No abstract available.
Bacteria, Anaerobic*

OBJECTIVE: The aneurysm remnants rate was evaluated via three-dimensional digital subtraction angiography (3D-DSA) in the postoperative evaluation of clipped aneurysms. METHODS: Data on surgically clipped aneurysms of anterior circulation obtained via postoperative 3D-DSA from February 2007 to March 2009 were gathered. The results of the postoperative 3D-DSA and of two-dimensional digital subtraction angiography (2D-DSA) for the detection of aneurysm remnants were compared, and an investigation was performed as to why 2D-DSA had missed some aneurysm remnants that were detected in the 3D-DSA. Various surgical factors that revealed aneurysm remnants in the 3D-DSA were also evaluated. RESULTS: A total of 39 neck remnants of 202 clipped aneurysms (19.3%) were confirmed in 3D-DSA, and these were classified according to Sindou's classification of aneurysm remnants. Patients with only a neck remnant found in the 3D-DSA represented 17.3% (35/202 aneurysms) of the whole series, and those with a residuum of neck plus sac found in the 3D-DSA represented 1.9% (4/202 aneurysms). The causes of aneurysm remnants were no full visualization (14/39, 35.9%), parent and perforator artery protection (10/39, 25.6%), clip design problems (8/39, 20.5%), and broad-necked aneurysm (7/39, 17.9%). CONCLUSION: Patients with < or = 2 mm aneurysm remnants showed an increased risk of undetectable aneurysm remnants in the 2D-DSA. The most frequent location of the missed aneurysm in 2D-DSA was the anterior communicating artery. 3D-DSA showed more aneurysm remnants than what is indicated in the existing literature, the 2D-DSA.
Aneurysm ; Angiography, Digital Subtraction ; Arteries ; Humans ; Neck ; Parents

Choroid plexus papillomas (CPPs) are typically considered as benign tumors, with a favorable long-term prognosis. Drop metastasis of CPP into the spinal subarachnoid space is rare. We report a 42-year-old woman who presented with headache and back pain 6 years after removal of a posterior fossa CPP. Magnetic resonance imaging revealed mass lesions in the lumbosacral subarachnoid space and recurrent intracranial tumor. The lesions were resected and histologically diagnosed was CPP. We consider that CPP can spread via cerebrospinal fluid pathways and cause spinal drop metastasis. Therefore, it is necessary to evaluate the whole spinal axis and to perform periodic follow-up examinations in patients with CPP.
Adult ; Axis, Cervical Vertebra ; Back Pain ; Cerebrospinal Fluid ; Choroid Plexus* ; Choroid* ; Female ; Headache ; Humans ; Magnetic Resonance Imaging ; Neoplasm Metastasis* ; Papilloma, Choroid Plexus* ; Prognosis ; Subarachnoid Space

Discal cysts are a rare cause of lumbar radiculopathy. There are only a few reports of this disease in medical literature. The authors describe the case of a 40-year-old man with a lumbar discal cyst that led to radiculopathy. An intraspinal extradural cystic mass was responsible for low and high signal intensities observed in lumbar lesions on T1 and T2 weighted magnetic resonance images. This cyst was a grossly spherical mass with clear serous fluid, which was connected to an adjacent intervertebral disc. Histopathology of the cystic walls revealed fibrous connective tissues without specific cell linings. Clinical symptoms were promptly relieved after surgical resection. Further research on the pathophysiology and treatment of discal cysts are needed.
Adult ; Connective Tissue ; Humans ; Intervertebral Disc ; Intervertebral Disc Displacement ; Magnetic Resonance Spectroscopy ; Radiculopathy

Discal cysts are a rare cause of lumbar radiculopathy. There are only a few reports of this disease in medical literature. The authors describe the case of a 40-year-old man with a lumbar discal cyst that led to radiculopathy. An intraspinal extradural cystic mass was responsible for low and high signal intensities observed in lumbar lesions on T1 and T2 weighted magnetic resonance images. This cyst was a grossly spherical mass with clear serous fluid, which was connected to an adjacent intervertebral disc. Histopathology of the cystic walls revealed fibrous connective tissues without specific cell linings. Clinical symptoms were promptly relieved after surgical resection. Further research on the pathophysiology and treatment of discal cysts are needed.
Adult ; Connective Tissue ; Humans ; Intervertebral Disc ; Intervertebral Disc Displacement ; Magnetic Resonance Spectroscopy ; Radiculopathy

OBJECTIVE: Percutaneous endoscopic lumbar discectomy (PELD) and microdiscectomy with the microscope endoscopic tubular retractor system(METRx-MD) are considered popular minimally invasive surgery (MIS) methods for the treatment of lumbar disc herniation. Many authors have also reported good clinical outcomes of these methods, but there are few comparative studies of them. This report compares the clinical outcomes of PELD and METRx-MD for lumbar disc herniation as MIS methods and discusses the efficacy of PELD. METHODS: Seventy-two patients who had undergone single-level unilateral discectomy using two different methods, PELD and METRx-MD, between 2009 and 2011 were given a follow-up examination prospectively. Thirty-seven of these patients underwent discectomy using PELD, and the remaining 35 patients underwent discectomy using METRx-MD. In addition to the general parameters, clinical outcomes were assessed as specific parameters using the Visual Analogue Scale (VAS) score, the Oswestry Disability Index (ODI), the Short-form 36 (SF-36), and the return-to-work time. RESULTS: Sixty-seven percent (25/37) of the patients in the PELD group and 74%(26/35) in the METRx-MD group were included in follow-up more than 6 months post-operatively. The mean improvements in the VAS scores for the back pain, leg pain, and ODI were 2.6, 4.8, and 30.1% for the PELD group and 2.8, 4.6, and 33.2% for the METRx-MD group, respectively. The SF-36 physical health component subscale score improved from 40.6 pre-operatively to 68.3 at the last follow-up for the PELD group post-operatively, and from 48.5 to 65.1 in the mental component subscale (METRx-MD group: from 34.4 to 66.5 and from 44.87 to 56.7). Complications occurred in 3/37 patients in the PELD group and in 2/35 patients in the METRx-MD group in the peri-operative period. The mean return-to-work times were 37.5 days in the PELD group and 42.5 days in the METRx-MD group. CONCLUSION: The outcomes for the PELD group are comparable to those for the METRx-MD group. It can thus be concluded that PELD for lumbar disk herniations may be performed safely and effectively. Also, PELD can be considered one of the treatment modalities of lumbar disk herniation.
Back Pain ; Diskectomy ; Diskectomy, Percutaneous ; Follow-Up Studies ; Humans ; Leg ; Prospective Studies ; Return to Work

PURPOSE: To assess the location and associated findings of fractures of the posterior lumbar vertebral ring apophysis as seen on MRI. MATERIALS AND METHODS: We retrospectively evaluated MR findings in 77 patients (86 lesions) with lumbar apophyseal ring fractures. Their age ranged from ten to 67 (mean 33-1) years. To confirm the presence of verterbral ring fractures, CT was performed in 29 patients (31 lesions) within two weeks of MR imaging. Open laminectomy was performed in ten patients, percutaneous automated nucleotomy in three, and LASER operation in four. RESULTS: The most common location of fractures was the superior margin of L5 (36 lesions 41.9%), next was superior margin of S1 (21 lesions, 24.4%). On CT, a bony fragment was seen in 28 patients (30 lesions); the positive predictive value of MR was 99.7 %. Multiple lesions were seen in nine patients. Associated disc herniation and bulging were noted in 64 (74.4%) and 15 lesions (17.4%), respectively, and a high signal intensity rim aound the bony fragment on T1 weighted image was noted in 33 (38.4%). Other associated findings were spondylolysis in eight patients, retrolisthesis in five, and spondylolisthesis in three. Operative outcomes were variable. The results of open laminectomy were better than those of percutaneous automated laminectomy or LASER operation. CONCLUSION: In patients with lumbar apophyseal ring fractures, their exact location and associated findings could be evalvated by MRI, which was therefore useful in the planning of appropriate surgery.
Humans ; Laminectomy ; Lumbar Vertebrae* ; Magnetic Resonance Imaging* ; Retrospective Studies ; Spondylolisthesis ; Spondylolysis

PURPOSE: Peripheral adrenergic nervous system controls the penile erection and alpha adrenoceptors greatly outnumber beta adrenoceptors. It is known that adrenaline has a facilitatory effect but serotonin has an inhibitory effect on sexual drive centrally. But few about the effect of central alpha adrenergic drug to the release of serotonin centrally are known. Major adrenergic and serotoninergic innervation is found at the hippocampus. This study was performed to investigate the effect of alpha adrenergic drugs on serotonergic nervous system in rat hippocampal slices. MATERIALS AND METHODS: The hippocampus from the male rat brain was sliced. After 30 minutes` preincubation in the normal buffer, the slices were incubated for 20 minutes in a buffer containing 0.1 microM [3H]5-hydroxytryptamine(5-HT) for uptake, and washed. After administration of phenylephrine or clonidine, the release of [3H]5-HT into the buffer was measured and the radioactivities in each buffer and the tissue were counted and the results were expressed as a percentage of the total activity. The value of released [3H]5-HT was expressed as percent of the value at 50 minutes when a steady state of [3H]5-HT release was obtained. RESULTS: After administration of phenylephrine(10-5 M), clonidine(10-5 M), the values(mean+/-SE) were 133.4+/-7.3, 103.0+/-0.3 at 60 minutes and 128.8+/-4.6, 100.4+/-4.1(%) at 70 minutes compared to the values of control group, 96.6+/-1.9 % at 60 minutes and 89.6+/-2.3% at 70 minutes. The release of serotonin was increased significantly after administration of phenylephrine. CONCLUSIONS: It is suggested that alpha-1 adrenergic drugs may increase the release of serotonin and therefore the integration of these two neurotransmitters may be considered.
Adrenergic Agents ; Animals ; Brain ; Clonidine ; Epinephrine ; Hippocampus ; Humans ; Male ; Nervous System ; Neurotransmitter Agents ; Penile Erection ; Phenylephrine ; Radioactivity ; Rats* ; Receptors, Adrenergic ; Serotonin*

PURPOSE: Nocturia is a bothersome symptom that impacts sleep quality in patients with lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH). This study was performed to evaluate the impact of nocturia on sleep quality. MATERIALS AND METHODS: A total of 58 male patients with LUTS/BPH were enrolled. LUTS/BPH patients without nocturia were included in the control group. The inclusion criteria were eight or more points on the International Prostate System Score (IPSS) including more than one episode of nocturia and a prostate volume larger than 20 ml. IPSS, prostate volume, uroflowmetry, and the Pittsburgh Sleep Quality Index (PSQI) from each patient were recorded. RESULTS: Patients with nocturia showed a higher mean global PSQI (8.5+/-0.4) than patients without nocturia (4.82+/-0.4) (p<0.01). Patients with nocturia showed a higher percentage of severe sleep disorders (74.1%) than patients without nocturia (35.3%) (p<0.01). The regression coefficient between the number of episodes of nocturia and mean global PSQI was 0.42 (p<0.01). CONCLUSIONS: Patients with nocturia showed poor sleep quality, and this was related to the number of episodes of nocturia. This suggests that nocturia has a strong impact on sleep quality in patients with LUTS/BPH.
Humans ; Lower Urinary Tract Symptoms ; Male ; Nocturia ; Prostate ; Prostatic Hyperplasia ; Sleep Wake Disorders

Objectives: . Head and neck squamous cell carcinomas (HNSCs) are frequently diagnosed at the locoregional advanced stage (stage IVa), but controversy remains regarding whether stage IVa HSNCs should be treated with upfront surgery or definitive chemoradiation therapy (CRT). The purpose of this study was to compare overall survival (OS) and disease-free survival (DFS) in patients with stage IVa HNSC treated primarily by surgery with curative intent with/without (neo)adjuvant treatment (surgery group) versus those treated primarily with CRT (CRT group). Methods: . We reviewed data of 1,033 patients with stage IVa HNSC treated with curative intent at 17 cancer centers between 2010 and 2016. Results: . Among 1,033 patients, 765 (74.1%) received upfront surgery and 268 (25.9%) received CRT. The 5-year OS and DFS rates were 64.4% and 62.0% in the surgery group and 49.5% and 45.4% in the CRT group, respectively. In multivariate analyses, OS and DFS were better in the surgery group than in the CRT group (odds ratio [OR] for death, 0.762; 95% confidence interval [CI], 0.592–0.981; OR for recurrence, 0.628; 95% CI, 0.492–0.802). In subgroup analyses, the OS and DFS of patients with oropharyngeal cancer were better in the surgery group (OR for death, 0.548; 95% CI, 0.341–0.879; OR for recurrence, 0.598; 95% CI, 0.377–0.948). In the surgery group, patients with laryngeal cancer showed better OS (OR for death, 0.432; 95% CI, 0.211–0.882), while those with hypopharyngeal cancer DFS was improved (OR for recurrence, 0.506; 95% CI, 0.328–0.780). Conclusion . A survival benefit from surgery may be achieved even in patients with stage IVa HNSC, particularly those with oropharyngeal and laryngeal cancer. Surgery led to a reduction in the recurrence rate in patients with hypopharyngeal cancer.