Surgical treatment of cerebral arteriovenous malformations(AVM's) that are high flow and large remain particularly difficult to manage. It has been reported that normal perfusion pressure breakthrough(NPPB) syndrome occur more frequently in such AVM's and managing such AVM's by staged treatment may help to avoid the occurrence of this complication. The authors report our experience with one case of high flow, large AVM that would pose a great operative difficulty if it was to be managed by surgical resection alone. The patient was treated by a staged procedure in which a preoperative embolization was followed by a complete microsurgical excision. The staged, complementary approach proved to be quite useful and safe for the treatment of high flow, large AVM.
Arteriovenous Malformations ; Humans ; Intracranial Arteriovenous Malformations* ; Microsurgery* ; Perfusion

Conventional methods for stabilization of unstable cervical spines caused by flexion injury are sublaminar wiring and palte and screw fixation. These methods, however, carry the risk of damage to the cervical cord and or vertebral artery. We have used interlaminar clamps for the stabilization of sixteen cases of unstable cervical spine, including for cases of odontoid process fracture. There was suecessful fusion in all cases, no slippage of clamp and no deterioration of neurological function. Advantages of this method include the fact the there is no need for bone graft and that it is technically easy and inexpensive. Good stabilization allows early ambulation and so prevents complications such as pneumonia and decubitus ulcer.
Early Ambulation ; Odontoid Process ; Pneumonia ; Pressure Ulcer ; Spine* ; Transplants ; Vertebral Artery

Isolated hydroceohalus is an uncommon entity wihch results from obstruction of the level of the foramen of Monnro. We have recently expierience three cases of isolated loculations of the lateral ventricle cause by intraventricular hemorrhage and ventriculitis. All patients were treated sucessfully using one or multiple shunts.
Hemorrhage ; Humans ; Lateral Ventricles*

Isolated hydroceohalus is an uncommon entity wihch results from obstruction of the level of the foramen of Monnro. We have recently expierience three cases of isolated loculations of the lateral ventricle cause by intraventricular hemorrhage and ventriculitis. All patients were treated sucessfully using one or multiple shunts.
Hemorrhage ; Humans ; Lateral Ventricles*

The purpose of this study was to analyze and evaluate therapeutic results of stereotactic evacuation of hematoma, urokinase irrigation and external ventricular drainage(EVD) in comatose patients who had hypertensive supratentorial intracerebral hemorrhage. The authors carried out stereotactic evacuation of hematoma and external ventricular drainage in the consecutive 45 cases who were admitted to the Department of Neurosurgery, Chosun University Hospital. from Sep. 1990 to Jun. 1993. The therapeutic results were as follows : 1) The peak age incidences were 6th to 7th decades. The incidence was higher in female than male. The age was not related to the prognosis. 2) The hematoma was located at the basal ganglia in 37 cases, and the thalamic area in 8 cases. The prognosis was poorer as the area of hematoma extended more wider and deeper. 3) The volume of hematoma ranged from 8 to 155 ml. The prognosis of the patient was unfavorable in large volume of hematoma. 4) Intraventricular hemorrhage(IVH) occured in forty cases(89.9%) and mortality rate was 45%. The mortality rate was increased in cases with IVH than in case without it. 5) The mortality rates based on the Glasgow coma scale(GCS) on admission were 50% in GCS score 4 group, 50% in GCS score 5 group, 40% in GCS score 6 group, 27% in GCS score 7 group. Cases of low Glasgow coma scale on admission showed high mortality rate. 6) The overall mortality rate was 42%. These results suggest that stereotactic evacuation of hematoma and EVD decreased the mortality rate when compared with conservative treatment and conventional craniotomy in the literatures.
Basal Ganglia ; Cerebral Hemorrhage* ; Coma* ; Craniotomy ; Drainage* ; Female ; Glasgow Coma Scale ; Hematoma* ; Humans ; Incidence ; Intracranial Hemorrhage, Hypertensive ; Male ; Mortality ; Neurosurgery ; Prognosis ; Urokinase-Type Plasminogen Activator

Isoconazole nitrate is one of the broad-spectrum antimycotic agents recently developed from imidazole derivatives. Authors performed ulticenter trials to evaluate the therapeutic effect of Travogen and Travocort in superficial fungal diseases. In the usual superficial fungal diseases, Travogen was applied 4 weeks. In the inflammatory and eczematoid superficial fungal diseases, Travocort was applied 2 weeks initially and then followed by 2 weeks application of Travogen. One hundred and ninty one patients with superficial fungal diseases were included in this study during g months from December, 1982 to August, 19$3 The obtained results were as follows; The overall cure rate of Travogen and Travocort in each superficial fungal diseases were gl 7g (tinea pedis), 98. L% (tinea cruris), 1ppg, (tinea corporis), 9g. 100% (tinea manus), 1ppg (tinea capitis) and 1pgg (candidiasis) respectively. Trichophyton rubrum(51. 3%), Trichophyton mentagrophytes(29.3g), Tricho -countinue-
Humans ; Trichophyton

PURPOSE: To prospectively investigated the symptom changes in women with an overactive bladder (OAB) after discontinuation of 3 months of successful treatment with antimuscarinics and the pre-treatment factors that contributed to retreatment. MATERIALS AND METHODS: Sixty-eight women (mean age 51.4 years) with improvement in the symptoms of OAB after 4 weeks of treatment with propiverine hydrochloride (20mg/day) were prospectively enrolled in a protocol consisting of 8 further weeks of medication and a 4-week period of discontinuation. The frequency-volume charts were assessed before treatment, after the 12 weeks of therapy, and 4 weeks the end of the therapy. Changes in the frequencies, nocturia, urgency scores and urge incontinence at 12 and 16 weeks were evaluated. RESULTS: All of the OAB symptoms 4 weeks after discontinuation of medication remained improved compared to those initially recorded, but then deteriorated during further medication. At the baseline, and 12 and 16 weeks, the mean frequencies, nocturia and urgency scores per day were 11.2, 7.3 and 8.3, 1.6, 0.4 and 0.8, and 1.7, 0.6 and 1.2, respectively. The retreatment rate was 35.3%. Patients in the retreatment group were older (58.8 vs. 47.3 years, p<0.001) and had higher initial urgency scores (1.9 vs. 1.6, p=0.034). In an urodynamic study of 23 patients, those without detrusor overactivity (DO) maintained a significantly improved frequency after cessation of mediation, whereas those with DO (60.9%) did not. The retreatment rate was higher in patients with DO, but the difference was not significant. CONCLUSIONS: Three months of antimuscarinic therapy for OAB may not be sufficient. Older patients, or those with severe urgency, may be more likely to return to treatment.
Female ; Humans ; Muscarinic Antagonists ; Negotiating ; Nocturia ; Prospective Studies* ; Retreatment ; Urinary Bladder, Overactive* ; Urinary Incontinence, Urge ; Urodynamics

BACKGROUND: The release of interferon-gamma (IFN-gamma) by T lymphocytes increases after rechallenge with Mycobacterium tuberculosis antigen, especially, at a localized site of tuberculosis (TB) infection. We aimed to compare the clincial efficacy of two commercial IFN-gamma release assays from pleural fluid for the diagnosis in tuberculous pleurisy. METHODS: We performed T-SPOT.TB and QuantiFERON-TB Gold tests simultaneously on pleural fluid and peripheral blood samples from patients with pleural effusion, in South Korea, an area with intermediate TB burden. RESULTS: Thirty-six patients were enrolled prospectively, and tuberculous pleurisy was found in 21 patients. Both the numbers of IFN-gamma secreting T cells and the concentration of IFN-gamma were greater in the pleural tuberculous group, comparing with the non-tuberculous group. Moreover, in the tuberculous group, there was a significant difference in IFN-gamma producing spot-forming cells using the T-SPOT.TB method between pleural fluid and peripheral blood. The receiver operating characteristic (ROC) curve, was the greatest for pleural fluid T-SPOT.TB test, followed by peripheral blood T-SPOT.TB test, peripheral blood QuantiFERON-TB Gold test, and pleural fluid QuantiFERON-TB Gold test (area under the ROC curve of 0.956, 0.890, 0.743, and 0.721, respectively). The T-SPOT.TB assay produced less indeterminate results than did QuantiFERON-TB Gold assay in both pleural fluid and peripheral blood. CONCLUSION: These findings suggest that the pleural fluid T-SPOT.TB test could be the most useful test among the IFN-gamma release assays for diagnosing tuberculous pleurisy in an area with an intermediate prevalence of TB infection.
Humans ; Interferon-gamma ; Interferon-gamma Release Tests ; Mycobacterium tuberculosis ; Pleural Effusion ; Prevalence ; Prospective Studies ; Republic of Korea ; ROC Curve ; T-Lymphocytes ; Tuberculosis ; Tuberculosis, Pleural

PURPOSE: To compare prospectively and randomly tension-free vaginal tape(TVT) with transobturator vaginal tape inside-out(TVT-O) for the surgical treatment of female stress urinary incontinence(SUI). MATERIALS AND METHODS: One hundred twenty women with SUI were alternately assigned to either the TVT group(n=60) or TVT-O group(n=60). The preoperative evaluation included urodynamic study and a Korean version of the incontinence quality of life questionnaire(I-QoL). At 1-year after operation, surgical outcome, patient I-QoL parameters, long-term complications and uroflowmetry were evaluated in 2 groups. RESULTS: Preoperative patient characteristics including I-QoL and urodynamic study were comparable in the two groups. The rates of cure(86.8% for TVT vs. 86.8% for TVT-O), improvement(6.6% for TVT vs. 8.2% for TVT-O), and failure (6.6% for TVT vs. 5.0% for TVT-O) were similar for the two groups. The I-QoL parameters one year after surgery were improved significantly in both groups(p<0.001) and there was no difference between the two groups(p>0.05). The rates of the patient satisfaction with the procedure were 93.4% in the TVT group versus 95.0% in the TVT-O group(p>0.05). Mean operation time(11.5+/-1.4 min versus 15.2+/-1.8 min, p<0.05) was significantly shorter in the TVT-O than TVT. There were no long-term complications, such as vaginal erosion and prolonged voiding difficulty, in either group. CONCLUSION: TVT-O appears to be equally effective as TVT for the surgical treatment of stress urinary incontinence in women at a 1-year follow-up.
Female* ; Follow-Up Studies* ; Humans ; Patient Satisfaction ; Prospective Studies* ; Quality of Life ; Suburethral Slings* ; Urinary Incontinence* ; Urinary Incontinence, Stress ; Urodynamics

Erdheim-Chester disease (ECD) is a rare disease that is characterized by multi-organ involvement of foamy histiocytes. It causes systemic inflammation, and also demonstrates various clinical manifestations and has a poor prognosis. We encountered a case of ECD in a patient that had been treated for underlying polycythemia vera. As far as we know, this is the first reported case worldwide where ECD developed in association with polycythemia vera. A 59-year-old man visited our hospital due to pleuric pain at the right side of the chest. Pleural tissue that was obtained following a thoracoscopic biopsy showed non-Langerhan's cell histiocytosis, suggesting the presence of ECD. The histiocytes stained positively for CD68, but were negative for S-100 and CD1a. The patient also complained of pain at both hips and the right shoulder area. An X-ray and magnetic resonance image demonstrated that the lesion showed sclerosis and osteolysis in both the proximal femur and right humerus. Treatment was started with predinisolone, and subsequently cyclophosphamide was added. ECD is a very rare multi-systemic disease, and its cause and therapeutic options have not yet been defined. ECD has a poor prognosis. Therefore, we believe that additional case studies are needed prior to the determination of a novel therapy for ECD.
Biopsy ; Cyclophosphamide ; Erdheim-Chester Disease ; Femur ; Hip ; Histiocytes ; Histiocytosis ; Humans ; Humerus ; Inflammation ; Magnetic Resonance Spectroscopy ; Middle Aged ; Osteolysis ; Polycythemia Vera ; Prognosis ; Rare Diseases ; Sclerosis ; Shoulder ; Thorax