Exercise-Induced Paraspinal Muscle Rhabdomyolysis with Seconary Compartment Syndrome: A Case Report

Lumbar paraspinal compartment syndrome is an uncommon cause of acute lower back pain. It can result from intense physical activity or as a complication of surgery or medication. Lumbar paraspinal compartment syndrome without external trauma is rarely reported in literature. We report a case of compartment syndrome that followed back muscle exercise and caused rhabdomyolysis. MRI findings include bilateral bulging of the paraspinal muscle, hyperintensity on T2-weighted image, and heterogeneous enhancement. Moreover, loss of intramuscular vasculature on a contrast-enhanced CT scan attributed to diagnose compartment syndrome in this case.

Association between the serum TSH concentration and thyroid cancer incidence / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the association between serum TSH concentration and thyroid cancer incidence.</p><p><b>METHODS</b>Three hundred and thirty patients with thyroid tumors who underwent surgical treatment were included in this study (99 cases of malignancy and 231 cases of benign tumors). The data of their serum TSH level, gender, age, tumor type, and number of tumors detected by ultrasonic inspection were retrospectively analyzed, and their association with thyroid cancer incidence was explored.</p><p><b>RESULTS</b>The proportion of thyroid cancer in the groups of younger than twenty years and older than seventy years were 63.0% and 58.3%, respectively, significantly higher than that in the group of age between 60 and 69 years (23.3%, P < 0.05). The incidence of thyroid cancer of the 81 male patients was 43.2%, significantly higher than that in the 249 female patients (25.7%, P = 0.003). The incidence of thyroid cancer in the 112 patients with single nodule was 42.0%, significantly higher than that in the 218 patients with multiple nodules (23.9%, P < 0.001). In the groups with TSH level lower than 0.28 mIU/L and higher than 4.20 mIU/L, the incidence of thyroid cancer were 54.6% and 50.0%, respectively, significantly higher than that in the group with TSH level between 0.28 and 1.44 mIU/L (16.1%, P < 0.05). The proportion of patients with thyroid cancer was also increased with the increasing serum TSH level in the normal range (P < 0.001). High serum TSH level (OR = 1.465, P = 0.014), male (OR = 1.964, P = 0.016) and a single thyroid nodule (OR = 2.090, P = 0.006) are independent risk factors of thyroid cancer.</p><p><b>CONCLUSION</b>The high serum TSH level, male, single thyroid nodule are factors leading to a high incidence of thyroid cancer.</p>

Spinal Intradural Extramedullary Cavernoma Presenting with Intracranial Superficial Hemosiderosis

A case of intradural extramedullary cavernous angioma is presented with headache, dizziness, and bilateral sensorineural hearing loss caused by an intracranial superficial hemosiderosis. It was incidentally found in a patient with a 3-month history of sustained headache, dizziness and a 3-year history of hearing difficulty. The neurological examination was unremarkable in the lower extremity. MR images showed an intracranial superficial hemosiderosis mostly in the cerebellar region. Myelography and MR images of the thoracolumbar spine revealed an intradural extramedullary mass, which was pathologically proven to be a cavernous angioma. T12 total laminoplastic laminotomy and total tumor removal were performed without any neurologic deficits. The patient's symptoms, including headache and dizziness, have been absent for three years. Intradural extramedullary cavernous angioma can present with an intracranial superficial hemosiderosis as a result of chronic subarachnoid hemorrhage.

Dystrophic Calcification in the Epidural and Extraforaminal Space Caused by Repetitive Triamcinolone Acetonide Injections

The authors report a case of epidural and extraforaminal calcification caused by repetitive triamcinolone acetonide injections. A 66-year-old woman was admitted presenting with lower extremity weakness and radiating pain in her left leg. Ten months before admission, the patient was diagnosed as having an L4-5 spinal stenosis and underwent anterior lumbar interbody fusion followed by posterior fixation. Her symptoms had been sustained and she did not respond to transforaminal steroid injections. Repetitive injections (10 times) had been performed on the L4-5 level for six months. She had been taking bisphosphonate as an antiresorptive agent for ten months after surgery. Calcification in the ventral epidural and extraforaminal space was detected. The gritty particles were removed during decompressive surgery and these were proven to be a dystrophic calcification. The patient recovered from weakness and radiating leg pain. Repetitive triamcinolone acetonide injections after discectomy may be the cause of dystrophic calcification not only in the degenerated residual disc, but also in the posterior longitudinal ligament. Possible mechanisms may include the toxicity of preservatives and the insolubility of triamcinolone acetonide. We should consider that repetitive triamcinolone injections in the postdisectomy state may cause intraspinal ossification and calcification.

Long-term Sequela of Intradural Extramedullary Tuberculoma in the Thoracic Dorsal Spinal Cord: Case Report and Review of the Literature

A 45-year old man, who had tuberculosis five years ago presented with paresthesia, decreased proprioception, and gait disturbance in the lower extremity which were aggravated for a month. Magnetic resonance imaging revealed the T3-7 intradural extramedullary fibrotic mass with dark signal intensity on T2-weighted images. The yellowish material in the thick fibrous mass was confirmed as caseous necrosis. Two days after the operation, the symptoms improved. Although quite rare, intradural extramedullary tuberculoma should be considered as a chronic sequel of the previous medical history of pulmonary tuberculosis or tuberculous meningitis.

Eosinophilic Granuloma in an Adult Thoracic Spine: A Case Report

In adults, eosinophilic granuloma of the spine is a rare, benign osteolytic lesion. In a case of a 33-year-old man with neurologic deterioration, magnetic resonance imaging (MRI) showed an osteolytic lesion of the T4 vertebra with spinal cord compression. Involvement of the left pedicle of T4 and paravertebral soft tissue was also observed. On the second day after a fluoroscopic percutaneous needle biopsy, the patient abruptly developed paraplegia. He underwent an emer- gency operation with posterior decompression, followed by anterior stabilization and corpectomy several days later. Histological examination of the tissue, including the paravertebral soft tissue, showed features of eosinophilic granuloma. After surgery, the patient returned to full activity. Eosinophilic granuloma of the spine is a rare disease in adults and may affect all the vertebral structures. Surgical treatment seems necessary for cases specifically involving progressive neurologic deficits.

Bowel preparation with sodium phosphate versus polyethylene glycol: a prospective, randomized, controlled clinical trial / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the efficacy, tolerance and safety between oral sodium phosphate(NaP) and polyethylene glycol(PEG) on bowel preparation.</p><p><b>METHODS</b>One hundred and fifteen inpatients were randomly divided into NaP group and PEG group. The questionnaire was designed for scoring by patients and doctors regarding to tolerance, taste, side effects and cleaning degree etc.</p><p><b>RESULTS</b>Compared with PEG group, NaP presented better tolerance, lower side effects and higher rate of adequate cleaning quality(P<0.05). NaP could cause electrolytic alterations, such as hyperphosphatemia, hypernatremia, hypocalcemia and hypopotassemia, but these changes were transient and without clinical significance.</p><p><b>CONCLUSION</b>Sodium phosphate is safe and effective for bowel preparation, and is better than polyethylene glycol in tolerance.</p>

Unilateral Augmented Pedicle Screw Fixation for Foraminal Stenosis

OBJECTIVE: The purpose of this study is to evaluate the effectiveness of unilateral decompression and pedicle screw fixation for the unilateral symptomatic foraminal stenosis. METHODS: The study group comprises consecutive 16 patients who underwent unilateral decompression and bone cement augmented pedicle screw fixation from May 2003 to January 2006. The patients were evaluated by visual analog scale (VAS) for pain and the scoring system of the Japanese Orthopedic Association (JOA) for low back pain. The result of surgery was also evaluated with McNab's classification. Excellent or good outcome was considered as successful. The patients were followed at postoperative 1 month, 3 month, 6 month, and 1 year with standing AP and lateral films. RESULTS: The average VAS and JOA score of the 16 patients were 7.8 (range, 6-9) and 5.8 (range, 3 - 10) before surgery and 2.2 (range, 0 - 5) and 12.3 (range, 9 - 15) at the time of last follow up. Both VAS and JOA score improved significantly after the surgery (p < 0.05, t-test). All patients improved after the operation and no revision surgery was required. No metal failure or pseudoarthrosis was observed during the follow-up. The success rate was 87.5%. CONCLUSION: Our data suggest that unilateral decompression and pedicle screw fixation for the unilateral symptomatic foraminal stenosis is an effect method for obtaining satisfactory clinical outcome. Its possible advantage is shorter operation time and reduced surgical extent. We believe that the reduced stiffness of unilateral fixation was compensated by pedicle screw augmentation and interbody fusion.

Cervical Intervertebral Disc Arthroplasty: Update

Since 1966 the first metal ball shape implant was inserted into the cervical and lumbar areas by Dr. Fernstrom, numerous attempts and prostheses have been tried to maintain physiologic range of motion and prevent adjacent segment degeneration (ASD) after surgery. However fusion itself is not a single causative factor of ASD and other biologic factors including natural progression of degenerative process and mechanical factors also contribute in the development of ASD. Several well designed prospective randomized control studies for Bryan disc and Prodisc C have been recently documented preservation of spinal motion, superior or, at least, equivalent clinical outcome in comparing with anterior cervical arthrodesis, and less adverse postoperative events both in frequency and severity. Still remained or undetermined problems in cervical arthroplasty are heterotopic ossifications, segmental kyphosis of implanted levels, MR imaging compatibility, vertebral body fracture by keeled prostheses and long term wear properties. In spite of these unsolved problems and incompleteness of prosthetic design, cervical arthroplasty is now considered as one of standard methods in surgical management of one or two level cervical disc diseases and its indication may be broader in near future.

Paragangliomas in Cauda Equina Region: Clinicopathoradiologic Findings in Four Cases

OBJECTIVE: Four cases of non-secreting paraganglioma of the cauda equina are present with an emphasis on magnetic resonance (MR) images correlated with pathological features. METHODS: From 1973 to 2001, 703 patients with spinal cord tumors had been treated with surgery at our hospital. Among them, four patients had been diagnosed as paragangliomas, all of which occurred in the cauda equina. We analyzed clinical data, including medical records, radiological, and histopathological findings for four patients. RESULTS: Some findings may help us to differentiate spinal paraganglioma from other spinal tumors. The MR images of the tumor were generally nonspecific. However, tumor margins were hypointense on T2-weighted images and serpiginous flow voids were noted in the tumor. Histopathologically paragangliomas were composed of an organoid or `zellballen' arrangement of polyhedral and argyrophilic cells, circumscribed by a richly vascular stroma. Immunohistochemical examination showed positive reaction to synaptophysin, chromogranin, vimentin, neuron specific enolase, and S100 protein. CONCLUSION: Although it is difficult to make a correct diagnosis as paraganglioma preoperatively for the intradural extramedullary tumors, especially in the cauda equina, paraganglioma should be included in the differential diagnoses.

Unusual Giant Mycotic Aneurysm at the Middle Cerebral Artery: Case Report / 대한뇌혈관학회지

Aneurysms at the distal branch of the middle cerebral artery may be mycotic or congenital in origin. A 34 year-old male patient was admitted with a seizure and a 7-day history of upper respiratory tract infection. The neurological examination showed no abnormality except for headache and mild dysarthria. There was no intracardiac lesion suggesting infective endocarditis. CT, MRI and cerebral angiograms revealed a partially thrombosed giant aneurysm at the distal branch of the middle cerebral artery. Pathologic examination revealed acute inflammatory cells and focal necrosis in the aneurysmal wall as well as recent thrombus. Here, we are reporting an unusual case with a giant distal middle cerebral artery aneurysm with intramural inflammation, suggesting a congenital giant aneurysm with secondary infectious inflammation.

The Effect of alpha MSH Analogues on Rat Bones

Melanocortin is the downstream mediator of leptin signaling and absence of leptin signaling in ob/ob and db/db mice revealed the enhancement of bone formation through the central regulation. While alpha-melanocyte-stimulating hormone (alpha MSH) inhibits the secretion of interleukin-1 alpha and tumor necrosis factor-alpha from the inflammatory cells, alpha MSH can also enhance clonal expansion of pro B cells linked to stimulation of osteoclastogenesis. Therefore, we tested the effect of melanocortin on bones. alpha MSH analogues [6His] alpha MSH-ND and [6Asn] alpha MSH-ND were synthesized and the radio-ligand receptor binding- and cyclic AMP generating activity were analyzed in China Hamster Ovary cell line over- expressing melanocortin receptors. The EC50 of [6His] alpha MSH-ND measured from melanocortin-1, 3, 4 and 5 receptors were 0.008 0.0045, 1.523 0.707, 0.780 0.405, and 250.320 42.234 nM, respectively, and the EC50 of [6Asn] alpha MSH-ND were 16.8 6.94, 271.8 21.95, 8.0 1.21, and 1132.5 635.46 nM, respectively. Four weeks after the subcutaneous injection of the analogues, the body weights in the [6His] alpha MSH-ND and the [6Asn] alpha MSH-ND treated groups (346.0 20.63 g vs. 350.0 13.57 g) were lower than that of the vehicle treated group (375.8 17.31 g, p 0.05). There was no difference in the total femoral BMD measured by dual x-ray absorptiometry among the three groups. Among the three groups, there were no differences in the total numbers of crystal violet positive- or alkaline phosphatase positive colonies, in the expression of Receptor Activator of Nuclear Factor Kappa-B ligand on the tibia and the total number of multinucleated osteoclast-like cells differentiated from primary cultured bone marrow cells. From the above results, no evidence of bone gain or loss was found after treatment of the alpha MSH analogues peripherally.

Clinical Characteristics of Geriatric Brain Tumors

OBJECTIVE: The authors analyze the clinical characteristics of the geriatric brain tumors and suggest the treatment modality. METHODS: Patients older than 65years, managed between Jan 1980 and Feb 2002 in our department, were included in this study and the number of patients was 315. Age, sex, medical history, performance scale, treatment modality, morbidity and mortality as well as the incidence of brain tumor in this age group were analyzed. RESULTS: Geriatric brain tumors were comprised of 7.8% of the adult brain tumors. The mean age was 68.7 years and male to female ratio was 1 : 1.3. The most common one was meningioma(114, 36.2%), followed by metastatic tumor(49, 15.6%), high grade glioma(39, 12.4%), schwannoma(38, 12%) and pituitary adenoma(35, 10.5%) in the order of frequency. The incidence of pre-existing disease, such as hypertension(25%), caridiovascular disease(15%), diabetes melitus(12%) was high. Surgical outcome was good with acceptable operative morbidity and mortality rate 26% and 3% respectively. Frequent postoperative surgical complications were tumor bed bleeding and wound infection. During perioperative course, medical complications such as cardiovascular problem, delirium, pneumonia and sepsis were common. CONCLUSION: Incidence of combined medical problem in the geriatric patients was considerablly high. However, in the case of surgically accesible benign tumor or even malignant tumor, surgical treatment should be considered.