BACKGROUND: The consensus is that a bony Bankart lesion shorter than 25% of the length of glenoid does not affect the clinical result; hence, such lesions were often neglected. However, small bony Bankart lesions are associated with various types of capsulolabral lesions. METHODS: A total of 82 patients who had undergone arthroscopic capsulolabral lesion repair surgery for anterior shoulder dislocation were reviewed. The prevalence rates of early and late type of capsulolabral lesions were compared between a group of patients with and a group without small bony Bankart lesions. In addition, the types of accompanying capsulolabral lesion were analyzed according to the type of bony Bankart lesion. Finally, the clinical outcomes were evaluated (active range of motion, American Shoulder and Elbow Surgeons score and Rowe's score). RESULTS: Among the 13 patients who had small bony Bankart lesions, the prevalence rate of early and late type of capsulolabral lesions was 38.5% and 61.5%, respectively. Among the 69 patients without bony Bankart lesion, the prevalence rates of early and late type of capsulolabral lesions were 74% and 26%, respectively. Significantly worse clinical outcome was observed for the group of patients with both small bony Bankart lesions and late type of capsulolabral lesion. CONCLUSIONS: More severe type of small bony Bankart lesion appears to be associated with late type of capsulolabral lesion. The significantly worse clinical outcome for patients with both small bony Bankart lesion and late type of capsulolabral lesion indicates that small bony Bankart lesions cannot always be neglected.
Consensus ; Elbow ; Humans ; Prevalence ; Range of Motion, Articular ; Shoulder Dislocation* ; Shoulder*

In spite of technical advances in neuroradiology, neuroanesthesiology, and microneurosurgery, the treatment of giant aneurysms remains problematic. Between 1983 and 1995, the authors encountered 42 consecutive cases of giant aneurysms, and this study focuses on their clinical manifestations, management, and outcome. The patients' ages ranged from 5 to 73 years, with peak incidence in the sixth decade ; the male to female ratio was 12 : 30. The follow-up period was from 2 to 110(mean, 36) months. The most common presenting symptom was a mass effect found in 22 patients(52%), followed by subarachnoid hemorrhage in 16(38%). Thirty patients underwent a surgical or interventional radiological procedure, comprising direct neck clipping(n=13), proximal clipping(n=7), detachable balloon occlusion(n=4), wrapping(n=3), trapping(n=1), and partial clipping with thrombectomy(n=2). The mortality rate was 16.7% and the morbidity rate, 40% ; the most common postoperative complication was distal cerebral infarction. At the last follow-up, 22 patients(73%) were able to perform daily activities without assistance. In this clinical study, the authors reviewed general aspects of the treatment of giant aneurysms. In conclusion, treatment of giant aneurysms should-for best results-be tailored to patients' individual requirements, determined after thorough examination. Despite advanced neurosurgical techniques, morbidity and mortality rates remain high.
Aneurysm* ; Cerebral Infarction ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Mortality ; Neck ; Postoperative Complications ; Subarachnoid Hemorrhage

BACKGROUND: Although the wet earwax has been known to be related with the incidence of tinea versicolor, very little has been revealed on how they are correlated with each other. The incidence of Malassezia furfur, the etiological organism of tinea versicolor, and its population densities as yearst and mycelial form in the different types of earwax, the dry and the wet, have not been studied. METHODS: The type of earwax in 65 patients with tinea versicolor were classified into 2 types, dry and wet, by its appearence and the subjective complaints of the patients. The dry and wet cerumens were obtained from 142 and 49 individulas without tinea versicolor respectively. The cerumens were stained with 10% Parker ink-KOH solution. The incidence and its population densities of yeast and mycelial M. furfur in the wet cerumens were compared with those in the dry cerumens according to a new grading method using bacterial index(BI) of lepra bacilli. RESULTS: 1. Dry and wet earwax were observed in 58.5%(38 cases) and 41.5%(27 cases) of 65 patients respectively. 2. The incidence of yeast M. furfur in the dry and wet cerumens were 100% and 63.3%(31 of 49 cases) respectively, and that of mycelial M. furfur, 28.2%(40 of 142 cases) and 32.7%(16 of 49 cases) respectively. 3. The population densities(from 3+ to 6+) of yeast M. furfur in the dry and wet cerumens were ob served in 93.0%(132 of 142 cases) and 49.0%(24 of 40 cases), and those(3+) of mycelial M. furfur, 21.1%(30 of 142 cases) and 24.5%(12 of 49 cases) respectively. CONCLUSION: The incidence(41.5%) of wet earwax in tinea versicolor patients is significantly higher than that(0.8%) in The Korean control group. The ratio between the incidence of mycelial M. furfur and that of yeast M. furfur in the wet cerumens is higher than in the dry cerumens, and the ratio of population densities in the wet cerumens is also higher. These observations suggest that the skin surface conditions of the wet earwax group may be more suitable for yeast-mycelial transformation of M. furfur than those of the dry earwax group. The comparison of chemical compositions of the skin surface between dry and wet earwax groups is needed to elucidate the correlation between tinea versicolor and the types of earwax in the future.
Cerumen ; Humans ; Incidence* ; Malassezia* ; Population Density* ; Skin ; Tinea Versicolor* ; Tinea* ; Yeasts

Eczema herpeticum occurred in a patient with pemphigus foliaceus and esophageal cancer. The patient's initial skin lesions composed of large flaccid bullaes showed subcorneal bullae with typical acantholytic cells. Subsequent grouped small vesicles appeared widely on the erythematous base were diagnosed herpes simplex virus infection by Tzanck smear and histopathological findings. The patient died one week after the development of the widespread herpes virus infection.
Eczema* ; Esophageal Neoplasms ; Humans ; Kaposi Varicelliform Eruption* ; Pemphigus* ; Simplexvirus ; Skin

No abstract available.
Intracranial Arteriovenous Malformations* ; Risk Factors*

The measurement of the relative X-ray abssorption coefficient (CT No.) and the size of the lesion on CT ishighly valuable in the diagnosis of the certain disease, guide to treatment planning, and follow-up of patientunder treatment. But as the CT is a synthetic image, CT No. and size displayed in CT are greatly influenced byvarious factors such as KVp, slice thickness, scan time, CT No. of the surrounding, geometry of lesion in gantry,window width(W.W) and window level(W.L) etc. The study was performed ot evaluate the accuracy and error range ofthe CT measurement, including CT No. and size affected by various conditons using phantom model designed byauthor., Author also propose the optimum window width and window level for measurement of real size on CT. Theresulsts are as follows; 1. The CT No. of the lesion increases as the CT N. of surround increase if the CT No. ofthe lesion is below-100 H.U., while the CT No. of the lesion decreases as the CT No. of surround increases if theCT No. of the lesion is above 900 H.U. 2. The CT No. increases as photon influx (mAs) during scan increases. The higher the CT No. of the lesion, the greater the degree of increases are. 3. If the CT No. of the lesion is greater than that of surround, the size of the lesion increases as window level decreases. The narrower the windowwidth, the larger the difference between the maximum and minimum value of measurement and the steeper the slope ofchange is. 4. The window width affects the size if the measured size is sufficiently different from the true size.5. The greater the difference between the CT No. of the lesion and that of surround, the greater the differencebetweeen the maximum and minimum value of measurement. and as the CT No. of surround increases, the differencebetween the minimum and maximum value also increases. 6. The optimal window width and level for size measurementareas follows; Soft tissue
Diagnosis ; Follow-Up Studies

OBJECTIVE: To evaluate the relationship between postoperative increase in intervertebral disc space height (IVH) and posterior axial neck in cases of degenerative cervical disease treated with anterior cervical discectomy and fusion (ACDF). METHODS: A total of 155 patients who underwent ACDF with more than 1 year follow up were included. Radiologically, IVH and interfacet distance (IFD) of the operated segment were measured preoperatively and postoperatively. We clinically evaluated neck and arm pains according to visual analogue scale (VAS) scores and assessed neck disability index (NDI) scores preoperatively, postoperatively, at 3 months, 6 months, and 1 year postoperatively. The relationship between radiological parameters, and clinical scores were analyzed using a regression analysis. RESULTS: The mean increase in IVH was 2.62 mm, and the mean increase in IFD was 0.67 mm. The VAS scores for neck pain preoperatively, postoperatively, and at 3 months, 6 months, 1 year postoperatively were 4.46, 2.11, 2.07, 1.95, and 1.29; those for arm pain were 5.89, 3.24, 3.20, 3.03, and 2.18. The NDI scores were improved from 18.52 to 7.47. No significant relationship was observed between the radiological evaluation results regarding the increase in intervertebral height or interfacet distance and clinical changes in VAS or NDI scores. CONCLUSION: The increase in intervertebral space or interfacet distance by the insertion of a large graft material while performing ACDF for the treatment of degenerative cervical disease was not related with the change in VAS scores for neck and arm pains and NDI scores postoperatively and during the follow-up period.
Arm ; Diskectomy ; Follow-Up Studies ; Humans ; Intervertebral Disc* ; Neck ; Neck Pain* ; Transplants

STUDY DESIGN: Retrospective analysis. OBJECTIVES: To analyze the usefulness of Zero-P® by analyzing the radiological and clinical outcomes with a minimum of 2 years of follow-up. SUMMARY OF LITERATURE REVIEW: Anterior discectomy and fusion (ACDF) using Zero-P® showed excellent results. However, there is a lack of studies focusing on long-term outcomes. MATERIALS AND METHODS: Ninety-eight patients who underwent single-level ACDF using Zero-P® with more than 2 years of follow-up were included for analysis. In the radiological analysis, we evaluated disc height, segmental lordosis, and subsidence in the preoperative, postoperative, and last follow-up periods. The Neck Disability Index (NDI), Neck Visual Analogue Scale (VAS), and Arm VAS were also evaluated for clinical assessment. Radiological bony fusion was assessed, and radiological and clinical differences according to bony fusion were evaluated. RESULTS: Intervertebral disc height had increased 2.92 mm after surgery and subsided to 2.36 mm at the final follow-up. Subsidence of the screw was 0.58 mm at final follow-up. Segmental lordosis was 3.97° at the preoperative assessment, 8.39° in the postoperative follow-up, and 5.83° in the last follow-up. The Neck VAS score was 4.47, 2.28, and 1.27, respectively. The Arm VAS score was 5.73, 3.13, and 2.18; and NDI score was 17.8, 11.7, and 7.89, respectively. There was no association between the radiological and clinical results. Radiological nonunion was found in 18 subjects. There were no significant differences in radiological and clinical parameters according to bony union. CONCLUSIONS: ACDF with Zero-P® for treatment of degenerative cervical disease showed subsidence in 55.1% and nonunion in 18% of cases. However, the radiological results were not related to the clinical results.
Animals ; Arm ; Diskectomy ; Follow-Up Studies* ; Humans ; Intervertebral Disc ; Lordosis ; Neck ; Retrospective Studies

Surgical treatment of posterior circulation aneurysms are still challenging to the neurosurgeons, requiring highly skilled hands. During the past 10 years, the senior author(DH Han) operated upon 64 posterior circulation aneurysms. The number of the basilar bifurcation aneurysms(BBAA) were 31(48%), the posterior cerebral artery aneurysms(PCEAA) 7, the superior cerebellar artery aneurysms(SCAA) 10, the anterior inferior cerebellar aneurysms(AICAA) 3, the vertebro-basilar junction aneurysms(VBJA) 2, the vertebral artery aneurysms(VAA) 5 and the posterior inferior cerebellar artery aneurysms(PICAA) 6. The surgical approaches for BBAA, SCAA and PCEAA(proxinal to P4) were pterional route in 41 aneurysms and subtemporal in 4. Modified pterional approach was suitable for most of such aneurysms. For lower basilar trunk aneurysms(AICAA and VBJA), both far lateral suboccipital craniectomy and petrosal presigmoid approach had been tried and the presigmoid one seemed to be the choice of approach. The authors achieved aneurysmal neck clipping in the 48(75%) aneurysms, wrapping in other 8 and proximal clipping in the other 8. The operative mortality and morbidity were 6% and 17% each, which were comparable to the other series. Concerning surgical complications, transient oculomotor palsies were most frequent(38%), followed by transient hemiparesis, thalamic infarction, status epilepticus and peripheral infarction of the parent-arterial territory.
Aneurysm* ; Arteries ; Hand ; Infarction ; Mortality ; Neck ; Paralysis ; Paresis ; Posterior Cerebral Artery ; Status Epilepticus ; Vertebral Artery

To settle the controversy over the optimum management strategy for patients with poor-grade(Hunt-Hess grade IV and V) aneurysmal subarachnoid hemorrhage, the medical records of 50 patients admitted in poor Hunt-Hess grade have been examined retrospectively with literature review. Twelve patients underwent early surgery for aneurysmal neck clipping, and for the other patients, initial conservative management was done followed by delayed operation for 19 patients who showed stabilization or improvement of neurologic status. All patients were managed by active treatment(hypertensive, hypervolemic and hemodilutional therapy) after aneurysmal neck clipping. Initial findings such as better neurological condition(Hunt-Hess grade IV) and presence of intracerebral hemorrhage were indicators of good prognosis. Patients with intraventricular hemorrhage and uncontrollably increased intracranial pressure(>40 cm H20 after extraventricular drainage) resulted in severe morbidity or mortality. Regarding the timing of surgery, early intervention led to a better outcome with less morbidity(8% vs. 26%) compared with delaying operation, because of the lower incidence of rebleeding, reduced vasospasm and more effective management of delayed ischemia after surgery. The incidence of intraoperative premature rupture and mortality were not significantly influenced by the timing of surgery. It is concluded that, for poor-grade aneurysm patients without a definite evidence of irreversibility such as brainstem failure signs or uncontrollably increased intracranial pressure, early surgery followed by aggressive treatment to prevent cerebral vasospasm is the treatment of choice.
Aneurysm ; Brain Stem ; Cerebral Hemorrhage ; Early Intervention (Education) ; Hemorrhage ; Humans ; Incidence ; Intracranial Pressure ; Ischemia ; Medical Records ; Mortality ; Neck ; Prognosis ; Retrospective Studies ; Rupture ; Subarachnoid Hemorrhage ; Vasospasm, Intracranial