Brain Tumors in Which Lactate and Lipid Have Been Detected: A Proton Magnetic Resonance Spectroscopy Study

To determine the spectral pattern of metabolites in 31 brain tumors in which the presence of lipids, lactate and additional intermediary metabolites had been detected, in vivo 1H-MR spectroscopy was performed. Metastasis (n=3), meningioma(n=7), astrocytic tumors of different grades(n=11), postop recurrent tumors(n=2) and other tumors(n=10) were examined using the stimulated echo(STEAM, TE=30ms) or double spin echo technique(PRESS, TE=272ms) with CHESS pulse for water suppression. The detection of lactate in astrocytic tumors correlated with a higher grade of malignancy, and lipid was observed in most glioblastomas. Elevated lactate levels in tumors do not simply originate in the necrotic region, but are related to the high glycolytic activity of adequately perfused, viable neoplastic cells. Lipid signals were detected in high grade, late stage brain tumors, indicating the need for enhanced phospholipid metabolism and membrane degradation, respectively. The absence of lactate and presence of alanine, glutamate/glutamine in most meningiomas distinguished them from schwannomas and other glial tumors. Observation of the spectral pattern of metabolites in brain tumors in which lipid and lactate has been detected might play an important prognostic role in the management and differentiation of metastasis, glial tumors, tumor recurrence, and other non-neoplastic diseases.

Malignant Transformation and Extracranial Metastasis of a Meningioma

Since its earliest description in the 18th century, meningioma has been considered a relatively indolent benign tumor which can be completely removed. Some grow very quickly, however, recur more frequently and with each recurrence, may change their biology to a more malignant form. A meningioma rarely metastasizes to the extracranium; the most frequent extracranial metastatic sites include the lung, musculoskeletal system and lymph node. The authors report a rare case of meningotheliomatous meningioma which occurred in the left parasagittal area and invaded the superior sagittal sinus; after surgery, it showed multiple recurrences and regrowth, and finally metastasized to the left thoracic cage. The authors also reviw the literature.

Lumbo-Peritoneal Shunt: Review of a Series

The author reviewed a series of 48patients who underwent lumbo-peritoneal shunt operation at Taegu Catholic University Hospital during recent five years. Among them, 10 cases were excluded in this study because of their poor neurologic status which was not adequate to estimate the operative result. In our series, lumbo-peritoneal shunt was done in 34 cases of communicating hydrocephalus due to aneurysmal subarachnoid hemorrhage, head injury, spontaneous intracerebral hemorrhage with/without intraventicular hemorrhage and brain tumor, 2 cases of pseudomeningocele and 2 cases of normal pressure hydrocephalus. The results of this review demonstrate clinical improvement in 28 cases(73.7%), 10 cases(26.7%) of no clinical improvement. There were 9 complications including 8 shunt dysfunction and 1 infection. Among the 8 cases of shunt dysfunction, 5 cases showed postoperative early clinical improvement but revealed shunt dysfunction of delayed onset. In conclusion, lumbo-peritoneal shunt was considered as a good initial CSF diversion procedure in the treatment of communicating hydrocephalus and pseudomeningocele.

Remote Intracerebral Hematoma after Supratentorial Graniotomy

Four cases of intracerebral hemorrhage remote from the site of initial supratentorial craniotomy are presented. Traumatic cases are excluded in this report and all cases developed after uneventful elective craniotomy. Two patients had ruptured aneurysm and the other two had giant supratentorial tumors, one craniophayrngioma and one ependymoma. All patients were operated on supine position and no patient had preoperative hypertension. Two had hematoma in the sucortical white matter, one in the cerebellar hemisphere and the other one showed hematoma both in the cerebellar hemisphere and the supratentorial subcortical area. The size of hematoma ranged from 8-20cc in volume. No definite cause could be found except one in which the blood pressure was transiently elevated during induction of anesthesia. A possible cause might be the sudden changes of blood pressure during induction and recovery from anesthesia, overdrainage of CSF, continuous CSF drainage and sudden changes in intracranial dynamics by removal of a huge intracranial mass. One patient with intracerebellar hemorrhage needed emergency suboccipital craniectomy for removal of the hematoma. One patient shows no improvement due to aspiration pneumonia and subsequent lung abscess. Although rare, these conditions may occur after any craniotomy and surgeons should always be alert to the possibilities of such comlication, especially when intracranial pressure(ICP) was elevated.

Central Neurocytoma: A Case Report

A rare case of intraventricular central neurocytoma in 17-year-old male is reported. The patient had diffuse headache and diplopia. Radiologic findings displayed obstructive hydrocephalus and a large, well-demarcated intraventricular mass lesion obstructing the foramen of Monroe. The tumor arouse from the splenium of corpus callosum. It was removed successfully using two different approaches after extraventricular drainage of the cerebrospinal fluid(CSF). Histologically, the tumor showed pathological features as that of oligodengroglioma on the light microscope. In immunohistochemical examination, glial fibrillary acidic protein(GFAP) was negative and synaptophysin, positive. Numerous neurosecretory granules were found and no typical synapsis was noticed on the electron microscope. No shunt operation was needed. Postoperative radiotherapy or chemotherapy was not performed and no tumor recurrence was detected during the one year follow-up period. We present the case together with a review of the literatures.

The Effects of Dexamethasone, 6 alpha-Methylprednisolone, and Retinoic Acid on the Growth and Morphology of a Rat Glioma Cell Line, C6

Glucocorticoids, dexamethasone, 6 alpha-methylprednisolone are routinely administered to brain tumor patients to reduce peritumoral edema before surgical removal of the tumor. In addition, the glucocorticoids can inhibit growth of several cell lines. Retinoic acid, a derivative of vitamin A is also known to inhibit growth of several cell lines. Sometimes inhibition of growth accompany morphological changes. In the present study, we compared the effects of dexamethasone, 6 alpha-methylprednisolone, and retinoic acid on the growth and on the morphology of a rat glioma cell line, C6. We found that all of them can maximally inhibit the growth of C6 by approximately 30%(p<0.0025) in the presence of 10 microM of either dexamethasone, 6 alpha-methylprednisolone or retinoic acid under our experimental conditions. However, only retinoic acid could induce the morphological changes of C6 at the concentrations over 1 microM concentration, which was elongation of the cells. The morphological changes were observed both at the subconfluent and confluent cell population. When mixture of 10 microM of dexamethasone and 10 microM of retinoic acid was added, no further increase in the inhibition of growth was observed compared with the inhibition obtained by adding 10 microM of dexamethasone only. The results suggest that the glucocorticoids might have effedts of growth inhibition of the glial tumor in vivo.

Growing Fracture of the Skull: A Case Report

The authors report a case of growing fracture of the skull, also called as leptomeningeal cyst, in a young boy who presented with symptoms of skull defect, headache, and pulsating mass on right posterior parietal area. Successful duroplasty and cranioplasty with autogenous bone were performed resulting in disappearance of all symptoms. The most significant factor contributing to the growing fracture is an underlying dura tear. A brief review of the relevant literature is also presented.

Growing Fracture of the Skull: A Case Report

The authors report a case of growing fracture of the skull, also called as leptomeningeal cyst, in a young boy who presented with symptoms of skull defect, headache, and pulsating mass on right posterior parietal area. Successful duroplasty and cranioplasty with autogenous bone were performed resulting in disappearance of all symptoms. The most significant factor contributing to the growing fracture is an underlying dura tear. A brief review of the relevant literature is also presented.

Subdural Fluid Collection after Intracranial Aneurysmal Surgery

The clinical course of subdural fluid collection(SDGC) was studied in 32 cases of patients which underwent craniotomy for intracranial aneurysm and analysed regard to patients' age, sex, degree of initial subarachnid hemorrhage, the operating time of aneurysm, duration to appearance of SDFC from craniotomy, changes of clinical state, disappearance time, site, maximal thickness and changes of SDFC, management and prognosis. The results were summarized as followings. 1) SDFC was found in 33 of 85 patients(38.8%). 2) The older age group had higher incidence of SDFC than the younger age group. 3) The older age grop had thicker SDFC than the younger age group in the maximal thickness of SDFC, and that was statistically significant. 4) The early surgery group of aneurysm had lower incidence of SDFC compared with the delayed surgery group. 5) There were minimal changes of clinical states when SDFC was diagnosed by brain CT. 6) The frontal area was involved in all cases and bilateral involvement was noted in 15 cases(45.5%). 7) Surgical procedures were needed in 8 cases(24.2%) of SDFC, including 2 cases of chronic subdural hematoma. 8) Ventricular dilatation with spontaneous improvement of SDFC were noted in 8 cases(24.2%) and lumboperitoneal shunt for hydrocephalus was needed in only 2 cases of them.

Malignant Fibrous Histiocytoma of the Pericranium with Intracranial Extension: A Case Report

A case of malignant fibrous histiocytoma(MFH) arising from the pericranium which extend to the calvaria and the dura mater in a 32-year-old man is reported. This tumor presented as scalp induration and headache without any other neurologic abnormalities. Radical excision presented a surgical challenge because of the extensiveness of the lesion. In this case radical excision of pericranial and calvarial lesions were possible, however it is impossible to remove the lesion in the dura mater radically because of its extensiveness. Thus the radiation therapy was necessary after operation. Histologically, pericranial, calvarial and dura mater tumor tissues were same as that of the typical malignant fibrous histiocytoma of the soft tissue. The authors review the literatures of the MFH involving central nerve systems and discuss the management and the radiologic findings of this rare tumor.

A Case of Adult Brain Stem Tuberculoma:MR Imaging: Case Report

A 39 years old healthy male patient with intracranial brain stem tuberculoma manifested hydrocephalic symptoms due to obstruction of aqueduct of sylvius is presented. Surgical excision was undertaken for obtaining histologic diagnosis and resolving hydrocephalus, which made postoperative neurologic deficits. CT and Magnetic resonance(MR) imaging of intracranial tubercuroma were studied for approaching nonsurgical diagnosis of tuberculoma. MR imaging of tuberculoma shows low intensity on T2-weighted imaging with Magnevistring enhancement. The MR imaging feature of the tuberculoma were found to be distinct from those abscess, metastasis and glioma. Antituberculous chemotherapy is thought to be better than surgical approach in managing brain stem tuberculoma if radiologic diagnosis was obtained.

Association between cancer and selenium concentration in blood and toenails / 영남의대학술지

A case-control study was conducted to investigate the association between the risk of cancer and selenium concentration in blood and toenails. Seventy three patients and two hundreds eighty three controls were selected at the Yeungnam University Hospital between May and September in 1991. The selected cases were patients who had been hospitalized for stomach or colon cancer at the Department of General Surgery. The controls were people who visited to check physical examination at the Automated Mediscreening Center. The selenium concentration in whole blood and toenails were measured by atomic absorption spectrophotometer equipped with graphite furnace atomizer. The following information was ascertained for all cancer patients and controls: sex, age, body mass index, blood pressure, total serum cholesterol, and history of smoking and drinking. The mean selenium concentration in blood and toenail for all cancer patients were 143.6±10.8 µg/l and 1.04±0.62 µg/g and for the controls. 167.0±14.5 µg/l and 1.15±0.55 µg/g, respectively. The difference in blood and toenail selenium concentrations of the two cancer sites was not statistically significant. Metastasis did not influence the concentration of selenium in blood and toenails. In the multiple logistic regression analysis, the blood selenium concentration (aOR: 0.888, 95% CI: 0.860-0.918), age, BMI and total serum cholesterol were significant variables for risk of cancer, but the selenium concentration in toenail was not shown to be a significant variable in this regression analysis. The coefficient for blood selenium concentration adjusted for age, sex, diastolic blood pressure, total serum cholesterol, body mass index and smoking was -0.1184 (p<0.01). These findings suggest that low selenium concentration is associated with gastrointestinal cancers. Further epidemiologic studies including important variables such as other antioxidant micronutrients will be necessary.

A Case of Spontaneous Cervical Spinal Epidural Hematoma: Case Report

Spontaneous spinal epidural hematoma is a rare cause of spinal cord compression. Recently, at our hospital, the author et al had the opportunity of observing case with spontaneous cervical epidural hematoma in a 28 years old woman who had suddenly felt a strong pain in interscapular area. Rapidly after she noticed weakness in her legs and one day later she was completely paraplegia. The MRI of spine was done. There show tubular like low signal intensity at posterior epidural space of C7 level and ghigh signal intensity of cord at C7 level due to cord compression effect. In this article, we are adding one more rare case of spontaneous cervical spinal epidural hematoma confirmed by MRI.

Standard Body Weight in Korean Industrial Workers / 대한산업의학회지

To contribute to promotion of health and preservation of labor power of Korean laborers, the body height and body weight were measured for 10,407 workers (6,201 male, 4,206 female) in the age group of 20-29, engaged in manufactures in the Gumi industrial complex, Gumi city, Kyungpook province. The above data were extracted from the 1985 periodic examination chart for calculation of the mean body weight, mean body height, correlation coefficient and regression equation between weight and height, standard body weight, body mass index(BMI) and distribution of laborers within Garrow's classification of BMI by age and sex group. Mean body height of 20-29 age group was 168.2+/-5.61 cm for male and 155.9+/-5.26 cm for female. Mean body weight of 20-29 age group was 61.4+/-6.56 kg for male and 52.4+/-6.00 kg for female. Correlation coefficient and regression equation of 20-29 age group were +0.541 and Y(Wt)=0.632X(Ht)-44.975 for male and +0.559 and Y(Wt)=0.637X(Ht)-46.898 for female. Standard body weight of 20-29 age group was 53.0kg at 155cm, 59.3kg at 165cm, 65.6kg at 175cm for male and 51.8kg at 155cm, 58.2kg at 165cm, 64.6kg at 175 cm for female. Range of normal body weight of 20-29 age group was 47.5+/-58.5kg at 155cm, 53.8+/-64.8kg at 165cm, 60.1+/-72.1kg at 175cm for male and 46.9+/-56.8kg at 155cm, 53.2+/-63.2kg at 165cm, 59.6+/-69.6 kg at 175 cm for female. Range of obesity of 20-29 age group was 64.1kg and over at 155cm, 70.3kg and over at 165cm, 76.7kg and over at 175cm for male and 61.8kg and over at 155cm, 68.2kg and over at 165cm, 74.5kg and over at 175 cm for female. Body mass index (kg/m2) of 20-29 age group was 21.7+/-1.95 for male and 21.6+/-2.05 for female, 75.9% of male laborers and 71.3% of famale counterparts fall in the desirable range of BMI by Garrow's classification.

Two Cases of Redundant Nerve Root Syndrome of Cauda Equina

Two cases of redundant nerve root syndrome of cauda equina in patient was described. The general clinical features were the intermittent neurologic claudication with improvement at rest, low back pain of long duration and radicular pain in one or both legs, sensory & motor change in one or both legs. Myelography revealed a partial to complete block with characteristic serpentine filling defects above or below the block simulating a vascular malformation. One case was associated with lumbar H.N.P and the other cases were associated with L-H.N.P and pseudospondylolithesis. In addition to, we reviewed the literature of redundant nerve root syndrome of the cauda equina.

Giant Serpentine Aneurysm of the Posterior Cerebral Artery: Case Report

Aneurysms of the posterior cerebral artery are rare, furthermore giant serpentine aneurysms-partially thrombosed aneurysms containing a tortuous vascular channel-of the posterior cerebral artery are extremely rare. The author et al. were able to remove 3.9cm x 2.9cm x 3.0cm sized giant serpentine aneurysm of the distal PCA totally, without any significant postoperative neurological sequela except transient ipsilateral third cranial nerve paresis and transient hemihypesthesia. Various kinds of surgical treatment were proposed by several authors in managing unclippable giant aneurysms:excision including partial excision;clipping of feeding artery and excision;trapping and excision;revascularization and excision;anastomosis only. We took subtemporal approach under the surgical microscope and trapping & excision was performed in several steps:proximal clipping of the PCA distal to the Pcom-PCA junction;reducing volume of the mass through piecemeal resection of the aneurismal wall;distal clipping of the PCA;total excision and final trapping just proximal and distal to the origin of the aneurysm. We are discussing the characteristics of the giant serpentine aneurysm, precognition of rich collateral circulation of the PCA distal to trapping and surgical management of the giant serpentine aneurysm.

The Status of Central Nervous System Tumors in Daegu City and Kyungbook Province

The authors analized statistically 403 cases of C.N.S. tumors confirmed by pathology in the boundary of Daegu city and Kyungbook province from January 1984 to December 1986. The results were as follows: 1) The each cases of male and female were 220(54.6%) and 183(45.4%). 2) Intracranial tumors were 288 cases(71.5%), spinal tumors 75(18.6%), and others 40(9.9%). 3) Numbers of C.N.S. tumors were 8.7/100,000 population in city and 6.3/100,000 in country. 4) Among the intracranial tumors, glioma(30.9%) was the most common and followed by meningioma(16.3%) and metastatic tumor(8.7%). Among the spinal tumors, metastatic tumors was 34.6%, neurofibroma 30.7%, and meningioma 5.3%. 5) The majority of intracranial tumors were found in supratentorial region(76.3%), in which area frequency of tumor incidence were as follows; glioma, meningioma, metastatic tumor. Among the infratentorial area(22.6%), the sequence of tumor incidence were glioma, medulloblastoma, and neurilemmoma, 6) Tumors predominantly in male were oligodendroglioma(2:1), metastatic tumor(1.8:1), and medulloblastoma(1.7:1), and in female were meningioma(1:2), neurilemmoma(1:1.7), and pituitary tumor(1:1.5). 7) Peak age incidence of glioma, meningioma, and neurilemmoma were from 40 to 60 years, pituitary tumor and oligodendroglioma were 30 to 50 years, craniopharyngioma and ependymoma were around 10 years old, and metastatic tumor was 50 to 70 years old. 8) In the spinal tumors, the most favorable site of longitudinal axis was thoracic area(62.7%) and transverse location was epidural space(45.3%). 9) The most common site of metastatic tumor were came from lung(29.1%) in brain metastasis and prostate(19.2%) in spine.

Von Hippel-Lindau's Disease: Case Report

Although cases of von Hippel-Lindau syndrome are not rare, the fact that hemangioblastomans can occur at sites in the nervous system other than the cerebellum is not appreciated. We are reporting a case of VHL complex in 23-year-old male. In this case, there were multiple cerebellar hemangioblastomas, retinal angiomas, multiple spinal hemangioblastomas, syringomyelia, and papillary cystadenoma of epididymis. There was no evidence of polycythe mia or abnormality of other organs. Large cystic cerebellar hemangioblastomas were removed surgically and papillary cystadenoma of epididymis were excised, too. Total laminectomy of T2, T3 and T4 revealed abnormal meningeal varicosities, enlarged spinal cord, inra-axial hemangioblastomas, and syringomyelia.

A Case of Primary Malignant Leptomeningeal Melanoma of the Spinal Cord: Case Report

The primary malignant melanoma of spinal cord is a rare tumor cause of compression of the cord 6)7). We are reporting a case of malignant melanoma, apparently originating from leptomeninges, of with diffuse neoplastic process widely spreaded over the area of cervicothoracic spinal cord of 34-yr-old woman.

Medulloblastoma with Extracranial Metastates: Case Report

Intracranial tumor with extracranial metastasis has been seldom reported. A 28 year-old-male was admitted to Presbyterian Hospital in Daegu on May 9, 1977. Who was diagnosed to have a medulloblastoma in the right cerebellar hemisphere with metastases to the right axillary lymphnode and head of pancreas by pathological reports. In generally medulloblastoma with extracranial metastasis occurs very rarely in the cerebellar hemisphere, and especially in adulthood. Distant metastasis of the intracranial tumor is discussed with review of the literatures.