No abstract available.
Femur Neck* ; Fractures, Stress*

OBJECTIVE: The goal of this study was to compare the therapeutic and the functional value between translaminar approach and transforaminal approach of epidural steroid injection in patient with refractory radicular pain. METHOD: Among 31 patients with unilateral herniated nucleus pulposus (HNP) which was confirmed by physical examination and magnetic resonance imaging (MRI), 17 patients received a transforaminal approach and 14 patients received a translaminar approach. All patients were evaluated by independent observer and were checked by visual analogue scale (VAS), functional score before and 1 day, 2 weeks and 4 weeks after injection. RESULTS: The VAS of transforaminal approach was significantly lower than that of translaminar approach after 2 weeks and after 4 weeks (p<0.05), although there were no statistical difference before and 1 day after injection. The functional score of transforaminal approach was significantly higher than that of translaminar approach after 4 weeks (p<0.05), although there were no statistical difference before and 1 day, 2 weeks after injection. The translaminar approach needs more frequent injection (p<0.05). CONCLUSION: This study suggests that both translaminar approach and transforaminal approach could be valuable to the initial management of refractory radicular pain, but the duration of therapeutic effects was relatively short in translaminar approach. Transforaminal approach will be the promising treatment of refractory radicular pain, because it has better therapeutic efficacy, safety and longer duration of therapeutic effects than translaminar approach.
Humans ; Magnetic Resonance Imaging ; Physical Examination

Kernohan-Woltman notch phenomenon (KWP) is an ipsilateral motor weakness due to compression of the contralateral cerebral peduncle. We report two cases of KWP following traumatic brain injury. In case 1, ipsilateral hemiplegia was noted after right subdural hemorrhage. Although magnetic resonance imaging showed no abnormal signal changes on cerebral peduncle, diffusion tensor tractography (DTT) revealed interruption of corticospinal tract (CST) at lower level of the midbrain level. In case 2, there was abnormal signal change of the right cerebral peduncle contralateral to the primary lesion and we could not reconstruct right CST. Case 1 showed unsatisfactory motor recovery even after 15 months, and follow-up DTT showed no change. In case 2, follow-up DTT was not performed, but her ipsilateral hemiparesis had almost disappeared during the 15 months. DTT would be useful in detecting ipsilateral hemiparesis due to KWP and the clinical course may differ according to the lesion characteristics.
Brain Injuries ; Diffusion Tensor Imaging ; Diffusion* ; Follow-Up Studies ; Hematoma, Subdural ; Hemiplegia ; Magnetic Resonance Imaging ; Mesencephalon ; Paresis ; Pyramidal Tracts ; Tegmentum Mesencephali

A 69-year-old woman presented with right abducent nerve paresis caused by an ectopic pituitary adenoma invading the posterior wall of the sphenoid sinus. The tumor was removed via transsphenoidal approach. The histological diagnosis was invasive pituitary adenoma with bony destruction. The symptom was improved without complication. The authors present a rare case of ectopic pituitary adenoma with a literature review.
Abducens Nerve ; Aged ; Diagnosis ; Female ; Humans ; Paresis ; Pituitary Neoplasms* ; Sphenoid Sinus*

Distal caries of the second molar is common indication for the mandibular third molar surgery and there are no universally acceptable predictive criteria for distal caries of the second molar. To analyze the correlation of the distal caries of the second molar and the eruption state of the mandibular third molar using panoramic radiographs statistically and propose the acceptable guideline for preventive extraction of the mandibular third molar. 786 patients who were extracted the mandibular third molar from 2002 to 2006 at Samsung medical center were examined. The presence and absence of distal caries of mandibular second molar, age, gender, angulation, impaction degree, distance between distal cementoenamel junction of the second molar and mesial cementoenamel junction of the mandibular third molar were assessed. 79.6% of third molars had a mesial angulation of between 40 degrees and 80 degrees. The mean age of third molar removal for distal caries of second molar was 33.86+/-9.81. The prophylactic removal of a mesio-angular third molar about 40 degrees and 80 degrees could prevent distal cervical caries forming in the mandibular second molar.
Humans ; Molar ; Molar, Third ; Root Caries ; Tooth Cervix

BACKGROUND: Unintended intravenous injection of bupivacaine causes severe cardiovascular complication, which is known for its difficulty in resuscitation. This study was performed to evaluate the effects of pretreatment with midazolam and droperidol in the cardiac toxicity caused by intravenous infusion of bupivacaine. METHODS: Thirty rabbits were divided into three groups; saline- as a control, midazolam, and droperidol pretreated group. We observed the time intervals for the arrhythmia, 25% and 50% reduction in baseline mean arterial blood pressure, and arrest. We also checked the dose of infused bupivacaine to be required for arrest during continuous intravenous infusion of bupivacaine at the rate of 1 mg/kg/min. RESULTS: The onset of dysrhythmia and the time to 50% reduction in baseline mean arterial blood pressure and arrest were significantly more delayed in the midazolam group than the control group (P < 0.05). With respect to the time to 25%, 50% reduction in baseline mean arterial blood pressure and arrest, the data of the droperidol group was significantly shorter than that of the control group (P < 0.05). CONCLUSIONS: Droperidol pretreatment hastened bupivacaine induced cardiac arrest in rabbits. Midazolam pretreatment exerted protective effects on arrhythmia and cardiac arrest. Thus midazolam would be a preferable agent as a supplement for regional anesthesia using bupivacaine.
Anesthesia, Conduction ; Arrhythmias, Cardiac ; Arterial Pressure ; Bupivacaine* ; Droperidol* ; Heart Arrest ; Heart Arrest, Induced ; Infusions, Intravenous ; Injections, Intravenous ; Midazolam* ; Rabbits* ; Resuscitation

The inheritance of ABO blood type group is actually determined by triple allelic gene, A, B and O. Transmission of blood group AB by a single chromosome, instead of by two separate chromosomes, was reported and called cis AB. The anesthesiologists, who meet many cases of the transfusions, may anesthetize cis AB patients for surgery. Recently the authors have experienced one case of patient with cis AB blood type undergoing emergency craniotomy and removal of hematoma. We transfused the patient with Rh+O packed red blood cell without any significant transfusion reactions.
Blood Group Incompatibility ; Craniotomy ; Emergencies ; Erythrocytes ; Genes, vif ; Hematoma ; Humans ; Wills

PURPOSE: To clarify the clinical and radiologic parameters that can be used to differentiate odontogenic keratocyst and ameloblastoma MATERIALS AND METHODS: The records of 46 patients of ameloblstoma and 48 patients of odontogenic keratocyst at the Yonsei University Dental Hospital during the period of 1979 to 1995 were retrospestively reviewed. As a possible means for differentiating between the odontogenic keratocyst and ameloblastoma, the clinical parameters and the radiologic parameters were evaluated. RESULTS: In the clinical parameters, there was no significant defference in age, sex, and sign and symptoms(p>0.05).In the radiologic parameters, there was significant difference in site, shape of the lesion, and external root resorption of adjacent teeth(p<0.05). CONCLUSION: The site, shape of the lesion, and external root resorption of adjacent teeth can be the parameters to differentiate odontogenic keratocyst and ameloblastoma, but a definite differentiation of these two lesions needs a more specialized imaging modality.
Ameloblastoma* ; Diagnosis, Differential* ; Humans ; Odontogenic Cysts* ; Root Resorption ; Tooth

PURPOSE: An understanding of the immunological process is required if primary prevention of atopic diseases is to be developed in early childhood. But, it is too hard to distinguish atopy from nonatopy under the age of two clinically, because the expression of phenotype and cytokines is vague in early childhood. We evaluated DNA methylation changes at Th2 interleukin-4 gene in peripheral blood from atopic children. METHODS: We selected 15 allergic children (mild: eight, moderate to severe: seven) and seven normal controls by using family allergy scores and clinical histories. We measured Total IgE and Der f II specific IgE levels and cultured peripheral blood mononuclear cells with Der f II stimulation and extracted DNA from Der f II specific T cells. We examined the change of CpG methylation in DNA from atopic and nonatopic children. RESULTS: In T cells from normal children, IL-4 DNA were predominantly methylated; otherwise, CpG demethylation occurred in Der f II specific T cells from allergic children. CONCLUSION: IL-4 DNA methylation changes occurred in T genes from allergic children and DNA methylation assay in early childhood.
Child* ; Cytokines ; DNA Methylation* ; DNA* ; Humans ; Hypersensitivity ; Immunoglobulin E ; Interleukin-4* ; Methylation ; Phenotype ; Primary Prevention ; T-Lymphocytes

BACKGROUND: We evaluated the optimal concentrations of eye opening and orientation after propofol- fentanyl TCI by CSDT of the pharmacokinetic model using DiprifusorTM in adults retrospectively. Furthermore, we tried to compare those data with the cases of using propofol TCI alone that had been reported. METHODS: After obtaining informed consent and IRB approval, 124 patients of ASA class I or II scheduled for elective surgery were allocated into 3 groups according to age. Three groups were group 1 (n = 40): 18 - 29 years, group 2 (n = 42): 30 - 39 years, group 3 (n = 42): 40 - 54 years. Propofol infusion was started at a propofol target concentration (CT) of 6 microgram/ml by using DiprifusorTM. Anesthesia was mostly maintained with propofol CT 3.5 microgram/ml and fentanyl CT 1.5 ng/ml using a Stelpump and 67% nitrous oxide in oxygen. We estimated the average concentrations of propofol at eye opening and orientation in each group with DiprifusorTM, and we also evaluated the correlation coefficient. RESULTS: Total requirements of propofol in cases of propofol-fentanyl TCI were decreased by 18-26% than in propofol TCI alone. The average concentrations of propofol at eye opening and orientation after surgery were 1.2 - 1.4 microgram/ml. The times to show eye opening and orientation after surgery from stopping of nitrous oxide and infusion were 10.4 - 14.5 min in the propofol-fentanyl group compared with 7.5 - 11 min using propofol TCI alone. CONCLUSIONS: We concluded that the optimal concentrations of propofol at eye opening and orientation after surgery in cases of combination with fentanyl were 1.2 - 1.4 microgram/ml instead of 1.4 - 1.6 microgram/ml with using propofol alone.
Adult ; Anesthesia ; Ethics Committees, Research ; Fentanyl ; Humans ; Informed Consent ; Nitrous Oxide ; Oxygen ; Propofol* ; Retrospective Studies