The orbitll sparganosis is an extremely rare disease which clinical signes were similar to orbital-cellulitia. Authors reported a case of sparganosis which a 59 years old Korean man complained swellina of lid, chemosis and dull ocular pain in the right eye for 5 months. On eye examination, the visual acuity was 0.5 in the right eye and 0.8 in the left which was incorrectable because of bilateral senile cataract. The left eye had no other anomalities. The right eye was markedly chemotic and restricted ocular motility in the 6 cardinal directions but no exophthalmos. There was a soft elevated and mobile nodule subconjunctivally on the upper portion of the globe and the other nodule was palpated along lower orbital margin. Roentgenologic findings showed diffuse increased radiopaque density but no bony changes in the orbit. Chest and skull x-ray were normal. In the laboratory findings, eosinophilia showed in CBC, hookworm, trichuris T., and T. orientalis in stool examination and positive skin test in Paragonimus westermani and Clonorchis sinensis. On the 3rd, Sep., 1971, we found 4 spargana on surgical exploration of which sizes were approximately 8.5, 9.5, 5.0, and 3.6 cm. in length. A sparganum in upper portion freely stirred sluggishIy in the subconjunctiva but the other 3 in the lower orbital portion were found in the seperated long cysts. The cystic tissue showed nonspecific chronic inflammatory reaction in pathological examination. The infected source was suggested to a history of having taken raw flesh of snake about 30 years ago. Orbital signs were much regressed 15 days later after operation.
Ancylostomatoidea ; Cataract ; Clonorchis sinensis ; Eosinophilia ; Exophthalmos ; Humans ; Middle Aged ; Orbit ; Paragonimus westermani ; Rare Diseases ; Skin Tests ; Skull ; Snakes ; Sparganosis* ; Sparganum ; Thorax ; Trichuris ; Visual Acuity

The orbitll sparganosis is an extremely rare disease which clinical signes were similar to orbital-cellulitia. Authors reported a case of sparganosis which a 59 years old Korean man complained swellina of lid, chemosis and dull ocular pain in the right eye for 5 months. On eye examination, the visual acuity was 0.5 in the right eye and 0.8 in the left which was incorrectable because of bilateral senile cataract. The left eye had no other anomalities. The right eye was markedly chemotic and restricted ocular motility in the 6 cardinal directions but no exophthalmos. There was a soft elevated and mobile nodule subconjunctivally on the upper portion of the globe and the other nodule was palpated along lower orbital margin. Roentgenologic findings showed diffuse increased radiopaque density but no bony changes in the orbit. Chest and skull x-ray were normal. In the laboratory findings, eosinophilia showed in CBC, hookworm, trichuris T., and T. orientalis in stool examination and positive skin test in Paragonimus westermani and Clonorchis sinensis. On the 3rd, Sep., 1971, we found 4 spargana on surgical exploration of which sizes were approximately 8.5, 9.5, 5.0, and 3.6 cm. in length. A sparganum in upper portion freely stirred sluggishIy in the subconjunctiva but the other 3 in the lower orbital portion were found in the seperated long cysts. The cystic tissue showed nonspecific chronic inflammatory reaction in pathological examination. The infected source was suggested to a history of having taken raw flesh of snake about 30 years ago. Orbital signs were much regressed 15 days later after operation.
Ancylostomatoidea ; Cataract ; Clonorchis sinensis ; Eosinophilia ; Exophthalmos ; Humans ; Middle Aged ; Orbit ; Paragonimus westermani ; Rare Diseases ; Skin Tests ; Skull ; Snakes ; Sparganosis* ; Sparganum ; Thorax ; Trichuris ; Visual Acuity

The authors presented a case of Goldenhar's Syndrome which was shown the following findings, such as epibulbar dermoid, bilateral colobomas of upper eye lids, pretragal blind fistulas, preauricular appendages, skin tags, lacrimal fistula, persistant pupillary membrane, myopia and alopecia atropicans with bulae.
Alopecia ; Coloboma ; Dermoid Cyst ; Fistula ; Membranes ; Myopia ; Skin

Neuroimaging of the brain is useful diagnostic evaluation of patients with hepatic encephalopathy msofar as it is able to exclude other causes of abno rmal mental status. Recently, changes of basal ganglia on MRI characteriwd by increased signal mtensity on Tl-weighted images were reported m patients with liver cirrhosis. Signal abnormality involves mainly the globus pallidus and seems to be specific for patients with chronic liver disease. Its pathogenesis and significance are obscure, and no pathological reports have been made. We experienced 3 cases of Chronic acquired hepatic failure whose MRI showed increased signal in-tensity in the basal ganglia on Tl-weighted imaging. Our findings su-ggest that basal ganglia signal abnormality could arise as a marker of brain impairment related to deposition of an unidentified paramagnetic substance or altered intracellular water relaxation.
Basal Ganglia ; Brain ; Globus Pallidus ; Hepatic Encephalopathy ; Humans ; Liver Cirrhosis ; Liver Diseases ; Liver Failure* ; Magnetic Resonance Imaging ; Neuroimaging ; Relaxation

BACKGROUND: A randomized trial of unruptured brain arteriovenous malformations (ARUBA) reported superior outcomes in conservative management compared to interventional treatment. There were numerous limitations to the study. This study aimed to investigate the efficacy of gamma knife radiosurgery (GKS) for patients with brain arteriovenous malformations (AVMs) by comparing its outcomes to those of the ARUBA study. METHODS: We retrospectively reviewed ARUBA-eligible patients treated with GKS from June 2002 to September 2017 and compared against those in the ARUBA study. AVM obliteration and hemorrhage rates, and clinical outcomes following GKS were also evaluated. RESULTS: The ARUBA-eligible cohort comprised 264 patients. The Spetzler-Martin grade was Grade I to II in 52.7% and III to IV in 47.3% of the patients. The mean AVM nidus volume, marginal dose, and follow-up period were 4.8 cm³, 20.8 Gy, and 55.5 months, respectively. AVM obliteration was achieved in 62.1%. The annual hemorrhage rate after GKS was 3.4%. A stroke or death occurred in 14.0%. The overall stroke or death rate of the ARUBA-eligible cohort was significantly lower than that of the interventional arm of the ARUBA study (P < 0.001) and did not significantly differ from that of the medical arm in the ARUBA study (P = 0.601). CONCLUSION: GKS was shown to achieve a favorable outcome with low procedure-related morbidity in majority of the ARUBA-eligible patients. The outcome after GKS in our patients was not inferior to that of medical care alone in the ARUBA study. It is suggested that GKS is rather superior to medical care considering the short follow-up duration of the ARUBA study.
Arm ; Arteriovenous Malformations ; Brain ; Cohort Studies ; Follow-Up Studies ; Hemorrhage ; Humans ; Intracranial Hemorrhages ; Mortality ; Netherlands ; Radiosurgery ; Retrospective Studies ; Stroke

Intracranial aneurysmal rupture causes subarachnoid hemorrhage which usually leads to fatality or severe disability. Treatment of unruptured intracranial aneurysms (UIAs) can substantially reduce the risk of rupture and prevent the grave consequences, but the risk of prophylactic treatment cannot be ignored. UIAs have diverse characteristics and management strategy needs to be tailored according to their location, size and clinical status. In the absence of level I evidence, the treatment guidance often relied on expert's opinions and experience. Knowledge of the natural course and management risks of individual aneurysms can help to guide treatment decision, but the natural history is still controversial and risks are not clearly defined. The Korean Society of Cerebrovascular Surgeons (KSCVS) decided to issue a Korean version of UIA management guideline as a framework for the treatment decision and as a basis for future studies, following 'Guideline Development Manual' of the Clinical Research Center for Stroke (CRCS). The organized committee systematically reviewed relevant literature and major guidelines published between January 2000 and July 2010 and took a developmental strategy of adaptation rather than de novo methods. On the basis of interpretation of the published evidences, recommendations were synthesized, and the level of evidence and the grade of recommendation were determined using the methods adapted from those of the US Agency for Healthcare Policy and Research and CRCS. The current guideline focuses on three domains of natural history, diagnosis and treatment of UIAs. The hierarchy of evidence and the recommendation grading indicate the current level by the literature and do not indicate the necessity or the prohibition of a certain clinical practice. Accordingly, this guideline cannot provide the answer for every clinical situation and should not take precedence over the clinical judgment of responsible physicians for individual patients. The final judgment regarding the care of a particular patient must be made by the physician and patient in light of circumstances specific to that patient. This is the first version of the UIA management guideline in Korea and new evidences will be timely and continuously updated in the future guidelines.
Aneurysm ; Calcium Hydroxide ; Delivery of Health Care ; Humans ; Intracranial Aneurysm ; Judgment ; Korea ; Light ; Natural History ; Risk Management ; Rupture ; Stroke ; Subarachnoid Hemorrhage ; Zinc Oxide

PURPOSE: Primary CNS lymphoma(PCNSL) is a rare brain tumor which has poor prognosis. It is sensitive to steroid or radiation therapy(RT), but the effect is transient. Recently, many centers have tried to increase survival rate and to lower recurrence rate by combined chemotherapy. Aim of this study is to investigate the response rate, performance status change and complications after combined modality treatment in our patients with PCNSL. PATIENTS AND METHODS:Fifteen consecutive PCNSL patients were included in this study. There was no immune compromized patient. All patients underwent pre-radiation systemic MTX, 1g/m 2, plus 6 doses of intrathecal MTX at 12mg per dose. Cranial RT(WBRT 40Gy, Boost 14.4Gy) was followed by two cycles of intravenous infusion of high dose cytarabine(Ara-C). We reviewed medical records, radiologic findings for evaluation of response and performance status. RESULTS: Seven patients completed this protocol. Response rate(CR + PR/total) after radiation and after completion of combined modality were 80% and 87%, respectively. No patients showed the decrease in performance status 20 more than pre-treatment status during treatment. Four CSF cytology positive patients had undergone all negative conversion after completion of intrathecal MTX chemotherapy. CONCLUSION: The addition of chemotherapy to cranial RT for initial treatment of PCNSL had favorable response rate, CSF cytology negative conversion rate, and maintaining performance status. But, we also have observed treatment failure including life threatening compications and non-responder. Therfore, careful monitoring of medical status should warranted and neuropsychological functions should also be evaluated.
Brain Neoplasms ; Central Nervous System* ; Cytarabine* ; Cytosine* ; Drug Therapy* ; Humans ; Infusions, Intravenous ; Lymphoma* ; Medical Records ; Methotrexate* ; Prognosis ; Recurrence ; Survival Rate ; Treatment Failure

OBJECTIVE: For lumbar spondylolisthesis, various spinal operation methods have been used to relieve clinical symptoms and to stabilize the spine. To determine the effectiveness of the lumbar interbody metal cages and pedicle screw fixation in patients with spondylolisthesis, the authors retrospectively reviewed 70 patients under-going surgery, and also analyzed the relationship between post-operative clinical improvement and bony fusion, postoperative reduction, as well as transitional vertebrae. METHODS: The authors performed the lumbar interbody metal cages and pedicle screw fixation in 70 consecutive patients suffering from spondylolisthesis between November 1994 and December 1997. Follow-up averaged 18 months(range, 3 to 39 months). The post-operative clinical outcome was expressed as good, fair, or poor. The bony fusion was determined by post-operative simple X-ray films. RESULTS: Of 70 patients with clinical, radiologically unstable spondylolisthesis, the clinical results were good and fair in 92% of the patients, and radiological bony fusion were occurred in 86%. There was the significant relationship between clinical improvement and bony fusion. But there was no significant relationship between clinical improvement and post-operative reduction as well as transitional vertebrae. The post-operative complications occurred in 4% of patients and reoperation was required in 1 patient. CONCLUSION: This study demonstrates that the lumbar interbody cage with pedicle screw fixation is the effective operation method in the treatment of spondylolisthesis, though it demands more difficulties technically.
Follow-Up Studies ; Humans ; Reoperation ; Retrospective Studies ; Spine ; Spondylolisthesis* ; X-Ray Film

Endoscopic surgery opened new fields in pituitary tumor surgery, not only by direct endonasal access, but also by affording a panoramic view inside the sphenoidal sinus and the sellar turcica. It provides an extremely sharp image with high resolution. We describe our initial experience in using the endonasal endoscopy for the pituitary tumor surgery. Seven operations were performed by the endonasal endoscopy. The endoclinologic diagnosis were prolactinoma in four cases and GH secreating adenoma in three. Four cases were macroadenoma and three were microadenoma. Among the three patients with GH secreting adenomas, two improved clinically with normal serum GH level, one improved clinically with elevated serum GH levels postoperatively. Of the four patients with prolactinomas, all four improved clinically elevated with serum prolactin levels. Two patients developed postoperative complications; one was transient cerebrospinal fluid(CSF) leakage and the other was transient diabetes insipedus(DI). The use of the endoscope allowed close inspection of sella and parasellar structures as well as differentiation between tumor tissue and normal pituitary gland. Gross total removal was possible with the help of angled view of the telescope even in the cases of moderate supra-and parasellar extensions. Although from short and early experience, endoscopic endonasal approach seems to be a valuable and safe procedure for removing pituitary adenomas. With improved techniques and an accumulation in operative experience, endoscopic pituitary surgery will gain in importance and present new horizons in pituitary surgery.
Adenoma ; Diagnosis ; Endoscopes ; Endoscopy ; Humans ; Pituitary Gland ; Pituitary Neoplasms* ; Postoperative Complications ; Prolactin ; Prolactinoma ; Telescopes

The best treatment modality for spontaneous intracerebral hemorrhage still remains to be controversial. Stereotactic surgery can be performed safely and easily but its indication and optimal timing of operation have to be determined. We treated 80 patients with spontaneous intracerebral hemorrhage by stereotactic surgery from October 1994 to December 1997. We investigated clinical status of the patients before and after surgery, amount of hematoma, evacuation rate, timing of operation, transcranial Doppler sonography(TCD), and computerized tomography(CT) findings. The results were as follows: 1) The outcome of early surgery(within 24 hours of bleeding) was better than that of late surgery(after 24 hours of bleeding)(p=0.034). 2) The outcome was better in the patient with higher evacuation rate(p=0.014). 3) TCD monitoring showed beneficial effect of surgery on hemodynamic status. We conclude that the early surgery within 24 hours after bleeding is correlated with the better outcome, and TCD monitoring is useful for evaluation of perioperative hemodynamic change.
Cerebral Hemorrhage* ; Hematoma ; Hemodynamics ; Hemorrhage ; Humans