We report a case of neurilemmoma of deep peroneal nerve sensory branch that triggered sensory change with compression test on lower extremity. After resection of tumor, there are evoked thermal changes on pre- and post-operative infrared (IR) thermographic images. A 52-year-old female presented with low back pain, sciatica, and sensory change on the dorsal side of the right foot and big toe that has lasted for 9 months. She also presented with right tibial mass sized 1.2 cm by 1.4 cm. Ultrasonographic imaging revealed a peripheral nerve sheath tumor arising from the peroneal nerve. IR thermographic image showed hyperthermia when the neurilemoma induced sensory change with compression test on the fibular area, dorsum of foot, and big toe. After surgery, the symptoms and thermographic changes were relieved and disappeared. The clinical, surgical, radiographic, and thermographic perspectives regarding this case are discussed.
Female ; Fever ; Foot ; Humans ; Low Back Pain ; Lower Extremity ; Middle Aged ; Neurilemmoma* ; Peripheral Nerves ; Peroneal Nerve* ; Sciatica ; Toes

PURPOSE: Chemotherapy targets all rapidly growing cells, not only cancer cells, and thus is often associated with unpleasant side effects. Therefore, examination of the chemosensitivity based on genotypes is needed in order to reduce the side effects. MATERIALS AND METHODS: Various computational approaches have been proposed for predicting chemosensitivity based on gene expression profiles. A linear regression model can be used to predict the response of cancer cells to chemotherapeutic drugs, based on genomic features of the cells, and appropriate sample size for this method depends on the number of predictors. We used principal component analysis and identified a combined gene expression profile to reduce the number of predictors. RESULTS: The coefficients of determinanation (R²) of prediction models with combined gene expression and several independent gene expressions were similar. Corresponding F values, which represent model significances were improved by use of a combined gene expression profile, indicating that the use of a combined gene expression profile is helpful in predicting drug sensitivity. Even better, a prediction model can be used even with small samples because of the reduced number of predictors. CONCLUSION: Combined gene expression analysis is expected to contribute to more personalized management of breast cancer cases by enabling more effective targeting of existing therapies. This procedure for identifying a cell-type-specific gene expression profile can be extended to other chemotherapeutic treatments and many other heterogeneous cancer types.
Breast Neoplasms* ; Breast* ; Drug Therapy ; Gene Expression* ; Genotype ; Humans ; Linear Models ; Methods ; Principal Component Analysis ; Sample Size ; Transcriptome*

OBJECTIVE: In the management of degenerative conditions of the lumbar spine, spinal fusion is a popular management option and posterior interbody fusion is gaining wide acceptance for the treatment of segmental instability, spondylolisthesis, and discogenic pain. Many methods have been described, including use of autograft or allograft bone, in either structural or nonstructural form, with or without additional fixation. METHOD: The authors retrospectively analyzed 102 cases of posterior lumbar interbody fusion with BAK cage from March 1993 to April 1998. All patients have been followed for 24 to 56 months. Postoperative clinical and radiological changes are evaluated by Mcnab criteria and dynamic lumbar spine lateral measurement. RESULTS: Stable bony fusion was accomplished in 81.9% of patients at 12 months, in 87.4% of patients at 24months, and in 91.2% of patients at 3 years after surgery and their overall outcome was also remarkable(excellent: 42.2%, good: 49.1%). Postoperative correction of slipping was average 3.1mm in spondylolisthesis group. Seventy-eight percent of the previously employed patients returned to work by 24 months after surgery, and 94% were working at 3 years after surgery. CONCLUSION: The results of this study strongly imply that the BAK cage is safe and effective in the management of certain forms of degenerative conditions of lumbar spine. However proper patient selection is critical and experienced and properly trained spinal surgeons should perform this procedure.
Allografts ; Autografts ; Humans ; Patient Selection ; Retrospective Studies ; Spinal Fusion ; Spine ; Spondylolisthesis

The germ cell tumors are classified to germinoma, immature teratoma, mature teratoma, choriocarcinoma, yolk sac tumor and embryonal carcinoma. We analyzed 10 cases of suprasellar germ cell tumors which had been treated at Yonsei Uviversity Hospital from 1980 to 1990. Results of our study were summurized as follows : Common clinical symptoms are diabetes insipidus, visual dysfunction, panhypopituitarism, etc. Therapeutic plan can be based on serum and CSF AFP and HCG level. Pretreatment and posttreatment bormonal evaluation were performed and hrmonal replacement were required in all patients. Germinoma showed good outcome but immature teratoma showed bad outcome by multisystem involvement. More advanced new chemotherapeutic and immunotherapeutic agents must be studied for this tumor.
Carcinoma, Embryonal ; Choriocarcinoma ; Diabetes Insipidus ; Endodermal Sinus Tumor ; Female ; Germ Cells* ; Germinoma ; Humans ; Neoplasms, Germ Cell and Embryonal* ; Pregnancy ; Teratoma

Congenital dermal sinus (CDS) is a rare entity widely known to occur as a result of the of the failure of the neuroectoderm to separate from the cutaneous ectoderm during the process of neurulation at the third to fifth week of gestation. The lesion can occur at any level of the craniospinal axis, but are located predominantly at the lumbosacral and occipital region. CDS of thoracic region and cervical region are rare. The patient with CDS presents with meningitis and/or mass effect from the associated inclusion tumor. They are usually dermoid or epidermoid cyst. Teratoma is rarely associated with CDS. We report our experience of CDS an 11-month old boy associated with an intramedullary dermoid tumor at the thoracic region, and together we report a review of the literature.
Axis, Cervical Vertebra ; Dermoid Cyst ; Ectoderm ; Epidermal Cyst ; Humans ; Infant ; Male ; Meningitis ; Neural Plate ; Neurulation ; Pregnancy ; Spina Bifida Occulta* ; Teratoma

Thermography shows the skin temperature changes in various conditions of the body. The skin temperature varies according to subcutaneous blood flow under the control of autonomic nervous system. Lumbar radiculopathy due to disc hernation makes difference in the temperature of lower extremities caused by the changes in general functions and autonomic functions of the nerve root. Digital infrared thermographic imaging(DITI) system has been used to diagnose radiculopathy without any hazards or discomforts and shows the pain due to LDH by objective change of temperature. This study has used DITIs of 55 control cases and 217 cases of LDH patients and analysed it statistically. In the room the temperature stable at 20 degrees C, the temperature distribution of the lower extremities of the control cases ranged from 24.9 degrees C to 29.9 degrees C. The significant minimal temperature difference between right and left lower extremities range from 0.1 degrees C to 0.4 degrees C. The more distal, the greater the temperature difference was. The thermatome of L4, L5 and S1 was drawn in radiating type and spot type. The thermatome showed larger area than the sensory dermatome and sympathetic dermatome. There was significant increase or decrease of temperature in thermatome in LDH patients. In conclusion, preoperative DITI of the LDH patient can be helpful for diagnosing the level of LDH and the areas of pain.
Autonomic Nervous System ; Humans ; Lower Extremity ; Radiculopathy ; Skin Temperature ; Thermography

Localization of the specific symptomatic level in multiple lumbar disc herniations is very important in the decision of surgical levels and operative method and is also one of the rate limiting factor for the successful postoperative results. Until now pain provocation test with discography is known as the unique functional and physiological method to localize the symptomatic level of disc herniation. But it is an invasive study and there is still an ongoing argument about discography for their diagnostic accuracy and specificity. Digital infrared thermographic imaging technique is a non-invasive technique to detect the discogenic pain with high accuracy. Authors evaluated the diagnostic efficacy of digital infrared thermographic imaging in 202 cases of multiple lumbar disc herniations by analysis of symptom correlation and the accuracy with operative findings. And also the correlation of digital infrared thermographic imaging technique with discography was analyzed. The digital infrared thermographic imaging technique showed high sensitivity(86.4%) to the clinical symptom and good correlation with the operative findings. It also revealed high correlation rate(81.4%) with discography. As a conclusion, digital infrared thermographic imaging technique is a highly effective diagnostic tool in the localization of the symptomatic level in multiple disc herniations.
Sensitivity and Specificity

Object: To treat hydrocephalus by ventriculo-peritoneal shunt operation, the correct positioning of the proximal catheter in the ventricle is very important. The purpose of this study was to develop the "shunt guiding kit" for the proper positioning of the proximal shunt catheter to the ventricle in the ventriculo-peritoneal shunt operation. MATERIALS AND METHODS: The "shunt guiding kit" is made of tungsten alloy and it consists of one frame, two screws and one guider. Through the guider, the proximal shunt catheter operates by mechanically coupling the posterior burr hole to the anterior target point. RESULTS: We have treated three hydrocephalus patients with use of the "shunt guiding kit", and achieved good location of proximal shunt catheters. CONCLUSION: We developed the "shunt guiding kit" for the proper positioning of the proximal shunt catheter to the ventricle, and this would be very useful for preventing ventriculo-peritoneal shunt malfunction and preventing possible brain injury during the procedures.
Alloys ; Brain Injuries ; Catheters* ; Humans ; Hydrocephalus ; Lateral Ventricles* ; Tungsten ; Ventriculoperitoneal Shunt*

OBJECTIVE: The authors conducted a retrospective study of patients with degenerative lumbar spinal disorders who received a posterior lumbar interbody fusion (PLIF) with the IS(R) cage. METHODS: We assessed 105 patients who underwent on a PLIF with or without pedicle screws using the IS(R) cage in our institute from November 2007 to December 2008. Clinical outcomes were analyzed with a Visual Analog Scale (VAS) for back and leg pain. Radiographs were obtained before and after the surgery. In some cases, a lumbar spinal computed tomography scan was obtained. Radiological outcomes of intercage distance, fusion rate, and intervertebral disc height were assessed. In scoliosis or lateral translation, the extent of correction was examined. RESULTS: The mean VAS score for back pain improved from 6.86 preoperatively to 2.66 at postoperative month 12, and the score for leg pain decreased from 7.92 to 1.78. The mean intervertebral disc height was 8.71+/-2.35mm before the surgery, and it increased to 11.67+/-1.77mm at 7 days postoperative and decreased to 9.57+/-1.90mm at 6 months postoperative. The fusion rate was 95.65%. For scoliosis or lateral translation, thesegmental angle of scoliosis decreased from 11.10+/-5.82degrees before the surgery to 5.61+/-3.71degrees by month 6 postoperative. The extent of the lateral translation changed from 6.04+/-1.73mm before the surgery to 3.56+/-4.99mm at month 6 postoperative. CONCLUSION: There have been low complication rates with the IS(R) cage during the follow-up period, and the results of this study demonstrates a wide fusion area, partial reduction of lateral translation and scoliosis, good clinical success, and a high fusion rate.
Back Pain ; Follow-Up Studies ; Humans ; Intervertebral Disc ; Leg ; Retrospective Studies ; Scoliosis ; Spinal Fusion

OBJECTIVE: A minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) has recently been introduced. However, MIS TLIF is a technically challenging procedure. The authors performed retrospective analysis about MIS TLIF using a single interbody cage. METHODS: Twenty-eight consecutive patients were treated by MIS TLIF. Of these 28 patients, 20 patients were included in this retrospective study. Perioperative, clinical, and radiologic outcomes were assessed. Clinical outcomes were assessed using Oswestry Disability Index (ODI) and Visual Analogue Scores (VAS). Fusion rates and cross-sections of operated spinal canals were assessed by CT. RESULTS: Twelve patients underwent MIS TLIF at one segment and 8 patients at two segments (L3/4: 4, L4/5: 17, L5/S1: 7). Operation time for a single segment was 131.7 min and for two segment was 201.4 min, and corresponding blood losses were 208.3 mL and 481.2 mL, respectively. ODI and VAS scores were significantly improved at 6 months postop (ODI from 30.32 to 15. 54, VAS from 7.80 to 2.20, p = 0.001). Twenty-two segments (78.6%) achieved grade I fusion, 4 segments (14.3%) achieved grade II, 2 segments (7.1%) achieved grade III and 0 segments achieved grade IV at 12 months. Postoperatively at 12 months, spinal canal cross sectional areas at disc spaces significantly increased from 157.5 to 294.3 mm2 (p = 0.012). CONCLUSION: MIS TLIF achieved good clinical outcomes and high fusion rates. Our findings show that MIS TLIF performed with a single interbody cage and a tubular retractor system can be used as a standard MIS TLIF technique.
Humans ; Lumbar Vertebrae ; Retrospective Studies ; Spinal Canal ; Spinal Fusion