We have retrospectively analyzed the clinical and radiological outcome in 22 cervical spondylotic myeloradiculopathy patients who underwent combined front anterior decompression and fusion) and back (open door laminoplasty) surgery between Mar. 1991 and Jan. 1995. Clinical symptoms were evaluated by Japanese Orthopaedic Association(JOA) score and the recovery rate. Plain radiogram and MIR were taken before and after surgery, and then the cervical curvature, change of body to canal ratio and the A-P compression ratio of the cord were measured and compared to the clinical symptoms. Results : The mean JOA score increased from 10.1±3.3 preoperatively to 14.7±1.4 at the final follow-up with a mean recovery rate of 64.4%. No patients deteriorated as a result of the combined procedure. Post-op. radiograms showed an increasement of body to ratios (average 0.69±0.09 pre-op. to 1.0±0.13 post-op.) and maintenance or recovery of cervical Lordosis. On MRI, the A-P compression ratios of the cord were increased with recovery of subarachnoid space after the operation in most cases (average 38.4±7.6 pre-op. to 55.7±7.2 post-op.). Conclusion : This combined procedure safely and effectively resulted in decompression of the spinal cord and good functional recovery in patients with 1) anterior and posterior pathology, 2) narrow spinal canal and large spondylotic bar or herniated disc encroaching the spinal canal more than 5mm, 3) narrow spinal canal and kyphotic deformity, 4) narrow spinal canal and segmental instability, 5) multisegmental cord compression and severe radiculopathy.
Animals ; Asian Continental Ancestry Group ; Congenital Abnormalities ; Decompression ; Follow-Up Studies ; Humans ; Intervertebral Disc Displacement ; Lordosis ; Magnetic Resonance Imaging ; Pathology ; Radiculopathy ; Retrospective Studies ; Spinal Canal ; Spinal Cord ; Subarachnoid Space

The significance of the physical examination is controversial since Slocum and Larson first described the concept of rotatory instability of the knee. The findings of the physical examination of the 101 knees of 95 patients from 1982 to 1985 were compared with the operative findings. The results were as follows. 1. Valgus stress test a) The valgus stress test c the knee in extension was positive in 1) combined tear of medial collateral ligament, posterior oblique ligament, either anterior or posterior cruciate ligament, 2) avulsion fracture of medial collateral ligament and 3) extensive tear of medial capsular ligament. But the test was negative when the posterior oblique ligament was intact although the medial collateral ligament and the anterior cruciate ligament were torn. b) The valgus stress test c the knee in 30° flexion was positive in all cases of torn medial collateral ligament, But it was severer in cases of positive test in full extension. 2. The varus stress test in extension was positive when the anterior or posterior cruciate ligament was torn in addition to lateral collateral ligament and posterolateral capsule. 3. The Slocum test was negative, or positive only in neutral rotation in isolated tear of the anterior cruciate ligament. 4. The Ritchey-Lachman test was positive in all cases of torn anterior cruciate ligament. 5. The posterior drawer test could be positive in cases of intact posterior cruciate ligament. 6. The pivot shift test was negative in cases of torn medial collateral ligament and posterior oblique ligament although there was associated tear of the anterior cruciate ligament. 7. The flexion rotation drawer test was positive in all cases of torn anterior cruciate ligament although there was associated tear of the medial collateral ligament. The positive test didn't always mean anterolateral rotatory instability, 8. The reversed pivot shift test was positive in cases of posterolateral rotatory instability but it was negative in cases of associated tear of posteromedial capsule. 9. The drawback of external rotation drawer test was that it depended on subjective evaluation. 10. The rotation test was very good for the rotatory instability but it could not be used in bilateral injury and the anterolateral rotatory instability of isolated tear of anterior cruciate ligament.
Anterior Cruciate Ligament ; Collateral Ligaments ; Exercise Test ; Humans ; Knee ; Lateral Ligament, Ankle ; Ligaments ; Physical Examination ; Posterior Cruciate Ligament ; Tears

No abstract available.
Femur* ; Hip Fractures* ; Hip*

In the orthopaedic field, some elective surgery such such as joint replacement, spinal surgery and limb sparing procedures for musculoskeletal tumors frequently need various amounts of blood trans- fusion. But homologous transfusion occasionally result in various side effect including allergic reaction, febrile reaction, coagulopathies due to reduced platelets and coagulating factors, graft versus host disease(GVHD) and transmission of infectious diseases such as malaria, syphilis, hepatitis and AIDS. Recently these complications especially in elective surgery might result in medicolegal and social problem. Risks of transfusion could be minimized with autologous blood. So many authors are interested in prebanked autologous transfusion in elective orthopaedic surgery to prevent these problems. But there might be need of additional homologous blood transfusion because of the time limited and low yield of autologous blood. Recombinant human erythropoietin(4-HuEPO) has been shown to increase erythropoiesis. The authors could yield 5 units during 14 days using r-HuEPO without any adverse reactions. Therefore we could performed decompression, posterolateral fusion with pedicular screw fixation in spondylolisthesis without additional homologous transfusion.
Blood Transfusion ; Communicable Diseases ; Decompression ; Erythropoiesis ; Erythropoietin ; Extremities ; Hepatitis ; Humans ; Hypersensitivity ; Joints ; Malaria ; Social Problems ; Spondylolisthesis ; Syphilis ; Transplants

Degenerative lumbar spondylolisthesis requires fusion of the involved segments and decompression laminectomy because it is mechanically unstahle and usually associated with stenosis of the spinal canal. Transabdominal retroperitoneal approach through small longitudinal pararectal skin incision provides easy and safe access to L3-4 and L4-5 disc spaces with less bleeding. We thought that anterior interbody fusion enable us to restore the disc space and to reduce partially the listhesis with less hleeding and less harvest of graft hone compared to posterolateral fusion, and also without the risk of neural or dural damage which could he occurred in posterior lumbar interbody fusion 4.15.16.17). Thus, authors performed the same-day anterior and posterior spinal surgery (APSS) in 28 patients (30 disc spaces) from 1992 to 1996 and analyzed the clinical and radiological results. The most common site of involvement was L4-5 level (82.1%). The mean follow-up period was 2 years and 2 months (from l2 months to 4 years). Fusion was ohtained at 29 disc spaces (96.7%) within 24 weeks (average, I 6 weeks). The anterior displacement was corrected up to the average of 65.4% (5.8mm) postoperatively and the average of 60.7% (5.2mm) correction remained at last follow-up. The intervertebral disc space was restored up to the average of 96.9% (7.5mm) postoperatively and the average of 86.0% (6.2mm) restoration remained at last follow-up. Twenty-five out of 28 patients (89.2%) showed excellent or good clinical results hy the criteria of Kim, et al6). In conclusion, the same-day procedure of successive anterior interbody fusion, decompression laminectomy and posterior pedicular instrumentation for the degenerative lumbar spondylolisthesis associated with spinal stenosis was thought to be a good method of treatment.
Constriction, Pathologic ; Decompression ; Follow-Up Studies ; Hemorrhage ; Humans ; Intervertebral Disc ; Laminectomy ; Skin ; Spinal Canal ; Spinal Stenosis ; Spondylolisthesis* ; Transplants

Endocrinological studies of mental disorder are based on the fact that the neuroendocrinological system is under central nervous system control, thus linking peripheral hormonal secretion and brain activity. Neuroendocrine basis for the onset of schizophrenia which often occurs in adolescence and the gender differences in the clinical expression of illness have been explored. However, the studies of neuroendocrine alterations in schizophrenic patients are rarer and more inconsistent than affective disorder. Although the nature of neuroendocrinological dysfunction is less well characterized in schizophrenia than in mood disorder and anxiety disorder, a number of neuroendocrine abnormalities have been described. In schizophrenic patients, hypercortisolemia has been described especially during acute exacerbation, and persistent hypercortisolemia has been associated with ventricular enlargement and poor prognosis. Also, abnormality in HPA axis, HPG axis, HPT axis, prolactin, growth hormone and other neurohormonal profile has been described in schizophrenia. Although the precise neuroendocrinological alterations of schizophrenia is incompletely understood, the explored neurohormonal changes are helpful in the confirmation of recurrence, the selection of effective therapeutic agents, developing new therapeutic modalities, and prediction of treatment response and prognosis. This article reviews several neurohormonal researches on schizophrenia. For the further development of psychoneurohormonal researches in schizophrenic illness, more extensive studies in many aspects are needed.
Adolescent ; Anxiety Disorders ; Axis, Cervical Vertebra ; Brain ; Central Nervous System ; Growth Hormone ; Humans ; Mental Disorders ; Mood Disorders ; Prognosis ; Prolactin ; Recurrence ; Schizophrenia*

Over the physiologic range of heart rate, the duration of electrical systole(QT) is shorter than that of electromechanical systole(QS2), which reflects direct physiologic link between electrical repolarization and mechanical events of the cardiac cycle. The present study designed to test usefulness of systolic time intervals and QT-QS2(QT minus QS2) value as complication predictors, which may predict prognostic status of myocardial infarction. The studied subjects were consisted of 33 healthy adults as control(22 men, 11 women) and 35 patients with myocardial infarction. And studied patients were divided into 3 groups; group I of 14 patients with or without complication in acute stage, group II of 11 uncomplicated patients under recovery of chronic status, group III of 10 complicated patients under recovery or chronic status. The observation periods were 3 to 13 days in group I, 5 to 96 weeks in group II and III after their onset. The results were follows; 1) The normal ranges were defined as mean+/-2 standard deviations of the measured values of control, that of QTc were shorter than 431ms of man and 458ms of woman, that of QS2 I were longer than 503ms of man and 514ms of woman, that of PEP/LVET ratio was less than 0.40, that of QT-QS2 value was less than 0 ms respectively. 2) QTc of all patient groups were significantly prolonged compared with that of control, and that of group III was significantly longer than that of group II(481+/-25 vs 432+/-32, p<0.005). 3) The changes of QS2 I were not significant in all patient groups compared with QS2 I of control. 4) QT-QS2 value showed QT>QS2 in group I and III. and QTQS2 had positive predictive value of 82% for predicting probability of previous complicated status. We concluded that QT-QS2 value, including PEP/LVET ratio and QTc, could be used as complication predictors. But it is necessary to examine these indicators prospectively to confirm its clinical applicability.
Adult ; Female ; Heart Rate ; Humans ; Male ; Myocardial Infarction* ; Reference Values ; Sensitivity and Specificity ; Systole*

This article reviews the characteristics and major pharmacological treatment modalities of bipolar depression, which is distinguished from unipolar depression by etiologic differences, symptomatic features, clinical courses, and treatment responses. Bipolar depression is often disabling and very challenging to treat. In acute and prophylactic phases, mood stabilizers such as lithium, divalproex, and lamotrigine are used as first-line treatment, unless the patient is psychotic or markedly dysfunctional. Carbamazepine and oxcarbazepine can be used as a second-line treatment or in a combination regimen. Depressive episodes that do not respond to mood stabilizers, as well as relapsing episodes despite prophylactic therapy, justify treatment with antidepressants. Many clinicians also advocate the early use of antidepressants and antipsychotics when depressive episodes are severe or psychotic. Selective serotonin reuptake inhibitors and bupropion are considered the first choices for use in combination with a mood stabilizer. Bupropion in particular yields stability against manic switches or cycle acceleration. Traditionally, clinicians have used antipsychotics as a combination option when treating patients with bipolar depression who exhibit psychotic features. However, extensive and well controlled recent studies have shown that atypical antipsychotics such as quetiapine, olanzapine, and an olanzapine/fluoxetine combination can yield therapeutic efficacy and good tolerability for treating bipolar depression with or without psychotic features. In particular, a randomized controlled trial (RCT) using quetiapine monotherapy to treat patients with bipolar depression yielded significantly reduced depressive symptomatology. Other atypical antipsychotics such as amisulpride, aripirazole, risperidone, and ziprasidone have yielded antidepressive efficacy, but no RCT trials have been conducted on patients with bipolar depression. Some preliminary studies have shown that newly developed agents such as dopamine agonist, agomelatine, riluzole, mefepristone, and uridine effectively improve mood symptoms among patients with bipolar depression. More extensive clinical trials are needed.
Acceleration ; Acetamides ; Antidepressive Agents ; Antipsychotic Agents ; Benzodiazepines ; Bipolar Disorder ; Bupropion ; Carbamazepine ; Depressive Disorder ; Dibenzothiazepines ; Dopamine Agonists ; Humans ; Lithium ; Piperazines ; Riluzole ; Risperidone ; Serotonin Uptake Inhibitors ; Sulpiride ; Thiazoles ; Triazines ; Uridine ; Valproic Acid ; Quetiapine Fumarate

This article reviews the characteristics and major pharmacological treatment modalities of bipolar depression, which is distinguished from unipolar depression by etiologic differences, symptomatic features, clinical courses, and treatment responses. Bipolar depression is often disabling and very challenging to treat. In acute and prophylactic phases, mood stabilizers such as lithium, divalproex, and lamotrigine are used as first-line treatment, unless the patient is psychotic or markedly dysfunctional. Carbamazepine and oxcarbazepine can be used as a second-line treatment or in a combination regimen. Depressive episodes that do not respond to mood stabilizers, as well as relapsing episodes despite prophylactic therapy, justify treatment with antidepressants. Many clinicians also advocate the early use of antidepressants and antipsychotics when depressive episodes are severe or psychotic. Selective serotonin reuptake inhibitors and bupropion are considered the first choices for use in combination with a mood stabilizer. Bupropion in particular yields stability against manic switches or cycle acceleration. Traditionally, clinicians have used antipsychotics as a combination option when treating patients with bipolar depression who exhibit psychotic features. However, extensive and well controlled recent studies have shown that atypical antipsychotics such as quetiapine, olanzapine, and an olanzapine/fluoxetine combination can yield therapeutic efficacy and good tolerability for treating bipolar depression with or without psychotic features. In particular, a randomized controlled trial (RCT) using quetiapine monotherapy to treat patients with bipolar depression yielded significantly reduced depressive symptomatology. Other atypical antipsychotics such as amisulpride, aripirazole, risperidone, and ziprasidone have yielded antidepressive efficacy, but no RCT trials have been conducted on patients with bipolar depression. Some preliminary studies have shown that newly developed agents such as dopamine agonist, agomelatine, riluzole, mefepristone, and uridine effectively improve mood symptoms among patients with bipolar depression. More extensive clinical trials are needed.
Acceleration ; Acetamides ; Antidepressive Agents ; Antipsychotic Agents ; Benzodiazepines ; Bipolar Disorder ; Bupropion ; Carbamazepine ; Depressive Disorder ; Dibenzothiazepines ; Dopamine Agonists ; Humans ; Lithium ; Piperazines ; Riluzole ; Risperidone ; Serotonin Uptake Inhibitors ; Sulpiride ; Thiazoles ; Triazines ; Uridine ; Valproic Acid ; Quetiapine Fumarate

PURPOSE: We evaluated oncologic outcomes of chondrosarcomas and analyzed the disease-free survival rate of chondrosarcomas according to the various factors. MATERIALS AND METHODS: We performed a retrospective study for the disease-free survival rate of 48 chondrosarcomas, 44 of which underwent surgical treatment and followed up more than 18 months since 1993, and in the remaining 4 cases, the patients died before 18 months after surgery. The vsariables were location, tumor volume, histologic grade, stage, age at presentation and treatment performed. The mean follow up period was 43.8 months (1-196 months). RESULTS: The overall disease-free survival rate was 77.1% at mean 43.8 month follow up. The 5 year- and 10 year disease-free survival rates were 64% and 58% respectively. The histologic grade, stage, age at presentation revealed statistical significance on disease-free survival. All 9 patients treated with extended curettage for grade 1 central chondrosarcomas revealed disease-free survival with excellent functional outcome. CONCLUSION: The disease-free survival rate of chondrosarcomas mainly depended on histologic grade, stage and age at presentation. Local recurrence and distant metastasis also revealed statistically significant differences of disease-free survival rate. Comparing to wide resection, extended curettage for low-grade central chondrosarcomas in extremities were efficient methods with similar survival rate and less functional losses and complications.
Chondrosarcoma ; Curettage ; Disease-Free Survival ; Extremities ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies ; Survival Rate ; Tumor Burden