OBJECTIVE: In recent years, the neurosurgeon's role in managing cerebrovascular diseases (CVD) has becomes rapidly challenged and overlapped with other specialists. Furthermore, the patterns of CVD and patient recruitment have also changed. We conducted a retrospective study regarding the practical trends of CVD with reference to the management paradigms at our institute. METHOD: We reviewed all the available data, including the annual reports, the daily department records, the medical records and the radiographic films of the CVD patients who had been admitted to our Neurosurgery Department during the five years between Jan. 2004 and Dec. 2008. RESULTS: The total numbers of CVD operations showed a slight initial increase, but then they remained steady for the latter 3 years. The number of cases of non-angiomatous hemorrhage has been relatively steady, regardless of surgery. The total numbers of treated aneurysms increased, but the main body of this increment was attributed to the initiation of endovascular treatment and increased identification of unruptured vascular lesions. Vascular malformations were sustained with a small number of cases due to referring them to other institutes for radiosurgery, except for the cases that required urgent hemorrhagic evacuation. CONCLUSION: Hemorrhagic CVDs tended to decrease either due to increasing identification before rupture or shifting such patients into a large volume hospital. The increasing awareness of ischemic CVD, the early detection of unruptured aneurysms, and the separation of medical responsibilities from neurologists have all pushed neurosurgeons to make treatment plans in a more cooperative fashion, instead of a competitive way. Neurosurgeons should be furnished with several revolutionary surgical options to widen their scope of managing patients with CVD.
Academies and Institutes ; Aneurysm ; Hemorrhage ; Humans ; Infarction ; Intracranial Aneurysm ; Medical Records ; Neurosurgery ; Patient Selection ; Radiosurgery ; Retrospective Studies ; Rupture ; Specialization ; Subarachnoid Hemorrhage ; Vascular Malformations ; X-Ray Film

No abstract available.
Epidermolysis Bullosa ; Muscular Dystrophy, Duchenne ; Ornithine Carbamoyltransferase ; Polymerase Chain Reaction* ; Preimplantation Diagnosis*

Familial benign pemphigus is a skin disease with recurrent blistering lesions, mainly in the neck and intertriginous areas. The course of the disease is characterized by spontaneous exacerbations and remissions. The many remedies for this disorder include topical and systemic glucocorticosteroids, and antibacterial and antimycotic agents. However, these therapies usually do not prolong the remission periods. Surgical treatments, such as skin graft, have been more successful. Laser treatment has reported to be effective in recurrent familial benign chronic phemphigus. Here we report a case of familial benign chronic phemphigus that was treated with carbin dioxide laser.
Blister ; Carbon Dioxide* ; Carbon* ; Lasers, Gas* ; Neck ; Pemphigus ; Pemphigus, Benign Familial* ; Skin ; Skin Diseases ; Transplants

Familial benign pemphigus is a skin disease with recurrent blistering lesions, mainly in the neck and intertriginous areas. The course of the disease is characterized by spontaneous exacerbations and remissions. The many remedies for this disorder include topical and systemic glucocorticosteroids, and antibacterial and antimycotic agents. However, these therapies usually do not prolong the remission periods. Surgical treatments, such as skin graft, have been more successful. Laser treatment has reported to be effective in recurrent familial benign chronic phemphigus. Here we report a case of familial benign chronic phemphigus that was treated with carbin dioxide laser.
Blister ; Carbon Dioxide* ; Carbon* ; Lasers, Gas* ; Neck ; Pemphigus ; Pemphigus, Benign Familial* ; Skin ; Skin Diseases ; Transplants

OBJECTIVE: Transpedicular screw fixation has some disadvantages such as postoperative back pain through wide muscle dissection, long operative time, and cephalad adjacent segmental degeneration (ASD). The purposes of this study are investigation and comparison of radiological and clinical results between interspinous fusion device (IFD) and pedicle screw. METHODS: From Jan. 2008 to Aug. 2009, 40 patients underwent spinal fusion with IFD combined with posterior lumbar interbody fusion (PLIF). In same study period, 36 patients underwent spinal fusion with pedicle screw fixation as control group. Dynamic lateral radiographs, visual analogue scale (VAS), and Korean version of the Oswestry disability index (K-ODI) scores were evaluated in both groups. RESULTS: The lumbar spine diseases in the IFD group were as followings; spinal stenosis in 26, degenerative spondylolisthesis in 12, and intervertebral disc herniation in 2. The mean follow up period was 14.24 months (range; 12 to 22 months) in the IFD group and 18.3 months (range; 12 to 28 months) in pedicle screw group. The mean VAS scores was preoperatively 7.16+/-2.1 and 8.03+/-2.3 in the IFD and pedicle screw groups, respectively, and improved postoperatively to 1.3+/-2.9 and 1.2+/-3.2 in 1-year follow ups (p<0.05). The K-ODI was decreased significantly in an equal amount in both groups one year postoperatively (p<0.05). The statistics revealed a higher incidence of ASD in pedicle screw group than the IFD group (p=0.029). CONCLUSION: Posterior IFD has several advantages over the pedicle screw fixation in terms of skin incision, muscle dissection and short operative time and less intraoperative estimated blood loss. The IFD with PLIF may be a favorable technique to replace the pedicle screw fixation in selective case.
Back Pain ; Follow-Up Studies ; Humans ; Incidence ; Intervertebral Disc ; Muscles ; Operative Time ; Skin ; Spinal Fusion ; Spinal Stenosis ; Spine ; Spondylolisthesis

We report a case of linear arranged multiple cutaneous leiomyoma in a 45-year-old man. About 20 years ago, multiple normal skin colored firm papules developed on the left anterior chest and increased in number and size arranging in linear pattern. Some larger nodular lesions changed into brown in color and became painful after cold exposure. The lesions looked like keloid at first sight but the histopathologic finding showed typical leiomyoma in which the interlacing bundles of smooth muscle fibers with varying amount of collagen bundles intermingled.
Collagen ; Humans ; Keloid ; Leiomyoma* ; Middle Aged ; Muscle, Smooth ; Skin ; Thorax

We present a case of acute subarachnoid hemorrhage in a 64-year-old male with sudden onset of left ophthalmoplegia. Cerebral angiography demonstrated a 10mm elongated aneurysmal sac which arose from the left internal carotid-anterior choroidal artery junction. The pterional approach was performed as an early surgery for aneurysm clipping. At operative field, the anterior choroidal artery aneurysm which directed posteromedially and compressed the origin of left oculomotor nerve was confirmed. And the blood blister like-aneurysm was also seen at the superolateral portion of the proximal bifurcation of the internal carotid-anterior choroidal artery. A large anterior choroidal artery aneurysm was clipped and the blood blister like-aneurysm was reinforced. No case report has been previously published describing a ruptured anterior choroidal artery aneurysm accomplished with third cranial nerve palsy. We reported a case of multiple aneurysms of anterior choroidal artery that caused ipsilateral oculomotor nerve palsy.
Aneurysm* ; Arteries* ; Blister ; Cerebral Angiography ; Choroid* ; Humans ; Male ; Middle Aged ; Oculomotor Nerve Diseases* ; Oculomotor Nerve* ; Ophthalmoplegia ; Paralysis ; Subarachnoid Hemorrhage

We present a case of acute subarachnoid hemorrhage in a 64-year-old male with sudden onset of left ophthalmoplegia. Cerebral angiography demonstrated a 10mm elongated aneurysmal sac which arose from the left internal carotid-anterior choroidal artery junction. The pterional approach was performed as an early surgery for aneurysm clipping. At operative field, the anterior choroidal artery aneurysm which directed posteromedially and compressed the origin of left oculomotor nerve was confirmed. And the blood blister like-aneurysm was also seen at the superolateral portion of the proximal bifurcation of the internal carotid-anterior choroidal artery. A large anterior choroidal artery aneurysm was clipped and the blood blister like-aneurysm was reinforced. No case report has been previously published describing a ruptured anterior choroidal artery aneurysm accomplished with third cranial nerve palsy. We reported a case of multiple aneurysms of anterior choroidal artery that caused ipsilateral oculomotor nerve palsy.
Aneurysm* ; Arteries* ; Blister ; Cerebral Angiography ; Choroid* ; Humans ; Male ; Middle Aged ; Oculomotor Nerve Diseases* ; Oculomotor Nerve* ; Ophthalmoplegia ; Paralysis ; Subarachnoid Hemorrhage

We describe a true posterior communicating artery (PCoA) aneurysm, which is an uncommon variant of intracranial aneurysm that was treated by endosaccular embolization. A 64-year-old woman was admitted for management of an unruptured left PCoA aneurysm. She had undergone microsurgical clipping of an ipsilateral internal carotid artery (ICA)-PCoA aneurysm 23 years prior to the current presentation. Angiography showed a saccular aneurysm 3 mm distal to the junction of the ICA and the fetal-type PCoA arising on the opposite side of the vessel to that of the previous clipping. Endovascular embolization was performed to occlude the lumen of the aneurysm while preserving the patency of the PCoA. Based on angiograms, hemodynamic stress seems to be the most feasible explanation for the de novo development of an aneurysm at the first acute bend within the PCoA in our patient. For this anatomical reason, endosaccular coil deployment was possible without the use of a balloon or stent.
Aneurysm ; Angiography ; Arteries ; Carotid Arteries ; Carotid Artery, Internal ; Female ; Glycosaminoglycans ; Hemodynamics ; Humans ; Intracranial Aneurysm ; Middle Aged ; Stents ; Surgical Instruments

OBJECTIVE: Embryonic stem (ES) cells could be differentiated into the specific cell types by alternation of culture condition and modification of gene expression. This study was performed to evaluate the differentiation protocol for mouse and human ES cells to insulin secreting cells. METHODS: Undifferentiated mouse (JH-1) and human (Miz-hES1) ES cells were cultured on STO feeder layer, and embryoid bodies (EBs) were formed by suspension culture. For the differentiation, EBs were cultured by sequential system with three stage protocol. The differentiating ES cells were collected and marker gene expressions were analyzed by semi-quantitative RT-PCR in each stage. Amount of secreted insulin levels in culture media of human ES cells were measured by human insulin specific RIA kit. RESULTS: During the differentiation process of human ES cells, GATA-4, alpha-fetoprotein, glucose transporter-2 and Ngn-3 expression were increased whereas Oct-4 was decreased progressively. Insulin and albumin mRNAs were expressed from stage II in mouse ES cells and from stage III in human ES cells. We detected 3.0~7.9 microU/ml secretion of insulin from differentiated human ES cells by in vitro culture for 36 days. CONCLUSION: The sequential culture system could induce the differentiation of mouse and human ES cells into insulin secreting cells. This is the first report of differentiation of human ES cells into insulin secreting cells by in vitro culture with serum and insulin free medium.
alpha-Fetoproteins ; Animals ; Culture Media ; Embryoid Bodies ; Embryonic Stem Cells* ; Feeder Cells ; Gene Expression ; Glucose ; Humans ; Insulin* ; Insulin-Secreting Cells* ; Mice ; RNA, Messenger