Arteriovenous malformation(AVM) of the medial temporal lobe would be interesting to neurosurgeons enough to draw their attentions because it's obscure location, making resection more difficult than the usual AVM and high possibility of operative morbidity caused by intraventricular hermorrhage and/or injury of the adjacent structures such as optic tract, brain stem and basal ganglia. A patient who underwent successful excision of AVM of this region is presented. It has ben confirmed that a transcortical surgical approach through the inferior portion of the temporal lobe could minimize retraction of the brain to avoid operative morbidity and manage a main feeding artery without difficulty.
Arteries ; Arteriovenous Malformations* ; Attention ; Basal Ganglia ; Brain ; Brain Stem ; Humans ; Temporal Lobe* ; Visual Pathways

Simultaneous early repair of the myelomeningocele and ventriculoperitoneal shunt in patients with myelomenimgocele and hydrocephalus not only decreases further brain damage, but also eliminates dangers of wound break down, CSF leak, and secondary CSF infection. During the years 1975-1990, we have experienced 45 patients with neural tube dysraphism which consist of 32 lipomyelomenigocele, 8 myelomeningocele, 3 meningocele and 2 encephalocele. Among those, 7 patients underwent simultaneous repair of myelomeningocele and insertion of ventriculoperitoneal shunt. 2 Patients developed wound infection, but none of the patients developed myelomeningocele repair break down or shunt infection in the follow up period of 1 to 4 years. All patients underwent neuropsychological testing during their follow up period and 5 patients were found to have their normal growth and developments. 1 patient developed low intelligence and moderate degree gait disturbance and the other 1 patient developed voiding difficulty. The authors suggest that this technique may be safe and helpful in some infants born with a myelomeningocele and hydrocephalus overt at birth.
Brain ; Encephalocele ; Follow-Up Studies ; Gait ; Humans ; Hydrocephalus* ; Infant* ; Intelligence ; Meningocele ; Meningomyelocele* ; Neural Tube ; Neuropsychological Tests ; Parturition ; Ventriculoperitoneal Shunt* ; Wound Infection ; Wounds and Injuries

Radiosurgery requires integral procedure where special devices and computer systems are needed for localization, dose planning and treatment. The aim of this work is to verify the overall mechanical accuracy of our LINAC and develop dose calculation algorithm for LINAC radiosurgery. The alignment of treatment machine and the performance testing of the entire system were extensively carried out and the basic data such as percent depth dose, off-axis ratio and output factor were measured. A three dimensional treatment planning system for stereotactic radiosurgery has been developed. We used an IBM personal computer with C programming language (IBM personal system/2, Model 80386, 1BM Co., USA) for calcu1ating the dose distribution. As a result, deviations at isocenter on gantry and table rotation for our treatment machine were acceptable since they were less than 2 mm. According to the phantom experiments, the focusing isocenter were successful by the error of less than 2 mm. Finally, the mechanical accuracy of our three dimensional planning system was confirmed by film dosimetry in sphere phantom.
Computer Systems ; Film Dosimetry ; Humans ; Microcomputers ; Programming Languages ; Radiosurgery*

PURPOSE: This study is a retrospective analysis of patients who had undergone surgical treatment for non-union of distal humerus fracture. We evaluated them in terms of causes of injury, radiologic findings, and clinical outcomes such as prognosis. MATERIALS AND METHODS: Seven consecutive radiologic patients who were confirmed to have nonunion of a distal humerus fracture underwent reoperations. These patients had already undergone operations for distal humerus fractures. This survey was held from 2005 to 2010. The average period up to diagnosis of non-union after the first operation was 7.4 months (4 to 16 months). The mean follow-up period was 24.6 months (12 to 65 months). Each patient was graded functionally according to the Mayo Elbow Performance Score and the Disabilities of the Arm, Shoulder and Hand Score. RESULTS: Osteosynthesis was performed by internal fixation with plates and screws and then a bone graft for non-union of the distal humerus fracture. The average range of motion within the elbow joints was found to be a flexion contracture of 18.8 degrees (0~30 degrees) and further flexion of 120.2 degrees (102~140 degrees). Among postoperative complications, three cases of medium-degree stiffness, two cases of medial column nonunion, and one case of dissociation of the internal fixator were reported. CONCLUSION: Stable internal fixation for maintenance reduction status is essential after accurate initial anatomical reduction. We concluded that nonunion could be prevented by additional surgical treatment such as autogenous bone graft, if it is necessary.
Arm ; Contracture ; Dissociative Disorders ; Elbow ; Elbow Joint ; Follow-Up Studies ; Hand ; Humans ; Humerus ; Internal Fixators ; Postoperative Complications ; Range of Motion, Articular ; Retrospective Studies ; Shoulder ; Transplants

PURPOSE: We present the clinical and radiological results of open reduction and internal fixation for scaphoid fracture with retrograde headless screw fixation via dorsal approach. METHODS: This study carried out a survey targeting 15 patients who have a retrograde headless screw fixation on nonunion of scaphoid fracture without previous operation, 2 patients who have a retrograde headless screw fixation on nonunion of scaphoid fracture with previous operation and 8 patients who have a trans-scaphoid perilunate dislocation. We figured out a mechanism of injury, and clinical symptom, radiologic findings. The surgery was done with open dorsal approach which is retrograde headless screw fixation internally, with or without bone graft. We analyzed the result by Maudsley method, in terms of bone union, duration for union, radiologic finding, clinical outcomes. RESULTS: After surgery, 22 of 25 patients had union result on fracture and other 3 patients had nonunion result. It took 12 weeks to achieve bone union on average. Based on radiograhs, we had one case of partial avascular necrosis of proximal fragment without clinical symptoms. We had one case of each scaphoid nonunion without previous operation, with operation and trans-scaphoid perilunate dislocation had arthritic change and non-symptomatic nonunion result. In terms of clinical outcome, 22 patients showed satisfactory results and 3 patients had slight limitation of range of motion. CONCLUSION: Retrograde headless screw fixation with or without bone graft for the treatment of scaphoid fracture is recommendable.
Dislocations ; Humans ; Necrosis ; Transplants

PURPOSE: There have been few reports about the endoscopic carpal tunnel release (ECTR) in elderly patients and its efficacy and safety are not well-known. We evaluated the clinical outcomes of ECTR using Agee technique in patients older than 65 years. MATERIALS AND METHODS: From October 2000 to January 2007, thirty-five patients (42 hands) who underwent ECTR using Agee technique were enrolled. The average age of the patients was 67.2 years (range, 65-71 years). The duration of symptoms averaged 10 months (range, 6-33 months). For evaluation of the clinical outcomes, physical examination and subjective assessment of the hand function using the Boston carpal tunnel questionnaire were performed at postoperative 1-year follow-up and compared with those obtained at preoperative evaluation. The mean follow-up period was 18 months (range, 12-24 months). RESULTS: There were no neurovascular injury and scar tenderness. At postoperative 1-year follow-up, paresthesia, numbness, Phalen's sign, tinel sign, two point discrimation, and grip power were significantly improved compared with those obtained at preoperation. According to the Boston questionnaire, symptom severity score improved from 3.43 preoperatively to 1.89 postoperatively, and functional status score improved from 3.18 preoperatively to 2.21 postoperatively (p<0.05). Thenar atrophy still remained in 32 hands (76.2%). CONCLUSION: Although thenar atrophy did not improve in many cases, symptom severity and functional status scores improved in most patients treated with ECTR. The single portal ECTR is a safe and efficacious treatment option in elderly patients with carpal tunnel syndrome.
Aged ; Atrophy ; Boston ; Carpal Tunnel Syndrome ; Cicatrix ; Follow-Up Studies ; Hand ; Hand Strength ; Humans ; Hypesthesia ; Paresthesia ; Physical Examination ; Surveys and Questionnaires

PURPOSE: This study was designed to measure time-dependent changes in muscle excursion and collagen content after tenotomy, and to analyze the correlation between muscle excursion and collagen content in a rabbit model. MATERIALS AND METHODS: Twenty-four rabbits underwent tenotomy of the second extensor digitorum longus (EDL) muscles on the right legs and were randomly assigned to three groups based on the period of time after tenotomy (2, 4, and 6 weeks). The second EDL muscles on left legs were used as controls. At each time after tenotomy, passive muscle excursion and collagen content, determined by hydroxyproline content, were measured bilaterally, and the ratio of each value to the normal one was used. RESULTS: The mean ratio of muscle excursion after tenotomy to the value of the control decreased in a time-dependent fashion: 92.5% at 2 weeks, 78.6% at 4 weeks, and 55.1% at 6 weeks. The mean ratio of hydroxyproline content in muscle to the value of the control increased in a time-dependent fashion: 119.5% at 2 weeks, 157.3% at 4 weeks, and 166.6% at 6 weeks. There was a significant negative correlation between the ratio of hydroxyproline content in muscle after tenotomy to the control values and the ratio of muscle excursion after tenotomy to the control values (r=-0.602, p=0.002). CONCLUSION: The decrease in muscle excursion seems to correlate with the increase in collagen content in the muscle in a time-dependent fashion following tenotomy.
Animals ; Collagen/*metabolism ; Hydroxyproline/metabolism ; Muscle, Skeletal/*metabolism ; Rabbits ; Tendon Injuries/*metabolism ; Tendons ; Tenotomy ; Time Factors

A rare case of intrasellar arachnoid cyst is reported. The patient was a 55 years old woman presented with 8 years history of blurred vision, headache and bitemporal visual field cuts aggravated for last 4 months. The pathophysiology and the CT and MRI findings being useful in the differentiation of cystic sellar masses were discussed.
Arachnoid* ; Female ; Headache ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Visual Fields

To evaluate the validity of serum pepsinogen levels as a screening tool for gastric cancer and adenoma, immunoradiometric assays of serum pepsinogen I level (PG I), II level (PG II) and esphagogastroduodenal endoscopies were done in 757 health examlnees. Serum PG I level was higher in subjects with active duodenal ulcer (n=45, 75.2+/-34.3 microgram/l(mean+/-standard deviation), p<0.01) and gastroduodenal ulcers (n=8,756+/-19.8 microgram/l, p<0.05), and was lower in those with gastric adenoma (n=4,37.7+/-37.2 microgram/l, p<0.2) than those with normal, mild gastritis findings or ulcer scars (n=378, 56.6+/-24.9 microgram/l). Serum PG II level las higher in subjects with active duodenal ulcer (17.2+/-13.8 microgram/l, p<0.2), active gastro-duodenal ulcers (l8.3+/-7.4 microgram/l, p<0.2) and gastric carcinoma (n=3, 23.8+/-10.9 microgram/l, p<0.05) than those with normal, mild gastritis findings or ulcer scars (14.5+/-7.9 microgram/l). Serum PG I/PG 11 ratio was higher in subjects with active duodenal ulcer (5.1+/-1.6, p<0.05) and was lower in those with chronic gastritis (n=107, 4.1+/-1.7, p<0.05), gastric polyp (n=19, 3.9+/-1.4, p<0.2), gastric adenoma (n=4, 2.1+/-1.9, p<0.01) and gastric carcinoma (n=3, 2.7+/-1.2, p<0.1) than those with normal, mild gastritis findings or ulcer scars (4.5+/-1.7). Serum PG 11 level increased with age until 6th decade, whereas serum PG I/PG II ratio decreased with age in 378 subjects with normal, mild gastritis findings or ulcer scars. The screening criteria of serum PG I<70 microgram/l and PG I/PG II ratio<3.0 for detecting gastric cancer and adenorna gave a positive rate of 15.7%, sensitivity of 57.1% and specificity of 84.7%.
Adenoma* ; Cicatrix ; Duodenal Ulcer ; Gastritis ; Immunoradiometric Assay ; Korea* ; Mass Screening* ; Pepsinogen A* ; Peptic Ulcer ; Polyps ; Sensitivity and Specificity ; Stomach Neoplasms* ; Ulcer

PURPOSE: Calcific lesion of the hand is infrequently recognized, presenting with severe pain and swelling of the affected joint. The purpose of this study is to describe clinical features associated with this condition by reviewing surgically treated patients. MATERIALS AND METHODS: A retrospective study was carried out in 11 patients who had operation clinical and radiographic data were collected by medical records. RESULTS: Eight patients were females and three were males with age ranging between 27-75 years (mean: 48 years). By location, five cases of interphalangeal joint, three cases of metacarpophalangeal joint of thumb, two cases of carpal tunnel and one case of distal ulna area were noted. Interval between symptom presentation and operation was 9.4 month (range: 6-18 month). During 10 month follow-up (range: 6-12 month), recurrence had not occurred. CONCLUSION: Although the prevalence of calcific lesion of hand and wrist is low, it may cause severe pain and swelling. If conservative treatment fails or any nerve compression symptom develops, surgical removal of the calcific lesion is recommended.
Female ; Follow-Up Studies ; Hand ; Humans ; Joints ; Male ; Metacarpophalangeal Joint ; Prevalence ; Recurrence ; Retrospective Studies ; Thumb ; Ulna ; Wrist