OBJECTIVE: In accordance with the increasing number of elderly people in our society, the incidence of pedicle screw fixation which is a technically demanding procedure and requires a lengthy operation time has increased in the patients with lumbars instability over 60 years old. To ascertain the outcome and efficacy of the pedicle screw fixation in patients over 60 years old, we analyzed the surgical results including complications. PATIENTS AND METHOD: From May, 1994 to September, 1997, we assessed 30 patients over 60 years of age and 159 patients under the age of 60 with lumbar spinal instability who underwent surgery of pedicle screw fixation and compared with the results of surgery between two groups. RESULTS: For the elderly, the average operation time was 244 minutes and the transfusion amount was 3.3 pints. For younger patient the average operation time was 246 minutes and the transfusion amount was 3.2 pints. Four surgical complications occurred; two patients with voiding difficulty, one patient with heart problem, and a patient with DIC(Disseminated Intravascular Coagulation). However, all complications were controlled without further problems. The success rate in the elderly was 60%, which was lower than the success rate of 76% among younger patients. CONCLUSION: Considering the condition of the diseases in the elderly and the fact that the operations were performed without any major problems, these results are acceptable. Based on our analysis, it is our view that advanced age per se should not be regarded as a contraindication for pedicle screw fixation.
Aged ; Follow-Up Studies* ; Heart ; Humans ; Incidence ; Middle Aged*

The application of stereotactic techniques and endoscopy dates back to the beginning of this century and is almost as old as neurosurgery itself. However, endoscopic techniques progressed slowly for several reasons. A reappraisal of endoscopic techniques become popular about 1985. The major indication of endoscope in neurosurgical field is intraventricular procedures. Recently it can be used selectively in the intraaxial mass lesion associated cavity. For example, cystic mass, with liquefied necrosis, blood clot can be approached with endoscope. Authors present its intraaxial application in basal ganglionic hematoma in three patients. Conventional stereotactic guidance of neuroendoscope was done and the hematoma was gently removed through continuous irrigation and suction under video-guidance. The clinical course was uneventful. Brief overview is given of this intraaxial neuroendoscopic procedure.
Endoscopes ; Endoscopy ; Ganglion Cysts* ; Hematoma* ; Humans ; Necrosis ; Neuroendoscopes ; Neurosurgery ; Stereotaxic Techniques ; Suction

Insulinoma is clinically characterized by fasting hypoglycemia, various neuropsychiatric symptoms, and these caused by secondary to hypoglycemia.Of patients with insulinoma, 80 percent have single benign tumors, 11 percent have multiple benign tumors, 6 percent have single malignant tumors, and the remainder have multiple malignant tumors or islet hyperplasia according to Service's statement.A 42 year-old male chemical engineer who had insulinoma associated with regional lymph node metastasis has been successfully performed with curative resection and consecutive postoperative therapy with streptozotocin.He entered to this hospital because of frequent occasion of bizarre behavior and language, transient unconsiousness and syncopal episode, and sweating associated with hypoglycemia especially in night four months prior to addmission in November 1992. Those symptoms and hypoglycemia were controlled by intravenous glucose injection and/or oral feeding of glucose riched stuffs.No physical abnormalities were found except neuropsychiatric symptoms. On admission the fasting blood glucose level was 10 mg/dl, plasma immunoreactive plasma insulin level was 125.23 uU/ml, and plasma C-peptide level was 10.24 ng/ml, respectively.Abdominal CT was suggestive of retroperitoneal tumor just behind the pancreas. Selective celiac axis angiography demonstrated hypervascular mass supplied by dorsal pancreatic artery which was compatible with insulinoma. Surgical intervention including distal pancreatectomy, as well as splenectomy and parital omental resection were performed successfully. Consecutive postoperative treatment of streptozotocin was done without any side effects.His condition is very good and enjoyed his life with full activity to date.
Angiography ; Arteries ; Blood Glucose ; C-Peptide ; Fasting ; Glucose ; Humans ; Hyperplasia ; Hypoglycemia ; Insulin ; Insulinoma ; Lymph Nodes ; Male ; Neoplasm Metastasis ; Pancreas ; Pancreatectomy ; Plasma ; Splenectomy ; Streptozocin ; Sweat ; Sweating ; Syncope

Radial tunnel syndrome is a rare disorder and it's symptoms sometimes so closely overlap those lateral epicondylitis, causing difficulties to differentiate. A 39-year-old man was presented who had a 2.5-year history of right elbow and forearm pain which was unseccesfully treated as 'tennis elbow'. Clinically, severe tender point over the forearm was relieved after a local anesthetic injection. Axial STIR(short tau inversion recovery) image showed high signal intensity at the origin of the extensor carpi radialis brevis, which was so minimal that it was not comparable to clinical symptoms. But radial nerve was revealed normal. So we decided that the symptoms were caused not by lateral epicondylitis but rather by radial tunnel sybdrome and an operation was performed. In the operative field, the most proximal part of the superficial head of the supinator muscle was tendinous and formed a fibrous arch, which was resected. After the operation, the right arm pain was relieved. This is a case diagnosed as lateral epicondylitis which showed no improvement under conservative treatment, but improved after a local anesthetic injection on the tender point. When a case with no correlations between lateral epicondylitis degree in MRI and clinical symptoms, one should take the possibility of radial tunnel syndrome into consideration.
Adult ; Arm ; Elbow ; Forearm ; Head ; Humans ; Magnetic Resonance Imaging ; Radial Nerve

No abstract available.
Biopsy* ; Brain* ; Protons*

We present a case of ganglioneuroma arsing from the sympathetic ganglia in the pelvic cavity.
Ganglia, Sympathetic ; Ganglioneuroma*

OBJECTIVE: It is difficult to localize accurately the small mass lesions seen in CT, MRI images in the operating field, espacially in the subcortical location. To minimize possible neurologic deficit for intraprenchymal exploration, the stereotactic technique is essential. Authors evaluated the stereotactic craniotomy and transsulcal approach in localizing various small subcortical mass lesions. METHOD: For last 3 years, stereotactic craniotomy was done in 7 patients in our institute. They were 1 cysticercosis, 1 cavernous hemangioma, 1 inflammatory sclerosis, 3 tuberculous granulomas, 1 metastatic tumor. They were all subcortical location and associated with mass effect. According to locations, four of them were located in the somatosensory cortex, 1 in supplementary frontal cortex, 1 in temporal cortex, 1 in parietal cortex. After application of stereotactic frame, the patients were transferred to CT/MR unit for target localization. Multiple target points were obtained from images and the patient were taken to the operating room. Scalp incisions and bone flaps were designed with physical placement method with stereotactic probe. After dural opening, the subcortical mass was traced with stereotactic probe. Transgyral approaches were used in 4 patients and transculcal approach in 3 patients under the stereotactic guidance. RESULTS: Small craniotomy with accurate localization was possible without difficulty in all cases. Furthermore there was no need for intraparenchymal exploration to localize the subcortical mass. There was no operative mortality, 1 patient developed transient hemiparesis lasting 3 weeks. No other patient showed neurologic deficit. CONCLUSION: Stereotactic craniotomy and localization seems to be helpful for removal of small subcortical masses. small craniotomy with accurate localization was possible. In the eloquent areas, transsulcal approach seems to be particularly useful to prevent possible neurologic sequele.
Craniotomy* ; Cysticercosis ; Granuloma ; Hemangioma, Cavernous ; Humans ; Magnetic Resonance Imaging ; Mortality ; Neurologic Manifestations ; Operating Rooms ; Paresis ; Rabeprazole ; Scalp ; Sclerosis ; Somatosensory Cortex ; Stereotaxic Techniques

BACKGROUND AND OBJECTIVES: Papillary thyroid cancers (PTCs) often present as multifocal tumors. Whether multifocal tumors are associated with increased risk of recurrence and mortality is still the subject of controversy. The aim of current study was to individualize factors associated with multifocality of papillary thyroid cancer and determine the clinical significance of multifocal thyroid cancer. SUBJECTS AND METHOD: We undertook a retrospective study of 403 patients treated between January, 2003 and June, 2007 for papillary thyroid carcinoma by total thyroidectomy and central compartment neck dissection (n=403) with or without comprehensive lateral neck dissection. There were 342 women and 61 men whose mean age was 47.3 years old. Following criteria were used to study the pattern of and factors related with multifocality : sex, age, extracapsular extension, central compartment lymph node metastasis, the involvement of lateral neck lymph node, AMES risk group, distant metastasis. RESULTS: Of those factors, sex (p=0.0481), central compartment lymph node metastasis (p=0.0007), the involvement of lateral neck lymph node (p=0.0001) were significantly related factors for multifocality of papillary thyroid cancer. Age, primary tumor size, AMES risk group were not significantly related with multifocality. Bilateral or contralateral central compartment lymph node metastasis occurred more frequently in multifocal PTCs (64.0%) than solitary PTCs (46.9)(p=0.012). CONCLUSION: Our data suggest that the multifocal tumors in patients with papillary thyroid carcinoma are associated with increased risk of bilateral central compartment and lateral cervical lymph node metastasis. Therefore, total thyroidectomy and bilateral central compartment lymph node dissection should be recommended as a routine procedure in multifocal papillary carcinoma
Carcinoma ; Carcinoma, Papillary ; Factor IX ; Female ; Humans ; Lymph Node Excision ; Lymph Nodes ; Male ; Neck ; Neck Dissection ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies ; Sex Factors ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy

BACKGROUND: Cancer is the second cause of childhood death following accident, and leukemia is the most frequent childhood cancer in Korea. For the desirable control of childhood leukemia, of which the mortality is still high, the basic data for the incidence has a great importance. This is the second report from the data during 1991~1995 following the first one that analyzed the data from 328 cases of childhood leukemia during 1981~1990 in the same area, Pusan city, Korea. METHODS: The data were obtained from 138 new cases(84 males and 54 females from 0 to 15 years old) of childhood leukemia who had been living in the city of Pusan and were admitted to the 4 university hospitals and 11 general hospitals from 1991 to 1995. The cases were confirmed by CBC and bone marrow examination. RESULTS: The crude annual incidence rate per 100,000 population varied 1.50~5.30, 2.59~6.00 and 1.58~2.61 in the age group of 0~4 years, 5~9 years and 10~14 years, respectively. The standardized annual incidence rate per 100,000 population varied from 2.05 to 3.46(male 2.96~4.89, female 0.98~3.57). Sex ratio(male to female) was 1.58:1, 1.44:1, and 1.82:1 in total cases, ALL and AML, respectively, while incalculable in CML. By the major types of childhood leukemia, the cases were composed of 105 ALL (76.1%), 31 AML(22.5%), 2 CML(1.4%). CONCLUSION: It was concluded that the annual incidence rate of childhood leukemia per 100,000 population in Pusan city during 1991~1995 was similar to that of previous report during 1981~1990, while the proportion of ALL had tendency to increase up to that of United States, in contrast to the low proportions of ALL in the previous reports.
Bone Marrow Examination ; Busan* ; Female ; Hospitals, General ; Hospitals, University ; Humans ; Incidence* ; Korea* ; Leukemia* ; Male ; Mortality ; United States

We investigated the antineoplastic potentials of recombinant adenovirus containing wild-type p53 cDNA (Ad5CMV-p53) for malignant gliomas. In four human glioma cell lines (U-251 and LG expressing endogenous mutant p53, and U-87 and EFC-2 expressing wild-type p53) and two rat glioma cell lines (9L and C6, each expressing mutant and wild-type p53), gene transfer efficiency determined by X-gal staining and Western blotting was varied (10-99% at 10-500 multiplicity of infection, MOI). Growth inhibitory effect was drastic (>90% at 100 MOI) in U-251 cells and only moderate or minimal in other cell lines harboring wild-type p53 or low gene transfer efficiency. Ex vivo transduction of U-251 cells with Ad5CMV-p53 suppressed the in vivo tumorigenicity of the cells. Histopathologic examination for Ad5CMV-p53 toxicity to rat brains showed inflammatory reactions in half of the tested brains at 10(8) MOI. U-251 cells were inoculated intracerebrally in nude mice and injected Ad5CMV-p53 into the tumor, in which neither the tumor suppression nor the survival benefit was observed. In conclusion, heterogeneity of the cellular subpopulations of malignant glioma in p53 status, variable and insufficient gene delivery to tumor, and adenoviral toxicity to brain at higher doses may be limiting factors to be solved in developing adenovirus-p53 gene therapy for malignant gliomas.
Adenoviruses, Human ; Animal ; Brain Neoplasms/therapy* ; Cell Division ; Gene Therapy* ; Genetic Vectors ; Glioma/therapy* ; Human ; Mice ; Mice, Nude ; Protein p53/physiology ; Protein p53/genetics* ; Rats ; Tumor Cells, Cultured