No abstract available.
Free Tissue Flaps* ; Head* ; Neck*

No abstract available.
Pneumonia, Aspiration*

It is well known that after removal of one cerebral hemisphere all experimental animals, such as monkeys, dogs, cats and rabbits, circle in walking toward the side of the lesion with deviation of head and eyes to the same side for a while. However, the cause of circling gait following cerebral hemispherectomy is not clearly established. In this experiments physiological phenomena were observed in the dog and rabbit following unilateral or bilateral frontal or occipital lobectomies or partial ablations, parietal lobe lesions, section of unilateral optic nerve or optic tract. The results were as follows : 1) All experimental animals circled in walking toward the side of lesion with deviation of head and eyes to the same side for about one week following unilateral frontal lobectomy of partial ablation. There were transient motor weakness for a few days and pseudohemianopsia for about one week on the contralateral side. 2) Bilateral frontal lobectomies did not induce circling gait. But there was a lack of response to visual stimuli for a week. 3) Unilateral parietal lobe ablation did not induce circling gait nor pseudohemianopsia. 4) All experimental animals circled in walking toward the occipital lobectomized side for about 2 or 3 weeks, but deviation of head and eyes toward the side of lesion was not so evident as frontal lobectomized animals. The permanent neurological deficit was contralateral hemianopsia. 5) Bilateral occipital lobectomies was followed by a blindness in all experimental animals. They walked without a definite direction. 6) Section of unilateral optic nerve induced ipsilateral blindness. All experimental animals showed a tendency to walk toward the opposite side but did not circle in walking. 7) Section of unilateral optic tract induced permanent contralateral hemianopsia. All experimental animals circled in walking toward the side of the lesion of a while but deviation of the head was not evident. It is our conclusion that circling gait following cerebral hemispherectomy may be attributed by the permanent and transient hemianopsia and some neurological functional imbalance between the removed cerebral hemisphere, and the intact opposite cerebral hemisphere and brain stem.
Animals ; Blindness ; Brain Stem ; Cats ; Cerebrum ; Dogs ; Gait* ; Haplorhini ; Head ; Hemianopsia ; Hemispherectomy* ; Optic Nerve ; Parietal Lobe ; Physiological Phenomena ; Rabbits ; Visual Pathways ; Walking

Esophageal perforation is a rare disease, which require emergent diagnosis and therapeutic procedure. In this paper, we present one case of esophageal perforation by traction of toothbrush which was swallowed during pharyngeal irritation. After the toothbrush was inserted to stomach by gastroscope, gastrostomy was performed for removal of toothbrush and the esophageal perforation was repaired by operation.
Diagnosis ; Esophageal Perforation* ; Gastroscopes ; Gastrostomy ; Rare Diseases ; Stomach ; Traction

The entity of nonketotic hyperglycemic hyperosmolar coma(NHHC) was described as a severe and often fatal complication in 1957 (Sament and Schwartz), but since then it has been observed as a complication of various primary diseases, both in diabetic and nondiabetic patients. Various predisposing factors in its development include administration of prolonged mannitol, steroid, Dilantin, hyperosmolar tube feeding, dehydration, and diabetes. Combination of these factors are frequently used I the management of patients with neurological disorders and cerebral edema, consequently, a higher prevalence of NHHC might be expected in these patients. We have recently experienced a case of typical NHHC, in whom treated by mannitol, steroid, and Dilantin after emergency craniotomy for head injury.
Brain Edema ; Causality ; Coma* ; Craniocerebral Trauma ; Craniotomy ; Dehydration ; Emergencies ; Enteral Nutrition ; Humans ; Mannitol ; Nervous System Diseases ; Phenytoin ; Prevalence

The entity of nonketotic hyperglycemic hyperosmolar coma(NHHC) was described as a severe and often fatal complication in 1957 (Sament and Schwartz), but since then it has been observed as a complication of various primary diseases, both in diabetic and nondiabetic patients. Various predisposing factors in its development include administration of prolonged mannitol, steroid, Dilantin, hyperosmolar tube feeding, dehydration, and diabetes. Combination of these factors are frequently used I the management of patients with neurological disorders and cerebral edema, consequently, a higher prevalence of NHHC might be expected in these patients. We have recently experienced a case of typical NHHC, in whom treated by mannitol, steroid, and Dilantin after emergency craniotomy for head injury.
Brain Edema ; Causality ; Coma* ; Craniocerebral Trauma ; Craniotomy ; Dehydration ; Emergencies ; Enteral Nutrition ; Humans ; Mannitol ; Nervous System Diseases ; Phenytoin ; Prevalence

No abstract available.
Free Tissue Flaps* ; Mouth* ; Oropharynx* ; Rectus Abdominis*

Retrospective analysis of reoperation and complication was made for 186 patients with lumbar herniated disc. The results showed complication rate of 7%(13 cases) and reoperation rate of 10.2%(19 cases). The primary complications were infections(9 cases), technical errors(2 cases), and scores(2 cases). Rate of discitis was 1.6%(3 cases). The outcomes of reoperation resulted in excellent recovery of 16%(3 cases) and good recovery of 58%(11 cases). The most common intraoperative findings of reoperation were inadequate disectomy or missed disc fragments 31.6% or 6 cases;epidural fibrosis 26.3% or 5 cases;and new herniation at other level 15.8% or 3 cases. Excellent and good results could be achieved in patients operated within 1 month or more than 6 months after while the patients who underwent reoperation between 1 month and 6 months showed poor results. The delicate perioperative menagement and complete discectomy, adequate bleeding control and laminectomy were considered to be essential in reducing the chance of complication and reoperation.
Discitis ; Diskectomy ; Fibrosis ; Hemorrhage ; Humans ; Intervertebral Disc Displacement ; Laminectomy ; Reoperation* ; Retrospective Studies

A 44-year-old Korea woman was admitted to our department on March 5, 1973 with complaints of low back pain and radiating leg pain on the right side which have persisted for past 4 years. Howeve , the patient had a history of radiating leg pain on the left side about 8 years ago. Physical examination revealed paravertebral muscle spasm on both sides, limited backward bending, normal straight leg raising test, decreased ankle jerk on both sides and mild sensory change in the right L5 dermatome. Plain radiograms of the lumbar spine showed decreased normal lumbar lordosis and narrowing of L4-5 and L5-S1 interspaces. Myelogram demonstrated partial obstruction by marked bilateral indentation filling defect at L4-5 level, narrowing of dye column below that level, and abnormal root sleeves. Under the impression of herniated L4-5 intervertebral disc, total laminectomies of the 4th and 5th lumbar vertebrae were performed and found relatively hypertrophic limagentum flavum and bilaterally conjoined roots commonly originating from dural sac. Following decompression that would was closed routinely. Postoperatively all symptoms were improved.
Adult ; Animals ; Ankle ; Decompression ; Female ; Humans ; Intervertebral Disc ; Korea ; Laminectomy ; Leg ; Lordosis ; Low Back Pain ; Lumbar Vertebrae ; Physical Examination ; Spasm ; Spine

The purpose of this report is to evaluate the validity of the differential diagnosis of epidural and subdural hematomas on the basis of the varied angiographic findings and also to determine the correlation between hematoma shape and the injury-angiogram time interval in subdural hematomas. Conventional cerebral angiograms in 27 cases of epidural and 53 cases of subdural hematoma among surgically proven 155 intracranial hematoma patients, observed at the Department of (Neurosurgery) Seoul National University Hospital, during the past 5 years from August, 1968 to July 1973, were reviewed. 53 subdural hematomas were subdivided into three groups upon the injury-angiogram time interval as follows: acute; within 48 hours ---------- 28 cases, subacute; 3 days to 2 weeks ---------- 14 cases, chronic; over 2 weeks ---------- 11 cases. The results were as follows: 1. In epidural hematoma, the A-P view of angiogram showed typical lentiform (biconvex) avascular zone in 11 cases and crescent-shaped avascular zone in 3 cases among total 27 cases, whereas in acute to subacute subdural hematoma it showed crescent-shaped avascular zone in 15 cases but only 2 cases showed the lentiform appearance. 2. Lentiform avascular zone was also typically seen in 5 cases of chronic subdural hematoma, but it might be differentiated from that of epidural hematoma with more clear inner margin in the former. 3. In epidural hematoma, the following characteristic findings providing excellent diagnostic aids were also noted. 1) medial or inward displacement of middle meningeal artery ---------- 3 cases, 2) extravasation from middle meningeal artery into arterio-venous sheath-4 cases into hematoma ---------- 2 cases, 3) amputation of middle meningeal artery ---------- 2 cases, 4) extravasation from dural sinus ---------- 4 cases, 5) displacement of dural sinus from the inner table of skull ---------- 4 cases, 6) lentiform avascular zone only ---------- 4 cases. In 20 cases of epidural hematoma, one or more of the above findings could be found. Among them, extravasation from middle meningeal artery and dural sinus, amputation of middle meningeal artery and displacement of dural sinus were thought as pathognomonic. In subdural hematoma, none of the above findings was seen. 4. In subdural hematoma, hematoma shape (avascular zone) showed some tendency to change its from according to the injury-angiogram time interval: in the group ranging from 1 to 7 days and over a month, the crescent-shaped hematoma was predominant and in the group between these periods, lentiform hematoma and hematoma with flat inner margin were somewhat predominant. But there was no valid basis for predicting the age of subdural hematoma from its configuration at angiography. 5. There was no direct correlation between the shape of the hematoma and the patients' age. 6. Simple skull roentgenogram provided some aids in the differential diagnosis between epidural and chronic subdural hematoma. 20 cases out of 27 epidural hematomas showed linear or depressed skull fracture, whereas only 1 out of 11 cases of chronic subdural hematoma showed linear skull fracture.
Amputation ; Angiography ; Diagnosis, Differential ; Hematoma ; Hematoma, Subdural* ; Hematoma, Subdural, Chronic ; Humans ; Meningeal Arteries ; Seoul ; Skull ; Skull Fracture, Depressed ; Skull Fractures