Clinical Experience of Mesenchymal Hamartoma of Liver

Purpose: Mesenchymal hamartoma of the liver (MHL) is an uncommon benign disease of childhood, yet its biology and pathogenesis are still unknown. It is difficult to diagnose from other hepatic tumors, and malignant transformation can occur. It has caused a debate regarding choice of the proper management of each neoplasm of liver in childhood. Methods: We analyzed histologically confirmed MHLs from 1998 to 2008. Results: Six patients presented at a median age of 21months, with a painless abdominal mass. Gastrointestinal symptoms were present in two patients. Abdominal ultrasonography and CT scans revealed a cystic, septated mass within the liver in all patients. Three patients underwent major hepatic resections, one had a simple excision of the tumor, and two were observed after biopsy. The median follow up period was 46months (range 6-115months), and there were neither recurrences of tumors nor complications, in patients who underwent surgical treatment. Conclusion: Resectable mesenchymal hamartoma of the liver in childhood with normal liver function studies can be cured by complete excision without complications and without recurrence.

Measurement of the Axial Isthmus for Atlantoaxial Transarticular Screw Fixation / 대한해부학회지

Pre-operative evaluation of the anatomy of the axis, such as the size and angle of the axial isthmus, is very important to minimize complications in atlantoaxial transarticular screw fixation. To provide basic data useful for atlantoaxial transarticular screw fixation in Korean, the width and height of the axial isthmus as well as ideal insertion angle of the screw were measured in this study. Fifty seven (male, 36; female, 21) dried axes obtained from Korean adult cadavers, 60.5 years old in average, were used. The shortest distance in the width and height of the axial isthmus was measured at the level of transverse foramen by using Vernier calliper. The ideal screw insertion angle was set up as an angle between a parasagittal line and the line passing through the center of the isthmus and screw insertion point which is located 2 mm lateral to and 3 mm superior to the posteromedial end of the inferior articular surface of the axis. The mean width of the axial isthmus was 8.14 mm (8.42 mm in male; 7.86 mm in female) in the right and 8.46 mm (8.80 mm in male; 8.12 mm in female) in the left side, and 8.61 mm in male and 7.99 mm in female. Although the width of the axial isthmus was slightly greater in the left and in male, there was no significant difference between both sides or sexes. The mean height of the axial isthmus was 7.17 mm (7.49 mm in male; 6.84 mm in female) in the right and 7.43 mm (7.90 mm in male; 6.96 mm in female) in the left side, and 7.69 mm in male and 6.90 mm in female. However there was no significant difference between both sides or sexes, as like in the width. In the atlantoaxial transarticular screw fixation, the axis with isthmus lesser than 5 mm in its width or height is regarded as risk group in general. The frequency of the risk group in the width was 3.5% (2 cases) in the right and 1.8% (1 case) in the left, while that in the height was 8.8% (5 cases) in the right and 7.0% (4 cases) in the left. The mean ideal insertion angle of the screw was 5.6 degrees, 4.4 degrees in the right and left side of male, and 4.7 degrees, 5.5 degrees in the right and left side of female respectively. However the insertion angle dispersed over a wide range between 0 degree ~ 12 degrees. In conclusion, measurement of the isthmus height and insertion angle, besides the isthmus width, should be involved in the pre-operative examination, to minimize complications during the atlantoaxial transarticular screw fixation.

Changes of Adjacent Segment in Anterior Cervical Fusion / 대한척추외과학회지

STUDY DESIGN: A retrospective radiographic and medical record analysis of 36 patients. OBJECTIVES: To describe the incidence and consequence of the distribution of sagittal plane motion, across the adjacent cervical motion segment, after cervical fusion. Furthermore, to find the cause of the progression of degenerative changes in intervertebral discs adjacent to the fused segment. SUMMARY OF LITERATURE REVIEW : Anterior cervical fusion has been widely used in the treatment of degenerative cervical spine. An increased incidence of degenerative disease may exist at the levels immediately adjacent to a cervical fusion. However, the frequency of these complications is probably overestimated, and their effect on clinical outcome remains unknown. MATERIALS AND METHODS: From 1990 to 1996, 36 patients who underwent anterior cervical spine fusion for degenerative disorders were reviewed retrospectively with an average follow up of 6.9 years. Lateral views in neutral position, in flexion, and in extension of the preoperative cervical roentgenograms were analyzed in comparison with the last follow-up films in the range of motion of the neck, and in the intervertebral angular mobility and anteroposterior displacement of the vertebral bodies, and finally to quantify the incidence of the spinal instability. RESULTS: Degenerative change in adjacent intervertebral level was observed in 16 of the 36 patients (44.4%), above the fusion in 10, below the fusion in 4, and both above and below the fusion in 2 cases. In addition, degenerative change in adjacent intervertebral level was observed in 68% of cases of loss of lordosis of the fused segment, and degenerative change occurred more frequently in younger patients to a statistically significant extent. CONCLUSIONS: Loss of lordosis of the fused segment and young age are two factors promoting degenerative changes in adjacent intervertebral levels after anterior cervical fusion.

Treatment of Posterior Facet Fracture-Dislocation in Lumbar Spine / 대한척추외과학회지

STUDY DESIGN: Retrospective study. OBJECTIVES: The purpose of this study is to compare the outcomes of short segment fusion and long segment fusion in posterior facet fracture-dislocation in the lumbar spine. SUMMARY OF LITERATURE REVIEW: There are many controversies exist about the treatment of fracture-dislocation in lumbar spine. MATERIAL AND METHODS: Sixteen patients with lumbar fracture-dislocation were studied retrospectively. The patients divided two groups; group one treated with one level above and below the fracture segment fixation, group two treated with two level above and below the fracture segment fixation. Two groups were compared with neurologic recovery, bladder function recovery and radiologic changes of deformities. RESULTS: The neurologic deficit in two groups was improved more than one Frankel grade at last follow up. Patients who showed intact dura were neurologically improved significantly than the patients whose dura was ruptured. Radiologic changes were not a sinificant difference in two groups. CONCLUSION: In lumbar fracture-dislocation treatment, one level above and below the fracture segment fixed with pedicle screw fixation system was an effective treatment method which preserved the mobile segment lumbar spine.

Treatment of Thoracolumbar Fracture with Anterior Approach / 대한척추외과학회지

The anterior approach to the spine offers several unique solution to problems posed by patients with thoracolumbar injuries. The major weight-bearing elements of the spine are anterior and this is the area where injured elements impinging on the spinal cord can cause significant but reversible damage. The two primary areas of concern for surgeons treating these patients are restoration of mechanical stability of the spinal column and restoration or preservation of neurologic function. Indications for anterior decompression, 1)a large retropulsed fragment with significant (>50%) canal compromise, 2)anterior column comminution and marked kyphosis, and a time lapse of greater than 10 days from the time of injury. Anterior approaches are also recommended for the late treatment of symptomatic post-traumatic kyphosis that causes pain or neurologic deficit. The flexion-compression injuries addressed with anterior decompression and strut graft fusion require additional stability for satisfactory healing with maintenance of position assured during bone graft incorporation. Anterior instrumentation is most effective when balanced by an intact posterior ligamentous tension band. The anterior approach is more superior in canal clearance and effective in restoring bladder and bowel function.

Magnetic Resonance Imaging of Acute Cervical Cord Injuries (Clinical Correlation and Prognosis) / 대한척추외과학회지

STUDY DESIGN: Retrospective evaluation of MRI and clinical examinations in 60 acute cervical spine cord injury. OBJECTIVES: To determine whether initial MRI appearances of the spinal cord in acute trauma correlate with clinical presentation and prognosis. SUMMARY OF LITERATURE REVIEW: Magnetic resonance imaging was known to be the best imaging modality to evaluate spinal cord injury. However, there was no sufficient report to correlate between clinical presentation, prognosis and findings of mag-netic resonance imaging. METHODS: Sixty patients with cervical SCI were evaluated their clinical manifestations, prognosis and MRI findings. MRI was taken with 10 days after trauma in all patients. The patients initial and final neurologic status and functional outcome were evaluated and correlation with initial MRI findings. RESULTS: Edema 37%, swelling 33%, contusion 20%, normal 10% was found at initial magnetic resonance imaging. The group of edema and swelling was more neurological deficit than other groups and low functional and neurological recovery was found at last follow up. The average length of the edema and swelling was each other 19.8, 20.4 mm. There was more neurological deficit, lower functional recovery in longer length of the edema and swelling. CONCLUSION: There is a close correlation between initial magnetic resonance imaging and final neurological, functional recovery in acute spinal cord injury. Magnetic resonance imaging is useful in predicting the clinical outcome and prognosis.

Morphometric Study on the Coracoacromial Arch, the Acromial Articular Surface, and the Glenoid Cavit of the Scapula in Koreans / 체질인류학회지

The present study was performed to provide an anatomical basis of the coracoacromial (CA) arch and the articular surfaces of the scapula which can be applied to the diagnosis and treatment of some common shoulder problems. The standard dimensions and the range of variation of the CA arch, the acromial articular surface and the glenoid cavity were investigated in 114 dry scapulae obtained from 57 (male, 35 ; female, 22) Korean cadavers ranging in age from 18 to 97 years (average age of 67). The results were as follows : 1. The length (46.3mm), width(25.2mm), thickness (8.2mm) and height (4.5mm) of the acromion were measured. The length, width and thickness were significantly larger in the males. The slope of the acromion was 51.5°, and the slope of the scapular spine was 118.5°. 2. The height (13.5mm), slope of the root (138.4°) and the horizontal part (25.3°) of the coracoid process, and the angle between the root and the horizontal part (106.6°) were measured. There were no significant differences between sexes and sides in all morphometric values related to the coracoid process. 3. The length (67.6mm) and height (24.7mm) of the CA arch, the height of the CA ligament from the supraglenoid tubercle (13.1mm), and length of the CA ligament (27.6mm) were measured. Both the length and height of the CA arch and the length of the CA ligament were significantly larger in the males. The slope and anterior and posterior angles of the CA arch were 16.8°, 42.2°, and 34.7°, respectively. 4. The long (13.8mm) and short (8.0mm) diameters of the acromial articular surface were measured, and both diameters were significantly longer in the males. The acromial articular surface was 8.4mm away from the tip of the acromion and extended 1.4mm inferiorly below the inferior surface of the acromion. 5. The long (34.8mm) diameter, and superior (15.0mm), middle (19.5mm), and inferior (25.6mm) short diameters of the glenoid cavity were measured. The long and both superior and inferior short diameters were significantly longer in the males.