No abstract available.
Carcinoma, Renal Cell*

Spontaneous Spinal Epidural Hematoma has been reported to be associated with vascular malformations, tumors, infections, pregnancy, ankylosing spondylitis, rheumatoid arthritis, artherosclerosis, and hypertension. Approximately half of the cases, however, have no apparent cause. The most widely accepted hypothesis of the source of bleeding is that epidural veins are torn by the variations of abdominal or thoracic pressure. The normal hemodynamic fluctuations during usual daily activities are not, however, enough to explain the rare incidence of the spontaneous spinal epidural hematoma, requiring further consideration of the pathogenic factors. The author experienced a case of spontaneous spinal epidural hematoma associated with the ossification of the ligamentum flavum at the lower portion of the hematoma. Venous bleeding from distended epidural veins was observed at the lateral sides of the dural sac after removal of the hematoma. In addition, no vascular malformation was not found in the operative field. Consequently, the auther cautiously suggests that the ossification of the ligamentum flavum may have resulted in the formation of an abnormally dilated vein which ultimately caused bleeding in the patient.
Arthritis, Rheumatoid ; Hematoma ; Hematoma, Epidural, Spinal* ; Hemodynamics ; Hemorrhage ; Humans ; Hypertension ; Incidence ; Ligamentum Flavum* ; Pregnancy ; Spine* ; Spondylitis, Ankylosing ; Vascular Malformations ; Veins

OBJECTIVE: There has been a lack of enthusiasm for posterior lumbar interbody fusion(PLIF) in revision surgery. PLIF in revision surgery requires more excessive distraction of neural structures and excessive removal of the facet-laminar structure which plays a significant mechanical role, especially in rotatory stability. The author reports facetolaminoplastic PLIF which provides safe and effective PLIF and even natural circumferential fusion as well. PATIENTS AND METHODS: This study consistes of 6 patients. The facetolaminotomy was performed by osteotomizing bilateral pars interarticularis with a Gigli saw. PLIF was performed through more widely exposed intervertebral space by inserting a pair of carbon fiber cages and medial iliac bone blocks between the cages. The facetolaminotomy flap was returned to the previous site and was fixed by trans-laminar and trans-isthmic screw fixation. Bilateral facet arthrodesis was also performed. RESULTS: There were no neural complications related to facetolaminotomy nor were there any complications related to the screw fixation for the restoration of the posterior construct. Of these 6 cases, radiological union at the interbody fusion site and at both pars interarticularis was noted in 5 cases at a 6-month postoperative follow-up. An incomplete union at unilateral pars interarticularis was noted in remaining one case. CONCLUSIONS: The PLIF by facetolaminoplasty in revision surgery not only provides a wide interspace for safe and effective PLIF but also restores the posterior constructs, thereby preserving its important mechanical roles and often even achieving natural circumferential arthrodesis.
Arthrodesis ; Carbon ; Follow-Up Studies ; Humans ; Spine*

After attempts of percutaneous laser disc decompression on 14 patients of lumbar disc herniations, disappointing results were recorded as follows, 2 cases(14.2%) were considered excellent, 2 cases(14.2%) good, 2 cases(14.2%) fair and 8 cases(57.1%) poor. While successfully treated patients had minimal subligamentous extension of nucleus pulposus, failed cases had moderate to severe subligamentous extension of nucleus pulposus through the annular tearing. In preliminary conclusion of percutaneous laser disc decompression, successful result can be expected only on the minimal subligamentous extension cases, and chemonucleolysis will be better choice for the moderate to severe subligamentous extension cases.
Decompression* ; Humans ; Intervertebral Disc Chemolysis

Thirty three cases with agenesis of the corpus callosum were reviewed from the base of brain CT findings for last 7 years. Clinical features, associated clinical anomalies and CT findings were also analysed and the embryological basis for agenesis of the corpus callosum were reviewed from the literature.
Agenesis of Corpus Callosum* ; Brain ; Corpus Callosum ; Embryology

C1/2 posterior transarticular screw fixation has become an accepted method of rigid internal fixation for patients requiring posterior C1/2 fusion. Especially,Surgery for Os odontoideum can be troublesome due to its severe tranlational instability, canal stenosis requiring decompressive laminectomy and defective C1 posterior arch. The author reports three cases of complicated Os odontoideum(one case of failed occipito-C2 fusion, two cases requiring C1 laminectomy) with C1/2 transarticular screw fixation and interarticular bone fusion. All required decompressive laminectomy and demonstrated highly unstable translational instabilities. On the basis of these experiences, it is postulated that C1/2 transarticular screw fixation seems to be superior to other methods in stabilization and fusion for complicated Os-odontoideum.
Constriction, Pathologic ; Humans ; Laminectomy

Although C1-C2 transarticular screw fixation has become a popular surgical method of treating atlantoaxial instability, we remain concerned about the potential for injury to the vertebral artery. Because of the lack of an objective measuring method, surgical unsuitability has been decided on the basis of individual experiences as reported in 18-23% of cases. In this study, the point of screw intersection(the passing points) on the superior articular surface of C2 were measured and the directions of these were thus objectified. Sixty-four healthy volunteers underwent 1mm fine-slice C1-C2 CT scanning, and sagittal images were reconstructed at 3.5mm(3.5mm lateral image) and 6mm(6mm lateral image) lateral to the spinal canal. The C1/2 transarticular screw trajectories making the longest paths or violating the transverse foramen(dangerous trajectory) were drawn and the distance from their points of screw intersection on the superior articular surface of C2 were measured from the posterior rim of the superior articular surface of C2. When the space available for screw(SAS) posterior to the passing point of the dangerous trajectory was equal to or less than 3.5mm(major diameter of the commonly used screw), the case was considered unacceptable, when SAS was over 3.5mm but equal to or less than 4.5mm, screw placement were considered risky. The trajectories made the longest paths when they passed 3.6+/-1.6mm(mean+/-S.D.) and 2.8+/-1.7mm(mean+/-S.D.) anterior to the posterior rim of the posterior articular surface of C2 as seen on 3.5mm lateral images and 6mm lateral images, respectively. While four of 64 cases(6.3%) were unilaterally unacceptable or risky on 3.5mm lateral images, 21 cases(32.8%) were unacceptable or risky on 6mm lateral images(unilateral, 15cases; bilateral, 6 cases). When the trajectories inclined forward to 0%, 25%, 50%, 75% and 100% points of AP diameter of the superior articular surface of C2 from the posterior rim, the respective risks of the involvement of the transverse foramen increased to 0.78%, 1.5%, 25%, 74% and 100%, as seen on 3.5mm lateral images and 10.9%, 14%, 62.5%, 95% and 100%, on 6mm lateral images.
Healthy Volunteers ; Spinal Canal ; Tomography, X-Ray Computed ; Vertebral Artery

Verrucous carcinoma of the oral cavity is a rare tumor representing 4.5-9.0% of oral squamous tumors. Involvement of the lip is less common within the oral cavity. It presents as a slowly enlarging, exophytic warty growth with extensive local invasion, though well-differentiated and rarely metastaticl. We herein repart a case of verrucous carcinoma on the lower lip in a 31-year-old man.
Adult ; Carcinoma, Verrucous* ; Humans ; Lip* ; Mouth

Both CT scan and MRI were taken on 200 randomly chosen patients of degenerative lumbar spine diseases for the double blind comparison of the diagnostic accuracy of these studies. While osseous changes such as canal stenosis, lateral recess stenosis and facet hypertrophy were graded more severe on CT scan than on MRI, facet joint laxity was graded more severe on MRI than on CT scan. MRI could not detect 44% of ligament ossifications and 45.3% of vertebral osteoplytes which were diagnosed on CT scan. MRI gave more valuable information about the direction of the disc herniation than CT scan.
Constriction, Pathologic ; Humans ; Hypertrophy ; Ligaments ; Magnetic Resonance Imaging* ; Spine* ; Tomography, X-Ray Computed* ; Zygapophyseal Joint

We successfully closed the isolated patent ductusarteriosus(PDA) in 2 female patients using the Rashkind Double-Disc Occlusion system. nonsurgical closure of PDA usin plug was introduced by Porstmann in 1968 through transfemoral artery catheter and using umbrella by Rashkind in 1977 througth venous site. There has been continued improvement and simplification of the equipment as well as in the implantation technique. Nowaday, a multicenter study was conducted to test the safety and effectiveness of this interventioal method in States. Successful closure rate was high but some problems were reported such as embolization, abnormal deployment and residual shunt. Residual shunt was visualized by aortography in our both cases immediately after intervention but continuous murmur could not be heard in both cases. Oxygen step-up disappeared immediately after occluder implantation in both cases. Complete occlusion was expected with thrombus in near future.
Aortography ; Arteries ; Catheters ; Ductus Arteriosus, Patent* ; Female ; Humans ; Oxygen ; Thrombosis