OBJECTIVE: The aim of this study is to determine the factors influencing the surgical outcome following craniotomy for head injury and to establish the criteria for surgical intervention in the age of 65 years or older. METHODS: We retrospectively investigated the mechanism of injury, types of computed tomography lesions, Glassgow coma scale(GCS) score at admission, pupillary reactivity, past medical history and surgical outcome following craniotomy in the elderly during 8 year period. RESULTS: There were 35 men and 21 women with a mean age of 70.7 years(range 65-87 years). The mortality rate at discharge was 58.9%. Good outcome was achieved only in 25 percent of the patients. The cause of injury did not affect on the surgical outcome. All of 19 patients with GCS of 5 or less at admission had poor outcome. Outcome was significantly worse in older patients(more than 75 years) compare to younger patients(less than 75 years). Ninety percent of the patients with pupillary abnormality had poor outcome, whereas 57.7 percent of the patients with bilateral reactive pupil had poor outcome. Past medical history did not affect on the surgical outcome following craniotomy. CONCLUSION: Surgical outcome is unexceptionally poor in the elderly head-injuried patients if the age is 75 years old or older, the GCS is 5 or less and the pupil is bilaterally dilated. Craniotomy under those circumstances is not desirable.
Aged* ; Coma ; Craniocerebral Trauma ; Craniotomy ; Female ; Humans ; Intracranial Hemorrhage, Traumatic* ; Male ; Mortality ; Pupil ; Retrospective Studies

No abstract available.
Fatigue* ; Sciatica*

No abstract available.

No abstract available.
Brain Injuries* ; Child* ; Glasgow Coma Scale ; Humans

Low back pain is one of the most common symptoms in medical practice. Differential diagnosis of back pain is complicated, however. Self-reported pain intensity and disability may affect on the decision for diagnosis or therapy. Exaggerated symptoms may cause unnecessary investigations or even surgical interventions. Self-reported pain intensity and disability are not in proportion to the objective physical findings. We investigated the relationship between self-reported pain intensity or disability and sleep disturbance or fatigue. The study was conducted as a survey using a questionnaire from November 1997 to March 1998. The survey included consecutive 368 patients who visited the neurosurgical out-patient department complaining of low back pain. Pain intensity was measured by visual analog scale, and disability was assessed by Waddell's chronic disability index. By multiple regression analysis, self-reported pain intensity corresponded best with the sleep disturbance. Age and fatigue were also related to the pain intensity. There was no good agreement between pain intensity and region or duration of the pain, appetite or indigestion. Disability corresponded best with the sleep disturbance. Fatigue, appetite, and indigestion were also related to the disability. There was no good relationship between disability and region or duration of the pain, or age. Self-reported pain intensity and disability are related to the psychological distress represented as sleep disturbance, fatigue, poor appetite or indigestion. Inquiring about sleep or fatigue is important to understand the underlying psychological condition, which may exaggerate pain intensity and disability.
Appetite ; Back Pain ; Diagnosis ; Diagnosis, Differential ; Dyspepsia ; Fatigue* ; Humans ; Low Back Pain ; Outpatients ; Surveys and Questionnaires ; Spine ; Visual Analog Scale

Tables and figures are very useful tools to support the author's point or opinion. It should be made according to instructions for the authors of the given Journal. The Journal of Korean Neurosurgical Society requires simple and clear English titles and explanations for the tables, figures and photos, which should be attached at the end of the manuscript. The author examined correctness of the tables and figures in the Jormnal of Korean Neurosurgical Society Volume 26. In 1997, 240 articles published in the Journal of Korean Neurosurgical Society. All 240 articles used at least one table or a figure. Tables were used in 157 articels, of which 107 articles(68.2%) have at least one incorrect table. Blanks in the field(26.2%), omitting the column headings(25.2%), and incorrect footnotes(19.6%) were common errors in the tables. Figures were used in 208 articles, of which 31 articles(14.9%) have at least one incorrect figure. Identifiable name or hospital number(35.5%), wrong numbering(29.0%), and duplication of tables and figures (19.4%) were common errors in the figures. It is important for the contributors to keep the instruction. To improve the quality of the journal, proper education for the manuscript and meticulous review of an article are necessary. It may be useful to illustrate an example of a table in the instruction of the Jormnal of Korean Neurosurgical Society.
Education

The Journal of Korean Neurosurgical Society is the unique official journal of Korean Neurosurgical Society. However, it is not yet indexed in the Index Medicus or Medline. The author investigated the accuracy of the references in the Jourmnal of Korean Neurosurgical Society Volume 26 and frequency of citation. In 1997, 240 articles published in the Journal of Korean Neurosurgical Society. The average number of references and frequency of citation were evaluated. Accuracy of the references was examined according to the instructions for the contributors which was revised at 1995. The references were described correctly in 104 articles(43.3%). In 136 articles(56.7%), there was at least one descriptive error. The most common error was an incorrect abbreviation of the journals, which was found in 87 articles (36.3%). Incorrect description of the books or chapters in a book was found in 62 articles(25.8%). Describing more than three authors was found in 31 articles(12.9%). There were some other faults, such as an incorrect author's name, omitting an article in the references, wrong order, or different description of the pages. The average number of references were 27.1 in total. The average number of Korean references were 1.3, and that of the Journal of Korean Neurosurgical Society was 0.93. It shared only 3.43% of all references. Only 108 articles (45.0%) cited at least one Korean reference. The number of articles citing the Journal of Korean Neurosurgical Society was 97(40.4%). It is an honor to publish an article in the official journal of his own academic society. However, submitting an articles which do not follow the instructions and publishing an inadequate article without proper correction would pull down the quality and the value of the journal. It is important to teach the way how to prepare an article. Meticulous review of an article is essential to improve the quality of the journal. It is also necessary to monitor the reviewer's missing.
MEDLINE

Respiratory syncytial virus (RSV) is the major cause of lower respiratory tract infection in infants. Life-threatening RSV infection is often reported in young children and immunocompromised hosts. Since there is no report on ribavirin therapy for RSV pneumonia in pediatric cancer patients in Korea, we report one case of RSV pneumonia that developed in an infant with acute lymphoblastic leukemia (ALL). Despite administration of oral ribavirin and intravenous immunoglobulin, the patient's respiratory distress worsened and admission to an intensive care unit was necessary. Chest x-ray showed multifocal consolidation, pneumothorax, and pneumomediastinum. Treatment with aerosolized ribavirin led to significant clinical improvement. The role of aerosolized ribavirin is still controversial, but it might have a therapeutic potential for severe RSV pneumonia in children with leukemia.
Child ; Humans ; Immunocompromised Host ; Immunoglobulins ; Infant ; Intensive Care Units ; Korea ; Leukemia ; Mediastinal Emphysema ; Pneumonia ; Pneumothorax ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Respiratory Syncytial Viruses ; Respiratory Tract Infections ; Ribavirin ; Thorax

Mortality after cervical spine injury is reportes as high as 15~30%, and it is intimately related to the initial cardiopulmonary function. We analysed the cause of death and initial cardiopulmonary function in 30 patients who expired at Soonchunhyang University Chonan Hospital after cervical spine injury between 1986 and 1993. Overall 42 patients(20.5%) expired in 205 patients with cervical spine injuries. Except 12 cases with concomitant fatal head injury and/or multiple systemic injuries, the mortality rate of cervical spine injury was 15.5%. It was 28.9% in cases with cord injury, and 2.1% in cases without cord injury. Male to female ratio was 5 : 1. Fifth to seventh decades constituted 63.3%. Common causes of spinal injury were in-car accident(46.7%) and fall/slip(36.7%). The level of spinal injury was above C5(upper cervical group ; UCG(55.6%) than the LCG(25.0%). Associated injuries were found in 66.7%, and the head injury was the most common one. The injury severity score was over 25 in 93.3%. The higher the score, the earlier the patients expired(Fisher's test, P<0.05). On arrival, hypotension(systolic blood pressure below 70 mmHg), bradycardia(less than 60/min), and respiratory arrest was found in 23.3%, 26.7%, and 16.7%, respectively. The episode of bradycardia was found in 56.7%. It was more common in cases of the early death(69.2%) than those of the late death(47.1%). Hypoxia, hypercarbia, and acidosis was observed in 19.2%, 7.7% and 5.38%, respectively. Respiratory failure was responsible for the majority(86.7%) of death. In UCG and cases of the early death, primary respiratory dysfunction was the main cause of death, while in LCG and cases of the death, pulmonary complication was the major reason(Fisher's test, P<0.01, respectively.
Acidosis ; Anoxia ; Blood Pressure ; Bradycardia ; Cause of Death* ; Chungcheongnam-do ; Craniocerebral Trauma ; Female ; Humans ; Injury Severity Score ; Male ; Mortality ; Respiratory Insufficiency ; Spinal Injuries ; Spine*

We present a retrospective study on the results of posterior instrumentation with various devices after thoracolumbar spinal injuries. From Jaunary 1985 to December 1990, we operated 61 patients in Soonchunhyang University Chonan Hospital. Fourty-six patients were followed at least three months(three to 40 months). Rod system was used in 21 patients and pedicle screw system was used in 27 patients. In two patients, both systems were used. We divided them into two group ; Group A for the patients operated with rod system and Group B for the patients operated with pedicluar screw system. We analysed and compared the results of these two groups. There were no significant differences in the age, sex, causes of injury, levels and types of injury, and the incidence of cord injury. The final wedge deformity was less severe in Group B than A(P<0.02). However, the final angular deformity did not significantly differ in two groups. The mean hospital stay of Group B was shorter than that of Group A, but the difference was not statistically significant. Although there was no statistical significance, the final wedge deformity was severe in patients who were older than 40 years of age, who follwed up for more than 300 days, and who had cord injury. The final wedge deformity and angular deformity were severe in patients whose preoperative deformity was great(P<0.05 and P<0.02, respectively). The angular deformity was also severe Group A, in patients who had cord injury, who followed up for more than 300 days, and who were younger than 40 years of age, but these differences lack the statistical significance. Although the rate of complication in Group B(40.7%) was higher than Group A(28.6%), this diference was not significant. The most common complication was rod displacement in Group A and screw fracute in Group B. Pedicle screw system was superior to the rod system in this study. Improving the instruments and accumulating clinical experiences, pedicle screw system will be an effective method for thracolumbar stabilization.
Chungcheongnam-do ; Congenital Abnormalities ; Humans ; Incidence ; Length of Stay ; Retrospective Studies ; Spinal Injuries