Decompressive Sacral Foraminotomy for Nerve Root Injury during Conservative Treatment of Sacral Fracture: A Case Report

A 35-year-old woman visited the emergency department for a pedestrian traffic accident. Severe tenderness was noted at the posterior sacrum area, without open wound or initial neurologic deficit. Fracture of the left sacral ala extended to the S1 foramen, anterior acetabulum, and pubic ramus. Two weeks after the injury, she presented aggravating radiculopathy with the weakness of the left great toe plantar flexion. The S1 nerve root was compressed by the fracture fragments in the left S1 foramen. Decompressive S1 foraminotomy was performed. The postoperative follow-up computed tomography scan showed successful decompression of the encroachment, and the patient recovered well from the radiculopathy with motor weakness. She was able to resume her daily routine activity. We suggest that early decompressive sacral foraminotomy could be a useful additional procedure in selective sacral zone II fractures that are accompanied by radiculopathy with a motor deficit.

Decompressive Sacral Foraminotomy for Nerve Root Injury during Conservative Treatment of Sacral Fracture: A Case Report

A 35-year-old woman visited the emergency department for a pedestrian traffic accident. Severe tenderness was noted at the posterior sacrum area, without open wound or initial neurologic deficit. Fracture of the left sacral ala extended to the S1 foramen, anterior acetabulum, and pubic ramus. Two weeks after the injury, she presented aggravating radiculopathy with the weakness of the left great toe plantar flexion. The S1 nerve root was compressed by the fracture fragments in the left S1 foramen. Decompressive S1 foraminotomy was performed. The postoperative follow-up computed tomography scan showed successful decompression of the encroachment, and the patient recovered well from the radiculopathy with motor weakness. She was able to resume her daily routine activity. We suggest that early decompressive sacral foraminotomy could be a useful additional procedure in selective sacral zone II fractures that are accompanied by radiculopathy with a motor deficit.

The Impact of Fentanyl Matrix on Pain and Function in Spinal Disorder-Related Chronic Pain: An Open Label Trial in Korea

STUDY DESIGN: This is a multicenter, open-label prospective, non interventional study. PURPOSE: We wanted to evaluate the impact of fentanyl matrix on the pain and function of patients with spinal disorder-related chronic, non-malignant pain. OVERVIEW OF LITERATURE: Patients with severe non-malignant chronic low back pain may require opioid analgesics for effective pain management. METHODS: A total of 1,576 patients with severe pain (numeric rating scale = 7) were evaluated for their pain intensity at the initial visit and at weeks 4 and 8 (Visits 1, 2, and 3, respectively). Disturbances in sleep, daily living and social activities, the Oswestry Disability Index (ODI), the researchers' and patients' global assessment and the patients' treatment preference were also assessed. RESULTS: The pain intensity score significantly decreased from 8.1 at Visit 1 to 5.4 and 4.4 at Visits 2 and 3, respectively. Sleep disturbance also significantly decreased and the extent of disturbance of daily and social activities was also significantly improved. The ODI significantly decreased from 61.9% to 45.8% and 38.2% at Visits 1, 2, and 3, respectively. Adverse events were reported by 197 (12.5%) patients and severe adverse events were reported by 12 (0.76%) patients. Overall, 76.3% of the patients and 78.4% of the investigators rated the test drug as effective. CONCLUSIONS: The fentanyl matrix is believed to be effective for the treatment of pain, sleep disturbance and the impact upon daily and social activities, yet physicians should pay attention to the risks of abuse and the adverse events.

Surgical Consideration for Internal Carotid Superior Wall Aneurysm

Seven cases of aneurysm arising from the superior wall of the internal carotid artery were operated on from January 1993 through December 1997. They consist of 3.7% among 191 operated cases of the internal carotid artery aneurysms and 1.2% among 590 operated cases of total intracranial aneurysms. Aneurysmal adhesion to the optic nerve was observed in five cases and the arteriosclerotic change in two cases. Four aneurysms were blister-like and thin-walled, and the other two aneurysms were covered with thick hematoma. Premature rupture occurred in three cases, two cases during aneurysmal clipping and one case during aneurysmal dissection. In three cases the aneurysms were clipped, and in the other four cases the aneurysms were wrapped circumferentially with the dacron mesh silastic sheet and clipped. Among the four wrap-clipping cases, two cases were associated with very fragile aneurysmal walls. There were neither clip sliding nor the regrowth of aneurysms on the following angiograms. The Glasgow Outcome Scale at discharge showed good recovery in five cases, moderately disabled in one case, and severely disabled in one case. In conclusion, wrap-clipping with the silastic sheet is helpful for the superior wall aneurysms of internal carotid artery with very fragile and thin walls or avulsion of aneurysmal neck.

Effect of Trolox, Cycloheximide or MK-801 on the Neuronal Cell Death Induced by FeCl2, Buthionine Sulfoximine or KCN in Primary Murine Mixed Cortical Cell Culture

Oxidative stress is known to be a major neuropathologic mechanism in chronic neurodegenerative disorders as well as in stroke, trauma and epilepsy, and many kinds of oxidative insults induce neuronal injury. The purpose of this study was to examine the temporal effects of trolox(TLX; water and lipid soluble vitamin E analog), cycloheximide(CHX; protein synthesis inhibitor) and MK-801(NMDA receptor antagonist) on neuronal death indu-ced by different kinds of oxidative insults in primary murine mixed cortical cell culture(14-16 days in vitro), and to gain information on the mechanisms underlying oxidative cell death. As oxidative insults, the authors used iron(FeCl2), buth-ionine sulfoximine(BSO; glutathione depletor) and potassium cyanide(KCN; ATP depletor). Cell death was assessed by measurement of LDH efflux to bathing media at the end of exposure. All three agents induced neuronal cell death associated with cell body swelling. FeCl2(30nM-1mM) induced conce-ntration- and exposure time-dependent neurotoxicity, while BSO(10nM-3mM) showed little neurotoxicity at the end of 24 hrs exposure, but marked neuronal cell death at the end of 48 hrs; at concentrations of over 100uM of BSO neurotoxicity reached a plateau. KCN(0.1mM-1mM) also showed dose-dependent neurotoxicity. TLX(100nM) did not affect the neurotoxicity induced by KCN(1mM) but almost completely block BSO(1mM)- or FeCl2(100, 300nM)- induced neuronal cell death. CHX(1ng/ml) significantly attenuated BSO-induced cell death but did not protect against KCN(1mM)-induced cell death. CHX treatment, on the other hand, significantly potentiated FeCl2(100 or 300nM)-induced death. MK-801(10nM) markedly inhibited KCN-induced cell death but had no effect on FeCl2-induced death. MK-801 also significantly attenuated BSO-induced neurotoxicty after exposure for 48hrs but this protective effect disappeared at the end of 72hr. These results suggest that protein synthesis as well as lipid peroxidation of cell membrane may involve oxidative neuronal injury and that one oxidative agent may induce various cell death processes.

A Case of Subclinical Hypothyroidism Associated with Turner's Syndrome / 대한내분비학회지

Recently it is known that Turner's syndrome is frequently associated with hypothyroidism. We report a case of Turner's syndrome associated with subclinical hypothyroidism. A 23-year-old female was admitted to the hospital with complaints of amenorrhea and short stature. She had a mosaicism of 45, X0/46, Xi(X_q) in the cell, cultured from the peripheral blood. The plasma thyroxine and triiodothyronine were normal and there was no clinical symptom of hypothyroidism. But the thyroid-stimulating hormone(TSH) concentration was unusually higher(184 uU/L). She has been treated with the cyclic therapy of conjugated estrogen and medroxyprogesterone, in addition to the thyroxine replacement therapy. After 2 months, the menstruation was restored and TSH was normalized.

Studies on the Changes of Blood Pressure and Heart Rate by Intracerebroventricular Bicuculline in Rabbits

To elucidate the role of CNS GABA ergic system in the regulation of cardiovascular function, the effects of intracerebroventricular(icv) bicuculline(BIC), a selective GABAA antagonist, on blood pressure and heart rate were investigated in urethane anesthetized rabbits. 1) Icv BIC produced dose-dependent pressor and bradycardiac effect, while intravenous(iv) BIC had no effect on blood pressure and heart rate. 2) The pressor effect of BIC(10(g) was significantly attenuated by pretreatments with icv ketamine(5 mg) or icv diazepam(0.1 mg, 1 mg). Bilateral vagotomy and pretreatment with icv mecamylamine(0.2 mg), iv chlorisondamine(1 mg/kg), in phentolamine(1 mg/kg) did not affect the pressor action. 3) The bradycardiac effect of BIC(10(g) was abolished or reversed to slight tachycardia by bilateral vagotomy and pretreatment with icv ketamine(2.5 mg, 5 mg), icv diazepam(0.1 mg, 1 mg) and iv chlorisondamine(1 mg/kg). Neither icv mecamylamine(0.2 mg) nor iv phentolamine(1 mg/kg) affected the bradycardia. These results suggest that blockade of GABAA receptor produce pressor action which is associated with central excitatory amino acid system and produce reflex bradycardia induced by the pressor effect, and that sympathetic nervous system might not be involved in the pressor effect.

Clinical Observation on Effect of Diltiazem(Herben(R)) in Angina Pectoris

We evaluate the effects of diltiazem in 19 patients with ischemic heart disease (15 patients) of classical anginal pectoris & 4 patients of variant angina) by means of clinical status & electrocardiographic changes and obtain the results as follows: 1. The pulse rate & blood pressure were decreased by diltiazem slightly but these decreases were not significant in statistical meaning. 2. Diltiazem administration of 4 weeks duration normalized EKG completely in 4 patients & partially in 3 patients among the 13 patients who showed abnormal resting EKG initially. 3. All 19 patients who received diltiazem showed clinical improvement; 9 patients had excellent responses, 7 patients good responses & 3 patients fair responses. 4. Diltiazem had side effects in 3 patients, drowsiness, mild euphoria & possibly tolerance respectively in each patients.