Achalasia is a rare neurological deficit of the esophagus that produces an impaired relaxation of the lower esophageal sphincter and decreased motility of the esophageal body. Achalasia is generally accepted to be a pre-malignant disorder, since, particularly in the mega-esophagus, chronic irritation by foods and bacterial overgrowth may contribute to the development of dysplasia and carcinoma. We present a case of a 51-year-old man with achalasia combined with esophageal cancer who has had dysphagia symptoms for more than 20 years. Since there was a clinically high possibility of supraclavicular lymph node metastasis, concurrent chemoradiation therapy was scheduled. After the third cycle of chemoradiation therapy, transthoracic esophageolymphadenectomy was performed. Histopathological examination of the main esophagus specimen revealed no residual carcinoma. And the entire regional lymph node areas were free of carcinoma except for one azygos metastatic lymph node. In summary, achalasia is a predisposing factor for esophageal squamous cell carcinoma. Although surveillance endoscopy in achalasia patients is still controversial, periodic screening for cancer development in long-standing achalasia patients might be advisable.
Carcinoma, Squamous Cell ; Deglutition Disorders ; Endoscopy ; Esophageal Achalasia ; Esophageal Neoplasms ; Esophageal Sphincter, Lower ; Esophagus ; Humans ; Lymph Nodes ; Mass Screening ; Middle Aged ; Neoplasm Metastasis ; Relaxation

Carcinoembryonic antigen(CEA) in blood and CSF was reported to be increased in cases of nervous system neoplasms by some investigators. To evaluate the oncological diagnostic value of CEA in the neurosurgical conditions, this study has been performed on 24 nervous system neoplasms and 8 non-nervous system as well as 49 controls. In addition, alpha-fetoprotein was also measured on the same conditions because of its close oncologic nature and recent diagnostic application on the general surgical conditions. The CEA concentration in blood and CSF were determined by CEA Radioimmunoassay kit, and the alpha-fetoprotein in blood and CSF were determined by GammaDab kit. The result showed that concentration of CEA and alpha-fetoprotein was higher and seemed to diagnostic in Extra-CNS neoplasma. In nerovous system, however, these were the lower than we expected, although were higher than control. Moreever, these levels were not unique on same oncologic condition and rather somewhat variable. From these results, increased concentration of these itself may be considered suggestive of existence of nervous system neoplasm, but it does mean neither degree of malignancy nor its origin.
alpha-Fetoproteins* ; Carcinoembryonic Antigen* ; Central Nervous System ; Humans ; Nervous System Neoplasms ; Radioimmunoassay ; Research Personnel

We must once consider spondylitis, if the patient complains of severe back pain and back muscle spasm following a more or less improvement after disk surgery. The etiology of these postoperative complications is not well understood in suspected cases of spondylitis, but the most likely causes reveals to be low grade infection, aseptic necrosis and pyogenic infection etc. Conservative treatment with complete bed rest and antibiotics led to satisfactory results in major cases, but there is no improvement in spite of application strong antibiotics and muscle relaxant in some cases. In later cases, we got the good results with immediate pain relieve and reducing hospital day by anterior interbody fusion. So we report 4 cases of aseptic spondylitis with review of literature.
Anti-Bacterial Agents ; Back Muscles ; Back Pain ; Bed Rest ; Humans ; Necrosis ; Postoperative Complications ; Spasm ; Spondylitis*

Spontaneous acute cerebellar hemorrhage is not really a rare lesion and their incidence is greater than is previously appreciated, accounting for ten percent of all spontaneous intracranial hemorrhages. And it is not easy to understand why it is rarely diagnosed clinically and is explosive course in its nature. Therefore, successful management entails early correct recognition, followed by early surgical intervention. In many cases, the cerebellar signs & other neurological signs are of little value in the localization of cerebellar hemorrhage. In such cases, CT scan may prove to be a rapid & reliable method for localizing acute cerebellar hemorrhage. The authors collected three cases of spontaneous acute cerebellar hemorrhage which were diagnosed by computed tomography, admitted to the department of neurosurgery of National Medical Center from June 1979 to October 1980 and all patients received suboccipital craniectomy.
Hemorrhage* ; Humans ; Incidence ; Intracranial Hemorrhages ; Neurosurgery ; Tomography, X-Ray Computed

The author experienced 2 cases of cerebellar abscess, which were secondary to otogenic disease. Increased intracranial pressure signs were developed, in one case from the PTA 3 days and in the other case 12 days after radical mastoidectomy in patient with chronic otitis media. Brain CT scan. Revealed ring enhanced hypodensity on posterior fossa. Total excisions were made with complete recovery: First case 3/4 2 stage operation, aspiration and total excision. Second case 3/4 Total excision.
Abscess* ; Brain ; Humans ; Intracranial Pressure ; Otitis Media ; Tomography, X-Ray Computed

The author experienced 2 cases of cerebellar abscess, which were secondary to otogenic disease. Increased intracranial pressure signs were developed, in one case from the PTA 3 days and in the other case 12 days after radical mastoidectomy in patient with chronic otitis media. Brain CT scan. Revealed ring enhanced hypodensity on posterior fossa. Total excisions were made with complete recovery: First case 3/4 2 stage operation, aspiration and total excision. Second case 3/4 Total excision.
Abscess* ; Brain ; Humans ; Intracranial Pressure ; Otitis Media ; Tomography, X-Ray Computed

Two cases of traumatic intraventricular hemorrhage, readily assessed by cerebral computed tomography, are presented. Patho-dynamic factors of traumatic pure intraventricular hemorrhage are uncertain until now. Prognosis of that is relatively ominous. Is one case, of which all ventricles filled with hematoma after blunt head injury, soon ended her life in vain. In other case, in which 4 th ventricular hemorrhage with acute hydrocephalus developed, after falling in drunken state. The latter noted improved clinical state with only extraventricular drainage through frontal route and discharged without neurological deficit.
Drainage ; Head Injuries, Closed ; Hematoma ; Hemorrhage* ; Hydrocephalus ; Prognosis

A rare case of cerebellar infarction is presented with the finding of CT scan and angiography. In the case of cerebellar infarction, early diagnosis and emergency posterior fossa decompression is the important point in the rapidly deteriorating patient due to brain stem compression.
Angiography ; Brain Stem ; Decompression ; Early Diagnosis ; Emergencies ; Humans ; Infarction* ; Tomography, X-Ray Computed

The occurrence of coincidental intracranial aneurysms with tumors of pituitary origin is very rare. Silent intracranial aneurysms located distant from the lesion to treated have little relevance to surgical management of most patients. However, aneurysms of the major arteries adjacent to pituitary and suprasellar mass are an additional hazard to surgical treatment. We experienced silent multiple aneurysms located just below the bifurcation of both internal carotid arteries associated with symptomatic pituitary adenoma(acromegaly). Transfrontal removal of the pituitary eosinophillic adenoma was carried out without treatment of the aneurysms. The angiographic data considered significant to the safety of the procedure. So the necessity of the cerebral angiography is stressed to show the precise relationships of vessels to masses in the pituitary region. Also the possible reasons for the occurrence of aneurysms in association with these tumors were discussed.
Adenoma ; Aneurysm* ; Arteries ; Carotid Artery, Internal ; Cerebral Angiography ; Eosinophils ; Humans ; Intracranial Aneurysm ; Pituitary Neoplasms*

Orbital meningioma is relatively rare. A case of intraorbital meningioma arising from optic nerve sheath is presented, which extended intracranially through the optic canal. Transfrontal intradural and extradural approach under the operating microscope is the best successful exposure for the orbital meningioma when there is suspected intracranial extension of the tumor.
Meningioma* ; Optic Nerve ; Orbit*