The Limitations of Thrombectomy with Solitaire(TM) AB as First-line Treatment in Acute Ischemic Stroke: A Single Center Experience

OBJECTIVE: A self-expanding retrievable intracranial stent, such as Solitaire AB, is useful for mechanical thrombectomy, producing novel results in the treatment of acute ischemic stroke. On the other hand, difficult situations can arise after a thrombectomy when using as in first-line treatment. METHODS: This was a retrospective, single-center study of 23 patients with an acute ischemic stroke attributable to a large artery occlusion within the first eight hours from symptom onset. The occlusion sites were the T segment in five patients, proximal middle cerebral artery in six patients, distal middle cerebral artery in three patients, vertebral and/or basilar artery in five patients, proximal internal cerebral artery in one patient and tandem in three patients. All patients underwent a mechanical thrombectomy using the Solitaire(TM) stent system as the first-line treatment but required additional procedures due to the unsatisfactory results of a thrombectomy. RESULTS: Only six patients achieved complete recanalization by a thrombectomy using the Solitaire. Permanent stent deployment after the thrombectomy was performed in ten patients. Stent and balloon angioplasty was performed after a stent-based thrombectomy in six patients. Balloon angioplasty after thrombectomy was performed in one patient. CONCLUSION: Mechanical thrombectomy with the Solitaire(TM) stent as a first-line treatment can produce unfortunate results that will require additional procedures.

Cavernous Hemangioma Occurred Between the Trapezius and Splenius Capitis Muscle

Hemangiomas are the most common benign tumor of soft tissue. They are frequently seen on the trunk and extremities. In addition, most of them exist at the skin and subcutaneous layer, but fewer than 1% does in the intramuscular layer. For the diagnostic images of the intramuscular cavernous hemangioma, ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) are used currently. Multiple therapeutic methods are used, but surgical excision is considered as the most ideal treatment. We describe the recurred cavernous hemangioma occurred between the trapezius and splenius capitis muscle. The mass was well demarcated but scattered and infiltrated into the adjacent muscle layer, therefore, extensive resection was unavoidable. When determining a treatment regime for the hemangioma, it is essential to consider the size of the mass, cosmetic and functional aspects of the patient.

Cavernous Hemangioma Occurred Between the Trapezius and Splenius Capitis Muscle

Hemangiomas are the most common benign tumor of soft tissue. They are frequently seen on the trunk and extremities. In addition, most of them exist at the skin and subcutaneous layer, but fewer than 1% does in the intramuscular layer. For the diagnostic images of the intramuscular cavernous hemangioma, ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) are used currently. Multiple therapeutic methods are used, but surgical excision is considered as the most ideal treatment. We describe the recurred cavernous hemangioma occurred between the trapezius and splenius capitis muscle. The mass was well demarcated but scattered and infiltrated into the adjacent muscle layer, therefore, extensive resection was unavoidable. When determining a treatment regime for the hemangioma, it is essential to consider the size of the mass, cosmetic and functional aspects of the patient.

Usefulness of SPAIR Image, Fracture Line and the Adjacent Discs Change on Magnetic Resonance Image in the Acute Osteoporotic Compression Fracture

OBJECTIVE: Osteoporotic compression fracture is an increasing issue in this community and its diagnosis depends on the magnetic resonance images (MRI). Although T1- and T2-weighted images (T1WI and T2WI) have high sensitivity and specificity, the fat suppression technique gives more clear delineation of this abnormalities. Accordingly, we re-evaluated its exact sensitivity and specificity for the imaging diagnosis of osteoporotic compression fractures in our cases. For additional information about the osteoporotic compression fractures, we evaluate the fracture lines, fluid sign and adjacent discs change on the MRI. METHODS: Retrospectively, total 85 patients who had been diagnosed with acute osteoporotic compression fracture were enrolled. They all had been underwent MRI including T1WI, T2WI and T2- Spectral Adiabatic Inversion Recovery (SPAIR) sequence. RESULTS: In this study, the incidence of high signal intensity on T2-SPAIR image was very high (0.9917). The fluid sign was seen in 56.7% on the SPAIR image. The fracture lines were more observed on the T2WI than T1WI (p=0.0062). The adjacent discs change on T2WI and T2-SPAIR image were higher than T1WI (p<0.001). CONCLUSION: For the acute osteoporotic compression fracture, T2-SPAIR image is the most specific sequence of the all sequences. The fluid sign is another suggestive finding when considered other studies. T2WI is more useful to find the fracture line than T1WI. Abnormal signal intensity on the adjacent discs may provide additional information for the acute osteoporotic compression fractures.

Surgical Outcome of the Unruptured Intracranial Aneurysm / 대한뇌혈관외과학회지

OBJECT: The surgical management of patients with intracranial aneurysm continues to be controversial, but the best results of treating an aneurysm can be achieved with treating it before it ruptures. The purpose of this study is to evaluate the surgical risk of treating unruptured intracranial aneurysms. METHODS: Between January 2000 to December 2007, 46 unruptured intracranial aneurysms were treated with aneurismal neck clipping. The clinical outcome was retrospectively evaluated according to the Glasgow Outcome Scale about one month after surgery. RESULTS: The patients consisted of 24 females and 22 males. The mean age was 56.6 years (range: 37-80). For the aneurysm location, 27 (58.8%) were at the middle cerebral artery, 10 (21.7%) were at the anterior communicating artery, three (6.5%) were at the posterior communication artery, two (4.3%) were at the internal carotid artery, two (4.3%) were at the anterior choroidal artery, one (2.2%) was at the anterior cerebral artery and one (2.2%) was at the vertebral artery. The size of the aneurysm was below 5mm for 6 patients (13%), 6 to 10mm for 30 patients (65.2%), 11 to 25mm for 9 patients (19.6%) and > or =25mm for 1 patient (2.2%). The clinical outcome was good for 39 patients (84.8%), moderate disability was noted for 5 patients (10.9%) and severe disability was noted for 2 patients (4.3%). CONCLUSION: In this study, the morbidity and mortality rates were favorable compared with those of the previous reports. Our results suggest that aneurysms associated with a ruptured lesion or those larger than 10mm could be considered for treatment. These results will be very helpful to determine whether or not to proceed with surgery.

Delayed Spinal Cord Injury Following Low Voltage Electrical Accident

Although the prediction of a delayed spinal cord injury after a low voltage electrical accident is difficult, we present a young paraplegic man who had delayed spinal cord injury after a low voltage electrical accident while working. Because the passage of an electric current is variable, the tissues far distant from the point of entry may be damaged, including the spinal cord. Low voltage itself is not a safe.

A Case of Malignant Proliferating Trichilemmal Tumor Occurring in Lower Lip / 대한이비인후과학회지

Proliferating trichilemmal tumor is one of rare benign tumors originating from the outer root of the hair follicle sheath. The tumor is clinically benign, although it can display nuclear atypia, dyskeratotic cells, and mitotic figures. These features can be misleading, and a false diagnosis of a squamous cell carcinoma is possible. An abrupt enlargement of size is suggestive of malignant changes of the tumor. We report a case of a malignant proliferating trichilemmal tumor which occurred not on the scalp but on the lower lip. A 75-year-old man presented a lower lip mass with a smooth surface, measuring 4.5X3 cm, and his right submandibular lymph node was also palpable. The tumor was widely excised with bilateral functional neck dissection, and the defect on the lip was reconstructed using radial forearm free flap including the palmaris longus tendon. No recurrence was observed during the follow-up period.

A Case of Myxoma of the Maxillary Sinus / 대한이비인후과학회지

Myxomas of the maxillary sinus are rare but well described mesenchymal neoplasms. They may be related to dental malformations or missing teeth, but may also occur without any such abnormalities. Although these tumors are well circumscribed, they are often more extensive than apparent because of their local aggressiveness and ability to erode bone. They tend to recur despite their benign nature, so it should be widely resected to prevent recurrence. A brief overview of the literature and a report of a case of myxoma of the maxillary sinus is presented.

A Case of Artificial Testis Implantation Using Tissue Expander in Anorchidism with Scrotal Hypoplasia / 대한비뇨기과학회지

A hypoplastic empty scrotum is a critical factor in the success of implantation of artificial testis. A hypoplastic scrotum increases the postoperative complication, such as wound dehiscence and prosthesis extrusion. Any technique cannot overcome this problem satisfactorily. Furthermore previous operative scars and inflammatory disease as epididymo-orchitis have often added to the difficulties. Enlarging the scrotum by gradual distention of a tissue expander implanted in the contracted scrotum has been successful in overcoming this problem. We report a case of successful artificial testes implantation after gradually enlarging scrotum by tissue expander in a 6 year old boy, who was diagnosed anorchidism with scrotal hypoplasia.