Heterotopic salivary gland tissue (HSGT) consists of salivary tissue in places where it does not normally exist. Usually, HSGT presents as a draining sinus or nodule of the neck. The pathogenesis of HSGT of the neck remains uncertain. But HSGT in the neck is most widely thought to arise from defective closures and ectodermal hetroplasia of the precervical sinus of His. HSGT in the neck is rare and only a few cases have been reported in Korea. We recently experienced a case of HSGT in the neck presenting as a fistula of the anterior lower neck. We thought this as a 2nd brachial cleft anomaly; however, biopsy revealed HSGT. HSGT in the neck should be considered as one of the causes of a neck mass or fistula in children. Herein, we report this case of HSGT with a literature review.

OBJECTIVE: Age is a strong predictor of mortality in traumatic brain injuries. A surgical decision making is difficult especially for the elderly patients with severe head injuries. We studied so-called 'withholding a life-saving surgery' over a two year period at a university hospital. METHODS: We collected data from 227 elderly patients. In 35 patients with Glasgow Coma Score 3-8, 28 patients had lesions that required operation. A life-saving surgery was withheld in 15 patients either by doctors and/or the families (Group A). Surgery was performed in 13 patients (Group B). We retrospectively examined the medical records and radiological findings of these 28 patients. We calculated the predicted probability of 6 month mortality (IPM) and 6 month unfavorable outcome (IPU) to compare the result of decision by the International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT) calculator. RESULTS: Types of the mass lesion did not affect on the surgical decision making. None of the motor score 1 underwent surgery, while all patients with reactive pupils underwent surgery. Causes of injury or episodes of hypoxia/hypotension might have affected on the decision making, however, their role was not distinct. All patients in the group A died. In the group B, the outcome was unfavorable in 11 of 13 patients. Patients with high IPM or IPU were more common in group A than group B. Wrong decisions brought futile cares. CONCLUSION: Ethical training and developing decision-making skills are necessary including shared decision making.
Aged* ; Brain Injuries ; Coma ; Craniocerebral Trauma* ; Decision Making* ; Humans ; Medical Records ; Missions and Missionaries ; Mortality ; Patient Participation ; Prognosis ; Pupil ; Retrospective Studies

OBJECTIVE: The purpose of this study is to investigate the risk factors for hematoma enlargement(HE) in the patients with spontaneous putaminal hemorrhage. METHODS: Among the 620 patients with putaminal hemorrhage admitted to our hospital during the period of 1990-2000, sixty patients(9.7%) had HE on the second computed tomographic(CT) scan at the interval of mean 38 hours after attack(range 1.8-168 hours). Clinical features and CT findings of these 60 patients with HE were compared with those of the remaining 560 patients without HE. RESULTS: Multivariate logistic regressional analysis revealed that the independent risk factors for HE were CT finding showing the separation of hematoma(odds ratio[OR] 3.5, 95% confidence interval [CI] 1.7-7.3, p=0.0006) or the hypodensity around or within hematoma(OR 2.5, 95% CI 1.2-5.6, p=0.0194), alcoholism(OR 4.8, 95% CI 2.0-11.7, p=0.0004), hematoma volume of 20-39cc(OR 2.54, 95% CI 1.0-6.3, p=0.0424), Glasgow Coma Scale(GCS) score of 8-11(OR 3.1, 95% CI 1.4-6.9, p=0.0046) and glutamic-pyruvic transaminase>50 IU/L(OR 6.54, 95% CI 2.1-20.5, p= 0.0013). CONCLUSION: Alcoholism and liver dysfunction appear to increase the risk of HE in putaminal hemorrhage. Particularly, careful observation for HE is needed in the patients who are GCS score of 8-11 at the time of admission, who have hematoma volume of 20-39cc and the CT finding showing the separation of hematoma or the hypodensity around or within hematoma.
Alcoholism ; Coma ; Hematoma ; Humans ; Liver Diseases ; Logistic Models ; Putaminal Hemorrhage* ; Risk Factors*

OBJECTIVES: Criteria for evaluating the results of treating low back pain vary widely. We examined the methods measuring the outcome in the papers of Journal of Korean Neurosurgical Society. METHODS: We selected all published articles describing the methods measuring the outcome of low back pain in the journal. They were classified into 3 periods such as period 1 for volume 1-20, 2 for volume 21-25, and 3 for volume 26-28. RESULTS: There are 25 articles in period 1, 44 in period 2, and 30 in period 3. The outcome was classified into 0 to 5 classes by more than 15 different methods. Although the terms and descriptive criteria differ, 4 classes were the most common classification, being 16 in period 1, 39 in period 2, and 19 in period 3. The outcome was usually measured by authors' own method in period 1. In period 2, criteria by Gill et al was most commonly used along with many different criteria. Criteria by Prolo et al became a common method in period 3. CONCLUSION: Varying methods compromised comparative analyses of outcome. A more simple and universally applicable criteria is necessary to facilitate comparisons among various methods of treatment.
Animals ; Classification ; Gills ; Humans ; Low Back Pain* ; Spine

Central diabetes insipidus caused by pineal gland neoplasm is rare. Here, we describe a case of central diabetes insipidus and pineal germinoma with seeding to pituitary stalk along CSF pathway. A 27 year-old male patient was admitted due to polyuria, polydipsia, headache, vomiting, diplopia, and decreased visual acuity for recent two months. Urine osmolality measured after water deprivation was below 100mOsm/kg. However, urine osmolality increasd above 300 mOsm/kg with pitressin administration. Brain MRI showed a 2cm sized mass with seeding into pituitary stalk along CSF in pineal region. Surgical biopsy revealed pineal germinoma. Two cycles of chemotherapy with etoposide and cis-platin were done followed by brain irradiation(2,500cGy). Follow up brain MRI after second chemotherapy showed complete remission. The patient had no neurologic and endocrinologic deficit after the treatment.
Adult ; Biopsy ; Brain ; Diabetes Insipidus* ; Diabetes Insipidus, Neurogenic ; Diplopia ; Drug Therapy ; Etoposide ; Follow-Up Studies ; Germinoma ; Headache ; Humans ; Magnetic Resonance Imaging ; Male ; Osmolar Concentration ; Pineal Gland ; Pinealoma ; Pituitary Gland ; Polydipsia ; Polyuria ; Vasopressins ; Visual Acuity ; Vomiting ; Water Deprivation

BACKGROUND: Oxytocin may cause adverse cardiovascular effects, including tachycardia and hypotension, whereas the optimal dose of oxytocin at elective cesarean section is unclear. To determine the lowest effective dose of oxytocin, we studied the hemodynamic effects of three doses during spinal anesthesia for elective single cesarean delivery. METHODS: Sixty women received oxytocin by continuous (0.5 IU/min) or bolus-continuous (2 or 5 IU prior to 0.25 IU/min continuous intravenous injection) intravenous injection after clamping of the umbilical cord. We compared changes in heart rate (HR), mean arterial pressure (MAP) and estimated blood loss (EBL). Uterine tone (UT) was assessed by palpation on a linear analog scale (LAS) at 5, 10, 15, 20 and 25 minutes after the oxytocin injection. In addition, oxytocin-related side-effects such as nausea and vomiting were recorded. RESULTS: Marked hemodynamic changes such as HR and MAP occurred in the bolus-continuous groups but not in the continuous groups. Although we were not able to observe a variation of EBL in each group, the UT significantly increased in the bolus-continuous groups when compared with that the continuous groups. In addition, the hemodynamic changes such as HR and MAP were lower in the two IU bolus-continuous group than those in the five IU group. CONCLUSIONS: Although bolus-continuous injection of oxytocin resulted in more hemodynamic changes than continuous injection, bolus-continuous injection had a greater effect on uterine contraction. Furthermore, two IU bolus-continuous injection showed lower hemodynamic changes than in the five IU bolus-continuous injection.
Anesthesia, Spinal ; Arterial Pressure ; Cesarean Section ; Constriction ; Female ; Heart Rate ; Hemodynamics ; Humans ; Hypotension ; Injections, Intravenous ; Nausea ; Oxytocin ; Palpation ; Pregnancy ; Tachycardia ; Umbilical Cord ; Uterine Contraction ; Vomiting

OBJECTIVES: This study aimed to investigate the correlations between neurological and psychiatric symptoms at two weeks after stroke. METHODS: For 412 stroke patients, stroke severity was evaluated by the National Institutes of Health Stroke Scale (NIHSS), disability by the Barthel Index(BI) and modified Rankin Scale(mRS), cognitive function by the Korean Mini-Mental State Examination(K-MMSE), and muscle power by grip strength. Psychiatric symptoms were assessed by Symptom check list-90-Revision(SCL-90-R), consisted of nine symptom domains : Somatization, Obsessive-compulsive, Interpersonal sensitivity, Depression, Anxiety, Hostility, Phobic anxiety, Paranoid ideation, Psychoticism, and Additional items. The correlations between the neurological and psychiatric symptoms were investigated at the time of admission and before discharge(i.e. before and after treatment). RESULTS: At the time of admission, NIHSS score was associated with scores on Phobic anxiety and Additional items ; and scores on BI and mRS were associated with Depression, Phobic anxiety and Additional items. At the time of discharge, NIHSS score was associated with scores on Somatization, Depression, Phobic anxiety, and Additional items ; scores on BI and mRS were associated with scores on Depression, Phobic anxiety and Additional items ; MMSE score was associated with Obsessive-compulsive, Depression, Phobic anxiety, and Additional items ; and grip strength was associated with Somatization, Depression, Anxiety and Additional items. CONCLUSIONS: More severe neurological symptoms were associated with higher psychiatric morbidity particularly in depression, phobic anxiety, sleep and appetite disturbance at acute stage of stroke. More intensive psychiatric care and intervention are needed for the high risk group.
Anxiety ; Appetite ; Depression ; Hand Strength ; Hostility ; Humans ; Muscles ; National Institutes of Health (U.S.) ; Neurologic Manifestations ; Stroke

Reports of neural and non-neural injury associated with anesthesia have appeared in the medical literature. The majority of these injuries were due to improper patient positioning on the operating table and mostly correlated with the duration of surgery. We observed a case of lumbar disc herniation that was detected after general anesthesia in the traditional supine position. A 34-year-old woman underwent an operation for removal of uterine myoma. She complained of newly developed severe back pain that radiated down the lower right leg. HIVD L4~5 confirmed by lumbar MRI at POD 4th. We felt the cause of HIVD was related to the supine position or preexisting back pain with HIVD was exacerbated during surgery. This is possible to be prevented by evaluating the patient's postural limitation during the visit before anesthesia, padding under lumbar area and a more appropriate position to suit the patient needs for example, Lawn-chair position. The patient was treated with epidural injection of steroid at pain clinic.
Adult ; Anesthesia ; Anesthesia, General* ; Back Pain ; Female ; Humans ; Injections, Epidural ; Leg ; Leiomyoma ; Magnetic Resonance Imaging ; Operating Tables ; Pain Clinics ; Patient Positioning ; Supine Position

Reports of neural and non-neural injury associated with anesthesia have appeared in the medical literature. The majority of these injuries were due to improper patient positioning on the operating table and mostly correlated with the duration of surgery. We observed a case of lumbar disc herniation that was detected after general anesthesia in the traditional supine position. A 34-year-old woman underwent an operation for removal of uterine myoma. She complained of newly developed severe back pain that radiated down the lower right leg. HIVD L4~5 confirmed by lumbar MRI at POD 4th. We felt the cause of HIVD was related to the supine position or preexisting back pain with HIVD was exacerbated during surgery. This is possible to be prevented by evaluating the patient's postural limitation during the visit before anesthesia, padding under lumbar area and a more appropriate position to suit the patient needs for example, Lawn-chair position. The patient was treated with epidural injection of steroid at pain clinic.
Adult ; Anesthesia ; Anesthesia, General* ; Back Pain ; Female ; Humans ; Injections, Epidural ; Leg ; Leiomyoma ; Magnetic Resonance Imaging ; Operating Tables ; Pain Clinics ; Patient Positioning ; Supine Position

The tissues of gluteal region including skin and underlying gluteus maximus muscle are used for reconstructions of head and neck deformities caused by trauma and lumbosacral defects caused by bed sores, and for reconstruction of breast. Moreover, gluteus maximus flaps were used for reconstruction of anal -and vaginal -sphincter dysfunctions after radical resection for treatment of cancer in anorectal or vaginal region. Because the knowledge on the precise course and branching patterns of the arteries supplying the gluteus maximus muscle enables the prediction of the safety of surgery, the perforating branches supplying skin and subcutaneous tissues which exited from the gluteus maximus muscle, the positions of the superior and inferior gluteal arteries exited from pelvic cavity under the gluteus maximus muscle, and the course of these arteries under surface of the muscle were investigated. Total ninety -one dissected gluteus maximus from 47 Korean cadavers (44 bilateral specimens and 3 unilateral specimens) were observed. The perforating branches exited from the gluteus maximus were divided into upper and lower parts. The superior gluteal artery supplied upper two fifth of gluteal region and the inferior gluteal artery supplied the rest of gluteal region. The positions of superior and inferior gluteal arteries exited from pelvic cavity were in 1 cm medial to upper one third point on connecting line from posterior superior iliac spine to greater trochanter of femur, and middle point on connecting line from posterior superior iliac spine to ischial spine, respectively. The courses of the superior and the inferior gluteal arteries were classified into four types by distribution patterns. The most common incidence (46.5%) was observed in the typical type (Type I) that the superior and inferior gluteal artery supplied the upper or lower part of gluteus maximus muscle, respectively. The incidence of type II that some branches of inferior gluteal artery run up to the area supplied by superior gluteal artery was 16.3%. In contrast to type II, the incidence of type III that some branches of superior gluteal artery run down to the area supplied by inferior gluteal artery was 18.6%. The incidence of Type IV that only superior gluteal artery supplied the muscle was 18.6%.
Arteries* ; Breast ; Buttocks ; Cadaver ; Congenital Abnormalities ; Femur ; Head ; Incidence ; Myocutaneous Flap* ; Neck ; Pressure Ulcer ; Skin ; Spine ; Subcutaneous Tissue