Cerebrospinal fluid leak treated by aspiration and epidural blood patch under computed tomography guidance.

BACKGROUND AND OBJECTIVES: Cerebrospinal fluid (CSF) leakage secondary to surgery of the spine is usually treated by drainage of CSF through a subarachnoid catheter or surgical repair of the dural tear. We present 2 cases in which the pseudomeningocele was treated by aspiration of the leaked CSF and blood patch under computed tomography (CT) guidance. CASE REPORT: Two patients had headache after spine surgery. Physical examination showed a bulging accumulation of fluid at the laminectomy site. Aspiration of the fluid followed by injection of the patients' blood was performed aseptically under CT guidance. The patients had resolution of their headache, and follow-up showed no recurrence of the CSF leak. CONCLUSIONS: CSF leak secondary to a surgical tear of the dura can be successfully treated by aspiration of the fluid followed by injection of the patient's blood. CT guidance is recommended to assess the extent of the CSF leakage, determine the degree of evacuation of the leaked CSF, and to confirm the injection of the blood into the epidural space and the space created by the pseudomeningocele.

[The effect of dental plaque on human salivary protein composition]. / Uticaj zubnog plaka na proteinski sastav humane pljuvacke.

The investigation of mixed saliva protein structure of persons with healthy oral and dental tissues before and after detailed cleaning of teeth from dental plaque. Electrophoretic examination of liophylised saliva of children aged 13-15 years was done on polyacrylamide gel SDS. The comparison was performed compared to the normal human serum in pulled sample. Obtained results revealed that electrophoresograms of persons with healthy periodontal and dental tissues were the same as electrophoresograms of persons with periodontal disease and caries. Electrophoresogram was improved after the detailed teeth cleaning and plaque removal and was similar to the sample of persons with healthy periodontal and dental tissues. Electrophoresograms before and after dental treatment were used for the comparison. The alterations of protein structure of mixed saliva showed that the tendency of establishing the dynamic balance in relation to adjacent tissues existed inspite of continual secretion.

Lymphatic drainage after lumbar surgery.

STUDY DESIGN: A case report of lymphatic drainage after anterior retroperitoneal debridement and reconstruction for lumbar osteomyelitis. OBJECTIVES: To report a case of protracted lymphatic drainage after anterior lumbar surgery, a complication that has not been reported previously. SUMMARY OF BACKGROUND DATA: Lymphatic drainage after transthoracic surgery is a well-recognized complication. The possibility of lymphatic drainage after anterior lumbar surgery is less likely to be considered. METHODS: The cause, clinical symptoms and appearance, treatment, and differential diagnosis are reviewed. RESULTS: Lymphangiography is useful in diagnosis and should be performed early if the diagnosis is in doubt. Percutaneous drainage can facilitate early wound healing. CONCLUSION: Lymphatic drainage should be considered in the differential diagnosis of postoperative wound drainage, particularly after surgical debridement for osteomyelitis.

Anatomic considerations in lumbar posterolateral percutaneous procedures.

STUDY DESIGN: Intervertebral foraminal anatomy of L2-S1 was investigated by the anatomic dissection of 96 foraminal levels in 12 human cadaveric spines. OBJECTIVES: The goal of this study was to determine the dimensions of the "safe zone" and a safe point of insertion in percutaneous intradiscal procedures and the largest safe working cannula diameter. SUMMARY OF BACKGROUND DATA: Working cannulas are used in percutaneous lumbar procedures. The dimensions of the safe zone of insertion and determination of the optimal cannula size based on these measurements and point of insertion are unclear from the literature. METHODS: Safe zone dimensions from L2-L3 to L5-S1 were determined as were two cannula diameters, C1 and C2. C1 was the maximal cannula size that can be placed within the safe zone. C2 is the maximal size allowable when the point of insertion lies in the midline of the pedicle. RESULTS: The average triangular safe zone was 18.9 mm wide and 12.3 mm high; the hypotenuse measured 23.0 mm. The maximum C1 diameter ranged 5.0-10.0 mm. The corresponding safe point of insertion lay along the medial one third of the pedicle. The maximum C2 diameter ranged 4.0-8.9 mm. The corresponding safe point of insertion lay in the midline of the pedicle. CONCLUSIONS: Either a 7.5-mm cannula placed in line with the medial one third of the pedicle or a 6.3-mm cannula located in the midline of the pedicle appears safe.

Results of operative treatment of idiopathic scoliosis in adults.

We compared the results in eighty-one patients (average age, fifty-six years; range, forty-three to eighty-three years) who had had operative treatment of idiopathic scoliosis with those in thirty patients (average age, fifty-eight years; range, forty-five to seventy years) who had declined operative treatment. Seventy-six individuals (average age, forty-eight years; range, thirty-five to seventy-four years) who did not have scoliosis served as a control group. The average duration of follow-up was five years (range, two to seventeen years). The population base consisted of 454 patients who were seen between 1970 and 1985. The treated patients were drawn from a group of 160 patients for whom an operation had been recommended; 110 patients agreed to the operation and fifty refused. The remaining 294 patients had curves of insufficient severity to warrant concern about progression, had symptoms unrelated to the scoliosis, or had curves that did not necessitate any intervention. The functional status since the operation (for the treated patients), since recommendation of the operation (for the untreated patients), or within the last ten years (for the control group) was evaluated with a comprehensive questionnaire designed to elicit details regarding pain, fatigue, and any disability in the performance of twenty-six activities of daily living. At the most recent follow-up examination, the treated patients reported a significantly greater decrease in pain and fatigue and significantly more improvement in self-image and in the ability to perform physical, functional, and positional tasks than did the untreated patients (p = 0.0001).

A thoracolumbar epidural hematoma simulating a disc syndrome.

Epidural hematoma, a rare entity, may occur spontaneously, although a factor such as anticoagulation therapy is more frequently the cause. Epidural hematomas most commonly manifest with pain and neurologic deficit. Only six cases of lumbar hematoma simulating a herniated disc syndrome have been reported in the literature. In this article a thorough knowledge of the natural history and the differential diagnosis of disc disease as well as the importance of a complete physical examination are emphasized. Sagittal MRI imaging, as shown here, has proved to be an important adjunct in the evaluation of multilevel spinal disorders.

[Acid and basic glycoproteins of human saliva. 2. Investigation of glycoprotein of parotid saliva]. / Glikoproteini humane pljuvacke. II. Ispitivanje glikoproteina parotidne plkuvacke.

We applied the standard diagnostic electrophoretic method on lyophilized human parotid saliva under the appropriate conditions (pH = 8.6 voltage 90 V and time of 30 seconds). The variation of the essential electrophoretic parameters (volume, time, voltage and pH) gave the best protein separation results in the natural range (pH = 7). Also in all cases, except pH = 11, the catodic side was richer in fractions than the anodic one; this was the qualitative characteristic of the protein component of the parotid saliva. Consequently, the protein content of the parotid saliva was rich in basic elements with the typical electrophoregram and densitogram for human serum and mixed saliva. The Pol-E agarose film method is appropriate for investigation and detection of the protein content in human, especially parotid saliva. It also enables differentiation of samples of mixed and parotid saliva on the basis of appropriate densitograms which are the consequence of different protein and especially glycoprotein components of the content.

Anatomic consideration for sacral screw placement.

Instrumentation of the lumbosacral spine increasingly involves screw fixation to the sacrum. Recommended locations and techniques for screw placement vary, particularly when bicortical purchase of the sacrum is performed. The purpose of this study was to describe the critical anatomy and potential injuries to neurovascular and visceral structures anterior to the sacrum. Lack of awareness can lead to life-threatening complications. The study included 22 fresh human cadavers with no prior spinal surgery. Specimens were placed in a prone position, and the lumbosacral spine was exposed. Two 6.5-mm screws were inserted using one of two techniques, respectively: Starting just inferior to the S1 facet one screw was angled 25 degrees caudally and 30 degrees laterally; in the second technique, lateral inclination was increased to 45 degrees. In addition, all specimens had screws placed in the S2 pedicles. An anterior dissection was performed to allow evaluation of the neurovascular and visceral structures at risk for injury by, or adjacent to, the screw tips. All significant neurovascular structures in the area of concern were constant in position. The internal iliac vein and the lumbosacral nerve trunk were most at risk for injury by the 30 and 45 degrees laterally directed screws. The sigmoid colon, though close to the S2 screw, was protected by its mesentery. Screws placed in the S1 pedicle were least likely to injure the neurovascular bundle. A lateral and a midline safe zone were identified.

Radiographic assessment of sacral screw placement.

Sacral screw penetration of the anterior sacral cortex runs the risk of injury to neural, vascular, and visceral structures. This study examined the accuracy of the standard anteroposterior (AP) and lateral roentgenographic views as compared to a modified pelvic inlet (MPI) view in determining sacral screw penetration and angulation. Ten human cadaveric specimens were studied. Screw depth and screw angulation in the transverse plane were best evaluated with the MPI view. Screw penetration was overestimated by 0.4 mm (+/- 2.2 mm) on the MPI view, whereas the lateral view overestimated screw penetration by 2.8 mm (+/- 4.7 mm). Screw angulation in the sagittal plane could only be evaluated by the lateral view. The standard anteroposterior view provided little useful information on sacral screw orientation. To study all parameters of sacral screw placement, the radiographic series should include a modified pelvic inlet view and a lateral sacral view.

[Acid and basic glycoproteins of human saliva. 1. Investigation of glycoproteins of mixed saliva]. / Glikoproteini humane pljuvacke. I. Ispitivanje glikoproteina mesovite pljuvacke.

By investigating the possibility of the use of elektrophoretic method on the Pol-E agarose film in human mixed saliva, we concluded that these samples should be lyophilised, and the content of proteins of dissolved samples should sorrespond to the concentration which is situated in the normal human serum. The electrophoretic mobility of fractions of mixed saliva in each varied condition (pH = 5,9 pH = 7 pH = 8,6 and pH = 11) of time, of voltage and of different sample volume applicated to the gel. Thet mobility was exclusively anodic. The majority of fractions (5 fractions) xas separated at pH = 11 and a prolonged of electrophoresis. These fractions were acid and of the biggest electrophoretic mobility. According to the place of separation and intensity (in relation to the normal human serum) it was evident that it was question of acid fractions. In mixed saliva characteristic glyco-and phosphoproteins and albumins were registered. This method enables the registration of enumerated fractions, though it is not selective enough for saliva as a biological material.

[Possibility of use of electrophoresis on polyacrylamide gel with SDS in native human saliva]. / Mogucnost primene elektroforeze na poliakrilamidnom gelu uz dodatak SDS na uzorke nativne humane pljuvacke.

The pooled mixture of mixed and parotid samples of human saliva were investigated. The contents of proteins used in gel were lower than 300 micrograms and higher than 300 micrograms, depending on electric power and used boiled water bath. We established that the method according to Laemmli requires the mixture of buffer samples in which the content of proteins is over 300 micrograms, boiled one minute and a half in water bath. The electrophoretic process was carried out with electric power of 1 mA per sample and reproducible results were obtained. This method can also be simply used in the examination of acid proteins and basic characteristic, which are of great importance in the maintenance of normal physiological position of oral tissues. This new method can be performed without previous concentration or liophylisation of saliva.

[Isoelectric focusing of mixed saliva proteins in individuals with HGH caries prevalence]. / Izoelektricno fokusiranje proteina mesovite pljuvacke osoba sa frekventnim karijesom.

The protein content of mixed saliva was analysed in patients with low, mid and high caries prevalence by isoelectric focusing in different pH gradient on Servalyt plates. Determination of the protein fractions in pH-3-6.gradient points out a significant increase of glycoprotein fractions of pH = 4.7. The most basic fractions of this range (pH = 5.9) are disappearing within the high caries prevalence. Isoelectric focusing in pH-6-9 gradient points out that with the increase of caries prevalence there is an increase in protein fractions of pH = 8.3. Protein fractions of lysosomal prigin, pH = 10.65, are disappearing with the increase of caries prevalence in all analysed specimens. IEF method on Servalyt plates and polyacrylamid gel enables analysis of the Ca-precipitable acid and base like glyco-and phosphoprroteins (pHi = 4 and 8.3) which are of significance in maintaining physiological properties of the soft and hard teeth tissues.

Treatment of the isolated lumbar intervertebral disc herniation: microdiscectomy versus chemonucleolysis.

A long-term goal of spine surgeons has been to reduce the morbidity, cost, and recuperative period of primary lumbar disc surgery. In this paper, microdiscectomy and chemonucleolysis are evaluated and compared with respect to achieving these goals. Two groups of successive, noncompensation patients numbering 50 each were studied. All patients met standard clinical and imaging criteria for an isolated lumbar vertebral disk herniation. One group was treated with chemonucleolysis and the second with micodiscectomy. Average follow-up exceeded 3 years. While both treatment groups achieved the stated goal when compared with traditional laminectomy, the microdiscectomy groups demonstrated statistically superior treatment results, with reduced time to return to work, and fewer required subsequent surgical procedures.