Aneurysms of the superior mesenteric artery are rare, accounting for 8% of visceral artery aneurysms. About 60% of all superior mesenteric artery aneurysms have a mycotic origin. The only helpful clinical manifestations are episodes of previous abdominal pain and a history of valvular heart disease. In this case, a 66-year-old female patient with mitral regurgitation and aortic regurgitation presented with pain in the upper abdominal area. A superior mesenteric artery aneurysm was diagnosed at the time of impending rupture. Since excellent collateral circulation was present, an aneurysmectomy without revascularization was performed, and no ischemic symptom occurred. The patient presented no major complications during the postoperative course.
Abdominal Pain ; Aged ; Aneurysm ; Aneurysm, Infected* ; Aortic Valve Insufficiency ; Arteries ; Collateral Circulation ; Endocarditis* ; Female ; Heart Valve Diseases ; Humans ; Mesenteric Artery, Superior* ; Mitral Valve Insufficiency ; Rupture

No abstract available.
Echinococcosis, Hepatic*

We describe a patient with an unusual cause of the occlusions of both femoral arteries by myxomas. A 41-year-old man presented with sudden onset of both leg pain and paresthesia. His hematological and cardiological status was normal. Lower peripheral angiography was performed and demonstrated thrombotic occlusion, both common femoral artery and superficial femoral and proximal portion of deep femoral artery. He was successfully treated with surgical and forgaty catheter extraction. Histologic finding was myxoma probably from cardiac origin. Cardiac investigations to determine the source of the myxoma, including 2-D echocardiography and Transesophageal echocardiogram (TEE) of the heart, failed to demonstrate residual myxoma in heart. No residual tumor or potential source of the tumor was found. The cause of both leg pain was the occlusions of the both common femoral arteries by myxomas. An entire cardiac tumor might have embolized with no detectable residual tumor in the heart; alternatively a myxoma might have originated as a primary tumor in the femoral artery.
Adult ; Angiography ; Catheters ; Echocardiography ; Femoral Artery* ; Heart ; Heart Neoplasms ; Humans ; Leg ; Myxoma* ; Neoplasm, Residual ; Paresthesia

The majority of cases of pneumocephalus are secondary to trauma or medical intervention. Spontaneous, non-traumatic pneumocephalus is an uncommon condition. Most cases of spontaneous pneumocephalus require surgery. However, if there is no evidence of infection or cerebrospinal fluid leak, bed rest and follow-up imaging is an alternative treatment. Herein, we report a 31-year-old man with spontaneous pneumocephalus associated with pneumosinus dilatans.
Adult ; Bed Rest ; Cerebrospinal Fluid Rhinorrhea ; Follow-Up Studies ; Humans ; Pneumocephalus

OBJECTIVE: The incidence and pathophysiologic mechanisms of chronic hydrocephalus requiring shunting after aneurysmal subarachnoid hemorrhage(SAH) is not precisely known. Authors investigated whether the initial external ventricular drainage in patients with aneurysmal subarachnoid hemorrhage can effect on the late onset of shunt-dependent hydrocephalus. METHODS: In this prospective nonrandomized study, 311 patients with aneurysmal SAH treated using either surgical clip application or endovascular coil embolization were studied between Jan 2004 and Dec 2006. Chronic hydrocephalus was defined as clinically and radiographically demonstrated hydrocephalus that lasted 2 weeks or longer after the subarachnoid hemorrhage. 128 patients underwent perioperative extracranial ventricular drainage to allow brain relaxation and to drain intraventricular hematoma. The occurrence of asymptomatic and shunt-dependent hydrocephalus was analyzed in both treatment groups. Patients clinical grade was evaluated with WFNS (World Federation of Neurosurgical Societies) Grades, and Fisher Grades was used for evaluating radiological condition of the patient. RESULTS: Among 128 patients, who underwent perioperative EVD, total 76 patients diagnosed as hydrocephalus later, and 23 patients needed shunt operation. The occurrence of hydrocephalus was significantly higher in patients underwent perioperative EVD (p<0.001), but there were no statistical significance between the perioperative EVD and the onset of shunt-dependent hydrocephalus (p=0.190). Among variable factors, Fisher grade, WFNS grade, amount of IVH on admission, and site of ruptured aneurysm showed statistical significance in related with the shunt-dependent hydrocephalus. Results of logistic regression analyses, perioperative EVD carried low risk of hydrocephalus (OR 0.408, 95% CI 0.224-0.745), but no statistically significant risk was shown related with the onset of shunt-dependent hydrocephalus. CONCLUSION: As a result of this study, perioperative EVD in patients with aneurysmal SAH identified as a risk factor of the hydrocephalus. But there were no statistical significance as a risk factor of the shuntdependent hydrocephalus. Poor clinical and radiological status showed higher valuable risk of the shunt-dependent hydrocephalus rather than perioperative EVD. No hesitation seems to be needed for the perioperative EVD, especially in patients with poor neurological and radiological condition.
Aneurysm* ; Aneurysm, Ruptured ; Brain ; Drainage* ; Embolization, Therapeutic ; Hematoma ; Humans ; Hydrocephalus* ; Incidence ; Logistic Models ; Prospective Studies ; Relaxation ; Risk Factors ; Subarachnoid Hemorrhage* ; Surgical Instruments

OBJECTIVE: Balloon kyphoplasty can effectively relieve the symptomatic pain and correct the segmental deformity of osteoporotic vertebral compression fractures. While many articles have reported on the effectiveness of the procedure, there has not been any research on the factors affecting the deformity correction. Here, we evaluated both the relationship between postoperative pain relief and restoration of the vertebral height, and segmental kyphosis, as well as the various factors affecting segmental deformity correction after balloon kyphoplasty. METHODS: Between January 2004 and December 2006, 137 patients (158 vertebral levels) underwent balloon kyphoplasty. We analyzed various factors such as the age and sex of the patient, preoperative compression ratio, kyphotic angle of compressed segment, injected PMMA volume, configuration of compression, preoperative bone mineral density (BMD) score, time interval between onset of symptom and the procedure, visual analogue scale (VAS) score for pain rating and surgery-related complications. RESULTS: The mean postoperative VAS score improvement was 4.93+/-0.17. The mean postoperative height restoration rate was 17.8+/-1.57% and the kyphotic angle reduction was 1.94+/-0.38 degrees. However, there were no significant statistical correlations among VAS score improvement, height restoration rate, and kyphotic angle reduction. Among the various factors, the configuration of the compressed vertebral body (p=0.002) was related to the height restoration rate and the direction of the compression (p=0.006) was related with the kyphotic angle reduction. The preoperative compression ratio (p=0.023, p=0.006) and injected PMMA volume (p<0.001, p=0.035) affected both the height restoration and kyphotic angle reduction. Only the preoperative compression ratio was found to be as an independent affecting factor (95% CI : 1.064-5.068). CONCLUSION: The two major benefits of balloon kyphoplasty are immediate pain relief and local deformity correction, but segmental deformity correction achieved by balloon kyphoplasty does not result in additional pain relief. Among the factors that were shown to affect the segmental deformity correction, configuration of the compressed vertebral body, direction of the most compressed area, and preoperative compression ratio were not modifiable. However, careful preoperative consideration about the modifiable factor, the PMMA volume to inject, may contribute to the dynamic correction of the segmental deformity.
Bone Density ; Congenital Abnormalities* ; Fractures, Compression* ; Humans ; Kyphoplasty* ; Kyphosis ; Pain, Postoperative ; Polymethyl Methacrylate

OBJECTIVE: The purpose of this study was to assess the usefulness of combination of bone formation and resorption markers in predicting the bone mineral density (BMD), and to see there was a correlation with years since menopause(YSM) and BMD according to the combination of bone turnover marker and bone sites. METHOD: BMD and bone turnover marker(serum osteocalcin and urine deoxypyridinoline) was assessed in 266 healthy postmenopausal women at the time of first visiting in postmenopausal clinic and were divided into six groups based on combination of their reference range in bone turnover markers. RESULTS: We evaluated the discrimination power of the combination of bone turnover marker in assessing BMD among the six gorups, there was no statistically significant difference in BMD of Lumbar2-4 and Femur (Neck, Ward. Trochanter). In case of both higher than reference range of osteocalcin and deoxypyridinoline(D-pyr), BMD of Lumbar2-4 and Femur in postmenopausal women had a negative correlation with YSM. In case of higher than normal reference range of D-pyr and within the reference range of osteocalcin, BMD of Femur had a negative correlation with YSM. CONCLUSION: Thus each bone site had its own good combination of bone marker levels to correlate the BMD according to the YSM.
Biomarkers* ; Bone Density* ; Discrimination (Psychology) ; Female ; Femur ; Humans ; Menopause ; Osteocalcin ; Osteogenesis ; Reference Values

Nipple hypertrophy in male patients is a very rare condition but still requires surgical correction regardless of its rarity. It is important to consider two factors during surgical correction of nipple hypertrophy in male patient. First, the size of men's nipple is quite smaller than that of female's. Therefore, diameter as well as vertical height should be reduced simultaneously to achieve more satisfactory aesthetic result. Second, it is not required to preserve ductal function as long as nipple sensory is kept intact. Our new technique can reduce the diameter of the hypertrophic nipple as well as the vertical height efficiently and safely. No complication including nipple necrosis or sensory loss were found after 2 months of folllow-up.
Humans ; Hypertrophy* ; Male* ; Necrosis ; Nipples*

Ruptured dissecting aneurysm of the vertebral artery requires a rapid treatment because of the high rate of fatal early rebleeding. Stent-assisted coil embolization has been introduced as an effective procedure for both aneurysmal occlusion and parent artery preservation. We report a case of successful urgent treatment of ruptured dissecting aneurysm using a self-expandable, intracranial stent (Neuroform(R)) and a coated coil (HydroCoil(R)).
Aneurysm ; Aneurysm, Dissecting* ; Arteries ; Embolization, Therapeutic ; Humans ; Parents ; Stents* ; Vertebral Artery*

Objective: : This study aimed to assess the relationship between increased intracranial pressure (ICP) and mastoid effusions (ME). Methods: : Between January 2015 and October 2018, patients who underwent intracranial surgery and had ICP monitoring catheters placed were enrolled. ICP was recorded hourly for at least 3 days. ME was determined by the emergence of opacification in mastoid air cells on follow-up brain imaging. C-reactive protein (CRP) levels, presence of endotracheal tube (ETT) and nasogastric tube (NGT), duration of intensive care unit (ICU) stay, duration of mechanical ventilator application, diagnosis, surgical modalities, and presence of sinusitis were recorded. Each factor’s effect on the occurrence of ME was analyzed by binary logistic regression analyses. To analyze the independent effects of ICP as a predictor of ME a multivariable logistic regression analysis was performed. Results: : Total of 61 (53%) out of 115 patients had ME. Among the patients who had unilateral brain lesions, 94% of subject (43/50) revealed the ipsilateral development of ME. ME developed at a mean of 11.1±6.2 days. The variables including mean ICP, peak ICP, age, trauma, CRP, ICU stays, application of mechanical ventilators and presence of ETT and NGT showed statistically significant difference between ME groups and non-ME groups in univariate analysis. Sex and the occurrence of sinusitis did not differ between two groups. Adding the ICP variables significantly improved the prediction of ME in multivariable logistic regression analysis. Conclusion : While multiple factors affect ME, this study demonstrates that ICP and ME are probably related. Further studies are needed to determine the mechanistic relationship between ICP and middle ear pressure.