Imaging problems and clinical findings in adolescent lumbar disc herniation: a retrospective study.

OBJECTIVES: Disc degeneration probably begins in childhood although low back pain and radicular leg pain is not as common a complaint as in adults. However as yet no explanation exists for the appearance of advanced degenerative changes seen occasionally in patients in their twenties. PATIENTS AND METHODS: We report 12 adolescents between the ages of 15 and 20 among a total of 1068 cases with radiologically demonstrated lumbar disc herniations treated between March 1991 and March 1996. RESULTS: Most of their findings were in good agreement with earlier and more recent reports. The only different findings worth commenting upon were the common presence of multiple level disc herniations, and the occasional presence of a so called "fractured epiphysial plate". CONCLUSION: Depending on magnetic resonance imaging findings coupled with computed tomographic images; we suppose that the so called "fractured bone fragments of the vertebral epiphysial rim impinging on the spinal canal at multiple levels" and "wedges of bone attached to the disc end plate and associated bony defects in the margins of the posterior vertebral bodies" reported to be demonstrated on computed tomographic (CT) images may in fact be false images. Inappropriately angled CT scan slices may cut partly through the epiphysial ring which has totally been distracted backwards together with the firmly attached avulsed disc annuli, designated as an "epiphysial avulsion"; giving rise to the mistaken interpretation as a "fractured epiphysial ring" appearance. Such a mechanism may also involve the posterior longitudinal ligament, which is firmly attached to the neighboring annuli, accounting for the common multilevel involvement.

Redundant ventriculomegaly associated with brain abscess.

OBJECTIVE: The aim of this clinical retrospective review was to emphasize the recently observed high incidence of ventriculomegaly, a wellknown complication of brain abscesses. MATERIALS AND METHODS: Among twelve brain abscess cases operated on in our institution during five years, the most common surgical procedure was burr-hole aspiration applied in ten of the cases, while in the remaining two a standard craniotomy and total excision was performed. Ventriculomegaly was assessed by the "Evans' Ratio" values calculated using the frontal ventricular horn measurements made on axial tomographic images. RESULTS: The signs, symptoms, radiological findings and clinical features of the patients were in accordance to the pertinent literature. The only finding worth commenting on was the surprisingly high incidence of ventriculomegaly (5/12) and periventricular edema (4/12). Concerning the outcome, there was only one death. CONCLUSIONS: The "Evans' Ratio" either worsened or remained the same in four out of five cases during the early postoperative period (ranging from one to three months) and it got better in one case in the late postoperative control (1.5 years). Furthermore, periventricular edema persisted just in the same manner in three of the four cases.

Redundant ventriculomegaly associated with brain abscess

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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.

Observation of 95 patients with extradural hematoma and review of the literature.

The authors review the cases of 95 patients with extradural hematoma managed at Gazi Hospital in the last 4 years. The common factors in craniocerebral traumas, the time interval between admittance and trauma, the interval between admittance and operation, and the location of hematomas are determined. The arterial origins demonstrated at operation in extradural hematomas are described. The interactions between all these factors and mortality are discussed. Availability of computed tomography scanning accounts for the present mortality rate of 9.4% when compared with the mortality rate of 33% for conventional diagnostic facilities.