Abducens nerve palsy associated with spinal surgery is extremely rare. We report an extremely rare case of abducens nerve palsy after lumbar spinal fusion surgery with inadvertent dural tearing, which resolved spontaneously and completely. A 61-year-old previous healthy man presented with chronic lower back pain of 6 weeks duration and 2 weeks history of bilateral leg pain. He was diagnosed as having isthmic spondylolisthesis at L4-5 and L5-S1, and posterior lumbar interbody fusion was conducted on L4-5 and L5-S1. During the operation, inadvertent dural tearing occurred, which was repaired with a watertight dural closure. The patient recovered uneventfully from general anesthesia and his visual analogue pain scores decreased from 9 pre-op to 3 immediately after his operation. However, on day 2 he developed headache and nausea, which were severe when he was upright, but alleviated when supine. This led us to consider the possibility of cerebrospinal fluid leakage, and thus, he was restricted to bed. After an interval of bed rest, the severe headache disappeared, but four days after surgery he experienced diplopia during right gaze, which was caused by right-side palsy of the abducens nerve. Under conservative treatment, the diplopia gradually disappeared and was completely resolved at 5 weeks post-op.
Abducens Nerve ; Abducens Nerve Diseases ; Anesthesia, General ; Bed Rest ; Diplopia ; Headache ; Humans ; Leg ; Low Back Pain ; Middle Aged ; Nausea ; Paralysis ; Spinal Fusion ; Spondylolisthesis

No abstract available.

PURPOSE: Recently developed BMS(TM) (Zassi Bowel Management System(TM): Hollister Inc., Illinois, USA) can provide effective nonsurgical fecal diversion without the risks associated with colostomy creation and subsequent closure. Our aim is to evaluate the effectiveness of the BMS in diverting feces from the perianal wide surgical wound in patients with Fournier's gangrene. METHODS: BMS(TM) was applied in five patients (male: 2, median age; 44) with Fournier's gangrene from January 2000 to September 2001. The treatments consist of three times a day wound dressing after wide surgical debridement and intravenous antibiotic therapy. For evacuation of feces, twice daily warm saline irrigation was administered via BMS(TM) or low daily doses of polyethylene glycol solutions were orally taken in. An endoscopic and anorectal manometric study was done to evaluate possible mucosal complications and anorectal functional changes. RESULTS: The average duration of the BMS application was 41 (range, 22~63) days. The result of a manometric study after immediate removal of the BMS(TM) showed a decreased mean resting pressure (range: 22~36 mmHg) and a decreased mean squeezing pressure (range: 32~39 mmHg). After 3 days, the sphincter pressure had improved markedly: mean resting pressures of 38, 45, 60, and 63 mmHg and mean squeezing pressure of 78, 89, 91, and 101 mmHg respectively. Fecal incontience was not noted in any patient. Other possible mucosal complications were not noted. There were no mortalit. CONCLUSIONS: BMS(TM) application in Fournier's gangrene patients after surgery successfully avoids a defunctioning colostomy. Furthermore, no significant complications were noted over a prolonged period up to 63 days.
Bandages ; Colostomy ; Debridement ; Fasciitis, Necrotizing ; Feces ; Fournier Gangrene ; Humans ; Illinois ; Polyethylene Glycols

Two types of urine dipstick assays, Multistix-SG and Comber-9-Test RL, were compared for compatibility, accuracy, specificity and predictive values of a positive and negative test in 501 patients' urine and artificially prepared specimen. We found that the results of semiquantitative tests of Multistix-SG and Comber-9-Test RL performed were statistically similar in patients' specimen. The urinary leukocyte esterase tests of Comber-9-Test RL assays compared with urine sediment microscopy in regard to compatibility, sensitivity, specificity, and predictive values of a positive and negative test 83.7%, 48.1%, 90.3%, 47.4% and 90.1%, respectively. The urinary nitrite tests of Comber-9-Test RL assays compared with urine culture tests, in regard to compatibility, sensitivity, specificity, and predictive values of a positive and negative test were 90.3%, 19.4%, 84.7%, 53.8% and 94.1, respectively. For the urinary protein, the sulfosalicylic acid method was the most sensitive test for any kinds of protein, and Multistix-SG appeared more sensitive than Comber-9-Test RL for the albuminuria. For the urinary bilirubin and glucose, two dipstick assays were similar in their diagnostic efficiency. Finally in the urinary occult blood tests, Comber-9-Test RL assays was more sensitive than Multistix-SG.
Albuminuria ; Bilirubin ; Glucose ; Leukocytes ; Methods ; Microscopy ; Occult Blood ; Sensitivity and Specificity ; Urinalysis

Carotid endarterectomy is superior to medical treatment in preventing secondary stroke in patients with symptomatic high grade carotid stenosis. Transluminal angioplasty is a promising procedure as an alternative treatment for these patients. We report two cases of carotid angioplasty with Palmaz-Schatz stent in patients with carotid artery occlusive disease. One patient presented with decreased right visual acuity because of retinal arterial embolism. The angiogram demonstrated a discrete tight stenosis of right internal carotid artery carotid stenting with Palmaz-Schatz coronary stent was performed without any significant complications. The other patient presented with recurrent episodes of cerebral infarction, for which he had undergone left carotid erdarterectomy 3-years ago. The carotid angiogram demonstrated tight stenoses of both internal carotid arteries. Carotid artery stenting was performed at left and right internal carotid arteries without any complications. We suggest that stenting may be an effective and safe therapeutic alternative to surgical treatment in some selected patients with carotid artery occlusive disease.
Angioplasty* ; Carotid Arteries* ; Carotid Artery, Internal ; Carotid Stenosis* ; Cerebral Infarction ; Constriction, Pathologic ; Embolism ; Endarterectomy, Carotid ; Humans ; Retinaldehyde ; Stents* ; Stroke ; Visual Acuity

Spinal cord infarction as a complication of spine surgery occurs rarely. Herein, a case of spinal cord infarction, which developed in a 69 year old woman following posterior decompression and internal fixation for a T11 bursting fracture, is descirbed. The anesthetic induction and intraoperative course were uneventful, except at the end of the procedure, where her blood pressure suddenly dropped from 130/90 to 90/60 mmHg. The patient was aggressively treated with a transfusion and vasopressor, the blood pressure then returned to its usual value within 10 minutes. However, during a physical examination in the recovery room, the patient was found to have flaccid lower limbs, with impaired sensory function below the T8 level. Her cord diameter had increased, and a high signal lesion was observed within the thoracic spinal cord, from T9 to T12 level on T2-weighted MR images, which was diagnosing as a spinal cord infarction, was and showed no improvement despite the immediate and aggressive treatment.
Aged ; Blood Pressure ; Decompression ; Female ; Humans ; Infarction* ; Lower Extremity ; Physical Examination ; Recovery Room ; Sensation ; Spinal Cord* ; Spine*

OBJECTIVES: The aim of this study was to examine the association of attention-deficit hyperactivity disorder (ADHD) in Korean populations with functional polymorphisms of six genes dopamine receptors (Ser311/Cys311 polymorphism, Taq1 A polymorphism, and Taq1 B polymorphism in DRD2, BalI polymorphism in DRD3, and promoter -521 C/T polymorphism and exon III 48 bp repeat polymorphism in DRD4) and one gene in dopamine transporter (DAT1). METHODS: Participants were 58 children with ADHD and 110 control children. The genotypes were determined by PCR. RESULTS: There was a statistically significant difference in genotype frequency of -521 C/T polymorphism within the promoter region of the DRD4 between two groups. Furthermore, in the male group, both genotype and allele frequencies showed statistically significant differences. CONCLUSION: Findings of the study indicate that -521 C/T polymorphism in promoter region of DRD4 appears to be a possible candidate gene for ADHD in Korean population.
Attention Deficit Disorder with Hyperactivity ; Child ; Dopamine ; Dopamine Plasma Membrane Transport Proteins ; Exons ; Gene Frequency ; Genotype ; Humans ; Male ; Promoter Regions, Genetic ; Receptors, Dopamine

No abstract available.
Child* ; Humans ; Meningitis* ; Scrub Typhus*

No abstract available.
Leukemia*

No abstract available.
Cesarean Section* ; Female ; Pregnancy