The major cause of early dislocation after total hip arthroplasty is malposition of acetabular cup. Therefore, radiographic evaluation of acetabular cup placement is essential in determining the postsurgical prognosis. The purpose of this study was to establish principles which would aid in checking the radiography. We evaluated 33 patients who were treated with total hip arthroplasty between Jan. 1988 and Aug. 1993 and investigated the methods of measuring the position of the acetabular cup on radiography using pelvic skeleton and acetabular cup. The results were analyzed as followings. l. After the total hip arthroplasty, the inclination of the acetabular cup shows average 37.1 degress in pelvis AP, 36.4 degrees in hip AP and 43.4 degrees in femur AP. This result means that the more X-ray beam focus is far from the acetabular cup, the more inclination of acetabular cup on radiography is incerased. 2. After the total hip arthroplasty, the difference of acetabular cup angle between pelvis AP and hip AP is average 0.7 degree, 6.4 degrees between pelvis AP and femur AP and 7.1 degrees between hip AP and femur AP. This result means that the more X-ray beam focus is far from acetabular cup, the larger difference between acetabular cup angle on radiography is.3. In experimental study with pelvic rotation, acetabular cup angle on radiography is average 45.7 degrees in neutral position, 42.8 degrees in 10 degree rotation, and 39.6 degrees in 20 degree rotation. This result means that the more rotation of pelvic bone is increased, acetabular cup angle on radiography is reversely diminished. 4. In experimental study with pelvic flexion-extension, acetabular cup angle on radiography is average 45.7 degrees in neutral position, 56.4 degrees in 20 degree pelvic flexion, and 32.3 degrees in 20 degree pelvic extension. This result means that when the pelvis is flexed, acetabular cup angle on radiography is increased, and when the pelvis is extended, acetabular cup angle is decreased than normal acetabular cup angle. 5. In experimental study with X-ray beams, acetabular cup angle on radiography is average 45.7 degrees in pelvis AP, 45.5 degrees in femur AP and 50.4 degrees femur AP. This result means that the more X-ray beam focus is far from acetabular cup, the more inclination of acetabular cup on radiography is increased. As the result of the study, radiographs which focus centered on hip demonstrated a nearly true representation of acetabular cup angle.
Acetabulum ; Arthroplasty, Replacement, Hip ; Dislocations ; Femur ; Hip ; Humans ; Pelvic Bones ; Pelvis ; Prognosis ; Radiography ; Skeleton

PURPOSE: Internal fixation using compression hip screws (CHS) and traction tables placing patients in the supine position is a gold standard option for treating intertrochanteric fractures; however, at our institution, we approach this treatment with patients in a lateral decubitus position. Here, the results of 100 consecutive elderly (i.e., ≥45 years of age) patients who underwent internal fixation with CHS in lateral decubitus position are analyzed. MATERIALS AND METHODS: Between March 2009 and May 2011, 100 consecutive elderly patients who underwent internal fixation with CHS for femoral intertrochanteric fracture were retrospectively reviewed. Clinical outcomes (i.e., Koval score, Harris hip score [HHS]) and radiographic outcomes (i.e., bone union time, amount of sliding of lag screw, tip-apex distance [TAD]) were evaluated. RESULTS: Clinical assessments revealed that the average postoperative Koval score decreased from 1.4 to 2.6 (range, 0–5; P < 0.05); HHS was 85 (range, 72–90); and mean bone union time was 5.0 (range, 2.0–8.2) months. Radiographic assessments revealed that anteroposterior average TAD was 6.95 (range, 1.27–14.63) mm; lateral average TAD was 7.26 (range, 1.20–18.43) mm; total average TAD was 14.21 (range, 2.47–28.66) mm; average lag screw sliding was 4.63 (range, 0–44.81) mm; and average angulation was varus 0.72°(range, −7.6°−12.7°). There were no cases of screw tip migration or nonunion, however, there were four cases of excessive screw sliding and six cases of varus angulation at more than 5° CONCLUSION: CHS fixation in lateral decubitus position provides favorable clinical and radiological outcomes. This technique is advisable for regular CHS fixation of intertrochanteric fractures.
Aged ; Hip Fractures ; Hip ; Humans ; Retrospective Studies ; Supine Position ; Traction

PURPOSE: The phosphodiesterase 5 inhibitor sildenafil has antinociceptive effects, mediated by an increase in cGMP. This study examined the role of spinal adenosine and serotonin receptors played in the antinociceptive effects of intrathecal sildenafil. MATERIALS AND METHODS: Intrathecal catheters were inserted into the subarachnoid space of Sprague-Dawley male rats as a drug delivery device. Pain was induced by injecting formalin into the plantar surface of rats and observing nociceptive behavior (flinching response) for 60 mininutes. Then, the effects of intrathecal adenosine and serotonin receptor antagonists on the antinociceptive activity of intrathecal sildenafil were examined. RESULTS: Intrathecal sildenafil suppressed the flinching response in a dose-dependent manner during phases 1 and 2 in the formalin test. Both CGS 15943 and dihydroergocristine decreased the antinociceptive effects of sildenafil during phases 1 and 2 in the formalin test. CONCLUSION: Intrathecal sildenafil effectively attenuated the pain evoked by formalin injection. Both adenosine and serotonin receptors may be involved in the antinociceptive action of sildenafil at the spinal level.
Adenosine/metabolism ; Analgesics/*therapeutic use ; Animals ; Cyclic GMP/metabolism ; Dihydroergocristine/pharmacology ; Injections, Spinal ; Male ; Pain/*drug therapy ; Piperazines/*pharmacology ; Purines/pharmacology ; Rats ; Rats, Sprague-Dawley ; Receptors, Purinergic P1/*metabolism ; Receptors, Serotonin/*metabolism ; Spinal Cord/*metabolism ; Sulfones/*pharmacology ; Vasodilator Agents/therapeutic use

BACKGROUND: Mirror movement is common in young children, and it could be seen in normal adults. Several mechanisms including motor pathway reorganization involved in motor recovery after stroke. Motor pathway reorganization has been reported to be a mechanism in several studies of patients with mirror movement. However, the correlation of motor recovery and mirror movement has been debated. We studied the degree of mirror movement in stroke patients compared with a controlled group to look into their relationship. METHODS: Our controls were 50 adults without neurologic symptoms and signs. The hemiparetic group was comprised 94 patients who had incurred unilateral brain lesion: 36 patients were acute stroke patients, 58 patients were chronic stroke patients. Mirror movements were assessed by three different tasks: abduction of thumb, sequential finger tapping, and grasping. We analyzed mirror movements in controls and patients, and tried to find a correlation between the degree of mirror movement and the recovery of motor power in chronic stroke patients. RESULTS: In controls, male exhibited more frequent mirror movement than female at specific tasks, and there was no difference between tasks of right or left hand. In stroke patients, there was more mirror movement in the nonparetic hand than in the paretic one during the movement of contralateral hand. In acute stroke, the frequency of mirror movement had no variability according to the degree of motor power. The recovery of motor power at a late stage was not correlated with the degree of mirror movement. Consclusions: Motor pathway reorganization seems to be insignificant for motor recovery because the degree of mirror movement was not correlated with the recovery of motor power in this study.
Adult ; Brain ; Child ; Female ; Fingers ; Hand ; Hand Strength ; Humans ; Male ; Neurologic Manifestations ; Stroke* ; Thumb

Focal ventricular dilatation of the temporal horn caused by an occlusion of the cerebrospinal fluid pathway at the atrium of the lateral ventricle is a form of non communicating hydrocephalus, and this condition is termed as "entrapment of the temporal horn". The choroid plexus is important central nervous system(CNS) structure, but it is often neglected in pathologic and clinical studies of intracranial diseases. Even though choroid plexitis is very rare, it may be occurred as the resultant of CNS infections and primary choroid plexitis can be associated with bacterial, viral, and parasitic etiologies. Some aspects of the neuroimaging findings of this infection mimick those of a intraventricular neoplasms. The most important neoplasms which should be differentiated, are choroid plexus papilloma and carcinoma. Wherem primary neoplasms of the choroid plexus are well known, but primary infections of the choroid plexus (such as choroid plexitis) are not commonly encountered. Pseudomonas stutzeri infections are especially rare as the causative organism of the choroid plexitis and often have serious underlying disease but generally respond well to treatment with antibiotics. We report a 65-year-old female patient with primary choroid plexitis due to Pseudomonas stutzeri and the findings of her brain computerized tomography and magnetic resonance imaging. In conclusion, our case revealed that choroid plexitis may result in ventricular entrapment and mimick intraventricular tumors. Although it is very rare, when a intraventricular mass was observed in imaging studies and combined with signs and symptoms suggesting CNS infection, choroid plexitis should be considered.
Aged ; Animals ; Anti-Bacterial Agents ; Brain ; Cerebral Ventricle Neoplasms ; Cerebrospinal Fluid ; Choroid Plexus ; Choroid* ; Dilatation ; Female ; Horns* ; Humans ; Hydrocephalus ; Lateral Ventricles* ; Magnetic Resonance Imaging ; Neuroimaging ; Papilloma, Choroid Plexus ; Pseudomonas stutzeri* ; Pseudomonas*

Apraxia of lid opening is a nonparalytic motor abnormality characterized by difficulty in initiating the act of lid elevation. It has been reported in various extrapyramidal disorders(Parkinson's disease, Huntington's chorea, progressive supranuclear palsy), right middle cerebral infarction and Wilson's disease. We report a case of apraxia of opening in Wilson's disease, 34-year-old man was noted to have resting tremor and voluntary eye opening difficulty. Wilson's disease without Kayser-Fleisher ring was diagnosed by serum Cu, serum ceruloplasmin and liver biopsy. He was treated with D-penicillamine anticholinergics, amantadine, and levodopa.
Adult ; Amantadine ; Apraxias* ; Biopsy ; Cerebral Infarction ; Ceruloplasmin ; Cholinergic Antagonists ; Hepatolenticular Degeneration* ; Humans ; Huntington Disease ; Levodopa ; Liver ; Penicillamine ; Tremor

BACKGROUND & OBJECTIVES: It is widely believed that the post-lumbar puncture headache(PLPH) is related to CSF leakage through the dural hole made by needle tract. So it is accepted that PLPH is prevented by at least 4 hour bed rest after lumbar puncture (LP). If bed rest was unneccessary, the administrative and nursing advantages would be obvious,, especially in neurologic units, whereLP has been done frequently. Therefore, we evaluate the incidence of PLPH in the ambulant and bed-rest patients prospectively and compared the incidence difference between two group. METHODS: Eighty-eight patients without preceding headache who were done lumbar puncture for diagnostic purpose were selected prospectively. We compared the incidence of PLPH between the ambulant (50 patients) and bed-rest group (38 patient,) at 6 hour and 24 hours. We also evaluated the effect of the CSF profile (count of RBC and WBC, protein level and opening pressure) on PLPH. RESULTS: The PLPH was found in 11 cases(12.5%) among bed-rest and ambulant groups. The frequency of each group was 8% (3/38) in bed-rest group and 16%(8/50) in ambulant group, but there is no significant difference between two groups (p-vaIue = 0.26). The frequency of PLPH is also not correlated to the CSF profiles; count of RBC and WBC, protein level, and opening pressure. CONCLUSIONS: There is no significant difference between the ambulant and bed rest group in the frequency of the PLPH. We conclude that the bed rest after LP is unnecessary for the prevention of the PLPH.
Bed Rest* ; Headache ; Humans ; Incidence ; Needles ; Nursing ; Post-Dural Puncture Headache* ; Prospective Studies ; Punctures ; Spinal Puncture

Creatinine ; Humans ; Male ; Meals ; Methods ; Nitrogen ; Osmolar Concentration ; Potassium ; Sodium ; Sodium, Dietary ; Specific Gravity ; Urea ; Urine Specimen Collection

Ulcerative colitis is an inflammatory bowel disease (IBD) characterized by recurrent episodes of colonic inflammation and tissue degeneration in human or animal models. The contractile force generated by the smooth muscle is significantly attenuated, resulting in altered motility leading to diarrhea or constipation in IBD. The aim of this study is to clarify the altered contractility of circular and longitudinal smooth muscle layers in proximal colon of trinitrobenzen sulfonic acid (TNBS)-induced colitis mouse. Colitis was induced by direct injection of TNBS (120 mg/kg, 50% ethanol) in proximal colon of ICR mouse using a 30 G needle anesthetized with ketamin (50 mg/kg), whereas animals in the control group were injected of 50% ethanol alone. In TNBS-induced colitis, the wall of the proximal colon is diffusely thickened with loss of haustration, and showed mucosal and mucular edema with inflammatory infiltration. The colonic inflammation is significantly induced the reduction of colonic contractile activity including spontaneous contractile activity, depolarization-induced contractility, and muscarinic acetylcholine receptor-mediated contractile response in circular muscle layer compared to the longitudinal muscle layer. The inward rectification of currents, especially, important to Ca2+ and Na+ influx-induced depolarization and contraction, was markedly reduced in the TNBS-induced colitis compared to the control. The muscarinic acetylcholine-mediated contractile responses were significantly attenuated in the circular and longitudinal smooth muscle strips induced by the reduction of membrane expression of canonical transient receptor potential (TRPC) channel isoforms from the proximal colon of the TNBS-induced colitis mouse than the control.
Acetylcholine ; Animals ; Colitis ; Colitis, Ulcerative ; Colon ; Constipation ; Contracts ; Diarrhea ; Edema ; Ethanol ; Humans ; Inflammation ; Inflammatory Bowel Diseases ; Membranes ; Mice ; Mice, Inbred ICR ; Models, Animal ; Muscle, Smooth ; Muscles ; Needles ; Protein Isoforms

Ictal blindness is a deficient symptomatology of partial seizure arising from visual cortex and usually short lived. When the blindness is the initial semiology of seizures, epileptic discharge arising from the primary visual cortex is associated. Ictal blindness has been reported in many patients with occipital lobe epilepsy, but prolonged ictal blindness called status epilepticus amauroticus has been reported only in few patients. We report a 45-year-old woman who had suffered prolonged epileptic blindness. The epileptic blindness was accompanied with rapid eyelid blinking and upward turning of head and eyeballs. Motor seizure and mental changes were not occurred. Ictal EEG showed 11-13 Hz repetitive spikes on the right occipital area followed by propagation to ipsilateral temporal area and contralateral occipital area. On T2-weighted MRI, abnormal lesions with high signal intensity were noted within bilateral occipital areas. She had been improved dramatically by loading dose of intravenous phenytoin.
Blindness ; Blinking ; Electroencephalography ; Epilepsies, Partial ; Epilepsy ; Eyelids ; Female ; Head ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Phenytoin ; Seizures ; Status Epilepticus* ; Visual Cortex