OBJECTIVE: Obturator neuropathy is a rare condition. Many neurosurgeons are unfamiliar with the obturator nerve anatomy. The purpose of this study was to define obturator nerve landmarks around the obturator foramen. METHODS: Fourteen cadavers were studied bilaterally to measure the distances from the nerve root to relevant anatomical landmarks near the obturator nerve, including the anterior superior iliac spine (ASIS), the pubic tubercle, the inguinal ligament, the femoral artery, and the adductor longus. RESULTS: The obturator nerve exits the obturator foramen and travels infero-medially between the adductors longus and brevis. The median distances from the obturator nerve exit zone (ONEZ) to the ASIS and pubic tubercle were 114 mm and 30 mm, respectively. The median horizontal and vertical distances between the pubic tubercle and the ONEZ were 17 mm and 27 mm, respectively. The shortest median distance from the ONEZ to the inguinal ligament was 19 mm. The median inguinal ligament lengths from the ASIS and the median pubic tubercle to the shortest point were 103 mm and 24 mm, respectively. The median obturator nerve lengths between the ONEZ and the adductor longus and femoral artery were 41 mm and 28 mm, respectively. CONCLUSION: The obturator nerve exits the foramen 17 mm and 27 mm on the horizontal and sagittal planes, respectively, from the pubic tubercle below the pectineus muscle. The shallowest area is approximately one-fifth medially from the inguinal ligament. This study will help improve the accuracy of obturator nerve surgeries to better establish therapeutic plans and decrease complications.
Cadaver ; Femoral Artery ; Ligaments ; Obturator Nerve* ; Spine

Primary leptomeningeal melanoma is a rare and aggressive tumor that originates from pial melanin-bearing cells typically along the cerebral conveidties or at the. Base of the brain. It has been hypothesized that malignant transformation Of the preexisting precursor cells leads to diffuse infiltration of the meninges by tumor and the onset of neurological symptoms and signs . The typical neurological symptoms and signs include psychiatric disturbances, seizures, and symptoros and signs of raised intracranial pressure secondary to hydrocephalus. Blindness has been reported as a late feature. Radiotherapy and chemotherapy has been using, but prognosis is poor We d be our experience with 24-years-woman in which the diagnosis of primary leptomeningea1 melanoma without melanotic pigmentation of variable areas of the skm was made.
Blindness ; Brain ; Diagnosis ; Drug Therapy ; Hydrocephalus ; Intracranial Pressure ; Melanoma* ; Meninges ; Pigmentation ; Prognosis ; Radiotherapy ; Seizures

The efficacy of electroconvulsive therapy (ECT) in depression is dependent on the duration of seizure. Over a course of ECT, progressive reduction in the duration of the induced seizure is common. Caffeine pretreatment is reported to prolong seizure activity in patients experiencing inadequate seizure activity although maximal electrical stimulus for ECT is applied. The side effects of caffeine are anxiety, psychomotor agitation, prolonged seizures, enhanced hemodynamic changes and arrythmias. Caffeine is generally well tolerated by most patients, but it should be used with caution for those medically fragile patients, i.e., with preexisting cardiac disease. We describe here a case of anesthesia for ECT with caffeine augmentation. A 61-year-old man was diagnosed of major depression. Caffeine pretreatment with ECT was scheduled after antidepressants and 3 ECTs failed. Hypertension and tachyarrythmia were treated with esmolol.
Anesthesia* ; Antidepressive Agents ; Anxiety ; Arrhythmias, Cardiac ; Caffeine* ; Depression ; Electroconvulsive Therapy* ; Heart Diseases ; Hemodynamics ; Humans ; Hypertension ; Middle Aged ; Psychomotor Agitation ; Seizures

PURPOSE: The purpose of this study was to evaluate the risks of undergoing intramedullary nailing with minimum surgical optimization (fast-track) for geriatric trochanter fracture due to fall from a standing height. MATERIALS AND METHODS: From May 2006 to August 2013, 48 fractures were enrolled in fast-track, and were an average age of patients was 77.6 years (range, 62-97 years). They underwent primary testing for anesthesia, including basic body fluid test, arterial blood, electrocardiography, and chest radiographs. The time from visit to surgery was 28.9 hours (range, 1-96 hours). RESULTS: During hospitalization, there was one case of stress-induced cardiac arrest; however, other complications, infection, and 30-day mortality did not occur. According to preoperative classic test, the average albumin was 3.45 g/dl, blood sugar, 169 mg/dl, blood urea nitrogen, 20.5 mg/dl, Cr, 1.5 mg/dl, Na, 135.3 mEq/L, and K, 4.21 mEq/L. The average PaCO2 of arterial blood was 37.6 mmHg. CONCLUSION: We found that the fast-track for trochanteric fracture due to slip-down was relatively safe, and could be considered as a therapeutic approach.
Aged* ; Anesthesia ; Blood Glucose ; Blood Urea Nitrogen ; Body Fluids ; Electrocardiography ; Femur* ; Fracture Fixation, Intramedullary ; Heart Arrest ; Hospitalization ; Humans ; Mortality ; Osteoporotic Fractures ; Prospective Studies* ; Radiography, Thoracic

PURPOSE: The aim of this study was to evaluate the difference of clinical features among patients with enteroviral mengitis according to the presence of cerebrospinal fluid (CSF) pleocytosis. METHODS: This was a retrospective analysis of the patients' data diagnosed with enteroviral meningitis by CSF reverse transcriptase polymerase chain reaction (RT-PCR). We reviewed the medical records of children younger than 16 years who visited Korea University Ansan Hospital and Guro Hospital for meningitis or encephalitis between March 2013 and August 2013. Clinical and laboratory variables were compared with regard to the presence of CSF pleocytosis. RESULTS: Among 49 patients with enteroviral meningitis, eight of 49 (16.3%) did not have pleocytosis. The enteroviral meningitis patients without pleocytosis had lower CSF protein level than patients with pleocytosis (18.9+/-4.3 vs 34.9+/-18.3 mg/dL; P=0.002). Age, duration of hospital stay, severity of clinical symptom, peripheral white cell blood counts, absolute neutrophil counts and CSF/serum glucose ratio were not different between two groups. CONCLUSION: Enteroviral meningitis could manifest without pleocytosis. We therefore think that CSF RT-PCR is helpful for the diagnosis, especially in suspected cases, which leads to shorter hospital stay and minimal use of antibiotics.
Anti-Bacterial Agents ; Cerebrospinal Fluid ; Child ; Diagnosis ; Encephalitis ; Enterovirus ; Glucose ; Gyeonggi-do ; Humans ; Korea ; Length of Stay ; Leukocytosis* ; Medical Records ; Meningitis* ; Neutrophils ; Retrospective Studies ; Reverse Transcriptase Polymerase Chain Reaction

Leber's Hereditary Optic Neuropathy(LHON) is a maternally inherited disorders that occurs primarily in young males and is characterized by subacute, sequential, bilateral central visual loss, ultimately, optic atrophy. We report 2 cases of molecularly confirmed LHON which reveal 11778 and 14484 mitochondral DNA mutation, respectively but there is no family history of visual loss. So the diagnosis of LHON deserves to be considered in all crypotogenic cases of acute or subacute optic or chiasmal neuropathy. Late or early age at onset, female gender, and a negative family history should not be dissuasive.
Diagnosis ; DNA ; Female ; Humans ; Male ; Molecular Biology* ; Optic Atrophy ; Optic Nerve Diseases*

OBJECTIVE: This study was designed to evaluate the effect of growth hormone on bone mineral density of corticosteoid-induced osteoporosis in male rat. METHOD: Twenty Sprague-Dwaley male rats was studied, divided into four group, each group has 5 rats. The group 1 was treated with saline. The group 2 was treated with corticosteroid (Methylprednisolone 10 mg/kg). The group 3 was treated with corticosteroid and growth hormone (recombinant human growth hormone 0.5 IU/kg). The group 4 was treated with growth hormone after corticosteroid treatment. The treatment duration was 6 weeks for each group. After six weeks of hormone administration, the animals were sacrificed, the bilateral femur were removed and tested for bone mineral density using dual energy X-ray absorptiometry and examined histomorphometrically. RESULTS: Administration of growth hormone after corticosteroid therapy, the growth hormone could reverse the decrease in body weight and bone mineral density induced by corticosteroid therapy (p<0.05). CONCLUSION: When growth hormone is administrated after corticosteroid therapy, the growth hormone can protect the osteoporosis in male rats induced by a high dose of corticosteroid.
Absorptiometry, Photon ; Animals ; Body Weight ; Bone Density* ; Femur ; Growth Hormone* ; Human Growth Hormone ; Humans ; Male ; Osteoporosis* ; Rats*

OBJECTIVE: To compare key-person method with census method on the prevalence of physically disabled students and to obtain the prevalence of the physically disabled students in rural community. METHOD: Total 4,890 students of 20 schools in Kyungaido province were surveyed in 1997. Two-thousands and twenty-two students of 8 schools were surveyed by a census method and 2,868 students of 12 schools by a key-person method. RESULTS: The prevalence of the physically disabled students in rural community was 0.53% of the population. The prevalence of the physically disabled students was 0.69% by a census method and 0.42% by a key-person method. This result suggests that there is no significant difference in the prevalence of physically disabled students between the two survey methods (p>0.05). CONCLUSION: A key-person method is as effective as a census method for prevalence survey of physically disabled students in rural communities because of cost effectiveness and less personnel.
Censuses ; Cost-Benefit Analysis ; Surveys and Questionnaires ; Disabled Persons* ; Humans ; Prevalence* ; Rural Population*

The purpose of this study was to detect where the center of pressure in foot would be located at the end point of loading response and the terminal stance by the dynamic plantar pressure measurement. Seventeen adults who had the usual feet without a pathologic gait were evaulated simultaneously by the motion analysis using VICON 370, and the plantar pressure measurement using EMED-SF. Two devices were set in the 60 Hz frame. The foot was divided into 3 different zones; hindfoot, midfoot, and forefoot. The end point of loading response was located at the 1.92+/-1.46 frame distal to the hindfoot- midfoot borderline. The end point of terminal response was located at the 2.27+/-1.96 frame distal to the maximal pressure points of metatarsal head. Authors could differentiate each period of stance phase; the initial contact, loading response, mid-stance, terminal stance, and preswing, using the analysis of center of pressure by the dynamic plantar pressure measurement.
Adult ; Foot* ; Gait* ; Head ; Humans ; Metatarsal Bones

OBJECTIVE: This study was designed to evaluate the relation of leg length discrepancy on ankle muscle strength. METHOD: Twenty four adult women were tested (12 leg length equality and 12 leg length discrepancy). Leg length was measured by tape ruler from anterior superior iliac spine to medial malleolus, three times by three different trained examiners. The muscle strength (bilateral ankle dorsiflexors and plantarflexors) was measured by using Cybex 340 dynamometer at 30 degree/sec and 120 degree/sec. RESULTS: The mean value of leg length discrepancy was 0.89+/-0.24 cm. In leg length discrepancy group, the peak torque of ankle plantarflexor were 44.50+/-20.94 Nm in long leg and 51.83+/-12.75 Nm in short leg at 30 degree/sec angular velocity (p<0.05). CONCLUSION: We concluded that there were significant increase in plantar flexor peak torques of short leg than those of long legs at 30 degree/sec (P<0.05). Perhaps the difference of the muscle strength might be due to compensatory mechanism of short leg in propulsion during gait.
Adult ; Ankle* ; Female ; Gait ; Humans ; Leg* ; Muscle Strength ; Spine ; Torque