A Case of Sporadic Suprasellar Hemangioblastoma Mimicking Meningioma

Hemangioblastoma (HBL) in the suprasellar region is very rare and a few cases have been reported. Suprasellar HBL without von Hippel-Lindau disease is much rarer. A 76-year old male patient presented progressively deteriorating visual disturbance. MRI demonstrated solid suprasellar mass of 20 mm in diameter, broadly based to planum sphenoidale and diaphragm sella and dural tail sign after the administration of gadolinium diethylene triamine penta-acetic acid (Gd-DTPA). Preoperative diagnosis was meningioma. Total resection of the tumor was not accomplished because of massive hemorrhage, and the histopathologic examination revealed the tumor to be HBL. The visual disturbance of the patient was not improved. The authors reviewed the literature and considered a differential diagnosis of suprasellar tumors and treatment of suprasellar HBL.

Sellar-Suprasellar Extraventricular Choroid Plexus Papilloma : A Case Report and Review of the Literature

Choroid plexus papillomas (CPPs) are relatively rare neuroectodermal tumors that develop from choroid plexus epithelial cells and are usually restricted to the ventricles. Extraventricular CPPs are very unusual and can be difficult to diagnose and treat. A 50-year-old male patient was admitted to our clinic complaining of headache and visual deterioration. Neurological examination found no abnormalities except decreased light perception and secondary optic atrophy in the left eye. Endocrine testing revealed normal levels of hormones produced by the pituitary and target glands. Magnetic resonance imaging of the brain revealed a huge regular-shaped lesion in the sellar-suprasellar region occupying the sella turcica and extending into the suprasellar cistern and planum sphenoidale. The lesion was completely excised by microsurgery via an ordinary left-sided pterional approach. Histopathology identified the lesion as a choroid plexus papilloma. Following the case report, literature on the origin, differential diagnosis, and treatment of this rare tumor is reviewed.

Effect of MRI Scanner Noise on Blood Oxygen Level-Dependent Activation of Cortical and Subcortical Auditory Centers / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: We compared functional MRI acquisition methods of sparse temporal acquisition (STA) and continuous acquisition (CA) to estimate the effect of MRI scanner background noise (SBN) on blood oxygen level-dependent (BOLD) activation of cortical and subcortical auditory centers during auditory stimulation. SUBJECTS AND METHOD: Fourteen healthy subjects (eight males, age 30.6+/-4.7 years) were presented with classical music in a block paradigm (36 s on/off) in two STA [repitition time (TR)=12 s, 60 volumes] and two CA (TR=2 s, 360 volumes) functional MRI sessions. To account for the sample size difference, an additional volume-matched continuous dataset (CAm) was generated by matching CA to 60 volumes of STA. A group-level analysis based on BOLD activation maps was performed. Percent signal change (PSC), T-statistic values and signal variability in cortical and subcortical auditory regions of interest (ROIs) were calculated from individual activation maps and compared between the STA, CA, and CAm. RESULTS: The group analysis showed activation in the primary and secondary auditory cortices in all datasets. However, the activation of subcortical auditory centers above the accepted threshold was only observed in STA. STA (less SBN) showed higher PSCs and T-statistic values in all ROIs except planum temporale when compared to CAm. However, there was no difference in signal variability among the datasets. CONCLUSION: Our results suggest that SBN should be considered as a significant confounder in auditory-evoked functional MRI studies particularly in the activation of subcortical auditory centers, and that STA can be an effective imaging method for reducing the effect of SBN.

Language Lateralization in Patients with Temporal Lobe Epilepsy : A Comparison between Volumetric Analysis and the Wada Test

OBJECTIVE: Determining language lateralization is important for the presurgical evaluation of patients with medically intractable epilepsy. The Wada test has been the gold standard for lateralization of language dominance before epilepsy surgery. However, it is an invasive test with risk, and have some limitations. METHODS: We compared the volumetric analysis with Wada test, and studied the clinical potential of volumetric analysis to assess language laterality in large surgical candidates with temporal lobe epilepsy (TLE). To examine the efficacy of volumetric analysis to determine language lateralization during presurgical evaluation, we compared the volumetric analysis of the bilateral planum temporale with the results of Wada test in 59 patients with chronic intractable TLE (rTLE, n=32; lTLE, n=27) who underwent epilepsy surgery. We measured the gray matter volumes of planum temporale (PT) of each patients using the VoxelPlus2 program (Mevisys, Daejeon, Korea). RESULTS: Overall congruence of the volumetric analysis with the Wada test was 97.75% in rTLE patients and 81.5% in lTLE patients. There were more significant leftward asymmetry of the PT in rTLE patients than lTLE patients. In lTLE patients, relatively high proportion (37%) of the patients showed bilateral or right hemispheric language dominance. CONCLUSION: These results provide evidence that the volumetric analysis of the PT could be used as an alternatives in language lateralization. Also, the results of the Wada test suggested that there was considerable plasticity of language representation in the brains of patients with intractable TLE and it was associated with an earlier age of brain injury.

Surgical Experience of Transsphenoidal Supradiaphragmatic Intradural Approach to Presellar and Suprasellar Lesions

OBJECTIVE: In selected cases, the transsphenoidal approach(TSA) can be extended anteriorly to the tuberculum sellae, chiasmatic sulcus, and planum sphenoidale to obtain direct exposure of the suprasellar cisterns and its contents. We applied this modification of the TSA to various lesions of the presellar and suprasellar areas. We evaluate our clinical experience of this technique and review the related literature. METHODS: From 1999 to 2004, we used the transsphenoidal supradiaphragmatic intradural approachs(TSIAs) in 9 patients who had various lesions at the pre- and suprasellar regions. Concomitant presellar extension of the bone window was performed with the sublabial or transnasal transseptal transphenoidal techniques. After removal of the lesions, sellar or anterior cranial floor was repaired with silicone plate substitute. RESULTS: The TSIAs have been applied in the following cases: four tuberculum sellae meningiomas, two craniopharyngiomas, two Rathke's cleft cysts, and one non-functioning macroadenoma. The complications were one case of visual acuity decrease and one cerebrospinal fluid rhinorrhea. CONCLUSION: The TSIA is easily applicable through a minor modification of the standard TSA. It is suitable for removing lesions located in the presellar and suprasellar area adjacent to the pituitary stalk with minimal brain manipulation and decreased morbidity.

A Case of Type IIa Hyperlipoproteinemia with Xanthoma Striatum Palmare / 대한피부과학회지

We report a case of type IIa hyperlipoproteinemia associated with xanthoma planum and xanthoma striatum palmare. The laboratory findings showed increased serum cholesterol and triglyceride on the lipid profile, and an increased beta fraction on electrophoresis of lipoprotein, suggesting type IIa hyperlipoproteinemia. The biopsy specimens of orange yellow colored plaques on the left axillary area of a 54-year-old female showed characteristic findings of xanthoma.

Determinacion delos metabolitos del Diazepam en pacientes del Hospital Psiquiatrico de la C.N.S. de la ciudad de La Paz mediante espectrometria de Absorcion Ultravioleta y Enzimoinmuno Analisis Homogeneo / Determination of the metabolitos of the Diazepan in patients of the Psiquiatrico Hospital of the C.N.S. of the city of La Paz by means of espectrofotometria of Absorption Ultravioleta and Enzimoinmuno Analisis Homogeneo

Se ha realizado un estudio para demostrar que existe abuso en el consumo de Diazepam en pacientes del Hospital Psiquiátrico de la C.N.S de la ciudad de La Paz, mediante análisis de sus metabolitos (Oxazepam y Temazepam) en 100 muestras de orina con ayuda de patrones de referencia, a través de pruebas cuantitativas, cualitativas y de Microcristalización. Se tilizaron los métodos cuantitativos de Enzimoinmuno Análisis Homogéneo y Espectrofotometría de Absorción Ultravioleta con una longitud de onda de 225 nm; Se realizaron extracciones de los metabolitos del Diazepam con solventes orgánicos, cuya presencia fue confirmada mediante pruebas cualitativas: Bratton Marshall y Microcristalización. Se ha determinado que el Oxazepam se encuentra en mayor cantidad con respecto al Temazepam, aunque queda demostrado que algunas personas solamente eliminan Temazepam Esta concentración es determinada por interpolación de las absorbancias de las muestras con la curva patrón del Oxazepam y del Temazepam respectivamente. Existe abuso en un 51porciento de las muestras analizadas por la técnica de Espectrofotometría y en un 46porciento por Enzimoinmuno Análisis Homogéneo, resultado basado en la cuantificación del Oxazepam, que por ambos métodos es de 400 ng/m

A Case of Type IIb Hyperlipoproteinemia with Xanthoma Tuberosum, Xanthoma Planum and Xanthoma Striatum Palmare / 대한피부과학회지

We report a case of type IIb hyperlipoproteinemia associated with xanthoma tuberosum, xanthoma planum and xanthoma striatum. Serum lipoprotein electrophoresis showed increased beta fraction and pre-beta fraction, suggesting type IIb hyperlipoproteinemia.

Prognostic Factors in the Treatment of Anterior Communicating Artery Aneurysms

OBJECTIVE: The anterior communicating artery(ACoA) is known to be the most frequent location of intracranial aneurysms, but the complex arterial anatomy of the ACoA region makes this aneurysm among the most difficult one to treat. In the treatment of ACoA aneurysms, the direction of aneurysmal fundus is known to be very important in the surgical tactics. All ACoA aneurysms in our series were classified according to its direction, and analyzed the clinical features in order to investigate the prognostic factors influencing upon the surgical outcome. METHODS: The authors reviewed 236 cases of ruptured ACoA aneurysms that were operated from 1990 to 1997, were classified according to Pia's classification. RESULTS: The incidence rate of the ACoA aneurysm was 35.1%(236/672). Ventral group was more common than dorsal group, especially in ventro-caudal projection subgroup(36.0%). Poor preoperative clinical grade(Hunt-Hess grade IV and V) patients were more common in dorsal group(13.1%) than ventral group(2.6%). Rebleeding and intracerebral hematoma were more commonly seen in ventral group. However, vasospasm, hydrocephalus, hyponatremia, and intraventricular hemorrhage were observed more frequently in dorsal group. Worse outcome was more common in dorsal group than ventral group, especially in dorso-caudal projection subgroup. Also, poor outcome was identified in patients with intracerebral hematoma, intraventricular hemorrhage, hyponatremia, and hypertension, although statistically insignificant. In cases with the A1 dominancy, there was no difference in surgical outcome between the right and left side approach. The higher the aneurysmal neck from the planum sphenoidale, the worse outcome via pterional approach. CONCLUSION: It seems that the preoperative clinical grade, aneurysmal direction, and the height of aneurysmal neck, especially in the pterional approach, would be the major prognostic factors, and that intracerebral hematoma, intraventricular hemorrhage, hyponatremia, hydrocephalus and the intraoperative aneurysmal rupture would be the minor prognostic factors.

Surgical Approach to Large Anterior Basal Meningioma

Anterior basal meningiomas, which belong the olfactory groove and suprasellar meningioma account for 12 to 22% of all intracranial meningioma. Anterior cranial base meningioma are difficult to operate on because of their proximity to the important neurovascular structure. The authors report 25 cases of large meningiomas of the anterior. cranial base operated on during recent 5-year period. The tumor ranged from 3cm to 6.5cm in diameter. Fifteen tumors were located in the suprasellae(included tuberculum sellae, planum sphenoidale, diaphragma sellae,and anterior clinoid process), ten on olfactory groove. The mean age of 19 female and 6 male patient was 55years. The main clinical symptom were visual disturbance, anosmia, headache, and psychotic syndrome. Tumors were approached in 11 cases by pterional, in 9 cases by bifrontal, in 3 cases by transbasal, in 2 case by orbitozygomatic infratemporal and in 1 case by combined approach with tranabasal and orbitozygomatic infratemporal. Total tumor removal was performed in 80% of cases. Postoperative complication include accentuated psychotic syndrome in two cases, worsening of visual function in two, major vessel injury in one, infection in one, CSF rhinorrhea in one, and oculomotor palse in one. Postoperative death was in four(16%). Results at follow up of the 21 survivours were good in 17(68%), fair in 4(16%). Selection criteria for operative approach is discussed with review of pertinent literature.

A Case of Type IIa Hyperlipoproteinemia with Xanthoma Planum , Xanthoma Tendinosum and Xanthoma Tuberosum / 대한피부과학회지

We report a case of a 59 year-old female with hyperlipoproteinernia who had xanthoma tuberosum, xanthoma tendinosurn and xanthoma planum. Yellowish nodules appeared on the right elbow 26 years ago and the lesions gradually increased in size and spread to the elbow, hand, knee, foot and achilles tendon. Except for the skin lesion, she was normal on physical examination. The laboratory findings showed that the serum cholesterol, beta lipoprotein and total lipid were increased. The beta band was rnarkedly elevated on electrophoresis, which suggested type IIa hyperlipoproteinemia. Histopathological findings shc wed many aggregates of foam cells and foreign body giant cells were seen in the dermis.

Efecto de una beta lactama de 1.5 benzodiazepina sobre el sueño / Effect of a beta lactame of 1.5 benzodiacepine upon sleep

Existen numerosas substancias, de estructura química diversa que han sido utilizadas como inductoras de sueño. Sin embargo, debido a que producen efectos colaterales indeseables, constantemente son substituidas por fármacos de reciente creación. Este trabajo se llevó a cabo con el propósito de analizar el efecto sobre el sueño de una beta lactama de 1.5 benzodiazepina, administrada intraperitonealmente (0.9 mg/kg) a ratas wistar. Los resultados indican que esta substancia incrementa de manera significativa, tanto al sueño lento como al paradójico a expensas de la vigilia. La lactancia de la primera fase de sueño paradójico, se prolonga significativamente. Se concluye que esta substancia facilita la presencia de sueño, manifestándose su acción durante un período relativamente largo

Comparative study between the influence of laryngeal mask airway [LMA] and endo-tracheal intubation on intra-ocular pressure [IOP] during general anesthesia

Intra-ocular pressure was measured before and during general anesthesia using airway establishment in two groups of patients; laryngeal mask airway was used in one group and tracheal tube was used in the second one. Similar measurements were made during removal of either airway. There was a significant decrease in intra-ocular pressure [P < 0.001] using the laryngeal mask airway, both on placement and removal, than with the tracheal tube. There was significantly greater rise in heart rate using the tracheal tube [P < 0.001] probably due to an increased cardiovascular response. Systolic and diastolic blood pressure increased also with endotracheal intubation. The incidence of coughing noted in the first two minutes after removal of either airway was significantly reduced using the laryngeal mask airway [P < 0.001]. The laryngeal mask airway is recommended as an alternative to endotracheal intubation in routine and emergency intra-ocular surgery

Drug-excipients physicochemical in compatibility studies involving temazepam, medazepam and lorazepam

Differential scanning calorimetry [DSC] was mainly employed to predict the physicochemical incompatibility of 3 benzodiazepines, viz. temazepam, medazepam and lorazepam, with some common pharmaceutical excipients. The 3 drugs were found to be compatible with Avicel, Ac- Di-Sol, lactose, HPMC, dibasic calcium phosphate, starch, PVP and magnesium stearate. However, interactions of the benzodiazepines with PEG and stearic acid were detected and well confirmed utilizing TLC technique in addition to DSC

Visual Recovery with Surgical Managment of Suprasellar Meningioma

The visual outcome in consecutive 16 cases of suprasellar meningioma treated during the past 7 years was reivewed. Progressive visual loss, the most frequent initial complant(93.8%), occurred over a mean of 35.4 months, was often unilateral(6 patients) or bilateral but asymmetrical(6 patients) and was severe in 12 cases. All 16 patients hadvisual field abnormalities. There were 9 patients with tumors lager than 3cm in diameter and 7 patients with tumors less than 3cm in diameter. Four patients had tumors limited to the tuberculum sellae. The tumors extended from the tuberculum sellae onto the planum sphenoidale in four patients. into one optic canal in three patients, onto the diaphragm sellae in four patients and onto the medial sphenoid wing in one patient. Three tumors were incompletely resected(one involoving the medial sphenoid wing, one involving the diaphragm sellare and one involving the lanum sphenoidale). There was one operative death. Overall, 73% of patients had improved vision postoperatively, 27% remained unchanged. Tumor invoving the diaphragm sellae was associated with postoperative visual field deterioration. The visual outcome was affected by the severity of preoperative visual loss but not by the tumor size and duration of visual symptom. After a mean follow-up of 14.5 months, 15 patients are performing normal activities with improved vision.

Temazepam en el tratamiento de pacientes psiquiátricos con insomnio / Temazepam in the treatment of psychiatric patients with insomnia

Se administró temazepam en cápsulas de gelatina blanda para el tratamiento de 33 pacientes psiquiátricos ambulatorios que presentaban insomnio como síntoma importante. Desde la primera semana, los pacientes mostraron mejoría clínica significativa del insomnio en todas las escalas de evaluación utilizadas, pero la patología psiquiátrica de fondo permaneció básicamente inalterada. Se concluye que el temazepam en cápsulas de gelatina blanda es eficaz y seguro para el tratamiento del insomnio en pacientes con trastornos mentales.

Temazepam in soft gelatin capsules was administered to 33 psychiatric outpatients presenting with insomnia as an important symptom. Patients showed a significant clinical improvement from the first week of treatment regarding insomnia, but the basic psychopathological profile remained basically unchanged. It is concluded that tamazepam in soft gelatin capsules is clinically effective and safe for the treatment of insomnia in psychiatric outpatients.

A Case of the Tolosa-Hunt Syndrome

Painful ophthalmoplegia due to idiopathic granulomatous inflammation of the cavernous sinus or superior orbital fissure has been termed Tolosa-Hunt syndrome. We have experienced a case of Tolosa-Hunt syndrome in an 11 year old boy who has diagnosed with several clinical signs and symptoms such as severe ocular pain, headache, ptosis, proptosis, slight limitation of eyeball motion, nausea and vomiting, and the brain and orbital C-T scan which shows the right ethmoid and sphenoid sinusitis and inflammatory thickening of dura an the planum spenoidale.