OBJECTIVE: The presence of an intracerebral hematoma from a ruptured aneurysm is a negative predictive factor and it is associated with high morbidity and mortality rates even though clot evacuation followed by the neck clipping is performed. Endovascular coil embolization is a useful alternative procedure to reduce the surgical morbidity and mortality rates. We report here on our experiences with the alternative option of endovascular coil placement followed by craniotomy for clot evacuation. MATERIALS AND METHODS: Among 312 patients who were admitted with intracerebral subarachnoid hemorrhage during the recent three years, 119 cases were treated via the endovascular approach. Nine cases were suspected to show aneurysmal intracerebral hemorrhage (ICH) on CT scan and they underwent emergency cerebral angiograms. We performed immediate coil embolization at the same session of angiographic examination, and this was followed by clot evacuation. RESULTS: Seven cases showed to have ruptured middle cerebral artery (MCA) aneurysms and two cases had internal carotid artery aneurysms. The clinical status on admission was Hunt-Hess grade (HHG) IV in seven patients and HHG III in two. Surgical evacuation of the clot was done immediately after the endovascular coil placement. The treatment results were a Glasgow Outcome Scale score of good recovery and moderate disability in six patients (66.7%). No mortality was recorded and no procedural morbidity was incurred by both the endovascular and direct craniotomy procedures. CONCLUSION: The results indicate that the coil embolization followed by clot evacuation for the patients with aneurysmal ICH may be a less invasive and quite a valuable alternative treatment for this patient group, and this warrants further investigation.
Treatment Outcome ; Tomography, X-Ray Computed ; Retrospective Studies ; Middle Aged ; Male ; Intracranial Aneurysm/radiography/*therapy ; Humans ; Hematoma/radiography/*therapy ; Female ; Embolization, Therapeutic/*methods ; Drainage/*methods ; Cerebral Angiography ; Aneurysm, Ruptured/radiography/*therapy ; Adult

Extramammary Paget's disease (EMPD) is an intraepithelial neoplastic disorder which is included as a rare malignant condition. However, it sometimes shows aggressive behavior of local recurrence and coexisting malignancy. We had experienced nine cases of EMPD involving the scrotum for seven years. Two cases of them presented metastasis. The first case presented extensive inguinal lymph node metastasis with underlying adnexal adenocarcinoma one year after wide local excision. The second case initially presented multiple metastasis to the liver and in the lymph node. The latter, showing fulminant progression with liver metastasis, may be only the second case reported in English literature. EMPD is considered as a malignant neoplasm with aggressive behavior from initial presentation. Because wide local excision of the lesion alone may be occasionally insufficient, a careful follow-up must be done to detect recurrence or internal malignancy.
Aged ; Case Report ; Fatal Outcome ; Female ; Human ; Liver Neoplasms/secondary* ; Magnetic Resonance Imaging ; Male ; Paget's Disease, Extramammary/surgery ; Paget's Disease, Extramammary/pathology* ; Testicular Neoplasms/surgery ; Testicular Neoplasms/pathology*

Neovascularization is an important factor in the prognosis of brain tumor and many angiogenetic factors have been evaluated for prognostic significance. Among them, basic fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF) are known as potent angiogentic factors and mitogens. We evaluated seven cases of grade II brain astrocytoma. Four, group A, was diagnosed as anaplastic progression at their second operation, and three, group B, did not. Using monoclonal antibodies to bFGF and VEGF in paraffin embedded tissue from first operation, their immunoreactivity and differences between two groups were examined. The growth fractions of these tumor were also measured by Ki-67 monoclonal antibodies (MIB1). Immunostaining for bFGF in tumor cells were observed in both nuclei and cytoplasm, and for VEGF, mainly observed in the cytoplasm. Mean cell count number +/- standard deviation per high power field in each were as follows: 1) for bFGF, 20.08 +/- 6.38 in group A and 0.87 +/- 0.90 in group B (p< 0.01), 2) for VEGF, 43.75 +/- 17.09 in group A, and 0.8 +/- 1.06 in group B (p< 0.05) and 3) for the proliferation index with Ki-67 antibodies, 3.20 +/- 0.81 in group A and 0.77 +/- 1.03 in group B (p< 0.05). This data supports the assertion that angiogenetic factor such as bFGF and VEGF may contribute to progressive change of astrocytoma by tumor angiogenesis.
Adolescent ; Adult ; Astrocytoma/*pathology ; Brain/*blood supply ; Brain Neoplasms/*pathology ; Endothelial Growth Factors/*metabolism ; Female ; Fibroblast Growth Factor 2/*metabolism ; Human ; Lymphokines/*metabolism ; Male ; Middle Age ; Neovascularization, Pathologic/*genetics ; Prognosis ; Tumor Markers, Biological

No abstract available.
Carcinoma, Non-Small-Cell Lung* ; Cisplatin* ; Drug Therapy, Combination* ; Etoposide* ; Fluorouracil*

SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome designates a group of articular and osseous manifestations frequently combined with skin disorders. Its fundamental component is inflammatory, pseudoinfectious, and sterile osteitis. The anterior chest wall is the most frequent localization and all the components of this structure may be involved. Palmoplantar pustulosis, psoriasis, acne conglobata, acne ulcerans, acne fulminans, pyoderma gangrenosum can be associated with the characteristic bone lesions. We report two cases of SAPHO syndrome : A 40-year-old female presented with both buttock pain with hyperostosis, costochondritis, synovitis and pustulosis palmaris and a 23-year-old male presented with migrating polyarthritis with costochondritis, synovitis, acne, pustulosis.
Acne Vulgaris ; Acquired Hyperostosis Syndrome* ; Adult ; Arthritis ; Buttocks ; Female ; Humans ; Hyperostosis ; Male ; Osteitis ; Psoriasis ; Pyoderma Gangrenosum ; Skin ; Synovitis ; Thoracic Wall ; Young Adult

OBJECTIVE: To investigate the clinical characteristics of Korean JRA and the possible profiles related to prognosis and to compare these data to pre-existing occidental reports. METHODS: 140 cases of JRA patients were randomly selected from 1986 through 1995. Juvenile ankylosing spondylitis was excluded with the aid of modified New York criteria for ankylosing spondylitis. We used the classification of progression of rheumatoid arthritis (radiological stage III+IV / I+II+III+IV) as a index of prognosis. The study factors were sex, age, type, affected joints, degree of destruction of joint, anti-nuclear antibody (ANA), rheumatoid factor (RF), HLA-B27 and extra-articular manifestations. Chi-square test, One-way ANOVA test, and Pearson' s correlation coefficient were used as statistical methods. RESULTS: Our study show results as follows : (1) Systemic onset type (ll%) { polyarthritis subset (66%), oligoarthritis subset (34%) }, oligoarthritis onset type (62%) { sero (-) -HLA-B27 (+) subset (66%) , RF (+) subset (20%), not otherwise classified subset (14%) ANA(+)-chronic uveitis subset(O%) }, polyarthritis onset type (27%) { RF(+) subset (66%), not otherwise classified subset (34%) }, (2) Sex ratio was M:F=1.8:l. (3) Age of onset was 11+3.6 years. (4) Affected joints were knee, ankle, hand in decreasing order of frequency. (5) Patients show seropositivity of RF in 31%, HLA-B27 in 54%, ANA in 8%. (6) Chronic uveitis was observed in 7 cases (5%) (all oligoarthritis onset type, M:F=6:1, age of onset 11+4.3 years, ANA (0%), HLA-B27 (86%) , 2 cases leading to blindness. (7) Destructive bone change was significantly more prominent in female (p<0.01) , RF(+) (p<0.01), HLA-B27(-) (p<0.01) , polyarthritis onset type (p=0.02). CONCLUSIONS: In this study, we obtained interesting results that are somewhat different from Occidental data in sex ratio (male dominance), age of onset (older age) , profiles of HLA-B27 (high positivity in spite of low HLA-B27 positivity in Korean (about 2. 3%) , low rate of destructive change) , ANA (low positivity, older age of onset) , chronic uveitis (low incidence, male dominance, older age of onset, high association with HLA-B27, not associated with ANA) . This study suggests possible racial difference in clinical features of JRA. But for prove of racial difference, further multi-center trial and large scale epidemiological study should be done.
Age of Onset ; Ankle ; Antibodies, Antinuclear ; Arthritis ; Arthritis, Juvenile* ; Arthritis, Rheumatoid ; Blindness ; Classification ; Epidemiologic Studies ; Female ; Hand ; HLA-B27 Antigen ; Humans ; Incidence ; Joints ; Knee ; Male ; Prognosis ; Rheumatoid Factor ; Sex Ratio ; Spondylitis, Ankylosing ; Uveitis

OBJECT: With the recent variable treatment modalities and the development of microsurgical techniques, outcomes of surgical and medical management of aneurysm have shown much progress in the last 10 years. However, the management of posterior circulation aneurysm is still a debatable due to its difficulty in limited surgical approach, complicated anatomical structure and many small perforators to vital structure. The purpose of this study is to compare the results of clinical manifestation and outcome of surgery with respect to anterior and posterior circulation aneurysms. MATERIAL AND METHODS: We evaluated the 33 patients with PCAs(posterior circulation aneurysm) and 359 patients with ACAs(anterior circulation aneurysm) treated between 1994 and 1999, retrospectively. RESULTS: Posterior circulation aneurysms showed higher tendency(5 cases, 14.7%) to have unusual shapes, such as dissecting or fusiform compared with anterior circulation aneurysm(15 cases, 4.2%). There were more multiple aneurysms in posterior circulation aneurysm(8 cases, 26.5%) than anterior circulation aneurysm(59 cases, 16.2%). The number of patients with Hunt-Hess grade III or IV on admission were 91(25.3%) in anterior circulation aneurysms, and 14(42.4%) in posterior circulation aneurysms. There were higher incidences of vasospasm and acute hydrocephalus in patients with posterior circulation aneurysm. In cases of anterior circulation aneurysm, neck clipping was possible in 97%. But, in posterior circulation aneurysm, neck clipping was possible only in 67.7% of each. Two hundred forty four cases(85.0%) of all anterior circulation aneurysms and 22 cases(78.6%) of all posterior circulation aneurysms showed good recovery(GR) or moderate disability(MD). The postoperative mortality rates of anterior and posterior circulation aneurysms were 4.9% and 10.7%, respectively. CONCLUSION: These results indicate that there exist substantial differences with respect to that there were few difference in the aspect of surgery and management outcome between posterior circulation aneurysms and anterior circulation aneurysms.
Aneurysm* ; Humans ; Hydrocephalus ; Incidence ; Mortality ; Neck ; Retrospective Studies

Rice bodies are numerous small fibrinous, cartilaginous-like materials which were first described in tuberculous joints. Rice bodies are common findings in joints afflicted with rheumatoid arthritis or other seronegative arthropathy. But less commonly, those can be seen in periarticular bursae or at the sites of tendon or ligament insertion. Rice bodies, thought to be a nonspecific response to synovial inflammation, probably evolve from ischemia in a proliferative synovium. Some of these bodies contain a core of collagen with a mantle of fibrin, others contain only fibrin. Subacromial bursa are sometimes involved in the patients with rheumatoid arthritis and can reach impressive dimensions before becoming clinically detectable because significant constrain is lacking. Subacromial arthrography or magnetic resonance imaging accurately delineated the existence of cartilaginous loose bodies before surgical exision. We experienced a man with rheumatoid arthritis who had massive subacromial bursitis with rice bodies. His shoulder had been swollen since 5 years ago. He felt no pain and had only mild limitation of motion. Subacromial arthrography or magnetic resonance imaging of right shoulder showed multiple rice bodies in enlarged subacromial bursa. Operation finding showed a large encapsulated mass in the subacromial bursa, and hundreds of fibrinous rice bodies were revealed, which were resected. We report this patient with a review of literatures.
Arthritis, Rheumatoid* ; Arthrography ; Bursitis* ; Collagen ; Fibrin ; Humans ; Inflammation ; Ischemia ; Joints ; Ligaments ; Magnetic Resonance Imaging ; Shoulder ; Synovial Membrane ; Tendons

OBJECTIVE: This study was undertaken to review the disease course, clinical and laboratory manifestations, prognosis and treatment of adult onset Still s disease (AOSD) in Korea. METHODS: Thirty-two patients with AOSD were enrolled from 1986 to 1997 in Hanyang University Hospital. Diagnosis of AOSD was based on the criteria proposed by Yamaguchi. We classified the disease course into self-limited, inter mittent, or chronic disease course. RESULTS: Twenty-four (75%) patients were female. Skin rash occurred in 28 (88%) patients, lymphadenopathy in 8 (25%), hepatomegaly in 4 (13%), and pericarditis in 2 (6%) out of 32 patients. The most commonly affected joints were knee joints (88%). Elevated LDH was seen in 18 (60%) patients and decreased CK in 17 (61%) patients. Rheumatoid factor was detected in 4 (13%) patients and ANA in 12 (38%) patients. Anemia (Hb < 10 g/dL) was seen in 13 (41%) patients and hypoalbuminemia (<3. 5 g/dL) in 14 (52%) patients. Elevated ferritin (300 ng/mL) level was seen in 23 (79%) patients. Twenty-five (78%) patients had elevated serum transaminase. Bone marrow studies were performed in 16 patients. Nine out of 16 patients showed hyperplasia of the myeloid series and 2 patients displayed the features of a hemophagocytic syndrome. The mean duration of follow up of 32 patients was 32 months (range 3- 108). Eight (27%) patients had a self-limited, 9 (30%) an intermittent, and 13 (43%) a chronic disease course. The hypoalbuminemia was significantly associated with an "intermittent or chronic disease group" (p<0. 05). Thirty-two patients received systemic corticosteroids and 21 patients received single or combination of disease modifying antirheumatic drugs. CONCLUSION: We found that hypoalbuminemia at presentation was significantly associated with an unfavorable outcome, intermittent or chronic disease group. The clinical manifestations and disease course of AOSD in Korea were similar to those previously reported in other countries except significantly lower incidence of lymphadenopathy, hepatomegaly, and pericarditis.
Adrenal Cortex Hormones ; Adult* ; Anemia ; Antirheumatic Agents ; Bone Marrow ; Chronic Disease ; Diagnosis ; Exanthema ; Female ; Ferritins ; Follow-Up Studies ; Hepatomegaly ; Humans ; Hyperplasia ; Hypoalbuminemia ; Incidence ; Joints ; Knee Joint ; Korea* ; Lymphatic Diseases ; Lymphohistiocytosis, Hemophagocytic ; Pericarditis ; Prognosis ; Rheumatoid Factor ; Still's Disease, Adult-Onset*

OBJECTIVES: In the connective tissue disease patients, esophageal dysfunction is often closely associated with the presence of Raynaud's phenomenon. But there are no previous reports concerning the values of esophageal manometry in the connective tissue disease with Raynaud s phenomenon in Korea. Therefore, we performed this study to evaluate esophageal function in connective tissue disease with Raynaud' s phenomenon. METHODS: Total 86 subjects were employed in this study including 30 normal control group, 14 mixed connective tissue disease(MCTD), 21 systemic sclerosis, 16 systemic lupus erythematosus(SLE), and 5 Raynaud s phenomenon only. In each subject, esophageal manometric study was performed with lower compliance capillary infusion system. RESULTS: The mean age(+SD) of patients and controls were as follows : MCTD 34.1(+8.9), systemic sclerosis 44.9(+9. 3), SLE 32. 1(+7.9), and normal controls 31. 9 (+ 5. 3). All patients with MCTD and systemic sclerosis had Raynaud s phenomenon. Twelve out of 14 patients with MCTD, 17 out of 21 patients with systemic sclerosis, were abnormal in esophageal manometry. Nine out of 16 SLE had Raynaud s phenomenon. Among 9 SLE with Raynaud s phenomenon, 5 patients(55.5%) were abnormal in esophageal manometry, and among 7 SLE without Raynaud's phenomenon, 2 patients (28. 6%) were abnormal in esophageal manometry. Among 5 patients with Raynaud's phenomenon, 3 patients were abnormal in esophageal manometry. Abnormal esophageal manometry finding is more common in the connective tissue disease patients with Raynaud's phenomenon compared with the patients without Raynaud's phenomenon (P=O. 0219). CONCLUSIONS: Abnormal esophageal manometry finding is more common in the connective tissue disease patients with Raynauds phenomenon compared with the patients without Raynaud s phenomenon.
Capillaries ; Compliance ; Connective Tissue ; Connective Tissue Diseases ; Humans ; Korea ; Manometry ; Mixed Connective Tissue Disease ; Scleroderma, Systemic