Intervertebral disc calcification in a child

Disc calcification in children is a rare condition of which only approximately 200 cases have been reported worldwide and one from India and we report one such case. A five year–old boy presented with neck pain, torticollis and limitations of cervical motions following a fall while playing 3 months back. He had low grade fever cervical lymphadenopthy, paraspinal muscle spasm. His blood counts and ESR was raised. Fine needle aspiration cytology of lymph node revealed reactive lymphadenitis. His cervical radiograph slowed calcification of C 6-7. MRI scan showed hypointense signals in C6-C7 and D5-D6 disc on both T1 and T2 W images. Cerebrospinal fluid examination was normal. He improved on analgesics, bed rest and cervical traction.     

Intervertebral disc infection after lumbar chemonucleolysis: report of a case

Intervertebral disc space infection can be a serious and disabling complication of any procedure that affords entry for bacteria into the susceptible disc space. Most disc space infections occur after cervical or lumbar laminectomies. Discitis has been reported after myelography, lumbar puncture, paravertebral injection, and obstetrical epidural anesthesia. A case of septic discitis occurring after intradiscal therapy with chymopapain is presented. Patients who return for evaluation of recurrent spinal pain after chemonucleolysis, especially those with paravertebral muscle spasm, should be evaluated for the possibility of disc space infection by obtaining an erythrocyte sedimentation rate, peripheral white count, differential cell count, and plain roentgenograms. Radionuclide bone scans, although not specific, may provide further objective evidence leading to the diagnosis of an intervertebral disc space infection.     

手术治疗腰椎间盘突出症术后椎间隙感染

腰椎间盘突出症术后椎间隙感染是一种较严重的手术并发症,目前对该病的病因及治疗均有争议。本院至1988年12月至1997年12月共收治腰椎间盘髓核摘除术后椎间隙感染患者8例,采用后路手术治疗,清除病灶加大量冲洗,取得满意效果。1　临床资料1.1　一般资料　本组病例男5例,女3例。年龄2 6～5 6岁,平均39岁。6例继发于单侧开窗髓核摘除术,2例继发于半椎板切除髓核摘除术。病变间隙:L4 ,56例,L5/S12例。其中2例由外院术后发病转入我院。发病时间3～10d ,平均7d。1.2　临床表现　腰椎间盘髓核摘除术后患者原有神经根压迫症状均有不同程度的缓解甚…     

Tolosa-Hunt syndrome. Report of a surgical case

A 58-year-old male presented with painful right ophthalmoplegia and was diagnosed as having Tolosa-Hunt syndrome. High-dose oral administration of a corticosteroid provided significant pain relief, but total ophthalmoplegia persisted. Computed tomography (CT) showed a tumor-like mass in the bilateral cavernous sinus. Angiography revealed occlusion of the right internal carotid artery. According to the literature, about 70% of cases of Tolosa-Hunt syndrome are caused by parasellar neoplasms. A transcranial biopsy of the patient's lesion revealed a nonspecific granulomatous process in the wall of the right cavernous sinus. He was again placed on high-dose corticosteroid therapy and within 1 week the right visual acuity improved slightly. The corticosteroid dose was gradually tapered over 3 months. After 2 months of therapy, the external ocular movement had almost fully recovered, although the light reflex was absent and the CT findings did not change.     

Liver rupture in HELLP syndrome. Report of a case

Liver rupture and hemorrhage, are the most unusual and serious complications of HELLP syndrome (hemolysis--elevated liver enzymes--low platelet count). The management should be aggressive by treating coagulopathy and favouring a prompt delivery. Liver rupture remains a surgical emergency with control of bleeding based on trauma surgery. The aggressive approach to the management of these patients led to a remarkable decrease of mortality rates.     

Cholecystolithiasis causing Mirizzi's syndrome with a rare anomaly of the extrahepatic bile duct in a child. Report of a case

A 14 year-old girl, who was admitted to our hospital due to increasing jaundice, intermittent right upper quadrant pain and fever, underwent operation based on the diagnosis of the Mirizzi's syndrome. Calculi filled the cystic duct and compressed the right hepatic duct. The right and left hepatic ducts lay closer to the duodenum than usual. The operation was limited to cholecystectomy alone. The calculi showed laminar cut surfaces and were composed of bilirubin lime. In addition to reporting our case, the literature dealing with this particular entity is reviewed.     

Mediastinal lymphangiomyoma in a child: Report of a case

Lymphangiomas and lymphangiomyomas are benign abnormal collections of lymphatic vessels which form a cystic mass. The mediastinum is an uncommon location for these hamartomas in children, but may be life-threatening. We report herein the case of a 23-month-old boy who presented with stridor and a history of recurrent respiratory tract infections. Soon after his admission he suddenly developed respiratory failure and was found to have a multiloculated cystic mediastinal mass which was initially thought to be a lymphangioma. The mass was extensively infiltrative, and histological examination showed prominent smooth muscle proliferation in the walls of the cysts, confirming a diagnosis of lymphangiomyoma. The terminology and relevant literature on the topic are reviewed following the presentation of this case.     

Traumatic subclavian steal syndrome. Report of a case

Traumatic obstruction of the subclavian artery without major hemorrhage is rare. Only eleven cases have been disclosed retrograde flows from the ipsilateral vertebral artery into the distal segment of subclavian artery in the world. One case of the traumatic subclavian occlusion is presented in this paper. A 63-year-old man was struck on his chest by heavy machinery. On admission he was alert and had no neurological deficits. His blood pressure was 140/80 mmHg in his right arm but was not palpable in his left radial artery. Aortogram showed incomplete obstruction of the left subclavian artery 2 cm beyond its origin. On the second admission day it was occluded and the distal flow was supplied from the left vertebral artery in a retrograde fashion. Without operative vascular reconstruction he has never experienced ischemic symptoms for a year.     

Intervertebral disc changes in adolescents with isthmic spondylolisthesis.

The lower lumbar discs in adolescent patients with isthmic L5 spondylolisthesis requiring operative treatment were evaluated by means of plain radiography, discography, and magnetic resonance imaging (MRI). There were 14 girls and 13 boys, mean age on admission 14.4 (range, 11-18) years. The mean slip in girls was 45 +/- 23% and in boys 27 +/- 17% (p less than 0.05). Discography was performed in 23 patients (42 discs) and MRI in 16. In 12 patients, both examinations were made. In plain radiographs, normal presacral disc height was seen in 11 patients with mean 14.5% slip, narrowing of the disc height less than 50% in four patients with mean 24% slip, and greater than 50% in 12 patients with mean 52.6% slip. In discograms and MRIs, the presacral disc was pathologic in all patients. Pathologic changes of the fourth lumbar disc were frequent. Concerning disc degeneration, there was poor correlation between findings in plain radiography compared with those seen in MRI or discography. MRI findings correlated with those of discography in most cases. However, MRI was normal in two discs with a pathologic discogram.