OBJECTIVE: For the treatment of carotid cavernous fistula(CCF), transarterial detachable balloon occlusion(DBO) is the method of choice. When it has failed to occlude the fistula, various embolization methods are used to treat the fistula. Transvenous embolization through the superior ophthalmic vein(SOV) is another method of treatment. The venous approach through the SOV after surgical dissection and exposure of this vein has been recommended by some delete, but(here) delete delete(an) alternative treatment method by percutaneous puncture of the SOV without surgical dissection(is described). METHODS: A 19-year-old woman admitted to our hospital two months after accident, presented with proptosis, chemosis, occulomotor and abducens nerve palsies, and bruit of the right eye. The authors tried DBO via transarterial route in initial treatment and the fistula was occluded with subsequent disapearance of bruit. However, 2 weeks later, she complained of recurence of bruit. Transarterial approach was attempted again, but the fistula hole was too small for this approach. The venous approach via SOV by percutaneous puncture was then tried. Puncture was made at the medial one third of the superior orbital rim and the fistula was embolized with Guglielmi detachable coils (GDCs). RESULTS: The fistula was completely occluded and no early and late complications noted. The patient's clinical symptoms were improved within a few days. CONCLUSION: Treatment of CCF by percutaneous puncture of the SOV is an alternative and effective method when other approaches are not feasible.
Abducens Nerve Diseases ; Exophthalmos ; Female ; Fistula* ; Humans ; Orbit ; Punctures* ; Veins* ; Young Adult

PURPOSE: Neuroendocrine (NE) cells of the prostate are considered to be involved in the pathogenesis of benign prostate hyperplasia (BPH). By a comparative analysis of NE cell density in BPH tissue of men who were either exposed to or not exposed to 5alpha-reductase inhibitor, we investigated the relationship between NE cells and BPH, and the effect of androgen deprivation on NE cells. MATERIALS AND METHODS: Prostate tissue specimens, obtained from 30 men by transurethral resection of the prostate or radical cystoprostatectomy, were used. Of the 30 patients, 10 had a prostate smaller than 25 ml (normal control), the other 20 had a prostate larger than 40ml, 10 of who had taken 5alpha-reductase inhibitor (finasteride) for 3 months before surgery (androgen blockade group), and 10 who had not (BPH group). The distribution of NE cells in the prostate was examined using the anti-chromogranin A (CgA) antibody, and the density of the CgA-positive cells was compared by an optical dissector method. Immunoblotting was performed using the neuron specific enolase (NSE) antibody. A Mann-Whitney U test was used in a statistical analysis. RESULTS: Most of the CgA-positive NE cells were localized between the acinar epithelial cells. The mean numbers of CgA-positive NE cells per acinus in the normal controls and the BPH groups were 1.67+/-0.78 and 4.45+/-2.54, respectively, and the difference was statistically significant (p<0.05). However, the mean number of CgA-positive NE cells in the androgen blockade group, was 4.93+/-2.17, which was similar to the BPH group. In a NSE immunoblotting study, a distinct band was observed in the BPH and androgen blockade groups, but the density of the band was higher in the androgen blockade group. CONCLUSIONS: Our results suggest that NE cells may be involved in the hyperplastic process of BPH. Inhibition of dihydrotestosterone, caused by the oral administration of the 5alpha-reductase inhibitor, failed to induce any significant change in the NE cells, probably due to the incomplete androgen blockade.
Administration, Oral ; Cell Count ; Dihydrotestosterone* ; Epithelial Cells ; Humans ; Hyperplasia ; Immunoblotting ; Male ; Neuroendocrine Cells* ; Phosphopyruvate Hydratase ; Prostate ; Prostatic Hyperplasia*

No abstract available.
Neurilemmoma* ; Neurofibromatoses* ; Neurofibromatosis 2*

The cleidocranial dysostosis is relatively rare congenital and familial disorder with autosomal dominant inheritance. After the first report of a case of this was that of Cutter in 1870, which was quoted from Soule, A., in 1946, Marie and Sainton supplied the name of the Cleidocranial dysostosis with the report of 2 cases of this in 1897. Since that time approximately 350 cases have been described in the literature. This condition is characterized by deficient formation of the clavicle, delayed and imperfect ossification of the cranium and less often involvement of other bones, We experienced 2 cases of this and reported them in this paper with a brief review of the literatures.
Clavicle ; Cleidocranial Dysplasia ; Skull ; Wills

PURPOSE: The objective of this study was to ascertain the relationship between epidermal growth factor receptor(EGFR) status and estrogen receptor(ER) and other prognostic factors in primary human breast cancer patients. We tried to evaluate the value of EGFR as a prognostic factor. MATERIALS AND METHODS: EGFR and ER were measured by immunohistochemical staining. It was performed on section from paraffin blocks of 60 primary breast cancer patients who underwent mastectomy at Chung-Ang University Hospital. And we evaluate the relationship between EGFR and ER and other prognostic factors. RESULTS: In 20 of 60 patients(33.3%), the staining was positive for the expression of EGFR. Of the 60 patients, 6 were both positive for EGFR and ER, 25 were both negative, 14 were EGFR positive and ER negative, 15 were EGFR negative and ER positive. Between EGFR and estrogen receptor(ER) status, previously known clear inverse relationship was not observed in our study. The EGFR status was not correlated with axillary lymph node involvement, histologic type, and histologic grading. But it was correlated with tumor size(p=0.049), and there was a high tendency of recurrence rate of patients with EGFR-positive tumors as compared with those with EGFR-negative tumors(p=0.078). CONCLUSION: EGFR status may be valuable as a prognostic factor in determining the prognosis of breast cancer. However, the study of more cases will be needed for the significance of the information about the EGFR as an independent prognostic factor.
Breast Neoplasms* ; Breast* ; Epidermal Growth Factor* ; Estrogens ; Humans ; Lymph Nodes ; Mastectomy ; Paraffin ; Prognosis ; Receptor, Epidermal Growth Factor* ; Recurrence

PURPOSE: Bone metastasis from stomach cancer occurs only rarely and it is known to have a very poor prognosis. This study examined the clinical characteristics and prognosis of patients who were diagnosed with stomach cancer and bone metastasis. MATERIALS AND METHODS: The subjects were 19 patients who were diagnosed with stomach cancer at Hanyang University Medical Center from June 1992 to August 2010 and they also had bone metastasis. The survival rate according to many clinicopathologic factors was retrospectively analyzed. RESULTS: 11 patients out of 18 patients (61%) who received an operation were in stage IV and the most common bone metastasis location was the spine. Bone scintigraphy was mostly used for diagnosing bone metastasis and PET-CT and magnetic resonance imaging were used singly or together. The serum alkaline phosphatase at the time of diagnosis had increased in 12 cases and there were clinical symptoms (bone pain) in 16 cases. Treatment was given to 14 cases and it was mostly radiotherapy. There were 2 cases of discovering bone metastasis at the time of diagnosing stomach cancer. The interval after operation to the time of diagnosing bone metastasis for the 18 cases that received a stomach cancer operation was on average 14.9+/-17.3 months and the period until death after the diagnosis of bone metastasis was on average 3.8+/-2.6 months. As a result of univariate survival rate analysis, the group that was treated for bone metastasis had a significantly better survival period when the bone metastasis was singular rather than multiple, as compared to the non-treatment group, yet both factors were not independent prognosis factors on multivariate survival analysis. CONCLUSIONS: An examination to confirm the status of bone metastasis when conducting a radio-tracer test after the initial diagnosis and also after an operation is needed for stomach cancer patients, and bone scintigraphy is the most helpfully modality. Making the diagnosis at the early stage and suitable treatments are expected to enhance the survival rate and improve the quality of life even for the patients with bone metastasis.
Academic Medical Centers ; Alkaline Phosphatase ; Humans ; Magnetic Resonance Imaging ; Neoplasm Metastasis ; Prognosis ; Quality of Life ; Retrospective Studies ; Spine ; Stomach Neoplasms ; Survival Rate

PURPOSE: To determine the accuracy of predicting potential visual acuity in cataract using the illuminated near card (INC). METHODS: Thirty-nine eyes (34 patients) having cataract were studied prospectively by comparing the postoperative distance Snellen acuity to the visual acuity (VA) obtained preoperatively using the INC viewed through a pinhole. RESULTS: The INC predicted postoperative acuity within two Snellen lines in 20 of 39. The accuracy between predicted and achieved acuities was follows: 61.5% in patients with a preoperative acuity of better than 0.3, 53.8% of better than 0.1, 50.0% of better than 0.05 and 28.6% of worse than 0.05. The disparity between INC results and postoperative VA was 3.89 lines (cortical opacity, nucleosclerosis, subcapsular opacity), 2.48 lines (cortical and subcapsular opacity), 2.08 lines (cortical opacity, nucleosclerosis), 1.8 lines (nucleosclerosis only), 3.3 lines (nucleosclerosis, subcapsular opacity), 1.6 lines (subcapsular opacity) and 3.0 lines (the others). CONCLUSIONS: The INC is easy to use and is a fast and accurate measurement instrument for predicting postoperative VA after cataract operation.
Cataract* ; Humans ; Prospective Studies ; Visual Acuity*

The relationship between the serum values of prostate-specific antigen (PSA) and the histologic composition of benign prostatic hyperplasia (BPH) was investigated in 32 symptomatic BPH patients undergoing transurethral resection of the prostate. We evaluated the free and total PSA concentrations by ACS-PSA2 (Ciba-Corning) assay. The stereological analysis was made by computer aided-area densitometry using H & E stained slides to quantify stromal and glandular areas in the resected prostate tissue. The total PSA concentration versus percentage of glandular area (%G) and stromal-glandular ratio (SGR) correlated significantly (p<0.05 for both) whereas the free PSA concentration and free/total PSA ratio did not (p>0.05 for both). These data suggest that total PSA is directly correlated with the histologic composition of the prostate in men with BPH, however, the proportion of free to total PSA was not informative to predict the histology. Thus, pretreatment evaluation of total PSA would be useful as part of an evaluation method of BPH for medical therapy.
Densitometry ; Humans ; Male ; Prostate ; Prostate-Specific Antigen* ; Prostatic Hyperplasia*

PURPOSE: To report three cases of severe endothelial cell density loss after iris claw phakic intraocular lens (Artisan® lens) implantation. CASE SUMMARY: A 32-year-old woman underwent iris claw intraocular lens implantation in both eyes. Preoperative corneal endothelial cell count was 2,556 cells/mm² in the right eye and 2,674 cells/mm² in the left eye. After 4 years, the corneal endothelial cell count was 1,968 cells/mm² in the right eye and 1,997 cells/mm² in the left eye. A 27-year-old woman underwent iris claw intraocular lens implantation in both eyes. Preoperative corneal endothelial cell count was 3,222 cells/mm² in the right eye and 3,122 cells/mm² in the left eye. After 4 years 8 months, the corneal endothelial cell count was 2,729 cells/mm² in the right eye and 2,488 cells/mm² in the left eye. A 39-year-old woman underwent phakic intraocular lens implantation in other clinic, and the lens of left eye was removed the same day because of elevated intraocular pressure. She underwent iris claw intraocular lens implantation in the left eye. Preoperative corneal endothelial cell count was 2,500 cells/mm² in the left eye, which decreased to 1,873 cells/mm² after 8 years. Six months after intraocular lens removal and cataract surgery, her cornea endothelial cell count was 1,412 cells/mm². CONCLUSIONS: Although iris-fixed intraocular lens implantation is safe and effective for correcting myopia, at least 4 years of long-term observation for evaluating corneal endothelial cell density maybe necessary.
Adult ; Animals ; Cataract ; Cornea ; Endothelial Cells* ; Female ; Hoof and Claw ; Humans ; Intraocular Pressure ; Iris ; Lens Implantation, Intraocular ; Lenses, Intraocular ; Myopia ; Phakic Intraocular Lenses*

OBJECTIVE: Adenoid cystic carcinoma is a relatively slowly growing malignant tumor. Probably at least 40-50% of patients eventually develop distant metastases. We present the natural history and treatment modality of this malignancy from our experience and review of literature. METHODS: We report a case of a 30-year-old man who complained of a headache, facial pain and hearing disturbance in the right ear. Physical examination revealed soft, protruded mass and narrowed external auditory canal. The cranial MRI showed a well defined mass in the extradural middle cranial fossa. RESULTS: The patient underwent subtotal resection of the lesion after tumor embolization was performed. The pathological diagnosis was adenoid cystic carcinoma. The patient received postoperative radiation therapy(56Gy) resulting in a complete neurological recovery. Fifteen months later, the patient was readmitted for severe back pain. Bone scan disclosed hot uptakes at the upper cervical spine, the 4th lumbar vertebra, and the pelvic area. These areas were irradiated(40Gy) and the presenting symptoms were relieved. Twenty months later, he complained of respiratory difficulty and was found to have a multiple nodule(s) in the lung. He was given 10 cycles of chemotherapy but discharged because of unresponsivencess and development of new lesions. Brain MRI and bone scan were checked 10 months after his discharge due to more aggravated lung metastasis although local tumor was controlled. Adjuvant radiation therapy(18Gy) was performed and he continued to be functional independently, although he was no longer working as a registered nurse. Two months later, dyspnea and hemoptysis were more improved and chest X-ray showed decreased mass. During the follow up period, he complained of intercostal pain, chest X-ray showed more aggregated lung mass. Chest CT scan showed multiple lung metastases and liver metastasis. In spite of adjuvant radiotherapy, the patient died of multiple systemic metastases 47 months after the first operation. CONCLUSION: Surgery is essential in the treatment of adenoid cystic carcinoma. Radiotherapy has gained acceptance as a palliative therapy, as it reduces tumor bulk and relieves symptoms. The combined treatment do not, however, prevent further recurrence and distance metastasis.
Adenoids* ; Adult ; Back Pain ; Brain ; Carcinoma, Adenoid Cystic* ; Chest Pain ; Cranial Fossa, Middle ; Diagnosis ; Drug Therapy ; Dyspnea ; Ear ; Ear Canal ; Facial Pain ; Follow-Up Studies ; Headache ; Hearing ; Hemoptysis ; Humans ; Liver ; Lung ; Magnetic Resonance Imaging ; Natural History ; Neoplasm Metastasis* ; Palliative Care ; Physical Examination ; Radiotherapy ; Radiotherapy, Adjuvant ; Recurrence ; Spine ; Thorax ; Tomography, X-Ray Computed