No abstract available.
Aneurysm* ; Bone Cysts* ; Spine*

The fat embolism is a complication which occurs rarely in cases of long bone of lower extremity and pelvic bone fractures or after severe injury of soft tissue, and may result in an embolism in the lungs, brain, heart, kidneys and other important vessels when fat globules flow from bone marrow into such areas. There has been much adverse criticism about the pathogenesis of fat embolism including the incidence, diagnosis and treatment of it, and studies on this subject have been prevalent in recent years. The following results have been obtained through the study of 9 cases of fat embolism at the Department of Orthopaedic Surgery, Dong San Medical Center, Keimyung University during the period from 1973 to 1984. 1. By sex and age distribution, most of the patients were under the age of 40 and there were more male than female patients. 2. Seven cases were caused by traffic accidents and two were caused by falls accompanied by multiple fractures of the femur and pelvic bone. 3. Symptoms generally occured within 48 houres after trauma, however some cases were within 12 houres, some were 5 days and others 12 days. Clinical symptoms which were present at the time admission revealed increased erythrocyte sedimentation tates and decreased hemoglobin and platelete in most cases. Bilateral infiltrates and cotton ball appearances were found in all cases on thoracic radiology, but no fat globules were found in the urine or in frozen sections of clotted blood. 4. Blood gas analysis was performed in 4 cases and Pa02 under 60mmHg found in all cases increased gradually after treatment. 5. Of the 9 cases with fat embolism 6 cases completely recovered and three cases expired.
Accidental Falls ; Accidents, Traffic ; Age Distribution ; Blood Gas Analysis ; Blood Platelets ; Blood Sedimentation ; Bone Marrow ; Brain ; Clinical Study ; Diagnosis ; Embolism ; Embolism, Fat ; Female ; Femur ; Fractures, Multiple ; Frozen Sections ; Heart ; Humans ; Incidence ; Kidney ; Lower Extremity ; Lung ; Male ; Pelvic Bones

The authors have described a case with pure red cell aplasia (P.R.C.A.) caused by the administration of diphenylhydantoin after head injury. P.R.C.A. associated with diphenylhydantoin is very rare and easily treated with a discontinuation of diphenylhydantoin & steroids.
Craniocerebral Trauma ; Phenytoin* ; Red-Cell Aplasia, Pure* ; Steroids

The therapeutic goal for the spinal injury has been focused on preventing the secondary ischemic changes because of the poor regeneration of human spinal cord. Naloxone, an antagonist of endogenous opiates, has been clinically used for the purpose of preventing ischemic change and improving the recovery of neurological function after spinal injury. Recently, thyrotropin releasing hormone(TRH), a hypothalamic hormone inducing the thyrotropin secretion in anterior pituitary gland, has been known as a potent stimulator of cardiovascular functions in shock and the neurologic recovery in injuries of central nervous system, however, its underlying mechanism is still obscure. The present study was designed to determine whether TRH was also effective to improve the experimentally induced spinal injury as naloxone did, Somatosensory evoked potentials(SEPs) have used as an index for recovery of neurological function after the spinal injury which was induced by the 400gm.cm contusion of the T-7 spinal level in cats. The results are summarized as follows : 1. SEPs abolished soon after spinal contusion were reappeared 3 hours after injury when either of naloxone(10mg/kg) or TRH(4mg/kg) was administrated intravenously. Its recovery was completed after 24 hours. 2. The recovery rates of SEPs after treatments of naloxone and TRH were 62.5% and 64.7% of experimental animals, respectively. In conclusion, the present studies confirm the therapeutic benefit of TRH in experimental spinal injury and demonstrate that it is superior to treatment with naloxone. Further studies would be needed to explain the underlying mechanism of TRH effects.
Animals ; Cats* ; Central Nervous System ; Contusions ; Evoked Potentials, Somatosensory* ; Humans ; Naloxone ; Opioid Peptides ; Pituitary Gland, Anterior ; Regeneration ; Shock ; Spinal Cord Injuries* ; Spinal Cord* ; Spinal Injuries ; Thyrotropin* ; Thyrotropin-Releasing Hormone*

OBJECTIVES: Spinal nerve root compression occurs commonly in conditions, such as herniated nucleus pulposus, spinal stenosis, intervertebral foraminal stenosis, and trauma. However, the pathophysiolosy of the symptoms and signs related to spinal nerve root compression is poorly understood. The purpose of the present study was to assess and compare the changes of various pressures of intervertebral foraminal pressure before and after decompression. METHOD: After laminetomy without foraminotomy was performed, pressure sensor tip of Camino parenchymal type was located at the middle-central portion of the intervertebral foramen and anterior portion of nerve root for the foraminal pressure before decompression of the intervertebral foramen. After laminectomy with foraminotomy, the same method was used for the foraminal pressure after decompression. The authors studied 40 consecutive patients (57 disc spaces) with severe constant root pain to the lower leg, pain unrelived by bed rest, and minimal tension signs, diagnosed by MRI. RESULTS: In patients with intervertebral foraminal stenosis, the intraforaminal pressure was decreased from 86+/-2.23mmHg to 17.1+/-1.51mmHg and in patients without stenosis, from 55.9+/-1.08mmHg to 11.9+/-1.25mmHg. All patients below 20mmHg after decompression showed good outcome, but 4 cases who showed poor outcome had foraminal stenosis, posterolateral type of the herniated disc, and above 30mmHg of foraminal pressure after decompression. CONCLUSION: These findings suggest that if the foraminal pressure falls below 20mmHg after decompression, good outcome can be anticipated. Central type of the herniated disc shows better outcome compared to the posterolateral type.
Bed Rest ; Constriction, Pathologic ; Decompression ; Foraminotomy ; Humans ; Intervertebral Disc Displacement ; Laminectomy ; Leg ; Magnetic Resonance Imaging ; Spinal Nerve Roots ; Spinal Stenosis

We have had 37 patients with cerebral arteriovenous malformation and subarachnoid hemorrhage, who were admitted to the Department of Neurosurgery, Yonsei Medical Center from 1964 to 1976. All of the cerebral arteriovenous malformations were proved by cerebral angiography. Since the site of the lesions were considered to have a close relation to the neurologic deficit and the results of surgery, various analysis of clinical manifestations and of the cerebral angiographic findings were attempted. Out of 37 patients, surgery was performed in 28 and the results were analysed according to the various type of surgical procedure.
Adolescent ; Adult ; Cerebral Angiography ; Child ; Child, Preschool ; Female ; Human ; Infant ; Infant, Newborn ; Intracranial Arteriovenous Malformations/radiography ; Intracranial Arteriovenous Malformations/surgery* ; Male ; Methods ; Middle Age ; Subarachnoid Hemorrhage/radiography ; Subarachnoid Hemorrhage/surgery

The basic requirements for photomicrography of neurosurgery include the following : 1) proper microscope and accessories. 2) good knowledge about the surgical microscope and photographic instrument. 3) proper exposure. 4) sharp focus with adequate depth of field. 5) removal of factors which could cause a bad result. We will discuss about the set up of surgical microscope including photographic instruments and photographic technique.
Neurosurgery ; Photography ; Photomicrography

Hemangioblastomas are rare benign tumor of the central nervous system that commonly occur in the posterior fossa around the 4th ventricle. In case of von Hippel-Lindau disease, hemangioblastomas involve multiple regions such as cerebellum, spinal cord and brainstem but, rarely show simultaneous involvement of cerebellum and spinal cord. We have experienced a case of multiple hemangioblastomas that were located at the cerebellum, cervical cord and conus medullaris and also had multiple lesions that a part of von Hippel-Lindau disease;retinal angioma, syringomyelia, multiple cyst on kidney and pancreas, renal cell carcinoma on left kidney. Hemangioblastomas on cerebellum and spinal cord were removed totally, retinal angioma was treated with laser photocoagulation and renal cell carcinoma was also totally excised. The authors report a case of von Hippel-Lindau disease had multiple located hemangioblastomas on cerebellum, cervical cord and conus medullaris with review of literature.
Brain Stem ; Carcinoma, Renal Cell ; Central Nervous System ; Cerebellum* ; Conus Snail ; Hemangioblastoma* ; Hemangioma ; Humans ; Kidney ; Light Coagulation ; Pancreas ; Retinaldehyde ; Spinal Cord* ; Syringomyelia ; von Hippel-Lindau Disease*

The Subtrochanteric fracture requires long period healing time and is difficult for treatment because it occurs in bone that is predominantly cortical and high stress concentrates in this region. The Subtrochanteric fracture is difficult for the reduction and maintenance because many of these fractures are comminuted from high velocity trauma and the angulation rotation occurs by the influence of the surrounding large and powerful muscles. During the period of February, 1980 to April, 1985, 62 cases of Subtrochanteric fractures were admitted and treated at the Department of Orthopedic Surgery, School of Medicine, Keimyung University, and results were obtained as follows: 1. Of 62 cases, 42 in man and 20 in woman and diffuse in ages. 2. Causes of Subtrochanteric fractures were 32 cases of traffic accidents, 21 cases of fall or slip down, 5 cases of others, and 3 cases of pathologic fractures. 3. Of 62 cases, Type I by Zickel classification was predominant (33 cases), and Type III-A, “three-part spiral fracture“ by Seinsheimer was predominant (24 cases). 4. The better results can be achieved through the bone graft in severe comminuted fracture and through the provision of good cortical load-bearing medially between the fragment during the reduction and fixation. 5. Earlier bone union and low complication of metallic failure and nonunion were achieved with Compression Hip Screw rather than Jewett nail. 6. The causes for the 6 metallic failure cases were comminuted fracture of medial cortical bone, failure in contact and fixation of medial free fragment, and weight bearing before complete union was achieved. 7. There was a breakage in nail-plate junction when Vitalium jewett nail was used. Also there were breakage and loosening of screws when Stainless steel Jewett nail was used. 8. Further studies in the advantages and disadvantages of Zickel nail, Ender nail, Compression Hip Screw, and Kuntscher nail treatment of subtrochanteric fracture are needed.
Accidents, Traffic ; Classification ; Clinical Study ; Female ; Femur ; Fractures, Comminuted ; Fractures, Spontaneous ; Hip ; Hip Fractures ; Humans ; Muscles ; Orthopedics ; Stainless Steel ; Transplants ; Weight-Bearing

OBJECTIVE: The goal of this retrospective study was to assess clinical and radiographic outcomes of posterior surgical decompression with stabilization followed by image-guided robot Cyberknife radiosurgery for encircling malignant tumors of the spine. METHODS: From August 2008 to December 2009, 14 consecutive patients with a malignant spinal metastatic lesion with cord compression were treated at the author's institute. Patients underwent on a decompressive surgery by the posterior approach, and latent unstable spines were stabilized with instrumentation. After recovery, radiosurgery was administered at doses ranging from 16 to 26 Gy (mean 20.1Gy) prescribed to the 75-85% isodose line that encompassed at least 95% of tumor volumes. Visual Analogue Scale, American spine injury association grades, and MRI with gadolinium enhancement were used to monitor pain, neurology, and radiological outcomes, respectively, after the radiosurgery. RESULTS: No acute radiation-induced toxicity or new neurological deficit occurred during the follow-up period (mean 4.5 months). Axial pain improved in 10 out of the 14 patients. No hardware failure was encountered. At 3-6 months after the Cyberknife radiosurgery, local control and effective therapeutic rates were both 80%(8/10) and no lesion enhancement on vertebral bodies or pedicles was visualized by MRI. CONCLUSION: Posterior decompression with stabilization followed by radiosurgery of residual tumor in the anterolateral region is useful in cases where an anterior approach or a circumferential approach is not an option due to medical condition. Longer term follow-up is required to evaluate survival and late toxicities.
Decompression ; Decompression, Surgical ; Follow-Up Studies ; Gadolinium ; Humans ; Neoplasm, Residual ; Neurology ; Organothiophosphorus Compounds ; Radiosurgery ; Retrospective Studies ; Spine