STUDY DESIGN: A retrospective analysis of 166 patients was undertaken to observe radiologically the changes of adjacent segments at follow-up more than three years after lumbar fusion. OBJECTIVES: The purpose of this study is to analyse the changes of adjacent segments and to correlate these changes to the length of using level and to the degree of deviation from physiologic lumbar lordosis. The authors also correlate these radiologic changes to the clinical symptoms. MATERIALS AND METHODS: In simple x-ray, authors observed traction spur, disc space narrowing, endplate sclerosis and vacuum phenomenon of adjacent segments. Authors used Gelb's criteria in segmental lordosis angle(SLA) and Katz's classification in clinical results. RESULTS: The average age was 49.6 years old and the average follow-up period was 57.2 months(4 years and 9.2 months). We observed radiologically the traction spurs in 35 cases(21.1%), end-plate sclerosis in 32 cases(19.3%), disc space narrowing in 33 cases(19.9%) and the vacuum phenomenon in 10 cases(6.0%). The numbers of fusion segments and the degree of unphysiologic segmental lordosis angle in fusion segments were related with the frequency and degree of changes of adjacent segments(P<0.05). The clinical results showed satisfaction in 142 cases(85.5%), unsatisfaction in 24 cases(14.5%) and low back pain in 24 cases(14.5%), leg pain in 11 cases(6.6%) and extension of fusion level in 4 cases(2.4%). In low back pain patients more than two kinds of radiological changes were frequently observed than the patients without low back pain(P<0.05). CONCLUSIONS: The radiological changes of adjacent segments were more frequently observed in long fusion and in fusion with unphysiologic lumbar lordosis angle. And these changes are frequently associated with low back pain. Thus long fusion and fusion with unphysiologic lumbar lordosis angle should be avoided if possible.
Animals ; Classification ; Follow-Up Studies* ; Humans ; Leg ; Lordosis ; Low Back Pain ; Retrospective Studies ; Sclerosis ; Spinal Fusion* ; Traction ; Vacuum

The general consensus of the treatment for ankle fracture is anatomical reduction and restoration of the distal tibiofibular relationship. In general, stabilization of the disrupted syndesmosis may be achieved by repairing ruptured ligament; fixing associated fractures of the fibular, avulsed tubercles, and medial malleolus; or by placing a screw between the tibia and the fibular to hold the syndesmosis in position until some degree of syndesmotic ligament healing can occur. However, the managements of syndesmosis remain controversial. The purpose of this study is to evaluate the effect of the syndesmotic fixation in the ankle fractures. The patients with syndesmotic disrupted ankle fracture, who were treated operatively between 1990 and 1995 at St. Benedict Hospital, were divided into the two groups based on whether trans-syndesmotic screw was used or not. The group I included 42 ankle fractures that were treated with trans-syndesmotic screw, while the group II included 28 ankle fractures that were treated without syndesmotic screw. The results obtained from this study were as follows. 1). There was no significant difference of the clinical result between the two groups. 2).When the diastasis was satisfactorily reduced after rigid, anatomic medial and lateral fixation, syndesmotic screw fixation was not required to maintain the integrity of the tibiofibular joint.
Ankle Fractures* ; Ankle* ; Consensus ; Humans ; Joints ; Ligaments ; Tibia

Rapid-eye-movement (REM) sleep behavior (RBD) is a form of REM sleep motor dyscontrol characterized by complex, vigorous, and frequently violent behaviors without atonia during the REM sleep. The motor dyscontrol may include not only cataplexy and sleep paralysis but alto periodic limb movements during REM and non-REM sleep. We examined two patients with charateristic episodes of behavioral manifestations during the REM sleep as well as with other sleep disorders such as narcolepsy and periodic limb movement disorder. The one patina was an 18 year-old man who had childhood-onset RBD associated with narcolepsy since 10 years old. The polysomnographic studies showed excessive augmentation of chin EMG and 6 attacks of violent behavior during REM sleep. He also complained of cataplexic symptomes. Multiple sleep latency tests (MSLT) showed four sleep onset REMs and two episodes of violent behavior during the REM sleep. The other patient was a 74 year-old man who complained of violent behaviors during the REM sleep and polysomnographic studies showed excessive augmentation of chin EMG during the REM sleep and periodic leg movements for 24min. And 14sec. During the sleep. We report two patients with RBD which were associated with narcolepsy, and periodic limb movememt disorder irrespectively, suggesting that RBD, narcolepsy and periodic limb movement disorder could occur coincidently and be understood as a motor dyscontrol during REM sleep.
Adolescent ; Aged ; Cataplexy ; Child ; Chin ; Extremities ; Humans ; Leg ; Mental Disorders* ; Narcolepsy* ; Nocturnal Myoclonus Syndrome* ; REM Sleep Behavior Disorder ; Sleep Wake Disorders ; Sleep Paralysis ; Sleep, REM*

Many methods are available for monitoring spinal cord conductian during operation. It is essential for the anesthesiologist to the know potential interactions between the drugs used during the operation and the neurophysiologic response. The purpose of the present study was to experimentally examine the effects of ketamine and fentanyl used in the operating room. Twenty-three patients, 23 to 68 years of age, ASA I-II, free of neurologic disease and scheduled for elective operations were randomly selected for the study. Averaged somatosensory evoked potentials to stimulation of the posterior tibial nerve at the ankle were recorded. After baseline recording of the somatosensory evoked potential, ketamine (1.5 mg/kg) or fentanyl (3u/kg) was administered by bolus injection in each patient. Additional somatosensory evoked potential after the drug injection was recorded. ECG, blood pressure and heart rate were monitored throughout the measuring procedure. 1) The mean values of latency (Pl, Nl, P2) and amplitude (Pl-N1, Nl-P2) were 39.58, 48.36 and 60. 74 msec and 7.88 and 10.30uV respectively. Those values were changed to 38.54, 46.67 and 60.50 msec and 6.55 and 9.85uV in patients in the ketamine injected group. 2) The mean values of latency and amplitude were 37.90, 45.93 and 61.01 msec and 7.35 and 7.21uV respectively in the baseline state. Each value changed to 38.10, 47.06 and 61.88 msec and 6.67 and 8.49uV respectively after fentanyl injection. There was no statistical difference in latencies and amplitudes between the pre-injection state and post-injection state in both the ketamine and fentanyl groups. Therefore, we suggested that the use of ketamine or fentanyl could be administered successfully during intraoperative somatosensory evoked potential monitoring without much influence on tibial nerve stimulation.
Ankle ; Blood Pressure ; Electrocardiography ; Evoked Potentials, Somatosensory* ; Fentanyl* ; Heart Rate ; Humans* ; Ketamine ; Operating Rooms ; Spinal Cord ; Tibial Nerve

PURPOSE: The purpose of the present retrospective study was to report the clinical and radiological results of 31 total hip arthroplasties of 28 patients with bony ankylosed hip. MATERIALS AND METHODS: Conversions to cementless total hip arthroplasty between August 1983 and May 1999 were reviewed after followups ranging from 3 years 1 month to 18 years. The mean age of the patients at the time of operation was 35.0 years. The mean duration of the ankylosis was 15 years 7 months. RESULTS: At the time of the last follow-up, the mean arc of flexion was 84.6 degrees. The mean Harris hip score improved from 47.7 to 84.9. There were no significant differences in clinical results according to the type and duration of ankylosis. Radiographs showed one acetabular loosening, six acetabular osteolysis and five femoral osteolysis. In cases of osteolysis, the average wear rate was 0.28 mm/year. CONCLUSION: The conversion of bony ankylosed hip to a cementless total hip arthroplasty revealed a favorable outcome, and the risk of failure was found to be unrelated to the type and the duration of ankylosis. However, since some patients show excessive wear with osteolysis, polyethylene liner wear will be of critical importance in terms of long-term results.
Acetabulum ; Ankylosis ; Arthroplasty ; Arthroplasty, Replacement, Hip* ; Follow-Up Studies ; Hip* ; Humans ; Osteolysis ; Polyethylene ; Retrospective Studies

Although quantitative EEG parameters, such as spectral band powers, are sensitive to centrally acting drugs in dose- and time-related manners, changes of the EEG parameters are redundant. It is desirable to reduce multiple EEG parameters to a few components that can be manageable in a real space as well as be considered as parameters representing drug effects. We calculated factor loadings from normalized values of eight relative band powers (powers of 0.5, 1.0~2.0, 2.5~4.0, 4.5~5.5, 6.0~8.0, 8.5~12.0, 12.5~24.5, and 25~49.5 Hz bands expressed as ratios of the power of 0.5-49.5 Hz band) of EEG during pre-drug periods (11:00~12:00) by factor analysis and constructed a two-dimensional canonical space (reference canonical space) by canonical correlation analysis. Eight relative band powers of EEG produced by either physostigmine or yohimbine were reduced to two canonical scores in the reference canonical space. While changes of the band powers produced by physostigmine and yohimbine were too redundant to describe the difference between two drugs, locations of two drugs in the reference canonical space represented the difference between two drug's effects on EEG. Because the distance between two locations in the canonical space (Mahalanobis distance) indicates the magnitude of difference between two different sets of EEG parameters statistically, the canonical scores and the distance may be used to quantitatively and qualitatively describe the dose-dependent and time-dependent effects and also tell similarity and dissimilarity among effects. Then, the combination of power spectral analysis and statistical analysis may help to classify actions of centrally acting drugs.
Animals ; Electroencephalography ; Factor Analysis, Statistical ; Physostigmine ; Rats ; Yohimbine

Dumbbell-shaped spinal extradural cavernous hemangioma is rare. The differential diagnosis of dumbbell-shaped spinal tumors based on magnetic resonance imaging includes schwannoma and lymphoma. Here, we report a dumbbell-shaped spinal extradural cavernous hemangioma with intrathoracic growth on T2-3 in a 64-year-old man complaining of right side infrascapular area back pain with no neurologic deficit. The cavernous hemangioma was resected through combined video-assisted thoracoscopy and laminectomy without a fusion procedure. The patient had tolerable operative wound pain with no neurologic deficit after surgery. Based on magnetic resonance imaging findings and a review of the literature, we discuss cavernous hemangioma among the differential diagnosis of paravertebral dumbbell-shaped spinal tumors and the importance of complete resection.
Back Pain ; Diagnosis, Differential ; Hemangioma ; Hemangioma, Cavernous* ; Humans ; Laminectomy ; Lymphoma ; Magnetic Resonance Imaging ; Middle Aged ; Neurilemmoma ; Neurologic Manifestations ; Spine ; Thoracoscopy ; Wounds and Injuries

Wide-necked aneurysms of the posterior inferior cerebellar artery (PICA) are infrequently encountered in cerebrovascular practice, and endovascular treatment is difficult or impossible even with the use of several neck remodeling techniques. We present the case of a patient with a wide-necked aneurysm of the PICA, which was treated by the retrograde stenting through the contralateral vertebral artery and vertebrobasilar junction with antegrade coil embolization.
Cerebellar Diseases/radiography/*therapy ; Cerebral Angiography ; Embolization, Therapeutic/instrumentation/*methods ; Humans ; Intracranial Aneurysm/radiography/*therapy ; Male ; Middle Aged ; *Stents ; Tomography, X-Ray Computed

BACKGROUND: Hormone replacement therapy in postmenopausal women is widely used for the relief of menopausal symptoms and the prevention of bone loss. But, it has been reported that many women discontinue hormone replacement therapy within early period, because the women suffer from breast pain, bleeding and weight gain. Also, further adverse influence of hormone replacement therapy on cardiovascular risk and breast cancer has been suggested. There are many controversies due to conflicting data of that. Recent studies suggest that low-dose estrogen provide bone benefits and micronized progesterone have favorable effects on lipid metabolism and breast density. This clinical trial evaluated the short-term effects of low-dose estrogen and micronized progesterone on bone turnover markers and serum lipid profiles in postmenopausal women. METHODS: This was a 12-week study in which 90 postmenopausal women received hormone replacement therapy. Participants were assigned in equal numbers to the following groups: (1) daily treatment with 0.625 mg conjugated equine estrogens (CEE) with medroxyprogesterone acetate MPA 2.5 mg to 5 mg, daily or cyclically; (2) daily treatment with 0.625 mg CEE with micronized progesterone (MP) 100 mg to 200 mg, daily or cyclically; (3) daily treatment with 0.3 mg CEE with MP 100 mg to 200 mg, daily or cyclically. Changes in bone turnover markers and serum lipid profiles were assessed. RESULTS: At 12-week, all treatment groups significantly improved bone turnover markers and serum lipid profiles, specifically serum alkaline phosphatase, serum osteocalcin, urine deoxypyridinoline and serum high density lipoprotein cholesterol level. CEE 0.625/MPA and CEE 0.625/MP significantly decreased serum low density lipoprotein cholesterol level. CEE 0.625/MPA significantly increased serum triglyceride level. CEE 0.625/MPA produced greater decreases in serum alkaline phosphatase level than CEE 0.625/MP and CEE 0.3/MP. CEE 0.625/MP produced greater increases in serum high density lipoprotein cholesterol level than CEE 0.625/MPA. CEE 0.625/MPA produced greater increase in serum triglyceride level than CEE 0.3/MP. CONCLUSION: Low-dose estrogen and MP generally improved bone turnover markers and serum lipid profiles. But, MP produced lesser favorable effects on a part of bone turnover markers. MP produced significantly greater increases in serum high density lipoprotein cholesterol than that of MPA. And Low-dose estrogen produced significantly lesser increases in triglyceride than that of conventional dose.
Alkaline Phosphatase ; Breast ; Breast Neoplasms ; Cholesterol, HDL ; Cholesterol, LDL ; Estrogens* ; Estrogens, Conjugated (USP) ; Female ; Hemorrhage ; Hormone Replacement Therapy ; Humans ; Lipid Metabolism ; Mastodynia ; Medroxyprogesterone Acetate ; Osteocalcin ; Progesterone* ; Triglycerides ; Weight Gain

BACKGROUND: The hormone replacement therapy (HRT) and bisphosphonate alendronate are efficacious in the prevention and treatment of postmenopausal osteoporosis. Acting by different mechanisms, these two agents decrease bone resorption and thereby increase or preserve bone mineral density. The combined effects of these medications have not been rigorously studied. This clinical trial examined the combined effects of HRT and oral alendronate on bone mineral density (BMD) and biochemical markers of bone turnover in 50 postmenopausal women with low bone mass. METHODS: This was a 1-year study in which 50 postmenopausal women received daily treatment with 0.625 mg conjugated equine estrogens (with medroxyprogesterone acetate 2.5 mg to 5 mg, daily or cyclically) alone or in combination with 10 mg alendronate. All of the women received a supplement of 600 mg elemental calcium daily. Changes in BMD at the lumbar spine and biochemical markers of bone turnover were assessed. RESULTS: At 1-year, significant increases from baseline in lumbar spine BMD were observed in both treatment groups [combined HRT and alendronate, 10.3%(p < 0.001); HRT alone, 4.5% (p < 0.05)]; Compared with HRT alone, combined HRT and alendronate significantly produced greater increases in BMD of the lumbar spine (p < 0.001). Both treatment groups significantly decreased biochemical markers of bone turnover, especially mean serum osteocalcin level and mean serum alkaline phosphatase level. The combined HRT and alendronate significantly produced greater decreases in mean serum alkaline phosphatase level than HRT alone (p < 0.05). CONCLUSION: Combined use of HRT and alendronate significantly produced greater increases in lumbar spine BMD and greater decreases in biochemical markers of bone turnover than that of HRT alone. Thus, the therapy of combined HRT and alendronate produced favorable effects on bone mineral metabolism in postmenopausal women with osteoporosis.
Alendronate* ; Alkaline Phosphatase ; Biomarkers ; Bone Density ; Bone Resorption ; Calcium ; Estrogens, Conjugated (USP) ; Female ; Hormone Replacement Therapy* ; Humans ; Medroxyprogesterone Acetate ; Metabolism* ; Osteocalcin ; Osteoporosis* ; Osteoporosis, Postmenopausal ; Spine