The authors analized the 98 cases of cervical spine injuries without fracture or dislocation by hyperflexion/hyperextension of the neck. The peak incidence of the age was in the second to fourth decades(69.4%). There was a male preponderance with a sex ratio of. 1.8 : 1. Sources of trauma were motor vehicle accident, object falling on and motorcycle accident in the order of frequency. The common mechanisms of injury were flexion-extension, extension and flexion injury in the order of frequency. There were 10 cases of cervical cord injury without fracture or dislocation and operative management was given in 6 cases of them. The most common preexisting disease was congenital cervical stenosis. Surgical modality such as laminectomy, laminoplasty and anterior decompressive procedure made them improved. The authors discuss the mechanism of injury and surgical management of the patients with cervical cord injury in the absence of concomittent fracture or dislocation.
Constriction, Pathologic ; Dislocations* ; Humans ; Incidence ; Laminectomy ; Male ; Motor Vehicles ; Motorcycles ; Neck ; Preexisting Condition Coverage ; Sex Ratio ; Spine*

PURPOSE: To evaluate the severity of tissue necrosis of liver according to various kinds of contrast materials used in percutaneous transhepatic procedure. MATERIALS AND METHODS: Four kinds of commercially available contrast material were used in the this study :meglumine ioxithalamate (ionic monomer, Telebrix 30, Guerbet, France), meglumine ioglicinate (ionic dimer, Rayvist 300, Schering, Germany), iopromide (nonionic monomer, Ultravist 300, Schering, Germany), and iotrolan (nonionic dimer, Isovist 300, Schering, Germany). The same amount(0.1 ml) of each contrast material was directly injected into the liver of Sprongue-Dawley rats. After two days and four weeks, the histopathologic findings of resected liver were assessed and analysed with special emphasis on the difference in the area of tissue necrosis between each group. RESULTS: In the liver resected 48 hours later, the area of necrosis was related to the osmolality and ionicity of contrast material used :the higher the osmolality, the wider the area of necrosis and ionic contrast material exhibited wider area of necrosis than nonionic contrast material. In the liver resected four weeks later, almost complete recovery was seen at the site of necrosis in all groups. CONCLUSION: Nonionic contrast materials caused less tissue necrosis than ionic contrast materials in percutaneous transhepatic procedure because of their lower osmolality.
Animals ; Contrast Media* ; Liver* ; Meglumine ; Necrosis ; Osmolar Concentration ; Rats*

The authors describe the case of a man who presented with T2-T3 disc herniation. The lesion was successfully identified by computed tomography with iopamidol myelogram and other radiological examinations. A posterolateral approach was tried and made successful result by the aids of microsurgical divices.
Iopamidol

PURPOSE: Little is known about the effect of the prostate volume on the free prostate-specific antigen(PSA) level and the percent of the free PSA level with administering finasteride medication. We studied the effect of finasteride therapy on the levels of serum PSA, the free PSA and the percentage of free PSA according to the prostate volume. MATERIALS AND METHODS: Patients with lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia(BPH) and who were over 50 years old were treated with finasteride 5mg for 6 months. Male patients with a PSA level between 3.5ng/ml and 15ng/ml were included and these patients were biopsied. alpha-blockers were prescribed to treat them for LUTS. The serum levels of the total PSA and free PSA were measured at baseline and after 6 months. We analyzed the changes of PSA and fre-PSA before and after finasteride administration. We also analyzed the patients' changes based on the prostate volume. RESULTS: The analysis included 44 patients with a mean age of 71.7 years, a baseline prostate volume of 56.0cc and a baseline total PSA level of 6.74ng/ml. The total PSA and free PSA levels declined from 6.74ng/ml and 2.57ng/ml at baseline to 3.83ng/ml and 1.45ng/ml after 6 months of treatment, respectively(p<0.05). The mean percent free PSA was not significantly altered by finasteride treatment. Those patients with a small prostate volume showed larger decrements in the PSA and free PSA than did the patients with a large prostate volume, but the prostate volume at baseline did not affect the percent free PSA levels. CONCLUSIONS: It is debatable that the application of the 'double's rule' without considering the volume of the prostate is appropriate for the treatment of patients who are taking finasteride medication.
Finasteride* ; Humans ; Lower Urinary Tract Symptoms ; Male ; Middle Aged ; Prostate* ; Prostate-Specific Antigen* ; Prostatic Hyperplasia

Although the medical applications of He-Ne lasers remain controversial, the clinical use of these devices for a variety of analgesic and wound healing applications is steadily increasing. Research studies of the effects of He-Ne laser irradiation on biologic function are growing in number and scope. Many investigators have described successful treatment of a wide variety of painful musculoskeletal, rheumatologic, and neurologic conditions with He-Ne lasers. Since we have recently initiated studies examing the effects of He-Ne lasers on wound healing and pain relief, we investigated the effect of He-Ne laser irradiation on the healing of skin defect, abrasion, burn and on the pain relief of temporomandibular joint dysfunction in admitted patients. The total number of patients was 96. The He-Ne laser power was 1 mW, dose was 1 J/cm2 and the wavelength was 632.8 nm. Each patient underwent 2 to 8 trials of irradiation on point around the wound area and painful joint at a frequency of 2 times a week. After every 1 trial up to 8 trials, we evaluated the efficacy of He-Ne laser irradiation by checking the wound size and by questioning the patients about degree of pain. Following the estimation by patients, excellent, good, and fair were accounted as effective, and poor as noneffective. The efficacy of the laser at the end of 2 to 8 trials was noticed on 78.1%, and the degree of pain relief was 73.9%. These results suggested that the irradiation of He-Ne laser is an effective and safe treatment for wound healing and pain relief. In this overview, we are summarizing some of our results which suggest a potential usefulness of He-Ne lasers for stimulation of wound healing and pain relief. Although its clinical use can be anticipated in the future, further research is required to clarify the basic mechanisms and the preferred optical parameters, such as treatment time and intensity, for increased wound healing and pain relief.
Burns ; Humans ; Joints ; Research Personnel ; Skin ; Temporomandibular Joint ; Wound Healing ; Wounds and Injuries

The authors described different type of aneurysms in the distal anterior cerebral artery(DACA), which is difficult to approach surgically. there are anomalies of distal anterior cerebral artery in about one fourth and narrow space, which made more careful surgical dissection. We experienced 7 cases of DACA aneurysm, 6 cases of which were treated surgically through the interhemispheric approach via the unilateral frontal paramedian craniotomy on the non-dominant side. Surgical results were anatomical complexities, modern microsurgical technique aided by microscope make the approach more exactly and safely.
Aneurysm ; Anterior Cerebral Artery* ; Craniotomy ; Intracranial Aneurysm*

The authors describe 2 cases of multiple thoracic disc herniations in the level of T5~6, T6~T7, T7~8 and T8~9, T9~10, T10~11. Thoracic disc herniations is rare and occurs in less than 4% of all diseases. Moreover, multiple thoracic disc herniations is very rare and only 7 cases were reported in the literatures, which occurred at two levels in 6 cases and five levels in one case. The lesions were determined by thoracic CT myelogram and MRI study. A microsurgical posterolateral approach made them curative. Surgical instruments such as downbite curette and surgical microscope were essential for successful treatment.
Magnetic Resonance Imaging ; Surgical Instruments

BACKGROUND: Pulmonary complications including pneumonia and pulmonary edema frequently develop in critically ill surgical patients. Lung ultrasound (LUS) is increasingly used as a powerful diagnostic tool for pulmonary complications. The purpose of this study was to report how LUS is used in a surgical intensive care unit (ICU). METHODS: This study retrospectively reviewed the medical records of 67 patients who underwent LUS in surgical ICU between May 2016 and December 2016. RESULTS: The indication for LUS included hypoxemia (n = 44, 65.7%), abnormal chest radiographs without hypoxemia (n = 17, 25.4%), fever without both hypoxemia and abnormal chest radiographs (n = 4, 6.0%), and difficult weaning (n = 2, 3.0%). Among 67 patients, 55 patients were diagnosed with pulmonary edema (n = 27, 41.8%), pneumonia (n = 20, 29.9%), diffuse interstitial pattern with anterior consolidation (n = 6, 10.9%), pneumothorax with effusion (n = 1, 1.5%), and diaphragm dysfunction (n = 1, 1.5%), respectively, via LUS. LUS results did not indicate lung complications for 12 patients. Based on the location of space opacification on the chest radiographs, among 45 patients with bilateral abnormality and normal findings, three (6.7%) and two (4.4%) patients were finally diagnosed with pneumonia and atelectasis, respectively. Furthermore, among 34 patients with unilateral abnormality and normal findings, two patients (5.9%) were finally diagnosed with pulmonary edema. There were 27 patients who were initially diagnosed with pulmonary edema via LUS. This diagnosis was later confirmed by other tests. There were 20 patients who were initially diagnosed with pneumonia via LUS. Among them, 16 and 4 patients were finally diagnosed with pneumonia and atelectasis, respectively. CONCLUSIONS: LUS is useful to detect pulmonary complications including pulmonary edema and pneumonia in surgically ill patients.
Anoxia ; Critical Care* ; Critical Illness ; Diagnosis ; Diaphragm ; Fever ; Humans ; Lung* ; Medical Records ; Pneumonia ; Pneumothorax ; Pulmonary Atelectasis ; Pulmonary Edema ; Radiography, Thoracic ; Retrospective Studies ; Ultrasonography* ; Weaning

OBJECTIVE: We conduct a study to determine the fusion rate and clinical outcome after mini-open anterior lumbar interbody fusion(ALIF) in selected patients with a degenerative lumbar disc disease. METHODS: Ninety-four patients underwent the ALIF procedure between November 2000 and June 2002. The subjects were 23 men and 71 women, with a mean age of 52 years(range, 25-72). The mean follow-up duration was 21 months(range, 13-32). Clinical outcome was assessed using the modified Japanese Orthopedic Association(JOA) low back pain score and the 10-point visual analogue scale(VAS). Radiologic evaluation was performed using plain radiographs. The intervertebral disc height was measured and expressed as the percentage of the total disc height to the AP diameter of the vertebral body. RESULTS: The overall fusion rate in our series was 88.3%. The mean preoperative JOA score was 8.3+/-1.6. At the last follow up visit, the mean JOA score was increased to 13.1+/-1.1, respectively(p<0.001). VAS showed a similar result to JOA score(p<0.001). The preoperative intervertebral disc height was 36.7+/-9.9%. Postoperatively, the disc height spread to 53.3+/-10.8% one month after surgery, but diminished to 46.6+/-11.9% at the last follow-up. CONCLUSION: Our study shows that ALIF using stand-alone rectangular cages remains effective for the indicated conditions in patients with a degenerative lumbar disc disease.
Asian Continental Ancestry Group ; Female ; Follow-Up Studies ; Humans ; Intervertebral Disc ; Low Back Pain ; Male ; Orthopedics ; Retrospective Studies*

A type I Arnold-Chiari malformation (ACM1) is characterized by herniation of cerebellar tonsils at least 3 mm below the plane of the foramen magnum and can present with various clinical symptoms, frequently occipital headache, lower cranial nerve palsy, or ataxia. However, syncope has rarely been described as an initial manifestation of ACM1. An 18-year-old girl experienced a falling to the ground with a loss of consciousness for a minute. The fall occurred with a sensation of vertigo when she was extending her neck to pick up a shuttlecock. Electroencephalography, autonomic function tests, and echocardiography did not demonstrate abnormalities. An magnetic resonance image showed a ACM1. A second-degree atrioventricular block was noted on the initial 24-hour EKG, but not on the second and the third ones taken after neck movement had been restricted by a brace. The initiation of syncope with a sensation of vertigo during excessive head movement and the absence of any other common causes of syncope except for the transient second-degree atrioventricular block disappearing after restriction of neck movement raise the possibility that the syncope was due to the ACM1. Therefore, we recommend that a differential diagnosis of syncope should include ACM1 on the initial evaluation.
Adolescent ; Arnold-Chiari Malformation* ; Ataxia ; Atrioventricular Block ; Braces ; Cranial Nerve Diseases ; Diagnosis, Differential ; Echocardiography ; Electrocardiography ; Electroencephalography ; Female ; Foramen Magnum ; Head Movements ; Headache ; Humans ; Magnetic Resonance Imaging ; Neck ; Palatine Tonsil ; Sensation ; Syncope* ; Unconsciousness ; Vertigo