OBJECTIVE: This study is to evaluate the efficacy of dorsal short-segment fixation in unstable thoracolumbar junction fractures. METHODS: The cases of 20 patients who underwent dorsal short-segment fixation were reviewed retrospectively. Clinical outcomes were analysed using Sonntag's pain level, work status, and neurological scale according to the modified Frankel classification. Radiological outcomes were analysed using Mumford's anterior body compression(%), canal compromise ratio, and Cobb's kyphotic angle. RESULTS: At the latest clinical follow-up (average=14.6 months), there were 19 (95.0%) in group I and 1 patient (5.0%) in II in pain level35). The postoperative work status were 17 (85.0%) in group I, 2 patients (10.0%) in II, and 1 patient (5.0%) in V. Surgery brought to improve the neurologic status. In success group (19 cases, 95%), the average canal compromise ratio was reduced from 0.57 (+/-0.07) to 0.05 (+/-0.08) (P<0.05), the average anterior body compression (%) was reduced from 41% (+/-17) to 18% (+/-14) (P<0.05), and the average preoperative kyphotic angle was 20.0 degrees (+/-9.0), and corrected to 5.7 degrees (+/-7.1) postoperatively, and progressed to 7.8 degrees (+/-6.2) at the latest follow-up. There was a case of implantation failure in an elderly osteoporotic patient. CONCLUSION: Although there are limitations in the patient number and follow-up period, the present study favors dorsal short-segment fixation for selective cases in unstable thoracolumbar junction fractures.
Aged ; Classification ; Follow-Up Studies ; Humans ; Retrospective Studies

Desmoplastic fibromas are rare intraosseous bone tumors. They are benign but locally aggressive and frequently found in the long bones and mandible. We report radiographic and histopathologic finding of a case desmoplastic fibroma involving right temporal skull bone. A 53-year-old woman presented at our hospital complaining of continuous right side headaches for a year. Simple skull X-ray film showed 3 x 2.5 cm lytic lesion with mild sclerotic margin on right temporal area. A large craniectomy 1cm lateral to margin was fashioned. The resected mass showed encapsulated mass colored white gray. Histologic diagnosis was compatible with that of a the desmoplastic fibroma. There was no evidence of recurrence during the 15months of follow-up period.
Diagnosis ; Female ; Fibroma, Desmoplastic* ; Follow-Up Studies ; Headache ; Humans ; Mandible ; Middle Aged ; Recurrence ; Skull* ; Temporal Bone ; X-Ray Film

No abstract available.
Anoxia* ; Neurons*

BACKGROUND: There are several reports on outbreaks of V. paraphaemolyticus enteritis, however, these are only complicated cases or microbiologic surveillance in marine environment. We experienced an outbreak associated with eating flavored crabs and investigated the magnitude of the outbreak on a large scale located in Inchon. METHOD: We took medical history and stool cultures from patients with diarrhea, visited the Inha University Hospital from September 14 to September 30, 1998. Pulsed-field gel electrophereis of isolates from stool culture performed to identify the relation. We counted the number of diarrheal patients visited the emergency rooms of 5 other general hospitals and 9 private clinics in Inchon from August 16 to September 30, 1998. We bought 6 crabs and 2 flavored crabs at a nearby market and cooked 6 crabs flavored at our hospital. Cultures from the flavored crabs stored at a refrigerator were done daily for consecutive 5 days. RESULTS: The outbreak began on September 5 and ended on September 29, 1998. The numbers of patients visiting ERs of 6 general hospitals and private clinics during outbreak were estimated 1,033 and 4,530, respectively. All 8 crabs revealed Vibrio spp., but identification up to species level was not possible. Pulsed-field gel electrophoresis of 12 isolates showed different patterns and suggested different sources. CONCLUSION: In 1998, an outbreak estimated more than 5,000 patients of V. parahaemolyticus enteritis occurred in Inchon, Korea. Because the magnitude of food-associated enteritis is enormous, that surpass the number which we assumed from clinical practice, early report and prompt investigation of such cases are necessary.
Diarrhea ; Disease Outbreaks ; Eating ; Electrophoresis, Gel, Pulsed-Field ; Emergency Service, Hospital ; Enteritis* ; Hospitals, General ; Humans ; Incheon* ; Korea* ; Vibrio parahaemolyticus* ; Vibrio*

This is a report of 15 consecutive cases of petroclival lesions performed by transpetrosal approach over five years. Pathologies from these cases include 13 cases of tumors and two cases of aneurysms. All cases of tumors were over 4.5cm in size. Two cases of very low-lying basilar bifurcation aneurysms and one case of facial schwanoma extended to the petrosal tip and temporal fossa were operated with anrerior transpetrosal approach, where as nine cases of petroclival tumor which was localized in the posterior fossa were operated via posterior transpetrosal approach. Of these nine cases, one case with lower clival extension was removed totally by adding a retrosigmoid dural opening. Remaining three cases extended to the Meckel's cave or cavernous sinus were operated by combined anterior-posterior transpetrosal approach. Of the 12 cases done with posterior transpetrosal or combined approach, nine cases with preserved serviceable hearing were approached by retrolabylinthine technique and remaining three cases without preservation of serviceable hearing were operated via retrolabylinthine technique. Total removal was achieved in 9 of 13 tumor cases. Of two cases, aneurysmal neck of the first case was clipped completely but was clipped together with right posterior cerebral artery in second case. There was no operative mortality. Immediate postoperative neurological dysfunction were appered in 12 cases. These were significantly improved by the time of follow up examination. Permanent postoperative dysfunction was present in 6 cases, hemiparesis in 2, facial paralysis in 2 and hearing impairment in 2 cases. These results suggest that when selecting the surgical approach to the petroclival lesions, the size, location, extent of the lesion and preoperative status of the hearing were important factors to be considered. We recommend combined anterior-posterior transpetrosal approach for the complex lesions in the petroclival area which extends into the middle fossa(Meckel's cavum or cavernous sinus). Also, we recommend combining with retrosigmoid dural opening or a far lateral type of suboccipital exposure in cases of complex petroclival lesions involving the entire clivus or foramen magnum. In cases with brain stem invasion by tumor, vascular encasement or cavernous sinus invasion without cranial nerve involvement, we recommend subtotal resection of the tumor and radiosurgery to prevent permanent postoperative sequele.
Aneurysm ; Brain Stem ; Cavernous Sinus ; Cranial Fossa, Posterior ; Cranial Nerves ; Facial Paralysis ; Follow-Up Studies ; Foramen Magnum ; Hearing ; Hearing Loss ; Mortality ; Neck ; Paresis ; Pathology ; Posterior Cerebral Artery ; Radiosurgery

In central neurons, an excessive or sustained rise in the concentration of free cytoplasmic Ca2+ ions([Ca2+]i) after hypoxia may promote rapid neurodegeneration both in vitro and in vivo. Treating cells with Ca2+ chelating agents may prevent or delay a loss of cellular Ca2+ homeostasis after hypoxic injury and thus constitute an effective strategy for minimizing neuronal damage. Cell-permeant Ca2+ chelators such as 1,2-bis-(2-aminophenoxy) ethrane -N,N,N',N' -tetraacetic acid acetoxymethyl ester(BAPTA-AM) have shown evidence of neuroprotective effect against hypoxic neuronal injury. This study was designed to examine dose response and to estimate therapeutic window of BAPTA-AM for the recovery from hypoxia in vitro. Electrophysiological studies were made in CA1 neurons in rat hippocampal slices which were superfused with artificial cerebrospinal fluid(ASCF) in tissue chamber. Hypoxia was induced by replacement of 95% N2+5% CO2 from 95% O2+5% CO2 for 20min. Recovery from hypoxic injury was evaluated by using a percentage recovery of population spike. BAPTA-AM in concentration of 1, 10 and 50micrometer were administered to the artificial cerebrospinal fluid(ASCF) for 2 hours prior to hypoxia, simultaneous with hypoxia and after hypoxia. The experimental specimens were divided to seven groups and each group was compared to control ASCF group. Recovery of population spike after hypoxia was about 70% in control ASCF group, which was mild type hypoxic injury. BAPTA-AM in 10 micrometer concentration, when given just prior to hypoxia, enhanced recovery of poppulation spikes at 15 and 30min following reoxygenation(p<0.05), in comparison with control ASCF. BAPTA-AM had no neuroprotective acitvity when given after the onset of hypoxia. Also, BAPTA-AM in 1 and 50 micrometer concentration did not accentuate recovery of population spike after hypoxia. Dose response curve was inverted U-shape and the response was maximun in 10 micrometer concentration of BAPTA-AM.
Animals ; Anoxia ; Chelating Agents ; Cytoplasm ; Enflurane ; Homeostasis ; Neurons ; Neuroprotective Agents* ; Rats

Understanding of the surgical anatomy of patients with double outlet right ventricle (DORV) is important in the planning of biventricular repair. From May 1995 to September 1996, 7 patients underwent biventricular repair for DORV with remote ventricular septal defect. There were 5 males and 2 females. Age at operation varied from 2 to 9 years(mean 3.4+/-2.7years). Preoperative diagnostic assessment was made by two-dimensional echocardiography and cardiac catheterization. Ventricular septal defect was perimembranous inlet type in all patients. Associated cardiac anomalies were pulmonary atresia in two, pulmonary stenosis in five and tricuspid chordae attachment to conal septum in five. The operations were performed intraventricular repair and pulmonary enlargement in two, REV operation in two, and Rastelli operation in three. There was no early postoperative deaths and complications. The follow-up period was from 1 month to 18months, averaging 10+/-6.1 months. In the past,we considered the Fontan operation indicative as primary choice when DORV was associated with abnormal tricuspid chordal attachment to the conal septum,but now we believe that biventricular repair is feasible for those cases by making conal flap or reattachment method. Biventricular repair has theoretic advantages because it estabilishes normal anatomy and physiology,and it was concluded that the precise preoperative evaluation using both echocardiography and cardiac catheterization was essential to the successful surgery.
Bays ; Cardiac Catheterization ; Cardiac Catheters ; Double Outlet Right Ventricle* ; Echocardiography ; Female ; Follow-Up Studies ; Fontan Procedure ; Heart Septal Defects, Ventricular* ; Humans ; Male ; Pulmonary Atresia ; Pulmonary Valve Stenosis

Pulmonary atresia with ventricular septal defect and major aortopulmonary collaterals is a rare and complex lesion in which great morphologic variability exists regarding the sources of pulmonary blood flow. We report a case of this disease with no true central pulmonary arteries in a 9-month-old-boy successfully treated by one-stage complete unifocalization and repair from a midline sternotomy approach.
Heart Septal Defects, Ventricular* ; Pulmonary Artery ; Pulmonary Atresia* ; Sternotomy

Congenital tracheal stenosis is very rare, but it leads to life threatening obstruction in infancy and childhood. Recently, we experienced two cases of congenital tracheal stenosis, involving half of the distal trachea. We adopted slide tracheoplasty procedure proposed by Peter Goldstraw. Tracheoplasty was performed by dividing the stenosis at midpoint, incising the proximal and distal narrow segments vertically on opposite anterior and posterior surfaces, and sliding these together. On case 1, the patient is now doing well. On case 2, the patient succumbed due to anastomotic disruption at postoperative day 4.
Constriction, Pathologic ; Humans ; Trachea ; Tracheal Stenosis*

Proximal cerebrospinal fluid shuntmalfunction due to ventricular catheter occlusion remains the most common sourceof the shunt problem. The position of the hole-bearing segment of the catheter affects the long term patency of the ventricular catheter of a cerebrospinalfluid shunt.Placementof thissegmentnear thechoroidplexus or injured ependyma increases the probability of obstruction. Accurate locationof ventriculoperitoneal(V-P)shunt tip inrelation to foramen Monro canbe well establishedby plain radiographyregardless of agesor sizes and shapes of head dueto the fact that foramen Monro tothe spatial matrix of the skull is constant. Of 147patients who underwentV-P shunt operations, 49(33.3%)patients had more thanone operations. Radiologicgradingof theventricularcatheterposition is compared betweensingle operatedgroup andreoperated group.Single operated group showed excellentin 33.6%, good41.8%, poor 24.4%of accuracy rateof catheter tip position. Incases ofreoperation, placement ofcatheter tipresulted in excellent 12.5%, good21.8%, and poor 65.6%.These results indicatethat accurate location of ventricular catheter tip affects favorably to the patency of V-P shunt.
Catheters ; Cerebrospinal Fluid ; Ependyma ; Head ; Skull ; Ventriculoperitoneal Shunt*