It is well known that stereotaxic urokinase(UK) irrigation through a catheter is one of surgical methods in the management of hypertensive intracerebral hematoma(ICH) patients. Several authors recommended irrigation with 6000 IU UK, 4 times per a day. Based on authors' experience some patients who were managed with above protocol suffered from complications such as meningitis and/or pneumonia. It might be partially caused by prolonged duration of irrigation and immobilization of the patients. In order to reduce complications and to improve the final outcome of hypertensive ICH patients, we tried high dose UK irrigation(group II:irrigation with 50ml of normal saline mixed with 200,000 IU UK at immediate postoperative period, followed by two times of 20,000 IU UK irrigation per a day) to remove the ICH rapidly in those patients since Oct. 1991. We compared the rate of decreasing volume of hematoma, Glasgow coma scale(GCS) score change according to postoperative period, final outcome, and the rate of complications between this group(group II) and group I(4 times irrigation with 6,000 IU UK per a day). The results shows that the rate of decreasing volume of hematoma is slightly more rapid in group II than group I. The rate of poor outcome(vegetative and death) is lower in group II than I(group I vs. II:34% vs. 20% respectively). The rate of complication is lower in group II than I(group I vs. II:38.5% vs. 0.0%, respectively). One case(5%) of postoperative rebleeding was noted in group II. From this study, we concluded that, even if the beneficial effects are small, the high dose UK irrigation is one of protocols in the management of hypertensive ICH patients.
Catheters ; Coma ; Hematoma* ; Humans ; Immobilization ; Meningitis ; Pneumonia ; Postoperative Period ; Urokinase-Type Plasminogen Activator*

The authors report two cases of trigeminal neuralgia caused by epidermoid tumor in the cerebellopontine angle. The one case showed that trigeminal nerve was displaced superiorly by the tumor and was adhesed to the superior cerebellar artery. The other case showed that tumor mass encircled the facial, acoustic nerves as well as trigeminal nerve entirely and after removal of the tumor petrosal vein was found at the root entry zone of the trigeminal nerve. Interestingly these two cases were devoid of neurologic deficit. We tried microvascular decompression as well as removal of tumor and were satisfied with its result. We reviewed the literature and discussed these cases in point of mechanisms of trigeminal neuralgia.
Arteries ; Cerebellopontine Angle* ; Cochlear Nerve ; Microvascular Decompression Surgery ; Neurologic Manifestations ; Trigeminal Nerve ; Trigeminal Neuralgia* ; Veins

A case of dumbbell-shaped hypoglossal neurinoma is reported. Neurinomas of the hypoglossal nerve are very rare, only 35 cases reported. Of these cases, most are intracranial and only 7 were dumbbell-shaped with both intracranial and extracranial components. The clinical feature of the patient was marked ipsilateral atrophy of the tongue. Magnetic resonance imaging should be included in the examination of tumors, and great aids in planning the radical removal of the tumor. In this one-stage operation which was modified lateral inferior suboccipital craniectomy, the most important aspect was removal of the posterior wall of anterior condylar canal and lateral mass of C1. This approach requires a thorough understanding of microsurgical anatomy of the region of foramen magnum. Patient's postoperative course was uneventful. The literatures concerning this lesion were reviewed.
Atrophy ; Foramen Magnum ; Humans ; Hypoglossal Nerve ; Magnetic Resonance Imaging ; Neurilemmoma* ; Tongue

PURPOSE: The purpose of this study is to evaluate the usefulness of locally harvested bone in anterior cervical interbody fusion. MATERIALS AND METHODS: A retrospective review was conducted, including 31 patients who underwent anterior cervical interbody fusion using a polyetheretherketone (PEEK) cage and anterior plate fixation. We randomly divided the patients into two groups, local bone group and iliac bone group. In 15 patients of the local bone group, the cage was filled with locally harvested bone, and in another 16 patients of the iliac bone group, the cage was filled with autogenous iliac bone. RESULTS: Improvements in mean visual analogue scale (VAS) scores, from 5.8 and 7.7 to 1.6 and 2.3 for neck pain and arm pain, respectively, were observed in cases using locally harvested bone, while the improvements were from 5.7 and 7.2 to 1.4 and 2.2, respectively, in those using autogenous iliac bone grafts. However, no significant differences in mean VAS and neck disability index were observed between the two groups at the last follow up (p>0.05). Radiologic union was achieved at 14.0+/-2.50 weeks in the local bone group, and at 12.62+/-1.58 weeks in the iliac bone group. However, no significant difference was observed between the two groups (p=0.076). CONCLUSION: Utilization of locally harvested bone for packing in a PEEK cage for anterior cervical interbody fusion is considered a useful method because it gives satisfactory clinical results for retention of bone union and lordosis angles.
Animals ; Arm ; Follow-Up Studies ; Humans ; Lordosis ; Neck ; Neck Pain ; Retrospective Studies ; Transplants

OBJECTIVE: The aim of this study was to examine how many Korean rheumatoid arthritis (RA) patients fulfilling the 2008 American College of Rheumatology (ACR) recommendation, 2007 British Society for Rheumatology (BSR) guideline and 2010 Japan College of Rheumatology (JCR) guideline for TNF-alpha blocker, meet the Korean National Health Insurance reimbursement criteria and to evaluate the reasons for failing the Korean National Health Insurance reimbursement criteria. METHODS: Data were obtained from a registry of RA patients who visited rheumatology clinics of Hallym university affiliated hospitals. Patients who were previously prescribed with methotrexate or leflunomide for more than 3 months and had at least one DAS28 examination were included in the present study. RESULTS: Of 642 patients included, 118 episodes meeting ACR guideline for using TNF-alpha blocker were identified in 88 patients (13.7%). In addition, 19 episodes meeting BSR guideline in 17 patients (2.6%) and 21 episodes meeting JCR guideline in 21 patients (6.2%) were identified. Four episodes (4.8%) meeting ACR recommendation, 0 episodes meeting BSR criteria and 5 episodes (12%) meeting JCR criteria, respectively, were eligible for TNF-alpha blocker according to the Korean National Health Insurance reimbursement guideline. The most common reason for failing the Korean National Health Insurance reimbursement criteria was the number of active joint counts (92.6%). CONCLUSION: Our results show that the majority of RA patients satisfying the ACR guideline, BSR and JCR guideline for use of the TNF-alpha blocker did not meet the Korean National Health Insurance reimbursement criteria. Patients most often failed due to active joint count criteria.
Arthritis, Rheumatoid ; Humans ; Isoxazoles ; Japan ; Joints ; Methotrexate ; National Health Programs ; Rheumatology ; Tumor Necrosis Factor-alpha

While nontuberculous mycobacterium (NTM) infections are recently on the rise, arthritis caused by NTM is hardly reported in Korea. NTM arthritis has no distinctive clinical characteristics from chronic arthritis. Tuberculosis of the joint specifically produces similar clinical and pathologic presentations to NTM arthritis, so it is not easy to distinguish between them. We report a case of Mycobacterium intracellulare in an arthritis patient after trauma and surgical repair of the injury. At the beginning, the patient was diagnosed as tuberculous tenosynovitis through pathology without microbiologic evidence. The final diagnosis was made after subsequent recurrences for several years. The misdiagnosis and delayed diagnosis led to irreversible joint destruction and functional impairment. NTM infection must be included in the differential diagnosis of chronic arthritis at the outset.
Arthritis ; Delayed Diagnosis ; Diagnosis, Differential ; Diagnostic Errors ; Humans ; Joints ; Korea ; Mycobacterium ; Mycobacterium avium Complex ; Mycobacterium avium-intracellulare Infection ; Nontuberculous Mycobacteria ; Recurrence ; Tenosynovitis ; Tuberculosis

PURPOSE: In recent years, the number of elderly patients visiting from residential aged care facilities (RACFs) has been increasing. We analyzed a comparison of characteristics between patients who visited the ER with diseases from RACFs and those who visited from home. METHODS: A retrospective study was conducted in a public hospital between January 2013 and December 2014. The subjects included patients who visited the ED from RACFs and elderly patients who visited the ED from home. Comparisons of the following parameters were made between the two groups: gender, age, mode of insurance, mode of ED visit, mobile status, Charlson comorbidity index (CCI), chief complaint, final results in the ED, and length of stay (LOS) in the ED and hospital. RESULTS: A total of 7,603 patients were enrolled during the study period. There were 6,401 elderly patients who visited from home and 1,202 patients who visited from RACFs. Patients from RACFs were older than those from home (79.90±8.01 vs. 75.78±7.26, p<0.001). More patients from RACFs were on Medicaid (56.6% vs. 27.9%, p<0.001), took more ambulance (86.3% vs. 49.4%, p<0.001), more bedridden (68.2% vs. 6.4%, p<0.001), and higher CCI (2.38±1.99 vs. 1.45±1.84, p<0.001). Compared with patients from home, those from RACFs showed a significantly higher proportion of admission (63.2% vs. 32.9%, p<0.001), ED LOS (403.03±361.77 vs. 277.07±258.82, p<0.001), and hospital LOS (19.65±18.58 vs. 15.67±15.63, p<0.001). Patients from RACFs showed especially longer ED LOS from discharged ED than those from home (388.87±422.88 vs. 221.90±215.30, p<0.001). CONCLUSION: Compared with elderly patients from home, patients from RACFs also had higher admission rate and longer ED LOS, as well as hospital LOS. Patients from RACFs had long ED LOS. The findings in this study suggest that there could be ED overcrowding in the near future.
Aged* ; Ambulances ; Comorbidity ; Emergencies* ; Emergency Service, Hospital* ; Hospitals, Public ; Humans ; Insurance ; Length of Stay ; Medicaid ; Nursing Homes ; Residential Facilities ; Retrospective Studies