Management Outcome and Clinical Manifestation of Posterior Circulation Aneurysms VS. Anterior Circulation Aneurysm

OBJECT: With the recent variable treatment modalities and the development of microsurgical techniques, outcomes of surgical and medical management of aneurysm have shown much progress in the last 10 years. However, the management of posterior circulation aneurysm is still a debatable due to its difficulty in limited surgical approach, complicated anatomical structure and many small perforators to vital structure. The purpose of this study is to compare the results of clinical manifestation and outcome of surgery with respect to anterior and posterior circulation aneurysms. MATERIAL AND METHODS: We evaluated the 33 patients with PCAs(posterior circulation aneurysm) and 359 patients with ACAs(anterior circulation aneurysm) treated between 1994 and 1999, retrospectively. RESULTS: Posterior circulation aneurysms showed higher tendency(5 cases, 14.7%) to have unusual shapes, such as dissecting or fusiform compared with anterior circulation aneurysm(15 cases, 4.2%). There were more multiple aneurysms in posterior circulation aneurysm(8 cases, 26.5%) than anterior circulation aneurysm(59 cases, 16.2%). The number of patients with Hunt-Hess grade III or IV on admission were 91(25.3%) in anterior circulation aneurysms, and 14(42.4%) in posterior circulation aneurysms. There were higher incidences of vasospasm and acute hydrocephalus in patients with posterior circulation aneurysm. In cases of anterior circulation aneurysm, neck clipping was possible in 97%. But, in posterior circulation aneurysm, neck clipping was possible only in 67.7% of each. Two hundred forty four cases(85.0%) of all anterior circulation aneurysms and 22 cases(78.6%) of all posterior circulation aneurysms showed good recovery(GR) or moderate disability(MD). The postoperative mortality rates of anterior and posterior circulation aneurysms were 4.9% and 10.7%, respectively. CONCLUSION: These results indicate that there exist substantial differences with respect to that there were few difference in the aspect of surgery and management outcome between posterior circulation aneurysms and anterior circulation aneurysms.

Total Hip replacement with AML Prosthesis for Avascular Necrosis of the Femoral Head / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the clinical and radiographic results of the primary total hip arthroplasty with uncemented AML (anatomic medullary locking) hip prosthesis for avascular necrosis of the femoral head. MATERIALS AND METHODS: Forty-nine patients (65 hips) had a primary total hip arthroplasty between May 1987 and March 1992. Average follow-up was 9.6 years. The mean age of the patients was 46.9 years. The canal fit of the stem at the proximal canal and isthmus level was obtained from postoperative radiograph. Components stability, stress shielding, polyethylene wear and periprosthetic osteolysis were evaluated from serial follow up radiographs. RESULTS: The average Harris Hip Score was to 92.1 points at the last follow-up. Twelve hips (18.5%) had a good fit at both the proximal canal and isthmus level and 15 hips (23.1%) had a poor fit at both levels. All twelve hips that had a good fit at both the proximal canal and isthmus level had bone ingrowth. Thirty-three hips (56.3%) had femoral osteolysis. Twenty-one hips (32.3%) had acetabular osteolysis. Fourteen hips had acetabular and femoral osteolysis. The overall rate of revision was 16.7% (11 hips). Ten cases were revised because of excessive polyethylene wear and osteolysis. Revision of the femoral component for aseptic loosening was only one case. CONCLUSION: The result of our study suggests that total hip arthroplasty using the AML hip prosthesis with an ACS (acetabular cup system) polyethylene liner should be monitored closely for catastrophic wear of the polyethylene liner. We recommend early revision arthroplasty in case of excessive wear of the ACS polyethylene liner.

One-year Experience with Argon Laser Thermal Angioplasty Using a Metal Hot Tip Contact Probe / 日本心臓血管外科学会雑誌

Laser thermal angioplasty with a metal hot tip probe for atherosclerosis obliterans of iliac, femoral and popliteal artery lesions was used instead of conventional balloon angioplasty. Initial angiographic and clinical success was achieved in 24 of 28 (85.7%) vessels. The 1-year cumulative patency rate was 82.6 % of 19 vessels with clinical success in 23 vessels (one of 24 clinical success cases died due AMI at 14 days after operation). In the 8 iliac and 15 femoro-popliteal arteries, the cumulative success rates were 100% and 73.3%, respectively. Complications were observed in 25% of vessels (7 of 28 vessels). One of them necessitated emergency bypass surgery but not the others. In the 24 laser thermal angioplasty, other revascularization methods were performed on 12 cases (50%) at the same time. Although many problems remain to be solved laser thermal angioplasty can be effective for atherosclerotic disease.