Treatment of High-Flow Carotid Cavernous Fistula Using a Graft Stent: Case Report / 대한신경손상학회지

Currently, endovascular treatment of carotid cavernous fistula (CCF) is widely accepted and performed. However, a graft stent is rarely used for the treatment of high-flow CCF. Here we describe our experience using a graft stent to treat CCF and discuss the indications for its use.

The Usefulness of Compliant Balloon for Recanalization of Acute Ischemic Stroke

OBJECTIVE: We report on our experience using a compliant balloon for treatment of thrombi resistant to simple mechanical thrombolysis. METHODS: We conducted a retrospective investigation of 46 consecutive acute ischemic stroke patients who were treated by intraarterial thrombolysis (IAT) between January 2008 and July 2010. We compared IAT results between the balloon group (BG) and the simple mechanical thrombolysis (with microcatheter and microguidewire) group (SG). The Thrombolysis in Myocardial Infarction (TIMI) grading system was used for grading of the degrees of vessel recanalization. In addition, a modified Thrombolysis in Cerebral Infarction (TICI) score was used for post-IAT TIMI grade 2 patients. Modified Rankin Scale scores were used at three months for assessment of clinical outcomes. RESULTS: Twenty of the 46 subjects were treated with a compliant balloon. The mean initial National Institutes of Health Stroke Scale score was 15.1 in the BG and 14 in the SG. The mean time from symptom onset to initiation of IAT was 225 minutes in the BG and 177 in the SG (p = 0.004). The overall rate of successful recanalization (TIMI grade 2 or 3) was 85% in the BG and 73% in the SG (p = 0.476). In the TIMI grade 2 group, modified TICI 2b was 90% in the BG and 16% in the SG (p = 0.001). Postprocedure intraparenchymal hemorrhage occurred in two subjects in the BG and 10 subjects in the SG (p = 0.029). No significant difference in clinical outcomes was observed between the BG and SG (p = 0.347). CONCLUSIONS: The compliant balloon showed high potential for recanalization following acute ischemic stroke, especially when simple mechanical thrombolysis had failed.

Risk Factors Affecting Clinical Outcome of Ruptured Vertebrobasilar Saccular Aneurysms

OBJECTIVE: Ruptured vertebrobasilar (VB) saccular aneurysm is a difficult lesion to treat, and is associated with high rates of morbidity and mortality. The aim of this study is to investigate the risk factors associated with the clinical outcome of ruptured VB aneurysms. METHODS: A retrospective review of 29 patients with ruptured VB saccular aneurysms between 2002 and 2010 was conducted between Jan 2002 and Dec 2010. Univariate and multivariate analyses were performed for determination of the statistical significance of the Glasgow Outcome Scale (GOS) at three months, according to age, initial Hunt-Hess grade, the presence of acute hydrocephalus, and treatment modality. RESULTS: The study included 24 (82.7%) females and five (17.3%) males, with a mean age of 59 years (range, 22-78 years). Seventeen patients were treated with surgical clipping and 12 patients were treated with endovascular coil embolization. No statistical significance was observed between clinical outcome and treatment modalities (clipping or coiling; p = 0.803). Seventeen (58.6%) patients achieved favorable outcome, defined as GOS score of 4-5, at 3 months. Procedure-related complications occurred in seven patients (24.1%). Results of multivariate analysis indicated that initial Hunt-Hess grade and the presence of acute hydrocephalus were independent predictors of unfavorable outcome, defined as GOS score of 1-3 (Odds ratio (OR) = 8.63, Confidence interval (CI) [95%] 1.11-66.84, p = 0.039 and OR = 36.64, CI [95%] 2.23-599.54, p = 0.012, respectively). CONCLUSION: The present study suggests that the clinical outcomes are related to the initial Hunt-Hess grade and the presence of acute hydrocephalus in ruptured saccular VB aneurysms.

A case of Patent Urachus / 대한비뇨기과학회지

The patent urachus is the failure of complete urachal lumen closure results in a free communication between the bladder and the umbilicus. The urachus remains patent and urine leaks from the umbilicus. A 53 day old female infant was admitted to Seoul Red Cross Hospital due to urine leakage accompanied by varing purulent discharge from the enlarged protruding umbilicus, measuring 2 Cm x 2 Cm x 2 Cm, since birth. The fistulogram showed a long fistulous tract communicate with bladder and umbilicus. After complete resection of the urachus and umbilicus with a bladder cuff, the patient had no urine leakage from umbilicus. We report a case of patent urachus with some literature.

Comparison Between the Results of Transurethral Resection and Open Prostatectomy for the Benign Prostatic Hypertrophy of 20 gm or More / 대한비뇨기과학회지

Among the 65 patients undergoing transurethral resection of the prostate from 1985 to 1988, the complication incidence was significantly higher in 25 patients whose weight of resected prostate was above 20 gm than in 40 patients below 20 gm (p<0.05). So to choose mote proper surgical method, the results of operation, motality and morbity of these 25 TURP patients were compared with 35 open prostatectomy patients whose weight of resected prostate was between 20 gm and 60 gm during same period. The mean incidence of complication for open prostatectomy (60%) was nearly twice that of the TURP (32%) (p<0.05). The age of the patient had no significant influence on the incidence of complication in both groups. In case of the weight of resected prostate below 40 gm complication incidence for the TURP (26.3%) was significantly lower compared with open prostatectomy(66.7%) (p<0.05), but in case of above 40 gm there was no significant difference in both groups. In case of the length of resection below 120 min complication incidence was significantly low in TURP (21.4%) compared with open prostatectomy (61.5%) (p<0.05), but in case of above 120 min. there was no significant difference in both groups. In the open prostatectomy there was no increase in complication incidence by the weight of the gland and the operation time, but in TURP, complicat,40 gm incidence was definitely increased when either weight of the resected prostate was above 40 gm or length of resection was above 120 minutes. Therefore, it seems that TURP is preferable surgical method for benign prostatic hypertrophy unless open surgery is necessarily indicated.