Various interventions exist to treat non-motor impairments caused by stroke. Adjuvant treatments such as non-invasive brain stimulation, virtual reality, computer-assisted training, neurostimulation, and biofeedback are being investigated and applied in the areas of cognitive dysfunction, language problems, visual disorders, dysphagia, mood disorders, and post-stroke pain. Most of these treatments have shown efficacy and symptom improvement, but further investigation is required to fully clarify their effects.

BACKGROUND AND OBJECTIVE: The transsynaptic transfer of neurotropic viruses is an effective tool for tracing chains of connected neurons because the replication of virus in the recipient neurons after transfer amplifies the "tracer signal". The purpose of study was to identify the location of spinal nucleus of the accessory nerve and the central neural pathways using Bartha strain of Pseudorabies virus (PRV-Ba), as a transsynaptic tracer. MATERIALS AND METHODS: PRV-Ba was injected into the sternocleidomastoid muscle of a rat, and the localization of PRV-Ba in the rat spinal cord and CNS was identified with light microscopic immunohistochemistry using primary antibodies against the PRV-Ba. RESULTS: Sequential tracing of retrogradely labeled cells was done. The shapes of positive immunoreactive cells were mostly ovoid or polygonal, and were shown in the spinal nucleus of the accessory nerve, nucleus ambiguus, paraventricular nucleus, and the primary motor area of cerebral cortex. CONCLUSIONS: These results showed the location of spinal accessory nucleus and the central neural pathways of spinal accessory nerve using PRV-Ba.
Accessory Nerve* ; Animals ; Antibodies ; Cerebral Cortex ; Herpesvirus 1, Suid* ; Immunohistochemistry ; Neural Pathways* ; Neurons ; Paraventricular Hypothalamic Nucleus ; Pseudorabies* ; Rats ; Spinal Cord

Noninvasive techniques of antenatal detection of the fetal development and well-being such as biophysical profile, non-stress and stress remain major challenges in modern obstetric practice. To obtain and analyze umbilical artery velocity waveform by pulsed-wave doppler ultrasound, a total of 160 determinations were carried out on 157 normal pregnant women between 16th to 41st week gestation. The ratio of peak systolic to end-diastolic flow velocity (S/D ratio), pulsatility index and resistance index were measured as indices of the resistance in feto-placental circulation. The results were as follows: As gestation advances, the mean values for peak systolic and end-diastolic velocities raised progressively. As gestation advances, the mean values for the S/D ratio declined progressively, exhibiting high diastolic flow velocity caused by low resistance. Pulsatility index, and resistance index were also declined progressively, as gestation advances. The analysis of umbilical artery blood flow velocity waveforms provides a new noninvasive technique to evaluate fetal development and well-being, and may be expected a reliable method for assessment of fetal life.
Blood Flow Velocity* ; Female ; Fetal Development ; Humans ; Methods ; Pregnancy* ; Pregnant Women ; Ultrasonography ; Umbilical Arteries*

BACKGROUND: Clonidine, an 2-adrenergic agonist, shows the analgesic effect and potentiates the analgesic effect of opioid. However, when it is injected with bolus technique, it reveals the short duration of inadequate analgesia and induces hypotension, bradycardia or sedation. We examined the analgesic and side effects of clonidine administered by continuous epidural infusion over 24 hrs, following epidural morphine injection. METHODS: Sixty parturients, scheduled for elective cesarean section under epidural anesthesia were randomly allocated into three groups. They received an infusion of saline alone (group 1, n= 20), clonidine 20 g/hr (group 2, n= 20), or 40 g/hr (group 3, n= 20) respectively, following epidural morphine 3 mg injection at the end of operation. The total doses and number of request for supplemental analgesic, blood pressure, heart rate, and degree of sedation were measured during 24 hrs. RESULTS: There were significant differences in pain relief between clonidine groups and group 1. The total doses and number of patient's request for supplemental analgesic in clonidine groups, compared to group 1 were significantly decreased (p<0.05), but no significant differences between the two clonidine groups. The diastolic pressure of group 3 was significantly lower than that of group 1 over 24 hrs, and that of group 2 at 18 hr, 24 hr (p<0.05). However, there was no severe hypotension, bradycardia or sedation in the three groups. CONCLUSION: Clonidine administered by continuous epidural infusion over 24 hrs enhances the analgesic effect of epidural morphine, and the infusion of clonidine with 20 g/hr rather than 40 g/hr shows minimal changes of blood pressure. Therefore, administration of epidural clonidine (20 g/hr) following epidural morphine may be considered as a regimen for pain management after cesarean section.
Analgesia* ; Anesthesia, Epidural ; Blood Pressure ; Bradycardia ; Cesarean Section* ; Clonidine* ; Female ; Heart Rate ; Hypotension ; Morphine ; Pain Management ; Pregnancy

PURPOSE: The purpose of this study was to evaluate computed tomographic (CT) findings of deep neck space infection(DNSI) with particular attention to the differences in the spaces involved and in complications between odontogenic and nonodontogenic groups. MATERIALS AND METHODS: Forty-four patients(21 odontogenic and 23 nonodontogenic) were included in this study. Among odontogenic DNSls, 15 had the dental infection in the second or third mandibular molar. We compared the CT features between odontogenic and nonodontogenic DNSIs with special emphasis on the differences in the spaces involved and in the rate and type of complications. RESULTS: In all patients, CT clearly differentiated abscess from cellulitis. The most common spaces involved in 21 patients with odontogenic DNSl were the parapharyngeal(n=18), the submandibular(n=18), the anterior visceral(n=13), the masticator(n=9), and the sublingual(n=7) spaces. In contrast, in 23 patients with nonodontogenic DNSI, the anterior visceral space(n=14) was most frequently involved. The parapharyngeal, the submandibular, and the masticator spaces were statistically more frequently involved in odontogenic than in nonodontogenic DNSI(p<.05). Twenty-two patients had one or more complications shown by CT, of which airway compromise was more frequent and severe in odontogenicthan in nonodontogenic DNSI. CONCLUSION: We conclude that the parapharyngeal, the submandibular, and the masticator spaces are more significantly vulnerable in odontogenic DNSl than in nonodontogenic DNSl. The predilection for certain spaces of the neck in odontogenic DNSl seems to originate from the intimate relationship of the mandibular molars to the adjacent deep neck spaces.
Abscess ; Cellulitis ; Humans ; Molar ; Neck*

PURPOSE: The purpose of this study was to evaluate computed tomographic (CT) findings of deep neck space infection(DNSI) with particular attention to the differences in the spaces involved and in complications between odontogenic and nonodontogenic groups. MATERIALS AND METHODS: Forty-four patients(21 odontogenic and 23 nonodontogenic) were included in this study. Among odontogenic DNSls, 15 had the dental infection in the second or third mandibular molar. We compared the CT features between odontogenic and nonodontogenic DNSIs with special emphasis on the differences in the spaces involved and in the rate and type of complications. RESULTS: In all patients, CT clearly differentiated abscess from cellulitis. The most common spaces involved in 21 patients with odontogenic DNSl were the parapharyngeal(n=18), the submandibular(n=18), the anterior visceral(n=13), the masticator(n=9), and the sublingual(n=7) spaces. In contrast, in 23 patients with nonodontogenic DNSI, the anterior visceral space(n=14) was most frequently involved. The parapharyngeal, the submandibular, and the masticator spaces were statistically more frequently involved in odontogenic than in nonodontogenic DNSI(p<.05). Twenty-two patients had one or more complications shown by CT, of which airway compromise was more frequent and severe in odontogenicthan in nonodontogenic DNSI. CONCLUSION: We conclude that the parapharyngeal, the submandibular, and the masticator spaces are more significantly vulnerable in odontogenic DNSl than in nonodontogenic DNSl. The predilection for certain spaces of the neck in odontogenic DNSl seems to originate from the intimate relationship of the mandibular molars to the adjacent deep neck spaces.
Abscess ; Cellulitis ; Humans ; Molar ; Neck*

Clay-shoveler’s fractures are rare stress-type avulsion fractures of the spinous processes especially in sports. There have been two case reports that discussed clay-shoveler’s fractures in golf. A 36-year-old beginner golfer presented with a pain in the back after practicing golf swing. No fractures were detected using cervical radiography; however, computed tomography (CT) and magnetic resonance imaging (MRI) revealed T2∼T3 spinous process fractures. The patient was treated conservatively and his pain subsided. The mechanism of injury is speculated to that of clay-shoveler’s fractures. Therefore, if a golfer suffers persistent pain in the cervicothoracic region, clay-shoveler’s fracture is one possibility to consider.

Clay-shoveler’s fractures are rare stress-type avulsion fractures of the spinous processes especially in sports. There have been two case reports that discussed clay-shoveler’s fractures in golf. A 36-year-old beginner golfer presented with a pain in the back after practicing golf swing. No fractures were detected using cervical radiography; however, computed tomography (CT) and magnetic resonance imaging (MRI) revealed T2∼T3 spinous process fractures. The patient was treated conservatively and his pain subsided. The mechanism of injury is speculated to that of clay-shoveler’s fractures. Therefore, if a golfer suffers persistent pain in the cervicothoracic region, clay-shoveler’s fracture is one possibility to consider.

No abstract available.
Cervix Uteri* ; Female ; Humans

OBJECTIVE: The aim of this study is the determination the value of early decompressive craniectomy in patients with severe cerebral edema. METHODS: We prospectively studied 23 consecutive patients with severe cerebral edema received decompressive craniectomy from July 1999 to March 2001. The indication for decompression was the progressive therapy-resistant intracranial hypertension and edema in patients with clinically and radiologically poor condition. We analyzed the results(GCS score, GOS score) with the variables such as cause(trauma, aneurysmal rupture, infarction), dominant edema side, midline shift on CT scan(<10mm), dilating of pupils, preoperative GCS score(<8). RESULTS: The overall rate of good recovery(GOS score 4 or 5) who underwent craniectomy was 48%(11 of 23 patients), poor recovery(GOS score 2 or 3) was 30%(7 of 23 patients), and mortality rate was 22%(5 of 23 patients). All of survived patients had improved GCS score(mean 12.61) compared with the preoperative GCS score(mean 7.89). The pupilary dilatation was the only statistically significant factor (p<0.05). CONCLUSION: Our results provide favorable evidence that early decompressive craniectomy with duraplasty is effective in patients with progressive therapy-resistant cerebral edema. Early decompression may have an effect in preventing this secondary adverse effect, thus is considered in early cerebral edema.
Aneurysm ; Brain Edema* ; Decompression ; Decompressive Craniectomy* ; Dilatation ; Edema ; Humans ; Intracranial Hypertension ; Mortality ; Prospective Studies ; Pupil ; Rupture