Motor weakness is one of the neurological complication that can occur after aneurysmal subarachnoid hemorrhage (SAH); incidence of motor weakness of 14~29% has been reported. Detailed information on the pathogenic mechanism of motor weakness is essential for brain rehabilitation because it enables estimation of the severity of injury, establishment of scientific rehabilitative strategies, and prediction of motor outcomes by clinicians. However, the exact pathogenic mechanisms of motor weakness following aneurysmal SAH have not been clearly elucidated. In this article, 14 previous studies on pathogenic mechanisms in patients with aneurysmal SAH were reviewed according to the location of the lesion (cerebral cortex, brainstem, spinal cord, and peripheral nerve). The following pathogenic mechanisms have been suggested: vasospasm, cerebral ischemia, hydrocephalus, compression of cerebral cortex, neural injury, spinal cord infarction, and radiculo-neuropathy. Considering the high incidence of aneurysmal SAH and motor weakness following aneurysmal SAH, we believe that the pathogenic mechanisms of motor weakness have been relatively understudied. More effort should be taken to investigate this important topic.
Subarachnoid Hemorrhage

This treatise summarizes the medical facts about the persistent vegetative state(PVS) and the associated issues. In August 1998, the opinions of the 380 neurologists and the 1007 neurosurgeons are inquired about the diagnostic criteria of PVS, the degree and the withdrawal of treatment on PVS patients. The response rate is 18.8%. The diagnostic criteria of PVS is determined by the items approved above 5007o of responses. (1) no evidence of cerebral function and an inability to interact with visual, auditory stimuli and follow commands. (2) maintaining the respiratory function with spontaneous respiration and normal respiratory pattern. (3) spontaneous eye opening and eye ball movements without sustained tracking. (4) variably preserved brain stem reflexes. (5) presence of sleep-wake cycles. (6) (1)-(5) symptoms should be persist for 6 months after the development of vegetative state. (7) the diagnostic criteria of PVS should be applied more than 3 times during the minimum observation period. (8) this diagnostic criteria of PVS could be applied to adults over 7 ages. As to the degree of treatment, nasogastric tube feeding and air-way keeping through the tracheostomy are approved over 9007b. Also antibiotics can be used in infection. As to the withdrawal of treatment, do not resuscitate order of patient s family is accepted by 46.1% in an emergency condition like cardiac arrest. But discharge against medical advice by the patient s family is accepted by 73.107o in non-emergency condition. In the case of neonates, parents decision is more determinative than any other thing.
Adult ; Anti-Bacterial Agents ; Brain Stem ; Emergencies ; Enteral Nutrition ; Heart Arrest ; Humans ; Infant, Newborn ; Korea* ; Parents ; Persistent Vegetative State* ; Reflex ; Respiration ; Tracheostomy

OBJECTIVE: Lithium inhibits the action of inositol monophosphatase(IMPase) in phosphoinositide(PI) signal transduction system at therapeutically relevant concentration. The depletion of inositol by lithium itself cannt explain the lithium's therapeutic effect. However, attention has focused on the abnormality of PI signal transduction system as the pathophysiology of bipolar affective disorder(BPD). We investigated whether IMPase mRNA levels of lymphocytes would be different between BPD patients(n=16) and age, sex-matched normal controls(n=16). We also investigated the change of IMPase mRNA level by lithium during 4 weeks to probe the possibility that IMPase mRNA levels could predict the therapeutic response to lithium and clinical course. METHOD: Relative IMPase mRNA levels in lymphocyte were quantified by reverse transcriptase(RT)-PCR in sixteen drug-free BPD patients and sex, age-matched normal controls. The psychopathology of patients were measured using YMRS(Young Mania Rating Scale) and CGI(Clinical Global Impression). RESULTS: There was no significant difference in IMPase mRNA levels between BPD patients and normal controls. And the IMPase mRNA levels were not significantly changed by 4 week treatment with lithium. However, the basal IMPase mRNA levels were negatively correlated with the changes of CGI after 4 weeks. Furthermore, the patients with relatively high basal IMPase mRNA levels showed much more improvement during 4 weeks. CONCLUSIONS: BPD patients and normal controls were not distinguished by lymphocyte IMPase mRNA level. Although we do not support the hypothesis that lymphocyte IMPase activity would be related with the pathogenesis of BPD and the action of lithium, these data raise the possibility that lymphocyte IMPase mRNA levels could function as a predictor of therapeutic response and clinical course of BPD.
5'-Nucleotidase ; Bipolar Disorder ; Humans ; Inositol* ; Lithium* ; Lymphocytes* ; Mood Disorders* ; Psychopathology ; RNA, Messenger* ; Signal Transduction

Pathologic fracture occurs in a bone with preexisting stuctual weakness. The author reviewed 30 cases of pathologic fractures in which admission record and X-ray finding was well preserved among 53 cases admitted patients in the department of Orthopaedic Surgery, Seoul National Universty Hospital for 10 years from 1967. The results were as follows: 1.Age & Sex incidence showed even distribution. 2. The most frequent involved site was femur (40%) 3. The underlying etiology was as follows: 2 chronic osteomyelitis 1 homophilia 7 benign tumor 20 malignant tumor 4. metastatic tumor was the most frequent cause in 30 cases. 5. Treatment was as follows: Conservative treatment 4 cases Surgery 21 cases.
Clinical Study ; Femur ; Fractures, Spontaneous ; Humans ; Incidence ; Osteomyelitis ; Seoul

The result of interference with the conductibility of the spinal cord is one of the most disabling and distressing complications of splnal tuberculosis. This fact was recognized as early as in 1779, when Pott published. The antituberculous drugs and improved surgical treatment have made possible a more effective treatment than before and improved the prognosis but not solved all problems completely. The following results were shown by analysis of 63 cases of spinal tuberculosls with neurological symptom experienced in the Department of Orthopedic Surgery, Seoul National University in the past 9.5 years from Jan. 1970 to Jun. 1979. 1. Number of cases In child was 15. (29%). 2. Pulmonary and other tuberculous diseases were manifested in 29 cases (46%). 3. Regions of the spine inovolved were most common In thoracic spine (43 cases), especially lower thoracic spine. 4. There were 49 early and 14 late paraplegia 5. There were 24 complete and 39 incomplete paraplegia. 6. Spastic type was more common than flaccid type. 7. Anterior fusion was done in 55 cases and costotransversectomy in 8. 8. There were 36 cases (57%) of complete recovery and 8 of fallure. 9. The prognosis for recovery from paraplegia appeared to depend on age, duration, type and onset of paraplegia.
Child ; Humans ; Muscle Spasticity ; Orthopedics ; Paraplegia ; Prognosis ; Seoul ; Spinal Cord ; Spine ; Tuberculosis ; Tuberculosis, Spinal

BACKGROUND: Surgical correction of patent ductus arteriosus (PDA) is relatively safe and effective since it does not remain in the category of open-heart-surgery. Although the surgical practice for PDA is performed in almost all hospitals, they contain the problems of anxiety of patients, remained surgical wounds on patients' chests and complications of surgery and general anesthesia. Recently non-surgical methods for the obstruction of PDA have been developed and some of them including buttoned devices are used now. The success rates of these methods approach to 84%. But the problems of embolization, incomplete closure, hemolysis, stenosis of aorta and left pulmonary artery have been reported. We invented new PDA occluder , using stainless steel wire and polyurethane foam. Therefore we investigated the efficacy of occluding blood flow with the new PDA occluder in the vessels of experimental animals. METHOD: Using 304 stainless steel wire which is self-expandable stent, two star-shaped frames were made, each frame forming cone and facing the other's tip. And in the center of the frames polyurethane foam was inserted. 316L stainless steel wire was used to fix the elements described above and some portion of the wire was extracted outside of the frames, shaping hook or round loop with which the occluder could be pulled out in case of misplacement. To create the similar situation to PDA, we made shunts from artery to vein between carotid arteries and jugular veins with surgical bypass grafts or made shunts of direct artery to vein connections without grafts in 4 dogs and 1 pig. Through 8F sheath, we deployed the occluders into the shunts made of 5 grafts or made of 3 arterial ends. Also the occluders were inserted into the femoral artery of dog and iliac artery of pig. After deployment of occluders, angiograms were performed to obscure the efficacy of blocking blood flow and follow-up angiogrms were done in one and two weeks. The animals were sacrificed in one and two weeks to get the tissues including occluders inside. Gross findings were checked about thrombi formation in and around polyurethane foam. RESULTS: The 10 occluders were placed successfully except one site due to misplacement. The occluders successfully blocked the blood flows in all 10 sites within 3 - 60 minutes. Each follow-up angiogram for occluders in one and two weeks revealed good maintenance of blockade in blood flow. Observed gross findings on tissues were packed thrombi formation in the polyurethane foam and membrane formation along the occluder. CONCLUSIONS: This newly developed device revealed good efficacy for occlusion of blood flow including shunts in immediate and follow-up study. Practical method for the delivery of the device and some design modification for proper fitting into the PDA especially for small patients would be required. Longer period of follow-up with more animal experiments for other possible complications including distal embolization would be required also before clinical trial.
Anesthesia, General ; Animal Experimentation ; Animals ; Anxiety ; Aorta ; Arteries ; Carotid Arteries ; Constriction, Pathologic ; Dogs ; Ductus Arteriosus, Patent* ; Femoral Artery ; Follow-Up Studies ; Hemolysis ; Humans ; Iliac Artery ; Jugular Veins ; Membranes ; Polyurethanes ; Pulmonary Artery ; Stainless Steel ; Stents ; Thorax ; Transplants ; Veins ; Wounds and Injuries

We present a series of 10 Patients(Seven men and three women with an average age of 53 years) who underwent decompressive craniectomy for treatment to massive brain swelling following acute cerebral infarction. Clinical signs of cerebral herniation(anisocoria or fixed and dilated pupil, and/or hemiplegia with decerebrate righidity) were present in all patients. Computed tomography and magnetic resonance imaging showed the mass effect by cerebral edema through midline shift. All patients were treated with an extensive craniectomy and duroplasty. Among them, one recovered without neurological deficit, three were moderately disabled but functionally dependent, three remained in a persistent vegetative state and three died within 9 days after surgery(good recovery=1, moderate disability=3, persistent vegetative state=3, death=3). The results suggest that decompressive craniectomy can be an useful lifesaving procedure for massive cerebral edema following widespread hemispheric infarction.
Brain Edema ; Cerebral Infarction* ; Decompressive Craniectomy* ; Female ; Hemiplegia ; Humans ; Infarction ; Magnetic Resonance Imaging ; Male ; Persistent Vegetative State ; Prognosis ; Pupil

Oro-facial dyskinesia (OFD) is involuntary, abnormal, uncontrolled and stereotyped movements, consisting of forehead furrowing, eye opening and closing, smacking and pursing of the lips, lateral deviation and protrusion of the tongue, and occasionally lateral deviation and protrusion of the jaw.1 OFD is known to have various complications including speech difficulty, chewing and eating disorders, and social embarrassment; facial muscle stiffness, mucosal and gingival traumatic lesions. In addition, it may leads to cranio-mandibular joint (TMJ) complications in the presence of intense and prolonged abnormal movements, with pain and degeneration.1,2 There is no previous report of TMJ dislocation due to OFD. In this report, we describe a patient who developed bilateral anterior TMJ dislocation due to OFD which occurred following intra-cranial hemorrhage (ICH).
Movement Disorders ; Dyskinesias

No abstract available.
Cleft Lip ; Humans ; Orthognathic Surgery ; Palate

0.05). 3. There was some correlation between condylar change(T2C-T1C) and TMJ dysfunction. It seemed that postoperative condylar change had influenced postoperative TMJ dysfunction, through there was no statistical significance (p>0.05). As we have observed the change of condylar axis in the group that complained of TMJ dysfunction in cases of large amount of mandibular setback. So we consider that the more trying to conserve condylar position will decrease occurrence rate of post operational TMJ dysfunction.]]>
Axis, Cervical Vertebra ; Female ; Humans ; Malocclusion ; Orthognathic Surgery ; Prognathism ; Temporomandibular Joint