The authors experienced two cases of cervical epidural AVM resembling that of tumor. It is the purpose of this report to point out by means of two cases the problem involved in establishing the diagnosis. To our knowledge, our two cases of cervical epidural AVM is the first report in Korea.
Diagnosis ; Korea

We report one case of aseptic necrosis of both talus which has developed without any evidence of previous trauma. Aseptic necrosis of the talus is known to occur after any trauma which result in iterruption the blood supply to talus. Atraumatic aseptic necrosis of talus is extremely rarre condition. Some cases of atraumatic aseptic necrosis of talus were repoted by some authers, in whom Garcia described the first case in 1928. Most of the reported atraumatic aseptic necrosis were due to long term steroid therapy for unrelated medical problems and others were related to Alcoholism, Sepsis and Tuber culosis. ln this case we think for it may be caused or contributed by steroid therapy.
Alcoholism ; Necrosis ; Sepsis ; Talus

Recently, transsphenoidal approach is regarded as the principal method for the resection of pituitary tumor. The sublabial transseptal transsphenoidal hypophysectomy is a classical one, but it has certain limitations and postoperative problems. So various modifications of transsphenoidal hypophysectomy have been proposed. The columellar flap is one of such modified approaches.
Hypophysectomy ; Pituitary Neoplasms

No abstract available.
Intra-Articular Fractures* ; Tibia*

The anterior communicating artery is one of common sites of intracranial aneurysms, and the anterior communicating artery aneurysms are operated by pterional approach most commonly. Anatomical variation around anterior communicating artery is one of the limiting factors in surgery. Pterional approach can be made from either left or right side according to many factors, such as, dominant feeding artery, shape, size and direction of aneurysm, vascular anomaly and variation around anterior communicating artery, existence of hematoma, and multiple aneurysms. Authors analyzed 62 cases of anterior communicating artery aneurysm and discussed optimal surgical direction in pterional approach and evaluated the usefulness of position of bilateral A1-A2 junction in lateral compression angiogram. The results were as follows: 1) In the existence of another aneurysm in the carotid or middle cerebral artery, optimal surgical direction is to the side of another aneurysm. 2) Significant amount of hematoma should be considered in selecting the surgical direction. 3) If the aneurysm is large, thrombosed, and fundus is broad, the approach should be made to the side which facilitate the exposure of the neck of aneurysm first. 4) Right side approach has advantages that nondominant hemisphere is retracted and surgical manipulation is convenient with small craniotomy. 5) Exposure of the neck of the aneurysm and temporary clip is easier when approach is made along the main feeding artery. 6) Approach to the side of posteriorly placed A1-A2 junction can be another useful option in selecting optimal surgical direction.
Aneurysm ; Arteries ; Craniotomy ; Hematoma ; Intracranial Aneurysm* ; Middle Cerebral Artery ; Neck

Dural carotid-cavernous sinus fistula is an abnormal communication between small vssels emanating from intracavernous carotid artery supplying the regional dura and cranial nerves, and cavernous sinus. It is a rare entity that tends to appear in middle aged to elderly women and generally presents with a "red eye", or insidiously progressive glaucoma and may resolve without treatment. We have observed such a fistula in a 51-year-old woman and confirmed by TFCA(transfemoral carotid angiography) and have treated with manual carotid compressions and antiglaucomatous medication.
Aged ; Carotid Arteries ; Carotid-Cavernous Sinus Fistula* ; Cavernous Sinus ; Cranial Nerves ; Female ; Fistula ; Glaucoma ; Humans ; Middle Aged

No abstract available.
Vasculitis*

BACKGROUND: Herpes simplex virus thymidine kinase (HSVtk) phosphorylates the prodrug ganciclovir to a nucleoside analog that inhibits DNA synthesis, causing cell death. Neighbouring nontransfected cells may be affected through a 'bystander effect', thereby amplifying the antiproliferative actions. This study was carried out to determine whether retrovirus-mediated HSVtk gene therapy could reduce intimal hyperplasia and prevent stenosis following balloon injury of the rat carotid artery. METHODS: A replication-defective recombinant retroviral vector containing HSVtk cDNA (LtkSN) was constructed. Cultured primary rat smooth muscle cells (SMCs) infected with this vector (SMC/LtkSN) were transplanted to the balloon injured rat right carotid artery. One week after transplantation, HSVtk gene therapy group was administered a 2-week treatment of ganciclovir (30 mg/kg/d). Three weeks after balloon injury and SMC/LtkSN transplantation, carotid arteriography was performed and carotid arteries were perfusion-fixed for histologic examination. RESULTS: Carotid arteriographic evaluation comparing with the uninjured left carotid artery showed that the mean luminal diameter of HSVtk gene therapy group (n=5, 85+/-3%) was significantly larger than that of balloon injury only group (n=5, 65+/-5%). The neointimal mass of HSVtk gene therapy group was less than that of balloon injury only group. SMC/LtkSN transplantation without ganciclovir treatment group (n=3) showed asymmetric intimal proliferation probably because of gravitational pooling of seeding. There were inflammatory cell infiltrations at the gravity dependent portion of HSVtk gene therapy group. CONCLUSION: Retrovirus-mediated HSVtk gene therapy following balloon injury of the rat carotid artery reduced neointimal expansion and arteriographic stenosis.
Angiography ; Animals ; Carotid Arteries* ; Carotid Artery Injuries* ; Cell Death ; Constriction, Pathologic* ; DNA ; DNA, Complementary ; Ganciclovir ; Genetic Therapy* ; Gravitation ; Herpes Simplex* ; Hyperplasia ; Myocytes, Smooth Muscle ; Phenobarbital ; Phosphotransferases* ; Rats* ; Simplexvirus* ; Thymidine Kinase ; Zidovudine

No abstract available.
Humans* ; Retroviridae*

The authors present a retrospective analysis of 100 consecutive patients who between February 1993 and June 1996 underwent computed tomography(CT)-guided stereotactic biopsy using the Riechert-Mundinger system. The patients were aged between ten and 70(mean 41) years and the male-to-female ratio was 58 : 42. All were suffering from intracranial lesion(s) which had not been correctly diagnosed by CT and/or magnetic resonance(MR) imaging. Among these 100 patients, 102 stereotactic biopsy procedures were carried out ; in two cases, the procedure was repeated, due to initial failure. Diagnostic yield was 92%(94 procedures) and the accuracy by image was 100%. After biopsy, eleven glioma cases underwent craniotomy ; in ten of these(92%), the diagnosis was the same on craniotomy and on biopsy. The exception had on biopsy been diagnosed as anaplastic astrocytoma, but on craniotomy was diagnosed as anaplastic oligoastrocytoma. The treatment plan for 27 of 85 patients(31%) was changed after biopsy. The mortality rate was 1%(one case) ; after biopsy, a patient with brain abscess and impending herniation died due to progressive brain edema. The morbidity rate was 7%(seven cases) ; one patient showed transient symptoms of increased intracranial pressure, five showed transient weakness, and one, transient speech disturbance. In conclusion, our system for CT-guided stereotactic biopsy is highly diagnostic, accurate, effective for treatment planning, and in diagnosing brain lesions, does not damage tissue. The possible causes and the solutions for non-specific diagnoses are also discussed.
Astrocytoma ; Biopsy* ; Brain Abscess ; Brain Edema ; Brain* ; Craniotomy ; Diagnosis ; Glioma ; Humans ; Intracranial Pressure ; Mortality ; Retrospective Studies