Posterior Cervical Microscopic Foraminotomy and Discectomy with Laser for Unilateral Radiculopathy / 전남의대학술지

Surgical decompression for cervical radiculopathy includes anterior cervical discectomy and fusion, anterior or posterior cervical foraminotomy, and cervical arthroplasty after decompression. The aim of this study was to evaluate the usefulness of a CO2 laser in posterior-approach surgery for unilateral cervical radiculopathy. From January 2006 to December 2008, 12 consecutive patients with unilateral cervical radiculopathy from either foraminal stenosis or disc herniation, which was confirmed with imaging studies, underwent posterior foraminotomy and discectomy with the use of a microscope and CO2 laser. For annulotomy and discectomy, we used about 300 joules of CO2 laser energy. Magnetic resonance imaging (MRI) was used to evaluate the extent of disc removal or foraminal decompression. Clinical outcome was evaluated by using visual analogue scale scores for radicular pain and Odom's criteria. For evaluation of spinal stability, cervical flexion and extension radiographs were obtained. Single-level foraminotomy was performed in 10 patients and two-level foraminotomies were performed in 2 patients. Preoperative radicular symptoms were improved immediately after surgery in all patients. No surgery-related complications developed in our cases. Postoperative MRI demonstrated effective decompression of ventral lesions and widened foraminal spaces in all cases. There was no development of cervical instability during the follow-up period. Posterior foraminotomy and discectomy using a microscope and CO2 laser is an effective surgical tool for unilateral cervical radiculopathy caused by lateral or foraminal disc herniations or spondylotic stenosis. Long-term follow-up with radiographs showed no significant kyphotic changes or spinal instability.

Posterior Cervical Microscopic Foraminotomy and Discectomy with Laser for Unilateral Radiculopathy / 전남의대학술지

Surgical decompression for cervical radiculopathy includes anterior cervical discectomy and fusion, anterior or posterior cervical foraminotomy, and cervical arthroplasty after decompression. The aim of this study was to evaluate the usefulness of a CO2 laser in posterior-approach surgery for unilateral cervical radiculopathy. From January 2006 to December 2008, 12 consecutive patients with unilateral cervical radiculopathy from either foraminal stenosis or disc herniation, which was confirmed with imaging studies, underwent posterior foraminotomy and discectomy with the use of a microscope and CO2 laser. For annulotomy and discectomy, we used about 300 joules of CO2 laser energy. Magnetic resonance imaging (MRI) was used to evaluate the extent of disc removal or foraminal decompression. Clinical outcome was evaluated by using visual analogue scale scores for radicular pain and Odom's criteria. For evaluation of spinal stability, cervical flexion and extension radiographs were obtained. Single-level foraminotomy was performed in 10 patients and two-level foraminotomies were performed in 2 patients. Preoperative radicular symptoms were improved immediately after surgery in all patients. No surgery-related complications developed in our cases. Postoperative MRI demonstrated effective decompression of ventral lesions and widened foraminal spaces in all cases. There was no development of cervical instability during the follow-up period. Posterior foraminotomy and discectomy using a microscope and CO2 laser is an effective surgical tool for unilateral cervical radiculopathy caused by lateral or foraminal disc herniations or spondylotic stenosis. Long-term follow-up with radiographs showed no significant kyphotic changes or spinal instability.

Spinal Burkitt's Lymphoma Mimicking Dumbbell Shape Neurogenic Tumor: A Case Report and Review of the Literature

Non-Hodgkin's lymphoma (NHL), a disease which may involve the spine, is frequently associated with advanced disease. Radiculopathy caused by spinal root compression as the initial presentation in patients with NHL is very rare and thought to occur in less than 5% of cases. A 69-year-old woman complained of a history of low back pain with right sciatica for 1 month prior to admission. Computed tomography and magnetic resonance imaging of the lumbar spine showed a dumbbell-shape epidural mass lesion extending from L2 to L3, which was suggestive of a neurogenic tumor. After paraspinal approach and L2 lower half partial hemilaminectomy, total excision of the tumor was achieved, followed by rapid improvement of back pain and radiating pain. The lesion was confirmed to be Burkitt's lymphoma by histopathological examination. We then checked whole-body PET-CT, which showed multifocal malignant lesions in the intestine, liver, bone and left supraclavicular lymph node. Although a rare situation, Burkitt's lymphoma should be considered in the differential diagnosis for patients presenting with back and lumbar radicular pain without a prior history of malignancy. Burkitt's lymphoma could be the cause of dumbbell-shape spinal tumor.

The Usefulness of Electromagnetic Neuronavigation in the Pediatric Neuroendoscopic Surgery

OBJECTIVE: Neuroendoscopy is applied to various intracranial pathologic conditions. But this technique needs informations for the anatomy, critically. Neuronavigation makes the operation more safe, exact and lesser invasive procedures. But classical neuronavigation systems with rigid pinning fixations were difficult to apply to pediatric populations because of their thin and immature skull. Electromagnetic neuronavigation has used in the very young patients because it does not need rigid pinning fixations. The usefulness of electromagnetic neuronavigation is described through our experiences of neuroendoscopy for pediatric groups and reviews for several literatures. METHODS: Between January 2007 and July 2011, nine pediatric patients were managed with endoscopic surgery using electromagnetic neuronavigation (AxiEM, Medtronics, USA). The patients were 4.0 years of mean age (4 months-12 years) and consisted of 8 boys and 1 girl. Totally, 11 endoscopic procedures were performed. The cases involving surgical outcomes were reviewed. RESULTS: The goal of surgery was achieved successfully at the time of surgery, as confirmed by postoperative imaging. In 2 patients, each patient underwent re-operations due to the aggravation of the previous lesion. And one had transient mild third nerve palsy due to intraoperative manipulation and the others had no surgery related complication. CONCLUSION: By using electromagnetic neuronavigation, neuroendoscopy was found to be a safe and effective technique. In conclusion, electromagnetic neuronavigation is a useful adjunct to neuroendoscopy in very young pediatric patients and an alternative to classical optical neuronavigation.

Technical Considerations to Prevent Postoperative Endocrine Dysfunction after the Fenestration of Suprasellar Arachnoid Cyst

OBJECTIVE: The endocrine dysfunction after the operation for suprasellar arachnoid cysts is not rare. The careful operation to prevent structures can prevent this complication, but it is not enough and effective to prevent it. Authors present technical surgical considerations to prevent this complication with a review of our suprasellar arachnoid cyst patients who had postoperative endocrine dysfunction. METHODS: From January 2002 to December 2009, eight patients who had suprasellar arachnoid cysts with visual impairment underwent surgery. The mean age was 57.1 years (range, 33-77). Preoperatively, their endocrine function was clinically normal, and laboratory hormonal levels were within normal ranges. Cyst fenestration was performed by craniotomy (n=6) or by a neuro-endoscopic procedure (n=2), and, simultaneously, along with a cyst wall biopsy. RESULTS: The surgery was uneventful in all eight patients, and there were no neurological morbidities. However, in four patients, endocrine dysfunction occurred postoperatively. We compared these four patients (group A) to the other 4 patients without endocrine dysfunction (group B) with intraoperative findings and with the histopathological findings of the cyst wall biopsy. The group A patients had more abundant vasculature on the cystic wall than the group B patients according to both the intraoperative findings and the histopathological findings. CONCLUSION: When performing a surgical cyst wall fenestration, surgeons should try to minimize the destruction of the cystic wall vasculature and not to make the fenestration at a site that contains many vascular striae.

Anterior Neck Approach for 4-vessel Occlusion in Rats: A Study for Immunohistological Changes and the Effects of Aminoguanidine on Neuronal Cell Death in the Hippocampus

BACKGROUND: Clinically relevant cerebral ischemia is encountered most frequently as a cardiac arrest or as single or multiple occlusions of the intracranial or extracranial cerebral arteries. Yamaguchi et al. has introduced a one-stage anterior approach to occlude the common carotid arteries (CCAs) and vertebral arteries (VAs). METHODS: We used a 2-stage anterior approach for producing transient global ischemia by 4-vessel occlusion (4-VO). Four to five days after electrocauterization of two VAs using the anterior neck approach, two CCAs were clipped for 10 min under anesthesia. Aminoguanidine (100 mg/kg) was administered intraperitoneally immediately after 4-VO, and then twice a day for three consecutive days. Cresyl violet staining and immunohistochemical analysis for the expression of GFAP, CD11b, nitrotyrosine, iNOS, and Bax were performed, using brain slices obtained from the rats that were sacrificed 1, 3, 5 and 7 days after reperfusion. RESULTS: Aminoguanidine reduced neuronal cell death in the CA1 region of the hippocampus. Expression of GFAP, CD11b, nitrotyrosine, iNOS, and Bax were significantly increased in the CA1 region of the hippocampus three days after 4-VO. CONCLUSIONS: We believe that modified 4-VO is a good method to study transient forebrain ischemia as it is simple and inexpensive to perform and can be utilized without stereotaxis, a pivoting dissection microscope, EEG, a laser flowmeter or the use of Mongolian gerbils.

Nicotinamide Reduces the Infarct Volume in a Rat Model of Transient Middle Cerebral Artery Occlusion

BACKGROUND: Cerebral ischemia depletes ATP and causes irreversible tissue injury. Nicotinamide is a precursor of NAD+ and it is also a poly (ADP-ribose) polymerase (PARP) inhibitor that increases the neuronal ATP concentration and so protects against stroke. Therefore we examined whether nicotinamide could protect against cerebral ischemia by using a model of transient middle cerebral artery occlusion (MCAO) (reperfusion 2 h post ischemia) in Sprague-Dawley rats. METHODS: Nicotinamide (500 mg/kg) or normal saline was administered intraperitoneally 24 and 0 h before and after MCAO, respectively. The infarction volumes were determined with triphenyltetrazolium chloride staining 24 h after reperfusion. The nitrotyrosine, PAR polymer and PARP-1 expressions were examined by immunohistochemistry with using brain slices obtained from the rats that were sacrificed at 0, 15, 30, 60 and 120 min after reperfusion. RESULTS: The infarction volumes were significantly attenuated (21.8%, p<0.05). The nitrotyrosine expressions were increased at 0, 15 and 30 min, and those expressions for PARP polymer and PARP-1 were increased at 60 and 120 min, respectively. Nicotinamide partly reduced the expressions for nitrotyrosine and PAR polymer except for PARP-1. CONCLUSIONS: These results suggest that nicotinamide may attenuate ischemic brain injury through its antioxidant activity and the inhibition of PARP-1.

A case of papillary thyroid carcinoma arising from sacrococcygeal teratoma / 대한내과학회지

35-year-old female presented with recurrent spinal mass that was resected. Pathologic examination revealed mature teratoma consisting of thyroid follicles, fibroadipose tissue, and mature bony particles. And in this teratoma, focal area of papillary thyroid carcinoma component arising from the normal thyroid follicles were observed. This finding was clearly distinguished from metastasis from thyroid or from other sites. The patients underwent evaluation of thyroid gland, and there was a 1.2 x 1.1 x 2 cm sized nodule. It was well-margined, round, mixed and hyperechoic by sonographic evaluation, and its aspirates contained benign-looking follicular cells only. The patient refused further evaluation or treatment about thyroid cancer, and was discharged. To date, there are only one case of thyroid carcinoma arising from a sacrococcygeal mass containing thyroid tissue components alone (Thyroid 2004:14:548-552). We believe that this patient is a very rare case of thyroid cancer primarily arising from teratoma due to malignant transformation of its thyroid tissue component.

Relationship between Cavum Septum Pellucidum and Epilepsy

OBJECTIVE: The authors study a relationship between the presence of cavum septum pellucidum(CSP) and the development of epilepsy by comparing the presence of CSP, which has been known to be a normal variation, in normal control group and epilepsy patients. METHODS: This study included 377 patients with epilepsy and 252 controls without epilepsy. Of epilepsy patients, 168 patients underwent surgery due to intractability and 209 patients was on medication of antiepileptic drugs. Control group had only headache and no visible lesion in MRI. Of 168 surgical patients, 102 patients had temporal lobe epilepsy and 66 patients had extratemporal lobe epilepsy. Ninty five patients showed a neuronal migration disorder in histopathologic findings. Definition of "CSP" and "partial CSP" was followed by Pauling's classification. RESULTS: CSP was present 8.2% of epilepsy patients and 1.6% of control group(p<0.01). CSP was detected in 11.3% of patients with surgical treatment and in 5.7% of patients with medical treatment. CSP was noticed in 8.9% of temporal lobe epilepsy, in 15.2% of extratemporal lobe epilepsy, in 13.7% of patients with neuronal migration disorder, and in 8.2% of patients with no neuronal migration disorder. CONCLUSION: Presence of CSP is statistically higher in epilepsy patients than in control group. This results indicates that the presence of CSP may not be a simple normal variation, and it can be considered a developmental anomaly that may contribute to epileptogenesis.

Minocycline Attenuates the Development of Allodynia: An Immunohistochemical Study on CD11b, GFAP and c-Fos in the Spinal Dorsal Horn in SD Rat

BACKGROUND: Minocycline, a semisynthetic second-generation tetracycline, is an antibiotic that has excellent ability to penetration into the CNS via the brain-blood barrier. Minocycline has emerged as a potent inhibitor of microglial activation, and it is an effective neuroprotective agent in experimental brain ischemia. Glial cell activation and proliferation are known to be associated with neuropathic pain in the peripheral nerve injuries. METHODS: The fifty percent threshold of withdrawal responses was measured in the hindpaws of SD rats following tight ligation of left fifth lumbar spinal nerve. Rats were sacrificed at 1, 3, 5, and 7 days and at 0.5, 1, 2, and 4 h post ligation (n=5/group/time point). Immunohistochemistry for GFAP, CD11b and c-Fos was done on the spinal cord at the level of the fifth lumbar nerve. Minocycline (45 mg/kg) and normal saline (300-400 microL) were administered intraperitoneally, 1 day and 1 h before the operations, and every day postoperatively until the rats were sacrificed. RESULTS: Treatment with minocycline reduced allodynia and the expressions of CD11b at 5 days and c-Fos at 1 and 2 h post operation compared with the saline treatment (control). CONCLUSIONS: It was thought that minocycline reduced the allodynia induced by tight ligation of the fifth lumbar spinal nerve in rats through the inhibition of microglial activation and c-Fos expression.

A Case of CMV Infection Associated with Simultaneous Esophageal and Colonic Ulcers / 대한소화기내시경학회지

Gastrointestinal cytomegalovirus (CMV) disease causes substantial morbidity and mortality in immunocompromised patients, especially in transplant recipients and those who infected with HIV. Although acute infection is generally asymptomatic or produces only non-specific symptoms in the immunocompetent host, acute CMV infection accompanies gastrointestinal ulceration in a small number of patients. The colon is the most common site of the infection, although it may occur in other gastrointestinal tract. CMV infection associated with simultaneous esophageal and colonic ulcers has not been reported in Korea. We report a patient with subarchnoid hemorrhage who had suffered from simultaneous esophageal and colonic ulcers associated with CMV infection which showed characteristic histologic findings of CMV infection.

Increased Corpora Amylacea in the Intractable Temporal Lobe Epilepsy: Case Report

Hippocampal sclerosis is the most common abnormal pathologic substrate found in patients with intractable temporal lobe epilepsy. Histopathological findings of hippocampal sclerosis are characterized by the presence of neuronal cell loss and astrocytic proliferation in the facsia dentata, Ammon's horn, presubiculum, and subiculum. Despite numerous studies having been conducted, the pathogenesis of hippocampal sclerosis is still controversial. Recently, it has been reported that increased numbers of corpora amylacea can be found in the hippocampus, the gray and white matter of the temporal lobe, in association with hippocampal sclerosis, which may give another clue to the pathogenesis of the hippocampal sclerosis. The authors report 3 patients with medically intractable temporal lobe epilepsy with hippocampal sclerosis in association with an increased numbers of corpora amylacea in the temporal white matter.

A Case of Acute Renal Failure Caused by Toxic Epidermal Necreolysis Combined with Rhabdomyolysis in A Patient with Idiopathic Hypoparathyroidism / 대한신장학회잡지

Idiopathic hypoparathyroidism is extremely rare disease. We experienced an interesting case of idiopathic hypoparathyroidism associated with acute renal failure caused by toxic epidermal necrelysis combined with rhabdomyolysis. This 36-years-old male patient was suffered from bullous erythematous scalding skin lesion on lower extremity, back, and chest. After 10 days, he was admitted with the chief complaints of generalized seizure, carpopedal spasm, stuporous mentality. Skin biopsy showed edematous change with extravasated erythrocytes in upper dermis and several individually necrotic keratinocytes. On laboratory finding, marked decreased serum PTH level were demonstrated. Increased muscle uptake of technetium-99m MDP were noticed on bone scan. Prolonged Q-T interval on electrocardiogram was also noted. We could diagnose his disease as severe hypocalcemia(hypocalcemic crisis) developed associated with acute renal failure caused by toxic epidermal necrolysis combined with rhabdomyolysis in patient with idiopathic hypoparathyroidism. He was treated by hydration, urine alkalinization, 2 times of hemodialysis and supplementary calcium, vitamin D during the admission.

A Case of Pure Red Cell Aplasia Associated with Sinus Histiocytosis with Multiple Lymphadenopathy / 대한혈액학회지

Pure red cell aplasia (PRCA) is characterized by severe anemia with reticulocytopenia and absence of erythroblast from the bone marrow. Sinus histiocytosis with massive lymphadenopathy (SHML : Rosai-Dorfman disease) is rare systemic disease characterized by painless cervical, axillary, inguinal and mediastinal lymphadenopathy and frequent extranodal invasion. Histologically, lymph node sinuses are expanded by numerous distinctive histiocytes which contains well preserved lymphocytes. We report a case of sinus histiocytosis with massive lymphadenopathy in inguinal lymph node biopsy with polyclonal gammopathy and pure red cell aplasia in bone marrow biopsy who was infected by Epstein-Barr virus.

Differentiation of Medial or Lateral Temporal Lobe Epilepsy by F-18-Fluorodeoxyglucose Positron Emission Tomography: Comparative Study with Magnetic Resonance Imaging in 113 Surgically and Pathologically Proven Patients / 대한핵의학회잡지

PURPOSE: As mesial temporal lobe epilepsy (TLE) shows hypometabolism of medial and lateral tempora lobe, we investigated whether symmetric uptake of F-18-FDG in medial temporal lobes can differentiat mesial from lateral TLE. MATERIALS AND METHODS: In 113 patients (83 mesial TLE, 30 lateral TLE) wh underwent anterior temporal lobectomy and/or corticectomy with good surgical outcome, we performe F-18-FDG PET and compared F-18-FDG uptake of medial and lateral temporal lobes. All the patients wi mesial TLE had hippocampal sclerosis except one congenital abnormal hippocampus. Patients with latera TLE revealed cerebromalacia, microdysgenesis, arteriovenous malformation, old contusion, and cortical dys plasia. RESULTS: Sensitivity of F-18-FDG PET and MR for mesial TLE was 84% (70/83) and 73% (61/83 respectively. Sensitivity of F-18-FDG PET and MR for lateral TLE was 90% (27/30) and 66% (20/30 respectively. Twelve patients were normal on F-18-FDG PET. 101 patients had hypometabolism of latera temporal lobe. Among 88 patients who showed hypometabolism of medial temporal lobe as well as later temporal lobe, 70 were mesial TLE patients and 18 were lateral TLE on pathologic examination. Positive predictive value of medial temporal hypometabolism for mesial TLE was 80%. Among 13 patients wh showed hypometabolism of only lateral temporal lobe, 4 were mesial TLE and 9 were lateral TLE. Positive predictive value of hypometabolism of lateral temporal lobe for the diagnosis of lateral TLE was 69% ( 13). Normal MR findings stood against medial TLE, whose negative predictive value was 66%. Conclusion Lateral temporal lobe epilepsy should be suspected when there is decreased F-18-FDG uptake in latera temporal lobe with normal uptake in medial temporal lobe.

Four case of silicone fluid induced acute pulmonary embolism / 대한내과학회지

Silicone(polydimethylsiloxane) is a liquid polymer, widely used for medical purpose, especially breast augmentation and other cosmetic procedures, with a minimal tissue reaction and a high degree of thermal stability. Illegal injections of slilicone in human beings, however have been associated with many adverse effects, including migration of the silicone, skin hypopigmentation, granulomatous hepatitis, mastitis, human adjuvant disease (progressive systemic sclerosis, SLE, mixed connective tissue disease, rheumatoid Arthritis, Hashimoto's thyroiditis, morphea, etc.). Pulmonary involvement has rarely been mentioned in the literature. We experienced the unusual four cases of respirtory difficulty after injection of liquid silicone in the breast, vigina, uterus, hip. They were all young adult female and previously healthy, one of them died of the injection, and the others survived with health. Two patients were admitted because of dypena, cough, chest discomfort and bilateral pulmonary infiltration after injection of silicone. Transbrochial lung biopsy and autopsy disclosed numerous oil like materials filling the alveolar septal capillaries and marcrophages. High resolution C.T. disclosed multiple alveolar lesion in the peripheral lesion of both lung. Transbronchial lung biopsy, autopsy, high resolution C.T. lung scan disclosed abnormalities compatible with silicone fluid induced pulmonary embolism, which is followed by acute respiratory distress syndrome, especially after injection of liquid silicone in the vagina, uterus. The other patients had mild dypnea, cough, pulmonary function test initially showed mild restrictive pattern in one patient. Lung scan disclosed abnormalities compatible with silicone induced pulmonary embolism, after injection in the hip, breast. It is strongly suggested that illegal injection of slilicone fluid carries pulmonary problem and can induce acute pulmonary embolism followed by acute respiratory distress syndrome, especially after silicone injection in vigina and uterus surrounded by numerous blood vessels.

Prognostic significance of epidermal growth factor receptor expression in human gastric carcinoma / 대한암학회지

No abstract available.

Genitoplasty by horizontal osteotomy

No abstract available.