To increase the understanding of the pathophysiologic mechanisms present in epileptic seizures, and to correlate the clinical features with the EEG findings, a review of the recent literature has been made. Epileptic seizures are classified into three types:focal(or partial), generalized and unilateral seizures. In the first type, the focal seizure, there are two sites which have been thought to have one or the other of an initial discharge. The first site is the cortical pole, and the second is the end pole of the interconnected subcortical nuclear system. the cortical pole, and the second is the end pole of the interconnected subcortical nuclear system, the cortical pole is more accessible and vulnerable to seizures. The end pole of the interconnected subcortical nuclear system has two sectors which may be involved. the first sector, the cortico-thalamic system, includes filstly the specific cortico-thalamic system in which the focal stimulation is related to relatively simple somato-motor, sensory and autonomic nervous functions. Secondly, in this first sector, is the non-specific corticothalamic systems which includes the body integrative functions which underlie psychic elaboration of primary sense data. The second sector in the subcortical nuclear system is the amygdalo-brain stem sector. In this non-thalamic system there are the deep temporal structures of the brain such as the amygdalahippocampal complex. These structures are involved in the regulation of emotions, in memory functions and in the maintenance of consciousness. A schematic diagram is prepared to explain the mode of propagation of the epileptic discharge from the initial focus along pathways in the brain structures. This diagram is explained and discussed. The second type of seizure is the generalized seizure. This type is subdivided into two groups:convulsive and non-convulsive. The convulsive group of seizures includes tonic clonic(grandmal), tonic, clonic, infantile spastic, and bilateral myoclonic seizures. These are discussed. The non-convulsive group of seizures includes the following kinds:typical absence(petitmal), atypical absence(petitmal varient), absence status, and atonic seizures. In this group of seizures the initial discharge occurs at the centrencephalon(diencephalo-mesencephalo-rhombencephalon). The intricate mode of propagation of this type of discharge, which involve the recruiting and inhibitory systems, was discussed and also presented schematically.
Brain ; Consciousness ; Electroencephalography* ; Epilepsy ; Memory ; Muscle Spasticity ; Seizures ; Status Epilepticus

The therapeutie efficacy of ranitidine was evaluated itn 48 in- and out- patients with endoscopically diagnosed 18 cases of gaetric ulcer and 30 casea of ducnienal ulcer. In the open study, every pabenta was treated with ranitidine 150 mg b.i.d. for 4 weeks, and waa followed up by gastroscopy after 4 weeks of the treatment. The reeults obtained were summarized as follows; 1) 15 out of 18 cases (83. 3%) of gastric ulcers and 26 out of 30 cases (86. 7%) of duodenal ulcers had been completely healed up in 4 weeks. 2) There was a significant relationship between healing of ulcer and the relief of symptoms (x =6.12, P<0.005).3) There were no significant untoward reactions, efther subjective or objective, to the administration of the drug, except one case of severe epigastic discomfort. In conclusion ranitidine appears to be fairy effective and safe for the treatment of patient with peptic ulcr diseases.
Duodenal Ulcer ; Gastroscopy ; Humans ; Peptic Ulcer* ; Ranitidine* ; Stomach Ulcer ; Ulcer

The reconstruction of soft tissue defects with open fracture around the knee joint is limited by its unique location. Free tissue transfer is hindered by the selection of the recipient vessel and problems of microsurgery. The arc of rotation, defect size, and location must be taken into consideration in the use of regional muscle transfer such as gastrocnemius. According to Mathes et al, the flap survival can be enhanced by selective division of the dominant segmental pedicles, only a part of which can normally be transposed safely on its minor segmental pedicle. Neovascularization, vascular proliferation, and dilatation have also been produced by the delay procedure using silicone sheets. The authors have used the delay procedures with wrapping of the gracilis or sartorius muscle which enabled distally-based transposition of these muscles. The method showed satisfactory outcome in resurfacing the wound around the knee joint. The indictions for this procedure were defects of moderate size and those difficult to reach with conventional muscle flaps. The flap could reach the upper one-third of the lower leg. Other merits are relative simplicity and reliability without significant extension of hospital stay. The drawbacks are the two operative procedures necessary and the risk of infection due to silicone sheets.
Dilatation ; Fractures, Open ; Knee Joint* ; Knee* ; Leg ; Length of Stay ; Microsurgery ; Muscles ; Silicones ; Surgical Procedures, Operative ; Wounds and Injuries*

Lymphomatous involvement of the gallbladder is rarely identified and manifests mostly as a local involvement of disseminated disease. There have been reported only about 20 primary malignant lymphomas of the gallbladder without involvement of other sites. A 63-year-old woman presented with jaundice, epigastric pain, and weight olss of two months duration. There was no systemic lymphadenopathy elsewhere. Abdominal computed tomograph revealed a focal thickening of the gallbladder wall. The removed gallbladder contained a well circumscribed, 5x3 cm-sized, slightly elevated firm area with accentuated mucosal papillary excrescences near the neck protion. The lesion involved whole thickness of the wall, and was made up of diffuse atypical lymphoid cell infiltrates of variable size accompanying plasmacytoid differentiation in areas. Some large tumor cells were pleomorphic and contained prominent nucleoli. To our knowledge, this is the first case of primary malignant lymphoma of the gallbladder in Korean literature.
Female ; Humans

For the last 20 years, several different techniques of fat injections have been developed. However, a standard technique of fat grafts has not yet been adopted for all practitioners. The purpose of this study was to evaluate the safety and long-term results of fat grafts using the modified Colman's technique. A total of 234 patients who underwent fat injections were retrospectively reviewed. The results were evaluated by patient satisfaction and photographs. The patient satisfaction was assessed using visual analogous scale(VAS), and photographs were evaluated by medical professionals. The fat was harvested using tumescent liposuction with a two hole Coleman harvesting cannula, and centrifuged at 3000rpm for 3 minutes. The refined fatty tissue was then transferred into a 1-ml syringe, and injected subcutaneously using 17-gauge cannula. The amount of fat tissue placed with each withdrawal of a cannula was 0.3~0.5mL. This technique showed good results with long-lasting volume consistency and few complications. The average value of VAS scored by patients was 8.7, and that by surgeons was 8.5, showing statistically no significant difference between the values evaluated by patients and surgeons. Author's fat injection procedure is a good choice for the correction of cosmetic defects and facial rejuvenation.
Adipose Tissue ; Catheters ; Cosmetics ; Follow-Up Studies ; Humans ; Lipectomy ; Patient Satisfaction ; Rejuvenation ; Retrospective Studies ; Syringes ; Transplants

We analyzed the mRNA expression patterns of major potassium channel genes to determine the mechanism of hypokalemia in familial hypokalemic periodic paralysis. We used quantitative RT-PCR to examine the mRNA levels of both inward (KCNJ2, KCNJ6, and KCNJ14) and delayed rectifi er (KCNQ1 and KCNA2) potassium channel genes in skeletal muscle cells from both normal and patient groups, prior to and after exposure to 4 mM and 50 mM potassium buffers. Quantitative RT-PCR analysis revealed no changes in the mRNA levels of these genes in normal and patient cells on exposure to 4 mM potassium buffer. However, after exposure to 50 mM potassium buffer, which was used to induce depolarization, normal cells showed a signifi cant decrease in KCNJ2, KCNJ6, and KCNJ14 expression, but no change in KCNQ1 and KCNA2 expression. In contrast, patient cells showed no change in KCNJ2 and KCNJ6 expression, but an increase in KCNJ14 expression. Furthermore, KCNQ1 and KCNA2 showed decreased expression. We found that the expression levels of both inward and delayed rectifi er potassium channel genes in patient cells differ from those in normal cells. Altered potassium channel gene expression in patient cells may suggest a possible mechanism for hypokalemia in familial hypokalemic periodic paralysis.

BACKGROUND: When used to reverse the anticoagulant effect of heparin, protamine administration after cardiovascular bypass often can lead to systemic hypotension. During the reversal of heparin-induced anticoagulation, the effects of protamine on both a heparin-protamine complex and free protamine on the cardiovascular system should be considered. METHOD: To determine whether the hypotensive effect of heparin-protamine and/or protamine could be caused by endothelium-dependent and-independent component, we studied rings of the arotic arteries in rats suspended in organ chambers containing Tris Tyrode solution at 37oC and 100% O2. Arterial rings with or without endothelium were contracted with 40 mM KCl or 3 +/- 10-6M phenylephrine and then exposed to increasing concentrations of protamine (final organ bath concentration, 40~400 g/ml) both in the absence and presence of heparin (200 U/ml). RESULTS: Protamine induced concentration-dependent relaxation in arterial rings with endothelium, which were significantly greater than in rings without endothelium. The endothelium-dependent relaxation induced by protamine was inhibited by NG-monomethyl-L-arginine (L-NMMA) (10-5M) pretreatment, but was not inhibited by indomethacin (3x10-6M) pretreatment on rings with endothelium. Furthermore, the contractile inhibition was enhanced by superoxide dismutase (100 U/ml). Also, such vasodilating actions were not influenced in the presence of heparin (200 U/ml). In endothelium-denuded strips, protamine (400ug/ml) inhibited Ca++ induced contraction, which was evoked in Ca++-free solution containing 40 mM K+, and also inhibited the norepinephrine (NE)-induced contraction. Protamine inhibited on the NE-induced contraction, but not the caffein-induced contration in Ca++ free, 2 mM EGTA solution. Also, such inhibition of contracions were not inluenced in the presence of heparin (40 U/ml). CONCLUSION: This study demonstrates that protamine (in the presence or absence of heparin) acts on endothelial cell receptors to stimulate the production of nitric oxide and inhibits both Ca++-influx and the NE-induced Ca++ release from intracellular stores.
Animals ; Arteries* ; Baths ; Cardiovascular System ; Egtazic Acid ; Endothelial Cells ; Endothelium ; Heparin* ; Hypotension ; Indomethacin ; Nitric Oxide ; Norepinephrine ; omega-N-Methylarginine ; Phenylephrine ; Rats* ; Relaxation ; Superoxide Dismutase ; Vasodilation*

Since the first report by Tansini in 1896, the latissimus dorsi muscle free flap has been widely used for various types of soft tissue defect due to reliable anatomy with a sufficient diameter of neurovascular pedicle and a sizable muscle. However, for relatively small soft tissue defect, latissimus dorsi free flap offers several distinct disadvantages of donor site including loss of the posterior axillary fold and flattening of the posterolateral chest wall, weakness of upper arm strength in extension, adduction and internal rotation. We treated three patients having various types of soft tissue defect using segmental latissimus dorsi muscular free flap depending on its descending branch of thoracodorsal neurovascular pedicles. There were no serious complications during 18 months of mean follow-up. We concluded that this method has some advantages such as no weakness of strength of the upper arm including walking on crutches, preserving the posterior axillary fold, preventing winging of the scapula and increased chance of using a flow-through technique. Here we present our cases of reconstruction of soft tissue defect using segmental latissimus dorsi free flap with a review of the literature.
Arm ; Crutches ; Follow-Up Studies ; Free Tissue Flaps* ; Humans ; Scapula ; Superficial Back Muscles* ; Thoracic Wall ; Tissue Donors ; Walking

Pelvic actinomycosis is a rare disease, and has variable clinical manifestations and courses, which make it difficult to diagnose the disease initially. We experienced a pelvic actinomycosis in a woman who complained vaginal discharge and lower abdominal pain, and had not been carring a intrauterine contraceptive device. This infection results in tissue destruction, fibrosis, and the formation of draining sinuses. We describe the case with brief review of clinical diagnosis and management.
Abdominal Pain ; Actinomycosis* ; Diagnosis ; Female ; Fibrosis ; Humans ; Intrauterine Devices ; Rare Diseases ; Vaginal Discharge

Colon has the highest bacterial concentration in the gastrointestinal tract. When the colon is perforated, the operator has to decide whether to perform primary closure, resection with anastomosis, proximal colostomy, and exteriorizatoion. In this retrospective study, from October, 1993, through July 1998, 56 patient with panperitonitis due to colon perforation were operated at Ewha womans University medical center. The rectal perforation was limited the intraperitoneal portion. Our cases were divided into two groups. Group I included 34 patients who treated with one step operations of primaryrepair or resection anastomosis. Group II included 22 patients who treated with two step operations of proximal colostomy or exteriorization. The one step operations were performed in 34 patients, proximal colostomy in 21 patients, and exteriorization in 1 patient. There was 13.7% in the incidence of motality and 33.3% in the incidence of morbidity. The Chi-square test was used to evaluate the significance of differences between two groups. Independent risk factors for adverse outcomes were compared and used to analyse the probability for adverse outcomes with respect to the mode of treatmen. The mode of treatment was not dependent on the risk factors. These results suggest that one could select positively primary closure or resection with anastomosis for the treatment of patients with panperitonitis due to colon perforation.
Academic Medical Centers ; Colon* ; Colostomy ; Female ; Gastrointestinal Tract ; Humans ; Incidence ; Retrospective Studies ; Risk Factors