No abstract available.
Endolymphatic Hydrops*

No abstract available.
Otitis Externa*

No abstract available.
Cerebral Infarction* ; Craniocerebral Trauma* ; Head* ; Humans ; Oxygen*

Creutzfeldt-Jakob disease (CJD) is one of the transmissible spongiform encephalopathies, which is mediated by what has been known as "prion". It is a rare and fatal progressive neurodegenerative disease that affects the middle and old aged. There are a number of subtypes of CJD, one of which is the sporadic type characterized by rapidly progressing clinical symptoms, including progressive dementia, myoclonic jerk, and pyramidal or extrapyramidal syndrome. Patients usually end up dying within 1 to 2 years of contacting the disease. We report an autopsy-proven case of sporadic CJD with clinical symptoms that progressed within several days, along with dramatic changes on diffusion weighted magnetic resonance images.
Brain ; Creutzfeldt-Jakob Syndrome ; Dementia ; Diffusion ; Humans ; Myoclonus ; Neurodegenerative Diseases ; Prion Diseases

Objectives:This study was conducted to evaluate the ventilatory function in shipyard welders using the lifetime cumulative exposure to welding fumes. METHODS: Ventilatory function tests were performed on 241 male welders at one large shipyard,exposed to welding fumes for over five years,and was compared to 80 male control subjects. Ventilatory function indices, such as forced vital capacity(FVC), one-second forced expiratory volume(FEV 1), ratio of FEV 1 to FVC(FEV 1%), maximal mid-expiratory flow(MMF), peak expiratory flow rate(PEFR)and maximal expiratory flow at 50 and 75% of expired FVC(FEF50 and FEF75), were obtained by analyzing forced expiratory spirograms and maximal expiratory flow-volume curves that were simultaneously measured by an Impulse ocillometry(IOS)program in the standing position. RESULTS: FEF50 and FEF75 expressed as a percentage of the predicted values were significantly lower in the exposure group than in the controls, and the MMF tended to decrease.The means of all the ventilatory indices,expressed as percentage of the predicted values, were not significantly increased at the current exposure levels. The MMF, FEF50 and FEF75, expressed as a percentage of the predicted values, were significantly decreased with an increase in exposure duration.Only the FEF75 , expressed as a percentage of the predicted value, was significantly decreased with an increase in the cumulativeexposure to welding fumes(C1). The FEF75, expressed as a percentage of the predicted value, was significantly decreased with an increase in the cumulative exposure to welding fumes(C2). The above parameters were calculated to consider the current exposure level, exposure duration, application of the ventilatory system, production rate, personal protection evice, electrode and welding wire. The MMF and FEF50, expressed as a percentage of the predicted value, tended to decrease. The proportion of workers with abnormal MMF, FEF50 and FEF75 were significantly increased with an increase in the cumulative exposure to welding fumes(C2). CONCLUSIONS: These findings suggested that the MMF, FEF50 and FEF75 are sensitive and practical indices for the evaluation of the ventilatory function of workers exposed to welding fumes, when the lifetime cumulative exposure(C2) is considered as a factor affecting exposure.
Electrodes ; Humans ; Male ; Maximal Expiratory Flow-Volume Curves ; Welding*

OBJECTIVE: Hirabayashi's open-door laminoplasty is a good procedure to use to treat patients with myelopathy of the cervical spine; however, the authors have experienced problems in maintaining an open-window in cervical spines after the surgery. The authors developed a modified method of the expanded open-door laminoplasty and compared the radiological and clinical results with those of the classical method. METHODS: In the modified method, wiring fixation with lateral mass screws on the contra lateral-side instead of fixing the paraspinal muscle or facet joint, as in the classical methods, was used in the open window of the cervical spine. Fifteen patients with cervical myelopathy were treated using the classical method and 12 patients were treated using the modified method. Preoperative and postoperative clinical conditions were assessed according to the Japanese Orthopedic Association (JOA) score. The radiological results were compared with the preoperative and postoperative computed tomography (CT) findings. RESULTS: In both methods, the clinical results revealed a significant improvement in neurological function (p<0.001). Image analysis revealed that the cervical canals were continuously expanded in patients treated using the modified methods. However, authors have observed restenosis during the follow-up periods in 4 patients treated using the original method. Progression to deformity and spinal instability were not observed in any of the patients in the radiological results. CONCLUSION: Although analysis with a larger population and a longer follow-up period needs to be undertaken, our modified open-door laminoplasty has shown an advantage in better maintaining an open window in comparison with the Hirabayashi's open-door laminoplasty.
Asian Continental Ancestry Group ; Congenital Abnormalities ; Follow-Up Studies ; Humans ; Orthopedics ; Paraspinal Muscles ; Spinal Cord Diseases ; Spine ; Spondylosis ; Zygapophyseal Joint

OBJECTIVE: Hirabayashi's open-door laminoplasty is a good procedure to use to treat patients with myelopathy of the cervical spine; however, the authors have experienced problems in maintaining an open-window in cervical spines after the surgery. The authors developed a modified method of the expanded open-door laminoplasty and compared the radiological and clinical results with those of the classical method. METHODS: In the modified method, wiring fixation with lateral mass screws on the contra lateral-side instead of fixing the paraspinal muscle or facet joint, as in the classical methods, was used in the open window of the cervical spine. Fifteen patients with cervical myelopathy were treated using the classical method and 12 patients were treated using the modified method. Preoperative and postoperative clinical conditions were assessed according to the Japanese Orthopedic Association (JOA) score. The radiological results were compared with the preoperative and postoperative computed tomography (CT) findings. RESULTS: In both methods, the clinical results revealed a significant improvement in neurological function (p<0.001). Image analysis revealed that the cervical canals were continuously expanded in patients treated using the modified methods. However, authors have observed restenosis during the follow-up periods in 4 patients treated using the original method. Progression to deformity and spinal instability were not observed in any of the patients in the radiological results. CONCLUSION: Although analysis with a larger population and a longer follow-up period needs to be undertaken, our modified open-door laminoplasty has shown an advantage in better maintaining an open window in comparison with the Hirabayashi's open-door laminoplasty.
Asian Continental Ancestry Group ; Congenital Abnormalities ; Follow-Up Studies ; Humans ; Orthopedics ; Paraspinal Muscles ; Spinal Cord Diseases ; Spine ; Spondylosis ; Zygapophyseal Joint

BACKGROUND AND OBJECTIVES: he patients with atrial septal defect generally have no symptoms in the childhood, and have nonspecific symptoms such as dyspnea on exertion, fatigue, and palpitation even in the late period of adult. Thus delayed diagnosis for whom surgical correction was undoubtedly needed remains to be resolved. Accordingly, the simple and noninvasive method such as electrocardiography in patients with atrial septal defect having the nonspecific symptoms or having no symptoms warrants to be developed. This study was performed to see whether the crochetage pattern on R wave in inferior limb leads is effective for the electrocardiographic diagnosis of atrial septal defect and relates to the magnitude of left to right shunt. METHODS: Our subjects were 129 patients diagnosed as the atrial septal defect by the echocardiography and cardiac catheterization from January 1992 to June 1998. We selected 57 persons, as control group, who showed the normal findings under the echocardiography and also showed the incomplete right bundle branch block on the electrocardiography. We compared the frequency of the crochetage pattern in inferior limb leads between the two groups. Also we compared the frequency of the crochetage pattern before operation and after operation according to the quantity of the left to right shunt in the operated 40 patients with atrial septal defect. RESULTS: ) The crochetage pattern was observed in 61.2% in patients with atrial septal defect and its frequency was greater than that of the control group (38.6%, p=0.005). 2) The crochetage pattern was disappeared by the operation in 16/29 patients (55.2%, p=0.001). 3) The frequency of disappearance of the crochetage pattern after operation differed significantly according to shunt severity: 72.2% for a Qp/Qs> or =3.0 group, 18.2% for a Qp/Qs<3.0 group (p=0.015). CONCLUSION: The crochetage pattern on R wave in inferior limb leads was helpful to the electrocardiographic diagnosis of the atrial septal defect. The disappearance of the crochetage pattern after operation was correlated with shunt severity.
Adult ; Bundle-Branch Block ; Cardiac Catheterization ; Cardiac Catheters ; Delayed Diagnosis ; Diagnosis ; Dyspnea ; Echocardiography ; Electrocardiography* ; Extremities* ; Fatigue ; Heart Septal Defects, Atrial* ; Humans

OBJECTIVES: The aim of this study is to evaluate the practical role of 3D-CTA in planning the surgery for intracranial aneurysm from a viewpoint of operator. METHODS: Since May 1997 to April 1998, a total of 65 patients who were suspected to have intracranial aneurysms were studied with 3D-CTA using a General Electric Hispeed Advantage helical scanner. Conventional intraarterial digital subtraction angiographies(IA-DSAs) were performed in all patients except four who were in urgent situation. With the images obtained from the 3D-CTA, we performed preoperative assessments for the targeted aneurysms and evaluated its usefulness for planning the aneurysm surgery. RESULTS: 3D-CTA revealed 69 intracranial aneurysms in 55 patients and the size of aneurysms detected were 2-17mm in diameter. The sensitivity of 3D-CTA(95.8%) which was based on the comparison with IA-DSA and supplemented by microsurgical finding was similar to that of IA-DSA(94.1%) and its specificity(81.8%) was lower than that of IA-DSA(100%). Time consuming for getting images from 3D-CTA was no more than 20 minutes and this rapidity was very useful in the emergent situation such as cases of large intracerebral hematoma or massive intraventricular hemorrhage. 3D-CTA proffered various perspective views including surgical view, which were valuable to estimate the degree of head rotation and the direction of clip insertion and to determine the permanent clip type preoperatively. Careful reviewing of 3D-CTA made it possible to minimize surgical procedures. We could omit routine rectus gyrus resection in twelve of 16 surgeries for A-com aneurysm and could operate sixteen of 19 ICA aneurysms successfully without routine extracranial carotid artery preparation. On the basis of 3D-CTA, we could select the appropriate surgical approach in cases of ophthalmic aneurysm or posterior circulation aneurysm. Moreover, in cases of bilateral multiple aneurysms, 3D-CTA was helpful for evaluating the possibility of visualizing contralateral aneurysm through unilateral approach. The extent of bone work could be determined preoperatively through reviewing the 3D-CTA images and possible rupture of MCA aneurysm during bone work could be avoidable. However, 3D-CTA had some limitations for the describing fine vascular architecture such as the teat of aneurysm, a clue for the ruptured aneurysm in multiple aneurysms and most of fine caliber vessels such as hypoplastic posterior communicating artery or anterior choroidal artery was missed on the 3D-CTA. 3D-CTA lacked description for the hemodynamics of cerebral circulation. CONCLUSIONS: Although the 3D-CTA is still insufficient to be the complete substitute for conventional intraarterial digital subtraction angiography, it may be excellent adjunctive tool in planning the surgery of intracranial aneurysm considering that understanding the exact relationship of aneurysm with surrounding structure is mandatory for minimizing the possible risk during surgery.
Aneurysm ; Aneurysm, Ruptured ; Angiography* ; Angiography, Digital Subtraction ; Arteries ; Carotid Arteries ; Choroid ; Head ; Hematoma ; Hemodynamics ; Hemorrhage ; Humans ; Intracranial Aneurysm* ; Rupture

OBJECTIVE: We report an outcome of surgical treatment of the elderly patients with spinal stenosis, managed by a bilateral narrowed spinal canal widening technique through unilateral approach. METHODS: The operations were performed in 16 patients who diagnosed with spinal stenosis. All individuals had been presented with low-back pain, neurogenic claudication or radiculopathy and unresponsive to conservative treatment over six months. We perfomed hemi-laminectomy at the appropriate levels on the most symptomatic side preserving the facet joint. And the ligamentum flavum, as well as the cortical bone on the ventral surface of the contralateral laminae were removed. The spinous process was left as possible as we can, and the contralateral side of the spinal canal was decompressed completely. RESULTS: The mean age of the patients was 71 years. The mean operation time was 73 minutes. Despite of old age, the patients were able to walk in three days after the surgery. The significant pain scale improvement(7.73 to 2.68) and widening of the spinal canal diameter(7.60+/-1.75 to 17.77+/-1.47mm) were noted after the operation. No patient was presented spinal instability on their follow-up period over 24 months. CONCLUSION: The bilateral canal widening technique through the unilateral approach, minimizes the damage to the inter-spinous ligament and the inter-spinous muscle, and saves the operation time because it is not necessary to use the instruments which prevent spinal instability, despite spinal canal was sufficiently enlarged.
Aged* ; Follow-Up Studies ; Humans ; Ligaments ; Ligamentum Flavum ; Radiculopathy ; Spinal Canal ; Spinal Stenosis* ; Zygapophyseal Joint