Stereotatic Aspiration of Simultaneous Bilateral Spontaneous Intracerebral Hemorrhage: Case Report

The simultaneous occurrence of intracerebral hemorrhages in different arterial territories is an uncommon clinical event. The authers report a case of simultaneous bilateral intracerebral hemorrhages treated with stereotactic aspiration. A 64-year-old male presented with simultaneous bilateral intracerebral hemorrhages in the both putamens. The hematomas were demonstrated by computed tomography performed after a few hours of onset. The patient underwent computed tomography-guided stereotactic aspiration but he finally became vegetative state. Most of patients reported previously usually have unfavorable functional outcome and high mortality because of the severe neurological deficits. Therefore, the role of the surgical treatment in case of bilateral intracerebral hemorrhages should be surveyed closely in according to clinical state. The authors describe a case of simultaneous bilateral intracerebral hemorrhages and with discussion focused in the predisposing factors, pathogenesis and therapeutic approach.

Surgical Treatment for Posterior Fossa Epidural Hematomas

OBJECTIVE: The purpose of this study is to investigate the interactions between prognostic factors and functional outcome of patients surgically treated posterior fossa epidural hematomas. METHODS: Between 1992 and 2001, twenty patients were surgically treated for the posterior fossa epidural hematomas. The medical records and radiologic findings of the patients were reviewed retrospectively. Information on potential prognostic factors was collected, and then univariate analysis was performed to determine significant prognostic factors. RESULTS: Initial Glasgow Coma Scale scores of 12 patients were 13 or better. Occipital skull fractures were found in 16 cases(80%). The degree of 4th ventricle compression measured on computed tomography scan. Seven cases showed total obliteration, nine cases showed partial obliteration and four cases showed normal. Eighteen patients experienced good or moderate outcomes(Glasgow Outcome Scale scores of 4 or 5). Functional outcome showed a significant correlation with Glasgow Coma Scale score, degree of 4th ventricle compression(p<.05). CONCLUSION: If poor initial consciousness level and severe 4th ventricle compression are noted, early and aggressive treatment are required. Although clinical progression of posterior fossa epidural hematoma is silent and slow, the deterioration might be sudden and quick to become fatal if not promptly treated.

Predictors of Lymph Node Metastasis in Submucosal Gastric Carcinomas

PURPOSE: Submucosal gastric carcinomas metastasize to lymph nodes more often than the intramucosal gastric carcinomas. The objectives of this study are to clarify the characteristics of submucosal gastric carcinomas, especially in reference to the status of lymph node metastasis, and to explore the possibility of a minimally invasive operation. MATERIALS AND METHODS: The clinicopathologic features of 88 patients with submucosal gastric carcinoma, all of whom were treated with a D(2)(+)alpha gastrectomy between January 1994 and December 1999, were examined retrospectively with respect to the status of lymph nodes. The size, depth of submucosal invasion, histologic differentiation, location, and macroscopic finding of the tumor were investigated in association with the presence or the absence of lymph node metastasis. RESULTS: Among the 88 patients, 15 (17.05%) had lymph node metastasis, and the status of metastasis was significantly correlated with tumor size and depth of submucosal invasion. The frequency of metastasis was 0% (0/7) of up to 1.0cm and 18.5% (15/81) over 1.0 cm in size (P=0.034) and 6.1% (2/33) of up to 1.0 mm and 23.6% (13/55) over 1.0 mm in depth of submucosal invasion (P=0.042). CONCLUSION: The tumor size and depth of submucosal invasion are useful indicators of lymph node metastasis in submucosal gastric carcinoma. A minimally invasive operation can be applied for submucosal gastric carcinoma up to 1.0 cm in size. Further studies are needed to limited surgery for depth of submucosal invasion.

A Case of Tuberculous Spondylitis Combined with Schwannoma of Spinal Cord

The authors report a very rare case of tuberculous spondylitis combined with a schwannoma of spinal cord. A 39-year-old man was admitted because of paraparesis(G1/G2). MRI showed severe cord compression at two different levels. One was by the bulged soft tissue and subligamentous abscess extending from T7 to T9 and the other was by an intradural extramedullary cord tumor at the level of T1-2. At first operation, T8 corpectomy and T7-9 plate fixation with autogenous iliac bone graft were performed. After then, Paraparesis was improved(G2/G3) postoperatively. The second operation underwent two weeks later. The tumor was totally removed and shortly after second operation, paraparesis was markedly improved(G3/G4). Histological diagnosis were tuberculous spondylitis and schwannoma, respectively. The authors reviewed this case where good surgical outcome was obtained by two stage operation.

Clinical Analysis of Phyllodes Tumor of the Breast / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Phyllodes tumors are fibroepithelial mammary lesions that tend to behave in a benign fashion but may undergo sarcomatous transformation. They account for 0.3 to 0.5 percent of all breast tumors. Their behavior is not well understood by many clinicians. MATERIALS AND METHODS: We retrospectively reviewed the clinical, radiologic, and pathologic finding and treatment modality of 31 patients of phyllodes tumor diagnosed at the Breast Clinic, Gachon Medical School Gil Medical Center between July 1992 and July 2000. RESULTS: Pathologically, 6 patients (19.3%) had malignant tumor and 25 patients (80.7%) had benign lesions. All were women with average age of 36 years. The patients with malignant tumors tended to be older and had larger tumors and shorter duration. For preoperative diagnosis, we used mammography, sonography, and MIBI Scintimammography, fine needle aspiration cytology and biopsy. All these diagnostic methods suggested the diagnosis of phyllodes tumors in only 8 cases (26%). All patients received surgical treatment: excision in 21 cases, wide excision in 3 cases, simple mastectomy in 5 cases, and simple mastectomy with axillary lymph node dissection 2 cases. One patient with malignant tumor, two patients with borderline tumor and three patients with benign tumor experienced recurrence (19.3%). CONCLUSION: None of the clinical or radiologic characteristics was useful in predicting for phyllodes tumor. Phyllodes tumors were difficult to make proper preoperative diagnoses and to differ malignant tumor from a benign one. This led to a simple excision and resulted in high local recurrence. We suggest that the initial or subsequent wide excision is an appropriate surgery to decrease the recurrence.

Predictors of Lymph Node Metastasis in Submucosal Gastric Carcinomas

PURPOSE: Submucosal gastric carcinomas metastasize to lymph nodes more often than the intramucosal gastric carcinomas. The objectives of this study are to clarify the characteristics of submucosal gastric carcinomas, especially in reference to the status of lymph node metastasis, and to explore the possibility of a minimally invasive operation. MATENRIALS AND METHODS: The clinicopathologic features of 88 patients with submucosal gastric carcinoma, all of whom were treated with a D2+alpha gastrectomy between January 1994 and December 1999, were examined retrospectively with respect to the status of lymph nodes. The size, depth of submucosal invasion, histologic differentiation, location, and macroscopic finding of the tumor were investigated in association with the presence or the absence of lymph node metastasis. RESULTS: Among the 88 patients, 15 (17.05%) had lymph node metastasis, and the status of metastasis was significantly correlated with tumor size and depth of submucosal invasion. The frequency of metastasis was 0% (0/7) of up to 1.0 cm and 18.5% (15/81) over 1.0 cm in size (p=0.034) and 6.1% (2/33) of up to 1.0mm and 23.6% (13/55) over 1.0 mm in depth of submucosal invasion (p=0.042). CONCLUSION: The tumor size and depth of submucosal invasion are useful indicators of lymph node metastasis in submucosal gastric carcinoma. A minimally invasive op-eration can be applied for submucosal gastric carcinoma up to 1.0 cm in size Further studies are needed to limited surgery for depth of submucosal invasion.

Treatment of Cerebral Arteriovenous Malformations by Preoperative Embolization and Microsurgery

No abstract available.

Clinical Analysis of Anterolateral Approach with Instrumentation for the Thoracolumbar Lesions

Forty one patients with unstable thoracolumbar lesions were treated using anterior internal fixation device. There were 39 cases with unstable thoracolumbar fracture, 1 case with post-traumatic kyphosis, and 1 case with aspergillosis spondylitis. The procedures consisted of anterior decompression through vertebrectomy and discectomy, interbody fusion using autogenous iliac bone or rib, realignment and stabilization with Kaneda device(7 cases), or Z-plate ATL device(34 cases). Most patients with incomplete neurologic deficit were improved one or two grades according to Frankel's classification. No patient showed neurological deterioration after surgery. We concluded that the anteroloteral approach with instrumentation in various unstable thoracolumbar lesions would provide satisfactory neurologic improvement as well as immediate firm stability with early ambulation and high fusion rate involving only a minimum number of motion segments.

Aspergillosis of Thoracolumbar Vertebra: A Case Report

As the use of the antibiotics, antitumor substances, steroid hormone and immunosuppressive agent have been increased remarkably, the incidence of the fungal infection has also been increased. Aspergillus is a fungus belonged to ascomycetes family and distributed world-widely. Aspergillus infection of the spine is very rare. Mode of vertebral Aspergillosis is direct extension of primary lesion of lung in children, on the other hand, hematogenous metastasis in adults. We report a adult woman who suffered from thoracolumbar pain without any neurological deficit for 6 months prior to admission. Imaging studies revealed irregular bony destruction on the adajacent end plates of T12 and L1 vertebras with kyphotic change. We underwent operation via anterolateral approach using Z-plate fixation. followed by amphotericin-B administration.