No abstract available.
Fatigue* ; Sciatica*

No abstract available.

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

OBJECTIVE: Normal pressure hydrocephalus (NPH) is a syndrome characterized by gait disturbance, memory impairment and urinary incontinence. The isotope cisternography (ICG) became less useful because of low accuracy and complications. We tried to evaluate the safety and value of the ICG. METHODS: We retrospectively collected data on ICG of 175 consecutive patients with a suspected hydrocephalus. We classified the ICG into four types by the ventricular reflux and circulation time. The ventricular size was measured by Evans index and the width of the third ventricle. RESULTS: There were three complications including one case of paraplegia. Type 4 was the most common type, observed in 53%. Type 3 (33%), type 2 (7%), and type 1 (7%) were observed less often. Type 4 was more common in patients with large ventricles. Types of the ICG were not related to the causes of hydrocephalus, gender, or age of the patients. Shunting was more frequently performed in type 4 (71%), compared to type 1 (17%), type 2 (33%), and type 3 (46%). Surgery was more common when the cause was vascular. After the shunt surgery, 33.0% were graded as the improved. Although there were some improvements even in the not-improved patients, they still needed many helps. The improvement was related to the preoperative state. CONCLUSION: ICG may bring a serious complication, however the incidence is very low. Although the predictability of response rate on the shunting is doubtful, ICG is a cheap and useful tool to select surgical candidates in NPH.
Diagnosis ; Gait ; Humans ; Hydrocephalus* ; Hydrocephalus, Normal Pressure ; Incidence ; Malpractice ; Memory ; Meningitis, Aseptic ; Paraplegia ; Radionuclide Imaging ; Retrospective Studies ; Third Ventricle ; Urinary Incontinence

OBJECTIVE: Cranioplasty is necessary to repair the cranial defect, produced either by decompressive craniectomy or removal of the contaminated depressed skull fracture. Complications are relatively common after cranioplasty, being reported up to 23.6%. We examined the incidence and risk factors of infectious complications after cranioplasty during last 6 year period. METHODS: From January 2000 to December 2005, 107 cranioplasties were performed in our institution. The infectious complications occurred in 17 cases that required the removal of the bone flap. We examined the age of the patients, causes of the skull defect, timing of the cranioplasty, the size of the defect, and kinds of the cranioplasty material. The size of the skull defect was calculated by a formula, 3.14 x long axis x short axis. The cranioplasty material was autogenous bone kept in a freezer in 74 patients, and polymethylmetacrylate in 33 patients. Statistical significance was tested using the chi-square test. RESULTS: The infection occurred in 17 patients in 107 cranioplasties (15.9%). It occurred in 2 of 29 cases of less than 75 cm2 defect (6.9%), and 6 in 54 cases of 75~125 cm2 defect (11.1%). Also, it occurred in 9 of 24 cases of more than 125 cm2 defect (37.5%). This difference was statistically significant (p<0.01). CONCLUSION: During the cranioplasty, special attention is required when the skull defect is large since the infection tends to occurr more commonly.
Axis, Cervical Vertebra ; Craniocerebral Trauma ; Decompressive Craniectomy ; Humans ; Incidence ; Polymethyl Methacrylate ; Risk Factors ; Skull ; Skull Fracture, Depressed ; Surgical Flaps

OBJECTIVE: The distribution of disorders changes according to the change of environment or customs with time. Geriatric disorders are increasing along with the increase of the life span. A new therapeutic method may change the management of a certain disease. As a Korean neurosurgeon, they should have sufficient knowledge on certain disorders that are common or practically significant in Korea. There are few reports to evaluate the distribution or trends of neurosurgical disorders in Korea. We evaluated the distribution and trends of neurosurgical disorders of the patients who admitted to a neurosurgical department of a university hospital in Korea during a 5-year-period. METHODS: From January 1997 to December 2001, the total number of admission was 4, 772. The total number of operation was 2, 603. We used a standardized database model for collection of the patient data, which was developed by one of us. Disorders are classified into 13 categories, such as head injury, spine injury, vascular disorders, degenerative spinal disorders, cranial tumors, spinal tumors, infection, peripheral nerve disorders, functional disorders, pain, congenital disorders, and others. RESULTS: Head injury(32.5%), vascular disorders(27.7%), spine injury(15.5%), and degenerative spinal disorders(11.5%) occupied 87.2% of total disorders of the inpatient. The age distribution was peak at 61-75 year old group, about 60% of the total inpatients was 45 year old or more. During this 5-year-period, patients more than 60 year old were increasing, while patients of 16-30-year-old group were decreasing. The proportions of the head injury and vascular disorders were decreasing, while those of the degenerative spinal disorders, spine injury and cranial tumors were increasing. CONCLUSION: We should pay attention to the common or increasing disorders. It seems to be of value to collect and analyze the neurosurgical epidemiological data for education and planning of the neurosurgical manpower.
Age Distribution ; Congenital, Hereditary, and Neonatal Diseases and Abnormalities ; Craniocerebral Trauma ; Data Collection ; Education ; Epidemiology ; Head ; Humans ; Incidence ; Inpatients ; Korea ; Middle Aged ; Neurosurgery ; Peripheral Nerves ; Spine ; Vascular System Injuries

OBJECTIVE: The purpose of this study is to investigate the significance of an early clinical course during the external ventricular drainage(EVD) in patients with thal amic hemorrhage. METHODS: During the last 11 years(1990-2000), a hundred patients with thalamic hemorrhage who underwent EVD were studied. Thirty-four patients underwent temporary closing of EVD at the mean interval of 4.5 days after EVD. The clinical course was divided into 3 groups according to change of Glasgow Coma Scale(GCS) scores of 2 or more within 3 days after EVD compared with those just before EVD: deteriorated, unchanged, and improved. RESULTS: The factors affecting mortality were unchanged(odds ratio [OR] 0.05, 95% confidence interval [CI]0.01-0.38, p=0.0028) and deteriorated clinical course(OR 0.06, 95% CI 0.01-0.38, p=0.0033), GCS scores at the time of admission(OR 1.3, 95% CI 1.02-1.66, p=0.0346), amount of hematoma(OR 0.91, 95% CI 0.83-1.00, p=0.0461) and hematoma enlargement(OR 0.06, 95% CI 0.01-0.65, p=0.0198). The factor affecting the early clinical deterioration was the hematoma enlargement(OR 0.11, 95% CI 0.03-0.38, p=0.0005). The shunt operation was predicted in patients who showed the clinical improvement after EVD followed by the clinical deterioration within 48 hours after temporary closing of EVD. CONCLUSION: It is suggested that an early clinical course during the maintenance of EVD is important to predict mortality and necessity of shunt operation.
Coma ; Drainage* ; Hematoma ; Hemorrhage* ; Humans ; Mortality

No abstract available.
Neoplasm Metastasis*