STUDY DESIGN: A case report. OBJECTIVES: To report a rare case of remote cerebellar hemorrhage (RCH), which was a complication after posterior decompression and lumbar interbody fusion (PILF). SUMMARY OF LITERATURE REVIEW: Remote cerebellar hemorrhage (RCH) after spinal surgery is a rare complication, and its cause is known to be due to a loss of cerebral spinal fluid (CSF) through the dural tear. Most of the literature has disclosed that early diagnosis and treatment of RCH is very important in the patient with suspicious symptoms. MATERIALS AND METHODS: A 57-year-old woman had posterior lumbar decompression and interbody fusion for the severe spinal stenosis at L4-5. During surgery, an accidental dural tear with CSF leakage occurred. The torn dura was sutured. Postoperatively, she developed nausea and a severe headache. Hypotension developed at postoperative 2 hours. A brain CT showed RCH. The patient was conservatively managed with clamping of the wound drainage. RESULTS: The nausea and severe headache were controlled and normal blood pressure could be maintained without dopamine therapy at postoperative day 2. The patient was discharged without any neurological deficit, and her consciousness was clear at postoperative 2 weeks. CONCLUSIONS: Persistent postoperative nausea, headache, and hypotension after repair of the torn dura may suggest that the treating surgeons pay careful attention due to the possibility of RCH, even though the amount of CSF leakage is small.
Blood Pressure ; Brain ; Consciousness ; Constriction ; Decompression* ; Dopamine ; Drainage ; Early Diagnosis ; Female ; Headache ; Hemorrhage* ; Humans ; Hypotension ; Lumbar Vertebrae ; Middle Aged ; Nausea ; Postoperative Nausea and Vomiting ; Spinal Stenosis ; Wounds and Injuries

STUDY DESIGN: A prospective study. OBJECTIVES: To introduce a new technique, direct vertebral rotation (DVR), and to compare the surgical results with those of a simple rod derotation (SRD). SUMMARY OF BACKGROUND DATA: Pedicle screw fixation, with a simple rod derotation maneuver, enables powerful coronal and sagittal plane corrections in scoliosis surgery. However, the ability for rotational correction is still unclear. METHODS: Thirty-eight AIS patients, treated with segmental pedicle screw fixation, were analyzed. The first group (n=17) was treated by DVR, and the second (n=21) by SRD. Having similar preoperative curve patterns, both groups were evaluated for the deformity correction and spinal balance. RESULTS: In the DVR group, the average preoperative AVR of 16.7 degrees was corrected to 9.6 degrees, showing a 42.5% correction, while in the SRD group, the correction was negligible, from 16.1 degrees to 15.7 degrees(2.4%). In the DVR group, the preoperative thoracic curve of 55 degreeswas corrected to 12 degrees(79.6%), and the lumbar curve from 39 degreesto 7 degrees(80.5%). In the SRD group, the preoperative thoracic curve of 53 degreeswas corrected to 17 degrees(68.9%), and the lumbar curve from 39 degreesto 16 degrees(62.2%). The average LIVT correction was 80.6 and 66.3% in the DVR and SRD group, respectively. There were statistically significant differences in the coronal curve, LIVT and rotational correction (p<0.05, Mann-Whitney u test). CONCLUSIONS: The segmental pedicle screw fixation with 'direct vertebral rotation'showed better rotational and coronal corrections than the 'simple rod derotation'.
Adolescent* ; Congenital Abnormalities* ; Humans ; Prospective Studies ; Scoliosis*

Even though suicide ranks as the fourth cause of death and is causing a significant loss in Korea, it seems that the conventional notion regarding suicide as a feasible way of solving a troublesome life situation hinders early recognition and proper management of suicide. This article reviews suicide prevention strategies recommended based on robust experience and scientific understanding of the characteristics of the suicide problem. In the UK, a suicide prevention strategy was formed at the national level suggesting significant goals to reduce the rate of suicide. In the US, the Institute of Medicine study committee examined the state of the science base, gaps in knowledge, strategies for prevention, and research designs for the study of suicide. This recommendation includes more science-based, coherent and well-coordinated multidisciplinary approaches, and thus suggests important practical recommendations for a suicide prevention strategy of Korea. The author concludes that suicide should be defined as a treatable and even preventable medical condition. Constructing a national network of suicide research, data surveillance, developing tools for suicide prevention including early detection and safety planning, and comprehensive insurance coverage are recommended.
Cause of Death ; Depression ; Institute of Medicine (U.S.) ; Insurance Coverage ; Korea ; Research Design ; Suicide

OBJECTIVES: The purpose of this study was to investigate the clinical characteristics and the risk factors of Intrauterine fetal death (IUFD). METHODS: We did retrospective review and investigated the risk factors from medical records of the 62 pregnancies with IUFD between January 2000 and December 2007. Also we statistically analyzed that maternal and perinatal risk factors compared with 3,887 live-birth pregnancies. RESULTS: The overall incidence of IUFD was 1.57%. The age distribution of mother with IUFD was between 21 to 41, and was highest in the 30 to 34 year old age group (41.94%). There were 29 cases (46.78%) with nulliparous and 5 cases (8.06%) with previous IUFD. IUFD was the most prevalent (48.39%) at 20-29 weeks of gestation and the sex ratio of male versus female fetus was 1.03:1. Most of cases (80.64%) were delivered vaginally (spontaneous labor: 62.90%, labor induction: 17.74%), and laparotomy was 19.35%. Risk factors were maternal obesity, infection, placental abnormality, advanced maternal age (> or =35), and unexplained cause in that order. 50 cases included more than two risk factors. The risk analysis showed statistically significant risk in preeclampsia (OR 2.733; 95% CI 1.408-5.306) and placental abruption (OR 5.190; 95% CI 2.165-12.441). CONCLUSION: Identification of risk factors for IUFD assists the clinician in performing a risk assessment for each patient. Clinicians need to be able to assess each patient's risk for IUFD and to have a low threshold to evaluate fetal growth in at-risk pregnancies.
Abruptio Placentae ; Age Distribution ; Cohort Studies ; Female ; Fetal Death ; Fetal Development ; Fetus ; Humans ; Incidence ; Laparotomy ; Male ; Maternal Age ; Medical Records ; Mothers ; Obesity ; Pre-Eclampsia ; Pregnancy ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Sex Ratio

Peutz-Jeghers syndrome (PJS) is a rare hereditary disease where the clinical manifestations are multiple harmatomatous gastrointestinal polyps and pigmentations of the skin. A harmatomatous polyp can develop at any part of the gastrointestinal tract, and the proximal small bowel is frequently involved. Intestinal obstruction, bleeding and intussusception, caused by GI polyps have been reported, which often require repeated surgery. A female patient presented with suffering of abdominal pain for two days duration. The patient was diagnosed with intussusception, and a resection and anastomosis of the small bowel was performed. The patient was treated for 15 days, and was discharged from the hospital without any particular complications. We report this case with a review of the literature.
Abdominal Pain ; Female ; Gastrointestinal Tract ; Genetic Diseases, Inborn ; Hemorrhage ; Humans ; Intestinal Obstruction ; Intussusception ; Peutz-Jeghers Syndrome ; Pigmentation ; Polyps ; Skin ; Stress, Psychological

Renal angiomyolipoma is composed of mature fats, smooth muscles and abnormal blood vessels which arises mainly from renal parenchyme and compresses the calyx or protrudes the renal cortex, but which extends into the renal cyst is rare. Recently it can be easily diagnosed preoperatively by several diagnostic modalities such as ultrasonography, computed tomography and several clinical signs associated with tuberous sclerosis, although it`s clinical and radiological features are similar with renal cell carcinoma. We report a case of renal angiomyolipoma without tuberous sclerosis, extending into the renalcyst, which was confused with renal pelvis tumor in a 73 years old male.
Aged ; Angiomyolipoma* ; Blood Vessels ; Carcinoma, Renal Cell ; Fats ; Humans ; Kidney ; Kidney Pelvis* ; Male ; Muscle, Smooth ; Tuberous Sclerosis ; Ultrasonography

PURPOSE: The prism-cover test has been known to be the most accurate method in measuring ocular angle deviation, but the Hirschberg test is used in poorly cooperative patients. To enhance the accuracy of Hirschberg test, we designed a geometric model using digital photographs. METHODS: Fifty normal volunteers were included in this study, who had no ocular disorders. Digital photographs were obtained in the subjects seated 2 m in front of the fixation targets and the camera was set 1 m in front of subjects. In each photograph, the apparent width of the cornea and the distance from the corneal light reflex to the limbus were measured using computer program for calculation of angle deviation. Then we compared the calculated angle deviation with the actual one. RESULTS: Calculated angle deviations with digital image photographs were corresponded to the actual ones from esodeviation 40delta to 10delta (p>0.05), whereas in esodeviation 60delta, 70delta and exodeviation, the larger the deviation angle, the larger the calculated angle composed with the actual one. CONCLUSIONS: Angle deviation measurement using digital photographs appears to be relatively precise and its clinical application will be available in measuring angle deviation of esodeviation.
Cornea ; Esotropia ; Exotropia ; Healthy Volunteers ; Humans ; Reflex

Autogenous bone grafts are frequently harvested for the purposes of bone union and stability. Ilium is the most common site for bone-graft harvesting. Although some donor site complications may be unavoidable, awareness of the anatomy and complications may aid in planning the approach and minimizing the risks. A tricortical graft from the anterior ilium should be taken at least 2cm posterior to the anterior superior iliac spine(ASIS). Iliac donor-site complications include pain, neurovascular injury, avulsion fractures of the ASIS, hematoma, infection, herniation of abdominal contents, gait disturbance, cosmetic deformity, violation of the sacroiliac joint, and ureteral injury. The neurovascular structures at risk for injury during iliac bone-graft harvesting include the lateral femoral cutaneous, iliohypogastric, and ilioinguinal nerves anteriorly and the superior cluneal nerves and superior gluteal neurovascular bundle posteriorly. Violation of the sacroiliac joint can be avoided by not penetrating the inner cortex. The caudal limit for bone harvesting should be the inferior margin of the roughened area anterior to the PSIS on the outer table to keep from injuring the superior gluteal artery. Strict observation of relevant anatomic considerations will help in avoiding these complications.
Arteries ; Congenital Abnormalities ; Gait ; Hematoma ; Humans ; Ilium ; Sacroiliac Joint ; Tissue Donors ; Transplants* ; Ureter

Acute pancreatitis is an uncommon complication of CAPD. The clinical diagnosis of acute pancreatitis is difficult, since the presenting features are similar to those of dialysis associated peritonitis, and a high index of suspicion is necessary. Serum amylase values three times greater than the upper limit of normal and effluent amylase greater than 100U/L are helpful in diagnosing acute pancreatitis in CAPD patients. We report a case of pancreatitis in a patient on CAPD in whom diagnosis was made by serum amylase, effluent amylase, abdominal sonogram.
Amylases ; Diagnosis ; Dialysis ; Humans ; Pancreatitis* ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis

PURPOSE: Polyglutamine diseases are a group of diseases caused by the expansion of a polyglutamine tract in the protein. The present study was performed to verify if polyglutamine disease transgenic Drosophila models show similar dysfunctions as are seen in human patients. METHODS: Polyglutamine disease transgenic Drosophila were tested for their climbing ability. And using genetic methods, the effects of anti-apoptotic gene bcl-2 and chemical chaperones on neurodegeneration were observed. Also, spinocerebellar ataxia 2 (SCA2) transgenic Drosophila lines were generated for future studies. RESULTS: Expanded forms of spinocerebellar ataxia 3 (SCA3) transgenic protein causes characteristic locomotor dysfunction when expressed in the nervous system of Drosophila but the anti-apoptotic gene bcl-2 shows no evidence of ameliorating the deleterious effect of the expanded protein. However, Glycerol, a chemical chaperone, seemed to reduce the toxicity, at least in the eyes of the transgenic flies. The level SCA2 expression is too weak in the transgenic SCA2 Drosophila for evaluation. CONCLUSION: SCA3 transgenic Drosophila show ataxic behavior as observed in human patients. Chemical chaperones such as glycerol may prove beneficial in this class of genetic disease, which has no current method of cure.
Diptera ; Drosophila* ; Glycerol ; Humans ; Machado-Joseph Disease ; Nervous System ; Spinocerebellar Ataxias