A giant serpentine aneurysm (GSA) in the anterior cerebral artery (ACA) poses a technical challenge in treatment given its large size, unique neck, and dependent distal vessels. Here we report the case of a GSA in the ACA successfully treated with a combined surgical and endovascular approach. A 54-year-old woman presented with dull headache. On brain computed tomography (CT), a large mass (7 cm × 5 cm × 5 cm) was identified in the left frontal lobe. Cerebral angiography revealed a GSA in the left ACA. Bypass surgery of the distal ACA was performed, followed byocclusion of the entry channel via an endovascular approach. Follow-up CT performed 5 days after treatment revealed disappearance of the vascular channel and peripheral rim enhancement. Follow-up imaging studies performed 7 months after treatment revealed gradual reduction of the mass effect and patency of bypass flow. No complications were noted over a period of 1 year after surgery.
Aneurysm* ; Anterior Cerebral Artery* ; Brain ; Cerebral Angiography ; Cerebral Revascularization ; Female ; Follow-Up Studies ; Frontal Lobe ; Headache ; Humans ; Intracranial Aneurysm ; Middle Aged ; Neck

Development of de novo aneurysm or aneurysm regrowth after complete clipping of an intracranial aneurysm is rare. We report coiled cases of de novo aneurysm and aneurysm regrowth. We retrospectively reviewed 107 cases of intracranial aneurysm coiling performed in our hospital, identifying five cases of coiled aneurysm that were de novo aneurysm or aneurysm regrowth. In all the cases, total or near total occlusion was seen. There were no complications related to the procedure. In two of the three patients with ruptured aneurysms, consciousness level on admission was stupor. When the patient was discharged after the treatment, one of them had 4 of the modified Rankin Scale. The other one had 5 on discharge. The rest three patients had 0. As for a de novo aneurysm or a regrowth of aneurysm, coiling may be considered when clipping is difficult.
Aneurysm ; Aneurysm, Ruptured ; Consciousness ; Humans ; Intracranial Aneurysm ; Retreatment ; Retrospective Studies ; Stupor ; Subarachnoid Hemorrhage

No abstract available.
Lichen Nitidus* ; Lichens*

OBJECTIVE: Self-expanding stents are increasingly used for the treatment of complex intracranial aneurysms. The purpose of this study was to evaluate the usefulness and safety of a self-expanding nitinol stent (Enterprise) in the treatment of wide-necked intracranial aneurysms. METHODS: This was a retrospective study of 39 patients with 40 wide-necked intracranial aneurysms who were enrolled in a single-center registry of patients treated with the Enterprise between June 2009 and December 2011. Thirty patients were asymptomatic, four had cerebrovascular accident sequelae, and five had suffered subarachnoid hemorrhage. One aneurysm had reopened after prior coil embolization, while 39 had not been treated. Clinical charts, procedural data, and angiographic results, including both immediate post-procedural angiograms and follow-up imaging, were reviewed. RESULTS: The mean neck size of the aneurysms was 5.58 mm (range 3-15.1 mm). Embolization was successful in all patients. There were five procedure-related events. There were no fatalities, but one procedure-related morbidity was noted. The immediate angiographic results included eight complete occlusions (20%), six remnant necks (15%), and 26 remnant sacs (65%). At angiographic follow-up (mean: 11.3 months), out of 18 of the aneurysms treated with stent-assisted coiling, there were 13 (72.2%) complete occlusions, four (22.2%) remnant necks, and one recanalization (5.6%). CONCLUSION: Stent-assisted coiling using the Enterprise is effective for the treatment of wide-necked intracranial aneurysms. Further angiographic and clinical follow-up investigation will be needed for evaluation of the long-term outcomes.
Aneurysm* ; Embolization, Therapeutic ; Follow-Up Studies ; Humans ; Intracranial Aneurysm* ; Neck ; Retrospective Studies ; Stents* ; Stroke ; Subarachnoid Hemorrhage

OBJECTIVE: The purpose of this study is to evaluate the effectiveness of unilateral decompression and pedicle screw fixation for the unilateral symptomatic foraminal stenosis. METHODS: The study group comprises consecutive 16 patients who underwent unilateral decompression and bone cement augmented pedicle screw fixation from May 2003 to January 2006. The patients were evaluated by visual analog scale (VAS) for pain and the scoring system of the Japanese Orthopedic Association (JOA) for low back pain. The result of surgery was also evaluated with McNab's classification. Excellent or good outcome was considered as successful. The patients were followed at postoperative 1 month, 3 month, 6 month, and 1 year with standing AP and lateral films. RESULTS: The average VAS and JOA score of the 16 patients were 7.8 (range, 6-9) and 5.8 (range, 3 - 10) before surgery and 2.2 (range, 0 - 5) and 12.3 (range, 9 - 15) at the time of last follow up. Both VAS and JOA score improved significantly after the surgery (p < 0.05, t-test). All patients improved after the operation and no revision surgery was required. No metal failure or pseudoarthrosis was observed during the follow-up. The success rate was 87.5%. CONCLUSION: Our data suggest that unilateral decompression and pedicle screw fixation for the unilateral symptomatic foraminal stenosis is an effect method for obtaining satisfactory clinical outcome. Its possible advantage is shorter operation time and reduced surgical extent. We believe that the reduced stiffness of unilateral fixation was compensated by pedicle screw augmentation and interbody fusion.
Asian Continental Ancestry Group ; Constriction, Pathologic ; Decompression ; Follow-Up Studies ; Humans ; Imidazoles ; Low Back Pain ; Nitro Compounds ; Orthopedics ; Pseudarthrosis

No abstract available.
Diskectomy* ; Dust* ; Transplants*

We reviewed 42 cases (mean age 48.3+/-7.6 years, range 30 to 63 years) who underwent the modified Gittes bladder neck suspension for female stress urinary incontinence between January 1990 and May 1995 to evaluate the efficacy of two different suspension suture materials and new suspension suture carrier. At first we used the No. 1-0 Prolene as suspension suture in 24 cases (group I) and secondly No. 1-0 Ethibond in 18 cases (group II) with Ostycut bone biopsy needle (Angiomed) as suture carrier Following results were obtained. 1. The patient's ages ranged from 30 to 63 years (mean age 48.3+/-7.6 years), and most patients were multiparous with an average of 3.3+/-1.2 deliveries and we classified the patients according to Blaivas classification and there was statistically no difference of variables in both groups except the parity. 2. The mean values of operative time, postoperative days on catheter, and postoperative hospitalization were 65.5+/-11.4 minutes, 6.9+/-1.6 days, 7.3+/-1.4 days respectively. 3. The postoperative complications were transient urinary retention 8 cases (21.1%), vaginitis or cystitis 5 cases (11.9%), wound bleeding 1 case (2.4%) and deviation of urinary steam 1 case (2.4%). 4. The success rate was 83.3% in the group I, 94.4% in group II with minimum followup of 12 months (mean 24.6+/-5.0 months) but the latter wasn't significantly higher than the former statistically. The overall success rate was 88.1%. 5. The Ostycut bone biopsy needle as suspension suture carrier was simple and safe in the bladder neck suspension treatment. With above results, we recommend the No. 1-0 Ethibond as suspension suture material rather than the Prolene in bladder neck suspension and Ostycut bone biopsy needle as suspension suture carrier.
Biopsy ; Catheters ; Classification ; Cystitis ; Female ; Follow-Up Studies ; Hemorrhage ; Hospitalization ; Humans ; Neck* ; Needles ; Operative Time ; Parity ; Polypropylenes ; Postoperative Complications ; Steam ; Sutures* ; Urinary Bladder* ; Urinary Incontinence ; Urinary Retention ; Vaginitis ; Wounds and Injuries

No abstract available.
Ligamentum Flavum* ; Spinal Cord Diseases*

PURPOSE: Childhood obesity is associated with complications such as hyperinsulinemia/insulin resistance, dyslipidemia and fatty liver. The aims of this study were to evaluate the difference of measurements between obese and normal weight children and to investigate the factors related to complications of obesity. METHODS: The body mass index (BMI), trunk and total fat percent, lipid profiles, ALT, AST, leptin, LH, FSH, fasting insulin, glucose, IGF-1, IGFBP-3 were measured in 97 children (49 obese children and 48 non-obese controls). We calculated G/I ratio, loginsuin, HOMA-IR, logHOMA-IR, and QUICKI and evaluated the relationship between each anthropometric data and metabolic data. RESULTS: Hyperinsulinemia, dyslipidemia and abnormal ALT showed high prevalence in obese children. In obese, BMI was correlated with G/I ratio (r=-0.309, P<0.05), loginsuin (r=0.381, P<0.05), logHOMA-IR (r= 0.342, P<0.05), QUICKI (r=-0.343, P<0.05), ALT (r=0.451, P<0.01)) and AST (r=0.289, P<0.05). Serum insulin level had positive correlation with BMI (r=0.345, P<0.01), serum triglyceride (r=0.332, P<0.05) and all insulin resistance indices (P<0.01). Serum leptin levels were significantly correlated with BMI (r=0.555, P<0.01), trunk (r=0.463, P<0.01)) and total (r=0.506, P<0.01) fat percent, LDL (r=0.350, P<0.05), total cholesterol (r=0.297, P<0.05). CONCLUSION: BMI is valuable for predicting insulin resistance and prevalence of abnormal ALT or AST. Monitoring of insulin level is helpful to assess the morbidities of obesity. Also, serum leptin level might be an important predictor of obesity.
Body Mass Index ; Child ; Cholesterol ; Dyslipidemias ; Fasting ; Fatty Liver ; Glucose ; Humans ; Hyperinsulinism ; Insulin ; Insulin Resistance ; Insulin-Like Growth Factor Binding Protein 3 ; Insulin-Like Growth Factor I ; Leptin ; Obesity ; Pediatric Obesity* ; Prevalence ; Triglycerides

A 64-year-old man was treated with sunitinib as a first-line therapy for metastatic renal cell carcinoma. He was given oral sunitinib in cycles of 50 mg once daily for 2 weeks followed by a week off. During the 5th week of treatment right upper quadrant pain developed, but this resolved spontaneously during the 6th week (off treatment). However, on the 8th week of treatment, he was admitted to hospital because the acute right upper quadrant pain recurred with nausea, vomiting, and fever. Acute acalculous cholecystitis was then diagnosed by ultrasonography and CT. In addition, his laboratory findings indicated disseminated intravascular coagulation. Accordingly, sunitinib therapy was discontinued and broad-spectrum antibiotics initiated. He subsequently recovered after emergent percutaneous cholecystostomy. His Naranjo Adverse Drug Reaction Probability Scale score was 7, indicaing a probable association of the event with sunitinib. Suspicion of sunitinib-related acute cholecystitis is required, because, although uncommon, it can be life-threatening.
Acalculous Cholecystitis ; Anti-Bacterial Agents ; Carcinoma, Renal Cell ; Cholecystitis, Acute ; Cholecystostomy ; Disseminated Intravascular Coagulation ; Drug-Related Side Effects and Adverse Reactions ; Fever ; Humans ; Middle Aged ; Nausea ; Ultrasonography ; Vomiting