Use of vaginal misoprostol before endometrial biopsy in premenopausal women: an observational study

Background: It is well-known since long time the beneficial effects of misoprostol particularly as a cervical softening agent in obstetric practice. Keep in view, study aimed to evaluate the efficacy of vaginal misoprostol 400 mcg before endometrial biopsy in premenopausal women.Methods: All the 200 patients were classified into two groups viz. study group (Group I) with 100 patients and control group (Group II) with 100 patients. To Group I patients, 400 mcg of misoprostol was given vaginally, 4 hours prior to the commencement of endometrial biopsy whereas no medication was received by Group II patients.Results: In the present study, the base line cervical dilatation is found to be 5.8±1.3 mm in Group I patients whereas 3.8±0.92 mm in Group II patients which is significantly higher (p<0.05). Only 32 patients in Group I required further dilatation whereas 88 patients in Group II underwent further dilatation. The mean time required for further dilatation in Group I and Group II patients was 42.6±17.4, 64.6±16.8 sec respectively and was significantly higher in Group II patients (p<0.05). Out of 100 patients in Group I, only 2% of patients complained severe pain whereas in Group II 48% of patients experienced intolerable pain and required anesthesia.Conclusions: Vaginal administration of 400 mcg misoprostol 4 hours prior to endometrial biopsy in premenopausal women had a significant effect on cervical resistance and cervical dilatation.

Anterior fixation of odontoid fractures: results / Fixação anterior de fraturas do processo odontoide: resultados

ABSTRACT Objective: To evaluate the clinical and radiological outcomes of the surgical treatment in patients diagnosed with odontoid fracture who underwent open reduction and internal fixation (ORIF) with screws. Methods: This was a retrospective study with nine patients. Pain (visual analog scale [VAS]) and neurological status (Frankel scale) were assessed. The neck disability index (NDI) and the post-operative cervical range of motion were calculated. The cervical spine was radiologically evaluated (X-ray and CT) pre- and postoperatively. Results: The mean age of patients was 70 years. All patients presented type IIb (Grauer classification) fractures, with a mean deviation of 2.95 mm. Two patients had subaxial lesions. The mean follow-up was 30 months. The mean time from trauma to surgery was seven days. The pre-operative Frankel score was E in all except one patient (B), in whom a post-operative improvement from B to D was observed. Post-operative pain was 2/10 (VAS). A total of 77% of patients presented a mild or moderate disability (NDI). Six patients regained full range of cervical movement, and bone union required approximately 14 weeks. Pseudarthrosis complications were observed in two patients (77% union rate), one patient presented screw repositioning and one case, dysphonia. Conclusion: Delayed diagnosis is still an issue in the treatment of odontoid fractures, especially in elderly patients. Concomitant lesions, especially in younger patients, are not uncommon. The literature presents high fusion rates with ORIF (≥80%), which was also observed in the present study. However, surgical success depends on proper patient selection and strict knowledge of the technique. This pathology presents a reserved functional prognosis in the medium-term, especially in the elderly.

RESUMO Objetivo: Avaliar os resultados clínicos e radiológicos do tratamento cirúrgico em pacientes com diagnóstico de fratura do processo odontoide submetidos a redução aberta e fixação interna (RAFI) com parafusos. Métodos: Estudo retrospectivo com nove pacientes. Avaliada a dor (escala visual analógica [EVA]) e o estado neurológico (escala de Frankel). O Neck Disability Index (NDI) e a amplitude de movimento cervical pós-operatória foram calculados. A coluna cervical foi avaliada radiologicamente (raios X e TC) nos períodos pré- e pós-operatório. Resultados: A idade média dos pacientes foi de 70 anos. Todos apresentaram fraturas do tipo IIb (classificação de Grauer), com desvio médio de 2,95 mm. Dois apresentaram lesões subaxiais. O seguimento médio foi de 30 meses. O tempo médio entre trauma e cirurgia foi de sete dias. O escore pré-operatório de Frankel foi E em todos, exceto em um paciente (B), no qual se observou uma melhoria pós-operatória de B para D. A dor pós-operatória foi 2/10 (EVA). Apresentaram incapacidade leve ou moderada (NDI) 77% pacientes. Seis pacientes recuperaram toda a amplitude de movimento cervical; a consolidação óssea levou aproximadamente 14 semanas. Foram observadas complicações de pseudartrose em dois pacientes (taxa de consolidação: 77%), um paciente necessitou reposicionamento do parafuso e um paciente, disfonia. Conclusão: O diagnóstico tardio ainda é um problema no tratamento de fraturas do odontoide, especialmente em pacientes idosos. As lesões concomitantes, especialmente em pacientes mais jovens, não são incomuns. A literatura apresenta altas taxas de consolidação com RAFI (≥ 80%), o que também foi observado no presente estudo. No entanto, o sucesso cirúrgico depende da seleção adequada do paciente e do conhecimento rigoroso da técnica. Essa patologia apresenta um prognóstico funcional reservado em médio prazo, especialmente em idosos.

Posterior Internal Fixation with Pedicle Screw Rod System for Upper Cervical Vertebra Injury: 16 Cases Report / 中国康复理论与实践

@#Objective To observe the feasibility of posterior internal fixation with pedicle screw rod system for upper cervical vertebra injury. Methods 16 patients with upper cervical vertebra injury accepted posterior pedicle screw system internal fixation were reviewed. Results Venous plexus behind C2 damaged in operation in a case, who needed a microscope for hemostasis. No complication, such as neurological symptoms worse, cerebrospinal fluid leakage, hematoma and infection of incision happened post operation. The neurological symptoms improved 81.8% in all the 7 cases who complained before operation. No complication was found in the follow-up 3 to 18 months after discharge. Their activities of upper cervical was basically unaffected. Conclusion Posterior internal fixation with pedicle screw rod system can provide stable support for patients with upper cervical injury.

Posterior Internal Fixation with Pedicle Screw Rod System for Upper Cervical Vertebra Injury：16 Cases Report / 中国康复理论与实践

Objective To observe the feasibility of posterior internal fixation with pedicle screw rod system for upper cervical vertebra injury. Methods 16 patients with upper cervical vertebra injury accepted posterior pedicle screw system internal fixation were reviewed. Re-sults Venous plexus behind C2 damaged in operation in a case, who needed a microscope for hemostasis. No complication, such as neurologi-cal symptoms worse, cerebrospinal fluid leakage, hematoma and infection of incision happened post operation. The neurological symptoms improved 81.8%in all the 7 cases who complained before operation. No complication was found in the follow-up 3 to 18 months after dis-charge. Their activities of upper cervical was basically unaffected. Conclusion Posterior internal fixation with pedicle screw rod system can provide stable support for patients with upper cervical injury.

Occupational injury at Gangsaw machine A rare occurrence.

Since last few decades, occupational injuries have been a major cause of morbidity and mortality among people working in factories, especially those working with unprotected rotating machines. Women are specifically prone to such injuries because of their long unprotected hairs being trapped in moving parts of the machines. Long hairs can get entangled in moving machinery resulting in complete or partial avulsion of scalp. A large scalp avulsion injury may lead to severe bleeding and may cause trauma to forehead, eyebrows and per auricular tissue, which may further bring fatal results aesthetically and functionally. Severe deformities as a result of this trauma may lead to severe psychological trauma, disabling the patient to lead a normal social life. Here, we are presenting a case report of a patient who had an occupational injury causing scalp avulsion with cervical spine injury at gang saw machine.

Three Cases of Delayed Onset Post-traumatic Segmental Spinal Myoclonus

Segmental myoclonus can be seen in variable lesions of the brainstem or spinal cord, but the pathophysiology of the segmental myoclonus is not fully defined yet. We describe three patients with delayed developed and chronically persisted involuntary movement restricted to one arm after mild cervical injury. Myoclonus developed 1 month later in 2 patients and the other 5 months later after the injury. They suffered from myoclonus for more than 2 months, 1 year, and 25 years, respectively. Clonazepam and phenytoin were tried, but not satisfactory.

Three Cases of Delayed Onset Post-traumatic Segmental Spinal Myoclonus

Segmental myoclonus can be seen in variable lesions of the brainstem or spinal cord, but the pathophysiology of the segmental myoclonus is not fully defined yet. We describe three patients with delayed developed and chronically persisted involuntary movement restricted to one arm after mild cervical injury. Myoclonus developed 1 month later in 2 patients and the other 5 months later after the injury. They suffered from myoclonus for more than 2 months, 1 year, and 25 years, respectively. Clonazepam and phenytoin were tried, but not satisfactory.

Treatment of inferior cervical injuries by anterior cervical approach

Six patients were operated on with Robinson Technique-Lesions are the following: disruption of cervical spine: 4 disruption associated with fracture of the vertebral body:2 Association with disc herniation: 2. Results: complete or nearly complete neurological recovery: 3. No improvement: 3. - Mortality: 0. Advantages of the technique. 1. Compression fragments, disc at the anterior part of the spinal cord demonstrated by CT scanner or MRI, can be removed. 2. Immobilisation by plates and screws at the vertebral bodies is stable, enabling early rehabilitation. 3. Good reduction and stabilisation.

Clinical Analysis of Upper Cervical Spine Injuriesur

This review of upper cervical spine injuries includes 51 patients admitted to Korea University Hospital, Seoul during the period 1 Jan. 1990 to 31 Dec. 1994. The incidence of upper cervical injury was 13.6% in the 375 spine injury cases and 31.7% in the 161 cervical spine injuries. The most common type of injury was odontoid fracture, ie. 16 cases or 31.3%. The male-to-female ratio was 2.6:1 and the 4th decade showed peak incidence. 33 cases(64.7%) of the injuries were caused by traffic accidents. The chief complaints on admission were neck pain with limited range of motion in 39 cases(76.5%), motor weakness in 3 cases(5.9%), and sensory disturbance in 2 cases(3.9%). Operative treatment was performed in 23 patients resulted in neurologic improvement in 22 Cases(95.7%) and 28 patients were managed by conservative treatment with 25 cases(89.3%) of neurologic improvement. Mortality rate of the upper cervical spine injury was 3.9%. The above represents our experience with 51 patients suffering from upper cervical injuries. Management and follow-up guidelines are also reviewed.

A Clinical Analysis of Treatment of Traumatic Cervical Fracture and Dislocation

The authors analyzed 52 patients with traumatic cervical fracture and dislocation admitted to the department of neurosurgery, Gyeongsang National University Hospital between July, 1989 and December, 1993. The most common age group was 21-30 years old, and 46 were male. The most frequent cause of injury was motor vehicle accident. High cervical injuries were 11 cases and mid-low cervical injuries were 41 cases. 34 cases had surgical intervention by anterior approach with bone graft only(5), anterior approach with bone graft and instrumentation(9), posterior approach with wiring and bone graft(18) and total laminectomy(2). The others had conservative treatment and immobilized by traction(9), Halo-vest(8) or neck collar(1). The average post of immobilization of conservatively treated patients was 9.7weeks, anterior approach without instrumentation was 9 weeks and posterior approach was 5.4 weeks, but patients who treated by anterior approach with instrumentation keep soft collar only. At final follow-up, no significant differences were noted between surgically and conservatively treated group but initial neurologic state correlates with prognosis, independent of modality of treatment. Thus the surgical intervention does not significantly influence the prognosis of the patient but shortens the duration of postoperative immobilization.

A Clinical Analysis of Traumatic Cervical Spine Injuries

Of eighty-two patients who were hospitalized for acute cervical injuries, seventy five lived, seven died within 5 months of injury, and one was lost to follow-up. These patients were grouped by injury mechanism, level of vertebral injury, level and type of cord injury, and management. Degree of injuries and prognosis were classified by modified Frankel's classification. The ratio of male to female was 3.3 to 1. The causes of traumas were traffic accidents, falling down, sports, diving, slip down. Traffic accident was the most common cause of trauma, and passenger injury was the most frequent cause among that. The most common level of dislocation was C5-6 followed by C4-5 level. The C5 vertebra was most commonly fractured. Injury mechanisms divided into 4 groups(compressive or disruptive flexion, compressive or disruptive extenstion. Disruptive extension was less common than other three groups. Vertebral fractures were more common in flexion mechanism than in the extension mechanism. Cord injuries were more common in the compressive injury groups than disruptive one. Spinal cord was frequently injured by compressive flexion mechanism(p<0.005). Complete cord injury was the most common type of cord injury. And complete cord injuries were most frequently ocured by compressive flexion mechanism(p<0.005). On the other hand, forty one cases of asymtomatic spinal column injuries were frequently seen in disruptive flexion mechanism group(p<0.005). Of twenty four patients were operated, forty one were fused posteriorly, one anteriorly, one was performed discectomy, and one was fused anteriorly and posteriorly. Operations were more frequently applied in the compressive mechanism groups(p<0.005). The rate of neurologic improvement was 76.2%, 91.3%, 73.9% and 75% in compressive flexion, disruptive flexion, compressive extension and disruptive extension group respectively. The rate of neurological improvement in the operated group was 83.3%, and 73.7% in the non-operated group. Common complications were urinary tract infection, pneumonia, bed sore, gastrointestinal bleeding. The more frequent complications were urinary tract infection and pneumonia. The rate of complications was more common when the initial neurologic status was worse(p<0.005). Expire rate was high in the compressive flexion mechanism group. When the initial neurologic statue was A, when cord injury was at C6 or higher levels. The most common cause of was pulmonary problem.

Analysis of Upper Cervical Injuries

During the past five years we have treated twenty-seven cases of upper cervical injury among total three hundred and seventeen spine injuries. A follow-up study has done on twenty-one upper cervical injuries and the result is reported. The incidence of upper cervical injury was 8.5% of the total spine injury and 17.5% of the cervical injury. Almost all of the injuries(95.2%) were caused by traffic accidents and falls. The types of injury were odontoid fracture(38.1%), hangman's fracture(28.6%), atlanto-axial instability(19.1%), tear drop fracture of the axis(9.5%), and Jefferson's fracture(4.8%). Chief complaints on admission were motor weakness(57.1%), neck pain with limitted range of motion(42.9%), and sensory disturbance was noted in six cases of the motor weakness group(28.6%). Out of twenty-one cases, operative fixation was performed in eight cases with good result in five(62.5%) and thirteen patients were treated conservatively with eleven cases(84.6%) of good result. In chronic nonunited or malnunited cases, it seems to be safer to fuse the level both by anterior and posterior routes than by either route alone because it is not always stable and needs long period of immobilization.

Injury of the Cervical Spine

Thirty two cases of the cervical spinal injury have been collected except those which associated with the injury on the other sites, such as head or internal organs. Nine cases of them were managed with surgery anterior and/or posterior approaches. The others were only immobilized by traction. Independent of operative method, we acquired slight to moderate improvement in all operative cases. Two cases with skeletal traction, however, became more aggravated. Indication of operation has much controversies as yet. A Major problem at present falls on the difficulty of functional recovery.