A Case of Choroid Plexus Papilloma of a Child with Anorexia and Failure to Thrive / 대한소아신경학회지

Choroid plexus papilloma is a very rare disease in children. The manifestations of the disease differ according to the tumor size and the location. Increased CSF production by the tumor, hydrocephalus and symptoms of increased ICP are the main symptoms. The first line of treatment is surgical excision, but sometimes excision itself is very difficult due to the site and the size of the mass. Adjunctive radiation therapy or chemotherapy is not recommended. Since gross total resection without adjunctive therapy offers highest likelihood of success. Significant prognostic factors are sex, age, time of diagnosis, the duration between the appearance of symptoms and diagnosis, tumor volume, tumor site and the extent of surgery. We report a case of choroid plexus papilloma, in a child with anorexia and failure to thrive.

Gender Differences in Expression of Apoptosis, p53, and Bcl-2 in Delayed Focal Cerebral Infarction in Rats

Apoptosis is a normal physiological process. Morphological studies have shown that cells die by physiological mechanisms after undergoing characteristic changes termed 'apoptosis' or 'programmed cell death'. Several genes were known to participate in the apoptotic process including p53 as a proapoptic gene and Bcl-2 as an antiapoptic gene. It was also known that there are certain gender differences in the cerebrovascular accidents and their effect on tissue damage. The purpose of this study is to evaluate how the apoptotic genes are expressed in delayed focal cerebral infarction and peri-infarct area in male and female adult rats by comparing the immunoexpression of p53 and Bcl-2 and p53:Bcl-2 ratio at delayed focal cerebral infarction between both sexes. In sixteen adult Spraugue-Dawley rats (nine males and seven females), the right MCA and both CCA were ligated for thirty minutes to make a delayed focal cerebral infarction in right frontal lobe. Their brains were taken at seventy two hours after the operation. And then the brains were prepared for immunohistochemical stains for apoptosis, p53 and Bcl-2 proteins. The infarction volume of male rats (11.3 mm3) was larger than that of female rats (7.3 mm3) (p<0.01). In male group, the width (micrometer2) of the apoptotic area (46.4 micrometer2) was significantly larger than those in female group (38.9 micrometer2) (p<0.005). The p53 : Bcl-2 ratio was significantly higher in male group (3.23) compared with female group (2.18) (p<0.01). As a result, the p53:Bcl-2 ratio seemed to be related to the gender differences in neuronal apoptosis after delayed focal cerebral infarction.

Primary Intramedullary Spinal Cord Lymphoma: Case Report

The authors report a primary intramedullary spinal cord lymphoma in a 49-year-old man who presented with right arm pain, voiding difficulty and progressive walking difficulty. Preoperative cervical spinal CT and MRI studies were highly suggestive of spinal stenosis with compressive myelopathy but histopathological study of the specimen after surgery revealed spinal cord lymphoma. As no tumorous lesion was found other than the spinal cord, he was given 6000 rad of radiation under the diagnosis of primary CNS lymphoma. The neurologic deficits improved partially after the surgery but delete right arm pain persisted. One year later, follow up studies showed neither local nor systemic tumor recurrence.

The Clinical Analysis of Stereotactic Aspiration of Spontaneous Intracerebral Hemorrhage

To date no consensus has been reached regarding the suitability of surgical treatment for spontaneous intracerebral hemorrhage, especially in deep seated cases. With the recent introduction of an alternative to conservative therapy, craniotomy or stereotactic aspiration, it has become even more difficult to determine which therapeutic approaches should be used. We used stereotactic aspiration technique under a local anesthesia instead of craniotomy to treat 48 patients, because we believe that better therapeutic results could be obtained by minimal invasion to the brain. In present study, we analysed the level of consciousness and clinical outcome, location and volume of hematoma, interval of operation from ictus, and rate of hematoma removal. Our series consist of 18 males and 30 females. The most prevalent age group of intracerebral hemorrhage patients were the 6th decades. The hematoma were located at basal ganglia in 75%, thalamus in 15%, pons in 8%, and lobar 2%. The prognosis was favorable in patients with good neurological grade at admission, but was unfavorable in those with large volume although the statistical difference was not significant. Rate of hematoma removal was high in the cases where operations performed after 4 days. The statistical difference between the time interval from hemorrhage to operation and prognosis was not significant. The overall mortality rate was 17%. These results seem to indicate that stereotactic aspiration may play a comparable indices in the treatment of spontaneous intracerebral hemorrhage.

A Case of a Recurrent Postoperative Discitis

The etiology of the postoperative discitis is not fully known, but most likely, the cause seems to be of a low grade infection and chemical and mechanical injuries. The incidence of these complication is from 0.12% to 2.6% of all cases. The characteristics of this disease are recurrence of severe lower back and gluteal pain, spasm of lumbar paravertebral muscle and elevated E.S.R. following the asymptomatic post-operative period, a roentgenogram showed an early destructive change in the adjacent vertebra, the narrowing of the intervertebral disc space, sclerotic changes in the vertebral bone and occasional fusion of the spine, and relatively good prognosis. We present a case of recurrent postoperative discitis with E.S.R. change and roentgenographic change.