Introduction
The case report evaluates the clinical and radiological success of early reposition, posterior decompression, posterolateral fusion and stabilization by titanium pedicle screws and rods, ...performed within six hours after injury in young patient with C-type second lumbar vertebrae (L2) fracture.
Material and Methods
22 years old male patient presented in our Clinic with C-type L2 fracture after accident on work site when a part of truck engine felt on his back. The severity of injury was determined using the ASIA (American Spinal Injury Association) scale. Preoperative ASIA impairment scale was evaluated as grade C, with L2 as the most caudal segment with normal motor function. ASIA muscle grading was grade ⅖ evaluated bilaterally on knee extensors, ankle dorsiflexors, long toe extensors and ankle plantar flexors. Patient had voluntary anal contraction and normal anal sensation. ASIA sensory pin prick and light touch scores were in the normal range. Concomitant injuries included transverse process fractures of first, third and fourth lumbar vertebrae (L1, L3, L4) with dislocation, bilateral pneumothorax, fracture of eighth rib on right side and right-sided pulmonary contusion. MSCT showed multifragmentary fracture of anterior and posterior elements of L2 with dislocation and luxation. Preoperative treatment included corticosteroid therapy according to NASCIS III protocol and was continued 3 days postoperatively. Surgery was performed within 6 hours after injury. Reposition of lumbar luxation, posterior decompression, stabilization by titanium pedicle screws and rods and posterolateral fusion with autologous bone graft was done. Postoperatively patient wore a thoracolumbar orthosis for 12 weeks. Physical therapy started second day after surgery and was continued for 12 weeks.
Results
Patient underwent neurological and radiological evaluation 3 days and 12 weeks postoperatively. MSCT and MR imaging were performed. 3 days postoperatively ASIA impairment scale was grade D, showing neurological recovery on lower limbs with muscle grading ⅘ on knee extensors, ankle dorsiflexors, long toe extensors and ankle plantar flexors. 12 weeks postoperatively ASIA impairment scale remained D but complete motor recovery was noticed on knee extensors and long toe extensors bilaterally. Radiological examinations showed residual dislocation in L1/L2 segment with faset joints subluxation and right-sided foraminal stenosis. 12 weeks postoperatively patient was walking independently with residual motor deficit seen on ankle dorsiflexors and ankle plantar flexors on both legs.
Conclusion
In young patient with C-type lumbar fracture and incomplete neurological deficit open reposition, posterior decompression, posterolateral fusion and instrumented stabilization is a safe and effective procedure. It is important to involve corticosteroid therapy and to perform a surgery in early phase after traumatic incident. Our results showed that there is a great possibility of neurological recovery if the surgery is performed within 6 hours after injury.
Metastatska bolest kralježnice je dosta učestala i zasigurno zaslužuje pozornost i liječenje zbog visoke vjerojatnosti da bi inače bolesnici s karcinomom ostali oduzeti u svojim posljednjim mjesecima ...života. Novija postignuća i shvaćanja ponašanja raznih tipova tumora te unaprjeđenja u kirurškim tehnikama omogućuju evoluciju algoritama, pogotovo kada se kirurško liječenje razmatra. Ovaj rad daje pregled postupka donošenja odluka i ističe razne kirurške mogućnosti koje su trenutno dostupne.
Spontaneous splenic rupture is a rare but potentially fatal complication of infectious mononucleosis. Abdominal pain is uncommon in infectious mononucleosis, and splenic rupture should be strongly ...considered whenever abdominal pain occurs. The onset of pain may be insidious or abrupt. The pain is usually in the left upper quadrant.
To indicate that infectious mononucleosis is not always the innocent kissing disease, but could be complicated with splenic rupture as a life-threathenig condition.
Our first case is described and a short literature review is provided. We report on the case of a 27-year-old man with infectious mononucleosis who had spontaneous splenic rupture that was successfully managed by splenectomy. On admission, he was febrile (38.5 degrees C) with hepatosplenomegaly, and had a blood pressure of 100/70 mm Hg. Six hours later, the patient complained of increasing abdominal pain. Abdominal ultrasound and computed tomography showed a 16.5 cm heterogeneous splenomegaly with subcapsular hematoma as well as free ascites. Laparotomy confirmed spontaneous rupture of the splenic capsule with active abdominal bleeding. Splenectomy was performed with a good clinical response. Examination of the spleen revealed a ruptured capsule with a subcapsular hematoma.
Infectious mononucleosis is the most common infectious disease to result in spontaneous spleen rupture. The prognosis is favorable when diagnosis is made on time and correct treatment is started immediately. Although splenectomy was advocated as definitive therapy in the past, numerous recent reports have documented good outcomes with non-operative management. Based on the literature review, an approach to the management of a spontaneously ruptured spleen secondary to infectious mononucleosis is suggested. Non-operative management can be successful in hemodynamically stable patients, i.e. in patients with subcapsular hematoma without overt rupture of the capsule to avoid complications of splenectomy (e.g. post-splenectomy sepsis).
We report on a 27-year-old man with infectious mononucleosis who had spontaneous splenic rupture that was successfully managed by splenectomy.
This paper deals with the reflections on the problems involved in the marketing of health care services. There are a number of particularities and limitations requiring a creative approach to the ...application of marketing to health care organizations. The first part of the paper summarizes theoretical contributions on specific characteristics of services marketing in health care. Exploratory research of the perceptions among surgeons of health services marketing, which is described in the second part, provides a useful insight into the possibility of applying marketing to specialist surgical services. Research was conducted among general surgeons employed at Croatian public health care organizations. Results show a discrepancy between the awareness of services marketing and its application to surgical practice. Continuous education is necessary to better acquaint surgeons with services marketing as a business philosophy, which may improve performance in the provision of health services. (PUBLICATION ABSTRACT)
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