With the growing interests in the treatment of osteoporosis. percutaneous Vertebroplasty aimed at stabilizing and preventing progressiv eosteoporotic vertebral compression fracture has been tried. We analyzed 60 cases of vertebroplasty for senile osteporotic vertebvral compression fractures performed from April to August, 1999 at Wooridul Spine Hospital. We observed dramatic pain relief in almost cases within 6~72 hours(mean, 36 hours). Mean value of the Visual Analogue Scale(VAS) decreased from 8.3 to 2.8 after the procudure. The Operative complications were as follows ; epidural leakage(70 levels). Paraparesis(2 cases), Paravertebral venous leakage, Intradiscal leakage, foraminal leakage transient hypotension and transient apnea. This procedure is relatively safe and effective treatment modality for osteoporotic compression fracture. But much attention is required in selection of the cases such as severe crushing fracture, suspicions cortical fracture of the endplate and bursting fracture. The viscosity of the material and avoidance of rapid injection were important in preventing complications.
Aged* ; Apnea ; Fractures, Compression ; Humans ; Hypotension ; Osteoporosis ; Spine ; Vertebroplasty* ; Viscosity

PURPOSE: To evaluate a role as over 35 years, maternal serum markers, and a false positive screen for Down syndrome were the predictor of adverse pregnancy outcome. Materials and METHODS: From Mar.1994, through Feb.1996, 5284 women were screened triple test to detect Down syndrome in the second trimester and were delivered Samsung Cheil hospital. The values of each maternal serum markers were measured with radioimmunoassay. And then, the screen positive of Down syndrome was calculated using alpha-software Version 4.0. The adverse outcome of the fetus and the mother included low birth weight(LBW) ( <2500gm), prematurity( <37 gestational weeks), placenta previa, preterm premature rupture of membranes(PPROM), pregnancy induced hypertension(PIH),abruptio placenta, and intrauterine fetal death(IUFD). The predictor markers included over 35years, elevated alpha-fetoprotein (AFP), elevated human chorionic gonadotropin(hCG), lowered unconjugated estriol (uE3), and a false positive screen for Down syndrome. RESULTS: Mean age and mean gestational weeks in the study were 30+/-4.8 years and 17.1 weeks respectively. The adverse pregnancy outcomes were 357 LBW(6.8%), 253 prematurity(4.8%), 108 placenta previa(2.0%), 68 PPROM(1.3%), 66 PIH(1.3%), 24 abruptio placenta(0.5%), and 20 IUFD(0.4%). In univariate analysis, over 35 years was significantly associated with abruptio placenta, prematurity, and placenta previa, elevated MS-AFP( >2.0 MoM) associated with IUFD, LBW, PIH, prematurity, and PPROM , elevated MS-hCG (>3.0 MoM) associated with IUFD, LBW, PIH, prematurity, and placenta previa, lowered uE3 (<0.75) associated with IUFD, abruptio placenta, LBW, and prematurity.(P <0.05). In multivariate logistic regression analysis, IUFD was significantly associated with only elevated MS-AFP, LBW associated with elevated MS-AFP, elevated MS-hCG, and lowered uE3, PIH associated with only elevated MS-AFP, PPROM only elevated MS-AFP, prematurity only elevated MS-AFP, and placenta previa over 35 years, elevated MS-hCG.(P <0.05). However, abruptio placenta was not significantly associated with predictor markers.(P >0.05) CONCLUSIONS: Some predictors such as over 35 year, elevated hCG, lowered uE3, a false positive screen for Down syndrome were significantly associated with adverse pregnancy outcome. Also in multivariate analysis, we identified especially elevated AFP to be the most reliable predictor for adverse pregnancy outcome.
alpha-Fetoproteins ; Biomarkers ; Chorion ; Down Syndrome ; Estriol ; Female ; Fetus ; Humans ; Logistic Models ; Mothers ; Multivariate Analysis* ; Parturition ; Placenta ; Placenta Previa ; Pregnancy ; Pregnancy Outcome* ; Pregnancy Trimester, Second ; Pregnancy* ; Radioimmunoassay ; Rupture

In literatures, most of the studies of severe hyponatremia during or following its treatment has been concentrated with special references to the rate of correction and its neurologic outcomes. But, there is relatively few ones analyzing the diverse clinical manifestations of neurologic symptorns or complications during the course of treating severe hyponatremia. We experienced a catastrophic course related to hyponatremia in a 51 year woman with severe rheumatoid arthritis, who underwent knee joint replacement, and this case revealed the initial transient neurologic recovery for 3 days by the initial rapid correction of hyponatremia, then followed by delayed deterioration of osmotic demyelination syndrome leading to locked-in syndrome. Reported cases with similar clinical course (biphasic course) in the world lituratures were reviewed with special interests in the initial maximum rate of correction of hyponatremia and radiologic findings. This review suggests that clinicians treating the patients with severe symptomatic hyponatremia should be aware of the possibility of delayed neurologic sequelae despite the recovery of neurologic status as well as the degree of hyponatremia in the early treatment course of hyponatremia.
Arthritis, Rheumatoid ; Demyelinating Diseases* ; Female ; Humans ; Hyponatremia ; Knee Joint ; Quadriplegia

Macrocephaly commonly occurs in children with untreated or neglected hydrocephalus, and in most cases this is accompanied with discrepancy between the volume of the brain and the cranial cavity. Macrocephaly usually interferes with head control, seating, locomotion, and social acceptance. So the goals of the reduction cranioplasty lie in reconstruction of the head shape, control of intracranial pressure, obstruction of the growth of the head, which enables to ambulate. However, reports about surgery of macrocephaly are scanty. A 24-month-old girl suffered from hydrocephalus with macrocephaly. Her head circumference was 71cm and couldn't control her head or lie in lateral position. The surgical technique we used was a one-stage operation, using a sagittal hinge flap. This technique includes infracturing with wedge resection of the marginal skull and pushing it inward. The dura mater in the frontal region was plicated, while care was taken to maintain attachment of the superior sagittal sinus, the fixation was done with microplates, screws and wirings. After the operation, she had no air embolism, venous infarction, infection, neurologic deficit and had satisfactory cosmetic results. History of the operation of macrocephaly, tactical considerations and possible risks are discussed with our surgical experience in this publication.
Brain ; Child ; Child, Preschool ; Dura Mater ; Embolism, Air ; Female ; Head ; Humans ; Hydrocephalus ; Infarction ; Intracranial Pressure ; Locomotion ; Macrocephaly* ; Neurologic Manifestations ; Publications ; Skull ; Social Distance ; Superior Sagittal Sinus

The authors analysed 39 cases chronic subdural hematoma admitted to the Department of Neurosurgery, Seoul Red Cross Hospital from January 1990 to June 1993. The results were as follows : 1) The ratio of male versus female was 6.8 : 1 and the incidence was predominant in patients whose ages were over 50. 2) Past history of head trauma was found in 28 cases(72%) and head trauma with habitual alcoholism was found in 6 cases(15%). 3) Symptoms and signs at admission were headache(90%), hemiparesis(62%), mental change(46%) and vomiting(36%). 4) The densities of hematoma shown in Brain CT scan were iso, hypo, mixed, and hyperdense and the shapes of hematoma were crescenteric, planoconvex, and biconvex in order of frequency. 5) We have found an association between the neurologic grade at admission and the prognosis, and noted full recovery in 33 cases(84%) and no death as a result of the 2-burr hole trephination.
Alcoholism ; Brain ; Craniocerebral Trauma ; Female ; Hematoma ; Hematoma, Subdural, Chronic* ; Humans ; Incidence ; Male ; Neurosurgery ; Prognosis ; Red Cross ; Seoul ; Tomography, X-Ray Computed ; Trephining

A case of Cessation of massive vaginal bleeding after TAE in giant Arteriovenous Malformation (AVM) of the Uterus. A 68-year old woman who had massive vaginal bleeding was diagnosed of AVM of uterus by ultrasonogram, CT, MRI, and angiography. In our case report, we tried transarterial embolization 2 times by spring coils and detachable balloons. She was treated successfully by TAE resulting in prompt cessation of life- threatened vaginal bleeding. Color and duplex doppler US is an appropriate modality for the detection and diagnosis of uterine AVMs and for follow-up after embolization. Transarterial embolization is a safe and effective method of treating this disease.
Aged ; Angiography ; Arteriovenous Malformations* ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Ultrasonography ; Uterine Hemorrhage ; Uterus*

OBJECTIVES: Paroxetine is known to have fewer cognitive side effects than older antidepressants such as amitriptyline. To confirm this objectively, we compared the effects of paroxetine on the psychomotor performance with those of amitriptyline in 10 healthy volunteers. METHOD: Paroxetine and amitriptyline were administered orally in a double-blind, two-way, single dose, crossover design. Assessments of psychomotor performances were carried out before and 2 and 6 hours after administration of single dose of paroxetine (40mg) or amitriptyline (50mg). Each treatment day was separated by 1 week of washout period. The psychomotor performances were measured using Vienna Determination Unit, Vienna Reaction Time, Vienna Signal Detection, Grooved Pegboard Test and Finger Tapping Test. The data were analyzed using two-way, repeated measures ANOVA on a crossover model. RESULTS: The results showed that paroxetine 40mg produced no significant performance decrements on the every test of psychomotor performances, whereas amitriptyline 50mg produced markedly impaired performance on most of the psychomotor tests. CONCLUSION: This study confirmed pervious findings that paroxetine is generally devoid of adverse side effects on psychomotor performance.
Amitriptyline* ; Antidepressive Agents ; Cross-Over Studies ; Fingers ; Healthy Volunteers* ; Paroxetine* ; Psychomotor Performance ; Reaction Time

PURPOSE: To determine the effect of central corneal thickness (CCT) on the measurement of intraocular pressure (IOP) and diagnosis of glaucoma on the resultant reclassification of patients as having primary open-angle glaucoma (POAG), normal tension glaucoma (NTG), or ocular hypertension (OHT). METHODS: Intraocular pressure (Goldmann applanation tonometry) and visual field test (Humphrey 24-2) were measured in 22 eyes of 23 patients with OHT, 20 eyes of 20 patients with POAG, 31 eyes of 31 patients with NTG, 27 eyes of 27 control subjects. CCT was measured and used to obtain a corrected value for the IOP and to reclassify the type of glaucoma. RESULTS: There was no significant difference in CCT between controls and patients with POAG, but the CCT in the group with NTG was significantly lower than that in the control group (p=0.012), and the CCT in the group with OHT was significantly higher than in controls (p=0.002). Correcting IOP for corneal thickness, 22.58% of patients with NTG could be reclassified as having POAG, and 56.52% of the patients with OHT as normal. CONCLUSIONS: Underestimation of the IOP in patients with POAG who have thin cornea may lead to a misdiagnosis of NTG, while overestimation of the IOP in normal subjects who have thick cornea may lead to a misdiagnosis of OHT. We suggest that CCT must be considered in diagnosis of glaucoma.
Cornea ; Diagnosis* ; Diagnostic Errors ; Glaucoma* ; Glaucoma, Open-Angle ; Humans ; Intraocular Pressure ; Low Tension Glaucoma ; Ocular Hypertension ; Visual Field Tests

BACKGROUND AND OBJECTIVES: A stellate ganglion block (SGB) induces vasodilatation in the head, neck, and upper extremities. Based on this principle, SGB has been widely used as one of the treatment modalities in sudden idiopathic sensorineural hearing loss (S-SNHL). However, until now, published data establishing the statistical significance of the effect of SGB has been slim. We conducted this study to find out the effect of SGB in the treatment of idiopathic S-SNHL and to find out the factors influencing the prognosis of the disease. MATERIALS AND METHODS: We reviewed the records of 221 patients seen in the past eight years between 1990 to 1997 who had an initial diagnosis of idiopathic S-SNHL and was admitted for treatment. One hundred twenty patients were treated with SGB and the other 101 patients were treated without SGB to use as a control group. RESULTS: The therapeutic result of SGB group was better than that of the control group. Especially, statistical difference was found in the following two subgroups; one in which the interval between the onset of disease and the initiation of treatment was from 8 to 28 days, and the other when the initial hearing loss was below 90 dB. CONCLUSION: We suggest that this study could be utilized as a standard of clinical treatment when SGB is performed.
Diagnosis ; Head ; Hearing Loss ; Hearing Loss, Sensorineural* ; Humans ; Neck ; Prognosis ; Stellate Ganglion* ; Upper Extremity ; Vasodilation

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