Radiologic Follow-up of Ruptured Arachnoid Cysts With or Without Hemorrhage: Five Case Reports and a Review of the Literature

Arachnoid cysts are usually asymptomatic and discovered incidentally. However, cysts may occasionally rupture because of minor head trauma. We describe the radiologic follow-up of 5 patients with ruptured arachnoid cysts featuring spontaneous resolution, subdural hygroma formation, and cystic and subdural hemorrhage. From January 2004 through July 2020, 5 patients (1.3%) with ruptured arachnoid cysts were evaluated out of 388 patients with arachnoid cysts encountered at our institution at that time. The 5 patients were all male, and they ranged in age from 6–17 years (median, 12 years).The median duration of radiologic follow-up was 3.5 years (range, 2.3–10.1 years). All of the ruptured arachnoid cysts were overlying the temporal lobe with Galassi type II. The median cyst diameter was 4.9 cm (range, 4.4–8.9 cm). Four patients had a history of recent minor head trauma. There were no particular neurologic symptoms in their past medical history in all patients. In the follow-up, two patients’ cysts resolved spontaneously without hemorrhage. One patient’s cyst resolved post-burr-hole drainage for chronic subdural hemorrhage. Another patient, whose cyst led to a hemorrhage and chronic subdural hemorrhage, recovered following a craniotomy, hematoma removal, and cyst fenestration. Another patient, presenting with hygroma, cystic hemorrhage, and chronic subdural hemorrhage, was treated with burr-hole drainage. Three patients recovered postoperatively. Arachnoid cysts rarely rupture, and surgical intervention is required for some cases associated with hemorrhage. Postoperatively, all patients had good outcomes without complications in this series.

Distinct Specialized Center of Excellence, the Story of Hwasun Neurosurgery at Chonnam National University Hwasun Hospital

The paper provides a comprehensive overview of the growth and development of Hwasun Neurosurgery at Chonnam National University Hwasun Hospital over the past 18 years. As the first brain tumor center in Korea when it was established in April 2004, Hwasun Neurosurgery has since become one of the leading institutions in brain tumor education and research in the country. Its impressive clinical and basic research capabilities, dedication to professional education, and numerous academic achievements have all contributed to its reputation as a top-tier institution. We hope this will become a useful guide for other brain tumor centers or educational institutions by sharing the story of Hwasun Neurosurgery.

Septic Cavernous Sinus Thrombosis Caused by Dental Infection

Purpose@#We report a case of bilateral septic cavernous thrombosis caused by a dental infection.Case summary: A 58-year-old male was transferred to our hospital because of left-sided proptosis and eyelid swelling. The patient had fever and left temporal headache, which did not respond to oral and intravenous antibiotics. After experiencing a tooth injury while chewing hard food 3 months ago, the patient developed toothache and swelling around the tooth for which he did not take any treatment. The patient had left eyelid edema, ptosis, chemosis, and conjunctival congestion. The left eye movements were limited in all directions. Brain magnetic resonance imaging showed dilatation and thrombosis of the left superior ophthalmic vein and thrombosis of bilateral cavernous sinuses. The patient was treated with systemic antibiotics and anticoagulants. The blood culture showed growth of Parvimonas micra and Dialister Pneumosintes, which are common causes of dental infection. @*Conclusions@#Septic thrombosis of the cavernous sinus and superior ophthalmic vein thrombophlebitis can occur due to the spread of dental infection. Prompt diagnosis and treatment are important for rapid resolution of symptoms and good prognosis.

A Case of Successful Living Donor Liver Transplantation after Down-staging of Hepatocellular Carcinoma with the Beyond Milan Criteria by Radioembolization, Hepatic Arterial Infusion Chemotherapy, and Stereotactic Body Radiation Therapy

Liver transplantation for patients with hepatocellular carcinoma (HCC) within the Milan criteria generally yields a 4-year overall survival rate of 75% and 4-year recurrence free survival rate of 83%. But, many HCC patients present with the disease beyond the Milan criteria. On the other hands, the overall survival of patients with advanced HCC with portal vein invasion is very poor. We report a case of successful living donor liver transplantation for advanced HCC with portal vein invasion by down-staging through radioembolization, hepatic arterial infusion chemotherapy, and stereotactic body radiation therapy.

A Case of Complete Remission in Patient with Extrahepatic Metastasis after Curative Resection of Hepatocellular Carcinoma by Radiotherapy, Lung Resection and Systemic Chemotherapy

Surgical resection is mainstay treatment of hepatocellular carcinoma (HCC). However, its prognosis is poor, because of the high incidence of HCC recurrence (cumulative 5-year HCC recurrence rate of 70-80%). The most common site of HCC recurrence is the remnant liver, and extrahepatic recurrence occurs in 6.7-13.5% of patients. Because the tumor characteristics in extrahepatic recurrence are usually multiple and aggressive, the optimal treatment modality has not yet been determined. We report a case of complete remission and long term survival over 60 months in patient with extrahepatic metastasis after curative resection of HCC by aggressive treatment, which include lung resection for lung metastasis, radiotherapy for mediastinal lymph node metastasis, and systemic chemotherapy.

Parotid sialolithiasis in a two-year-old boy / 소아과

Sialolithiasis is caused by the obstruction of a salivary gland or its excretory duct by the formation of calcareous concretions or sialoliths; this results in salivary ectasia and provokes subsequent dilation of the salivary gland. Sialolithiasis is relatively common, accounting for 30% of salivary diseases; however, it is rarely observed in childhood. This case report describes a 2-year-old male patient who complained of a painful swelling over the right cheek, and presented with palpable stones and pus discharge from the orifice of the right Stensen's duct. Computerized tomography of the neck confirmed the diagnosis, and the patient received intravenous empiric antibiotics combined with intraoral sialolithotomy. We also provide a review of the spectrum of concepts regarding the pathogenesis, diagnosis, and treatment of sialolithiasis.

Robotic Mechanical Localization of Prostate Cancer Correlates with Magnetic Resonance Imaging Scans

PURPOSE: To evaluate the concordance of cancer location of the tissue mapping from a mechanical pressure transducer with magnetic resonance imaging (MRI) scans. MATERIALS AND METHODS: A total of 60 indentations were performed on 5 prostate specimens obtained after radical prostatectomy utilizing a robotic indentation system. The mechanical elastic moduli of suspected malignant lesions were calculated and mapped, and their locations were compared with suspicious areas of malignancy on MRI scans. RESULTS: The concordance rate between the location mapping from the robotic indentation system and MRI scans results was 90.0% (54/60). The sensitivity and specificity of the robotic indentation system were 87.9% (29/33) and 92.6% (25/27), respectively. The positive predictive value and negative predictive value were 93.5% (29/31) and 93.1% (27/29), respectively. CONCLUSION: The locations of malignant lesions derived from our robotic indentation system correlated strongly with the locations of suspected areas of malignancy on MRI scans. Our robotic system may provide a more targeted biopsy of the prostate than conventional non-targeted systemic biopsy, possibly improving the diagnostic accuracy of prostatic biopsies for cancer.

Development of Periventricular Leukomalacia and Severe Intraventricular Hemorrhage in Very Low Birth Weight Newborns and Relationship with Ventilator Care (Study of Ventilator Care as a Risk Factor of PVL and PV-IVH) / 소아과

PURPOSE: It has been suggested that changes in cerebral blood flow by ventilator care could be a risk factor in periventricular leukomalacia (PVL) and severe periventricular-intraventricular hemorrhage (PV-IVH). The study aims to assess the relationship between perinatal clinical events, including ventilator care, and the development of PVL and severe PV-IVH; especially, whether ventilator care could be causers of PVL and severe PV-IVH as an individual risk factor. METHODS: Among 255 very low birth weight infants who survived in the Fatima neonatal intensive care unit from January 1999 to December 2003, 15 infants with PVL and eight infants with severe PV-IVH were classified as a study group, while 231 infants were enrolled as a control group. The analysis was performed retrospectively with medical records. RESULTS: Twenty four infants were diagnosed with PVL or severe PV-IVH. Asphyxia, recurrent apnea, sepsis, acidosis and ventilator care were significantly increased in the PVL goup. Asphyxia, recurrent apnea, RDS, acidosis and ventilator care were significantly increased in the severe PV-IVH group. CONCLUSION: Infants with PVL or severe PV-IVH may have multiple perinatal risk factors including asphyxia, recurrent apnea, sepsis, acidosis, RDS and ventilator care. Because most patients with ventilator care have multiple perinatal risk factors, ventilator care does not cause PVL and severe PV- IVH independently. Therefore, incidences of PVL and severe PV-IVH can be decreased by not only gentle ventilation, but also more professional antenatal care.

A Case of Chronic Inflammatory Demyelinating Polyradiculoneuropathy Associated with Perianal Abscess by Klebsiella pneumoniae

Chronic inflammatory demyelinating polyradiculoneuropathy(CIDP) is a rare acquired demyelinating disease of peripheral nervous system(PNS), characterized by relapsing or progressive proximal and distal muscle weakness with possible sensory loss. It is one of several chronic neuropathic syndromes that are believed to have an autoimmune etiology. We experienced a case of CIDP in a 3-month-old boy associated with perianal abscess by Klebsiella pneumoniae who had a precipitous onset of symptoms after anesthesia. He was treated with intravenous immunoglobuline with little improvement but showed a remarkable clinical and electrophysiologic improvement after methylprednisolone pulse therapy. We report this case with a brief review of related literature.

Effect of Endoscopic Sinus Surgery in Samter's Triad Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Chronic sinusitis with nasal polyposis, asthma and aspirin sensitivity characterize Samter's triad. The sinusitis associated with the triad is often difficult to treat and aggravates the asthmatic symptoms. This study was conducted to evaluate the feature of the triad and the outcome of endoscopic sinus surgey (ESS) as a treatment for chronic paranasal sinusitis with nasal polyposis in patients with Samter's triad. MATERIALS AND METHOD: The study group contained 16 patients with the triad who were compared with the control group (60 patients). The study was conducted in retrospective fashion focusing clinical characteristics, recurrence and re-operation rate of sinusitis and severity of asthma. RESULTS: ESS in Samter's triad patients was effective on the improvement of nasal symptoms. Fourteen of 16 patients recurred after ESS. Seven patients of 14 patients received systemic steroid therapy. Four patients of 7 patients underwent revision surgery. Three patients had asthmatic attack after postoperative use of analgesics. There was no significant improvement of asthmatic symptoms after ESS. CONCLUSION: This study suggests that the surgical intervention was less effective on Samter's triad patients. The recurrence and reoperation rate of nasal polyposis in Samter's triad patients were high. The use of NSAID should be avoided after ESS in asthmatics with nasal polyposis.

A Case of Necrolytic Migratory erythema Induced by a Pancreatic Insufficiency / 대한피부과학회지

Necrolytic migratory erythema is a cutaneous reaction pattern with specific histopathologic features that is typically associated with a functioning pancreatic islet cell neoplasm such as a glucagonoma. However, cases without. glucagonoma have also been reported, such as, liver cirrhosis, chronic pancreatitis, celiac sprue etc. Other clinical features include anemia, glossitis and weight loss. We report a case of neccrolytic migratory erythema induced by a pancreatic insufficiency without glucagonoma. A 43-year-old male was seen at our department because of rnultiple erythematous, desquamative and erosive patches on the whole body for 1 month. He also had weight loss(25Kg) and stomatitis. Seven years previously he had a Whipple's procedure for a pancreatic head rupture. The laboratory data showed a low protein and zinc level, and high glucagon level. Histopathologic findings of the case showed epidermal edema and pallor, and superficial epiderrnal necrosis. The patient improved progressively after intravenous infusion of amino acids with a pancreatic enzyme supplementation.

Lymphomatoid Papulosis : A Clinical , Histopathologic and Follow - up Study / 대한피부과학회지

BACKGROUND: Lymphomatoic papulosis, a disease with recurrent and hemorrhagic papu-lonodular lesions, shows a benign course clinically but lymhomatous features histopathologically. Although sporadic cases have been reported, we could not find any comprehensive report of clinical and histopathologic features of lymphomatoid papulosis in Korean literature. OBJECTIVE: The purpose of this study was to examine the clinical and histopathologic features and follow up observation of 16 patients with lymphomatoid papulosis. METHODS: We reveiwed the clinical and histopathologic findings, associated diseases, and response to various treatments in 16 patients with lymphomatoid papulosis during the 10 year period from January 1984 to May 1994. RESULTS: The results were summarized as fallows. 1. There were 14 males and 2 females. Sex distribution showed a male predominence with male : female ratio of 7: 1. 2. Age distribution ranged from 20 to 65, with the mean age of 43 years. 3. Duration of symptoms ranged from 4 days to 10 years, with a mean duration of 2.4 years. 4. The lesions were located on the trunk and extremities(7 cases), extremities(7 cases), and trunk(2 cases). 5. The morphology of lesions were papules or plaques(11 cases), and nodules(5 cases). 6. Associated diseases were tuberculosis(2 cases), Behcet's disease(2 cases), Klatskin tumor(1 case), osteomyelitis(1 case), hypertesion and peptic ulcer(1 case), and chronic active hepatitis(1 case). 7. Histopathologic features revealed wedge-shaped superficial and deep perivascular polymorphic infiltrate with pleomorphic cells in all specimens except one. Histopathologic types classified by Willemze's Classification were type A(9 cases), type B(6 cases), and type A and type B(1 case). 8. Treatment including PUVA, methotrexate and systemic steroid had beneficial effect only temporarlly. 9. In one patient, large anaplastic CD30 lymphoma(Ki-1 lymphoma) of the skin and inguinal lymph node developed 3 years after the onset of Lymphomatoid papulosis. CONCLUSION: All pat.ients with lymphomatoid papulosis should be followed up for a long-term period to rule out the development of lymphoma.

Lymphomatoid Papulosis : A Clinical , Histopathologic and Follow - up Study / 대한피부과학회지

BACKGROUND: Lymphomatoic papulosis, a disease with recurrent and hemorrhagic papu-lonodular lesions, shows a benign course clinically but lymhomatous features histopathologically. Although sporadic cases have been reported, we could not find any comprehensive report of clinical and histopathologic features of lymphomatoid papulosis in Korean literature. OBJECTIVE: The purpose of this study was to examine the clinical and histopathologic features and follow up observation of 16 patients with lymphomatoid papulosis. METHODS: We reveiwed the clinical and histopathologic findings, associated diseases, and response to various treatments in 16 patients with lymphomatoid papulosis during the 10 year period from January 1984 to May 1994. RESULTS: The results were summarized as fallows. 1. There were 14 males and 2 females. Sex distribution showed a male predominence with male : female ratio of 7: 1. 2. Age distribution ranged from 20 to 65, with the mean age of 43 years. 3. Duration of symptoms ranged from 4 days to 10 years, with a mean duration of 2.4 years. 4. The lesions were located on the trunk and extremities(7 cases), extremities(7 cases), and trunk(2 cases). 5. The morphology of lesions were papules or plaques(11 cases), and nodules(5 cases). 6. Associated diseases were tuberculosis(2 cases), Behcet's disease(2 cases), Klatskin tumor(1 case), osteomyelitis(1 case), hypertesion and peptic ulcer(1 case), and chronic active hepatitis(1 case). 7. Histopathologic features revealed wedge-shaped superficial and deep perivascular polymorphic infiltrate with pleomorphic cells in all specimens except one. Histopathologic types classified by Willemze's Classification were type A(9 cases), type B(6 cases), and type A and type B(1 case). 8. Treatment including PUVA, methotrexate and systemic steroid had beneficial effect only temporarlly. 9. In one patient, large anaplastic CD30 lymphoma(Ki-1 lymphoma) of the skin and inguinal lymph node developed 3 years after the onset of Lymphomatoid papulosis. CONCLUSION: All pat.ients with lymphomatoid papulosis should be followed up for a long-term period to rule out the development of lymphoma.

A Case of Hemosiderosis due to Multiple Transfusion / 대한피부과학회지

Hemosiderosis is a disorder characterized by deposits of hemosicerin in multiple organs without organ dysfunction or injury. The color of the skin becomes brown, espeially on sun exposured areas. Mucous mernbranes are also affected in up to 5-25% of cases. A 43-year-old woman visited our clinic due to generalized brown colotation of her skin, including conjunct we and oral mucous mernbrane which she had had for 10 months. She had been treated with multiple he nodialysis combined with periodic transfusion for renal failure 3 times a month during the last 5 yeadrs Her plasma ferrit in level was elevated markedly and TIBC decreased, but cortisol and ACTH levels were within normal limits, Histopathologic findings of the neck skin showed hyperpigmentation of basal layer and deposition of brown pigment wrthin and around the sweat glands. In Fontana-Masson stain, the lower epidermis showed a massive deposition of melanin. Prussian blue stain revealei hemosiderin within snd around, the sweat glands. Hemosiderin could also be noticed on specirnens of thliver biopsy. The patient improved progressively after the rstriction of trasnfusion and treatment of renal failure.