No abstract available.
Humans

Lumbar spinal stenosis is a common category of spinal disease in which a decrease in the volume of the spinal canal results in compression of the neural elements. Its pressure symptoms are characterized by vague back-pain and chronic sciatica. The goals of surgical treatment in lumbar spinal stenosis are the relief of pain and the preservation or restoration of neurologic function. Extensive laminectomy in lumbar spinal stenosis results in postoperative instability and postoperative vertebral subluxation with pain, restricted movement, and further neural compression occurs after decompressive laminectomy. Therefore internal fixation devices have been used in these circumstances to prevent postoperative instability while the fusion being consolidated. From February 1988 to October 1988, 36 patients of lumbar spinal stenosis had undergone operations with decompressive laminectomy and segmental spinal instrumentation with transpedicular screws at the department of Orthopaedic Surgery, Yonsei University College of Medicine. In 18 patients degenerative changes in lumbar spine were the principal aetiologic factor:7 patients had spondylolisthetic spinal stenosis:ll patients had combined spinal stenosis. All patients were followed up for periods varying between twelve and ninteen months. According to Kim's criteria, the postoperative results were as follows;excellent in 17 cases(47.2% ), good in 15 cases(41.7% ) and fair in 4 cases(11.1% ). The study revealed that segmental spinal instrumentation with transpedicular screws provided a rigid fixation, early ambulation, minimal fusion and reducing of recovery period were possible. In conclusion, segmental spinal instrumentation with transpedicular screws is a good and reliable method of stabilization after extensive decompressive laminectomy.
Early Ambulation ; Humans ; Internal Fixators ; Laminectomy ; Methods ; Sciatica ; Spinal Canal ; Spinal Diseases ; Spinal Fusion ; Spinal Stenosis ; Spine

STUDY DESIGN: This study is a retrospective evaluation of the high lumbar disc herniations. OBJECTIVE: The purposes of this study is to observe the clinical and radiological findings and out-comes of the high lumbar disc herniations, thus providing a guideline for making diagnosis and for proper treatment modality. SUMMARY OF LITERATURE REVIEW: High lumbar disc herniations at the L1 -2, L2-3 and L3-4 levels represent less than 5% of all disc herniations. The location of pain was highly complected. The represented symptoms and signs such as motor, sensory and reflex changes were variable and potentially misleading in suggesting a level of the disc herniation. MATERIAL AND METHODS: Thirty-one patients with high lumbar disc herniations were retrospectively evaluated. Seventeen patients were treated conservatively and fourteen patients underwent surgery. Review of results was undertaken by an independent observer using a proven outcome assessment measure. RESULTS: The incidence of high lumbar disc herniation is 4.7%(L1-2: 13%, L2-3: 29%, L3-4: 58%) with declining frequency as the level ascends. The peak age incidence is 6th decade in male and 5th decade in female. The positive rate of femoral nerve stretching test(74%) is higher than that of straight leg raising test(51%). In fourteen operative cases, the positive rate of straight leg raising test is 86%. The accuracy of MRI findings in predicting the type of herniated disc is 93%. In results of operation thirteen cases showed more than fair grade(93%). CONCLUSION: The age incidence of the high lumbar disc herniation is older than that of the lower lumbar disc herniation. The femoral nerve stretching test is more useful than straight leg raising test in making diagnosis of high lumbar disc herniations. The prognosis after treatment is comparable with high lumbar disc herniations.
Diagnosis ; Female ; Femoral Nerve ; Humans ; Incidence ; Intervertebral Disc Displacement ; Leg ; Magnetic Resonance Imaging ; Male ; Prognosis ; Reflex ; Retrospective Studies

We report an autopsy case of secondary hemochromatosis associated with multiple frequent blood transfusion for the treatment of aplastic anemia. A 23-year-old man had been diagnosed as having aplastic anemia at the age of 13. He received a whole blood transfusion, about 1280 ml, every month during the past 10 years. Recently he developed diabetes mellitus and a congestive heart failure. The autopsy revealed that multiple organs were affected by secondary hemochromatosis, including the liver, heart, pancreas, spleen, bone marrow, stomach, thyroid gland, adrenal glands, and testes. The lungs and liver showed gross and microscopic findings consistent with a congestive heart failure in addition to hemochromatosis. The details are presented. This is a case of rare secondary hemochromatosis occurring in a young man and presenting the classic histopathologic changes indistinguishable from those of primary hemochromatosis.
Adrenal Glands ; Anemia ; Anemia, Aplastic* ; Autopsy* ; Blood Transfusion ; Bone Marrow ; Diabetes Mellitus ; Heart ; Heart Failure ; Hemochromatosis* ; Humans ; Liver ; Lung ; Pancreas ; Spleen ; Stomach ; Testis ; Thyroid Gland ; Young Adult

PURPOSE: To describe the magnetic resonance (MR) findings of pigmented villonodular synovitis(PVNS) of the knee, and to evaluate the clinical value of MR in the diagnosis of PVNS. MATERIALS AND METHODS:MR imagings of seven patients with PVNS were studied. The type of lesion, presence of bony erosion, the signal intensity, and the relationship between contrast enhancement and signal intensity on T2-weighted images were analyzed, retrospectively. RESULTS: The lesion was mainly villous in three patients and nodular in four, and bony erosion was seen in one patient. On T2-weighted image, the signal intensity of the villous form was mixed iso- and hypointense in two, hypointense in one, and that of the nodular form was heterogeneous with hypo-, iso-, and hyperintensities. The hypointense portion on T2-weighted image showed poor contrast enhancement, which may suggest hemosiderin deposition or advanced fibrosis. The iso- or hyperintense portion on T2-weighted image showed strong enhancement, which suggest active cellular proliferation. CONCLUSION:MR imaging could be a very useful modality in the diagnosis as well as prediction of histological findings of the PVNS.
Cell Proliferation ; Diagnosis ; Fibrosis ; Hemosiderin ; Humans ; Knee* ; Magnetic Resonance Imaging* ; Retrospective Studies ; Synovitis, Pigmented Villonodular*

The objective of this paper is to introduce the schematic protocol of radiofrequency (RF) ablation for the treatment of varicose veins. Indication: anatomic or pathophysiologic indication includes venous diameter within 2-20 mm, reflux time > or =0.5 seconds and distance from the skin > or =5 mm or subfascial location. Access: it is recommended to access at or above the knee joint for great saphenous vein and above the mid-calf for small saphenous vein. Catheter placement: the catheter tip should be placed 2.0 cm inferior to the saphenofemoral or saphenopopliteal junction. Endovenous heat-induced thrombosis > or =class III should be treated with low-molecular weight heparin. Tumescent solution: the composition of solution can be variable (e.g., 2% lidocaine 20 mL+500 mL normal saline+bicarbonate 2.5 mL with/without epinephrine). Infiltration can be done from each direction. Ablation: two cycles' ablation for the first proximal segment of saphenous vein and the segment with the incompetent perforators is recommended. The other segments should be ablated one time. During RF energy delivery, it is recommended to apply external compression. Concomitant procedure: It is recommended to do simultaneously ambulatory phlebectomy. For sclerotherapy, it is recommended to defer at least 2 weeks. Post-procedural management: post-procedural ambulation is encouraged to reduce the thrombotic complications. Compression stocking should be applied for at least 7 days. Minor daily activity is not limited, but strenuous activities should be avoided for 2 weeks. It is suggested to take showers after 24 hours and tub baths, swimming, or soaking in water after 2 weeks.
Baths ; Catheter Ablation* ; Catheters ; Consensus* ; Heparin ; Knee Joint ; Lidocaine ; Saphenous Vein ; Sclerotherapy ; Skin ; Stockings, Compression ; Swimming ; Thrombosis ; Varicose Veins* ; Walking

No abstract available.
Nocardia Infections*

To evaluate the role of magnetic resonance(MR) imaging in the diagnosis of the discoid meniscus, the authors reviewed 31 cases of discoid menisci diagnosed by MR imaging among which 16 cases received arthroscopy. Using knee surface coil, sagittal T1, T2, & protein density images and coronal T1 weighted images were obtained with 18 cm FOV & 4mm/1 mm thickness/gap. A discoid meniscus was considered if three or more contiguous sagittal images demonstrated continuity of the meniscus between the anterior and posterior horns or the diameter of the mid-portion of the meniscus exceeded 15 mm on the coronal image. The authors also observed the associated abnormalities including tears of meniscus and ligament, meniscal cyst, and osteochondral defects. All discoid menisci were lateral menisci and torn discoid lateral menisci were present in 26 cases(83%). In two cases, tears of the contralateral medial meniscus were present. The tears of anterior and posterior cruciate ligaments, meniscal cyst, and osteochondral defects were present in 4, 2, 4, and 5 cases respectively. All collateral ligaments were intact. In conclusion MR imaging was useful for the detection of discoid meniscus and associated abnormalities.
Animals ; Arthroscopy ; Collateral Ligaments ; Diagnosis ; Horns ; Knee* ; Ligaments ; Magnetic Resonance Imaging* ; Menisci, Tibial ; Posterior Cruciate Ligament ; Tears

No abstract available.
Oncogene Proteins* ; Oncogenes* ; Teratocarcinoma*

PURPOSE: To compare two combined surgical techniques, endoscopic endonasal surgery with transconjunctival reconstruction and transcaruncular surgery with transconjunctival reconstruction, when used to treat both medial and inferior orbital wall fractures. METHODS: A retrospective review of 63 patients who were followed up from January 2011 to December 2014 at Inha University Hospital for surgical reconstruction of combined medial and inferior orbital wall fractures was undertaken. We compared between the patients the computed tomographic scans, diplopia, extraocular muscle (EOM) movements, and Hertel's exophthalmometer exams pre- and post-6 months surgery. A total of 29 patients received endoscopic transnasal surgery with trasconjunctival reconstruction, and 34 received transcaruncular surgery with trans-conjunctival reconstruction. RESULTS: There were no significant differences between the two combined methods in terms of the primary and peripheral gaze diplopia or the restriction of EOM movement 6 months after surgery. However, statistically significant differences were observed in exophthalmometer measurements 6 months after surgery. CONCLUSIONS: The two combined surgical methods showed similar results in terms of postoperative primary and peripheral gaze diplopia, EOM restriction, and enophthalmos. With respect to postoperative peripheral diplopia, endoscopic endosnasal surgery with transconjunctival reconstruction showed several advantages over the other method considered in this study. An appropriate surgical method should be selected by comparing the relative advantages and disadvantages.
Diplopia ; Enophthalmos ; Humans ; Methods ; Orbit* ; Retrospective Studies