The occurrence of coincidental intracranial aneurysms with tumors of pituitary origin is very rare. Silent intracranial aneurysms located distant from the lesion to treated have little relevance to surgical management of most patients. However, aneurysms of the major arteries adjacent to pituitary and suprasellar mass are an additional hazard to surgical treatment. We experienced silent multiple aneurysms located just below the bifurcation of both internal carotid arteries associated with symptomatic pituitary adenoma(acromegaly). Transfrontal removal of the pituitary eosinophillic adenoma was carried out without treatment of the aneurysms. The angiographic data considered significant to the safety of the procedure. So the necessity of the cerebral angiography is stressed to show the precise relationships of vessels to masses in the pituitary region. Also the possible reasons for the occurrence of aneurysms in association with these tumors were discussed.
Adenoma ; Aneurysm* ; Arteries ; Carotid Artery, Internal ; Cerebral Angiography ; Eosinophils ; Humans ; Intracranial Aneurysm ; Pituitary Neoplasms*

The medulloblastoma is a tumor of the cerebellum, particulary common in children. Most of them in childhood are situated in the midline vermis, but in adults are in the lateral lobes. The authors reported two cases of medulloblastoma which developed in the midline vermis although the patients were adult, and reviewed with concerned articles.
Adult* ; Cerebellum ; Child ; Humans ; Medulloblastoma*

We have recently experienced a rare case of extradural epidermoid cyst in the left middle cranial fossa associated with trigeminal neuralgia. A 22-year old female has intermittently developed lancinating pain in the left of face and dark reddish rhinorrhea for 5 years. Plain skull films showed an elevation of lesser wing of sphenoid bone and protrusion of left zygomatic arch with deepening of left middle cranial fossa. Carotid angiograms and brain scan with technetium 99m revealed a large cystic mass in left middle cranial fossa. A left temporal craniotomy was done and a large cystic mass filled with dark bluish colored fluid was removed at the left middle cranial fossa. Postoperatively the trigeminal neuralgia subsided completely. We have discussed the pathogensis and clinical symptoms with the review of the literatures.
Brain ; Cranial Fossa, Middle* ; Craniotomy ; Epidermal Cyst* ; Female ; Humans ; Skull ; Sphenoid Bone ; Technetium ; Trigeminal Neuralgia* ; Young Adult ; Zygoma

The authors present a case of respiration arrest after posterior lumbar interbody fusion. This rare complication occurred because of the tension pneumoperitoneum and pneumomediastinum. We report the pathophysiology and treatments.
Mediastinal Emphysema* ; Pneumoperitoneum* ; Pneumothorax* ; Respiration

OBJECTIVE: Since the evaluation of negative symptoms has depended on the clinician's objective observation, the patients' subjective experience of negative symptoms has been neglected. However, in fact, a lot of patients are aware of their negative symptoms. There are several reports suggesting that patients suffer from the subjective experiences of their deficit symptoms, even though the objective positive and negative symtoms cannot be observed. Under these circumstances, we have attempted this study with the idea that it would be helpful in understanding the psychopathology of schizophrenia. Also it would help clarifying the relationship between subjective experience of negative symptoms and objective positive and negative symptoms, depression, anxiety symptoms, and extrapyramidal symptoms. METHOD: All the 37 patients satisfied the diagnostic criteria of DSM-IV for schizophrenia . The subjective experiences of negative symptoms were evaluated using Scale for the Subjective Experience of Negative Symptoms, Korean version(K-SENS), and for the depression, anxiety, extrapyramidal symptoms, we used Hamilton Rating Scale for Depression(HAM-D), Hamilton Rating Scale for Anxiety (HAM-A), and Extrapyramidal Symptom Rating Scale(ESRS). The correlation between each psychopathology was tested by calculating Spearman correlation coefficient. RESULTS: There was a significant correlation between the ratio of items experienced as uncomfortable symptoms among 24 items of K-SENS, and the score of PANSS positive subscale(gamma=-0.40, p<0.05). Among the positive symptoms, grandiosity(gamma=-0.46, p<0.05), suspiciousnes/persecution(gamma=-0.34, p<0.05), and hostility(gamma=-0.52, p<0.05) showed a significant correlation with the ratio of items experienced as uncomfortable symptoms among 24 items of K-SENS. There was no significant correlation between the ratio of items experienced as uncomfortable symptoms among 24 items of K-SENS, and PANSS total score(gamma=-0.25, p>0.05), or negative subscale score(gamma=-0.20, p>0.05), or general psychopathology subscale score(gamma=-0.08, p>0.05), respectively. There was no significant correlation between the ratio of items experienced as uncomfortable symptoms among 24 items of K-SENS, and HAM-D(gamma=-0.01, p>0.05), or HAM-A(gamma=-0.11, p>0.05), ESRS(gamma=0.34. p>0.05), respectively. CONCLUSION: These results revealed that the negative correlation between the subjective negative symptoms experienced as an uncomfortable ones and the objective positive symptoms such as grandi-osity, suspiciousness/persecution, and hostility. From these results, the possibility that positive symptoms are used as a defense to hide from the subjectively experienced negative symptoms, or that patients may not be aware of their negative symptoms because they are overwhelmed by their positive symtpoms. is suggested. These results also suggest that subjective experiences of negative symptoms are independent from depression, anxiety and extrapyramidal symptoms.
Anxiety ; Depression ; Diagnostic and Statistical Manual of Mental Disorders ; Hostility ; Humans ; Psychopathology ; Schizophrenia*

Hypotensive anesthesia is widely used in an operation since 1) it minimizes bleeding and provides a good operation field, 2) it prevents massive hemorrhage in an operation which otherwise involves a large amount of b1ood loss and 3) it is useful in an operation for hypertensive patients. This procedure also involves a number of risks such as delayed awakening, reactionary bleeding, decrease in urine output and tissue hypoxia. The most dangerous complication can be hypoxia especially in the vital organs. 1t is therefore necessary to treat dehydration or blood loss before hypotensive anesthesia is induced. Since hypotensive anesthesia was introduced by Gardner (1947) for an operation of olfactory groove meningioma, various methods of deliberate hypotension have been developed. The most common method of hypotensive anesthesia in the present day is to use drugs, such as trmetaphan, nitroprusside and halothane. The effect of hypotensive anesthesia an various physiological functions of animals have been investigated is the past. Giffiths and Gillies (1948) reported that, in the hypotension induced by sympathectomy, an arterial systolic pressure of 32 mmHg is the minimum to overcome peripheral resistance. Chung (19743 observed in the halothane-induced hypotensive dogs that a systolic pressure of 30mmHg was required to assure adequate cerebral oxygenation. In the present study, we have investigated the effect of halothanie-induced hypotension on the renal function of dogs. The arterial systolic pressure was successively reduced to 60 and 30mmHg for 30min. each, and changes is various renal functions were studied during 100min. of the recovery period. The results are summarized as follows: 1. The systolic blood pressure was completely reeovered 80min. after the cessation of halothane inhalation. 2. Average renal blood flow Cestimated by Cppe) and glomerular filtration rate (estimated by Cg) during the first 20min. of the recovery phase were 26% ind 45% of the control level. However after 100min. of thy recovery period, repal blood flow was recovered to 63% and glomerular filtration rate to 74%of the control leveL 3. Average urine flow during the first 20min. of that recovery phase was approximately 40% of the control. 4. U/P osm. ratio was reduced to 90% the control level during the first 20min. of recovery, but it exceeded the control value after 20min. of recovery. 5. Thero was only 24% of the-tml value in the first 20min. of receavery phese, but there- after it gradually returned to the control level. 6. FEH2O (fractional excretion of N2) was and significantly changed- by halothane inhalation although there was a tendency to slight reduction at the beginning of the recovery phase. 7. FEK was 47% of the control value dqring ghe initial phase of recovery, but it returned to the control level after 40min. of the recovery period. 8. FE, and FEH2O were reduced to 56% and 50% of the control level after the hypotensive period, but returned to 70% and 82% of the control level after 40min. of the recovery period. These results indicate that although the systemic blood pressure completely recovered after halothane-induced hypotension, renal hemodynamics are not completely recovered with 100min. of the recovery period. However renal functions are mostly reversible, suggesting that halathane -induced hypotension did not induce irreversible damage of renal tissue.
Anesthesia ; Animals ; Anoxia ; Blood Pressure ; Dehydration ; Dogs ; Glomerular Filtration Rate ; Halothane ; Hemodynamics ; Hemorrhage ; Humans ; Hypotension ; Inhalation ; Kidney* ; Meningioma ; Nitroprusside ; Oxygen ; Renal Circulation ; Sympathectomy ; Vascular Resistance