We report a rare case of symptomatic Rathke's cleft cyst with thick calcified wall. Brain CT scans revealed a large cystic mass with round thick calcified wall. In this case, we selected the pterional approach instead of transsphenoidal approach due to the possibility of cystic craniopharyngioma. Histopathologically, it was calcified Rathke's cleft cyst with focal epithelial metaplasia. This case illustrates that calcification of the suprasellar cyst does not always suggest craniopharyngioma and the calcification pattern of Rathke's cleft cyst is different from that of the craniopharyngioma.
Brain ; Central Nervous System Cysts ; Craniopharyngioma ; Metaplasia

PURPOSE: To compare the variable inflammatory parameters of acute pyelonephritis patients treated with inpatient therapy at 13 hospitals, according to the age and gender distributions. MATERIALS AND MATHODS: A total of 3,544 medical records of patients with confirmed acute pyelonephritis, and admitted to hospital between January 2000 and December 2005, were retrospectively analyzed. RESULTS: The mean age of the patients was 43.2+/-16.2 years old, with a male:female ratio of 1 : 5.1. The average duration of hospital admission was 7.9+/-5.3 days. Underlying diseases were found in 23.0% (749/3,252 patient), largely due to diabetes (35.1%). Radiological abnormal findings were found in 13.7%. The leukocyte count, ratio of segmented form, erythrocyte sedimentation rate (ESR), c-reactive protein, pyuria, positive blood culture, positive urine culture were 11,014+/-5,778/mm(3), 74.8+/-14.5%, 44.0+/-32.0 mm/hr, 12.4+/-9.3mg/dl, 83.9%, 10.5% and 46.7%, respectively. E. coli grow in 79% of the urine culture positive patients. In a comparison of 3 age groups (<40 years, 40-60 years, >61 years), the elderly patients had a greater number of underlying diseases and more pathogens in cultured blood. When divided into males and females, the elderly male patients had more pathogen in cultured urine, but contrary to the male patients, the elderly female patients had elevated leukocyte count and erythrocyte sedimentation rate. Also, the old patient group had more resistance to ampicillin when they had E. coli as the uropathogen (p=0.021). Patients with higher ESR required longer hospital admission periods. CONCLUSIONS: It was found that variable clinical parameters of acute pyelonephritis patients treated with inpatient therapy differed according to both gender and age group in Korea. Therefore, these factors should be taken into account in the treatment plan.
Aged ; Ampicillin ; Blood Sedimentation ; C-Reactive Protein ; Female ; Humans ; Inpatients ; Korea ; Leukocyte Count ; Male ; Medical Records ; Pyelonephritis* ; Pyuria ; Retrospective Studies

Schizencephaly is an unusual condition rarely detected antenatally. It is a neuronal migrational disorder consisting of clefts in the brain that communicate with the lateral ventricles. The etiology and the pathogenesis is not clearly estabilished. While some authors advocate a vascular insult with a secondary effect on brain development, others suggest a primary cerebral dysgenesis by genetic or acquired factors. The importance of making an accurate antenatal diagnosis is that the outcome for schizencephaly in considerably poor than for other causes of ventriculomegaly. Typical symtoms include seizures, mental retardation, spastic tetraplagia and blindness. We report a case of typeIIschizencephaly that was diagnosed antenatally in the third trimester with a brief reiew of literatures.
Blindness ; Brain ; Female ; Humans ; Intellectual Disability ; Lateral Ventricles ; Malformations of Cortical Development* ; Muscle Spasticity ; Neurons ; Pregnancy ; Pregnancy Trimester, Third ; Prenatal Diagnosis ; Seizures

STUDY DESIGN: A retrospective analysis about related diagnostic and therapeutic factors in postoperative deep infection cases after posterior spinal instrumentation. OBJECTIVES: Analysis of the inherent risk factors associated with deep infection and the efficacy of management with prolonged suction drainage without removal of implants. SUMMARY OF LITERATURE REVIEW: Various treatment modalities have been applied to control deep infection after spinal instrumentation. Validity of removing implants to control the infection is still controversial because it may cause loss of spinal stability. MATERIALS AND METHODS: Five cases of postoperative deep infection after posterior spinal fixation from May 1996 to May 2000 were investigated about combined general illness, features of infection, various profiles on management of the infection with surgical irrigation and debridement followed by prolonged suction drainage, and final outcomes. RESULTS: Remarkable risk factors were diabetes and obesity. Evidences of infection such as discharge from the wound, dehiscence, fever were observed since average 18.8th day postoperatively. By only one surgical procedure for each patient followed by prolonged suction drainage for mean 19.2 days and administration of IV antibiotics for average 43.6 days followed by oral antibiotics for 33.8 days, deep infections were controlled successfully without removal of implants and without any grave complications. All achieved favorable clinical results and posterolateral fusion. CONCLUSION: Irrigation and debridement accompanied by prolonged suction drainage using Hemo-vac and administration of susceptible antibiotics seemed to be one of the effective methods in controlling deep infection after posterior instrumentation and in maintaining the postoperative stability of spine.
Anti-Bacterial Agents ; Debridement ; Fever ; Humans ; Obesity ; Retrospective Studies ; Risk Factors ; Spine ; Suction* ; Wounds and Injuries

PURPOSE: To Investigate the patterns and to document the clinical and technical significances of the leg injuries of drivers of short-fronted vehicles in frontal collision accidents. MATERIALS AND METHODS: Twelve cases of jammed leg injury were chosen from hospitals in the Chungcheong Province area and investigated in terms of nature of the accident, distribution of injuries, methods and duration of treatment and final sequelae. RESULTS: The patients had multiple injuries on the lower extremities, such as, fractures of the femoral shaft, tibial shaft, foot and ankle and soft tissue injuries, requiring an average 8.3 surgical procedures and 7 months admission, and from which permanent sequlae resulted, though associated injuries of the head, chest, abdomen were not significant. CONCLUSION: "Jammed leg injury" seemed to be related with the design of short-fronted vehicles. As these injuries can cause considerable functional and socioeconomic loss with long treatment periods and permanent residual sequelae. Preventive measures appear to be necessary, possibly involving vehicle design modification.
Abdomen ; Ankle ; Foot ; Head ; Humans ; Leg ; Leg Injuries ; Lower Extremity ; Multiple Trauma ; Soft Tissue Injuries ; Thorax

PURPOSE: We attempted to differentiate the heel pain in seronegative spondyloarthropathy from that in the posterior heel pain syndrome. MATERIALS AND METHODS: Forty one patients who complained of heel pain were included in this study. The evaluation consisted of history taking, physical examination, roentgenogram, bone scan, and serological tests including ESR, CRP, rheumatoid factor, and HLA-B27. The patients were classified into two groups. Group A consisted of seronegative spondyloarthropathy patients and group B consisted of plantar fasciitis, Achilles tendinitis, and retrocalcaneal bursitis patients. RESULTS: There were 14 patients in group A, and 27 patients in group B. The characteristic clinical features were the following in group A compared with those in group B. The age of patients was younger and males predominated. Also patients complained of a combined metatarsalgia or other joint pain. On the physical examination, tenderness existed on the calcaneal body rather than the bony attachment site of Achilles tendon or plantar fascia. Serologic tests revealed an elevated ESR, and a positive HLA-B27. A bone scan showed diffuse uptake in the calcaneal body and the metatarsophalangeal joint area, and an increased SIS ratio. CONCLUSION: Seronegative spondyloarthropathy should be differentiated in a patient who complains of heel pain.
Achilles Tendon ; Arthralgia ; Bursitis ; Diagnosis, Differential* ; Fascia ; Fasciitis, Plantar ; Heel* ; HLA-B27 Antigen ; Humans ; Male ; Metatarsalgia ; Metatarsophalangeal Joint ; Physical Examination ; Rheumatoid Factor ; Serologic Tests ; Spondylarthropathies* ; Tendinopathy

STUDY DESIGN: A retrospective study about the efficacy of bridge reconstruction of donor iliac defect utilizing resected rib dur-ing surgical approach of thracolumbar vertebrae. OBJECTIVES: To evaluate the outcome in clinical aspect for cosmesis and pain, and radiological aspect for incorporation of rib with crest. SUMMARY OF LITERATURE REVIEW: Many iliac donor site problems were reported such as pain, deformity, fracture etc. Filling the bone defect with bone, cement, or artificial bone seems to reduce the donor site problems. MATERIALS AND METHODS: In fourteen patients who underwent anterior fusion of vertebrae, bridge reconstructions of iliac crest using resected rib for thoracoabdominal approach to vertebral body were performed. Postoperatively, donor site pain, residual deformity, and radiologic finding of the union between rib and iliac crest were evaluated. RESULTS: No patients had significant pain on donor iliac crest. Acceptable pain was complained by five patients after 1 month postoperatively and by three patients after 2 months postoperatively. After 3 months, no patients had pain problem at iliac donor site. Two patients presented palpable step-off on iliac crest, but external contours of iliac crest were satisfactory in all patients. Radi-ologic union of the rib-crest junction was confirmed within 6 months postoperatively in all cases. CONCLUSIONS: Bridge reconstruction of iliac crest defect using resected rib is a simple and effective method that can minimize residual donor site problems in anterior spinal surgeries of thoracic and upper lumbar vertebrae.
Congenital Abnormalities ; Humans ; Lumbar Vertebrae ; Retrospective Studies ; Ribs* ; Spine* ; Tissue Donors*

PURPOSE: The causative pathology of chronic low back pain cannot be defined in many patients. To evaluate the relations between psychoneurotic status and chronic low back pain, the authors surveyed Minnesota Multiphasic Personal Inventory (MMPI) in the patients with chronic low back pain. MATERIALS AND METHODS: From July 1997 to December 1998, questionaire including MMPI were given to the patients who visited our Department for chronic (>6 weeks) low back pain. 50 patients (33 male, 17 female) completed MMPI. The mean age was 33.4 years (range 17-55) . MMPI scores were evaluated in two ways for each individual, mean scores of each clinical scale and two code method. Then mean scores were compared according to sex, radiating pain, radiologic abnormalities. RESULTS: In total 50 patients, three scales showed mean score over 55. Those were Hs:59.1 +/- 10.3, D:55.4 +/- 11.2 and Hy: 59.0 +/- 10.8. No significant differences were observed between the groups divided according to the sex, radiating pain, radiologic abnormalities. The two code method revealed that at least one of the neurotic triad (Hy, Hs, D) ranked within the highest two in 46 (92%) patients. CONCLUSION: It seemed that large proportion of patients with chronic low back pain had psychological tendency to hypochondriasis and/or depression and/or hysteria. MMPI seemed to be one of the useful methods in evaluation of psychogenic factors in chronic low back pain patients without definite organic pathology.
Depression ; Humans ; Hypochondriasis ; Hysteria ; Low Back Pain* ; Male ; Minnesota ; MMPI* ; Pathology ; Weights and Measures

STUDY DESIGN: A retrospective case report of lumbar disc herniation with cauda equina syndrome after self traction therapy. OBJECTIVES: Documentation of clinical significance and manifestations of disc herniation with cauda equina syndrome as one of the complications after self traction therapy. SUMMARY OF BACKGROUND DATA: Various conservative managements of acute low back pain in adults such as traction, spine manipulation therapy(SMT), and exercise therapy may produce harmful complications, especially when performed by non-professional therapists. Recently, reports of complication from SMT are increasing, however, understanding of biomechanism and natural history of traction, SMT, and exercise therapy are still poor. Therefore background information on the possible complications from their management is essential for physicians. METHOD: A case of acute cauda equina syndrome after self traction therapy in a 41 year-old man. Magnetic resonance imaging revealed severe compression of cauda equina by a huge mass. Emergency lumbar laminectomy was performed and all the compressing mass was removed. The mass was proven to be prolapsed disc of nearly whole nucleus amount and scanty nucleus was found within the disc space. RESULT: Acute low back pain and radiating pain disappeared immediately after operation. And neurologic deficits began to improve after postoperative 1 week. At the 15 month follow-up, the patient had recovered fully except minimal paresthesia on the right foot. CONCLUSION: More attentions to the possibility and clinical features of this complication seemed to be needed to the clinicians and therapists who do conservative management for the low back problems, especially SMT, traction, exercise therapy etc.
Adult ; Attention ; Cauda Equina* ; Emergencies ; Exercise Therapy ; Follow-Up Studies ; Foot ; Humans ; Intervertebral Disc Displacement ; Laminectomy ; Low Back Pain ; Magnetic Resonance Imaging ; Natural History ; Neurologic Manifestations ; Paresthesia ; Polyradiculopathy* ; Retrospective Studies ; Spine ; Traction*

The purpose of this study is to see the value of transsectional morphology of polyethylene for evaluation of wear and characteristics of ultra-high molecular weight polyethylene. Retrieved nineteen polyeth- ylene tibial components were examined for this study. Ten components were the directly molded 1900 Himont polyethylene, and 9 components were the machined GUR 415 polyethylene. Transsection of polyethylene(thickness: 60 - 150 micron) was obtained by microtome and was examined microscopical- ly for the fusion defects, subsurface white bands, and delamination as a mode of wear. Significant differ- ences between two groups of polyethylene were found. Fusion defects greater than 100 micron were observed in 5 among 9 GUR 415 polyethylene. Subsurface white band were observed in 7 among 9 GUR 415 polyethylene. Delamination was found in 6 arnong 9 GUR 415 polyethylene. Neither fusion defects greater than 100 micron, nor delamination were observed in 1900 Himont polyethylene. Morphological examination of polyethylene section is an efficient way to differentiate the polyethylene and to evaluate the wear behavior of retrieved polyethylene. This study suggests that delamination of polyethylene tibial components is influenced by resin type and / or manufacturing method.
Arthroplasty* ; Fungi ; Knee* ; Molecular Weight ; Polyethylene*