Experiences of Reoperation on Failed Lumbar Disc Surgery

Nine patients, who had once low back operation due to herniated lumbar disc, underwent repeated low back surgery at the same level because of persistent or recurred symptoms. All patients were proved to have no psychological or compensative problems. Seven of them had satisfactory results but two, one who had no definite symptom free interval and had surgically proven epidural fibrosis only and another who underwent reoperation as early as 45 days after the first operation had persistent previous symptoms. After review of these cases we obtained several favorable factors which influence the post-operative results. When a patient had a definite symptoms free interval longer than 2 years or the main offending lesion was proved to be a disc herniation or spinal stenosis, satisfactory results could be anticipated.

Clinical Analysis of 65 Operated Cases of Lumbar Spinal Stenosis

No abstract available.

Continuous Free External Ventricular Drainage in Hypertensive Intracerebral Hemorrhage with Ventricular Rupture

There are several methods in the surgical treatment of hypertensive intracerebral hemorrhage, such as craniotomy and hematoma removal, stereotaxic aspiration of hematoma and external ventricular drainage with maintaining physiologic ventricular pressure(over-pressure EVD). In spite of all these methods, surgical treatment yields unsatisfactory results when the patient is comatous and show herniation signs preoperatively. We treated 9 cases of hypertensive intracerebral hemorrhage with ventricular rupture by hematoma removal and continuous free external ventricular drainage instead of over-pressure drainage. In 4 cases, during the drainage, obstruction of the drainage catheter by blood clots or clamping resulted in immediate deterioration of the patient's condition, which was reversed by maintaining the patency suggesting that postoperative control of ICP was essential in treating hypertensive intracerebral hemorrhage in addition to hematoma removal. 7 out of 9 cases regained consciousness and improved gradually with mild to serve neurologic deficit. One patient died of rebleeding in the midbrain and one was discharged by family's will.

Lysis of Intracerebral Hematoma with Thrombolytic Agents in a Rabbit Model

The lysing capability urokinase(UK) and streptokinase (SK) in intracerebral hematoma were examined in vitro and in a rabbit model. Intracerebral-intraventricular(IC-IV) hematomas were created by stereotaxically injecting 0.2ml of clotted human blood into the frontal lobe and lateral ventricle of a total of 87 house rabbits(weighing 1.5-2.7kg). Control animals received 0.2ml of physiologic saline infused into the clot, and the experimental group received an equal volume of UK solution(50,000units/ml), SK solution(50,000units/ml), UK-SK mixture(0.1ml of UK solution, 0.1ml of SK solution) respectively after the clot infusion. Forty two animals were sacrificed at 3 hours and 45 animals at 24 hours after infusion, The results obtained were as follows: 1) At 3 hours, clot lysis had been achieved in 8(67%) of 12 UK-infused animals, 5(36%) of 14 SK-infused animals and 6(60%) of 10 UK-SK-infused animals as compared to zero of 6 controls. 2) At 24 hours, clots had been lysed in 11(73%) of 15 UK-infused animals, 8(67%) of 12 SK-infused animals, 8(67%) of 12 UK-SK-infused animals and in 2(33%) of 6 controls. 3) There was mild inflammatory reaction by the clotted blood, but no additional histologic abnormality by thrombolytic agents(UK,SK) on microscopic examination. 4) Therefore we suggest that UK, SK or UK-SK mixture may be effectively used for the lysis of clotted intracerebral hematoma in the rabbit model and UK, UK-SK mixture are more effective than SK at 3 hours.

Superior Facet Syndrome: Case Report

The intense radicular pain of sciatica caused by a herniated disc is familiar. That similar symptoms may result from nerve root entrapment in a stenotic lateral vertebral recess without discal herniation is less well known and its possibility should be considered in the patients with root pain. We recently experienced a case of superior facet syndrome in a 57 years old female with intense sciatic pain. On operation, the right L-5 root was found to be entrapped in a stenotic lateral recess beneath the superior articular facet of the L-5 vertebra. There was no evidence of a herniated disc. The result was clinically excellent with surgical unroofing of the lateral recess with removal of the overhanging horizontal portion of the superior facet, L-5 vertebra of right.

A Clinical Study of FDP Value in Patients with Altered Consciousness

Recent reports have proved that the activity of blood coagulation change in the patients with head injury because of destruction of brain tissue. To evaluate the relationship of the activity of blood coagulation with patient's consciousness level, clinical course, neurological deficit and findings of computed tomography of brain in the patients with head injury and cerebrovascular disease. Coagulation studies(fibrin/fibrinogen degradation product concentration, plasma fibrinogen, prothrombin time, and activated partial thromboplastin time) and computed tomography of brain were in 102 patients with altered consciousness(66 patients of blunt head injury, 36 patients of cerebrovascular disease). Blood specimen were taken for coagulation studies within 24 hours after head injury or attack of cerebrovascular disease because of that, in the first 24 hours after brain injury, activated coagulation was present after injury. Statistical methods employed were Spearman's rank correlation coefficient and Chi-square test. The results were as follows : 1) Among 66 patients of head injury, 26 patients showed abnormal coagulation results(39%). The one patient of them showed increased FDP value, decreased fibrinogen, abnormal prothrobin time and activated partial thromboplastin time, clinically suggested disseminated intravascular coagulation, and remainder of them(25 patients, 37.9%) revealed abnormality only in FDP value. 2) In patients with head injury, the value of FDP had a close relationship with the state of consciousness on admission, the patient's clinical course, and neurological deficits(P<0.005). 3) In patients with head injury, the value of FDP was proportional to the degree of contusion and midline shift shown on computed tomography of brain(P<0.005). 4) It was concluded that some degree of disseminated intravascular coagulation in patients with blunt head injury occurs more often than expected clinically or subclinically and that coagulation studies might have both diagnostic and prognotic values. 5) In patients with cerebrovascular disease, the value of FDP was abnormal in 19.4% only in intracerebral hemorrhage and normal in other cases(other coagulation tests were normal in all cases). 6) In cases of intracerebral hemorrhage, the value of FDP had a meaningful correlation with amount of hematoma and degree of brain stem dsyfunction, but not with other findings. 7) In cases of intracerebral hemorrhage, the clinical course correlated with the site of hemorrhage and it's extension rather than the amount of brain destruction.

Intracranial Subdural Empyema: Case Report

Subdural empyema is a uncommon fulminating disease which rapidly terminates in death if untreated. When a patient with acute sinus or otitic infection complain headache, vomiting, impairment of consciousness, seizures of focal neurological signs, the possibility of intracranial infection should be considered. We recently experienced a case of subdural empyema in a 22 yrs old male who had not any previous history of infection. This patient with signs of IICP and seizures was diagnosed as space occupying lesion in the subdural space, right frontotemporal by carotid angiography but trephination revealed a subdural empyema which was drainaged through multiple burr holes. After 2 weeks of uneventful course, the computed tomography was done because of reappeared signs of IICP and three encapsualated subdural abscess were found. The patient was discharged from hospital in the excellent condition after total extirpation through craniotomy of above abscess.