Experimental Study for the Effect of Myelotomy on Acute Spinal Cord Injury

This study involved 29 adult cats with acute spinal cord injuries produced experimentally in which a myelotomy was performed in 10 cats one hour(1-hour myelotomy group) after and in remaining 9 animals 6 hours(6-hour myelotomy group) after the injury. The remaining 10 animals served as controls and were only subjected to the spinal cord injury. The spinal cord injury with 400gm-cm blow was inflicted by dropping a 20gm cylindrical weight from a height of 20cm onto the impounder rested epidurally over the entire dorsal surface of the cord at T10 or T12 vertebral level. Under the operating microscope, a myelotomy, dorsal midline longitudinal, approximately 1.0cm to 1.5cm long, was made at the injury site. The myelotomy extended 4mm into cord completely through to the anterior surface of the cord. Animals were evaluated neurologically after the injury in time sequence of 4 hours, 8 hours, 2 days 4 days and 7 days after which they were sacrified, and the spinal cord and meninges were removed for pathological study. Acute spinal cord injury produced in this study immediately resulted in total paralysis of both hind limbs in all animals after injury and the weakness lasted throughout whole experimental period. There was no significant improvement in recovery of neurological function in control and in 6-hour yelotomy groups, but there was a significant improvement in recovery of motor function in the group of 1-hour myelotomy animals as compaired with the other groups. Histopathological findings of injured spinal cord were mainly those of hemorrhage, necrosis of cavity formation in the central gray and degenerative changes in the white and gray matters, and of edema and swelling of the spinal cord. In the group treated with myelotomy after the injury, the degree of destruction of the spinal cord was lesser histologically than those in control group, and that, in the group of 1-hour myelotomy, no central cavitation or necrosis were observed. It was observed that the neurological functional deficits tended to correlate with the degree of destruction to the spinal cord, and when the myelotomy was done earlier in the post-traumatic period and extended for the full depth of the cord, the improvement of neurological function and the prevention of further destruction of the spinal cord were significant. It is well to say that a number of possible mechanism to account for this beneficial effectiveness of myelotomy may be attributed to drainage of blood and necrotic tissue from the injury site. Myelotomy may prevent cavitation of spinal cord, and thus prevent the surviving axons from further damage, and it may reduce tissue pressure.

Clinical Study on Chronic Subdural Hematoma

Chronic subdural hematoma is a relatively common disease which is practically always secondary to severe or minor injury to the head but may occur in connection with blood dyscrasias or cachexia in the absence of trauma. Early diagnosis and proper operative treatment result in complete recovery in most cases, but the outcome without operative treatment is almost invariably fatal. During 1972 to 1975, 28 patients with chronic subdural hematoma were examined and operated in the Department of Neurosurgery, Korea University, and clinical observation and analysis were made particularly of the relationship of age to clinical and pathological findings. Incidence of hematoma was predominated by men and estimated as 71.4% of total cases over the age group of 31 to 40 years and In the group of under 10 years were found in 3 cases A history of craniocerebral trauma in varying degrees was obtained in 23 cases(82%), and remainings had no history of it or any other illness. The average time interval from trauma to operation was 31.7 days and it was shorter in the young patients who had more evidence of increased intracranial pressure. The prevalence of the most commonly encountered symptoms and signs, especially in different age groups were analyzed. Headache was by far the commonest symptom in this series, being present in 20(71.4%) vomiting in 15(53,6%), hemiparesis in 13(16.43%) speech disturbance in 5(18%), papilledema in 16(57.2%), and convulsion in 2(7.14%). There was a tendency that young patients had headache more frequent and severe than the older patients, while mental symptoms, such as somnolence, confusion, and memory less were significantly more frequent in the older age group. Hemiparesis and other pyramidal tract signs were more frequent in the older age group. Leukocytosis in peripheral blood was investigated in 75% of cases and roentgenograms of the skull showed evidence of a linear fracture in 10 of the total cases. Carotid angiograms were of diagnostic value in that they demonstrated a lentiform shaped avascular zone by in 28% and a crescent shaped-one in the remainders by an inward displacement of the terminal branches of the middle cerebral artery. The hematomas were most frequently found in the parietotemporal region. The thickness of the hematomas as measured from angiograms increased with the age of the patient. Only 1 of 28 cases died of reaccumulation of blood in the subdural space and bleeding in the gastrointestinal tract following the operation. Excellent recovery following operation is obtained in 82% of the cases at the time of discharge from hospital.

Exprimental Injection Injury of the Sciatic Nerve: Part III Physiological Study

This experimental study was conducted in order to observe the change and degree of the functional disability of the sciatic nerve following injection of various drugs such as Rheumapyrine, Chloromycetin, Penicillin and physiological normal saline solution. In clinical practice a serious sciatic nerve injury may result from an erroneous injection of commonly used antibiotics and other therapeutic or prophylactic agents into the gluteal region which can occur at any age, especially common in infants, children and small debilitated patients. Thirty-six normal adult rabbits were divided into four groups depending on injected materials and also divided into two groups of simplex exposure and closure of the nerve and of simple puncture of the exposed nerve with injection needle. The drugs were injected into the right sciatic nerve intraneurally and around the left sciatic nerve perineurally. For the functional study in the nerve, needle electrode was inserted into the calf muscle which was a pick-up muscle, and nerve potential was recorded on an electromyography(EMG) and motor nerve conduction velocity(M.N.C.V.) was also measured in the calf muscle at interval of 3, 7, 10 and 14 days after the injection. In normal control group, electrical activity on EMG was silent in resting state of the muscle and was normal motor unit action potential(normal motor unit) in volition state by demonstrating biphasic or triphasic wave patterns. Distal latency average 1.1 msec and amplitude of action potential was average 6.4 mV. The experimental groups of simple exposure and closure of the nerve and of simple puncture of the exposed nerve with injection needle showed identical EMG findings with those in normal control group. In EMG findings of both groups of normal saline and Chloromycetin injections, there were no significant differences in comparison with those in normal control group. No abnormal E.M.G. findings were observed in the left side where the drugs were injected around the sciatic nerve perineurally. Abnormal EMG findings were observed in both Penicillin and Rheumapyrine injection groups, which showed fibrillation potential and positive sharp wave in resting state and decreased amplitude or reduced numbers of normal motor unit in volition state, along with delayed M.N.C.V. Two of five cases with Penicillin injection showed denervation potentials and delayed M.N.C.N. 10 days after the injection, while all cases with Rheumapyrine injection started to demonstrate the denervation patterns on EMG and delayed M.N.C.V. 3 days after the injection, and these abnormal findings were become more evident and severe to be partial or complete denervation as the time elapsed following the injection. It was postulated that functional and physiological disabilities recorded on E.M.G. were developed after the injection only when there was a severe degree of nerve damages on the basis of histopathological study.

Percutaneous Streotaxic Gasserian Ganglionotomy with Radiofrequency Current in Trigeminal Neuralgia

Chemical destruction of Gasserian ganglion by either alcohol or phenol has remained a popular form of treatment for tic pain. However, control of the lesion size is inaccurate and various complications have often resulted. With advent of radiofrequency generator, percutaneous coagulation of the Gasserian ganglion is now possible, and the need for open surgery or chemical destruction have been drastically reduced. We treated 3 cases of trigeminal neuralgia with the radiofrequency current. Modified Hartel's anterior appaorch for the injection of the Gasserian ganglion is utilized and the radiofrequency lesions were made in the second branches of the trigeminal nerve selectively preserving the touch sensation in our patients. We reviewed the literature and described the technical procedures.

Herniated Upper Lumbar Disc: Case Report

No abstract available.

Fibrous Dysplasia: Case Report

Fibrous dysplasia of bone is an uncommon condition of unknown etiology in which the bones become progressively thicker and lose their normal structure. The skull and the bones in other parts of the body are involed in a process characterized by small areas of bone destruction or massive sclerotic overgrowth. They appear denser, although actually are softer, and give a rather homogenous, smeary impression. There may be cyst like areas within the large, dense, homgenous-appearing amorphous bone. Although the skull may be the only area of involvement it is not uncommon to have similar but more cystic appearing lesions in many other bones. The authors report two cases of fibrous dysplasia involving frontal, orbital roof, ethmoid, zygoma and sphenoid bone in the left by which disfiguration of appearance of the face was resulted in association with exophthalmus.