electrodes in one. In ictal recordings, the ictal rhythms never spread to the contralateral neocortex before the ipsilateral neocortex. Most of the ictal rhythms began focally with periodic spikes or fast activities in the depth electrode, then spread to the ipsilateral strip electrode after 14 to 90 seconds (mean : 35.2 seconds). If ictal rhythms propagated to the contralateral side, it took 14 to 140 seconds (mean : 64.2 seconds). Subdural strip electrodes were less sensitive than depth electrodes in the detection of seizure onset and subclinical seizures, but were accurate when lateralized. CONCLUSIONS: We conclude that EEG recordings with depth and subdural strip electrodes correctly identify and lateralize temporal lobe seizures more often than subdural electrodes alone.
Brain ; Electrodes* ; Electroencephalography ; Epilepsies, Partial ; Epilepsy, Temporal Lobe* ; Humans ; Magnetic Resonance Imaging ; Neocortex ; Scalp ; Seizures ; Temporal Lobe*

Nonconvulsive status epilepticus (NCSE) of frontal origin is rare. The symptoms are unusual and different from that of temporal origin which makes it difficult to be diagnosed. We report two cases with NCSE of frontal origin. The first case was a 17-year-old girl who presented indifference and reduced word fluency, responsiveness, and facial expres-sion daylong with intermittent unresponsiveness and slight rightward eye and head deviations. Confusion was not noted. Electroencephalogram (EEG) showed the recurrent 2 Hz spike-wave ictal discharges on the left frontal area, sometimes spreading to the opposite side. The second case was a 57-year-old woman who had a medically intractable epilepsy. During long-term Video/EEG monitoring, the continuous 2 Hz spike-and-wave complexes were noted on the right hemisphere and the left frontal area. At that time, neurological examination including cognitive functions was normal except for a mild jaw tremor. No confusion was noted. However, she looked depressed, inactive, and affectively indifferent. Intravenous lorazepam injection abolished status EEG activities as well as clinical symptoms. Ictal single photon emission computed tomography (SPECT) showed an increased perfusion in the right frontal lobe. Cortical dysplasia was pathologically diagnosed after a right frontal lobectomy.
Adolescent ; Electroencephalography ; Epilepsy ; Female ; Frontal Lobe ; Head ; Humans ; Jaw ; Lorazepam ; Malformations of Cortical Development ; Middle Aged ; Neurologic Examination ; Perfusion ; Status Epilepticus* ; Tomography, Emission-Computed, Single-Photon ; Tremor

PURPOSE: Usefulness of sphenoidal electrodes for detecting mesial temporal seizure foci remains controversial. Our aim is to determine whether sphenoidal electrodes are superior to surface electrodes for EEG localization in patients with mesial temporal lobe epilepsy (TLE). METHODS: We retrospectively reviewed ictal EEGs recorded simultaneously with standard International 10-20 System, subtemporal and sphenoidal electrodes in 92 patients who underwent temporal lobectomy. Patients were divided into mesial (n=67) and neocortical (n=25) TLE. Ictal EEGs were reviewed in a blinded fashion in both longitudinal bipolar and Pz referential montages. RESULTS: Thirty four (13.1%) of 259 mesial temporal seizures were exclusively isolated to sphenoidal electrode at least 3 seconds before involvement of subtemporal electrodes or were localized to temporal lobe on sphenoidal electrode when scalp electrode failed to localize seizure onset, whereas only 2 (2.6%) of 75 neocortical temporal seizures were (p<0.05). The usefulness of sphenoidal electrode was related to the distribution but not the frequency of ictal onset on scalp EEG. CONCLUSIONS: Although isolated or localized sphenoidal seizure onset in patients with mesial TLE are not frequent, sphenoidal electrodes are superior to scalp electrodes for the localization of mesial temporal seizure foci.
Electrodes* ; Electroencephalography* ; Epilepsy, Temporal Lobe ; Humans ; Retrospective Studies ; Scalp ; Seizures* ; Temporal Lobe*

OBJECTIVES: Ciprofloxacin, one of the most widely used fluoroquinolone, has been used for some abdominal and genitourinary infections in emergency departments (EDs). This investigation was performed to identify the risk factors of inappropriate use of ciprofloxacin in the ED. METHODS: We retrospectively reviewed the medical records of patients who had visited the ED of Seoul National University Hospital from January 2002 to December 2002 and who had been prescribed ciprofloxacin as an initial empirical antibiotic. The appropriateness of ciprofloxacin use was judged according to existing institutional guidelines. RESULTS: Of the total 577 patients (219 males, mean age 53.0+/-17.1; 358 females, mean age 50.3+/-18.7), ciprofloxacin was used appropriately in 289 (50.1%). In the univariate analysis, gender, site of suspected infection, route of administration, and disposition were significantly different between the appropriate and the inappropriate use groups (p<0.005). In multivariate analysis, the adjusted odds ratio for related factors for inappropriate ciprofloxacin use was significantly higher in old age patients (>65 years old) than in younger patients (under 30 years old; OR=2.02, 95% CI=1.01-4.03), in patients having the GI tract infections than in patients having genitourinary tract infections (OR=14.28, 95% CI=8.76-23.29), in patients who were administered orally than intravenously (OR=2.45, 95% CI=2.08-5.71), and in patients who stayed in the ED than in those who were admitted (OR=4.29, 95% CI=1.98-9.34). CONCLUSION: Inappropriate use of ciprofloxacin in the ED is very common. If the emergence of ciprofloxacin resistance is to be avoided, education and efforts for judicious use of ciprofloxacin are warranted.
Adult ; Ciprofloxacin* ; Education ; Emergencies* ; Emergency Service, Hospital* ; Female ; Gastrointestinal Tract ; Humans ; Male ; Medical Records ; Multivariate Analysis ; Odds Ratio ; Retrospective Studies ; Risk Factors* ; Seoul