OBJECTIVE: Using the standardization of disease diagnosis of disease, and surgical procedures, the authors have made a clinical application for the analysis of inpatient data with the ability to search for information pertinent for writing of clinical articles. METHODS: A client-server system and database software was developed for networking. For clinical application, a computerized daily report has been developed. Data from Neurosurgical patients admitted at Soonchunyang University Hospital from January to December 1998 were analyzed with this system. Data for clinical articles was obtained using the search mode, information such as orbital infarction syndrome following intracranial aneurysm surgery and epidemiological analysis or geriatric neurosurgical patients. RESULTS: For the daily report it takes approximately 10 minutes to input the patients demographic information, name of disease, diagnosis and surgical procedure. The daily report also numbers and sorts the inpatients according to large categories of diagnosis, reports the ratio between inpatients and operative patients. The annual report that was obtained was very accurate and gave rapid statistics for the one year. By retrospective study for the past 18 years, we calculated the incidence of orbital infarction syndrome following intracranial aneurysm surgery as 1.4%, and also estimated the population of geriatric inpatients as 18.3% by retrospective study. CONCLUSIONS: It has been found to be most useful to make a daily and annual report for tracking and research purposes. For use in clinical articles, it can be possible to do a search of the patients using the standardized disease, diagnosis and neurosurgical procedures application and obtain pertinent information in a timely manner.
Diagnosis ; Epidemiology* ; Humans ; Incidence ; Infarction ; Inpatients ; Intracranial Aneurysm ; Neurosurgical Procedures* ; Orbit ; Retrospective Studies ; Writing

OBJECTIVE: The the international classification of disease and surgical procedure has been found to be a lengthy and time-consuming text for use by neurosurgeons. A more subject matter related classification system is needed for use by this specialty. The author has developed a more comprehensive and standardized classification system specified for diagnosis of neurological disease and neurosurgical procedures. METHODS: Standardization of disease was completed by modifying the name of disease according to that which was used for daily report past 10 years, and from textbook of neurosurgery. The fields of international coding are continued in each. Neurosurgical procedures were designated and modified according to Current Procedure Terminology 96. Client-server system will be used for networking and database software applications have been developed. RESULTS: Disease was classified in 14 large categories and 379 subcategories. Diagnosis was classified in 12 large categories and 43 subcategories. Neurosurgical procedure has 20 large and 202 subcategories. The international coding system such as ICD-10 and ICD-9CM is maintained for the diagnosis and procedures to each category. CONCLUSIONS: It could be possible to make and use a standardized database model of disease, diagnosis and neurosurgical procedures to be used by physician.
Classification ; Clinical Coding ; Diagnosis ; Epidemiology* ; International Classification of Diseases ; Neurosurgery ; Neurosurgical Procedures*

To investigate the clinical significance of intracerebral hematoma(ICH) in patients with spontaneous subarachnoid hemorrhage(SAH), the authors reviewed 527 consecutive patients with SAH during the past 7 years. Computed tomography(CT) visible ICH was found in 115 patients(21.8%). In patients over 50 years old, ICH was found more frequently than patients aged 50 years or less(p<0.05). Patients with ICH had a higher incidence of intraventicular hemorrhage or rebleeding compared with patients without ICH(p<0.005). No significant association was found between pre-existing hypertension and ICH. Patients with ICH were in higher Hunt and Hess Grade(HHG) on admission(p<0.005), and had a poorer outcome compared with patients without ICH(p<0.005). Seventy-nine(20.2%) among the 392 patients with aneurysmal subarachnoid hemorrhage had ICHs, of whom the frequent site of aneurysm was the middle cerebral artery in 45.3%, anterior cerebral artery in 17.9%. The rate of good recovery in these patients was significantly low compared with patients without ICH. The mortality in 313 operated patients with aneurysmal subarachnoid hemorrhage was 36.4% in patients with ICH and 14.6% in those without ICH (p<0.005). Particulary, in the patients with middle cerebral artery or internal carotid artery aneurysm, ICH had a significant influence on the good recovery and mortality(p<0.005). Even though the surgical mortality of the patients with large hematoma more than 30 cc in amount was 64.7%, one half of the survivors showed good recovery. This study suggests that the prognosis after subarachnoid hemorrhage is poorer in patients with an ICH. Although the initial clinical grade is an important prognostic factor, the prognosis for patients in the same initial clinical grade is poorer when ICH is accompanied. In regard with an increased incidnece of rebleeding episode and an increased intracranial pressure in the patients with ICHs, we emphasize the importance of early surgical intervention.
Aneurysm ; Anterior Cerebral Artery ; Carotid Artery, Internal ; Hematoma* ; Hemorrhage ; Humans ; Hypertension ; Incidence ; Intracranial Pressure ; Middle Aged ; Middle Cerebral Artery ; Mortality ; Prognosis ; Subarachnoid Hemorrhage* ; Survivors

Complications such as infection, seizure, or intracranial hemorrhage are relatively common after depressed skull fractures. However, indications, methods, and efficacy of the surgical treatment are controversial. This study includes 113 patients with depressed skull fractures who were treated at Soonchunhyang University Chonan Hospital between 1989 and 1992. Methods of treatment, complications, and the prognosis were retrospectively collected and the prognostic factors were analysed. Depressed skull fracture was common below the age of 20 years(38%). Male to female ration was 5.3:1. Traffic injury was the most common of depressed skull fracture(68.1%). Glasgow coma score(GCS) on admission was 13-15 in 52%, 9-12 in 18.6%, and closed in 32%. Intracranial injury was accompanied in 43%. The frontal area was the most common site of depression(53%), and the parietal region was the next(28%). In 65% of open fractures and 28% of closed ones, the lesions were surgically corrected. Cranitomy with primary reconstruction was the most common operative procedure. The mean hospital stay was 26 days in surgically treated patients, and it was 17 days in conservatively managed patients. Prophylactic anticonvulsants were administered in 43%. Seizures occured in 6.2%, and infections were encountered in 3.5%. The outcome was favorable(good recovery and moderate disability) in 80% and the mortality rate was 16%. The outcome was better when the GCS on admission was high(P<0.005), the pupillary response was normal(P<0.005), and the lesion was treated by surgery(P<0.005). Seizures were more common when the GCS was low(P<0.005). Although infections were developed in surgically treated patients only, this difference lacked a statistical significance.
Anticonvulsants ; Chungcheongnam-do ; Coma ; Craniocerebral Trauma ; Female ; Fractures, Open ; Humans ; Intracranial Hemorrhages ; Length of Stay ; Male ; Mortality ; Prognosis* ; Rabeprazole ; Retrospective Studies ; Seizures ; Skull ; Skull Fracture, Depressed* ; Surgical Procedures, Operative

Eaton Lambert Syndrome (ELS) is a disorder of neuromuscular transmission. The defect of neuromuscular transmission is due to decrease in the release of acetylcholine quanta from nerve terminal. This syndrome is frequently associated with bronchogenic carcinoma. The diagnosis is established by electromyography, which characteristically shows 1) low amplitude of evoked compound muscle potential to a single supramaximal stimulus on nerve, 2) significant decremental response at low rates of stimulation 3) marked incremental response at high rates of stimulation. Our patient is 52year old man with dyspnea, coughing and muscle weakness of proximal lower limbs. He has small cell lung cancer and associated with ELS, Superior vena cava syndrome and has metastatic lesion on right supraclavicular lymph node confirmed by pathology. Metastatic mass and SVC syndrome are marked improved following chemotherapy and radiotherapy, however follow up EMG finding does not improved. We are here reporting one case which considered compatible for ELS, with a few elementary reviewed literatures.
Acetylcholine ; Carcinoma, Bronchogenic ; Cough ; Diagnosis ; Drug Therapy ; Dyspnea ; Electromyography ; Follow-Up Studies ; Humans ; Lambert-Eaton Myasthenic Syndrome* ; Lower Extremity ; Lymph Nodes ; Muscle Weakness ; Pathology ; Radiotherapy ; Small Cell Lung Carcinoma* ; Superior Vena Cava Syndrome

To investigate the clinical significance of and risk factors for rebleeding in patients with spontaneous subarachnoid hemorrhages(SAH), the authors reviewed the consecutive cases of 527 patients admitted in the 7-year period from 1988 to 1995. Of these patients, 75(14.2%) rebled. Rebleeding occurred within 24 hours in 45 patients, among whom 32 cases rebled within 12-24 hours after initial SAH, within 1-3 days in 19, within 4-7 days in 9, and after 1 week in 2. These patients had an overall mortality of 82.9% compared to 28.4% for patients without rebleeding. The patients with rebleeding within 24 hours after the initial attack had an operative rate of 34.9% and a postoperative mortality of 53.3% compared to 26.8%, 37.5%, respectively, for patients with rebleeding after 24 hours. The significant factors affecting rebleeding were as follows;Over 70 years in age, association with intracerebral hematoma(10-20cc), sizure before operation, aneurysms on the vertebrobasilar system, poor neurological condition on admission, and angiography within 6 hours of initial SAH. Ultra-early operation within 24 hours following intentional delay in angiography of at least 6 hours from the initial rupture is recommended if the associated hematoma is not large enough to show mass effect.
Aneurysm ; Angiography ; Hematoma ; Humans ; Mortality ; Risk Factors* ; Rupture ; Subarachnoid Hemorrhage*

Despite recent advances in the care of such patients, subarachnoid haemorrhage(SAH) due to ruptured intracerebral aneurysm continues to carry a high rate of morbidity and mortality. During the acute phase of SAH, various factors can aggravate a patients initial good neurological state, and every effort should thus be made to prevent such occurrences. Although not a major problem, seizure is a well known factor influencing the course of the disease. The authors studied 476 cases of SAH occurring during the preceding eight-year period and reported the incidence of seizure, the risk factors which evoke it, and the optimal time required to prevent it. The incidence was 11%, and 48% of seizures occurred within three days of SAH. The risk factors were Hunt-Hess grade at admission, degree of neurologic deficit, and the presence and timing of rebleeding. Regardless of initial grade, seizure led to a poorer outcome. We conclude that seizure in aneurysmal subarachnoid hemorrhage occurs during the early stage of the disease and aggravates the prognosis. The recognition of risk factors and early prevention of seizure are thus necessary.
Aneurysm ; Humans ; Incidence ; Intracranial Aneurysm* ; Mortality ; Neurologic Manifestations ; Prognosis ; Risk Factors ; Seizures* ; Subarachnoid Hemorrhage

The origin and clinical importance of subdural hygroma(SDG) are still uncertain. Its pathogenetic mechanism and natural history have not yet been settled. Although the incidence of traumatic SDG has been reported to be 5-20% of posttraumatic space-occupying lesions, the true incidence has not been documented in prospective study. Therefore, authors have tried to determine the incidence of traumatic SDG prospectively during past six months. Serial computed tomography(CT) or magnetic resonance imaging(MRI) studies were done in all patients who were admitted to our department after head injuries. Data on the age, sex, Glasgow coma scale(GCS) on admission, and initial CT findings were collected and analyzed to determine the true incidence, pattern and premorbid conditions for the development of traumatic SDG. Serial CT or MRI scans were performed on the date of admission, the second to sixth hospital day, and the seventh to fourteenth hospital day. Study population consisted of 115 patients, excluding 31 expired, discharged, or transferred patients within a week. Subdural hygroma was noted in 42(35.6%) patients. It shared 45.2% of posttraumatic mass lesion. More than half (54.7%) of patients aged 40 or more had subdural hygromas. They were generally delayed lesions, due to the fact that most of them(81%) were observed at four days or more after the injury. All hygromas were located at the frontal or fronto-temporo-parietal regions. Bilaterality was seen in 54.7%. SDGs occurred earlier when the age of the patients were 40 years old or more(p=0.037). It occurred earlier when the initial CT scans were normal, when there was no accompanying traumatic intracranial lesions, and high GCS on admission. However, these differences were statistically not significant(p>0.05). These results suggest that the premorbid conditions for the development of subdural hygroma were sufficient potential subdural space and separation of the dural border cell layer, although former seemed to be more important that the later. Osmotic dehydration in the aged victims should be serially reevaluated, because the subdural hygroma may develop when the intracranial pressure is excessively low.
Adult ; Coma ; Craniocerebral Trauma ; Dehydration ; Epidemiology ; Humans ; Incidence* ; Intracranial Pressure ; Lymphangioma, Cystic ; Magnetic Resonance Imaging ; Natural History ; Prospective Studies* ; Subdural Effusion* ; Subdural Space ; Tomography, X-Ray Computed

We present a series of 97 patients with spinal cord injury. Those patients were treated at Soonchunhyan University Chonan Hospital during six-year-period(January 1986-December 1992), and followed up for at least 3 months. They were divide into four groups ; complete-surgical, complete-conservative, partial-surgical, and partial-conservative. Male to female ratio was 3.6:1, and the peak age was the fifth decade. Passenger's traffic accident(46%) was the most common cause of injury and fall/slip(39%) followed next. Level of spinal injury was cervical in 51%, thoracic in 29%, lumbar in 13%, and others in 7%. Type of injury was fracture-dislocation in 31%, dislocation in 19%, compression fracture in 19%, burst fracture in 18%, cord injury without bony lesion in 7%, and others in 7%. Cord injury was complete in 36 patients(37%) and partial in 61 patients(63%). Surgery was performed in 20 patients with complete cord injury and 34 patients with partial injury. Majority of operations were performed for spinal stability, and posterior instrumentation was the most commonly used operative method. The mean neurotrauma motor index on admission was 44.1 in the complete-surgical group, 39.5 in complete-conservative group, 70.1 in partial-surgical group, and 63.2 in partial-conservative group. It improved to 52.5, 50.3, 90.4, 80.3 at 3 months, and 53.4, 51.7, 91.8, 82.0 at final examination(mean follow-up period was 182.2 days), respectively. The mean values of the final index were higher in the surgically treated groups than the conservatively treated groups, but these differences were not statistically significant(student t-test p>0.1) The mean recovery rate was 14.2% in the complete-surgical group, 17.7% in complete-conservative group, 66.1% in partial-surgical group, and 46.1% in partial-conservative group at 3 months. It improved to 16.6%, 19.3%, 70.0%, and 48.7% at final examination, respectively. The mean recovery rates were higher in the partially injured groups than the completely injured groups(student t-test, p<0.01), regardless the methods of treatment. The final neurotrauma motor index was significantly(regression analysis, p<0.01) related to the initial index except the partial-surgical group. Neurotrauma motor index was a useful method for assessing the injury severity, comparing the recovery rate and predicting prognosis.
Chungcheongnam-do ; Dislocations ; Female ; Follow-Up Studies ; Fractures, Compression ; Humans ; Male ; Prognosis* ; Spinal Cord Injuries* ; Spinal Cord* ; Spinal Injuries

OBJECTIVE: Although posterior wiring techniques have been commonly used with good results in treating the traumatic atlantoaxial instabilities, screw fixation technique has been gaining popularity to secure atlantoaxial arthrodesis in recent years. The purpose of this study is to compare the surgical results of posterior arthrodesis for the traumatic atlantoaxial instability between these two methods. METHODS: Twenty patients underwent 21 procedures over a 6-year period with a mean follow-up of 23 months. The most common condition of traumatic atlantoaxial instability was dens fracture(15 patients) followed by transverse atlantal ligament injury(4 patients), and traumatic os odontoideum(2 patients). Thirteen posterior wiring and eight posterior screw fixations were performed. Among 13 wiring methods, nine Galli fusions, two occipito-cervical fusions, one Brooks fusion, and one C1-C3 fusion were done. RESULTS: No patient developed neurological worsening after surgery. Compared to wire method, all patients of screw group had significant pain reduction when the patients was younger than 50 years old(p=0.01). The postoperative changes in distances of space available for cord(SAC) was not statistically significant between wire and screw methods(p=0.7). The rate of complication(23% in wire vs 25% in screw) was comparable to two methods. Although two screw malposition(25%) among screw fixations were developed, all revealed solid fusion without additional surgeries. The rate of fusion(85% in wire vs 100% in screw) was excellent in screw group. Postoperative loss of reduction, including redisplacement and kyphosis, was present only in wire group(31%). Two(15%) of wire fusions had redisplacement; both of these patients were type 2 dens fracture. Three procedures(23%) of wire fusions resulted in kyphotic change which occurred when delayed surgeries were done between 40 days and 90 days(mean: 63 days) after trauma. CONCLUSION: Considering both reduction loss and fusion rate, wire method caused more spinal deformity than screw method(38% vs 0%). This study demonstrates that screw method is a better surgical option for management of traumatic atlantoaxial instability.
Arthrodesis* ; Congenital Abnormalities ; Follow-Up Studies ; Humans ; Kyphosis ; Ligaments