The study was undertaken to assess the ventricular system of the brain in normal korean adults on the base ofCT. The computerized tomographic examinations of 334 Korean adults between ages of 15 to 50 years, performed atSeoul National University Hospital, were evaluated. The known to be a reliable indicator of the ventricular size.This ratio was measured at the level of the lateral, third and fourth ventricles respelctively. The shape of thequardigeminal and suprasellar cistern was analyzed. The resuls are as follows; 1. The cerebroventricular ratios ofthe lateral ventricle at the level of the widest bifrontal and bicaudate diameters were 0.30±0.04 and 0.14±0.02,respectively. The lateral ventricle was asymmetric in 12.6%, of which the left side was usually larger than theright. 2.There was correlation between the cerebroventricular ratio and age, i,e., with increase of age, the C-Vratio increased slightly. 3. The cerebroventricular ratio of the third ventricle was 0.03±0.01. 4. Thecerebroventricular ratio of the fourth ventricle in width and height was 0.14±0.02 and 0.10±0.03, respectively.The anteroposterior position index of the fourth ventricle was 0.42±0.04. 5. The quadrigeminal cistern showedU-shape in 23.4%. 6. The suprasellar cistern showed pentagonal shape in 61.1%, round in 28.4% and hexagonal in10.5%. 7. There was no significant difference between male and female according to the above results.
Adult ; Brain ; Female ; Fourth Ventricle ; Humans ; Lateral Ventricles ; Male ; Third Ventricle

Between 1984 and 1996, 8 patients who were suffered from stage g Kienbock's disease underwent interpositional arthroplasty using pronator quadratus pedicled bone. Patients comprised 2 males and 6 females, with an average age of 33 years(range 19-47). Range of motion of the wrist, residual pain, grip strength, and carpal height ratio of the patients were analyzed. The follow-up period was between 1.5 years and 12.5 years(average 5.5 years). The arc of flexion-extension of the wrist was increased from average 74 degrees preoperatively to 96 degrees postoperatively. Among eight patients, five were free of pain and three had intermittent pain during heavy work. None of eight patients had any discomfort in daily work and changed his or her occupation. The grip strength was average 83% of the normal side. Carpal height ratio was average 0.48 preoperatively and was not changed postoperatively. Clinical results, assessed by Lichtman-Evans criteria, showed 4 good and 4 fair. The interpositional arthroplasty using pronator quadratus pedicled bone was considered as a very effective method for the treatment of stage III Kienbock's disease.
Arthroplasty* ; Female ; Follow-Up Studies ; Hand Strength ; Humans ; Male ; Occupations ; Osteonecrosis* ; Range of Motion, Articular ; Wrist

PURPOSE: The aim of this study was to evaluate the preliminary results using the 4+5 extensor compartmental vascularized bone graft for the treatment of stage III Kienbock's disease and to report the usefulness of this procedure. METHODS: A retrospective study was carried out on five patients who had undergone 4+5 extensor compartmental vascularized bone graft for stage III Kienbock's disease between Jan. 2005 and Aug. 2006. All patients were composed of two patients in stage IIIA and three patients in stage IIIB according to Lichtman classification. The radiographic findings were evaluated by carpal height ratio, Stahl's index, ulnar variance and scapholunate angle. The clinical outcome was assessed using the Mayo wrist score. RESULTS: The mean age of 43.4 years(range, 21-61) and the mean follow up of 23.6 months(range, 14-31) were presented. All patients were satisfied and the mean Mayo wrist score was 78(range, 70-85). Two patients showed further lunate collapse on follow-up radiographs. Four patients had no pain in the activity of daily living, one patient had a mild occasional pain. CONCLUSION: The 4+5 extensor compartmental vascularized bone graft for the surgical treatment of stage III Kienbock's disease is the effective treatment showing satisfactory clinical results, but a lunate collapse proceeds. Before this operation, the possibility of lunate collapse should be considered.
Follow-Up Studies ; Humans ; Osteonecrosis ; Retrospective Studies ; Transplants ; Wrist

We experience a case of 34-year-old Turner's syndrome(45, XO) associated with atrial septal defect(secondum type) and mitral valve prolapse who was admitten due to moderate exertional dyspnea. It is well know hat chromosomal abnormality is one of the etiology of congenital heart disease. In case of Turner's syndrome, coarctation of aorta or bocuspid aortic valve is frequently combined, but atrial septal defect simultaneously with mitral valve prolapse is not reported till now in Krea. We report this case with a brief review of the literature.
Adult ; Aortic Coarctation ; Aortic Valve ; Chromosome Aberrations ; Dyspnea ; Heart Defects, Congenital ; Heart Septal Defects, Atrial* ; Humans ; Mitral Valve Prolapse* ; Mitral Valve* ; Turner Syndrome*

BACKGROUND: This clinical trial was performed to evaluate the hemodynamic and side effects of enoximone, a newly developed phosphodiesterase inhibitor, in moderately severe congestive heart failure in Korean population and to base the development of long acting oral preparations in the future. METHODS: Principal admission criteria for this trial were a left ventricular ejection fraction of less than 45% by radionuclide ventriculography, NYHA functional class II or III and a documented congestive cardiomyopathy. Exclusion criteria were restrictive cardiomyopathy, valvular heart disease, multisystemic lillness and uncontrolled ventricular tachyarrhythmia. The hemodynamic measurements were made by using the thermodilution Swan-Ganz catheter and radial arterial canulation. Enoximone was administered(continuous infusion) for 24 hours after initial bolus. The hemodynamic parameters to be observed were blood pressure, heart rate, cardiac output, pulmonary capillary wedge pressure, systemic and pulmonary vascular resistance. The clinical reponse, hematology, blood chemistry, and Holter monitoring were checked before and after enoximone trial. RESULTS: The following results are obtained. 1) The included patients were 15 females, 24 males, total 39 patients and mean age of 55.3 years old(28-70 years old). 2) The causes of congestive cardiomyopathy were idiopathic 35(89.9%), hypertensive 3(7.7%), and alcoholic 1(2.6%). 3) The mean ejection fraction measured by radionuclide left ventriculography were 28. 6%. 4) THe cardiac output was significantly increased(50%), and pulmonary capillary wedge pressure(38%), systemic vascular resistance(34%), pulmonary vascular resistance(27%) were significantly decreased during enoximone infusion. 5) NYHA Functional Class was improved by 1 step with enoximone. 6) There were no significant changes in hematology, blood chemistry, and Holter monitoring with enoximone. CONCLUSION: From the above results, the short term intravenous enoximone was very effective in moderately severe congestive heart failure in congestive cardiomyopathy without major adverse effects in Korean.
Alcoholics ; Blood Pressure ; Capillaries ; Cardiac Output ; Cardiomyopathy, Dilated ; Cardiomyopathy, Restrictive ; Catheters ; Chemistry ; Electrocardiography, Ambulatory ; Enoximone* ; Estrogens, Conjugated (USP)* ; Female ; Heart Failure* ; Heart Rate ; Heart Valve Diseases ; Hematology ; Hemodynamics* ; Humans ; Male ; Pulmonary Wedge Pressure ; Radionuclide Ventriculography ; Stroke Volume ; Tachycardia ; Thermodilution ; Vascular Resistance

PURPOSE: We analysed the position of screws whithin the scaphoid on computed tomographic images of patients treated by volar percutaneous screw fixation for scaphoid fractures. MATERIALS AND METHODS: We reviewed 16 patients treated by volar percutaneous screw fixations for scaphoid fractures. In three (proximal, middle, distal) portions of the scaphoid, the distance from the center of the screw to the edge of the cortex and the diameter of the scaphoid were measured on the sagittal and coronal reconstructive computed tomographic images. We divided into two groups: the risk group with cortical breakage or penetration by the screw and the safe group with no cortical breakage. The position of screws was analysed and compared between two groups. RESULTS: The position of screws in the proximal scaphoid was more central than the distal scaphoid (p<0.05). The central screw placement in the distal scaphoid correlated with that in the proximal scaphoid. The average distance from the volar surface of the scaphoid tuberoisity to the entry point was 7.0 mm(5.0~8.8 mm) in risk group and 4.7 mm(1.5~7.6 mm) in safe group. It was differed significantly between risk group and safe group(p<0.05). CONCLUSION: This study suggests that volar percutaneous screw fixation for scaphoid fractures can achieve central screw placement in the proximal scaphoid. For the safe placement of the screw, a surgeon should be careful not to locate the entry point too far posteriorly on the scaphotrapezial joint.
Humans ; Joints

PURPOSE: We assessed the usefulness of magnetic resonance angiography(MRA) and its techniques for differential diagnosis of hemorrhagic causes in patients with non-traumatic intracranial hemorrhagic disease. MATERIALS AND METHODS: We retrospectively reviewed 74 patients with non-traumatic intracranial hemorrhagic diseases, which were confirmed by radiological examinations(36 cases) and operations(38 cases). We compared the usefulness of magnetic resonance imaging(MRI) alone from MRI with MRA in evaluation of hemorrhagic causes. MRA was obtained by Time-of-Flight(TOF) and Phase Contrast(PC) technique. We investigated the usefulness of TOF and PC technique. RESULTS: MRI with MRA for detection of hemorrhagic causes(89%, 66 cases) was better than MRI only (64%, 47 cases). PC was better than TOF for evaluation of arteriovenous malformation and aneurysm due to subtraction of background noise(hemorrhage). CONCLUSION: MRI with MRA in more useful than MRI alone for evaluation of non-traumatic intracranial hemorrhagic causes.
Aneurysm ; Angiography* ; Arteriovenous Malformations ; Diagnosis, Differential ; Humans ; Magnetic Resonance Imaging ; Retrospective Studies

Cavernous angiomas are commonly found within the intracranial cavity. However, these malformations are uncommon in the spinal column and rarely found within the spinal cord. There have been only a few isolated reports on surgical resection for spinal cord intramedullary cavernous malformations. However, cavernous angiomas are being increasingly well recognized throughout the central nervous system since introduction of magnetic resonance image(MRI). A series of six patients with spinal cord intramedullary cavernous angioma, which were treated by complete surgical excision, is described. Intramedullary cavernous angiomas cause sensorimotor symptoms, typically with progressive painful paraparesis. The cavernous angioma manifest as reticulated mixed signal areas on both T-1 and T-2 weighted images, surrounded by low signal intensity prominent in T-2 weighted images. Intramedullary cavernous angiomas are mostly located in dorsal aspect of spinal cord. In the five cases, a bluish area is visible on the spinal surface and myelotomy is performed at this level. Four cases improved but two cases worsened in Nurick classification. A worsened case had a ventrally located cavernous angioma. Sensory function were aggravated in four cases. It is concluded that intramedullary spinal cord cavernous angiomas are uncommon causes of progressive myelopathy that can be safely and effectively treated by surgical excision.
Central Nervous System ; Classification ; Hemangioma, Cavernous* ; Humans ; Paraparesis ; Sensation ; Spinal Cord Diseases ; Spinal Cord* ; Spine

OBJECTIVE: To describe the underlying causes, surgical results, and prognostic factors in thoracic stenosis causing myelopathy, retrospective analysis for 28 cases of thoracic stenosis with surgery was performed MATERIALS AND METHOD: Twenty-eight patients(male, 15; female, 13) who underwent decompressive surgery for thoracic stenosis between 1987 and 1997 were analyzed. The mean age was 49 and the mean follow-up was 30.6 months. Statistical analysis with SPSS(r) was performed. Chi-square test was used for the analysis of relationship between subjects and multivariate analysis with general linear model was used to find prognostic factors. RESULT: Degenerative spondylosis was the most common cause, and three cases were associated with systemic diseases. Decompressive laminectomy was done in 23 cases, anterior decompression in four cases, and combined decompression in one case. Ossification of ligamentum flavum was found in 18 cases, facet hypertrophy in 13, ossification of posterior longitudinal ligament in six, and ventral spur in four. Postoperatively, 16 patients improved functionally and 4 patients worsened. The group of which initial symptom duration was less than two years showed better result(p=0.003). The group with sufficient decompression and no additional proximal stenosis had better outcome(p=0.002, p=0.001). CONCLUSION: Chronic myelopathy caused by thoracic stenosis can be reversible with appropriate decompression.
Constriction, Pathologic ; Decompression ; Female ; Follow-Up Studies ; Humans ; Hypertrophy ; Laminectomy ; Ligamentum Flavum ; Linear Models ; Multivariate Analysis ; Ossification of Posterior Longitudinal Ligament ; Retrospective Studies ; Spinal Cord Diseases ; Spinal Stenosis* ; Spondylosis

PURPOSE: To evaluate the effect of the tourniquet on intraoperative patellar tracking and to determine how this may influence the decision to perform lateral release during primary total knee arthroplasty (TKA). MATERIALS AND METHODS: From Jan. 1998 to Feb. 1999, 126 TKAs in which patellar tracking was assesed with tourniquet inflated were chosen as a control group. From May 1999 to June 2000, a total of 221 consecutive TKAs in which patellar tracking was assessed before and after tourniquet release were selected as a study group and were placed into 1 of 3 groups: Group I (49 out of 221) were knees that tracked properly both before and after tourniquet release. Group II (150 out of 221) were knees that maltracked with the tourniquet inflated and subsequently corrected with the tourniquet deflated. Group III (22 out of 221) were knees that maltracked both before and after tourniquet release, therefore required a lateral release. The lateral release rate, patella tilt and displacement were compared among groups. RESULTS: In control group, the lateral release rate was 65.9%(83/126). The patella tilit and displacemen were 2.65+/-0.78 degree and 3.51+/-1.68 mm respectively. In study group, the lateral release rate was 10.0%(22/221). The patella tilit and displacement were 0.76+/-0.85degree and 2.96+/-1.96 mm in study group. CONCLUSION: Tourniquet application alters intraoperative patellar tracking during TKA. When contemplating lateral retinacular release, tourniquet release and reevaluation of patellar tracking should be considered.
Arthroplasty* ; Equidae ; Knee* ; Patella ; Tourniquets*