Morphometric Study of the Lumbar Posterior Longitudinal Ligament

OBJECTIVE: Morphometric data for the lumbar posterior longitudinal ligament (PLL) was investigated to identify whether there is a difference in the morphometry of the PLL of the lumbar spine at each level with respect to the pattern of intervertebral disc displacement.METHODS: In 14 formalin-fixed adult cadavers (12 males and 2 females), from L1 to L5, the authors measured the width and height of the PLL and compared them with other landmarks such as the disc and the pedicle.RESULTS: Horizontally, at the upper margin of the disc, the central portion of the superficial PLL covered 17.8–36.9% of the disc width and the fan-like portion of the PLL covered 63.9–76.7% of the disc width. At the level of the median portion of the disc, the PLL covered 69.1–74.5% of the disc width. Vertically, at the level of the medial margin of the pedicle, the fan-like portion of the PLL covered 23.5–29.9% of the disc height. In general, a significant difference in length was not found in the right-left and male-female comparisons.CONCLUSION: This study presents the morphometric data on the pattern of intervertebral disc displacement and helps to improve the knowledge of the surgical anatomy of the lumbar PLL.

Morphometric Study of the Lumbar Posterior Longitudinal Ligament

OBJECTIVE: Morphometric data for the lumbar posterior longitudinal ligament (PLL) was investigated to identify whether there is a difference in the morphometry of the PLL of the lumbar spine at each level with respect to the pattern of intervertebral disc displacement. METHODS: In 14 formalin-fixed adult cadavers (12 males and 2 females), from L1 to L5, the authors measured the width and height of the PLL and compared them with other landmarks such as the disc and the pedicle. RESULTS: Horizontally, at the upper margin of the disc, the central portion of the superficial PLL covered 17.8–36.9% of the disc width and the fan-like portion of the PLL covered 63.9–76.7% of the disc width. At the level of the median portion of the disc, the PLL covered 69.1–74.5% of the disc width. Vertically, at the level of the medial margin of the pedicle, the fan-like portion of the PLL covered 23.5–29.9% of the disc height. In general, a significant difference in length was not found in the right-left and male-female comparisons. CONCLUSION: This study presents the morphometric data on the pattern of intervertebral disc displacement and helps to improve the knowledge of the surgical anatomy of the lumbar PLL.

Idiopathic Thoracic Epidural Lipomatosis with Chest Pain

Spinal epidural lipomatosis (SEL) is an overgrowth of the normally encapsulated adipose tissue in the epidural space around the spinal cord in the thoracic and lumbar spine causing compression of the neural components. Idiopathic SEL in non-obese patients is exceptional. Idiopathic SEL can result in thoracic myelopathy and lumbar radiculopathy. A thoracic radiculopathy due to idiopathic SEL has not been reported yet. We report a case of idiopathic SEL with intractable chest pain and paresthesia. We suggest that idiopathic SEL should be considered as a cause of chest pain.

Morphometric Study of the Upper Thoracic Sympathetic Ganglia

OBJECTIVE: Morphometric data for the sympathetic ganglia (SG) of the upper thoracic spine was investigated to identify the exact location of the SG in order to reduce normal tissue injury in the thoracic cavity during thoracoscopic sympathectomy. METHODS: In 46 specimens from 23 formalin-fixed adult cadavers, the authors measured the shortest distance from the medial margin of the T1, T2 and T3 SG to the most prominent point and medial margin of the corresponding rib heads, and to the lateral margin of the longus colli muscle. In addition, the distance between the most prominent point of the rib head and the lateral margin of longus colli muscle and the width of each SG were measured. RESULTS: The shortest distance from the medial margin of the SG to the prominent point of corresponding rib head was on average 1.9 mm on T1, 4.2 mm, and 4.1 mm on T2, T3. The distance from the medial margin of the SG to the medial margin of the corresponding rib head was 4.2 mm on T1, 5.9 mm, and 6.3 mm on T2, T3. The mean distance from the medial margin of the SG to the lateral margin of the longus colli muscle was 6.7 mm on T1, 8.8 mm, 9.9 and mm on T2, T3. The mean distance between the prominent point of the rib head and the lateral margin of the longus colli muscle was 4.8 mm on T1, 4.6 mm, and 5.9 mm on T2, T3. The mean width of SG was 6.1 mm on T1, 4.1 mm, and 3.1 mm on T2, T3. CONCLUSION: We present morphometric data to assist in surgical planning and the localization of the upper thoracic SG during thoracoscopic sympathectomy.

The Identification of Genetic Alteration in Cervical Cancer by Comparative Genomic Hybridization (CGH) / 대한부인종양콜포스코피학회잡지

Until recently, cytogenetic studies failed to identify any landmark chromosomal aberrations associated with cervical carcinomas, Recent comparative genome hybridization(CGH) studies have, however, demonstrated that one of the most consistent chromosomal abnormality that marks the transition of carcinoma in situ (CIS) of the cervix to invasive carcinoma is the gain of specific chromosome 3q sequences. Although HPV infection has been demonstrated to be a most important initiating event in the development of most cervical cancers, other additional genetic events are also required for eventual development or progression of invasive cancer. The genetic alterations in cervical cancer were investigated by CGH method using fh frozen specimens. CGH is based on two-color in situ hybridization where genomic tumor DNA is labeled with fluorochrome (FITC) and a normal reference genome is labeled with fluorochrome (Rhodamine) by nick translation. Following co-hybridization of the deferentially labeled genomes to normal reference metaphase chromosomes, Computer Assisted Image Analyzer interprets multicolor fluorescence. The volumetric change in the dual color is typically detected as gain or loss of the DNA sequences in specific region of chromosome. In this study, the pattern of chromosomal aberrations in cervical cancer was not similar to that reported previously by other authors. Overall chromosomal aberration was observed in 46.2%(12/26 cases). The gain of chromosome 5, 11q, 15q, and 17q was most frequent. In deletion, 1q loss was most frequent. There was some cell to cell variability of CGH results in a same tumor sample. The results await careful interpretation and there are several possible reasons of such difference. First reason is a possibility of racial difference in the pattern of chromosomal alteration necessary for cervical carcinogenesis and second one is a possibility of faulty analysis by either improper standardization of computer software or heterogeneity of specimen due to normal cell contamination. However, from the finding that there was no chromosomal aberration in all myometria used for normal control, threshold of normal fluorescence profile in our CGH seems to be reliable. The genetic studies on cervical cancer by this CGH technique should provide new insights into the molecular pathogenesis of lower genital tract cancer and allow for more logical and targeted approach to the cervical cancer management.

Squamous Cell Carcinoma of the Conjunctiva

Most squamous cell carcinomas arise in the interpalpebral area of the perilimbal conjunctiva and grow in an exophytic, sometimes papillary, fashion. These tend to be only superficially invasive and to have a relatively benign clinical course. We experienced two cases of squamous cell carcinoma of the conjunctiva. A 32 year old man had a hard, nontender, round mass at the temporal portion of the limbus and a 63 year old man showed an irreqular surfaced, large mass of the inferior-temporal portion of the bulbar conjunctiva with extension to the cornea. Complete excision of the mass, cryotherapy and 95% alcohol cauterization were performed. After the follow up period of 9 to 22 months, the two patients revealed no recurrence of the tumor.

The Effect of the Prophylactic Cryopexy in the Experimental Penetrating Ocular Injury with Retinal Laceration

Retinal detachment was studied in a rabbit model of penetrating ocular injuries with retinal laceration. In experimental group, to study its effect on the prevention of retinal detachment, cryopexy was performed at the site of penetrating ocular injury. No retinal detachment was found when the injury was made in 3 mm radial incision from corneoscleral limbus. When the injury was extended to the equator of the globe, namely 6 mm radial incision from corneoscleral limbus, the incidence of retinal detachment was 35%. But when the incision was made circumferentially 6 mm through the retina near ora serrata ie, 3 mm from the limbus, the incidence was 65%. The higher incidence of retinal detachment following injuries located at the ora serrata is probably due to the involvement of the vitreous base. However, there was no significant difference in the incidence of retinal detachment between control and experimental groups. And the cryotherapy can release viable retinal pigment epithelial cells into the vitreous cavity which can cause proliferative vitreoretinopathy. Therefore, the cryotherapy should be limited in posterior penetraring ocular injuries. The histopathologic examination of proliferative vitreoretinopathy in rabbit eyes with posterior penetrating ocular injuries revealed Muller cells, fibroblast and retinal pigment epithelial cells as main cellular components. Through this experiment, cryopexy was proved to be little effect in prevention of retinal detachment in rabbit eyes with perforating eye injuries.

Clinical Evaluation of Treatment of the Optic Nerve Damage

Clinical signs of the optic nerve injury are characterized by absent or diminished light reaction of the pupil on the affected side, a wound in the lateral part of the eyebrow and bleeding from the nose. On X-ray studies, the optic canal fracture can be noticed occasionally. In this study, eleven cases of the optic nerve damage due to a blunt head trauma were studied for 6 to 30 months(average 9 months). Of these, the optic canal fracture was revealed in 5 cases. Among the 5 cases, three cases received surgical decompression of the optic canal through frontotemporal approach with visual improvement in 2 cases(66%). Eight cases were treated by medical therapy with visual improvement in 5 cases(63%). Visual recovery of the optic nerve injury with optic canal fracture(60%, 3/5) was similar to those with no optic canal fracture(66%, 4/6). On the bases of our study, the optic nerve damage should be treated by intensive medical treatment and if the optic canal fracture exists, early surgical intervention should be performed.