Percutaneous Epidural Neuroplasty / 대한정형외과학회잡지

Interventional pain management by percutaneous epidural neuroplasty (PEN) has potential as a useful treatment method in chronic low back and/or radicular pain that is refractory to other conservative treatments. The effect of PEN is known to result from targeting of drug delivery to areas of pathology in the spinal epidural space. The procedure involves removing barriers, such as epidural fibrosis, that prevent drug from reaching target sites. Therefore, the goal during lysis of epidural adhesions is to penetrate mechanical barriers impeding injected material from spreading effectively into the areas of pathology in the epidural space by the catheter. An additional lavage effect, reducing the local concentration of proinflammatory substances seems possible. Although a true mechanical lysis of postsurgical adhesions or scar tissues by means of PEN appears to be impossible because it has been proven by experimental biomechanical study, mild to moderate adhesions may be broken up by a PEN catheter allowing the medications to reach the target site through the new channel made by the catheter. This review will focus on the adhesiolysis technique using the sacral hiatus approach in treatment of chronic low back pain with/without lumbosacral radiculopathy.

Factors Influencing the Recurrence of a Giant Cell Tumor of the Bone / 대한정형외과학회잡지

PURPOSE: The aim of this study was to evaluate the recurrence rates of a giant cell tumor of the bone an determine what, if any, patient factors, tumor characteristics and surgical treatments correlate with the incidence of a local recurrence. MATERIALS AND METHODS: The records of fifty two cases who were diagnosed with a giant cell tumor of the bone between March 1992 and March 2001 and were could be followed up for at least 2 years were analysed retrospectively. This study reviewed the clinical characters, and the treatment method, recurrence, complication, the result of the follow-up. A Fisher' exact test was carried out to analyse the statistics. RESULTS: Sixteen patients (31%)had a local recurrence. The average time to recurrence was 17 months. All but case one recurred within 2 years after receiving surgical treatment. There was no significant differences in the recurrence rates based on the following variables: gender, tumor location, Campanacci grade, the presence of a pathologic fracture, primary versus recurrent tumor at presentation, resection margin, the use of a bone graft, internal fixation or polymethylmethacrylate. CONCLUSION: The clinical characters and methods of treatment were not correlated with a local recurrence. Most recurrences of a giant cell tumor can be expected within the first two to three years. Therefore the patient needs to be followed up in that period and longer for the a late recurrence and pulmonary metastasis.

Fluid Attenuated Inversion-Recovery Magnetic Resonance Imaging of Acute Subarachnoid Hemorrhage: Comparison with Non-Contrast-Enhanced Computed Tomography

OBJECTIVE: Our aim is to evaluate the usefulness of fluid-attenuated inversion recovery(FLAIR) magnetic resonance(MR) imaging for detection of acute subarachnoid hemorrhage(SAH) compared with non-contrast-enhanced computed tomography(CT). METHODS: We compared FLAIR MR images with non-contrast-enhanced CT scans in 34 patients with acute SAH. Findings of SAH on CT and MR images were graded as 0(absence), 1(suspicious), and 2(definite) in the cerebral sulci, sylvian fissures, basal cisterns, and cisterns of the posterior cranial fossa. We also compared FLAIR MR images of 34 patients with those of 35 normal subjects, and then the sensitivity, specificity, and diagnostic accuracy of FLAIR MR image for detection of acute SAH were calculated. RESULTS: FLAIR MR image was superior to CT in detecting SAH in the cranial fossa posterior(1.41+/-0.74 vs. 0.78+/-0.80, p<0.05) and cortical sulci(1.11+/-0.80 vs. 0.70+/-0.83 p<0.05). There was no significant difference between FLAIR MR image and CT in detecting SAH in the basal cisterns and sylvian fissures. The sensitivity, specificity, and diagnostic accuracy of FLAIR MR image for detection of SAH were 100% in all. CONCLUSION: FLAIR MR image is useful in detecting acute SAH, especially in patients with SAH in the posterior cranial fossa and cerebral sulci.

Differences in p53 Protein Expression between Delayed and Completed Focal Cerebral Infarction in Rats

OBJECTIVE: We investigate and compare geometric patterns and degree of p53 protein expression in a peri-infarction area between two different types of cerebral infarction, delayed and completed focal cerebral infarctions. METHODS: For the delayed focal cerebral infarction group(Group 1 ; n=8), right middle cerebral artery(MCA) and bilateral common carotid artery(CCA) were ligated temporarily for thirty minutes, and their brains were obtained after 72 hours. For the completed focal cerebral infarction group(Group2 ; n=11), right MCA and CCA were occluded permanently, and contralateral CCA was occluded for thirty minutes, and their brains were obtained after 24 hours. RESULTS: The infarction volume was significantly larger in Group 2(267.2+/-29.6mm3) than that of Group 1(10.4+/-2.7mm3)(p<0.001). The width of p53 protein positive area was significantly longer in Group 1(107.8+/-60.5micro meter) than that in Group 2(75.0+/-7.1micro meter)(p<0.05). The density of p53 positive cell was more compact in group 2(48.2+/-1.7cells/HPF) than group 1(28.3+/-9.1cells/HPF)(p<0.001). CONCLUSION: It is suggested that the decreased p53 protein expression in the delayed infarction has certain roles other than apoptosis. The degree of p53 protein expression in the completed focal cerebral infarction seems to be closer to a critical level of gene expression that might determine cell death.

Expression of p27(Kip1) in gastric cancers and precancerous lesions / 대한내과학회지

BACKGROUND: The cyclin-dependent kinase inhibitor p27(Kip1) is a negative regulator of cell cycle progression at G1/S transition. Recently, the expression level of p27(Kip1) was decreased in many cancers such as breast, pituitary gland, colon and stomach. We studied the expression of p27(Kip1) in gastric cancers, precancerous lesions and normal gastric tissues and analysed its correlation to clinicopathologic data including tumor differentiation, tumor depth, nodal and distant metastasis in gastric cancers. METHODS: p27(Kip1) were immunohistochemically stained in the tissue specimens of 62 resected cancers, 110 corresponding adjacent non-neoplastic tissues, 22 gastric adenomas and 10 normal gastric tissues. Adjacent non-neoplastic tissues consisted of 32 chronic gastritis, 29 intestinal metaplasia and 49 transitional mucosa. RESULTS: Gastric cancers showed significantly decreased expression level of p27(Kip1) when compared with non-neoplastic lesions and adenomas. Labeling index of p27(Kip1) were more decreased in chronic gastritis, intestinal metaplasia and transitional mucosa than in normal mucosa. Early gastric cancers showed significantly decreased expression level of p27(Kip1) when compared with advanced gastric cancers. In gastric cancers, p27(Kip1) labeling index was significantly decreased in diffuse type and presence of nodal metastasis however did not show relationship with distant metastasis and tumor depth of advanced gastric cancers. CONCLUSION: We suggest that p27(Kip1) may be decreased in the early stage of gastric carcinogenesis and play an important role in the progression and differentiation of gastric cancers. More further studies are thought to be necessary in order to evaluate its prognostic factor in gastric cancers.

Comparison of Fluid-Attenuated Inversion-Recovery Magnetic Resonance Imaging with Computed Tomography in Acute Intraventricular Hemorrhage

OBJECTIVE: Our aim is to evaluate the usefulness of fluid-attenuated inversion recovery(FLAIR) magnetic resonance(MR) imaging for detection of acute intraventricular hemorrhage(IVH) compared with pre-contrast computed tomography(CT). METHODS: Twenty-eight patients with acute IVH were evaluated with FLAIR MR imaging and precontrast CT. All MR and CT examination were performed within two days from symptom onset. One neurosurgeon and one radiologist evaluated the detectability and conspicuity of acute IVH on FLAIR MR imaging and pre-contrast CT. RESULTS: Acute IVH was detected in all patients on FLAIR MR imaging and in 23(82%) of 28 patients on pre-contrast CT. The conspicuity of IVH on FLAIR MR imaging was as good as or better than that on pre-contrast CT in 28 patient. CONCLUSION: It is suggested that FLAIR MR imaging is superior to pre-contrast CT in the diagnosis of acute IVH.

Skull Metastasis of Thyroid Carcinoma: Case Report

No abstract available.

The Effects of Lipoxygenase and Cyclooxygenase Inhibitors to Meningioma Cell Proliferation in vitro

No abstract available.

A Clinical Analysis on Traumatic Subarachnoid Hemorrhage

No abstract available.

Spontaneous Thoracic Epidural Hematoma: Case Report

No abstract available.

Multiple Hypertensive Intracerebral Hemorrhage: A Case Report

Spontaneous intracerebral hemorrhage is one of the most devastating forms of cerebrovascular disease, and is most frequently caused by hypertension in the distribution of the perforating arteries. Generally, hypertensive intracerebral hemorrhage is usually a single lesion, and recurrent intracerebral hemorrhage due to hypertension is not a rare condition. But multiple simultaneous intracerebral hemorrhage caused by hypertension is very rare. The authors report 4 cases of multiple hypertensive intracerebral hemorrhage. This represents 0.77% of total 514 hypertensive intracerebral hemorrhages treated between January, 1994 and December, 1997 in our institution. All patients had chronic history of hypertension, and the locations of the hematomas were as follows: both basal ganglia in two cases, right basal ganglia and left thalamus in one case, cerebellum and left parietal lobe in one case. Two cases were treated by surgical evacuation of hematoma and remaining two were treated by conservative management. The results of treatment were poor in all patients.

Supratentorial Meningeal Hemangioblastoma: Case Report

Supratentorial hemangioblastomas are rare and a meningeal location is even rarer. We report a solid meningeal hemangiblastoma in left parietal region, mimicking a meningioma on CT scan. There was no manifestation of von Hippel-Lindau disease. The literature on supratentorial meningeal hemangioblastoma was reviewed.

Treatment of Severely comminuted Tibial condylar Fracture through anterior Approach with Z - tenotomy of the Patella Tendon / 대한정형외과학회잡지

Severely comminuted tibial condylar fracture is a major threat to the structures and function of the knee joint. Recently, anterior approach with Z-tenotomy of the patellar tendon was introduced for these complicated fractures. It provides wide exposure of the tibial articular surface for maximum joint reconstruction. The purpose of this study was to describe the operative technique and to evaluate the clinical results of this method. We had performed operative treatment in 13 cases (12 patients) of severely comminuted Schatzkers type II, V, and VI tibial condylar fractures through anterior approach from December 1993 to April 1996. Twelve cases out of 13 (92%) showed acceptable results according to Blokkers criteria. There was no superficial or deep infection. On the basis of these results, we suggest that the anterior approach is a valuable aid in the operative treatment of severely comminuted tibial condylar fractures.

A Study on the Distance and Height of the Suprasternal Notch: Cervicothoracic Vertebrae in Normal Korean Adults

The upper thoracic vertebrae through anterior approach depends upon several variables; The diameter of the thoracic inlet, the height of the clavicles and manubrium anteriorly, and the extent of the cervicothoracic kyphosis. Preoperatively, the upper margin of the manubrium should be compaired with the vertebral body level on a standard lateral roentegenogam or mid-sagittal MRI of the upper thoracic spine. We measured the distance and the level of the corresponding vertebra of line A(horizontal line from the suprasternal notch to the corresponding vertebra) and line B(perpendicular line from the suprasternal notch to the corresponding vertebra ; thoracic inlet) on mid-sagittal MRI of normal subjects. The results were as follows: 1) In 95 cases(94 cumulative %), the line A fell to the T2 lower one third through T4 lower one third and the mean distance was 49.8+/-4.2mm(means standard deviation). 2) In 92 cases(91 cumulative %), the line B fell to the T1 lower one third to T3 middle one third and the mean distance was 45.5+/-4.9mm(means standard deviation). 3) The relation of the height and the distance with age, sex, weight, height, and body mass index were not statistically significant. We concluded that anatomical analysis of the mid-sagittal MRI of the cervicothoracic vertebrae will be helpful in selecting the access route to the cervicothoracic lesion.

Pleomorphic Xanthoastrocytoma: Report of 2 Cases

Pleomorphic xanthoastrocytoma is a recently characterized neoplasm with relatively favorable prognosis despite aggressive histological features. Two cases of pleomorphic xanthoastrocytoma involving the left temporal lobe are reported, both occurring in adolescents. The tumor is considered to arise from the subpial astrocytes of the superficial cortex. Electron microscopic examination and immunoperoxidase stains for glial fibrillary acidic protein(GFAP) are helpful in making a definitive histologic diagnosis. In contrast to malignant gliomas, pleomorphic xanthoastrocytoma does not appear to require aggressive postoperative radiation therapy or chemotherapy. Therefore, It is important to recognize and identify this type of glioma as a distinct entity.

Trigeminal Neuralgia due to Unusual Offending Vessels and Tic Convulsif

Trigeminal neuralgia is a cranial rhizopathy characterized by paroxysms of hyperactivity strictly limited to the anatomical distributions of the fifth cranial nerve. One of a documented cause is vascular cross-compression at the root entry zone of the fifth cranial nerve near the brain stem. The offending vessels are the superior cerebellar artery, anterior inferior cerebellar artery, small arteriole, vein only, and vertebrobasilar artery in order of frequency. When trigeminal neuralgia and hemifacial spasm occur together in the same patient in rare occasions, they are termed "tic convulsif" We have recently experienced three cases of trigeminal neurlgia caused by unusual offending vessels and one case of tic convulsif. They were treated by microvascular decompression using Teflon felt. Post-operative courses were uneventful and marked symptomatic improvement had been achieved.

Clinical Study According to the Modality of Treatment of Cerebral Arteriovenous Malformations

A series of 44 patients with cerebral arteriovenous malformations(AVM's) treated by various modalities from January, 1987, to March, 1994, at Chung-Ang University Hospital were reviewed with emphasis on the outcome. Of these patients, 8 received conservative treatment, 16 only surgery, 4 combined embolization and surgery, and 16 embolization alone. The follow-up period ranged from 7 months to 54 months with a mean of 20.6 months. The efficacy of the combined treatment was evaluated by the complications and the clinical outcome. When compared with surgery alone, preoperative embolization facilitated surgery by reducing intraoperative bleeding and shortening the time of surgery. Clinical outcome was better after preoperative embolization, with no occurrence of major complications and mortality. Five AVM's were totally occluded by embolization alone, but of the 5 cases, 1 case was readmitted due to bleeding 2 years after the embolization. It is concluded that combined treatment with preoperative embolization and surgery was helpful in the management of large, high grade AVM's by reducing the complications associated with their surgical removal.

The Neuroprotective Effects of Transdermal Nitroglycerin and Intraperitoneal Phenytoin on Ischemic-Hypoxic Injury in Developing Rat Brains

The goal of this study was to evaluate neuroprotective effects of nitroglycerin and phenytom using in the developing rat brains Seven days old Sprague-Dawley rats underwent right carotid ligation followed by 8% 02 exposure (humidified, balanced with mtrogen) for 3 hours under the halothane anesthesia (control group, N=58). Body temperature of rats was accurately controlled before and during hypoxia. In nitroglycerin treated group (N=33), nitroglycerin was delivered chronically via patches (in escalating doses to 4mg/kg/hr) for 36hrs before and 48hrs postischemia. Phenytoin treated group(N=17) received intraperitoneal phenytoin(30mg/kg) before ischemia. Combined treated group(N=31) with nitroglycerin and phenytoin received two compounds with same method as above. Animals. Sacrificed one week later and histopathological evaluation for ischernic neuronal damage were conducted employing hemat,oxylin eosin staining and measurements of the hemispheric weight difference. Phenytoin was effective in reducing neuronal damage in terms of weight comparison(24+2.4%, atrophy in control vs. 5+2.9% in phnytoin group, p<0.001) and ischemic changes in hippocampal area(p<0.05 in CA1, CA2, and CA3 area). Transdermal nitroglycerin did not show any beneficial effects compared with control group(23+3.0% in nitroglycerin group vs. 24+2.5% in control). Combined treated group showed neuroprotection on weight comparison(24+2.4% in control vs 4+1.8% in combined group, p<0.001) and ischemic changes in hippocampal area(p<0.05 in CA1, CAZ and CA3 area) but dldnot show any additional neuroprotective effects compared with phenytoin group on weight comparison and histological changes. These data suggest that the degree of the injury from hypoxic-iwhemic insults of developing rat brain may be reduced by the compounds that modulate voltagedependent sodium channels such as phenytom but not by nitroglycein.

A case of fabry's disease with chronic renal failure effectively managed with CAPD / 대한신장학회잡지

No abstract available.

A case of primary amyloidosis presenting with macroglossia / 대한신장학회잡지

No abstract available.