It should be stressed that intracranial tumors in childhood are common. If the leukemia are excluded, intracranial neoplasms are the relatively common type of neoplasms seen in childhood. There are many different kinds of tumor which occur within the cranial cavity. These different tumors grow at different rates of speed and the diversity of location is sufficient so that there is a broad spectrum of different clinical syndromes. However, it is important to recognize the earliest symptoms because of the possibility of operable management and high cure rate on some cases. The author analyzed 58 cases of intracranial neoplasm which were histologically confirmed after operation and autopsy, seen at the Department of Neurosurgery, Jung-Ang University, Sung-Sim Hospital and National Medical Center over the recent several years. These tumors were explored surgically and the diagnosis was made through histological examination. The cases were reviewed as to history, development and progression of the neurological features, laboratory findings, neuroradiological findings, operative methods and pathology. The author emphasized some interesting points and the following were presented here-in as the results. 1) Among 58 cases of intracranial neoplasms in Korean children below 15 years old, the most common tumor was astrocytoma(36%), and the next common tumors were craniopharyngioma(15.5%), ependymoma(12%), and medulloblastoma(10.3%) in that orders. It was interesting that 3 cases of tuberculomas were found in recent three years(1975-1977) and all were located in the cerebellum. A 5 years old boy who was operated for 4 th. Ventricle medulloblastoma confirmed by clinicopathological finding, had another tumor, craniopharyngioma which was found at the postmortem examination. 2) The tumors were occupied on the infratentorial region in 30(5.7%) cases and supratentorial region in 28(48.3%) cases. The most frequent tumor in supratentorial region was craniopharyngioma and in infratentorial region was cerebellar astrocytoma. And the glioma and medulloblatoma were common in turn. 3) Fifty eight cases comprised 36 males and 22 females with a ratio of 1.5 to 1. The age ranged from 5 months old to 15 years old with the peak in the incidence between 5-11 years of age. 4) The main clinical symptoms and signs were headache(84.5%), vomiting(77.6%), papilledema(67.2%), and cranial nerve dysfunction(62%). It was interesting points that neck stiffness(27.6%) and abdominal pain(15.5%) were frequent complaints which should not overlook for the symptoms of simple gastritis or tuberculous meningitis. 5) The results of operative management obtained as follows with excellent in 4, good in 8, fair in 13, and poor in 9 cases. The overall mortality rare was 41% and recurrence rate was 14% during 5 years follow up.
Adolescent ; Astrocytoma ; Autopsy ; Brain Neoplasms ; Cerebellum ; Child* ; Child, Preschool ; Cranial Nerves ; Craniopharyngioma ; Diagnosis ; Female ; Follow-Up Studies ; Gastritis ; Glioma ; Humans ; Incidence ; Infant ; Leukemia ; Male ; Medulloblastoma ; Mortality ; Neck ; Neurosurgery ; Pathology ; Recurrence ; Tuberculoma ; Tuberculosis, Meningeal

Sacral schwannoma is a rare lesion with a tendency to reach large proportions. The authors report a case of giant intrasacral schwannoma in a 49-year-old man who had persistent lumbago and sciatica over 15 years period. Plain spine X-ray revealed destruction of the sacrum and myelogram demonstrated a complete ampu-tation of the lumbosacral cul-de-sac at the L5/S1 level. CT and MRI showed a destructive mass lesion within the upper part of sacrum with a large mass extending into the presacral space. The patient underwent su rgery consisted of posterior lumbosacral laminectomy and subtotal removal of tumor. Pathologic examination revealed a benign schwannoma. The patient returned to work 1 month postoperatively with improvement of symptoms. Characteristics of this case with a pe rtinent literature are reviewed.
Humans ; Laminectomy ; Low Back Pain ; Magnetic Resonance Imaging ; Middle Aged ; Neurilemmoma* ; Sacrum ; Sciatica ; Spine

Agenerally accepted consensus of end-of-life (EOL) care decision-making did not appear in Korean medical society until the year 2009. To enhance physician's ethical perception of EOL care, consensus guidelines to withdrawing life-sustaining therapies endorsed by Korean Medical Association, Korean Academy of Medical Science, and Korean Hospital Association, were published on October 13, 2009. In this article, the characteristics and issues with the guidelines are presented to improve understanding by physicians who interact with EOL patients. According to the guidelines, physicians should identify, document, respect, and act on hospitals inpatients' needs, priorities, and preferences for EOL care. The guidelines advocate that competent patients express their right of self-determination in EOL care decisions through advance directives. However, there are barriers to adopting advance directives as a legitimate tool of EOL decision-making in our current society. The guidelines stressed the importance of open communication between care-givers and patients or their surrogates. Through communication, physicians can create a plan regarding how to manage EOL until the patients' last day of life. Concerted actions among the general public, professionals, other stake-holders for EOL care, and governmental organizations to improve EOL care in our society are also stipulated. Physicians, who know the clinical meaning of the treatments available to EOL patients, should play a central role based on the consensus guidelines to help patients and their families make informed decisions about EOL care.
Advance Directives ; Consensus ; Humans ; Societies, Medical

The traumatic intracranial aneurysm within the posterior cranial fossa is extremely rare. The case of a 18-year-old boy who developed an saccular aneurysm lately in the posterior fossa after a blunt head injury is reported. Repeated follow-up angiography demonstrated an saccular aneurysm at the junction of vertebral artery and posterior inferior cerebellar artery. Early brain MRI disclosed neither aneurysm nor mass. Late brain MRI revealed a partially thrombosed saccular aneurysm at the cerebello pontine angle. Follow-up MRI and angiography is recommended if traumatic aneurysm is suspected.
Adolescent ; Aneurysm* ; Angiography ; Arteries ; Brain ; Cranial Fossa, Posterior* ; Follow-Up Studies ; Head Injuries, Closed ; Humans ; Intracranial Aneurysm ; Magnetic Resonance Imaging ; Male ; Vertebral Artery

Background: In 2015, the Korean Atopic Dermatitis Association (KADA) working group published consensus guidelines for treating atopic dermatitis (AD). Objective: We aimed to provide updated consensus recommendations for systemic treatment of AD in South Korea based on recent evidence and experience. Methods: We compiled a database of references from relevant systematic reviews and guidelines on the systemic management of AD. Evidence for each statement was graded and classified based on thestrength of the recommendation. Forty-two council members from the KADA participated in three rounds of voting to establish a consensus on expert recommendations. Results: We do not recommend long-term treatment with systemic steroids forpatients with moderate-to-severe AD due to the risk of adverse effects. We recommend treatment with cyclosporine or dupilumab and selective treatment with methotrexate or azathioprine for patients with moderate-to-severe AD. We suggest treatment with antihistamines as an option for alleviating clinical symptoms of AD. We recommend selective treatment with narrowband ultraviolet B for patients with chronic moderate-to-severe AD. We do not recommend treatment with oral antibiotics for patients with moderate-to-severe AD but who have no signs of infection. We did not reach a consensus on recommendations for treatment with allergen-specific immunotherapy, probiotics, evening primrose oil, orvitamin D for patients with moderate-to-severe AD. We also recommend educational interventions and counselling for patients with AD and caregivers to improve the treatment success rate. Conclusion We look forward to implementing a new and updated consensus of systemic therapy in controlling patients with moderate-to-severe AD.