PURPOSE: The aim of this study was to describe the clinical course and outcome of the patient with epilepsy after acute febrile encephalopathy. METHODS: Medical records of the twenty patients with acute febrile encephalopathy from Mar. 2003 to Dec. 2011, were reviewed. The outcome of epilepsy over 12 months after discharge from encephalopathy was investigated and compared with non-epilepsy group on several clinical and laboratory aspects. RESULTS: All revealed negative on viral study. Eight of 20 patients evolved to epilepsy eventually and 3 out of them had a status epilepticus as initial manifestation. Five of them remained medically intractable. Two showed ongoing violent behavior during follow-up period and 1 had motor weakness of lower limbs for a year. All had non-specific brain MRI findings, except the one who showed suspected cerebritis of right basal ganglia on follow-up study. Five of 8 epilepsy patients showed epileptic discharges on the first electroencephalogram. Two of them showed sustained frontal spikes and one who had abnormal brain MRI findings showed left temporal spike on follow-up EEG. Longer period of altered mentality and more frequent epileptiform discharges on initial EEG appeared to be related with progression to epilepsy during follow-up period. CONCLUSION: Acute febrile encephalopathy in children may be related to poor seizure outcome and resultant psychomotor problems. Further studies including laboratory exams to define its pathophysiology would be needed.
Basal Ganglia ; Brain ; Child ; Electroencephalography ; Epilepsy ; Fever ; Follow-Up Studies ; Humans ; Lower Extremity ; Medical Records ; Seizures ; Status Epilepticus

We studied the motor innervation and the nerve pathway of glabellar expression muscles and a kind of glabellar skin wrinkles. Electric stimulation and surface tracing of the temporal and zygomatic branches of the facial nerve was performed using an electric nerve stimulator on both sides of 14 healthy volunteers. Micro- dissection of four cadaveric heads were also performed to confirm the results of nerve stimulation test. The corrugator supercilii muscle is innervated by the temporal branch of the facial nerve. The depressor supercilii muscle, the medial head of the orbicularis oculi muscle, and the procerus muscle are innervated by the zygomatic branch. The temporal branch to the corrugator supercilii muscles travels in a curvilinear pattern superior to the upper margin of the eyebrow. The zygomatic branch to the glabellar expression muscles travels in a curvilinear pattern inferior to the inferior orbital rim in the proximal portion and in a cobwebby pattern medial to the medial orbital rim in the distal portion. In cadaveric study, the zygomatic nerve branches off in the inferomedial orbital portion, and its fine branches enter into the procerus muscle, the depressor supercilii muscle, and the orbicularis oculi muscle. The surface pathway of the motor nerve to the glabellar expression muscles is described. We think that the zygomatic and temporal branches both should be blocked simultaneously to improve glabellar skin wrinkles completely.
Cadaver ; Electric Stimulation ; Eyebrows ; Facial Nerve ; Head ; Healthy Volunteers ; Muscles* ; Orbit ; Skin

The sacral area is the most frequent site of pressure sore. Because bony prominence is broad and flat along with little soft tissue padding. Between many muscle flaps, the gluteus maximus myocutaneous flap is the most reliable one for surgery of sacral pressure sores. After complete resection of ulcer, the gluteus maximus muscle detached from its original site including posterior iliac crest. After adequate dissection proceeded and bony prominence removed, flap repair is done at the central line. When performing this flap, most surgeon use elliptical design and incision. In the past, we also used elliptical incision and sometimes experienced some drawbacks especially when wound extended close to anus. There are difficulties on repair of perianal skin, central tension of long vertical scar, perianal skin adhesion and natal cleft distortion and resulting asymmetry of gluteal contour and contamination of operation site by defication. After review of the photographs in the references dealing with pressure sores, we had an impression that there are skin adhesion near the anus in some cases and actually experienced such cases in other surgeon's operations. This time, we applicate new design called the "Bomb-shape" design when performing this flap to patients who have a broad wound extent close to anus or perianal skin. The "Bomb-shape" design is a concept of adding bilateral subcutaneous incisions to lower part of classic elliptical incision and we named as such because it resembles the military bomb in shape. We expect the effect of preserving the perianal skin and preventing the skin adhesion or natal cleft distortion and performed this procedure in 15 patients whose defect close to anus. Consequently, benefits of this method are spreading tension of vertical scar, decreased contamination in wound care, earn skin stability without perianal skin adhesion or natal cleft distortion, so maintain the symmetry of gluteal contour and get better cosmetic result. There is no significant increase in operation time in that no need of handling the "dog-ear", and all 15 patients have good results and are satisfied, so we introduce this flap design carefully with concurrent review of literature.
Anal Canal ; Bombs ; Cicatrix ; Concurrent Review ; Humans ; Military Personnel ; Myocutaneous Flap ; Pressure Ulcer* ; Skin ; Ulcer ; Wounds and Injuries

Pleomorphic adenoma is a benign tumor originated from the mature salivary tissue. Ectopic pleomorphic adenoma is defined as an unusual presentation of pleomphic adenoma in other sites except the major salivary gland and the minor salivary gland. Ectopic pleomorphic adenoma was found in the soft tissue of the neck, in the skin of the external auditory canal, in the subcutaneous layer of the nose, and in the lymph node of the mediastinum. Ectopic pleomphic adenoma could appear due to the metastasis, the neoplastic degeneration of the ectopic salivary tissue, or the implantation after the surgery of a salivary gland tumor. We present a case of pleomorphic adenoma found in the superficial subcutaneous layer above the superficial musculoaponeurotic system(SMAS) of the preauricular area. The patient had no history of the surgery of the salivary tumor and no specific physical finding. We discussed the previous cases of ectopic salivary tissues and ectopic pleomorphic adenomas. No case of the ectopic salivary tissue nor ectopic pleomorphic adenoma in the superficial subcutaneous layer of the preauricular area has been reported. This case could be a rare presentation of the ectopic pleomorphic adenoma from the ectopic salivary tissue arising from the division of the parotid gland in early embryonic period.
Adenoma ; Adenoma, Pleomorphic* ; Ear Canal ; Humans ; Lymph Nodes ; Mediastinum ; Neck ; Neoplasm Metastasis ; Nose ; Parotid Gland ; Salivary Glands ; Salivary Glands, Minor ; Skin

Vascular endothelial growth factor (VEGF) is known to play a key role in tumor angiogenesis. The tumor-suppressor gene p53 has been thought to regulate VEGF. We investigated the effect of VEGF on esophageal carcinoma and the correlation between VEGF and p53. Tissue samples were taken from 81 patients with esophageal carcinoma after surgery. VEGF and p53 expressions were examined by immunohistochemical staining. Microvessels in the tumor stained for CD34 antigen were also counted. VEGF and p53 expressions were observed in 51.3% (41/80) and 51.9% (41/79), respectively. The microvessel density was 70.9+/-6.7 (mean+/-SE) in VEGF-positive group and 68.7+/-5.1 in VEGF-negative group. However, no correlation was noted between VEGF and p53 expression. Whereas the tumor size, nodal status, depth of invasions, and tumor stage were associated with poor overall survival, VEGF expression or p53 expression was not. These results indicate that VEGF and p53 are highly expressed in esophageal carcinomas. Since the VEGF expression is not correlated with the p53 expression, microvessel density or clinicopathological findings, further studies with other angiogenic molecules are needed to determine the role in esophageal carcinomas.
Adult ; Aged ; Capillaries ; Carcinoma, Squamous Cell/classification/*metabolism/pathology ; Endothelial Growth Factors/*biosynthesis ; Esophageal Neoplasms/classification/*metabolism/pathology ; Female ; Humans ; Lymphatic Metastasis ; Lymphokines/*biosynthesis ; Male ; Middle Aged ; Neoplasm Staging ; *Neovascularization, Pathologic ; Prognosis ; Retrospective Studies ; Tumor Suppressor Protein p53/*biosynthesis ; Vascular Endothelial Growth Factor A ; Vascular Endothelial Growth Factors

Burn induced helical keloid is usually manifested by the severe disfigurement. The satisfactory reconstruction of the helical rim has not been achieved by the methods such as full thickness skin grafting(FTSG), core extirpation, and simple excision combined with intralesional steroid injection. In treatment with FTSG, the frequent failure of skin graft in the helical rim is due to the lack of adequate vascular supply in the recipient bed and the exposed helical cartilage after keloid excision. However, if the recipient bed with rich vascularity is widen and sufficient to maintain the viability of the graft, FTSG is the best method that leaves less donor morbidity and is able to reconstruct the natural appearance of helix. We proposed that the improved survival of skin graft could be achieved by better vascular supply by the deepithelialization of the surrounding normal skin after keloid excision. Five helical burn keloids and hypertrophic scars were reconstructed by the method of excision and FTSG. There were no recurrence and the results showed good texture and similar skin color. Excision of scar and FTSG is a satisfactory method to treat helical burn keloid.
Burns* ; Cartilage ; Cicatrix ; Cicatrix, Hypertrophic ; Ear ; Humans ; Keloid* ; Recurrence ; Skin Transplantation* ; Skin* ; Tissue Donors ; Transplants

Desmoid tumors are rare soft tissue neoplasms derived from fascial or musculoaponeurotic structures. These tumors are histologically benign but may behave aggressively at the local level with frequent recurrence after complete resection. Wide regional excision with negative pathologic margins is the treatment of choice for most desmoid tumors. A 36-year-old man was presented with a huge mass of 25 cm in diameter from right side of neck extended to ipsilateral chest wall. He was complaining discomfort during neck exercise and focal paresthesia on his right 2nd, 3rd, and 4th finger volar side without functional limitation. The lesion was evaluated preoperatively through MRI, angiographies and bone scan. It was originated from right scalenius medius muscle of neck extended to ipsilateral axilla and chest wall adhering to the brachial plexus. Tumor resection sparing brachial plexus was executed and postoperative radiotherapy was accompanied. After 9 months, there was no evidence of tumor recurrence and no major function limitation of right arm and hand.
Adult ; Angiography ; Arm ; Axilla ; Brachial Plexus ; Fibromatosis, Aggressive* ; Fingers ; Hand ; Humans ; Magnetic Resonance Imaging ; Neck* ; Paresthesia ; Radiotherapy ; Recurrence ; Soft Tissue Neoplasms ; Thoracic Wall* ; Thorax*

Surgical reconstruction of malignancies of the head and neck often leave large defects that demands reconstruction. A maxillectomy defect creates a communication from oral cavity to nasal cavity that may extend to the orbit. This can leave a large anatomical defect that invades surrounding anatomical boundaries including the oral cavity, nasal cavity, orbital cavity, soft tissues of the face, and anterior skull base. Surgical repair of maxillary defects has been widely reported. Skin graft, local and regional flaps such as local mucosal flaps, buccal fat pad, temporalis muscle and pectoralis major muscle pedicled flaps, and free tissue transfer can be used depending largely on the size of the defect. We performed facial reconstruction using a latissimus dorsi musculocutaneous free flap for covering large defects that involved exposed orbit, nasal, and oral cavities in seven patients after total maxillectomy for maxillary cancer. One case was immediate reconstruction and the others were secondary reconstruction during the follow up period after primary cancer surgery. The skin of the latissimus dorsi musculocutaneous flap was pliable and its texture was similar to that of the face. The muscle bulkiness was sufficient to reconstruct the soft tissue of the intraoral and nasal lining and external skin deficits. All flaps had survived and serious complications were not developed. None of the patients need secondary defatting procedures later for the excessive bulkiness, but oronasal fistulas developed in two patients and one patient had cicatrical ectropion of lower eyelid. All donor defects were closed primarily and there has been no noticeable residual functional problems or discomfort in the shoulder area.
Adipose Tissue ; Ectropion ; Eyelids ; Fistula ; Follow-Up Studies ; Free Tissue Flaps* ; Head ; Humans ; Mouth ; Myocutaneous Flap ; Nasal Cavity ; Neck ; Orbit ; Shoulder ; Skin ; Skull Base ; Superficial Back Muscles* ; Surgical Flaps ; Tissue Donors ; Transplants

A large gap in peripheral nerve will not allow effective regenaration unless a grafting conduit is used to bridge the defect. Conventionally, nerve tissue has been used as a conduit in nerve reconstruction; however, results from techniques using these grafts are often unsatisfactory. A number of recent investigations have indicated that nerve fibers will regenerate through a nonneural tube. A 45-years-old female patient with a protruding mass on her lateral neck area visited our hospital. She complained of tingling sensation on the lateral aspect of palm, extending to 4, 5th finger. Mild degree of hypothenar muscular atrophy was also observed. Magnetic resonance image showed well-circumscribed mass with homogenous density located in brachial plexus area. We performed tumor excision with conglumerated C7 resection. The histologic finding was schwannoma with mixed type of Antoni A and B. A piece of sternocleidomastoid muscle was used as a conduit to bridge the gap and entubulization, the implantation of silicone guide tubes, was performed as an alternative method to the repair of transected nerves in the silicone tubes. The proximal and distal nerve stumps are introduced into each end of the tube and are held in place by epineural sutures. During three months of follow-up period, neuropathic pain and tingling sensation slowly subsided. Nerve conduction test and electromyography performed at the time of 86th day after the surgery showed much improved pattern compared to those performed on the 14th day after the operation. These results show that basement membrane of muscle fiber and silicone tube are able to orientate and promote peripheral nerve regeneration in a manner analogous to the endoneurial tubes of peripheral nerves.
Basement Membrane ; Brachial Plexus* ; Electromyography ; Female ; Fingers ; Follow-Up Studies ; Humans ; Muscle, Skeletal* ; Muscular Atrophy ; Neck ; Nerve Fibers ; Nerve Regeneration ; Nerve Tissue ; Neural Conduction ; Neuralgia ; Neurilemmoma* ; Peripheral Nerves ; Regeneration ; Sensation ; Silicones* ; Sutures ; Transplants

The orbital wall resection with removal of tumor in patient who has malignant tumor in paranasal sinuses or nasal cavity causes enophthalmos, dystopia, or severe facial deformities. The methods of reconstruction of orbital wall have been used skin graft, muscular sling, parietotemporal fascial calvarial bone flap, and free flaps. The parietotemporal fascial calvarial bone flap has been used as a pedicle flap, but it can not be used in reconstruction of medial wall of the orbit because it has a short vascular pedicle. Therefore we designed the galeal-frontalis- pericranial-calvarial bone flap which is a new pedicled bone flap for reconstruction of orbital wall. We used this flap in 2 patients who have orbital wall defect following resection of malignant tumor arising from the nasal cavity or maxilla. The outcome was gratifying in all two patients. We think that this flap is a new useful method in reconstruction of the orbit.
Congenital Abnormalities ; Enophthalmos ; Free Tissue Flaps ; Humans ; Maxilla ; Nasal Cavity ; Orbit* ; Paranasal Sinuses ; Skin ; Transplants