A 74-year-old man presented with recurrent vomiting and aspiration pneumonia in the left lower lobe. He entered the intensive care unit to manage the pneumonia and septic shock. Although a percutaneous endoscopic gastrostomy tube was implanted for recurrent vomiting, vomiting and aspiration recurred frequently during admission. Subsequently, he complained of neck pain when in an upright position. A videofluoroscopic swallowing study showed compression of the esophagus by cervical osteophytes and tracheal aspiration caused by an abnormality at the laryngeal inlet. Cervical spine X-rays and computed tomography showed anterior cervical osteophytes at the C3-6 levels. Surgical decompression was scheduled, but was cancelled due to his frailty. Unfortunately, further recurrent vomiting and aspiration resulted in respiratory arrest leading to hypoxic brain damage and death. Physicians should consider cervical spine disease, such as diffuse skeletal hyperostosis as an uncommon cause of recurrent aspiration pneumonia.
Aged ; Bays ; Decompression, Surgical ; Deglutition ; Esophagus ; Gastrostomy ; Humans ; Hyperostosis ; Hypoxia, Brain ; Intensive Care Units ; Neck Pain ; Osteophyte* ; Pneumonia ; Pneumonia, Aspiration* ; Shock, Septic ; Spine ; Vomiting

PURPOSE: This study compared the accuracy of an abutment-framework (A-F) taken with open tray impression technique combining cementon crown abutments, a metal framework and resin cement to closed tray and resin-splinted open tray impression techniques for the 3-implant definitive casts. The effect of angulation on the accuracy of these 3 techniques was also evaluated. MATERIAL AND METHODS: Three definitive casts, each with 3 linearly positioned implant analogs at relative angulations 0, 30, and 40 degrees, were fabricated with passively fitted corresponding reference frameworks. Ten impressions were made and poured, using each of the 3 techniques on each of the 3 definitive casts. To record the vertical gap between reference frameworks and analogs in duplicate casts, a light microscope with image processing was used. Data were analyzed by two-way analysis of variance and the Tukey test. RESULTS: The open tray techniques showed significantly smaller vertical gaps compare to closed tray technique (P < .05). The closed tray and the resin-splinted open tray technique showed significantly different vertical gaps according to the angulation of implant (P < .05), but the A-F impression technique did not (P > .05). CONCLUSION: The accuracy of the A-F impression technique was superior to that of conventional techniques, and was not affected by the angulation of the implants.
Crowns ; Light ; Resin Cements

Lumbar puncture is a simple bedside procedure that is essential for the diagnosis and treatment of several neurologic diseases. Known complications include headache, backache, infection, and hemorrhage, with the most common being postpuncture headache. We report a case of postpuncture spinal subdural hematoma-which is extremely rare-in a 29-year-old female. Although most cases of postpuncture spinal hematomas are associated with coagulation abnormalities, this case shows that it can occur in the absence of predisposing factors.
Back Pain ; Female ; Headache ; Hematoma ; Hematoma, Subdural, Spinal ; Hemorrhage ; Humans ; Spinal Puncture

The authors describe a technique consisting of subfascial temporalis dissection and performing a pedicled bone flap in pterional craniotomy. This technique provides reliable preservation of the frontalis nerve, does not necessitate the reconstruction of the temporalis muscle at the end of the surgery, and does not compromise the operative exposure.
Craniotomy

The authors present a case of cervical syringomyelia associated with cerebellar mixed oligoastrocytoma in an 18-month-old boy who was normally delivered at full-term. The child presented with an increasing incidence of vomiting and irritability, and a poor truncal control. Preoperative magnetic resonance imaging of the brain revealed cerebellar vermian tumor with an obstructive hydrocephalus and a small-sized syringomyelia at the 6th cervical vertebral level. The tumor was completely removed via suboccipital craniectomy. Histologically, the tumor consisted of mixed oligo-astrocytoma. The cervical syringomyelia was conservatively managed with no specific operative treatment. At two months postoperatively, magnetic resonance imaging of the cervical spine showed a remarkable reduction in size of the syringomyelic cavity.
Astrocytoma ; Brain ; Cerebellar Neoplasms ; Child ; Humans ; Hydrocephalus ; Incidence ; Infant ; Magnetic Resonance Imaging ; Male ; Spine ; Syringomyelia* ; Vomiting

A 74-year-old man presented with recurrent vomiting and aspiration pneumonia in the left lower lobe. He entered the intensive care unit to manage the pneumonia and septic shock. Although a percutaneous endoscopic gastrostomy tube was implanted for recurrent vomiting, vomiting and aspiration recurred frequently during admission. Subsequently, he complained of neck pain when in an upright position. A videofluoroscopic swallowing study showed compression of the esophagus by cervical osteophytes and tracheal aspiration caused by an abnormality at the laryngeal inlet. Cervical spine X-rays and computed tomography showed anterior cervical osteophytes at the C3-6 levels. Surgical decompression was scheduled, but was cancelled due to his frailty. Unfortunately, further recurrent vomiting and aspiration resulted in respiratory arrest leading to hypoxic brain damage and death. Physicians should consider cervical spine disease, such as diffuse skeletal hyperostosis as an uncommon cause of recurrent aspiration pneumonia.
Aged ; Bays ; Decompression, Surgical ; Deglutition ; Esophagus ; Gastrostomy ; Humans ; Hyperostosis ; Hypoxia, Brain ; Intensive Care Units ; Neck Pain ; Osteophyte ; Pneumonia ; Pneumonia, Aspiration ; Shock, Septic ; Spine ; Vomiting

OBJECTIVES: This study was performed to estimate the prevalence and possible risk factors of the metabolic syndrome in steel-mill workers, and to evaluate the relation between gamma-glutamyltransferase (gamma-GTP) and the metabolic syndrome. METHODS: The study subjects comprised 1,604 male steel-mill workers. The indices of metabolic syndrome, such as BMI, triglyceride, HDL-cholesterol, blood pressure, fasting glucose, and gamma-GTP were analyzed in each subject. We collected information about demographic characteristics, behavioral patterns, such as alcohol drinking, smoking, and exercise, and family medical history through a self-administered questionnaire. Statistical analysis was done by using the chi-square test, Mantel-Haenszel trend test and logistic regression model. RESULTS: The crude and age-adjusted prevalences of the metabolic syndrome were 21.3% and 15.5%, respectively, in the steel-mill workers. Age (OR: 1.063, 95% CI: 1.033-1.094), alcohol drinking (OR: 1.657, 95% CI: 1.175-2.337) and smoking (OR: 1.359, 95% CI: 1.017-1.816) were risk factors for the metabolic syndrome. Meanwhile, shift work showed a significant relation with hypertension (OR: 1.329, 95% CI: 1.038-1.700), but not with other metabolic syndrome components. However, tenure, exercise and family medical history were not significant factors for the metabolic syndrome in this study. The risk ratio of the metabolic syndrome (OR: 3.345, 95 % CI: 2.534-4.416) and its components, such as obesity, hypertriglyceridemia, hypertension and hyperglycemia, were higher in the high gamma-GTP group (> or =63 IU/ liter) than in the controls (<63 IU/liter). CONCLUSIONS: These results confirm the need for health education to control the metabolic syndrome by improving behavioral patterns, such as alcohol drinking and smoking, in factory workers. In addition, it is suggested that gamma-GTP might be a useful candidate in screening for the metabolic syndrome.
Alcohol Drinking ; Blood Pressure ; Fasting ; gamma-Glutamyltransferase ; Glucose ; Health Education ; Humans ; Hyperglycemia ; Hypertension ; Hypertriglyceridemia ; Logistic Models ; Male ; Mass Screening ; Obesity ; Odds Ratio ; Prevalence ; Questionnaires ; Risk Factors* ; Smoke ; Smoking ; Triglycerides

Two cases of vertex epidural hematomas are described to illustrate their unique diagnostic and treatment problems. Due to its specific location, a correct diagnosis of the intracranial hematoma was delayed in the first case. Quantitative analysis of the hematoma volume was performed in the second case. We would like to emphasize the usefulness of the magnetic resonance imaging and quantitative analysis of vertex epidural hematoma in choosing treatment options in such patients.
Adult ; Case Report ; Hematoma, Epidural/*diagnosis/surgery ; Human ; Magnetic Resonance Imaging ; Male

Intraoperative aneurysmal rupture is an undesired event that not only interrupt surgical procedures but also has negative effects on surgical outcome. To define the incidence, cause, and management of the intraoperative aneurysmal rupture, a retrospective analysis was performed on patients with cerebral aneurysms operated from January 1990 to December 1994. A total of 292 aneurysmal patients were included in this study. There were 15 intraoperative aneurysmal ruptures(5.4%). Rupture occurred during predissection in 1 case, during the dissection in 8 cases, and during the clip application in 6 cases. Admission grade, size, location of aneurysm, operation timiming, and mean arterial pressure during the dissection did not have significant influence on the incidence of intraoperative rupture. The outcomes were worse in the patients with intraoperative rupture than in non-ruptured patients(p<0.05). The skills and experience of the surgeon, rather than the location of aneurysm, stage of rupture, and treatment methods, may be the more crucial factor that determine the surgical outcomes.
Aneurysm* ; Arterial Pressure ; Humans ; Incidence* ; Intracranial Aneurysm ; Retrospective Studies ; Rupture*

Background: The present study investigates whether modifiable behavioral factors of current cigarette smoking, heavy alcohol consumption, and regular exercise are associated with risk of lower extremity amputation (LEA) in diabetic patients. Methods: A total of 2,644,440 diabetic patients (aged ≥20 years) was analyzed using the database of the Korean National Health Insurance Service. Cox proportional hazard regression was used to assess adjusted hazard ratios (HRs) for the behavioral factors with risk of LEA under adjustment for potential confounders. Results: The risk of LEA was significantly increased by current cigarette smoking and heavy alcohol consumption (HR, 1.436; 95% confidence interval [CI], 1.367 to 1.508 and HR, 1.082; 95% CI, 1.011 to 1.158) but significantly decreased with regular exercise (HR, 0.745; 95% CI, 0.706 to 0.786) after adjusting for age, sex, smoking, alcohol consumption, exercise, low income, hypertension, dyslipidemia, body mass index, using insulin or oral antidiabetic drugs, and diabetic duration. A synergistically increased risk of LEA was observed with larger number of risky behaviors. Conclusion Modification of behaviors of current smoking, heavy alcohol intake, and exercise prevents LEA and can improve physical, emotional, and social quality of life in diabetic patients.