OBJECTIVE: The objective of this study is to investigate clinical characteristics, management methods and possible causes of intracranial fusiform aneurysm. METHODS: Out of a series of 2,458 intracranial aneurysms treated surgically or endovascularly, 22 patients were identified who had discrete fusiform aneurysms. Clinical presentations, locations, treatment methods and possible causes of these aneurysms were analyzed. RESULTS: Ten patients of fusiform aneurysm were presented with hemorrhage, 5 patients with dizziness with/without headache, 4 with ischemic neurologic deficit, and 1 with 6th nerve palsy from mass effect of aneurysm. Two aneurysms were discovered incidentally. Seventeen aneurysms were located in the anterior circulation, other five in the posterior circulation. The most frequent site of fusiform aneurysm was a middle cerebral artery. The aneurysms were treated with clip, and/or wrapping in 7, resection with/without extracranial-intracranial (EC-IC) bypass in 6, proximal occlusion with coils with/without EC-IC bypass in 5, EC-IC bypass only in 1 and conservative treatment in 3 patient. We obtained good outcome in 20 out of 22 patients. The possible causes of fusiform aneurysms were regard as dissection in 16, atherosclerosis in 4 and collagen disease or uncertain in 2 cases. CONCLUSION: There is a subset of cerebral aneurysms with discrete fusiform morphology. Although the dissection or injury of internal elastic lamina of the cerebral vessel is proposed as the underlying cause for most of fusiform aneurysm, more study about pathogenesis of these lesions is required.
Abducens Nerve Diseases ; Aneurysm ; Atherosclerosis ; Collagen Diseases ; Dizziness ; Glycosaminoglycans ; Headache ; Hemorrhage ; Humans ; Intracranial Aneurysm ; Middle Cerebral Artery ; Neurologic Manifestations

OBJECTIVE: The purpose of this study was to report the morbidity, mortality, angiographic results, and merits of elective coiling of unruptured intracranial aneurysms. METHODS: Ninety-six unruptured aneurysms in 92 patients were electively treated with detachable coils. Eighty-one of these aneurysms were located in the anterior circulation, and 15 were located in the posterior circulation. Thirty-six aneurysms were treated in the presence of previously ruptured aneurysms that had already undergone operation. Nine unruptured aneurysms presented with symptoms of mass effect. The remaining 51 aneurysms were incidentally discovered in patients with other cerebral diseases and in individuals undergoing routine health maintenance. Angiographic and clinical outcomes and procedure-related complications were analyzed. RESULTS: Eight procedure-related untoward events (8.3%) occurred during surgery or within procedure-related hospitalization, including thromboembolism, sac perforation, and coil migration. Permanent procedural morbidity was 2.2% ; there was no mortality. Complete occlusion was achieved in 73 (76%) aneurysms, neck remnant occlusion in 18 (18.7%) aneurysms, and incomplete occlusion in five (5.2%) aneurysms. Recanalization occurred in 8 (15.4%) of 52 coiled aneurysms that were available for follow-up conventional angiography or magnetic resonance angiography over a mean period of 13.3 months. No ruptures occurred during the follow-up period (12-79 months). CONCLUSION: Endovascular coil surgery for patients with unruptured intracranial aneurysms is characterized by low procedural mortality and morbidity and has advantages in patients with poor general health, cerebral infarction, posterior circulation aneurysms, aneurysms of the proximal internal cerebral artery, and unruptured aneurysms associated with ruptured aneurysm. For the management of unruptured aneurysms, endovascular coil surgery is considered an attractive alterative option.
Aneurysm ; Aneurysm, Ruptured ; Angiography ; Cerebral Arteries ; Cerebral Infarction ; Follow-Up Studies ; Hospitalization ; Humans ; Intracranial Aneurysm ; Magnetic Resonance Angiography ; Neck ; Rupture ; Thromboembolism

Fibromuscular dysplasia (FMD) is a rare, segmental nonatheromatous angiopathy of unknown etiology affecting small to medium-sized arteries. The most common angiographic pattern is the classic string-of-beads appearance. But the tubular stenosis type of the FMD is a rare finding and has not been reported previously. We report a case who presented with recurrent intracerebral hemorrhages, whose angiographic features were long tubular stenosis type of FMD affecting the both internal carotid arteries associated with terminal carotid occlusions.
Arteries ; Carotid Artery, Internal ; Cerebral Hemorrhage* ; Constriction, Pathologic ; Fibromuscular Dysplasia*

Methyl bromide is presently used as a fumigant for insects in soil, grains or fruit in storage or transport. It is a neurotoxic agent and has been responsible a number of deaths or acute poisonings among occupationally exposed persons. We report 2 patients, who had worked fumigation warehouse, presented with seizures and altered mental state. The serum concentrations of bromide were elevated 32.9 and 42.5 mg/l, respectively. Brain MRI showed bilateral symmetric high signal intensities in the splenium of corpus callosum, the globus pallidus, the quadrigeminal plate, the periaqueductal gray matter, the red nucleus, the substantia nigra, the medial lemniscus, the pontine tegmentum, the dentate nucleus, and the medulla. There was no brain lesion in the other patient. Appropriate and supervised handling of the chemical and regular education to workers are important to avoid the risk of methyl bromide poisoning.
Brain ; Edible Grain ; Cerebellar Nuclei ; Corpus Callosum ; Education ; Fruit ; Fumigation ; Globus Pallidus ; Humans ; Insects ; Magnetic Resonance Imaging ; Occupations ; Periaqueductal Gray ; Poisoning ; Red Nucleus ; Seizures* ; Soil ; Substantia Nigra ; Tectum Mesencephali

OBJECTIVE: T(-)-Epigallocatechin gallate(EGCG) `a green tea polyphenol' is a potent antioxidant and known to reduce the free radical-induced lipid peroxidation. In our previous study, systemic administration of EGCG immediately after ischemia has been shown to inhibit the hippocampal neuronal damage in the gerbil model of global ischemia. Polyamines, especially putrescine(PU) is thought to be important in the generation of brain edema and neuronal cell damage associated with various types of excitotoxic neuronal injury. We investigate the effects of delayed administration of EGCG on the changes in polyamine levels and neuronal damage after transient global ischemia in gerbils. METHODS: To produce transient global ischemia, both common carotid arteries were occluded for 3 min with micro-clips. The gerbils were treated with EGCG(50mg/kg, i.p.) immediately or 2hr after ischemia. Putrescine levels were examined in the cerebral cortex and hippocampus 24 hours after ischemia using high performance liquid chromatography. RESULTS: PU levels in the cerebral cortex and hippocampus were increased significantly after the ischemia. The administrations of EGCG immediately after the ischemia attenuated the ischemia-induced increase of PU level, however, 2 hr delayed EGCG administration did not reduce the increase of PU level. EGCG administered immediately or 2 hr after ischemia significantly reduced neuronal damage in the hippocampal CA1 region, respectively. CONCLUSION: These findings suggest that EGCG may has a promise in the management of stroke.
Brain Edema ; CA1 Region, Hippocampal ; Carotid Artery, Common ; Cerebral Cortex ; Chromatography, Liquid ; Gerbillinae* ; Hippocampus ; Ischemia* ; Lipid Peroxidation ; Neurons* ; Polyamines ; Putrescine* ; Stroke ; Tea*

BACKGROUND: Glioblastomas are one of the most common and aggressive malignant glial tumors occuring in the central nervous system. This study analyzed the status of p15INK4b, p14ARF, p16INK4a, MTAP, IFNA, and IFNB genes in 36 primary glioblastomas to investigate whether the inactivation of these genes participate in primary glioblastoma tumorigenesis. METHODS: We used polymerase chain reaction, polymerase chain reaction/single strand conformational polymorphism (PCR/SSCP) analysis, and methylation-specific PCR. RESULTS: Homozygous deletions at the p16INK4a gene were detected in 11 cases (30.5%) of 36 primary glioblastomas, and the promoter hypermethylation was found in 3 cases (8.3%) of 36 primary glioblastomas. In mutational analysis for the p16INK4a gene by PCR/SSCP, there was no abnormal mobility-shifted band in 36 cases of primary glioblastomas. The overall frequency of p16INK4a alterations including homozygous deletion and promoter hypermethylation in 36 primary glioblastomas was 38.8% (14 of 36). Deletions of p15INK4b were noted in 4 cases (11.1%), whereas deletions of the p14ARF and MTAP genes were detected in 1 case of 36 cases of primary glioblastomas. But deletions of the INFA and B genes were not found. CONCLUSIONS: These results suggest that alterations of the p16INK4a gene can be important mechanisms of the tumorigenesis of primary glioblastomas, and the p16INK4a gene is inactivated by mechanisms including homozygous deletion and promoter hypermethylation.
Brain Neoplasms ; Carcinogenesis ; Central Nervous System ; Genes, p16 ; Glioblastoma* ; Humans ; Polymerase Chain Reaction ; Tumor Suppressor Protein p14ARF

Few patients with traumatic aortic laceration remain undiagnosed and survive long enough to develop a chronic aneurysm. Such aneurysms are frequently asymptomatic: alternatively, they may manifest chest pain, dysphagia, bronchial irritation, or sudden death. A case of aortobronchial fistula secondary to a chronic post-traumatic aneurysm of the aortic isthmus is presented. Hemoptysis was the main sign. The affected segment of the thoracic aorta was repaired with a Hemashield patch and a left upper lobectomy was performed.
Aneurysm ; Aorta, Thoracic ; Chest Pain ; Death, Sudden ; Deglutition Disorders ; Fistula* ; Hemoptysis ; Humans ; Lacerations ; Thorax*

OBJECTIVES: This study was designed to examine whether melatonin has a neuroprotective effect against hippocampal neuronal damage following transient global ischemia in a gerbil. Polyamine is known to play a role in the pathophysiology of ischemic neuronal damage, we evaluated the influences of melatonin on the polyamine level as well as histology. MATERIAL AND METHODS: Male Mongolian gerbils (60-80 g) were used in this study. Transient global ischemia was induced by occlusion of the bilateral common carotid arteries for 3 min with microclips. Melatonin was administered immediately after occlusion. The animals were decapitated 24 h after the occlusion for polyamine measurement by a high performance liquid chromatography (HPLC) and 4 days after the occlusion for histological evaluation (hematoxylin and eosin staining). A histological examination was performed by a blinded investigator. RESULTS: The hippocampal putrescine level increased compared to sham-operated animals and the increase of putrescine was attenuated by 20 mg/kg melatonin administration. Spermidine and spermine levels didn't show significant changes after ischemia. Hippocampal neuronal damage in the CA1 region was markedly observed in vehicle-treated animals compared to sham-operated animals. Melatonin administration (10 or 20 mg/kg) significantly inhibited hippocampal CA1 neuronal damage after ischemia compared to corresponding vehicle-treated animals (p<0.05 and p<0.01, respectively). CONCLUSION: Melatonin attenuates the putrescine level after transient global ischemia and may have putative neuroprotective effects against global ischemia induced neuronal damage.
Animals ; Brain* ; Carotid Artery, Common ; Chromatography, Liquid ; Eosine Yellowish-(YS) ; Gerbillinae* ; Hippocampus ; Humans ; Ischemia* ; Male ; Melatonin* ; Neurons* ; Neuroprotective Agents ; Putrescine ; Research Personnel ; Spermidine ; Spermine

Boerhaave's syndrome has the worst prognosis of the esophageal perforation, despite the advancement in the treatment of esophageal perforation due to the development of ICU care and antibiotics. There were controversies in the treatment of esophageal perforation when diagnosed after 24hrs. From 1995 to 2000, we performed a buttressed primary repair and mediastinal drainage in 6 Boerhaave's syndrome patients among 13 esophageal perforation patients. Two patients died(33%). They died because of pneumonia, ARDS and sepsis on 38th, 39th post-operative day respectively. Two patients had leak at the site of repair which was treated completely with conservative treatment. We report on the result of a buttressed primary repair and mediastinal drainage for 6 Boerhavve's syndrome patients.
Anti-Bacterial Agents ; Drainage ; Esophageal Perforation ; Esophagoplasty ; Humans ; Pneumonia ; Prognosis ; Sepsis

Instrumentation for periodontal therapy may induce marginal damage which increases plaque accumulation and result in periodontal disease. But there have not been many reports of instrumentations on the artificial crown so far. Therefore this study is conducted to evaluate the effects of various repeated instrumentations on the porcelain crown marginal portion. Of the 10 extracted periodontally diseased maxillary first premolars, were 12 proximal surface used in this study. The finishing line of the preparation was placed on the root surface below CEJ and then the crown was cast and cemented in usual manner. Every 4 surfaces of the 3 instruments-curet, ultrasonic scaler, and ultrasonic curet- is used. and four samples used in each instruments. The relevant procedures and measurements were repeated 3 times in each surfaces. Marginal gap is measured by the microscope and surface roughness, Scannig Probe Microscope. Measurements are made at 5 points in each surfaces, making 20 points in each instrument. The results evaluated statistically were as follows 1. As instrumentation was repeated, both marginal gap and roughness were increased in all group 2. In the hand curet, marginal gap was increased every instrumentation and roughness was increased after second. 3. In the ultrasonic scaler, both marginal gap and roughness were increased every instrumentation. 4. In the ultrasonic curet, marginal gap was increased after third instrumentation and roughness was increased after second. 5. Marginal gap and roughness used by the ultrasonic curet were lower than the others and no difference was seen between the hand curet and ultrasonic scaler From the results of this study, the ultrasonic curet was useful in some aspect, but careful instrumentation was needed. Furthermore it was important to minimize the instrumentation through complete periodontal therapy before setting and adequate plaque control.
Bicuspid ; Crowns* ; Dental Porcelain* ; Hand ; Periodontal Diseases ; Tooth Cervix ; Ultrasonics