The sublabial approach for transseptal transsphenoidal surgery of pituitary tumors has been the most popular procedure since Cushing first introduced this technique in early 1900's. In recent years, various modifications for transseptal route and their obvious advantages over the sublabial approach have been reported. Currently, in our institute, the preferred method is the external rhinoplasty approach, suggested by Braint and descried by McCurdy. After experiencing 54 cases since 1995 DEC, we found this technique simple, providing good exposure and short distance for instrumentation, preserving nasal tip projection, avoding postoperative numbness of upper teeth and especially beneficial to revision surgery when septal cartilage has been removed by a previous sublabial approach and to surgery for acromegaly patients.
Acromegaly ; Cartilage ; Humans ; Hypesthesia ; Pituitary Neoplasms* ; Rhinoplasty* ; Tooth

OBJECTIVE: Surgically removed herniated lumbar disc specimen are immunostained to evaluate the production of MMPs(Matrix metalloproteinases) -1, 2, 3 for the investigation of the possible correlation of MMPs in lumbar disc herniation depending on the types of disc herniation. METHODS: The study population consists of 30 patients with lumbar disc herniation. There were 18 men and 12 women with patient age averaging 43.4 years(19-68years). The types of disc herniation identified at the time of surgery were classified as follow ; protruded type(Group 1, 10cases), extruded type(Group 2, 10cases), sequestrated type(Group 3, 10cases). Immunohistochemical study for the MMPs of the herniated disc tissue was performed and results of staining were graded to examine differences in histology among three types of disc herniation . RESULTS: The MMPs immunopositive cells were increased in old patients but statistically it was not significant(p=0.074). A significantly increased incidence of positive cells for MMP-1, 2 was found in the herniated lumbar disc tissue than the control group(p=0.02) but there were no significant differences among the three types of disc herniation. The MMP-3 positive cells were predominantly detected in the sequestrated disc tissue group(p=0.037) more than other groups. CONCLUSION: These results suggest that the MMP-1, 2, 3 may play important roles in the process of degeneration, herniation, and resorption of the lumbar intervertebral discs and that the MMP-3 may express the severity of lumbar disc herniation and play a role in resorption of the sequestrated disc tissue.
Female ; Humans ; Immunohistochemistry ; Incidence ; Intervertebral Disc ; Intervertebral Disc Displacement ; Male ; Matrix Metalloproteinases*

To study the isolation and purification and proliferation of the cell in cell culture system, and to develop an improved culture method by a modified cell isolation technique and modified culture medium. The RPE cells were cultured in 3 different mediums: type I(MEM medium with 20% FCS) type II(F-10 medium with 20% FCS) and type III(DMEM medium with 10% FCS, EGF, hydrocortisone, insulin, ethanolamine, phosphoethanolamine, chorea toxin, triiodotyronine, adenine, transferrin and BPE). We compared population doubling(P.D.), population doubling time(P.D.T), morphologic changes and phagocytic activity during a 7week period. Rapid proliferation and high purity of retinal pigment epithelial cells(RPE cells) showed in type III culture medium. Type III culture medium presented the best results in P.D., P.D.T. and cell purification. In type III culture medium, single RPE cells produced about 6 X 10(7) RPE cells in the 7week period and morphology and phagocytic activity were well maintained, when UV-B irradiation at RPE was used to produce melanin, it had no effect, but the RPE cell was inhibited by UV-B irradiation. This improved culture method for RPE cells will provide a good in-vitro model for the studies of biochemistry, cellular function of the RPE cell, as well as its clinical application in eye disease.
Adenine ; Biochemistry ; Cell Culture Techniques ; Cell Separation ; Chorea ; Epidermal Growth Factor ; Epithelial Cells* ; Ethanolamine ; Eye Diseases ; Hydrocortisone ; Insulin ; Melanins ; Retinaldehyde* ; Transferrin

Fibrous hamartomas of infancy(FHI) are rare, benign, fibroproliferative tumors which usually present in the first 2 years of life. They arise from the subcutanous tissue and usually appear as a single tumor in the axilla, shoulder, groin, digit, vulva, extremities, and trunk. Because of their pathologic findings, high degree of cellularity and the presence of immature cells, they can be erroneously diagnosed as malignant tumor and can lead to overtreatment of these benign disorder. This can be avoided by an awareness of the clinical and histologic characteristics of fibrous hamartomas of infancy. The authors present one case of fibrous hamartoma of infancy developed in the trunk of extensively large size which was successfully removed.
Axilla ; Extremities ; Groin ; Hamartoma* ; Shoulder ; Vulva

Bacterial endophthalmitis is an ocular emergency that requires rapid diagnosis and therapeutic decision making. The introdection of intravitreal injection of antibiotics has been a major advancement because it has resulted in a marked improvement in visual outcome. The intravitreal injection of steroids may be potentially useful in the treatment of endophthalmitis and other ocular inflammatory diseases. Forty eyes of pigmented rabbits were used, and divided into two groups. Group I was eyes without vitrectomy. In the right eye, 100 microliter of 1mgvancomycin, 400 microliter amikacin and 400 microliter dexamethasone injected was done. Group II was eyes with vitrectomy and lensectomy. At 2 weeks after lens and vitreous removal, rabbit eyes received an injection of a combination of 1mg vancomycin, 400 microliter amikacin and 400 microliter dexamethasone in right eye and BSS in left eye. The effect of combination injection was examined by light and transmission, scanning electron microscope at 3 days, 1 week, 2 weeks and 6 weeks following injection. The injection of combination without vitrectomy produced no toxicity. After injections of either combination or BSS after vitrectomy, macrophages were observed on the surface of retinal pigment epithelium and disorganized outer segments. This finding seems to be produced by vitrectomy procedure rather than drug toxicity. These results supports the hypothesis that the injection of these combinations is not toxic to aphakic/vitrectomized eyes.
Amikacin ; Anti-Bacterial Agents ; Decision Making ; Dexamethasone* ; Diagnosis ; Drug-Related Side Effects and Adverse Reactions ; Emergencies ; Endophthalmitis ; Intravitreal Injections ; Macrophages ; Rabbits ; Retinal Pigment Epithelium ; Steroids ; Vancomycin ; Vitrectomy*

Recently, the detection of traumatic intracerebral hematoma has been greatly expedited by the advent of computed tomography. However, traumatic basal ganglia hemorrhage(TBGH) in child have remained rare. The authors obtained following results with analysis of clinical features and outcome in 8 cases of child's TBGH who had been treated at the department of neurosurgery, chonnam university hospital from January 1984 to December 1986. 1) Age distribution was ranged from 3 to 9 years with an average age 5.1 years and 5 were males and 3 were females. 2) Blow of site of the head were right frontal 3, left frontal 3, right parietal 1 and right temporal 1. However, hematoma in the basal ganglia occurred 6 in the left and 2 in the right. 3) On admission, the consciousness level appeared 2 cases in drowsy state(GCS 13), 3 cases in stuporous state(GCS 8,9) and 3 cases in semicomcatose state(GCS 5,7). 4) CT findings of TBGH were classified into 3 types; Type I; spotty type, Type II; moderate type and Type III : massive type. The number of patients was 4 in type I, 2 in type II and 2 in type III. 5) Neurological examination revealed contralateral hemiparesis to the hematoma in all cases(8), facial nerve palsy in 3 cases, motor aphasia in 4 cases and decerebrate rigidity in 2 cases. 6) Of all cases (8), conservative treatment were done in 5 and surgical treatment in 3. As regards the outcome of all cases (8), showed good recovery in 3, moderate disabilety in 2 and death in 3. It was concluded that the first regimen to be chosen in the management of TBGH in child was medical treatment. The patient of moderately disturbed conseionsness would be successfully managed by conservative treatment. The indication for surgery should be restricted to such cases in which the consciouness status were getting worse in spite of active conservative treatment.
Age Distribution ; Aphasia, Broca ; Basal Ganglia* ; Child ; Consciousness ; Decerebrate State ; Facial Nerve ; Female ; Head ; Hematoma ; Hemorrhage* ; Humans ; Jeollanam-do ; Male ; Neurologic Examination ; Neurosurgery ; Paralysis ; Paresis ; Rabeprazole ; Stupor

Effect of infusion and bolus injection of lidocaine on the pressure response to the increased intracranial pressure(ICP) was investigated in urethane-anesthetized rabbits. 1) Arterial blood pressure(BP) and ICP were significantly raised by infusing saline(0.05ml/min) into an epidural balloon. 2) Infusing of lidocaine(0.5mg/kg/min) into an ear vein minutely inhibited the elevation of BP and ICP when infusing saline into an epidural balloon. However, infusion of lidocaine(1.5mg/kg/min) markedly inhibited the elevation of BP and ICP. 3) Repeating the infusion of saline into the epidural balloon with intervals, the duration reached to the level of 80-10 mmHg ICP was gradually shortened. Each depressor response to the first, second and third injection of lidocaine(3 mg/kg) was similar. The first injection transiently reduced the elevated ICP, but the second and third injection reduced that significantly and the reducing effect was gradually prolonged according to repeating the lidocaine injection. These results show that lidocaine could delay the elevation of ICP and reduce the previously increased ICP by infusing saline into an epidural balloon.
Ear ; Intracranial Hypertension* ; Lidocaine* ; Rabbits* ; Veins

During the past five years(1990. 7-1995. 6,) eighteen patients with symptomatic lumbar spondylolisthesis whose neurogenic intermittent claudication appeared within fifteen minutes of walking, but otherwise suffered from no significant disc herniation at the involved level, underwent operation. The lumbar spine was stabilized by transpedicular screw fixation and modified posterior fusion instead of posterior lumbar interbody fusion(PLIF). There were three males and fifteen females and the average age was fourty-seven years(range, thirty-six to sixty-four years). After an average follow-up period of thirty-one months(range, fifteen to fifty-two months), the result were excellent in eight, good in seven, moderate in two, and poor in one patients. The satisfactory result of 83.3 percent of the patients suggested that the modified posterior fusion, instead of posterior lumbar interbody fusion, in which the spinous process, the lamina, the facet joint, and only the base of the transverse process were included, after transpedicular screw fixation in lumbar spondylolis thetic patients would be enough when there is no significant disc herniation at the involved level.
Female ; Follow-Up Studies ; Humans ; Intermittent Claudication ; Male ; Spine ; Spondylolisthesis* ; Walking ; Zygapophyseal Joint

No abstract available.
Meningioma* ; Skull Base* ; Skull*

Dens fractures are a common traumatic cervical spine injury. Among them, a type III fracture is the second common fracture. Although there are several treatment options, it has been accepted that type III fracture is usually healed by non-surgical method. After adequate reduction with traction, subsequent external immobilization has been associated with successful union rates. However, in the review of literatures, there are some cases with neurological deterioration after application of skull traction. So, the authors report a case of type III dens fracture with initially unrecognized ligamentous injury in which vertical dissociation and quadriplegia occurred after only five-pound Gardner-Well tongs traction. And also, the authors raise awareness of this potentially injury.
Cervical Vertebrae ; Female ; Immobilization ; Ligaments* ; Quadriplegia ; Skull ; Spine ; Traction*