The authors reviewed the medical records of 103 patients who were diagnosed and treated as myasthenia gravis (MG)at Seoul National University Hospital from March 1979 to March 1984. Among them 16 cases were selected according to the criteria of crisis in MG defined by Blaugrund SM et al(1964) and were studied with a special emphasis on crisis as a natural course of MG in Korea. The authors studied about the incidence of crisis, the aggravating factors or causes, the relationship between crisis and thymus pathology, and the clinical appllcability of the modified classification of crises in MG including a newly-defined steroid-inducd crisis. The results were not significantly different from those by others in general. The incidence rate of crisis was 16% and highest in the female group having the onest of MG in the fourth decade of life. Four patients(25%) had thymomas(2, noninvasive: 2, invasive). The intervals between the onset of MG and the first crises were significantly shorter in male patients and thymoma group, showing the more fulminant course in them. Some probable risk factors were suggested, though not analyzed statistically, which might foretell the prognosis of each patient having MG and might help management and prevention of crisis. They were as follows: (1) Female with onset of MG in her fourth decade, (2) Male with duration less than one year, (3) Patient with thymoma, (4) Patient classified into Osserman's group III, (5) Patient with brittle MG, (6) Patient with an infectious process, especially with repiratory infection Early detection of respiratory insufficiency, intensive respiratory care, and removal of aggravating causes as soon as possible played the critical role in the management of patients at crises. It could also be concluded that steroid therapy was an important therapeutic step during crisis in brittle myasthenics. The outcome of crises was 19% of fatality rate in crises(3 deaths among 16 cases) and 3% mortality rate in MG. There was no recurrence in 11 survivors and followup was lost in two other survivors.
Classification ; Female ; Follow-Up Studies ; Humans ; Incidence ; Korea ; Male ; Medical Records ; Mortality ; Myasthenia Gravis* ; Pathology ; Prognosis ; Recurrence ; Respiratory Insufficiency ; Risk Factors ; Seoul ; Survivors ; Thymoma ; Thymus Gland

BACKGROUND AND OBJECTIVES: The transradial approach for coronary intervention has a lower incidence of access site complications and can increase patient comfort after percutaneus tansluminal coronary angioplasty(PTCA). The purpose of this study is to compare procedural success and complication rates of percutaneous transradial coronary stenting which was performed by four operators in two hospitals with those using transfemoral approach. MATERIALS AND METHOD: From September 1998 to July 1999, one hundred seventy five consecutive patients(201 lesions) treated with coronary stent implantation were enrolled for this study : 84 patients underwent transradial coronary stenting(Radial Group), and 91 patients transfemoral coronary stenting(Femoral Group). RESULTS: Seven patients who failed coronary cannulation via radial artery were crossed over to the Femoral Group. The measurements of the radial artery were not done. Patient demographics were similar in both groups. Procedural success was similar in both group(95.2% in Radial Group vs. 97.8% in Femoral Group, p=S). All transradial coronary stenting were possible using conventional guiding catheters which are used in transfemoral intervention. Local vascular complication rates showed a trend toward a reduction in the Radial Group(2.4% vs. 8.8%, p=.06). CONCLUSION: This study showed the similarity in the safety and efficacy of transradial coronary stenting compared to those of transfemoral approach.
Catheterization ; Catheters ; Demography ; Humans ; Incidence ; Radial Artery ; Stents*

No abstract available.
Hysterectomy*

No abstract available.
Thyrotropin*

BACKGROUND: The clinical use of intracoronary stents is impeded by the risk of subacute stent thrombosis and complications associated with the anticoagulant regimen. The use of high pressure balloon dilatations and confirmation of adequate stent expansion by intravascular ultrasound provide assurance that anticoagulation therapy can be safely omitted. Therefore, we evaluated the effect of anticoagulation of subacute thrombosis sfter stenting retrospectively on a consecutive series of patients who received palmaz-Schatz coronary stents with high pressure balloon dilatation. METHOD: From March 1995 to August 1995, 62 patients underwent Palmaz-Schatz coronary stent implantation. After deploying stents successfully, high pressure overdilatation of the stents was performed in all patients. According to post-stent anticoagulation, 32 patients received aspirin 200 mg/day, ticlopidine 500 mg/day and warfarin for two months, 30 patients received aspirin and ticlopidine. RESULTS: The clinical or angiographic variables were not significantly different between the two groups. There was no acute or subacute thrombosis in the two groups. The hospital stay after stenting was significantly shorter in the patients without antcoagulation than in patients with anticoagulation. CONCLUSION: The Palmaz-Schatz stent can be safely implanted without anticoagulation provided that stent expansion is daequate by the use high pressure balloon dilatation This technique significantly reduces hospital time and vascular complications and has a low stent thrombosis rate.
Aspirin ; Dilatation* ; Humans ; Length of Stay ; Retrospective Studies ; Stents* ; Thrombosis ; Ticlopidine ; Ultrasonography ; Warfarin

OBJECTIVE: The natural course of unruptured vertebral artery dissection remains unclear. The clinical manifestation of unruptured vertebral artery dissection varies from headache, focal neurologic deficits caused by ischemia to subarachnoid hemorrhage with high mortality. The purpose of this study is to investigate the clinical course of unruptured vertebral artery dissection. METHODS: From March 2011 to April 2013, 7 patients with headache or nuchal pain by spontaneous vertebral artery dissection visited our institute were retrospectively reviewed. Their clinical data was obtained by medical records and radiologic studies including computed tomographic angiography, magnetic resonance imaging, magnetic resonance angiography and digital subtraction angiography. RESULTS: No patient experienced fatal outcome by subarachnoid hemorrhage or vertebrobasilar ischemia during follow-up period. Radiologic studies also did not show the evidence of subarachnoid hemorrhage or vertebrobasilar ischemia. Follow-up angiography showed the decreased size or disappearance of aneurysm in 3 patients. CONCLUSION: This study suggests that the natural course of unruptured vertebral artery dissection is not aggressive. Patients with unruptured vertebral artery dissection could be managed with conservative treatment including anticoagulants and/or antiplatelet agents.
Aneurysm ; Aneurysm, Dissecting ; Angiography ; Anticoagulants ; Fatal Outcome ; Follow-Up Studies ; Headache ; Humans ; Ischemia ; Magnetic Resonance Angiography ; Magnetic Resonance Imaging ; Medical Records ; Mortality ; Neurologic Manifestations ; Platelet Aggregation Inhibitors ; Retrospective Studies ; Subarachnoid Hemorrhage ; Vertebral Artery Dissection* ; Vertebral Artery* ; Vertebrobasilar Insufficiency

Objective: : Anterior cervical spine surgery (ACSS) is a common surgical procedure used to treat cervical spinal degenerative diseases. One of the complications associated with ACSS is prevertebral soft tissue swelling (PSTS), which can result in airway obstruction, dysphagia, and other adverse outcomes. This study aims to investigate the correlation between various cervical sagittal parameters and PSTS following single-level ACSS, as well as to identify independent risk factors for PSTS. Methods: : A retrospective study conducted at a single institution. The study population included all patients who underwent single-level ACSS between January 2014 and December 2022. Patients with a history of cervical spine surgery or trauma were excluded from the study. The presence and severity of PSTS was assessed by reviewing pre- and postoperative imaging studies. The potential risk factors for PSTS that were examined include patient age, sex, body mass index, tobacco use, comorbidities, serum albumin levels, operative time, implant type, implanted level, and various cervical spine sagittal parameters. Multivariate linear regression analysis was performed to identify the independent risk factors for PSTS. Results: : A total of 62 consecutive patients who underwent single-level ACSS over a 8-year period at a single institution were enrolled in this study. Only preoperative segmental angle showed positive correlation with PSTS among various cervical spine sagittal parameters (r=0.36, p=0.005). Artificial disc replacement showed a negative correlation with PSTS (β=-0.38, p=0.002), whereas the use of demineralized bone matrix (DBM) had a positive impact on PSTS (β=0.33, p=0.009). We found that male sex, lower preoperative serum albumin, and implantation of upper cervical level (above C5) were independent predictors for PSTS after single-level ACSS (β=1.21; 95% confidence interval [CI], 0.27 to 2.15; p=0.012; β=-1.63; 95% CI, -2.91 to -0.34; p=0.014; β=1.44; 95% CI, 0.38 to 2.49; p=0.008, respectively). Conclusion : Our study identified male sex, lower preoperative serum albumin levels, and upper cervical level involvement as independent risk factors for PSTS after single-level ACSS. These findings can help clinicians monitor high-risk patients and take preventive measures to reduce complications. Further research with larger sample sizes and prospective designs is needed to validate these findings.

OBJECTIVE: Resorption of autologous bone flap grafts is a known long-term complication of cranioplasty following decompressive craniectomy (DC). We analyzed our data to identify risk factors for bone flap resorption (BFR) following cranioplasty. METHODS: A total of 162 patients who underwent cranioplasty following DC due to life-threatening elevated intracranial pressure between October 2003 and December 2012, were included in our investigation. Follow-up exceeded one year. RESULTS: BFR occurred as a long-term complication in 9 of the 162 patients (5.6%). The affected patients consisted of individuals who had undergone DC for traumatic brain injury (TBI; n=4), for subarachnoid hemorrhage (SAH; n=3), for cerebral infarction (n=1), and intracerebral hemorrhage (n=1). Logistic regression analysis identified no significant risk factors for BFR. CONCLUSION: TBI and SAH as initial diagnoses are more often associated with BFR than other diagnoses. This finding may influence future surgical decision making, especially in patients with possible risk factors for BFR. A prospective study with a large number of patients is needed to identify potential predictors of BFR such as bone flap sterilization and preservation.
Bone Resorption ; Brain Injuries ; Cerebral Hemorrhage ; Cerebral Infarction ; Decision Making ; Decompressive Craniectomy* ; Diagnosis ; Follow-Up Studies ; Humans ; Intracranial Hypertension ; Logistic Models ; Risk Factors ; Sterilization ; Subarachnoid Hemorrhage ; Transplants

BACKGROUND: In elective intervention, the implantation of an intracoronary stent is an established treatment modality to reduce restenosis in comparison with balloon angioplasty. However, stenting was empirically thought to be contraindicated for acute myocardial infarction because of the propensity for thrombosis, althought the percutaneous transluminal coronary balloon angioplasty(PTCA) on infarct-related artery is associated with a high incidence of restenosis. To knowlege, there is no report comparing the longterm efficacy of coronary stenting with PTCA in patients with acute myocardial infarction. Accordingly, we investigated the effect of stent implantation on restenosis of infarct-related artery in acute myocardial infarction, comparing with conventional balloon angioplasty. METHOD: From January 1994 to December 1995, 97 patients (stenting in 45 patients : PTCA in 52 patients) underwent intracoronary stenting or PTCA on infarct-related artery successfully at 7-10 days after onset of infarction. The coronary stents were Palmaz-Schatz stent in 35 patients and Cordis stent in 10 patients. Follow-up coronary angiography was performed in all patients 6 months later after intervention. RESULTS: No death, emergency coronary artery bypass surgery or reinfarction occurred during hospitalization in 97 patients. In 45 patients with stent implantation, no stent thrombosisoccurred. The 6-months angiographic restenosis rate was 13 percent in patients assigne to stent implantation and 52 percent in patients assigned to PTCA(p<0.05). CONCLUSION: We conclude that the intracoronary stent implantation on infarct-related artery at 7-10 days after acute myocardial infarction is safe, feasible and significantly reduces the restenosis rate.
Angioplasty, Balloon ; Arteries ; Coronary Angiography ; Coronary Artery Bypass ; Emergencies ; Follow-Up Studies ; Hospitalization ; Humans ; Incidence ; Infarction ; Myocardial Infarction* ; Stents* ; Thrombosis

OBJECTIVE: Acute vertebral burst fractures warrant extensive fixation and fusion on the spine. Osteoplasty (vertebroplasty with high density resin without vertebral expansion) has been used to treat osteoporotic vertebral compression fractures. We report our experiences with osteoplasty in acute vertebral burst fractures. METHODS: Twenty-eight cases of acute vertebral burst fracture were operated with osteoplasty. Eighteen patients had osteoporosis concurrently. Preoperative MRI was performed in all cases to find fracture level and to evaluate the severity of injury. Preoperative CT revealed burst fracture in the series. The patients with severe ligament injury or spinal canal compromise were excluded from indication. Osteoplasty was performed under local anesthesia and high density polymethylmethacrylate(PMMA) was injected carefully avoiding cement leakage into spinal canal. The procedure was performed unilaterally in 21 cases and bilaterally in 7 cases. The patients were allowed to ambulate right after surgery. Most patients discharged within 5 days and followed up at least 6 months. RESULTS: There were 12 men and 16 women with average age of 45.3(28-82). Five patients had 2 level fractures and 2 patients had 3 level fractures. The average injection volume was 5.6cc per level. Average VAS (Visual Analogue Scale) improved 26mm after surgery. The immediate postoperative X-ray showed 2 cases of filler spillage into spinal canal and 4 cases of leakage into the retroperitoneal space. One patient with intraspinal leakage was underwent the laminectomy to remove the resin. CONCLUSION: Osteoplasty is a safe and new treatment option in the burst fractures. Osteoplasty with minimally invasive technique reduced the hospital stay and recovery time in vertebral fracture patients.
Anesthesia, Local ; Female ; Fractures, Compression ; Humans ; Laminectomy ; Length of Stay ; Ligaments ; Magnetic Resonance Imaging ; Male ; Osteoporosis ; Retroperitoneal Space ; Spinal Canal ; Spine ; Vertebroplasty