PURPOSE: We designed this study to evaluate the incidence of spinal cord injury and the results of surgical treatment of lower cervical spine injury, and to suggest a rational treatment guideline according to the stages of Allen's mechanistic classification of the lower cervical spine injury. MATERIALS AND METHODS: We reviewed the medical records and roentgenograms of 66 patients (49 men and 17 women), who were treated surgically for acute fracture and dislocation of the lower cervical spine since March. 1991 to March. 1996. These patients ranged in age from 17 to 68 years (average age- 38 years). We used Allen's mechanistic classification to analyze fractures in the lower cervical spine injury. We divided neurologic status by complete, incomplete, root injury and no neurologic deficit group, Surgical treatment was performed for those with unstable fracture/dislocation, progressive neurologic deficit with conservative care, neurologic deficit with spinal cord compression by fracture fragment or extruded disc material. Surgical approach was determined according to the site of lesion. We analyzed the surgical treatment results according to neurologic recovery, radiologic bone union and complications, We used chisquare test for statistical analysis of neurologic improvement between the different surgical treatments. RESULTS: Twenty-nine cases were distractive-flexion (DF) phylogeny, 19 cases were compressive-flexion (CF), 2 cases were vertical-compression (VC), 8 cases were compressive-extension (CE), and 8 cases were distractive-extension (DE) phylogeny. For definitive surgical treatments we performed anterior cervical discectomy and fusion (ACDF) in 25, ACDF with anterior stabilizaiton in 30, posterior fusion in 5, and circumferential fusion in 6. There was no neurologic recovery in complete cord injury. There were 32 cases of incomplete cord injury all 8 anterior cord syndromes had no neurologic recovery, among 22 patients with central cord syndrome 18 had neurolgic recovery in various degrees and 2 with Brown-Seguard syndrome showed significant neurologic recovery. In nerve root injury, all patients had complete neurologic recovery. There was no radiologic nonunion at all and it took 10.3 weeks in average for radiologic bone union. There were neurogenic bladder, bed sore, local kyphosis, duodenal ulcer, respiratory infection, persistent neck pain and superficial wound infection in complications. Summary and CONCLUSIONS: In extension (CE, DE) injuries with neurologic deficit, anterior approach should be recommended because the major pathology is located in the anterior structure of the cervical spine. In flexion (DF and CF) injuries with major posterior osteoligamentous disruption, posterior approach could fix the posterior structures. Anterior decompression and fusion should be followed whenever anterior pathology is compressing the spinal cord or nerve root. Posterior open reduction and fusion is necessary whenever there is unreduced facet joint dislocation with or with out neurologic deficit. To prevent the late local kyphosis and persistent neurologic deficit with neck pain after prolonged external immobilization with ACDF, anterior stabilization with a plate and screw system is necessary to augment the surgical treatment of the unstable lower cervical spine injury which necessitates anterior decompression.
Central Cord Syndrome ; Classification ; Decompression ; Diskectomy ; Dislocations ; Duodenal Ulcer ; Humans ; Immobilization ; Incidence ; Kyphosis ; Male ; Medical Records ; Neck Pain ; Neurologic Manifestations ; Pathology ; Phylogeny ; Pressure Ulcer ; Spinal Cord ; Spinal Cord Compression ; Spinal Cord Injuries ; Spine* ; Urinary Bladder, Neurogenic ; Wound Infection ; Zygapophyseal Joint

In view of the sparsity of report on normal and abnormal pattern of the major arteries during fetal life, the authors undertook investigation of the aortas, coronary arteries, renal arteries, and the umbilical arteries of 76 korean fetuses, ranging from 21/2 months to full-term, A normal pattern and its evolution of the intima, media, and the adventitia was described. The P. A. S. positive substance was most abundantly found in the media of the umbilical arteries, medium amount in the media and intima of the renal arteries and the aortas, and lesser amount in the media of the coronary arteries. A surprisingly high incidence of the alteration of the internal elastic membrane of the aorta simulating to the early lesions of atherosclerosis in adult and neonatal life was observed. In e1even instances, microcystic degeneration of the inner media of the aorta was observed, and its relationship to the idiopathic cystic medial necrosis and dissecting aneurysm was discussed.
Arteries/*embryology ; Arteriosclerosis/*etiology ; Female ; Histocytochemistry ; Human ; Korea ; Pregnancy

Nineteen patients suffering from post-traumatic intracerebral hematoma, being managed by stereotactic aspiration of hematoma were evaluated. The outcome in this series is quite satisfactory, with 58% of patients having a functional survival. Eight patients died, of which three patients died of brain swelling and 5 died of systemic causes such as respiratory failure, gastrointestinal(GI) bleeding, and renal failure. It is our belief that stereotactic aspiration is helpful in managing patients with traumatic intracerebral hematoma without herniation and wevere brain swelling.
Brain Edema ; Hematoma* ; Hemorrhage ; Humans ; Renal Insufficiency ; Respiratory Insufficiency

OBJECTIVES: There have been several studies documenting the changing level of the conus throughout infancy and childhood, but there is only a little detailed study that documents the range of conus positions in a living adult population, especially in Korean, without spinal deformity. METHODS: we made a sequential study of magnetic resonance images of the lumbar spine to determine the variation in position of the conus medullaris in 650 living korean adults population without spinal deformity who checked MRI to identify the cause of low back pain. The study population consisted of patients over the age of 16 years. A T1-weighted, midline, sagittal image was reviewed for identifying the postion of conus. This location was recorded in relation to the upper, middle, or lower third of the adjacent vertebral body or the adjacent intervertebral disc. RESULTS: The study group consisted of 305 men(47%) and 345 women(53%) with a mean age 45.9 years(range, 16-79 years). The conus existed commonly at the middle third of L1(131cases, 20.2%), at the L1-2 intervertebral space(129cases, 19.8%), and the lower third of L1(123cases, 18.9%). The mean position of conus was the lower third of L1(range, middle third of T12 to middle third of L3). Conclusions:The mean position of conus was at the lower third of L1(range, middle third of T12 to middle third of L3). This results was same as that of foreign study. Our results of living korean adult population could allow for safe clinical procedures such as lumbar puncture, spinal anesthesia, and help to explain the differences among observed neurologic injuries from fracture-dislocation at the thoracolumbar junction.
Adult* ; Anesthesia, Spinal ; Congenital Abnormalities ; Conus Snail* ; Humans ; Intervertebral Disc ; Low Back Pain ; Magnetic Resonance Imaging* ; Spinal Puncture ; Spine

PURPOSE: The main cause of flap loss in microsurgical tissue transfer is venous insufficiency. Whether or not multiple venous anastomoses prevents vascular thrombosis and reduces the risk of flap failure remains controversial. Some researchers are in favor of performing dual venous anastomoses, but the counterargument holds that performing a single venous anastomosis does provide advantages. MATERIALS AND METHODS: We carried out a retrospective analysis of 15 cases of anterolateral thigh free flap for extremity reconstruction performed between January 2011 and December 2013. The patients were categorized into two groups: group A that received a single venous anastomosis and group B that received dual venous anastomoses. The time of the anastomosis, size of the flap, complications of the flap, and survival rate of each group were analyzed. RESULTS: The total microsurgical time in the single venous anastomosis group ranged from 28 to 43 minutes (mean 35.9 minutes). The total time in the dual anastomoses group ranged from 50 to 64 minutes (mean 55.7 minutes). No statistically significant difference was found between the two groups with regards to postoperative complications and flap failure. CONCLUSION: Our study suggests that the use of a single venous anastomosis in the venous drainage of anterolateral thigh free flaps is a safe and feasible option for extremity reconstruction and provides shorter operative time and easy flap dissection.
Anastomosis, Surgical ; Drainage ; Extremities* ; Free Tissue Flaps* ; Humans ; Operative Time ; Postoperative Complications ; Reconstructive Surgical Procedures ; Retrospective Studies ; Survival Rate ; Thigh* ; Thrombosis ; Venous Insufficiency

No abstract available.
Cheek* ; Humans ; Psychotic Disorders*

This is a clinical observation of congenital anomalies in 97newborn infants associated with hydramnios. These infants were born at severance Hospital, Wonju Christian Hospital and Jeonju Presbyterian Hospital from Jan. 1966 to Aug. 1975. The results were as follows: 1. The frequency of hydramnios was 86 cases in 25,566 deliveries in that period, which was 0.34%. 40infants (41.2%) has congenital anomlies of 97 infants associated with hydramnios by adding twin babies. 2. Hydramnios was associated with high incidence of prematurity and low-birth-weight infant. Who also has high incidence of anomalies 3. The incidence of associating anomalies was 77.8%(75 cases) and multiple anomaly was noticed in 37.5%(15 cases)of these infants. The most common organ involved with these anomalies was central nervous system in 32.0% (24 cases). 13 cases of anencephaly was included. 4. The perinatal mortality rate was 46.4%(45cases) and 60.0%(27cases) of these were associated with congenital anomalies. 20 (60.0%) of 33 live-births with congenital anomalies were died in neonatal period.
Anencephaly ; Central Nervous System ; Gangwon-do ; Humans ; Incidence ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Jeollabuk-do ; Perinatal Mortality ; Polyhydramnios* ; Protestantism ; Twins

No abstract available.
Carotid-Cavernous Sinus Fistula* ; Facial Bones* ; Humans

BACKGROUND AND OBJECTIVES: The transradial approach for coronary intervention has a lower incidence of access site complications and can increase patient comfort after percutaneus tansluminal coronary angioplasty(PTCA). The purpose of this study is to compare procedural success and complication rates of percutaneous transradial coronary stenting which was performed by four operators in two hospitals with those using transfemoral approach. MATERIALS AND METHOD: From September 1998 to July 1999, one hundred seventy five consecutive patients(201 lesions) treated with coronary stent implantation were enrolled for this study : 84 patients underwent transradial coronary stenting(Radial Group), and 91 patients transfemoral coronary stenting(Femoral Group). RESULTS: Seven patients who failed coronary cannulation via radial artery were crossed over to the Femoral Group. The measurements of the radial artery were not done. Patient demographics were similar in both groups. Procedural success was similar in both group(95.2% in Radial Group vs. 97.8% in Femoral Group, p=S). All transradial coronary stenting were possible using conventional guiding catheters which are used in transfemoral intervention. Local vascular complication rates showed a trend toward a reduction in the Radial Group(2.4% vs. 8.8%, p=.06). CONCLUSION: This study showed the similarity in the safety and efficacy of transradial coronary stenting compared to those of transfemoral approach.
Catheterization ; Catheters ; Demography ; Humans ; Incidence ; Radial Artery ; Stents*

PURPOSE: To evaluate the efficacy of intravitreal dexamethasone implants for the treatment of macular edema (ME) due to branch retinal vein occlusion (BRVO) according to the duration of symptoms. METHODS: Thirty-one patients who received an intravitreal dexamethasone implant for ME due to BRVO were included in this retrospective study. The patients were divided into 2 groups. Group A included eyes with symptom duration less than 12 weeks and Group B included eyes with symptom duration of 12 weeks or longer. The main efficacy outcomes such as best-corrected visual acuity (BCVA) and central macular thickness (CMT) were measured at baseline and every 4 weeks over 24 weeks. Retreatment criteria included an increased CMT of 150 microm or reduction of logarithm of the minimal angle of resolution (log MAR) scores of at least 0.2. RESULTS: The CMT and BCVA improved significantly at each follow-up compared with the baseline (p < 0.001, p < 0.05, respectively). At 4 and 8 weeks after the first injection, CMT in Group A (285.3 +/- 19.9, 276.1 +/- 23.1 microm, respectively) was less than in Group B (310.3 +/- 37.5, 318.1 +/- 39.6 microm; p = 0.033, p = 0.001, respectively). At 4 weeks, the BCVA in Group A was better than in Group B (p = 0.009). Rate and timing of recurrence were not different between the 2 groups (p > 0.05). At 24 weeks, Group A showed less CMT and better BCVA compared with Group B (p = 0.043, p = 0.041, respectively). CONCLUSIONS: The intravitreal dexamethasone implant significantly reduced the CMT and improved BCVA in patients with ME due to BRVO. Patients with shorter symptom duration showed better anatomical and functional outcomes over 24 weeks. Early treatment with the intravitreal dexamethasone implant could produce better clinical results.
Dexamethasone* ; Follow-Up Studies ; Humans ; Macular Edema* ; Recurrence ; Retinal Vein Occlusion* ; Retinal Vein* ; Retinaldehyde* ; Retreatment ; Retrospective Studies ; Visual Acuity