PTCA has been widely applied in patients with symptomatic coronary artery disease since 1977. The PTCA was performed on a total of 25 patients (19 men and 6 women) from Feburary 1988 to January 1990 at Inje University Baik Hospital. Their mean age was 51.4+/-10.1 years. The 20 patients had unstable angina, and 5 patients had stable angina. The 6 patients had a previous myocardial infarction. The 17 patients had one vessel disease, 6 patients had two vessel disease and 2 patients had three vessel disease. Primary success was achieved in 24 of 25 patients. The mean degree of stenosis was reduced from 80.7+/-2.9% to 16.2+/-3.3% (p<0.01). After PTCA, pain was relieved or subsided in all patients. In 6 patients, mild chest pain has reccured during the short term follow up. Repeat PTCA was performed in 2 of 6 patients successfully. Complications occurred in 3 patients ; coronary artery spasm, ventricular fibrillation and femoral artery hematoma in each patients.
Angina, Stable ; Angina, Unstable ; Angioplasty, Balloon, Coronary* ; Arteries ; Chest Pain ; Constriction, Pathologic ; Coronary Artery Disease* ; Coronary Vessels* ; Femoral Artery ; Follow-Up Studies ; Hematoma ; Humans ; Male ; Myocardial Infarction ; Spasm ; Ventricular Fibrillation

From June, 1988 to Feb, 1989 a total of 47 cases of percutaneous mitral valve balloon valvuloplasty(PMV) and 4 cases of aortic valve balloon valvuloplasty(PAV) were done at the Guro Hospital of the Korea University. Among these patients first 18 patients of PMV are the subjects of this study. 1) Among a total of 28 patients,10 patients were male and 18 patients were female patients. The age of the patients were between 21 and 59 years with the mean age of 40.9+/-12.2 Aortic Valve ; Atrial Fibrillation ; Balloon Valvuloplasty* ; Blood Pressure ; Cardiac Output ; Cardiac Tamponade ; Catheters ; Drainage ; Electrocardiography ; Embolism ; Female ; Humans ; Korea ; Male ; Middle Cerebral Artery ; Mitral Valve Insufficiency ; Mitral Valve Stenosis* ; Mitral Valve* ; Sepsis ; Thrombosis ; Vascular Resistance

Using computerized motion analysis techniques, kinematics of foot trajectories were quantitatively analyzed in twelve rats before and after dorsal spinal cord hemisection at the T6 level. Although overground locomotion in these animals returned to normal within four weeks, some kinematic variables during treadmill locomotion did not recover to pre-lesion level. Immediately following dorsal hemisection, amplitudes of both hindfeet horizontal and vertical movements were dramatically reduces. However, in three weeks, the amplitudes of horizontal movement(stride length) became significantly larger than of pre-lesion strides. On the other hand, amplitude of hindlimb vertical movement showed very little recovery. Forelimb-hindmill coordination was also disrupted initially but returned to normal within three weeks. The duration of hindlimb swing phase became significantly longer after sectioning and gradually recovered, but never to pre-lesion levels. Interestingly, amplitudes of forelimb vertical movement. which was depressed initially, became significantly largery three weeks after lesioning. A dramatic increase in the statistical variation of limb kinematics, which persisted even after motor recovery, is an important parameter for the evaluation of neural deficits in spinal cord injuries. Kinematic analysis is a sensitive technique for the detection of minor motor deficits following nerve injuries.
Animals ; Biomechanical Phenomena ; Extremities ; Foot ; Forelimb ; Hand ; Hindlimb ; Locomotion* ; Rats* ; Spinal Cord Injuries ; Spinal Cord*

The purposes of this study were to describe the magnetic resonance(MR) manifestations of wallerian degeneration occurring above and below a spinal cord injury site, to determine the post-injury time interval when the wallerian degeneration becomes evident in MR images, and to correlate the MR findings with post mortem histopathology. Twenty-three postmortem spinal cords, all from patients with cervical(14), thoracic(5), and lumbar(4) cord injuries, were studied with axial TI-and T2-weighted spin-echo MR imaging. Injury to death intervals varied from 8 days to 22 years. We examined these specimen for abnormal cord contour and alteration of signal above and below the injury site. Histological studies of these cords with axon, myelin, and connective tissue stains were performed at levels equivalent to the MR sections. Studies using plastic embedded sections and antibodies to Glial Fibrillary Acetic Protein(GFAP) were also performed on some of the above cords. Pathological-imaging correlations were made. MR images of the cord specimen showed increased signal intensity in the dorsal columns above the injury level as well as in the lateral corticospinal tracts below the injury level in all cases in which cord injury had occurred seven or more weeks premortem. In one case where cord injury had occurred eight days prior to death the MR showed no signal abnormalities, histological analysis showed evidence of early wallerian degeneration in the dorsal columns above the lesion but no change was detected in the lateral columns below the lesion. After 12 days, early stage wallerian degeneration was detected by histological examination in both the lateral columns below the lesion and in the dorsal columns above the lesion. Wallerian degeneration in spinal cords, as demonstrated by histological examination, was identified on MR as areas of increased T2 weighted signal intensity site in the dorsal column above the injury site and in the corticospinal tracts below the injury site in all specimen in which the injury-to-death interval was greater than 7 weeks. The ability to recognize wallerian degeneration on MR allows a more comprehensive analysis of the injury, explains abnormal MR signals at sites that are remote from the epicenter of injury, and may be helpful in the assessing of results of therapeutic interventions.
Antibodies ; Axons ; Coloring Agents ; Connective Tissue ; Humans ; Magnetic Resonance Imaging ; Myelin Sheath ; Plastics ; Pyramidal Tracts ; Spinal Cord Injuries* ; Spinal Cord* ; Wallerian Degeneration*

Our objective was a retrospective assessment of the management modalities that provided the most beneficial treatment in hemorrhagic moyamoya disease during the last 13 years at our institution. The clinical results of 44 patients with hemorrhagic moyamoya disease were investigated, comparing revascularization surgery (direct, indirect, and combined bypass) or conservative treatment. Angiographic features, rebleeding, and clinical outcome were investigated. Six of the 35 patients (17.1%) with revascularization surgery experienced rebleeding, as did 4 of 9 patients (44.4%) with conservative treatment. However, patients who underwent bypass surgery had a lower chance of rebleeding. No significant difference in chance of rebleeding was observed between bypass surgery and non surgery groups (p > 0.05). Cerebral angiography performed after bypass surgery showed that for achieving good postoperative revascularization, direct and combined bypass methods were much more effective (p < 0.05). While the risk of rebleeding in the revascularization group was generally lower than in the conservative treatment group, there was no statistically significant difference between treatment modalities and conservative treatment. Although statistical significance was not attained, direct and combined bypass may reduce the risk of hemorrhage more effectively than indirect bypass.
Adult ; Cerebral Angiography ; Hemorrhage ; Humans ; Intracranial Hemorrhages ; Moyamoya Disease ; Retrospective Studies

Our objective was a retrospective assessment of the management modalities that provided the most beneficial treatment in hemorrhagic moyamoya disease during the last 13 years at our institution. The clinical results of 44 patients with hemorrhagic moyamoya disease were investigated, comparing revascularization surgery (direct, indirect, and combined bypass) or conservative treatment. Angiographic features, rebleeding, and clinical outcome were investigated. Six of the 35 patients (17.1%) with revascularization surgery experienced rebleeding, as did 4 of 9 patients (44.4%) with conservative treatment. However, patients who underwent bypass surgery had a lower chance of rebleeding. No significant difference in chance of rebleeding was observed between bypass surgery and non surgery groups (p > 0.05). Cerebral angiography performed after bypass surgery showed that for achieving good postoperative revascularization, direct and combined bypass methods were much more effective (p < 0.05). While the risk of rebleeding in the revascularization group was generally lower than in the conservative treatment group, there was no statistically significant difference between treatment modalities and conservative treatment. Although statistical significance was not attained, direct and combined bypass may reduce the risk of hemorrhage more effectively than indirect bypass.
Adult ; Cerebral Angiography ; Hemorrhage ; Humans ; Intracranial Hemorrhages ; Moyamoya Disease ; Retrospective Studies

Fracture-dislocations of the fifth lumbar vertebra are rare. Treatment of L5 vertebra fractures depends on fracture type and neurological findings. The authors describe a single-staged surgical technique of only posterior circumferential decompression, spinal reconstruction with expandable cage insertion and instrument fixation.
Decompression ; Spine

Fracture-dislocations of the fifth lumbar vertebra are rare. Treatment of L5 vertebra fractures depends on fracture type and neurological findings. The authors describe a single-staged surgical technique of only posterior circumferential decompression, spinal reconstruction with expandable cage insertion and instrument fixation.
Decompression ; Spine

INTRODUCTION: The purpose of this study was to analyze the safety, pullout strength and radiographic characteristics of unicortical and bicortical screws of cervical facet within cadaveric specimens and evaluate the influence of level of training on the positioning of these screws. METHODS: Twenty-one cadavers, mean 78.9 years of age, underwent bilateral placement of 3.5mm AO lateral mass screw from C3-C6(n=168) using a slight variation of the Magerl technique. Intraoperative imaging was not used. The right side(unicortical) utilized only 14mm screws(effective length of 11mm) while on the left side to determine the length of the screw after the ventral cortex had been drilled. Three spine surgeons(attending, fellow, chief resident) with varying levels of spine training performed the procedure on seven cadavers each. All spines were harvested and lateral radiographs were taken. Individual cervical vertebrae were carefully dissected and then axial radiographs were taken. The screws were evaluated clinically and radiographically for their safety. Screws were graded clinically for their safety with respect to the spinal cord, facet joint, nerve root and vertebral artery. The grades consisted of the following categories: "satisfactory", "at risk" and "direct injury". Each screw was also graded according to its zone placement. Screw position was quantified by measuring a sagittal angle from the lateral radiograph and an axial angle from the axial radiograph. Pull-out force was determined for all screws using a material testing machine. RESULTS: Dissection revealed that fifteen screws on the left side actually had only unicortical and not bicortical purchase as intended. The majority of screws(92.8%) were satisfactory in terms of safety. There were no injuries to the spinal cord. On the right side(unicortical), 98.9% of the screws were "satisfactory" and on the left side(bicortical) 68.1% were "satisfactory". There was a 5.8% incidence of direct arterial injury and a 17.4% incidence of direct nerve root injury with the bicortical screws. There were no "direct injuries" with the unicortical screws for the nerve root or vertebral artery. The unicortical screws had a 21.4% incidence of direct injury of the facet joint, while the bicortical screws had a 21.7% incidence. The majority of "direct injury" of bicortical screws were placed by the surgeon with the least experience. The performance of the resident surgeon was significantly different from the attending or fellow(p<0.05) in terms of safety of the nerve root and vertebral artery. The attending's performance was significantly better than the resident or fellow(p<0.05) in terms of safety of the facet joint. There was no relationship between the safety of a screw and its zone placement. The axial deviation angle measured 23.5+/-6.6 degrees and 19.8+/-7.9 degrees for the unicortical and bicortical screws, respectively. The resident surgeon had a significantly lower angle than the attending or fellow(p<0.05). The sagittal angle measured 66.3+/-7.0 degrees and 62.3+/-7.9 degrees for the unicortical and bicortical screws, respectively. The attending had a significantly lower sagittal angle than the fellow or resident(p<0.05). Thirty-three screws that entered the facet joint were tested for pull-out strength but excluded from the data because they were not lateral mass screws per-se and had deviated substantially from the intended final trajectory. The mean pull-out force for all screws was 542.9+/-296.6N. There was no statistically significant difference between the pull-out force for unicortical(519.9+/-286.9N) and bicortical(565.2+/-306N) screws. There was no significant difference in pull-out strengths with respect to zone placement. CONCLUSION: It is our belief that the risk associated with bicortical purchase mandates formal spine training if it is to be done safely and accurately. Unicortical screws are safer regardless of level of training. It is apparent that 14mm lateral mass screws placed in a supero-lateral trajectory in the adult cervical spine provide an equivalent strength with a much lower risk of injury than the longer bicortical screws placed in a similar orientation.
Adult ; Cadaver ; Cervical Vertebrae ; Female ; Humans ; Incidence ; Spinal Cord ; Spine* ; Vertebral Artery ; Zygapophyseal Joint

OBJECTIVES: Polymethylmethacrylate(PMMA) is often used to reconstruct the spine after total corpectomy, but the exothermic curing of liquid PMMA poses a risk of thermal injury to the spinal cord. The purposes of this study are to analyze the heat blocking effect of pre-polymerized PMMA sheet in the corpectomy model and to establish the minimal thickness of PMMA sheet to protect the spinal cord from the thermal injury during PMMA cementation of vertebral body. MATERIALS AND METHODS: An experimental fixture was fabricated with dimensions similar to those of a T12 corpectomy defect. Sixty milliliters of liquid PMMA were poured into the fixture, and temperature recordings were obtained at the center of the curing PMMA mass and on the undersurface(representing the spinal cord surface) of a pre-polymerized PMMA sheet of variable thickness(group 1:0mm, group 2:5mm, or group 3:8mm). Six replicates were tested for each barrier thickness group. RESULTS: Consistent temperatures(106.8+/-3.9degreesC) at center of the curing PMMA mass in eighteen experiments confirmed the reproducibility of the experimental fixture. Peak temperatures on the spinal cord surface were 47.3degreesC in group 2, and 43.3degreesC in group 3, compared with 60.0degreesC in group 1(p<0.00005). So pre-polymerized PMMA provided statistically significant protection from heat transfer. The difference of peak temperature between theoretical and experimental value was less than 1%, while the predicted time was within 35% of experimental values. The data from the theoretical model indicate that a 10mm barrier of PMMA should protect the spinal cord from temperatures greater than 39degreesC(the threshold for thermal injury in the spinal cord). CONCLUSION: These results suggest that pre-polymerized PMMA sheet of 10mm thickness may protect the spinal cord from the thermal injury during PMMA reconstruction of vertebral body.
Cementation ; Hot Temperature ; Models, Theoretical ; Polymethyl Methacrylate* ; Spinal Cord* ; Spine