BACKGROUNDS: Percutaneous radiofrequency neurotomy of posterior primary ramus has been in use as a treatment for persistent, mechanical low back pain for two decades. However, there has been limited studies regarding to prognostic factors related to outcome. We report our experience with at least 2-year follow up with special aftention on prognostic factors. METHODS: Of total 228 patients who underwent percutaneous radiofrequency neurotomy (PRN) of posterior primary ramus for refractory low back pain during last 3 years, 128 patients whose pain was considered to be originated from facets joints or their surrounding soft tissue and responded to temporary blocks were assigned to a group II. All patients had more than 6 months of pain. These patients were compared with 100 patients to whom PRN were provided for chronic nonspecific low back pain without all inclusion criteria (Group I). RF procedures were done under local anesthesia with C-arm intensifier guidance. Pain reliefs were estimated at 1week, 1month, 6months and 2 years using visual analog scale(VAS). For patients with more that 50% reduction of previous pain was regarded as positive responder. Various clinical variables such as age, sex, symptom duration, types of pain, bilaterality, and previous surgery were studied for prognostic factors. RESULTS: Positive responders were 56% at 1week, 46% at lmonth, 18% at 6months, and 13% at 2years after PRN in group I, and 78.9% at lweek, 75.4% at lmonth, 62.5% at 6months, and 54.7% at 2years in group II. Some variables were found to be significantly related to outcome including prominent local tenderness, percussion tenderness, combination of symptoms with pain on gefting up, extension, transitional movement, pain radiating to buttock and/or posterior thigh, and good immediate response. Age, sex, symptom duration, bilaterality, imaging study results, previous lumbar surgery, and degrees of pain relief from diagnostic block were not related to outcome. CONCLUSIONS: These results indicate that PRN of posterior primary ramus has a moderate overall long-term beneficial effect, with no morbidity in our series. But, the long-term good results will be anticipated only in properly selected patients with low back pain originating from facet joints and surrounding structures.
Anesthesia, Local ; Buttocks ; Follow-Up Studies ; Humans ; Joints ; Low Back Pain* ; Percussion ; Thigh ; Zygapophyseal Joint

BACKGROUND: Tracheal intubation for general anesthesia often leads to trauma of the airway mucosa, resulting in postoperative sore throat and hoarseness. Numerous studies have investigated the factors as contributing causes, but the influence of method of anesthesia induction and time for extubation of the endotracheal tube has not been systematically examined. The aim of this study was to establish the effects of the methods of anesthesia induction and timing of extubation on postoperative sore throat and hoarseness. METHODS: Eighty patients with ASA physical status 1 or 2 were randomly divided into four groups. Group 1 patients (n=20) recieved succinylcholine 1.0 mg/kg for intubation and early extubated ; group 2 patients (n=20) recieved succinylcholine 1.0 mg/kg for intubation and lately extubated ; group 3 patients (n=20) recieved pancuronium 0.1 mg/kg for intubation and early extubated ; group 4 patients (n=20) recieved pancuronium 0.1 mg/kg for intubation and lately extubated. All patients were interviewed 6, 24, 48, and 72 hrs after operation by an anesthesiologist in a double-blind manner. RESULTS: The incidence of sore throat at postoperative 6 and 24 hrs were decreased in group 3 compaired with group 1, 2, and 4 (p<0.05), respectively. The severity of sore throat at postoperative 6 hrs were decreased in group 3 compared with group 1, 2 and 4 (p<0.05), and that of postoperative 24 hrs were decreased in group 3 compared with group 1 and 2 (p<0.05), respectively. The severity of hoarseness at postoperative 6 hrs were decreased in group 3 compared with group 2 (p<0.05). CONCLUSIONS: We suggest that postoperative sore throat and hoarseness may be developed more when extubation was perfomed lately than early. Therefore, early extubation provide advantage in terms of reducing sore throat and hoarseness in limited cases of anesthesia.
Anesthesia* ; Anesthesia, General ; Hoarseness* ; Humans ; Incidence ; Intubation ; Mucous Membrane ; Pancuronium ; Pharyngitis* ; Succinylcholine

No abstract available.
Hemorrhage*

OBJECTIVE: The beneficial effect of decompressive craniectomy in the treatment of patients with uncontrolled intracranial hypertension is controversial. We conducted this study to evaluate the efficacy of decompressive craniectomy in patients with refractory intracranial hypertension. METHODS: We retrospectively investigated 38 patients who underwent decompressive craniectomy as the treatment of increased intracranial pressure in our hospital from October 1999 to March 2002. The causes of intracranial hypertension were traumatic brain injury(28 cases), cerebrovascular disease(8 cases), and tumor(2 cases). Age, Glasgow Coma Scale at admission, preop and postop, intracranial pressure and findings on Computed Tomography before and after decompressive craniectomy, and finally Glasgow Outcome Scale at 6 months after surgery were evaluated. RESULTS: Favorable outcome(good or moderate disability) was 39%(15 of 38 patients) and poor outcome(severe disability, vegetative state or death) was 61%(23 of 38 patients). Overall mortality rate was 47%(18 of 38 patients). After decompressive craniectomy, statistically significant decrease in intracranial pressure and improvement of midline shifting were observed. Two important prognostic factors in our study were neurological status before surgery and findings in follow-up brain CT after decompressive craniectomy. CONCLUSION: Decompressive craniectomy for the refractory intracranial hypertension is an effective strategy to decrease intracranial pressure. So it may contribute to improve the patient's outcome. But it is necessary to conduct the multi-institutional randomized prospective study to determine whether the decompressive craniectomy actually improves the patient's outcomes or not.
Brain ; Decompressive Craniectomy* ; Follow-Up Studies ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Humans ; Intracranial Hypertension* ; Intracranial Pressure ; Mortality ; Persistent Vegetative State ; Retrospective Studies

OBJECTIVE: Spinal tuberculosis-associated symptoms are not so unique as to immediately indicate the proper diagnosis in most cases. Distinguishing spinal tuberculosis (Pott's disease) from pyogenic spondylitis is often difficult, and lesions metastatic from systemic malignancy are the other major entity from which spinal tuberculosis must be distinguished. CLINICAL PRESENTATION: A 27-year-old male patient presented with a history of back pain after a minor trauma 1 month ago. Computed tomography and magnetic resonance imaging of the thoracic spine showed multiple osteolytic bone lesions at the bodies of T9, T10 and T11 vertebrae and the spinous processes of T12 and L1. Other noncontiguous osteolytic lesions were noted at S2 body and right sacro-iliac joint. INTERVENTION: To confirm the pathologic diagnosis, the patient underwent an open biopsy for the T12 and L1 spinous process lesions and a percutaneous transpedicular biopsy on T9, T10, T11 lesions. Frozen biopsy was reported as compatible with chronic granulomatous caseating necrosis without malignant cells. The final diagnosis was an atypical presentation of multiple spinal tuberculosis. The patient received an appropriate enteral anti-tuberculosis therapy and recovered without any complications. Follow-up MRI taken after a year of medical treatment revealed marked resolution of the lesions. CONCLUSION: Current research indicates the incidence of multi-level noncontiguous, remote vertebral tuberculosis is 1.1% to 16%. Because tuberculous spondylitis could represent variant and atypical pattern, the disease should be considered in differential diagnosis along with other diseases such as metastatic neoplasm, pyogenic spondylitis, especially when the radiologic studies are revealing multiple spinal lesions.
Adult ; Back Pain ; Biopsy ; Diagnosis ; Diagnosis, Differential ; Follow-Up Studies ; Humans ; Incidence ; Joints ; Magnetic Resonance Imaging ; Male ; Necrosis ; Spine ; Spondylitis ; Tuberculosis ; Tuberculosis, Spinal*

No abstract available.
Lymphoma, Non-Hodgkin* ; Spinal Cord Compression* ; Spinal Cord*

Schwannomas are the most common benign nerve sheath tumors originating in Schwann cells. With special conditions like neurofibromatosis type 2 or entity called schwannomatosis, patients develop multiple schwannomas. But in clinical setting, distinguishing schwannomatosis from neurofibromatosis type 2 is challengeable. We describe 58-year-old male who presented with severe neuropathic pain, from schwannomatosis featuring multiple schwannomas of spine and trunk, and underwent surgical treatment. We demonstrate his radiologic and clinical findings, and discuss about important clinical features of this condition. To confirm schwannomatosis, we performed brain magnetic resonance imaging, and took his familial history. Staged surgery was done for pathological confirmation and relief of the pain. Schwannomatosis and neurofibromatosis type 2 are similar but different disease. There are diagnostic hallmarks of these conditions, including familial history, pathology, and brain imaging. Because of different prognosis, the two diseases must be distinguished, so diagnostic tests that are mentioned above should be performed in caution.
Brain ; Diagnostic Tests, Routine ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Nerve Sheath Neoplasms ; Neuralgia ; Neurilemmoma* ; Neurofibromatosis 2 ; Neuroimaging ; Pathology ; Prognosis ; Schwann Cells ; Spine*

OBJECTIVE: We report our experience of percutaneous radiofrequency neurotomy(PRN) on the posterior primary ramus with at least two years follow up. METHODS: Two hundred and twenty-eight patients were underwent PRN on the posterior primary ramus for refractory low back pain during last three years. One hundred and twenty-eight patients were met all inclusion criteria indicating facetal originated pain(group II), and 100 patients were not(group I). Radiofrequency procedures were done in usual manner. Pain reliefs were estimated at 1 week, 1 month, 6 months and 2 years using visual analog scale. RESULTS: Positive responders were 56% at 1 week, 46% at 1 month, 18% at 6 months, and 13% at 2 years after PRN in group I, and 78.9% at 1 week, 75.4% at 1 month, 62.5% at 6 months, and 54.7% at 2 years in group II. Prominent local tenderness, percussion tenderness, pain on getting up, extension and transitional movement, radiating pain on buttock and/or posterior thigh, and good immediate response were found to be significantly related to outcome. And age, sex, symptom duration, bilateral symptoms, favorable imaging study results, previous lumbar surgery, and degrees of pain relief from diagnostic block were not. CONCLUSION: Percutaneous radiofrequency neurotomy on the posterior primary ramus has long-term beneficial effect, without any morbidity in our series. And the long-term good results will be anticipated after proper selection among patients with facet joints related low back pain.
Buttocks ; Follow-Up Studies ; Humans ; Low Back Pain ; Percussion ; Thigh ; Visual Analog Scale ; Zygapophyseal Joint

A 42-year-old female was admitted with an 11-month history of progressive spastic paraparesis and ataxic gait. Magnetic resonance imaging showed intraspinal space occupying lesion compressing the spinal cord posteriorly, located from C5 to T2 with iso to high signal intensity at T2-weighted images and high signal intensity at T1-weighted images. The patient underwent surgery for decompression of the affected spinal cord because of the progressive neurological deficit. At surgery, the lesion was intradural extramedullary lipoma composed with mature adipose tissue. Partial tumor removal to decompress the neural structures and laminoplasty to avoid postoperative instability and deformity were performed. Postoperatively, she demonstrated improvement in paraparesis and was able to walk without assistance. Though attempts to decrease the size of or even to totally remove a lipoma are not required to achieve satisfactory results and carry considerable risks of surgical morbidity, a careful and limited decompression of the affected spinal cord through a partial removal of the tumor and laminoplasty could result in a significant neurological improvement.
Adipose Tissue ; Adult ; Congenital Abnormalities ; Decompression ; Female ; Gait ; Humans ; Lipoma* ; Magnetic Resonance Imaging ; Paraparesis ; Paraparesis, Spastic ; Spinal Cord

The content of meconium in amniotic fluid(AF) is important for assessing the risk of several perinatal problems such as asphyxia, meconium aspiration syndrome and various perinatal infections. This estimate is usually performed subjectively by visual inspection. The purpose of this study is to develop the objective method for quantitative measurement of meconium content in AF. Absorption spectra and meconium-crit of the solutions with various concentrations of meconium were measured. EfFects of filtration and blood contamination on the measurement of meconium content were also estimated by the same methods. Optical densities(OD) were correlated with concentrations of meconium in the whole range of scanned wavelengths. A specific peak of meconium was not available but the highest OD around 410 nm was shown. OD were linearly related to the concentrations of meconium. Meconium-crits were also well-correlated with the concentrations of meconium. Filtration of AF as well as blood contamination in AF severely affected the measurement of meconium content in AF. From the results of this study, both the spectrophotometric method and meconium-crit couid be objective methods for measuring meconium content. Both methods had merits and shortcomings. Filtration and blood contamination should be avoided for the measurement of meconium content in AF. We hope that both or either one of the two methods will be clinically used.
Absorption ; Amniotic Fluid* ; Asphyxia ; Female ; Filtration ; Hope ; Infant, Newborn ; Meconium Aspiration Syndrome ; Meconium*