Hypothalamic hamartomas are often associated with early onset gelastic seizures, precocious puberty, behavioral problem and suboptimal response to antiepiletptic drugs. Until now, four surgical options have been reported to reduce seizure by >50%. Surgical excision have good seizure outcome but postoperative complications were not infrequent, whether by pterional or transcallosal interforniceal approach. Radiosurgery is noninvasive alternative to resective surgery but the effect usually does not appear until several months later. Radiofrequency ablation is less invasive than surgical resection and its effect is immediate, but lacks long term follow-up data. It also requires three dimensional analysis of the lesion to enhance effi cacy and safety. As hypothalamic hamartoma is intrinsically epileptogenic and epileptogenic discharges spread from the lesion, blocking the seizure propagation through endoscopic disconnection is regarded as an effective and safer option. Surgical choice for a particular patient should take into account the hamartoma’s size, location, surgeon’s preferences, possible complication as well as the effect and risk of the various surgical methods. In the present review, open surgery, endoscopic disconnection, radiosurgery and radiofrequency ablation are discussed.

This study was undertaken to investigate mineral changes in weathered scalp hair after burial. EDX (energy dispersive X-ray spectroscopy) analysis was performed to measure the presence of minerals on the hair surface. Twelve scalp hairs, buried for 5-40 years, were chosen from deceased individuals buried in tombs in Soha-Ri, Kyonggi-Do, and other regions in Korea. Three normal hairs were used as the control group. EDX data showed that carbon, oxygen, and sulfur were detected in hair collected from all three burial grounds. In contrast, calcium was only detected in hair collected from tombs in Soha-ri. The amounts of calcium and sulfur were found to decrease with time for hair collected from tombs in Soha-ri. Similar results were observed with sodium for hair collected from other regions. These results show region specific mineral detection and a decrease in the concentration of minerals with time. Consequently, it is suggested that changes in minerals concentration in weathered hair could be used as basic data in the field of forensic medicine.
Burial ; Calcium ; Carbon ; Forensic Medicine ; Forensic Sciences ; Hair ; Humans ; Korea ; Minerals ; Oxygen ; Scalp ; Sodium ; Spectrometry, X-Ray Emission ; Sulfur ; Weather

BACKGROUND: There are several ways to treat for recurrent pericardial effussion and cardiac tamponade due to malignancy. They are repeated pericardiocentesis, pericardial instillation of sclerosing and chemotherapeutic agents, surgical creation of a pericardial window and transthoracic pericardiectomy. Surgical techniques are usually effective but bear a significant morbidity and mortality especially in chronic debilitating cancer patients. So percutaneous balloon pericardial window as an alternative to surgery in these patients. METHODS: After pericardiocentesis was performed, a 0.035 inch J-tip guidewire was advanced into the pericardial space. And a pigtail catheter was advanced over the wire. A moderate amount of pericardial fluid were removed. A nd then the pigtail catheter was withdrawn and 8F sheath was inserted. A20mm diameter, 4cm long(Single balloon method) or two 10mm diameter, 4cm long balloon dilating catheter(Double balloon medium) was advanced over the wire to straddle the parietal pericardial border though the sheath. Several inflations of the balloon with a solution containing 50% radiographic contrast medium were performed until disappearance of the balloon waist. After balloon dilation, contrast medium from the pericardial space to subcutaneous tisse suggesting successful PBPWF. Single ballon method was employed in 4 patients and Dould balloon method in 2 patients. RESULT: We performed percutaneous balloon pericardial window formation in 6 patiemts with malignant pericardial effusion. We did percutaneous balloon pericardial window formation successfully in 5 patients and failed due to adhesion of parietal pericardium in 1 patient. One patient developed recurrent pericardial effusion with tamponade at a mean follow-up of 11.49.6 months(1.5-26 months). Conclusion: These results suggest that PBPWF is an alternative method less invasive than subxiphoid surgical windowing, espesially in critically ill patients with recurrent malignant pericardial effussion. It carries less risks and has more constant effect than repeated pericardiocentesis.
Cardiac Tamponade ; Catheters ; Critical Illness ; Follow-Up Studies ; Humans ; Mortality ; Pericardial Effusion* ; Pericardiectomy ; Pericardiocentesis ; Pericardium ; Rabeprazole

BACKGROUND: Management of massive rotator cuff tears can be challenging because of the less satisfactory results and a higher retear rate regardless of the use of open or arthroscopic repair technique. METHODS: We retrospectively analyzed 102 cases of massive rotator cuff tear treated with either open or arthroscopic repair. Open repair was performed in 38 patients; and arthroscopic repair, in 64 patients. The mean age at the time of surgery was 59.7 years in the open group and 57.6 years in the arthroscopic group. RESULTS: The Constant score increased from the preoperative mean of 55.9 to 73.2 at the last follow-up in the open repair group and from 53.8 to 67.6 in the arthroscopic repair group (p<0.001 and <0.001, respectively). The University of California at Los Angeles (UCLA) score increased from a preoperative mean of 17.7 to 30.8 at the last follow-up in the open group and from 17.5 to 28.7 in the arthroscopic group (p<0.001 and <0.001, respectively). No statistically significant difference in the Constant and UCLA scores was observed between the two groups at the last follow-up (p=0.128 and 0.087, respectively). Retear was found in 14 patients (36.8%) in the open group and 39 patients (60.9%) in the arthroscopic group (p=0.024). CONCLUSIONS: Open and arthroscopic repairs of massive rotator cuff tears may provide satisfactory clinical results with no significant difference. However, a significantly lower retear rate was observed for the open repair group compared with the arthroscopic repair group.
Arthroscopy ; California ; Follow-Up Studies ; Humans ; Retrospective Studies ; Rotator Cuff* ; Shoulder ; Tears* ; Tendon Injuries

We report a case of necrotizing arteritis involving the gallbladder. This case was clinically diagnosed as cholelithiasis with cholecystitis, and necrotizing arteritis was found in the surgically resected specimen. Vascular changes were similar to those seen in classic polyarteritis nodosa, involving medium-sized muscular arteries and characterized by fibrinoid necrosis and panarterial and periarterial inflammation varying from active to resolving stages. Acute cholecystitis is a rare initial clinical manifestation of the systemic vasculitis. If acute cholecystitis is found in the absence of obvious cause, careful examination is essential. Since steroid therapy improves the prognosis in the systemic vasculitis, clinicians and pathologists should be aware of this unusual lesion.
Arteries ; Cholecystitis ; Cholecystitis, Acute ; Cholelithiasis ; Gallbladder* ; Inflammation ; Necrosis ; Polyarteritis Nodosa ; Prognosis ; Systemic Vasculitis ; Vasculitis*

OBJECTIVE: To identify the thickness of gastrocnemius muscles (GCM) in normal children and children with spastic cerebral palsy using ultrasonography and to determine the influencing factors in order to increase the accuracy of intramuscular injection of botulinum toxin A. METHOD: Fifty-six children with spastic cerebral palsy (Group A) with no fixed contractures or operation history were involved in this study and they were compared with normal children (Group B). Children lay prone and one examiner measured the thickness of medial and lateral GCM using ultrasonography. Relationship between GCM thickness and clinical variables (age, height, weight, body mass index (BMI), calf circumference, Gross Motor Function Classification System (GMFCS) level, spasticity, number of botulinum toxin injections) were determined with Pearson's correlation. RESULTS: The thickness of medial and lateral GCM were 78.06+/-14.66 mm, 66.90+/-12.23 mm respectively, in Group A, and 103.44+/-12.04 mm, 79.95+/-9.76 mm respectively, in Group B. Medial GCM were thicker than lateral GCM in both groups. The age, height, weight, BMI, calf circumference and the thickness of GCM were higher in Group B. In group A, weight, BMI, calf circumference showed positive correlations with the thickness of medial GCM and GMFCS showed negative correlation with the thickness of medial GCM. CONCLUSION: To increase the accuracy of intramuscular injection of botulinum toxin A, we should keep in mind that the thickness of GCM may be influenced by several factors. Further controlled study including larger group is needed.
Body Weight ; Botulinum Toxins ; Cerebral Palsy ; Child ; Contracture ; Humans ; Injections, Intramuscular ; Muscle Spasticity ; Muscle, Skeletal ; Muscles

PURPOSE: Atopic dermatitis (AD) is a chronic relapsing inflammatory skin disease. Vitamin D and interleukin-31 (IL-31) are known to be related to the pathogenesis of AD with pruritus. The purpose of this study was to investigate the relationship between serum levels of 25-hydroxyvitamin D (25(OH)D) and IL-31 and the disease severity of AD in children with AD. METHODS: We recruited 160 children with AD and 42 controls. We used the SCORing Atopic Dermatitis (SCORAD) index to measure the severity of AD. Serum IL-31 and 25(OH)D levels were assayed using enzyme-linked immunosorbent assay and high-performance liquid chromatography, respectively. Serum levels of total IgE, specific IgE to common allergens and peripheral blood total eosinophil count were carried out in children with AD. RESULTS: Serum IL-31 level was significantly higher in AD group compared to control group and 25(OH)D level was significantly lower in AD group than control group. Serum IL-31 level showed the highest level in severe AD group followed by moderate and mild AD group, whilst serum 25(OH)D level was the lowest in severe AD group compared to moderate and mild AD group. There was no difference in serum IL-31 level between AD group and nonatopic dermatitis group. IL-31 level was positively correlated with subjective SCORAD index indicating pruritus in children with AD, and 25(OH)D was inversely correlated with SCORAD index. CONCLUSION: IL-31 and vitamin D may be related to the pathogenesis of AD, especially with regard to the pruritus.
Allergens ; Child* ; Chromatography, Liquid ; Dermatitis ; Dermatitis, Atopic* ; Enzyme-Linked Immunosorbent Assay ; Eosinophils ; Humans ; Immunoglobulin E ; Pediatrics ; Pruritus ; Skin Diseases ; Vitamin D

Acanthamoeba keratitis is uncommon and rarely reported in Korea. It has been reported in world literature as a very severe, progressive necrotizing stromal keratitis due to a non-parasitic free-living amoeba. It is frequently associated with minimal corneal trauma especially from contact lens but sometimes occurs in patients without any past history. We report a case of acanthamoeba keratitis without a specific past history in a 42-year-old man. Light and electron microscopy demonstrated severe stromal keratitis with numerous thick-walled cysts, 10~15 m in diameter, scattered in the superficial and deep stroma. Because this keratitis is most often mistaken for fungal, bacterial or herpetic keratitis, early confirmatory diagnosis by direct smear, biopsy or culture is essentially required for the prevention of visual loss or devastating eyeball loss.
Acanthamoeba Keratitis* ; Acanthamoeba* ; Adult ; Amoeba ; Biopsy ; Diagnosis ; Humans ; Keratitis ; Keratitis, Herpetic ; Korea ; Microscopy, Electron

No abstract available.
Wandering Spleen*

PURPOSE: The objective of this study was to evaluate an immunoassay for urinary nuclear matrix protein (NMP22) as an indicator for transitional cell carcinoma of the bladder. MATERIALS AND METHODS: Three groups of subjects attended the trial of NMP22. First group was 27 patients with transitional cell carcinoma of the bladder, second group was 24 patients with other urinary cancer consisted of prostate cancer and renal cell carcinoma, and third group was 24 healthy volunteers. NMP22 was determined using a commercial test kit, which is based on an enzyme-linked immunosorbent assay. RESULTS: In normal healthy volunteers and other urinary cancer group median NMP22 levels were 2.24 and 3.27 U/ml, respectively. Median urinary NMP22 levels in patients with transitional cell carcinoma of the bladder were 54.30 U/ml. It was significantly greater than other two groups. Median NMP22 levels according to the tumor stage and the tumor grade did not show the significant difference statistically. CONCLUSIONS: Urinary NMP22 is a useful marker that is more specific for bladder cancer thsn for other urinary cancer. Further tests are required to clarify the influence of other spe- cific conditions, such as urinary tract infection, and intravesical drug instillation or procedure.
Carcinoma, Renal Cell ; Carcinoma, Transitional Cell* ; Enzyme-Linked Immunosorbent Assay ; Healthy Volunteers ; Humans ; Immunoassay ; Instillation, Drug ; Nuclear Matrix* ; Prostatic Neoplasms ; Urinary Bladder Neoplasms ; Urinary Bladder* ; Urinary Tract Infections