Pedicle screw instrumentation has proven to be reliable and effective in the surgical management of lumbosacral disorders, yet the appropriateness in the thoracic spine is not known. To evaluate the accuracy of the pedicle screw placement in the surgical management of the thoracic spinal disorders and to establish its risks and benefits, a prospective study was designed. One hundred and two thoracic pedicle screws in 22 consecutively treated patients were investigated after surgery by computed tomography scans. Twenty-one(20.5%) screws penetrated the pedicle cortex or the vertebral body anterior cortex. Three screws penetrated the medial cortex of the pedicle by the averages of 2mm to a maximum 4mm. Fifteen screws(14.7%) penetrated laterally by an average of 1.5mm. There were 3 screws of caudal penetration. The screws inserted at T1-T8 revelaed a higher penetration rate than those inserted at T9-T12(35.7% versus 14.7%)(p<0.05). Hardware failures causing the preoperative defor-mity were seen in a patient to whom half the cephalad screws were laterally misplaced. However, there were no major neurologic complications. Although segmental pedicle screw fixation of the thoracic spine requires meticulous measures and considerable experience, it was therefore can be considered as a safe and effective method for stabilizing the thoracic spine.
Humans ; Prospective Studies ; Risk Assessment ; Spine*

Secondary brain insults such as cerebral compression, hypoxia, and ischemia materially influence the outcome of human traumatic brain injury(TBI). Memory dysfunction following such injury is a common clinical observation, but the pathologic substrate underlying this loss of function has not been well-characterized. In the present study, we examined the effects of immediate hemodynamic change resulting from moderate closed head injury on memory dysfunction, neuronal cell loss and synaptic loss in the CA1 sector of the hippocampus. A modified Morris Water Maze(MWM) memory paradigm was used to assess memory retention in rats for five consecutive days before and for two days after injury. A total of 24 Sprague-Dawley rats, regardless of sex, weighing 250-330gm, were used, and were divided into four groups : sham control, head injury-no treatment(group 1), head injury-hypotension(group 2), and head injury-resuscitation(group 3). After injury, latency time to invisible platform in spatial navigation was longer in the head injury-hypotension group(group 2) than in the other injury groups(p<0.05). At the completion of cognitive testing, the animals were sacrificed and neuronal cell loss and synaptic loss in the hippocampal CA1 sector were examined with H and E staining and immunohistochemical staining to synaptophysin. The number of pyramidal neurons in the hippocampal CA1 sector per 5000nm2 was lower in the injury groups(20.3+/-3.0 in group 1, 20.2+/-3.4 in group 2, 19.8+/-2.1 in group 3, mean+/-standard deviation) than in the sham control group(23.7+/-3.5). The density of immunohistochemical staining to synaptophysin tended to be less in groups 1 and 2 than in the sham control group, and tended to increase to the level of the sham control group in group 3. The present study showed that during a period of acute TBI, neuronal and/or synaptic loss in the hippocampal CA1 sector may be responsible for transient memory disturbance and that to prevent neurologic deficit after TBI, active therapy or stabilization of the hemodynamic state is important.
Animals ; Anoxia ; Brain ; Brain Injuries* ; Head ; Head Injuries, Closed ; Hemodynamics* ; Hippocampus* ; Humans ; Ischemia ; Memory* ; Neurologic Manifestations ; Neurons ; Rats* ; Rats, Sprague-Dawley ; Synapses ; Synaptophysin

The author has performed an experimental study in order to investigate the effect of nimodipine on the production of CSF in 12 cats. The cats were divided into 2 groups, one for nimodipine intravenous infusion and the other for its vehicle infusion group. Using ventriculo-cisternal perfusion method, nimodipine and its vehicle were examined for their effects on CSF formation rate respectively. Baseline CSF formation rate was 22.5+/-2.9 microliter/min(S.E.) and it gradually reduced to 17.0+/-3.4 microliter/min(S.E.) after final infusion of nimodipine at 60 microgram/kg/min. Vehicle infusion revealed no significant change in CSF formation rate. Although the nimodipine insuion revealed declining tendency in CSF formation rate along with increment of nimodipine concentration, it was not statistically different from that of vehicle infusion group. Systolic blood pressure was significantly reduced after nimodipine infusion(133+/-31.8mmHg at baseline, 93.9+/-19.1mmHg at the end of the experiment) on oneway ANOVA test and it was significantly different from that in vehicle infusion group(p<0.01).
Animals ; Blood Pressure ; Cats ; Infusions, Intravenous ; Nimodipine* ; Perfusion

A nerve ganglion cyst is characterized by the accumulation of a mucoid substance in or around the nerve, which leads to the formation of a pseudocyst. This 53-year-old man presented with left foot drop of three-year duration, using magnetic resonance imaging, 3-cm ganglion cyst of the peroneal nerve was preoperatively diagnosized. Surgical exploration disclosed a lobulated cystic mass filled with gelatinous material, and the lesion was completely resected. No connection with the knee joint was found, and postoperative recovery of motor function was good. The authors describe a case of intraneural ganglion cyst of the peroneal nerve which illustrates the value of MR in diagnostic imaging.
Diagnosis* ; Diagnostic Imaging ; Foot ; Ganglion Cysts* ; Gelatin ; Humans ; Knee Joint ; Magnetic Resonance Imaging* ; Middle Aged ; Peroneal Nerve*

A nerve ganglion cyst is characterized by the accumulation of a mucoid substance in or around the nerve, which leads to the formation of a pseudocyst. This 53-year-old man presented with left foot drop of three-year duration, using magnetic resonance imaging, 3-cm ganglion cyst of the peroneal nerve was preoperatively diagnosized. Surgical exploration disclosed a lobulated cystic mass filled with gelatinous material, and the lesion was completely resected. No connection with the knee joint was found, and postoperative recovery of motor function was good. The authors describe a case of intraneural ganglion cyst of the peroneal nerve which illustrates the value of MR in diagnostic imaging.
Diagnosis* ; Diagnostic Imaging ; Foot ; Ganglion Cysts* ; Gelatin ; Humans ; Knee Joint ; Magnetic Resonance Imaging* ; Middle Aged ; Peroneal Nerve*

The author has examined the effect of cortical spreading depression(CSD) on the changes in extracellular concetration of aspartate and glutamate in the neocortex of anesthetized rats using microdialysis and high performance liquid chromatography(HPLC). The rats were prepared by halothane anesthesia and artificial ventilation. Rats were placed in a stereotaxic frame, and craniotomies were performed over the frontal and parietal cortexes on one side. The CSD was elicited by local application of KCI-soaked small pellets to the frontal cortex. The CSD was monitored by the changes of direct current(DC) potential in the parietal cortex. The microdialysis probe was implanted in the anterior part of the parietal cortex. Amino acids were analyzed by HPLC and fluorescence detection. Baseline concentration of the aspartate was 34.9+/-15.9nM and that of glutamate was 189.8+/-29.1nM(mean standard deviation). The perfusate for analysis was obtained 30 minutes after the beginning of the 300mM KCl induced CSD. Aspartate was found to increase to 146+/-55% baseline, glutamate up to 173+/-30% baseline(mean standard deviation). The increment of glutamate was statistically significant(p<0.05). Then 2M KCI-doaked pellets were applied for more frequent CSD amd the samples were collected. Aspartate increased up to 258+/-97% baseline, glutamate up to 174+/-57% baseline(mean standard deviation), The increment of glutamate and aspartate accompanying 2M KCI induced CSD were also statistically significant(p<0.05). These data suggest that the excitatory amino acids were released during the CSD and this may explain the various aspects of CSD that could contribute to the secondary neuronal damage in the compromised nerve cell.
Amino Acids ; Anesthesia ; Animals ; Aspartic Acid* ; Cerebral Cortex* ; Chromatography, High Pressure Liquid ; Cortical Spreading Depression* ; Craniotomy ; Excitatory Amino Acids ; Fluorescence ; Glutamic Acid* ; Halothane ; Microdialysis ; Neocortex ; Neurons ; Rabeprazole ; Rats* ; Ventilation

In 614 of 793 cases with subarachnoid hemorrhage(SAH), four vessel cerebral angiography was performed to investigate the source of the hemorrhage. The first four vessel study revealed 501 cases of ruptured cerebral aneurysms; during initial pan-angiography studies, 113 SAH patients did not show vascular lesions. Thirty two of 71 patients(45.1%) showed aneurysms on repeat angiography: fifteen of them had aneurysms in the anterior communicating artery. Among patients whose Hunt Hess grade on admission was poor(III-IV), the possibility of revealing aneurysm during repeated angiography was higher than in those whose grade was good(I-II)(p<0.05, Fisher exact test). On repeat angiography, the age, sex and CT grade of patients with aneurysm were indistinguishable from those of patients without: even in those who on initial angiography showed angiographic vasospasm, the chance of revealing an aneurysm was the same as in those without spasm. We concluded that repeated angiography, especially after 3 weeks of ictus, was valuable for the detection of an initially undefined aneurysm.
Aneurysm ; Angiography* ; Arteries ; Cerebral Angiography ; Hemorrhage ; Humans ; Intracranial Aneurysm ; Spasm ; Subarachnoid Hemorrhage*

BACKGROUND: Liver fibrosis evaluation is an important issue in chronic liver disease patients. We aimed to develop noninvasive liver fibrosis biomarkers based on transient elastography (TE, FibroScan®) through retrospective review of clinicopathological data. METHODS: We recruited 278 chronic hepatitis B patients who underwent Fibroscan and HBV DNA testing. A total of 115 HBeAg-positive and 159 HBeAg-negative chronic hepatitis B patients were analyzed. A total of 100 hepatitis C patients were analyzed. Successful fibroscan data, gamma-glutamyl transferase (GGT) to platelet ratio (GPR), platelet count, AST, ALT, international normalized ratio of prothrombin time, total cholesterol, triglycerides, bilirubin, mean platelet volume, AST to platelet ratio index, fibrosis index based on four factors (FIB-4), neutrophil to lymphocyte ratio (NLR), and NLR to platelet ratio were analyzed to determine the new noninvasive markers for assessing liver fibrosis. RESULTS: Elevated GPR (OR=9.1, P=0.011) and FIB-4 (OR=2.3, P=0.01) were associated with greater risk of liver fibrosis in chronic hepatitis B patients. FIB-4 (OR=6.04, P=0.005) was a risk factor for liver fibrosis in HBeAg-positive patients. FIB-4 (OR=2.371, P=0.015) and GPR (OR=33.78, P=0.003) were liver fibrosis risk factor in HBeAg-negative patients. In chronic hepatitis C patients, GGT (OR=1.033, P=0.002), triglyceride (OR=−0.990, P=0.038) and FIB-4 (OR=3.499, P=0.006) showed statistical significances. The AUCs were 0.816 in FIB-4 (P<0.001) and 0.849 in GPR (P<0.001). CONCLUSIONS: FIB-4 and GPR may be useful blood markers for assessing liver fibrosis in chronic hepatitis B and hepatitis C patients. Further well-designed prospective study is required to validate these noninvasive blood markers in clinical practice.
Area Under Curve ; Bilirubin ; Biomarkers ; Blood Platelets ; Cholesterol ; DNA ; Elasticity Imaging Techniques ; Fibrosis ; Hepatitis B ; Hepatitis B, Chronic ; Hepatitis C ; Hepatitis C, Chronic ; Hepatitis ; Hepatitis, Chronic ; Humans ; International Normalized Ratio ; Liver Cirrhosis ; Liver Diseases ; Liver ; Lymphocytes ; Mean Platelet Volume ; Neutrophils ; Platelet Count ; Prospective Studies ; Prothrombin Time ; Retrospective Studies ; Risk Factors ; Transferases ; Triglycerides

The present study was performed to investigate the relationship between the concentrations of tissue-type plasminogen activator (t-PA) and plasminogen activator inhibitor (PAI) and the CT images in 23 cases of chronic subdural hematomas (SDHs). The concentrations of t-PA and PAI-1 were quantified by enzyme-linked immunosorbent assay (ELISA). Chronic SDHs were divided into five groups according to their appearance on computed tomography: high-density (n = 4), isodensity (n = 8), low-density (n = 5), mixed-density (n = 3), layering (n = 3) types. The volume of hematoma was measured with an image analyzing software program. The concentrations of t-PA were higher in layering (41.2 +/- 0.3 ng/ml, mean +/- standard error of the mean) and high-density (40.0 +/- 1.1 ng/ml) types compared to those of low-density (23.3 +/- 4.1 ng/ml) and iso-density (25.1 +/- 3.7 ng/ml) types. The concentrations of PAI-1 were lower in layering (95.9 +/- 1.0 ng/ml) and high-density (103.4 +/- 34.5 ng/ml) types compared to that of low-density (192.5 +/- 2.6 ng/ml) type. So the ratio between t-PA and PAI-1 (t-PA/PAI) was greater in layering and high-density types. The volume of hematoma was larger in mixed-density and layering types but statistically insignificant. These results presumably suggest that the ratio between t-PA and PAI concentration may contribute to the pathogenesis of the chronic SDH.
Adult ; Aged ; Enzyme-Linked Immunosorbent Assay ; Female ; Hematoma, Subdural/*metabolism ; Human ; Male ; Middle Age ; Plasminogen Activator Inhibitor 1/*analysis ; Tissue Plasminogen Activator/*analysis ; Tomography, X-Ray Computed

OBJECTIVE: Although surgical clipping of intracranial aneurysm is the definite method of treatment, there remains a small number of patients in whom surgical clipping is not technically possible. In such difficult cases, surgeon has to consider other therapeutic alternatives. In this report, we analyze our aneurysmal cases treated by wrapping and coating method and evaluate their surgical outcome and follow-up results. METHOD: Among the total of 877 patients operated from 1990 to 1999 for intracranial aneurysms at our hospital, 40 cases(4.6%) were treated by wrapping and coating method. They included 24 cases of single ruptured aneurysms and 16 with unruptured ones in multiple aneurysms. Wrapping with temporalis muscle and/or muslin gauze and coating with bioadhesive agent such as fibrin glue were performed. RESULT: Wrapping and coating method was performed mostly to the anterior communicating artery aneurysm (35%), and mostly because of the broad-based neck of an aneurysm(43%). At the time of discharge, 30 out of 40 patients(80%) showed favourable outcome and three cases died. The patients were monitored for average of 37 months(3-75 months). Among 24 cases with single ruptured aneurysm, 4 cases(17%) had early rebleeding within 6 months from the initial hemorrhage, and such rebleeding occurred within the first postoperative month in 3 cases. However, there was no rebleeding after the 6 months. Among 16 patients whose aneurysms were unruptured ones, none of them showed bleeding episode. CONCLUSION: It seems likely that the wrapping and coating method would be some help to prevent the rebleeding of an intracranial aneurysm. In order to obtain more accurate results regarding the efficacy of such method, it will be necessary to perform a multi-center study for longer follow-up periods and various wrapping and coating materials.
Aneurysm ; Aneurysm, Ruptured ; Fibrin Tissue Adhesive ; Follow-Up Studies ; Hemorrhage ; Humans ; Intracranial Aneurysm* ; Neck ; Surgical Instruments