Recurrent laryngeal nerve injury with anterior cervical spine surgery risk with laterality of surgical approach.

STUDY DESIGN: A detailed review of anterior cervical fusion procedures from a university-based spine specialty service was completed. Noted were the laterality of approach, number of levels, discectomy or corpectomy, use of instrumentation, and cases of reoperation. OBJECTIVES: The primary purpose of the study is to determine whether there is in fact a greater risk of recurrent laryngeal nerve (RLN) injury with approach on the right or left side. Also evaluated is the risk with corpectomy, reoperative procedures, and instrumentation. BACKGROUND: Anatomic considerations have been used as justification to determine the side of surgical approach. However, few clinical studies have delineated the side of surgical approach in their results. METHODS: A total of 328 anterior cervical spine fusion procedures completed between 1989 and 1999 were reviewed. All speech changes reported were noted throughout follow-up. RESULTS: There were 187 anterior discectomy and 141 corpectomy procedures. There were 21 reoperative anterior fusions. There were 173 procedures completed from the right side and 155 from the left. There were nine patients documented to have dysphonia after surgery. Five had a left-sided approach and four had a right-sided approach. CONCLUSIONS: The incidence of RLN symptoms after surgery was 2.7% (9 of 328). The incidence of RLN symptoms was 2.1% with anterior cervical discectomy, 3.5% with corpectomy (5 of 141), 3% with instrumentation (8 of 237), and 9.5% with reoperative anterior surgery (2 of 21). There was a significant increase in the rate of injury with reoperative anterior fusion. There was no association between the side of approach and the incidence of RLN symptoms.

[Flow cytometric examinations of patients after radical surgery for prostatic cancer]. / Flow cytometriás vizsgálatok radikálisan operált prosztatarákos betegekben.

Biological behavior of prostatic cancer is influenced by different tumor factors. The proliferative activity of the malignancies could be one of those parameters which serve as basis to design therapy and to estimate prognosis. Here ploidity and S-phase fraction of 44 prostatic cancer obtained by radical prostatectomy were compared to other known tumor characteristics (PSA, staging, grading). There are correlations between the PSA concentration, grading, staging and S phase fraction. The ploidity correlates with the grading. Neither of kinetic parameter correlated with the nodal involvement.

DNA content of prostatic cancer measured by flow cytometry in patients undergoing radical prostatectomy.

The biological behavior of prostatic cancer is influenced by many host and tumor factors. The proliferative activity of the malignancies can be one of those parameters which serve as the basis to estimate prognosis and design treatment. Here, DNA content and S-phase fraction of prostatic cancer samples obtained by radical prostatectomy from 46 patients were related to other known tumor characteristics (PSA, staging, grading). Nuclei from the paraffin embedded materials were isolated with overnight trypsin-ribonuclease mixture digestion. DNA content and cell cycle distribution were determined by flow cytometry. A correlation was found between the PSA concentration, grading and staging on the one hand and S-phase fraction on the other. DNA content correlated with grading. No kinetic parameter correlated with the nodal involvement. Due to the association between abnormal DNA content plus SPF > 5% with advanced stage and less differentiated appearance of the tumor, we can conclude that these parameters are useful to estimate prognosis.

Malignant schwannoma of kidney capsule.

This report is of a malignant schwannoma originating in the capsule of the right kidney. Using sonography, nephroangiography, cavography, computer tomography, and bone scanning, metastases in the kidney or a retroperitoneal tumor could be diagnosed. After transperitoneal exploration, the right kidney and mesenteric metastases were removed. Due to tumor infiltration into the liver and tumor masses in the retroperitoneum, only nephrectomy and palliative excision of retroperitoneal metastases were done. Pulmonary metastases developed postoperatively, and the patient died three months after the operation.

[Value of computer tomography in staging urological tumors before radical surgery]. / A computertomographia értéke urológiai daganatok radikális mtétek elötti stádium meghatározásában.

The authors investigated by conventional CT 66 urological tumorous patients before radical operations, and compared with the findings of the histological investigations of the lymph nodes removed by the lymphadenectomy. The coincidence between the two investigations were 80%.

[Post-traumatic hematoma simulating a left-sided adrenal gland tumor]. / Vortäuschung eines linksseitigen Nebennierentumors durch posttraumatisches Haematom.

Typical signs of posttraumatic adrenal gland haematoma in computer-tomography are, besides an enlargement of the adrenal gland, a stripy infiltration of surrounding tissue and a thickening of the homolateral crus of the diaphragma, located primarily in the right adrenal gland. We report a case of an isolated enlargement of the left adrenal gland with normal surrounding tissue, which histologically proved to be a posttraumatic hematoma within the adrenal gland medulla.

[Chordoma as osteolytic space-occupying lesion of the anterior lumbar spine]. / Chordom als osteolytische Raumforderung der oberen LWS.

A case of a 78-year old woman with a chordoma destroying the second lumbal vertebra is reported. Radiologic and histologic feature of this rarely diagnosed tumor is demonstrated. An overview about the therapeutic modalities is given.

[Malignant schwannoma of the renal capsule]. / A vesetok malignus schwannomája.

The authors report on a malignant schwannoma originating in the capsule of the right kidney. By sonography, nephroangiography, cavography, computer tomography and bone scanning, metastases in the kidney or a retroperitoneal tumor could be diagnosed. After transperitoneal exploration, the right kidney and mesenteric metastases were removed. Due to tumor infiltration into the liver and tumor masses in the retroperitoneum, we confined our operation to nephrectomy and palliative excision of retroperitoneal metastases. The patient developed pulmonary metastases postoperatively and died three months after the operation.

Spinal epidural compression secondary to osteoblastic metastatic vertebral expansion.

We present two cases in which spinal epidural compression was caused by the expansion of bony elements into the spinal canal as a result of osteoblastic metastases. The precise nature of the compression was appreciated only on computed tomography. One patient had immediate and sustained neurological improvement after laminectomy. The other benefited temporarily, but widespread involvement of his spine ultimately led to paraplegia despite two more decompressive procedures. We think that bony expansion of the spine secondary to osteoblastic metastasis is not reversible with radiation therapy alone and is, therefore, an absolute indication for surgical decompression.