A case of a ruptured aneurysm originating at the proximal portion of the left posterior inferior cerebellar artery and an arteriovenous malformation in the left cerebellar hemisphere fed by the same artery is reported. The coincidental occurrence of these two vascular anomalies within the posterior fossa is uncommon. Aneurysms of the posterior inferior cerebellar artery require special consideration during surgical planning and operation because of the proximity of the posterior inferior cerebellar artery to the brain stem and to the origin of the lower cranial nerves. In our reported case, the aeurysm was located 2.7mm from the midline and 4.7mm from the clivus when measured radiometrically. The operation was carried out with the patient in a three quarter prone position through a left lateral suboccipital approach. Clipping of the neck of the aneurysm and total removal of the arteriovenous malformation were performed successfully in a one-stage operation.
Aneurysm* ; Aneurysm, Ruptured ; Arteries* ; Arteriovenous Malformations* ; Brain Stem ; Cranial Fossa, Posterior ; Cranial Nerves ; Humans ; Intracranial Aneurysm ; Neck ; Prone Position

Our experience of surgical management of 20 adrenal tumors was present during the period from June, 1988 to May, 1993. The results of clinical study were as follows ; 1. Average age of patients was 40.9 years with the highest incidence in sixth decade occupying 40% and male to female ratio was 1:1 and right to left ratio was equal also. 2. The adrenal tumors consist of 8 adrenocortical adenoma( including 3 primary aldosteronisms and 1 Cushing syndrome), 4 adrenocortical carcinoma(including 1 Cushing syndrome), 7 pheochromocytomas and l neuroblastoma. 3. The 11 functioning adrenal tumors( including 4 adrenocortical adenomas, 1 adrenocortica1 carcinoma and 6 pheochromocytomas) showed specific symptoms and signs and the majority symptom and sign of the 9 non-functioning adrenal tumors( including 4 adrenocortical adenomas, 3 adrenocortical carcinomas, 1 neuroblastoma and 1 pheochromocytoma) showed abdominal discomfort and pain. 4. For initial diagnosis of the adrenal tumors, USG, CT, MRI and angiography are reliable but IVP was reliable in large adrenal tumor 5. The surgical approaches were transperitoneal in 18 patients and retroperitoneal in 2 patients and postoperative surgical complication occurred in 3 patients of transperitoneal approaches that were prolonged ileus, spleen injury and pancreatic injury with pleural effusion.6. The tumor masses were 12gm to 4,000gm in weight (mean: 616gm). The adrenal benign and malignant tumor were significantly different in weight ( 120gm : 1817gm).
Adrenocortical Adenoma ; Adrenocortical Carcinoma ; Angiography ; Diagnosis ; Female ; Humans ; Ileus ; Incidence ; Magnetic Resonance Imaging ; Male ; Neuroblastoma ; Pheochromocytoma ; Spleen

Sphenoid sinus mucoceles represent 1% of all paranasal sinus mucoceles. Patients with a sphenoid sinus mucocele often experience only ophthalmic symptoms such as visual impairment, diplopia and external ophthalmoplegia. The ophthalmic symptoms seem to be caused mainly by compression or inflammatory changes. CT scan and MRI help in the correct assessment of this lesion. We have experienced a rare case of optic neuropathy caused by sphenoid sinus mucocele which is likely to misdiagnose to optic neuritis. The mucocele was managed successfully by endoscopic marsupialization. We report this case with a review of related literature.
Diplopia ; Endoscopy ; Humans ; Magnetic Resonance Imaging ; Mucocele* ; Ophthalmoplegia ; Optic Nerve Diseases* ; Optic Neuritis ; Sphenoid Sinus* ; Tomography, X-Ray Computed ; Vision Disorders

Hemangiopericytoma was first described by Stout & Murray in 1942 and was an uncommon soft tissue tumor thought to be derived from vascular pericytes. Approximately 10-15% of the cases occur in children have a propensity to develop in the region of head, neck and lower extremities. We experienced a case of congenital hemangiopericytoma of small bowel in a male neonate who showed vomiting and abdorninal distension. We reported a case of congenital hemangiopericytoma of small bowel with brief review of related literature.
Child ; Head ; Hemangiopericytoma* ; Humans ; Infant, Newborn ; Intestinal Obstruction* ; Intestine, Small ; Lower Extremity ; Male ; Neck ; Pericytes ; Vomiting

p53 is a tumor suppressor gene product identified in a wide range of tumor including colorectal carcinoma. Genetic alterations in the p53 tumor suppressor gene are common in human colorectal carcinoma. bcl-2 is a protooncogene that inhibits apoptosis. The products of mutant p53 gene and bcl-2 have been associated with prognosis in several malignancies including colorectal carcinomas. This study was undertaken to evaluate values of p53 and bcl-2 oncoproteins as prognostic factors relative to clinicopathological factors and correlation of their expression. Analyses were made on achieval pathologic tissues of 80 patients with colorectal carcinomas including 34 patients able to follow-up over 5 years. The oncoproteins were localized using commercially available monoclonal antibodies:DO-7 for p53, clone124 for bcl-2. Expression of bcl-2 was cytoplasmic, whereas nuclear p53 expression was localized in carcinoma cells. The patients were 17 to 83 years of age. The expression of p53 and bcl-2 was determined respectively in 30 (37.5%) and 21 (26.3%)cases. The expression of p53 nuclear expression was not correlated with tumor location, size, histologic grade, Duke's classification, regional lymph node metastasis and tumor recurrence. The cytoplasmic expression of bcl-2 was not correlated with tumor location, size, histologic grade, Duke's classification, regional lymph node metastasis and recurrence. Univariate analysis showed that patients with p53 nuclear expression were not associated with poorer overall survival than patients with p53 negative, and also showed in patients with bcl-2 expression. The expression of p53 did not affect to that of bcl-2. We concluded that the p53 nuclear and bcl-2 cytoplasmic expression were not independent prognostic factors in colorectal carcinomas. Evidence of reciprocity of bcl-2 and p53 expression was not found.
Apoptosis ; Classification ; Colorectal Neoplasms* ; Cytoplasm ; Follow-Up Studies ; Genes, p53 ; Genes, Tumor Suppressor ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Oncogene Proteins ; Prognosis ; Recurrence

No abstract available.
Decompression* ; Follow-Up Studies* ; Spine* ; Titanium*

BACKGROUND: There is growing interest in the anesthetic approach using total intravenous anesthesia (TIVA) with propofol and remifentanil for the prevention of postoperative nausea and vomiting (PONV). The aim of this study was to compare between the two anesthetic techniques for preventing PONV in the patients undergoing mastoidectomy with tympanoplasty. METHODS: After obtaining informed consent, 62 patients aged between 20 to 60 years undergoing elective mastoidectomy and tympanoplasty were randomized into two equal study groups: group P/R (n = 31) included patients undergoing TIVA with propofol and remifentanil, and group S/R (n = 31) included patients undergoing balanced anesthesia with sevoflurane and remifentanil. The incidences of PONV and complete response (no PONV, no rescue) were assessed at 1 and 24 h after surgery, using the Rhodes Index. Also, the usage of rescue antiemetics and pain intensity were recorded. RESULTS: The Rhodes Index including the occurrence score, distress score and experience score was significantly lower in the P/R group compared to that in the S/R group during the study period (P < 0.05), and the incidence of complete response was significantly higher in the P/R group compared to that in the S/R group, during the first 24 h after surgery. 4 patients in the S/R group requested antiemetics during the first 1 h after surgery. There were no significant differences in pain intensity among groups. CONCLUSIONS: Compared to balanced anesthesia with sevoflurane and remifentanil, TIVA with propofol and remifentanil was followed by significantly lower incidence and severity of PONV.
Aged ; Anesthesia ; Anesthesia, Intravenous ; Antiemetics ; Balanced Anesthesia ; Humans ; Incidence ; Informed Consent ; Methyl Ethers ; Piperidines ; Postoperative Nausea and Vomiting ; Propofol ; Tympanoplasty

BACKGROUND: The injection pain of microemulsion propofol is frequent and difficult to prevent. This study examined the prevention of pain during microemulsion propofol injection by pretreatment with different doses of remifentanil or saline, and premixing of lidocaine. METHODS: One hundred sixty ASA physical status 1-2 adult patients scheduled for elective surgery were enrolled into one of four groups (n = 40, in each). The patients received saline (group LS), remifentanil 0.3 microg/kg (group LR 0.3), remifentanil 0.5 microg/kg (group LR 0.5), or remifentanil 1.0 microg/kg (group LR 1.0), and after 90 seconds received an injection of 2 mg/kg microemulsion propofol premixed with lidocaine 40 mg. Pain was assessed on a four-point scale during microemulsion propofol injection. RESULTS: The incidence of microemulsion propofol-induced pain was significantly lower in the LR 0.3, LR 0.5 and LR 1.0 groups than in the LS group (37.5%, 12.5% and 10% vs 65%, respectively). The LR 0.5 and LR 1.0 groups showed significantly less frequent and intense pain than the LR 0.3 group. However, both incidence and severity of pain were not different between LR 0.5 and LR 1.0 groups. CONCLUSIONS: The combination of remifentanil and lidocaine is effective in alleviating pain associated with a microemulsion propofol injection compared with just lidocaine. Remifentanil 0.5 microg/kg had a similar analgesic effect compared to the 1.0 microg/kg dose.
Adult ; Humans ; Incidence ; Lidocaine ; Piperidines ; Propofol

A 2-year-old girl had 2-month history of both secretory otitis media . Nine weeks after the first visit, physical examination revealed a whitish mass behind the intact right tympanic membrane. A CT study showed absence of the right foramen spinosum. The right ICA had an aberrant course running laterally in the middle ear cavity with ossesous canal. The soft tissue density in the normal location of the tympanic segment of facial nerve was markedly enlarged. A diagnosis of aberrant ICA and persistent stapedial artery was made. Vascular mass in the middle ear space are very uncommon. They continue to present a diagnostic problem, as the clinical symptoms and signs are often nonspecific and require radiological investigation to distinguish between glomus tumors, other vascular tumors, a dehiscent jugular bulb and an aberrant internal carotid artery. In approximately one per cent of the population, a dehiscent ICA canal is present and can result in the passing of an aberrant ICA through the middle ear space. The persistent stapedial artery is a rare congenital vascular anomaly that may present as a pulsatile middle ear mass or that may appear as an incidental finding. It is important for the otologist to be aware of this anomaly, as a misdiagnosis can have catastrophic consequences.
Arteries* ; Carotid Artery, Internal* ; Child, Preschool ; Diagnosis ; Diagnostic Errors ; Ear, Middle ; Facial Nerve ; Female ; Glomus Tumor ; Humans ; Incidental Findings ; Otitis Media with Effusion ; Physical Examination ; Running ; Tympanic Membrane

Fifty-two patients with unstable cervical spine injuries underwent operations between January 1, 1990 to June 30, 1997 in our institution and this is retrospective study on clinical results about these patients. Patients with cervical instability resulted from injury posterior column, being included in White's criteria, were treated with Hafifax interlaminar clamps for cervical instability. We followed up forty-two cases for more than one year. All of the forty- two cervical fixations showed immediate and long term stability and there were no neurological complication. Neu rologic improvements were seen in thirty three, but thirteen cases were unchanged. These results indicate that Halifax interlaminar clamps are consider to be a safe and effective method for posterior stabilization of va rious causes of cervical spine instability.
Humans ; Retrospective Studies ; Spine*