Thoracotomy in spine surgery.

OBJECTIVE: Aim of the study was the assessment of thoracotomies performed for spine surgery. METHODS: All patients undergoing spine surgery with thoracotomy between December 2004 and October 2007 were included and evaluated with regard to their age, gender, etiology, the level of the intervention and the types of procedures performed. RESULTS: A total of 29 patients undergoing spine surgery were included. Mean age was 45 years (range: 6-75) and the female to male ratio was 9 : 20. Trauma (14 patients, 48 %) and malignancy (5 patients, 17 %) were the most frequent reasons for surgery. A total of 7, 8 and 14 patients were operated at T3-T6, T7-T10, and T11-L2 levels, respectively. A left thoracotomy was performed in all but three patients (n = 26). The most frequent procedure was corpectomy and stabilization (n = 25, 86 %). CONCLUSION: An anterior approach with thoracotomy is needed for spine surgery in subjects with conditions such as lung cancer, trauma, hydatid cyst, etc. A good preoperative assessment of the vertebrae requiring intervention and the use of appropriate techniques for separating the diaphragm during thoracotomy may provide a good exposure up to the L3 level.

A case of brain abscess due to Entamoeba species, Eikenella corrodens and Prevotella species.

We report a case of brain abscess due to multiple pathogens including Entamoeba species, Eikenella corrodens and Prevotella species. Patient had odontogenic infection without any site of amoebic infestation. Complete recovery was achieved with surgical treatment and antimicrobial therapy.

Endothelial nitric oxide synthase gene [G894T] polymorphism as a possible risk factor in aneurysmal subarachnoid haemorrhage.

BACKGROUND: The exact aetiology, growth and rupture of intracranial aneurysms is unclear. In this study we investigated a possible association between intracranial aneurysm rupture and polymorphism of the endothelial nitric oxide synthase gene G894T. METHODS: Endothelial nitric oxide synthase gene polymorphism of 53 patients with ruptured intracranial aneurysms and 60 control subjects were analysed by the polymerase chain reaction-restriction fragment length polymorphism technique. The genotype distribution and allele frequencies of endothelial nitric oxide synthase gene polymorphism in patients with ruptured intracranial aneurysm and healthy subjects were compared. FINDINGS: The homozygous (TT) genotype frequency was significantly higher in patients with ruptured intracranial aneurysms. It was also found that the presence of eNOS 894TT genotype was significantly associated with the risk of intracranial aneurysm rupture (p < 0.05). CONCLUSION: Polymorphism in exon 7 of the endothelial nitric oxide synthase gene G894T seems to be a possible risk factor for intracranial aneurysm rupture.

The effects of the electrical stimulation of the nasal mucosa on cortical cerebral blood flow in rabbits.

The cerebral vessels have sympathetic, parasympathetic, and sensory innervations. A sensory innervation of the cerebral vessels originating in the trigeminal ganglion has been described in a number of species by several investigations. It has been shown that the electrical stimulation of the trigeminal ganglion causes an increase of cerebral blood flow (CBF). The aim of our present study is to stimulate the trigeminal ganglion with an extracranial and non-invasive method. A stimulating electrode was put in the nasal mucosa via right nares of rabbits and trigeminal ganglion was stimulated orthodromically via nasociliary nerve (NCN). Variations in the cortical CBF were evaluated by laser Doppler flowmetry. In experiment group, CBF increased together with the beginning of electrical stimulation. The flow values were remained high as long as the stimulation. In post-stimulation period, the CBF was decreased gradually and returned to the baseline values at 120s. This study demonstrated that the electrical stimulation of the NCN branch of the trigeminal nerve increases the cortical CBF under physiological conditions.

Orbital lymphangioma and its association with intracranial venous angioma.

Orbital lymphangioma is an uncommon, benign cystic lesion, generally manifest in childhood. It usually presents with a slowly progressive proptosis, displacement of the globe, ptosis and restriction of eye movements. Occasionally, focal lesions may remain asymptomatic. Spontaneous intraorbital haemorrhage may cause acute proptosis, compressive optic neuropathy and loss of vision. An 8-year-old girl presented with progressive left proptosis and a unilateral soft tissue mass at the supraorbital frontal region. Multiple intracranial venous angiomas were seen on MRI. Surgical decompression of the optic nerve was performed because of progressive decrease in visual acuity. We review the relevant literature; rarity of the orbital lymphangioma and its association with non-contiguous intracranial vascular anomalies were emphasized.

Primary multiple cerebral hydatid cysts with unusual features.

We present a case of 45 years old female patient with two primary cerebral hydatid cysts, each localised in separate hemispheres. Detailed studies revealed no evidence of hydatid disease elsewhere in the body. The cysts were removed by two separate operations. Though the cyst in the right posterior parietal lobe was delivered unruptured, seven months later a new cyst was detected in the same cavity, which seems to show relatively rapid growth in a year, and was also removed unruptured. This case is presented here for its unusual features such as having two primary cerebral hydatid cysts simultaneously in separate hemispheres, one of which partly localised intraventricularly, and the occurrence of a new cyst in the same cavity following intact removal of the previous cyst.

The therapeutic effect of continuous intracisternal L-Arginine infusion on experimental cerebral vasospasm.

BACKGROUND: Recent studies on the pathogenesis of cerebral vasospasm following subarachnoid haemorrhage (SAH) suggest a breakdown of the balance between the vasoconstrictor and vasodilator systems. A shortage of a major cerebral vasodilator, nitric oxide (NO), has been accused of causing this breakdown. We investigated the effect of continuous intracisternal infusion of a NO precursor, L-Arginine, in a rabbit SAH model. METHOD: Three experimental groups were designated: Group 1--Cerebral blood flow (CBF) data was obtained via transorbital Doppler ultrasonography (TDU) in 8 normal rabbits. Group 2--Intracisternal catheter placement and TDU study during saline infusion were performed in 8 animals at the 4th day of SAH, Group 3--SAH occurred in 8 animals. 4 days later, L-Arginine was infused intracisternally for 1 hour, while TDU was performed before and during infusion. CBF parameters which were obtained via TDU measurement or calculations, were compared. FINDINGS: The results of TDU revealed significant vasospasm in all SAH animals, as well as resolution of vasospasm with L-Arginine infusion. After 20 minutes of infusion, a steady and sustained vasodilation was obtained in the third group. The analysis of CBF data revealed a significant difference in SAH values, and no difference in control animals. INTERPRETATION: Our results support the contribution of the "NO shortage" concept in the pathogenesis of cerebral vasospasm and overconsumption of L-Arginine during the post-SAH period may cause this shortage. L-Arginine treatment may be useful for the prophylaxis and treatment of cerebral vasospasm. The intracisternal infusion method can eliminate the short action time disadvantage of L-Arginine.