No abstract available.
Hyperostosis, Cortical, Congenital*

Polands syndrome is a congenital disorder associated with thoracic anomalies and ipsilateral syndactly. It was described first by Alfred Poland in 1841 year. We has been experienced 2 cases of Polands Syndrome recently. Two cases were male. Each case revealed one side thoracic muscle anomalies, that is, absence of sternocostal head of pectorails major with hypoplasia of nipple and, breast, and ipsilateral syndactyly with partial aplasia and hypoplasia of midphalanges.
Breast ; Congenital, Hereditary, and Neonatal Diseases and Abnormalities ; Head ; Humans ; Male ; Nipples ; Poland ; Syndactyly

BACKGROUND: The previous reports have demonstrated that coronary artery flow profiles might change in patients with aortic valve disease. Our objective was to assess phasic coronary artery flow and velocity characteristics and coronary flow reserve in patients with severe aortic vale disease. METHOD: We studied six patients (4 men and 2 women, mean age 61.3+/-6.3 years) with aortic regurgitation and seven patients (3 men and 4 women, mean age 66.3+/-10.3 years) with aortic stenosis. Coronary flow velocity was measured at the proximal portion of left anterior descending artery with 0.014-inch Doppler tipped guide wire and intracoronary injection of adenosine. Nineteen patients (11 men and 8 women, mean age 52+/-9.8 years) with normal coronary artery were served as normal control. Result: The velocity-time integral of systolic coronary flow (SPVi) was significantly higher in patient with severe aortic regurgitation than control (21.1+/-5 vs 9.4+/-3.1, p<0.05, respectively) and ratio of diastlic to systolic the velocity-time integrals (DSiR) was significantly lower in patient with severe aortic regurgitation than control subject (1.5+/-0.5 vs 3.7+/- 0.8 p<0.05, respectively). Patients with severe aortic stenosis had significantly higher velocity-time integral of diastolic coronary flow (DPVi) than control subject (17+/-9.7 vs 8.8+/-3.0 p<0.05, respectively) and slighly higher DSiR than control subject (4.0+/- 2.5 vs 3.7+/-0.8 p<0.05, respectively). Coronary flow reserve was significantly decreased in patient with aortic valve disease compared with control subject (2.1+/-0.8 vs 3.2+/-0.4 p<0.05, respectively). CONCLUSION: Coronary flow reserve decreased significantly in patients with AR and with AS compared with normal control. Coronary blood flow profiles in patients with AR was characterized by systolic flow predominance and reduced diastolic flow whereas patients with AS was a tendency toward decreased systolic flow and increased diastolic flow.
Adenosine ; Aortic Valve Insufficiency ; Aortic Valve Stenosis ; Aortic Valve* ; Arteries ; Coronary Vessels* ; Female ; Humans ; Male

Spontaneous migration of the shunt catheter into the posterior cranial fossa is very rare complication of lumboperitoneal shunt operation. The authors report a case with communicating hydrocephalus following ruptured intracranial aneurysm for which a lumboperitoneal shunt was placed. Four years later, she was presented with low back pain after the slip-down in jury, and radiologic studies revealed compression fracture at T12 and intracranial migration of shunt catether into the posterior fossa. From our knowledge, there is only one other such case reported in the literature.
Catheters* ; Cranial Fossa, Posterior ; Fractures, Compression ; Hydrocephalus ; Intracranial Aneurysm ; Low Back Pain

BACKGROUND: Previous studies indicated that a recently approved synthetic HMG-CoA reductase inhibitor, atorvastatin, reduces LDL cholesterol and triglyceride. To assess the efficacy on the level of serum LDL cholesterol and other lipoprotein fractions and its safety, we investigated 59 patients for lipid and side effect profile. METHOD: In patients with hypercholesterolemia, who showed 12-hours fasting serum LDL cholesterol>145 mg/dl and <250 mg/dl and triglyceride levels<400 mg/dl were enrolled to diet therapy for 4 weeks. After 4 weeks of diet therapy, serum lipid profile were reevaluated and patients with LDL cholesterol > or =130 mg/dl were assigned to receive 10 mg dose of atorvastatin once daily for 4weeks. After 4 weeks of drug therapy, serum lipid profile were rechecked, if showed LDL cholesterol level> or =130 mg/dl, assigned to receive 20 mg dose of atorvastatin once daily until 8 weeks. RESULTS: Of the 59 patients were assigned to receive atorvastatin therapy, 52 patients completed the study. Among lipid profiles, total cholesterol, triglyceride, LDL-cholesterol and apolipoprotein B levels showed significant reduction with mean reduction rate of 28%, 13%, 38%, 32% respectively after 4 weeks and 31%, 13%, 41% and 34% respectively after 8 weeks. HDL-Cholesterol and lipoprotein (a) level did not show significant change after 8 weeks of therapy. Nine patients had mild adverse events, such as elevated ALT, epigastric pain, insomnia, thumb pain. postural hypotension, palpitation and constipation. Only three patients of fifty-nine withdrew from the study due to adverse events related to drug treatment. CONCLUSION: The atorvastatin was highly effective and generally well tolerated with an acceptable safety profile in patients with primary hypercholestelemia.
Apolipoproteins ; Cholesterol ; Cholesterol, LDL ; Constipation ; Diet Therapy ; Drug Therapy ; Fasting ; Humans ; Hypercholesterolemia* ; Hypotension, Orthostatic ; Lipoprotein(a) ; Lipoproteins ; Oxidoreductases ; Sleep Initiation and Maintenance Disorders ; Thumb ; Triglycerides ; Atorvastatin Calcium

BACKGROUND: Atlanto-axial dislocation (AAD) is a common complication of rheumatoid arthritis (RA). Diverse or different patterns of neurological manifestations including brainstem signs, myelopathy, vertebrobasilar insufficiency, and radiculopathy are expected in each type of AAD. This study is designed for the evaluation of neurological manifes-tations of AAD in RA, and for the comparison of clinical profiles with radiological findings. METHODS: Thirty patients compatible with radiological criteria of AAD were selected. The age, sex, symptom duration, and neurological signs were evaluated in the clinical profiles. Based on the neurological signs, the patients were classified into three groups. Radiological classifications of AAD were done according to the direction of AAD (anterior, vertical, lateral, mixed) and degrees of dislocation (grade I, II, III). Correlational analysis was performed as a measure of association with the clinical profiles and radiological findings. RESULTS: Neurological manifestations were present/found in 50% of the patients. Each types of AAD were distributed into the following groups:; anterior - 76.7%, mixed - 13.3%, lateral -10%, pure vertical - 0% in our study. The various groups determined by the neurological signs may be correlated with the severity of AAD, especially in the anterior type (> 8mm) and mixed type. Neurological signs were not noted in the pure lateral type. Vascular signs such as vertebrobasilar insufficiency (VBI) were more common in the anterior-AAD, but myelopathic or brainstem signs were more common in the mixed type. CONCLUSIONS: Diverse neurological findings exist in AAD. Different and characteristic manifestations are also noted in each type of AAD. Critical neurological signs including myelopathic, brainstem signs and VBI are prominent in severe anterior-AAD or mixed type.
Arthritis, Rheumatoid* ; Brain Stem ; Classification ; Dislocations ; Humans ; Neurologic Manifestations* ; Radiculopathy ; Spinal Cord Diseases ; Vertebrobasilar Insufficiency

BACKGROUND: Atlanto-axial dislocation (AAD) is a common complication of rheumatoid arthritis (RA). Diverse or different patterns of neurological manifestations including brainstem signs, myelopathy, vertebrobasilar insufficiency, and radiculopathy are expected in each type of AAD. This study is designed for the evaluation of neurological manifes-tations of AAD in RA, and for the comparison of clinical profiles with radiological findings. METHODS: Thirty patients compatible with radiological criteria of AAD were selected. The age, sex, symptom duration, and neurological signs were evaluated in the clinical profiles. Based on the neurological signs, the patients were classified into three groups. Radiological classifications of AAD were done according to the direction of AAD (anterior, vertical, lateral, mixed) and degrees of dislocation (grade I, II, III). Correlational analysis was performed as a measure of association with the clinical profiles and radiological findings. RESULTS: Neurological manifestations were present/found in 50% of the patients. Each types of AAD were distributed into the following groups:; anterior - 76.7%, mixed - 13.3%, lateral -10%, pure vertical - 0% in our study. The various groups determined by the neurological signs may be correlated with the severity of AAD, especially in the anterior type (> 8mm) and mixed type. Neurological signs were not noted in the pure lateral type. Vascular signs such as vertebrobasilar insufficiency (VBI) were more common in the anterior-AAD, but myelopathic or brainstem signs were more common in the mixed type. CONCLUSIONS: Diverse neurological findings exist in AAD. Different and characteristic manifestations are also noted in each type of AAD. Critical neurological signs including myelopathic, brainstem signs and VBI are prominent in severe anterior-AAD or mixed type.
Arthritis, Rheumatoid* ; Brain Stem ; Classification ; Dislocations ; Humans ; Neurologic Manifestations* ; Radiculopathy ; Spinal Cord Diseases ; Vertebrobasilar Insufficiency

OBJECTIVE: A 10-year retrospective lumboperitoneal(LP) shunt surgery was reviewed in order to verify the several prognostic factors including the etiology, the findings of brain computed tomography(CT) and/or magnetic resonance imaging(MRI), and the effect of lumbar drainage which have been implicated in the result of LP shunt. PATIENTS AND MEHTODS: A series of 32 patients who underwent LP shunt surgery between March 1988 and May 1998 for the management of communicating hydrocephalus was reviewed. RESULTS: The etiology of communicating hydrocephalus was subarachnoid hemorrhage(SAH) in 19 cases(59.4%), head trauma in 10 cases(31.2%), intracerebral hemorrhage in 2 cases(6.3%), meningitis in 1 case(3.1%), tumor in 1 case(3.1%), and idiopathic in 2 cases(6.3%). The mean follow-up period was 1.2 years(range, 2 week to 8.5 year). Among them, twenty four patients(75%) were clinically improved after shunt operation. The result of LP shunt was not related to the etiologies and many findings of brain CT/MRI such as ventricular index, Evan's index, periventricular low density, obliteration of cerebral sulci and cortical atrophy. However, the result of LP shunt was significantly related to the effect of preoperative lumbar drainage(p=0.0184). CONCLUSION: This result suggests that the effect of preoperative lumbar drainage has a significant role in predicting the result of LP shunt in patients with communicating hydrocephalus.
Atrophy ; Brain ; Cerebral Hemorrhage ; Craniocerebral Trauma ; Drainage ; Follow-Up Studies ; Humans ; Hydrocephalus* ; Meningitis ; Retrospective Studies

Several prognostic factors have been implicated in survival prolongation in patients with metastatic brain tumors. Among these, surgery has been regarded as very significant one with respect to life prolongation and improving the quality of survival in such patients. From August 1982 through July 1996, a series of 31 patients with metastatic brain tumors among 785 patients with operated brain tumors, whose medical records, X-rays and follow-ups were avilable, was studied retrospectively to evaluate the beneficial effects of surgery. Despite the limitations inherent to the retrospective study and limited number of patients, we divided these patients into two groups to find out any statistical differences in terms of survival and quality of survival among them: 1) Conservative group(8 nonoperated patients: 5 patients with biopsy or partial resection): 13, and 2) Surgical treatment group(17 totally resected patients: one patient with subtotal resection): 18. The quality of survival was assessed by Karnofsky performance(KP) scale before and after each treatment. The survival of the patients in the surgical treatment group was longer than the conservative treatment group(14.5 months/10 months), but this was not statistically significant(p value: 0.3305). However, improvement of quality of survival, in terms of KP scale, was significantly higher in the surgical treatment group(p value: 0.0027). Although confounded by the lack of controlled, randomized study and limitations of retrospective study, aggressive surgery can be regarded to have a significant role in improving the quality of survival in patients with metastatic brain tumors.
Biopsy ; Brain Neoplasms* ; Brain* ; Follow-Up Studies ; Humans ; Life Support Care ; Medical Records ; Pheniramine ; Retrospective Studies

PURPOSE: The megacolon after repairing an anorectal malformation is not a rare complication, and there is much controversiy on the causes, the treatment of choice and the results after a longterm follow-up. We present 5 cases of a megacolon after the repair of an anorectal malformation, which were controlled with either a surgical resection or conservative treatment. METHODS: Five patients with a megacolon after the repair of an anorectal malformation were studied. A retrospective chart review was done and fecal continence was evaluated with an individual interview. RESULTS: All five patients initially underwent conservative treatment with laxatives and/or enemas. One Patient responded well to conservative treatment and the diameter of the bowel reduced to normal size. Another patient responded to conservative treatment after correcting the location of the anus. Three patients needed a surgical resection and one of those needed a further procedure to correct the anal location. After the surgical resection of the megacolon and/or correction of the anus (one out of the three patients), they soon reported an almost normal bowel habit. CONCLUSION: The first step in treating a megacolon after repairing an anorectal malformation was conservative treatment. However patients without an adequate response to conservative treatment are best managed with a surgical resection. The cause of the megacolon is now under investigation and the lack of adequate management after repair is one of the subjects.
Anal Canal ; Enema ; Follow-Up Studies ; Humans ; Laxatives ; Megacolon* ; Retrospective Studies