To investigate the effect of Kawasaki syndrome on left ventricular function, we studied 52 patients with Kawasaki syndrome at initial visit and after 3 months (36 patients). Using Pulsed Doppler echocardiogram,we obtained aortic velocity (peak and mean), acceleration time(AT),ejection time(ET), ratio of AT to ET(AT/ET), acceleration (peak and mean) and velocity time integral and mitral velocity of E and A waves(peak and mean) and velocity time integral. Mitral time for peak velocity time integral. Mitral time for peak velocity was significantly prolonged in Kawasaki syndrome,being a mean(+/-SD) of 66.2(+/-14) msec in the control group, 79.2(+/-13)msec at initial vist(p<0.05) and 79.4(+/-13) msec after 3 months (p<0.05). Aortic peak acceleration was significantly decreased in Kawasaki syndrome being a mean(+/-SD) of 2590(+/-785) cm/sec2 after 3 months (P<0.05).Aortic mean acceleration was also significantly decreased in Kawasaki syndrome being a mean(+/-SD) of 1575( +/-542)cm/sec2 in the control group, 1198(+/-351)cm/sec2at initial visit(p<0.05)and 1124 +/-275cm/sec2 after 3 months(p<0.01). Aortic acceleration time was significantly prolonged in Kawasaki svndrome being a mean(+/-SD) of 62(+/-13) msec in the control group, 72(+/-13) msec at initial visit(p<0.05) and 76(+/-16) msec in the control group, 72(+/-13) msec at initial visit(p<0.05) and 76(+/-16) msec after 3 months (p<0.01). We conclude that early abnormalities of left ventricular function, as assessed by echocardiograpy,gencrally persist after 3 months of onset.
Acceleration ; Echocardiography* ; Humans ; Mucocutaneous Lymph Node Syndrome* ; Ventricular Function, Left*

PURPOSE: Conventional MRI may not visualize the structural abnoramlity in large proportion of patients with intractable extratemporal lobe epilepsy. METHODS: Five patients with intractable extratemporal lobe epilepsy underwent resective surgery. Preoperatively, all patients underwent video-EEG monitoring using extracranial electrodes and MRI. Three had PET scans and four had MRS. 3D-reconstruction of the MRI was performed in all patients. Then, subdural grid electrodes were implanted on the suspected lesion in 3D-reconstructed brain; One had bitemporal depth electrodes insertion, and subdural grid electrodes implantation on bilateral frontal lobe. Two had frontal resection and including supplementary sensorimotor area in one. Parietal and parieto-temporal resection was performed in each. One had partial occipital lobe resection. RESULTS: All had complex partial seizures and four of them had lateralizing signs. Standard surface EEG recordings were not reliable in lateralizing or localizing the epileptogenic zone in any of patients. Conventional MRI revealed subtle abnormality in the superior parietal lobule, and atrophic changes in parietal lobe and posterior portion of the superior temporal gyrus, in each. Three did not show any structural abnormalities. MRS showed abnormal NAA/Ch: Cr ratio in two; one in the lesion and one in the bilateral hipocampus. PET showed hypometabolism in the extensive area in three with limitation in localizing the epileptogenic zone. All had abnormal gyral and sulcal paterns in 3D-reconstructed brain; two in the frontal lobe, superior parietal lobule, and inferior parietal and posterior portion of the superior temporal gyrus, in each, and one in the occipital lobe. Histopathologic findings revealed cortical dysplasia in all. Three were seizure free and two were class I in Engel's classification during follow-up between 4 to 24 months. CONCLUSIONS: This study suggests that in the surgical treatment of the extratemporal lobe epilepsy without prominent abnormalities in conventional MRI, 3D-reconstruction of the MRI may be of value in localizing the epileptogenic zone.
Brain ; Classification ; Electrodes ; Electroencephalography ; Epilepsy ; Follow-Up Studies ; Frontal Lobe ; Humans ; Magnetic Resonance Imaging* ; Malformations of Cortical Development ; Occipital Lobe ; Parietal Lobe ; Positron-Emission Tomography ; Rabeprazole ; Seizures

We performed this study to analyse the morbidity and mortality of stoma formation in infants and children over a 17-year period. Thirty-seven stoma formations were performed in 37 patients: 21 for anorectal malformation, 9 for Hirschsprung's disease, 3 for necrotizing enterocolitis, 2 for multiple ileal atresia, 1 for volvulus neonatorum with perforation, and 1 for diaphragmatic hernia with colon perforation. There were 26 boys and 11 girls with a mean age of 0.4 years. Complications after stoma formation were encountered in 12 patients(32.4%) and included stomal prolapse, stenosis, retraction, dysfunction, skin excoriation and parastomal hernia. Four patients(10.8%) required stomal revision. The incidence of complications was neither related to the age nor to the primary indication for the stoma formation, but sigmoid colostomy was associated with a lower complication rate compared to transverse colostomy(22.1% versus 42.1%, P<0.05). Five patients died, but only one(2.7%) was dead, which was directly related to stoma formation. Eighteen of these children subsequently underwent stoma closure which was associated with complications in six patients(33.3%). The most common complication after stoma closure was wound sepsis in 4 children. In conclusion, because the significant morbidity of stoma formation still exists the refinements in surgical technique may help in reducing the incidence of complications and a sigmoid loop colostomy should be used whenever possible.
Child* ; Colon ; Colon, Sigmoid ; Colostomy ; Constriction, Pathologic ; Enterocolitis, Necrotizing ; Female ; Hernia ; Hernia, Diaphragmatic ; Hirschsprung Disease ; Humans ; Incidence ; Infant* ; Intestinal Volvulus ; Mortality ; Prolapse ; Sepsis ; Skin ; Wounds and Injuries

A study on the penile and testicular sizes was made on 1,071 Korean children. The penile length was obtained by assessing stretched length from the tip of the glans to the base of the penis at its attachment to the symphisis pubis. The testicular relative volume was obtained by use of the testicular length, and following results were obtained. l. In newborn, the mean and standard deviation of the stretched penile length were 3.3cm and O.5 cm. 2. The penile length has increased slowly till 4 years old and, following the steady phase, it increased rapidly from the puberty. At the age of l4, it reached 8.8cm. 3. The testicular growth begun with the onset of the puberty. Its relative volume of 14 years of age was 13.7 times as much as that of newborn.
Adolescent ; Child* ; Child, Preschool ; Humans ; Infant, Newborn ; Male ; Penis ; Puberty ; Testis

Several symptoms of dry eye in the patients who underwent cataract surgery are related to the stability of precorneal tear film layer. We studied the change of the lipid layer pattern in tear film after cataract surgery. Ninety-eight eyes of 87 patients were evaluated for the lipid layer patterns before operation and at two months after operation. Thirty-two eyes(32.7%) among 98 eyes had the change of the pattern of lipid layer. The change was more marked in the eyes of color fringe pattern preoperatively than others(p=0.000). The rate of change was not significantly different between the superior limbal incision group and temporal clear corneal incision group, and between the groups according to the number of sutures(p>0.05). The eyes which had had the dry eye symptoms developed more change of the lipid layer pattern(p=0.006). After cataract surgery, the change of the lipid layer pattern got more marked especially in the eyes which had had color fringe pattern before surgery. In the eyes which had had the dry eye symptoms, however, no difference was shown by the incisional site and by the number of sutures.
Cataract* ; Humans ; Sutures ; Tears*

No abstract available.
Intercellular Adhesion Molecule-1* ; Interleukin-6* ; Keratinocytes*

Speech lateralization by Wada is a necessary step in the presurgical evaluation of patients with intractable epilepsy. It, however, is invasive. We studied the usefulness of a noninvasive technique: MRI-based volumetric and anatomical analysis of the anterior speech area as compared to Wada test. Thirty nine patients with intractable epilepsy under presurgical evaluation includding Wada test for hemispheric lateralization for language, were studied: patients with left language dominance(n=20) and right language dominance (n=19). Sagittal and coronal T1-weighted turbo FLASH scans were acquired. Every image in each patient was reconstructed and inferior frontal gyrus was identified on the 3D-surface rendered brain. Then cortical gray matter of inferior frontal gyrus in each image was segmented and reconstructed using a 3D software(Allegro, ISG, Toronto, Canada). Sulcal and gyral patterns of the inferior frontal gyrus were evaluated and classified comparing with the normotive data of Steinmetz. Total volume of inferior frontal gyrus(ifg), regional volumes of pars triangularis(tr) and pars opercularis(op) were obtained. Asymmetry Quotient(AQ) of inferior frontal gyrus, (right-left)/0.5(right+left), between left and right were calculated in each patient. AQ from both groups of patients were compared and data was analysed. Complicated gyral pattern and presentation of a diagonal sulcus in the pars opercularis were prominent in the left side in patients with the left hemispheric dominance for language(p<0.006, p<0.02), and in the right side in patients with the right hemispheric dominance(p<0.002, p<0.03). In patients with language dominance in the left hemisphere, AQ of each portion of anterior speech area showed significant leftward asymmetry(M: Mean, SEM: Standard Error of Mean, Mifg=-.24; SEMifg=0.04, Mtr=-.19; SEMtr=0.09, Mop=-.26; SEMop=0.06). In patients with language dominance in the right hemisphere, AQ showed mild rightward asymmetry or no asymmetry(Masa=0.21; SEMifg=0.06, Mtr=0.15; SEMtr=0.08, Mop=0.24; SEMop=0.09). Fisher's Exact test demonstrated significant value of AQ in each portion of inferior frontal gyrus correlated with hemispheric dominance for language with confidence index(CI)in 95%. Interestingly, AQ of pars triangularis plus pars opercularis showed the highest value(p=0.00001) in predicting the language dominant hemisphere. MRI-based sulcal, gyral patterns and volumetric asymmetry of inferior frontal gyrus correlate with speech lateralization on Wada test. This is a promising noninvasive technique in hemispheric lateralization for language.
Brain ; Epilepsy ; Humans

BACKGROUND: Tumor necrosis factor-alpha(TNF-alpha) has been thought to play a major role in neurological injury during global brain ischemia and subsequent reperfusion following resuscitation in cardiac arrest. So, we hypothesized that the elevation in TNF-alpha was dependent upon the duration of the global brain ischemia, and related to delayed neuronal damage. METHODS: Fourteen rats were divided two groups ; 1 minute-cardiac arrest group(n=7) and 3 minute-cardiac arrest group(n=7). we induced cardiac arrest by chest compression and damping of tracheal tube for 1 minute and 3 minutes respectively. And then, resuscitation was initiated. To measure the plasma activity of TNF-alpha, blood samples were drawn before and at the end of cardiac arrest, and 30, 60, 90, and 120 minutes after initiation reperfusion. At 72 hours after resuscitation, the ND(neurologic deficit) score was determined and the histopathologic outcome of hippocampal CA1 neuron was observed by the percent dead hippocampal CA1 neurons. RESULTS: 1. TNF-alpha level during the early reperfusion period(<2h) was significantly increased in 3 min-cardiac arrest group compared with 1 min-cardiac arrest group(p=0.0001). 2. There was a no significant difference of neurologic deficit score between 1 min- and 3 min-cardiac arrest. 3. Percent dead hippocampal neurons were significantly increased in 3 min-cardiac arrest group compared with 1 min-cardiac arrest group(9.1+/-1.2% vs 1.2+/-0.9%, p<0.05). CONCLUSION: The results suggest that longer duration of global brain ischemia causes a more profound increase in plasma TNF-alpha level during the early reperfusion period(<2h) and more delayed neuronal damage than lessor duration of global brain ischemia, and that increase in TNF-alpha level during the early reperfusion period(<2h) is related to delayed neuronal damage.
Animals ; Brain Ischemia ; Brain* ; Heart Arrest* ; Heart Arrest, Induced ; Necrosis ; Neurologic Manifestations ; Neurons ; Plasma ; Rats* ; Reperfusion ; Reperfusion Injury* ; Resuscitation ; Thorax ; Tumor Necrosis Factor-alpha*

Background: Bone grafts can provide an optimal environment for permanent tooth to erupt and enhance the stability of the alveolar maxilla. Although autologous bone is an optimal source for osteogenesis, its inevitable donor site morbidity has led to active research on bone substitutes. This study was designed to evaluate the safety and feasibility of using biphasic calcium phosphate (BCP; Osteon) as a bone substitute in dogs. Methods: Bilateral third and fourth premolars of four 15-week-old mongrel dogs were used. All teeth were extracted except the third premolar of the right mandible, which was used as a control. After extraction of the premolars, each dog was administered BCP (Osteon), demineralized bone matrix (DBM; DBX), and no graft in the hollow sockets of the right fourth premolar, left fourth premolar, and left third premolar, respectively. Radiographs were taken at 2-week intervals to check for tooth eruption. After 8 weeks, each dog was sacrificed, and tooth and bone biopsies were performed to check for the presence of tooth and bone substitute particle remnants. Results: Four weeks after the operation, permanent tooth eruptions had started at all the extraction sites in each dog. Eight weeks after the operation, all teeth had normally erupted, and histological examination revealed BCP particles at the right fourth premolar. Conclusion: In all four dogs, no delay in the eruption of the teeth or shape disfigurement of permanent teeth was observed on gross inspection and radiologic evaluation. On histological examination, most of the BCP and DBM were replaced by new bone. Bone substitutes can be used as graft materials in patients with alveolar clefts.

Mazabraud syndrome (MS) is a rare and sporadic disorder. It is mainly characterized by fibrous dysplasia (FD) of single or multiple bones and intramuscular myxomas (IM). Data on the prevalence since it was first reported, clinical features, and prognosis are extremely scarce. We report a case of a 59-year-old woman with IM and polyostotic FD. She also had multiple cafe’-au-lait spots suggestive of McCune-Albright syndrome (MAS). On magnetic resonance imaging, there are masses with well-defined heterogeneous enhancement, accompanied by an inner cyst in the vastus lateralis muscle and femur. These radiological results are identical to those of FD. After surgical intervention with excision of intramuscular soft-tissue mass, a diagnosis of IM of MS was confirmed. Given that cafe’-au-lait spots also appeared, the patient was diagnosed with a variant of MS with some of the clinical characteristics of MAS.