Treatment modalities for herniated lumbar intervertebral disc are the conservative method, chemonucleolysis, percutaneous diskectomy and operation. Conservative treatment is effective in 70–80% of the acute stage and the other 20% requires chemonucleolysis, percutaneous diskectomy or operation. Indications for operation are cases not improved after conservative treatment, recurrent cases and cauda equina syndrome. Mixter and Barr(1934) demonstrated that laminectomy and surgical removal of disc material could relieve symptoms, but spinal segmental instability, incomplete removal of the disc and postoperative adhesion of the nerve root caused low back pain after long-term follow up. Thus, the authors evaluated the plain X-ray and computed tomographic findings in 21 cases of failed laminectomy to determine the cause of failure. The results were as follows ; 1. Among 21 cases, 18 cases complained of low back pain with sciatica and 3 cases complained of low back pain. 2. In all cases, disc space narrowing was detected on plain X-ray. Total laminectomy and diskectomy promote insufficiency and instability of the lumbar and lumbosacral spine. Whenever one attempts to do total laminectomy and diskectomy, it is recommended that spine fusion be performed in same operating field. 3. Several findings were detected on CT scan : 8 disc protrusions in the operation site, 6 disc protrusions in the operation site and spinal stenosis, 4 extradural scars, 1 extradural scar and other site disc protrusion and 2 cases of spinal stenosis and spondyloisthesis. 4. Computed tomography in cases of failed laminectomy offers more information than has been available by any other imaging method.
Cicatrix ; Diskectomy ; Diskectomy, Percutaneous ; Follow-Up Studies ; Intervertebral Disc ; Intervertebral Disc Chemolysis ; Laminectomy ; Low Back Pain ; Methods ; Polyradiculopathy ; Sciatica ; Spinal Stenosis ; Spine ; Tomography, X-Ray Computed

Chondroblastoma is a rare primary neoplasm of bone which involves the epiphysis of the long bone and develops mostly in the 2nd decade of life. We reviewed the cases of twenty patients with chondroblastoma who were treated at the Department of Orthopaedic Surgery, Yonsei University College of Medicine between 1969 and 1989. All patients were followed for 1 year or longer. The results were as follows. 1. The proximal end of the humerus(25%) and the proximal end of the femur(25%) were the most common sites. 2. 85% of patients were between 11 to 20 years old and male to female ratio was 3:2. 3. The most common symptom was pain and in 30% of patients it was appeared after minor trauma. 4. The average diameter of lesion is 4.2cm in its long axis and the more longer the duration, the more larger the size of lesion. 5. Involvement of the epiphyseal plate was twice as common in the patients with a closing plate as in those with an open one. 6. The most common microscopic finding was the presence of chondroblast and chondroid matrix. 7. Two patients(10%) had a local recurrence. 8. The final functional results were considered to be good in sixteen(80%) patients. 9. Accurste localization of the lesion during biopsy is very important especially in the case of deep seated lesion.
Biopsy ; Chondroblastoma ; Chondrocytes ; Epiphyses ; Female ; Growth Plate ; Humans ; Male ; Recurrence

No abstract available.
Abscess/*diagnosis/microbiology ; Anti-Bacterial Agents/therapeutic use ; Cephalosporins/therapeutic use ; Gastroscopy ; Humans ; Klebsiella Infections/*drug therapy ; Klebsiella pneumoniae/*isolation & purification ; Male ; Middle Aged ; Stomach Diseases/*diagnosis/microbiology ; Tomography, X-Ray Computed

The Cavitron ultrasonic Surgical Aspirator has been used clinically in 79 cases for removal of intracranial tumors. Ultrasonic aspiration of intracranial tumors has definite advantage in comparison with the previous conventional technique. The results were summarized as follows; 1) Ultrasonic aspirator provides a method of removing intracranial tumors that are not of a consistency to allow removal with suction and cautery alone. 2) There is a good proprioceptive feedback for the surgeon while using the ultrasonic aspirator. So the blood vessels were selectively exposed, operation was performed without severe bleeding. 3) Ultrasonic aspirator obviates the need for the cautery cutting loop. This is particularly advantageous when dealing with tumors in the cerebellopontine angle or close to important structures, such as the optic nerve or carotid artery. 4) Ultrasonic aspirator allows direct visualization of the tissue being removed.
Blood Vessels ; Carotid Arteries ; Cautery ; Cerebellopontine Angle ; Feedback, Sensory ; Hemorrhage ; Optic Nerve ; Suction ; Ultrasonics*

Intracranial meningioma is a common benign tumor. Although tumor mass might have been totally removed, aggravation of symptoms or recurrence of mass may sometimes be noticed. Histopathologic finding has been known as one of probable prognostic factors in meningiomas. In this study, correlation between DNA contents and histopathologic findings were evaluated to elucidate further such factors having role in the recurrence or prognosis in meningiomas. Seventy four cases of meningiomas were selected to review clinical prognosis and histopathologic findings. The speciemens were re-evaluated with flow cytometry to get DNA histogram. DNA fractions and proliferation index(PI) were calculated. The correlations were statistically analyzed with t-test and ANOVA test. Benign meningiomas were 53(71.6%), atypical 19(25.7%), and malignant 2(2.7%). PI of benign was 10.80+/-1.36 and that of atypical being 18.00+/-5.19. Diploid cases were 48 in number(64.9%) and aneuploid 26(35.1%). PI of diploid was 8.10+/-5.56 and that of aneuploid 24.06+/-18.51. DNA index was 1.00+/-0.00 in enign, 1.00+/-0.33 in atypical, and 1.50+/-0.71 in malignant. There was one case(2%) in benign, 2(11%) in atypical, and 2(100%) in malignant meningioma which showed recurrence(p=0.0002). In benign meningioma, 1 out of 4 subtotally removed cases recurred whereas atypical and malignant meningiomas recurred even in totally removed cases. In conclusion, histopathologically malignant meningiomas have not been always aneuploid. If total removal is done in benign tumor, long-term follow-up is not needed because of no recurrence and no aggravation of symptom. Atypical meningioma with aneuploid and high PI(above 24) should be followed in longer duration, and malignant meningioma should be closely observed due to their higher recurrence rate.
Aneuploidy ; Diploidy ; DNA* ; Flow Cytometry ; Follow-Up Studies ; Meningioma* ; Prognosis ; Recurrence ; Statistics as Topic

Intracranial meningioma is a common benign tumor. Although tumor mass might have been totally removed, aggravation of symptoms or recurrence of mass may sometimes be noticed. Histopathologic finding has been known as one of probable prognostic factors in meningiomas. In this study, correlation between DNA contents and histopathologic findings were evaluated to elucidate further such factors having role in the recurrence or prognosis in meningiomas. Seventy four cases of meningiomas were selected to review clinical prognosis and histopathologic findings. The speciemens were re-evaluated with flow cytometry to get DNA histogram. DNA fractions and proliferation index(PI) were calculated. The correlations were statistically analyzed with t-test and ANOVA test. Benign meningiomas were 53(71.6%), atypical 19(25.7%), and malignant 2(2.7%). PI of benign was 10.80+/-1.36 and that of atypical being 18.00+/-5.19. Diploid cases were 48 in number(64.9%) and aneuploid 26(35.1%). PI of diploid was 8.10+/-5.56 and that of aneuploid 24.06+/-18.51. DNA index was 1.00+/-0.00 in enign, 1.00+/-0.33 in atypical, and 1.50+/-0.71 in malignant. There was one case(2%) in benign, 2(11%) in atypical, and 2(100%) in malignant meningioma which showed recurrence(p=0.0002). In benign meningioma, 1 out of 4 subtotally removed cases recurred whereas atypical and malignant meningiomas recurred even in totally removed cases. In conclusion, histopathologically malignant meningiomas have not been always aneuploid. If total removal is done in benign tumor, long-term follow-up is not needed because of no recurrence and no aggravation of symptom. Atypical meningioma with aneuploid and high PI(above 24) should be followed in longer duration, and malignant meningioma should be closely observed due to their higher recurrence rate.
Aneuploidy ; Diploidy ; DNA* ; Flow Cytometry ; Follow-Up Studies ; Meningioma* ; Prognosis ; Recurrence ; Statistics as Topic

A case of pleomorphic xanthoastrocytoma that occured in a 27-year-old woman is reported. Despite of cellular pleomorphism and presence of bizarre giant cells in the microscopic picture, the relatively favourable prognosis is the most important characteristic.
Adult ; Female ; Giant Cells ; Humans ; Prognosis

The intracranial hematoma following cerebral aneurysmal rupture makes patient's clinical status and outcome worse by pressure effect on the brain structure. It's incidence has varied with authors between 5-30% of patients with ruptured cerebral aneurysms. Several authors emphasized the importance of early operation to obtain better results by early removal of hematoma and reducing intracranial pressure. The authors retrospectively evaluated seventy-six patients with intracranial hematomas in 370 patients with ruptured aneurysms from Jan. 1987 to Dec. 1992. The incidence of hematoma resulting from ruptured aneurysm was 20.5%. The most frequent site of aneurysm which was accompanied by intracranial hematoma was the middle cerebral artery, and the next was the anterior cerebral artery. The amount of hematoma and/or evidence of midline shift were the important factors in predicting the clinical outcome. The most favorable outcome was found in cases with intracerebral hematoma only, and the worst was in cases with intracerebral hematoma associated with intraventricular hemorrhage. Fifty out of 76 patients with intracranial hematomas were operated on. Their outcomes were more favorable than in the patients who were not operated on. Aggressive surgical intervention was especially effective in patients with poor Hunt & Hess grades(IV or V) .
Aneurysm ; Aneurysm, Ruptured* ; Anterior Cerebral Artery ; Brain ; Hematoma* ; Hemorrhage ; Humans ; Incidence ; Intracranial Aneurysm ; Intracranial Pressure ; Middle Cerebral Artery ; Retrospective Studies ; Rupture

The authors present a case of huge intraventricular meningioma on the trigone of the right lateral ventricle of a 42-year old female. The mass was a huge multilobulated yellowish gray tumor, which was relatively rubbery hard. Intratumoral removal was performed by ultrasonic aspirator at east. Later thin outer surface of the tumor was retracted and extirpated. Microscopic examination revealed transitional type of meningioma consisted of concentric whorls of elongated tumor cells and psammoma bodies. Occasionally the center of whorls contained capillary blood vessels. Postoperative course was uneventful. Extremely minimal visual field defect was detected without the patient's subjective complaint.
Adult ; Blood Vessels ; Capillaries ; Female ; Humans ; Lateral Ventricles ; Meningioma ; Ultrasonics ; Visual Fields

The auther has studied 60 patients of degenerative spondylolisthesis diagnosed and operatively treated at Hanyang University Hospital from January 1987 to June 1992, and analized the outcome. The results were summarized as followings: 1) Male to female ratio was 1:4, showing female predominance. Average peak ages were 5th and 6th decades. 2) "Pedicle-Facet Angle" and the degree of slipping had directly proportional relationship(Y=0.58X+110). The wider the angle is, the more slipping develops. 3) The significant symptom and sign were neurogenic intermittent claudication and negative straight-leg-raising test. 4) The degenerative spondylolisthesis developed most frequently at L4-5 level(74%), L5-S1(15%), L3-4(8%), 57 cases(95%) fell into Grade by Meyerding classification. 5) Complete or incomplete block on myelogram was present in 59%, and pseudodisc and lumbar spinal stenosis were noticed on CT. 6) Laminectomy with P.L.I.F. were done in 50 cases(83%) and total laminectomy and medial facetectomy and foraminotomy were done in only 4 cases(7%). In the comparision on the slipping degree before & after operation, in 55 cases(92%), slipping degrees showed no great change less than 2mm, but the almost showed exellent & good results. So we considered decom pression & fusion without excessive reduction was sufficient. 7) Threaded fusion cage(T.F.C) had the several benefits that 1) stability was good, 2) osteosynthesis through threaded was possible and 3) postoperative ambulation was possible earlier. Therefore recently, P.L.I.F. using T.F.C in the treatment of degenerative spondylolisthesis were used in many cases and further evaluation for T.F.C. should be considered.
Classification ; Female ; Foraminotomy ; Humans ; Intermittent Claudication ; Laminectomy ; Male ; Spinal Stenosis ; Spondylolisthesis ; Walking