The intraphepatic migration of a distal ventriculopritoneal shunt tube(Accu-flo shunt system medium pressure) is reported. This is rare complication of ventriculoperitoneal shunt, which was diagnosed by abdominal computed tomography. To our knowledge, this is the third reported case complication with migration of a peritoneal shunt tube into the liver.
Catheters* ; Liver ; Ventriculoperitoneal Shunt

The authors studied angiographic features in relation to risk of hemorrhage in 102 cerebral arteriovenous malformations(AVM;s). Statistical analysis demonstrated that AVM's with following characteristics had high risk of hemorrhage : 1) small nidus ; 2) deep, posterior fossa, cortico-callosal, cortico-ventricular location ; 3) one or two draining veins ; 4) deep venous drainage ; 5) high grade stenosis of major venous drainage. The authors suggest that as the venous drainage system is significantly associated with the risk of hemorrhage in AVM's, careful preoperative angiographic evaluation of the venous drainage system is mandatory for decision making in the management of patients with AVM's.
Arteriovenous Malformations ; Constriction, Pathologic ; Decision Making ; Drainage ; Hemorrhage ; Humans ; Intracranial Arteriovenous Malformations* ; Veins

Neurofibromatosis 1(NF-1, Von Recklinghausen disease) and Neurofibromatosis 2(NF-2, bilateral acoustic neurinoma) have been established as distinct disorders by the National Institutes of Health(NIH) Consensus Development Conference in 1988. We recently have encountered a patient of NF-2 who develop multiple intracranial and spinal tumors 12 years after the surgical treatment of Schwannoma of lumbar nerve roots. The tumors were right acoustic neurinoma, left cerebellopontine angle(CPA) meningioma, multiple intracranial meningiomas, intraorbital glioma, multiple ependymomas of the brain stem and cervical spinal cord, and meningiomas of cervical nerve roots. We present this case with a review of reported cases of neurofibromatosis.
Academies and Institutes ; Acoustics ; Brain Stem ; Ependymoma ; Glioma ; Humans ; Meningioma ; Neurilemmoma ; Neurofibromatoses* ; Neurofibromatosis 2* ; Neuroma, Acoustic ; Spinal Cord

Despite modern advances in endovascular techniques, intraaneurysmal coil embolization may be associated with serious complications such as parent artery occlusion by thromboembolism and coil migration or incomplete treatment, which require surgery. We report 5 cases in which surgical interventions had been necessary following coil embolization with Guglielmi Detachable Coil, either due to incomplete aneurysm obliteration or acute complication of parent artery occlusion by coil migration and throm-boembolism. Surgical intervention include removal of the coils and clipping of the aneurysm. Immediate recanalization of the occluded artery by use of intra-arterial thrombolytics and surgery is very important. The role of neurosurgical management in the care of the patients suffering from unsuccessful endovascular therapy of aneurysm is demonstrated.
Aneurysm* ; Arteries ; Embolization, Therapeutic* ; Endovascular Procedures ; Humans ; Parents ; Thromboembolism

The authors collected 53 consecutive cases of chronic subdural hematoma which were diagnosed by carotid angiography and brain scanning. There were 39 males and 14 females. The mean age was 45.6 years old. 80% of all cases had a history of head injury and one of the clinical manifestations of increased intracranial pressure as well as contralateral hemiparesis. The most common site of hematoma was fronto-parietal region. 42 cases were treated with simple drainage and 11 cases with membranectomy. Post-op. course was excellent in all cases of simple drainage, but in 2 cases of membranectomy, recollection of hematoma developed after surgery.
Angiography ; Brain ; Craniocerebral Trauma ; Drainage ; Female ; Hematoma ; Hematoma, Subdural, Chronic* ; Humans ; Intracranial Pressure ; Male ; Paresis

OBJECTIVE: Traumatic pseudoaneurysms are rare but life-threatening lesions. We investigated the patients with these lesions to clarify their clinical characteristics and therapeutic strategies and we also reviewed the literatures on the treatment principles, possible options, and outcomes. METHODS: There were a total of 8 patients who were treated with traumatic intracranial pseudoaneurysms between April 1980 and January 2009. Medical charts and the imaging studies were reviewed for analysis. The outcome was measured with modified Rankin Scale (mRS) score at 6 months after treatment. RESULTS: All 8 patients were male and the mean age was 25 years old. Six of those were located at the cavernous segment of the internal carotid artery (ICA) and the other 2 was located at the M2 segment of middle cerebral artery. The causes of trauma were car accidents in 6, penetrating injury through the orbit in 1, and slip down injury in 1 patient. Massive epistaxis or hematemesis occurred in all patients with a pseudoaneurysm at the cavernous and ophthalmic segment of the ICA. All 6 patients of the cavernous and ophthalmic ICA group showed favorable outcome of mRS 0 to 1. The outcome of patients with middle cerebral artery pseudoaneurysm was mRS 2 to 3. CONCLUSION: Upon prompt diagnosis and proper treatment planning, it is possible to achieve favorable outcome in these patients. Lesions located at the cavernous segment of the ICA favored endovascular treatment while those at the middle cerebral artery favored surgical treatment.
Aneurysm, False* ; Carotid Artery, Internal ; Craniocerebral Trauma ; Diagnosis ; Epistaxis ; Hematemesis ; Humans ; Intracranial Aneurysm ; Male ; Middle Cerebral Artery ; Orbit ; Subarachnoid Hemorrhage

Compound nevus is considered to be a common benign cutaneous tumor which is composed of nevus cells containing melanin pigment. However, compound nevus which has junctional activity has been described as actual precursors of malignant melanoma. Recently we experienced a case of compound nevus of the auditory canal, causing ear canal obstruction, intermittent hearing impairment and otorrhea in a 34-year-old female patient. The compound nevus was treated with a wide excison and full thickness skin graft by endaural approach.
Adult ; Ear Canal* ; Female ; Hearing Loss ; Humans ; Melanins ; Melanoma ; Nevus* ; Skin ; Transplants

BACKGROUND: Metabolic syndrome (MetS) is a known predictor of diabetes mellitus (DM), but whether longitudinal changes in MetS status modify the risk for DM remains unclear. We investigated whether changes in MetS status over 2 years modify the 10-year risk of incident DM. METHODS: We analyzed data from 7,317 participants aged 40 to 70 years without DM at baseline, who took part in 2001 to 2011 Korean Genome Epidemiology Study. Subjects were categorized into four groups based on repeated longitudinal assessment of MetS status over 2 years: non-MetS, resolved MetS, incident MetS, and persistent MetS. The hazard ratio (HR) of new-onset DM during 10 years was calculated in each group using Cox models. RESULTS: During the 10-year follow-up, 1,099 participants (15.0%) developed DM. Compared to the non-MetS group, the fully adjusted HRs for new-onset DM were 1.28 (95% confidence interval [CI], 0.92 to 1.79) in the resolved MetS group, 1.75 (95% CI, 1.30 to 2.37) in the incident MetS group, and 1.98 (95% CI, 1.50 to 2.61) in the persistent MetS group (P for trend <0.001). The risk of DM in subjects with resolved MetS was significantly attenuated compared to those with persistent MetS over 2 years. In addition, the adjusted HR for 10-year developing DM gradually increased as the number of MetS components increased 2 years later. CONCLUSION: We found that discrete longitudinal changes pattern in MetS status over 2 years associated with 10-year risk of DM. These findings suggest that monitoring change of MetS status and controlling it in individuals may be important for risk prediction of DM.
Diabetes Mellitus ; Epidemiology ; Follow-Up Studies ; Genome ; Life Style ; Proportional Hazards Models

BACKGROUND AND OBJECTIVES: Clinical differentiation of peritonsillar abscess from peritonsillar cellulitis can be difficult and often relies on diagnostic needle aspiration that is invasive. The differential diagnosis of the two conditions is very important for the planning of treatment. This study is to evaluate the usefulness of gray scale image (GSI) and color doppler image (CDI) using intraoral ultrasonography in differential diagnosis of the peritonsillar abscess from peritonsillar cellulitis. MATERIALS AND METHODS: Twenty patients with suspected peritonsillar abscess were included in this study. GSI and CDI of the intraoral ultrasonography with 7-MHz curved linear array transducer were used. RESULTS: The peritonsillar abscess showed inhomogeneously hypoechoic or cystic space on GSI and rim-shaped color flow signal on CDI. The peritonsillar cellulitis showed homogeneously hypoechoic or striated textual appearance on GSI and diffusely increased color signal on CDI. The sensitivity of GSI for diagnosis of peritonsillar abscess and peritonsillar cellulitis was 91.7% and 77.8%, respectively, whereas the specificiy of CDI proved to be 100% for the diagnosis of both conditions. CONCLUSION: This study demonstrates that intraoral ultrasonography is a useful and noninvasive technique for diagnosis of peritonsillar abscess.
Cellulitis ; Diagnosis* ; Diagnosis, Differential ; Humans ; Needles ; Peritonsillar Abscess* ; Transducers ; Ultrasonography*

Objective: Endovascular coil embolization is the primary treatment modality for intracranial aneurysms. However, its long-term durability remains of concern, with a considerable proportion of cases requiring aneurysm reopening and retreatment. Therefore, establishing optimal follow-up imaging protocols is necessary to ensure a durable occlusion. This study aimed to develop guidelines for follow-up imaging strategies after endovascular treatment of intracranial aneurysms. Methods: A committee comprising members of the Korean Neuroendovascular Society and other relevant societies was formed. A literature review and analyses of the major published guidelines were conducted to gather evidence. A panel of 40 experts convened to achieve a consensus on the recommendations using the modified Delphi method. Results: The panel members reached the following consensus: 1. Schedule the initial follow-up imaging within 3-6 months of treatment. 2. Noninvasive imaging modalities, such as three-dimensional time-of-flight magnetic resonance angiography (MRA) or contrast-enhanced MRA, are alternatives to digital subtraction angiography (DSA) during the first follow-up. 3. Schedule mid-term follow-up imaging at 1, 2, 4, and 6 years after the initial treatment. 4. If noninvasive imaging reveals unstable changes in the treated aneurysms, DSA should be considered. 5. Consider late-term follow-up imaging every 3–5 years for lifelong monitoring of patients with unstable changes or at high risk of recurrence. Conclusions The guidelines aim to provide physicians with the information to make informed decisions and provide patients with high-quality care. However, owing to a lack of specific recommendations and scientific data, these guidelines are based on expert consensus and should be considered in conjunction with individual patient characteristics and circumstances.