An Experimental Study for Minimum Level of Decalcification to Detect the Osteolytic Bone Metastasis of Long Bone on Plain Radiography

BACKGROUND: In 1951, Ardran reported that metastatic bone lesions could be detectable on plain radiography with 30% to 50% of decalcification. Authors performed experimental study for minimum level of decalcification to detect the osteolytic bone metastasis of long bone with recent technique of radiographs. METHODS: One pair of fibula and humerus from two cadavers was cut into specimen 1 inch in length. Distal half of specimen was dipped into hydrochloride (HCl) with 15 min interval. All 16 specimens were checked by film-type radiography (FR), computed radiography (CR), digital radiography (DR). To exclude inter-observer's variance, 3 radiologists evaluated images. Calcium amount before and after decalcification was measured and expressed in percentage of decalcification. RESULTS: Osteolytic changes were detectable with 11% to 16% of decalcification for fibula and 3% to 8% for humerus on plain radiography with FR, CR, and DR. CONCLUSIONS: Our study showed that minimum of 3% and maximum of 16% of decalcification is necessary when osteolytic metastatic bone lesions of long bone could be detected on plain radiography.

Spontaneous Subdural Hematoma at Thoracolumbar spine: A Case Report / 대한척추외과학회지

A 63 year-old female was brought to our hospital with severe lower back pain. She received antihypertensive drugs for 2 years but her blood pressure was normal upon arrival. She could not stand up or even walk. The MRI showed a subdural hematoma at the thoracolumbar region, which was extremely rare. The treatment applied was decompression through a spinal tap without surgery. After this, her pain subsided considerably. Two weeks later, MRI confirmed that there was no hematoma in the same region. She was discharged and has enjoyed her daily activities free of pain. A spontaneous subdural hematoma is an extremely rare disease. The condition was treated successfully in a conservative manner.

Thrower's Fracture on the Shaft of the Humerus: 4 Cases Report / 대한정형외과학회잡지

A fracture of the shaft of the humerus in young adults is known to occur as a result of high energy injuries such as traffic accidents and falls from a height. In baseball, which is one of the popular sports in the world, the incidence of a fracture of the shaft of the humerus during pitch motion is increasing even in non-professional players. Over the course of a year, we analyzed four cases of humeral shaft fractures that occurred during pitch motion through the pitch count, type of pitch, duration of playing, and prodromal pain. It was found that these fractures can easily occur through the torsion developed by the uncoordinated contraction of the muscle. The mechanism of the fracture should be recognized in order to prevent this type of fracture while playing baseball.

Epidural Hemangioma: A Case Report / 대한척추외과학회지

STUDY DESIGN: A case report and review of the literature. OBJECTIVES: To discuss an epidural hemangioma and review the literature. MATERIAL AND METHOD: A 56-year-old woman had back pain and pain radiating to the left lower extremity that had gradually worse over 2 weeks. No definite history of trauma was disclosed. The straight leg raising test was positive at 60degree on the left side. Sensation to pinprick was diminished in the L5, S1 dermatome on her left leg. Examination of the left leg revealed weakness of the extensor hallucis longus(3/5 strength). Plain films of the lumbar spine showed degenerative scoliosis and degenerative L4-5 spondylolisthesis with no bone involvement. In retrospective study, T1-,T2-weighted image showed a hyperintense signal mass, unlike an usual MR imaging of epidural hemangioma. A preoperative diagnosis of spondylolisthesis with spinal stenosis was made. RESULTS: The mass compressing L5 root was excised through posterior approach and the fusion was performed from L4 to S1 with bone graft, instumentation. A purple encapsulated tumor, size 1.5x1x.8cm, was found. Histopathologic examination revealed a thin walled sinusoidal vascular space of varying sizes, lined with a single layer of endothelial cells, consistent with typical hemangioma. The patient had a complete neurologic recovery and is doing well 5 months after surgery. CONCLUSIONS: Although the diagnosis of epidural hemangioma was difficult, because of the rarity of that, we should pay attention to awareness of the possibility of such lesion, differential diagnosis in clinical manifestration, neuroradiologic study.