Successful Renal Autotransplantation for the Treatment of Severe Renovascular Hypertension in a 14-year-old Boy

Percutaneous transluminal renal angioplasty (PTRA) is the current treatment of choice for renal artery revascularization, but renal autotransplantation has been an alternative treatment for complex cases. Here we report a 14-year-old boy with severe hypertension successfully treated with PTRA and renal autotransplantation. Doppler ultrasonography and computed tomography (CT) angiography revealed slight narrowing in the right renal artery ostium and complete obstruction in the left renal artery ostium with multiple collaterals. PTRA with stent insertion was performed for the treatment of the right renal artery, but it was impossible for the left renal artery due to the total obstruction. Therefore, left nephrectomy for autotransplantation was done with the peritoneal approach and the left kidney was autotransplanted to the ipsilateral iliac fossa. Postoperatively, Doppler ultrasonography and mercapto-acetyl-triglycine (MAG-3) renogram were performed, which showed normal renal artery blood flow and kidney function. Blood pressure was normalized and anti-hypertensive drugs were gradually tapered. Fibromuscular dysplasia was suspected to be responsible for the renal artery stenosis based on clinical aspects. In conclusion, renal autotransplantation is also a good treatment option for children with severe renovascular hypertension when endovascular treatment has failed or is not possible.

The Clinical Characteristics of Type 2 Diabetes Mellitus with and without beta-cell Autoantibody in Children and Adolescents / 대한소아내분비학회지

PURPOSE: The aim of this study is to investigate the differences in clinical characteristics and disease process between autoantibody-positive and -negative patients with type 2 diabetes mellitus (DM). METHODS: We investigated 162 patients diagnosed as DM between January 2000 and July 2009. 120 were classified as type 1 and 42 as type 2 DM. The clinical and laboratory data were obtained from medical records, retrospectively. RESULTS: The age at diagnosis, average BMI and serum C-peptide levels were significantly higher in type 2 DM patients than in type 1 DM patients. Type 2 DM patients had a significantly higher family history of diabetes and less frequent ketonuria. There were no significant differences between autoantibody-positive and -negative type 2 DM patients in age at diagnosis, BMI, C-peptide levels, HbA1c levels or family history. During the follow-up period, C-peptide levels were lower in the autoantibody-positive group than in the autoantibody-negative group, while. HbA1c levels were higher in the autoantibody-positive group. However, these differences were not statistically significant. CONCLUSION: In autoantibody-positive type 2 DM patients, progressive loss of beta-cell function leads to reduced insulin secretion and poor glycemic control as the disease progresses, and some may be reclassified as slowly progressive type 1 DM. Ccntinued and careful follow-up is therefore needed.

The Results of Distal Chevron Osteotomy with Lateral Soft Tissue Release for Hallux Valgus Deformity / 대한족부족관절학회지

PURPOSE: To evaluate the results and effectiveness of distal chevron osteotomy combined with lateral soft tissue release for the correction of hallux valgus deformity. MATERIALS AND METHODS: 31 patients who underwent distal chevron osteotomy with lateral soft tissue release between July 2002 and June 2003, were analyzed in terms of hallux valgus angle, intermetatarsal angle, subluxation of sesamoid, AOFAS score and the occurrence of avascular necrosis of the first metatarsal head. RESULTS: The mean amount of the correction of hallux valgus angle was 26.3 degrees . The mean amount of the correction of intermetatarsal angle was 6.6 degrees. The mean amount of the correction of sesamoid subluxation was 1.2 points. The mean improvement of AOFAS score was 25.8 points. Avascular necrosis of the first metatarsal head was not found in any cases. CONCLUSION: For correction of hallux valgus deformity, distal chevron osteotomy with lateral soft tissue release showed improvement of hallux valgus angle, sesamoid subluxation and AOFAS score with no evidence of avascular necrosis of the first metatarsal head.

Interleukin-10 Gene -592 Promoter Polymorphism in Patients with Endometriosis / 대한산부인과학회지

OBJECTIVE: To explore the association of the interleukin-10 (IL-10) gene -592 promoter polymorphism with endometriosis in a Korean population. METHODS: This study comprised 254 women with surgically or histologically diagnosed endometriosis, 236 control women with no evidence of endometriosis by laparoscopy or laparotomy. Following extraction of genomic DNA, genotyping of the IL-10 gene -592 polymorphism was performed by polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) analysis. RESULTS: The distribution of genotypes and allele frequencies of IL-10 gene -592 polymorphism in the endometriosis group did not differ from those in the control group (A/A: A/C: C/C, 41.3%: 51.2%: 7.5% vs. 44.9%: 50.8%: 4.2%). And when classified by stage, there was also no significant difference in the distribution of IL-10 gene -592 polymorphism between patients with stage I-II (ASRM, 1997) endometriosis or patients with stage III-IV endometriosis and controls. CONCLUSION: These results suggest that IL-10 gene -592 promoter polymorphism is not associated with the risk for endometriosis in the Korean women.

Selective Peripheral Denervation for the Treatment of Spasmodic Torticollis

OBJECTIVE: Various methods of treatment for idiopathic cervical dystonia have been tried in the past with unsatisfactory results. The authors report cases of five patients who underwent selective peripheral denervation for spasmodic torticollis. METHODS: Between July 2002 and December 2003, 5 patients underwent surgery at St. Mary's Hospital for spasmodic torticollis. Age of the patient at the onset of symptoms ranged from 29 to 56years (mean 43.75years). Selective peripheral denervation(SPD) was performed at 7 to 11months after the onset of symptoms (mean 8.75 months). A patient was considered to be the candidate for surgery if conservative methods were unsuccessful and symptoms persisted for longer than 7months. In addition, 2patients who refused treatment with botulinum toxin were also enrolled in this study. RESULTS: Although one patient underwent reoperation, all of the five patients' symptoms were improved after the operation. Clinically, patients with retrocollis showed better improvement than laterocollis patients. CONCLUSION: Although injection of botulinum toxin is the first-choice in treatment modality, when surgery is required, selective peripheral denervation provides good results with minimum side effects.

Prognostic Factors of Hemiarthroplasty for the Proximal Humeral Fractures / 대한정형외과학회잡지

PURPOSE: The purpose of the study was to evaluate the results and analyze various prognostic factors of hemiarthroplasty for proximal humeral fractures. MATERIALS AND METHODS: Thirty-one cases, who underwent hemiarthroplasties for proximal humeral fractures, were evaluated with ASES score at a mean follow-up of 45 months (1-8 years). Global Total Shoulder (Depuy.) (TS Gr) for 21 cases, and Global FX (Depuy.) (FX Gr) for 10 cases were used. Twentysix cases were acute fractures within one month after injury. There were two cases with delayed union and three cases with nonunion. Prognostic values of age, delay of surgery, fracture type, position of the greater tuberosity and design of implant were assessed. RESULTS: The most important prognostic factor was the design of implant. Mean score of FX Gr was significantly higher than that of TS Gr (84.4 and 77.6 respectively, p=0.036). Age, fracture type, delay of surgery and position of the greater tuberosity did not show any prognostic value. CONCLUSION: The clinical results of Hemiarthroplasty specially designed for the proximal humeral fractures has better than that of preexisting implant. Design of the implant was considered to be the most important prognostic factor of hemiarthroplasty for the proximal humeral fractures.

A Case of Flavobacterium Indologenes Keratitis

PURPOSE: Flavobacterium indologenes is known to cause keratitis very rarely. Authors have experienced 1 case of keratitis from Flavobacterium indologenes with history of diabetes mellitus, thereby reporting it. METHODS: History taking, slit lamp examination, staining and culture, sensitivity test about antibiotics were performed on 1 case of keratitis. RESULTS: Flavobacterium indologenes was detected in staining and culture that was performed on the first visit. Piperacillin was used based on the sensitivity test about antibiotics. Improvement of corneal lesion and symptom was observed with the use of piperacillin. CONCLUSIONS: Flavobacterium indologenes can be considered as a casual pathogen in keratitis with condition susceptible to opportunistic infection such as systemic illness or abnormal ocular immunity.

Hormonal Regulation of Dazla Expression in the Follicle Development of Mouse Ovary / 대한불임학회지

No abstract available.

Effects of Glutathione on Reactive Oxygen Species-Induced Cytotoxicity in Human Retinal Pigment Epithelial Cell Line

PURPOSE: Oxidative stress is the well known causative factor for retinal damage. This study investigated the effects of glutathione on reactive oxygen species(ROS) induced injury in human retinal pigment epithelial(HRPE) cells. OBJECTS AND METHODS: HRPE cells (ATCC:CRL-2302) were cultured with DMEM media and exposed to oxidative stress (paraquat, hydrogen peroxide) and/or glutathione modulator[(buthionine sulfoximine (BSO), glutathione (GSH), 2-oxo 4-thiazolidine carboxylic acid (OTC)] for 2 days. The cell viability was determined by measuring the amount of reduced 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide (MTT). RESULTS: The rate of MTT reduction of HRPE cells decreased by either paraquat or hydrogen peroxide treatment. BSO as a inhibitor of glutathione biosynthesis potentiated paraquat- or hydrogen peroxideinduced HRPE cells injury. On the other hand GSH or OTC reduced the rate of decrement of MTT reduction in HRPE cells by paraquat and hydrogen peroxide. CONCLUSIONS: Glutathione seemed to play some role in prevention of ROS-induced HRPE cells injury and OTC may be used as an agents for prevention of free radical induced HRPE cell injury.

Barrier Techniques for Spinal Cord Protection from Thermal Injury in Polymethylmethacrylate Reconstruction of Vertebral Body:Experimental and Theoretical Analyses

OBJECTIVES: Polymethylmethacrylate(PMMA) is often used to reconstruct the spine after total corpectomy, but the exothermic curing of liquid PMMA poses a risk of thermal injury to the spinal cord. The purposes of this study are to analyze the heat blocking effect of pre-polymerized PMMA sheet in the corpectomy model and to establish the minimal thickness of PMMA sheet to protect the spinal cord from the thermal injury during PMMA cementation of vertebral body. MATERIALS AND METHODS: An experimental fixture was fabricated with dimensions similar to those of a T12 corpectomy defect. Sixty milliliters of liquid PMMA were poured into the fixture, and temperature recordings were obtained at the center of the curing PMMA mass and on the undersurface(representing the spinal cord surface) of a pre-polymerized PMMA sheet of variable thickness(group 1:0mm, group 2:5mm, or group 3:8mm). Six replicates were tested for each barrier thickness group. RESULTS: Consistent temperatures(106.8+/-3.9degreesC) at center of the curing PMMA mass in eighteen experiments confirmed the reproducibility of the experimental fixture. Peak temperatures on the spinal cord surface were 47.3degreesC in group 2, and 43.3degreesC in group 3, compared with 60.0degreesC in group 1(p<0.00005). So pre-polymerized PMMA provided statistically significant protection from heat transfer. The difference of peak temperature between theoretical and experimental value was less than 1%, while the predicted time was within 35% of experimental values. The data from the theoretical model indicate that a 10mm barrier of PMMA should protect the spinal cord from temperatures greater than 39degreesC(the threshold for thermal injury in the spinal cord). CONCLUSION: These results suggest that pre-polymerized PMMA sheet of 10mm thickness may protect the spinal cord from the thermal injury during PMMA reconstruction of vertebral body.

Percutaneous Polymethylmethacrylate Vertebroplasty in the Treatment of Osteoporotic Thoracic and Lumbar Vertebral Body Compression Fractures: Outcome of 159 Patients

PURPOSE: To assess therapeutic effects of percutaneous polymethylmethacrylate(PMMA) vertebroplasty on the pain caused by osteoporotic thoracic and lumbar vertebral body compression fractures in a large scale of a prospective clinical design, and to determine clinical factors influencing its therapeutic effects. METHODS: A prospective clinical study was carried out in 349 vertebral levels of 159 patients between April 1998 and July 1999. The compression fractures were confirmed with bone scan and spine CT, and bone marrow density was measured. Visual analogue scale(VAS) score was used for pre- and post-operative assessments of the pain. All 159 patients were assessed immediately after surgery, and 140 patients of them were followed-up for about 6 months in average. RESULTS: Partial and complete pain relief was sustained immediately after operation in 73%, through follow-up period in 88% of the patients. Pain relief was not proportional to the amount of PMMA or the rate of increase in the height of the compressed vertebral body. It appears that 3 to 6cc of PMMA was proper enough to sustain pain relief. Better clinical improvement was achieved in the patients treated within 6 months after occurrence of vertebral body fracture. The most frequent surgical complication was epidural leakage of PMMA, and the most serious complication was extravertebral leakage into the paravertebral muscles, which appeared to exert the worst influence on the outcome. However, surgery was not required in these patients. CONCLUSION: Therapeutic effects of PMMA percutaneous vertebroplasty on osteoporotic vertebral body compression fractures were confirmed in a relatively large scale of prospective clinical study. It appears that good outcome can be achieved in patients treated within 6 months after fracture, treated each level with 3 to 6cc of PMMA in amount. without serious complications.

Comparisons of Unicortical and Bicortical Lateral Mass Screws in the Cervical Spine: Safety vs Strength

INTRODUCTION: The purpose of this study was to analyze the safety, pullout strength and radiographic characteristics of unicortical and bicortical screws of cervical facet within cadaveric specimens and evaluate the influence of level of training on the positioning of these screws. METHODS: Twenty-one cadavers, mean 78.9 years of age, underwent bilateral placement of 3.5mm AO lateral mass screw from C3-C6(n=168) using a slight variation of the Magerl technique. Intraoperative imaging was not used. The right side(unicortical) utilized only 14mm screws(effective length of 11mm) while on the left side to determine the length of the screw after the ventral cortex had been drilled. Three spine surgeons(attending, fellow, chief resident) with varying levels of spine training performed the procedure on seven cadavers each. All spines were harvested and lateral radiographs were taken. Individual cervical vertebrae were carefully dissected and then axial radiographs were taken. The screws were evaluated clinically and radiographically for their safety. Screws were graded clinically for their safety with respect to the spinal cord, facet joint, nerve root and vertebral artery. The grades consisted of the following categories: "satisfactory", "at risk" and "direct injury". Each screw was also graded according to its zone placement. Screw position was quantified by measuring a sagittal angle from the lateral radiograph and an axial angle from the axial radiograph. Pull-out force was determined for all screws using a material testing machine. RESULTS: Dissection revealed that fifteen screws on the left side actually had only unicortical and not bicortical purchase as intended. The majority of screws(92.8%) were satisfactory in terms of safety. There were no injuries to the spinal cord. On the right side(unicortical), 98.9% of the screws were "satisfactory" and on the left side(bicortical) 68.1% were "satisfactory". There was a 5.8% incidence of direct arterial injury and a 17.4% incidence of direct nerve root injury with the bicortical screws. There were no "direct injuries" with the unicortical screws for the nerve root or vertebral artery. The unicortical screws had a 21.4% incidence of direct injury of the facet joint, while the bicortical screws had a 21.7% incidence. The majority of "direct injury" of bicortical screws were placed by the surgeon with the least experience. The performance of the resident surgeon was significantly different from the attending or fellow(p<0.05) in terms of safety of the nerve root and vertebral artery. The attending's performance was significantly better than the resident or fellow(p<0.05) in terms of safety of the facet joint. There was no relationship between the safety of a screw and its zone placement. The axial deviation angle measured 23.5+/-6.6 degrees and 19.8+/-7.9 degrees for the unicortical and bicortical screws, respectively. The resident surgeon had a significantly lower angle than the attending or fellow(p<0.05). The sagittal angle measured 66.3+/-7.0 degrees and 62.3+/-7.9 degrees for the unicortical and bicortical screws, respectively. The attending had a significantly lower sagittal angle than the fellow or resident(p<0.05). Thirty-three screws that entered the facet joint were tested for pull-out strength but excluded from the data because they were not lateral mass screws per-se and had deviated substantially from the intended final trajectory. The mean pull-out force for all screws was 542.9+/-296.6N. There was no statistically significant difference between the pull-out force for unicortical(519.9+/-286.9N) and bicortical(565.2+/-306N) screws. There was no significant difference in pull-out strengths with respect to zone placement. CONCLUSION: It is our belief that the risk associated with bicortical purchase mandates formal spine training if it is to be done safely and accurately. Unicortical screws are safer regardless of level of training. It is apparent that 14mm lateral mass screws placed in a supero-lateral trajectory in the adult cervical spine provide an equivalent strength with a much lower risk of injury than the longer bicortical screws placed in a similar orientation.

Posterior Lumbar Interbody Fusion Using Posterolateral Placement of A Single Cylindrical Threaded Cage and Two Regular Cages: A Biomechanical Study

OBJECTIVES: An in vitro biomechanical study of posterior lumbar interbody fusion(PLIF) with threaded cage using two different approaches was performed on eighteen functional spinal units of bovine lumbar spines. The purpose of this study was to compare the segmental stiffnesses among PLIF with one long posterolateral cage, PLIF with one long posterolateral cage and simultaneous facet joint fixation, and PLIF with two posterior cages. METHODS: Eighteen bovine lumbar functional spinal units were divided into three groups. All specimens were tested intact and with cage insertion. Group 1(n=12) had a long threaded cage(15x36mm) inserted posterolaterally and oriented counter anterolaterally on the left side by posterior approach with left unilateral facetectomy. Group 2(n=6) had two regular length cages(15x24mm) inserted posteriorly with bilateral facetectomy. Six specimens from group 1 were then retested after unilateral facet joint screw fixation in neutral(group 3). Likewise, the other six specimens from group 1 were retested after fixation with a facet joint screw in an extended position(group 4). Nondestructive tests were performed in pure compression, flexion, extension, lateral bending, and torsion. RESULTS: PLIF with a single cage, group 1, had a significantly higher stiffnesses than PLIF with two cages, group 2, in left and right torsion(p<0.05). Group 1 showed higher stiffness values than group 2 in pure compression, flexion, left and right bending but were not significantly different. Group 3 showed a significant increase in stiffness in comparison to group 1 for pure compression, extension, left bending and right torsion(p<0.05). For group 4, the stiffness significantly increased in comparison to group 1 for extension, flexion and right torsion(p<0.05). Although there was no significant difference between groups 3 and 4, group 4 had increased stiffness in extension, flexion, right bending and torsion. CONCLUSION: Posterior lumbar interbody fusion with a single long threaded cage inserted posterolaterally with unilateral facetectomy enables sufficient decompression while maintaining a majority of the posterior elements. In combination with a facet joint screw fixation, adequate postoperative stability can be achieved. We suggest that posterolateral insertion of a long threaded cage is biomechanically an ideal alternative to PLIF.

A Comparative Study of Recurrence Rate in Bilateral Pterygium Surgery: Conjunctival Autograft Transplantation Versus Bare Scleral Techinque

PURPOSE: When the patients with both recurrent and primary pterygia, We performed conjunctival autograft transplantation for recurrent pterygium and bare sclera technique for primary pteygium. We then compared the recurrence of each case in order to find out the usefulness of each surgery and effective mothod of surgery. METHODS: We performed follow-up on 26 eyes of 13 patients for 14 months (mean); 8 patients (16 eyes) were female, and 5 patients (10 eyes) male. The mean age of the patients was 49.5 years ranging from 37 to 63. In the operation, all patients received with 0.02% Mitomycin C for 1 minute. RESULTS: Pterygium recurred in 3 of 13 eyes which underwent bare sclera technigue, and did not recur in 13 eyes undergoing conjunctival autograft transplantation, but there was no significant difference because of a small number of study cases (P=0.07). We found postoperative complications such as corneal fila-ment and conjunctival granuloma in the case of bare sclera technique; but none in conjunctival autograft transplantation. CONCLUSIONS: We recommend a conjunctival autograft transplantation with application of low concen-tration of Mitomycin C as a safe and effective method for recurrent pterygium or pterygium with high recurrence rate.

Anterior Ceervical Interbody Fusion: Comparison Study between Simple Fusion, Locked and Non-locked Plating Systems

The use of metallic plate and screws in the anterior cervical fusion has become generally acceptable and popular. Mainly, there are two different plating systems available. However, there has been few attempts to compare their clinical results with and without a plating system or between two different systems in a single series of clinical study. The authors reviewed 117 patients who underwent anterior cervical fusion during the period of January 1992 to September 1996. Simple fusion without a plating system was applied in 55 cases(group 1), a bicortical non-locked plate screw system in 25(group 2), and a monocortical locked plate screw system in 37(group 3). The average follow-up period was 13. 2 months. In group 1, twenty-two patients(40%) with fracture-dislocation or corpectomy required a rigid brace such as halo brace and Minerva cast for 3 months postope ratively and seven patients(13%) experienced graft complications, mainly graft extrusion. In group 2 and 3, the patients required only soft b races for 4 to 8 weeks and no patients experienced serious graft complications like ones in group 1 but, instead two patients with screw breakages, two back-outs and one non-union were observed. In comparison of the clinical complications such as hoarsness, there were no significant differences between the groups. In conclusion, the plating system in anterior cervical fusion appears to be safe despite the facts that mo re technical demands are required during surgery. It also provides better postoperative stability in the spine and permits earlier ambulation without a rigid brace. A monocortical locked plate screw system appears to have less hardware failures and better su rgical results than a bicortical non-locked plate screw system.

Improvement of Cerebrovascular Reserve Capacity by Bypass Surgery in Patients with Hemodynamic Cerebral Ischemia

To study the effect of extracranial-intracranial(EC/IC) bypass on symptomatic patients with hemodynamic cerebral ischemia, we prospectively reviewed 14 patients who underwent EC/IC bypass surgery. A series of 14 patients treated in a 2 years period met the following criteria, 1) symptomatic internal carotid artery(ICA) or middle cerebral aetery(MCA) obstruction or stenosis over 80M, 2) decrease in basal cerebral blood flow(CBF) over 10%, 3) hyporeactivity to acetazolimide of CBF Amomg these, the type of ischemic episode was transient ischemic attack(TIA) or reversible ischemic neurological deficit(RIND) in 4, minor stroke in 8, and major stroke in 2. Of these, 10 patients had multiple episode of ischemic attack. CT or MRI were showed infarction of the MCA territory in 3, border zone infarction in 5, basal ganglia infarction in 2 and multiple lacunar infarction in 4. Based on our criteria, superficial temporal artery(STA)-MCA anastomosis was performed in 13 cases and EC-IC bypass grafting using radial artery in one. Average follow up period was 24 months. Postoperative course was uneventful in 12 patients. One patient suffered a postoperative stroke with complete recovery and another suffered operative wound infection. Of the 14 patients 12(85.7 % ) have had an excellent to good outcome with complete resolution or significant improvement of preoperative neurologic symptom, remaining two show no improvement of preoperative neurologic deficit. Bypass patency was confirmed by postoperative angiography in all cases except for one. Postoperative follow up studies of the basal CBF and response to the acetazolamide of the CBF showed significant increased CBF activity to acetazolamide in 12 cases(85. 7%) while the basal CBF was essentially unchanged in all cases except for two. In view of these finding, the authors suggest that EC-IC bypass surgery to be considered as an appropritate therapy for improvement of the cerebrovascular reserve capacity in patients with hemodynamic cerebral ischemia, defined using the strict selection criteria employed in this study.

A Case of Multiple Myeloma Presented with a Bulky Cranial Plasmacytoma Invading Cerebrum / 대한혈액학회지

Although neurologic complications of multiple myeloma are common, brain-involvement is rare, despite the high frequency of the cranial lesions. The cranial plasmacytoma grows only from bone, dura mater or adjacent mucous membrane and cerebral structures are affected secondarily. It is less likely that a solitary cranial plasmacytoma exists, and patients who harbor these neoplasms should undergo complete evaluations to exclude multiple myeloma. Solitary plasmacytoma is radiosensitive and the definite treatment for the cranial plasmacytoma usually consists of complete surgical resection with adjacent radiation therapy. However, the treatment and prognosis of the cranial plasmacytoma depends on whether this neoplasm is primary or secondary. Most of patients develop cranial plasmacytoma as the presenting form of multiple myeloma and the treamtment of in these speical cases is usually unsatisfatory. We report a case of multiple myeloma presented with the motor weakness of both upper and lower extremities by a bulky cranial plasmacytoma invading cerebrum treated with surgery, radiation therapy and chemotherapy.

Surgical Approach to Large Anterior Basal Meningioma

Anterior basal meningiomas, which belong the olfactory groove and suprasellar meningioma account for 12 to 22% of all intracranial meningioma. Anterior cranial base meningioma are difficult to operate on because of their proximity to the important neurovascular structure. The authors report 25 cases of large meningiomas of the anterior. cranial base operated on during recent 5-year period. The tumor ranged from 3cm to 6.5cm in diameter. Fifteen tumors were located in the suprasellae(included tuberculum sellae, planum sphenoidale, diaphragma sellae,and anterior clinoid process), ten on olfactory groove. The mean age of 19 female and 6 male patient was 55years. The main clinical symptom were visual disturbance, anosmia, headache, and psychotic syndrome. Tumors were approached in 11 cases by pterional, in 9 cases by bifrontal, in 3 cases by transbasal, in 2 case by orbitozygomatic infratemporal and in 1 case by combined approach with tranabasal and orbitozygomatic infratemporal. Total tumor removal was performed in 80% of cases. Postoperative complication include accentuated psychotic syndrome in two cases, worsening of visual function in two, major vessel injury in one, infection in one, CSF rhinorrhea in one, and oculomotor palse in one. Postoperative death was in four(16%). Results at follow up of the 21 survivours were good in 17(68%), fair in 4(16%). Selection criteria for operative approach is discussed with review of pertinent literature.

Clinical Analysis of Management of Spine-injuried Patients: Experince in the Suburban

The incidence of spine trauma has been increasing. To investigate the incidence, characteristics, and difficulty in management of the acute spine-injuried patients in suburban area we analyzed 50 cases treated conservatively or by operative fusion over a recent one-year period. This study comprised of 26 females and 24 males, between 23 and 83 years old patients with injury of whole column of spine. The most frequent cause of injury was traffic accident. The most common lesion was the compression fracture of the first lumbar spine. Most patients complained neck or back pain on admission. In 3 cases, neurological deficits were noted. For six patients, surgical treatment were performed and 44 patients has been conservatively managed with halo brace, neck collars, and thoracolumbar orthoses. The average period of admi-ssion and immobilzation for the conservatively treated patients was 6 weeks. During which time a few complications such as progressive kyphosis, hypoalbuminemia, thrombophlebitis, urinary tract infection, paralytic ileus, bed sore, and alcohol withdrawal syndrome were aroused. In most cases, good outcomes were achieved. Most of geriatric patients, concomitant systemic diseases with cardiovascular and pulmonary dysfunction were usually present and absence of the insight on spine injury made difficulties in managment. On the basis of these results we concluded that most elderly patients with spine fracture coulde be effectively treated by conservative methods, and also careful and systemic management with adequate education for patients and their families were required.

Usefulness of Magnetic Resonance Imaging in the Evaluation of Spine Following Instrumentation with Titanium Implants

Over the past six years, titanium alloy has been replacing the stainless steel in spinal implants owing to its magnetic resonance imaging(MRI) compatibility. However, studies about the usefulness of MRI, from a clinical standpoint, when it is used for spinal implants have been scarce. The purpose, therefore, is to determine whether postoperative MRIs would provide satisfactory information in evaluating the spine having various titanium implants. Authors reviewed the spinal MR images of sixteen patients who had previously received eleven different kinds of titanium implants, and compared postoperative images to preoperative images regarding the quality of images of spinal cord, nerve root, spinal canal, and the aforementioned implants. Types of implants included anterior cervical plate/screws, lateral cervical mass plate/screws, Halifax interlaminar clamps, anterior thoracolumbar rods/screws, posterior thoracolumbar rods/hooks, and posterior thoracolumbar transpedicular rods/screws. Anterior cervical plate/screws, lateral cervical mass plate/screws, Halifax clamps, and anterior thoracolumbar rod/screws produced small distortions of the images at the spinal canal or neural foramen. In contrast, posterior thoracolumbar transpedicular rods/screws created severe image distortions at the neural foramen in the postoperative MRIs. Metal-induced artifacts were most marked in the image from gradient echo sequence. Posterior thoracolumbar rods/hooks produced some artifacts at the posterior portion of the spinal canal. Although our series are limited in number, it can be concluded that MRI is informative and it is useful in postoperative evaluation of the spine with most types of titanium implants. However, postmyelogram computed tomography is recommended in cases where posterior thoracolumbar transpedicular rods/screws have been used.