We report a case of irreducible atlantaxial dislocation with spinal cord injury. The patient was a 36-year-old man who suffered from the sudden onset of shallow respiration and severe motor weakness after slip down. We have performed the one-stage operation, the transoral decompression, reduction and posterior interspinous wiring with bone fusion. Three weeks after surgery, the reduction state and posterior wiring procedure were failed, due to severe osteoporotic change. So, we have performed second operation, the transarticular facet screw fixation and occipito-cervical fixation with Steinmann pin, from which good postoperative stability and neurological improvements, were obtained.
Adult ; Decompression* ; Dislocations* ; Humans ; Osteoporosis ; Respiration ; Spinal Cord Injuries* ; Spinal Cord*

188 consecutive cases with basilar skull fractures(BSF) out of 2676 head injury patients who were treated in Chung-Ang Gil Hospital from July 1993 to June 1995, were analyzed. These fractures are difficult to diagnose by ordinary X-ray examinations, routine head computed tomography(CT) and are frequently inferred by clinical signs. Therefore, it's diagnosis is somtimes delayed or missed in initial assessment of trauma patients. They are different from cranial vault fractures in several aspects other than difficulties in the diagnosis. It involves more commonly the cranial nerves(CN), makes cerebrospinal fluid(CSF) fistulae and leads to central nervous system(CNS) infections if the CSF fistulae are not detected or treated early and properly. The authors reviewed the clinical features, radiological findings, rate of delayed diagnosis, complications and outcomes. The most common feature of BSF was otorrhea(64.4%) and followed by rhinorrhea(39.4%), raccoon eye(32.4%) and hemotympanum(24.5%). In only 6.4% of cases, the fracture lines were detected by ordinary skull radiographs and diagnosed as BSF. In contrast, the high resolution skull base CT confirmed the fractures in 62.2%. Clinical diagnoses were made in 14.9%. Commonly combined craniofacial lesions were cranial vault fractures(51.1%), intracranial hemorrhages(46.3%), and facial bone fractures(34.0%). Most of CSF leakages(89.7%) were noted within 24 hours after injury and most of the leakages (87.7%) had ceased by conservative management within 2 weeks, but 5.1% that did not respond to conservative treatment and lumbar CSF drainage, needed invasive operative repair. The incidence of meningitis was 3.2% and the prophylactic antibiotics had no benificial effect on lowering the infection rate. Facial nerve was the most frequently involved cranial nerve followed by vestibulo-cocchlear, oculomotor, and olfactory nerve in decreasing order of frequency. The onset of facial palsy was immediate in 31.8% and the remainder were delayed more than 24 hours after head injury. Of 188 patients, 21 cases(11.2%) were delayed in the diagnosis of BSF.
Anti-Bacterial Agents ; Cranial Nerves ; Craniocerebral Trauma ; Delayed Diagnosis ; Diagnosis ; Drainage ; Facial Bones ; Facial Nerve ; Facial Paralysis ; Fistula ; Head ; Humans ; Incidence ; Meningitis ; Olfactory Nerve ; Raccoons ; Skull ; Skull Base ; Skull Fracture, Basilar*

We report a series of 19 consecutive patients with post-traumatic cerebral infarction. Post-traumatic cerebral infarction(PTCI) was diagnosed by CT within 24 hours of admission in 6 cases and up to 14 days after admission in 13 cases of 1092 patients who required cranial CT for trauma during the period. The frequency, vaascular territories, cause, and mortality rate of post traumatic cerebral infarction were discussed.
Cerebral Infarction* ; Humans ; Mortality

OBJECTIVE: This paper describes our experience and implant technique for cranioplasty of a large cranial defects using a porous polyethylene implant(Medpor) and compares the results with polymethylmethacrylate(PMMA). METHODS: Sixteen cranioplasties were performed using Medpor(n=10) and PMMA(n=6) implants between June 2003 and January 2005. The criterion for patient enrollment was a defect larger than 10cm in diameter. This study compared the operation times and complications. RESULTS: The operation times ranged from 105 to 250minutes(Mean 180 degrees +/-44minutes) in Medpor and from 185 to 460minutes (mean 128minutes) in PMMA. The absolute operation times were shorter using the Medpor implant and the differences were statistically significant(P=0.030). Satisfactory cosmetic results were obtained in all cases using the Medpor implant and with no implant-related complications. Bone ingrowth to the medpor implant was presumed to be the result on an increase in Houndsfield units of the implant, particularly at the marginal areas in the serial follow-up brain computed tomography images. CONCLUSION: It is believed that the properties of a Medpor implant make this implant an good alternative to the existing methods of a cranial contour correction. However, a further follow-up study will be needed.
Brain ; Follow-Up Studies ; Humans ; Polyethylene* ; Polymethyl Methacrylate

Carboplatin intra-arterial chemotherapy(IAC) has an advantage of increased uptake during the first passage of the drugs through tumor capillaries. Although not common, this type of therapy is known to cause neurological complications, myelosuppression, and ototoxicity. However, the incidence of ocular toxicity is reported to be rare. Eleven of our patients with glioma(Grade II Astrocytoma: 3, Grade III Astrocytoma: 1, Grade IV Astrocytoma: 5, Gliofibroma: 1, Oligodendroglioma: 1) underwent IAC regimen with carboplatin(300mg/m2) which were administrated after blood-brain barrier disruption. Of there, 3 patients had ocular complications after supra-ophthalmic IAC injection of carboplatin but fully recovered following steroid therapy. Although our results from IAC seem to be favorable for these patients, we suggest that its complications, such as ocular toxicity, need to be carefully considered prior to treatment.
Astrocytoma ; Blood-Brain Barrier ; Capillaries ; Carboplatin* ; Glioblastoma ; Glioma* ; Humans ; Incidence ; Oligodendroglioma

We report a case of intracranial dissemination developing approximately 4 months after partial removal of a spinal cord anplastic astrocytoma in a 22-year-old male. He presented with paraplegia on initial admission at a local hospital. Spinal magnetic resonance (MR) images disclosed multiple intramedullary lesions at the T3-11. The tumor was partially removed. The final histologic diagnosis was anaplastic astrocytoma. Four months after the operation, he was admitted with the symptoms of headache and deterioration of consciousness. MR images showed enhanced lesions in the anterior horn of the left lateral ventricle, and septum pellucidum. He underwent computed tomography-guided stereotactic biopsy and histological appearance was consistent with anaplastic astrocytoma. The clinical course indicates that the tumor originated in the spinal cord and extended into the subarachnoid space, first the spinal canal and later intracranial.
Animals ; Astrocytoma ; Biopsy ; Consciousness ; Headache ; Horns ; Humans ; Lateral Ventricles ; Magnetic Resonance Spectroscopy ; Male ; Paraplegia ; Septum Pellucidum ; Spinal Canal ; Spinal Cord ; Subarachnoid Space ; Young Adult

Macrophages play a key role in iron metabolism by recycling iron through erythrophagocytosis. Ferroportin-1 (FPN1) is a transporter protein that is known to mediate iron export from macrophages. Since divalent metals often interact with iron metabolism, we examined if divalent metals could regulate the expression of FPN1 in macrophages. J774 macrophage cells were treated with copper, manganese, zinc, or cobalt at 10, 50, or 100 microM for 16 to 24 h. Then, FPN1 mRNA and protein levels were determined by quantitative real-time PCR and Western blot analyses, respectively. In addition, effects of divalent metals on FPN1 promoter activity were examined by luciferase reporter assays. Results showed that copper significantly increased FPN1 mRNA levels in a dose-dependent manner. The copper-induced expression of FPN1 mRNA was associated with a corresponding increase in FPN1 protein levels. Also, copper directly stimulated the activity of FPN1 promoter-driven reporter construct. In contrast, manganese and zinc had no effect on the FPN1 gene expression in J774 cells. Interestingly, cobalt treatment in J774 cells decreased FPN1 protein levels without affecting FPN1 mRNA levels. In conclusion, our study results demonstrate that divalent metals differentially regulate FPN1 expression in macrophages and indicate a potential interaction of divalent metals with the FPN1-mediated iron export in macrophages.
Blotting, Western ; Cobalt ; Copper ; Gene Expression ; Ions ; Iron ; Luciferases ; Macrophages ; Manganese ; Metals ; Real-Time Polymerase Chain Reaction ; Recycling ; RNA, Messenger ; Zinc

Cadmium intoxication has been associated with the dysregulation of iron homeostasis. In the present study, we investigated the effect of cadmium on the expression of ferroportin 1 (FPN1), an important iron transporter protein that is involved in iron release from macrophages. When we incubated cadmium with J774 mouse macrophage cells, FPN1 mRNA levels were significantly increased in a dose- and time-dependent manner. Furthermore, the cadmium-induced FPN1 mRNA expression was associated with increased levels of FPN1 protein. On the other hand, cadmium-mediated FPN1 mRNA induction in J774 cells was completely blocked when cells were co-treated with a transcription inhibitor, acitomycin D. Also, cadmium directly stimulated the activity of the FPN1-promoter driven luciferase reporter, suggesting that the cadmium up-regulates FPN1 gene expression in a transcription-dependent manner. Finally, cadmium exposure to J774 macrophages increased intracellular reactive oxygen species (ROS) levels by ~ 2-fold, compared to untreated controls. When J774 cells were co-treated with antioxidant N-acetylcystein, the cadmium-induced FPN1 mRNA induction was significantly attenuated. In summary, the results of this study clearly demonstrated that cadmium increased FPN1 expression in macrophages through a mechanism that involves ROS production, and suggests another important interaction between iron and cadmium metabolism.
Animals ; Cadmium ; Cation Transport Proteins ; Gene Expression ; Hand ; Homeostasis ; Iron ; Luciferases ; Macrophages ; Mice ; Reactive Oxygen Species ; RNA, Messenger

OBJECTIVE: Radiation therapy is an important treatment for brain tumor. However, serious complications such as radiation necrosis can occur and it may be secondary to the expression of acute phase genes, like cytokines. In particular, inflammatory cytokines (IL-1beta, TNF-alpha) and other immunomodulatory cytokines (TNF-alpha, TGF-beta1) might be changed after irradiation (high single dose irradiation). Although it has been reported that IL-1 level is remarkably elevated within 8 week after the irradiation to the rat brain, the change of cytokines levels at acute phase (within 24 hours) has not been reported. In the present study, we examined TNF-alpha, TGF-beta1, and IL-1beta levels in acute phase to clarify the early effect of cytokines on the radiation-induced brain damage. METHODS: Fifty Sprague-Dawley rats were used and these were divided into irradiation group and control group. After a burr-hole trephination on the right parietal area using a drill, a single 10 Gy was irradiated at the trephined site. Their forebrains were extirpated at 30 min, 2 hr, 8 hr, 12 hr and 24 hr, respectively and examined for the expression of TNF-alpha, TGF-beta1 and IL-1beta. RESULTS: The expression of TNF-alpha and TGF-beta1 were decreased until 12 hr after irradiation but elevated thereafter. The expression of IL-1 was peak at 8 hr and then decreased until 12 hr but elevated after this time window. The present study indicated that expression of cytokines (TNF-alpha, TGF-beta1 and IL-1beta) were increased at 24 hr after the irradiation to the rat brain. IL-1beta level, on the other hand, reached peak at 8 hr after radiation injury. CONCLUSION: These findings indicate that IL-1, among various cytokines, may have a more important role in the inflammatory reaction by radiation injury at acute phase and provide some clues for better understanding of the pathogenesis of radiation injury.
Animals ; Brain Injuries ; Brain Neoplasms ; Brain* ; Cytokines* ; Hand ; Interleukin-1 ; Necrosis ; Prosencephalon ; Rabeprazole ; Radiation Injuries ; Rats ; Rats, Sprague-Dawley ; Transforming Growth Factor beta1 ; Trephining ; Tumor Necrosis Factor-alpha

OBJECTIVE: Radiation therapy is an important treatment for brain tumor. However, serious complications such as radiation necrosis can occur and it may be secondary to the expression of acute phase genes, like cytokines. In particular, inflammatory cytokines (IL-1beta, TNF-alpha) and other immunomodulatory cytokines (TNF-alpha, TGF-beta1) might be changed after irradiation (high single dose irradiation). Although it has been reported that IL-1 level is remarkably elevated within 8 week after the irradiation to the rat brain, the change of cytokines levels at acute phase (within 24 hours) has not been reported. In the present study, we examined TNF-alpha, TGF-beta1, and IL-1beta levels in acute phase to clarify the early effect of cytokines on the radiation-induced brain damage. METHODS: Fifty Sprague-Dawley rats were used and these were divided into irradiation group and control group. After a burr-hole trephination on the right parietal area using a drill, a single 10 Gy was irradiated at the trephined site. Their forebrains were extirpated at 30 min, 2 hr, 8 hr, 12 hr and 24 hr, respectively and examined for the expression of TNF-alpha, TGF-beta1 and IL-1beta. RESULTS: The expression of TNF-alpha and TGF-beta1 were decreased until 12 hr after irradiation but elevated thereafter. The expression of IL-1 was peak at 8 hr and then decreased until 12 hr but elevated after this time window. The present study indicated that expression of cytokines (TNF-alpha, TGF-beta1 and IL-1beta) were increased at 24 hr after the irradiation to the rat brain. IL-1beta level, on the other hand, reached peak at 8 hr after radiation injury. CONCLUSION: These findings indicate that IL-1, among various cytokines, may have a more important role in the inflammatory reaction by radiation injury at acute phase and provide some clues for better understanding of the pathogenesis of radiation injury.
Animals ; Brain Injuries ; Brain Neoplasms ; Brain* ; Cytokines* ; Hand ; Interleukin-1 ; Necrosis ; Prosencephalon ; Rabeprazole ; Radiation Injuries ; Rats ; Rats, Sprague-Dawley ; Transforming Growth Factor beta1 ; Trephining ; Tumor Necrosis Factor-alpha