We report here on a 64-year-old woman with extramedullary plasmacytoma involving the bilateral adrenal glands. Primary adrenal extramedullary plasmacytoma is extremely rare and only three cases of extramedullary plasmacytoma in the unilateral adrenal gland have currently been reported on. This case is of interest in that the bilateral adrenals were involved. In this article, we present the MRI findings and we briefly review the relevant literature.
Adrenal Gland Neoplasms/*diagnosis/surgery ; Back Pain/etiology ; Female ; Humans ; Kidney/pathology ; *Magnetic Resonance Imaging ; Middle Aged ; Neoplasm Invasiveness ; Plasmacytoma/*diagnosis/surgery ; Vena Cava, Inferior/pathology

No abstract available.
Adolescent ; Back Pain/diagnosis/*etiology/surgery ; Decompression, Surgical ; Humans ; Laminectomy ; Magnetic Resonance Imaging ; Male ; Osteoblastoma/*complications/pathology/radiography/surgery ; Pain Measurement ; Radiotherapy, Adjuvant ; Spinal Neoplasms/*complications/pathology/radiography/surgery ; *Thoracic Vertebrae/pathology/radiography/surgery ; Tomography, X-Ray Computed ; Treatment Outcome

A young woman with severe vitamin D deficiency presented with proximal muscle weakness, fragility fracture and pseudoarthrosis. On evaluation, she was found to have hypercalcaemia, a single parathyroid adenoma and an undetectable 25-hydroxyvitamin D level. She received parenteral cholecalciferol and subsequently underwent curative parathyroidectomy. Postoperatively, she had hungry bone syndrome, which she gradually recovered from with calcium and calcitriol replacement. Notably, her calcium levels were in the lower limit of normal range and associated with elevated alkaline phosphatase levels at postoperative Day 14. Follow-up for the next four years showed that the patient had remarkable symptomatic and radiological improvements. In this report, we discuss the pathophysiological interactions between vitamin D deficiency and associated primary hyperparathyroidism.
Adenoma ; diagnosis ; diagnostic imaging ; surgery ; Adult ; Female ; Follow-Up Studies ; Fractures, Spontaneous ; diagnostic imaging ; etiology ; surgery ; Humans ; Hyperparathyroidism, Primary ; complications ; diagnosis ; surgery ; Low Back Pain ; diagnosis ; etiology ; Muscle Weakness ; diagnosis ; etiology ; Parathyroid Neoplasms ; diagnosis ; diagnostic imaging ; surgery ; Parathyroidectomy ; methods ; Pseudarthrosis ; diagnostic imaging ; etiology ; physiopathology ; Radiography ; Severity of Illness Index ; Singapore ; Treatment Outcome ; Vitamin D Deficiency ; complications ; diagnosis

OBJECTIVETo explore the methods of diagnosis and surgical treatment for patients with back pain originating from endplate.

METHODSAll patients received examinations of radiography, CT, and MR imaging. Pain level of disc was decided by discography in each patient. The principal outcome judgment were pain and disability, and the efficacy of surgical treatment was assessed by visual analog scale (VAS) for pain, and the Oswestry disability index (ODI) for functional recovery.

RESULTSAll patients with a diagnosis of back pain originating from endplate according to discography were treated with anterior or posterior fusion surgery. The mean follow-up period was three years and five months (from 2 to 6 years). Among of the 21 patients, 20 (95%) reported a disappearance or marked alleviation of low back pain, and experienced a definite improvement in physical function. A statistically significant and clinically meaningful improvement on the ODI and the VAS scores were obtained in the patients with chronic low back pain originating from endplate (P = 0.0001) after treatment.

CONCLUSIONSThe study suggests that the discography and fusion surgery may be very effective methods for the diagnosis and treatment of chronic back pain originating from endplate respectively.

Adult ; Female ; Follow-Up Studies ; Humans ; Low Back Pain ; diagnosis ; etiology ; surgery ; Male ; Middle Aged ; Spinal Fusion ; methods ; Spinal Injuries ; complications ; Treatment Outcome

Chronic neck and arm pain or cervicobrachialgia commonly occurs with the degeneration of cervical spine. Authors investigated the usefulness of radiofrequency (RF) neurotomies of cervical medial branches in patients with cervicobrachialgia and analyzed the factors which can influence the treatment outcome. Demographic data, types of pain distribution, responses of double controlled blocks, electrical stimulation parameters, numbers and levels of neurotomies, and surgical outcomes were evaluated after mean follow-up of 12 months. Pain distribution pattern was not significantly correlated with the results of diagnostic blocks. Average stimulation intensity was 0.45 V, ranging from 0.3 to 0.69, to elicit pain response in cervical medial branches. The most common involvement of nerve branches was C4 (89%), followed by C5 (82%), C6 (75%), and C7 (43%). Among total of 28 patients, nineteen (68%) reported successful outcome according to outcome criteria after 6 months of followup (p=0.001), and eight (42%) of 19 patients reported complete relief (100%) of pain. Four patients showed recurrence of pain between 6 and 12 months. It was therefore concluded that cervical medial branch neurotomy is considered useful therapeutic modality for the management of cervicobrachialgia in selected patients, particularly in degenerative zygapophyseal disorders.
Adult ; Aged ; Aged, 80 and over ; Back Pain/etiology/surgery ; Brachial Plexus/pathology/*surgery ; Brachial Plexus Neuritis/complications/diagnosis/*surgery ; Chronic Disease ; Electrosurgery/methods ; Female ; Humans ; Male ; Middle Aged ; Neck Pain/etiology/surgery ; Nerve Block/methods ; Neurosurgical Procedures/instrumentation/*methods ; Treatment Outcome

The authors hypothesized that the placement of the interspinous implant would show a similar clinical outcome to the posterior lumbar interbody fusion (PLIF) in patients having spinal stenosis with mild segmental instability and that this method would be superior to PLIF without significantly affecting degeneration at the adjacent segments. Forty two adult patients having degenerative spinal stenosis with mild segmental instabilit who underwent implantation of Coflex(TM) (Spine motion, Germany) or PLIF at L4-5 between January 2000 and December 2003 were consecutively selected and studied for one-year clinical outcome. At 12 months after surgery, both groups showed a significant improvement in the visual analogue scale score and Oswestry disability index score for both lower extremity pain and low back pain. However, the range of motion at the upper adjacent segments (L3-4) increased significantly after surgery in the PLIF group, which was not manifested in the Coflex(TM) group during the follow-up. The authors assumed that interspinous implantation can be an alternative treatment for the spinal stenosis with segmental instability in selected conditions posing less stress on the superior adjacent level than PLIF.
Treatment Outcome ; Spinal Stenosis/complications/*surgery ; Spinal Fusion/*instrumentation/methods ; Prosthesis Design ; Pain Measurement ; Outcome Assessment (Health Care) ; Middle Aged ; Male ; Lumbar Vertebrae/*surgery ; Longitudinal Studies ; Joint Instability/complications/*prevention & control ; Intermittent Claudication/diagnosis/etiology/*prevention & control ; Humans ; Female ; Equipment Failure Analysis ; Back Pain/diagnosis/etiology/*prevention & control ; Aged ; Adult

Renal angiomyolipomas are benign neoplasms composed of varying amounts of adipose tissue, smooth muscles and blood vessels. They typically contain macroscopic fat, which is seen as negative attenuation on computed tomography. Calcification and scarring is rarely seen in renal angiomyolipomas. We report the case of a 40-year-old man who was found to have a renal angiomyolipoma with a central stellate scar and focal calcification. The lesion was initially misdiagnosed as a calyceal calculus.
Adipose Tissue ; diagnostic imaging ; pathology ; Adult ; Angiomyolipoma ; diagnosis ; surgery ; Biopsy, Needle ; Calcinosis ; diagnostic imaging ; pathology ; Diagnosis, Differential ; Humans ; Immunohistochemistry ; Kidney Calculi ; diagnosis ; surgery ; Kidney Calices ; diagnostic imaging ; pathology ; Kidney Neoplasms ; diagnosis ; surgery ; Low Back Pain ; diagnosis ; etiology ; Male ; Risk Assessment ; Tomography, X-Ray Computed ; methods ; Treatment Outcome ; Urography ; methods

OBJECTIVETo investigate the diagnostic value of lumbar discography in discogenic low back pain and the effects of intervertebral fusion surgery.

METHODSForty-five cases with 101 discs underwent discography, 360 degree fusion manipulation were performed on 18 discography abnormal cases, 27 cases were treated conservatively. Discography, MRI and provocative pain were observed and all the cases were followed up.

RESULTSTwenty-one cases showed positive provocative pain (21/45, 47%), and 21 discs of 101 were concordant discography (21/101, 21%). All cases were followed up for an average 16 months (15 to 23 months), the satisfactory rate was 83% (15/18) in the surgery group and 41% (11/27) in the conservative group.

CONCLUSIONSIt is concluded that the discography is moderately sensitive in the diagnosis of discogenic low back pain. Furthermore, the short term follow-up reveals that operative group has better pain relief than conservative group.

Adult ; Aged ; Arthrography ; methods ; Diskectomy ; Female ; Follow-Up Studies ; Humans ; Intervertebral Disc ; diagnostic imaging ; Low Back Pain ; diagnosis ; etiology ; surgery ; Lumbar Vertebrae ; diagnostic imaging ; Male ; Middle Aged ; Sensitivity and Specificity ; Spinal Diseases ; complications ; Spinal Fusion

OBJECTIVETo study the diagnosis and treatment of lumbar internal disc disruption (IDD).

METHODSThirty-six patients with chronic disabling low back pain proved by discography as IDD were treated with disc excision and lumbar interbody fusion, and 8 cases were treated with PLIF, 28 with ALIF. The clinical results were evaluated by pre- and post-operative VAS, and the fusion results were evaluated by X-ray studies of the lumbosacral spine.

RESULTSThe average period of follow-up was 18 months, ranging from 6 to 26 months. Six patients treated with PLIF basically disappeared low back pain, 2 complained of mild back pain; the VAS after operation was decreased significantly in comparison with that of pre-operation (P < 0.01). Twenty-seven treated with ALIF basically disappeared low back pain; the VAS after operation was decreased significantly in comparison with that of pre-operation (P < 0.01). Fusion rate was 88% in patients who were treated with PLIF, and 97% in patients with ALIF.

CONCLUSIONDisc excision and interbody fusion is an effective method for the treatment of IDD, but the operation indications should be known well.

Adolescent ; Adult ; Female ; Follow-Up Studies ; Humans ; Internal Fixators ; Intervertebral Disc ; diagnostic imaging ; Low Back Pain ; etiology ; Lumbar Vertebrae ; diagnostic imaging ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Spinal Diseases ; complications ; diagnosis ; surgery ; Spinal Fusion ; instrumentation ; methods ; Tomography, X-Ray Computed ; Treatment Outcome ; Young Adult