Rully Hanafi Dahlan

Predictive Factors of Cervical Traction based on Cervical Spine Realignment shown by Series Lateral Cervical X-ray in Subaxial Cervical Spine Injury Patients

Introduction: Cervical spine injury is the most feared spinal injury for physicians, patients, and their families. All patients with unstable subaxial cervical spine injury must be managed by cervical traction and stabilization. Lateral cervical X-ray remains standard diagnostic tools to evaluate the stability of cervical spine structure and has a high diagnosis value in evaluating the success of the cervical traction. The success of the cervical traction could be predicted by observing the alignment of the cervical based on series lateral cervical spine X-ray. Materials and methods: This retrospective study involves 30 patients with subaxial cervical spine injury admitted to the Emergency Unit of Dr. Hasan Sadikin Hospital, Bandung, Indonesia, from 2012 to 2016. This study uses the logistic regression analysis with p < 0.05 considered to be significant and the confidence interval (CI) of 95%. Results: The results of this study showed that the failure of cervical traction (closed reduction) was mainly determined by interval admission time and facet lock (FL). The interval admission time (p = 0.015; two-sided tail, Pearson’s chi-square) and distribution of FL showed significant results (p = 0.001; two-sided tail Fisher’s exact test). Odds ratio (OR) whether FL is present or absent is 3.8; 95% CI 0.5 to 27.1, with p = 0.001. Conclusion: It is concluded that informed consent regarding cervical traction failure is needed in subaxial cervical injury >24 hours, where in patients with FL cervical traction trail is not needed, instead immediate definitive management (opened reduction) with stabilization is recommended.

Presurgical Aspects of Nutrition in Tuberculous Spondylitis Patients

Tuberculous spondylitis is a chronic infectious disease caused by Mycobacteriumtuberculosis on the vertebral bone. Involved less than 3% of all cases of TB, but the incidencevaries around the world, and is associated with the quality of public health and socioeconomicconditions.The purpose of this study is to investigate the presurgical aspects of nutrition inpatients with tuberculous spondylitis. A total of 39 consecutive patients between January 2011-December 2012 were evaluated retrospectively. All patients diagnosed with spondylitistuberculousis and treated with decompression, stabilization and fusion. All patients had beendiagnosed with Spondylitis tuberculousis based on history taking, physical examination,laboratory finding and MRI. Our study showed that of all subjects, ten male patients and eightfemale patients had cervical (n=1), thoracic (n=15), and lumbar (n=2) tuberculousspondylitis.The average age of the patients was 32.83 ± 12.25 (17-56) years old. The averagepreoperative body mass index (BMI) was 16.67 ± 1.2 kg / m2, albumin levels 3.23 ± 0.21 g / dl,total protein level 6.2 ± 0.34 g/dL. These were lower than normal value. We conclude thattuberculous spondylitis patients experience nutritional deficiencies presurgically andnutritional support should be considered pre-operatively.Keywords: Mycobacterium tuberculosis, nutritional state, presurgical aspect,tuberculousspondylitis

Intervertebral Disc Characteristic on Progressive Neurological Deficit

Objective: To examine the intervertebral disc characteristic on magnetic resonance imaging (MRI) in lumbar herniated disc (LHD) patients with progressive neurological deficit. Methods: Patients were collected retrospectively from Dr. Hasan Sadikin General Hospital Database from 2011–2013 with LHD, had neurological deficit such as radiculopathy and cauda equine syndrome for less than four weeks with a positive sign confirmed by neurological examination and confirmatory with MRI examination. Results: A total of 14 patients with lumbar herniated disc disease (10 males, 4 females) suffered from progressive neurological deficit with an average age of (52.07±10.9) years old. Early disc height was 9.38±0.5 mm and progressive neurological deficit state disc height was 4.03±0.53 mm, which were significantly different statisticaly (p<0.01). Symptoms of radiculopathy were seen in 11 patients and cauda equine syndrome in three patients. Modic changes grade 1 was found in five patients, grade 2 in eight patients,grade 3 in one patient, Pfirmman grade 2 in eleven patients and grade 3 in three patients. Thecal sac compression 1/3 compression was seen in four patients and 2/3 compression in ten patients. Conclusions: Neurosurgeon should raise concerns on the characteristic changes of intervertebral disc in magnetic resonance imaging examination to avoid further neural injury in lumbar herniated disc patients. Keywords: Lumbar herniated disc, magnetic resonance imaging, progressive neurological deficit DOI: 10.15850/ijihs.v5n2.1042

Surgical management of giant skull osteomas

Objective: Surgical management of giant skull osteomas Osteomas are benign, generally slow growing, bone forming tumors limited to the craniofacial and jaw bones. Materials and Methods: A retrospective review of all cases of osteoma diagnosed from 2009 to 2013 treated in our hospital. The data collected included age at diagnosis, gender, lesion location, size, presenting and duration of symptoms, treatment, complication and outcome. Results: During our study period there were 15 cases that were treated surgically. Their mean age was 42 years (range: 15–65 years) and all of our patients were female. The average duration of symptoms was 3 years and size varying from 4 cm to 12 cm. Eight patients complained of headache, whereas 6 patients complained about esthetics, and 1 patient presented with proptosis. The tumor was excised by cutting the base of the tumor and then residual tumor was grinded using a round head cutting bar. Osteoma was removed with esthetically acceptable appearance. Conclusion: There were no major complications during operative and postoperative period. Although osteomas are usually slow growing but surgery is usually performed due to esthetic reasons. It is important to plan an appropriate surgical approach that minimizes any damage to the adjacent structures.

Hollow-organ perforation following thoracolumbar spinal injuries of fall from height

Highlights • We describe two cases of Hollow-organ perforation following thoracolumbar injury.• All patient have mild inferior motoric parapareses 4/5 and 3/5 also complaint diffusely abdominal tenderness.• The mechanism of hollow organ perforation. The mechanism of hollow organ perforation following blunt thoracoabdominal is the theory suggests that these injuries may arise due to the shear stress exerted on the hollow organ wall.

A rare giant scalp dermatofibrosarcoma protuberans.

Background: Giant dermatofibrosarcoma protuberans (DFSP) of the scalp is a rare case, which is an intermediate grade soft tissue neoplasm originating from the dermal layer of the skin, which usually occurs in adults. Case Description: We describe such a case in a 26-year-old male. A wide local excision of the tumor with a generous tissue margin was performed; microscopic and immunohistochemical findings established the diagnosis of recurrent DFSP. Conclusion: Our case is unique in that it is presented as a dermatofibrosarcoma protuberans of the scalp, which is an extremely rare clinical entity, and the patient remains well after 14 months with no further treatment, without any tumor recurrence.