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

OBJECTIVE: Vertebral body replacement following corpectomy in thoracic or lumbar spine is performed with titanium mesh cage (TMC) containing any grafts. Radiological changes often occur on follow-up. This study investigated the relationship between the radiological stability and clinical symptoms. METHODS: The subjects of this study were 28 patients who underwent corpectomy on the thoracic or lumbar spine. Their medical records and radiological data were retrospectively analyzed. There were 23 cases of tumor, 2 cases of trauma, and 3 cases of infection. During operation, spinal reconstruction was done with TMC and additional screw fixation. We measured TMC settlement in sagittal plane and spinal angular change in coronal and sagittal plane at postoperative one month and last follow-up. Pain score was also checked. We investigated the correlation between radiologic change and pain status. Whether factors, such as the kind of graft material, surgical approach, and fusion can affect the radiological stability or not was analyzed as well. RESULTS: Mean follow-up was 23.6 months. During follow-up, 2.08+/-1.65degrees and 6.96+/-2.08degrees of angular change was observed in coronal and sagittal plane, respectively. A mean of cage settlement was 4.02+/-2.83 mm. Pain aggravation was observed in 4 cases. However, no significant relationship was found between spinal angular change and pain status (p=0.518, 0.458). Cage settlement was seen not to be related with pain status, either (p=0.644). No factors were found to affect the radiological stability. CONCLUSION: TMC settlement and spinal angular change were often observed in reconstructed spine. However, these changes did not always cause postoperative axial pain.
Follow-Up Studies ; Humans ; Medical Records ; Retrospective Studies ; Spine* ; Titanium ; Transplants

Dedifferentiated chordoma (DC) is defined as a chordoma containing sarcoma components. DC is distinguished from conventional chordoma by the rapidity of tumor growth and the potential for distant metastasis. We report two cases of DC, which are developed in the sacrum. We reviewed the medical records and imaging studies of 2 patients diagnosed with DC and the literature published. In the first case, percutaneous biopsy revealed that it was conventional chordoma in the sacrum. Patient underwent radiation therapy (RT). Six years after the RT, the tumor recurred. Surgical removal was performed and the recurrent tumor was diagnosed as DC in histopathologic examination. In the second case, a patient underwent gross total resection of sacral tumor, which was diagnosed with conventional chordoma. Aggravated tumor was detected after 4 months, and patient underwent reoperation. The second operation revealed the transformation of the tumor into DC. The survival time of the patients after the diagnosis was 10 and 31 months. Dedifferentiated chordoma is a rare and highly aggressive tumor. De novo type exists, but it usually transformed from recurrent chordoma after surgical resection or radiation.
Biopsy ; Chordoma* ; Diagnosis ; Humans ; Medical Records ; Neoplasm Metastasis ; Reoperation ; Sacrum* ; Sarcoma

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*

To determine the effects and its complications of ventral cervical and selective spinal accessory nerve rhizotomy in the spasmodic torticollis, 14 patients who had undergone surgery between 1989 and 1997 were reviewed retrospectively. In overall twenty four operations were performed. The ventral cervical rhizotomy with spinal accessory nerve rhizotomy were performed in nine patients and the ventral cervical rhizotomy without spinal accessory nerve rhizotomy were done in two patients. Five cases of sternocleidomastoid myotomy with or without peripheral accessory neurectomy, and the five cases of peripheral accessory neurectomy were also performed. In two patients, the selective peripheral denervations were performed. In overall thirteen patients(93%) showed improvement in their condition. Of the eleven patients with the ventral cervical rhizotomy and spinal accessory nerve rhizotomy, nine patients(82%) improved. Five patients suffered from dysphagia or dysphonia postoperatively for several months, but one patient is having more than two years. Of these six patients, five patients had undergone the bilateral upper cervical rhizotomy and bilateral accessory nerve rhizotomy. Therefore to reduce the postoperative dysphagia or dysphonia, the authors recommend to save the unilateral cervical ventral roots or unilateral accessory nerve root. The authors also stress that the selective peripheral denervation would be the choice of operation in cases with the spasmodic torticollis because of its effectiveness and rarity of complications.
Accessory Nerve ; Deglutition Disorders ; Denervation ; Dysphonia ; Humans ; Retrospective Studies ; Rhizotomy* ; Spinal Nerve Roots ; Torticollis*