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

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

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*

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

Synchronous anal squamous cell carcinoma with colorectal adenocarcinoma is a very rare and interesting disease entity because these neoplasms are essentially different from each other in terms of their anatomical locations, clinical behaviors, histopathological characteristics and treatment. To date, there have been very few case reports regarding the concurrent occurrence of these two distinct neoplasms. Nonetheless, it is recommended that patients with squamous cell carcinoma of the anus and who are older than 50 years should undergo colonoscopy in order to rule out a synchronous colorectal neoplasm. We recently encountered a 72-year-old woman who presented with synchronous squamous cell carcinoma of the anal canal and adenocarcinoma of the rectosigmoid junction. The patient underwent curative surgical resection for the colorectal adenocarcinoma and chemoradiotherapy for the concurrent anal squamous cell carcinoma. We describe here our clinical experience with this unusual case and we also conduct a short review of relevant literature.
Adenocarcinoma ; Aged ; Anal Canal ; Anus Neoplasms ; Carcinoma, Squamous Cell ; Chemoradiotherapy ; Colonic Neoplasms ; Colonoscopy ; Colorectal Neoplasms ; Female ; Humans

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

OBJECTIVE: This study is designed to identify the clinical characteristics and the optimal treatment modality of hydrocephalus in posterior fossa tumors. METHODS: The authors reviewed 154 infratentorial tumor patients. Age, sex, clinical symptoms, types of treatment, and surgical results of posterior fossa tumor patients with hydrocephalus were analyzed, retros-pectively. Factors which might predict the need for external ventricular drainage(EVD) or ventriculo-peritoneal shunt were analyzed statistically. RESULTS: Hydrocephalus was noted in 86 cases(56%), and it was associated with medulloblastoma in 16 cases(89%), hemangioblastoma in 12(63%) and brain stem glioma in three(33%). The surgical results of the posterior fossa tumors with hydrocephalus were poorer than those without hydrocephalus(p<0.05). A large tumor(p<0.05) and an incomplete removal(p<0.05) were factors predicting the need for EVD or shunt. Complications of intraoperative EVD or shunt developed in four cases. They were infection, he-morrhage at puncture site, and obstruction. Five patients in whom intraoperative EVD or shunt had not been performed developed a fatal hydrocephalic attack at immediate postoperative period, and the pos-toperative computed tomography scan revealed intraventricular hemorrhages in three cases cerebellar swellings in two cases. CONCLUSION: Intraoperative EVD or shunt is a safe, effective treatment modality especially in large size tumor and/or incomplete tumor resection. Intraventricular hemorrhages or cerebellar swellings during immediate postoperative period might cause fatal hydrocephalic attack, therefore EVD or shunt might be recommended in selected cases.
Brain Stem ; Glioma ; Hemangioblastoma ; Hemorrhage ; Humans ; Hydrocephalus* ; Infratentorial Neoplasms* ; Medulloblastoma ; Postoperative Period ; Punctures ; Ventriculoperitoneal Shunt