Intratumoral Hemorrhage of the Cervical Spinal Schwannoma Presenting: Acute Quadriparesis

Schwannomas are the most common extramedullary spinal tumors, with chronic progressive symptoms being the most common presenting features. The acute hemorrhagic onset of a spinal schwannoma is a rare occurrence. Here, we report the case of a 37-year-old male who presented with complaint of neck pain and an acute onset of quadriparesis. MRI of his cervical spine revealed an intradural extramedullary lesion in the C2 to C3 cervical segment, with features of acute hemorrhage but mild enhancement. He was operated in emergency and complete microsurgical resection of tumor was achieved. Histopathology revealed features of an ancient schwannoma with hemorrhage. Postoperatively, the patient showed significant improvement.

Anti-apoptotic and myocardial protective effects of ethyl pyruvate after regional ischaemia/reperfusion myocardial damage in an in vivo rat model

<p><b>INTRODUCTION</b>The integration of reactive oxygen species is strongly associated with important pathophysiological mechanisms that mediate myocardial ischaemia/reperfusion (I/R) damage. Pyruvate is an efficacious scavenger of reactive oxygen species and a previous study has shown that ethyl pyruvate (EP) has a myocardial protective effect against regional I/R damage in an in vivo rat model. The purpose of this study was to determine whether the myocardial protective effect of EP is associated with anti-apoptosis.</p><p><b>METHODS</b>Rats were allocated to receive EP dissolved in lactated Ringer's solution or lactated Ringer's solution alone, via intraperitoneal infusion one hour before ischaemia. They were exposed to 30 minutes of ischaemia followed by reperfusion of the left coronary artery territory over two hours. Anti-apoptotic effects were checked using several biochemical parameters after two hours of reperfusion. Apoptosis was analysed using measured caspase-3 activity, Western blotting of B-cell lymphoma 2 (Bcl-2) family protein cleaved by caspase-3, and assessment of DNA laddering patterns and the terminal deoxynucleotidyl transferase dUTP nick end labelling (TUNEL) staining test.</p><p><b>RESULTS</b>In ischaemic myocardium, EP increased Bcl-2 expression, but reduced Bcl-2-associated X protein and cleaved caspase-3 expressions. EP reduced the expression of DNA laddering and the number of myocardial I/R-damaged TUNEL-positive cells.</p><p><b>CONCLUSION</b>This study demonstrated that EP has an anti-apoptotic effect after regional I/R damage in an in vivo rat heart model. The myocardial protective effect of EP may be related to its anti-apoptotic effect.</p>

Posttraumatic Guillain-Barré Syndrome Immediately Following a Traffic Accident

Guillain-Barré syndrome (GBS) is an inflammatory demyelinating polyneuropathy characterized by areflexic paralysis. Most cases of GBS are preceded by an infection, however, posttraumatic GBS has also recently been reported. We report a case of posttraumatic GBS immediately following a traffic accident. We think this case is of clinical significance for practitioners because of the rare cause of a sudden flaccid paralysis following trauma.

Comparative Analysis of the Combined Therapeutic Effects of Lipoprostaglandin E1 on Sudden Idiopathic Sensorineural Hearing Loss

BACKGROUND AND OBJECTIVES: Viral and vascular disorders are considered to be a major cause of idiopathic sudden sensorineural hearing loss (ISSNHL). Lipoprostaglandin E₁ (lipo-PGE₁) has vasodilating activity and has been used to treat ISSNHL. The purpose of this study was to determine the specific therapeutic effects of lipo-PGE₁ and compare them to other treatment modalities for ISSNHL. SUBJECTS AND METHODS: The study group had 1,052 patients diagnosed with ISSNHL. All were treated with steroid, carbogen inhalation, stellate ganglion block (SGB), or PGE₁. The CP group (steroid, carbogen inhalation, and PGE1 injection; 288 patients) was treated with lipo-PGE₁ and carbogen inhalation, the CS group (steroid, carbogen inhalation, and stellate ganglion block; 232 patients) with steroid, carbogen inhalation, and SGB, the C group (steroid and carbogen inhalation; 284 patients) with steroid and carbogen, and the control group (steroid only; 248 patients) with steroid only. Patients in the groups receiving lipo-PGE₁ received a continuous infusion of 10 µL lipo-PGE₁. RESULTS: The overall recovery rate after treatment was 52.2%, and recovery rates by group were 67.7% in the CP group, 54.3% in the CS group, 52.1% in the C group, and 32.2% in the control group. Therefore, the therapeutic results in groups treated with lipo-PGE₁ were better than results in other groups. The difference was statistically significant. CONCLUSIONS: The study results suggested that the CP group received effective treatment modalities for ISSNHL. The combined therapy of lipo-PGE₁ with carbogen inhalation in patients with ISSNHL was more beneficial than other treatment modalities.

A conversion to implant overdenture in failed fixed implant prosthesis of edentulous maxilla: A case report / 대한치과보철학회지

Fixed implant prosthesis and removable implant overdenture are the main treatment options for treating edentulous maxilla with implants. If clinicians select one of the treatment options without accurate diagnosis and evaluation, this may lead to unfavorable treatment result and one would not be able to guarantee successful long term prognosis. In this case, 69 year-old female presented with failed fixed implant prosthesis that was treated in private dental clinic. Since the patient did not want additional insertion of implants and considering factors such as oral hygiene maintenance, splinting effect, and esthetics, the patient was treated with removable implant bar type overdenture using pre-existing implants. The clinical results were satisfactory in the aspect of esthetics and masticatory function, oral hygiene maintenance.

Clinical Analysis and Management of Esophageal Perforation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Esophageal perforation is relatively uncommon and requires careful diagnostic evaluation and expert management. It has a high mortality due to significant mediastinal and pleural contamination leading to sepsis and multiple organ failure. We reviewed our experience of esophageal perforation to determine how to better recognize such a lesion and facilitate its correct management. SUBJECTS AND METHOD: A retrospective chart review was performed on all patients treated for esophageal perforation from January 2000 to March 2016. These patients have been studied with respect to gender and age distribution, causes, sites, clinical manifestation, complications, management and postoperative complications. RESULTS: Patients ranged in age from 21 to 87 years, with an average age of 57.6±12.4 years. Fifty of the patients were men and 21 were women. The causes of the perforations were as follows: foreign body retention (18 patients), trauma (17 patients), Boerhaave's syndrome (22 patients), and iatrogenic (14 patients). The sites of esophageal perforation were: the cervical esophagus (25 patients), thoracic esophagus (44 patients) and abdominal esophagus (2 patients). Primary repair only was performed in seven (9.9%) patients, whereas 32 (45%) patients were treated with primary repair & patch, seven (9.9%) patients with T-tube drainage. Exclusion & division were performed in three (4.2%) patients and esophagectomy was performed in two (2.8%) patients. Twenty (28.2%) patients were treated conservatively. CONCLUSION: Early recognition and appropriate management of esophageal perforation are essential for reduction of morbidity and mortality.

Cervical Myelopathy Secondary to Atlanto-occipital Assimilation: The Usefulness of the Simple Decompressive Surgery

Atlanto-occipital assimilation is one of the most common osseous anomalies observed at the craniocervical junction. Most patients with atlas assimilation show no symptom, but some have neurological problems such as myelopathy that may require surgical treatment. Occipitocervical fusion may be required if atlato-occipital assimilation is accompanied by occipito-axial instability. However, in cases of symptomatic atlas assimilation with minor cord compression without instability, simple decompressive surgery may be the treatment modality. This report describes a case of successful treatment of a patient with myelopathy secondary to atlanto-occipital assimilation without instability, using posterior simple decompressive surgery.

Extensive Spinal Epidural Abscess: The Usefulness of Minimal Invasive Surgical Technique using Epidural Irrigation Catheter

Spinal epidural abscess (SEA) is a rare infection but may be devastating and fatal. We describe a case of a42-year-old male who presented with a posteriorly located SEA extending from C2 to the sacrum with severe neurologic deficits. We had the emergency surgery with the minimal invasive technique using epidural irrigation catheter, and then obtained an excellent recovery. The purpose of this report introduces the usefulness of minimal invasive surgical technique for extensive SEA.

Phosphorylation of 14-3-3zeta at serine 58 and neurodegeneration following kainic acid-induced excitotoxicity / 대한해부학회지

Oxidative stress-induced cell death leads to phosphorylation of 14-3-3zeta at serine 58. 14-3-3zeta is detected at significant levels in cerebrospinal fluid after kainic acid (KA)-induced seizures. Here we examined temporal changes in 14-3-3zeta phosphorylation in the hippocampus and amygdala of mice after KA treatment. Mice were killed at 2, 6, 24, or 48 h after KA (30 mg/kg) injection. We observed an increase in TUNEL and Fluoro-Jade B (FJB)-stained neurons in the hippocampus and amygdala of KA-treated mice. Phospho (p)-14-3-3zeta and p-JNK expression was increased in the hippocampus 2 and 6 h after KA treatment, respectively. In immunohistochemical analysis, p-14-3-3zeta-positive cells were present in the CA3 region of the hippocampus and the central nucleus of amygdala (CeA) of KA-treated mice. Thus, phosphorylation of 14-3-3zeta at serine 58 may play an important role in KA-induced hippocampal and amygdaloid neuronal damage.

Ethanol down regulates the expression of myelin proteolipid protein in the rat hippocampus / 대한해부학회지

It is well known that chronic ethanol treatment affects the synthesis of RNA and protein in the brain and the maintenance and function of nervous system. The changes in myelination-related genes are most prominent in human alcoholics. Previously, our cDNA microarray study showed altered Proteolipid protein (PLP), a major protein of central myelin. The present study aimed to gain more understanding of the expression of PLP after chronic ethanol treatment. Male Sprague-Dawley rats were daily treated with ethanol (15% in saline, 3 g/kg, i.p.) or saline for 14 days. Messenger RNAs from hippocampus of each group were subjected to cDNA expression array hybridization to determine the differential gene expressions. Among many ethanol responsive genes, PLP was negatively regulated by ethanol treatment, which is one of the most abundant proteins in the CNS and has an important role in the stabilization of myelin sheath. Using northern blot and immunohistochemical analysis, we showed the change in expression level of PLP mRNA and protein after ethanol treatment. PLP mRNA and protein were decreased in hippocampus of rat with chronic ethanol exposure, suggesting that ethanol may affect the stabilization of myelin sheath through the modulation of PLP expression and induce the pathophysiology of alcoholic brain.

Clinical Analysis of Patients who Survived for Less than 3 Months After Brain Metastatectomy

In the patients with brain metastasis (BM), it is impossible to determine who will benefit from surgery because of limited survival. In an attempt to identify optimal candidates for brain metastatectomy, we analyzed patients who survived for <3 months after craniotomy for a single BM lesion. Between January 1st, 1997 and July 31st, 2007, 83 patients with a single BM underwent craniotomy. Of these patients, 25 patients (30.1%) died within 3 months of craniotomy. The primary lesions were non-small call lung cancer in 15, colon cancer in 6, and breast cancer, renal cell carcinoma, ovarian cancer, or esophageal cancer in one apiece. Of the 25 patients, 19 (79%) were of tumor stage IV and had extra-cranial metastasis. Eleven (44%) of the 25 primary cancers had a well-controlled status. Twelve patients (48%) had a Karnofsky Performance Scale (KPS) score of <70, and 13 (52%) were of Recursive Partitioning Analysis (RPA) class 3. Primary cancer status, RPA class, and functional status were found to be critical factors for consideration when selecting surgical candidates. In addition, adjuvant therapy was found to have an important role on survival.

Clinical Comparison between Simple Craniectomy and Lesionectomy in the Patients with Acute Cerebral Infarction / 대한뇌혈관외과학회지

OBJECTIVE: Life-threatening middle cerebral artery infarction may be accompanied by severe post-ischemic brain swelling due to cytotoxic vasogenic edema. The resultant progressive mass effect may prove fatal, owing to increased intracranial pressure and herniation. Recent studies have shown that early decompressive craniectomy decreases mortality, but no comparison has been performed between the outcomes achieved with simple craniectomy and those achieved with craniectomy combined with lesionectomy. This study was performed to compare the outcomes achieved after simple craniectomy and after craniectomy combined with lesionectomy. MATERIALS AND METHODS: We prospectively reviewed the records of 59 patients who presented with acute middle cerebral infarction between January 2001 and October 2007. Thirty-one patients (Group A) underwent simple decompressive craniectomy, and 28 patients (Group B) underwent lesionectomy with craniectomy. In all patients, lesion volume and mid-line shift were measured radiologically. Outcomes were quantified using the Glasgow Outcome Scale. RESULT: Patient factors (age, sex), Glasgow Coma Scale, radiologic findings, and lobe involvement were the same for the two groups. However, the outcomes for the two groups were different. At 6 months after surgery, the mean Glasgow Outcome Scale for Group A was 2.71 and that for Group B was 3.39 (p<0.05). CONCLUSION: Surgical treatment, especially decompressive craniectomy combined with lesionectomy, was beneficial in the setting of malignant cerebral infarction.

Anterior and Posterior Stabilization by One Stage Posterolateral Approach in the Unstable Fracture of Thoracolumbar and Lumbar Spine

OBJECTIVE: The purpose of this study is to investigate the clinical results of anterior and posterior stabilization by one stage posterolateral approach for the unstable fracture of thoracolumbar and lumbar spine. METHODS: By posterolateral approach with curved skin incision, unilateral facet and pedicle were removed. Through this route, corpectomy was performed, and then this space was replaced with mesh cage filled up with autologous bone graft. Both side pedicle screw fixation was followed to upper and lower levels. RESULTS: Six of seven patients of this study showed neurological improvement. The other one patient showed no neurological change. One patient had postoperative infection, another patient had postoperative kyphosis. The other patient had epidural hematoma on operation site after surgery. And all patinets on this study made to have spinal stability except one patient happened postoperative kyphosis. CONCLUSION: In the unstable fracture of thoracolumbar and lumbar spine, one stage anterior and posterior stabilization and fusion by posterolateral approach seems to be an effective procedure, if we have more care and supplementation.

Endoscopic Surgery for Pituitary Tumor

OBJECTIVE: The purpose of this study is to assess the efficacy and advantages of an endoscopic endonasal approach for the treatment of pituitary tumors. METHODS: We retrospectively analyzed the records of 31 patients with pituitary tumors having endoscopic endonasal surgery between March 1999 and August 2003. RESULTS: Among 31 patients with pituitary adenomas, 25 (81%) patients exhibited gross total removal of tumor on postoperative MRI within 3 days after surgery. Among 6 patients removed subtotally, 2 had only radiosurgery, 3 have had periodic follow-up MRIs and one patient with large extended tumor (grade IV, Stage E) had secondary transcranial removal of tumor before radiosurgery. Postoperative complications included cerebrospinal fluid leak in 2 patients, sinusitis in 1 patient, and one patient died due to unexpected intracerebral hemorrhage on 5 days after surgery. Besides considerable experiences with this approach are needed because of narrow working channel to the sella turcica, the results of our study showed following advantages of this procedure: visualization of areas not seen with the operating microscope, elimination of oronasal complications, more functional and cosmetic outcome, and shortened operative time and hospital stay. CONCLUSION: The authors consider that endoscopic endonasal transsphenoidal approach provides good results with minimal invasion for patients with pituitary tumors.

Anterior Cervical Interbody Fusion with the Carbon Composite Osta-Pek Frame Cage in Degenerative Cervical Diseases

OBJECTIVE: Different types of interbody fusion cages are available for use in the surgical treatment of degenerative cervical diseases. The purpose of this study is to assess the technical feasibility, clinical efficacy and radiological results of intervertebral fusion with a carbon composite Osta-Pek frame cage (Co-Ligne AG, Switzerland) following anterior cervical discectomy. METHODS: 41patients (25males and 16females) with minimum 6months follow-up were included in the study. Disc height, cervical lordotic angle, segmental angle, and fusion rate were assessed by lateral radiographs. In this retrospective analysis, clinical outcome was assessed as evaluated according to Odom's criteria. RESULTS: Fifty-four cages were implanted in 30 single-level, 9 two-level, and 2 three-level procedures. The mean disc height, cervical lordosis angle, segmental angle were 4.2+/-1.8mm, 23.5+/-7.2degrees, 2.3+/-3.3degrees pre-operatively and 5.3+/-2.1mm, 24.2+/-8.3degrees, 3.8+/-3.5degrees at 6months after the surgery. Six months after surgery, there was radiographic evidence of fusion in 92.7% (38/41) of the patients. According to Odom's criteria, 37 of 41 (90.2%) patients experienced good to excellent functional recovery. CONCLUSION: These clinical and radiological results suggest that the carbon composite Osta-Pek frame cages are safe and effective alternative to autologous bone graft after anterior cervical discectomy for treatment of degenerative cervical disease.

Surgical Treatment for Posterior Fossa Epidural Hematomas

OBJECTIVE: The purpose of this study is to investigate the interactions between prognostic factors and functional outcome of patients surgically treated posterior fossa epidural hematomas. METHODS: Between 1992 and 2001, twenty patients were surgically treated for the posterior fossa epidural hematomas. The medical records and radiologic findings of the patients were reviewed retrospectively. Information on potential prognostic factors was collected, and then univariate analysis was performed to determine significant prognostic factors. RESULTS: Initial Glasgow Coma Scale scores of 12 patients were 13 or better. Occipital skull fractures were found in 16 cases(80%). The degree of 4th ventricle compression measured on computed tomography scan. Seven cases showed total obliteration, nine cases showed partial obliteration and four cases showed normal. Eighteen patients experienced good or moderate outcomes(Glasgow Outcome Scale scores of 4 or 5). Functional outcome showed a significant correlation with Glasgow Coma Scale score, degree of 4th ventricle compression(p<.05). CONCLUSION: If poor initial consciousness level and severe 4th ventricle compression are noted, early and aggressive treatment are required. Although clinical progression of posterior fossa epidural hematoma is silent and slow, the deterioration might be sudden and quick to become fatal if not promptly treated.

Stereotatic Aspiration of Simultaneous Bilateral Spontaneous Intracerebral Hemorrhage: Case Report

The simultaneous occurrence of intracerebral hemorrhages in different arterial territories is an uncommon clinical event. The authers report a case of simultaneous bilateral intracerebral hemorrhages treated with stereotactic aspiration. A 64-year-old male presented with simultaneous bilateral intracerebral hemorrhages in the both putamens. The hematomas were demonstrated by computed tomography performed after a few hours of onset. The patient underwent computed tomography-guided stereotactic aspiration but he finally became vegetative state. Most of patients reported previously usually have unfavorable functional outcome and high mortality because of the severe neurological deficits. Therefore, the role of the surgical treatment in case of bilateral intracerebral hemorrhages should be surveyed closely in according to clinical state. The authors describe a case of simultaneous bilateral intracerebral hemorrhages and with discussion focused in the predisposing factors, pathogenesis and therapeutic approach.

Delayed Cerebral Infarction after Resection of Craniopharyngioma

Delayed cerebral infarction after resection of craniopharyngioma is a uncommon entity, but leads to high morbidity and mortality. We present 3 such cases and discuss the etiology and pathogenesis with review of pertinent literatures. In our cases, delayed deterioration of consciousness was observed in all cases. All of them expired. The cause may be multifactorial and the surgical approach may contribute to the pathogenesis of delayed cerebral infarction. We suspect vasospasm might be the major mechanism of pathogenesis. Vessels were primed to spasm during operation due to blood in the cistern or mechanical injury. Vasoactive materials may have been liberated from the pituitary stalk or injured hypothalamus, either at the time of surgery, or later, after portions of tumor have undergone necrosis. The high degree of suspicion to detect vasospasm should be done in the case of the delayed deterioration of mental status at an early stage of craniopharyngioma surgery. Possible mechanism underlying this delayed cerebral infarction are discussed.

Recurrence and Extraneural Metastasis in 31 Meningeal Hemangiopericytomas

Purpose: Meningeal hemangiopericytoma(M-HPC), characterized by a high local recurrency and metastatic potential, is a rare neoplasm arising from perivascular pericytes. A retrospective study was performed to identify the recurrence and extraneural metastasis in M-HPC. MATERIALS AND METHODS: We reviewed the records of 31 M-HPC patients treated from 1982 through 1999 at our institution. The time to recurrence and the various parameters affecting recurrence were determined. Extreneural metastasis was also analyzed. RESULTS: The rate of local recurrency was 38.7%(12/31). The overall average recurrence-free period(RFP) before the first recurrence was 104 months, with overall recurrence-free rates(RFRs) at 5 and 10 years after first surgery of 59.2% and 33.6%, respectively. Of the 12 patients who experienced local recurrence, 4 had recurrences 5 years later after the first surgery. Complete excision at the first operation significantly extended the average time before first recurrence from 43 to 111 months. The 5-year RFRs for the groups of complete excision and incomplete excision were 72.7% and 20.8%, respectively(p=0.0060). Although there was no statistical significance, complete excision followed by adjuvant radiotherapy of more than 50Gy extended the RFP. The 5-year RFRs for the groups of complete excision and complete excision with adjuvant radiotherapy were 70.3% and 100%, respectively(p=0.3359). Four patients(12.9%) presented one or more extraneural metastases that were developed at an average of 107 months after the first operation with the 5- and 10-year metastasis rates of 4.4% and 24.9%, respectively. Conclusions: M-HPC has a propensity to recur either locally or at distant sites after surgical resection. Complete excision is the most important factor to reduce recurrence. However, even with complete excision, adjuvant radiotherapy of more than 50Gy significantly reduces the risk of recurrence. Local and distant recurrences may occur after a prolonged disease-free interval, emphasizing the need for long-term follow-up.

Intracranial Cavernous Hemangioma after Radiotheraphy for Astrocytoma

Radiation is a common treatment modality for central nervous system neoplasms. However, secondary tumor development must be considered in the differential diagnosis in patients with new or recurring symptoms after treatment with conventional radiotherapy. A 28-year-old woman developed a cavernous hemangioma about 9 years after brain irradiation for astrocytoma. Clinical and histopathological details are presented, and previous reports of radiation-induced intracranial cavernous hemangioma are reviewed.