No abstract available.
Muscle Spasticity* ; Rhizotomy* ; Upper Extremity*

No abstract available.
Acoustics* ; Dysarthria*

The extratemporal operative approaches for intractable epilepsy are reviewed. Intracranial recordings are often necessary for extratemporal epilepsy to define the lateratization as well as the localization of epileptogenic regions and tailor the resection. The operative procedures include cortical resections, corpus callosotomy, and functional hemispherectomy. The author presents an overview of indications for surgery, oprative methods, and risks in the medically intractable epileptic patient with extratemporal focus.
Epilepsy* ; Hemispherectomy ; Humans ; Surgical Procedures, Operative

Cortical dysplasia is a cause of intractable epilepsy and a candidate for surgical resection to control epileptic attacks. The neuronal cytomegaly and balloon cell change are the diagnostic hallmarks of cortical dysplasia. Little research has been performed about the normal-sized dysplastic neuron which has complex arborizing dendrites and lacks in its polarity. The aim of this study was to define the histopathologic characteristics of the neurons in cortical dysplasia. Twelve cases of cortical dysplasia who underwent partial lobectomy for intractable seizures were selected and immunohistochemical staining for NF-M/H, MAP2, tau, and ubiquitin was performed. The perikarya and dendrite of dysplastic neurons were more intensely labeled with antibodies for the high and medium molecular weight neurofilament proteins (NF-M/H) than normal neurons. Immunoreactivity with the MAP2 antibody expressed mainly within the somatodendritic regions was present in the dysplastic or normal neurons without any significant difference in intensity. The complex arborizing dendrites of dysplastic neurons were easily identified due to pronounced immunoreactivity within the somatodendritic regions. Immunoreactivity with the primary antibody against tau and ubiquitin was present in the normal-looking neurons as well as the dysplastic neurons. This study suggests that the dysplastic neurons in cortical dysplasia are accompanied by changes of cytoskeletal neurofilaments, and the immunohistochemical stains for NF-M/H, MAP2, tau, and ubiquigin are useful to detect them.
Antibodies ; Coloring Agents ; Dendrites ; Epilepsy ; Malformations of Cortical Development* ; Molecular Weight ; Neurofilament Proteins ; Neurons ; Seizures ; Ubiquitin

PURPOSE: We wanted to investigate the efficacy of percutaneous radiofrequency (RF) neurotomy of the medial branch for the management of chronic low back pain due to lumbar zygapophysial joint dysfunction. MATERIALS AND METHODS: Thirteen patients who had unremitting chronic low back pain for more than 6 months and whose VAS scores were over 7 were selected on the basis of double comparative nerve blocks. The patients consist of three males and 10 females, and their nean age was 67 years. Sensory stimulation was performed to detect the "pathologic branches" that were responsible for pain generation. RF neurotomy was performed using a lesion generator at 80 C for 90 seconds. The postoperative outcome was classified, depending on the degree of pain reduction, as excellent (> or = 75%), good (50-75%), and poor (<50%). Follow-up evaluation was performed at 6 weeks, 3 months and 6 months after surgery. RESULTS: The mean number of medial branches was 6.2. Eleven patients had bilateral disease and two had unilateral disease. Sensory stimulation was positive in all patients with a mean amplitude of 4.5V (range: 0.15-6 V). The L5 dorsal ramus was the most frequently involved segment, and this was followed by L4, L3 and L2. The number of lesionings for each medial branch was 3.7. The surgical outcome was graded as excellent (53%), good (23%), and poor (24%) after 6 months of follow-up. Transient backaches were noticed in two patients; however, complications were not observed. Recurrences were not demonstrated during the follow-up period CONCLUSION: We conclude that RF neurotomy of the medial branches is an efficient method to substantially alleviate the chronic low back pain caused by zygapophysial joint dysfunction.
Arthralgia* ; Back Pain ; Female ; Follow-Up Studies ; Humans ; Joints* ; Low Back Pain ; Male ; Nerve Block ; Recurrence ; Spine

Chronic low back pain (CLBP) has become more prominent with globally increasing life expectancy. Its cause is more attributable to degenerative changes than to traumatic lesions. Although the diagnosis of CLBP is recently on higher demand, lack of clinical features and non-informative imaging findings in patients with CLBP are challenging to clinicians to establish the diagnosis. Therefore, understanding of the new concept of pathogenesis, elimination of prejudice, and evidence-based diagnostic steps are required to resolve the question of pain source. Analysis of pain distribution patterns and careful history taking can be utilized as an initial guide to divide CLBP into somatic and radicular pain. Zygapophyseal joint pain and sacroiliac joint pain representing somatic pain can be further investigated using medial branch and sacroiliac joint blocks. However, comparative blocks are essential to decreased false positive rate. Infiltration of a small volume of local anesthetics can increase the specificity of the procedures. Discogenic pain stemming from internal disk derangement can be confirmed by pressure-controlled discography. Automated discography is recommended to provide the constant rate of dye injection with obviating the fluctuation of intradiscal pressure. Evidencebased concept and diagnostic procedures can provide more accurate and efficient methods to establish the diagnosis of CLBP.
Anesthetics, Local ; Diagnosis ; Evidence-Based Medicine ; Humans ; Life Expectancy ; Low Back Pain* ; Nerve Block ; Nociceptive Pain ; Prejudice ; Sacroiliac Joint ; Sensitivity and Specificity ; Zygapophyseal Joint

The immunocompetence is important not only to kill the neoplastic cells but also to keep the neoplastic cells from growing further. T lymphocyte is plays the most important role in maintaining the tumor immunity efficiently. T lymphocyte has its specific functions depending in the subset of T lymphocytes. The author analyzed the T lymphocyte subsets in 31 brain tumor patients using anti-CD3, anti-CD4, anti-CD8 monoclonal antibodies and flow cytometry to determine the immunological status of brain tumor patients. All CD3, CD4 and CD8 subsets were reduced in both benign and malignant brain tumor patients but more signigicantly reduced in malignant tumor group. But in benign tumor group, the subtypes of T lymphocytes were not so different from those of normal healthy controls except the pituitary tumor patients, who showed the significant decrease in all the subtypes. In malignant tumor group, each subtype was signigicantly reduced and CD8 subtypes was markedly reduced in metastatic tumor patients, These analyses were considered to have the possibility to be contributable to planning the further immunotherapy and also the possibility to moniter the brain tumor patients clinically.
Antibodies, Monoclonal ; Brain Neoplasms* ; Brain* ; Flow Cytometry ; Humans ; Immunocompetence ; Immunotherapy ; Lymphocytes ; Pituitary Neoplasms ; T-Lymphocyte Subsets* ; T-Lymphocytes*

OBJECTIVE: This study was designed to investigate automated pressure-controlled discography (APCD) findings, to calculate the elastance of intervertebral discs, and to assess the relationship between the calculated elastance and disc degeneration. METHODS: APCD was performed in 19 patients. There were a total of 49 intervertebral discs treated. Following intradiscal puncture, a dye was constantly injected and the intradiscal pressure was continuously measured. The elastance of the intervertebral disc was defined as unit change in intradiscal pressure per fractional change in injected dye volume. Disc degeneration was graded using a modified Dallas discogram scale. RESULTS: The mean elastance was 43.0 +/- 9.6 psi/mL in Grade 0, 39.5 +/- 8.3 psi/mL in Grade 1, 30.5 +/- 22.3 psi/mL in Grade 2, 30.5 +/- 22.3 psi/mL in Grade 3, 13.2 +/- 8.3 psi/mL in Grade 4 and 6.9 +/- 3.8 psi/mL in Grade 5. The elastance showed significant negative correlation with the degree of degeneration (R2 = 0.529, p = 0.000). CONCLUSION: APCD liberates the examiner from the data acquisition process during discography. This will likely improve the quality of data and the reliability of discography. Elastance could be used as an indicator of disc degeneration.
Humans ; Intervertebral Disc ; Intervertebral Disc Degeneration ; Low Back Pain ; Punctures

Kainic acid(KA) is an excitotoxic analogue of glutamate which is now widely used in the studies of epilepsy. Electroencephalographic, behavioral and pathologic observation were done for 2 months after microinjection of kainic acid(Kainic acid group;0.4 microgram, 0.8 microgram, 1.2 microgram, 1.6 microgram, 2.0 microgram, 3.0 microgram) and phosphate buffer solution(Control group) into the left basolateral amygdala(AMG) in 30 Spaque-Doley rats. The control group showed no change in EEG and behavior during the observation period and pathologic findings were normal. One of four rats which 1.2 microgram of KA was injected, four of six rats of 1.6 microgram, all six rats of 2.0 microgram, one of four rats of 3.0 microgram developed acute complex partial seizure and multiple epileptic spikes with high amplitude in EEG. One of four rats of 1.2 microgram, one of six rats of 1.6 microgram, three of six rats of 2.0 microgram, showed spontaneous limbic seizure 14~21days after kainic acid injection. Among those which developed spontaneous limbic seizure, two rats demonstrated spontaneous secondarily generalized seizure 30~60days after kainic acid injection. Pathological examination revealed focal necrosis with perifocal gliosis at the tip of the cannula in the left amygdala. Neuronal cell loss was observed in the CA3 portion of pyramidal cell layer of the hippocampus on the injected side of KA, which developed spontaneous secondarily generalized seizure. But the cellular architecture was normal in the contralateral hippocampus. This is regarded as a good medel of spontaneous generalized complex partial seizure, which is similar to that of temporal lobe epilepsy in human.
Amygdala* ; Animals ; Catheters ; Electroencephalography ; Epilepsy ; Epilepsy, Temporal Lobe ; Gliosis ; Glutamic Acid ; Hippocampus ; Humans ; Kainic Acid* ; Microinjections* ; Necrosis ; Neurons ; Pyramidal Cells ; Rats* ; Seizures*

Chondroma is a benign bone tumor and rarely involves the spine ; even if this occurs however, neurological symptoms and signs rarely arise. We encountered one case of chondroma which developed in the posterior arch of the atlas. The patient complained of quadriparesis, hypesthesia, and urinary frequency. MR imaging showed that the tumor had compressed the cord dorsolaterally at the C1 level. It was completely removed, and the posterior arch of the atlas and surrounding ligamentum flavum disclosed hypertrophy. Postoperatively, the neurological status of the patient improved. On pathologic examination, hypocellularity and mature hyaline cartilage was seen, as well as chondrocytes residing in the lacunae ; all these findings were compatible with benign chondroma.
Chondrocytes ; Chondroma* ; Humans ; Hyaline Cartilage ; Hypertrophy ; Hypesthesia ; Ligamentum Flavum ; Magnetic Resonance Imaging ; Quadriplegia ; Spinal Cord Compression* ; Spinal Cord* ; Spine