Objective: Unilateral biportal endoscopic (UBE) discectomy and tubular microdiscectomy (TMD) are widely practiced methods for treatment of lumbar disc herniation. Good clinical outcomes of these methods are reported in many papers, but there are a few comparative studies. This study reports the clinical outcomes of UBE and TMD as minimally invasive surgery methods for lumbar disc herniations and discusses the effectiveness of UBE.Methods: Sixty-seven patients who had undergone single-level discectomy using one of two methods, UBE or TMD, underwent a prospective follow-up examination. Thirty-four of these patients underwent discectomy using UBE, and the remaining 33 patients underwent TMD. In addition to the traditional measures of outcome, the improvement of generic health-related quality of life and disease-specific measurements like Visual Analogue Scale (VAS) score, Short-form 36 (SF-36), and Oswestry Disability Index (ODI) were evaluated and compared.Results: Sixty-seven patients with more than 6 months of post-operative follow-up evaluations were included. The mean improvements in the VAS scores for back pain and leg pain and ODI were 2.0, 3.7, and 26.5 for the UBE group and 1.6, 3.0, and 19.4 for the TMD group. The SF-36 physical health component subscale score improved from 35.4 pre-operatively to 54.8 at the last follow-up in the UBE group, and the mental health score improved from 43.5 to 55.1 (TMD group: from 34.9 to 54.3 and 44.2 to 57.1, respectively). Conclusion: The clinical outcomes of the UBE group are comparable to those of the TMD group. The results indicate that UBE for lumbar disc herniation can be performed safely and effectively as a treatment modality.
=Abstract=Mesenchymal hamartoma of the liver is an uncommon benign lesion that appears as a large abdominal mass, almost exclusively in the first 2 years of life. It has been believed that this lesion is not a true neoplasm but rather a kind of hamartomatous lesion arising from the connective tissue of the portal tracts at some point in their development. Minor components of liver cells and bile ducts are considered a result of entrapment. We report a case of typical cystic mesenchymal hamartoma in a 17-month-old boy who first presented with an abdominal mass at 7 months of age. The tumor was located in the right lobe, 17 cm in maximum diameter, and was largely cystic and partly solid, The cysts were multiloculated and lined by a single layer of tall columnar partly ciliated epithelium, and the irregular admixture of mature liver cell islands and intervening loose myxoid stroma was evident. Electronmicroscopic study revealed that the lining epithelium was the same as that of the bile duct, and the liver cell element was so mature that it couldn't be differentiated from normal hepatocytes. The stroma cell resembled fibroblast.
Hydranencephaly is a rare congenital disease defined as an absence of cerebral hemispheres with an intact thalamus, brain stem, and cerebellum. Generally, patients with hydranencephaly require cerebro-spinal fluid diversion due to progressive hydrocephalus. An excellent view of the choroid plexus and advancement of the neurosurgical endoscope were possible, leading to easy coagulation of the choroid plexus to balance cerebro-spinal fluid production without the use of a shunt device. We present this rare case and good treatment outcome from endoscopic coagulation of the choroid plexus.
Lichenoid drug eruption is lichenoid skin eruptions caused by certain drugs and compounds, and can be identical or similiar to lichen planus. A 75-year-old woman who had taken antituberculosis medication(INH, ethambutol, rifampin) for 4 months developed pruritic generalized erythematous papular eruptions on the trunk and extremities, alopecia and nail dystropy. Histopathologic findings were hyperkeratosis, hypergranulosis, hyc rophic degenaration of basal layer, band like lymphohistiocytic infiltration in the upper dermis and perivascular lymphohistiocytic infiltration in the deep dermis. She was treated with systemic corticosteroid, and then skin lesion were slightly improved. After termination of antituberculosis medication, skin lesions were markedly improved with residual hyperpigmentation. Alopecia and nail dystrophy were also improved.
The method of approach during transforaminal endoscopic lumbar discectomy (TELD) has been the subject of repeated study. However, the ideal entry point during TELD has not been studied in detail. Therefore, this study investigated the ideal entry point for avoiding complications using computed tomography (CT) scans obtained from patients in the prone position.Using CT scans obtained from patients in the prone position, we checked for retroperitoneal or visceral violations and measured the angles of approach with five conventional approach lines drawn on axial CT scans at each disc space level (L2-3, L3-4, and L4-5). We also determined the ideal entry point distance and approach angles for avoiding retroperitoneal or visceral violations. Correlation analysis was performed to identify the patient characteristics related to the ideal entry point properties.We found that the far lateral approach at the L2-3 level resulted in high rates of visceral violation. However, rates of visceral violation at the L3-4 and L4-5 levels were remarkably low or absent. The ideal angles of approach decreased moving caudally along the spine, and the ideal entry point distances increased moving caudally along the spine. Weight, body mass index (BMI), and the depth of the posterior vertebral line from the skin were positively associated with the distance of the ideal entry point from the midline.We reviewed the risk of the extreme lateral approach by analyzing rates of retroperitoneal and visceral violations during well-known methods of approach. We suggested an ideal entry point at each level of the lumbar spine and found a positive correlation between the distance of the entry point to the midline and patient characteristics such as BMI, weight, and the depth of the posterior vertebral line from the skin.
Vertebral artery dissecting aneurysm (VADA) is a rare and critical disease. VADA rupture can cause subarachnoid hemorrhage which is a major complication of VADA due to their high rebleeding rate and poor outcome. In the present study, ruptured and unruptured VADAs were compared by analyzing angiographic findings to determine useful predisposing factors for VADA rupture for appropriate treatment selection.Subjects with VADA treated during a 10-year period were retrospectively identified. The 57 cases diagnosed with VADA were divided into ruptured (n=15) and unruptured (n=42) groups. In addition, each case was analyzed using angiographic 3-dimensional (3-D) reconstructed images. Factors such as length, dilated and stenotic diameter, shape, and vessel around the vertebral artery (VA) were measured and statistically compared.In the ruptured group, stenotic findings of the affected lesion were more common and severe than in the unruptured group. The average stenotic diameter was 2.27 mm (vs. 2.84 mm). And stenotic degree was 62% and 53% in the ruptured and unruptured groups, respectively. Posterior communicating artery (PcomA) flow was more common in the ruptured group (87% vs. 55%, p=0.028). Conclusions: Based on angiographic findings, stenotic lesions, which may be influenced by PcomA flow, are more common in ruptured VADAs.
We report a case of subungual solitary glomus tumor in a 28-year-old female, who has suffered from pain and tenderness of the left 4th finger tip for about 5 years. Simple surgical excision was performed for removal of the tumor mass and for the relief of the subjective symptoms. No recurrence has been observed for 5 months following excision of the tumor.
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