STUDY DESIGN: A case report and review of the literature. OBJECTIVES: To discuss the iatrogenic intradural-extramedullary epidermoid cyst and review the literatures. SUMMARY OF LITERATURE REVIEW: Intradural epidermoid cyst has two types of lesions, congenital and iatrogenic. The former is fre-quently associated with bone or skin malformations(spina bifida. etc) and the latter resulting from lumbar puncture, due to direct implantation of epithelial cell by puncture needle. MATERIALS AND METHODS: A 13-year-old boy had pain radiating down to the right lower extremity and hypoesthesia on the anterolateral aspect of right thigh. Straight leg raising was markedly limited. T1 weighted image reveals round intradural mass on L3-4, which was not enhanced by gadolinium. He had the history of spinal tapping two and a half years ago for the work-up of headache. RESULTS: The mass was excised through posterior approach and midline durotomy. It was whitish ovoid mass, measuring 2x1.5x1.5cm in size and histologically diagnosed as epidermoid cyst consisting of keratinous material and cholesterol. All the symptoms were completely relieved at 16 months follow-up. CONCLUSIONS: A case of iatrogenic epidermoid cyst was successfully treated by excision. Epidermoid cyst must be ruled out if space occupying lesion exists in lumbar spine and patients complaining of lower back pain.
Adolescent ; Cholesterol ; Epidermal Cyst* ; Epithelial Cells ; Follow-Up Studies ; Gadolinium ; Headache ; Humans ; Hypesthesia ; Leg ; Low Back Pain ; Lower Extremity ; Male ; Needles ; Punctures ; Skin ; Spinal Puncture ; Spine ; Thigh

PURPOSE: In a retrospective study for the pediatric patients who underwent liver transplantation in the past 6 years at Samsung Medical Center, the clinical features of 5 patients with posttransplant lymphoproliferative disorder (PTLD) were analyzed. METHODS: Between June 1996 and June 2002, 41 pediatric patients underwent liver transplantation. Seven of them died in the postoperative period. Thirty-five including one patient who died of PTLD were finally reviewed. Patients were divided into two groups: high risk group, EBV naive recipients of EBV-positive grafts; low risk group, the patients other than those in high risk group. The authors reviewed age at operation, immunosuppressive agent, postoperative duration until diagnosis, postoperative duration until EBV seroconversion, presence of treatment against rejection, and presenting symptoms of PTLD. RESULTS: Five of 41 patients (12.2%) developed PTLD. All of them belonged to high risk group, and the incidence of PTLD in high risk group was 31.3% (5/16). The mean age at operation was 10.8 months old and the mean duration between operation and diagnosis for PTLD was 9.8 months. Primary EBV infection developed after a median of 6 months after transplantation. One patient was diagnosed as laryngeal and gastrointestinal PTLD and the other four, gastrointestinal PTLD. The following symptoms and signs were seen in the patients: anemia (100%), hypoalbuminemia (100%), fever (80%), diarrhea (80%), gastrointestinal bleeding (80%), and anorexia (60%). CONCLUSION: PTLD is one of the major complications after pediatric liver transplantation, especially in the group of high-risk recipients. Anemia, hypoalbuminemia, fever, diarrhea and gastrointestinal bleeding were features that are characteristic of PTLD. The common features of PTLD development were: (i) EBV-positive donors placed into EBV naive recipients, (ii) primary EBV infection about 6 months after transplantation, (iii) young age, about 1 year old at operation, and (iv) the requirement for intensive posttransplant immunosuppression.
Anemia ; Anorexia ; Diagnosis ; Diarrhea ; Epstein-Barr Virus Infections ; Fever ; Hemorrhage ; Herpesvirus 4, Human ; Humans ; Hypoalbuminemia ; Immunosuppression ; Incidence ; Liver Transplantation* ; Liver* ; Lymphoproliferative Disorders* ; Postoperative Period ; Retrospective Studies ; Tissue Donors ; Transplants

PURPOSE: To report a case of corneal ulcer caused by Paecilomyces lilacinus after penetrating keratoplasty. CASE SUMMARY: A 67-year-old male with a history of penetrating keratoplasty in the left eye 7 years prior and re-penetrating keratoplasty in the left eye due to graft failure in June 2013, visited our clinic for ocular pain and conjunctival injection in the left eye 3 days in duration. Corneal scrapings were performed for Gram and fungal stains and cultures. The patient was admitted to the hospital for hourly topical fortified ceftazidime and amphotericin B. Despite intensive topical therapy, no improvement was observed. Three days later, fungal culture confirmed Paecilomyces lilacinus and topical voriconazole was prepared from the intravenous formulation and was administered topically and intravenously. Despite medical therapy with voriconazole, perforation occurred requiring a tectonic keratoplasty. CONCLUSIONS: Keratitis caused by Paecilomyces lilacinus is difficult to eradicate and refractory to amphotericin B. We suggest early use of topical eyedrops, intracameral, and intravitreal injections of voriconazole may be an appropriate treatment for patients with Paecilomyces lilacinus keratitis.
Aged ; Amphotericin B ; Ceftazidime ; Coloring Agents ; Corneal Transplantation ; Corneal Ulcer ; Humans ; Intravitreal Injections ; Keratitis* ; Keratoplasty, Penetrating* ; Male ; Ophthalmic Solutions ; Paecilomyces* ; Transplants

The Cauda Equina syndrome after spine surgery is a relatively uncommon condition, but it is a serious complication that needs emergency treatment. A 35-year-old woman was transferred to our hospital and she presented with decreased perianal sensation and rectal tone after percutaneous endoscopic discectomy. Magnetic resonance image showed that the dura sac was compressed by herniated disc material at L5-S1. After performing emergency open discectomy for the cauda eguina syndrome, the patient's neurologic symptoms were completely resolved at 12 months follow-up. There has been no previous report on Cauda Equina syndrome after percutaneous endoscopic discectomy, and so we report here on one case.
Adult ; Cauda Equina* ; Diskectomy* ; Emergencies ; Emergency Treatment ; Female ; Follow-Up Studies ; Humans ; Intervertebral Disc Displacement ; Neurologic Manifestations ; Polyradiculopathy* ; Sensation ; Spine

OBJECTIVE: We studied the use of smartphone technology in stroke rehabilitation in Korea and gathered opinions on how it would best be utilized it in a clinical setting. METHOD: Physiatrists, occupational therapists, physical therapists, and rehabilitation ward nurses were surveyed to examine smartphone propagation among the rehabilitation team, current therapeutic knowledge, the use of smartphone technology, and perceptions regarding the potential therapeutic use of smartphones in rehabilitation. The respondents were also asked to specify the applications considered to be the most appropriate for rehabilitation. We also examined applications available for stroke rehabilitation at Android and Apple stores. RESULTS: Of the respondents, 92% had never using smartphone technology in rehabilitation with their clients. The greatest barrier to use was that "smartphone technology and appropriate applications were not available for rehabilitation settings" (71.4%). Areas identified as most appropriate for smartphone use in therapy included provision of information (82.4%) and cognitive (72.5%) and language training (68.1%). We found only a few applications in android and Apple application stores. Of the respondents, 89% intended to use smartphone applications in rehabilitation in the future. CONCLUSION: Smartphone applications developed for stroke rehabilitation are promising. Further research and the development of new therapeutic applications for use in rehabilitation and across health care are needed.
Surveys and Questionnaires ; Delivery of Health Care ; Humans ; Korea ; Language Therapy ; Physical Therapists ; Stroke ; Smartphone

OBJECTIVE: We studied the use of smartphone technology in stroke rehabilitation in Korea and gathered opinions on how it would best be utilized it in a clinical setting. METHOD: Physiatrists, occupational therapists, physical therapists, and rehabilitation ward nurses were surveyed to examine smartphone propagation among the rehabilitation team, current therapeutic knowledge, the use of smartphone technology, and perceptions regarding the potential therapeutic use of smartphones in rehabilitation. The respondents were also asked to specify the applications considered to be the most appropriate for rehabilitation. We also examined applications available for stroke rehabilitation at Android and Apple stores. RESULTS: Of the respondents, 92% had never using smartphone technology in rehabilitation with their clients. The greatest barrier to use was that "smartphone technology and appropriate applications were not available for rehabilitation settings" (71.4%). Areas identified as most appropriate for smartphone use in therapy included provision of information (82.4%) and cognitive (72.5%) and language training (68.1%). We found only a few applications in android and Apple application stores. Of the respondents, 89% intended to use smartphone applications in rehabilitation in the future. CONCLUSION: Smartphone applications developed for stroke rehabilitation are promising. Further research and the development of new therapeutic applications for use in rehabilitation and across health care are needed.
Surveys and Questionnaires ; Delivery of Health Care ; Humans ; Korea ; Language Therapy ; Physical Therapists ; Stroke ; Smartphone

STUDY DESIGN: A retrospective study. OBJECTIVE: To analyze the clinical features and prognosis of intraoperative incidental durotomy during posterior surgery for degenerative lumbar disease. In addition, we tried to evaluate clinical outcome and safety of skillful neglect of pin point dural tear. SUMMARY OF LITERATURE REVIEW : Incidental durotomy is one of the most common complications during the operation of degenerative lumbar disease. It may cause signs and symptoms of cerebrospinal fluid leakage and complications such as meningitis, wound infection, pseudomeningocele and fistula. From the literature review, primary repair is mandatory even in the case of pin point dural tear. MATERIALS AND METHODS: Seven hundred fifty-five patients with degenerative lumbar disease, who were operated posteriorly from Jan. 1990 to Feb. 2002, were reviewed retrospectively. Primary operations were 378 cases of laminectomy without instrumentation and 377 cases of decompression and instrumented fusion. Of these patients, 44 (6 percent) sustained an incidental dural tear. We analyzed the mechanisms of dural tear, intraoperative treatment, postoperative management and clinical outcome. RESULTS: Eight cases (2.1%) of dural tears occurred during discectomy, 36 (9.5%) during instrumentation and fusion, and 12 (20%) during revision surgery. Dural tears were treated intraoperatively by primary repair in 20 cases, by fascial graft in 2 and without repair (skillful neglect) in 22. There were no cases of persistent cerebrospinal fluid leakage or fistula formation, and the symptoms of cerebrospinal fluid leakage were transient. Of 36 patients followed for more than one year, 82% had good or excellent result. CONCLUSION: Incidental durotomy occurred in 5.8 percent of lower back surgery patients, and more frequently in revision surgery. Very small dural tears did not have significant influence on the clinical outcome, whether they were repaired or not. Skillful neglect of pin point dural tear may be a reasonable treatment option.
Cerebrospinal Fluid ; Decompression ; Diskectomy ; Fistula ; Humans ; Laminectomy ; Meningitis ; Prognosis ; Retrospective Studies ; Transplants ; Wound Infection

PURPOSE: The aim of this study was to evaluated biphasic calcium phosphate applied in surgically created 1-wall periodontal intrabony defects in dogs by histometrical analysis. MATERIAL AND METHOD: Critical sized(4 mm x 4 mm), one wall periodontal intrabony defects were surgically produced at the proximal aspect of mandibular premolars in either right and left jaw quadrants in four canines. The control group was treated with debridement alone, and experimental group was treated with debridement and biphasic calcium phosphate application. The healing processes were histologically and histometrically observed after 8 weeks. RESULTS: In biphasic calcium phosphate group, more new bone and cementum formation, less epithelium and connective tissue attachment were observed compared to other groups. But there was no statistical significance. CONCLUSION: Though the statistically significant difference could not be found, it seemed that there was more new bone and cementum formation with applying biphasic calcium phosphate in 1 wall intrabony defects in dogs by preventing junctional epithelium migration.
Animals ; Bicuspid ; Calcium ; Connective Tissue ; Debridement ; Dental Cementum ; Dogs ; Epithelial Attachment ; Epithelium ; Hydroxyapatites ; Jaw

STUDY DESIGN: A case report and literature review. OBJECTIVES: To discuss pyogenic infections of the facet joints and paraspinal intramuscular abscess that developed after a steroid injection into the facet joint of the lower back. MATERIAL AND METHODS: A 39-year-old man who received a steroid injection to the facet joint, 3 weeks prior to admission, experienced increasing lower back pain and a high fever. RESULTS: Plain radiographs of the lumbar spine showed osteolytic erosion of the articular process at the L3-4 facet joint. On a CT scan, the destructed facet joint was connected to a paraspinal intramuscular abscess. MR images also showed a paraspinal intramuscular abscess on multiplane views. In the operative field, the paraspinal abscess, which extended from 2nd to 5th lumbar vertebrae, was found on the right side, with the L3-4 facet destructed and directly connected to the abscess. Some chalky material, considered to be steroid crystals, was found at the L3-4 facet joint. Drainage, debridement and irrigation were performed. Staphylococcus aureus was isolated from the culture. After surgery, intravenous antibiotics were administered, and the patients' symptoms quickly resolved. CONCLUSIONS: A posterior facet joint injection has its own risks of developing a pyogenic infection of the facet joint. Pyogenic facet joint infections may progress to a paraspinal intramuscular abscess. Surgical drainage is mandatory in cases resistant to antibiotic treatment, with evidence of pus formation on imaging studies.
Abscess* ; Adult ; Anti-Bacterial Agents ; Arthritis* ; Debridement ; Drainage ; Fever ; Humans ; Low Back Pain ; Lumbar Vertebrae ; Spine ; Staphylococcus aureus ; Suppuration ; Tomography, X-Ray Computed ; Zygapophyseal Joint*

STUDY DESIGN: A retrospective study OBJECTIVE: To analyze the safety and effectiveness of treatments using metallic implants in the tuberculous spondylitis. SUMMARY OF LITERATURE REVIEW: Residual kyphosis and loss of correction remain the major problems following surgery for tuberculous spondylitis. Several authors have used metallic implants for the prevention of these complications. However, the safety of metallic implants use in tuberculous spine infections are still controversial. MATERIALS AND METHODS: Seventeen patients, who underwent surgery, and were stabilized by the use of a metallic implant for tuberculous spondylitis, and followed up for more than 1 year were included in this study. All patients were treated with combined anterior fusion (with or without mesh) and/or posterior pedicle screw instrumentation. The patients were followed up with serial plain radiographs, laboratory inflammatory parameters and neurological recovery. RESULTS: The overall correction of the kyphotic deformity was initially 8.5 degrees, and loss of correction occurred at 5.8 degrees. Although some loss of correction occurred, even after the use of a metallic implant, clinically significant kyphotic deformity was effectively prevented. There were no cases of persistent infection or failure to control infection when the metallic implantation was combined with an anterior radical debridement and chemotherapy. The erythrocyte sedimentation rate and C-reactive protein were eventually normalized in all patients. The preoperative neurological deficits were: incomplete paralysis in 9 cases and radiculopathy in 4. At the final follow-up, 11 cases had completely recovered, partial residual neurological deficits remaining in 2. CONCLUSIONS: The use of instrumentation with metallic implants, in tubercuous spondylitis of the spine, provided immediate stability, and did not prohibit the control of infection when combined with radical debridement and anti-tuberculous chemotherapy.
Blood Sedimentation ; C-Reactive Protein ; Congenital Abnormalities ; Debridement ; Drug Therapy ; Follow-Up Studies ; Humans ; Kyphosis ; Paralysis ; Radiculopathy ; Retrospective Studies ; Spine ; Spondylitis*