The authors studied 5 cases of idiopathic CNS hypersomnia who visited Division of Sleep Studies, Seoul National University Hospital in 1995. Detailed medical history was taken and nocturnal polysomnography(NPSG), multiple sleep latency test(MSLT)and human leukocyte antigen(HLA) typing were performed. Neither cataplexy nor hypnagogic hallucination was reported in all cases and in NPSGs, there were tendencies of increased sleep period time and decreased slow wave sleep time. In MSLT, all the subjects showed average sleep latencies less than 8 minutes without sleep-onset rapid eye movement period(SOREMP). In HLA typing, some correlation between idiopathis CNS hypersomnia and HLA DR4 was observed. in contrast to previous reports, overall treatment response with methylphenidate was remarkable. Therefore, the authors suggest that patients suspected of idiopathic CNS hypersomnia be actively evaluated and treated with rather optimistic perspective.
Cataplexy ; Central Nervous System* ; Disorders of Excessive Somnolence* ; Hallucinations ; Histocompatibility Testing ; Humans ; Leukocytes ; Methylphenidate ; Seoul ; Sleep, REM

No abstract available.
Spondylolisthesis*

No abstract available.
Female ; Laparoscopy* ; Methotrexate* ; Pregnancy ; Pregnancy, Ectopic*

We studied the effectiveness of serotonin 1a agonist(8 OH DPAT) on the 24 hour ionic lesion volume produced by permanent occlusion of the middle cerebral artery(MCAo) in rats. A 4-hour intravenous infusion of 30 micro mg/kg/hr of 8 OH DPAT were given starting at 10 minutes after occlusion. Tissue concentrations of Na, K, and water at infarct and peri-infarct zone were measured by atomic absorption spectroscopy and by wet-dry weight measurements 24 hours after occlusion. Compared with vehicle treatment, 8 OH DPAT treatment reduced tissue water accumulation by 10% and 55% in the frontopyriform cortex(L1) and frontoparietal cortex(L2), sodium accumulation by 20% at L1 and 47% at L2, potassium loss by 24% at L1 and 44% at L2, cell volume fraction loss by 24% at L1 and 47% at L2. Finally the treatment reduced overall lesion volume by about 37%. All these changes were statistically significant at p<0.05. Our findings suggest strongly that 8 OH DPAT is neuroprotective in the rat MCAo model of focal cerebral ischemia.
Absorption ; Animals ; Brain Ischemia ; Cell Size ; Infarction, Middle Cerebral Artery* ; Infusions, Intravenous ; Ischemia* ; Middle Cerebral Artery* ; Potassium ; Rats* ; Receptor, Serotonin, 5-HT1A* ; Serotonin* ; Sodium ; Spectrum Analysis

The purpose of this study was to establish whether pre-injury administration of the methylprednisolone sodium succinate(MP) is effective for the treatment of acute spinal cord injury in rat, as it has ben demonstrated that high dose of MP is effective in the treatment of acute spinal cord injury. Spinal cord injury was made by dropping a rod weighing 10 gm from a height of 1.25, 2.5, and 5.0cm onto the rat spinal cord at T-10, which had been exposed via laminectomy. In order to determine the effectiveness, single dose of 5, 15 and 30mg/kg of MP was administrated at 10 minute before injury. The primary outcome was 24-hour spinal cord lesion volume estimated from spinal cord Na+ and K+ shifts. Surprisingly, we failed to find any statistically significant preventive effect compare to control vehicle. Until this result is clearfied, we recommend that acute pre-injury MP therapy be cautiously applied in operating room. The possible causes of this unexpected result are discussed.
Animals ; Laminectomy ; Methylprednisolone* ; Operating Rooms ; Rats ; Sodium ; Spinal Cord Injuries* ; Spinal Cord*

Left ventricular free wall rupture following acute myocardial infarction (AMI) is the second most common cause of death and has been reported to be responsible for 4 to 24% of all infarction deaths. The rupture occurs anywhere from a few hours to several days after AMI. The common findings of ventricular rupture are persistent chest pain bradycardia and shock. This may be often mistaken for the ruptured dissection of the ascending aorta. The different points from dissection are 1) persistent chest pain 2)persistent ST segment elevation and 3) only intramural hematoma in ascending aorta. We have sucessfully managed two patients with postinfarction myocardial rupture. Surgical management consisted of infarctectomy repairi of the ventricular rupture and coronay artery bypass grafting. We conclude that successful surgical management of ventricular free wall rupture should require prompt diagnosis and emergency operation.
Aorta ; Arteries ; Bradycardia ; Cause of Death ; Chest Pain ; Diagnosis ; Emergencies ; Heart Rupture* ; Hematoma ; Humans ; Infarction ; Myocardial Infarction ; Rupture ; Shock ; Transplants

Sinus histiocytosis with massive lymphadenopathy known as Rosai-Dorfman disease is characterized by painless bilateral cervical lymphadenopathy. Extranodal manifestations are uncommon and spinal involvement is rare. A 15-year-old man presented with intermittent midthoracic back pain only. He had no specific findings on neurologic examinations, hematologic and biochemical laboratory tests. Radiological examination of thoracic spine revealed collapse of T6 vertebrae with thoracic kyphosis and osteolytic lesion of T12 vertebra body. He underwent a removal of bone tumor, anterior reconstruction with mesh and pedicle screw fixation via posterior approach for pathologic confirmation and stabilization. Histopathologic study of the lesion revealed focal infiltration of large histiocytes showing emperipolesis. Immunochemistry stain of histiocytes was positive for CD68 and S-100 but negative for CD1a. This report presents a rare case and literature review of extranodal Rosai-dorfman disease in thoracic spine.
Adolescent ; Back Pain ; Emperipolesis ; Fractures, Compression* ; Histiocytes ; Histiocytosis, Sinus* ; Humans ; Immunochemistry ; Kyphosis ; Lymphatic Diseases ; Neurologic Examination ; Spine*

PURPOSE: The purpose of this study was to evaluate the safety, feasibility and effectiveness of an endoluminally-placed bifurcated stent-graft (Vanguard) for the treatment of infrarenal abdominal aortic aneurysm (AAA). METHODS: Transluminal endovascular stent-graft placements were attempted in 29 patients (28 male, mean age 69+/-7 years) with AAAs involving the common iliac arteries from Aug. 1997 to Jan. 1999. Endovascular therapy was performed in the cardiac catheterization laboratory with epidural anesthesia. One side of the femoral artery was opened by surgical cutdown for the bifurcated stent-graft entry and the other side was punctured percutaneously for the straight stent-graft. Computed tomography and/or intraarterial angiography were performed during an average follow-up of 10 months (2-18 months). RESULTS: Primary success rate was 75.9% (22 of 29 patients) and the overall success rate was 79.3% with successful correction of one perigraft leak. Twenty patients (69.0%) had significant coronary artery disease. There were two technical failure cases, the one was tortuous iliac vessel with spasm, the other was disconnection of the stent-graft connecting portion. Complications related to procedure occurred in 13.8% of patients (4 of 29 patients) and two of these four patients had procedure-related mortality because of acute renal failure following contrast overdose and sepsis after operation. CONCLUSIONS: Endovascular treatment of infrarenal AAA with bifurcated stent-graft (Vanguard<0A397>) is effective, feasible and relatively safe. However, further investigation for the outcome, complication and long-term follow-up are needed.
Acute Kidney Injury ; Anesthesia, Epidural ; Angiography ; Aortic Aneurysm, Abdominal* ; Cardiac Catheterization ; Cardiac Catheters ; Coronary Artery Disease ; Endoleak ; Femoral Artery ; Follow-Up Studies ; Humans ; Iliac Artery ; Male ; Mortality ; Sepsis ; Spasm

No abstract available.

OBJECTIVE: To determine the efficacy of various posterior fusion techniques in managing C1/2 instability. PATIENTS AND METHODS: Retrospective review of patients undergoing C1/2 posterior fusioin was undertaken with the aim of determining the long-term outcome of the selected procedures. Forty-two patients requiring posterior atlantoaxial fusion for various pathologies were treated with various instruments for internal spinal fixation. Forty-two patients underwent 45 procedures from 1990 to 1997, with a mean follow-up of 2.7 years(range 8 months-7 years) RESULTS: The most common disease processes were odontoid fracture(12 patients), os odontoideum(13), and rheumatoid instability(7). Nineteen interspinous wirings, 17 transarticular screw fixations, 9 halifax clamp applications were performed. Three of Halifax fixation and 2 of wiring failed in long term follow up. Among of them, bony fusion was failed in 3 patients which consequently required reoperation. All transarticular screw procedures resulted in successful fusions. CONCLUSIONS: Transarticular screw fixatioin has several potential advantages compare to other procedures as a technique for C1/2 posterior arthrodesis.
Arthrodesis ; Follow-Up Studies* ; Humans ; Pathology ; Reoperation ; Retrospective Studies