Pleomorphic xanthoastrocytoma(PXA) is a benign brain tumor with favorable prognosis in spite of its marked pleomorphism. We report a case with review of the literature. An eight-year-old boy presented with headache and vomiting. Plain skull X-ray showed findings of increased intracranial pressure. The MR imaging demonstrated superficially located large cystic mass with a Iobulated mural nodule in the left frontal lobe. The mural nodule abutting leptomeninges showed intense enhancement on postcontrast Tl-weighted images, but the cyst wall was not enhanced. Preoperative diagnosis of PXA with the MRI findings could lead to avoidance of more aggressive brain resection and therefore more favorable neurological outcome
Brain ; Brain Neoplasms ; Child* ; Diagnosis ; Frontal Lobe ; Headache ; Humans ; Intracranial Pressure ; Magnetic Resonance Imaging ; Male ; Prognosis ; Skull ; Vomiting

A case of malignant synovioma of the right knee joint is presented. Microscopically it showed sarcomatous growth of spindle cells and irregular slit spaces which were lined by tumor cells. A–K amputation has carried out on 10th hospital day and discharged on 30th hospital day without any complications.
Amputation ; Knee Joint ; Sarcoma, Synovial

AIMTo investigate how erectile dysfunction (ED) medications affect morning erection in patients with ED and how they respond to the return of morning erection.

METHODSThis study was conducted in 120 patients who experienced successful intercourse with either tadalafil or sildenafil. Using a random face-to-face interview and a questionnaire (about the quality and number of days getting morning erection after using the two medications), the impact of the medications on the morning erections was investigated, and the participants were asked about their feelings on regaining morning erection.

RESULTSOf the respondents, 81% (68% of those with sildenafil and 99% of those with tadalafil) experienced morning erections after taking an oral ED medication. The men who took tadalafil mainly for 2 days with one dose, while those who took sildenafil experienced morning erections mainly for 1 day. The major sentiment upon regaining a morning erection was, "having more confidence as a man"(74%). Among the 96 respondents who experienced morning erections with tadalafil, 52% preferred tadalafil over sildenafil, not only because of freedom from concerns about a specific time to have relations, but also regaining morning erection.

CONCLUSIONRegaining a morning erection affects the recovery of confidence as a man and influences the preference for tadalafil over sildenafil.

Aged ; Carbolines ; pharmacokinetics ; therapeutic use ; Circadian Rhythm ; Erectile Dysfunction ; drug therapy ; psychology ; Humans ; Male ; Middle Aged ; Penile Erection ; physiology ; psychology ; Phosphodiesterase Inhibitors ; therapeutic use ; Piperazines ; therapeutic use ; Purines ; Self Concept ; Sildenafil Citrate ; Sulfones ; Tadalafil

OBJECTIVE: We wanted to present our experiences for performing transradial cerebral angiography during the learning period, and we also wanted to demonstrate this procedure's technical feasibility and utility in various clinical situations. MATERIALS AND METHODS: Thirty-two patients were enrolled in the study. All of them had unfavorable situations for performing transfemoral angiography, i.e., IV lines in the bilateral femoral vein, a phobia for groin puncture, decreased blood platelet counts, large hematoma or bruise, atherosclerosis in the bilateral femoral artery and the insistence of patients for choosing another procedure. After confirming the patency of the ulnar artery with a modified Allen's test and a pulse oximeter, the procedure was done using a 21-G micorpuncture set and 5-F Simon II catheters. After angiography, hemostasis was achieved with 1-2 minutes of manual compression and the subsequent application of a hospital-made wrist brace for two hours. The technical feasiblity and procedure-related immediate and delayed complications were evaluated. RESULTS: The procedure was successful in 30/32 patients (93.8%). Failure occurred in two patients; one patient had hypoplasia of the radial artery and one patient had vasospasm following multiple puncture trials for the radial artery. Transradial cerebral angiography was technically feasible without significant difficulties even though it was tried during the learning period. Pain in the forearm or arm developed in some patients during the procedures, but this was usually mild and transient. Procedure-related immediate complications included severe bruising in one patient and a small hematoma in one patient. Any clinically significant complication or delayed complication such as radial artery occlusion was not demonstrated in our series. CONCLUSION: Transradial cerebral angiography is a useful alternative for the patients who have unfavorable clinical situations or contraindications for performing transfemoral cerebral angiography. For the experienced neurointerventionalists, it seems that additional training for perfoming transradial cerebral angiography is not needed.
Subarachnoid Hemorrhage/radiography ; Radial Artery ; Middle Aged ; Male ; Intracranial Hemorrhages/radiography ; Humans ; Female ; Feasibility Studies ; Cerebral Angiography/*methods ; Catheterization/*methods ; Aged ; Adult

One hundred and eighty one cases, which comfirmed tobe intussusception, were reviewed retrospectively to identify the differences between radiologic findings of reduced and nonreduced intussusceptions by barium enema. The number of cases of reduced intussusception was 148 and nonreduced was 33, so the rate of reduction was 82%. On conventional radiographs, air-fluid levels were seen in 23 cases(15.5%) of the reduced intussusception and in 18 cases(54.6%) of the nonreduced intussusception, and soft tissue masses were seen in 20 cases(13.5%) of the reduced intussusception and in 2 cases(36.4%) of the nonreduced intussusception. The mean value of a ratio of maximal diameter of small bowel to interpedicular distance of L3vertebral body was 0.93 in the reduced intussusception and 1.25 in the nonreduced intussusception. On barium enema, the dissection sign was seen in 33.1% of the reduced intussusception and in 75.8% of the nonreduced intussusception. The morphologic abnormalities of ascending colon were seen in 11.5% of the reduced intussusception and in 38.7% of the nonreduced intussusception. So, the findings of the air-fluid level soft tissue mass, marked small bowel dilatation, dissection sign and morphologic abnormality of ascending colon were more frequently seen in the nonreduced intussusception than the reduced cases. There was no correlation between the location of intussusceptum and the reduction rate.
Barium* ; Colon, Ascending ; Dilatation ; Enema* ; Intussusception* ; Retrospective Studies

BACKGROUND: To assess the current level of development of emergency medicine (EM) systems in Asia. METHOD: Survey of EM professionals from 12 Asian countries during a 90-day period from August to November 1998. 12 EM professionals from 12 Asian countries completed the survey. All participants were physicians. 7 participants (58%) gave presentations at an international EM conference during the study period. Respondents completed a 103 question questionnaire about the status of EM specialty, academic, patient care, information and management systems and the factors influencing the future of EM in their countries. RESULTS: 92% of respondents stated that their countries have hospital-based emergency departments (ED). More than 80% of respondents reported that their countries have EMS systems and ED systems for trauma care and patient transfer. More than 70% stated that their countries have national EM organizations, EM research, national EMS activation phone numbers, ED systems for pediatric emergency care, emergency physician (EP) training in ACLS and ATLS and peer review. More than 60% reported official recognition of EM as an independent specialty status, ED triage systems and systems for customer service. More than 50% reported EM residency training programs, EM journals and EP ability to perform rapid sequence intubation (RSI). 50% reported EP ability to perform thrombolysis for acute MI and 33% reported EP ultrasonography. 92% felt that a lack of funding posed a moderate or great obstacle to the future development of EM in their countries. CONCLUSION: Many essential systems of EM now exist throughout Asia. In the systems of administration and emergency medical information in many countries, there are some parts to be developed further.
Asia ; Asian Continental Ancestry Group* ; Surveys and Questionnaires ; Education ; Emergencies* ; Emergency Medical Services ; Emergency Medicine* ; Emergency Service, Hospital ; Financial Management ; Humans ; Internship and Residency ; Intubation ; Patient Care ; Patient Transfer ; Peer Review ; Triage ; Ultrasonography

Intraoperative Radiation Therapy(IORT) delivers a high single dose of radiation to a localized volume encompassing the tumor tissue as well as a minimal amount to the surrounding brain. The aims of the study are to evaluate the feasibility of IORT for the treatment of brain tumors, its effect on survival, and possible complications. Nineteen brain tumor patients underwent wide resection of the tumor followed by IORT at the first surgery or at the second salvage surgery. IORT was given for primary tumors in two patients, but was used for treating recurrent tumors in the other 17 patients. IORT doses of 15-25Gy was delivered depending on the tumor volume and previous radiation therapy. The mean follow-up after IORT was 11.5 months(range: 1-40 months). There were several complications after IORT; 1 radiation necrosis, 1 hydrocephalus,and 3 wound infections. For Glioblastomas cases, the median survival time after initial diagnosis was 14 months(SD, 6.4mo; range 10-28mo). An Unresectable huge highly vascularized meningioma was removed successfully after IORT. Based on our limited experiences, IORT may be considered as an adjuvant therapeutic modality, especially for malignant brain tumors and large rich vascularized meningioma.
Brain Neoplasms* ; Brain* ; Diagnosis ; Follow-Up Studies ; Glioblastoma ; Humans ; Meningioma ; Necrosis ; Tumor Burden ; Wound Infection

The expression of vascular endothelial growth factor (VEGF) and fibroblast growth factor (FGF)2 in the irradiated brain was examined to test how a single high dose radiation, similar to that used for intraoperative radiation therapy given to the normal cerebrum, can affect the vascular endothelium. After a burr hole trephination in the rat skull, the cerebral hemisphere was exposed to a single 10 Gy dose of gamma rays, and the radiation effect was assessed at 1, 2, 4, 6, and 8 weeks after irradiation. His-tological changes, such as reactive gliosis, inflammation, vascular proliferation and necrosis, were correlated with the duration after irradiation. Significant VEGF and FGF2 expression in the 2- and 8-week were detected by enzyme-linked immunosorbent assay quantification in the radiation group. Immunohistochemical study for VEGF was done and the number of positive cells gradually increased over time, compared with the sham operation group. In conclusion, the radiation injuries consisted of radiation necrosis associated with the expression of VEGF and FGF2. These findings indicate that VEGF and FGF2 may play a role in the radiation injuries after intraoperative single high-dose irradiation.
Animals ; Brain/metabolism/pathology/radiation effects ; Brain Injuries/etiology/*metabolism/*pathology ; Fibroblast Growth Factor 2/*metabolism ; Necrosis ; Radiation Injuries/*pathology ; Radiosurgery/*adverse effects ; Rats ; Rats, Sprague-Dawley ; Up-Regulation/radiation effects ; Vascular Endothelial Growth Factor A/*metabolism

Astrocytes play important roles in normal brain development and the physiological processes. In particular, 30% of the brain volume consists of astrocytes, and they are the primary target cell in the brain for cellular injuries from chemical exposures. The present study attempts to establish an immortalized murine astrocyte cell line to study the mechanisms of chemical-induced carcinogenesis of astrocytes. Primary astrocytes isolated from mice were transfected with plasmid carrying the SV40 T antigen. Clonal cells obtained after G418 selection were continuously subcultured to establish an immortalized astrocyte cell line. The cell line was positive on GFAP expression and was sensitive to exposure to such chemicals as MNNG. Cells were treated with MNNG for 5 days, with doses ranging from 0.001ug/ml to 1ug/ml. Dose-dependent cellular transformations of astrocytes were observed. Treatments at 0.01ug/ml showed the most distinct characteristics of neoplastic transformation. Subsequent treatment with TPA produced higher levels of neoplastic cell transformation than MNNG treatment alone, as evidenced by increases of saturation density, soft-agar colony formation and cell aggregation. Promotional effects of TPA on cell transformation was further demonstrated by the shortening duration of foci appearance. Addition of hydrocortisone to the culture media resulted in further promotion of cell transformation in astrocytes treated with MNNG and TPA, suggesting that glucocortocoid also plays a role in the promotion of chemical-induced astrocyte transformation. The present study demonstrates that astrocytes are susceptible to chemical-induced carcinogenicity and subject to mechanisms of multistage carcinogenesis. Analysis of MNNG-transformed astrocytes showed that, while the expression of TGF-beta was decreased, expression of GFAP, IL-1betaand fibronectin were increased. The results suggest that these factors are associated with mechanisms of MNNG-induced astrocyte transformation and may be used as potential candidates for biomarkers representing astrocyte-related tumors and cell toxicities. The study showed scientific evidence that growth factors, cytokine and the extracellular matrix are involved in processes of chemical-induced transformation of astrocytes. In addition, the present work provided an excellent opportunity to develop an immortalized astrocyte cell line that can be used for studying mechanisms of astrocyte-related diseases.
Animals ; Antigens, Viral, Tumor ; Astrocytes* ; Biomarkers ; Brain ; Carcinogenesis* ; Cell Aggregation ; Cell Line ; Cell Transformation, Neoplastic ; Culture Media ; Extracellular Matrix ; Fibronectins ; Hydrocortisone ; Intercellular Signaling Peptides and Proteins ; Methylnitronitrosoguanidine ; Mice ; Physiological Processes ; Plasmids ; Transforming Growth Factor beta

Objective: To understand the anatomic characteristics of the aortic arch (AA) and its major branches to build a foundation toward performing endovascular surgery safely. Methods: A total of 25 formalin fixed Korean adult cadavers were used. The authors investigated : anatomical variations of the AA and its major branches; curvature of the AA; distance from the mid-vertebrae line to the origin of the major branches; distances from the origin of the major branches of AA to the origin of its distal branches; and the angle of the three major branches, the brachiocephalic trunk (BCT), the left common carotid artery (LCCA) and the left subclavian artery (LSCA) arising from AA. Results: The three major branches directly originated from AA in 21 (84%) of the cadavers. In two (8%) of remaining four cadavers, orifice of LCCA was slightly above the stem of BCT. In remaining two (8%) cadavers, the left vertebral artery (LVA) was directly originated from AA. Average angle of AA curvature to the coronal plane was 62.2 degrees. BCT originated 0.92 mm on the right of the mid-vertebrae line. LCCA and LSCA originated from 12.3 mm and 22.8 mm on the left of the mid-vertebrae line. Mean distance from the origin of the BCT to the origin of the RCCA was 32.5 mm. Mean distance from the origin of the LSCA to the origin of the LVA was 33.8 mm. Average angles at which the major branches arise from the AA were 65.3, 46.9 and 63.8 degrees. Conclusion: This study may provides a basic anatomical information to catheterize AA and its branches for safely performing endovascular surgery.
Adult ; Aorta ; Aorta, Thoracic ; Atherectomy ; Brachiocephalic Trunk ; Cadaver ; Carotid Artery, Common ; Catheters ; Formaldehyde ; Humans ; Subclavian Artery ; Vertebral Artery