Craniosynostosis has a varied clinical spectrum, ranging from isolated single suture involvement to multi-sutural fusions. Greater understanding of the pathogenesis of craniosynostosis has led to the development of practical treatment protocols. Three stages of growth have determined the approach to managing craniosynostosis : the early period, up to 12 months; the intermediate period, from 1 to 10 years; and the late period, beginning at 10 years. This review discusses current surgical management and future perspectives in craniosynostosis.
Clinical Protocols ; Craniosynostoses* ; Neurosurgery ; Sutures

We report a cace of 69-year-old man who developed massive pulmonary hemorrhage and subsuquent adult respiratory distress syndrome following intravenous urokinase for acute myocardial infarction. Pulmonary hemorrhage is a rare but a potentially life-threatening complication after thrombolytic therapy and should be considered in the differential diagnosis of pulmonary infiltrates of falling hemoglobin after thrombolytic therapy for acute myocardial infarction with no obvious site of bleeding.
Adult* ; Aged ; Diagnosis, Differential ; Hemorrhage* ; Humans ; Myocardial Infarction* ; Respiratory Distress Syndrome, Adult* ; Thrombolytic Therapy* ; Urokinase-Type Plasminogen Activator

Purpose: To evaluate changes in central macular thickness (CMT) and subfoveal choroidal thickness (SFCT) after phacovitrectomy over a 2-year period in idiopathic epiretinal membrane (ERM) patients. Methods: The records of 52 idiopathic ERM patients (52 eyes) who underwent phacovitrectomy, without recurrence of the condition over a 2-year follow-up period, were reviewed retrospectively. Changes in CMT and SFCT, as measured by optical coherence tomography, were analyzed and compared with those of a normal control group over a 2-year period. Results: The mean preoperative CMT and SFCT were 425.67 ± 84.67 and 257.56 ± 90.13 μm, respectively. Postoperative CMT was reduced significantly to 372.17 ± 45.26 μm at 1 year and 363.15 ± 47.35 μm at 2 years (p < 0.001). SFCT at 1 and 2 years postoperatively was significantly reduced to 238.85 ± 84.85 and 230.31 ± 87.95 μm, respectively (p < 0.001). In the control group, there was no significant change in CMT; however, the SFCT decreased by 11.09 ± 22.36 μm during the 2-year follow-up (p = 0.007). In contrast, in the patient group, CMT and SFCT decreased by 62.52 ± 71.45 and 27.25 ± 41.97 μm, respectively, showing a significant difference from the control group (p < 0.001 and p = 0.043, respectively). Both before surgery and at 1 year postoperatively, the thinner the CMT, the better the best-corrected visual acuity (BCVA) (p = 0.010 and p = 0.018, respectively). A better postoperative BCVA at 2 years was associated with a thinner CMT and better BCVA before surgery (p < 0.001 and p < 0.001, respectively). Conclusions Following a phacovitrectomy procedure, ERM patients showed significant reductions in both the CMT and SFCT at the 2-year follow-up.

OBJECTIVE: The model of focal ischemia that involves occlusion of middle cerebral artery(MCA) is one of the most commonly used methods in the rat, which can be considered to be equivalent to a focal cerebral infarction in man. Infarction size is often used as the standard to assess potential therapeutic regimens in models of focal cerebral infarction. In practice, scientists have estimated infarction volume by a variety of methods. One of the fundamental problems in measuring infarction volume is the enlargement of infarcted tissue by edema. To minimize the error of overestimation that may be caused by edema, several methods have been proposed. METHOD:The author assessed the antiischemic effect of a competitive N-methyl-D-aspartate(NMDA) antagonist, D-(E)-4-(3-phosphonoprop-2-enyl) piperazine-2carboxylic acid(D-CPPene) in MCA occlusion model in the rat. Four different morphometric analysis were used to measure infarction volume a real measurement, the Swanson's method designed to minimize the error of overestimation, a measurement using a diagram, percentage method (infarction volume divided by the volume of ipsilateral hemisphere), which were to elucidate the effects of each method upon measuring the infarction volume regarding the possible influence of edema. The animals were sacrificed 24 hours after MCA occlusion and the amount of ischemic brain damage was assessed by 8 predetermined coronal planes. RESULT: Post-occlusion treatment of D-CPPene which was initiated 15 minutes after MCA occlusion, produced reduction of infarction volume to about 40% compared to the control(p<0.05). The volume of infarction determined by a real measurement was much larger than that by the Swanson's or diagram method(p<0.05), about 70% larger in the control and 2 times larger in the treated group. However, there was no significant difference in the measured volume between the Swanson's and diagram methods. The protection rate which was obtained by subtracting the infarction volume of the treated from that of the control, was larger by the Swanson's and diagram method than by a real measurement and percentage method. CONCLUSION: These results demonstrate that a competitive NMDA antagonist, D-CPPene which was administered 15 minutes after post-occlusion, has a significant neuroprotective effect on ischemic brain damage in focal cerebral infarction. But it appears to have no specific protective effect on ischemic brain edema. The overestimation of infarction volume at the peak time of brain edema could be substantially reduced by not only the Swanson's method but also the diagram method.
Animals ; Brain Edema* ; Brain* ; Cerebral Infarction* ; Edema ; Infarction ; Ischemia ; N-Methylaspartate ; Neuroprotective Agents ; Rats*

PURPOSE: To evaluate tumor-specific immunity and define the mechanisms involved in the cryoimmunologic response, we compared the tumor control efficacy and immunologic responses of cryoablation with those of surgical excision in a tumor rechallenge model. MATERIALS AND METHODS: Sixty BALB/c mice with RENCA tumors that were generated in the left flank area underwent cryoablation or radical excision. The mice successfully treated were rechallenged with RENCA or an undifferentiated colon carcinoma cell line, CT26, in the contralateral right flank area. The recurrence rate after tumor rechallenge in each group was then observed. To assess the immunologic response of each treatment modality, fluorescent-activated cell sorting (FACS) analysis and a cytotoxicity assay using 51Cr release were performed. RESULTS: After reinoculation of the RENCA cells, the rate of tumor growth was significantly higher in the surgical excision group than in the cryoablation group (94.4% vs. 11.1%, p=0.001). In the cryoablation group, the tumor growth rate was significantly increased after rechallenge of CT26 cells compared with RENCA (94.1% vs. 11.1%, p=0.001). The cryoablation group showed an elevated CD3, CD4, CD8 T, and natural killer cell count in the FACS analysis and also showed significantly increased cytotoxicity in the 51Cr release assay compared with the excision group. CONCLUSIONS: These results showed that cryoablation, compared to surgical resection, was more effective in preventing tumor growth after rechallenge with RENCA cells and that this response was tumor-specific, because the CT26 cells did not have the same effect.
Animals ; CD4-Positive T-Lymphocytes/immunology ; CD8-Positive T-Lymphocytes/immunology ; Carcinoma, Renal Cell/*immunology/pathology/*surgery ; Cell Death ; Cryosurgery/*methods ; Cytotoxicity, Immunologic ; Disease Models, Animal ; Kidney Neoplasms/*immunology/pathology/*surgery ; Lymphocyte Count ; Lymphocytes, Tumor-Infiltrating/immunology ; Mice, Inbred BALB C ; Neoplasm Recurrence, Local/immunology ; Neoplasm Transplantation

Previous studies reported that oxaliplatin is associated with sinusoidal obstruction syndrome. However few reports on oxaliplatin induced liver fibrosis are found in the literature. Furthermore pathogenesis of liver fibrosis is not well known. We report a case of 45-yr-old Korean man in whom liver fibrosis with splenomegaly developed after 12 cycles of oxaliplatin based adjuvant chemotherapy for colon cancer (T4N2M0). Thorough history taking and serological examination revealed no evidence of chronic liver disease. Restaging CT scans demonstrated a good response to chemotherapy. Five month after chemotherapy, he underwent right hepatectomy due to isolated metastatic lesion. The liver parenchyma showed diffuse sinusoidal dilatation and centrilobular vein fibrosis with necrosis without steatosis. We could conclude that splenomegaly was due to perisinusoidal liver fibrosis and liver cell necrosis induced portal hypertension by oxaliplatin. In addition, to investigate the pathogenesis of liver fibrosis, immunohistochemical stains such as CD31 and alpha-smooth muscle actin (alpha-SMA) were conducted with control group. The immunohistochemical stains for CD31 and alpha-SMA were positive along the sinusoidal space in the patient, while negative in the control group. Chemotherapy with oxaliplatin induces liver fibrosis which should be kept in mind as a serious complication.
Actins/metabolism ; Antigens, CD31/metabolism ; Antineoplastic Combined Chemotherapy Protocols/*therapeutic use ; Camptothecin/*analogs & derivatives/therapeutic use ; Chemotherapy, Adjuvant ; Colonic Neoplasms/*drug therapy ; Fluorouracil/therapeutic use ; Humans ; Hypertension, Portal/etiology ; Immunohistochemistry ; Leucovorin/therapeutic use ; Liver Cirrhosis/*diagnosis/etiology/pathology ; Liver Neoplasms/secondary/surgery ; Male ; Middle Aged ; Organoplatinum Compounds/*administration & dosage/adverse effects/therapeutic use ; Splenomegaly/*diagnosis/etiology ; Thrombocytopenia/etiology ; Tomography, X-Ray Computed

OBJECTIVE: The adolescent presentation of tethered cord syndrome (TCS) is well-recognized, but continues to pose significant diagnostic and management controversies. The authors conducted a retrospective study of clinical outcomes after surgical intervention in 24 school-aged children, adolescents, and young adults with TCS. METHODS: All 83 patients with a lipomyelomeningocele (LMMC) underwent untethering surgery for caudal cord tethering between 1987 and 2007. The clinical charts and follow-up data were reviewed. Of these patients, 24 school-aged children, adolescents, and young adults with TCS were studied with respect to the clinical, radiologic, pathologic features, and surgical outcomes. RESULTS: Untethering procedures were performed in 24 patients (age range, 7-25 years) for TCS of various origins (lipoma, lipomyelomeningocele, and tight filum terminale). Specific circumstances involving additional tugging of the already tight conus, and direct trauma to the back precipitated the onset of symptom in 50% of the patients. Diffuse and non-dermatomal leg pain, often referred to the anorectal region, was the most common presenting symptom. Progressive sensorimotor deficits in the lower extremities, as well as bladder and bowel dysfunction, were also common findings, but progressive foot and spinal deformities were noted less frequently. The most common tethered lesions were intradural lipomas, thickened filum and fibrous band adhesions into the placode sac. The surgical outcome was gratifying in relation to pain and motor weakness, but disappointing with respect to resolution of bowel and bladder dysfunction. Of the 24 patients with TCS, pre-operative deficits improved after surgery in 14 (58.3%), remained stable in 8 (33.4%), and worsened in 2 (8.3%). CONCLUSION: The pathologic lesions of tethered cord syndrome in school-aged children, adolescents, and young adults, are mostly intradural lipomas and tight filum. It is suggested that the degree of cord traction results in neurologic dysfunction in late life due to abnormal tension, aggravated by trauma or repeated tugging of the conus during exercise. Early diagnosis and adequate surgical release might be the keys to the successful outcome in school-aged children, adolescents, and young adults with TCS.
Adolescent ; Child ; Congenital Abnormalities ; Conus Snail ; Early Diagnosis ; Follow-Up Studies ; Foot ; Humans ; Leg ; Lipoma ; Lower Extremity ; Meningomyelocele ; Neural Tube Defects ; Neurologic Manifestations ; Retrospective Studies ; Traction ; Urinary Bladder ; Young Adult

We report a case of tuberous sclerosis associated with two histologically different renal cell carcinomas (RCCs) and multiple angiomyolipomas (AMLs) in the same kidney. A 43-year-old female was admitted to our hospital with left flank pain and a huge palpable mass in the left flank area. Abdominal computed tomography revealed two concurrent RCCs and multiple AMLs in the left kidney. Because of the clinical suspicion of RCC, the patient underwent left radical nephrectomy. On gross examination, the total size of the resected left kidney was 30.5x17x8 cm. Microscopically, the upper pole tumor features were consistent with chromophobe RCC and the midpole tumor was a clear-cell RCC. The multifocal masses in the remaining remnant parenchyma were AMLs. Six months after surgery, the patient is healthy without signs of tumor recurrence.
Adult ; Angiomyolipoma ; Carcinoma, Renal Cell ; Female ; Flank Pain ; Humans ; Kidney ; Nephrectomy ; Recurrence ; Tuberous Sclerosis

PURPOSE: We previously described a new procedure specific module (Tube 3) to allow the practice of vesicourethral anastomosis after robot-assisted radical prostatectomy. Herein, we report a predetermined proficiency level of Tube 3 and preliminary validation to explore whether this new module can lead to performance improvement in the da Vinci system. MATERIALS AND METHODS: Eight urology residents and three urology fellows performed the Tube 3 module 1 hour daily for 7 days. The learning curve was depicted through a scatterplot and the stable point was identified through the cumulative sum chart. Concurrent and predictive validations were performed with the da Vinci system. The mean time to complete the task and end product rating score between Tube 3 training group and no Tube 3 training group were compared. RESULTS: Concerning the learning curve, about 41 repetitions comprising about 5 hours were needed to achieve this stable point when the mean time to complete Tube of 384 seconds was set as a target. With regarding to the concurrent and predictive validation, there significant differences were evident in the mean time to complete 16 needle passages and the vesicourethral anastomosis and the end product rating score. CONCLUSIONS: The virtual reality (VR) simulator can yield sufficient improvement in technical performance in Tube 3 within 5 hours. The acquired proficiency can be transferable to the vesicourethral anastomosis using the da Vinci system.
Anastomosis, Surgical/methods ; Clinical Competence ; Computer Simulation ; Education, Medical, Graduate/*methods ; Humans ; Learning Curve ; Male ; Prostatectomy/*education/methods ; Robotic Surgical Procedures/*education/methods ; Simulation Training/methods ; Urethra/surgery ; Urinary Bladder/surgery ; User-Computer Interface

PURPOSE: We evaluated the efficacy of parenchymal compression in open partial nephrectomies (OPNs) compared with that of the conventional vascular clamping method. MATERIALS AND METHODS: OPNs were conducted by means of the parenchymal compression technique at our institution from April 2006. Among these, the operative outcomes of 20 consecutive patients with normal preoperative renal function (Group 1) were matched with those of 20 control patients from the database of previous operations who underwent OPN with a conventional vascular clamping method (Group 2). RESULTS: All preoperative characteristics were similar in both groups. The operative time was significantly higher for Group 2 (132.4+/-17.7 vs. 151.4+/-21.4 minutes, p=0.031). Estimated blood loss was slightly higher for Group 2, with marginal statistical significance (173.7+/-11.5 vs. 211.2+/-43.8 ml, p=0.06). Histologic examination revealed that over 80% of the tumors in both groups were renal cell carcinomas. For all patients, the pathology results of specimens were negative. Serum creatinine, checked at 1, 3, and 7 days after the operation, was significantly increased in both groups to a similar degree. However, 30 days after surgery, the patterns of serial serum creatinine levels demonstrated statistically significant differences by repeated-measures ANOVA (p<0.001), with a trend of more elevated in Group 2 than in Group 1, although values were within the normal range. No major complications occurred in either group. CONCLUSIONS: OPN using the parenchymal compression method had acceptable outcomes in terms of complete tumor control, avoiding warm ischemic time, and minimizing blooding, with good preservation of renal function and minimal complications.
Carcinoma, Renal Cell ; Constriction ; Creatinine ; Humans ; Kidney Neoplasms ; Nephrectomy ; Operative Time ; Organ Preservation ; Reference Values ; Warm Ischemia