A case of basilar impression surgically treated in a female patient aged 22 years is presented. A myriad of abnormal neurologic findings were present that were secondary to compression of neural tissue by anormalous bony structure at craniovertebral junction. Metrizamide computerized tomography with coronal and sagittal reconstruction identified bony abnomalities and displacement of the surrounding neural structures. The surgical intervention for the treatment of the basilar impression consisted of ventral decompression by transoral odontoidectomy and of dorsal decompression by an enlargement of foramen magnum and by laminectomy of C1, followed by occipito-atlanto-axial bony fusion.
Decompression ; Female ; Foramen Magnum ; Humans ; Laminectomy ; Metrizamide ; Neurologic Manifestations ; Platybasia*

Impact injuries to the surgically exposed dura overlying the lumbar cord at L2 were produced in cats. Cytochrome oxidase activities in frozen-dried sample of spinal cord gray matter were measured and analyzed as a step in the investingation of the possible effects of spinal cord trauma on mitochondria. As conservative index of mitochondria damage in gray matter resulting from inactivation on cytochrome oxidase activity, electron microscopic studies of mitochondrial ultrastructural changes in traumatized gray matter were performed. The effects of Naloxone on the alteration of the cytochrome oxidase activities and ultrastructures of the mitochondria in the gray matter were studied. A drop in cytochrome oxidase activities to approximately 50% of normal value was found as early as 15 minutes post-trauma, which greatest decrease at 1/2 hour and 1 hour post-trauma. Ultrastructural changes of the mitochondria continued to proceed with the lapse of time after the injury. Mitochondriae were slightly enlarged with decreased number of cristae at 15 minutes post-trauma. Enlargement of the mitochondria with disintegration of cristae and electron-lucent area in the matrices were observed at 1 hour and 4 hour post-trauma. As relatively less change to the mitochondrial ultrastructures was observed in the Naloxone-treated group than in the non-treated group, the results of this study suggest that Naloxone confers beneficial effects in enhancing the cytochrome-oxidase activity and preserving the mitochondrial ultrastructures from injury.
Animals ; Cats ; Cytochromes* ; Electron Transport Complex IV* ; Mitochondria ; Naloxone* ; Reference Values ; Spinal Cord Injuries* ; Spinal Cord*

Of the many potential source of free radial generation, the enzyme xanthine oxidase has been shown to be important in ischemia in non-cerebral tissues. Oxygen-derived free radicals have been implicated in various pathological conditions including ischemia. Xanthine oxidase serve as a source of oxidizing agents such as superoxide radical and hydrogen peroxide. It is investigated that the effect of a specific xanthine oxidase inhibitor, allopurinol, on infarct size in a model of continuous partial cerebral ischemia in rats. Infarct volume was measured by triphenyl tetrazolium chloride staining of brains removed 24 hours after middle cerebral arterial occlusion. Cortical tissue was more effectively protected than basal tissue, especially in allopurinol pretreated group. On histological examinations, hemispheric swelling, PMN cell infiltration and endothelial damage were noted irrespective of allopurinol treatment. It was speculated that free radicals are important in infarction secondary to partial continuous cerebral ischemia and that xanthine oxidase may by the primary source of these radicals.
Allopurinol* ; Animals ; Brain Infarction* ; Brain Ischemia ; Brain* ; Free Radicals ; Hydrogen Peroxide ; Infarction ; Infarction, Middle Cerebral Artery* ; Ischemia ; Middle Cerebral Artery* ; Oxidants ; Rats ; Superoxides ; Xanthine Oxidase

The author investigated the cerebral circulatory and metabolic effects of systemic and intracisternal administration of nicardipine in a canine model of chronic cerebral vasospasm. Twenty-one dogs were assigned to one of three groups; control, intravenous nicardipine, and intracisternal nicardipine. All animals received a total of 12 ml of fresh unheparinized autologous blood via three cisternal injections. Sequential measurements of cerebral blood flow(CBF), cerebral metabolic rate of oxygen(CMRO2), and cerebral metabolic rate of glucose(CMRG) were chacked four times in nine days. Animals were sacrificed at Day 9 and amount of clot remained in brainstem and basal cistern was graded accordingly. Significant improvement of cerebral blood flow was noted in Day 6, Day 9 of intracisternal group and in Day 3, Day 6 of intravenous group(each, p<0.05) with slight better results seen in intracisthernal group. Results of sequential changes of CMRO2 and CMRG indicated possible role of nicardipine in protective effects on deleterious neuronal damage following ischemic changes after vasospasm, but definitive statements on this subject matter should be reserved until further study, espedially on morphologic examinations is carried on, Significantly less amount of clot remained in intracisthernal group may be due to effects of nicardipine in its inhibitory action on platelet aggregation, and/or stimulatory effect on prostacyclin production. These factors along with other possible factors should be speculated.
Animals ; Brain Stem ; Calcium* ; Dogs ; Epoprostenol ; Neurons ; Nicardipine ; Platelet Aggregation ; Vasospasm, Intracranial

PURPOSE: The purpose of this study was to evaluate the radiological and clinical results of modified scarf osteotomy for hallux valgus with lesser metatarsalgia. MATERIALS AND METHODS: Total 19 patients (24 feet) were reviewed by medical records and radiographs. All patients were female and the mean age at the time of operation was 46.4 years. The mean follow-up time was 14.8 months. We modified original scarf osteotomy by adding the procedure of closing wedge osteotomy at the medial side of distal fragment for achieving of the supination of the first metatarsal head. Additionally, Akin osteotomy of the first proximal phalanx was done in 16 patients (20 feet) and no lesser metatarsal operation was done. First-second intermetatarsal, hallux valgus and distal metatarsal articular angles were analyzed radiologically before and after the operation. And 3-dimensional CT was used to evaluate the supination of the first metatarsal head. Clinical results were assessed by American Orthopaedic Foot and Ankle Society (AOFAS) score and persistence of lesser metatarsalgia. RESULTS: First-second intermetatarsal and hallux valgus angles were reduced from the mean pre-operative values of 14.2degrees and 32.5degrees to 8degrees and 12.5degrees, respectively, 12 months after the operation. And the supination of the first metatarsal head was confirmed by 3-dimensional CT. The mean AOFAS score improved from 41.4 points pre-operatively to 87.2 points at follow-up. Lesser metatarsalgia still remained in 2 patients (2 feet). CONCLUSION: Modified scarf osteotomy would be an effective surgical procedure, especially, for achieving downward displacement and supination of the first metatarsal head in hallux valgus with lesser metatarsalgia.
Animals ; Ankle ; Displacement (Psychology) ; Female ; Follow-Up Studies ; Foot ; Hallux ; Hallux Valgus ; Head ; Humans ; Medical Records ; Metatarsal Bones ; Metatarsalgia ; Osteotomy ; Supination

The author analyzed 177 consecutive cases of saccular, ruptured intracranial aneurysms admitted to the Department of Neurosurgery in Korea University Hospital during the period from August 1983 to July 1987. the results of analysis were summarized as follows. 1) Mean age of the patients was 50.4 years. 2) Incidence of clinical vasospasm was 27.2%(46/177) and of rebleeding was 10.7%(19/177). 3) Surgery was done for patients which accounts for 57.6% of all patients. Functional recovery was noted in 84 of the these surgically treated patients(84.6%). 4) The prognostic factors are age, hypertension, size of aneurysm, site of aneurysm, preoperative neurological state, vasospasm, hydrocephalus, rebleeding, timing of operation, multiplicity. 5) The mean size of aneurysms was 6.9mm. The direction of aneurysms was variable, but most of them pointed in the direction of blood flow in afferent arteries.
Aneurysm ; Arteries ; Humans ; Hydrocephalus ; Hypertension ; Incidence ; Intracranial Aneurysm* ; Korea ; Neurosurgery

The author analyzed 177 consecutive cases of saccular, ruptured intracranial aneurysms admitted to the Department of Neurosurgery in Korea University Hospital during the period from August 1983 to July 1987. the results of analysis were summarized as follows. 1) Mean age of the patients was 50.4 years. 2) Incidence of clinical vasospasm was 27.2%(46/177) and of rebleeding was 10.7%(19/177). 3) Surgery was done for patients which accounts for 57.6% of all patients. Functional recovery was noted in 84 of the these surgically treated patients(84.6%). 4) The prognostic factors are age, hypertension, size of aneurysm, site of aneurysm, preoperative neurological state, vasospasm, hydrocephalus, rebleeding, timing of operation, multiplicity. 5) The mean size of aneurysms was 6.9mm. The direction of aneurysms was variable, but most of them pointed in the direction of blood flow in afferent arteries.
Aneurysm ; Arteries ; Humans ; Hydrocephalus ; Hypertension ; Incidence ; Intracranial Aneurysm* ; Korea ; Neurosurgery

Tuberculous meningitis, which commonly causes thick granulations over the base of the brain, is a frequent cause of post-meningitic hydrocephalus. Raised intracranial tension affects the cause of tuberculous meningitis adversely. The development of hydrocephalus may account for the raised intracranial pressure. Insertion of a V-A(V-P) shunt significally alters the course of the disease. The results in 5 cases have been detailed and discussed. Operation could be performed even in an active stage of the disease without much fear of milliary dissemination.
Brain ; Hydrocephalus* ; Intracranial Pressure ; Tuberculosis, Meningeal*

It is the purpose of this experimental study to investigate the alterations of the amount of adenosine nucleotides and adenylate energy charge in the acute focal cerebral ischemia of cats utilizing high performance liquid chromatography and to make a comparative study of protective effects of recirculation and combined therapy with mannitol, steroid and barbiturate. Acute focal cerebral ischemia in cats was induced by occlusion of the left middle cerebral artery through the postorbital technique. The experimental animals were divided into four groups according to the duration of occlusion time. The experimental results are obtained as follows: 1) In 1, 3 and 5 hour-occlusion groups, amount of adenosine triphosphate and summation of adenosine nucleotides decreased significantly to 21.4%, 5% & 0%, 44.0%, 29.9% & 10.8% of the sham control, respectively. Also in these groups adenylate energy charge decreased significantly to 62.7%, 38.7% and 30.7% of the sham control, respectively. It was suggested that the longer duration of occlusion time was, the more amount of adenosine triphosphate, summation of adenosine nucleotides and adenylate energy charge decreased significantly. 2) In 1 and 3 hour-occlusion groups, 2 hour-recirculation increased significantly amount of adenosine triphosphate and summation of adenosine nucleotides to 37.4% & 29.4%, and 62.1% & 58.3% of the sham control, respectively. Also in these groups recirculation increased significantly adenylate energy charge to 70.7% and 65.3% of the sham control, respectively. Whereas there was a slight increase of adenylate energy charge after recirculation in 5 hour-occlusion group, but not significant. 3) In the groups of recirculation following 5 hour-occlusion, pretreatment of combination of mannitol and steroid, or mannitol, steroid and barbiturate increased significantly amount of adenosine triphosphate, summation of adenosine nucleotides, and adenylate energy charge to 57.2% or 66.1%, 80.9% or 83.5% and 82.7% or 84.0% of sham control, respectively.
Adenosine ; Adenosine Triphosphate ; Animals ; Brain Ischemia ; Cats ; Chromatography, Liquid ; Mannitol ; Metabolism* ; Middle Cerebral Artery ; Nucleotides

Chronic subdural hematoma is a relatively common disease which is practically always secondary to severe or minor injury to the head but may occur in connection with blood dyscrasias or cachexia in the absence of trauma. Early diagnosis and proper operative treatment result in complete recovery in most cases, but the outcome without operative treatment is almost invariably fatal. During 1972 to 1975, 28 patients with chronic subdural hematoma were examined and operated in the Department of Neurosurgery, Korea University, and clinical observation and analysis were made particularly of the relationship of age to clinical and pathological findings. Incidence of hematoma was predominated by men and estimated as 71.4% of total cases over the age group of 31 to 40 years and In the group of under 10 years were found in 3 cases A history of craniocerebral trauma in varying degrees was obtained in 23 cases(82%), and remainings had no history of it or any other illness. The average time interval from trauma to operation was 31.7 days and it was shorter in the young patients who had more evidence of increased intracranial pressure. The prevalence of the most commonly encountered symptoms and signs, especially in different age groups were analyzed. Headache was by far the commonest symptom in this series, being present in 20(71.4%) vomiting in 15(53,6%), hemiparesis in 13(16.43%) speech disturbance in 5(18%), papilledema in 16(57.2%), and convulsion in 2(7.14%). There was a tendency that young patients had headache more frequent and severe than the older patients, while mental symptoms, such as somnolence, confusion, and memory less were significantly more frequent in the older age group. Hemiparesis and other pyramidal tract signs were more frequent in the older age group. Leukocytosis in peripheral blood was investigated in 75% of cases and roentgenograms of the skull showed evidence of a linear fracture in 10 of the total cases. Carotid angiograms were of diagnostic value in that they demonstrated a lentiform shaped avascular zone by in 28% and a crescent shaped-one in the remainders by an inward displacement of the terminal branches of the middle cerebral artery. The hematomas were most frequently found in the parietotemporal region. The thickness of the hematomas as measured from angiograms increased with the age of the patient. Only 1 of 28 cases died of reaccumulation of blood in the subdural space and bleeding in the gastrointestinal tract following the operation. Excellent recovery following operation is obtained in 82% of the cases at the time of discharge from hospital.
Cachexia ; Craniocerebral Trauma ; Early Diagnosis ; Gastrointestinal Tract ; Head ; Headache ; Hematoma ; Hematoma, Subdural, Chronic* ; Hemorrhage ; Humans ; Incidence ; Intracranial Pressure ; Korea ; Leukocytosis ; Male ; Memory ; Middle Cerebral Artery ; Neurosurgery ; Papilledema ; Paresis ; Prevalence ; Pyramidal Tracts ; Seizures ; Skull ; Subdural Space ; Vomiting