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

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*

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*

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.

The Prader-Willi syndrome (PWS) is a rare disorder characterized by infantile hypotonia, subsequent obesity with hyperphagia. Hypogonadism, cryptorchidism, delayed psychomotor development, short status, strabismus, myopia, scoliosis, kyphosis and temperature regulation abnormality are other features. The cause of this syndrome is unknown, but a disturbance in the hypothalamus has been postulated because of the various manifestation of the syndrome. The major genetic mechanism giving rise to PWS is a paternal deletion of about the same size in the 15q11-q13 region, that occurs in 70% of the cases. The principal problems related to anesthesia are those that are secondary to the patient's hypoglycemia, skeletal muscle hypotonia and obesity. An 20-month-old boy with PWS was scheduled for surgical correction of bilateral undescended testes. The trachea was intubated with the aid of succinylcholine 7.5 mg intravenous injection. Muscle relaxation was facilitated with intermittent intravenous administration of atracurium (total dose 8 mg). No prolonged effect of muscle relaxants was observed during anaesthesia. High grade fever (38-39 degrees C) was present during anaesthesia.
Administration, Intravenous ; Anesthesia ; Atracurium ; Cryptorchidism ; Fever ; Humans ; Hyperphagia ; Hypoglycemia ; Hypogonadism ; Hypothalamus ; Infant ; Injections, Intravenous ; Kyphosis ; Male ; Muscle Hypotonia ; Muscle Relaxation ; Muscle, Skeletal ; Myopia ; Obesity ; Prader-Willi Syndrome* ; Scoliosis ; Strabismus ; Succinylcholine ; Trachea

PURPOSE: To describe the clinical and radiologic findings of all-trans-retinoic acid (ATRA) syndrome in acute promyelocytic leukemia. MATERIALS AND METHODS: Among 21 patients with acute promyelocytic leukemia who were treated with all-trans- retinoic acid between 1995 and 1998, we retrospectively evaluated the cases of four with ATRA syn-drome. Two were male and two were female, and their mean age was 58 years. The clinical and radiologic findings of chest radiography (n=4) and HRCT (n=1) were analyzed. RESULTS: Between seven and 13 days after ATRA treatment, dry cough, dyspnea and high fever developed in all patients. The WBC count in peripheral blood was significantly higher [2.9 -25.3(mean, 10.8)-fold] than before ATRA treatment, and in all patients, chest radiography revealed ill-defined consolidation and pleural effu-sion. Kerley 's B line (n=3) and hilar enlargement (n=3) were also seen, and in one patient, HRCT demonstrated septal line thickening. Among four patients treated with prednisolone and Ara-C,three recovered and one CONCLUSION: In acute promyelocytic patients treated with all-trans-retinoic acid, radiologic findings of ill-de-fined consolidation, pleural effusion, hilar prominence and Kerley 's B line may suggest ATRA syndrome. The early diagnosis of this will improve the patients' prognosis.
Cough ; Dyspnea ; Early Diagnosis ; Female ; Fever ; Humans ; Leukemia, Promyelocytic, Acute* ; Male ; Pleural Effusion ; Prednisolone ; Prognosis ; Radiography ; Retrospective Studies ; Thorax ; Tretinoin

BACKGROUND/AIMS: Cancer-induced bone pain (CIBP) is one of the most common pains in patients with advanced neoplasms. Because of treatment-associated side effects, more than half of cancer patients are reported to have inadequate and undermanaged pain control. New mechanism-based therapies must be developed to reduce cancer pain. Quetiapine is a commonly used atypical antipsychotic drug. We report a study of the potential analgesic effects of quetiapine in a mouse model of CIBP and examine the mechanism of bone pain by analyzing the expression of various nociceptors. METHODS: Fifteen male C3H/HeN mice were arbitrarily divided into five groups: control and, CIBP with no treatment, quetiapine treatment, opioid treatment, and melatonin treatment. The mice were tested for mechanical hyperalgesia by determining the nociceptive hind paw withdrawal pressure threshold. Tissues from tibia were removed and subjected to quantitative and qualitative evaluations of transient receptor potential vanilloid 1 (TRPV1), TRPV4, acid-sensing ion channel 1 (ASIC1), ASIC2, and ASIC3 expression. RESULTS: Paw withdrawal pressure threshold was improved in the quetiapine treatment group compared with the CIBP group. Expression of TRPV1, TRPV4, ASIC1, ASIC2, and ASIC3 in the CIBP with quetiapine treatment group was significantly lower than that in the CIBP group. CONCLUSIONS: Our results suggest an analgesic effect of quetiapine in the CIBP animal model and implicate TRPV and ASICs as potential targets for cancer pain management.
Animals ; Evaluation Studies as Topic ; Humans ; Hyperalgesia ; Ion Channels ; Male ; Melatonin ; Mice* ; Models, Animal ; Nociceptors ; Pain Management ; Quetiapine Fumarate* ; Tibia