Excessive production of parathyroid hormone causes bony disorder such as periosteal bone resorption and bone pain due to excessive skeletal demineralization. A Class III facial deformity case with generalized root resorption presented here was turned out to be due to hyperparathyroidism. Clinical and cephalometric analysis revealed a straight skeletal profile with a retruded maxilla and a prognathic mandible. The x-ray findings demonstrated generalized root resorption of entire dentition to different degree. There also appeared osteoporosis like immature trabecular structure with the evidence of ground glass appearance. Serum test showed elevated level of parathyroid hormone and growth hormone. Change of cranial growth by hyperparathyroidism can be dependent upon a decreased bone apposition in viscerocranial growth site and abnormalities in cranial suture growth. It is possible to hypothesize that growth retardation of maxilla at least partially be accounted for hyperparathyroidism. Therefore, regarding to the definite etiology of skeletal Class III and orthodontic treatment planning considering root resorption and osteoporosis, the early diagnosis for the hyperparathyroidism should be carefully carried by clinical and laboratory studies.
Bone Resorption ; Congenital Abnormalities ; Cranial Sutures ; Dentition ; Diagnosis* ; Early Diagnosis ; Glass ; Growth Hormone ; Hyperparathyroidism* ; Mandible ; Maxilla ; Osteoporosis ; Parathyroid Hormone ; Root Resorption*

The authors have clinically analysed the patients who required the reoperations after the aneurysmal clippings with intention to decrease the rate of reoperation as predicting the risk factors causing the postoperative complications or sequelae of subarachnoid hemorrhage. Between 1991 and 1996, we have performed total operation on 691 patients with aneurysmal subarachnoid hemorrhage. Among these, 72 patients(10.4% of total) required to be reoperated due to various causes. The shunt for hydrocephalus which was the most common cause of reoperation, performed in 57 patients(79.2% of the reoperated), and next, trephination for the subdural hygroma in 12 cases (16.7%), removal of the intracranial hematoma on the operated site in 7 cases(9.7%), reclipping of aneurysms for the regrowing of aneurysm rest or undiscovered aneurysm preoperatively in 5 cases(7%), and decompressive surgery for postoperative brain swelling and vasospasm in 2 cases(2.8%). The authors suggest that the perfect aneurysmal clipping and the detailed evaluation to decrease these complications of aneurysmal surgery, and careful attention should be given to find out the hidden or regrowing of aneurysmal rest are needed on pre-, postoperatively, and during the operation procedure.
Aneurysm* ; Brain Edema ; Hematoma ; Humans ; Hydrocephalus ; Intention ; Postoperative Complications ; Reoperation ; Risk Factors ; Subarachnoid Hemorrhage ; Subdural Effusion ; Trephining

Nocturnal enuresis has been recognized as an adverse effect of clozapine treatment. We reported 3 chronic schizophrenic patients who had showed nocturnal enuresis following clozapine treatment. Oxybutynin hydrochloride on clozapine-induced enuresis was very effective in 3 patients. The dose in our patients was 5 to 10mg/day. This medication was well tolerated. It is suggested that oxybutynin hydrochloride is a effective therapeutic option in clozapine-induced nocturnal enuresis.
Clozapine* ; Enuresis ; Humans ; Nocturnal Enuresis* ; Schizophrenia

BACKGROUND: A 9-year-old male showed severe defects in midface structures, which resulted in maxillary hypoplasia, ocular hypertelorism, relative mandibular prognathism, and syndactyly. He had been diagnosed as having Apert syndrome and received a surgery of frontal calvaria distraction osteotomy to treat the steep forehead at 6 months old, and a surgery of digital separation to treat severe syndactyly of both hands at 6 years old. Nevertheless, he still showed a turribrachycephalic cranial profile with proptosis, a horizontal groove above supraorbital ridge, and a short nose with bulbous tip. METHODS: Fundamental aberrant growth may be associated with the cranial base structure in radiological observation. RESULTS: The Apert syndrome patient had a shorter and thinner nasal septum in panthomogram, PA view, and Waters’ view; shorter zygomatico-maxillary width (83.5 mm) in Waters’ view; shorter length between the sella and nasion (63.7 mm) on cephalogram; and bigger zygomatic axis angle of the cranial base (118.2°) in basal cranial view than a normal 9-year-old male (94.8 mm, 72.5 mm, 98.1°, respectively). On the other hand, the Apert syndrome patient showed interdigitating calcification of coronal suture similar to that of a normal 30-year-old male in a skull PA view. CONCLUSION: Taken together, the Apert syndrome patient, 9 years old, showed retarded growth of the anterior cranial base affecting severe midface hypoplasia, which resulted in a hypoplastic nasal septum axis, retruded zygomatic axes, and retarded growth of the maxilla and palate even after frontal calvaria distraction osteotomy 8 years ago. Therefore, it was suggested that the severe midface hypoplasia and dysostotic facial profile of the present Apert syndrome case are closely relevant to the aberrant growth of the anterior cranial base supporting the whole oro-facial and forebrain development.
Acrocephalosyndactylia ; Adult ; Child ; Exophthalmos ; Forehead ; Hand ; Humans ; Hypertelorism ; Male ; Maxilla ; Nasal Septum ; Nose ; Osteotomy ; Palate ; Prognathism ; Prosencephalon ; Skull ; Skull Base ; Sutures ; Syndactyly

BACKGROUND/AIMS: Increasing evidence suggests that manganese deposition in globus pallidus is responsible for MRI signal hyperintensity and for extrapyramidal symptoms in cirrhotics. However, the relationships between blood manganese, the severity of liver dysfunction, the pallidal signal intensity, and neurological signs have not been well established. METHODS: Blood manganese concentrations were measured together with brain MRI and neurological evaluation in six controls, six patients with Parkinson's disease with normal liver function, and fourteen cirrhotic patients with hepatic encephalopathy including six cirrhotics with extrapyramidal symptoms. The neurological state was evaluated using the Columbia scale and the pallidal index (PI). The ratio of globus pallidus to frontal subcortical white-matter signal intensity was measured-multiplied by 100. RESULTS: Pallidal signal hyperintensity was observed in 85.7% of cirrhotics, and the PI was higher in cirrhotics with extrapyramidal signs or high grade varices than those without them, but there was no increase in the Parkinson's disease patients. No correlations were demonstrated between the blood manganese level and PI as well as the Child-Pugh score. The blood manganese level was not significantly different between cirrhotics and other groups. However, there was an overt increase only in two cirrhotic patients with extrapyramidal signs. The Columbia scale did not reveal any correlations with the blood manganese level and the Child-Pugh score. CONCLUSIONS: Cirrhotics with extrapyramidal signs showed a significant increase in PI, but there was no increase in the patients with Parkinson's disease. The PI was not significantly correlated with the blood manganese level. These findings suggest that extrapyramidal signs in cirrhotics might be caused by a different mechanism than those in Parkinson's disease, which could possibly be related with manganese.
Brain ; Globus Pallidus ; Hepatic Encephalopathy ; Humans ; Liver ; Liver Diseases ; Magnetic Resonance Imaging ; Manganese* ; Parkinson Disease ; Varicose Veins