PURPOSE: Direct injection of doxorubicin into the eyelids results in permanent loss of muscle fiber and it is considered an attractive nonsurgical method in essential blepharospasm therapy. However, necrosis of skin overlying orbicularis oculi muscle is the most serious side effect of this therapy. The purpose of this study is to determine the effect of doxorubicin delivered by osmotic pump which release doxorubicin slowly, and to evaluate the degree of overlying skin injury following chemical myectomy. METHODS: Thirty three rabbits were assigned to three groups according to the doxorubicin concentration. The first group received direct injections of 0.5 mg doxorubicin diluted in 0.1 ml of saline in the right lower eyelid. and osmotic pump was inserted into the left lower eyelid which contained 0.5 mg doxorubicin in 0.1 ml of saline. The second group received 1 mg doxorubicin and the third group received 2 mg doxorubicin. Eight weeks after injection, the eyelids were assessed for the degree of muscle fiber loss microscopically. For the evaluation of functional change of muscle, an EMG study was carried out. RESULTS: Skin necrosis developed in all rabbits except for one which received injection of 0.5 mg doxorubicin. Skin necrosis appeared earlier in the direct injection group. The duration of skin necrosis was shortened at lower concentrations(0.5 mg, 1.0 mg) with a pump delivery(P<0.05). But there was no statistical differences in the 2.0 mg concentration. The size of necrosis was much smaller in rabbits using pump delivery than those of direct injection group in high doxorubicn concentrations(1.0 mg, 2.0 mg)(P<0.05). The total size of muscle fiber was decreased after a doxorubicin injection. There was no statistical difference between the direct injection group and the pump group(P<0.05). The similar effect on the muscle was noted regardless of the slow release of the doxorubicin into the muscle. Light microscopic study demonstrated destructive change of muscle and it was replaced by connective tissues. Electron microscopic study showed destruction of micro-architecture of muscle fibers. Functionally, in EMG study, there was no motor activity in the injection area. But some motor unit potentials appeared in the periphery of skin necrosis site. CONCLUSIONS: These results suggest that the osmotic pump may be used as an effective adjuvant in preventing skin necrosis in blepharospasm treatment.
Blepharospasm ; Connective Tissue ; Doxorubicin* ; Eyelids* ; Motor Activity ; Necrosis* ; Rabbits ; Skin*

Recently there has been a progressive increase of thoracolumbar fractures with neurologic symptoms. It has been thought that laminectomy increased instability and was therefore considered a contraindication. Currently, with the development of instrument for posterior stabilization, it is possible to perform posterior fusion and instrumentation, both with and without laminectomy. To compare the effect of neurologic recovery with and without laminectomy, we analyzed the clinical records of 38 patients with neurologic symptoms who were evaluated with plain radiographs and CT before and after surgery from 1989 to 1996 in Gyeong-Sang National University Hospital. We divided our cases into two groups, one group consisted open reduction with laminectomy and instrumentation with posterior fusion. The other group consisted of open reduction without laminectomy and instrumentation with posterior fusion. Twenty three of 38 were operated with open reduction and internal fixation with laminectomy and others were operated without laminectomy. The results were that both groups had improvement of neurologic symptoms after surgery and at follow-up. There was no significant statistical difference between the two groups. Depending on the time interval between injury and surgery, patients who were underwent emergency surgery had an marked improvement of neurologic symptoms. Except cases of complete paraplegia, incomplete paraplegic patients who were operated within 24 hours with laminectomy group had greater improvement than those without laminectomy. The improvement was statistically significant(P<0.05).
Emergencies ; Follow-Up Studies ; Humans ; Laminectomy* ; Neurologic Manifestations* ; Paraplegia

The possibility of whether minimal F-wave latency and a simple ratio between the sural and superficial radial sensory response amplitudes may provide a useful electrodiagnostic test in diabetic patients was investigated in this report. To evaluate the diagnostic sensitivity of minimal F-wave latency, the Z-scores of the minimal F-wave latency, motor nerve conduction velocity (MCV), amplitude of compound muscle action potentials (CMAP), and distal latency (DL) of the median, ulnar, tibial, and peroneal nerve were compared in 37 diabetic patients. For the median, ulnar, and tibial nerves, the Z scores of the minimal F-wave latency were significantly larger than those of the MCV. In addition for all four motor nerves, the Z scores of the minimal F-wave latency were significantly larger than those for the CMAP amplitude. Furthermore, 19 subjects showing abnormal results in the standard sensory nerve conduction study had a significantly lower sural/radial amplitude ratio (SRAR), and 84% of them had an SRAR of less than 0.5. In conclusion, minimal F-wave latency and the ratio between the amplitudes of the sural and superficial radial sensory nerve action potential are sensitive measures for the detection of nerve pathology and should be considered in electrophysiologic studies of diabetic polyneuropathy.
Aged ; Diabetic Neuropathies/physiopathology ; Diabetic Neuropathies/diagnosis* ; Electrodiagnosis* ; Female ; Human ; Male ; Middle Age ; Polyneuropathies/physiopathology ; Polyneuropathies/diagnosis* ; Radial Nerve/physiopathology* ; Reaction Time ; Sural Nerve/physiopathology*

Sixteen cases of intracranial arachnoid cyst were diagnosed with computerized tomography(CT). Four patients also had subdural hematoma, two of them following head trauma. Arachnoid cysts in Sylvian fissure are divided into three types, according to their shape and extension on CT. Male was predominant in sex distribution and Sylvian fissure was prevalent in location. Seizure and focal thinning of bone were the most frequently encountered clinical and radiological findings. Surgical procedure was performed in nine cases with partial excision of the cyst membrane or cystoperitoneal shunt. The authors discussed the pathogenesis, clinical findings and treatment of the intracranial arachnoid cyst. We support the congenital origin as pathogenesis, with the experience of one case, which was diagnosed before delivery with ultrasonogram. Considering the potential morbidity of the cyst, as subdural hematoma formation, we propose the surgical treatment as soon as the diagnosis is made.
Arachnoid Cysts ; Arachnoid* ; Craniocerebral Trauma ; Diagnosis ; Hematoma, Subdural ; Humans ; Male ; Membranes ; Seizures ; Sex Distribution ; Ultrasonography

No abstract available.
Cytomegalovirus* ; DNA* ; Glomerulonephritis* ; Polymerase Chain Reaction*

A case of intracerebral ependymal(neuroepithelial) cyst of developmental origin is presented. The cyst had no communication with ventricular system or subarachnoid space. The protein content of cyst fluid was higher than that of the CSF. The preoperative, postoperative CT scan and operative findings are presented. The authors reviewed and discussed the previously reported cases. .
Cyst Fluid ; Subarachnoid Space ; Tomography, X-Ray Computed

The authors analysed 74 cases of ruptured aneurysms confirmed by CT, angiography and surgery during the period from September 1982 to August 1984 at Keimyung University Dongsan Hospital for the study of the relationship between the amount of subarachnoid hemorrhage(SAH) detected by CT and the preoperative clinical grade (Hunt & Hess), the later development of cerebral vasospasm, ischemic neurologic deficit(IND) and the postoperative prognosis. We also attempted to investigate the relationship between the low density in the hypothalamus and/or midbrain on CT and the preoperative clinical grade and the angiographic vasospasm. There was no definite difference in age and sex distribution according to the severity of SAH on CT except in predominantly female cases of severe SAH(CT grade III). 75% of the cases with the absence of SAH(CT grade I) were preoperatively clinical grade I or II. However, 76% of the severe SAH cases(CT grade III) showed preopertively clinical grade III, IV or V. In case with no angiographic vasospasm(Ag0), 70% were shown to be clinical grade I or II. But in cases of severe vasospasm seen by angiography(Ag3), 80% were clinical grade III or IV. 17% of the cases that showed an absence of angiographic vasospasm(Ar0) showed a low density in the hypothalamus and/or midbrain on CT as did 48% of the cases with mild angiographic vasospasm(Ag1), 75% with moderate angiographic vasospasm(Ag2) and 100% of the cases with severe angiographic vasospasm(Ag3). It was noticed on the CT in cases of clinical grade I and II, there was a 14% and 24% low density in the hypothalamus and/or midbrain respectively. But in the cases of clinical grade III and IV, it was noticed that there was a 65% and 100% low density in hypothalamus and/or midbrain respectively. Ischemic neurological deficit(IND) developed in 9% of the cases having an absence of SAH(CT grade I) on CT and in 48% of the cases of severe SAH(CT grade III) on CT during the care if the patients. 100% of the cases showed good postoperative results in patients who had an absence of or thin SAH(CT grade I or II) on CT and only 50% of the cases who had severe SAH(CT grade III) obtained good postoperative results. The authors found a correlation between the amount of SAH and the preoperative clinical grade, the development of angiographic cerebral vasospasm, IND and the postoperative prognosis. The low density in the hypothalamus and/or midbrain on CT also has a relationship with the preoperative clinical grade and the development of angiographic vasospsm. We suggest that the severity of SAH on CT and the low density in the hypothalamus and/or midbrain may be of great value in the prediction of cerebral vasospasm and treatment of aneurysmal patients.
Aneurysm* ; Aneurysm, Ruptured ; Angiography ; Female ; Humans ; Hypothalamus ; Intracranial Aneurysm ; Mesencephalon ; Prognosis ; Sex Distribution ; Subarachnoid Hemorrhage* ; Vasospasm, Intracranial

The double stapling technique has become an established reconstruction method for patients undergoing low anterior resection. We have used a modification of the conventional technique in which the lower rectal segment is closed with a linear stapler (TA-55) and the anastomosis is performed by using the circular EEA(CEEA) instrument across the linear staple line of the double stapling technique. The aim of this study was to evaluate the prophylactic effect of a loop ileostomy preventing anastomotic leakage. Stapled colorectal anastomosis and stapled coloanal anastomosis in 60 patients forms the basis for the report. The sixty patients were treated by using the double stapling technique either with or without a loop ileostomy. This review presents the advantages and disadvantages of a loop ileostomy for coloanal anastomosis. Postoperative anastomotic leakage in the double stapling technique group occurred in 5 (10.6%)cases of the total 31 cases while in the double stapling technique with loop ileostomy group, it allowed 1(3.4%) of the total 29 cases. This study suggests that the double stapling technique with a loop ileostomy is more effective than the double stapling technique without a loop ileostomy in preventing anastomotic leakage. The addition of a loop ileostomy to protect the low anastomosis might also be expected to influence anastomotic healing.
Anastomotic Leak ; Humans ; Ileostomy ; Rectal Neoplasms*

We tested the hypothesis that the extent of necrosis at the initial MRI predicts the subsequent risk of collapse of the femoral head in a randomized clinical trial conducted to compare the core decompression to the conservative treatment. After the initial clinical evaluation including plain roentgenography and MRI, 37 hips of early-stage osteonecrosis (ON) in 33 patients were randomly assigned to core decompression group or conservative treatment group. All the patients were regularly followed by clinical evaluation including plain roentgenography and MRI at three-month intervals. The extent of ON was estimated on the basis of the percentage of abnormal signal intensity in the weight-bearing portion of the femoral head as determined on a combination in coronal aod sagittal MR images. The angle of necrotic portion in mid-coronal image (A) and that in mid-sagittal image (B) were used to quantify the extent of necrotic portion by the formula; (A/180) x (B/180) x 100%. A strong association was observed between the percentage of necrotic portion and the development of collapse. We concluded that the extent of necrotic portion is a major risk factor of the collapse and proposed a systematic method of classifying the percentage of necrotic portion, which might be useful as a predictive index for the fate of early-stage ON.
Classification* ; Decompression ; Head* ; Hip ; Humans ; Magnetic Resonance Imaging* ; Necrosis ; Osteonecrosis* ; Radiography ; Risk Factors ; Weight-Bearing

Foot complications are a well known factor which contribute to the morbidity of diabetes and increases the chance of amputation. A total of 126 consecutive diabetic patients were evaluated by diabetic foot screening. Forty-one patients showed an impaired protective sense when tested with Semmes-Weinstein monofilament 5.07 (10 g), and 92% of them showed peripheral polyneuropathy in nerve conduction study (NCS). The mean vibration score of the Rydel-Seiffer graduated tuning fork in patients with peripheral polyneuropathy in nerve conduction (NCV) study was 5.38+/-2.0, which was significantly different from that of patients without polyneuropathy in NCS. Among the deformities identified on examination, callus, corn, and hallux valgus were the greatest. While checking the ankle/ brachial index (ABI), we also evaluated the integrity of vasculature in the lower extremities. After extensive evaluation, we classified the patients into eight groups (category 0,1,2,3,4A,4B,5,6). The result of this study suggested that the Semmes-Weinstein monofilament test, Rydel-Seiffer graduated tuning fork test, and checking the ankle/brachial index were simple techniques for evaluating pathologic change in the diabetic foot by office screening, and that this screening based on treatment-oriented classification helps to reduce pedal complications in a diabetic population
Diabetic Angiopathies/diagnosis ; Diabetic Angiopathies/complications ; Diabetic Foot/physiopathology ; Diabetic Foot/diagnosis* ; Diabetic Foot/classification ; Diabetic Neuropathies/diagnosis ; Diabetic Neuropathies/complications ; Female ; Foot/physiopathology ; Human ; Male ; Mass Screening ; Middle Age ; Podiatry/methods ; Sensory Thresholds