Cerebral Aneurysm and Aortic Coarctation in a 46, XY Female. Is it Causal or Coincidental?

Most vascular disorders tend to affect both the brain and heart, and among them, a clinical syndrome constituting cerebral aneurysm and aortic coarctation(AC) has been well recognized. Persistent hypertensive impact to the cerebral vasculature with developmental anomaly of the neural crest, precursor of ectomenchymal, would be closely associated with development of the cerebral aneurysm in AC. Gonadal steroid hormone, a guardian of the cardiovascular system, has been known for its protective effects on the vascular wall. Gonadal steroid hormone (androgen) insensitivity such as 46, XY female syndrome may increase the risk of hypertention and subsequent vascular anomalies. The authors report on a 46-year-old 46, XY female patient with AC who underwent surgical clipping of the ruptured cerebral aneurysm. Clinical implications and proposed pathogenetic mechanisms of aneurysm in this intersex syndrome are presented and discussed.

Radiologic Evaluation of Proper Pedicle Screw Placement after Pedicle Screw Fixation in Degenerative Lumbar Disc Disease

OBJECTIVE: With the increasing popularity of pedicle screw fixation devices for several indications, the safety and reliability of screw insertion in the small pedicle has become a major issue. Many studies have investigated the accuracy of screw placement after pedicle screw fixation using various method. The reported displacement rates have been very different. The purpose of the study is to investigate the proper placement of pedicle screw insertion in the lumbar spine on 26 consecutive patients. METHODS: Between September and December 2003, 26 consecutive patients (16women and 10men) were analyzed after transpedicular screw fixation of the lumbar and lumbosacral spine. After pedicle screw fixation in this study, 2-mm slices of CT scan were performed in all patients to detect caudal and cranial deviation of screw and medial and lateral deviation. Pedcile screw placement related complication was evaluted clinically. RESULTS: A total of 144 inserted pedicle were analyzed in 26patients, and 58pedicle screws (40.3%) were detected to be improper placement. There were 14level (9.0%) of caudal or cranial deviation and 44level (30.6%) of medial or lateral deviation to the pedicle. Extra-pedicle placement was found on 4levels (2.7%) with only 1case of neurologic injury. CONCLUSION: Proper screw placement, though complication rate is low, is important not only for clinical symptom but also for biomechanics. Further study for screw placement related biomechanical changes is needed.