Adult Patients with Congenital Muscular Torticollis Treated with Bipolar Release: Report of 31 Cases

OBJECTIVE: We assessed the surgical results of bipolar release in 31 adult patients with uncorrected congenital muscular torticollis (CMT) and more than 12 months of follow-up. METHODS: Thirty-one patients underwent a bipolar release of the sternocleidomastoid muscle (SCM) and were retrospectively analyzed. The mean follow-up period was 14.9 months (range, 12–30). The mean age at time of surgery was 30.3 years (range, 20–54). Patients were evaluated with a modified Lee’s scoring system, cervicomandibular angle (CMA) measurement, and a global satisfaction rating scale using patient self-reporting. RESULTS: The modified Lee’s scoring system indicated excellent results in 4 (12.9%) patients, good in 18 (58.1%), and fair in 9 (29.0%) at the last follow-up after surgery. The improvements in neck movement and head tilt were statistically significant (p<0.05). The preoperative mean CMA was 15.4° (range, 5.4–29.0), which was reduced to a mean of CMA of 6.3° (range, 0–25) after surgery (p<0.05). The global satisfaction rating scale was 93.7% (range, 90–100). A transient sensory deficit on the ipsilateral lower ear lobe was noted in three cases. No significant permanent complications occurred. CONCLUSION: Bipolar release of the SCM is a safe and reliable technique for the treatment of CMT in adults.

Pneumocephalus and Pneumorrhachis due to a Subarachnoid Pleural Fistula That Developed after Thoracic Spine Surgery

Development of a communication between the spinal subarachnoid space and the pleural space after thoracic spine surgery is uncommon. Subarachnoid pleural fistula (SAPF), a distressing condition, involves cerebrospinal fluid leakage. Here we report an unusual case of SAPF, occurring after thoracic spine surgery, that was further complicated by pneumocephalus and pneumorrhachis postthoracentesis, which was performed for unilateral pleural effusion.

A Groove Technique for Securing an Electrode Connector on the Cranial Bone: Case Analysis of Efficacy

OBJECTIVE: A groove technique for securing an electrode connector was described as an alternative surgical technique in deep brain stimulation (DBS) surgery to avoid electrode connector-related complications, such as skin erosion, infection, and migration. METHODS: We retrospectively reviewed 109 patients undergoing one of two techniques; the standard technique (52 patients using 104 electrodes) and the groove technique (57 patients using 109 electrodes) for securing the electrode connector in DBS surgery, regardless of patient disease. In the standard percutaneous tunneling technique, the connector was placed on the vertex of the cranial surface. The other technique, so called the groove technique, created a groove (about 4 cm long, 8 mm wide) in the cranial bone at the posterior parietal area. Wound erosion and migration related to the connectors were compared between the two techniques. RESULTS: The mean follow-up period was 73 months for the standard method and 46 months for the groove technique. Connector-related complications were observed in three patients with the groove technique and in seven patients with the standard technique. Wound erosion at the connector sites per electrode was one (0.9%) with the groove technique and six (5.8%) with the standard technique. This difference was statistically significant. The electrode connector was migrated in two patients with the groove technique and in one patient with the standard technique. CONCLUSIONS: The groove technique, which involves securing an electrode using a groove in the cranial bone at the posterior parietal area, offers an effective and safe method to avoid electrode connector-related complications during DBS surgery.

Hemangiopericytoma of the Posterior Fossa: A Case Report and Review of the Literature

Intracranial hemangiopericytoma is unusual, and those occurring in the posterior fossa is extremely rare; we report such a rare case of hemangiopericytoma of the posterior fossa. The radiologic findings and gross characteristics of hemangiopericytomas are sometimes quite similar to those of meningiomas. Although extremely rare, the operator should be aware of the existence of this disorder to dexterously manage the aggressive nature and high vascular tendency of hemangiopericytomas. The radiological features and histological findings in this case are discussed in this study.

The relationship between age and the mandibular cortical bone thickness by using panoramic radiograph / 대한구강악안면방사선학회지

PURPOSE: This study was to determine the relationship between age and the mandibular cortical bone thickness on panoramic radiograph. MATERIALS AND METHODS: Panoramic radiographs of 360 patients (180 men and 180 women) over 20 years old, who visited the Chonbuk National University Hospital from January to December in 2007, were assessed. The subjects were divided into 5 age groups. Five indices such as cortical bone thickness at the gonion (GI), antegonion (AI), and below the mental foramen (MI), the panoramic mandibular index (PMI), the mandibular cortical index (MCI) were measured on panoramic radiographs. RESULTS: All five indices including GI, AI, MI, PMI, and MCI showed significant differences between third decade and over 8 decade groups (p<0.05). PMI, MI and GI showed significant differences with gender statistically (p<0.05). CONCLUSION: The mandibular cortical bone thickness showed negative correlation with age, and the value of the thickness (PMI, MI, and GI) was greater in men than in women.

Effects of iontophoretically applied substance P, calcitonin gene-related peptide on excitability of dorsal horn neurones in rats

Spontaneous pain, allodynia and hyperalgesia are well known phenomena following peripheral nerve or tissue injury, and it is speculated that secondary hyperalgesia and allodynia, are generally thought to depend on a hyperexcitability (sensitization) of neurons in the dorsal horn. It is supposed that the sensitization may be due to various actions of neurotransmitters (SP, CGRP, excitatory amino acids) released from the primary afferent fibers. In this study, we examined effects of the iontophoretically applied SP and CGRP on the response to EAA receptor agonists (NMDA and non-NMDA) in the WDR dorsal horn neurones and see if the effects of SP or CGRP mimic the characteristic response pattern known in various pain models. The main results are summarized as follows: 1) SP specifically potentiated NMDA response. 2) CGRP non-specifically potentiated both NMDA and AMPA responses. Potentiation of NMDA response, however, was significantly greater than that of AMPA response. 3) 50% of SP applied cells and 15.8% of CGRP applied cells showed reciprocal changes(potentiation of NMDA response and suppression of AMPA response). These results are generally consistent with the sensitization characteristics in diverse pain models and suggests that the modulatory effects of SP and CGRP on NMDA and non-NMDA (AMPA) response are, at least in part, contribute to the development of sensitization in various pain models.

MRI Findings of Traumatic Spinal Subdural Hematoma

PURPOSE: To describe the MR imaging findings of traumatic spinal subdural hematoma. MATERIALS AND METHODS: We retrospectively reviewed the MR images of six patients, with symptoms of acute spinal cord or cauda equena compression after trauma, together with spinal subdural hematoma. We analysed the extent, location, configuration and signal intensity of the lesions. RESULTS: In five of six cases, hematomas were distributed extensively throughout the thoracolumbosacral or lumbosacral spinal levels. In five cases they were located in the dorsal portion of the thecal sac, and in one case, in the ventral portion. On axial images, hematomas showed a concave or convex contour, depending on the amount of loculated hematoma. A lobulated appearance was due to limitation of free extension of the hematoma within the subdural space at the lateral sites (nerve root exist zone) at whole spine levels, and at the posteromedian site under lumbar 4-5 levels. CONCLUSION: In cases of spinal subdural hematoma, the lobulated appearance of hematoma loculation in the subdural space that bounds the lateral sites at all spinal levels and at the posteromedian site under L4-5 levels is a characteristic finding.

The effect of carbon monoxide on contraction, cytosolic Ca2+ level and ionic currents in guinea pig ileal smooth muscle

The aim of this study was to clarify the mechanism of the inhibitory action of carbon monoxide (CO) on contraction, by measuring cytosolic Ca2+ level ((Ca2+)i) and ionic currents in guinea-pig ileum. CO (10%) inhibited 40 mM KCl-induced contraction and this effect was blocked by ODQ (1 micrometer), a soluble guanylyl cyclase (sGC) inhibitor. CO inhibited the 40 mM KCl-induced contraction without changing (Ca2+)i. Cumulative addition of KCl induced a graded increase in (Ca2+)i and muscle tension. In the presence of CO, cumulative addition of KCl induced smaller contraction than in the absence of CO. On the other hand, the increase in (Ca2+)i induced by cumulative addition of KCl was only slightly decreased in the presence of CO, and the (Ca2+)i-tension relationship shifted downwards. Using the patch clamp technique with a holding potential of -60 mV, we found that CO had little effect on the peak Ba currents (IBa) when voltage was stepped from -60 mV to 0 mV. In addition, CO showed no effect on the depolarization-activated outward K+ currents in the all potential ranges. We conclude that CO inhibits smooth muscle contraction mainly by decreasing the Ca2+ sensitivity of contractile elements via a cGMP-dependent pathway, not by involving L-type Ca2+ and outward-potassium currents in guinea-pig ileum.