Hyperlipidemia is an important risk factor of coronary atherosclerosis. Serum lipids, especially cholesterol level is closely related to coronary artery and early identification and treatment of hypercholesterolemia reduced the risk of ischemic heart disease. In secondary prevention studies, lipid regulation has been demonstrated to result in a reduced incidence of myocardial infarction and mortality. But during the acute phase of a myocardial infarction, the serum lipid pattern is known to be rapidly changed and consequently dose not reflect the baseline level of the patient. Total serum cholesterol concentrations measured within 24 hours after acute myocardial infarction are likely to reflect basal levels, thus they must be used as the reference for the diagnosis and treatment of hyperlipidemia. If serum lipid levels were not measured within 24 hours of acute chest pain, it is essential to correct the lipid level to the baseline level. So we investigated the following. First, serum lipid alteration during the acute phase of acute myocardial infarction, second, the factors that are related to lipid change, third, the time to check the baseline value of lipid level during the acute phase of myocardial infarction.

We have measured the total cholesterol, LDL cholesterol, HDL cholesterol and triglyceride at admission time and the next day in a group of 51 acute myocardial infarction patients who had acute chest pain.

First, total cholesterol, LDL cholesterol at the next day were significantly reduced. Second, positive correlation was noted between lipid alteration and the lipid level that was checked at admission time. Last, male groups had more significant reduction of LDL cholesterol than female groups.

Cholesterol levels thats were checked the next day were significantly reduced in comparison with the cholesterol value registered at hopital admission. Consequently, it is essential to check the lipid level at the time of hospital admission. But if it was not done, corrected values are a useful guide to patients basal lipid state and treatment references.

Lumbar disc herniations at the L1-L2, L2-L3, and L3-L4 level are rare. The purpose of this study is to observe the variable clinical finding of upper lumbar disc herniations and to provide proper treatment modality.

Between 1998 Jan. and 1999 Dec., seventeen patients with upper lumbar disc herniations who were undergone surgery in our institute were retrospectively evaluated. Patients were evaluated based on following factors : age, sex, aggravating factor, symptoms and signs type of disc herniation, type of surgery, and outcome of post-surgery.

The incidence of lumbar disc herniation at the level of L1-2, L2-3 and L3-4 is 6.1% with declining frequency as the level ascends. The peak age incidence is 6th decade in both sex. Preoperative symptomes and signs are variabe. In sixteen cases, posterior approach was done. In these cases, twelve cases were performed microscopic partial hemilaminectomy, and four cases with spinal stenosis were performed total laminectomy and posterior screw fixation with bone fusion. In one case, lateral extracavitary approach was done. In results of operation, fourteen cases showed more than good grade(82%).

The age incidence of lumbar disc herniations at the level of L1-2, L2-3 and L3-4 older than lumbar disc herniations at the lower level of L4-5 and L5-S1. The signs and symptoms are variable. In our cases, most of the patients were performed posterior approach with microscopic partial hemilaminectomy except the patients combined spinal stenosis. One case was performed a lateral extracavitary approach because the risk of the cord and cauda equina injuries. The prognosis of upper lumbar disc herniations after treatment with only microscopic partial hemilaminectomy and diskectomy is comparable with the prognosis of lumbar disc herniations at the lower level.