We report a case of cerebral lymphomatoid granulomatosis in a 50-year-old man. Lymphomatoid granulomatosis is an unusual condition which usually presents as a pulmonary manifestation, which occasionally affects the brain, and causes focal inflammatory lesions. Primary cerebral lymphomatoid granulomatosis is very rare. We describe a case of lymphomatoid granulomatosis in the left frontal lobe without pulmonary involvement.
Brain ; Frontal Lobe* ; Humans ; Lymphomatoid Granulomatosis* ; Middle Aged

PURPOSE: We conducted a study on patients who underwent hip joint arthroplasty because of unstable femur intertrochanteric fractures with greater trochanter bony fragments. After dividing patients into three groups depending on their fracture patterns, we evaluated the clinical and radiological outcomes of different operation methods applied to each of these groups. MATERIALS AND METHODS: Using Evan's classification, we defined an unstable intertrochanteric fracture as those characterized as stage 4 or 5. Of the 137 patients presenting with an intertrochanteric fracture with osteoporosis (bone mineral density, <−2.5) between March 2014 and October 2015, 63 met the eligibility criteria and were included in this study. Next, patients were divided into three groups based on their greater trochanter fracture patterns (discerned with three-dimensional computed tomography images); different fixation methods were applied to each group by a single orthopaedic surgeon. RESULTS: Taken as a whole, 50 out of 63 patients experienced no reduction in walking distance in their daily lives. Harris hip score increased from 74.8 to 85.7 point and we considered this a relatively good result. Radiologically, we observed complete bone union in 62 cases (98.4%); the lone exception was in a patient who experienced osteolysis. There were also 3 cases who removed greater trochanter reattachment device due to broken implant and 1 case of dislocation. CONCLUSION: The different fixation methods applied to three distinct groups with varying fractures patterns were successful in achieving proper reduction and fixation of greater trochanteric fractures. We also observed reduced bone union periods when arthroplasty was performed in patients with unstable intertrochanteric fractures. Lastly, we believe these approaches may also aid in achieving early ambulation and early rehabilitations.
Arthroplasty* ; Classification ; Dislocations ; Early Ambulation ; Femur* ; Hip ; Hip Fractures* ; Hip Joint ; Humans ; Methods* ; Miners ; Osteolysis ; Osteoporosis ; Walking

OBJECTIVE: Using the standardization of disease diagnosis of disease, and surgical procedures, the authors have made a clinical application for the analysis of inpatient data with the ability to search for information pertinent for writing of clinical articles. METHODS: A client-server system and database software was developed for networking. For clinical application, a computerized daily report has been developed. Data from Neurosurgical patients admitted at Soonchunyang University Hospital from January to December 1998 were analyzed with this system. Data for clinical articles was obtained using the search mode, information such as orbital infarction syndrome following intracranial aneurysm surgery and epidemiological analysis or geriatric neurosurgical patients. RESULTS: For the daily report it takes approximately 10 minutes to input the patients demographic information, name of disease, diagnosis and surgical procedure. The daily report also numbers and sorts the inpatients according to large categories of diagnosis, reports the ratio between inpatients and operative patients. The annual report that was obtained was very accurate and gave rapid statistics for the one year. By retrospective study for the past 18 years, we calculated the incidence of orbital infarction syndrome following intracranial aneurysm surgery as 1.4%, and also estimated the population of geriatric inpatients as 18.3% by retrospective study. CONCLUSIONS: It has been found to be most useful to make a daily and annual report for tracking and research purposes. For use in clinical articles, it can be possible to do a search of the patients using the standardized disease, diagnosis and neurosurgical procedures application and obtain pertinent information in a timely manner.
Diagnosis ; Epidemiology* ; Humans ; Incidence ; Infarction ; Inpatients ; Intracranial Aneurysm ; Neurosurgical Procedures* ; Orbit ; Retrospective Studies ; Writing

OBJECTIVE: The the international classification of disease and surgical procedure has been found to be a lengthy and time-consuming text for use by neurosurgeons. A more subject matter related classification system is needed for use by this specialty. The author has developed a more comprehensive and standardized classification system specified for diagnosis of neurological disease and neurosurgical procedures. METHODS: Standardization of disease was completed by modifying the name of disease according to that which was used for daily report past 10 years, and from textbook of neurosurgery. The fields of international coding are continued in each. Neurosurgical procedures were designated and modified according to Current Procedure Terminology 96. Client-server system will be used for networking and database software applications have been developed. RESULTS: Disease was classified in 14 large categories and 379 subcategories. Diagnosis was classified in 12 large categories and 43 subcategories. Neurosurgical procedure has 20 large and 202 subcategories. The international coding system such as ICD-10 and ICD-9CM is maintained for the diagnosis and procedures to each category. CONCLUSIONS: It could be possible to make and use a standardized database model of disease, diagnosis and neurosurgical procedures to be used by physician.
Classification ; Clinical Coding ; Diagnosis ; Epidemiology* ; International Classification of Diseases ; Neurosurgery ; Neurosurgical Procedures*

No abstract available.
Neoplasm Metastasis*

The authors report a rare case of thalamic abscess in a 38-year old male who suffered from a ventricular septal defect. Preoperative axial magnetic resonance imaging(MRI) showed two ring enhancing masses on T1-weighted image and a hypointensity of dark rim on T2-weighted image. Purulent material was aspirated by computerized tomography(CT)-guided stereotactic procedure following antibiotic therapy for 3 days. No growth was obtained in the culture of the purulent material. The disturbance of left ocular movement before surgery was completely recovered. Even though the abscess wall is uniform in thickness, it is difficult to distinguish from tumor. A rim like hypointensity surrounding the mass on T2-weighted MRI is helpful in distinguishing both lesions.
Abscess* ; Adult ; Heart Septal Defects, Ventricular ; Humans ; Magnetic Resonance Imaging ; Male

The authors report a rare case of thalamic abscess in a 38-year old male who suffered from a ventricular septal defect. Preoperative axial magnetic resonance imaging(MRI) showed two ring enhancing masses on T1-weighted image and a hypointensity of dark rim on T2-weighted image. Purulent material was aspirated by computerized tomography(CT)-guided stereotactic procedure following antibiotic therapy for 3 days. No growth was obtained in the culture of the purulent material. The disturbance of left ocular movement before surgery was completely recovered. Even though the abscess wall is uniform in thickness, it is difficult to distinguish from tumor. A rim like hypointensity surrounding the mass on T2-weighted MRI is helpful in distinguishing both lesions.
Abscess* ; Adult ; Heart Septal Defects, Ventricular ; Humans ; Magnetic Resonance Imaging ; Male

The origin and clinical importance of subdural hygroma(SDG) are still uncertain. Its pathogenetic mechanism and natural history have not yet been settled. Although the incidence of traumatic SDG has been reported to be 5-20% of posttraumatic space-occupying lesions, the true incidence has not been documented in prospective study. Therefore, authors have tried to determine the incidence of traumatic SDG prospectively during past six months. Serial computed tomography(CT) or magnetic resonance imaging(MRI) studies were done in all patients who were admitted to our department after head injuries. Data on the age, sex, Glasgow coma scale(GCS) on admission, and initial CT findings were collected and analyzed to determine the true incidence, pattern and premorbid conditions for the development of traumatic SDG. Serial CT or MRI scans were performed on the date of admission, the second to sixth hospital day, and the seventh to fourteenth hospital day. Study population consisted of 115 patients, excluding 31 expired, discharged, or transferred patients within a week. Subdural hygroma was noted in 42(35.6%) patients. It shared 45.2% of posttraumatic mass lesion. More than half (54.7%) of patients aged 40 or more had subdural hygromas. They were generally delayed lesions, due to the fact that most of them(81%) were observed at four days or more after the injury. All hygromas were located at the frontal or fronto-temporo-parietal regions. Bilaterality was seen in 54.7%. SDGs occurred earlier when the age of the patients were 40 years old or more(p=0.037). It occurred earlier when the initial CT scans were normal, when there was no accompanying traumatic intracranial lesions, and high GCS on admission. However, these differences were statistically not significant(p>0.05). These results suggest that the premorbid conditions for the development of subdural hygroma were sufficient potential subdural space and separation of the dural border cell layer, although former seemed to be more important that the later. Osmotic dehydration in the aged victims should be serially reevaluated, because the subdural hygroma may develop when the intracranial pressure is excessively low.
Adult ; Coma ; Craniocerebral Trauma ; Dehydration ; Epidemiology ; Humans ; Incidence* ; Intracranial Pressure ; Lymphangioma, Cystic ; Magnetic Resonance Imaging ; Natural History ; Prospective Studies* ; Subdural Effusion* ; Subdural Space ; Tomography, X-Ray Computed

To investigate the clinical significance of and risk factors for rebleeding in patients with spontaneous subarachnoid hemorrhages(SAH), the authors reviewed the consecutive cases of 527 patients admitted in the 7-year period from 1988 to 1995. Of these patients, 75(14.2%) rebled. Rebleeding occurred within 24 hours in 45 patients, among whom 32 cases rebled within 12-24 hours after initial SAH, within 1-3 days in 19, within 4-7 days in 9, and after 1 week in 2. These patients had an overall mortality of 82.9% compared to 28.4% for patients without rebleeding. The patients with rebleeding within 24 hours after the initial attack had an operative rate of 34.9% and a postoperative mortality of 53.3% compared to 26.8%, 37.5%, respectively, for patients with rebleeding after 24 hours. The significant factors affecting rebleeding were as follows;Over 70 years in age, association with intracerebral hematoma(10-20cc), sizure before operation, aneurysms on the vertebrobasilar system, poor neurological condition on admission, and angiography within 6 hours of initial SAH. Ultra-early operation within 24 hours following intentional delay in angiography of at least 6 hours from the initial rupture is recommended if the associated hematoma is not large enough to show mass effect.
Aneurysm ; Angiography ; Hematoma ; Humans ; Mortality ; Risk Factors* ; Rupture ; Subarachnoid Hemorrhage*

Cutaneous squamous cell carcinoma (SCC) is the second most common skin malignant neoplasm. Cutaneous SCC shows a broad spectrum, ranging from easily managed superficial tumors to highly infiltrative, metastasizing ones that can cause death. We have experienced two patients with SCC with intracranial extension. One case was an 88-year-old man with a tumor on the forehead treated with Mohs micrographic surgery who presented with local recurrence at the perilesional region of the primary site after 3 years. Wide excision was performed, and histologic findings showed a SCC that extended to the dura mater. The other case was a 69-year-old woman who presented with an erythematous 2x4 cm-sized plaque on the right temple, and a biopsy examination revealed SCC. The patient refused surgery and 7 months later, presented with a 5x10 cm-sized oozing plaque with multiple ulcers. Radiologic evaluation demonstrated intracranial invasion and right retropharyngeal metastatic lymph nodes. She was treated with radiotherapy for 4 months.
Aged ; Aged, 80 and over ; Biopsy ; Carcinoma, Squamous Cell* ; Dura Mater ; Female ; Forehead ; Humans ; Lymph Nodes ; Mohs Surgery ; Neoplasm Metastasis ; Radiotherapy ; Recurrence ; Skin ; Ulcer