For measurement of the degree of osteoporosis, various methods have been used. The Saville's index of the lumbar spine is very simple method. With the object of studying the reliability and clinical usefulness of Saville's index, authors compared the Saville's index with anteroposterior(A.P.) and lateral Dual x-ray absorptiometry, and the Singh's index with the anteroposterior D.X.A. We took the D.X.A. and simple lumbar spine lateral view in 124 patients in same time and also performed D.X.A. and both hips anteroposterior views in 112 patients, then analyzed the correlation between the A.P. and lateral D.X.A., Saville's index and D.X.A., Singh's index and D.X.A. The results were as follows. 1. The correlation coefficient of the A.P. and lateral D.X.A. was 0.46 and appeared the low degree of correlation. 2. The correlation coefficient of the A.P. and lateral D.X.A. compared with Saville's index were 0.68 and 0.83, respectively. Saville's index appeared the higher correlation in lateral D.X.A. than A.P. D.X.A. 3. The correlation coefficient of Singh's index and D.X.A. was 0.84, appeared nearly the same results of Saville's index with lateral D.X.A. 4. Intrapersonal differences were 36% in Saville's index, 28% in Singh's index. Saville's index appeared higher intrapersonal error than Singh's index. The lateral D.X.A. is more accurate and precise method than A.P. D.X.A. because lateral D.X.A. reduces the influence of soft tissue calcification and degenerative changes of spine. As Saville's index is a grading method based on lateral view of lumbar spine, we think that it should be compared with the lateral D.X.A. Regarding this results, authors suggest that Saville's index is not any accurate measurement of bone quantity, but has clinical usefulness for evaluation of osteroporosis.
Absorptiometry, Photon ; Bone Density ; Hip ; Humans ; Methods ; Osteoporosis ; Spine

No abstract available.
Carbon Dioxide* ; Carbon* ; Lasers, Gas* ; Vulva*

No abstract available.

The authors report the surgical results of thalamotomy and pallidotomy, performed at our hospital between 1983 and 1993 for the treatment of Parkinson's disease. The series included a retrospective analysis of 156 patients with this condition by stereotactic ventrolateral(VL) thalamotomy(126 patients, 138 thalamotomies) and posterolateral pallidotomy(30 patients, 30 pallidotomies). Each patient was followed up postoperatively, for one year. Among those who underwent the stereotactic VL thalamotomy, 136/138 procedures(99%) led to improvement of tremor, and 83/138(60%) resulted in reduced rigidity. Stereotactic posterolateral pallidotomy, led to improvement of bradykinesia after 27/30 procedures(90%), of rigidity after 22/30(73%) and of tremor after 13/30(43%). Drug-induced dyskinesia showed a 42% improvement in the thalamotomy series and a 93% improvement in the pallidotomy series; the difference between the two series was significant(p<0.001). The patients themselves and their relatives used the Hoehn & Yahr staging scale to assess postoperative improvement in disability, and according to the results, 91/126 patients(72%) in the thalamotomy series and 26/30(87%) in the pallidotomy series showed improvement. In the thalamotomy series, there was a significantly higher improvement in disability for preoperative groups I and II(Hoehn & Yahr staging scale) than for groups III and IV(p<0.029), while in the pallidotomy series, there was no statistically significant difference in postoperative improvement between these same groups(p>0.557). In addition, for groups with greater preoperative disability(Hoehn & Yahr staging, groups III and IV), improvement was more likely after pallidotomy than after thalamotomy. In the pallidotomy series, dysphasia was the only serious complication and this was seen after 20% of procedures. In the thalamotomy series, however, complications included hypotonia(24%), transient confusion(19%), transient dysphasia(11%), permanent dysarthria(7%), subjective numbness(4%) and epileptic seizure(3%). The authors believe that posterolateral pallidotomy is much more effective than VL thalamotomy for the control of Parkinsonian bradykinesia and rigidity, but that thalamotomy is still a useful surgical option for the control of Parkinsonian tremor.
Aphasia ; Dyskinesia, Drug-Induced ; Humans ; Hypokinesia ; Pallidotomy* ; Parkinson Disease* ; Retrospective Studies ; Tremor

STUDY DESIGN: Intertransverse lumbar fusion segments were evaluated in rabbits at 4, 8, 12, and 16 weeks after surgery. The calcium sulfate was used as a bone graft substitute and its fusion rate compared with the fusion rate of autogenous bone graft. OBJECTIVE: To investigate the efficacy of calcium sulfate as a bone graft substitute in achieving intertransverse fusion in rabbits. SUMMARY OF BACKGROUND: Calcium sulfate is a bone graft substitute made from medical grade calcium sulfate hemihydrate. Preclinical testing and clinical case studies demonstrate the excellent bone healing response and biocompatibility in long bone defect. MATERIALS AND METHODS: Forty adult New Zealand white rabbits were included in our study. In group I, the 0.8g of the calcium sulfate was grafted on the left inter transverse of L4-5 or L5-6 and the 0.8g of the autogenous iliac bone on the right side at the same level. In group II, the 0.4g of the calcium sulfate mixed with 0.4g of the autogenous graft on the left intertransverse of L4-5 or L5-6 and 0.8g of the autogenous iliac bone on the right side at the same level was grafted. At postoperative 4, 8, 12, 16 weeks, the plain roentgenogram was checked to evaluate the bony union. At 16 weeks, all rabbits were sacrificed and the histologic evidences of the bony union using H&E and trichrome stain were investigated. The molecular-biological study to detect the RNA of TNF-alpha was investigated in nonunion. RESULTS: Bone graft using calcium sulfate resulted in nonunion radiologically and histologically in all rabbits. 92.5% of calcium sulfate in group I and 80.0% in group II was resorbed within postoperative 12 weeks. There was statistical significance between group I and group II. In contrast, graft using autogenous cancellous bone showed complete bony union in 11 out of 20 rabbits. With molecular-biological study using PCR, the RNA of TNF-alpha was not detected from bony union site, but detected from nonunion site. CONCLUSION: The results of this study indicate that calcium sulfate is not an effective bone graft substitute for achieving stable intertransverse spinal fusion. TNF-alpha may have direct effects on autogenous graft bone with calcium sulfate resorption
Adult ; Calcium Sulfate* ; Calcium* ; Humans ; Polymerase Chain Reaction ; Rabbits* ; RNA ; Spinal Fusion ; Transplants* ; Tumor Necrosis Factor-alpha

Toxoplasma gondii has been shown to result in life-threatening encephalitis in immunocompromised patients after reactivation of dormant parasites. In order to obtain information on immune responses related to this phenomenon, BALB/c mice were infected with 25 cysts of the 76K strain of T. gondii, then, treated orally with dexamethasone (Toxo/Dexa-treated group) in order to reactivate the chronic toxoplasmosis. None of the T. gondii-infected mice died during the experimental periods, whereas the Toxo/Dexa-treated mice evidenced a significant attenuation of survival periods. Toxoplasma-specific IgG2a, IgA and IgM titers in sera were significantly depressed in the Toxo/Dexa-treated mice; however, the IgG1 sera titers were similar to those seen in the Toxoplasma-infected mice. The percentages of CD4+ and CD8 alpha + T cells in the Toxo/Dexa-treated mice were significantly reduced 2 weeks after dexamethasone treatment. IFN-gamma and IL-10 production levels in the Toxo/Dexa-treated mice were depressed significantly, whereas IL-4 production was increased temporarily. The expression levels of the Toxoplasma-specific P30 and B1 genes were found to have been increased in the Toxo/Dexa-treated mice in comparison with the Toxoplasmainfected mice. Collectively, the findings of this study demonstrate that reactivation of murine toxoplasmosis as the result of dexamethasone treatment induced a depression in Th1 immune responses, whereas Th2 immune responses were not significantly influenced.
Toxoplasmosis/*immunology/parasitology ; Toxoplasma/*immunology ; Th2 Cells/immunology ; Th1 Cells/immunology ; Mice, Inbred BALB C ; Mice ; Immunoglobulins/*biosynthesis/immunology ; Female ; Dexamethasone/*pharmacology ; Cytokines/*biosynthesis ; Antibodies, Protozoan/*biosynthesis/immunology ; Animals

OBJECTIVE: To find most effective pressure relief method in wheelchair seated spinal cord injured patients and to evaluate effectiveness of trunk lateral bending, trunk pulling and trunk forward flexion methods in practical environment METHOD: Twenty spinal cord injury patients were included in this study. After 5 cm air-filled cushion (ROHO(R)) was placed on wheelchair seat, patients were seated on wheelchair with neurtal position and interface pressure of buttock was measured by X-sensor 4.0 system. Patients took a posture lateral bending, trunk pulling, forward flexion methods. Mean and maximal pressure of buttock were measured at each pressure relief methods. RESULTS: Mean and maximal pressure of buttock were reduced by 90degrees trunk forward flexion (p<0.05). In trunk lateral bending method, pressure was reduced in non-weight bearing side of buttock, but pressure was highly elevated in weight bearing side. In trunk pulling method, pressure was elevated in both weigth bearing and non-weight bearing side. CONCLUSION: 90degrees trunk forward flexion method can be recommended to wheelchiar seated spinal cord injured patients for pressure relief of buttock.
Buttocks ; Humans ; Posture ; Spinal Cord Injuries ; Spinal Cord* ; Weight-Bearing ; Wheelchairs*

OBJECTIVES: Using two stimuli, this study was designed to evaluate variations of P300 in relations to reaction time of pressing the button for target tones in patients with schizophrenia. METHODS: The auditory oddball paradigm was used for the patients (N=22) and normal controls (N=23). The two stimuli were composed of target (20%, 2000 Hz, 75 dB) tone and standard (80%, 1000 Hz, 75 dB) tone, with 2 sec inter-stimulus interval, 50 msec duration and 10 msec rise or fall time. In each subject, P300s were acquired for both fast reaction time (FRT) and slow reaction time (SRT) to target response. RESULTS: P300 amplitude in patients with schizophrenia was lower than controls across FRT and SRT (p<0.001), but P300 latency was not delayed (p>0.8). In this study, even though the reaction time for the button pressing task might be faster in patients with schizophrenia (p<0.1), the P300 to FRT in patients with schizophrenia was lower than the P300 to SRT in controls (p<0.01). CONCLUSION: These results suggest that the lower P300 in patients with schizophrenia might be due to cognitive dysfunction and the patient's performance in reaction time for pressing buttons, both independently. Thus, P300 as well as reaction time may be used to further explore a variety of domains of cognitive function.
Evoked Potentials* ; Humans ; Reaction Time* ; Schizophrenia*

PURPOSE: To evaluate the diagnostic accuracy of CT in the differential diagnosis of tuberculous and malignant pleural effusion whether or not lung lesions are present, and to investigate the CT findings used for this differential diagnosis. MATERIALS AND METHODS: This study involved 30 patients with tuberculous pleural effusion (mean age, 44.6 years; M:F=19:11) and 20 with malignant pleural effusion (mean age, 57.2 years; M:F=10:10). All 50 patients underwent enhanced CT chest scans, and the respective conditions were pathologically confirmed. Two radiologists unaware of the pathologic results and distribution of patients reviewed these scans retrospectively and independently. They recorded the presence or absence of helpful lung lesions, CT findings of pleural effusions, their diagnoses, and the degree of confidence of their diagnoses. RESULTS: Among the total of 100 answeres, helpful long lesions were found in 57 cases. Fifty-three of 57 diagnoses (93%) were correct and 26 cases (46%) were diagnosed with a high degree of confidence. Thirty-two of 43 cases (74%) without helpful lung lesions were correct and 11(26%) were diagnosed with a high degree of confidence. All diagnoses made with a high degree of confidence were correct, even in cases without helpful lung lesions. Frequent CT findings in tuberculous pleural effusion included diffuse pleural thickening, enhancement of pleura, deposition of extrapleural fat, and pleural calcification; in malignant pleural effusion, nodular pleural thickening, pleural thickening over 1cm and associated lymphadenopathy were frequent. Mediastinal and circumferential pleural, as well as fissural involvement, were seen in both effusions; there were no statistical differences. CONCLUSION: In most cases, CT provided correct differential diagnosis between tuberculous and malignant pleural effusion. It can help determine the nature of associated lung and pleural lesions, and specific findings of the latter, and can accurately differentiate tuberculous and malignant pleural effusion.
Diagnosis ; Diagnosis, Differential* ; Humans ; Lung ; Lymphatic Diseases ; Pleura ; Pleural Effusion* ; Pleural Effusion, Malignant* ; Retrospective Studies ; Thorax

When the spasticity becomes wevere and hamful, in spite of physical and medical therapy, surgery can give functional improvement. The authors report two cases of selective neurotomy of the tibial nerve for the treatment of the spastic foot which led to abnormal posture, articular limitation, pain, and disturbances impairing standing and walking. Prior to surgery, the effectiveness of neurotomy had been verified by means of infiltrating the nerves with local anesthetic agents. The surgery was performed under the intraoperative electrostimulation for identifying the branches of tibial nerve to the muscle sustaining spasticity. After microdissection of each tibial nerve brance at the lower part of the popliteal region, the selected branches were cut, preserving at least one fourth of the motor fibers. Significant functional gains were observed as a result of substantial reduction of the harmful spasticity, without suppressing the useful muscle tone and impairing the residual motor and sensory function. For patients with disabling spastic foot, refractory to routine physical, orthopaedic and medical treatment a simple neurosurgical procedure, the selective tibial neurotomy has enabled them to stand and walk comfortably, and has allowed them to reach a significantly improved quality of life.
Anesthetics ; Foot* ; Humans ; Microdissection ; Muscle Spasticity* ; Neurosurgical Procedures ; Posture ; Quality of Life ; Sensation ; Tibial Nerve* ; Walking