The parathyroid cyst is a relatively uncommon disease and usually identified during the operation for a presumed thyroid mass. Thirteen cases of parathyroid cyst (2 males, 11 females) treated from 1981 to 1993 were reviewed. Ages ranged from 17 to 59 years(mean, 41 years). Gross measurement of the tumor size varied from 1.0 to 10.0 cm in diameter with a mean of 4.8cm. All of the 13 patients presented with a chief complaint of painless anterior cervical mass. Only one complained of mild symptom of dyspnea and voice change due to huge cyst in paratracheal space. No functional cyst was identified. Diagnostic studies included ^99mTc thyroid scan (n=11), ultrasonography (n=10), computerized tomography (n=4) and fine needle aspiration(FNA) (preoperative, n=4; intraoperative, n=3). All diagnostic precedures but needle aspiration were nonspecific. Cysts were found in right inferior parathyroid(n=4), left inferior parathyroid (n=7), or anterior superior mediastinum (n=2). The FNA of the cyst contents revealed watery clear fluid with elevated parathyroid hormone level and was diagnostic in each cases. Four patients were treated initially with needle aspiration, of which only one patient was successful, and 3 patients who were unsuccessful to needle aspiration and the remaining 9 were effectively treated with surgical extirpation. Our experience suggested that needle aspiration may be of significant help in diagnosis and treatment of parathyroid cyst, but most of the patient could be treated successfully by surgical extirpation with an excellent chance for curability.
Biopsy, Fine-Needle ; Diagnosis ; Dyspnea ; Humans ; Male ; Mediastinum ; Needles ; Parathyroid Hormone ; Thyroid Gland ; Ultrasonography ; Voice

Loss of radial nerve function in the hand results in a significant disability and so cannot extend the wrist, thumb & fingers according to the injury levels. Therefore the patient has great difficulty in grasping objects, especially power grip. Tendon transfers to restore function of extension of wrist and fingers are among the the best − most predictable transfers in the upper extremity. We performed 13 cases of tendon transfers for radial nerve palsy and extensive extensor ruptures from 1987 to 1993. The results were evaluated according to Arbitrary Value Method. Among 13 cases 30% of excellent, 46% of good, 24% of fair and no poor result were obtained and the better results were obtatined in low radial nerve lesion.
Fingers ; Hand ; Hand Strength ; Humans ; Methods ; Paralysis ; Radial Nerve ; Radial Neuropathy ; Rupture ; Tendon Transfer ; Tendons ; Thumb ; Upper Extremity ; Wrist

Using a rat model, this study examined the cerebral protective effect of moderate hypothermia and evaluated the effect on early local metabolic change of permanent focal cerebral ischemia. The middle cerebral artery(MCA) of the rat was approached subtemporally and was occluded, and its surface was cooled. Cerebral infarct size was measured at 1, 4 and 7 days after MCA occlusion in non-treated(n=27), 2-hour hypothermia(n=27) and 3-hour hypothermia(n=27) group, respectively, and regional cerebral glucose uptake(rCGU) was determined at 1 and 4 hour after MCA occlusion in the non-treated(n=8) and 3-hour hypothermia(n=8) group, respectively. Infarct size measured at 1, 4 and 7 days after MCA occlusion was 22.2%+/-4.4%, 14.3%+/-6.6%, 13.7%+/-5.3% in the non-treated group, 19.6%+/-10.0%, 12.5%+/-6.2%, 12.0%+/-6.9% in the 2-hour hypothermia group and 12.9%+/-5.6%, 8.3%+/-3.3%, 8.2%+/-2.3% in the 3-hour hypothermia group. In the 2-hour hypothermia group, no significant size reduction was seen, but in the 3-hour hypothermia group, infarct size had decreased to half of that of the non-treated group(p<0.05). This protective effect was observed untill 1 week after MCA occlusion. rCGU in the non-treated group measured at 1 hour after MCA occlusion had increased in the periphery of the ischemic core, but at 4 hours, periischemic hypermetabolism had disappeared and the area of low metabolism in the center had become larger. rCGU in the 3-hour hypothermia group measured at 1 hour after MCA occlusion(BT 26degreesC) showed a uniform decrease in all regions, supressing temporary periischemic hypermetabolism, and at 4 hours(BT 37degreesC) after occlusion, hypermetabolism was not prominent and the area of low metabolism in the center had narrowed. This study indicates that 3 hour moderate hypothermia immediately after MCA occlusion significantly reduces infarct size, and that this protective effect was associated with suppression of periischemic hypermetabolism occurring around 1 hour after MCA occlusion.
Animals ; Brain Ischemia* ; Glucose* ; Hypothermia* ; Metabolism ; Models, Animal ; Rats*

Authors report on the general features of postoperative central nervous system infection in patients undergoing neurosurgical procedures. The postoperative central nervous system infection was defined was defined as 1) emergence of purulent material from any site that had been exposed to surgical field, and/or 2) development of meningitis during postoperative recovery period. The materials were obtained from 50 cases of postoperative central nervous system infection out of 1,232 cases of operations that had been performed in neurosurgical department of Seoul National University Hospital during the last three years. Various predisposing factors, associated problems, and therapeutic aspects are discussed. General features of hospital infection are also considered.
Anti-Bacterial Agents ; Causality ; Central Nervous System Infections* ; Central Nervous System* ; Cross Infection ; Humans ; Meningitis ; Neurosurgical Procedures ; Seoul ; Wound Infection

Recently the cause of hemifacial spasm and trigeminel neuralgia is known to be vascular compression-distortion in the root exit and entry zone of each nerve. The microvascular decompression of the 5th and 7th cranial nerves is a method of refined and non-traumatic surgical treatment of these disabling diseases. 33 patients with intractable hemifacial spasm and 7 patients with trigeminal neuralgia were treated by microvascular decompression and the follow-up results were evaluated. The surgical results in 33 cases of hemifacial spasm were as follow: Excellent-18, Good-7, Fair-6, Poor-2. Disturbance of hearing as a complication appeared in 6 cases, but improved gradually except one case. The surgical finding and results in 7 cases of trigeminal neuralgia were as follow: In 6 cases the causative vessel was SCA and in one case SCV indented the nerve root. All 7 patients with trigeminal neuralgia were relieved from facial pain after surgery.
Cranial Nerves ; Facial Nerve* ; Facial Pain ; Follow-Up Studies ; Hearing ; Hemifacial Spasm ; Humans ; Microvascular Decompression Surgery* ; Neuralgia ; Trigeminal Neuralgia

By using technique of microvascular anastomosis under the operating microscope experimental aneurysms were produced in seven rats. These experimental aneurysms were adequately excluded by progressive carbonization of aneurysmal sac and then the remained portion of aneurysmal sacs were reinforced by wrapping with ethyl 2-cyanoacrylate. In this acute experiment all of the common carotid arteries were satisfactorily patent.
Aneurysm ; Animals ; Carbon ; Carotid Artery, Common ; Rats

Deep supratentorial veins are highly valuable in the diagnosis of hydrocephalus as well as deep seated telencephalic or diencephalic lesions. It is well known that the ends of the subependymal veins reach the wall of the frontal horn and the roof of the body of the lateral ventricle and when ventricles dilate, they are stretched and elongated in proportion to the degree of dilatation. Among the subependymal veins septal veins are most frequently visualized, so we can easily measure its length in lateral carotid phlebograms. The author calculated the ratio between the length of the septal vein and the distance from the frontal bone to the venous angle in 50 epileptic patients as normal control and in 29 patients with hydrocephalus to know how far the frontal horn reaches. The author also calculated the ratio between the height of the internal cerebral vein and the distance from the Twining's line to the vertex. The results were as follows ; 1) Internal cerebral veins were visualized in all patients and septal veins in 92.6% in epileptic patients and 76.3% in patients with hydrocephalus. 2) In epilepsy the ratio between the length of the septal vein and the distance from the frontal bone to the venous angle was 43.7+/-.68%. 3) In epilepsy the ratio between the distance from the frontal bone to the venous angle and the distance from the frontal bone to the occipital bone was 43.9+/-.00%. 4) In epilepsy the ratio between the distance from the Twining's line to the venous angle and the vertex was 34.8+/-.46%. 5) In epilepsy the ratio between the distance from the Twining's line to the highest point of the internal cerebral vein and the vertex was 37.9+/-.46%. 6) Septal veins were elongated in proportion to the enlargement of the lateral ventricles and they were rather elongated in epileptic patients who had extremely oblique and flat forehead. 7) Internal cerebral veins were displaced upward or downward under various influences.
Animals ; Cerebral Veins ; Diagnosis ; Dilatation ; Epilepsy ; Forehead ; Frontal Bone ; Horns ; Humans ; Hydrocephalus ; Lateral Ventricles ; Occipital Bone ; Veins*

In a consecutive series of 100 patients with ruptured saccular aneurysm, 69% of them under-went surgery and 31% did not. Of those who did not have surgery, half refused surgery and the other half had too high risk factors to be operated. Sixty seven percent of surgical cases under-went direct neck clipping, while 14% of them had wrapping or proximal clipping of anterior cerebral artery and 19% of them, carotid ligation. The mortality rate of non-microsurgery group was 14% and that of microsurgery group was 6%. The morbidity rate of non-microsurgery group was 19% and that of microsurgery group was 11%. The use of operating microscope brought about the significant reduction in the incidence of surgical mortality and morbidity.
Aneurysm* ; Anterior Cerebral Artery ; Humans ; Incidence ; Ligation ; Microsurgery ; Mortality ; Neck ; Risk Factors

The management of the patient undergoing posterior fossa surgery meets with various difficulties during and after the surgery due to the anatomical characteristics of the posterior fossa. Sitting position has been used popularly for its advantage of proper exposure of the posterior fossa lesions, but this position presents disastrous complications such as hypotension and air embolism not infrequently. Hydrocephalus, frequently complicating the posterior fossa lesions, also presents many problems during and after surgery. Postoperative brain swelling, CSF leakage and infection are other important problems of the posterior fossa surgery. The authors obtained following results with analysis of surgical results in 71 posterior fossa lesions. 1) The posterior fossa lesions are frequently present hydrocephalus and signs of increased intracranial pressure due to blockade of CSF flow. Their proper management such as steroid, diuretics and preoperative shunt made the operative manipulation easier and improved the postoperative course. 2) The major intraperative problems were air embolism and postural hypotension which were mainly related to th4 sitting position. To avoid these complications, the author propose lateral position for very old patients and those with cardiopulmonary disease or in surgery for CP angle lesion and cerebellar hemispheric lesion which can be exposed adequately with this position. 3) It way easy to detect and manage possible postoperative problems such as brain swelling, hematoma and persistent hydrocephalus with aid of CT scan and their serious outcome could be reduced.
Brain Edema ; Diuretics ; Embolism, Air ; Hematoma ; Humans ; Hydrocephalus ; Hypotension ; Hypotension, Orthostatic ; Intracranial Pressure ; Tomography, X-Ray Computed

Heat Shock Protein (HSP) is a genetic product reacting on stress. HSP is increased by physiological or environmental stress and expressed at gastrointestinal tumors such as stomach cancer, pancreatic cancer and large intestinal cancer, and at other various tumors such as lymphoma and breast cancer. The role of HSP is to interrupt the process of apoptosis interfering with formation of tumors, and weaken function of tumor control beyond that of immune surveillance. In case of causing the normal p53 to be mutated, it leads to morphological change of p53 protein and combine with HSP. But, it has not been clarified yet. We intend to examine the meaning of HSP 70 in bladder tumor by investigating the relations among HSP expression and tumor stage, tumor grade, P-gp (glycoprotein) expression as a product of multi-drug resistant gene, and p53 expression in 59 cases of bladder tumor. 1) There were HSP expressions of 8 cases (22%) among 36 superficial bladder tumors and of 9 cases (39%) among 23 invasive bladder tumors. 2) HSP positive reactions were observed in 1 case (8%) of 13 Grade I, and 6 cases (29%) of 21 Grade II and 10 cases (40%) of 25 Grade III. 3) Positive reactions of HSP were showed in 10 cases (40%) among 25 P-gp expression, and in 7 cases (21%) among 34 P-gp non-expression. 4) The p53 proteins were expressed in 12 cases (29%) among 42 ones of HSP non-expression and in 8 cases (47%) among 17 ones of HSP expression. 5) Positive reactions of HSP were showed in 9 cases (23%) among 39 ones of p53 non-expression, and in 8 cases (40%) among 20 ones of p53 expression. 6) 5 patients of 6 with negative expression of HSP and strong positive expression of p53 had poorly differentiated transitional cells, in which one of the patients accompanied with lung metastasis. In view of above study, HSP expression has no correlation with P-gp and stage in bladder tumor, but it has probable pertaining to tumor grade and p53. As it were, tumor cellular differentiation and p53 expression have weak correlations with HSP 70 expression. Meanwhile, judging from poor differentiation, in most cases of HSP non-expressed but p53 strongly expressed, HSP is insufficient to be a prognostic factor of bladder tumor independently, however, in case of using it, as supplementary one, concurrently with p53, it would be valuable prognostic factor in bladder tumor.
Apoptosis ; Breast Neoplasms ; Heat-Shock Proteins* ; Hot Temperature* ; HSP70 Heat-Shock Proteins* ; Humans ; Intestinal Neoplasms ; Lung ; Lymphoma ; Neoplasm Metastasis ; P-Glycoprotein ; Pancreatic Neoplasms ; Stomach Neoplasms ; Urinary Bladder Neoplasms* ; Urinary Bladder*