Epigenetic and Metabolic Changes in Diffuse Intrinsic Pontine Glioma

Diffuse midline glioma (DMG), hitherto known as diffuse intrinsic pontine glioma (DIPG), is a rare and aggressive form of brain cancer that primarily affects children. Although the exact cause of DMG/DIPG is not known, a large proportion of DMG/DIPG tumors harbor mutations in the gene encoding the histone H3 protein, specifically the H3K27M mutation. This mutation decreases the level of H3K27me3, a histone modification that plays a vital role in regulating gene expression through epigenetic regulation.The mutation also alters the function of polycomb repressive complex 2 (PRC2), thereby preventing the repression of genes associated with cancer development. The decrease in H3K27me3 caused by the histone H3 mutation is accompanied by an increase in the level of H3K27ac, a post-translational modification related to active transcription. Dysregulation of histone modification markedly affects gene expression, contributing to cancer development and progression by promoting uncontrolled cell proliferation, tumor growth, and metabolism. DMG/DIPG alters the metabolism of methionine and the tricarboxylic acid cycle, as well as glucose and glutamine uptake. The role of epigenetic and metabolic changes in the development of DMG/DIPG has been studied extensively, and understanding these changes is critical to developing therapies targeting these pathways. Studies are currently underway to identify new therapeutic targets for DMG/DIPG, which may lead to the development of effective treatments for this devastating disease.

Association between Depressive Symptoms and Vitamin D Deficiency in Adults with Overweight or Obesity / 우울ㆍ조울병

Background@#The relationship between a low vitamin D level and depression has been demonstrated repeatedly. We assessed the correlation between vitamin D status and the prevalence of depression according to body weight status. @*Methods@#Data from 1,747 participants who took part in the 2014 Korean National Health and Nutrition Examination Survey were analyzed. The presence of depression was identified by the brief, self-reported Patient Health Questionnaire-9 (PHQ-9), vitamin D status was defined based on the serum 25-hydroxyvitamin D [25(OH)D] level, and body weight status was expressed as the body mass index. @*Results@#After adjusting for potential confounding factors, participants in the vitamin D deficiency group (odds ratio [OR], 2.70; 95% confidence interval [CI], 1.01-7.20) and severe deficiency group (OR, 2.89; 95% CI, 1.04-8.00) were significantly more likely to experience depression. Multivariate logistic regression analyses indicated that among the participants with overweight or obesity, those in the vitamin D deficiency group were 3.71 times more likely than those in the sufficiency group (OR, 3.71; 95% CI, 1.08-12.74) to experience depression. @*Conclusion@#Our findings suggest a significant association between low vitamin D levels and depression in adults with overweight or obesity. Further studies are needed to elucidate the association between vitamin D status and depression according to body weight status.

Antidepressant-like Effects of p-Coumaric Acid on LPS-induced Depressive and Inflammatory Changes in Rats

Depression causes mental and physical changes which affect quality of life. It is estimated to become the second most prevalent disease, but despite its commonness, the pathophysiology of depression remains unclear and medicine is not sufficiently protective. p-Coumaric acid (p-CA) is a dietary phenolic acid which has been proven to have antifungal, anti-HIV, anti-melanogenic, antioxidant and anti-inflammatory effects. Considering these effects, we investigated whether p-CA can prevent depressive symptoms by reducing inflammatory cytokines in animals injected with lipopolysaccharide (LPS). Changes in despair-related behaviors, inflammatory cytokines, neurotrophic factors and synaptic activity were measured. In these animals, p-CA improved despair-related behavioral symptoms induced by LPS in the forced swim test (FST), tail suspension test (TST) and sucrose splash test (SST). p-CA also prevented the increase of inflammatory cytokines in the hippocampus such as cycloxigenase-2 and tumor necrosis factor-α due to LPS. Similarly, it prevented the reduction of brain-derived neurotrophic factor (BDNF) by LPS. Electrophysiologically, p-CA blocked the reduction of long-term depression in LPS-treated organotypic tissue slices. In conclusion, p-CA prevented LPS-induced depressive symptoms in animals, as determined by behavioral, biochemical and electrophysiological measures. These findings suggest the potential use of p-CA as a preventive and therapeutic medicine for depression.

Unusual Clinical Presentations of Cervical or Lumbar Dorsal Ramus Syndrome

OBJECTIVE: Patients with cervical (CDRS) or lumbar dorsal ramus syndrome (LDRS) are characterized by neck or low back pain with referred pain to upper or lower extremities. However, we experienced some CDRS or LDRS patients with unusual motor or bladder symptoms. We analyzed and reviewed literatures on the unusual symptoms identified in patients with CDRS or LDRS. METHODS: This study included patients with unusual symptoms and no disorders of spine and central nervous system, a total of 206 CDRS/LDRS patients over the past 3 years. We diagnosed by using double diagnostic blocks for medial branches of dorsal rami of cervical or lumbar spine with 1% lidocaine or 0.5% bupivacaine for each block with an interval of more than 1 week between the blocks. Greater than 80% reduction of the symptoms, including unusual symptoms, was considered as a positive response. The patients with a positive response were treated with radiofrequencyneurotomy. RESULTS: The number of patients diagnosed with CDRS and LDRS was 86 and 120, respectively. Nine patients (10.5%) in the CDRS group had unusual symptoms, including 4 patients with motor weakness of the arm, 3 patients with tremors, and rotatory torticollis in 2 patients. Ten patients (8.3%) in the LDRS group showed unusual symptoms, including 7 patients with motor weakness of leg, 2 patients with leg tremor, and urinary incontinence in 1 patient. All the unusual symptoms combined with CDRS or LDRS were resolved after treatment. CONCLUSION: It seems that the clinical presentationssuch as motor weakness, tremor, urinary incontinence without any other etiologic origin need to be checked for unusual symptoms of CDRS or LDRS.

Relationship Between Systemic Thrombogenic or Thrombolytic Indices and Acute Increase of Spontaneous Intracerebral Hemorrhage

OBJECTIVE: The objective of this study was to determine the correlations between changes in thrombogenesis or thrombolysis related factors, and the acute increase of a spontaneous intracerebral hemorrhage (sICH). MATERIALS AND METHODS: From January 2009 to October 2011, 225 patients with sICH were admitted to our hospital within 24 hours of onset. Among them, 111 patients with hypertensive sICH were enrolled in this study. Thrombogenic or thrombolytic factors were checked at admission. The authors checked computed tomography (CT) scans at admission and followed up the next day (between 12-24 hours) or at any time when neurologic signs were aggravated. Cases in which the hematoma was enlarged more than 33% were defined as Group A and the others were defined as Group B. RESULTS: Group A included 30 patients (27%) and group B included 81 patients (73%). Factors including activated partial thromboplastin time, prothrombin time, fibrinogen, and D-dimer showed a greater increase in group A than in group B. Factors including antithrombin III, factor V, and factor X showed a greater increase in group A than in group B. CONCLUSION: Based on the results of this study, it seems that the risk of increase in hematoma size can be predicted by serum thrombogenic or thrombolytic factors at admission.

Comparison of Transforaminal Lumbar Interbody Fusion with Direct Lumbar Interbody Fusion: Clinical and Radiological Results

OBJECTIVE: The use of direct lumbar interbody fusion (DLIF) has gradually increased; however, no studies have directly compared DLIF and transforaminal lumbar interbody fusion (TLIF). We compared DLIF and TLIF on the basis of clinical and radiological outcomes. METHODS: A retrospective review was performed on the medical records and radiographs of 98 and 81 patients who underwent TLIF and DLIF between January 2011 and December 2012. Clinical outcomes were compared with a visual analog scale (VAS) and the Oswestry disability index (ODI). The preoperative and postoperative disc heights, segmental sagittal/coronal angles, and lumbar lordosis were measured on radiographs. Fusion rates, operative time, estimated blood loss (EBL), length of hospital stay, and complications were assessed. RESULTS: DLIF was superior to TLIF regarding its ability to restore disc height, foraminal height, and coronal balance (p0.05). CONCLUSION: Both DLIF and TLIF are less invasive and thus good surgical options for treating degenerative lumber diseases. DLIF has higher potential in increasing neural foramina and correcting coronal balance, and involves a shorter operative time and reduced EBL, in comparison with TLIF. However, DLIF displayed a lower fusion rate than TLIF, and caused complications related to the transpsoas approach.

Risk Factors for Delirium after Spine Surgery in Elderly Patients

OBJECTIVE: Postoperative delirium is a common complication in the elderly after surgery but few papers have reported after spinal surgery. We analyzed various risk factors for postoperative delirium after spine surgery. METHODS: Between May 2012 and September 2013, 70 patients over 60 years of age were examined. The patients were divided into two groups : Group A with delirium and Group B without delirium. Cognitive function was examined with the Mini-Mental State Examination-Korea (MMSE-K), Clinical Dementia Rating (CDR) and Global Deterioration Scale (GDS). Information was also obtained on the patients' education level, underlying diseases, duration of hospital stay and laboratory findings. Intraoperative assessment included Bispectral index (BIS), type of surgery or anesthesia, blood pressure, fluid balance, estimated blood loss and duration of surgery. RESULTS: Postoperative delirium developed in 17 patients. The preoperative scores for the MMSE, CDR, and GDS in Group A were 19.1+/-5.4, 0.9+/-0.6, and 3.3+/-1.1. These were significantly lower than those of Group B (25.6+/-3.4, 0.5+/-0.2, and 2.1+/-0.7) (p<0.05). BIS was lower in Group A (30.2+/-6.8 compared to 35.4+/-5.6 in group B) (p<0.05). The number of BIS <40 were 5.1+/-3.1 times in Group A, 2.5+/-2.2 times in Group B (p<0.01). In addition, longer operation time and longer hospital stay were risk factors. CONCLUSION: Precise analysis of risk factors for postoperative delirium seems to be more important in spinal surgery because the surgery is not usually expected to have an effect on brain function. Although no risk factors specific to spinal surgery were identified, the BIS may represent a valuable new intraoperative predictor of the risk of delirium.

Risk Assessment of Postoperative Nausea and Vomiting in the Intravenous Patient-Controlled Analgesia Environment: Predictive Values of the Apfel's Simplified Risk Score for Identification of High-Risk Patients

PURPOSE: Opioid-based intravenous patient-controlled analgesia (IV PCA) is popular method of postoperative pain control, but many patients suffer from IV PCA-related postoperative nausea and vomiting (PONV). In this retrospective observational study, we have determined independent predictors of IV PCA-related PONV and predictive values of the Apfel's simplified risk score in pursuance of identifying high-risk patients. MATERIALS AND METHODS: We analyzed 7000 patients who received IV PCA with background infusion after elective surgery. Patients who maintained IV PCA for a postoperative period of 48 hr (completion group, n=6128) were compared with those who have discontinued IV PCA within 48 hr of surgery due to intractable PONV (cessation group, n=872). Patients, anesthetics, and surgical factors known for predicting PONV were evaluated by logistic regression analysis to identify independent predictors of IV PCA related intractable PONV. RESULTS: In a stepwise multivariate analysis, weight, background infusion dose of fentanyl, addition of ketolorac to PCA, duration of anesthesia, general anesthesia, head and neck surgery, and Apfel's simplified risk score were revealed as independent risk factors for intractable PONV followed by the cessation of IV PCA. In addition, Apfel's simplified risk score, which demonstrated the highest odds ratio among the predictors, was strongly correlated with the cessation rate of IV PCA. CONCLUSION: Multimodal prophylactic antiemetic strategies and dose reduction of opioids may be considered as strategies for the prevention of PONV with the use of IV PCA, especially in patients with high Apfel's simplified risk scores.

Expanding the donor pool for liver transplantation in the setting of an "opt-out" scheme: 3 years after new legislation

<p><b>INTRODUCTION</b>The revised Human Organ Transplant Act (HOTA) was implemented in Singapore in July 2004. We aim to evaluate expanding the potential donor pool for liver transplant in Singapore with the inclusion of marginal donors.</p><p><b>MATERIALS AND METHODS</b>All donor referrals between July 2004 and June 2007 were studied. All potential deceased liver donors were heart-beating. After being reviewed by the transplant coordinator, potential donors were assessed by a transplant hepatologist and a transplant surgeon for suitability of organ donation strictly based on the programme's donor assessment protocol. Reasons for rejection as potential donors were documented. The clinical characteristics of all donor referrals were retrospectively reviewed, and an independent decision was made as to whether liver retrieval in each rejected case might have been possible.</p><p><b>RESULTS</b>Among the 128 potential donor referrals, 20 donors (15.6%) underwent liver retrieval. Of the 20 livers retrieved, 16 were implanted and 4 were not implanted (3 unfit recipients, and 1 donor liver with 40% steatosis). Another 10 donor livers were assessed intraoperatively and were rejected because of varying levels of steatosis. Of these livers assessed, 5 donor livers had steatosis <40% and 5 had steatosis >40%. Of the remaining potential donors, 45 were deemed not possible because of prolonged hypotension (9), on-going or unresolved sepsis (13), high-risk behaviour (4), non-actualisation (8), or pre-existing medical conditions (11). Another 53 donors may potentially have been suitable donors but were rejected because of possible sepsis (13), no suitable recipients (12), transient hypotension (10), transient abnormal liver function test (6), history of alcohol ingestion (5), non-actualisation because of consent (4) and other reasons (3). Overall, it was deemed that 61 donors (47.7%) might potentially have been suitable liver donors.</p><p><b>CONCLUSIONS</b>Despite new legislation (HOTA) in Singapore, the utilisation of cadaveric donor livers showed no increase in the last 3 years. By expanding our donor criteria to include marginal donors, we could potentially increase the availability of deceased donor livers to meet our waiting list demands.</p>

A Relationship between the Obstructive Sleep Apnea Syndrome and the Erythrocyte Sedimentation Rate

OBJECTIVES: The erythrocyte sedimentation rate (ESR) is a marker for inflammation, and it has been identified as a risk factor for atherothrombotic cardiovascular disease. The aim of this study was to determine the relationship between the plasma ESR level and nocturnal oxygen desaturation or other polysomnographic variables and to examine the role of obesity in patients with obstructive sleep apnea syndrome (OSAS). METHODS: This retrospective study included 72 patients with a diagnosis of OSAS who underwent overnight polysomnography and routine blood tests between July and December of 2005. We compared the plasma ESR level with the sum of all the polysomnographic variables and divided the patient group into obese and non-obese patients. RESULTS: The mean ESR level was 8.45 mm/hr. There was a significant difference in the ESR level between genders (P or =25, N=43, P=0.012). In addition, the ESR levels had a positive correlation with age in the obese group (P=0.002). However, there was no significant correlation with the percentage of time spent at a SpO2 below 90% in the whole group of patients and in the non-obese group (BMI <25, N=29). The ESR level showed no correlation with the other polysomnographic variables. CONCLUSION: The duration of deoxygenation in obese patients with OSAS may be associated with the ESR level which is an independent predictor of cardiovascular disease.

Development of Flexible Interface Software for Autoanalyzer using Unidirectional and ASTM Bidirectional Protocol / 대한임상병리학회지

BACKGROUND: The Laboratory Information Management System (LIMS) requires instrument interfacing for good efficiency. However, most instrument interfacing cannot be used easily because instruments have different interface protocols and database systems are different in each hospital LIMS. Therefore, it is necessary to establish flexible interface software that would be useful for various instrument interfacing and can be handled by laboratory workers. METHODS: We categorized the raw data acquisition format of instruments into 7 classification according to the field delimiter, the field position and the test ID, and created software so that anyone could make the interface protocols for any instrument that supports the unidirectional or ASTM interface protocol, according to classification. The software also provides various functions, such as host communications and printing. RESULTS: With this software, we have interfaced 23 instruments without program languages (C, C++, Basic, Pascal, etc.) coding. It took about 1-4 hours for each instrument interface. The software supports a maximum of 8 simultaneous instrument connections with one personal computer. Also, it is possible to retrieve acquisition data from instruments with Microsoft Excel without LIMS. CONCLUSTIONS: The advantages of this software are as follows; 1. Markedly shortens the input time for data generated from automated instruments and reduces errors of manual data entry, 2. Effective increase in host computer performance, 3. Significantly saves time and cost for instrument interfacing. Therefore, this software was considered to be very useful for laboratory instrument interfacing.

Clinical and Histopathological Analysis of 494 Cases of Percutaneous Renal Biopsies / 대한신장학회잡지

Percutaneous renal biopsy is an essential component for diagnosis and management of glomerular diseases. In order to elucidate clinical and pathological features, 494 renal patients who had undergone renal biopsies at Gil Medical Center from January 1989 to June 1999 were studied retrospectively. The male to female ratio was 1.3 : 1 and average age was 33.2 years. There were 370(83.5%) cases of primary glomerular disease and 58(13.1%) cases of secondary glomerular disease. Among primary glomerular disease, IgA nephropathy was the most common(175 cases), followed by minimal change disease(84 cases), membranous glomerulonephritis(34 cases), and focal segmental glomerulosclerosis(33 cases). In secondary glomerular disease, lupus nephritis was the most common(21 cases), followed by 11 cases of hepatitis B associated glomerulonephritis, 9 cases of Henoch-Sch nlein purpura, and 4 cases of diabetic nephropathy. Among 99 cases of asymptomatic urinary abnormalities, IgA nephropathy was most common(69 cases) followed by 12 cases of thin basement membrane disease, 4 cases of minimal change disease, and 3 cases of focal segmental glomerulosclerosis, membranous glomerulonephritis, nonspecific glomerulonephritis. Among 159 cases of nephrotic syndrome, minimal change disease was most common(60 cases) followed by 25 cases of IgA nephropathy, 23 cases of focal segmental glomerulosclerosis, 21 cases of membranous glomerulonephritis, and 13 cases of lupus nephritis. Documented complication of renal biopsies included 23 cases of gross hematuria, 6 cases of perirenal hematoma, and 4 cases of infection. Death, AV fistula, aneurysm or serious compications that required surgical intervention were not reported. In conclusion, the percutaneous renal biopsy is relatively safe, and useful for diagnosis and management of glomerular diseases. The most common type of primary glomerular disease was IgA nephropathy.

A Case of Iatrogenic Wernicke's Encephalopathy Following Chemotherapy and Total Parenteral Nutrition / 대한혈액학회지

Wernicke's encephalopathy is a neuropsychiatric condition generally caused by acute thiamine deficiency. Although it is common in the severe alcoholics, several other causes also have been identified, such as total parenteral nutrition (TPN) use, persistent vomiting, hyperemesis gravidarum, anorexia nervosa and malnutrition. The classic triad of Wernicke's encephalopathy are ataxia, altered mentation and ophthalmoplegia. A 19-year-old boy had been treated with high dose Ara-C and mitoxantrone for acute myelogenous leukemia and intravenous hyperalimentation due to persistent vomiting. He suddenly complained of diplopia, gait disturbance and generalized weakness at 36th day after chemotherapy. Physical examinations showed disorientated mentality, oculomotor palsy and horizental nystagmus. The diagnosis of Wernicke's encephalopathy was made with classical brain MRI and decreased thiamine level. The patient was successfully treated with vitamin B1. We presented a case of acute Wernicke's encephalopathy developed after high dose Ara-C chemotherapy followed by intravenous hyperalimentation in a patient with acute myelogenous leukemia.

Stenting of Extracranial Carotid Artery Stenosis

BACKGROUND: Surgical endarterectomy had been known to be the standard treatment modality in management of carotid stenosis. However, endarterectomy had several limitations in high-risk patients, particulary with coronary artery disease. Carotid angioplasty and stenting has been suggested to be a safer and more cost-effective alternative to carotid endarterectomy in the management of symptomatic carotid artery disease. The purpose of this study is to evaluate the feasibility and safety of elective carotid artery stent implantation in patients with carotid artery stenosis. METHOD: We treated 19 patients with symptomatic and asymptomatic stenosis of >60% in 19 carotid arteries with balloon angioplasty followed by elective stent implantation. Of all carotid stenting procedures, 18 stents were implanted in obstructing atherosclerotic plaques and in one for Takayasu's arteritis. Of all patients, 10 patients were symptomatic with a history of stroke or transient ischemic attacks which were ipsilateral to the treated carotid artery. 12 patients represented a high-risk subset with myocardial infarction, previous coronary artery bypass graft and coronary artery stenosis. 6 months follow up angiogram was done in 7 patients, a patient(Takayasu's arteritis) showed restenosis. Result: Angiographic and procedural success rate were 100%, and there were no acute or subacute stent thrombosis. Immediately after initial carotid stenting, the mean(+/-SD) stenosis was reduced from 74.9+/-13.6% to 10.2+/-8.7% and the minimal luminal diameter was increased from 1.4+/-0.8mm to 5.3+/-1.0mm corresponding to an acute gain of 3.9mm. There were no major or minor stokes during follow-up. CONCLUSION: Percutaneous carotid angioplasty with stenting is a safe and feasible procedure. It is associated with high immediate success rates and relatively low complications in the management of carotid artery stenosis. Carotid stenting seems to be a reasonable alternatives to medical management for the treatment of carotid stenosis in patients deemed to be poor candidates for standard carotid endarterectomy.

Apoptosis and the Expression of p53, Bcl-2 in Very Delayed Focal Cerebral Infarction and Penumbra

Apoptosis is a physiological or programmed cell death process controlled by genes, which is thought to be one of the main mechanisms of cell death in cerebral infarction. The apoptosis is controlled by several protooncogenes including p53 and Bcl-2 genes. The purpose of this study is to evaluate how the apoptotic genes express in the focal cerebral infarction and penumbra at very delayed focal cerebral infarction in adult rats. In twelve adult Sprague-Dawley rats of both sex, the right middle cerebral artery(MCA) and both common carotid arteries were ligated for thirty minutes and the rats were killed after seventy-two hours to obtain a focal cerebral infarction. Immunohistochemical stains for the apoptosis, p53, and Bcl-2 proteins were performed. The thickness (micrometer) and the area(mm2) of the infarction core and periinfarct areas containing apoptotic cells, p53, or Bcl-2 protein were measured. The apoptosis, p53, and Bcl-2 positive cells were counted, and the p53: Bcl-2 ratio was calculated at each sector. The p53 area was the widest(6.8+/-2.4mm2) and the apoptosis area was the narrowest(3.1+/-2.1mm2). The apoptotic cells were mostly concentrated in the peripheral portion of the infarction core(6.1+/-3.7/HPF). The p53 positive cells were mostly concentrated(26.6+/-8.0/HPF) in the adjacent periinfarct area with a gradual decrease peripherally, and it seemed that p53 expression was reversely proportional to the regional cerebral blood flow(rCBF). The p53: Bcl-2 ratio was significantly higher at the apoptosis-positive zone(3.3+/-2.7) compared with the apoptosis-negative zone(2.2+/-1.8)(p<0.05). From these results, it could be postulated that the proapoptotic action of the p53 protein and the antiapoptotic action of Bcl-2 protein were closely interactive in the periinfarct area. These data indicate that the p53 protein positive area might be compatible with the penumbric area of cerebral infatction.

Acute Subdural Hematoma: An Analysis of 244 Operated Cases

This study is a retrospective clinical analysis of two hundred forty-four consecutive cases of acute subdural hematoma which were confirmed by operation during the last five years at the Department of Neurosurgery of the Dong-guk University Hospital. The authors have attempted, through this analysis to identify the factors affecting the outcome of acute subdural hematoma. A favorable outcome occurred in 40%, and an unfavorable outcome in 21% of patients at the time of discharge while a death ocurred in 39% of the cases. We have concluded that initial GCS, pupillary status, systolic arterial blood pressure, FDP vaules, presence or absence of skull fracture. IICP findings on brain CT, hematoma amount, and associated intracranial lesions are all prognostic factors, although the timing of operation did not reflect a significant difference in the outcome, however the sooner the intracranial hematoma lesion is evacuated, the better the outcome will be.

A Case of Migrated Peritoneal Catheter of V-P Shunt System into Right Ventricle: Case Report

Variety of complications following ventriculoperitoneal(V-P) shunt have been reported. However, right ventricular migration of a V-P shunt has never been documented. The authors present a case of migrated peritoneal catheter of a V-P shunt system into the right venticle. To our knowledge, this is the first reported case complicated with migration of a peritoneal tube into the right ventricle. The patient was presented with fever and the migration was diagnosed by chest X-ray, and neck and cardiac ultrasonography.

A Clinical Analysis of Delayed Traumatic Intracerebral Hematoma

The development of sophisticated diagnostic modalities, most notably computerized tomography(CT), led to an increasing awareness of delayed traumatic intracerebral hematoma(DTICH). But the general prognosis for functional recovery was poor in patients who developed DTICH. The author analysed 95 cases of DTICH admitted to the department of Neurosurgery, Dong-Guk University Hospital during three years from January 1990 to December 1992. The result were as follows: 1) The incidence of the DTICH was 5.1% of all head injured patients. 2) The average age of patient was 43.3 years and the most common cause was traffic accident(61.6%). 3) Of the 95 patients who were diagnosed as DTICH, the clues to undergo follow up CT were divided as routine follow up in 39, changes of the consciousness level in 38, changes of the pupil size in 18 patients. 4) Most of the DTICH formation were related to contusion site of the brain and were more commonly associated with rotational forces. 5) Twenty-one cases of DTICH occurred within 24 hours after trauma and 18 cases at 2 days after trauma. 6) The most common site of hematoma was frontal lobe followed by temporal lobe. 7) The factors affecting prognosis (1) age(p<0.01) (2) Glasgow Coma scale(GCS) at admission(p<0.01) (3) time interval between trauma and discovery(p<0.01) (4) hematoma volume(p<0.01). Location of hematoma did not affect outcome, but the patients with multiple hematoma or basal ganglia hematoma showed higher fatality than the others. 8) The overall fatality rate was 40%.

Clinical Studies on the Outcome of Operated Intracranial Aneurysms

The authors evaluated results of surgical outcome of aneurysmal subarachnoid hemorrhage in 190 patients between May, 1988, and April 1991, At admission, 78% of the patients were in relatively good neurologic condition and surgery was performed. At dischage, 10% of the patients had died and 58%, exhibited a complete recovery. Predictors for poor prognosis included the patient's low level of consciousness, old age, male sex, thickness of the subarachnoid blood clot on computerized tomography, preexisting hypertension, middle or anterior cerebral artery aneurysm and vasospasm.

Empty sella: incidence and significance in MR

No abstract available.