The authors analyzed 105 cases of spinal cord tumor in regarding to the age, sex, location and distribution, clinical presentation and postoperative outcome. They were confirmed by pathologic study at the Kyung Hee Medical Cented from 1981 to 1991. The incidence of spinal cord tumors was slightly predominant in males. The most commom tumor was neurogenic tumor. The neurogenic tumor composed 43.8%(46 cases), and the rests were meningioma 15.2%(16 case), metstasis 10.5%(11 cases) and others. The tumor were located most frequently in the thoracic area(31.4%) and in the intradural extramedullary space(56.1%). Most common initial symptom of spinal cord tumors were pain and it's mean duration was 8.3 month. The patients were assigned to one of four groups according to their neurologic deficit. About 66.6%(70 cases) of the patients were included in Groups I and II(mild neurologic deficit), and others were classified in Groups III and IV(significant to severe neurologic deficit). Complete tumor removal was achieved in 70.4%(4 cases) of the patients, and subtotal removal was performed in 26.7%(28 cases), and biopsy was performed in 2.9%(3 cases). Among the 105 patients, the postoperative outcomes on dischage were recovery in 36 cases(34.3%), improved in 45 cases(42.9%), stationary state in 12 cases(11.4%), and progression in 12 cases(11.4%).
Biopsy ; Hospital Distribution Systems ; Humans ; Incidence ; Male ; Meningioma ; Neurologic Manifestations ; Spinal Cord Neoplasms ; Spinal Cord*

Two patients with basilar bifurcation aneurysm were treated by different approach, low lying posteriorly projecting aneurysm was clipped with subtemporal approach and high bifurcated basilar bifurcation aneurysm with multiplicity approached through pterional method. The author reviewed literature concerning the approaches of basilar bifurcation aneurysm.
Aneurysm* ; Deception ; Humans

PURPOSE: Henoch-Sch nlein purpura(HSP) is a common pediatric disease presenting most frequently with skin, gastrointestinal, joint and renal manifestations. The prognosis of HSP is mainly determined by the involvement of the kidney, but prognostic markers have not been established. We evaluated the patients who have HSP nephritis with nephrotic syndrome. METHOD: Clinical manifestations and laboratory findings were observed and analyzed in 34 cases with HSP which were manifested by nephrotic syndrome, hospitalized at Kyung Hee university Hospital during the period from Jan. 1990 to Dec. 1998. RESULTS: 1) Male to female ratio was 1.3:1, and mean age at onset was 8.3 year. 2) Mean duration from symptom onset to renal biopsy was 10.5 weeks. 3) Proportion of patients presenting with acute nephritis was 32.4%, gross hematuria 17.6%, microscopic hematuria 50%. 4) The findings of renal biopsy were 20 cases of grade II, 11 cases of grade III, 2 cases of grade I, 1 case of grade IV according to classification by ISKDC. 5) Patients with grade I were recovered with no residual defect, but patients with grade IV shows active renal disease(states C). CONCLUSION: Among the patients with Henoch-Sch nlein purpura accompanying nephrotic syndrome, more aggressive treatment might be needed in patients showing crescents formation on renal biopsy. A prospective study will be needed to explore the progression of this disease.
Biopsy ; Classification ; Female ; Hematuria ; Humans ; Joints ; Kidney ; Male ; Nephritis* ; Nephrotic Syndrome ; Prognosis ; Purpura ; Skin

No abstract available.
Animals ; Magnetic Resonance Spectroscopy* ; Rats* ; Skin*

The facial contour deformity can cause significant handicaps in social life and a psychological stress to the patient. From January 1991 to November 1998, ten patients were operated on for correction of facial contour deformities with three types of free flap: deepithelialized scapular (n = 6), deepithelialized groin (n = 3) and omental free flap (n = 1). The distribution of diseases were Romberg's disease (n = 3), hemifacial microsomia (n = 2), facial lipodystrophy (n = 1), sequelae after surgery (n = 3) and post-traumatic deformity (n = 1). The patient ages ranged from 12 to 42 years. An incision was made at preauricular (n = 3) or submandibular area (n = 7). After making a subcutaneous pocket just above SMAS, the flap was placed within the pocket. The microvascular anastomosis was performed using superficial temporal vessel (n = 3) or facial vessel (n = 6) as a recipient. The flap margin was sutured to the fascia or periosteum and fixed by bolster sutures to reduce gravitational migration. There were no flap loss. Flap revisions consisting of minor contour corrections were performed in eight patients. A stable restoration of facial contour was achieved in all patients. Microvascular free tissue transfer has the advantages that it can be used on the irradiated bed and restore a large defect of facial contour. The deepithelialized groin free flap is suitable for correction of generalized defect of facial contour such as hemifacial microsomia because of its abundance of fatty tissue. In the deepithelialized scapular free flap, the dorsal thoracic fascia can be folded and tailored into variable width and thickness to correct subtle deformity of facial contour such as Romberg's disease or facial lipodystrophy. The omental free flap is not considered the first choice in facial contouring surgery as it requires laparotomy and has a greater tendency to gravitational migration.
Adipose Tissue ; Congenital Abnormalities ; Facial Hemiatrophy ; Fascia ; Free Tissue Flaps ; Goldenhar Syndrome ; Groin ; Humans ; Laparotomy ; Lipodystrophy ; Periosteum ; Stress, Psychological ; Sutures

The author analyzed the r-CBF data of 19 patients who admitted to the Kyung Hee University Medical Center under the diagnosis of definite "Moyamoya" disease from 1983 to 1992. Seven of them were followed-up from 1 to 18 months. The results were as fllow : 1) In moyamoya disease patients, the mean hemispheric r-CBF has a tendency to be lower than that of healthy persons. 2) In moyamoya disease patients, the ipsilateral r-CBF also shows a tendency to be lower than that of contralateral side. 3) The 133Xe-inhalation method is one of useful methods to evaluate CBF in Moyamoya disease, especially for follow-up. 4) The results of follow-up study for Moyamoya disease by 133Xe-inhalation method corelate very well with the change in clinical status of the patients. 5) In Moyamoya disease patients, the follow-up by means of 133Xe-inhalation method is one of useful methods to select a good candidate for surgical treatment such as STA-MAC anastomosis.
Academic Medical Centers ; Diagnosis ; Follow-Up Studies ; Humans ; Moyamoya Disease*

BACKGROUND: The effect of spinal nitric oxide (NO) on mechanical allodynia brought about by Freund's complete adjuvant (FCA)-induced inflammation is not known. From our previous experiment nitric oxide synthase (NOS) inhibitor nitroG-L-arginine methyl ester (L-NAME) given intraplantarly during the induction period decreased a mechanical hyperalgesia occurring because of FCA-induced inflammation. Therefore, we investigated the spinal effect of NO on mechanical allodynia after the development of allodynia produced by FCA-induced inflammation in rats. METHODS: Male Sprague Dawley rats were prepared with lumbar intrathecal catheter implantation. Inflammation was induced in the rats by injecting 0.1 ml of FCA under halothane anesthesia. Behavioral tests were done 1, 3, 6, 24, and 48 hours after injection of FCA. In the other group, intrathecal L-NAME (10 microgram) was given prior to FCA injection to examine the effect of pretreatment. On postinjection day 2, either L-NAME (10 microgram) or methylene blue (10 and 30 microgram) was administered intrathecally after the baseline measurement. The withdrawal response on mechanical allodynia was assessed by applying von Frey filaments to the right lesioned hindpaw and contralateral paw (as control) at 15, 30, 45, 60, 90, and 120 minutes. Sodium nitroprusside was administered intrathecally to determine the reversal effect of increased threshold in the L-NAME group. RESULTS: Injection of FCA produced a significant mechanical allodynia over time. Pretreatment with L-NAME did not prevent such a mechanical allodynia. Intrathecal L-NAME, but not methylene blue, reduced the mechanical allodynia, which was reversed by sodium nitroprusside. CONCLUSIONS: Spinal NO is likely invloved in the mechanism of the development and maintenance of mechanical allodynia in a state of FCA-induced inflammation.
Anesthesia ; Animals ; Catheters ; Halothane ; Humans ; Hyperalgesia* ; Inflammation* ; Male ; Methylene Blue ; NG-Nitroarginine Methyl Ester ; Nitric Oxide ; Nitric Oxide Synthase ; Nitroprusside ; Rats ; Rats, Sprague-Dawley

BACKGROUND:Rocuronium is a non depolarizing muscle relaxant of rapid onset and of intermediate action duration. It is particularly suitable for short operation and rapid control airway. But, intravenous rocuronium cause pain and a withdrawal movement. The purpose of this study was to evaluate the effect of intravenous lidocaine on pain and withdrawal movement in patients receiving rocuronium. METHODS: The study was approved by our institutional review board, and informed consent was obtained from all patients. One hundred and twenty patients, ASA physical status 1-2 undergoing general anesthesia for elective surgery were randomly enrolled. Allergy history to trial drug, chronic pain, pregnancy, patient on analgesics, difficult vein access and deeply sedated patients were excluded. Patients were not premedicated, and had a 20-18 G intravenous catheter inserted into a hand dorsum before operation. On arrival in the operation room, routine non-invasive monitors were placed and the free flow of intravenous fluid without edema, redness or hardness was confirmed. A subparalyzing dose of rocuronium 0.06 mg/kg (RS group) or vecuronium 0.01 mg/kg (VS group) was administered after 2 ml of 0.9% NaCl in one group, and a subparalyzing dose of rocuronium 0.06 mg/kg (RL group) or vecuronium 0.01 mg/kg (VL group) was administered after 2 ml of 2% lidocaine injection in a second group. All patients then received 5 mg/kg of 2.5% thiopental sodium and 0.6 mg/kg rocuronium (RS and RL group) or 0.1 mg/kg of vecuronium (VS and VL group). Muscle relaxant-induced pain and withdrawal movements were assessed using 4-grade scales (0-3). Vein redness was measured just after administration and vein hardness five minutes after intubation using 4-grade scales (0-3). RESULTS: Incidence of pain (8.2 times) and withdrawal movement (6.2 times) was more frequent in the rocuronium group than in the vecuronium group (P< 0.01). Lidocaine pretreatment decreased the incidence of pain significantly (5.7 times, P < 0.01). CONCLUSIONS: Rocuronium causes more pain and withdrawal movements than vecuronium. Lidocaine pretreatment significantly reduced the incidence and severity of pain, and withdrawal movements in both groups.
Analgesics ; Anesthesia, General ; Catheters ; Chronic Pain ; Edema ; Ethics Committees, Research ; Hand ; Hardness ; Humans ; Hypersensitivity ; Incidence ; Informed Consent ; Intubation ; Lidocaine* ; Pregnancy ; Thiopental ; Vecuronium Bromide ; Veins ; Weights and Measures

Three cases of cerebral rete mirabile associated with aneurysms are presented. In two cases the aneurysms were located at the anterior communicating arteries, and in one at the peripheral portion of the middle cerebral artery. For the anterior communicating artery aneurysms, operations were performed. Based on these experiences, the difficulties and necessities of operations for the aneurysms associated with cerebral rete mirabilies are briefly discussed.
Aneurysm* ; Arteries ; Intracranial Aneurysm ; Middle Cerebral Artery ; Mirabilis ; Moyamoya Disease*

BACKGROUND: The effect of substance P (SP) on the hyperalgesia induced by inflammation is controversial, and as SP remains in the periphery just for a short period of time after release from the nerve ending, the contribution of SP on the development of sustained mechanical hyperalgesia in rats with inflammation is questionable. The purpose of this experiment is to evaluate the effect of SP on the development of mechanical hyperalgesia induced by Freund's complete adjuvant (FCA) using SP antagonist [D-Arg, D-Phe, D-Trp, Leu]-substance P (SPA). METHODS: Male Sprague Dawley rats were divided into four groups; control (normal saline) and three different doses of SPA (0.25 microgram, 2.5 microgram, 25 microgram/0.1 ml). Inflammation was induced in rats by injecting 0.15 ml of FCA intraplantarly. Rats showed typical hyperalgesia within 12 hours after injection and maintained it for about one week. To test the effect of SPA on the developement of inflammation, either SPA or saline was injected at 1 h before and at the time of FCA injection under light halothane anesthesia after a baseline test. The effect of SPA on hyperalgesia was assessed by measuring mechanical hyperalgesia at 2, 6, 12, 24 hrs and 4 days after injection of the drug. To test the effect of SPA on fully developed inflammation, tests were done 2 days after injection of FCA. Mechanical hyperalgesias were assessed at 15, 30, 60, 90, 120 min after the drug injections. RESULTS: SPA injected to suppress the initial SP spill over decreased the mechanical hyperalgesia in a dose dependent manner. SPA injected after the full development of inflammation also decreased mechanical hyperalgesia. CONCLUSIONS: SP released at the initial phase of inflammation as well as SP released after the development of inflammation are all important for the maintainance of mechanical hyperalgesia.
Anesthesia ; Animals ; Halothane ; Humans ; Hyperalgesia* ; Inflammation* ; Male ; Nerve Endings ; Rats* ; Rats, Sprague-Dawley ; Substance P*