Three cases of cerebral rete mirabile associated with aneurysms are presented. In two cases the aneurysms were located at the anterior communicating arteries, and in one at the peripheral portion of the middle cerebral artery. For the anterior communicating artery aneurysms, operations were performed. Based on these experiences, the difficulties and necessities of operations for the aneurysms associated with cerebral rete mirabilies are briefly discussed.
Aneurysm* ; Arteries ; Intracranial Aneurysm ; Middle Cerebral Artery ; Mirabilis ; Moyamoya Disease*

A gas forming brain abscess that was resistant to treatment with antibiotics, blycerol, and steroids is reported. A CT scan showed a frontal epidural gas shadow which progressed in 3 weeks to massive frontal cerebritis with gas within the abscess, ventricle, and basal cisterns. An anaerobic culture of CSF revealed peptostreptococus, which was been increasing recently as a causative organism in brain abscess. We feel that the primary management of brain abscess should be surgical excision followed by appropriate antibiotic therapy.
Abscess ; Anti-Bacterial Agents ; Brain Abscess* ; Brain* ; Peptostreptococcus* ; Steroids ; Tomography, X-Ray Computed

Acoustic neurinoma are the most frequent tumors in the region of the cerebellopontine angle. They usually present with a gradual onset of symptoms and slow progression. Development of spontaneous hemorrhage with sudden aggravation of symptoms is rare. The authors present a case of acoustic neurinoma associated with a spontaneous intratumoral hemorrhage. Sudden aggravation of symptoms was noticed. The cranial computed tomography revealed multiple blood-fluid levels within the cysts of the tumor which was located in the region of the right cerebellopontine angle. Operation was performed, which confirmed recent hemorrhage within the tumor. Pathological study revealed a typical neurilemmoma associated with hemorrhage, vascular proliferation and macrophages which phagocytosed hemosiderin pigments. The rare sudden aggravation of symptoms in cases of acoustic neurinoma may suggest hemorrhage.
Acoustics* ; Cerebellopontine Angle ; Hemorrhage* ; Hemosiderin ; Macrophages ; Neurilemmoma ; Neuroma, Acoustic*

Two cases of calcified pituitary adenoma are reported, which comprise 2.44% among a surgical series of 82 pituitary adenomas. Both patients had very high serum prolactin level, which suggested the possibility of hormonal influence in formation of the calcification. The tumors were removed by a subfrontal approach to prevent and reduce possible damage to the surrounding structures.
Humans ; Pituitary Neoplasms* ; Prolactin

The authors report a case of pterional meningioma invading the sphenoid bone, orbital roof and lateral orbit, and temporal bone with hyperostosis, which extended into temporal muscle. Extensive removal of orbital, sphenoid and basal skull bone was carried out with total excision of tumor mass in and out of the cranium. Preoperative exophthalmos still remained postoperatively. The mode of extension, result of surgery and CT findings are discussed.
Exophthalmos ; Hyperostosis ; Meningioma* ; Orbit ; Skull ; Sphenoid Bone ; Temporal Bone ; Temporal Muscle

The lumbar discectomy has steadily improved since its introduction by Mixter and Barr in 1934. The results of standard discectomy are good, but surgeons must still contend with the "failed disc" syndrome. This is most likely caused by excessive damage to the contents of the epidural space during surgery. The application of microsurgical techniques to lumbar discectomy greatly minimizes disruption of the integrity of normal anatomy. Meticulous hemostasis may help to speed the process of convalescene, and the retention of epidural fat around the nerve root may help to prevent adhesions, which is a common cause of late, "failed disc" syndrome. High resolution computerized tomography of the lumbar spine provides an accurate means of preoperatively assessing both bony and soft tissue pathology of the spine, including nerve roots and the thecal sac. The author reviewed 84 cases of microsurgery of herniated lumbar discs at Yonsei University, Severance hospital and Young Dong hospital from April, 1982 to August, 1982 to August, 1983. Conclusions: 1) Among 84 patients, the ratio of male to female was 1.63:1(52pts:32pts) and cases in the 3rd and 4th decades were 60.7% of the total. 2) The most frequent level of herniation was L4-5 intervertebral space(73%), left side. 3) In preoperative studies, a spinal CT scan was taken in 78pts(93%), and in 31pts(37%), a spinal CT scan alone was taken. The accuracy of spinal CT scan was 100%. 4) Of operative findings, 50 lesions(60%) were identified as protruding discs and 34 lesions(18.1%) as ruptured ones. 5) Among 84 cases, 31pts(37%) received flavotomy and 53pts(63%) received flavectomy or small partial hemilaminectomy. 6) The advantages of microsurgery of herniated lumbar discs were magnified vision and brilliant illumination, precise identification of structures in deep fields(including nerve root and its related structures), a marked advantage to dissect the adhered nerve root to its surrounding structures, its capacity to preserve the integrity of normal tissue, and meticulous hemostasis. This resulted in marked reduction in immediate postoperative pain, early ambulation and early discharge. 7) 100% of microsurgery for herniated lumbar disc disclosed from good to excellent results. 8) After microsurgery, no cases needed re-operation and there were no recurrent disc herniations.
Diskectomy ; Early Ambulation ; Epidural Space ; Female ; Hemostasis ; Humans ; Lighting ; Male ; Microsurgery* ; Pain, Postoperative ; Pathology ; Spine ; Tomography, X-Ray Computed

PURPOSE: The value of carcinoembryonic antigen(CEA) and carbohydrate antigen 19-9(CA19-9) in periampullary cancers have not been clearly established. Diagnostic and prognostic values of these two markers in resectable periampullary cancer were clarified in this study. METHODS: Preoperative serum levels of CEA and CA19-9, and clinicopathologic features were reviewed in 151 surgical patients with periampullary cancer who were admitted in department of General Surgery of Seoul National University Hospital from Feb. 1996 to Dec. 2000. Postoperative serum levels of these tumor markers were also reviewed. For comparison with benign disease, preoperative serum levels of these tumor markers in GB stone patients were reviewed. After resection, serial tumor markers had been followed up. Disease recurrence was confirmed by imaging study. RESULTS: The CA19-9 concentration was above the cut-off limit (37U/ml) in 60.8% and the CEA concentration was above the cut-off limit(5ng/ml) in 10.5% of the periampullary cancer. Preoperative serum CEA and CA19-9 did not demonstrate the TMN stage, pathologic differentiation and the tumor size. The difference between the survival curves of the preoperative serum CA19-9 level (cut-off 100U/ml) was highly significant (p<0.05) in ampullary cancer. After curative resection, the serum CEA and CA19-9 level were decreased below cut-off level (5ng/mg in CEA, 37U/ml in CA19-9) in 55.6% and 71.2% of total periampullary cancer patients respectively. The mean survival period of the group with normalized CA19-9 level after surgery was significantly longer than that of the group with persistent elevated serum CA19-9 level (52.18 vs 21month, p<0.005) in ampullary cancer. The recurrent sensitivities of the CA19-9 were 57%, 50%, 67% in ampullary cancer cancer, distal CBD cancer, pancreatic head cancer respectively. CONCLUSION: Serial check of serum levels of the CA19-9, CEA is useful in diagnosis and recurrence detection in periampullary cancer.
Diagnosis ; Head and Neck Neoplasms ; Humans ; Pancreatic Neoplasms ; Recurrence ; Seoul ; Biomarkers, Tumor

BACKGROUND/AIMS: After common bile duct exploration, placement of drainage tube was accepted as the standard treatment for choledocholithiasis patients. But placement of the drainage tube may create several complications including bile leakage. We undertake primary common bile duct closure with temorary antegrade stent after common duct exploration in cholodocholithiasis patients to prevent the complications due to drainage tube. METHODS: Between Febuary 1999 and January 2001, 38 patients underwent primary common bile duct closure with antegrade stent after common bile duct exploration without the placement of drainage tube. The study population included 19 men and 19 women with a median age of 61 years (range 26 to 84 years). Laparoscopic choledochotomy was perfromed in 10 patients . Open choledochotomy was performed in 28 patients. Antegrade stent was inserted using choledochoscope. RESULTS: Postoperative hospital stay of the laparoscopic choledochotomy patients were 6 +/- 1.8 days and of the open choledochotomy patients were 10 +/- 4.3 days. Antegrade stent was spontneously passed through the papailla and disappeared in the abdomen in 22 +/- 12.4 days postoperatively. Treatment-related morbidity was seen in 2 cases ( 5.3 %). CONCLUSION: Primary common bile duct closure with temporary antegrade stent after common bile duct exploration is a safe, effective alternative to the routine T-tube drainage in the choledocholithiasis patients.
Abdomen ; Bile ; Choledocholithiasis* ; Common Bile Duct* ; Drainage ; Female ; Humans ; Length of Stay ; Male ; Stents*

BACKGROUND/AIMS: Intrahepatic duct stone (IHDS) present serious health problem in East Asian countries including Korea because of recurrent or residual stones and stones induced hepatic damage. Hepatic resection is known as most definitive procedure especially in patients with ductal stricture, but postoperative morbidity and residual or recurrent stones are still high. METHODS: We analyzed early and late complication according to type of hepatic resection in IHDs (38 cases) and also determined the predisposing factors related to complication. RESULTS: Location of IHDs was left in 30 cases (78.9%), right in 1 case (2.7%), both in 7 cases (18.4%), and 28 cases (73.7%) had concomitant extrahepatic duct stone. The type of hepatic resection was left lateral segmentectomy in 24 cases (63.2%), left lobectomy in 11 cases (28.9%) and right lobectomy in 3 cases (7.9%). Overall complication rate was 44.7% and it was increased by extension of resection (p<0.05). Overall incidence of residual or recurrent stone was 36.8% and it was higher in patients with left lateral segmentectomy and without biliary drainage procedure although statistically not significant. The postoperative mortality was 11.8% (2 cases). CONCLUSIONS: Hepatic resection can be a curative therapy in IHDS and routine use of intraoperative choledochoscopy and additional drainage procedures are recommended to minimize the incidence of residual or recurrent stones.
Asian Continental Ancestry Group ; Causality ; Constriction, Pathologic ; Drainage ; Humans ; Incidence ; Korea ; Mastectomy, Segmental ; Mortality

BACKGROUND/AIMS: Vascular endothelial growth factor (VEGF) is one of the most potent angiogentic factors in several tumors including hepatocellular carcinoma (HCC). This study was planned to evaluate the correlation between the expression patterns of VEGF and the clinicopathologic features of patients with HCC. METHODS: Twenty-seven patients with curatively resected HCCs were included in this study. To determine the expression patterns of VEGF, western blotting and immunohistochemical staining were performed using polyclonal rabbit VEGF IgG (Santa Cruz, CA) as a primary antibody. These results were compared and analyzed to clinicopathologic features of patients. RESULTS: In Western blotting, Only 5 cases exhibited higher VEGF expression (T/N > or = 0.8) in tumorous region, which was well correlated to the immunohistochemical staining. Between higher and lower VEGF expression group, there were no significant differences in the hypervascularities on angiography or microangiogenic invasions on histologic finding. Other clinicopathologic factors had no significances on VEGF expression. Two year disease-free suvival rate in higher VEGF expression group was 20.0%, which was significantly lower than 73.7% in lower VEGF expression group (p=0.02). But, in two year overall suvival rate, there were no differences between two groups (80.0% vs 82.8%; p=0.80). CONCLUSION: In this study, higher VEGF expression seems to be correlated with higher recurrence rate of HCC. Wide-based prospective study is needed to confirm the potentiality of VEGF expression as a prognostic factor of HCC.
Angiography ; Blotting, Western ; Carcinoma, Hepatocellular* ; Humans ; Immunoglobulin G ; Immunohistochemistry ; Recurrence ; Vascular Endothelial Growth Factor A*