Chemonucleolysis with chymopapain has been shown to be an effective alternative to surgery for the treatment of Sciatica secondary to lumbar disc herniation after failure of conservative treatment. 92 lumbar herniated disc patients had been treated by chemonucleolysis in Eul Ji General Hospital during 3 years from March 1988 to 1991 and were evaluated clinically. 1) Of 92 patients, 60 patients(65%) were between 20 and 30 years old age group and male was predominent. 2) The lesion was the most common in L4-5space(52 patients, 56.6%). 3) The results were better in the younger group and the more limited straight leg raising group. 4) The excellent and good results were obtained in 82.6%. 5) In noncompensation cases, 69 patients(88.0%) had marked improvement, but in compensation cases, 7 patients(50%) had marked improvement. 6) In conclusion, above finding suggest that chemonucleolysis is a safe and effective nonsurgical method for treatment of herniated lumbar disc before surgical intervention.
Adult ; Chymopapain ; Compensation and Redress ; Hospitals, General ; Humans ; Intervertebral Disc Chemolysis ; Intervertebral Disc Displacement ; Leg ; Male ; Sciatica ; Spine*

No abstract available.
Hematoma*

No abstract available.

Ependymomas are originated from the ependymal cells and are mostly confined to the central nervous system. Rarely, they may occur in extradural sites such as skin or subcutaneous tissue of sacrococcygeal region. The myxopapillary ependymoma is the most common type of ependymoma in the sacrococcygeal region. We operated on 54-years old female with a sacrococcygeal mass. Tumor was removed totally and histologic study revealed as myxopapillary ependymoma. Clinicopathologic features are discussed along with pertienent literature.
Central Nervous System ; Ependymoma* ; Female ; Humans ; Middle Aged ; Sacrococcygeal Region ; Skin ; Subcutaneous Tissue

The authors present a case of intracranial chordoma in a 53-year-old woman who presented with gradual onset of dizziness, gait disturbance. Clinical features and various diagnostic findings are described.
Chordoma* ; Dizziness ; Female ; Gait ; Humans ; Middle Aged

65 consecutive patients with basal skull fracture admitted to Eul-Ji General Hospital, between March 1990 and March 1993 was carried out to study it's clinical and radiological presentations, complications, and outcomes. 1) Two thirds of the patients were between 20 and 40 years old and 82% were male. 2) 78% of the injuried were by traffic accidents and 17% were by fall down. 3) The outcomes of treatment were related to initial GCS(Glasgow coma scale) of the patients. 4) Clinical features were ear bleeding-54%, Racoon's eye-35%, hemotympaneum-32%, hearing loss-25%. 5) The combined lesions were skull fractures-43%, facial bone fractures-31%, subdural hematoma-19%, epidural hematoma-14%, and pneumocephalus-14%. 6) The combined cranial nerves injuried were facial nerve-32%, vestibulocochlear nerve-12%, oculomotor nerve-12%, abducens nerve-12%. 7) The location of basal skull fracture according to clinical feature and CT bone window were middle cranial fossa-54%, on anterior cranial fossa-22%, anterior and posterior cranial fossa-12%, posterior cranial fossa-2%. 8) Clinical features associated with types of petrous bone fractures were analyzed. 9) The time of onset and the degree of facial palsy had a influence on recovery of facial nerve function and the types of hearing loss had a role in recovery of hearing function. 10) CSF leakage were present in 16 cases and immediate type was more than delayed type. 11) Three patients(4.6%) developed meningitis, especially associated with CSF leakage and it's rate was higher when CSF leakage persisted over 1 week.
Accidents, Traffic ; Adult ; Coma ; Cranial Nerves ; Ear ; Facial Bones ; Facial Nerve ; Facial Paralysis ; Hearing ; Hearing Loss ; Hospitals, General ; Humans ; Male ; Meningitis ; Petrous Bone ; Skull Fractures* ; Skull*

No abstract available.
Hemangioblastoma* ; Spinal Cord*

OBJECTIVE: This study estimated the expected cost-effectiveness ratio expressed as the incremental cost per seizure-free day (SFD) gained and the incremental cost per quality adjusted life year (QALY) gained when using levetiracetam (LEV) as add-on therapy from a third-party payer perspective. METHODS: A 1-year dose-escalation decision-tree model comparing LEV plus standard therapy (ST) with ST alone was designed to combine transition probabilities, costs and outcomes. The short-term outcomes and probabilities were derived from a prospective, open-label clinical trial with 100 Korean adults with refractory partial epilepsy. All data for the direct medical costs were derived from Korean cost data extracted from reports published by the National Health Insurance Corporation. RESULTS: The average gain in SFDs attributed to LEV add-on was 18.3 days per patient per year and the incremental cost-effectiveness ratios (ICERs) for LEV add-on were US$ 44 per SFD per patient and US$ 11,084 per QALY gained. All sensitivity analyses showed that the model was robust to the assumptions made. CONCLUSION: The economic evaluation indicates that, given a wide range of assumptions, the increased cost of treating patients having refractory partial epilepsy with LEV may be partially offset by a reduction in other direct medical costs. This reduction is a consequence of an increase in the number of SFDs and improved quality of life.
Adult ; Epilepsies, Partial ; Epilepsy ; Humans ; Insurance, Health, Reimbursement ; Korea ; National Health Programs ; Piracetam ; Prospective Studies ; Quality of Life ; Quality-Adjusted Life Years

The authors analyzed the radiographs(brain CT and cerebral angiograms) and medical & surgical records of 54 cases of ruptured anterior communicating artery aneurysms resulted in operations at our hospital from January 1991 to December 1995. The results were summarized as follows: 1) The rate of incidence was found to be highest in sixth decade and the ratio of male to female was 1:1. 2) On the preoperative brain CT, ventricular or cerebral hemorrhage combined cases had high Hunt-Hess and Fisher grades. 3) Of 54 cases, hypertension was observed in 20 cases(37%). Hypertension had no effect on the admission Hunt-Hess and Fisher grades. 4) Classification of the anterior communicating artery aneurysms according to its directions were as follows; anterior direction in 57.4%, superior direction in 18.5%, posterior direction in 13%, inferior direction in 11.1%. 5) The afferent artery of anterior communicating artery aneurysms were as follows; left A1 in 38 cases(70.4%), right A1 in 12 cases(22,2%), bilateral A1 in 4 cases(7.4%). 6) The ranges of diameters of the aneurysm was as follows;6-10mm in 57.4%, below 5mm in 22.2%. 7) The posteriorly directing aneurysms showed less favorable preoperative state, and preoperative hydrocephalus was most common on the posteriorly directing aneurysms. 8) There was no significant relationship between direction of aneurysm and prognosis. However, better Hunt-Hess grades seem to correlate better prognosis. 9) The operation was performed by pterional approach in all cases, the approach side was selected for the presence of dominant feeding artery in 50 cases(92.6%). 10) Overall mortality rate was 1.8%, the patients who died are of the older age group and the cause of death was medical complication in 6 cases.
Aneurysm ; Arteries ; Brain ; Cause of Death ; Cerebral Hemorrhage ; Classification ; Female ; Humans ; Hydrocephalus ; Hypertension ; Incidence ; Intracranial Aneurysm* ; Male ; Mortality ; Prognosis

Bilateral hypoplasia of the internal carotid arteries is a rare condition. The authors experienced two cases of bilateral hypoplasia of the internal carotid arteries. In one case, a 46-year-old female patient, presented with subarachnoid hemorrhage. Internal carotid angiograms showed right hypoplastic internal carotid artery and left agenetic internal carotid artery. An aneurysm, believed to be the source of the subarachnoid hemorrhage, took origin from the trunk of the basilar artery. In another case, a 48-year-old male, presented with semicomatous mentality. Brain CT demonstrated intracranial hemorrhage on the parasylvian area, and high density on the basal cistern, quadrigerminal cistern and temporal horn of left lateral ventricle. Initially, aortic arch injection did not visualized the origin of the common carotid arteries. It revealed only the vertebral arteries and both external carotid artery originating from each vertebral artery. A selective left vetebral artery study demonstrated a communication between the hypertrophied basilar artery and the posterior cerebral arteries. The anterior and middle cerebral vessels, in turn, were opacified through the circle of Willis, via the posterior communicating arteries. In addition, an aneurysm, believed to be the sourse of the subarachnoid hemorrhage, took origin from the posterior cerebral artery. The cases of the bilateral hypoplasia of internal carotid artery with intracranial aneurysm are reported as above, together with literature review.
Aneurysm ; Animals ; Aorta, Thoracic ; Arteries ; Basilar Artery ; Brain ; Carotid Artery, Common ; Carotid Artery, External ; Carotid Artery, Internal* ; Circle of Willis ; Collateral Circulation ; Female ; Horns ; Humans ; Intracranial Aneurysm* ; Intracranial Hemorrhages ; Lateral Ventricles ; Male ; Middle Aged ; Posterior Cerebral Artery ; Subarachnoid Hemorrhage ; Vertebral Artery