The Effectiveness of Decompressive Craniectomy with Dural Augmentation in Malignant Cerebral Infarction

OBJECTIVES: There is continuing controversy about the benefits of decompressive craniectomy in massive cerebral edema following space occupying hemispheric cerebral infarction. The aims of this study are to determine the effectiveness and to confirm the life-saving nature of decompressive craniectomy with dural augmentation for massive cerebral infarction. PATIENTS AND METHODS: We present twelve patients with medically uncontrollable hemispheric cerebral infarction. All were treated with extensive craniectomy and duroplasty without resection of necrotic tissue. We evaluated various characteristics(size of hemispheric infarction, Glasgow Coma Scale, volume of low density and midline shift in CT) at three different periods(preoperative, immediate postoperative and 3-4weeks after operation) and evaluated effectiveness of hemicraniectomy for massive cerebral edema after large hemispheric infarction. RESULTS: All patients have survived from surgery. Nine patients with nondominant hemispheric infarction showed significant functional recovery with minimal assistance, and remaining two patients with dominant hemispheric infarction and one patient with nondominant hemispheric infarction have functionally dependent. The volume of low density and midline shift in CT were significantly reduced after decompressive craniectomy. CONCLUSIONS: Our results indicate that decompressive craniectomy with dural augmentation without resection of necrotic tissue for massive cerebral hemispheric infarction not only reduce the mortality and infarction size but also significantly improve the outcome, especially for nondominant hemispheric infarction.

The Availability of Allogenic Fibular Bone Graft with Autogenous Bone Dust in Anterior Cervical Fusion after Cervical Discectomy

No abstract available.

Thoracic Myelopathy and Radiculomyelopathy due to Ossification of the Ligamentum Flavum: A Cases Report

No abstract available.

Surgical Treatment of Posterior Circulation Aneurysms in Mother and Son: Report of Two Cases

Familial intracranial aneurysm is rare. We have clipped two posterior circulation intracranial aneurysms in mother and son. Mother was 48 years old and presented with severe headache and drowsy mentality. A basilar artery bifurcation aneurysm was found on DSA(digital subtraction angiography) and successfully clipped with transsylvian pterional approach. Her son was 24-year-old and presented with seizure and drowsy mentality. An aneurysmal sac was found on the bifurcation of vertebral artery and posterior inferior cerebellar artery. We have clipped it successfully with far lateral suboccipital approach. The authors recommended the use of screening test, such as MRIand high resolution CT, on the group of patients with the characteristic features of familial intracranial aneurysm.

A Case of Metastatic Spinal Tumor in the Upper and Lower Thoracic Region Arising from Follicular Carcinoma of the Thyroid Gland

Among spinal tumors, the metastatic form is the most common form. This report describes a case of metastatic spinal tumor in the upper and lower thoracic region arising from follicular carcinoma of the thyroid gland. A 53-year-old female presented with a history of several months radiating pain in the right shoulder and arm. Magnetic resonance imaging showed bony expansion and a mass lesion of the first thoracic vertebra together with subtle cord compression. Using the anterior approach, the tumor was removed, and a bone graft was performed ; this was followed by radiation therapy. After discharge, the patient was followed up for 18 months, but was then readmitted due to right intercostal and midback pain. Plain X-ray and magnetic resonance imaging showed a destructive lesion of the right tenth rib and thoracic vertebra caused by an invasive tumor. Using the costotransversectomy approach, this was removed, and a bone graft was performed ; radiation and chemotherapy followed. The histological diagnosis was follicular carcinoma of the thyroid gland and the patient was discharged with no neurologic deficits. For neurologic recovery and the maintenance of stability, surgical treatment of a metastatic spinal tumor is thus necessary.

Surgical Treatment of Tuberculous Spondylitis

Tuberculous spondylitis develops at 5 percents of patients with systemic tuberculosis. Clinical findings of tuberculous spondylitis are back pain, paraparesis, kyphosis, and sensory disturbance. The aims of treatment are eradication of the infection, prevention of neurologic complication and spinal deformity. The authors reviewed ten cases of tuberculous spondylitis from 1992 to 1995. Nine patients had vertebral body involvements and seven had neurologic complications. Sites of involvement were thoracic(five), lumbosacral(two), and multiple levels(thoracic/lumbar, three). Tuberculous spondylitis involving multiple levels or posterior column were misdiagnosed as spinal tumor. Operative approaches were anterior approach(six), posterior approach(three), and both(one). The procedures of operation comprised of drainage of abscess, debridement of sequestered bone, decompression of spinal cord, and stabilization of the spine for correction of deformity. All patients had good neurologic outcome by way of drainage, decompression, and stabilization procedure. Thus we concluded that aggressive management should be considered when treating the patients with tuberculous spondylitis.

A Study on Immunity of Welders / 대한산업의학회지

The authors examined human immunity indicators such as CD4, CD8, Natural Killer (NK) cell, IgG, IgA, and IgM, and heavy metals such as Pb, Cr, Cd to evaluate the health hazard of welders. We selected total 126 male subjects, 60 welders who had more than 5 year working history as an exposure group, and 66 office workers and medical college students as a control group. This immunity evaluation approach is the first newly designed study that has never been tried in past studios on welder's heath evaluation. And the results were as follows. 1. Total lymphocyte count of peripheral blood was significantly higher in welder group, 2,615+/-650 ea/microliter compared with 2,368+/-681 ea/microliter in control group (p or =0.05). 3. IgG, IgA, and IgM in welder group were 15.9 mg/dl, 2.7 mg/dl, and 1.5 mg/dl, respectively, and 15.6 mg/dl, 2.9 mg/dl and 1.7 mg/dl in control group. There was no statistical significance between two groups(p> or =0.05). 4. Blood lead, cadmium and chromium concentrations were 4.2+/-1.8 microgram/dl, 0.4+/-0.38 microgram/dl, 1.2+/-0.6 microgram/dl in welder group and 3.2+/-1.7 microgram/dl, 0.44+/-0.29 microgram/dl, 1.1+/-0.6 microgram/dl in control group, respectively, and these value were within normal ranges.

A Study on Possibility of Special Health Examination to the Hospital Employees / 대한산업의학회지

This study was performed to decide the possibility of special health examination to the hospital employees. We carried out questionnaire survey for 830 subjects at 2 general hospitals located in Pusan city. The summary of this study are as follows. 1. Above 10% of total hospital employees were replied that they exposed to 16 hazard items, such as dust, noise, stress and etc. Among them, over 50% of hospital employees exposed to dust(69.8%), noise(52.3%), stress(60.1%). And hospital employees exposed to alcoholic disinfectant(41.3%), radiation(34.6%), drug(33.3%), VDT(25.2%), and aldehyde(18.7%) also. 2. 63% of the hospital employees replied that there were hazardous factors in hospital environments, and 80% insisted the necessity for hospital environment measuring. 35.7% of respondents replied that they had never taken the education about hazardous factors. 35.7% of the total respondents answered that they didn't use protective equipment when exposed to hazardous factors. And 48.6% answered they took periodic health examination. Only 7.2% replied that ventilation condition of office room was proper. As shown in above results, hospital employees are exposed to various hazards, and turn out neglecting to health problems caused these hazardous factors. So at first, it is necessary to measuring hospital working environment, and then will be decided the possibility of special health examination to the hospital employees.

A Study on Possibility of Special Health Examination to the Hospital Employees / 대한산업의학회지

This study was performed to decide the possibility of special health examination to the hospital employees. We carried out questionnaire survey for 830 subjects at 2 general hospitals located in Pusan city. The summary of this study are as follows. 1. Above 10% of total hospital employees were replied that they exposed to 16 hazard items, such as dust, noise, stress and etc. Among them, over 50% of hospital employees exposed to dust(69.8%), noise(52.3%), stress(60.1%). And hospital employees exposed to alcoholic disinfectant(41.3%), radiation(34.6%), drug(33.3%), VDT(25.2%), and aldehyde(18.7%) also. 2. 63% of the hospital employees replied that there were hazardous factors in hospital environments, and 80% insisted the necessity for hospital environment measuring. 35.7% of respondents replied that they had never taken the education about hazardous factors. 35.7% of the total respondents answered that they didn't use protective equipment when exposed to hazardous factors. And 48.6% answered they took periodic health examination. Only 7.2% replied that ventilation condition of office room was proper. As shown in above results, hospital employees are exposed to various hazards, and turn out neglecting to health problems caused these hazardous factors. So at first, it is necessary to measuring hospital working environment, and then will be decided the possibility of special health examination to the hospital employees.

A Study on Food Intake and Associated Factors of the Urban Poor Elderly / 예방의학회지

This study was carried out to analyse the food intake and associated factors of the urban poor elderly by comparing poor district, Unbong rental apartment in Bonsong 2 dong with other areas in Pusan. 135 elderlies(men 36, women 99) in Unbong rental apartment 136 elderlies(men 45, women 91 ) in the other areas were investigated during the period of March to August in l994. The assumption that the study area represented poor district was satisfied because the age and sex distribution was not significantly different, and the income of the study area was significantly lower than that of the control area. The variables of hospitalized in previous 12 month, gastrointestinal problem, alcohol drinking, cigarette smoking did not differ significantly. But the variables of chronic disease, take medicine, perceive, vitamin supplement differed significantly between two groups. Therefore some factors associated with health state in the study area are worse than those of the control areas. At most of all variables, nutrients intake of the study area did not reach the recommended dietary allowances(RDA) for Koreans, and that nutrient intakes of the study area were significantly lower than those of the control area. The hypothesis of this study that nutrient status depends on economical status was proved. As for the score of nutritional knowledge, the study area was significantly lower than the control area. But as for the score of nutritional behavior, two areas were not significantly different. The latter is counter result of our hypothesis, owing to the effect of the confounding factors including education etc. As for the correlation of variables, not only economic status and educational level, but the score of nutritional knowledge effects strongly on nutrient status in the study area, the poor district. Therefore, adequate nutritional education to the elderly in the poor district should be considered.

Sociomedical Survey on the Occupational Low Back Injuries of the Some Workers in Pusan Area / 예방의학회지

This survey was performed to obtain the basic information for the prevention and management of occupational low back injury(LBI). The subjects of this survey were 952 workers(male, 892;female, 60) who had taken occupational LBI in some industries of Pusan area from January 1 to December 31, 1991. Observation period was 2.6 years from the beginning to the end of medical treatment. The obtained results were summarized as follows; 1. The proportion of LBI workers was 15.9% of the workers who had taken any occupational injuries and 0.32% of all workers in this surveyed area. 2. 8.0% of the workers had taken LBI on the 1st day of employment and 55.2% of the workers were within one year, 91.4% of the workers were within 10 years according to cumulative frequency distribution. 3. Handling of heavy objects was the most common cause of LBI(32.0%) and fall down(26.9%) and slip down(16.3%) were the next in order. 4. The most common causes of both lumbar sprain and HNP were handling of heavy objects and that of lumbar fracture was fall down. 5. The mean duration for medical treatment of LBI workers was 143 days. 6. The total direct compensation cost for LBI workers was 6,736 million Won and the proportion of medical, resting, disability compensation costs were 25.0%, 37.0%, 38.0% respectively. 7. The percentages of retreated workers and disabled workers were 11.9%(113 persons) and 22.9%(218 persons) of total LBI workers respectively.