Experimental Study on Acute Gastric Mucosal Lesion

Acute gastric mucosal lesions (AGM lesions) is a general term applied to conditions characterized by the acute development of mucosal lesions in the form of erythema, mucosal hemorrhage, erosions and ulcerations in the mucosa of the stomach and duodenum. Although the pathopphysiological events leading to the formation of these lesions remain unknown, we do know that they are after preceded by one of many situations. It has become traditional to use the term stress ulcer to describe AGM lesions proceded by a major stress such as that of an operation or of severe thermal burns or hemorrhagic shock. The silent clinical manifestation of acute gastric mucosal lesions, regardless of their cause, is bleeding. AGM lesions were experimentally produced by brain injury and administration of steroid. This experimental study was conducted in order to study the so called AGM lesions, especially on production and pathology of them. This experimental animals, normal adult rate, were divided into 4 groups the first group of brain injury, the second group of brain injury and administration of steroid, the third group of administration of steroid only, and the fourth group of normal control with administration of normal saline and normal rats. The frequency of AGM lesions was studied in relation to each experimental group, experimental period and grade of lesions. The AGM lesions were divided into 3 grades depending on the macroscopic and microscopic findings. 1. AGM lesions were observed in 34 out of 63 all experimental animals except for control group of animal. Majority of the lesions were found in the glandular portion of the stomach. 2. In the brain injured group, the lesions that was erythematous and superficial mucosal erosion were found in 3 out of 21(14.3%), which were observed only in experimental period of 3-5 days. 3. In the group with brain injury and steroid administration, the lesions were found in 16 out of 21 animals(76.2%) among them grade 1 was in 2 out of 16, grade 2 in 10 and grade 3 in 4, which observed in the period of 2-7 days. 4. In the group with administration of steroid, the lesions were found in 15 out of 21 animals(71.4%), among them grade 1 was 2 out of 15, grade 2 in 11 and grade 3 in 2, which started to be observed form 2nd day through out the experimental period. 5. No lesions were investigated in the control group. No correlation between the variety of brain injury and production of AGM lesion was studied.

A Case of Salmonella Osteomyelitis in Lumbar Spine

Since Maisonneuve mentioned osteomyelitis by typhoid fever for the first time in 1835, numerous investigators had reported salmonella osteomyelitis. But these are very rare in its incidence ; only 0.82% of patients with typhoid infections have skeletal involvement. The authors recently experienced a case of salmonella osteomyelitis in lumbar spine respectively caused by salmonella typhi D group. A 48 year-old female was admitted to our Dept. of Neurosurgery with 4 months history of severe lumbago. On hospitalization her emperature raised upto 39 degrees C once and widal test showed salmonella typhosa OH 640x. Lumbar spine X-ray films demonstrated irregular bony destruction of L2 and L3 with mild degree of narrowing of intervertebral space of L2-3. Pus evacuation and currettage of involved vertebrae surgically were performed. Salmonella osteomyelitis involving intervertebral space was confirmed by culture of pus obtained from pathologic lesion and by biochemical test. Satisfactory result is obtained by surgical and antibiotic therapy.

A Case of Fibromuscular Dysplasia of the Extracranial Internal Carotid Artery

A case is presented in which left-sided hemiparesis was caused by a fibromuscular dysplasia of the right internal carotid artery in the neck, and it used as a basis for discussion of the angiographic features. The 24-year-old woman was admitted to our Department of Neurosurgery, Korea University hospital, with the complaints of headache and left-sided hemiparesis which developed abruptly about one month before this admission. The carotid angiography was performed by puncture of the right common carotid artery under the clinical impression of cerebral thrombosis, which showed no gross intracranial abnormalities. But the characteristic findings were observed under and widening of the arterial lumen which are so-called loose stocking appearance or 'string of beads' appearance and are the typical feature of fibromuscular dysplasia. No surgical interventions such as arterial reconstruction and grafting, or arterial dilatation with bougies were applied on the patient, and she was discharged from the hospital three days after the admission. Fibromuscular dysplasia is a rare sclerotic, noninflammatory lesion of unknown etiology involving the wall of large arteries. This disease is found most frequently in early adult life and women are afflicted more often than men, This condition has been described most often in the renal arteries, where it has been found to be a cause of hypertension. Among the involvement of carotid system, the cervical portion of the internal carotid artery is most often affected, and the involvements are often bilateral. When localized to the internal carotid arteries, it can give symptoms of intermittent or permanent cerebral ischemia, but is usually asymptomatic. The typical angiographic appearance is the main parameter for diagnosis of fibromuscular dysplasia.

The Treatment of Anterior Communicating Artery Aneurysms by Proximal Occlusion of the Dominant Anterior Cerebral Artery

A direct intracranial operative approach that occludes the neck of the aneurysmal sac by clipping, and excludes it from the circulation without interference with the lumen of the parent vessel, is the ideal treatment of symptomatic intracranial aneurysm. With this procedure, however, there is no assurance of complete obliteration of the aneurysmal sac. Furthermore aneurysms arising from the anterior communicating artery are particularly dangerous because of the effects produced by spasm of the important neighboring perforating vessels. Since Logue published on the treatment of anterior communicating aneurysms by proximal ligation of an anterior cerebral artery in 1956, there has been by the large number of series of cases reported by other surgeons. Tindall classified three pattern of angiographic filling in patients with anterior communicating aneurysms and in type III, each anterior cerebral artery fills from its respective side, while the aneurysm fills from one side only, proximal ligation of anterior cerebral artery was performed with good effect. Five patients with anterior communicating artery aneurysm were treated by proximal occlusion of the dominant anterior cerebral artery with no mortality or morbidity. There was also instance of recurrent hemorrhage during the follow up period for 8 months to 5 years. We thought this operative procedure, therefore, can offer a highly acceptable result if the surgeon applies strict criteria to patient selection. Technically, the procedure was simple, earlier and could be performed more quickly than the direct attack.

Ventriculo-peritoneal(-atrial) Shunt in Tuberculous Meningitis with Hydrocephalus

Tuberculous meningitis, which commonly causes thick granulations over the base of the brain, is a frequent cause of post-meningitic hydrocephalus. Raised intracranial tension affects the cause of tuberculous meningitis adversely. The development of hydrocephalus may account for the raised intracranial pressure. Insertion of a V-A(V-P) shunt significally alters the course of the disease. The results in 5 cases have been detailed and discussed. Operation could be performed even in an active stage of the disease without much fear of milliary dissemination.

A Case of Pituitary Abscess

Abscess formation within the sellar turcica is a rather entity. The development of such as abscess may be due to a direct extension of adjacent infections, such as sphenoid sinusitis, osteomyelitis of the floor of the sella or infections of other sinuses, or may be transmitted through the blood stream. Several intrinsic lesions of the pituitary gland may favor the development of infections. A case of pituitary abscess is reported in which the clinical history, manifestation and laboratory data of 32 year-old Korean female showed a strong resemblance to those in pituitary adenomas. At operation a soft cystic mass was exposed and identified in the pituitary fossa of which content was yellow pus and drained. Studies of the cyst wall and content demonstrated non-specific inflammation of the pituitary gland. A brief review of abscess in the pituitary fossa is presented.

A Case of Giant Osteoma of the Skull

Osteomas are benign tumors of membraneous bones, often arising in the calvaria or paranasal sinuses. Osteomas usually grow no larger than 2cm in diameter and are asymptomatic except when they interfere mechanically with joints, soft tissues, or with drainage of the paranasal sinuses. We have reported a giant osteoma in an adult having right eye protrusion and pain and interference of eye ball movements. The mass was totally removed by transcranial route successfully with no development of significant complications. The mass extremely hard and well circumscribed and enormous dimensions extended into right frontal, ethmoid sinuses, orbital cavity and root and nasal cavity.

A Case of Trigeminal Neurinoma

Trigeminal neurinomas are relatively rare tumors that arise from the sheath of Schwann and constitute 2.9% of intracranial neurinomas and 0.26% of all brain tumors. The most cases are confined to the middle fossa and arising from the Gasserian ganglion. In slight fewer cases the tumor occupy the cerebellopontine angle. In minority it is an hourglass form both situations. By reason of their rarity, the complex clinical problems which may present and the difficult technical aspects involved in their removal, neurinomas of the Gasserian ganglion are of extreme interest. We are reporting a case of trigeminal neurinoma which was arised from the right Gasserian ganglion and located in both situations of middle and posterior cranial fossas. A 37 year-old female was admitted to our department with characteristic symptoms and signs involving many cranial nerves, cerebellum and cerebral peduncle. We chose temporal craniotomy and approached to and exposed the mass by extradural and intradural techniques. Complete removal of the tumor occupying the middle and posterior cranial fossas are accomplished satisfactorily.

A Case of Intracranial Malignant Teratoma

A teratoma is a true tumor or neoplasm composed of multiple tissue of kinds foreign to the part in which it arises. Predilection site of intracranial teratoma are the pineal body, the pituitary region and the posterior fossa in order of frequency. We have reported a case of teratoma experienced in a boy aged 12 who disclosed various clinical manifestations of right frontal lobe tumor. The teratoma was malignant histologically and located deeply in the white matter of the right posterior frontal lobe.

A Case of Intracranial Dermoid Cyst

Dermoid cysts mostly occur in the posteior fossa, a mid-line position in the vermis or adjacent meninges being favoured : the cavity of the fourth ventricle may be occupied. We have reported a case of dermoid cyst in male patient aged 16 and it was located in between midbrain tectum and artial portion of the left lateral ventricle.

Spontaneous Rhinorrhea Induced by Metastatic Carcinoma of the Sphenoid Bone

We have presented a case of spontaneous rhinorrhea which showed recurrence of supparative meningitis and destruction of the sella turhica and sphenoid sinus on the plain skull roentgenograms. By transantral and transnasal route, the portion of sphenoid sinus could easily be approached and exposed. Surgery with microscope easily permitted an identification of the point of cerebrospinal fluid fistula and the repair of it with graft and packing of temporal muscle fascia and pieces of gelfoam. The histopathology of sphenoid bone biopsied was an infiltrating carcinoma.

A Case of Cerebral Cysticercosis

We presented a case of cerebral cysticercosis which involved the right frontal subcortical region. Five years old girl was admitted to the hospital because of repeated vomitings and severe headaches which developed and progressed gradually following head injury 15 days prior to admission. On admission, there were no localizing or lateralizing neurological abnormalities except for bilateral optic papilledemas and signs of increased intracranial pressure. Right carotid angiogram disclosed an avascular zone in the right frontoparietal region suggesting an intracranial space occupying lesion. At operation, rather well circumscribed mass, walnut sized, was found deeply in the right frontal subcortical area but no hematomas epidurally or subdurally. The mass was totally excised. Histological diagnosis of the specimen was cysticercosis to be granulomatous mass in big size. It would be controversial whether cerebral cysticercosis should be operated surgically or not, but surgery may be indicated if there are signs of increased intracranial pressure in the presence of single large granulomatous mass in the portion of the cerebral hemisphere.

A Case of Osteolytic Dumb-bell Formed Meningioma

A 37-year-old Korean male was admitted to the hospital in December 1976 because of a slow growing hard mass in the right frontoparietal region near the midline. The patient had noted the mass accidentally while combing his hair six years prior to admission. Since then, the mass had grown slowly but progressively. On admission, there was a hard ovoid mass, 9 by 7 cm in size, over the right frontoparietal region, projecting 3 to 4cm above the normal level of the skull. Skull roentgenogram disclosed a large area of bone destruction and defect, 8 by 6cm, in size at the site of the tumor, accompanying sclerosis along the margin of the bony defect. A tumor located in extracalvarial portion of the head was a well circumscribed one, 9x7x4 cm in size, with no bone tissue over tissue over the tumor. A tumor located in intracranial portion was also a well circumscribed one measuring 5x4x3cm, compressing the brain but not infiltrating. Extracalvarial and intracranial portions of the tumor were interconnected by the pedicle which was a part of the tumor and passed through the defect of the dura mater, 3cm in diameter, nearly in the center of the bony defect. The tumor, dumb-bell formed in extracalvarial and intracranial growths, was completely excised. Pathological diagnosis of the specimen was fibroblastic meningioma.

Cases Simulating Cerebrovascular Accident

Although there are differences in the mode of onset, symptomatology and clinical course in the various types of cerebrovascular lesions, the general picture may be quite similar and it is often difficult to determine the nature of the lesion in any individual case from the clinical data. In the vast majority of cases the symptoms of a cerebrovascular accident are of sudden onset and reach maximum intensity within few minutes or a few hours at the most. Locksley, et al. have reported autopsies on people who died from spontaneous intracerebral or subarachnoid hemorrhage, and they found that a primary or metastatic brain tumor was the cause of hemorrhage in only 2%~3% of their necropsy. We presented our experience with two such patient whose clinical pictures before the surgery were quite similar with those of cerebrovascular accident. Cases with a large chronic subdural hematoma and cerebral glioblastoma multiforme demonstrated a sudden and dramatic onset of coma and focal neurological symptoms immediately before admission to the hospital. The responsible mechanism or etiology for the mode of such sudden dramatic onset of symptoms may be derangement of intracranial pressure mechanism and sudden hemorrhage in the tumor.

Two Cases of Entrapment Neuropathy

We presented two cases of entrapment neuropathy which were confused with herniated lumbar disc syndrome. One was "meralgia paresthetica in association with lumbar disc herniation", and "the other inguinal neuritis along with obturator neuritis". Syndromes of these entrapment neuropathies were confirmed by subcidence of pain and creation of progressively longer pain-free intervals after analgesic blocks of the corresponding nerves by infiltration of Xylocaine and prednisolone.

Experimental Studies on Cerebrospinal: Part I: Immunological Assessment of Age of Bloody Cerebrospinal Fluid

Bleeding into the subarachnoid space is one of frequent complications in neurosurgical practice and most frequently caused by rupture of meningeal by trauma to the head. Hemorrhage into the subarachnoid space may occur in patient with blood dyscrasias, intracranial tumors, vascular anomalies, certain toxic or infectious disease of the nervous system, and intracerebral hemorrhages. In may be worthy academic interest and clinical practice to estimate the age of blood after hemorrhage into cerebrospinal fluid (CSF). The age was estimated and assessed by an immunological method with hemoagglutination activity using native Korean phytoagglutinin. The age of the red blood cells in RBC-CSF suspension of normal subjects was assessed and estimated by the hemoagglutination of phytoagglutinin in vitro. Vicia PHA and Clerodendron PHA chosen from among 18 different varieties of PHA are panhemoagglutinin and demonstrated the agglutination reaction most effectively. The agglutination activity of PHA with RBC-CSF suspension decreased gradually as time elapsed and activity subsided on 7~8th day. The age of RBC in CSF can be estimated by titration. The agglutination activity of PHA to RBC in CSF suspension continued for a longer period than that of PHA to either RBC in normal saline or anti-serum A and B in CSF. It would be well to say that the experimental results can be applied to clinical situations, especially subarachnoid hemorrhage.

Experimental Brain Edema

By the expansion of stalk of laminaria inserted into the right epidural space of the rabbit head, cerebral compression and edema were produced. The studies of the occurrence and changes of experimental brain edema have been observed by weighing the wet and dry brain tissue, and by calculating the percentage of water content and that of swelling, with rate of per cent water content to that of control group. The percentage of water content and swelling of cerebral gray and white matters in the compressed site showed higher values than those in control and in non-compressed groups. As compared with normal group, the rate of per cent water content of cerebral gray matter at the site of compression showed gradually increasing tendency as time elapsed by 12 hours, while that of white matter demonstrated a increase of it by 24 hours and decreased gradually thereafter. Cerebral edema induced by laminaria compression was more evident and severe in the white matter than in the gray. Oxygen and glucose that are utilized the brain are two of the most important substances and play very important roles in the brain to form high energy bond and nucleic acid. Authors have attempted to measure oxygen consumption in normal rabbit brain and diseased brain that are produced by the expansion of stalk of laminaria in the intracranial epidural space. The value of oxygen consumption of cerebral gray and white matters in the compressed hemispheres showed higher values than those in control group, and they revealed a tendency of rather rapid increases at early experimental stages, an of gradual decrease thereafter.

A Case of Intracranial Chloroma

Clinical and pathological manifestation of leukemic involvement of the central nervous system have been known from any years. Infiltration and enlargement of organ is quite common in acute leukemia ; however, the formation of solid tumor masses is very rare. Most of the described tumor occur predominantly around the orbits or arise from bones, with only a few cases of soft tissue tumors reported. A case of chloroma is reported, in which a large solid tumor of immature granulocytic cells was over the cerebral convexity compressing the brain diffusely on the right and not preceded by myelogenic leukemia.

A Case of Intracranial Chloroma

Clinical and pathological manifestation of leukemic involvement of the central nervous system have been known from any years. Infiltration and enlargement of organ is quite common in acute leukemia ; however, the formation of solid tumor masses is very rare. Most of the described tumor occur predominantly around the orbits or arise from bones, with only a few cases of soft tissue tumors reported. A case of chloroma is reported, in which a large solid tumor of immature granulocytic cells was over the cerebral convexity compressing the brain diffusely on the right and not preceded by myelogenic leukemia.

Two Cases of Brain Tumor Simulating Meningitis

Brain tumors are manifest in a limited variety of ways, presenting with symptoms of increased intracranial pressure and of localized destruction or compression of nervous tissue. Two cases of brain tumor were reported, in which clinical manifestations resembled those of the meningitis, that is, clinical signs and symptoms, as well as cerebrospinal fluid pleocytosis, were consistent with the diagnosis of meningitis.