RESUMO
BACKGROUND: Because of the severity and fatal outcome of traumatic vertical atlantoaxial dislocation (AAD), most patients may die in the early post-traumatic period. The post-injury management of patients with vertical AAD has been rarely reported. Improper treatment may lead to disastrous outcome and further aggravate the neurologic symptoms. CASE PRESENTATION: This report describes the perioperative management and outcome of a rare improperly treated patient with traumatic vertical AAD. The severe pulmonary infection of this patient prevented further surgery for vertical AAD. After placement of a halo vest, combined with effective antibiotic drug treatment, the patient's pulmonary infection was brought under control. The patient underwent atlantoaxial fusion using C1 lateral mass screws and C2 pedicle screws with the assistance of the halo vest. A computed tomography scan at 1 year follow-up indicated that the bone graft was fused and the patient was able to walk independently. CONCLUSION: Skull traction is contraindicated in patients with traumatic vertical AAD. Application of a halo vest can be used for temporary fixation of the cervical spine and atlantoaxial fixation should be performed to maintain the stability of atlantoaxial articulation.
Assuntos
Articulação Atlantoaxial , Luxações Articulares , Parafusos Pediculares , Fusão Vertebral , Traumatismos da Coluna Vertebral , Humanos , Vértebras Cervicais/cirurgia , Luxações Articulares/cirurgia , Resultado do Tratamento , Fusão Vertebral/métodos , Articulação Atlantoaxial/diagnóstico por imagem , Articulação Atlantoaxial/cirurgia , Articulação Atlantoaxial/lesõesRESUMO
RATIONALE: Charcot arthropathy, also known as Neuropathic arthropathy (NA), is an unusual chronic degenerative disease. To date, there exists a paucity of research on NA caused by syringomyelia. PATIENTS CONCERNS: A 52-year-old non-diabetic female presented with progressive swelling, pain and limited movement in her left shoulder joint combined with asthenia of her left upper extremity for three months. DIAGNOSES: Neuropathic arthropathy of the shoulder associated with the cervicothoracic syrinx and basilar impressions was diagnosed. INTERVENTIONS: The treatment is directed to its potential cause to cease its progression. A posterior fossa decompression (PFD) was conducted for this patient. OUTCOMES: Postoperatively, the patient's symptoms were relieved and the size of syrinx was reduced at the 6-month follow-up. LESSONS: Taken together with 34 previous reports identified from a PubMed search, an analysis of 35 cases of Charcot arthropathy was conducted. Surgical decompression is an effective treatment, but the optimal treatment remains controversial. Thus, the aim of this literature review was to remind us to diagnose the potential cause as early as possible and we should spare no efforts on the exploration of etiology and adjuvant therapy for this disease.
Assuntos
Artropatia Neurogênica/etiologia , Articulação do Ombro/inervação , Siringomielia/complicações , Artropatia Neurogênica/diagnóstico , Artropatia Neurogênica/cirurgia , Descompressão Cirúrgica , Feminino , Humanos , Pessoa de Meia-Idade , Articulação do Ombro/cirurgia , Resultado do TratamentoRESUMO
OBJECTIVE: To evaluate the effectiveness and safety to treat Chiari malformation with the surgical decompression of the foramen magnum under endoscope. METHODS: In 1 patient with Chiari malformation with syringomyelia, we made a 2.5 cm incision under the endoscope for the surgical decompression of the foramen magnum. RESULTS: All the symptoms and signs were remarkably relieved, and the patient could walk the next day and was discharged 3 days after the operation. CONCLUSION: The endoscope-assisted decompression of the foramen magnum is a safe and effective surgical method to treat Chiari malformation.
Assuntos
Malformação de Arnold-Chiari/cirurgia , Descompressão Cirúrgica/métodos , Adulto , Malformação de Arnold-Chiari/complicações , Feminino , Forame Magno/cirurgia , Humanos , Siringomielia/etiologia , Siringomielia/cirurgia , Resultado do TratamentoRESUMO
BACKGROUND: Seizures are a potentially devastating complication of brain tumors. Several studies in the past have attempted to demonstrate that prophylactic antiepileptic drugs (AEDs) in patients with brain tumors can decrease the incidence of seizures. However, it is currently unclear whether AEDs should be routinely administered to patients with brain tumors who have never had a seizure. OBJECTIVE: A meta-analysis of randomized trials was conducted to estimate the effectiveness of seizure prophylaxis in people with brain tumors. METHODS: A range of electronic databases were searched (1966-2014): MEDLINE, the Cochrane Library Database, EMBASE, CINAHL, Web of Science and the Chinese Biomedical Database (CBM) without language restrictions. Two independent reviewers assessed trials for eligibility and quality, and meta-analysis was performed using the STATA 12.0 software. Integrated Odd Ratio (OR) with its corresponding 95% confidence interval (95%CI) was calculated. RESULTS: Six RCTs were included with a total of 547 patients with brain tumors. The meta-analysis results revealed that patients with brain tumors who received prophylactic antiepileptic interventions did not have significantly lower epilepsy incidence than those in controlled groups (OR=0.939, 95%CI=0.609-1.448, z=0.29, P=0.775). Sensitivity analysis suggested the statistical results were robust. No publication bias was detected in this meta-analysis (P>0.05). CONCLUSION: Although some past studies indicated AEDs can be used in patients with brain tumors to relieve epilepsy, present integrated evidences cannot show in unequivocal terms that brain tumor patients can benefit from seizure prophylaxis.
Assuntos
Anticonvulsivantes/uso terapêutico , Neoplasias Encefálicas/complicações , Convulsões/prevenção & controle , Humanos , Convulsões/complicações , Resultado do TratamentoRESUMO
Hong Kong's health system was established within the framework of a perfect market-oriented economic matrix, where there are wide-ranging social security and medical service systems. There are many differences in the economic foundations, social systems, and ideologies between Hong Kong and mainland China, therefore, it would probably be entirely impossible to copy Hong Kong's health care system mode. However, under the framework of one country, two systems, the referential significance of relevant concepts of Hong Kong's medical service system to mainland China cannot be ignored, and merits further study.