No abstract available.
Seoul*

Since Maisonneuve mentioned osteomyelitis by typhoid fever for the first time in 1835, numerous investigators had reported salmonella osteomyelitis. But these are very rare in its incidence ; only 0.82% of patients with typhoid infections have skeletal involvement. The authors recently experienced a case of salmonella osteomyelitis in lumbar spine respectively caused by salmonella typhi D group. A 48 year-old female was admitted to our Dept. of Neurosurgery with 4 months history of severe lumbago. On hospitalization her emperature raised upto 39 degrees C once and widal test showed salmonella typhosa OH 640x. Lumbar spine X-ray films demonstrated irregular bony destruction of L2 and L3 with mild degree of narrowing of intervertebral space of L2-3. Pus evacuation and currettage of involved vertebrae surgically were performed. Salmonella osteomyelitis involving intervertebral space was confirmed by culture of pus obtained from pathologic lesion and by biochemical test. Satisfactory result is obtained by surgical and antibiotic therapy.
Female ; Hospitalization ; Humans ; Incidence ; Low Back Pain ; Middle Aged ; Neurosurgery ; Osteomyelitis* ; Research Personnel ; Salmonella typhi ; Salmonella* ; Spine* ; Suppuration ; Typhoid Fever ; X-Ray Film

We presented two cases of entrapment neuropathy which were confused with herniated lumbar disc syndrome. One was "meralgia paresthetica in association with lumbar disc herniation", and "the other inguinal neuritis along with obturator neuritis". Syndromes of these entrapment neuropathies were confirmed by subcidence of pain and creation of progressively longer pain-free intervals after analgesic blocks of the corresponding nerves by infiltration of Xylocaine and prednisolone.
Lidocaine ; Nerve Compression Syndromes ; Neuritis ; Prednisolone

Although there are differences in the mode of onset, symptomatology and clinical course in the various types of cerebrovascular lesions, the general picture may be quite similar and it is often difficult to determine the nature of the lesion in any individual case from the clinical data. In the vast majority of cases the symptoms of a cerebrovascular accident are of sudden onset and reach maximum intensity within few minutes or a few hours at the most. Locksley, et al. have reported autopsies on people who died from spontaneous intracerebral or subarachnoid hemorrhage, and they found that a primary or metastatic brain tumor was the cause of hemorrhage in only 2%~3% of their necropsy. We presented our experience with two such patient whose clinical pictures before the surgery were quite similar with those of cerebrovascular accident. Cases with a large chronic subdural hematoma and cerebral glioblastoma multiforme demonstrated a sudden and dramatic onset of coma and focal neurological symptoms immediately before admission to the hospital. The responsible mechanism or etiology for the mode of such sudden dramatic onset of symptoms may be derangement of intracranial pressure mechanism and sudden hemorrhage in the tumor.
Autopsy ; Brain Neoplasms ; Coma ; Glioblastoma ; Hematoma, Subdural, Chronic ; Hemorrhage ; Humans ; Intracranial Pressure ; Stroke* ; Subarachnoid Hemorrhage

A case is presented in which left-sided hemiparesis was caused by a fibromuscular dysplasia of the right internal carotid artery in the neck, and it used as a basis for discussion of the angiographic features. The 24-year-old woman was admitted to our Department of Neurosurgery, Korea University hospital, with the complaints of headache and left-sided hemiparesis which developed abruptly about one month before this admission. The carotid angiography was performed by puncture of the right common carotid artery under the clinical impression of cerebral thrombosis, which showed no gross intracranial abnormalities. But the characteristic findings were observed under and widening of the arterial lumen which are so-called loose stocking appearance or 'string of beads' appearance and are the typical feature of fibromuscular dysplasia. No surgical interventions such as arterial reconstruction and grafting, or arterial dilatation with bougies were applied on the patient, and she was discharged from the hospital three days after the admission. Fibromuscular dysplasia is a rare sclerotic, noninflammatory lesion of unknown etiology involving the wall of large arteries. This disease is found most frequently in early adult life and women are afflicted more often than men, This condition has been described most often in the renal arteries, where it has been found to be a cause of hypertension. Among the involvement of carotid system, the cervical portion of the internal carotid artery is most often affected, and the involvements are often bilateral. When localized to the internal carotid arteries, it can give symptoms of intermittent or permanent cerebral ischemia, but is usually asymptomatic. The typical angiographic appearance is the main parameter for diagnosis of fibromuscular dysplasia.
Adult ; Angiography ; Arteries ; Brain Ischemia ; Carotid Artery, Common ; Carotid Artery, Internal* ; Diagnosis ; Dilatation ; Female ; Fibromuscular Dysplasia* ; Headache ; Humans ; Hypertension ; Intracranial Thrombosis ; Korea ; Male ; Neck ; Neurosurgery ; Paresis ; Punctures ; Renal Artery ; Transplants ; Young Adult

By the expansion of stalk of laminaria inserted into the right epidural space of the rabbit head, cerebral compression and edema were produced. The studies of the occurrence and changes of experimental brain edema have been observed by weighing the wet and dry brain tissue, and by calculating the percentage of water content and that of swelling, with rate of per cent water content to that of control group. The percentage of water content and swelling of cerebral gray and white matters in the compressed site showed higher values than those in control and in non-compressed groups. As compared with normal group, the rate of per cent water content of cerebral gray matter at the site of compression showed gradually increasing tendency as time elapsed by 12 hours, while that of white matter demonstrated a increase of it by 24 hours and decreased gradually thereafter. Cerebral edema induced by laminaria compression was more evident and severe in the white matter than in the gray. Oxygen and glucose that are utilized the brain are two of the most important substances and play very important roles in the brain to form high energy bond and nucleic acid. Authors have attempted to measure oxygen consumption in normal rabbit brain and diseased brain that are produced by the expansion of stalk of laminaria in the intracranial epidural space. The value of oxygen consumption of cerebral gray and white matters in the compressed hemispheres showed higher values than those in control group, and they revealed a tendency of rather rapid increases at early experimental stages, an of gradual decrease thereafter.
Brain Edema* ; Brain* ; Edema ; Epidural Space ; Glucose ; Head ; Laminaria ; Oxygen ; Oxygen Consumption

Bleeding into the subarachnoid space is one of frequent complications in neurosurgical practice and most frequently caused by rupture of meningeal by trauma to the head. Hemorrhage into the subarachnoid space may occur in patient with blood dyscrasias, intracranial tumors, vascular anomalies, certain toxic or infectious disease of the nervous system, and intracerebral hemorrhages. In may be worthy academic interest and clinical practice to estimate the age of blood after hemorrhage into cerebrospinal fluid (CSF). The age was estimated and assessed by an immunological method with hemoagglutination activity using native Korean phytoagglutinin. The age of the red blood cells in RBC-CSF suspension of normal subjects was assessed and estimated by the hemoagglutination of phytoagglutinin in vitro. Vicia PHA and Clerodendron PHA chosen from among 18 different varieties of PHA are panhemoagglutinin and demonstrated the agglutination reaction most effectively. The agglutination activity of PHA with RBC-CSF suspension decreased gradually as time elapsed and activity subsided on 7~8th day. The age of RBC in CSF can be estimated by titration. The agglutination activity of PHA to RBC in CSF suspension continued for a longer period than that of PHA to either RBC in normal saline or anti-serum A and B in CSF. It would be well to say that the experimental results can be applied to clinical situations, especially subarachnoid hemorrhage.
Agglutination ; Cerebral Hemorrhage ; Cerebrospinal Fluid* ; Clerodendrum ; Communicable Diseases ; Erythrocytes ; Head ; Hemorrhage ; Humans ; Nervous System ; Rupture ; Subarachnoid Hemorrhage ; Subarachnoid Space ; Vicia

We found an error in this article. The author's name should be corrected as following: from "Younsuk Koh" to "Younsuck Koh".

BACKGROUND: Critical care physician staffing is a crucial element of the intensive care unit (ICU) organization, and is associated with better outcomes in ICUs. Adult ICUs in Korea have been suffering from inadequate full-time intensivists and nurses because of insufficient reimbursement rates (<50% of the original critical care cost) from the National Health Insurance System. Recently, full-time intensivists have been introduced as a prerequisite for adult ICUs of tertiary hospitals in Korea. The purpose of this study was to examine the perception of intensivist staffing among critical care program directors regarding the barriers and solutions when implementing an intensivist model of critical care in Korea. METHODS: An email survey of critical care program directors in designated teaching hospitals for critical care subspecialty training by the Korean Society of Critical Care Medicine was performed. The survey domains included vision, culture, resources, barriers, and potential solutions to implementing intensivist physician staffing (IPS). RESULTS: Forty-two critical care program directors were surveyed. A total of 28 directors (66.7%) responded to email queries. Of these, 27 directors (96.4%) agreed that IPS would improve the quality of care in the ICU, although half of them reported a negative perception of relevant clinical colleagues for the role of full-time intensivists and poor resources for IPS in their hospitals. Increased financial burden due to hiring full-time intensivists and concerns regarding exclusion from the management of their critically ill patients in the ICU, together with loss of income for primary attending physicians were stated by the respondents to be major barriers to implementing IPS. Financial incentives for the required cost from the health insurance system and enhancement of medical law relevant to critical care were regarded as solutions to these issues. CONCLUSIONS: Critical care program directors believe that intensivist-led critical care can improve the outcome of ICUs. They indicated the financial burden due to IPS and underestimation of a full-time intensivist's role to be major barriers. The program directors agreed that a partnership between hospital leaders and the Ministry of Health and Welfare was needed to overcome these barriers.
Adult* ; Critical Care ; Critical Illness ; Electronic Mail ; Hospitals, Teaching ; Humans ; Insurance, Health ; Intensive Care Units ; Jurisprudence ; Korea ; Motivation ; National Health Programs ; Personnel Staffing and Scheduling ; Surveys and Questionnaires ; Tertiary Care Centers

Acute gastric mucosal lesions (AGM lesions) is a general term applied to conditions characterized by the acute development of mucosal lesions in the form of erythema, mucosal hemorrhage, erosions and ulcerations in the mucosa of the stomach and duodenum. Although the pathopphysiological events leading to the formation of these lesions remain unknown, we do know that they are after preceded by one of many situations. It has become traditional to use the term stress ulcer to describe AGM lesions proceded by a major stress such as that of an operation or of severe thermal burns or hemorrhagic shock. The silent clinical manifestation of acute gastric mucosal lesions, regardless of their cause, is bleeding. AGM lesions were experimentally produced by brain injury and administration of steroid. This experimental study was conducted in order to study the so called AGM lesions, especially on production and pathology of them. This experimental animals, normal adult rate, were divided into 4 groups the first group of brain injury, the second group of brain injury and administration of steroid, the third group of administration of steroid only, and the fourth group of normal control with administration of normal saline and normal rats. The frequency of AGM lesions was studied in relation to each experimental group, experimental period and grade of lesions. The AGM lesions were divided into 3 grades depending on the macroscopic and microscopic findings. 1. AGM lesions were observed in 34 out of 63 all experimental animals except for control group of animal. Majority of the lesions were found in the glandular portion of the stomach. 2. In the brain injured group, the lesions that was erythematous and superficial mucosal erosion were found in 3 out of 21(14.3%), which were observed only in experimental period of 3-5 days. 3. In the group with brain injury and steroid administration, the lesions were found in 16 out of 21 animals(76.2%) among them grade 1 was in 2 out of 16, grade 2 in 10 and grade 3 in 4, which observed in the period of 2-7 days. 4. In the group with administration of steroid, the lesions were found in 15 out of 21 animals(71.4%), among them grade 1 was 2 out of 15, grade 2 in 11 and grade 3 in 2, which started to be observed form 2nd day through out the experimental period. 5. No lesions were investigated in the control group. No correlation between the variety of brain injury and production of AGM lesion was studied.
Adult ; Animals ; Brain ; Brain Injuries ; Burns ; Duodenum ; Erythema ; Hemorrhage ; Humans ; Mucous Membrane ; Pathology ; Rats ; Shock, Hemorrhagic ; Stomach ; Ulcer