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

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

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*

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

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

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

BACKGROUND/AIMS: The rate of laparoscopic appendectomy has been gradually increasing. The following studies were conducted to compare laparoscopic appendectomy (LA) with open appendectomy (OA). METHODS: We compared retrospectively 48 patients in the LA group with 135 patients in the OA group, all of whom were operated at Anam hospital, Korea University, from January 1996 to January 1997. Documentation included information such as age, sex, diagnostic method, postoperative diagnosis, misdiagnosis rate, operative time, conversion to open appendectomy, analgesics injection, hospital stay, and complicatians. RESULTS: 1) The mean age and male to female ratio were 28.5 years and 1: 2.4 in LA group, and 34.1 years and 1: 1.1 in OA group, respectively. 2) An abdominal sonogram was perfomed in 18.8% of the LA group and 28.9% in OA group (p < 0.05). 3) The operative time was 68.4 minutes in the LA group and 53.7 minutes in the OA group (p<0.05). 4) The number of analgesic injections was 1.23 in the LA group and 2.65 in the OA group (p<0.05). 5) The postoperative hospital stay was 3.38 days in the LA group and 3.84 days in the OA group (p > 0.05). 6) The complication rate was 10.9% in the LA group and 15,5% in the OA group (p >0.05), but the wound infection rate was 2.2% in the LA group and 8.5% in the OA group (p<0.05). CONCLUSIONS: LA is a safe and effective operation for acute appendicitis, and is particularly superior to OA in regard to diagnosis, postoperative pain, wound infection, and cosmetic benefits.
Analgesics ; Appendectomy* ; Appendicitis ; Diagnosis ; Diagnostic Errors ; Female ; Humans ; Korea ; Length of Stay ; Male ; Operative Time ; Pain, Postoperative ; Retrospective Studies ; Wound Infection