Anomalous systemic arterial supply to lung without sequestration in an infant who has congenital heart disease: a case report / 소아과

Systemic arterial supply from the aorta to the lung is a rare congenital anomaly within the spectrum of bronchopulmonary sequestration according to Pryce's terminology. We describe our experience of this anomaly in an infant with congenital cardiac disease confirmed by multidetector CT scan. We found a systemic arterial supply from the aorta to the right lower lobe of lung without right lower lobar pulmonary artery and bronchopulmonary sequestration. This combination of congenital anomaly is most rare form.

One Stage Spondylodesis for the Bursting Fracture of the Thoracolumbar Spine Through Unilateral Posterior Approach

OBJECTIVE: The purpose of this study is to report the technical feasibility and the result of one stage operation for the bursting fracture of the thoracolumbar spine by posterior approach. METHODS: Seven patients underwent corpectomy and replaced the space with titanium mesh cage filled up with autologous bone pieces through unilateral posterior route after removal of the facet joint and the pedicle followed by pedicle screw fixation at the same surgical field. RESULTS: All patients tolerated the procedures well except one patient complicated with air embolism. Postoperative radiographs showed effective decompression and well placed instruments. Preoperative neurological deficits disappeared completely in two patients but some deficits persisted in the remainders. In two patients, epidural venous bleeding was troublesome and he needed transfusion of 5 pints of packed red blood cell. And another patient complicated with air embolism during operation was recovered with impunity after operation. To insert the mesh cage through the narrow corridor posterolaterally, it was unavoidable to sacrifice one spinal root. CONCLUSION: In spite of technical difficulty, one stage spondylodesis for the bursting thoracolumbar spine though unilateral posterior approach seem to be an effective operative procedure.

Differences in Biomechanical Factors for Fusion Transition Syndrome of Lumbar Spine between Pedicle Screw Fixation and Posterior Lumbar Interbody Fusion Groups

OBJECTIVE: We present the investigation of the biomechanical factors of the degeneration process after lumbar fusion. METHODS: Thirty-five patients underwent L4-5 fusion operation. We measured radius(cm), top angle(TA)(degree), and flexion-extension angle(FEA) at L3-4 joint in pedicle screw fixation(PSF)(n=27) and posterior lumbar interbody fusion(PLIF)(n=8)groups. They were divided into early(3 to 6 months) and late(over 1 year) groups according to post-operative period. RESULTS: The pre-operative radius, TA and FEA in PSF were 6.2+/-0.4, 9.0+/-0.8, and 8.2+/-0.8. The early and late post-operative radius, TA and FEA in PSF were 6.4+/-0.5, 6.9+/-0.8, 6.8+/-0.8, and 5.5+/-0.7, 12.1+/-0.9, 11.0+/-0.9, respectively. The pre-operative radius, TA and FEA in PLIF were 5.4+/-0.5, 8.9+/-0.8, and 9.5+/-1.2. The early and late post-operative Radius, TA and FEA in PLIF were 5.0+/-0.4, 5.8+/-0.9, 5.2+/-0.7, and 5.0+/-0.5, 8.4+/-0.9, 7.6+/-0.8, respectively. In late PSF, TA and FEA were significantly increased(p<0.05)but radius was significantly decreased (p<0.05) compared with pre-operative ones. But in late PLIF, all the factors were decreased compared with pre-operative ones. CONCLUSION: Biomechanical factors of chronic complications were different between PSF and PLIF. Increased FEA seems to be an important factor for post-operative degeneration in PSF, whereas increased stiffness and stress seems more important in PLIF.

Development of Upgraded Cortical Impact Model(Part I: Mechanics)

OBJECTIVE: Head trauma model is important and essential to development of new therapeutic modality. We present a upgraded head trauma model for experimental animals. METHODS: Using pneumatic cylinder, solenoid valve, linear variable differential transformer(LVDT) and load cell, we developed "Chung-Ang University Hospital Model 1.0(CAUH-1)" based on controlled cortical impact model. RESULTS: Changing pressure, impact velocity could be controlled up to 4m/sec. Using solenoid valve, we could control dwell time precisely. Real time impact force could be measured with load cell. CONCLUSION: Controlling dwell time, impact velocity, depth of deformation, this model would reproduce variable degrees of head injury. This model is so precise and versatile that it would be useful in diverse animal experimental researches.

The Results of DREZ Operation on Deafferentation Pain

OBJECTIVE: The authors present dorsal root entry zone(DREZ) operations on deafferentation pain patients suffered from brachial plexus avulsion(BPA), phantom pain(PP) and postherpetic pain(PHP). METHODS: Eight patients(Six BPA, one PP and one PHP) underwent DREZ operations on the cervical, thoracic and thoracolumbar spinal cords. The patients were 7 men and 1 woman who were in between thirties and sixties. The lesions were made by inserting 2mm bare tip of standard type DREZ electrode connected to Radionics radiofrequency generator into the DREZ 45 degree off the sagittal plane. The tissue was heated to 75degrees C for 15 seconds. RESULTS: All BPA patients had immediate and long-lasting pain relief regardless of the duration and character of the pain but patients with PP and PHP complained rather aggravation of pain after the operation. CONCLUSION: DREZ operation is effective for BPA pain, however, it needs to have attention in performing this surgery for PP or PHP.

The Effect of Additional Transpedicular Instrumentation for Patients with Symptomatic Degenerative Spondylosis with Instability Treated with Posterior Lumbar Interbody Fusion Using Autologous Iliac Bone Dowels

OBJECTIVE: The purpose of this study is to determine whether the additional transpedicular instrumentation improves the clinical outcome and fusion rate of patients undergoing posterior lumbar interbody fusion with autologous iliac bone dowels after decompression for spinal stenosis with spondylolisthesis or instability. METHODS: Among 51 patients who had symptomatic spondylolisthesis or instability with stenosis, 24 patients underwent decompressive laminectomy and interbody graft with autologous iliac bone dowels (Group A) and 27 patients had additional transpedicluar instrumentation after decompression and interbody fusion(Group B). Patients were followed up for more than two years after the operation and meanwhile change of the symptoms, patient's satisfaction, fusion rates and surgical complications were checked. RESULTS: Mean age(year), duration of the symptoms(months), and follow-up period(months) of the two groups were 47, 42, 42 and 51, 86, 32 respectively. Seventy-nine percent in Group A and 86% in Group B reported good to excellent clinical outcomes. Successful interbody fusion was accomplished in 50% in Group A and 87% in Group B(p<0.001). Anterior slippage correction rates were 40%(Group A) and 45%(Group B). Complications occurred in 5 cases of Group A(2 donor site pain, 3 reoperations) and 9 cases of Group B(5 donor site pain, 3 reoperations, 1 screw fracture). CONCLUSION: In patients undergoing one or two level interbody bone graft for symptomatic spondylolis-thesis or instability, the use of pedicle screws improve the fusion rates, but do not necessarily guarantee favorable clinical outcome and may increase the complication rates with instrumentation. Pedicle screw fixation procedure need to be selected cautiously in symptomatic degenerative spondylosis patients.

Radiation Dermatitis after GDC Embolization: Case Report

Guglielmi Detachable Coil(GDC) embolization is interventional radiology procedure for the management of aneurysm. The technique is recommended in case of patients' poor general condition, difficult surgical approach, but there is concerning about complications due to radiation exposure. We experienced a patient of radiation-induced dermatitis after GDC embolization. She presented with erythema, pus-like discharge, ulceration on scalp and right preauricular area, which symptoms was improved with medical managements. The authors report the case with pertinent literature review.

In Vitro Effect of Liposome-mediated Combined p16 and p53 Gene Transfer to the Human Glioblastoma Cell Lines

OBJECTIVE: To overcome the limitations of the single gene transfer, the authors present the results of wild-type p16 and p53 combined genes transfer in vitro to the U251MG and U373MG cell lines using cationic liposome as a vector. METHODS: To compare the therapeutic effect of the combined p16 and p53 genes transfer with the single p16 and p53 gene transfer, full length of wild-type human p16 and p53 gene, and combined p16-p53 genes were transferred in vitro to the U251MG and U373MG cell lines using cationic liposome as a vector. As the U251MG and U373MG cell lines are devoid of p16 and p53 genes, the therapeutic effect of the three groups of gene transfer could be evaluated by the growth suppression or percentage of the viable cells. Reverse transcription polymerase chain reaction(RT-PCR), flow cytometry, and electron microscopy(EM) were used for evaluation of the growth suppression or apoptosis of the tumor cells. RESULTS: p16 gene, p53 gene and the combined p16-p53 genes were effectively transferred to the cell lines using cationic liposome as a vector resulting in dramatic decrease of the viable tumor cells in comparison to the control group(p=0.004). The cytotoxic effect of the gene transfer in the U251MG cell line was the most significant in the combined p16-p53 group. However, in the U373MG cell line p53 single gene transfer group showed more significant effect than the combined gene transfer group. Apoptosis was confirmed by EM in the combined p16-p53 genes group. The G1 phase arrest effect, confirmed by the flow cytometry was more prevalent in the p16 gene transfer group than the other groups. CONCLUSION: Cationic liposome-mediated transfer of combined p16-p53 genes to the human glioblastoma cell lines is proven effective. However, the therapeutic effect of the combined p16-p53 genes transfer was not consistently superior to the single p16 or p53 gene transfer.

Percutaneous Tunnel Ventriculostomy for the Hydrocephalus Complicated with Ventriculitis: Case Report

Thirty nine-year-old man who required urgent shunt operation due to rapidly deteriorating visual acuity suffered from ventriculitis after aneurysmal operation. Daily dose of 20mg of vancomycin and amikyn were given intraventricularly via external ventricular catheter after failure of various kinds of systemic antibiotics. The exit of the catheter was made on the upper chest wall to prevent superinfection. External ventricular drainage could finally be switched to ventriculo-peritoneal shunt and he was discharged with clinical improvement.

Biomechanical Effects of Facet Capsule Injuries in Posterior Lumbar Fusion Operations

OBJECTIVES: Although posterior lumbar fusion operations had been reported to accelerate spinal degeneration, there have been only a few studies for their biomechanical effects. We have studied the change of motion range at the vertebral joint one level above the fusion(UVJ) in pedicle screw fixation group(PSF)(n=13) where facet capsule was destroyed and in posterior lumbar interbody fusion group(PLIF)(n=8) where it was spared. PATIENTS AND METHODS:The patients were divided into early(3 to 6 months) and late(over 12 months) according to postoperative follow-up period. The flexion, extension and flexion-extension angles(FA, EA, FEA) were measured at the UVJ with pre-operative, early and late post-operative films. RESULTS: Mean age and male to female ratio were 52.7+/-9.3 and 1:3.2. Mean follow-up periods were 144.1+/-30.0 and 528.8+/-160.3 days in early and late groups, respectively. The FEA and FA in the late PSF(11.8+/-3.1, 8.5+/-2.9) were significantly greater than pre-operative angles(7.8+/-3.9, 5.1+/-3.7)(p<0.01, p<0.05). All angles in the PLIF showed no significant changes with time. The FEA and FA in the late PSF(11.8+/-3.1, 8.5+/-2.9) were significantly greater than those of the late PLIF(7.6+/-2.3, 3.4+/-2.0)(p<0.01, p<0.001). All angles at early follow-up period were similar between PSF and PLIF. The EA showed no significant change in relation with follow-up period or fusion method. CONCLUSION: As a result, the facet capsule injury in pedicle screw fixation seems to be related with increased flexion angle or degeneration of the adjacent joint above the fused vertebra in the late phase.

A Case of Pituitary Abscess with Abnormal MRI Features: A Case Report

No abstract available.

Cytokine Induction of Intercellular Adhesion Molecule-1(ICAM-1) Expression on Human Glioblastoma Cell Line, U-251 MG, U-373 MG

No abstract available.

Surgical Treatment of a Chordoma Arising from the Second Thoracic Vertebral Body through the Modified Anterior Approach: Case Report

No abstract available.

Gender Differences in Expression of Apoptosis, p53, and Bcl-2 in Delayed Focal Cerebral Infarction in Rats

Apoptosis is a normal physiological process. Morphological studies have shown that cells die by physiological mechanisms after undergoing characteristic changes termed 'apoptosis' or 'programmed cell death'. Several genes were known to participate in the apoptotic process including p53 as a proapoptic gene and Bcl-2 as an antiapoptic gene. It was also known that there are certain gender differences in the cerebrovascular accidents and their effect on tissue damage. The purpose of this study is to evaluate how the apoptotic genes are expressed in delayed focal cerebral infarction and peri-infarct area in male and female adult rats by comparing the immunoexpression of p53 and Bcl-2 and p53:Bcl-2 ratio at delayed focal cerebral infarction between both sexes. In sixteen adult Spraugue-Dawley rats (nine males and seven females), the right MCA and both CCA were ligated for thirty minutes to make a delayed focal cerebral infarction in right frontal lobe. Their brains were taken at seventy two hours after the operation. And then the brains were prepared for immunohistochemical stains for apoptosis, p53 and Bcl-2 proteins. The infarction volume of male rats (11.3 mm3) was larger than that of female rats (7.3 mm3) (p<0.01). In male group, the width (micrometer2) of the apoptotic area (46.4 micrometer2) was significantly larger than those in female group (38.9 micrometer2) (p<0.005). The p53 : Bcl-2 ratio was significantly higher in male group (3.23) compared with female group (2.18) (p<0.01). As a result, the p53:Bcl-2 ratio seemed to be related to the gender differences in neuronal apoptosis after delayed focal cerebral infarction.

Third Ventricular Chordoid Glioma: Case Report

No abstract available.

The Change of Motion Ranges of Adjacent Vertebral Joints after Lumbar Fusion Operation

No abstract available.

A Case of Intramedullary Schwannoma at the Cervicomedullary Junction: A Case Report

No abstract available.

Primary Intramedullary Spinal Cord Lymphoma: Case Report

The authors report a primary intramedullary spinal cord lymphoma in a 49-year-old man who presented with right arm pain, voiding difficulty and progressive walking difficulty. Preoperative cervical spinal CT and MRI studies were highly suggestive of spinal stenosis with compressive myelopathy but histopathological study of the specimen after surgery revealed spinal cord lymphoma. As no tumorous lesion was found other than the spinal cord, he was given 6000 rad of radiation under the diagnosis of primary CNS lymphoma. The neurologic deficits improved partially after the surgery but delete right arm pain persisted. One year later, follow up studies showed neither local nor systemic tumor recurrence.

Neuroprotective Effects of Magnesium Sulfate and Dextromethorphan on Cerebral Ischemia after Middle Cerebral Artery Occlusion in Rats

OBJECTIVE: Much evidence implicates that excitatory amino acids play a crucial role in neuronal death under ischemic conditions, of which the neurotoxic effects are thought to be mediated by overstimulation of glutamate receptors causing a massive influx of calcium ions into the cell. The author examined the effect of MgSO4 and dextromethorphan, N-methyl-D-aspartate(NMDA) receptor antagonists, on ischemic injury in a reversible model of middle cerebral artery(MCA) occlusion in rats. MATERIALS AND METHODS: Forty Sprague-Dawley rats were equally divided into four groups and treated with vehicle(group I), MgSO4 in the amount of 90mg/kg(group II), dextromethorphan of 50mg/kg(group III), and simultaneously MgSO4 of 90mg/kg and dextromethorphan of 50mg/kg(group IV). Following the pretreatment, the animals were subjected to 90 minutes of temporary middle cerebral artery occlusion induced by means of a 3-0 poly-L-lysine coated nylon suture inserted retrogradely via the external carotid artery into the internal carotid artery and MCA. Reperfusion was achieved by retracting the occluding suture. RESULTS: Automated, volumetric measurements of the infarct size demonstrated a statistically significant decrease in GroupII, III, IV compared with GroupI. Neuroprotection was greater in Group IV(64.3% reduction in infarct volume, p<0.001, Student's t-test)than that of Group II or Group III(55.0%, p<0.001, 22.9% reduction, p<0.01, respectively). Group II showed a 41.6% reduction in infarct volume compared with Group III(p<0.001), and Group IV showed a 53.7% reduction in infarct volume compared with Group III(p<0.001). Only Group IV demonstrated protection of both cortex and striatum(p<0.001). CONCLUSION: This beneficial effect of MgSO4 and dextromethorphan in transient focal cerebral ischemia, particularly their combined synergistic effect, indicates their possible usefulness in treating patients with acute ischemic stroke.

Early Postoperative Kinetic Changes in Cervical Spine after Anterior Cervical Fusion

Although anterior cervical fusion(AC) was accepted as an ideal method to treat spondylotic myeloradiculopathy, it was found that the vertebrae adjacent to the fused level tended to undergo an accelerated degeneration. The reasons for this phenomenon thought to be the hypermotility of the intervertebral joints without any pertinent biomechanical explanations. In this study, early kinetic changes in cervical spine after ACF were investigated to find out biomechanical factors related to the accelerated degeneration of adjacent vertebrae. Twelve patients with ccervicalspondylotic myeloradiculopathy who underwent ACF from May 1995 to February 1996 were included. Male to female ratio was 1:2. Mean age was 47.6 years. Simple radiographic flexion and extension views of cervical spine were taken from 40 days to 224 days after the operations. The flexion-extension angle(FEA), top angle, radius of coupling motion at each intervertebral joint were measured. The postoperative changes of FEA were variable. In eleven cases, the top angle decreased at the upper vertebra adjacent to the fused level. Also, eleven cases revealed decreased radius at the adjacent upper vertebra. The decreased top angle and radius indicate the increment of stiffness and tension according to the stiffness coefficient(Stiffness coefficient=orque/Angular displacement in radians, Nm/rad) and torque equation(Torque=istanceXForce, Nm), respectively. As a result, it can be said that the important early kinetic factors acting on the accelerated degeneration after ACF are the increased stiffness of vertebral joints followed by shortening of radius and increased stress.