BACKGROUND: McKeown first described two autopsy cases of esophageal small cell carcinoma (SMC) in 1952; about 230 cases have since been reported in the literature. Small cell carcinoma has been reported to account for 0.4% to 7.6% of all esophageal malignancies. SMC of the esophagus as regarded as having a poor prognosis with frequent systemic dissemination. Choice of treatment remains controversial. MATERIAL AND METHOD: From August 1987 to December 1998, a review of the records and histologic sections of 8 patients with primary small cell carcinoma of the esophagus seen in 11 years was undertaken. RESULT: Small cell carcinoma of the esophagus constituted 1.5% of all esophageal cancers. The median age was 61.5 years (range from 42 to 71 years). Seven patients were male, tumor was mainly located in the middle and lower thirds (6 cases) of the esophagus. Pure SMC is 5 cases, and mixed SMC is 3 cases. Operative procedure were as follow: transthoracic esophagectomy with thoracic or cervical reconstructon in 7 patients, transhiated esophagectomy with cervical reconstruction in one. The operative death was none. Adjuvant chemotherapy was performed in 7 patients except one who had poor general condition. Recurrence was observed in 4 patients (mediastinal LN, abdominal LN, SCN, bone). The overall median survival was 15.9 months. Only one patient survived for more than 5 years. CONCLUSION: We considered that esophageal SMC should be regarded as a systemic disease, and multimodality treatment including chemotherapy should be used. Surgery may be offered in selected patients to manage local disease as part of a chemotherapy based treatment program.
Autopsy ; Carcinoma, Small Cell* ; Chemotherapy, Adjuvant ; Drug Therapy ; Esophageal Neoplasms ; Esophagectomy ; Esophagus* ; Humans ; Male ; Prognosis ; Recurrence ; Surgical Procedures, Operative

The case of 17-year-old boy is presented, in whom back pain progressed to paraplegia. A spinal epidural hematoma was removed at surgery with complete recovery. No traumatic or febrile episode was obtainable. The importance of early diagnosis and early spinal decompression is stressed.
Adolescent ; Back Pain ; Decompression ; Early Diagnosis ; Hematoma, Epidural, Spinal* ; Humans ; Male ; Paraplegia

Gastrobronchial fistula is an extremely rare condition. It is usually associated with trauma, esophagogastric surgery, subphrenic abscess, gastric ulcer, and neoplasm. A case of recurrent gastrobronchial fistula secondary to a benign gastric ulcer 2 and 3 years after Ivor Lewis procedure for treatment of esophageal carcinoma is described. The literature of this subject is reviewed and discussed.
Bronchial Fistula ; Esophageal Neoplasms ; Esophagectomy* ; Fistula* ; Postoperative Complications ; Stomach Ulcer ; Subphrenic Abscess

Aneurogenic pulmonary edema(NPE) following an aneurysmal subarachnoid hemorrhage(SAH) is a rare but devastating complication. The authors analyzed the clinical characteristics, therapeutic problems and management results from our cases in order to throughly evaluate for future therapeutic guide for such patients. There were seven patients diagnosed as NPE out of 546 patients who were admitted within one day following a SAH(1.3%) during the past 13 years. They were relatively young(average 51.3 years), had poor clinical grades on admission and had large amount of SAH. Hypotension and hypoxia on admission were also characteristics. Good results were obtained in 4 of the 7 patients by rapid correction of hypoxia and hypotension with intubation, mechanical ventilation and with positive end-expiratory pressure, diuretics and hypertensive drugs. We conclude that NPE following SAH may be triggered by an acute rise in intracranial pressure followed by a simultaneous decrease of the function of the heart and lungs. Although the patients had shown fulminant clinical state on admission, we recommend aggressive management of these patients because some of these patients can recover without neurological deficits by an aggressive treatment.
Aneurysm* ; Anoxia ; Diuretics ; Heart ; Humans ; Hypotension ; Intracranial Aneurysm ; Intracranial Pressure ; Intubation ; Lung ; Positive-Pressure Respiration ; Pulmonary Edema* ; Respiration, Artificial ; Subarachnoid Hemorrhage*

A 61-year-old woman with a left cavernous sinus dural arteriovenous fistula presented with left 6th nerve palsy. Initial brain MRI showed findings consistent with left-sided pontine infarction. Follow-up MRIs revealed an enlarged pontine lesion, and additional lesions in the right hippocampus, both basal ganglia and centrum semiovale mimicking a brain tumor or a demyelinating disease. We suggest that the MRI lesions are venous congestions caused by the shunting of blood flow from the left carotid artery into the venous system. (J Korean Neurol Assoc 19(5):520~525, 2001)
Abducens Nerve Diseases ; Basal Ganglia ; Brain ; Brain Neoplasms ; Carotid Arteries ; Cavernous Sinus* ; Central Nervous System Vascular Malformations* ; Cerebrum* ; Demyelinating Diseases ; Estrogens, Conjugated (USP) ; Female ; Follow-Up Studies ; Hippocampus ; Humans ; Hyperemia* ; Infarction ; Magnetic Resonance Imaging ; Middle Aged ; Pons*

Cell cultures of adults bovine retinal pigment epithelium(RPE) were propagated from central and peripheral regions of the same eyes to study the topographical differences in cell growth and to compare the differences in growth rate between two areas. The results obtained were as follows: A regional variation in the morpholgy was observed between the RPE from central and that from peripheral regions. Retinal pigment epithelium from central region attached to culture dish more slowly(average 4 days) than those from peripheral region(average 3.5 days) The growth rate of retinal pigment epithelium declined with serial passage in culture. The growth rate of retinal pigment epithelium from peripheral region at the first generation was highest. And there was a statistical difference in growth rate with passing in generation(P<0.05). This study reveals that growth rate and cell activity of RPE from central region are lower than from peripheral region.
Adult ; Cell Culture Techniques ; Humans ; Macular Degeneration ; Retinal Pigment Epithelium* ; Retinaldehyde* ; Serial Passage

In order to find out the effect of blood glucose on the ischemic brain injury, the authors studied the relationship between the blood glucose level and the infarct volume in a focal cerebral ischemia-reperfusion model in a series of 60 adult rats. The experimental animals were divided into 4 groups of 15 rats: rats in group I were allowed free access to food until ischemic insults: rats in group II were fasted for 24 hours prior to ischemic insult: rats in group III were fed but received intraperitoneal injection of 1.7unit/kg of insulin 50 minutes before the onset of ischemia: and rats in group IV were fed and received intraperitoneal injection of 2g/kg of 50% glucose during ischemia. The ischemia was made through unilateral occlusion of the middle cerebral artery(MCA) by inserting a 16mm length of 4-0 nylon surgical thread through the internal carotid artery as well as occlusion of both common carotid arteries(CCA) using nontraumatic aneurysm clips. Reperfusion was induced by pulling the thread that occluded the MCA as well as removing the aneurysm clips from both of the CCAs. Each group was further divided into a(2 hour), b(4 hour), and c(6 hour) subgroups of 5 rats according to the duration of ischemia. All animal were killed 3 hours after reperfusion, and infarct volume determined by triphenyltetrazolium chloride was calculated by a computer image software. The results showed that rats of glucose loaded during ischemia(group IV) developed the highest blood glucose levels during ischemia and post-ischemia and the largest infarct volume among groups. The rats which were fed until ischemic insult(group I) developed higher blood glucose levels and larger infarct volume than those developed in group II and III. The rats of group III developed higher blood glucose levels and larger infarct volume than group II. According to our data, lowering the blood glucose level by fasting or intraperitoneal injection of insulin reduced the infarct volme in model of transient focal cerebral ischemia. These results suggest that maintenance of low level of blood glucose during early phase of cerebral infarction may reduce volume of infarction and neurological sequelae.
Adult ; Aneurysm ; Animals ; Blood Glucose* ; Brain Injuries ; Brain Ischemia ; Carotid Artery, Internal ; Cerebral Infarction ; Fasting ; Glucose ; Humans ; Infarction ; Injections, Intraperitoneal ; Insulin ; Ischemia ; Ischemic Attack, Transient* ; Nylons ; Rats* ; Reperfusion

OBJECTIVE: This study was undertaken to investigate the clinical and computerized tomographic(CT) features between the false negative aneurysms, in which the cerebral aneurysms missed by the initial angiography and false positive aneurysms, in which aneurysms were not existed at surgery in spite of the aneurysm suggested by the cerebral angiography, and to verify the causes of false negative and positive aneurysms. METHODS: The differences of the clinical and CT characteristics between false negative and positive aneurysmal patients, and the sites of aneurysm in false negative aneurysmal patients and suspicious sites of aneurysms in false positive aneurysmal patients, and the main causes of cerebral aneurysms missed by initial angiography and false aneurysmal findings in cerebral angiography were investigated. RESULTS: There were 36 false negative aneurysmal patients and 14 false positive aneurysmal patients in our series. The clinical grades and amount of subarachnoid hemorrhage(SAH) in false negative aneurysmal patients were more severe than those of false positive non-aneurysmal patients. The most frequent false negative and positive aneurysmal sites were anterior communicating(Acom) arteries. All missing aneurysmal site due to incomplete study was posterior inferior cerebellar artery. The main causes for missing aneurysm in angiography were aneurysmal thrombosis with or without small size of aneurysmal neck, overlapping vessels and small size of aneurysm itself. The main causes of false aneurysmal findings in cerebral angiography were junctional dilatation of posterior communicating artery(Pcom), dilatation of perforators origin and focal atherosclerotic dilatation of cerebral main vessels. All cases who had SAH in the perimesencephalic cistern were false positive non-aneurysmal patients. In some cases of A2 aneurysm showed more severe SAH in the basal cistern than that in the anterior interhemispheric fissure. CONCLUSION: The repeat-angiography should be performed for all cases of unexplained SAH, especially for poor clinical grade patients with thick SAH and cases with incomplete visualization of all vascular trees. Surgery should be decided more carefully for patients with perimesencephalic basal cistern SAH who show Pcom artery aneurysm by cerebral angiography. We also stress that some of A2 aneurysms may show inconsistent sites of SAH from the origin of aneurysm.
Aneurysm* ; Aneurysm, False ; Angiography ; Arteries ; Cerebral Angiography ; Dilatation ; Humans ; Intracranial Aneurysm ; Neck ; Subarachnoid Hemorrhage ; Thrombosis

PURPOSE: To identify the clinical and electroencephalographic factors which are independently predictive of a postoperative seizure-free outcome for 4 years. We compared the outcomes of the first 2 years with the subsequent 2 years one after anterior temporal lobectomy (ATL) for mesial temporal lobe epilepsy (MTLE) with unilateral hippocampal atrophy (HA) on MRI. METHODS: We studied 51 consecutive operated patients who had above 4 years of follow-up and had MTLE with definite unilateral HA on MRI. The surgical outcome was classified as either seizure-free or not seizure-free in the first postoperative 2 years and the subsequent 2 years. Several clinical variables were included. The scalp EEG parameters included the lateralization of interictal epileptiform discharges, ictal onset location, ictal onset frequency, ictal EEG lateralization, and ictal scalp EEG propagation (bitemporal asynchrony or switch of lateralization). Variable factors were subjected to univariate analysis. RESULTS: Overall, 36 patients (71%) became seizure-free during the postoperative 4 years. On univariate analysis, only one factor was significantly associated with poor outcome (p<0.05): ictal scalp EEG propagation pattern such as bitemporal asynchrony or switch of lateralization. The seizure-free outcome was seen in 88.9% of patients without bitemporal asynchroncy, or switch of lateralization while only 54.5% of patients with those patterns (p=0.007) during the postoperative third and fourth year. However, those propagation patterns did not show the prognostic value during the first 2 years (p=0.449). Other variable factors were found not to be predictive of prognosis on early or late recurrence. CONCLUSIONS: Bitemporal asynchrony or a switch of lateralization in the ictal scalp EEG might be a highly predictive factor for an undesirable surgical outcome, late recurrence of seizure during a follow-up period after ATL, and probably an index of bitemporal epileptogenicity in MTLE.
Anterior Temporal Lobectomy ; Atrophy* ; Electroencephalography ; Epilepsy, Temporal Lobe* ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging* ; Prognosis ; Recurrence ; Scalp ; Seizures ; Temporal Lobe*

BACKGROUND: The origin site of carcinoma invading esophagogastric junction is variable. It may arise from squamous cell carcinoma of low esophagus, adenocarcinoma arising from Barrett's esophagus, adenocarcinoma of gastric cardia, or extension from proximal stomach cancer. In Korea, the majority of adenocarcinoma invading esophago-gastric junction seems to arise from proximal gastric carcinoma. MATERIAL AND METHOD: We reviewed the data of surgically-resected gastric adenocarcinoma involving esophagogastric junction in KCCH between 1988 and 1999. RESULT: There were 212 cases. Male to female ratio was 156 to 56. Age distribution was between 22 and 78. Variable surgical approaches including median laparotomy, laparotomy with left or right thoracotomy, left thoracotomy, and thoracoabdominal approach were used. Postoperative pathologic stages were : Stage IA-7, IB-11, II-25, IIIA-73, IIIB-34, and IV-57. Curative resection was performed in 199 patients, and total gastrectomy was performed in 200 patients. There were 77.4%(164 cases) with esophageal involvement, 74.1%(157 cases) with tumor involvement in the abdominal LN, and 8%(17 cases) with mediastinal LN metastasis. Operative mortality was 3.3%, and over-all 5 year survival rate was 35%. CONCLUSION: There are various surgical approaches and many things to consider for surgical resection, thoracic and abdominal approach may need for obtain proper resection margin and adequate lymph node dissection in stomach cancer invading esophagogastric junction.
Adenocarcinoma ; Age Distribution ; Barrett Esophagus ; Carcinoma, Squamous Cell ; Cardia ; Esophagogastric Junction* ; Esophagus ; Female ; Gastrectomy ; Humans ; Korea ; Laparotomy ; Lymph Node Excision ; Male ; Mortality ; Neoplasm Metastasis ; Stomach Neoplasms* ; Stomach* ; Survival Rate ; Thoracotomy