Nerve-root anomalies are very uncommon, and there symptoms and signs are nearly similar with those of disc herniation. So we can misdiagnois them for intervertebral disc herniation. The negative Lasegue' sign is the only distinct feature of the nerve root anomalies. The authors report a case of Nerve-Root Anomaly associated with disc herniation in lumbar 4-5 interspace, which was diagnosed preoperatively in myelogram and confirmed surgically.
Intervertebral Disc*

BACKGROUND/AIMS: Adenosine is an endogenous modulator of nociception. Its role in visceral nociception, particularly in visceral hyperalgesia, has not been studied. The aim of this study was to determine the effects of adenosine receptor agonists in a model of visceral hyperalgesia. METHODS: The visceromotor response (VMR) in rats to colorectal distension (CRD; 80 mmHg, 20 seconds) was quantified by electromyographic recordings from the abdominal musculature. Three hours after the intracolonic administration of zymosan (25 mg/mL, 1 mL), VMRs to CRD were measured before and after either subcutaneous or intrathecal administration of an adenosine receptor agonist. RESULTS: Subcutaneous injection of 5'-N-ethylcarboxyamidoadenosine (NECA; an A1 and A2 receptor agonist), R(-)-N6-(2-phenylisopropyl)-adenosine (R-PIA; a selective A1 receptor agonist), or CGS-21680 hydrochloride (a selective A2a receptor agonist) dose-dependently (10-100 mg/kg) attenuated the VMR to CRD, although hindlimb weakness occurred at the higher doses tested. Intrathecal administration of NECA or R-PIA dose-dependently (0.1-1.0 microgram/kg) decreased the VMR, whereas CGS-21680 hydrochloride was ineffective over the same concentration range. Higher intrathecal doses of the A1/A2 receptor agonist NECA produced motor weakness. CONCLUSIONS: Adenosine receptor agonists are antihyperalgesic, but also produce motor weakness at high doses. However, activation of the spinal A1 receptor significantly attenuates the VMR to CRD without producing motor weakness.
Adenosine ; Adenosine-5'-(N-ethylcarboxamide) ; Animals ; Hindlimb ; Hyperalgesia ; Injections, Subcutaneous ; Nociception ; Purinergic P1 Receptor Agonists ; Rats ; Receptors, Purinergic P1 ; Zymosan

Since Jafferson has reported the atlantal fracture in 1920, and its mechanism and type of fracture in detail, a few authers have reported the cases in their literature because the atlantal fractures are one of rare case in cervical injuries. The clinical signs are sparse indeed after acute transection or contusion of medulla. One survived has had a minimal neurologic deficit on account of wide vertebral canal for the cervical cord. The patient has complained the occipital headache and limited motion of neck commonly, without any neurological disturbance. The cervical tracton has been applied for the case usually. Recently, we experienced a case of atlantal fracture with occipito-atlantal dislocation and atlanto-axial dislocation, associated-with quadriplegia for 2.5 years progressively after cervical injury. On simple films of lateral view of cervical spine, it revealed a separated posterior arch was anteriorly dislocated and impacted into the vertebral canal, and anterior arch was markedly displaced anteriorly and had a bony union with the axis in angulated form. The odontoid process of axis is upward translocation. No fracture was found in open mouth view for the axis. The occipito-atlantal and atlanto-axial dislocation were found. On myelogram, the contrast media was almost obliterated in the false occipito-axial joint level by the compression of the fragmented posterior arch of atlas. On vertebral angiogram, it revealed a reverse curve of 3rd. portion of vertebral artery, representing the anterior arch of atlas included the arch retracted the vertebral artery anteriorly. We performed the suboccipital craniectomy and lanimectomy on the atlas for removal of posterior arch of atlas without any spine fusion, Because of the dislocated atlanto-axial joint had a bony union alreadly. The post-operative recovery was very rapid and satisfactory.
Atlanto-Axial Joint ; Axis, Cervical Vertebra ; Contrast Media ; Contusions ; Dislocations* ; Headache ; Humans ; Joints ; Ligaments* ; Mouth ; Neck ; Neurologic Manifestations ; Odontoid Process ; Quadriplegia* ; Rupture* ; Spine ; Vertebral Artery

The post-traumatic leptomeningeal cyst, so-called growing fracture, is one of the complication of the skull fracture in childhood especially under the 3 years old, but very rare in the adult. Since Taveras and Ranschoff proposed the mechanism for production of the expanding fracture post-traumatically in 1953, many authers have explained the mechanism clinically and experimentally. Now we proposed a additional mechanism for producing the brain herniation into the expanding fracture as a case of post-traumatic leptomeningeal cyst reported. A 25 years old male patient was admitted to the department of Neurosurgery, Seoul Red Cross Hospital, because of headache, convulsion, and growing the mass with skull defect. The patient has had a history of skull fracture at the age of 2 years old. The simple skull films revealed a scalloped and saucerized margin of skull defect on left parietal bone. On electroencephalogram, we found a moderated abnormalities in the left parietal area. The left carotid angiogram showed a stretching of middle cerebral artery and elevation of left Sylvian point. The small capillary branches of middle cerebral artery has pushed out through the skull defect, which indented brain herniation into the skull defect. No cystic picture was found. We operated this case with the dura repair and grafting, and then cranioplasty with resion. On operative finding, we found that one edge on torn dura has impacted into the opposite edge of fractured skull tightly, which suggested the pulling up the dura and brain into the skull defect by growing rate of the skull bone. By the craniectomy for the bone, impacted dura, was free from the impacted bone and the above continued procedure had completely successful . The post-operative course was very satisfactory. According to the operative finding, the skull fracture with dural tearing are essential factors in producing the post-traumatic leptomeningeal cyst in infancy(usually under the 3 years old). When the one edge of torn dura is impacted into the edge of same side of fractured bone, or was left free, it will produce the simple leptomeningeal cyst during the improportional growing the skull bone and brain. On the other hand, when one edge of torn dura is impacted into the opposite edge of fracture bone, the growing parietal bone pulled up the encircled brain into the skull defect aperture gradually, which produced the brain herniation, a type of post-traumatic leptomeningeal cyst. We reported a case of the post-traumatic leptomeningeal cyst in adult very rarely, and proposed a mechanism for producing a brain herniation into skull defect, a type of post-traumatic leptomeningeal cyst.
Adult ; Arachnoid Cysts* ; Brain ; Capillaries ; Child, Preschool ; Electroencephalography ; Hand ; Headache ; Humans ; Male ; Middle Cerebral Artery ; Neurosurgery ; Parietal Bone ; Pectinidae ; Rabeprazole ; Red Cross ; Seizures ; Seoul ; Skull ; Skull Fractures ; Transplants

Recently, we experienced two cases of tuberous sclerosis, in 4-year-4-month-old female and 17-month-old male patient. The diagnoses were established by typical clinical manifestations and brain CAT. Especially, in latter case, calcific density was successfully detected by brain CAT, while plain radiographs of the skull revealed still no evidence of calcification. A brief review of related literatures was made.
Animals ; Brain ; Cats ; Diagnosis ; Female ; Humans ; Infant ; Male ; Skull ; Tuberous Sclerosis*

PURPOSE: Conventional contrast dacryocystography(C-DCG) has been used mainly for anatomical assessment of the lacrimal drainage apparatus, due to its limited information on the dynamics of the lacrimal system, and thus correlation role in epiphora. The purpose of study was to improve the diagnostic value in epiphora by utilizing RI dacryocystography(RI-DCG) with quantitative criteria. MATERIALS AND METHODS: The patient for RI dacryocystography set erect with the head fixed in front of gamma camera fitted with a standard 6 mm pinhole collimater. Both eyes of 85 patients(170 eyes) were scanned with 99rnTc-pertechnetate followed by conventional dacryocystography. The data from gamma camera were recorded simultaneously on a computer system for subsequent quantitative analysis. RESULTS: In 94 of 96 eyes without epiphora, RI-DCG was correlated with normal C-DCG and % of emptying was at least over 50%. In 58 of 74 eyes with epiphora, RI-DCG was correlated with abnormal C-DCG and % of emptying was at most below 50%. In 16 eyes with functional block, quantitative RI-DCG showed abnormal % of emptying. CONCLUSION: Nuclear DCG with quantitation had higher diagnostic yield in functional block and correlated higher with epiphora. Thus nuclear DCG with quantitation would be a valuable functional test after postprocedures such as dacryocystoplasty.
Computer Systems ; Drainage ; Gamma Cameras ; Head ; Humans ; Lacrimal Apparatus Diseases* ; Radionuclide Imaging*

Endoscopic biopsy is necessary to confirm a histopathologic diagnosis. Currently, 6 to 8 biopsies are recommended for diagnosis of a suspected malignant lesion. However, multiple biopsies may result in several problems, such as an increased risk of bleeding, procedure prolongation, and increased workload to pathologists. The aim of this study was to clarify the optimal number of endoscopic biopsy specimens required in diagnosis of advanced gastrointestinal cancer. Patients who were diagnosed with advanced gastrointestinal cancer during endoscopy were included. Five specimens were obtained sequentially from viable tissue of the cancer margin. Experienced pathologists evaluated each specimen and provided diagnoses. A total of 91 patients were enrolled. Fifty-nine subjects had advanced gastric cancer, and 32 had advanced colon cancer. Positive diagnosis rates of the first, second, and third advanced gastric cancer specimens were 81.3%, 94.9%, and 98.3%, respectively, while positive diagnosis rates of advanced colon cancer specimens were 78.1%, 87.5%, and 93.8%. Further biopsies did not increase positive diagnosis cumulative rates. This study demonstrated that three specimens were sufficient to make correct pathologic diagnoses in advanced gastrointestinal cancer. Therefore, we recommend 3 or 4 biopsies from viable tissue in advanced gastrointestinal cancer to make a pathologic diagnosis during endoscopy.
Adult ; Aged ; Biopsy/*statistics & numerical data ; Colorectal Neoplasms/*diagnosis/pathology ; *Endoscopy, Digestive System ; Female ; Humans ; Male ; Middle Aged ; Stomach Neoplasms/*diagnosis/pathology

Transfusion-induced hyperkalemia can lead to cardiac arrest, especially when the patient rapidly receives a large amount of red blood cells (RBCs), previously stored for a long period of time, irradiated or both. We report on a case of application of the Continuous AutoTransfusion System (CATS) to wash RBCs, in order to lower the high potassium (K+) level in the packed RBCs unit, during massive transfusion following transfusion-induced hyperkalemic cardiac arrest. After the washing process using CATS, there was no more electrocardiographic abnormality or cardiac arrest due to hyperkalemia. This case emphasizes the potential risk to develop transfusion-related hyperkalemic cardiac arrest, during massive transfusion of irradiated, pre-stored RBCs. CATS can be effectively used to lower the K+ concentration in the packed RBCs unit, especially when the risk of transfusion-induced hyperkalemia is high.
Animals ; Blood Transfusion ; Blood Transfusion, Autologous ; Cats ; Electrocardiography ; Erythrocytes ; Heart Arrest ; Humans ; Hyperkalemia ; Potassium

BACKGROUND: CarboMedics and St.Jude Medical bileaflet valves are in widespread use but few noninvasive studies about the two types of valves were performedd. The aim of this study was to assess the characterisics of the normally functioning CarboMedics and St.Jude Medical prosthesis in the mitral position. METHODS: Patients with normally functioning CarboMedics and St.Jude Medical valve in the mitral position were included. They underwent transthoracic and transesophageal echocardiography 7 to 14days after mitral valve replacement. With the use of color flow Doppler transesophageal echocardiography, we measured the length, width, and area of maximal physiologic regurgitation and by using 2-D transesophageal echocardiography, we measured the opening and closing angles of the bileaflet valves and we tried to elucidate whether spontaneous echo contrast is present in the left atrium. RESULTS: 31 pateints underwent mitral valve replacement with CarboMedics and 10 patients with St.Jude Medical. The length of maximal physiologic regurgitation ranged from 11mm to 44mm in carboMedics mitral valve and from 12mm to 36mm in St.Jude Medical mitral valve. The area ranged from 0.19cm2to 3.48cm2in CarboMedcs and from 0.58cm2to 4.49cm2in CarboMedics and The mean opening and closing angles are 83.2(+/-1.1)degrees, 22.3(+/-1.3)degrees in CarboMedics and 86.5(+/-1.2)degrees 26.2(+/-3.2)degrees in St.Jude Medical. Spontaneous echo contrast was positive in 66% of patients, of whom patioents with atrial fibrillation showed nuch higher revalence of SEC than patients with sinus rhythm. CONCLUSION: These finding valve will give us a reference valvue for the evaluation of prosthetic valve function in mitral position.
Atrial Fibrillation ; Echocardiography* ; Echocardiography, Transesophageal ; Heart Atria ; Humans ; Mitral Valve* ; Prostheses and Implants

Background/Aims: The risk of recurrence of colorectal adenoma among obese individuals without metabolic abnormalities or in those with metabolically healthy obesity is largely unexplored.Therefore, we longitudinally investigated the risk of adenoma occurrence in individuals undergoing surveillance colonoscopy according to metabolic status and obesity. Methods: This retrospective cohort study included 16,872 Korean adults who underwent their first screening colonoscopy between 2003 and 2012 and who then underwent follow-up colonoscopy until 2017. Participants were categorized into a metabolically healthy nonobese group (reference group), a metabolically healthy obese group, a metabolically abnormal nonobese group, and a metabolically abnormal obese group. Hazard ratios (HRs) for adenoma recurrence compared to the reference group were calculated in each group. Results: During a median follow-up duration of 47.3 months (interquartile range, 35.6 to 58.9 months), 3,673 (21.8%) and 292 (1.73%) participants developed adenoma and advanced adenoma, respectively. When age, sex, smoking, alcohol consumption, family history of colorectal cancer, and baseline adenoma risk were adjusted, the risk of adenoma recurrence was increased in metabolically healthy obese individuals (HR, 1.33; 95% confidence interval [CI], 1.12 to 1.57) and metabolically abnormal obese individuals (HR, 1.18; 95% CI, 1.08 to 1.30) but not in metabolically abnormal nonobese individuals (HR, 1.03; 95% CI, 0.94 to 1.13). Conclusions In this study, metabolically healthy obese individuals and metabolically abnormal obese individuals exhibited increased risks of occurrence of colorectal adenoma diagnosed by surveillance colonoscopy. This finding implies that obesity itself, even without metabolic abnormalities, is associated with an increased risk of adenoma recurrence.