No abstract available.
Spinal Cord Diseases* ; Spinal Cord*

A woman suffered from massive blunt injuries in a motor vehicle accident at a presumed 4 weeks' gestation, but she successfully carried the fetus for an additional 29 weeks. Premature labor began at 33 weeks' gestation and a live 1,890 g male was delivered. His development was normal for the 12-months postnatal follow-up period. The patient remained in a persistent vegetative state. Only 12 cases of severely brain-injured pregnant patients who delivered babies have been reported in English literature. Such patients need special maternal and fetal monitoring. As shown in our patient, successful fetal outcome could be obtained in a mother who suffered from hypovolemic shock and diffuse axonal injury, was treated with numerous medications from 4 weeks' gestation, and survived premature labor at 33 weeks' gestation in a persistent vegetative state. This report represents the longest interval from maternal vegetative state to obstetric delivery. From our case, it would seem that no clear limit exists that restricts the phy-sician's ability to support a severely injured pregnant patient.
Adult ; Case Report ; Coma/*physiopathology ; Female ; Human ; Pregnancy ; Pregnancy Complications/*physiopathology ; Wounds and Injuries/*physiopathology

OBJECTIVE: To determine whether there is a re-closure capacity of the open neural tube defect(ONTD) and to characterize its re-closing process, the morphological changes and the re-closure rate of a surgically induced ONTD are examined chronologically in early chick embryos. METHODS: Embryos of Hamburger and Hamilton stage 18-19 were used. The posterior roof of the central canal in the closed neural tube was incised longitudinally at the wing bud level. The incision was 3 somites long, which was equivalent to approximately 0.8mm. Following surgery, the embryos were re-incubated in ovo for three or five days. The area of the incision was observed with a stereomicroscope. Some of them were examined histologically with the transverse section of the wing bud area. They were divided into two groups(POD 3 and POD 5) according to the re-incubation period at the time of sacrifice and then into two subgroups(re-closure and defect group) according to the presence of ONTD at the operative site. RESULTS: The results showed : 1) Re-closure of ONTD occurred in 58%(23/40) of POD 3 embryos and 46%(22/48) of POD 5 embryos. The difference of re-closure was not statistically significant. 2) Most of the re-closed neural tubes revealed no significant difference from the controls in the histological examination. 3) In POD 3 and 5 groups, there was a tendency of zipper-like fusion in both re-closure and defect groups. CONCLUSION: The results of study showed that the neural tube of the early chick embryo has a re-closure capacity after being surgically reopened. Seemingly, re-closure occurs mainly before POD 3 and progresses from the ventral to the dorsal part of the neural tube. The mechanism of re-closure needs to be investigated further.
Animals ; Chick Embryo* ; Embryonic Structures ; Neural Tube Defects* ; Neural Tube* ; Somites ; Wings, Animal

Objective: Animal models of spinal cord injuries (SCIs) use rats to simulate human SCIs.Among the various techniques, clips have been used to reproduce the compression-contusion model. However, the mechanism of injury in discogenic incomplete SCI may differ from that in clip injury; however, a model has yet to be established. Previously, we issued a patent (No.10-2053770) for a rat SCI model using Merocel ® , a water-absorbing self-expanding polymer sponge. The objectives of this study were to compare the locomotor and histopathological changes between the Merocel ® -compression model (MC group) and clip compression model (clip group). Methods: This study included 4 groups of rats: MC (n=30), MC-sham (n=5), clip (n=30), and clip-sham (n=5). Locomotor function was evaluated in all groups using the Basso, Beattie, and Bresnahan (BBB) scoring system, 4 weeks after injury. Histopathological analyses included morphology, presence of inflammatory cells, microglial activation, and extent of neuronal damage, which were compared among the groups. Results: The BBB scores in the MC group were significantly higher than those in the clip group throughout the 4 weeks (p<0.01). Neuropathological changes in the MC group were significantly less severe than those in the clip group. In addition, motor neurons were well preserved in the ventral horn of the MC group but poorly preserved in the ventral horn of the clip group. Conclusion The novel MC group can help elucidate the pathophysiology of acute discogenic incomplete SCIs and may be applied in various SCI therapeutic strategies.

OBJECTIVE : The purpose of this study was to characterize the Rolandic fissure(Rf) and was to identify the Rf using the surface bony landmarks which can be usually exposed on craniotomy. METHODS : After morphological evaluation of the Rfs using 21 Korean adult formalin fixed cadavers, craniometric measurement was carried out from the surface bony landmarks of nasion, glabella, bregma, and lambda. RESULTS : The Rfs of both hemispheres did not show the mirror image. The Rfs ran forward and downward toward the sylvian fissure keeping the mean angle of 67degrees from mid-sagittal line as elongated S-shape in left and the elongated reverse S-shape in right hemisphere. Connections between the Rf and the longitudinal fissure and between the Rf and the sylvian fissure were found in 3 (7.1%) and 2 (4.8%) of 42 hemispheres, respectively. Most Rfs extended superiorly to 2-3mm lateral to the most superomedial surface of hemispheres and extended inferiorly to 3-5mm superior to the sylvian fissures. The mean distances from the nasion, glabella, bregma, and lambda to the most superomedial aspect of the Rf were 18.8+/-0.9cm, 16.6+/-0.8cm, 5.2+/-0.6cm, and 6.9+/-1.0cm, respectively. The mean distance measured between the Rf and the nasion using traditional method was 18.4+/-0.6cm. CONCLUSION : The distance between the Rf and the nasion roughly correspond within the range of mean 4 mm compared with that measured by the traditional measurement. These data may be more helpful to delineate the Rf after the placement of drapes for craniotomy.
Adult ; Cadaver ; Craniotomy ; Formaldehyde ; Humans

Liver abscess following ventriculoperitoneal (VP) shunting occurs very rarely. We report an unusual case of multiple liver abscesses caused by Staphylococcus capitis in a 50-year-old compromised woman due to a complicating VP shunt infection. We reviewed the nine cases of VP shunt complications reported in the English literature, and speculated that the most likely pathogenetic mechanism in our case is an infected peritoneal tip that migrated to and penetrated the liver, which subsequently caused the formation of multiple liver abscesses. The patient was successfully treated with percutaneous aspiration, drainage of the abscesses, intravenous antibiotics, and shunt revision. Awareness and vigilance of the possibility of liver abscess formation caused by VP shunt infection will help establish an early accurate diagnosis and therapeutic strategy.
Abscess ; Anti-Bacterial Agents ; Catheter-Related Infections ; Diagnosis ; Drainage ; Female ; Humans ; Liver Abscess* ; Liver* ; Middle Aged ; Staphylococcus ; Ventriculoperitoneal Shunt*

Informed consent (IC) should be a form of communication between a physician and patient in which information regarding all options of a medical procedure and the patient's preference is shared. The aim of this study was to create a standard for communication by IC for physicians. The IC standard was developed based on an analysis of a dialogue in our previous experience with a medical communication program and a review of the literature. The dialogue pattern of the IC standard had the following six elements: opening; orientation; disclosure of information; conforming and complementing; shared decision making; and closing. Factors that influenced effective IC-based communication included preparation, attitude, empathy, listening, a psychosocial factor, nonverbal communication, explanation, and understanding. The IC communication standard will be useful in improving the quality of communication between a physician and patient in obtaining IC. It will also be used as a guideline for communication educators and medical students. Innovative strategies and rigorous studies are needed to improve IC counseling to establish effective patient-centered interviews.
Complement System Proteins ; Counseling ; Decision Making ; Disclosure ; Empathy ; Humans ; Informed Consent* ; Nonverbal Communication ; Psychology ; Students, Medical

Vascular injuries in lumbar disc surgery are serious complications which may be overlooked due to a broad range of clinical manifestations. It is important to be aware of the perioperative implications of this rare occurrence to lower mortality risk. A 20-yr-old man with a right L4-5 lumbar disc protrusion was operated on routinely under a surgical microscope. A bloody surgical field was noted temporarily during a discectomy along with a decreased blood pressure. After fluid resuscitation with an ephedrine injection, the bleeding soon stopped spontaneously and his vital signs were stabilized. Fifty hours after the operation, the patient showed signs of hypovolemic hypotension with abdominal distension. The right femoral artery pulsation was absent on palpation. An enhanced CT angiography revealed a retroperitoneal hematoma and obstruction of the left common iliac artery. An urgent laparotomy was done to repair the injured vessel by excision and interposition of a graft. The patient had an uneventful recovery.The subacute course of deterioration might have been due to intermittent blood leakage from the lacerated common iliac artery, which was sealed spontaneously. It is very important to pay close attention to post-surgical clinical manifestations to avoid a potentially fatal outcome in lumbar disc surgery.
Angiography ; Diskectomy/*adverse effects ; Hematoma/etiology ; Humans ; Iliac Artery/*injuries ; Intervertebral Disc ; Lacerations/*etiology ; Lumbar Vertebrae/*surgery ; Male ; Tomography, X-Ray Computed ; Young Adult

We report a case of fatal duret hemorrhage (DH) in a patient with acute tentorial subdural hematoma and bilateral chronic subdural hematoma along the cerebral hemispheres. Preoperative CT angiography (CTA) revealed prominent parenchymal enhancement in the ventral pontomesencephalic area. After burr-hole drainage, a large hemorrhage developed in this area. The parenchymal enhancement in the CTA may reflect the pontomensencephalic perforating vessel injury, and may be a sign of impending DH of acute transtentorial downward herniation. Previous use of aspirin and warfarin might have potentiated the process of DH and increase the extent of the bleed.
Angiography ; Aspirin ; Cerebrum ; Drainage ; Glycosaminoglycans ; Hematoma, Subdural ; Hematoma, Subdural, Chronic ; Hemorrhage ; Humans ; Warfarin