STUDY DESIGN: This study assessed the final functional results after treatment of thoracolumbar burst fractures and compared the relationship between the results and the parameters of reduction and state of the fractures. OBJECTIVES: To define prognostic factors affecting the final results and to present some precautions to minimize the treatment failure. SUMMARY OF LITERATURE REVIEW: In the treatment of the thoracolumbar burst fractures in which flexion loads are predominant, the sagittal contour is crucial to achieve permanent pain-free stability, but definitive therapeutic guidelines have remained a controversal topic. MATERIALS AND METHODS: We reviewed 37 thoracolumbar burst fractures with an average follow up period of 1.8 years: group 1 consisting of 20 cases treated conservatively and group 2 consisting of 17 cases treated surgically with posterior instrumentation. Finally functional results were analysed with the Denis'pain and work scores, and were compared between groups on anterior body height and local kyphosis. RESULTS: A satisfactory pain score less than or equal to P3 was in 15(75%) in group 1 and 15(88.2%) in group 2(p>0.05), but satisfactory work score less than or equal to W3 was in 12(60%) in group 1 and in 14(82.4%) in group 2(p<0.05). But, some loss of body height and local kyphosis in group 1 was not reversely related with functional outcomes. Eight cases in group 1 showing unsatisfactory result in work scores were analyzed as 4 osteoporosis(Jikei grade I, II/III), 3 associated compression fracture of the contiguous vertebra and one combined osteoporosis and compression fracture, showing significant loss of vertebral height and increase of kyphosis(p<0.01). CONCLUSIONS: Functional results of group 1 showing loss of vertebral height less than 50% and increased kyphosis less than 200 were comparable to those of group 2. The osteoporosis and associated compression fracture of adjacent vertebra were the risk group to develop posttraumatic kyphosis and might be added to the surgical indication of the thoracolumbar burst fractures.
Body Height ; Follow-Up Studies ; Fractures, Compression ; Kyphosis ; Osteoporosis ; Spine ; Treatment Failure

Open tibial pilon fractures present extensive soft tissue disruption and common complications such as sepsis or skin slough, and deserve special cosideration in addition to the challenging reconstructive problems. The purpose of this study is to assess the effectiveness of limited internal fixation and external fixation for the treatment of the open tibial pilon fractures, and to introduce some idea in Ilizarov device use. We reviewed 27 open tibial pilon fractures treated with limited internal fixation and external fixation from Feb. 1992 to Mar. 1996(follow-up range, 1 to 5 years). Fracture classification(Ruedi and Allgower) was type I in 5, type II in 10 and type III in 12, open wound type(Gustilo-Anderson) was II in 8, IIIA in 17 and IIIB in two. Secondary procedures were 16 soft tissue procedures, 13 bone graftings and 2 limb lengthening. Mean time for removal of the external fixators was 3.5 months(range, 6 to 21 weeks), and clinical union averaged 4.3 months(range, 12 to 25 weeks). At the time of last follow-up, radiologic grading(Burwell and Charnley) showed 13 good(48%), 10 fair(37%) and 4 poor results(15%). Objective functional grading(Ovadia and Beals) showed 5 excellent(19%), 15 good(56%), 6 fair(22%) and 1 poor(4%), and subjective grading 2 excellent(7%), 16 good(59%), 7 fair(26%) and 2 poor(7%). Common complications included 10 wound sepsis(37%), 6 posttraumatic arthritis(22%) and 5 malunions(19%). In conclusion, we cosider limited internal fixation and external fixation is an effective treatment modality till bone union for open tibial pilon fractures, and Ilizarov method using tension wires crossed only through the fracture fragments can provide a sufficient early and late stability.
External Fixators ; Extremities ; Follow-Up Studies ; Ilizarov Technique ; Sepsis ; Skin ; Tibia ; Transplants ; Wounds and Injuries

No abstract available.
Cystadenoma, Mucinous* ; Mucins* ; Pancreas*

No abstract available.
Colonoscopy*

Serial Brain MRI was performed on a seventeen-year-old girl with Kearns-Sayre syndrome. At the age of 11, she complained bilateral ptosis. Two years later, bilateral blepharoplasty was done and brain MRI was taken. T2-weighted MRI sequence showed high signal intensity areas in the brainstem, thalamus and white matter of the cerebrum and cerebellum bilaterally. Four years later, chronic progressive external ophthalmoplegia developed and serial MRI and proton MRS were taken. Follow-up MRI showed similar but slightly progressed findings compared with previous films. The proton MR spectroscopic imaging demonstrated focal localization of abnormally increased lactate content in the involved area of the brain.
Blepharoplasty ; Brain ; Brain Stem ; Cerebellum ; Cerebrum ; Female ; Follow-Up Studies* ; Humans ; Kearns-Sayre Syndrome* ; Lactic Acid ; Magnetic Resonance Imaging* ; Magnetic Resonance Spectroscopy ; Ophthalmoplegia, Chronic Progressive External ; Protons ; Thalamus

n the patients with epilepsy, especially in psychomotor epilepsy the epileptiform discharges occasionally has its origin from the basal structure of brain or the mesial side of temporal lobe which is not accessible to the standard surface EEG. The nasopharyngeal electrode, which was introduced by Grinker and Serota in 1938 and modified several times, is a kind of special electrodes to investigate electrical activity from the mesiobasal part of the temporal lobe, and there are several studies about clincial usefulness of the nesopharyngeal EEGs with some controversies in other countries. In this country, however, there is no reports about this topic, and in fact only a few laboratories are known to use the nasopharyngeal electrode. To determine clinical significance of nasapharyngeal EEG in patients with psychomotor seizure, the selecting records of 123 cases who had been taken both standard surface and nasopharyngeal EEG are analysed and compared with each other. Eight nine of cases are the patients with seizure disorder including 13 simple partial seizure with or without secondary generalization, 47 psychomotor seizure (or complex partial seizure) with or without secondary generalization and 29 primary generalized seizure, diagnosed by history and clincial findings. The other 34 cases are the patients with similar symptoms of psychomotor seizure but without definite convulsion. The standard surface EEG revealed 48 (56%) of epileptiform activity, 24(28%) of nonspecific dysrrhytmia and 17(19%) of normal record in 89 patients with seizure discharges. There are 38 patients who showed spike or sharp wave on nasopharyngeal generalized seizures. In nonseizure cases, however, epileptiform activity is not detected on nasopharyngeal electrodes. Five cases are technically unsatisfactory. The significances of nasopharyngeal EEG in 38 with epiletiform discharges on nasopharyngeal electrode(s) are; more definite and prominent epileptiform activity in 17 and unexpected nasopharyngeal discharges in 10 patients including 5 with normal standard surface EEGs. In 47 psychomotor seizure, 42 cases (89%) reveal epileptiform discharges on standard surface and/or nasopharyngeal EEG and the sensitivity of nasopharyngeal EEG (75%) is higher than that of standard surface.
Brain ; Electrodes ; Electroencephalography* ; Epilepsy ; Epilepsy, Complex Partial ; Generalization (Psychology) ; Humans ; Seizures* ; Temporal Lobe

OBJECTIVES: Anticardiolipin antibody (ACA) and lupus anticoagulant (LA) are acquired antiphospholipid antibodies (APAs), which are regarded as important risk factors far vascular thrombosis and recurrent fetal loss. Although the clinical relevance of APAs in dialysis patients is uncertain, recent studies have suggested that APAs are involved in bioincompatibility and thrombogenic complications in hemadialysis (HD) patients. METHOD: We performed a cross sectional study of ACA and LA in 50 stable HD patients and their 68 vascular accesses (52 native arteriovenous fistulae and 16 synthetic arterovenous grafts), with the analysis of factors associated with the presence of APAs and the retrospective evaluation of vascular access occlusion (VAO). LA was assessed by platelet neutralization method whereas IgG-ACA was measured by a solid phase ELISA. Values higher than 23GPLU/ml (IgG phospholipid units) were considered to be positive for IgG-ACA and positive values for LA was more than 8 seconds in prolongation of the clotting time with human platelet lysate. Vascular access survival was assessed by Kaplan- Meier method, RESULTS: The mean age of the subject (M:F 21:29) was 46 years and the mean duration of hemodialysis was 49 months. The frequency of VAO in entire subjects was 0.45+/-0.98 episodes/patient year. The median value of IgG-ACA was 16.0 GPLU/ml with a distribution from 2.7 to 46.1GPLU/ ml. The median titer of I.A was 4.5 (3.1-45.6) seconds. Fourteen patients (28%) were found to have at least one episode of VAO. In spite of comparable clinical and biochemical data according to the presence of VAO, the titers of IgG-ACA (13.6+/-7.7 vs, 20.3+/-8.7GPLIJ/ml, P<0.05) and LA (4.5+/-2.9 vs. 11.7 +/-12.6sec, P<0.05) were significantly higher in VAO group. Six out of 50 patients(12%) had an increased titer of IgG-ACA and LA was found in 11 patients(22%). No patients were positive for ACA and LA simultaneously. There was no significant difference in sex, etiology of ESRD, diabetic status, the dosage of heparin during HD or the amount of erythropoietin administered according to the presence of APAs. We could not find any significant correlation between the titer of APAs and age, duration of dialysis, blood pressure, platelet count and biochemical parameters. In the patients with positive ACA, the frequency of VAO was 1.05+/-0.12 episodes/patient year, which was significantly higher than patients without ACA (0.33+/-0.17 episodes/ patient year, P<0.05). In the patients with the presence of LA(1.06+/-0.43 vs. 0.12+/-0.06 episodes/ patients year, P<0.01). The median vascular access survival time in IgG-ACA positive patients (32.7 months) was significantly decreased compared to 66.8 months in IgG-ACA negative group. CONCLUSION: Our data suggest that the presence of APAs (ACA and/or LA) affects the event-free vascular access survival in HD patients. Therefore the evaluation of APAs status have to be included in the diagnostic strategies for the patients with recurrent VAO. Further studies are necessary to explore the pharmacologic intervention method to decrease APAs and prevent VAO in HD patients.
Antibodies, Anticardiolipin* ; Antibodies, Antiphospholipid ; Arteriovenous Fistula ; Blood Platelets ; Blood Pressure ; Dialysis ; Enzyme-Linked Immunosorbent Assay ; Erythropoietin ; Heparin ; Humans ; Kidney Failure, Chronic ; Lupus Coagulation Inhibitor* ; Platelet Count ; Renal Dialysis* ; Retrospective Studies ; Risk Factors ; Thrombosis

Ischemia is a rare cause of the optic chiasmal syndrome and is sometimes hard to define. The present report describes a 73 year ~ old male with abruptly developed visual field defect involving bitemporal hemianopsia and inferior binasal quadrantanopsia. The MRI study revealed focal anterior hypothalarnic atrophy which might be due to focal infarction. These findings are suggesting common blood supply of superior chiasmal circulation and anterior inferior hypothalamus.
Atrophy ; Hemianopsia ; Humans ; Hypothalamus ; Infarction* ; Ischemia ; Magnetic Resonance Imaging ; Male ; Optic Chiasm* ; Visual Fields

Acute sensorimotor polyneuropathy that resembles Guillain-Barre syndrome (GBS) is rarely accompanied with nephrotic syndrome, and its underlying immunological mechanisms are unclear. A 56-year-old man presented with simultaneous acute progressive symmetric sensorimotor polyneuropathy and proteinuria. A kidney biopsy revealed focal segmental glomerulosclerosis. Serial electrophysiologic studies showed only a transient proximal conduction block in the median nerve, stimulated somatosensory evoked potential and prolonged terminal latencies of the median and peroneal nerves. The patient's neurologic deficits and kidney dysfunction recovered with corticosteroid treatment. Our case showed that somatosensory evoked potential study can be an important objective tool in the diagnosis of acute polyneuropathy with normal distal nerve conduction and that corticosteroids should be considered in the initial treatment of GBS-resembling polyneuropathy associated with nephrotic syndrome.
Evoked Potentials, Somatosensory/physiology ; Humans ; Male ; Middle Aged ; Nephrotic Syndrome/*diagnosis/*physiopathology ; Polyneuropathies/*diagnosis/*physiopathology

BACKGROUND: The purpose of this study was to compare prospectively two different anesthetic techniques with isoflurane or propofol for postoperative nausea, vomiting and recovery after tonsillectomy in children. METHODS: Sixty children, ASA physical status I, were assigned randomly to one of two groups. In group I, anesthesia was induced with thiopental 5 mg/kg and maintained with isoflurane 1~1.5 vol%. In group P, anesthesia was induced with fentanyl 1 mcg/kg, propofol 2 mg/kg and maintained with propofol infusion 5~10 mg/kg/hr. Both group received vecuronium 0.1 mg/kg for tracheal intubation and were ventilated with 33% O2 in N2O. The time to extubation, time to eye opening, PACU time, incidence and numbers of postoperative nausea and vomiting, and degree of sedation were recorded as well as perioperative complications. RESULTS: There were no significant difference in the duration of anesthesia and PACU time between two groups. The time to extubation and eye opening of group P were significantly shorter than group I (p<0.05). The degree of sedation and incidence of postoperative nausea and vomiting of group P were significantly lower than group I (p<0.05). But the frequency of intraoperative bradycardia was significantly higher in group P than group I (p<0.05). CONCLUSIONS: Propofol-fentanyl anesthesia results in less nausea and vomiting during postoperative period and more rapid recovery compared to isoflurane anesthesia and may be recommended in children undergoing tonsillectomy and adenoidectomy.
Adenoidectomy ; Anesthesia* ; Bradycardia ; Child* ; Fentanyl ; Humans ; Incidence ; Intubation ; Isoflurane* ; Nausea ; Postoperative Nausea and Vomiting* ; Postoperative Period ; Propofol* ; Prospective Studies ; Thiopental ; Tonsillectomy* ; Vecuronium Bromide ; Vomiting*