Two techniques are available for endovascular treatment of post-SAH vasospasm: mechanical angioplasty and phamacologic infusion(papaverine or other vasodilator). The advantages of papaverine infusion are simplicity, safety, and the ability to reach small distal vessels. The disadvantages are that the treatment results may be temporary and inconsistant. The advantages of balloon angioplasty are rapid, dramatic result and consistantly successful. It is important to treat vasospasm as soon as possible for two reasons: vascular response is better and permanant ischemic damage is minimized. If ischemic symptom have developed, it may already to be late. So, the treatment of vasospasm should be proreactive rather than reactive.
Angioplasty ; Angioplasty, Balloon ; Papaverine

The most important assets of a responsible and successful neuro-endovascular surgeon are knowledge of the possible technical difficulties, complications that may be encountered during the procedures. The intrinsic risks of complications involved with GDC embolization for cerebral aneurysms are multifactorial; the experience and skill of the physician, the different kind of devices used and geometry of aneurysm. Any complication can be totally unpredictable and even unknown for a time. Duration of the procedures another critical factor, so some of the complications (eg., vascular damage, thrombosis, intimal damage) is simply from the length of the procedure.
Aneurysm* ; Intracranial Aneurysm ; Thrombosis

BACKGROUND: The p53 gene mutations have been found in a variety of human skin cancers. To date most studies concerning p53 gene mutations in skin cancers focused on squamous cell carcinoma(SCC) and its precancerous lesions such as actinic keratosis and Bowen's disease, especially related to ultraviolet light, but few on basal cell carcinoma(BCC). OBJECTIVE: This study was aimed to investigate the aberrant expression rates on p53 mutant gene in BCCs as well as in SCCs and their changes depending upon their clinicopathologic characteristics. METHODS: An immunohistochemical study was employed using the mouse monoclonal antibody raised against recombinant human p53 in 30 BCCs and 16 SCCs. Also, clinical and histopathologic analyses for age, sex, site, duration and histopathologic classification were performed. RESULTS: p53 immunoreactivity was observed in 57% of BCCs and 75% of SCCs. In BCCs P53 immnoreacticvity was increased by up to 61% in cases(28/30) developed on the sun-exposed area. In SCCs p53 immunoreactivity(89%) on non-sun-exposed area was unexpectantly higher than that(57%) on sun-exposed area. No significant correlation between p53 imunoreactivity and clinicopathologic characteristics in BCCs and SCCs was noted. CONCLUSION: Mutations of p53 may play an important role of the pathogenetic sequence in a large part of the pathogenetic sequence in a large part of BCCs as well as SCCs.
Animals ; Bowen's Disease ; Carcinoma, Basal Cell* ; Carcinoma, Squamous Cell ; Classification ; Genes, p53 ; Humans ; Keratosis, Actinic ; Mice ; Skin Neoplasms ; Ultraviolet Rays

The anatomy of spinal cord vessels is formed systematically by three constitutions, extrinsic and intrinsic spinal arteries and veins. The extrinsic arterial supply to the cord has a metameric organization and makes a functionally efficient system that assimilates different tissues with single source of supply. The intrinsic blood supply to the spinal cord covers the territories under the control of the sulcal arteries anteriorly and radial arteries arising from pial network. As with the cerebral vasculature, increased interest is paid in the role of the vein that present the key factor of equilibrium in the tissue perfusion of the normal spinal cord. The normal anatomy of the spinal vessels as well as the tremendous interindividual variations forms the basis for our understanding of primary or secondary spinal cord circulatory disorders.
Arteries ; Constitution and Bylaws ; Perfusion ; Radial Artery ; Spinal Cord* ; Veins

The goals of embolization of arteriovenous malformations(AVMs) is to reduce the size and decrease the anomalous flow of the vascular malformation to reduce the risk of hemorrhage, so that the curative procedures of surgical resection or radiosurgery can be performed with minimal risk. Endovascular cure rate for AVMs is limited to 5% to 10%, and when some symptomatic relief is desired in a surgically inadvisable AVMs, partial embolization can be performed. In the planning of the managements of AVMs, the thorough interpretation of the angioarchitecture of AVMs is mandatory as not only the natural history of AVMs but also the difficulties and risks of embolization is directly related with it. Hemorrhage from the AVMs is usually related to an associated aneurysm, out flow restriction and pure deep venous drainage. And so the intranidal aneurysm should be obliterated firstly. In the presence of fistulous rapid flow in AVM nidus, the risk of venous side embolic occlusion and resulting hemorrhage is increased. Staged procedure is necessary to avoid rapid hemodynamic changes in regions of chronic ischemia surrounding the AVMs, however delay in definitive treatment allows the recruitment of leptomeningial collaterals and deep perforators, and recanalization of previously embolized pedicle. Recanalization of pre-radiosurgery embolization segment can be a cause of incomplete obliteration after radiosurgery. The management of AVMs is best accomplished by the multimodality treatment that is based on the recognition of these benefits and limits of embolization.
Aneurysm ; Drainage ; Hemodynamics ; Hemorrhage ; Ischemia ; Natural History ; Radiosurgery ; Vascular Malformations*

OBJECTIVES: The purpose of this study was to evaluated the difference of depressive symptoms and attention between estrogen user and non-user in postmenopausal women. METHODS: 30 Estrogen users and 30 non-users were participated in this study. They were all menopausal for at least 1 year and have 12 or more education years. We used BDI(Beck Depression Inventory), digit span and digit symbol to evaluate depressive symptoms and attention in both groups. We also measured the plasma estradiol level and identified the correlation between estradiol level and BDI, digit span and digit symbol. RESULTS: The demographic data was not different between both groups. Estrogen users scored higher than non-users in digit span(forward) and lower than non-users in BDI. The correlation between estradiol level BDI, digit span and digit symbol was not significant. CONCLUSION: Estrogen replacement therapy was effective in alleviation depressive symptoms but ineffective in improving attention in postmenopausal women.
Depression* ; Education ; Estradiol ; Estrogen Replacement Therapy* ; Estrogens* ; Female ; Humans ; Plasma

Carotid angioplasty and stenting (CAS) for carotid stenosis has been increasingly used as an alternative treatment in patients not eligible for surgery. Even though CAS can be performed relatively simply in many cases, various complications can occur. We report four cases of CAS using the Carotid Wallstent, which were complicated by delayed shortening of the stent, resulting in restenosis after successful CAS.
Angioplasty ; Carotid Arteries ; Carotid Stenosis ; Humans ; Stents

We report herein a case of lymphomatoid papulosis showing atypical clinical manifestations. A 54- year-old man had had recurrent erythematous necrotic papules and nodues, numbering more than 200 lesions at the most aggravated time, on the trunk, extremities, buttok, and face for the last twenty years. Recently, he complained of tender swelling on the neck, axillae, and inguinal lymph nodes accompanied by mild fever and gerneral weakness. We had performed thorough examinations including biopsy from the skin lesions, lymph node, and bone marrow to detect some evidences of transforming to malignant lymphoma, but found no evidence of malignant lymphoma except aneuploidy on DNA histogram. The patients showed proinpt response to methotrexate 10-30mg par week wit,hout showing distinct side reactions to the accurvulated dose of 780mg for the last 16 months.
Aneuploidy ; Axilla ; Biopsy ; Bone Marrow ; DNA ; Extremities ; Fever ; Humans ; Lymph Nodes ; Lymphoma ; Lymphomatoid Papulosis* ; Methotrexate ; Neck ; Skin

OBJECTIVE: Perfusion-computed tomography (CT) is useful and quick diagnostic tool for evaluating ischemic stroke patients. We evaluated three measurement maps, cerebral blood flow (CBF), cerebral blood volume (CBV) and time to peak (TTP) for their usefulness in deciding on revascularization surgery using CT parameters after single photon emission computed tomography (SPECT) findings in chronic steno-occlusive disease patients. METHODS: We retrospectively investigated 47 patients with unilateral internal carotid artery (ICA) or middle cerebral artery (MCA) steno-occlusive disease . All patients underwent digital subtraction angiography (DSA) as well as an acetazolamide challenge with SPECT and perfusion CT. Patients who showed decreased reserve capacity with a Diamox challenge were classified in the positive group, whereas patients who had no difference in reserve capacity were placed in the negative group. RESULTS: Thirty-one patients were positive and the remaining 16 were negative. Differences in rCBV and rCBF parameters between normal cerebral hemispheres and cerebral hemispheres with steno-occlusive disease did not correlate with SPECT results, but TTP values did. SPECT results seemed relevant when TTP differences between hemispheres with normal and steno-occlusive disease were more than 1.55 times. CONCLUSION: Perfusion CT is a useful tool for the rapid, adequate diagnosis of large territorial infarcts, and the TTP map of perfusion CT is a sensitive and reliable parameter to show the status of collateral circulation in chronic cerebrovascular ischemic disease.
Acetazolamide ; Angiography, Digital Subtraction ; Blood Volume ; Carotid Artery, Internal ; Cerebrum ; Collateral Circulation ; Hemodynamics ; Humans ; Middle Cerebral Artery ; Perfusion ; Retrospective Studies ; Stroke ; Thymine Nucleotides ; Tomography, Emission-Computed, Single-Photon

The surgical as well as endovascular treatment of blood-blister-like aneursysms (BBAs) is extremely difficult because of these pathological natures, such as small and the fragile necks. The optimal treatment of BBAs has remained uncertain. Stents are known to divert blood flow and induce thrombosis of intracranial aneurysms. We report 3 cases of successful obliteration of BBAs after multiple stents placement.
Aneurysm ; Intracranial Aneurysm ; Neck ; Stents ; Thrombosis