Over the past decade, development of noninvasive diagnostic modalities for the diagnosis of intracranial aneurysms have led to a dramatic change in the management in which patients with unruptured intracranial aneurysms are diagnosed and treated. A patient with an unruptured intracranial aneurysm has three treatment options: endovascular coiling, surgical clipping, and observation. The decision making about management of intracranial aneurysms should be based on the risk of rupture and risks associated with surgical or endovascular treatment. In this report, we review the recent published articles pertaining to diagnositic modalities, natural history, management, and follow-up of unruptured intracranial aneurysms.
Decision Making ; Diagnosis ; Follow-Up Studies ; Humans ; Intracranial Aneurysm* ; Natural History ; Rupture ; Surgical Instruments

OBJECTIVE: We evaluated the efficacy of intra-arterial nimodipine, a calcium-channel blocker acting mainly on cerebral vessels, in patients with symptomatic cerebral vasospasm following subarachnoid hemorrhage. METHODS: Clinical records of 8 consecutively treated patients were reviewed. Patients were considered to determine the indication for cerebral angiography and subsequent endovascular treatment if they presented symptomatic cerebral vasospasm. Nimodipine was infused intra-arterially via microcatheter in the internal carotid artery or basilar artery at a rate of 0.1 mg/min. Immediate angiographic vasodilatation and clinical improvement were assessed. RESULTS: Thirteen procedures were performed in 8 patients. Clinical improvement was observed in 7 (88%) patients. 5 of 8 patients were clinically improved within 24 hours after the first endovascular treatment, and two after the third. The notable arterial dilatation at postprocedural angiography was observed in 9 (70%) of 13 procedures. After follow-up of 3-6 months, 7 (88%) patients had a favorable outcome (Glasgow Outcome Scale score of 5-4). No procedure related complications were observed. CONCLUSION: Intra-arterial nimodipine infusion is effective and safe for the treatment of symptomatic vasospasm after subarachnoid hemorrhage. Further prospective randomized studies are needed to support these results.
Aneurysm* ; Angiography ; Basilar Artery ; Carotid Artery, Internal ; Cerebral Angiography ; Dilatation ; Follow-Up Studies ; Humans ; Nimodipine* ; Subarachnoid Hemorrhage* ; Vasodilation ; Vasospasm, Intracranial*

Tissue engineering can serve as an alternative treatment for a malfunctioning or lost organ. Isolated and expanded cells adhere to a temporary scaffold, proliferate, and secrete their own extracellular matrices (ECM) replacing the biodegrading scaffold. The genitourinary system, composed of the kidney, ureter, bladder, urethra, and genital organs, is exposed to a variety of possible injury sites from the time of fetal development. All the urinary organs are mainly composed of smooth muscle and uroepithelial cells and which may be approached by tissue engineering techniques. A large number of materials, including naturally-derived and synthetic polymers have been utilized to fabricate prostheses for the genitourinary system. Usually, whenever there is a lack of native urologic tissue, reconstruction is considered with native non-urologic tissue, such as, gastrointestinal segments, or skin or mucosa from multiple body sites. Engineering tissues using selective cell transplantation may provide a means to create functional new genitourinary tissues. This review concerns urinary tissues reconstructed with bladder uroepithelial cells and smooth muscle cells (SMCs) implanted on biodegradable polymer matrices.
Animal ; Biomedical Engineering*/methods ; Bioreactors ; Cytological Techniques/trends ; Human ; Stem Cells/physiology ; Urinary Tract*

PURPOSE: To evaluate the usefulness of the coaxial technique in US-guided breast core biopsy. Materials andMethods : Using the coaxial technique, US-guided breast core biopsy was performed in 49 breast lesions (40patients). Under US-guidance the 17-gauge, 13 cm long introducer needle was positioned proximal to the lesion.Once the needle was in place, the central trocar was removed and was replaced with the core biopsy needle. We usedan 18-gauge, 16-cm-long core biopsy needle with a 17 mm specimen notch. Four to eight tissue specimens wereobtained from each lesion, and the quality and quantity of specimens, procedure time, and complications and theirrate were evaluated. RESULTS: For 48 of 49 lesions, specimens were adequate for histopathologic diagnosis, andthe findings were as follows : six cases of invasive ductal carcinoma, one of ductal carcinoma in situ, 29 offibrocystic disease, eight of fibroadenoma, two of chronic inflammation, and two of sclerosing lesion. In 12lesions agreement between the pathologic results of needle core biopsy and surgical results was 100%. Theprocedure time was about 15 minutes and no significant complications were noted. CONCLUSION: In breast corebiopsy, the coaxial technique is simple and time-saving, and compared with stan-dard breast core biopsy, may alsobe less traumatic and decrease the potential risk of seeding the biopsy tract with malignant cells.
Biopsy* ; Breast* ; Carcinoma, Ductal ; Carcinoma, Intraductal, Noninfiltrating ; Diagnosis ; Fibroadenoma ; Inflammation ; Needles ; Surgical Instruments

A linear intracardiac foreign body was identified following a total hip replacement (THR) on chest CT and transesophageal echocardiography in a 60-year-old woman with rheumatoid arthritis. Leakage and migration of bone cement during arthroplasty is a possible explanation for this rare complication. Therefore, adequate preparation and handling of cement using biplane fluoroscopy are recommended during arthroplasty.
Arthritis, Rheumatoid ; Arthroplasty ; Arthroplasty, Replacement, Hip* ; Echocardiography, Transesophageal ; Female ; Fluoroscopy ; Foreign Bodies* ; Humans ; Middle Aged ; Tomography, X-Ray Computed

Dissecting aneurysms of intracranial artery often arise in the posterior circulation, but those in the anterior circulation are rare, presenting with hemorrhagic event. So, we report an unusual case of isolated dissecting aneurysm of the pericallosal artery presenting with spontaneous subarachnoid hemorrhage. A 46-year-old hypertensive woman presented with severe headache and intense nuchal rigidity after onset of two days. Computed tomography (CT) brain scan revealed a subarachnoid hemorrhage and an interhemispheric hematoma. This was due to dissecting aneurysm of left pericallosal artery on conventional cerebral angiography. Total occlusion of the dissecting aneurysm was performed with five Guglielmi detachable coils, with no apparent procedure-related complications. Endovascular treatment by aneurysm and parent artery occlusion is a relatively reliable alternative to surgery for isolated dissecting aneurysm of pericallosal artery.
Aneurysm ; Aneurysm, Dissecting ; Arteries ; Brain ; Cerebral Angiography ; Female ; Headache ; Hematoma ; Humans ; Middle Aged ; Muscle Rigidity ; Parents ; Subarachnoid Hemorrhage

Background: Surgical treatment consisting of decompression and fusion is generally known to produce good clinical results for lumbar spinal stenosis with degenerative spondylolisthesis. However, the clinical outcome of decompression alone, without fusion, remains unclear, and long-term follow-up results are scarce. This study aimed to retrospectively analyze the 5-year clinical results of decompression only in patients with lumbar spinal stenosis and degenerative spondylolisthesis. Methods: Among the patients diagnosed as having lumbar spinal stenosis with degenerative spondylolisthesis, 36 patients who underwent decompression without fusion and were followed up for minimum 5 years were included in this study. The average follow-up period was 7.2 years, and the mean age of patients was 63.2 years. Visual analog scale (VAS) score and Oswestry disability index (ODI) were investigated pre- and postoperatively, and also radiologic displacement and instability were measured. In addition, patients who needed fusion or redecompression at the decompression site postoperatively were also investigated. Results: VAS score and ODI improved from an average of 7.8 points and 57 points preoperatively, respectively, to 1.4 points and 19 points at 5 years postoperatively, respectively. The degree of radiologic displacement increased from an average of 5.1 mm preoperatively to 6.4 mm at the final follow-up. Radiological instability was detected in five patients. Two patients (9.5%) required fusion. Conclusions The long-term follow-up results revealed that satisfactory clinical outcomes were obtained with decompression alone, without fusion, for patients with lumbar spinal stenosis and degenerative spondylolisthesis.

It is often possible to diagnose a pheochromocytoma only when a disastrous cardiac complication like a hypertensive crisis, episodes of unexpected left ventricular failure, myocarditis, arrhythmias, myocardial infarction and sudden death appears secondarily. We revealed that a patient who had been treated with a reversible left ventricular systolic dysfunction with cardiogenic indeed had a pheochromocytoma. Upon initial admission, a 35 years old man had upper respiratory tract infection and abdominal discomfort. Blood pressure was 140/90 mmHg and EKG showed transiently paroxysmal supraventricular tachycardia. Eight hours after admission, he appeared to be in cardiogenic shock. Echocardiography showed extensive global hypokinesia with severe left ventricular systolic dysfunction. Following conservative management he progressively recovered normal cardiac function although we did not discern the etiology of the left ventricular systolic dysfunction. He was readmitted six months later due to episodic headache and high blood pressure. Fortunately, due to the history of reversible left ventricular systolic dysfunction with cardiogenic shock, we were able to quickly assess him as having a pheochromocytoma. The laboratory data and radiological findings were compatible with this tumor, which was subsequently successfully removed through surgery. We suggest that the diagnosis of pheochromocytoma should be considered in young patients presenting with acute heart failure of non-specific origin.
Adult ; Arrhythmias, Cardiac ; Blood Pressure ; Death, Sudden ; Diagnosis ; Echocardiography ; Electrocardiography ; Headache ; Heart Failure ; Humans ; Hypertension ; Hypokinesia ; Myocardial Infarction ; Myocarditis ; Pheochromocytoma* ; Respiratory Tract Infections ; Shock ; Shock, Cardiogenic* ; Tachycardia, Supraventricular

We present MR diffusion-weighted imaging (DWI) findings of status epilepticus in two patients. DWI showed a focal or diffuse hyperintensity with decreased apparent diffusion coefficient (ADC) value, indicating cytotoxic edema in the cerebral hemispheric cortices. The hyperintensities were located in the bilateral temporoparietooccipital areas and insular cortex in one patient, and unilaterally in the temporal lobe in the other patient.
Diffusion ; Edema ; Humans ; Status Epilepticus* ; Temporal Lobe

Bednar tumor was described by Bednar in 1957. The histologic pattern of this tumor shows similar to dermatofibrosarcoma protuberans (DFSP) but melanin pigments are scattered within the tumor, It's rare neoplasm accounting for approximately 1-5% of all case of DFSP. Clinically, this tumor is considered to be intermediated malignancy, because of slow growth and frequent local recurrence and lack of distant metastasis. The majority are located on the trunk and the upper and lower extremities, but extremely rate in the head and neck area. Microscopically, this tumor is characterized by tight storiform spindle cells and long slender cells that admixed with a small population of melanin containing dendritic cells. This dendritic cells are the primary features distinguising this lesion from conventional DFSP. Complete surgical excision and close follow-up case are necessany for this neoplasm because of probable intermediate malignancy. A patient was admitted to Our Department of Oral and Maxillofacial Surgery due to swelling on right parotid area and numbness of the right lower lip on September, 1994, By clinical examinations and C-T finding, we dignosed tentatively as myxoma or pleomorphic adenoma. Surgical excision of this tumor was performed with parotidectomy and mandibular osteotomy under the frozen biopsy. By final microscopic and electromicroscopic examination and immunohistochemical study, this tumor was diagnosed as Bednar tumor. So, we report a case of pigmented DFSP with review of literatures.
Adenoma, Pleomorphic ; Biopsy ; Dendritic Cells ; Dermatofibrosarcoma* ; Follow-Up Studies ; Head ; Humans ; Hypesthesia ; Lip ; Lower Extremity ; Mandibular Osteotomy ; Melanins ; Myxoma ; Neck ; Neoplasm Metastasis ; Recurrence ; Surgery, Oral