Pulmonary Aspergillomas usually arise from proliferation of Aspergillus in preexisting parenchymal cavities.202 college students (99 men, 103 women) aged 18% 26 years. Fasting blood samples were. The most common symptom in this disorder is hemoptysis, which may be minimal in amount or it may be massive & life threatening. The optimum therapy for pulmonary aspergilloma is controversial. The major options available include surgical resection of the lesion, a number of medical therapies, or simple observation of the patient for a time. Surgery is the most effective treatment but it is limited to some patient because most patients haute underlying pulmonary disease. Thus the various form of medical therapy was available with successful result. The authors present a case of percutaneous intracavitary amphoterician B injection for the treatment of pulmonary aspergilloma & its successful effect for the repetitive hemoptysis.
Amphotericin B* ; Aspergillus ; Fasting ; Hemoptysis* ; Humans ; Lung Diseases ; Male

Authors analyzed the post-operative subdural hygroma using radioisotope(RI) cisternography in 30 cases following aneurysmal surgery with pterional approach from October, 1995 to March, 1996. Age, CSF flow from basal cisterns, and etent of opening of Liliequist's membrane during operation were significantly related to the development of post-operative subdural hygroma. Computed tomography(CT) scan of brain and RI cisternography were performed in all patients at three weeks following operations. RI diffusion time from the interpeduncular cistern to the cerebral convexity of ipsilateral side with surgically opened Liliequist's membrane was compared with contralateral nonoperated normal side. Diffusion time of ipsilateral side(mean 5.2+/-8.4hr) was faster than that of contralateral one. Age, cerebrospinal fluid(CSF) from basal cistern, and extent of opening of Liliequist's membrane during operation were significantly related to development of post-operative subdural hygroma. Development of subdural hygroma after pterional approach for aneurysmal operations in our series is believed to be caused by stagnation of CSF in the convexity until its absorption into the arachnoid villi. Increased CSF flow from the infratentorial space to the supratentorial space through extensively opened Liliequist's membrane is considered to contribute development of its formation.
Absorption ; Aneurysm* ; Arachnoid ; Brain ; Diffusion ; Humans ; Membranes ; Subdural Effusion*

The authors report clinical results of fifty-two traumatic thoracolumbar bburstfractures treated by internal fixation with Kaneda device after anterior decompression during recent six years. The burst fractures occurred most frequently at the age of twenties and thirties. The main causes of injury were vehicle accident and fall.In all cases, spinal decompression, internal instrumet fixation and bone fusion(rib, iliac bone) were performed. No patient showed neurological deterioration after surgery and almost all patients improved post operatively by on grade of Frankel's(classification). Thirty-three patients(85%) with Denis type I and II showed the correction of the fracture deformities with good bony fusion and 9 of 13 patients(70%) with Denis type IV showed bony fusion in serial follow-up. It if thus concluded that anterolateral internal fixation combined with bony fusion provide good mechanical stability and decompression of protruding ventral bone fragments above conus medullaris level.
Congenital Abnormalities ; Conus Snail ; Decompression ; Decompression, Surgical* ; Follow-Up Studies ; Humans

Telecanthus in congenital blepharophimosis has traditionally been repaired with conventional methods such as medial canthal tendon tucking and transnasal wiring.We report 2 cases of patients with telecanthus who underwent repair with titanium miniplate. After the anterior limb of medial canthal tendon was dissected, its insertion site was drilled and a titanium miniplate was fixed with screws.The dissected medial canthal tendon was fixed with 4-0 mersilene to a miniplate hole.After the surgery, we obtained a mean decrease of 11 mmin intermedial canthal distance and no complications except scar in incision site. We believe that this procedure has advantages such as short operation time, precise placement of the medial canthal tendon.For these reasons, it seems to be an excellent alternative to transnasal wiring, but considers this operation because of scar in incision site.
Blepharophimosis* ; Cicatrix ; Extremities ; Humans ; Tendons ; Titanium*

PURPOSE: There have been many trials to find a cure for inoperable multiple hepatocellular carcinomas (HCC), but no effective therapy has been found. As the combined therapy of tumor reductive surgery and intraoperative radio-frequency ablation (RFA) is by far the best known effective treatment modality, the effect of a combined resection and intraoperative RFA for multiple HCC was evaluated. METHODS: Between July 1999 and 2004, a retrograde study was conducted on 8 patients who had undergone combined therapy for HCC, with respect to the number of tumors, location, size, postoperative complications and recurrence. RESULTS: The average age of the patients was 51. A Rt. hepatectomy, Lt. Lateral sectionectomy, bi-segmentectomy, segmentectomy and wedge resection were performed. The total number of tumors and resected tumors were 21 and 8, respectively; with an average size of 6.6 cm. Thirteen tumors, with average size of 2 cm, were treated with RFA. Seven postoperative complications were encountered in 2 patients, with 2 operation related complications biloma and ascites. One patient suffered from pleural effusion and a wound complication. One patient went through a RFA-related complication biliary-cutaneous fistula. Four patients suffered a recurrence one at the RFA site, and the rest at the remnant liver. The treatments used for the recurrences were TACE/ TACI, percutaneous Holmium injection and surgical resection. All patients survived, with an average survival and a median disease free survival time of 15 and 11 months, respectively. CONCLUSION: Until now, surgery has been the least favored choice for the treatment of multiple HCC. However, thinking our opinion, the combined therapy of hepatectomy with intraoperative RFA is beneficial. Our group of patients was small, with a short follow up period, without any definite indication; therefore, it will be necessary to conduct continuous follow up, with the collection of appropriate data.
Ascites ; Carcinoma, Hepatocellular* ; Catheter Ablation ; Disease-Free Survival ; Fistula ; Follow-Up Studies ; Hepatectomy ; Holmium ; Humans ; Liver ; Mastectomy, Segmental ; Pleural Effusion ; Postoperative Complications ; Recurrence ; Thinking ; Wounds and Injuries

Inducible nitric oxide synthase (iNOS) expression of several organs on the lipopolysaccharides (LPS)-injected rats and on excisional wound was observed by immunohistochemical methods to investigate iNOS-positive cells during inflammation. iNOS expression was induced in response to LPS in the brain and these reactions were observed in the choroidal epithelium, ependymal cells and a few of nerve cells and fiber. A more intensive reaction of nerve cell and fiber was mainly observed in the corpus callosum and hypothalamus. Induction of iNOS of the lung was observed in alveolar macrophage, smooth muscle, pneumocytes and inflammatory cells infilterated in the alveolar septum. iNOS expression of the liver was detected in Kupffer cells, hepatocytes, bile duct and inflammatory cells of spotty necrosis. The cardiac muscle and endothelial cell of the heart showed positive iNOS expression. In the excisional wound, inflammatory cells including macrophages, neutrophil and fibrobast showed iNOS expression and mainly detected necrobiotic layer. Collectively, iNOS expression was induced in the several cell types during inflammatory process. So for better understanding the function of iNOS, more research should be done in relation to each cell type of organ.
Animals ; Bile Ducts ; Brain ; Choroid ; Corpus Callosum ; Endothelial Cells ; Epithelium ; Heart ; Hepatocytes ; Hypothalamus ; Inflammation ; Kupffer Cells ; Lipopolysaccharides ; Liver ; Lung ; Macrophages ; Macrophages, Alveolar ; Muscle, Smooth ; Myocardium ; Necrosis ; Neurons ; Neutrophils ; Nitric Oxide Synthase Type II* ; Pneumocytes ; Rats* ; Shock* ; Wound Healing* ; Wounds and Injuries*

PURPOSE: To evaluate the diagnostic accuracy of MR imaging in posterior cruciate ligament(PCL) injuries, to describe the variety of these injuries and to assess the type and frequency of associated knee injuries. MATERIALS AND METHODS: We retrospetively analysed 75 cases with knee injuries. In all cases, the prescence of a PCL tear was determined by arthroscopy or surgery and the type of tear and patterns of associated knee injuries were described. RESULTS: Twenty-eight PCL tears were identified with arthroscopy or surgery. Figures for the sensitivity, specificity, and accuracy of MR diagnosis for the PCL injury were 86%, 94% and 91% respectively. Twenty-one cases(75%) had complete PCL tears and seven (25%) had partial tears. The commonest tear site was midsubstance(18 cases, 64.3%). Twenty-seven cases(96%) had associated knee injuries ; the remaining patient(4%) had isolated PCL injuries. There were 19 cases(68%) of ligamentous injuries, ten (36%) of meniscal tear, ten (36%)of bony injuries, and 20 (71%) of joint effusions. Of the ligamentous injuries, those involving the medialcollateral ligament were most often seen(10 cases, 36%). CONCLUSIONS: MR imaging is an accurate method for the detection and evaluation of PCL injury and associated knee abnormalities.
Arthroscopy ; Diagnosis ; Joints ; Knee ; Knee Injuries ; Ligaments ; Magnetic Resonance Imaging* ; Posterior Cruciate Ligament* ; Sensitivity and Specificity

OBJECTIVE: In June 28, 2012, a 'Hospitalization guideline for car accident patients' was announced to mediate the clash of opinions about the hospitalization of minor head trauma patients among doctors, patients and insurance companies. The guideline was issued to describe the patients' symptoms and emotions in detail after the injury. In this paper, evaluation for the guideline and suggestions for modifications was done. METHODS: Thirty-two doctors, 96 patients and 60 employees were each given surveys about the hospitalization guidelines, related personnels' attitude and evaluation of patients' emotional problems. The frequency, ratio and chi-square test were performed. RESULTS: Sixty-eight point eight percent of doctors, 79.8% patients and 91.6% insurance company employees agreed to the need for a guideline. Among the 68.8% doctors that supported the need for a guideline, 18.8% knew that the guideline actually existed. Sixty-nine point two percent of doctors said that they would apply the guideline once they were introduced to it. Among the announced guideline provisions, 'Glasgow coma score less than 15' and 'socially not suitable for discharge' required reevaluation since 40.6% all surveyors consented that these two criteria were not suitable. The consensus supporting the need for emotional evaluation came out to be 78.1%, 58.5%, 50.9% in doctors, patients and insurance employees respectively. CONCLUSION: Although a guideline for hospitalization of minor head injury patients is necessary, some part of it seems to be reevaluated and improved, especially for clauses related to the patient's emotional problems. These changes and revisions to the guideline require further speculation and research.
Coma ; Consensus ; Craniocerebral Trauma* ; Hospitalization* ; Humans ; Insurance ; Patient Admission

OBJECTIVE: We compared the effect of decompressive craniectomy between patients < 65 and ≥ 65 years age and investigated prognostics factors that may help predict favorable outcome in acute stroke patients undergoing decompressive surgery. MATERIALS AND METHODS: 52 patients diagnosed with acute middle cerebral artery (MCA) territory infarction that underwent decompressive craniectomy were retrospectively reviewed. The outcome of all patients were evaluated by assessing the Glasgow coma scale, Glasgow outcome scale (GOS), and Modified Rankin scale (mRS) six months after the onset of the disease. 21 patients were preoperatively evaluated with a computed tomography angiography (CTA). Leptomeningeal collateral (LMC) circulation was graded using CTA by experienced neurosurgeons to assess its prognostic value. RESULTS: The thirty day mortality for patients ≥ 65 was 35.0% compared to 37.5% in patients < 65. There was no significant difference in the clinical and function outcome between the two groups (4.8 ± 1.2 vs. 4.5 ± 1.5, p = 0.474). Mortality was lower with early surgery (within 24 hours) group for both age groups (25% vs. 37.5% in ≥ 65, 20% vs. 40.7% in < 65). Longer intensive care units stay time and good collateral supply score were correlated with favorable outcome (p = 0.028, p = 0.018). CONCLUSION: Decompressive craniectomy within 24 hours of stroke symptom onset improved survival in both the < 65 and ≥ 65 age groups. There was no significant difference in the functional outcome of both age groups. Unlike previous reports, old age, delayed operation, and multiple of infarct territories were not predictive of poor functional outcome. The presence of good collateral circulation may be a predictor of positive clinical outcome in acute ischemic stroke patients undergoing decompressive craniectomy.
Aged* ; Angiography ; Brain Edema ; Cerebral Infarction ; Collateral Circulation ; Decompressive Craniectomy* ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Humans ; Infarction ; Infarction, Middle Cerebral Artery* ; Intensive Care Units ; Middle Cerebral Artery* ; Mortality ; Neurosurgeons ; Retrospective Studies ; Stroke

PURPOSE: To evaluate the diagnostic value of source images of 3D TOF MR angiography in patients with hemifacial spasm. MATERIALS AND METHODS: Thirteen patients with surgically-confirmed hemifacial spasm and 30 who were not suffering from this condition were included in this study. T1 and T2-weighted images and 3D TOF MR angiography were performed. In 43 randomly-selected individuals, we retrospectively determined whether source images obtained during 3D TOF MR angiography could be used to evaluate symptoms. The results were correlated with surgical findings. RESULTS: Sensitivity was 92% and specificity was 86%. In all 13 patients with hemifacial spasm, neurovascular compression was detected during their operation. Offending vessels were the anterior inferior cerebellar artery (AICA) in four cases, the posterior inferior cerebellar artery (PICA) in seven, both the vertebral artery and PICA in one, and the vertebral vein, also in one. There were ten false-positive cases in the asymptomatic control group, nine of which showed neurovascular contact in the root entry zone of the facial nerve; one case showed indentation of the pons. CONCLUSION: Source images obtained during 3D TOF MR angiography are useful in the preoperative evaluation of hemifacial spasm.
Angiography ; Arteries ; Facial Nerve ; Hemifacial Spasm* ; Humans ; Pica ; Pons ; Retrospective Studies ; Sensitivity and Specificity ; Veins ; Vertebral Artery