No abstract available.

No abstract available.
Fatigue* ; Sciatica*

PURPOSE: This study was performed to examine if CT classification of renal blunt injury could aid in expectation of hemodynamic stability and clinical decision of whether to intervene surgically. MATERIALS AND METHODS: Over a 80-month period between July 1987 and March 1994, 41 patients were admitted to our hospital with the diagnosis of renal blunt injury. The renal blunt injuries were classified on Fedede's three-point scale CT classification methods :grade I, contusion, intrarenal hematoma, segmental infarction, and small subcapsular hematoma;grade II, complete or incomplete laceration, large subcapsular hematoma, and renal fracture;grade Ill, shattered kidney and renal pedicle injury. Hemodynamic stability, treatment method and clinical outcome of the patients with different CT grade were analyzed retrospectively. RESULTS: All 34 patients with grade I or II CT findings were hemodynamically stable and were successfully managed with conservative method. Among 7 patients with grade III CT findings, 6 patients were hemodynamically unstable. Out of the 6, One patient with grade IIIb or renal pedicle injury was expired before surgical intervention due to ischemic shock. Four patients were intervened surgically with one failure to thrive. The remaining one patient refused to be intervened surgically, and was discharged against medical advice. Only one out of 7 patients was hemodynamically stable and was managed conservatively. CONCLUSION: The patients with grade I or II CT findings are prone to be hemodynamically stable and to be managed with conservative method. But the patients with grade III CT findings are more likely to be hemodynamically unstable. Therefore patients with grade III CT findings should be closely monitored and be pre- pared for the possibility of immediate surgical intervention
Classification* ; Contusions ; Diagnosis ; Failure to Thrive ; Hematoma ; Hemodynamics ; Humans ; Infarction ; Kidney ; Lacerations ; Retrospective Studies ; Shock ; Wounds, Nonpenetrating

Primary malignant melanoma arising from the leptomeninges is a rare entity. We report two cases of primary intracranial melanoma developed in one aged 65 years female and the other 70 years male. One case died 2 years after the operation, and the other case is still living more than 1 year after operation. Both cases seems to have a relatively long survival. The literature on this subject is briefly reviewed.
Female ; Humans ; Male ; Melanoma*

No abstract available.
Brain Injuries* ; Child* ; Glasgow Coma Scale ; Humans

We examined the initial CT findings of the early(within on week) death after head injury, retrospectively. The patient population consisted of 182 patients who were admitted to the Soonchunhyand University Chonan Hospital, and were examined by CT, from August 1986 to May 1990 after head injury. We compared clinical features and radiological findings between the group of focal lesion and the group of diffuse lesion. The focal lesion was found in 47.8%, while the diffuse lesion was found in 45.6%. Statistically significant differences were found in the age, Glasgow Coma Score(GCS) on admission, injury Severity Score(ISS), hypotension, and hypoxia. The focal lesion was more common in the aged, while the diffuse lesion was common in the young(less than 40 years of age). Patients with high GCS(more than 8) constitued 25.3% of the focal lesion, while only 6.0% of the duffuse lesion had the high GCS. ISS was higher than 30 in 67.5% of the diffuse lesion, while 32.2% of the focal lesion had ISS of 30 or more. The causes of injury was pedestrian traffic accident in 46.5% and passanger's traffic accident in 31.8%. Midline shift(more than 3mm), compressed ventricles, and obliteration of the suprasellar cistern and quadrigeminal cistern were observed in 34.1%, 82.4%, 67.6%, and 58.2%, respectively. Lesions with severe midline shift were focal in 93.1% and lesions without midline shift were diffuse in 88.4%(P<0.005). Cranial vault fracture was noticed in 68.2%, and basal skull fracture was found in 28.8%. The frequency of basal skull fracture was high in the diffuse lesion(P<0.005). In this study, we could presumed that 17.2% to 25.3% of the patients with focal lesions could be saved, if proper treatment was given. Since the diffuse lesion was responsible for nearly half of the early death after head injury, proper treatment or prevention should be made. Prevention of the diffuse lesion seems to be possible by correction of hypotension and hypoxia for the diffuse lesions were intimately related to them. At any event, further studies on the diffuse brain injury are required.
Accidents, Traffic ; Anoxia ; Brain Injuries ; Chungcheongnam-do ; Coma ; Craniocerebral Trauma* ; Head* ; Humans ; Hypotension ; Retrospective Studies ; Skull Fractures

We report a unique case of a 12-year-old girl with unilateral proptosis form orbital extension of an extensive bilateral cephalhematoma. Loss of vision in the left eye due to severe proptosis was reversed by prompt aspiration and tarsorrhaphy.
Cerebral Hemorrhage/*complications/radiography ; Child ; Exophthalmos/*etiology/radiography ; Female ; Hematoma/*complications/radiography ; Humans

The following is our report a series of 220 patients who visited the neurosurgical out-patient department from January 1994 to June 1994 complaining of low back pain. We investigated how they were treated and what was the outcome on December 1995. Three certified neurosurgeons had managed these patients. Although the patients were not significantly different in terms of age, sex, and the duration of pain, the diagnostic methods(p<0.005), impression(p<0.01), and the methods of treatment(p<0.01) differred from doctor to doctor. The rates of admission and operation were 11.8% and 7.3%, respectively, and found to be consistent among doctors. We conducted telephonic interviews of 123 patients during December 1995 with the following outcome : improved in 69.1%, unchanged in 22.0%, and aggravated in 4.1%, together with six(4.9%) deaths. The cause of death was cancer in four cases, respiratory failure in one, and unknown in one. Sixteen patients underwent surgery in this hospital, while the other 12 patients were operated on in other hospitals. The outcome was favorable when 1) the patients were female, 2) the age was 21-40 years old, 3) presence of sciatica, 4) the duration was 1 week to 3 months, 5) the diagnostic impression was herniated lumbar disc, 6) drugs were not prescribed, and finally 7) managed by senior doctor. However, these differences were statistically not significant(p>0.1). Although low back pain is a very common complaint, there was enormous ambiguity with respect to its diagnosis and management. Neverthless, the outcomes were not significantly different. Despite the above, we still feel that low back pains should be more systematically classified and precisely dignosed. Also the therapeutic efficacies of different modalities of treatment should be critically reviewed.
Cause of Death ; Diagnosis ; Female ; Humans ; Low Back Pain* ; Outpatients* ; Respiratory Insufficiency ; Sciatica

Recent advances in diagnosis and therapy for head injury have brought some changes in concepts, definition of the terms, therapeutic methods and the duration of treatment. In medical certificates, the diagnosis and duration of treatment also need to be changed according to the new concepts. Mixed use of the terms according to the classic and the new concepts may cause confusion. We investigated with a questionnaire to assess the acceptability of the new concepts of head injury, and seeked for a plan to avoid possible confusion in medical certificates. We sent questionnaires for diagnosis and duration of treatment of 10 given examples of head injury to 367 neurosurgeons whose addresses could be identified. Questionnaires were answered by 52 neurosurgeons. The diagnosis described in the questionnaires showed wide variability with a range of 10 to 32 different descriptions, on average 16.8 different descriptions for each case. Duration of treatment also revealed great discrepancy. Coefficients of variation for duration of treatment varied from 33.44% to 54.37%. Cerebral contusion was the most commonly used term. It was described in every 10 given examples, and to take an average, 32.3 neurosurgeons used cerebral contusion or each case. To avoid possible confusion in medical certificates, it is necessary to make a guide for medical certificates for head injuries according to the new concepts, and a chance of training of this guide should be provided.
Contusions ; Craniocerebral Trauma* ; Diagnosis* ; Head* ; Surveys and Questionnaires*

Acute subdural hematoma (ASDH), chronic subdural hematoma (CSDH) and subdural hygroma (SDG) occur in the subdural space, usually after trauma. We tried to find a certain relationship among these three traumatic subdural lesions in 436 consecutive patients. We included all subdural lesions regardless of whether they were main or not. We evaluated the distribution, age incidence and interval from injury to diagnosis of these lesions, and the frequency of new subdural lesions in each lesion. ASDH constituted 68.6%, SDG 15.8%, and CSDH 15.6%, Age incidence of CSDH was similar to that of SDG, but differed from that of ASDH. Mean interval from injury to diagnosis was 0.4 days in ASDH, 13.4 days in SDG, and 51.6 days in CSDH. Focal brain injuries accompanied in 37.5% of ASDH, 5.8% of SDG, and no CSDH. In ASDH, 2 recurrent ASDHs, 17 SDGs and 9 CSDHs occurred. In SDG, 3 postoperative ASDHs and 8 CSDHs occurred. In CSDH, 2 postoperative ASDHs, 2 SDGs and 1 CSDH occurred. These results suggest that the origin of CSDH is not only ASDH, but also SDG in upto a half of cases. SDG is produced as an epiphenomenon by separation of the dural border cell layer when the potential subdural space is sufficient. A half of CSDHs may originate from ASDHs. ASDH may occur in CSDH by either a repeated trauma or surgery. Such transformation or development of new lesions is a function of a premorbid condition and the dynamics between the absorption capacity and expansile force of the lesion.
Adolescent ; Adult ; Age Factors ; Aged ; Brain Injuries/complications/pathology ; Child ; Female ; Glasgow Coma Scale ; Hematoma, Subdural/etiology/*pathology/therapy ; Human ; Male ; Middle Age ; Subdural Space/*pathology ; Tomography Scanners, X-Ray Computed