Hydranencephaly is congenital absence of the cerebral hemispheres which are replaced by a large fluid-filled cavity. The brain stem and basal ganglia are well formed and rudiments of frontal k occipital cortex may be present. We experienced a case of hydranencephaly caused by both internal carotid artery stenosis. We diagnosed it through the brain CT sonogram and doppler sonogram. A brief review of the related literatures was made.
Basal Ganglia ; Brain ; Brain Stem ; Carotid Artery, Internal* ; Carotid Stenosis* ; Cerebrum ; Hydranencephaly*

Fifty two cases of displacecd supracondylar fractures were divided into three groups according to the methods of fracture stabilization. Cast immobilizations without pin fixation were included to the group 1 (12 cases), fixation with lateral pins to the group 2 (22 cases), and lateral and medial cross pins to the group 3 (18 cases). In each group we attempted a radiological analysis for the stabilization failure through measurements of the horizontal rotation and the mediolateral tilting in their preoperative, postoperative and follow-up X-rays. Stabilization failure during the follow-up period was presumpted to be present in those cases that show (1) a development or increase of the horizontal rotation in follow-up lateral X-ray, and (2) accompanied change in Baumann's angle of more than 5 degrees. The failed stabilizations were in three cases (25%) in the group 1. In the group 2 the horizontal rotations after initial fixation were developed in four fractures. However, only two (9%) of the four cases accompanied significant changes in the Baumann's angle. Loss of the initial fixation in the cross pin group was found in one case. These results demonstrate that the cross pin fixation is the most stable form. Fixation in only lateral side sometimes shows rotational instability, but this method seems to be still useful because singificant coronal tilting develops in only a few occasions of those with horizontal rotation.
Child ; Follow-Up Studies ; Humans ; Humerus ; Methods

PURPOSE: Failure of adequate gastric emptying frequently interferes with successful enteral nutrition in infants. Study of gastric emptying in preterm infants has been hampered by the absence of a suitable and, valid technique, but ultrasonic assessment is well tolerated by infants. The aim of this study is to compare gastric emptying rates of breast milk and formula within preterm infants using an ultrasonic technique. METHODS: Ten infants(6 males, 4 females) were studied on 20 occasions. Median gestation of the group was 33 wks(29-38 wks), birthweight was 1506gms(850-1870gms). Each infant was receiving a minimum of 150 ml/kg/day of breast milk. We conducted the study with breast milk first and with formula milk 2 days later. With the infant in the right lateral position, ultrasonic images of the gastric antrum were obtained using the aorta bifurcational branch of superior mesenteric artery as constant landmarks. Measurements of antral cross sectional area(ACSA) were made before the feed and then sequentially, following its completion until ACSA returned to its pre-feeding state. Half-emptying time(t1/2) was calculated as the time taken for the ACSA to fall to half the maximal increment. The test was well tolerated by all subjects. RESULTS: There was a strong linear relationship between gastric volume and ACSA. The half-emptying time for breast milk was less than formula : t1/2 breast milk 32.0+/-9.8 min; t1/2 formula 45.0+/-11.6 min, P=0.0004. CONCLUSION: The data demonstrate that human milk increases gastric emptying compared to formula. This has important implications for the management of preterm infants who have feeding intolerances.
Aorta ; Breast* ; Enteral Nutrition ; Gastric Emptying* ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Male ; Mesenteric Artery, Superior ; Milk* ; Milk, Human* ; Pregnancy ; Pyloric Antrum ; Ultrasonics

BACKGROUND: In experimental cerebral ischemia, hypothermia protects the brain, while hyperglycemia aggravates ischemic damage. Clinical studies have also reported worse outcomes in ischemic stroke patients with hyperglycemia or fever and improved outcomes with hypothermic therapy. However, it is not well known what will happen if these opposite effects exist together. METHODS: Sixty male Sprague-Dawley rats were used. Focal cerebral ischemia was induced for 2 hours by an intraluminal thread followed by reperfusion for 4 hours. Rats were divided into 4 groups; 1) normo-glycemic normothermic (NGNT), 2) normoglycemic hypothermic (low temperature) (NGLT), 3) hyperglycemic normothermic (HGNT), and 4) hyperglycemic hypothermic (HGLT) groups (n=15 for each group). Hyperglycemia wasmade by intraperitoneal injection of streptozotocin (60 mg/kg) 3 days before ischemia. The body temperature was maintained at 37+/-1 degrees C in normothermic animals, while lowered at 32+/-1 degrees C in hypothermic animals during the ischemic period. Following reperfusion, 2-mm thick coronal slices were obtained and stained by triphenyltetrazolium chloride. The infarct volume was measured using an image analyzer. RESULTS: Mean glucose levels (mean+/-SD in mg/dl) were 77.9+/-9.3 in NGNT, 77.7+/-11.5 in NGLT, 311.0+/-69.2 in HGNT, and 355.3+/-57.7 in HGLT. Mean infarct volumes (mean+/-SD in mm 3) were 168.2+/-44.2 in NGNT, 66.2+/-24.2 in NGLT, 417.6+/-123.2 in HGNT, and 337.2+/-89.3 in HGLT. The protective effect of hypothermia was less evident in hyperglycemic rats and the aggravating effect of hyper-glycemia was more evident in hypothermic rats. Infarct volume of HGLT was 2-fold bigger than that of NGNT (p<0.05). CONCLUSIONS: Our results suggest that the detrimental effect of hyperglycemia may override the protective effect of hypothermia in transient focal cerebral ischemia.
Animals ; Body Temperature ; Brain ; Brain Ischemia* ; Fever ; Glucose ; Humans ; Hyperglycemia* ; Hypothermia* ; Injections, Intraperitoneal ; Ischemia ; Male ; Rats* ; Rats, Sprague-Dawley ; Reperfusion ; Streptozocin ; Stroke

PURPOSE: Conventional indomethacin therapy(0.2mg/kg every 12 hours for three doses) has been used for closure of PDA. The effect of prolonged low dose of indomethacin therapy(0.1mg/kg daily for six days)had been reported in foreign country but, nothing had been reported in our country. So we attempted this study to examine effects of these two methods. METHODS: Forty one infants with PDA of prematurity from January 1992 to July 1995 who were admitted in NICU of Il Sin Christian Hospital were included. 27 of these infants received conventional dose of indomethacin therapy and 14 received prolonged low dose of indomethacin therapy, and we examined with closure rate and complication etc. RESULTS: 1) Closure of PDA was observed in 15(55.6%) and relapse was 3(11.1%) in conventional dose therapy group. In prolonged low dose therapy group, closure was 8(57.1%) and relapse was none. 2) Intraventricular hemorrhage was observed in 20(74.1%), 6(42.9%) and gastrointestinal tract bleeding was 6(22.2%), 13(92.2%) in each group. There was statistically significant between the two groups(p<0.05). 3) The rise of serum BUN, creatinine was observed in 9(33.3%), 6(46.2%), bleeding tendency was 9(33.3%), 8(57.1%), necrotizing enterocolitis was 2(7.4%), 0 and retinopathy of prematurity was 8(29.6%), 3(21.4%) in each group.But there was not statistically significant correlation between the two groups. 4) The development of sepsis and broncopulmonary dysplasia was slightly more in prolonged low dose therapy group. 5) The reduction of urine output was observed in 11(40.7%), 2(14.3%) in each group but, absolute oliguria was not observed in both groups. CONCLUSIONS: Though the closure rate of PDA was similar in both groups, prolonged low dose indomethacin therapy can be recommanded with its effectiveness on preventing the relapse of PDA and the accurrence of necrotizing enterocolitis.
Creatinine ; Enterocolitis, Necrotizing ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Indomethacin* ; Infant ; Oliguria ; Recurrence ; Retinopathy of Prematurity ; Sepsis

BACKGROUND: Transient global ischemia causes delayed neuronal death (DND) in the CA1 area, of which the mecha-nism is controversial. Induction of apoptosis-regulating proteins during the process of DND has been reported, howev-er ,the exact role of Bcl-2/Bax is not well understood. We tried to reveal the pattern of the Bax/Bcl-2 expression modi-fied by the duration of ischemia and hypothermia. METHODS: Global ischemia was induced in Mongolian gerbils for 2, 5, and 10 minutes under the temperature of 36 degrees C and 32 degrees C. Hippocampal sections were evaluated 48 hours after ischemia with H&E and immunohistochemical staining to Bcl-2/Bax. Viable neuronal density and semi-quantitative grading were compared. RESULTS: In the CA1 area, neurons were intact in 2 min ischemia, while partial or significant ischemic changes were observed in 5-10 min ischemia of 36 degrees C setting, which were less severe in 32 degrees C . Bcl-2 was posi-tive in 2 min ischemia, while negative in 5~10 min ischemia of 36 degrees C . Bax was negative in 2 and 10 min ischemia, while positive in 5 min ischemia. In 32 degrees C setting, Bcl-2 was also positive in 2 min ischemia and partially positive in 5- 10 min ischemia, although Bax expression was not different from 36 degrees C. CONCLUSIONS: The complex mechanism of DND, which is in the spectrum of apoptosis and necrosis, seems to be determined by the severity of ischemia. The bal-ance between Bcl-2 and Bax may determine the survival of neurons in mild to moderate ischemia. Further evidence remains to be determined by morphological and molecular biological methods.
Apoptosis ; Body Temperature* ; Gerbillinae ; Hypothermia ; Ischemia* ; Necrosis ; Neurons

Extradural spinal meningiomas are uncommon, and their pathophysiology is not entirely understood. Here, we present the case of a 49-year-old woman with low back and left leg pain of 5 years duration. Magnetic resonance imaging revealed a mass, 1.8-cm in size, with rim enhancement in the spinal canal at the T12 level and extending into the left T12-L1 foramen. In the surgical field, the mass presented with the characteristics of an extra-intradural spinal meningioma. The patient underwent a T12 total laminectomy. A linear durotomy was performed at the midline, and the intradural portion was removed. The extradural portion was not separable from the adjacent dura and the left T12 root, and it was removed by dural excision. Pathological examination confirmed the diagnosis of psammomatous meningioma. We also conducted a literature review of similar cases. Based on our experience with this case, we believe that it is important to clearly distinguish extradural meningiomas from other types of tumors as misdiagnosis can change the operative plan. The long term prognosis of extradural meningiomas is not clear but total excision is thought to be essential.
Diagnosis ; Diagnostic Errors ; Female ; Humans ; Laminectomy ; Leg ; Magnetic Resonance Imaging ; Meningioma* ; Middle Aged ; Prognosis ; Spinal Canal

Visuomotor ataxia, a difficulty in reaching for or in seizing a well visualized object, has been described as resulting from lesion in premotor area or posterior parietal lobe or deep white matter connecting the two. We report a case of unilateral, both direct and crossed, visuomotor ataxia in the right homonymous half field of vision in the patient with left parieto-occipital arteriovenous malformation.
Arteriovenous Malformations ; Ataxia* ; Humans ; Intracranial Arteriovenous Malformations* ; Parietal Lobe

OBJECTIVE: We performed the surgery using titanium double cylindrical cage for anterior cervical discectomy and interbody fusion in various degenerative cervical diseases. We compared the clinical results and radiologic results in cervical anterior disectomy. Method: From October 2007 to October 2008, 19 patients diagnosed with degenerative disease underwent anterior cervical disectomy and interbody fusion. The postsurgical clinical results were analyzed retrospectively by classifying them into four levels based on Odom's criteria(excellent, good, fair, and poor) after a more than 6-month follow-up period. RESULTS: In all cases, a single segment was involved, and surgery was performed for 19 segments. The C5-C6 inter-vertebral disc was the most commonly affected(9 cases). The clinical outcome was excellent, good, and fair in 5(26.3 %), 10(52.6%), and 4(21.0%) cases, respectively. An excellent or good outcome was considered as a successful result, showing an approximately 78.9% cure rate. No patient had aggravated symptoms compared with their preoperative status. CONCLUSION: Relatively satisfactory clinical and radiographic results were obtained with double cylindrical cages. The surgical method is relatively simple, allows good synostosis, and prevents many complications associated with autografting. It is also less traumatic to the spinal cord during cage insertion. Therefore, double cylindrical cages are generally more recommended for treating cervical spondylosis accompanied with flat cages.
Diskectomy ; Follow-Up Studies ; Humans ; Retrospective Studies ; Spinal Cord ; Spondylosis ; Synostosis ; Titanium ; Transplantation, Autologous

BACKGROUND: Inverted papilloma is an uncommon benign tumor which is characterized by local aggressiveness, high recurrence rate, associated malignancy and tendency to multicentricity. Most authors advocate radical surgical removal of these tumors; however, conservative endoscopic surgery has been reported to be effective in selected cases. OBJECTIVES: To compare with operative methods of the inverted papilloma. MATERIAL AND METHODS: This study comprised 14 cases of inverted papilloma, which were divided into 3 groups. The first was lateral rhinotomy and traditional medial maxillectomy treated group with 7 cases. The second group was treated with conservative endoscopic intranasal resection of 4 cases and the third group was treated by endoscopic medial maxillectomy of 3 cases. RESULTS: The follow-up periods in average were 23 months, 19 months and 11 months in first, second and third groups respectively. All cases showed no recurrence. CONCLUSION: Although follow-up periods are insufficient, the endoscopic approaches are meaningful methods to treat inverted papilloma.
Follow-Up Studies ; Papilloma, Inverted* ; Recurrence