A percutaneous endoscopic gastrostomy tube was inserted in a 59-year-old man who was undergoing craniotomy due to subarachnoid hemorrhage, because it was estimated that he could not have oral intake for a period of 4 weeks. Seventy days after the insertion, the percutaneous endoscopic gastrostomy tube was replaced because of its accidental removal by the patient. Two months after the second insertion, the tube had to be replaced due to nonfunctioning. The buried bumper syndrome was diagnosed on physical examination, and was confirmed by endoscopy, with findings of mucosal dimpling and nonvisualization of the internal bumper. The tube was removed by external traction without any abdominal incision, and the same site was used for the insertion of a replacement tube over a guidewire. The patient remained symptom-free during 18 months of follow-up.
These findings suggest a relationship between recurrence of craniopharyngiomas and angiogenesis. New treatment modalities with selective PDGFR-alpha blockers may represent a novel and effective therapeutic option for the treatment of craniopharyngiomas.
Although the healing time is longer, the open technique is more advantageous with respect to shorter operating time, less discomfort in the early postoperative period, and lower morbidity rate.
This study, for the first time, provides experimental semiquantitative data to compare the angiogenic potentials of embolized and gamma knife-treated AVM tissues. Embolization may increase angiogenic activity, and gamma knife radiosurgery may decrease it when compared with activity in previously untreated AVMs. These data can be useful to understand why recurrence of AVMs after angiographically demonstrated endovascular occlusion is common but after gamma knife occlusion is rare.
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