The disc internal disruption syndrome is not well known to us, but the following hypothesis is widely accepted in clinical practice. The disc internal disruption syndrome may develop intractable back pain with aggravated of pain, loss of spinal motion with any physical exercise, leg pain, loss of energy, marked weight loss, and profound depression. The patient with this syndrome will be found to have normal plain roentgenograms, myelograms, CT scans, results of blood examination and neurologic findings. For these reasons, this syndrome was frequently diagnosed by abnormal discographic findings. We had experience with two cases of disc internal disruption syndrome with clinical, roentgenographic and discographic evaluations. Thus we present these case with a brief review of the concerned literature.
Back Pain ; Depression ; Exercise ; Humans ; Leg ; Neurologic Manifestations ; Tomography, X-Ray Computed ; Weight Loss

No abstract available.
C-Reactive Protein*

PURPOSE: To compare efficacy and safety between early extracorporeal shock wave lithotripsy (eESWL) and deferred ESWL (dESWL) in colic patients with ureteral stones and to investigate whether eESWL can play a critical role in improving treatment outcomes. MATERIALS AND METHODS: A total of 279 patients who underwent ESWL for single radio-opaque ureteral stones of 5 to 20 mm in size were included in this retrospective study. The patients were categorized into two groups according to the time between the onset of colic and ESWL: eESWL (<48 hours, n=153) and dESWL (> or =48 hours, n=126). Success was defined as stone-free status as shown on a plain radiograph within 1 month of the first session. RESULTS: For all patients, the success rate in the eESWL group was significantly higher than that in the dESWL group. The eESWL group required significantly fewer ESWL sessions and less time to achieve stone-free status than did the dESWL group. For 241 patients with stones <10 mm, all treatment outcomes in the former group were superior to those in the latter group, but not for 38 patients with stones sized 10 to 20 mm. The superiority of eESWL over dESWL in the treatment outcomes was more pronounced for proximal ureteral stones than for mid-to-distal ureteral stones. Post-ESWL complication rates were comparable between the two groups. In the multivariate analysis, smaller stone size and a time to ESWL of <48 hours were independent predictors of success. CONCLUSIONS: Our data suggest that eESWL in colic patients with ureteral stones is an effective and safe treatment with accelerated stone clearance.
Colic ; Humans ; Lithotripsy ; Multivariate Analysis ; Retrospective Studies ; Shock ; Ureter ; Ureteral Calculi

The finite element method was utilized to find the rigidity of the device in changing the parameters, such as geometrical configuration, material property, and loading condition in an external fixation. In the experimental analysis, a universal testing machine(UTM) was used to evaluate the rigidity of EBI, Monofixator and Hoffmann under the different type of lodings, such as axial compression, bending and torsion in changing the parameters. The result was compared with those of the experimental work. The results were as follows: 1) In standard condition, the yielding loads in axial compression were 85Kg in the EBI, 55Kg in the Hoffmann, and 100Kg in the Monofixator, The rigidity figures were 2930N/cm in the EBI, 764N/cm in the Hoffmann, and 2391M/cm in the Monofixator. Z) The experimental method was adapted to figure out the effect of parametric change on the stiffness of 3 different external fixation apparatus(Monofixator,EBI, Hoffmann). A Monofixator with a parametric change of pin diameter from 6mm to 5mm indicated 40% reduction of stiffness in axial compression and 60% reduction of stiffness in torsion. Also, in the case of the change of pin group separation from 20cm to 15cm it showed 64% increase of stiffness in, AP bending. EBI with the increase of the distance between pin and aluminum bar to 8cm showed 32% decrement of stiffness in axial compression and 38% decrement of stiffness in AP bending. The stiffness of the Hoffmann device was remarkable according to the number of the pin used and the distance between the pin and the aluminum bar. 3) Concerning the difference between the experimental analysis and finite element method in a Monofixator, the results of the experimental analysis were 10% to 37% lower than those of the finite element method. The reason is thought to be caused by complete binding. The obtained data shed light on the future guide-lines and future alterations of the design factors in external fixation device. Approprate use of the obtained information is desirable for the optimal,treatment of the fractured long bone.
Aluminum ; External Fixators ; Methods

OBJECTIVE: Radiation injury includes radiation necrosis and apoptosis. Though some of its mechanism in brain are reported, those in spinal cord are not determined yet. The purpose of this study is to see whether nimodipine, one of calcium channel blockers, is effective for the prevention of high dose irradiation-induced apoptosis in the rat spinal cord. METHODS: Forty eight Sprague-Dawley rats were divided into four experimental groups, such as non-treated group(control group) after 5Gy and 10Gy irradiation(n=24), and nimodipine-treated group after 5Gy and 10Gy irradiation(n=24). Each group was divided by irradiation doses. After the drug was administered, the spinal cord was exposed to 5Gy and 10Gy dose of gamma rays using Ir-192. All spinal cord underwent histological examination at 4 hours, 8 hours, 12 hours after irradiation to evaluate the number of apoptotic cells. Apoptotic cells were detected by TUNEL assay, and determined by direct visual counting at x200, magnification RESULTS: In nimodipine-treated group, apoptotic cell counts were reduced significantly, compared to that of control group after irradiation(p < 0.05). CONCLUSION: These results suggest that nimodipine treatment may have effects on the prevention of radiationinduced apoptosis. If it could be established that calcium channel blockers inhibit radiation injury, they might be useful in radiation therapy.
Animals ; Apoptosis* ; Brain ; Calcium Channel Blockers ; Cell Count ; Gamma Rays ; In Situ Nick-End Labeling ; Necrosis ; Nimodipine* ; Radiation Injuries ; Rats* ; Rats, Sprague-Dawley ; Spinal Cord*

STUDY DESIGN: Case report. OBJECTIVES: We report the case of a long, solitary, rosary-shaped neurofibroma that was misdiagnosed as another disease due to the patient's surgical history involving repetitive procedures and its abnormal appearance. SUMMARY OF LITERATURE REVIEW: Neurofibroma is an intradural-extramedullary spinal tumor. It is generally not difficult to diagnose due to its frequent occurrence and specific magnetic resonance imaging (MRI) findings. However, to date, neurofibromatosis stigmata and long, solitary, rosary-shaped neurofibromas have rarely been reported. MATERIALS AND METHODS: A 60-year-old woman was admitted to our hospital due to persistent pain, despite previous surgery and repetitive procedures. On physical examination, vision loss, hearing loss, skin discoloration, or subcutaneous nodules were not observed. A neurologic examination revealed normal motor and sensory function and voiding sensation. No pathologic reflexes such as the Babinski sign were observed. Previous sequential MRIs revealed intradural lesions that progressed from the thoracic vertebra 11 to the lumbar vertebra 3. She had no signs of neurofibromatosis stigmata, and the neurologic examination was unremarkable. The initial diagnosis was based on serial MRIs, which revealed a parasite infestation, a spinal cord tumor (myxopapillary-type ependymoma with hemorrhage), arachnoiditis, and vascular malformations. Total mass excision was performed, and the final diagnosis was neurofibroma. RESULTS: There were no signs of a tumor remnants or local recurrence in a 1-year follow-up MRI study. CONCLUSIONS: Although intradural spinal tumors are very rare, their clinical features are nonspecific and resemble other degenerative spinal diseases, including spinal stenosis and disc herniation. These diseases may easily be overlooked by physicians.
Arachnoid ; Arachnoiditis ; Christianity ; Diagnosis ; Diagnostic Errors ; Ependymoma ; Female ; Follow-Up Studies ; Hearing Loss ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Neurofibroma* ; Neurofibromatoses ; Neurologic Examination ; Parasites ; Physical Examination ; Recurrence ; Reflex ; Reflex, Babinski ; Sensation ; Skin ; Spinal Cord Neoplasms ; Spinal Diseases ; Spinal Stenosis ; Spine ; Vascular Malformations

PURPOSE: The Purpose was to evaulate the efficacy of sodium hyaluronate (HA) according to the degree of osteoarthritis, body mass index and tibiofemoral alignment. MATERIALS AND METHODS: 53 of 73 patients who had osteoarthritis of the knee were underwent intraarticular injection weekly for 5 weeks with hyaluronic acid (HA, hyruan(R), MW:1MDa) and 20 of 73 patients with placebo (normal saline). The patients were followed for 27 weeks. Results were evaluated with visual analogue scale for pain, Lequesne algofunctional index for functional severity and Tegner activity score for activity. The degree of severity of osteoarthrtis of knee was stratified by Kellgren classification. RESULTS: In the group treated with HA, the patients classified as Kellgren classification II and III showed much better improvement in efficacy for pain, function and activity compared with group IV. In the femorotibial alignment, neutral and valgus alignment group showed better results than varus group. There is no statistical significance in the knee pain and function between normal and overweight group. Best symptomatic improvement according to the subjective symptom revealed at 3 week in 25 patients (47.2%). Placebo treated patients had slight pain and improved functional perfomance but less effect in compared with HA treated patients. CONCLUSION: Intraarticular administration of HA relieve the symptom of osteoarthritis and improve the function of knee joint. Especially, the patients classified with Kellgren classification II, III and valgus, neutral tibiofemoral alignmen groups showed much better improvement than grade IV and varus group.
Body Mass Index ; Classification ; Humans ; Hyaluronic Acid* ; Injections, Intra-Articular ; Knee Joint ; Knee* ; Osteoarthritis* ; Overweight

BACKGROUND: Malnutrition is a frequent nutritional problem among ICU patients, and their nutritional status is known to affect clinical prognosis. We conducted this study to examine nutritional status and actual nutrition delivery in the ICU patients and its relations to clinical outcomes. METHODS: This study was a multicenter retrospective observational study based on the medical records of 163 patients admitted to ICU of tertiary teaching hospitals in Korea. We included the patients who were treated with mechanical ventilation for 3 or more days and received enteral or parenteral nutrition. RESULTS: According to albumin and total lymphocyte count levels, 54.6% of the subjects were moderately or severely malnourished. Mean percentage of calorie and protein delivery to estimated needs for 10 days were 55.8 +/- 29.3% and 46.1 +/- 30.1%, respectively. While parenteral nutrition (PN) started at 1.6 +/- 1.4 days after admission, enteral nutrition (EN) did at 3.6 +/- 2.1 days. Days to PN and EN start, the calorie and protein amount via EN or PN were significantly different among 6 hospitals. No clinical outcomes differed by the levels of calorie or protein delivery. In-hospital mortality was significantly higher in the severely malnourished group at admission as compared to the other 2 groups (54.3% vs. 31.2% vs. 27.7%, p < 0.05) CONCLUSIONS: Malnutrition prevalence is high among Korean intensive care unit patients, but current nutritional therapy practice is inconsistent across institutions and far below the international guidelines. Systematic efforts should be made to develop nutritional support guidelines for Korean ICU patients.
Critical Illness ; Enteral Nutrition ; Hospital Mortality ; Hospitals, Teaching ; Humans ; Critical Care ; Intensive Care Units ; Korea ; Lymphocyte Count ; Malnutrition ; Medical Records ; Nutritional Status ; Nutritional Support ; Parenteral Nutrition ; Prevalence ; Prognosis ; Respiration, Artificial ; Retrospective Studies

PURPOSE: To investigate the success rate of trial without catheter (TWOC) for postoperative urinary retention (POUR) after non-urological surgery and to determine predictors of successful TWOC. METHODS: A total of 104 patients who underwent non-urological surgery and were referred to the department of urology for POUR were included in this retrospective study. All eligible patients underwent indwelling catheterization as an initial treatment and then TWOC was performed 3 to 7 days later. POUR was defined as micturition difficulty with greater than 400 mL of postvoid residual (PVR) urine volume measured by catheterization after non-urological surgery. Successful TWOC was defined as voiding with less than 100 mL of PVR urine volume. Predictive factors were identified by multivariate regression analysis. All definitions corresponded to recommendations of the International Continence Society. RESULTS: The mean age of the patients was 65.2 (range, 23 to 92) years. There were 45 male and 59 female patients. Intraoperative indwelling catheterization was performed in 69 (66.3%) patients. Mean duration of indwelling catheterization for POUR was 5.0 (range, 3.0 to 7.0) days and 83 (79.8%) patients received medication with an alpha-blocker. A successful TWOC was observed in 70 (67.4%) patients. The mean age of the patients with failure of TWOC was significantly higher than that of the patients with successful TWOC. The percentages of female patients, spinal surgery, and prone position during surgery in patients with unsuccessful TWOC were higher than in those with successful TWOC. In the multivariate logistic regression analysis, age and location of surgery (spine vs. non-spine) were the independent predictors of successful TWOC for POUR. CONCLUSIONS: Our data suggest that older age and spinal surgery may be important risk factors for failure of TWOC for POUR after non-urological surgery. Thus, adequate prevention measures may be necessary for POUR after non-urological surgery, especially in patients with these risk factors.
Catheterization ; Catheters ; Catheters, Indwelling ; Female ; Humans ; Logistic Models ; Male ; Postoperative Care ; Prone Position ; Retrospective Studies ; Risk Factors ; Urinary Retention ; Urination ; Urology

BACKGROUND/AIMS: Mesenchymal tumors are the most frequent submucosal tumors in gastrointestinal trail. We reviewed the mesenchymal tumors which are confirmed by pathology to examine whether the invasive approach of all mesenchymal tumors is necessary. METHODS: This study was performed on fifty-nine patients who has mesenchymal tumors confirmed by endoscopic or surgical resection from January 2000 to June 2004. RESULTS: Mesenchymal tumors consisted of thirty-six gastrointestinal stromal tumors (GISTs), 20 leiomyomas and 3 schwannomas. All the esophageal tumors were leiomyoma (12/12, 100%). In stomach, there were 32 GISTs (76.2%), 7 leiomyomas (16.7%) and 3 schwannomas (7.1%). And there were 4 GISTs (80.0%) and 1 leiomyoma (20.0%) in duodenum. Tumors less than 1 cm in maximal diameter were leiomyoma or GISTs with very low risk of aggressive behavior. 56.1% of the tumors larger than 1 cm consisted of low, intermediate or high risk GISTs. CONCLUSIONS: Biopsy must be considered according to its size and anatomic location of mesenchymal tumors. The invasive approach for every esophageal submucosal tumor is not necessary unless the size is very large, because most of them are benign in nature. However, the gastric submucosal tumor with more than 1 cm in diameter should be carefully and regularly followed up or biopsied because it cannot be assumed to be benign for any GIST more than 1 cm in size at the present time, safely.
Adult ; Aged ; *Biopsy, Needle ; Endoscopy, Gastrointestinal ; Female ; Gastrointestinal Neoplasms/*pathology ; Gastrointestinal Stromal Tumors/*pathology ; Humans ; Leiomyoma/pathology ; Male ; Middle Aged ; Neurilemmoma/pathology ; Upper Gastrointestinal Tract