Metastasis of Hepatocellular Carcinoma to Pituitary Adenoma: A Case Report

Metastasis to the pituitary gland is unusual, and metastasis to pituitary adenoma is extremely rare. We report here on a case of hepatocellular carcinoma metastasizing to a pituitary adenoma with MRI findings.

Multiple Intracranial Aneurysms Associated with Behçet's Disease

Behçet's disease is an inflammatory disorder involving multiple organs. Its cause is still unknown, but vasculitis is the major pathologic characteristic. The common vascular lesions associated with Behçet's disease are aneurysm formation, arterial or venous occlusive diseases, and varices. Arterial aneurysms mostly occur in large arteries. Intracranial aneurysms hardly occur with Behçet's disease. We would like to present a 41-year-old female patient with Behçet's disease who showed symptoms of severe headache due to subarachnoid hemorrhage. Brain computed tomography revealed multiple aneurysms. We also present a literature review of intracranial arterial aneurysms associated with Behçet's disease.

Two Cases of Onychomadesis Caused by Hand-Foot-Mouth Disease / 대한피부과학회지

Hand-foot-mouth disease (HFMD) is an infectious viral disease that is common among children. It is clinically characterized by vesicular eruptions on the palms and soles and a maculopapular rash. Onychomadesis is a periodic idiopathic shedding of the nails at their proximal ends and results from arrest of the proliferative function of the nail matrix. Recently, a few reports described onychomadesis following HFMD, although the mechanism remains unclear. To our knowledge, this association has not been reported in Korea. Herein, we report two cases of onychomadesis following HFMD and review the published data.

Paraspinal Muscle Sparing Versus Percutaneous Screw Fixation: A Comparative Enzyme Study of Tissue Injury during the Treatment of L4-L5 Spondylolisthesis

OBJECTIVE: Screw fixation via the paraspinal muscle sparing approach and by percutaneous screw fixation are known to diminish the risk of complications, such as, iatrogenic muscle injury as compared with the conventional midline approach. The purpose of this study was to evaluate tissue injury markers after these less traumatic screw fixation techniques for the treatment of L4-L5 spondylolisthesis. METHODS: Twenty-two patients scheduled for posterior lumbar interbody fusion (PLIF) at the L4-L5 segment for spondylolisthesis were prospectively studied. Patients were divided into two groups by screw fixation technique (Group I: paraspinal muscle sparing approach and Group II: percutaneous screw fixation). Levels of serum enzymes representing muscle injury (CK-MM and Troponin C type 2 fast), pro-inflammatory cytokine (IL-8), and anti-inflammatory cytokine (IL-1ra) were analyzed using ELISA techniques on the day of the surgery and 1, 3, and 7 days after the surgery. RESULTS: Serum CK-MM, Troponic C type 2 fast (TNNC2), and IL-1ra levels were significantly elevated in Group I on postoperative day 1 and 3, and returned to preoperative levels on postoperative day 7. No significant intergroup difference was found between IL-8 levels despite higher concentrations in Group I on postoperative day 1 and 3. CONCLUSION: This study shows that percutaneous screw fixation procedure is the preferable minimally invasive technique in terms of minimizing muscle injury associated with L4-L5 spondylolisthesis.

Symptomatic Myelopathy Caused by Ossification of the Yellow Ligament

OBJECTIVE: This study was performed to describe the clinical presentation, surgical outcome in patients with symptomatic myelopathy caused by ossification of the yellow ligament (OYL). METHODS: The authors reviewed consequent 12 patients in whom posterior decompressive laminectomies were performed for OYL from 1999 to 2005. Diagnostic imagings including simple radiographs, computed tomography and magnetic resonance images were performed in each case. The patients were reviewed to evaluate the clinical presentation, surgical outcome and complications of the operation. RESULTS: In all patients, OYL was located in the lower thoracic region and all patients presented with numbness on both limbs and pain. Among them, 5 patients presented with gait disturbance due to paraparesis and two patients had sphincter dysfunction. Decompressive laminectomy through a posterior approach using microscope resulted in improvement of symptoms in all patients, but, recovery was incomplete in a half of the patients. The mean postoperative Japanese orthopaedics association (JOA) score was 7.9 when compared with 4.9 in preoperative assessment and the mean recovery rate was 65%. Dural tear was noticed in four patients, so dural repair was performed, but there were no neurological deficits related to neural injury. CONCLUSION: OYL is an uncommon cause of myelopathy but it can lead to debilitating thoracic myelopathy. Careful decompressive laminectomy can achieve favorable results.

A Comparative Study of the Clinical Findings Associated with Herpes Zoster and According to Age / 대한피부과학회지

BACKGROUND: Patients with herpes zoster generally complain typical manifestations, including prodromal pain, a grouped vesicular rash and prickling pain on unilateral dermatomes. However, there have been a few reports showing clinical differences by age. OBJECTIVE: The purpose of this study was to evaluate the clinical differences among the various aged populations that suffer with herpes zoster. METHODS: The medical records of 921 patients who were diagnosed with herpes zoster at our institution between January 2002 and December 2008 were reviewed, and if necessary, telephone interviews were done. According to the age groups as classified with a decade-scale, the data was assessed with respect to gender, seasonal occurrence, the dermatomal distribution, prodromal pain, the chief symptom, the range of lesion, underlying diseases and postherpetic neuralgia. RESULTS: The mean age of the subjects was 57.7 and the ratio of males to females was 1:1.4. The proportions of female patients gradually increased in the over 40 year-old group (p<0.001). As one grows older, there is a trend for a higher occurrence of herpes zoster in winter (p=0.011). The likelihood of attacks on the trigeminal dermatome appeared to increase with age, but that of the spinal dermatomes, including the cervical, thoracic and lumbosacral area, showed a decrease with age (p=0.01). The rate of prodromal pain was higher with age (p=0.004). The rate of prickling pain increased with age, but that of pruritus decreased with age (p=0.001). The presence of widely involved lesion (p=0.013), an underlying disease (p<0.001) and postherpetic neuralgia (p<0.001) increased with age. CONCLUSION: The results of this study demonstrated that the clinical findings associated with herpes zoster were not always consistent in different aged populations. The rate of female patients, occurrence in winter, an attack on the trigeminal dermatome, prodromal pain, prickling pain, larger lesion, underlying disease and postherpetic neuralgia showed a tendency to increase with age.

Efficacy of Spinal Implant Removal After Thoracolumbar Junction Fusion

OBJECTIVE: The purpose of this study was to evaluate the efficacy of spinal implant removal and to determine the possible mechanisms of pain relief. METHODS: Fourteen patients with an average of 42 years (from 22 to 67 years) were retrospectively evaluated. All patients had posterior spinal instrumentation and fusion, who later developed recurrent back pain or persistent back pain despite a solid fusion mass. Patients' clinical charts, operative notes, and preoperative x-rays were evaluated. Relief of pain was evaluated by the Visual Analog Scale (VAS) pain change after implant removal. Clinical outcome using VAS and modified MacNab's criteria was assessed on before implant removal, 1 month after implant removal and at the last clinical follow-up. Radiological analysis of sagittal alignment was also assessed. RESULTS: Average follow-up period was 18 months (from 12 to 25 months). There were 4 patients who had persistent back pain at the surgical site and 10 patients who had recurrent back pain. The median time after the first fusion operation and the recurrence of pain was 6.5 months (from 3 to 13 months). All patients except one had palpation pain at operative site. The mean blood loss was less than 100ml and there were no major complications. The mean pain score before screw removal and at final follow up was 6.4 and 2.9, respectively (p<0.005). Thirteen of the 14 patients were graded as excellent and good according to modified MacNab's criteria. Overall 5.9 degrees of sagittal correction loss was observed at final follow up, but was not statistically significant. CONCLUSION: For the patients with persistent or recurrent back pain after spinal instrumentation, removal of the spinal implant may be safe and an efficient procedure for carefully selected patients who have palpation pain and are unresponsive to conservative treatment.

Minimally Invasive Lumbar Spinal Decompression: A Comparative Study Between Bilateral Laminotomy and Unilateral Laminotomy for Bilateral Decompression

OBJECTIVE: Bilateral laminotomy and unilateral laminotomy for bilateral decompression are becoming the minimally invasive procedures for lumbar spinal stenosis (LSS). With the aim of less invasiveness and better preservation of spinal stability, these techniques have been developed. But there are no large randomized studies to show the surgical results between these two techniques. The objective of this study was to examine the safety and efficacy of these two minimally invasive techniques. METHODS: A total of 80 patients were included in this study (Group I : bilateral laminotomy, Group II : Unilateral laminotomy for bilateral decompression). Perioperative parameters and complications were analyzed. Symptoms and scores such as visual analog scale (VAS) scores, Oswestry Disability Index (ODI) scores, and SF-36 scores of prospectively accrued patients were assessed preoperatively and at 1 month and 12 months after surgery. Paired-t test, two-sample student-t tests, and nonparametric tests were used to determine cross-sectional differences between two groups. RESULTS: No major complications such as spinal instability or deaths occurred during follow-up periods. VAS, ODI scores and SF-36 body pain and physical function scores showed statistically significant improvements in both groups (p<0.001). The significant widening of the spinal canal diameter was also noted in both groups. But, in Group II, there were minor postoperative complications such as dural tear (2 cases 5.0%), fracture of ipsilateral inferior facet (1 case 2.5%), and 5 cases of transient leg symptoms of contralateral side. CONCLUSION: Both bilateral laminotomy and unilateral laminotomy for bilateral decompression allow achievement of adequate and long-lasting operative results in patients with LSS. But postoperative complications are more frequent in Group II (unilateral laminotomy and bilateral decompression). These results indicate that bilateral laminotomy is the preferred minimally invasive technique to treat symptomatic LSS.

Minimally Invasive Lumbar Spinal Decompression: A Comparative Study Between Bilateral Laminotomy and Unilateral Laminotomy for Bilateral Decompression

OBJECTIVE: Bilateral laminotomy and unilateral laminotomy for bilateral decompression are becoming the minimally invasive procedures for lumbar spinal stenosis (LSS). With the aim of less invasiveness and better preservation of spinal stability, these techniques have been developed. But there are no large randomized studies to show the surgical results between these two techniques. The objective of this study was to examine the safety and efficacy of these two minimally invasive techniques. METHODS: A total of 80 patients were included in this study (Group I : bilateral laminotomy, Group II : Unilateral laminotomy for bilateral decompression). Perioperative parameters and complications were analyzed. Symptoms and scores such as visual analog scale (VAS) scores, Oswestry Disability Index (ODI) scores, and SF-36 scores of prospectively accrued patients were assessed preoperatively and at 1 month and 12 months after surgery. Paired-t test, two-sample student-t tests, and nonparametric tests were used to determine cross-sectional differences between two groups. RESULTS: No major complications such as spinal instability or deaths occurred during follow-up periods. VAS, ODI scores and SF-36 body pain and physical function scores showed statistically significant improvements in both groups (p<0.001). The significant widening of the spinal canal diameter was also noted in both groups. But, in Group II, there were minor postoperative complications such as dural tear (2 cases 5.0%), fracture of ipsilateral inferior facet (1 case 2.5%), and 5 cases of transient leg symptoms of contralateral side. CONCLUSION: Both bilateral laminotomy and unilateral laminotomy for bilateral decompression allow achievement of adequate and long-lasting operative results in patients with LSS. But postoperative complications are more frequent in Group II (unilateral laminotomy and bilateral decompression). These results indicate that bilateral laminotomy is the preferred minimally invasive technique to treat symptomatic LSS.

Surgical Results of Meralgia Paresthetica

OBJECTIVE: Meralgia Paresthetica is an entrapment neuropathy involving the lateral femoral cutaneous nerve. The aim of the present study is to evalute results of two surgical procedures(neurolysis and transection) for this disease. METHODS: The authors reviewed the 11 patients who underwent surgery in our hospital for meralgia paresthetica for last 15 years. Preoperatively all patients were treated by conservative management which was failed. Visual analogue scale(VAS) sore was used for pre-and post-operative assessments of the pain. Operation is performed by infrainguinal ligament approach. Nine patients underwent neurolysis, and two patients underwent transection of the lateral femoral cutaneous nerve. The average follow-up period was 14.3 months. RESULTS: In 10 cases good relief of symptom was obtained, but in one case relief of symptom was not. Superior result of transection as a treatment for meralgia paresthetica was obtained. But, there was no statistically significant difference between two procedures because of small group. CONCLUSION: When surgery is indicated for patients in whom pain is severe and persistent despite adequate conserative management, it appears to offer good results.