No abstract available.
Decompression* ; Head* ; Osteonecrosis*

The purpose of this study is to access and describe the status of patients with untreated anterior cruciate ligament ruptures to determine if prediction of functional deterioration in these knees were inevitable. 29 patients with rupture of the anterior cruciate ligament verified arthroscopically were evaluated at an average of 3 years and 8 month after injury. This group of patients was selected by the retrospective review in patients who were treated with traumatic ligament injury of the knee joint. The average age at the injury time was 25.9 years ranged from 16 to 44 years and most of injuries occured during sports activities including 12 cases (4196) occured while the patients were playing football. Meniscal lesions were found in 21 cases(72.4%) of all 29 cases of which were 15 cases in the medial, 4 in the lateral and 2 in both side. Follow up functional average score using the Hospital for Special Surgery Knee was 35.8 which would be fall in the Fair range defined as moderate functional disability and depending on the condition of thigh muscle, the functional score was 38.3 in case of less than 2cm atropy of the thigh on the involved side and 32.6 in case of more than 2cm atrophy. There was statistically significant difference (p < 0.05) of the functional score. Reinjuries of the same knee joint were experienced in 22 cases (76%). Rehabilitation of thigh muscles would play an important part in recovery from the injuries.
Anterior Cruciate Ligament ; Atrophy ; Follow-Up Studies ; Football ; Humans ; Knee Joint ; Knee ; Ligaments ; Muscles ; Rehabilitation ; Retrospective Studies ; Rupture ; Sports ; Thigh

Cholangiocarcinoma has been associated with various fibrocystic diseases of liver and biliary tract, but cholangiocarcinoma in polycystic liver disease (PLD) was extremely rare. It was reported that the prognosis of cholangiocarcinoma associated PLD was very poor and distant metastases were common. We report a rare case of intrahepatic cholangiocarcinoma associated with PLD in 58- year- old female who presented vague abdominal pain. She had also polycystic kidneys with normal renal function. MRI showed well demonstrated tumor with central scar and a adjacent large cyst in the left lobe of the liver. She underwent extended left lobectomy. On microscopic examination, the tumor was moderately differentiated cholangiocarcinoma having abundant fibrous stroma and necrosis and the adjacent cyst showed focal in situ carcinomatous changes in the lining epithelium.
Abdominal Pain ; Biliary Tract ; Cholangiocarcinoma* ; Cicatrix ; Epithelium ; Female ; Humans ; Liver Diseases* ; Liver* ; Magnetic Resonance Imaging ; Necrosis ; Neoplasm Metastasis ; Polycystic Kidney Diseases ; Prognosis ; Cholangiocarcinoma

A 49 years old male patient who suffered from deterioration of posterior neck pain, left hand numbness, left lower limb pain and gait disturbance for 3 years visited our outpatient department. He had been diagnosed as non-dysraphic cervical intradural lipoma and operated in August 1990. On the radiologic images, we found the regrowth of non-dysraphic cervical intradural lipoma from C2 to C7 level, which surrounds and compresses the cervical spinal cord. Previous subtotal laminectomy from C2 to C7 and severe cervical lordosis were also found. Appropriate debulking of lipoma mass without duroplasty was successfully done with intraoperative neurophysiological monitoring (IONM). We are following up the patient for 24 months via outpatient department, his neurologic symptoms such as hand numbness, gait disturbance, left lower limb pain and posterior neck pain have improved. We describe a rare case of regrowth of non-dysraphic cervical intradural lipoma.
Animals ; Gait ; Hand ; Humans ; Hypesthesia ; Intraoperative Neurophysiological Monitoring ; Laminectomy ; Lipoma* ; Lordosis ; Lower Extremity ; Male ; Neck Pain ; Neurologic Manifestations ; Outpatients ; Spinal Cord ; Spinal Dysraphism*

OBJECTIVE: Anterior cervical discectomy and fusion (ACDF) is a choice of surgical procedure for cervical degenerative diseases associated with radiculopathy or myelopathy. However, the patients undergoing ACDF still have problems. The purpose of the present study is to evaluate the radiologic results of 3 different methods in single-level ACDF. METHODS: We conducted a retrospective collection of radiological data from January 2011 to December 2014. A total of 67 patients were included in this study. The patients were divided into 3 groups by operation procedure: using stand-alone cage (group cage, n=20); polyether-ether-ketone (PEEK)-titanium combined anchored cage (group AC, n=21); and anterior cervical cage-plate (group CP, n=26). Global cervical lordosis (C2-C7 Cobb angle), fused segment height, fusion rate, and cervical range of motion (ROM) were measured and analyzed at serial preoperative, postoperative, 6-month, and final 1-year follow-up. RESULTS: Successful bone fusion was achieved in all patients at the final follow-up examination; however, the loss of disc height over 3 mm at the surgical level was observed in 6 patients in group cage. Groups AC and CP yielded significantly better outcomes than group cage in fused segment height and cervical ROM(p=0.01 and p=0.02, respectively). Furthermore, group AC had similar radiologic outcomes to those of group CP. CONCLUSION: The PEEK-titanium combined anchored cage may be a good alternative procedure in terms of reducing complications induced by plate after ACDF.
Animals ; Cervical Vertebrae ; Diskectomy* ; Female ; Follow-Up Studies ; Humans ; Lordosis ; Methods* ; Postoperative Complications ; Radiculopathy ; Radiography ; Range of Motion, Articular ; Retrospective Studies ; Spinal Cord Diseases ; Spinal Fusion

OBJECTIVE: The purpose of this prospective study was to evaluate the effects of body mass index (BMI) on intra-abdominal pressure (IAP) and intraoperative blood loss (IBL) during lumbar spinal surgery. METHODS: Thirty patients scheduled for single level posterior lumbar interbody fusion were allocated equally to a normal group (Group 1, BMI;18.5-22.9 kg/m2), an overweight group (Group 2, BMI; 23-24.9 kg/m2), and an obese group (Group 3, BMI; 25.0-29.9 kg/m2) according to BMI. IAP was measured using a urinary bladder catheter; 1) supine after anesthesia induction, 2) prone at skin incision, 3) prone at the end of surgery. In addition, IBL was also measured in the three groups. RESULTS: IAP in the supine position was not significantly different in groups 1, 2, and 3 (2.7 mm Hg, 3.0 mm Hg, and 4.2 mm Hg, respectively) (p=0.258), and IAP in the prone position at incision increased to 7.8 mm Hg, 8.2 mm Hg, and 10.4 mm Hg, respectively, in the three groups, and these intergroup differences were significant, especially for Group 3 (p=0.000). IAP at the end of surgery was slightly lower (7.0 mm Hg, 7.7 mm Hg, and 9.2 mm Hg, respectively). IBLs were not significantly different between the three groups. However, IBLs were found to increase with IAP in the prone position (p=0.022) and BMI (p<0.05). CONCLUSION: These results show that BMI affects IAP in the prone position more than in the supine position during lumbar spinal surgery. In addition, IBLs were found to increase with IAP in the prone position and with BMI. Thus, IBLs can be expected to be higher in morbidly obese patients due to an increased IAP.
Anesthesia ; Body Mass Index ; Humans ; Overweight ; Prone Position ; Prospective Studies ; Skin ; Spine ; Supine Position ; Urinary Bladder

A 33-year-old male presented with an acute onset of back pain and abdominal pain. He was 189.9 cm tall and had an arm span of 194 cm, and had mild pectus carinatum as well as arachnodactyly. Plain radiographs showed kyphoscoliosis of the lumbar spine, bamboo spine of the thoracic spine, and sacroiliitis of the pelvis. Abdominal computed tomography revealed debakey type 3 aortic dissection. We prescribed beta blockers to control his blood pressure. According to the modified New York criteria, we diagnosed him with HLA negative ankylosing spondylitis and initiated therapy with nabumetone and sulfasalazine. We later diagnosed Marfan syndrome based on the Ghent criteria and mutation screening at the fibrillin-1. After treatment, he has been followed up without symptoms or complications.
Abdominal Pain ; Arachnodactyly ; Arm ; Back Pain ; Blood Pressure ; Butanones ; Humans ; Male ; Marfan Syndrome ; Mass Screening ; Microfilament Proteins ; New York ; Pelvis ; Sacroiliitis ; Spine ; Spondylitis, Ankylosing ; Sulfasalazine

Seizure following percutaneous endoscopic lumbar discectomy (PELD) is extremely rare. We report that generalized seizure occurred in a patient with radiating right leg pain after PELD under sevoflurane anesthesia. Cerebrospinal fluid (CSF) was detected from a dura tear in the operative field. On emergence from anesthesia, generalized tonic-clonic activity continued for approximately 2 minutes and the level of consciousness was decreased to a stuporous state. Under sedation, a pneumocephalus which was thought to be caused by the dura tear was evaluated with a brain computed tomography (CT) and a continuous slow wave was found on electroencephalography (EEG) without any epileptiform discharges. Eight hours postoperatively, the decreased level of consciousness recovered, and after 2 weeks, the patient was discharged without any neurologic sequealae. Clinicians should recognize the epileptogenic potential of sevoflurane and limit the maximum dose with avoidance of hypocapnia by hyperventilation. If an intracerebral lesion is accompanied, it may increase the possibility of the occurrence of seizure.
Anesthesia ; Brain ; Consciousness ; Diskectomy ; Electroencephalography ; Humans ; Hyperventilation ; Hypocapnia ; Leg ; Methyl Ethers ; Pneumocephalus ; Seizures ; Stupor

OBJECTIVE: This study is performed to compare the clinical courses (feature, treatment and outcomes) in patients with negative versus positive culture result in pyogenic spondylodiscitis. METHODS: From January 2001 to December 2006, we reviewed clinical data in 26 consecutive patients with pyogenic spondylodiscitis retrospectively. We exclude patients that underwent surgical irrigation or debridement with biopsy. We measured clinical outcomes, length of antibiotic administration, recurrence rate, laboratory studies (CRP, ESR and leukocyte counts) and complications between two groups. Clinical outcomes were rated with Macnab's criteria. RESULTS: Causative organisms were confirmed in 6 cases and the other 20 cases had negative culture result. Mean follow-up duration was 13 months. Mean intravenous antibiotics administration duration of patients having negative culture result was 8.4 weeks and oral was 5 months. On the other hand, in cases of positive culture result, mean intravenous duration was 8.7 weeks and oral was 5.2 months. Initial mean ESR and CRP were elevated, and decreased in both groups according to antibiotics medication (p<0.001 and p=0.001). But initial mean WBC count was normal range. There was no difference in tendencies of decrement of ESR and CRP between two groups (p=0.61 and p=0.571). Clinical outcomes (p=0.231) and complications (p=0.558) were not significantly different. There were no recurrence case for followup period. CONCLUSION: Negative culture results did not significantly affect the clinical course of pyogenic spondylodiscitis when we compared the clinical courses of both groups.
Anti-Bacterial Agents ; Biopsy ; Debridement ; Discitis ; Follow-Up Studies ; Hand ; Humans ; Leukocytes ; Recurrence ; Reference Values ; Retrospective Studies

Paraplegia following spinal epidural anesthesia is extremely rare. Various lesions for neurologic complications have been documented in the literature. We report a 66-year-old female who developed paraplegia after left knee surgery for osteoarthritis under spinal epidural anesthesia. In the recovery room, paraplegia and numbness below T4 vertebra was checked. A magnetic resonance image (MRI) scan showed a spinal thoracic intradural extramedullary (IDEM) tumor. After extirpation of the tumor, the motor weakness improved to the grade of 3/5. If a neurologic deficit following spinal epidural anesthesia does not resolve, a MRI should be performed without delay to accurately diagnose the cause of the deficit and optimal treatment should be rendered for the causative lesion.
Aged ; Anesthesia, Epidural ; Female ; Humans ; Hypesthesia ; Knee ; Magnetic Resonance Spectroscopy ; Neurologic Manifestations ; Osteoarthritis ; Paraplegia ; Recovery Room ; Spine