No abstract available.
Osteoarthritis*

Various kinds of spinal instrumentation have been developed for treatment of spinal disorders which are associated with instability. Recently, newly designed devices using pedicle screw were developed with advantages of short segment fixation and firm internal fixation. This is a retrospective clinical and roentgenographic study to evaluate the effectiveness of Cotrel 1. Of the 27 cases, spinal stenosis were 11, spondylolisthesis were 8, spondylolysis were 4, burst fracture were 2, metastatic bone tumor was 1, and failed back syndrome was 1 case. 2. Result of clinical evaluation by Hanley's criteria at last follow up were excellent in 7(27%), Good in 15(58% ), fair in 4(15%). (1 case of metastatic bone tumor was excluded). 3. In the cases of spondylolisthesis, we tried to reduce the displacement in 2 cases of Meyerding Grade II, and 1 case was reduced and 1 case was not reduced. In the cases of of Meyerding Grade I, no further displacement was developed. 4. The complications were observed in 10(37%)cases. A) Generalized complications were 2 cases of hematoma, 3 cases of superficial infection of wound, and 1 case of nerve root irritation. B) Failure in instrmentation were 1 case of screw breakage, 1 case of complete loss of fixation between screw and rod, and 2 cases of partial loss of fixation. 5. To prevent above mentioned complications in fixation of the instrument, the following factors are recommended: 1) Selection of the adequate length of rod. 2) Fixation of the additional implant such as security bolt when instability between screw and rod is predictable. 3) Selection of the closed head screw in the fixation of proximally sided screw if possible. 6. Cotrel-Dubousset instrument has many advantages such as rigid internal fixation, anatomical reduction, and good maintenance and also effective in reduction and maintenance of spondylolisthesis and in wide posterior decompression of spinal stenosis, but for prevention of some complications, precise use of instrument and good application of surgical technique will be needed.
Decompression ; Follow-Up Studies ; Head ; Hematoma ; Internal Fixators ; Pedicle Screws ; Retrospective Studies ; Spinal Stenosis ; Spine ; Spondylolisthesis ; Spondylolysis ; Wounds and Injuries

No abstract available.
Dislocations*

We report a case of 64-year-old female patient who has had factitious skin lesions for 20 years. She complained formification sense and severe itching on her face. These symptoms were improved with squeezing and bleeding. There were scuare shaped ulcerated nodule on the right cheek and white depressed scar on the left cheek. She was treated with wet dressing and occlussive dressing, and skin lesions were nearly cleared within 3 weeks, but new lesion appeared. Pimozide 2mg #1 p.o were given under the diagnosis of delusion of parasitosis from June, 1984. Her symptoms were improved without recurrence till now. Treatment with pimozide in monosymptomatic hypochondriacal syndrome is discussed.
Bandages ; Cheek ; Cicatrix ; Delusions ; Dermatitis* ; Diagnosis ; Female ; Hemorrhage ; Humans ; Middle Aged ; Pimozide* ; Pruritus ; Recurrence ; Skin ; Ulcer

Abnormalities in the number and function of platelets may contribute to thromboembolic complications in patients with essential thrombocythemia(ET). Physicians often use hydroxyurea which reduces the platelet count for the initial treatment of ET. A 74-year-old man with ET was presented with headache, dysarthria, and right hemiparesis 10 months after discontinuation of hydroxyurea. Initial platelet count was 450x103/microliter and we gave him heparin. However, his platelet count rised upto 1,019x103/microliter within 4 days. He was on hydroxyurea 1.5 g/day and his symptoms improved with decrease of platelet count. We report a case of left MCA(middle cerebral artery) multifocal infarction in ET after discontinuation of hydroxyurea.
Aged ; Cerebral Infarction* ; Dysarthria ; Headache ; Heparin ; Humans ; Hydroxyurea* ; Infarction ; Paresis ; Platelet Count ; Thrombocythemia, Essential*

There are many advantages in treating long bone fractures with interlocking intramedullary nail and its advantages are well known. Although it is used widely, many major and minor complication can develop in spite of meticulous operation techniques. Frist fifty consecutive interlooking intramedullary nail of two different surgeon, total of 100 cases that were operated in Seoul Paik Hospital from January, 1991 to July, 1994, were reviewed and the complications were analyzed with various factors. 1. Among the 100 cases, a total of 30(30%) major and minor complications had developed. But only 4 major complications which needed reoperation or poor result occurred. 2. Among the complications that had developed, angulation and rotation deformity being 10 cases were the most common, other complications were delayed union in 5 cases, nonunion in 2 cases, problem of screw in 4 cases, metal failure in 2 cases, misentry point in 2 cases and others in 5 cases. 3. There were no remarkable difference between surgeon A and surgeon B. The complications decreased abruptly after 30th case for each surgeon and only a few complications, probably due to complex fracture pattern, occurred. In conclusion, complications after interlocking intramedullary nailing can be reduced by meticulous preoperative planning and learning process of surgeon.
Congenital Abnormalities ; Fracture Fixation, Intramedullary ; Fractures, Bone ; Learning ; Reoperation ; Seoul

Pelvic bone is complex in its shape, so we often miss to find the fractures in cases with unclear fracture line. We studied 25 patients who were suspected to have occult fractures in pelvic area. We were able to find lots of occult fractures with bone scan followed by CT scan. The results were as follows; 1. There were 31 unexpected hot spots in 25 patients in bone scan. 2. Six cases (19.3%j of new injuries were found on re-evaluation of plain film or additionally rechecked plain films. 3. Twenty-one new fractures (67.7%) were found on CT film study. 4. Total 27 additional fractures (89.1%) were found after bone scan followed CT scan. In conclusion Bone Scan followed by CT is a effective method of detecting occult fracture in pelvic area.
Fractures, Closed ; Humans ; Pelvic Bones* ; Pelvis ; Tomography, X-Ray Computed*

Schwannomas are soft tissue sarcomas arising from neurilemma of Schwann cells in peripheral nerves, and is the most frequent type of benign tumor found in these nerves. We report a case of a Schwannoma of the ulnar nerve in the elbow joint, and along this report, give a review of the literature. A 46-year-old male patient was hospitalized with complaints of swelling and pain in the left elbow and a tingling sensation and hypoesthesia of the fourth and fifth fingers. Physical examination of the patient showed he was positive for Tinel's sign, and magnetic resonance imaging results demonstrated the presence of a Schwannoma. Subsequent biopsy and excision of the Schwannoma was carried out. The suspected mass, which had a clear margin separating it from the healthy nerve of the medial left elbow, was removed along with its 2 x 2 x 3 cm capsule after a histological diagnosis of a Schwannoma was made. Pathophysiological results confirmed the excised mass as a Schwannoma. Schwannoma of the ulnar nerve within the elbow joint is rare and differential diagnosis is difficult. Therefore, treatment can only proceed after the presence of Schwannoma has been confirmed by physical and radiological examinations.
Biopsy ; Diagnosis ; Diagnosis, Differential ; Elbow Joint ; Elbow* ; Fingers ; Humans ; Hypesthesia ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neurilemma ; Neurilemmoma* ; Peripheral Nerves ; Physical Examination ; Sarcoma ; Schwann Cells ; Sensation ; Ulnar Nerve*

PURPOSE: In order to provide a systematic and standardized treatment course for MVD patients, a critical pathway (CP) program was developed and the results of its long term application were analyzed. METHODS: This was a methodological study. The CP was established and applied to 75 (step I) and 1,216 (step II). Another group of 56 with similar features was used as a control group. RESULTS: The application of CP turned out to be useful in many regards: the rate of hearing loss was reduced from 1.8% to 0% (step I) and 0.5% (step II), and low cranial nerve palsy was reduced from 1.8% to 1.3% and 0.7%, respectively. The length of hospitalization decreased by 2.56 days (25.2%) for step I and 3.05 days (30.0%) for step II. Days of ICU stay were reduced by 7.9% and 1.8%. The total cost per patient was reduced by 14.8% (step I). The cost per day was increased by 13.7% and 52.4%. An increase in the patient satisfaction index was noted, as shown in the ICU information guide (p=.002). CONCLUSION: The development and application of CP was found to improve the quality of medical treatment and the efficacy of hospital management in MVD patients. Well organized and efficient system and multidisciplinary teamwork are the key component of the successful application of CP.
Cranial Nerve Diseases ; Critical Pathways* ; Hearing Loss ; Hospitalization ; Humans ; Methods ; Microvascular Decompression Surgery* ; Patient Satisfaction ; Quality Control

No abstract available.
Bile Ducts* ; Bile* ; Choledochal Cyst*