Epidural hematoma (EDH) of the spine represents an uncommon neurosurgical disorder that sometimes requires emergent surgical decompressive therapy. Traumatic EDH of the cervical spine is exceedingly ...rare. The hematoma is usually located dorsally in the epidural space. We present one case of acute EDH located ventrally in the cervical spine. Special emphasis is placed on the role of spinal endoscopy in surgical treatment.
After a fall from a tree, a 69-year-old man with rapidly increasing tetraparesis was referred to our institution. Plain films of the cervical spine revealed nothing abnormal. The results of computed tomography were highly suspicious for EDH. A myelogram and a post-myelographic computed tomographic scan demonstrated the lesion and its extent craniocaudally.
Emergency decompressive surgery and removal of the hematoma were performed via an anterior approach. Control for total removal of the EDH was achieved using a flexible neuroendoscope providing visualization of the anterior epidural space from the foramen magnum to the T1 level. Surgery was accomplished by vertebral body replacement and anterior plating.
Spinal endoscopy seems to be a useful tool in the surgical treatment of spinal EDH, providing control of the adjacent levels and allowing the limitation of the extent of bony resection.
The morphology of the sinusoidal and postsinusoidal hepatic vein system in liver cirrhosis is shown by postmortem venography, microangiography and micropreparation. The normal angioarchitecture of ...the sinusoidal and hepatic vein system in lost in cirrhotic alteration of the liver. The hepatic veins are partly stenosed and displaced. Regenerate nodules, pseudolobules and extremely vascularized connective tissue septa, characterize the venous parenchymogram and microangiogram. The size of the regenerate nodules corresponds well to a granulomatous contrast of the parenchyma. The disordered intrahepatic angioarchitecture has clinical significance for hemodynamics and hepatic venous pressure measurement.
Iotrolan is a new nonionic, dimeric contrast medium that is distinguished by its special physicochemical and low chemotoxic properties. It displays near isotonicity with blood and cerebrospinal fluid ...in all clinically used concentrations (190, 240, and 300 mg I/ml). The controlled, double-blind study of iotrolan versus iopamidol presented here shows that iotrolan is significantly superior to the monomeric contrast medium in lumbar and direct cervical myelography. Use of the dimeric contrast medium reduced not only the incidence of side effects, but also their severity and duration. The chemotoxicity of contrast media commonly used was significantly less with iotrolan in all neuroradiologic diagnostic studies of the spine. The diagnostic quality of lumbar and direct cervical myelography with iotrolan was high. In this randomized, double-blind study versus iopamidol, iotrolan proved to be the safer and better myelographic agent for contrast studies of the spinal canal.
Currently the diagnosis of tumorous lesions of the carotid bifurcation is the domain of magnetic resonance imaging (MRI) and digital subtraction angiography (DSA). So far, colour Doppler imaging ...(CDI) has not been playing an important part in this field. The aim of this study was to define the diagnostic value of CDI in the evaluation of these tumours related to the big arteries and to compare the different imaging techniques.
6 female patients with suspected tumours of the carotid bifurcation were examined with CDI. Additionally 5 MRI examinations and 3 preoperative diagnostic DSA examinations were performed in the same patients. Pathologically, there were 4 typical carotid body tumours, 1 neuroma of the sympathetic trunk and 1 multifocal paraganglioma of the neck.
In carotid body tumours we found a characteristic broadening of the bifurcation with shifting of the internal carotid artery posteriorly and laterally and of the external carotid artery anteriorly and medially. The highly vascularized tumour is surrounded by the arteries. This combination of ultrasound findings was absent in cases of sympathetic neuroma and multifocal paraganglioma. No additional information was achieved with MRI and DSA.
CDI and MRI evaluation revealed the same diagnostic value in cases of vascularised tumours of the carotid bifurcation. CDI proved to be as accurate as DSA in the imaging of the big arteries and their relationship to the tumour, as well as of the small tumour feeding vessels. Therefore DSA may be omitted as an invasive diagnostic tool in the diagnosis of carotid body tumours.
One hundred three first-time myocardial infarction (MI) patients were randomly assigned to either an experimental or a control condition. Patients completed a cardiac rehabilitation program during ...hospitalization ad were interviewed to assess intentions to follow regimen prescriptions, attitudes toward the prescriptions, coping methods, and he perceived beliefs of others concerning their intentions. Patients were visited at home 30 days after discharge and reassessed on each of the above variables except that their behavior was substituted for intentions and societal adjustment was assessed. The experimental group was given an intervention program which included a discussion of assessment data, identification of problems, and establishment of goals. The assessment was repeated 60 days after discharge. No differences were found between experimental and control groups for either medical regimen adherence or societal adjustment. There was a significant decrease in mean scores for all variables from hospital to 30 days for both groups, but no change from 30 to 60 days. Attitudes and perceived beliefs of others were predictive of adherence, and it was concluded that these variables need to be included in any rehabilitation program.
