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ABSTRACT: Malignant peripheral nerve sheath tumor (MPNST) of the cauda equina is rare, with only four reported patients in the literature. We present a 70-year-old woman with a history of left sciatic nerve MPNST that had been treated by left hemipelvectomy 4 years prior. She then presented with disabling right leg weakness that progressed over 7months. Spine imaging revealed an intradural extramedullary lesion from L5 to S1 with compression of the cauda equina. She underwent an L3-S1 laminectomy with subtotal resection of the lesion, which was diagnosed as a metastatic MPNST. At the 3-month postoperative visit, her lower extremity strength had returned to baseline. The only notable postoperative complication was a superficial wound infection that resolved with antibiotic treatment and wet-to-dry dressing changes. Thus, although uncommon, the spinal canal and cauda equina should be considered as possible locations for metastatic MPNST in the appropriate clinical scenario. To our knowledge, this is the first report of a patient with a metastatic MPNST to the cauda equina.
Journal of Clinical Neuroscience 03/2011; 18(6):844-6. · 1.25 Impact Factor
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Plastic and reconstructive surgery 08/2009; 124(1):307-8. · 2.74 Impact Factor
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Plastic and reconstructive surgery 06/2008; 121(6):435e-440e. · 2.74 Impact Factor
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ABSTRACT: The word Doppler is used synonymously in hand surgery for evaluating patency of vascular structures; however, the science and history behind the Doppler effect are not as well-known. We will present the theories behind the Doppler effect and the history of the person who made this discovery.
The Journal Of Hand Surgery 01/2008; 32(10):1595-9. · 1.35 Impact Factor
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ABSTRACT: Malingering is a condition in which patients exaggerate incapacity. Feigned hand weakness is one form of malingering, and it is often seen after work-related hand injuries. Malingering is prevalent in the workers' compensation system, which devotes a large proportion of valuable resources to unwarranted claims. Feigned hand weakness must be detected early because it is relatively prevalent and expensive to society. Clinical evaluation is the first step in detecting feigned hand weakness, but it is not very specific. Therefore, every suspected positive clinical result must be followed up with a more advanced test that has better specificity. Three advanced tests are (1) five-rung grip test, (2) rapid grip tests (rapid exchange grip and rapid simultaneous grip), and (3) computerized measure of grip. Among these, computerized measure of grip is the most specific; therefore, it is the best second-line test.
The Journal Of Hand Surgery 01/2008; 32(10):1638-43. · 1.35 Impact Factor
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ABSTRACT: Hand signs (called mudras in Sanskrit) play an important role in Buddhist art. They represent specific events from the life of Sidharta Gautama, the founder of Buddhism. These events symbolize moral principles important to the discipline. There are six important hand signs: (1) dhyana mudra, (2) varada mudra, (3) abhaya mudra, (4) vitarka mudra, (5) dharmachakra mudra, and (6) bhumispara mudra. The use of these hand signs was popularized by Buddhist universities in India around the 4th or 5th century ad. This paper will examine the symbolism behind the six main hand signs and reveal their message, which will be valuable for modern society.
The Journal Of Hand Surgery 32(6):918-22. · 1.35 Impact Factor
