An 89-Year-old female patient had had a pea-sized encrusted ulcer on the vermillion border of her right upper lip for 4 years. Histopathological features of the biopsy specimen consisted of tumor islands with peripheral, palisading basaloid cells, some of which had become transformed into atypical, dyskeratotic squamous cells with ample eosinophilic cytoplasm in their centers. Total excision was advised.
Aged, 80 and over ; Biopsy ; Carcinoma, Basal Cell ; Carcinoma, Basosquamous* ; Cytoplasm ; Eosinophils ; Female ; Humans ; Islands ; Lip ; Ulcer

Epilepsy surgery in Korea began as early as in the 1940s and continued to develop through the second half of the 20th century. Introduction of neuroimaging modalities, establishment of epilepsy monitoring units and the epilepsy team approach contributed to the rapid development. �or about 300�- 400 operations carried out yearly��, t�here i��s at �prese�nt suffi���cien�t n�umb ��er of ep�ileps� y surg�ery cen�ters�� an�d q�ualifi��ed neurosurgeons in Korea. However, Korean neurosurgeons should adapt themselves to changing recent trends. Etiologies of epilepsy have dramatically changed from head trauma and infectious diseases to tumors and developmental abnormalities. Although traditional resective surgery still constitutes the main bulk of the operations, new therapeutic procedures based on neuro�modulation are emerging as alternative treatments. There should also be participation in basic science research which would leads to future innovations in treatment of epilepsy.

We describe a 23-year-old man showing typically clinical and histological features of targetoid hemosiderotic hemangioma. About 35 cases of this newly-described entity have been reported since the first description by Santa Cruz and Aronherg in 1988. It is important to distinguish these tumors from patch stage Kaposi's sarcoma, retiform hemangioendothelioma and progressive lymphangioma.
Hemangioendothelioma ; Hemangioma* ; Humans ; Lymphangioma ; Sarcoma, Kaposi ; Young Adult

BACKGROUND: Cerebral cortical dysplasia (CD) is one of the important causes of intractable epilepsies and characterized histologically by disorganized cortical lamination and cytomegalic dysplastic neurons. Although various cytoskeletal abnormalities have been found in dysplastic neurons of CD, the pathogenetic role of dysplastic neurons has rarely been investigated. METHODS: In this study, immunohistochemical analysis was performed using antibodies against non-phosphorylated high- or medium-molecular weight neurofilament protein and microtubule-associated protein 2 (MAP-2) in surgical specimens of CD. In order to know the possible relationship of dysplastic neurons with cytoskeletal abnormalities and various neurotrophin receptors, NGFR p75, trkA, trkB, and trkC immunoreactivities were also analyzed. RESULTS: Dysplastic neurons showed strong immunoreactivities for non-phosphorylated high- or medium-molecular weight neurofilament protein and MAP-2, which might reflect abnormal outgrowth and altered plasticity of the dysplastic neurons. TrkB and trkC were strongly expressed in dysplastic neurons and NGFR p75 was also strongly expressed in some dysplastic neurons. CONCLUSIONS: Since it has been known that brain-derived neurotrophic factor (BDNF) and neurotrophin-3 (NT-3) have effects on the differentiation of neuronal precursor cells from the cortex and on dendritic and axonal arborization, increased expression of trkB and trkC may play a role in cytoskeletal abnormalities and altered synaptic transmission in dysplastic neurons.
Antibodies ; Axons ; Brain-Derived Neurotrophic Factor ; Epilepsy ; Malformations of Cortical Development* ; Microtubule-Associated Proteins ; Neurons* ; Plastics ; Receptors, Nerve Growth Factor ; Synaptic Transmission

No abstract available.
Spinal Cord Diseases* ; Spinal Cord*

Brucellosis is not a rare disease, although it has not been reported recently in Korea. Spondylitis is the most prevalent and important clinical form of osteoarticular involvement in adults infected by Brucella. Concerning brucellosis, clinical diagnosis of brucellosis starts with a suspicion of the disease. Vertebral body signal changes without destructive changes, marked signal increase in the intervertebral disc on T2-weighted and contrast-enhanced sequences, soft tissue involvement without abscess formation and facet joint involvement, can be distinguishing magnetic resonance imaging(MRI) features of brucellar spondylitis. Tuberculous spondylitis, metastasis, spinal degenerative diseases, and postoperative changes Should be differentiated. We report upon the first case of brucellar spondylodiscitis in a Korean, and present review of the literature.
Abscess ; Adult ; Brucella ; Brucellosis ; Diagnosis ; Discitis* ; Humans ; Intervertebral Disc ; Korea ; Neoplasm Metastasis ; Rare Diseases ; Spondylitis ; Zygapophyseal Joint

Tumors of the lung and bronchi containing cartilage were known by a variety of names, chondroma, adenochondroma, chondromatous hamartoma and mixed tumor. This variation in nomenclatures explain the difference of illustration on the nature of these tumor. The concept pulmonary harmatomas are benign neoplasm and not developmental malformations, has gained wide acceptance in recent years. We have experienced four cases of intrapulmonary hamartoma which were all discovered during routine chest film check up for certificate of health and evaluation of other disease. One case is added further detailed histologic examination by electron microscopy. The age at time of the detection were 53 (male), 23 (male), 39 (female), and 56 (female) years old. The mean size is 4.3x3.7x3.4 cm. The locations were three left upper lobes and one right upper lobe. Lobectomy and wedge resecions were done. Cut surface showed promiment lobular structures, papillary configuration and multiple cleft like spaces. Predominant cellular components were cartilage but fat tissue in one of the four cases. Microscopic findings showed abundant hyaline cartilages bearing lobular configuration and overlying pseudostratified ciliated columnar and cuboidal epithelium. Fibromyxoid and undifferentiated cells were seen in myxoid and fatty tissue. Electron microscopic findings revealed stellate, undifferentiated mesenchymal cells bearing collagen formation, stellate smooth muscle and transition areas between undifferentiated mesenchymal cells and mature cartilage. Epithelial components were similar to terminal bronchiole and alveolar epithelium. These findings suggest the concept that intrapulmonary hamartoma represent a histologic specturm of benign mesenchymal neoplasms, which originate in peribronchial connective tissue.
Female ; Male ; Humans ; Hamartoma

We report a case of atlantoaxial subluxation with bilateral high-riding vertebral artery with narrow isthmus. Because of the potential risk of bilateral vertebral artery injury, we performed atlantoaxial fixation using rod and screw instead of transarticular screw fixation. Although postoperative computed tomography reconstruction demonstrated slight breach of bilateral vertebral artery groove, postoperative angiography showed no evidence of vertebral artery injury. Though technically demanding, atlantoaxial fixation using rod and screw can be a one of the treatment options for atlantoaxial instability with bilateral high riding vertebral artery.
Angiography ; Vertebral Artery*

More than 30% of epilepsy patients are not controlled by anti-epileptic medications. For patients having intractable epilepsy, epilepsy surgery is an effective treatment, which provides not only control of seizures but also improvement of quality of life. Epilepsy surgery can provide complete seizure control in over 60% of patients having medically intractable epilepsy. In order to identify surgical candidates, various diagnostic modalities are being used. The value of video-EEG monitoring and MR imaging study cannot be over-emphasized. For certain circumstances, other diagnostic modalities, such as PET, SPECT, and MEG, provide complementary data. If the findings from these non-invasive studies collectively indicate that the patient can benefit from surgery, surgical resection can be performed. However, if the findings do not,, invasive studies should follow. New surgical modalities for the treatment for epilepsy have been developed, including surgical resection of epileptogenic zone or lesion, disconnection of epileptogenic zone from the surrounding normal brain, and neuromodulation, such as vagal nerve stimulation, deep brain stimulation, etc. Also, newly emerging diagnostic modalities, such as high tesla MR imaging, magnetoencephalography or brain mapping technology, can help select surgical candidates more easily in the near future.
Brain ; Brain Mapping ; Deep Brain Stimulation ; Epilepsy ; Humans ; Magnetic Resonance Imaging ; Magnetoencephalography ; Quality of Life ; Seizures ; Tomography, Emission-Computed, Single-Photon ; Treatment Outcome ; Vagus Nerve Stimulation

The perioperative use of anticonvulsants in patients receiving craniotomy for various CNS diseases has been a routine practice in neurosurgery. However, there have been no unified evidence-based guidelines for the perioperative use of anticonvulsants. We searched for published studies related to this subject in MEDLINE and reviewed them. Several randomized controlled studies were regarded as more important because they could provide strong evidence. The conclusions are as follows. First, postoperative seizures are serious problems in neurosurgical practice and should be strictly controlled. Second, anticonvulsants could decrease the occurrence of postoperative seizures. Third, the therapeutic serum levels of anticonvulsants are of utmost importance in the prevention of postoperative seizures. Fourth, valproic acid has no advantage over phenytoin in the prevention of postoperative seizures.
Anticonvulsants* ; Central Nervous System Diseases ; Craniotomy ; Humans ; Neurosurgery* ; Phenytoin ; Seizures ; Valproic Acid