The author performed radiosurgery with linear accelerator(LINAC) on two patients who were unable to receive surgical treatment. A 75-year-old-male patient(case 1) whose main complaints were gait disturbance and headache had undergone total resection of cerebellar hemangioblastoma five years before the admission and the lesion recurred. Because the patient's general condition was poor, radiosurgery with LINAC was performed and at 1 month after the radiosurgery, obstructive hydrocephalus developed, and ventriculoperitoneal shunt was done. After 11 months, follow-up brain magnetic resonance image findings showed the decrease of the size of the tumor, and the patient's consciousness returned to alertness. He could also walk using a cane. A 28-year-old male paient(case 2) whose main complaints were vertigo, ataxia refused to receive surgical resection due to his religious beliefs, and radiosurgery was performed, after cyst aspiration with ommaya reservoir insertion as an alternative. Eighteen months later, the tumor size has decreased and there were no radiosurgical complications. The patient has been followed-up at the outpatient without any notable symptoms. Through these two cases, the authors experienced tumor control by LINAC radiosurgery when surgical treatment is not acceptable. Radiosurgery seems safe and effective in the treatment of hemangioblastoma, but there is the need for further evaluation.
Adult ; Ataxia ; Brain ; Canes ; Consciousness ; Follow-Up Studies ; Gait ; Headache ; Hemangioblastoma* ; Humans ; Hydrocephalus ; Male ; Outpatients ; Radiosurgery* ; Religion ; Ventriculoperitoneal Shunt ; Vertigo

Coronary stent embolization is a rare event but may result in clinically relevant cardiac ischemia or peripheral embolization during the procedure. We report a case of systemic embolizations of two coil stents during the primary PTCA in acute myocardial infarction, who were treated successfully with a double wire helix technique and a gooseneck snare. Although in our experience this rare complication did not produce any clinical complications, care should be taken to prevent this possibility, especially in patients with significant vessel tortuosity, calcification, total occlusion, or mild stenosis proximal to the target lesion.
Constriction, Pathologic ; Humans ; Iliac Artery* ; Ischemia ; Myocardial Infarction ; SNARE Proteins ; Stents*

PURPOSE: The bone defects that are associated with shoulder anterior instability may be the causes of failure of arthroscopic surgery. For the treatment of traumatic shoulder instability, we tried to determine the arthroscopic techniques that can be used for the bone defect of the glenoid and the humeral head. The purpose of this study is to assess the surgical techniques for the arthroscopic reconstruction of the shoulder with anterior instability and bone defects. MATERIALS AND METHODS: We analyzed the articles that have been recently published on anterior shoulder instability and we assessed the arthroscopic surgical techniques. We compared the articles and the methods of arthroscopic surgical techniques for treating bone defects of the anteroinferior glenoid and the posterolateral humeral head, which were considered as the causes of recurrence of shoulder instability. RESULTS: There are the anteroinferior bone defects of the glenoid and Hill-Sachs lesions in the bone defects that appear in patients with anterior shoulder instability. These bone defects are currently the causes of failure of arthroscopic surgery. CONCLUSION: Open shoulder surgery may be the treatment of the choice for a shoulder with instability and significant bone defects of the glenoid and the humeral head. But efforts are being made to overcome the weaknesses of open surgery by the use of arthroscopy
Arthroscopy ; Humans ; Humeral Head ; Recurrence ; Shoulder

Surgical endarterectomy has been shown to be superior to medical treatment in the management of severe carotid stenosis. Endarterectomy, although effective, does have limitations, and percutaneous transluminal angioplasty with stent may offer an alternative modality of treatment. We report on a patient with severe coronary disease that femoral arterial cannulation was not possible due to aorto-femoral shunt operation and absent pulse. The transradial approach was used for aortography, bilateral carotid angiography and successful elective stent deployment in the left internal carotid artery. The transradial approach might be useful alternative in case of problems with femoral approach.
Angiography ; Angioplasty* ; Aortography ; Carotid Arteries* ; Carotid Artery, Internal ; Carotid Stenosis* ; Catheterization ; Coronary Disease ; Endarterectomy ; Humans ; Stents*

OBJECTIVE: Distal anterior cerebral artery(DACA) aneurysms are relatively uncommon, and have special aspects. We discuss clinical features and surgical results of DACA aneurysms with review of literatures. METHODS: Among 725 cases of intracranial aneurysms operated from 1989 to 2001 in our hospital, 38 cases of DACA aneurysms were studied retrospectively. The clinical presentations, neurological findings, operative approaches and outcome were analyzed. RESULTS: The incidence of the DACA aneurysm was 5.2% of total 725 aneurysms. Multiple aneurysms were found in 10 patients. Among the 38 patients, 15 were men and 23 were women. The mean age was 49.8 years. 2 aneurysms were located at frontobasal artery, 5 at the origin of frontopolar artery, 28 at the bifurcation between callosomarginal and pericallosal artery, 3 at the origin of pericallosal artery. 32 patients had good outcomes after surgery. 4 patients remained disabled, and 2 patients died. Postoperative complications were vasospasm, cerebral infarction, intracranial hemorrhage, pneumonia. CONCLUSION: The incidence of DACA aneurysm was relatively rare than other location. We think that unilateral interhemispheric approach is useful for aneurysm in most DACA, and approaches should be chosen according to the location of aneurysm and presence or absence of multiple aneurysms. The Glasgow Outcome Scale score was good in patient with low Hunt & Hess grade preoperatively. And early operation can reduce the rate of rebleeding and improve outcome of DACA aneurysms.
Aneurysm ; Anterior Cerebral Artery* ; Arteries ; Cerebral Arteries ; Female ; Glasgow Outcome Scale ; Humans ; Incidence ; Infarction ; Intracranial Aneurysm* ; Intracranial Hemorrhages ; Male ; Pneumonia ; Postoperative Complications ; Retrospective Studies ; Subarachnoid Hemorrhage ; Vasospasm, Intracranial

BACKGROUND AND OBJECTIVES: Practical concerns about transradial approach are increasing in consideration of high procedural success rate, low local complications, and patient's convenience. There was no available data about repeated-use of radial artery for coronary procedures. We evaluate the changes of radial arterial diameter and procedural outcomes of repeated transradial procedure. MATERIALS AND METHOD: Of consecutive 1771 transradial coronary procedures, 117 patients received repeated transradial procedures through the same radial artery. Radial arterial diameter, vascular access time and procedural outcomes were evaluated in between the group of first-use and repeated-use of radial artery. RESULTS: Among 117 patients of second transradial coronary procedure in the repeated-use group, 47 patients (41.6%) underwent coronary intervention and 66 patients (58.4%) underwent coronary angiography. The right radial approach was used in 82.9% of the cases. There was no significant difference in radial artery mean diameter between pre-procedure and 1 day after procedure in patients with first-use and repeated-use group. There was no significant change of radial arterial diameter after first-use depending on the SAR (the ratio of sheath outer diameter to radial artery inner diameter). However, after repeated-use of radial artery, there was significant reduction of radial arterial diameter 1 day after procedure in the patients with SAR more than 0.9 (p<0.05). In repeated-use group, the mean radial arterial diameter was 2.63 +/- 0.35mm mm before the procedure and 2.51 +/- 0.29mm during follow-up (136 +/- 123 days) (p<0.05). There was no significant difference of the vascular access time between the first-use and repeated-use procedures (2.9+/-3.1 vs 3.3+/-3.6 minutes, p<0.05). The procedural success and vascular complication rate of repeated-use of radial artery were as similar to those of the first-use, but total occlusion of radial artery was higher in the repeated-use group (2.6% vs 0.7%, p<0.05). CONCLUSION: The diameter of radial artery after transradial procedures was significantly reduced during follow-up and the incidence of asymptomatic radial artery occlusion was more frequent after repeated-use. However, repeated-use of radial artery was feasible in most patients with high procedural success rate and low vascular complications.
Coronary Angiography ; Follow-Up Studies ; Humans ; Incidence ; Radial Artery*

Subacute thyroiditis is a frequent benign thyroid disease associated with previous viral upper respiratory tract infection. Known complications of this disease are long-standing subclinical hypothyroidism, persistent anterior neck pain and rarely Graves disease. In general, thyroid abscess is an uncommon disease because of anatomic isolation of the gland and its rich system of drainage for blood and lymph. Especially, development of thyroid abscess in subacute thyroiditis is extremely rare phenomenan, but significant bad outcomes can be resulted. Its clinical BACKGROUND containes immune-suppressed state, anatomic defect, presence of underlying other thyroid disease and of non-thyroidal infectious foci. We experienced a case of subacute thyroiditis complicated with streptococcal thyroid abscess during glucocorticoid therapy. The patient was a 19-year-old female who was admitted due to anterior neck pain for 1 month. Typical subacute thyroiditis was suggested from initial laboratory findings including CBC, erythrocyte sedimentation rate, serum T3, T4, TSH levels, thyroid scan & thyroid uptake. But during oral prednisolone therapy, unexpected bacterial thyroid abscess was developed. We report this unusual case with review of literatures.
Abscess ; Blood Sedimentation ; Drainage ; Female ; Graves Disease ; Humans ; Hypothyroidism ; Neck Pain ; Prednisolone ; Respiratory Tract Infections ; Thyroid Diseases ; Thyroid Gland* ; Thyroiditis, Subacute* ; Young Adult

BACKGROUND: Dermatitis occurring after ingestion of the urushiol chicken is quite common in Korea. Although many cases of the systemic contact dermatitis due to urushiol chicken have already been reported, systemic study on its epidemiology is not done yet. OBJECTIVE: To elucidate the demography of the eaters of the urushiol chicken with its general understandings in society and the incidence of the resultant systemic dermatitis. METHODS: By the help of the patients who developed the dermatitis, all the persons who ate it together with the patients were interviewed. RESULTS AND CONCLUSION: l. 171 eaters of the urushiol chicken(125 male and 46 female) were enrolled in this study(M:F= 3.1:1). The age group in 4th decade was the most common in male, the 5th decade in female. The age prevalence of the systemic contact dermatitis corresponded to the age prevalence of the eater. 2. Incidence rate of systemic contact dermatitis among the eaters was 32.2% (55/171). Incidence rate according to each age group were as follows : 0% in 2nd decade, 33.3% in the 3rd decade, 32.4% in 4th decade, 32.8% in 5th decade, 33.3% in 6th decade, 25% in the 7th decade. 3. One third (57/171) of the eaters ate the urushiol chicken to strengthen their internal organs, especially stomach, which they believed to be weak 70 persons (40.9%) ate it at home, 101 persons (59.1%) ate it at a restaurant. 4. Out of 67 persons having past history of allergic contact dermatitis to Rhus tree, 28 persons (41.8%) showed systemic contact dermatitis. Out of 104 persons without past history of allergy to Rhus, 27 persons (26.0%) showed systemic contact dermatitis.
Chickens ; Demography ; Dermatitis ; Dermatitis, Allergic Contact ; Dermatitis, Contact* ; Eating* ; Epidemiologic Studies* ; Epidemiology ; Female ; Humans ; Hypersensitivity ; Incidence ; Korea ; Male ; Prevalence ; Restaurants ; Rhus* ; Stomach ; Trees

OBJECTIVE: The safety and effectiveness of Guglielmi Detachable Coil(GDC) embolization for cerebral aneurysm has been well documented. However, domestically there are few reports. The purpose of this study is to analyze procedural complications that occurred during endovascular coilling performed for cerebral aneurysms retrospectively. METHODS: From January 1996 to December 2003, a total of 453 patients (484 aneurysms) who had undergone GDC embolization for cerebral aneurysm were selected. The aneurysms were classified according to rupture history, location, dome and neck size. Procedural complications such as aneurysmal rupture, thrombosis and occlusion of patent vessels due to coil escape were noted. RESULTS: Procedural complications occurred 49 cases (10.1%). Among these, there were 27 of procedure-related aneurysmal rupture (5.6%), 14 of thrombosis (2.9%), 8 of occlusion of patent vessels due to coil escape (1.7%). Death or severe neurological deficit were seen in 18 cases of procedure-related rupture, 9 cases of thrombosis and 4 cases of coil escape. Procedure-related mortality and morbidity rates for endovascular coiling were calculated to be 2.9% and 3.6% respectively. CONCLUSION: The potential complications associated with shape, size and relationship to parent vessels of each specific cerebral aneurysm must be considered carefully before treatment. In order to reduce complications, proper equipment, knowledge on the hemodynamics and vascular anatomy, and operator's expertise are desired.
Aneurysm* ; Hemodynamics ; Humans ; Intracranial Aneurysm ; Mortality ; Neck ; Parents ; Retrospective Studies ; Rupture ; Thrombosis ; United Nations

The purpose of this study was to report a case with post-traumatic spinal epidural hematomas with abnormal neurologic findings, which is uncommon. A 40-year-old man presented at our clinic after a blunt trauma caused by a traffic accident in which he was a pedestrian. After admission, abnormal neurologic symptoms developed including loss of sensation and motor function in his left lower extremity. Magnetic resonance imaging demonstrated a spinal epidural hematoma with 40% canal stenosis at the L5-S1 level. Decompression including hematoma evacuation was done. Symptoms started to be reduced 18 days after operation. He was treated conservatively with medications and all symptoms resolved completely during admission and there were no further neurologic sequelae. Post-traumatic lumbar spinal epidural hematoma with abnormal neurologic findings is an uncommon condition that may present belatedly after trauma with significant neurologic compromise.
Accidents, Traffic ; Adult ; Constriction, Pathologic ; Decompression ; Hematoma ; Hematoma, Epidural, Spinal ; Humans ; Lower Extremity ; Magnetic Resonance Imaging ; Neurologic Manifestations ; Neurology ; Sensation