No abstract available.
Aneurysm* ; Angiography* ; Circle of Willis*

No abstract available.
Arteriovenous Fistula*

Congenital anomaly of the extrahepatic biliary system is relatively common, especially vascular variations are much more frequent than anatomic variations. The normal anatomical structure is encountered in only 35 percent of individuals, many of these variations have little or no clinical improtance, but some cases induce symptoms and signs or may lead to incorrect diagnosis and inappropriate management. These are very important to correct diagnosis of biliary variations observed during ultrasonography, cholangiography and endoscopic retrograde cholangiopancreatography(ERCP) and to accurate management by surgeon or endoscopist since accidental section or ligation of aberrant structures can lead to serious complications. We experienced a very rare case of extrahepatic bile duct anomaly confirmed by ERCP. The right and left extrahepatic ducts were connected at the level of the pancreatic segment of the common bile duct and the cystic duct drains to the right extrahepatic duct. There were several stones in the distal portion of the left extrahepatic duct and gallbladder.
Bile Ducts, Extrahepatic* ; Cholangiography ; Cholangiopancreatography, Endoscopic Retrograde ; Choledocholithiasis ; Common Bile Duct ; Cystic Duct ; Diagnosis ; Gallbladder ; Ligation ; Ultrasonography

Congenital anomaly of the extrahepatic biliary system is relatively common, especially vascular variations are much more frequent than anatomic variations. The normal anatomical structure is encountered in only 35 percent of individuals, many of these variations have little or no clinical improtance, but some cases induce symptoms and signs or may lead to incorrect diagnosis and inappropriate management. These are very important to correct diagnosis of biliary variations observed during ultrasonography, cholangiography and endoscopic retrograde cholangiopancreatography(ERCP) and to accurate management by surgeon or endoscopist since accidental section or ligation of aberrant structures can lead to serious complications. We experienced a very rare case of extrahepatic bile duct anomaly confirmed by ERCP. The right and left extrahepatic ducts were connected at the level of the pancreatic segment of the common bile duct and the cystic duct drains to the right extrahepatic duct. There were several stones in the distal portion of the left extrahepatic duct and gallbladder.
Bile Ducts, Extrahepatic* ; Cholangiography ; Cholangiopancreatography, Endoscopic Retrograde ; Choledocholithiasis ; Common Bile Duct ; Cystic Duct ; Diagnosis ; Gallbladder ; Ligation ; Ultrasonography

Supratentorial hemangioblastomas are rare tumors. The first documented case of congenital cystic supratentorial hemangiblastoma associated with intracystic hemorrhage is presented; it occurred in a 38-day-old male infant.
Hemangioblastoma* ; Hemorrhage* ; Humans ; Infant ; Male

Lymphangioma is a rare benign developmental vascular tumor that may be found in orbit, skull and elsewhere in head and neck. Few cases of extension of this benign but insidious tumor posteriorly out of the bony orbital cavity have been reported. The patient was 40-year-old man complaining of proptosis of right eye for one month. Physical examination revealed severe right exophthalmus, impairment of eyeball movement in all directions. Visual acuity was much impaired and he could percept only light with right eye. CT and MRI scans showed intraconal and extraconal involvement of ill-defined, heterogenous mass with extension of the tumor posteriorly beyond the orbital cavity involving right frontal and temporal lobe, skull and subcutaneous tissue. The tumor was subtotally removed via orbito-frontal approach without damaging vital neural and orbital component. Then, orbital roof reconstruction and cranioplasty were done with resin. Successful surgical removal of lymphangioma is very difficult due to its severe infiltration to surrounding tissue and tendency to bleed during debulking. We report a rare case of orbital cavernous lymphangioma with intracranial extension treated with surgical decompression, with review of literatures.
Adult ; Decompression, Surgical ; Exophthalmos ; Head ; Humans ; Lymphangioma* ; Magnetic Resonance Imaging ; Neck ; Orbit* ; Physical Examination ; Skull ; Subcutaneous Tissue ; Temporal Lobe ; Visual Acuity

Cytomegalovirus(CMV) is one of the leading cause of intrauterine infections of man with an incidence ranging from 0.48% to 2.2% of all live births. Although the majority of CMV-infected newborns are clinically asymptomatic at birth, some will have signs of congenital infection : Intrauterine growth retardation, petechial or purpuric rash, microcephaly, anemia, thrombocytopenia, jaundice, hepatosplenomegaly and intracranial calcification. We experienced a case of symptomatic congenital CMV infection in a 1-day-old male who presented generalized petechiae, hepatosplenomegaly, anemia, thrombocytopenia. Urine PCR and viral culture for CMV were positive, and a brain CT revealed ventriculomegaly and periventricular calcification. And auditory evoked potential revealed left sensorineural hearing loss. He received ganciclovir treatment for 6 weeks, was discharged in good health, and continued conunder follow-up at the outpatient department.
Anemia ; Brain ; Cytomegalovirus Infections* ; Cytomegalovirus* ; Evoked Potentials, Auditory ; Exanthema ; Fetal Growth Retardation ; Follow-Up Studies ; Ganciclovir ; Hearing Loss ; Hearing Loss, Sensorineural ; Hearing* ; Humans ; Incidence ; Infant, Newborn ; Jaundice ; Live Birth ; Male ; Microcephaly ; Outpatients ; Parturition ; Polymerase Chain Reaction ; Purpura ; Thrombocytopenia

Between January 1995 and May 1998, 177 patients with proven lumbar disc herniation were treated by microdiscectomy or by percutaneous endoscopic discectomy(PED). Among them, 43(24.2%) patients underwent PED and were followed for long term outcome. We included only those patients who were followed up more than 13 months. Three patients who did not improved immediately after PED and underwent microdiscectomy were excluded for this study. Of remaining 40 patients, there were 22 men and 18 women who ranged in age from 23 to 68 years (mean 38.1 years). The disc herniations were located at L1-2(1), L2-3(1), L3-4(1), L4-5(26) and L5-S1(11). Three patients were treated by biportal approach. The mean follow up period was 34.7 months(range 13-47 months). Overall, excellent and good results were achieved in 12(30%) and 19(47.5%) patients, and fair and poor results in 7(17.5%) and 2(5%) patients, respectively. Thirty-eight(95%) patients returned to their previous works and the mean duration was 5.7 months. Thirty-three(82.5%) patients answered that they would recommend this procedure to others. There was no complication except for one patient who suffered from discitis. The indication of PED is restricted to contained or small subligamentous lumbar disc herniation without stenosis, spondylolisthesis and sequestration. PED can be performed under local anesthesia and tissue trauma, risk of epidural scarring, hospitalization time and postoperative morbidity are minimal. The result of the present study justify the assumption that PED can be a surgical alternative for patients suitable for its indications.
Anesthesia, Local ; Cicatrix ; Constriction, Pathologic ; Discitis ; Diskectomy* ; Female ; Follow-Up Studies ; Hospitalization ; Humans ; Male ; Spondylolisthesis

To help clarify the comparative effects of percutaneous endoscopic discectomy and microsurgical discectomy in the treatment of lumbar disc herniation, the authors studied 37 consecutive patients with discogenic symptoms who had not responded to conservative treatment. Their indications are restricted to discogenic root compression with"contained"or small"noncontained"lumbar disc. Patients with sequestrated disc, spinal stenosis, or spondylolisthesis were excluded. All patients underwent magnetic resonance imaging and if the radiological interpretation was confused with extruded migrated disc, a discogram was also obtained. Of the 37 patients, 18 underwent percutaneous endoscopic discectomy and 19, microsurgical discectomy. In order to compare the efficacy of the two methods, both groups were investigated. Disc herniations were located at L4-5(24 patients), L5-S1(11 patients), or L4-5 and L5-S1(2 patients). With regard to age and sex distribution, preoperative complaints, and clinical symptoms, there were no differences between the two groups. At the last follow-up evaluation after percutaneous endoscopic discectomy, low back pain had disappeared in three patients(17.6%), sciatica in nine(50.0%), sensory deficits in two(16.7%), motor deficits in three(42.5%), and reflex differences in one (50%). After microsurgical discectomy, low back pain had disappeared in one patient(5.6%), sciatica in nine(47.4%), sensory deficits in five(33.3%), motor deficits in six(66.7%), and reflex differences in three(75.0%). In 83.3% of patients in the percutaneous endoscopic discectomy group, the outcome was successful(excellent or good result), compared with 78.9% of those who had undergone microsurgical discectomy. One patient in the percutaneous endoscopic discectomy group suffered from discitis. For patients with"contained"or slight subligamentous lumbar disc herniations, percutaneous endoscopic discectomy offers a surgical alternative.
Discitis ; Diskectomy* ; Follow-Up Studies ; Humans ; Low Back Pain ; Magnetic Resonance Imaging ; Reflex ; Sciatica ; Sex Distribution ; Spinal Stenosis ; Spondylolisthesis

Hypotension is one of the well-known complications following spinal anesthesia, and Trendelenburg position seems to have been used as one of the management of it. But, Trendelenburg position generally raises spinal anesthetic level with the use of hyperbaric tetracaine, and blood pressure may even further decrease. If simple elevation of lower extemities can prevent hypotension successfully without raising spinal anesthetic level following hyperbaric spinal anesthesia, there will be a possibility for us to replace Trendelenburg position with the elevation of lower extremities. We examined 50 cases of hyperbaric spinal anesthesia followed by elevation of lower extremities with the angles of l5 and 30 degrees. At each case, hydration with 10 ml per Kg was performed during the fixation time (about 30 minutes) and then, blood pressure(systolic and diastolic), heart rate were checked with the time-interval of 1 and 2 minutes for each angle. The paired T-test showed that systolic and diastolic blood pressure after spinal anesthesia was increased in all cases with mean values of 2.74~5.68 mmHg for systolic blood pressure(p<0.05) and 3.26~7.22 mmHg for diastolic blood pressure(p<0.05), and that heart rate was decreased by 3.54-5.82 beats per minute(p<0.05). In conclusion, simple elevation of lower extremities and routine hydration therapy seemed to elevate blood pressure, making it possible for us to consider elevation of lower extremities to prevent hypotension without raising spinal anesthetic level in routine hyperbaric spinal anesthesia.
Anesthesia, Spinal* ; Blood Pressure ; Head-Down Tilt ; Heart Rate ; Hemodynamics* ; Hypotension ; Lower Extremity ; Tetracaine