Insulinoma is a functional endocrine tumor arising from the beta cells of islets of Langerhans of pancreas. The only effective treatment of insulinoma was surgical removal of the tumor. Recently, laparoscopic surgery for islet cell tumors of the pancreas is introduced. Laparoscopic enucleation or resection of benign islet tumors results in a shorter hospital recovery and is a good alternative to open surgery We report a case of insulinoma that was treated sucessfully by laparoscopic enucleation.
Adenoma, Islet Cell ; Insulinoma* ; Islets of Langerhans ; Laparoscopy ; Pancreas

OBJECTIVE: Despite improvement of therapeutic regimen, incidence of stroke increases and it remains a leading cause of death. Our study aims at offering variable data on recurrent strokes. METHODS: There were 59 patients who admitted from Jan. 2002 to Dec. 2004 due to recurrent strokes. A retrospective longitudinal cohort study was done. RESULTS: Four-hundred-seventy five patients, diagnosed with acute stroke, experienced 491 strokes in 3 years, and there were 75 recurrent strokes (15.3%) in 59 patients. These 59 patients were included in the study. First hemorrhagic cases (H) were 19 (32%), and the first infarction cases (I) were 40 (68%). Subsequent strokes after first stroke were as follows : H-->H 14 (23.7%)cases, H-->I 5 (8.5%), I-->H 8 (13.6%), I-->I 32 (54.2%). A Cox regression analyses showed that the first type of stroke was a significant factor to the second stroke as follows : if one has had a hemorrhagic stroke, the possibility of second hemorrhagic attack (H-->H attack) increase 3.2 times than ischemic type and in ischemic stroke (I-->I attack) 3.6 times increased incidence of second ischemic attack. CONCLUSION: The recurrence rate of stroke was 12.4% (59 of 475 patients). If the first stroke is hemorrhage or infarction, the next stroke would have high potentiality of hemorrhage, or infarction. The possibility of same type in second stroke increase over 3 times. In H-->H group, the time interval between first and second stroke was shorter and the age of onset was earlier than in I-->I group. Moreover, the infarction was more frequent than hemorrhage in multiple strokes. There was a correlation in lacunar type infarction between first and second attack.
Age of Onset ; Cause of Death ; Cerebral Hemorrhage ; Cerebral Infarction ; Cohort Studies ; Epidemiology* ; Hemorrhage ; Humans ; Incidence ; Infarction ; Recurrence ; Retrospective Studies ; Stroke*

The purpose of this study was to investigate the effect of various technical parameters for the dose optimization in pediatric chest radiological examinations by evaluating effective dose and effective detective quantum efficiency (eDQE) including the scatter radiation from the object, the blur caused by the focal spot, geometric magnification and detector characteristics. For the tube voltages ranging from 40 to 90 kVp in 10 kVp increments at the FDD of 100, 110, 120, 150, 180 cm, the eDQE was evaluated at the same effective dose. The results showed that the eDQE was largest at 60 kVp when compares the eDQE at different tube voltage. Especially, the eDQE was considerably higher without the use of an anti-scatter grid on equivalent effective dose. This indicates that the reducing the scatter radiation did not compensate for the loss of absorbed effective photons in the grid. When the grid is not used the eDQE increased with increasing FDD because of the greater effective modulation transfer function (eMTF). However, most of major hospitals in Korea employed a short FDD of 100 cm with an anti-scatter grid for the chest radiological examination of a 15 month old infant. As a result, the entrance surface air kerma (ESAK) values for the hospitals of this survey exceeded the Korean DRL (diagnostic reference level) of 100 microGy. Therefore, appropriate technical parameters should be established to perform pediatric chest examinations on children of different ages. The results of this study may serve as a baseline to establish detailed reference level of pediatric dose for different ages.
Child ; Humans ; Infant ; Korea ; Photons ; Thorax

Splenic tubeculosis is a very rare disorder, few reported in the literature. Here we report 2 patients with splenic tuberculosis, who were admitted to our hospital due to unknown origin fever. Computerized tomography and abdominal ultrasonography revealed the presence of multiple hypodense and anechoic or hypoechoic lesions in spleen. Ultrasonography-guided percutaneous aspiration was suitable in our cases. All laboratory test showed non-specific findings. Splenectomy was performed. After splenectomy they were treated with appropriate antibiotics. They were discharged with a good general condition without any complications.
Anti-Bacterial Agents ; Fever of Unknown Origin ; Humans ; Spleen ; Splenectomy ; Tuberculosis ; Tuberculosis, Splenic* ; Ultrasonography

Cilostazol is a selective inhibitor of type 3 phosphodiesterase (PDE3) and has been widely used as an antiplatelet agent. Cilostazol mediates this activity through effects on the cyclic adenosine monophosphate (cAMP) signaling cascade. Recently, it has attracted attention as a neuroprotective agent. However, little is known about cilostazol's effect on excitotoxicity induced neuronal cell death. Therefore, this study evaluated the neuroprotective effect of cilostazol treatment against hippocampal neuronal damage in a mouse model of kainic acid (KA)-induced neuronal loss. Cilostazol pretreatment reduced KA-induced seizure scores and hippocampal neuron death. In addition, cilostazol pretreatment increased cAMP response element-binding protein (CREB) phosphorylation and decreased neuroinflammation. These observations suggest that cilostazol may have beneficial therapeutic effects on seizure activity and other neurological diseases associated with excitotoxicity.
Adenosine Monophosphate ; Animals ; Cell Death* ; Cyclic AMP Response Element-Binding Protein ; Hippocampus ; Kainic Acid ; Mice ; Neurons ; Neuroprotective Agents ; Phosphorylation ; Seizures ; Therapeutic Uses

The author described a comparative study of 2 different experiemental methods of reperfusion models in rat;1) transcranial method(TC) and 2) extracranial method(EC). The transcranial method was performed by a direct approach to the middle cerebral artery(MCA) after temporozygomatic craniotomy in which a wire was hooked on the proximal portion of middle cerebral artery(MCA) and pulled it to make occlusion of MCA. For the extracranial method, a nylon surgical thread was inserted intraluminally along the internal carotid artery(ICA) to reach the anterior communicating artery. Recirculation of blood was accomplished by removal of the hook or of the thread after 4 hours occlusion of MCA. Two different models were subdivided into 4 chronological groups:pre-reperfusion, 30 minutes, 2 hours, and 48 hours after reperfusion. The differences were evaluated with morphometric analysis after neutral red(NR) or tetrazolium salt(TTC) staining. From the evaluation of initial ischemic area, the extracranial method showed a larger infarct volume as compared to the transcranial method(p=0.013). Mean value(SD) of infracted area of EC and TC were 28.7%(4.4%) and 14.4%(8.1%) respectively. Recovery from the initial ischemia after reperfusion was gradually achieved in both of two groups(p<0.05). The restoration of blood flow after reperfusion was more rapid in EC group and only 2 hours' reperfusion was enough to show no difference between two methods. In TC group followed by 48 hours' reperfusion, 40% of animals resulted in gross infarction of MCA territory as noted with TTC stain, most probably due to reperfusion failure. EC group showed only one such a case(12.5%). But this difference was not in the range of significance statistically. From a technical point of view, EC was more simple, needed less time since a craniotomy was not performed, and required no manipulation of the brain or any intracranial vessels. From these results the author concluded that the extracranial method is a more reliable and technically more manageable one to be used as a reperfusion model for investigating the focal cerebral ischemia.
Animals ; Arteries ; Brain ; Brain Ischemia ; Craniotomy ; Infarction ; Ischemia ; Middle Cerebral Artery* ; Nylons ; Rats* ; Reperfusion*

PURPOSE: The purpose of this study is to evaluate the diagnostic capability of MR imaging for distinguishingcholesteatoma from other causes of inflammation. MATERIALS AND METHODS: We prospectively evaluated the MR imagesof 17 patients with a fully opacified middle ear in whom CT of the temporal bone suggested cholesteatoma. Allpatients underwent middle ear surgery and cholesteatoma was verified in 15 cases, granulation tissue in 15,cholesterol granuloma in four and hemotympanium in one. For each lesion, MR and pathologic findings werecorrelated. RESULTS: All cases of cholesteatoma showed low to intermediate signal intensity on T1-weightedimages. On T2-weighted images, 11 cases showed high signal intensity, while seven were less than CSF and four werethe same. Four cases revealed central low signal intensity with peripheral rim of high signal intensity. On GdDTPA-enhanced images, peripheral or marginal enhancement due to surrounding granulation tissue was noted in 12cases. Two appeared to be totally enhanced. One case of congenital cholesteatoma showed no enhancement. OnT2-weighted images, all cases of granulation tissue showed high signal intensity, and on neither T1- norT2-weighted images could these be distinguished from cholesteatoma. On Gd DTPA-enhanced study, all cases ofgranulation tissue were enhanced, and on T1WI, all cases of cholesterol granuloma showed homogeneous bright signalintensity on T1WI. One case of cholesterol granuloma in the mastoid showed bright signal intensity mixed withirregular areas of dark signal intensity. A further comparison of MR imaging with CT is that two case oflabyrinthitis and one of meningitis were diagnosed on Gd- enhanced T1-weighted images. CONCLUSION: Todifferentiate cholesteatoma from granulation tissue and cholesterol granuloma by the evaluation of their signalintensities and enhancement patterns, MR imaging is superior to CT. When there are cholesteatoma-associatedcomplications such as labyrinthitis or meningitis, postcontrast MR imaging can provide better information.
Cholesteatoma* ; Cholesterol ; Ear, Inner ; Ear, Middle ; Granulation Tissue ; Granuloma ; Humans ; Inflammation ; Labyrinthitis ; Magnetic Resonance Imaging ; Mastoid ; Meningitis ; Prospective Studies ; Temporal Bone*

OBJECTIVES: Balloon cells and dysplastic neurons are histopathological hallmarks of the cortical tubers of tuberous sclerosis complex (TSC) and focal cortical dysplasia (FCD) of the Taylor type. They are believed to be the epileptogenic substrate and cause therapeutic drug resistant epilepsy in man. P-glycoprotein (P-gp) is the product of multidrug resistance gene (MDR1), and it maintains intracellular drug concentration at a relatively low level. The authors investigated expression of P-gp in balloon cells and dysplastic neurons of cortical tubers in patients with TSC. METHODS: An immunohistochemical study using the primary antibody for P-gp, as an indicative of drug resistance, was performed in the cortical tuber tissues in two patients of surgical resection for epilepsy and six autopsy cases. RESULTS: Balloon cells of each lesion showed different intensity and number in P-gp immunopositivity. P-gp immunopositivity in balloon cells were 28.2%, and dysplastic neurons were 22.7%. These immunoreactivities were more prominent in balloon cells distributed in the subpial region than deeper region of the cortical tubers. Capillary endothelial cells within the cortical tubers also showed P-gp immunopositivity. CONCLUSION: In this study, the drug resistance protein P-glycoprotein in balloon cells and dysplastic neurons might explain medically refractory epilepsy in TSC.
Autopsy ; Drug Resistance* ; Drug Resistance, Multiple ; Endothelial Cells ; Epilepsy ; Genes, MDR ; Humans ; Malformations of Cortical Development ; Neurons ; P-Glycoprotein ; Tuberous Sclerosis* ; Up-Regulation*

A case of cystic acoustic Neurinoma is reported. The Patient was 41 year old man with temporal lobe epilepsy. Computerized tomography disclosed a low density cystic mass at left cerebellopontine angle that extended to suprasellar cistern through tentorium. At operation, multiloculated cysts were found that looked like cysticercosis. Pathological examination revealed a typical neurilemmoma with Antoni A and B area that formed cyst wall.
Acoustics* ; Adult ; Cerebellopontine Angle ; Cysticercosis ; Epilepsy, Temporal Lobe ; Humans ; Neurilemmoma ; Neuroma, Acoustic*

OBJECTIVE: The purpose of this reports is to describe the influence of continuous external ventricular drainage (EVD) on delayed ischemic neurologic deficit (DIND) after early surgery in ruptured aneurysmal patients. METHODS: The authors reviewed 229 patients with aneurysmal subarachnoid hemorrhage (SAH) who had been treated with clipping at a single institution between 1998 and 2004. Of these, 121 patients underwent continuous EVD (Group A) postoperatively, whereas 108 patients did not (Group B). EVD was performed at ipsilateral Kocher's point and maintained 2 to 14 days postoperatively. RESULTS: DIND occurred in 15.7% (19 cases) of patients in Group A, 25% (27 cases) from Group B (P value=0.112). Compared with Group A, Group B was more likely to suffer acute symptom of DIND and showed poor response to 3- H therapy. Major symptoms of DIND in Group A were mild confusion (36.8%) and mild deterioration of mental state (26.3%), contrary to weakness of extremities (59.2%) in Group B. At discharge, Glasgow Outcome Scales (GOS) of Group A were: good recovery (63.2%), moderately disabled (21%), severely disabled (10.5%), dead (5.3%) and Group B : good recovery (48.1%), moderately disabled (37%), severely disabled (14.8%) and dead (0%). Of 121 patients from group A, 35 patients (28.9%) suffered ventriculitis. CONCLUSION: Continuous EVD after aneurysmal clipping in patients with SAH reduced the risk of DIND and its sequelae, relieved its symptoms, and improved the outcome.
Aneurysm* ; Aneurysm, Ruptured ; Drainage* ; Extremities ; Humans ; Neurologic Manifestations* ; Subarachnoid Hemorrhage* ; Ventriculostomy ; Weights and Measures