STUDY DESIGN: Case study of two cases. OBJECTIVES: The aim of our study is to describe the rare MR imaging patterns of infectious spondylitis. SUMMARY OF LITERATURE REVIEW: It is generally accepted that the intravertebral cleft sign is not shown in cases of infection or malignancy, and thus, its recognition can obviate unnecessary imaging or biopsy because of its benign significance. MATERIALS AND METHODS: Two patients are presented who developed worsening back pain after a minor trauma. Preoperative MR images of these patients showed intravertebral fluid and benign vertebral compression fractures. Anterior decompression and fusion were done and the bacteria isolated from the intraoperative cultures were Listeria monocytogenes and Mycobacterium tuberculosis, respectively. RESULTS: After 2 years of follow-up, the patients were free of pain, without signs of infection, and showed correct fusion. CONCLUSIONS: MR findings in infectious spondylitis may simulate the patterns of osteoporotic VCFs.
Back Pain ; Bacteria ; Biopsy ; Decompression ; Follow-Up Studies ; Fractures, Compression* ; Humans ; Listeria monocytogenes ; Magnetic Resonance Imaging ; Mycobacterium tuberculosis ; Spondylitis*

Transient mutism resolving to cerebellar speech after posterior fossa surgery is a well recognized phenomenon, particularly in pediatric patients. The anatomic basis for this postoperative functional change is unclear, but may reside in the dominant superior cerebellar hemisphere or the medial deep cerebellar nuclei. We report a case of a 9-year-old boy who presented for surgical resection of a medulloblastoma. Preoperatively, his complaint consisted of headache, nausea, vomiting and cerebellar ataxia. He had normal speech. At one day after operation, suddenly he was unable to speech, however, communication through a variety of verbal cues, including sign language was possible. His mutism lasted 12 days and cerebellar dysarthria was slowly resolved.
Cerebellar Ataxia ; Cerebellar Nuclei ; Child* ; Cues ; Dysarthria ; Headache ; Humans ; Male ; Medulloblastoma* ; Mutism* ; Nausea ; Sign Language ; Vomiting

Tension pneumocephalus is a rare complication of craniotomy, however, it should be managed promptly due to rapid neurological deterioration. We report a case of tension pneumocephalus after transsphenoidal surgery for a giant pituitary tumor. It may have developed because of the cerebrospinal fluid rhinorrhea and presence of an external lumbar drain.
Cerebrospinal Fluid Rhinorrhea ; Craniotomy ; Pituitary Neoplasms* ; Pneumocephalus*

OBJECTIVE: We report the correlation between known risk factors for cerebrovascular disease and formation of multiple intracranial aneurysms. METHODS: We reviewed the medical records and outcomes of 524 patients who had undergone aneurysmal operation at our hospital between January 1996 and May 2001. Of 524 patients who had undergone operations with intracranial aneurysm, 130 patients had multiple intracranial aneurysms. The authors examined the correlations between the risk factors(patient age, sex, menopausal state of female patients, hypertension, cigarette smoking) and the presence of multiple intracranial aneurysms by using chi-square test retrospectively. RESULTS: The male to female ratio was about 1 : 2.05(male : female=129 : 265) for patients with single intracranial aneurysm, and male to female was about 1 : 3.06(male : female=32 : 98) for patients with multiple intracranial aneurysms. Among 256 female patients with single intracranial aneurysm, 182 patients(68.9%) were postmenopausal, and, among 98 female patients with multiple intracranial aneurysms, 81 patients(82.6%) were postmenopausal. The mean age of the patients with single intracranial aneurysm was 54 years, and, with multiple intracranial aneurysms, the mean age was 57.8 years. The presence of hypertension was found in 149 patients(37.8%) with single intracranial aneurysm, and, in 55 patinets (42.3%) with multiple intracranial aneurysms. Cigarette smoking was found in 116 patients(29.4%) with single intracranial aneurysm and 47 patients(36.1%) with multiple intracranial aneurysms. CONCLUSION: There is a significant correlation between menopausal state of female patients and presence of multiple intracranial aneurysms. However, gender, hypertension and smoking are not related to multiple intracranial aneurysms.
Aneurysm ; Female ; Humans ; Hypertension ; Intracranial Aneurysm* ; Male ; Medical Records ; Postmenopause ; Retrospective Studies ; Risk Factors* ; Smoke ; Smoking ; Tobacco Products

Post-thoracotomy pain is so severe that may lead to postoperative complications, such as sputum retention, atelectasis, pneumonia and respiratory failure. These complications are associated with shallow breathing and inability to cough due to pain. To reduce postoperative pulmonary complications and improve respiratory mechanics, effective pain relief is essential. Among the many methods, epidural administrations of narcotics or local anesthetics have been shown to provide profound relief of postoperative pain. Forty-five patients undergoing thoracotomy were randomized into three groups based on a postoperative pain regimen as indi-cated: Group I; intermittent intramusculal injections of nalbuphine 0.2mg/kg for pain control(n= 15) Group II; intermittent epidural injections of mixtures of 0.2% bupivacaine and fentanyl 3 ug/ ml (n=15) Group III: continuous epidural infusion of mixtures of 0.2% bupivacaine and fentanyl 3 ug/ml at a rate of 4-5 ml/hr with supplementation on pain complaint. We evaluated postoperative pain score at 30 minutes, 8 hours, 16 hours, 24 hours, 32 hours, 40 hours, and 48 hours after thoracotomy. And we observed the duration of analgesia and the incidence of systemic side effects of three methods. The results were as follows; 1) The pain score was significantly decreased in group III compared to group I and II<0. 05). 2) The mean duration of analgesia was significantly longer in group III compared to group I and II(p<0.05). 3) the number of case of systemie side effects in group I was one case of nausea and vomiting, in group II, two cases of mild hypotension, and one case of nausea and vomiting, pruritus, headache, and urinary retention each respectively and in group III, one case of ruinary retention.
Analgesia* ; Anesthetics, Local ; Bupivacaine* ; Cough ; Fentanyl* ; Headache ; Humans ; Hypotension ; Incidence ; Injections, Epidural ; Nalbuphine ; Narcotics ; Nausea ; Pain, Postoperative ; Pneumonia ; Postoperative Complications ; Pruritus ; Pulmonary Atelectasis ; Respiration ; Respiratory Insufficiency ; Respiratory Mechanics ; Sputum ; Thoracotomy* ; Urinary Retention ; Vomiting

BACKGROUND: Minimally invasive techniques for open heart surgery are widely accepted in these days. There are minimally invasive approaches by the right or left parasternal incision and another approaches by mini-sternotomy of upper or lower half or sternum. We report the safety and efficacy of minimally invasive technique with right parasternal incision compared with the routine full sternotomy. MATERIAL AND METHOD: From April 1997 through February 1999, 20 patients (Group A) underwent minimally invasive cardiac operations. We chose 41 patients (Group B) whose preoperative diagnosis were the same and general conditions were similar and who underwent routine full sternotomy before April 1997. We compared A group and B group in many aspects. We performed routine full median sternotomy in B group but we did a minimally invasive technique through a small right parasternal incision in A group. RESULT: mean age was 36.1 years in both groups. In disease entities, there were 11 cases of ASD, 9 cases of mitral valve disease in group A, and 16 cases of ASD, 25 cases of mitral valve diseases in group B. In ASD, operation time, cardiopulmonary bypass time of aortic occulusion time were 263 min, 82 min, and 41 min in group A and 180 min, 53 min, and 32 min in group B. In mitral valve disease, operation time, cardiopulmonary bypass time and aortic occlusion time were 267min, 106 min, and 70min in A group and were 207 min, 82 min, and 69 min in group B. There were significant differences in operation time, CPB time, and ACC time between group A and group B. There was a significant difference in the amount of bleeding in postoperative day 1 between group A and group B of mitral diasease. However, there was no significant difference in the amount of bleeding in other comparisons. Mean length of incision was 8.7 cm in group A. There was no significant difference in postoperative complications between A group and B group. There was no mortality in either group. CONCLUSION: We conclude that this minimally invasive technique with right parasternal incision is cosmetically excellent but it is not effective in reducing operative time and there was no significant difference in recovery time and postoperative complications compared with routine full sternotomy.
Cardiopulmonary Bypass ; Diagnosis ; Hemorrhage ; Humans ; Mitral Valve ; Mortality ; Operative Time ; Postoperative Complications ; Sternotomy ; Sternum ; Thoracic Surgery*

BACKGROUND: There has been controversy over the prevalence of recoarctation in infants treated by subclavian flap aortoplasty (SFA) for coarctation of the aorta. To assess the rate of recurrence of coarctation after SFA, we reviewed the surgical results of SFA in infants with coarctation of the aorta. MATERIAL AND METHOD: Between 1986 and 1998, a total of 25 patients less than 1 year of age (12 neonates and 13 infants) underwent SFA for aortic coarctation. Age at operation was 3.0+/-3.0 months (mean +/- standard deviation); mean weight was 5.0+/-1.4kg. Classic SFA was performed in 20 patients, reversed SFA in 2 patients, subclavian artery reimplantation in 2 patients and the combined resection-flap aortoplasty in one. The aortic clamping time ranged from 20 to 88 minutes(mean 35.8 minutes). There were one operative death and two late deaths. There was no case of paraplegia or left arm ischemia in complications. Twenty-one (84%) of 24 hospital survivors were followed for 26.0+/-24.0 months. The risk of recoarctation in neonates (33.3%) was a little greater than infants (25.0%) without statistical significance. CONCLUSION: This study revealed that SFA resulted a relatively high incidence of recarctation in infants. It is desirable to select other methods of surgical treatment (combined resection-flap aortoplasty, extended end-to-end repair etc.) for severe isthmic coarctation or hypoplasia of the distal aortic arch in infants, instead of choosing SFA indiscriminately.
Aorta, Thoracic ; Aortic Coarctation* ; Arm ; Constriction ; Humans ; Incidence ; Infant* ; Infant, Newborn ; Ischemia ; Paraplegia ; Prevalence ; Recurrence ; Replantation ; Subclavian Artery ; Survivors

BACKGROUND: Median sternotomy remains the standard approach used by surgeons for most intracardiacscar we have tried to use alternative skin incision (bilateral subm-ammary skin incision) to median sternal skin incision, In this study we have tried to compare different postoperative results of wound between two different skin incisional methods. MATERIAL AND METHOD: Between June 1997 and June 1998, a bilateral subma-mmary skin incision combined with v operations but the residual scar is cosmetically unsatisfactory. To avoid an unsightly midline ertical sternotomy was performed in 21 pediatric female patients (submammary group)to repair acyanotic congenital heart disease. after the period we carried out a retrograde sion controls in whom there were 23 pediatric patients (control group). RESULT: Patients' age ranged from 14 to 96 months(mean 38.2 months) Mean duration of subcutaneous drains using Hemovac which was used only in the patients of submammary group was 4.2 days and total amount of the drained effusion was 51.1 ml. Postoperative wound complications included wound eruption in one patient wound disruption in one patient and skin necrosis in 3 patients in submammary group and included wound disruption in 4 patients in controls. mean duration required for wound healing was 15,5 days in submammary group versus 10.4 days in controls. The mean scar length was 12.5 cm in submammary group versus 11.3 cm in controls. The average follow-up was 8.2 months in submammary group versus 9.0 months in controls. In submammary group 3 patients parents(14.3%) were pleased with their cosmetic results of wound scar but 8(38.1%) were dissatisfied. Among the 23 patients in control group 8(34.8%) were pleased but 8(34.8%) complained ofunhappiness with the scar.
Cicatrix ; Female ; Follow-Up Studies ; Heart Defects, Congenital ; Heart* ; Humans ; Necrosis ; Skin* ; Sternotomy* ; Thoracic Surgery* ; Wound Healing ; Wounds and Injuries*

BACKGROUND: The aim of this study is to define the cardioprotective effects (hemodynamic, cytochemical and ultrastructural of the newly developed Histidine-Tryptophan-Ketoglutarate (HTK) cardioplegia compared to DelNido cardioplegia. MATERIAL AND METHOD: Seventy-nine isolated rat hearts were divided into three groups on the basis of techniques of cardioplegia infusion. Twenty-eight hearts (Group 1) were flushed with cold DelNido cardioplegia with every 40 minutes for 2 hours. Twenty-seven hearts (Group 2) were flushed with cold HTK cardioplegia for once during the 2 hours. Twenty-four hearts (Group 3) were flushed with cold HTK cardioplegia with every 40 minutes for 2 hours. Heart rate, left ventricular developed pressure (LVDP), changes of +dp/dt max, coronary flow, and rate-pressure product value were measured at pre-ischemic, post-reperfusion 15 minutes, 30 minutes, and 45 minutes for hemodynamic study. Aspartate aminotransferase (AST), lactate dehydrogenase (LD), creatine kinase (CK), CK- MB, troponin-I, myoglobin, and lactate were measured at pre-ischemic and post-reperfusion 45 minutes for cytochemical parameters. Mitochondrial scores were counted in 3 cases from each group for ultrastructural assessment. RESULT: In hemodynamic study, there were no significant differences among group 1, group 2, and group 3. However, the decrease values of heart rate in group 2 and 3 exhibited significantly lower values than in group 1. In cytochemical study, there were no significant differences among group 1, group 2, and group 3. However, the increase values of lactate in group 2 and 3 exhibited significantly lower values than in group 1. In ultrastructural assessment, the mean myocardial mitochondria scores in group 1, group 2, and group 3 were 2.14+/-0.10, 1.52+/-0.57, and 2.10+/-0.16. CONCLUSION: HTK solution provides adequate myocardial protection with some advantages over DelNido solution in isolated rat hearts.
Animals ; Aspartate Aminotransferases ; Cardioplegic Solutions ; Creatine Kinase ; Heart Arrest, Induced* ; Heart Rate ; Heart* ; Hemodynamics ; L-Lactate Dehydrogenase ; Lactic Acid ; Mitochondria, Heart ; Myoglobin ; Rats* ; Troponin I

STUDY DESIGN: This is a retrospective study OBJECTIVES: This study compared the clinical outcomes of posterior lumbar interbody fusion (PLIF) using hydroxyapatite blocks with PLIF using a metal or poly-ether-ether-ketone (PEEK) cage. SUMMARY OF THE LITERATURE REVIEW: There are few reports on the clinical outcomes of PLIF using a hydroxyapatite block for treating lumbar degenerative disease. MATERIALS AND METHODS: The 27 PLIF cases (62 units, HA block) that were followed up for 1-year were compared with 13 cases using a metal cage and 13 cases using a PEEK cage. Pedicle screw fixation was performed for all the cases. If the local bone is deficient, then an additional bone graft with autogeous iliac bone or bone substitute was used. The visual analog scale(VAS) for low back pain and radiating pain, the Oswestry disability index (ODI), the intervertebral height and the halo sign around the cages and pedicle screws were comparatively analyzed. RESULTS: The mean VAS score for low back pain before PLIF and using the HA block, the metal cage and the PEEK cage was 7.5, 8.3 and 6.2, respectively, and this was 3.3, 2.9 and 4.8 after PLIF (P<0.05 with using the HA block and the metal cage (Wilcoxon test). The mean VAS score for radiating pain before PLIF was 7.9, 8.3 and 8.5, respectively, and the VAS score was 3.5, 3.1 and 3.9, respectively, after PLIF (P<0.05 for all cases, Wilcoxon test). For the ODI, the means before PLIF were 60.3, 51.2 and 53.8, respectively, and they changed to 30.5, 24.9 and 29.7, respectively, after PLIF (P<0 .05 for all cases, Wilcoxon test). On the X-ray images, there was no halo sign greater than 2 mm near the pedicle screws or greater than 1 mm near the cages and no breakage of the HA block. No additional bone graft was needed for the PLIF using the HA block and local bone. There was no statistically significant differences among the groups (P>0.05, One-way ANOVA). CONCLUSION: PLIF using a HA block showed improvements, including the back pain, and the ODI was satisfactory and this didn't fall below those ODIs of using metal or PEEK cages. Although a HA block may have higher tendency to break, there was no breakage at the 1-year follow up.
Back Pain ; Bone Substitutes ; Durapatite ; Follow-Up Studies ; Ketones ; Low Back Pain ; Polyethylene Glycols ; Retrospective Studies ; Transplants