Management of cement vertebroplasty in the treatment of vertebral hemangioma.

BACKGROUND: The vertebral hemangiomas are benign vascular lesions occurring in spine. Although uncommon, symptomatic vertebral hemangiomas can be painful and can limit daily activities. A number of methods have been used in the treatment of symptomatic and aggressive vertebral hemangioma, but none of them is optimal. Treatment with cement vertebroplasty showed very good results. This study aims to illustrate the validity of the treatment with cement vertebroplasty in patients with painful vertebral hemangiomas. PATIENTS AND METHODS: From January 2000 to January 2007, 24 patients were treated by percutaneous vertebroplasty because of hemangioma: 16 thoracic, 8 lumbar. There were 11 males and 13 females. The average age at the time of surgery was 48 years. All the patients complained of a pain syndrome resistant to continuing medication. All patients underwent X-ray examination, CT-scan and MR of the involved level preoperatively. A unipedicular approach under fluoroscopic guidance has been performed in all patients. All procedures have been carried out under the local anesthesia. The mean follow-up was 5.8 years. RESULTS: In all the patients a successful outcome has been observed with a complete resolution of pain symptom. Extravertebral vascular cement leakage has been observed in 3 patients, without any clinical radicular syndrome onset due to the epidural diffusion. Clinical and radiological follow-up showed stability of the treatment and absence of pain in all patients. CONCLUSION: Percutaneous treatment with vertebroplasty for symptomatic vertebral hemangiomas is a valuable, less-invasive, and a quick method that allows a complete and enduring resolution of the painful vertebral symptoms without findings of the vertebral body's fracture.

[Penetrating combat injuries of the colorectal region]. / Penetrierende Kriegsverletzungen der Colorectalregion.

INTRODUCTION: Colorectal war injuries can be treated with primary repair or by colostomy. We report our experience with both treatments. METHODS: During the Croatian war from July 1991 to March 1994, 155 patients with colorectal injuries were treated at the Surgical Clinic, University Hospital Split. This group represents 7% of all patients (n = 2220) with gunshot and shrapnel wounds treated in this period at our clinic. The median patient age was 24.7 years (range 14-70 years). The majority of the patients (96.7%) were male. Concomitant injuries of the colon (83.7%) and rectum (69%) were found more frequently than isolated ones. 50 patients were operated on as emergencies in our clinic, while 105 were operated on in field hospitals. In 28 patients primary repair of the colorectal injury was performed (without derivation), whereas 127 patients were treated by colostomy. In those patients 106 wounds were closed electively during a second operation. The average in hospital stay was 32.3 days (range 10-65 days). RESULTS: Using PATI and FCIS scores for colorectal injuries, 80% of our patients had life-threatening injuries. In the cases with primary repair the percentage of complications was high (92%). In the cases with the diverting colostomy it was only 34%. The high complication rate in the cases with primary repair was directly related to the presence of the anastomotic leaks and subsequent peritonitis. Explorative laparotomy was an effective diagnostic tool especially in the field hospitals. The overall mortality rate was 3.2%. CONCLUSION: In our operative strategy we preferred derivation operations in order to decrease major complications due to anastomotic leakage or peritonitis.

[Splenorrhaphy and partial splenectomy as an alternative to splenectomy in trauma--overview]. / Splenorafija i parcijalna splenektomija kao alternative splenektomiji kod traume--povijesni pregled.

For many year splenectomy was considered to be the only possible surgical treatment for all laceration of the spleen, whether resulting from abdominal contusion or not. Such factors have led to changes in practical attitudes to splenic lacerations but it would seem that indications for a conservative approach must be based upon the underlaying condition and the precise nature of the lesions. Splenectomy should be done promptly in cases of concomitant splenic and cerebral injury and in patients with injury of multiple organ systems. Present knowledge of the complications of anesplenia has led to new surgical techniques for conservation of splenic tissue. Splenorrhaphy was a frequently used treatment in the non-complicated traumatic lesions. The decision of whether or not to remove an injured spleen is one which must be made intraoperatively by the surgeon. Operative splenic repair and preservation of the spleen often requires considerable experience. We conclude that surgical splenic preservation is a viable and safe procedure, especially in infants and young children.

[Injuries of the urinary bladder]. / Povrede mokracnog mjehura.

The authors analyse 32 patients with injuries of the urinary bladder treated in Clinical Hospital Centre "Firule" in the period from 1976 to 1988 (Figure No 1). There were: 10 contusions of the bladder (31%), 5 extraperitoneal ruptures (16%), 16 intraperitoneal ruptures (50%), and 1 combined extra and intraperitoneal rupture (3%). The isolated injuries of the bladder are rare. Extraperitoneal ruptures most of them are connected with the pelvic fractures. The intraperitoneal ruptures of the bladder were connected with splenic rupture in 7 cases, with the rupture of the rectum in 1 case, with the vaginal rupture in 1 case, with the rupture of the aorta in 1 case, with the rupture of the ovarian cyst in 1 case and with the rupture of the ileum in 1 case. All the patients with the urinary bladder rupture were operated, what got sufficient drainage of the urine, and drainage of the perivesical space and closure of the defect of the bladder.

[Injuries of the pancreas]. / Ozljede pankreasa.

At the Surgical Clinic of the University Hospital Center "Firule" Split in the period from 1977-1987. years were treated 12 patients with injuries of the pancreas. That is 4% of all abdominal injuries treated in those 11 years. We presented 10 patients after blunt abdominal trauma and 2 after penetrating injuries of abdomen associated with acute pancreatic injury. The most important is early recognizing injury of pancreas and making the time from moment of injury to surgical exploration shorter as much as possible. There is no early specific signs of injury of pancreas and the key to treatment is accurate evaluation of extent of injury.

[Injuries of the diaphragm examined from 1976 to 1988]. / Povrede dijafragme posmatrane kroz period od 1976-1988, godine.

The authors review 28 patients with the diaphragmal injury treated at the Surgical Clinic of the Clinical hospital centre "Firule" Split in the period from 1976 to 1988. The distribution of the injuries in consideration of age and sex, the most frequent lesions of the organs connected with the diaphragmal injury, number of the patients in different years as the structure inside this group of the patients is shown.

[Epidemiologic aspects of splenic injuries observed from 1958 to 1988 in our department]. / Epidemioloski aspekt povreda slezene posmatran kroz period od 1958. do 1988. godine na nasem odjelu.

The authors have reviewed the frequency of the patients with splenic injuries treated on the Surgical clinics of the Clinical Hospital Centre "Firule" Split in period from 1958 to 1988. The distribution of the splenic injuries in consideration to age, sex such as the lethality inside this group is shown.

[Permanent decrease in immune function in patients with splenectomy for trauma]. / Dugotrajno smanjena imuna funkcija kod pacijenata splenektomiranih zbog traume.

The authors describe the peripheral blood analyses in patients splenectomized for trauma in consideration on the concentration of the immunoglobulins total complement CH50 levels, T and B lymphocyte populations and compare this with the control group. The levels of the IgM were significantly decreased (p0.001) in splenectomised while the levels of the IgA and IgG were significantly increased (for IgA - p0.001, for IgG p0.01). Total lymphocyte count averaged 54501999 in splenectomized, with number of T cells 2463930 and B lymphocyte 460236. The control group showed total lymphocyte count 460236. The control group showed total lymphocyte count 520235 (p0.001) with number of T cells 314147 (p0.001) and number of B cells 7434 (p0.001), what is significantly less than in splenectomized population. The level of total complement CH50 in splenectomized population was 11216 (p0.01), what is significantly less than in the control group 12515. These data demonstrate persistent abnormalities in immune function and suggest a possible explantation for the increased rizu of sepsis in this group of patients.

[Perforation of the small intestine as a sequela of blunt injuries of the abdomen during a 12-year period]. / Perforacija tankog crijeva kao posljedica tupe ozljede abdomena tijekom 12-godisnjeg razdoblja.

The paper presents 44 cases of small intestine perforation caused by blunt abdominal trauma in a period of 12 years. 34 patients were men and 10 were women. The patients were aged from 10 to 82 years which gives an average age of 39 years. The average incidence of cases was 4 per year. In 23 patients associated injuries were diagnosed, namely: 5 spleen ruptures, 3 liver ruptures, 5 colon perforations, 1 pancreas injury and 1 kidney injury. Associated injuries in which the dominant syndrome was intraabdominal hemorrhage presented no diagnostical difficulties seeing that the results of punction or abdomen lavage indicated immediate laparotomy. In patients with isolated injury of the small intestine and clinical signs of peritonitis laparotomy was treated with a two layer suture in 32 patients; in 12 patients resection with T-T or L-L anastomosis was made. Associated injuries were treated in the same act. Of 44 patients treated in our Clinic 37 were treated successfully, while 7 died.