BACKGROUND: Azacitidine (AZA) is standard care for patients with myelodysplastic syndrome (MDS) who have not had allogeneic stem cell transplantation. Chromosomal abnormalities (CA) including complex karyotype (CK) or monosomal karyotype (MK) are associated with clinical outcome in patients with MDS. METHODS: We investigated which prognostic factors including CAs would predict clinical outcomes in patients with International Prognostic Scoring System (IPSS) higher risk MDS treated with AZA, retrospectively. CK was defined as the presence of three or more numerical or structural CAs. MK was defined as the presence of two or more distinct autosomal monosomies or single autosomal monosomy with at least one additional structural CA. RESULTS: A total of 243 patients who treated with AZA, were enrolled. CK was present in 124 patients and MK was present in 90 patients. Bone marrow blasts > or =15% and CK were associated with poorer response (P=0.038, P=0.007) and overall survival (OS) (P<0.001, P<0.001) independently. Although MK in CK group was not associated with prognosis, non-MK status in non-CK group reflected favorable OS (P=0.005). The group including >3 CAs was associated with poorer OS (group including <3 CAs vs. only three CAs, P=0.001; group with >3 CAs vs. only three CAs, P=0.001). CONCLUSION: CK was an important prognostic parameter associated with worse outcome. MK may predict poor survival in only non-CK status. The higher number of CAs was associated with poorer survival.
Azacitidine* ; Bone Marrow ; Chromosome Aberrations ; Humans ; Karyotype* ; Monosomy ; Myelodysplastic Syndromes* ; Prognosis ; Retrospective Studies ; Stem Cell Transplantation

PURPOSE: We evaluated the differences between radiologically measured size and pathologic size of renal tumors. MATERIALS AND METHODS: The data from 171 patients who underwent radical or partial nephrectomy for a renal tumor at Ajou University Hospital were reviewed. Radiologic tumor size, which was defined as the largest diameter on a computed tomographic scan, was compared with pathologic tumor size, which was defined as the largest diameter on gross pathologic examination. RESULTS: Mean radiologic size was significantly larger than mean pathologic size for all tumors (p=0.019). When stratified according to radiologic size range, mean radiologic size was significantly larger than mean pathologic size for tumors <4 cm (p=0.003), but there was no significant difference between the sizes for tumors 4-7 cm and >7 cm. When classified according to histologic subtype, mean radiologic size was significantly larger than mean pathologic size only in clear cell renal cell carcinomas (p=0.002). When classified according to tumor location, mean radiologic size was significantly larger than mean pathologic size in endophytic tumors (p=0.043) but not in exophytic tumors. When endophytic tumors were stratified according to radiologic size range, there was a significant difference between the mean radiologic and pathologic sizes for tumors <4 cm (p=0.001) but not for tumors 4-7 cm (p=0.073) and >7 cm (p=0.603). CONCLUSIONS: Our results suggest that in planning a nephron-sparing surgery for renal tumors, especially for endophytic tumors of less than 4 cm, the tumor size measured on a computed tomography scan should be readjusted to get a more precise estimate of the tumor size.
Carcinoma, Renal Cell ; Humans ; Kidney ; Nephrectomy

OBJECTIVE: The precise intra- vs. extradural localization of aneurysms involving the paraclinoid internal carotid artery is critical for the evaluation of patients being considered for aneurysm surgery. The purpose of this study was to investigate the clinical usefulness of T2-weighted three-dimensional (3-D) fast spin-echo (FSE) magnetic resonance (MR) imaging in the evaluation of unruptured paraclinoid aneurysms. METHODS: Twenty-eight patients with unruptured cerebral aneurysms in their paraclinoid regions were prospectively evaluated using a T2-weighted 3-D FSE MR imaging technique with oblique coronal sections. The MR images were assessed for the location of the cerebral aneurysm in relation to the dural ring and other surrounding anatomic compartments, and were also compared with the surgical or angiographic findings. RESULTS: All 28 aneurysms were identified by T2-weighted 3D FSE MR imaging, which showed the precise anatomic relationships in regards to the subarachnoid space and the surrounding anatomic structures. Consequently, 13 aneurysms were determined to be intradural and the other 15 were deemed extradural as they were confined to the cavernous sinus. Of the 13 aneurysms with intradural locations, three superior hypophyseal artery aneurysms were found to be situated intradurally upon operation. CONCLUSION: High-resolution T2-weighted 3-D FSE MR imaging is capable of confirming whether a cerebral aneurysm at the paraclinoid region is intradural or extradural, because of the MR imaging's high spatial resolution. The images may help in identifying patients with intradural aneurysms who require treatment, and they also can provide valuable information in the treatment plan for paraclinoid aneurysms.
Aneurysm ; Arteries ; Carotid Artery, Internal ; Cavernous Sinus ; Humans ; Intracranial Aneurysm ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets ; Prospective Studies ; Subarachnoid Space

BACKGROUND/AIMS: The ability to visualize the small bowel mucosa by capsule endoscopy is limited. Moreover, studies involving small-bowel preparation with purgative drugs have failed to establish which preparations produce better images and higher diagnostic yields. The aim of this study was to evaluate the efficacies and diagnostic yields of different bowel preparations. METHODS: A cohort of 134 patients with suspected small bowel disease was randomly assigned to 3 groups. Patients in group A (n=44) fasted for 12 h before being administered an M2A capsule (Given Imaging, Yoqneam, Israel). Patients in group B (n=45) were asked to drink two doses of 45 mL of sodium phosphate (NaP) with water during the afternoon and evening on the day before the procedure and to drink at least 2 L of water thereafter. Patients in group C (n=45) drank 2 L of a polyethylene glycol (PEG) lavage solution the evening before the procedure. RESULTS: Overall cleansing of the small bowel was adequate in 43% of patients in group A, 77% of those in group B, and 56% of those in group C (group A vs group B, p=0.001). Diagnoses for obscure gastrointestinal bleeding were established in 9 patients (39%) in group A, 16 patients (69%) in group B, and 14 patients (50%) in group C. No significant difference in diagnostic yield was observed between groups. CONCLUSIONS: Bowel preparation with NaP for capsule endoscopy improved small-bowel mucosal visualization when compared to 12-h overnight fasting.
Capsule Endoscopy ; Cohort Studies ; Hemorrhage ; Humans ; Mucous Membrane ; Phosphates ; Polyethylene Glycols ; Prospective Studies ; Sodium ; Therapeutic Irrigation ; Water

OBJECTIVES: This report was designed to study the prognostic factors that affect the therapeutic results of dural arteriovenous fistula (DAVF). METHODS: We retrospectively reviewed 97 patients who were treated for DAVF at our institute from January, 2000 to August, 2008. The DAVFs were usually located in four sites (cavernous sinus, transverse-sigmoid sinus, superior sagittal sinus and others). The diagnosis and the results of treatment were obtained by performing cerebral angiography. RESULTS: The most common location of DAVF was the cavernous sinus (59.4%) and the next most common location was the transverse-sigmoid sinus (30.2%). Borden classification type II (72.2%) was most common and the next most common was type I (18.6%). Cortical venous reflux was abundant in the transverse-sigmoid sinus DAVFs and superior sagittal sinus DAVFs. Complete obliteration was achieved in 52 cases (55.3%) of all the 94 treated cases and incomplete obliteration was achieved in 42 cases (44.7%). Complete obliteration of the DAVF was achieved for 66.7% of the cavernous sinus lesions and in 41.4% of the transverse-sigmoid sinus lesions. Repeated treatments due to partial obliteration or recanalization were done in 18 cases. CONCLUSION: Transverse-sigmoid sinus lesion and cortical venous reflux in a DAVF are closely related to the aggressive clinical features. Active treatment should be considered to treat these lesions. (ED note: some of this abstract was not clear and you need to check the revised abstract.)
Cavernous Sinus ; Central Nervous System Vascular Malformations ; Cerebral Angiography ; Humans ; Retrospective Studies ; Superior Sagittal Sinus

OBJECTIVE: This study was designed to determine the clinical characteristics of patients with aneurysms that are located at the distal posterior inferior cerebellar artery (dPICA). PATIENTS & METHODS: From September 1976 to June 2007, 54 consecutive patients with PICA aneurysms were treated at our institute. Among them, 19 patients had PICA aneurysms distal to the junction of the vertebral artery-PICA. We retrospectively reviewed the database and imaging studies as sources of information for analysis. RESULTS: Five patients were male and 14 patients were female. The mean age was 44.6 years old (range: 23-70). Sixteen patients had ruptured lesions: 1 patient was Hunt and Hess Grade I, 4 were Grade II, 5 were Grade III, 4 were Grade IV and 2 were Grade V. Intraventricular hemorrhage or intracerebral hemorrhage was identified in 5 patients on the initial computed tomography (CT). Three patients had unruptured lesions. The locations of aneurysm were the lateral medullary segment in 10 patients, the tonsillomedullary segment in 1 patient, the telovelotonsillar segment in 5 patients and the cortical segment in 3 patients. Most aneurysms (17) were the saccular shape. Seventeen aneurysms were small and 2 were large or giant. The mean diameter of aneurysm was 6.5 mm (range: 2.0-28.0) and the mean diameter of the ruptured aneurysm was 4.8 mm (range: 2.0-12.0). Two patients had mirror aneurysms. Post-hemorrhagic hydrocephalus was identified in 10 patients on the initial CT and shunt surgery was performed on 3 patients. The obliteration methods of the aneurysms were microsurgery in 15 patients (midline suboccipital approach: 9, lateral suboccipital approach: 6) and endovascular surgery in 4 patients (therapeutic distal PICA occlusion: 3, intra-aneurysmal coiling: 1). Early surgery was performed on 2 patients, intermediate surgery (days between rupture: 4-10) was performed on 4 patients and delayed surgery was performed on 10 patients. The mean post-treatment follow up period was 49.5 months (range: 7-156). The clinical outcome was assessed using the modified Glasgow Outcome Scale. All the patients showed favorable outcomes. Five patients suffered from treatmentrelated complications (a CSF collection requiring wound revision for dura repair: 2, shunt surgery: 1 and transient hemiparesis due to impairment of the blood flow distal to the aneurysm: 2). CONCLUSIONS: In our series, distal PICA aneurysms had the characteristics of a female predominance, they more often presented with intraventricular hemorrhage and the rupture was of a relatively small size. Both microsurgery and endovascular surgery can be troublesome due to the small size, wide neck and tortuosity of the proximal parent artery and the location of aneurysms at a branching site. The surgeons should be careful for preserving vessel patency and insuring watertight dura repair.
Aneurysm ; Aneurysm, Ruptured ; Arteries ; Cerebral Hemorrhage ; Female ; Follow-Up Studies ; Glasgow Outcome Scale ; Glycosaminoglycans ; Hemorrhage ; Humans ; Hydrocephalus ; Intracranial Aneurysm ; Male ; Microsurgery ; Neck ; Parents ; Paresis ; Pica ; Retrospective Studies ; Rupture

OBJECTIVE: This study was designed to define the clinical characteristics and to establish the therapeutic strategies for treating aneurysms located at the M1 trunk of the middle cerebral artery (MCA). METHODS: During the past 30 years from September 1976 to December 2006, 47 (6.2% of the 755 treated MCA aneurysms) consecutive patients with M1 aneurysms were treated at our institute. We retrospectively reviewed the database and imaging studies of these 47 patients for analysis. Nine patients (19.1%) were male and 38 (80.9%) patients were female. The mean age was 51.7 years (range: 381 years). Thirty-three (70.2%) patients had ruptured lesions: 3 patients were Hunt and Hess Grade I, 16 patients were Grade II, 7 patients-were Grade III, 4 patients were Grade IV and 3 patients were Grade V. Intracerebral hemorrhage was identified in 9 patients on the initial computed tomograph images. Fourteen patients had unruptured lesions. The diameters of the aneurysms were <5 mm in 24 (51.1%), 5~9mm in 20 (42.6%), 10~24 mm in 1 and >25 mm in 2 patients. The mean diameter of the aneurysms was 5.1mm (range: 2.029.0mm). Eleven patients (23.4%) had multiple aneurysms. The repair methods for the aneurysms were microsurgery in 42 (89.4%) patients (clipping: 36, wrapping: 6, aneurysm resection and suture: 1) and coiling in 5 patients. The mean posttreatment follow up period was 45.5 months. The clinical outcome was assessed using the Glasgow Outcome Scale. The therapeutic results of lesion repair, the long-term clinical outcome and the causes of an unfavorable outcome were also analyzed. RESULTS: The overall outcome was favorable in 39 (82.9%) patients (excellent: 32, good: 7) and unfavorable in 8 (17.1%) (fair: 6, poor: 1, dead: 1) patients. The major causes of an unfavorable outcome were the initial insults. Seven patients suffered from a delayed ischemic deficit, and 3 of them were left with a permanent deficit. Surgery-related complications occurred in 8 patients (cerebral infarction: 6, intracerebral hemorrhage: 2) and 3 were left with a permanent deficit. The angiographic results of coiling were complete packing in 3 (60%), a neck remnant in 1 (20%) and incomplete packing for 1 (20%). There was no coiling-related complication. CONCLUSION: In our series, M1 aneurysms had characteristics of a female predominance, the patients more often presented with intracerebral hemorrhage, and a high risk of postoperative ischemic complication. Due to the small size, wide neck and location at the branching site, M1 aneurysms can be treated with surgery rather than coiling, but surgeons should be careful for injury of the branching vessels like the lateral lenticulostriate artery and they must be prepared for various inevitable situations that occur during surgery.
Aneurysm* ; Arteries ; Cerebral Hemorrhage ; Female ; Follow-Up Studies ; Glasgow Outcome Scale ; Humans ; Infarction ; Intracranial Aneurysm ; Male ; Microsurgery ; Middle Cerebral Artery* ; Neck ; Retrospective Studies ; Sutures

PURPOSE: Pathogenesis and treatment of spontaneous dissecting aneurysm of the intracranial vertebral artery (VA) remain controversial. This study was designed to provide management strategies and to improve management outcome in patients with these aneurysms. MATERIALA AND METHODS: Among a total of 1,990 patients treated for intracranial aneurysms from February 1992 to June 2005, 28 patients (1.4%) were treated either by surgery (8 patients) or neurointervention (20 patients) for spontaneous dissecting aneurysms of the intracranial VA. Twenty-two patients had ruptured aneurysms. We analyzed indications of surgery or neurointervention for each case, and assessed the management outcome at a 6-month follow-up. RESULTS: For selection of therapeutic options, patients were initially evaluated as possible candidates for neurointervention using the following criteria: 1) poor clinical grade; 2) advanced age; 3) medical illness; 4) unruptured aneurysm; 5) equal or larger opposite VA; 6) anticipated surgical difficulty due to a deep location of the VA-posterior inferior cerebellar artery (PICA) junction. Surgery was considered for patients with: 1) high-risk aneurysms (large or irregular shaped); 2) smaller opposite VA; 3) failed neurointervention; or 4) dissection involving the PICA. Management outcomes were favorable in 25 patients (89.3%). Causes of unfavorable outcome in the remaining 3 patients were the initial insult in 2 patients, and medical complications in one patient. CONCLUSION: Ruptured aneurysms must be treated to prevent rebleeding. For unruptured aneurysms, follow-up angiography would be necessary to detect growth of the aneurysm. Treatment modality should be selected according to the clinical characteristics of each patient and close collaboration between neurosurgeons and neurointerventionists is essential.
Adult ; Aged ; Aneurysm, Dissecting/*pathology/surgery/therapy ; Aneurysm, Ruptured/pathology/surgery/therapy ; Female ; Follow-Up Studies ; Humans ; Intracranial Aneurysm/*pathology/surgery/therapy ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Vertebral Artery/*pathology/surgery

OBJECTIVE: The aim of this study was to define the clinical characteristics of pediatric cerebral aneurysms. METHODS: During the past 30 years, among a total of 3,330 patients treated for cerebral aneurysms, 12 patients were under the age of 18. The authors reviewed the database and imaging studies as sources for identification and analysis. RESULTS: Seven patients were male and 5 were female. The mean age was 12.9 years old (range: 3~18). Nine patients had ruptured lesions and the remaining 3 had unruptured lesions. Four patients presented with a subarachnoid hemorrhage, and the other 5 patients presented with an intracerebral hemorrhage (ICH). Five aneurysms were located at the posterior cerebral artery or vertebrobasilar artery, 4 at the middle cerebral artery, and 3 at the internal carotid artery, respectively. The giant aneurysm was observed in 2 (18%) patients. Eleven aneurysms were saccular, and 1 was serpentine in shape. No patient had multiple aneurysms. Rebleeding was observed in 3 cases (33%). No child suffered from clinical vasospasm. All but one patient showed a favorable outcome (good: 11, dead: 1). CONCLUSIONS: Pediatric cerebral aneurysms in this study showed a male predominance, a high incidence of presentation with ICH, a location on the distal circulation of the major arteries or on the posterior circulation, and a large or giant aneurysm, high rebleeding rate and a low incidence of vasospasm. The overall clinical outcome was excellent in 91.7% in this study. With the knowledge of these features, aneurysmal obliteration and active brain resuscitation can improve the clinical outcome and prognosis.
Aneurysm ; Arteries ; Brain ; Carotid Artery, Internal ; Cerebral Hemorrhage ; Child ; Female ; Humans ; Incidence ; Intracranial Aneurysm* ; Male ; Middle Cerebral Artery ; Posterior Cerebral Artery ; Prognosis ; Resuscitation ; Subarachnoid Hemorrhage

OBJECTIVE: This study was designed to understand the clinical characteristics and to establish therapeutic options for arteriovenous malformations (AVM) in a pediatric age (1~8 year old) group. METHODS: We reviewed programmed clinical data, patients'medical records and imaging studies of the 164 pediatric AVM patients who were managed at Yonsei University Medical Center from 1975 to 2004. Clinical presentation, location, Spetzler-Marin grade, treatment modality and outcomes were analyzed. RESULTS: Ninety-one patients (55.5%) were male and seventy-three (44.5%) were female. The most common presenting symptom was hemorrhage (119 patients, 72.6%). In others the symptoms were seizure (26 patients, 15.9%), hemorrhage with seizure (6 patients, 3.6%), focal deficit (4 patients, 2.4%), headache (8 patients, 4.9%) and incidental (1 patients, 0.6%). The locations of AVMs were cerebral convexity (110 patients, 67.1%; 21 frontal, 40 parietal, 23 temporal, 23 occipital), basal ganglia and thalamus (24 patients, 14.6%), corpus callosum (12 patients, 7.3%), sylvian (3 patients, 1.8%), cerebellum (13 patients, 7.9%) and two patients had brain stem lesions (1.2%). According to the Spetzler-Martin grading system, at admission grade II and III AVMs were the most common lesions in our series (43.9% and 33.5%, respectively). The patients were treated with microsurgery in 70 patients (42.7%), radiosurgery in 87 patients, (53.0%), combined treatment in 5 patients (3.1%) and embolization in only 2 patients (1.2%). The average follow-up period was 4.8 years and the overall outcome was considered good in 139 patients (84.8%), fair in 18 patients (11.0%), and poor in 4 patients (2.4%), with 3 patients having died (1.8%). The causes of unfavorable outcomes were initial insult (4 patients), radiation necrosis (1 patient), bleeding during the latent interval (1 patient) and systemic complication (1 patient). CONCLUSION: Hemorrhagic presentation and deep brain (thalamus and ganglia) lesions were more common in the pediatric patients compared to adult patients. The treatment of choice for hemorrhagic pediatric AVMs is surgical excision, even for deep seated or eloquent area lesions. Radiosurgery is recommended especially for the non-hemorrhagic lesions, particularly in deep seated or eloquent area lesions. Regular imaging studies are necessary for detection of AVM regrowth, and signs of hemorrhage should be monitored during the latent period.
Academic Medical Centers ; Adult ; Arteriovenous Malformations ; Basal Ganglia ; Brain ; Brain Stem ; Cerebellum ; Corpus Callosum ; Female ; Follow-Up Studies ; Headache ; Hemorrhage ; Humans ; Intracranial Arteriovenous Malformations* ; Male ; Microsurgery ; Necrosis ; Rabeprazole ; Radiosurgery ; Seizures ; Thalamus