Eventhough the hippocampal sclerosis (HS) is crucial in pathophysiology of temporal lobe epilepsy (TLE), the seizure semiology in relation to the extent of hippocampal atrophy(HA) has not been well addressed. We attempted to investigate whether the extent of HA contributes to secondary generalized tonic-clonic seizure (2GTCS) occurrence in TLE. Clinical information in medical records, archived data of video-EEG monitoring (VEM) of 11 TLE patients were reviewed and findings of temporal lobe magnetic resonance imagines (TLMRIs) of those patients were analyzed. According to the extent of HA and the presence of amygdala atrophy (AA) in TLMRI findings, patients were divided into partial hippocampal atrophy group(PHA) (3 patients: HA limited to a partial portion of hippocampus), diffuse hippocampal atrophy group (DHA) (3 patients: extensive HA from head to tail of hippocampus) and amygdala atrophy group(AA) with HA(S patients). We analyzed 2GTCS occurrence rate (rate during previous one years and during VEM period) between PHA and DHA, between AA and only HA group, and between AA, DHA and PHA. There was no significant difference in age, sex, onset age, febrile seizure history and seizure duration. Both 2GTCS rate of the previous one month and that during VEM monitoring period were not significantly different between DHA and PHA, between AA and HA, and between AA, BHA and PHA, either. We preliminarily conclude that neither the hippocampal atrophy extent nor the presence of amygdala atrophy influenced the occurrence of 2GTCS in TLE.
Age of Onset ; Amygdala ; Atrophy* ; Butylated Hydroxyanisole ; Epilepsy, Temporal Lobe* ; Head ; Humans ; Medical Records ; Sclerosis ; Seizures* ; Seizures, Febrile ; Temporal Lobe*

Opsoclonus is the involuntary, repetitive, rapid conjugate ocular movements occurring in all directions that are irregular in amplitude and frequency. The cause of opsoclonus are idiopathic, paraneoplastic or postinfectious. Opsoclonus of the postinfectious origin often accompanies other abnormal movements such as tremor, myoclonus and ataxia, and shows a relatively benign course with good response to steroid. Six patients who suffered from myalgia, chilling, fever, cough and generalized weakness fior one to two weeks prior to the admission, experienced visual disturbance, gait unsteadiness and clumsiness of the upper extremities,, Prominent opsoclonus, tremulous movements of trunk and limbs, and intermittent myoclonus were observed. These symptoms markedly improved several days following the use of ACTH or dexametasone.
Adrenocorticotropic Hormone ; Adult* ; Ataxia ; Cough ; Dyskinesias ; Extremities ; Fever ; Gait ; Humans ; Myalgia ; Myoclonus ; Ocular Motility Disorders* ; Tremor ; Upper Extremity

Opsoclonus is the involuntary, repetitive, rapid conjugate ocular movements occurring in all directions that are irregular in amplitude and frequency. The cause of opsoclonus are idiopathic, paraneoplastic or postinfectious. Opsoclonus of the postinfectious origin often accompanies other abnormal movements such as tremor, myoclonus and ataxia, and shows a relatively benign course with good response to steroid. Six patients who suffered from myalgia, chilling, fever, cough and generalized weakness fior one to two weeks prior to the admission, experienced visual disturbance, gait unsteadiness and clumsiness of the upper extremities,, Prominent opsoclonus, tremulous movements of trunk and limbs, and intermittent myoclonus were observed. These symptoms markedly improved several days following the use of ACTH or dexametasone.
Adrenocorticotropic Hormone ; Adult* ; Ataxia ; Cough ; Dyskinesias ; Extremities ; Fever ; Gait ; Humans ; Myalgia ; Myoclonus ; Ocular Motility Disorders* ; Tremor ; Upper Extremity

BACKGROUND: It is well known that a lacunar infarction has characteristic clinical features and a relatively good prognosis. However, the significance of lesions in the parent artery of patients with lacunar syndrome as regard to the prognosis remains unsettled. METHODS: Using the data of consecutive patients with their first ischemic stroke and were followed longer than 1 year, were divided the patients by their clinical features and the results of the work-up was as follows; (1) mismatching [MM] group; lacunar syndrome and the presence of parent arterial lesion, (2) large artery artherosclerosis [LAD]; non-lacunar syndrome and the presence of parent arterial lesion, (3) no determined etiology [NE]; non-lacunar syndrome without parent arterial lesion, and (4) small artery disease [SAD]; lacunar syndrome without parent arterial lesion. Patients with a potential source of embolism were excluded from this study. The prognosis and recurrence rate of patients with the MM group were compared with those of other groups. RESULTS: A total of 176 patients were included; 56 LAD, 62 SAD, 22 MM and 36 NE groups. An unstable hospital course was more frequently found in LAD than in the other groups. The recurrence rate of the MM group (23%) was significantly higher than that of SAD (2%), but was similar to that of patients with non-lacunar syndrome (LAD 16%, NE 28%). CONCLUSIONS: Among patients with lacunar syndrome, the prognosis of those with parent arterial lesions was different from those without lesions. Therefore, a systematic work up of the stroke mechanism may be important in patients with lacunar syndrome.
Arteries ; Embolism ; Humans ; Parents* ; Prognosis ; Recurrence ; Stroke ; Stroke, Lacunar*

The steam burn caused by electric rice-cooker is a unique mode of burn injury in Korea. This type of burn injury is characterized by first, a predilection for the volar aspect of the hand in toddlers younger than 2 years old age second, The depth of burns are normally deep second degree to third degree and usually need operation at the time of injury, third, Flexion contractures of multiple finger joints and web space contracture are common sequelae. We hypothesized that primary FTSG would give more reliable results and eliminate the late reconstructive procedures. Between Jan. 1997 and Jan. 2002, 65 patients underwent primary FTSG, and the results of this primary FTSG group were compared with 124 patients who were treated with STSG(79/124, 63.7%) or by conservative management(45/124, 36.3%), and readmitted for the correction of hand deformities between Sep.1995 and Sep.1999. In the primary FTSG group, 9.2%(6/65) of mild web contractures and 6.1% (4/65) of finger joints contractures were documented and one patient was received the reconstructive procedure during a follow up period of 9.7+/-6.3 months. In 124 patients of the primary STSG or conservative group, the mean time interval to reoperation was 8.9+/-4.0 months and all patients received FTSG for correction of late hand deformities. In a retrospective study of the primary STSG group, 42 of 53 patients(79.2%) received reconstructive procedure. In this report, we propose that primary FTSG may be a reliable method for the treatment of this more severe type of acute burn in pediatric patients.
Burns* ; Child, Preschool ; Contracture ; Finger Joint ; Follow-Up Studies ; Hand ; Hand Deformities ; Humans ; Korea ; Reoperation ; Retrospective Studies ; Steam*

High-voltage electrical injury results in progressive deep tissue necrosis, often resulting in amputation when foot is involved. Complete surgical debridement and coverage with a vascularized free flap, when local flaps and skin graft are unsuitable, may protect partially devitalized structure, preserve function, and reduce the incidence of amputation. The free latissimus dorsi muscle flap for coverages of extensive soft tissue defect of foot has advantages over the musculocutaneous flap or perforator flap. The flap is less bulky, flexible, contoured easily, long pedicle and less donor morbidity. Well- vascularized muscle may be effective in getting under control infection. Vein anastomosis was performed to the venae comitantes and thoracodorsal vein, because electrical current produces tissue damage accompanied by valve fibrosis and coagulation of superficial blood vessel. The timing of surgical debridement remains controversial. Thus, we compared result of flap survivor with operation less than 3 weeks after injury and operation more than 3 weeks after injury, anastomosis of recipient vein that venae comitantes and saphenous vein from January 1997 to April 2002, 21 patients injured by electrical burn of foot treated reconstruction using the free latissimus dorsi muscle flap with meshed split- thickness skin graft coverage. As a result, we think that delayed debridement(more than 3 weeks after electrical burn injury) may result in increased saving of free flap, because it relatively makes demarcation of devitalized tissues and selection of uninjured recipient vessel clear. We suggest that using delayed operation and anastomosis of venae comitantes in electrical burn injury increase of survival rate free latissimus dorsi muscle flap.
Amputation ; Blood Vessels ; Burns* ; Debridement ; Fibrosis ; Foot* ; Free Tissue Flaps ; Humans ; Incidence ; Myocutaneous Flap ; Necrosis ; Perforator Flap ; Retrospective Studies* ; Saphenous Vein ; Skin ; Superficial Back Muscles* ; Survival Rate ; Survivors ; Tissue Donors ; Transplants ; Veins

BACKGROUND: The relative importance of embolic mechanisms as opposed to hemodynamic factor in the pathogenesis of ischemic strokes associated with atherosclerotic middle cerebral artery (MCA) or internal carotid artery (ICA) disease remains unresolved. We conducted the present study to identify the differences of clinicoradiological patterns between MCA or ICA diseases. METHODS: We defined atherosclerotic disease of MCA or ICA as > 50% stenotic lesions or ulcerative plaques. We divided the patients into groups of MCA and ICA diseases, and analyzed clinical, laboratory, and neuroradiological data. RESULTS: Among the 620 consecutive patients with acute ischemic strokes, 84 (12.9%) patients met the criteria for atherosclerotic MCA or ICA disease: 54 patients with MCA disease and 30 patients with ICA disease. The mean age was younger in patients with MCA than ICA disease (p=0.003). MCA disease clinically more frequently presented with lacunar syndrome (p=0.001). ICA disease more frequently presented with total anterior circulation infarct and had higher initial NIHSS scores than MCA disease (p=0.004 and 0.003, respectively). While whole MCA territorial infarcts were common in ICA disease, deep perforator infarcts were more significantly caused by MCA disease (p< 0.05). MR topographic patterns showed difference between MCA and ICA diseases according to the degree of stenosis (p< 0.05). Cortical dots were significantly accompanied by superficial perforator infarcts than internal borderzone infarcts (p=0.017). CONCLUSIONS: Our present study suggests that clinical and neuroradiological representations might be different between MCA and ICA diseases, which might reflect difference of underlying pathogenesis.
Carotid Artery, Internal* ; Constriction, Pathologic ; Hemodynamics ; Humans ; Infarction ; Middle Cerebral Artery* ; Stroke ; Stroke, Lacunar ; Ulcer

BACKGROUND: The relative importance of embolic mechanisms as opposed to hemodynamic factor in the pathogenesis of ischemic strokes associated with atherosclerotic middle cerebral artery (MCA) or internal carotid artery (ICA) disease remains unresolved. We conducted the present study to identify the differences of clinicoradiological patterns between MCA or ICA diseases. METHODS: We defined atherosclerotic disease of MCA or ICA as > 50% stenotic lesions or ulcerative plaques. We divided the patients into groups of MCA and ICA diseases, and analyzed clinical, laboratory, and neuroradiological data. RESULTS: Among the 620 consecutive patients with acute ischemic strokes, 84 (12.9%) patients met the criteria for atherosclerotic MCA or ICA disease: 54 patients with MCA disease and 30 patients with ICA disease. The mean age was younger in patients with MCA than ICA disease (p=0.003). MCA disease clinically more frequently presented with lacunar syndrome (p=0.001). ICA disease more frequently presented with total anterior circulation infarct and had higher initial NIHSS scores than MCA disease (p=0.004 and 0.003, respectively). While whole MCA territorial infarcts were common in ICA disease, deep perforator infarcts were more significantly caused by MCA disease (p< 0.05). MR topographic patterns showed difference between MCA and ICA diseases according to the degree of stenosis (p< 0.05). Cortical dots were significantly accompanied by superficial perforator infarcts than internal borderzone infarcts (p=0.017). CONCLUSIONS: Our present study suggests that clinical and neuroradiological representations might be different between MCA and ICA diseases, which might reflect difference of underlying pathogenesis.
Carotid Artery, Internal* ; Constriction, Pathologic ; Hemodynamics ; Humans ; Infarction ; Middle Cerebral Artery* ; Stroke ; Stroke, Lacunar ; Ulcer

A cross-over study was conducted to compare the pharmacokinetic properties of controled release form of Sodium Valproate (Orfil Retard(R)) with that of conventional forrnulation (Orfil(R) in healthy adult volunteers. The clinical efficacy of Orfil Retard(R) was also investigated in 15 epileptic patients under Orfil(R) monotherapy by replacing an equivalent bid dosage of Orfil Retard(R) for 2 months. Orfil Retard(R) achieved more stable blood level than Orfil(R), which was statistically significant(P;0.0051). Orfil Retard(R) was associated with less side effect. Especially of gastrointestinal system. None of epileptic patients showed worsening of seizure control after switch to the equivalent b.I.d. dosage of Orfil Retard(R). Our results indicate that Orfil Retard(R) offers more advantage than Orfil(R) in terms of more stable blood level and less side effect. Clinically. Orfil Retard(R) in equivalent b I d dose is as effective as Orfil(R) in b.I.d. or t.I.d. dosing schedule.
Adult ; Appointments and Schedules ; Cross-Over Studies ; Humans ; Seizures ; Sodium* ; Valproic Acid* ; Volunteers

No abstract available.
Budesonide* ; Humans