Rupture of spontaneous dissecting aneurysms of the middle cerebral artery (MCA) is rare and its etiology remains obscure, although the risk of rebleeding is greater than with saccular aneurysms. Most reports concerning the treatment of a ruptured dissecting aneurysm of the anterior circulation involve surgical trapping or wrapping. Here, we report on a case of an MCA dissecting rupture treated with endovascular procedures. A 22-year-old female presented with sudden stuporous mental change following severe headache and left side hemiparesis. A computed tomography scan showed a diffuse subarachnoid hemorrhage and diffusion MR showed diffusion restriction at the right putamen and internal capsule. A 3-hour follow-up digital subtraction angiography (DSA) showed a dissecting aneurysm, which was not seen on an initial DSA. A stent assisted coil embolization was performed and double stents were applied to achieve flow diversion effects. A small remnant area of the dissecting aneurysm had disappeared at 60-day and was not observed on 12-month follow-up DSA.
Aneurysm ; Aneurysm, Dissecting ; Angiography, Digital Subtraction ; Diffusion ; Embolization, Therapeutic ; Endovascular Procedures ; Female ; Follow-Up Studies ; Headache ; Humans ; Internal Capsule ; Middle Cerebral Artery* ; Paresis ; Putamen ; Rupture ; Stents ; Stupor ; Subarachnoid Hemorrhage ; Young Adult

The introduction of endoscopic spine surgery has led to a paradigm shift in the treatment of spinal disorders. In particular, biportal endoscopic surgery has gained traction for its wider visual field and improved the maneuverability of instruments, familiar anatomy, and costeffectiveness. In this study, we describe our en bloc removal of the ligamentum flavum using a “butterfly” technique. This approach had several advantages: (1) The flavum serves as a protective barrier for the dura during drilling. (2) There is less epidural bleeding, which provides (3) better visualization. (4) In an inadvertent durotomy, this usually occurs later in the procedure, which is more manageable than the early stages of decompression. Biportal decompression for spinal stenosis can be performed using an en bloc ligamentum flavum removal technique that is safe, reproducible, and efficient. A systematic approach will help early adopters overcome the steep learning curve.

The change in people's dietary life has led to an increase in an intake of processed foods and food chemicals, raising awareness about taste education for preschoolers whose dietary habits start to grow. This study aims to evaluate the effectiveness and satisfaction of parents and childcare personnel after developing a taste education program and demonstrating it in class. A part of the curriculum developed by Piusais and Pierre was referred for the program. After educating 524 preschoolers in child care facilities in Seoul, a satisfaction survey was conducted on the program. The data in this study were analyzed using SPSS 14.0. Statistical analysis was conducted based on the frequency after collecting the data. Mean +/- SD used to determine satisfaction with taste education, with preferences marked on a five-point scale and the alpha was set at 0.05. The program includes five teachers' guides with subjects of sweetness, saltiness, sourness, bitterness and harmony of flavor, and ten kinds of teaching tools. For the change in parents' recognition of the need for taste education based on five-point scale, the average of 4.06 +/- 0.62 before the program has significantly increased to 4.32 +/- 0.52 (P < 0.01). Regarding the change in the preferences for sweetness, saltiness, sourness, and bitterness, the average has increased to 3.83 +/- 0.61, 3.62 +/- 0.66, 3.64 +/- 0.66, and 3.56 +/- 0.75 respectively. In an evaluation of instructors in child care facilities, the average scores for education method, education effect, education contents and nutritionists, and teaching tools were at 4.15 +/- 0.63, 3.91 +/- 0.50, 4.18 +/- 0.50, and 3.80 +/- 0.56 respectively. In addition, the need for a continuous taste education scored 4.42 +/- 0.67. This program has created a positive change in preschoolers' dietary life, therefore the continuation and propagation of the taste education program should be considered.
Child ; Child Care ; Curriculum ; Food Habits ; Humans ; Parents

BACKGROUND: Acne is a common follicular inflammatory dermatoses affecting sebaceous glands. It has been known that Malassezia, the lipophilic normal human skin flora, contribute to the development of acne lesion, but the detailed clinical features and effective treatment methods are lacking. OBJECTIVE: In order to elucidate clinical features and efficacy of antifungal treatment in acne associated with Malassezia, we conducted a prospective clinical study with mild to moderate acne patients. METHODS: Twenty eight patients (13 men and 15 women, mean age 19.1+/-4.4 years) with the acneiform eruptions on their face and upper trunk who showed Malassezia from comedo on the KOH/Parker ink examination (spore load 3+ over) were included in this study. Oral itraconazole, 200mg/day, was given at the beginning of treatment for one week. Clinical assessment for the acne lesions(Cunliffe score by Leeds technique and Global acne grading system) and mycological examination were done at the beginning, 2 and 4 weeks of treatment. RESULTS: Acne associated with Malassezia showed polymorphous eruption composed of open and closed comedo, inflammatory papules and pustules. Acneiform eruptions were found on the forehead(67%), cheek(64%), submental(60%) and temple area of the face. Among the patients, seborrhea(21%) and seborrheic dermatitis(14%) were accompanied. The acneiform eruption was aggravated during the summer season(18%). Systemic corticosteroids(14%) and menstruation(27% in women) were also mentioned as the aggravating factors. Systemic itraconazole significantly improved acne lesions from 2 weeks after treatment. CONCLUSION: The results imply that Malassezia should be examined in patients with mild to moderate acne on the face and upper trunk, simultaneously. Use of anti-Malassezia agent such as itraconazole can be considered as an initial treatment in those patients.
Acne Vulgaris* ; Acneiform Eruptions ; Female ; Humans ; Ink ; Itraconazole ; Malassezia* ; Male ; Prospective Studies ; Sebaceous Glands ; Skin ; Skin Diseases ; Yeasts*

No abstract available.
Humans ; Phenotype*

Ceftriaxone is widely used in patients for the treatment of serious gram-negative infections. Ceftriaxone can induce some potential side effects, including neurotoxicity, however, nonconvulsive status epilepticus has rarely been reported. We report a case of acute reversible neurotoxicity associated with ceftriaxone. A 65-yr-old woman with chronic kidney disease developed altered consciousness during ceftriaxone treatment for urinary tract infection. The electroencephalogram demonstrated continuous bursts of generalized, high-voltage, 1 to 2 Hz sharp wave activity. Neurologic symptoms disappeared following withdrawal of ceftriaxone. The possibility of ceftriaxone-induced neurotoxicity should be considered in patients developing neurological impairment during ceftriaxone use, and the discontinuation of the drug could lead to complete neurological improvement.
Aged ; Anti-Bacterial Agents/*adverse effects/therapeutic use ; Anticoagulants/therapeutic use ; Ceftriaxone/*adverse effects/therapeutic use ; Electroencephalography ; Female ; Humans ; Nervous System Diseases/*etiology ; Renal Dialysis ; Renal Insufficiency, Chronic/pathology ; Seizures/etiology ; Thrombosis/diagnosis/drug therapy ; Tomography, X-Ray Computed ; Urinalysis ; Urinary Tract Infections/diagnosis/drug therapy

No abstract available.
BRCA1 Protein/*genetics ; BRCA2 Protein/*genetics ; Base Sequence ; DNA/chemistry ; Databases, Genetic ; Female ; Hereditary Breast and Ovarian Cancer Syndrome/genetics ; High-Throughput Nucleotide Sequencing ; Humans ; Polymorphism, Single Nucleotide ; Sequence Analysis, DNA

The treatment of total or near-total nasopharyngeal stenosis is challenging because of frequent restenosis. Many treatment strategies including scar release with CO₂ laser, mitomycin C application, balloon dilatation or nasopharyngeal stent had been proposed to reduce the restenosis of nasopharynx. But nasopharyngeal patency often fail even after multiple surgical trials. We report two successful cases of nasopharyngeal reconstruction with resurfacing by nasoseptal flap for patients with restenosis history.
Cicatrix ; Constriction, Pathologic ; Dilatation ; Humans ; Mitomycin ; Nasal Septum ; Nasopharyngeal Diseases ; Nasopharynx ; Stents ; Surgical Flaps

The treatment of total or near-total nasopharyngeal stenosis is challenging because of frequent restenosis. Many treatment strategies including scar release with COâ‚‚ laser, mitomycin C application, balloon dilatation or nasopharyngeal stent had been proposed to reduce the restenosis of nasopharynx. But nasopharyngeal patency often fail even after multiple surgical trials. We report two successful cases of nasopharyngeal reconstruction with resurfacing by nasoseptal flap for patients with restenosis history.

BACKGROUND AND OBJECTIVES: Consonants are uttered in the high frequency range in speech to bring out understanding of our language. As consonants convey most of the word information, listeners with high-frequency hearing loss find it hard to understand speech. Non-linear frequency compression (NLFC) technology compresses and moves higher frequencies into a lower frequency region where better residual hearing is present. The purpose of this study was to evaluate clinical effectiveness of NLFC technology in patients with high-frequency hearing loss. SUBJECTS AND METHOD: Twelve ears representing patients with sloping, high-frequency sensorineural hearing loss were involved in this study. Pure-tone audiometry and Threshold Equalizing Noise Test were conducted initially in all subjects. The subjects were tested in the counter-balanced order, and had two months of everyday experience with NLFC on/off before testing took place. A resting period intervened the two phases. Performance was repeatedly evaluated with Sound Field Audiometry, Word Recognition Score, Reception Threshold for Sentences and Korean version of International Outcome Inventory for Hearing Aids. RESULTS: Cochlear dead region was detected on 4 kHz of both ears in only one subject. Each subject showed diverse performance and satisfaction with active NLFC condition. Typically, audibility of high-frequency pure-tones improved with NLFC-on condition. However, speech perception both in quiet and noise was not much improved when compared with NLFC-off condition. CONCLUSION: The NLFC technology could improve audibility in high-frequency, but failed to demonstrate benefits regarding speech perception. Further research is needed to validate the effectiveness of the NLFC technology especially in terms of speech intelligibility.
Audiometry ; Audiometry, Pure-Tone ; Ear ; Hearing ; Hearing Aids ; Hearing Loss, High-Frequency* ; Hearing Loss, Sensorineural ; Humans ; Noise ; Speech Intelligibility ; Speech Perception