Giant bipolar intramedullary nondysraphic spinal cord lipoma: A case report.

INTRODUCTION: Intramedullary spinal cord lipomas (IMSCL) are a rare entity, accounting for less than 1% of spinal tumors. Most cases are associated with lumbosacral dysraphism and occur predominantly in the pediatric population. MATERIAL AND METHOD: We report the case of an isolated bipolar lipoma, which was very large in the cervicodorsal region and small in the conus medularis. The patient was a 9-years-old male who had muscle weakness for approximately 6 months. MRI showed a hyperintense lesion on T1, which was less intense on T2, without contrast enhancement at the cervicodorsal location and the conus medularis. At his admission, the patient experienced severe decompensation with flaccid tetraplegia and abdominal respiration. He immediately underwent decompression and partial resection of the cervical lesion. The anatomical pathology evaluation confirmed the diagnosis of a lipoma. DISCUSSION/CONCLUSION: The possibility of quality resection of intramedullary spinal cord lipomas is controversial due to the lack of a cleavage plane with the anterior tracts. Any attempt at total resection would expose the patient to the risk of neurological worsening which is often irreversible. In our case, the surgical indication was self-imposed, the main objective of which was decompression.

The value of suction drainage fluid culture during aseptic and septic orthopedic surgery: a prospective study of 901 patients.

There are no guidelines on the value of suction drainage fluid culture (SDC), and it is difficult to determine whether the organisms cultured from suction drainage fluid samples are pathogenic or simply contaminants. We performed 2989 cultures of suction drainage fluid samples obtained, during a 1-year period, from 901 patients who underwent aseptic or septic orthopedic surgery (946 operations). The culture results were analyzed to evaluate their ability to detect postoperative infection after aseptic operations or to detect either a persistent or new episode of sepsis in patients known to have infection. For aseptic operations, the sensitivity of SDC was 25%, the specificity was 99%, the positive predictive value was 25%, and the negative predictive value was 99%. For septic operations, the sensitivity of SDC was 81%, the specificity was 96%, the positive predictive value was 87%, and the negative predictive value was 94%. We conclude that, for aseptic orthopedic surgery, SDC is not useful in detecting postoperative infection. However, for septic orthopedic surgery, it is of clinical importance.