Recently, many authors have reported about the relationship of the volumes of hemorrhage in the brain parenchyma, hemorrhagic sites, optimal operation time, and the effects of mannitol and steroid on control of ICP to clinical manifestations. Many attempts to measure ICP in hydrocephalus, brain tumor, and head injury have been reported. But the measurements of intracranial pressure in spontaneous intracerebral hemorrhage are rare. Intracranial pressure was monitored prospectively in 30 patients who had stereotaxic surgery for spontaneous intracerebral hemorrhage. The results are as follows. 1. Intracranial pressure was increased in high PaCO₂. 2. There were no correlation in ICP, rebleeding and ADL ad discharge (P>0.05). 3. ICP was the most high level in 72 hours after operation. 4. There was 63.2% decrease in ICP after irrigation with 6000 IU urokinase in the site of hemorrhage. 5. There was no correlation between the numbers of natural drainage and ADL at discharge (P>0.05). 6. The higher the initial GCS, the higher the postoperative GCS.
Activities of Daily Living ; Brain ; Brain Neoplasms ; Cerebral Hemorrhage* ; Craniocerebral Trauma ; Drainage ; Hemorrhage ; Humans ; Hydrocephalus ; Intracranial Pressure* ; Mannitol ; Prospective Studies ; Urokinase-Type Plasminogen Activator

Injection of the tissue adhesive Histoacryl (N-butyl-2-cyanoacrylate, enbucrilate) has been more effective than conventional sclerosants in the treatment of active upper G-I bleeding. Histoacryl is an effective sclerosant that is polymerized immediately after contact with blood, and has been used for the treatment of bleeding gastric and esophageal varices. We present here a case of infarction of the caudate lobe that developed after an injection of a Histoacryl -Lipiodol mixture for the hemostasis of duodenal ulcer bleeding.
Duodenal Ulcer* ; Enbucrilate* ; Esophageal and Gastric Varices ; Hemorrhage* ; Hemostasis ; Infarction* ; Liver* ; Polymers ; Sclerosing Solutions ; Tissue Adhesives

OBJECTIVE: The goal of our study was to identify and evaluate risk factors for late post-traumatic seizure. METHODS: This study is a retrospective clinical analysis of 52cases of late post-traumatic seizures among 1472 head injury patients treated in our institute from July 1986 to June 1996 and at least followed up over 2 years after head injury. RESULTS: 1) The incidence of late post-traumatic seizure was 3.5% of patients treated for head injury. 2) The factors affecting the incidence of late post-traumatic seizure were initial low Glasgow coma scale(3-8), subdural hematoma, depressed skull fracture(p<0.05). 3) Skull fracture located in temporal area showed higher incidence of late post-traumatic seizure(p<0.05). CONCLUSION: The risk factors for post-traumatic seizure are subdural hematoma, initial low Glasgow coma scale, depressed skull fracture and temporal bone fracture. Both newer antiepileptic drugs and therapies aimed at prevening the brain damage that underlies the development of seizures need to be studied to find an effective way of preventing late post-traumatic seizure through prospective study.
Anticonvulsants ; Brain ; Coma ; Craniocerebral Trauma ; Epilepsy, Post-Traumatic* ; Glasgow Coma Scale ; Hematoma, Subdural ; Humans ; Incidence ; Retrospective Studies ; Risk Factors* ; Seizures ; Skull ; Skull Fracture, Depressed ; Skull Fractures ; Temporal Bone

Clinical and cerebral angiographic findings were reviews retrospectively in thirty-seven patients with intracranial artero-venous malformation(AVM). The results were as follow. Many opatients who were in reproductive age had visited due to seiure(27%) and its angiographic findings were mixed Type(80%). Bleeding was predominant in the patients who had small sized nidus than medium or large one, and deep draining vein than superficial one. Medium sized AVM was located mainly in the anatomically deep portion(71%) and drained to deep portion also(71%). Associated aneurysm was more prevalent in deep seated or large sized AVM. Low grade AVM according to Spetzler's grading system showed good results of treatment. Postoperative hemorrhage or sizure were frequently found in patients who had superfically located AVM.
Aneurysm ; Hemorrhage ; Humans ; Intracranial Arteriovenous Malformations* ; Postoperative Hemorrhage ; Retrospective Studies ; Veins

Astrocytoma in the thalamus in not so frequent in incidence (1%). Moreover, bilateral thalamic tumor is rare. Certain tumors of the thalamus are considered resectable but most of thalamic tumors are thought to be untouchable. Bilateral thalamic astrocytoma with hydrocephalus was diagnosed by stereotactic biopsy and ventriculoperitoneal shunt operation was done with result of improvement. We report a case of astrocytoma in the bilateral thalamus with literature review.
Astrocytoma* ; Biopsy ; Hydrocephalus ; Incidence ; Thalamus* ; Ventriculoperitoneal Shunt

The authors report the problems of treatment in 37 consecutive cerebralarteriovenous malformations(AVM's) who underwent embolization, operation, combined treatment, or conservative care. The preoperative embolization is an integral part of the multidisciplinary treatment protocol for patients with cerebral AVM's. Life threatening intracerebral hematoma caused by bleeding from AVM's will be managed effectively with stereotactic Urokinase irrigation for urgently reducing the increased intracranial pressure and getting a time to change emergent to elective surgery. We also discussed the problems along the management of cerebral AMV's.
Clinical Protocols ; Hematoma ; Hemorrhage ; Humans ; Intracranial Arteriovenous Malformations* ; Intracranial Pressure ; Urokinase-Type Plasminogen Activator

Recently various kinds of anterior or posterior cervical instruments have been used for stabilization of unstable cervical spinal injury. Every device has different characteristics, so none can cover all of the various types of unstable injuries. Forty six patients of unstable cervical spine fracture and subluxation underwent stabilizing operation using the anterior Caspar plate(6 cases) and the Roy-Camille posterior plate system(40 cases) during recent 3-years. Each approach employed depends on the site of compression and mechanism of injury. Six patients who had complete neurological injury expired after the surgery. The follow-up period for the 40 patients was from 5 to 32 months(average-17.5 months). During follow-up period, 16 out of 22 patients(72.7%) who had a neurological deficit showed minimal to moderate improvement and only 4 patients(10%) complained of significant arm or neck pain. The only complication of instrumentation was 5 cases of screw breakout, but 3 of them did not have any problem. Radiologically 37 patients(92.5%) had firm fixation after surgery.
Arm ; Follow-Up Studies ; Humans ; Neck Pain ; Spinal Injuries ; Spine*

OBJECTIVE: The purpose of this study is to determine the time evolution and distribution of cerebral apoptosis using the middle cerebral artery occlusion model in rats. METHODS: A total of twenty four male rats - with 2, 3, 4, 6, 8, 12, 24 and 48 hours of middle cerebral artery occlusion respectively - were studied. The terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick-end labeling(TUNEL) method was used for the observation of the apoptotic cells. The apoptotic ratio was calculated and the distribution of apoptosis was inspected in the pyriform cortex, basal ganglia and middle cerebral artery territory cortex. The rats were divided into three groups(Group I: 2~4 hours of occlusion, Group II: 6~12 hours of occlusion, Group III: 24~48 hours of occlusion). RESULTS: In this study, the proportion of apoptosis increased with the duration of middle cerebral artery occlusion and reached a maximum after about 12 hours of middle cerebral artery occlusion. The mean values of the apoptotic ratio were 30.7+/-11.3% in group I, 60.8+/-2.6% in group II and 48.7+/-0.7% in group III. The distribution of apoptosis differed in the pyriform cortex, basal ganglia and middle cerebral artery territory cortex according to the duration of time of the middle cerebral artery occlusion. CONCLUSION: In the middle cerebral artery occlusion model of the rats, apoptosis is found to increase according to the occlusion time, reaching a peak after 6 hours, and the distribution of apoptosis changed from the pyriform cortex to the basal ganglia and middle cerebral artery territory cortex.
Animals ; Apoptosis* ; Basal Ganglia ; Deoxyuridine ; Humans ; Infarction, Middle Cerebral Artery* ; Ischemia ; Male ; Middle Cerebral Artery* ; Rats*

BACKGROUND: The bcr-abl gene rearrangement is a very important genetic marker in at least 95% of cases of chronic myeloid leukemia (CML). The technique that allows the detection of bcr-abl gene rearrangement seem to be the testing for the diagnoses and the detection of minimal residual disease (MRD) and may help in monitoring patients. Recent introduction of real-time quantitative PCR should eventually allow actual quantification of the target gene during amplification. In the present study, we investigated bcr-abl chimeric mRNA quantification in CML after bone marrow transplantation (BMT) by real-time RT-PCR and its clinical applicability to the decision of therapeutic intervention. METHODS: The subjects were a consecutive series of 9 CML patients with serial quantification of bcr-abl chimeric mRNA by real-time RT-PCR in peripheral blood or bone marrow aspirates. The sensitivity of real-time RT-PCR was compared to conventional RT-PCR and then the correlation with FISH results was analyzed. RESULTS: Seventeen bone marrow samples and 40 peripheral bloods were obtained from patients. The sensitivity of real-time RT-PCR was 10(-6) and positive signals were detected in negative cases by conventional RT-PCR. A significant correlation between the bcr-abl/G6PDH ratio by real-time RT-PCR and the proportion of positive cells for bcr-abl gene rearrangement by FISH was obtained (r=0.64). In the serial blood and bone marrow specimens, we found a progressive decrease in the bcr-abl/G6PDH ratio in all the patients. CONCLUSIONS: Our findings indicated that quantitative analysis of bcr-abl chimeric mRNA by real-time RT-PCR might be a useful tool for the monitoring of minimal residual disease in bcr-abl positive leukemic patients.
Bone Marrow ; Bone Marrow Transplantation* ; Diagnosis ; Gene Rearrangement ; Genetic Markers ; Humans ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive* ; Neoplasm, Residual ; Polymerase Chain Reaction ; Real-Time Polymerase Chain Reaction* ; RNA, Messenger

A case of acute biphenotypic leukemia with mixed blast morphology and combined myeloid and T-lymphoid features is reported. The leukemic cells consisted of small to medium sized hand mirror shaped blasts and large blasts with cytoplasmic granules and some cytoplasmic inclusion bodies. The blast cells were found to be immature T-lymphoid cells(CD2+ and CD7+) that also expressed the myeloid antigens such as CD13 and CD33. In the review of the literatures, additional cases of acute mixed leukemia-hand mirror variant show strong expression of adhesion moleules such as CD2, CD7, and CD11b. Cytogenetic studies revealed a trisomy 4 previously described in acute undifferentiated myeloblastic leukemia with hand-mirror cells. This case represents a morphologically and phenotypically distinct subtype of acute biphenotypic leukemia with hand mirror morphologic features. Adult acute leukemia cases with hand mirror morphology should be considered the possibility of mixed lineage leukemia and processed further studies.
Adult* ; Cytogenetics ; Cytoplasmic Granules ; Granulocyte Precursor Cells ; Hand ; Humans ; Inclusion Bodies ; Leukemia ; Leukemia, Biphenotypic, Acute ; Trisomy