Leo Grandić

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 bodys fracture.

Subbrachial approach to humeral shaft fractures: new surgical technique and retrospective case series study

BACKGROUND There are few surgical approaches for treating humeral shaft fractures. Here we present our results using a subbrachial approach. METHODS We conducted a retrospective case series involving patients who had surgery for a humeral shaft fracture between January 1994 and January 2008. We divided patients into 4 groups based on the surgical approach (anterior, anterolateral, posterior, subbrachial). In all patients, an AO 4.5 mm dynamic compression plate was used. RESULTS During our study period, 280 patients aged 30-36 years underwent surgery for a humeral shaft fracture. The average duration of surgery was shortest using the subbrachial approach (40 min). The average loss of muscle strength was 40% for the anterolateral, 48% for the posterior, 42% for the anterior and 20% for the subbrachial approaches. The average loss of tension in the brachialis muscle after 4 months was 61% for the anterolateral, 48% for the anterior and 11% for the subbrachial approaches. Sixteen patients in the anterolateral and anterior groups and 6 patients in the posterior group experienced intraoperative lesions of the radial nerve. No postoperative complications were observed in the subbrachial group. CONCLUSION The subbrachial approach is practical and effective. The average duration of the surgery is shortened by half, loss of the muscle strength is minimal, and patients can resume everyday activities within 4 months. No patients in the subbrachial group experienced injuries to the radial or musculocutaneous nerves.

A rare cause of urosepsis: clinical quiz

An 81-year-old female presented to the emergency department. She had been unwell for three weeks, with increasing malaise, fever, chills, right flank pain and urinary symptoms. Antibiotics had produced no improvement. At admission: WBC 17 10/L, serum creatinine 142 mmol/L and C-reactive protein 200 mg/L. Urine had a murky appearance, with cellular debris, and white blood cells. Renal ultrasound showed two 7-mm mineral shadows and marked hydronephrosis of the right kidney. The following day, percutaneous nephrostomy was arranged for relief of urinary obstruction, and an anterograde pyelography was performed (Figure 1). Findings prompted a subsequent CT scan of abdomen (Figure 2).

A rare cause of urosepsis – answers

1. The anterograde pyelogram shows a fistulous tract between the right ureter and the sigmoid colon, with leakage of contrast into the colon. A linear filling defect can just be made out within the tract. 2. CT scan confirms the presence of a fistula connecting the right ureter and sigmoid colon at level of the iliac vessels. Gas locules – ‘air pockets’ are seen in the right ureter and fistula. Contrast from the pyelogram is seen in the sigmoid colon. 3. The filling defect in Figure 1 is seen as a hyperdense lesion on the CT. A foreign body? In Figure 1(b), it is measured as 2.2 cm in length. It looks like a toothpick . . .

A Case of 2-Year-Old Child with Entero-Enteric Fistula Following Ingestion of 25 Magnets

INTRODUCTION Magnet ingestion usually does not cause serious complications, but in case of multiple magnet ingestion or ingestion of magnet with other metal it could cause intestinal obstruction, fistula formation or even perforation. CASE REPORT We report case of intestinal obstruction and fistula formation following ingestion of 25 magnets in a 2-year-old girl. Intraoperatively omega shaped intestinal loop with fistula caused by two magnetic balls was found. Intestine trapped with magnetic balls was edematous and inflamed. Resection of intestinal segment was performed, followed by entero-enteric anastomosis. A total of 25 magnets were removed from resected intestine. CONCLUSION Single magnet ingestion is treated as non-magnetic foreign body. Multiple magnet ingestion should be closely monitored and surgical approach could be the best option to prevent or to cure its complications.