Congenital hypertrophic pyloric stenosis is the most common intra-abdominal disease required surgery during the first few months of life. The expression of pyloric stenosis is dependent upon the genetic influence of ancestors affected with the disease, as well as unknown environmental influences in the postnatal period. Pyloric stenosis has been reported in multiple sibs in a family, which suggests the genetic influence on the expression of this disease. Until now, the genetic influence is thought a sex-modified polygenic or multifactorial background which facilitates the expression of a common dominant gene. We experienced a case of congenital hypertrophic pyloric stenosis in a two siblings. The siblings suffered projectile vomiting for 2~4 days at 16 days old of age and 15 days old of age. After we confirmed the diagnosis by upper gastrointestinal series and abdominal sonogram, the Fredet-Ramstedt pyloromyotomy was done successfully. This case suggests the genetic influence on the expression of this disease.
Diagnosis ; Genes, Dominant ; Humans ; Pyloric Stenosis ; Pyloric Stenosis, Hypertrophic* ; Siblings* ; Vomiting

The current paper reports on a case of subdural empyema secondary to frontal sinusitis in an otherwise healthy child. Sinusitis is a common and benign condition in most pediatric cases. Because of the widespread use of antibiotics, intracranial extension of pediatric sinusitis is rarely seen today; however, complications (e.g., cavernous sinus thrombosis, orbital infection, meningitis, and subdural empyema) are potentially life threatening. A 15-year-old right-handed male presented with a 3-day history of fever, headache, and left-sided palsy. Computed tomography revealed right-sided subdural empyema with right frontal sinusitis and maxillary sinusitis. A postoperative inpatient neurological consultation was requested 2 months post-surgery due to motor function deficits. The results suggested that early and accurate diagnosis of subdural empyema leads to prompt treatment and a favorable outcome for the patient.
Adolescent ; Anti-Bacterial Agents ; Brain Abscess ; Cavernous Sinus Thrombosis ; Central Nervous System ; Child* ; Diagnosis ; Empyema, Subdural* ; Fever ; Frontal Sinus ; Frontal Sinusitis ; Headache ; Humans ; Inpatients ; Male ; Maxillary Sinus ; Maxillary Sinusitis ; Meningitis ; Orbit ; Paralysis ; Sinusitis*

A simple technique for transpedicular screw fixation of L5 is presented. This percutaneous screwing allows up-and-in screw placement without excessive lateral stretching and lessens the length of incision.
Spine*

A simple technique for transpedicular screw fixation of L5 is presented. This percutaneous screwing allows up-and-in screw placement without excessive lateral stretching and lessens the length of incision.
Spine*

OBJECTIVE: The lack of anatomical knowledge for the anterior cervical microforaminotomy is liable to injure the neurovascular structures. The surgical anatomy is examined with special attention to the ventral aspect exposed in anterior cervical microforaminotomy. METHODS: In 16 adult formalin fixed cadaveric cervical spine, the author measured the distances from the medical margin of the longus colli to the medical wall of the ipsilateral vertebral artery and the angle for the ipsilateral vertebral artery. The distances from the lateral margin of the posterior longitudinal ligament to the medial margin of the ipsilateral medial wall of the vertebral artery, to the ipsilateral dorsal root ganglion was measured too. RESULTS: The distance from the medial margin of the longus colli to the ipsilateral vertebral artery was 13.3~14.7mm and the angle for the ipsilateral vertebral artery was 41~42.5 degrees. The range of distance from the lateral margin of the posterior longitudinal ligament to the ipsilateral vertebral artery was 11.9~16.1mm, to the ipsilateral dorsal root ganglion was 11.6~12.9mm. CONCLUSION: These data will aid in reducing neurovascular injury during anterior cervical approaches.
Adult ; Cadaver ; Formaldehyde ; Ganglia, Spinal ; Humans ; Longitudinal Ligaments ; Spine ; Vertebral Artery

Cytogenetic techniques were used to detect specific chromosomal losses and / or stuctural changes in 6 meningioma cell population of 11meningioma patients. Polymorphic DNA markers were uti.lized to investigate the loss of constitutional heterozygosity on chromosomes 8. 17 and 22 in 9 meningioma cell population of 1l meningioma patients. As a result, 5 cases(M-2.4,5.9, and 10) represented 45. XX. -22 or 45, XY.-22 as stem line. In addition to chromosome 22, other chromosomes were lost randomly. In one case(M-3) normal karyotypic pattern was oberved. The 9q+ structural change was also noted in case M-2. This structural change was thought to be the chromosomal involvement secondary to the loss of chromosome 22 in meningioma. Retentions of constitutional heterozygosity on chromosomes 8 and 17 were found in all cases. Loss of constitutional hererozygosity on chromosome 22 were found at Hind m RFLP of v-sis in cases M-1 and M-7. EcoRI RFLP of v-sis in case M-1. Bgl II RFLP of v-sis case M-1. Xba I RFLP of v-sis in cases M-6. M-9 and M-11. And EcoRI RFLP of bcr in all cases. Rearrangement of chromosome 22 in case M-1 was detected on the Xba I RFLP of v-sis as extra band(3.14kb). The reduction to hemizygosity on chromosome 22 was one important step in tumorigenesis of meningioma. Monosomy 22 might operate at the primary level of tumor initiation. Random losses of other chromosomes or structural changes as 9q+ were postula!ed to be related to tumor development.
Carcinogenesis ; Chromosomes, Human, Pair 22 ; Cytogenetic Analysis ; Cytogenetics* ; Genetic Markers ; Humans* ; Meningioma* ; Monosomy ; Polymorphism, Restriction Fragment Length

OBJECTIVE: We report six patients with traumatic intracerebellar hematomas between 1997 and 2003 at our hospitals. METHODS: Each data about patients' clinicoradiologic findings, management, and outcomes, which were retrospectively reviewed. RESULTS: All patients had skull fracture on occiput and five patients with large hematomas(three cm or greater) were operated on. In the results of surgery, three patients were good outcome but two patients were fatal due to compression of brain stem. One patient with small hematoma (1.5cm) was treated conservatively and recovered. CONCLUSION: In our cases, the clinical course and prognosis of traumatic intracerebellar hematoma were grave. The results of this study support that early diagnosis based on strict observation in patients with occipital fracture will lead to best results.
Brain Stem ; Craniocerebral Trauma ; Early Diagnosis ; Hematoma* ; Humans ; Prognosis ; Retrospective Studies ; Skull Fractures

Traditional anterior interbody fusion with autograft has limitations such as graft collapse, graft extrusion, pseudoarthrosis, and donor site morbidity. A short hospital stay and reduced donor site complications can be achieved by using synthetic graft materials such as Biocompatible Orthopaedic Polymer(BOP). A retrospective study to evaluate bone graft was carried out in a series of 111 patients in whom interbody fusions were performed for cervical spondylosis and cervical spine injury using anterior(modified Trans-Unco-Discal) approach with autogenous ilium or BOP between January 1988 and December 1994 at our hospital. The radiological assessments were made between postoperative and follow-up x-ray findings, and the postoperative clinical results and complications were statistically analyzed. The major results were as follows: 1) Clinical results of spondylotic patients were graded excellent in 57%, good in 32% and fair in 11% in ilium group, and excellent 65%, good 25%, fair 5% and poor 5% in BOP group. Clinical results patients with cervical injury were graded excellent in 25%, good in 25%, fair in 25% and poor in 25% in ilium group, and excellent 29%, good 21%, fair 29% and poor 21% in BOP group. As to graft materials, there were no statistically significant difference in clinical results(p=0.76, p=0.75). 2) Mean height of graft bone were 13.0mm in ilium group and 10.0mm in BOP group at postoperative x-ray findings, and 11.6mm in ilium group and 6.1mm in BOP group at follow-up x-ray findings. Incidence where the height of graft bone at follow-up x-ray findings was less than 80% of immediately postoperative height were 7% in ilium group and 58% in BOP group, and there was a statistically significant difference(p<0.05). BOP sank into the adjacent end plate as compared to ilium. 3) Mean duration of period required for fusion was about 40 days in ilium group and 132 days in BOP group with a statistically significant difference (p<0.01). 4) The rate of complications related to bone graft was 16% in ilium group and 30% in BOP group. Incidence of complications was higher in BOP than ilium group, but there was no statistically significant difference(p=0.28). According to the above results, clinical results were not significantly different between both graft materials, but ilium was superior to BOP as a good spacer with maintenance of height of graft bone and good bony fusion.
Autografts ; Follow-Up Studies ; Humans ; Ilium* ; Incidence ; Length of Stay ; Pseudarthrosis ; Retrospective Studies ; Spine* ; Spondylosis ; Tissue Donors ; Transplants*

The presence of multiple, diverse primary brain tumors is infrequent in patients without phakomatosis. We wish to report two cases of multiple primary brain tumors. The first case, a 38-year-old female, suffered from headache, bilateral hearing loss for about 6 years prior to hospitalization. Camputed tomography scan demonstrated multiple well enhanced masses in the right frontal convexity, falx and both cerebellopontine angles. These lesions were removed successfully in 3 successive operations. Histologically the tumors were diagnosed as afibroblastic meningiomas and a acoustic neurinoma. Although none of the cutaneous stigmata of von Reck1inghausen's disease has been observed in her and any member of her family, we cant's exclude this case that belongs in the central form of neurofibromatosis. The 2nd case, a 71-year-old male, suffered from frontal headache with confusion for about 7 days prior to hospitalization. Computed tomography scan demonstrated a ring enhanced mass with surrounding edema in the left frontal lobe. The left frontal osteoplastic craniotomy was performed, a small mass with the dura attached could be found incidentally, and this small mass and the ring enhanced tumor in the frontal deep portion were grossly totally removed. Histologically the two tumors were dIagnosed as a menigotheliomatous meningioma and a malignant astrocytoma.
Adult ; Aged ; Astrocytoma ; Brain Neoplasms ; Brain* ; Cerebellopontine Angle ; Christianity ; Craniotomy ; Edema ; Female ; Frontal Lobe ; Headache ; Hearing Loss ; Hospitalization ; Humans ; Male ; Meningioma ; Neurilemmoma ; Neurocutaneous Syndromes ; Neurofibromatoses ; Neurofibromatosis 2 ; Neuroma, Acoustic

OBJECTIVE: Chronic hydrocephalus is one of the major complications following aneurysmal subarachnoid hemorrhage(SAH). However the incidence and predicting factors requiring shunting after SAH is not precisely known. The authors investigated the incidence of chronic hydrocephalus, timing of shunting procedure, and factors to predict the need for shunting in patients with aneurysmal SAH. PATIENTS AND METHODS: A series of 209 patients admitted to our institute from January 1993 to December 1997, who presented with SAH and underwent craniotomy for aneurysm clipping were studied retrospectively. Chronic hydrocephalus was defined as clinically and radiographically demonstrated hydrocephalus that lasted 2 weeks or longer after initial hemorrhage and that required shunting. The author divided study group into shunt group(SG, n=20) and non-shunt group(NSG, n=189). Patients were evaluated based on following factors: age, sex, history of hypertension and diabetes mellitus, consciousness at admission, Hunt-Hess grade, the presence of intracranial hemorrhage, Graeb's score, bifrontal index(BFI), Fisher grade, amount of SAH, location of aneurysm, time of aneurysm clipping, rebleeding, and vasospasm. RESULTS: The incidence of chronic hydrocephalus was 9.6%(20/209). The timing of the shunting procedure ranged from 16 days to 150 days after initial hemorrhage with the average being 77(+/-37)days. In a univariate analysis with chi-square test, age, consciousness, Hunt-Hess grade, amount of SAH, BFI, Fisher grade, and Graeb's score were significantly related with the need for shunting(p<0.05). In a multivariate logistic regression analysis, odds ratio was calculated for each variables. If the odds ratio of below 60 year of age was 1.0 then that of above 61 was 5.4(p<0.001). If the odds ratio of alert/drowsy was 1.0 then that of stupor/coma was 4.4(p<0.05). If the odds ratio of 0 of Graeb's score was 1.0 then that of 1-10 was 4.3(p<0.05). If the odds ratio of amount of SAH below score 3 was 1.0 then that of above score 4 was 1.8. If the odds ratio of BFI below 30 was 1.0 then that of above 31 was 1.1. CONCLUSION: The development of chronic hydrocephalus after aneurysmal SAH is multifactorial, but should be strongly suspected in patients with older age, decreased level of consciousness or IVH at admission. The patients require a shunt from 2 weeks to 5 months from the time of their initial hemorrhage.
Aneurysm* ; Consciousness ; Craniotomy ; Diabetes Mellitus ; Hemorrhage ; Humans ; Hydrocephalus ; Hypertension ; Incidence ; Intracranial Hemorrhages ; Logistic Models* ; Odds Ratio ; Retrospective Studies ; Subarachnoid Hemorrhage*