Is superselective embolization of the brain AVMs, the possibilities of adjacent normal brain tissue damage necessitates preembolic evaluation. The authors performed the Sodium Amytal test on 15 patients with brain AVMs. In the AVM patients with negative Amytal test(30 cases), all patients showed normal pattern on EEG and neurologic examinations after embolization Among the five patients with positive Amytal test, three cases showed neurologic deficit and the others two didn't. In eleven patients. Repeated embolization without the Amytal test were done. Among them, 5 cases showed neurlogic deficit and the others were quite normal. In conclusion, the Amytal test is a useful method of evaluation of the risk to damage normal brain tissue which are supplied by superselected feeding vessels. Combining the EEG with this test is a sensitive and objective method in evaluating patients following the Amytal test. And it is essential to performed the Amytal test for repeat embolization procedures.
Amobarbital* ; Arteriovenous Malformations* ; Brain* ; Electroencephalography ; Humans ; Methods ; Neurologic Examination ; Neurologic Manifestations

The thoracic and lumbar spine fractures were usually combined with neurological deficit. But the prognostic factors in degree of neurological damage and process of the recovery are controversial. The purpose of this study is to evaluate the factors affected neurological injury and the recovery. The 31 cases who had been performed surgical interventions due to traumatic thoracic or lumbar spine fractures with the neurological deficits were studied according to the radiographic findings of the spinal columns and neurological changes of the injured cord and/or the roots. The duration of mean follow-up was 32.6 months, and all cases were evaluated by motor index score and Frankel grade. Total cases were divided into complete paralytic (N=8) and partial paralytic(N=23) group. In incomplete paraplegia group, the neurological recovery rate was better than complete group(P < 0.001) and neurological recovery period was shorter than complete group (P=0.005). The neurologic deficits according to the Frankel grade were higher in Chance fracture, flexion-distraction and translation (complete paraplegia: 4/7 cases, 57.1%) than unstable bursting fracture (complete paraplegia: 4/24 cases, 16.7%)(P=0.031). The recovery rate of Chance fracture, flexion-distraction and translation were worse than unstable bursting fracture (0.001). The fracture which occurred in T5-11 showed higher incidence of complete paraplegia(75%) compared with that of the T12-L1(30.8%) & L2-4(7.1%)(p=0.021). The neurological recovery in motor index score in L2-4 was higher than T5-11 or T12-L1(P=0.0017). There was no correlation in kyphotic deformity and anterior body height loss between complete and incomplete paraplegia groups. But the A-P diameter of compromised neural canal showed significant difference between complete and incomplete paraplegia group(P=0.027)
Body Height ; Congenital Abnormalities ; Follow-Up Studies ; Incidence ; Neural Tube ; Neurologic Manifestations ; Paraplegia ; Spine

Inadvertent application of ionizing radiation, a valuable tool in diagnostic radiology and radiotherapy, results in injury and death of adjacent normal cells, inducing gene mutations or even producing latent cancers. Captopril, an angiotensin I converting enzyme (ACE) inhibitor, has been reported to prevent the structural and functional changes in variable organs, such as lung and kidney, from radiation injury in different experimental animal models. An experiment was carried out to elucidate the radiation-induced histomorphologic changes of small intestine, especially jejunum, and to determine whether captopril can reduce or prevent the radiation-induced injuries in jejunum. Twenty-six healthy Sprague-Dawley rats were used. Experimental group (n=24) was divided into two large groups: the first one (n=16) was treated with two different single dose (9 Gy, 17 Gy) irradiation only and was sacrificed at 12 hours and at 8 weeks following irradiation; the second one (n=8) received captopril 500 mg/l per oral continuously after same doses of irradiation and was sacrificed at 8 weeks. The control group (n=2) was maintained on a stock diet in a same period of experimental group and sacrificed coincidentally. On light and electron microscopy, the 9 Gy and 17 Gy 12 hours groups revealed frequent apoptosis and necrosis but extremely decreased mitotic figures of the crypt cells. However, the 9 Gy and 17 Gy 8 weeks groups and the combined irradiation with captopril groups showed extremely reduced apoptosis and necrosis with increased mitotic figures. There was good correlation between experimental groups in apoptotic count and mitotic count (p<0.05). In the 9 Gy and 17 Gy 12 hours groups, the mucosal surface was focally or diffusely fragmented and the villi were slightly to moderately distorted. Collagen deposition was very mild and confined to the lower portion of the lamina propria. The 9 Gy and 17 Gy 8 weeks groups showed more severe mucosal surface fragmentation even with foci of erosion, short and distorted villi, and more intense collagen deposition. In contrast, the combined irradiation with captopril groups revealed complete regeneration of the mucosal surface epithelium and absent collagen deposition. These findings suggest that the acute radiation injuries to small intestine occur principally in the mucosal crypt cells. Captopril, the ACE inhibitor, might provide a useful intervention in the radiation injuries of intestinal mucosa.
Animals ; Apoptosis ; Captopril ; Collagen ; Diet ; Epithelium ; Intestinal Mucosa* ; Intestine, Small ; Jejunum ; Kidney ; Lung ; Microscopy, Electron ; Models, Animal ; Mucous Membrane ; Necrosis ; Peptidyl-Dipeptidase A ; Radiation Injuries ; Radiation, Ionizing ; Radiotherapy ; Rats* ; Rats, Sprague-Dawley ; Regeneration

No abstract available.

OBJECTIVES: We report a case of Ogilvie's syndrome following posterior decompression surgery in a spinal stenosis patient who presented with acute abdominal distension, nausea, and vomiting.SUMMARY OF LITERATURE REVIEW: Ogilvie's syndrome is a rare and potentially fatal disease that can easily be mistaken for postoperative ileus, and is also known as acute colonic pseudo-obstruction. Early recognition and diagnosis enable treatment prior to bowel perforation and requisite abdominal surgery. MATERIALS AND METHODS: An 82-year-old woman presented with 6 months of worsening back pain with walking intolerance due to weakness in both legs. She had hypertension, asthma, and Cushing syndrome without bowel or bladder symptoms. Further workup demonstrated the presence of central spinal stenosis on magnetic resonance imaging. The patient underwent an L2-3 laminectomy and posterior decompression. Surgery was uneventful. RESULTS: The patient presented with acute abdominal distension, nausea, and vomiting on postoperative day 1. The patient was initially diagnosed with adynamic ileus and treated conservatively with bowel rest, reduction in narcotic dosage, and a regimen of stool softeners, laxatives, and enemas. Despite this treatment, her clinical course failed to improve, and she demonstrated significant colonic distension radiographically. Intravenous neostigmine was administered as a bolus with a rapid and dramatic response. CONCLUSION Ogilvie's syndrome should be included in the differential diagnosis of postoperative ileus in patients developing prolonged unexplained abdominal distension and pain after lumbar spinal surgery. Early diagnosis and initiation of conservative management can prevent major morbidity and mortality due to bowel ischemia and perforation.

STUDY DESIGN: Case report. OBJECTIVES: We report a case of Ogilvie's syndrome following posterior decompression surgery in a spinal stenosis patient who presented with acute abdominal distension, nausea, and vomiting. SUMMARY OF LITERATURE REVIEW: Ogilvie's syndrome is a rare and potentially fatal disease that can easily be mistaken for postoperative ileus, and is also known as acute colonic pseudo-obstruction. Early recognition and diagnosis enable treatment prior to bowel perforation and requisite abdominal surgery. MATERIALS AND METHODS: An 82-year-old woman presented with 6 months of worsening back pain with walking intolerance due to weakness in both legs. She had hypertension, asthma, and Cushing syndrome without bowel or bladder symptoms. Further workup demonstrated the presence of central spinal stenosis on magnetic resonance imaging. The patient underwent an L2-3 laminectomy and posterior decompression. Surgery was uneventful. RESULTS: The patient presented with acute abdominal distension, nausea, and vomiting on postoperative day 1. The patient was initially diagnosed with adynamic ileus and treated conservatively with bowel rest, reduction in narcotic dosage, and a regimen of stool softeners, laxatives, and enemas. Despite this treatment, her clinical course failed to improve, and she demonstrated significant colonic distension radiographically. Intravenous neostigmine was administered as a bolus with a rapid and dramatic response. CONCLUSION: Ogilvie's syndrome should be included in the differential diagnosis of postoperative ileus in patients developing prolonged unexplained abdominal distension and pain after lumbar spinal surgery. Early diagnosis and initiation of conservative management can prevent major morbidity and mortality due to bowel ischemia and perforation.
Aged, 80 and over ; Asthma ; Back Pain ; Colon ; Colonic Pseudo-Obstruction ; Cushing Syndrome ; Decompression ; Diagnosis ; Diagnosis, Differential ; Early Diagnosis ; Enema ; Female ; Humans ; Hypertension ; Ileus ; Ischemia ; Laminectomy ; Laxatives ; Leg ; Magnetic Resonance Imaging ; Mortality ; Nausea ; Neostigmine ; Spinal Stenosis ; Urinary Bladder ; Vomiting ; Walking

PURPOSE: With the gradual changes in the diet, the incidence of colonic diverticular disease, particularly that of the left side colon, has increased rapidly in Korea. The aim of this study was to evaluate the clinical features of diverticular disease and to compare the differences in treatment between right and left colonic diverticulitis. METHODS: The hospital records of 67 patients with diverticulitis were reviewed retrospectively. RESULTS: The incidence of right side colonic diverticulitis was 2.5 times higher than that of the left side (48 and 19 cases, respectively). The mean age of the patients was 51.3 years with a male to female ratio of 2.1:1. The left side colonic diverticulitis developed at an older age than that of the right side (mean age of 47.2 and 58.7 years, respectively, P= 0.03). Seventeen out of 48 (35.4%) right and 8 out of 19 (42.1%) left colonic diverticulitis patients were treated surgically. The ratio of surgical treatment was not different according to the location of diverticulitis (P=0.61). The age and gender of the patients or leucocytosis at the time of the diagnosis were not associated with the risk of surgical treatment. The presence of fever and high-grade sepsis on the CT scan (Hinchey grade) were significant risk factors for surgery. The symptom duration was longer in the surgically treated group than in the conservative treatment group in left colonic diverticulitis (P=0.03). Most surgical procedures for right colonic diverticulitis were a single-stage colon resection (16 out of 17 cases), whereas staged procedures including Hartmann's operation (3 cases) and proximal diversion (2 cases) with abscess drainage were performed in 5 out of the 8 left colonic cases. Postoperative complications were more frequent in the left colon cases. CONCLUSION: The left colon is a relatively rare site for diverticulitis in Korea. However, diverticulitis of this section of the colon requires more complicated surgical treatment and is associated with a higher rate of complications than that of the right colon. The earlier application of diagnostic work up might be necessary for patients suspected of having left colonic diverticulitis because a delayed diagnosis is associated with a risk of surgical treatment.
Abscess ; Colon* ; Delayed Diagnosis ; Diagnosis ; Diet ; Diverticulitis ; Diverticulitis, Colonic* ; Drainage ; Female ; Fever ; Hospital Records ; Humans ; Incidence ; Korea ; Male ; Postoperative Complications ; Retrospective Studies ; Risk Factors ; Sepsis ; Tomography, X-Ray Computed

BACKGROUND AND OBJECTIVES: It is very important to evaluate vestibular function in patients with sudden sensorineural hearing loss (SNHL) because vertigo combined with sudden SNHL is well known as an important prognostic factor. However, the vestibular function test is not usually performed in sudden SNHL patients without vertigo. We investigated whether different vestibular function tests such as the results of vestibular evoked myogenic potential (VEMP) testing or caloric testing were correlated to prognosis in not only sudden SNHL patients with vertigo but also in sudden SNHL patients without vertigo. SUBJECTS AND METHOD: We enrolled in our study 47 patients with idiopathic sudden SNHL with vertigo or without vertigo. The degree of initial hearing loss was categorized as mild, moderate, moderate-severe, severe, and profound group. Types of initial audiograms were categorized as high tone loss, low tone loss, flat and scale out type. We analyzed the association of the VEMP and caloric test with degree of hearing loss, type of audiogram, and hearing recovery in two month. RESULTS: The more sever the hearing loss was, the more increased was the rate of abnormal VEMP response (p=0.003). The rate VEMP and caloric abnormality was higher in hearing loss types with high tone loss than in the types with only low tone loss. The rate of accompanying vertigo was high (p=0.017), when the hearing loss was more severe. There was significant correlation between the hearing recovery and vestibular dysfunction (p=0.000, r=0.563). CONCLUSION: VEMP and caloric test are useful in evaluating vestibular function and prognosis of sudden SNHL patients.
Caloric Tests ; Evoked Potentials ; Hearing ; Hearing Loss ; Hearing Loss, Sensorineural ; Hearing Loss, Sudden ; Humans ; Prognosis ; Vertigo ; Vestibular Function Tests

Opioids are generally used to treat severe cancer pain. Usually, it is common to increase the dose of opioids to maintain analgesia. Opioid-induced hyperalgesia (OIH) is a paradoxical response to opioid resulting in increased perception of pain rather than antinociceptive effect. A 64-year-old female with pancreatic cancer was suffering from whole abdominal pain. She took massive opioid therapy, however, her pain had been worse and widen in the 3 months. Radiologic imaging was performed to exclude metastatic cancer. The result was negative. We suspected OIH, and reduced the amount of opioids, then, added to adjuvant analgesics. And also we performed celiac plexus neurolysis with the use of alcohol and continuous epidural catheter insertion. Her numeric rating pain scale (NRS) decreased from 9/10 to 3/10. This case suggests that adjuvant analgesics and interventional treatments can resolve a OIH patient with intractable cancer pain.
Abdominal Pain ; Analgesia ; Analgesics ; Analgesics, Opioid ; Catheters ; Celiac Plexus ; Female ; Humans ; Hyperalgesia ; Middle Aged ; Pain Management ; Pancreatic Neoplasms ; Stress, Psychological

PURPOSE: Radical prostatectomy is the gold standard treatment for clinically localized prostate cancer, a disease whose incidence is increasing. Erectile dysfunction(ED) after radical prostatectomy influences a patient's quality of life significantly. So we evaluated the correlation of preoperative and postoperative factors with postoperative ED and its treatment. MATERIALS AND METHODS: Hospital records of 27 patients who underwent radical prostatectomy by one surgeon at our department were retrospectively reviewed. We performed univariate analyses to correlate preoperative prognostic factors with intaoperative factors and postoperative variables. RESULTS: Excluding 10 patients who had preoperative ED, erectile dysfunction developed in 10 of 17 patients, and the rate was higher in the older age group(p=0.02). Patients underwent non-nerve sparing radical prostatectomy maintained their potency in 0.0% (0/1) comparative with 44.4% (4/9) in unilateral nerve sparing and 42.9% (3/7) in bilateral nerve sparing surgery. Patients with preexisting comorbidity, such as cardiovascular disease(OR=2.38) and margin positivity(OR=4.67) had greater risk of postoperative ED. In 8 erectile dysfunction patients, 3 sildenafil-treated and 2 alprostadil-treated patients showed improvement one year after the operation. CONCLUSIONS: Older patients have greater risk of postoperative ED, and they have more preexisting risk factors including hypertension, cardiovascular disease, diabetes mellitus, and margin positivity.
Cardiovascular Diseases ; Comorbidity ; Diabetes Mellitus ; Erectile Dysfunction* ; Hospital Records ; Humans ; Hypertension ; Incidence ; Male ; Prostatectomy* ; Prostatic Neoplasms ; Quality of Life ; Retrospective Studies ; Risk Factors ; Urinary Incontinence