BACKGROUND: The management of penetrating neck injuries presents a difficult problem. Although many authors have stated that surgical exploration should be mandatory for all neck injuries that penetrate platysma, recent reports from many centers now claim selective exploration. The aim of this study was to review a policy of selective neck exploration based on clinical presentation, anatomic location, and the result of diagnostic studies. METHOD: We reviewed retrospectively medical records of 66 patients who were admitted and managed at Yongdong Severance hospital, Yonsei university college of medicine due to penetrating neck injuries from Jan. 1990 to Dec. 1996. RESULTS: Forty-one patients(62%) were underwent immediate neck exploration, while the remaining 25 patients(38%) were admitted and observed. Three had esophagoscopy, four had esophagogram, and three had direct laryngoscopy, all of which revealed normal result except one patient had blood tinged larynx on laryngoscopy. Results of 12 neck explorations(29%) were negative. There was no delayed diagnosis during conservative treatment. There was no mortality. CONCLUSION: We concluded that selective exploration of penetrating neck injuries is both safe and resonable.
Delayed Diagnosis ; Esophagoscopy ; Humans ; Laryngoscopy ; Larynx ; Medical Records ; Mortality ; Neck Injuries* ; Neck* ; Retrospective Studies ; Tolnaftate

Reentrant tachycardias can often be terminated by discrete pacing stimuli that penetrate the reentrant circuit. Antitachycardia pacemaker PASAR 4172 (Programmable Automatic Scanning Arrhythmia Reversion, Model 4172, Telectronics) is designed to detect tachycardia automatically and subsequently to deliver programmed one or two extrastimuli to revert to sinus rhythm. We experienced two patients, one paroxysmal supraventricular tachycardia and one paroxysmal ventricular tachycardia, who had had frequent and often prolonged episodes of tachycardia that responded poorly to pharmacologic antiarrhythmic therapy. Each patient underwent a detailed preimplantation clinical electrophysiological study in order to determine the number of stimuli required for termination of tachycardia, the most satisfactory site for electrode placement, and the tachycardia termination zone. During the follow-up period of 7 to 11 months after implantation of PASAR 4172, no patient complained of an episode of sustained tachycardia although they experienced symptoms of an impending attack. We conclude that antitachycardia pacemaker PASAR 4172 is a safe, effective, and well tolerated method for the therapy of drug resistant paroxysmal supraventricular tachycardia and paroxysmal ventricular tachycardia.
Arrhythmias, Cardiac ; Electrodes ; Follow-Up Studies ; Humans ; Tachycardia ; Tachycardia, Paroxysmal* ; Tachycardia, Supraventricular ; Tachycardia, Ventricular

OBJECTIVE: The purpose of this study was to determine the optimal volume of injected cement and its distribution when used to treat vertebral compression fractures, and to identify factors related to subsequent vertebral fractures. METHODS: A retrospective analysis of newly developing vertebral fractures after percutaneous vertebroplasty was done. The inclusion criteria were that the fracture was a single first onset fracture with exclusion of pathologic fractures. Forty-three patients were included in the study with a minimum follow up period of six months. Patients were dichotomized for the analysis by volume of cement, initial vertebral height loss, bone marrow density, and endplate-to-endplate cement augmentation. RESULTS: None of the four study variables was found to be significantly associated with the occurrence of a subsequent vertebral compression fracture. In particular, and injected cement volume of more or less that 3.5 cc was not associated with occurrence (p = 0.2523). No relation was observed between initial vertebral height loss and bone marrow density (p = 0.1652, 0.2064). Furthermore, endplate-to-endplate cement augmentation was also not found to be significantly associated with a subsequent fracture (p = 0.2860) by Fisher's exact test. CONCLUSION: Neither volume of cement, initial vertebral height loss, bone marrow density, or endplate-to-endplate cement augmentation was found to be significantly related to the occurrence of a subsequent vertebral compression fracture. Our findings suggest that as much cement as possible without causing leakage should be used.
Bone Marrow ; Follow-Up Studies ; Fractures, Compression ; Fractures, Spontaneous ; Humans ; Retrospective Studies ; Vertebroplasty

Tumor of the trachea are uncommon. Trachea tumor are usually diagnosed late in their natural history, because the tracheal lumen may be extensively involved before symptoms occur, and because symptoms may be confused with those of asthma. Some 19% to 29% of the trachea tumor have laryngeal or lung malignancy. Squamous carcinoma is by far the most frequent among tracheal tumor, although adenocarcinoma and oat cell carcinoma have been described so. Oat cell carcinoma in the trachea are aggressive tumors as. they are in the lung and elsewhere. Oat cell carcinoma as well as squamous cell carcinoma are related with tobacco exposure. We presented a case of small cell carcinoma nearly obstructing the trachea and right main bronchus which was partially removed after bronchoscopic ethanol injection, along with a review of the literature.
Adenocarcinoma ; Asthma ; Bronchi ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Ethanol ; Lung ; Natural History ; Tobacco ; Trachea*

No abstract available.
Eosinophils* ; Histamine*

OBJECTIVE: The goal of study is the evaluation of clinicofunctional outcomes and fusion success rates of unilateral posterior lumbar interbody fusion(PLIF) using cages. METHODS: The authors conducted retrospective study of 81 patients who underwent unilateral PLIF using cages. The outpatient notes, standard hospital charts, and pre-and postoperative imaging studies were analyzed. In this study pre-and postoperative back pain, radiating pain, fusion success rates, pseudoarthrosis, clinicofunctional outcome, and complications were evaluated. Follow-up duration ranged from 3 to 8 years. RESULTS: Eighty-one patients underwent unilateral PLIF using 98 cages(TFC:37, CH cage:25, Novus cage 36). Two-level fusion was performed in 17 patients. There were 48 men(59%) and 33 women(41%). Seventh decade was most common(47%). The most common site of PLIF was at L4-5 space(69.4%) and left side(58%) was prevalent. Fusion was successful in 91 out of 98 levels(92.8%) and pseudoarthrosis was observed in five patients(7 level, 7%). The clinicofunctional results by Prolo scale were as follows:good(score 8-10):80.3%, moderate(score 6-7):14.8%, poor(score 5 or less 5):4.9%. Device migration was observed in six cases:5(20%) of 25 CH cages and 1(2.8%) of 36 Novus cages. CONCLUSION: Unilateral PLIF using cage is one of method to decrease the rates of iatrogenic complications in patient of unilateral symptomatic spinal instability while preserving normal anatomic structures with good fusion success rates and clinicofunctional results after surgery.
Back Pain ; Follow-Up Studies ; Humans ; Outpatients ; Pseudarthrosis ; Retrospective Studies

OBJECTIVE: The aim of this study is to analyze the clinical symptoms, radiological changes, interval from first operation to symptom recurrence and to propose the proper treatment method for re-operated patients following chronic subdural hematoma surgery. METHODS: Between January 1992 and April 2003, 18 of 138patients of chronic subdural hematoma repeatedly underwent surgical treatment. The symptoms, mental status by Bender grade, radiological hematoma size and midline shifting, interval from symptom onset to diagnosis, surgical method and prognosis by Glasgow outcome scale(GOS) between the first attack and the recurrence were compared. RESULTS: The symptoms at the time of recurrence were nearly the same as with the first attack, but two patients(2/18, 11.1%) showed a more declined mentality. In addition, the recurred hematoma sizes were the same or large than those previously found. Many patients were recurred within two weeks(13/18, 72.2%). Most patients were operated on using the previous burr hole, with the exception of one patient who recurred at a different site. All patients had a good prognosis more than GOS 4(GOS 4: 4 , GOS 5: 12), but two died due to extracranial complication and infection. CONCLUSION: These results suggest that the early diagnosis and treatment are important, mostly recurred same symptoms within two weeks. Re-operation using the previous burr hole site is a good method.
Diagnosis ; Early Diagnosis ; Hematoma ; Hematoma, Subdural, Chronic* ; Humans ; Prognosis ; Recurrence ; Retrospective Studies*

No abstract available.
Budesonide* ; Humans

No abstract available.
Animals ; Catalase* ; Glutathione* ; Lung* ; Rats*

OBJECTIVE: The objective of this study is to evaluate the efficacy of microdecompression (MD) with microscope and tubular retractor in lumbar foraminal stenosis (FS) and to analyze the clinical outcomes. METHODS: From January 2006 to December 2007, 22 patients with symptomatic lumbar FS underwent conventional decompressive surgery (CDS) and MD was performed in other 20 patients. Clinical outcome was measured using a Visual Analogue Scale (VAS) and Macnab?fs criteria. Spinal instability was determined by radiologic assessment of flexion-extension radiographs. RESULTS: The CDS group included 14 men and 8 women. The MD group included 14 men and 6 women. The mean age was 66.2 years (range, 46-80 yrs) in the CDS group and 65.4 years (range, 59-74 yrs) in the MD group. Average follow-up periods were 18.6 months in the CDS group and 16.5 months in the MD group. Mean operating time was 126 minutes in the CDS group and 168 minutes in the MD group. The mean VAS of back pain decreased from 2.68 to 1.36 in the CDS group and from 2.85 to 1.25 in the MD group. The mean VAS score of leg pain decrea- sed from 6.68 to 1.48 in the CDS group and from 6.65 to 1.40 in the MD group. The success rate of CDS group was 86.3 % (19/22), compared with 85.0% (17/20) for MD group. Radiologically, there was no spinal instability. CONCLUSION:MD could achieve neural decompression and offer an effective treatment of lumbar FS. However it was a technically demanding procedure and effective in limited operative indications. We need to consider long-term follow-up.
Back Pain ; Constriction, Pathologic ; Decompression ; Female ; Follow-Up Studies ; Humans ; Leg ; Male