Vertebral osteoblastoma: are radiologic structural changes necessary for diagnosis?

BACKGROUND: A case of osteoblastoma localized at the pedicle of the 10th thoracic vertebra is presented. CASE DESCRIPTION: The patient complained of nocturnal back pain not relieved by salycilates, a typical symptom of osteoblastoma. Bone scintigraphy showed a lower thoracic focus of increased osteoblastic activity; however, X-rays, computed tomography, and magnetic resonance images (MRI) were within normal limits, showing only obscure changes that were also noted in the rest of the spine. Repeat MRI with contrast revealed a focal enhancement. After pediculectomy, histopathologic examination confirmed the diagnosis of osteoblastoma. Fifteen months postoperatively, the patient is symptom-free. CONCLUSION: Our case demonstrates that some cases of osteoblastoma may not have the classical radiological appearance. Although non-contrast computed tomography and T1-weighted MRI are mildly positive in some instances, osteoblastoma is best visualized on MRI with gadolinium. Like any other neoplasm, osteoblastoma should be detected and removed early, before it can cause structural bony changes.

Clinical significance of acute traumatic intracranial pneumocephalus.

Among 1142 patients with head injuries hospitalized in the Neurosurgery Department of Gazi University Medical School during the period between 1979 and 1992, 583 had initial CT scans. A retrospective analysis of these initial CT images revealed intracranial air on admission in only 21 cases. These were classified as acute traumatic intracranial pneumocephalus: a potentially serious complication of head injury. CT scans were re-evaluated so as to reveal whether air was situated in the epidural, subdural, or subarachnoid spaces or intracerebrally; whether associated space-occupying lesions were present and whether the air bubbles were single or multiple. Clinical data such as the presence of persistent rhinorrhea and/or otorrhea, tension pneumocephalus, severity and type of trauma, and outcome were were also assessed to determine the significance of this rare finding.

Computed tomographic ventriculography: a clinicoradiological study of 31 cases.

We present 31 patients whose diagnoses were established by the aid of computed tomographic ventriculography. The indications for and diagnostic value of this method are reviewed.

Double-donor, single-lumen, end-to-side anastomosis.

One of the major problems in extracranial-intracranial bypass procedure is the inadequate caliber of the superficial temporal artery branches. In this study, a new end-to-side anastomosis technique that permits two small caliber arteries to be used as a single donor vessel is presented. The external and internal branches of the right common carotid artery were modified to provide a single lumen, and an end-to-side anastomosis was performed between these vessels and the contralateral common carotid artery in 10 rats. One week after the operation, angiography was performed and the patency of anastomoses was demonstrated in 9 of 10 rats.

Pharmacologic response of endothelium to microvascular temporary clip application.

To assess the effects of microvascular temporary clip application on vessel relaxing capability and endothelial substance release, the carotid rings of rats clipped for various durations were studied via bioassay. Noradrenaline and phenylephrine produced an immediate contraction and subsequent relaxation that failed to be suppressed by lysine acetylsalicylate or nicotine in the controls and in the arteries clipped for 0.5, 1, and 5 minutes; however, this relaxation was greatly reduced when the duration was 10 minutes. The results suggest the possible role of inadequate endothelium-derived relaxing factor release following prolonged application of the clips.

Late hypoglossal nerve palsy following fracture of the occipital condyle.

Fracture of the occipital condyle is a rare problem that can easily be overlooked. We report a patient with occipital condyle fracture who was neurologically intact on admission, and who developed hypoglossal nerve palsy in the late posttraumatic period. The diagnosis was facilitated by the aid of computed tomography.

Experimental model for internal repair of arteriovenous fistulas.

An artificial arteriovenous fistula was created by performing an end-to-side anastomosis between the anterior facial vein and carotid artery of the rat. An intraarterial venous graft was then used to seal the fistula. In 8 of 10 rats, carotid artery flow was found to be maintained as judged by angiography, carried out 14 days after the operation. The fistula remained closed in each case. The vessels were also examined with a scanning electron microscope.

A new technique for anastomosing veins to small-caliber arteries.

A new technique of arteriovenous anastomosis is presented which lessens the complication of intravascular turbulence and thrombosis seen with elongated and narrow anastomotic segments. The axillary artery and jugular vein were anastomosed in 10 ZBZ-Cara rats using microsurgical techniques. The jugular vein was prepared as a tubular structure facilitating two end-to-end anastomoses rather than the customary end-to-side technique. Angiographic patency was demonstrated at 3 weeks in 10/10 rats. Two of ten anastomotic segments were considered quite narrow; however, angiographic demonstration of flow was excellent.