The Results of Gamma Knife Radiosurgery for Vascular Lesions of the Brainstem

The optimal management of lesions located in the brainstem(BS) is problematic. As an alternative to microsurgical resection, stereotactic radiosurgery employing the Gamma unit has been used to manage BS lesions, and this can provide relatively safe and effective management. This study describes our experience with 17 patients who underwent Gamma Knife radiosurgery(GKR) for vascular lesions of the brainstem between June 1989 and May 1996. Six of these had BS arteriovenous malformations(AVMs). The minimal radiation dose to the margin of AVMs ranged from 15 to 25Gy(mean, 18.9Gy). Four of six cases were partially obliterated, and on follow-up angiography, one small AVM was seen to be completely obliterated. Twelve months after GKR, one patient experienced a temporary neurologic deficit due to the effects of radiation and another patient, who had a large AVM, showed a permanent deficit as a direct result of treatment. There have been no instances of hemorrhage after GKR and all the patients are still alive. GKR was used to manage 11 patients with angiographically occult vascular malformations (AOVMs) of the BS. The periphery of the lesions received a radiosurgical dose of between 12 and 20Gy(mean, 15.5Gy). In four patients, the lesions became smaller, but in one, an increase was seen. In the remaining six, size change was not documented. One patient's neurological deficit worsened, though that might be related not to GKR but to non-fatal post-GKR rebleeding. At seven months, one patient developed a temporary neurologic deficit in association with perilesional edema that resolved over time. Three patients experienced post-GKR rebleeding, and none died during the follow-up period. We believe that GKR is an excellent option for patients with BS AVMs: when the risks of microsurgery are deemed too high, it is a course of action which seems reasonable. GKR does not, though, appear to obliterate AOVMs as effectively as it does AVMs. To assess the long-term effectiveness of the technique on these lesions, longer follow-up intervals will, however, be required.

The effect of the occlusion of the left bronchial artery on the production of HSP70 cat lung / 결핵

Several stresses are known to induce synthesis of heat shock protein. The present study was performed to see whether pulmonary ischemia, induced by the bronchial artery occlusion, produced HSP70 in cat lung. To this aim we compared experimental and control groups of cats with respect to the HSP70 production in the lung. Experimental animals were subjected to 10-min bronchial artery occlusion followed by reperfusion. The interval between the end of the occlusion and the end of the reperfusion was 1 hour, 4 hours and 8 hours, whereas control animal was not subjected to any manipulation except anesthesia. According to the interval differences, experimental animals were divided into 1HR, 4HRs and 8HRs groups. To determine the induction of HSP70 in each group, total proteins of lung tissues were extracted and separated by PAGE electrophoresis. Immunoblotting with a mouse monoclonal anti-HSP70 IgG antibody revealed that HSP70 was not detected in the pulmonary tissues resected from control, 1HR or 4HRs groups. In contrast, HSP70 expression in 8HRs group was marked. These results suggest that pulmonary ischemia by the bronchial artery occlusion produces HSP70 in a delayed

A Case of Granular Cell Tumor of the Bronchus / 결핵

Granular cell tumor(myoblastoma) of the bronchus is an uncommon benign tumor that causes pulmonary complications due to obstruction of the airways. The tumor as origianally described by Abrikossoff was considered to be muscular origin, but currently neural derivation is favored. We report a case of granular cell tumor of bronchus of 27-year-old female patient with recurrent pneumonia that is confirmed by bronchoscopic biopsy, and review the liturature.

Clinical Observations of the Drug Induced Hepatitis during Antituberculosis Medication / 결핵

BACKGROUND: In Korea, the prevalence of tuberculosis and hepatitis is high, and combined therapy with rifampicin and pyrazinamide is used in tuberculosis, so drug induced hepatitis is not only problem of tuberculosis therapy but also cause of treatment failure. However most of recent reports on drug induced hepatitis during antituberculosis medication have dealt with its pathogenesis and have stressed the biochemical, and histopathological aspects of the disorder, whereas this study was designed primarily to provide information on the clinical features. METHOD: The subjects of study were 1414 patients treated with antituberculosis drugs on the department of chest medicine at National Medical Center during the 5-year 6-month period from January 1, 1988, to June 30, 1993. Retrospective analysis of clinical features for the 29 patients who developed drug induced hepatitis was done. RESULTS: 1) The incidence of antituberculosis drug induced hepatitis was 2.1%. 2) Male to female ratio of antituberculosis drug induced hepatitis was 2:1, but case rates among males and females were not significantly different. 3) Rates of drug induced hepatitis according to age distribution shows the most common incidence between 35 to 49 year old age group, but rates among groups of age were not significantly different. 4) Drug induced hepatitis was most common in the case of moderate advanced Pulmonary tuberculosis(rate is 2.78%), but rates among types of tuberculosis were not significantly different. 5) 18 cases(62%) of antituberculosis drug induced hepatitis patients had no signs or symptoms. In remaining cases, they were nausea, vomiting, jaundice, hepatomegaly, icteric sclera, right upper quadrant -tenderness in order 6) 22 cases(76%) of antituberculosis drug induced hepatitis cases had occurred within the first month. 7) The duration of abnormal liver function was 28±5(Mean±SD), ranged from 5 days to 180 days. 8) One case of antituberculosis drug induced hepatitis died. 9) The levels of abnormal GOT ranged from 64 to 1055U/L and GPT from 68 to 931U/L. CONCLUSION: There are no decided predisposing factors of antituberculosis drug induced hepatitis, so it should be done biochemical monitoring as week as close monitoring for overt signs or symptoms of hepatitis to avoid the development of irreversible hepatic reaction, especially at the treatment of the first month.