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1.
Introduction
Grisel's syndrome consists in rotational subluxation of C1–C2 following ENT infection or surgery. There is no consensus on management. We present 2 cases requiring surgical treatment in our center.Case reports
Two 10-year-old patients presented torticollis with cervical pain resistant to medical treatment, with onset a few months after tonsillectomy. In both cases, radiological assessment, comprising CT scan and MRI, showed Fielding–Hawkins type-3 C1–C2 rotational subluxation, without ligament lesion. After failure of conservative treatment, posterior reaming, realignment, C1–C2 arthrodesis using lateral masses and pars interarticularis screws and bone graft achieved good fusion and immediate spinal stability in all planes of the atlantoaxial complex.Discussion
Grisel's syndrome consists in non-traumatic subluxation of the atlantoaxial joint with intact atlantoaxial ligaments. Initial pharyngeal inflammation spreads to the prevertebral fascia via direct connections between the periodontoidal venous plexus and pharyngovertebral veins, inducing fasciitis that leads to abnormal relaxation of the atlantoaxial ligaments and reactional muscle contraction with ankylosis. This phenomenon, appearing gradually and insidiously over a period of a few weeks, creates a frozen joint with ankylosis. Medical treatment with NSAIDs, muscle relaxants, and immobilization is usually sufficient; cervical traction may be needed. Surgical treatment by C1–C2 arthrodesis is indicated in case of failure of medical management or onset of neurologic signs.Conclusion
Close collaboration between pediatricians, ENT surgeons and neurosurgeons is essential for early diagnosis and management, which is the main prognostic factor for successful medical treatment, avoiding surgery. 相似文献2.
Introduction and objectives
Thrombotic thrombocytopenic purpura and atypical haemolytic uremic syndrome (aHUS) are acute, rare, life-threatening thrombotic microangiopathies that require swift management. We report a case of acute microangiopathic haemolytic anaemia (MAHA) presenting in perioperative setting.Clinical case
After hepatic pericystectomy for hydatid cyst, a 46-year-old female developed MAHA, thrombocytopenia and acute renal failure in the immediate postoperative period. “aHUS” was considered and immediate plasma exchange was initiated. Plasma exchange was performed for 2 weeks with remission of renal dysfunction. Further evaluation of genetic mutations and immunological causes for MAHA were sought. Mutations in complement factor H associated with factor H deficiency were identified, which are associated with increased risk of aHUS.Conclusion
MAHA is a rare postoperative condition, requiring rapid differential diagnosis and treatment. Anaesthetists should bear in mind aHUS as a possible cause of MAHA, especially concerning immediate care for these patients. 相似文献3.
Rita Faria Marta O. Soares Eldon Spackman Hashim U. Ahmed Louise C. Brown Richard Kaplan Mark Emberton Mark J. Sculpher 《European urology》2018,73(1):23-30
Background
The current recommendation of using transrectal ultrasound-guided biopsy (TRUSB) to diagnose prostate cancer misses clinically significant (CS) cancers. More sensitive biopsies (eg, template prostate mapping biopsy [TPMB]) are too resource intensive for routine use, and there is little evidence on multiparametric magnetic resonance imaging (MPMRI).Objective
To identify the most effective and cost-effective way of using these tests to detect CS prostate cancer.Design, setting, and participants
Cost-effectiveness modelling of health outcomes and costs of men referred to secondary care with a suspicion of prostate cancer prior to any biopsy in the UK National Health Service using information from the diagnostic Prostate MR Imaging Study (PROMIS).Intervention
Combinations of MPMRI, TRUSB, and TPMB, using different definitions and diagnostic cut-offs for CS cancer.Outcome measurements and statistical analysis
Strategies that detect the most CS cancers given testing costs, and incremental cost-effectiveness ratios (ICERs) in quality-adjusted life years (QALYs) given long-term costs.Results and limitations
The use of MPMRI first and then up to two MRI-targeted TRUSBs detects more CS cancers per pound spent than a strategy using TRUSB first (sensitivity = 0.95 [95% confidence interval {CI} 0.92–0.98] vs 0.91 [95% CI 0.86–0.94]) and is cost effective (ICER = £7,076 [€8350/QALY gained]). The limitations stem from the evidence base in the accuracy of MRI-targeted biopsy and the long-term outcomes of men with CS prostate cancer.Conclusions
An MPMRI-first strategy is effective and cost effective for the diagnosis of CS prostate cancer. These findings are sensitive to the test costs, sensitivity of MRI-targeted TRUSB, and long-term outcomes of men with cancer, which warrant more empirical research. This analysis can inform the development of clinical guidelines.Patient summary
We found that, under certain assumptions, the use of multiparametric magnetic resonance imaging first and then up to two transrectal ultrasound-guided biopsy is better than the current clinical standard and is good value for money. 相似文献4.
Introduction
Epidermoid cyst is a benign tumour frequently observed throughout the body. It can grow in size and may get infected over a period of time.Observation
We are reporting a case of precoccygeal epidermoid cyst in a six year old female child which was managed successfully.Conclusion
Precoccygeal epidermoid cyst in female children has not been reported in the English literature so far. Hence, we are reporting this case. 相似文献5.
Mustafa Barut?uo?lu Mehmet Sel?uki Ahmet Sukru Umur Mesut Mete Seren Gulsen Gurgen Deniz Selcuki 《Indian Journal of Orthopaedics》2016,50(1):80-86
Background:
Tethered cord syndrome (TCS) is a progressive clinical entity that arises from abnormal spinal cord tension. Scoliosis may be a unique symptom in TCS. The aim of this study is to investigate prognosis after releasing the filum terminale in scoliosis due to TCS with/without findings in magnetic resonance imaging (MRI) and to draw attention to the importance of somatosensorial evoked potentials (SSEP) on the differential diagnosis of idiopathic scoliosis versus scoliosis due to TCS with normal appearance of filum terminale and conus medullaris.Materials and Methods:
Eleven female and seven male patients with progressive scoliosis were included in the study. They were evaluated radiologically, SSEP and urodynamical studies. Preoperative and postoperative anteroposterior full spine X-rays were obtained for measuring the Cobb''s angle. MRI was performed in all cases for probable additional spinal abnormalities. All patients underwent filum terminale sectioning through a L5 hemilaminectomy. The resected filum terminale were subjected to histopathological examination.Results:
The mean Cobb angle was 31.6° (range 18°–45°). Eight patients (44.45%) had a normal appearance of filum terminale and normal level conus medullaris in MRI, but conduction delay and/or block was seen on SSEP. In the histopathological examination of filum terminale dense collagen fibers, hyaline degeneration and loss of elastic fibers were observed. Postoperatively none of the patients showed worsening of the Cobb angle. Three patients showed improvement of scoliosis.Conclusion:
In TCS presented with scoliosis, untethering must be performed prior to the corrective spinal surgery. Absence of MRI findings does not definitely exclude TCS. SSEP is an important additional guidance in the diagnosis of TCS. After untethering, a followup period of 6 months is essential to show it untethering helps in stopping the progress of the scoliotic curve. In spite of non progression (curve stopped lesser than 45°) or even improvement of scoliosis, there may be no need for major orthopedic surgical intervention. 相似文献6.
F. Boyer G. Audibert C. Baumann S. Colnat-Coulbois C. Pinelli F. Claudot A. Baumann 《Neuro-Chirurgie》2018,64(6):401-409
Background/Introduction
In France, the law defines and prohibits “unreasonable obstinacy” and provides a framework for the subsequent decision to limit or to cease treatment. It also gives the person the right to appoint a trusted person and to draft advance directives regarding this issue. There have been few studies of neurosurgeons’ involvement in decision-making in regard to treatment limitation after severe traumatic brain injury.Aim of the study
The first aim of the study was to assess French neurosurgeons’ adherence to the law on patients’ rights and end of life which governs such decision-making. The second aim was to assess the prognostic and decision-making criteria applied by neurosurgeons.Methods
A declarative practice and opinion survey, using a self-administered questionnaire emailed to all practising neurosurgeons members of the French Society of Neurosurgery, was conducted from April to June 2016.Results
Of the 197 neurosurgeons contacted, 62 filled in the questionnaire. Discussions regarding treatment limitation were in all cases collegial, as required under the law, and the patient's neurosurgeon was always involved. The trusted person and/or family were always informed and consulted, but their opinions were not consistently taken into account. Advance directives were most often lacking (68%) [56; 80] or inappropriate (27%) [16; 38]. The most frequently used prognostic criteria were clinical parameters, intracranial pressure, cerebral perfusion pressure, and imaging, with significant interindividual variation in their use. The main decision-making criteria were foreseeable disability, expected future quality of life, and age.Conclusions
Neurosurgeons showed good compliance with legal requirements, except in the matter of calling for the opinion of an external consultant. Furthermore, this survey confirmed variability in the use of prognosis predictors, and the need for further clinical research so as to achieve more-standardized practices to minimise the subjectivity in decision-making. 相似文献7.
INTRODUCTION
Currarino syndrome (CS) is characterized by the triad of anorectal malformations, sacral bone defects, and presacral mass in which an autosomal dominant inheritance has been described. The surgical community has a little no knowledge of CS in adults, apart from, perhaps, a small number of paediatric surgeons. Therefore, we sought to describe this unusual cause of anal fistula.PRESENTATION OF CASE
A 55-year-old man was referred with an anal fistula. The patient was scheduled for drainage of multiple collections and an anal fistulectomy. Cytological results were confirmed that the cyst was dermoid (and non abscess). One month after surgery, the patient informs us of his CS. MRI was performed and it revealed an anterior sacral mass. It was to decide to realize an exeresis of this mass by coelioscopy. The patient experienced severely constipated and urinary retention. After therapy by Peristeen anal irrigation and self Intermittent catheterization (six times daily), there was a good improvement in symptoms.DISCUSSION
This is an extremely rare case of CS revealed in an adult. MRI is a sensitive non-invasive diagnostic tool, and could be performed on any patient with long-standing anal fistula.CONCLUSION
We recommend an early and multidisciplinary approach of CS is suspected in a patient. The surgeon must always be alert to the possibility of pelvic nerves injury during an exeresis of a retrorectal tumour fistulized. 相似文献8.
9.
Hagen Schmal Markus Walther Anja Hirschmüller Nina Bunert Norbert P. Südkamp Alexander T. Mehlhorn 《Foot and Ankle Surgery》2018,24(4):309-313
Background
Gastrocnemius recession (GR) has been introduced for treatment of forefoot overload syndrome (FOS). We questioned if GR leads to an altered forefoot load and weakness of plantarflexors in those patients.Methods
26 patients suffering from FOS and gastrocnemius tightness underwent GR. A strength power analysis of plantar flexors and a pedobarography was performed. Clinical outcome was measured by Foot Function Index (FFI).Results
Plantarflexors are impaired about 40% six weeks and around 10% 24 weeks following GR compared to the contralateral side. Patients experienced a pain relief and an improvement of ankle dorsiflexion from 2° to 15°. An increased contact time of the heel (15%) and a shift of metatarsal plantar pressure from lateral to medial could be demonstrated.Conclusions
This study suggests that GR leads to pain reduction by an increase in heel contact time and a shift of gait line to medial in patients with a FOS. Despite, a temporary impairment of muscle strength has to be considered. 相似文献10.
L. Mateu L. Peri A. Franco F. Roldán M. Musquera M.J. Ribal 《Actas urologicas espa?olas》2018,42(5):338-343
Objective
To assess the functional effects of prostatic cryosurgery on micturition.Material and methods
Prospective study of men who underwent cryosurgery (CS) for prostate cancer between 2013 - 2015. Low urinary tract symptoms (LUTS) and quality of life (QoL) were assessed 1 month before surgery using IPSS questionnaire, a three-day voiding diary (3 DVD) and uroflowmetry with ultrasound-measured postvoid residual volume. Need of medical treatment for LUTS was also recorded. The same assessment was performed at 3, 6 and 12 months after CS. Outcomes after surgery were compared to those prior to surgery.Results
Forty-five patients underwent a CS during the study period, of whom 25 patients could be recruited in the study. Mean age was 73.5 years (range 66-84). Nineteen CS (76%) were performed as a primary procedure, while 6 CS (24%) as a salvage procedure. No statistical differences were found comparing results of IPSS, QoL, D3vd or uroflowmetry and PVR at 3, 6 or 12 months after CS compared to before surgery. Before CS, 8 (32%) patients were on medical treatment for LUTS, while at 6 and 12 months after surgery, 3 (13.6%) and 2 (9.5%) patients required some medication, respectively.Conclusion
According to the punctuation of IPSS, QoL questionnaire, and a 3-day voiding diary, LUTS does not worsen after CS. Prostatic cryosurgery does not seem to impact uroflowmetry results. 相似文献11.
J. Seroussi C. Hautefort A. Gillibert R. Kania J.-P. Guichard H. Vitaux P. Herman E. Houdart A. Attyé M. Eliezer 《Diagnostic and interventional imaging》2018,99(11):679-687
Purpose
To report the postoperative magnetic resonance imaging (MRI) features after superior semicircular canal plugging in patients with Minor syndrome.Materials and methods
The MRI examinations with 3D T2-weighted SPACE sequence of 12 patients with superior semicircular canal dehiscence syndrome (SCDS) were retrospectively assessed. Two radiologists independently evaluated the presence of a filling defect of the superior semicircular canal above the superior ampulla and the common crus using an oblique plane parallel to the superior semicircular canal (Pöschl's plane).Results
Postoperative MRI showed a filling defect above the ampulla of the superior semicircular canal and the common crus in 8/12 patients (67%). Three patients (3/12; 25%) had a filling defect involving also the superior ampulla that caused postoperative labyrinthitis with labyrinthine enhancement on MRI in 2 patients. One patient (1/12; 8%) had incomplete plugging of superior semicircular canal with abnormal functional tests and remaining symptoms.Conclusion
Postoperative MRI shows a normal plugging aspect of the superior semicircular canal in 67% of patients. MRI can reveal complications that may have therapeutic implications. 相似文献12.
Birzat Emre Gölboyu Mürsel Ekinci Pınar Karaca Baysal Ayşe Nur Yeksan Erkan Cem Çelik Zeynep Bilgi Murat Aksun 《Brazilian Journal of Anesthesiology》2018,68(5):518-520
Background
Thoracic paravertebral block can provide analgesia for unilateral chest surgery and is associated with a low complication rate. Horner syndrome also referred to as oculosympathetic paresis, is a classic neurologic constellation of ipsilateral blepharoptosis, pupillary miosis, and facial anhidrosis resulting from disruption of the sympathetic pathway supplying the head, eye, and neck.Case report
We present a patient with an ipsilateral transient Horner syndrome after ultrasound guided single shot of 15 mL 0.25% levobupivacaine for thoracic paravertebral block at T5–6 level.Conclusions
It should be kept in mind that even a successful ultrasound guided single shot thoracic paravertebral block can be complicated with Horner syndrome due to unpredictable distribution of the local anesthetic. 相似文献13.
Catia Sousa Govêia Tiago Tolentino Mendes da Cruz Denismar Borges de Miranda Gabriel Magalhães Nunes Guimarães Luís Cláudio Araújo Ladeira Fernanda D’Ávila Sampaio Tolentino Marco Aurélio Soares Amorim Edno Magalhães 《Brazilian Journal of Anesthesiology》2018,68(5):442-446
Background and objective
There is a shortage of studies addressing the association between burnout syndrome and anxiety among anesthesiologists. Identifying the relationship between these two conditions is of fundamental importance for the prevention, follow‐up, and treatment of the professionals. Thus, we evaluated the association between burnout syndrome and anxiety in anesthesiologists and residents of anesthesiology in the Federal District.Method
A cross‐sectional study using a convenience sample of residents and anesthesiologists from the Federal District. The correlation between State Trait Anxiety Inventory and Burnout Syndrome (Maslach Burnout Inventory) was tested using multiple linear regression analysis, considering a significance level of 5%.Results
Of the 78 completed forms, there were predominance of males (57.69%), mean age of 42 ± 9.7 years for anesthesiologists and 30 ± 2.9 years for residents. Burnout syndrome had a prevalence of 2.43% among anesthesiologists and 2.70% among resident physicians, while a high risk for its manifestation was 21.95% in anesthesiologists and 29.72% in resident physicians. There was a correlation between state‐anxiety and the variables burnout emotional exhaustion, burnout depersonalization, and trait‐anxiety. Regarding trait‐anxiety, there was no statistically significant correlation with other variables.Conclusions
There is association between state‐anxiety and the emotional exhaustion dimensions of burnout, burnout depersonalization, and trait‐anxiety. The occurrence of anxiety can negatively influence the way the individual faces daily stressors, which may be related to the use of ineffective strategies to cope with stress. 相似文献14.
L. Al-Mehaisen Z. Amarin O. Bani Hani F. Ziad O. Al-Kuran 《The African Journal of Urology》2017,23(2):154-159
Objective
To review treatment modalities of Mayer–Rokitansky–Küster–Hauser syndrome, and to present further evidence on the successful use of ileum segment as an additional procedure for the creation of a neovagina.Methods
Five women presented with primary amenorrhea, normal secondary female sexual characteristics, normal external anatomy, shortening of the vagina, with only vaginal dimples. Abdominal ultrasound scans suggested the absence of uterus. Both ovaries were present with normal kidneys. Karyotyping confirmed XX genotype. Pelvi-abdominal MRI confirmed the diagnoses. All patients were started on nonsurgical treatment, in the form of graduated dilators, as a first-line approach. This was not acceptable to the patients. Decisions were made to resort to ileum vaginoplasty.Results
The mean surgical time was 5 h. Three patients sustained intra-operative bladder injury. All patients reported watery vaginal discharge. Four patients were followed up for 5 years, and were satisfied with their results. This was confirmed by clinical examination. The fifth patient failed to attend for immediate postoperative care. The vagina was 6–7 cm long with introital stricture.Conclusion
Women with Mayer–Rokitansky–Küster–Hauser syndrome who need vaginal reconstruction have the surgical option of a vascularized free ileum graft that provides a durable, lubricated neovagina without the scarring of skin grafts. 相似文献15.
Introduction
Moya-Moya angiopathy is a neurovascular disease that predisposes to ischemic or hemorrhagic strokes. It is generated by a steno-occlusion of the terminal portion of the internal carotid arteries, which induces the development of abnormal neovessels in the deep regions of the brain. Some pathologies such as sickle cell disease, Down syndrome or Graves’ disease may be associated with Moya-Moya angiopathy. These syndromic forms harbor several differences compared with idiopathic Moya-Moya disease.Case report
We report the case of a young patient who presented with a syndromic form of Moya-Moya angiopathy after cranial radiation therapy for an optic glioma associated with type 1 neurofibromatosis treated by combined revascularization. We discuss the particularities of syndromic forms, in their presentation and management based on a review of the literature.Conclusion
Many diseases can be associated with Moya-Moya syndrome. Symptomatic patients should undergo surgery, but the risk of postoperative complications appears to be greater than that encountered in patients with non-syndromic Moya-Moya angiopathy. 相似文献16.
P. Moscatiello D. Carracedo Calvo L. Yupanqui Guerra M.E. Rivera Martínez A. Mendiola de la Hoza M. Sánchez Encinas 《Actas urologicas espa?olas》2018,42(5):344-349
Introduction
Pudendal nerve entrapment syndrome (PNE) is characterised by the presence of neuropathic pain in the pudendal nerve (PN) territory, associated or not with urinary, defecatory and sexual disorders. Surgical PN decompression is an effective and safe alternative for cases when conservative treatment fails. The aim of this study is to describe the first robot-assisted pudendal neurolysis procedure performed in our country.Material and methods
We describe step by step the technique of robot-assisted laparoscopic neurolysis of the left PN performed with intraoperative neurophysiological monitoring on a 60-year-old patient diagnosed with left PNE.Results
The procedure was performed satisfactorily without complications. After 24 h, the patient was discharged from the hospital. We observed a 50% reduction in pain measured using the visual analogue scale 2 weeks after the procedure, which remained after 10 weeks of the neurolysis.Conclusions
Robot-assisted neurolysis of the PN constitutes a feasible and safe approach, enabling better visualisation and accuracy in the dissection of the PN. Intraoperative neurophysiological monitoring is useful for locating the PN and for detecting intraoperative changes after the release of the nerve. 相似文献17.
Introduction
Emphysematous pyelonephritis is a life threatening infection of the kidney and peri-renal tissues. We present an interesting and rare presentation of this condition which is the first such case to be reported in literature.Observation
A 52-year-old diabetic presented with a right groin swelling. On evaluation and imaging he had right emphysematous pyelonephritis with a peri-renal collection tracking down till the scrotum, mimicking a groin swelling. Management involved broad spectrum antibiotics and aggressive drainage and debridement.Conclusion
Emphysematous pyelonephritis is a rare but important differential diagnosis for a groin swelling where early diagnosis and aggressive management is necessary. 相似文献18.
A case of anterior sacral meningocele associated with tethered cord syndrome is reported. A 5-year-old boy was admitted for urinary and fecal incontinence which had persisted since his birth. Abdominal MRI and sacral CT showed a presacral cystic mass communicating with the spinal dural sac through a neck traversing a sacral bony defect and tethered spinal conus. Neurological examination showed that the patient had a neurogenic bladder, atrophy of the legs and anesthesia below the S3 level. Operative finding revealed a thickened filum terminale attached to the wall of the presacral meningocele. Agenesis of the nerve root below the S2 level was identified, and no neural elements entered into the sac. Untethering was performed. Postoperative course was uneventful and the patient is doing well with his neurogenic bladder gradually improving. 相似文献
19.
A 25-year-old male presented with an anterior sacral meningocele (ASM) manifesting as repeated urinary tract infections. Surgical correction was completed by simple ligation of the thecal sac next to the ostium via sacral laminectomy, and the thickened filum terminale was sectioned. A 22-year-old female presented with an ASM manifesting as transient difficulty in micturition. Subsequent to sacral laminectomy, the thickened filum terminale was sectioned. However, an aberrant nerve root over the ostium made simple ligation hazardous, so that transdural suture around the ostium was carried out. Complete obliteration was confirmed 5 months after the surgery. Magnetic resonance (MR) imaging could clearly demonstrate the involvement of neurologically important structures. Surgical strategy for ASM based on neurosurgical considerations is proposed, because of the frequent association of caudal spinal cord anomaly as well as presacral mass lesion. Intraoperative assistance systems such as endoscopy for cyst content examination and neurophysiological monitorings are recommended. Several months follow up with MR imaging is required to confirm successful surgical correction. 相似文献