Tuberous sclerosis is an autosomal dominant disease characterised by hamartomas (tubers) in many organ systems and the four major intracranial manifestations including cortical tubers, white matter abnormalities, subependymal nodules and subependymal giant cell astrocytoma. But there is immense variability in the clinical presentation of tuberous sclerosis and many incomplete forms (formes frustes) exist. Almost all patients with tuberous sclerosis have seizures and mental retardation. The authors experienced a 7-year-old boy with medically intractable epilepsy without any skin lesion or mental retardation. In terms of surgical standpoint for determination of extent of resection, corticectomy on the overriding cortex of right premotor and lesionectomy of periventricular calcified lesion were performed according to ictal single photon emission computed tomography(SPECT), which showed hyperperfusion in the subcortical and calcified area. Histopathologic findings showed a few cytologically abnormal neurons with extensive gliosis, containing many Rosenthal fibers, reactive astrocytes and dense calcification, composing of abundant calcospherites which suggested forme fruste tuberous sclerosis. During the follow-up period of eighteen months, seizure was free after surgery.
Astrocytes ; Astrocytoma ; Child ; Epilepsy* ; Follow-Up Studies ; Gliosis ; Hamartoma ; Humans ; Intellectual Disability ; Male ; Neurons ; Seizures ; Skin ; Tuberous Sclerosis*

BACKGROUND AND OBJECTIVES: In unilateral vocal fold paralysis (VFP), medialization thyroplasty (MT), arytenoid adduction (AA) and injection layrngoplasty (IL) are the most common procedures to correct phonatory problems. There is no consensus that which procedure is superior to the other for correcting the glottal insufficiency. The purpose of this study was to compare the phonatory parameters between MT, AA and AA with IL (AA+IL) in patients with unilateral VFP. MATERIALS AND METHODS: This retrospective study enrolled patients from 2005 to 2016. Total 72 patients (49 male, 23 female, mean age 54.5 years) were classified into three groups ; MT (n=28), AA (n=12), and AA+IL (n=32). GRBAS scales, maximum phonation time (MPT), jitter, shimmer, noise to harmonic ratio (NHR), and voice handicap index (VHI)-10 and VHI-30 were preoperatively and postoperatively collected and compared between the three groups. RESULTS: Age, gender and cause of VFP were not significantly different between the three groups. In MT and AA groups, MPT, VHI, G (overall grade) and B (breathiness) were significantly improved. In AA+IL group, jitter, shimmer, NHR, MPT, VHI, G and B were significantly improved. In analysis of differences (pre-postoperative values), Δ jitter (p < 0.001), Δ shimmer (p=0.031), and Δ NHR (p=0.002) were significantly different and AA+IL group showed the greatest improvement. CONCLUSION: Analysis of voice parameters showed that all the three procedures for patients with unilateral VFP are effective in the improvement of voice ; especially in MPT, VHI-10, G and B scales. Compared to the others, AA+IL provided the better acoustic values including jitter, shimmer and NHR.
Acoustics ; Consensus ; Female ; Humans ; Laryngoplasty* ; Male ; Noise ; Paralysis* ; Phonation ; Retrospective Studies ; Vocal Cords* ; Voice* ; Weights and Measures

We have checked levels of leukotriene(LT) C4, one of the arachidonic acid(AA) metabolites, in the lumbar, cisternal and ventricular cerebrospinal fluid(CSF) of 37 patients admitted with diagnosis of aneurysmal subarachnoid hemorrhage(SAH) and in lumbar CSF of 10 patients without aneurysmal SAH as the control group. We compared the levels of LTC4 in the CSF of the patients with aneurysmal SAH with those of the control group. We observed the changes of levels of LTC4 periodically after the onset of SAH. We devided the data of patients with aneurysmal SAH into 3 groups according to sampling days(respectively 1-4, 5-11, 12-24 days after SAH) and the clinical spasm group was compared with that of the non-spasm group. We also looked for the differences in the sampling sites and the correlation between the white blood cell counts and the levels of LTC4 in the CSF. The results of this study showed that the mean level of CSF LTC4(+/- standard deviation) of the SAH group was significantly higher than that of the control group(215.59+/-94.95 vs. 98.44+/-31.72pg/ml, respectively : P<0.001). The level of the CSF LTC4 progressively increased upto 7-8 days after SAH and decreased thereafter in the spasm group. The level of the CSF LTC4 of the spasm group was significantly higher than that of the non-spasm group(239.03+/-49.94 vs. 163.06+/-64.39pg/ml, respectively : P<0.05) in the first 4 days after SAH. There was no significant difference in the level of CSF LTC4 in the ventricular, cisternal, and lumbar CSF statistically(196.25+/-61.15 vs. 222.51+/-101.50 vs. 233.40+/-100.85pg/ml, respectively : P>0.05) even though we expected the level in the cisternal CSF to be higher than the lumbar CSF. There was no correlation between the white blood cell counts and the levels of LTC4 in the CSF(correlation coefficient=0.1240). From this study it is concluded that : 1) the AA metabolism via the lipoxygenase pathway is enhanced after SAH ; 2) the LTC4 may play a role in the pathogenesis of cerebral vasospasm, especially in the early days after SAH ; 3) the extraction of CSF via the external ventricular or cisternal drainage may decrease substances such as LTC4 which was thought to be vasoconstrictor material ; and 4) the granulocyte production of the LTC4 accounts for only a small part.
Aneurysm* ; Arachidonic Acid ; Cerebrospinal Fluid* ; Diagnosis ; Drainage ; Granulocytes ; Humans ; Leukocyte Count ; Leukotriene C4* ; Lipoxygenase ; Metabolism ; Spasm ; Subarachnoid Hemorrhage* ; Vasospasm, Intracranial

Insulinoma is clinically characterized by fasting hypoglycemia, various neuropsychiatric symptoms, and these caused by secondary to hypoglycemia.Of patients with insulinoma, 80 percent have single benign tumors, 11 percent have multiple benign tumors, 6 percent have single malignant tumors, and the remainder have multiple malignant tumors or islet hyperplasia according to Service's statement.A 42 year-old male chemical engineer who had insulinoma associated with regional lymph node metastasis has been successfully performed with curative resection and consecutive postoperative therapy with streptozotocin.He entered to this hospital because of frequent occasion of bizarre behavior and language, transient unconsiousness and syncopal episode, and sweating associated with hypoglycemia especially in night four months prior to addmission in November 1992. Those symptoms and hypoglycemia were controlled by intravenous glucose injection and/or oral feeding of glucose riched stuffs.No physical abnormalities were found except neuropsychiatric symptoms. On admission the fasting blood glucose level was 10 mg/dl, plasma immunoreactive plasma insulin level was 125.23 uU/ml, and plasma C-peptide level was 10.24 ng/ml, respectively.Abdominal CT was suggestive of retroperitoneal tumor just behind the pancreas. Selective celiac axis angiography demonstrated hypervascular mass supplied by dorsal pancreatic artery which was compatible with insulinoma. Surgical intervention including distal pancreatectomy, as well as splenectomy and parital omental resection were performed successfully. Consecutive postoperative treatment of streptozotocin was done without any side effects.His condition is very good and enjoyed his life with full activity to date.
Angiography ; Arteries ; Blood Glucose ; C-Peptide ; Fasting ; Glucose ; Humans ; Hyperplasia ; Hypoglycemia ; Insulin ; Insulinoma ; Lymph Nodes ; Male ; Neoplasm Metastasis ; Pancreas ; Pancreatectomy ; Plasma ; Splenectomy ; Streptozocin ; Sweat ; Sweating ; Syncope

Careful evaluation of vertebral artery injuries is important after cervical translation injuries or transverse foramen fractures. Treatment of trauma can be complicated in cases of concomitant vertebral artery injuries. A 76-year-old woman was admitted to our hospital with left hemiparesis (Motor grade 3) after a motorcycle accident. Cervical spine magnetic resonance imaging (MRI) and computed tomography (CT) revealed a C3 burst fracture and a left C3 lateral mass and lamina fracture. CT angiography revealed fracture fragments that predisposed the vertebral artery to injury throughout its course in the area. CT angiography confirmed that both vertebral arteries were occluded at the C3 fracture site. Subsequent brain MRI revealed acute infarction in the right occipital area. Although both vertebral arteries were occluded, the infarction site did not correspond to the territory supplied by these vessels; therefore, we performed transfemoral cerebral angiography, which revealed collateralization of the bilateral vertebral arteries by the deep cervical artery.. The deep cervical arteries are located between the posterior muscles; therefore, a fixation operation performed using the posterior approach may have affected the collateral circulation and led to exacerbation of the infarction site. Therefore, surgery was performed using an anterior approach and it was possible to minimize the risk of cerebral infarction through preservation of collateral circulation.

Objective: : This study aims to determine the optimal dose of recombinant-human bone morphogenic protein-2 (rhBMP-2) for successful bone fusion in minimally invasive lateral lumbar interbody fusion (MIS LLIF). Previous studies show that rhBMP is an effective alternative to autologous iliac crest bone graft, but the optimal dose remains uncertain. The study analyzes the fusion rates associated with different rhBMP doses to provide a recommendation for the optimal dose in MIS LLIF. Methods: : Ninety-three patients underwent MIS LLIF using demineralized bone matrix (DBM) or a mixture of rhBMP-2 and DBM as fusion material. The group was divided into the following three groups according to the rhBMP-2 usage : group A, only DBM was used (n=27); group B, 1 mg of rhBMP-2 per 5 mL of DBM paste (n=41); and group C, 2 mg of rhBMP-2 per 5 mL of DBM paste (n=25). Demographic data, clinical outcomes, postoperative complication and fusion were assessed. Results: : At 12 months post-surgery, the overall fusion rate was 92.3% according to Bridwell fusion grading system. Groups B and C, who received rhBMP-2, had significantly higher fusion rates than group A, who received only DBM. However, there was no significant increase in fusion rate when the rhBMP-2 dosage was increased from group B to group C. The groups B and C showed significant improvement in back pain and Oswestry disability index compared to the group A. The incidence of screw loosening was decreased in groups B and C, but there was no significant difference in the occurrence of other complications. Conclusion : Usage of rhBMP-2 in LLIF surgery leads to early and increased final fusion rates, which can result in faster pain relief and return to daily activities for patients. The benefits of using rhBMP-2 were not significantly different between the groups that received 1 mg/5 mL and 2 mg/5 mL of rhBMP-2. Therefore, it is recommended to use 1 mg of rhBMP-2 with 5 mL of DBM, taking both economic and clinical aspects into consideration.

PURPOSE: The aim of this study was to compare a negative pressure drain with a natural drain in order to determine whether a negative pressure drainage tube causes an increase in the drainage volume. MATERIALS AND METHODS: Sixty-two patients who underwent total thyroidectomy for papillary thyroid carcinoma (PTC) were enrolled in the study between March 2010 and August 2010 at Gyeongsang National University Hospital. The patients were prospectively and randomly assigned to two groups, a negative pressure drainage group (n=32) and natural drainage group (n=30). Every 3 hours, the volume of drainage was checked in the two groups until the tube was removed. RESULTS: The amount of drainage during the first 24 hours postoperatively was 41.68+/-3.93 mL in the negative drain group and 25.3+/-2.68 mL in the natural drain group (p<0.001). After 24 additional hours, the negative drain group was 35.19+/-4.26 mL and natural drain groups 21.53+/-2.90 mL (p<0.001). However, the drainage at postoperative day 3 was not statistically different between the two groups. In addition, the vocal cord palsy and temporary and permanent hypocalcemia were not different between the two groups. CONCLUSION: These results indicate that a negative pressure drain may increase the amount of drainage during the first 24-48 hours postoperatively. Therefore, it is not necessary to place a closed suction drain when only a total thyroidectomy is done.
Adult ; Aged ; Carcinoma/*surgery ; Drainage/*instrumentation/*methods ; Female ; Humans ; Male ; Middle Aged ; Postoperative Care/methods ; Postoperative Complications/surgery ; Postoperative Period ; Pressure ; Prospective Studies ; Reproducibility of Results ; Surgical Procedures, Operative ; Thyroid Neoplasms/*surgery ; Thyroidectomy/*instrumentation/*methods ; Time Factors ; Treatment Outcome

BACKGROUND AND OBJECTIVES: Surgery or radiation therapy is most widely employed in the treatment of early glottic cancer with no significant difference in the survival rate. Various treatment modalities including surgery, radiation therapy or combined therapy can also be adopted for recurring early glottic cancer. Nowadays, conservation salvage surgery presents as an excellent alternative to the traditional total laryngectomy with favorable results. The objective of this study is to compare the outcome of each treatment modality for early glottic cancer and evaluate the role of conservation salvage surgery for recurring cases. SUBJECTS AND METHOD: Seventy-three patients with early glottic cancer (stage Tis, T1, T2 N0M0) were treated between January 1995 and December 2001, and followed up for at least over an year. They were divided into two groups with the standards of whether they had surgery or radiation therapy as an initial treatment. Then, both groups were analyzed for local control and recurrence rate after initial treatment and conservation salvage surgery for recurrent case, respectively. RESULTS: Twenty-four patients had conservation surgery and 49 had radiation therapy as an initial treatment. Local control rate was 100% for conservation surgery, 93.9% for radiation therapy and there was no significant difference between groups. Recurrence rate for each group was 8.3% and 15.3%, respectively, but no statistical difference was found. Twelve patients showed recurreence or had remnant cancer. Conservation salvage surgery including laser cordectomy, hemilaryngectomy, frontolateral hemilaryngectomy, and supracricoid partial laryngectomy had been performed in 10 cases. In all cases, laryngeal preservation was possible and there was no recurrence of tumor during follow up periods. CONCLUSION: As an initial treatment modality, conservation surgery and radiation therapy was proven to be equally effective for early glottic cancer with no significant difference in local control and recurrence rate. For the recurrent cases, conservation salvage surgery including supracricoid partial laryngectomy was shown to be a very useful treatment modality with good oncological results and excellent laryngeal preservation.
Follow-Up Studies ; Humans ; Laryngeal Neoplasms ; Laryngectomy ; Recurrence ; Salvage Therapy ; Survival Rate ; Treatment Outcome

OBJECTIVE: Strategies for managing supratentorial primitive neuroectodermal tumors(PNETs) in children include surgical resection, craniospinal irradiation and chemotherapy. This study is performed in order to compare the efficacy of various methods of treatment and to describe its optimal management. METHODS: We have reviewed all medical records and pathology slides of six children(four males and two females) with supratentorial PNET from November, 1987 to May, 2003. The extent of resection was confirmed by computed tomography and magnetic resonance studies. RESULTS: The patients were aged 1 to 13 years and treated postoperatively with/without adjuvant therapy. Tumor location included was four cortical, one gangliobasal, and one pineal region. The presenting symptoms and signs consisted of increased intracranial pressure and focal neurological deficits such as seizure and hemiparesis. The treatment consisted of surgical resection alone in one patient, postoperative radiotherapy in one patient, postoperative chemotherapy in one, and postoperative radiotherapy with chemotherapy in three. Five patients lived more than 12 months after diagnosis and one patient among them has been living more than 5 years after diagnosis. CONCLUSION: We can improve the survival and prognosis of supratentorial PNET patients by radical gross total resection of tumor followed by craniospinal irradiation and aggressive chemotherapy. First of all, gross total resection of tumor is the most important among many factors.
Child* ; Craniospinal Irradiation ; Diagnosis ; Drug Therapy ; Humans ; Intracranial Pressure ; Male ; Medical Records ; Neural Plate ; Neuroectodermal Tumors, Primitive* ; Paresis ; Pathology ; Prognosis ; Radiotherapy ; Seizures

PURPOSE: Single incision laparoscopic cholecystectomy (SILC) is a minimally invasive surgery that is growing rapidly among surgical procedures. However, there is no standard method for SILC. Therefore, we evaluated the adequacy and feasibility of SILC using Konyang Standard Method. METHODS: We retrospectively reviewed our series of 307 SILCs performed between April 2010 and August 2012. Initially we excluded the patients who were more than 70 years old, had cardiologic or pulmonologic problems and complications of acute cholecystitis. After 50 cases, we did not apply the exclusion criteria. We performed SILC by Konyang Standard Method using three-trocar single port (hand-made) and long articulated instruments. RESULTS: Three hundred and seven patients underwent SILC. Male were 131 patients and female were 176 patients. Mean age was 51.6 +/- 13.7 years old and mean body mass index was 24.8 +/- 3.6 kg/m2. Ninety-three patients had histories of previous abdominal operation. Patient's pathologies included: chronic cholecystitis (247 cases), acute cholecystitis (30 cases), gall bladder (GB) polyps (24 cases), and GB empyema (6 cases). Mean operating time was 53.1 +/- 25.4 minutes and mean hospital stay was 2.9 +/- 3.4 days. There were four cases of 3-4 ports conversion due to cystic artery bleeding. Complications occurred in 5 cases including wound infection (2 cases), bile duct injury (1 case), duodenal perforation (1 case), and umbilical hernia (1 case). CONCLUSION: SILC using Konyang Standard Method is safe and feasible. Therefore, our standard procedure can be applied to almost all benign GB disease.
Aged ; Arteries ; Bile Ducts ; Body Mass Index ; Cholecystectomy, Laparoscopic* ; Cholecystitis ; Cholecystitis, Acute ; Empyema ; Female ; Hemorrhage ; Hernia, Umbilical ; Humans ; Length of Stay ; Male ; Pathology ; Polyps ; Retrospective Studies ; Surgical Procedures, Minimally Invasive ; Urinary Bladder ; Wound Infection