No abstract available.

No abstract available.
Fatigue* ; Sciatica*

Carotid angioplasty and stenting (CAS) for carotid stenosis has been increasingly used as an alternative treatment in patients not eligible for surgery. Even though CAS can be performed relatively simply in many cases, various complications can occur. We report four cases of CAS using the Carotid Wallstent, which were complicated by delayed shortening of the stent, resulting in restenosis after successful CAS.
Angioplasty ; Carotid Arteries ; Carotid Stenosis ; Humans ; Stents

Any foreign body in the esohagus means an acute danger because of the impending perforation followed by mediastinitis, the impending erosion of bigarteries, and impending aspiration in the care of esorhageal occlusion. Nowadays, foreign body can reliably be removed hy endoscopy, and do not perforate the wall, not changed their form. Complication at the endoscopic extraction of foreign body, that requre surgical intervention are very rare. We presented a case of esophageal foreign body complicated with esophageal ulcer in a 83 years old male.
Aged, 80 and over ; Endoscopy ; Foreign Bodies* ; Humans ; Male ; Mediastinitis ; Ulcer*

BACKGROUND: As intravenous thrombolysis (IVT) has very restricted inclusion criteria, eligible patients of IVT constitute a very small proportion and studies about their mortality are rare. The long-term mortality in a patients with contraindication of ineligible patients of IVT still under the debate. So, we investigated the proportion of patients with contraindication of IVT and the short and long-term mortality of them in AIS on emergency department comparing with the long-term effect of IVT in patients with moderate-to-severe stroke.METHODS: Using acute stroke assessment indication registry & Health Insurance Review and Assessment Service database, a total of 5,407 patients with NIHSS≥5 were selected from a total of 169 acute stroke care hospital nationwide during October-December 2011 and March-June 2013. We divided AIS patients into two groups: 1) IVT group who received IVT within 4.5 hours, and 2) non-IVT group who did not receive the IVT because of contraindications. And we divided the subgroups according to the reason of contraindication of IVT. The 5-year survival rate of each group was assessed using Kaplan-Meyer survival analysis.RESULTS: Of the 5,407 patients, a total of 1,027 (19%) patients who received IVT using r-tPA within 4.5 h after onset. Compared with the IVT group, hazard ratios of non-IVT group were 1.33 at 3 months, 1.53 at 1 year and 1.47 at 5 years (p<.001). A total of 4,380 patients did not receive IVT because of the following contraindications to IVT. 1) Time restriction: 3,378 (77.1 %) patients were admitted after 4.5 h following stroke onset, and 144 (3.3%) patients failed to determine the stroke onset time. 2) Mild symptoms:137 (3.1%) patients had rapid improvement or mild stroke on emergency room, 3) Bleeding diathesis or non-adjustable hypertension: 53 (1.2%) patients showed a bleeding tendency or severe hypertension. Compared with the IVT group, the subgroups of non-IVT group showed consistently high mortality during short and long term follow up. Mild symptom and bleeding diathesis or non-adjustable hypertension subgroup in the non-IVT group consistently showed the higher mortality than time restriction subgroup during the short and long-term follow-up (log-rank p<.001). Patients who had rapid improvement or mild stroke on emergency department had the higher mortality than time restriction group in short and long term follow up.CONCLUSION: The AIS patients with rapid improvement or mild stroke on emergency room had higher mortality than ineligible patients of IVT due to time restriction during the short and long-term follow-up. A further management and special support on emergency department is needed for these patients with initially mild stroke and rapid improvement in AIS to reduce the poor outcome.
Disease Susceptibility ; Emergency Medical Services ; Emergency Service, Hospital ; Follow-Up Studies ; Hemorrhage ; Humans ; Hypertension ; Insurance, Health ; Mortality ; Prognosis ; Stroke ; Survival Rate ; Thrombolytic Therapy ; Tissue Plasminogen Activator

We report a case of cervical epidural abscess occurring four years after instrumentation. This 70-year-old female patient visited due to sudden right hemiparesis for a week. She had undergone a sublaminar wiring with a rod from the atlas to C4 for unstable C2 and C3 body fracture, about four years ago. On admission, she had neither fever nor febrile episodes. Computed tomography of the cervical spine suggested a protruded wire into the right side of the spinal canal at C3 level. On the operation, there was an epidural abscess by Staphylococcus aureus around the atlas and the axis. After removal of the instrumentation and the lesion, the hemiparesis was resolved. Although it is rare and difficult to diagnose, delayed symptoms in patients who underwent instrumentation arouses suspicion of spinal epidural abscess.
Aged ; Axis, Cervical Vertebra ; Epidural Abscess* ; Female ; Fever ; Humans ; Paresis ; Postoperative Complications ; Spinal Canal ; Spine ; Staphylococcus aureus

OBJECTIVE: The aim of this study is to determine the factors influencing the surgical outcome following craniotomy for head injury and to establish the criteria for surgical intervention in the age of 65 years or older. METHODS: We retrospectively investigated the mechanism of injury, types of computed tomography lesions, Glassgow coma scale(GCS) score at admission, pupillary reactivity, past medical history and surgical outcome following craniotomy in the elderly during 8 year period. RESULTS: There were 35 men and 21 women with a mean age of 70.7 years(range 65-87 years). The mortality rate at discharge was 58.9%. Good outcome was achieved only in 25 percent of the patients. The cause of injury did not affect on the surgical outcome. All of 19 patients with GCS of 5 or less at admission had poor outcome. Outcome was significantly worse in older patients(more than 75 years) compare to younger patients(less than 75 years). Ninety percent of the patients with pupillary abnormality had poor outcome, whereas 57.7 percent of the patients with bilateral reactive pupil had poor outcome. Past medical history did not affect on the surgical outcome following craniotomy. CONCLUSION: Surgical outcome is unexceptionally poor in the elderly head-injuried patients if the age is 75 years old or older, the GCS is 5 or less and the pupil is bilaterally dilated. Craniotomy under those circumstances is not desirable.
Aged* ; Coma ; Craniocerebral Trauma ; Craniotomy ; Female ; Humans ; Intracranial Hemorrhage, Traumatic* ; Male ; Mortality ; Pupil ; Retrospective Studies

OBJECTIVE: Density of the chronic subdural hematoma (cSDH) is variable. It often appears to be mixed density. Multiple densities of cSDH may result from multiple episodes of trauma. We investigated the frequency of mixed density and the causes of head injuries representing each density. METHODS: We could collect 242 cases of chronic SDH. The cSDHs were classified into four groups; hypodensity, homogeneous isodensity, layered type, and mixed type on the basis of CT scans. RESULTS: The density of cSDH was isodense in 115 patients, hypodense in 31 patients, mixed in 79 cases, and layered in 17 cases. The cSDH was on the left side in 115 patients, on the right side in 70 patients, and bilateral in 40 patients. The history of trauma was identifiable in 122 patients. The etiology could be identified in 67.7% of the hypodense hematomas, while it was obscure in 59.5% of the mixed hematomas. CONCLUSION: Mixed density of cSDH results from multiple episodes of trauma, usually in the aged. It is hard to remember all the trivial traumas for the patients with the mixed density cSDHs. Although there were membranes within the mixed density hematomas, burr-holes were usually enough to drain the hematomas.
Aged ; Craniocerebral Trauma ; Hematoma ; Hematoma, Subdural, Chronic ; Humans

OBJECTIVE: Decompressive craniectomy is an effective therapy to relieve high intracranial pressure after acute brain damage. However, the optimal timing for cranioplasty after decompression is still controversial. Many authors reported that early cranioplasty may contribute to improve the cerebral blood flow and brain metabolism. However, despite all the advantages, there always remains a concern that early cranioplasty may increase the chance of infection. The purpose of this retrospective study is to investigate whether the early cranioplasty increase the infection rate. We also evaluated the risk factors of infection following cranioplasty. METHODS: We retrospectively examined the results of 131 patients who underwent cranioplasty in our institution between January 2008 and June 2015. We divided them into early (≤90 days) and late (>90 days after craniectomy) groups. We examined the risk factors of infection after cranioplasty. We analyzed the infection rate between two groups. RESULTS: There were more male patients (62%) than female (38%). The mean age was 49 years. Infection occurred in 17 patients (13%) after cranioplasty. The infection rate of early cranioplasty was lower than that of late cranioplasty (7% vs. 20%; p=0.02). Early cranioplasty, non-metal allograft materials, re-operation before cranioplasty and younger age were the significant factors in the infection rate after cranioplasty (p<0.05). Especially allograft was a significant risk factor of infection (odds ratio, 12.4; 95% confidence interval, 3.24–47.33; p<0.01). Younger age was also a significant risk factor of infection after cranioplasty by multivariable analysis (odds ratio, 0.96; 95% confidence interval, 0.96–0.99; p=0.02). CONCLUSION: Early cranioplasty did not increase the infection rate in this study. The use of non-metal allograft materials influenced a more important role in infection in cranioplasty. Actually, timing itself was not a significant risk factor in multivariate analysis. So the early cranioplasty may bring better outcomes in cognitive functions or wound without raising the infection rate.
Allografts ; Brain ; Cerebrovascular Circulation ; Cognition ; Decompression ; Decompressive Craniectomy ; Female ; Humans ; Intracranial Pressure ; Male ; Metabolism ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Wounds and Injuries

OBJECTIVE: Septa within the hematoma cavity are common, especially in the mixed density chronic subdural hematomas (CSHs). Although CT remains the diagnosis of choice, MRI is superior to detect the membranes in CSHs. We could obtain MRIs in 64 patients with CSH. We examined the value of MRI to understand the history of CSH. METHODS: We retrospectively examined the medical records and MRIs of 64 consecutive patients. MRI was selected to find any organic causes of neurologic symptoms. We classified the CSHs into septated or non-septated group, since classification of the septa was frequently obscure. RESULTS: Septa were identified by MRI in 43 patients (67%). They were more common in the over 70-years-old group. Unknown causes were more common in the septated group, which implies they might suffer from multiple traumas. The signal intensity of the CSH was variable. The methods of treatment were different between two groups. Surgery was more common in the septated group (p=0.021). Surgery was performed in 57 patients (89%). Burr-hole drainage was successful in 55 patients, even in the septated group. CONCLUSION: Septa within the hematoma cavity may be related to the multiple episodes of head trauma. Repeated trauma may cause acute bleedings over the CSHs, which is one of the pathogenic mechanisms of hematoma enlargement. MRI could show the history of CSH.
Classification ; Craniocerebral Trauma ; Diagnosis ; Drainage ; Hematoma ; Hematoma, Subdural, Chronic* ; Hemorrhage* ; Humans ; Magnetic Resonance Imaging* ; Medical Records ; Membranes ; Multiple Trauma ; Neurologic Manifestations ; Retrospective Studies