No abstract available.

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

It has recently become possible to record electrical activity originationg from abnormally conducting myocardium from the body surface with high-gain amplification and averaging technique. These signals, which result from delayed ventricular activation(late potentials), have been recorded in patients with documented ventricular tachyarrythmia. Several electrode lead system for detecting ventricular late potential were introduced. Pyramidal electrode lead system(PLS) is useful. Also interpretation of SAECG in the young could be of value in detecting those at risk for episodic ventricular tachycardia, but suffer from a lack of data in normal young people. There was no difference between normal values, determined by FLS and PLS at high pass filtering of 25 Hz and 80 Hz, but significant, difference was found in HFLAD and RMS-40 of 40 Hz (p<0.05). These results will provide a basis for interpretations of SAECG, determined by FLS and PLS in healthy young adults with normal QRS duration. SELECTION OF SUBJECTS: For this study, normal healthy young adult volunteers (age : mean 24 years) were recruited from the medical students at Yeungnam University Hospital, Internal Medicine. Twenty fourths male and seventeenths female subjects were selected. All subjects had normal resting ECGs as judged from both the standard 12 channel lead and echocardiography, and none had a history of cardiovascular disease. All subjects were considered to be in good general physical condition. SIGNAL-AVERAGED ELECTROCARDIOGRAPHY: In order to obtain low noise recordings with a small number of averaging cycles, all subject ware asked to relax completely in the supine position. Silver/silver chloride electrodes were attached after the skin was cleaned with alcohol, to constitute classic flank lead system(FLS) and pyramidal lead system(PLS). Signals were recorded and processed using a commercially available microprocessor-augmented ECG cart(Marquette Electronics, USA) suitable for portable bedside recording.
Cardiovascular Diseases ; Echocardiography ; Electrocardiography* ; Electrodes ; Female ; Humans ; Internal Medicine ; Male ; Myocardium ; Noise ; Patient Selection ; Reference Values ; Skin ; Students, Medical ; Supine Position ; Tachycardia, Ventricular ; Volunteers ; Young Adult*

Aneurysms arising from ICA bifucation are relatively rare. But they are paticulary difficult to treat surgically because of perforating arteries surrounding and adherent to the aneurysm. In an effort to determine their best management policy, and to improve their surgical outcome, a retrospective clinical analysis of 30 patients who underwent direct surgery from ICA bifucation aneurysm between January, 1984 and December, 1994 was performed. In the same period, total 990 patients with intracranial aneurysms were admitted in our department. The result of carotid bifucation aneurysm surgery was worse than the total surgical result. Motality and morbidity rates were 3/30(10%), 5/30(16%). Surgical complications in this group of aneurysms usually came from injury of perforating arteries, and the causes of death were intraoperative premature rupture and vasospasm. The surgical treatment of aneurysms of internal carotid bifucation is discussed, emphasizing the importance of avoiding damage to perforating vessels and premature rupture. A classification of these aneurysms, according to angiographic and anatomical considerations, is proposed. We suggest that four types of aneurysmal orientation at the bifucation of the internal carotid artery be distinguished:either projecting superiorly, anteriorly, inferiorly, or posteriorly. Posterior orientation was found in 13 cases(43.3%). Superior orientation was found in 11 cases(36.7%), inferior orientation was found in 4 cases(13.3%), and anterior orientation was found in 2 cases(6.7%). From an analysis of these cases and a review of the literature, some characteristics of these aneurysms and their surgical strategies are described.
Aneurysm* ; Arteries ; Carotid Artery, Internal ; Cause of Death ; Classification ; Humans ; Intracranial Aneurysm ; Retrospective Studies ; Rupture

The tumorous type of endobronchial tuberculosis was reported to be 5 to 10% in the bronchoscopic examination. It was protruding mass that tuberculous mediastinal lymph node ruptured into the bronchial lumen. Generally histologic examination has been performed for purpose of differentiation, because the tumorous type of endobronchial tuberculosis simulate lung cancer in bronchoscopic finding. A case considering operation similar to bronchial adenoma in the bronchoscopic finding was confirmed to endobronchial tuberculosis by positive AFB and disapperance of mass after antituberculosis medication. Case history was presented and reviewed.
Adenoma* ; Bronchoscopy ; Lung Neoplasms ; Lymph Nodes ; Tuberculosis*

We describe a case of brain abscess which developed in a 64-year-old man after hepatic artery chemoem-bolization(HACE) for hepatocellular carcinoma(HCC).On his first admission, percutaneous liver biopsy led to a diagnosis of type-C liver cirrhosis, he readmitted 5 years later and HCC was diagnosed. The patient underwent two HACE procedures, with a two-month interval. Three month later, he was readmitted to hospital with headache and brief loss of consciousness; brain magnetic resonance imaging(MRI) revealed a brain abscess. Stereotactic aspiration was performed and antibiotics sensitive to the klebsiella pneumonia bacteria cultured in the abscess were administrated intraveously. One month later, the abscess size became smaller and the patient was discharged. This report reviews the literature and discusses the pathogenesis of brain abscess after intra-arterial embolization.
Abscess ; Anti-Bacterial Agents ; Bacteria ; Biopsy ; Brain Abscess* ; Brain* ; Carcinoma, Hepatocellular* ; Diagnosis ; Headache ; Hepatic Artery* ; Humans ; Klebsiella ; Liver ; Liver Cirrhosis ; Middle Aged ; Pneumonia ; Unconsciousness

A free-floating ball thrombus in the left atrium is a rare complication of the mitral valvular disease. A 53-year-old man was admitted for pain and paresthesia on both legs. On admission he had auscultatory sign of mitral stenosis and mitral regurgitation, and the roentgenogram of his chest revealed a slight pulmonary ve..ous congestion, enlargement of the pulmonary conus and cardiomegaly. Laboratory findings including complete blood counts, coagulation studies and blood chemistry were normal. An echocardiographic examination revealed a mitral stenosis and a free-floating ball thrombus in the left atrium. We performed the emergent open heart surgery for removal of the ball thrombus and mitral replacement successfuly with Duromedics 29 mm valve. The size of thrombus was 39 X 32 X 30 mm.
Blood Cell Count ; Cardiomegaly ; Chemistry ; Conus Snail ; Echocardiography ; Estrogens, Conjugated (USP) ; Heart Atria ; Humans ; Leg ; Middle Aged ; Mitral Valve Insufficiency ; Mitral Valve Stenosis* ; Paresthesia ; Thoracic Surgery ; Thorax ; Thrombosis*

OBJECTIVE: The authors tried to reveal some unique features of lipomeningomyelocele (LMMC), including clinical presentation, factors precipitating onset of symptoms, pathologic entities of LMMC associated with tethered cord syndrome, and surgical outcome in LMMC patients. METHODS: Seventy-five patients with LMMC were enrolled in this study. Neuro-imaging and intraoperative findings allowed classification of LMMC into three Types. The patients were divided into two groups by age : A (51 patients), from birth to 3 years, and B (24 patients), from 3 to 24 years. For prevention of retethering of the cord, a mega-dural sac rebuilding procedure was performed in 15 patients. RESULTS: During a mean postoperative follow-up period of 4 years, the surgical outcome was satisfactory in terms of improved pain and motor weakness, but disappointing with reference to the resolution of bowel and bladder dysfunction. Among these 75 patients with LMMC, preoperative deficits were improved after surgery in 29 (39%), remained stable in 28 (37%), changed slightly in 13 (17%), and worsened in 5 (7%). Patients in group A achieved better outcomes than those in group B. Depending on the type of lesion, patients with types I and II LMMC have better outcomes than those with type III LMMC. Finally, retethering of the cord with neurological deterioration occurred in 4 (5.3%) of the 75 patients, but no retethering was found in the 15 patients who were recently treated with a mega-dural sac rebuilding procedure. CONCLUSION: Our data continue to support the opinion that early diagnosis and optimal surgery are still essential for the treatment of patients with LMMC, since there is a high likelihood of residual neurological functions that can be preserved. Based on our surgical experience of untethering and decompression of lipomas, a mega-dural sac repair is useful to prevent retethering of the cord.
Classification ; Decompression ; Early Diagnosis ; Follow-Up Studies ; Humans ; Lipoma ; Neural Tube Defects* ; Parturition ; Urinary Bladder

The staged decompression(posterior and anterior) of foramen magnum was performed in the patient with Chiari I malformation associated with basilar invagination. Three years prior to admission, the patient was admitted due to ataxia and dysmetria. After the posterior decompression of foramen magnum, the patient's cerebellar sign improved significantly. But spastic gait disturbace was noted two years later. We performed a transoral anterior decompression to relieve brain stem compression, and an occipitocervical fusion with contoured rod to prevent possible instability. Following the operation, the spasticity improved. The authors believe this sets the successful staged decompression of Chiari I malformation associated with basilar invagination.
Ataxia ; Brain Stem ; Cerebellar Ataxia ; Decompression* ; Foramen Magnum ; Gait Disorders, Neurologic ; Humans ; Muscle Spasticity

OBJECTIVE: The incidence of leptomeningeal dissemination from malignant glioma is rare, so the clinical features of this are not well documented yet. We attempted to determine the clinical features of leptomeningeal dissemination from malignant gliomas. METHODS: We retrospectively analyzed 11 cases of leptomeningeal dissemination of malignant glioma, who were treated at our institution between 2006 and 2009. We investigated the clinical features of these patients by considering the following factors : tumor locations, the events of ventricular opening during surgery and the cerebrospinal fluid (CSF) profiles, including the cytology. RESULTS: The group was composed of 9 males and 2 females. The histological diagnosis of their initial intracranial tumors were 4 primary glioblastoma, 3 anaplastic astrocytoma, 1 anaplastic oligoastrocytoma, 2 ganglioglioma and 1 pleomorphic xanthoastrocyotma with anaplastic features. The mean age of the patients at the time of the initial presentation was 42.8+/-10.3 years. The mean time between surgery and the diagnosis of spinal dissemination was 12.3+/-7.9 (3-28) months. The mean overall survival after dissemination was 2.7+/-1.3 months. All our patients revealed a history of surgical opening of the ventricles. Elevated protein in the CSF was reported for eight patients who had their CSF profiles checked. CONCLUSION: We propose that in the malignant gliomas, the surgical opening of ventricles can cause the spinal leptomeningeal dissemination and the elevated protein content of CSF may be a candidate marker of leptomeningeal dissemination.
Astrocytoma ; Female ; Ganglioglioma ; Glioblastoma ; Glioma ; Humans ; Incidence ; Male ; Retrospective Studies