To Determine the Previlance of Fungal Infection Among Patient with Sputum Negative Old Treated Pulmonary Tuberculosis

A descriptive study was conducted in the Department of Respiratory Medicine in a tertiary care center ofAmbala. Aim of the study was to determine the prevalence of fungal infection among patient presents withsputum negative old treated pulmonary tuberculosis. The study was carried out among 39 post treated casesof Pulmonary Tuberculosis, whose sputum or bronchial wash showed isolation of Aspergillus. Demographicdetails and clinical findings were noted. Data collected were entered into Excel spreadsheet and quantitativedata were expressed as number and percentage. The presentation of pulmonary aspergillosis in treated casesof pulmonary TB varies from aspergilloma (51.3%) to chronic necrotizing pulmonary aspergillosis (38.4%) toallergic bronchopulmonary aspergillosis (10.3%). Hemoptysis (79.5%) of varying severity was the mostcommon symptom. Most of the patients were farmers by occupation. The most common species wereAspergillus fumigatus; others were Aspergillus flavus, Aspergillus niger and Aspergillus terrus in 23.2%,20.5%, and 12.8 %, respectively. Here we conclude that Aspergillus fumigatus was the most frequentlyisolated species in our region and aspergilloma was the commonest pulmonary manifestation as post-TBsequel.

The True Intention of Rescue Squads in Terms of the CPA Transportation of Cancer Patients in the Terminal Phase of the Disease Who Make a DNAR Order

Background: Even for the emergency transportation of cancer patients in the terminal phase of the disease with a DNAR, all patients are transported while resuscitation is carried out. We examined how on-site rescue squads felt about this along with what was found therefrom. Methods: We conducted an anonymous questionnaire among 103 staff members involved in emergency activities in the area concerned. The contents included: Have you ever transported patients with a DNAR? If yes, what kind of activities did you carry out?; and If not bound by the Fire Services Act, what kind of activities would you have carried out? Results: Even if you express your DNAR order, they have no choice but to comply with the Fire Service Law. Even assuming that there is no Fire Service Law, about half of respondents responded to lifesaving treatment, but about half of them responded that they wanted to refuse transportation. Discussion: For rescue squads, a difference between resuscitation activities and transportation was observed. Lack of knowledge among those near the patient who request emergency transportation against the will of the patient is the major cause of transporting patients with a DNAR. In order to respect the will of patients, the permeation of advance care planning including decisions made by visiting physicians and the creation of advance directives and education of local residents are necessary.

Comissão setorial de avaliação do colégio politécnico (UFSM): diagnóstico orçamentário-financeiro / Sector assessment committee of the polytechnical college (UFSM): analysis of the budgetary-financial / Comisión sectorial de evaluación del colegio politecnico (UFSM): diagnóstico presupuestario financiero

Este estudo tem como objetivo analisar o diagnóstico orçamentário-financeiro da Comissão Setorial de Avaliação do Colégio Politécnico, vinculado à Universidade Federal de Santa Maria, a fim de identificar as ações da referida Comissão no direcionamento dos recursos financeiros, oriundos da Comissão Própria de Avaliação da instituição. Do ponto de vista metodológico, esta é uma pesquisa do tipo investigativo-documental com abordagem descritivo-quantitativa, valendo do método descrito e pela ótica de um estudo de caso no Colégio Politécnico/UFSM. Para coleta dos dados foram utilizados indicadores do Sistema de Informações Educacionais, obtidos junto à Direção Administrativa do Órgão. Esta análise permitiu a divulgação do orçamento financeiro da CSA/Politécnico, bem como a demonstração do uso do recurso financeiro direcionado às ações e propósitos estabelecidos no planejamento estratégico da UFSM.(AU)

The objective of this study is to analyze the budgetary-financial diagnosis of the Polytechnic Sector Evaluation Commission, linked to the Federal University of Santa Maria, in order to identify the actions of the said Commission in regard to financial resources from the institution's Self Evaluation Commission. From the methodological point of view, this is a research-documentary research with a descriptive-quantitative approach, using the method described and from the perspective of a case study in the Polytechnic College. For data collection, indicators of the Educational Information System were obtained from the administrative sector. This analysis allowed the disclosure of the financial budget of the CSA/Polytechnic, as well as the demonstration of the use of financial resources directed to the actions and purposes established in UFSM's strategic planning.(AU)

Este estudio tiene como objetivo analisar el presupuesto financiero de la Comisión Sectorial de Evaluación del Colegio Politecnico, vinculado a la Universidad Federal de Santa Maria, con la finalidad de identificar las acciones de dicha Comisión en el direccionamiento de los recursos financieros, originarios de la Comisión Propia de Evaluación de la institución. Del punto de vista metodologico, esta es una pesquisa investigativo-documental con abordaje descriptivo-cuantitativo, valiendo del metodo descripto y por la optica de un estudio de caso en el Colegio Politecnico/UFSM. Para colecta de datos fueron utilizados indicadores del sistema de informaciones educacionales, obtenidos junto a la dirección administrativa del órgano. Este análisis permitió la divulgación del presupuesto financiero de la CSA/ Politecnico, así como la demostración del uso de recursos financieros dirigidos a las acciones y propósitos establecidos en la planificación estratégica de UFSM.(AU)

¿Proyecto propio? Impacto positivo asegurado / Owr own proyect? Positive impact for sure

Las instituciones educativas son uno de los lugares de formación más significativos e importantes dentro de la comunidad. En ella, se pueden elaborar sus propios proyectos de participación social a través de diversas prácticas que seguramente impacten en la comunidad. El aprendizaje por medio de proyectos implica previamente un análisis de la realidad, un reconocimiento de las problemáticas y una toma de decisión acerca de las acciones a seguir para transformar el contexto. Los proyectos elaborados por la propia institución son un instrumento que al ponerse en práctica causa un impacto positivo dentro de la comunidad, por la pertinencia y el compromiso puestos en él(AU)

Insights into CYP2B6-mediated drug-drug interactions

Mounting evidence demonstrates that CYP2B6 plays a much larger role in human drug metabolism than was previously believed. The discovery of multiple important substrates of CYP2B6 as well as polymorphic differences has sparked increasing interest in the genetic and xenobiotic factors contributing to the expression and function of the enzyme. The expression of CYP2B6 is regulated primarily by the xenobiotic receptors constitutive androstane receptor (CAR) and pregnane X receptor (PXR) in the liver. In addition to CYP2B6, these receptors also mediate the inductive expression of CYP3A4, and a number of important phase II enzymes and drug transporters. CYP2B6 has been demonstrated to play a role in the metabolism of 2%-10% of clinically used drugs including widely used antineoplastic agents cyclophosphamide and ifosfamide, anesthetics propofol and ketamine, synthetic opioids pethidine and methadone, and the antiretrovirals nevirapine and efavirenz, among others. Significant inter-individual variability in the expression and function of the human CYP2B6 gene exists and can result in altered clinical outcomes in patients receiving treatment with CYP2B6-substrate drugs. These variances arise from a number of sources including genetic polymorphism, and xenobiotic intervention. In this review, we will provide an overview of the key players in CYP2B6 expression and function and highlight recent advances made in assessing clinical ramifications of important CYP2B6-mediated drug-drug interactions.

Establishment of cross priming amplification for influenza A virus (H1N1) and its clinical application / 中国人兽共患病学报

In this study ,we established Cross Priming Amplification (CPA ) technology for detection of influenza A virus (H1N1) approach ,and evaluated the method through clinical specimens .A set of specific primers were designed for CPA ac‐cording to the conservative gene sequences ,designed and realized in the same temperature reverse transcription of RNA and DNA amplification . The amplification products can be totally enclosed nucleic acid detection device for testing . Fourteen healthy pharyngeal swab specimens ,seven other respiratory viruses ,and six arboviruses strains were used as the controls .We used a method that application of gradient dilution to the H 1N1 virus strain as the control to test the sensitivity of the CPA .We also used 102 clinical pharyngeal swab specimens of H1N1 patients for detection object to evaluate the feasibility of CPA clinical detection .Results showed that the CPA reaction did not appear cross reaction on health cases samples and other viruses .The sensitivity of the CPA was approximately 10 copies/uL in the established method that exactly titer H1N1 virus strain gradient dilution test .As to the positive results among the clinical pharyngeal swab samples collected from patients at different stages after onset ,the CPA had the highest positive detection rate during the first three days after onset (100% ) .While the detection rate from day 4 to day 6 after onset was 79 .31% .After 7 days ,the detection rate was 9 .09% .The established CPA assay was a highly sensitive ,specific and reproducible approach for rapid detection of H1N1 virus ,which is conducive to the early diagno‐sis of influenza A virus (H1N1) for basic medical units .

The Role of PKMzeta in Drug Reward Memory / 대한정신약물학회지

Drug addiction is a chronic brain disease with a high incidence of relapse. Environmental cues that previously and repeatedly associated with drugs of abuse easily evoke relapse to addicts even after long period of drug-free state. Such a long lasting property of conditioning is considered a form of long-term memory and has a strong correlation with synaptic plasticity like long-term potentiation (LTP). Protein kinase M zeta (PKMzeta) has been known to play an important role in the maintenance of long-term memory as well as LTP in various brain areas. Likewise, in a few brain areas examined out of the rewarding circuit, PKMzeta seems to play a similarly important role in the maintenance of conditioned memory. These results suggest that PKMzeta may become a new target to manipulate to reverse pre-formed drug-related memory and accompanied behaviors.

Characterization of Clostridium perfringens isolated from mammals and birds from Guwahati city, India

Of the 102 samples collected from mammals and birds, both domestic and captive wild, 48 were found to be positive for Clostridium perfringens. Most of the mammal isolates (84.38%) appeared to have been collected from clinically affected animals, while 33.33% of the bird samples were from clinically affected and 21.43% from apparently healthy birds infected with C. perfringens. Isolates revealed high sensitivity to ciprofloxacin, enrofloxacin and norfloxacin. Among the isolated C. perfringens, 30 (62.50%) showed DNase production. Hemolytic activity was recorded in 14 (24.16%) of the isolates and 28 (58.33%) showed phospholipase C production. All the phospholipase C positive isolates revealed the presence of cpa gene encoding alpha (α) toxin. Of the 102 samples collected from mammals and birds, both domestic and captive wild, 48 were found to be positive for Clostridium perfringens. Most of the mammal isolates (84.38%) appeared to have been collected from clinically affected animals, while 33.33% of the bird samples were from clinically affected and 21.43% from apparently healthy birds infected with C. perfringens. Isolates revealed high sensitivity to ciprofloxacin, enrofloxacin and norfloxacin. Among the isolated C. perfringens, 30 (62.50%) showed DNase production. Hemolytic activity was recorded in 14 (24.16%) of the isolates and 28 (58.33%) showed phospholipase C production. All the phospholipase C positive isolates revealed the presence of cpa gene encoding α toxin.(AU)

Sudden Death in the Japanese Hot Bath in the Senior Population / 日本温泉気候物理医学会雑誌

  According to the annual report of the Japanese National Police Agency, about 100,000 cases of unnatural death are reported every year. More than 10,0000 of these cases occurred during bathing. In Akita Prefecture, more than 150 cases are reported every year which is represents about 10% of the total unexpected death. According to the epidemiological statistics by our department, sudden death or sudden cardio pulmonary arrest in the hot bath occurs mostly in winter time, from late October to early March, and more than 90% of the decedents are senior population. Although some cardiac or cerebral events might occur during bathing, few cases of those died in the bath tub are autopsied by forensic pathologists. In most cases, the cause of death is suspected by postmortem examination by police surgeon, and the cause of death are generally assigned to ischemic heart attack, cerebral stroke, or unclear cause of drowning. It is often difficult to determine the pathogenesis related to the cause of death in the bathtub even by full autopsy. It is reported that the past and/or present medical history of the deceased persons in the bath tub is reported as hypertension, arrhythmia, ischemic heart disease, or diabetes, it is still unclear what actually triggers a lapse in consciousness in the elderly during bathing. We examined the biodynamic change of elderly volunteers while bathing under actual bathing situations occurring in both the winter and summer seasons. Most subjects decreased the level of blood pressure gradually by bathing regardless the season, and some subjects in the elderly developed ECG changes while bathing such as supraventricular extrasystole or ventricular tachycardia. The body temperature increase to 38°C or more in both the elderly and young groups while bathing. By our observations, lower room temperature in the winter time, hot water immersion may result in risky changes in the above parameters which may partially explain some of the causes of the cases of lapse of consciousness and sudden cardiac arrest in the elderly while bathing.

Regulation of Ba2+-Induced Contraction of Murine Ureteral Smooth Muscle

This study was designed to characterize ureteral smooth muscle motility and also to study the effect of forskolin (FSK) and isoproterenol (ISO) on smooth muscle contractility in murine ureter. High K+ (50 mM) produced tonic contraction by 0.17+/-0.06 mN (n=19). Neuropeptide and neurotransmitters such as serotonin (5microM), histamine (20microM), and carbarchol (CCh, 10~50microM) did not produce significant contraction. However, CCh (50microM) produced slow phasic contraction in the presence of 25 mM K+. Cyclopiazonic acid (CPA, 10microM), SR Ca2+-ATPase blocker, produced tonic contraction (0.07 mN). Meanwhile, inhibition of mitochondria by protonophore carbnylcyanide m-chlorophenylhydrazone (CCCP) also produced weak tonic contraction (0.01 mN). The possible involvement of K+ channels was also pursued. Tetraethyl ammonium chloride (TEA, 10 mM), glibenclamide (10microM) and quinidine (20 microM) which are known to block Ca2+-activated K+ channels (KCa channel), ATP-sensitive K+ channels (KATP) and nonselective K+ channel, respectively, did not elicit any significant effect. However, Ba2+ (1~2 mM), blocker of inward rectifier K+ channels (KIR channel), produced phasic contraction in a reversible manner, which was blocked by 1microM nicardipine, a blocker of dehydropyridine-sensitive voltage-dependent L-type Ca2+ channels (VDCCL) in smooth muscle membrane. This Ba2+-induced phasic contraction was significantly enhanced by 10microM cyclopiazonic acid (CPA) in the frequency and amplitude. Finally, regulation of Ba2+-induced contraction was studied by FSK and ISO which are known as adenylyl cyclase activator and beta-adrenergic receptor agonist, respectively. These drugs significantly suppressed the frequency and amplitude of Ba2+-induced contraction (p<0.05). These results suggest that Ba2+ produces phasic contraction in murine ureteral smooth muscle which can be regulated by FSK and beta-adrenergic stimulation.

Analysis of Cardiopulmonary Arrested Patients on Arrival Attacked in a Bathroom / 日本温泉気候物理医学会雑誌

To clarify problems in the cardio-pulmonary arrest (CPA) cases that occurred in a bathroom, we investigated the medical care and results in 32 cases of CPA (14%) out of the 215 patients carried into our emergency center with CPA from August 2002 to July 2003.<br>The ages of patients ranged from 43 to 91, indicating a high incidence of CPA in ages over 70 but with no difference between sexes. Most of the cases (21/32, 65.6%) occurred from November to February. Through the exact time of onset was unknown because it was in a bathroom, it took an average of 8.4 minutes from receiving a 119 call until arrival of the ambulance. Average time at the site was 17.4 minutes, and it took an average of 11.0 minutes to transport the patients from the site to the hospital. Out of 32 patients, only six patients (18.8%) received cardiopulmonary resuscitation immediately after the onset. Advanced treatment (mainly airway management) was applied by paramedics on 23 out of 32 patients (71.9%). When carried into the hospital, patients were in CPA and electrocardiogram indicated asystole. Though advanced cardiovascular lifesaving means were applied promptly, most patients (31 cases) were already dead when carried in with one exception whose heartbeats resumed. Causes of onset estimated from clinical findings included 14 drowned, three with subarachnoid hemorrhage, one with trauma, one with aortic disease, one with respiratory disease, and 12 with suspected heart disease and/or unknown causes. In four cases in which subarachnoid hemorrhage or aortic disruption was detected, CT diagnosis clearly indicated that the cause of CPA was an internal disease<br>It is important to perform a sequence of lifesaving measures consisting of early access, early basic life support, early defibrillation and early advanced cardiovascular life support (ACLS). In the case of onset in a bathroom, in particular, it is highly probable that detection is delayed and that prognosis might be poor. However, it is possible to resuscitate patients with CPA that occurred due to an internal disease without any accompanying lethal influence on the respiratory and circulatory system, so it is important to provide training in cardiopulmonary resuscitation techniques. In addition, prudent bathing is required in winter seasons for the elderly who have some disorders.

A Trial of Surgical Clerkship for Developing Clinical Competency

PURPOSE: The surgery clerkship, focusing on the clinical competency, including critical thinking, problem solving, self-directed learning, autonomy and professionalism, were revised. The purposes of this study were to evaluate the students' assessment of the revised surgery clerkship program in order to improve the quality of surgical education. METHODS: Clinical competency was classified into 6 dimensions: intelligence, skill, relationship, attitude, problem solving performance, and autonomy. Problem based learning (PBL), procedural skill training, surgical anatomy, case discussion, pre-diagnosis at outpatient clinics, quiz, clinical performance assessment (CPA) and modified essay question (MEQ) were performed. Forty-nine 3rd year medical students participated during 2002. All students were asked to rate how far they had progressed in the 6 dimensions, in order to evaluate the course, and each program, and to suggest improvements at the end of the rotation. RESULTS: The students responded extremely positively and became been more motivated. They evaluated that the new clerkship had helped them increase their abilities in clinical reasoning, self-directed learning, problem solving and clinical techology, and to develop professionalism and autonomy. Most of students revealed that the PBL, case discussion, pre-diagnosis at outpatient clinics, CPA and MEQ programs were very helpful. They felt that procedural skill training and surgical anatomy programs required further improvements. CONCLUSION: The implementation of the new surgery clerkship was successful. The PBL, case discussion, pre-diagnosis at outpatient clinics, CPA and MEQ were valuable learning tools. More tools should be developed for procedural skill training and surgical anatomy education.

A Trial of Surgical Clerkship for Developing Clinical Competency

PURPOSE: The surgery clerkship, focusing on the clinical competency, including critical thinking, problem solving, self-directed learning, autonomy and professionalism, were revised. The purposes of this study were to evaluate the students' assessment of the revised surgery clerkship program in order to improve the quality of surgical education. METHODS: Clinical competency was classified into 6 dimensions: intelligence, skill, relationship, attitude, problem solving performance, and autonomy. Problem based learning (PBL), procedural skill training, surgical anatomy, case discussion, pre-diagnosis at outpatient clinics, quiz, clinical performance assessment (CPA) and modified essay question (MEQ) were performed. Forty-nine 3rd year medical students participated during 2002. All students were asked to rate how far they had progressed in the 6 dimensions, in order to evaluate the course, and each program, and to suggest improvements at the end of the rotation. RESULTS: The students responded extremely positively and became been more motivated. They evaluated that the new clerkship had helped them increase their abilities in clinical reasoning, self-directed learning, problem solving and clinical techology, and to develop professionalism and autonomy. Most of students revealed that the PBL, case discussion, pre-diagnosis at outpatient clinics, CPA and MEQ programs were very helpful. They felt that procedural skill training and surgical anatomy programs required further improvements. CONCLUSION: The implementation of the new surgery clerkship was successful. The PBL, case discussion, pre-diagnosis at outpatient clinics, CPA and MEQ were valuable learning tools. More tools should be developed for procedural skill training and surgical anatomy education.

Diagnostic Value of CPA Tumors on Enhanced MRI / 实用放射学杂志

Objective To explore enhanced MRI diagnostic value of CPA(cerebellopontine angle) tumors.Methods 68 cases of CPA tumors,including acoustic neuromas(n=34),trigeninal neuromas (n=5),meningiomas(n=20)and cholesteatomas(n=9),proved surgically and pathologically were studied.All patients were performed MR scans before and after contrasted-enhancement on axial,sagittal and coronal plane.Results 23 of 34 acoustic neuromas showed nodule-ring-like,wreathlike or mutilocular enhanced masses;11 were homogeneous masses.The facial-hearing nerve bundle were markedly thickened and enhanced in 34 cases and in which 15 presented "water-chestnut"sign;suggesting it was a typical appearance of acoustic neuromas.5 trigeminal neuromas manifested nodule-ring-like or multilocular enhanced masses(n=3),and dumbbell-like masses(n=2).20 meningiomas exhibited homogeneous massive enhancement,"dural tail"sign(n-11),the facial-hearing-nerve bundle on the affected side were enhanced but not thickened(n-5);which represented reactive changes to the tumors.9 cholesteatomas displayed long T 2 long T 1,no enhancement;spreaded along subarachnoid space and basilar artery encapsuled(n-5).Conclusion Enhanced MRI can reveal the characteristics of CPA tumors,it is of especial value for diagnosis of the tumors.

Peste suína clássica: ação térmica da amostra chinesa Porto Alegre (CPA) em coelhos / Classical swine fever: thermal reaction in rabbits to the chinese-Porto Alegre strain

Foram avaliadas a temperatura normal do coelho e sua reação térmica após inoculação com a amostra Chinesa Porto Alegre (CPA) do vírus da Peste Suína Clássica (PSC), sob três condições de temperatura ambiental. Os resultados mostraram que a temperatura normal do coelho aumenta com a elevação da temperatura ambiental (P<0,001). As médias das temperaturas normais dos coelhos foram de 39,53°C; 39,65°C e 39,92°C, nas temperaturas ambientais de 12,82 ± 1,29°C; 20,65 ± 1,79°C e 28,24 ± 2,09°C respectivamente. Os coelhos inoculados tiveram seu pique térmico também aumentado com a elevação da temperatura ambiental (P<0,001), mas não sofreram influência da diluição do vírus. As médias dos piques térmicos observados foram de 41,17°C; 41,24°C e 41,47°C. Para um intervalo de confiança de 95 por cento, estabeleceram-se as temperaturas de 40,60°C; 40,67°C e 40,90°C como limites, a partir dos quais a reação térmica foi considerada específica, em cada uma das temperaturas ambientais utilizadas. A elevação térmica não sofreu influência da temperatura ambiental nem da diluição do vírus, apresentando uma média global de 1,59°C. Para um intervalo de confiança a nível de 95 por cento, estabeleceu-se o limite de 1,06°C como o mínimo de elevação térmica para uma reação específica. O pique térmico iniciou a partir de 24h após inoculação. Seu início foi retardado com o aumento da diluição do vírus (P < 0,001), mas não com a temperatura ambiental. A sensibilidade e especificidade da reação térmica foi avaliada pelo teste de desafio. A análise de regressão permitiu concluir que um pique térmico mínimo de 40,6°C, associado a uma elevação térmica mínima de 1,06°C, pode ser considerada reação específica dos coelhos inoculados com a amostra CPA.

Rectal temperatures of normal rabbits inoculated with different dilutions of a vaccine prepared with Chinese-Porto Alegre (CPA) strain of classical swine fever virus, were evaluated under 3 different environmental temperatures. Temperatures of normal un-vaccinated rabbits increased significantly when environmental temperature increased (P<0.001). At environmental temperatures of 12.82 ± 1.29°C, 20.65 ± 1.79°C, and 28.24 ± 2.09°C me mean rectal temperatures were 39.53°C, 39.65°C and 39.92°C, respectively. Temperatures of me vaccinated rabbits also increased significantly when environmental temperature increased (P<0.001), but did not vary with different vaccine dilutions. At environmental temperatures of 12.82 ± 1.29°C, 20.65 ±1.79°C and 28.24 ± 2.09°C, the mean higher rectal temperature were 41.17°C, 41.24°C and 41.47°C, respectively. Within a 95 percent confidence interval was determined that, under the 3 environmental temperatures, the rectal temperatures equal to 40.60°C, 40.67°C and 40.90°C or higher, indicated a thermal reaction to the vaccine. In vaccinated rabbits, the mean thermic rise was of 1.59°C and there were no significant differences at different environmental temperatures or virus dilutions. Within a 95 percent confidence interval was determined that a rise of 1.06°C or higher indicated a specific reaction to the vaccine. The rise in temperature started 24 hours after the inoculation. This time was delayed when virus dilutions decreased (P<0.001), but did not vary with different environmental temperatures. The sensitivity and specificity of the thermic reaction was evaluated by the challenge test. By regression analysis was concluded that a temperature of 40.6°C, associated with a rise in at least 1.06°C, could be considered a specific reaction of the rabbits to the CPA strain.

A Case of Neurofibromatosis 2 with Multiple Intracranial and Intraspinal Tumors:Neurofibromatosis 2(NF2)

Neurofibromatosis 1(NF-1, Von Recklinghausen disease) and Neurofibromatosis 2(NF-2, bilateral acoustic neurinoma) have been established as distinct disorders by the National Institutes of Health(NIH) Consensus Development Conference in 1988. We recently have encountered a patient of NF-2 who develop multiple intracranial and spinal tumors 12 years after the surgical treatment of Schwannoma of lumbar nerve roots. The tumors were right acoustic neurinoma, left cerebellopontine angle(CPA) meningioma, multiple intracranial meningiomas, intraorbital glioma, multiple ependymomas of the brain stem and cervical spinal cord, and meningiomas of cervical nerve roots. We present this case with a review of reported cases of neurofibromatosis.

Combined Approach for Large CPA Tumor with Sacrifice of Sigmoid Sinus

With large CPA tumor(>3 mm), brain stem is usually displaced and distorted to contralateral side. It is important minimize retraction to protect brain stem and to lower morbidity. In our previous report, we reported the result and method of combined approach for large CPA tumor. In order to minimize brain stem retraction and to get good operating field, three of 7 cases of large CPA tumor with combined approach were operated with sacrifice of sigmoid sinus. The sigmoid sinus can be sacrificed if it can be angiographically verified that the sagittal sinus represents the major drainage to the contralateral sigmoid sinus. During operation, if pressure difference between before and after occlusion of sinus is less than 10 mmHg and any brain swelling does not develop after occlusion, the sigmoid sinus can be sacrificed.

Microsurgical Approach to Cerebellopontine Angle Tumors

The authors reviewed one hundred and twenty cases of cerebellopontine angle(CPA) tumors that were operated upon at the department of neurosurgery of Seoul National University Hospital between 1977 and 1987. The pathologic diagnosis of the tumors were acoustic neurinoma(66%), meningioma(13%), epidermoid(5%) and trigeminal neurinoma(5%). The age incidence was most frequent in the 5th and the 6th decades and 6.7% of cases occurred at the pediatric ages. Acoustic neurinomas were frequent in the 5th decade and on admission more than half of patients were poor clinical grades with large tumors more than 3cm in diameter(78.5%). There was good correlation between the clinical grade and tumor size on admission. All of the acoustic tumors were operated through the suboccipital transmeatal approach and total removal was possible in 73% with 5% of motality rate. Facial nerve was preserved in 62% of total removal-cases and the size of tumor was the important factor for the total removal of tumor with preservation of facial nerve. Cerebellopontine angle meningioma comprised 13% of all CPA tumors and incidence of male to female ratio was 2:13. Operations were performed either through retromastoid suboccipital approach or combined supra-infratentorial approach. Total temoval was possible in 67% without mortality. Six trigeminal neurinomas were located:one in the middle fossa, one in the posterior fossa and the other four cases appearing as dumbbell shape. Total removal was possible in two cases and subtotal removal in four cases and the outcome was rather good in all cases. Pediatric CPA tumors were two each of medulloblastomas and ependymomas and one each of astrocytoma, primitive neuroectodermal tumor(PNET) and trigeminal neurinoma, Masson's hemagioendothelioma. Total removal was possible in four cases and the outcome was good in all cases.