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*

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

Disseminated intravascular coagulation (DIC) is a pathological syndrome in which activation of coagulation cascade leads to fibrin clot formation, consumption of platelets and coagulation factors, and secondary fibrinolysis. We report a case of severe postoperative hemorrhagic diathesis due to DIC. A 59-year-old man was scheduled for reduction of tibia fracture and anatrophic nephrolithotomy of staghorn calculi. On the fifth postoperative day, second operation was performed for nephrectomy due to perirenal hematoma. Two days later, third operation was performed for hemostasis because of the continuous bleeding. Coagulation tests showed positive DIC profiles of thrombocytopenia, hypofibrinogenemia, increased fibrin degradation products, and prolonged prothrombin time and thrombin time. The patient recovered uneventfully and discharged on the 59th postoperative day.
Blood Coagulation Factors ; Calculi ; Dacarbazine ; Disseminated Intravascular Coagulation* ; Fibrin ; Fibrin Fibrinogen Degradation Products ; Fibrinolysis ; Hematoma ; Hemorrhage* ; Hemorrhagic Disorders ; Hemostasis ; Humans ; Middle Aged ; Nephrectomy ; Postoperative Complications ; Prothrombin Time ; Thrombin Time ; Thrombocytopenia ; Tibia

A patient had total occlusion of the left main coronary artery that was proved by coronary arteriography. Patients with total occlusion of the left main coronary artery have a varying clinical presentation and may have prolonged survival. In patients with good collaterals, left ventricular function may be preserved. This report reveiws the clinical and angiographic findings of a patient with occlusion of the left main coronary artery with symptoms of unstable angina pectoris but without congestive heart failure or EKG evidence of myocardial infarction.
Angina, Unstable ; Angiography ; Coronary Vessels* ; Electrocardiography ; Heart Failure ; Humans ; Myocardial Infarction ; Ventricular Function, Left

Isolated angiitis of the central nervous system is characterized by necrotizing vascular inflammation confined to the brain or spinal cord. The present report described a 22 year old female patient who experienced abruptly developing headache, dysarthria, swallowing difficulty, quadriparesis, and mental changes. The laboratory test of her blood, urine, and cerebrospinal fluid are all within normal range. Bliateral multiple small areas of low density were noted in the deep brain, cerebellun, and brainstem on brain C-T scan. There is no specific abnormal finding on the cerebral angiogram. The steroid treatment, 3 days of the 'pulse theraphy' followed by oral administration of prednisolone, dramatically ameliorated almost all symptoms and signs at first, but her symptoms were relapsed during tapering of oral prednisolone soon after. The second trial of the steroid treatment was not effective but there was a good response to the combined treatment of cyclophosphamide (Cytoxan) and prednisolone. The repeated brainstem auditary evoked potentials (BAEP) and somatosensory evoked potentials (SSEP) were helpful to determine the clinical course, as well as fluctuating abnormalities on brain CT scans.
Administration, Oral ; Brain ; Brain Stem ; Central Nervous System* ; Cerebrospinal Fluid ; Cyclophosphamide ; Deglutition ; Dysarthria ; Evoked Potentials ; Evoked Potentials, Somatosensory ; Female ; Headache ; Humans ; Inflammation ; Prednisolone ; Quadriplegia ; Reference Values ; Spinal Cord ; Tomography, X-Ray Computed ; Vasculitis* ; Young Adult

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*

In order to compare the corneal sensation after phacoemulsification and the planned extracapsular cataract extraction(p-ECCE), we studied 40 eyes of 31 patients prospetively. A Cochet-Bonnet esthesiometer was used to measure corneal sensitivity preoperatively and at one day, three day, one week, one month, and two months postoperatively, by the same surgeon using the same technique. There was no difference in corneal sensation between phacoemulsification and p-ECCE group preoperatively. The mean corneal sensitivity at 10:00(2:00) o`clock in phacoemulsificantion/p-ECCE was 17.3+/-7.0(18.2+/-6.7)/9.9+/-1.5(10.3+1.9), 22.1+/-6.9 (23.2+/-6.3)/14.1+/-2.3(14.3+/-2.3), 29.4+/-7.7(30.6+/-7.2)/17.7+2.2(18.7+/-2.2), 37.7+/-9.3(37.8+/-9.4)/26.3+/-7.9(27.7+/-8.4), 56.3+/-7.6(56.3+7.9)/59.2+/-3.8(59.4+/-2.7)mm after 1, 3, 7, 30, 60 days, respectively. Corneal sensation at the center and the 3, 6, and 9 o`clock positions was not changed in all eyes. Corenal sensitivity was significantly more recovered in phacoemulsification group than the p-ECCE group at postoperative onemonth(p<0.05). However, there were no statistically significant difference in recovery of corneal sensation between phacoemulsification group and p-ECCE group at postoperative two months. Conclusively corneal sensation returned to peroperative level at two months postoperatively in both groups.
Cataract Extraction* ; Cataract* ; Humans ; Phacoemulsification* ; Sensation*