BACKGROUND: Bone turnover markers (BTMs) are widely used tool for monitoring the response to osteoporosis therapy, and the normal adult reference range is the baseline value for the treatment of osteoporosis with anti-resorptive agents. This study was aimed to establish age- and sex-specific reference ranges of serum osteocalcin and serum type I collagen C-telopeptide (S-CTX) in adults based on menstrual stage. METHODS: Serum osteocalcin, S-CTX and bone mineral density (BMD) were measured in 291 adults (men: 162, women: 129), and follicle stimulating hormone (FSH) in women. Seven women whose serum FSH levels were >30 IU/mL were categorized as perimenopausal despite their regular menses. RESULTS: Among females with normal BMD, there were no difference in serum osteocalcin and S-CTX levels between premenopausal and postmenopausal women. Females with osteopenia in pre- and postmenopausal stage showed higher serum osteocalcin and S-CTX levels than females with normal BMD. For subjects with normal BMD, reference ranges of serum osteocalcin and S-CTX were 6.4~21.6 ng/mL and 0.08~0.85 ng/mL for 30~59-year-old females. For males with normal BMD, reference ranges of serum osteocalcin were 10.1~24.3 ng/mL for 30~39 years old and 7.7~22.4 ng/mL for 40~59 years old, and reference range of CTX was 0.13~1.27 ng/mL for 30~59 years old. CONCLUSIONS: This study will provide a redefinition of the criteria required in order to establish the normal reference ranges for BTMs. Moreover, we believe that our data will come in handy when used as normal reference ranges of BTMs in premenopausal women.
Adult ; Bone Density ; Bone Diseases, Metabolic ; Collagen Type I ; Female ; Follicle Stimulating Hormone ; Humans ; Male ; Osteocalcin ; Osteoporosis ; Peptides ; Reference Values

Cystic retrochiasmatic craniopharyngioma may reach enormous size by expanding into the posterior fossa along the retroclival area, which is very unusual finding. An 11-year-old girl presented with walking disturbance and irritability. On the neurological examination, she had positive Babinski sign, hyperactive deep tendon reflex, and left lateral gaze nystagmus. She also had right hearing disturbance. Initial magnetic resonance(MR) images revealed a huge, thin capsuled cystic mass which extended into the cerebellopontine angle down to the medulla oblongata. Secondary adjuvant chemotherapy, radiotherapy, and reoperation were necessary after first tumor removal by a suboccipital approach, due to the progression of disease. Finally, neurological condition was much improved without remnant tumor although some sequelae were remained. We report this interesting case because of its rarity, complex clinical presentation, and challenge in its management.
Cerebellopontine Angle ; Chemotherapy, Adjuvant ; Child ; Craniopharyngioma* ; Female ; Hearing ; Humans ; Medulla Oblongata* ; Neurologic Examination ; Radiotherapy ; Reflex, Babinski ; Reflex, Stretch ; Reoperation ; Walking

OBJECTIVE: The purpose of this study is to review retrospectively 28 patients with re-operation due to complications related to instrumentation from thoracic and lumbar spinal fusion surgery. METHODS: A total of 285 patients underwent spinal fusion surgery with instrumentation between 1996 and 2000. Of these, 11 men and 17 women(mean age 46 years, range 21 to 69 years) presented with complications related to instrumentation. Previous surgery was preformed for vertebral column instability secondary to fracture(4), spondylolisthesis(12), failed back surgery syndrome(7), osteomyelitis(1), herniated nuclus pulposus(4). All patients underwent repeated spinal surgery including removal of instrument, new instrument fixation, or I & D. The mean follow-up period after second operation was 19 months. RESULTS: The complications related instrumentation system include six interbody fusion system retropulsion, eight screw loosenings, five screw fractures, three screw malpositions, three osteomyelitis, and one donor site infection. After repeated surgery, eight became asymptomatic and did not require further treatment, but eleven showed persistent low back pain without neurological deficits and the remaining nine continued to have nerve root deficits. CONCLUSION: In conclusion, spinal fusion surgery with instrumentation offers an immediate postoperative stability of the thoracic and lumbar spine and enhances early fusion. However, it may be associated with few, but significant, complications which may permanantly. The proper selection of patients and meticulous surgical technique for surgery are probably the most important factors associated good outcomes and prevention of complications.
Follow-Up Studies ; Humans ; Low Back Pain ; Male ; Osteomyelitis ; Retrospective Studies ; Spinal Fusion* ; Spine ; Spondylolisthesis ; Tissue Donors

We describe a case of primary malignant melanoma in the fourth ventricle treated with surgery and fractionated high dose radiotherapy. A 27-year-old man was referred to our institution due to drowsy mentality, dysconjugated gaze, and pupil dilatation following vertigo and posterior neck pain. Preoperative magnetic resonance images revealed a fourth ventricular tumor extending to C2 level. The mass was high-signal intensity on T1-weighted image, low- on T2-weighted and homogeneous strong enhancement. Extraneural focus of primary site was not found. After grossly total removal in two staged operations, fractionated high dose radiotherapy was given(6300 cGy, 180cGy X 35 fraction). No tumor recurrence was seen for 12 months after operation. Aggressive treatment involving operative total tumor removal and combined radiotherapy is considered to increase the life span of the patient even with this type of tumor.
Adult ; Dilatation ; Fourth Ventricle* ; Humans ; Melanoma* ; Neck Pain ; Pupil ; Radiotherapy ; Recurrence ; Vertigo

Total excision is a treatment of choice in preventing the relapse of craniopharyn-gioma, but for tumors involving an extensive area, it is often associated with an increased risk of complications. We have performed a partial or subtotal tumor removal followed by repeated injection of bleomycin into the remaining tumor through a subcutaneous reservoir as postoperative adjuvant therapy. A retro-spective review of clinical, radiological, and surgical data was performed for 10 patients (5 males and 5 females; age, 3-65 yr; follow-up duration, 12-79 months) with cystic craniopharyngiomas. The measurements of lactate dehydrogenase (LDH) level at each aspiration were performed. The shrinkage and/or stabiliza-tion of tumor was initially noted in all cases. The recurrence of tumor was seen in 4 cases (40%). The decreased or increased level of LDH was interpreted as tumor shrinkage or recurrence, respectively. The transient toxic reactions were observed in 3 patients (30%). Our study demonstrates that postoperative bleo-mycin injection for cystic craniopharyngioma, although does not appear to eradi-cate the tumor, decreases and stabilizes the tumor size, when used as an adju-vant therapy in young patients.
Adolescent ; Adult ; Aged ; Antibiotics, Antineoplastic/administration & dosage/adverse effects/*therapeutic use ; Bleomycin/administration & dosage/adverse effects/*therapeutic use ; Brain/radiation effects ; Child ; Child, Preschool ; Craniopharyngioma/*drug therapy/radiography/surgery ; Female ; Follow-Up Studies ; Humans ; Injections ; L-Lactate Dehydrogenase/metabolism ; Male ; Middle Aged ; Pituitary Neoplasms/*drug therapy/radiography/surgery ; *Postoperative Care ; Retrospective Studies ; Tomography, X-Ray Computed/methods

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

Carboplatin intra-arterial chemotherapy(IAC) has an advantage of increased uptake during the first passage of the drugs through tumor capillaries. Although not common, this type of therapy is known to cause neurological complications, myelosuppression, and ototoxicity. However, the incidence of ocular toxicity is reported to be rare. Eleven of our patients with glioma(Grade II Astrocytoma: 3, Grade III Astrocytoma: 1, Grade IV Astrocytoma: 5, Gliofibroma: 1, Oligodendroglioma: 1) underwent IAC regimen with carboplatin(300mg/m2) which were administrated after blood-brain barrier disruption. Of there, 3 patients had ocular complications after supra-ophthalmic IAC injection of carboplatin but fully recovered following steroid therapy. Although our results from IAC seem to be favorable for these patients, we suggest that its complications, such as ocular toxicity, need to be carefully considered prior to treatment.
Astrocytoma ; Blood-Brain Barrier ; Capillaries ; Carboplatin* ; Glioblastoma ; Glioma* ; Humans ; Incidence ; Oligodendroglioma

OBJECTIVES: The prognosis of spontaneous intracerebral hemorrhage often depends on initial neurologic condition, size and location of hemorrhage and associated intraventricular hemorrhage. However, age of patient, coagulation state and other associated vascular diseases may also play a role when present. In recent years, the geriatric population has been increasing. The age distribution of the patients with intracerebral hemorrhages also has been increased, accordingly. However, such patients, especially when associated with poor initial conditions often tend to be managed rather conservatively. The authors analyzed retrospectively on forty-five patients with spontaneous intracerebral hemorrhage over the seventies with poor initial condition to find out whether there exists a difference of outcome between surgery and non-surgery group. MATERIAL AND METHOD: A total of 45 patients over seventies with spontaneous intracerebral hemorrhage with Glasgow Coma Scale(GCS) 4-8 treated over last six years were included. The validity of surgical management for these patients as well as clinical variables which might have been operated on the outcome of these patients were evaluated. The Glasgow Outcome Scale(GOS) after three months was used for comparison of outcome. RESULTS: In surgical group(19 cases), mean age was 74.5 years old, mean hematoma volume 67.2ml and mean GCS score 5.7 points. In nonsurgical group(26 cases), mean age was 79.3 years old, mean hematoma volume 32.1ml, and mean GCS score 6.8 points. Mortality rate in surgical group was 47.4%(9 patients), including 2 cases of post-operative rebleeding, while that in nonsurgical group was 46.2%. However, when patients with initial GCS 4-6 points and over 30ml in hematoma volume were regrouped, mortality rate in surgical group was 46.2%, whereas mortality rate in nonsurgical group was 66.7%. CONCLUSION: It is concluded that the mortality rate is much low in surgery group with initial GCS less than 6 points and hematoma volume over 30cc. There was no significant difference of outcome in patients with basal ganglia and thalamic hemorrhage. However, surgical treatment lowered the mortality and morbidity rate in patients with subcortical and cerebellar hemorrhage.
Age Distribution ; Basal Ganglia ; Cerebral Hemorrhage* ; Coma ; Geriatrics ; Hematoma ; Hemorrhage ; Humans ; Mortality ; Prognosis* ; Retrospective Studies ; Vascular Diseases

OBJECTIVES: The craniopharyngioma is a benign tumor located at least in part in the suprasellar cistern. However, the symptoms and signs from this tumor may be determined not only by the location of the tumor but also by its size and the age of the patient. The objective of our study is to analyze retrospectively the clinical manifestations of craniopharyngiomas with regards to tumor characteristics in children and adults. MATERIALS AND METHODS: Twenty-three patients(16 adults, 7 children) treated for craniopharyngioma between 1990 and 1999 were studied to demonstrate the relationship of tumor size, growth pattern, and its invasiveness with clinical symptoms. As part of the assessment, 16 adults(M:F=8:8, mean age:43.7 years) and 7 children(M:F=5:2, mean age:10.1 years) underwent magnetic resonance(MR) imaging and computerized tomography(CT) scanning with a three-dimensional volume acquisition sequence. RESULTS: The three major cardinal signs were defined to increased intracranial pressure, endocrine dysfunction, and visual problems. The tumor size in child group was larger than that in adult group. Also, visual problems, symptoms of increased intracranial pressure and hydrocephalus were more frequently observed in child group. However, endocrine dysfunction and neuropsychological symptoms related with hypothalamic connections to the thalamus, pituitary, frontal lobe, and other cortical areas were more frequent in adult group. Conclusions: In our series, the tumor size and invasiveness of craniopharyngioma revealed to be relevent with initial symptoms of increased intracranial pressure and visual symptoms which were more frequent in child group. As for the growth pattern, we did not find major difference between adults and children.
Adult* ; Child* ; Craniopharyngioma* ; Frontal Lobe ; Humans ; Hydrocephalus ; Intracranial Pressure ; Retrospective Studies ; Thalamus

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