Pneumothorax following thoracic radiation therapy for Hodgkin's disease.

Radiation therapy alone to the nodal drainage sites above the diaphragm, namely a "mantle" field, is often standard treatment for early stage Hodgkin's disease and may be used in combination with chemotherapy in more advance disease. Localised pneumonitis and fibrosis are recognised treatment related sequelae; however, other pulmonary complications, including pneumothorax, have been described. Two cases of spontaneous pneumothorax following mantle radiation therapy are presented.     

Transthoracic approaches to the lesions of thoracic cord and thoracic vertebrae

Experiences of transthoracic approaches to the thoracic cord lesions were reported. Since 1983, we have performed six transthoracic approaches to the thoracic lesions; one thoracic OPLL, one dumbbell-shaped neurinoma, two thoracic soft disc, one epidural metastatic tumor to thoracic vertebrae. From the viewpoint of surgical anatomy, the thoracic vertebrae show a physiological kyphosis and the subarachnoid space of the ventral site is narrower than that of the dorsal site. Due to such anatomical characteristics, the thoracic laminectomy for decompression is not so effective as in the cervical or lumbar region and a relatively small mass lesion can bring a paraplegic state. The lesion of the ventral site of the thoracic cord has been regarded as no man's land because of poor results of posterior approaches. Instead of posterior approaches, anterior or anterolateral approaches with transthoracic route have been adopted. In the present paper, we used transthoracic anterolateral approaches for four patients and anterior sternum-splitting approach for two patients. The operative procedures of the approaches were described in detail. By these approaches, we could treat four patients with favourable results but the result of thoracic OPLL was poor. The cause of this poor result seemed to depend upon the intraoperative compression of the thoracic cord. For the troublesome complication, we described the postoperative cerebrospinal fluid leakage into thoracic cavity with respiratory disturbance. Several devices to prevent such troublesome complication were discussed.     

Anterior approach to the upper thoracic vertebrae

The anterior exposure of the upper thoracic spine using standard methods is often difficult and limited. We report our experience using a technique described by Sundaresan et al. (1984) in which the medial portion of one clavicle and part of the manubrium sterni are excised. In 10 cases we found this to be a useful and safe procedure.     

A transsternal approach to the upper thoracic vertebrae

An anterior surgical approach to the upper thoracic vertebrae has been described. A T-shaped skin incision is used, with the horizontal limb 1 cm above the clavicle, and the vertical limb extending in the midline over the body of the sternum. A portion of the manubrium sterni, as well as the medial third of the clavicle, is resected; the avacular tissue plane between the carotid sheath laterally and the trachea and esophagus medially is developed to reach the prevertebral space. After surgery, immediate fusion is performed using the clavicle and manubrium. This procedure is well tolerated, and was associated with minimal morbidity and no mortality in a series of seven patients.     

Difficulty in treating spinal chordoma of the thoracic vertebrae

We report a case of iterative surgery of a spinal chordoma of the 10(th) thoracic vertebra. This kind of neoplasm constitutes 3 to 7% of primary malignant bone tumors. Approximately 50% originate in the sacrum, 35% at the base of the skull and 15% in the true vertebrae. The slow growth delays diagnosis and compromises effective surgical therapy. On the basis of a review of the literature, we advocate an aggressive surgical resection from the beginning, similar to management of solitary vertebral metastasis.     

胸椎椎弓根螺钉治疗上胸椎严重骨折

目的：探讨胸椎椎弓根螺钉治疗上胸椎严重骨折的方法及疗效。方法：自2000年3月至2008年6月回顾性分析18例上胸椎严重骨折患者的临床资料,男10例,女8例;年龄20～76岁,平均34.3岁。按Denis分型：爆裂骨折15例,骨折伴脱位3例。损伤节段：T1-T22例,T32例,T3-T42例,T4-T58例,T5-T62例。Wolter外伤性椎管狭窄分型：Ⅰ型9例,Ⅱ型7例,Ⅲ型2例。Frankel分级：A级5例,B级4例,C级2例,D级4例,E级3例。均采用后路胸椎椎弓根螺钉固定治疗,手术前后通过影像观察Cobb角及椎管狭窄度,通过Frankel分级的变化评估神经症状,通过CT复查术后椎弓根螺钉与椎弓根的位置。结果：18例患者均获随访,时间1～6年,平均2.3年。Cobb角由术前的（26.50±5.62）°改善为术后的（21.20±3.54）°（P〈0.05）;椎管内占位改善率61%。术后Frankel分级：A级4例,B级2例,C级3例,D级3例,E级6例,手术前后Frankel分级有明显改善（P〈0.05）。CT复查示椎弓根螺钉88.5%（69/78）位于椎弓根内。结论：后路椎弓根螺钉固定方法是坚强、安全、有效的胸椎严重骨折的治疗方法。     

胸椎复发性附件滑膜肉瘤1例报告

滑膜肉瘤是恶性程度较高的软组织恶性肿瘤,源于关节、滑膜及腱鞘滑膜组织。发病部位以四肢的大关节为多,但发生于脊柱十分罕见。2006年1月收治1例T,附件滑膜肉瘤患者,报告如下。     

胸椎结核后凸畸形与病变治愈型截瘫

目的探讨胸椎结核病变治愈型截瘫与后凸畸形的关系及其预防和治疗方法.方法分析20例胸椎结核病变治愈型截瘫患者的临床资料和17例患者手术治疗的资料.结果20例病变治愈型截瘫患者的Cobb角在30°以上者占95%.17例经椎管侧前方减压治疗,术后截瘫恢复率达70.5%.结论胸椎结核病变治愈型截瘫与椎体骨质缺损塌陷所引起的后凸畸形角度大小有直接关系.手术减压是目前治疗病变治愈型截瘫的唯一方法.     

Hydatid disease affecting the vertebrae

Summary Six cases of hydatid disease affecting the vertebrae are described. Four patients presented with paraparesis and sphincter disturbances while the other two presented with low back pain and sciatica.Myelographic findings were positive in all six patients. The CT scans showed a paravertebral mass with destruction of bone in two cases. The nuclear magnetic resonance performed in one patient showed the exact extent of the disease all along the spine.Posterior laminectomy with decompression of the spinal cord and removal of the hydatid cysts was performed in all six patients. After the operation four patients received oral treatment with mebendazole.The patients with paraparesis showed little improvement of their neurological status. The two patients with low back pain and sciatica showed marked improvement.Hydatid disease affecting the vertebrae presents with neurological complications due to cord compression. The prognosis remains poor in spite of laminectomy, although removal of the hydatid cysts and long-term mebendazole medication may result in relief of symptoms.     

胸腰椎损伤的分类

随着现代工业、交通运输业、建筑业和体育事业的发展,意外事故发生率随之上升,胸腰椎损伤亦日趋增多,损伤的分类及救治逐渐引起重视。以往对脊柱损伤的分类众说不一。近20年来,诊断技术不断提高,ＣＴ、ＥＣＴ、ＭＲＩ广泛应用于临床,电子计算机技术渗透到生物力学的研究,建立了更加贴近实际的生物及损伤模型,使脊柱损伤的诊断更加直接、明了,也促使脊柱损伤的分类不断完善。由于脊柱损伤的复杂性(一种暴力可产生一种以上的损伤)、检查条件的多层次性及研究侧重点的多面性,至今尚无公认的统一分类方法,往往根据治疗与研究需要,选择不同依据分…     

Multifocal extensive spinal tuberculosis (Pott's disease) involving cervical, thoracic and lumbar vertebrae

An unusual case is reported of a 53-year-old woman presenting with spinal tuberculosis involving cervical, thoracic and lumbar vertebrae. The patient originally presented with progressive quadriparesis, fever, night sweats and weight loss. Imaging studies demonstrated vertebral body destruction with and without paraspinal and/or intraspinal abscess in cervical, thoracic and lumbar regions. The laboratory studies confirmed the diagnosis of Pott's disease and the patient was placed on anti-tuberculosis chemotherapy. The anterior approach was used for removal of the infected necrotic material, bone grafting and instrumentation, in both cervical and thoracic vertebrae. The postoperative course was uneventful and the patient made an excellent neurological recovery. The present report is of the first published case of an extensive spinal tuberculosis involving cervical, thoracic and lumbar spine.     

Hodgkin's disease of the stomach

We have presented a case of Hodgkin's disease of the stomach; this is a rare entity. Our patient presented an ulcer syndrome with episodes of abdominal pain, nausea, vomiting and a weight loss of 19 pounds during a four-year period. The history is similar to that of other cases reported. The physical examination was essentially negative except for left upper quadrant tenderness. No lymph nodes were palpable in the cervical, axillary or inguinal regions. The positive laboratory findings were an elevated sedimentation rate of 24 mm. per hour and persistent occult blood in the stools. Roentgenograms showed a constant filling defect with ulceration of the lesser curvature of the stomach. X-ray diagnosis of carcinoma of the stomach was confirmed by gastroscopy. The patient was treated by a subtotal gastric resection and gastrojejunostomy. All of the diseased tissue was removed. The final diagnosis was made by histologic examination. We believe the prognosis in this case to be good. Deep x-ray and nitrogen mustard therapy has been advised.