A case report of Sustained triumph: 15-year recurrence-free survival following surgical resection of a cervical chordoma in a 15-year-old girl.

Introduction and importance: Chordoma of the cervical spine is a rare condition associated with poor long-term outcomes. This is mainly attributed to its pathological involvement of vital structures such as the cervical roots and vertebral artery (VA). Although the most appropriate management in these cases is total en bloc excision, attaining complete resection is relatively challenging due to the vicinity of the critical anatomical structures mentioned above. Case description: A 15-year-old female with middle cervical spine chordoma was treated by a multidisciplinary team involving neurosurgery and head and neck surgeons utilizing anterior and posterior approaches followed by high-beam X-ray radiotherapy. Histopathological examination matched the description of a chordoma. Fifteen years after the initial excision, the patient maintained her normal neurological function without local recurrence or metastasis. Clinical discussion: The patient underwent surgery in two stages. A posterior approach for C3, C4, and C5 laminectomies was performed in the first stage, with the second stage involving head and neck surgery for complete resection of the tumor. The patient also underwent radiotherapy 3 months after surgery for a total duration of 1 month. The patient is currently 30 years old with no evidence of chordoma recurrence. Conclusion: Patients afflicted with cervical chordomas often find themselves undergoing multiple operations due to high recurrence rates. Fortunately, the utilization of en bloc resection coupled with adjuvant radiotherapy presents a hopeful treatment modality that can serve to substantially reduce recurrence rates, increase survival rates, and ultimately enhance the quality of life.

Inter-Arm Blood Pressure Difference an Indicator of Coronary Artery Disease.

INTRODUCTION: Considering the scarcity of the literature on the association between inter-arms blood pressure difference (IABPD) and coronary artery disease (CAD). AIM: We performed this study to investigate the prevalence of IABPD within the Jordanian population and to assess if it has an association with CAD. METHODS: We sampled patients visiting the cardiology clinics at the Jordan University Hospital between October, 2019 and October 2021 into two groups. Participants were divided into two groups; patients with severe CAD and control group who had no evidence of CAD. RESULTS: We measured the blood pressure for a total of 520 patients. Of the included patients, 289 (55.6 %) had CAD while 231 (44.4%) were labeled as controls who were normal. A total of 221 (42.5%) participants had systolic IABPD above 10 mmHg, while 140 (26.9%) had a diastolic IABPD above 10 mmHg. Univariate analysis demonstrated that patients with CAD were significantly more likely to be older (p < 0.001), of the male gender (p < 0.001), hypertensive (p < 0.001), and having dyslipidemia (p < 0.001). Moreover, they had significantly higher IABPD differences in terms of both systolic and diastolic blood pressure (p < 0.001 and p = 0.022, respectively). Multivariate analysis showed that CAD was a positive predictor of abnormal systolic IABPD. CONCLUSION: In our study, elevated systolic IABPD was associated with a higher prevalence of severe CAD. Patients with abnormal IABPD might be subjected to more specialist investigation as IABPD consistently predicts coronary artery disease, peripheral arterial disease or other vasculopathy throughout the literature.

Splenic artery aneurysm rupture post-anterior cervical discectomy and fusion: Case report & literature review.

INTRODUCTION AND IMPORTANCE: Anterior cervical discectomy and fusion (ACDF) is a regular surgical procedure for correcting spinal deformities and pain relief. There are several rare complications of ACDF, one of which is postoperative hematomas. Here, we report an unexpected case of intra-abdominal hematoma after ACDF with no prior abdominal symptoms or underlying conditions identified since admission. This report will describe the events and interventions that took place for this patient. CASE DESCRIPTION: The patient is a 44-year-old female with a history of neck pain of four-month duration. On Magnetic Resonance Imaging (MRI), a degenerative cervical disk (C5-C6) was identified. Prior surgical history is significant for a C4-C5 ACDF 3 years ago. An anterior cervical discectomy and fusion was performed and the patient was doing well relatively post-surgery. However, in less than 24 h, the patient complained of severe abdominal pain. An abdominal Computerized topography angiogram (CTA) scan revealed internal bleeding and a splenic aneurysm rupture. The patient immediately underwent an urgent laparotomy and splenectomy. CLINICAL DISCUSSION: Splenic artery aneurysm incidence is rare and is detected incidentally by imaging technology in asymptomatic patients or upon rupture. Splenic artery aneurysm rupture can be spontaneous and unpredictable in previously undiagnosed patients leading to life-threatening symptoms of intra-abdominal hemorrhage. CONCLUSION: Patients undergoing ACDF should be monitored closely following surgery for any complications. Physicians should consider the possibility of any signs of hematoma due to underlying conditions that are undiagnosed in order to treat accordingly.