This study was carried out to investigate the light and electron microscopic findings of the livers of rats after an intraperitoneal injection of cadmium chloride. The Sprague-Dawley rats were intraperitoneally injected with cadmium chloride dissolved in water, once a day for three days. These animals were sacrificed at 1, 3, 8, and 24 hr after the last injection. Control groups of the rats were also sacrificed in the same manner. The liver was extirpated and examined by both light and electron microscopy. The results obtained are as follows: The parenchyma of the liver shows focal neutrophilic infiltration and spotty necrosis. The hepatocytes show fatty change, ballooning degeneration, swelling of the endoplasmic reticulum and mitochondria, increase numbers of secondary lysosomes and residual bodies. Focal patic venules and sinusoids of the liver are congested. The Kupffer cells are increase in number. Therefore, it can be concluded that the cadmium is directly acted to hepatocytes resulting in cellular injuries and deposits in the fat droplets of the cytoplasm of the hepatocytes, not Ito cells as previously suggeted.
Rats ; Animals

Ependymoma is the most common spinal intramedullary tumor in adults. The authors reviewed clinical data of 31 patients with spinal ependymoma who underwent operations between 1979 and 1996. The ages of the patients ranged from 15 to 62 years with a mean of 36.9. We analyzed clinical manifestations, radiologic findings, extents of surgical removal, histologic subtypes and follow-up results. Most patients were presented with sensory symptoms as initial symptoms which had lasted for 36.5 months on the average. The most frequent location was conus region(10 cases, 32%) followed by cervical, thoracic and cervico-thoracic spinal level. All cases were divided into two groups histologically, 12 myxopapillary subtypes and 19 non-myxopapillary subtypes. Operative results were dependent on the locations and the histologic subtypes of the tumor. Total removal was achieved in 4 cases out of 10 cases with masses around the conus and in 19 cases out of 21 cases with masses at other regions(p=0.003). Tumors were totally removed in 97% of 19 non-myxopapillary subtypes, but in 42% of 12 myxopapillary subtypes(p=0.001). From the follow-up data, we found that mean progression free interval was 83 months and 5 year progression free rate was 70%. Extent of removal was the only significant prognostic factor on multivariate analysis. Other factors such as tumor location, histologic subtype and radiation therapy were not significant. Disease progression was noted in 2 cases out of 23 cases of total removal group, but in 4 cases out of 8 cases of incomplete removal group (p=0.008). Postoperative radiation therapy was done in 4 cases in incomplete removal group and tumor regrowth was noted more frequently in non-radiation group than in radiation group without statistic significance. We concluded that disease progression can be determined by the extent of removal which is related to the tumor location and histologic subtypes.
Adult* ; Conus Snail ; Disease Progression ; Ependymoma* ; Follow-Up Studies ; Humans ; Multivariate Analysis ; Prognosis

OBJECTIVE: We have limited understanding on the presentation and survival of primary spinal sarcomas. The survival, recurrence rate, and related prognostic factors were investigated after treatment for primary sarcomas of the spine. METHODS: Retrospective analysis of medical records and radiological data was done for 29 patients in whom treatment was performed due to primary sarcoma of the spine from 2000 to 2010. As for treatment method, non-radical operation, radiation therapy, and chemotherapy were simultaneously or sequentially combined. Overall survival (OS), progression free survival (PFS), ambulatory function, and pain status were analyzed. In addition, factors affecting survival and recurrence were analyzed : age (< or =42 or > or =43), gender, tumor histologic type, lesion location (mobile spine or rigid spine), weakness at diagnosis, pain at diagnosis, ambulation at diagnosis, initial treatment, radiation therapy, kind of irradiation, surgery, chemotherapy and distant metastasis. RESULTS: Median OS was 60 months, the recurrence rate was 79.3% and median PFS was 26 months. Patients with distant metastasis showed significantly shorter survival than those without metastasis. No factors were found to be significant relating to recurrence. Prognostic factor associated with walking ability was the presence of weakness at diagnosis. CONCLUSION: Primary spinal sarcomas are difficult to cure and show high recurrence rate. However, the development of new treatment methods is improving survival.
Disease-Free Survival ; Humans ; Medical Records ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Retrospective Studies ; Sarcoma ; Spine ; Walking

OBJECTIVE: The objective of this study is to delineate clinical features and specific diagnostic and therapeutic implications of spinal metastasis occurring as the initial manifestation of malignancy(SM-IMM)-a less common event than spinal metastasis in the setting of previously established malignancy(SM-PEM). METHODS: The authors reviewed retrospectively the clinical records of 19 patients in SM-IMM group at Korean Cancer Center Hospital between January 1, 2000 and December 31, 2001 and analyzed symptom duration, primary origin, treatment modality and survival time. Then 287 cases of SM-PEM group were searched for primary origin. RESULTS: Thyroid cancer(36.8%), metastasis of unknown origin(31%), liver cancer(10.5%) and stomach cancer (10.5%) were found as primary tumor in SM-IMM group. But in SM-PEM group lung cancer was most frequent primary tumor(22%), breast cancer(17%), stomach cancer(7.3%) and liver cancer (7.3%) followed. Primary pathology was confirmed with spinal decompressive surgery(7 cases), biopsy of spinal lesion(5 cases), and biopsy of other sites except spine(7 cases). Patients in SM-IMM group showed short symptom duration and multi-segmental involvement at diagnosis. And post-treatment survival time was short except thyroid cancer in spite of aggressive treatment(mean survival time, 2.7 months). CONCLUSION: SM-IMM group showed different profile from SM-PEM group on primary origin. And in the diagnosis of primary origin in SM-IMM group, important clues were provided with history taking, physical examination and PET.
Biopsy ; Breast ; Diagnosis ; Humans ; Liver ; Liver Neoplasms ; Lung Neoplasms ; Neoplasm Metastasis* ; Pathology ; Physical Examination ; Retrospective Studies ; Stomach ; Stomach Neoplasms ; Thyroid Gland ; Thyroid Neoplasms

OBJECTIVE: Primary treatment of spinal metastasis has been external beam radiotherapy. Recent advance of technology enables radiosurgery to be extended to extracranial lesions. The purpose of this study was to determine the clinical effectiveness and safety of stereotactic radiosurgery using Cyberknife in spinal metastasis. METHODS: From June, 2002 to December, 2007, 129 patients with 167 spinal metastases were treated with Cyberknife. Most of the patients (94%) presented with pain and nine patients suffered from motor deficits. Twelve patients were asymptomatic. Fifty-three patients (32%) had previous radiation therapy. Using Cyberknife, 16-39 Gy in 1-5 fractions were delivered to spinal metastatic lesions. Radiation dose was not different regarding the tumor pathology or tumor volume. RESULTS: After six months follow-up, patient evaluation was possible in 108 lesions. Among them, significant pain relief was seen in 98 lesions (91%). Radiological data were obtained in 83 lesions. The mass size was decreased or stable in 75 lesions and increased in eight lesions. Radiological control failure cases were hepatocellular carcinoma (5 cases), lung cancer (1 case), breast cancer (1 case) and renal cell carcinoma (1 case). Treatment-related radiation injury was not detected. CONCLUSION: Cyberknife radiosurgery is clinically effective and safe for spinal metastases. It is true even in previously irradiated patients. Compared to conventional radiation therapy, Cyberknife shows higher pain control rate and its treatment process is more convenient for patients. Thus, it can be regarded as a primary treatment modality for spinal metastases.
Breast Neoplasms ; Carcinoma, Hepatocellular ; Carcinoma, Renal Cell ; Follow-Up Studies ; Humans ; Lung Neoplasms ; Neoplasm Metastasis ; Radiation Injuries ; Radiosurgery ; Tumor Burden

OBJECTIVE: To compare two testing protocols for evaluating range of motion (ROM) changes in the preloaded cadaveric spines implanted with a mobile core type Charite(TM) lumbar artificial disc. METHODS: Using five human cadaveric lumbosacral spines (L2-S2), baseline ROMs were measured with a bending moment of 8 Nm for all motion modes (flexion/extension, lateral bending, and axial rotation) in intact spine. The ROM was tracked using a video-based motion-capturing system. After the Charite(TM) disc was implanted at the L4-L5 level, the measurement was repeated using two different methods : 1) loading up to 8 Nm with the compressive follower preload as in testing the intact spine (Load control protocol), 2) loading in displacement control until the total ROM of L2-S2 matches that when the intact spine was loaded under load control (Hybrid protocol). The comparison between the data of each protocol was performed. RESULTS: The ROMs of the L4-L5 arthroplasty level were increased in all test modalities (p < 0.05 in bending and rotation) under both load and hybrid protocols. At the adjacent segments, the ROMs were increased in all modes except flexion under load control protocol. Under hybrid protocol, the adjacent segments demonstrated decreased ROMs in all modalities except extension at the inferior segment. Statistical significance between load and hybrid protocols was observed during bending and rotation at the operative and adjacent levels (p < 0.05). CONCLUSION: In hybrid protocol, the Charite(TM) disc provided a relatively better restoration of ROM, than in the load control protocol, reproducing clinical observations in terms of motion following surgery.
Arthroplasty ; Cadaver ; Chimera ; Displacement (Psychology) ; Humans ; Range of Motion, Articular ; Spine ; Track and Field

INTRODUCTION: Perioperative irradiation is often combined with spine tumor surgery. Radiation is known to be detrimental to healing process of bone fusion. We tried to investigate bone fusion rate in spine tumor surgery cases with perioperative radiation therapy (RT) and to analyze significant factors affecting successful bone fusion. METHODS: Study cohort was 33 patients who underwent spinal tumor resection and bone graft surgery combined with perioperative RT. Their medical records and radiological data were analyzed retrospectively. The analyzed factors were surgical approach, location of bone graft (anterior vs. posterior), kind of graft (autologous graft vs. allograft), timing of RT (preoperative vs. postoperative), interval of RT from operation in cases of postoperative RT (within 1 month vs. after 1 month) radiation dose (above 38 Gy vs. below 38 Gy) and type of radiation therapy (conventional RT vs. stereotactic radiosurgery). The bone fusion was determined on computed tomography images. RESULT: Bone fusion was identified in 19 cases (57%). The only significant factors to affect bony fusion was the kind of graft (75% in autograft vs. 41 in allograft, p=0.049). Other factors proved to be insignificant relating to postoperative bone fusion. Regarding time interval of RT and operation in cases of postoperative RT, the time interval was not significant (p=0.101). CONCLUSION: Spinal fusion surgery which was combined with perioperative RT showed relatively low bone fusion rate (57%). For successful bone fusion, the selection of bone graft was the most important.
Allografts ; Autografts ; Cohort Studies ; Humans ; Medical Records ; Retrospective Studies ; Spinal Fusion ; Spine* ; Transplants

OBJECTIVE: To describe the underlying causes, surgical results, and prognostic factors in thoracic stenosis causing myelopathy, retrospective analysis for 28 cases of thoracic stenosis with surgery was performed MATERIALS AND METHOD: Twenty-eight patients(male, 15; female, 13) who underwent decompressive surgery for thoracic stenosis between 1987 and 1997 were analyzed. The mean age was 49 and the mean follow-up was 30.6 months. Statistical analysis with SPSS(r) was performed. Chi-square test was used for the analysis of relationship between subjects and multivariate analysis with general linear model was used to find prognostic factors. RESULT: Degenerative spondylosis was the most common cause, and three cases were associated with systemic diseases. Decompressive laminectomy was done in 23 cases, anterior decompression in four cases, and combined decompression in one case. Ossification of ligamentum flavum was found in 18 cases, facet hypertrophy in 13, ossification of posterior longitudinal ligament in six, and ventral spur in four. Postoperatively, 16 patients improved functionally and 4 patients worsened. The group of which initial symptom duration was less than two years showed better result(p=0.003). The group with sufficient decompression and no additional proximal stenosis had better outcome(p=0.002, p=0.001). CONCLUSION: Chronic myelopathy caused by thoracic stenosis can be reversible with appropriate decompression.
Constriction, Pathologic ; Decompression ; Female ; Follow-Up Studies ; Humans ; Hypertrophy ; Laminectomy ; Ligamentum Flavum ; Linear Models ; Multivariate Analysis ; Ossification of Posterior Longitudinal Ligament ; Retrospective Studies ; Spinal Cord Diseases ; Spinal Stenosis* ; Spondylosis

STUDY DESIGN: A retrospective study. OBJECTIVES: By analyzing the patients of neurofibromatosis with spinal deformities, to identify presence of dystrophic changes, progression of deformity and associated factors, and treatment results according for sagittal curve pattern and operative methods. SUMMARY OF LITERATURE REVIEW: A single thoracic curve involving four, five, or six vertebrae is recognized as the most common pattern. Risk factors for progression of curve were anterior vertebral scalloping, particularly in younger patients, three or more penciled ribs, abnormal kyphosis, etc. It has been stated that the most effective management for dystrophic curves is early and aggressive surgery. MATERIALS AND METHODS: Thirty nine patients with neurofibromatosis and spinal deformities were reviewed with chart and radi-ographic review from 1977 to 1999. RESULTS: Four of thirty nine patients were nondystrophic type, and all patients were treated nonoperatively. Thirty five of thirty nine patients were dystrophic type, and twenty seven patients were treated operatively. Eight of these patients had been in progress till operation with 7.9 degrees/year progression rate, and their commonest pattern of deformity is a single curve in lower thoracic area with dystrophic changes such as vertebral scalloping, wedging, pencilling of average four ribs, particularly. Forty three percent of dystrophic type has sagittal plane deformities. The pedicle screw system was most excellent among the instrumentations. The complications of surgery were 6 progression of curve, 2 metal failure. Reoperation was done in 5 of 27 operated patients. CONCLUSIONS: Nondystrophic type had good results with nonoperative treatment, but dystrophic type mostly required surgical intervention and had rapid progression. The treatment should be done by rigid fixation after considering sagittal plane deformi-ties and long term follow-up was needed for progressions of curve.
Congenital Abnormalities* ; Follow-Up Studies ; Humans ; Kyphosis ; Neurofibromatoses* ; Pectinidae ; Reoperation ; Retrospective Studies ; Ribs ; Risk Factors ; Scoliosis ; Spine

OBJECTIVE: The treatment of giant cell tumor (GCT) is mainly performed surgically. However, GCT in spine seems difficult to treat because of the limited surgical accessibility and proximity. In this report, we analyzed the outcome of GCT treatment in spine. METHODS: Between 2000 and 2012, 19 patients received treatment for GCT in spine. Median age at their first diagnosis was 31 years, 10 patients were male, and 9 female. Fourteen tumors were located in the sacrum, 1 in cervical, 1 in thoracic and 3 in lumbar spine. As primary treatment, gross total removal (GTR) was done in 6 patients, and subtotal removal (STR) in 13 patients. Radiation therapy (RT) as an adjuvant therapy was performed in 2 cases in GTR group and 10 cases in STR group. RESULTS: During the follow-up, 7 patients had local recurrence (36.8%). The average period until recurrence after primary treatment was 14 months. No recurrence was detected in GTR group. Recurrence was noted in 7 out of 13 patients who underwent STR. These differences were statistically significant (p=0.024). A median of recurrence free period (RFP) was 84 months. Also average RFP of the RT group was 112 months, and non-RT group was 65 months. These differences were statistically significant (p=0.041). CONCLUSION: Treatment of choice for GCT in spine is a complete removal of tumor without neurological deficits. In case of incomplete removal, radiation therapy may be a useful adjuvant treatment modality.
Diagnosis ; Female ; Follow-Up Studies ; Giant Cell Tumors* ; Giant Cells* ; Humans ; Male ; Radiotherapy ; Recurrence ; Sacrum ; Spine*