Chemonucleolysis with chymopapain has been shown to be an effective alternative to surgery for the treatment of Sciatica secondary to lumbar disc herniation after failure of conservative treatment. 92 lumbar herniated disc patients had been treated by chemonucleolysis in Eul Ji General Hospital during 3 years from March 1988 to 1991 and were evaluated clinically. 1) Of 92 patients, 60 patients(65%) were between 20 and 30 years old age group and male was predominent. 2) The lesion was the most common in L4-5space(52 patients, 56.6%). 3) The results were better in the younger group and the more limited straight leg raising group. 4) The excellent and good results were obtained in 82.6%. 5) In noncompensation cases, 69 patients(88.0%) had marked improvement, but in compensation cases, 7 patients(50%) had marked improvement. 6) In conclusion, above finding suggest that chemonucleolysis is a safe and effective nonsurgical method for treatment of herniated lumbar disc before surgical intervention.
Adult ; Chymopapain ; Compensation and Redress ; Hospitals, General ; Humans ; Intervertebral Disc Chemolysis ; Intervertebral Disc Displacement ; Leg ; Male ; Sciatica ; Spine*

CHAP syndorme consists of choreoathetosis, orofacial dyskinesia, affective change, hypotonia, and pseudobulbar signs. CHAP syndrome was firstly des- cribed with onset 1 to 7 days after induced profound hypothermia and complete circulatory arrest for con- genital heart lesion repair. Since then, only a few cases have been reported until now. Case We report a patient who demonstrated all of the elements of the CHAP syndrome in severe cachexic state. Brain SPECT(99mTC-ECD) shows decreased perfusion in left fronto-parieto-temporal lobe. Comments The pathogenesis of CHAP syndrome is obscure. However our case led us to suggest that more essential component pre- disposing to the CHAP syndrome is hypoxia rather than hypothermia. Furthermore, it seems to be related with circulatory insufficiency in extrapyramidal nervous systems.
Anoxia ; Brain ; Heart ; Humans ; Hypothermia ; Movement Disorders ; Muscle Hypotonia ; Nervous System ; Perfusion

A case of neurofibroma in cauda equina which had been misdiagnosed as lumbar herniated nucleus puposus 6 years ago in other hospital was presented. In January 1984, the patient had taken the operation of total laminectomy and disckectomy at L2~3 level and symtoms were relieved thereafter. However severe low back pain and right sciatic radiation recurred in April 1990. In this hospital, lumbar myelography and spin C-T examination revealed the intradural extramedullary mass shadow at L2~3 level. On surgery, the dumbbell-shaped neurofibroma at the site was removed.
Cauda Equina* ; Humans ; Laminectomy ; Low Back Pain ; Myelography ; Neurofibroma

PURPOSE: The aim of this study is to correlate the non-characteristic dual-phase CT imaging findings of hepato-cellular carcinoma with the observed characteristics of surgical specimens. MATERIALS AND METHODS: We studied four cases in which homogeneous low attenuation was observed during the arterial and delayed phases of dynamic CT scanning and in which hepatocellular carcinoma with coagulation necrosis above 95% was pathologically confirmed. We compared the findings of dual phase CT scanning, ultrasonography, angiography and Lipiodol CT scanning with the observed features of surgical specimens. RESULTS: Nodules were 30-50 (mean, 41) mm in size, and were round in three cases and oval in one. In all four cases, a low density lesion was observed during the arterial and delayed phases of dual-phase CT scanning. Ultrasonography demonstrated internal echo and the presence of a hypoechoic halo, implying that in all cases a capsule was present. At angiography and LiCT, minimal peripheral and central tumor staining or lipiodol up-take was observed. In all surgical specimens a complete capsule was visible, and histologic structures were mainly of the trabecular type, Edmondson grade II or III was recorded, and the mass had undergone extensive coagulation necrosis (above 95%). CONCLUSION: In cirrhotic liver which is hepatitis B-antigen positive, clear sonographic findings of internal echo and a capsule, rather than a simple cyst, indicate the possibility of hepatocellular carcinoma with extensive coagulation necrosis. This is so even if the arterial and delayed phases of dual-phase CT scanning indicate the presence of a low-density lesion, and in such cases additional work-up is therefore required.
Angiography ; Carcinoma, Hepatocellular* ; Diagnosis* ; Ethiodized Oil ; Hepatitis ; Liver ; Liver Neoplasms ; Necrosis* ; Tomography, X-Ray Computed ; Ultrasonography

A prospective study was initiated to compare maternal serum concentration of CA-125 during the first trimester of normal and abnormal pregnancies. Serum specimens were obtained from 87 women with a normal intrauterine pregnancy and 47 women with abnormal pregnancies which were ended in spontaneo abortion or pathologically confirmed to be missed abortion. In normal pregnancies, the mean serum CA-125 concentrations were increased significantly from amenorhea 6 weeks (139.838.7 IU/ml), and were higher statistically than the values tested in the same weeks of abnormal pregnancies. In abnormal pregnancies serum CA-125 concentations were relatively lower than those of normal pregnancies. But these differences were not statistically significant except the values tested in amenorhea 6weeks. So serum levels of CA-125 may not be proved useful in monitoring of early pregnancies outcome.
Abortion, Missed ; Female ; Humans ; Pregnancy ; Pregnancy Trimester, First* ; Pregnancy* ; Prospective Studies

A retrospective study was conducted to evaluate the clinical outcomes of midtrimester emergency cervical cerclage in patients with painless cervical dilatation with/without prolapsed amniotic sac, including cases of no previous history of cervical incompetence. 10 patients including 1 twin pregnancy were teviewed for study, All had received emergency cervical cerclage with Macdonald operation or Shirodka operation at 18 to 31 weeksgestation. The procedures were carried out without serious complication except for one patient who had received re-operation 3 days after Macdonald operation because of re-protrusion of amniotic sae. The mean procedure to delivery internal was 8.9+/-5.3 (range 1 to 17) weeks. The mean gestational age at delivery was 32.4+/-5.6 (range 22 to 39+6) weeks for the entire group, 36.1+/-2.6 (range 32+4 to 39+6) weeks for the 6 who achived viability, and 27.6+/-5.0 (range 22 to 29+4) weeks for the 3 who died during the neonatal period. 1 died during gestation and was delivered at 33+6 weeksgestation. The mean birthweight was 2181.6+/-971.6 (range 498 to 3500)g for the entire group, and 2712.9+/- 571.5 (range 1860 to 3500)g for the 7 infants who lived until after neonatal period. The total survival rate for 11 babies was 64%. This study demonstrates that midtrimester emergency cervical cerclage for the patients who have dilated cervix with/without prolapsed amniotic sac is valuable method to try in the cases predicted they would lost the baby with conservative treatment only.
Cerclage, Cervical* ; Cervix Uteri* ; Dilatation* ; Emergencies* ; Female ; Gestational Age ; Humans ; Infant ; Labor Stage, First ; Pregnancy ; Pregnancy Trimester, Second ; Pregnancy, Twin ; Retrospective Studies ; Survival Rate