OBJECTIVE: Achieving successful posterolateral fusion across the lumbosacral junction is particularly problematic. In our hospital, bilateral S2 laminar hooks coupled with bilateral S1 screws have been appeared to provide successful posterolateral fusion of lumbosacral junction in high non-fusion risk patients. Therefore we study about the safety of sacral lamina hooks insertion. METHODS: We measured the anterior-posterior(A-P) diameter of sacral canal at a point where median sacral crest of S1 and S2 meet on lumbar magnetic resonance(MR) sagittal images. The number of analyzed subjects was one hundred and minimum A-P diameter of sacral canal to insert laminar hooks safely was thought to be 9mm. RESULTS: In 78% of study cases, the sacral canal diameter was 9mm or more. There were no statistically significant difference of sacral canal diameter with age, sex, weight and height. CONCLUSION: Preoperative analysis of the sagittal MR image may be helpful for the safe insertion of the sacral laminar hooks to enhance posterolateral fusion of lumbosacral junction in high non-fusion risk patients. And, safe sacral laminar hooks insertion may be possible in about 78% of study cases.
Humans ; Magnetic Resonance Imaging*

OBJECTIVE: The purpose of this study is to clarify good indication and possibility of prevention from ischemic attack and hemorrhage after the multiple burr hole operation. Additionally, progression of occlusion of main vessels and disappearance of moyamoya vessels are analyzed. METHODS: The subjects were eight patients(mean age: 49 years, male to female ratio: 1: 1) of moyamoya disease at our institution who underwent the multiple burr hole operation under local anesthesia between August 1999 and December 2001. Among eight patients, the preoperative angiographic findings according to Suzuki stage were stage II in 4, stage III in 5, and stage IV in 4 hemispheres. In all patients, cerebral blood flow decreased in HMPAO-SPECT. In six patients, the cerebral perfusion reserve was impaired and in two patients, the cerebral perfusion reserve did not increase over 30% in HMPAO-SPECT with acetazolamide by two radiologists. RESULTS: At follow-up angiograms, all patients were found neovascularization but two patients in whom the cerebral perfusion reserve did not increase over 30% were less effective. Disappearance of moyamoya vessels was found in five patients and progression of occlusion of major vessels in two patients. CONCLUSION: Neovascularization and disappearance of moyamoya vessels after the multiple burr hole operation are similar to those of other indirect surgery in adult moyamoya disease. But long-term follow-up studies are needed before conclusions can be drawn on the efficacy of the multiple burr hole operation.
Acetazolamide ; Adult* ; Anesthesia, Local ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Male ; Moyamoya Disease* ; Perfusion

Fibrous pseudotumor of the testicular tunics is a rare benign fibrous proliferative disorder, but it is the second most common mass-forining lesion of the testicular tunics. While these lesions are not strict neoplasms, they do form nodules and are often mistaken for neoplasms. Herein, we report 2 cases of fibrous pseudotumor with characteristic histologic findings. Both cases had been incidentally found as slow growing scrotal masses and underwent excision. There were several nodules along the testicular tunics which had bulging whitish-gray cut surface with focal myxoid change and a whorling appearance. These two cases showed the histologic spectrum seen in fibrous pseudotumor from a haphazard arrangement of fibroblastic type cells with intervening collagen and focal lymphocytic infiltrates in case 1, to a densely collagenized lesion in case 2.

The purpose of this study was to measure and compare tensile and shear strength for 4 types of new direct-bonding brackets and same brackets after recycling and to evaluate the change of bracket slot width after recycling. Four types of new direct-bond brackets were bonded to recently extracted human premolar teeth and the tensile and shear strength was measured by Universal Testing Machine. The brackets were recycled by chemical process and the tensile and shear test was repeated. To evaluate the change of the bracket slot width, slot width was measured by the Topcon Universal Measuring Microscope before and after recycling. Following results were obtained: 1. There was no satistically significant difference between the tensile and shear strength of recycled brackets and those of new brackets. 2. In both new and recycled brackets, the tensile and shear strength of perforated base bracket was lower than those of photoetched, foilmesh and contou-lok mesh base brackets. (P<0.01) 3. There was no statistically significant difference in bonding strengths of control group bonded only once and two times. 4. There was no statistically significant difference in the change of the bracket slow width after recycling process. 5. Of the failure, the combination type (58%) in the tensile strength and the tooth adhesive interface (65%) in the shear strength was the most common type.
Adhesives ; Bicuspid ; Chemical Processes ; Humans ; Recycling ; Shear Strength ; Tensile Strength ; Tooth

Three patients with primary non-Hodgkin's lymphoma of the uterine cervix are reported and the literature is reviewed. All the three patients in the current study presented with vaginal bleeding. They were found to have diffuse large cleaved cell lymphoma, one of which was multilobated variant with marked sclerosis. Histologically, differential diagnsis from undifferentiated small cell carcinoma, endometrial stromal sarcoma & other sarcomas was difficult and requires special stains including immunobistochemical study. Vaginal pap smears were diagnosed as 'class V; malignant lymphoma' in only one patient. Immunologically, two cases were beta-cell lineage and one case was T-cell lineage. All the patients were treated with chemotherapy only and showed good responses.

Posttraumatic instability of the carpometacarpal joint of the thumb are rarely reported. Consequently little is known about clinical and radiologic diagnosis, natural progress or treatment method. We report three cases of chronic instability of the carpometacarpal joint of the thumb treated with Eaton and Littler's ligament reconstruction. Satisfactory thumb functions were restored without arthritic change or recurrent subluxation.
Carpometacarpal Joints* ; Diagnosis ; Ligaments ; Methods ; Thumb*

No abstract available.
Ovarian Neoplasms*

Craniopharyngioma is one of the most challenging, Frustrating, and humbling benign intracranial tumors of childhood. Its behavior is a clinical malignancy even though it is benign tumor in microscopically. There is no single treatment of craniopharyngioma and there must be a plan customized for eacg patient. This decision may, be made from diagnostic studies alone, but in most cases exploration of the tumor and the testing of its adherence to its surroundings will be the only thorough and fair way to determine whether it can be totally excised or not. So the choice of treatment is "individualize". We experienced one case of giant cystic craniopharyngioma and performed combined operaion whih were percutaneous intermittent drainage of cystic fluid through Ommaya reservoir and following microsurgical radial excision. There was no complication and marked intellectual and psychological improvement until todays for 20 months.
Craniopharyngioma ; Drainage* ; Humans

The incidence of spine trauma has been increasing. To investigate the incidence, characteristics, and difficulty in management of the acute spine-injuried patients in suburban area we analyzed 50 cases treated conservatively or by operative fusion over a recent one-year period. This study comprised of 26 females and 24 males, between 23 and 83 years old patients with injury of whole column of spine. The most frequent cause of injury was traffic accident. The most common lesion was the compression fracture of the first lumbar spine. Most patients complained neck or back pain on admission. In 3 cases, neurological deficits were noted. For six patients, surgical treatment were performed and 44 patients has been conservatively managed with halo brace, neck collars, and thoracolumbar orthoses. The average period of admi-ssion and immobilzation for the conservatively treated patients was 6 weeks. During which time a few complications such as progressive kyphosis, hypoalbuminemia, thrombophlebitis, urinary tract infection, paralytic ileus, bed sore, and alcohol withdrawal syndrome were aroused. In most cases, good outcomes were achieved. Most of geriatric patients, concomitant systemic diseases with cardiovascular and pulmonary dysfunction were usually present and absence of the insight on spine injury made difficulties in managment. On the basis of these results we concluded that most elderly patients with spine fracture coulde be effectively treated by conservative methods, and also careful and systemic management with adequate education for patients and their families were required.
Accidents, Traffic ; Aged ; Aged, 80 and over ; Back Pain ; Braces ; Education ; Female ; Fractures, Compression ; Humans ; Hypoalbuminemia ; Incidence ; Intestinal Pseudo-Obstruction ; Kyphosis ; Male ; Neck ; Orthotic Devices ; Pressure Ulcer ; Spine ; Thrombophlebitis ; Urinary Tract Infections

Pseudohypoparathyroidism (PHP) is a rare clinical type of hypoparathyroidism. The patients with PHP show classic clinical and biochemical features of hypoparathyroidism, but elevated serum level of parathyroid hormone (PTH) and characteristic physical appearances termed 'Albright's hereditary osteodystrophy' (AHO). PHP is classified into types Ia, Ib, Ic and II according to the presence of AHO phenotype and the mechanism of PTH resistance. We experienced a case of PHP in a 12 year-old girl with carpopedal spasm, syncope and partial AHO. She showed very low serum calcium level (1.4 mmol/L), high phosphorus level (3.62 mmol/L) and high immunoreactive PTH level (186.6 ng/L). In the Ellsworth-Howard test, urinary cyclic adenosine monophosphate and phosphorus levels after an exogenous PTH injection remained unchanged. Therefore, we were able to classify the patient as either PHP type Ia or Ic. After the patient had been treated with daily calcium carbonate (1 g), cholecalciferol (250 IU) and calcitriol (0.5 microgram), her neurological signs and symptoms as well as her biochemical abnormalities of hypocalcemia and hyperphosphatemia were improved.
Adenosine Monophosphate ; Calcitriol ; Calcium ; Calcium Carbonate ; Child ; Cholecalciferol ; Female ; Humans ; Hyperphosphatemia ; Hypocalcemia ; Hypoparathyroidism ; Parathyroid Hormone ; Phenotype ; Phosphorus ; Pseudohypoparathyroidism* ; Spasm ; Syncope