We present a case with rare complication of percutaneous vertebroplasty with polymethylmethacrylate (PMMA). A pulmonary embolus was detected in a 79-year-old woman with osteoporotic compression fracture after percutaneous verteroplasty. Chest radiography, computed tomography, and ventilation perfusion lung scan con-firmed pulmonary infarction and the presence of PMMA in the pulmonary arteries. She was treated with anticoagulants and responded favorably. Although venous leakage of PMMA has shown to be not uncommon, only a few cases of symptomatic pulmonary embolism have been reported. Adequate preparation of PMMA, optimal injection technique, and confirmation with biplane fluoroscopy are mandatory to minimize this type of complication.
Aged ; Anticoagulants ; Embolism ; Female ; Fluoroscopy ; Fractures, Compression ; Humans ; Lung ; Perfusion ; Polymethyl Methacrylate* ; Pulmonary Artery ; Pulmonary Embolism* ; Pulmonary Infarction ; Radiography ; Thorax ; Ventilation ; Vertebroplasty*

We present a case of meningeal and brain metastasis of multiple myeloma. A 60-year-old woman who had been diagnosed as multiple myeloma two years ago, was referred to neurosurgery department because of headache and nausea. The magnetic resonance image of the brain showed a large epidural mass and the parenchymal enhancement. The patient received an operation of tumor removal and cranioplasty. A histological diagnosis of metastatic multiple myeloma was made.
Brain ; Diagnosis ; Female ; Headache ; Humans ; Immunoglobulin G* ; Middle Aged ; Multiple Myeloma* ; Nausea ; Neoplasm Metastasis ; Neurosurgery ; Plasmacytoma*

Arachnoid cyst of the velum interpositum is unusual and causes symptoms similar to those seen with a third ventricular mass. This report describes a case in which the arachnoid cyst occupied the cistern of the velum interpositum and was coincident with multiple cranial neuropathies. The patient was treated by endoscopic fenestration of the cyst. The surgery resulted in decreased in the size of the cyst but aggravation of cranial neuropathies. The patient underwent methylprednisolone pulse therapy and intravenous immunoglobulin administration under the impression of the multiple cranial neuropathies and recovered completely 3 months later. The authors conclude that combined neurological disease that needs medical treatment should be differentiated and priority of the treatment should be determined carefully if arachnoid cyst is associated with unrelated or ambiguous neurological symptoms and signs. Careful considerations of cause and effect may avoid an unnecessary surgical manipulation
Arachnoid* ; Cranial Nerve Diseases* ; Humans ; Immunoglobulins ; Methylprednisolone

Embolization of a carotid cavernous fistula(CCF) by means of a detachable balloon is a well-established method for treating CCFs while preserving a patent parent internal carotid artery(ICA). However, failure to embolize the CCF may occur on a few occasions. Herein we describe a stent-assisted Guglielmi detachable coil embolization that completely occludes the fistulous opening rather than fills the cavernous sinus. By applying this technique, we successfully treated a CCF, without compromise of the parent ICA in patients who has failed with balloon technique previously.
Cavernous Sinus ; Embolization, Therapeutic ; Fistula* ; Humans ; Parents ; Stents*

OBJECTIVE: Epigallocatethin gallate(EGCG) is a major green tea polyphenol and is known to have potent antioxidative and antiproliferative actions. This study is performed to investigate the antioxidative effect of EGCG on the various oxidative insults in mouse cerebral cortical cell cultures. METHODS: Mixed cortical cell cultures containing both neuron and glia prepared by plating fetal mice cortical cells on to an established glia of 24 well vessels. At 13-15 days in vitro, oxidative neuronal deaths were induced by the addition of oxidants into the cortical cultures. Iron ion(FeCl2), copper ion(CuCl2), sodium nitroprusside(SNP) and buthionine sulfoximine(BSO, a glutathione depletor) were used as oxidants. Cell death was assessed by LDH assay after microscopic examination. RESULTS: All four oxidants induced neuronal cell death associated with cell body swelling, which was markedly inhibited by Trolox(100muM), a vitamin E analog. EGCG(1-10muM) markedly inhibited the neuronal cell death induced by 20muM CuCl2, 1muM SNP, or 1mM BSO. Unexpectedly the neuronal cell death induced by 20muM FeCl2 was augmented by treatment with 1 or 3muM EGCG. EGCG itself induced concentration- and exposure time-dependent cell death at more than 30muM concentrations. EGCG(30, 100muM) injured not only neuronal cells but glial cells after 48 hour exposure. The EGCG-induced cytotoxicity was partially inhibited by protein synthesis inhibitors, cycloheximide(0.1 or 1mug/ml) and emetine (1mug/ml) or high potassium media(10 or 25mM) but was not affected by Trolox. CONCLUSION: These results suggest that the dual antioxidative-cytotoxic actions of EGCG are concentration-dependent and that the antioxidative aciton depends on the kind of oxidative insults, and that the EGCG-induced cytotoxicity be relevant to protein synthesis and/or membrane depolarization.
Animals ; Cell Culture Techniques* ; Cell Death ; Copper ; Emetine ; Glutathione ; Iron ; Membranes ; Mice ; Neuroglia ; Neurons ; Oxidants ; Potassium ; Protein Synthesis Inhibitors ; Sodium ; Tea ; Vitamin E ; Vitamins

OBJECTIVE: The authors present an investigation of alterations in nitric oxide synthase(NOS) activity and histopathological response after moderate diffuse axonal injury(mDAI). METHODS: A total of 40 anesthetized Sprague-Dawley adult rats were injured utilizing the Marmarou's weight-drop device through a Plexiglas guide tube. These rats were divided into 8 groups(control, 1 hr, 2 hr, 3 hr, 6 hr, 12 hr, 24 hr, 48 hr after trauma). The temporal pattern of apoptosis after mDAI in the adult rat brain was characterized using TUNEL stain and cDNA for NOS activity was amplified using RT-PCR. The PCR products were electrophoresed on a 2% agarose gel and then observed under a UV-transilluminator. The enhanced chemiluminescence method(Pierce, Rockford, IL) was used to visualize the protein bands, and the quantification was performed by using the image analysis soft-ware Bio-1D. RESULTS: eNOS activity was not detected at all groups, but nNOS activity was expressed at 3 hr and continuously by 48 hr after impact , which was especially showed about 2 times larger than control group at 12 and 24 hr(mean value=28314+/-35.07 in injury group, 13386+/-26.14 in control group, p<0.05), followed by being on the decrease at 48 hr. iNOS activity was showed fivetmes larger than control group at 12 hr and 24 hr(mean value=15264+/-38.37 in injury group, 3002+/-31.62 in control group, p<0.05) followed by dramatically decrease below the level of control group(2299+/-14.06). Histologically, significant apoptotic changes after brain injury were occurred from 12 to 24 hr post-injury(AI=24.8%, 27.5%, p<0.001). CONCLUSION: These data indicate that nNOS and iNOS activity are affected after mDAI in a time-dependent manner and there is a close relation between apoptotic changes and NOS activity. nNOS activity is not stronger than iNOS, which lately expressed. However, iNOS activity is markedly reduced by 48 hr compared to nNOS.
Adult ; Animals* ; Apoptosis ; Axons ; Brain ; Brain Injuries ; DNA, Complementary ; Head Injuries, Closed* ; Humans ; In Situ Nick-End Labeling ; Luminescence ; Models, Animal* ; Nitric Oxide Synthase ; Nitric Oxide* ; Polymerase Chain Reaction ; Polymethyl Methacrylate ; Rats ; Rats, Sprague-Dawley ; Sepharose

OBJECTIVE: This study is aimed to prove the neuroprotective effect of magnesium ion, which is known to have competitive action against calcium influx in the process of neuronal damage. METHODS: One hundred twenty five male Sprague-Dawley rats weighing 300-350gm were divided into control and MgSO4 injected groups. Middle cerebral artery occlusion was induced by nylon insertion near internal carotid artery bifurcation via external carotid artery. Forty rats which were alive for 48 hours after the induction of cerebral infarction were drawn from each group. Thirty minutes after the induction of cerebral infarction, 750mumol/Kg of MgSO4 was intramuscullary injected for the experimental group and same amount of normal saline was injected for the control group. Each group was subdivided into groups of 20 rats 48 hours after the cerebral infarction. Brain-sections of a subgroup were obtained after transcardially perfusion of 2% 2', 3', 5'-triphenyl-tetrazolium chloride and infarction volume was measured using imaging analysis program. Brain-sections of the other subgroup were stained with terminal deoxynucleotidyl-transferase-mediated biotin dUTP nick end labeling(TUNEL) and apoptotic index(AI) was estimated. RESULTS: The volume of cerebral infarction of the control and MgSO4 injected groups were 52.44+/-5.68% and 38.38+/-9.02% respectively, and the infarction volume was significantly reduced in MgSO4 injected group(p<0.001). Brain edema volume were 209.01+/-75.41mm3 in control group and 140.7+/-81.89mm3 in MgSO4 injected group that was a significant reduction in MgSO4 injected group(p<0.001). AI of 53.68+/-6.38 for control group and 29.80+/-6.77 for MgSO4 injected group were estimated and MgSO4 injected groups showed a significant reduction(p<0.001). CONCLUSION: Magnesium ion has neuroprotective effect in reduction of cerebral infarction volume, brain edema volume and AI. In the future, various attempts to prove protecting mechanism of magnesium ion should be made and TUNEL stain is thought to be an effective comparison method in such studies.
Animals ; Apoptosis ; Biotin ; Brain Edema ; Calcium ; Carotid Artery, External ; Carotid Artery, Internal ; Cerebral Infarction* ; Humans ; In Situ Nick-End Labeling ; Infarction ; Infarction, Middle Cerebral Artery* ; Magnesium ; Male ; Middle Cerebral Artery* ; Neurons ; Neuroprotective Agents ; Nylons ; Perfusion ; Rats ; Rats, Sprague-Dawley

OBJECTIVE: The authors present a retrospective clinical analysis of transsphenoidal surgery for acromegaly including preoperative factors determining the therapeutic outcome. METHODS: Forty-three patients(24 females, mean age 45.3 years) harboring growth hormone(GH)-secreting adenomas(13 microadenomas and 30 macroadenomas) were treated between the years 1987 and 2001. The mean duration of follow-up was 69 months. RESULTS: The average estimated duration of symptoms prior to diagnosis was 8 years. The control rate following surgery was 51%(22 out of 43 cases). Of the patients with postoperative persistent disease, 11 patients had had additional bromocriptine therapy with or without irradiation, and consequently 7 patients achieved biochemical remission. The overall remission rate of multimodality treatment was 67%. The preoperative GH value, tumor size, extrasellar extension of tumor, the number of surgeons, and the extent of the surgical removal were significant univariative predictors of outcome(p<0.05). CONCLUSION: This study suggests that surgical outcome for acromegaly could be achieved by a experienced neurosurgeon. In the group of the patients of large or invasive adenomas, with the less probability of surgical control, adjunctive medical or radiation therapy to control GH hypersecretion should be considered.
Acromegaly* ; Adenoma ; Bromocriptine ; Diagnosis ; Female ; Follow-Up Studies ; Growth Hormone ; Humans ; Microsurgery* ; Pituitary Neoplasms ; Retrospective Studies ; Treatment Outcome

INTRODUCTION: The authors present a retrospective analysis of the clinical features and prognostic factors of long-term survival in gliomatosis cerebri. METHODS: The authors reviewed the clinical features of 27 cases of gliomatosis cerebri treated between August 1988 and January 2001. Age at diagnosis ranged from 19 to 62(median 41) years and the male to female ratio was 18:9. Most cases presented as a headache or seizure and the mean duration of symptoms was 9.6 months. An ill defined, diffuse high signal intensity lesion extending two lobes or more, without a central necrotic center in T2-weighted magnetic resonance(MR) imaging was characteristic. All patients underwent histological confirmation by craniotomy(12 cases), stereotactic biopsy(14 cases) and stereotactic biopsy followed by craniotomy(1 case). External beam radiation therapy was administered in every case except two, one of which expired within a month of surgery and the other refused treatment. RESULTS: Mean survival time after diagnosis was 41.1 months. By univariate analysis, the symptom duration(lower than 12 months) and the Karnofsky performance scale at discharge(lower than 70), focal enhancement on preoperative MR imaging, postoperative increased intracranial pressure sign, pathologic grade(high grade) and p53(>5%) were correlated with the length of survival(p-values were 0.07, 0.00, 0.007, 0.001, 0.04, and 0.02 respectively). CONCLUSION: We suggest that:1) gliomatosis cerebri can be diagnosed by a combination of MR imaging and histopathological examination:2) confusion with extensive glioma is possible due to vague diagnostic criteria, and so survival might be better than expected had discrete diagnosis been made. 3) Initial active management for increased ICP and further radiation therapy might be an important therapy.
Biopsy ; Diagnosis ; Female ; Glioma ; Headache ; Humans ; Intracranial Pressure ; Magnetic Resonance Imaging ; Male ; Neoplasms, Neuroepithelial ; Retrospective Studies ; Seizures ; Survival Rate

OBJECTIVE: The purpose of this study is to review the cases of spinal plasma cell tumors treated in our department with regard to presenting symptoms and signs, diagnostic investigations, extent of surgical interventions, complications, survival time and influence on the quality of life. METHODS: In a retrospective study, twelve spinal plasma cell tumor patients who underwent surgery were evaluated between Oct. 1991 and Dec. 2000. Clinical staging system was evaluated by Durie-Salmon Staging System. RESULTS: There were multiple myeloma in nine and solitary plasmacytoma in three patients, six men and six women and aged 38 to 69 years(mean 56.8 years). The locations of the lesions were two cervical, two cervico-thoracic, three thoracic, one thoraco-lumbar, three lumbar and one sacral. The most common initial presenting symptom and sign were local pain and motor weakness. Radiographs showed pathologic compression fracture in six and the MRI finding were cortical infolding, focal to diffuse patterns of low-signal on T1WI, high signal intensity on T2WI, and variable of enhancement on Gadolinium enhanced T1W1. Sixteen operations were performed. and the adjuvant theraphy included radiotheraphy, chemotheraphy(combined oral melphalan and predinisone), and autologous PBST(peripheral blood stem cell transplantation). The follow-up period was three to sixty months(mean 27.0 months). The mean Karnofsky scale score was changed from 54.5 to 73.3 after follow up. One patient died of pulmonary metastasis and sepsis. CONCLUSION: Our experience suggests that treatment of spinal plasma cell tumor may be rewarding.
Female ; Follow-Up Studies ; Fractures, Compression ; Gadolinium ; Humans ; Karnofsky Performance Status ; Magnetic Resonance Imaging ; Male ; Melphalan ; Multiple Myeloma ; Neoplasm Metastasis ; Plasma Cells* ; Plasma* ; Plasmacytoma* ; Quality of Life ; Retrospective Studies ; Reward ; Sepsis ; Stem Cells