Ten emhalmed cadaveric adult bony hemipelvis specimens were ohtained to evaluate the configuration of the posterior column of acetabulum and to find a safe path for screw placement into it as well as to report on the morphological data of the ischial tuherosity and to determine the most optimaI technique for ischial tuberosity screw placement for open reduction and internal fixation of posterior acetabular fracture. Cadaveric studies were performed analyzing icm cross-sections through the acetabulum for the purpose of studying the anatomical configuration of the danger zone. The plane of the cross-section was perpendicular to the posterior column. Each cross-section had the medial boundary ot the acetabulum projected onto the posterior column. By analysing the projections on the posterior column, the exact configuration of the danger zone was determined. In this study, the average width of the posterior column at the mid-acetabular Ievel was 3.9cm. Computed tomography scan of the acetabulum yielded valuable int'ormation regarding screw placement in the posterior column. The average width, height and depth of the ischial tuberosity were 25.7 mm, 33. 1 mm and 31.7mm, respectively. The average angles hetween the posterior and medial aspects and hetween the posterior and lateral aspects of the ischial tuherosities were 79.5degreesand 111.5degrees, respectively. The entry point of the screw should be Smm or 10mm medial to the lateral margin of the ischial tuherosity and the screws should be directed 35-40degrees, 45-50degrees and 50-55degrees caudally at the level of the inferior acetahular margin and lcm and 2cm below it, respectively. to obtain the most favorable bony purchase.
Acetabulum* ; Adult ; Cadaver ; Humans

Neurilemmoma is a benign neoplasm arising from the Schwann cell of the nerve sheath. Acoustic nerve is the most common site of neurilemmoma and mandible is the most frequently involved in intraosseous neurilemmoma. Extradurally located dumbbell type neurilemmoma was rarely reported. The histology of neurilemmoma was first described by Verocay in 1908 and elaborated upon by Stout in 1935. Characteristic histologic patterns of neurilemmoma were encapsulation and Verocay bodies, Antoni type A and B areas, palisading nuclei, and lack of malignant characteristics. We experienced such a rare case of neurilemmoma which probably arised from the left first lumbar spinal nerve root, and located extradurally and paravertebrally, and confirmed by radiologic and pathologic findings.
Cochlear Nerve ; Mandible ; Neurilemmoma ; Spinal Nerve Roots

BACKGROUND AND OBJECTIVES: Long-term right ventricular (RV) apex pacing has been associated with left ventricular (LV) systolic dysfunction. However, pacing in the RV outflow tract (RVOT) is associated with a narrower QRS duration and may have a more normal LV activation in comparison to RV apical (RVA) pacing. We hypothesized that RVOT pacing is associated with less mechanical dyssynchrony compared to RVA pacing and that it also more closely resembles mechanical activation in normal controls with a narrow QRS. SUBJECTS AND METHODS: We studied 9 patients with RV pacing, 9 with left bundle branch block (LBBB), and 15 normal controls with a narrow QRS. In the RV pacing group, we paced from the RVA and RVOT. At the end of each pacing train, we obtained echocardiographic images in the apical 4- and 2-chamber views and obtained the following parameters: the compression/expansion crossover point (CEP) for myocardial strain and the time from QRS onset to the CEP in the strain image. The degree of dyssynchrony was evaluated using the dispersion and standard deviation of CEP times in 12 segments of the LV. RESULTS: Significant dyssynchrony was observed in the RVOT pacing group compared to the group with normal QRS. No significant difference was observed in LV mechanical dyssynchrony among the RVOT pacing, RVA pacing, and LBBB groups. CONCLUSION: RVOT pacing is associated with significant LV dyssynchrony. Although the RVOT has been recommended as an alternative site for pacing, this approach may have adverse effects on long-term LV function.
Bundle-Branch Block ; Heart Ventricles ; Humans ; Sprains and Strains

Nine adult patients with non-traumatic primary intraventricular hemorrhage (PIVH) were reviewed. Lack of lateralizing sign could be one of the differential points between PIVH and secondary intraventricular hemorrhage (SIVH). In three cases, vascular malformations were identified. Bleeding diathesis was present in one. The pathogenesis of hemorrhage in the remaining five cases was speculated. According to the mainly involved ventricle, prognosis was presumed to be variable. From this study, we conclude that for PIVH investigation including angiography and/or magnetic resonance imaging should be done to identify the etiology and to conduct appropriate management. Survival was more common than SIVH.
Adult ; Angiography ; Disease Susceptibility ; Hemorrhage* ; Humans ; Magnetic Resonance Imaging ; Prognosis ; Vascular Malformations

PURPOSE: To determine, by means of a phantom study, the distortion-related factors and appropriate iodine concentration for three-dimensional reconstruction rotational angiography. MATERIALS AND METHODS: Four phantoms were created: crossed metal rods, one metal rod, one contrast rod, and a contrast rod under water. Iodine concentrations were 300, 250, 200, and 150 Img/ml, respectively. For each phantom, rotational angiography was performed in the rotational, right-angled (90 degree to rotational), intermedial (45 degree), close to rotational (20 degree), and close to right-angled (70 degree) planes. Two-dimensional projection images were transferred to a workstation at which 3D images were produced using the volume rendering technique. Image quality in each plane was evaluated in terms of opacity, homogeneity, and margin sharpness, which were graded as low, intermediate or high by two neuroradiologists who used images obtained in the right-angled plane as the standard reference. The same assessors evaluated in terms of the same parameters, cross-sectional images obtained at the central, intermedial, and peripheral portions of one metal rod positioned in the right-angled, close to right-angled, and intermedial planes, and in order to compare the values at different sites, one neuroradiologist measured the horizontal and vertical diameters of each cut image. RESULTS: Three-dimensional images of all four phantoms were high quality in the close to right-angled and intermedial plane, but in the rotational and close to rotational plane were degraded. In particular, metal rod images obtained in the rotational plane were poor for all three items. In these two planes, image quality was better for the contrast rod than the metal rod, and at 200 and 250 Img/ml concentrations than at 300 and 150 Img/ml concentrations. There was no significant difference in image quality, nor in measured values of the diameter between cut images. CONCLUSION: A three-dimensional image was more distorted when a linear object was placed at a lesser angle to the rotational plane and when inherent X-ray attenuation was greater, a finding which must be closely related to the beam-hardening artifact. Distortion was least at 200-250 Img/ml of iodine concentration, the concentration thought to be most appropriate for in-vitro 3D angiography.
Angiography ; Angiography, Digital Subtraction ; Artifacts ; Imaging, Three-Dimensional ; Iodine ; Water

PURPOSE: To evaluate the distribution of normal intracranial artery diameter according to sex and age, using three-dimensional reconstruction rotational angiography. MATERIALS AND METHODS: One hundred and twenty-five adults with normal intracranial arteries who underwent 3D rotational angiography (n=177) were included in this study. The arterial diameter was measured at four sites of the internal carotid artery (cavernous, paraophthalmic, supraclinoid, and distal), that of the middle cerebral artery at two (proximal and distal), and that of the anterior cerebral artery at one (middle). For each sex and age group (<30, 30-39, 40-49, 50-59, > or = 60 years), the mean diameter of the artery at these seven sites was calculated, and differences analysed. In addition, the middle cerebral artery diameter was compared between a younger group (<50 years) and an older group (> or = 50 years). RESULTS: The mean diameter at each site for each sex was as follows: male (mean+/-SD): 4.61+/-0.69, 3.96+/- 0.60, 3.48+/-0.45, 3.61+/-0.50, 2.44+/-0.32, 2.44+/-0.37, 1.81+/-0.32; female: 4.29+/-0.57, 3.83+/-0.56, 3.37+/-0.56, 3.52+/-0.48, 2.32+/-0.37, 2.30+/-0.36, 1.76+/-0.34. For those in their 40s, the diameter at five sites (all four sites of the internal cerebral artery and a distal middle cerebral artery) was significantly greater in males than in females. For other age groups, however, the difference between the sexes was absent, or was significant at only one (cavernous internal cerebral artery for those in their 30s) or two (proximal and distal middle cerebral artery for those in their 50s) of the seven sites. In the older age group, the diameter of the proximal middle cerbral artery was 2.59+/-0.35 mm in males and 2.38+/-0.37 mm in females. For the distal middle cerebral artery, the corresponding figures were 2.63+/-0.43 and 2.39+/-0.35 mm, respectively. For both sexes, the differences between the two age groups were significant. CONCLUSION: For those in their 40s, the normal diameter of the intracranial artery at most arterial sites was significantly greater in males than in females. The normal diameter of the middle cerebral artery was significantly greater or tended to be greater among the older group than the younger group (for males and females, respectively, 2.59+/-0.35 mm and 2.38+/-0.37 mm at the proxinal site, and 2.63+/-0.43 mm and 2.39+/-0.35 mm at the distal site).
Adult ; Angiography ; Anterior Cerebral Artery ; Arteries* ; Carotid Artery, Internal ; Cerebral Angiography ; Cerebral Arteries ; Female ; Humans ; Male ; Middle Cerebral Artery

PURPOSE: The aim of this study is to find out the distribution of illness, patterns of medical care utilization and factors determining medical care utilization in elementary school children. METHODS: We performed the questionnaires in Gwangju city on 2,036 children of two elementary schools from June 1 to June 30, 1998. RESULTS: The prevalence rate of illness was 32.3%. The distribution of illness was respiratory disease(64.7%), gastrointestinal disease(12.8%), injury & poisoning. The rate of persons having received medical treatment when they were sick, was 89.8%. The selection distribution among various medical facilities was pediatric hospital(46.7%), otolaryngologic hospital(19.8%), pharmacy (13.2%) and internal medicine in the decreasing frequency sequence. The major factors influencing the selection of medical facility were geographic accessibility and good results. The most common reason for the first visit to the pediatric hospital was geographic accessibility. The most common reason for a visit and to otolaryngologic hospital was a good result. The most frequently utilized medical facility for respiratory symptoms and gastrointestinal symptoms was pediatric hospital. The persons influencing the selection of medical facility in the children were mother(73.3%), father(10.8%), doctor and others in decreasing sequence. The persons answering the questionaire thought that the optimal age of pediatric care was from 0 to 12 years(47.8%), to 10 years(22.4%) and to 15 years(18.5%) in decreasing rate. CONCLUSION: Other departments instead of pediatrics have treated children. Children have particular growth and development process, which is different to those of adults. So, it is necessary to choose special medical care and adequate medical facilities for children.
Adult ; Child* ; Growth and Development ; Gwangju ; Hospitals, Pediatric ; Humans ; Internal Medicine ; Patient Selection ; Pediatrics ; Pharmacy ; Poisoning ; Prevalence ; Surveys and Questionnaires

Pancreatic pseudocysts were complicated in 10-27% of acute pancreatitis and 11-41% of chronic pancreatitis. Asymptomatic pseudocysts require no treatment, but symptomatic pseudocysts should be decompressed. Surgical management had been the traditional approach to treating pancreatic pseudocysts. Endoscopic transpapillary or transduodenal cystoenterostomy were recently suggested as an alternative to surgery in order to avoid surgical complications. The success rates of endoscopic treatment was 65-94%, procedure related morbidity was 6-21% and mortality was 0-5%. We reported two cases of patients with pancreatic pseudocysts which were treated with endoscopic cystogastrostomy and proceeded to drain through stent and ENPD catheter.
Catheters* ; Humans ; Mortality ; Pancreatic Pseudocyst* ; Pancreatitis ; Pancreatitis, Chronic ; Stents*

Bleeding duodenal varices are a rare complication in patients with portal hypertension. Cirrhosis followed by portal vein obstruction and splenic vein obstruction are the most common causes. Although the prognosis of bleeding duodenal varices is usually poor, an awareness of its characteristic presentation may enable diagnostic and therapeutic proce- dures to be performed rapidly with an increased likelihood of a reaching successful out- come. In this study, we report a case of bleeding duodenal varices in a 23-year-old woman with idiopathic portal hypertension who was also suffering with recurrent melena. Panendoscopy identified prominant tortuous varices with central erosion in the 3rd portion of the duodenum and no esophageal and gastric varices. The varices were successfully treated by distal splenorenal shunt.
Duodenum ; Esophageal and Gastric Varices ; Female ; Fibrosis ; Hemorrhage* ; Humans ; Hypertension, Portal* ; Melena ; Portal Vein ; Prognosis ; Splenic Vein ; Splenorenal Shunt, Surgical ; Varicose Veins* ; Young Adult