Malignant neuroepithelioma is a rare neoplasm arising within the peripheral nervous system and usually occurs in the lower extremities. It may involve patients in any age group and have no gender predisposition. In adolescents and adults the tumor must be distinguished from other malignant round-cell tumors. The poor prognosis and the need for aggressive, combined surgical and chemotherapeutic modalities in treating this tumor necessitate a prompt and accurate diagnosis. Authors have experienced a case of malignant neuroepithelioma developed in left sciatic nerve. The diagnosis was confirmed by CT scan, M.R.I., light and electron microscopic findings.
Adolescent ; Adult ; Diagnosis ; Humans ; Lower Extremity ; Neuroectodermal Tumors, Primitive, Peripheral ; Peripheral Nervous System ; Prognosis ; Sciatic Nerve ; Tomography, X-Ray Computed

No abstract available.
Animals ; Doxorubicin* ; Rats*

Spinal instrumentation using pedicle screws offers several advantages such as 1) achievement of rigid fixation through the pedicles which is the strongest structure of spine, 2) nearly anatomic reduction by direct force on the deformed sites of fracture and 3) preservation of mobile segments by short segment fixation. The authors analysed 14 cases of unstable thoracolumbar and lumbar fracture treated by pedicle screw fixation from May 1988 to June 1989. Mean follow up was 14 months(8M.-20M.) and following results were obtained. 1. Most of the cases were male(13 cases) and their age ranged from 26 to 55 with an average of 36. 2. According to Denis classification, there were 7 cases of burst fracture, 5 cases of fracture-dislocation, 1 case of seat belt injury and unclassified one case. 3. After operation, the height of anterior column was reduced from 61% to 86%, posterior column, from 134% to 105%, local kyphosis, from 17.4% degrees to 3.4 degrees and anterior translation, from 6mm to 1.2mm. 4. In comparision of preoperative and postoperative moter index between fracture-dislocation and burst fracture, the former changed from 3.2 to 21.8 and the latter, from 40.2 to 48.6. 5. Significant neurologic recoveries were observed in all cases except one complete paraplegia. 6. There was no significant complication and minimal loss of correction was noted.
Classification ; Follow-Up Studies ; Kyphosis ; Paraplegia ; Pedicle Screws ; Seat Belts ; Spine

PURPOSE: Several approaches in endoscopic thyroid surgery have been developed to avoid large scars on the anterior neck. We assessed the feasibility and cosmetic benefit of performing gasless endoscopic thyroid surgery through a single infraclavicular approach. METHODS: Thirty-one patients with a benign thyroid mass on sonography received gasless endoscopic thyroidectomy through a single infraclavicular approach. A 5-cm infraclavicular incision was created laterally, depending on the distance from the clavicle to the thyroid mass, but which would be completely hidden by a V-shaped shirt collar. In some cases, hand-assisted vessel ligation was performed through this incision. RESULTS: The study included 26 female patients (out of 31), and the mean age was 38.2 years old (range, 14 to 70). All patients received a unilateral thyroid lobectomy, with or without isthmectomy, and tumors were benign (follicular adenoma in 12 and adenomatous hyperplasia in 19). A recurrent laryngeal nerve was identified in all cases. The mean operation time was 162.5 min (range, 100 to 300 min). No patients required conversion to conventional open surgery or showed postoperative bleeding, even without drainage. Hoarseness occurred in 1 patient with injury of the recurrent laryngeal nerve, which was repaired through the same incision and recovered within 6 months. Temporary hoarseness occurred in another 3 patients, but recovered within 3 months. CONCLUSION: Gasless endoscopic thyroidectomy through a single infraclavicular approach improved cosmetic outcomes and allowed for bleeding control through hand-assisted ligation of vessels. Therefore, the technique is suitable for surgeons inexperienced in endoscopic thyroidectomy.
Adenoma ; Cicatrix ; Clavicle ; Drainage ; Female ; Hemorrhage ; Hoarseness ; Humans ; Hyperplasia ; Ligation ; Neck ; Recurrent Laryngeal Nerve ; Surgeons ; Thyroid Gland* ; Thyroidectomy

PURPOSE: Nutritional as well as genetic and hormonal factors play an important role in the bone mineralization during childhood and adolescence. There are several physical and metabolic changes in obese children, and these changes may influence on the mineralization of the skeleton. The studies about bone mineralization of obese children are rare and contradictory. This study was performed to evaluate the influence of childhood obesity on bone mineral density(BMD). METHODS: The BMD of 49 obese and 41 non-obese children were measured at lumbar spines(L2-L4) using dual energy X-ray bone absorptiometry. Then, the results were assessed and compared according to the degree of obesity and pubertal sex maturation. RESULTS: There were no significant differences in BMD between obese children and non-obese children(0.87+/-.19 g/cm2 vs 0.81+/-.13 g/cm2). BMD increased according to the Tanner' pubertal staging, and the most marked increment was observed at overt puberty. No sex difference in BMD was seen in both obese and non-obese children. BMD was highly correlated with age, height, weight and body mass index(BMI), but there was no significant correlation between BMD and osteocalcin. CONCLUSION: BMD of obese children was not significantly different from that of non-obese children, and BMD also was not changed according to the degree of obesity. These findings suggest that BMD is not influenced by obesity in children.
Adolescent ; Bone Density* ; Calcification, Physiologic ; Child* ; Humans ; Obesity* ; Osteocalcin ; Pediatric Obesity ; Puberty ; Sex Characteristics ; Sexual Maturation ; Skeleton

BACKGROUND AND OBJECTIVES: Screening strategies for aortic aneurysm (AA) according to risk factors and ethnicity are controversial. This study explored the prevalence of AA and determined whether screening is necessary in a population of multiple risk factors. SUBJECTS AND METHODS: From June, 2012 to April, 2013, 542 consecutive elderly (> or =65 years) male hypertensive patients without a history of AA were prospectively enrolled. After excluding 15 patients (2.8%) with aortic valve surgery, 30 patients (5.5%) with suboptimal computed tomography (CT) images, the remaining 496 patients (age 73+/-5 years) comprised the study population. Maximal diameters of the thoracic and abdominal aorta were measured using non-contrast CT. RESULTS: The prevalence of thoracic AA (TAA, diameter > or =40 mm) and abdominal AA (AAA, diameter > or =30 mm) was 36.5% (181/496) and 6.0% (30/496), respectively. In the multivariate logistic regression analysis, determinants for TAA were age {odds ratio (OR) 1.059, 95% confidence interval (CI) 1.018-1.101, p=0.005}, dyslipidemia (OR 0.621, 95% CI 0.418-0.923, p=0.018), body surface area (OR 11.92, 95% CI 2.787-50.97, p=0.001), diastolic blood pressure (OR 1.029, 95% CI 1.009-1.049, p=0.004) and AAA (OR 3.070, 95% CI 1.398-6.754, p=0.005). In contrast, AAA was independently associated with dysplipidemia (OR 2.792, 95% CI 1.091-7.143, p=0.032), current/past smokerfs (OR 4.074, 95% CI 1.160-14.31, p=0.028), and TAA (OR 3.367, 95% CI 1.550-7.313, p=0.002). CONCLUSION: The prevalence of AA was significant and TAA was more prevalent than AAA in elderly Korean males with hypertension. Future research should establish distinct screening strategies for TAA and AAA according to risk factors and ethnicity.
Aged ; Aneurysm ; Aorta ; Aorta, Abdominal ; Aortic Aneurysm* ; Aortic Valve ; Blood Pressure ; Body Surface Area ; Dyslipidemias ; Humans ; Hypertension* ; Logistic Models ; Male ; Mass Screening* ; Prevalence ; Prospective Studies ; Risk Factors

Lateral ankle sprains are one of the most common injuries to the lower extremity. Most of them well respond to conservative treatments. However, simultaneous peroneal nerve injuries may occur rarely following lateral ankle ligamentous injuries. We report a case presents superficial peroneal nerve injury with dorsal foot pain lasting for more than 2 months after lateral ankle sprain and review the literature.
Animals ; Ankle ; Foot ; Ligaments ; Lower Extremity ; Peroneal Nerve ; Sprains and Strains

PURPOSE: Despite increased effort for the detection of early colorectal cancer, advanced disease presenting as obstruction or perforation still accounts for 8 to 29% and 3-8% of all colorectal cancers, respectively. The aim of this retrospective study was to evaluate the clinical characteristics, the surgical methods, the complications, and the risk factors of obstructive or perforated colorectal cancer that may influence the outcome. METHODS: A retrospective study was carried out in 60 patients with colorectal cancer, who underwent surgery due to obstruction or perforation from March 2000 to December 2005. The colorectal cancers were considered to be complicated when clinical signs of peritonitis were observed, the radiologic characteristics of the tumor did not permit preoperative mechanical bowel preparation, or perforation existed, when these observations were confirmed by operative findings. The following data were analyzed: clinical characteristics, surgical methods, complications, and risk factors. RESULTS: Thirty-three patients (55%) had obstruction, and 27 patients (45%) had perforation. Overall, major complications occurred in 33.3% and 48.5%, respectively. The mortality rates were 6.1% and 14.8%, respectively. Risk factors for major complication were age, perforation, and transfusion whereas those for mortality were perforation and American Society of Anesthesiologists (ASA) class. CONCLUSION: The risk factors of complication were old age, transfusion, and perforation and those for mortality was perforation and ASA class. Earlier diagnosis and prompt, intensive, careful management should be attempted in these high-risk patients.
Colorectal Neoplasms ; Emergencies ; Humans ; Multivariate Analysis ; Peritonitis ; Retrospective Studies ; Risk Factors

PURPOSE: The location of acetylcholinesterase-containing nerve fibers suggests a role for acetylcholine in both contractility and secretion in the prostate gland. The colocalization of nitrergic nerves with cholinergic nerves, and the cotransmission of nitric oxide with acetylcholine in cholinergic nerves, has been demonstrated in the prostate glands of various species. Thus, we investigated the effects of acetylcholine on phenylephrine-induced contraction and the correlation between cholinergic transmission and nitric oxide synthase by using isolated prostate strips of rabbits. MATERIALS AND METHODS: Isolated prostate strips were contracted with phenylephrine and then treated with cumulative concentrations of acetylcholine. Changes in acetylcholine-induced relaxation after preincubation with NG-nitroarginine methyl ester, 7-nitroindazole, and aminoguanidine were measured. The effects of selective muscarinic receptor antagonists were also evaluated. RESULTS: In the longitudinal phenylephrine-contracted strip, the cumulative application of acetylcholine (10(-9) to 10(-4) M) elicited a concentration-dependent relaxation effect. Acetylcholine-induced relaxation was inhibited not only by nitric oxide synthase inhibitors (10 microM L-NAME or 10 microM 7-nitroindazole) but also by 10 microM atropine and some selective muscarinic receptor antagonists (10(-6) M 11-([2-[(diethylamino)methyl]-1-piperdinyl]acetyl)-5,11-dihydro-6H-pyrido[2,3-b][1,4]benzodiazepine-6-one and 10(-6) M 4-diphenylacetoxy-N-methyl-piperidine). In contrast, relaxation was significantly increased by pretreatment of the strips with 10 mM L-arginine. CONCLUSIONS: Acetylcholine relaxed phenylephrine-induced contractions of isolated rabbit prostate strips. This relaxation may be mediated via both cholinergic and constitutive nitric oxide synthase with both the M2 and M3 receptors possibly playing key roles.
Acetylcholine ; Atropine ; Contracts ; Guanidines ; Indazoles ; Nerve Fibers ; Neurons ; NG-Nitroarginine Methyl Ester ; Nitrergic Neurons ; Nitric Oxide ; Nitric Oxide Synthase ; Nitric Oxide Synthase Type I ; Phenylephrine ; Prostate ; Receptor, Muscarinic M2 ; Receptor, Muscarinic M3 ; Receptors, Muscarinic ; Relaxation

STUDY DESIGN: This is a retrospective clinical study. OBJECTIVES: To know how the associated foot or ankle fracture influences the fracture pattern in the thoracolumbar burst fractures caused by falls from height. SUMMARY OF LITERATURE REVIEW: There were few studies on how the foot or ankle fracture influences the thoracolumbar fracture caused by falls from height. MATERIALS AND METHODS: We reviewed 46 subjects, who underwent surgery due to burst fracture of the thoracic or lumbar region, caused by fall accidents, from May 2004 to October 2008. Among them, we defined 19 cases that had associated foot or ankle fractures as group A, and the other 27 cases as group B. We analyzed the differences of radiological and clinical findings, and functional outcomes between the two groups. RESULTS: The falling heights were higher in group A than in group B (P<0.01). Thoracolumbar junction (T11-L2) was the most common location involved in both groups, but group A had more fractures on the lower lumbar region (L3-5), relatively (p=0.03). Kyphotic deformity was more severe in group B (p=0.01) but there were no significant differences in the wedge angle, amount of canal compromise, compression rate of anterior column between both groups (p=0.08, 0.46, 0.76). More segments were fused in group B (P=0.04). Neurologic deficit was more common in group B (p=0.03), but there were many complications related with foot or ankle fractures in group A (38%).There was no significant difference in the final clinical outcome between both groups (Pain scale p= 0.48, Work scale p=1.00). CONCLUSIONS: In patients who had burst fractures in the thoracic or lumbar region associated with foot or ankle fractures, there was a tendency to increase the incidence of lower lumbar fracture, relatively. The neurologic deficits were less common in this group of patients, but there was no difference in the functional outcome.
Animals ; Ankle ; Congenital Abnormalities ; Foot ; Humans ; Incidence ; Lumbosacral Region ; Neurologic Manifestations ; Retrospective Studies