No abstract available.
Humans ; Pneumothorax*

No abstract available.
Autopsy* ; Cardiomyopathies* ; Humans ; Infant, Newborn*

Reversible posterior leukoencephalopathy with hypertension is characterized by an acute and severe rise in blood pressure with headache, altered mental status, cortical visual disturbance, seizure and transient edematous changes in neuroimaging. The most common abnormality in neuroimaging is presumed edema involving the cortical and subcortical white matter predominant in the posterior region of the cerebral hemisphere and rarely the cerebellum and the brain stem, but not in the spinal cord. We experienced a case of 10-year-old girl with hypertensive encephalopathy involving the brainstem and the spinal cord.
Blood Pressure ; Brain Stem ; Cerebellum ; Cerebrum ; Child ; Edema ; Female ; Headache ; Humans ; Hypertension ; Hypertensive Encephalopathy ; Leukoencephalopathies* ; Neuroimaging ; Pheochromocytoma* ; Posterior Leukoencephalopathy Syndrome ; Seizures ; Spinal Cord*

OBJECTIVE: Because of the limited penetration into the central nervous system after systemic administration of numerous therapeutic compounds, intratumoral chemotherapy for brain tumors has also been used. However, the efficacy of intratumoral drug administration is restricted by the poor diffusion of drug through tumor and brain interstitium. In order to enhance the diffusion of chemotherapeutic agent and increase the cytotoxicity with minimal dose, the authors report the results of convection-enhanced delivery(CED) of chemotherapeutic agent to the malignant brain tumor as a method of enhancing cerebral drug delivery. METHODS: Authors used "CADD-Micro(R) ambulatory infusion pump" from Deltec, which can be programmed for continuous infusion. Intratumoral injection of chemotherapeutic drug using the pump was applied to eight patients with glioma and one patient with lymphoma. Surgery was done and tumor was removed as much as possible. The tip of catheter was placed in the center of tumor cavity. Adriamycin (0.16~0.32mg) was put in the reservoir which was connected to the proximal catheter and fixed in the pump device. Twenty-four hours after surgery, Adriamycin was infused. RESULTS: There was no adverse reaction of CED technique. Compared with current delivery techniques, the improvement of survival rate has been observed(5 patients: alive, 3 patients: dead, 1 patient: lost(alive to 5 mo.)). CONCLUSION: CED can be useful method for distributing therapeutic molecules in the interstitial space of tumor and can be utilized for chemotherapeutic agents, immunotoxins, and gene etc..
Brain ; Brain Neoplasms ; Catheters ; Central Nervous System ; Diffusion ; Doxorubicin ; Drug Therapy ; Glioma ; Humans ; Immunotoxins ; Lymphoma ; Survival Rate

Craniopharyngiomas exhibit benign histologic features. However, such tumors have a relatively high incidence of recurrence after surgical removal, In order to device reliable and efficient methods in identifying craniopharyngiomas with increased risk for recurrence after surgical removal, proliferating cell nuclear antigen(PCNA) expressions as well as histological characteristics of the tumor were analyzed. There were 43 patients who had been surgically confirmed and had paraffin-embedded tissue from June, 1984 to May, 1993 available for analysis from our department. Of the 43 patients, eighteen cases were in children(age of 15 years of less) and 25 cases were in adults. The mean follow-up period was 42.7 months. The histologic types were adamantinomatous in 30 cases, squamous papillary in 9 cases and mixed in 4 cases. There was no case of tumor recurrence in the squamous papillary group, while the recurrence rate was about 55% in the adamantinous group after surgical removal alone. The mean age of the admantinous group was younger than that of the squamous papillary group(17.5 vs. 37.9 years old. p=0.0012), and the squamous papillary type was found only in adults(age over 20). In the group of 30 patients treated by surgical removal without radiation, the PCNA labelling index, calculated by counting the basal cell layer only, was significantly higher in the group with recurrence than without recurrence(9.51 vs. 6.58. p=0.001). However, the PCNA labelling index obtained by counting all cells in the four high-power(x400) fields failed to demonstrate any correlation with tumor recurrence. With a reference value of 8, PCNA index of the basal cell layer demonstrated the predictive sensitivity of 81.8% and specificity of 84.2% for tumor recurrence. There was no significant difference in PCNA labelling indices between adamantinous and squamous papillary types. As PCNA labelling index of the basal cell layer, as well as the histologic type, are sensitive indicators for prediction of tumor recurrence after surgical removal of craniopharyngiomas, therefore they should be considered as an index for biologic behavior of the tumor.
Adult ; Craniopharyngioma* ; Follow-Up Studies ; Humans ; Incidence ; Proliferating Cell Nuclear Antigen* ; Recurrence ; Reference Values ; Sensitivity and Specificity ; Treatment Outcome*

We treated a 54-year-old woman who was suffering from membranoproliferative glomerulonephritis associated with a complete type of hydatidiform mole. The renal manifestations were proteinuria and hematuria. A renal biopsy, performed before gynecologic management, disclosed focal and segmental subendothelial deposits with a proliferation of the mesangial cell and showed irregularly thickened capillary loops by light and electronmicroscoy. Genralized edema, proteinuria and hematuria were completely recovered by suction and curettage of the hydatidiform mole with prophylactic chemotherapy. The clinical manifestation of earlier presented 3 cases have been the nephrotic syndrome. The common feature of them was a complete remission of the nephropathy after the removal of the hydatidiform mole. The relationship between the hydatidiform mole and glomerulonephritis remains unresolved at present. But we concluded that the hydatidiform mole might be a cause of glomerulonephritis in this case.
Case Report ; Diagnosis, Differential ; Edema/etiology ; Female ; Glomerulonephritis, Membranoproliferative/pathology ; Glomerulonephritis, Membranoproliferative/etiology* ; Hematuria/etiology ; Human ; Hydatidiform Mole/therapy ; Hydatidiform Mole/diagnosis* ; Hydatidiform Mole/complications* ; Middle Age ; Pregnancy ; Proteinuria/etiology ; Uterine Neoplasms/therapy ; Uterine Neoplasms/diagnosis* ; Uterine Neoplasms/complications*

PURPOSE: To determine the value of magnetic resonance imaging(MR) and magnetic resonance angiography(MRA) inassessing collateral vessels of moyamoya disease. MATERIALS AND METHODS: Twenty-four patients with moyamoyadisease who underwent MR, 3D TOF MRA, and conventional angiography participated in this study. Two radiologistsworking independently and with no knowledge of the angiographic findings, interpreted the MR and MRA images. Todetermine the presence of parenchymal and leptomeningeal collaterals(48 hemispheres) and transdural collaterals(38hemispheres in 19 patients were depicted by angiography of the external carotid), the findings were compared withthose of angiography. RESULTS: Parenchymal, leptomeningeal, and transdural collaterals were depicted byconventional angiography in 34(71%), 32(67%), and 11(29%) hemispheres respectively. The sensitivity andspecificity of MR/MRA for collateral vessels were 79.1/ 88.1% for parenchymal collaterals, 72.1/ 88.1% forleptomeningeal collaterals, and 0.1/18.1% for transdural collaterals, respectively. Respective sensitivity andspecificity of MR/MRA were 88.94/94.1% for leptomeningeal collaterals, and 18.93/55.1% for transdural collaterals,when the prominent posterior cerebral and external carotid artery were regarded as secondary signs ofleptomeningeal and transdural collateral vessels. CONCLUSION: In moyamoya disease, MR and MRA are useful imagingmodalities for the assessment of collateral vessels. The prominent posterior cerebral artery and external carotidartery can be useful secondary signs of leptomeningeal and transdural collateral vessels.
Angiography* ; Carotid Artery, External ; Cerebral Angiography ; Humans ; Moyamoya Disease* ; Posterior Cerebral Artery

Extrahepatic metastasis of Hepatocellular carcinoma(HCC) to the gastrointestinal tract is uncommon. Because most of metastases to the gastrointestinal tract have no clinical manifestations, they are usually found incidentally at the time of an autopsy or a laparotomy, We experienced a case of duodenal metastasis of HCC, which presented UGI bleeding. A 59 years old male was admitted to our hospital due to generalized jaundice, which lasted for about a week. From the third day of admission, he had episodes of hematemesis and melena. An abdoinal CT scan demonstrated multiple, variable sized low-density masses in the entire liver with portal vein thrombosis and conglomerated lymph nodes. An esophagogastroduodenoscopy showed a protruded submucosal mass-like lesion with multiple ulceration in the duodenal bulb. We confirmed the duodenal mass-like lesion to be hepatocellular carcinoma by a biopsy and a histoimmunochemical study.
Autopsy ; Biopsy ; Carcinoma, Hepatocellular* ; Endoscopy, Digestive System ; Gastrointestinal Tract ; Hematemesis ; Hemorrhage* ; Humans ; Jaundice ; Laparotomy ; Liver ; Lymph Nodes ; Male ; Melena ; Middle Aged ; Neoplasm Metastasis* ; Tomography, X-Ray Computed ; Ulcer ; Venous Thrombosis

Neurocutaneous melanosis is a rare congenital phacomatosis, characterized by the presence of multiple pigmented skin nevi at birth. Meningeal melanosis tending to become malignant and seizure. Dandy-Walker syndrome is a developmental disorder of brain characterized by cystic dilatation of the fourth ventricle and agenesis or hypoplasia of the cerebellar vermis. We studied a case of Dandy-Walker syndrome with neurocutaneous giant melanosis in a 3 years old boy.
Brain ; Child, Preschool ; Dandy-Walker Syndrome* ; Dilatation ; Fourth Ventricle ; Humans ; Male ; Melanosis* ; Neurocutaneous Syndromes ; Nevus ; Parturition ; Seizures ; Skin

Intradural lipomas not associated with spinal dysraphism are rare tumors of the spinal canal. The clinical course of most of the patients with intradural lipoma is slowly progressive with increasing leg weakness and gait disturbance during the first 5 years of life or early adulthood. Since neurologic deficits usually occur very slowly and insidiously, symptoms are present over 2 years in the majority of patients before a diagnosis is made. In view of such a clinical course, a huge intradural lipoma presenting with no neurological deficits in an adult is a very rare case. We present our recent experience with a case of a huge intradural lipoma of the cervical cord without any association with spinal dysraphism and other anomalies of the spine in a neurologically intact adult patient. A review of the literature is also discussed.
Adult ; Diagnosis ; Gait ; Humans ; Leg ; Lipoma* ; Neurologic Manifestations ; Spinal Canal ; Spinal Dysraphism ; Spine