Lipoma of the Sylvian Cistern

Intracranial lipoma is a rare benign brain tumor and ususally occurs in the midline structures, especially in the corpus callosum. The author report a case of intracranial lipoma in the left sylvian cistern. Sylvian cistern lipomas may be asymptomatic or present with epileptic seizures due to irritation of the cortex of the sylvian fissure. The majority of cases are incidental or autopsy findings and direct surgical approach is only rarely indicated. The patient complained severe headache after head injury, the severe headache did not respose to medical therapy. Craniectomy was performed and then the tumor was removed. The literatures on this rare tumor are reviewed and discussed.

Solitary Subdural Osteoma

Osteomas are benign neoplasms consisting of mature normal osseous tissue. They are common on the long bones of the extremities and found in the sinuses, facial bones, skull and madible in the head and neck region. Much rarer, however, are osteomas arising from subdural space with displacement of the underlying brain. A 42-year-old woman presented with a history of intermittent left frontal headache that was proved to be due to an intracranial lesion. After surgical removal, it was found to be an subdural osteoma. We report this case with pertinent literatual reviews.

Congenital Hypoplasia of the Bilateral Internal Carotid Artery: A Case Report

Congenital agenesis, aplasia or hypoplasia of the internal carotid artery is rare vascular disease and usually combine with intracranial aneurysm, subarachnoid hemorrhage, or intracerebral hemorrhage. We report a case of bilateral congenital hypoplasia of internal carotid artery in a 36 year-old woman presented with semicomatose mentality. The brain computed tomography(CT) revealed intracerebral hemorrhage with intraventricular hemorrhage, and cerebral angiography showed hypoplasia of bilateral internal carotid artery without narrowing of the bony carotid canal on the temporal bone CT.

The patient who presented to the Emergency Department because of domestic violence

BACKGROUND: It is important for the medical providers who work in the emergency department to ave the adequate knowledge about the nature and the ways to deal with the patients who suffer from domestic violence because in our country the management of them is primarily performed at the emergency centers. The purpose of this study is to provide basic data about the domestic violence and to help in developing the education and management model for the medical providers. METHODS: The authors retrospectively reviewed the medical records of 198 patients who visited the emergency center of Chunchon Sacred Heart Hospital from July 1997 to August 1998. RESULTS: The violence against the spouses was highest(108 cases:54.5%) and most of the victims were female(92%) in those cases. The violence against children younger than age 3 was 30%. The majority of the victims were arrived around noon(54.5%) and among them, the aged and children were more concentrated. The degree of injury was severer than that of the victims of general violence. CONCLUSION: In this study the violence against the spouses was the highest in incidence and against the aged was the lowest. The violence rate against children younger than age 3 was lower than that of other comparable studies. The incidence of sexual violence was significantly lower than that of other countries. The degree of injury was generally severer than that of general violence patients. But these result should be carefully criticized and accepted because up to now the system for the detection and management for them is not well established.

Public Heath Response for the 1999 Winter Asian Games

BACKGROUND: To determine the needs of medical service system for mass-gathering event. We analyzed the process of delivered medical care system and types of medical problems of 1999 Winter Asian Games thus we are able to provide the basic data for planning future events. METHODS: We surveyed the organizing system of 1999 Winter Asian Game such as the operating system, medical goods, equipments, and overall patient status created at the medical room by retrospective chart review form 31st January to 6th February. RESULTS: The medical room were operated at two athletic villages and six game grounds. The medical rooms of athletic villages were operated by doctors, nurses, pharmacists, and EMTs and the rooms at the game grounds were operated by a doctor and a nurse. the medical goods and equipments for minor patients were satisfied, but those for critical patients were not satisfied. Most of the patient visited the medical rooms, had minor symptoms or musculoskeletal injuries. The symptom complex of the upper respiratory infection was the most commonly complained symptom(250 patients), followed by the gastrointestinal symptoms(200 patients) and musculoskeletal injuries(168 patients). However there was also a patient with acute myocardial infarction who required medically critical management including oxygen supplement, EKG monitoring, and transfer to a specialized medical center. The oral medications(581 patients), bandages and dressings(35 patients), physical therapies(25 patients), eyedrops(23 patients), and injections(21 patients) were supplied to the patients. CONCLUSION: The organized medical care was mainly prepared by the administration. The management for minor patients was satisfied, but of the critical patients was not satisfied.

Immediate Replacement of Bone Fragments in Compound Comminuted Depressed Skull Fractures

No abstract available.

Victims of Child Abuse to present to the Emeregency Department

BACKGROUND: To develop the guidelines and the education models for primary agents caring for victims of child abuse, and investigate victims of child abuse visited the department of emergency medicine, College of Medicine, Hallym University, Choon-chun Sacred Heart Hospital. METHODS: Survey assessed the age, sex, visiting time, offender tools of maltreatment, types of maltreatment, and types of injury of 47 victims under 18 years old visited the emergency center, between the Jul. 1996 and the Aug. 1998. The injury severiy of victims of child abuse was compared with control group of 197 general violence victims visited the same emergency center at the same duration. RESULTS: The age distribution was 12.8%(n=6) of the 0-1 year old, 17%(n=8) of the 1-3 years old, 8.5%(n=4) of the 4-6 years old, 12.8%(n=6) of the 7-12 years old, and 48.9%(n=23) of over the 13 years old. The sex distribution was 49%(n=23) of male and 51%(n=24) of female. The most common visiting time was 59.6%(n=28) of the 22-02 o'clock. The types of abuse were 46.6%(n=22) of the physical abuse, 27.7%(n=13) of the neglect, 17%(n=8) of the psychic abuse, and 8.5%(n=4) of the sexual abuse. The offender was 38%(n=18) of the parents, 26%(n=12) of the relatives, 4.3%(n=3) of the grandmothers, and 6.4%(n=3) of the nurses. The severity of injury was applied to the ISS(injury severity score). The severity of injury according to ISS was mean ISS=3.82+/- 2.2 in the case of child abuse and mean ISS=1.86+/-1.6 in the case of general violence(P=0.000). CONCLUSION: Most victims of child abuse still never come to the overt attention of physicians, social workers, or other professionals. Therefore the establishment of CAN(Child abuse and neglect) protocol and the organization of CAN team in the hospital consisted by department of emergency medicine, pediatrics, and psychiatrics is essential. Furthermore, the co-operation system with child welfare facilities and polices in community is needed.

Anterior Cervical Fusion and Plate Stabilization in Patients with Lower Cervical Lesions

Anterior cervical discectomy and fusion is an efficacious procedure used to treat a variety of cervical spinal disorders, including spondylosis, myelopathy, herniated discs, trauma, and degenerative disc diseases. Refinements in instrumentation for the cervical spine have led to an increase in experience with these devices during the past decade. The need for postoperative immobilization, required to stabilize the patient while the fusion mass heals, is decreased or negated by internal fixation. The authors analyzed the results in 30 patients(22 traumatic; 8 non-traumatic) with lower cervical lesions, who underwent anterior interbody fixation with cervical plates between April, 1994 and June, 1996. We used either a unicortical(Orion TM) or bicortical screw system(Top TM): these two types of plates had no specific differences, but the Orion TM was easier and safer to operate. Although postoperative stability was successfully attained in all patients, two screw-related complications, which were fully resolved without causing any specific problems, were detected during the postoperative follow-up period. In nontraumatic lesions, we measured pre-and postoperative interbody heights at ten levels; postoperative interbody height was well preserved for one year. In conclusion, internal fixation may provide added security to the nervous system before bony fusion occurs, may lessen the number of levels requiring fusion, may increase the probability of successful fusion, and is conducive to early patient mobilization.

Lumbar Intraspinal Synovial Cyst: Case Report

True synovial cysts of the spine are rare, though they are included in the differential diagnosis of an extradural lesion in a patient with pain which is radicular or localized at the involved level of the spine. A case of a lumbar synovial cyst causing lumbar radiculopathy and mimicking an extradural tumor is presented. The lesion was demonstrated by magnetic resonance imaging, and the relief of symptoms was achieved by decompressive laminectomy and total removal of the mass.

Surgical Results of Stabilization of the Thoracolumbar Spine Fracture with the Internal Skeletal Fixation System

The thoracolumbar spine is frequently involved in spinal injuries, with more than 50% of all vertebral body fractures. This fractures may cause injuries to the spinal cord or nerve roots. Therefore the appropriate management, including surgery of that lesion, is very important and can determine the long-term outcome of the treatment. The authors analyzed the surgical results of twenty-nine thoracolumbar spine fractures treated with anterior or posterior internal skeletal fixation from August. 1990 to December, 1995. The indications for surgery were based on the neurological state and radiological findings of the patients. The selection of surgical approach(anterior or posterior) depended on the presence of neural or canal compression, the initial radiological findings, and the extent of reducibility of the fractures. Of twenty-nine patients, 21 cases were operated via the anterolateral route with Kaneda or Z-plate. The others were operated through the posterior approach with Diapason transpedicular system. They were grouped into one of three categories according to the radiological findings by Gertzbein's classification. A type fractures were most common(12 cases), B was 11, and C was 6 cases. Surgical results were evaluated by neurological recovery and achievement of stable reduction. Postoperative neurologic recovery rate was 76.2% in the case of anterolateral approach and 50.0% in the case of posterior approach. The reduction of kyposis and compression in types of A and B was prominent(P<0.01) but in type C it was not. The authors conclude that the operation with anterior and posterior internal skeletal fixation for the treatment of unstable thoracolumbar fractures can improve neurological recovery and normalize anatomical deformities.

Surgical Results of Stabilization of the Thoracolumbar Spine Fracture with the Internal Skeletal Fixation System

The thoracolumbar spine is frequently involved in spinal injuries, with more than 50% of all vertebral body fractures. This fractures may cause injuries to the spinal cord or nerve roots. Therefore the appropriate management, including surgery of that lesion, is very important and can determine the long-term outcome of the treatment. The authors analyzed the surgical results of twenty-nine thoracolumbar spine fractures treated with anterior or posterior internal skeletal fixation from August. 1990 to December, 1995. The indications for surgery were based on the neurological state and radiological findings of the patients. The selection of surgical approach(anterior or posterior) depended on the presence of neural or canal compression, the initial radiological findings, and the extent of reducibility of the fractures. Of twenty-nine patients, 21 cases were operated via the anterolateral route with Kaneda or Z-plate. The others were operated through the posterior approach with Diapason transpedicular system. They were grouped into one of three categories according to the radiological findings by Gertzbein's classification. A type fractures were most common(12 cases), B was 11, and C was 6 cases. Surgical results were evaluated by neurological recovery and achievement of stable reduction. Postoperative neurologic recovery rate was 76.2% in the case of anterolateral approach and 50.0% in the case of posterior approach. The reduction of kyposis and compression in types of A and B was prominent(P<0.01) but in type C it was not. The authors conclude that the operation with anterior and posterior internal skeletal fixation for the treatment of unstable thoracolumbar fractures can improve neurological recovery and normalize anatomical deformities.

Microvascular Decompression for Essential Hypertension

Idiopathic arterial hypertension, termed "essential" or "neurogenic", is a common generalized cardiovascular syndrome comprised of a sequence of pathologic changes and accommodations. Although an extensive literature exists concerning that, the primary etiology has been unclear yet. However, Jannetta and coworkers have reported a possible etiological connection between essential hypertension and intraoperatively observed neurovascular compression of the ventrolateral medulla at the level of the root entry zone of the ninth and tenth cranial nerves on the left, recently. They have also introduced one of new therapeutical concept for essential hypertension by microvascular decompression(MVD) of offending vessels. Based on Jannetta and coworker's hypothesis, the authors have made some operations for the control of hypertension. Seven essential hypertensive patients have been underwent retromastoid craniectomy and MVD in the left ventrolateral medulla between July 1992 and June 1993. Five of them showed multiple episodes of intracerebral hemorrhages, one was an intractable hypertension case and the other one had a left hemifacial spasm with essential hypertension. The most common offending vessel was the posterior inferior cerebellar artery and it had been confirmed during operation. Postoperatively, in three cases, blood pressure was lowered to normal without medications. Of remaining four cases, blood pressure was significantly improved in one and slightly improved in three. There were no major complications in patients with surgery and no poor outcomes. These results indicate that the MVD for essential hypertension is relatively safe procedure and alternative choice as one of the management of intractable essential hypertension, repeated hypertensive intracerebral hemorrhages and left cranial nerve hyperfunction disorders combined with essential hypertension.

Spinal Cysticercosis

Cysticercosis in the human is caused by infestation by larvae of pork tapeworm, taenia solium. Although they may grow anywhere in the body such as the liver, lung, eyes, heart, muscle, ect., they are most commonly found in the brain and its coverings. The cysticercus vesicles have occasionally been found in spinal structures other than the brain. We present a case of spinal cysticercosis in a 63-year-old male. The patient presented with a marked paraparesis and paresthesia below a T10 dermatome level, and moderately decreased deep tendon reflexes. After performing total laminectomies at T11-12 & L3-5, 30 cysticercus vesicles were removed.