A 18-month-old child admitted with neck pain, spasm and neck motion limitation after traffic accident. On C-spine lateral view, there was anterior angulation of odontoid process with anterior displacement of atlas. Neurologic examination showed no specific focal deficits. The patient was treated with Gardner-Wells tongs traction, skeletal traction with wiring, Halo vest for 2 months, Minerva cast for 2 months and cervical collar brace. Eight months after the trauma, follow-up dynamic C-spine lateral view showed bone fusion without false movement or growth retardation.
Accidents, Traffic ; Braces ; Child* ; Follow-Up Studies ; Humans ; Infant* ; Neck ; Neck Pain ; Neurologic Examination ; Odontoid Process* ; Spasm ; Traction

BACKGROUND: The purpose of this study is to evaluate and analyze the surgical results in patients undergoing operations for multiple for multiple valvular heart diseases. MATERIAL AND METHOD: From April 1982 to June 1997 multiple valve replacement was performed in 150 patients mitral and aortic valve replacement were done in 135 patients mitral and tricuspid valve replacements in 10 patients triple replacements in 4 patients and aortic and tricuspid valve replacement in 1 patient. Of the valves implanted 157 were St. Jude 104 Duromedics 20 Carpenter-Edwards 6 Bjork-Shiley 6 Ionescu-Shiley and 2 Medtronics. RESULT: The hospital mortality rate was 10.7% (16/150) and the late mortality rate was 7.2% (8/134) The mortality rate was high in early operative period but decreased with time. The causes of death were low cardiac output in 9 sudden death in 3 congestive heart failure in 3 bleeding in 2 cerebral thrombosis in 1 leukemia in 1 multiorgan failure in 1 and so on . The actuarial survival rate excluding operative death was 83.1% at 15 years. CONCLUSIONS: With a follow-up now extending to 15 years the multiple valve replacement continues to be reliable procedure with relatively low mortality and morbidity.
Aortic Valve ; Cardiac Output, Low ; Cause of Death ; Death, Sudden ; Follow-Up Studies ; Heart Failure ; Heart Valve Diseases ; Hemorrhage ; Hospital Mortality ; Humans ; Intracranial Thrombosis ; Leukemia ; Mortality ; Survival Rate ; Tricuspid Valve

Thirty six conseutive patients with recurrent hypertensive intracerebral hemorrhage were identified in a retrospective review of 307 cases of hypertensive intracerebral hemorrhage(HICH) treated at the Fatima hospital between September, 1989, and August, 1992. The recurrence rate was 1.7%. There were 14 males and 22 females, aged 38 to 83 years. Only one patient had recieved regular antihypertensive therapy after initial hemorrhage. The mean volume of hemorrhage was 21.7cc at first attack and 19.5cc at recurrent attack. The site of recurrent hemorrhage was putamen in 18 cases, thalamus in 12 cases, cerebellum in 8 cases and lobar in 3 cases. The most common pattern of recurrence was "Ganglionic-Ganglionic"(10 cases). Recurrent hemorrhage occurred at the same side in 54.8% and same side & same wite in 16.7% of recurrent hemorrhage. Mean interval between the hemorrhage was 17.4 months and 55.8% of recurrent hemorrhage occurred within 1 year. Initial condition was worse at recurrent hemorrhage and outcome also was worse regardless of treatment methods. We concluded that recurrent intracerebral hemorrhage in HICH patients was not a rare condition and regular follow up and antihypertensive therapy was important in prevention of recurrent hypertensive intracerebral hemorrhage.
Cerebellum ; Cerebral Hemorrhage ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Hypertension ; Intracranial Hemorrhage, Hypertensive* ; Male ; Putamen ; Recurrence ; Retrospective Studies ; Thalamus

OBJECTIVE: There have been numerous follow-up studies of patients who had ruptured or unruptured intracranial aneurysms treated by wrapping technique using various materials have been reported. Our objective was to ascertain whether our particular wrapping technique using the temporalis muscle provides protection from rebleeding and any aneurysm configuration changes in follow-up studies. METHODS: Clinical presentation, the location and shape of the aneurysm, outcomes at discharge and last follow-up, and any aneurysm configuration changes on last angiographic study were analyzed retrospectively in 21 patients. Reinforcement was acquired by clipping the wrapped temporalis muscle. Wrapping and clipping after incomplete clipping was also done. Follow-up loss and non-angiographic follow-up patient groups were excluded in this study. RESULTS: The mean age was 53 years (range 29-67), and 15 patients were female. Among 21 patients, 10 patients had ruptured aneurysms (48%). Aneurysms in 21 patients were located in the anterior circulation. Aneurysm shapes were broad neck form (14 cases), fusiform (1 case), and bleb to adjacent vessel (6 cases). Five patients were treated by clipping the wrapped temporalis, and 16 patients by wrapping after partial clipping. The mean Glasgow coma scale (GCS) at admission was 14.2. The mean Glasgow outcome scale (GOS) at discharge was 4.8, and 18 patients were grade 5. The mean period between initial angiography and last angiography was 18.5 months (range 8-44). Aneurysm size was not increased in any of these patients and configuration also did not change. There was no evidence of rebleeding in any of these treated aneurysms. CONCLUSION: Our study results show that wrapping technique, using the temporalis muscle and aneurysm clip(s), for intracranial aneurysm treatment provides protection from rebleeding or regrowth.
Aneurysm ; Aneurysm, Ruptured ; Angiography ; Blister ; Female ; Follow-Up Studies ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Glycosaminoglycans ; Humans ; Intracranial Aneurysm ; Muscles ; Neck ; Reinforcement (Psychology) ; Retrospective Studies ; Temporal Muscle

No abstract available.
Humans ; Infertility* ; Luteinizing Hormone, beta Subunit*

Subdural empyema is a fulminating, purulent, bacterial infection located between the dura and arachnoidal membrane. Early diagnosis, adequate antibiotic therapy and surgical treatment played important roles in the successful management of subdural empyema. Subdural empyema can develop secondary to sinusitis, otitis media, meningitis, trauma or craniotomy. Subdural empyema in infants commonly develops secondary to infected subdural effusion associated with purulent meningitis. The incidence of this complication of meningitis in infants is approximately 2%. We report a case of subdural empyema concomitant with bilateral subdural effusion, which was successfully treated with surgical intervention and antibiotic therapy.
Arachnoid ; Bacterial Infections ; Craniotomy ; Early Diagnosis ; Empyema, Subdural* ; Humans ; Incidence ; Infant* ; Membranes ; Meningitis* ; Otitis Media ; Sinusitis ; Subdural Effusion*

The present study was performed to identify the socio-psychiatric characteristics of mothers of delinquent male adolescent and thus to use them as basic material for ultimate prevention of adolescent delinquency by comparing their views with preceeding delinquent adolescent's own For this, we surveyed 111 mothers of delinquent male adolescent who had educationed in adolescent correctional institution in Pusan(B.B.S.) and 88 mothers of high school students through questionnaire of family environment and psychologic testings. Results were as follows: 1) By large, mothers of delinquent male adolescent were placed in poorer socio-economic conditions than those of control group's. 2) Degree of mantel harmony was nearly identical with preceeding survey of delinquent's The causes of marital disharmony were significant between delinquent and control group(delinquent group-economic difficulties, control group-personality difference). Types and resolution method of marital disharmony were also significant, delinquent group used more violent fighting type and more passive resolution method. 3) Mothers of delinquent male adolescent had low expectancy to their sons' future because of their own children's continuing delinquent behavior and low academic achievement. 4) For overcoming the difficult socio-economic situation, they participate in social activity This factors made them less attention to their children's life and thus their children's delinquent behavior were increased. 5) On results of MMFI test, both group had normal profiles and no significant differences except for L and Pa scores. On results of SCL 90-R test, both group also had normal profiles and no significant differences except for IS score only. According to above results, it would reasonable to introduce practitical, special socio educational program such as parent education and policy.
Adolescent ; Education ; Humans ; Mothers ; Parents ; Psychological Tests ; Surveys and Questionnaires

No abstract available.
Aneurysm* ; Angiography* ; Circle of Willis*

Matrix metalloproteinases are believed to play an important role in tumor invasion and metastasis. But little is known about the role of them in the gastric adenocarcinoma. We investigated the expression of matrix metalloproteinase-1,2,3 in eighty paraffin blocks of the primary gastric adenocarcinoma tissues with immunohistochemistry and analysed their correlation with lymph node metastasis and survival. MMP-1,2,3 were expressed most intensely in the fibroblasts around the tumor stroma. In our study the increased immunoreactivity of MMP-2 only showed statistically significant correlation with lymph node metastasis (P=0.0517, Odd's ratio=2.274). But MMP-1,2,3 all were correlated with survival. Type IV collagen was observed in the vascular basement membranes and tumor basement membranes and showed statistically significant correlation with lymph node metastasis (P=0.0002, Odd's ratio=0.194) and prognosis (P=0.0001). The immunoreactivity of MMP-2 and type IV collagen was inversely correlated (Kendall's Tau-b correlation = 0.37482, P=0.0001). Our results suggest that in human gastric adenocarcinoma the increased immunoreactivity of MMP-2 and the decreased immunoreactivity of type IV collagen has an important role in lymph node metastasis and prognosis. MMP-1,3 are not correlated with lymph node metastasis but correlated with survival. The mechanism responsible for the production of MMP by the host fibroblasts remains obscure and requires further investigation.
Adenocarcinoma* ; Basement Membrane ; Collagen Type IV* ; Fibroblasts ; Humans ; Immunohistochemistry ; Lymph Nodes* ; Matrix Metalloproteinases ; Neoplasm Metastasis* ; Paraffin ; Prognosis*

We reviewed 178 patients with hypertensive intracerebral hematoma(HICH), which were treated with computed tomography(CT) guided stereotactic aspiration from Aug. 1986 to Dec. 1993(166 CT guided U-loop and 12 Leksell system). Our series consisted of 82 males and 96 females. The hemorrhages were located in putamen in 67.4%, thalamus in 20.2%, subcortex in 9% and cerebellum in 3.4%. Mean removal rate of hematoma was 55.3%. The results for the 178 cases who underwent stereotactic aspiration were good recovery in 45.5%, moderate disability in 28.0%, severe disability in 9.0% and vegetative state in 4.0%. The infection rate and rebleeding rate of all cases were 1.7% and 6.8% respectively. The mortality rate of all cases was 13.5%. We analysed the factors affecting the prognosis in 178 patients. Factors affecting good prognosis were high initial GCS, less amount of initial hematoma and no presence of intraventricular hemorrhage. Stereotactic aspiration by CT-guided U-loop and Leksell system is simple, safe and can minimize the brain damage. This method can e performed under local anesthesia.
Anesthesia, Local ; Brain ; Cerebellum ; Female ; Hematoma ; Hemorrhage ; Humans ; Male ; Mortality ; Persistent Vegetative State ; Prognosis ; Putamen ; Thalamus ; Urokinase-Type Plasminogen Activator