Résumé
Many elderly people take warfarin due to underlying disease. Warfarin is a risk factor for developing chronic subdural hematomas and other intracranial hematomas. Our patient was on chronic warfarin treatment for longstanding atrial fibrillation and underwent burr hole trephination due to chronic subdural hematoma. Multiple intracerebral hemorrhages developed 7 days after surgery without resumption of warfarin. Here, we report and review this rare case.
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This case report presents a rare case of cerebral venous thrombosis (CVT) caused by spontaneous intracranial hypotension (SIH). The cause and prognosis of CVT can vary;CVT caused by SIH is uncommon and difficult to diagnose and treat. In this case, magnetic resonance imaging myelography showed definite cerebrospinal fluid leakage, and the patient's symptoms did not improve after conventional treatment. Furthermore, subdural hematoma occurred, causing mental deterioration; however, it improved dramatically after the blood patch procedure and burr hole drainage, which was performed after early cessation of anticoagulant therapy.
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OBJECTIVE: Chronic subdural hematoma drainage is one of the most common procedures performed in neurosurgical practice. Not only burr hole drainage but also small craniotomy (diameter 3–5 cm) is frequently used neurosurgical treatment of chronic subdural hematomas. We assessed to compare the postoperative recurrence rates between burr hole drainage versus small craniotomy with closed-system drainage for chronic subdural hematomas. METHODS: From January 2016 to December 2018, 75 patients who were treated with burr hole drainage and small craniotomy with closed system drainage for the symptomatic chronic subdural hematoma were enrolled. Pre and postoperative computed tomography (CT) were used for radiologic evaluation. The choice of procedure was decided by preoperative CT images. RESULTS: 60 patients out of 75 patients underwent burr hole drainage, whereas 15 patients underwent small craniotomy. The overall postoperative recurrence rate was 16%. The recurrence occurred in 8 patients out of 60 patients in burr hole drainage group (13.3%) and 7 patients out of 15 patients in small craniotomy group (46.7%). The number of days of hospitalization was 10.3 days in burr hole drainage group and 15.7 days in small craniotomy group. CONCLUSION: Burr hole drainage would be sufficient to evacuate chronic subdural hematoma with lower recurrence rate, but small craniotomy was also needed in some cases such as hematoma has solid portion or multiple septum.
Sujets)
Humains , Craniotomie , Drainage , Hématome , Hématome subdural chronique , Hospitalisation , Récidive , TrépanationRésumé
Trigeminal neuralgia is caused by compression of trigeminal nerve root and it leads to demyelination gradually. It was almost idiopathic and occurred unexpected. The upper cervical spinal cord contains the spinal trigeminal tract and nucleus. Fibers with cell bodies in the trigeminal ganglion enter in the upper pons and descend caudally to C2 level. We experienced a rare patient with facial pain, which was paroxysmal attack with severe pain after a clear event, cervical spinal injury (C2). So, this case reminds us of a possible cause of trigeminal neuralgia after a trauma of the head and neck.
Sujets)
Humains , Corps cellulaire , Moelle cervicale , Maladies démyélinisantes , Algie faciale , Tête , Cou , Processus odontoïde , Pont , Moelle spinale , Traumatisme du rachis , Ganglion trigéminal , Nerf trijumeau , Névralgie essentielle du trijumeauRésumé
Spinal surgery of the anterior aspect of the cervicothoracic junction is difficult and has technological challenges because of the kyphotic alignment of the upper thoracic spine. This approach requires knowledge of the cervicothoracic regional anatomy. Surgery in this region is rare because of its indications; despite this rarity, surgeons must be prepared to expose this region. In addition, surgery in this region demands extensive opening of the surgical field and results in severe postoperative pain. Therefore, a less invasive procedure must be considered. Six cases of cervicothoracic lesion operation have been reported. The patients were successfully treated using an anterior modified approach (J-type manubriotomy). Anterior reconstruction and instrumentation of the cervicothoracic junction offers a distinct advantage of a stable anterior implant bone construction while preserving the posterior osseo-ligamentous tension band. Moreover, the modified anterior approach (J-type manubriotomy) provides the same exposure of the cervicothoracic junction without a full median sternotomy and avoids injury to subclavian vessels during resection of the clavicle or sternoclavicular junction. Therefore, the anterior cervical approach combined with J-type manubriotomy allows extensive exposure of the cervicothoracic junction and causes less complications. We performed preoperative radiological evaluation to identify the cases in which J-type manubriotomy was necessary.
Sujets)
Humains , Anatomie régionale , Clavicule , Douleur postopératoire , Rachis , Sternotomie , ChirurgiensRésumé
A 49-year-old female patient was admitted due to memory disturbances. Magnetic resonance (MR) imaging suggested gliomatosis cerebri (GC), which had spread to both insular lobes, both frontal and basal ganglia and the brain stem. A stereotactic biopsy was performed at the high signal intensity area of the T2-weighted MR image, and the revealed a diffuse astrocytoma. Radiation therapy was judged not to be an appropriate treatment for the patient because of her cognitive impairment. A combinatorial chemotherapy regiment consisting of Procarbazine, CCNU, and Vincristine (PCV) was agreed upon after discussion. The patient underwent six cycles of PCV chemotherapy (a full dose was applied until the 3rd cycle, and dose then was reduced to 75% for the remaining cycles). Although the patient exhibited side effects such as bone marrow suppression and gastrointestinal symptoms, these were managed by medication. Over the 28 months following initiation of treatment, the high signal area in the right frontal and temporal lobes in the T2-weighted MR image decreased, and the patient's cognitive function [global deterioration scale (GDS) 4 points, mini-mental state examination (MMSE) 25 point] also improved (GDS 1 points, MMSE 29 points). PCV chemotherapy can therefore be an alternative therapeutic option for patients with GC who cannot be treated with radiation therapy or other chemotherapies.
Sujets)
Femelle , Humains , Adulte d'âge moyen , Astrocytome , Noyaux gris centraux , Biopsie , Moelle osseuse , Tronc cérébral , Traitement médicamenteux , Lomustine , Mémoire , Tumeurs neuroépitheliales , Procarbazine , Lobe temporal , VincristineRésumé
BACKGROUND: Reduced pulmonary function is a common outcome in pulmonary patients with reduced bone mineral density. But, there are few studies on the relationship in adult females who do not have pulmonary diseases. Thus, this study was to assess the correlation between bone mineral density and pulmonary function in healthy women. METHODS: A total of 193 subjects was selected among adult females who visited a health promotion center. BMD was measured by Dual energy X-ray absorptiometry and T-score of lumbar spine (L1-L4) was used. Pulmonary function was measured by spirometer and questionnaire survey was used to obtain information from the subjects. RESULTS: Mean T-score of L-spine was -0.284, FEV1 (pred %) was 98.82% and BMI was 23.50 kg/m2. The results showed positive correlation (0.128) between BMD and FEV1 by multiple regression analysis (P<0.05). CONCLUSION: As FEV1 of subjects increased, BMD increased in adult women who did not have pulmonary diseases.
Sujets)
Adulte , Femelle , Humains , Absorptiométrie photonique , Densité osseuse , Promotion de la santé , Maladies pulmonaires , Rachis , Enquêtes et questionnairesRésumé
Benign solitary osteochondroma is uncommon in the vertebra (2%). Vertebral ostoechondroma arises predominantly in the lumbar and cervical regions, and rarely in the sacrum. We describe a case of a sacral solitary senescent osteochondroma compressing the sciatic nerve, producing sciatica. The tumor was removed by posterior paramedian incision. The excised mass was cylindrical, measuring 3.5x1x1 cm in size and consisting of lamellar bone with Haversian system similar to the architecture of normal cortical bone and trabecular bone.
Sujets)
Système de Havers , Ostéochondrome , Sacrum , Nerf ischiatique , Sciatalgie , RachisRésumé
We compared 30 cases that had a laparoscopic cholecystectomy(L.C.) with 30 cases which revealed chronic cholecystitis on biopsy among the patients who had a standard open cholecystectomy(O.C.). The patients were treated at the Department of Surgery, Saint Columban Hospital, Mokpo, Korea, from January 1995 to July 1996. The results from the 60 patients are as follows: 1) The ratio of males to females was 1:2 in the L.C. group and 1:0.8 in the O.C. group. The prevalent age was the 6th decade in both groups. 2) Associated diseases were seen in 22 cases(73%) in the L.C. group and 20 cases(67%) in the O.C. group. 3) There were 6 cases(20%) of previous abdominal operations in the L.C. group and 7 cases(23%) in the O.C. group. 4) The mean operation time was 139.8+/-35.7 minutes in the L.C. group and 155.3+/-34.4 minutes in the O.C. group. 5) The mean hospital stay after the operation was shorter in the L.C. group(range: 4~7 days) than in the O.C. group(range:8~12 days). 6) Postoperative complications occurred in 2 cases(7%) in the L.C. group and 8 cases(27%) in the O.C. group. 7) The conversion rate from a laparoscopic cholecystectomy to an open cholecystectomy was 21%(8 cases). 8) Problem experienced during the laparoscopic cholecystectomy were bleeding at the operative field(4 cases), stone drop from gallbladder(3 cases), and bile leakage(1 case). 9) The time until postoperative oral intake was 2 postoperative days in the L.C. group and 4 postoperative days in the O.C. group. 10) The average duration of postoperative pain was 2.6+/-0.6 days in the L.C. group and 4.3+/-1.3 days in the O.C. group. 11) The average duration of narcotic requirement was 2.4+/-0.6 days in the L.C. group and 3.8+/-1.8 days in the O.C group.
Sujets)
Femelle , Humains , Mâle , Bile , Biopsie , Cholécystectomie , Cholécystectomie laparoscopique , Cholécystite , Hémorragie , Corée , Durée du séjour , Douleur postopératoire , Complications postopératoires , SaintsRésumé
Gaucher's disease is an uncommon metabolic disorder, which was first described by Gaucher in 1882, characterized by accumulation of distinctive Gaucher's cells in the reticuloendothelial system such as spleen, liver, and bone marrow. The great majority of cases have been reported in Jews, and others in negros and orientals. We are presenting two cases in homozygous twins in Korea, whose clinical manifestations are hepatosplenomegaly and bone lesions due to expansion of involved bones.
Sujets)
Humains , , Moelle osseuse , Maladie de Gaucher , Juif , Corée , Foie , Système phagocytaire mononucléé , Rate , JumeauxRésumé
No abstract available.
Sujets)
Enfant , Humains , Varices oesophagiennes et gastriques , Hypertension portale , Veine porteRésumé
No abstract available.
Sujets)
Femelle , Humains , Nourrisson , Liquide amniotique , Études prospectivesRésumé
No abstract available.
Résumé
During the period of 4 years from May, 1981 to April, 1985, 71 cases of obstructing subinfundibular muscular bundles of the right ventricle in congential cardiovascular anomalies were diagnosed by cariac catheterization and angiography at Hanyang University. The finding of right ventricular angiogram and degree of the right ventricular outflow obstruction, clinical data, electrocardiographic data and hemodynamic data were correlated irrespectively. The summary of this article is as follows. 1) The age of patients was ranged from 1 to 22 years old with a mean age of 8 years old. There were 39 males and 32 females with M:F ratio of 1.2:1. The incidence of obstructing subinfundibular muscular bundles of the right ventricle in congenital cardiovascular anomalies was higher with increasing age. 2) The associated cardic anomalies were as follows: 40 cases (56%) of isolated ventricular septal defect(VSD), 13(18%) of tetralogy of Fallot physiology, 7(10%) of patent ductus arteriosus(PDA), 3(4%) of pulmonary stenosis, 1 aortic stenosis, 1 double outlet of right ventricle(DORV), 1 trilogy, 1 ostium secundum defect, etc. The incidence of VSD with or without other associated cardiovascular anomalies was 56 cases(79%) out of 71 cases. 3) Maximum systolic pressure gradient between proximal and distal chamber of the right ventricle were under 25 mmHg in 32 cases, between 25 and 50 mmHg in 13 and above 50 mmHg in 26. Pressure gradients of all 7 cases with PDA were under 25 mmHg. 4) Correlative assesment of angiographic manifestation(2 indicies:Diameter of right ventricular outflow tract(systolic phase)/diameter of tricuspid valvular annulus(diastolic phase)=OT/TV, Diameter of right ventricular outflow tract(systolic phase)/Length of right ventricular diaphragmatic surface(systolic phase)=OT/RV) according to pressure gradient, OT/Tv and OT/RV values were lower the increasing pressure gradient, between proximal and distal chamber of the right ventricle. These were reverse correlations but coefficients of correlation(r) were-0.49and -0.48. Therefore, the degree of right ventricular outflow obstruction could be predicted, using 2 indices of right ventricular angiogram in individual cases, but could not be calculated accurately. 5) This indicated that pressuer gradient was also affected by technical errors, variable cardic anomalies, development of sinusoid, age and the other factors. 6) We assumed that non-invasive Doppler echocardiography could be useful in making the diagnosis and follow up of the patient with obstructing subinfundibular muscle bundles in right ventricle.