The authors report a case of traumatic cerebrospinal fluid rhinorrhea accompanied by psychotic symptoms in which intracranial approach was performed under the surgical microscope for closure of the cerebrospinal fluid fistula, and satisfactory result were obtained.
Cerebrospinal Fluid ; Cerebrospinal Fluid Rhinorrhea* ; Fistula

Chordomas are congenital tumor which develop from remnant of the notochord. Most of them arise at the clivus Blumenbachii, at the junction of the sphenoidal and occipital bones or sacrococcygeal region. Rarely chordomas arise at the thoracic spine, which compress the spinal cord epidurally and sometimes invade the substance of the spinal cord. The authors report a case of chordoma at T9-T10 vertebral level in which the characteristic "physaliferous" cells were found in the slides of operative specimen. The tumor was compressing the spinal cord and extending into body and lamine of the vertebra, which resulted the patient, 52 year-old Korean male, in paraplegia.
Chordoma* ; Cranial Fossa, Posterior ; Humans ; Male ; Middle Aged ; Notochord ; Occipital Bone ; Paraplegia ; Sacrococcygeal Region ; Spinal Cord ; Spine*

Chemical destruction of Gasserian ganglion by either alcohol or phenol has remained a popular form of treatment for tic pain. However, control of the lesion size is inaccurate and various complications have often resulted. With advent of radiofrequency generator, percutaneous coagulation of the Gasserian ganglion is now possible, and the need for open surgery or chemical destruction have been drastically reduced. We treated 3 cases of trigeminal neuralgia with the radiofrequency current. Modified Hartel's anterior appaorch for the injection of the Gasserian ganglion is utilized and the radiofrequency lesions were made in the second branches of the trigeminal nerve selectively preserving the touch sensation in our patients. We reviewed the literature and described the technical procedures.
Humans ; Phenol ; Sensation ; Tics ; Trigeminal Ganglion ; Trigeminal Nerve ; Trigeminal Neuralgia*

The experiments were carried out on 48 rabbits weighing between 1.7 and 2kg. The occurrence and changes of experimental brain edema have been studied by calculating wet weight, volume, dry weight, and percentage of both water content and swelling in the rabbits. The brain edema and swelling were produced by expansion of laminaria which was expanded gradually in the supratentorial extradural space of rabbit, and also, the brain edema with swelling were induced by intravenous injection of distilled water and pitressin. The effect of mannitol and steroid to these experimental brain edema with swelling and, especially, the effect and reaction of ethyl alcohol and diphenyl hydantoin on brain edema in distilled-water and pitressin groups were studied and the results obtained are as follows: The weight, volume, and percentages of water content and swelling in the compressed sides of hemisphere showed higher values compared them to the opposite noncompressed hemisphere in the "laminaria-compression" group and showed gradually increasing tendency as the time elapsed. The effect of mannitolization to "laminaria-compression" group showed anti-brain edema reaction while there showed no such effect after steroid injection. The acute brain edema with swelling was demonstrated in pitressin and distilled-water group by showing increased percentages of water and swelling than those of control group. Although the intravenous dilantin injection to these experimental groups showed no appreciable effect on anti-brain edema reaction and effect.
Brain Edema ; Edema* ; Ethanol ; Injections, Intravenous ; Laminaria ; Mannitol ; Phenytoin ; Rabbits ; Vasopressins ; Water

Prosthetic valve thrombosis (PVT) can be a life-threatening complication that requires immediate treatment. This is a case report on repeated thrombolytic therapy for thrombosis of a prosthetic tricuspid valve. After repeated urokinase therapy, mechanical clicks were audible and the hemodynamics of the patient rapidly improved. Echocardiography showed the disappearance of thrombi and a normalized pressure gradient. Cine-fluoroscopy showed a well-functioning prosthetic valve.
Echocardiography ; Hemodynamics ; Humans ; Thrombolytic Therapy ; Thrombosis* ; Tricuspid Valve* ; Urokinase-Type Plasminogen Activator*

PURPOSE: To evaluate the pathologic effects of preoperative radiotherapy on the resectable distal rectal cancer, we analyzed the results of postoperative pathologic findings for the patients with preoperative radiotherapy and surgery. MATERIALS AND METHODS: From July 1995 to April 1996, we treated sixteen patients of resectable rectal cancer with preoperative radiation therapy and curative surgery. At diagnosis, Thomas Jefferson (TJ) system was used for the clinical stage of the patients. We treated the patients with conventional radiation therapy of 4500-5000cGy before surgery. The surgery was carried out 4 weeks after completion of radiation therapy. Modified Astler Coller (MAC) system was used for the postoperative pathologic stage. We analyzed the pathologic stages and findings according to preoperative clinical stage and compared with those of the control group in similar clinical stages. RESULTS: All patients were treated with sphincter preservation surgery after preoperative radiation therapy. Pathologic complete response (CR) was shown in 1 case (6.3%). We compared the results between preoperative radiation therapy group (Preop.RT group) and surgery only group (control group). In TJ stage II, among nine patients of Preop.RT group, 8 patients (88.9%) were in MAC stage B except 1 CR patient, but among 17 patients of control group, 11 patients (64.7%) were in MAC stage B and 6 patients (35.3%) in MAC stage C. In TJ stage III, among 7 patients of Preop.RT group, 4 patients (57.1%) were in MAC stage B and 3 patients (42.9%) in MAC stage C. Among 14 patients of control group, 4 patients (28.6%) were in MAC stage B and 10 patients (71.4%) in MAC stage C. Above results showed that postoperative pathologic stage was decreased in Preop.RT group with statistical significance (p=0.049). The postoperative pathologic findings (blood vessel invasion, lymphatic vessel invasion, perineural invasion) were decreased in the Preop.RT group compared with those of control group. But statistical significance was found only in lymphatic vessel invasion (p=0.019). CONCLUSION: The postoperative pathologic stages and adverse prognostic pathologic findings were decreased in preoperative radiation therapy group. The lymphatic vessel invasion and MAC stage C findings were abruptly decreased in preoperative radiation therapy group. The preoperative radiation therapy was found to be effective in resectable rectal cancer. The patients group in our study was very small and long term follow up was not done. Therefore, further study about this issues is needed .
Diagnosis ; Follow-Up Studies ; Humans ; Lymphatic Vessels ; Radiotherapy ; Rectal Neoplasms*

PURPOSE: To evaluate the effectiveness and safety of fentanyl-TTS in the management of radiotherapy induced acute pain and cancer pain treated with radiotherapy. MATERIALS AND METHODS: Our study was open labelled prospective phase IV multi-center study. the study population included patients with more 4 numeric rating scale(NRS) score pain although managed with other analgesics or more than 6 NRS score pain without analgesics. Patients divided into two groups; patients with radiotherapy induced pain (Group A) and patients with cancer pain treated with radiotherapy (Group B). All patients received 25 ug/hr of fentanyl transdermal patch. Primary end point was pain relief; second end points were change in patient quality of life, a degree of satisfaction for patients and clinician, side effects. RESULTS: Between March 2005 and June 2005, 312 patients from 26 participating institutes were registered, but 249 patients completed this study. Total number of patients in each group was 185 in Group A, 64 in Group B. Mean age was 60 years and male to female ratio was 76:24. Severe pain NRS score at 2 weeks after the application of fentanyl was decreased from 7.03 to 4.01, p=0.003. There was a significant improvement in insomnia, social functioning, and quality of life. A degree of satisfaction for patients and clinician was very high. The most common reasons of patients' satisfactions was good pain control. Ninety six patients reported side effect. Nausea was the most common side effect. There was no serious side effect. CONCLUSION: Fentanyl-TTS was effective in both relieving pain with good tolerability and improving the quality of life for patients with radiotherapy induced acute pain and cancer pain treated with radiotherapy. The satisfaction of the patients and doctors was good. There was no major side effect.
Academies and Institutes ; Acute Pain ; Analgesics ; Female ; Fentanyl* ; Humans ; Male ; Nausea ; Prospective Studies ; Quality of Life ; Radiotherapy* ; Sleep Initiation and Maintenance Disorders ; Transdermal Patch*