A case of atlanto-axial dislocation caused by a pyogenic abscess was presented. A pyogenic abscess in the cervical region is rare and surgical treatment is indicated if the sign of spinal cord compression is present. The lesion was removed by transoral approach and effective decompression was obtained. We reviewed the literatures and discussed the advantage and applications of transoral approach in detail.
Abscess* ; Decompression ; Dislocations ; Spinal Cord Compression

The patients of developmental dislocation of the hip(DDH) are almost found after walking age because of early diagnosis of DDH in younger children is not easy. A controversy still exists as to the relative value of closed and operative management in the treatment of a child who has reached walking age. This study is a report of the results of 16 patients(17 cases) in developmental dislocation of the hip who have visited our hospital at the age of 9 months to 3 years old, and have been followed more than 12 months (12-112 months) on review of plain radiographs and arthrograms. The results were as follows 1. The age at diagnosis was 16.4 months(9-31 months) in average. The methods of treatment were conservative for 8 cases, and operation for 4 cases and secondary operation for 5 cases who were failed with conservative therapy. 2. By Severin's radiologic grade, the result was good in 4 cases, fair in 3 cases and poor in 1 case in conservative treatment. In operative treatment, fair was in 2 cases and poor in 2 cases. In secondary operative -patients who were failed with conservative therapy, good was in 2 cases, fair in 2 cases and poor in 1 case. 3. Avascular necrosis of femoral head was developed in 3 cases. 4. In the good reduction as determined by arthrogram according to Race and Herring, we can get a favorable result in conservative treatment, and in the poor reduction as determined by arthrogram, the better
Child ; Continental Population Groups ; Diagnosis ; Dislocations* ; Early Diagnosis ; Head ; Hip* ; Humans ; Necrosis ; Walking*

Endoscopic surgery is popular in the neurosurgical field. The purpose of this study was to determine the role of endoscopy in obstructive hydrocephalus. From 1989 to 1999, we performed 81 endoscopic third ventriculostomies and 10 septostomies. Seventy-one of 81 operations were performed with endoscopic third ventriculostomy alone and 10 patients had endoscopic third ventriculostomy and ventriculoperitoneal shunt simultaneously. Age distribution varied from 2 months to 62 years of age. Our selection criteria included aqueductal stenosis (39 patients) and obstructive hydrocephalus due to tumor or cyst (42 patients). The most common candidate for endoscopic septostomy was atresia of the foramen of Monro (4 patients). Endoscopic septostomy was also performed to simplify shunting in patient; with multiseptated ventricle due to shunt infection, germinoma, thalamic tumor, craniopharyngioma, cyst and brain abscess. Sixty-five of 71 patients who were treated with endoscopic third ventriculostomy alone showed successful results (91.5%). However, 6 patients had unsatisfactory results and they needed a ventriculoperitoneal shunt. With no mortality, transient surgical complications were observed in 7 patients: 2 transient diabetes insipidus from electrical injury to the pituitary stalk, 1 epidural hematoma from sudden drainage of CSF, 1 delayed intraventricular hemorrhage. 2 obstruction of fenestration site and 1 transient memory disturbance from injury to the fornix. Endoscopic septostomy was useful in simplifying shunting in all cases with complicated hydrocephalus. Endoscopic surgery is straightforward and effective in appropriately selected cases with obstructive by drocephalus.
Adolescence ; Adult ; Child ; Endoscopy* ; Human ; Hydrocephalus/surgery* ; Infant ; Male ; Septum of Brain/surgery* ; Ventriculostomy*

Purpose: The gold standard for assessing pubertal activation is the gonadotropinreleasing hormone (GnRH) stimulation test (GnRHST), which is invasive, timeconsuming, and inconvenient. This study evaluated whether a single random measurement of urinary luteinizing hormone (LH) concentration could substitute for the GnRHST in diagnosing and monitoring central precocious puberty (CPP) in girls. Methods: Fifty-five girls with breast buds before 8 years of age were assessed by both the GnRHST and urinary gonadotropin assays. Based on the GnRHST results, 29 girls were assigned to the CPP group (peak LH≥5 IU/L), and 26 were placed in the premature thelarche (PT) group (peak LH<5 IU/L). Auxological data and urine and serum samples were collected at baseline and after treatment with a GnRH agonist for 12 and 24 weeks. Results: Although the auxological data did not differ between the 2 groups, the serum levels of insulin-like growth factor-1, basal LH, follicle-stimulating hormone (FSH), estradiol, and peak LH; urinary LH; and peak serum LH/FSH and urinary LH/FSH ratios were higher in the CPP group than in the PT group. Pearson correlation analysis showed a positive correlation between the urinary and serum LH concentrations (r=0.660, P<0.001). Receiver-operating characteristic curve analyses showed that a urinary LH concentration of 0.725 IU/L was a cutoff that significantly predicted positivity on the GnRHST. Urinary LH and FSH concentrations declined significantly during GnRH agonist treatment. Conclusion A single, random measurement of urinary gonadotropin concentration could be a reliable tool for initial screening and therapeutic monitoring of CPP in girls.

Conservative treatment alone may not give satisfactory results for medial collateral ligament injuries, so surgical treatment may be needed.In this case, the distal end of the medial collateral ligament was treated surgically because the distal end of the medial collateral ligament was caught between the sartorial fascia rupture. Through physical examination and magnetic resonance imaging, avulsion damage at the distal attachment part of the medial collateral ligament was confirmed, and the method of anchoring the distal end of the ligament to the crural fascia helped the ligament to heal with minimal tissue damage. Subsequently, satisfactory results are obtained and reported.

Purpose: The gold standard for assessing pubertal activation is the gonadotropinreleasing hormone (GnRH) stimulation test (GnRHST), which is invasive, timeconsuming, and inconvenient. This study evaluated whether a single random measurement of urinary luteinizing hormone (LH) concentration could substitute for the GnRHST in diagnosing and monitoring central precocious puberty (CPP) in girls. Methods: Fifty-five girls with breast buds before 8 years of age were assessed by both the GnRHST and urinary gonadotropin assays. Based on the GnRHST results, 29 girls were assigned to the CPP group (peak LH≥5 IU/L), and 26 were placed in the premature thelarche (PT) group (peak LH<5 IU/L). Auxological data and urine and serum samples were collected at baseline and after treatment with a GnRH agonist for 12 and 24 weeks. Results: Although the auxological data did not differ between the 2 groups, the serum levels of insulin-like growth factor-1, basal LH, follicle-stimulating hormone (FSH), estradiol, and peak LH; urinary LH; and peak serum LH/FSH and urinary LH/FSH ratios were higher in the CPP group than in the PT group. Pearson correlation analysis showed a positive correlation between the urinary and serum LH concentrations (r=0.660, P<0.001). Receiver-operating characteristic curve analyses showed that a urinary LH concentration of 0.725 IU/L was a cutoff that significantly predicted positivity on the GnRHST. Urinary LH and FSH concentrations declined significantly during GnRH agonist treatment. Conclusion A single, random measurement of urinary gonadotropin concentration could be a reliable tool for initial screening and therapeutic monitoring of CPP in girls.

The recent introduction of an intraoperative near infrared fluorescence (INIF) imaging system installed on the da Vinci Si(R) robotic system has enabled surgeons to identify intravascular NIF signals in real time. This technology is useful in identifying hidden vessels and assessing blood supply to bowel segments. In this study, we report 3 cases of patients with rectal cancer who underwent robotic low anterior resection (LAR) with INIF imaging for the first time in Asia. In September 2012, robotic-assisted rectal resection with INIF imaging was performed on three consecutive rectal cancer patients. LAR was performed in 2 cases, and abdominoperineal resection was performed in the third case. INIF imaging was used to identify the left colic branch of the inferior mesenteric artery and to assess blood supply to the distal rectum. We evaluated the utility of INIF imaging in performing robotic-assisted colorectal procedures. Our preliminary results suggest that this technique is safe and effective, and that INIF imaging may be a useful tool to colorectal surgeons.
Aged ; Digestive System Surgical Procedures/*methods ; Female ; Fluorescence ; Humans ; Image Processing, Computer-Assisted/instrumentation/*methods ; *Intraoperative Care ; Male ; Middle Aged ; Rectal Neoplasms/*surgery ; Rectum/*surgery ; Robotics/*methods ; Spectroscopy, Near-Infrared/*methods ; Treatment Outcome

Object: To treat hydrocephalus by ventriculo-peritoneal shunt operation, the correct positioning of the proximal catheter in the ventricle is very important. The purpose of this study was to develop the "shunt guiding kit" for the proper positioning of the proximal shunt catheter to the ventricle in the ventriculo-peritoneal shunt operation. MATERIALS AND METHODS: The "shunt guiding kit" is made of tungsten alloy and it consists of one frame, two screws and one guider. Through the guider, the proximal shunt catheter operates by mechanically coupling the posterior burr hole to the anterior target point. RESULTS: We have treated three hydrocephalus patients with use of the "shunt guiding kit", and achieved good location of proximal shunt catheters. CONCLUSION: We developed the "shunt guiding kit" for the proper positioning of the proximal shunt catheter to the ventricle, and this would be very useful for preventing ventriculo-peritoneal shunt malfunction and preventing possible brain injury during the procedures.
Alloys ; Brain Injuries ; Catheters* ; Humans ; Hydrocephalus ; Lateral Ventricles* ; Tungsten ; Ventriculoperitoneal Shunt*

No abstract available.
Animals ; Evoked Potentials* ; Rats*

The authors analyzed 103 cases of chronic subdural hematoma(SDH) treated in the department of Neurosurgery, Yonsei University Hospital from January 1976 to September 1983. All of the cases were operated on except a single case, which was treated conservatively. The results of the analysis are summarized as follows: 1) The chronic SDH occurred most frequently in the 5th decade, and 71.8% of the patients were older than their 4th decade. The chronic SDH were far more common in men(84.5%) than women(15.5%). 2) Seventy two patients(79.6%) had a history of previous head injury. Chronic alcoholism was noted in thirteen patients(12.6%). 3) Presenting symptoms and signs in decreasing order were headache(76.9%), motor weakness(44.7%), mental disturbance(43.7%), papilledema(42.7%), and vomiting(35%). 4) Brain CT scan was not only the most accurate diagnostic procedure but also important for planning operative intervention as well as evaluating the prognosis. Four patterns of CT densities were noted in chronic SDH;hypodense(43.3%), isodense(37.8%), hyperdense(13.5%), and mixed density(5.4%). Cerebral expansion rates decreased with age, which was less than 80% in patients over their 40s. The chronic SDH was found on the right side in 45.6% of cases and 41.8% on the left, while 12.6% of chronic SDH were bilateral. 5) Operative procedures in 102 cases, were as follows; 32 Simple burr hole closed drainage, 31 Simple burr hole open drainage, 31 craniotomy and membranectomy, and 10 craniectomy and membranectomy. In conclusion, simple burr hole closed system drainage is the most effective and the least invasive procedure for the treatment of chronic SDH. Membranectomy with craniotomy or craniectomy should be reserved for such cases as recollection of SDH, failure of brain expansion, solid hematoma, and extensive swelling of the white matter subjacent to the hematoma.
Alcoholism ; Brain ; Craniocerebral Trauma ; Craniotomy ; Drainage ; Hematoma ; Hematoma, Subdural, Chronic* ; Humans ; Neurosurgery ; Prognosis ; Surgical Procedures, Operative ; Tomography, X-Ray Computed