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1.
Background context
Intramedullary spinal arachnoid cysts are considered to be very rare, and only 11 cases have been reported previously. Development of such a cyst in association with marked cervical spondylosis has not been reported until recently.Purpose
Brief review of reported cases and debate on likely treatment strategy when such a cyst is associated with symptomatic spondylosis.Study design
To report the first example of a cervicothoracic intramedullary arachnoid cyst along with a symptomatic cervical spondylosis.Methods
Evaluation of quadriparesis in a 58-year-old female resulted in detection of a cervical spondylotic stenosis that was accompanied with an intramedullary cystic lesion. Parallel management of both pathologies was through a wide laminectomy extending from the lower edge of C3 to T2 with subsequent fenestration and partial resection of the cyst wall via an appropriate dorsal entry root zone myelotomy. Cervicothoracic instrumentation from C3 down to T2 was done to prevent postlaminectomy deformity.Result
Histopathological findings were consistent with the diagnosis of arachnoid cyst. Postoperatively, the patient exhibited marked improvement in neurologic status.Conclusion
Through the review of the current case, first example from the literature, we concluded that surgery should target toward the proper management of both pathologies in a single-stage operation. 相似文献2.
Background context
Surgical treatment of intracanal (both intramedullary and extramedullary) spine lesions requires posterior decompressive techniques in nearly all instances. Postoperative spinal deformities, most notably sagittal and coronal decompensation, are of significant concern for both the patient and the spinal surgeon.Purpose
To review and define principles and features of spinal deformities after posterior spinal decompression for intracanal spinal lesions, and to define patients who may benefit from the concomitant spinal fusion.Methods
A systematic review of MEDLINE was conducted, including articles published between 1980 and 2011. Articles related to spinal deformities after posterior decompression for the treatment of intracanal spine lesions were identified.Results
Ten articles met all inclusion and exclusion criteria. All were case series with limited evidence (Level IV). Many risk factors to deformity were implied but with limited evidence. Young age was the most commonly identified risk in these articles.Conclusions
Spinal deformity after posterior decompression is a common complication, most notably in children and young adults, after the removal of intramedullary tumors. Many risk factors have been implied to increase the postoperative development of spinal deformity, including young age, laminectomy extension, preoperative deformity, and extensive facet resection, among others. However, there is a lack of high-quality evidence to propose an algorithm for treatment or preventive measures. New studies with larger series of patients and standardized clinical outcomes are necessary to establish optimal treatment protocols. 相似文献3.
Clara Isabel Bayarri Lara Sebastián Sevilla López Abel Sánchez-Palencia Ramos Amira Alkourdi Martínez Francisco Hernández Escobar Florencio Quero Valenzuela Francisco Javier Ruiz Zafra Antonio Cueto Ladrón de Guevara 《Cirugía espa?ola》2013
Introduction
Descending necrotizing mediastinitis (DNM) is a serious infection which occurs as a complication of oropharyngeal infection. Its surgical management and the routine transthoracic approach remain controversial. In this article we report our experience in the management of this disease, and review the different surgical approaches that have been reported in the medical literature.Material and methods
A retrospective review was made of the clinical records of 29 patients treated between 1988 and 2009. Several demographic variables were analyzed, origin of the initial infection, stage of the disease according to Endo's classification, surgical technique and outcome.Results
Surgical treatment consisted of both cervical and mediastinal drainage and radical debridement. The mediastinal drainage was made through a transcervical approach in 10 cases and transthoracic in 19, depending on the extent of the mediastinitis. The outcome was satisfactory in 24 patients and 5 died (mortality 17.2%).Conclusions
According to our results and the conclusions of the main authors, we recommend a prompt and aggressive surgery with a transthoracic approach in cases of widespread DNM. 相似文献4.
Hiroyuki Aono Shigeki KakunagaShuji Koide MD Hidekazu TobimatsuMasayuki Kuroda MD Ikuo KudawaraKiyoshi Mori MD PhD Eiichi KonishiTakafumi Ueda MD PhD 《The spine journal》2013,13(10):e27-e30
Background context
Localized amyloid deposits result in a mass, that is, so-called amyloidoma; it has been reported in every anatomic site, although systemic amyloid deposition is much more common. However, primary lumbar epidural amyloidoma without bony involvement is extremely rare. To the best of our knowledge, only one case has been reported previously.Purpose
To report and review the clinical presentations, imaging studies, and treatment of epidural and paravertebral amyloidoma.Study design
A case report and review of the literature.Methods
Lumbar epidural and paravertebral amyloidoma in a 75-year-old man with neurologic compromise is presented. Laminectomy with mass resection was performed.Results
After surgery, almost complete neurologic improvement was observed. Histologically, definite diagnosis was obtained only after the specific staining of tissue. No sign of local recurrence was evident 1 year after surgery.Conclusions
Primary amyloidoma, although rare, should be included in the differential diagnosis of epidural mass of the spine. Diagnosis before surgery is difficult as there were no characteristic findings in clinical and imaging studies. Special histologic technique and stains are useful to make a definite diagnosis. 相似文献5.
Junkoh Yamamoto Mayu Takahashi Yoshiteru Nakano Takeshi Saito Takehiro Kitagawa Kunihiro Ueta Ryo Miyaoka Eiichiro Nakamura Shigeru Nishizawa 《The spine journal》2013,13(10):e31-e38
Background context
Germ cell tumors are known to arise in the central nervous system, usually in the intracranial regions. However, primary spinal mixed germ cell tumors are extremely rare.Purpose
This is the first reported case of intratumoral hemorrhage because of a primary spinal mixed germ cell tumor consisting of germinoma and immature teratoma in the conus medullaris of an adult patient that presented with rapid changes on magnetic resonance image (MRI). We report this rare case and discuss the clinical manifestations of an intramedullary spinal mixed germ cell tumor in adult.Study design
A case report.Methods
A 42-year-old woman experienced buttock numbness, and a spinal cord tumor was observed on the conus medullaris on MRI. The patient was scheduled for an operation in 1 month, but she developed sudden-onset neurologic deterioration. Rapid progression of the tumor was observed on follow-up MRI. The tumor was removed by emergency surgery and was identified as a primary mixed germinoma and immature teratoma.Results
The patient received adjuvant chemotherapy and radiotherapy after gross total resection. The neurologic deficit of the patient was relieved, and recurrence of the tumor was not observed 26 months after the surgery.Conclusions
We present this rare case and emphasize the necessity of precise diagnosis and early treatment of primary spinal germ cell tumor. Close observation on MRI is required after surgery, and adjuvant chemotherapy and radiotherapy should be considered according to the pathologic features. 相似文献6.
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8.
Background context
Primary solitary amyloidosis or amyloidoma is a disease process characterized by the focal deposition of amyloid in the absence of a plasma cell dyscrasia with normal serum protein measurements. Solitary amyloidomas affecting the vertebrae are very uncommon but typically affect the thoracic spine. Primary cervical amyloidosis is an exceedingly rare entity with exceptionally good prognosis, but requires diligence of the treating physician to establish the diagnosis and implement the appropriate surgical intervention.Purpose
This study aimed to present a rare case of primary cervical amyloidosis with long-term follow-up and review the clinical presentation, characteristic imaging findings, diagnostic pathology, differential diagnosis, treatment algorithm, and prognosis of the disease entity. This case demonstrates the progressive resorption of the amyloidoma over time after surgical stabilization. Previous reported cases of primary cervical amyloidosis will also be reviewed.Study design
This study is a report and review of the literature.Methods
A 77-year-old woman presented with a several-week history of gradual progressive weakness in her upper and lower extremities. Computed tomography and magnetic resonance imaging demonstrated a retro-odontoid nonenhancing soft-tissue mass, with erosive bony changes and severe mass effect on the upper cervical cord. The patient was taken to the operating room for decompression and posterior spinal stabilization.Results
Intraoperative tissue specimens demonstrated amyloidosis and extensive systemic workup did not reveal any inflammatory processes, systemic amyloidosis, or plasma cell dyscrasia. Postoperatively, the patient regained full strength and ambulatory status. The patient remains asymptomatic at a 2-year follow-up. A postoperative follow-up magnetic resonance imaging demonstrated complete resorption of the residual amyloidoma.Conclusions
Primary solitary amyloidosis is a rare form of amyloidosis that is important to differentiate given its excellent prognosis with surgical management. Treatment should include surgical decompression and spinal stabilization. This is the first case report to clinically and radiographically demonstrate the progressive resorption of a primary amyloidoma over time after surgical stabilization in the upper cervical spine. It is imperative that surgeons encountering such lesions maintain a high suspicion for this rare disease entity and advise their pathologists accordingly to establish the correct diagnosis. 相似文献9.
Nirvana Sadaghianloo Elixène Jean-Baptiste Jean Breaud Serge Declemy Jean-Yves Kurzenne Réda Hassen-Khodja 《Injury》2014
Background
Blunt abdominal aortic trauma (BAAT) is a very rare occurrence in children, with significant morbidity and mortality. Varied clinical presentations and sparse literature evidence make it difficult to define the proper management policy for paediatric patients.Method
We report our centre's data on three consecutive children with BAAT managed between 2006 and 2010. A Medline search was also performed for relevant publications since 1966, together with a review of references in retrieved publications.Results
Forty children (range 1–16 years) were included in our final analysis. Motor vehicle crashes (MVC) were the leading cause of injury (65%). The in-hospital mortality rate was 7.5% (3/40). Nine patients (22.5%) ended up with residual sequelae. Main primary aortic lesions were complete wall rupture (12.5%), intimal transection (70%) and pseudoaneurysm (15%). Twenty-eight children underwent aortic surgical repair (70%). Among the 12 non-operatively managed patients, 41.6% had complications, including one death.Conclusion
Symptomatic lesions and complete ruptures should undergo immediate surgical repair. Circumferential intimal transections are at high risk of complication and should also receive intervention. Partial intimal transections and delayed pseudoaneurysms can be initially observed by clinical examination and imaging. Patients with these latter pathologies should be operated on at any sign of deterioration. 相似文献10.
Kristen E. Radcliff Charles A. Reitman Lawrence A. Delasotta Joseph Hong Timothy DiIorio James Zaslavsky Alexander R. Vaccaro John A. Hipp 《The spine journal》2010,10(10):e1-e5
Background context
Kyphoplasty is performed for the treatment of osteoporotic compression fractures. A theoretical advantage of this technique is the reduced risk of embolization of cement.Study design/setting
Case report of an incidental finding of cement pulmonary embolization after kyphoplasty of an osteoporotic vertebral compression fracture.Methods/results
Here we report a patient who presented with an incidental finding of pulmonary embolization after kyphoplasty and review the relevant literature.Conclusions
Patients who present with symptoms of respiratory distress after kyphoplasty should undergo workup for pulmonary embolism. Clinicians may consider routine postoperative chest radiographs after kyphoplasty to screen for embolic disease. Further research is necessary to identify the risk factors and possible long-term sequelae of cement embolization. 相似文献11.
Background context
Pseudomeningoceles are noted within the neural foramen after avulsion plexus injuries. We present the case of a cervicothoracic epidural pseudomeningocele with spinal cord compression 18 years after a brachial plexus injury.Purpose
To present a case report of a patient and literature review on cases with epidural pseudomeningoceles.Study design
Case report and review of the literature.Methods
Retrospective review of the medical records of a patient presenting with an epidural pseudomeningocele after a plexus injury.Results
A 37-year-old male presented with neurological decline 18 years after sustaining a brachial plexus injury. Magnetic resonance tomography revealed an epidural fluid collection from C5 to T7 with significant spinal cord compression. Surgical intervention initially involved fenestration of the cyst and then rhizotomies of the C7 and C8 roots resulting in resolution of his new symptoms.Conclusions
Pseudomeningoceles are common after brachial plexus avulsion injury and are usually stable, causing no symptoms, other than plexus neuropathies. We are unaware of previous reports of a patient with a traumatic brachial plexus avulsion who developed a large cervicothoracic, symptomatic, spinal, epidural, intracanalicular pseudomeningocele with cord compression 18 years after the initial injury. Patients with prior trauma and known plexus injuries with development of new neurological symptoms should be evaluated for the rare case of intradural pseudomeningoceles. Preoperative imaging with computed tomography myelography is important to isolate and definitively treat the fistulous connection. 相似文献12.
Nathan Lawrentschuk Renzo Colombo Oliver W. Hakenberg Seth P. Lerner Wiking Månsson Arthur Sagalowsky Manfred P. Wirth 《European urology》2010
Context
This review focuses on the prevention and management of complications following radical cystectomy (RC) for bladder cancer (BCa).Objective
We review the current literature and perform an analysis of the frequency, treatment, and prevention of complications related to RC for BCa.Evidence acquisition
A Medline search was conducted to identify original articles, reviews, and editorials addressing the relationship between RC and short- and long-term complications. Series examined were published within the past decade. Large series reported on multiple occasions (Lee [1], Meyer [2], and Chang and Cookson [3]) with the same cohorts are recorded only once. Quality of life (QoL) and sexual function were excluded.Evidence synthesis
The literature regarding prophylaxis, prevention, and treatment of complications of RC in general is retrospective, not standardised. In general, it is of poor quality when it comes to evidence and is thus difficult to synthesise.Conclusions
Progress has been made in reducing mortality and preventing complications of RC. Postoperative morbidity remains high, partly because of the complexity of the procedures. The issues of surgical volume and standardised prospective reporting of RC morbidity to create evidence-based guidelines are essential for further reducing morbidity and improving patients’ QoL. 相似文献13.
Luis Martínez-Piñeiro Nenad Djakovic Eugen Plas Yoram Mor Richard A. Santucci Efraim Serafetinidis Levent N. Turkeri Markus Hohenfellner 《European urology》2010
Context
These guidelines were prepared on behalf of the European Association of Urology (EAU) to assist urologists in the management of traumatic urethral injuries.Objective
To determine the optimal evaluation and management of urethral injuries by review of the world's literature on the subject.Evidence acquisition
A working group of experts on Urological Trauma was convened to review and summarize the literature concerning the diagnosis and treatment of genitourinary trauma, including urethral trauma. The Urological Trauma guidelines have been based on a review of the literature identified using on-line searches of MEDLINE and other source documents published before 2009. A critical assessment of the findings was made, not involving a formal appraisal of the data. There were few high-powered, randomized, controlled trials in this area and considerable available data was provided by retrospective studies. The Working Group recognizes this limitation.Evidence synthesis
The full text of these guidelines is available through the EAU Central Office and the EAU website (www.uroweb.org). This article comprises the abridged version of a section of the Urological Trauma guidelines.Conclusions
Updated and critically reviewed Guidelines on Urethral Trauma are presented. The aim of these guidelines is to provide support to the practicing urologist since urethral injuries carry substantial morbidity. The diversity of urethral injuries, associated injuries, the timing and availability of treatment options as well as their relative rarity contribute to the controversies in the management of urethral trauma. 相似文献14.
Naohisa Miyakoshi Michio HongoYuji Kasukawa MD PhD Yoichi Shimada MD PhD 《The spine journal》2010,10(11):e14-e18
Background context
Spinal extradural arachnoid cysts are rare expanding lesions in the spinal canal. Total removal of the cyst and repair of the dural defect is the primary treatment for symptomatic spinal extradural arachnoid cysts.Purpose
To report the usefulness of recapping T-saw laminoplasty in treating huge extradural arachnoid cyst.Study design
Case report.Methods
We report the case of a 43-year-old man who presented with a 2-year history of progressive muscle weakness and numbness of the lower extremities. Magnetic resonance imaging (MRI) showed a huge extradural arachnoid cyst at the T12–L3 level extending into bilateral neural foramina and severe posterior compression of the spinal cord and cauda equina.Results
The patient underwent total resection of the cyst and closure of the communication. En bloc recapping T-saw laminoplasty of T12–L2 including the T12–L1 and L1–L2 facet joints was performed to obtain extensive exposure and preserve posterior stability. Postoperatively, the patient achieved complete recovery of neurologic functions. Follow-up MRI demonstrated no recurrence of the cyst. Bone union after laminoplasty was obtained within 6 months.Conclusion
Total resection of the cyst and closure of the communication is curative for this rare lesion. Recapping T-saw laminoplasty provides extensive exposure for removal of a large cyst while allowing complete preservation of the posterior spinal elements. 相似文献15.
Introduction
A previous meta-analysis has found an association between red blood cell (RBC) transfusions and mortality in critically ill patients, but no review has focused on the trauma population only.Objectives
To determine the association between RBC transfusion and mortality in the trauma population, with secondary outcomes of multiorgan failure (MOF) and acute respiratory distress syndrome (ARDS) or acute lung injury (ALI).Data sources
EMBASE (1947–2012) and MEDLINE (1946–2012).Study eligibility criteria
Randomized controlled trials and observational studies were to be included if they assessed the association between RBC transfusion and either the primary (mortality) or secondary outcomes (MOF, ARDS/ALI).Participants
Trauma patients.Exposure
Red blood cell transfusion.Methods
A literature search was completed and reviewed in duplicate to identify eligible studies. Studies were included in the pooled analyses if an attempt was made to determine the association between RBC and the outcomes, after adjusting for important confounders. A random effects model was used for and heterogeneity was quantified using the I2 statistic. Study quality was assessed using the Newcastle-Ottawa Scale.Results
40 observational studies were included in the qualitative review. Including studies which adjusted for important confounders found the odds of mortality increased with each additional unit of RBC transfused (9 Studies, OR 1.07, 95%CI 1.04–1.10, I2 82.9%). The odds of MOF (3 studies, OR 1.08, 95%CI 1.02–1.14, I2 95.9%) and ARDS/ALI (2 studies, OR 1.06, 95%CI 1.03–1.10, I2 0%) also increased with each additional RBC unit transfused.Conclusions
We have found an association between RBC transfusion and the primary and secondary outcomes, based on observational studies only. This represents the extent of the published literature. Further interventional studies are needed to clarify how limiting transfusion can affect mortality and other outcomes. 相似文献16.
Introduction
Immediate total hip replacement (THR) in patients with acetabular fractures is controversial because of concerns about high complication rates. The current article is a systematic review of the literature on the use of acute THR for the treatment of acetabular fractures.Materials and methods
This systematic review included studies published in English between 1992 and 2012 of subjects with acetabular fracture undergoing immediate THR. Outcomes of interest included indications; clinical assessment, including walking ability; comparison with control group; associated procedures, and rate of complications, such as loosening or revision surgery.Results
This review identified six studies, of which only one included a control group. Acute THR was associated with satisfying outcomes with regard to clinical assessment and walking ability. The comparative study assessed the difference between acute THR and delayed THR in acetabular fractures: improved outcomes were observed in the delayed THR group, although the differences between the two groups were not statistically significant.Discussion
According to data reported in the literature, acute primary THR can be successful in patients with poor bone quality, combined acetabular and femoral neck fractures, or pathological fractures and concurrent osteoarthritis of the hip. Relative indications include old age, delayed presentation, substantial medical comorbidities, and pathologic obesity. Clinical outcomes with acute THR were similar to those with delayed THR. Although the results reported in the six studies reviewed here were satisfying overall, there is limited evidence in this area in the existing literature and future prospective investigations are required.Conclusion
Data reported in the literature indicate that immediate THR can be successful in appropriately selected elderly patients or patients with extensive osteoporosis, combined acetabular and femoral neck fractures or pathological fractures. There is currently a limited evidence base for THR in patients with acetabular fractures; therefore, physicians’ practice and expertise are the most useful tools in clinical practice. 相似文献17.
Kristen E. Radcliff Christopher K. Kepler Andre Jakoi Gursukhman S. Sidhu Jeffrey Rihn Alexander R. Vaccaro Todd J. Albert Alan S. Hilibrand 《The spine journal》2013,13(10):1339-1349
Background context
Adjacent segment disease (ASD) is symptomatic deterioration of spinal levels adjacent to the site of a previous fusion. A critical issue related to ASD is whether deterioration of spinal segments adjacent to a fusion is due to the spinal intervention or due to the natural history of spinal degenerative disease.Purpose
The purpose of this review is to summarize the recent clinical literature on adjacent segment disease in light of the natural history, patient-modifiable risk factors, surgical risk factors, sagittal balance, and new technology.Study design
This review will evaluate the recent literature on genetic and hereditary components of spinal degenerative disease and potential links to the development of ASD.Methods
After a meticulous search of Medline for relevant articles pertaining to our review, we summarized the recent literature on the rate of ASD and the effect of various interventions, including motion preservation, sagittal imbalance, arthroplasty, and minimally invasive surgery.Results
The reported rate of ASD after decompression and stabilization procedures is approximately 2% to 3% per year. The factors that are consistently associated with adjacent segment disease include laminectomy adjacent to a fusion and a sagittal imbalance.Conclusions
Spinal surgical interventions have been associated with ASD. However, whether such interventions may lead to an acceleration of the natural history of the disease remains questionable. 相似文献18.
Enrico Fiori Antonietta LamazzaErcole DeMasi M.D. Alessandro DeCesareAlberto Schillaci M.D. Antonio V. Sterpetti 《American journal of surgery》2013
Background
The authors report the final results of a prospective single-center randomized study whose aim was to compare the endoscopic placement of self-expandable stents with open surgical gastroenterostomy to relieve gastric outlet obstruction (GOO) in patients with advanced antropyloric adenocarcinoma. A systematic review of the medical literature from December 1999 to December 2011 was carried out to determine the results of endoscopic stenting in patients with GOO from unresectable primary cancer of the antropyloric region.Methods
In the prospective study, 18 patients with advanced adenocarcinoma of the antropyloric region and symptoms of GOO were enrolled. In 9 patients, self-expandable stents were placed, and in 9 patients, open surgical gastroenterostomy was performed. Patients were followed until death. Six hundred seventy-two patients with primary unresectable cancer of the antropyloric region and GOO syndrome who underwent endoscopic stenting were identified from the literature.Results
In the prospective study of 18 patients, there was no case of postprocedural mortality. Efficient gastric emptying resumed more quickly in patients who received stents, although 3 months after the procedures, there was no difference between the 2 groups. Mean crude survival was 258 days in patients who received stents and 283 days in those who underwent surgical gastroenterostomy (P = NS). In patients who underwent stent placement, there were 2 cases of stent migration and 2 cases of food impaction, which were resolved with endoscopy at a mean follow-up of 70 days. In the 672 patients from the literature, operative mortality and morbidity were very low. In prospective studies, complications related to stents were more common than previously thought.Conclusions
Endoscopic placement of metallic stents offers an effective therapy in patients with advanced primary adenocarcinoma of the antropyloric region and poor general condition. In patients with longer life expectancies, the form of therapy should be chosen individually, considering that surgical gastroenterostomy has fewer complications in the medium term and that in patients with endoscopic stenting, very careful follow-up is required, with the possibility of new operative endoscopy in half of the patients. 相似文献19.
Shehab Jabir Quentin Frew Naguib El-Muttardi Peter Dziewulski 《Burns : journal of the International Society for Burn Injuries》2014
Introduction
Free tissue transfer is a rarely indicated procedure in burns. However, in well selected cases it may play a pivotal role in optimizing outcomes in both primary and secondary burn reconstruction. We undertook a systematic review, based on the PRISMA statement for systematic reviews, of all published literature relating to the use of free flaps in acute burns and in secondary reconstructive procedures.Methods
Inclusion and exclusion criteria were defined and Medline, Embase, PubMed and Google Scholar databases were searched from 1980 onwards to May 2013 with the search terms: “free flaps”, “free tissue transfer”, “microvascular”, “burns”, “acute burns”, “primary reconstruction” and “secondary reconstruction”.Results
A total of 346 studies were retrieved following the search of which 30 studies met the inclusion criteria and were included in the review.Discussion
We present the indications, timing, complications and failure rates for free flaps in primary and secondary reconstruction based on the available literature. We also provide a list of the various free flap options for the commonest sites undergoing reconstruction following burns. Finally an algorithm to ensure optimal success of free flaps when used in primary and in secondary burn reconstruction is presented. 相似文献20.
Michael Froehner Maurizio A. Brausi Harry W. Herr Giovanni Muto Urs E. Studer 《European urology》2009,56(3):443-454