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

OBJECTIVE: We investigated the morphologic changes within 24 hours after a single gamma-irradiation in the rat brain. METHODS: Forty Sprague-Dawley rats were used. After a burr hole trephination on right parietal area, cerebral hemisphere was irradiated with 2Gy and 5Gy using iridium-192(192Ir), respectively. The effect was assessed at 4, 8, 12 and 24 hours after irradiation. The histological changes were scored following the detection of edema or disarray severity. TUNEL-positive cells exhibiting apoptotic morphology were counted in irradiated region. RESULTS: Cortical edema and disarray were initially showed at 4 or 8hour and almost all defined at 24hour after irradiation. And the injury was wedge shape. TUNEL-positive cells were minimal at 8hour after irradiation as the number of positive cells were 2.6+/-5.27(n=5) after 2Gy, and 0.8+/-0.84(n=5) after 5Gy. But, the number of apoptotic cells were increased markedly to 60+/-6.24 at 12hour after 2Gy and to 104+/-19.7 at 24hour after 5Gy. CONCLUSION: There were prominent morphologic changes immediately after gamma-irradiation. And, apoptosis was increased according to the time period. These findings implicate that brain irradiation induces rapid apoptotic change, which may play an important role in the pathogenesis of radiation-induced pathologic conditions.
Animals ; Apoptosis ; Brain* ; Cerebral Cortex* ; Cerebrum ; Cranial Irradiation ; Edema ; Rabeprazole ; Radiation Effects* ; Radiation Injuries ; Rats* ; Rats, Sprague-Dawley ; Trephining

Ten brain tumor patients underwent wide resection of the tumor followed by Intraoperative Radiation Therapy (IORT) at the first surgery or at the second salvage surgery after failure of conventional external beam irradiation. Two patients(1 meningioma, 1 glioblastoma multiforme) were treated at the first surgery and 8 patients(3 anaplastic astrocytoma, 3 glioblastoma multiforme, 1 meningioma, 1 gliosarcoma) were treated after salvage surgery. The IORT doses were ranged from 15-25 Gy depending on the tumor volume and previous radiation therapy. The neurological status(Karnofsky performance status) was improved in 4 cases, not changed in 6 cases after IORT. There were several complications after IORT; radiation necrosis, communicating hydrocephalus, wound infection, and abnormal CT findings such as diffuse low density area in an around operation site. The radiation necrosis was confirmed by operation in a recurrent meningioma patient 12 months after IORT. At follow-up, ranging from 1 to 16 months, there was no deaths. Based on our limited experiences, the IORT might be one of the adjuvant therapeutic modalities especially for the malignant brain tumors and unresectable huge meningioma.
Adult ; Astrocytoma/radiotherapy/surgery ; Brain Neoplasms/pathology/*radiotherapy/*surgery ; Combined Modality Therapy ; Female ; Glioblastoma/radiotherapy/surgery ; Gliosarcoma/radiotherapy/surgery ; Human ; Intraoperative Care ; Male ; Meningioma/radiotherapy/surgery ; Middle Age ; Salvage Therapy

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