Subcapsular Hepatic Hematoma after Endoscopic Retrograde Cholangiopancreatography / 대한내과학회지

Endoscopic retrograde cholangiopancreatography (ERCP) is a useful tool for the diagnosis and management of diseases of the pancreas and biliary tract. However, ERCP has a high risk of procedure-related complications compared with other endoscopic procedures performed in the upper gastrointestinal tract. The most common complications are pancreatitis, cholangitis, hemorrhage, and perforation. Extraluminal hemorrhagic complications after ERCP are relatively rare but potentially life threatening and should be identified and treated immediately. We report a case of subcapsular hepatic hematoma after guidewire injury during ERCP in a 64-year-old woman with choledocholithiasis who had undergone ERCP with guidewire-assisted papillotomy for stone extraction. Although subcapsular hepatic hematoma is a very rare complication after ERCP, it should be considered in the differential diagnosis of patients complaining of abdominal pain after ERCP.

Change of Middle Ear Mechanics after Tympanoplasty Type I with Thin Sliced Cartilage Island / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Cartilage offers the advantage of higher mechanical stability compared with membranous transplants but it may alter the acoustic transfer characteristics, which could depend on its thickness. So, author attempted to design the thin sliced cartilage island for grafting material by tragal cartilage. The purpose of this study is to understand the usefulness of the thin sliced cartilage technique by comparing with conventional temporalis fascia technique with the method of tympanometry. SUBJECTS AND METHOD: From March 2002 to August 2005, 101 cases of tympanoplasty type I using the thin sliced cartilage island technique and 50 cases of tympanoplasty type I using the temporalis fascia performed by one surgeon had been followed up for 6 months and reviewed. Static compliance, tympanometric width and tympanometric pattern were followed up after 6 month. RESULTS: The static compliance in the thin sliced cartilage island technique group was 72% and temporalis fascia group was 66% at normal compliance (0.2-1.6 ml). The tympanometric width in the thin sliced cartilage island technique group was 59% and temporalis fascia group was 54% at normal tympanometric width (60-150 mmH2O). The tympanometric pattern in the thin sliced cartilage island technique group was 67% and temporalis fascia group was 62% at normal tympanometric pattern (A type). CONCLUSION: There is no significant statistical difference between the thin sliced cartilage island and temporalis fascia observed in the impedence audiometry. The thin sliced cartilage island technique is suggested to be good for tympanoplasty.

The Effect of Lesser Palatine Nerve Block on Pain after Pediatric Tonsillectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This prospective, randomized double-blind study was performed to evaluate the analgesic effect of lesser palatine nerve block after pediatric tonsillectomy, and we measured analgesic efficacy and degree of blocks induced by ropivacaine. SUBJECTS AND METHOD: Children who weighed 20-40 kg and scheduled for an elective tonsillectomy were randomized into three groups. Patients received lesser palatine nerve block, using divided doses of 0.05 ml/kg of 0.2% ropivacaine (Naropin registered), 5 min prior to the beginning of tonsillectomy (Pre-block group) or immediately after surgery (Post-block group). Patients allocated into the control group did not receive any nerve blocks. Postoperative pain was measured immediately after surgery and at 3, 6, 12 and 24 hours following the operation by using a 0 to 4 points pain scale, based on a facial expression of pain scale ruler. Side effects and the number of analgesic inductions were observed for 24 hours postoperatively. RESULTS: No significant differences in the pain scores were observed immediately after surgery and at 3, 6, 12 and 24 hours after operation in the three group (p>0.05). The number of analgesic injections were similar in the groups. CONCLUSION: The results of this study reveal that the lesser palatine nerve block was not effective for postoperative pain control following pediatric tonsillectomy, and that the pre-emptive block offered no pain control benefit over the postoperative block. Therefore, we do not recommend lesser palatine nerve blocks for the management of postoperative pain after pediatric tonsillectomy.

Nevoid Basal Cell Carcinoma Syndrome: A Case Report and Literature Review / 대한이비인후과학회지

Nevoid basal cell carcinoma syndrome (NBCCS), also known as Gorlin-Goltz syndrome, shows autosomal dominant pattern of inheritance with variable expressivity. The most important features are the occurrence of basal cell carcinoma and odontogenic keratosis. Recently, we experienced a case of nevoid basal cell carcinoma syndrome with multiple odontogenic keratocysts, basal cell carcinoma on cheek, cerebral calcification and palmar pits. We report this case with literature review.

A Case of Peutz - Jeghers syndrome Accompanied with Intussusception / 대한소화기내시경학회지

The Peutz-Jeghers syndrome is a familial disesse charaeterized by mucocutaneaus pigmentation, gastrointestinal polyposis, and transmission of autosomal dominant trait. This syndrome is clinically important becuase of the coreplieation caused by the polyp, leading to abdominal pain, gastrointestinal bleeding, and intussusception. Authors experienced a case of Peutz-Jeghers syndrome admitted to Walace Memorial Baptist Hospital who was complained of recurrent abdominal pain, melanin pigmentation of lips, oral mucosa, and digits. UGI series, small bowel series, colon cnema, gastrofiberscopy, and colonoseopy revealed multiyle intestinal polyps. Pathologic findings on endoseopic polypectomy showed hamartomatous polyp.

The Effect of Corpus Callosotomy on the Electoroencephalography in the Experimentally Induced Epileptic Rats

In order to study effect of corpus callosotomy for epileptic lesions located at sensory-motor cortex/cortices, changes in amplitude, frequency of background activity and frequency of abnormal discharges of postcallosotomy electroenencephalography(EEG) recordings were observed in the crystal penicillin induced epileptic models of rats. In control group of 10 rats, simple right(craniotomy was) done and needle electrodes were bilaterally inserted into parietal and occipital scalp, connected to EEG recording system. Experimentally induced epileptic group was obtained by instillation of 1-2 drops of crystal penicillin solution(800,000 IU/ml) at right parietal area(20 rats). Postcallosotomy group was consisted of the animals streotactically performed callosotomy with blunt ended stainless steel, sized 3 mm, width and 0.5 mm, thickness(20 rats). Preoprative and postoperative EEG recordings were obtained in each animals over 20 minates. The results were as follows; 1) Bialteral synchronous epileptic discharges were shown in experimetally induced epileptic group, which compared to control group. 2) Section of the corpus callosum caused the abolition of bilateral synchronous epileptic discharges, when compared to experimentally induced epileptic group. 3) Frequency of abnormal discharges in the contralteral hemisphere was more decreased than crystal penicillin-instillated lesion in postcallosotomy group. 4) The Background activity of postcallosotomy group was slower than control group. From the results of EEG analysis, corpus callosum might paly a important role in formation of bilateral synchronous discharges and callosotomy was seemed to be an effective method to control crystal penicillin induced epileptic rats, which had epileptic focus in sensory-motor cortex.

Case Study of A Cauda Equina Meningioma: Case Report

Spinal meningiomas are most commonly found in the thoracic sections while it is extremely rare in the cervical, lumbar and sacral regions. In Elsberg's series, there were 10 cervical, 59 thoracic and 4 lumbar ; none below the 3rd lumbar segment. Recently, we encountered a case of cauda equina meningioma and was completely extirpated with no remnants of any neurological deficits.

A Clinical Analysis of 22 Patients with Discitis

From March 1966 to July 1988, 22 patients were diagnosed as discitis among the 2106 operation with total or hemilaminectomy in Department of Neurosurgery of Catholic University Medical College. Main symptoms were severe low back(95%) and buttock pain(86%). Physical examination showed severe paravertebral spasm and tenderness. The erythrocyte sedimentation rate was always elevated in all cases and averaged to 43 mm/hr. X-ray examination of the lumbar spine showed typical findings of decreased intervertebral space, subchondral sclerosis and bony fusion. In bacterial culture staphylococcus aureus and streptococcus epididymis were grown. Good long-term results were seen in all cases.

Transcutaneous Electric Stimulation in Chronic Pain Patients

Painful 203 patients with chronic pain were treated with transcutaneous electrical nerve stimulation in the CNS & Pain Management Institute of St. Paul's Hospital, Catholic Medical College, Seoul, Korea. Each patient was instructed on the method of autostimulation with variations in for an initial observation frequency and intensity. The effect were recorded daily period of about 3 weeks. The patients were evaluated at suitable intervals and asked to grade the relief of pain on a percentage scale. Four categories of pain relief were established : 80% to 100%(A), 60% to 80%(B), 30% to 60%(C), 0% to 30%(D). This procedure with modern, solid state devise has been tried enough that it can be recommended as a potentials treatment for most types of pain about 90% of pain problems can be managed in this way. The mode of action of transcutaneous Electrical nerve stimulation is most simple and can not be explained only by gate control theory.

Cavernous Hemangioma on the Frontal Lobe

Cerebral cavernous hemangioma is very rare disease in the cerebral vascular malformations. We experienced a case of this vascular malformations at the left frontal lobe near the cortex which had symptoms and signs of abrupt generalized tonic-clonic seizure. This malformation is encountered more commonly in adult in the third to fifth decade, and is found most frequently in the white matter of the cerebral hemisphere. The value of computerized tomography(C-T) in the detection of such malformations is stressed. Good result was obtained by the microsurgical approach to these malformations.

A Clinical Analysis of Chronic Subdural Hematoma in Aged Person

A series of 41 patients with chronic subdural hematoma, admitted to the Department of Neurosurgery of Catholic Medical College Hospital from May 1, 1980 to May 1, 1984 is presented. The following results were obtained : 1) Male were more frequently involved than female with the ratio of 4.9:1. The over 50 years old age group were predominately 75.6%. 2) The etiologic factors reveal younger group(under 50) has mainly unidentified factors, but older group(over 50) has mainly head trauma history and alcoholism. 3) Older group had more frequently focal neurologic deficit such as hemiplegia, however younger group presented as increased intracranial pressure signs such as headache and vomiting. 4) The hematoma density of C-T scan on admission was hypodense 50%, isodense 30%, mixed 28%, hyperdense 2% and no correlation to age. 5) Younger group performed burr hole with drainage, and older group performed craniotomy with removal of hematoma, but post-operative results were significantly good in older group with craniotomy.

Pseudoaneurysm of Extracranial High Internal Carotid Artery

Pseudoaneurysm of extracranial high internal carotid artery was rare lesion. Left hemiparesis was suddenly developed after 6 hours following penetrating injury at right mastoid area by air gun. On brain computerized tomography relatively well defined low density was noted at right temporo-parietal area. On right caratid angiography round aneurysmal dilatation, 2.5x3 cm sized was present at the site of metallic shadow in the atlas. The pseudoaneurysm was treated by the method of direct surgical approach, removal of aneurysm and end to end anastomosis with autogenous saphenous vein interposition bypass graft without difficulty. Postoperative course was not uneven.

Internal Wiring Fixation of Atlantoaxial Dislocation Caused by Odontoid Fracture in a Child

Although most patients with cervical fractures have damaged the lower cervical spine, there remain a significant number whose injury involve the atlanto-axial level. Since the diagnosis of fracture of he odontoid process was initially missed frequently, it is worth emphasizing the importance of adequate radiological studies for this potentially lethal lesion in head injury patient. The treatment for fractures of the odontoid process has consisted of reduction followed by immobilization using skeletal traction, a plaster case or halo device, or internal fixation by surgical intervention. The advantages of early surgical treatment to minimize external immobilization or prolonged bed confinement are generally accepted but the surgical techniques have varied widely. The authors have managed a case of traumatic atlanto-axial dislocation in a child combined with severe brain injury by internal fixation using wire only after reduction of the dislocation was accomplished by skeletal traction. The available literature regarding this injury is reviewed.

Motor and Sensory Evoked Potentials in Normal and Acute Spinal Cord Injured Rats

Electrical monitoring of the nervous system offers the potential for the detection of injury, intraoperatively. The relationship of MEP(Motor Evoked Potential) and SEO(Sensory Evoked Potential) taken in 30 rats before and after spinal cord injury is reported. MEP was obtained from distal portion to the site of spinal cord injury by electrical stimulation of the cerebral motor cortex after insertion of a ball electrode in the cerebral motor cortex. SEP was collected at the cerebral somatosensory cortex during the sciatic nerve stimulation. Experimental animals were divided into a 20 gcm spinal cord-trauma group and a 50 gcm spinal cord-trauma group. Changes of cardiopulmonary function after cerebral motor cortex stimulation and pre-and post-injury MEP and SEP were obtained at constant time interval. The results were follows : 1) Significant changes in blood pressure, pulse rate, and respiratory rate were noted to be elevated after stimulation of cerebral motor cortex and these were returned to normal in 10 minutes after stimulation. 2) MEP in control group showed that the latency was 8.6+/-1.54 msec and the amplitude was 20.60+/-3.2 microV. In MEP of 20 gcm spinal cord trauma group, the latency was increased to 30% (11.26+/-2.76 msec) compared to control group at 10 minutes after the injury and the amplitude was decreased to 29% (14.60+/-1.99 microV). The latency was slowly decreased with the passage of time, to 21% increase. (10.42+/-1.84 msec) at 1 hour after injury but the amplitude was not changes. In 50 gcm spinal cord-trauma group the latency was decreased to 75% (4.9+/-1.52 microV) compared to control group. With the passage of time. no change was revealed in latency but amplitude was decreased. The amplitude was decreased to 80% (4.00+/-1.49 microV) compared to control group. Change of MEP was marked in 50 gcm spinal cord-trauma group. With the passage of time MEP was slightly improved in 20 gcm spinal cord-trauma group but deteriorated in 50 gcm spinal cord-trauma group. 3) The latency of SEP in control group was 12.22+/-0.7 msec and the amplitude of those was 20.00+/-2.21 microV. No significant statistical change was recorded in the SEP of each spinal cord-trauma group compared to control group. MEP might be more important indicator than SEP in estimation and evaluation of the functional change of spinal cord injury.

Motor Evoked Potentials and Recovery of Motor Function in Spinal Cord Injuried Rats

Electrical monitoring of the nervous system offers the potential for the detection of injury and diagnosis of disease. Existing evoked potentials monitor one or another sensory modality, but no generally usable motor monitor exists. Recovery rates of motor function in rats with spinal cord injury were comparetively observed by MEP (Motor Evoked Potential) recorded in 20 spinal cord injured rats and 10 control from distal portion of the injury during stimulation of the cerebral motor cortex. Experimental animals were divided into 10 control and 20 spinal cord injury group which were 10 rats received 20 gcm using weight drop method injury and 10 rats received 50 gcm injury to the spinal cord injury. The relationship of changes in MEQ measured pre-and post-injury respectively and a recovery rats of motor function was analysed and obtained the following results. 1) In postinjury MEP by 20gcm spinal cord-injury rats, 28% latency increase (11.4+/-1.33 msec, control : 8.25+/-1.01 msec) and 14% amplitude decrease (17.77+/-7.7 microV, control 20.70+/-2.71 microV) were noted in the recording at 1 week after the injury. However, with the passage of time MEP showed improvement in latency and amplitude. In 50 gcm spinal cord-injury group, 76% latency increase (14.49+/-1.48 msec) and 65% amplitude decrease (6.70+/-2.21 microV) were observed and the latency and amplitude were not improved with the passage of time. 2) A recovery rate of motor function in the injury group was noted to be slowly increased after injury to the spinal cord in 20 gcm spinal cord-injury group, however there was no recovery of motor function in the 50 gcm spinal cord-injury group. 3) Histological examination demonstrated that ecchymotic hemorrhage was found in less than 25% of the cord in 20 gcm spinal cord-injury group, however, approximately 50% of the cord was noted to have ecchymosis and distruption of the neural tissue in 50 gcm spinal cord-injury group. MEP is probably sensitive in the detection of motor dysfunction after spinal cord injury, and clinically whenever MEP showed an improvement, recovery of motor function was followed. MEP might be clinically an important indicator for the prediction of motor function recovery in the patients with spinal cord injury.

Motor and Sensory Evoked Potential in the Evaluation of Increased Intracranial Pressure in Cats

Motor evoked potential(MEP) and sensory evoked potential(SEP) were recorded in 30 experimental cats in accordance with change of intracranial pressure. MEP was obtained on the thoracic cord after electric stimulation through a ball electrode directly installed on the cerebral motor cortex. SEP was elicited on the cerebral cortex after stimulation of thoracic cord. Experimental animals were composed of control group(10 cats) and raised intracranial pressure (ICP) group(20 cats) which included a group of 10 cats with 30 mmHg increased ICP and another group of 10 cats with 50 mmHg elevated ICP. Each evoked potential according to changes in ICP was obtained and the results were as follows: 1) MEP in control group showed that latency was 14.8+/-0.8 msec and amplitude was 24.4+/-2.1 microV. MEP after elevation of ICP showed more profound change in 50 mmHg increased ICP group than in 30 mmHg increased ICP group. Latency was prolonged by 152%(37.4+/-1.8 msec) of control group and amplitude was reduced to 82%(4.58+/-1.2 microV) of control group in the 50 mmHg increased ICP group. Recovery of MEP changes from increased ICP by reduction of the pressure was more prominent in 30 mmHg elevated group than 50 mmHg elevated group. 2) In control group SEP showed that latency was 25.38+/-1.5 msec and amplitude was 22.8+/-1.4 microV. SEP after elevation of ICP showed more profound change in 50 mmHg increased ICP group than 30 mmHg increased ICP group. Latency of SEP in 50 mmHg increased ICP group was prolonged by 54%(39.18+/-2.2 msec) of control group and amplitude reduced by 47%(10.98+/-0.9 microV) of control group was more prominent in 30 mmHg elevated group than 50 mmHg elevated group. changes in MEP after raised ICP were more remarkable than that of SEP. The degree of Recovery from raised ICP was more prominent in 30 mmHg group than 50 mmHg group. This study indicates that because change of MEP is more sensitive than that of SEP in the evaluation of cerebral function in case of increased ICP, MEP might be a paramount indicator in the evaluation of cerebral injury. Recording of MEP as well as ICP monitoring system might be a new method for the early detection of changes in cerebral function.

Early Microsurgical Treatment for Hypertensive Intracerebral Hemorrhage

We have reviewed 10 cases of hypertensive intracerebral hematoma operated within 48 hours following apopletic attacks. Computerized tomography permits the choice of the most direct approach to the hematoma. Postoperative CT and Evoked potential studies provides good control of the program of the hematoma removal. In early operation we have noted that intracranial pressure has not yet increased and the cerebral edema is minimal. Microsurgical technique with CO2 laser mes was used for bleeding controls and evacuation of the hematoma. At the three months follow-up study, 8 patients could walk unaided or with a cane, one was confined in bed and are had died.

Early Microsurgical Treatment for Hypertensive Intracerebral Hemorrhage

We have reviewed 10 cases of hypertensive intracerebral hematoma operated within 48 hours following apopletic attacks. Computerized tomography permits the choice of the most direct approach to the hematoma. Postoperative CT and Evoked potential studies provides good control of the program of the hematoma removal. In early operation we have noted that intracranial pressure has not yet increased and the cerebral edema is minimal. Microsurgical technique with CO2 laser mes was used for bleeding controls and evacuation of the hematoma. At the three months follow-up study, 8 patients could walk unaided or with a cane, one was confined in bed and are had died.

The Clinical Analysis of Surgical Treatment in the Medically Intractable Seizure

We performed callosotomy and amygdalo-hippocampectomy in medically intractable seizure patients. Symptom duration of these patients was over 2 years and seizure was not controlled with anticonvulsants in spite of high level in drug monitoring according to their seizure type. 7 patients with generalized epilepsy were treated by anterior callosotomy and 8 patients with temporal lobe epilepsy were treated by amygdalo-hippocampectomy. Anyone of these patients were not dead and discovered permanent complications. And so these methods, anterior callostomy and amygdalo-hippocampectomy seems to be relatively safety and effective methods in treatment of medically intractable seizure.

The relationship between uterine prolapse and osteoporosis in postmenopausal women / 대한산부인과학회잡지

No abstract available.