Surgical Treatment of Spinal Extradural Arachnoid Cyst: A Case Report

STUDY DESIGN: A case report. OBJECTIVES: To report a case of spinal extradural arachnoid cyst. SUMMARY OF LITERATURE REVIEW: Extradural arachonid cysts of the spine are a rare cause of spinal cord and nerve root compression. There are few reports about it, and the etiology remains unclear. MATERIALS AND METHODS: The authors performed a clinical and radiographic case review. RESULTS: A 56-year-old male patient presented with both lower extremity radiating pain and tingling sensation in both feet for four years. His MRI revealed a large, well-demarcated extradural lesion, isointense to cerebrospinal fluid from L1 to L3. We performed dural repair and laminectomy for partial resection of the cyst. The outcome was good in the immediate postoperative period, and the patient made a full recovery without complications. CONCLUSIONS: Surgical treatment should be considered for large spinal extradural arachnoid cysts with neurologic symptoms when conservative treatment does not work.

Development of a Semi-automatic Computer System to Register MRI Lesions Onto a Brain Template for Quantitative Analyses in Clinical Trials Having MRI Findings as Surrogate Endpoints: A Preliminary Report

BACKGROUND: Clinical trials that utilize imaging findings as surrogate endpoints are considered to be cost-effective. However, unlike numeric data, magnetic resonance imaging (MRI) findings are not quantifiable. Thus, we have begun to develop a software package that is able to convert qualitative MRI findings into quantifiable data. METHODS: Computer software (DUIH_Image) was created with which every patient's MRI data can be registered on a standard brain template. Interuser and intrauser reliabilities for the registration were measured, and then a proof-of-principle experiment was conducted to determine whether the system could identify factors that were associated with a greater National Institutes of Health Stroke Scale (NIHSS) score at admission. We studied 40 consecutive patients [65.1+/-14.2 years old (mean+/-SD); 22 males and 18 females] with first-ever acute lacunar infarction of the corona radiata, who were divided into two groups according to their NIHSS score (i.e., low: 0-2; high: > or =3). The following parameters were compared between these two groups: (1) data retrieved from clinical profiles, including demographic and risk factor variables; and (2) accumulated diffusion MRI lesions mapped on a standard template. RESULTS: Modest levels of interuser and intrauser reliability were observed (p<0.05, R(2)=0.63-0.84, Pearson correlations). Regarding the clinical profiles, no significant difference was found for the numeric data sets or infarct size between the two groups. However, on the accumulated lesion map image, the lesion area that overlapped the most was located more posterolaterally in the high NIHSS score group than in the low NIHSS score group. CONCLUSIONS: In this pilot study we have demonstrated the potential usefulness of the DUIH_Image software. We plan to update this software to enable its utilization in actual clinical trials.

Molecular Optical Imaging of Cathepsin-B Proteolytic Enzyme Activity to Reflect Atherosclerosis Pathophysiology and Anti-Atherosclerotic Therapeutic Effect

BACKGROUND: Protease-sensing molecular optical imaging can potentially identify vulnerable atherosclerotic plaques before cerebral infarcts occur. However, several translational issues need to be resolved before implementing human trials and clinical applications of the technique. We investigated whether molecular optical imaging reflects (1) atherosclerosis pathophysiology and (2) the atherosclerosis-modulating effect of a Western diet or atorvastatin treatment in ApoE-knockout mice. METHODS: We fed 21 8-week-old ApoE-knockout mice a normal chow diet (n=7), a Western diet (n=7), or a Western diet with atorvastatin (n=7) for 14 weeks. Blood was collected for measuring cholesterol levels at 24 hours after injecting the cathepsin-B (CatB) probe into the tail vein. Near-infrared fluorescence reflectance imaging of CatB activity was performed after excising the aorta. RESULTS: CatB molecular optical imaging precisely reflected the pathophysiologic alteration of atherosclerosis. The CatB activity signal was significantly stronger in the Western diet group (49.3+/-26.0 [mean+/-SD], arbitrary units) than in the atorvastatin group (25.3+/-8.7) and the normal chow diet group (20.6+/-21.1). The effect of the statin on CatB activity was independent of cholesterol lowering. CONCLUSIONS: CatB-sensing molecular optical imaging represents a valuable tool for evaluating atherosclerosis pathophysiology and for monitoring the effects of antiatherosclerotic therapeutic interventions.

Acute Ischemic Polyneuropathy after Acute Abdominal Aortic Occlusion: A case report

A 45-year-old man with a long history of nephrotic syndrome presented with low back pain and progressive weakness of both legs for one day. Physical examination showed an acutely ill-appearing patient with a loss of both femoral artery pulses. Immediate digital subtraction angiography of abdominal aorta revealed total occlusion of the distal abdominal aorta. Transvascular embolectomy using urokinase was undertaken 6 hours later. Digital subtraction angiography after embolectomy revealed both common ilicac arteries to be patent with good distal flow. Electrodiagnostic examinations (post embolectomy 5th and 45th day) revealed peripheral polyneuropathy of both lower extremity. Anticoagulation therapy was continued and the patient was discharged several months later. During this period, there was improvement in both lower limbs from power of grade 1 to 4 except for both ankle dorsiflexors which had not recovered. We report a rare case of peripheral ischemic polyneuropathy of both lower extremities as the result of acute abdominal aortic occlusion.

Relationship among Estradiol, Lipid Profile, Biochemical Markers, and Bone Mineral Density according to Postmenopausal Period

OBJECTIVE: To determine whether estradiol (E2), lipid profile, biochemical markers, and bone mineral density (BMD) are related according to postmenopausal period. METHOD: One hundred fifty four women were divided into four groups according to the time past menopause: group I (0~5 years), group II (6~10 years), group III (11~15 years), group IV (more than 16 years). Group I, II, III were subdivided into osteoporosis group (t-score or = 2.5). E2, lipid profile, osteocalcin, alkaline phosphatase, deoxypyridinoline, and BMD by DEXA were measured in all groups. RESULTS: There were significant inverse correlation between BMD and postmenopausal period (p<0.05). Deoxypyridinoline and osteocalcin were correlated with postmenopausal period but there was no statistical significance. Deoxypyridinoline and osteocalcin were increased in osteoporosis group compared to non-osteoporosis group but there was no statistical significance. E2 had significant inverse correlations with postmenopausal period (p<0.05). E2 had no correlation with factors such as biochemical markers and lipid profile in group I, II, III but had adverse correlation with deoxypyridinoline in group IV. CONCLUSION: No specific biochemical markers regarding the duration of menopause were found. Regardless of the duration of menopause, checking both osteocalcin and deoxypyridinoline was statistically significant for the evaluation of postmenopausal osteoporosis.

Usefulness of Questionnaires, Physical Examination and Median Mixed Nerve Conduction Studies in Patients with Diabetes Mellitus

OBJECTIVE: To find simple screening method for assessment of patients with diabetic neuropathy by use of brief questionnaire, scored physical examination including vibration perception threshold, and mixed median conduction study. METHOD: Subjects were 24 patients with diabetes mellitus. Conventional nerve conduction study was performed in 24 patients and the patients were divided into two groups: 11 patients with polyneuropathy; 13 patients of normal findings. The questionnaires were given for evaluation of sensory function in all the subjects. The questionnaires were followed by physical examination including two point discrimination, vibration perception threshold by using biothesiometer, 10 gram filament test, pin prick test, DTR check, and muscle strength test. Abnormality was determined by the number of positive responses or abnormal clinical findings. Finally, we recorded the conduction velocity and amplitude of median mixed nerve and compared these parameters to values of 20 normal adults. RESULTS: The questionnaire and physical exam scores were higher in patients with polyneuropathy (p<0.01). The patients with polyneuropathy showed higher vibration perception threshold values (p<0.01) and slower conduction velocity and smaller amplitude of median mixed nerve (p<0.05). In correlation with conventional nerve conduction study, the median mixed nerve conduction velocity had higher kappa value than amplitude in screening for diabetic polyneuropathy. CONCLUSION: We suggest the questionnaires, scored physical examination, vibration perception threshold, and median mixed nerve conduction velocity to be a simple screening method for assessment of patients with diabetic plyneuropathy.

Muscle Fiber Conduction Velocity and Histopathologic Findings after Intramuscular Injection with 7% Phenol Solution in Rat

OBJECTIVE: To investigate the muscle fiber conduction velocity and histopathologic changes in skeletal muscle after 7% phenol solutions intramuscular injection. METHOD: Forty-five Sprague Dawley rats were divided into two groups: Experimental group, 30; Control group, 15. Experimental and control groups were injected with 0.1 cc of 7% phenol solution and 0.9% saline in right gastrocnemius, respectively. The histopathologic findings and muscle fiber conduction velocity were evaluated at 0, 1, 5, 14, and 28 days after each injection. RESULTS: In the light microscopic examination of experimental groups, vacuolar change, atrophy of myofibers, and intermyofiber cell proliferation were shown. The expression of synaptophysin began to be seen at 5 days and S-100 protein was increased 14 days after injection. In the electron microscopic examination of experimental groups, vacuolar change and denuded postsynaptic membrane were shown. In muscle fiber conduction study of experimental groups, the mean velocity were significantly slowed at 1, 5, 14, and 28 days after injection than those of control groups (p<0.05). CONCLUSION: On the basis of histopathologic findings, it is presumed that the mechanisms of paralysis following intramuscular injection of 7% phenol solutions were both myogenic and neurogenic. The slowing of muscle fiber conduction velocity tended to be related with the histopathologic changes of skeletal muscles after intramuscular injection with 7% phenol solution.