The Factors Affecting Enlargement of Spontaneous Intracerebral Hemorrhage

OBJECTIVE: The goal of this study is to evaluate the incidence and factors of hematoma enlargement in patients with spontaneous intracerebral hemorrhage(ICH). METHODS: We analyzed 149 cases with spontaneous ICH who underwent computerized tomography (CT) scans from January, 1995 to December, 1998. The clinical characteristics, past medical history, laboratory findings, time intervals between onset of ICH and CT scan, CT findings and results of treatment were reviewed. RESULTS: Of the total 149 patients, 28(18.8%) had hematoma enlargement, of whom 24(85.7%) underwent a first CT scan within 3 hours after onset of ICH. The incidence of hematoma enlargement significantly decreased in patients who had CT scans 3 hours later after attack. Age, sex, and site of hematoma were not related to hematoma enlargement. Patients with an irregularly shaped hematoma, inhomogenous hematoma and large hematoma had a high risk of hematoma enlargement. Hematoma enlargement was associated with a poor clinical outcome and high mortality(46.7%). CONCLUSION: Patients admitted to a hospital within 3 hours of onset of ICH, and patients with inhomogenous hematoma on CT scan, irregularly shaped hematoma, or large hematoma should be closely observed for hematoma enlargement.

Expression of p27(Kip1) in gastric cancers and precancerous lesions / 대한내과학회지

BACKGROUND: The cyclin-dependent kinase inhibitor p27(Kip1) is a negative regulator of cell cycle progression at G1/S transition. Recently, the expression level of p27(Kip1) was decreased in many cancers such as breast, pituitary gland, colon and stomach. We studied the expression of p27(Kip1) in gastric cancers, precancerous lesions and normal gastric tissues and analysed its correlation to clinicopathologic data including tumor differentiation, tumor depth, nodal and distant metastasis in gastric cancers. METHODS: p27(Kip1) were immunohistochemically stained in the tissue specimens of 62 resected cancers, 110 corresponding adjacent non-neoplastic tissues, 22 gastric adenomas and 10 normal gastric tissues. Adjacent non-neoplastic tissues consisted of 32 chronic gastritis, 29 intestinal metaplasia and 49 transitional mucosa. RESULTS: Gastric cancers showed significantly decreased expression level of p27(Kip1) when compared with non-neoplastic lesions and adenomas. Labeling index of p27(Kip1) were more decreased in chronic gastritis, intestinal metaplasia and transitional mucosa than in normal mucosa. Early gastric cancers showed significantly decreased expression level of p27(Kip1) when compared with advanced gastric cancers. In gastric cancers, p27(Kip1) labeling index was significantly decreased in diffuse type and presence of nodal metastasis however did not show relationship with distant metastasis and tumor depth of advanced gastric cancers. CONCLUSION: We suggest that p27(Kip1) may be decreased in the early stage of gastric carcinogenesis and play an important role in the progression and differentiation of gastric cancers. More further studies are thought to be necessary in order to evaluate its prognostic factor in gastric cancers.

Detection of Acute Subarachnoid Hemorrhage: Comparison of FLAIR MR Imaging with Unenhanced CT

PURPOSE: Our aim was to evaluate the usefulness of fluid-attenuated inversion recovery (FLAIR) MR imaging for detection of acute subarachnoid hemorrhage (SAH) compared with unenhanced CT. MATERIALS AND METHODS: We compared FLAIR MR images with unenhanced CT scans in 28 patients with acute SAH. Findings of SAH on CT and MR images were graded as 0 (absence), 1 (suspicious), 2 (definite) in the cerebral sulci, sylvian fissure, basal cistern, and cisterns of the posterior fossa. We also compared FLAIR MR images of 28 patients with those of 35 normal subjects, and then the sensitivity, specificity, and diagnostic accuracy of FLAIR MR image for detection of acute SAH were calculated. RESULTS: FLAIR MR image was superior to CT in detecting SAH in the posterior fossa (1.41+/-.74 vs 0.78+/-.80; p<0.05) and cortical sulci(1.11+/-.80 vs 0.70+/-.83; p<0.05). There was no significant difference between FLAIR MR image and CT in detecting SAH in the basal cistern and sylvian fissure. The sensitivity, specificity, and diagnostic accuracy of FLAIR MR image for detection of SAH were 100% in all. CONCLUSION: FLAIR MR image is useful in detecting acute SAH, especially in patients with small amount of SAH or SAH in the posterior fossa.

Skull Metastasis of Thyroid Carcinoma: Case Report

No abstract available.

The Effects of Lipoxygenase and Cyclooxygenase Inhibitors to Meningioma Cell Proliferation in vitro

No abstract available.

A Clinical Analysis on Traumatic Subarachnoid Hemorrhage

No abstract available.

Multiple Hypertensive Intracerebral Hemorrhage: A Case Report

Spontaneous intracerebral hemorrhage is one of the most devastating forms of cerebrovascular disease, and is most frequently caused by hypertension in the distribution of the perforating arteries. Generally, hypertensive intracerebral hemorrhage is usually a single lesion, and recurrent intracerebral hemorrhage due to hypertension is not a rare condition. But multiple simultaneous intracerebral hemorrhage caused by hypertension is very rare. The authors report 4 cases of multiple hypertensive intracerebral hemorrhage. This represents 0.77% of total 514 hypertensive intracerebral hemorrhages treated between January, 1994 and December, 1997 in our institution. All patients had chronic history of hypertension, and the locations of the hematomas were as follows: both basal ganglia in two cases, right basal ganglia and left thalamus in one case, cerebellum and left parietal lobe in one case. Two cases were treated by surgical evacuation of hematoma and remaining two were treated by conservative management. The results of treatment were poor in all patients.

Supratentorial Meningeal Hemangioblastoma: Case Report

Supratentorial hemangioblastomas are rare and a meningeal location is even rarer. We report a solid meningeal hemangiblastoma in left parietal region, mimicking a meningioma on CT scan. There was no manifestation of von Hippel-Lindau disease. The literature on supratentorial meningeal hemangioblastoma was reviewed.

Clinical Analysis of Posttraumatic Infarct Patients

Posttraumatic cerebral infarction is a recognized complication of craniocerebral trauma, but, its frequency, cause, and influence on mortality are not well defined. During a two year period, 706 patients with head trauma were examined in our hospital with cranial CT studies. The CT findings which strongly suggested the herniation were seen in 46 patients. The posttraumatic cerebral infarction was diagnosed retrospectively in 18 of these patients. Detailed information, including CT findings were recorded from 1 to 10 days after admission. Posttraumatic cerebral infarctions were seen in the vascular territories of the middle cerebral artery(PCA) in 9 patients, posterior cerebral artery(PCA) in 4 patients, anterior cerebral artery(ACA) in 3 patients, and multiple in 2 patients. Outcomes of these 18 patients were severely disabled in 8 patients, moderate disabled in 6 patients, and death in 3 patients. Only one remaining patient was demonstrated a good recovery. These results suggest that cerebral infarction with severe head trauma might be associated with significantly bad influence on outcome of these patients when compared with those without cerebral infarction.

Periventricular Heterotopia: A Case Report

Anomalies of cell migration are due to various kinds of damage(vascular, infectious, teratogenic etc.) which interfere with neuronal migration between the 8th and 24th week of gestation. Periventricular heterotopias are nodular masses which protrude into the ventricular lumen. There is a high frequency of convulsive disorders. A 38-year-old woman presented to a intermittent headache, seizure-like activity and post-ictal subjective weakness on the left side. The computerized tomography findings and physical and neurologic examinations with an EEG revealed no specific abnormal findings. The MRI showed tumor-like nodular mass lesions at right periventricular area. The histological study of stereotactic excised biopsy demonstrated a composition of neuron and glia. After operation, headaches were slightly reduced and there was no reattack of seizure activity. Authors reports one case of periventricular heterotopia with a review of the literature.

Clinical Analyis of Acute Epidural Hematoma: Factors Affecting Its Outcome

As the development of CT scan enabled rapid and precise diagnoses of epidural hematoma, recent efforts have been sought to reduce its mortality rate. This study is a retrospective clinical analysis of one hundred eighty-one consecutive cases of epidural hematoma treated at the Department of Neurosurgery in Dong-guk University Hospital between Jan. 1991 and Dec. 1994. The rate of unsatisfactory outcome is 10.5%, While the mortality rate is 4.9%. Delayed epidural hematoma was founded tobe 12%. The authors have attempted to identify the factors influencing the prognosis of epidural hematoma. Based on the results of the above study we concluded that age, initial Glasgow coma scale, pupillary reflex and its size, IICP findings on brain CT, hematoma amount, associated intracranial lesions, rate of development of symptoms and timing of operation after injury are all relevant prognostic factors.

Acute Subdural Hematoma: An Analysis of 244 Operated Cases

This study is a retrospective clinical analysis of two hundred forty-four consecutive cases of acute subdural hematoma which were confirmed by operation during the last five years at the Department of Neurosurgery of the Dong-guk University Hospital. The authors have attempted, through this analysis to identify the factors affecting the outcome of acute subdural hematoma. A favorable outcome occurred in 40%, and an unfavorable outcome in 21% of patients at the time of discharge while a death ocurred in 39% of the cases. We have concluded that initial GCS, pupillary status, systolic arterial blood pressure, FDP vaules, presence or absence of skull fracture. IICP findings on brain CT, hematoma amount, and associated intracranial lesions are all prognostic factors, although the timing of operation did not reflect a significant difference in the outcome, however the sooner the intracranial hematoma lesion is evacuated, the better the outcome will be.

Clinical Analysis of Lymphocyte Population Changes in Severe Head Injured Patients Using Flow Cytometry

Despite advancement in diagnosis and progress in the management of intracranial pressure, infection remains a common complication following severe head injury. This following study attempts to better define the cell mediated immunity that decreased immediately following severe head injury. Twenty-five patients admitted with severe head injury(mean Glasgow Coma Scale, 5.32) were studied at the emergency rooms. The control group consisted of 25 mildly head-injured patients requiring hospital observation. Phenotyping of peripheral blood lymphocytes(PBL), determined by flow cytometry using monoclonal antibodies to lymphocytes subpopulation and HLA-DR receptors, was performed immediately following head injury. When severely head-injured patients were compared with controls, it was observed that the total T-cell counts(p<0.01) were markedly decreased, whereas the NK cell counts(p<0.01) were found to be increased. Infection rate of the study group was 44% and the majority of infections occur within the first 10 days after sever head injury. The results of this study suggests that severely head-injured patients had a decreased T-cell population and subpopulation in lines with higher infection rate.

A Case of Migrated Peritoneal Catheter of V-P Shunt System into Right Ventricle: Case Report

Variety of complications following ventriculoperitoneal(V-P) shunt have been reported. However, right ventricular migration of a V-P shunt has never been documented. The authors present a case of migrated peritoneal catheter of a V-P shunt system into the right venticle. To our knowledge, this is the first reported case complicated with migration of a peritoneal tube into the right ventricle. The patient was presented with fever and the migration was diagnosed by chest X-ray, and neck and cardiac ultrasonography.