Pathologic Changes of Blood vessels and Extracellular Matrix in the Subsynovial Connective Tissue of Idiopathic Carpal Tunnel Syndrome / 대한정형외과연구학회지

PURPOSE: The purpose of this study is to investigate pathologic changes of blood vessels and perivascular tissue in subsynovial connective tissue (SSCT) of idiopathic carpal tunnel syndrome (CTS) by examining elastin distribution and vascular morphology and by observing ultrasturctural changes of extracellular matrix using transmission electron microscope (TEM). MATERIALS AND METHODS: The Verhoeff-van Gieson stain was used to identify histopathology and to localize elastin in the SSCT of the middle finger flexor digitorum superficialis (FDS) within the carpal tunnel in ten CTS patients and ten cadaver specimens as control group. In each specimen, the elastin density within and around vessels was calculated with image analyzing software including Adobe photoshop 6.0 and Scion image analysis. The vessel number per unit area and the mean thickness of vessel walls were also calculated. The ultrastructural changes of SSCT were compared between the specimens of both groups by TEM. RESULTS: The mean elastin density within vessels was 0.10 +/- 0.03 (p=0.001) in the CTS group and 0.18 +/- 0.04 in the control group. The mean elastin density around vessels was 0.15 +/- 0.04 in the CTS group and 0.23 +/- 0.04 in the control group (p=0.002). The mean number of vessels per unit area (0.00155 mm2) was 0.36 +/- 0.12 in the CTS group and 0.15 +/- 0.10 in the control group (p=0.002). The mean thickness of blood vessels was 38.10 +/- 20.60 micrometer in the CTS group and 18.90 +/- 3.68 micrometer in the control group (p=0.023). In general, the severer the vascular hypertrophy and obstruction, the less elastin noted within and around blood vessels. The TEM showed some important ultrastructural changes in SSCT of CTS. Generally, SSCT contained two kinds of cells, fibroblast-like cells and macrophage-like cells. And these cells and elastin were dispersed among collagen fibrils. In SSCT of control group, the collagen fibrils showed round margin and uniform diameter in transverse section, and showed similar thickness in longitudinal section. However, in SSCT of CTS, the collagen fibrils had irregular margin called "spiraled collagen"and variable diameter in transverse section, and uneven thickness in longitudinal section. In addition, the elastolysis and the phagocytosis of the changed collagen fibrils were observed. CONCLUSION: SSCT of CTS showed significant decrease of elastin density within and around vessels along with degenerative histopathological vascular changes. In addition TEM revealed ultrastructural abnormalities like metamorphosis of collagen fibrils, phagocytosis of spiraled collagen fibrils and elastolysis. Therefore, it is suggested that pathology of CTS may involve active cellular processing related to ischemic cellular environmental changes in carpal tunnel as well as well known pathology of nerve.

Clinical Characteristics of Hypothermia with Osborn Wave on ECG Based on the Analysis of 5 Patients

BACKGROUND AND OBJECTIVES: The Osborn wave is the name designated to the wave formation produced when there is a large, prominent deviation of the J point from the baseline. The wave has been reported in many countries, but only 2 cases have been reported in Korea. Thus, the purpose of our study was to evaluate the clinical characteristics and therapy of hypothermia employing the Osborn wave with Koreans. SUBJECTS AND METHODS: Between February 2001 and April 2001, five patients visiting our department with hypothermia were enrolled in this study. We analyzed these patients for their distribution, symptoms and signs, associated disorders, risk factors, electrocardiogram and laboratory findings. RESULTS: All 5 patients were male with an average age was 44.8+/-12.7 years. Three patients had a semi-comatose mentality and 2 cases had a comatose mentality. Their associated disorders were diabetes (2 cases), psychotic problems (1 case) and nutritional deficiency (1 case). Risk factors were alcohol abuse (3 cases) and drug in toxication (1 case). Laboratory abnormalities were acidosis (4 cases), increased serum glucose levels (all 5 cases) and increased serum potassium levels (3 cases). After active core rewarming by a line heat exchanger, 3 of the 5 patients completely recovered from hypothermia, 1 case immediately expired following admission and 1 case survived for 10 days, but later expired due to acute respiratory distress syndrome. The Osborn wave was persistent in 1 case and disappeared in 3 cases. CONCLUSION: We experienced 5 cases of hypothermia with an Osborn wave. The mortality of patients displaying an Osborn wave is expected to decrease if this anomaly is immediately found and treated by an appropriate method.

EDTA-dependent Pseudothrombocytopenia Confirmed by Supplementation of Kanamycin: A Case Report

EDTA-dependent pseudothrombocytopenia (PTCP) is the phenomenon of a spurious low platelet count due to EDTA-induced aggregation of platelets. Since the failure to recognize EDTA-dependent PTCP may result in incorrect diagnosis and inappropriate treatment, the recognition of this phenomenon is very important. We report an insidious case of EDTA-dependent PTCP confirmed by supplementation of kanamycin to anticoagulant in a 53-year-old women. Although sodium citrate and heparin usually prevented the aggregation of platelets in EDTA-dependent PTCP patients, these anticoagulants failed in preventing PTCP in our case. EDTA-dependent PTCP was confirmed by the findings that the clumping of platelets on microscopic evaluation was found in EDTA-anticoagulated blood samples, whereas thrombocytopenia and platelet aggregation were not revealed in the sample supplemented with kanamycin.

Clinical Analysis of Postoperative Prognostic Factors of Cervical Anterior Decompression and Interbody Fusion for Ossification of Posterior Longitudinal Ligament

No abstract available.

A Case of Frontal Ganglioglioma Coincidence with Pituitary Adenoma

A case of frontal ganglioglioma coexisting with pituitary adenoma is reported. A 37-year-old male presented with chief complaint of headache for 2 months. A neurological examination of the patient revealed no deficit. Brain MRI showed a well enhanced lobulated mass on left frontal lobe and another homogeneously enhanced mass on intrasellar and suprasellar portion. The frontal mass was grayish in color and rubbery hard in consistency on operative field, having relatively good boundary from the adjacent normal brain tissue. The sellar mass was 3X3cm in size and compressed optic chiasm. Histological diagnosis of frontal mass was ganglioglioma and sella mass showed typical features of pituitary adenoma.

Osteochondroma of the Lumbar Spine Misdiagnosed as Calcified Disc

Cartilage-forming tumors are benign cartilaginous tumors that rarely affect the spinal canal. They account for 2% of all spinal tumors and 2.6% of all benign bone tumors, and involvement of the vertebral column is found in 3-5% of the cases. Pathologically, they may be classified as chondroma, osteochondroma, chondroblastoma and chondromyxoid fibroma. This oncotype may remain asymptomatic or may present as a hard paravertebral swelling, or -more rarely- be accompanied by a slowly developing neurologic syndrome. We report the case of a 38 -year- old man in whom pain in the left buttock and left leg developed. Surgery involved a left partial hemilaminectomy and the mass was totally excised.