Giant serpentine aneurysm(GSA) is a giant aneurysm containing a serpentine channel which enters and exits at separate sites and is continuous with the parent vessel. This 33-year-old man with a two-year history of frontal headache presented with bitemporal hemianopsia three months before admission. Suprasellar mass of computed tomography revealed a giant(3X2.5X2cm) mixed density, mimicking a brain tumor. Cerebral magnetic resonance images showed a flow void within the mass, and this was consistent with the serpentine vascular channel demonstrated by angiography. The aneurysm was revealed by surgery involving the frontobasal interhemispheric approach, left A1 & A2 were clipped and the mass of the aneurysm was removed in toto an aneurysmorrhaphy was constructed, and to preserve the distal blood flow to the left A2, the patient made an unevenful recovery.
Adult ; Aneurysm* ; Angiography ; Arteries* ; Brain Neoplasms ; Headache ; Hemianopsia ; Humans ; Parents

Adirect intracranial operative approach with clipping the neck of the aneurysm is generally considered to be the ideal treatment for the intracranial arterial aneurysms. Several strategies exist for treating unclippable aneurysms. Intravascular techniques, proximal occlusion of the parent artery or trapping of the aneurysm, microsurgical bypass of the involved arterial segment, and reinforcement or wrapping of the aneurysmal wall are frequently used. The authors report a case with long term(6 years) follow-up results of the circumferential wrapping with sutures-reinforcement for giant fusiform aneurysm of the internal carotid artery. The giant fusiform aneurysm and ideal wrapping materials were discussed with review of literature.
Aneurysm* ; Arteries ; Carotid Artery, Internal ; Endovascular Procedures ; Follow-Up Studies ; Humans ; Neck ; Parents ; Sutures

No abstract available.
Headache* ; Humans

This study investigated calcium/calmodulin kinase II (CaMKII) activity related to long-standing neuronal injury of the hippocampus in kainate (KA)-induced experimental temporal lobe epilepsy. Epileptic seizure was induced by injection of KA (1 g/L) dissolved in phosphate buffer (0.1 M, pH 7.4) into the left amygdala. Clinical seizures, histopathologic changes and CaMKII activity of the hippocampus were evaluated. Characteristic early limbic and late seizures were developed. Hippocampal CaMKII activity increased significantly 4 and 8 weeks after intra-amygdaloid injection of KA, when late seizures developed. The histopathologic changes of the hippocampus included swelling of neuronal cytoplasm with nuclear pyknosis and loss of neurons in CA3 during this period. The increased activity of CaMKII may correlate with appearance of distant damage in the hippocampus. The above results indicate that intra-amygdaloid injection of KA produces excitatory signals for ipsilateral CA3 neurons in the hippocampus and that subsequently increased levels of CaMKII in postsynaptic neurons induce neuronal injury via phosphorylation of N-methyl-D-aspartate type glutamate receptor.
Animal ; Ca(2+)-Calmodulin Dependent Protein Kinase/*metabolism ; Epilepsy, Temporal Lobe/chemically induced/*enzymology/pathology ; Hippocampus/*enzymology/pathology ; Kainic Acid/*toxicity ; Long-Term Potentiation/drug effects ; Male ; Rats ; Rats, Wistar

OBJECTIVE: This study was undertaken to study pedicle morphology in Koreans to provide a reference guide in transpedicular screw fixation. METHODS: Pedicle measurements were obtained from 35 dried human lumbar columns(175 lumbar vertebrae). Anatomic evaluation was focused on pedicle transverse diameter, pedicle axis length and the distance from the pedicle axis point to the midline of the transverse process. Pedicle angle and vertebral body length also were measured. RESULT: In the transverse plan, pedicle diameter increased from L1(7.8mm) to L5(15.5mm). But in 20.0% of L1 and L2, its diameters was under 6.0mm. In the sagittal plan, it was not as constant and had similar diameter from L1 to L5. In the transverse plan, the pedicle angle increased from L1 to L5. But in the sagittal plan it decreased from L1 to L5. Also, the pedicle axis length did not show concordant change, but rather had similar length in lumbar vertebrae. In 15%, its length was under 45mm. CONCLUSION: These results suggest that using above 6mm diameter and 45mm length of screw for L1 and L2 can violate the pedicle and vertebrae. Above L4, the pedicle axis point was superior to the midline of the transverse process, below L4, it was inferior to the midline of the transverse process. This information may prove to be helpful when contemplating the placement of screws to the lumbar pedicles.
Axis, Cervical Vertebra ; Humans ; Lumbar Vertebrae* ; Spine

Microsurgical anterior foraminodiscectomy was developed to improve the surgical result of cervical radiculopathy. We reviewed 40 patients with cervical spondylosis after anterior foraminodiscectomy with or without bony fusion over 5 years. The tunnel of anterior foraminodiscectomy was made at lateral one-third of the disc trajectory to intersect the uncinate process at the level of neuroforamen. The compressed nerve root and spinal cord were decompressed by removing the spondylotic spur and disc. The most common presenting symtom was radiating pain to upper extremity. The most frequent site of involvement was the C5-6. Operation of one level was performed in 57% of cases, 2 levels in 40% of cases and three levels in 3%. Of the 40 cases, interbody fusion was performed in 45% of cases. In 92.5% of the patient, the outcome was excellent or good based on Odom's criteria. Postoperative complications were encountered in 7.5%. The correlation between the clinical factors and postoperative results was assessed. As to age, duration of symtoms, herniation of soft and hard disc, number of the operative levels and with and without bony fusion, the clinical results were not stastistically significant.
Humans ; Postoperative Complications ; Radiculopathy ; Spinal Cord ; Spondylosis* ; Upper Extremity

OBJECT: To determine whether to use surgical or medical therapy in treatment of infectious intracranial aneurysms, we reviewed two recent cases of infectious intracranial aneurysms and others known previous reports of aforementioned cases. Hence, we attempted to compare the validity and effectiveness of surgical and medical treatment. METHOD: Recently, we treated two cases of ruptured infectious intracranial aneurysms. In former case, the aneurysm was located distal to the middle cerebral artery in a patient with mild mitral regurgitation of the heart. In latter case, the aneurysm was multiple with varying hemorrhage. The hemorrhage was located bilaterally and a moderate mitral regurgitation and infective endocarditis were accompanied in this patient. RESULT: Due to the large size of the intracranial hematoma, stable medical condition, and easy resectability, we treated the former patient surgically. And, because of successive hemorrhage by multiple aneurysmal rupture, and the risk of heart failure, we treated the latter patient medically with serial follow-up angiography. Both patients are at present in good health. CONCLUSION: Because of the variability in associated factors, such as the patient's health, the number of lesions, location, anatomy of the aneurysms and the causative organism, each patient's care must be individualized and tailored to the patient's particular clinical situation.
Aneurysm ; Angiography ; Endocarditis ; Follow-Up Studies ; Heart ; Heart Failure ; Hematoma ; Hemorrhage ; Humans ; Intracranial Aneurysm* ; Middle Cerebral Artery ; Mitral Valve Insufficiency ; Rupture

Pheochromocytoma is derived from the chromaffin tissue. The typical finding of pheochromocytoma is paroxysmal hypertension accompanied with various signs and symptoms that are due to the excess of catecholamines or other bioactive substances. Yet the diagnosis is sometimes difficult to make because its clinical presentation is quite variable. Especially, hemoptysis is a very rare symptom, so the diagnosis is often missed or delayed. Without making the correct diagnosis and then subsequently administering treatment, the condition may be fatal. We herein report on a 68 year-old woman who was admitted because of abdominal pain and hemoptysis. The initial radiologic findings suggested pulmonary edema with alveolar hemorrhage. The urine catecholamine levels were elevated and she developed catecholamine-induced cardiomyopathy. We performed bronchial arterial embolization and we administered alpha blocker medication for controlling the hemoptysis and hypertension. After the temporary symptomatic improvement, her clinical course was aggravated by pneumonia and pulmonary edema. In spite of performing definitive surgery for pheochromocytoma, she died of postoperative hemodynamic instability.
Abdominal Pain ; Cardiomyopathies ; Catecholamines ; Female ; Hemodynamics ; Hemoptysis ; Hemorrhage ; Humans ; Hypertension ; Pheochromocytoma ; Pneumonia ; Pulmonary Edema

BACKGROUND: The polymerase chain reaction (PCR) test is important for the confirmatory diagnosis of tuberculosis (TB) caused by Mycobacterium tuberculosis. The aim of this study was to analyze the yield of repeated PCR testing in patients with confirmed pulmonary TB. METHODS: The medical records of 130 patients, who had more than two consecutive PCR tests and a M. tuberculosis-positive sputum culture from August, 2006 to December, 2007, were retrospectively reviewed for the purposes of this study. A positive TB-PCR test was defined as at least one positive test result. RESULTS: The cumulative positive PCR test rate was 80% (104/130), with gradually increasing rates of positive findings upon the first, second and third TB-PCR tests with 52.3%, 68.5% and 75.4%, respectively. However, further testing did not increase the positive rate further. CONCLUSION: Repeated PCR testing at least three times for M. tuberculosis is helpful for diagnosis of pulmonary TB.
Humans ; Medical Records ; Mycobacterium tuberculosis ; Polymerase Chain Reaction ; Retrospective Studies ; Sputum ; Tuberculosis ; Tuberculosis, Pulmonary

A 55-year old woman with advanced stage non-small cell lung cancer was admitted to hospital for the management of severe chest pain, which measured 7 out of 10 on a numerical rating scale (NRS). Despite palliative radiation and the application of multiple epidural blocks, she continued to experience severe cancer pain. We gradually increased the dose of transdermal fentanyl patches from 500 microgram/hr to 3,650 microgram/hr, for 3 months without any significant side effects. Concomitantly, adjuvant therapy with antidepressants and anticonvulsants were added, decreasing the patient's pain to NRS 3~4 down from 7. After being transferred to a hospice clinic, her chest pain was well-controlled below NRS 4 by means of strong opioid medications, including the highest dose of transdermal fentanyl 4,050 microgram/hr for more than 16 months.
Analgesics, Opioid ; Anticonvulsants ; Antidepressive Agents ; Carcinoma, Non-Small-Cell Lung ; Chest Pain ; Female ; Fentanyl ; Hospices ; Humans ; Lung ; Lung Neoplasms