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

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 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: To compare the tensile properties of double helical twisting. MATERIALS AND METHODS: 21G and 18G stainless steel wires were used. Monostrand, untwisted double strand and manually twisted double helix wires were tested under gradually increasing tension force until the wires break. Data were analyzed by using a computer system to get force-strain curves. RESULTS: Forces at the break point showed no significant differences between untwisted double strand wires and helically twisted double strand wires. Forces at the yield point deformation were proportionally increased to the degree of helical twisting until the wires were twisted 20 times (piptch number: 24/10 cm) with no more increase after then. Final strain at break point decreased by helical twisting, which means the range of plastic deformation decreased. CONCLUSION: By helical twisting, the wires increase in elastic range and decrease in plastic deformation. Therefore, double helix wiring seemed to be a more effective method of fixation compared to the untwisted double strand wires.
Computer Systems ; Plastics ; Stainless Steel ; Tensile Strength*

A 13-year-old boy developed fever and right leg pain, and multiple acupunctures were done on legs, then visited our ER for high fever, chill and painful swellings in both legs. Bone scan showed multiple hot spots on both distal femur, both proximal tibia, and left distal tibia. MRI revealed subperiosteal abscess in right proximal and left distal tibia and signal changes without abscess in other hot spot sites on bone scan. Surgical drainage of subperiosteal abscess and curettage were performed in the right proximal and the left distal tibia. Percutaneous drillings were done to other hot spot sites. All the lesions were cured after combined antibiotic chemotherapy. Multifocal osteomyelitis in a rapidly growing adolescent has been reported not rarely. It seemed that more attentions should be paid to the possibility of multifocal acute osteomyelitis in an adolescent
Abscess ; Adolescent* ; Attention ; Curettage ; Drainage ; Drug Therapy ; Femur ; Fever ; Humans ; Leg ; Magnetic Resonance Imaging ; Male ; Osteomyelitis* ; Tibia