The crossing laminar screw fixation might be the most recently developed approach among various fixation techniques for C2. The new construct has stability comparable to transarticular or transpedicular screw fixation without risk of vertebral artery injury. Quantitative anatomical studies about C2 vertebra suggest significant variation in the thickness of C2 lamina as well as cross sectional area of junction of lamina and spinous process. We present an elderly patient who underwent an occipito-cervical stabilization incorporating crossed C2 laminar screw fixation. We preoperatively recognized that she had low profiles of C2 lamina, and thus made a modification of trajectory for the inferiorly crossing screw. We introduce a simple modification of crossing C2 laminar screw technique to improve stability in patients with low laminar profiles.
Aged ; Humans ; Spine ; Vertebral Artery

No abstract available.
Hemodynamics* ; Nitroprusside*

We have reviewed our experiences of computerized tomography(CT) in the fracture of the spine. Between December 1983 and June 1985, we treated 33 fractures of the spine in 32 patients. We have used CT for the diagnosis of fractures of the spine in 29 cases (28 patients). Also we have used Louis scoring system to evaluate the stability of the fractured spine. The results are as follows. 1. CT has many advantages that were not given from simple radiograp hies or laminagrams. It reveals the vertebral body, vertebral column, posterior compartments and surrounding soft tissues excellently, and it is easy to interpretate. Also it can be done comfortably and rapidly without the need of manipulations. 2. We could acquire many informations from post-operative or long term following up of CT examinations. 3. If the Louis score is higher than 3, we should think it is unstable, and should take internal fixation of the vertebral column. 4. There is a correlation between Louis score and neurologic signs (p < 0.01). If there was a neurologic sign with low Louis score, less than 1, the recovery was soon, less than 24 hours. 5. According to CT findings for fragmentation or location of fragment, we can alternate an anterior decompression or a posterior decompression. 6. It is necessary to use CT as a initial diagnostic procedure with the simple radiographic examination in spine fracture.
Clinical Study ; Decompression ; Diagnosis ; Humans ; Neurologic Manifestations ; Spine

Malakoplakia is an uncommon granulomatous disease most frequently found in the bladder or ureter. Howevcr, it has been reyorted in almost every ather organ and structure, the colon is the most common site of malakoplakia outside the urogenital tract and colonic carcinoma is the most commonly associated disease. A case of malakoplakia of the colon in a 54-year-old female is reported. Sigmoidoscopy revealed multiple whiteyellowish nodules simulating polypoid lesion at 10cm from the anal verge. The biopsy showed characteristically comprised submucosal proliferations of histiocyte and chronic inflammatory cells with typical cytoplasmic inclusions known as Michaelis-Gutmann bodies. Intravenous pyelogram showed no evidence of involvement of the urinary system. These nodules were removed by endoscopic polypectomy, So far, this is the first case of isolated colonic malakoplakia in Korea.
Biopsy ; Colon ; Female ; Histiocytes ; Humans ; Inclusion Bodies ; Korea ; Malacoplakia* ; Middle Aged ; Rectum ; Sigmoidoscopy ; Ureter ; Urinary Bladder

Chorea hyperglycemia basal ganglia (CHBG) syndrome is an uncommon manifestation of diabetes seen in patients with poor glycemic control. It is characterized by sudden onset of chorea with characteristic hyperintensities of the basal ganglia on brain magnetic resonance imaging. We report a case of a 31-year-old female patient with a history of type 1 diabetes mellitus, renal failure, and hypertension, who presented with acute symptoms of chorea involving both the upper and lower limbs with facial and cervical dystonia. Magnetic resonance imaging revealed bilateral hyperintensities of the globus pallidus and putamen. Control of blood glucose levels led to resolution of the choreic movements. In addition, follow-up magnetic resonance imaging studies revealed improvement in the hyperintensities of the basal ganglia bilaterally.

Chorea hyperglycemia basal ganglia (CHBG) syndrome is an uncommon manifestation of diabetes seen in patients with poor glycemic control. It is characterized by sudden onset of chorea with characteristic hyperintensities of the basal ganglia on brain magnetic resonance imaging. We report a case of a 31-year-old female patient with a history of type 1 diabetes mellitus, renal failure, and hypertension, who presented with acute symptoms of chorea involving both the upper and lower limbs with facial and cervical dystonia. Magnetic resonance imaging revealed bilateral hyperintensities of the globus pallidus and putamen. Control of blood glucose levels led to resolution of the choreic movements. In addition, follow-up magnetic resonance imaging studies revealed improvement in the hyperintensities of the basal ganglia bilaterally.

In Korea, careinoma of the cervix is the most common malignancy in women annually affecting 25 per every 100,000 female. The widespread use of the Papanicolaou smear has resulted in earlier detection of the tumor and a reduction in the number of patients with advanced disease, but the incidence of cervix. carcinoma is still the fifth most common malignancy in the world. Cervical carcinoma spreads to the small bowel primarily by direct extension from involved lymph nodes, most commonly from peraaortic or mesenteric nodes to the serosa of the bowel. But, the involvement of small bowel by cervical carcinoma is so rare, and shows a maximum incidence of small bowel involvement of less than 1.5%. We report a patient with squamous cell carcinoma of the cervix metastases to the second portion of the duodenum in whom the diagnosis was made by endoscopic biopsy of the lesion.
Biopsy ; Carcinoma, Squamous Cell ; Cervix Uteri ; Diagnosis ; Duodenum* ; Esophagus* ; Female ; Humans ; Incidence ; Intestines* ; Korea ; Lymph Nodes ; Neoplasm Metastasis ; Papanicolaou Test ; Serous Membrane ; Stomach*

PURPOSE: To investigate the correlations between Seoul Neuropsychological Screening Battery (SNSB) scores and the gray matter volumes (GMV) in patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI) and cognitively normal (CN) elderly subjects with correcting the genotypes. MATERIALS AND METHODS: Total 75 subjects were enrolled with 25 subjects for each group. The apolipoprotein E (APOE) epsilon genotypes, SNSB scores, and the 3D T1-weighted images were obtained from all subjects. Correlations between SNSB scores and GMV were investigated with the multiple regression method for each subject group using both voxel-based and region-of-interest-based analyses with covariates of age, gender, and the genotype. RESULTS: In the AD group, Rey Complex Figure Test (RCFT) delayed recall scores were positively correlated with GMV. In the MCI group, Seoul Verbal Learning Test (SVLT) scores were positively correlated with GMV. In the CN group, GMV negatively correlated with Boston Naming Test (K-BNT) scores and Mini-Mental State Examimation (K-MMSE) scores, but positively correlated with RCFT scores. CONCLUSION: When we used covariates of age, gender, and the genotype, we found statistically significant correlations between some SNSB scores and GMV at some brain regions. It may be necessary to further investigate a longitudinal study to understand the correlation.
Aged ; Alzheimer Disease ; Apolipoproteins ; Brain ; Genotype* ; Humans ; Mass Screening* ; Methods ; Mild Cognitive Impairment ; Seoul* ; Verbal Learning

Fractures of lumbo-sacral junction involving bilateral sacral wings are rare. Posterior lumbo-sacral fixation does not always provide with sufficient stability in such cases. Various augmentation techniques including divergent sacral ala screws, S2 pedicle screws and Galveston rods have been reported to improve lumbo-sacral stabilization. Galveston technique using iliac bones would be the best surgical approach especially in patients with bilateral comminuted sacral fractures. However, original Galveston surgery is technically demanding and bending rods into the appropriate alignment is time consuming. We present a patient with unstable lumbo-sacral junction fractures and comminuted U-shaped sacral fractures treated by lumbo-sacro-pelvic fixation using iliac screws and discuss about the advantages of the iliac screws over the rod system of Galveston technique.
Humans

The purpose of this study was to evaluate the efficacy of adenosine triphosephate (ATP) in comparison to sodium nitroprusside (SNP) in reducing left ventricular afterload in 20 patients, ASA physical status I, during ethrane-N2O anesthesia. Hemodynamic effects of intravenous ATP (30~250 ug/kg/min) were compared with those of SNP (0.3~2.5 ug/kg/min) in group 1 (n=10). In group 2 (n=10), hemodynamic and intrapulmonary shunt effects of dobutamine (1 ug/kg/min) alone and in combination with ATP or SNP, required to maintain mean arterial pressure around 70 mmHg, were compared. The results were as follows. 1) Both ATP and SNP reduced arterial pressure rapidly resulting from a marked decrease in systemic vascular resistance in a dose-related manner. 2) Cardiac index increased from 3.31+/-0.201/min/m2 to 4.04+/-0.281/min/m2 (p<0.01) following dobutamine alone, and increased further to 5.71+/-0.38 1/min/m2 (p<0.001) and decreased to 3.77+/-0.28 1/min/m (NS) in combination with ATP and SNP, respectively. 3) At equivalent decrease in mean arterial pressure, ATP increased heart rate significantly less than SNP. 4) Hypotensive response was more stable during ATP infusion than during SNP infusion. 5) Arterial oxygen tension was significantly higher during dobutamine/ATP infusion than during dobutamine/SNP infusion (268+/-6 vs 256+/-9 mmHg, p<0.05). 6) Intrapulmonary shunt fraction increased from 4.49+/-0.65% to 5.51+/-0.71% (p<0.05) following dobutamine alone, and increased further to 9.92+/-1.13 (p<0.001) and to 7.21+/-0.77% (p<0.01) in combination with ATP and SNP, respectively. These results suggest, although ATP increases intrapulmonary shunt fraction more than does SNP, ATP has significant advantage over SNP, either alone or in combination with dobutamine, in improving cardiac performance in patients with low output states due to high peripheral vascular resistance.
Adenosine Triphosphate* ; Adenosine* ; Anesthesia ; Arterial Pressure ; Dobutamine* ; Heart Rate ; Hemodynamics* ; Humans ; Lung ; Nitroprusside* ; Oxygen ; Pharmacology ; Sodium* ; Sympathetic Nervous System ; Vascular Resistance