The effects of hyperbaric oxygen on radiation cystitis have been reported in patients with radiation-induced hemorrhagic cystitis refractory to conventional therapy. Cessation of gross hematuria and reversal of cystoscopic bladder changes were seen in response to a series of hyperbaric oxygen therapy of 3 atmosphere absolute pressure for 2 hours. We report the experience of 2 cases of hyperbaric oxygen therapy for radiation-induced cystitis.
Atmosphere ; Cystitis* ; Hematuria ; Humans ; Hyperbaric Oxygenation ; Oxygen* ; Urinary Bladder

The surgical outcomes of Arnold-Chiari malformation associated with syringomyelia have been reported with respect to improvement in symptoms and signs. But there are only a few studies about the changes of size in syrinx cavity after the era of magnetic resonance image. The authors employed two different surgical modalities and compared the difference in outcomes. Between 1988 and 1994, 17 patients suffering from Arnold-Chiari malformation associated with syringomyelia were treated by foramen magnum decompression(FMD), with or without shunt. Their ages ranged from 3 to 62 (median, 42) years; four were males and 13 were females. Eight were treated by FMD with syringosubarachnoid shunt (FMD with shunt group) and 9 by FMD only(FMD group). Changes in the extent of syrinx and clinical improvements were retrospectively compared between the two groups; the median follow-up period was 22(range 5-79) months. Changes in the extent of syrinx were analyzed by pre- and postoperative magnetic resonance images; improvements in symptoms or signs were classified by lower cranial nerves, the cerebellum and the spinal cord. The size of syrinx was decreased in 7/8 patients of FMD with shunt group(88%) and in 7/9 patients of FMD group (78%) and there was no significant difference in ratio statistically(p=0.54). Shrinkage of syrinx cavity was occurred regardless of its preoperative extent. In FMD with shunt group, 5/8 patients(63%) were improved in symptoms or signs and in FMD group, 6/9 patients(67%)(p=0.21). In all 3 cases which showed no collapse of syrinx cavity, the clinical improvements were not found. There was correlation between collapse of syringomyelia and improvement of clinical findings(p=0.035).
Arnold-Chiari Malformation* ; Cerebellum ; Cranial Nerves ; Female ; Follow-Up Studies ; Foramen Magnum ; Humans ; Male ; Retrospective Studies ; Spinal Cord ; Syringomyelia*

Since 1966 the first metal ball shape implant was inserted into the cervical and lumbar areas by Dr. Fernstrom, numerous attempts and prostheses have been tried to maintain physiologic range of motion and prevent adjacent segment degeneration (ASD) after surgery. However fusion itself is not a single causative factor of ASD and other biologic factors including natural progression of degenerative process and mechanical factors also contribute in the development of ASD. Several well designed prospective randomized control studies for Bryan disc and Prodisc C have been recently documented preservation of spinal motion, superior or, at least, equivalent clinical outcome in comparing with anterior cervical arthrodesis, and less adverse postoperative events both in frequency and severity. Still remained or undetermined problems in cervical arthroplasty are heterotopic ossifications, segmental kyphosis of implanted levels, MR imaging compatibility, vertebral body fracture by keeled prostheses and long term wear properties. In spite of these unsolved problems and incompleteness of prosthetic design, cervical arthroplasty is now considered as one of standard methods in surgical management of one or two level cervical disc diseases and its indication may be broader in near future.
Arthrodesis ; Arthroplasty ; Biological Factors ; Intervertebral Disc ; Kyphosis ; Prostheses and Implants ; Range of Motion, Articular

Spinal arteriovenous malformations(AVM's) may subject patients to the risk of paraplegia or quadriplegia. To determine the clinical features of patients with spinal AVM's, the authors reviewed the medical records of 26 such patients diagnosed and treated in our department, between 1986 and 1996. Among these, there were two cases of dural arteriovenous fistula(dural AVF), eight of perimedullary fistula, twelve of intramedullary AVM, and three of intramedullary cavernous angioma. In one case, the type of AVM was not identified. The most common presenting symptom was acute or slowly progressive myelopathy. The patients were treated with embolization, surgery, or both, and because of residual or recurrent disease, treatment was repeated in six cases, five of which were intramedullary AVM. All patients with dural AVF improved after treatment. Among patients with intradural AVM(perimeudllary AVF or intramedullary AVM), 25% were improved and 25% deteriorated : two of three patients with cavernous angiomas improved. Diagnostic and therapeutic considerations in the cases of AVM of the spinal cord are discussed. Since recurrence or residual arteriovenous shunting is a common problem in the treatment of this condition, follow-up observation of clinical and angiographic findings is mandatory.
Arteriovenous Malformations* ; Central Nervous System Vascular Malformations ; Fistula ; Follow-Up Studies ; Hemangioma, Cavernous ; Humans ; Medical Records ; Paraplegia ; Quadriplegia ; Recurrence ; Spinal Cord Diseases ; Spinal Cord*

OBJECTIVE: The purpose of this study is to evaluate the effectiveness of unilateral decompression and pedicle screw fixation for the unilateral symptomatic foraminal stenosis. METHODS: The study group comprises consecutive 16 patients who underwent unilateral decompression and bone cement augmented pedicle screw fixation from May 2003 to January 2006. The patients were evaluated by visual analog scale (VAS) for pain and the scoring system of the Japanese Orthopedic Association (JOA) for low back pain. The result of surgery was also evaluated with McNab's classification. Excellent or good outcome was considered as successful. The patients were followed at postoperative 1 month, 3 month, 6 month, and 1 year with standing AP and lateral films. RESULTS: The average VAS and JOA score of the 16 patients were 7.8 (range, 6-9) and 5.8 (range, 3 - 10) before surgery and 2.2 (range, 0 - 5) and 12.3 (range, 9 - 15) at the time of last follow up. Both VAS and JOA score improved significantly after the surgery (p < 0.05, t-test). All patients improved after the operation and no revision surgery was required. No metal failure or pseudoarthrosis was observed during the follow-up. The success rate was 87.5%. CONCLUSION: Our data suggest that unilateral decompression and pedicle screw fixation for the unilateral symptomatic foraminal stenosis is an effect method for obtaining satisfactory clinical outcome. Its possible advantage is shorter operation time and reduced surgical extent. We believe that the reduced stiffness of unilateral fixation was compensated by pedicle screw augmentation and interbody fusion.
Asian Continental Ancestry Group ; Constriction, Pathologic ; Decompression ; Follow-Up Studies ; Humans ; Imidazoles ; Low Back Pain ; Nitro Compounds ; Orthopedics ; Pseudarthrosis

No abstract available.

Far lateral disc herniation(FLDH) with compression of the nerve root as it exits through the foramen has been a recognized entity for a number of years. Failure to diagonose and precisely localize these herniations can lead to unsuccessful surgical exploration or exploration of the innocent interspace. If these herniation are diagnosed, they often cannot be adequately exposed by the classic minline hemilaminectomy approach. A partial or complete unilateral facetectomy to expose these herniations can lead to vertebral instability or contribute to continued postoperative back pain. The authors present 5 patients who were diagnosed as having far lateral lumbar disc herniations from 1988 to 1990. Two of these were at L4-5 level, two at L5-S1 level and one at L3-4 level and all were over 60 years old. High resolution CT scan appeared to be the best study and the paramedian muscle splitting microsurgical approach, done in 3 cases, was found to be the most direct and favorable anatomical route to FLDH for vertebral stability and minimal postoperative back pain.
Back Pain ; Humans ; Middle Aged ; Tomography, X-Ray Computed

OBJECTIVE: Although gadolinium enhancement of compression fractures is well known, the enhancement pattern of the acute stage of a fracture is not completely understood. Here, we investigated the enhancement pattern of acute vertebral compression fractures (VCFs). METHODS: We conducted a retrospective study of patients with acute osteoporotic VCFs admitted to hospital between January 2004 and December 2005. The demographic details, stage of the fracture, management data, and results were analyzed. There were nine men and 22 women, and the mean age was 71 years (range, 53-92 years). According to the onset of pain, patients were divided into the following four groups : Group I (less than 3 days), Group II (4-7 days), Group III (8-14 days), and Group IV (14-30 days). RESULTS: All patients had central low-signal intensity of the nonenhancing part of vertebral bodies on T1 images. Enhancing box sign (EBS) was seen 7 days of VCF development. After 7 days of onset (Groups III and IV), patch or Kummell's enhancements occurred. EBS has been statistically correlated with stage of compression fracture (Pearson's correlation = -0.774). However, EBS had no statistically significant correlation with prognosis in our study (Pearson's correlation = 0.059). CONCLUSION: EBS represents a characteristic sign 7 days of VCF development.
Female ; Fractures, Compression ; Gadolinium ; Humans ; Magnetic Resonance Imaging ; Male ; Prognosis ; Retrospective Studies

Isolated ACTH deficiency is a rare cause of secondary adrenocortical insufficiency. Adrenal crisis in isolated ACTH deficiency is less common compared to primary adrenal insufficiency, but isolated ACTH deficiency is an important cause of hypoglycemia. Recently we experienced a 41-year-old man admitted because of mental confusion. On admission, plasma glucose and sodium concentration were 1.7, 132 mmol/L, respectively. Basal plasma ACTH and cortisol levels were low and other pituitary hormone showed normal response to combined pituitary stimulation test except growth hormone. Plasma ACTH concentration remained low even after intravenous injection of ovine corticotropin releasing factor. It suggest that the defect of ACTH secretion was apparently due to intrinsic pituitary rather than hypothalamic disease. The sellar CT showed the fossa to be filled by cerebrospinal fluid. After treatment with glucocorticoid, he had no further evidence of hypoglycemia and hyponatremia. In conclusion, we report a case of isolated ACTH deficiency with empty sella.
Addison Disease ; Adrenocorticotropic Hormone ; Adult ; Blood Glucose ; Cerebrospinal Fluid ; Corticotropin-Releasing Hormone ; Growth Hormone ; Humans ; Hydrocortisone ; Hypoglycemia ; Hyponatremia ; Hypothalamic Diseases ; Injections, Intravenous ; Plasma ; Sodium

The authors report a case of epidural and extraforaminal calcification caused by repetitive triamcinolone acetonide injections. A 66-year-old woman was admitted presenting with lower extremity weakness and radiating pain in her left leg. Ten months before admission, the patient was diagnosed as having an L4-5 spinal stenosis and underwent anterior lumbar interbody fusion followed by posterior fixation. Her symptoms had been sustained and she did not respond to transforaminal steroid injections. Repetitive injections (10 times) had been performed on the L4-5 level for six months. She had been taking bisphosphonate as an antiresorptive agent for ten months after surgery. Calcification in the ventral epidural and extraforaminal space was detected. The gritty particles were removed during decompressive surgery and these were proven to be a dystrophic calcification. The patient recovered from weakness and radiating leg pain. Repetitive triamcinolone acetonide injections after discectomy may be the cause of dystrophic calcification not only in the degenerated residual disc, but also in the posterior longitudinal ligament. Possible mechanisms may include the toxicity of preservatives and the insolubility of triamcinolone acetonide. We should consider that repetitive triamcinolone injections in the postdisectomy state may cause intraspinal ossification and calcification.
Aged ; Diskectomy ; Female ; Humans ; Leg ; Longitudinal Ligaments ; Lower Extremity ; Spinal Stenosis ; Triamcinolone ; Triamcinolone Acetonide