BACKGROUND: Therapy using a targeted epidural blood patch (EBP) has been linked to cerebrospinal fluid (CSF) hypovolemia syndrome empirically, when conservative therapies failed to relieve headaches. The aim of this study is to investigate the effectiveness of EBP, for those who are refractory to conservative therapy, as a treatment for syndrome of CSF hypovolemia. METHODS: Sixteen patients were studied, where six patients were treated with conservative therapy and 10 patients were treated with EBP. After the treatments, we evaluated the difference in the duration of headaches between the two groups. With the patients treated with EBP, we also evaluated the differences in the duration of headaches between those with or without pachymeningeal enhancement on a brain MRI, and those with or without CSF leakage site on RI cisternography. RESULTS: Mean duration (1.30 +/- 0.48 days) of headaches in those treated with EBP was significantly shorter than in those without EBP (p=0.022). There was no significant difference in duration of headaches between those with and without pachymeningeal enhancement in a brain MRI. There was also no significant difference in duration of headache between those with and without CSF leakage in RI cisternography. CONCLUSIONS: The EBP is an effective therapy for syndrome of CSF hypovolemia regardless of pachymeningeal enhancement in a brain MRI and CSF leakage in RI cisternography when conservative therapies fail to relieve headaches.
Blood Patch, Epidural* ; Brain ; Cerebrospinal Fluid* ; Headache ; Humans ; Hypovolemia* ; Magnetic Resonance Imaging

BACKGROUND AND OBJECTIVES: To report the clinical features of six patients diagnosed with cases of inferior vestibular neuritis based on abnormal vestibular evoked myogenic potential (VEMP) responses with normal caloric test results. MATERIALS AND METHODS: We retrospectively reviewed 62 patients presenting with dizziness. All patients underwent a battery of audiovestibular testing, including hearing tests, caloric test and VEMP test. RESULTS: Six patients were diagnosed as inferior vestibular neuritis. All patients presented with acute onset of prolonged vertigo. The pure tone audiograms and caloric test results were normal. VEMP response was absent unilaterally, and normal in the contralateral ear. CONCLUSION: Inferior vestibular neuritis should be considered in patients presenting with acute vertigo, but normal caloric responses. Comprehensive vestibular testing including VEMP is necessary.
Caloric Tests ; Dizziness ; Ear ; Hearing Tests ; Humans ; Retrospective Studies ; Vertigo ; Vestibular Evoked Myogenic Potentials ; Vestibular Function Tests ; Vestibular Neuronitis

PURPOSE: To determine the ultrasonographic findings and assess the usefulness of ultrasound (US)-guided biopsy of central lung tumors in patients with obstructive pneumonitis. MATERIALS AND METHODS: Fourteen patients with central lung tumors causing obstructive pneumonitis, as seen on chest radiographs and chest CT scans, were examined between January 1997 and January 2000. In no patient conclusive histologic diagnosis obtained by means of bronchoscopic biopsy or sputum cytology. Eleven patients were men and three were women, and their ages ranged from 45 to 83 (mean, 64) years. For all examinations, real-time, linear-array, convex US units with a 3.75- and a 5.0-MHz transducer were used. The images obtained were analyzed for evidence of consolidation or atelectasis in the lung, demonstrable tumors, and tumor size and echogenicity. For US-guided percutaneous transthoracic biopsy, 19.5G automatic biopsy devices, were employed. RESULTS: Lung consolidation due to a wedge-shaped, homogeneous, hypoechoic lesion was revealed by sonographic fluid bronchograms, air bronchograms, air alveolograms, and visualization of intraparenchymal pulmonary vessels, which showed appropriate motion with respiration. The tumor presumed to be causing obstruction was seen as a hypoechoic nodule near the hilum or as a well-defined hyperechoic mass inside the partially consolidated lung. Pleural effusion was observed in one case. The cytologic findings indicated the presence of squamous cell carcinoma (n=4), adenocarcinoma (n=4), small cell carcinoma (n=3), non-small cell carcinoma (n=2) and large cell carcinoma (n=1). The success rate was 100%, and there were no complications. CONCLUSION: In patients with central lung tumors causing obstructive pneumonitis, chest ultrasonography and US-guided biopsy are useful adjunctive diagnostic modalities and techniques.
Adenocarcinoma ; Biopsy* ; Carcinoma, Large Cell ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Diagnosis ; Female ; Humans ; Lung* ; Male ; Pleural Effusion ; Pneumonia ; Pulmonary Atelectasis ; Radiography, Thoracic ; Respiration ; Sputum ; Thorax ; Tomography, X-Ray Computed ; Transducers ; Ultrasonography

BACKGROUND: Chronic low back pain(CLBP) is one of the most common afflictions of humans. Between 70% and 80% of the population experience back pain some time during their lives. Especially, back pain is the most common cause of limited activity in individual under age 45. METHODS: The prepared questionnaire and SCL-MPD(symptom check list-minor psychiatric disorders) were presented to subjects who visited our hospital for occupational routine check. The questionnaire was composed of duration and severity of back pain. The subject were divided into two groups, respectively with chronic low back pain history and without history. The differences of psychogenic symptoms between both groups were analysed. RESULTS: In general characteristics, there was no significant difference between both groups. There were significant differences in somatization, anxiety, depression, anger-hostilily, phobic anxiety, neurasthenic, hypochondriacal, interpersonal sensitivity and general dimensions between both groups(P<0.05). There was no significant difference in obsessive-compulsive dimension between both groups. CONCLUSIONS: These results showed the presence of various psychogenic symptoms in chronic low back pain patients. Such psychosocial variables will need to receive additional careful attention in primary care setting.
Anxiety ; Back Pain ; Depression ; Humans ; Low Back Pain* ; Primary Health Care ; Surveys and Questionnaires

PURPOSE: The purpose of this study was to determine the efficacy of sonography in the evaluation of normal pseudocapsular morphology and the detection of complications after total hip arthroplasty. MATERIALS AND METHODS: Between Janvary 1997 and June 2000, 47 patients [35 men and 12 women aged 24 to 84 (mean, 61) years] using real-time linear-array, convex US units with 3.5-MHz and 10-MHz transducers. Normal capsular morphology in 30 with total hip replacements, who had been asymptomatic for at least one year, was studied, and the prosthetic joint infection demonstrated in six of 17 who had experienced was confirmed at surgery or by US-guided aspiration. RESULTS: Sonograms indicated that a normal pseudocapsule lay straight over the neck of the prosthesis or was slightly convex toward the neck, and that the mean bone-to-pseudocapsule distance was 2.9 mm. However, in the 11 symptomatic patients in whom no evidence of infection was revealed by cultures, th mean distance was 4.7 mm; in the remaining six patients, whose joints were infected (a condition strongly suggested by the presence of extracapsular fluid), the mean distance was 5.5 mm, with no significant difference between the two groups. CONCLUSION: Sonography can be used to evaluate normal caspular morphology after total hip replacement and to diagnose infection around hip prostheses. In all patients in whom sonography revealed the presence of extra-articular fiuid, infection had occurred.
Arthroplasty, Replacement, Hip* ; Female ; Hip Prosthesis ; Humans ; Joints ; Male ; Neck ; Prostheses and Implants ; Transducers ; Ultrasonography*

PURPOSE: To measure the normal size of the styloid process using 3D (three-dimensional) reconstruction CT. MATERIALS AND METHODS: We retrospectively analyzed 3D reconstruction images obtained after coronal and axial CT scanning of the temporal bone or neck of 115 patients. The length and shape of both sides of the styloid process, the location of its tip, and calcification of the stylohyoid ligament were retrospectively analysed. RESULTS: The mean length of the styloid process was 26.6 (+/-7.9)mm on the right side, and 26.4(+/-8.3)mm on the left, a statistically insignificant difference (p=0.694). Its mean length was 26.2 (+/-8.5)mm in men and 26.7 (+/-7.2)mm in women, a statically in significant difference (p=0.733). As for variation with age, mean length tended to increase until the third decade, but not beyond. Segmental type (104/230, 45.2%) and fragmental type (73/230, 31.7%) were more commonly seen in shape of styloid process, and tapering tip of styloid process (156/230, 67.9%) is more commonly seen than clubbing tip of it (74/230, 32.1%). The process was angulated in six cases (2.6%); its tip was more frequently located between the internal and external carotid artery (211 cases, 91.7%) than more medially (19 cases, 8.3%). In the former location, the length of the process was 26.2(+/- 7.2)mm, and in the latter, 37.0(+/-6.0)mm. The difference was statistically significant (p=0.000). Calcification had occurred in 33 cases (14.3%). CONCLUSION: The length of a normal styloid process was 18-32 mm. There were no statistically significant differences between its two sides, or between the sexes. Length tended to increase until the third decade, but not beyond. Predominantly the tip was located between the internal and external carotid artery, though the process was longer when its tip was located medially.
Carotid Artery, External ; Female ; Humans ; Ligaments ; Male ; Neck ; Retrospective Studies ; Temporal Bone ; Tomography, X-Ray Computed

No abstract available.
Baclofen* ; Drug Therapy, Combination* ; Hiccup* ; Omeprazole*

PURPOSE: Penile circular fasciocutaneous flap urethroplasty is a useful technique for a long anterior urethral stricture due to the flap's hairless nature and ample length. We investigated the surgical outcomes of urethroplasty for a complex anterior urethral stricture, performed using a penile circular fasciocutaneous flap. MATERIALS AND METHODS: Between 2008 and 2013, we performed a retrospective review of 29 patients who underwent urethroplasty using a penile circular fasciocutaneous flap and had at least 6 months of follow-up. A total of 20 cases utilized only a fasciocutaneous flap, while 9 cases combined a fasciocutaneous flap with other surgery. Success was defined as no requirement of additional urethral instrumentation. RESULTS: The overall success rate was 68.9% (20 out of 29 cases) at a median follow-up of 19 months. Furthermore, fasciocutaneous flap urethroplasty rendered the actual stricture-free rate of 79.3%. The location of recurrence was mostly at the junction of the flap. Among 9 surgical failures, 5 cases were treated successfully by using an additional surgical procedure. Fistula repair was needed in 1 case 4 months later. Further, periodic urethral dilation was performed in the remaining 3 cases. The failure rate was significantly higher in patients with suprapubic cystostomy than in patients without suprapubic cystostomy. The most common complication was post-micturition dribbling. CONCLUSIONS: Penile circular fasciocutaneous flap urethroplasty is a useful method for the reconstruction of a long anterior urethral stricture. A sufficient healthy margin should be acquired for better surgical results due to the fact that most recurrence occurs at the junction of the flap.
Cystostomy ; Fistula ; Follow-Up Studies ; Humans ; Male ; Penis ; Recurrence ; Retrospective Studies ; Surgical Flaps ; Urethral Stricture*

PURPOSE: Penile circular fasciocutaneous flap urethroplasty is a useful technique for a long anterior urethral stricture due to the flap's hairless nature and ample length. We investigated the surgical outcomes of urethroplasty for a complex anterior urethral stricture, performed using a penile circular fasciocutaneous flap. MATERIALS AND METHODS: Between 2008 and 2013, we performed a retrospective review of 29 patients who underwent urethroplasty using a penile circular fasciocutaneous flap and had at least 6 months of follow-up. A total of 20 cases utilized only a fasciocutaneous flap, while 9 cases combined a fasciocutaneous flap with other surgery. Success was defined as no requirement of additional urethral instrumentation. RESULTS: The overall success rate was 68.9% (20 out of 29 cases) at a median follow-up of 19 months. Furthermore, fasciocutaneous flap urethroplasty rendered the actual stricture-free rate of 79.3%. The location of recurrence was mostly at the junction of the flap. Among 9 surgical failures, 5 cases were treated successfully by using an additional surgical procedure. Fistula repair was needed in 1 case 4 months later. Further, periodic urethral dilation was performed in the remaining 3 cases. The failure rate was significantly higher in patients with suprapubic cystostomy than in patients without suprapubic cystostomy. The most common complication was post-micturition dribbling. CONCLUSIONS: Penile circular fasciocutaneous flap urethroplasty is a useful method for the reconstruction of a long anterior urethral stricture. A sufficient healthy margin should be acquired for better surgical results due to the fact that most recurrence occurs at the junction of the flap.
Cystostomy ; Fistula ; Follow-Up Studies ; Humans ; Male ; Penis ; Recurrence ; Retrospective Studies ; Surgical Flaps ; Urethral Stricture*

BACKGROUND: LORETA (Low Resolution Electromagnetic Tomography) produces a three-dimensional current density mapping from digitized EEG (electroencephalography) data. A comparison between visual waveform analysis of scalp EEG and LORETA method may be helpful for the exact localization of epileptiform discharges. METHODS: Digital EEG data from 20 subjects showing epileptiform discharges that were localized in the left or right frontotemporal regions (F7, F8) were studied. Those EEG waves were recorded using international 10~20 system. Phase reversals in bipolar montage were converted to referential montage and waveforms were analyzed visually. Those spike waves were converted into three-dimensional potential density mapping by LORETA method and maximum negative potential density region was determined. RESULTS: The same localization in the frontotemporal region (F7, F8) between two methods was noted in 16 subjects (80.0%). The discordant localization by LORETA method was noted in 4 subjects (20.0%). In different localiza-tion subjects, their locations were frontopolar region (Fp1, Fp 2) in 2 subjects, lateral temporal region (T7, T8) in 1 and posterior temporal region (P7, P8) in 1 subject, respectively. CONCLUSIONS: Even though the localization of epileptiform discharges by visual waveform analysis is a traditional method, electrical potential density mapping by LORETA can be a useful adjunctive localization method. If detailed localization is needed, LORETA method should increase accuracy.
Electroencephalography ; Magnets* ; Scalp