Carboplatin intra-arterial chemotherapy(IAC) has an advantage of increased uptake during the first passage of the drugs through tumor capillaries. Although not common, this type of therapy is known to cause neurological complications, myelosuppression, and ototoxicity. However, the incidence of ocular toxicity is reported to be rare. Eleven of our patients with glioma(Grade II Astrocytoma: 3, Grade III Astrocytoma: 1, Grade IV Astrocytoma: 5, Gliofibroma: 1, Oligodendroglioma: 1) underwent IAC regimen with carboplatin(300mg/m2) which were administrated after blood-brain barrier disruption. Of there, 3 patients had ocular complications after supra-ophthalmic IAC injection of carboplatin but fully recovered following steroid therapy. Although our results from IAC seem to be favorable for these patients, we suggest that its complications, such as ocular toxicity, need to be carefully considered prior to treatment.
Astrocytoma ; Blood-Brain Barrier ; Capillaries ; Carboplatin* ; Glioblastoma ; Glioma* ; Humans ; Incidence ; Oligodendroglioma

OBJECTIVE: To assess the clinical and radiological factors as predictors for successful outcomes in lumbar disc herniation (LDH) treatment. METHODS: Two groups of patients with single level LDH (L4–5) requiring treatment were retrospectively studied. The surgery group (SG) included 34 patients, and 30 patients who initially refused the surgery were included in the nerve blocks group (NG). A visual analogue scale (VAS) for leg and back pain and motor deficit were initially evaluated before procedures, and repeated at 1, 6, and 12 months. Radiological factors including the disc herniation length, disc herniation area, canal length-occupying ratio, and canal area-occupying ratio were measured and compared. Predicting factors of successful outcomes were determined with multivariate logistic regression analysis after the optimal cut off values were established with a receiver operating characteristic curve. RESULTS: There was no significant demographic difference between two groups. A multivariate logistic regression analysis with radiological and clinical (12 months follow-up) data revealed that the high disc herniation length with cutoff value 6.31 mm [odds ratio (OR) 2.35; confidence interval (CI) 1.21–3.98] was a predictor of successful outcomes of leg pain relief in the SG. The low disc herniation length with cutoff value 6.23 mm (OR 0.05; CI 0.003–0.89) and high baseline VAS leg (OR 12.63; CI 1.64–97.45) were identified as predictors of successful outcomes of leg pain relief in the NG. CONCLUSION: The patients with the disc herniation length larger than 6.31 mm showed successful outcomes with surgery whereas the patients with the disc herniation length less than 6.23 mm showed successful outcomes with nerve block. These results could be considered as a radiological criteria in choosing optimal treatment options for LDH.
Back Pain ; Humans ; Leg ; Logistic Models ; Nerve Block* ; Retrospective Studies ; ROC Curve

OBJECTIVE: Radiation therapy is an important treatment for brain tumor. However, serious complications such as radiation necrosis can occur and it may be secondary to the expression of acute phase genes, like cytokines. In particular, inflammatory cytokines (IL-1beta, TNF-alpha) and other immunomodulatory cytokines (TNF-alpha, TGF-beta1) might be changed after irradiation (high single dose irradiation). Although it has been reported that IL-1 level is remarkably elevated within 8 week after the irradiation to the rat brain, the change of cytokines levels at acute phase (within 24 hours) has not been reported. In the present study, we examined TNF-alpha, TGF-beta1, and IL-1beta levels in acute phase to clarify the early effect of cytokines on the radiation-induced brain damage. METHODS: Fifty Sprague-Dawley rats were used and these were divided into irradiation group and control group. After a burr-hole trephination on the right parietal area using a drill, a single 10 Gy was irradiated at the trephined site. Their forebrains were extirpated at 30 min, 2 hr, 8 hr, 12 hr and 24 hr, respectively and examined for the expression of TNF-alpha, TGF-beta1 and IL-1beta. RESULTS: The expression of TNF-alpha and TGF-beta1 were decreased until 12 hr after irradiation but elevated thereafter. The expression of IL-1 was peak at 8 hr and then decreased until 12 hr but elevated after this time window. The present study indicated that expression of cytokines (TNF-alpha, TGF-beta1 and IL-1beta) were increased at 24 hr after the irradiation to the rat brain. IL-1beta level, on the other hand, reached peak at 8 hr after radiation injury. CONCLUSION: These findings indicate that IL-1, among various cytokines, may have a more important role in the inflammatory reaction by radiation injury at acute phase and provide some clues for better understanding of the pathogenesis of radiation injury.
Animals ; Brain Injuries ; Brain Neoplasms ; Brain* ; Cytokines* ; Hand ; Interleukin-1 ; Necrosis ; Prosencephalon ; Rabeprazole ; Radiation Injuries ; Rats ; Rats, Sprague-Dawley ; Transforming Growth Factor beta1 ; Trephining ; Tumor Necrosis Factor-alpha

OBJECTIVE: Radiation therapy is an important treatment for brain tumor. However, serious complications such as radiation necrosis can occur and it may be secondary to the expression of acute phase genes, like cytokines. In particular, inflammatory cytokines (IL-1beta, TNF-alpha) and other immunomodulatory cytokines (TNF-alpha, TGF-beta1) might be changed after irradiation (high single dose irradiation). Although it has been reported that IL-1 level is remarkably elevated within 8 week after the irradiation to the rat brain, the change of cytokines levels at acute phase (within 24 hours) has not been reported. In the present study, we examined TNF-alpha, TGF-beta1, and IL-1beta levels in acute phase to clarify the early effect of cytokines on the radiation-induced brain damage. METHODS: Fifty Sprague-Dawley rats were used and these were divided into irradiation group and control group. After a burr-hole trephination on the right parietal area using a drill, a single 10 Gy was irradiated at the trephined site. Their forebrains were extirpated at 30 min, 2 hr, 8 hr, 12 hr and 24 hr, respectively and examined for the expression of TNF-alpha, TGF-beta1 and IL-1beta. RESULTS: The expression of TNF-alpha and TGF-beta1 were decreased until 12 hr after irradiation but elevated thereafter. The expression of IL-1 was peak at 8 hr and then decreased until 12 hr but elevated after this time window. The present study indicated that expression of cytokines (TNF-alpha, TGF-beta1 and IL-1beta) were increased at 24 hr after the irradiation to the rat brain. IL-1beta level, on the other hand, reached peak at 8 hr after radiation injury. CONCLUSION: These findings indicate that IL-1, among various cytokines, may have a more important role in the inflammatory reaction by radiation injury at acute phase and provide some clues for better understanding of the pathogenesis of radiation injury.
Animals ; Brain Injuries ; Brain Neoplasms ; Brain* ; Cytokines* ; Hand ; Interleukin-1 ; Necrosis ; Prosencephalon ; Rabeprazole ; Radiation Injuries ; Rats ; Rats, Sprague-Dawley ; Transforming Growth Factor beta1 ; Trephining ; Tumor Necrosis Factor-alpha

Kyphoscoliosis is a disease manifested as lateral curvature of spine and accompanying rotation of the vertebrae, resulting in distortion of rib cage. A curve greater than 40 degrees in considerd to be severe and most likely to be associated with physiologic derangements in cardiac and pulmonary function. Restrictive lung disease and pulmonary hypertension progressing to cor pulmonale are the major causes of mortality in patients with kyphoscoliosis. However, pregnancy itself increases cardiac output and circulating blood volume, and decreases total lung capacity due to enlarged uterus. So tidal volume is increased in pregnant women to compensate. But in kyphoscoliosis patients pulmonary fucntion is already impaired and cardiovascular reserve is minimal. So there is increasing tendency in actue cor pulmonale. Recently we experienced a case of cesarean section in patient with kyphoscoliosis, and observed severe hemodynamic changes especially in pulmonary capillary wedge pressure and cardiac output. And we investigated 7 cases of cesarean section of patients with kyposcoliosis.
Anesthesia* ; Blood Volume ; Cardiac Output ; Cesarean Section* ; Female ; Hemodynamics* ; Humans ; Hypertension, Pulmonary ; Lung Diseases ; Mortality ; Pregnancy ; Pregnant Women ; Pulmonary Heart Disease ; Pulmonary Wedge Pressure ; Ribs ; Spine ; Tidal Volume ; Total Lung Capacity ; Uterus

Currently, Korea is a low endemicity country for HAV, especially in children. However, recent reports of hepatitis A outbreaks show that there has been a shift of disease incidence to adolescents and young adults, with 2 cases of acute liver failure in one reported outbreak. We need to study the immune status for HAV in order to provide information for the establishment of preventive measures and possible consequences of HAV in Korea. A total of 334 infants, children and adolescents less than 20 years of age living in rural areas of Kyonggi Province, Korea were evaluated for anti-HAV immune status in 1996. Five hundred and eighty-four primary school children living in the same area were separately evaluated for the natural seroconversion rate between 1993 and follow-up samples taken in 1996. Anti-HAV IgG antibody was measured by enzyme immunoassay (HAVAB EIA kit, Abbott Laboratories, Chicago, Illinois, USA). In comparison with previous reports of seroprevalence rates, our data confirmed a dramatic drop in seroprevalence rates among children and adolescents under 20 years of age living in rural areas, from over 63.8% two decades ago to 4.6% in 1996. Natural acquisition of HAV antibody in primary school children rarely occurs, registering only 0.5% during three years. Several outbreaks in young adults during 1996-1998 suggested that immunity against HAV in this population is so low that massive outbreaks are unavoidable. Teenagers and young adults, especially soldiers, who are likely to be exposed to contaminated food or water, would also have a greater risk of hepatitis A. Immunizing children with HAV vaccine as a routine schedule should also be considered in Korea in the future, particularly if the disease burden could be estimated and the cost-effectiveness of the vaccine could be proved.
Adolescence ; Adult ; Age Distribution ; Child ; Child, Preschool ; Female ; Hepatitis A/prevention & control* ; Hepatitis A/epidemiology* ; Hepatitis A Vaccines ; Human ; Immunization* ; Infant ; Korea ; Male ; Prevalence ; Sex Distribution ; Viral Hepatitis Vaccines/therapeutic use*

The sacral spinal epidural space is an uncommon site for primary malignant lymphomas, presenting with symptoms associated with cauda equina compression. Especially, lumbo-sacral epidural lymphoma has been reported to be very rare. We present a rare case of 29-year-old male with sacral spinal epidural malignant lymphoma. The patient complained of tingling sensation in his buttocks that was radiating to his calf. The neurological examination was normal. Magnetic resonance imaging (MRI) with contrast showed a well-defined extradural mass lesion at the mid L5 to mid S2 level. The lesion was iso- to hypointense on T1 and T2 weighted images and showed homogenous enhancement and a focal enhancement in the L5 vertebral body on post-contrast images. The patient underwent a L5-S2 laminectomy and subtotal excision of the lesion. Intra-operatively, the lesion was extradural and not densely adherent to the dura; the lesion was friable, not firm, fleshy, brownish and hypervascular. The histologic diagnosis was grade 2 non-Hodgkin's follicular lymphoma. Even though the primary spinal epidural non-Hodgkin's lymphoma is a very rare disease, clinicians should take it into consideration in the differential diagnosis of patients with spinal epidural tumor.
Adult ; Buttocks ; Cauda Equina ; Diagnosis ; Diagnosis, Differential ; Epidural Neoplasms ; Epidural Space* ; Humans ; Laminectomy ; Lymphoma* ; Lymphoma, Follicular ; Lymphoma, Non-Hodgkin ; Magnetic Resonance Imaging ; Male ; Neurologic Examination ; Rare Diseases ; Sensation

OBJECTIVE: We compared the clinical and radiographic outcomes of stand-alone polyetheretherketone (PEEK) cage and Zero-Profile anchored spacer (Zero-P) for single level anterior cervical discectomy and fusion (ACDF). METHODS: We retrospectively reviewed 121 patients who underwent single level ACDF within 2 years (Jan 2011-Jan 2013) in a single institute. Total 50 patients were included for the analysis who were evaluated more than 2-year follow-up. Twenty-nine patients were allocated to the cage group (m : f=19 : 10) and 21 for Zero-P group (m : f=12 : 9). Clinical (neck disability index, visual analogue scale arm and neck) and radiographic (Cobb angle-segmental and global cervical, disc height, vertebral height) assessments were followed at pre-operative, immediate post-operative, post-3, 6, 12, and 24 month periods. RESULTS: Demographic features and the clinical outcome showed no difference between two groups. The change between final follow-up (24 months) and immediate post-op of Cobb-segmental angle (p=0.027), disc height (p=0.002), vertebral body height (p=0.033) showed statistically better outcome for the Zero-P group than the cage group, respectively. CONCLUSION: The Zero-Profile anchored spacer has some advantage after cage for maintaining segmental lordosis and lowering subsidence rate after single level anterior cervical discectomy and fusion.
Animals ; Arm ; Body Height ; Diskectomy* ; Follow-Up Studies ; Humans ; Kyphosis ; Lordosis ; Retrospective Studies

OBJECTIVE: The aim of this study is to analyze on the external ventricular drainage (EVD) related ventriculitis, especially on their risk factors, management, and prevention. METHODS: From January 2003 to December 2005, a total of 174 EVD catheters were placed in 112 patients at our institution. Of these patients, EVD-related ventriculitis were developed in 15 cases. Clinical variables such as age, sex, prior clinical diagnosis, placement of EVD insertion, duration of EVD, total numbers of EVD per person, and outcome were analyzed in theses cases to verify the risk factors, causative agents and outcomes. RESULTS: Fifteen cases of EVD related ventriculitis were noted presenting infection incidence of 13.39 % per patient and 8.62% per procedure. Of these, five patients died from sepsis, seven patients were recovered from infection but neurological complications remained and three patients were recovered without any complications. Microbes were obtained from cerebrospinal fluid only in six patients. Acinetobactoer baumanii was the most common pathogen in our study (4 cases). Among the various risk factors, only the prior clinical diagnosis showed the statistical significance. Patients who underwent decompressive craniectomy after severe brain trauma showed unfavorable outcome because of possible contaminative environment compared with other cases. CONCLUSION: EVD is considered as a safe procedure with good control of intracranial pressure if meticulous care is provided for EVD procedure and maintenance. With regards to risk factors and prevention, the higher incidence and unfavorable outcome was seen especially in patients with severe head trauma. Thus, special attention is required in these clinical settings.
Brain Injuries ; Catheters ; Cerebrospinal Fluid ; Craniocerebral Trauma ; Decompressive Craniectomy ; Diagnosis ; Drainage* ; Humans ; Incidence ; Intracranial Pressure ; Risk Factors ; Sepsis

The purpose of the present study was to assess the clinical efficacy of radiofrequency (RF) cervical zygapophyseal joint neurotomy in patients with cervicogenic headache. A total of thirty consecutive patients suffering from chronic cervicogenic headaches for longer than 6 months and showing a pain relief by greater than 50% from diagnostic/prognostic blocks were included in the study. These patients were treated with RF neurotomy of the cervical zygapophyseal joints and were subsequently assessed at 1 week, 1 month, 6 months, and at 12 months following the treatment. The results of this study showed that RF neurotomy of the cervical zygapophyseal joints significantly reduced the headache severity in 22 patients (73.3%) at 12 months after the treatment. In conclusion, RF cervical zygapophyseal joint neurotomy has shown to provide substantial pain relief in patients with chronic cervicogenic headache when carefully selected.
Zygapophyseal Joint/*innervation/*surgery ; Treatment Outcome ; Spinal Nerves/*surgery ; Post-Traumatic Headache/diagnosis/*surgery ; Pain Measurement ; Middle Aged ; Male ; Humans ; Female ; Denervation/*methods ; Catheter Ablation/*methods