No abstract available.
Rhinomanometry*

No abstract available.
Ureter*

No abstract available.

We analyzed 56 operations in 45 patients with sellar and parasellar tumors from March, 1990 to May, 1995, to evaluate the determining factors in selecting the surgical approaches for large and giant sellar and suprasellar tumors, based on clinical, endocrinological and radiological findings. The definition of "large" is when the longest diameter of the tumor is more than 20mm on radiographic studies and the term "small" is applied to tumor of diameter below 19mm. The results were as follows: 1) Number of the patients with small tumor was 14(31.1%) and all of them were treated with single stage transsphenoidal approach, and 42 operations were performed in 31(68.9%) patients with large tumors. 2) The approaches for large tumors were: transsphenoidal approach in 32 cases: pterional approach 5 cases: subfrontal interhemispheric approach 4 cases; and subfrontal paramedian approach 1 case. 3) The rate of complete removal for large and giant tumors in the first operation was 29.0%; in second operation, 72.7%; overall the rate was 54.8%. 4) Complications were; transient type diabetes insipidus in 24 cases; meningitis 2 cases; hypothalamic injury 3 cases; CSF rhinorrhea 1 case; and cerebral infarction 1 case; and death 1 case. 5) There was significant relationship between the size of the tumor and tumor types(p<0.05) and the degree of suprasellar extension(p>0.05) but not wih destruction of the sellar floor(p<0.05). 6) There was significant relationship between the surgical approaches and size of the tumors(p>0.05). 7) In case of incomplete removal with first transsphenoidal approach, a second operation seems to be helpful. 8) In second stage transcranial approach following first transsphenoidal approach, it is easier to remove the tumor due to the decreased tumor size and thus, a reduced need for marked brain retraction. From our findings, we suggest guidelines in choosing the surgical approach for sellar and parasellar tumors as follows: 1) Many of the tumors in the sellae and suprasellar area can be removed successfully by transsphenoidal approach. 2) Taranssphenoidal approach can be repeated safely in stage O, A, B and C, if the diaphragm sella remains intact. 3) Tanscranial approach is recommended primarily in stage D & E, if intrasellar portion of the tumor is not significant or opening of the diaphragm sella is narrow. 4) Transsphenoidal approach followed by transcranial approach is adequate in stage D & E, if significant amount of the tumor remaining in the sella or sellar floor is severely destructed(Grage III, IV).
Brain ; Cerebral Infarction ; Diabetes Insipidus ; Diaphragm ; Humans ; Meningitis

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

A variety of therapeutic options are available for managing arteriovenous malformations(AVM's) including microsurgical resection, embolization, stereotactic radiosurgery or a combination of these treatments. The primary advantages of neurosurgical resection include immediate and almost certain cure, immediate elimination of the risk of hemorrhage, and the absence of longterm delayed complications. Surgery, however, is more invasive than other therapeutic options and is associated with the potential for perioperative morbidity or mortality. A series of 42 patients undergoing microsurgical resection of AVM's of the brain between January 1990 and March 1998 were analyzed for complications and postoperative outcomes. Twelve patients(28.6%) had complications. There were 5 deaths(11.9%) which were thought to be caused by increased intracranial pressure(3 cases), venous infarction(1 case) and postoperative hemorrhage(1 case). Other nonfatal complications were 3 cases of motor weakness, a case of visual field defect following occipital lobe retraction, a case of dilated cardiomyopathy in children and two cases of new onset of seizures. All cases were graded according to the Spetzler-Martin classification. There were six cases of complications in 22 patients with Grade I AVM'(22.7%), three cases of complications in 10 patients with Grade II AVM'(30.0%), one case of complications in 7 patients with Grade III AVM'(14.2%), no complications in 1 patient with Grade IV AVM', and two cases of complications in 2 patients with Grade V AVM'(100%). The various components of the AVM' grading system were analyzed for the ability to predict complications, but there was no statistical significance in this study. The preoperative Glasgow coma scale accurately correlated with the incidence of postoperative complications(p=0.004).
Arteriovenous Malformations* ; Brain* ; Cardiomyopathy, Dilated ; Child ; Classification ; Glasgow Coma Scale ; Hemorrhage ; Humans ; Incidence ; Microsurgery ; Mortality ; Occipital Lobe ; Radiosurgery ; Seizures ; Visual Fields

Focal brainstem encephalitis due to Herpes simplex virus if a very rare infectious disease, occurs with a frequent of 1-2 million population per year. A 3 years old girl is described with infection due to Herpes simplex virus causing brainstem encephalitis. The diagnosis was established by enzyme immunosorbent assays of the cerebrospinal fluid and serum which demonstrated antibody responsed to Herpes simplex virus. The clinicopathological features, radiological findings, laboratories and brainstem biopsies are discussed in the context of the literature.
Biopsy ; Brain Stem* ; Cerebrospinal Fluid ; Child, Preschool ; Communicable Diseases ; Diagnosis ; Encephalitis* ; Female ; Herpes Simplex* ; Humans ; Simplexvirus*

No abstract available.
Ifosfamide*

The omentum has been used over the years for a variety of clinical problems. Recently it has shown that placing the omemtum on the brain and spinal cord can lead to an extensive development of vascular connections at the omental/CNS interface. Success with omental transposition to the human brain has led to increasing intreast in placing the omentum onto the human spinal cord. One paraplegic patient was chosen to enter into a feasibility study to see if omental transposition to their spianl cord might result in clinical benefit. The length of time from injury was about 21 months respecively. This patient had little, if any, motor and sensory function below umbilicus level. The operation required surgical lengthening of the pedicled omentum followed by its placement into a subcutaneous tunnel created backward along the lateral chest wall up to T-10, 11 level. An extensive thoracic laminectomy was then performed followed bya wide opening of the dura. In our case the cord showed segmental shrinkage of the spinal cord consistent with previous trauma. The omentum was laid directly onto the underlying spinal cord. Our observation for five months has shown that placement of the omentum onto the chronically injured spinal cord allowed for subsequent improvement in neuroelectrical activity, as manifested by reproducible somatosensory evoked potentials, and, more importantly, in moter function. It is considered that placing the omentum directly upon the brain or spinal cord may have the effect of either improving local vascular perfusion or, possibly, exerting some biochemicals(neurotransmitter), or as yet unknown, influence. But further observation is warranted to determine whether this improvement will be continued and will be observed in another cases.
Brain ; Evoked Potentials, Somatosensory ; Feasibility Studies ; Humans* ; Laminectomy ; Neurotransmitter Agents ; Omentum ; Perfusion ; Sensation ; Spinal Cord ; Spinal Cord Injuries ; Thoracic Wall ; Umbilicus

BACKGROUND: Although regional lymph-ode metastasis from early gastric cancer (EGC) is rare, it is well known that EGC patients with lymph-ode metastasis constitute a high-isk group for recurrence. Thus, it is important to clarify the characteristics of patients having lymph-ode metastasis in order to ascertain the optimal therapy. METHODS: We analyzed the clinical aspects of 34 cases of node-ositive EGC and compared them to 197 cases of node-egative EGC. All patients were operated on from June 1994 to December 1997 at Ajou University Hospital. Also, by using immunohistochemical staining, we examined the expression of cathepsin D in the tumors to identify its significance in EGC. RESULTS: Lymph-ode involvement correlated significantly with deeper tumor invasion, severity of lymphatic invasion, and larger tumor size. Age, sex, histologic type, location, gross appearance, and serum carcinoembryonic antigen (CEA) level were unrelated to lymph-ode involvement. Positive cytoplasmic staining for cathepsin D was detected in 100% of the tumors, and strongly positive staining was found in 33.3%. Also, strong positivity was found more frequently in tumors with lymph-ode involvement. CONCLUSION: Prophylactic lymph-ode dissection may be necessary for patients with EGC with submucosal invasion, lymphatic invasion, and larger tumor size. Also, cathepsin D can be a useful tool for understanding the pathophysiology of early gastric cancer.
Carcinoembryonic Antigen ; Cathepsin D ; Cytoplasm ; Humans ; Neoplasm Metastasis* ; Recurrence ; Risk Factors* ; Stomach Neoplasms