PURPOSE: We report clinical and radiologic outcomes after metacarpal extension osteotomy for mild osteoarthritis of the thumb carpometacarpal joint. MATERIALS AND METHODS: From 1999 to 2008, 11 patients were diagnosed with mild thumb carpometacarpal arthritis (Eaton stage I, II), and extension osteotomies were performed. Of these, seven patients with at least 6 years follow-up were analyzed retrospectively. Male to female ratio was 2:5, and mean age at time of surgery was 38.9 years old. Symptom onset period was a mean of 11.2 months. Two patients were I, and five patients were II in Eaton stage. Preoperative visual analogue scale (VAS) and disabilities of the arm, shoulder and hand scale (DASH) scores were 3.7 points (3-4 points), and 40.1 points (32-51 points). Radial abduction was 38.5degrees (30degrees-45degrees), and volar abduction was 42.1degrees (40degrees-45degrees). Grip strengths and pinch powers, compared with the normal contralateral side were 82% (64%-90%) and 72% (40%-100%), respectively. RESULTS: The mean follow-up period was 8.5 years, and all patients except one maintained their occupational activity during the follow-up period. Final VAS and DASH scores were 0.7 points (0-2 points) and 11.7 points (8-16 points), respectively, and were statistically significant. Volar abduction, grip strengths, and pinch power were improved to 45degrees (40degrees-50degrees), 92.3% (73%-117%), and 94.4% (75%-117%) with statistical significances. In five patients, Eaton stages did not change, and two patients advanced to the next stage (stage I to II in one patient, stage II to III in one patient). CONCLUSION: Among the various treatment options for mild thumb carpometacarpal arthritis, metacarpal extension osteotomy may be considered as an effective treatment.
Arm ; Arthritis* ; Carpometacarpal Joints ; Female ; Follow-Up Studies ; Hand ; Hand Strength ; Humans ; Male ; Osteoarthritis ; Osteotomy* ; Retrospective Studies* ; Shoulder ; Thumb*

Isolated abducens nerve paresis related to ruptured vertebral artery (VA) aneurysm is rare. It usually occurs bilaterally or ipsilaterally to the pathologic lesions. We report the case of a contralateral sixth nerve palsy following ruptured dissecting VA aneurysm. A 38-year-old man was admitted for the evaluation of a 6-day history of headache. Abnormalities were not seen on initial computed tomography (CT). On admission, the patient was alert and no signs reflecting neurologic deficits were noted. Time of flight magnetic resonance angiography revealed a fusiform dilatation of the right VA involving origin of the posterior inferior cerebellar artery. The patient suddenly suffered from severe headache with diplopia the day before the scheduled cerebral angiography. Neurologic examination disclosed nuchal rigidity and isolated left abducens nerve palsy. Emergent CT scan showed high density in the basal and prepontine cistern compatible with ruptured aneurismal hemorrhage. Right vertebral angiography illustrated a right VA dissecting aneurysm with prominent displaced vertebrobasilar artery to inferiorly on left side. Double-stent placement was conducted for the treatment of ruptured dissecting VA aneurysm. No diffusion restriction signals were observed in follow-up magnetic resonance imaging of the brain stem. Eleven weeks later, full recovery of left sixth nerve palsy was documented photographically. In conclusion, isolated contralateral abducens nerve palsy associated with ruptured VA aneurysm may develop due to direct nerve compression by displaced verterobasilar artery triggered by primary thick clot in the prepontine cistern.
Abducens Nerve ; Abducens Nerve Diseases ; Aneurysm ; Aneurysm, Dissecting ; Angiography ; Arteries ; Brain Stem ; Cerebral Angiography ; Diffusion ; Dilatation ; Diplopia ; Follow-Up Studies ; Headache ; Hemorrhage ; Humans ; Magnetic Resonance Angiography ; Magnetic Resonance Imaging ; Muscle Rigidity ; Neurologic Examination ; Neurologic Manifestations ; Paresis ; Subarachnoid Hemorrhage ; Vertebral Artery

Bilateral abducens nerve palsy related to ruptured aneurysm of the anterior communicating artery (ACoA) has only been reported in four patients. Three cases were treated by surgical clipping. No report has described the clinical course of the isolated bilateral abducens nerve palsy following ruptured ACoA aneurysm obliterated with coil. A 32-year-old man was transferred to our institution after three days of diplopia, dizziness and headache after the onset of a 5-minute generalized tonic-clonic seizure. Computed tomographic angiography revealed an aneurysm of the ACoA. Magnetic resonance imaging showed focal intraventricular hemorrhage without brain stem abnormalities including infarction or space-occupying lesion. Endovascular coil embolization was conducted to obliterate an aneurysmal sac followed by lumbar cerebrospinal fluid (CSF) drainage. Bilateral paresis of abducens nerve completely recovered 9 weeks after ictus. In conclusion, isolated bilateral abducens nerve palsy associated with ruptured ACoA aneurysm may be resolved successfully by coil embolization and lumbar CSF drainage without directly relieving cerebrospinal fluid pressure by opening Lillequist's membrane and prepontine cistern.
Abducens Nerve ; Abducens Nerve Diseases ; Aneurysm ; Aneurysm, Ruptured ; Angiography ; Arteries ; Brain Stem ; Cerebrospinal Fluid Pressure ; Diplopia ; Dizziness ; Drainage ; Headache ; Hemorrhage ; Humans ; Infarction ; Intracranial Aneurysm ; Magnetic Resonance Imaging ; Membranes ; Paresis ; Seizures ; Subarachnoid Hemorrhage ; Surgical Instruments

Purpose: This study used a mixed methods research design in an attempt to verify the effects of robot-assisted rehabilitation on the gait ability of stroke patients with hemiplegia, and thereby further understand the benefits and challenges of stroke patients’ experiences relying on robot-assisted rehabilitation. Methods: An exploratory sequential mixed methods study design was used in order to combine both quantitative and qualitative data. For the quantitative data collection, a total of 30 stroke patients with hemiplegia were recruited from one rehabilitation hospital. Qualitative data were collected through individual interviews using semi-structured questionnaires for a group of 15 patients who were currently undergoing robot-assisted rehabilitation. The data were analyzed through qualitative content analysis. Results: As a result of the quantitative analysis, there were significant differences between the two groups in terms of daily living activity patterns, total number of steps, and average walking speed. As a result of the qualitative analysis, the four main themes derived consisted of, ‘curiosity about the usage of robot-assisted rehabilitation,’ ‘pleasure experienced while using the robots,’ ‘insufficient information about robots,’ and ‘a lack of education about robot-assisted rehabilitation.’ Conclusions Robot-assisted rehabilitation had a significant effect on the walking ability of stroke patients with hemiplegia. Additionally, stroke patients with hemiplegia experienced difficulty during the course of their robot-assisted rehabilitation, due to a lack of sufficient information on correct usage techniques. These quantitative and qualitative findings could provide the basic foundation for the development of an educational program on robot-assisted rehabilitation.

OBJECTIVE: This study is to report our experience of 40 cases of spinal schwannoma. METHODS: From 1995 to 2006, medical records were retrospectively reviewed in 40 cases of spinal schwannoma. RESULTS:We treated 40 spinal schwannomas in 38 (22 male and 16 female) patients. The mean age was 50.2. Four cases were sited in the cervical spine, 11 cases in the thoracic spine, and 25 cases in the lumbar spine. Two patients showed recurrences. Thirty-eight cases were intradural-extramedullary type and 2 cases were extradural. Two cases (5%) including 1 recurred case had no postoperative motor improvement. Ninety-five percents of patients improved on postoperative motor grade. CONCLUSION: Spinal schwannoma is mostly benign and extramedullary tumor. There were 2 recurred cases (5%) that had history of previous subtotal removal at first operation and had shown worse prognosis compared with the cases without recurrence. To reduce the recurrence of spinal schannoma, total excision of tumor mass should be done.
Humans ; Male ; Medical Records ; Neurilemmoma ; Prognosis ; Recurrence ; Retrospective Studies ; Spine

OBJECTIVE: Subdural hygroma (SDG) is a complication occurring after head trauma that may occur secondary to decompressive craniectomy (DC). However, the mechanism underlying SDG formation is not fully understood. Also, the relationship between the operative technique of DC or the decompressive effect and the occurrence and pathophysiology of SDG has not been clarified. Purpose of this study was to investigate the risk factors of SDG after DC in our series. METHODS: From January 2004 to December 2008, DC was performed in 85 patients who suffered from traumatic brain injury. We retrospectively reviewed the clinical and radiological features. For comparative analysis, we divided the patients into 2 groups : one group with SDG after craniectomy (19 patients; 28.4% of the total sample), the other group without SDG (48 patients; 71.6%). The risk factors for developing SDG were then analyzed. RESULTS: The mean Glasgow Outcome Scale (GOS) scores at discharge of the groups with and without SDG were 2.8 and 3.1, respectively (p<0.0001). Analysis of radiological factors showed that a midline shift in excess of 5 mm on CT scans was present in 19 patients (100%) in the group with SDG and in 32 patients (66.7%) in the group without SDG (p<0.05). An accompanying subarachnoid hemorrhage (SAH) was seen in 17 patients (89.5%) in the group with SDG and in 29 patients (60.4%) in the group without SDG (p<0.05). Delayed hydrocephalus accompanied these findings in 10 patients (52.6%) in the group with SDG, versus 5 patients (10.4%) in the group without SDG (p<0.05). On CT, compression of basal cisterns was observed in 14 members (73.7%) in the group with SDG and in 18 members of the group without SDG (37.5%) (p<0.007). Furthermore, tearing of the arachnoid membrane, as observed on CT, was more common in all patients in the group with SDG (100%) than in the group without SDG (31 patients; 64.6%) (p<0.05). CONCLUSION: GOS showed statistically significant difference in the clinical risk factors for SDG between the group with SDG and the group without SDG. Analysis of radiological factors indicated that a midline shifting exceeding 5 mm, SAH, delayed hydrocephalus, compression of basal cisterns, and tearing of the arachnoid membrane were significantly more common in patients with SDG.
Arachnoid ; Brain Injuries ; Craniocerebral Trauma ; Decompressive Craniectomy ; Glasgow Outcome Scale ; Humans ; Hydrocephalus ; Membranes ; Retrospective Studies ; Risk Factors ; Subarachnoid Hemorrhage ; Subdural Effusion

OBJECTIVE: Obtaining real-time image is essential for neurosurgeons to minimize invasion of normal brain tissue and to prompt diagnosis of intracranial event. The aim of this study was to report our three-year experience with a mobile computed tomography (mCT) for intraoperative and bedside scanning. METHODS: A total of 357 mCT (297 patients) scans from January 2009 to December 2011 in single institution were reviewed. After excluding post-operative routine follow-up, 202 mCT were included for analysis. Their medical records such as diagnosis, clinical application, impact on decision making, times, image quality and radiologic findings were assessed. RESULTS: Two-hundred-two mCT scans were performed in the operation room (n=192, 95%) or intensive care unit (ICU) (n=10, 5%). Regarding intraoperative images, extent of resection of tumor (n=55, 27.2%), degree of hematoma removal (n=42, 20.8%), confirmation of catheter placement (n=91, 45.0%) and monitoring unexpected complications (n=4, 2.0%) were evaluated. A total of 14 additional procedures were introduced after confirmation of residual tumor (n=7, 50%), hematoma (n=2, 14.3%), malpositioned catheter (n=3, 21.4%) and newly developed intracranial events (n=2, 14.3%). Every image was obtained within 15 minutes and image quality was sufficient for interpretation. CONCLUSION: mCT is feasible for prompt intraoperative and ICU monitoring with enhanced diagnostic certainty, safety and efficiency.
Brain ; Catheters ; Decision Making ; Follow-Up Studies ; Hematoma ; Intensive Care Units ; Korea ; Medical Records ; Neoplasm, Residual

PURPOSE: The purpose of this study was to determine the prevalence of symptomatic femoroacetabular impingement (FAI) in athletic patients. MATERIALS AND METHODS: From July 2003 to May 2013, 388 patients (422 hips) who underwent arthroscopic surgery for FAI were evaluated demographic characteristics. The patients' age, gender, diagnosis, and type of sports were analyzed using medical records and radiography. RESULTS: Among 422 hips in 388 patients, 156 hips were involved with sports. Among the 156 hips, 86, 43, and 27 hips were categorized as cam, pincer, and mixed type, respectively. Types of sports were soccer, baseball and taekwondo which showed 44, 36 and 35 hips, respectively. Also, cases related to sports according to age were 63 hips for twenties and 12 hips for teenagers in which the two showed highest association to FAI. The kinds of sports that showed high association were 28 hips of soccer and 20 cases of martial arts such as taekwondo and judo for twenties and 9 hips of martial arts for teenagers which was the highest. CONCLUSION: FAI usually occurs in young adults and is highly related to sports activity. Most of the FAI type related to sports activity was cam type, and soccer and martial arts such as taekwondo were the most common cause of it.
Adolescent ; Arthroscopy ; Athletes* ; Baseball ; Diagnosis ; Epidemiology* ; Femoracetabular Impingement* ; Hip ; Humans ; Martial Arts ; Medical Records ; Prevalence ; Radiography ; Soccer ; Sports ; Young Adult

The Philadelphia (Ph) chromosome is a well- known chromosome abnormality in adults with B-lineage ALL, and is associated with a poor prognosis. This study compared the clinical manifestations and prognosis in adult Ph-positive and Ph-negative ALL patients. MATERIALS AND METHODS: We retrospectively analyzed the clinical records of adult patients newly diagnosed as B-lineage ALL, between January 1995 and February 2001. Fifty five patients were included in this study. We divided the patients into Ph-positive and Ph-negative groups. RESULTS: Eighteen of the 55 patients (32.7%) were found to have the Ph chromosome. At initial diagnosis, the Ph-positive patients had higher circulating leukocyte counts, lower platelet counts and had a greater tendency to bleed, than the Ph-negative group. The complete remission rates were 83.3% and 83.8% for the Ph-positive and the Ph-negative groups, respectively. Four of the Ph-positive, and 13 of the Ph-negative, patients underwent allogenic bone marrow transplantation. The median follow-up for the surviving patients was 39.3 months. The three-year survival rates were 10.4% and 51.8% for the Ph-positive and the Ph-negative groups, respectively. The median disease-free survival was 7.7 months for the Ph-positive group, but did not reach the median value in the Ph-negative group. Among the Ph-positive patients, age was the only factor that had an impact on the disease outcome. CONCLUSION: In adult B-lineage ALL, the Ph-positive patients had similar complete remission rates to other patients; however, the remission was of shorter duration, with a higher relapse rate in the Ph-positive patients. More effective treatments are needed to improve the survival of the Ph-positive patients.
Adult* ; Bone Marrow Transplantation ; Chromosome Aberrations ; Diagnosis ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Hydrogen-Ion Concentration ; Leukocyte Count ; Philadelphia Chromosome ; Platelet Count ; Prognosis* ; Recurrence ; Retrospective Studies ; Survival Rate

PURPOSE: The goal of this retrospective study is to compare radiologic outcome and clinical outcome between operative and non-operative treatment of unstable distal radius fracture in patients over 65-year-old. METHODS: From December 2006 to December 2011, 114 patients over 65-year-old were enrolled in the present study. 45 patients underwent non-operative treatment, and 69 patients underwent operative treatment. We retrospectively reviewed radiologic results and clinical results and then compared the two groups. Radiologic results include radial inclination (RI), volar tilt angle (VT) and radial shortening (RS) shown on the last radiograph and clinical results including disabilities of the arm, shoulder and hand (DASH) scores, modified Mayo wrist score (MMWS), and range of motion (ROM) of wrist. RESULTS: All cases presented bone-union. Among the patients who received non-operative treatments, average RI of 15.5degrees, average VT of 14.1degrees, average RS of 5.3 mm, The patients who received operative treatments showed average volar tilt of 3.9degrees, average VT of 18.2degrees, and average RS of 1.1 mm. RS showed a significant difference (p<0.05). At Clinical evaluation, DASH score, MMWS score, the ROM of wrist joint did not show significant difference (p>0.05). CONCLUSION: Our results suggest that non-operative treatment is initially recommended in patients over 65 years who have an unstable distal radius fracture in terms of functional results.
Aged* ; Arm ; Hand ; Humans ; Radius Fractures* ; Range of Motion, Articular ; Retrospective Studies ; Shoulder ; Wrist ; Wrist Joint