OBJECTIVE: The purpose of this study is to assess the factors related to the outcome of 84 patients who underwent surgery for anterior communicating Artery(ACoA) aneurysms. METHODS: The authors review 84 patients who were undertaken from January 1998 to May 2004. In the management of ACoA aneurysms, the outcome was based on several factors: Clinical condition, Distribution of hemorrhage, Time between aneurysmal rupture and surgery, Direction and shape of the aneurysm. RESULTS: The incidence rate of the ACoA aneurysm was 35%. Seventy four patients were classified as those having a good recovery, but 5 patients suffered from some morbidity and 5 patients died. The rate of good outcome for the patients with Hunt and Hess grade was as follows 100% in grade I, 95% in grade II, 80% in grade III, IV and V. The rate of good outcome for the patients with Fisher grade was as follows 98% in grade I, II and 81% in grade III, IV. Nineteen of 22 patients who underwent early surgery were rated as good, while twenty six of 30 patients for whom surgery was delayed showed a favorable result. The unfavorable outcomes were also attributed by vasospasm or other medical problems. CONCLUSION: For further improvement of the overall surgical outcome: First, early surgical intervention is recommended for good grade patients. Second, active management of poor grade patients should be scrutinized with early surgery. Third, it is also important to step up the effort to minimize the risk of medical complications to enhance surgical results on top of the mainstay of prevention efforts for vasospasm and rebleeding.
Aneurysm ; Hemorrhage ; Humans ; Incidence ; Intracranial Aneurysm* ; Rupture

OBJECTIVE: The aim of this study is to determine the treatment strategies for the poor grade patients with aneurysmal subarachnoid hemorrhage(SAH) with respect to the timing of surgery. METHODS: We have analyzed 51 patients of Hunt and Hess grade IV and V at admission among 140 SAH patients who were managed during recent three years. They were devided into two groups according to the interval between SAH and surgery: 30 early treatment group(operated within 3 days) and 21 delayed treatment group(6 delayed operation cases and 15 unoperated cases). RESULTS: Clinical outcome of early surgery group was favorable(Good or Fair) in 23 cases(76.7%) and unfavorable in 7 cases(23.3%, 2 Poor, 5 Dead). On the contrary, those of delayed surgery group or without surgery group was favorable in 4 cases(19.1%) and unfavorable in 17 cases(80.9%, 1 Poor, 16 Dead). Overall management outcome of poor grade SAH patients was favorable in 27 cases(52.9%), unfavorable in 24 cases(47.1%) and mortality rate was 41.2%. Unfavorable outcome in poor grade SAH patients was largely affected by the initial hemorrhage and subsequent development of intractable intracranial hypertension(Hunt and Hess grade IV: 5 cases, grade V: 8 cases), cerebral infarction(grade IV: 3 cases, grade V: 1), rebleeding(grade IV: 3 cases), and surgical complication(4 cases). CONCLUSION: An active treatment policy including early surgery might achieve a better outcome of poor grade SAH patients.
Aneurysm* ; Hemorrhage ; Humans ; Mortality ; Subarachnoid Hemorrhage*

OBJECTIVE: The aim of this study is to determine the treatment strategies for the poor grade patients with aneurysmal subarachnoid hemorrhage(SAH) with respect to the timing of surgery. METHODS: We have analyzed 51 patients of Hunt and Hess grade IV and V at admission among 140 SAH patients who were managed during recent three years. They were devided into two groups according to the interval between SAH and surgery: 30 early treatment group(operated within 3 days) and 21 delayed treatment group(6 delayed operation cases and 15 unoperated cases). RESULTS: Clinical outcome of early surgery group was favorable(Good or Fair) in 23 cases(76.7%) and unfavorable in 7 cases(23.3%, 2 Poor, 5 Dead). On the contrary, those of delayed surgery group or without surgery group was favorable in 4 cases(19.1%) and unfavorable in 17 cases(80.9%, 1 Poor, 16 Dead). Overall management outcome of poor grade SAH patients was favorable in 27 cases(52.9%), unfavorable in 24 cases(47.1%) and mortality rate was 41.2%. Unfavorable outcome in poor grade SAH patients was largely affected by the initial hemorrhage and subsequent development of intractable intracranial hypertension(Hunt and Hess grade IV: 5 cases, grade V: 8 cases), cerebral infarction(grade IV: 3 cases, grade V: 1), rebleeding(grade IV: 3 cases), and surgical complication(4 cases). CONCLUSION: An active treatment policy including early surgery might achieve a better outcome of poor grade SAH patients.
Aneurysm* ; Hemorrhage ; Humans ; Mortality ; Subarachnoid Hemorrhage*

The purpose of this study was to compare surface roughness and morphologic changes after use of various plaque control devices to titanium implant surfaces. The study materials were 6 ITI titanium implants(Bonefit(R)) and 5 plaque control devices. 6 implants were divided into 6 different groups and instrumented by each plaque control devices as follows. 1) Group I : untreated control 2) Group II : Titanium curette(Titanium curette(R), 3i) 80 vertical/horizontal strokes 3) Group III : Plastic curette(Implacare(R), Hu-Friedy) 80 vertical/horizontal strokes 4) Group IV : Plastic tip-ultrasonic scaler(Amdent(R), Amdent) 160 seconds 5) Group V : Rotating interdental brush(Identobrush(R), Identoflex) 160 seconds 6) Group VI : Abrasive rubber cup polisher(Zircate(R), Prophy paste, Dentsply) 160 seconds. All specimens were prepared for evaluation by surface roughness tester, optical stereomicroscopy(OM) and scanning electron microscopy(SEM). The Ra and Rt mean values of the tested specimens were 1) Group I (Ra=0.170+/-0.007micrometer, Rt=1.297+/-0.016micrometer) 2) Group II (Ra=0.209+/-0.006micrometer, Rt=1.602+/-0.110micrometer) 3) Group III (Ra=0.179+/-0.001micrometer, Rt=1.429+/-0.055micrometer) 4) Group IV (Ra=0.182+/-0.005micrometer, Rt=1.511+/-0.085micrometer) 5) Group V (Ra=0.301+/-0.008micrometer, Rt=1.882+/-0.131micrometer) 6) Group VI (Ra=0.147+/-0.010micrometer, Rt=1.059+/-0.021micrometer) In Ra values, experimental group II, V, VI were statistically significant different when compared with control. OM and SEM observation showed that experimental group III, IV were minimal changes when compared with control and group VI was smoothest among other experimental groups. The results suggested that plastic curette and plastic tip-ultrasonic scaler were predictable devices to titanium implant surface.
Plastics ; Rubber ; Stroke ; Titanium*

When mucoperiosteal flaps are positioned and sutured to desirable position, the wound contains several interface between tissues which differ fundamentally in composition & biological reaction. Thus the C-T surface of the flap will, on one hand, oppose another vascularized surface, and on the other, the avascular dental material for example, when root resoptions, fractured root, endodontic perforation, deep root carious lesions were filled with amalgam, glass ionomer, resin etc. Recently, a number of case report described the successful treatment of a subgingival root lesion with restorative material & free gingival graft, open flap surgery, but more objective research was needed. Most of study on restorative materials were concerned for cytotoxicity not for actual healing event on that materials and its influencing factors such as biocompatibility, surface wettability, surface topography. The aim of this in vitro study was to evaluate the effect of amalgam, resin modified glass ionomer, composite resin per se, and their surface roughness on the growth of human gingival fibroblast. The cells were obtained and placed on culture flask and incubated for 3 days with the prepared test materials. Then count the attached cell number with hemocytometer,(n=12) and 2 samples were examined with SEM about attachment cell morphology. Another 4 samples were evaluated on their surface roughness with Talysurf and average surface roughness value(Ra) were obtained. Statistical difference in attached cell number, roughness value were analyzed using ANOVA. The number of attached cell was as follows, for root dentin specimen 16.7+/-4.41, resin modified glass ionomer 14.0+/-4.15, resin 8.13+/-3.63, amalgam 0.72+/-3.33(x10(3)). Between root dentin and resin-modified glass ionomer, no significant difference was observed, but resin, amalgam showed a significant less cell numbers than for root dentin, resin modified glass ionomer cement. SEM examination expressed many cell surface attachment apparatus in root dentin and resin modified glass ionomer specimens. For resin specimen, cell attachment was observed but exposed less appratus. The average surface roughness value are following results. Dentin specimen 0.6972+/-0.104, resin modified glass ionomer 0.0822+/-0.009, resin 0.0875+/-0.005, amalgam 4.2145+/-0.985(micrometer). Between root dentin, resinmodified glass ionomer, and resin, no significant difference was observed, but amalgam showed a significant more rough surface than other groups. When evlauated the interrelationship between cell attachment and surface roughness, therefore, there was weak reverse correlation.(pearson correlation : -0.593) These results suggest that resin modified glass ionomer have the favorable healing potential when used for subgingival restoration. And for relationship between cell attachment and surface characteristics, further investigations were needed.
Cell Count ; Dental Materials ; Dentin ; Fibroblasts* ; Glass ; Glass Ionomer Cements ; Hand ; Humans* ; Transplants ; Wettability ; Wounds and Injuries

This study examined the human fibroblasts cell attachment to commercially pure titanium surface which had been instrumented by 3 types of periodontal instruments. Commercially pure titanium plates were uniformly scaled using plastic, stainless steel, titanium curette. these all experimental groups 65 undirectional strokes with the designated curettes. Alteration of the surfaces due to instrumentation was evaluated by Form Talysurf(R) and reported as Ra value(mean surface roughness). Then other experimental groups were immersed in a cell suspension of human gingival fibroblasts(1x10(5) cell/ml). After 3 days of culture, cell attachment and morphology was observed by SEM, and attached cell were counted by Hemocytometer. A significant difference in mean Ra value was observed for surface instrumented by metal curette compared to either control surface or surface instrumented by the plastic curette(P<0.01). No stastically significant difference was noted between control surface and those instrumented by the plastic curette. SEM observation showed that cell morphology and attachment to the commercially pure titanium plate was similar appearance on the all experimental groups. Experimental groups instrumented by titanium curette and stainless steel curette were more attached cell number than control group, but experimental group instrumented by plastic curette were similar with control groups(P<0.01). In summary, metal curette produced an significant alteration of the commercially pure titanium surface and more favorable surface topography for cell attachment. Otherwise plastic curette was insignificantly altered the commercially pure titanium surface(P<0.01).
Cell Count ; Fibroblasts* ; Humans* ; Plastics ; Stainless Steel ; Stroke ; Titanium*

OBJECTIVE: Hydrocephalus is a common sequelae of aneurysmal subarachnoid hemorrhage (SAH) and patients who develop hydrocephalus after SAH typically have a worse prognosis than those who do not. This study was designed to identify factors predictive of shunt-dependent chronic hydrocephalus among patients with aneurysmal SAH, and patients who require permanent cerebrospinal fluid diversion. METHODS: Seven-hundred-and-thirty-four patients with aneurysmal SAH who were treated surgically between 1990 and 2006 were retrospectively studied. Three stages of hydrocephalus have been categorized in this paper, i.e., acute (0-3 days after SAH), subacute (4-13 days after SAH), chronic (> or =14 days after SAH). Criteria indicating the occurrence of hydrocephalus were the presence of significantly enlarged temporal horns or ratio of frontal horn to maximal biparietal diameter more than 30% in computerized tomography. RESULTS: Overall, 66 of the 734 patients (8.9%) underwent shunting procedures for the treatment of chronic hydrocephalus. Statistically significant associations among the following factors and shunt-dependent chronic hydrocephalus were observed. (1) Increased age (p < 0.05), (2) poor Hunt and Hess grade at admission (p < 0.05), (3) intraventricular hemorrhage (p < 0.05), (4) Fisher grade III, IV at admission (p < 0.05), (5) radiological hydrocephalus at admission (p < 0.05), and (6) post surgery meningitis (p < 0.05) did affect development of chronic hydrocephalus. However the presence of intracerebral hemorrhage, multiple aneurysms, vasospasm, and gender did not influence on the development of shunt-dependent chronic hydrocephalus. In addition, the location of the ruptured aneurysms in posterior cerebral circulation did not correlate with the development of shunt-dependent chronic hydrocephalus. CONCLUSION: Hydrocephalus after aneurysmal SAH seems to have a multifactorial etiology. Understanding predisposing factors related to the shunt-dependent chronic hydrocephalus may help to guide neurosurgeons for better treatment outcomes.
Aneurysm ; Aneurysm, Ruptured ; Animals ; Cerebral Hemorrhage ; Hemorrhage ; Horns ; Humans ; Hydrocephalus ; Meningitis ; Prognosis ; Retrospective Studies ; Subarachnoid Hemorrhage ; Ventriculoperitoneal Shunt

OBJECTIVE: To elucidate the role of aquaporin-4(AQP4) in cerebral edema formation, we studied the expression and subcellular localization of AQP4 in astrocytes after focal cerebral ischemia. METHODS: Cerebral ischemia were induced by permanent middle cerebral artery(MCA) occlusion in rats and estimated by the discoloration after triphenyltetrazolium chloride(TTC) immersion. Change of AQP4 expression were evaluated using western blot. Localization of AQP4 was assessed by confocal microscopy and its interaction with alpha-syntrophin was analyzed by immunoprecipitation. RESULTS: After right MCA occlusion, the size of infarct and number of apoptotic cells increased with time. The ratio of GluR1/GluR2 expression also increased during ischemia. The polarized localization of AQP4 in the endfeet of astrocytes contacting with ventricles, vessels and pia mater was changed into the diffuse distribution in cytoplasm. The interactions of AQP4 and Kir with alpha-syntrophin, an adaptor of dystrophin complex, were disrupted by cerebral ischemia. CONCLUSION: The deranged spatial buffering function of astrocytes due to mislocalized AQP4/Kir4.1 channel as well as increased assembly of Ca2+ permeable AMPA receptors might contribute to the development of edema formation and the excitotoxic neuronal cell death during ischemia.
Animals ; Apoptosis ; Aquaporin 4 ; Astrocytes ; Blotting, Western ; Brain Edema* ; Brain Ischemia* ; Cell Death ; Cerebral Infarction ; Cytoplasm ; Dystrophin ; Edema ; Immersion ; Immunoprecipitation ; Ischemia ; Microscopy, Confocal ; Neurons ; Pia Mater ; Rats* ; Receptors, AMPA ; Receptors, KIR

BACKGROUND AND OBJECTIVES: Oxygen radical scavengers and inhibitors are known to have protective functions (or roles) against hypoxia and noise exposure in the cochlea and brain. The purpose of this study was to examine the toxic effect of oxygen radicals (xanthine oxidase and hypoxanthine) on cultured mouse facial nerve Schwann cells, and determine if antioxidants (TPEN and DFO) might ptotect Schwann cells from oxidant-induced neurotoxicity. MATERIALS AND METHODS: Dissociated cell cultures were prepared from the facial nerve of a mouse. After dissociation of Schwann cells, isolated cells were washed, resuspended in feeding medium, and plated onto poly-L-lysine-coated Aclar plastic cover slips (12 mm diameter) in petri dishes or in 96 well multichambers at cell density of 2X105 ceIls/coverslip or lX10(5) ceIls/we11. The feeding medium consisted of Eagle's minimum essential medium (MEM) containing 5% horse serum, 5 mg/ml D-glucose, and 25 ng/ml gentamicin. Cultures were grown in 5% CO2/95% atmosphere at 37degreesC, and the medium was renewed twice a week. Cultures grown for 4-5 days were utilized for experiments. Oxygen radical exposure was done using XO and HX, and antioxidant pretreatment was carried out using tetrakis (2-pyridylmethyl) ethylenediamine (TPEN) and desferrioxamine (DFO). Cytotoxicity assay was performed by MTT [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide cytotoxic assay and inverted microscopy. RESULTS: Cell viability of cultured mouse Schwann cells treated with markedly decreased in a dose-dependent manner. Cultured mouse Schwann cells exposed to XO/HX for 4 hours showed degenerative changes such as the decrease of cell number and process. Pretreatment of 80 uM TPEN for 2 hours increased remarkably the cell viability of cultured Schwann cells exposed to 20 mU/ml XO/0.1 mM HX, while DFO did not show any protective effects on oxidant-induced neurotoxicity in these cultures. CONCLUSION: It is suggested that oxygen radicals induce neurotoxic effect on cultured mouse Schwann cells, and that selective antioxidants such as TPEN is very effective in blocking oxidant-induced neurotoxicity.
Animals ; Anoxia ; Antioxidants* ; Atmosphere ; Brain ; Cell Count ; Cell Culture Techniques ; Cell Survival ; Cochlea ; Deferoxamine ; Facial Nerve ; Gentamicins ; Glucose ; Horses ; Mice* ; Microscopy ; Noise ; Oxidoreductases ; Oxygen* ; Plastics ; Reactive Oxygen Species* ; Schwann Cells*

Desmoplastic cerebral astrocytoma of infancy is a massive cystic tumor, typically occurring in the cerebral hemisphere and a rare intracranial tumor that arises in subjects usually below the age of 18 months and shows a favorable prognosis. A 5.5-month-old boy was presented with a rapidly increasing head circumference and lethargy. A computerized tomography scan revealed a large, multicystic, partially enhancing right parieto-occipital mass with hydrocephalus. This patient was treated with a surgery and a firm plaque-like tumor along withmulticystic component was gross totally removed. The tumor mass was firmly attached to the dura and extended in fingerlike projections onto the cortical surface. The infant underwent no further therapy and has developed normally during 6 months after surgery. Desmoplastic cerebral astrocytoma of infancy is a rare intracranial tumor but recognition of this tumor should be appreciated because, despite its massive size and rapidly growing characterstics, this tumor often has a relatively benign clinical course.
Astrocytoma* ; Cerebrum ; Head ; Humans ; Hydrocephalus ; Infant ; Lethargy ; Male ; Prognosis