The authors retrospectively analized the radiographs and medical records of 135 consecutive patients who underwent minimaly invasive spinal surgery from January, 1990 to December, 1994 at our institution. Among these, 72 patients have had chemonucleolysis and others percutaneous automated lumbar discectomy(PALD). The success rate was similar in both groups, ie, 75% in chemonucleolysis and 74.6% in PALD by Macnab's criteria. The higher success rate could be obtained in 1) younger age below 30, 2) predominant sciatica than lower back pain, 3) eccentric bulged disc with minimal degeneration, 4) abscent or minimal neurologic deficits. In conclusion, provided patients are carefully screened, minimal invasive spinal surgery is more preferable over conventional surgery, providing a safe and effective therapeutic alternative to many patients suffering from herniated lumbar disc.
Diskectomy* ; Humans ; Intervertebral Disc Chemolysis* ; Low Back Pain ; Medical Records ; Neurologic Manifestations ; Retrospective Studies ; Sciatica

Computerized tomography(CT) have been available for diagnosis and localization of intracerebral hematoma. CT-guided stereotactic evacuation of spontaneous intracerebral hematoma was performed in 34 cases; 25 basal ganglionic hematomas with or without ventricular perforation, 4 subcortical, 3 thalamic, 1 cerebellar and 1 pontine. The biplane CT image were taken to determine the coordinates of the target point, which was the center of the hematoma. The liquefied or solid portion of the hematoma was aspirated through a burr-hole under local anesthesia. And a silastic tube(3.3mm in outer diameter and 2.0mm in inner diameter) was then inserted into the center of the hematoma. Immediately after the first trial of hematoma aspiration, urokinase(6000IU/5ml saline) was administered through the tube. Subsequently, aspiration and infusion of urokinase were repeated every 6 or 12 hours until the hematoma was almost completely evacuated. The follow-up results indicate that this procedure was more superior over the conventional craniotomy. This CT-guided stereotactic operation has the following advantages; 1) the procedure is simple and safe; 2) the procedure can be performed under local anesthesia; and 3) the hematoma can be completely drained with the aid of urokinase. This procedure can be used as a standard treatment for intracerebral hematoma. We have draw the following conclusions; As a result of the above study 1) Stereotactic surgery is more effective in the patients with neurologic grade 3 than conservative one (p<0.05). 2) To use urokinase or perform the early surgery within 24 hours did not seem to be the cause of rebleeding. 3) In the case of pons or cerebellar hemorrhage, stereotactic surgery had definite benefit in the recovery of consciousness even if recovery of motor function was dismal. 4) In patients with spontaneuous ICH, the favorable prognostic indicatiors were as follows: the size of hematoma less thas 50ml, no signs of transtentorial herniation and patient's age under 60.
Anesthesia, Local ; Consciousness ; Craniotomy ; Diagnosis ; Follow-Up Studies ; Ganglion Cysts ; Hematoma* ; Hemorrhage ; Humans ; Pons ; Urokinase-Type Plasminogen Activator

Alagille syndrome (AGS) is a rare autosomal dominant inherited disorder, with major clinical manifestations of bile duct paucity, cholestasis, cardiovascular anomaly, ophthalmic abnormalities, butterfly vertebrae, and dysmorphic facial appearance. It is caused by heterozygous mutations in JAG1 or NOTCH of the Notch signaling pathway presenting with variable phenotypic penetrance and involving multiple organ systems. The following case report describes a unique case of a 16-year-old female with AGS who presented with the primary complaint of renovascular hypertension. She had a medical history of ventricular septal defect and polycystic ovary syndrome. The patient had a dysmorphic facial appearance including frontal bossing, bulbous tip of the nose, a pointed chin with prognathism, and deeply set eyes with mild hypertelorism. Stenoocclusive changes of both renal arteries, celiac artery, lower part of the abdominal aorta, and left intracranial artery, along with absence of the left internal carotid artery were found on examination. Whole exome sequencing was performed and revealed a pathologic mutation of JAG1, leading to the diagnosis of AGS. Reverse phenotyping detected butterfly vertebrae and normal structure and function of the liver and gallbladder. While the representative symptom of AGS in most scenarios is a hepatic problem, in this case, the presenting clinical features were the vascular anomalies. Clinical manifestations of AGS are diverse, and this case demonstrates that renovascular hypertension might be in some cases a presenting symptom of AGS.

PURPOSE: AHC characterized by sudden onset of gross hematuria, dysuria and frequency occurs in children and young adults as a self-limited disease that should be differentiated from serious renal disorders. We have performed this study to establish the cause and characterize the clinical features of this illness in Korean children. METHODS: 19 cases collected prospectively for 30 month-period over 1991-1993 were reviewed. Urine specimens were obtained after normal voidings and inoculated into Hep-2 cell monolayers for virologic study, and cultured as standard method for bacteria. Isolates producing a cytopathic effect characteristic of adenovirus were confirmed by indirect immunofluorescent staining with monoclonal antibody specific to adenovirus and also by electron microscopy. Adeno-viruses were typed by hemagglutination-inhibition test by Dr. Piedra at the Texas Medical Center, USA. RESULTS: The ages of the patients were between 5 months and 14 years. Adenovirus was isolated from the urine in 8 cases(42%) and E. coli in 2(10.5%). Of 8 patients with positive culture, adenovirus type 7a was recovered in 4 cases, and adenvirus type 11 in 4 cases. Seven of the 8 patients with positive adenovirus culture were boys while E. coli was isolated only in girls. No sexual difference was found in cultur-negative group(M:F=4:5). The sudden onset of painful hematuria was the most impressive manifestation. Gross hematuria continued for 3 to 15(average 8.9) days. Suprapubic pain was present in 4. Only one patient had mild fever. Ten of 11 ultrasonic examinatinons showed thickening of bladder wall and decreased filling capacity. CONCLUSIONS: These data suggest that culture for viruses may be useful method for differential diagnosis of AHC and adenovirus type 7a is newly identified to be one of the important causes of this illness. Further studies on ABC are needed to investigate the unexplained part of etiology.
Adenoviridae ; Bacteria ; Child* ; Diagnosis, Differential ; Dysuria ; Female ; Fever ; Hematuria ; Humans ; Microscopy, Electron ; Piedra ; Prospective Studies ; Texas ; Ultrasonics ; Urinary Bladder ; Young Adult

PURPOSE: To determine the patterns of evaluation and treatment in the patient with early breast cancer treated with conservative surgery and radiotherapy and to improve the radiotherapy techiniques, nationwide survey was performed. MATERIALS AND METHODS: A web-based database system for Korean Patterns of Care Study (PCS) for 6 common cancers was developed. Two hundreds sixty-one randomly selected records of eligible patients treated between 1998~999 from 15 hospitals were reviewed. RESULTS: The patients ages ranged from 24 to 85 years(median 45 years). Infiltrating ductal carcinoma was most common histologic type (88.9%) followed by medullary carcinoma (4.2%) and infiltrating lobular carcinoma (1.5%). Pathologic T stage by AJCC was T1 in 59.7% of the casses, T2 in 29.5% of the cases, Tis in 8.8% of the cases. Axillary lymph node dissection was performed in 91.2% of the cases and 69.7% were node negative. AJCC stage was 0 in 8.8% of the cases, stage I in 44.9% of the cases, stage IIa in 33.3% of the cases, and stage IIb in 8.4% of the cases. Estrogen and progesteron receptors were evaluated in 71.6%, and 70.9% of the patients, respectively. Surgical methods of breast-conserving surgery was excision/lumpectomy in 37.2%, wide excision in 11.5%, quadrantectomy in 23% and partial mastectomy in 27.5% of the cases. A pathologically confirmed negative margin was obtained in 90.8% of the cases. Pathological margin was involved with tumor in 10 patients and margin was close (less than 2 mm) in 10 patients. All the patients except one recieved more than 90% of the planned radiotherapy dose. Radiotherapy volume was breast only in 88% of the cases, breast+supraclavicular fossa (SCL) in 5% of the cases, and breast+SCL+posterior axillary boost in 4.2% of the cases. Only one patient received isolated internal mammary lymph node irradiation. Used radiation beam was Co-60 in 8 cases, 4 MV X-ray in 115 cases, 6 MV X-ray in 125 cases, and 10 MV X-ray in 11 cases. The radiation dose to the whole breast was 45~9.4 Gy (median 50.4) and boost dose was 8~20 Gy (median 10 Gy). The total radiation dose delivered was 50.4~70.4 Gy (median 60.4 Gy). CONCLUSION: There was no major deviation from current standard in the patterns of evaluation and treatment for the patients with early breast cancer treated with breast conservation method. Some varieties were identified in boost irradiation dose. Separate analysis for the datails of radiotherapy planning will be followed and the outcome of treatment is needed to evaluate the process.
Breast Neoplasms ; Breast* ; Carcinoma, Ductal ; Carcinoma, Lobular ; Carcinoma, Medullary ; Estrogens ; Humans ; Korea* ; Lymph Node Excision ; Lymph Nodes ; Mastectomy, Segmental* ; Radiotherapy