Aneurysms of the great vein of Galen are rare and the authors report a case of primary type aneurysm of the great vein of Galen. Clinicaly aneurysm of great vein of Galen give rise to different symptoms and signs at different age. New born infants have intractable heart failure, infancy have hydrocephalus, and adolescents have headache and syncope. The diagnosis rests upon angiography, especially four-vessel angiography is mandatary to delineate all of the feeding arteries. The posterior cerebral arteries supply most of the blood to the aneurysm. The only effective treatment is ligation of the feeding vessels at the point of entry into the vein of Galen.
Adolescent ; Aneurysm* ; Angiography ; Arteries ; Cerebral Veins* ; Diagnosis ; Headache ; Heart Failure ; Humans ; Hydrocephalus ; Infant ; Ligation ; Posterior Cerebral Artery ; Syncope ; Veins*

Authors analysed 25 cases of the narrow spinal canal in cervical and lumbar region, who admitted to the Catholic Medical Center, Seoul from Jan. 1970 to August 1976. Correlation between neurologic feature and radiologic finding was attempted and compared the measurements of narrow cervical and lumbar spinal canal with that of the healthy Korean. The mean anterioposterior diameter of the cervical canal in healthy Korean was 16.2mm at C4, 16.4mm. at C5, 16.6mm. at C6, and 16.4mm. at C7. The ratio of canal to vertebral body in the plain lumbar spine was 1 : 3.9 at L3, 1 : 3.8 at L4 and 1 : 3.8 at L5. The measurements of 25 cases of narrow spinal canal were significantly reduced comparing with the healthy one. The clinical symptoms were closely related to the severity of the narrow spinal canal while there was intermittent or insidious course of symptom in the group of mild narrow spinal canal. Symptom of root compression or neurogenic claudication is frequent manifestation in the severe narrow spinal canal. and the symptom is correlated to the severity of the narrowing. Urinary disturbance and pyramidal tract sign were evident in the cervical narrow canal. The characteristic myelographic feature was multiple constrictive defect at the level of the narrow canal. Common findings in laminectomy were the thickened laminae and hypertrophied ligamentum flavum in the narrow canal. Herniated disc was not found but in one case in the cervical narrow canal at surgery. The recovery of the symptom was better in the group of the narrow canal who had mild degree of narrowing or who had the symptom in short duration rather than prolonged course.
Intervertebral Disc Displacement ; Laminectomy ; Ligamentum Flavum ; Lumbosacral Region ; Pyramidal Tracts ; Seoul ; Spinal Canal* ; Spine

Microscopic calcification within the basal ganglia was reported by Virchow and Bamberger in 1855. The description of symmetrical cerebral calcification, particularly of the basal ganglia and often of the dentate nuclei, associated with hypoparathyrodism as related by Eaton, Camp and Love(1939) was a significant development in the field of calcification. Calcification of the basal ganglia has been visualized by skull radiography and computed tomography(CT) scan, and in two-third of cases, it has been associated with metabolic and endocrine abnormalities. Computed tomography is more sensitive to detect the intracranial calcification than plain skull radiography. The purpose of our report was evaluate the significance of basal ganglia calcification as visualized by CT, discusses on pathogensis of calcification, clinical significance and management under the hypocalemia.
Basal Ganglia* ; Hypoparathyroidism* ; Radiography ; Skull

Intramedullary neurilemmoma of the spinal cord is extremely rare. This is not surprising, since schwann cells, considered the histogenetic source of such a tumor, normally are not present within the spinal cord. A case of intramedullary neurilemmoma in 47-year-old man is reported and the hypotheses as to it's origin are discussed. In a discussion on the origin of the condition, its is concluded that this case might have an origin from the dorsal root entry zone.
Humans ; Middle Aged ; Neurilemmoma* ; Schwann Cells ; Spinal Cord ; Spinal Nerve Roots

A 42-year-old male was scheduled for left fronto-temporo-parietal craniotomy and subdural hematoma removal under general anesthesia. The past history was diabetes mellitus, hypertension, and chronic alcoholism. He was moderately obese, short neck, and deep drowsy. After rapid sequence induction with fentanyl, thiopental sodium and succinylcholine, anesthesia was maintained with nitrous oxide-oxygen-isoflurane. His head was fixed on horseshoe head rest with right side tilted. Throughout the 4 hours of anesthesia, cardiovascular and respiratory variables remained within normal limit. After extubation, upper respiratory obstruction developed, presumably as the result of the tongue's falling back against the posterior pharyngeal wall. This was only partly corrected by insertion of a rubber oral airway, but it was fully relieved when the lower jaw was lifted forward by bilateral digital pressure applied behind the angles of the mandible about ten minutes. At the intensive care unit, left partial facial nerve paresis developed with mild weakness of the right corner of the mouth, and striking right parotid swelling and tenderness. The parotid swelling receded over 2 weeks, and the paresis resolved over 3 weeks to complete recovery.
Adult ; Alcoholism ; Anesthesia ; Anesthesia, General* ; Craniotomy ; Diabetes Mellitus ; Facial Nerve* ; Fentanyl ; Head ; Hematoma, Subdural ; Humans ; Hypertension ; Intensive Care Units ; Jaw ; Male ; Mandible ; Mouth ; Neck ; Paralysis* ; Paresis ; Rubber ; Strikes, Employee ; Succinylcholine ; Thiopental

Little is known about the treatment-seeking behaviors of acne patients, especially Asian acne patients. This study was performed to obtain detailed information about the treatment-seeking behaviors in Korean acne patients. Patients who visited the dermatology departments at 17 university hospitals completed a self-administered questionnaire. Most patients obtained information about acne from doctors or the Internet. The most important criteria for selecting a treatment method or choosing a particular clinic were effectiveness and accessibility. Patients used traditional medicine, visited beauty clinics, drank more water, and used over-the-counter topical agents more frequently than they sought doctors during the worsening period. The degree of satisfaction in treatment was found to depend on the total cost of treatment, number of places visited, site affected by acne, and emotional stress. Those who had experienced a side effect tended to have been treated for longer, to have paid more for treatment, and to have an associated skin disease. Treatments prescribed by dermatology clinics had the lowest aggravating rate, although improvement rates for family medicine clinics were also fairly high. This is the first study to investigate in detail the demographic features and characteristics of the treatmentseeking behaviors of acne patients in Asia.
Acne Vulgaris/epidemiology/*psychology/therapy ; Adult ; Demography ; Female ; Health Behavior ; Health Knowledge, Attitudes, Practice ; Hospitals, University ; Humans ; Korea ; Male ; *Patient Satisfaction ; Questionnaires ; Sex Factors ; Stress, Psychological ; Young Adult

PURPOSE: To assess the value of computed tomography (CT) in the preoperative staging of transitional cellcarcinoma (TCC) of the renal pelvis. MATERIALS AND METHODS: We retrospectively evaluated the CT TNM staging of 38patients with TCC of the renal pelvis who had undergone preoperative abdominal CT examination between January 1990and January 1998. In CT staging for differentiation between early-stage (TO-2) and advanced-stage disease (T3-T4),three criteria were used, namely the presence or obliteration of the renal sinus fat layer, the smoothness orirregularity of margin between the tumor and renal parenchyma, and the presence or absence of hydronephrosisproximal to the tumor. CT staging was performed by two genitourinary radiologists blinded to the pathologicresults, and was compared with pathologic staging. RESULTS: Pathologic results revealed 19 cases of early stagedisease (TO=8, T1=9, T2=2) and 19 of advanced stage (T3=12, T4=7). Overall CT staging accuracy was 82%(31/38);fourcases were overstaged and three were understaged. In early-stage disease, sensitivity and specificity were 79%,and 84%, and in advanced stage disease were 83% and 80%. Three of four overstaged cases showed hydronephrosisproximal to the tumor. In the second CT staging, using proximal hydronephrosis of the tumor as a criterion forearly-stage disease, the sensitivity and specificity of early-stage disease were 95% and 75%, respectively, andthe specificity of advanced-stage disease was 95%. CONCLUSION: When hydronephrosis proximal to a tumor wasconsidered to be a sign of early stage disease, the CT staging of renal pelvic TCC was highly accurate.
Hydronephrosis ; Kidney Pelvis* ; Neoplasm Staging ; Retrospective Studies ; Sensitivity and Specificity ; Tomography, X-Ray Computed

Takayasu's arteritis(aortoarteritis) is a chronic inflammatory disease involving the aorta, the arteries arising from the aorta, and the pulmonary arteries also may be involved. The inflammation leads to either stenosis and occlusion of the involved artery or formation of aneurysm or both. The arterial lesions can lead to secondary hypertension, retinopathy, cardiac involvement, cerebrovascular events, and premature death. The course and prognosis of patients with aortoarteritis show wide variation, and few authors have published systematic studies documenting the natural history of this disease. While the etiology of Takayasu's arteritis remains unknown, various modes of treatment including steroids, vascular surgery, and balloon angioplasty have been used for management of these patients. We experienced a case of Takayasu's arteritis with multiple occlusion of pulmonary arteries, which was confirmed by angiography and perfusion scan, so reported it with a review of literature.
Aneurysm ; Angiography ; Angioplasty, Balloon ; Aorta ; Arteries ; Constriction, Pathologic ; Humans ; Hypertension ; Inflammation ; Mortality, Premature ; Natural History ; Perfusion ; Prognosis ; Pulmonary Artery* ; Steroids ; Takayasu Arteritis*

PURPOSE: Proteinuria is the hallmark of glomerular injury and results from alterations in glomerular permeability. The permeability of diseased glomerulus has been estimated by selectivity of proteinuria. Recently, some authors showed a significant relationship between selectivity of proteinuria and tubulointerstial damage. The present study examines the role of protein selectivity as a prognostic marker in patients with IgA nephropathy and its correlation with other prognostic indices. METHODS: The selective proteiuria index of 81 cases with IgA nephropathy diagnosed between 1990 and 2000 were reviewed, and each case was subclassified using the following : highly selective(SPI0.2). The mean age of the patients was 27+/-15 years with a follow-up period of 38+/-24 months. Six patients had highly selective proteinuria, thirty three patients had moderately selective proteinuria, and forty two patients had nonselective proteinuria. RESULTS: 1) A significant relationship was found between the SPI and Haas subclasess(p=0.01). With respect to clinical presentaion, hypertension(0, 4, 11 cases, p<0.05), proteinuria(0.52+/-0.35, 1.85+/-1.55, 2.79+/-2.51 g/day, p<0.05) were significant correlation.2) Chronic renal failure was significantly higher in patients with nonselective proteinuria in comparison with patients with selective proteinuria(p<0.05).3) Markers of renal failure by the Cox proportional hazards model were Cr(Exp(B)=4.2, p<0.001), Ccr (Exp(B)=2.1, p<0.05), SPI(Exp(B)=1.7, p<0.05), hypertension(Exp(B)=1.6, p<0.05). 4) In 28 patients of IgA nephropathy with nephrotic syndrome, 9 patients were moderately selective, 19 patients were nonselective. The response to therapy, evaluated retrospectively, was 67% and 16% in moderate and nonselective proteinuria(p=0.01). CONCLUSION: There is a significant relationship between selectivity of proteinuria and clinical para meters. Moreover, the selectivity of proteinuria has a predictive value on functional outcome.
Predictive Value of Tests

PURPOSE: Protein-calorie malnutrition is common in continuous ambulatory peritoneal dialysis (CAPD) patients and is associated with an increase in morbidity and mortality. This cross-sectional study was carried out to investigate prevalence of protein-calorie malnutrition in Korean CAPD patients. Other purposes were to ascertain relationship between various nutritional parameters and to evaluate factors independently associated with malnutrition in CAPD patients. METHODS: Subjects were clinically stable 127 patients who have been on CAPD for more than 3 months. Nutritional status was assessed by subjective global assessment (SGA), biochemical, anthropometric, and urea kinetic parameters. RESULTS: The mean age of the patients was 50.7+/-11.4 years with sex ratio (M : F) 1 : 1, and mean duration of dialysis was 67.3+/-39.7 months. Patients were divided into 3 groups according to SGA : group I (normal nutrition, n=75, 59.0%), group II (mild malnutrition, n=30, 23.6%) and group III (moderate to severe malnutrition, n=22, 17.4%). There were significant differences in age, CAPD duration, peritonitis rate and hospital-days per year between group I and group III. Among biochemical variables, serum creatinine, triglyceride, protein, albumin, prealbumin, IGF- 1, transferrin and leptin were significantly lower in group III compared to group I (p<0.05), and CRP, ferritin, and IL-6 were significantly higher in group III than group I. There were significant differences in serum albumin among all three groups. There were no differences in Kt/Vurea, nPNA and SCCr among three groups. However, there were significant differences in residual renal function (p<0.05) and PNA (p<0.05) between group I and group III. Among anthropometric variables, body weight, %IBW, BMI, %body fat mass, MAC, TSF, BSF, CAMA, and TBM were significantly lower in group III than the other two groups (p<0.05). But, there was no differences in exercise capacity and food intake among the three groups. To evaluate relationship between various parameters used for assessing malnutrition, we conducted Pearson's rank correlation test. Serum albumin (gamma=0.45), age (gamma=-0.29), %IBW (gamma=0.52), leptin (gamma=0.32), CRP (gamma=-0.24), TSF (gamma=0.45) and CAMA (gamma=0.41) significantly correlated with SGA. As a result of multiple regression analysis, albumin, leptin, and CRP were independent predictors of malnutrition (p<0.05). CONCLUSION: About 40% of CAPD patients were malnourished according to SGA, and multiple regression analysis revealed that serum albumin, leptin and CRP were independent predictors of malnutrition. These results suggest that acute and chronic inflammatory response plays an important role in the development of protein-calorie malnutrition in CAPD patients with comparable food intake and dialysis dose.
Body Weight ; Camassia ; Creatinine ; Cross-Sectional Studies* ; Dialysis ; Eating ; Ferritins ; Humans ; Interleukin-6 ; Leptin ; Malnutrition* ; Mortality ; Nutritional Status ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis ; Prealbumin ; Prevalence ; Protein-Energy Malnutrition ; Serum Albumin ; Sex Ratio ; Transferrin ; Triglycerides ; Urea