Mycotic aneurysms are produced by an infected embolus from vegetations on the heart valves in bacterial endocarditis, which breaks off and lodges in the cerebral blood vessels. The wall of the embolized vessel becomes infected, invasion by inflammatory cells and necrosis of the wall are often followed by rupture and formation of a aneurysmal sac. These aneurysms are very are in incidence and are usually located more peripherally in the vascular tree than berry aneurysms, are more irregular in shape and are not necessarily located at bifurcations. Recently we experienced a case of mycotic aneurysm with intracerebral hematoma which had developed in a subacute bacteria endocarditis patient. The patient was 44 years old male patient with dilated right pupil and left hemiplegia. He was treated surgically by evacuation of intracerebral hematoma and excision of mycotic aneurysm. We also experienced another case of mycotic aneurysm with intracerebral hematoma in 17 years old male patient who had been suffered from fever of unknown origin. He was also treated surgically. We now reports 2 cases of mycotic aneurysm with intracerebral hematoma with a brief review of the literatures.
Adolescent ; Adult ; Aneurysm ; Aneurysm, Infected* ; Bacteria ; Blood Vessels ; Embolism ; Endocarditis ; Endocarditis, Bacterial ; Fever of Unknown Origin ; Heart Valves ; Hematoma* ; Hemiplegia ; Humans ; Incidence ; Intracranial Aneurysm ; Male ; Necrosis ; Pupil ; Rupture

Massive transfusion may be defined as the acute administration of more than one and a half times of the patient's estimated circulating volume. Many of the problems associated with massive transfusion are due to the biologic changes of the stored blood with preservation which eventually replace the most of the recipient's circulating blood. In neurosurgical field, massive transfusion therapy is seldom necessary except in case of the operative intervention of meningioma, sinus rupture, aneurysm and large vessel injury from direct operative procedures. But the necessity of massive transfusion is getting increased recently with the improvement of neurosurgery and anestheology that permits the inoperable surgery in the past possible. On these basis. this article presents the case summary of the 3 patients who received massive transfusion during neurosurgical procedures and the brief review of the problems and their possible mechanisms associated with massive transfusion. The problems are acid-base disturbance, shift to the left of oxygen dissociation curve due to the decrease of 2,3-DPG, coagulopathy, shock lung and transmission of viral hepatitis through transfusion. To reduce these complication, the following managements will work well if properly handled. 1. Administer blood that is as fresh as possible. If available, prepare platelet concentrates. 2. Monitor platelet count, plasma fibrinogen level, partial thromboplastin time and clot for lysis after every 5 to 10 pints of blood administered. 3. Analyze arterial blood for PaCO2, PaO2 and pH after every 5 pints of blood transfusion to allow precise bicarbonate administration. 4. Monitor the EKG continuously to detect changes in potassium or calcium concentration and to correct immediately when indicated. 5. Warm all the blood before transfusion. 6. When the patient develops severe respiratory insufficiency with normocapneic hypoxemia and diffuse homogenous density due to parenchymatous infiltration, in the chest roentgenogram, consider the situation as the establishment of shock lung and treat with artificial respirator and oxygen.
2,3-Diphosphoglycerate ; Aneurysm ; Anoxia ; Blood Platelets ; Blood Transfusion ; Calcium ; Electrocardiography ; Fibrinogen ; Hepatitis ; Humans ; Hydrogen-Ion Concentration ; Meningioma ; Neurosurgery ; Neurosurgical Procedures ; Oxygen ; Partial Thromboplastin Time ; Plasma ; Platelet Count ; Potassium ; Respiratory Distress Syndrome, Adult ; Respiratory Insufficiency ; Rupture ; Surgical Procedures, Operative ; Thorax ; Ventilators, Mechanical

Massive transfusion may be defined as the acute administration of more than one and a half times of the patient's estimated circulating volume. Many of the problems associated with massive transfusion are due to the biologic changes of the stored blood with preservation which eventually replace the most of the recipient's circulating blood. In neurosurgical field, massive transfusion therapy is seldom necessary except in case of the operative intervention of meningioma, sinus rupture, aneurysm and large vessel injury from direct operative procedures. But the necessity of massive transfusion is getting increased recently with the improvement of neurosurgery and anestheology that permits the inoperable surgery in the past possible. On these basis. this article presents the case summary of the 3 patients who received massive transfusion during neurosurgical procedures and the brief review of the problems and their possible mechanisms associated with massive transfusion. The problems are acid-base disturbance, shift to the left of oxygen dissociation curve due to the decrease of 2,3-DPG, coagulopathy, shock lung and transmission of viral hepatitis through transfusion. To reduce these complication, the following managements will work well if properly handled. 1. Administer blood that is as fresh as possible. If available, prepare platelet concentrates. 2. Monitor platelet count, plasma fibrinogen level, partial thromboplastin time and clot for lysis after every 5 to 10 pints of blood administered. 3. Analyze arterial blood for PaCO2, PaO2 and pH after every 5 pints of blood transfusion to allow precise bicarbonate administration. 4. Monitor the EKG continuously to detect changes in potassium or calcium concentration and to correct immediately when indicated. 5. Warm all the blood before transfusion. 6. When the patient develops severe respiratory insufficiency with normocapneic hypoxemia and diffuse homogenous density due to parenchymatous infiltration, in the chest roentgenogram, consider the situation as the establishment of shock lung and treat with artificial respirator and oxygen.
2,3-Diphosphoglycerate ; Aneurysm ; Anoxia ; Blood Platelets ; Blood Transfusion ; Calcium ; Electrocardiography ; Fibrinogen ; Hepatitis ; Humans ; Hydrogen-Ion Concentration ; Meningioma ; Neurosurgery ; Neurosurgical Procedures ; Oxygen ; Partial Thromboplastin Time ; Plasma ; Platelet Count ; Potassium ; Respiratory Distress Syndrome, Adult ; Respiratory Insufficiency ; Rupture ; Surgical Procedures, Operative ; Thorax ; Ventilators, Mechanical

Although transitional vertebrae are relatively frequent in limbosacral area, it is generally accepted that one cannot state whether the transition is due to lumbarization of S1 or sacralization of L5 from simple lumbar X-ray film alone. However, for the practical purpose, the author attempted to obtain a possible method to determine the level of the lumbosacral spine in simple X-ray films through the analysis of the 100 operated patients and 25 lumbago and/or sciatica patients. Furthermore to determine the level of the intervertebral disc space in post-operative films, a silver clip was attached near the operated region and reviewed the post-operative findings in simple lumbar X-ray films. The results were as follows : 1) To determine the level of the interverbral disc space in simple lumber X-ray films, origin of the psoas muscle shadow can be utilized as a landmark with about 80% accuracy. But if one leave the silver clip at the operated region, he can state the level in 100% accuracy with the information of pre-operative symptoms. 2) Sacralization was 10% in operated cases, 6% in non-operated cases and lumbarization was 6% in operated cases, 3.2% in non-operated cases. Spina bifida was 12% in operated cases, 11.2% in non-operated cases. Lumbar rib was 2% in all of operated and non-operated cases.
Humans ; Intervertebral Disc* ; Low Back Pain ; Psoas Muscles ; Ribs ; Sciatica ; Silver ; Spinal Dysraphism ; Spine ; X-Ray Film

Eosinophilic gastroenteritis, which shows characteristic eosinophilic inflammation, involves any part of the intestine from esophagus to colon. The immunopathogenesis is expected to be associated with IgE-mediated or non-IgE-mediated reaction, but the precise mechanism is not revealed yet. The clinical manifestation is variably dependent on the extent of eosinophilic infiltration. Usually the symptoms, such as abdominal pain, diarrhea, vomiting, wax and wane for a few months result in failure to thrive, which implicates the importance of early detection. Although the diagnosis is made through clinical and histopathologic evidences, we should suspect the illness in a case of anemia, hypoalbuminemia, and peripheral eosinophilia. Recently, we experienced a case of non- IgE-mediated eosinophilic colitis in a 11-year-old male who complained of diarrhea, right lower abdominal pain, body weight loss, was diagnosed with peculiar histopathologic finding of sigmoid colon specimens obtained by sigmoidoscopy.
Abdominal Pain ; Anemia ; Body Weight ; Child* ; Colitis* ; Colon ; Colon, Sigmoid ; Diagnosis ; Diarrhea ; Eosinophilia ; Eosinophils* ; Esophagus ; Failure to Thrive ; Gastroenteritis ; Humans ; Hypoalbuminemia ; Inflammation ; Intestines ; Male* ; Sigmoidoscopy ; Vomiting

Metastatic malignant tumors involving the thyroid gland are not as unusual as was once believed. They may in fact be more common than primary cancer of the thyroid, especially if careful screening is performed at autopsy. The origins of primary neoplasms that metasta size to the thyoid are myriad, but reports obviously indicate predminantly cancers of the kidney, breast, and lung and malignant melanoma. Occasienally, metastatic lesions from several gastrointestinal neoplasms such as colo-retal and esophageal carcinoma are seen, but metastasis from gastric cancer is very rare. We have seen one case of thyroid cancer metastasized from the stomach cancer. It simultaneously spread to the breast also and confirmed with gastrofiberscopic biopsy, fine needle aspiration cytology of the thyroid and excisonal biopsy of the breast. We report this case with reriew of literature.
Autopsy ; Biopsy ; Biopsy, Fine-Needle ; Breast* ; Gastrointestinal Neoplasms ; Kidney ; Lung ; Mass Screening ; Melanoma ; Neoplasm Metastasis* ; Stomach Neoplasms* ; Thyroid Gland* ; Thyroid Neoplasms

Lymphadenitis is a common pediatric disease associated with infection and inflammation. Acute lymphadenitis in children is usually accompanied by systemic viral illness, and subsides within a few days to two weeks. However, chronic lymphadenopathy or lymphadenitis is a rare disease, and is due to a reactive response to infections including tuberculosis, neoplasms, and noninflammatory lesions. The diagnostic evaluation of chronic lymphadenitis may be very complicated and it is important to consider chronic infectious diseases and rare malignancies as possible etiologies. We report a 13-year old boy who was eventually diagnosed with tuberculous lymphadenitis. The patient was initially admitted for enlarged cervical, axillary, and epitrochlear lymph nodes. Biopsy of a cervical lymph node showed the findings compatible with angioimmunoblastic lymphadenopathy with dysproteinemia (AILD) associated with EBV infection. During treatment with prednisolone, the enlarged lymph node decreased in size. However, the lymph node enlargement resumed and we performed a second biopsy. At this time the biopsy showed tuberculous lymphadenitis and a culture of gastric juice showed M. tuberculosis. With the initiation of antituberculous treatment, the patient improved clinically.
Adolescent ; Biopsy ; Child ; Communicable Diseases ; Epstein-Barr Virus Infections ; Gastric Juice ; Herpesvirus 4, Human* ; Humans ; Immunoblastic Lymphadenopathy ; Inflammation ; Lymph Nodes ; Lymphadenitis* ; Lymphatic Diseases ; Male ; Prednisolone ; Rare Diseases ; Tuberculosis ; Tuberculosis, Lymph Node*

Lymphadenitis is a common pediatric disease associated with infection and inflammation. Acute lymphadenitis in children is usually accompanied by systemic viral illness, and subsides within a few days to two weeks. However, chronic lymphadenopathy or lymphadenitis is a rare disease, and is due to a reactive response to infections including tuberculosis, neoplasms, and noninflammatory lesions. The diagnostic evaluation of chronic lymphadenitis may be very complicated and it is important to consider chronic infectious diseases and rare malignancies as possible etiologies. We report a 13-year old boy who was eventually diagnosed with tuberculous lymphadenitis. The patient was initially admitted for enlarged cervical, axillary, and epitrochlear lymph nodes. Biopsy of a cervical lymph node showed the findings compatible with angioimmunoblastic lymphadenopathy with dysproteinemia (AILD) associated with EBV infection. During treatment with prednisolone, the enlarged lymph node decreased in size. However, the lymph node enlargement resumed and we performed a second biopsy. At this time the biopsy showed tuberculous lymphadenitis and a culture of gastric juice showed M. tuberculosis. With the initiation of antituberculous treatment, the patient improved clinically.
Adolescent ; Biopsy ; Child ; Communicable Diseases ; Epstein-Barr Virus Infections ; Gastric Juice ; Herpesvirus 4, Human* ; Humans ; Immunoblastic Lymphadenopathy ; Inflammation ; Lymph Nodes ; Lymphadenitis* ; Lymphatic Diseases ; Male ; Prednisolone ; Rare Diseases ; Tuberculosis ; Tuberculosis, Lymph Node*

PURPOSE: Due to its size and locatin, the liver is frequently injured in abdominal trauma. Recently, nonoperative management for liver injuries has been extended due to the development CT imaging, intensive care units, and their equipment and techniques. Herein, patients with traumatic liver injury were analyzed to evaluate its treatment and prognostic factors. METHODS: From 2001, January to 2003, July, 65 patients at our facility were confirmed to have traumatic liver injury. The operative or nonoperative managements were decided on the basis of the systolic blood pressure if no peritoneal irritation sign was noted. If the systolic blood pressure was stable, or recovered to within the normal range following hydration and transfusion at the emergency room, patients were managed nonoperatively. Hemodynamically unstable patients were managed operatively. The data were analysed using the SPSS program (Chi-squared tests and logistic regression analyses). RESULTS: 48 patients were treated nonoperatively, with 3 mortalities. The overall mortality rate was 15.8%, but only 6.4% in the nonoperative management group, compared to 67% in operative management group. In a Multivariate analysis the systolic blood pressure was found to be a reliable factor in traumatic liver injury and the mentality and ISS (injury severity score) reliable in finding complications in the nonoperative management group. The mentality was found statistically reliable for determining mortality in the operative management group, with the exception for the systolic blood pressure. CONCLUSION: The systolic blood pressure was an important indicator when considering the treatment plan in traumatic liver injury. An extensive study will be required that incorporates both nonoperative and operative management groups.
Blood Pressure ; Emergency Service, Hospital ; Humans ; Intensive Care Units ; Liver* ; Logistic Models ; Mortality ; Multivariate Analysis ; Reference Values

BACKGROUND: Surgical resection is generally accepted as the first choice of treatment for primary hepatic malignancy. But liver resection of primary hepatic malignancy is associated with a high incidence of recurrence, that has a poor prognosis. The goal of this research was to assess the rationale and result of treatment of recurrence following resection of primary hepatic malignancy. PATIENTS & METHODS: This was a retrospective study of 258 patients who had done hepatic resection with primary hepatic malignancy from 1990. Jan to 1999. Dec. And retrospective analysis of 72 patients with recurrent intrahepatic malignancy after hepatic resection. We exclude extrahepatic recurrence. The treatment methods of intrahepatic recurrence are variable. They include repeated hepatic resection, transcatheter arterial chemoembolization, percutaneous injection therapy of alcohol or hot saline, holmium-166 injection therapy, systemic chemotherapy and combined therapy. RESULTS: The cases of hepatic re-resection are 8, the cases of transcatheter arterial chemoembolization are 19, the cases of percutaneous injection therapy of alcohol or hot saline are 7, the cases of holmium- 166 injection therapy are 6, the cases of systemic chemotherapy are 13 and the cases of combined therapy are 13. In the poor general condition, 6 patients, only conservative therapy was applied. The survival rate of 72 patients with recurrent intrahepatic malignancy after hepatic resection is 61.6%, 46.6%, 33.5%, 26.9%, 15.5%, 2.7% at 3 month, 6 month, 9month, 1year, 2year, 3year. The survival rate of the cases of hepatic re-resection is 100%, 85.7%, 71.4%, 71.4%, 47.6%. The survival rate of transcatheter arterial chemoembolization is 89.5%, 73.0%, 61.8%, 61.8%, 44.1%. 11.0%. The survival rate of percutaneous injection therapy of alcohol or hot saline is 100%, 71.4%, 42.9%, 42.9%, 14.3%, 0%. The survival rate of holmium-166 injection therapy is 66.7%, 66.7%, 66.7%, 33.3%, 33.3%. The survival rate of systemic chemotherapy is 53.9%, 38.5%, 30.8%, 15.4%, 15.4%, 0%. The survival rate of combined therapy is 100%, 84.6%, 69.2%, 69.2%, 41.5%, 0%. And the survival rate of conservative therapy is 54.1%, 39.8%, 19.9%, 14.2%, 7.6%, 3.8%. CONCLUSION: We got results that the hepatic resection, holmium-166 injection therapy, and transcatheter arterial chemoembolization combined therapy were better than systemic chemotherapy and percutaneous injection therapy of alcohol or hot saline in longterm survival rate.
Drug Therapy ; Humans ; Incidence ; Liver ; Prognosis ; Recurrence* ; Retrospective Studies ; Survival Rate