No abstract available.

An en bloc bilateral osteotomy of the orbital roofs and frontal sinus for large or deeply situated anterior skull base tumors offers less brain retraction and a wide exposure. The authors describe en bloc bilateral osteotomy of the orbital roofs and frontal sinus, with skull base reconstruction using inner table of the patient's own frontal bone flap. The approach in this report offers the advantage of wide exposure, one-site operation and short operation time.
Brain ; Frontal Bone ; Frontal Sinus ; Orbit ; Osteotomy ; Skull Base* ; Skull*

No abstract available.
Sterilization, Tubal*

OBJECTIVE: The purpose of this study was to review our experience with subdural empyema. Clinical presentation, methods of diagnosis, results of microbiological tests, types of therapy, and outcome of patients are presented and compared with previous reports. METHODS: The study consists of 10 patients with subdural empyema treated from January 1988 to December 1997. Clinical records and radiologic studies were reviewed retrospectively. The patient population consisted of 8 men and 2 women, whose ages ranged from 12 to 65 years(mean 49.1 years). Diagnosis of subdural empyema was confirmed with contrastenhanced CT scanning or Gadoliniumenhanced MR imaging. Seven patients received surgical treatments and three patients were treated with a multiple antibiotics only. RESULTS: The subdural empyema have been found to occur most commonly after paranasal sinusitis and postoperative infection in four cases respectively, otitis media and mastoiditis in one case respectively. The organism were found to be staphylococci in three cases, streptococci in two cases, anaerobic streptococci in one case, sterile in one case, and unknown in three cases. Relative frequency of signs and symptoms revealed fever in eight cases, headache in seven cases, vomiting in five cases, hemiparesis in three cases, and epilepsy in two cases. The outcome was revealed good in eight cases, poor in two cases. CONCLUSION: Although subdural empyema is considered a rare condition, it constitutes between 13 and 23 per cent of all intracranial infectin. It usually presents as a fulminant clinical picture and rapid neurological deterioration. In this sense, it constitutes a true neurosurgical emergency. Diagnosis of subdural empyema is best made by either CT with contrast or by MRI. Both of these tests are also helpful in establishing the presence or absence of sinusitis. Subsequently, surgery along with antibiotics help to lower mortality rate. Antibiotics therapy should be selected according to final culture results and continued for 4 to 6 weeks. The general consensus is in favour of early drainage to reduce the mortality and clinical deterioration. In our study, the overall mortality rate was 0%, and 20% of patients had neurological deficiencies at the time of discharge from the hospital. It is very important for clinician to detect this condition early to keep low mortality and morbidity.
Anti-Bacterial Agents ; Consensus ; Diagnosis ; Drainage ; Emergencies ; Empyema, Subdural* ; Epilepsy ; Female ; Fever ; Headache ; Humans ; Magnetic Resonance Imaging ; Male ; Mastoid ; Mastoiditis ; Mortality ; Otitis Media ; Paresis ; Retrospective Studies ; Sinusitis ; Tomography, X-Ray Computed ; Vomiting

Displaced fracture of the ankle are probably the most common skeletal injury managed today by open reduction and internal fixation. But, it is recommended that metallic implant might be removed to restore normal biomechanical forces on hone and to reduce discomfort directly under the skin. in order to reduce the resources needed for the removal of metallic fixation devices, absorbable impiants of biodegradable synthetic polymers were deveioped. However reports of clinical application of such implants have so far been very few. This prospective study represents the good resuits in 15 displaced non-comminuted closed malleolar fractures of the ankle treated using hiodegradahle internal fixation in department of orthopedic surgery of Kwang Myung Sung Ae general hospitai from June I 995 to December 1996. The results were as follows 1. All cases were united and the average time for union was 7.6 weeks. 2. As a results of comparison with normal side, a restriction of 10 degrees or more of dorsiflexion of the ankle joint was present in 4 cases, a restriction of 20 degrees or more of plantar tlexion was present in 2 cases, a restriction of supination was present in 3 cases and a restriction of plantar flexion was present in 4 cases. 3. According to Phillips functional scoring scale, 4 cases were excellent, 7 cases good, 4 cases fair and no cases were poor. 4. There were no complications in all cases.
Ankle ; Ankle Joint ; Orthopedics ; Polymers ; Prospective Studies ; Skin ; Supination

A technique for Thallium-201 imaging after two separate injections of the tracer, which took less than I hour, was performed to evaluate if this technique could be used clinically as a noninvasive screening test of angina pectoris. 29 patients who complained of chest pain were included in this study: 18 patients were proven to have coronary artery disease by coronary angiography and 11 patients had normal coronary arteries. With the patient supine at rest, 1.0 mCi of Thallium was injected intravenously and imaging was performed in the anterior and 50degrees left anterior oblique projections for a preset time according to Okada's protocol. Immediately after acquisition of the rest images, without moving the camera head, an infusion of dipyridamole was done at the rate of 0.14 mg/Kg/min for 4 minutes. Two minutes after stopping the infusion, 1.0 mCi of Thallium was injected intravenously and 50degrees left anterior oblique and anterior projection images were acquired. Images of the same projection were realigned using computer image registration approach (PDP-11/34 computer of DEC company). The rest image was then subtracted from the realigned dipyridamole image to produce an image representing perfusion during dipyridamole induced hyperemia (subtraction image). The results were as follows; 1) All of the subtraction images were of adequate quality for interpretation. 2) 16 cases in 18 patients of angina pectoris and 1 case in 11 normal control showed perfusion defects, so the over all sensitivity and specificity of the subtraction versus rest Thallium image technique for diagnosis of angina pectoris were 89% and 91%, respectively. 3) All patients (8 cases) whose left ventriculography revealed abnormality of regional wall motion showed perfusion defects in corresponding segments. But qualitative analysis of Thallium image could not predict if the patient whose Thallium image revealed perfusion defect has abnormality of regional wall motion. 4) segmental analysis was performed to know the association between the site of coronary artery stenosis and the perfusion defects in Thallium scan, which revealed the sensitivities for detecting stenosis of LCX, LAD & RCA were 50-60% in range and the range of specificities were 89-92%. 5) Adverse effects of dipyridamole were headache (2 cases) and chest pain (4 cases) but aminophylline was not needed in any case. In conclusion, split dose Thallium dipyridamole scan can be used as a noninvasive screening test of angina pectoris reducing the total duration of imaging to less than one hour. Futher applications of this technique may include the assessment of myocardial perfusion before and immediately after coronary angioplasty and coronary artery bypass graft and the evaluation of the impact of pharmacotheraphy on regional myocardial perfusion.
Aminophylline ; Angina Pectoris* ; Angioplasty ; Chest Pain ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Bypass ; Coronary Artery Disease ; Coronary Stenosis ; Coronary Vessels ; Diagnosis* ; Dipyridamole* ; Head ; Headache ; Humans ; Hyperemia ; Mass Screening ; Perfusion ; Sensitivity and Specificity ; Thallium ; Transplants

Primary hyperparathyroidism is a rare disease that can be accurately diagnosed and effectively treated in most patients. The diagnosis is established by a persistent elevation of serum calcium and parathyroid hormone and by clinical evaluation. With the introduction of a biochemical screening test for calcium and the development of radiologic techniques, the detection of hyperparathyroidism has increased slightly. However, the parathyroidectomy is still not a common operation in Korea.Twenty-eight patients with primary hyperparathyroidism comprised of 14 males and 14 females, were treated by operation from January 1986 to December 1995 at Kyunghee University Hospital and the data were analyzed retrospectively. The results are as follows: 1) The sex distribution was 14 males & 14 females, and the age distribution was from 14 to 79 years. 2) The clincal manifestations were renal symptoms (42.9%), skeletal symptoms (28.6%), a neck mass (10.7%), pancreatitis (7.1%), no symptoms (7.1%), polydipsia (3.6%) in order of frequency. 3) Most of the patients showed hypercalcemia above 11mg/dl, but five patients had calcium levels which were either slightly increased or in the upper normal range . 4) The preoperative localization methods were mainly combinations of sonography, C.T.,and Tl-Tc subtraction scans and showed high sensitivity & specificity (above 90%). 5) The main tumor locations were the Rt. lower pole in 10 cases, the Rt. upper pole in 5 cases, the Lt. upper pole in 3 cases, the Lt. lower pole in 7 cases; there were 2 cases of ectopic location and 1case of hyperplasia at the Rt. upper & the Lt. lower pole. 6) The pathologic findings revealed a solitary adenoma in 25 patients, a carcinoma in two patients, and hyperplasia associated with MEN2a in 1 patient. 7) We experienced one case of recurrence after primary excision at the Rt. lower pole. Reoperation for a missed gland, after the primary operation, was performed in one patient; the excision of the tumor was performed successsfully. 8) We performed surgical excisions and 17 patients showed hypocalcemia postoperatively. Most of the hypocalcemia was transient and disappeared after ingestion of oral calcium agents or usuage of Vit. D3.
Adenoma ; Age Distribution ; Calcium ; Diagnosis ; Eating ; Female ; Humans ; Hypercalcemia ; Hyperparathyroidism ; Hyperparathyroidism, Primary* ; Hyperplasia ; Hypocalcemia ; Male ; Mass Screening ; Multiple Endocrine Neoplasia Type 2a ; Neck ; Pancreatitis ; Parathyroid Hormone ; Parathyroidectomy ; Polydipsia ; Rare Diseases ; Recurrence ; Reference Values ; Reoperation ; Retrospective Studies ; Sensitivity and Specificity ; Sex Distribution

No abstract available.
Pregnancy*

Pseudotumor cerebri syndrome is characterized clinically by raised intracranial pressure without ventriculomegaly. Several conditions known to interfere with CSF absorption pathways at the level of the arachnoid villi can produce the pseudotumor cerebri syndrome. Systemic lupus erythematosus (SLE) is an autoimmune, inflammatory and chronic disorder characterized by multi-organ involvement including the nervous system. Clinical evidence of central nervous system involvement includes headache, seizure, psychosis and altered mental status. However, pseudotumor cerebri syndrome has been reported infrequently as a primary feature of central nervous system involvement or a complication of SLE. A 19 year-old female was admitted with seizure preceded by headache and blurred vision. Ophthalmoscopic examination showed papilledema. The diagnosis of pseudotumor cerebri syndrome was confirmed by increased intracranial pressure(>550mmH2O) in the absence of any abnormal radiological findings of the brain. We described a 19-year-old girl whose first clinical manifestation was pseudotumor cerebri syndrome, which was diagnosed as SLE later. Therefore pseudotumor cerebri syndrome may be the part of the spectrum of clinical manifestation of SLE.
Absorption ; Arachnoid ; Brain ; Central Nervous System ; Diagnosis ; Female ; Headache ; Humans ; Intracranial Pressure ; Lupus Erythematosus, Systemic* ; Nervous System ; Papilledema ; Pseudotumor Cerebri* ; Psychotic Disorders ; Seizures ; Young Adult

Pseudotumor cerebri syndrome is characterized clinically by raised intracranial pressure without ventriculomegaly. Several conditions known to interfere with CSF absorption pathways at the level of the arachnoid villi can produce the pseudotumor cerebri syndrome. Systemic lupus erythematosus (SLE) is an autoimmune, inflammatory and chronic disorder characterized by multi-organ involvement including the nervous system. Clinical evidence of central nervous system involvement includes headache, seizure, psychosis and altered mental status. However, pseudotumor cerebri syndrome has been reported infrequently as a primary feature of central nervous system involvement or a complication of SLE. A 19 year-old female was admitted with seizure preceded by headache and blurred vision. Ophthalmoscopic examination showed papilledema. The diagnosis of pseudotumor cerebri syndrome was confirmed by increased intracranial pressure(>550mmH2O) in the absence of any abnormal radiological findings of the brain. We described a 19-year-old girl whose first clinical manifestation was pseudotumor cerebri syndrome, which was diagnosed as SLE later. Therefore pseudotumor cerebri syndrome may be the part of the spectrum of clinical manifestation of SLE.
Absorption ; Arachnoid ; Brain ; Central Nervous System ; Diagnosis ; Female ; Headache ; Humans ; Intracranial Pressure ; Lupus Erythematosus, Systemic* ; Nervous System ; Papilledema ; Pseudotumor Cerebri* ; Psychotic Disorders ; Seizures ; Young Adult