OBJECTIVES: The purpose of this study was to assess the complications, duration of admission, cost effectiveness, radiologic stabilization of the anterior cervical bone fusion in the treatment of cervical disc disease with and without plating. MATERIALS AND METHODS: Fifty-two surgically treated patients for cervical disc disease were reviewed. Group I consisted of consecutive treated patients with iliac auto-bone graft without instrumentation after anterior cervical discectomy. Group II consisted of consecutive treated patients with iliac autologous-bone graft with CASPER cervical plate fixations. Radiologic fusion was decided when loss of end plate boundary between graft bone and vertebral body and immobile, maintenance of the disc space were evident on simple dynamic plain films. The patients were discharged after the stabilization of cervical motion by films was of tained. These groups were analysed multiple variably with Mann-Whitney U-test. RESULTS: Group I consisted of 18 patients, group II consisted of 34 patients. Mean age was 49.0+/-8.1 years, mean duration of admission was 17.27+/-10.51 days, mean costs for treatment was 1,970,000+/-475,000 won. In group I, mean age was 47.7(34-60) years, 16 patients had undergo on one-level operation, 2-patients had undergo on two-level operation, mean duration of admission was 28.7+/-10.4 days, mean costs for treatment was 2,194,473+/-561,639 won. The periods of stabilization was 6.6+/-3.36 weeks on radiologic study. Mean periods of out patient follow up was 16.8(6-64) weeks after discharge. Mean period of radiologic follow up was 17.3(4-6) weeks after surgical operation. In group II, mean age was 49.7(37-62) years and 18 patients one-level operation, 14-patients had undergo on two-level operation and 2-patients three-level operation. Mean duration of admission was 11.24+/-3.29 days, mean costs for treatment was 1,850,823+/-389,372 won. The periods of stabilization was 5.88+/-7.07 weeks on radiologic study. Mean period of out patients follow up was 16.7(4-60) weeks after discharge. Mean period of radiologic follow up was 12.4(3-52) weeks after surgical operation. The duration of admission showed statistical significance in Group II but other items showed no significant difference between two groups. CONCLUSIONS: The more economic, early life return and effective method of cervical disc disease in our series were evident in patients who had undergone, iliac bone graft and plate fixations after anterior discectomy.
Cost-Benefit Analysis ; Diskectomy ; Follow-Up Studies ; Humans ; Outpatients ; Transplants*

OBJECTIVE: In the central nervous system, gamma-aminobutyric acid (GABA) is well known to act as an inhibitory neurotransmitter by hyperpolarizing postsynaptic neurons through gating GABA-activated Cl- channels. To date, however, the functional roles of GABA remain unclear in the autonomic nervous system. In the present study, we characterize GABA-activated Cl- currents in the neurons of major pelvic ganglia (MPG). METHODS: MPG neurons, located on the lateral surfaces of the prostate gland, from male rats were enzymatically dissociated. Ionic currents were recorded using whole-cell variant patch-clamp technique. Membrane potential was recorded under current clamp mode. Current traces were filterd at 2kHz by using 4-pole Bassel filter in the amplifier. RESULTS: Application of GABA (100micrometer) induced inward currents in the neurons, with holding potentials being maintained below the Cl- equilibrium potential (ECl). The GABA response was concentration-dependent and its reversal potential was close to the theoretical ECl. The GABA-induced Cl- currents were largely blocked by bicuculline (10micrometer, n=5), a GABAA receptor antagonist, but were not affected by 9-AC and niflumic acid, chloride channel blockers. GABA also produced significant membrane depolarization (19mV, n=28). As in the case of the Cl- currents, the GABA-induced depolarizations were largely blocked by bicuculline(10micrometer, n=6), but not by DIDS(50micrometer, n=4), another chloride channel blocker. CONCLUSION: The data suggest that GABAergic roles may be due to it's activation of excitatory GABAA receptors, which are expressed in MPG neurons.
Animals ; Autonomic Nervous System ; Bicuculline ; Central Nervous System ; Chloride Channels ; gamma-Aminobutyric Acid* ; Ganglia* ; Humans ; Male ; Membrane Potentials ; Membranes ; Neurons* ; Neurotransmitter Agents ; Niflumic Acid ; Patch-Clamp Techniques ; Prostate ; Rats

Pheochromocytoma is a tumor which secretes catecholamine and produces remarkable hemodynamic changes during the perioperative period. It is reported that in cases where a patient with undiagnosed pheochromocytoma is operated on, the mortality rate can reach 25% to 50%. The subject in this study was a 55-year-old female patient who was diagnosed having a retroperitoneal mass which looked like a neurogenic tumor. During the manipulation, serious hypertension and tachycardia were developed. The authors at that time suspected a pheochromocytoma, interrupted the operation, and after insertion of arterial line and sodium nitroprusside infusion, the rest of the operation was restarted. After the extirpation of the tumor, as the patient suffered serious hypotension, the concentration of the inhalation agent was reduced, ephedrine was injected, the proper amount of fluid and blood were administered, and, as a result, the operation was carried out safely, and postoperative course was unremarkable.
Ephedrine ; Female ; Hemodynamics ; Humans ; Hypertension ; Hypotension ; Inhalation ; Middle Aged ; Mortality ; Nitroprusside ; Perioperative Period ; Pheochromocytoma* ; Tachycardia ; Vascular Access Devices

BACKGROUND AND OBJECTIVES:Conventional vestibular rotation testing with the head centered on the axis stimulates the semicircular canals evoking compensatory eye movements. By placing subjects off from the axis of rotation, the otolithic organ may also be simultaneously stimulated by additional linear acceleration forces. In the present study, we compared the rotation with subjects placed on axis to those placed in an eccentric position. MATERIALS AND METHOD:In the eccentric rotation, the head of subject was facing outward and placed eccentrically for 33cm on naso-occipital axis. Slow harmonic acceleration test and velocity step test were performed. RESULTS:The sinusoidal eccentric rotation at 0.32, 0.64 Hz produced a significantly higher vestibulo-ocular reflex gain than did on axis rotation. In velocity step test, initial slow component velocity was significantly higher in eccentric rotation than in centric rotation. CONCLUSION:These finding suggest that the gain enhancement due to eccentric rotation is a result of tangentiallinear acceleration, probably sensed by the otolithic organ. This study raises the possibility of using eccentric rotation for the diagnosis of the patients with otolithic dysfunction.
Acceleration ; Axis, Cervical Vertebra ; Diagnosis ; Exercise Test ; Eye Movements ; Head ; Humans ; Otolithic Membrane ; Reflex* ; Reflex, Vestibulo-Ocular ; Semicircular Canals

OBJECTIVE: The purpose of this study is to compare the outcomes of two methods for stabilization and fusion: Postero-Lateral Fusion (PLF, pedicle screw fixation with bone graft) and Posterior Lumbar Interbody Fusion (PLIF, cage insertion) for spinal stenosis and recurred disc herniation except degenerative spondylolisthesis. METHODS: Seventy one patients who underwent PLF (n=36) or PLIF (n=35) between 1997 and 2001 were evaluated prospectively. These two groups were compared for the change of interbody space, the range of segmental angle, the angle of lumbar motion, and clinical outcomes by Prolo scale. RESULTS: The mean follow-up period was 32.6 months. The PLIF group showed statistically significant increase of the interbody space after surgery. However, the difference in the change of interbody space between two groups was insignificant (P value= 0.05). The range of segmental angle was better in the PLIF group, but the difference in the change of segmental angle was not statistically significant (P value=0.017). Angle of lumbar motion was similar in the two groups. Changes of Prolo economic scale were not statistically significant (P value=0.193). The PLIF group showed statistically significant improvement in Prolo functional scale (P value=0.003). In Prolo economic and functional scale, there were statistically significant relationships between follow-up duration (P value<0.001), change of interbody space (P value<0.001), and range of segmental angle (P value<0.001). CONCLUSION: Results of this study indicate that PLIF is superior to PLF in interbody space augmentation and clinical outcomes by Prolo functional scale. Analysis of clinical outcomes showed significant relationships among various factors (fusion type, follow-up duration, change of interbody space, and range of segmental angle). Therefore, the authors recommend instrumented PLIF to offer better clinical outcomes in patients who needed instrumented lumbar fusion for spinal stenosis and recurred disc herniation.
Follow-Up Studies ; Humans ; Prospective Studies ; Spinal Stenosis ; Spondylolisthesis

Abnormal coagulatioin is a frequent complication in patients with head injury. Hemostasis in 56 patients with head injuries, not associated with serious systemic injuries, was screened using platelt count, bleeding time, prothombin time, thrombin time, activated partial thrombin time, fibrinogen level, fibrin degradation product(FDP), protamin sulfate test, ethanol gelation test, and d-dimer test. Frequency of coagulopathy was 28.6% in all patients, 24.2% in the group of Glasgow Coma Scale(GCS) 9~15, and 36.8% in GCS 3~8. Patients with poor outcome, who had Glasgow Outcome Scale(GOS) 1~3, had higher frequency of abnormal laboratory results. Particularly, platelet was significantly reduced in the group of GOS 1~3 than GOS 4~5. In the patients without intracranial hematoma, fequency of coagulopathy was significantly higher in the patients with poor outcome than favorable outcome. In the group of GCS 3~8, patients with hematoma had significantly higher frequency of coagulopathy than patients without hematoma. Coagulopathy did not significantly changed the outcome of the patients. Most of the results of the tests except platelet count FDP returned to normal limit on the follow-up tests done 3 days later.
Bleeding Time ; Blood Platelets ; Coma ; Craniocerebral Trauma* ; Ethanol ; Fibrin ; Fibrinogen ; Follow-Up Studies ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Head* ; Hematoma ; Hemostasis ; Humans ; Platelet Count ; Thrombin Time

Among 202 aneurysmal patients with SAH who were admitted to Kyungpook National University Hospital from Jan. 1984 through Jan. 1988, the incidence of ventricular dilatation confirmed by postoperative follow-up brain CT scannings was 32.2%(65 cases). And 33 cases(19.3%) was in mild ventricular dilatation, 9 cases(4.5%) was in moderate and 23 cases(11.4%) in severe who needed the shunting procedure were analysed. The incidence of ventricular dilatation to the site of aneurysm was highest in A-com A. aneurysm(42.2%), followed by P-com A. aneurysm(36.4%) and MCA aneurysm(11.3%). The incidence of ventricular dilatation and the need for shunting was higher in multiple bleeding patients than the single. The good risk patients had meaningfully lower incidence of ventricular dilatation than the poor risk group. In the delayed surgical group showed significantly more numbers of ventricular dilatation needing the shunt than the cases in early group.
Aneurysm* ; Brain ; Dilatation* ; Follow-Up Studies ; Gyeongsangbuk-do ; Hemorrhage ; Humans ; Incidence ; Tomography, X-Ray Computed

Analyses and studies have been made on 34 cases of the combined ICH, showing mass effect among 305 male and female ruptured intracranial aneurysmal patients who were admitted to Kyungpook National University Hospital from Mar. 1984, through Feb. 1990. The incidence of the large ICH was 11.1% with 2.1 to 1 ratio of male to female. The highest age incidence of the hematoma was in the 40 to 60 years bracket. The most frequent site of the aneurysm combined with the large ICH was at MCA aneurysm, 38.6%, followed by at A-com artery aneurysm, 4.8%. The most frequent location of the hematoma was in temporal lobe, 88.2%. The rate of combined large ICH was 20.3% in multiple aneurysmal bleeding patients who revealed higher incidence of the hematoma than the single bleeding patients. In amount of the hematoma, 30-40ml bracket ranked top occupying 32.4% of all cases. After surgical treatment, 29.4% patient was improved to the good and fair on discharge. The rate of mortality was 61.8%, which was mainly due to direct effect of hematoma and cerebral infarction caused by vasospasm.
Aneurysm ; Arteries ; Cerebral Infarction ; Female ; Gyeongsangbuk-do ; Hematoma* ; Hemorrhage ; Humans ; Incidence ; Intracranial Aneurysm* ; Male ; Mortality ; Temporal Lobe

OBJECTIVE: In these retrospective studies, the authors report an evaluation of clinical and radiological outcome in patients with cervical spine injury who underwent anterior cervical fusion with Caspar Plating system. METHODS: The authors studied 45 patients with unstable cervical spine after trauma between July 1996 and December 2001. Our series consist of 39 male and 6 female. The cervical spine injury was most common in men in fourth decade. Motor vehicle accidents were a frequent cause of cervical spine injury. Thirty-three patients had fractures with instablity, ten a ligamental injury without fracture, one traumatic hernated disc. Lateral cervical spine X-rays were reviewed for evaluation of fusion and instrumentation failure. RESULTS: In most cases, operation for stabilization was done around one weeks after trauma. In all patients excellent immediate postoperative stability of the spine was obtained, although posterior fusion was necessary at same time in one patient. Solid fusion was achieved in all except two patients who died during the first 2 months after the operation. Three patients developed instrumentation related failure(6.7%): Two patients had screw loosening, one infection. Two of these patients underwent reoperation. The most dreaded complication of dural or cord penetration by drilling or screw placement was not observed. There was no postoperative neurological disturbances. Four patients died of causes unrelated to operation: Two patients died of upper gasterointestinal bleeding, and the other two died of pneumonia and sepsis respectively. CONCLUSION: The Caspar plating system affords an effective means of improving the fusion rate with acceptable instrumentaton-related morbidity in cervical spine injury.
Female ; Hemorrhage ; Humans ; Ligaments ; Male ; Motor Vehicles ; Pneumonia ; Reoperation ; Retrospective Studies ; Sepsis ; Spine*

Purpose: To identify the effect of a new leadership type by confirming the effect of clinical nurses' grit and nursing work environment on nursing performance and retention intention with the mediating effect of compassionate rationalism leadership in the process. Methods: A proportional stratified sampling method was used with 45 tertiary general hospitals nationwide as the sampling unit. An online survey targeting nurses who have been working continuously for more than one year was conducted from October 14 to November 9, 2022. The final analysis included 1,256 questionnaires. The correlation between the participants' variables was analyzed using Pearson's correlation coefficients. The mediating effect was confirmed using a regression analysis, and bootstrapping. Results: The compassionate rationalism leadership had a mediating effect on the relationship between grit and nursing performance (F=203.21, p<.001), nursing work environment and nursing performance (F=109.48, p<.001), grit and retention intention (F=149.90, p<.001), and nursing work environment and retention intention (F=25.14, p<.001). Conclusion The compassionate rationalism leadership of nursing managers had a positive effect on nursing performance and retention intention.Therefore, with the development and application of educational programs of compassionate rationalism leadership, it can be used to improve nursing performance and operate an efficient nursing organization.