OBJECTIVE: The aim of this study is to biomechanically assess the pullout strength of the dynamic osteosynthesis construct(DOC) cervical plating system to consider the effects of screw triagulation in the cervical spine. METHODS: Twelve fresh cadaveric cervical spines(C4-C7) were randomly instumented with DOC cervical system with 20 degree(six specimens) or 30 degree platforms(six specimens). All specimens were tested on an MTS Alliance RT/10 testing machine. Load-displacement data was sampled at a rate of 50Hz. After the biomechanical testing, specimens were cut on sagittal plane and the penetrating depths of screw were measured. RESULTS: Mean insertion torque of 20 degree was 1.025 newton-meters and that of 30 degree was 1.031 newton-meters(p>0.05). Mean penetration depth of 20 degree was 11.82mm(C4), 12.20mm(C7) and that of 30 degree platforms were 12.22mm(C4), 13.04mm(C7). Mean pullout strength with 20 degree platforms was 642.2 N ; with 30 degree platforms was 537.7N(p>0.05). CONCLUSION: There is no statistical differences in pullout strength between 20 degree platform and 30 degree platform that were plated in cervical vertebral bodies, even though a literature shows that more increased screw angulation of 30 degree than that of 20 degree would decrease pullout resistance due to less amount of bone purchase against the pullout force in parallelogram shaped cervical vertebral body.
Cadaver ; Spine ; Torque

OBJECTIVE: The aim of this study is to evaluate the efficacy of anterior cervical plating systems, such as ORION? plate(locked plate), PCB plate-cage, TOP plate(unlocked plate). METHODS: This study was performed in 97 degenerative cervical spondylotic patients who adimitted to the hospital from January 1996 to March 1999. The average follow-up period was 13 months. RESULTS: One-level anterior plating appeared to have better surgical results(p<0.05) and a lower complication rate(p<0.001) than multi-level plating. And a group of patients with radiculopathy appeared to have better surgical results than that of patients with myelopathy(p<0.001). Unlocked TOP? plate system appeared to have higher metallic failure rate(p<0.001) and worse results(p<0.05) than the other plating systems. The outcome based on Odom's criterion was excellent or good in 95.8% of the patients. CONCLUSION: The one-level anterior plating of cervical anterior fusion in degenerative cervical spondylotic patients appears to have better result and no complication than multi-level plating. Also, locked plating system appears to have better result and no metallic failure than unlocked plating system.
Follow-Up Studies ; Humans ; Radiculopathy ; Spondylosis*

Nineteen patients suffering from post-traumatic intracerebral hematoma, being managed by stereotactic aspiration of hematoma were evaluated. The outcome in this series is quite satisfactory, with 58% of patients having a functional survival. Eight patients died, of which three patients died of brain swelling and 5 died of systemic causes such as respiratory failure, gastrointestinal(GI) bleeding, and renal failure. It is our belief that stereotactic aspiration is helpful in managing patients with traumatic intracerebral hematoma without herniation and wevere brain swelling.
Brain Edema ; Hematoma* ; Hemorrhage ; Humans ; Renal Insufficiency ; Respiratory Insufficiency

No accepted standard currently exists to classify asphyxia and define its subtypes. Sauvageau and Boghossian proposed an asphyxia classification system in 2010 that divided asphyxia into suffocation, strangulation, mechanical asphyxia, and drowning. Here, we present a modification of this classification system. We propose to classify asphyxia into four main categories: suffocation, strangulation, mechanical asphyxia, and complicated asphyxia. Suffocation includes smothering and choking as well as confined spaces, entrapment, and vitiated atmosphere. Strangulation is subdivided into hanging, ligature strangulation, manual strangulation, and other unspecified strangulation. Mechanical asphyxia includes positional and traumatic asphyxia. Finally, complicated asphyxia is defined as cases with two or more identifiable mechanisms of asphyxia. In this study, we review autopsy cases from 2012 diagnosed as asphyxia and classify them according to our proposed asphyxia classification system. In 24.7% of cases, the age range was 40-49 years, and 51.9% were men. The most common method of asphyxia was hanging (245 cases, 55.1%), followed by ligature or manual strangulation (53 cases, 11.9%). Most hangings were suicides; smothering, ligature, and manual strangulation were usually homicides. Eighteen cases were complicated asphyxia. This classification provides a simplified, unified, and useful tool to classify and understand deaths due to asphyxia.
Airway Obstruction ; Asphyxia* ; Atmosphere ; Autopsy* ; Classification* ; Confined Spaces ; Drowning ; Homicide ; Humans ; Korea* ; Ligation ; Male ; Suicide

Fungal infection of the central nervous system tends to occur in immunosuppressed patients. In the pediatric population, it is usually seen in severely immunocompromised patients, particulary in children with chronic granulomatous disease, hematopoietic malignancies, and those receiving chemotherapy or corticosteroid therapy. Literature indicates rare survivors from neonatal aspergillosis. We report a case of multiple brain abscess caused by Aspergillus in a 15-day-old male neonate, who had suffered from high fever, generalized seizure, severe dehydration, and azotemia. The patient was immunologically competent and successfully treated with surgical removal and antifungal agents.
Abscess* ; Antifungal Agents ; Aspergillosis ; Aspergillus* ; Azotemia ; Brain Abscess ; Central Nervous System ; Child ; Dehydration ; Drug Therapy ; Fever ; Granulomatous Disease, Chronic ; Hematologic Neoplasms ; Humans ; Immunocompromised Host ; Infant, Newborn* ; Male ; Seizures ; Survivors

Fungal infection of the central nervous system tends to occur in immunosuppressed patients. In the pediatric population, it is usually seen in severely immunocompromised patients, particulary in children with chronic granulomatous disease, hematopoietic malignancies, and those receiving chemotherapy or corticosteroid therapy. Literature indicates rare survivors from neonatal aspergillosis. We report a case of multiple brain abscess caused by Aspergillus in a 15-day-old male neonate, who had suffered from high fever, generalized seizure, severe dehydration, and azotemia. The patient was immunologically competent and successfully treated with surgical removal and antifungal agents.
Abscess* ; Antifungal Agents ; Aspergillosis ; Aspergillus* ; Azotemia ; Brain Abscess ; Central Nervous System ; Child ; Dehydration ; Drug Therapy ; Fever ; Granulomatous Disease, Chronic ; Hematologic Neoplasms ; Humans ; Immunocompromised Host ; Infant, Newborn* ; Male ; Seizures ; Survivors

Congenital dermal sinus (CDS) is a rare entity widely known to occur as a result of the of the failure of the neuroectoderm to separate from the cutaneous ectoderm during the process of neurulation at the third to fifth week of gestation. The lesion can occur at any level of the craniospinal axis, but are located predominantly at the lumbosacral and occipital region. CDS of thoracic region and cervical region are rare. The patient with CDS presents with meningitis and/or mass effect from the associated inclusion tumor. They are usually dermoid or epidermoid cyst. Teratoma is rarely associated with CDS. We report our experience of CDS an 11-month old boy associated with an intramedullary dermoid tumor at the thoracic region, and together we report a review of the literature.
Axis, Cervical Vertebra ; Dermoid Cyst ; Ectoderm ; Epidermal Cyst ; Humans ; Infant ; Male ; Meningitis ; Neural Plate ; Neurulation ; Pregnancy ; Spina Bifida Occulta* ; Teratoma

Medicolegal autopsy is a vital tool for obtaining reliable injury mortality data. This study statistically analyzed data obtained from medicolegal autopsies performed in Korea in 2013. The aim of this study was to analyze various aspects of the 4,861 deaths that were categorized as unusual in Korea in 2013. A total of 4,861 deaths were analyzed by gender, age, manner of death, and cause of death. Of the 4,861 deaths, 3,542 (73.3%) were of men and 1,302 (26.7%) were of women. With respect to the manner of death, 54.4% were recorded as unnatural deaths, 38.8% were natural deaths, and 6.9% had unknown causes. Of the 2,642 unnatural deaths, 45.0% were determined to be accidental deaths, 26.3% suicidal, 16.9% homicidal, and 11.8% undetermined. Of the total number of unnatural deaths, 42.1% were trauma-related deaths, for which falling down accounted for 33.8%. Asphyxiation accounted for 16.0% of unnatural deaths, and of these, the predominant cause was hanging (58.8%). In addition, 14.4% of deaths were due to drowning, 12.9% poisoning, 11.0% thermal injuries, 1.8% complications arising from medical procedures, and 0.8% electrocution, starvation, or neglect. Among the 1,886 natural deaths, heart diseases accounted for 52.0% and vascular diseases accounted for 16.9%. Of the 196 deaths among children under the age of 10 years, 41.8% were recorded as unnatural deaths, 45.1% were natural deaths, and 1.5% had unknown causes.
Autopsy* ; Cause of Death ; Child ; Data Interpretation, Statistical ; Drowning ; Female ; Heart Diseases ; Humans ; Korea ; Male ; Mortality ; Poisoning ; Starvation ; Vascular Diseases

OBJECTIVE: There are also few studies demonstrating the relationship between ossification of nuchal ligament (ONL) and ossification of posterior longitudinal ligament (OPLL). We compared the prevalence, location, and type of OPLL between patients with ONL and matched patients without ONL.We also compared the bone mineral densities (BMDs) between the 2 groups. METHODS: total of 124 cervical ONL patients were enrolled in this study. The control group of 124 patients was matched with 124 patients with ONL by age and sex on a 1:1 basis to minimize confounding factors. We reviewed the prevalence, location, and type of OPLL in both groups. RESULTS: The prevalence of OPLL was almost 2.5 times greater in patients with ONL than those without ONL. The mean value of BMD in patients with ONL was greater at the lumbar spine (L1-L4) than in patients without ONL. The mean T score of the lumbar spine was 0.25±1.68 in the patients with ONL and -0.73±1.64 in the patients without ONL. CONCLUSION: The prevalence of OPLL in patients with ONL was significantly higher than in patients without ONL. Because ONL is innocuous and may be seen more readily than OPLL on simple cervical radiographs, clinicians should consider the possibility of coexisting OPLL when ONL, especially extensive ONL, is detected in patients with neck pain, radiculopathy, or myelopathy, to facilitate proper treatment.
Bone Density* ; Humans ; Ligaments* ; Neck Pain ; Ossification of Posterior Longitudinal Ligament* ; Prevalence* ; Radiculopathy ; Spinal Cord Diseases ; Spine

The authors analyzed 53 cases with spontaneous intracerebellar hemorrhage diagnosed by brain CT scan and assessed the correlation between the mental status at admission, the outcome and the CT findings. The location of hematoma, volume of hematoma, quadrigeminal cistern obliteration, intraventricular hemorrhage and hydrocephalus were correlated to the mental status assessed by GCS at admission. The GCS score at admission, location of hematoma, volume of hematoma, quadrigeminal cistern obliteration, intraventricular hemorrhage and hydrocephalus were correlated to the outcome. We conclude that decreased GCS score at admission, large volume of hematoma, quadrigeminal cistern obliteration, presence of intraventricular hemorrhage and hydrocephalus could be considered as surgical indications and contributing factors for poor prognosis in the patients with spontaneous intracerebellar hemorrhage.
Brain ; Hematoma ; Hemorrhage* ; Humans ; Hydrocephalus ; Prognosis* ; Tomography, X-Ray Computed