Intracranial arachnoid cyst are becoming a more frequent finding as a result of the increased use of cranial computed tomography. But the best treatment of arachnoid cysts remains the subject of controversy. We report 46 cases of patients with arachnoid cyst. Thirty nine cases(84.7%) had supratentorial locations. The cases of 22 patients with mild symptoms and small cysts were treated with conservative management only. Surgical treatment was performed on 24 patients with severe or uncontrolled symptoms and large sized cysts. Surgery consisted of craniotomy and cyst excision with communication to basal cistern. Surgical results and long-term outcomes were good. However there was a one operative death due to acute subdural hematoma. It is, therefore conclued that surgical excision of arachnoid cyst with communication to basal cistern is one of the more effective methods of alternative treatment. And further studies of the natural history of conservative cases should be undertaken for a futher understanding.
Arachnoid Cysts ; Arachnoid* ; Craniotomy ; Hematoma, Subdural, Acute ; Humans ; Natural History

Aneurysms of the vertebral artery are relatively uncommon. Diagnois and treatment of such condition aneurysm has a potentially higher degree of technical difficulty. We retrospectively analyzed the clinical features and therapentic outcomes of 12 consecutive patients with vertebral aneurysms that we have encountered during the last 11 years. Most of these aneurysms occured in females (9 of 12). Eight patients presented as classic subarachnoid hemorrhage, three were diagnosed incidentally, and the other one patient had fusiform aneurysm presented with mass effect. Among the 12, there were 7 saccular aneurysms, 2 fusiform aneurysms, and 3 dissecting aneurysms. Eight of these were located at the origin of the posterior inferior cerebellar artery(PICA), two were at the junction of the vertebral and basilar arteries, and two were at the distal portion of PICA. Direct neck clipping was performed in 8 patients and proximal ligation of the vertebral artery was done in 4 patients due to the impossibility of direct neck clipping. Eleven of them experienced no major morbidity. However, one patient with fusiform aneurysm treated by vertebral artery clipping developed right cerebellar hemispheric infarction. Unfortunately this patient died 10 months after surgery due to lung abscess related to Behcet's disease.
Aneurysm* ; Aneurysm, Dissecting ; Basilar Artery ; Female ; Humans ; Infarction ; Ligation ; Lung Abscess ; Neck ; Pica ; Retrospective Studies ; Subarachnoid Hemorrhage ; Vertebral Artery

Aspergillus tracheobronchitis is one form of invasive pulmonary aspergillosis which is characterized by ulcers and pseudomembrane formation in tracheobronchial tree. In Aspergillus tracheobronchitis, the infection is often limited to the mucosa and it accounts for less than 10 percents of invasive disease. Invasive aspergillosis mainly occurs in immunocompromized patients with prolonged neutropenia, advanced AIDS, organ transplantation, high-dose glucocorticoid therapy or cytotoxic therapy although it can occur in less immunocompromised patients, such as after influenza, COPD, old age, and diabetes. We report a case of Aspergillus tracheobronchitis in a 61 year-old patient with diabetes and Child Pugh class A liver cirrhosis. He presented with cough and purulent sputum for 10 days. He was diagnosed by bronchoscopy and successfully treated with antifungal therapy.
Aspergillosis ; Aspergillus ; Bronchitis ; Bronchoscopy ; Child ; Cough ; Diabetes Mellitus ; Humans ; Immunocompromised Host ; Influenza, Human ; Invasive Pulmonary Aspergillosis ; Liver Cirrhosis ; Mucous Membrane ; Neutropenia ; Organ Transplantation ; Pulmonary Disease, Chronic Obstructive ; Sputum ; Transplants ; Ulcer

Behcet's disease is chronic, relapsing, multi-systemic inflammatory vasculitis. Unlikely the other autoimmune diseases, gastric non-Hodgkin's lymphoma has rarely been reported in a patient with Behcet's disease. We report here on a 40-year-old man who had Behcet's disease for several years and who suffered recurrent oral ulcer, genital ulcer and skin lesion. The patient was treated with azathioprine and intermittent oral steroid. He complained of epigastric pain for 1 month, and he had a large ulcerative lesion seen on endoscopic evaluation. We confirmed the lesion was a gastric, diffuse, large B cell lymphoma by endoscopic biopsy. The patient was treated with the rituximab-CHOP regimen, and he has achieved a complete remission for 3 years. We report here on a case of gastric non-Hodgkin's lymphoma in a patient with Behcet's disease and who also had an ileocecal valve ulcer.
Adult ; Autoimmune Diseases ; Azathioprine ; Biopsy ; Humans ; Ileocecal Valve ; Lymphoma ; Lymphoma, B-Cell ; Lymphoma, Non-Hodgkin ; Oral Ulcer ; Skin ; Stomach ; Ulcer ; Vasculitis

Surgery of aneurysms around the basilar bifurcation artery is still one of the most difficult and challenging operations in the field of neurosurgery, because of their rare occurrences, unfamiliar anatomy and deeply located lesions. Two major surgical approaches, pterional approach and subtemporal approach, are conventionally used for upper basilar artery aneurysm. Neither approach, however, ensures easy treatment of high basilar bifurcation aneurysm, because there is always the chance of excessive retraction of the brain, nerves and vessels. In order to gain sufficient exposure of highly placed basilar bifurcation aneurysms, the surgical approach needs to be in the direction in which the surgeon can see the interpeduncular fossa from below. In an attempt to gain better exposure of these lesions, neurosurgeons have used a variety of surgical approaches. We have used forntosupraorbital(FSO) approach and orbitozygomatic temporopolar(OZTP) approach for seven cases of high basilar aneurysm including basilar bifurcation artery-SCA aneurysm. The advantage of these approaches are multidirectional view, wide operative field, less brain retraction and easy application of temporary clip. Therefore, authors would like to recommended these approaches in case of for high basilar aneurysm as a effective method of aneurysmal neck clipping.
Aneurysm* ; Arteries ; Brain ; Intracranial Aneurysm ; Neck ; Neurosurgery

Esophageal involvement in tuberculosis is rare, and the clinical presentation may mimic an esophageal submucosal tumor. A 30-year-old woman presented with dysphagia for 1 month. At esophagoscopy, a 3-cm subepithelial mass with normal covering mucosa was found 28~25 cm from the upper incisors. We diagnosed the lesion as a submucosal tumor of the esophagus and performed endoscopic ultrasonography 1 week after the first examination. The second endoscopy showed a large, linear ulceration on the same subepithelial mass. The histologic examination obtained following an endoscopic biopsy revealed chronic granulomatous inflammation, and a molecular nested PCR study for Mycobacterium tuberculosis was positive. The final diagnosis was mediastinal tuberculous lymphadenitis with invasion into the esophagus. We suggest the use of molecular biology techniques when there is a strong clinical suspicion of tuberculosis and difficulty in arriving at a definite diagnosis.
Adult ; Biopsy ; Deglutition Disorders ; Endoscopy ; Endosonography ; Esophagoscopy ; Esophagus ; Female ; Humans ; Hydrazines ; Incisor ; Inflammation ; Mediastinum ; Molecular Biology ; Mucous Membrane ; Mycobacterium tuberculosis ; Polymerase Chain Reaction ; Tuberculosis ; Tuberculosis, Lymph Node ; Ulcer