Subcutaneous angiolymphoid hyperplasia is an uncommon disease characterized by eosinophilia, proliferation of the capillary vessels and lymphoid tissue and infiltration of the inflammatory cell, especially eosinophils. The etiology of the disease are obscure, but probably trauma, lower grade infection, nervous factor & hormonal status etc. The predilection sites are face, ears, scalf & neck, but rarely reported in the extremities. We experienced a case of subcutaneous angiolymphoid hyperplasia of the inguinal region and anteromedial side of the proximal thigh in a 10 year-old man who complained pain and tenderness on the above region. The patient was treated by excision with satisfactory result.
Capillaries ; Ear ; Eosinophilia ; Eosinophils ; Extremities ; Humans ; Hyperplasia ; Lymphoid Tissue ; Neck ; Thigh

Patients with extra-axial mass lesions of the posterior fossa frequently demonstrate signs of brainstem dysfunction. These dysfunctions may be induced by the change of regional cerebral blood flow and electrophysiological status as well as mechanical compression and distortion of the brainstem. Frontal cortical regional cerebral blood flow(rCBF), pontine rCBF, brainstem autidory evoked potentials(AEPs), infratentorial intracranial pressure(infratentorial ICP) and mean arterial blood pressure(MABP) were recorded before and after expansion of an infratentorial epidural ballon in anesthetized experimental cat models. After the elevation of MABP during the increased infratentorial ICP, frontal cortical and potine rCBF, AEPs were recorded every 30 minutes. The results suggest that the elevating the MABP to improve cerebral perfusion pressure before irreversible change occurs in the brain may preserve cerebral function. We conclude that if the volume of the space in the posterior fossa that is occupied by the mass can be estimated, brain damage from low rCBF and brain compression due to intracranial hypertension can be prevented by the elevation of MABP before irreversible damage of the brain occurs.
Animals ; Blood Pressure* ; Brain ; Brain Stem ; Cats ; Evoked Potentials, Auditory* ; Humans ; Intracranial Hypertension ; Intracranial Pressure* ; Perfusion

OBJECTIVE: Extracranial-intracranial arterial bypass (EIAB) has proved to be useful in selected patients with artherosclerotic cerebral ischemia and moyamoya disease. But neurological deterioration (ND) after EIAB has occasionally been reported in spite of successful EIAB. We have performed EIAB in 150 patients with artherosclerotic cerebral ischemia and moyamoya disease during the recent 8 years. We analyzed the patients who exhibited ND after successful EIAB was performed for a selected group of patients with artherosclerotic cerebral ischemia and moyamoya disease. METHODS: Among 150 patients, the cause of the hemodynamic ischemia was atherosclerotic in 90 and moyamoya disease in 60. Eighteen patients experienced ND after successful EIAB. There were 14 patients with temporary neurologic deficit and 5 patients had a permanent deficit. We divided these 18 patients into two groups. Group 1 revealed relative hyperperfusion of a chronically hypoperfused area of the brain after successful EIAB. Group 2 showed hypoperfusion of the brain by the change of the flow pattern after successful EIAB. RESULTS: Of the 18 patients who experienced ND after successful EIAB, 8 patients belonged to group 1 and 10 patients belonged to group 2. We divided group II into four subgroups according to angiographic flow patterns. The first subgroup (2 patients) showed delayed filling of one division out of two divisions of the middle cerebral artery. The second subgroup (3 patients) showed collision between the orthograde flow and the retrograde flow from the grafted vessel, which resulted in more profound hypoperfusion. The third subgroup (2 patients) exhibited a complete occlusion of the preoperative stenotic artery. The fourth subgroup (3 patients) included the cases with marginal hypoperfusion in the periphery of the perfused region from the grafted extracranial artery. CONCLUSION: EIAB is a reliable, reasonably safe method for establishing new pathways of collateral circulation to the brain. However, this operation can have potential complications according to the relative hyperperfusion or hypoperfusion that's due to the altered flow pattern after the bypass.
Arteries ; Brain ; Brain Ischemia ; Cerebral Revascularization ; Collateral Circulation ; Glycosaminoglycans ; Hemodynamics ; Humans ; Ischemia ; Middle Cerebral Artery ; Moyamoya Disease ; Neurologic Manifestations ; Transplants

OBJECTIVE: The authors evaluated the effect of direct bypass (superficial temporal artery-middle cerebral artery bypass) in the prevention of rebleeding episodes in patients suffering from hemorrhagic moyamoya disease by comparing this method with indirect bypass. METHODS: Fifteen patients who had hemorrhagic moyamoya without aneurysm comprised the study group. The mean age of patients was 44.4 years and follow up period ranged from 0.8 to 7.1 years (mean; 3.61 years). Revascularization surgery was performed in 21 sides in 15 patients. Direct bypass was performed in 17 sides and indirect bypass in the other 4 sides. RESULTS: During the follow-up period after the revascularization surgery, three sides (14.3%) of the 21 sides presented with rebleeding episode, one of 17 sides (mean follow-up periods; 2.94 years) treated with direct method and 2 of 4 sides (mean follow-up periods; 6.45 years) treated with indirect method. Kaplan-Meier analysis of rebleedingfree survival showed quite different between direct and indirect method but statistically insignificant (p=0.0541). CONCLUSION: Direct bypass may reduce the risk of hemorrhage more effectively than indirect bypass. However, direct bypass cannot always prevent rebleeding.
Aneurysm ; Cerebral Arteries ; Follow-Up Studies ; Hemorrhage* ; Humans ; Kaplan-Meier Estimate ; Moyamoya Disease*

OBJECTIVE: The authors evaluated the effects of direct revascularization (superficial temporal artery-middle cerebral artery bypass) in the prevention of further stroke, including recurrent ischemic event or bleeding in patients with ischemic type of adult moyamoya disease by clinical, pathophysiological and angiographical studies. MATERIALS AND METHODS: Twenty four patients who had ischemic symptoms in adult moyamoya disease were investigated. The mean age of the patients was 40.8 years. The follow up period ranged from 6 months to 8 years. In 24 patients who were surgically treated, thirty one sides (both sides in 7 patients) were performed to superficial temporal artery-middle cerebral artery anastomosis and dura splitting. RESULT: Average follow up period was 4.12 years. Perioperative and postoperative course was uneventful in 16 patients. 2 patients had new ischemic attack probably due to intracerebral steal phenomenon during operation, 6 patients had neurologic symptoms due to change of hemodynamic flow pattern after successful EC-IC bypass that included temporary neurologic deficit in 4, postbypass occlusion of the preoperative stenosis of anterior cerebral artery in one and focal seizure in one. Long term follow up results of 24 patients were showing major deficit in one and minor deficit in two. All patients experienced no further ischemic or hemorrhagic events during follow up period. In postoperative angiogram, drastic diminution of basal moyamoya vessels, which are supposed to be responsible for hemorrhage, was observed in 15 of 18 patients(83%) who were capable of postoperative 3-6 months follow up angiogram. CONCLUSION: In case of adult moyamoya disease, direct bypass surgery is particularly important on the prevention of recurrent ischemic or hemorrhagic events. And a decrease in basal moyamoya vessels was induced significantly by direct bypass surgery, which may reduce the expected risk of hemorrhage effectively. But direct bypass in moyamoya disease had operative morbidity in high frequence. So, moyamoya disease patients who undergo direct revascularization should be monitored carefully during the perioperative and postoperative period.
Adult ; Anterior Cerebral Artery ; Cerebral Arteries ; Constriction, Pathologic ; Follow-Up Studies ; Hemodynamics ; Hemorrhage ; Humans ; Moyamoya Disease ; Neurologic Manifestations ; Seizures ; Stroke

OBJECTIVE: Extracranial-intracranial(EC-IC) bypass procedures have proved to be useful and safe in selected patients for revascularization. We have performed EC-IC bypass procedures in 170 patients with atherosclerotic cerebral ischemia and moyamoya disease. We analyzed the cases that had permanent complications after performing EC-IC bypass procedures in these 170 patients. METHODS: We performed ECIC bypass surgery during the recent 10 years for augmenting the cerebral blood flow in 170 patients with atherosclerotic cerebral ischemia and moyamoya disease. Of the 170 patients, the pathologic lesions were atherosclerotic cerebral ischemia in 125 and moyamoya in 45. All the patients were symptomatic and in a hemodynamic cerebral ischemic state, as diagnosed by the acetazolamide loading test. Superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis was performed in 158 cases and graft bypass with using the saphenous vein or radial artery was done in 12 cases. RESULTS: Of 170 patients who underwent bypass surgery, twenty four patients had postoperative neurologic deficits. Of these 24 patients, the neurologic deficits of 17 patients resolved completely within 3 weeks, but the remaining 7 patients (moyamoya in 5 patients and 2 patients were atherosclerotic) had permanent deficits. The probable causes of the permanent neurologic deficits were that bypass was done too soon after an ischemic attack or hemorrhage (3 cases), intracerebral steal phenomenon during anesthesia (2 case), postbypass thrombotic occlusion of the prebypass stenotic artery (1 case) and postbypass thromboembolism (1 case) CONCLUSION: Permanent neurologic deficits could complicate some cases following bypass surgery. The suggested causes of neurologic deficit were hypoperfusion and inappropriate CO2 tension in the blood and fluctuation of the blood pressure during the perioperative period. To prevent complications, maintain an appropriate perfusion pressure and blood pressure control and follow this with antiplatelet or anticoagulation therapy as soon as possible.
Acetazolamide ; Anesthesia ; Arteries ; Blood Pressure ; Brain Ischemia ; Cerebral Arteries ; Hemodynamics ; Hemorrhage ; Humans ; Ischemia ; Moyamoya Disease ; Neurologic Manifestations ; Perfusion ; Perioperative Period ; Radial Artery ; Saphenous Vein ; Thromboembolism ; Transplants