Sacral insufficiency fractures are unexpected causes of inguinal, lower back and buttock pain in elderly women with osteoporosis who have sustained unknown or only minimal trauma. Differential and radiological diagnoses of these fractures are often difficult. Bone scan remains the standard diagnostic tool, but computed tomography or magnetic resonance image may be required to differentiate insufficiency fracture from other diseases such as malignant bone lesion. The fracture usually extends vertically in the sacral ala, parallel to the sacroiliac joints. This distribution suggests that such fractures could be partially caused by weight-bearing transmitted through the spine. We report the treatment of insufficiency sacral fracture in one osteopenic patient who has been confirmed by computed tomography and treated with conservative method that convinced by follow up computed tomography.
Aged ; Buttocks ; Diagnosis ; Female ; Follow-Up Studies ; Fractures, Stress* ; Humans ; Osteoporosis ; Sacroiliac Joint ; Sacrum* ; Spine ; Weight-Bearing

STUDY DESIGN: A case report. OBJECTIVES: To report a rare case of a surgically treated tuberculous myelitis and arachnoiditis patient with incomplete paraplegia. SUMMARY OF LITERATURE REVIEW: Tuberculous myelitis and arachnoiditis is a rare disease with a high rate of neurologic deficit. This condition is treated using antituberculous medication and high-dose steroid therapy, but surgical treatment has rarely been reported and the outcomes vary. MATERIAL AND METHODS: A 29-year-old female had tuberculous myelitis and arachnoiditis. The patient was treated with antituberculous medication and high-dose steroid therapy, but the treatment failed and the patient could not walk because of incomplete paraplegia. The surgical treatment was performed twice; we decompressed by total laminectomy and debrided the infected arachnoid membrane. Four months after surgery, we performed anterior interbody fusion due to the development of spondylitis with kyphosis. RESULTS: Three years after the first operation, the patient's neurologic state improved and she could walk 90 m without assistance. CONCLUSIONS: Here, we report a very rare case of surgically treated tuberculous myelitis and arachnoiditis and provide a treatment option for this condition to spine surgeons.
Adult ; Arachnoid* ; Arachnoiditis* ; Brain* ; Female ; Humans ; Kyphosis ; Laminectomy ; Membranes ; Meningitis* ; Myelitis* ; Neurologic Manifestations ; Paraplegia ; Rare Diseases ; Spine ; Spondylitis*

The familial occurrence of intracranial aneurysms, defined as the presence of one or more aneurysms in two or more blood relatives, is well established and is relatively rare. The pattern of inheritance in these families is not usually known. The authors report one case of familial intracranial aneurysm, without specific genetic disorder, occurring during a recent six-month period in three of five siblings. Two of these were females, aged 36 and 39, and the other was a 40-year-old male. Two of these patients had ruptured aneurysms, but in the other, the aneurysm was unruptured. All were treated successfully by clipping of the aneurysmal neck, without any neurological deficits. The authors describe their experience of a rare familial intracranial aneurysm, occurring in the absence of a specific genetic disorder, and review the literature concerning this type of aneurysm.
Adult ; Aneurysm ; Aneurysm, Ruptured ; Female ; Humans ; Intracranial Aneurysm* ; Male ; Neck ; Siblings ; Subarachnoid Hemorrhage ; Wills

Sturge-Weber syndrome was rare. But reported from 1860. We present a typical case of Sturge-Weber syndrome in a child and discussed the symptoms, signs, and pathological finding of various examinations in neurosurgical field such as plain x-ray, 4-vessel angiography, CT scan, EEG, IQ test, exophthamometry, opthalmometry, and fundoscopy. We find marked abnormality and asymmetry in that examination.
Angiography ; Child ; Electroencephalography ; Humans ; Sturge-Weber Syndrome* ; Tomography, X-Ray Computed

Radiologic findings of Middle East respiratory syndrome (MERS), a novel coronavirus infection, have been rarely reported. We report a 30-year-old male presented with fever, abdominal pain, and diarrhea, who was diagnosed with MERS. A chest computed tomographic scan revealed rapidly developed multifocal nodular consolidations with ground-glass opacity halo and mixed consolidation, mainly in the dependent and peripheral areas. After treatment, follow-up imaging showed that these abnormalities markedly decreased but fibrotic changes developed.
Adult ; Coronavirus Infections/pathology/*radiography ; Fever/virology ; Fibrosis ; Humans ; Male ; *Middle East Respiratory Syndrome Coronavirus ; Radiography, Thoracic/*methods ; Republic of Korea ; Tomography, X-Ray Computed/*methods

Carcinoembryonic antigen(CEA) in blood and CSF was reported to be increased in cases of nervous system neoplasms by some investigators. To evaluate the oncological diagnostic value of CEA in the neurosurgical conditions, this study has been performed on 24 nervous system neoplasms and 8 non-nervous system as well as 49 controls. In addition, alpha-fetoprotein was also measured on the same conditions because of its close oncologic nature and recent diagnostic application on the general surgical conditions. The CEA concentration in blood and CSF were determined by CEA Radioimmunoassay kit, and the alpha-fetoprotein in blood and CSF were determined by GammaDab kit. The result showed that concentration of CEA and alpha-fetoprotein was higher and seemed to diagnostic in Extra-CNS neoplasma. In nerovous system, however, these were the lower than we expected, although were higher than control. Moreever, these levels were not unique on same oncologic condition and rather somewhat variable. From these results, increased concentration of these itself may be considered suggestive of existence of nervous system neoplasm, but it does mean neither degree of malignancy nor its origin.
alpha-Fetoproteins* ; Carcinoembryonic Antigen* ; Central Nervous System ; Humans ; Nervous System Neoplasms ; Radioimmunoassay ; Research Personnel

We report a case of a 21-year-old male who died from lethal Aspergillus endocarditis 3 months after heart transplantation. He underwent heart transplantation in other country. He was treated with hemodialysis for acute renal failure due to cyclosporine and then transferred to our hospital. When he complained high fever, follow-up echocardiography showed a large mobile echogenic mass attached to posterior mitral valve leaflet. The result of serum Aspergillus galactomannan antigen assay was positive. He was empirically treated with intravenous amphotericin B and antibiotics. However, he was rapidly deteriorated and died on hospital day 3.
Acute Kidney Injury ; Amphotericin B ; Anti-Bacterial Agents ; Aspergillus* ; Cyclosporine ; Echocardiography ; Endocarditis* ; Fever ; Follow-Up Studies ; Heart Transplantation* ; Heart* ; Humans ; Male ; Mitral Valve ; Renal Dialysis ; Young Adult

This study analyzed the outcome of 26 cases of cesarean hysterectomy performed at Wonju Christian Hospital, College of medicine, Yonsei university during 15 years from January, 1982 to May, 1996. There were 27,602 deliveries during this period. Cesarean hysterectomy was performed in 11 of 10,373 cesarean section(0.11 %) and in 15 of 17,229 vaginal deliveries(0.09 %). The age of patients varied from 20 to 48. Indications for emergency cesarean hysterectomy were uterine atony (46.2 %), uterine rupture(26.9 %), and placenta accreta(19.2 %). The relative risk of emergency hysterectomy was 1.22(95 % confidence interval 0.56 to 2.65) for cesarean deliveries, 1.91(95 % confidence interval 0.73 to 4.98) for prior cesarean deliveries and 20.56(95 % confidence interval 10.85 to 38.95) for placenta previa. The patients who had cesarean hysterectomy received from 750 ml to 11,500 ml of blood transfusion with a mean of 3,500 ml. No significant differences in length of operating time, amount of blood loss and postoperative complications were found between total abdominal hysterectomy and subtotal abdominal hysterectomy. In about 1/2 of total patients (46.2 %), there were no operative complications. Maternal death was found in 1 case. Hemorrhage still remains main cause of maternal mortality, the decision of hysterectomy must be conjunction with maternal life saving and free from various dangerous sequalae. So in this study, clinical evaluation for cesarean hysterectomy and an attempt to identify risk factor that might pridict those patients likely to require emergency hysterectomy was made.
Blood Transfusion ; Emergencies ; Gangwon-do ; Hemorrhage ; Humans ; Hysterectomy* ; Maternal Death ; Maternal Mortality ; Placenta ; Placenta Previa ; Postoperative Complications ; Risk Factors ; Uterine Inertia

Congenital Abnormalities ; Dental Arch ; Dentofacial Deformities ; Esthetics ; Magnetic Resonance Imaging ; Maxilla ; Orthognathic Surgery ; Vertical Dimension

OBJECTIVE: Angiogenesis, the proliferation of capillary endothelial cells, is a vital component in the development, progression, and metastasis of many human tumors. Vascular endothelial growth factor(VEGF) is an endothelial cell-specific mitogen and induces angiogenesis and vascular permeability. The features of glioblastoma, distinct from low grade astrocytomas, are the presence of necroses and vascular endothelial proliferation. In this study, we investigated VEGF expression in the different grades of astrocytomas and determined whether VEGF expression correlates with development of glioblastoma and progression of astrocytomas. PATIENTS AND METHODS: Forty seven patients with astrocytic tumors(24 males and 23 females), aged 3 to 65 years, were evaluated. Immunohistochemical staining was carried out using labelled streptavidin biotin method and primary antibody was a antirabbit polyclonal Ab against N-terminus region of VEGF165(Oncogene research product, MA, USA). Immunoreactivity(IR) was classified into no IR(absent or a trace of stain), moderate IR and intense IR by level of staining amount and intensity. RESULTS: Six pilocytic astrocytomas showed 3 no IR and 3 moderate IR, 10 astrocytomas showed 2 no IR, 6 moderate IR and 2 intense IR, 12 anaplastic astrocytomas showed I no IR, 7 moderate IR and 4 intense IR and 19 glioblastomas showed 1 no IR, 11 moderate IR and 7 intense IR. Immunoreactivity was significantly different between low and high grade of tumors but there was no significant difference between anaplastic astrocytomas and glioblastomas. Gemistocytic tumor cells represented the predominent VEGF-immunoreactive cell types, as compared with compactly-arranged small tumor cells. In glioblastomas VEGF IR was observed in both perinecrotic and vital tumor areas. CONCLUSION: VEGF seems to be a important angiogenic factor in anaplastic astrocytomas and glioblastomas and VEGF expression may contribute to neovascularization of human astrocytomas.
Angiogenesis Inducing Agents ; Astrocytoma ; Biotin ; Capillary Permeability ; Endothelial Cells ; Glioblastoma ; Humans ; Male ; Necrosis ; Neoplasm Metastasis ; Streptavidin ; Vascular Endothelial Growth Factor A*