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At least 685 records · Page 38Linked to original sources
PubMed1976

[Sciatica and occult sacral meningocele].

The authors present the case of a 43-years-old man who had suffered from back pain for 7 to 8 years followed by sciatic. X-rays showed an abnormal sacral cavity extending from S1 to S3. Wtih the suspicion of an occult sacral meningocoele, Dimer X radiculography showed a cystic formation at S2 which only partially filled the sacral cavity. There was also an L5-S1 disc protrusion. At operation, after exploration of the roots on both sides, it was possible to remove a disc herniation at L5-S1 on the right. Laminectomy of S1 and opening of the posterior wall of the sacral canal at S2 and S3 revealed a large cyst of epidural location, touching both S1 roots superiorly and situated behind the communicating cystic cavity seen at radiculography. Histological examination of the sacral cyst showed it to be a dura mater structure, in fact anon-communicating meningocoele.

Adult↗
PubMed1993

Anterior and posterior spinal fusion: comparison of one-stage and two-stage procedures.

OBJECTIVE: To compare postoperative morbidity and length of hospital stay after combined anterior and posterior spinal fusion for patients treated by a one-stage procedure and those treated in two stages, 1 to 2 weeks apart. DESIGN: Retrospective review of all cases handled by the first author between July 1989 and November 1991. The patients had been referred for treatment of severe spinal deformity, scoliosis or kyphosis by combined anterior and posterior spinal fusion. SETTING: The operations were performed at McMaster University Medical Centre, Hamilton, Ont., by the first author, who was assisted by another specialist in spinal surgery and a fellow or resident. PATIENTS: Eleven operations of each type were performed. The mean age of the 22 patients was 16.6 and 14.6 years for those who underwent the one-stage and the two-stage procedures respectively. The diagnoses included neuromuscular disease, neurofibromatosis, spina bifida, congenital kyphoscoliosis and severe idiopathic spinal curvature. The one-stage procedure was used after the surgical team became able to provide the care associated with this type of major surgery; selection of patients also involved preoperative risk assessment and the feasibility of combining two surgical procedures that would take a maximum of 9 hours. The preoperative plan was to spend a maximum of 9 hours in performing the one-stage procedure. INTERVENTIONS: Similar surgical procedures were performed in both groups. The average number of intervertebral levels fused during the anterior component of the operation was 4.6 in the one-stage procedure and 6.0 in the two-stage procedure. Thoracolaparotomy was performed in four patients who underwent the two-stage procedure. During the posterior component of the operation, instrumentation was inserted through an average of 11.6 and 12.6 intervertebral levels in the groups undergoing the one-stage and the two-stage procedures respectively. Total operating time averaged 7 hours and 15 minutes for the one-stage procedure and 11 hours for the two-stage procedure. Mean blood loss was 1830 mL for the one-stage procedure and 2270 mL for the two-stage procedure. MAIN OUTCOME MEASURES: The number of days spent in the intensive care unit (ICU) and the total number of days spent in hospital, as well as morbidity after the operation, were determined. RESULTS: Postoperative morbidity included five minor complications in patients who underwent a one-stage procedure; all of these complications resolved well. Among those who underwent the two-stage procedure there were 11 complications; in two patients further surgery was required. The patients' stay in the ICU averaged 2.6 and 7.7 days respectively for one-stage and two-stage procedures, and the total stay in hospital averaged 14 and 33 days respectively. CONCLUSIONS: When possible, the one-stage procedure for anterior and posterior spinal fusion is preferred over the two-stage procedure because of a significant reduction in the length of stay in the ICU and in hospital, as well as reduced morbidity. However, this analysis should be interpreted cautiously because of the small number of cases and the variables encountered in treating this type of spinal deformity.

Adolescent↗
PubMed1993

[Symptomatic Chiari type-II malformation in the neonatal period: a review of 4 cases].

Four newborn patients with symptomatic Chiari II malformations were studied retrospectively. Clinical manifestations and surgical results are presented. All of these patients had hydrocephalus, which was symptomatic in two patients from the first day of life. Three of them had bradycardia and apnea spells. Two patients had lower cranial nerve palsies. Cranial sonography was the first neuroimaging procedure used and it played an important role during the follow-up period, especially for the study of the hydrocephalus. Two newborns could be studied with Magnetic Resonance Imaging (MRI). It defined the level of the decent of the fossa posterior structures and the associated malformations. All of the patients were treated with surgical repair of the spinal dysraphism, ventricular shunt and decompressive surgery. Two patients died before the age of three months. Two other patients showed better evolution after their two year and four year check-ups, respectively. Bradycardia and apnea spells are features that worsen the prognosis as compared with other manifestations.

Central Nervous System↗
PubMed1993

Soft tissue reconstruction. Coverage of the chest wall and spine.

Advances in reconstructive surgery achieved during the past decade have considerably broadened the range of options available for coverage of the chest wall and spine. Flaps can be designed to maximize function and provide bulk, bony rigidity, sensation, or function, when needed. Local musculocutaneous and muscle flaps are preferred, but, at times, a free flap is more appropriate, either because the local tissue is inadequate or because a free flap best meets the needs of the recipient site. With current techniques, donor-site morbidity, flap survival, and, ultimately, patient outcome can be optimized to a much greater extent than in years past.

Humans↗
PubMed1996

The role of the pediatrician in prescribing therapy services for children with motor disabilities. American Academy of Pediatrics Committee on Children With Disabilities.

Pediatricians are often called upon to prescribe physical and occupational therapy service for children with motor disabilities. This statement defines the context in which rehabilitation therapies should be prescribed, emphasizing the identification and enhancement of the child's function and abilities. The statement encourages the pediatrician to work with teams including the parents, child, teachers, therapists, and other physicians.

Arthrogryposis↗
PubMed1996

[Currarino triad : a case report].

The authors report a case of Currarino triad comprising anorectal malformations, sacral bony anomaly and presacral mass. A 1-year-old boy was presented with constipation as his chief complaint. No neurological deficit was found on admission. There was no cutaneous evidence of underlying spinal dysraphism. Lumbar X-ray films showed bony defect caudal to the third sacral vertebra. A barium-enema examination revealed an anterior displacement of the rectum. A myelography showed a presacral cavity filled with contrast medium. MRI demonstrated a thick filum terminale, and a round hypointense mass in the pelvis on T1 weighted images and hyperintense on T2 weighted images. Surgically we released the thick filum terminale, and obliterated the anterior sacral meningocele, because total removal would have been hazardous. Postoperatively transient dysuria was observed for a month, and the difficulty in defecation persisted. Recognition of this rare condition will lead to correct diagnosis and proper treatment.

Abnormalities, Multiple↗
PubMed1996

Nonunion of a distal femoral epiphyseal fracture-separation.

Distal femoral physeal fractures account for approximately 1% of all epiphyseal injuries. Complications include growth arrest and leg length discrepancy, malunion and deformity, and stiffness and knee instability. However, nonunion of such a fracture is exceedingly rare and has only been reported in patients with spinal dysraphism. We report a case of distal femoral physeal nonunion in a neurologically intact adolescent athlete. Initially, there was a delay in the diagnosis of this nondisplaced fracture, as the patient had normal roentgenograms. Additional imaging modalities (magnetic resonance imaging, stress radiographs) should be performed if there is a high index of suspicion of physeal injury when roentgenograms are normal.

Bone Screws↗
PubMed1996

[The tethered spinal cord: diagnosis and surgical considerations].

The tethered spinal cord consists of complex malformations that result from disturbances in the closure of the neural tube early in embryonic development. Among patients with occult or open spinal dysraphic anomalies, late progressive neurologic deterioration commonly occurs due to a treatable cause. Most of the patients treated surgically showed improvement of their presenting complaints. The paper describes modern diagnostic methods and surgical indications. Close clinical and radiodiagnostic follow-up of this high risk patient population is indicated.

Humans↗
PubMed1997

[Particular aspects of ulcers in children].

Leg ulcers of juvenile onset are uncommon. The infectious origin is fairly frequent but the presence of leg ulcers in children should prompt an investigation into possible underlying causes especially hemangioma, vasculitis, inborn errors of metabolism (i.e. prolidase deficiency), hemoglobinopathies, occult spinal dysraphism and immunodeficiencies. Bacteriological investigations are essential and a skin biopsy specimen may be able to differentiate some of these disorders.

Age Distribution↗
PubMed1998

[Cone beam CT utilizing a rotational digital radiographic system: early clinical experience on pulmonary and skeletal lesions].

Utilizing a rotational digital radiographic system (SF-VA 100, Hitachi) 289 digital images were obtained during a 360-degree rotation in 4.8 seconds. The images were transferred to a high-speed workstation and post-processed to create volume data in 9 minutes. The multi-planar reconstruction method reconstructed high-quality tomographic images with equal resolution in any direction. We applied this system as a cone beam CT in order to demonstrate pulmonary and spinal lesions. Early clinical experience suggested the usefulness of the method in the evaluation of diseases in organs with high radiographic contrast.

Arteriovenous Fistula↗