The transpedicular screw fixation is known to be capable of providing more secure correctional, force and rigid fixation to the spine. But it is often accompanied by various complications, including stress shield effects, loosening in osteoporotic spine, pseudoarthrosis, hardware problems and long-term change in motion behaviors at the adjacent motion segment and etc. The purpose of this study is to compare the flexible and rigid rods system in terms of complications and problems for various degenerative lumbar diseases. From September 1991 to November 1994, 41 patients were operated with the flexible rods system (group A) and 39 patients with the rigid rods system (group B). They were followed up for more than 4 years. The flexible rods system was composed of 41 cases of Wiltse system and the rigid rods system was composed of 29 cases of Diapason, 8 cases of TSRH and 2 cases of CD instrument. The resuits of the study were as follows: 1. By standard Cobb lateral measurement, 7 cases in group A and 10 cases in group B showed significant loss of sagittal angle (>4), post-operatively. 2. Hardware failure was noted in 7 cases in group A and 10 cases in group B. In group A, rod bending was seen in 4 cases, rod breakage in 2 and screw loosening in one. In group B, screw loosening was observed in 5 and screw-rod locking mechanism failure in 5 cases. 3. In spondylolisthesis patients, 10 cases in group A and 14 in group B, there was no statistically significant differences between the two groups in the reduction rate immediately after surgery and loss of reduction at the last follow up. 4. Clinical results were good to excellent in 85.4% of patients in group A and 82.1% of group B. No statistically significant differences between the two groups were found, 5. No statistically significant differences between the two groups were found with respect to degenerative changes at the adjacent motion segment to the fused level and pseudoarthrosis.
Follow-Up Studies ; Humans ; Pseudarthrosis ; Spine* ; Spondylolisthesis

With the radioactivity clearance curve of 99mTc-DTPA which was injected into the flusing device, the authors measured cerebrospinal fluid(CSF) flow rate through the shunt tube. The CSF flow rates in resting state in control group and malfunction group were considerably variable and there was no difference of CSF flow rates between the two groups. The significance, advantages, and problems of CSF flow rate measurement were discussed. The changes of CSF flow rate according to physiologic and pathologic fluctuation of intracranial pressure(ICP) should be taken into consideration for a valuable clinical application of this study.
Radioactivity

To test the hypothesis that hyperinsulinemia and/or abnormalities of red cell membrane Na^+ transport are concerned in the pathogenesis of hypertension, we investigated the relationship between blood pressure, insulin level and red cell membrane Na^+ transport in patients with acromegaly which is frequently associated with hypertension, hyperinsulinemia and abnormalities of red cell membrane Na^+ transport.The results were as follows;1) BMI and both systolic and diastolic blood pressure were significantly higher in patients with acromegaly than in control subjects.2) Fasting glucose and insulin levels were higher, and both serum glucose and insulin responses after a 75g glucose load were significantly increased in patients with acromegaly as compared with control subjects.3) Vmax of Na^+-Li^+ countertransport were significantly higher in patients with acromegaly than in control subjects while red cell Na^+ concentration and Vmax of Na^+, K^+ ATPase were similar in the two groups.4) In multiple stepwise regression analysis, age was directly correlated with both systolic and diastolic blood pressure in acromegaly. On the other hand both insulin level and red cell membrane Na^+ transport showed little correlation with either systolic or diastolic pressure. 5) Prevalence of hypertension in acromegaly was 39%(9 out of 23) and only age except for blood pressure was significantly higher in hypertensive acromegalic patients than in normotensive acromegalic patients while GH level, insulin levels and red cell membrane Na^+ transport were similar in the two groupsThese results suggest that hyperinsulinemia or abnormalities of red cell membrane Na^+ transport are not causally related to hypertension in patients with acromegaly.
Acromegaly ; Adenosine Triphosphatases ; Blood Glucose ; Blood Pressure ; Cell Membrane ; Fasting ; Glucose ; Hand ; Humans ; Hyperinsulinism ; Hypertension ; Insulin ; Prevalence

Congenital chylothorax is a rare disorder and can be diagnosed by prenatal ultrasonography recently. Most cases of congenital chylothorax were characterized by different clinical courses of respiratory distress. We describe two female cases with congenital chylothorax observed by ultra- sonography prenatally. In the first case, left-sided pleural effusion was noted by prenatal ultrasonography taken at 34 weeks of gestation, and then pleural fluid was extracted by intrauterine thoracentesis under sonography guidance. After birth, this patient was managed by TPN(total parentral nutrition) and intermittent thoracentesis without surgical treatment. But, pleural fluid was accumulated recurrently and respiratory distress was aggravated. At 15th hospital day, shock state was developed and patient died. In the second case, bilateral pleural effusion and ascites were noted by prenatal ultrasonography, and then patient was delivered immediately without intrauterine thoracentesis. After birth, the second case received conservative therapy including mechanical ventilation, TPN, intermittent thoracentesis and paracentesis. The patient was discharged with complete regression of chylothorax. We report the two cases with brief review of related literatures.
Ascites ; Chylothorax* ; Female ; Humans ; Paracentesis ; Parturition ; Pleural Effusion ; Pregnancy ; Respiration, Artificial ; Shock ; Ultrasonography, Prenatal*

No abstract available.
Thrombosis*

No abstract available.
Pneumothorax* ; Thoracotomy*

No abstract available.
Humans ; Hypoplastic Left Heart Syndrome* ; Survivors*

The infusion edema model was applied to study the effect of l-glutamic acid on the central conduction time of the cat somatosensory pathway which was compromised in the deep white matter by infusion known amount of l-glutamic acid and physiologic saline in the left and right frontal respectively. According to the different acidity of the l-glutamic acid three groups A(pH=3.22), B(pH=5.13), and C(pH=7.39) were made, but the concentration of glutamic acid was 20m Mol/L in all groups. Infusion of normal saline(0.9%, pH=5.11) into the right frontal deep white matter was common in all groups. During 4 hours of slow infusion of the infusates (average 0.48ml in each side totally) central conduction times were measured every hour via contralateral median nerve stimulation, bilaterally. Finally the cat was sacrificed and specimens of the edematous white matter obtained bilaterally. Finally the cat was sacrificed and specimens of the edematous white matter obtained bilaterally at the corresponding points and percentage water content was measured. The results were as follows : 1) Overall average percentage water content was 82.36% and there was no statistically significant differences between the glutamic acid and saline infusion sites in each group. 2) The I-N1 interpeak latency was labelled as central conduction time(CCT), and overal baseline CCT was 5.04msec, 5.09msec, left and right side respectively. 3) The differences of CCT between glutamic and saline infusion edema were statistically significant in group A and B at 2, 3, 4 hours infusion, but the differences of CCT from the baseline value in the same side were absent in group A and B. In contrast, group C showed no differences in CCT between glutamic acid and saline infusion edema, but CCT comparisons with baseline value among same infusate were significantly prolonged at 4 hours infusion on both sides. Intergroup unpaired t-test for checking intergroup differences among the three glutamic acid groups showed no intergroup differences in CCT. 4) In the combined group the CCT was significantly different between the glutamic and saline sides at 2 hours(P<0.005), 3 hours(P<0.005), 4 hours(P<0.025) infusion. The comparison of each hour CCT with the baseline value showed statistically significant prolongation of CCT only in glutamic side at 3,4 hours infusion. The results indicate the l-glutamic acid which is normally present in brain edema fluid can modulate local biochemical milieu of the brain as to increase the CCT.
Animals ; Brain Edema* ; Brain* ; Cats* ; Edema ; Evoked Potentials, Somatosensory* ; Glutamic Acid* ; Median Nerve

No abstract available.
Insulinoma*

PURPOSE: To assess the role of the preoperative portal vein embolization (PVE) in patients in need of major hepatectomy. MATERIALS AND METHODS: Total of 11 cases consisted of Klatskin tumor (n:6), gallbladder cancer (n=2), and hepatocellular carcinoma (n=3). After percutaneous transhepatic puncture of portal vein (right:7, left:4), the embolization of 1st order branch of right portal vein was done with Gentamicin soaked Gelfoam cubes. Radiologically, the angle between the middle hepatic vein and the inferior vena cava was measured on pre- and post-PVE CT (F/U :10 days) to evaluate the hypertrophy of the left lobe. Clinically, amount and nature of the drained bile through the PTBD tube of both lobes were analyzed in 5 patients with Klatskin tumor. The interval between PVE & operation was 10-24 days. Operative findings & the changes of postop. total bilirubin were analyzed and the complication after procedure was checked. RESULTS: There was decrease in mean angle between the middle hepatic vein and the inferior vena cava from 35.9 degree to 23.9 degree, but it was insignificant statistically (p=0.09). The embolization of right portal vein was done and there was increase in amount of drained bile from the nonembolized left lobe by 2-3 folds 8-14 days after PVE. The color and consistency between both lobes were significantly different; right lobe was darker in color and softer in consistency. Postoperative total bilirubin increased by 2-3 folds 1 to 4 days after PVE and normalized 10 to 14 days after PVE. Most of the patients had mild abdominal pain and fever after PVE and 1 patient had localized hematoma at puncture site which was subsided spontaneously. CONCLUSION: The preoperative portal vein embolization is a useful method for minimizing postoperative liver failure in patients in need of major hepatectomy.
Abdominal Pain ; Bile ; Bilirubin ; Carcinoma, Hepatocellular ; Fever ; Gallbladder Neoplasms ; Gelatin Sponge, Absorbable ; Gentamicins ; Hematoma ; Hepatectomy* ; Hepatic Veins ; Humans ; Hypertrophy ; Klatskin's Tumor ; Liver Failure ; Portal Vein* ; Punctures ; Vena Cava, Inferior