OBJECTIVE: We tried to investigate impact of early tracheostomy on hospital-acquired pneumonia and infection of anterior cervical fusion site in patients with acute cervical cord injury undergoing respiratory difficulty. METHODS: A retrospective analysis was done with 42 subjects received tracheostomy of patients with acute cervical cord injury admitted in our institution from Jan. 2001 to Dec. 2010. The subjects were classified into early tracheostomy group (< or =7 days after endotracheal intubation) and delayed (>7 days). We analyzed the incidence of post-tracheostomy pneumonia, intensive care unit (ICU) stay, hospital stay, in-hospital mortality and tracheostomy or anterior cervical fusion site infections. RESULTS: Early tracheostomy was performed in 13 patients (31.0%) and delayed in 29 (69.0%). The incidence of post-tracheostomy pneumonia was significantly lower in the early tracheostomy group than in the delayed (p=0.018). ICU stay was also significantly lower in the early tracheostomy group than in the delayed (p=0.013). Hospital stay was lower in the early tracheostomy group than in the delayed (p=0.061), but was not statistically significant. In-hospital mortality was not different between two groups. There were no patients with infection of anterior cervical fusion site as a consequence of tracheostomy in both groups. CONCLUSION: This study suggests that early tracheostomy may have beneficial effects in patients with acute cervical cord injury. Tracheostomy was not found to increase the risk of infection in previous anterior cervical surgery.
Hospital Mortality ; Humans ; Incidence ; Intensive Care Units ; Length of Stay ; Pneumonia ; Retrospective Studies ; Spinal Cord Injuries ; Tracheostomy

We report a rare case of a 71-year-old male patient who had suffered from long-lasting neurogenic shock for 13 weeks after cervical spinal cord injury (SCI) caused by a bicycle accident. The neurogenic shock was resolved dramatically 2 weeks after the administration of alpha-1-adrenergic agonist, midodrine hydrochloride. In usual cases, neurogenic shock tends to improve between 2 and 6 weeks after SCI; however, in a few cases, the shock lasts for several months. In our case, spinal shock lasted for 13 weeks and exhibited very sensitive decline of blood pressure for even a slight decrease of dopamine despite recovered bulbospongiosus reflex. Three days after midodrine hydrochloride was added, hypotension improved dramatically. We discuss our rare case with pertinent literatures.
Adrenergic alpha-Agonists ; Aged ; Blood Pressure ; Dopamine ; Humans ; Hypotension ; Male ; Midodrine* ; Reflex ; Shock* ; Spinal Cord Injuries* ; Spinal Cord*

Pituitary apoplexy usually presented with abrupt onset of neurological deterioration of headache, visual disturbance and decreased mental status. Post-traumatic pituitary apoplexy generally occurs in patients who have suffered from severe head injury, but there are rare reports occurred in patients with mild head injury. We describe a rare case of atypical presentation of acute pituitary apoplexy following mild head injury. A 68-year-old woman presented with right parietal scalp swelling after minor head trauma. Glasgow Coma Scale (GCS) score was 14. Initial computed tomography (CT) scans showed multiple contusions in the basal forebrain, falx hemorrhage and a linear skull fracture near the midline. In addition, there was a suprasellar-extended pituitary macroadenoma with suspicious intratumoral hemorrhage. After admission, cloudy consciousness, poor oral intake and high fever continued for several days. On seventh day, her condition has abruptly deteriorated and hypotensive shock developed. She recovered dramatically two days after steroid replacement therapy. The mechanism of pituitary apoplexy after mild head injury discussed with a relevant literature.
Consciousness ; Contusions ; Craniocerebral Trauma ; Female ; Fever ; Glasgow Coma Scale ; Head ; Headache ; Hemorrhage ; Humans ; Pituitary Apoplexy ; Pituitary Neoplasms ; Prosencephalon ; Scalp ; Shock ; Skull Fractures

OBJECTIVE: Contrary to some clinical belief, there were quite a few studies regarding animal models of intracerebral hemorrhage (ICH) in vivo suggesting that prior use of statins may improve outcome after ICH. This study reports the effect of 3-hydroxy-3-methyl-glutaryl-coenzyme A (HMG CoA) reductase inhibitor, simvastatin given before experimental ICH. METHODS: Fifty-one rats were subjected to collagenase-induced ICH, subdivided in 3 groups according to simvastatin treatment modality, and behavioral tests were done. Hematoma volume, brain water content and hemispheric atrophy were analyzed. Immunohistochemical staining for microglia (OX-42) and endothelial nitric oxide synthase (eNOS) was performed and caspase-3 activity was also measured. RESULTS: Pre-simvastatin therapy decreased inflammatory reaction and perihematomal cell death, but resulted in no significant reduction of brain edema and no eNOS expression in the perihematomal region. Finally, prior use of simvastatin showed less significant improvement of neurological outcome after experimental ICH when compared to post-simvastatin therapy. CONCLUSION: The present study suggests that statins therapy after ICH improves neurological outcome, but prior use of statins before ICH might provide only histological improvement, providing no significant impact on neurological outcome against ICH.
Animals ; Atrophy ; Brain ; Brain Edema ; Caspase 3 ; Cell Death ; Cerebral Hemorrhage ; Hematoma ; Inflammation ; Microglia ; Models, Animal ; Nitric Oxide Synthase Type III ; Oxidoreductases ; Rats ; Simvastatin

OBJECTIVE: The informed consent, in literal sense, is a medicolegal process that requires full explanation and clear disclosure about the illness, and thorough comprehension and autonomous consent to the respective medical services of the competent recipient. The authors review the theoretical background of the informed consent and investigate pertinent problems encountered in medical practice. METHODS: We gathered 153 consecutive cases of written form of the informed consent regarding diagnosis and treatment from Mar 2001 to Jun 2002. The authors evaluate the completeness of the process by looking into the possible omitted components in whole cases and degree of recall for the explained risk by telephone questionnaire in 128 available cases. RESULTS: In a total 153 cohort, 21 emergency operation cases invariably showed structural deficiencies of free-ended discussion due to short of time. Thorough past history taking and physical examination was necessary to perform reoperation for the postoperative hematoma in 3 cases and solid intimate relationship was necessary to treat previously disclosed complication in 7 cases of invasive diagnostic and minimum operative procedures, respectively. Among the available 128 patients, only 33(25%) ones could recall the given risks addressed at the consent approximately 6 weeks later. CONCLUSION: The informed consent is a process that dictates the free dialogue between the patient and the physician, not a simple paper expressed in published characters. However, to enhance the effectiveness of the consent process, both free discussion and writing down contents are prerequisite.
Cohort Studies ; Comprehension ; Diagnosis ; Disclosure ; Emergencies ; Hematoma ; Humans ; Informed Consent ; Physical Examination ; Surveys and Questionnaires ; Reoperation ; Surgical Procedures, Operative ; Telephone ; Writing

"Paradoxical deterioration" during antituberculous therapy is generally defined as the clinical or radiological worsening of pre-existing tuberculous lesions or the development of new lesions in a patient who initially improves. The phenomenon of paradoxical deterioration in intramedullary tuberculoma of the spinal cord is rare and is a less established entity. The authors present an unusual case of paraparesis as a result of paradoxical deterioration of intramedullary tuberculoma despite adequate antituberculous therapy. Here, we review the relevant literatures and discuss its possible pathogenic mechanisms.
Humans ; Paraparesis ; Spinal Cord ; Tuberculoma*

Distant metastasis of squamous cell carcinoma from the anal canal is an uncommon event. However, hematogenous spread to the vertebrae may occur in the course of this disease. The route of metastasis from the anal canal seems to be Batson's vertebral venous system. A 52-year-old female patient presented with lower back and right leg pain of one-week history. She has undergone radiotherapy and chemotherapy for squamous cell carcinoma of the anal canal and then was followed by surgical resection. Three months later, magnetic resonance images of the lumbar spine disclosed a well-enhanced mass of L5 vertebral body compressing the thecal sac. Surgical decompression and biopsy were performed. Histopathological study confirmed carcinoma of the squamous cell origin. We report a rare case of vertebral metastasis from squamous cell carcinoma of the anal canal with a pertinent review of literature.
Anal Canal* ; Anus Neoplasms ; Biopsy ; Carcinoma, Squamous Cell* ; Decompression, Surgical ; Drug Therapy ; Female ; Humans ; Leg ; Middle Aged ; Neoplasm Metastasis* ; Radiotherapy ; Spine

Bilateral traumatic hemorrhage of the basal ganglia is an extremely rare neuropathologic entity. This report describes a 50-year-old man with bilateral basal ganglia hemorrhage with occipital fracture of the skull after head trauma. The mechanism of development of traumatic hemorrhage of the basal ganglia has been not clear. But, it is presumed to be secondary to rupture of the lenticulostriate or anterior choroidal artery by shearing as a result of acceleration/deceleration forces. We briefly summarize our uncommon case and discuss its possible mechanisms.
Arteries ; Basal Ganglia Hemorrhage ; Basal Ganglia* ; Choroid ; Contusions ; Craniocerebral Trauma ; Hemorrhage* ; Humans ; Middle Aged ; Rupture ; Skull

Follicular thyroid carcinoma with metastasis rarely manifests as spinal cord compression without any previous symptoms of its malignancy. This report describes a 64-year-old man with follicular thyroid carcinoma who presented initially with left arm motor weakness. Magnetic resonance images demonstrated severe cervical cord compression by a mass with destruction of C4 vertebra. Corpectomy of C4 and anterior interbody fusion was carried out. Histopathological study revealed a metastatic follicular carcinoma of the thyroid. We present our case, especially focused of its possible pathophysiology, with review of pertinent literatures.
Adenocarcinoma, Follicular* ; Arm ; Humans ; Middle Aged ; Neoplasm Metastasis ; Spinal Cord Compression* ; Spinal Cord* ; Spine ; Thyroid Gland ; Thyroid Neoplasms

OBJECTIVE: We conducted this study to evaluate the clinical impact of early enteral nutrition (EN) on in-hospital mortality and outcome in patients with critical hypertensive intracerebral hemorrhage (ICH). METHODS: We retrospectively analyzed 123 ICH patients with Glasgow Coma Scale (GCS) score of 3-12. We divided the subjects into two groups : early EN group (< 48 hours, n = 89) and delayed EN group (> or = 48 hours, n = 34). Body weight, total intake and output, serum albumin, C-reactive protein, infectious complications, morbidity at discharge and in-hospital mortality were compared with statistical analysis. RESULTS: The incidence of nosocomial pneumonia and length of intensive care unit stay were significantly lower in the early EN group than in the delayed EN group (p < 0.05). In-hospital mortality was less in the early EN group than in the delayed EN group (10.1% vs. 35.3%, respectively; p = 0.001). By multivariate analysis, early EN [odds ratio (OR) 0.229, 95% CI : 0.066-0.793], nosocomial pneumonia (OR = 5.381, 95% CI : 1.621-17.865) and initial GCS score (OR = 1.482 95% CI : 1.160-1.893) were independent predictors of in-hospital mortality in patients with critical hypertensive ICH. CONCLUSION: These findings indicate that early EN is an important predictor of outcome in patients with critical hypertensive ICH.
Body Weight ; C-Reactive Protein ; Cerebral Hemorrhage ; Enteral Nutrition ; Glasgow Coma Scale ; Hospital Mortality ; Humans ; Incidence ; Intensive Care Units ; Intracranial Hemorrhage, Hypertensive ; Multivariate Analysis ; Pneumonia ; Retrospective Studies ; Serum Albumin