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

Purpose: This study was aimed to investigate the changes in pediatric injury-related visits at an emergency department (ED) during coronavirus disease 2019 pandemic. Methods: We retrospectively compared injury-related visits to an ED in Korea by children aged 15 years or younger during February 2020-December 2021 (pandemic period), and the visits during February 2018-December 2019. Clinical characteristics, injury mechanisms, diagnostic codes, and ED outcomes were noted. We performed 2 sub-analyses of the pandemic period: biannual changes in the visits, and monthly trends of proportions of concussion and superficial injury as diagnostic codes using linear regression. Results: Despite a 51.2% reduction in injury-related visits during the pandemic, the proportion of the visits increased (25.2% vs. 40.0%; P < 0.001). Overall, increases were noted in proportions of use of emergency medical services and high acuity (P < 0.001). Among the diagnostic codes, brain injuries, fracture and dislocation, and laceration increased while superficial injuries, burn, intoxication, and foreign body ingestion decreased (P < 0.001). As the pandemic prolonged, injury-to-ED time shortened and ED length of stay lengthened while the abovementioned trends remained unchanged. Linear regression showed that the proportions of concussion and superficial injury respectively increased and decreased by 0.01% per month (P < 0.001). Conclusion The changes in pediatric injury-related visits at the ED during the coronavirus disease 2019 pandemic may serve as a basis for distributing emergency medicine resources in future infectious disease outbreaks.

A Swan-Ganz catheter is a useful monitoring device for measuring the pulmonary artery pressure, pulmonary capillary wedge pressure and cardiac output, but its insertion brings about many complications, including dysrhythmias, pulmonary artery rupture, thrombosis and infection. We report here on a case of malposition of a Swan-Ganz catheter in a 49-year-old female patient who had undergone liver transplantation due to alcoholic liver cirrhosis.
Cardiac Output ; Catheters* ; Female ; Humans ; Liver Cirrhosis, Alcoholic ; Liver Transplantation ; Middle Aged ; Pulmonary Artery ; Pulmonary Wedge Pressure ; Rupture ; Thrombosis

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

Purpose: To assess the effect of medically-attended injury (MAI) on the use of home safety equipment, we analyzed the differences in parents’ perception and attitude about injury prevention, and use of home safety equipment depending on the children’s MAI experiences. Methods: From March 2018 through February 2019, we surveyed parents of children aged 5 years or younger via a mobile phone. The parents were divided into the MAI and non-MAI groups. The mobile survey focused on the perception and attitude about injury prevention, and use of home safety equipment (if not used, barriers). Results: Of the 204 parents, 75 (36.8%) reported their children’s MAI, comprising the MAI group. This group used the safety equipment more frequently than the non-MAI group (odds ratio, 7.03; 95% confidence interval, 3.39-14.59; P < 0.001). No significant differences between the 2 groups were found in the perception and attitude about injury prevention, barriers to the use of the equipment, and the type of the equipment in use. Conclusion Parents’ experience in their children’s MAIs was associated with the use of home safety equipment, but it did not affect their perception and attitude about injury prevention. A visit to the emergency department with MAI is an opportunity for education on injury prevention and changes of the attitude.

Purpose: The optimal time for home safety intervention for children’s injury prevention is during the injury-related visits to emergency departments. The authors investigated the effect of home safety equipment provision on the guardians’ perception of injury prevention and attitude toward it, and the use of home safety equipment. Methods: We conducted a double blind randomized controlled study on guardians of children aged 7 years or younger who visited the emergency department with accidental injuries. After completing the structured, pre-intervention survey on home safety, the guardians were randomly assigned to receive either home safety equipment (the intervention group) or stationery (the control group) in the same opaque boxes enclosing pamphlets about home safety education. After 4 weeks, the guardians were contacted for the post-intervention survey. The questionnaires for the latter survey consisted of the same contents with 2 added questions regarding the use of new home safety equipment after intervention. Logistic regressions were conducted to identify factors associated with the outcome (i.e., behavioral change). Results: From April through October 2019, we approached 972 guardians. Of these, 59 guardians answered both pre- and post-intervention surveys. No differences were found in the perception and attitude, and use of home safety equipment between the intervention and control groups at the pre- and post-intervention surveys. No variables were associated with the primary outcome. Conclusion Provision of home safety equipment may be inadequate to improve guardians’ behaviors about prevention of domestic injuries.

Purpose: To assess the effect of medically-attended injury (MAI) on the use of home safety equipment, we analyzed the differences in parents’ perception and attitude about injury prevention, and use of home safety equipment depending on the children’s MAI experiences. Methods: From March 2018 through February 2019, we surveyed parents of children aged 5 years or younger via a mobile phone. The parents were divided into the MAI and non-MAI groups. The mobile survey focused on the perception and attitude about injury prevention, and use of home safety equipment (if not used, barriers). Results: Of the 204 parents, 75 (36.8%) reported their children’s MAI, comprising the MAI group. This group used the safety equipment more frequently than the non-MAI group (odds ratio, 7.03; 95% confidence interval, 3.39-14.59; P < 0.001). No significant differences between the 2 groups were found in the perception and attitude about injury prevention, barriers to the use of the equipment, and the type of the equipment in use. Conclusion Parents’ experience in their children’s MAIs was associated with the use of home safety equipment, but it did not affect their perception and attitude about injury prevention. A visit to the emergency department with MAI is an opportunity for education on injury prevention and changes of the attitude.

Purpose: The optimal time for home safety intervention for children’s injury prevention is during the injury-related visits to emergency departments. The authors investigated the effect of home safety equipment provision on the guardians’ perception of injury prevention and attitude toward it, and the use of home safety equipment. Methods: We conducted a double blind randomized controlled study on guardians of children aged 7 years or younger who visited the emergency department with accidental injuries. After completing the structured, pre-intervention survey on home safety, the guardians were randomly assigned to receive either home safety equipment (the intervention group) or stationery (the control group) in the same opaque boxes enclosing pamphlets about home safety education. After 4 weeks, the guardians were contacted for the post-intervention survey. The questionnaires for the latter survey consisted of the same contents with 2 added questions regarding the use of new home safety equipment after intervention. Logistic regressions were conducted to identify factors associated with the outcome (i.e., behavioral change). Results: From April through October 2019, we approached 972 guardians. Of these, 59 guardians answered both pre- and post-intervention surveys. No differences were found in the perception and attitude, and use of home safety equipment between the intervention and control groups at the pre- and post-intervention surveys. No variables were associated with the primary outcome. Conclusion Provision of home safety equipment may be inadequate to improve guardians’ behaviors about prevention of domestic injuries.