PURPOSE: To investigate the various ictal perfusion patterns and find the relationships between clinical factors and different perfusion patterns. MATERIALS AND METHODS: lnterictal and ictal SPECT and SPECT subtraction were performed in 61 patients with partial epilepsy. Bath positive images showing ictal hypoperfusion and negative images revealing ictal hypoperfusion were obtained by SPECT subtraction. The ictal perfusion patterns of subtracted SPECT were classified into focal hypoperfusion, hypoperfusion-plus, combined hypoperfusion-hypoperfusion, and focal hypoperfusion only. RESULTS: The concordance rates with epileptic focus were 91.8% in combined analysis of ictal hypoperfusion and hypoperfusion images of subtracted SPECT, 85.2% in hypoperfusion images only of subtracted SPECT, and 68.9% in conventional ictal SPECT analysis. Ictal hypoperfusion occurred less frequently in temporal lobe epilepsy (TLE) than extratemporal lobe epilepsy. Mesial temporal hypoperfusion alone was seen only in mesial TLE while lateral temporal hypoperfusion alone was observed only in neocortical TLE. Hippocampal sclerosis had much lower incidence of ictal hypoperfusion than any other pathology. Some patients showed ictal hypoperfusion at epileptic focus with ictal hypoperfusion in the neighboring brain regions where ictal discharges propagated. CONCLUSION: Hypoperfusion as well as hypoperfusion in ictal SPECT should be considered for localizing epileptic focus. Although the mechanisrn of ictal hypopertusion could be an intra-ictal early exhaustion of seizure focus or a steal phenomenon by the propagation of ictal discharges to adjacent brain areas, further study is needed to elucidate it.
Baths ; Brain ; Epilepsies, Partial* ; Epilepsy ; Epilepsy, Temporal Lobe ; Humans ; Incidence ; Pathology ; Perfusion* ; Sclerosis ; Seizures ; Tomography, Emission-Computed, Single-Photon*

PURPOSE: The detection of epileptogenic lesion plays an important role in the management of patients with partial epilepsy. Although the development of MRI improved the examination of cerebral hemispheres greatly, many patients with neocortical temporal lobe epilepsy (TLE) or extratemporal lobe epilepsy (extra-TLE) still show no lesion in conventional two-dimensional (2D) images. To increase the yield of MRI in those patients, we performed three-dimensional (3D) surface-projection rendering (SPR) of the cerebral hemispheres. METHODS: Conventional 2D MRI (T1, T2, FLAIR, thin slice SPGR) and 3D SPR were performed in 24 patients with neocortical TLE and extra-TLE, and 20 normal subjects. Sulcogyral patterns were evaluated blindly to clinical information. The locations of the epileptogenic zone, ictal onset zone (IOZ) and irritative zone (IRZ) were determined by intracranial EEG monitoring and epilepsy surgery. RESULTS: The 2D MRI identified epileptogenic lesions in five of the 10 neocortical TLE (50%) and five of the 14 extra-TLE (35.7%). 3D SPR revealed abnormal sulcogyral patterns in 9 of the 10 neocortical TLE (90%) and 9 of the 14 extra-TLE (64.3%). Cortical deformation zones with sulcogyral anomalies included the whole area of IOZ in 10 (55.5%) and IRZ in 6 (33.3%), overlapped with IOZ in 7 (38.9%) and IRZ in 11 (61.1%), were connected to IOZ in 1 (5.6%) and IRZ in 1 (5.6%). CONCLUSION: 3D SPR of volumetric MRI data can detect epileptogenic structural lesions of neocortical epilepsy that are not visible in the conventional 2D images.
Brain* ; Cerebrum ; Electroencephalography ; Epilepsies, Partial ; Epilepsy* ; Epilepsy, Temporal Lobe ; Humans ; Magnetic Resonance Imaging*

PURPOSE: To investigate the use of pretreatment carbohydrate antigen (CA) 19-9 and carcinoembryonic antigen (CEA) as prognostic factors to determine survival in pancreatic adenocarcinoma. MATERIALS AND METHODS: A retrospective review of the medical records of patients who were diagnosed with pancreatic adenocarcinoma and received surgery, chemoradiotherapy or chemotherapy was performed. Factors, including CA 19-9 and CEA, associated with the survival of pancreatic cancer patients were analyzed. RESULTS: Patients with the median age of 65 years were included (n=187). Elevated serum CA 19-9 levels and CEA levels were observed in 75.4% and 39% of patients at diagnosis, respectively. CEA was correlated with tumor stages (p=0.005), but CA 19-9 was not. CA 19-9 and CEA were elevated in 69.0% and 33.3% of patients with resectable pancreatic cancer, and elevated in 72.9% and 47.2% of patients with advanced pancreatic cancer, respectively. The median overall survival of the normal serum CEA group was longer than that of the elevated serum CEA group (16.3 months vs. 10.2 months, p=0.004). However, the median overall survival of the normal serum CA 19-9 group was not different from that of the elevated serum CA 19-9 group (12.4 months vs. 13.5 months, p=0.969). The independent factors associated with overall survival were advanced pancreatic cancer [harzard ratio (HR) 4.33, p=0.001] and elevated serum CEA level (HR 1.52, p=0.032). CONCLUSION: Patients with elevated serum CEA level at diagnosis demonstrated poor overall survival. Pretreatment CEA level may predict the prognosis of patients with pancreatic adenocarcinoma.
Adenocarcinoma/blood/*diagnosis ; Adult ; Aged ; Aged, 80 and over ; Antigens, Tumor-Associated, Carbohydrate/*blood ; Carcinoembryonic Antigen/*blood ; Female ; Humans ; Male ; Middle Aged ; Pancreatic Neoplasms/blood/*diagnosis ; Prognosis ; Retrospective Studies ; Survival Analysis

PURPOSE: To compare the sedation quality of oral chloral hydrate against intramuscular ketamine in children requiring primary repair in the emergency department. METHODS: Patients needing primary repair of lacerations (range 1.6 years of age) were blindly randomized to either chloral hydrate or ketamine groups. One group received intramuscular ketamine at 4 mg/kg and the other group received oral chloral hydrate at 50 mg/kg. Both groups received lidocaine for local anesthesia. Physiologic parameters (heart rate, blood pressure and respiratory rate), the time from sedation to recovery, and the degree of sedation as measured by the Ramsay sedation score and the Modified Aldrete recovery score were recorded during the treatment. Overall behavior and complication were assessed both at baseline and at the end of the treatment. RESULTS: Data are mean+/-SD. We enrolled 80 consecutive patients into the study; 39 received intramuscular ketamine and 41 were administered oral chloral hydrate. The two groups were similar with regard to age, sex, and body weights. No patient had a clinically significant change in vital signs and the time from sedation to recovery. Changes in the Modified Aldrete recovery score after sedation were not statistically significant. However, statistically significant differences were observed for the Ramsay sedation score at 15 minutes after sedation (4.89+/-0.32 versus 4.23+/-0.48; p=0.024). No differences at other time points achieved statistical significance in the Ramsay sedation score. CONCLUSION: Both oral chloral hydrate and intramuscular ketamine are safe and effective for the sedation of children requiring laceration repair in the emergency department.
Anesthesia, Local ; Blood Pressure ; Body Weight ; Child* ; Chloral Hydrate* ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Ketamine* ; Lacerations ; Lidocaine ; Vital Signs

The purpose of this study was to evaluate the human pulpal response to Dentin Bonding Desensitizer. Class v cavities were prepared on the buccal surfaces of the first premolars and Dentin Bonding Desensitizer(ALL-BOND Desensitizer, Bisco, Inc. U.S.A.) was applicated in ten experimental teeth, or ZOE(PROPAC, GC Co. TOKYO, JAPAN) cement in eight control teeth and cavities were filled with light curing glass ionomer(Fuji II LC, GC Co., TOKYO, JAPAN). At 3-day and 25-day postoperative interval, pulpal response was observed and evaluated histologically with light microscope. The results were as follows. : 1. At 3-day postoperative interval, the control teeth were grade 1 inflammatory cell response and grade 1 connective tissue response. 2. At 25-day postoperative interval, all control teeth were grade 1 inflammatory cell response and in three control teeth grade 1 connective tissue response were observed, and one teeth showed grade 2 connective tissue response. 3. At 3-day postoperative interval, the experimental teeth were grade 1 inflammatory cell response and grade 1 connective tissue response. Below the cavity a few inflammatory cell(PMNs) in odontoblastic layer, increased blood vessels and pulpal cells were seen and this pulpal response was similar to control teeth. 4. At 25-day postoperative interval, in four experimental teeth grade 1 inflammatory cell response and grade 1 connective tissue response were observed, and one experimental teeth showed mild inflammatory response. 5. At 3-day and 25-day postoperative interval, no reparative dentin deposition was seen. 6. Both experimental and control group, pulpal response showed difference between 3 and 25-day of postoperative interval. In control teeth, increased predentin and pulpal cells were seen and in experimental teeth, congestion of blood vessels and increased pulpal cells were seen. In conclusion, the pulpal irritation due to this Dentin Bonding Desensitizer was not severe, and it was considered that agent was not harmful to the human pulp.
Bicuspid ; Blood Vessels ; Connective Tissue ; Dentin* ; Estrogens, Conjugated (USP) ; Glass ; Humans* ; Odontoblasts ; Tooth

Erythromelalgia is an extraordinary condition of unknown etiology characterized by recurrent attacks of burning pain, redness, swelling, and warmth of the extremities. Characteristically the symptoms are provoked by heat, exercise, and dependency. Several classifications of erythromelalgia have been documented and include an erythromelalgia associated with thrombocythemia, primary erythermalgia, and secondary erythermalgia. Secondary erythermalgia develops in association with certain diseases or as a consequence of adverse drug reactions. So treat the underlying disease or withdrawal the offending drug leads to resolution of these symptoms. But primary erythermalgia occurs in the absence of any underlying disorder and is refractory to pharmacologic measures.We present a 28-year-old woman with primary erythermalgia who had recurrent episodes of severe burning pain on her feet. The pain did not respond to analgesics but relieved by immersion in cold water. The results of clinical, laboratory, and electrophysiologic investigations showed no underlying disorder. She was treated with aspirin and morphine, but it provided minimal relief only.
Adult ; Analgesics ; Aspirin ; Burns ; Classification ; Drug-Related Side Effects and Adverse Reactions ; Erythromelalgia* ; Extremities ; Female ; Foot ; Hot Temperature ; Humans ; Immersion ; Morphine ; Thrombocythemia, Essential ; Water

Most regional anesthesia in breast surgeries is performed as postoperative pain management under general anesthesia, and not as the primary anesthesia. Regional anesthesia has very few cardiovascular or pulmonary side-effects, as compared with general anesthesia. Pectoral nerve block is a relatively new technique, with fewer complications than other regional anesthesia. We performed Pecs I and Pec II block simultaneously as primary anesthesia under moderate sedation with dexmedetomidine for breast conserving surgery in a 49-year-old female patient with invasive ductal carcinoma. Block was uneventful and showed no complications. Thus, Pecs block with sedation could be an alternative to general anesthesia for breast surgeries.
Anesthesia ; Anesthesia, Conduction ; Anesthesia, General* ; Breast* ; Carcinoma, Ductal ; Conscious Sedation ; Dexmedetomidine ; Female ; Humans ; Mastectomy, Segmental* ; Middle Aged ; Nerve Block ; Pain, Postoperative

Typographical error has been detected in acknowledgements.

It has been reported that the number of patients with hypertension increases yearly, and this imposes many anesthetic problems during surgery. The etiology of essential hypertension is unknown, but it affects primarily the brain, heart and kidney. The main causes of mortality due to hypertension are cerebrovascular accident, congestive heart failure, myocardial infarction and uremia. For the better anesthetic management of patients wuth hypertension, it is essential to clearly understand the pathophysiologic changes and hemodynamic patterns of hypertension. Because of the controversy regarding the appropriateness of preoperative treatment of hypertension, this article will evaluate the effect of preoperative antihypertensive medication on blood pressure during anesthesia of hypertensive patients. Patients with hypertension were divided into two groups, one group consisting of ll patients, who received antihypertensive medication in the preoperative period, and the other group, consisting of 11 patients, who did not received antihypertensive medication for the control of high blood pressure preoperatively. Changes of arterial blood pressure during anesthesia were analyzed, and data were compared between the two groups. The results were as follows: The patient who receivecd antihypertensisve medication for preoperative anesthetic management showed the same arterial blood pressure fluctuation during general anesthesia, as the patients who had not received antihypertensive medication (p < 0. 05). In the treated group, the blood pressure and heart rate changes during preinduction and intubation showed significant increase compared to the ward's values, but did not show a significant increase during operation annd recovery. In the nontreated group, the results showed similar changes with the treated group. It may be suggested from the above observation that the preoperative control of hypertension dose not affect the changes of blood pressure in the perioperative period.
Anesthesia* ; Anesthesia, General ; Arterial Pressure ; Blood Pressure* ; Brain ; Heart Failure ; Heart Rate* ; Heart* ; Hemodynamics ; Humans ; Hypertension ; Intubation ; Kidney ; Mortality ; Myocardial Infarction ; Perioperative Period ; Preoperative Period ; Stroke ; Uremia

PURPOSE: The purpose of this research was to analyze drinking on the day of injury, usual drinking pattern, factors associated with the injury and socioeconomic factors for patients who visited the emergency room (ER) for injuries. METHODS: From among all the trauma patients who visited ER, this research included 474 patients who were over 18 years of age and who visited the ER within 48 hours of their injury. Questionnaire surveys, telephone surveys, and serologic tests were conducted for all the patients. RESULTS: The drinking rate before injury was 51.9% among the 337 drinkers. The rate of drinkers was 72.2% (male 85%, female 42.6%), and the rate of habitual drinkers was 22.4% among the 466 subjects. The rates of habitual drinkers and nonhabitual drinkers were 31.5% and 68.5%, retrospectively, among the 337 drinkers. Such groups as assaulted patients, patients operated on under local anesthesia, patients injured indoor or outdoor except on roads, patients diagnosed as laceration, and patients injured between midnight and 8 a.m., and between 4p.m. and midnight had significantly higher incidents of drinking on the day of the injury (p=0.00~0.02). Such groups as males, older people, married people, people with low levels of education, people with high incomes and assaulted patients had significantly higher numbers of habitual drinkers (p= 0.00 ~ 0.04 ). CONCLUSION: This study suggests that alcohol use is an important factor for patients who visit the ER for injuries and alcohol drinking. But it can not be concluded that there is a causal relation between alcohol use and injury. Such groups who visit the ER for injuries as males, older people, married people, people with low levels of education, people with high incomes and assaulted patients need to be screened for alcohol misuse.
Alcohol Drinking ; Anesthesia, Local ; Drinking* ; Education ; Emergencies* ; Emergency Service, Hospital* ; Female ; Humans ; Lacerations ; Male ; Surveys and Questionnaires ; Retrospective Studies ; Serologic Tests ; Socioeconomic Factors ; Telephone