Acute posterior fossa syndrome following lumbar drainage for treatment of suboccipital pseudomeningocele. Report of three cases

The authors report on a series of patients who underwent lumbar drainage of cerebrospinal fluid (CSF) for treatment of posterior fossa pseudomeningoceles and who subsequently developed an acute posterior fossa syndrome. These patients were found to have similar radiological findings demonstrating acute mass effect secondary to movement of CSF from the pseudomeningocele into the cerebellar parenchyma. Discontinuation of lumbar drainage resulted in symptomatic and radiological improvement in all patients. From these cases the authors infer that not all pseudomeningoceles communicate directly with the subarachnoid space. A readily recognizable appearance on magnetic resonance imaging that is useful in diagnosing this reversible complication of treatment for posterior fossa pseudomeningocele is also illustrated.     

Late vertebral body fracture after lumbar transpedicular fixation. Report of three cases

Late-onset vertebral body (VB) fracture after lumbar transpedicular fixation has not been previously described in the literature. The authors present three cases in which VB fracture occurred several months after posterolateral fixation in patients with degenerative disease or traumatic injury. The authors suggest that postoperative osteopenia, modified load-sharing function, and intravertebral clefts were responsible for the fractures. Two women and one man were evaluated at a mean follow-up interval of 3 months. Two patients suffered recurrent lumbar pain. Radiography and magnetic resonance imaging revealed fracture of some of the instrumentation-treated VBs. These two patients underwent surgical superior or inferior extension of instrumentation. The third, an asymptomatic patient, received conservative management. The two patients who underwent reoperation made complete recoveries, and there was no evidence of further bone collapse in any case. The authors speculate that alterations in the VBs may occur following application of spinal instrumentation. In rare cases, the device can fracture and consequently lead to recurrent lumbar back pain. Recovery can be achieved by extending the instrumentation in the appropriate direction.     

Mutism after posterior fossa surgery in children. Report of three cases

Three patients aged 5 1/2 to 9 years old with mutism after posterior fossa surgery are presented. The entity is discussed with a review of 15 additional previously reported cases in children aged 2 to 11 years. In all 18 patients, a large midline tumor of the posterior fossa (medulloblastoma in nine cases, astrocytoma in five, and ependymoma in four), often attached to one or both lateral recesses of the fourth ventricle, was removed. Mutism developed 18 to 72 hours after the operation (mean 41.5 hours) in patients with no disturbance of consciousness and no deficits of the lower cranial nerves or of the organs of phonation. All of these children had spoken in the first hours after surgery. The disorder lasted from 3 to 16 weeks (mean 7.9 weeks). Speech was regained after a period of dysarthria in six of the 10 cases for whom this information was available. The various hypotheses advanced to explain the pathogenesis of this speech disorder are analyzed.     

Ogilvie's syndrome after lower extremity arthroplasty.

OBJECTIVE: To alert surgeons who perform arthroplasty to the possibility of acute colonic pseudo-obstruction (Ogilvie's syndrome) after elective orthopedic procedures. To identify possible risk factors and emphasize the need for prompt recognition, careful monitoring and appropriate management so as to reduce morbidity and mortality. DESIGN: A case series. SETTING: A university-affiliated hospital that is a major referral centre for orthopedic surgery. PATIENTS: Four patients who had Ogilvie's syndrome after lower extremity arthroplasty. Of this group, 2 had primary hip arthroplasty, 1 had primary knee arthroplasty and 1 had revision hip arthroplasty. MAIN OUTCOME MEASURES: Morbidity and mortality. RESULTS: In all 4 patients Ogilvie's syndrome was recognized late and required surgical intervention. Two patients died as a result of postoperative complications. CONCLUSIONS: Our case series identified increasing age, immobility and patient-controlled narcotic analgesia as potential risk factors for Ogilvie's syndrome in the postoperative orthopedic patient. Prompt recognition and early consultation with frequent clinical and radiographic monitoring are necessary to avoid colonic perforation and its significant associated death rate.     

腰椎术后手术部位深部感染的诊断与治疗

目的 :探讨腰椎术后手术部位深部感染的诊断与治疗方法。方法 :回顾性分析2012年1月~2017年7月我院骨科收治的14例腰椎术后深部感染患者的临床资料、诊疗方法、随访结果。其中男性9例,女性5例,平均年龄53.0±13.1岁(19~73岁);早期感染(30d)13例,迟发感染(≥30d)1例;应用内固定物13例,未应用内固定物1例。患者出现感染征象后,立即留取标本送检并经验性静脉应用抗生素,随后根据细菌培养结果与病情变化调整抗生素种类,待主要炎症指标正常后改为口服抗生素。12例单纯抗生素治疗后病情未见改善者,予全麻下彻底清创;其中4例清创术后采用对口持续灌洗引流,另8例清创术后采用VSD负压引流,随访观察治疗效果。结果:本组共7例患者细菌培养结果阳性,其中单一细菌感染6例,混合感染1例。所有患者均应用抗生素治疗;静脉抗生素使用时间平均39.7±13.2d(24~77d),口服抗生素使用时间平均32.9±3.1d(28~38d)。13例内固定置入术后感染患者中11例内固定物得以保留,2例因多次清创无效后移除部分内固定物。14例患者均逐渐好转、最终治愈出院,平均住院时间51.4±13.1d。所有患者经平均32.4±18.6个月(4~67个月)随访,至末次随访时未见感染复发,且均主诉满意。结论:抗生素治疗、外科彻底清创是腰椎术后深部感染的有效治疗手段;对于有内固定物者,早期感染获得积极治疗后可保留内固定。     

退变性腰椎疾病的诊断和治疗

腰腿痛是困扰人类的常见病和多发病，引起腰腿痛的主要原因是退变性腰椎疾病（degenerative lumbar spinal dis-ease，DLSD）。笔者对DLSD的诊断及治疗进展作一综述。     

Omental transfer for the treatment of sternal infection after cardiac surgery: Report of three cases

Sternal infection is an uncommon but serious complication following cardiac surgery. We report herein three cases of postoperative sternal osteomyelitis successfully treated by omental transfer. Two patients had undergone valve surgery and the other underwent division of an accessory pathway for Wolff-Parkinson-White syndrome. Gram-positive organisms were identified in cultures of the exudate in all three patients, asStaphylococcus epidermidis in two and Methicillin-resistantStaphylococcus aureus in one, and concomitant me diastinitis was demonstrated by computed tomography in two cases. Each patient initially underwent sternal debridement and closed irrigation with 0.5% povidone-iodine solution, following which the cultured exudate from two of the patients was negative. The omentum was transferred in two of the patients because they had poor granulation tissue and in the third patient to fill a large dead space, and the postoperative course was uneventful in all three patients. Thus, we conclude that omental transfer is a useful technique for the treatment of postoperative sternal osteomyelitis.     

Postoperative CSF problems after spinal and lumbar surgery. General review.

Although the dura is frequently traumatized in surgery, and during lumbar punctures, it is surprising that the "CSF problem" is a rare complication in the surgical treatment for herniated intervertebral disc (0.1%); and exceptionally rare at cervical or dorsal level. In the upright position the CSF pressure at the site of the potential leak is greater in the lumbar region, lumbar operations are more frequently performed than cervical, and, perhaps, also because cervical operations are performed by fewer surgeons with greater specific experience. The purpose of this work is to describe the etiopathology, the symptomatology, the diagnosis and treatment of early and delayed CSF problems.     

Kallmann综合征的诊断与治疗(附11例报告)

目的:探讨Kallmann综合征的诊断及治疗方法.方法:回顾分析11例Kallmann综合征临床资料,全部病例伴嗅觉缺失或减退,同时给予促性腺激素和性激素联合替代治疗.结果:随访12～23个月,平均15个月,所有患者阴茎长度、睾丸体积、性激素水平均较治疗前明显改善,第二性征均有不同程度的发育和改善.结论:早期正确诊断是治疗Kallmann综合征的关键,及时给予激素替代治疗可以最大限度地促进睾丸发育,缓解患者的临床症状.     

退变性腰椎不稳症的诊断与治疗

目的:探讨退变性腰椎不稳症的诊断与治疗,比较手术治疗与非手术治疗的效果。方法:103例腰椎不稳症患者被分成两组进行为期10年的调查,其中手术组49例,采用后路棘突椎板间“H”型植骨融合术治疗;保守治疗组54例。所有患者均分别于治疗前、治疗后1年、10年,由专人随访并予问卷调查及评分。结果:治疗后1年,手术组、保守治疗组评分由1郾65、1郾74提高至2郾88、2郾06;治疗后10年,手术组及保守治疗组评分分别提高至3郾61、2郾59,与术前相比均有明显提高。两组间评分亦有显著差异,其中中、青年组评分手术组显著高于保守治疗组(P<0郾001),而老年组间则无显著差异(P>0郾05)。结论:退变性腰椎不稳症的诊断应主要依靠临床表现及X线测量。手术治疗应考虑患者的临床症状、年龄、职业及X线测量等多种因素。对中、青年患者,腰椎融合术可以减轻症状,缩短病程,早日恢复工作,是较好选择;而对老年患者,保守治疗效果并不低于手术治疗效果。     

Arteriovenous malformation in moyamoya syndrome. Report of three cases

Three patients are reported with the rare combination of moyamoya disease and features of an associated arteriovenous malformation. Two of the patients developed ischemic symptoms, and the third patient presented with an intracerebral hemorrhage. All three patients fit the criteria of a stage III moyamoya syndrome on the basis of the angiographic classification described by Suzuki and Takaku. The patients were referred to this medical center following angiography with the presumptive diagnosis of arteriovenous malformation.     

Diagnosis and treatment of pheochromocytoma. Report of 49 cases

From 1958 to 1990, 49 patients with pheochromocytoma were treated surgically. The tumors were located in the adrenal gland in 34 cases (69.4%) and in the extra-adrenal gland in 15 cases (30.6%). In two cases the tumors were pheochromoblastoma and in 6 cases the tumors were asymptomatic. Determination of urine VMA has a screening value for patients with pheochromocytoma. The corresponding rate was 91.3% by B-ultrasonography to localize the tumor. CT scanning can clearly identify pheochromocytoma of its size and relation to the adjacent organs, which may provide a basis for the selection of operative methods. Administration of alpha-adrenoceptor blocking drugs and expanding blood volume are very important procedures, which can effectively reduce the mortality rate.     

Malignant lymphoma of the spinal epidural space. Report of three cases

Three patients with non-Hodgkin's lymphoma involving the spinal epidural space are reported. All three patients, a 3-year-old boy (Case 1), a 63-year-old female (Case 2), and a 64-year-old male (Case 3), manifested signs and symptoms of neurological involvement before the diagnosis of malignant lymphoma was established by tissue examination. The tumors were located in the thoracic (Case 3) and thoracolumbar regions (Cases 1 and 2). The initial signs and symptoms of all cases were low back pain and progressing myelopathies. Bony abnormalities of the vertebrae, seen on both plain X-rays and computed tomographic scans, were unremarkable except for bilateral L1 pedicle erosion observed in Case 2. Total or subtotal tumor removal was followed by radiation therapy with or without chemotherapy in all cases. The primary lesion in Case 1 was a paravertebral lymphoma that had invaded the adjacent thoracolumbar epidural space through the intervertebral foramina. In Case 2, the primary lesion, documented by post-mortem examination, was a submucosal lymphoma of the stomach. In Case 3, the site of primary lesion could not be determined, although splenic and retroperitoneal nodal involvement was found at autopsy. The authors take a skeptical view of the existence of "primary" spinal epidural lymphoma, which has been reported a few times. Each of the three patients reported here presented with an epidural mass as the initial clinical manifestation of malignant lymphoma.     

Leptomeningeal spread of intramedullary spinal cord tumors. Report of three cases

Three patients with intramedullary spinal cord tumors and secondary leptomeningeal spread of their tumors are presented. Two patients had astrocytomas and one had a ganglioglioma. Two tumors were located in the cervical spinal cord and one within the thoracic spinal cord. Review of the past and recent literature shows leptomeningeal dissemination of spinal cord tumors to be relatively rare, but it should be suspected and investigated in any patient whose condition deteriorates following removal of a spinal cord neoplasm.