An MRI study of lateral vascular safety zones in oblique lumbar interbody fusion surgery / 中国修复重建外科杂志

OBJECTIVE@#To study the anatomical characteristics of blood vessels in the lateral segment of the vertebral body through the surgical approach of oblique lumbar interbody fusion (OLIF) using MRI imaging, and evaluate its potential vascular safety zone.@*METHODS@#The lumbar MRI data of 107 patients with low back and leg pain who met the selection criteria between October 2019 and November 2022 were retrospectively analyzed. The vascular emanation angles, vascular travel angles, and the length of vessels in the lateral segments of the left vertebral body of L 1-L 5, as well as the distance between the segmental vessels in different Moro junctions of the vertebral body and their distances from the edges of the vertebrae in the same sequence (bottom marked as I, top as S) were measured. The gap between the large abdominal vessels and the lateral vessels of the vertebral body was set as the lateral vascular safe zones of the lumbar spine, and the extent of the safe zones (namely the area between the vessels) was measured. The anterior 1/3 of the lumbar intervertebral disc was taken as the simulated puncture center, and the area with a diameter of 22 mm around it as the simulated channel area. The proportion of vessels in the channel was further counted. In addition, the proportions of segmental vessels at L 5 without a clear travel and with an emanation angel less than 90° were calculated.@*RESULTS@#Except for the differences in the vascular emanation angles between L 4 and L 5, the vascular travel angles between L 1, L 2 and L 4, L 5, and the length of vessels in the lateral segments of the vertebral body among L 1-L 4 were not significant ( P>0.05), the differences in the vascular emanation angles, vascular travel angles, and the length of vessels between the rest segments were all significant ( P<0.05). There was no significant difference in the distance between vessels of L 1, L 2 and L 2, L 3 at Moro Ⅰ-Ⅳ junctions ( P>0.05), in L 3, L 4 and L 4, L 5 at Ⅱ and Ⅲ junction ( P>0.05). There was no significant difference in the vascular distance of L 2, L 3 between Ⅱ, Ⅲ junction and Ⅲ, Ⅳ junction, and the vascular distance of L 3, L 4 between Ⅰ, Ⅱ junction and Ⅲ, Ⅳ junction ( P>0.05). The vascular distance of the other adjacent vertebral bodies was significant different between different Moro junctions ( P<0.05). Except that there was no significant difference in the distance between L 2I and L 3S at Ⅰ, Ⅱ junction, L 3I and L 4S at Ⅱ, Ⅲ junction, and L 2I and L 3S at Ⅲ, Ⅳ junction ( P>0.05), there was significant difference of the vascular distance between the bottom of one segment and the top of the next in the other segments ( P<0.05). Comparison between junctions: Except for the L 3S between Ⅰ, Ⅱ junction and Ⅱ, Ⅲ junction, and L 5S between Ⅰ, Ⅱ junction and Ⅱ, Ⅲ and Ⅲ, Ⅳ junctions had no significant difference ( P>0.05), there were significant differences in the distance between the other segmental vessels and the vertebral edge of the same sequence in different Moro junctions ( P<0.05). The overall proportion of vessels in the simulated channels was 40.19% (43/107), and the proportion of vessels in L 1 (41.12%, 44/107) and L 5 (18.69%, 20/107) was higher than that in the other segments. The proportion of vessels in the channel of Moro zone Ⅰ (46.73%, 50/107) and zone Ⅱ (32.71%, 35/107) was higher than that in the zone Ⅲ, while no segmental vessels in L 1 and L 2 were found in the channel of zone Ⅲ ( χ 2=74.950, P<0.001). Moreover, 26.17% (28/107) of the segmental vessels of lateral L 5 showed no movement, and 27.10% (29/107) vascular emanation angles of lateral L 5 were less than 90°.@*CONCLUSION@#L 1 and L 5 segmental vessels are most likely to be injured in Moro zones Ⅰ and Ⅱ, and the placement of OLIF channels in L 4, 5 at Ⅲ, Ⅳ junction should be avoided. It is usually safe to place fixation pins at the vertebral body edge on the cephalic side of the intervertebral space, but it is safer to place them on the caudal side in L 1, 2 (Ⅰ, Ⅱ junction), L 3, 4 (Ⅲ, Ⅳ junction), and L 4, 5 (Ⅱ, Ⅲ, Ⅳ junctions).

Closed reduction and percutaneous k-wire fixation for distal end radius fractures

Background: To evaluate radiological and functional outcome in fractures of the distal radius treated by K-wire fixation.Methods: Forty patients (16 males, 24 females) with different types of fractures of distal radius were treated. K-wire fixation was performed under axillary bolock or general anaesthesia. Anatomical  restoration was evaluated by postero-anterior and lateral radiographs obtained preoperatively and at 09 months of follow up to evaluate Radial Height (RH), Radial Inclination (RI) and Volar Tilt (VT). Functional outcome was evaluated using Mayo scoring system.Results: According to Mayo score 72.5% (n=29) of our patients had excellent to good outcome while as 17.5% (n=7) had fair outcome and 10% (n=4) patients had poor outcome.Conclusions: Kirschner wire fixation is an inexpensive procedure that  provides anatomic  reduction,  fracture  fixation,  and maintenance  of  reduction  with  an  adequate method of  immobilization.

Clinical Analysis of Subarachnoid Haemorrhage of Unknown Aetiology (SAHUE).

Spontaneous subarachnoid haemorrhage accounts for 15 cases per lakh population. There are few reports of patients with perimesencephalic haemorrhage and few reports with limited number of patients. Therefore, the aim of the present study was to investigate the clinical course and outcome in patients with SAH. METHODSIn our study, we identified a total of 55 patients admitted to the Neurosurgery department of Sri Ramachandra Institute of Higher Study and Research with subarachnoid haemorrhage between 2018 and 2019. Medical records of all patients who underwent treatment for subarachnoid haemorrhage from July 2018 to April 2019 in the tertiary-care center were reviewed from a prospectively collected database. A detailed analysis was performed on potential predictors of post-operative complications, including age, gender, and type of admission. RESULTSNegative sub-arachnoid haemorrhage angiogram exhibited very mild prognosis than with aneurysmal sub-arachnoid haemorrhage. All patients had presence of blood either in perimesencephalic cisterns and in the lateral cisterns. The prognosis of patient varies based on the thickness of hematoma and people with hydrocephalus had poor prognosis. CONCLUSIONSEach patient with subarachnoid haemorrhage should be monitored as an individual case and to prevent death it is important to identify patients to reduce the aneurysms and modify the risk factors associated with.

A study of radiological presentation in bronchogenic carcinoma along with prevelance of pulmonary TB in a tertiary center

Background: Lung cancer is most common cause of cancer related death in men and women world wise responsible for over 1 million death annually. Lung cancer is leading cause of cancer death in united states and worldwide. Lung cancer is the most common neoplasm contributing more frequent among males causing cancer related mortality in both sexes. Objective of this study was to radiological presentation in bronchogenic carcinoma along with   prevalence of pulmonary TB in a tertiary center.Methods: Total of 100 patients with histologically proven lung cancer, from July 2018 to June 2019 at a tertiary center Kota Rajasthan. Data of participants regarding demographics, history of smoking habit, clinical presentation, histopathological type, radiographic findings on chest radiograph, ultrasonography, computed tomography (CT) scan, Statistical analysis was performed using descriptive statistics of the collected data.Results: Most common age group of bronchogenic carcinomas was seen between 60-69 years of age (37%) with male predominance (82%).  smoking history present in about (80%) patients.  Most common radiological presentation was a mass lesion present in 91% patients (n=91) followed by unilateral hilar prominence present in 44% of patients (n=44). Other common finding includes mediastinal widening (38%), collapse (26%). pleural effusion (22%), metastasis (22%), cavitation (13%), consolidation (12%), bony erosion (11%), pneumothorax (5%), and pancost tumor (4%).  prevalence of pulmonary TB in bronchogenic carcinoma is 9% and this is due to high burden of pulmonary TB in India.Conclusions: In this study adenocarcinoma was found to be most common type of lung cancer. Smoking is most common risk factor. Pulmonary TB coexistence with bronchogenic carcinoma was more common. The local immunity is deteriorated in cancer cases.

Clinical and Radiological Evaluation of Emphysematous Chest - A Prospective Study

Introduction: Worldwide, COPD is the major cause ofhealth care burden and the only leading cause of death that isincreasing in prevalence. Hence present study was undertakento correlate clinical and radiological findings of PulmonaryEmphysema. Imaging spectrum of Emphysema was analysedby chest X ray and computerized tomography and they werecorrelated with stages of COPD as per GOLD guidelinesbased on PFT.Material and Methods: The source of data for this prospectivestudy were 150 patients with probable diagnosis of COPDreferred to our department of Radio diagnosis. After informedconsent, clinical history and clinical examination was done.PFT, chest radiographs and CT were performed.Results: There was a significant association between X rayfinding with PFT and CT findings with PFT with P Value 0.001and P value 0.0002 respectively using Fischer’s exact test.There was a significant association between the features likehyperinflation, bullae and tubular heart noted on X ray withCT. CT was much more sensitive in diagnosis of emphysemain even mild type of COPD.Discussion: COPD is a disease of old age and is associatedwith prolonged duration of exposure to smoke and noxiousparticles. CT is undoubtedly more sensitive(100%) than chestradiographs in diagnosing emphysema and in determiningits type and extent and has a significant association withPFT.Conclusion: This hospital based study had limitations ofsmall sample size and inherent bias, but clearly shows thatCT has important diagnostic role in Emphysema with highsensitivity and specificity.

Evaluación clínica y por imágenes de la esclerosis múltiple progresiva / Clinical and radiological outcomes measures in progressive multiple sclerosis

Durante los últimos años, el desarrollo de medidas de evaluación de la acumulación de la discapacidad y la actividad inflamatoria en las formas progresivas de esclerosis múltiple (EM) ha sido un punto central de investigación de diversos grupos. Se han desarrollado y aplicado distintos instrumentos con el fin de identificar en forma precisa y precoz la actividad y la progresión en este fenotipo de EM. Muchas de esas herramientas, con mayor o menor sensibilidad, han sido utilizadas en ensayos clínicos, aunque su uso en la práctica asistencial no es del todo familiar para los profesionales involucrados en el cuidado de pacientes con EM. El objetivo de esta revisión es describir las medidas de evaluación clínica y por imágenes implementadas durante los últimos años para la identificación de la actividad y evolución de esta enfermedad en sus formas progresivas.

During recent years, the development of measures to assess the accumulation of disability and inflammatory activity in the progressive forms of multiple sclerosis (MS) has been a central point of research in various groups. Several instruments have been developed and implemented in order to accurately and early identify the activity and progression in this MS phenotype. Many of these tools, with greater or lesser sensitivity, have been used in clinical trials, although their use in healthcare practice is not entirely familiar to professionals involved in the care of patients with MS. The objective of this review is to describe the clinical and imaging evaluation measures implemented during the last years to identify the activity and the evolution of the disease in its progressive forms.

Therapeutic potential of ethyl acetate fraction of Tephrosia purpurea Linn. leaves in a rat model of gout / 中西医结合学报

OBJECTIVE@#The present study is to determine the potential treatment effects of ethyl acetate fraction of Tephrosia purpurea Linn. leaves (EATP) against gout.@*METHODS@#Gout in experimental rats was induced with potassium oxonate at the dose of 250 mg/kg (intraperitoneal injection) for 7 consecutive days; EATP was administered 1 h after administration of the potassium oxonate on each day of experiment. Potassium oxonate was discontinued on the 8th day; thereafter allopurinol (10 mg/kg, p.o.) and EATP (200 and 400 mg/kg, p.o.) were continued until day 14. The uric acid level was measured from serum and urine during the experiment. Other biochemical parameters were assessed, including blood and urine creatinine, erythrocyte sedimentation rate, and total protein. Blood urea nitrogen, serum aspartate aminotransferase serum alanine aminotransferase and alkaline phosphatase were also measured. The blood was analyzed for levels of malondialdehyde and the antioxidant enzymes such as superoxide dismutase, catalase and glutathione peroxidase. Histopathological and radiological changes in the ankle of rats were observed after completion of the experiment.@*RESULTS@#EATP was able to decrease serum uric acid and creatinine level; it also reduced inflammation, oxidative stress and lysosomal enzyme level, which has a role in acute inflammation. EATP increased uric acid excretion through urine due to its uricosuric effect.@*CONCLUSION@#EATP lowered the serum uric acid level and increased the urine uric acid level through excretion, which is useful in the treatment of gout. Hence the EATP was found to be helpful in the treatment of gout.

Radiological evaluation of neonatal thoracic lesions in 118 neonates.

Background: within 48 – 72 hours, most common disorder that occurs in neonate is respiratory distress. Post natal respiratory distress is the most important indication for chest X- ray. Clinically it is very difficult to distinguish between pulmonary and extra pulmonary causes. Aim: To show the radiographic appearances of various causes of neonatal respiratory distress, and varied appearances of each pathology. Material and methods: This was a prospective observational study that was conducted in Dhiraj General Hospital. Antero-posterior chest radiograph in supine position of (118) neonates were taken, presented with a chief complaint of respiratory distress. Chest X-ray was taken presented with a chief complaint of respiratory distress. Chest X-ray was taken with the help of portable X-ray machine in NICU department. Chest X-ray were taken on first day of admission and then follow up chest X-rays were taken. Results: The commonest cause of respiratory distress in neonates which presented with respiratory distress was transient tachypnoea of new born, which was (32.20%), followed by hyaline membrane disease (20.33%) , neonatal congenital pneumononia (16.94%), meconium aspiration syndrome (11.86%), cardiac causes (5.08%), trachea-oesophageal fistula (4.23%), congenital diaphragmatic hernia (2.54%), aspiration pneumonia (2.54%), idiopathic persistent pulmonary hypertension (1.69%), eventration of diaphragm (1.69%) followed by pneumoperitonium (0.84%). Conclusion: Any sign of respiratory distress is an indication for roentgenogram of the chest which should be taken as early as possible.

Results of Anterior Cervical Discectomy without Interbody Fusion

Anterior cervical discectomy with or without interbody fusion has been conventionally used to treat patients with cervical disc diseases. However, discectomy without bone fusion has been abandoned due to the feat of early collapse of interbody space and recurrency. The author has analysed twenty-two cases of microsurgical cervical discectomy without bone fusion between Jan. 1993 and Mar. 1994. All patients were followed up for more than 6 months or as long as 21 months with repeat interview, physical examination, and radiological evaluation. The analysis revealed that the results were highly satisfactory in 21 cases with radiculopathies in terms of early ambulation, no discomfort in the iliac bone, and shorter hospital stay, but unsatisfactory in one cases which needed reoperation due to postoperative scar. The above method which had demonstrated promising results is recommended for the patients suffering from radiculopathy.

Radiological Evaluation of Posterior Cruciate Ligament Injury at Quadriceps Neutral angle / 대한정형외과학회잡지

A method for exact evaluation of ligament integrity of the knee joint would be of clinical importance from the diagnostic point of view as well as from the desire to introduce objective measurement of stability either pre-and postoperatively, or before and after conservative treatment. Assessment of the posterior cruciate injury has been considered by numerous authors over the past decades. Even stress machine, such as Gonylaxometer, knee ligament arthrometer(KT-l000) and Genucome, have many problems such as soft tissue error, expansiveness and low popularity. Generally, orthopedic surgeons use passive tests, in which the displacing force is applied externally, to evaluate the integrity of the ligaments of the knee. Posterior tibial displacement of knee was measured at quadriceps neutral angle using a specially designed frame which minimized the rotational error to negate the quadriceps pulling effect. Posterior displacement of both sides of knee was measured in 15 patients who had posterior cruciate ligament injury and 40 adults who had normal knee. The following results were obtained. l. In the normal knee, the mean score of posterior tibial displacement was 3.0875mm in left, 2.8125mm in right each other and there was a mean of 1.05mm posterior displacement of tibia compared to the contralateral knee(range: 0–2.5mm). 2. More than 6mm displacement of lateral femoral condyle compared to the uninjured knee suggested posterior cruciate ligament injury. 3. This radiological measurement seems very efficient in detecting the posterior cruciate ligament instability of knee because of its simplicity, inexpensiveness and easy reproducibility with minimal error.

Radiological Evaluation of Posterior Cruciate Ligament Injury / 대한정형외과학회잡지

The evaluation of posterior cruciate ligament injury of the knee should be objective. Then stress machine, Gonylaxometer, knee ligament arthrometer (K-T 1000) and Genucome were introduced recently, but they have many problems such as soft tissue error, expensiveness and low popularity. Authors modified the radiological assessment of anterior cruciate ligament injury, reported by Hooper(1986), and applied to the evaluation of posterior cruciate ligament injury. The patient was positioned supine with the one side of leg held on a support so that the knee was flexed approximately 45°to 60°. The thigh was unsupported and a weight(0.9 Kg to 4.5 Kg with increment of 0.9 Kg) was placed on the anterior leg (just distal to the patellar tendon) and lateral view had been taken in this stressed position. Same procedure was done on the other side and the posterior displacement of both knees were compaired. The differences of posterior displacement between both knees of 50 normal adults were studied and 9 cases of posterior cruciate ligament injury were studied, too. The following results were obtained. 1. The difference of posterior displacement could be measured objectively and it is useful for the diagnosis of posterior cruciate ligament injury and the objective evaluation after conservative or operative treatment of posterior cruciate ligament injury patient. 2. The differences of posterior displacement between both knees of 50 normal adults were ranged from 0 to 3 mm with a mean of from 0.88 ±0.87mm to 1.14 ±0.94mm. 3. The differences of posterior displacement between injured knee and normal knee of posterior cruciate ligament injury patient were more than 6mm in 9 patients. 4. The radiological method was inexpensive and easy to perform.

Clinical and Radiological Evaluation of the Renal Injuries / 대한비뇨기과학회지

Clinical and radiological evaluation was made on the 30 kidneys of 28 patients with renal injury, who were admitted in the Department of Urology, Kyung Hee University Hospital during the period from January 1, 1980 through December 31, 1982. The results were as follows: 1. They were non-penetrating injuries and the causes were traffic accident in 13 kidneys, fall in 10 kidneys and blow in 7 kidneys. 2. Associated injuries other than kidney were seen in 15 patients with the majority of rib fracture. 3. Severity of the renal injury was classified in 3 categories according to modified Scott's classification. Of 19 minor injuries, 16 kidneys were contusions and 3 kidneys were shallow cortical lacerations. Major injuries of parenchymal laceration involving calyx were seen in 4 kidneys. Pedicle injuries were seen in 7 kidneys. 4. The most frequent symptoms and signs were hematuria, 26cases, and flank pain, 26 cases. Abdominal pain, nausea and vomiting, and palpable abdominal mass were also seen. 5. Excretorgraphy was the diagnostic procedure with satisfactory information in 60% of the cases. It is considered to be the screening procedure of choice. 6. Selective renal arteriography is considered to be the best diagnostic procedure in case of major and pedicle injuries for planning the proper treatment and determining the prognosis. 7. Conservative treatment was done in 18 cases and nephrectomy in 10 cases.

Clinical and Radiological Evaluation of the Renal Injuries / 대한비뇨기과학회지

Clinical and radiological evaluation was made on the 30 kidneys of 28 patients with renal injury, who were admitted in the Department of Urology, Kyung Hee University Hospital during the period from January 1, 1980 through December 31, 1982. The results were as follows: 1. They were non-penetrating injuries and the causes were traffic accident in 13 kidneys, fall in 10 kidneys and blow in 7 kidneys. 2. Associated injuries other than kidney were seen in 15 patients with the majority of rib fracture. 3. Severity of the renal injury was classified in 3 categories according to modified Scott's classification. Of 19 minor injuries, 16 kidneys were contusions and 3 kidneys were shallow cortical lacerations. Major injuries of parenchymal laceration involving calyx were seen in 4 kidneys. Pedicle injuries were seen in 7 kidneys. 4. The most frequent symptoms and signs were hematuria, 26cases, and flank pain, 26 cases. Abdominal pain, nausea and vomiting, and palpable abdominal mass were also seen. 5. Excretorgraphy was the diagnostic procedure with satisfactory information in 60% of the cases. It is considered to be the screening procedure of choice. 6. Selective renal arteriography is considered to be the best diagnostic procedure in case of major and pedicle injuries for planning the proper treatment and determining the prognosis. 7. Conservative treatment was done in 18 cases and nephrectomy in 10 cases.