Mesenchymal Chondrosarcoma of the Cervical Spine

Mesenchymal chondrosarcoma is a rare tumor occurring in both bone and soft tissues and exhibits characteristic of a malignant nature. The authors experienced a case of mesenchymal chondrosarcoma occurring in a 23-year-old woman which had invaded the cervical spine. The patient presented with severe both shoulder pain, left upper extremity weakness(Grade IV) and paresthesia at admission. Radiologic studies of the cervial spine showed an aggressive osteolysis of C4 vertebral body, pedicle and lamina with compression of the spinal cord posteriorly on C3, C4, C5 levels. The tumor was totally removed by a combined anterior and posterior approach. The removed vertebral body was replaced with autogenous bone and stabilized by Codman locking plate symtem. The pathological examination showed characteristic of mesenchymal chondrosarcoma.previous symptoms well improved postoperatively. The authors present a case of mesenchymal chondrosarcoma with review of literature.

Effect of Pinacidil on the Contraction of Rabbit Carotid Artery

The effect of pinacidil, a K+ channel opener, on the contraction of rabbit carotid artery was investigated by using muscle contraction and Ca2= uptake experiments. Pinacidil reduced phenylephrine-induced contraction by dose dependent manner, which was antagonized by glibenclamide, a blocker of the ATP sensitive K+ channel. Phenylephrine-induced tonic contraction was more reduced by pinacidil than its phasic contraction. In the effect of pinacidil on the Ca2+ uptake of rabbit carotid artery, pinacidil decreased it at the resting state of tissue, dose-dependently. Phenylephrine-induced stimulation of Ca2+ uptake was also reduced by pinacidil. Pinacidil 10micrometer reduced high potassium-induced contraction, which was not reversed by glybenclamide 10micrometer. Threshold concentration of K+ increased by pinacidil pretreatment. Phorbol 12, 13-dibutyrate, an activator of protein kinase C, induced sustained contraction of rabbit carotid artery, which was reduced by pinacidil but not antagonized by glibenclamide. In Ca2+-free buffer, pinacidil also decreased phorbol 12, 13-dibutyrate-induced contraction. These results indicate that pinacidil reduces Ca2+ uptake of vascular smooth muscle by stimulation of K+ channel which could be antagonized by glibenclamide, and another mechanism of vasorelaxation which could not be antagonized by glibenclamide. It was indecated that pinacidil affects the contaction of smooth muscle by the inhibition of protein kinase C.

Clinical Analysis and Treatment of Cervical Spine Injury

This study analyzed 88 patients who sustained a cervical spine injury during the past 4 years(Jan, 1993-May, 1996) in whom had 33 anterior, 21 posterior interventions were underwent and 34 remaining patients recieved conservative treatment with halovest. In 45 cases of upper cervical injuries, 16 operations were done. Among these, anterior approach was used in 3 patients and posterior approach in 13 patients. In 43 cases of lower cervical injuries, 39 operations were done. The anterior approach was used in 30 patients, posterior approach in 9 patients, and bilateral approached in remaing 4 cases. For patients with a predominent posterior ligamentous or osteoligamentous lesion, we selected anterior approach, when closed reduction was possible. Whenever the facet joint remained interlocked, a posterior approach was chosen. This report does not mentioned priority of anterior procedure at any case. Although clinical experience does not support the experimental data, we examined the reliability of anterior approach with use of internal fixation.

Delayed Nonunion of a Type II Odontoid Fracture, after Apparent Bony Fusion: Case Report

We managed a 27-year-old woman, who suffered from a type II odontoid fracture, with a halo-vest. After 12 weeks, we confirmed bony fusion on cervical spine CT and managed her with a neck collar. During the OPD follow up, we checked the cervical spine film every 1 month. After two and half months, displaced odontoid process was noted on routine cervical film, and a bony gap was found at the previous fracture wite on cervical spine CT. There is only one report in the literlature describing a nonunion after radiographically confirmed healing of a type II odontoid fracture. We report this case in order to emphasize the importance of scheduled follow up examination and evaluate precipitating factors of delayed nonunion of odontoid fracture.

Solitary Osteochondroma of the Atlas with Cervical Cord Compresion: Case Report

The following is the authors' case report of a 24-year-old man with solitary osteochondroma on the C1 posteior arch. The patient experienced an acute onset of cervical cord compression symptome after rotation injury. Cervical magnetic resonance imaging and cervical computed tomography reveald extensive extradural cervical spinal cord compression. As a result surgical removal of osteochondroma was performed. Osteochondroma is a rare cause of spinal pathology and neurological dysfunction. The above case of cervical osteochondroma with spinal cord compression is reported and the patholgical, clinical and radiological features are discussed with brief review of the literature.

Posterior Atlantoaxial Transarticular Screw Fixation with Interspinous Iliac Bone graft for Atlantoaxial Inxtability

Atlato-axial instability is a serious condition that often requires operation. Atlanto-axial subluxation may cause severe symptoms; and threaten the intergrity of the spinal cord, leading to quadriplegia or sudden death. A techique of combining C1-C2 posterior screw fixation with a supplemental bone wire fusion has been advocated for the management of atlantoaxial instability. It was used in 9 patients with this disorder. Patients ages ranged from 20 years to 52 years; follow-up period ranged from 3 to 16 months with a mean of 9.8 months. All nine patients gained immediate rigid fixation of C1,2 with this technique. Of these 9 patients, instability occurred due to trauma in seven, os odotoideum in one and os odontoideum with trauma in another one. One patient was presented with nonunion and C1,2 instability after a Halovest applications a result of type II odontoid fracture. All 9 patients were placed in a philedelphia collar for 12weeks and all achieved solid fusion. Posterior atlantoaxial facet screw fixation provides immediate multidirectional rigid fixation of C1,2 and is mechanically superior to siring or clamp fixation. This technique maximizes success without the need for a supplemental rigid external orthosis.

Transoral Decompression and Posterior Fusion for Unstable Os Odontoideum and Cord Compression: Case Report

The authors present the one case of a 22-year-old man admitted with intermittent quadriparesis and respiratory difficulty. On investigation, atlantoaxial instability and upper cervical cord compression due to abnormal soft tissue were revealed. We have performed transoral decompression and biopsy, and then posterior transarticular facet screw fixation with interspinous wiring and fusion. We could obtain immediate and long-term postoperative stability with Philadelphia collar only. The pathologic examination reveald connective soft tissue hypertrophy due to chronic mechanical irritation.

Blood Glucose Level and Neurological Outcome in Head-Injured Patients

The authors had analysed retrospectively a series of 286 consecutive patients with head injury who were admitted to the department of neurosurgery. Dong Gang Hospital between March and July, 1992. 59 cases underwent craniotomy for evacuation of intracranial hematoma and/or placement of subarachnoid bolt for intracranial pressure monitoring under general anesthesia. Patients with a Glasgow Coma Scale(GCS) Score of 8 or less had significantly higher serum glucose levels postoperatively than patients with GCS score of 12 to 15(p<0.05). Patients who subsequently remained in a vegetative state or died had significantly higher glucose levels postoperatively than patients who had good outcome or moderate disability(p<0.05). Among the more severely injured patients(GCS Score< or =8), a serum glucose level greater than 200mg/dl on admission is associated with a significantly worse outcome(p<0.05). The results suggest that severely head-injured patients frequently showed hyperglycemia and the elevted serum glucose level may worsen the neurological outcome in such patients.

Primary Intracranial Choriocarcinoma: Case Report

Primary intracranial choriocarcinoma is a extremely rare neoplasm since the case was reported by Askanasy, in 1906, there have been 35 reported, even if germinal neoplasms containing chorocarcinoma-like tissue are added. But pure choriocarcinoma was rarely reported. The purpose of this paper is to report a case of 18-year-old boy with tumor in subependymal region around left frontal horn, which was present with high level of serum beta chain of chorionic gonadotropin(B-HCG) and was verified as germine choriocarcinoma by biopay.

A Case of Penetrating Cranial Injury by a Wooden Foreign Body

Many objects create penetrating cranial injuries. Metallic objects and low velosity missiles are the most common offenders. Wood as wounding agent of the brain, has some characteristics. It has profound risk of infection, a significant propensity to fragmentation that is virtually undetechable on routine X-ray screening and very low atteunation value in CT scan. Because of its characteristics and rarity, we report a case of penetrating cranial injury by a wooden foreign body with review of literature.

Intracerebral Fungal Abscess Due to Candida Albicans

Intracerebral abscess secondary to Candida albicans is very rare but its incidence is increasing after the introduction of broad-spectrum antibiotics. Generally, in cerebral fungal abscess, multiple predisposing factors life diabetes mellitus were known. Before the introduction of broad-spectrum antibiotics, cryptococcosis was more prevalent than moniliasis. But after the introduction of broad-spectrum antibiotics, moniliasis was more prevalent than other fungal infections. A patient with multiple rain abscess due to Candida albicans is reported. This 17-year-old girl had diabetes mellitus for 1 year. This report presents a case of cerebral abscess of Candida albicans with its autopsy findings and the review of the literature.

Effect of Pentobarbital on Experimental Brain Edema in Rabbit

This study was undertaken to identify the effect of pentobarbital on the traumatic brain edema in the rabbit by measuring the regional specific gravity with modified serial copper sulfate method. After delivery of brain injury on the frontal area, the animals were sacrificed at 30 minutes, 2 hours, 4 hours and 6 hours. And the regional specific gravity was taken in the frontal lobe, occipital lobe, basal ganglia, cerebellum, pons and medulla. The specific gravity after administration of pentobarbital(40mg/kg) in the head-injured rabbit was also taken with the same method and compared with the specific gravity in the absence of pentobarbital to identify the effect of pentobarbital on the brain edema. The results were summarized as follows: 1) The brain edema was peak at 4 hours after head trauma. 2) Significant increase of specific gravity was noted in all regions at 30 minutes, 2 hours and 4 hours after administration of pentobarbital. The findings were similar to both contused and uncontused sides. But all specific gravity data were decreased in all regions at 6 hours. 3) The decrease in brain water content was peak at 30 minutes after administration of pentobarbital, but almost brain water content was reversely increased at 6 hours. These results suggest that the pentobarbital was effective in decreasing the brain edema.