PURPOSE: We designed this study to evaluate the incidence of spinal cord injury and the results of surgical treatment of lower cervical spine injury, and to suggest a rational treatment guideline according to the stages of Allen's mechanistic classification of the lower cervical spine injury. MATERIALS AND METHODS: We reviewed the medical records and roentgenograms of 66 patients (49 men and 17 women), who were treated surgically for acute fracture and dislocation of the lower cervical spine since March. 1991 to March. 1996. These patients ranged in age from 17 to 68 years (average age- 38 years). We used Allen's mechanistic classification to analyze fractures in the lower cervical spine injury. We divided neurologic status by complete, incomplete, root injury and no neurologic deficit group, Surgical treatment was performed for those with unstable fracture/dislocation, progressive neurologic deficit with conservative care, neurologic deficit with spinal cord compression by fracture fragment or extruded disc material. Surgical approach was determined according to the site of lesion. We analyzed the surgical treatment results according to neurologic recovery, radiologic bone union and complications, We used chisquare test for statistical analysis of neurologic improvement between the different surgical treatments. RESULTS: Twenty-nine cases were distractive-flexion (DF) phylogeny, 19 cases were compressive-flexion (CF), 2 cases were vertical-compression (VC), 8 cases were compressive-extension (CE), and 8 cases were distractive-extension (DE) phylogeny. For definitive surgical treatments we performed anterior cervical discectomy and fusion (ACDF) in 25, ACDF with anterior stabilizaiton in 30, posterior fusion in 5, and circumferential fusion in 6. There was no neurologic recovery in complete cord injury. There were 32 cases of incomplete cord injury all 8 anterior cord syndromes had no neurologic recovery, among 22 patients with central cord syndrome 18 had neurolgic recovery in various degrees and 2 with Brown-Seguard syndrome showed significant neurologic recovery. In nerve root injury, all patients had complete neurologic recovery. There was no radiologic nonunion at all and it took 10.3 weeks in average for radiologic bone union. There were neurogenic bladder, bed sore, local kyphosis, duodenal ulcer, respiratory infection, persistent neck pain and superficial wound infection in complications. Summary and CONCLUSIONS: In extension (CE, DE) injuries with neurologic deficit, anterior approach should be recommended because the major pathology is located in the anterior structure of the cervical spine. In flexion (DF and CF) injuries with major posterior osteoligamentous disruption, posterior approach could fix the posterior structures. Anterior decompression and fusion should be followed whenever anterior pathology is compressing the spinal cord or nerve root. Posterior open reduction and fusion is necessary whenever there is unreduced facet joint dislocation with or with out neurologic deficit. To prevent the late local kyphosis and persistent neurologic deficit with neck pain after prolonged external immobilization with ACDF, anterior stabilization with a plate and screw system is necessary to augment the surgical treatment of the unstable lower cervical spine injury which necessitates anterior decompression.
Central Cord Syndrome ; Classification ; Decompression ; Diskectomy ; Dislocations ; Duodenal Ulcer ; Humans ; Immobilization ; Incidence ; Kyphosis ; Male ; Medical Records ; Neck Pain ; Neurologic Manifestations ; Pathology ; Phylogeny ; Pressure Ulcer ; Spinal Cord ; Spinal Cord Compression ; Spinal Cord Injuries ; Spine* ; Urinary Bladder, Neurogenic ; Wound Infection ; Zygapophyseal Joint

No abstract available.
Snake Bites* ; Snakes*

Chronic complication of diving and working in compressed air is dysbaric osteonecrosis. Dysbaric osteonecrosis could be diagnosed by simple bone x-ray, in the case of exposure history to dysbaric atmosphere. The case is 44 years old man who worked as a shell fish diver for 20 years. He was exposed dysbaric atmosphere during diving. He had bone necrosis in both femur head, both distal femur and proximal tibia. He had multiple attacks of decompression sickness. Other causes of bone necrosis are ruled out. We conclude that diver's bone necrosis is dysbaric osteonecrosis.
Adult ; Atmosphere ; Compressed Air ; Decompression Sickness ; Diving ; Femur ; Femur Head ; Humans ; Necrosis ; Osteonecrosis* ; Tibia

A case of cutaneous sarcoidosis in the 66 year-old Korean female patient is presented. She shows typical skin manifestations of plaque type in the absence of other common objective evidence of systemic involvement. Diagnosis was confirmed by charcteristic histological findings and positive Kveim test with the support of other compatible clinical and biochemical findings. She had been followed up for 3 years since the first visiting. Recently chest X-ray, slit lamp examination and skin biopsies were taken again, but failed to reveal any significant interval changes.
Aged ; Biopsy ; Diagnosis ; Female ; Humans ; Kveim Test ; Sarcoidosis* ; Skin ; Skin Manifestations ; Thorax

The serum level of immunoglobulin E (IgE) in 28 atopic patients and 41 healthy, normal, non-allergic subjects were measured by standard radial immunodiffusion method (RIDT). The correlation between IgE level and clinical manifestations are studied. The results are as follows. 1) IgE value was higher in atopic dermatitis than normal subjects. 2) IgE value in atopie dermatitis revealed no sigaificant difference between in male and in female. 3) IgE value was increased parallel with the severity of the disease. 4) IgE value was not correlated with the extent of disease. 5) IgE value was not correlated with the duration of disease. 6) IgE value was not correlated with the age of onset. 7) IgE value was not correlated with the eosinophil count of peripheral blood.
Age of Onset ; Dermatitis ; Dermatitis, Atopic* ; Eosinophils ; Female ; Humans ; Immunodiffusion ; Immunoglobulin E* ; Immunoglobulins ; Male

To investigate the effect of hyperoxia on EKG findings and to evaluate the applicability of EKG as noninvasive monitoring index of oxygen toxicity, 38 rabbits were continuously exposed to 6 different conditions-3 hyperbaric oxygenations (HBO-2.5, 3.5 and 5ATA, 100% O2), normobaric oxygenation (NBO, 100% O2), hyperbaric aeration (HBA-5ATA, 21% O2) and normobaric aeration (NBA, 21% O2)-for 120 minutes and their EKG and time to dyspnea and convulsion were recorded. Dyspnea and death were observed in exposure conditions of HBO-3.5 and HBO-5 (Positive rate of dyspnea; 10%, 100%, death; 10%, 25%, respectively) only, and convulsion in 4 oxygenation groups (NBO; 20%, HBO-2.5; 20%, HBO-3.5; 20%, HBO-5; 88%). Abnormal EKG findings included arrhythmia and ST-T changes and the incidences was increasing with doses(partial pressure of oxygen). In addition to EKG change, findings observed during exosure were dyspnea and convulsion in the order of appearence and when non specific ST-T change was accepted as positive (abnormal) finding, the frequency of abnormal EKG was statistically significant(p<0.01), but when it was excluded from positive results, the frequency of EKG change was not significant(p>0.05). These results suggest that the effect of hyperoxia on heart is myocardial ischemia and arrhythmia, that oxygenation more than 3.5ATA causes myocardial damage in 120 minutes exposure, and that EKG is valuable as monitoring index of oxygen toxicity.
Arrhythmias, Cardiac ; Dyspnea ; Electrocardiography* ; Heart ; Hyperbaric Oxygenation ; Hyperoxia* ; Incidence ; Myocardial Ischemia ; Oxygen ; Rabbits* ; Seizures

Melanoma is relatvely uncommon malignant tumor arising in the skin from epidermal melanocytes, from the junctional component of a cellular nevus or, rarely within a blue nevus and frequently metastasizes to regional lymph nodes first, followed by hematogenous spread to lungs, liver, gastrointestinal tract, pancreas, adrenal, heart and brain. All melanoma patients are carefully evaluated according to several parameters. A complete history and physical examination are carried out, with particular attention being devoted to other pigmented tumors that the patient may have. The patient should be further evaluated to determine the presence or absence of metastases by chest X-ray examination, metastatic series or bone scan, liver function studies, liver scan, EKG, etc. Special factors such as age, sex, and race, as well as site, size, and growth rate of lesions are also evaluated. We had a case of 59 year-old male patient with disseminated malignant melanoma. Upon his first visit, we did not find any abnormality in his physical examination and routine laboratory findings except skin tumors on left heel and left leg.
Brain ; Continental Population Groups ; Electrocardiography ; Gastrointestinal Tract ; Heart ; Heel ; Humans ; Leg ; Liver ; Lung ; Lymph Nodes ; Male ; Melanocytes ; Melanoma* ; Middle Aged ; Neoplasm Metastasis ; Nevus ; Nevus, Blue ; Pancreas ; Physical Examination ; Skin ; Thorax

Many investigators are trying to elucidate the pathogenesis of psychiatric disorders on the basis of neuroendocrine responses to stimulation or perturbation. Dexamethasone(DEX) suppression has been the most widely utilized as the prototypical challenge test. Dexamethasone suppression test(DST) has proven to be valuable in diagnosing the depressive spectrum disorder. Reported specificity of diagnosis of depression is relatively high, but sensitivity is limited. Some researchers used the combination of dexamethasone and corticotropin releasing hormone(CRH) in order to improve the sensitivity. They reported that combined DEX/CRH test, i.e., we administered the insulin instead of CRH. Total subjects were 28(7 normal controls, 10 manic patients, 11 schizophrenic, patients). Subject were token DEX(1.5mg p.o.) at 11 p.m., insulin 16 hours later(0.1 unit/kg i.v.). Five blood samples for the determination of cortisol and ACTH were serially drawn at 15 minute interval. The results are as following : 1) The cortisol an ACTH levels of manic subjects increased following insulin administration. Manic subjects showed higher levels of cortisol and ACTH than schizophrenic and normal control subjects. The cortisol and ACTH levels of schizophrenic and normal control subjects did not show gross changes. 2) The sensitivity of the test was lower than that of reported DEX/CRH test.
Adrenocorticotropic Hormone ; Depression ; Dexamethasone ; Diagnosis ; Humans ; Hydrocortisone ; Insulin ; Research Personnel ; Sensitivity and Specificity

Osteosarcoma is a malignant tumor arising from the undifferentiated fibrous tissue of bone and one of the mostcommon pirmary malignant tumors of bone. The diagnosis of osteosarcoma is based one can be diagnosed with areasonable degree of confidence from the conbination of the lesion site, age and radiological findings. This is aclinical and radiological observation of 40 cases of osteosarcoma which were experienced at Chonnam NationalUniversity Hospital, Chosum University Hospital and Kwangju Christian Hospital from 1978 to 1981. The results wereas follows; 1. The peak incidence was in the age group from 10 to 19 years in 21 cases (52.5%). 2. In sexdistribution, male group showed slightly higer incidence than in female group with the ratio of 1.35;1. 3. Themost commonly affected site was proximal tibia(35%). The lesion was found around the knee in 65% of the studiedcases. 4. Increment of the level of serum alkaline phosphase was observed in 25 cases (62.5%), and the averagevalue of serum alkaline phosphature in these cases was 5.6 Bessay Lowry units. 5. Radiographically, osteoblastictype was 14 cases (35%), and soft tissue mass shadow with calcification was observed in 34 cases (85%). 6.Cortical destruction was observed in 30 cases (75%), and soft tissue mass shadow with calcification was observedin 34 cases (85%). 7. Solid periosteal reaction, sunburst periosteal reaction and Codman's triangle were observedin 35%, 57.5% and 22.5% respectively. 8. At the first visit, lung meatastasis was found in 5 cases (12.5%) andinguinal lymphnode metastasis in 2 cases (5%)
Diagnosis ; Female ; Gwangju ; Humans ; Incidence ; Jeollanam-do ; Knee ; Lung ; Male ; Neoplasm Metastasis ; Osteosarcoma ; Sulindac

A total 48 cases of myelography using Metrizamide were performed between August 1981 and July 1983 at the department of Orthopedic Surgery, Kwangju Christian Hospital. Of these cases, H.N.P was 26, tuberculous spondylitis 16, spondylolisthesis 4, and multiple sclero-sis 2 cases. The advantages of this study were as folows: 1. Complications were minimal in most of the cases except a slight headache. 2. Large amount of infusion was possible. 3. Rootlet was clearly seen. 4. Removal of dye was not necessary. 5. It gave a good contrast for the radiologic study.
Gwangju ; Headache ; Metrizamide ; Myelography ; Orthopedics ; Spondylitis ; Spondylolisthesis ; Water