No abstract available.
Abscess*

OBJECTIVE: Traditionally, the main indications for surgery in vascular-related lesion were based upon reduction or control of seizures, reversal of symptoms of deficits related to mass effect, and prevention of hemorrhage or recurrent hemorrhage. However, the results of surgical treatment for seizure control are disappointing in some reports. Here we describe surgical strategies and our experience in treating patients with intractable seizures associated with vascular-related lesions according to sophisticated presurgical and intraoperative evaluation. METHODS: Twelve(4.5%) patients were selected for this study out of total 264 patients with resective epilepsy surgery at our epilepsy center during four years since 1992. All were treated with anticonvulsant agents but became refractory. These patients operated on under local or general anesthesia for resection surgery, underwent presurgical and intraoperative evaluation for identification of adjacent, beyond or remote epileptogenic area and the eloquent area. RESULTS: Of these 12 patients, vascular malformations(AVM, cavernous angioma) were 7, overt hemorrhage due to vascular lesion were 2 and intractable ongoing seizure after vascular surgery were 3. Other vascular lesion including occlusive disease, moyamoya disease or previous hemorrhage were excluded in this study. The location of the lesion was mainly temporal and peri-Rolandic areas, and dual pathology was verified in 2 cases of 6 temporal lesion. The surgical outcome(class I;7, II;3, III;1, IV;1) was excellent by Engel's classification. CONCLUSION: Control of seizures related to vascular lesions remains strong indication for surgical resection. For this reason, careful presurgical evaluations are essential to evaluate the remote epileptogenic area, especially in temporal lesion. Intraoperative acute recording(ECoG) and functional mapping by electrical stimulation or SSEP are important for maximal resection of epileptogenic area with minimal sequellae.
Anesthesia, General ; Classification ; Electric Stimulation ; Epilepsy* ; Hemangioma, Cavernous ; Hemorrhage ; Humans ; Moyamoya Disease ; Pathology ; Seizures

No abstract available.

No abstract available.
Arthritis, Juvenile*

Visualization of falx cerebri on non-enhanced CT of children with severe head injuries (the falx sign) has been regarded as an evidence of subarachnoid hemorrhage. On the contrary, other authors have reported reverse results. To evaluate clinical significance of the falx sign, authors studied frequency of visualization and CT number of falx cerebri and dural sinuses in 65 children with head injury and 65 children without head injury examined by cranial CT at the Dep. of Radiology, St. Paul's Hospital, Catholic Medical College from March to Sept. 1981. All patients with head trauma were studied within 1 week of the traumatic event. Visualization of falx cerebri was observed at slice in the region of lateral ventricle and slice near to vertex respectively. On the slice in the region of lateral ventricle, falx cerebri was identified in 82% of all of the children examined, of which 92%showed partial visualization of falx cerebri and remaining 8% totally. On the slice near to vertex, falx cerebri was identified in 92% of all the children examined, of which 38% showed partial visualization of falx cerebri and remaining 62% totally. In head trauma group, frequency of visualization of falx cerebri was 78% on the slice in the region of lateral ventricle and 89% on the slice near to vertex; in non-traumatic group, frequency of visualization of falx cerebri was 86% and 94% respectively. The highest numerical value of the falx densities averaged 47 Hounflieds (range, 32-63) in non-traumataic group, averaged 49 Housfields (range, 32-69) in head trauma group. All or a portion of the superior sagittal sinus was visualized in 59% of all of the cases studied, 50% in head trauma group, and 69% in nontraumatic group. The straight sinus was identified in 45% of all of the cases studied, 39% in head trauma group, and 51% in non-traumatic group. In conclusion, there was no distinction between head trauma and non-traumatic group in visualization of falx cerebri and dural sinuses, and we could frequently identify the falx density in normal. Also we could find that frequency for visualization of falx cerebri and drual sinuses increased as the age increased.
Child ; Craniocerebral Trauma ; Humans ; Lateral Ventricles ; Spinal Cord ; Subarachnoid Hemorrhage ; Superior Sagittal Sinus

No abstract available.
Intracranial Arteriovenous Malformations* ; Radiosurgery*

Although it is commonly appreciated that there is an inordinately large number of anormalies associated with the excretory ducts of the liver, comparatively little attention has been paid to the position of the orfice of the common bile duct into the duodenum. But, obiviously the site of entrance of the common bile duct into the duodenum becomes of great importance to the endoscopist, radiologist, and surgeon in diseases of the extra-hepatic biliary tract diag-nostically and therapeutically. We report 'a case of anomalous termination of the common bile duct into the duodenal bulb with the gall bladder empyema.
Biliary Tract ; Cholecystitis* ; Common Bile Duct* ; Duodenum ; Liver

We experienced 2 cases of cerebral arteriovenous malformation(AVM) with tital extirpation recently. One patient, 23 year old man had chief complaints of sudden headache and loss of consciousness of 3 days duration. On admission, the patient was in a drowsy mental state and had mild papilledema on both sides. Other neurological and physical examinations were normal. Right carotid angiogram revealed AVM which is fed from the right middle cerebral artery and is drained into the right transverse sinus. We found intracerebral hematoma(100 cc) on operative field. The other patient, 30 year old man had chief complaints of Jackson's type seizure several times on the left hand during a five month duration and also had a severe headache intermittently for three months. Left carotid angiogram revealed AVM which is fed from the left anterior cerebral artery and left middle meningeal artery, and is drained into the superior sagittal sinus. We did not find intracerebral hematoma but found an old hemorrhage pouch. The 2 cases of AVM lesions were not found on the postoperative carotid angiogram.
Adult ; Anterior Cerebral Artery ; Hand ; Headache ; Hematoma ; Hemorrhage ; Humans ; Intracranial Arteriovenous Malformations* ; Meningeal Arteries ; Middle Cerebral Artery ; Papilledema ; Physical Examination ; Seizures ; Superior Sagittal Sinus ; Unconsciousness ; Young Adult

BACKGROUND: Smoking is a high risk factor for various chronic diseases. Therefore, physicians are expected to play a critical role in patients smoking cessation. There have been a number of studies which show that cessation recommendation by physicians is effective for patients to stop smoking. The purpose of this study is to assess physicians smoking status and its effect on physicians attitude for their advice to patients to quit smoking. METHODS: During August and September in 1995, self-report questionnaire was distributed to doctors in Jin-Gu, Pusan. It consisted of inquiries on their demographic features, their smoking status, whether physicians ask patients their smoking status or not, whether physicians advise patients to quit smoking or not, and whether physicians confirm patients smoking cessation. Among 203 responses returned, 193 cases was analyzed. RESULTS: Among the total 193 persons, 60 persons are smoking now(31.4%, Men 34.5%, women 0%), and 88 persons(67.2%) are ex-smoker. 84.1% of smokers have tried to quit smoking, and stress was the most common reason for failure. Smoking rate and experience rate were higher in men than in women(P<0.001), but there were no significant differences in smoking rate and experience rate according to ages, religions, specialties, hospital types, and positions. Among responders 144 cases(75.0%) asked smoking status of patients. 21.4% of them asked smoking status of all patients who may smoke, and 25.0% of them hardly ask smoking status of patients. For question about patients' smoking status, the younger physicians were more active in asking smoking status of patients(p=0.038), and the physicians in hospital did much more than physicians in university hospital and private clinics(p=0.015). Among responders, 161 persons(84.7%) advised patients to quit smoking, and 19.5% of them advised to quit smoking for all patients who smoked. However, 15.3% of them hardly gave patients such suggestion. It was found that there was no significant relationship between physicians smoking status and attitudes toward giving patients suggestion to quit smoking. CONCLUSIONS: This study revealed that there was no significant relationship between physicians smoking status and their attitudes toward giving patients suggestion to quit smoking, and physicians smoking status did not have any effect on smoking cessation advice. However, this study does not exclude the possibility that the results might be reversed, if the census would be extended to broader area. Physicians should take an active role against smoking.
Busan ; Censuses ; Chronic Disease ; Female ; Humans ; Male ; Risk Factors ; Smoke* ; Smoking Cessation* ; Smoking* ; Surveys and Questionnaires

The clinical value of lumbar epidural venography(L.E.V.) has been stressed in diagnosing lumbar disc since Batson's desciption of vertebral venous system in 1940. We have tried this procedure by the selective catheterization of ascending lumbar and, or internal iliac vein to 16 patients with disc symptoms. In 6 patients with abnormal myelography, 4 revealed abnormal L.E.V. and in 2, the above procedure was failed. In 6 patients with disc-like symptoms but normal myelography, 2 were abnormal L.E.V., 2 normal and 2 failed. 3 with disc-like symptoms but equivocal myelography, abnormal L.E.V. was definitely shown in 2 patients and failed. Operation was done in 7 patients(6, abnormal myelography and one, only abnormal L.E.V.).
Catheterization ; Catheters ; Humans ; Iliac Vein ; Myelography ; Phlebography*