BACKGROUND: Liver fibrosis evaluation is an important issue in chronic liver disease patients. We aimed to develop noninvasive liver fibrosis biomarkers based on transient elastography (TE, FibroScan®) through retrospective review of clinicopathological data. METHODS: We recruited 278 chronic hepatitis B patients who underwent Fibroscan and HBV DNA testing. A total of 115 HBeAg-positive and 159 HBeAg-negative chronic hepatitis B patients were analyzed. A total of 100 hepatitis C patients were analyzed. Successful fibroscan data, gamma-glutamyl transferase (GGT) to platelet ratio (GPR), platelet count, AST, ALT, international normalized ratio of prothrombin time, total cholesterol, triglycerides, bilirubin, mean platelet volume, AST to platelet ratio index, fibrosis index based on four factors (FIB-4), neutrophil to lymphocyte ratio (NLR), and NLR to platelet ratio were analyzed to determine the new noninvasive markers for assessing liver fibrosis. RESULTS: Elevated GPR (OR=9.1, P=0.011) and FIB-4 (OR=2.3, P=0.01) were associated with greater risk of liver fibrosis in chronic hepatitis B patients. FIB-4 (OR=6.04, P=0.005) was a risk factor for liver fibrosis in HBeAg-positive patients. FIB-4 (OR=2.371, P=0.015) and GPR (OR=33.78, P=0.003) were liver fibrosis risk factor in HBeAg-negative patients. In chronic hepatitis C patients, GGT (OR=1.033, P=0.002), triglyceride (OR=−0.990, P=0.038) and FIB-4 (OR=3.499, P=0.006) showed statistical significances. The AUCs were 0.816 in FIB-4 (P<0.001) and 0.849 in GPR (P<0.001). CONCLUSIONS: FIB-4 and GPR may be useful blood markers for assessing liver fibrosis in chronic hepatitis B and hepatitis C patients. Further well-designed prospective study is required to validate these noninvasive blood markers in clinical practice.
Area Under Curve ; Bilirubin ; Biomarkers ; Blood Platelets ; Cholesterol ; DNA ; Elasticity Imaging Techniques ; Fibrosis ; Hepatitis B ; Hepatitis B, Chronic ; Hepatitis C ; Hepatitis C, Chronic ; Hepatitis ; Hepatitis, Chronic ; Humans ; International Normalized Ratio ; Liver Cirrhosis ; Liver Diseases ; Liver ; Lymphocytes ; Mean Platelet Volume ; Neutrophils ; Platelet Count ; Prospective Studies ; Prothrombin Time ; Retrospective Studies ; Risk Factors ; Transferases ; Triglycerides

Aneurysms of the distal anterior cerebral artery (DACA) are rare and their surgical treatments present some unique difficulties from a technical standpoint. In this report, we presented our experiences of cases with DACA aneurysms, and analyzed the clinical features and prognostic factors affecting the final outcomes. Among 770 cases of intracranial aneurysms operated from 1990 to 1998, 19 cases of DACA aneurysms (2.5%) were studied retrospectively. The characteristic findings were female preponderance (M:F=1:2.8), common multiple aneurysms (57.9%), and frequent intracerebral hemorrhage (ICH) on initial brain CT scan (42.1%). All patients were operated via interhemispheric approach. Intraoperative aneurysmal rupture was developed only in 3 cases (15.8%), and had no relationship with the final outcome Fifteen out of 19 patients (78.9%) showed favorable outcome with a mortality rate of 5.3%. The follow-up data suggest that the initial ICH on brain CT scan portend a poor prognosis.
Adult ; Age Distribution ; Aged ; Cerebral Hemorrhage/mortality/pathology/surgery ; Female ; Human ; Incidence ; Intracranial Aneurysm/mortality/*pathology/*surgery ; Male ; Middle Age ; Sex Distribution ; Treatment Outcome

BACKGROUND: Although leptin and its principal mediators, neuropeptide Y (NPY) and -melanocyte stimulating hormone (MSH) are postulated to play a pivotal role in the energy balance in experimental animals, the physiologic roles of leptin and its molecular targets are not fully identified in cases of human obesity. METHODS: The subjects consisted of 16 obese women (mean BMI 35.6 kg/m2) before and after weight loss that was induced by a 2 week-very low caloric diet (800 kcal/day) and 14 normal weight women (who had a mean BMI of 20.4 kg/m2). We evaluated the plasma and cerebrospinal fluid (CSF) leptin, NPY and alpha -MSH levels and their relationship in normal weight and obese women. Additionally, changes of these peptides during a negative energy balance (800 kcal/day) were assessed in causes of human obesity. RESULTS: Obese subjects exhibited a 6.3-fold higher plasma leptin level (21.9+/-1.2 vs 3.5+/-0.4 ng/mL, p<0.05) and a 2.8-fold higher CSF leptin level (0.29+/-0.02 vs 0.10+/-0.01 ng/mL, p<0.05) compared to control subjects. The CSF/plasma leptin ratio in normal weight subjects was 2.3-fold higher than that in obese subjects. After a weight loss in obese subjects, the plasma leptin level decreased by 40% and the CSF level decreased by 51%. The CSF/plasma leptin ratio was slightly lower than the baseline level. There was a positive linear correlation between CSF and plasma leptin level at the baseline in obese subjects (r= 0.74, p<0.05) and a positive logarithmic correlation in normal weight subjects and in obese subjects after a weight loss (r= 0.66, p<0.05). The BMI negatively correlated with the CSF/plasma leptin ratio (r=-0.86, p<0.05) in any subjects. Neither the baseline plasma levels nor the baseline CSF levels of NPY were different between the normal weight subjects and obese subjects. After a weight loss the CSF NPY level decreased significantly compared to the baseline values in obese subjects. The alpha -MSH levels in plasma and CSF did not differ significantly from controls in obese subjects at the baseline or after a weight loss. The baseline CSF leptin level neither correlated with the baseline CSF NPY level nor the baseline CSF alpha -MSH level. CONCLUSION: These results demonstrated that the efficiency of leptin delivery to the CNS is reduced in human obesity and that the CNS leptin uptake involves the combination of saturable and unsaturable mechanisms. A marked reduction in the CSF leptin levels compared to the plasma level after a weight loss in obese subjects can be a potent stimulus for the body to regain weight. In contrast to the results that were observed in experimental animals, the CSF NPY and alpha -MSH did not differ from the controls in human obesity and there was no significant correlation between the CSF leptin and CSF of these neuropeptides. This could have resulted from leptin resistance in cases of human obesity although the mechanisms for this resistance remain to be determined.
alpha-MSH ; Animals ; Cerebrospinal Fluid* ; Diet ; Female ; Humans ; Leptin* ; Neuropeptide Y ; Neuropeptides ; Obesity ; Peptides ; Plasma* ; Weight Loss*

Residual aneurysm is a challenging problem after clipping procedure for the aneurysms. The anthors describe one patient in whom endovascular treatment was sucessfully done to treat residual aneurysm after surgical clipping. We discussed the role of endovascular coil occlusion in case of incomplete surgical obliteration of aneurysms.
Aneurysm ; Humans ; Intracranial Aneurysm* ; Surgical Instruments

OBJECTIVE: Although surgical clipping of intracranial aneurysm is the definite method of treatment, there remains a small number of patients in whom surgical clipping is not technically possible. In such difficult cases, surgeon has to consider other therapeutic alternatives. In this report, we analyze our aneurysmal cases treated by wrapping and coating method and evaluate their surgical outcome and follow-up results. METHOD: Among the total of 877 patients operated from 1990 to 1999 for intracranial aneurysms at our hospital, 40 cases(4.6%) were treated by wrapping and coating method. They included 24 cases of single ruptured aneurysms and 16 with unruptured ones in multiple aneurysms. Wrapping with temporalis muscle and/or muslin gauze and coating with bioadhesive agent such as fibrin glue were performed. RESULT: Wrapping and coating method was performed mostly to the anterior communicating artery aneurysm (35%), and mostly because of the broad-based neck of an aneurysm(43%). At the time of discharge, 30 out of 40 patients(80%) showed favourable outcome and three cases died. The patients were monitored for average of 37 months(3-75 months). Among 24 cases with single ruptured aneurysm, 4 cases(17%) had early rebleeding within 6 months from the initial hemorrhage, and such rebleeding occurred within the first postoperative month in 3 cases. However, there was no rebleeding after the 6 months. Among 16 patients whose aneurysms were unruptured ones, none of them showed bleeding episode. CONCLUSION: It seems likely that the wrapping and coating method would be some help to prevent the rebleeding of an intracranial aneurysm. In order to obtain more accurate results regarding the efficacy of such method, it will be necessary to perform a multi-center study for longer follow-up periods and various wrapping and coating materials.
Aneurysm ; Aneurysm, Ruptured ; Fibrin Tissue Adhesive ; Follow-Up Studies ; Hemorrhage ; Humans ; Intracranial Aneurysm* ; Neck ; Surgical Instruments

No abstract available.
Stroke*

It is well known that moyamoya disease is often accompanied by an intracranial aneurysm. We present 3 patients, among total 40 patients with moyamoya disease over a recent 4-year period, in whom moyamoya disease and an intracranial saccular aneurysm were discovered simultaneously. In 2 of the 3 patients, the aneurysms were occluded endovascularly by Guglielmi detachable coils(GDC). Here, with review of pertinent literature, we discuss the clinical characteristics of an intracranial aneurysm associated with moyamoya disease and the benefits and drawbacks between two therapeutic options- direct surgery and endovascular treatment.
Aneurysm ; Humans ; Intracranial Aneurysm* ; Moyamoya Disease*

Pedicle screw instrumentation has proven to be reliable and effective in the surgical management of lumbosacral disorders, yet the appropriateness in the thoracic spine is not known. To evaluate the accuracy of the pedicle screw placement in the surgical management of the thoracic spinal disorders and to establish its risks and benefits, a prospective study was designed. One hundred and two thoracic pedicle screws in 22 consecutively treated patients were investigated after surgery by computed tomography scans. Twenty-one(20.5%) screws penetrated the pedicle cortex or the vertebral body anterior cortex. Three screws penetrated the medial cortex of the pedicle by the averages of 2mm to a maximum 4mm. Fifteen screws(14.7%) penetrated laterally by an average of 1.5mm. There were 3 screws of caudal penetration. The screws inserted at T1-T8 revelaed a higher penetration rate than those inserted at T9-T12(35.7% versus 14.7%)(p<0.05). Hardware failures causing the preoperative defor-mity were seen in a patient to whom half the cephalad screws were laterally misplaced. However, there were no major neurologic complications. Although segmental pedicle screw fixation of the thoracic spine requires meticulous measures and considerable experience, it was therefore can be considered as a safe and effective method for stabilizing the thoracic spine.
Humans ; Prospective Studies ; Risk Assessment ; Spine*

Spinal intramedullary teratoma is a rare tumor. A case of intramedullary teratoma of the conus medullaris with caudal development is presented. The patient underwent magnetic resonance imaging and then the tumor was removedd surgically. It was reportedwith the review of literatures.
Conus Snail* ; Humans ; Magnetic Resonance Imaging ; Teratoma*

Although chronic subdural hematoma(CSDH) is a well known entity, there is little knowledge concerning whether the results of radiological imaging can be used to predict CSDH recurrence or whether surgical methods can influence this rate. The aims of this study are to evaluate; 1) the relationship between the recurrence rate of CSDHs and their appearance on preoperative computerized tomography(CT) or magnetic resonance(MR) images and 2) relationship between the recurrence rate of CSDHs and the amount of postoperative drainage, and 3) the usefulness of one burr-hole irrigation with close-system drainage. From January 1991 through March 1998, 166 patients who were surgically treated were included. Thirty-six of these patients underwent bilateral operation and thus 202 operative sites of CSDH were analyzed. Preoperative CT was done in 151 patients and MR was done in the others. The cases of CSDH were separated into low-, iso-, layered-, high-, mixed-density groups on the basis of the appearance on CT images, and high-, nonhigh-intensity groups on T1-weighted MR images. All patients had underwent one burr-hole irrigation with closed system drainage and the drain was kept in place for 5 days. The amount of postoperative drainage decreased significantly from the 2nd day after operation compared to the 1st day after operation and decreasing tendency was continued through the rest of the days(p<0.0001) Overall recurrence rate was 3.5% and there was no significant relationship between the recurrence rate and their appearance on preoperative CT or MR. The average amount of postoperative drainage was larger in unrecurred CSDHs(381.0+/-36.9 ml, mean+/-standard error) than recurred cases(188.9+/-40.7ml). One burr-hole irrigation with closed-system drainage was useful regardless of CT findings. The amount of postoperative drainage, which means permeability of hematoma membrane, may be useful in predicting the propensity of CSDHs to recur.
Drainage* ; Hematoma ; Hematoma, Subdural, Chronic* ; Humans ; Membranes ; Permeability ; Recurrence*