Solid hemangioblastomas of the medulla oblongata are benign vascular neoplasms located in a critical area. We experienced a case of solid hemangioblastoma originated in the medulla oblongata with the syrinx in the cervical spinal cord. Preoperative magnetic resonance imaging provided precise anatomical location and radiologic features of the tumor, which facilitated its total removal. Cardiovascular and pulmonary disorders often complicate this type of surgery, and postoperative dysphagia is a frequent sequelae.
Deglutition Disorders ; Hemangioblastoma* ; Magnetic Resonance Imaging ; Medulla Oblongata* ; Spinal Cord ; Vascular Neoplasms

To achieve optimal decalcification in tissue and tissue preservation, we have tried magnetic field method and made some promising results. We used pulsed unipolar magnetic field obtained by rectification of 250 V-60 cycle, A.C. As a new method of bony decalcification, using 5% nitric acid, 10% formic acid and 10% formic acid+3% hydrochloric acid solutions, experimental groups were decalcified in the center of the magnetic field. The concentration of calcium ion in the decalcifying solution was measured by calcium-oxalate turbidity test by photometry method, and direct visualization of calcium radiopacity was obtained by soft X-ray view during the decalcification process. The pH change during decalcification was continuously checked and needle penetration method was also used. All the decalcification solution used in this study showed accelerated effect of bony decalcification in the strong magnetic field. Among them 5% nitric acid produced complete decalcification for the medium size bony specimen (less than 10x10x10 mm) within 24 hours, and the histologic feature was almost free of acid-chemical degeneration. The pH of all the decalcification solutions decreased in the strong magnetic field, maximum within 4~6 hours, and kept strong acidity throughout the decalcification procedure. After removal of the magnetic field the pH of all the decalcification solution returned to their original values after 24 hours. It was presumed that the cause of the accelerated decalcification in the magnetic field was due to combined effects of the rapid increase of acidity and the increased molecular resonance to stimulate the ionization of mineral elements.

The management of pineal region tumors remains controversial. Advocates of a conservative approach emphasize the excellent results of radiotherapy, particularly with germinoma, while a number of recent reports have demonstrated the safety of direct surgery. We analyzed 8 cases of pineal region tumors which had been treated at our institution over the past 7 years. Tissue diagnosis was obtained in 3 patients before irradiation and 5 patients underwent irradiation without histological diagnosis. Among 5 irradiated patients initially, four patients had been achieved complete remission by radiotherapy thus they were presumptively germinoma, but other one patient had no response, so she had been underwent surgery. Among 3 biopsy proven cases, 2 were teratoma and other one was embryonal carcinoma. Complete gross microsurgical excision of well encapsulated tumor was possible in two teratoma cases. MRI and other neuroradiological studies have ben found to be useful in indicating the biological nature and histological type of pineal tumor. So, consideration of MRI scans together with tumor markers and response to small dose irradiation will generally allow a specific diagnosis with a high degree of probability. In this way, germinomas may be selected for radiotherapy and the tumor less likely to response may be subject to primary surgery to obtain complete tumor extirpation or tissue diagnosis.
Biopsy ; Carcinoma, Embryonal ; Diagnosis ; Germinoma ; Humans ; Magnetic Resonance Imaging ; Pinealoma ; Radiotherapy ; Teratoma ; Biomarkers, Tumor

PURPOSE: To evaluate the outcome and efficacy of transobturator adjustable (TOA) tape sling operations on women with intrinsic sphincter deficiency (ISD) and/or detrusor underactivity (DU) combined with stress urinary incontinence (SUI). MATERIALS AND METHODS: This retrospective analysis comprised 60 TOA patients. 30 patients hadDU (Qmax < 15ml/s) and/or ISD (Valsalva leak point pressure;VLPP < 60cmH20) on the preoperative UDS and the rest only had SUI. I-QoL, visual analog scale (VAS), Patient's Perception of Urgency Severity (PPUS), and Self-Assessment/Sandvik Questions were performed before and 1 year after surgery. The mesh tension was controlled at 1 day after surgery. The objective cure rate was defined as no leakage using the cough test with a full bladder. RESULTS: Patients were divided into two groups: Group A:SUI with ISD and/or DU, n=30; Group B:only SUI without ISD and DU, n=30. The two groups showed a difference in Qmax and VLPP preoperatively. Objective success rates were 18 (60.0%) completely cured, 10 (33.3%) improved in Group A, and 23 (76.7%) completely cured, 7 (23.3%) improved in Group B. Three cases needed tape-tension adjustment due to urinary leakage one-day after surgery (2 in Group A, 1 in Group B). There was no postoperative urinary retention. CONCLUSIONS: After TOA for SUI with ISD and/or DU, 3 cases were needed tension adjustment after surgery. TOA procedures seem to be effective and safe, more clinical studies with long-term follow up are required for a definite conclusion.
Cough ; Female ; Follow-Up Studies ; Humans ; Retrospective Studies ; Suburethral Slings ; Urinary Bladder ; Urinary Incontinence ; Urinary Retention ; Urodynamics

PURPOSE: Klinefelter syndrome (KS) is related to testicular insufficiency, which causes low testosterone levels in serum. Generally, sex hormone levels and bone mineral density (BMD) are lower in patients with KS than normal. We investigated the effects of testosterone replacement on serum testosterone levels and BMD in KS patients. MATERIALS AND METHODS: From December 2005 to March 2008, 18 KS patients with a 47, XXY karyotype were treated with initial intramuscular injections of long-acting testosterone undecanoate (Nebido(R), 1000 mg/4 mL) at baseline and second injections after six weeks. An additional four injections were administered at intervals of 12 weeks after the second injection. BMD was measured at the lumbar spine (L2-4), the left femoral neck and Ward's triangle, using dual energy X-ray absorptiometry. Medical histories, physical examinations and prostate specific antigen, hematology and serum chemistry were conducted for each patient. In addition, total testosterone and sex hormone-binding globulin levels were measured. RESULTS: Following testosterone replacement, mean serum total testosterone increased significantly from baseline (0.90 vs. 4.51 ng/mL, p<0.001), and total testosterone rose to normal levels after replacement in all patients. The mean BMD of the lumbar spine increased significantly (0.91 vs. 0.97 g/cm2, p<0.001). Similar increases of BMD were also observed at the femoral neck, but this increase was not significant. CONCLUSION: These findings suggest that testosterone replacement therapy may be effective in treating BMD deficiency in men with testosterone deficiency, especially those with Klinefelter syndrome.
Adult ; Bone Density/*drug effects ; Female ; Hormone Replacement Therapy/*methods ; Humans ; Klinefelter Syndrome/*drug therapy ; Male ; Testosterone/*therapeutic use

Osteopetrosis is a rare disease by a generalized increase in skeletal density and by abnormalities of bone modeling secondary to defective osteoclastic function with impairment of bone resorption. The various cranial nerve palsies may occur secondary to bony encroachment on the cranial foramina. The authors report a case of osteopetrosis with trigeminal neuralgia. This 30-year-old woman presented with the recurring attacks of severe lancinating paroxysmal pain on her right face(mandibular division>maxillary division>ophthalmic division) for 10 years and anosmia, both blindness for 20 years. Her foramen ovale and optic canal narrowings were caused by osteopetrosis. The neuralgia was refractory to medical treatment. Percutaneous radio-frequency rhizotomy for trigeminal neuralgia was performed and pain relief have been obtained. She was satisfied with the procedure, even if with facial numbness. In the case of trigeminal neuralgia in young patient without abnormal mass lesion on brain radiologic imaging studies, it is important to investigate the bony abnormalities of skull base. The authors believe that radiofrequency rhizotomy is the first choice of treatment for trigeminal neuralgia caused by the bony abnormalities of skull base such as osteopetrosis.
Adult ; Blindness ; Bone Resorption ; Brain ; Cranial Nerve Diseases ; Female ; Foramen Ovale ; Humans ; Hypesthesia ; Neuralgia ; Olfaction Disorders ; Osteoclasts ; Osteopetrosis* ; Rare Diseases ; Rhizotomy ; Skull Base ; Trigeminal Neuralgia*

PURPOSE: To define the causes of obstructive azoospermia (OA) and evaluate the possibility and efficacy of microsurgical correction. MATERIALS AND METHODS: Sixty-seven patients diagnosed as OA with normal spermatogenesis preoperatively and initially planned to microsurgical vasoepididymostomy from December 2003 and November 2009 were retrospectively analyzed. Causes of OA were analyzed and patency rate and pregnancy outcomes of their female partners were measured. RESULTS: Thirty-one patients (46.3%) could not correct their OA because of obstruction of the distal vas deferens, epididymal atrophy and/or hypotrophy and vasal injury due to previous surgery. Among the 36 patients undergone microsurgical vasoepididymostomy (mean age of patients and their female partners were 32.9 and 31.3 years, respectively), 32 patients (88.9%) were corrected bilaterally and 4 patients (11.1%) unilaterally. The overall patency rate was 17 patients (47.2%); being 15 and 2 patients for bilateral and unilateral procedure, respectively. Among the 17 patients regained the patency after surgery, except 3 cases without followed up, 6 cases achieved natural pregnancy and also 6 cases achieved the pregnancy using the assisted reproduction. CONCLUSIONS: According to the affected point of reproductive tract, not all men with obstructive azoospermia were candidates for microsurgical reconstruction. However, reasonable outcomes were achieved in the microsurgical reconstruction cases and it should be primary therapeutic method in obstructive azoospermia. For those in whom reconstruction is not a viable option, surgical methods for sperm retrieval are available to have their own biological children.
Atrophy ; Azoospermia ; Child ; Epididymis ; Female ; Humans ; Male ; Microsurgery ; Pregnancy ; Pregnancy Outcome ; Retrospective Studies ; Sperm Retrieval ; Spermatogenesis ; Vas Deferens

A 27-year-old woman suffered a sudden visual disturbance in the right eye. The right eye had a visual acuity of 0.02 and a relative afferent pupillary defect. A visual-field examination revealed an inferotemporal field defect in the right eye. A fundus examination revealed no abnormalities that were responsible for the visual-field defect. Multifocal electroretinography showed decreased responses in the right eye at the corresponding area with the visual-field defect. She was diagnosed as acute zonal occult outer retinopathy.
Adult ; Electroretinography ; Eye ; Female ; Fluconazole ; Humans ; Optic Neuritis ; Pupil Disorders ; Scotoma ; Visual Acuity

A 47-year-old patient with diabetes mellitus was admitted with the complaints of sore throat and dysphagia. We performed an esophagogastroduodenoscopy and found esophageal ulcers. Histological examination of the esophageal biopsy revealed sulphur granules, and immunological findings ruled out viral infection. Thus, we diagnosed an isolated actinomycotic infection of the esophagus and treated the infection with oral amoxicillin. This case illustrates that actinomycotic infection of the esophagus can occur in immunocompetent patients. Therefore, when evaluating dysphagia, the probability of actinomycotic infection must be considered not only in immunocompromised patients, but in immunocompetent individualswith diabetes mellitus.
Actinomycosis ; Amoxicillin ; Biopsy ; Deglutition Disorders ; Diabetes Mellitus ; Endoscopy, Digestive System ; Esophagitis ; Esophagus ; Humans ; Immunocompromised Host ; Middle Aged ; Pharyngitis ; Ulcer

OBJECTIVE: The aim of this study is to investigate the various causes of male infertility using multiple approaches. METHODS: Nine-hundred-twenty infertile male patients were analyzed at their first visit with one physician between January 1 and December 31, 2009. All patients were subjected to physical examination, semen analysis and azoospermic patients underwent hormonal testing, chromosomal tests, and testicular biopsy. Semen analysis was based on the definition of the World Health Organization. RESULTS: Among the 920 patients, 555 patients (60.3%) had semen results within the normal range, 269 patients (29.2%) within the abnormal range, and 96 (10.5%) were diagnosed with azoospermia. Varicoceles were diagnosed in 84 of the 555 normal-range patients (15.1%) and in 113 of the 269 abnormal-range patients (42.0%). Of the 96 patients with azoospermia, 24 patients (25%) were diagnosed with obstructive azoospermia, 68 patients (71%) with non-obstructive azoospermia, and 4 patients (4%) with retrograde ejaculation. CONCLUSION: Various causes of male infertility have been reported and diverse treatment methods can be adopted for each cause. In this regard, research must be conducted on a larger number of patients to accurately assess the various causes of infertility in Korean patients and to investigate various infertility treatment methods.
Azoospermia ; Biopsy ; Humans ; Infertility ; Infertility, Male ; Korea ; Male ; Physical Examination ; Reference Values ; Semen ; Semen Analysis ; Varicocele ; World Health ; World Health Organization