Persistent nerve root compression by buckling of the longitudinal ligament after chemonucleolysis.

Buckling of the posterior longitudinal ligament with compression against the thecal sac was the cause of persistent positional back pain after chemonucleolysis. Computed tomography in the supine and prone positions was helpful in making the diagnosis, and the cause was confirmed at laminectomy.

Stereotactic aspiration of a brain stem hematoma.

A medical student developed a progressive mesencephalic lesion found to be cystic in nature by computed tomographic (CT) scanning. Stereotactic aspiration of a pontomesencephalic hematoma was carried out twice, and the patient recovered. Angiography and CT scanning demonstrated a vascular lesion compatible with a venous angioma.

The abducted arm as a sign of ruptured cervical disc.

A helpful clinical sign of ruptured cervical disc is pain relief upon arm abduction. When the disease process is spondylosis with foraminal stenosis, changing arm position does not relieve pain. Anatomical considerations are discussed.

Spontaneous cervical epidural hematoma. A consideration of etiology.

The medical literature relating to spontaneous cervical epidural hematoma has been reviewed, and two new cases have been added. In total, 43 cases have been analyzed in detail, and the authors present some new hypotheses as to the pathophysiology of this disorder.

Osteolytic skull lesions secondary to trauma. Report of two cases.

Two patients with posttraumatic osteolytic skull lesions are presented and discussed. One was operated on, and pathological examination confirmed an inflammatory reactive process within the bone lesion.

Consequences of dural defects acquired in infancy.

Four infants underwent craniectomy for craniosynostosis and subsequently developed an expanding cranial defect with herniation of brain. All four had an unrepaired laceration of the dura. The pathophysiology of this entity and of the growing fracture of childhood are discussed, and a unified interpretation of the consequences of unrepaired dural defects is proposed.

Continuous intraoperative electromyographic recording during spinal surgery.

One hundred fifty patients underwent spinal surgery for radiculopathy; of these, 120 underwent lumbar surgery and 30 had cervical operations. All of the surgeries were performed to alleviate symptoms due to disc herniation, spondylosis, or both. During the surgical procedures continuous intraoperative electromyograph recordings were taken from the muscle corresponding to the involved nerve root. In baseline recordings taken in the operating room 10 minutes before lumbar surgery, electrical discharge or firing was recorded from the muscle in 18% (22 of 120 patients) of the cases. Once the nerve was decompressed, muscle firing ceased. Electrical discharges were produced with regularity on nerve root retraction. This study concludes that continuous electromyograph monitoring can be accomplished easily and yields valuable information that indicates when the nerve root is adequately decompressed or when undue retraction is exerted on the root.

Protruding arachnoid granulations mimicking dermoid cysts.

This is the report of two children who had prominent arachnoid granulations that were mistaken clinically for dermoid cysts. These lesions appeared in the midline, primarily posteriorly. During surgery, the lesions extended through the dura connected by a stalk. A pathologic examination confirmed the lesions to be arachnoid granulations.

Health professionals' knowledge of women's health care.

Until 1986, the only issues in women's health which received direct attention were those related to childbearing. At that time the National Institutes of Health made inclusion of women in research a criteria for funding. Since then, the knowledge base to guide disease prevention and treatment of women has grown dramatically. Unfortunately, the incorporation of these data into clinical practice has been much slower. The purpose of this needs assessment was to establish a comprehensive data base on which future programming decisions could be based. Areas of interest identified by health care providers included stress reduction, breast health, prevention of heart disease, and osteoporosis. Other topics that emerged were menopause and reproduction issues, cancer prevention, domestic violence, substance abuse, nutrition, and weight control. These data suggest topics for future programming.

Direct demonstration of transsynaptic degeneration in the human visual system: a comparison of retrograde and anterograde changes.

Transneuronal degeneration of retinal ganglion cells was directly demonstrated in a patient who had unilateral removal of the striate cortex forty years prior to necropsy. For comparison, another case is presented showing anterograde transneuronal atrophy forty years after enucleation of one eye.