BACKGROUND: One of the most, probable pathogenesis of vitiliga is autoimmune. Systemic cor tico st,eroids suppress immunity and may arrest the progression of vitiligo and lead to repigmentation. OBJECTIVE: We have assessed the clinical effect of a oral small oral dose of corticosteroid to minimize side effects in vitiligo patients. METHODS: Thirty four patients(9;male, 25;female) with vitiligo were evaluated in this study. The patients took 7.5mg-20mg prednisolone initially for 2 months and then the dosage was tapered to half of the initial dosiat the 3rd month and half of dose of 3rd month for the last 4th month. We compared the effcct of treatment of vitiligo before and aft.er the study by photographs. and side efferts were issessed at. 1, 2, 3 and 4 month. RESULTS: The arrest of the progression of vitiligo was noticed in 79% of patients and repigmentation was noticed in 59% of patients which is statistically significant. The effect, of treatment according to extent, duiation, type, and site of vitiligo were not statistically significant. The side effects of treatment were minimal and did not affect the course of treatment. CONCLUSION: Small doses of iral corticosteroids are effective without any significant side effects in preventing progression and loiiduce repigmentation of active spreading vitiligo and generalized type of vitiligo that is difficult to treat with topical corticosteroids.
Adrenal Cortex Hormones* ; Humans ; Prednisolone ; Vitiligo*

No abstract available.
Niemann-Pick Disease, Type A*

No abstract available.
Adenoma* ; Humans ; Infant, Newborn*

Shunt malfunctions that require surgical intervention during pregnancy and the postpartum period are rare. Furthermore, no study has reported on an acute shunt malfunction immediately after cesarean section. Here, we describe the case of a 32-yr-old woman who became drowsy 12 hr after cesarean section delivery of her second child. She had a ventriculoperitoneal shunt placed to treat hydrocephalus associated with meningitis at 26 yr of age. Marked ventriculomegaly was seen on brain computed tomography and her consciousness recovered temporarily after aspirating cerebrospinal fluid from the flushing device. At surgery, the distal catheter tip was plugged by a blood clot. We believe that the blood spilled over during the cesarean section. The clogged catheter end was simply cut off and the remaining catheter was repositioned in the peritoneal cavity. Her consciousness recovered fully.
Adult ; *Cesarean Section ; *Equipment Failure ; Female ; Humans ; Hydrocephalus/etiology/surgery ; Meningitis/complications ; Pregnancy ; *Ventriculoperitoneal Shunt/adverse effects/instrumentation

It is important to obtain a good exposure of the root exit zone(REZ) of the facial nerve during microvascular decompression(MVD) for hemifacial spasm(HFS). For this purpose, authors dissected cerebellar cortical artery in addition to exposing the proximal portion of lower cranial nerves. During MVD for HFS, surgeons frequently meet a cerebellar cortical artery along the inferolateral aspect of cerebellar hemisphere. It is usually hemispheric branch of anterior inferior cerebellar artery(AICA) or posterior inferior cerebellar artery(PICA). It is reason that authors have dissected the outside arachnoid membrane attached pia mater of cerebellar cortical artery with a arachnoid knife or microscissor but preserve the inside arachnoid membrane attached dura mater. Microsurgical retractor is placed inferolaterally between cerebellar cortical artery and cerebellar hemisphere and elevated from the floor of the posterior fossa. The subarachnoid cisterns over the lower cranial nerves are opened with sharp dissector and wide operative fields and good exposure of REZ of facial nerve is obtained.
Arachnoid ; Arteries* ; Cranial Nerves ; Dura Mater ; Facial Nerve ; Hemifacial Spasm* ; Membranes ; Microvascular Decompression Surgery* ; Pia Mater

As the number of elderly people increases, the incidence of stroke, especially the hemorrhagic stroke, is increasing. A large-scale survey of the entire country pertaining to the incidence and demographic characteristics of hemorrhagic stroke in elderly is necessary. Through information garnered from a basic survey and clinical study, we must design a treatment program to reduce the mortality of elderly people through elucidating the specific properties of stroke pathophysiology.
Aged* ; Humans ; Incidence* ; Mortality ; Stroke*

The authors report two cases of epidermoid cyst in the cerebellopontine angle which presented as trigeminal neuralgia. The tumors were surgically removed by suboccipital craniectomy. The cysts were densely adherent to multiple cranial nerves, including the trigeminal nerve, and the tumors occupied adjacent cisterns. After removal of the cystic content, it was sometimes difficult to differentiate the tumor capsule from the arachnoid membrane. In one patient, trigeminal neuralgia was resolved immediately after the operation, while for two weeks postoperatively, the other suffered severe headache and facial dysesthesia due to aseptic meningitis. To avoid surgical complications, it is resonable to leave a minute capsule attached to cranial nerves or blood vessels.
Arachnoid ; Blood Vessels ; Cerebellopontine Angle* ; Cranial Nerves ; Epidermal Cyst* ; Headache ; Humans ; Membranes ; Meningitis, Aseptic ; Paresthesia ; Trigeminal Nerve ; Trigeminal Neuralgia*

Significantly decreased perfusion pressure is common in vascular territories irrigating neuronal tissue in patients with AVMs. There is evidence that "adaptive autoregulatory displacement" occurs in these patients which maintains cerebral blood flow above ischemic levels. Chronic arteriolar vasodilatation does not usually lead to vasomotor paralysis because most patients maintain a constant cerebral blood flow in spite of increased systemic arterial pressure. AVM hemodynamics appears to play an important role in the etiology of spontaneous intracerebral hemorrhage. Large AVM with high-flow and severe arterial hypotension are least likely to hemorrhage. In patients with AVMassociated aneurysm, the etiology of these dual lesions is likely multifactorial, with hemodynamic stresses having a dominant influence.
Aneurysm ; Arterial Pressure ; Cerebral Hemorrhage ; Hemodynamics* ; Hemorrhage ; Humans ; Hypotension ; Neurons ; Paralysis ; Perfusion ; Vasodilation

When a tear occurs in one of the major cervicocerebral arteries and allows blood to enter the wall of the artery and split its layers, the result is either stenosis or aneurysmal dilatation of the vessel. Vertebral artery dissection (VAD) is an infrequent occurrence but is a leading cause of stroke in young and otherwise healthy patients. This article discusses recent developments in understanding of the epidemiology and pathogenesis of VAD and the various clinical manifestations, methods of diagnosis, and approaches to treatment.
Aneurysm ; Arteries ; Constriction, Pathologic ; Dilatation ; Glycosaminoglycans ; Humans ; Natural History ; Stroke ; Vertebral Artery ; Vertebral Artery Dissection

No abstract available.
Aneurysm* ; Subarachnoid Hemorrhage*