Complication and Reoperation after Surgery for Lumbar Disc Herniation

Retrospective analysis of reoperation and complication was made for 186 patients with lumbar herniated disc. The results showed complication rate of 7%(13 cases) and reoperation rate of 10.2%(19 cases). The primary complications were infections(9 cases), technical errors(2 cases), and scores(2 cases). Rate of discitis was 1.6%(3 cases). The outcomes of reoperation resulted in excellent recovery of 16%(3 cases) and good recovery of 58%(11 cases). The most common intraoperative findings of reoperation were inadequate disectomy or missed disc fragments 31.6% or 6 cases;epidural fibrosis 26.3% or 5 cases;and new herniation at other level 15.8% or 3 cases. Excellent and good results could be achieved in patients operated within 1 month or more than 6 months after while the patients who underwent reoperation between 1 month and 6 months showed poor results. The delicate perioperative menagement and complete discectomy, adequate bleeding control and laminectomy were considered to be essential in reducing the chance of complication and reoperation.

Mechanical Failure of Internal Fixation in Femoral Fractures / 대한정형외과학회잡지

Operative internal fixation of femoral fractures is widely accepted as the best method of treatment but the techniques are by no means devoid of complications, nor are they simple to execute. A method of treatment must be based on the analysis of the :"personality of the fracture", that is, the nature of the fracture and of patient. Mechanical failure such as metal failure, loosening of screw or nail after internal fixation, residual deformity, and nonunion, may impose serious problems on the surgeon and patient unless treatment is appropriate. The authors analyzed 14 mechanical failures of internal fixation in 12 femoral fractures from Dec. 1987 to Aug. 1992 in the department of orthopedic surgery, Ansan Hospital Korea University to study the possible cause of mechanical failure of internal fixation and pursue the way of reducing that complications and obtained the following results. 1. Eleven were males and one was female, most of them were in age of active life. 2. The level of fractures in 12 femorals were subtrochanteric in two, shaft in nine and supracondylar in one. 3. The time interval between internal fixation and failure in 10 failures was 5.5 months on average(range, 3month to 11months). It was uncertain in 4 failures. 4. Mechanical failure were presented as breakage in five plates, loosening of screw in five plates, loosening of screw in two DCP fixation, loosening of nail in one interlocking nail, bending of nail in one Kuntscher nail, one breakage and one bending in two condylar buttres plates, and cutting-out of hip screw in three compression hip screw. 5. The causes of failure were presumed to be improper surgical technique in 7 failures, inadequate selection of internal fixatives in 5 failures, and inadequate postoperative care in 1 case.

Traumatic Dislocation of the Knee / 대한정형외과학회잡지

Traumatic dislocation of the knee is an uncommon but serious injury associated with extensive soft tissue damage and the danger of neurological and vascular involvement. During the periods from September 1983 to September 1992, we had experienced 21 cases of the traumatic dislocation of knee at the Guro and Ansan Hospital, Korea University College of Medicine. The results obtained from this study were as follows ; 1. The age of initial dislocation varied from 11 to 79 years with the average of 32. 8 years and the ratio of male to female was 20: 1. 2. Dislocations were classified into 5 types which were anterior in 9, posterior in 4, medial in 1, lateral in 4 and rotatory in 2 cases and also unclassified in 1 case. 3. Causes of the injury were traffic accident in 9, sports injury in 7, fall down in 4 and industriai injury was 1 case. 4. Complications of traumatic dislocation of the knee included popliteal artery rupture in 3, compartment syndrome in 2 and peroneal nerve palsy in 4 cases. 5. All of ligamentous injuries were repaired and augmented except 2 cases which were treated conservating 10-14 days after trauma and all of the cases of arterial injuries were repaired with an autogenous vein graft. 6. Results were excellent 3, good 12, fair 4, and poor 2 cases by Marvin classification at the average 27 months after operation. 7. Prompt completion of vascular repair is critical to avoid amputation and also operative repair of injured ligaments seems to be good method to yield good results with the improved stability.

Nontraumatic Intracranial Dissecting Aneurysm of Vertebral Artery: Case Report

We present two cases with dissecting aneurysm of intracranial vertebral artery. One of them had brain stem infarction and the other one developed subarachnoid hemorrhage. Cerebral angiogram revealed fusiform dilatation with proximal and distal narrowing of the affected vessel. Magnetic resonance imaging showed subacute blood clot inthe right vertebral artery which suggested dissection. Differentiation from vasospasm and from atherosclerosis is critical. At surgical exposure, the aneurysms were appeared as dark-purplish sausage like masses. The proximal portions of the intracranial vertebral arteries were clipped. The post-operative courses were benign and at present they regained their normal daily lives.

Middle Cerebral Artery Occlusion in Rats : Evaluation of the Model With or Without Craniectomy

The purpose of our present study was to asses the effectiveness of middle cerebral artery occlusion in producing acute focal cerebral ischemia in rats by use of Bederson's or Longa's method in which occlusion was performed with or without craniectomy respectively. In twenty-nine Sprague-Dawley rats weighing 250-300 gm, right middle cerebral artery occlusion was achieved by use of either Bederson's method or Long's method. After 4 hours of ischemia, neurological evaluation was performed and then brain water content was determined in the central, intermediate, and outer zones of each cortical mantle. in both groups, a significant neurological deficit caused by focal cerebral ischemia was observed. More severe neurological deficit was achieved by Longa's method than by Bederson's method(p<0.001). In Bederson's method group, significant brain edema was observed only in the ischemic central and intermediate zones. However, in Longa's method group, significant brain edema was observed in all of the three ischemic zones. And more severe brain edema was achieved by Long's method in each of three ischemic zones than by Bederson's method(p<0.001, respectively). Theses results incicate that Longa's method is more effective and persistent method in producing acute focal cerebral ischemia than Bederson's method. Longa's method is considered as one of a good, less invasive, and technically easy method to achieve focal cerebral ischemia in rats.

Clinical Analysis of Anterior Fixation with Caspar Plate in Unstable Cervial Spine

The authors analyzed 19 cases of unstable cervical spine injuries who had been treated by anterolateral approach with Caspar plate at the department of neurosurgery of Hangang Sacred Heart hospital during 3 years from 1989. The results were as follows: 1) The unstable cervical spine injury was most common in 3rd decade of age. Male to female ratio was 3.75:1. 2) Regarding the level of injury, C5-6 injury was most common. 3) The most common cause of injury was fall down from height(47.4%) and the next was traffic accident(36.8). 4) In all cases received anterior reconstructive surgery using Caspar plate showed significant neurologic improvement. 5) In all cases received anterior reconstructive surgery showed a good restoration of cervical spinal stability. 6) The major surgical complication was esophageal fistula and all complications were treated without any sequelae. 7) Anterior reconstructive surgery using Caspar plate is considered one of the surgical options in patient of cervical spine injury with severe instability.

Clinical analysis of acute traumatic hemarthrosis of the knee / 대한정형외과학회잡지

No abstract available.

Effect of Preservation of Head Temperature on the Formation of Brain Edema during Focal Ischemia in Rats

No abstract available.

The Effect of Ketamine Anesthesia on the Formation of Brain Edema During Focal Ischemia in Rats

Excitatory amino acids have been implicated as one of the important putative cellular toxins in ischemic brain. Ketamine antagonizes the excitotoxic action of excitatory amino acids in the central nervous system. The present study was undertaken to determine whether ketamine anesthesia protect the formation of brain edema in the model of focal cerebral ischemia in rats. Forty adult male Sprague-Dawley rats weighing between 300gm and 400gm were used in this study. The animals were anesthetized with either halothane or ketamine, and then right middle cerebral artery occlusion were performed. After 4 hours of ischemia, the brain water and ion contents(Na+ and K+) were determined in the central, intermediate, and outer zones of each cortical mantle. In both halothane and ketamine anesthetized groups, there were significant brain edema in the ischemic central and intermediate zones. Ionic shifts were also observed in the ischemic central and intermediate zones to approximately same extent as the brain water content in both groups. However, there were no significant differences of brain edema between the two groups in the corresponding ischemic zones. These results suggest that ketamine anesthesia does not have significant protective effect on the formation of brain edema during the early stages of permanent incomplete cerebral ischemia.

A Clinical Analysis of Cranioplasty Using Methyl Methacrylate

Cranioplasty has long been performed by many physicians with different materials from the prehistoric era. Among the materials, methyl methacrylate has been known to be the superior to any other substitutes since 1940s in biologic, chemical and physical characteristics and its availability. So the authors review 72 patients who underwent cranioplasty with methyl methacrylate at out hospital from 1985 to 1989. The clinical analyses were as follow : 1) There was male predominance and epidural hematomas, compound, comminuted depressed fractures by traffic accidents or fall down injuries were the main causes of craniectomy. 2) The location of defects was mainly frontal and/or parietal area and average size of defects was 17cm2 in plain skull film measurements. 3) The cosmetic results were satisfactory. 4) Complication rate was 6% and there was no mortality.

Angiographically Occult Vascular Malformations of the Brain: Report of Three Cases

The authors experience 3 cases of angiographically occult vascular malformation(AVOM) of the brain during the last 3 months in 1990. All cases were diagnosis of either operative or pathological finding and were associated with intracerebral hemorrhage. The authors recommend that surgery should be considered even to those angiographically negative intracerebral hemorrhage cases, once clinical features are highly suggestive of AOVM. Surgery can be an effective and define therapy for these entities, which are prone to cause recurrent hemorrhage and persistent neural deficits.

The Clinical Significance of SPECT in Head Trauma

SPECT(single photon emission computed tomography) using 99m-Tc-HMPAO is a current method of identifying the relative condition of cerebral blood perfusion in pathologic conditions of the brain such as TIA, complete cerebral infarction, dementia, and psychologically ill states. The purpose of this article is to evaluate the significance of SPECT in head injuries. According to the other previous reports, there are several drawbacks in SPECT to evaluate the victims of head injury such as uncooperability of the patient, long scanning time. poor patient monitoring during the scanning time. poor availability, ete. The authors analyzed 54 cases of head injury patients, studying SPECT and CT in regard to the comparison of CT and SPECT, the relation of SPECT and the severity of the head injury, the duration of admission and the SPECT findings. The results were as follows: 1) In focal lesion, CT was more available for the quick evaluation of the location, size, and rapid decision making, and SPECT was available for the adjuvant method of postoperative follow-up. 2) In diffuse brain lesion, CT showed only the diffuse brain swelling and SPECT was available for more fine localization of the lesion. 3) In mild head injury, CT could not identify the location of the lesion and SPECT showed focal perfusion defects(55%).

The Pathomorphologic Study of Spinal Stenosis as Seen on CT - Myelography of the Lumbar

This study has been examined different morphologic measurements in the evaluation of patients with lumbar spinal stenosis. Preoperative CT-Myelography from 30 patients who underwent surgery for central lumbar stenosis were analyzed. Based on this, we concluded as follows : 1) Bony measurement alone did not reliably identify patients with spinal stenosis. 2) Measurement of the transverse area of the dural sac on CT-Myelography was the most accurate method for identifying stenosis. 3) Lumbar myelography was still considered to have an important role in the valuation of a patient with stenosis because of correlation between the cross-sectional area of the dural sac and the anteroposterior diameter of the dural sac was excellent. 4) We identified soft-tissue problems as the main cause of stenosis. 5) The most common level of maximum stenosis was L4-5.

A Case of Cerebral Primary Reticulum Cell Sarcoma

A case of histologically proved primary reticulum cell sarcoma is presented. A female patient with headache and left hemiplegia was proved to have reticulum cell sarcoma after surgery. The tumor was single in the frontal cortex and showed peculiar contrast enhancement pattern on computed tomogram. Near-total extirpation was verified by post-operative CT.

A Clinical Observation on Craniocerebral Injuries in Adults: Analysis of 1547 Cases

During the five years from 1972 to 1976, 2308 cases of head injury were admitted to Han Kang Sung Shim Hospital and were treated in the department of neurosurgery. Of these, 1547 were adults aged 16 and over, and 761 were infants and children up to the age of 15. The results of clinical analysis of 761 cases of above series have been reported early in 1977. In this paper, a clinical analysis of 1547 adult cases of above series was performed and following results were obrained. 1) There were 1077 males and 470 females, and the proportion of male was much greater than female, male-female ratio was 2.3:1. 2) The age incidence was greater in the age group between 16 to 40, becoming maximal at the second decade. 3) Traffic accidents form by far the largest group (62%), and next are, in order of incidence, accidents due to blow or assault, fall from a height, simple fall, and industrial accidents. 4) Among the 1547 patients investigated, 20 of 1275 cases those conscious or confused on admission were died and 103 of 272 those semicomatose or comatose were died. 5) Skull fractures were seen in 504 cases, and nearly half of those, 242 or 48%, were linear fractures. 6) Of the 333 patients with intracranial hemorrhage or subdural hygroma, 181 were accompanied by skull fracture and epidural hematoma showed highest incidence, 80.46%. 7) Of 87 epidural hematoma, 69(79%) were found in the temporal and parietal fossae of the skulls, and of 70 subdural hematoma, 60(85.7%) were found in the parietal and temporal surface of brains. 8) Operation were carried out in 228 patients and surgical mortality was 24.5%, and subdural hematoma showed highest mortality, 40.0%. 9) Among the 228 surgical cases mortalities were 30% in those operation have been carried out within 6 hours of injury, 24% in those within hours 6 to 24, and 14% in those after 24 hours. The earlier the surgery had to be carried out, the higher operation mortality was noted. 10) The overall mortality in this series was 7.95%.

A Case of Primary Osteogenic Sarcoma of the Thoracic Spine with Paraplegia

Osteogenic sarcoma arise from primitive bone forming mesenchyme which is transformed into neoplastic osteoid and bone. Most osteogenic sarcomas originate in long bone, only rarely do they occur as primary tumor of the spine. A case is presented in which a patient who had suffered from paraplegia and self voiding difficulty. It was diagnosed as osteogenic sarcoma of the 5th thoracic spine which was operated and confirmed by microscopically, and is discussed with a brief review of the literatures.

A Clinical Observation on Craniocerebral Injuries in Infants and Children(Analysis of 481 Cases)

Clinical observation and analysis were performed on 481 cases of craniocerebral injuries under 15 years of age those were treated at Chung-ang University hospital during the period from January, 1972 to August, 1975. Following results were obtained: 1. There were 302 males and 179 females and sex ratio was 1.7:1. 2. Age incidence of the accidents was greatest at 5 years of age and mostly distributed to the age group between 5 to 7. 3. Seasonal peak of the accidents was at June. 4. The most frequent cause of the craniocerebral injuries was traffic accident(277 cases, 57.59%), and the next was fall from height(159 cases, 33.06%). 5. No deterioration of consciousness before and after the admission was observed in 176 cases(3.6%). 6. Pupillary change was observed in 28 cases in which unilateral were 21 and bilateral were 7. Babinski sign was elicitable in 91 cases. 7. Early convulsion and vomiting were frequent symptoms in childhood. 8. Skull fracture was observed in 204 cases(40.33%) in which linear fracture was most frequent. The location of the linear fracture was parietal and the predilection sites of the depressed fractures were frontal and parietal. 9. The accompanying rate of skull fracture in intracranial hemorrhage was;epidural 75%, subdural 50% and subarachnoid 17.3%. 10. The overall mortality was 8.32%. In non-surgical group(442 cases), the mortality rate was 7.47% but in surgical group(39 cases), operation mortality was 17.95%.

A Case of Crouzon's Disease

A case of Crouzon's disease, in spite of the relatively small number of cases reported until recently. The patient was 3years old male and hospitalized Woo-Sok University hospital 5 May, 1970. the appearance of the patient was striking type of facial deformity. There is a marked frontal boss forming a prominent bregmatic tumour, hooked nose, a small receding maxilla and a pronounced prognathism in wthich the teeth of the lower jaw protrude several centimetres beyond those of the upper. Proptosis and subnormal mentality was present, Cerebral decompression had been performed to the patient for his exophthalmos, it was aggreviated after the operation and thus enucleation was done finally.