Intraoperative neurophysiological monitoring (INM) is underutilized during the anteromesial temporal resection (AMTR) in epilepsy surgery. Herein we report a case with intraoperative capsular infarction which was early detected by INM. Among the modalities of INM, left motor evoked potentials (MEP) showed suddenly decreased amplitude of compound muscle action potentials, after the electrocoagulation in left mesial temporal areas. Postoperative neurologic and MRI findings were well correlated to the intraoperative MEP features. We also discuss the usefulness of INM during the AMTR.

Intraoperative neurophysiologic monitoring during brain tumor surgery should acquire a baseline data as soon as possible. However, motor unit potentials (MEP) in our case showed baseline data could not be acquired in the early stage of surgery, but consecutive trials had abrupt appearance of MEP just after dura opening. This case shows the acquisition of baseline MEP during brain tumor surgery should not be given up until the dura is open especially in a state of raised intracranial pressure.

Intraoperative neurophysiologic monitoring during brain tumor surgery should acquire a baseline data as soon as possible. However, motor unit potentials (MEP) in our case showed baseline data could not be acquired in the early stage of surgery, but consecutive trials had abrupt appearance of MEP just after dura opening. This case shows the acquisition of baseline MEP during brain tumor surgery should not be given up until the dura is open especially in a state of raised intracranial pressure.

Intraoperative neurophysiologic monitoring during brain tumor surgery should acquire a baseline data as soon as possible. However, motor unit potentials (MEP) in our case showed baseline data could not be acquired in the early stage of surgery, but consecutive trials had abrupt appearance of MEP just after dura opening. This case shows the acquisition of baseline MEP during brain tumor surgery should not be given up until the dura is open especially in a state of raised intracranial pressure.

Bell's palsy is the most common cause of facial paralysis with a lifetime risk of one in 60 in general population. The exact pathophysiology is unknown, but it is suspected to be associated with viral infections such as herpes simplex virus (HSV). Recurrent facial palsy is a rare condition that can be caused by various factors but the cause remains unknown. We report a case of recurrent facial palsy who had antibodies of Lyme immunoglobulin G (IgG), HSV IgG, and IgM.

Bell's palsy is the most common cause of facial paralysis with a lifetime risk of one in 60 in general population. The exact pathophysiology is unknown, but it is suspected to be associated with viral infections such as herpes simplex virus (HSV). Recurrent facial palsy is a rare condition that can be caused by various factors but the cause remains unknown. We report a case of recurrent facial palsy who had antibodies of Lyme immunoglobulin G (IgG), HSV IgG, and IgM.

Bell's palsy is the most common cause of facial paralysis with a lifetime risk of one in 60 in general population. The exact pathophysiology is unknown, but it is suspected to be associated with viral infections such as herpes simplex virus (HSV). Recurrent facial palsy is a rare condition that can be caused by various factors but the cause remains unknown. We report a case of recurrent facial palsy who had antibodies of Lyme immunoglobulin G (IgG), HSV IgG, and IgM.

Necrotizing pancreatitis is associated with high rates of morbidity and mortality. Managing necrotizing pancreatitis is challenging, and minimally invasive treatment modalities recently replaced traditional open necrosectomy. Percutaneous catheter drainage and endoscopic necrosectomy are now widely used because they are less invasive, safer, and can more effectively remove necrotic materials. Various methods and novel techniques have been introduced to manage walled-off necrosis. Herein, we report a case series of patients with necrotizing pancreatitis who were successfully treated using fully covered esophageal metal stent and endoscopic necrosectomy via the percutaneous approach. Percutaneous endoscopic necrosectomy using a fully covered esophageal stent is an effective endoscopic treatment for patients with walled-off necrosis that extends along both sides of the paracolic gutter, reduces the number of necrosectomy sessions, and improves disease status faster than conventional treatment.
Catheters ; Drainage ; Humans ; Mortality ; Necrosis ; Pancreatitis ; Stents*

Objective: Various tools using the length-based method for weight estimation and decisions regarding equipment size have been used in pediatric resuscitation globally. The Korean Pediatric Resuscitation Tape (KPRT) is one such tool that has been developed recently. This study was performed to validate the use of KPRT in Korean children. Methods: Data on the measured weights and the endotracheal tube (ETT) sizes used for children aged 12 years or less, who received general anesthesia, were collected by reviewing medical records from June 2018 to October 2020 at two hospitals in the urban areas of Korea. We compared the weight and ETT size estimated by the KPRT to the actually measured weight and ETT size used for the study population. We also calculated the weight and ETT size using an age-based formula and compared these values to the actual values of the patients. We then analyzed the agreement between these estimated values and the actual values of the children. Results: A total of 1,237 children were included in this study. The intra-class correlation coefficient of agreement between the actual weight and estimated weight by the KPRT was 0.94 compared to 0.93 when estimated by the age-based formula. The weighted kappa coefficient of the agreement between the ETT size actually used, and the size estimated by the KPRT was 0.61 compared to 0.74 when estimated by the age-based formula. The estimated ETT sizes using the KPRT were smaller than the actual size used in children under three years old, whereas it was larger for children aged eight years or more. Conclusion Our study showed that the KPRT was a dependable tool for estimating the weight and ETT size of Korean children. Future studies would be needed to augment the reliability of the KPRT in pediatric resuscitation.

PURPOSE: Status epilepticus (SE) is a pathologic state where pharmacokinetic alterations can be more pronounced and more rapid than during the other epileptic states. The consequences of such changes can exert negative influences on the timely adequate treatments for stopping uncontrolled seizures during SE. Topiramte (TPM) is one of new antiepileptic drugs with high efficacy in epilepsy, which can also be effectively used in SE. The aim of this study was to evaluate the pharmacokinetic changes during the SE by an analysis of the therapeutic drug monitoring (TDM) of TPM in patients with SE.METHODS: We retrospectively analyzed 49 serum measurements of TPM from 22 subjects with SE. The serum concentrations of TPM were measured by HPLC-tandem mass spectrometry. TDM data were categorized into malignant status epilepticus (MSE), refractory status epilepticus (RSE), and non-status epilepticus (NSE) groups. We compared concentration-to-dose ratio (CDR) among those groups.RESULTS: Among 49 cases, 11 were in MSE, 19 in RSE, and 19 in NSE. The daily dose of TPM was higher in MSE (median, interquartile range: 600, 600-800 mg) than in RSE (300, 250-600 mg) and NSE (200, 150-400 mg). The daily dose adjusted for body weight was also higher in MSE (12.2, 10.4-13.9 mg/kg) than in RSE (4.5, 3.8-12.2 mg/kg) and NSE (4.1, 2.3-7.1 mg/kg) (p<0.01). Serum concentrations of TPM were less in MSE (5.8, 4.2-7.3 mg/L) and RSE (4.9, 2.9-6.0 mg/L) than in NSE (5.5, 3.3-9.0 mg/L), which were not significantly different among the groups (p>0.1). However, the concentration-to-dose ratio (CDR) was significantly lower in MSE (0.41, 0.35-0.59 kg/L) and RSE (0.85, 0.39-1.23 kg/L) than in NSE (1.72, 0.96-2.24 kg/L) (post hoc analysis, p<0.005, 0.05).CONCLUSIONS: The serum concentrations of TPM can be influenced by SE, particularly in MSE. The higher range of dose of TPM could be needed for an adequate treatment of SE.
Anticonvulsants ; Body Weight ; Drug Monitoring ; Epilepsy ; Fructose ; Humans ; Mass Spectrometry ; Retrospective Studies ; Seizures ; Status Epilepticus