Owing to the focal wall defect covered with thin fibrous tissues, an aneurysm arising from the dorsal wall of the internal carotid artery (ICA) is difficult to manage either surgically or endovascularly and is often associated with high morbidity and mortality. Unfortunately, the definitive treatment modality of such highly risky aneurysm has not yet been demonstrated. Upon encountering the complex intracranial pathophysiology of such a highly precarious aneurysm, a neurosurgeon would be faced with a challenge to decide on an optimal approach. This is a case of multiple paraclinoid aneurysms including the ICA dorsal wall aneurysm, presented with spontaneous subarachnoid hemorrhage. With respect to treatment, direct clipping with a Sundt graft clip was performed after multiple endovascular interventions had failed. This surgical approach can be a treatment modality for a blood blister-like aneurysm after failed endovascular intervention(s).
Aneurysm* ; Carotid Artery, Internal* ; Mortality ; Subarachnoid Hemorrhage ; Transplants*

No abstract available.
Humans ; Siblings*

The tibial plateau fracture is a fracture of the proximal end of the tibia, involving the weight bearing articular surface. This fracture often presents some problems in treatment and prognosis, because it is frequently accompanied by soft tissue injuries such as collateral ligament, cruciate ligament and menisci. During a period of 3 1/2 years, from Febuary 1980 to July 1983, We observed 78 cases of tibial plateau fractures at Gang Nam Sacred Heart Hospital. Of the above cases, 40 could be followed for a period of anywhere from 3 months to 3 years. They have been analysed according to the cause, classification, method of treatment and final result of treatment. Among these 21(52.5%) were treated by cast immobilization, 3(7.5%) by skeletal traction, 16 (40%) by open reduction and internal fixation. Thirty two cases (80% ) out of 40 indicated the result of the Acceptable group according to Hohl and Lucks criteria.
Classification ; Clinical Study ; Collateral Ligaments ; Heart ; Immobilization ; Ligaments ; Methods ; Prognosis ; Soft Tissue Injuries ; Tibia ; Traction ; Weight-Bearing

Intraspinal cavernous malformation (CM) accounts for 5% to 16% of all spinal vascular abnormalities. Multiple spinal cord CMs are very rare and only a few cases have been described. We report a patient presented with right chest paresthesia and seizure, and diagnosed as multiple spinal intramedullary CM and intracranial involvement.
Humans ; Paresthesia ; Seizures ; Spinal Cord ; Spine ; Thorax

Cleidocranial dysplasia is a well-documented rare autosomal dominant skeletal dysplasia characterized by hypoplastic/aplastic clavicles, brachycephalic skull, patent sutures and fontanelles, midface hypoplasia, and abnormalities of dentition. Patients with cleidocranial dysplasia often complain about undesirable esthetic appearance of their forehead and skull. Notwithstanding many studies of molecular, genetics and skeletal abnormalities of this congenial disorder, there have been very few written reports of cranioplasty involving cleidocranial dysplasia. Thus, we report a rare case of successful cranioplasty using a modified split calvarial graft technique in patient with cleidocranial dysplasia.
Clavicle ; Cleidocranial Dysplasia* ; Dentition ; Forehead ; Genetics ; Humans ; Skull ; Sutures ; Transplants*

BACKGROUND: Although current dietary guidelines recommend to increase the consumption of whole grain, these recommendations are mainly derived from the belief that replacing fats with carbohydrate may reduce risk of coronary artery disease (CAD) by improving serum lipids. Our objective was to evaluate whether the isocalorical replacement of refined rice with whole grain reduce CAD risk factors such as insulin demand and lipid peroxidation in CAD patients. METHODS: Thirty-eight male patients with CAD were provided with 70 g powder of whole grain (220 kcal) for 16 weeks, replacing cooked refined rice as a carbohydrate source of breakfast. An oral glucose tolerance test (OGTT) was performed in all subjects to determine the effect of whole grain consumption on serum concentrations of insulin and glucose in CAD patients with different degree of glucose tolerance. RESULTS: With the substitution of whole grain for refined rice, serum glucose concentrations decreased by 24% without altering body weight and energy intake. Estimates of daily fiber and vitamin E intakes increased by 24% and 50%, respectively. Whole grain consumption in CAD patients without diabetes decreased fasting glucose (22%) and the area under the curve (AUC) for insulin (26%) and glucose (19%) during an OGTT. CAD patients with diabetes also showed reductions in fasting glucose (27%) and AUC for glucose (25%) during the OGTT, compared with baseline values. Whole grain consumption reduced plasma malondialdehyde and homocysteine and urinary 8-epi-prostaglandin F 2alpha concentrations by about 30%. Lipid-corrected concentrations of alpha-carotene, retinol, alpha- and gamma-tocopherol and lycopene increased by 22-46%, compared with baseline values. Whole grain consumption decreased the percentage composition of w6 fatty acids of serum phospholipid increased by 14%. CONCLUSION: The replacement of refined rice with whole grain as a carbohydrate source of a meal showed significant beneficial effects on glucose, insulin and homocysteine concentrations and lipid peroxidation in CAD patients. These effects are likely to substantially reduce the risk factors of CAD and diabetes in CAD patients.
Area Under Curve ; Blood Glucose ; Body Weight ; Breakfast ; Edible Grain* ; Coronary Artery Disease* ; Coronary Vessels* ; Energy Intake ; Fasting ; Fats ; Fatty Acids ; gamma-Tocopherol ; Glucose ; Glucose Tolerance Test ; Homocysteine* ; Humans ; Insulin* ; Lipid Peroxidation* ; Male ; Malondialdehyde ; Meals ; Nutrition Policy ; Plasma* ; Risk Factors ; Vitamin A ; Vitamin E ; Vitamins

OBJECTIVE: Our purpose of this study is to compare insertion angles and screw lengths from Roy-Camille, Magerl, and our designed method for cervical lateral mass screw fixation in the Korean population by quantitative measurement of reformatted two dimensional (2D) computed tomography (CT) images. METHODS: We selected thirty Korean patients who were evaluated with thin section CT scans and reconstruction program to obtain reformatted 2D-CT images of the transversal plane passing the cranio-caudal angle using three different techniques. We measured the minimum angle to avoid vertebral artery (VA) injury, the ideal angle and depth for bicortical screwing of cervical lateral mass. Morphometric measurements of the lateral masses from C3-C7 were also taken. RESULTS: In all three techniques, the mean safety angles from the VA were less than 8 degrees and the necessary depth of the screw was about 14 mm for safety to the VA and for the bicortical purchase. In our designed technique, the mean beta angles of each level from C3 to C7 were 29.0, 29.8, 29.5, 26.3, and 23.9 degrees, respectively. CONCLUSION: Results of this study and data from the literature indicate that differences may exist between the Korean and Western people in the length and angle for ideal lateral mass screw fixation. In addition, our technique needs further cadaveric and clinical study for safety and efficacy for being performed as alternative method for cervical lateral mass fixation.
Cadaver ; Cervical Vertebrae ; Female ; Humans ; Vertebral Artery

No abstract available.
Epidermal Growth Factor* ; Gonadotropin-Releasing Hormone* ; Myoma* ; Receptor, Epidermal Growth Factor*

OBJECTIVE: The risk of complications is high for patients with a large cranial defect and hydrocephalus, undergoing cranioplasty and ventriculoperitoneal (VP) shunt operation. The purpose of this study is to examine retrospectively such cases with complications and contrive an operative technique to reduce complications. METHODS: Nineteen patients underwent cranioplasty and VP shunt operation due to large cranial defects and hydrocephalus. These patients were divided into two groups: Group A with 10 patients who underwent staged-operations, and Group B with 9 patients who underwent one-stage operation. Their complications in each group were retrospectively reviewed. Another five patients underwent a one-stage operation with temporary occlusion of the distal shunt catheter to improve on the technique and were categorized as Group C. Complications in these groups were compared and analyzed. RESULTS: The results of the data analysis revealed that complications related to anesthesia (40%) and those related to antibiotic prophylaxis (30%) were high in Group A, while non-infectious delayed complications (45%) and perioperative complications such as intracranial hematoma (33%) were high in Group B. However, for patients in Group C, it showed less complication with the operative technique devised by these authors, as opposed to two previous procedures. CONCLUSION: In patients with hydrocephalus and a large cranial defect, complications arising from existing one-stage operation or staged-operations can be reduced by implementing the technique of "one-stage operation with temporary occlusion of the distal shunt catheter."
Anesthesia ; Antibiotic Prophylaxis ; Catheters ; Decompressive Craniectomy ; Hematoma ; Humans ; Hydrocephalus* ; Retrospective Studies ; Statistics as Topic ; Ventriculoperitoneal Shunt*

Epithelioid trophoblastic tumor is a rare type of gestational trophoblastic disease that is distinct from placental site trophoblastic tumor and choriocarcinoma, and epithelioid trophoblastic tumor has features resembling a carcinoma. We report here on an epithelioid trophoblastic tumor that was discovered as a solitary pulmonary nodule in the lung of a 50-year-old woman. The patient had suffered from a hydatidiform mole 20 years previously. Wedge resection of the lung was done and this showed a 1.9x1.5 cm sized, relatively well defined mass composed of mononuclear tumor cells admixed with hyaline-like material and necrosis. The tumor cells were positive for EMA, Cam5.2, alpha-inhibin, PLAP and hCG. After consulting the gynecologic department, a 7.5x6.5 cm sized mass was discovered in the uterine fundus. Hysterectomy was then done. The tumor cells were same to those of the lung mass. The lung mass is considered to be metastasis from the epithelioid trophoblastic tumor of the uterus. She has been an uneventful clinical course for three years.
Biomarkers ; Choriocarcinoma ; Female ; Gestational Trophoblastic Disease ; Humans ; Hydatidiform Mole ; Hysterectomy ; Inhibins ; Keratins ; Lung ; Middle Aged ; Necrosis ; Neoplasm Metastasis ; Pregnancy ; Solitary Pulmonary Nodule ; Trophoblastic Neoplasms ; Trophoblastic Tumor, Placental Site ; Trophoblasts ; Uterus