STUDY DESIGN: Ninty eight patients with multilevel spinal stenosis who were treated with posterior decompression and instrumented posterolateral fusion were reviewed retrospectively. All patients were divided two groups by pathologic level and surgery level. One is complete level decompression group (whole pathologic levels were decompressed) and the other is limited level decompression group (less than pathologic levels were decompressed). SUMMARY OF BACKGROUND DATA: Many patients with spinal stenosis haute multilevel pathology, which is very difficult problem to make surgical strategy for determination of decompression level. METHOD: Patients were reviewed using combination of clinical records, follow-up examinations and radiographs. Posterior decompression and instrumented posterolateral fusion were performed in all patients using pedicle screw fixation (TSRH 49 cases, Diapason 37 cases, CCD 12 cases) and either autogenous bone graft alone or autograft with allograft. The average follow-up period was 19.7 months. RESULTS: In the clinical results by the criteria of Kirkalldy-Willis, there was no difference between complete level decompression group and limited level decompression group. By the bone graft mothorts, fusion rate was no difference between autograft alone group and autograft with allograft group, but fusion periods were more shorter in autograft alone group than in autograft with allograft group(P>0.05). CONCLUSION: In multilevel spinal stenosis, the segments that associated with neurologic symptoms or seyeie stenosis on radiograph must be decompressed but the segments that not associated with neurologic symptoms and mild stenosis on radiograph do not need preventive decompression.
Allografts ; Autografts ; Constriction, Pathologic ; Decompression ; Follow-Up Studies ; Humans ; Neurologic Manifestations ; Pathology ; Retrospective Studies ; Spinal Stenosis* ; Transplants*

The authors have clinically analysed the patients who required the reoperations after the aneurysmal clippings with intention to decrease the rate of reoperation as predicting the risk factors causing the postoperative complications or sequelae of subarachnoid hemorrhage. Between 1991 and 1996, we have performed total operation on 691 patients with aneurysmal subarachnoid hemorrhage. Among these, 72 patients(10.4% of total) required to be reoperated due to various causes. The shunt for hydrocephalus which was the most common cause of reoperation, performed in 57 patients(79.2% of the reoperated), and next, trephination for the subdural hygroma in 12 cases (16.7%), removal of the intracranial hematoma on the operated site in 7 cases(9.7%), reclipping of aneurysms for the regrowing of aneurysm rest or undiscovered aneurysm preoperatively in 5 cases(7%), and decompressive surgery for postoperative brain swelling and vasospasm in 2 cases(2.8%). The authors suggest that the perfect aneurysmal clipping and the detailed evaluation to decrease these complications of aneurysmal surgery, and careful attention should be given to find out the hidden or regrowing of aneurysmal rest are needed on pre-, postoperatively, and during the operation procedure.
Aneurysm* ; Brain Edema ; Hematoma ; Humans ; Hydrocephalus ; Intention ; Postoperative Complications ; Reoperation ; Risk Factors ; Subarachnoid Hemorrhage ; Subdural Effusion ; Trephining

The onset time of the non-depolarizing muscle relaxants can be shortened significantly when small dose of the same or different non-depolarizing muscle relaxant is administered prior to single sufficient dose. Likewise, the hypothesis that administration of neostigmine in divided dose accelerate the antagonism of neuromuscular blockade from "priming priciple" is not known, but under this Phenomenon the Present study was investigated the reversal effects following administration of neostigmine in divided dories compared wish single bolus dose. All patients were ASA physical status class l or ll undergoing minor surgery, free from neuromusfular, renal or hepatic diseases and not taking any drugs known to interfere with neuromuscular function. In all patients, anesthesia was induced with thiopental sodium (5 mg/kg) and endotracheal intubation preceding by vecuronium(0.08 mg/kg) and was mainteined with 50% N2O in oxygen and enflurane (1.0~2.0%) with continuous vecuronium infusion (0.06 mg/kg/hr). The EK7, heart rate, mean arterial prssure and nasopharrngeal temperature by Datascope 2100, and Train of four(T1 and T4) sequence 2 Hz every 20 second and end tidal CO2 using Datex ABM were monitored continuously. At the end of operation, continuous vecuronium infusion was discontinued but N2O and enflurane was received until all measurements were complete. When T1 had returned to 10% of control value, anticholinesterase mixture (anti-chE : neostigmfne 0.04 mg/kg) was admini-stered as following; Anti-chE was administered in a single bolus dose(control group, n=10), in an initial dose 20% of anti-chE(group l , n=10), in an initial dose 50% of anti-chE(group ll , n=7) and in an initial dose toff of anti-chIn(group lll, n=8) followed three minutes later by remaining dose for antagonism of vecuronium induced blockade respectively. The recovery of T1 twitch height was faster from 8 minutes in group l, and 5 minutes in group ll and lll after anti-chE administration, compared with control group, but group If was statistically insignificant. The recovery of T4 twitch height was faster from 9 minutes in group 1, 6 minutes in group ll and 8 minutes in group B after anti-chE administration compared with control gro-up but in group ll it was statistically ignificant. T4 recovery (TOF artio, fade) which depend upon T1 in three divided group was faster than control group. After anti-ch E administration, in all groups, heart rate was increased following decreased, and the change of mean arterial pressure within+/-6% after anti-chE administration was observed. In conclusion, the administration of anti-chE mixture(neostigmine 0.04mg/kg and and atr-opine 0.02mg/kg) in divided dose accelerated a significantly more rapid reversal of vecuron-ium infusion induced neuromusculas blockade as compared to a single administration, especially in an priming dose as 20% of anti-chE mixture.
Anesthesia ; Arterial Pressure ; Enflurane ; Heart Rate ; Humans ; Intubation, Intratracheal ; Neostigmine* ; Neuromuscular Blockade ; Neuromuscular Nondepolarizing Agents ; Oxygen ; Surgical Procedures, Minor ; Thiopental ; Vecuronium Bromide*

Cysts of the adrenal glands are uncommon and present difficult problems in differential diagnosis. In autopsy studies, the incidence of adrenal cysts is ranges from 0.064% to 0.18%. Recently, we have experienced a 22-year-old female patient with spontaneous hemorrhagic pseudocyst of adrenal gland without known cause, presenting symptoms of nausea, epigastric discomfort and intermittent pain of right upper abdomen. In clinical presentation, abdominal ultrasonogram and computerized tomogram suggest cystic degeneration of malignant pheochromocytoma, but screening hormonal evaluation was normal. Selective adrenal venous sampling, adrenal scintigram and pathologic examination were not compatible with the functioning adrenal cortical or medullary adenoma/carcinoma, the mass results in spantaneous hemorrhagic necrosis and cystic degeneratio#n of adrenal gland. The authors reported a case of spontaneous hemorrhagic pseudocyst of adrenal gland, which was successfully resected by laparoscopic excision with reviews of the literatures.
Abdomen ; Adrenal Glands* ; Autopsy ; Diagnosis, Differential ; Female ; Humans ; Incidence ; Mass Screening ; Nausea ; Necrosis ; Pheochromocytoma* ; Ultrasonography ; Young Adult

Nocturnal enuresis has been recognized as an adverse effect of clozapine treatment. We reported 3 chronic schizophrenic patients who had showed nocturnal enuresis following clozapine treatment. Oxybutynin hydrochloride on clozapine-induced enuresis was very effective in 3 patients. The dose in our patients was 5 to 10mg/day. This medication was well tolerated. It is suggested that oxybutynin hydrochloride is a effective therapeutic option in clozapine-induced nocturnal enuresis.
Clozapine* ; Enuresis ; Humans ; Nocturnal Enuresis* ; Schizophrenia

PURPOSE: The purpose of this study was to analyze the radiological and clinical outcomes in elderly patients with unstable intertrochanteric femur fractures in accordance with the length of intramedullary nail. MATERIALS AND METHODS: Between August 2009 and December 2014, a total of 139 patients–older than 65 years of age with AO/OTA classification of 31-A2 unstable intertrochanteric femur fracture–who has been followed-up for at least 1 year after the treatment with internal fixation by using an intramedullary nail were enrolled for this retrospective control study. The subjects were classified into two groups according to the length of intramedullary nail: 106 patients in the short group (group I) and 33 patients in the long group (group II). For radiological assessments, the reduction state, time to union, and implant related complications were examined. The clinical outcomes were assessed by preoperative hemoglobin, operating time, intraoperative bleeding amount, blood transfusion rate, hospitalization period, and Charnley hip pain scoring system at the final follow-up. RESULTS: The postoperative radiographs showed good or acceptable reduction in all cases. The mean time of radiologic bone union was 4.8 months, and there was no difference between the two groups. With respect to surgical time, the group II was found to take longer (57.87 minutes) than the group I (45.65 minutes) (p=0.003). The bleeding amount during surgery of the group II was greater (288.78 ml) than that of the group I (209.90 ml) (p=0.046). The clinical results at the final follow-up were found to be satisfactory in both groups. CONCLUSION: In cases of good reduction of the fracture from the treatment of unstable intertrochanteric femur fracture accompanying the posteromedial fragment in elderly patients, both groups–long and short intramedullary nails–showed satisfactory radiological and clinical outcomes.
Aged* ; Blood Transfusion ; Classification ; Femoral Fractures* ; Femur ; Follow-Up Studies ; Fracture Fixation, Intramedullary* ; Hemorrhage ; Hip ; Hip Fractures ; Hospitalization ; Humans ; Operative Time ; Retrospective Studies

Ossification of ligamentum flavum is a very rare disease and one of the new disease entities in myelopathy. We report three cases of ossification of ligamentum flavum in thoracic spine causing thoracic myelopathy. Main symptoms of this disease are numbness of both legs and feet, gait disturbance and spastic motor weakness. Simple spine X-ray, metrizamide myelogram, CT and MRI are most useful diagnostic tools. Sufficient decompressive laminectomy and facetectomy are treatment of choice.
Foot ; Gait ; Hypesthesia ; Laminectomy ; Leg ; Ligamentum Flavum* ; Magnetic Resonance Imaging ; Metrizamide ; Muscle Spasticity ; Rare Diseases ; Spinal Cord Diseases* ; Spine

PURPOSE: Gingko biloba extract (GBE), a natural product extracted from Gingko leaves, is known to increase the radiosensitivity of tumors. This radiosensitization probably arises from the increase in the peripheral blood flow by decreasing the blood viscosity and relaxing the vasospasm. The influence of a GBE on the metabolic status in fibrosarcoma II (FSaII) of a C3H mouse was investigated using 31P magnetic resonance spectroscopy (MRS). MATERIALS AND METHODS: Eighteen C3H mice with fibrosarcoma II (from 100 mm3 to 130 mm3) were prepared for this experiment. The mice were divided into 2 groups; one (9 mice) without a priming dose, and the other (9 mice) with a priming dose of GBE. The GBE priming dose (100 mg/kg) was administered by an intraperitoneal (i.p.) injection 24 hours prior to the measurement. First 31P MRS spectra were measured in the mice from each group as a baseline and test dose of GBE (100 mg/kg) was then administered to each group. One hour later, the 31P MRS spectra were measured again to evaluate the change in the energy metabolic status. RESULTS: In the group without the priming dose, the mean pH, PCr/Pi, PME/ATP, Pi/ATP, PCr/(Pi+ME) values 1 hour after the test dose were not changed significantly compared to the values at the baseline. However, in the group with the priming dose, the mean PCr/Pi, Pi/ATP, PCr/(Pi+PME) values 1 hour after the test dose changed from the baseline values of 0.49, 0.77, 0.17 to 0.74, 0.57, 0.28 respectively. According to the paired t-test, the differences were statistically significant. CONCLUSION: The above findings suggest that the metabolic status is significantly improved after administering GBE if the priming dose is given 24 hours earlier. This shows that the radiosensitizing effect of GBE is based on the increase of tumor blood flow and the improvement in the metabolic status.
Animals ; Blood Viscosity ; Energy Metabolism ; Fibrosarcoma* ; Ginkgo biloba* ; Hydrogen-Ion Concentration ; Magnetic Resonance Spectroscopy* ; Mice ; Mice, Inbred C3H* ; Radiation Tolerance ; Radiation-Sensitizing Agents

Transient monocular blindness (TMB) may occur in patients with systemic lupus erythematosus (SLE). Several mechanisms have been suspected as the causes of such TMBs. A 32-year-old female patient with SLE presented recurrent monocular altitudinal visual field defects lasting for several minutes and occurring less than six times per day. Her anticardiolipin antibody level was persistently positive. All cerebrovascular imagings were normal. We report a case of recurrent TMBs in SLE with antiphospholipid antibody syndrome, which may have been induced by vasospasm.
Adult ; Amaurosis Fugax* ; Antibodies, Anticardiolipin ; Antibodies, Antiphospholipid* ; Antiphospholipid Syndrome* ; Female ; Humans ; Lupus Erythematosus, Systemic* ; Visual Fields

BACKGROUND: The cause of autoimmune thyroid diseases (AITD), including Graves disease and Hashimotos thyroiditis, is largely unknown. To identify the genes responsible, most attention has been focussed on the HLA regions in the early studies. However, these studies have repeatedly shown a weak association between AITD and the HLA-DR3 in Caucasians. To understand and find out the mechanisms underlying the development of AITD, a search for non-HLA linked susceptibility genes is important. A recent study from American population have indicated an association between a polymorphism of CILA-4 gene and Graves disease. To clarify the relationship of the CTLA-4 polymorphism and AITD, the allele frequency of CTLA-4 gene from the patients with Graves disease and with Hashimotos thyroiditis in Korean papulation were analysed. METHODS: The CTLA-4 exon 1 polymorphism (49, A/G) was analysed by PCR-based, RFLP (Restriction Fragment Length Polymorphism) from 92 women and 37 men with Graves disease and 50 women and 9 men with Hashimotos thyroiditis diagnosed. Also, 287 healthy controls including 155 women and 132 men with no clinical evidence or family history of thyroid disease were enrolled. RESULTS: 1) In the group of Graves disease, there was significantly more patients with alanine homozygote (GG) than in control group (P<0.0005, RR=1.40). However, there was not significant with threonine homozygote (AA) between two groups (P=0.052). In the group of Hashimotos thyroiditis, no significant differences were found between all homozygotes and heterozygote. 2) In the group of Graves disease, there were significantly more patients with alanine homozygote (GG) (P<0.0001, RR=1.85) and significantly fewer patients with threonine homozygote (AA) than in the group of Hashimoto's thyroiditis (P<0.005, RR 0.25). CONCLUSION: Regardless of sex difference, alanine homozygote (GG) at exon 1 (codon 17) of CTLA-4 is associated with Graves disease in Korean population, which suggests genetic susceptibility is some role in the pathogenesis of Graves disease.
Alanine ; Exons ; Female ; Gene Frequency ; Genetic Predisposition to Disease ; Graves Disease ; Heterozygote ; HLA-DR3 Antigen ; Homozygote ; Humans ; Lymphocytes* ; Male ; Polymorphism, Restriction Fragment Length ; Sex Characteristics ; Threonine ; Thyroid Diseases* ; Thyroid Gland* ; Thyroiditis