• Journal of Korean Neurosurgical Society
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• 제46권5호
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• pp.468-471
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• 2009

Objective : The adolescent presentation of tethered cord syndrome (TCS) is well-recognized, but continues to pose significant diagnostic and management controversies. The authors conducted a retrospective study of clinical outcomes after surgical intervention in 24 school-aged children, adolescents, and young adults with TCS. Methods : All 83 patients with a lipomyelomeningocele (LMMC) underwent untethering surgery for caudal cord tethering between 1987 and 2007. The clinical charts and follow-up data were reviewed. Of these patients, 24 school-aged children, adolescents, and young adults with TCS were studied with respect to the clinical, radiologic, pathologic features, and surgical outcomes. Results : Untethering procedures were performed in 24 patients (age range, 7-25 years) for TCS of various origins (lipoma, lipomyelomeningocele, and tight filum terminale). Specific circumstances involving additional tugging of the already tight conus, and direct trauma to the back precipitated the onset of symptom in 50% of the patients. Diffuse and non-dermatomal leg pain, often referred to the anorectal region, was the most common presenting symptom. Progressive sensorimotor deficits in the lower extremities, as well as bladder and bowel dysfunction, were also common findings, but progressive foot and spinal deformities were noted less frequently. The most common tethered lesions were intradural lipomas, thickened filum and fibrous band adhesions into the placode sac. The surgical outcome was gratifying in relation to pain and motor weakness, but disappointing with respect to resolution of bowel and bladder dysfunction. Of the 24 patients with TCS, pre-operative deficits improved after surgery in 14 (58.3%). remained stable in 8 (33.4%). and worsened in 2 (8.3%). Conclusion : The pathologic lesions of tethered cord syndrome in school-aged children, adolescents, and young adults, are mostly intradural lipomas and tight filum. It is suggested that the degree of cord traction results in neurologic dysfunction in late life due to abnormal tension, aggravated by trauma or repeated tugging of the conus during exercise. Early diagnosis and adequate surgical release might be the keys to the successful outcome in school-aged children, adolescents, and young adults with TCS.

• Advances in pediatric surgery
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• 제19권2호
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• pp.81-89
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• 2013

The purposes of this study was to describe the clinical correlation of mass size and gestational age, prognostic factors in sacrococcygeal teratoma (SCT) at a tertiary pediatric surgery, University of Ulsan College of Medicine and Asan Medical Center (AMC), Seoul, Korea. Fifty five patients admitted to the AMC with a SCT between May 1989 and April 2013 were included in this retrospective review. Mean follow up was 861 days. Mean maternal age at delivery was $30{\pm}2.7$ year, mean gestational age (GA) was $36.9{\pm}3.6$ wks, and preterm delivery was 21.8%. Birth body weight was $3182{\pm}644$ g and male vs. female ratio was 1:2.05. We can't find significant difference between Caesarean section and maternal age at delivery (p =0.817). But, caesarean section was favored by gestational age (p = 0.002), larger tumor size (p =0.029) or higher tumor weight fraction rate to birth body weight (p =0.024). Type I was 13, II 21, III 17, and IV 3 according to Altman et al. classification. The tumor component was predominantly cystic(> 50%) in 73.1 %. And the majority histological classification of tumors were mature teratoma (70.3%). The motality rate was 5.5%. Three patients expired because of postpartum bleeding, post-op bleeding related complication such as DIC. SCT recurred in four patients. The interval between first and second operation was $206.2{\pm}111.0$ d (range 53~325 d). In two patients, serum AFP levels were elevated at a regular checkup without any symptom, and subsequent imaging studies revealed SCT. The most common cause of death was bleeding and bleeding related complication. So Caesarean section and active peripartum and perioperative management will be needed for huge solid SCT. In the case of Yolk sac tumor or huge immature teratoma, possibility of recurrence have to be always considered, so follow up by serial AFP and MRI is important for SCT management.

• 한국어류학회지
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• 제12권2호
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• pp.137-145
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• 2000

1997년 6월에 한국 중서부에 위치한 경기도 강화도연안에서 가숭어 어미를 채집하여 인위적인 방법으로 난을 수정시킨 후, 난 및 자치어의 형태발달을 조사하였다. 가숭어의 수정난은 구형으로 무색투명하고 1개의 유구를 가지며, 난경은 0.95~1.08 mm로 위란강의 폭은 좁았고, 40시간만에 처음으로 부화하기 시작하였다. 부화직후 자어는 전장 2.35~2.68 mm로 입은 열리지 않았으나, 항문은 열려 있고, 23개의 근절을 가지며, 항문전장은 전장의 58.7~6 1.6%이고, 유구는 난황의 후단부에 위치하였다. 이 시기의 흑색소포는 나뭇가지 모양으로 주로 몸통부의 배쪽 측면을 따라 분포하며, 꼬리부의 앞끝 부위와 유구 표면에도 일부 나타났다. 부화후 3일째 자어는 전장 3.08~3.36 mm로 난황이 완전히 흡수되어 후기자어기로 이행하며, 처음으로 입이 열리고, 부레가 생겨나며, 막상의 가슴지느러미와 장이 현저히 발달하였다. 부화후 8일째 전장 5.09 mm의 개체는 척색 말단이 굽어지기 시작하며, 꼬리지느러미 줄기 7개, 제 2 등지느러미 및 뒷지느러미 원기가 분화하기 시작하고, 이 시기에 흑색소포는 나뭇가지 모양으로 주로 꼬리부의 전반부에 집중되며, 두정부, 주둥이, 아래턱의 배쪽 가장자리와 협부에도 일부 나타났다. 부화후 12일째 전장 8.48 mm의 개체는 모든 지느러미가 정수 (D. IV-9; P1. 16; P2. I, 5; A. II, 9)에 달하여 치어기로 이행하며, 이 시기에는 꼬리부의 측면 중앙 부위의 흑색소포가 이전보다 발달된 형태로 나타나며, 몸통부의 등쪽 측면과 뺨에도 흑색소포가 일부 출현하였다.