This study has been examined different morphologic measurements in the evaluation of patients with lumbar spinal stenosis. Preoperative CT-Myelography from 30 patients who underwent surgery for central lumbar stenosis were analyzed. Based on this, we concluded as follows : 1) Bony measurement alone did not reliably identify patients with spinal stenosis. 2) Measurement of the transverse area of the dural sac on CT-Myelography was the most accurate method for identifying stenosis. 3) Lumbar myelography was still considered to have an important role in the valuation of a patient with stenosis because of correlation between the cross-sectional area of the dural sac and the anteroposterior diameter of the dural sac was excellent. 4) We identified soft-tissue problems as the main cause of stenosis. 5) The most common level of maximum stenosis was L4-5.
Constriction, Pathologic ; Humans ; Myelography* ; Spinal Stenosis*

No abstract available.
Adenocarcinoma, Papillary* ; Thyroid Gland*

Contrast angiograplly is a reliable method for obtaing morphologic and hemodynamic informations about the blood vessels. The morbidity assoicated with angiographic procedures includes the possibility of stroke, renal failure, and discomforts from catheter insertion and contrast media injection. A noninvasive alternative angiographic method would be clearly desirable. This article discusses 70 examples of our initial experience with MR angiography (time-of-flight and phase contrast methods). The correlation between MR angiography and contrast angiography was relatively good. Conventional MR neuroangiography was better for the evaluation of collateral circulation than MR angiography. On MR angiography. The over estimation of luminal narrowing resulted from complex flow that occurred normally in carotid bifurcation as well as distal to stenosis. Contrast material was used for better monitoring of the spins of the capillary circulation. Feeding arteries and draining veins of vascular malformations were well delineated only in a large one, but not delineated in a small AVM and in a venous angioma Only six cases of aneurysm were experienced in this study and a aneurysm as small as 4 mm could be shown, The obstructed vessels were well demonstrated on MR angiography. 2-D time-of-flight MR angiography of trans verse sinus thrombosis could confirm the clinical impression by the showing of little now in the transverse sinus. MR angiography of the head and neck offers great promise as a noninvasive and useful means of studying vascular abnormalities and as an alternative means of difficult cases for contrast angiography.
Aneurysm ; Angiography* ; Arteries ; Blood Vessels ; Capillaries ; Catheters ; Collateral Circulation ; Constriction, Pathologic ; Contrast Media ; Head* ; Hemangioma ; Hemodynamics ; Neck* ; Phenobarbital ; Renal Insufficiency ; Sinus Thrombosis, Intracranial ; Stroke ; Vascular Malformations ; Veins

CT has become one of the most important diagnostic method in the evaluation of ruptured intracranial aneurysm with direct detection of subarachnoid, intracerebral and intraventricular hemorrhage, and identification of complications such as recurrent bleeding, hydrocephalus and infarction secondary to arterial spasm. Angiography gives precise information on the location, size of aneurysm and presence of arterial spasm. Authors attempted toperedict the location of ruptured intracranial aneurysm confiremd by CT and angiography at Keimyung University Hospital for last 2 years. The results were as follows; 1 The age and sex distribution; the most prevalent agegroup was 5th to 6th decades (70%), and female patient was slightly more than male patient(57.5%: 42.5%). 2. The locaiton of aneruysms were; posterior communicating artery group 17 cases (42.2%), middle cerebral artery group 10 cases (25.0%), anterior communicating artery group 7 cases (17.5%), basilar artery bifucation 1 case (2.5%),posterior inferior cerebellar artery 1 case(2.5%), and multiple aneurysms 4 case (10%) in order to frequency. 3.Characteristic distributions of intracranial hemorrhage in CT were as follows; 1) In 6 cases (85.7%) of anterior communicating artery aneurysm, interhemispheric fissure hemorrhage was noted. 2) The ipsilateral sylvian fisuurehemorrhage was noted in all cases of middle cerebral artery aneurysm(10 cases) and 12 cases (70.6%) of posterior communicating artery aneurysm. 3) Localized hematoma in frontal lobe near interhemispheric fissure (2 cases:28.6%), septum pellucidum (1 case: 14.3%) and corpus callosum (1 case: 14.3%) were characteristic in anterior communicating artery aneurysm. 4) Comma-shape sylvian fissure hematoma (5 cases: 50%) and temporal lobe hematomanear sylvian fissure (5 cases: 50%) may indicate middle cerebral artery anerysm, 5) Intraventricular hemorrhage (6cases: 15%) has no particular predilection of aneurysmal location. 4. In 9 patients (22.5%) of clinicallysuggesting subarachnoid hemorrhage, no extravasated blood was noted in preenhancement CT alone. 5. Six cases (15%)showed aneurysm itself on preenhancement CT as a round or ovoid hyperdense area or isodense area with mass effectsuch as cisternal obliteration. 6. Hydrocephalus was noted in 9 cases (22.5%). 7. There was no direct correlation between the size of the intracranial aneurysm and extent of the hemorrhage in CT, and between the size of the intracranial aneurysm and clinical grade. 8. There was direct correlation between the extent of blood in CT andclinical grade.
Aneurysm ; Angiography ; Arteries ; Basilar Artery ; Corpus Callosum ; Female ; Frontal Lobe ; Hematoma ; Hemorrhage ; Humans ; Hydrocephalus ; Infarction ; Intracranial Aneurysm ; Intracranial Hemorrhages ; Male ; Methods ; Middle Cerebral Artery ; Septum Pellucidum ; Sex Distribution ; Spasm ; Subarachnoid Hemorrhage ; Temporal Lobe

OBJECTIVE: Lumbar foraminal or extraforaminal disc herniations (FEFDH) have unusual clinical features and higher incidence in elderly patients compared to usual intraspinal canal disc herniations. We evaluated the efficacy of microdiscectomy via paramedian approach for lumbar FEFDH in elderly patients over the age of 65. METHODS: Retrospective study was performed in 68 patients over the age of 65 (23 male and 45 female patients; 71.46±3.87 years) who underwent microdiscectomy via paramedian approach for unilateral lumbar FEFDH causing sciatica. The radiological factors including degree of slippage, presence of instability, disc height, and degree of disc degeneration; pain and functional status by the means of visual analogue scale score, Oswestry Disability Index score, and Macnab classification were analyzed preoperatively and during the postoperative follow-up period of 3 years to evaluate the efficacy of the surgical treatment. RESULTS: Pain and functional status improved according to short- and long-term follow-up evaluations after surgery. Radiological changes following surgery, which can be understood as structural deteriorations and deformations, did not represent patient condition. Nine patients underwent additional surgery due to sustained or recurring leg pain of aggravation of back pain, and fusion surgery was required for 3 patients. Degree of preoperative slippage was the only statistically significant factor related to additional surgery (p<0.05). CONCLUSION: Microdiscectomy via paramedian approach for FEFDH may be a good surgical alternative in elderly patients. Radiological changes after surgery did not show a concordance with patients' actual functional status. The excessive preoperative slippage tended to lead to unfavorable result after surgery and was associated with additional surgery.
Aged* ; Back Pain ; Classification ; Female ; Follow-Up Studies ; Humans ; Incidence ; Intervertebral Disc Degeneration ; Intervertebral Disc Displacement ; Leg ; Male ; Retrospective Studies ; Sciatica

No abstract available.

Recently, techniques of magnetic resonance angiography(MRA) have been developed that permit a three dimensional display of vessel without infusion of a contrast agent. However, to be competitive with conventional angiography(CA). MRA should show not only morphology of vessel but should also provide functional inforrnation, as selective delineation of specific vascular territories. Selective presaturation of individual vessels causes signal loss within the territory supplied by the presaturated artery, without affecting vessels not crossing the presaturation slab. We applied the selective MRA to the study of blood flow dynamics in five patients wiih ischemic stroke, showing patent middle cerebral arteIy in spite of obstruction or severe stenosis of the ipsilateral internal carotid artery on MRA. Selective MRA was able to demonstrate the direction of blood flow and presence of collateral blood flow. Findings of selective MRA were correlated with those from CA. Selective MRA can be used as a noninvasive and useful means for imaging the blood supply of the major intracranial arteries.
Arteries ; Carotid Artery, Internal ; Constriction, Pathologic ; Humans ; Magnetic Resonance Angiography* ; Stroke*

Racemic verapamil has been shown to have local anesthetic activity, and fast sodium channel blockade is responsible for its inhibitory effect on nerve conduction. This study de- scribes the dose response inhibition of nerve conduction hy verapamil and bupivacaine alone as well as in combination of both on an isolated rat sciatic nerve preparation. In addition, it describes the effect of caleium ion concentration on this in vitro nerve preparation. Sciat- ic nerve preparation from rats were placed in mammarian ringer solution(MRS) adjusted to pH 7.4 at 22degrees C. Each nerve was mounted in a nerve conduction chamber containing MRS in the presence of verapamil(10-5M-2X10-3 M), bupivacaine(10-6M-10-3M) or a combination of both. Each nerve was stimulated with a square wave pulse at twice threshold potential(4 -7V), 0.02msec of duration, 10Hz of frequency. Compound action potentials(CAP) were photographed and measured on a Tektronix oscilloscope. The nerve was first equilibrated in the nerve conduction chamber in MRS, (pH 7.4, 22degrees C for 30min) and CAP was recorded for control(100% recovery). Then, the nerve was exposed to increasing concentrations of verapamil and bupivacaine for 12 minutes and a CAP was measured after each exposure. All CAP were compared to the control CAP and the results were expressed as a % of control CAP. We got dose response curve of verapamil, bupivacaine and combination of both. Also, we determined EC 25%, 50%, 75% from these data(EC % : Effective concentra- tions of drug for % CAP inhibition). Each of the experiments was performed on at least 4 nerves and differences between groups were analyzed using ANOVA test. Verapamil is shown to inhibit nerve conduction with an EC 25% = 2.2X10-4M, EC 50%=3.8X10-4M, EC 75% =6.3X10-4M and EC 50% for bupivacaine was 5.0X10-5 M. When verapamil dose response curves were performed in the presence of a wide range of CaCl2 containing MRS solutions, there was no significant differences in the response curve(P>0.05). In conclusion, racemic verapamil was shown to have dose dependent local anesthetic activity with a relative potency of 1/8 of bupivacaine. When combined with bupivaeaine, local anesthetic activity inereased in an additive manner. This suggests that these two drugs act on the nerve membrane in a similar fashion. Various CaCl2 concentrations have no effect on nerve conduction inhibition of verapamil. This implicates sodium channel blockade as the mechanism of local anesthetic activity of verapamil.
Animals ; Bupivacaine* ; Hydrogen-Ion Concentration ; Membranes ; Neural Conduction* ; Rats* ; Sciatic Nerve ; Sodium Channels ; Verapamil*

Potassium channel blockers slow depolarization, broaden the action potential, and thus pro- mote the open and inactivated Na+ channel states. The ability of local anesthetics to reduce the amplitude of compound action potential(CAP) of rat sciatic nerve was examined in the presence and absence of teteraethylammonium chloride(TEA) that selectively block K+ channels, In the presence of 1.3X10-5 M bupivacaine that inhibit the CAP by 22.5% at tonic stimulation, the addition of TEA(10-1M) increased this inhibition by another 27.5% and increased another 50% by phasic stimulation(20Hz). Also, dose response curve of bupivacaine in the presence of TEA(10-1M) showed marked shift to left of curve. The re- covery kinetics of bupivacaine in the presence of various coneentration of TEA(10-2-10-1M) showed marked delay of recovery(2X10-2 M), reocurrence of inhibition(90min,5X10-2 M), even no recovery(10-1M). TEA alone slightly depolarized the resting membrane which was represented as increment of CAP height from 0.9%(3min) to 12.3%(80min), and broadened mid-peak amplitude width by 2 times in 5X10-1M, 5.3 times in 1M. These experiments directly demonstrated that TEA potentiated the inhibition of CAP by bupivacaine and showed the poesibility of mixture of TEA and local anesthetics to potenti- ate impulse conduction blockade.
Action Potentials ; Anesthetics, Local ; Animals ; Bupivacaine* ; Kinetics ; Membranes ; Potassium Channel Blockers ; Rats ; Sciatic Nerve ; Tea ; Tetraethylammonium*

No abstract available.
Choledochal Cyst*