Economic Evaluation of Add-on Levetiracetam for the Treatment of Refractory Partial Epilepsy in Korea

OBJECTIVE: This study estimated the expected cost-effectiveness ratio expressed as the incremental cost per seizure-free day (SFD) gained and the incremental cost per quality adjusted life year (QALY) gained when using levetiracetam (LEV) as add-on therapy from a third-party payer perspective. METHODS: A 1-year dose-escalation decision-tree model comparing LEV plus standard therapy (ST) with ST alone was designed to combine transition probabilities, costs and outcomes. The short-term outcomes and probabilities were derived from a prospective, open-label clinical trial with 100 Korean adults with refractory partial epilepsy. All data for the direct medical costs were derived from Korean cost data extracted from reports published by the National Health Insurance Corporation. RESULTS: The average gain in SFDs attributed to LEV add-on was 18.3 days per patient per year and the incremental cost-effectiveness ratios (ICERs) for LEV add-on were US$ 44 per SFD per patient and US$ 11,084 per QALY gained. All sensitivity analyses showed that the model was robust to the assumptions made. CONCLUSION: The economic evaluation indicates that, given a wide range of assumptions, the increased cost of treating patients having refractory partial epilepsy with LEV may be partially offset by a reduction in other direct medical costs. This reduction is a consequence of an increase in the number of SFDs and improved quality of life.

Rate and Predictors of Mortality in Elderly Nursing Home Residents with Dementia:5-Year Follow-Up Study

OBJECTIVES:To investigate mortality rates and predictors of mortality in dementia patients (prevalence cohort) resident at institution. METHODS:We followed up a dementia cohort for 5 years. A total of 273 subjects with dementia were longitudinally assessed at baseline, 6 months and 12 months and then checked whether alive or dead every 1 year for 5 years. Their mortality was compared with sociodemographic and clinical variables using Cochran-Mantel-Haenszel test and independent sample t-test. Survival time quartiles were used to describe the time until when 25%, 50%, and 75% of patients died. Kaplan Meier log-rank tests were used for testing the equality of survival among groups when identifying some disruptive agitated behaviors as mortality predictors. Relative risk (RR) with 95% confidence intervals were calculated by the Cox regression analysis. RESULTS:In this study, overall 5-year mortality rate was 63.0% (12.6% per year). Median survival after baseline evaluation was 2.85 years, whereas median survival after institutionalization was 6.42 years. Log-rank tests revealed that some disruptive behaviors (i.e., Cagras syndrome, screaming, trying to get to a different place, intentional falling) were significantly higher in the deceased group. Mortality in subjects with dementia depended on old age {over 85, relative risk (RR):1.04;95% confidence interval (CI):1.02-1.06}, male gender (RR:2.04;CI:1.28-3.25), lower MMSE-K score (RR:1.03;CI:1.00-1.06). CONCLUSION:We expect that this study may provide basic health information for health policy making in institutional care approaches in Korea

Anterior Cervical Microforaminotomy: A Minimally Invasive Anterolateral Approach for Spondylotic Lesions

No abstract available.

Endoscopic Removal of Traumatic Intracerebral Hematoma via Superolateral Keyhole

No abstract available.

Intramedullary Hemangioblastoma of Cervicomedullary Junction with Diffuse Spinal Cord Enlargement and Cyst Formation : A Case Report

No abstract available.

A Case of Subcutaneous Sacrococcygeal Myxopapillary Ependymoma: A Case Report

Ependymomas are originated from the ependymal cells and are mostly confined to the central nervous system. Rarely, they may occur in extradural sites such as skin or subcutaneous tissue of sacrococcygeal region. The myxopapillary ependymoma is the most common type of ependymoma in the sacrococcygeal region. We operated on 54-years old female with a sacrococcygeal mass. Tumor was removed totally and histologic study revealed as myxopapillary ependymoma. Clinicopathologic features are discussed along with pertienent literature.

A Case of Gliosarcoma with Hemorrhage: Case Report

The authors encountered a case of gliosarcoma with hemorrhage arising in the left frontotemporal lobe of a 34-year old woman who five months previously had undergone surgery for an ICH in the same lobe. On CT brain scan, we could a slight hyperdense tumor with irregular enhancement could be detected, and perilesional edema and obvious mass effect were also noted. The tumor was firm and surgically,its margine was somewhat poor. On pathologic and histochemical study, the presence of a gliosarcoma was confirmed.

Two Cases of Langerhans' Cell Histiocytosis: Report of Two Cases

The authors encountered two cases of Langerhans' cell histiocytosis. One, a three-year-old male, had persistent epiphora and showed exophthalmos of the left eye. A mass was detected in the left orbit and was removed subtotally; pathologic examination revealed Langerhans cell histiocytosis. The other case, a 24-year-old male, presented with a gradually growing palpable mass in the parietal area; the skull defect was punched out in shape. The mass, which was tightly attached to the outer layer of the dura mater, was completely removed. On the basis of pathologic findings, Langerhans' cell histiocytosis was diagnosed, and the patient subsequently underwent radiotherapy.

The Clinical Study and Analysis of Anterior Communicating Artery Aneurysm

The authors analyzed the radiographs(brain CT and cerebral angiograms) and medical & surgical records of 54 cases of ruptured anterior communicating artery aneurysms resulted in operations at our hospital from January 1991 to December 1995. The results were summarized as follows: 1) The rate of incidence was found to be highest in sixth decade and the ratio of male to female was 1:1. 2) On the preoperative brain CT, ventricular or cerebral hemorrhage combined cases had high Hunt-Hess and Fisher grades. 3) Of 54 cases, hypertension was observed in 20 cases(37%). Hypertension had no effect on the admission Hunt-Hess and Fisher grades. 4) Classification of the anterior communicating artery aneurysms according to its directions were as follows; anterior direction in 57.4%, superior direction in 18.5%, posterior direction in 13%, inferior direction in 11.1%. 5) The afferent artery of anterior communicating artery aneurysms were as follows; left A1 in 38 cases(70.4%), right A1 in 12 cases(22,2%), bilateral A1 in 4 cases(7.4%). 6) The ranges of diameters of the aneurysm was as follows;6-10mm in 57.4%, below 5mm in 22.2%. 7) The posteriorly directing aneurysms showed less favorable preoperative state, and preoperative hydrocephalus was most common on the posteriorly directing aneurysms. 8) There was no significant relationship between direction of aneurysm and prognosis. However, better Hunt-Hess grades seem to correlate better prognosis. 9) The operation was performed by pterional approach in all cases, the approach side was selected for the presence of dominant feeding artery in 50 cases(92.6%). 10) Overall mortality rate was 1.8%, the patients who died are of the older age group and the cause of death was medical complication in 6 cases.

Bilateral Hypoplasia of Internal Carotid Arteries Associated with Intracranial Aneurysm: Report of Two Case

Bilateral hypoplasia of the internal carotid arteries is a rare condition. The authors experienced two cases of bilateral hypoplasia of the internal carotid arteries. In one case, a 46-year-old female patient, presented with subarachnoid hemorrhage. Internal carotid angiograms showed right hypoplastic internal carotid artery and left agenetic internal carotid artery. An aneurysm, believed to be the source of the subarachnoid hemorrhage, took origin from the trunk of the basilar artery. In another case, a 48-year-old male, presented with semicomatous mentality. Brain CT demonstrated intracranial hemorrhage on the parasylvian area, and high density on the basal cistern, quadrigerminal cistern and temporal horn of left lateral ventricle. Initially, aortic arch injection did not visualized the origin of the common carotid arteries. It revealed only the vertebral arteries and both external carotid artery originating from each vertebral artery. A selective left vetebral artery study demonstrated a communication between the hypertrophied basilar artery and the posterior cerebral arteries. The anterior and middle cerebral vessels, in turn, were opacified through the circle of Willis, via the posterior communicating arteries. In addition, an aneurysm, believed to be the sourse of the subarachnoid hemorrhage, took origin from the posterior cerebral artery. The cases of the bilateral hypoplasia of internal carotid artery with intracranial aneurysm are reported as above, together with literature review.

An Arachnoid Cyst in Cervical Spinal Canal: Case Report

The authors have experienced a case of an arachnoid cyst within the cervical canal. The patient suffered from right upper extremity pain and numbness for 1 month. On cervical MRI, intradural extramedullary mass was detected. A total laminectomy of C5, C6 and C7 was performed. We could diagnose by radiological and pathological findings.

An Arachnoid Cyst in Cervical Spinal Canal: Case Report

The authors have experienced a case of an arachnoid cyst within the cervical canal. The patient suffered from right upper extremity pain and numbness for 1 month. On cervical MRI, intradural extramedullary mass was detected. A total laminectomy of C5, C6 and C7 was performed. We could diagnose by radiological and pathological findings.

A Clinical Study and Analysis of Chemonuecleolysis Versus Automated Percutaneous Lumbar Discectomy in Herniated Nucleus Pulposus of the Lumbar Spine

The authors reviewed the radiographs and medical records of 134 consecutive patients who underwent chemonucleolysis and automated percutaneous lumbar discectomy(APLD) between March 1990 and December 1994 at our institute. Among the 34 consecutive patients, 90 patients underwent chemonucleolysis and the other remaining patients underwent APLD using a nucleotome. The results are summarized as follows: 1) In both groups, predominent patients were of young age and males. 2) The most common lesion was in L4-5 interspace in both groups 3) The posteior lateral type showed high incidence in APLD group. 4) The results were better in the younger age group and when spinal CT demonstrated posterior lateral type in both groups. 5) The results showed relatively good success rate of 84.4% in chemonucleolysis group and 88.6% in APLD group. 6) Better results can be anticipated when patients are carefully selected and operated on with a higher skillful technique.

A Case of Primary Epidural Ewing's Sarcoma, Originated in Sacral Area

Recently we experienced a soft tissue sarcoma originated in the spinal epidural space at upper sacral area and extending into intrapelvic area in a young male patient. It was diagnosed primary Ewing's sarcoma histologically. Ewing's sarcoma is usually found in long bones. But rarely discovered in an extraosseous area. So, spinal epidural Ewing's sarcoma is rare to be found. Only 6 cases were reported in the English literature until 1986. We present the case with review of literatures.

Area-Specific Postnatal Maturation of the Calcium-Binding Proteins Parvalbumin- and Calbindin-Immunoreactive Neurons in the Rat Hippocampus

The present study was attempted to obtain the regional differences of development of the parvalbumin- and calbindin-ir neurons in the maturing rat hippocampus. Sprague-Dawley rats at 3, 7 days, 2, 3, 4, 5, 6, and 9 weeks of age were transcardially perfused with 4% paraformaldehyde fixative. The hippocampus was cut into 30 or 40(m sections with a cryostat. Immunohistochemical staining was performed for the parvalbumin and the calbindin using ABC method. The parvalbumin-ir neurons and their axon plexuses achieved the adult patterns as following sequences;CA2 and CA3 at ghe second postnatal week, CA1 at the third week, and dentate granule cell layer by fifth postnatal week. In addition, the calbindin-ir neurons showed the adult patterns by second postnatal week in CA2, CA3, mossy fibers, and the molecular layer of the dentate gyrus, the CA1 at the third week, and finally the dentate granular cell layer by fifth week. These results revealed that time course of the maturation of the parvalbumin- and calbindin-ir neurons in the rat hippocampus showed an area-specificity. The delayed maturation of CA1 and the latest maturation of the dentage granular cell layer suggested that the neurons in these locations seemed to exhibit differential responses to the conditions of increased intracellular calcium, when compared with other areas or with the adult hippocampus.

Clinical Analysis of Subdural Hygroma

We have analysed 111 cases of subdural hygroma that were development after various neurosurgical conditions including head injuries. The results were summarized as follows. 1) The peak incidence was the age of 50's and occured most frequently in male. 2) Causes were head injuries(91 cases), traumatic intracranial hematoma removal(10 cases), operation for intracranial aneurysms(4 cases), hypertensive intracerebral hemorrhage evacuation(2 cases), ventriculoperitoneal shunt(2 cases), brian tumor removal(1 cases), arachnoid cyst excision(1 cases), and cerebral infarction(1 cases). 3) Acute subdural hematoma was most often associated with complex subdural hygrom. 4) Clinical manifestations were headache, altered mental state, disorientation, nausea in order. 5) Operation were underwent in 27 cases and surgical complications were reaccumulation and pneumocephalus in order. 6) Mortality rate was 6.3%. 7) The prognois of the simple hygroma was very good, but the complex was not.

A Clinical Study of 65 Cases in Basal Skull Fracture

65 consecutive patients with basal skull fracture admitted to Eul-Ji General Hospital, between March 1990 and March 1993 was carried out to study it's clinical and radiological presentations, complications, and outcomes. 1) Two thirds of the patients were between 20 and 40 years old and 82% were male. 2) 78% of the injuried were by traffic accidents and 17% were by fall down. 3) The outcomes of treatment were related to initial GCS(Glasgow coma scale) of the patients. 4) Clinical features were ear bleeding-54%, Racoon's eye-35%, hemotympaneum-32%, hearing loss-25%. 5) The combined lesions were skull fractures-43%, facial bone fractures-31%, subdural hematoma-19%, epidural hematoma-14%, and pneumocephalus-14%. 6) The combined cranial nerves injuried were facial nerve-32%, vestibulocochlear nerve-12%, oculomotor nerve-12%, abducens nerve-12%. 7) The location of basal skull fracture according to clinical feature and CT bone window were middle cranial fossa-54%, on anterior cranial fossa-22%, anterior and posterior cranial fossa-12%, posterior cranial fossa-2%. 8) Clinical features associated with types of petrous bone fractures were analyzed. 9) The time of onset and the degree of facial palsy had a influence on recovery of facial nerve function and the types of hearing loss had a role in recovery of hearing function. 10) CSF leakage were present in 16 cases and immediate type was more than delayed type. 11) Three patients(4.6%) developed meningitis, especially associated with CSF leakage and it's rate was higher when CSF leakage persisted over 1 week.

A Case of Intracranial Chordoma

The authors present a case of intracranial chordoma in a 53-year-old woman who presented with gradual onset of dizziness, gait disturbance. Clinical features and various diagnostic findings are described.

The Clinical Study of Chemonucleolys in Herniated Nucleus Pulposus of Lumbar Spine

Chemonucleolysis with chymopapain has been shown to be an effective alternative to surgery for the treatment of Sciatica secondary to lumbar disc herniation after failure of conservative treatment. 92 lumbar herniated disc patients had been treated by chemonucleolysis in Eul Ji General Hospital during 3 years from March 1988 to 1991 and were evaluated clinically. 1) Of 92 patients, 60 patients(65%) were between 20 and 30 years old age group and male was predominent. 2) The lesion was the most common in L4-5space(52 patients, 56.6%). 3) The results were better in the younger group and the more limited straight leg raising group. 4) The excellent and good results were obtained in 82.6%. 5) In noncompensation cases, 69 patients(88.0%) had marked improvement, but in compensation cases, 7 patients(50%) had marked improvement. 6) In conclusion, above finding suggest that chemonucleolysis is a safe and effective nonsurgical method for treatment of herniated lumbar disc before surgical intervention.

A Case of Dumbbell-Shaped Neurobibroma in Cauda Equina

A case of neurofibroma in cauda equina which had been misdiagnosed as lumbar herniated nucleus puposus 6 years ago in other hospital was presented. In January 1984, the patient had taken the operation of total laminectomy and disckectomy at L2~3 level and symtoms were relieved thereafter. However severe low back pain and right sciatic radiation recurred in April 1990. In this hospital, lumbar myelography and spin C-T examination revealed the intradural extramedullary mass shadow at L2~3 level. On surgery, the dumbbell-shaped neurofibroma at the site was removed.