Résumé
OBJECTIVE: Extracranial-intracranial(EC-IC) bypass procedures have proved to be useful and safe in selected patients for revascularization. We have performed EC-IC bypass procedures in 170 patients with atherosclerotic cerebral ischemia and moyamoya disease. We analyzed the cases that had permanent complications after performing EC-IC bypass procedures in these 170 patients. METHODS: We performed ECIC bypass surgery during the recent 10 years for augmenting the cerebral blood flow in 170 patients with atherosclerotic cerebral ischemia and moyamoya disease. Of the 170 patients, the pathologic lesions were atherosclerotic cerebral ischemia in 125 and moyamoya in 45. All the patients were symptomatic and in a hemodynamic cerebral ischemic state, as diagnosed by the acetazolamide loading test. Superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis was performed in 158 cases and graft bypass with using the saphenous vein or radial artery was done in 12 cases. RESULTS: Of 170 patients who underwent bypass surgery, twenty four patients had postoperative neurologic deficits. Of these 24 patients, the neurologic deficits of 17 patients resolved completely within 3 weeks, but the remaining 7 patients (moyamoya in 5 patients and 2 patients were atherosclerotic) had permanent deficits. The probable causes of the permanent neurologic deficits were that bypass was done too soon after an ischemic attack or hemorrhage (3 cases), intracerebral steal phenomenon during anesthesia (2 case), postbypass thrombotic occlusion of the prebypass stenotic artery (1 case) and postbypass thromboembolism (1 case) CONCLUSION: Permanent neurologic deficits could complicate some cases following bypass surgery. The suggested causes of neurologic deficit were hypoperfusion and inappropriate CO2 tension in the blood and fluctuation of the blood pressure during the perioperative period. To prevent complications, maintain an appropriate perfusion pressure and blood pressure control and follow this with antiplatelet or anticoagulation therapy as soon as possible.
Sujets)
Humains , Acétazolamide , Anesthésie , Artères , Pression sanguine , Encéphalopathie ischémique , Artères cérébrales , Hémodynamique , Hémorragie , Ischémie , Maladie de Moya-Moya , Manifestations neurologiques , Perfusion , Période périopératoire , Artère radiale , Veine saphène , Thromboembolie , TransplantsRésumé
OBJECTIVE: Spinal epidural hematoma (SEDH) and spinal subdural hematoma (SSDH) are rare diseases and they may have various causes such as trauma, lumbar puncture, anticoagulant therapy, tumor, blood dyscrasia and vascular malformation. In general, SEDH and SSDH are regarded as surgical emergency. We reviewed our cases with patients with SEDH or SSDH. They were surgically treated or conservatively treated. We examined the relationship between the surgical timing and the neurological outcome. METHODS: Twelve patients (8 cases for SEDH, 4 cases for SSDH) were included in our study. There were seven male and five female patients (mean age: 50.2 yrs, ranged from 18 to 87 years). Ten patients were surgically treated (7 cases for SEDH, 3 cases for SSDH) and two patients were conservatively treated (1 case for SEDH, 1 case for SSDH). We checked preoperative Frankel grade, time interval between onset of symptom and operation and post-operative neurologic change of each case. We investigated relationship between surgical timing and neurological outcome and also relationship between pre-operative Frankel grade and post-operative outcome. RESULTS: In seven cases (70%) of operated cases, there were postoperative improvements in clinical symptoms. Two cases had time interval within 6 hours from onset of symptoms to operations and their neurologic deficits were not improved. There were 2 cases with time interval of more than 6 hours and within 12 hours. And there were 6 cases with time interval over 12 hours. Seven of eight cases with time interval over 6 hours were improved after surgical treatments. CONCLUSION: There are various factors which may affect post-operative neurologic prognosis. Surgical timing is generally regarded as one of the most critical factors. However, in our study, preoperative neurologic status of patients functioned as the most important factor in clinical outcomes. We thought that the initial neurologic status of patient, as well as the surgical timing, may predict the prognosis.
Sujets)
Femelle , Humains , Mâle , Urgences , Hématome épidural rachidien , Hématome subdural , Hématome subdural spinal , Manifestations neurologiques , Pronostic , Maladies rares , Fractures du rachis , Ponction lombaire , Anomalies vasculairesRésumé
Hemangioblastoma is uncommon, accounting for 1 to 2.5% of all primary neoplasms of the central nervous system. Ten to 20% of hemangioblastomas occur as part of Von Hippel-Lindau disease(VHL). Multiple hemangioblastomas are seen only with VHL and these are seen in up to half of VHL-associated hemangioblastomas. We have treated two cases of multiple hemangioblastomas associated with VHL disease in a family, sister(case I, 48/female) and her brother(case II, 41/male). Both patients had renal and pancreatic cysts in addition to CNS hemangioblastomas. Their hemangioblastomas were removed totally, and then their neurological symptoms had Improved. With a review of the literature, the authors present a family of VHL-associated multiple hemangioblastomas.
Sujets)
Humains , Système nerveux central , Hémangioblastome , Kyste du pancréasRésumé
This study was performed to locate the anteroposterior position of the center of resistance of upper anterior teeth when intrusive forces are acted on them by applying segmented arch mechanics. Three-dimensional finite elernent model of upper six anterior teeth, periodontal ligament and alveolar bone was constructed The locations of the center of resistance were compared according to the three variables, which are number of teeth contained in anterior segment, axial inclination of anterior teeth, and degree of alveolar bone loss. The following conclusions were drawn from this study; 1. When the axial inclination and alveolar bone height were normal, the locations of center of resistance of anterior segment according to the number of teeth contained were as follows; 1). In 2 teeth segment, the center of resistance was located in the distal area of lateral incisor bracket 2) In 4 teeth segment, the center of resistance was located in the distal 2/3 of the distance between the brackets of lateral incisor and canine. 3) In 6 teeth segment, the center of resistance was located in 3mm distal of canine bracket, which is interproxirnal area. between canine and 1st premolar. 4) As the number of teeth contained in anterior segment increased, the center of resistance shifted to the distal side. 2. As the labial inclination of incisors increased, the center of resistance shifted to the distal side. 3. As the alveolar bone loss increased, the center of resistance shifted to the distal side.
Sujets)
Résorption alvéolaire , Prémolaire , Analyse des éléments finis , Incisive , Mécanique , Desmodonte , DentRésumé
Tuberculosis of the upper respiratory tract is an uncommon disease, and the nasopharynx is particulary a rare site. Tuberculosis of the nasopharynx is mainly secondary infection from pulmonary tuberculosis via contagious, hematogenous or lymphogenous routes. The nasopharynx may be a portal entry for tubercle bacilli in patients who develope cervical lymphadenitis. Involvement of the nasopharynx by tuberculosis may be underdiagnosed because it does not produce obvious symptoms or phyiscal signs. Recently authors experinced a case of nasopharyngeal tuberculosis, here we present this case with a review of literature.
Sujets)
Humains , Co-infection , Lymphadénite , Partie nasale du pharynx , Appareil respiratoire , Tuberculose , Tuberculose pulmonaireRésumé
This study investigated the effects of vitamin C supplementation on the nutritional iron status of 31 adolescent girls, aged 12-15 years, with low hemoglobin levels. They were randomly divided into four groups, and for two groups daily150 mg or 900 mg of L-ascorbic acid(AsA) was given in three equal doses at three meals during 9 weeks. To another group daily 60 mg iron as ferrous sulfate was given in the same way as AsA. The control group was given sugar placebo. Body iron status was monitored through the determination of Hb, Hct, MCHC, and serum ferritin concentrations. Dietary AsA and iron intakes were measured from food consumption surveys performed by 3-day 24-hour recalls. The amount of absorbed iron was estimated from the model of Monsen et al. The average amounts of food iron for four groups were 12.3- 15.0 mg and 11.1 - 18.9 mg at initial and at final period of the supplementation trial, respectively. The tentatively estimated amount of absorbed iron was significantly increased in the 900 mg AsA and iron supplementing groups, but not in the 150 mg AsA and placebo groups. Both Hb and MCHC were improved to above normal levels in all groups except the placebo group. Hct was elevated only in the AsA 900 mg group whose Hct was relatively lower than the other groups. Serum ferritin concentrations of the four groups, which were as low as 8.50 - 14.39ng/mL on average at the intial periods, augmented significantly to 20.18ng/mL and 26.63ng/mL in the 900 mg AsA and iron groups, respectively. Serum ferritin was not elevated in either the AsA 300 mg group or the placebo group. The above data indicated that the daily supplementaion of 150 mg AsA to the meals containing 12-15 mg iron per day promoted Hb levels of adolescent girls with low Hb, and the 900 mg AsA supplementing improved not only Hb level but also body iron store. A supplementation of 60 mg iron per day appeared to be slightly more effective in improving the iron status in comparison to the 900 mg AsA supplement.
Sujets)
Adolescent , Femelle , Humains , Acide ascorbique , Ferritines , Fer , Repas , VitaminesRésumé
Patients with extra-axial mass lesions of the posterior fossa frequently demonstrate signs of brainstem dysfunction. These dysfunctions may be induced by the change of regional cerebral blood flow and electrophysiological status as well as mechanical compression and distortion of the brainstem. Frontal cortical regional cerebral blood flow(rCBF), pontine rCBF, brainstem autidory evoked potentials(AEPs), infratentorial intracranial pressure(infratentorial ICP) and mean arterial blood pressure(MABP) were recorded before and after expansion of an infratentorial epidural ballon in anesthetized experimental cat models. After the elevation of MABP during the increased infratentorial ICP, frontal cortical and potine rCBF, AEPs were recorded every 30 minutes. The results suggest that the elevating the MABP to improve cerebral perfusion pressure before irreversible change occurs in the brain may preserve cerebral function. We conclude that if the volume of the space in the posterior fossa that is occupied by the mass can be estimated, brain damage from low rCBF and brain compression due to intracranial hypertension can be prevented by the elevation of MABP before irreversible damage of the brain occurs.
Sujets)
Animaux , Chats , Humains , Pression sanguine , Encéphale , Tronc cérébral , Potentiels évoqués auditifs , Hypertension intracrânienne , Pression intracrânienne , PerfusionRésumé
One hundred and twenty four patients with hypertensive putaminal hemorrhage were analyzed by time course. All patients were brought to the emergency room within 3 hours after the ictus. Seventy three patients were conservatively treated and 51 patients operatively. The neurologic condition of each patient was evaluated by means of the Glasgow coma scale(GCS) score every 1 hour. CT scan of the brain of these patients were taken within 6 hours after the ictus. Clinical severity of the putaminal hemorrhage was graded as rapid deterioration, slow deterioration, and non deterioration by the CT and neurological status. A precise time course analysis of putaminal hemorrhage were compared with the conservative group and surgical group in a 7 hospital day period. Outcome was assessed 6 months later based on the degree of functional recovery(DOFR). The overall mortality was 16.1% and surgical mortality was 13.7%. Surgical treatment for the rapidly deteriorating patients appears to be beneficial when compared with the slowly deteriorating patients. Outcome of the non deteriorating patients didn't show any differences in the quality of life regardless of treatment modality.
Sujets)
Humains , Encéphale , Coma , Service hospitalier d'urgences , Mortalité , Hémorragie putaminale , Qualité de vie , TomodensitométrieRésumé
This study was undertaken to analyze the growth of mandible in surgically repaired unilateral cleft lip and palate. The subjects consisted of 63 unilateral cleft lip and palate individuals, 60 class III malocclusion and 60 normal occlusions ranging from 6 to 15 years old. Each group was divided into two age groups. (6-10 Y and 11-15 Y) The results obtained from UCLP compared with other groups were as follows: 1. The anteroposterior position of the chin was similar to that of the normal occlusions. 2. The shape of the mandible was similar to that of the class III malocclusions. 3. In mandibular size, ramus height was the smallest among three groups, but body length and overall mandibular length were similar to those of the normal occlusions. 4. The lower border of the mandible was the steepest among three groups and strong vertical or clockwise growth tendency was indicated. 5. The position of condyle in relation to the cranial base showed little difference in three groups. 6. In older age group, vertical growth tendency of the mandible decreased more or less.