Cervical Cerebrospinal Fluid Leakage Concomitant with a Thoracic Spinal Intradural Arachnoid Cyst / 대한신경손상학회지

We encountered a very rare case of spontaneous spinal cerebrospinal fluid (CSF) leakage and a spinal intradural arachnoid cyst (AC) that were diagnosed at different sites in the same patient. These two lesions were thought to have interfered with the disease onset and deterioration. A 30-year-old man presented with sudden neck pain and orthostatic headache. Diplopia, ophthalmic pain, and headache deteriorated. CSF leakage was confirmed in C2 by radioisotope cisternography, and an epidural blood patch was performed. While his symptoms improved gradually, paraparesis suddenly progressed. Thoracolumbar magnetic resonance imaging (MRI) revealed an upper thoracic spinal intradural AC, which was compressing the spinal cord. We removed the outer membrane of the AC and performed fenestration of the inner membrane after T3-4 laminectomy. Postoperative MRI showed complete removal of the AC and normalized lumbar subarachnoid space. All neurological deficits including motor weakness, sensory impairment, and voiding function improved to normal. We present a case of spontaneous spinal CSF leakage and consecutive intracranial hypotension in a patient with a spinal AC. Our report suggests that if spinal CSF leakage and a spinal AC are diagnosed in one patient, even if they are located at different sites, they may affect disease progression and aggravation.

Effects of Newly Designed Drainage Catheter in Treating Chronic Subdural Hematoma / 대한신경손상학회지

OBJECTIVE: Chronic subdural hematoma (cSDH) is a common disorder that is readily surgically treated but has high recurrence rate. This is a preliminary report to evaluate the effectiveness of a newly designed catheter compared with the conventional one in treating cSDH. METHODS: We conducted a retrospective study of 111 patients with unilateral chronic subdural hematoma treated by burr hole craniostomy with closed-system drainage from November 2009 to September 2012. Group A was defined as patients treated with an external ventricular drainage (EVD) catheter and B as patients treated with the new catheter. We measured changes of thickness of hematoma and midline shifting in brain computed tomography (CT), amount of drainage and recurrence rate in both groups. RESULTS: Group A consisted of 54 and B of 57 cases. The mean duration for total removal of hematoma was 42.6+/-13.9 hours in group A and 30.3+/-11.9 hours in group B (p<0.05). The mean amount of drainage counted per six hours cumulatively differed significantly between groups. The result (p<0.05) showed that the newly designed catheter effectively removed the hematoma. The total recurrence rate in group A was 11% and 3.5% in group B. CONCLUSION: The study showed that the newly designed catheter effectively removed the hematoma in less time than the conventional one. This helps re-expand the brain block CSF from flowing into the subdural space and decrease the recurrence rate.

Endovascular Mechanical Thrombectomy in Basilar Artery Occlusion: Initial Experience

OBJECTIVE: This study was conducted to assess the efficacy and safety of endovascular mechanical thrombectomy (EMT) for patients diagnosed with basilar artery (BA) occlusion. MATERIALS AND METHODS: We retrospectively analyzed clinical and imaging data of 16 patients diagnosed with BA occlusion who were treated with endovascular intervention from July 2012 to February 2013. Direct suction using the Penumbra system and thrombus retrieval by the Solitaire stent were the main endovascular techniques used to restore BA flow. The outcomes were evaluated based on rate of angiographic recanalization, rate of improvement of National Institutes of Health Stroke Scale (NIHSS) score, rate of modified Rankin Scale (mRS) at discharge and after 3 months, and rate of cerebral hemorrhagic complications. Successful recanalization was defined as achieving Thrombolysis In Cerebral Infarction (TICI) of II or III. RESULTS: Sixteen patients received thrombectomy. The mean age was 67.8 +/- 11 years and the mean NIHSS score was 12.3 +/- 8.2. Eight patients treated within 6 hours of symptom onset were grouped as A and the other 8 patients treated beyond 6 hours (range, 6-120) were grouped as B. Successful recanalization was met in six patients (75%) for group A and 7 (87.5%) for group B. Favorable outcome occurred in 4 patients (50%) for group A and 5 (62.5%) for group B. CONCLUSION: Our study supports the effectiveness and safety of endovascular mechanical thrombectomy in treating BA occlusion even 6 hours after symptom onset.

Endovascular Mechanical Thrombectomy in Basilar Artery Occlusion: Initial Experience

OBJECTIVE: This study was conducted to assess the efficacy and safety of endovascular mechanical thrombectomy (EMT) for patients diagnosed with basilar artery (BA) occlusion. MATERIALS AND METHODS: We retrospectively analyzed clinical and imaging data of 16 patients diagnosed with BA occlusion who were treated with endovascular intervention from July 2012 to February 2013. Direct suction using the Penumbra system and thrombus retrieval by the Solitaire stent were the main endovascular techniques used to restore BA flow. The outcomes were evaluated based on rate of angiographic recanalization, rate of improvement of National Institutes of Health Stroke Scale (NIHSS) score, rate of modified Rankin Scale (mRS) at discharge and after 3 months, and rate of cerebral hemorrhagic complications. Successful recanalization was defined as achieving Thrombolysis In Cerebral Infarction (TICI) of II or III. RESULTS: Sixteen patients received thrombectomy. The mean age was 67.8 +/- 11 years and the mean NIHSS score was 12.3 +/- 8.2. Eight patients treated within 6 hours of symptom onset were grouped as A and the other 8 patients treated beyond 6 hours (range, 6-120) were grouped as B. Successful recanalization was met in six patients (75%) for group A and 7 (87.5%) for group B. Favorable outcome occurred in 4 patients (50%) for group A and 5 (62.5%) for group B. CONCLUSION: Our study supports the effectiveness and safety of endovascular mechanical thrombectomy in treating BA occlusion even 6 hours after symptom onset.

Unilateral Renal Cystic Disease / 대한비뇨기과학회지

Unilateral renal cystic disease (URCD) is a rare, non-familial, non-progressive renal disorder that is not associated with cysts or disorders in other organs, and it is not related to other genetic cystic diseases. URCD is pathologically indistinguishable from autosomal dominant polycystic kidney disease (ADPKD). However, URCD is clinically and radiologically characterized by a negative family history, normal renal function and unilateral localization. We present here a case in which the final diagnosis was made by pathologic documentation through laparoscopic radical nephrectomy. This is the 26th case that has been reported on in the medical literature, and this case was pathologically diagnosed.

Comparison of Recovery Periods according to Treatment Modalities in Zoster-associated Voiding Dysfunction

PURPOSE: We compared the recovery periods in zoster-associated voiding dysfunction according to the treatment modality to establish the best treatment policy. MATERIALS AND METHODS: From January 2004 to August 2006, medical records of 250 patients admitted for zoster infection were reviewed. Of 250 patients, patients complaining of lower urinary tract symptoms(LUTS) were selected. The clinical and urodynamic features, and treatment outcomes were analyzed. RESULTS: Thirty eight(15.2%) of 250 patients had zoster-associated LUTS. Urinary retention was the most common symptom. Urodynamically, detrusor underactivity was the most common finding(71.8%). Twenty were followed, of which 5 received oral medication, 10 received clean intermittent catheterization(CIC), 4 received indwelling catheterization(IC) and remained 1 was observed without treatment. All patients regained normal voiding function. Mean recovery period was 12 days. According to the treatment modality, mean recovery period was 21 days in medication group, 10 days in CIC group, and 6 days in IC group. The mean recovery period was significantly shorter in CIC or IC group than medication group(p=0.013, 0.005). CONCLUSION: Zoster-associated voiding dysfunction is a reversible condition. Thus, patients with mild symptoms can be observed. However, if symptoms are severe or retention develops, catheterization is recommended rather than medication alone.

Cavernous Lymphangioma of the Retroperitoneal Space / 대한비뇨기과학회지

A retroperitoneal lymphangioma is a rare tumor, most commonly affecting the neck or axillary area. We report a case of a 60-year-old man, with left flank pain, who had a retroperitoneal cavernous lymphangioma, with hemorrhagic complication. The diagnosis was made after complete excision of the tumor, followed by pathologic documentation.

Non-ischemic Partial Nephrectomy with Using the Microwave Tissue Coagulator / 대한비뇨기과학회지

PURPOSE: When performing partial nephrectomy, there is a risk of excessive blood loss; this necessitates transfusion and it also results in deterioration of the renal function when a vascular clamp is used. We evaluated the usefulness of the microwave tissue coagulator for performing partial nephrectomy for renal cell carcinoma and benign renal tumors. MATERIALS AND METHODS: From October 2000 to January 2005, partial nephrectomy was performed without renal pedicle clamping with using the microwave tissue coagulator for 9 patients with seven renal cell carcinomas and two angiomyolipomas. RESULTS: In 6 patients, partial nephrectomy was successful with using the microwave tissue coagulator without renal pedicle clamping. The mean operative time and blood loss were 184 minutes and 223ml, respectively. For the remaining cases, three had positive tumor margins, so radical nephrectomy was performed for those cases. The mean creatinine level was not increased postoperatively. The mean preoperative and postoperative hemoglobin levels were 12.6g/dl and 11.7g/dl, respectively. CONCLUSIONS: Partial nephrectomy with using the microwave tissue coagulator can be safe and successful without performing renal pedicle clamping. However, the insertion line of the microwave electrode must be carefully determined for the resection to be curative, the same as when making the cut line for conventional partial nephrectomy.

A Phase I/II Trial of DA3030 in Chemotherapy Induced Neutropenia / 대한암학회지

PURPOSE: We planned to evaluate the toxicity and efficacy of DA-3030 to determine the recommended dose for phase III clinical trial based on the biologically active doses from phase I/II clinical trial. MATERIALS AND METHODS: Open non-randomized phase I/II study was carried out in 64 cancer patients with chemotheray-induced myelosuppression. After 1 cycle of control period (chemotherapy without DA-3030), DA-3030 was started 24 hours after the second cycle of chemotherapy to 4 groups of patients with the doses of 50 microgram/m2/day (step I), 100 microgram/m2/day (step II), 150 microgram/m2/day (step III), 200microgram/m2/day (step IV) by once-a-day subcutaneous administration for 10 days. RESULTS: Of the 64 enrolled patients, 46 patients were evaluable. Tmax reached after 2 hours of injection in step I and 4 hours in step II-IV. Terminal half life was 1.8 hours in step I and 3.2 hours in step II, 3.3 hours in step III, 3.0 hours in step IV. Area under the curve (AUC) and AUMC increased dose dependently from step I through step IV. Total clearance rate decreased in a dose dependent manner but the volume of distribution showed no differences between the steps.The mean nadir count of total WBC and neutrophil increased in all 4 steps of DA-3030 administration. Also the duration of leukopenia, equal to or less than 2,000/uL or neutropenia and the recovery time of WBC or neutrophil from nadir decreased with DA-3030 administration in all 4 steps. But no differece of DA-3030 effect was found among 4 steps. When we compared the clinical efficacy of DA-3030 with total WBC and neutrophil criteria, it was 58.3% and 58.3% in step I, 90.0% and 80.0% in step II, 91.7% and 91.7% in step III, 75.0% and 70.0% in step IV. Although the duration of antibiotics administration showed no difference between control and DA-3030 administration period in step I, it decreased with DA-3030 administration in step II-IV. Infection was found only in step I. Life-threatening side effect was not found in all steps. Only mild myalgia was found without any dose relationship. CONCLUSION: When we considered the efficacy, toxicity and pharmacokinetic parameters, we suggest that 100microgram/m2 is an appropriate dosage for the phase III clinical trial.

A case of chronic intestinal pseudo-obstruction syndrome

No abstract available.

A case of intestinal lymphangiectasia

No abstract available.

A case of acute lymphoblastic leukemia complicating neuroblastoma in remission

No abstract available.