A S Lieu

Kaohsiung Medical University, Kao-hsiung-shih, Kaohsiung, Taiwan

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Publications (23)19.88 Total impact

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    ABSTRACT: BackgroundDelayed cerebral vasospasm is one of the major causes of mortality and neurological morbidity in patients afflicted with aneurysmal subarachnoid haemorrhage (SAH). A burgeoning body of evidence suggests that endothelin (ET) may be critical in the pathophysiology of cerebral vasospasm after SAH. Administration of estrogen promotes vasodilation in humans as well as in experimental animals, in part by decreasing the production of ET-1. This study was designed to evaluate the influence of 17β-estradiol (E2) on the production of ET-1 and cerebrovasospasm after SAH. MethodExperimental SAH was induced in male Sprague-Dawley rats by injecting 0.3 ml autogenous blood into the cisterna magna on day 0 and day 2. A 30-mm Silastic® tube filled with E2 in corn oil (0.3mg/ml) was subcutaneously implanted in the rats just before induction of SAH. The degree of vasospasm was determined by averaging the cross sectional areas of basilar artery seven days after first SAH. Plasma samples collected before sacrifice were assayed for ET-1. FindingsE2-treatment significantly attenuated SAH-induced vasospasm. ET-1 concentrations were significantly increased in SAH only and SAH plus vehicle groups and were not significantly different in SAH plus E2 and E2 only groups when compared to the controls. There was a significant correlation between the cross sectional areas of basilar artery and ET-1 levels (p<0.001). ConclusionsOur finding further confirmed the anti-spastic effect of E2 after SAH. The mechanism of E2 on attenuation of SAH-induced vasospasm may partially be due to decreasing ET-1 production.
    12/2007: pages 135-138;
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    ABSTRACT: BackgroundRecent studies showed that the expressions of endothelial nitric oxide synthase (eNOS) and inducible nitric oxide synthase (iNOS) after SAH were upregulated and downregulated after subarachnoid haemorrhage (SAH), respectively, implying that NOS may play a crucial role in SAH-induced vasospasm. Adenosine is a potent vasodilator and an important modulator of cardiac function. Further studies demonstrated that adenosine A1 receptors decrease the production of NO by arterial endothelial cells. The present study evaluates the effect and possible mechanism of an adenosine A1 agonist, N6-cyclopentyladenosine (CPA), on SAH-induced vasospasm in a rodent model of SAH. MethodOne hundred and twelve rats were evenly divided into the following four groups: 1) control (no SAH); 2) SAH only; 3) SAH plus vehicle; 4) SAH plus CPA (0.003mg/kg). The degree of vasospasm was determined by averaging the cross sectional areas of the basilar artery 2 days after SAH. Expressions of eNOS and iNOS in basilar artery were also evaluated. FindingsThere were no significant differences among the control and treated groups in physiological parameters recorded. CPA-treatment significantly attenuated SAH-induced vasospasm and reversed the down-regulation of eNOS-mRNA and protein after SAH. However, the post SAH upregulation of iNOS-mRNA and proteins in the basilar artery were not significantly diminished by CPA-treatment. ConclusionsCPA could partially prevent SAH-induced vasospasm and preserved the downregulation of eNOS expression after SAH. However, the incomplete anti-spastic effect of CPA may be related to the lack of inhibition of iNOS expression after SAH. Our study further confirmed the role of iNOS and eNOS in the mediating of vasospasm after SAH.
    12/2007: pages 149-153;
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    ABSTRACT: BACKGROUND: Adenosine is a potent vasodilator and an important modulator of cardiovascular function. It has been postulated that nitric oxide (NO) is involved in adenosine-induced vasodilation. This study was designed to examine the effect of an adenosine A1 agonist, N6-cyclopentyladenosine (CPA), in the prevention of subarachnoid haemorrhage (SAH)-induced vasospasm. Method. Experimental SAH was induced in Sprague-Dawley rats by injecting 0.3 mL autogenous blood into the cisterna magna. Intraperitoneal injections of CPA (0.003 mg/kg), or vehicle were administered 5 min and 24 hours after induction of SAH. The degree of vasospasm was determined by averaging the cross sectional areas of the basilar artery 2 days after SAH. Expressions of endothelial nitric oxide synthase (eNOS) and inducible nitric oxide synthase (iNOS) in basilar artery were evaluated. Findings. There were no significant differences among the control and treated groups in physiological parameters recorded before sacrifice. When compared with animals in the control group, cross-sectional area of basilar arteries areas in the SAH only, SAH plus vehicle and SAH plus CPA groups were reduced by 19% (p < 0.01), 22% (p < 0.01), and 9% (p = 0.133), respectively. The cross-sectional areas of the CPA-treated group differed significantly from those of the SAH only and SAH plus vehicle group (p < 0.05). Induction of iNOS-mRNA and protein in basilar artery by SAH was not significantly diminished by CPA. The SAH-induced suppression of eNOS-mRNA and protein were relieved by CPA treatment. Conclusions. This is the first evidence to show an adenosine A1 receptor agonist is effective in partially preventing SAH-induced vasospasm without significant cardiovascular complications. The mechanisms of adenosine A1 receptor agonists in attenuating SAH-induced vasospasm may be, in part, related to preserve the normal eNOS expression after SAH. Inability in reversing the increased iNOS expression after SAH may lead to the incomplete anti-spastic effect of CPA.
    Acta Neurochirurgica 09/2006; 148(8):873-9; discussion 879. · 1.55 Impact Factor
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    ABSTRACT: Simultaneous occurrence of multiple intracerebral haemorrhages (ICHs) in different arterial territories is a rare clinical event which has been reported to be associated with cerebral amyloid angiopathy, venous sinus thrombosis, coagulopathy, vasculitis, haemorrhagic transformation of cerebral infarcts and multiple intracranial pathologies such as vascular anomalies or tumours. Although hypertension is the most common etiological factor for the development of spontaneous single intracerebral bleeding, its role in simultaneous multiple ICHs is not clear. The authors have reviewed all patients with non-traumatic ICH admitted to Kaohsiung Medical University Hospital from 1993 to 2002. Ten hypertensive patients with simultaneous multiple ICHs were found. For the purpose of comparison, another 600 cases with solitary hypertensive ICH were also reviewed as a control group. Computerized tomographic scans and medical records concerning patients' histories, clinical presentations, locations of haematomas, associated risk factors, and outcome were analyzed. The mean age and sex distribution were similar in both patient groups. Bilateral putaminal or thalamic haemorrhages were the most common combinations of simultaneous bleedings. As for the individual location of haematoma, there was a strong preponderance for the supratentorial space with the thalamus being the most preferable site. The duration of hypertension was longer and the percentage of previous stroke was higher in patients with multiple ICHs. Other associated risk factors were similar in both groups except for higher incidence of hypercholesterolemia in multiple ICHs group. Patients with simultaneous multiple ICHs had a much worse outcome compared to those with solitary ICH. As with solitary ICH, hypertension is still the most important etiological factor for simultaneous multiple ICHs. The widespread and prolonged degeneration of intracerebral arterioles predispose patients to the development of multiple ICHs, which could be justified by the longer history of hypertension and higher incidence of former strokes. Only hypercholesterolemia was identified to be significantly associated with this unusual brain event in our study. The mechanism underlying the development of simultaneous multiple ICHs is not clear although structural and haemodynamic changes of first haemorrhage may be responsible for the second one. Poorer outcome in patients with multiple ICHs can be explained by the concomitant destruction of crossing and non-crossing fiber tracts and bilateral diaschisis phenomenon.
    Acta Neurochirurgica 05/2005; 147(4):393-9; discussion 399. · 1.55 Impact Factor
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    ABSTRACT: Recent studies have demonstrated that Rac is a regulator of cell morphology and growth. Rac1 gene appears to have involvement in tumorigenesis and metastatic potential. In our previous study of rac1 gene in 45 human brain tumors, rac1 pseudogene was found. The rac1 pseudogene is an intronless pseudogene and has a similarity of 86% with rac1 nucleotide sequence. The rac1 pseudogene contains 579 nucleotides and only 46 amino acids can be translated. Little is known about the expression of rac1 pseudogene in human tissues or tumors. The expression of rac1 gene and rac1 pseudogene in different human tissues and brain tumors was investigated by the use of reverse transcriptase-polymerase chain reaction and Northern blotting. The rac1 gene is apparently expressed in these 8 human tissues. The rac1 pseudogene is also apparently expressed in human tissues except for brain tissue. The overexpression of rac1 gene in brain tumors was 8% (2/25) and the overexpression of rac1 pseudogene was 76.9% (20/26). Only two astrocytomas had overexpression of rac1 gene, compared with normal brain tissues. The overexpression of rac1 pseudogene was 6 of 9 in meningiomas, 7 of 9 in astrocytomas, and 7 of 8 in pituitary adenomas. High frequency of overexpression of rac1 pseudogene was detected in the human brain tumors when compared with that expressed in the normal brain tissues. Our study suggested that the rac1 pseudogene may play an important role of the tumorigenesis of brain.
    European Surgical Research 01/2005; 37(2):100-4. · 0.75 Impact Factor
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    ABSTRACT: Massive intracerebral air embolism is a rare pathologic state and never in association with meningitis and lumbar spondylitis. To the best of our knowledge, our presented case is the first of a massive intracerebral air embolism associated with meningitis and lumbar spondylitis of Klebsiella pneumonia. A 55-year-old man presented with a high fever and low back pain. Blood culture showed Klebsiella pneumonia. Lumbar computed tomography (CT) revealed discitis at L1-2 and L2-3 levels and paraspinal abscess in which air was found. Despite management with antibiotics, patient's consciousness deteriorated, and brain CT revealed diffuse intravenous air embolism and severe brain swelling. Cerebrospinal fluid (CSF) examination demonstrated bacterial meningitis, and the CSF culture showed Klebsiella pneumonia. Later, septic shock occurred and patient expired. Intracerebral air embolism can occur in the Klebsiella pneumonia meningitis that resulted from lumbar spondylitis and sepsis.
    Surgical Neurology 11/2004; 62(4):362-5; discussion 365. · 1.67 Impact Factor
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    ABSTRACT: Rac1 is a member of the Ras superfamily of small GTPase and plays a fundamental role in cytoskeleton reorganization, regulation of gene expression and cell proliferation, and cellular transformation. Though recent studies point to an involvement of rac1 in tumorigenesis, little is known about the alteration of rac1 gene in human brain tumours. Reverse transcription-polymerase chain reaction (RT-PCR), TA cloning, and DNA sequencing were performed to detect rac1 gene mutations in the surgical specimens of 45 human brain tumours. Twelve of 45 cases had base changes in the rac1 gene. The frequency of rac1 alterations was seven of 18 meningiomas, three of 14 astrocytomas, one of seven pituitary adenomas, and one of four metastatic brain tumours. No mutation was detected in acoustic neurilemomas. The subtypes of seven meningiomas include three meningotheliomatous, two atypical, one transitional and one angioblastic meningioma. Three astrocytomas had rac1 gene mutation, including one grade II, one grade III, and one grade IV astrocytoma. All of single base changes were transitions, five of them being T to C transitions. Sites of rac1 mutation were found in codons 34, 41 (two cases), 42 (two cases), 43, 44, 46 and 58. These mutations are mainly localized in the putative effector-domain of rac1 gene and may enhance the activity of rac1, which increases the survival of brain tumours. Our results suggest that rac1 gene may play a role in some brain tumours of divergent histogenesis and that the alterations of rac1 gene may contribute to tumorigenesis and/or metastasis.
    European Journal of Surgical Oncology 03/2004; 30(1):68-72. · 2.61 Impact Factor
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    ABSTRACT: By the use of conditional probabilities of survival, we studied the yearly survival rates for individual tumor survivors. Conditional survival rate was estimated in 114 consecutive patients with anaplastic astrocytoma or glioblastoma multiforme. Conditional probabilities of surviving some years given survival to a specific period of time after craniotomy and 95% confidence intervals were calculated in the individual tumor survivors. The estimated median survival was 30 months for 45 patients with anaplastic astrocytoma and 12 months for 69 patients with glioblastoma multiforme. The conditional probabilities of surviving next one year given survival to 1 year, 2 years, 3 years, 4 years, or 5 years after craniotomy for anaplastic astrocytoma were 86.2%, 75.0%, 85.9%, 77.8%, or 85.7%, respectively; for glioblastoma multiforme 64.8%, 58.7%, 85.7%, 80.0%, or 75.0%, respectively. The conditional probability of surviving to 5 years given survival to 2 years after craniotomy for anaplastic astrocytoma, i.e., surviving an additional 3 years, was 50.1%, which was better than observed 5-year survival rate (28.6%); for glioblastoma multiforme it was 40.2%, which also was better than observed 5-year survival rate (12.4%). The conditional probability of survival was a good method to clinically predict yearly survival rate for individual tumor survivors. In addition, the method can estimate the probabilities of surviving next some years given survival to a specific period of time after craniotomy. It also showed a more encouraging result than observed survival rate in patients with supratentorial malignant astrocytomas.
    Surgical Neurology 12/2003; 60(5):402-6; discussion 406. · 1.67 Impact Factor
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    ABSTRACT: The improved diagnostic capacity of computed tomography (CT) may have resulted in improved detection of intracranial tumors. We were interested to know whether the frequency of intracranial tumors has changed after the introduction of CT in Taiwan. The relative incidences of intracranial tumors in Taiwan were analyzed from the hospital based data. Our data showed that meningiomas were the most encountered intracranial tumors. Neuroepithelial tumors in our series (in the post-CT era) (23.9%) were apparently lower than those found in the pre-CT era (36.0%). However, the relative incidences of meningiomas and pituitary adenomas after the use of CT (24.2%, 21.1%, respectively) were much higher than those found before the use of CT (14.5%, 7.7%, respectively). Our data suggest that the increased incidence for benign tumors and the decreased incidence for malignant tumors may have resulted from the improved diagnostic capacity of CT, which reduces the number of undetected tumor cases.
    The Kaohsiung journal of medical sciences 08/2000; 16(7):345-50. · 0.50 Impact Factor
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    ABSTRACT: The difference of prognosis in patients with the same WHO grade of astrocytic tumors suggests that such tumors comprise a heterogeneous group in biological behavior. The correlation between p53 immunoreactivity and prognosis has often been reported but remains controversial. From the perspective of clonal expansion of p53 immunopositive cells, the distribution patterns of p53 immunoreactivity can be divided into four types: negative, scattered, focally clustered, and diffusely clustered. The survival rate was evaluated by classifying the p53 immunoreactivity into two groups: the significantly immunopositive patterns (focally and diffusely clustered types) and the significantly immunonegative patterns (negative and scattered types). The survival analysis showed a highly significant difference between these two patterns within the same WHO grade of astrocytic tumors (p = 0.0185). Our studies demonstrate that the distribution patterns of p53 immunoreactivity, which reflect the trends of clonal expansion of p53 immunopositive cells, are significantly valuable in predicting the prognosis of patients with the same WHO grade of astrocytic tumors.
    The Kaohsiung journal of medical sciences 07/2000; 16(6):279-84. · 0.50 Impact Factor
  • A S Lieu, S L Howng
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    ABSTRACT: In a retrospective study of a consecutive series of 222 surgically treated meningiomas, it was found that 26.6% of the patients presented epilepsy as their initial symptom. In this group, surgical excision of the intracranial meningiomas stopped the epilepsy in about 62.7% of the patients. But approximately one-fifth of the patients with intracranial meningiomas and no history of preoperative epilepsy developed new onset postoperative seizures. Of the patients with early onset of postoperative epilepsy, epilepsy appeared in 66.7% within first 48 h after surgery. Of the patients with postoperative epilepsy, 71.2% were seizure-free following 1 year of anticonvulsant therapy. Regarding preoperative existing factors, intracranial meningiomas located at supratentorium, convexity, and with evidence of or severe peritumoral edema significantly contributed to preoperative epilepsy. And in patients with preoperative epilepsy, those tumors with evidence of or severe perifocal edema and cerebral edema at the operative site were significantly more likely to suffer from postoperative epilepsy.
    Epilepsy Research 02/2000; 38(1):45-52. · 2.24 Impact Factor
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    ABSTRACT: Various types of brain tumors may cause hemorrhage. The purpose of the study was to examine the clinical relevance of tumor hemorrhage and the hemorrhagic mechanism from the pathologic viewpoint. We retrospectively reviewed 761 consecutive brain tumor cases according to clinical, operative, and pathologic records. Pituitary adenomas and recurrent tumors were excluded. Twenty-seven patients (17 men and 10 women, mean age, 50 years) with brain tumor hemorrhage were identified, resulting in an incidence of 3.5%. In 632 cases of primary brain tumors, there were 15 cases with hemorrhage, resulting in an incidence of 2.4%. There were 12 cases of brain tumor hemorrhage in 129 patients with metastatic tumors, for an incidence of 9.3% Among hemorrhagic cases, 63.0% of patients presented with acute onset of clinical deterioration. In 72.7% of gliomas with hemorrhage, hematoma appeared within the tumor, and 75% of metastatic brain tumors with hemorrhage were intracerebral hemorrhages around the borders of the tumors. The highest hemorrhage rate for primary brain tumors occurred in pilocytic astrocytomas, while the highest hemorrhage rates in secondary tumors occurred in metastatic thyroid papillary carcinomas and hepatocellular carcinomas. In our pathology study, increasing intratumor vascularization with dilated, thin-walled vessels and tumor necrosis were the most important mechanisms of hemorrhage.
    Journal of the Formosan Medical Association 06/1999; 98(5):365-7. · 1.00 Impact Factor
  • C K Lin, A S Lieu, S L Howng
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    ABSTRACT: Papillary thyroid carcinoma has a low incidence of distant metastases. Brain metastasis is extremely rare with a frequency of 0.1-1.3%. In the present series, the rate was 1.5%, only two cases had cerebral metastases in 136 patients with papillary thyroid carcinoma from January 1988 to April 1998. Cerebellar metastasis is even rarer, and solitary cerebellar metastasis has not been reported to the best of our knowledge. Two cases of papillary thyroid carcinoma with cerebellar metastases presenting as tumor hemorrhage are reported. In one patient, the lesion was in the bilateral cerebellar hemispheres with obstructive hydrocephalus. After operation, the patient had an uneventful course with recovery of her consciousness. In the other, the solitary lesion was in the left cerebellar hemisphere without obstructive hydrocephalus. After surgical treatment, the patient had a smooth course with resolution of his neurological deficit. It shows the importance of surgery in the management of a hemorrhagic cerebellar metastasis from papillary thyroid carcinoma, not only in reducing acute aggravating cerebral symptoms, but also in prolonging survival time.
    The Kaohsiung journal of medical sciences 05/1999; 15(4):234-8. · 0.50 Impact Factor
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    ABSTRACT: Multiple spinal meningiomas are relatively rare and account for only 2 to 3.5% of all spinal meningiomas. A case of multiple meningiomas of the thoracic (T) spine was reported. This 77-year-old woman was admitted with progressive motor weakness and sensation disturbance in both legs for 4 months. Neurological findings on admission revealed paraparesis, hyperesthesia, and hypalgesia below the dermatome of T10 level and hyporeflexia of both ankles. Urinary and stool incontinence were also noted. Magnetic resonance imaging (MRI) documented two intradural extramedullary lesions with different intensity at the T9 and T12 levels. Both tumors were totally resected. Histopathologic examination showed all psammomatous meningiomas with more or less psammoma bodies. There were no any manifestations of von Recklinghausen's disease in this patient. MRI is a choice of diagnostic tool to detect spinal tumors, especially multiple spinal meningiomas. Different intensities in MRI may infer different components of meningiomas. Follow-up study after operation three months later disclosed she could walk very well.
    The Kaohsiung journal of medical sciences 04/1999; 15(3):182-6. · 0.50 Impact Factor
  • A S Lieu, S L Howng
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    ABSTRACT: Intracranial meningioma with hemorrhage is not frequently reported. The available articles in the literature regarding intracranial meningioma with hemorrhage are reviewed to the best of our knowledge, and the sixty-one cases have so far been reported. The authors report three cases. In about half of the 64 cases including ours, the tumor was located at the convexity, and histologically classified as meningotheliomatous meningioma. The site of hemorrhage was mainly in the subarachnoid space. In most cases the onset of presenting signs and symptoms was acute. The mean age at the time of tumor hemorrhage was 51 years. There was no sex difference statistically. The importance of the diagnosis of associated hemorrhage and subsequent surgical intervention is emphasized.
    The Kaohsiung journal of medical sciences 03/1999; 15(2):69-74. · 0.50 Impact Factor
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    ABSTRACT: In patients with severe head injury, hypothalamohypophyseal impairment with subsequent hormone abnormalities has been well documented. Stress ulcer is another commonly encountered problem in such patients. However, little has been reported in the literature about the alterations of pituitary hormones in acute head-injured patients with stress ulcer. Forty consecutive male patients with head injury were studied. The other criteria for eligibility were: 1) Glasgow coma scale 4 to 10; 2) within 24 hours after head injury; 3) not in shock or sepsis; and 4) no past history of peptic ulcer. Stress ulcer was confirmed by endoscopic examination. The basal serum levels of pituitary hormones were measured and the response of pituitary to the provocative testing with thyrotropin-releasing hormone and gonadotropin-releasing hormone was also evaluated. Twenty-seven (67.5%) of forty patients showed evidence of stress ulcer by endoscope. In the patients without stress ulcer, the basal serum levels of thyroid-stimulating hormone (TSH), prolactin (PRL), growth hormone (GH), luetinizing hormone (LH), and follicle-stimulating hormone (FSH) were found to be within normal range. However, the basal levels of PRL in the patients with stress ulcer were abnormally elevated and significantly higher than those in the patients without stress ulcer (p < 0.001). The basal levels of TSH and GH were significantly lower in the patients with stress ulcer than those without stress ulcer (p < 0.001). In the patients with stress ulcer, significant increases (p < 0.001) of serum levels of TSH, PRL, LH and FSH after thyrotropin-releasing hormone (TRH) and gonadotropin-releasing hormone (GnRH) provocation were identified. Hypothalamohypophyseal dysfunction and stress ulcer may occur in severely head-injured patients. In patients with stress ulcer, the abnormalities of pituitary hormones and provocative response of the pituitary with TRH and GnRH revealed normal pituitary function with hypothalamic insufficiency. Our study suggested that stress ulcers in acute head-injured patients were associated with hypothalamic damage.
    The Kaohsiung journal of medical sciences 10/1998; 14(9):554-60. · 0.50 Impact Factor
  • A S Lieu, S L Howng
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    ABSTRACT: We studied retrospectively a series of 36 patients who underwent the surgical removal of an intracranial meningioma between April, 1982 and April, 1997. Their ages ranged from 65 to 78 years (mean age: 70.2 years); 27 patients were female, and 9 were male. Thirteen (36.1%) were located at the convexity, 6(16.7%) at the falx/parasagittal area, and 16(44.4%) at the skull base, tentorium, and posterior fossa. Operative mortality was 11.1%, but the rate was increased to 16.7% at 3 months follow-up. It was significantly higher than the younger age group (p < 0.05). Postoperative complications were manifested in 17 of 36 patients (47.2%). The postoperative morbidity rate was significantly higher in patients with class III of ASA physical status (American Society of Anesthesiology classification). Twenty-three (63.9%) patients had good postoperative outcome (Karnofsky rating scale of 80 or more). Various prognostic factors were evaluated, the most important of which were preoperative general health condition and neurological status. Age per se is not a contraindication to the surgery of intracranial meningiomas in the elderly patient.
    The Kaohsiung journal of medical sciences 08/1998; 14(8):498-503. · 0.50 Impact Factor
  • A S Lieu, S L Howng
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    ABSTRACT: A retrospective review of 42 patients who had undergone anterior cervical discectomy without bone fusion using an operating microscope was performed to analyze the results in patients who had a diagnosis of soft disc herniation or spondylosis between 1988 and 1994. There were 29 males and 13 females (age range, 30 to 77 years). Discectomy of single level was performed in 28 cases and at two levels in 14 cases. A soft disc lesion was found in 15 patients and a hard disc in 27 patients. A good result was achieved in 93% of patients with soft disc and 59% of those with hard disc lesion. Twenty-six patients underwent radiological evaluation after the surgical intervention. Collapse of disc space was observed in 43% of these and vertebral fusion in 28% of these. In analysis of the influencing factors, it can be seen the pattern of the onset of symptoms significantly influences the surgical result. A comparison of our results at follow-up with published series in which the anterior cervical discectomy without bone fusion was used, shows no significant differences. Therefore, we recommend the anterior discectomy without fusion as the treatment of choice for soft disc lesion.
    The Kaohsiung journal of medical sciences 05/1998; 14(4):212-6. · 0.50 Impact Factor
  • A S Lieu, S L Howng
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    ABSTRACT: Neurinomas of trigeminal nerve are rare intracranial tumors and spontaneous intratumoral hemorrhage occurred exceedingly rarely in them. Herein, we report one case of trigeminal neurinoma presenting spontaneous intratumoral hemorrhage. Presenting symptoms were headache, lethargy and vomiting of sudden onset. Unenhanced computed tomography scans showed a high density mass in the left cerebellopontine angle cistern. On magnetic resonance images, they revealed hyperintensity on both T1- and T2-weighted images. A left retromastoid suboccipital craniectomy was performed and nearly total tumor removal was achieved. Histologically, increased vascularity, dilated vessels and hemosiderin were observed in the specimen. Tumor size, hypervascularity and vascular change are important factors for hemorrhage.
    The Kaohsiung journal of medical sciences 04/1998; 14(3):181-5. · 0.50 Impact Factor
  • A S Lieu, Z M Sun, S L Howng
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    ABSTRACT: A skull bone fracture was detected in a neonate immediately after filling down. Bilateral epidural hematoma was diagnosed by plain CT scans. Craniotomy and evacuation of hematoma was done when the neurological signs were worsening. Epidural hematoma was documented communicating, via the fracture site with the overlying cephalohematoma. Good recovery was achieved following the operation. The longterm follow-up of this patient is mandatory.
    The Kaohsiung journal of medical sciences 08/1996; 12(7):434-6. · 0.50 Impact Factor