Early postoperative seizures after posterior fossa surgery

A review is reported of the seizure incidence in 726 patients who underwent 740 posterior fossa operations via a suboccipital craniectomy without prophylactic anticonvulsant agents. Thirteen patients (1.8%) experienced seizures within 2 weeks postoperatively. Five of these patients (0.7% of the series) had seizures within 24 hours after operation. The incidence was highest for patients with medulloblastoma (7.2%) followed by those with astrocytoma (2.3%). Also, a higher percentage was found in patients with preoperative ventriculoperitoneal shunt or intraoperative ventriculostomy (2.7%) than in those without (1%), but the difference was not statistically significant. Metabolic acidosis (80%) and hyponatremia (20%) were the major causes of the seizures that developed within 24 hours after operation. Follow-up computerized tomography showed no definite lesion in these patients. Hydrocephalus (75%) and supratentorial hemorrhage remote from the operative site (25%) were detected in the patients who developed seizures between the 2nd and 14th postoperative day. Two of these patients also had postoperative bacterial meningitis. This review suggests that seizures are a possible complication in the early postoperative period after suboccipital craniectomy for posterior fossa lesions.     

Treatment of unstable fractures of the distal radius by external fixation

The Roger Anderson external fixator was used in the treatment of unstable fractures of the distal radius in 52 patients, and the results evaluated after a follow-up averaging 58 months. The indications for its use were failure to maintain adequate closed reduction using plaster, and instability of the fracture as determined by the initial radiographs. Our radiological criteria for instability included dorsal angulation of more than 20 degrees, fractures involving the joint, radial shortening of more than 10 mm, and severe dorsal comminution. Using the Lucas modification of the Sarmiento demerit point-rating system, we found that 46 patients (89%) had good or excellent results and six (11%) were classified as fair. There were no poor results. Seven patients (14%) developed complications. None of these affected the long-term results except in one elderly woman where the pins loosened and had to be removed.     

Cellular immunocompetence in melanoma: effect of extent of disease and immunotherapy.

Cell mediated immunocompetence was measured serially in 35 patients with malignant melanoma in order to determine the effect of extent of disease and prognosis as well as the influence of BCG immunotherapy on immune reactivity. Compared with normal adult controls, statistically significant lymphopenia occurred only in patients with widespread disease. Seventeen of 21 patients with negative pre-therapy PPD skin test converted to skin test positivity. PHA blastogenesis was depressed only in patients in the pre-terminal stages of their disease using optimal mitogen concentrations for stimulation. Threshold concentrations of this mitogen more clearly demonstrated a depressed responsiveness which correlated in severity with extent of disease. PPD induced blastogenesis was normal or increased in the majority of patients; however, the degree of stimulation by PPD was less in the BCG induced convertors than in those patients who were skin test positive before BCG treatment. Comparison of the pre- and post BCG assessments reveals no significant differences except in relation to PPD conversion. We conclude that using threshold concentrations of PHA, impaired responses are regularly associated with disease beyond the regional lymph nodes. Routine assessment of lymphocyte function by these parameters did not provide information that was not available from clinical evaluation.     

A Study Into the Risk of Exacerbation of Chronic Hepatitis B After Liver Resection for Hepatocellular Carcinoma

Liver resection is commonly performed for solitary hepatocellular carcinoma (HCC) in well-compensated cirrhotic and noncirrhotic patients. Data concerning exacerbation of chronic hepatitis B (ECHB) post-liver resection are scant. To determine the incidence, risk factors, and clinical outcomes of ECHB in patients who underwent hepatic resection for HCC. The methods consisted of a retrospective review of consecutive patients with chronic hepatitis B virus (HBV) infection who had undergone liver resection for HCC from January 2002 to December 2004. Seventy-seven patients underwent 82 liver resections; the mean age was 58.0 ± 12.1 years; 87% male; 20% hepatitis B e-antigen positive. Incidence of all causes of postoperative hepatitis was 25.6% (n = 21), and ECHB was 8.5% (n = 7). Both groups had their peak alanine aminotransferases, 231.0 IU/L (74–1,400) and 312 IU/L (147–1,400), respectively, observed at day 84 postresection. Three patients died as a result of ECHB within 4 months postsurgery. One- and 2-year survival rates were poorest for the ECHB group at 42.9 and 21.4%, compared with those with postoperative hepatitis due to other causes at 60.3 and 45.2% and those without postoperative hepatitis at 87.7 and 73.5% (p < 0.001). Liver resection for HCC in patients with chronic HBV infection carries a risk for ECHB, and affected patients have poorer clinical outcomes. There is a need for close monitoring of these patients preoperatively and in the early postoperative period. This paper was presented as a poster in the American Association for the Study of Liver Disease Liver Meeting in San Francisco in November 2005     

A case of histiocytic necrotizing lymphadenitis showing focal lymph nodes swelling in the abdomen]

A case was 23 years old woman. She came to our hospital with complain of continuing fever after common cold and mass like an egg was touched in right lower abdomen. No other surface lymph node was swelling. Abdominal US, CT and MRI showed that the mass was existed in the front of the psoas muscle and the maximum diameter of it was 6 cm in which necrotizing lesion was recognized. The size of the lymph node became smaller slowly but we could not perfectly exclude malignant disease, we examined needle biopsy for the diagnosis. The histopathological findings showed the histiocytic necrotizing lymphadenitis (HNL). HNL usually appears in the neck area, but in this case it was detected only in the abdomen. This case was very rare and we reported.     

Treatment of root fracture with accompanying resorption using cermet cement.

A method of treating an apical root fracture with accompanying resorption at the junction of the fracture fragments using glass-cermet cement is described. Endodontically, the material had previously been used for repair of lateral resorptive root defects and retrograde root fillings. Complete bone regeneration was observed three years post-operatively following treatment of the root fracture in the conventional manner. The various advantages of glass-cermet cement as a root filling material used in the technique described are discussed.     

Brain abscess secondary to intracranial extradural epidermoid cyst

A case of brain abscess in the right temporal lobe secondary to an intracranial extradural epidermoid cyst in the right parasellar region is reported. The etiology of the brain abscess in this particular case was deduced using the findings of computed tomography, carried out several times over a 3-year period, after an initial operation to remove the epidermoid cyst. One of the scans showed a very-low-density spot in the right parasellar region compatible with air, suggesting a communication between the intracranial space and the paranasal sinuses.     

Intracellular localization of 99Tcm-d,l-HMPAO and 201Tl-DDC in rat brain

The intracellular localization and relative distribution of 99Tcm-hexamethylpropyleneamine-oxime (99Tcm-d, l-HMPAO) and 201Tl-diethyldithiocarbamate (201Tl-DDC), which have been used to assess regional cerebral blood flow (rCBF) in man, were investigated in rat brain. 99Tcm-d, l-HMPAO was found attached mainly to cell organelles whilst 201Tl-DDC was localized mainly in free state in the cytosolic fraction. Isolation of neuronal and glial nuclei showed that there is higher uptake of 99Tcm-d, l-HMPAO in neuronal nuclei than in glial nuclei for all the different regions of the rat brain investigated. These data demonstrate a different subcellular localization of the two lipophilic agents studied. In view of their proposed clinical utility, this difference merits further investigation.