ABSTRACT
A 50-year-old woman presented with mid-thoracic back pain that radiated to the left rib cage in a radicular manner. Magnetic resonance imaging revealed an extradural mass compressing the left T9 nerve root. The mass was adjacent to a degenerated T9-10 facet joint with an enhancing low signal intensity rim. Recognition of the characteristic imaging findings of an intraspinal synovial cyst resulted in the correct preoperative diagnosis despite the unusual location of this lesion at T9-10.
Subject(s)
Magnetic Resonance Imaging , Spinal Diseases/diagnosis , Synovial Cyst/diagnosis , Female , Humans , Laminectomy , Middle Aged , Nerve Compression Syndromes/etiology , Spinal Diseases/complications , Spinal Diseases/surgery , Spinal Nerve Roots , Synovial Cyst/complications , Synovial Cyst/surgery , ThoraxABSTRACT
This randomized clinical trial evaluated the efficacy of injections of a dextrose-glycerine-phenol connective tissue proliferant into the posterior ligaments, fascia, and joint capsules to treat chronic low back pain. Seventy-nine patients with chronic low back pain that had failed to respond to previous conservative care were randomly assigned to receive a double-blind series of six injections at weekly intervals of either Xylocaine/saline solution or Xylocaine/proliferant into the posterior sacroiliac and interspinous ligaments, fascia, and joint capsules of the low back from L4 to the sacrum. Patients were observed with a visual analog, disability, and pain grid scores, and with objective computerized triaxial tests of lumbar function for 6 months following conclusion of injections. Pretreatment imaging tests with either magnetic resonance imaging (MRI) or computed tomography (CT) scans were performed in all patients. Thirty of the 39 patients randomly assigned to the proliferant group achieved a 50% or greater diminution in pain or disability scores at 6 months compared to 21 of 40 in the group receiving lidocaine (p = 0.042). Subjective parameters measured at 6 months posttreatment improved (p < 0.001) overall in both the treatment and control group compared to baseline. Improvements in visual analog (p = 0.056), disability (p = 0.068), and pain grid scores (p = 0.025) were greater in the proliferant group. Objective testing of range of motion, isometric strength, and velocity of movement showed significant improvements in both groups following treatment but did not favor either group. The MRI and CT scans showed significant abnormalities in both groups, but these did not correlate with subjective complaints and were not predictive of response to treatment.
Subject(s)
Glucose/therapeutic use , Glycerol/therapeutic use , Low Back Pain/therapy , Phenols/therapeutic use , Sclerosing Solutions/therapeutic use , Adult , Biomechanical Phenomena , Combined Modality Therapy , Double-Blind Method , Drug Combinations , Exercise Therapy , Fascia , Female , Glucose/administration & dosage , Glycerol/administration & dosage , Humans , Injections , Ligaments, Articular , Low Back Pain/diagnostic imaging , Low Back Pain/pathology , Magnetic Resonance Imaging , Male , Middle Aged , Pain Measurement , Phenol , Phenols/administration & dosage , Sclerosing Solutions/administration & dosage , Severity of Illness Index , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
The opening force of aneurysm clips can be determined easily with a dynamometer tension guage. The method is described.
Subject(s)
Aneurysm/surgery , Vascular Surgical Procedures/instrumentationABSTRACT
Bipolar coagulation may be more effective if the currents is delivered in short bursts. This technique is described, along with a bipolar coagulator which automatically dispenses the current in short regularly cycled bursts.
Subject(s)
Electrocoagulation/instrumentation , Electrocoagulation/methodsABSTRACT
The subtle manner in which subarachnoid hemorrhage frequently presents may delay appropriate treatment. The patient may deteriorate and die from aneurysmal rebleeding or from cerebral ischemia associated with vasospasm before the true nature of the disease is recognized. Five patients are described in whom subarachnoid hemorrhage was initially not recognized. Pitfalls in diagnosis are discussed, and an outline is presented for the evaluation of patients suspected of harboring ruptured intracranial aneurysms.
Subject(s)
Intracranial Aneurysm/complications , Subarachnoid Hemorrhage/diagnostic imaging , Adult , Cerebral Angiography , Evaluation Studies as Topic , Female , Humans , Male , Middle Aged , Rupture, Spontaneous , Subarachnoid Hemorrhage/etiologyABSTRACT
Eleven patients with vascular malformations of the cervical spinal cord have been operated upon at the University of Zürich. Total microsurgical excision was achieved in all. One patient had a lesion which was entirely intramedullary. Nine patients had combined lesions, intramedullary and extramedullary. Only one patient had a lesion which was entirely extramedullary. There was one operative death from meningitis. Another patient improved slightly postoperatively, but eventually died of urological complications. One patient had the operation immediately following his only subarachnoid hemorrhage, and has thus been protected from neurological damage. One patient has had postoperative reversal of his progressive neurological deterioration and severe pain. Six patients severely impaired preoperatively improved dramatically. One patient who was quadriplegic preoperatively has regained function in her upper extremities. The treatment of choice in lesions such as these is complete microsurgical excision.
