An 89-Year-old female patient had had a pea-sized encrusted ulcer on the vermillion border of her right upper lip for 4 years. Histopathological features of the biopsy specimen consisted of tumor islands with peripheral, palisading basaloid cells, some of which had become transformed into atypical, dyskeratotic squamous cells with ample eosinophilic cytoplasm in their centers. Total excision was advised.
Aged, 80 and over ; Biopsy ; Carcinoma, Basal Cell ; Carcinoma, Basosquamous* ; Cytoplasm ; Eosinophils ; Female ; Humans ; Islands ; Lip ; Ulcer

Epilepsy surgery in Korea began as early as in the 1940s and continued to develop through the second half of the 20th century. Introduction of neuroimaging modalities, establishment of epilepsy monitoring units and the epilepsy team approach contributed to the rapid development. �or about 300�- 400 operations carried out yearly��, t�here i��s at �prese�nt suffi���cien�t n�umb ��er of ep�ileps� y surg�ery cen�ters�� an�d q�ualifi��ed neurosurgeons in Korea. However, Korean neurosurgeons should adapt themselves to changing recent trends. Etiologies of epilepsy have dramatically changed from head trauma and infectious diseases to tumors and developmental abnormalities. Although traditional resective surgery still constitutes the main bulk of the operations, new therapeutic procedures based on neuro�modulation are emerging as alternative treatments. There should also be participation in basic science research which would leads to future innovations in treatment of epilepsy.

We describe a 23-year-old man showing typically clinical and histological features of targetoid hemosiderotic hemangioma. About 35 cases of this newly-described entity have been reported since the first description by Santa Cruz and Aronherg in 1988. It is important to distinguish these tumors from patch stage Kaposi's sarcoma, retiform hemangioendothelioma and progressive lymphangioma.
Hemangioendothelioma ; Hemangioma* ; Humans ; Lymphangioma ; Sarcoma, Kaposi ; Young Adult

Tumors of the lung and bronchi containing cartilage were known by a variety of names, chondroma, adenochondroma, chondromatous hamartoma and mixed tumor. This variation in nomenclatures explain the difference of illustration on the nature of these tumor. The concept pulmonary harmatomas are benign neoplasm and not developmental malformations, has gained wide acceptance in recent years. We have experienced four cases of intrapulmonary hamartoma which were all discovered during routine chest film check up for certificate of health and evaluation of other disease. One case is added further detailed histologic examination by electron microscopy. The age at time of the detection were 53 (male), 23 (male), 39 (female), and 56 (female) years old. The mean size is 4.3x3.7x3.4 cm. The locations were three left upper lobes and one right upper lobe. Lobectomy and wedge resecions were done. Cut surface showed promiment lobular structures, papillary configuration and multiple cleft like spaces. Predominant cellular components were cartilage but fat tissue in one of the four cases. Microscopic findings showed abundant hyaline cartilages bearing lobular configuration and overlying pseudostratified ciliated columnar and cuboidal epithelium. Fibromyxoid and undifferentiated cells were seen in myxoid and fatty tissue. Electron microscopic findings revealed stellate, undifferentiated mesenchymal cells bearing collagen formation, stellate smooth muscle and transition areas between undifferentiated mesenchymal cells and mature cartilage. Epithelial components were similar to terminal bronchiole and alveolar epithelium. These findings suggest the concept that intrapulmonary hamartoma represent a histologic specturm of benign mesenchymal neoplasms, which originate in peribronchial connective tissue.
Female ; Male ; Humans ; Hamartoma

Brucellosis is not a rare disease, although it has not been reported recently in Korea. Spondylitis is the most prevalent and important clinical form of osteoarticular involvement in adults infected by Brucella. Concerning brucellosis, clinical diagnosis of brucellosis starts with a suspicion of the disease. Vertebral body signal changes without destructive changes, marked signal increase in the intervertebral disc on T2-weighted and contrast-enhanced sequences, soft tissue involvement without abscess formation and facet joint involvement, can be distinguishing magnetic resonance imaging(MRI) features of brucellar spondylitis. Tuberculous spondylitis, metastasis, spinal degenerative diseases, and postoperative changes Should be differentiated. We report upon the first case of brucellar spondylodiscitis in a Korean, and present review of the literature.
Abscess ; Adult ; Brucella ; Brucellosis ; Diagnosis ; Discitis* ; Humans ; Intervertebral Disc ; Korea ; Neoplasm Metastasis ; Rare Diseases ; Spondylitis ; Zygapophyseal Joint

In order to define the hospital course and the best surgical timing for the poor grade subarachnoid hemorrhage(SAH) patients, 131 patients(from 1989 to 1991) whose clinical grade on admission were Hunt and Hess grade III to V were analyzed. Their admission grades was III(90 patients), IV(30 patients), and V(11 patients). Patients were grouped into the early surgery group(within 3 days of the last hemorrhage), the intermediate group(4 to 14 days), the late surgery group(14 days after the last hemorrhage), and non-surgical group. Early surgery was performed on 17 patients, intermediate on 31 patients, and late on 54 paients. Twenty-nine patients did not undergo surgery. This non-surgical group had a high mortality rate(72.4%). During the waiting period for a delayed surgery(later than 3 days), 21% improved their clinical state, 53.5% were stationary and 25.5% became worse. Morbidity and mortality were compated among these three surgical groups and the non-surgical group, with sratistical analysis using chi square test and Fisher's exact test. No statistical differences were noted between the management groups in terms of associated disease, location of aneurysms, Fisher's grade, occurrence of hydrocephalus or symptomatic vasospasm. The mortality rate was significantly lower in the combined surgical groups than in the non-surgical group(p<0.05). Mortality was related to the timing of surgery. It was higher after early surgery than in the other two gorups, but it was not different between the intermediate and late surgery groups. Morbidity was not different among the three surgery groups. The major cause of morbidity and mortality in the early surgery group was brain swelling, while rebleeding, hydrocephalus, and vasospasm, were the main causes in the intermediate and delayed surgery groups. It is concluded that it is not recommended that early surgery must be done in all the poor grade SAH patients. However three days after the last hemorrhage, it is better to perform surgery as soon as possible, because there were no statistically significant differences between the intermediate group and the late surgery groups in the mortality and the morbidity rates.
Aneurysm ; Brain Edema ; Hemorrhage ; Humans ; Hydrocephalus ; Mortality ; Subarachnoid Hemorrhage*

More than 30% of epilepsy patients are not controlled by anti-epileptic medications. For patients having intractable epilepsy, epilepsy surgery is an effective treatment, which provides not only control of seizures but also improvement of quality of life. Epilepsy surgery can provide complete seizure control in over 60% of patients having medically intractable epilepsy. In order to identify surgical candidates, various diagnostic modalities are being used. The value of video-EEG monitoring and MR imaging study cannot be over-emphasized. For certain circumstances, other diagnostic modalities, such as PET, SPECT, and MEG, provide complementary data. If the findings from these non-invasive studies collectively indicate that the patient can benefit from surgery, surgical resection can be performed. However, if the findings do not,, invasive studies should follow. New surgical modalities for the treatment for epilepsy have been developed, including surgical resection of epileptogenic zone or lesion, disconnection of epileptogenic zone from the surrounding normal brain, and neuromodulation, such as vagal nerve stimulation, deep brain stimulation, etc. Also, newly emerging diagnostic modalities, such as high tesla MR imaging, magnetoencephalography or brain mapping technology, can help select surgical candidates more easily in the near future.
Brain ; Brain Mapping ; Deep Brain Stimulation ; Epilepsy ; Humans ; Magnetic Resonance Imaging ; Magnetoencephalography ; Quality of Life ; Seizures ; Tomography, Emission-Computed, Single-Photon ; Treatment Outcome ; Vagus Nerve Stimulation

The perioperative use of anticonvulsants in patients receiving craniotomy for various CNS diseases has been a routine practice in neurosurgery. However, there have been no unified evidence-based guidelines for the perioperative use of anticonvulsants. We searched for published studies related to this subject in MEDLINE and reviewed them. Several randomized controlled studies were regarded as more important because they could provide strong evidence. The conclusions are as follows. First, postoperative seizures are serious problems in neurosurgical practice and should be strictly controlled. Second, anticonvulsants could decrease the occurrence of postoperative seizures. Third, the therapeutic serum levels of anticonvulsants are of utmost importance in the prevention of postoperative seizures. Fourth, valproic acid has no advantage over phenytoin in the prevention of postoperative seizures.
Anticonvulsants* ; Central Nervous System Diseases ; Craniotomy ; Humans ; Neurosurgery* ; Phenytoin ; Seizures ; Valproic Acid

Microgyria is one type of cortical dysplasia with dyslaminations and anomalous cell densities, which could be produced experimentally. In a normal rat cortical development, overproduced neuroblasts gradually die by apoptosis. Thus, the diminished apoptosis may lead to the anomalous cell densities and dyslaminations. This study examined the ontogeny of cell densities in rat microgyria, in homotopic contralateral cortex and in control cortex. Multiple applications of cold probe (-70degrees C) on the right hemisphere in postnatal day (PN) 0 rat pups produced unilateral microgyria. Cell densities had decreased from PN 1 to 2 in microgyria, in the contralateral left hemisphere, and in the control cortex. From PN3 to PN10, while the cell density of the microgyria had increased (p<0.001), cell densities of the control and homotopic area continued to decrease. Apoptosis was greater in the microgyria than in the control and left hemisphere from PN1 to 3 and then remarkably decreased (p<0.001). These results suggest that the increased cell density in microgyria is not from decreased apoptosis, but probably caused by the increased proliferation or migration.
Animals ; Apoptosis* ; Cell Count ; Cell Movement ; Malformations of Cortical Development* ; Rats*

There are many factors affecting surgical results of cervical spondylotic myelopathy. Age, duration of symptom, neurologic status, and direction of surgical approach are side to have prognostic implications. Also a high signal intensity on T2 weighted magnetic resonance imaging(HSI on T2WI) is insisted as a poor prognostic factor. We analyzed these factors in 56 patients treated over a 10-year period retrospectively. Statistical analysis was done using chi square, Mantel-Haenszel. Cochran-Mantel-Haenszel, Wilcoxon, and logistic procedure. We preferred anterior decompression when compressive lesions existed ventrally. However posterior decompression was performed in a 4 or more level stenosis. Age ranged from 22 to 74 year(mean : 50.8). 25 patients underwent the anterior procedure, 33 patients the posterior procedure, and 2 both procedures. Neurologic status was graded both preoperatively and at follow-up using the Nurick grading system from 1 to 5. The preoperative Nurick grade was 2.75+/-0.16(mean+/-SE). Mean follow-up period was 13.8 months(SE 0.14). The follow-up Nurick grade was 2.125+/-0.14, and these was noted an improvement of 0.63+/-0.12. The amount of improvement was equivalent between the anterior and the posterior approaches(0.52 vs. 0.73 respectively, p=0.67). There was no mortality. Uni- and multivariant analysis demonstrated that age, duration of symtom and HSI on T2WI had no significant effect on either follow-up Nurick grade or amount of improvement, but the preoperative Nurick grade had a significant effect(p<0.000). Comparable results can be obtained with either approaches if chosen properly. Only the preoperative Nurick grade has the prognostic value.
Constriction, Pathologic ; Decompression ; Follow-Up Studies ; Humans ; Mortality ; Neurologic Manifestations ; Prognosis ; Retrospective Studies ; Spinal Cord Diseases ; Spondylosis