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Sample records for herniation causing transient

  1. Lung herniation: an unusual cause of dysphagia.

    Science.gov (United States)

    Mason, Karen; Riordan, Richard D

    2013-12-01

    Lung herniation is a rare condition that can be classified on the basis of location and etiology. We report an unusual case of right apical lung herniation presenting with dysphagia. Computed tomography of the neck demonstrated an air-containing structure in the root of the right side of the neck, related to but separate from the anteromedial aspect of the right lung apex. The diagnosis of an apical lung hernia was confirmed using high-resolution CT reconstructions. This case highlights that, although uncommon, apical lung hernias should always be considered when investigating abnormalities of swallowing. Identification of an apical lung hernia on plain chest radiographs avoids further unnecessary investigations and surgical intervention. Knowledge of their presentation may avoid complications that could arise from neck interventions such as subclavian central catheter insertion.

  2. Dual Etiologic Back Pain in Pregnancy: A Case Report with Lumbar Disc Herniation and Transient Osteoporosis of the Bilateral Hip

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    Aynur Aydoğan İzol

    2018-01-01

    Full Text Available Low back pain in pregnancy is a common complaint. It has been reported that the pregnancy is an independent risk factor for lomber disc herniation and may worsen the existing herniation. Transient osteoporosis of the hip (TOH, is a rare, self-limiting and gestational disease of unknown cause. In this article, we report a case of acute lomber disc hernia and later bilateral temporal osteoporosis of the hip that was treated with conservative methods during the same gestational period. With this pathologic case it is emphasized that, two pathological phenomenon can be seen in the same patient at the same time. It should be kept in mind TOH and radiculopathy should be considered in the differential diagnosis in pregnant patients who complains back and hip pain.

  3. Brain herniation

    Science.gov (United States)

    ... herniation; Uncal herniation; Subfalcine herniation; Tonsillar herniation; Herniation - brain ... Brain herniation occurs when something inside the skull produces pressure that moves brain tissues. This is most ...

  4. Ageing of the bony orbit is a major cause of age-related intraorbital fat herniation.

    Science.gov (United States)

    Kim, Junhyung; Park, Sang Woo; Choi, Jaehoon; Jeong, Woonhyeok; Lee, Seongwon

    2017-11-28

    We evaluated the relationship between infraorbital fat herniation and age-related changes in the bony orbit and orbital fat density using computed tomography. Two hundred and sixty-five patients were enrolled (60 patients were evaluated for changes in the bony orbit and 205 for changes in orbital fat density). Five measurements using parasagittal sections and one measurement using three-dimensional images were obtained. Intraorbital fat herniation length was positively correlated with orbital rim inclination. Lowering of the inferior orbital rim, which is connected to the orbicularis retaining ligament, tear trough ligament and orbital septum, can cause mechanical stretching of the lower eyelid and may contribute to infraorbital fat herniation. A strong and significant negative correlation was observed between orbital fat density and age, indicating that existing orbital fat can accommodate an enlargement in bony orbit volume without orbital fat hyperplasia/hypertrophy. In other words, an increased orbital fat volume may be a by-product of the adaptation of orbital fat to changes in bony orbit volume. Mechanical stretching of the lower eyelid due to ageing of the bony orbit and weakening of the lower eyelid due to age-related factors such as dermal/fat/muscle atrophy and loss of muscle tone can together result in anterior drooping of the lower eyelid. Therefore, age-related changes in the bony orbit contribute to intraorbital fat herniation. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  5. Giant posterior fossa arachnoid cyst causing tonsillar herniation and cervical syringomyelia

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    Vijay P Joshi

    2013-01-01

    Full Text Available Acquired cerebellar tonsillar herniation and syringomyelia associated with posterior fossa mass lesions is an exception rather than the rule. In the present article, we describe the neuroimaging findings in a case of 28-year-old female patient presented with a history of paraesthesia involving right upper limb of 8-month duration. Magnetic resonance imaging showed a giant retrocerebellar arachnoid causing tonsillar herniation with cervical syringomyelia. The findings in the present case supports that the one of the primary mechanism for the development of syringomyelia may be the obstruction to the flow of cerebrospinal fluid causing alterations in the passage of extracellular fluid in the spinal cord and leading to syringomyelia.

  6. Mood and anxiety disorders in patients with chronic low back and neck pain caused by disc herniation.

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    Kayhan, Fatih; Albayrak Gezer, İlknur; Kayhan, Ayşegül; Kitiş, Serkan; Gölen, Mustafa

    2016-01-01

    We investigated the prevalence of mood and anxiety disorders in patients with chronic low back and neck pain caused by disc herniation and the relationships between pain and mood, and anxiety disorders. In total, 149 patients with disc herniation and 60 healthy subjects were included. Disc herniation was diagnosed based on a physical examination and magnetic resonance imaging. Mood and anxiety disorders were diagnosed using the Structured Clinical Interview of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition/Clinical Version. The mean age of the study subjects (n = 209) was 45.96 ± 11.45 years. Seventy (46.6%) patients with disc herniation met the criteria for at least one mood or anxiety disorder. The prevalence rates of mood and anxiety disorders were 16.6% and 35.8%, respectively. The most common specific diagnoses were major depression (n = 25, 16.9%) and generalised anxiety disorder (n = 19, 12.8%). Mood and anxiety disorders were more commonly seen in patients with lumbar or cervical disc herniation than in those without herniation. No relationship was detected between pain severity and mood or anxiety disorders. However, mood and anxiety disorders were associated with neurological deficits.

  7. A Rare Case of Progressive Palsy of the Lower Leg Caused by a Huge Lumbar Posterior Endplate Lesion after Recurrent Disc Herniation

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    Masatoshi Morimoto

    2016-01-01

    Full Text Available A lesion of the lumbar posterior endplate is sometimes identified in the spinal canal of children and adolescents; it causes symptoms similar to those of a herniated disc. However, the pathology of the endplate lesion and the pathology of the herniated disc are different. We present a rare case of a 23-year-old woman who developed progressive palsy of the lower leg caused by huge lumbar posterior endplate lesion after recurrent disc herniation.

  8. Brain herniations into the dural venous sinus or calvarium: MRI findings, possible causes and clinical significance

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    Battal, Bilal; Hamcan, Salih; Akgun, Veysel; Sari, Sebahattin; Tasar, Mustafa [Gulhane Military Medical School, Department of Radiology, Ankara (Turkey); Oz, Oguzhan [Gulhane Military Medical School, Department of Neurology, Ankara (Turkey); Castillo, Mauricio [University of North Carolina School of Medicine, Division of Neuroradiology, Department of Radiology, Chapel Hill, NC (United States)

    2016-06-15

    To determine frequency, imaging features and clinical significance of herniations of brain parenchyma into dural venous sinuses (DVS) and/or calvarium found on MRI. A total of 6160 brain MRI examinations containing at least one high-resolution T1- or T2-weighted sequence were retrospectively evaluated to determine the presence of incidental brain herniations into the DVS or calvarium. MRI sequences available for review were evaluated according to their capability to demonstrate these herniations. Patients' symptoms and clinical findings were recorded. Twenty-one (0.32 %) brain parenchyma herniations into the DVS (n = 18) or calvarium (n = 3) in 20 patients were detected. The most common locations of the herniations were the transverse sinuses (n = 13) and those involving inferior gyrus of the temporal lobe (n = 9). High-resolution T1- and T2-weighted sequences were equally useful in the detection of these brain herniations. According to clinical symptoms, brain herniations were considered to be incidental but headaches were present in nine patients. Brain herniations with surrounding cerebrospinal fluid (CSF) into the DVS and/or calvarium are incidental findings and not proven to be associated with any symptoms. Although rare, these herniations are more common than previously recognized and should not be confused with arachnoid granulations, clots or tumours. (orig.)

  9. Paraplegia caused by giant intradural herniation of a lumbar disk after combined spinal-epidural anesthesia in total hip arthroplasty.

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    Sawai, Toshiyuki; Nakahira, Junko; Minami, Toshiaki

    2016-08-01

    Total paraplegia after epidural or spinal anesthesia is extremely rare. We herein report a case of total paraplegia caused by a giant intradural herniation of a lumbar disk at the L3-L4 level after total hip arthroplasty for coxarthrosis. The patient had no preoperative neurologic abnormalities. Intraoperative anesthetic management involved combined spinal-epidural anesthesia at the L3-L4 level with continuous intravenous propofol administration. Postoperatively, the patient complained of numbness and total paraplegia of the lower extremities. Magnetic resonance imaging showed a giant herniation of a lumbar disk compressing the spinal cord at the L3-L4 level. The intradural herniation was surgically treated, and the patient's symptoms completely resolved. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Heritable change caused by transient transcription errors.

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    Alasdair J E Gordon

    2013-06-01

    Full Text Available Transmission of cellular identity relies on the faithful transfer of information from the mother to the daughter cell. This process includes accurate replication of the DNA, but also the correct propagation of regulatory programs responsible for cellular identity. Errors in DNA replication (mutations and protein conformation (prions can trigger stable phenotypic changes and cause human disease, yet the ability of transient transcriptional errors to produce heritable phenotypic change ('epimutations' remains an open question. Here, we demonstrate that transcriptional errors made specifically in the mRNA encoding a transcription factor can promote heritable phenotypic change by reprogramming a transcriptional network, without altering DNA. We have harnessed the classical bistable switch in the lac operon, a memory-module, to capture the consequences of transient transcription errors in living Escherichia coli cells. We engineered an error-prone transcription sequence (A9 run in the gene encoding the lac repressor and show that this 'slippery' sequence directly increases epigenetic switching, not mutation in the cell population. Therefore, one altered transcript within a multi-generational series of many error-free transcripts can cause long-term phenotypic consequences. Thus, like DNA mutations, transcriptional epimutations can instigate heritable changes that increase phenotypic diversity, which drives both evolution and disease.

  11. Percutaneous endoscopic lumbar discectomy for a huge herniated disc causing acute cauda equina syndrome: a case report.

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    Jha, Subash C; Tonogai, Ichiro; Takata, Yoichiro; Sakai, Toshinori; Higashino, Kosaku; Matsuura, Tetsuya; Suzue, Naoto; Hamada, Daisuke; Goto, Tomohiro; Nishisho, Toshihiko; Tsutsui, Takahiko; Goda, Yuichiro; Abe, Mitsunobu; Mineta, Kazuaki; Kimura, Tetsuya; Nitta, Akihiro; Hama, Shingo; Higuchi, Tadahiro; Fukuta, Shoji; Sairyo, Koichi

    2015-01-01

    Microsurgery for lumbar disc herniation that requires surgical intervention has been well described. The methods vary from traditional open discectomy to minimally invasive techniques. All need adequate preanesthetic preparation of patients as general anesthesia is required for the procedure, and nerve monitoring is necessary to prevent iatrogenic nerve injury. Conventional surgical techniques sometimes require the removal of the corresponding lamina to assess the nerve root and herniated disc, and this may increase the risk for posterior instability of the vertebral body. Should this occur, fusion surgery may be needed, further increasing morbidity and cost. We present here a case of lumbar herniated disc fragments causing acute cauda equina syndrome that were endoscopically resected through a transforaminal approach in an awake patient under local anesthesia. Percutaneous endoscopic discectomy under local anesthesia proved to be a better alternative to open back surgery as it made immediate intervention possible, was associated with fewer perioperative complications and morbidity, minimized soft tissue damage, and allowed early rehabilitation with a better outcome and greater patient satisfaction. In addition to these advantages, percutaneous endoscopic discectomy protects other approaches that may be needed in subsequent surgeries, whether open or minimally invasive.

  12. Herniated disk

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    ... pulposus Herniated disk repair Lumbar spinal surgery - series Herniated lumbar disk References Gardocki RJ, Park AL. Lower back pain and disorders of intervertebral discs. In: Canale ST, Beaty JH, eds. Campbell's Operative ...

  13. Complex Regional Pain Syndrome Caused by Lumbar Herniated Intervertebral Disc Disease.

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    Kim, Se Hee; Choi, Sang Sik; Lee, Mi Kyung; Kin, Jung Eun

    2016-07-01

    Most cases of complex regional pain syndrome (CRPS) occur after some inciting injury. There are a few cases of CRPS after an operation for disc disease. CRPS from a mild herniated intervertebral disc (HIVD) without surgical intervention is even rarer than CRPS after an operation for disc disease.A 22-year-old man was transferred to a pain clinic. He had continuously complained about back and right leg pain. He presented with a skin color change in the right lower leg, intermittent resting tremor, stiffness, and swelling in the right leg. He complained of a pulling sensation and numbness in his right buttock, posterior thigh, lateral calf, and ankle. This symptom was in accordance with L4/5 radiculopathy. Magnetic resonance imaging (MRI) also showed L4/5 HIVD that was central to the bilateral subarticular protrusion.He was diagnosed as having CRPS, which fits the revised International Association for the Study of Pain (IASP) criteria. He fulfilled 4 symptom categories (allodynia, temperature asymmetry and skin color change, sweating changes, decreased range of motion and motor dysfunction) and 3 of 4 sign categories (allodynia, temperature asymmetry and skin color changes, decreased range of motion and motor dysfunction). The bone scan and thermography also revealed CRPS.For the past 2 months, we have performed intensive treatments. But, he never became pain-free and walking for 5 minutes led to persistent leg pain. We decided to perform percutaneous nucleoplasty, which can directly decompress a HIVD. On the next day, he achieved dramatic symptom relief. The visual analog scale (VAS) score improved to 3, compared to the VAS score of 9 at the first visit. The skin color change, allodynia, and tremor in the right leg disappeared, and the temperature asymmetry normalized. Motor weakness of the right leg also recovered.We report an unusual case of CRPS that was caused by L4/5 HIVD without a history of trauma or surgery. It has a clear causal relationship between HIVD

  14. Sequencing of Escherichia coli that cause persistent and transient Mastitis

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    The genomes of two strains of Escherichia coli that cause bovine mastitis were sequenced. These strains are known to be associated with persistent and transient mastitis: strain ECA-B causes a transient infection, and ECC-M leads to a persistent infection....

  15. Cervical Intradural Disc Herniation Causing Progressive Quadriparesis After Spinal Manipulation Therapy: A Case Report and Literature Review.

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    Yang, Hwan-Seo; Oh, Young-Min; Eun, Jong-Pil

    2016-02-01

    Cervical intradural disc herniation (IDH) is an extremely rare condition, comprising only 0.27% of all disc herniations. Three percent of IDHs occur in the cervical, 5% in the thoracic, and over 92% in the lumbar spinal canal. There have been a total of 31 cervical IDHs reported in the literature. The pathogenesis and imaging characteristics of IDH are not fully understood. A preoperative diagnosis is key to facilitating prompt intradural exploration in patients with ambivalent findings, as well as in preventing reoperation. The purpose of reporting our case is to remind clinicians to consider the possibility of cervical IDH during spinal manipulation therapy in patient with chronic neck pain.The patient signed informed consent for publication of this case report and any accompanying image. The ethical approval of this study was waived by the ethics committee of Chonbuk National University Hospital, because this study was case report and the number of patients was manipulation for chronic neck pain over the course of a month. The day prior, he had noticed neck pain and tingling in the bilateral upper and lower extremities during the manipulation procedure. The following day, he presented with bilateral weakness of all 4 extremities, which rendered him unable to walk. Neurological examination demonstrated a positive Hoffmann sign and ankle clonus bilaterally, hypoesthesia below the C5 dermatome, 3/5 strength in the bilateral upper extremities, and 2/5 strength in the lower extremities. This motor weakness was progressive, and he further complained of voiding difficulty.Urgent magnetic resonance imaging (MRI) of the cervical spine revealed large, central disc herniations at C4-C5 and C5-C6 that caused severe spinal cord compression and surrounding edema. We performed C4-C5-C6 anterior cervical discectomy and fusion.The patient's limb weakness improved rapidly within 1 day postoperatively, and he was discharged 4 weeks later. At his 12-month follow-up, the patient had

  16. Herniated Cervical Disc

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    ... and Emotional Distress Muscle Spasms Pinched Nerve Discitis Degenerative Conditions Bulge vs Herniation Cervical Stenosis, Myelopathy, and Radiculopathy Herniated Lumbar Disc Herniated Cervical Disc ...

  17. Efficacy of epidural neuroplasty versus transforaminal epidural steroid injection for the radiating pain caused by a herniated lumbar disc.

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    Kim, Hae Jong; Rim, Byeong Cheol; Lim, Jeong-Wook; Park, Noh Kyoung; Kang, Tae-Wook; Sohn, Min Kyun; Beom, Jaewon; Kang, Sangkuk

    2013-12-01

    To compare the treatment effects of epidural neuroplasty (NP) and transforaminal epidural steroid injection (TFESI) for the radiating pain caused by herniated lumbar disc. Thirty-two patients diagnosed with herniated lumbar disc through magnetic resonance imaging or computed tomography were included in this study. Fourteen patients received an epidural NP and eighteen patients had a TFESI. The visual analogue scale (VAS) and functional rating index (FRI) were measured before the treatment, and at 2 weeks, 4 weeks and 8 weeks after the treatment. In the epidural NP group, the mean values of the VAS before the treatment, and at 2 weeks, 4 weeks and 8 weeks after the treatment were 7.00±1.52, 4.29±1.20, 2.64±0.93, 1.43±0.51 and those of FRI were 23.57±3.84, 16.50±3.48, 11.43±2.44, 7.00±2.15. In the TFESI group, the mean values of the VAS before the treatment, and at 2 weeks, 4 weeks and 8 weeks after the treatment were 7.22±2.05, 4.28±1.67, 2.56±1.04, 1.33±0.49 and those of FRI were 22.00±6.64, 16.22±5.07, 11.56±4.18, 8.06±1.89. During the follow-up period, the values of VAS and FRI within each group were significantly reduced (pherniated lumbar disc. We recommend that TFESI should be primarily applied to patients who need interventional spine treatment, because it is easier and more cost-effective than epidural NP.

  18. MR-based outcome predictors of lumbar transforaminal epidural steroid injection for lumbar radiculopathy caused by herniated intervertebral disc.

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    Lee, Joon Woo; Choi, Seung Woo; Park, Sung Hee; Lee, Guen Young; Kang, Heung Sik

    2013-01-01

    To evaluate the MR-based outcome predictors of lumbar transforaminal epidural steroid injection (ESI) for lumbar radiculopathy caused by herniated intervertebral disc (HIVD). A total of 149 patients (male/female 75:74; mean age 51.5 years) with the very worst (87 patients) or the very best outcome (62 patients) after ESI were enrolled in this study. They were selected from 1,881 patients who underwent lumbar transforaminal ESI for lumbar radiculopathy caused by HIVD from January 2007 to December 2008. Two radiologists reviewed MR in consensus. Chi-square test and Fisher's exact test were used to evaluate the difference between the two groups. HIVD in the foraminal-extraforaminal zone were significantly more common in the very best outcome group (16/24, 66.6 %) than HIVD in the central-subarticular zone (46/125, 36.8 %) (P = 0.012). Other factors such as HIVD zone, T2-high signal, relation to nerve root, corner change, Modic change, disc height loss, grade of disc degeneration, and osteophyte were not statistically significant. HIVD in the foraminal or extraforaminal zone is the only good MR-based outcome predictor of lumbar transforamial ESI for lumbar radiculopathy.

  19. Herniated Cervical Disc

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    ... recovery. Surgery is very effective in reducing the pain in the arms and shoulders caused by a herniated cervical disc. However, some ... time. How is this diagnosed? A thorough clinical evaluation to determine the character and location of the pain plus an examination of the neck and careful ...

  20. [A rare cause of heart failure: aortocaval fistula associated with herniated lumbar disc surgery].

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    Çelebi, Aksüyek Savaş; Tosya, Alper; Uymaz, Barış; Ömürlü, Kenan; Aybek, Tayfun

    2014-12-01

    Although aortocaval fistula is mostly encountered as a complication of abdominal aortic aneurysms, it may also arise as a complication of lumbar disc surgery. Great arteriovenous shunts especially may lead to high-output heart failure in due time. In this paper, we aim to present a case of high-output heart failure secondary to aortocaval fistule caused by lumbar disc surgery.

  1. Use of magnetic resonance imaging to identify outcome predictors of caudal epidural steroid injections for lower lumbar radicular pain caused by a herniated disc.

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    Cha, Sung Oh; Jang, Chul Hoon; Hong, Jin Oh; Park, Joon Sang; Park, Jung Hyun

    2014-12-01

    We used lumbar magnetic resonance image (MRI) findings to determine possible outcome predictors of a caudal epidural steroid injection (CESI) for radicular pain caused by a herniated lumbar disc (HLD). Ninety-one patients with radicular pain whose MRI indicated a HLD were enrolled between September 2010 and July 2013. The CESIs were performed using ultrasound (US). A responder was defined as having complete relief or at least a 50% reduction of pain as assessed by the visual analog scale (VAS) and functional status on the Roland Morris Disability Questionnaire (RMDQ); responder (VAS n=61, RMDQ n=51), and non-responder (VAS n=30, RMDQ n=40). MRI findings were analyzed and compared between the two groups with regard to HLD level, HLD type (protrusion or exclusion), HLD zone (central, subarticular, foraminal, and extraforaminal), HLD volume (mild, moderate, or severe), relationship between HLD and nerve root (no contact, contact, displaced, or compressed), disc height loss (none, less than half, or more than half ), and disc degeneration grade (homogeneous disc structure or inhomogeneous disc structure-clear nucleus and height of intervertebral disc). A centrally located herniated disc was more common in the responder group than that in the non-responder group. Treatment of centrally located herniated discs showed satisfactory results. (VAS p=0.025, RMDQ p=0.040). Other factors, such as HLD level, HLD type, HLD volume, relationship to nerve root, disc height loss, and disc degeneration grade, were not critical. The HLD zone was significant for pain reduction after CESI. A centrally located herniated disc was a predictor of a good clinical outcome.

  2. Early Prediction of Transient Voltage Sags caused by Rotor Swings

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    Weckesser, Johannes Tilman Gabriel; Jóhannsson, Hjörtur; Van Cutsem, Thierry

    2014-01-01

    The paper investigates various methods to predict voltage sags at load buses caused by large generator rotor swings and following a transient disturbance. Three different prediction methods are proposed, which all use real-time measurements from PMUs. One of the methods uses a slightly extended...... version of the E-SIME method. The other two methods use Measurements and process them by recursive least square estimation. It is shown that the prediction method employing E-SIME allows the earliest detection of a critical voltage sag with satisfactory accuracy....

  3. Lymphangitic Carcinomatosis as a Cause of Malignant Transient Pleural Transudate

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    Raquel Garcia Sevila

    2009-01-01

    Full Text Available Although it is generally accepted that a malignant transient pleural transudate may appear during the early stages of lymphatic obstruction, cases demonstrating such probability are rare in literature. A 67-year-old woman was admitted to hospital because a lymphangitic carcinomatosis and a transudative infrapulmonary pleural effusion with a cytology positive for adenocarcinoma. One month later the effusion keeps being positive for adenocarcinoma but exudative in character. Lymphatic obstruction appears as the cause of the initial transudative characteristics of the pleural effusion.

  4. Intervertebral disc herniation: prevalence and association with ...

    African Journals Online (AJOL)

    Background: Low back pain is one of the common health problems encountered in life with intervertebral disc herniation being a common cause of its occurrence. Magnetic resonance imaging has emerged the gold standard for diagnosing a herniated disc. Aims and Objectives: To assess the frequency and pattern of ...

  5. Three-level cervical disc herniation

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    St. Iencean Andrei

    2015-09-01

    Full Text Available Multilevel cervical degenerative disc disease is well known in the cervical spine pathology, with radicular syndromes or cervical myelopathy. One or two level cervical herniated disc is common in adult and multilevel cervical degenerative disc herniation is common in the elderly, with spinal stenosis, and have the same cause: the gradual degeneration of the disc. We report the case of a patient with two level cervical disc herniation (C4 – C5 and C5 – C6 treated by anterior cervical microdiscectomy both levels and fusion at C5 – C6; after five years the patient returned with left C7 radiculopathy and MRI provided the image of a left C6 – C7 disc herniation, he underwent an anterior microsurgical discectomy with rapid relief of symptoms. Three-level cervical herniated disc are rare in adults, and the anterior microdiscectomy with or without fusion solve this pathology.

  6. The Causes and Consequences of Transient Epileptic Amnesia

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    Butler, Christopher R.; Zeman, Adam

    2011-01-01

    Transient epileptic amnesia (TEA) is a recently recognised syndrome of epilepsy in which the principle manifestation of seizures is recurrent episodes of isolated memory loss. In this article, we describe the clinical and cognitive profile of this emerging syndrome, and present new data that provide at most weak support for its proposed relationship to cerebrovascular disease. TEA is often associated with two unusual forms of interictal memory impairment: accelerated long-term forgetting and remote memory impairment. We discuss the clinical and theoretical implications of these relatively novel cognitive deficits. PMID:22063818

  7. Transient Pseudohypoparathyroidism as a Cause of Late-onset Hypocalcemia in Neonates and Infants

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    Cheng-Ting Lee

    2008-10-01

    Conclusion: Neuromuscular irritability is usually the initial clinical presentation of transient pseudohypoparathyroidism. Aside from delayed renal maturation, pseudohypoparathyroidism is also caused by magnesium deficiency. Such a disturbance usually resolves before 3 months of age.

  8. Oral hypertonic saline causes transient fall of vasopressin in humans

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    Seckl, J.R.; Williams, D.M.; Lightman, S.L.

    1986-08-01

    After dehydration, oral rehydration causes a fall in plasma arginine vasopressin (AVP) that precedes changes in plasma osmolality. To investigate further the stimulus for this effect, its specificity, and association with thirst, six volunteers were deprived of water for 24 h and given a salt load on two separate occasions. On each study day they then drank rapidly 10 ml/kg of either tap water or hypertonic saline (360 mosmol/kg). There was a significant fall in plasma AVP from 2.0 +/- 0.3 to 1.2 +/- 0.4 pmol/l 5 min after drinking water and from 1.8 +/- 0.3 to 0.9 +/- 0.2 pmol/l after hypertonic saline. Plasma osmolality fell 30-60 min after water and was unchanged after saline. Plasma renin activity, oxytocin, and total protein all remained unchanged. All subjects reported diminished thirst after hypertonic saline. Gargling with water reduced thirst but did not affect plasma AVP. There appears to be a drinking-mediated neuroendocrine reflex that decreases plasma AVP irrespective of the osmolality of the liquid consumed. The sensation of thirst did not correlate with plasma osmolality and was not always related to plasma AVP concentration. AVP was measured by radioimmunoassay.

  9. Non-Surgical Treatment and Prevention of Recurrent Disc Herniation

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    Ya.V. Fischenko

    2014-10-01

    Full Text Available The treatment of pain syndrome caused by herniated disc is one of topical issues of modern orthopedics. Up-to-date treatment modality is epidural adhesiolysis. Objective of this work — to evaluate the efficacy of using combined drug treatment (epidural adhesiolysis and kinesotherapy in patients with lumbar herniated disc. 54 patients were enrolled in the study — 24 women and 30 men aged 25 to 47 years with clinical and morphological signs of lumbar herniated disc. The application of kinesotherapy after performed epidural adhesiolysis in patients with lumbar herniated disc can improve and prolong the efficacy of the procedure.

  10. Papillary fibroelastoma of the aortic valve as a cause of transient ischemic attack.

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    Akay, Mehmet H; Seiffert, Moritz; Ott, David A

    2009-01-01

    Diagnostic evaluation of embolic neurologic events requires the consideration of cardiac causes. We recently encountered a case that emphasizes the importance of cardiac tumor as a source of embolic events. We present herein the case of a 42-year-old woman who suffered a transient ischemic attack caused by a papillary fibroelastoma that originated from the aortic valve.

  11. Regression of lumbar disk herniation

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    G. Yu Evzikov

    2015-01-01

    Full Text Available Compression of the spinal nerve root, giving rise to pain and sensory and motor disorders in the area of its innervation is the most vivid manifestation of herniated intervertebral disk. Different treatment modalities, including neurosurgery, for evolving these conditions are discussed. There has been recent evidence that spontaneous regression of disk herniation can regress. The paper describes a female patient with large lateralized disc extrusion that has caused compression of the nerve root S1, leading to obvious myotonic and radicular syndrome. Magnetic resonance imaging has shown that the clinical manifestations of discogenic radiculopathy, as well myotonic syndrome and morphological changes completely regressed 8 months later. The likely mechanism is inflammation-induced resorption of a large herniated disk fragment, which agrees with the data available in the literature. A decision to perform neurosurgery for which the patient had indications was made during her first consultation. After regression of discogenic radiculopathy, there was only moderate pain caused by musculoskeletal diseases (facet syndrome, piriformis syndrome that were successfully eliminated by minimally invasive techniques. 

  12. Retro-ureteral Small Bowel Herniation After Radical Cystectomy

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    Abbey L. Cole-Clark

    2017-11-01

    Full Text Available Small bowel obstruction caused by internal herniation under ureteric bands is a rare occurrence. Only 6 previous cases have been documented. This case report reviews the case of a 79-year-old male who presented to emergency with abdominal pain requiring subsequent laparotomy and release of internal herniation of bowel under ureter.

  13. Herniated lumbar disc

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    Jordon, Jo; Konstantinou, Kika; O'Dowd, John

    2009-01-01

    Herniated lumbar disc is a displacement of disc material (nucleus pulposus or annulus fibrosis) beyond the intervertebral disc space. The highest prevalence is among people aged 30-50 years, with a male to female ratio of 2:1.

  14. Herniated lumbar disc

    OpenAIRE

    Jordan, Jo; Konstantinou, Kika; O'Dowd, John

    2011-01-01

    Herniated lumbar disc is a displacement of disc material (nucleus pulposus or annulus fibrosis) beyond the intervertebral disc space. The highest prevalence is among people aged 30 to 50 years, with a male to female ratio of 2:1.

  15. Remote transient Lactobacillus animalis bacteremia causing prosthetic hip joint infection: a case report

    Directory of Open Access Journals (Sweden)

    R. Somayaji

    2016-11-01

    Full Text Available Abstract Background Lactobacillus spp. are uncommon pathogens in immunocompetent hosts, and even rarer causes of prosthetic device infections. Case presentation A case of chronic hip prosthetic joint infection (PJI caused by L. animalis is described. This occurred 5 years after a transient bacteremia with the same organism. Whole genome sequencing of both isolates proved this PJI infection resulted from this remote bacteremia. Conclusions We document that prosthetic joint infections may be a consequence of bacteremia as much as 3 years before the onset of symptoms.

  16. Herniated Lumbar Disc

    Science.gov (United States)

    ... Manipulation may provide short-term relief from nonspecific low back pain, but should be avoided in most cases of herniated disc. At first, the exercises you learn may be gentle stretches or posture changes to reduce the back pain or leg ...

  17. [Financial expenses incurred by herniated disk in health professionals].

    Science.gov (United States)

    Zonana-Nacach, Abraham; Moreno-Cazares, Marco Cesar; Gómez-Naranjo, Rafael

    2013-01-01

    Long-term sick leave by illeness is cause of financial expences and worker's loss of productivity. To evaluate the financial expense incurred by spinal disk herniation in health professionals. 3000 health professionals of the Instituto Mexicano del Seguro Social work in Tecate, Tijuana and Rosarito, cities of Baja California, Mexico. During 2009-2011, 1070 health professionals had long sick leave certificates and 48 had a cervical or lumbar disk herniation. We evaluated the total days of absenteeism in comparison with the absenteeism days suggested by the Medical Disability Advisor. Of the 48 spinal herniated disks, 54% were cervical and 65% had surgical management. The mean (± SD) days of absence was 125 ± 84 and 24 (50%) of the spinal herniated disks exceeded the Medical Disability Advisor disability duration parameters, in 6 (26%), 12 (52%), and 5 (22%) patients due to no diagnostic concordance, diagnosis delay and residual pain, respectively. The total cost of the spinal herniated disks that extended outside of the Medical Disability Advisor disability duration parameters was 683,026 pesos versus 367,081 pesos of the spinal herniated disks that did not exceed the Medical Disability Advisor disability duration parameters. After 12 months of follow-up, 9 (18.8%) continue with sick leave and 2 (4%) had permanent disability. In patients with a spinal herniated disk, the costs of subsidies were two-fold more due principally to a not diagnostic agreement.

  18. Sensitivity based Assessment of Transient Voltage Sags caused by Rotor Swings

    DEFF Research Database (Denmark)

    Weckesser, Johannes Tilman Gabriel; Jóhannsson, Hjörtur; Østergaard, Jacob

    2014-01-01

    The paper introduces an approach to investigate voltage sags, which are caused by large generator rotor swings following a transient disturbance. Therefore, the method exploits sensitivities derived from the algebraic network equations. These provide information on the impact of a generator...... on the voltage magnitude at a load bus and the effect of load variation on the generator’s power injection. It is shown that these sensitivities give valuable information to identify critical generator-load pairs and locations for applying preventive control measures....

  19. Derivation and application of sensitivities to assess transient voltage sags caused by rotor swings

    DEFF Research Database (Denmark)

    Weckesser, Johannes Tilman Gabriel; Jóhannsson, Hjörtur; Østergaard, Jacob

    2015-01-01

    The paper introduces an approach to investigate voltage sags, which are caused by large generator rotor swings following a transient disturbance. Therefore, the method exploits sensitivities derived from the algebraic network equations. These provide information on the impact of a generator...... on the voltage magnitude at a load bus and the effect of load variation on the generator’s power injection. It is shown that these sensitivities give valuable information to identify critical generator–load pairs and locations for applying preventive control measures....

  20. Spontaneous lung herniation after a single cough

    Energy Technology Data Exchange (ETDEWEB)

    Tack, D.; Delcour, C. [Dept. of Radiology, C. H. U. de Charleroi (Belgium); Wattiez, A. [Dept. of Pneumology, C. H. U. de Charleroi (Belgium); Schtickzelle, J.C. [Dept. of Emergency Medicine, C. H. U. de Charleroi (Belgium)

    2000-03-01

    Herniation of the lung is commonly caused by congenital rib abnormalities, blunt trauma, or thoracic surgery. Spontaneous hernias are rarely described in the literature. We report a case of a spontaneous intercostal pulmonary hernia following a single cough. In addition, a review of the literature is presented which outlines the classification, causes, and incidence of lung hernias. Some reference is made to possible methods of treatment. (orig.)

  1. [Physiotherapy in lumbar disc herniation ].

    Science.gov (United States)

    Stoll, T; Germann, D; Hagmann, H

    2001-08-01

    Physiotherapy is the treatment of choice in patients with symptoms caused by a lumbar disc herniation. In clinical practice a broad range of physiotherapeutic modalities has been revealed to be helpful. During the acute stage the efficacy of the McKenzie-concept, mobilisation therapies and traction has been demonstrated in randomized controlled trials with a blind assessor. In addition, pain reducing physical therapies such as cold or electrotherapy and non-steroidal anti-inflammatory drugs, analgesics and/or muscle relaxants are sensible initial accompanying treatments. The effectiveness of active physiotherapies such as training of local strength endurance of back and abdominal muscles has been proven in patients during the chronic stage. The indications for a in-patient rehabilitation programme, for surgery and the danger of developing chronic low back pain are discussed.

  2. Transient mass transfer caused by local surface heating in close binaries

    Science.gov (United States)

    Modisette, J. J.; Kondo, Y.

    1980-01-01

    The surge of mass from one component of a binary system resulting from local surface heating is analyzed. The impact of such surges on the companion can produce transient phenomena such as those seen in X-ray binaries, RS CVn objects, and cataclysmic variables. The heating may be caused by nonlinear g-mode oscillations or by X-ray heating by the companion in X-ray binaries, among other possible mechanisms. As an example, model calculations have been performed for a surge, triggered by a relatively moderate local heating, in a hypothetical X-ray binary; the results show that such a surge can account for X-ray turn-ons.

  3. Prolonged conservative treatment or 'early' surgery in sciatica caused by a lumbar disc herniation: rationale and design of a randomized trial [ISRCT 26872154

    Science.gov (United States)

    Peul, Wilco C; van Houwelingen, Hans C; van der Hout, Wilbert B; Brand, Ronald; Eekhof, Just AH; Tans, Joseph ThJ; Thomeer, Ralph TWM; Koes, Bart W

    2005-01-01

    Background The design of a randomized multicenter trial is presented on the effectiveness of a prolonged conservative treatment strategy compared with surgery in patients with persisting intense sciatica (lumbosacral radicular syndrome). Methods/design Patients presenting themselves to their general practitioner with disabling sciatica lasting less than twelve weeks are referred to the neurology outpatient department of one of the participating hospitals. After confirmation of the diagnosis and surgical indication MRI scanning is performed. If a distinct disc herniation is discerned which in addition covers the clinically expected site the patient is eligible for randomization. Depending on the outcome of the randomization scheme the patient will either be submitted to prolonged conservative care or surgery. Surgery will be carried out according to the guidelines and between six and twelve weeks after onset of complaints. The experimental therapy consists of a prolonged conservative treatment under supervision of the general practitioner, which may be followed by surgical intervention in case of persisting or progressive disability. The main primary outcome measure is the disease specific disability of daily functioning. Other primary outcome measures are perceived recovery and intensity of legpain. Secondary outcome measures encompass severity of complaints, quality of life, medical consumption, absenteeism, costs and preference. The main research question will be answered at 12 months after randomization. The total follow-up period covers two years. Discussion Evidence is lacking concerning the optimal treatment of lumbar disc induced sciatica. This pragmatic randomized trial, focusses on the 'timing' of intervention, and will contribute to the decision of the general practictioner and neurologist, regarding referral of patients for surgery. PMID:15707491

  4. Inguino-scrotal herniation of the ureter containing stones.

    Science.gov (United States)

    Prete, F P; Pezzolla, A; De Leo, V; Di Palma, G; Prete, F

    2016-12-01

    Inguino-scrotal herniation of the ureter is a rare and difficult situation for a surgeon, especially if only recognized during inguinal hernia repair. An 83-year-old gentleman, with a previous history of radiation treatment for squamous anal cancer, presented with a large left inguinoscrotal hernia causing occasional pain at the base of the scrotum. Follow-up, post-radiation therapy CT scan showed a hernia sac containing the bladder and large bowel. Calcifications in the sac were interpreted as bladder stones, in keeping with the history of left renal calculi. During hernia repair careful dissection revealed a herniated portion of the left ureter located alongside a large hernia sac, complicated by ureteral calculi. Following stones extraction and ureteral repair, hernia repair with mesh was successfully accomplished. Pathogenesis of ureteric herniation is reviewed. A herniated ureter is potentially a source of serious renal or ureteral complications. When discovered, ureteric hernias should be surgically repaired. If preoperative detection of a ureter herniation alongside an inguinal hernia is missed, awareness of the existence of this condition may help avoid iatrogenic ureteral damage injury during a complex hernioplasty. Documentation of unexplained, sizeable and distinct calcifications in an inguino-scrotal hernia sac, particularly in a patient with a history of urolithiasis, may suggest the presence of a herniated, calculus-filled ureter. In such cases, retrograde pyelograms may be considered for a definitive diagnosis prior to surgery.

  5. Pseudoenhancement of intervertebral disc herniation

    Energy Technology Data Exchange (ETDEWEB)

    Araki, Y.; Ootani, M.; Furukawa, T.; Tsukaguchi, I. (Dept. of Radiology, Osaka Rosai Hospital (Japan)); Mitomo, M. (Dept. of Radiology, Osaka Univ. Medical School (Japan))

    1992-08-01

    Two patients with intervertebral disc herniation appeared to demonstrate abnormally diffuse and intense enhancement of the disc after intravenous administration of gadolinium-DTPA for MRI. Surgery disclosed a dilated epidural venous plexus in one and vascular granulation tissue in the other, associated with the herniated disc material. The mechanism of this 'pseudoenhancement' of the disc appears to be a partial volume effect of disc material and the adjacent veins or granulation tissue. Pseudoenhancement of a herniated disc should be included in the differential diagnosis of a diffusely enhancing epidural mass. (orig.).

  6. Paraduodenal herniation: An internal herniation in a virgin abdomen

    Directory of Open Access Journals (Sweden)

    Dana Kabbani

    2014-01-01

    CONCLUSION: The patient underwent exploratory laparotomy, and the herniated bowel was found to be ischemic. The hernia was reduced, and the ischemic bowel resected. The defect was closed, and the patient had a non-complicated recovery.

  7. Spontaneous Regression of Herniated Lumbar Disc with New Disc Protrusion in the Adjacent Level.

    Science.gov (United States)

    Hakan, Tayfun; Gürcan, Serkan

    2016-01-01

    Spontaneous regression of herniated lumbar discs was reported occasionally. The mechanisms proposed for regression of disc herniation are still incomplete. This paper describes and discusses a case of spontaneous regression of herniated lumbar discs with a new disc protrusion in the adjacent level. A 41-year-old man was admitted with radiating pain and numbness in the left lower extremity with a left posterolateral disc extrusion at L5-S1 level. He was admitted to hospital with low back pain due to disc herniation caudally immigrating at L4-5 level three years ago. He refused the surgical intervention that was offered and was treated conservatively at that time. He had no neurological deficit and a history of spontaneous regression of the extruded lumbar disc; so, a conservative therapy, including bed rest, physical therapy, nonsteroidal anti-inflammatory drugs, and analgesics, was advised. In conclusion, herniated lumbar disc fragments may regress spontaneously. Reports are prone to advise conservative treatment for extruded or sequestrated lumbar disc herniations. However, these patients should be followed up closely; new herniation at adjacent/different level may occur. Furthermore, it is important to know which herniated disk should be removed and which should be treated conservatively, because disc herniation may cause serious complications as muscle weakness and cauda equine syndrome.

  8. Spontaneous Regression of Herniated Lumbar Disc with New Disc Protrusion in the Adjacent Level

    Directory of Open Access Journals (Sweden)

    Tayfun Hakan

    2016-01-01

    Full Text Available Spontaneous regression of herniated lumbar discs was reported occasionally. The mechanisms proposed for regression of disc herniation are still incomplete. This paper describes and discusses a case of spontaneous regression of herniated lumbar discs with a new disc protrusion in the adjacent level. A 41-year-old man was admitted with radiating pain and numbness in the left lower extremity with a left posterolateral disc extrusion at L5-S1 level. He was admitted to hospital with low back pain due to disc herniation caudally immigrating at L4-5 level three years ago. He refused the surgical intervention that was offered and was treated conservatively at that time. He had no neurological deficit and a history of spontaneous regression of the extruded lumbar disc; so, a conservative therapy, including bed rest, physical therapy, nonsteroidal anti-inflammatory drugs, and analgesics, was advised. In conclusion, herniated lumbar disc fragments may regress spontaneously. Reports are prone to advise conservative treatment for extruded or sequestrated lumbar disc herniations. However, these patients should be followed up closely; new herniation at adjacent/different level may occur. Furthermore, it is important to know which herniated disk should be removed and which should be treated conservatively, because disc herniation may cause serious complications as muscle weakness and cauda equine syndrome.

  9. [Treatment of thoracic disc herniation. Case report].

    Science.gov (United States)

    Picado-Baca, Mauricio Leonardo; Mireles-Cano, José Nicolás; León-Meza, Víctor Manuel; García-González, Oscar Guillermo; Ramos-Trujillo, Alejandro

    2016-01-01

    Herniated thoracic intervertebral disc is a rare cause of spinal cord compression. Its frequency varies from 0.15% to 1.7% of all disc herniations, and produces symptoms in 0.5% to 0.8%. Case 1. A 50-year-old woman, with pain and burning sensation in left hemithorax of four months of onset. It was treated as a herpetic syndrome, with no improvement. She was seen after thirteen days of exacerbation of clinical symptoms. The physical examination showed asymmetric paraparesis, lower left pelvic limb 1/5, and right pelvic limb 3/5¸ sensory level T8, with left Babinski positive. A thoracic disc herniation in space T8-T9 was diagnosed. A 55-year-old patient with a history of presenting pain in lumbar area of 5 years onset. She also had radicular pain that radiated to the right pelvic limb, with intensity 10/10 on a Visual Analogue Scale. Her physical examination showed muscle strength 5/5, with normal sensitivity in all dermatomes and tendon reflexes, and a positive right Babinski. Thoracic disc herniation T7-T8 level was diagnosed. Due to anatomical conditions that define this type of hernia, the extracavitary posterolateral approach should be the recommended surgical procedure when the simultaneously performed anterior decompression and fixation with posterior instrumentation are the treatments proposed. Despite the different anatomical structures of this special area, it was possible to obtain satisfactory results for both clinical cases. Copyright © 2015 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  10. Psilocybin dose-dependently causes delayed, transient headaches in healthy volunteers.

    Science.gov (United States)

    Johnson, Matthew W; Sewell, R Andrew; Griffiths, Roland R

    2012-06-01

    Psilocybin is a well-characterized classic hallucinogen (psychedelic) with a long history of religious use by indigenous cultures, and nonmedical use in modern societies. Although psilocybin is structurally related to migraine medications, and case studies suggest that psilocybin may be efficacious in treatment of cluster headache, little is known about the relationship between psilocybin and headache. This double-blind study examined a broad range of psilocybin doses (0, 5, 10, 20, and 30 mg/70 kg) on headache in 18 healthy participants. Psilocybin frequently caused headache, the incidence, duration, and severity of which increased in a dose-dependent manner. All headaches had delayed onset, were transient, and lasted no more than a day after psilocybin administration. Possible mechanisms for these observations are discussed, and include induction of delayed headache through nitric oxide release. These data suggest that headache is an adverse event to be expected with the nonmedical use of psilocybin-containing mushrooms as well as the administration of psilocybin in human research. Headaches were neither severe nor disabling, and should not present a barrier to future psilocybin research. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  11. Transient mathematical model for the axial annular fluid flow caused by drillpipe motion

    Energy Technology Data Exchange (ETDEWEB)

    Kimura, Hudson F.; Ramalho, Vanessa A.O.; Negrao, Cezar O.R.; Junqueira, Silvio L.M. [Universidade Tecnologica Federal do Parana (UTFPR), Curitiba, PR (Brazil). Dept. Academico de Mecanica. Lab. de Ciencias Termicas]. E-mails: hudsonhfk@yahoo.com.br; vanessinha123@gmail.com; negrao@utfpr.edu.br; silvio@utfpr.edu.br; Martins, Andre Leibsohn [PETROBRAS S.A., Rio de Janeiro, RJ (Brazil). Centro de Pesquisas (CENPES). Tecnologia de Engenharia de Pocos (TEP)]. E-mail: aleibsohn@petrobras.com.br

    2008-07-01

    The axial movement of drill pipes is a common operation in oil well drilling. This motion displaces the drilling fluid and causes pressure changes in the borehole. The descending pipe movement increases the pressure at the bottomhole (surge) and its extraction reduces it (swab). If the bottomhole pressure overcomes the formation fracture pressure, circulation loss may take place. On the other hand, if the pressure within the well is smaller than the pore pressure, kicks can occur. In order to maintain the bottomhole pressure within the formation fracture and pore pressures, the drill pipe must be moved slowly and therefore, the task becomes quite time consuming. The current work presents a mathematical model to predict surge and swab pressures in annular spaces. The approach is based on conservation equations of mass and momentum. The fluid flow is considered laminar, one-dimensional, compressible, isothermal and transient. The fluid is regarded as Newtonian with constant compressibility. The viscous effect is lumped and the concept of friction factor is applied. The governing differential equations are non-linear and therefore, they are solved numerically by the finite volume method. A sensitivity analysis of the flow parameters is carried out. For instance, the pressure wave propagation is observed for low compressibility fluids. Pressure oscillation is observed for low aspect ratio ratios. (author)

  12. Does nuclear tissue infected with bacteria following disc herniations lead to Modic changes in the adjacent vertebrae?

    DEFF Research Database (Denmark)

    Albert, H. B.; Lambert, Peter; Rollason, Jess

    2013-01-01

    PURPOSE: To investigate the prevalence of infected herniated nucleus material in lumbar disc herniations and to determine if patients with an anaerobic infected disc are more likely to develop Modic change (MC) (bone oedema) in the adjacent vertebrae after the disc herniation. MCs (bone oedema...... due to cytokine and propionic acid production. METHODS: Patients undergoing primary surgery at a single spinal level for lumbar disc herniation with an MRI-confirmed lumbar disc herniation, where the annular fibres were penetrated by visible nuclear tissue, had the nucleus material removed. Stringent......) in vertebrae are observed in 6 % of the general population and in 35-40 % of people with low back pain. These changes are strongly associated with low back pain. There are probably a mechanical cause and an infective cause that causes MC. Several studies on nuclear tissue from herniated discs have demonstrated...

  13. Transient multiple acyl-CoA dehydrogenation deficiency in a newborn female caused by maternal riboflavin deficiency

    DEFF Research Database (Denmark)

    Chiong, M A; Sim, K G; Carpenter, K

    2007-01-01

    riboflavin deficient and showed a typical MADD profile on plasma acylcarnitine testing. A possible genetic defect in riboflavin transport of metabolism in the mother is postulated to be the cause of the transient MADD seen in the infant. Sequencing of the SLC16A12, RFK and FLAD1 genes encoding key enzymes...

  14. Defective zoospore encystment and suppressed cyst germination of Phytophthora palmivora caused by transient leaching treatments

    NARCIS (Netherlands)

    Dijksterhuis, J; Deacon, J W

    2003-01-01

    The behaviour of encysting zoospores of Phytophthora palmivora during leaching conditions was studied. Zoospores encysted and germinated successfully on polycarbonate membranes after mechanical agitation. Transient (10 min) leaching treatments with nutrient-free buffer underneath the membranes

  15. Study of Frequency of Low Back Pain and Lumbar Disc Herniation in Patients of Hamadan MRI Center in 2002

    Directory of Open Access Journals (Sweden)

    M. Jabbari

    2004-07-01

    Full Text Available Low back pain is one of the prevalent diseases of the world. In this research, with helping of MRI the incidence of disc herniation in patients of low back pain in our living area was studied. Survey of the specifications of disc herniation was carried out and data was compared with some performed studies in other parts of the world. In this study, for 600 patients referred to HAMEDAN MRI CENTER, who had complaint of low back pain, MRI study was performed. Then, MRI Images of the patients who had disc hernition, studied for number, form, severity and anatomic position of the herniated disc and family history of low back pain. 83.7% of the studied cases was pathologic and 16.3% was normal. Among the pathologic cases, 70.12% had disc herniation. The most common age group in both sex for disc herniotion was 30-50 years. Disc herniation in men was more common than women. The most common anatomic position of the herniated disc was L4- L5 disc, mostly was one herniated disc and centrolateral form. There was not any meaningful relation between family history of the low back pain and lumbar disc herniation. This study showed that lumbar disc herniation is one of the common causes of the low back pain in our living area and MRI is the choice imaging modality for diagnosis and survey of low back pain and disc herniation.

  16. Acute monoplegia associated with non-traumatic intradural cervical disc herniation:

    Directory of Open Access Journals (Sweden)

    Ahmet Menkü

    2014-03-01

    Full Text Available Intradural disc herniation has been reported as a rare and particular type of intervertebral disc herniation. It occurs mostly in the lumbar spine, and rarely in the cervical or thoracic spine. Non-traumatic cervical intradural disc herniation is rare, with only 17 cases reported in English literature at the cervical region and can manifest itself by severe symptoms such as Brown-Sequard syndrome, transverse myelopathy and radiculopathy. We present a unique case of intradural cervical disc herniation only causing lower extremity monoplegia. To our knowledge, this is the first case described in the literature. The patient underwent microsurgical removal of the herniated disc via an anterior approach followed by interbody fixation using a cervical cage. J Clin Exp Invest 2014; 5 (1: 112-114

  17. Rare Cause of Hip Pain: Transient Osteoporosis of the Hip-Two Case Reports

    Directory of Open Access Journals (Sweden)

    Senem Şaş

    2015-12-01

    Full Text Available Transient osteoporosis of the hip (TOH is a rare disease affecting especially middle-aged men and women in the third trimester of pregnancy with unknown etiology. It has a benign course with spontaneous resolution. Transient osteoporosis may be confused with other diseases such as avascular necrosis. Early diagnosis is important to identify and plan correct treatment. In this report, two male cases with complaint of hip pain and difficulty in walking, which were diagnosed with TOH was presented by reviewing current literature.

  18. Lumbar disc herniation with contralateral radiculopathy: do we neglect the epidural fat?

    Science.gov (United States)

    Yang, Jun-Song; Zhang, Dong-Jie; Hao, Ding-Jun

    2015-01-01

    Lumbar disc herniation (LDH) is the most common cause of radiculopathy, whose pathological entity underlying nerve root compression is usually on the same side as the symptoms. However, LDH causing contralateral radiculopathy are sometimes encountered by pain physicians. There have been tremendous developments in the treatment options for LDH; the situation of LDH causing contralateral radiculopathy is indeed a dilemma for some pain physicians. We will report a case of a patient with a L4-5 disc herniation whose left herniated disc caused radiculopathy on the right side. After a percutaneous lumbar endoscopic discectomy via the side ipsilateral to the symptomatic side, this case obtained a significant symptom remission. The migrated epidural fat is discussed as a cause of associated contralateral neurological deficit. Only via a surgical approach ipsilateral to the herniated side, could there be a clinical improvement postoperatively.

  19. Hydraulic Transients Caused by Air Expulsion During Rapid Filling of Undulating Pipelines

    Directory of Open Access Journals (Sweden)

    Ciro Apollonio

    2016-01-01

    Full Text Available One of the main issues arising during the rapid filling of a pipeline is the pressure transient which originates after the entrapped air has been expelled at the air release valve. Because of the difference in density between water and air, a pressure transient originates at the impact of the water column. Many authors have analyzed the problem, both from the theoretical and the experimental standpoint. Nevertheless, mainly vertical or horizontal pipelines have been analyzed, whereas in real field applications, the pipe profile is a sequence of ascending and descending pipes, with air release/vacuum valves at high points. To overcome lack of knowledge regarding this latter case, laboratory experiments were carried out to simulate the filling of an undulating pipeline, initially empty at atmospheric pressure. The pipe profile has a high point where an orifice is installed for air venting, so as to simulate the air release valve at intermediate high point of a supply pipeline. In the experiments, the diameter of the orifice and the opening degree of both upstream and downstream valves were varied, in order to analyze their effect on the pressure transient. The experiments were also carried out with a longer descending pipe, in order to assess the effects on the pressure surge of the air volume downstream of the orifice.

  20. Middle East respiratory syndrome coronavirus (MERS-CoV) causes transient lower respiratory tract infection in rhesus macaques

    OpenAIRE

    De Wit, Emmie; Rasmussen, Angela L; Falzarano, Darryl; Bushmaker, Trenton; Feldmann, Friederike; Brining, Douglas L; Fischer, Elizabeth R.; Martellaro, Cynthia; Okumura, Atsushi; Chang, Jean; Scott, Dana; Arndt G. Benecke; Katze, Michael G.; Feldmann, Heinz; Munster, Vincent J.

    2013-01-01

    The Middle East respiratory syndrome coronavirus (MERS-CoV) is the latest emerged coronavirus causing severe respiratory disease with a high case fatality rate in humans. To better understand the disease caused by MERS-CoV, we developed a rhesus macaque model. Infection of rhesus macaques with MERS-CoV resulted in the rapid development of a transient pneumonia, with MERS-CoV replication largely restricted to the lower respiratory tract. This affinity of MERS-CoV for the lungs partly explains ...

  1. Ultrasonic Measurement of Transient Change in Stress-Strain Property of Radial Arterial Wall Caused by Endothelium-Dependent Vasodilation

    Science.gov (United States)

    Ikeshita, Kazuki; Hasegawa, Hideyuki; Kanai, Hiroshi

    2008-05-01

    The endothelial dysfunction is considered to be an initial step of atherosclerosis. Additionally, it was reported that the smooth muscle, which constructs the media of the artery, changes its characteristics owing to atherosclerosis. Therefore, it is essential to develop a method for assessing the regional endothelial function and mechanical property of the arterial wall. There is a conventional technique of measuring the transient change in the diameter of the brachial artery caused by flow-mediated dilation (FMD) after the release of avascularization. For more sensitive and regional evaluation, we developed a method of measuring the change in the elasticity of the radial artery due to FMD. In this study, the transient change in the mechanical property of the arterial wall was further revealed by measuring the stress-strain relationship during each heartbeat. The minute change in the thickness (strain) of the radial arterial wall during a cardiac cycle was measured by the phased tracking method, together with the waveform of blood pressure which was continuously measured with a sphygmometer at the radial artery. The transient change in stress-strain relationship during a cardiac cycle was obtained from the measured changes in wall thickness and blood pressure to show the transient change in instantaneous viscoelasticity. From the in vivo experimental results, the stress-strain relationship shows the hysteresis loop. The slope of the loop decreased owing to FMD, which shows that the elastic modulus decreased, and the increasing area of the loop depends on the ratio of the loss modulus (depends on viscosity) to the elastic modulus when the Voigt model is assumed. These results show a potential of the proposed method for the thorough analysis of the transient change in viscoelasticity due to FMD.

  2. Overpressure and Fluid Diffusion Causing Non-hydrological Transient GNSS Displacements

    Science.gov (United States)

    Rossi, Giuliana; Fabris, Paolo; Zuliani, David

    2017-11-01

    In this work, global navigation satellite system (GNSS) observations from the northern tip of the Adria microplate are analysed to differentiate non-periodic (transient) tectonic signals from other deviations from the linear trends primarily due to hydrological loading effects. We tested a recently proposed hypothesis that a porosity wave generated by fault-valve mechanisms in a seismogenic fault in the Bovec basin (western Slovenia) propagated throughout the surrounding region. After excluding potential spatially correlated common-mode errors in the considered time series, we investigated the relationship between the GNSS observations and periodic hydrological loading variations. The tests demonstrated that subtracting the hydrological term was effective at the global scale and that the frequency band of the transient signal (1.5 < T < 3.5 years) was not correlated with hydrological effects at the local scale (within a few kilometres of the station). Next, the results of previous works are used to calculate the permeability values and pore-pressure state at the source of the transient signal. The permeability values for the four main rock formations in the region are consistent with independent observations for similar lithotypes. The ratio between the effective stress and lithostatic load for different vertical profiles in the Bovec area indicated a state of overpressure, with pore-pressure close to the value of the lithostatic load. Thus, our results help define a scenario in which the porosity wave could have originated. Indeed, the formation of the domains of interconnected fractures, such as during the formation of a porosity wave, increases the permeability values, thereby relieving overpressure and restoring a state of equilibrium.

  3. Transition of a herniated lumbar disc to lumbar discal cyst: A case report

    OpenAIRE

    Bansil, Rohit; Hirano, Yoshitaka; Sakuma, Hideo; Watanabe, Kazuo

    2016-01-01

    Background: Another rare cause of lower back pain with radiculopathy is the discal cyst. It is believed to arise from degeneration of a herniated disc, although many other theories of its origin have been proposed. Here, we report a patient with lower back pain/radiculopathy attributed originally to a herniated lumbar disc, which transformed within 6 months into a discal cyst. Case Description: A 42-year-old male had a magnetic resonance (MR) documented herniated lumbar disc at the L4-5 l...

  4. An Unusual Cause of Transient Ischemic Attack in a Patient with Pacemaker

    Directory of Open Access Journals (Sweden)

    Jagadeesh Kumar Kalavakunta

    2014-01-01

    Full Text Available Pacemaker lead malposition in various locations has been described in the literature. Lead malposition in left ventricle is a rare and an underdiagnosed complication. We present a 77-year-old man with history of atrial fibrillation and pacemaker placement who was admitted for transient ischemic attack. He was on aspirin, beta blocker, and warfarin with subtherapeutic international normalized ratio. His paced electrocardiogram showed right bundle-branch block, rather than the typical pattern of left bundle-branch block, suggesting pacemaker lead malposition. Further, his chest X-ray and echocardiogram confirmed the pacemaker lead position in the left ventricle instead of right ventricle. He refused surgical removal of the lead and we increased his warfarin dose. Diagnosis of lead malposition in left ventricle, though easy to identify in echocardiogram, requires high index of clinical suspicion. In asymptomatic patients, surgical removal may be deferred for treatment with lifelong anticoagulation.

  5. Global aphasia without hemiparesis may be caused by blunt head trauma: An adolescent boy with transient aphasia.

    Science.gov (United States)

    Şahin, Sevim; Türkdoğan, Dilşad; Hacıfazlıoğlu, Nilüfer Eldeş; Yalçın, Emek Uyur; Eksen, Zehra Yılmaz; Ekinci, Gazanfer

    2017-05-01

    Global aphasia without hemiparesis is a rare condition often associated with embolic stroke. Posttraumatic causes have not been reported, in the literature, to our knowledge. We report a 15-year old boy with transient global aphasia without hemiparesis due to blunt head trauma. In our case, clinical findings occurred 1week later following head trauma. Emergence of the symptoms after a period of the first mechanical head trauma, draws attention to the importance of secondary process in traumatic brain injury. Copyright © 2016 Elsevier Ltd. All rights reserved.

  6. Imaging findings of Hoffa's fat pad herniation

    Energy Technology Data Exchange (ETDEWEB)

    Chauvin, Nancy A.; Khwaja, Asef [The Children' s Hospital of Philadelphia, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (United States); Epelman, Monica [Nemours Children' s Hospital, Department of Medical Imaging, Orlando, FL (United States); Callahan, Michael J. [Harvard Medical School, Department of Radiology, Boston Children' s Hospital, Boston, MA (United States)

    2016-04-15

    We report the radiologic findings of herniation of Hoffa's fat pad through a defect in the lateral patellar retinaculum in young children who presented with painless masses visible by ultrasound (US) only with flexion of the knee. Six children, between the ages of 1-8 years, presented with an anterolateral knee mass that was not tender and was only seen and palpable with knee flexion. An US was performed in all patients, magnetic resonance imaging (MRI) in 2 patients and knee radiographs in 1 patient. US imaging displayed focal herniation of Hoffa's fat pad within the infrapatellar region through a defect of the lateral retinaculum, visible only during dynamic imaging when the knee was in flexion. MRI performed in knee extension did not demonstrate a mass; however, it revealed a focal defect in the lateral retinaculum in the region of the abnormality. Radiographs were normal. Focal herniation of Hoffa's fat pad is an uncommon cause of an anterolateral knee mass in young children. When a knee mass is only identified in flexion, focal fat herniation through a defect in the retinaculum should be suspected and a dynamic US should be performed. (orig.)

  7. The cauda equina syndrome in pregnant woman with a massive disc herniation.

    Science.gov (United States)

    Antón Capitán, B; Malillos Torán, M

    Low back pain during pregnancy is a common cause of medical consultation. Although back pain is very common, the incidence of low back pain secondary to lumbar disk herniation in pregnancy is low (1: 10,000). Cauda equina syndrome from lumbar disk herniation is a serious complication. The delay in diagnosis and treatment can be a cause of chronic disability secondary to neurological sequelae. Numerous cases of disk herniation in pregnancy have been reported, however the association of a cauda equina syndrome as a result of disk herniation is rare. A case is presented of cauda equina syndrome in a pregnant woman at 12-week gestation. Copyright © 2015 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  8. Tegmen Tympani Defect and Brain Herniation Secondary to Mastoid Surgery: Case Presentation

    Directory of Open Access Journals (Sweden)

    Oguz Kadir Egilmez

    2014-01-01

    Full Text Available Brain herniation into the middle ear is very rarely seen. In addition to reasons like congenital factors, trauma, and infection, tegmen defect may develop as a result of iatrogenic events secondary to chronic otitis media surgery with or without cholesteatoma. Since it may cause life-threatening complications, patients must be evaluated and monitored for tegmen defect. In this paper, diagnosis and treatment of a brain herniation case due to iatrogenic tegmen defect were described along with relevant literature.

  9. Herniation of the anterior lens capsule

    Directory of Open Access Journals (Sweden)

    Pereira Nolette

    2007-01-01

    Full Text Available Herniation of the anterior lens capsule is a rare abnormality in which the capsule bulges forward in the pupillary area. This herniation can be mistaken for an anterior lenticonus where both the capsule and the cortex bulge forward. The exact pathology behind this finding is still unclear. We report the clinical, ultrasound biomicroscopy (UBM and histopathological findings of a case of herniation of the anterior lens capsule. UBM helped to differentiate this entity from anterior lenticonus. Light microscopy revealed capsular splitting suggestive of capsular delamination and collection of fluid (aqueous in the area of herniation giving it a characteristic appearance.

  10. Transient osteoporosis of the hip: A mysterious cause of hip pain in adults

    Directory of Open Access Journals (Sweden)

    Raju Vaishya

    2017-01-01

    Full Text Available Background: Transient osteoporosis of the hip (TOH is a poorly understood and forgotten clinical entity. The diagnosis is often delayed, and inappropriate treatment is provided, due to the lack of its awareness among the clinicians. Materials and Methods: Twelve patients (11 male and one female within the age group of 35–50 years, were identified retrospectively from the hospital records between July 2011 and June 2015 who had evidence of TOH on clinical and radiological parameters. Results: All the patients were treated conservatively by nonweight bearing mobilization, anti-inflammatory drugs, bisphosphonates, calcium, and Vitamin D supplements. None of our patients had any symptoms after 6 months of conservative management. The disease did not progress, and there was no evidence of hip joint involvement in any of the cases. Plain radiographs were not diagnostic in the early detection of TOH. Magnetic resonance imaging was found to be highly specific and sensitive in diagnosing TOH. The clinical condition of TOH is characterized by its acute onset of hip pain in middle-aged people, and its symptoms are out of proportion to the radiological findings. Conclusion: The TOH is a nondestructive and self-limiting condition of the hip, which responds well to the conservative treatment. We believe that TOH could be a subset of complex regional pain syndrome type 1, as it has many similarities in clinical presentation and management. Awareness of this entity is important to the clinicians for an early diagnosis and to avoid unnecessary treatment for other mimicking conditions.

  11. Do Turkish patients with lumbar disc herniation know body mechanics?

    Science.gov (United States)

    Topcu, Sacide Yildizeli

    2017-01-01

    Most common and important cause of the low back pain is lumbar disc herniation. Patients with lumbar disc herniation face with difficulties during daily activities due to the reduction of physical functions. In order to maintain daily activities without pain and discomfort, the patients should be informed about proper positions and body mechanics. The aim of the study was to determine the knowledge and the applications of the patients with lumbar disc herniation about body mechanics. This descriptive study was conducted with 75 patients with lumbar disc herniation in Edirne, Turkey. The population consisted of 75 patients who accepted to participate in the study. In the collection of data the questionnaire, which was developed according to literature by the researcher, was used. Descriptive statistics, student t-test, variance and correlation analysis were used for assessment of the data. The significance level was accepted at 0.05. It was found that 53.3% of the patients experienced awful/very severe pain. and there were some points that the patients have enough information about; mobilisation, standing, carrying the goods, leaning back while sitting, leaning somewhere while standing, getting support from the chair when standing up, avoiding sudden position changes, changing feet frequently while standing. It was detected that a statistical relation between educational level and knowledge about body mechanics exists. This study shows that individuals with lumbar disc herniation have not enough information about body mechanics and they experienced long-term severe pain. Nurses and other health care workers have important role in explaining the importance of body mechanics to the patients and should encourage them to use that in daily life.

  12. Light-induced retinal degeneration causes a transient downregulation of melanopsin in the rat retina.

    Science.gov (United States)

    García-Ayuso, Diego; Galindo-Romero, Caridad; Di Pierdomenico, Johnny; Vidal-Sanz, Manuel; Agudo-Barriuso, Marta; Villegas Pérez, María P

    2017-08-01

    In this work we study the effects of an acute light-induced retinal degeneration on the population of melanopsin positive retinal ganglion cells (m+RGCs) and the expression of the melanopsin protein in the retina. The m+RGCs may be more resistant than other RGCs to lesion, but the effects of an acute light exposure in this population are unknown. Albino rats were exposed to white light (3000 lux) continuously for 48 h and processed 0, 3, 7 or 30 days after light exposure (ALE). Whole-mounted retinas were immunodetected with antibodies against melanopsin, Brn3a, and rhodopsin to study the populations of m+RGC, Brn3a+RGC and rods (which are the most abundant photoreceptors in the rat retina). Three days ALE there was substantial rod loss in an arciform area of the superior retina and with time this loss expanded in the form of rings all throughout the retina. Light exposure did not affect the number of Brn3a+RGCs but diminished the numbers of m+RGCs. Immediately ALE there was a significant decrease in the mean number of immunodetected m+RGCs that was more marked in the superior retina. Later, the number of m+RGCs increased progressively and reached normal values one month ALE. Western blot analysis showed that melanopsin expression down-regulates shortly ALE and recovers thereafter, in accordance with the anatomical data. This study demonstrates that there is a transient downregulation of melanopsin expression in the RGCs during the first month ALE. Further studies would be needed to clarify the long-term effect of light exposure on the m+RGC population. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  13. Genotypic and antimicrobial characterisation of Propionibacterium acnes isolates from surgically excised lumbar disc herniations

    DEFF Research Database (Denmark)

    Rollason, Jess; McDowell, Andrew; Albert, Hanne B

    2013-01-01

    The anaerobic skin commensal Propionibacterium acnes is an underestimated cause of human infections and clinical conditions. Previous studies have suggested a role for the bacterium in lumbar disc herniation and infection. To further investigate this, five biopsy samples were surgically excised...... from each of 64 patients with lumbar disc herniation. P. acnes and other bacteria were detected by anaerobic culture, followed by biochemical and PCR-based identification. In total, 24/64 (38%) patients had evidence of P. acnes in their excised herniated disc tissue. Using recA and mAb typing methods...... isolate collection (63%) suggests that the role of P. acnes in lumbar disc herniation should not be readily dismissed....

  14. The effects of elastic supports on the transient vibroacoustic response of a window caused by sonic booms.

    Science.gov (United States)

    Ou, Dayi; Mak, Cheuk Ming

    2011-08-01

    The transient vibration and sound radiation (TVSR) of plate-like structures with general elastic boundary conditions was investigated using the time-domain finite element method (TDFEM) and time-domain boundary element method (TDBEM). In this model, the structure can have arbitrary elastic boundary conditions and hence the effects of the boundary conditions on the TVSR can be effectively studied. The predicted results agreed well with existing experimental data using two classical boundary conditions: simply supported at all edges and clamped-free-free-free. The TVSR of a single panel with a more general boundary condition in two connected chambers was also measured. The predicted results agreed well with these experimental results. The prediction method was subsequently applied to evaluate the effects of elastic boundary supports on the TVSR of a window caused by a sonic boom. Loudness, non-audible acoustic perception, and tactile vibration thresholds were analyzed for different boundary conditions (varying between clamped and simply supported). The possibility of improving the transient vibration and noise isolation performance by selecting an appropriate boundary condition was thereby demonstrated.

  15. Intrauterine myelomeningocele repair reverses preexisting hindbrain herniation.

    Science.gov (United States)

    Tulipan, N; Hernanz-Schulman, M; Lowe, L H; Bruner, J P

    1999-09-01

    It has been reported that intrauterine myelomeningocele repair reduces the amount of hindbrain herniation normally seen in association with the Chiari type II malformation. It is not yet known, however, whether hindbrain herniation is prevented, or whether preexisting herniation is reversed. The following study was designed to elucidate this issue. A series of 9 patients underwent intraoperative ultrasound examinations immediately prior to intrauterine myelomeningocele repair. These same patients were then evaluated postnatally using ultrasound and/or MRI. The degree of hindbrain herniation before and after repair was compared using a grading system devised by the authors. Eight patients had clear evidence of moderate to severe hindbrain herniation on intraoperative scans while one was mild. In contrast, on postnatal studies 5 of 9 patients had no evidence of hindbrain herniation, while the other 4 had only mild herniation. Intra-uterine myelomeningocele repair appears to reverse preexisting hindbrain herniation. It is postulated that continuous flow of cerebrospinal fluid through the neural placode is the force responsible for inducing migration of the cerebellum and brain stem downward through the foramen magnum. By interrupting that flow during gestation, intrauterine myelomeningocele repair enables the cerebellum and brain stem to resume a normal, or nearly normal, configuration.

  16. Effect of continuous lumbar traction on the size of herniated disc material in lumbar disc herniation.

    Science.gov (United States)

    Ozturk, Bulent; Gunduz, Osman Hakan; Ozoran, Kursat; Bostanoglu, Sevinc

    2006-05-01

    We investigated the effects of continuous lumbar traction in patients with lumbar disc herniation on clinical findings, and size of the herniated disc measured by computed tomography (CT). In this prospective, randomized, controlled study, 46 patients with lumbar disc herniation were included, and randomized into two groups as the traction group (24 patients), and the control group (22 patients). The traction group was given a physical therapy program and continuous lumbar traction. The control group was given the same physical therapy program without traction, for the same duration of time. Data for the clinical symptoms and signs were collected before and after the treatment together with calculation of a herniation index, from the CT images that showed the size of the herniated disc material. In the traction group, most of the clinical findings significantly improved with treatment. Size of the herniated disc material in CT decreased significantly only in the traction group. In the traction group the herniation index decreased from 276.6+/-129.6 to 212.5+/-84.3 with treatment (p0.05). Patients with greater herniations tended to respond better to traction. In conclusion, lumbar traction is both effective in improving symptoms and clinical findings in patients with lumbar disc herniation and also in decreasing the size of the herniated disc material as measured by CT.

  17. Analysis of pressure transients in Safety Injection (SI) piping for the opening cause of SKN 3 Safety Relief Valves

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Suk-Ho; Lim, Sang-Gyu; Kim, Han-Gon [KHNP CRI, Daejeon (Korea, Republic of)

    2016-10-15

    During preoperation and tests for that, the damage of Safety Relief Valves (SRVs) located at the exit of Safety Injection Pumps (SIPs) has been observed and issued recently. To resolve this issue, the opening cause of SRVs was examined from system design, piping design and operating condition. SRV performs the function of thermal relief to protect the over-pressure depending on the temperature increase in the isolated piping. We recognized that the thermal expansion did not result in the opening of SRV because there was not the cause increasing the temperature in piping at that time. In addition, it was examined that there wasn't the external cause increasing the pressure in piping to the set pressure (144.0kg/m{sup 2}) of SRV. To confirm this, mini-flow tests for SIP performance were carried out again through enough air venting in the early of 2015. As shown in table 1, the results following SIPs startup were reasonable. Otherwise, maximum pressure was greater than 142.0 kg/m{sup 2} and the fluctuation of pressure was also greater than 10.0 kg/m{sup 2} in the results of 2014 having the possibility of air present in piping and the damage of SRV. So, the objective of this paper is to evaluate pressure transients depending upon air present in SI piping as the opening cause of SKN 3 SRVs. The damage of SRVs located at the exit of SIP has been observed during pre-operation and tests of SKN 3. According to the possibility of air present in SI piping, its effect for pressure transient was evaluated at the same condition using RELAP5 code. The evaluation results for various cases demonstrate that the compression and expansion of trapped air in piping following SIP startup happen and have an effect on the opening of SRV by inducing the fluctuation of pressure and over-pressure in excess of set pressure. Also, the sensitivity results for the amount of air show that the maximum pressure in SI piping is different depending upon the amount of air and the optimal amount of

  18. Three dimensional analysis of spino-pelvic alignment in individuals with acutely herniated lumbar intervertebral disc.

    Science.gov (United States)

    Khallaf, Mohamed Elsayed

    2017-01-01

    Lumbar intervertebral disc herniation affects a large number of patients annually and are the most common cause of sciatica. This study was aimed at measuring the spino-pelvic alignment and its relation to the functional limitations in subjects with acutely herniated lumbar disc. Sixteen patients with acute Lumbar Disc Herniation (LDH group) and 16 healthy matched volunteers (healthy group) represented the sample of the study. The patients were recently diagnosed as lumbar disc herniation (L4-5 or L5-S1) with acute sciatica and antalgic posture using magnetic resonance imaging. Spino-pelvic alignment was measured via Rasterstereography. Functional disability among patients was assessed using Oswestry Disability Index Arabic version. Trunk inclination, trunk imbalance, pelvic obliquity, pelvic torsion, lordotic and scoliotic angles were significantly different between groups (P ≤ 0.05). A non-significant difference in kyphotic angle was found between the patients and healthy controls. There was no association between the measured postural changes and functional disabilities in patients with lumbar disc herniation (P ≤ 0.05). There are significant postural changes in patients with acutely herniated lumbar disc which has no relation to functional disability. These results support the concept of staying active during acute stage.

  19. Transition of a herniated lumbar disc to lumbar discal cyst: A case report.

    Science.gov (United States)

    Bansil, Rohit; Hirano, Yoshitaka; Sakuma, Hideo; Watanabe, Kazuo

    2016-01-01

    Another rare cause of lower back pain with radiculopathy is the discal cyst. It is believed to arise from degeneration of a herniated disc, although many other theories of its origin have been proposed. Here, we report a patient with lower back pain/radiculopathy attributed originally to a herniated lumbar disc, which transformed within 6 months into a discal cyst. A 42-year-old male had a magnetic resonance (MR) documented herniated lumbar disc at the L4-5 level. It was managed conservatively for 6 months, after which symptoms recurred and progressed. The follow-up MR study revealed a discal cyst at the L4-5 without residual herniated disc. Of interest, the cyst communicated with the L4-5 intervertebral disc, which was herniated under the posterior longitudinal ligament and the disc space. During surgery, the cyst was completely removed, and his symptoms/signs resolved. A discal cyst develops as pathological sequelae of a degenerated herniated disc. Although rare, these lesions must be considered among the differential diagnoses in young patients with radicular back pain. MR study clearly documents these lesions, and surgical excision of the cyst is the treatment of choice.

  20. Huge Intracanal lumbar Disc Herniation: a Review of Four Cases

    Directory of Open Access Journals (Sweden)

    Farzad Omidi-Kashani

    2016-01-01

    Full Text Available Lumbar disc herniation (LDH is the most common cause of sciatica and only in about 10% of the affected patients, surgical intervention is necessary. The side of the patient (the side of most prominent clinical complaints is usually consistent with the side of imaging (the side with most prominent disc herniation on imaging scans. In this case series, we presented our experience in four cases with huge intracanal LDH that a mismatch between the patient’s side and the imaging’s side was present. In these cases, for deciding to do the operation, the physicians need to rely more on clinical findings, but for deciding the side of discectomy, imaging characteristic (imaging side may be a more important criterion.

  1. Cervical disc herniation manifesting as a Brown-Sequard syndrome

    Directory of Open Access Journals (Sweden)

    Kunio Yokoyama

    2012-01-01

    Full Text Available Brown-Sequard syndrome is commonly seen in the setting of spinal trauma or an extramedullary spinal neoplasm. The clinical picture reflects hemisection of the spinal cord. We report a rare case of Brown-Sequard syndrome caused by a large cervical herniated disc. A 63-year-old man presented with progressive right hemiparesis and disruption of pain and temperature sensation on the left side of the body. Magnetic resonance imaging showed large C3-C4 disc herniation compressing the spinal cord at that level, with severe canal stenosis from C4 through C7. Decompressive cervical laminoplasty was performed. After surgery, complete sensory function was restored and a marked improvement in motor power was obtained.

  2. Transient Global Amnesia

    Science.gov (United States)

    ... sudden memory loss. Request an Appointment at Mayo Clinic Causes The underlying cause of transient global amnesia is unknown. There appears to be a link between transient global amnesia and a history of migraines, though the underlying factors that contribute ...

  3. Transradicular lumbar disc herniation: An extreme variant of intraradicular disc herniation

    Directory of Open Access Journals (Sweden)

    Manish K Kasliwal

    2015-01-01

    Full Text Available Intradural or intraradicular lumbar disc herniation (IDH is a relatively rare condition often diagnosed intraoperatively. We encountered an extreme variant of IDH - a transradicular herniation as the disc material extruded through the lumbar nerve root through a split essentially transecting the nerve root. While failure to recognize intradural and intraradicular disc herniation can lead to failed back surgery, the variant described in the present case could lead to iatrogenic injury and complication if not recognized. A unique case of transradicular lumbar disc herniation in a 25-year-old patient is presented with the depiction of intraoperative images supplementing the text.

  4. Spontaneous temporomandibular joint herniation into the external auditory canal through a patent foramen of Huschke: A case report

    Directory of Open Access Journals (Sweden)

    Kyeong Hwa Ryu, M.D.

    2017-06-01

    Full Text Available Temporomandibular joint herniation (TMJ can be caused by inflammation, trauma, tumor, or otologic procedures. However, spontaneous TMJ herniation can also occur as a result of a congenital bony defect in the external auditory canal (EAC, known as the patent foramen of Huschke (PFH, and occurs in 0.4% of the population. Herein, the authors present a case of spontaneous TMJ herniation through the PFH with clicking tinnitus. The patient underwent the surgical repair of bony defect in the EAC with placement of titanium mesh, and the symptom disappeared after surgery. They also review the relevant literature regarding this disease and discuss its embryologic development and clinical significance.

  5. Clinical Features of Herniated Disc at Cervicothoracic Junction Level Treated by Anterior Approach.

    Science.gov (United States)

    Lee, Jun Gue; Kim, Hyeun Sung; Ju, Chang Il; Kim, Seok Won

    2016-06-01

    The anterior approach for C7-T1 disc herniation may be challenging because of obstruction by the manubrium and the narrow operative field. This study aimed to investigate the clinical and neurological outcomes of anterior approach for C7-T1 disc herniation. We retrospectively evaluated 13 patients who underwent the anterior approach for C7-T1 disc herniation by a single surgeon within a period of 11 years (2003-2014). The minimum follow-up duration was 6 months. We describe the clinical presentation, radiographic findings, neurological outcome, and related complications. Of 372 patients with single-level anterior discectomy and fusion or artificial disc replacement for cervical disc herniation, 13 (3.5%) had C7-T1 disc herniation. The main clinical presentation was unilateral motor weakness in intrinsic hand muscles (11 patients), along with numbness, pain, and tingling sensation that radiate down the arm to the little finger. Most of the patients improved after surgery via the anterior approach. Ten patients underwent successful anterior discectomy and fusion by the standard supramanubrial Smith-Robinson approach, but 2 needed additional manubriotomy and sternotomy. In 1 patient, we performed surgery at a wrong level because the correct level was difficult to identify intraoperatively. Two patients had transient vocal dysfunction, but none had major complications related to injuries of the great vessels such as the thoracic duct or esophagus. For patients who require direct anterior decompression for C7-T1 disc herniation, the anterior approach is relatively feasible. However, care should be taken to overcome physical constraints by the manubrium and slope.

  6. Spontaneous Regression of Lumbar Herniated Disc

    Directory of Open Access Journals (Sweden)

    Chun-Wei Chang

    2009-12-01

    Full Text Available Intervertebral disc herniation of the lumbar spine is a common disease presenting with low back pain and involving nerve root radiculopathy. Some neurological symptoms in the majority of patients frequently improve after a period of conservative treatment. This has been regarded as the result of a decrease of pressure exerted from the herniated disc on neighboring neurostructures and a gradual regression of inflammation. Recently, with advances in magnetic resonance imaging, many reports have demonstrated that the herniated disc has the potential for spontaneous regression. Regression coincided with the improvement of associated symptoms. However, the exact regression mechanism remains unclear. Here, we present 2 cases of lumbar intervertebral disc herniation with spontaneous regression. We review the literature and discuss the possible mechanisms, the precipitating factors of spontaneous disc regression and the proper timing of surgical intervention.

  7. Antifungal treatment of wild amphibian populations caused a transient reduction in the prevalence of the fungal pathogen, Batrachochytrium dendrobatidis.

    Science.gov (United States)

    Geiger, Corina C; Bregnard, Cindy; Maluenda, Elodie; Voordouw, Maarten J; Schmidt, Benedikt R

    2017-07-20

    Emerging infectious diseases can drive host populations to extinction and are a major driver of biodiversity loss. Controlling diseases and mitigating their impacts is therefore a priority for conservation science and practice. Chytridiomycosis is a devastating disease of amphibians that is caused by the fungal pathogen Batrachochytrium dendrobatidis (Bd), and for which there is an urgent need to develop mitigation methods. We treated tadpoles of the common midwife toad (Alytes obstetricans) with antifungal agents using a capture-treat-release approach in the field. Antifungal treatment during the spring reduced the prevalence of Bd in the cohort of tadpoles that had overwintered and reduced transmission of Bd from this cohort to the uninfected young-of-the-year cohort. Unfortunately, the mitigation was only transient, and the antifungal treatment was unable to prevent the rapid spread of Bd through the young-of-the year cohort. During the winter, Bd prevalence reached 100% in both the control and treated ponds. In the following spring, no effects of treatment were detectable anymore. We conclude that the sporadic application of antifungal agents in the present study was not sufficient for the long-term and large-scale control of Bd in this amphibian system.

  8. TRANSIENT EARLY-LIFE FOREBRAIN CRH ELEVATION CAUSES LONG LASTING ANXIOGENIC AND DESPAIR-LIKE CHANGES IN MICE

    Science.gov (United States)

    Kolber, Benedict J.; Boyle, Maureen P.; Wieczorek, Lindsay; Kelley, Crystal L.; Onwuzurike, Chiamaka C.; Nettles, Sabin; Vogt, Sherri K.; Muglia, Louis J.

    2010-01-01

    During development, early-life stress, such as abuse or trauma, induces long-lasting changes that are linked to adult anxiety and depressive behavior. It has been postulated that altered expression of corticotropin-releasing hormone (CRH) can at least partially account for the various effects of stress on behavior. In accord with this hypothesis, evidence from pharmacological and genetic studies has indicated the capacity of differing levels of CRH activity in different brain areas to produce behavioral changes. Furthermore, stress during early life or adulthood causes an increase in CRH release in a variety of neural sites. To evaluate the temporal and spatial specificity of the effect of early-life CRH exposure on adult behavior, the tetracycline-off system was used to produce mice with forebrain-restricted inducible expression of CRH (FBCRHOE). After transient elevation of CRH during development only, behavioral testing in adult mice revealed a persistent anxiogenic and despair-like phenotype. These behavioral changes were not associated with alterations in adult circadian or stress-induced corticosterone release but were associated with changes in CRH receptor type 1 expression. Furthermore, the despair-like changes were normalized with antidepressant treatment. Overall, these studies suggest that forebrain-restricted CRH signaling during development can permanently alter stress adaptation leading to increases in maladaptive behavior in adulthood. PMID:20164342

  9. Primary posterior perineal herniation of urinary bladder

    Directory of Open Access Journals (Sweden)

    Kurumboor Prakash

    2013-01-01

    Full Text Available Primary perineal hernia is a rare clinical condition wherein herniation of viscera occurs through pelvic diaphragm. They are usually mistaken for sciatic hernia, rectal prolapse or other diseases in the perineum. Correct identification of the type of hernia by imaging is crucial for planning treatment. We present a case of primary posterior herniation of urinary bladder and rectal wall through levator ani repaired laparoscopically using a mesh repair.

  10. CT findings of calcified herniated lumbar disc

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Hyo Kun; Lee, Jun Hyung [Chang Dong Armed Forces Evacuation Hospital, Seoul (Korea, Republic of)

    1987-12-15

    Computed tomography (CT) of 10 calcified herniated lumber discs among 46 operated cases were analysed at the aspects of incidence, location, shape, etc. The results are as follows: 1. The incidence of calcification is 22% (10/46). 2. Among 10 cases, 3 cases are at the level of L4-5 disc space and 7 cases are at the level of L5-S1 disc space. 3. Central herniation (8 cases) are more common than posterolateral herniation (2 cases). 4. Linear or band-like calcifications in the periphery of herniated disc (annulus fibrosus type) are 6 cases and dense patchy calcification in the central portion of herniated disc (nucleus pulposus type) are 4 cases. 5. Two cases (50%) of 4 cases with nucleus pulposus type calcification were found to be ruptured at operation, but none of 6 annulus fibrous calcification types showed rupture. 6. Because more wide operation field and invasive exploration were required in calcified cases than non-calcified cases, it is suggested to evaluate the presence, location, and type of calcification in herniated disc in detail.

  11. Transient transmembrane secretion of H2O2: a mechanism for the citral-caused inhibition of aflatoxin production from Aspergillus flavus.

    Science.gov (United States)

    Li, Jinhan; Li, Jialin; Lu, Zhisong; Liu, Yang; Li, Chang Ming

    2015-12-21

    A polydopamine-Fe3O4 nanocomposite-based H2O2 electrochemical sensor is fabricated to real-time monitor the transmembrane release of reactive oxygen species from citral-treated Aspergillus flavus, revealing a mechanism involving transient transmembrane secretion of H2O2 for the citral-caused inhibition of aflatoxin production from a fungus for the first time.

  12. Value of CT in the evaluation of nerve root compression in the lumbar herniated disc disease: comparative study with myelography

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Kun Il; Ku, Yong Woon; Sol, Chang Hyo; Kim, Byung Su [Pusan National University College of Medicine, Busan (Korea, Republic of)

    1988-04-15

    High resolution computed tomography is the most accurate diagnostic tool to define a lumbar herniated disc disease, because it provides a complete in vivo analysis of bony framework of lumbar spine as well as the supporting soft tissue structures and neural elements. The purpose of this study is to estimate the valve of CT in athe evaluation of nerve root compression caused by herniated disc disease. We analyzed 52 roots of 26 patients of single level herniated disc disease with definite evidence of bilateral or unilateral neurologic deficit who had both CT and myelography at Pusan National University Hospital from May 1983 to March, 1987. The results were as follows: 1. Sensitivity and specificity of CT is 77% and 81%, respectively in the diagnosis of nerve root compression caused by lumbar herniated disc disease. 2. Sensitivity and specificity of myelography is 77% and 81% respectively, in the diagnosis of nerve root compression caused by lumbar herniated disc disease. 3. The results of this study indicate that high resolution CT was equivalent to myelography in the diagnosis of nerve root compression caused by lumar herniated disc disease.

  13. Can Prevention of a Reherniation Be Investigated? Establishment of a Herniation Model and Experiments With an Anular Closure Device

    Science.gov (United States)

    Wilke, Hans-Joachim; Ressel, Lena; Heuer, Frank; Graf, Nicolas; Rath, Stefan

    2013-01-01

    Study Design. Biomechanical in vitro study. Objective. To establish a reliable in vitro herniation model with human cadaver spines that enables evaluation of anular closure devices. Summary of Background Data. Biomechanically, it is desirable to close anulus defects after disc herniation to preserve as much nucleus as possible. Multiple anular closure options exist to prevent reherniation. A reliable test procedure is needed to evaluate the efficacy and reliability of these implants. Methods. Two groups of human lumbar segments (n = 6 per group) were tested under cyclic loading until herniation occurred or 100,000 load cycles were applied. One group contained moderate/severe degenerated discs. A second group had mild degenerated discs. Intradiscal pressure was measured in the intact state to confirm disc quality. If herniation occurred, the extruded material was reinserted into the disc and the anulus defect was treated with the Barricaid anular closure device (Intrinsic Therapeutics, Inc., Woburn, MA). Disc height and 3-dimensional flexibility of the specimens in the intact, defect, and implanted states were measured under pure moments in each principal motion plane. Afterwards, provocation of reherniation was attempted with additional 100,000 load cycles. Results. Likelihood of herniation was strongly linked to disc degeneration and supported by the magnitude of intradiscal pressure. In moderate/severe degenerated discs, only 1 herniation was created. In mild degenerated discs, herniations were reliably created in all specimens. Using this worst-case model, herniation caused a significant reduction of disc height, which was nearly restored with the implant. In no case was reherniation or implant migration visible after 100,000 load cycles after Barricaid implantation. Conclusion. We established a human herniation model that reliably produced nucleus extrusion during cyclic loading by selecting specimens with low disc degeneration. The Barricaid seems to prevent

  14. Transient Oxygen/Glucose Deprivation Causes a Delayed Loss of Mitochondria and Increases Spontaneous Calcium Signaling in Astrocytic Processes.

    Science.gov (United States)

    O'Donnell, John C; Jackson, Joshua G; Robinson, Michael B

    2016-07-06

    Recently, mitochondria have been localized to astrocytic processes where they shape Ca(2+) signaling; this relationship has not been examined in models of ischemia/reperfusion. We biolistically transfected astrocytes in rat hippocampal slice cultures to facilitate fluorescent confocal microscopy, and subjected these slices to transient oxygen/glucose deprivation (OGD) that causes delayed excitotoxic death of CA1 pyramidal neurons. This insult caused a delayed loss of mitochondria from astrocytic processes and increased colocalization of mitochondria with the autophagosome marker LC3B. The losses of neurons in area CA1 and mitochondria in astrocytic processes were blocked by ionotropic glutamate receptor (iGluR) antagonists, tetrodotoxin, ziconotide (Ca(2+) channel blocker), two inhibitors of reversed Na(+)/Ca(2+) exchange (KB-R7943, YM-244769), or two inhibitors of calcineurin (cyclosporin-A, FK506). The effects of OGD were mimicked by NMDA. The glutamate uptake inhibitor (3S)-3-[[3-[[4-(trifluoromethyl)benzoyl]amino]phenyl]methoxy]-l-aspartate increased neuronal loss after OGD or NMDA, and blocked the loss of astrocytic mitochondria. Exogenous glutamate in the presence of iGluR antagonists caused a loss of mitochondria without a decrease in neurons in area CA1. Using the genetic Ca(2+) indicator Lck-GCaMP-6S, we observed two types of Ca(2+) signals: (1) in the cytoplasm surrounding mitochondria (mitochondrially centered) and (2) traversing the space between mitochondria (extramitochondrial). The spatial spread, kinetics, and frequency of these events were different. The amplitude of both types was doubled and the spread of both types changed by ∼2-fold 24 h after OGD. Together, these data suggest that pathologic activation of glutamate transport and increased astrocytic Ca(2+) through reversed Na(+)/Ca(2+) exchange triggers mitochondrial loss and dramatic increases in Ca(2+) signaling in astrocytic processes. Astrocytes, the most abundant cell type in the brain

  15. The Causes of Chronic and Transient Poverty and Their Implications for Poverty Reduction Policy in Rural China

    OpenAIRE

    Shi Li; Pingping Wang; Ximing Yue

    2007-01-01

    The study focuses on two components of total poverty: chronic and transient poverty, and investigates their relative importance in total observed poverty, as well as the determinants of each components. We found that transient poverty accounts for a large proportion of total poverty observed in the poor rural areas of China. By analyzing the determinants of the two types of poverty, we found that household demographic characteristics, such as age of the head of households, family sizes, labou...

  16. Cancer cachexia causes skeletal muscle damage via transient receptor potential vanilloid 2-independent mechanisms, unlike muscular dystrophy.

    Science.gov (United States)

    Iwata, Yuko; Suzuki, Nobuyuki; Ohtake, Hitomi; Kamauchi, Shinya; Hashimoto, Naohiro; Kiyono, Tohru; Wakabayashi, Shigeo

    2016-06-01

    Muscle wasting during cancer cachexia contributes to patient morbidity. Cachexia-induced muscle damage may be understood by comparing its symptoms with those of other skeletal muscle diseases, but currently available data are limited. We modelled cancer cachexia in mice bearing Lewis lung carcinoma/colon adenocarcinoma and compared the associated muscle damage with that in a murine muscular dystrophy model (mdx mice). We measured biochemical and immunochemical parameters: amounts/localization of cytoskeletal proteins and/or Ca(2+) signalling proteins related to muscle function and abnormality. We analysed intracellular Ca(2+) mobilization and compared results between the two models. Involvement of Ca(2+)-permeable channel transient receptor potential vanilloid 2 (TRPV2) was examined by inoculating Lewis lung carcinoma cells into transgenic mice expressing dominant-negative TRPV2. Tumourigenesis caused loss of body and skeletal muscle weight and reduced muscle force and locomotor activity. Similar to mdx mice, cachexia muscles exhibited myolysis, reduced sarcolemmal sialic acid content, and enhanced lysosomal exocytosis and sarcolemmal localization of phosphorylated Ca(2+)/CaMKII. Abnormal autophagy and degradation of dystrophin also occurred. Unlike mdx muscles, cachexia muscles did not exhibit regeneration markers (centrally nucleated fibres), and levels of autophagic proteolytic pathway markers increased. While a slight accumulation of TRPV2 was observed in cachexia muscles, Ca(2+) influx via TRPV2 was not elevated in cachexia-associated myotubes, and the course of cachexia pathology was not ameliorated by dominant-negative inhibition of TRPV2. Thus, cancer cachexia may induce muscle damage through TRPV2-independent mechanisms distinct from those in muscular dystrophy; this may help treat patients with tumour-induced muscle wasting.

  17. Role of interleukin-17 in chondrocytes of herniated intervertebral lumbar discs.

    Science.gov (United States)

    Tian, Peng; Li, Zhi-Jun; Fu, Xin; Ma, Xin-Long

    2015-07-01

    Lumbar disc herniation (LDH) is a common cause of lumbosacral radiculopathy. An autoimmune response to a herniated nucleus pulposus (NP) has been suggested to play an important role in the initiation of radiculopathy. Interleukin-17 (IL-17) is a cytokine associated with inflammation and autoimmunity. The presence of IL-17 has been studied in patients with LDH; however, extensive investigation into the expression of IL-17 in different disc pathologies of LDH has not yet been conducted. The aim of the present study was to investigate the role of neovascularization and hypertrophic chondrocytes in herniated intervertebral lumbar discs. Fifty-two intervertebral lumbar disc specimens were extracted from 46 patients with LDH and were subsequently classified as either contained or non-contained disc herniation (CDH and NCDH, respectively). The specimens were stained with hematoxylin and eosin or toluidine blue, or were immunostained with polyclonal antibodies to IL-17 using the streptavidin-peroxidase method. The neovascular tissue and staining results were graded to establish the histological differences between the two herniation types. The intervertebral discs (IVDs) obtained from patients with NCDH showed significantly more neovascularization and granulation tissue than the discs obtained from patients with CDH (Pherniated IVDs.

  18. Exacerbation of Symptoms of Lumbar Disc Herniation Complicated by a Schwannoma: A Case Report

    Directory of Open Access Journals (Sweden)

    Sen-Yung Liu

    2007-09-01

    Full Text Available Herniation of the lumbar disc is a common cause of low back pain. Conservative management with physiotherapy, such as lumbar spine traction, is usually effective. Although a schwannoma of the lumbar spine is relatively uncommon, the clinical manifestations are similar to those of lumbar disc herniation, making the diagnosis difficult. This case report describes a 51-year-old male who had suffered from low back pain for 3 years and who was diagnosed with L2/L3 lumbar disc herniation. The low back pain was well-controlled by conservative treatment and the symptoms improved progressively. Two months prior to our evaluation, however, the symptoms worsened acutely, and were accompanied by the onset of symptoms of cauda equina syndrome. A small tumor at the site of the L2/L3 disc herniation, observed incidentally during magnetic resonance imaging, was responsible for the symptoms of spinal stenosis at the lumbar region. The patient underwent laminectomy, tumor resection, and discectomy with near-complete resolution of symptoms. In patients with lumbar disc herniation that improves with conservative treatment, the recurrence of symptoms should prompt a thorough review of the medical history, physical examination, and imaging studies to establish the diagnosis and prevent delay in treatment.

  19. Herniated Lumbar Disks: Real-time MR Imaging Evaluation during Continuous Traction.

    Science.gov (United States)

    Chung, Tae-Sub; Yang, Hea-Eun; Ahn, Sung Jun; Park, Jung Hyun

    2015-06-01

    To assess the morphologic changes in herniated lumbar intervertebral disks and surrounding structures during lumbar traction by using real-time magnetic resonance (MR) imaging. This prospective study was approved by the institutional review board, and written informed consent was obtained from all participants. Forty-eight consecutive patients with lumbar disk herniation (13 men and 35 women) were treated with continuous lumbar traction by using a nonmagnetic traction device. Real-time MR imaging of the lumbar spine was performed before the initiation of traction and at 10-minute intervals during 30 minutes of 30 kg of continuous traction. Sagittal and axial MR images were analyzed to determine qualitative changes during lumbar traction. Quantitative changes caused by traction on the lumbar spine were determined by measurement of lumbar vertebral column elongation and the disk reduction ratio. Continuous traction on herniated lumbar disks and surrounding structures resulted in change in disk shape, disk reduction with opening in the intervertebral disk, reduction of herniated disk volume, separation of the disk and adjoining nerve root, and widening of the facet joint. Both the mean lumbar vertebral column length (elongation of 1.45% after 30 minutes, P traction, respectively) increased with time of traction. The results of this study demonstrated that the real-time effects of continuous traction on herniated lumbar intervertebral disks and their surrounding structures can be visualized by using MR imaging. RSNA, 2015

  20. [Imaging study of lumbar intervertebral disc herniation and asymptomatic lumbar intervertebral disc herniation].

    Science.gov (United States)

    Yu, Qing-yang; Yang, Cun-rui; Yu, Lang-tao

    2009-04-01

    Using regional assignment to forked method to study lumbar intervertebral disc hemiation (bugle, hernia, prolapse) dependablity and reason of lumbar intervertebral disc herniation and asymptomatic lumbar intervertebral disc herniation. From March 2005 to October 2006, 120 patients of match condition from orthopaedics dept and rehabilitative dept of the Boai hospital of Longyan were studied. All patients were equally divided into two groups according to whether or not accompany with symptom of lumbar intervertebral disc herniation. There was not statistical difference in sex, age, course of disease, segment of intervertebral disc between two groups. Sixty patients of symptomatic lumbar intervertebral disc herniation were equally divided into three groups according to (bugle, hernia, prolapse) image on CT. Sixty patients of asymptomatic lumbar intervertebral disc herniation were equally divided into three groups according to (bugle, hernia, prolapse) image on CT. The age was 20-59 years old with an average of 38.5 years. Using regional assignment to give a mark respectively for every group. The sagittal diameter index (SI), anterior diastema of flaval ligaments, the width of superior outlet of latero-crypt, anteroposterior diameter of dura sac were respectively measured by sliding caliper. CT value and protrusible areas were respectively evaluated by computer tomography. Adopting mean value to measure three times. (1) There were not statistical difference in SI, CT value, hernia areas, anteroposterior diameter of dura sac between two groups (symptomatic lumbar intervertebral disc herniation and asymptomatic lumbar intervertebral disc herniation). There were statistical difference in the width of superior outlet of latero-crypt, anterior diastema of flaval ligaments between two groups (symptomatic lumbar intervertebral disc herniation and asymptomatic lumbar intervertebral disc herniation). (2) There were statistical difference in protrusible type,protrusible segment

  1. Spontaneous Regression of a Cervical Disk Herniation

    Directory of Open Access Journals (Sweden)

    Emre Delen

    2014-03-01

    Full Text Available A 54 years old female patient was admitted to our outpatient clinic with a two months history of muscle spasms of her neck and pain radiating to the left upper extremity. Magnetic resonance imaging had shown a large left-sided paracentral disk herniation at the C6-C7 disk space (Figure 1. Neurological examination showed no obvious neurological deficit. She received conservative treatment including bed rest, rehabilitation, and analgesic drugs. After 13 months, requested by the patient, a second magnetic resonance imaging study showed resolution of the disc herniation.(Figure 2 Although the literature contains several reports about spontaneous regression of herniated lumbar disc without surgical intervention, that of phenomenon reported for herniated cervical level is rare, and such reports are few[1]. In conclusion, herniated intervertebral disc have the potential to spontaneously regress independently from the spine level. With further studies, determining the predictive signs for prognostic evaluation for spontaneous regression which would yield to conservative treatment would be beneficial.

  2. Co-occurrence of lumbar spondylolysis and lumbar disc herniation with lumbosacral nerve root anomaly

    Science.gov (United States)

    Yılmaz, Tevfik; Turan, Yahya; Gülşen, İsmail; Dalbayrak, Sedat

    2014-01-01

    Lumbosacral nerve root anomalies are the leading cause of lumbar surgery failures. Although co-occurrence of lumbar spondylolysis and disc herniation is common, it is very rare to observe that a nerve root anomaly accompanies these lesions. A 49-year-old male patient presented with sudden-onset right leg pain. Examinations revealed L5/S1 lumbar spondylolysis and disc herniation. At preoperative period, he was also diagnosed with lumbosacral root anomaly. Following discectomy and root decompression, stabilization was performed. The complaints of the patient diagnosed with lumbosacral root anomaly at intraoperative period were improved at postoperative period. It should be remembered that in patients with lumbar disc herniation and spondylolysis, lumbar root anomalies may coexist when clinical and neurological picture is severe. Preoperative and perioperative assessments should be made meticulously to prevent neurological injury. PMID:25210343

  3. Co-occurrence of lumbar spondylolysis and lumbar disc herniation with lumbosacral nerve root anomaly

    Directory of Open Access Journals (Sweden)

    Tevfik Yilmaz

    2014-01-01

    Full Text Available Lumbosacral nerve root anomalies are the leading cause of lumbar surgery failures. Although co-occurrence of lumbar spondylolysis and disc herniation is common, it is very rare to observe that a nerve root anomaly accompanies these lesions. A 49-year-old male patient presented with sudden-onset right leg pain. Examinations revealed L5/S1 lumbar spondylolysis and disc herniation. At preoperative period, he was also diagnosed with lumbosacral root anomaly. Following discectomy and root decompression, stabilization was performed. The complaints of the patient diagnosed with lumbosacral root anomaly at intraoperative period were improved at postoperative period. It should be remembered that in patients with lumbar disc herniation and spondylolysis, lumbar root anomalies may coexist when clinical and neurological picture is severe. Preoperative and perioperative assessments should be made meticulously to prevent neurological injury.

  4. Computed tomography in the diagnosis of the lumbar disc herniation

    Energy Technology Data Exchange (ETDEWEB)

    Iwakura, Yuichiro (Yatsushiro General Hospital, Kumamoto (Japan)); Hayashi, Yasuo; Suzuki, Mutsuaki; Uemura, Mitsuharu; Fukuda, Kazuyuki; Koito, Hirofumi

    1984-06-01

    In this study, effectiveness of computed tomography (CT) in diagnosing lumbar disc herniation was evaluated. Twenty CT examinations which were interpreted as positive for a herniated disc, and were comfirmed by myelography, were reviewed. In 19 patients, CT demonstrated posterior protrusion of the disc but in one normal disc. Three typical cases were described. This study suggests that CT accurately demonstrates lumbar disc herniation.

  5. Serum cytokines, a diagnostic tool for herniated lumbar disc type ...

    African Journals Online (AJOL)

    This study aimed at assessing the agreement of serum and operation-field cytokines in diagnosis of herniated lumbar disc type. In this study, 43 patients with lumbar disc herniation were recruited in Tabriz Imam Reza Hospital during a 12-month period. According to the type of herniation, the patients were categorized in two ...

  6. Scrotal Herniation of Bladder: A Case Report

    Directory of Open Access Journals (Sweden)

    Ali Hamidi Madani

    2013-03-01

    Full Text Available Inguinal bladder hernia is a rare clinical condition, with 1–3% of all inguinal hernias involving the bladder. Any portion of the bladder may herniate, from a small portion or a diverticulum to most of the bladder. We present a 55-year-old male with an intermittent right scrotal mass of 6 months’ duration. The mass lesion protruded through the right inguinal canal before voiding and reduced after that. Scrotal sonography revealed a hypoechoic lesion in the scrotum that stretched cranially to the intra-abdominal portion of the bladder. Excretory urography showed a duplicated system in the left kidney and deviation of the left orifice to the right side of the trigon. Finally, cystography illustrated herniation of the bladder to the right scrotum. Surgical repair of the hernia was done with mesh. Follow-up cystography one month postoperatively revealed no herniation.

  7. Peripheral nerve injury causes transient expression of MHC class I antigens in rat motor neurons and skeletal muscles

    DEFF Research Database (Denmark)

    Maehlen, J; Nennesmo, I; Olsson, A B

    1989-01-01

    After a peripheral nerve lesion (rat facial and sciatic) an induction of major histocompatibility complex (MHC) antigens class I was detected immunohistochemically in skeletal muscle fibers and motor neurons. This MHC expression was transient after a nerve crush, when regeneration occurred...

  8. Physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain.

    NARCIS (Netherlands)

    Windt, D.A.W.M. van der; Simons, E.; Riphagen, I.I.; Ammendolia, C.; Verhangen, A.P.; Laslett, M.; Devillé, W.; Deyo, R.A.; Bouter, L.M.; Vet, H.C.W. de; Aertgeerts, B.

    2010-01-01

    Background: Low-back pain with leg pain (sciatica) may be caused by a herniated intervertebral disc exerting pressure on the nerve root. Most patients will respond to conservative treatment, but in carefully selected patients, surgical discectomy may provide faster relief of symptoms. Primary care

  9. Anterior cervical discectomy without fusion for a symptomatic cervical disk herniation

    NARCIS (Netherlands)

    de Rooij, J.D. (Judith D.); P.S. Gadjradj (Pravesh S.); J.S.S. van Hoeve (John); B.S. Harhangi (Biswadjiet)

    2017-01-01

    textabstractBackground: Cervical radiculopathy is characterized by dysfunction of the nerve root usually caused by a cervical disk herniation. The most important symptom is pain, radiating from the neck to the arm. When conservative treatment fails, surgical treatment is indicated to relieve

  10. Traumatic Lung Herniation following Skateboard Fall

    Directory of Open Access Journals (Sweden)

    Dafney L. Davare

    2016-01-01

    Full Text Available Lung herniation (LH is a rare clinical entity involving the protrusion of lung outside the thoracic cage. It has a variety of etiologies and clinical presentations, making diagnosis difficult. We present a case of a 20-year-old male who reported pleuritic pain after falling from a skateboard. Evaluation through computed tomography (CT scanning of the chest revealed an anterior lung hernia associated with rib fractures. This case emphasizes the need for clinicians to include lung herniation in the differential diagnosis of patients with trauma and inexplicable or persistent pulmonary issues.

  11. Apoptosis in chronic myeloid leukemia cells transiently treated with imatinib or dasatinib is caused by residual BCR-ABL kinase inhibition.

    Science.gov (United States)

    Simara, Pavel; Stejskal, Stanislav; Koutna, Irena; Potesil, David; Tesarova, Lenka; Potesilova, Michaela; Zdrahal, Zbynek; Mayer, Jiri

    2013-05-01

    Transient, potent BCR-ABL inhibition with tyrosine kinase inhibitors (TKIs) was recently demonstrated to be sufficient to commit chronic myeloid leukemia (CML) cells to apoptosis irreversibly. This mechanism explains the clinical efficacy of once-daily dasatinib treatment, despite the rapid clearance of the drug from the plasma. However, our in vitro data suggest that apoptosis induction after transient TKI treatment, observed in the BCR-ABL-positive cell lines K562, KYO-1, and LAMA-84 and progenitor cells from chronic phase CML patients, is instead caused by a residual kinase inhibition that persists in the cells as a consequence of intracellular drug retention. High intracellular concentrations of imatinib and dasatinib residues were measured in transiently treated cells. Furthermore, the apoptosis induced by residual imatinib or dasatinib from transient treatment could be rescued by washing out the intracellularly retained drugs. The residual kinase inhibition was also undetectable by the phospho-CRKL assay. These findings confirm that continuous target inhibition is required for the optimal efficacy of kinase inhibitors. Copyright © 2013 Wiley Periodicals, Inc.

  12. Effectiveness of percutaneous laser disc decompression versus conventional open discectomy in the treatment of lumbar disc herniation; Design of a prospective randomized controlled trial

    NARCIS (Netherlands)

    P.A. Brouwer (Patrick); W.C. Peul (Wilco); R. Brand (René); M.P. Arts (Mark); B.W. Koes (Bart); A.A. van den Berg (Annette); M.A. van Buchem (Mark)

    2009-01-01

    textabstractBackground. The usual surgical treatment of refractory sciatica caused by lumbar disc herniation, is open discectomy. Minimally invasive procedures, including percutaneous therapies under local anesthesia, are increasingly gaining attention. One of these treatments is Percutaneous Laser

  13. Natural history of symptomatic lumbar disk herniation controlled by MRI

    Energy Technology Data Exchange (ETDEWEB)

    Komori, Hiromichi; Yamaura, Isakichi; Kurosa, Yoshiro; Yoshida, Hirotoshi (Toride Kyodo General Hospital, Ibaraki (Japan)); Nakai, Osamu

    1994-04-01

    The purpose of this study was to compare changes in clinical symptoms and sequential findings of magnetic resonance imaging (MRI) in 66 patients managed with conservative treatment for lumbar disc herniation. In all but 12 patients, there was a good correlation between leg pain and MRI findings, although findings of MRI tended to slightly follow symptom improvement. A notable reduction of herniated mass was seen in a high frequency in sequentrated herniation from an extremely degenerated lumbar disk. The greater the degree of sequentration, the greater the reduction of herniated mass. A shorter duration of leg pain was significantly associated with greater reduction of the herniated mass; leg pain disappeared within 2 months when the herniated mass disappeared on MRI. Because herniated mass disappeared within a short period of time, the involvement of immune reaction was suggested, as well as the possibility of sequentration, degeneration, and phagocytosis. (N.K.).

  14. Herniation through gastrostomy site: Case report

    Directory of Open Access Journals (Sweden)

    Fernando Navarro

    2016-01-01

    Conclusion: Herniation through gastrostomy site is a possible complication of PEG tube and clinicians should consider this possibility in patients with ongoing leakage, bulge or pain at the gastrostomy site. This entity can be safely corrected via laparoscopic or open techniques.

  15. Transient Hearing Loss Within a Critical Period Causes Persistent Changes to Cellular Properties in Adult Auditory Cortex.

    Science.gov (United States)

    Mowery, Todd M; Kotak, Vibhakar C; Sanes, Dan H

    2015-08-01

    Sensory deprivation can induce profound changes to central processing during developmental critical periods (CPs), and the recovery of normal function is maximal if the sensory input is restored during these epochs. Therefore, we asked whether mild and transient hearing loss (HL) during discrete CPs could induce changes to cortical cellular physiology. Electrical and inhibitory synaptic properties were obtained from auditory cortex pyramidal neurons using whole-cell recordings after bilateral earplug insertion or following earplug removal. Varying the age of HL onset revealed brief CPs of vulnerability for membrane and firing properties, as well as, inhibitory synaptic currents. These CPs closed 1 week after ear canal opening on postnatal day (P) 18. To examine whether the cellular properties could recover from HL, earplugs were removed prior to (P17) or after (P23), the closure of these CPs. The earlier age of hearing restoration led to greater recovery of cellular function, but firing rate remained disrupted. When earplugs were removed after the closure of these CPs, several changes persisted into adulthood. Therefore, long-lasting cellular deficits that emerge from transient deprivation during a CP may contribute to delayed acquisition of auditory skills in children who experience temporary HL. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  16. Transient overexpression of exogenous APOBEC3A causes C-to-U RNA editing of thousands of genes.

    Science.gov (United States)

    Sharma, Shraddha; Patnaik, Santosh K; Kemer, Zeynep; Baysal, Bora E

    2017-05-04

    APOBEC3A cytidine deaminase induces site-specific C-to-U RNA editing of hundreds of genes in monocytes exposed to hypoxia and/or interferons and in pro-inflammatory macrophages. To examine the impact of APOBEC3A overexpression, we transiently expressed APOBEC3A in HEK293T cell line and performed RNA sequencing. APOBEC3A overexpression induces C-to-U editing at more than 4,200 sites in transcripts of 3,078 genes resulting in protein recoding of 1,110 genes. We validate recoding RNA editing of genes associated with breast cancer, hematologic neoplasms, amyotrophic lateral sclerosis, Alzheimer disease and primary pulmonary hypertension. These results highlight the fundamental impact of APOBEC3A overexpression on human transcriptome by widespread RNA editing.

  17. Genotypic and Antimicrobial Characterisation of Propionibacterium acnes Isolates from Surgically Excised Lumbar Disc Herniations

    Directory of Open Access Journals (Sweden)

    Jess Rollason

    2013-01-01

    Full Text Available The anaerobic skin commensal Propionibacterium acnes is an underestimated cause of human infections and clinical conditions. Previous studies have suggested a role for the bacterium in lumbar disc herniation and infection. To further investigate this, five biopsy samples were surgically excised from each of 64 patients with lumbar disc herniation. P. acnes and other bacteria were detected by anaerobic culture, followed by biochemical and PCR-based identification. In total, 24/64 (38% patients had evidence of P. acnes in their excised herniated disc tissue. Using recA and mAb typing methods, 52% of the isolates were type II (50% of culture-positive patients, while type IA strains accounted for 28% of isolates (42% patients. Type III (11% isolates; 21% patients and type IB strains (9% isolates; 17% patients were detected less frequently. The MIC values for all isolates were lowest for amoxicillin, ciprofloxacin, erythromycin, rifampicin, tetracycline, and vancomycin (≤1mg/L. The MIC for fusidic acid was 1-2 mg/L. The MIC for trimethoprim and gentamicin was 2 to ≥4 mg/L. The demonstration that type II and III strains, which are not frequently recovered from skin, predominated within our isolate collection (63% suggests that the role of P. acnes in lumbar disc herniation should not be readily dismissed.

  18. Anterior herniation of lumbar disc induces persistent visceral pain: discogenic visceral pain: discogenic visceral pain.

    Science.gov (United States)

    Tang, Yuan-Zhang; Shannon, Moore-Langston; Lai, Guang-Hui; Li, Xuan-Ying; Li, Na; Ni, Jia-Xiang

    2013-01-01

    Visceral pain is a common cause for seeking medical attention. Afferent fibers innervating viscera project to the central nervous system via sympathetic nerves. The lumbar sympathetic nerve trunk lies in front of the lumbar spine. Thus, it is possible for patients to suffer visceral pain originating from sympathetic nerve irritation induced by anterior herniation of the lumbar disc. This study aimed to evaluate lumbar discogenic visceral pain and its treatment. Twelve consecutive patients with a median age of 56.4 years were enrolled for investigation between June 2012 and December 2012. These patients suffered from long-term abdominal pain unresponsive to current treatment options. Apart from obvious anterior herniation of the lumbar discs and high signal intensity anterior to the herniated disc on magnetic resonance imaging, no significant pathology was noted on gastroscopy, vascular ultrasound, or abdominal computed tomography (CT). To prove that their visceral pain originated from the anteriorly protruding disc, we evaluated whether pain was relieved by sympathetic block at the level of the anteriorly protruding disc. If the block was effective, CT-guided continuous lumbar sympathetic nerve block was finally performed. All patients were positive for pain relief by sympathetic block. Furthermore, the average Visual Analog Scale of visceral pain significantly improved after treatment in all patients (P herniation of the lumbar disc when forming a differential diagnosis for seemingly idiopathic abdominal pain. Continuous lumbar sympathetic nerve block is an effective and safe therapy for patients with discogenic visceral pain.

  19. Expression of the JAK/STAT3/SOCS3 signaling pathway in herniated lumbar discs.

    Science.gov (United States)

    Osuka, Koji; Usuda, Nobuteru; Aoyama, Masahiro; Yamahata, Hitoshi; Takeuchi, Mikinobu; Yasuda, Muneyoshi; Takayasu, Masakazu

    2014-05-21

    The inflammatory cytokine interleukin-6 (IL-6) plays an important role in causing symptoms of lumbar disk herniation. The present study clarifies the expression of the signaling pathway of IL-6 in herniated discs. Homogenates prepared from lumbar herniated discs from 10 patients were assessed. The expression of janus kinase 1 (JAK1), signal transducer and activator of transcription 3 (STAT3), phosphorylated (p)-STAT3 at Tyr(705), suppressor of cytokine signaling 3 (SOCS3) and actin was examined by Western blot analysis. The expression of JAK1, STAT3, and p-STAT3 at Tyr(705) was also examined by immunostaining. JAK1, STAT3, p-STAT3 at Tyr(705) and SOCS3 were detected in almost all cases. Immunoreactivity against JAK1 and STAT3 was observed mainly in chondrocytes, whereas immunoreactivity against p-STAT3 at Tyr(705) was observed in the nuclei of chondrocytes. The JAK/STAT signaling pathway might be activated by IL-6 and transmit messages from the cell surface to the nucleus, and the pathway is negatively regulated by SOCS3. These JAK1, STAT3 and SOCS3 molecules might tightly regulate and play a role in the degeneration of chondrocytes within herniated discs. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  20. Lumbar multifidus muscle changes in unilateral lumbar disc herniation using magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Altinkaya, Naime [Baskent University Medical School, Department of Radiology, Adana (Turkey); Cekinmez, Melih [Baskent University Medical School Adana, Department of Neurosurgery, Adana (Turkey)

    2016-01-15

    To assess multifidus muscle asymmetry using the cross-sectional area (CSA) and perpendicular distance of the multifidus muscle to the lamina (MLD) measurements in patients with nerve compression due to lumbosacral disc hernia. In total, 122 patients who underwent microdiscectomy for unilateral radiculopathy caused by disc herniation, diagnosed by magnetic resonance imaging (MRI), were evaluated retrospectively. Posterolateral or foraminal disc herniation at only one disc level, the L3-4, L4-L5, or L5-S1 region, was confirmed using MRI. Subjects were divided by symptom duration: 1-30 days, (group A), 31-90 days (group B), and > 90 days (group C). There were 48 cases in group A, 26 in group B, and 48 in group C. In groups A, B, and C, the median MLD differed significantly between the diseased and normal sides (P < 0.05). The MLD increased on the diseased side with symptom duration by lumbar disc herniation. The diseased side MLD was 5.1, 6.7, and 7.6 mm in groups A, B, and C, respectively (P < 0.05). The cut-off values for the MLD measurements were 5.3 mm (sensitivity = 62.3 %, specificity = 55.5 %; P < 0.05). In groups A, B, and C, the median CSA of the multifidus muscle was not significantly different between the diseased and the normal side (P > 0.05). The MLD measurement correlated significantly with multifidus asymmetry in patients with lumbar disc herniation. (orig.)

  1. Inguinal Herniation of the Urinary Bladder Presenting as Recurrent Urinary Retention

    Directory of Open Access Journals (Sweden)

    Amit Frenkel

    2015-01-01

    Full Text Available Herniation of the urinary bladder into the inguinal canal is an uncommon finding, observed in 0.5–4% of inguinal hernias (Curry (2000. It is usually associated with other conditions that increase intra-abdominal pressure such as bladder neck obstruction due to prostatic hypertrophy. Consequently, in men, it is usually associated with some degree of urinary retention. We present a 42-year-old man in whom herniation of the urinary bladder was the cause of urinary retention, and not vice versa. The patient was on tumor necrosis factor alpha antagonist (TNFA (Etanercept for severe Ankylosing spondylitis. Initially, the urinary retention was thought to be a side effect of the medication, but after the drug was discontinued, urinary retention persisted. CT and MRI demonstrated huge herniation of the urinary bladder into the inguinal canal. Immediately after the hernia was repaired, bladder function was restored. TNF treatment was restarted, and no further urinary symptoms were observed in the next two years of follow-up. In this case, the primary illness and its treatment were distracting barriers to early diagnosis and treatment. In younger patients with a large hernia who develop unexpected urinary retention, herniation of the urinary bladder should be highly considered in the differential diagnosis.

  2. Omental herniation through a 3-mm umbilical trocar site: unmasking a hidden umbilical hernia.

    Science.gov (United States)

    Bergemann, J L; Hibbert, M L; Harkins, G; Narvaez, J; Asato, A

    2001-06-01

    The incidence of umbilical hernia following laparoscopic surgery varies from 0.02-3.6%. The incidence of pre-existing fascial defects, however, may be as high as 18% in patients undergoing abdominal laparoscopic surgery. Previous recommendations have been made to close any fascial defect greater than or equal to 10 mm. Reported here is a case of herniation through a 3-mm trocar site incision and the discovery of a pre-existing fascial defect. A 32-year-old female underwent an uncomplicated laparoscopic tubal ligation using a 3-mm umbilical port. Prior to umbilical trocar removal at the completion of the case, the carbon dioxide was evacuated from the abdomen and the sleeve was withdrawn under direct vision. Neither the fascial nor skin incisions were sutured. On postoperative day two, the patient returned with omentum herniating from the 3-mm site. At surgery, a 1.5-cm pre-existing fascial defect was discovered adjacent to the trocar site. The hernia sac tracked laterally to the base of the umbilicus, and the omentum had slid into the sac and out the skin opening. As this report illustrates, herniation associated with laparoscopic trocar sites can occur with incisions as small as 3 mm. The presence of pre-existing fascial defects can cause increased morbidity in any laparoscopic surgery, and as illustrated in this report, may predispose the patient to site herniation. The detection and management of these defects is crucial in preventing postlaparoscopic complications.

  3. Spontaneous regression of herniated lumbar discs.

    Science.gov (United States)

    Kim, Eric S; Oladunjoye, Azeem O; Li, Jay A; Kim, Kee D

    2014-06-01

    The spontaneous regression of a lumbar herniated disc is a common occurrence. Studies using imaging techniques as well as immunohistologic analyses have attempted to explain the mechanism for regression. However, the exact mechanism remains elusive. Understanding the process by which herniated discs disappear in the absence of surgery may better guide treatment. Recent case reports, radiographic and immunohistologic studies show that the extent of extrusion of the nucleus pulposus is related to a higher likelihood of regression. To our knowledge, Patient 3 is the first report of spontaneous regression occurring within 2 months. This occurrence was discovered intraoperatively. We present three illustrative patients. Patient 1, a 53-year-old man, presented with a large L2-L3 disc herniation. His 2 year follow-up MRI revealed a complete regression of the extruded fragment. Patient 2, a 58-year-old man, presented with an L3-L4 disc herniation with cephalad migration of a free fragment. MRI 9 months later showed no free fragment but progression of a disc bulge. Intraoperative exploration during the L3-L4 microdiscectomy confirmed the absence of the free fragment. Patient 3, a 58-year-old woman, presented with a large L2-L3 disc extrusion with cephalad migration. An imaging study performed 2 months after the initial study revealed an absence of the free fragment. Our case reports demonstrate the temporal variance in disc regression. While the time course and extent of regression vary widely, the rapid time in which regression can occur should caution surgeons contemplating discectomy based on an MRI performed a significant period prior to surgery. Copyright © 2013 Elsevier Ltd. All rights reserved.

  4. The Clinical Results of Percutaneous Endoscopic Interlaminar Discectomy (PEID) in the Treatment of Calcified Lumbar Disc Herniation: A Case-Control Study.

    Science.gov (United States)

    Dabo, Xu; Ziqiang, Chen; Yinchuan, Zhao; Haijian, Ni; Kai, Chen; Yanbin, Liu; Qiang, Fu; Chuanfeng, Wang

    2016-02-01

    Percutaneous endoscopic interlaminar discectomy (PEID), which poses advantages for certain types of herniated disc, is gaining wider acceptance in clinical practice. We retrospectively analyzed the efficacy of the PEID technique in treatment of calcified lumbar disc herniation. A retrospective case-control study. University hospital in China. To evaluate the efficacy of the PEID technique in treatment of calcified lumbar disc herniation, and a comparison between calcified and noncalcified disc herniation was drawn to analyze the causes of herniated disc calcification. Data from patients who underwent full-endoscopic lumbar discectomy in our department between March 2011 and May 2013 were collected. Thirty cases with calcified lumbar disc herniation were included in the study group, and 30 age-, gender-, and body mass index (BMI)-matched cases with noncalcified lumbar disc herniation served as controls. Perioperative data, preoperative and postoperative Visual Analog Scale (VAS) scores, Oswestry Disability Index (ODI) values, MacNab scores, and postoperative low-extremity dysesthesia among patients in the 2 groups were collected. The values of computed tomography (CT) in the calcified group were significantly higher than those in the noncalcified group (P 0.05). Three months after surgery, the rate of low-extremity dysesthesia in the calcified group was significantly higher than that in the control group (P = 0.03) but became similar at 6 months. By applying MacNab criteria the proportions of good and excellent were greater than 90% in both groups, and there was no difference between groups (P > 0.05). The sample size was small in this retrospective study. The PEID technique is an effective method in the treatment of calcified lumber disc herniation, although the rate of postoperative dysesthesia is higher in this group during the early postoperative period. Long-term TCM administration may be related to the calcification of herniated lumbar discs.

  5. Traumatic lumbar vertebral ring apophysis fracture with disk herniation in an adolescent

    Directory of Open Access Journals (Sweden)

    Geetanjalee Kadam, MBBS, DNB

    2017-06-01

    Full Text Available We present a case of a 15-year-old male with history of back pain and bilateral lower limb radiculopathy due to fall. The magnetic resonance imaging scan showed disc bulge at L2-L3 level causing compression on contained nerve roots. In this case, computed tomography scan was indispensable for diagnosis and classification of the vertebral apophyseal fracture and to guide appropriate further management. Apophyseal ring fracture is an uncommon cause of back pain with radiculopathy in adolescents and athletes. High degree of suspicion is necessary to differentiate these injuries from disc herniation so as to further guide appropriate conservative or surgical management. The common cause of back pain in this population is related to musculoskeletal injuries. Lumbar disc herniation contributes to negligible number of cases in this age group, as against that seen in the adult population. An important and rare etiology to be considered for these patients includes vertebral ring apophyseal fracture.

  6. The role of CT discography in far lateral disk herniation

    Energy Technology Data Exchange (ETDEWEB)

    Koh, Hyun Shim; Yun, Seung Soo; Park, Jun Kyun; Kim, Young Chul; Kim, Young Sook; Oh, Jae Hee [College of Medicine, Chosun University, Kwangju (Korea, Republic of)

    1995-10-15

    To evaluate the value and the radiologic findings of CT discography in the diagnosis of the far lateral disk herniation. We retrospectively reviewed 7 cases of surgically proven far lateral lumbar disc herniation. CT discography was performed for all cases. Four cases underwent conventional CT and three cases MRI as a primary diagnostic imaging method. Far lateral diac herniation was divided into 3 groups by location; Intraforaminal herniation, extraforaminal herniation, and mixed type. We analyzed the findings of CT discography including location and extent of far lateral disc herniation. In all 7 cases, CT discography clearly demonstrated the filling of contrast media in laterally-protruded disc material. Intraforaminal and extraforminal types were seen in 2 cases each, and mixed type in 3 cases. Subligamentous herniated nucleus pulposus was present in 6 cases and extruded disc in 1 cases. Far lateral disc herniation was located at L4-5 in 5 cases and L5-S1 in 2 cases. CT discography can help establishing accurate preoperative diagnosis for far lateral disc herniation.

  7. Spontaneous regression of a lumbar disc herniation: case report

    Directory of Open Access Journals (Sweden)

    Mostarchid Brahim El

    2016-12-01

    Full Text Available Lumbar disc herniation is a common disease that induces back pain and radicular pain. Some cases require conservative treatment or at times relived spontaneously. Spontaneous regression of disc herniation is an atypical clinical presentation, and it has been recognized with the advancement of recent advances in imaging techniques. We present a 35-year-old woman presented a spontaneous regression of a lumbar disc herniation with good outcome after intensive physical therapy program. Spontaneous regression of disc herniation is thought to occur via an inflammatory reaction with molecular mechanisms of phagocytic processes.

  8. Acupuncture and Spontaneous Regression of a Radiculopathic Cervical Herniated Disc

    Directory of Open Access Journals (Sweden)

    Kim Sung-Ha

    2012-06-01

    Full Text Available The spontaneous regression of herniated cervical discs is not a well-established phenomenon. However, we encountered a case of a spontaneous regression of a severe radiculopathic herniated cervical disc that was treated with acupuncture, pharmacopuncture, and herb medicine. The symptoms were improved within 12 months of treatment. Magnetic resonance imaging (MRI conducted at that time revealed marked regression of the herniated disc. This case provides an additional example of spontaneous regression of a herniated cervical disc documented by MRI following non-surgical treatment.

  9. CT- and fluoroscopy-guided percutaneous discectomy for lumbar radiculopathy related to disc herniation: a comparative prospective study comparing lateral to medial herniated discs

    Energy Technology Data Exchange (ETDEWEB)

    Amoretti, Nicolas; Huwart, Laurent; Marcy, Pierre-Yves [Centre Hospital-Universitaire de Nice, Department of Radiology, Hopital archet 2, Nice (France); Foti, Pauline [Centre Hospital-Universitaire de Nice, Department of Medical Statistics, Hopital archet 2, Nice (France); Hauger, Olivier [Centre Hospitalo-Universitaire de Bordeaux, Department of Radiology, Hopital Pellegrin, Bordeaux (France); Boileau, Pascal [Centre Hospital-Universitaire de Nice, Department of Orthopedic Surgery, Hopital archet 2, Nice (France)

    2013-01-15

    To evaluate and compare two groups of patients with sciatica due to intervertebral disc herniation with no neurologic deficit. The groups consisted of patients with intervertebral disc herniation in a medial location (group 1) and those in a lateral location (group 2). A total of 200 patients were included in the study and were followed for a minimum of 6 months. In our series, we treated 80 postero-lateral herniated discs (40% of cases), 46 postero-medial herniated discs (23%), and 74 foraminal herniated discs (37%). Level L3-L4 was treated in 30 cases (15%), L4-L5 in 98 cases (49%), and L5-S1 in 72 cases (36%). The procedure was performed under dual guidance: fluoroscopic and CT. A helical probe was activated. It penetrates the herniated disc and causes the pulpous material to be mechanically evacuated through the probe. All 200 patients were followed for a minimum of 6 months. In group 1, the patients had a mean pain score of 7.9 {+-} 2.5 VAS units (range 6-10 units) prior to intervention. This was reduced to 3.2 {+-} 2.1 VAS units (range 0-10 units) at 48 h follow-up and increased to 3.9 {+-} 1.2 VAS units (range 0-10 VAS units) at 1 month follow-up and further reduced to 2.7 {+-} 1.2 units (range 0-10 VAS units) at 6 month follow-up. In group 2, the patients had a mean pain score of 8.2 {+-} 3.2 VAS units (range 6-10 units) prior to intervention. This was reduced to 2.8 {+-} 1.5 VAS units (range 0-10 units) at 48 h follow-up and decreased to 1.5 {+-} 0.9 VAS units (range 0-10 units) at 1 month and further reduced to 1.1 {+-} 0.5 VAS units (range 0-10 units) at 6 months. Our study showed that results were more satisfactory for the hernia located laterally (postero-lateral, foraminal, and extra-foraminal) as compared to the hernia located posteromedially. (orig.)

  10. CT- and fluoroscopy-guided percutaneous discectomy for lumbar radiculopathy related to disc herniation: a comparative prospective study comparing lateral to medial herniated discs.

    Science.gov (United States)

    Amoretti, Nicolas; Huwart, Laurent; Marcy, Pierre-Yves; Foti, Pauline; Hauger, Olivier; Boileau, Pascal

    2013-01-01

    To evaluate and compare two groups of patients with sciatica due to intervertebral disc herniation with no neurologic deficit. The groups consisted of patients with intervertebral disc herniation in a medial location (group 1) and those in a lateral location (group 2). A total of 200 patients were included in the study and were followed for a minimum of 6 months. In our series, we treated 80 postero-lateral herniated discs (40% of cases), 46 postero-medial herniated discs (23%), and 74 foraminal herniated discs (37%). Level L3-L4 was treated in 30 cases (15%), L4-L5 in 98 cases (49%), and L5-S1 in 72 cases (36%). The procedure was performed under dual guidance: fluoroscopic and CT. A helical probe was activated. It penetrates the herniated disc and causes the pulpous material to be mechanically evacuated through the probe. All 200 patients were followed for a minimum of 6 months. In group 1, the patients had a mean pain score of 7.9 ± 2.5 VAS units (range 6-10 units) prior to intervention. This was reduced to 3.2 ± 2.1 VAS units (range 0-10 units) at 48 h follow-up and increased to 3.9 ± 1.2 VAS units (range 0-10 VAS units) at 1 month follow-up and further reduced to 2.7 ± 1.2 units (range 0-10 VAS units) at 6 month follow-up. In group 2, the patients had a mean pain score of 8.2 ± 3.2 VAS units (range 6-10 units) prior to intervention. This was reduced to 2.8 ± 1.5 VAS units (range 0-10 units) at 48 h follow-up and decreased to 1.5 ± 0.9 VAS units (range 0-10 units) at 1 month and further reduced to 1.1 ± 0.5 VAS units (range 0-10 units) at 6 months. Our study showed that results were more satisfactory for the hernia located laterally (postero-lateral, foraminal, and extra-foraminal) as compared to the hernia located posteromedially.

  11. Surgical Outcome of Two-Level Transforaminal Percutaneous Endoscopic Lumbar Discectomy for Far-Migrated Disc Herniation

    Science.gov (United States)

    Wu, Xinbo; Fan, Guoxin; Gu, Xin

    2016-01-01

    Objective. To describe the two-level percutaneous endoscopic lumbar discectomy (PELD) technique in transforaminal approach for highly migrated disc herniation and investigate its clinical outcomes. Methods. A total of 22 consecutive patients with highly migrated lumbar disc herniation were enrolled for the study from June 2012 to February 2014. Results. There were 12 males and 10 females, with a mean age of 41.1 (range 23–67) years. The mean follow-up period was 18.05 (range 14–33) months. According to the modified MacNab criteria, the clinical outcome at the final follow-up was excellent in 14, good in 6, and fair in 2 patients and the satisfactory rate (excellent and good) was 90.9%. The improvements in VAS and ODI were statistically significant. One patient had recurrent herniation in 18 months after the first surgery and underwent open discectomy. One patient showed symptoms of postoperative dysesthesia (POD), but the POD symptom was transient and partial remission was achieved in two months after conservative treatment. Conclusion. Two-level PELD in transforaminal approach can be a safe and effective procedure for highly migrated disc herniation. PMID:28070509

  12. Surgical Outcome of Two-Level Transforaminal Percutaneous Endoscopic Lumbar Discectomy for Far-Migrated Disc Herniation

    Directory of Open Access Journals (Sweden)

    Xinbo Wu

    2016-01-01

    Full Text Available Objective. To describe the two-level percutaneous endoscopic lumbar discectomy (PELD technique in transforaminal approach for highly migrated disc herniation and investigate its clinical outcomes. Methods. A total of 22 consecutive patients with highly migrated lumbar disc herniation were enrolled for the study from June 2012 to February 2014. Results. There were 12 males and 10 females, with a mean age of 41.1 (range 23–67 years. The mean follow-up period was 18.05 (range 14–33 months. According to the modified MacNab criteria, the clinical outcome at the final follow-up was excellent in 14, good in 6, and fair in 2 patients and the satisfactory rate (excellent and good was 90.9%. The improvements in VAS and ODI were statistically significant. One patient had recurrent herniation in 18 months after the first surgery and underwent open discectomy. One patient showed symptoms of postoperative dysesthesia (POD, but the POD symptom was transient and partial remission was achieved in two months after conservative treatment. Conclusion. Two-level PELD in transforaminal approach can be a safe and effective procedure for highly migrated disc herniation.

  13. Tamoxifen affects glucose and lipid metabolism parameters, causes browning of subcutaneous adipose tissue and transient body composition changes in C57BL/6NTac mice

    Energy Technology Data Exchange (ETDEWEB)

    Hesselbarth, Nico; Pettinelli, Chiara [Department of Medicine, University of Leipzig, D-04103 Leipzig (Germany); Gericke, Martin [Institute of Anatomy, University of Leipzig, D-04103 Leipzig (Germany); Berger, Claudia [IFB Adiposity Disease, Core Unit Animal Models, University of Leipzig, D-04103 Leipzig (Germany); Kunath, Anne [German Center for Diabetes Research (DZD), Leipzig (Germany); Stumvoll, Michael; Blüher, Matthias [Department of Medicine, University of Leipzig, D-04103 Leipzig (Germany); Klöting, Nora, E-mail: nora.kloeting@medizin.uni-leipzig.de [IFB Adiposity Disease, Core Unit Animal Models, University of Leipzig, D-04103 Leipzig (Germany)

    2015-08-28

    Tamoxifen is a selective estrogen receptor (ER) modulator which is widely used to generate inducible conditional transgenic mouse models. Activation of ER signaling plays an important role in the regulation of adipose tissue (AT) metabolism. We therefore tested the hypothesis that tamoxifen administration causes changes in AT biology in vivo. 12 weeks old male C57BL/6NTac mice were treated with either tamoxifen (n = 18) or vehicle (n = 18) for 5 consecutive days. Tamoxifen treatment effects on body composition, energy homeostasis, parameters of AT biology, glucose and lipid metabolism were investigated up to an age of 18 weeks. We found that tamoxifen treatment causes: I) significantly increased HbA{sub 1c}, triglyceride and free fatty acid serum concentrations (p < 0.01), II) browning of subcutaneous AT and increased UCP-1 expression, III) increased AT proliferation marker Ki67 mRNA expression, IV) changes in adipocyte size distribution, and V) transient body composition changes. Tamoxifen may induce changes in body composition, whole body glucose and lipid metabolism and has significant effects on AT biology, which need to be considered when using Tamoxifen as a tool to induce conditional transgenic mouse models. Our data further suggest that tamoxifen-treated wildtype mice should be characterized in parallel to experimental transgenic models to control for tamoxifen administration effects. - Highlights: • Tamoxifen treatment causes significantly increased HbA{sub 1c}, triglyceride and free fatty acid serum concentrations. • Tamoxifen induces browning of subcutaneous AT and increased UCP-1 expression. • Tamoxifen changes adipocyte size distribution, and transient body composition.

  14. Episodic edema in type 2 lepra reaction can be caused by transient lymphatic obstruction in the lymph node.

    Science.gov (United States)

    Stanley, J N; Pearson, J M; Ridley, D B

    1986-06-01

    Fourteen patients with lepromatous leprosy developed attacks of edema of the hands and/or feet associated with attacks of type 2 lepra reaction (erythema nodosum leprosum). The regional lymph nodes were enlarged and often tender when edema was present. Lymph node biopsies in five cases showed compression of the subcapsular sinus against the thickened fibrotic capsule of the inflamed node. It is suggested that this obstructs the inflow of lymph into the regional nodes, thereby causing the edema.

  15. Transiently increasing cAMP levels selectively in hippocampal excitatory neurons during sleep deprivation prevents memory deficits caused by sleep loss.

    Science.gov (United States)

    Havekes, Robbert; Bruinenberg, Vibeke M; Tudor, Jennifer C; Ferri, Sarah L; Baumann, Arnd; Meerlo, Peter; Abel, Ted

    2014-11-19

    The hippocampus is particularly sensitive to sleep loss. Although previous work has indicated that sleep deprivation impairs hippocampal cAMP signaling, it remains to be determined whether the cognitive deficits associated with sleep deprivation are caused by attenuated cAMP signaling in the hippocampus. Further, it is unclear which cell types are responsible for the memory impairments associated with sleep deprivation. Transgenic approaches lack the spatial resolution to manipulate specific signaling pathways selectively in the hippocampus, while pharmacological strategies are limited in terms of cell-type specificity. Therefore, we used a pharmacogenetic approach based on a virus-mediated expression of a Gαs-coupled Drosophila octopamine receptor selectively in mouse hippocampal excitatory neurons in vivo. With this approach, a systemic injection with the receptor ligand octopamine leads to increased cAMP levels in this specific set of hippocampal neurons. We assessed whether transiently increasing cAMP levels during sleep deprivation prevents memory consolidation deficits associated with sleep loss in an object-location task. Five hours of total sleep deprivation directly following training impaired the formation of object-location memories. Transiently increasing cAMP levels in hippocampal neurons during the course of sleep deprivation prevented these memory consolidation deficits. These findings demonstrate that attenuated cAMP signaling in hippocampal excitatory neurons is a critical component underlying the memory deficits in hippocampus-dependent learning tasks associated with sleep deprivation. Copyright © 2014 the authors 0270-6474/14/3415715-07$15.00/0.

  16. Treatment and outcome of herniated lumbar intervertebral disk in a ...

    African Journals Online (AJOL)

    The goal of treatment in cases of lumbar disk herniation is to return the patient to normal activities as quickly as possible. Therefore unnecessary surgery should be avoided (2). However about 10% of patients with lumbar disk herniation will ultimately require surgery (3). Surgery is recommended if the sciatica is severe and ...

  17. Spontaneous regression of lumbar herniated disc Case presentation

    Directory of Open Access Journals (Sweden)

    Chiriac A.

    2015-12-01

    Full Text Available Intervertebral disc herniation is a common disease that usually requires surgical intervention. However, in some cases, neurological symptoms may improve with conservative treatment. In this article, we present a case with spontaneous regression of extruded lumbar herniated disc correlated with clinical improvement and documented with follow up MRI studies.

  18. Clinical Outcomes of Percutaneous Transforaminal Endoscopic Discectomy Versus Fenestration Discectomy in Patients with Lumbar Disc Herniation

    OpenAIRE

    Zheng-mei DING; Yong-qing TAO

    2017-01-01

    Background: Fenestration discectomy (FD) is a common treatment method for lumber disc herniation (LDH), with good effects obtained. Nevertheless, it also causes many complications, such as lumbar instability, lumbago and back pain. Percutaneous endoscopic lumbar discectomy (PTED) is a new minimally invasive treatment available for LDH with conservative therapy failure. At present, this technique has been carried out in China. The purpose of this study was to conduct a randomized prospective t...

  19. An intronic variation in SLC52A1 causes exon skipping and transient riboflavin-responsive multiple acyl-CoA dehydrogenation deficiency.

    Science.gov (United States)

    Mosegaard, Signe; Bruun, Gitte Hoffmann; Flyvbjerg, Karen Freund; Bliksrud, Yngve Thomas; Gregersen, Niels; Dembic, Maja; Annexstad, Ellen; Tangeraas, Trine; Olsen, Rikke Katrine Jentoft; Andresen, Brage S

    2017-11-02

    Vitamin B2, riboflavin is essential for cellular function, as it participates in a diversity of redox reactions central to human metabolism, through its role as precursor for the cofactors flavin mononucleotide (FMN) and flavin adenine dinucleotide (FAD), which are electron carriers. The electron transfer flavoprotein (ETF) and its dehydrogenase (ETFDH), uses FAD as cofactor. The ETF and ETFDH are forming the electron transport pathway for many mitochondrial flavoprotein dehydrogenases involved in fatty acid, amino acid and choline metabolism. A variation in either ETF or ETFDH causes multiple acyl-CoA dehydrogenation deficiency (MADD), but genetic variations in the riboflavin metabolism or transportation of riboflavin can also cause MADD. The most common variations are located in the riboflavin transporter 2 (RFVT2) and 3 (RFVT3), that are highly expressed in brain and intestinal tissues, respectively. Deficiency of riboflavin transporter 1 (RFVT1), encoded by the SLC52A1 gene, highly expressed in the placenta, has only been reported once. We here report a case of transient MADD, caused by a heterozygous intronic variation, c.1134+11G>A, in the SLC52A1 gene encoding RFVT1. This variation creates a binding site for the splice inhibitory hnRNP A1 protein and causes exon 4 skipping. Riboflavin deficiency and maternal malnutrition during pregnancy might have been the determining factor in the outcome of this case. Copyright © 2017. Published by Elsevier Inc.

  20. Research on the Cascading Tripping Risk of Wind Turbine Generators Caused by Transient Overvoltage and Its Countermeasures

    Science.gov (United States)

    Yu, Haiyang; Zhang, Meilun; Zu, Guangxin

    2017-12-01

    At present, China’s electricity utility develops rapidly, however, the wind power consumption ability has been unable to meet the actual demand of consumption. Therefore, it is necessary to send wind power across the region. The commutation failure in the operation will lead to the cascading tripping of wind turbines. In order to solve the above problems, this paper will analyze the causes of such problems, analyze the basic principles of wind power cascading trips and analyze the specific solutions, hoping to give some reference for relevant people.

  1. Intraoperative Atelectasis Due to Endotracheal Tube Cuff Herniation: A Case Report

    Directory of Open Access Journals (Sweden)

    Hossein Madineh

    2012-09-01

    Full Text Available Endotracheal tube (ETT cuff herniation is a rare, and often difficult to diagnose, cause of bronchial obstruction. We present a case of outside cuff herniation of an endotracheal tube that caused pulmonary right lung atelectasis. A 29-year-old man ,a case of car accident with multiple fractures, was admitted to the emergency ward and transferred to the operating room(OR for open reduction and internal fixation (ORIF of all fractures .The procedures were done under general anesthesia (G/A. The past medical history of the patient did not indicate any problem. Anesthesia was induced with thiopental, atracurium and then maintained by propofol and remifentanyl infusions and 100% O2 via orally inserted ETT. The patient was positioned in left lateral decubitus position for operation. Two hours after induction of anesthesia, the oxygen saturation level dropped to 85 % and the breath sounds in the right side of the chest were weakened. The chest x-ray images showed right lung atelectasis especially in the upper lobe. The problem was disappeared after removal of the ETT. In this case, we observed that an ETT cuff herniation can be a cause of airway obstruction. If there is a decreased unilateral breath sounds, we recommend replacement or repositioning of ETT.

  2. Physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain (Review)

    NARCIS (Netherlands)

    van der Windt, D.A.W.M.; Simons, E.; Riphagen, I.I.; Ammendolia, C.; Verhagen, A.P.; Laslett, M.; Devillé, W.; Deyo, R.A.; Bouter, L.M.; de Vet, H.C.W.; Aertgeerts, B.

    2011-01-01

    Background Low-back pain with leg pain (sciatica) may be caused by a herniated intervertebral disc exerting pressure on the nerve root. Most patients will respond to conservative treatment, but in carefully selected patients, surgical discectomy may provide faster relief of symptoms. Primary care

  3. Percutaneous treatment of lumbar disc herniation

    Energy Technology Data Exchange (ETDEWEB)

    Leonardi, M.; Resta, F.; Bettinelli, A. [Ospedale Maggiore di Milano (Italy); Lavaroni, A.; Fabris, G. [Ospedale Civile di Udine (Italy); Abelli, F. [Fondazione Clinica del Lavorno, Pavia (Italy)

    1994-12-31

    918 patients were subjected to percutaneous treatment of lumbar herniated disc. 733 of these were treated through enzymatic nucleolysis with chymopapain, for a total 883 levels. Chemonucleolysis was carried out on 733 patients (79.8%). Automated discectomy has been carried out in 185 cases (20.1%). Chemonucleolysis has led to the resolution of the symptoms in a high percentage of cases (82.2%). Nucleotomy has proved to be an effective method in 74.6% of cases. (author). 7 refs, 6 figs, 1 tab.

  4. Postpartum trifecta: simultaneous eclamptic intracerebral hemorrhage, PRES, and herniation due to intracranial hypotension.

    Science.gov (United States)

    Orehek, Eleanor K; Burns, Joseph D; Koyfman, Feliks; Azocar, Ruben J; Holsapple, James W; Green, Deborah M

    2012-12-01

    In the postpartum patient, sudden depression of consciousness may be caused by a number of etiologies and can result in serious consequences. Rapid, accurate diagnosis allows for specific treatments that optimize outcome, but diagnosis can be challenging in this population. We present a case of postpartum herniation due to intracranial hypotension in a patient with eclampsia, posterior reversible encephalopathy syndrome (PRES), and intracerebral hemorrhage (ICH). Case report. A 26-year-old woman developed headache on postpartum day (PD) 1 after cesarean section with epidural anesthesia. Over the next 3 days, she developed progressively worsening headache and hypertension. On PD 5, she had a generalized seizure, leading to endotracheal intubation, propofol infusion, and transfer to our institution. By PD 6, she opened her eyes to voice, followed commands, moved all extremities, and had briskly reactive 4 mm pupils. MRI showed L parasagittal ICH with minimal mass effect, edema consistent with PRES, and brain descent with obliteration of the basal cisterns and tonsillar herniation. Later on PD 6, after diuresis for pulmonary edema, she became unresponsive with a dilated and nonreactive left pupil. She was laid flat for transport to CT, with improvement in arousal and pupil reactivity within 5 min. Intravascular volume was repleted with normal saline and albumin, and she was placed in the Trendelenburg position. Over the subsequent 8 h, she developed a dilated and nonreactive left pupil whenever her head was raised to horizontal. Her head position was gradually successfully raised over 48 h without need for a lumbar epidural blood patch. She was discharged home on PD 13 with only mild left arm dysmetria. Intracranial hypotension may coexist with other potential causes of cerebral herniation in the postpartum period. Establishing this diagnosis is crucial because its treatment is opposite that of other causes of herniation.

  5. Multi-Point Detection of the Elf Transient Caused by the Gamma Flare of December 27, 2004

    Science.gov (United States)

    Nickolaenko, A. P.; Schekotov, A. Yu.; Hayakawa, M.; Hobara, Y.; Sátori, G.; Bor, J.; Neska, M.

    2014-07-01

    We present the experimental records of the radio pulse related to the gamma burst that took place on December 27, 2004. The records, which are synchronized by GPS time marks, were obtained in the observatories at Moshiri and Onagawa (Japan), Esrange (Sweden), Karimshino (Kamchatka, Russia), Nagycenk (Hungary), and Hornsund (Polish Polar Station Spitzbergen). The data demonstrate exceptional similarity and contain characteristic pulses that correspond to the time of gamma-ray arrival. Processing of the signals shows that along with the time match, the following modeling predictions are confirmed: radio pulses contain a signal at the main frequency of the Schumann resonance, the field source has positive polarity (the current is directed from the ionosphere towards the Earth), the polarization of the horizontal magnetic field of the radio wave is almost linear, and the directions towards the source indicate the epicenter of the gamma-quanta flux collision with the ionosphere. These properties correspond to the concept of the parametric electromagnetic pulse that is produced due to a significant change in the current in the global electric circuit, which is caused by a cosmic gamma-ray flare.

  6. Lumbar herniated disc: spontaneous regression.

    Science.gov (United States)

    Altun, Idiris; Yüksel, Kasım Zafer

    2017-01-01

    Low back pain is a frequent condition that results in substantial disability and causes admission of patients to neurosurgery clinics. To evaluate and present the therapeutic outcomes in lumbar disc hernia (LDH) patients treated by means of a conservative approach, consisting of bed rest and medical therapy. This retrospective cohort was carried out in the neurosurgery departments of hospitals in Kahramanmaraş city and 23 patients diagnosed with LDH at the levels of L3-L4, L4-L5 or L5-S1 were enrolled. The average age was 38.4 ± 8.0 and the chief complaint was low back pain and sciatica radiating to one or both lower extremities. Conservative treatment was administered. Neurological examination findings, durations of treatment and intervals until symptomatic recovery were recorded. Laségue tests and neurosensory examination revealed that mild neurological deficits existed in 16 of our patients. Previously, 5 patients had received physiotherapy and 7 patients had been on medical treatment. The number of patients with LDH at the level of L3-L4, L4-L5, and L5-S1 were 1, 13, and 9, respectively. All patients reported that they had benefit from medical treatment and bed rest, and radiologic improvement was observed simultaneously on MRI scans. The average duration until symptomatic recovery and/or regression of LDH symptoms was 13.6 ± 5.4 months (range: 5-22). It should be kept in mind that lumbar disc hernias could regress with medical treatment and rest without surgery, and there should be an awareness that these patients could recover radiologically. This condition must be taken into account during decision making for surgical intervention in LDH patients devoid of indications for emergent surgery.

  7. Akt/PKB isoforms expression in the human lumbar herniated disc: correlation with clinical and MRI findings.

    Science.gov (United States)

    Pasku, Dritan; Soufla, Giannoula; Katonis, Pavlos; Tsarouhas, Alexandros; Vakis, Antonis; Spandidos, Demetrios A

    2011-10-01

    Intervertebral disc (IVD) degeneration suggests a complex process influenced by genetics, lifestyle and biomechanics, which accounts for the development of low back pain (LBP) and lumbar radiculopathy, a major cause of musculoskeletal disability in humans. The family of Akt/PKB kinases is a principal mediator in the signal transduction pathways, which contribute to transcriptional regulation, cell growth, proliferation, apoptosis, and survival ability. The purpose of this study was to evaluate the transcriptional profile of the AKT family genes in human herniated discs and the involvement of the PI3K-Akt signaling pathway in human IVD degeneration. Real-time PCR analysis was used to assess the mRNA expression pattern of the three Akt/PKB isoforms in 63 herniated and 10 control disc specimens. Our results showed a significant positive correlation between AKT1 and AKT3 mRNA in herniated discs suggesting a synergistic action between these isoforms in disc herniation. Interestingly, AKT2 mRNA was up-regulated in patients with acute pain during the first 12 months, indicating that AKT2 transcriptional activation may be associated with acute rather than chronic inflammation and phagocytosis. Finally, Akt1/PKB transcription presented a stepwise activation as disc herniation deteriorated. Our findings provide evidence on the transcriptional activation of the Akt/PKB pathway indicating that it is involved in lumbar disc degeneration. There is need for further studies to elucidate the exact role and down-stream signaling action of Akt/PKB isoforms in the pathogenesis of lumbar disc herniation.

  8. The morphology of acute disc herniation: a clinically relevant model defining the role of flexion.

    Science.gov (United States)

    Veres, Samuel P; Robertson, Peter A; Broom, Neil D

    2009-10-01

    Hydrostatically induced disruption of flexed lumbar intervertebral discs followed by microstructural investigation. To investigate how flexion affects the anulus' ability to resist rupture during hydrostatic loading, and determine how the characteristics of the resulting disc failures compare with those observed clinically. While compression of neutrally positioned motion segments consistently causes vertebral failure, compression of flexed segments can induce herniation. Why flexion has this effect remains unclear. A vast range of herniation characteristics have been documented clinically; whether flexion-related herniations are likely to possess a subset of these is unknown. Forty-two ovine lumbar motion segments, dissected from the same 3 levels of 14 spines, were each flexed 7 degrees or 10 degrees from the neutral position. While maintained at one of these angles, the nucleus of each segment was gradually injected with a viscous radio-opaque gel via an injection screw placed longitudinally within the inferior vertebra, until failure occurred. Each segment was then inspected using microcomputed tomography and oblique illumination microscopy in tandem. RESULTS.: Eighteen segments suffered disc failure; 14 of these were caused by direct radial rupture of the anular wall. All radial ruptures were located in the central posterior anulus. Nine radial ruptures contained nuclear material, which had breached the posterior longitudinal ligament in 1 disc, and reached it in 5 others forming transligamentous and subligamentous nuclear extrusions, respectively. The most common radial rupture route, occurring in 10 discs, involved a systematic anulus-endplate-anulus failure pattern. Flexion places the anulus at risk by facilitating nuclear flow, limiting circumferential disruption while promoting radial rupture, and rendering the endplate/vertebra junction vulnerable to failure. Flexion may play a developmental role in those herniations possessing a central posterior radial

  9. Blunt traumatic pericardial rupture and cardiac herniation with a penetrating twist: two case reports

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    Galloway Robert

    2009-12-01

    Full Text Available Abstract Background Blunt Traumatic Pericardial Rupture (BTPR with resulting cardiac herniation following chest trauma is an unusual and often fatal condition. Although there has been a multitude of case reports of this condition in past literature, the recurring theme is that of a missed injury. Its occurrence in severe blunt trauma is in the order of 0.4%. It is an injury that frequently results in pre/early hospital death and diagnosis at autopsy, probably owing to a combination of diagnostic difficulties, lack of familiarity and associated polytrauma. Of the patients who survive to hospital attendance, the mortality rate is in the order of 57-64%. Methods We present two survivors of BTPR and cardiac herniation, one with a delayed penetrating cardiac injury secondary to rib fractures. With these two cases and literature review, we hope to provide a greater awareness of this injury Conclusion BTPR and cardiac herniation is a complex and often fatal injury that usually presents under the umbrella of polytrauma. Clinicians must maintain a high index of suspicion for BTPR but, even then, the diagnosis is fraught with difficulty. In blunt chest trauma, patients should be considered high risk for BTPR when presenting with: Cardiovascular instability with no obvious cause Prominent or displaced cardiac silhouette and asymmetrical large volume pneumopericardium Potentially, with increasing awareness of the injury and improved use and availability of imaging modalities, the survival rates will improve and cardiac Herniation could even be considered the 5th H of reversible causes of blunt traumatic PEA arrest.

  10. A Symptomatic Spinal Extradural Arachnoid Cyst with Lumbar Disc Herniation

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    Yoshinori Kadono

    2015-01-01

    Full Text Available Spinal epidural arachnoid cyst (EAC is a rare, usually asymptomatic condition of unknown origin, which typically involves the lower thoracic spine. We report a case of posttraumatic symptomatic EAC with lumbar disc herniation. A 22-year-old man experienced back pain and sciatica after a traffic accident. Neurological examination revealed a right L5 radiculopathy. Magnetic resonance imaging demonstrated a cystic lesion at the L3 to L5 level and an L4-5 disc herniation; computed tomography myelography showed that the right L5 root was sandwiched between the cyst and the herniation. A dural defect was identified during surgery. The cyst was excised completely and the defect was repaired. A herniation was excised beside the dural sac. Histology showed that the cyst wall consisted of collagen and meningothelial cells. Postoperatively the symptoms resolved. Lumbar spinal EACs are rare; such cysts may arise from a congenital dural crack and grow gradually. The 6 cases of symptomatic lumbar EAC reported in the literature were not associated with disc herniation or trauma. In this case, the comorbid disc herniation was involved in symptom progression. Although many EACs are asymptomatic, comorbid spinal disorders such as disc herniation or trauma can result in symptom progression.

  11. First trimester fetal physiologic midgut herniation: Transvaginal sonographic findings

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    Kwon, Tae Hee; Park, Yong Hyun [CHA General Hospital. Pochon College of Medicine, Seoul (Korea, Republic of)

    1999-06-15

    To evaluate the sonographic features and appearance time of the physiologic midgut herniation early in pregnancy. Sonograms of 87 features ranging from 7 to 13 weeks were obtained over a 2-month period. The presence or absence, the size and echogenecity of the physiologic midgut herniation were evaluate on each examination. Disappearance of the midgut herniation was confirmed on follow-up sonogram at 13-20 weeks, 3-12 weeks after the first sonogram. The results were analyzed in terms of appearance or disappearance time of midgut herniation. In all cases of physiologic midgut herination, an echogenic mass measuring 0.4-0.7 cm wa demonstrated within the base of the umbilical cord at its insertion into the fetal abdomen. This herniation was detected in 3/6 cases (50%) at 8 weeks, in 15/16 cases (94%) at 9 weeks, in 22/24 cases (92%) at 10 weeks and in 12/27 cases (44%) at 11 weeks gestation. None of the features studied at 7 weeks and 12 weeks had a midgut herniation. Sonographic findings of a 0.4-0.7 cm sized echogenic mass within the base of the umbilical cord which appears from 8 weeks to 12 weeks pregnancy represent physiologic midgut herniation in early pregnancy and should not be confused with pathologic ventral wall defected such as omphalocele or gastroschisis.

  12. Transient tic disorder

    Science.gov (United States)

    ... makes 1 or many brief, repeated, movements or noises (tics). These movements or noises are involuntary (not on purpose). Causes Transient tic ... less than a year. Other disorders such as anxiety , attention deficit hyperactivity disorder ( ADHD ), uncontrollable movement ( myoclonus ), ...

  13. Lumbar disc herniation presenting with contralateral symptoms: a case report.

    Science.gov (United States)

    Koh, Zhi Sheng Darren; Lin, Shuxun; Hey, Hwee Weng Dennis

    2017-03-01

    Lumbar disc herniation is common and may be symptomatic. The magnetic resonance imaging (MRI) scan is an appropriate tool to confirm the diagnosis and affected level of the spine. While a disc herniation is usually associated with ipsilateral symptoms, a few cases have been reported to present with contralateral symptoms. We report a unique case of left lumbar disc herniation at L5/S1 who presented with contralateral symptoms and was successfully treated with a right L5/S1 foraminal block. However, the patient developed concordant ipsilateral symptoms 6 weeks later and was treated with left L5/S1 microdiscectomy.

  14. Migration patterns of herniated disc fragments: a study on 1,020 patients with extruded lumbar disc herniation.

    Science.gov (United States)

    Daghighi, Mohammad Hussein; Pouriesa, Masoud; Maleki, Mirjalil; Fouladi, Daniel Fadaei; Pezeshki, Mohammad Zakaria; Mazaheri Khameneh, Ramin; Bazzazi, Amir Mohammad

    2014-09-01

    Herniated disc fragments are known to migrate in various directions within the spinal canal. To date, no comprehensive studies have been undertaken to examine the migration patterns of herniated disc material using a standard nomenclature and classification system. To report migration patterns of extruded lumbar disc fragments. A review of magnetic resonance (MR) images. A total of 1,020 consecutive Azeri patients with symptomatic extruded lumbar intervertebral disc herniation. Migration patterns of extruded lumbar disc fragments in vertical and horizontal planes and their association with age, gender, body mass index (BMI), and the level of herniation. High-quality axial and sagittal MR images of the lumbar spine were used. Disc material that was displaced away from the site of extrusion, regardless of continuity, was considered "migrated." The migration patterns observed were rostral or caudal in the vertical plane and central, paracentral, subarticular, foraminal, or extraforaminal in the horizontal plane. In the vertical plane, rostral and caudal migrations were observed in 27.8% and 72.2% of the patients, respectively. The number of rostral migrations increased significantly with increasing age and in higher levels in the lumbar spine (pherniation and migration pattern in the horizontal plane. Caudal and paracentral migrations are the most common patterns of migration in patients with extruded lumbar disc herniation in the vertical and horizontal planes, respectively. Age and the level of herniation may affect the migration patterns of herniated lumbar disc material. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. Syncope in children and adolescents as asudden, transient, short-term and spontaneously reversible loss of consciousness caused by adecrease in cerebral perfusion

    Directory of Open Access Journals (Sweden)

    Ewa Nowakowska

    2014-09-01

    Full Text Available Syncope is a common symptom in adolescents who come to the hospital emergency wards. The most common form of syncope is neurogenic type caused by impaired autoregulation of the circulatory system. This syncope is not generally life-threatening condition in a contrast to the less common but most dangerous cardiogenic type (e.g. cardiac arrhythmias due to Wolff–Parkinson–White syndrome, long QT time interval, atrioventricular blocks, haemodynamic obstructions in the outflow tract of the left or right ventricle, cardiomyopathy or coronary abnormalities. This paper refers to a new term, i.e. transient loss of consciousness. According to the new definition of syncope from 2009, temporary loss of consciousness has four components: a sudden occurrence, transient nature, short duration, and spontaneous regression. Currently, there are three main types of syncope associated with the cardiovascular system: neurogenic, orthostatic hypotension and a cardiac. The most common form in adolescents are neurogenic fainting which are often preceded by prodromal symptoms, i.e. decrease in blood pressure and heart rate. They can also occur in response to the stress or unusual situations. In the orthostatic syncope the loss of consciousness occurs in a very short time after the upright position and unlike neurogenic form, usually there are no prodromal symptoms, but tachycardia is present. The rarest, but also the most dangerous form of syncope is a cardiogenic type caused by arrhythmias or structural heart disease. This form may be the first sign of serious heart disease or even precede sudden cardiac death.

  16. Evaluation of epidural blockade as therapy for patients with sciatica secondary to lumbar disc herniation

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    Rogerio Carlos Sanfelice Nunes

    2016-08-01

    Full Text Available ABSTRACT OBJECTIVE: Sciatic pain secondary to lumbar disc herniation is a complex condition that is often highly limiting. The causes of pain in disc herniation are multifactorial. Two physiopathological mechanisms are involved in discogenic pain: mechanical deformation of nerve roots and a biochemical inflammatory component resulting from contact between the intervertebral disc and neural tissue, by way of the nucleus pulposus. The aim of this study was to evaluate the efficacy and safety of epidural blockade as therapy for bulging lumbar disc herniation. METHODS: A clinical study was conducted based on a retrospective and prospective survey. The blockade consisted of interlaminar puncture and bolus drug delivery. The number of procedures varied according to the clinical response, as determined through weekly evaluations and then 30, 90, and 180 days after the final session. A total of 124 patients who received one to five blockades were evaluated. RESULTS: The success rate (defining success as a reduction in sciatic pain of at least 80% was 75.8%. CONCLUSION: The results demonstrated the therapeutic action of epidural blockade over the short term, i.e. in cases of acute pain, thus showing that intense and excruciating sciatic pain can be relieved through this technique. Because of the multifactorial genesis of sciatica and the difficulties encountered by healthcare professionals in treating this condition, epidural blockade can become part of therapeutic arsenal available. This procedure is situated between conservative treatment with an eminently clinical focus and surgical approaches.

  17. Relationship between fear avoidance beliefs and burnout syndrome in patients with lumbar disc herniation.

    Science.gov (United States)

    Taspinar, Ferruh; Taspinar, Betul; Ozkan, Yasemin; Afsar, Emrah; Gul, Canan; Durmaz, Elif Dilara

    2016-06-17

    Lumbar disc herniation leads to disability by restricting of patients' lives and reducing their quality of life. This situation causes a decrease in motivation of patients by triggering depressive mood. Therefore, the aim of the study was investigation of correlation between fear avoidance beliefs and burnout syndrome in patients with lumbar disc herniation. Totally forty-seven patients (24 male and 23 female patients) diagnosed lumbar disc herniation was included in this study. Maslach II Burnout Inventory (MBI) and Fear Avoidance Beliefs Questionnaire (FABQ) for determining of levels of burnout and fear avoidance level were used, respectively. It was observed that MBI and FABQ scores of the patients were 50.78 ± 10.07 and 36.61 ± 13.91, respectively. Moderate level correlation was found between FABQ and MBI total scores (r= 0.49, p= 0.00). Fear avoidance beliefs of patients with chronic back pain can affect level of burnout syndrome. Therefore, symptoms of burnout syndrome and fear avoidance beliefs of patients should be considered in evaluation and treatment process.

  18. The Relationship between Lifestyle and Pain in Patients with Spinal Disc Herniation

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    Monireh Dadashzadeh

    2016-12-01

    Full Text Available Due to the rapid growth of the industries and constantly involvement of the new technologies into the human lives, the lifestyles of the people are altering. Simultaneously few new disorders in their lifestyles and diseases in their lives are also emerging. The spinal cord abnormalities i.e., the spinal disc herniation and/or low back pain is one of them which have made the life of some people very miserable (Farahani et al., 2012. Indeed the overall lifestyle of a human being regulates the musculoskeletal symptoms. Differences in lifestyle and psychosocial factors associated with individuals' lifestyle are effective in experiencing the level of pressure in musculoskeletal systems. Studies related to the lifestyle and musculoskeletal system, including pain and inflammation, are largely correlate (Mikkonen et al., 2015. Proper knowledge regarding the relationship between lifestyle and spinal disc herniation is very important. Social habits such as diet, exercise, weight gain, anxiety, and depression can cause changes in the spinal cord and spinal disc herniation (Kadow et al., 2014. Further, some of the lifestyle parameters such as smoking, nutrition, BMI, level of activity, sleep status, stress, and anxiety are also seen to reduce the need for medication or avoid and reduce musculoskeletal pain (Dean et al., 2015. As per Bohman et al. (2014 people with a healthy lifestyle suffer 66% less from low back pain than those who have unhealthy lifestyles.

  19. Single level cervical disc herniation: A questionnaire based study on current surgical practices

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    Abrishamkar Saeid

    2009-01-01

    Full Text Available Background: Operative procedures like simple discectomy, with or without fusion and with or without instrumentation, for single level cervical disc herniation causing neck pain or neurological compromise have been described and are largely successful. However, there is a debate on definitive criteria to perform fusion (with or without instrumentation for single level cervical disc herniation. Hence, we conducted a questionnaire based study to elicit the opinions of practicing neurosurgeons. Materials and Methods: About 148 neurosurgeons with atleast 12 years of operative experience on single level cervical disc herniation, utilizing the anterior approach, were enrolled in our study. All participating neurosurgeons were asked to complete a practice based questionnaire. The responses of 120 neurosurgeons were analysed. Results: The mean age of enrolled surgeons was 51 yrs (range 45-73 with mean surgical experience of 16.9 yrs (range 12-40 yrs on single level cervical disc herniation. Out of 120 surgeons 10(8% had 15-25 years experience and always preferred fusion with or without instrumentation and six (five per cent with 17-27 yrs experience had never used fusion techniques. However, 104 (87% surgeons with 12-40 yrs experience had their own criteria based on their experiences for performing fusion with graft and instrumentation (FGI, while. 85 (75% preferred auto graft with cage. Conclusions: Most of surgeons performed FGI before the age of 40, but for others, patient criteria such as job (heavier job, physical examination (especially myelopathy and imaging findings (mild degenerative changes on X-ray and signal change in the spinal cord on MRI were considered significant for performing FGI.

  20. Medical image of the week: pulmonary herniation

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    Baalachandran R

    2014-10-01

    Full Text Available A 49-year-old obese gentleman with a known history of chronic obstructive pulmonary disease, diabetes mellitus and GERD presented with complaints of a popping sensation in his left chest with coughing and deep breathing, associated with pain at the same site. Physical examination showed small bulge at the level of the herniation that was most obvious with coughing. CT scan of chest done 2 months ago showed 2. 5 cm pulmonary hernia identified at the left 7-8 costal interspace (Figures 1 and 2. This was thought to have resulted from an open lung biopsy of his left lung done 4 years before presentation to evaluate for acute respiratory failure or chest tube insertion at same site 3 years prior to presentation for treatment of a pneumothorax. Surgical repair was done with round Bard Kugel hernia patch. His symptoms resolved after the procedure.

  1. [Individualized treatment of lumbar intervertebral disc herniation].

    Science.gov (United States)

    Han, Jian; Tang, Yong-an; Yin, Zhan-hai

    2009-04-01

    To investigate the necessity, practicability for individualized treatment of lumbar intervertebral disc herniation and analyze its clinical effect. Five hundred and three cases of lumbar intervertebral disc herniation from March 2005 to March 2008 were individually treated by conservative treatment, minimal surgical procedures, open operation according to the protrusible size, rupture status of annular fibrosus, liberation or prolapse of disk tissue, accompanying conditions like spinal stenosis, spondylolisthesis or nerve involvement. Three hundred and ninety-three cases (male 189, female 204) were followed with an average age of 44.6 years old (range from 23 to 76). Among them, 210 cases were treated by conservative method, 145 cases by minimal surgical procedures and 38 cases by open operation. Therapeutic effect was evaluated by Macnab criteria. The mean follow-up duration was 16 months (range from 3 months to 3 years). Therapeutic effect was noted as 346 of excellence, 29 of effective, 18 of ineffective. Excellence rate was 88%(346/393) and effective rate was 95% (375/393). No severe complication was found. The recurrence rate of conservative treatment, minimal surgical procedures, open operation was respectively 18.1% (38/210), 9.6% (14/145), 5.3% (2/38). Conservative treatment is generally applied, its effect is reliable for patients of mild symptom. Minimal surgical procedures is applied more and more wide, the method will become prevalent. The indications for open operation became stricter and traditional surgical methods was challenged by less invasive methods. Individualized treatment basing on indication judgment was the most importance to improve therapeutic effect.

  2. Spinal Neurofibroma Masquerading as a Herniated Disc; A case report

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    Tariq Lamki

    2012-11-01

    Full Text Available We present the only case in English medical literature of a spinal neurofibroma misdiagnosed as a herniated disc using magnetic resonance imaging (MRI. This case presented with typical symptoms and radiological findings of a herniated disc. Intraoperatively, an abnormality was noted at the S1 nerve root sleeve. Further exploration revealed a spinal neurofibroma which was completely resected, resulting in an improvement in the patient’s symptoms. Currently, there is heavy reliance on MRI as a highly sensitive and specific tool used in the diagnosis of herniated lumbar discs. Although there have been occasional reports of misdiagnoses using MRI, there are no reported cases of a spinal neurofibroma being misdiagnosed as a herniated lumbar disc. Despite great advances in radiological diagnostic imaging, surgical surprises do still occur. Ultimately, instinct is still essential in intraoperative surgical decisions.

  3. Clinical study of CT discography for the lumbar disc herniation

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    Sakamoto, Tadashi (Yamaguchi Univ., Ube (Japan). School of Medicine)

    1990-08-01

    The purpose of this clinical study was to introduce technique for correct positioning of the needle into the center of the disc for discography by means of CT analysis and also to clarify usefulness of CT discography for diagnosis of the lumbar disc herniation. We have taken CT analysis in order to determine correct place and the angle of inserting the needle. This measurement provides easy needle insertion. Unless the needle tip places center of disc, discogram false positive or negative will occur as a result. The materials of this study are 222 discs of 105 cases with the lumbar disc herniation. Comparative study of the findings among myelography, discography and CT discography was investigated. The results indicated that CT discography demonstrates the most clear findings and is useful in the diagnosis of lumbar disc herniation, especially in obtaining detailed observation of herniated discs. (author).

  4. Operated herniated disk and lumbar spinal stenosis in Togolese ...

    African Journals Online (AJOL)

    Operated herniated disk and lumbar spinal stenosis in Togolese patients: anatomical aspects and results of surgical treatment. AVE Koffi-Tessio, H Fatiga, P Houzou, K Kakpovi, E Fianyo, O Oniankitan, M Mijiyawa ...

  5. Transient early-life forebrain corticotropin-releasing hormone elevation causes long-lasting anxiogenic and despair-like changes in mice.

    Science.gov (United States)

    Kolber, Benedict J; Boyle, Maureen P; Wieczorek, Lindsay; Kelley, Crystal L; Onwuzurike, Chiamaka C; Nettles, Sabin A; Vogt, Sherri K; Muglia, Louis J

    2010-02-17

    During development, early-life stress, such as abuse or trauma, induces long-lasting changes that are linked to adult anxiety and depressive behavior. It has been postulated that altered expression of corticotropin-releasing hormone (CRH) can at least partially account for the various effects of stress on behavior. In accord with this hypothesis, evidence from pharmacological and genetic studies has indicated the capacity of differing levels of CRH activity in different brain areas to produce behavioral changes. Furthermore, stress during early life or adulthood causes an increase in CRH release in a variety of neural sites. To evaluate the temporal and spatial specificity of the effect of early-life CRH exposure on adult behavior, the tetracycline-off system was used to produce mice with forebrain-restricted inducible expression of CRH. After transient elevation of CRH during development only, behavioral testing in adult mice revealed a persistent anxiogenic and despair-like phenotype. These behavioral changes were not associated with alterations in adult circadian or stress-induced corticosterone release but were associated with changes in CRH receptor type 1 expression. Furthermore, the despair-like changes were normalized with antidepressant treatment. Overall, these studies suggest that forebrain-restricted CRH signaling during development can permanently alter stress adaptation leading to increases in maladaptive behavior in adulthood.

  6. Cerebellar Herniation after Lumbar Puncture in Galactosemic Newborn

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    Salih Kalay

    2011-09-01

    Full Text Available Cerebral edema resulting in elevated intracranial pressure is a well-known complication of galactosemia. Lumbar puncture was performed for the diagnosis of clinically suspected bacterial meningitis. Herniation of cerebral tissue through the foramen magnum is not a common problem in neonatal intensive care units because of the open fontanelle in infants. We present the case of a 3-week-old infant with galactosemia who presented with signs of cerebellar herniation after lumbar puncture.

  7. Kidney herniation through lumbar triangle following open pyeloplasty

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    Qais Al Hooti

    2014-01-01

    Full Text Available Kidney herniation through the lumbar triangle is an uncommon type of hernia which is classically managed surgically. Contrast enhanced computerised tomography revealed lower pole of the right kidney herniating through the lumbar triangle in a 60-year-old woman, 10 years after an open right pyeloplasty. Surgical intervention was advised, however, patient opted for non-surgical management. Patient was successfully treated conservatively in clinic requiring regular analgesics for relief of mild pain.

  8. High degree of kinesiophobia after lumbar disc herniation surgery

    OpenAIRE

    Svensson, Gunilla Limb?ck; Lundberg, Mari; ?stgaard, Hans Christian; Wendt, Gunilla Kjellby

    2011-01-01

    Background and purpose Several studies have investigated outcomes after disc surgery. However, the occurrence of kinesiophobia has not been investigated previously in patients after disc herniation surgery. In this cross-sectional study, we investigated kinesiophobia in patients who had been treated surgically for lumbar disc herniation, and we related the results to established outcome measures. Patients and methods 10?34 months after surgery, questionnaires were sent to 97 patients who had ...

  9. PERCUTANEOUS DISCECTOMY: A CURRENT TREATMENT FOR LUMBAR DISC HERNIATION

    OpenAIRE

    Pablo Gerardo Lima-Ramírez; David Benavides-Rodríguez; Juan Yahir Viera-Ordóñez; José Augusto Ruíz-Gurría; Iván del Castillo-Vergara; Braulio Hernández Carbajal; Diego Fernando León-López

    2016-01-01

    ABSTRACT Objective: Describe the functional outcomes of patients with contained lumbar disc herniation (L4-L5, L5-S1) treated with manual percutaneous nucleotomy (MPN) and demonstrate that it remains a technique with good results. Methods: A prospective, longitudinal study with 110 patients contained with lumbar disc herniation (LDH) treated with (MPN). The evaluation was pre-surgical and 4, 30, 180 and 365 days after the surgery. We used Numeric Pain Scale (NPS), Oswestry Disability Index ...

  10. Gastric outlet obstruction secondary to paraesophageal herniation of gastric antrum after laparoscopic fundoplication

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    Selcuk Coskun

    2015-04-01

    Full Text Available The most common causes of acute gastric outlet obstruction (GOO are duodenal and type 3 gastric ulcers. However, mechanical or functional causes may also lead to this pathology. Acute GOO is characterized by delayed gastric emptying, anorexia, or nausea accompanied by vomiting. Herein we report a 56-year-old man diagnosed with GOO secondary to paraesophageal hiatal herniation of gastric antrum after laparoscopic fundoplication. Because of the rarity of this disease, common gastrointestinal complaints may mislead the emergency physician to diagnose a nonsurgical gastrointestinal disease if a detailed history and physical examinations are not obtained.

  11. Percutaneous treatment of cervical and lumbar herniated disc.

    Science.gov (United States)

    Kelekis, A; Filippiadis, D K

    2015-05-01

    Therapeutic armamentarium for symptomatic intervertebral disc herniation includes conservative therapy, epidural infiltrations (interlaminar or trans-foraminal), percutaneous therapeutic techniques and surgical options. Percutaneous, therapeutic techniques are imaging-guided, minimally invasive treatments for intervertebral disc herniation which can be performed as outpatient procedures. They can be classified in 4 main categories: mechanical, thermal, chemical decompression and biomaterials implantation. Strict sterility measures are a prerequisite and should include extensive local sterility and antibiotic prophylaxis. Indications include the presence of a symptomatic, small to medium sized contained intervertebral disc herniation non-responding to a 4-6 weeks course of conservative therapy. Contraindications include sequestration, infection, segmental instability (spondylolisthesis), uncorrected coagulopathy or a patient unwilling to provide informed consent. Decompression techniques are feasible and reproducible, efficient (75-94% success rate) and safe (>0.5% mean complications rate) therapies for the treatment of symptomatic intervertebral disc herniation. Percutaneous, imaging guided, intervertebral disc therapeutic techniques can be proposed either as an initial treatment or as an attractive alternative prior to surgery for the therapy of symptomatic herniation in both cervical and lumbar spine. This article will describe the mechanism of action for different therapeutic techniques applied to intervertebral discs of cervical and lumbar spine, summarize the data concerning safety and effectiveness of these treatments, and provide a rational approach for the therapy of symptomatic intervertebral disc herniation in cervical and lumbar spine. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  12. Tissue Engineering a Biological Repair Strategy for Lumbar Disc Herniation

    Science.gov (United States)

    O'Connell, Grace D.; Leach, J. Kent; Klineberg, Eric O.

    2015-01-01

    Abstract The intervertebral disc is a critical part of the intersegmental soft tissue of the spinal column, providing flexibility and mobility, while absorbing large complex loads. Spinal disease, including disc herniation and degeneration, may be a significant contributor to low back pain. Clinically, disc herniations are treated with both nonoperative and operative methods. Operative treatment for disc herniation includes removal of the herniated material when neural compression occurs. While this strategy may have short-term advantages over nonoperative methods, the remaining disc material is not addressed and surgery for mild degeneration may have limited long-term advantage over nonoperative methods. Furthermore, disc herniation and surgery significantly alter the mechanical function of the disc joint, which may contribute to progression of degeneration in surrounding tissues. We reviewed recent advances in tissue engineering and regenerative medicine strategies that may have a significant impact on disc herniation repair. Our review on tissue engineering strategies focuses on cell-based and inductive methods, each commonly combined with material-based approaches. An ideal clinically relevant biological repair strategy will significantly reduce pain and repair and restore flexibility and motion of the spine. PMID:26634189

  13. Percutaneous treatment of cervical and lumbar herniated disc

    Energy Technology Data Exchange (ETDEWEB)

    Kelekis, A., E-mail: akelekis@med.uoa.gr; Filippiadis, D.K., E-mail: dfilippiadis@yahoo.gr

    2015-05-15

    Therapeutic armamentarium for symptomatic intervertebral disc herniation includes conservative therapy, epidural infiltrations (interlaminar or trans-foraminal), percutaneous therapeutic techniques and surgical options. Percutaneous, therapeutic techniques are imaging-guided, minimally invasive treatments for intervertebral disc herniation which can be performed as outpatient procedures. They can be classified in 4 main categories: mechanical, thermal, chemical decompression and biomaterials implantation. Strict sterility measures are a prerequisite and should include extensive local sterility and antibiotic prophylaxis. Indications include the presence of a symptomatic, small to medium sized contained intervertebral disc herniation non-responding to a 4–6 weeks course of conservative therapy. Contraindications include sequestration, infection, segmental instability (spondylolisthesis), uncorrected coagulopathy or a patient unwilling to provide informed consent. Decompression techniques are feasible and reproducible, efficient (75–94% success rate) and safe (>0.5% mean complications rate) therapies for the treatment of symptomatic intervertebral disc herniation. Percutaneous, imaging guided, intervertebral disc therapeutic techniques can be proposed either as an initial treatment or as an attractive alternative prior to surgery for the therapy of symptomatic herniation in both cervical and lumbar spine. This article will describe the mechanism of action for different therapeutic techniques applied to intervertebral discs of cervical and lumbar spine, summarize the data concerning safety and effectiveness of these treatments, and provide a rational approach for the therapy of symptomatic intervertebral disc herniation in cervical and lumbar spine.

  14. Lumbar disc herniation and cauda equina syndrome following spinal manipulative therapy: a review of six court decisions in Canada.

    Science.gov (United States)

    Boucher, Pierre; Robidoux, Sébastien

    2014-02-01

    The purpose of this review is to expand practitioners' knowledge on areas of liability when treating low back pain patients. Six cases where chiropractors in Canada were sued for allegedly causing or aggravating lumbar disc herniation after spinal manipulative therapy were retrieved using the CANLII search database. The case series involves 4 men and 2 women with an average age of 37.3 years (range, 31-48 years). Trial courts' decisions were rendered between 2000 and 2011. This study highlights the following conclusions from Canadian courts: 1) informed consent is an ongoing process that cannot be entirely delegated to office personnel; 2) when the patient's history reveals risk factors for lumbar disc herniation the chiropractor has the duty to rule out disc pathology as an etiology for the symptoms presented by the patients before beginning anything but conservative palliative treatment; 3) lumbar disc herniation may be triggered by spinal manipulative therapy on vertebral segments distant from the involved herniated disc such as the thoracic spine. Copyright © 2014 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  15. Minimally invasive transmuscular approach for the treatment of lumbar herniated disc: far lateral lumbar disc herniation: a clinical study. Applications for cervical and thoracic disc herniation.

    Science.gov (United States)

    Peltier, E; Blondel, B; Dufour, H; Fuentes, S

    2013-06-01

    In this study, we are using a recently developed method: a minimally invasive retractor system and an operating microscope to treat far lateral lumbar herniated disc. This method decreases tissue dissection and blood loss, and improves postoperative recovery. This is a retrospective study of 46 patients, there was 25 female and 21 male. They all underwent minimal invasive surgery. The average age was 56 years old (19-83 years). Lumbar disc herniation is a common pathology. Far lateral disc herniation accounts for 2.6% to 11.2% of all lumbar disc herniation. A few surgical techniques have been describes to treat this type of disc pathology. All patients were operated under general anesthesia. The fluoroscopic guidance was absolutely necessary. A 12-15 mm skin incision was made on the side of the disc herniation (30 mm from the midline). Then, we inserted a tubular retractor system (muscle splitting approach) followed by a 14 mm diameter-working channel. Under operating microscope the pars interarticularis was dreamed to expose the nerve root and the disc. After removing the intertransverse ligament, we removed the herniated disc. The average time of surgery was 55 min. The operating time decreased with the experience of the surgical team. Postoperatively the radicular pain was around 2 (using an analogical visual scale), over 7 preoperatively. The length of hospitalization was 3 days. There were no complications in our study. The average follow-up was 2 years (6-36 months). There was no complication, no postoperative infection. This technique combines the advantages of endoscopic surgery and microscope guided surgery (3D vision) and provides good functional results in this study.

  16. Hérnia discal lombar Lumbar disc herniation

    Directory of Open Access Journals (Sweden)

    Luis Roberto Vialle

    2010-01-01

    Full Text Available A hérnia discal lombar é o diagnóstico mais comum dentre as alterações degenerativas da coluna lombar (acomete 2 a 3% da população e a principal causa de cirurgia de coluna na população adulta. O quadro clínico típico inclui lombalgia inicial, seguida de lombociatalgia e, finalmente, de dor ciática pura. A história natural da hérnia de disco é de resolução rápida dos sintomas (quatro a seis semanas. O tratamento inicial deve ser conservador, com manejo medicamentoso e fisioterápico, podendo ser acompanhado ou não por bloqueios percutâneos radiculares. O tratamento cirúrgico está indicado na falha do controle da dor, déficit motor maior que grau 3, dor radicular associada à estenose óssea foraminal ou síndrome de cauda equina, sendo esta última uma emergência médica. Uma técnica cirúrgica refinada, com remoção do fragmento extruso, e preservação do ligamento amarelo, resolve a sintomatologia da ciática e reduz a possibilidade de recidiva em longo prazo.Lumbar disc herniation is the most common diagnosis amongst the degenerative conditions of the lumbar spine (affecting around 2 to 3% of the population, and is the principal cause of spine surgery in the adult population. The typical clinical picture includes initial lumbalgia, followed by progressive sciatica. The natural history of disc herniation is one of rapid resolution of the symptoms (from 4-6 weeks. Early treatment should be conservative, with pain management and physiotherapy, sometimes associated with selective nerve root block. Surgery should be considered if pain management is unsuccessful, if there is a motor deficit (strength grade 3 or less, where there is radicular pain associated with foraminal stenosis, or in the presence of cauda equina syndrome, the latter representing a medical emergency. A refined surgical technique, with removal of the extruded fragment and preservation of the ligamentum flavum, resolves the sciatic symptoms and reduces

  17. [Transient epileptic amnesia].

    Science.gov (United States)

    Muramatsu, Kazuhiro; Yoshizaki, Takahito

    2016-03-01

    Transient amnesia is one of common clinical phenomenon of epilepsy that are encountered by physicians. The amnestic attacks are often associated with persistent memory disturbances. Epilepsy is common among the elderly, with amnesia as a common symptom and convulsions relatively uncommon. Therefore, amnesia due to epilepsy can easily be misdiagnosed as dementia. The term 'transient epileptic amnesia (TEA)' was introduced in the early 1990s by Kapur, who highlighted that amnestic attacks caused by epilepsy can be similar to those occurring in 'transient global amnesia', but are distinguished by features brevity and recurrence. In 1998, Zeman et al. proposed diagnostic criteria for TEA.

  18. The therapeutic effect of percutaneous transforaminal endoscopic discectomy through interlaminar approach for treating lumbar disc herniation

    Directory of Open Access Journals (Sweden)

    Wan-ru DUAN

    2016-04-01

    Full Text Available Objective To evaluate the therapeutic efficacy of percutaneous transforaminal endoscopic discectomy (PTED through interlaminar approach in the treatment of lumbar disc herniation (LDH.  Methods From October 2013 to January 2015, 54 LDH patients underwent PTED by using transforaminal endoscopic spine system (TESSYS in our hospitial. CT or MRI indicated L4-5 disc herniation in 13 patients and L5-S1 disc herniation in other 41 patients. Visual Analogue Scale (VAS and Oswestry Disability Index (ODI were used to evaluate the degree of pain in the low back and leg before operation, one day, 3 months and one year after operation. MRI was performed after operation to assess if the nucleus pulposus was removed completely and whether there was a relapse.  Results The success rate of operations was 96.30% (52/54. Two patients suffered from rupture of spinal dura mater during the surgery, and underwent fenestration laminectomy in turn. The average operation time was 58.35 min and median hospital stay was 3 d. At discharge, pain was disappeared in 52 patients and relieved in 2 patients, however, 5 patients presented worsened numbness of lateral lower leg. Compared with preoperation, VAS and ODI scores decreased significantly one day, 3 months and one year after operation (P = 0.000, for all. Lumbar MRI one day after operation revealed nucleus pulposus had been completely removed and the compression of nerve root had been relieved in all cases. There was no relapse in MRI findings 3 months and one year after operation. No surgical complication, such as infection, was found. One patient with L5-S1 disc herniation presented postoperative numbness of S1 nerve root region caused by heavy stretching of nerve root during the operation, and was improved one month later.  Conclusions Percutaneous transforaminal endoscopic discectomy through interlaminar approach in the treatment of lumbar disc herniation is effective and safe. DOI: 10.3969/j.issn.1672-6731.2016.04.006

  19. A REVIEW OF 3200 CASES 0F HERNIATED LUMBAR DISC

    Directory of Open Access Journals (Sweden)

    A. ALIMOHAMMADI

    1987-05-01

    Full Text Available I t 1S a t t emted t o reV1ew 3200 c a s e s of herniat ed lumbar d isc t o point out the i ndic a tions for ope ra t i o n , the value o f myelog raphy . t he r esult o f ope rat ion and the caus e s o f comp l i cat i ons . We believe tha t myelography s houl d be performed i n a l most a ll patients. I n ne a rl y"n96 .8 pe rcent of cases my e l o grams co r r e s pond to clinical f i ndings. In general when there is clear s igns and s ympt oms of dis c disease , con fi rmed r adiolo gically, i n the hand of an e xpo r t surgeon. in 93 percent the result will be excel e nt .

  20. Magnetic resonance imaging for each type of herniated cervical intervertebral disc

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ham Gyum [Ansan 1 College, Ansan (Korea, Republic of)

    2000-04-15

    The classification of herniated intervertebral cervical disc types are clinically important, as treatment methods would be slightly different according to the specific type of the herniated disc. 423 patients who suffered from herniated intervertebral cervical discs were tested with Magnetic Resonance Imaging (MRI), to distinguish the type of the herniated discs. The following are the results: The age of the patients tested ranged from 16 to 75 years old and the mean age of the patients was 41.4 years of age. There were twice as many male patients with a ratio of 288: 135 men to women. 101 patients suffered from single herniated discs while 322 patients suffered from multi-herniated discs. Of single herniated disc injuries. 52 patients had protruded discs (52%) while 25 patients had extruded discs (25%). 21 Patients (21%) had herniated intervertebral discs between C{sub 4} {approx} C{sub 5} and 51 patients (50%) and had the same injury between C{sub 5} and C{sub 6}. Of multi-herniated disc injuries. 140 patients had protruded discs (44%). while 45 patients had extruded discs (14%). 54 patients had both protruded and extruded discs (17%). 36 patients (11%). herniated discs C{sub 3} {approx} C{sub 6}: 69 patients (21%). herniated discs C{sub 3} {approx} C{sub 7}: 47 patients (15%) herniated discs C{sub 4} {approx} C{sub 6} and 67 patients (20%) herniated discs C{sub 5} {approx} C{sub 7}.

  1. History of lumbar disc herniation with Gd-DPTA enhanced MRI

    Energy Technology Data Exchange (ETDEWEB)

    Iwahara, Toshihito; Satou, Toshikazu [Wakkanai Municipal Hospital, Hokkaido (Japan)

    1995-09-01

    The pathological changes of primary lumbar disc herniation was monitored on T1-weighted and Gd-weighted MR imagings. The subjects were 11 patients whose symptoms improved solely by conservative therapy. Herniated area on T1-weighted images (whole herniated area), enhanced herniated area on Gd-MRI (enhanced area), and non-enhanced herniated area on Gd-MRI (non-enhanced area) were calculated, and each proportion to the vertebral canal was assessed. Changes in herniated area was correlated with changes of enhanced area. Gd-MRI was found to be useful in predicting the prognosis of primary herniation, as well as in differentiating recurrent herniation and cicatricial tissues. (S.Y.).

  2. Outcomes of cervical and lumbar disk herniations in Major League Baseball pitchers.

    Science.gov (United States)

    Roberts, David W; Roc, Gilbert J; Hsu, Wellington K

    2011-08-01

    The effects of disk herniations on the career and performance outcomes of Major League Baseball (MLB) pitchers are unknown. The purpose of this study is to determine the outcomes after a cervical or lumbar disk herniation for MLB pitchers. Forty MLB pitchers from 1984 to 2009 with a cervical disk herniation or lumbar disk herniation were identified using a previously established protocol. Cervical disk herniation was identified in 11 pitchers, 8 of which were treated operatively. The majority of pitchers with cervical disk herniation (8/11) returned to play at an average of 11.6 months. Lumbar disk herniation was identified in 29 pitchers, 20 of which were treated operatively. All pitchers with lumbar disk herniation (29/29) returned to play at an average of 7.3 months after diagnosis. Copyright 2011, SLACK Incorporated.

  3. Computed tomography in lumbar herniated disc

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Chul Soon; Chang, Kee Hyun; Han, Man Chung [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1984-09-15

    197 spine CTs were performed from 29th , March 1982 to 7th March, 1984. Among them, 39 patients preoperatively diagnosed as herniated nucleus pulposus or bulging disc with CT and myelography were operated. 43 disc spaces of disc disease are analysed in true positive and false negative cases. Finally the accuracy, sensitivity and specificity of spine CT and myelography are calculated. The results are as follows: 1. The CT findings of disc diseases are in order of frequency, asymmetrical obliteration of epidural fat (82%) , ventral indentation or compression on dural sac (72%), focal protrusion of disc (64%), root changes - obliteration, displacement, compression, non-filling of metrizamide - (54%), diffuse disc bulging (36%), disc at body level (31%), disc calcifications (26%), disc vacuum (10%) and other associated findings - spinal stenosis, foraminal stenosis, ligament flavum thickening, facet joint hypertrophy (26%). 2. Sensitivities of spine CT and myelography are 95% and 94%, specificities are 67%, 50% and overall accuracies 93%, 87%, respectively. 3. Therefore, it is recommended that the spine CT be used as a primary diagnostic method and the myelography as a secondary complementary study when the CT gives no conclusive findings.

  4. [Anatomical characteristics and surgical selections of upper lumbar disc herniation].

    Science.gov (United States)

    Liang, Cheng-Min; Cui, Xi-Long; Yu, Hai-Yang; Jiang, Wei; Zhai, Yun-Lei

    2016-07-25

    To explore the anatomical characteristics and surgical selections of upper lumbar disc herniation, and evaluate its clinical effects. From January 2009 to January 2013, 26 patients with upper lumbar disc herniation were treated in our department. There were 16 males and 10 females, aged from 28 to 51 years old with an average of 45.7 years, 4 cases were in L₁,₂, 9 cases in L₂,₃, and 13 cases in L₃,₄. The data was collected including distance between outer edge of lower facet and the spinous process, the outer edge of the isthmus and spinous process, the lower edge of lamina and the upper edge of the intervertebral space, nerve root arising points and lower edge of the corresponding pedicle. Transforaminal discectomy and interbody fusion combined with pedicle screw fixation was performed in patients with L₁,₂, L₂,₃ herniated disk and 5 patients with L₃,₄ herniated disk complicated with lumbar instability. However another 8 patients with L₃,₄ herniated disk were treated with posterior fenestration decompression. Clinical effects were evaluated by Japanese Orthopaedic Association(JOA). The relative height rate(R) of the intervertebral space was measured preoperatively and 1 year postoperatively. The fusion of the bone graft was also observed. Intraoperative anatomical measurement was taken in all patients. All patients were followed up for more than 1 year with an average of 16 months, and all incisions got healing, JOA was improved from preoperative(10.13±1.49) points to last follow up (25.21±2.13) points with the improvement rate of 79.9%. Among the patients underwent fusion operation, 17 cases obtained bone fusion and 1 case maybe non fusion and no internal fixation failure was found;the R value was (0.231±0.056) mm preoperatively, however (0.345±0.076) mm at 1 year after operation with statistical difference( P 0.05). No spinal instability and lumbar disc herniation recurrence were found in these patients. According to the

  5. Enhanced MRI in lumbar disc herniation. Study on the types of herniation and histological findings

    Energy Technology Data Exchange (ETDEWEB)

    Koh, Sadao; Okamura, Yuji; Honda, Eiichiro; Takazawa, Shunji [Misato Junshin Hospital, Saitama (Japan); Ohno, Ryuichi; Yasuma, Tsuguo

    1999-06-01

    In the cases which had surgery after enhanced MRI, prolapsed form of hernia and the usefulness of enhanced MRI were examined. The patients were 13 males (14 intervertebral discs) and 5 females (6 intervertebral discs) with lumber disc herniation. The lumber disc herniation was classified into 3 types reference to Macnab's classification; SE (protrusion and subligamentous extrusion), TE (transligamentous extrusion) and SEQ (sequestration). Prolapsed forms were identified in 20 intervertebral discs. Enhanced MRI showed positive in 9 intervertebral discs (SE 1, TE 4 and SEQ 4) and showed negative in 11 discs (SE 10 and TE 1). As for the period from development to enhanced MRI, the significant difference wasn't recognized between positive group and negative group. The diagnostic rate of enhanced MRI was 88.9% (8/9) in sensitivity, 90.9% (10/11) in specificity and 90.0% (18/20) in accuracy. In enhanced MRI, engorged epidural venous plexus was also imaged, and minute change as only annular tear couldn't be detected. Looking from 2 directions crossing at right angles, the effect of contrast enhancement should be judged. (K.H.)

  6. Suspected herniated lumbar disc - computed tomography in differential diagnosis of non-disc-related sciatica

    Energy Technology Data Exchange (ETDEWEB)

    Weiss, T.; Koehler, D.; Treisch, J.; Claussen, C.; Felix, R.

    1984-07-01

    The most common reason a patient is referred for spinal CT examination is to exclude a ruptured intervertebral disc. Besides nerve root entrapment due to herniated disc, a number of unusual or unexpected conditions have been encountered in the course of CT lumbar spine studies. These include spondylolisthesis, spinal dysraphism, Paget's disease, and inflammatory, neoplastic, or metastatic lesions. The application of spinal (small-circle) target imaging includes the risk of overlooking soft tissue lesions that extend beyond the reconstruction circle. Therefore, complete (large-circle) circumferential abdominal scanning is recommended in case of a suspected extraspinal cause of sciatica.

  7. Treatment of lumbar disc herniation: Evidence-based practice

    Directory of Open Access Journals (Sweden)

    Andrew J Schoenfeld

    2010-07-01

    Full Text Available Andrew J Schoenfeld1, Bradley K Weiner21Department of Orthopedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, El Paso, TX, USA; 2Weill Cornell Medical College and The Methodist Hospital, Houston, TX, USAClinical question: What is the best treatment for lumbar disc herniations? Results: For patients failing six weeks of conservative care, the current literature supports surgical intervention or prolonged conservative management as appropriate treatment options for lumbar radiculopathy in the setting of disc herniation. Surgical intervention may result in more rapid relief of symptoms and restoration of function.Implementation: While surgery appears to provide more rapid relief, many patients will gradually get better with continued nonoperative management; thus, patient education and active participation in decision-making is vital.Keywords: lumbar disc, herniation, back pain, spine

  8. Nontraumatic Acute Paraplegia Associated With Cervical Disk Herniation

    Science.gov (United States)

    Liu, Chao; Huang, Yue; Cai, Hong-Xin; Fan, Shun-Wu

    2010-01-01

    Background: Acute paraplegia is a true emergency. It is often the result of trauma but is rarely reported in association with cervical disk herniation in patients without antecedent injury. Methods: Case report. Findings: This 75-year-old man presented with acute paraplegia due to severe compression of the spinal cord by herniation of the C4-C5 cervical disk. He underwent emergency diskectomy and anterior fusion. Postoperatively, his neurologic functions improved gradually. Conclusions: Cervical disk herniation should be considered in the differential diagnosis of nontraumatic acute paraplegia. Pre-existing narrowed canal is an important predisposing factor and excessive neck movements are believed to be triggering factors. Immediate early decompressive surgery is recommended to avoid irreversible progression of neurologic deficit. PMID:21061902

  9. A radiological study on lumbar disc herniation in Korean

    Energy Technology Data Exchange (ETDEWEB)

    Seol, Hae Young; Park, In Sik; Suh, Won Hyuk; Lee, Min Jae [Korea University College of Medicine, Seoul (Korea, Republic of)

    1979-12-15

    Among the patients operated because of lumbar disc herniation from January 1973 to May 1979 at Korea University Hospital, 154 cases were analyzed radiologically and the following conclusions were obtained. 1. The ratio of male to female was 1.96 : 1. 2. The incidences of single and multiple involvement were 74.7% and 25.3%. 3. Most frequent level of lumbar disc herniation was L4-5 interspace. 4. The incidences of left, central and bilateral defects were 45.45%, 33.76%, 12.33% and 8.44% respectively. 5. The incidences of spina bifida and transitional vertebra were 24.04% and 9.09% respectively. 6. The overall mean of the lumbosacral angle was 33.97 .deg. 7. The overall mean depth of the lumbar lordosis was 8.48 mm. 8. The ratio of the height of L4-5 interspace to the shorter anteroposterior diameter of L-5 body was obtained by authors' idea. The mean ratios of male and female patients of L4-5 disc herniation which had no evidence of the narrowing of L4-5 interspace on simple radiologic finding were 0.3042 and 0.3064 respectively. So the ratio had a little value in the diagnosis of L4-5 disc herniation on simple radiologic study. 9. Myelography had high diagnostic accuracy, and the majority of the pseudonegative finding on lumbar disc herniation myelographically was seen at L4-5 disc herniation.

  10. Operative treatment of anterior thoracic spinal cord herniation : three new cases and an individual patient data meta-analysis of 126 case reports

    NARCIS (Netherlands)

    Groen, Rob J. M.; Middel, Berrie; Meilof, Jan F.; de Biezenbos, J. B. Margot de Vos-van; Enting, Roelien H.; Coppes, Maarten H.; Journee, Louis H.

    OBJECTIVE: Anterior thoracic spinal cord herniation is a rare cause of progressive myelopathy. Much has been speculated about the best operative treatment. However, no evidence in favor of any of the promoted techniques is available to date. Therefore, we decided to analyze treatment procedures and

  11. Translaminar approach to cranio-laterally herniated lumbar disc prolapse.

    Science.gov (United States)

    Schulz, C; Abdeltawab, A; Mauer, U M

    2012-04-01

    For cranio-laterally extruded disc fragments, a far enlargement of the standard interlaminar fenestration is necessary. This strategy harbours a potential risk for relevant destruction of the facet joints and postsurgical instability could be the consequence. For preserving the facet joint, a limited approach through the hemilamina is possible. After the standard paramedian soft tissue approach and retraction of the paravertebral muscles laterally, the hemilamina is exposed and fenestrated, preserving the bony borders of the lamina. The disc herniation can be extracted via this lamina fenestration. This surgical strategy is safe and effective in approaching cranially herniated disc fragments.

  12. Intradural tumor and concomitant disc herniation of cervical spine

    Directory of Open Access Journals (Sweden)

    Mihir R Bapat

    2011-01-01

    Full Text Available We report a rare patient of a simultaneous extradural and intradural compression of the cervical spinal cord due to co-existent intervertebral disc herniation and an intradural schwannoma at the same level. The intradural lesion was missed resulting in recurrence of myelopathy after a surprisingly complete functional recovery following anterior cervical discectomy. Retrospectively, it was noted that the initial cord swelling noticed was tumor being masked by the compression produced by the herniated disc. A contrast magnetic resonance imaging scan is important in differentiating intradural tumors of the spinal cord. A high index of suspicion is often successful in unmasking both the pathologies.

  13. Inguinal herniation of a mineralized paraprostatic cyst in a dog.

    Science.gov (United States)

    Vititoe, Kyle P; Grosso, Federico Vilaplana; Thomovsky, Stephanie; Lim, Chee Kin; Heng, Hock Gan

    2017-12-01

    A firm mass was noted in the right inguinal subcutaneous region of an 11-year-old intact male Labrador retriever dog presented for right pelvic limb weakness. Pelvic radiographs showed 2 large ovoid structures with circumferential thin eggshell-like mineralization in the right external inguinal region. The structures were confirmed sonographically, and on magnetic resonance imaging as a large folded herniated mineralized paraprostatic cyst through a defect in the right inguinal wall. To the author's knowledge, this is the first published report of an inguinal herniated mineralized paraprostatic cyst.

  14. Postfixed brachial plexus radiculopathy due to thoracic disc herniation in a collegiate wrestler: a case report.

    Science.gov (United States)

    Kuzma, Scott A; Doberstein, Scott T; Rushlow, David R

    2013-01-01

    To present the unique case of a collegiate wrestler with C7 neurologic symptoms due to T1-T2 disc herniation. A 23-year-old male collegiate wrestler injured his neck in a wrestling tournament match and experienced pain, weakness, and numbness in his left upper extremity. He completed that match and 1 additional match that day with mild symptoms. Evaluation by a certified athletic trainer 6 days postinjury showed radiculopathy in the C7 distribution of his left upper extremity. He was evaluated further by the team physician, a primary care physician, and a neurosurgeon. Cervical spine injury, stinger/burner, peripheral nerve injury, spinal cord injury, thoracic outlet syndrome, brachial plexus radiculopathy. The patient initially underwent nonoperative management with ice, heat, massage, electrical stimulation, shortwave diathermy, and nonsteroidal anti-inflammatory drugs without symptom resolution. Cervical spine radiographs were negative for bony pathologic conditions. Magnetic resonance imaging showed evidence of T1-T2 disc herniation. The patient underwent surgery to resolve the symptoms and enable him to participate for the remainder of the wrestling season. Whereas brachial plexus radiculopathy commonly is seen in collision sports, a postfixed brachial plexus in which the T2 nerve root has substantial contribution to the innervation of the upper extremity is a rare anatomic variation with which many health care providers are unfamiliar. The injury sustained by the wrestler appeared to be C7 radiculopathy due to a brachial plexus traction injury. However, it ultimately was diagnosed as radiculopathy due to a T1-T2 thoracic intervertebral disc herniation causing impingement of a postfixed brachial plexus and required surgical intervention. Athletic trainers and physicians need to be aware of the anatomic variations of the brachial plexus when evaluating and caring for patients with suspected brachial plexus radiculopathies.

  15. Similar outcome despite slight clinical differences between lumbar radiculopathy induced by lateral versus medial disc herniations in patients without previous foraminal stenosis: a prospective cohort study with 1-year follow-up.

    Science.gov (United States)

    Mérot, Oriane A; Maugars, Yves M; Berthelot, Jean-Marie M

    2014-08-01

    lying or standing), but slight significant differences (t testlumbar spine (above L4-L5: 7/28 vs. 3/31), motor weakness was more frequent (25% vs. 3%), SLR was less restricted (65.0°±24.5° vs. 51.1°±25.7°), DN4 score of neuropathic pain was higher (4.4±2.1 vs. 3.2±1.8), anxiety level was higher (10.3±4.1 vs. 7.9±3.2), length of hospital stay was longer (5.7±2.4 days vs. 4.5±1.4 days), and physician's prognosis of a good outcome was poorer (6.6±2.2 vs. 8.0±1.6). However, at the end of follow-up (12.2±3.3 months), outcome was similar: 37% (vs. 41% for medial herniations) had transiently relapsed, 66% felt finally improved (vs. 63%), and walking capacity was nearly identical despite the fact that only 18% had to be operated (vs. 32% of those with medial herniations). Despite differences in clinical presentation, the outcome of radiculopathy induced by the more lateral lumbar disc herniations was not worse than the outcome of patients with only medial disc herniations. Previous claims of poorer outcome in foraminal herniations might be explained by the inclusion of patients with associated foraminal stenosis. Copyright © 2014 Elsevier Inc. All rights reserved.

  16. Minimally Invasive Endourological Techniques may Provide a Novel Method for Relieving Urinary Obstruction due to Ureterosciatic Herniation

    Science.gov (United States)

    Kato, Tomonori; Komiya, Akira; Ikeda, Ryoichi; Nakamura, Takeshi; Akakura, Koichiro

    2015-01-01

    Ureterosciatic herniation, the protrusion of the hernia sac through the sciatic foramen, is an extremely rare cause of ureteral obstruction. We describe a case revealed by severe left back pain in a 72-year-old female. She was referred to our hospital for urological assessment of left hydronephrosis observed by ultrasonography. Intravenous ureterography (IVU) showed findings compatible with a left sciatic ureter, a dilated ureter with a fixed kinking, which is known as the ‘curlicue’ sign. We decided to attempt recovery of the herniated ureter using a retrograde approach. Ureteral stent placement was performed to decompress the dilated upper urinary tract. The ureterosciatic hernia was relieved with the passage of a flexible guide wire and a double-pigtail stent. Three months after ureteral stenting, she refused continuing to have an indwelling stent and the stent was removed. Thereafter, IVU revealed recurrent ureterosciatic hernia; however, there was no hydroureter or hydronephrosis. The patient is currently being under observation for 6 years after stenting and continues to be without hydronephrosis or symptoms. Placement of an internal stent possibly provides the rigidity to the ureter, thereby reducing the hernia and urinary obstruction. In the previous reports, most symptomatic patients have been treated surgically, with conservative therapy reserved for asymptomatic patients. For the patient who is elderly or a poor surgical candidate, retrograde stenting may provide safe reduction and efficacious treatment. This endourological approach provides a minimally invasive means for the management of urinary obstruction caused by ureterosciatic herniation. PMID:25849669

  17. Transient Atmospheric Circulation Response to An Instantaneous Doubling of Carbon Dioxide: Understanding Cause and Effect in Atmospheric Circulation Adjustment to Global Warming

    Science.gov (United States)

    Wu, Y.; Seager, R.; Ting, M.; Naik, N.; Shaw, T. A.

    2011-12-01

    As a consequence of increased carbon dioxide emission, the atmospheric general circulation is expected to change. IPCC AR4 coupled models have consistently projected a poleward shift in tropospheric zonal jets and midlatitude storm tracks. We explore the associated dynamical mechanisms by looking into the transient step-by-step adjustment of the circulation. This allows an assessment of the causality sequence in the circulation and thermal structure response prior to establishment of a quasi-equilibrium state. The transient atmospheric adjustment is examined using the National Center for Atmospheric Research Community Atmospheric Model Version 3 coupled to a slab ocean model and the CO2 concentration in the atmosphere is uniformly and instantaneously doubled. The thermal structure and circulation response is well established after one year of integration with the magnitudes gradually increasing afterwards towards quasi-equilibrium. Tropical upper tropospheric warming occurs in the first month. The expansion of the warming in the middle and upper troposphere to the subtropics occurs later and is found to be primarily dynamically-driven due to the intensification of transient eddy momentum flux convergence and resulting anomalous descending motion in this region. This linkage between the eddy-driven vertical motion anomaly and the subtropical warming expansion in the middle and upper troposphere is also confirmed in the late 21st century in the IPCC AR4 simulations. The poleward displacement of the midlatitude tropospheric jet streams occurs together with the change in eddy momentum flux convergence but only after the intensification of the subpolar westerlies in the stratosphere. The results demonstrate the importance of the tropospheric eddies in setting up the extratropical tropospheric response to global warming. Our modeling results also show the sequence of the zonal wind anomaly in the vertical column of the atmosphere during the period of transient adjustment

  18. Surgical vs. nonsurgical management of post-traumatic intercostal lung herniation in children

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    Mila Kolar

    2018-01-01

    strapping, with complete resolution of herniation within 2–6 weeks. There was no reported complications or recurrence following either type of management. Conclusions: Postraumatic intercostal lung herniation in children is a rare condition. Including our case reported here, there are only 16 reported cases. In children ILH is mostly seen after blunt chest trauma caused by bicycle handle bar injury. Given the rarity of the condition, the pediatric literature on this subject is scarce, with no published guidelines or evidence based recommendations for imaging and management approaches (surgical vs. nonsurgical. Although rare, the pediatric surgeon should be familiar with this condition in order to avoid potentially harmful, invasive or unnecessary diagnostic and therapeutic approaches that are extrapolated from experience in adult patients. Noninvasive imaging modalities including chest radiographs and ultrasound, and nonsurgical management of posttraumatic intercostal lung herniation should be considered as an initial treatment option in the management of asymptomatic patients.

  19. Surgical treatment of foraminal herniated disc of the lumbar spine

    OpenAIRE

    Halikov Shavkatbek; Abduhalikov Alimjon Karimjanovich

    2017-01-01

    Herniated lumbar intervertebral disc have a significant impact on both the patient’s life as well, and because of the high prevalence and economic impact on society as a whole. Designed scheduling algorithm foraminal hernia surgical treatment of lumbar intervertebral disc, based on the preoperative detection of compressing factors allows to define differentiated indications for decompressive or decompressive-stabilizing surgery.

  20. Management of Symptomatic Lumbar Disk Herniation: An International Perspective

    NARCIS (Netherlands)

    P.S. Gadjradj (Pravesh S.); M.P. Arts (Mark); M.W. van Tulder (Maurits); Rietdijk, W.J.R. (Wim J. R.); W.C. Peul (Wilco); B.S. Harhangi (Biswadjiet)

    2017-01-01

    textabstractObjective To evaluate the current practice patterns of surgeons regarding both the surgical and nonsurgical management of lumbar disk herniation (LDH) worldwide and to compare this with the current literature Summary of Background Data Sciatica is a common diagnosis in the general

  1. Gd-DTPA-enhanced MR in thoracic disc herniations

    Energy Technology Data Exchange (ETDEWEB)

    Parizel, P.M.; Rodesch, G.; Baleriaux, D.; Segebarth, C.; Zegers de Beyl, D.; Haens, J. d' ; Noterman, J.

    1989-03-01

    The Gd-DTPA-enhanced magnetic resonance findings in two patients with herniated thoracic intervertebral discs are reported. The first patient was a 56-year-old woman with a small subligamentous T6-7 disc herniation, slightly lateralized to the right. The second patient was a 51-year-old man with a central and right posterolateral disc herniation, including a large calcified fragment, at the T8-9 level. The nonenhanced MR examination revealed the presence of an extradural mass lesion in both patients, impinging upon the dural sac and compressing and displacing the spinal cord posteriorly. The lesion was slightly hypointense on both T1- and T2-weighted spin echo sequences. Following intravenous injection of Gd-DTPA in a dosage of 0.1 mmol/kg body weight, enhancement of the posterior longitudinal ligament was noted and triangular areas of contrast uptake were seen to occur in the epidural space above and below the herniated disc. At surgery, they were found to correspond to dilated and congested epidural veins.

  2. Surface image of herniated disc on three-dimensional CT

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    Chung, Kyung Il; Jeon, Chang Hoon; Kim, Sun Yong; Kim, Ok Hwa; Suh, Jung Ho [Ajou Univ. College of Medicine, Suwon(Korea, Republic of)

    1996-03-01

    To evaluate surface configuration of herniated disc on three-dimensional CT. Three dimensional surface images reconstructed from CT scans(1 mm thick) of 24 surgically confirmed herniated discs in 23 patients were reviewed. Disc surface was classified into peripheral and central zones in contact with consecutive peripheral ring and central endplate. Surface irregularity was categorized into two types(local and general). The incidence, size, and extent of local irregularity were observed. General irregularity incidence and severity ranges in 4 grades, and peripheral width were evaluated. The findings were correlated with discography. Local irregularity compatible with anulus tear in discography was shown in all. It was large(13/24) and mainly peripheral tract extending to disc margin in protrusion(3/5) and sequestration(5/7), and cleft encompassing central zone to disc margin in extrusion(9/12). General irregularity was predominantly grade 3(15/22) and was shown in all except in 2 protrusions. Peripheral width was 0.56 of central radius. Extrusion in herniated disc shows characteristic cleft encompassing central zone to disc margin whereas sequestration or protrusion displays tract extending from peripheral zone to disc margin. Thus, three dimensional surface imaging may aid the diagnosis, follow-up, prediction, and treatment of herniated disc.

  3. Sonographic findings of inguinal herniation of the ovary

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Yoon Kyung; Lee, Sun Wha [Ewha Womans University College of Medicine, Seoul (Korea, Republic of)

    2003-09-01

    To describe the sonographic findings of inguinal herniation of the ovary. Forty-five girls aged 1-12 (mean, 4.7) months with a groin mass underwent sonographic examination, and in seven of the 45, inguinal herniation of the ovary was detected, and confirmed at surgery. Gray-scale and color Doppler sonographic examinations were performed to evaluated the size, echo pattern, and blood flow of the mass. Sonography of the pelvis and contralateral groin was also performed. In all seven cases, sonography revealed an oval-shaped complex mass 15-25 mm in maximal diameter and composed of heterogeneous hypoechoic portions and one to seven small internal cysts, each 2-9 mm in diameter. Blood flow was observed in all cases, though was subtly decreased in one. In two there was associated herniation of the salpinx, and in two others, incarceration. In four, contralateral inguinal hernia was present. Sonographic findings of an oval-shaped heterogeneous hypoechoic mass with internal small cysts, present in the groin, indicate inguinal herniation of the ovary.

  4. Lumbar Herniation of Kidney following Iliac Crest Bone Harvest

    Directory of Open Access Journals (Sweden)

    Michael Justin Willcox

    2016-01-01

    Full Text Available The iliac crest is a popular source for autogenous bone harvesting, but the process is rife with complications. This case report presents a patient that experienced incisional lumbar herniation of her kidney following an iliac crest bone harvesting procedure. A discussion is included on the underappreciated complications of this procedure and recommendations for improving outcomes with more thorough evaluation and documentation.

  5. Central brain herniation in shunted Dandy Walker cyst.

    Science.gov (United States)

    Mandiwanza, Tafadzwa; Kaliaperumal, Chandrasekaran; Caird, John

    2013-06-01

    Dandy-Walker Syndrome (DWS) is a constellation of congenital anomalies of the central nervous system consisting of cerebellar vermis hypoplasia or agenesis, cystic dilatation of the fourth ventricle, enlarged posterior fossa, and a high tentorium. Hydrocephalus is a common occurrence in DWS and its treatment varies between shunting-ventriculoperitoneal or cystoperitoneal or both, endoscopic cyst fenestration, and third ventriculostomy. Chronic cerebral herniation is a known complication of treatment in DWS; however, we present an unusual case of central brain herniation. A 2 year old boy with shunted DWS presented with status epilepticus. Initial CT brain scan showed no increase in ventricle or cyst size; however, tapping the shunt reservoir did not yield any CSF prompting a shunt revision. Postoperatively, he was very slow to wake and subsequently experienced an episode of fixed pupils and extensor posturing. MRI brain demonstrated severe herniation of both thalami through the tentorium. This child had chronic central brain herniation (CCBH) secondary to the shunting of his cyst. To our knowledge, this is the first case of CCBH following treatment of DW cyst.

  6. Lumbar disc herniation at high levels : MRI and clinical findings

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    Paek, Chung Ho; Kwon, Soon Tae; Lee, Jun Kyu; Ahn, Jae Sung; Lee, Hwan Do; Chung, Yon Su; Jeong, Ki Ho; Cho, Jun Sik [Chungnam National Univ. College of Medicine, Taejon (Korea, Republic of)

    1999-04-01

    To assess the frequency, location, associated MR findings, and clinical symptoms of the high level lumbar disc herniation(HLDH). A total of 1076 patients with lunbar disc herniation were retrospectively reviewed. MR images of 41 of these with HLDH(T12-L1, L1-2, L2-3) were analysed in terms of frequency, location, and associated MR findings, and correlated with clinical symptoms of HLDH. The prevalence of HLDH was 3.8%(41/1076). HLDH was located at T12-L1 level in four patients(10%), at L1-2 level in 14(34%), at L2-3 level in 21(51%), and at both L1-2 and L2-3 levels in two. The age of patients ranged from 20 to 72 years (mean, 44), and there were 26 men and 16 women. In 11(27%), whose mean age was 32 years, isolated disc herniation was limited to these high lumbar segments. The remaining 30 patients had HLDH associated with variable involvement of the lower lumbar segments. Associated lesions were as follow : lower level disc herniation(14 patients, 34%); apophyseal ring fracture(8 patients, 19%); Schmorl's node and spondylolisthesis (each 6 patients, each 14%); spondylolysis(3 patients, 7%); and retrolisthesis(2 patients, 5%). In 20 patients(49%) with HLDH(n=41), there was a previous history of trauma. Patients with HLDH showed a relatively high incidence of associated coexisting abnormalities such as lower lumbar disc herniation, apophyseal ring fracture, Schmorl's node, spondylolysis, and retrolisthesis. In about half of all patients with HLDH there was a previous history of trauma. The mean age of patients with isolated HLDH was lower; clinical symptoms of the condition were relatively nonspecific and their incidence was low.

  7. Prevalence of Concomitant Sacroiliac joint Dysfunction in Patients With Image Proven Herniated Lumbar Discs

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    Salah Alalawi

    2009-05-01

    Full Text Available Background:Sacroiliac joint (SIJ dysfunction is a widely known but poorly defined cause of low back pain. To our knowledge, few published studies have been conducted to evaluate systematically the prevalence and significance of concomitant sacroiliac joint dysfunction in patients with herniated lumbar discs. As concomitant SIJ dysfunction in low back pain patients is likely to respond to particular noninvasive interventions such as manipulation,improved understanding of the relationship between these two diagnoses would improve clinical decision making and research.Methods:This study was designated to estimate the prevalence of concomitant sacroiliac joint dysfunction in sub acute low back pain patients with image proven discopathy and evaluate the theory that sacroiliac joint dysfunction can be a source of pain and functional disability in discopathy. A total of 202 patients with sub acute radicular back pain and MRI proven herniated lumbar discs underwent standardized   physiatrist history and physical examination, specified for detection of concomitant sacroiliac joint dysfunction.Results: Sacroiliac joint dysfunction is a concomitant finding in 72.3% of evaluated patients.There was significantly higher SIJ dysfunction prevalence in female patients (p <0.0001. Conclusion: SIJ dysfunction is a significant pathogenic factor with high possibility of occurrence in low back pain. Thus, in the presence of radicular and sacroiliac joint symptoms, SIJ dysfunction, regardless of intervertebral disc pathology, must be considered in clinical decisiomaking.

  8. The Association Between Modic Changes of Lumbar Endplates and Spontaneous Absorption of Herniated Intervertebral Discs.

    Science.gov (United States)

    Ding, Lingzhi; Teng, Xiao; Fan, Shunwu; Zhao, Fengdong

    2015-04-01

    Herniated disc (HD) is one of the most common causes of lower back pain. Treatment for HD includes conservative therapy and surgical intervention. Following conservative treatment, spontaneous absorption of HD occurs in some patients. To assess whether modic changes are associated with spontaneous absorption of HD, 85 patients with or without modic changes were followed up after 6 months of conservative treatment. As result, we found modic changes of lumbar endplates are associated with poor absorption of HD after conservative treatment. In addition, patients with modic changes exhibit significantly increased cartilage content and decreased neovascularization and macrophage infiltration in HD tissues, all of which are known to impair spontaneous absorption of herniated tissues. At molecular level, modic changes are associated with decreased expression of matrix metalloproteinase-3 gene, which is a key matrix-degrading enzyme for tissue absorption. Our study established a strong association between modic changes of lumbar endplates and spontaneous absorption of lumbar HD, which provided a potential novel method for prediction of spontaneous absorption.

  9. Posterior pelvic pain provocation test is negative in patients with lumbar herniated discs.

    Science.gov (United States)

    Gutke, Annelie; Hansson, Eva Roos; Zetherström, Gunilla; Ostgaard, Hans Christian

    2009-07-01

    The classification of pelvic girdle pain can only be reached after lumbar causes have been excluded by a clinical examination. During clinical examination, the posterior pelvic pain provocation test is a well-established method for verifying pelvic girdle pain. However, a criticism of pelvic pain provocation tests is that they may have an effect on lumbar structures, thus yielding false-positive results. The posterior pelvic pain provocation test was performed with four groups of patients: patients with computed tomography-verified disc herniations (1) on the waiting list for surgery (14 women; 9 men); (2) 6 weeks after disc surgery (18 women, 12 men); (3) pregnant women seeking care for pelvic girdle pain (n = 25); and (4) women with persistent pelvic girdle pain after delivery (n = 32). The sensitivity of the posterior pelvic pain provocation test was 0.88 and the specificity was 0.89. The positive predictive value was 0.89 and the negative predictive value was 0.87. Analysis of only women showed similar results. In our study, the posterior pelvic pain provocation test was negative in patients with a well-defined lumbar diagnosis of lumbar disc herniation, both before and after disc surgery. Our results are an important step toward the more accurate classification of lumbopelvic pain.

  10. Conventional physical therapy with lumbar traction; clinical evaluation and magnetic resonance imaging for lumbar disc herniation.

    Science.gov (United States)

    Kamanli, A; Karaca-Acet, G; Kaya, A; Koc, M; Yildirim, H

    2010-01-01

    This study measures and compares the outcome of conservative physical therapy with traction, by using magnetic resonance imaging and clinical parameters in patients presenting with low back pain caused by lumbar disc herniation. A total of 26 patients with LDH (14F, 12M with mean aged 37 +/- 11) were enrolled in this study and 15 sessions (per day on 3 weeks) of physical therapy were applied. That included hot pack, ultrasound, electrotherapy and lumbar traction. Physical examination of the lumbar spine, severity of pain, sleeping order, patient and physician global assessment with visual analogue scale, functional disability by HAQ, Roland Disability Questionnaire, and Modified Oswestry Disability Questionnaire were assessed at baseline and at 4-6 weeks after treatment. Magnetic resonance imaging examinations were carried out before and 4-6 weeks after the treatment All patients completed the therapy session. There were significant reductions in pain, sleeping disturbances, patient and physician global assessment and disability scores, and significant increases in lumbar movements between baseline and follow-up periods. There were significant reductions of size of the herniated mass in five patients, and significant increase in 3 patients on magnetic resonance imaging after treatment, but no differences in other patients. This study showed that conventional physical therapies with lumbar traction were effective in the treatment of patient with subacute LDH. These results suggest that clinical improvement is not correlated with the finding of MRI. Patients with LDH should be monitored clinically (Fig. 3, Ref. 18).

  11. Physical activity is associated with elevated arterial stiffness in patients with lumbar disk herniation.

    Science.gov (United States)

    Jin, Gang; Cao, Zhi-gang; Zhang, Yi-na; Li, Ying; Shen, Bao-zhong

    2015-02-01

    A cross-sectional study in a general health examination. To investigate the relationship between brachial-ankle pulse wave velocity (baPWV) and lumbar disk herniation (LDH). Lumbar disk herniation (LDH) is a major cause of low back pain and sciatica. Various vascular risk factors such as obesity, diabetes mellitus, and smoking have been reported to be associated with LDH. BaPWV is an early indicator of subclinical atherosclerosis. A total of 490 participants with LDH and 490 participants without LDH were selected for the evaluation of baPWV. BaPWV was measured using an automatic device. The prevalence of LDH was calculated by the quartiles of baPWV levels. Multiple linear regression analysis was performed to evaluate the risk factors for baPWV. LDH patients had significantly higher readings of baPWV compared with non-LDH subjects (P<0.001). The prevalence rate of LDH gradually increased according to baPWV quartiles. In addition, the levels of baPWV tended to increase as the frequency of physical activity reduced. Multiple linear regression analysis showed that body mass index, low-density lipoprotein cholesterol, physical activity, and systolic blood pressure contributed to increased baPWV. The findings showed that LDH patients had higher baPWV levels. In addition, reduced physical activity was a risk factor contributing to increased baPWV. Further studies are warranted to determine the role of baPWV in LDH.

  12. The Pathogenesis of Ventral Idiopathic Herniation of the Spinal Cord: A Hypothesis Based on the Review of the Literature

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    Ronald H. M. A. Bartels

    2017-09-01

    Full Text Available Idiopathic ventral herniation of the spinal cord (SC is not often encountered in daily practice. Its clinical prevalence, however, will increase through increasing awareness and more frequent use of MRI. A clear explanation of its pathophysiology has never been formulated. It was hypothesized that the findings during surgery might indicate the real causative mechanism. An extensive literature search was performed, using Embase, PubMed, and Google Scholar. Titles and abstracts were screened by two investigators, using strict inclusion and exclusion criteria. Reference lists of the full paper versions of each included article were checked. The following data were registered for the articles included: age, gender, level of herniation, relation to intervertebral disk, duration of symptoms, findings from surgery, and outcomes. Nine cases treated at our department were added. A total of 117 articles reporting on 259 patients were included. Including our cases, 268 patients were reviewed. Females outnumbered males (160/100. The mean age was 51.3 ± 12.0 years. In 236 patients, the duration of symptoms was reported: 55.5 ± 55.6 months. In 178 patients, the intraoperative findings for the herniated part of the SC were not mentioned. In 59 patients, a tumor-like extrusion was seen, without any alteration to the SC. Deformation of the SC itself was never observed. Biopsies of these structures were without clinical consequence. Based on the intraoperative findings reported in literature and the cases presented, acquired causes, such as trauma and erosion of the dura due to a herniated disk, were not plausible. We hypothesize that a non-functioning appendix to the SC can only develop during an early embryologic phase, in which several layers separate. We propose renaming this entity as congenital transdural appendix of the SC.

  13. ASSOCIATION OF SPINOPELVIC PARAMETERS WITH THE LOCATION OF LUMBAR DISC HERNIATION

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    Jefferson Coelho de Léo

    2015-09-01

    Full Text Available Objective:To associate spinopelvic parameters, pelvic incidence, sacral slope, pelvic tilt and lumbar lordosis with the axial location of lumbar disc herniation.Methods:Retrospective study, which evaluated imaging and medical records of 61 patients with lumbar disc herniation, who underwent surgery with decompression and instrumented lumbar fusion in only one level. Pelvic incidence, sacral slope, pelvic tilt and lumbar lordosis with simple lumbopelvic lateral radiographs, which included the lumbar spine, the sacrum and the proximal femur. The affected segment was identified as the level and location of lumbar disc herniation in the axial plane with MRI scans.Results:Of 61 patients, 29 (47.5% had low lumbar lordosis; in this group 24 (82.8% had central disc herniation, 4 (13.8% had lateral recess disc herniation and 1 (3.4% had extraforaminal disc herniation (p<0.05. Of the 61 patients, 18 (29.5% had low sacral slope; of this group 15 (83.3% had central disc herniation and 3 (16.7% had disc herniation in lateral recess (p<0.05.Conclusions:There is a trend towards greater load distribution in the anterior region of the spine when the spine has hypolordotic curve. This study found an association between low lordosis and central disc herniation, as well as low sacral slope and central disc herniation.

  14. Feasibility of Percutaneous Lumbar Discectomy Combined with Percutaneous Cementoplasty for Symptomatic Lumbar Disc Herniation with Modic Type I Endplate Changes.

    Science.gov (United States)

    Tian, Qing-Hua; Lu, Ying-Ying; Sun, Xi-Qi; Wang, Tao; Wu, Chun-Gen; Li, Ming-Hua; Cheng-Ying, Sheng

    2017-05-01

    Treatment of symptomatic lumbar disc herniation with Modic type I endplate changes is complex and challenging, requiring systemic and local therapies which include conservative therapy, epidural infiltrations, percutaneous therapeutic techniques, and surgical options. The clinical management of symptomatic lumbar disc herniation involving Modic type I endplate changes is uniquely challenging because it requires alleviating pain caused by both the herniated disc and the endplate osteochondritis. Through different approaches, percutaneous lumbar discectomy (PLD) and percutaneous cementoplasty (PCP) have been introduced into clinical practice as alternatives to traditional surgical and radiotherapy treatments of symptomatic lumbar disc herniation and other spine diseases. To evaluate the feasibility of PLD and PCP for symptomatic lumbar disc herniation with Modic type I endplate changes. PLD and PCP in 7 patients with symptomatic lumbar disc herniation with Modic type I endplate changes and its clinical effects were retrospectively evaluated. This study was conducted by an interventional therapy group at a medical center in a major Chinese city. Seven consecutive patients (2 men, 5 women; median age, 74.14 ± 5.34 years; age range, 68 - 82 years) who underwent percutaneous lumbar discectomy and cementoplasty for the treatment of symptomatic lumbar disc herniation with Modic type I changes between May 2013 and August 2015 were retrospectively analyzed. The MacNab Criteria, visual analog scale (VAS), and Oswestry Disability Index (ODI) for pain were assessed before and one week, 6 months, and one year after the procedure. Furthermore, the procedure duration, hospital stay length, and complications were assessed. The VAS of the back and leg decreased from 6.14 ± 0.69 (range, 5 - 7) and 7.29 ± 0.76 (range, 6 - 8) preoperatively to 2.29 ± 1.38 (range, 1 - 5) and 2.71 ± 0.60 (range, 1 - 6) one week, 1.86 ± 0.69 (range, 1 - 3) and 2.00 ± 0.58 (range, 1 - 3) 6 months

  15. Effects of segmental traction therapy on lumbar disc herniation in patients with acute low back pain measured by magnetic resonance imaging: A single arm clinical trial.

    Science.gov (United States)

    Karimi, Noureddin; Akbarov, Parvin; Rahnama, Leila

    2017-01-01

    Low Back Pain (LBP) is considered as one of the most frequent disorders, which about 80% of adults experience in their lives. Lumbar disc herniation (LDH) is a cause for acute LBP. Among conservative treatments, traction is frequently used by clinicians to manage LBP resulting from LDH. However, there is still a lack of consensus about its efficacy. The purpose of this study was to evaluate the effects of segmental traction therapy on lumbar discs herniation, pain, lumbar range of motion (ROM), and back extensor muscles endurance in patients with acute LBP induced by LDH. Fifteen patients with acute LBP diagnosed by LDH participated in the present study. Participants undertook 15 sessions of segmental traction therapy along with conventional physiotherapy, 5 times a week for 3 weeks. Lumbar herniated mass size was measured before and after the treatment protocol using magnetic resonance imaging. Furthermore, pain, lumbar ROM and back muscle endurance were evaluated before and after the procedure using clinical outcome measures. Following the treatment protocol, herniated mass size and patients' pain were reduced significantly. In addition, lumbar flexion ROM showed a significant improvement. However, no significant change was observed for back extensor muscle endurance after the treatment procedure. The result of the present study showed segmental traction therapy might play an important role in the treatment of acute LBP stimulated by LDH.

  16. Automatic diagnosis of lumbar disc herniation with shape and appearance features from MRI

    Science.gov (United States)

    Alomari, Raja'S.; Corso, Jason J.; Chaudhary, Vipin; Dhillon, Gurmeet

    2010-03-01

    Intervertebral disc herniation is a major reason for lower back pain (LBP), which is the second most common neurological ailment in the United States. Automation of herniated disc diagnosis reduces the large burden on radiologists who have to diagnose hundreds of cases each day using clinical MRI. We present a method for automatic diagnosis of lumbar disc herniation using appearance and shape features. We jointly use the intensity signal for modeling the appearance of herniated disc and the active shape model for modeling the shape of herniated disc. We utilize a Gibbs distribution for classification of discs using appearance and shape features. We use 33 clinical MRI cases of the lumbar area for training and testing both appearance and shape models. We achieve over 91% accuracy in detection of herniation in a cross-validation experiment with specificity of 91% and sensitivity of 94%.

  17. Salvage of Herniated Flow Diverters Using Stent and Balloon Anchoring Techniques: A Technical Note.

    Science.gov (United States)

    Jagadeesan, Bharathi D; Sandhu, Divyajot; Hong, Kim Jae; Roshan Khanipour, Sara; Grande, Andrew W; Tummala, Ramachandra P

    2017-03-01

    The pipeline embolization device (PED; Medtronic, MN, USA) can sometimes herniate into the aneurysmal sac in an unexpected manner during or shortly after its deployment due to device foreshortening. In this report, we describe 2 endovascular techniques, which can be used to reposition a herniated PED construct into a more favorable alignment. In a 67-year-old patient who had an intraprocedural herniation of a PED device into a giant cavernous aneurysm, a stent anchor technique was used to reverse the herniation, reorient the PED construct, and achieve successful flow diversion. In a different patient with a giant superior hypophyseal aneurysm, a balloon anchor technique followed by deployment of an LVIS Jr (Microvention, Tustin, CA, USA) stent was used to reverse the herniation into the aneurysmal sac. Stent anchor and balloon anchor techniques as described here can be used to reposition PED constructs, which have unexpectedly herniated into the aneurysm sac during attempted flow diversion for the treatment of giant aneurysms.

  18. Is that lumbar disc symptomatic? Herniated lumbar disc associated with contralateral radiculopathy.

    Science.gov (United States)

    Abdul Jalil, Muhammad Fahmi; Lam, Miu Fei; Wang, Yi Yuen

    2014-05-07

    Herniated lumbar disc may be asymptomatic or associated with lower limb radiculopathy. Most spinal surgeons would offer surgery following a period of conservative measures if the radiological and clinical findings correlate. However, the existing dictum that lumbar radiculopathy should correlate with ipsilateral lumbar disc herniation may not be accurate as it can rarely present with contralateral sciatica. Literature regarding this phenomenon is scarce. Therefore, we report a patient with herniated lumbar disc presenting with predominantly contralateral motor weakness radiculopathy, which resolved after discectomy.

  19. Episodic cauda equina compression from an intradural lumbar herniated disc: a case of 'floppy disc'.

    Science.gov (United States)

    Nagaria, J; Chan, Cc; Kamel, Mh; McEvoy, L; Bolger, C

    2011-09-01

    Intradural disc herniation (IDDH) is a rare complication of intervertebral disc disease and comprises 0.26-0.30% of all herniated discs, with 92% of them located in the lumbar region (1). We present a case of IDDH that presented with intermittent symptoms and signs of cauda equina compression. We were unable to find in the literature, any previously described cases of intermittent cauda equina compression from a herniated intradural disc fragment leading to a "floppy disc syndrome". © JSCR.

  20. Spontaneous Regression of Herniated Lumbar Disc with New Disc Protrusion in the Adjacent Level

    OpenAIRE

    Hakan, Tayfun; G?rcan, Serkan

    2016-01-01

    Spontaneous regression of herniated lumbar discs was reported occasionally. The mechanisms proposed for regression of disc herniation are still incomplete. This paper describes and discusses a case of spontaneous regression of herniated lumbar discs with a new disc protrusion in the adjacent level. A 41-year-old man was admitted with radiating pain and numbness in the left lower extremity with a left posterolateral disc extrusion at L5-S1 level. He was admitted to hospital with low back pain ...

  1. Diaphragmatic laceration, partial liver herniation and catamenial pneumothorax.

    Science.gov (United States)

    Bobbio, Antonio; Carbognani, Paolo; Ampollini, Luca; Rusca, Michele

    2007-06-01

    Catamenial pneumothorax is a recurrent pneumothorax temporally associated with menstruation. Pathogenesis remains debated however pleural endometriosis or diaphragmatic abnormalities are almost always present. We report the case of a 35-year-old woman with recurrent right catamenial pneumothorax. At thoracoscopy a large laceration of the diaphragm with partial intrathoracic liver herniation was seen. Treatment involved repair of the diaphragmatic lacerations, and pleurodesis. This report shows that large diaphragmatic defects may be observed in patients with catamenial pneumothorax.

  2. CT scan of the spine for herniated discs

    Energy Technology Data Exchange (ETDEWEB)

    Gulati, A.N.; Weinstein, R.; Studdard, E.

    1981-10-01

    The high resolution conversion kit introduced for the EMI CT 5005 scanner has twice the spatial resolution of the usual scan mode and has proven to be quite useful in evaluation of the spinal canal. The present study was performed to determine the capability of the high resolution system to diagnose herniated lumbar disc without intrathecal contrast. HNP was diagnosed in 83% of the cases which had a positive myelogram, 70% of which had operation and all were proven positive.

  3. Unloaded Treadmill Training Therapy for Lumbar Disc Herniation Injury

    OpenAIRE

    Simpson, Steve; Bettis, Brad; Herbertson, James

    1996-01-01

    The low back region is an area that is very susceptible to injury in athletes. Running is an activity that can be significantly affected by chronic overuse stress. The athlete presented in this case report suffered a herniation of the disc between L-4 and L-5 while training for and racing in a national championship marathon. The athlete was placed on a treatment program of heat, electrical muscle stimulation, and strength and flexibility exercises. The athlete also continued to train by unloa...

  4. Physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain.

    Science.gov (United States)

    van der Windt, Daniëlle Awm; Simons, Emmanuel; Riphagen, Ingrid I; Ammendolia, Carlo; Verhagen, Arianne P; Laslett, Mark; Devillé, Walter; Deyo, Rick A; Bouter, Lex M; de Vet, Henrica Cw; Aertgeerts, Bert

    2010-02-17

    Low-back pain with leg pain (sciatica) may be caused by a herniated intervertebral disc exerting pressure on the nerve root. Most patients will respond to conservative treatment, but in carefully selected patients, surgical discectomy may provide faster relief of symptoms. Primary care clinicians use patient history and physical examination to evaluate the likelihood of disc herniation and select patients for further imaging and possible surgery. (1) To assess the performance of tests performed during physical examination (alone or in combination) to identify radiculopathy due to lower lumbar disc herniation in patients with low-back pain and sciatica;(2) To assess the influence of sources of heterogeneity on diagnostic performance. We searched electronic databases for primary studies: PubMed (includes MEDLINE), EMBASE, and CINAHL, and (systematic) reviews: PubMed and Medion (all from earliest until 30 April 2008), and checked references of retrieved articles. We considered studies if they compared the results of tests performed during physical examination on patients with back pain with those of diagnostic imaging (MRI, CT, myelography) or findings at surgery. Two review authors assessed the quality of each publication with the QUADAS tool, and extracted details on patient and study design characteristics, index tests and reference standard, and the diagnostic two-by-two table. We presented information on sensitivities and specificities with 95% confidence intervals (95% CI) for all aspects of physical examination. Pooled estimates of sensitivity and specificity were computed for subsets of studies showing sufficient clinical and statistical homogeneity. We included 16 cohort studies (median N = 126, range 71 to 2504) and three case control studies (38 to100 cases). Only one study was carried out in a primary care population. When used in isolation, diagnostic performance of most physical tests (scoliosis, paresis or muscle weakness, muscle wasting, impaired

  5. Relationship between neovascularization and degenerative changes in herniated lumbar intervertebral discs.

    Science.gov (United States)

    Rätsep, Tõnu; Minajeva, Ave; Asser, Toomas

    2013-11-01

    Lumbar disc degeneration may be associated with intensity of neovascularization in disc herniations. Our study was designed to evaluate how much the severity of histodegeneration is related to the development of neovascularization and to the level of pleiotrophin in the herniated lumbar discs. Surgically excised lumbar disc specimens were obtained from 29 patients with noncontained (i.e., extruding through the posterior longitudinal ligament) and 21 patients with contained disc herniations. The histodegeneration scores and levels of neovascularization were estimated according to semiquantitative analysis in lumbar disc and endplate samples. Immunohistochemical staining were performed to identify the newly formed blood vessels and to detect the presence of pleiotrophin in the specimens. Higher levels of disc and endplate neovascularity were registered in noncontained herniations. The level of neovascularization was significantly related to the score of histodegeneration in the herniated disc tissues but not in the endplate specimens. Both contained and noncontained herniations had the highest values of histodegeneration in conjunction with the highest level of neovascularization but the relations between neovascularity and degenerative changes remained to be significant only in the group of noncontained herniations. Registration or frequency of pleiotrophin positive cells did not correlate significantly with histodegeneration or level of neovascularization in the disc samples. Severe histodegeneration of the lumbar disc herniations is associated with enhanced neovascularization and potentially also spontaneous regression of the herniated tissue.

  6. Blunt traumatic rupture of the pericardium with cardiac herniation: two cases diagnosed using computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Schir, F.; Thony, F.; Coulomb, M. [Dept. of Medical Imaging, Michallon Hospital, Grenoble (France); Chavanon, O.; Perez-Moreira, I.; Blin, D. [Dept. of Cardiac Surgery, Michallon Hospital, Grenoble (France)

    2001-06-01

    Traumatic ruptures of the pericardium with cardiac herniation are infrequent, and their radiological pattern little familiar, so that they are often missed preoperatively. Few reports have emphasised the use of a CT scan as a tool for diagnosis and CT scan signs have not been well documented. We report on two cases of traumatic herniation of the heart for which a CT scan brought a major contribution for diagnosis. We describe the presence of an empty pericardial sac on CT slices which allowed us to diagnose the cardiac herniation. These observations demonstrate that CT scans can contribute to the diagnosis of pericardial rupture with cardiac herniation. (orig.)

  7. CT five years after myelographic diagnosis of lumbar disk herniation

    Energy Technology Data Exchange (ETDEWEB)

    Hurme, M.; Katevuo, K.; Nykvist, F.; Aalto, T.; Alaranta, H.; Einola, S. (Turku Univ. Central Hospital (Finland). Dept. of Surgery Turku Univ. Central Hospital (Finland). Dept. of Diagnostic Radiology Social Insurance Inst., Turku (Finland). Rehabilitation Research Centre)

    1991-07-01

    Fifty-seven patients were examined with CT 5 years after primary myelography for disabling sciatica and suspected herniated lumbar disk. Forty were in an operated group, 22 with good and 18 with poor results evaluated by occupational handicap (21) 5 years after surgery. Seventeen patients had myelography indicating disk herniation, but were treated conservatively, 9 with good and 8 with poor result. Various spinal dimensions measured at CT did not correlate with outcome. Operated patients had narrower canals than others, and male canals were broader than those in females. Increased amount of scar tissue at L4 level correlated with poor result (p=0.008). Operated patients with poor result had more advanced lateral stenosis than those treated conservatively (p<0.001). Patients with good result after operation had more degeneration observed on CT of erector spinae muscle than those treated conservatively with good outcome. Only 9% of operated patients did not have muscle degeneration. A tendency for more frequent recurrent disk herniations could be ssen for conservatively treated patients. The narrowing of the spinal canal 5 years after operation did not correlate with the 5-year outcome. (orig.).

  8. Paradoxical Herniation in the Postcraniectomy Syndrome: Report and Literature Update.

    Science.gov (United States)

    Ramos-Zúñiga, Rodrigo; Mares-Pais, Roberto; Gutiérrez-Avila, Oscar; Saldaña-Koppel, Daniel A

    2016-03-01

    Introduction The decompressive craniectomy is a surgical strategy widely used with specific criteria to control the refractory intracranial pressure (ICP). However, it is important to warn about the presence of a postcraniectomy syndrome and analyze the risk-benefit on a long term. Case Report A 72-year-old male patient diagnosed with a subarachnoid hemorrhage secondary to the rupture of an anterior circulation aneurysm that develops vasospasm, secondary ischemia, and edema with signs of herniation that required a decompressive craniectomy on a first step. Afterwards, the aneurysm was approached and he consequently developed hydrocephaly. A ventriculoperitoneal shunt is installed, contralateral to the craniectomy, and progressive sinking of the skin flap, there is neurological deterioration and paradoxical herniation. Its association with the clinical deterioration by bronchoaspiration did not allow the cranioplasty to resolve the ICP decompensation. Conclusions The paradoxical herniation as part of the postcraniectomy syndrome is an increasingly common condition identified in adult patients with cortical atrophy, and who have also been treated with ventricular shunt systems. Timely cranioplasty represents the ideal therapeutic plan once the compromise from the mass effect has resolved to avoid complications derived from the decompressive craniectomy per se.

  9. High degree of kinesiophobia after lumbar disc herniation surgery

    Science.gov (United States)

    2011-01-01

    Background and purpose Several studies have investigated outcomes after disc surgery. However, the occurrence of kinesiophobia has not been investigated previously in patients after disc herniation surgery. In this cross-sectional study, we investigated kinesiophobia in patients who had been treated surgically for lumbar disc herniation, and we related the results to established outcome measures. Patients and methods 10–34 months after surgery, questionnaires were sent to 97 patients who had undergone standardized open discectomy. Outcome measures included Tampa scale for kinesiophobia (TSK); Oswestry disability index (ODI); European quality of life in 5 dimensions (EQ-5D); visual analog scale (VAS) for leg and back pain, work disability, and patient satisfaction; Zung self-rating depression scale (ZDS); pain catastrophizing scale (PCS); and a self-efficacy scale (SES). Results 36 of 80 patients reported having kinesiophobia. There were statistically significant differences in ODI, EQ-5D, VAS leg and back pain, ZDS, PCS, and SES between patients with and without kinesiophobia. Interpretation Half of the patients suffered from kinesiophobia 10–34 months after surgery for disc herniation. These patients were more disabled, had more pain, more catastrophizing thoughts, more symptoms of depression, lower self-efficacy, and poorer health-related quality of life than patients without kinesiophobia. PMID:22066555

  10. COMPARATIVE STUDY ON THE TREATMENT OF DISC HERNIATIONS

    Directory of Open Access Journals (Sweden)

    María Luz Suárez-Huerta

    Full Text Available ABSTRACT Objective: To compare the results of treatment of patients with low back pain and radiculalgia resulting from disc herniation associated with disc degeneration through instrumentation with pedicle screws and dynamic rod, with root release and without diskectomy compared with other non-instrumented techniques (microdiskectomy with or without foraminotomy. Methods: This is a retrospective descriptive study of interventions for patients with herniated discs in the Traumatology and Neurosurgery that used the following variables: age, sex, type of technique, surgical time, time of evolution, degree of satisfaction, and complications. Two groups were formed: instrumentation with dynamic rods and non-instrumented techniques, comparing the results of each group. The software used was the SPSS v20.0. Results: We presented 142 interventions carried out between 2009 and 2012, 86 with dynamic instrumentation and 56 by other decompression techniques without instrumentation. No statistically significant differences were observed between age and sex groups and time elapsed until intervention. We found statistically significant differences (p=0.001 in surgical time, which was lower in the instrumented technique. No significant differences were found in complications between the techniques in both re-operations and in infections. Conclusions: In this study, we found no significant differences between the use of instrumentation with dynamic rods with respect to other non-instrumented surgical techniques in the treatment of herniated discs over 6 months of evolution or the complications and the degree of the patients' satisfaction.

  11. [Lumbar herniated disks treated with a dynamic interspacer].

    Science.gov (United States)

    Cueva-del Castillo Mendoza, J F; Franco-López, E A; Hinojosa-Sandoval, F; de León-Martínez, U A; Cueva-del Castillo Mendoza, F J

    2013-01-01

    Lumbar herniated disks result in lumbar pain with neurologic involvement. Medical treatment and rehabilitation provide improvement for this type of lumbar pain at the early stages. When conservative treatment fails, the surgical option offers the possibility of improving patients' health status. Moojen considers that the application of interspinous spacers provides good results. The purpose of this research is to assess the clinical and imaging results in patients with contained lumbar herniated disk treated with the DYNAMIC INTERSPACER interspinous spacer, a Mexican product. The efficacy of the interspinous device was assessed by means of a near-investigational and longitudinal study conducted at "General Ignacio Zaragoza" ISSSTE Regional Hospital in patients with a diagnosis of lumbar pain. The mean age of the sample is 46.1 years, with an age range of 26-55 years. The treated levels were 6 L5-S1 and 5 L4-L5; two levels were treated in two patients. The mean preoperative VAS score was 8.1. The mean VAS score at postoperative year three was 1.6. Multiple types and brands of foreign interspinous devices are applied in Mexico which results in patients' clinical improvement. We proved that the use of the Mexican interspinous device can clinically improve patients with lumbar pain due to herniated disk. A decrease in the compression of the sac or the nerve roots by the hernia was observed in the comparative preoperative and postoperative MRI images.

  12. Transient cerebral ischemia.

    OpenAIRE

    Cusimano, M D; Ameli, F M

    1989-01-01

    Stroke is a major cause of disability and death in North America. About 30% to 40% of patients with stroke have had transient ischemic attacks (TIAs). The recognition and treatment of TIAs and possibly of asymptomatic stenoses of the carotid arteries may be beneficial in preventing stroke. We review the epidemiologic features, natural history, pathogenetic features, clinical presentation, methods of investigation and management of patients with TIAs.

  13. Radiculopathy Caused by Discal Cyst

    OpenAIRE

    Kim, Sae Young

    2013-01-01

    Discal cyst is an intraspinal cyst with a distinct communication with the corresponding intervertebral disc. It is a rare condition and could present with radiculopathy similar to that caused by lumbar disc herniation. We present a patient with a large discal cyst in the ventrolateral epidural space of the 5th lumbar vertebral (L5) level that communicated with the adjacent 4th lumbar and 5th lumbar intervertebral disc, causing L5 radiculopathy. We alleviated the radiating pain with selective ...

  14. Effectiveness of percutaneous laser disc decompression versus conventional open discectomy in the treatment of lumbar disc herniation; design of a prospective randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Koes Bart W

    2009-05-01

    Full Text Available Abstract Background The usual surgical treatment of refractory sciatica caused by lumbar disc herniation, is open discectomy. Minimally invasive procedures, including percutaneous therapies under local anesthesia, are increasingly gaining attention. One of these treatments is Percutaneous Laser Disc Decompression (PLDD. This treatment can be carried out in an outpatient setting and swift recovery and return to daily routine are suggested. Thus far, no randomized trial into cost-effectiveness of PLDD versus standard surgical procedure has been performed. We present the design of a randomized controlled trial, studying the cost-effectiveness of PLDD versus conventional open discectomy in patients with sciatica from lumbar disc herniation. Methods/design The study is a randomized prospective multi-center trial, in which two treatment strategies are compared in a parallel group design. Patients (age 18–70 years visiting the neurosurgery department of the participating hospitals, are considered for inclusion in the trial when sciatica due to lumbar disc herniation has lasted more than 8 weeks. Patients with disc herniation smaller than 1/3 of the spinal canal diameter, without concomitant lateral recess stenosis or sequestration, are eligible for participation, and are randomized into one of two treatment arms; either Percutaneous Laser Disc Decompression or conventional discectomy. The functional outcome of the patient, as assessed by the Roland Disability Questionnaire for Sciatica at 8 weeks and 1 year after treatment, is the primary outcome measure. The secondary outcome parameters are recovery as perceived by the patient, leg and back pain, incidence of re-intervention, complications, quality of life, medical consumption, absence of work and secondary costs. Discussion Open discectomy is still considered to be the golden standard in the surgical treatment of lumbar disc herniation. Whether Percutaneous Laser Disc Decompression has at least as

  15. Deficiency of Thrombospondin-4 in Mice Does Not Affect Skeletal Growth or Bone Mass Acquisition, but Causes a Transient Reduction of Articular Cartilage Thickness.

    Directory of Open Access Journals (Sweden)

    Anke Jeschke

    Full Text Available Although articular cartilage degeneration represents a major public health problem, the underlying molecular mechanisms are still poorly characterized. We have previously utilized genome-wide expression analysis to identify specific markers of porcine articular cartilage, one of them being Thrombospondin-4 (Thbs4. In the present study we analyzed Thbs4 expression in mice, thereby confirming its predominant expression in articular cartilage, but also identifying expression in other tissues, including bone. To study the role of Thbs4 in skeletal development and integrity we took advantage of a Thbs4-deficient mouse model that was analyzed by undecalcified bone histology. We found that Thbs4-deficient mice do not display phenotypic differences towards wildtype littermates in terms of skeletal growth or bone mass acquisition. Since Thbs4 has previously been found over-expressed in bones of Phex-deficient Hyp mice, we additionally generated Thbs4-deficient Hyp mice, but failed to detect phenotypic differences towards Hyp littermates. With respect to articular cartilage we found that Thbs4-deficient mice display transient thinning of articular cartilage, suggesting a protective role of Thbs4 for joint integrity. Gene expression analysis using porcine primary cells revealed that Thbs4 is not expressed by synovial fibroblasts and that it represents the only member of the Thbs gene family with specific expression in articular, but not in growth plate chondrocytes. In an attempt to identify specific molecular effects of Thbs4 we treated porcine articular chondrocytes with human THBS4 in the absence or presence of conditioned medium from porcine synovial fibroblasts. Here we did not observe a significant influence of THBS4 on proliferation, metabolic activity, apoptosis or gene expression, suggesting that it does not act as a signaling molecule. Taken together, our data demonstrate that Thbs4 is highly expressed in articular chondrocytes, where its

  16. Frequency-Domain Transient Imaging.

    Science.gov (United States)

    Jingyu Lin; Yebin Liu; Jinli Suo; Qionghai Dai

    2017-05-01

    A transient image is the optical impulse response of a scene, which also visualizes the propagation of light during an ultra-short time interval. In contrast to the previous transient imaging which samples in the time domain using an ultra-fast imaging system, this paper proposes transient imaging in the frequency domain using a multi-frequency time-of-flight (ToF) camera. Our analysis reveals the Fourier relationship between transient images and the measurements of a multi-frequency ToF camera, and identifies the causes of the systematic error-non-sinusoidal and frequency-varying waveforms and limited frequency range of the modulation signal. Based on the analysis we propose a novel framework of frequency-domain transient imaging. By removing the systematic error and exploiting the harmonic components inside the measurements, we achieves high quality reconstruction results. Moreover, our technique significantly reduces the computational cost of ToF camera based transient image reconstruction, especially reduces the memory usage, such that it is feasible for the reconstruction of transient images at extremely small time steps. The effectiveness of frequency-domain transient imaging is tested on synthetic data, real data from the web, and real data acquired by our prototype camera.

  17. MR imaging of herniated lumbar disc : morphologic change between supine and flexed-prone position

    Energy Technology Data Exchange (ETDEWEB)

    Seong, Jin Yong; Lee, Seung Ro; Moon, Won Jin; Park, Dong Woo; Hahm, Chang Kok [Hanyang Univ., Seoul (Korea, Republic of); Kim, Sung Tae [Sungnam Inha Hospital, Sungnam (Korea, Republic of)

    1997-12-01

    The purpose of this study is to determine morphologic change in a herniated lumbar disc, as seen on MR imaging according to position change (supine and flexed-prone positions). A hundred and twenty-two patients with herniated lumbar discs, as seen on supine MR imaging, underwent repeat MR imaging in the flexed-prone position; 100 patients, who showed more than 2 deg of flexion angle difference, were included in this study. Sixty-two were men and thirty-eight were women, and their ages ranged from 13 to 59 (mean, 30) years. Disc degeneration was graded as 1,2 or 3, depending on the area of decreased signal intensity seen on a T2-weighted MR image. Difference in the angle of flexion is defined as the angle difference of lumbar curvature, calculated by the Begg-falconer method in supine and flexed-prone positions. Morphologic changes in herniated discs in difference positions were analysed on the basis of shape change of anterior epidural spaces, thecal sacs and posterior margins of herniated discs, and classified as either A (not changed) or B (changed). Group B was subtyped as type I (decreased herniation without change of shape), type II (decreased herniation with change of shape) or type III (increased disc herniation). We statistically analysed correlations between a patient`s age, morphologic change in a herniated disc in different positions, and degree of degeneration in such a disc, as well as the correlation between morphologic change in a herniated disc in different positions and the degree of the flexion angle. In the flexed-prone position, which is similar to that used during surgery, MRI can reveal various morphologic changes in a herniated lumbar disc, mainly decreased herniation, and is helpful in making decisions related to surgery. (author). 12 refs., 2 tabs., 4 figs.

  18. An intronic variation in SLC52A1 causes exon skipping and transient riboflavin-responsive multiple acyl-CoA dehydrogenation deficiency

    DEFF Research Database (Denmark)

    Mosegaard, Signe; Bruun, Gitte Hoffmann; Flyvbjerg, Karen Freund

    2017-01-01

    transfer flavoprotein (ETF) and its dehydrogenase (ETFDH), uses FAD as cofactor. The ETF and ETFDH are forming the electron transport pathway for many mitochondrial flavoprotein dehydrogenases involved in fatty acid, amino acid and choline metabolism. A variation in either ETF or ETFDH causes multiple acyl...

  19. Transiently increasing cAMP levels selectively in hippocampal excitatory neurons during sleep deprivation prevents memory deficits caused by sleep loss

    NARCIS (Netherlands)

    Havekes, Robbert; Bruinenberg, Vibeke M.; Tudor, Jennifer C.; Ferri, Sarah L.; Baumann, Arnd; Meerlo, Peter; Abel, Ted

    2014-01-01

    The hippocampus is particularly sensitive to sleep loss. Although previous work has indicated that sleep deprivation impairs hippocampal cAMP signaling, it remains to be determined whether the cognitive deficits associated with sleep deprivation are caused by attenuated cAMP signaling in the

  20. Transient receptor potential cation channel A1 (TRPA1) mediates decrements in cardiac mechanical function and dysrhythmia caused by a single air pollution exposure in mice

    Science.gov (United States)

    This work, which will be presented at SOT 2014, demonstrates that a single exposure to either ozone or acrolein causes decrements in cardiac function and altered electrical activity (i.e. arrhythmia). The results suggest that this effect is mediated by the airway sensor TRPA1. ...

  1. Iliacus abscess with radiculopathy mimicking herniated nucleus ...

    African Journals Online (AJOL)

    An iliacus abscess is an extremely rare cause of low back pain. With an iliacus abscess, the classical signs seen with a psoas abscess are frequently absent. Therefore, a timely diagnosis at the initial visit is difficult and inadequate treatment usually results in high mortality. Here, we report the case of 19-year-old man who ...

  2. Reoperation rate after surgery for lumbar herniated intervertebral disc disease: nationwide cohort study.

    Science.gov (United States)

    Kim, Chi Heon; Chung, Chun Kee; Park, Choon Seon; Choi, Boram; Kim, Min Jung; Park, Byung Joo

    2013-04-01

    Retrospective cohort study using national health insurance data. To provide a longitudinal reoperation rate after surgery for lumbar herniated intervertebral disc (HIVD) disease, and to compare the reoperation rates of surgical methods. Herniated intervertebral disc disease is the most common cause of lumbar spinal surgery. Despite improved surgical techniques and instrumentation, reoperation cannot be avoided. The reoperation rates were in the range of 6% to 24% in previous studies. A population-based study is less subject to bias; hence, a nationwide longitudinal analysis was warranted. A national health insurance database was used to identify a cohort of patients who underwent first surgery for herniated intervertebral disc disease in 2003 and 18,590 patients were selected. Individual patients were followed for at least 5 years through their encrypted unique resident registration number. The primary endpoint was any type of second lumbar surgery. After adjusting for confounding factors, 5 surgical methods (fusion, laminectomy, open discectomy, endoscopic discectomy, and nucleolysis [including mechanical nucleus decompression]) were compared. Open discectomy was used as the reference method. Open discectomy was the most common procedure (68.9%) followed by endoscopic discectomy (16.1%), laminectomy (7.9%), fusion (3.9%), and nucleolysis (3.2%). The cumulative reoperation rate was 5.4% at 3 months, 7.4% at 1 year, 9% at 2 years, 10.5% at 3 years, 12.1% at 4 years, and 13.4% at 5 years. The reoperation rates were 18.6%, 14.7%, 13.8%, 12.4%, and 11.8% after laminectomy, nucleolysis, open discectomy, endoscopic discectomy, and fusion, respectively. Compared with open discectomy, the reoperation rate was higher after laminectomy at 3 months, whereas the other surgical methods had similar rates. The cumulative reoperation rate after 5 years was 13.4% and half of the reoperations occurred during the first postoperative year. With the exception of laminectomy, the

  3. An updated review of automated percutaneous mechanical lumbar discectomy for the contained herniated lumbar disc.

    Science.gov (United States)

    Manchikanti, Laxmaiah; Singh, Vijay; Falco, Frank J E; Calodney, Aaron K; Onyewu, Obi; Helm, Standiford; Benyamin, Ramsin M; Hirsch, Joshua A

    2013-04-01

    Lumbar disc prolapse, protrusion, and extrusion are the most common causes of nerve root pain and surgical interventions, and yet they account for less than 5% of all low back problems. The typical rationale for traditional surgery is that it is an effort to provide more rapid relief of pain and disability. It should be noted that the majority of patients do recover with conservative management. The primary rationale for any form of surgery for disc prolapse associated with radicular pain is to relieve nerve root irritation or compression due to herniated disc material. The primary modality of treatment continues to be either open or microdiscectomy, although several alternative techniques, including automated percutaneous mechanical lumbar discectomy, have been described. There is, however, a paucity of evidence for all decompression techniques, specifically alternative techniques including automated and laser discectomy. A systematic review of the literature of automated percutaneous mechanical lumbar discectomy for the contained herniated lumbar disc. To evaluate and update the effectiveness of automated percutaneous mechanical lumbar discectomy. The available literature on automated percutaneous mechanical lumbar discectomy in managing chronic low back and lower extremity pain was reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria, as utilized for interventional techniques for randomized trials, and the criteria developed by the Newcastle-Ottawa Scale criteria for observational studies.The level of evidence was classified as good, fair, and limited or poor, based on the quality of evidence scale developed by the U.S. Preventive Services Task Force (USPSTF). Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to September 2012, and manual searches of the bibliographies of known primary and review articles. Pain relief was the primary

  4. Clinical study on microsurgical treatment of lumbar disc herniation assisted by METRx system

    Directory of Open Access Journals (Sweden)

    Xin-gang ZHAO

    2016-04-01

    Full Text Available Objective To explore the techniques and curative effect of microsurgical procedures assisted by minimal exposure tubular retractor system (METRx in the treatment of lumbar disc herniation (LDH.  Methods A total of 51 LDH patients, including 24 patients with L4-5 herniation and 27 patients with L5-S1 herniation, underwent discectomy assisted by METRx system. The operation time, intraoperative blood loss, postoperative complications and hospital stay were recorded. Visual Analogue Scale (VAS and Oswestry Disability Index (ODI were used to evaluate the degree of low back pain before operation, one week, 3 months after operation, and in the last follow-up. Lumbar MRI was used to evaluate the decompression of spinal canal.  Results The success rate of operations in 51 cases was 98.04% (50/51. The average operation time was 125 min, the average intraoperative blood loss was 50 ml, the mean hospital stay was 5 d, all patients were followed up for 6-48 months (average 24 months. Compared with preoperation, both VAS and ODI scores decreased significantly one week after operation (P = 0.036, 0.029, 3 months after operation (P = 0.018, 0.023 and in the last follow-up (P = 0.007, 0.013. The improvement rate of ODI was 35.37% in the last follow-up. No infection, postoperative cerebrospinal fluid (CSF fistula, neurological defects or incision infection was found. One patient presented acute abdominalgia on the 2nd day after operation, and was diagnosed as annexitis. One patient showed nerve root irritation symptoms after operation caused by thick nerve root during the surgery. They were cured after symptomatic treatment.  Conclusions Microsurgical procedures for treating LDH assisted by METRx system can effectively relieve nerve root compression, protect the dural sac and nerve roots, and reduce surgical complications. DOI: 10.3969/j.issn.1672-6731.2016.04.008

  5. Anterior or posterior approach of thoracic disc herniation? A comparative cohort of mini-transthoracic versus transpedicular discectomies

    NARCIS (Netherlands)

    Arts, M.P.; Bartels, R.H.M.A.

    2014-01-01

    BACKGROUND CONTEXT: The optimal surgical treatment of thoracic disc herniations remains controversial and depends on the consistency of the herniation and its location related to the spinal cord. PURPOSE: To compare the outcomes of patients with symptomatic thoracic disc herniations treated with

  6. Effect of Age and Lordotic Angle on the Level of Lumbar Disc Herniation

    Science.gov (United States)

    Skaf, Ghassan S.; Ayoub, Chakib M.; Domloj, Nathalie T.; Turbay, Massud J.; El-Zein, Cherine; Hourani, Mukbil H.

    2011-01-01

    It has been previously suggested in the literature that with aging, degenerative changes as well as disc herniation start at the lower lumbar segments, with higher disc involvement observed in an ascending fashion in older age groups. We conducted a study to investigate this correlation between age and level of disc herniation, and to associate it with the magnitude of the Lumbar Lordotic Angle (LLA), as measured by Cobb's method. We followed retrospectively lumbosacral spine MRI's of 1419 patients with symptomatic disc herniation. Pearson's correlation was used in order to investigate the relationship between LLA, age, and level of disc herniation. Student's t-test was applied to assess gender differences. Young patients were found to have higher LLA (R = 0.44, P disc herniation (R = 0.302, P herniation in lower LLA group (mean LLA 28.6° and 25.4°) and lower level herniation in high LLA group (mean LLA 33.2°). We concluded that Lumbar lordotic Cobb's angle and age can be predictors of the level of lumbar disc herniation. This did not differ among men and women (R = 0.341, P < 0.0001). PMID:21991424

  7. Surgery versus conservative management of sciatica due to a lumbar herniated disc : a systematic review

    NARCIS (Netherlands)

    Jacobs, Wilco C H; van Tulder, Maurits; Arts, Mark P.; Rubinstein, Sidney M; van Middelkoop, Marienke; Ostelo, Raymond; Verhagen, Arianne; Koes, Bart; Peul, Wilco C.

    The effectiveness of surgery in patients with sciatica due to lumbar disc herniations is not without dispute. The goal of this study was to assess the effects of surgery versus conservative therapy (including epidural injections) for patients with sciatica due to lumbar disc herniation. A

  8. Diagnostic accuracy of the clinical examination in identifying the level of herniation in patients with sciatica

    NARCIS (Netherlands)

    Hancock, M.J.; Koes, B.W.; Ostelo, R.W.J.G.; Peul, W.C.

    2011-01-01

    Study Design.: Cross sectional Objective.: To investigate the ability of the neurological examination to identify the specific level of a disc herniation in patients with sciatica and confirmed disc herniation. Summary of Background Data.: Tests included in a neurological examination theoretically

  9. Surgical techniques for sciatica due to herniated disc, a systematic review

    NARCIS (Netherlands)

    Jacobs, Wilco C H; Arts, Mark P.; van Tulder, Maurits W; Rubinstein, Sidney M; van Middelkoop, Marienke; Ostelo, Raymond W; Verhagen, Arianne P; Koes, Bart W; Peul, Wilco C.

    2012-01-01

    INTRODUCTION: Disc herniation with sciatica accounts for five percent of low-back disorders but is one of the most common reasons for spine surgery. The goal of this study was to update the Cochrane review on the effect of surgical techniques for sciatica due to disc herniation, which was last

  10. Uncal herniation in a fully conscious patient-The sliding uncus syndrome.

    Science.gov (United States)

    Katzir, Miki; Attia, Moshe; Sviri, Gill E; Zaaroor, Menashe

    2015-04-01

    Uncal herniation is accompanied by a decreased level of consciousness. We describe a patient who remained fully alert despite the uncal herniation. The computed tomography (CT) scans allowed us to visualize the uncus and its spatial relation to the cerebral peduncle. We describe the sliding uncus syndrome.

  11. Reactor transient

    Energy Technology Data Exchange (ETDEWEB)

    Menegus, R.L.

    1956-05-31

    The authors are planning a calculation to be done on the Univac at the Louviers Building to estimate the effect of xenon transients, a high reactor power. This memorandum outlines the reasons why they prefer to do the work at Louviers rather than at another location, such as N.Y.U. They are to calculate the response of the reactor to a sudden change in position of the half rods. Qualitatively, the response will be a change in the rooftop ratio of the neutron flux. The rooftop ratio may oscillate with high damping, or, instead, it may oscillate for many cycles. It has not been possible for them to determine this response by hand calculation because of the complexity of the problem, and yet it is important for them to be certain that high power operation will not lead us to inherently unstable operation. Therefore they have resorted to machine computation. The system of differential equations that describes the response has seven dependent variables; therefore there are seven equations, each coupled with one or more of the others. The authors have discussed the problem with R.R. Haefner at the plant, and it is his opinion that the IBM 650 cannot adequately handle the system of seven equations because the characteristic time constants vary over a range of about 10{sup 8}. The Univac located at the Louviers Building is said to be satisfactory for this computation.

  12. Computed tomography in the diagnosis of cervical disc herniation with radiculopathy

    Energy Technology Data Exchange (ETDEWEB)

    Isu, Toyohiko; Iwasaki, Yoshinobu; Abe, Hiroshi; Miyasaka, Kazuo; Tashiro, Kunio (Hokkaido Univ., Sapporo (Japan). School of Medicine)

    1984-02-01

    Computed tomography (CT) is an accurate method of diagnosing cervical disc herniation in patients with radiculopathy. We evaluated 7 patients for the treatment of radiculopathy. The CT features of lateral cervical disc herniation include: (1) plain CT reveals a soft tissue mass compatible with laterally herniated disc material within the intervertebral foramen; (2) plain CT shows a soft tissue mass, which implies a fragmented disc, in the lateral recess; (3) CT with the intravenous administration of the contrast medium shows no delineation of the nerve root in the intervertebral foramen; and (4) CT metrizamide myelography demonstrates the filling defect of the root sleeve and hypertrophy of the nerve root. In those seven patients, all CT examinations were interpreted as positive for lateral disc herniation. There was a good correlation between the results of the neurologic examination and the CT findings. We wish to stress the usefulness of CT in the diagnosis of lateral cervical disc herniation.

  13. Semimembranosus muscle herniation: a rare case with emphasis on muscle biomechanics

    Energy Technology Data Exchange (ETDEWEB)

    Naffaa, Lena [American University of Beirut, Department of Diagnostic Radiology, P.O. Box 11-0236, Riad El-Solh, Beirut (Lebanon); Moukaddam, Hicham [Saint Rita Medical Center, Lima, OH (United States); Samim, Mohammad [New York University, Department of Radiology, Hospital for Joint Disease, New York, NY (United States); Lemieux, Aaron [University of California, San Diego School of Medicine, La Jolla, CA (United States); Smitaman, Edward [University of California, San Diego, Teleradiology and Education Center, San Diego, CA (United States)

    2017-03-15

    Muscle herniations are rare and most reported cases involve muscles of the lower leg. We use a case of muscle herniation involving the semimembranosus muscle, presenting as a painful mass in an adolescent male after an unspecified American football injury, to highlight a simple concept of muscle biomechanics as it pertains to muscle hernia(s): decreased traction upon muscle fibers can increase conspicuity of muscle herniation(s) - this allows a better understanding of the apt provocative maneuvers to employ, during dynamic ultrasound or magnetic resonance imaging, in order to maximize diagnostic yield and, thereby, limit patient morbidity related to any muscle herniation. Our patient subsequently underwent successful decompressive fasciotomy and has since returned to his normal daily activities. (orig.)

  14. Transforaminal Percutaneous Endoscopic Lumbar Diskectomy with Percutaneous Epidural Neuroplasty in Lumbar Disk Herniation: Technical Note.

    Science.gov (United States)

    Lee, Hyeong-Jin; Kim, Jin-Sung; Ryu, Kyeong-Sik

    2017-02-01

    Percutaneous endoscopic lumbar diskectomy and percutaneous epidural neuroplasty is a commonly used minimally invasive spinal surgery in lumbar disk herniation. But to our knowledge, there is no report about the results of percutaneous endoscopic lumbar diskectomy with percutaneous epidural neuroplasty. We did this study to evaluate the effect of percutaneous endoscopic lumbar diskectomy with percutaneous epidural neuroplasty in lumbar disk herniation. We report a series of cases about techniques and results of percutaneous endoscopic lumbar diskectomy with percutaneous epidural neuroplasty in lumbar disk herniation, as well as introduce technical procedures and advantages. Seven patients improved axial back pain with percutaneous endoscopic lumbar diskectomy with percutaneous epidural neuroplasty and had no complications. The percutaneous endoscopic lumbar diskectomy with percutaneous epidural neuroplasty has many advantages with removing lumbar disk herniation in procedures. Percutaneous endoscopic lumbar diskectomy with percutaneous epidural neuroplasty is a safe and effective surgical method in lumbar disk herniation. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Does a herniated nucleus pulposus contribute significantly to a decrease in height of the intervertebral disc? Quantitative volumetrich MRI

    Energy Technology Data Exchange (ETDEWEB)

    Holodny, A.I.; Kisza, P.S.; Contractor, S.; Liu, W.C. [Department of Radiology, UMDNJ-New Jersey Medical School, University Hospital C-320, 150 Bergen Street, Newark, NJ 07103-2714 (United States)

    2000-06-01

    A lumbar intervertebral disc with a herniated nucleus pulposus (HNP) often exhibits a decrease in the height of the intervertebral space. Our purpose was to ascertain whether the loss of volume of an HNP is sufficient to cause a perceptible decrease in the height of the intervertebral space. MRI of 44 patients with 51 HNPs were reviewed. The volumes of the herniated material and of the intervertebral discs were calculated for every level from L 1-2 to L 5-S 1. The average volume of the HNP was 503{+-}301 mm{sup 3}. The average volumes of all 220 intervertebral discs and of the 127 normal-appearing discs were 14442{+-}4200 mm{sup 3} and 17476{+-}2885 mm{sup 3} respectively. The average volume of the HNP represented 3.5% of the parent disc. An average HNP caused a decrease in intervertebral space height of 0.35 mm (0.56 pixels). Therefore, the loss of the volume of the HNP does not cause a significant decrease in the intervertebral space height. The average calculated decrease in the disc height is less than that reported in normal diurnal variation. (orig.)

  16. Static axial overloading primes lumbar caprine intervertebral discs for posterior herniation.

    Directory of Open Access Journals (Sweden)

    Cornelis P L Paul

    Full Text Available Lumbar hernias occur mostly in the posterolateral region of IVDs and mechanical loading is an important risk factor. Studies show that dynamic and static overloading affect the nucleus and annulus of the IVD differently. We hypothesize there is also variance in the effect of overloading on the IVD's anterior, lateral and posterior annulus, which could explain the predilection of herniations in the posterolateral region. We assessed the regional mechanical and cellular responses of lumbar caprine discs to dynamic and static overloading.IVDs (n = 125 were cultured in a bioreactor and subjected to simulated-physiological loading (SPL, high dynamic (HD, or high static (HS overloading. The effect of loading was determined in five disc regions: nucleus, inner-annulus and anterior, lateral and posterior outer-annulus. IVD height loss and external pressure transfer during loading were measured, cell viability was mapped and quantified, and matrix integrity was assessed.During culture, overloaded IVDs lost a significant amount of height, yet the distribution of axial pressure remained unchanged. HD loading caused cell death and disruption of matrix in all IVD regions, whereas HS loading particularly affected cell viability and matrix integrity in the posterior region of the outer annulus.Axial overloading is detrimental to the lumbar IVD. Static overloading affects the posterior annulus more strongly, while the nucleus is relatively spared. Hence, static overloading predisposes the disc for posterior herniation. These findings could have implications for working conditions, in particular of sedentary occupations, and the design of interventions aimed at prevention and treatment of early intervertebral disc degeneration.

  17. Static axial overloading primes lumbar caprine intervertebral discs for posterior herniation.

    Science.gov (United States)

    Paul, Cornelis P L; de Graaf, Magda; Bisschop, Arno; Holewijn, Roderick M; van de Ven, Peter M; van Royen, Barend J; Mullender, Margriet G; Smit, Theodoor H; Helder, Marco N

    2017-01-01

    Lumbar hernias occur mostly in the posterolateral region of IVDs and mechanical loading is an important risk factor. Studies show that dynamic and static overloading affect the nucleus and annulus of the IVD differently. We hypothesize there is also variance in the effect of overloading on the IVD's anterior, lateral and posterior annulus, which could explain the predilection of herniations in the posterolateral region. We assessed the regional mechanical and cellular responses of lumbar caprine discs to dynamic and static overloading. IVDs (n = 125) were cultured in a bioreactor and subjected to simulated-physiological loading (SPL), high dynamic (HD), or high static (HS) overloading. The effect of loading was determined in five disc regions: nucleus, inner-annulus and anterior, lateral and posterior outer-annulus. IVD height loss and external pressure transfer during loading were measured, cell viability was mapped and quantified, and matrix integrity was assessed. During culture, overloaded IVDs lost a significant amount of height, yet the distribution of axial pressure remained unchanged. HD loading caused cell death and disruption of matrix in all IVD regions, whereas HS loading particularly affected cell viability and matrix integrity in the posterior region of the outer annulus. Axial overloading is detrimental to the lumbar IVD. Static overloading affects the posterior annulus more strongly, while the nucleus is relatively spared. Hence, static overloading predisposes the disc for posterior herniation. These findings could have implications for working conditions, in particular of sedentary occupations, and the design of interventions aimed at prevention and treatment of early intervertebral disc degeneration.

  18. Transmesenteric Internal Herniation of Small Bowel in an Elderly

    Directory of Open Access Journals (Sweden)

    Lu-Chih Kung

    2012-03-01

    Full Text Available A 68-year-old male complained of epigastric pain and coffee ground vomitus for hours. Emergent panendoscopy revealed diffuse esophageal ulcers, mild hiatal hernia, and gastric erosion. An abdominal computed tomography (CT scan was performed due to the persistent abdominal pain with peritonitis. CT scan without enhancement showed transmesenteric internal herniation of the small bowel with strangulation. The condition of the patient deteriorated and he died from extreme shock and peritonitis after 3 hours of observation in the surgical intensive care unit.

  19. OUTCOMES OF TRANSFORAMINAL ENDOSCOPIC DISCECTOMY FOR LUMBOSACRAL DISC HERNIATION

    Directory of Open Access Journals (Sweden)

    I. V. Volkov

    2017-01-01

    Full Text Available Introduction. Lumbar disc herniation is a frequent pathology and surgical target. Endoscopic discectomy becomes more popular due to minimally invasive surgical technique. There is a deficit of scientific papers dedicated to analysis of potential for endoscopic discectomy depending on the specifics of spinal anatomy and degenerative changes.The purpose of the study was to evaluate the efficacy of transforaminal endoscopic discectomy (TED in comparison with microdiscectomy (MD and to specify factors determining complications and failures.Materials and methods. The authors performed randomized controlled study where main group of patients included data on prospective examination of 101 patients after TED procedure for lumbar intervertebral disc herniation. Age of patients ranged from 19 to 81 years with average of 41,4±12,6 years. Control group included data of retrospective examination of 153 patients that were operated by the same surgeon in the period from 201 till 2104 with microdiscectomy procedure. Age of patients ranged from 18 to 77 years with average of 47,8±11,3 years. Inclusion criteria were as follows: surgical procedure at the same level of the primary intervertebral herniation. Exclusion criteria were: degenerative spinal canal stenosis, spondylolisthesis, spine deformity.Results. Clinical outcomes after TED demonstrated no difference from MD procedure. No factors of significant influence on outcomes after surgical procedure were observed. The main group was characterized by more cases of revisions and conversions of endoscopic into open procedures (13,9% which was related to mistakes in transforaminal approach due to features of intervertebral joints and foramina anatomy resulting in impossibility to achieve adequate spinal canal decompression.Conclusion. Transforaminal endoscopic discectomy is an effective and safe method of lumbar intervertebral herniation treatment. Complications and failures during learning curve of endoscopic

  20. Mammoth orbitofrontal neurofibromatosis with herniating meningo-encephalocele

    Directory of Open Access Journals (Sweden)

    Dhanraj Prema

    2010-01-01

    Full Text Available We are presenting a mammoth orbito-frontal neurofibroma with a herniating meningo-encephalocele in a 23 year old African male. The tumour measured 87cm Χ 54cm and occupied the right orbito-temporo-facial region and had destroyed the right orbit. A pre operative embolization of the feeding vessels was followed by a one stage near total excision of the tumour and repair of the meningo-encephalocele in hypotensive anaesthesia. The excised tumour weighed 8 Kg and, to the best of our knowledge, is the largest orbito-facial neurofibroma reported in literature.

  1. Horseshoe lung associated with diaphragmatic herniation of the liver.

    Science.gov (United States)

    Cicak, Biserka; Mihatov-Stefanović, Iva; Vrsalović, Renata; Babić, Nenad; Markicević-Ruzicić, Karmen

    2010-12-01

    Horseshoe lung is a rare congenital pulmonary anomaly in which the caudal and basal segments of the left and right lungs are joined together behind the pericardium at the height of cardiac apex. Most patients with horseshoe lung have many other cardiovascular anomalies typical of the scimitar syndrome or the hypogenetic right lung syndrome. We report on a patient with horseshoe lung not associated with scimitar syndrome, but presented with a focal diaphragmatic herniation of the liver, such as never reported before in case of horseshoe lung without associated scimitar syndrome.

  2. Transient tachypnea - newborn

    Science.gov (United States)

    TTN; Wet lungs - newborns; Retained fetal lung fluid; Transient RDS; Prolonged transition; Neonatal - transient tachypnea ... Newborns with transient tachypnea have breathing problems soon after birth, most often within 1 to 2 hours. ...

  3. Intermittent Suckling Causes a Transient Increase in Cortisol That Does Not Appear to Compromise Selected Measures of Piglet Welfare and Stress †

    Science.gov (United States)

    Turpin, Diana L.; Langendijk, Pieter; Chen, Tai-Yuan; Lines, David; Pluske, John R.

    2016-01-01

    Simple Summary This study assessed the effects intermittent suckling (IS) had on physiological and behavioral indices of piglets before and after weaning. Piglets were allocated to either a control treatment (conventional weaning) or an IS treatment (separation from the sow for 8 h per day starting the week before weaning). Apart from an initial peak in cortisol at the start of IS, piglets subjected to IS did not show physiological changes suggestive of a chronic stress response before and after weaning. The event of weaning still caused a decrease in growth rate and an increase in white blood cell parameters in both treatment groups. However, the IS piglets tended to gain more weight in the second half of the week after weaning. The results of this study suggest that short periods of separation (e.g., 8 h/day) do not appear to compromise piglet welfare over the peri-weaning period. Abstract This study tested the hypothesis that piglets subjected to intermittent suckling (IS) would show changes in physiological and behavioral indices indicative of compromised welfare in the peri-weaning period. A total of 21 primiparous sows and their litters were allocated to either a control treatment (n = 10) where piglets were weaned conventionally, or an IS treatment (n = 11) where piglets were separated daily from their sows for 8 h starting the week before weaning. Performance, physiological and behavioral measures were taken at various time points during the week before and after weaning. Plasma cortisol levels were higher (p = 0.01) in IS piglets 7 d before weaning. Regardless of treatment, the N:L ratio at 3 d and 7 d after weaning was higher (p piglets ate more creep feed during lactation (p piglets to gain more weight between 3 d and 7 d after weaning (p piglets subjected to IS did not display physiological or behavioral changes indicative of compromised welfare. PMID:26999224

  4. Randomized clinical trial comparing lumbar percutaneous hydrodiscectomy with lumbar open microdiscectomy for the treatment of lumbar disc protrusions and herniations

    Directory of Open Access Journals (Sweden)

    Alexandre Fogaça Cristante

    2016-05-01

    Full Text Available OBJECTIVES: Hydrodiscectomy is a new technique used for percutaneous spinal discectomy that employs a high-intensity stream of water for herniated disc ablation and tissue aspiration. No previous clinical study has examined the effects of percutaneous hydrodiscectomy. The aim of this study is to evaluate the outcomes of hydrodiscectomy compared to open microdiscectomy regarding pain, function, satisfaction, complications and recurrence rates. METHODS: In this randomized clinical trial, patients referred to our tertiary hospital for lumbar back pain were recruited and included in the study if they had disc protrusion or small herniation in only one level, without neurological deficits and with no resolution after six weeks of conservative treatment. One group underwent open microdiscectomy, and the other group underwent percutaneous microdiscectomy via hydrosurgery. Function was evaluated using the Oswestry Disability Index and pain was assessed using a visual analog scale. Evaluations were performed preoperatively, and then during the first week and at one, three, six and twelve months postoperatively. Personal satisfaction was verified. Clinicaltrials.gov: NCT01367860. RESULTS: During the study period, 20 patients were included in each arm and 39 completed one-year of follow-up (one patient died of unrelated causes. Both groups exhibited equal improvement on the visual analog scale and Oswestry evaluations after treatment, without any significant differences. The improvement in the lumbar visual analog scale score was not significant in the hydrodiscectomy group (p=0.138. The rates of infection, pain, recurrence and satisfaction were similar between the two groups. CONCLUSION: Percutaneous hydrodiscectomy was demonstrated to be as effective as open microdiscectomy for reducing pain. The rates of complications and recurrence of herniation were similar between groups. Patient satisfaction with the treatment was also similar between groups.

  5. Radiological evaluation of preoperative and postoperative plain radiographs as related to postoperative clinical symptom in lumbar disc herniation

    Energy Technology Data Exchange (ETDEWEB)

    Jaun, Woo Ki; Eun, Chung Kie; Han, Chang Yul [Baik Hospital, Inje Medical CollegeIn, Seoul (Korea, Republic of)

    1979-06-15

    In the great majority of cases with the lower back pain, the lumbar herniated disc is one of the common causes. The plain radiographs of preoperative and postoperative periods and relationship with clinical symptom were studied in 76 cases which were surgically verified as lumbar herniated disc at Baik Hospital. The following results were obtained: 1. Males were affected more frequently than females with the ratio of 1.6 to 1. In male it is most common in the 3rd decade of life and in female in the 4th decade. 2. In preoperative plain radiograph, 16.9% of 76 cases revealed no specific abnormality. The most common positive finding was the straightening of the lumbar curvature (56.6%). Other common positive findings was a relative narrowing of the intervertebral disc space (46.1%) 3. The greatest incidence of preoperative intervertebral disc space was between 0.8 cm and 1 cm (48.8% of case) and next 1.1cm - 1.3cm (37.8%) 4. Among 82 lesions of herniated lumbar disc, the greater incidence of location was L4-L5 disc space (86.6%) 5. The overall mean of lumbosacral angle in preoperative plain radiography was 29.8 .deg in male and 29.5 .deg in female. The greatest incidence of lumbosacral angle was between 31 .deg and 40 .deg (31.6% of cases) and next 21 .deg-30 .deg (30.3%) 6. Study of postoperative (after 1 month-1 year) radiograph and it's relationship to postoperative clinical symptom.

  6. Spinal Cord Herniation After Cervical Corpectomy with Cerebrospinal Fluid Leak: Case Report and Review of the Literature.

    Science.gov (United States)

    Guppy, Kern H; Silverthorn, James W

    2017-04-01

    Spinal cord herniation (SCH) is rare, is mostly idiopathic, and occurs predominantly in the thoracic spine. SCH is less common in the cervical spine and has been reported after posterior cervical spine surgery associated with the development of pseudomeningoceles. Two cases of SCH have been reported after anterior cervical corpectomies for ossified posterior longitudinal ligament with cerebrospinal fluid (CSF) leaks. We report the third such case, but the first in a patient without ossified posterior longitudinal ligament (degenerative disc disease and pseudarthrosis). A 56-year-old woman presented with bilateral arm pain and weakness. She had undergone 3 previous anterior cervical spine surgeries at an outside medical center with the most recent 7 years ago with C5 and C6 corpectomies and fusion with a persistent CSF leak. Magnetic resonance imaging and computed tomography myelography showed spinal cord herniation through the mesh cage at C6. The patient underwent a redo C5 and C6 corpectomy with untethering of the spinal cord. The patient was asymptomatic 2 years later. This is the first reported case of anterior cervical SCH in a patient without ossified posterior longitudinal ligament after multiple anterior cervical fusions including a cervical corpectomy for pseudarthrosis with a CSF leak. We hypothesize that persistent CSF leak causes a pressure gradient across the dura mater through the cage to the lower pressure in the retropharyngeal space, which led to herniation of the spinal cord into the anterior cage. We review the literature and discuss the treatment choices for anterior cervical SCH. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Retrocerebellar arachnoid cyst resulting in syringomyelia in a patient without tonsillar herniation: successful surgical treatment with reconstruction of CSF flow in the foramen magnum region.

    Science.gov (United States)

    Sun, Liyong; Emich, Stephan; Fu, Wenzhuo; Chen, Zan; Hao, Wu; Ling, Feng; Jian, Fengzeng

    2016-04-01

    A retrocerebellar arachnoid cyst causing syringomyelia is extremely rare without tonsillar herniation. The authors present a 44-year-old woman with symptoms of foramen magnum compression and syringomyelia. Magnetic resonance imaging demonstrated a large retrocerebellar arachnoid cyst with a large cervicothoracic syrinx but no signs of tonsillar herniation or hydrocephalus. The patient underwent a foramen magnum decompression with C1 laminectomy, microsurgical fenestration of the cyst, and duraplasty. After successful reconstruction of CSF flow, the patient experienced a relief of symptoms and a significant reduction of the syrinx. The intraoperative findings support the theory of a piston mechanism in the development of syringomyelia. Additional arachnoidal adhesions may also obstruct the CSF flow around the craniocervical junction. We recommend the surgical treatment should consist of an adequate decompression of the foramen magnum, wide microsurgical arachnoidal debridement, and duraplasty with autologous grafts sutured in a watertight way.

  8. [Transient removable dentures].

    Science.gov (United States)

    Kouadio, A A; Jordana, F; N'Goran, J K; Le Bars, P

    2015-09-01

    Removable dentures are always transient current. The epidemiology and causes of tooth gaps demonstrate the need to master the different prosthetic treatment. This made whether to propose treatment plans that take into account psychological, physiological and technical support for this patient. Different situations may arise. A gradual transition may be considered or immediate passage to the total edentulous according to general criteria, local and desiderata of patients. After tooth extraction, the transitional prosthesis can control bone lysis thereby it is part of a complete treatment before prosthesis. It also facilitates a good psychological and physiological integration before the prosthesis use.

  9. Identification of ventrolateral intramedullary intervertebral disc herniation in a dog

    Directory of Open Access Journals (Sweden)

    Masato Kitagawa

    2012-09-01

    Full Text Available A 10-year-old male cross-breed dog was brought to Nihon University Animal Hospital with a history of acute onset of paralysis in the pelvic limbs 13 days previously. Magnetic resonance imaging revealed an intramedullary linear tract in the spinal cord at the thoracic vertebrae 12–13 region, which appeared hyperintense on T2-weighted images, but was hypointense and isointense on T1-weighted images when compared with normal parenchyma of the spinal cord. A hemilaminectomy was performed and a blob of what appeared to be fibrous tissue was found adhering to the surface of the dura mater. The diameter of the blob was about 4 mm. A durotomy was performed over the affected area and chondroid material was found within the spinal cord. Material from the nucleus pulposus penetrated the dura mater from the ventral aspect of the spinal cord in previously reported intramedullary intervertebral disc herniation cases, but, in this case, penetration occurred from the left ventrolateral aspect and progressed through to the right lateral aspect, forming a visible blob of what appeared to be fibrous tissue on the surface of the dura mater at the exit point. To the best of our knowledge, this was the first case report of an intramedullary intervertebral disc herniation originating from the ventrolateral aspect of the spinal cord in a dog.

  10. Posteriorly migrated thoracic disc herniation: a case report

    Directory of Open Access Journals (Sweden)

    Miyakoshi Naohisa

    2013-02-01

    Full Text Available Abstract Introduction Posterior epidural migration of thoracic disc herniation is extremely rare but may occur in the same manner as in the lumbar spine. Case presentation A 53-year-old Japanese man experienced sudden onset of incomplete paraplegia after lifting a heavy object. Magnetic resonance imaging revealed a posterior epidural mass compressing the spinal cord at the T9-T10 level. The patient underwent emergency surgery consisting of laminectomy at T9-T10 with right medial facetectomy, removal of the mass lesion, and posterior instrumented fusion. Histological examination of the mass lesion yielded findings consistent with sequestered disc material. His symptoms resolved, and he was able to resume walking without a cane 4 weeks after surgery. Conclusions Pre-operative diagnosis of posterior epidural migration of herniated thoracic disc based on magnetic resonance imaging alone may be overlooked, given the rarity of this pathology. However, this entity should be considered among the differential diagnoses for an enhancing posterior thoracic extradural mass.

  11. A radiological study on lumbar herniated intervertebral disc diseases

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Hae Soon [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1974-10-15

    During 5 years and 8 months, from September 1968 to May 1974, myelographic studies followed by operation were carried out on 118 cases of lumbar HIVD at Seoul National University Hospital. The myelographic findings and operative findings were analyzed and following conclusions were obtained. 1. The sex ratio wa 75 males to 43 females. 2. Among the 118 cases, myelographic findings were consisted of the unilateral defect; 78 cases (67.0%), central defect: 30 cases (25.5%), and, bilateral defects; 10 cases (8.5%) respectively. 3. Among the 118 cases, the greatest incidence was L4-L5 disc space: 87 cases (73.7%) and next incidence was L5-S1 disc space: 25 cases (21.2%). 4. Among the 118 cases of lumbar herniated intervertebral disc disease, the false positive was 8 cases (6.8%) and diagnostic accuracy of myelography was 91.5%. 5. Plain radiography has little value in diagnosis of lumbar herniated intervertebral disc disease among 118 cases, about 30% show significant sign in plain film study.

  12. Left Diaphragmatic Herniation following Orthotopic Liver Transplantation in an Adult

    Directory of Open Access Journals (Sweden)

    Adriá Rosat

    2015-01-01

    Full Text Available Diaphragmatic herniation is an uncommon complication in the postquirurgic follow of the liver transplant. The associated symptoms are unspecific and may not suggest the correct diagnosis. It may explain why in many patients the diagnosis remains unmade or it is made only after a long interval of time. We present the case of a fifty-seven-year-old male who required an orthotopic liver transplant in 2010 due to a trifocal hepatocarcinoma. In postoperatory follow-up the patient showed alimentary regurgitation, vomiting, and dyspepsia. The diagnosis was made by an oesophagogastroduodenal transit with barium and an abdominal CT scan that showed a left diaphragmatic herniation with the gastric fundus into the thorax. With these findings we decided to perform a programmed surgery. After takedown of adhesions and replacement of the stomach into the upper abdomen, the palm-sized diaphragmatic opening was closed with a synthetic material. The patient’s condition remained stable throughout the entire operation. The postoperative course was uneventful and he was discharged at the fifth day after surgery with a normal digestive intake. In a 12-month follow-up the patient shows no symptoms.

  13. Left Diaphragmatic Herniation following Orthotopic Liver Transplantation in an Adult

    Science.gov (United States)

    Rosat, Adriá; Alonso, Ayaya; Padilla, Javier; Sanz, Pablo; Varona, M. Aránzazu; Méndiz, Javier; Moneva, Enrique; Barrera, Manuel

    2015-01-01

    Diaphragmatic herniation is an uncommon complication in the postquirurgic follow of the liver transplant. The associated symptoms are unspecific and may not suggest the correct diagnosis. It may explain why in many patients the diagnosis remains unmade or it is made only after a long interval of time. We present the case of a fifty-seven-year-old male who required an orthotopic liver transplant in 2010 due to a trifocal hepatocarcinoma. In postoperatory follow-up the patient showed alimentary regurgitation, vomiting, and dyspepsia. The diagnosis was made by an oesophagogastroduodenal transit with barium and an abdominal CT scan that showed a left diaphragmatic herniation with the gastric fundus into the thorax. With these findings we decided to perform a programmed surgery. After takedown of adhesions and replacement of the stomach into the upper abdomen, the palm-sized diaphragmatic opening was closed with a synthetic material. The patient's condition remained stable throughout the entire operation. The postoperative course was uneventful and he was discharged at the fifth day after surgery with a normal digestive intake. In a 12-month follow-up the patient shows no symptoms. PMID:26064764

  14. Delayed Diaphragmatic Herniation Masquerading as a Complicated Parapneumonic Effusion

    Directory of Open Access Journals (Sweden)

    John Tsang

    1999-01-01

    Full Text Available Injury to the diaphragm following blunt or penetrating thoraco-abdominal trauma is not uncommon. Recognition of this important complication of trauma continues to be a challenge because of the lack of specific clinical and plain radiographic features, the frequent presence of other serious injuries and the potential for delayed presentation. Delayed diaphragmatic herniation often presents with catastrophic bowel obstruction or strangulation. Early recognition of diaphragmatic injury is required to avoid this potentially lethal complication. The case of a 35-year-old man with a history of a knife wound to the left flank 15 years previously, who presented with unexplained acute hypoxemic respiratory failure and a unilateral exudative pleural effusion that was refractory to tube thoracostomy drainage, is reported. After admission to hospital, he developed gross dilation of his colon; emergency laparotomy revealed an incarcerated colonic herniation into the left hemithorax. Interesting clinical features of this patient's case included the patient's hobby of weightlifting, a persistently deviated mediastinum despite drainage of the pleural effusion and deceptive pleural fluid biochemical indices.

  15. Time-dependent wellbore breakout growth caused by drilling-induced pore pressure transients: Implications for estimations of far field stress magnitude

    Science.gov (United States)

    Olcott, K. A.; Saffer, D. M.; Elsworth, D.

    2013-12-01

    One method used to constrain principal stress orientations and magnitudes in the crust combines estimates of rock strength with observations of wellbore failures, including drilling-induced tensile fractures (DITF) and compressional borehole breakouts (BO). This method has been applied at numerous Integrated Ocean Drilling Program (IODP) boreholes drilled into sediments in a wide range of settings, including the Gulf of Mexico, the N. Japan and Costa Rican subduction margins, and the Nankai Trough Accretionary Prism. At Nankai and N. Japan, BO widths defined by logging-while-drilling (LWD) resistivity images have been used to estimate magnitudes of far-field horizontal tectonic stresses. At several drillsites (C0010, C0002, and C0011), sections of the borehole were relogged with LWD after the hole was left open for times ranging from ~30 min to 3 days; times between acquisition were associated with pipe connections (~30 min), cleaning and circulating the hole (up to ~3 hr), and evacuation of the site for weather (~3 days). Relogged portions exhibit widening of BO, hypothesized to reflect time-dependent re-equilibration of instantaneous changes in pore fluid pressure (Pf) induced by opening the borehole. In this conceptual model, Pf decrease caused by initial excavation of the borehole and resulting changes in the state of stress at the borehole wall lead to an initial strengthening of the sediment. Re-equilibration of Pf results in time-dependent weakening of the sediment and subsequent BO growth. If correct, this hypothesis implies that stress magnitudes estimated by BO widths could be significantly underestimated. We test this idea using a finite-element model in COMSOL multiphysics that couples fluid flow and deformation in a poroelastic medium. We specify far-field horizontal principal stresses (SHmax and Shmin) in the model domain. At the start of simulations/at the time of borehole opening, we impose a decreased stress at the borehole wall. We consider a

  16. The radiological symptoms of lumbar disc herniation and degenerative changes of the lumbar intervertebral discs.

    Science.gov (United States)

    Łebkowski, Wojciech J; Łebkowska, Urszula; Niedźwiecka, Maria; Dziecioł, Janusz

    2004-06-01

    The x-ray examination is one of the fundamental diagnostic modalities in patients with low-back-pain. The aim of study was to establish relation between radiological findings and herniation type and its localization. As well, we looked for relation between radiological findings and progression of disc degeneration. The study enrolled 187 individuals operated due to lumbar disc herniation. In each case the x-ray examination of lumbar spine was performed. Herniation was classified as protrusion, prolapse or disc sequestration. According to localization, herniation was defined as central, lateral or intermediate. Removed discs were histologically evaluated to determine degeneration symptoms. The radiological picture was related to the degeneration of the intervertebral discs. The statistical analysis revealed the only one relation -between traction osteophytes and herniation classified as disc prolapse (pintervertebral space, diminished lordosis, scoliosis) and herniation and its localization within the spinal canal. Also there is no relation between disc degeneration and radiological findings. Classic x-ray examination presents low value in diagnostics of lumbar disc degeneration and its herniation. There is no relation between radiological picture and intensity of degenerative changes within the lumbar discs.

  17. Hiatus Hernia: A Rare Cause of Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    Shruti Patel

    2016-01-01

    Full Text Available Hiatal hernia (HH is the herniation of elements of the abdominal cavity through the esophageal hiatus of the diaphragm. A giant HH with pancreatic prolapse is very rare and its causing pancreatitis is an even more extraordinary condition. We describe a case of a 65-year-old man diagnosed with acute pancreatitis secondary to pancreatic herniation. In these cases, acute pancreatitis may be caused by the diaphragmatic crura impinging upon the pancreas and leading to repetitive trauma as it crosses the hernia; intermittent folding of the main pancreatic duct; ischemia associated with stretching at its vascular pedicle; or total pancreatic incarceration. Asymptomatic hernia may not require any treatment, while multiple studies have supported the recommendation of early elective repair as a safer route in symptomatic patients. In summary, though rare, pancreatic herniation should be considered as a cause of acute pancreatitis. A high index of suspicion for complications is warranted in cases like these.

  18. Conservative treatment of lumbar disc herniation. Epidural steroid injection and MRI findings

    Energy Technology Data Exchange (ETDEWEB)

    Ohmura, Munehisa; Sakanaka, Hideki; Wada, Eiji; Inaoka, Masahiro; Yonenobe, Sakuo [Kansai Rosai Hospital, Amagasaki, Hyogo (Japan)

    1996-01-01

    A study was made on the efficacy of the epidural injection of steroids in 65 patients of lumbar disc herniation. It was recognized that epidural steroids were effective in 49 cases (75 percent) and the effect was closely correlated with the prognosis of lumbar disc herniation. On follow-up MRI studies, a definite decrease in the size of the herniated nucleus pulposus was observed in six patients of the sequestration type: disappearance in five. No definite change was observed except for one patient in the protrusion type. (author).

  19. Surgical Management of the Pregnant Patient With Lumbar Disc Herniation in the Latter Stage of the Second Trimester.

    Science.gov (United States)

    Hayakawa, Kazuo; Mizutani, Jun; Suzuki, Nobuyuki; Haas, Christopher; Kondo, Akira; Otsuka, Seiji; Fukuoka, Muneyoshi; Otsuka, Takanobu

    2017-02-01

    Case report. To report on a pregnant woman successfully treated with microendoscopic discectomy in the left lateral position under general anesthesia at 24-week gestation. Treatment for lumbar disc herniation in pregnant women poses a particular challenge due to the complexity of the clinical situation. Review of the literature emphasizes timely diagnosis with adequate management specific for each gestational period. A surgical approach mandates consideration of the physiologic parameters of pregnancy and the effects of these stressors on the fetus. A 38-year-old primigravid woman presented with persistent and incapacitating low back and left leg pain. Magnetic resonance imaging demonstrated a herniated disc at L4-5 with a severely compressed left L5 nerve root. Symptoms were resistant to conservative treatment (acetaminophen; 1200 mg/day) and nerve root block with corticosteroids (1 mg/0.5 mL of betamethasone plus 0.5 mL of 1% lidocaine) provided only transient pain relief. Operative management with surgical discectomy was discussed. Anesthesiologists, obstetricians, and neonatologists were consulted for preoperative planning, focusing on appropriate anesthesia, ideal positioning for surgical access, and provision for emergent fetal care. Surgery was ultimately performed in the left lateral position, in contrast to the oft-used prone position. Microendoscopic discectomy was performed under general anesthesia at 24-week gestation. The patient experienced complete relief from pain after surgical intervention and delivered a healthy baby at 39-week gestation after normal labor. Our methods, used in accordance with our preoperative simulation, resulted in a satisfactory outcome for both mother and child. Although previously published cases noted the safety of operating in the prone position under epidural anesthesia, we performed minimally invasive microendoscopic discectomy in the left lateral position in combination with general anesthesia and found that

  20. Current interruption transients calculation

    CERN Document Server

    Peelo, David F

    2014-01-01

    Provides an original, detailed and practical description of current interruption transients, origins, and the circuits involved, and how they can be calculated Current Interruption Transients Calculationis a comprehensive resource for the understanding, calculation and analysis of the transient recovery voltages (TRVs) and related re-ignition or re-striking transients associated with fault current interruption and the switching of inductive and capacitive load currents in circuits. This book provides an original, detailed and practical description of current interruption transients, origins,

  1. Inflammatory Processes Associated with Canine Intervertebral Disc Herniation

    Directory of Open Access Journals (Sweden)

    Marie Monchaux

    2017-12-01

    Full Text Available Intervertebral disc herniation (IVDH is an important pathology in humans and also in dogs. While the molecular disease mechanisms are well investigated in humans, little is known about the inflammatory mediators in naturally occurring canine IVDH. The objective of this study was to investigate whether the involved proinflammatory cytokines in human IVDH are also key cytokines in canine IVDH and thus to elucidate the suitability of the dog as a model for human trials. 59 samples from 25 dogs with surgically confirmed thoracolumbar IVDH were collected and classified in three subgroups: herniated (H, affected non-herniated (NH disc, and adjacent non-affected (NA disc. Discs from 11 healthy dogs acted as controls (C. Samples were analyzed for IL-1, IL-6, IL-8, and TNF-α expression (qPCR/ELISA as well as cell infiltration and activation of the MAP kinase pathways (immunohistochemistry. Gene and protein expression of all key cytokines could be detected in IVDH affected dogs. Canine IVDH was significantly associated with a higher gene expression of IL-6 (H > C, NH > C and TNF-α (H > C, NH > C, NA > C and a significant down-regulation of IL-1β (H < C. Dogs with spontaneous pain had significantly higher IL-6 mRNA compared to those with pain arising only upon palpation. An inter-donor comparison (H and HN relative to NA revealed a significant increase of IL-6 gene expression (H > NA, NH > NA. IL-8 (H > C, NA > C and TNF-α (NH > C protein levels were significantly increased in diseased dogs while inversely, IL-6 protein levels were significantly higher in patients with better clinical outcome. Aside from resident IVD cells, mostly monocytes and macrophages were found in extruded material, with concomitant activation of extracellular signal-regulated kinase p38 in the majority of samples. Dogs with spontaneous IVDH might provide a useful model for human disc diseases. Although the expression of key cytokines

  2. Transient hypogonadotropic hypogonadism caused by critical illness.

    Science.gov (United States)

    Woolf, P D; Hamill, R W; McDonald, J V; Lee, L A; Kelly, M

    1985-03-01

    The effects of acute severe illness on pituitary-gonadal function were determined in 35 men and 19 women, including 12 who were postmenopausal. Seventeen men and 5 women had traumatic brain injury which resulted in coma. Twelve postmenopausal and 2 premenopausal women had intracranial vascular accidents. Eleven men had myocardial infarctions, while 7 men underwent elective surgery. Serial plasma samples were examined for testosterone (men), percentage of ultrafiltrable testosterone (men), estradiol (women), sex hormone-binding globulin, LH, and FSH. In men, mean testosterone levels fell by 271 +/- 72 (+/- SE), 202 +/- 63 and 195 +/- 75 ng/dl within 24 h of brain injury, myocardial infarction, or elective surgery, representing decreases of 55%, 43%, and 58%. Further declines occurred in the first and third groups to mean nadirs of 93 +/- 16 and 117 +/- 5 ng/dl, respectively. During recovery of neurological function there was no correlation between the testosterone level and the degree of neurological impairment; testosterone levels eventually returned to normal (627 +/- 77 ng/ml). The percentage of ultrafiltrable testosterone and sex hormone-binding globulin did not change in any group. Although significant decreases in mean immunoreactive LH and FSH levels were found after head trauma, and decreases in FSH were found in the men after surgery, these changes occurred after the decline in testosterone. Despite the fall in basal gonadotropin levels in the head trauma group, there were no significant differences in the gonadotropin responses to GnRH (100 micrograms) in 4 patients during their acute illness or recovery. LH, FSH, and estradiol levels in the premenopausal women were significantly lower on the second day of brain injury (LH, 10.3 +/- 4.7 vs. 3.5 +/- 0.6 mIU/ml; FSH, 3.8 +/- 1.9 vs. 1.4 +/- 0.8 mIU/ml, estradiol, 200 +/- 41 vs. 102 +/- 16 pg/ml) and remained suppressed for 7 days. Gonadotropin levels also fell in the postmenopausal women within 24 h; reductions in LH of 74% and in FSH of 62% were present by day 7 of study. We conclude that both men and women who are critically ill uniformly develop temporary hypogonadotropic gonadal insufficiency regardless of their illness. In men, it is manifested by low testosterone levels, while a comparable decrease in estradiol is present in women. The low testosterone concentrations are not due to reduced sex hormone-binding capacity. Based upon our data in postmenopausal women, hypogonadotropism also occurs in the presence of nonfunctioning gonads. Although our studies do not completely establish the pathophysiology of this disorder, they suggest a suprapituitary origin.

  3. Percutaneous transforaminal endoscopic surgery (PTES) for symptomatic lumbar disc herniation: a surgical technique, outcome, and complications in 209 consecutive cases.

    Science.gov (United States)

    Gu, Yu-Tong; Cui, Zhan; Shao, Hong-Wei; Ye, Yun; Gu, Ai-Qun

    2017-02-08

    We designed an easy posterolateral transforaminal endoscopic decompression technique, termed PTES, for radiculopathy secondary to lumbar disc herniation. The purpose of the study is to describe the technique of PTES and evaluate the efficacy and safety for treatment of lumbar disc herniation including primary herniation, reherniation, intracanal herniation, and extracanal herniation and to report outcome and complications. PTES was performed to treat 209 cases of intracanal or extracanal herniations with or without extruding or sequestrated fragment, high iliac crest, scoliosis, calcification, or cauda equina syndrome including recurrent herniation after previous surgical intervention at the index level or adjacent disc herniation after decompression and fusion. Preoperative and postoperative leg pain was evaluated using the 10-point visual analog scale (VAS) and the results were determined to be excellent, good, fair, or poor according to the MacNab classification at 2-year follow-up. The patients were followed for an average of 26.3 ± 2.3 months. The VAS score of leg pain significantly dropped from 9 (6-10) before operation to 1 (0-3) (P PTES for lumbar disc herniation is an effective and safe method with simple orientation, easy puncture, reduced steps, and little X-ray exposure, which can be applied in almost all kinds of lumbar disc herniation, including L5/S1 level with high iliac crest, herniation with scoliosis or calcification, recurrent herniation, and adjacent disc herniation after decompression and fusion. The learning curve is no longer steep for surgeons.

  4. Lumbar herniation following extended autologous latissimus dorsi breast reconstruction.

    Science.gov (United States)

    Fraser, Sheila Margaret; Fatayer, Hiba; Achuthan, Rajgopal

    2013-05-30

    Reconstructive breast surgery is now recognized to be an important part of the treatment for breast cancer. Surgical reconstruction options consist of implants, autologous tissue transfer or a combination of the two. The latissimus dorsi flap is a pedicled musculocutaneous flap and is an established method of autologous breast reconstruction.Lumbar hernias are an unusual type of hernia, the majority occurring after surgery or trauma in this area. The reported incidence of a lumbar hernia subsequent to a latissimus dorsi reconstruction is very low. We present the unusual case of lumbar herniation after an extended autologous latissimus dorsi flap for breast reconstruction following a mastectomy. The lumbar hernia was confirmed on CT scanning and the patient underwent an open mesh repair of the hernia through the previous latissimus dorsi scar. Lumbar hernias are a rare complication that can occur following latissimus dorsi breast reconstruction. It should be considered in all patients presenting with persistent pain or swelling in the lumbar region.

  5. CT of lumbar spine disk herniation: correlation with surgical findings

    Energy Technology Data Exchange (ETDEWEB)

    Firooznia, H.; Benjamin, V.; Kricheff, I.I.; Rafii, M.; Golimbu, C.

    1984-03-01

    Computed tomography (CT) of the lumbar spine was performed with selectively positioned 5-mm-thick axial cross sections to examine each disk level from the top of the neural foramen to the pedicle of the next caudad vertebra. One hundred consecutive patients with 116 surgical disk explorations were reviewed. There was agreement between the CT and surgical findings in 89 patients (104 explorations) in determination of presence or absence of a herniated nucleus pulposus (HNP). Discrepancy occurred in 12 instances (11 patients): two because of incorrect interpretations, five in previously operated patients, three in spondylolisthesis, and two in spinal stenosis. There were 97 true-positives, eight false-negatives, seven true-negatives, and four false-positives. If nine previously operated patients are excluded from the study, then CT was accurate in detection of presence or absence of an HNP in 93% of the disk explorations.

  6. PERCUTANEOUS DISCECTOMY: A CURRENT TREATMENT FOR LUMBAR DISC HERNIATION

    Directory of Open Access Journals (Sweden)

    Pablo Gerardo Lima-Ramírez

    Full Text Available ABSTRACT Objective: Describe the functional outcomes of patients with contained lumbar disc herniation (L4-L5, L5-S1 treated with manual percutaneous nucleotomy (MPN and demonstrate that it remains a technique with good results. Methods: A prospective, longitudinal study with 110 patients contained with lumbar disc herniation (LDH treated with (MPN. The evaluation was pre-surgical and 4, 30, 180 and 365 days after the surgery. We used Numeric Pain Scale (NPS, Oswestry Disability Index (ODI and Macnab criteria. Descriptive and inferential statistics for differences. Results: N=110: 58 (52.72% men, 52 (47.27% women; average age 37.95 years (14-56 ± 10.60; most affected level: L4-L5 in 63 (57.14% patients. NPS preoperative average: 7.75 (5-9 ± 1.12, and at 365 days: 2.14 (0-7 ± 2.37. The mean preoperative ODI was 37% (28%-40% + 3.06, and at 365 days 9.52% (0%-40% + 13.92. The prognosis (ODI was good to 79 (71.81% patients at 365 days, regular in 26 (23.63% and poor in 5 (4.57%, corresponding respectively to patients with no, mild, moderate and severe disability. The Macnab criteria showed similar results (p = 0.00, 95% CI 0.00 to 0.13 - Student's t. Conclusions: The results were good at one-year follow-up (p = 0.00, demonstrating that the MPN is still a good option for lumbosciatic pain relief.

  7. Effect of Decompression Therapy Combined with Joint Mobilization on Patients with Lumbar Herniated Nucleus Pulposus

    National Research Council Canada - National Science Library

    Lee, Younghwa; Lee, Chang-Ryeol; Cho, Misuk

    2012-01-01

    [Purpose] The purpose of this study was to examine the effects of decompression therapy combined with joint mobilization on the pain and range of motion of patients with lumbar herniated nucleus pulposus. [Subjects...

  8. The Clinical Analysis on 32 Cases of Herniated Lumbar Disc Patients according to Lumbar CT scan

    Directory of Open Access Journals (Sweden)

    Jeong-ho Kim

    2010-06-01

    Full Text Available Objective : This study is to evaluate the effectiveness of the oriental medicine treatment on lumbar disc herniation. Subjects and Methods : The clinical analysis was done on 32 cases of patients with lumbar disc herniation diagnosed by lumbar CT scan. Patients who admitted in Cheongju Oriental Medicine Hospital from April 2007 to April 2008 were analyzed according to the distribution of sex, age, the period of disease, condition on admission, the symptom on admission, Admission day, the treatment efficacy at discharge day. Results : 1. The forties was the most, the acutest phase the most, the day of 8-14 days the most. 2. Multiple bulging disc in 37.5% of CT scan was the most common, followed by a single HNP was 28.1%. 3. Almost 81% patients showed effective efficacy under VAS 3 at discharge day. 4. Single bulging and herniated disc were more short admission days than multiple bulging and herniated disc.

  9. Comparative study of myelography with postmyelographic CT in cervical spondylosis and herniated disk

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Kyoon Soon; Park, Yong Tae; Choi, Woo Suk; Lee, Sun Wha; Lim, Jae Hoon [Kyung Hee University College of Medicine, Seoul (Korea, Republic of)

    1988-10-15

    Eight patients, who had symptoms and signs of cervical spondylosis and/or disk were studied with myelography (using Omnipaque) followed by postmyelographic computed tomography to evaluate the relative efficacy of these two methods in the determination of cervical herniation and spondylosis. Thirty nine levels in 26 patients were confirmed by surgery. Of these, 20 levels proved to have operative evidence of herniated disk. Postmyelographic CT adds useful information to the myelographic findings. Cord and root compression are better evaluated and osteopathy can be differentiated from disk herniation. In osteopathy, myelography was as diagnostic as postmyelographic CT. But, disk herniation was identified in 70% (14/20 levels) with postmyelographic CT and only in 15% (3/20 levels) with myelography.

  10. Herniation of the colon through the foramen of Winslow—A case report

    Directory of Open Access Journals (Sweden)

    Lucia E. Duinhouwer

    2016-01-01

    Conclusion: Herniation through the foramen of Winslow is a rare condition. Patients will present with sudden onset abdominal pain. Early imaging helps to recognize the diagnosis and could prevent bowel ischemia.

  11. Transforaminal endoscopic surgery for symptomatic lumbar disc herniations: a systematic review of the literature

    NARCIS (Netherlands)

    Nellensteijn, J.M.; Ostelo, R.W.J.G.; Bartels, R.; Peul, W.; van Royen, B.J.; van Tulder, M.W.

    2010-01-01

    The study design includes a systematic literature review. The objective of the study was to evaluate the effectiveness of transforaminal endoscopic surgery and to compare this with open microdiscectomy in patients with symptomatic lumbar disc herniations. Transforaminal endoscopic techniques for

  12. HERNIATION OF THE PREGNANT UTERUS THROUGH THE PREVIOUS CESAREAN SECTION INCISION

    Directory of Open Access Journals (Sweden)

    Vahraz Ghaffari

    1993-06-01

    Full Text Available This is a rare case of pregnancy following the previous cesarean section with diastasis of the recti abdominis and extensive necrosis of the skin over he pendulous herniated uterus.

  13. Analysis of discrepancy between neurologic findings and CT findings in 60 patients with herniated nucleus pulposus

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hyun; Kim, Kab Tae; Sol, Chang Hyo; Kim, Byung Soo [College of Medicine, Pusan National University, Busan(Korea, Republic of)

    1987-06-15

    The herniated nucleus pulposus (HNP) is a major cause of low back pain and sciatica. High resolution computed tomography is the most accurate diagnostic tool to define a HNP, because it provides a complete in vivo analysis of bony framework of lumbar spine as well as the supporting soft tissue structures and neural elements. But the discrepancy between neurologic findings and CT findings is often confusing. From May 1983 to August 1986, sixty patients with HNP who had both CT and surgical intervention at Pusan National University Hospital were analyzed. The feasibility of the neurologic examination on HNP and the effect of HNP on nerve root were evaluated on the basis of CT findings. The results were as follows : 1. Thirty-four cases (56.7%) of clinical impression were matched to CT findings in determining level of HNP and affected nerve root. 2. In evaluation of affected level, there was high trend to cause discrepancy between neurologic findings and CT findings in multiple disc involvement than in single involvement. 3. There was no correlation between degree of nerve root compression determined by CT and pattern of neurologic signs (motor weakness, sensory deficit, and reflex change)

  14. Lumbar spinal canal MRI diameter is smaller in herniated disc cauda equina syndrome patients

    OpenAIRE

    Korse, Nina S.; Kruit, Mark C.; Peul, Wilco C.; Vleggeert-Lankamp, Carmen L. A.

    2017-01-01

    Introduction Correlation between magnetic resonance imaging (MRI) and clinical features in cauda equina syndrome (CES) is unknown; nor is known whether there are differences in MRI spinal canal size between lumbar herniated disc patients with CES versus lumbar herniated discs patients without CES, operated for sciatica. The aims of this study are 1) evaluating the association of MRI features with clinical presentation and outcome of CES and 2) comparing lumbar spinal canal diameters of lumbar...

  15. Is that lumbar disc symptomatic? Herniated lumbar disc associated with contralateral radiculopathy

    OpenAIRE

    Abdul Jalil, Muhammad Fahmi; Lam, Miu Fei; Wang, Yi Yuen

    2014-01-01

    Herniated lumbar disc may be asymptomatic or associated with lower limb radiculopathy. Most spinal surgeons would offer surgery following a period of conservative measures if the radiological and clinical findings correlate. However, the existing dictum that lumbar radiculopathy should correlate with ipsilateral lumbar disc herniation may not be accurate as it can rarely present with contralateral sciatica. Literature regarding this phenomenon is scarce. Therefore, we report a patient with he...

  16. CT of adult lumbar disc herniations mimicking posterior apophyseal ring fractures

    Energy Technology Data Exchange (ETDEWEB)

    Gomori, J.M. (Hadassah Univ. Hospital, Jerusalem (Israel). Dept. of Radiology); Floman, Y.; Liebergall, M. (Hadassah Univ. Hospital, Jerusalem (Israel). Dept. of Orthopedics)

    1991-10-01

    This report concerns 35 adult patients with lumbar or sciatic pain and axial CT findings reportedly associated with posterior apophyseal ring fractures. Review of the CT images suggested two pathophysiologic categories. (1) Posterior Schmorl - A posterior intravertebral disc herniation with posterior displacement of a fractured or remodelled vertebral margin. (2) Calcified subligamentous - Reactive annular and or posterior longitudinal ligament calcification at the periphery of a herniated disc with or without remodelling and anterior displacement of the posterior vertebral margin. (orig.).

  17. The role of transforaminal percutaneous endoscopic discectomy in lumbar disc herniations

    OpenAIRE

    Sarang Gotecha; Deepak Ranade; Sujay Vikhe Patil; Ashish Chugh; Megha Kotecha; Shrikant Sharma; Prashant Punia

    2016-01-01

    Objectives: To study 1)the efficacy of transforaminal percutaneous endoscopic lumbar discectomy in lumbar disc herniations.2) limitations and advantages of the surgical procedure. 3)morbidity and complications associated with the procedure. Materials and Methods: This study was carried out on 120 patients who had single level herniated disc Pre-operative assessment of VAS and MSS scoring systems were documented one day prior to surgery. Post operative results were determined by MacNab crit...

  18. Herniated disks unchanged over time: Size reduced after oxygen–ozone therapy

    OpenAIRE

    Bonetti, Matteo; Zambello, Alessio; Leonardi, Marco; Princiotta, Ciro

    2016-01-01

    The spontaneous regression of disk herniation secondary to dehydration is a much-debated topic in medicine. Some physicians wonder whether surgical removal of the extruded nucleus pulposus is really necessary when the spontaneous disappearance of a herniated lumbar disk is a well-known phenomenon. Unfortunately, without spontaneous regression, chronic pain leads to progressive disability for which surgery seems to be the only solution. In recent years, several studies have demonstrated the ut...

  19. Besonderheiten eines Bandscheibenvorfalles bei Spondylolisthese [ = Characteristics of an intervertebral disk herniation in spondylolisthesis

    OpenAIRE

    Grifka, Joachim; Möller, J.

    1991-01-01

    Treatment of intervertebral disc herniation associated with spondylolisthesis is not different from common procedures concerning indication for surgery and surgical technique as far as sciatica is not related to retrolisthetic soft tissue or the posterior edge of the vertebral body. In a case of a disc herniation L5/S1 and an olisthesis grade I with radicular pain L5 a microdiscectomy of the prolapse and parts of the retrolisthetic soft tissue was performed. An immediate reintervention was ne...

  20. Three-dimensional analysis of volumetric changes in herniated discs of the lumbar spine: does spontaneous resorption of herniated discs always occur?

    Science.gov (United States)

    Seo, Jun-Yeong; Roh, Young-Ho; Kim, Young-Hoon; Ha, Kee-Yong

    2016-05-01

    To investigate volumetric changes in lumbar disc herniation (LDH) using three-dimensional measurements obtained by magnetic resonance imaging (MRI) and to identify possible factors affecting such changes. Between January 2004 and December 2011, 43 patients who underwent conservative treatment for LDH were enrolled. In all, 56 disc levels were investigated. MRI was performed on two or more occasions (minimally, at the initial visit and 6 months later). The volume of each herniated disc was determined. For each patient, disc migration, morphology, initial LDH size, and clinical outcome were evaluated. The mean volumes of herniated discs at the initial and follow-up visits were 1,304.57 ± 837.99 and 993.84 ± 610.04 mm(3), respectively. The mean change in volume from the initial to the follow-up visit was 310.73 ± 743.60 mm(3). Volumes decreased at 35 disc levels and increased at 21 levels. The disc containment, the extent of LDH, the initial size of the herniated disc, and the degree of intactness of the posterior longitudinal ligament were significantly correlated with disc resorption and an increase in disc volume (p = 0.01, p = 0.018, p = 0.001, and p disc volumetric change and clinical outcome. We observed that LDH is a dynamic disease and that a herniated disc is not always spontaneously resorbed, in contrast to what has been reported previously. Alleviation of clinical symptoms can be achieved via conservative treatment even if the volume of the herniated disc changes. Spinal surgeons should not only present an option of initial non-surgical treatment to LDH patients but should also inform them that the LDH may change in size during daily activity or exercise.

  1. Magnetic resonance imaging of lumbar disc herniation with special reference to the myelographic and anatomical correlation

    Energy Technology Data Exchange (ETDEWEB)

    Iwamura, Yuichi; Imamura, Kiyohiko; Uematsu, Hirokazu; Sakai, Naotaka; Yamashita, Hajime; Takemura, Kenji (Yokosuka Kyosai Hospital, Kanagawa (Japan))

    1992-08-01

    T1-weighted magnetic resonance (MR) images of 49 lumbar vertebrae from 44 patients were restrospectively reviewed, focusing on herniated material, low signal intensity zone and extradural fatty tissue in the posterior edge of intervertebral disc. Morphological MR appearance was correlated with myelograms and surgical findings to determine which morphology can be detected by MR imaging alone. The MR features of the posterior edge of intervertebral disc were morphologically divided into three main types: (I) massive, swollen herniation and clear low signal intensity zone, but little or no disruption of the extradual fatty tissue; (II) posterior protrusion of the segmental herniation, partial unclearness or lack of low signal intensity zone, and disrupted extradual fatty tissue; and (III) massive herniation, lack of low signal intensity zone, and widespread disruption of the extradual fatty tissue. Types I, II and, III were seen in 18, 19, and 12 vertebrae, respectively. Herniation was clearly visualized on T1-weighted images in 73% for Type II and 83% for Type III, compared to 28% for Type I. Herniated material was seen as isointensity in 18 vertebrae in Type II and as hyperintensity in 7 vertebrae in Type III. Fifteen vertebrae (79%) in Type II and 9 vertebrae (75%) in Type III were diagnosed by MR imaging alone, which is contrast with Type I in which 11 vertebrae required myelography for diagnosis. In evaluable 25 vertebrae, common surgical findings were bulging in Type I, prolaps in Type II, and extrusion or sequestration in Type III. (N.K.).

  2. Intradural herniation of a thoracic disc presenting as left radicular pain and left drop foot

    Directory of Open Access Journals (Sweden)

    Takuji Matsumoto

    2015-09-01

    Full Text Available Intradural disc herniation is a rare pathological entity. Normally, it is associated with severe neurological deficits, including compression syndrome of the spinal cord or cauda equina. Intradural disc herniations comprise 0.26% to 030% of all herniated discs. Overall, 5% are found in the thoracic region, 3% in the cervical region, and 92% in the lumbar region. Although intradural disc herniation may be suspected preoperatively because of myelography, computed tomography, and magnetic resonance imaging results, establishing the diagnosis before surgery is difficult. We report a patient with thoracic intradural disc herniation at T11-12 who presented with left radicular pain and left drop foot. Preoperative magnetic resonance imaging, computed tomography, and myelography failed to demonstrate an intradural lesion. The patient underwent T11-L1 dorsal hemilaminectomy with lateral extension to the left side. The herniation was identified only intraoperatively during inspection of the thecal sac. The disc was removed surgically, and the operation was performed safely under intraoperative spinal cord monitoring. The patient had a good neurological recovery. She remains pain-free 2 years after the surgery.

  3. Comparison between cranial thoracic intervertebral disc herniations in German Shepherd dogs and other large breed dogs.

    Science.gov (United States)

    Gaitero, Luis; Nykamp, Stephanie; Daniel, Rob; Monteith, Gabrielle

    2013-01-01

    Cranial thoracic intervertebral disc herniations have been reported to be rare in dogs due to the presence of the intercapital ligament, however some studies have proposed they may not be uncommon in German Shepherd dogs. The purpose of this retrospective study was to compare cranial thoracic intervertebral disc herniations in German Shepherd dogs and other large breed dogs (control group). Medical records at the Ontario Veterinary College were searched for German Shepherd dogs and other large breed dogs that had magnetic resonance imaging studies including the T1-T9 region. For each dog and each disc space from T1-T9, three variables (compression, disc degeneration, and herniation) were recorded and graded based on review of sagittal T2-weighted images. Twenty-three German Shepherd dogs and 47 other large breed dogs met inclusion criteria. The German Shepherd dog group had higher scores than the control group for compression (P = 0.0099) and herniation (P dog group, intervertebral discs T2-T3 and T4-T5 had an increased risk for compression and T3-T4 had an increased risk for compression and herniation. Findings from this study indicated that German Shepherd dogs may be more likely than other large breed dogs to have spinal cord compression due to cranial thoracic disc herniations. Imaging of the cranial thoracic spine, including T2-T3, is recommended for German Shepherd dogs with T3-L3 neurological signs. © 2012 Veterinary Radiology & Ultrasound.

  4. Transient drainage summary report

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-09-01

    This report summarizes the history of transient drainage issues on the Uranium Mill Tailings Remedial Action (UMTRA) Project. It defines and describes the UMTRA Project disposal cell transient drainage process and chronicles UMTRA Project treatment of the transient drainage phenomenon. Section 4.0 includes a conceptual cross section of each UMTRA Project disposal site and summarizes design and construction information, the ground water protection strategy, and the potential for transient drainage.

  5. Clinical Outcomes of Percutaneous Transforaminal Endoscopic Discectomy Versus Fenestration Discectomy in Patients with Lumbar Disc Herniation

    Directory of Open Access Journals (Sweden)

    Zheng-mei DING

    2017-03-01

    Full Text Available Background: Fenestration discectomy (FD is a common treatment method for lumber disc herniation (LDH, with good effects obtained. Nevertheless, it also causes many complications, such as lumbar instability, lumbago and back pain. Percutaneous endoscopic lumbar discectomy (PTED is a new minimally invasive treatment available for LDH with conservative therapy failure. At present, this technique has been carried out in China. The purpose of this study was to conduct a randomized prospective trial to compare the surgical outcomes of PTED and FD, explore the clinical application value of PTED, and discuss the operative manipulated skills of PTED.Methods: Totally 100 patients with LDH were enrolled from March 2014 to December 2015 and randomly divided into PTED group and FD group, 50 cases in each group. FD group received FD including epidural anesthesia, unilateral fenestration decompression, removal of nucleus pulposus, and nerve root decompression and release, while FTED group received PTED including local anesthesia, endoscopic removal of herniated nucleus pulposus and nerve root decompression and release. Both groups were followed up postoperatively. The duration of operation, incision length, postoperative bed-rest and hospital stay were compared between two groups, and the visual analogue scale (VAS, Oswestry disability index (ODI, and therapeutic effects at the final follow-up time were recorded and compared between 2 groups.Results: All patients completed the operation successfully. The surgical duration was similar between two groups (P>0.05. PTED group showed a less incision length and shorter postoperative bed-rest time and hospital stay than FD group (P<0.01. The VAS and ODI scores showed a significant decrease in both groups postoperatively when compared with operation before (P<0.05, but with no significant difference between two groups (P>0.05. Moreover, the excellent and good rate was higher in PTED group thanin FD group, with no

  6. PSH Transient Simulation Modeling

    Energy Technology Data Exchange (ETDEWEB)

    Muljadi, Eduard [National Renewable Energy Laboratory (NREL), Golden, CO (United States)

    2017-12-21

    PSH Transient Simulation Modeling presentation from the WPTO FY14 - FY16 Peer Review. Transient effects are an important consideration when designing a PSH system, yet numerical techniques for hydraulic transient analysis still need improvements for adjustable-speed (AS) reversible pump-turbine applications.

  7. Transient Ischemic Attack

    Medline Plus

    Full Text Available Transient Ischemic Attack TIA , or transient ischemic attack, is a "mini stroke" that occurs when a blood clot blocks an artery for a short time. The only ... TIA is that with TIA the blockage is transient (temporary). TIA symptoms occur rapidly and last a ...

  8. Lumbar spinal canal MRI diameter is smaller in herniated disc cauda equina syndrome patients.

    Science.gov (United States)

    Korse, Nina S; Kruit, Mark C; Peul, Wilco C; Vleggeert-Lankamp, Carmen L A

    2017-01-01

    Correlation between magnetic resonance imaging (MRI) and clinical features in cauda equina syndrome (CES) is unknown; nor is known whether there are differences in MRI spinal canal size between lumbar herniated disc patients with CES versus lumbar herniated discs patients without CES, operated for sciatica. The aims of this study are 1) evaluating the association of MRI features with clinical presentation and outcome of CES and 2) comparing lumbar spinal canal diameters of lumbar herniated disc patients with CES versus lumbar herniated disc patients without CES, operated because of sciatica. MRIs of CES patients were assessed for the following features: level of disc lesion, type (uni- or bilateral) and severity of caudal compression. Pre- and postoperative clinical features (micturition dysfunction, defecation dysfunction, altered sensation of the saddle area) were retrieved from the medical files. In addition, anteroposterior (AP) lumbar spinal canal diameters of CES patients were measured at MRI. AP diameters of lumbar herniated disc patients without CES, operated for sciatica, were measured for comparison. 48 CES patients were included. At MRI, bilateral compression was seen in 82%; complete caudal compression in 29%. MRI features were not associated with clinical presentation nor outcome. AP diameter was measured for 26 CES patients and for 31 lumbar herniated disc patients without CES, operated for sciatica. Comparison displayed a significant smaller AP diameter of the lumbar spinal canal in CES patients (largest p = 0.002). Compared to average diameters in literature, diameters of CES patients were significantly more often below average than that of the sciatica patients (largest p = 0.021). This is the first study demonstrating differences in lumbar spinal canal size between lumbar herniated disc patients with CES and lumbar herniated disc patients without CES, operated for sciatica. This finding might imply that lumbar herniated disc patients with a

  9. Lumbar spinal canal MRI diameter is smaller in herniated disc cauda equina syndrome patients.

    Directory of Open Access Journals (Sweden)

    Nina S Korse

    Full Text Available Correlation between magnetic resonance imaging (MRI and clinical features in cauda equina syndrome (CES is unknown; nor is known whether there are differences in MRI spinal canal size between lumbar herniated disc patients with CES versus lumbar herniated discs patients without CES, operated for sciatica. The aims of this study are 1 evaluating the association of MRI features with clinical presentation and outcome of CES and 2 comparing lumbar spinal canal diameters of lumbar herniated disc patients with CES versus lumbar herniated disc patients without CES, operated because of sciatica.MRIs of CES patients were assessed for the following features: level of disc lesion, type (uni- or bilateral and severity of caudal compression. Pre- and postoperative clinical features (micturition dysfunction, defecation dysfunction, altered sensation of the saddle area were retrieved from the medical files. In addition, anteroposterior (AP lumbar spinal canal diameters of CES patients were measured at MRI. AP diameters of lumbar herniated disc patients without CES, operated for sciatica, were measured for comparison.48 CES patients were included. At MRI, bilateral compression was seen in 82%; complete caudal compression in 29%. MRI features were not associated with clinical presentation nor outcome. AP diameter was measured for 26 CES patients and for 31 lumbar herniated disc patients without CES, operated for sciatica. Comparison displayed a significant smaller AP diameter of the lumbar spinal canal in CES patients (largest p = 0.002. Compared to average diameters in literature, diameters of CES patients were significantly more often below average than that of the sciatica patients (largest p = 0.021.This is the first study demonstrating differences in lumbar spinal canal size between lumbar herniated disc patients with CES and lumbar herniated disc patients without CES, operated for sciatica. This finding might imply that lumbar herniated disc patients with

  10. A retrospective study of epidural and intravenous steroids after percutaneous endoscopic lumbar discectomy for large lumbar disc herniation

    Directory of Open Access Journals (Sweden)

    Yang Zhang

    2017-02-01

    Conclusion: Patients who underwent PELD with epidural steroid administration for large lumbar disc herniation showed favorable curative effect compared with those who underwent PELD with intravenous steroid administration.

  11. Scoliotic posture as the initial symptom in adolescents with lumbar disc herniation: its curve pattern and natural history after lumbar discectomy

    Science.gov (United States)

    2011-01-01

    Background There have been few studies focusing on the curve pattern of scoliosis caused by lumbar disc herniation (LDH) in adolescents and the natural history of scoliosis after discectomy. The current study was carried out to identify the curve pattern of scoliosis and investigate the effect of posterior discectomy on the curve improvement in adolescents with LDH. Methods This review focused on a group of 26 adolescents with LDH who initially presented to our clinic for evaluation of scoliosis, followed by posterior discectomy between 2000 and 2009. Radiographic measurements included curve pattern, specific curve features, trunk shift, and sagittal profile. The correlation between the side of disc herniation and the direction of lumbosacral curve and the trunk shift was evaluated. Results A typical curve pattern was initially identified in all of the patients as a short lumbosacral curve accompanied with a long thoracic or thoracolumbar curve toward the opposite side. 23 of 26 patients (88.5%) had a trunk shift more than 2.0 cm away from the midline, showing a poor coronal balance. A relatively straight sagittal profile was noted in all the patients. 84.6% (22/26) patients had a disc herniation at the convex side of lumbosacral curve. Similarly, 73.1% (19/26) patients showed a trunk shift toward the opposite side of disc herniation. All of the patients had an marked curve improvement immediately after discectomy. In the 17 patients with a more than 2-year follow-up, only two had a residual lumbosacral curve greater than or equal to 20 degrees. The mean ODI improved from 21.4% before surgery to 7.3% at the final follow-up. Conclusions A short lumbosacral curve accompanied with a long thoracic or thoracolumbar curve toward the opposite side, and a relatively straight sagittal profile have been noted in all the patients. The direction of lumbosacral curve and trunk shift was related to the side of disc herniation. A majority of patients have a small curve size while

  12. Scoliotic posture as the initial symptom in adolescents with lumbar disc herniation: its curve pattern and natural history after lumbar discectomy

    Directory of Open Access Journals (Sweden)

    Ding Yitao

    2011-09-01

    Full Text Available Abstract Background There have been few studies focusing on the curve pattern of scoliosis caused by lumbar disc herniation (LDH in adolescents and the natural history of scoliosis after discectomy. The current study was carried out to identify the curve pattern of scoliosis and investigate the effect of posterior discectomy on the curve improvement in adolescents with LDH. Methods This review focused on a group of 26 adolescents with LDH who initially presented to our clinic for evaluation of scoliosis, followed by posterior discectomy between 2000 and 2009. Radiographic measurements included curve pattern, specific curve features, trunk shift, and sagittal profile. The correlation between the side of disc herniation and the direction of lumbosacral curve and the trunk shift was evaluated. Results A typical curve pattern was initially identified in all of the patients as a short lumbosacral curve accompanied with a long thoracic or thoracolumbar curve toward the opposite side. 23 of 26 patients (88.5% had a trunk shift more than 2.0 cm away from the midline, showing a poor coronal balance. A relatively straight sagittal profile was noted in all the patients. 84.6% (22/26 patients had a disc herniation at the convex side of lumbosacral curve. Similarly, 73.1% (19/26 patients showed a trunk shift toward the opposite side of disc herniation. All of the patients had an marked curve improvement immediately after discectomy. In the 17 patients with a more than 2-year follow-up, only two had a residual lumbosacral curve greater than or equal to 20 degrees. The mean ODI improved from 21.4% before surgery to 7.3% at the final follow-up. Conclusions A short lumbosacral curve accompanied with a long thoracic or thoracolumbar curve toward the opposite side, and a relatively straight sagittal profile have been noted in all the patients. The direction of lumbosacral curve and trunk shift was related to the side of disc herniation. A majority of patients have

  13. Herniation of the retina in the central macula in an adult after iridocyclitis.

    Science.gov (United States)

    Guo, Qing; Pi, Yuli; Gao, Ting

    2014-09-01

    To report an unusual case of retinal hernia in the central macula in an adult after iridocyclitis. We report a case of a 46-year-old male who presented with blurred vision 2 weeks after complete resolution of acute iridocyclitis. Anterior segment and vitreous body examinations were unremarkable. Yellowish spots in the macular area were observed. Spectral domain optical coherence tomography (SD-OCT) imaging of the macula showed loss of the inner segment/outer segment (IS/OS) photoreceptor junction, with irregularity of the retinal pigment epithelium (RPE), and a V-shaped hernia of the retina into the choroid. The macular lesions emerged as mild window defects on fluorescein angiography and were visualized as hypofluorescent patches on all-phase indocyanine green angiography. At a one month follow-up, the best-corrected visual acuity improved to 20/20, which was followed by partial restoration of the IS/OS line, but a V-shaped hernia of the retina remained unchanged on SD-OCT. Ophthalmologists should be alert to the changes in OCT of the macula in patients after iridocyclitis and further research on the cause and possible predisposing factors for retinal herniation is warranted.

  14. Kinesio Taping in patients with lumbar disc herniation: A randomised, controlled, double-blind study.

    Science.gov (United States)

    Keles, Betul Yavuz; Yalcinkaya, Ebru Yilmaz; Gunduz, Berrin; Bardak, Ayşe Nur; Erhan, Belgin

    2017-01-01

    Lumbar disc herniation (LDH) causes pain and working day loss when activated. Patients spend most of their time in the hospital. And also it may limit patients' daily living activities. Kinesio Taping (KT) is a method that can be easily applied to the patients and does not interfere with their daily activities or movements of body. This study investigated the effects of KT in patients with low back pain due to LDH. Randomised-placebo controlled double blind clinical trial. Sixty Patients with low back pain due to LDH were randomised as KT group or placebo taping group. Taping was performed once a week for three weeks. Patients were followed up during twelve weeks. Numeric rating scale (NRS), lumbar flexion, Health Assessment Questionnaire (HAQ), Oswestry Disability Index (ODI) and paracetamol tablets taken were used for outcome measurements. Demographic and clinical features of the groups were similar. There were significant improvements in all parameters during intervention period in groups. Improvements in NRS-activity, HAQ and ODI continued to twelfth weeks only in KT group. In KT group, analgesic need was significantly less at follow-up. KT reduced analgesic need of patients with LDH when compared with placebo taping.

  15. Dysuria due to discospondylitis and intervertebral disc herniation in a male alpaca (Vicugna pacos).

    Science.gov (United States)

    Sickinger, Marlene; Hirz, Manuela; Schmidt, Martin J; Reinacher, Manfred

    2016-05-31

    Dysuria in camelids is usually associated with the presence of lower urinary tract disease such as urolithiasis. As another differential diagnosis, urine retention may be caused by neurological disturbances resulting from infections of the spinal cord, discospondylitis or trauma. A 2.5-year-old male Huacaya alpaca (Vicugna pacos) presented with dysuria due to damage of the lumbosacral intumescence of the spinal cord. On presentation the alpaca was recumbent. Clinical examination revealed abdominal pain, oliguria, leucopenia with neutrophilia, and slightly elevated creatinine kinase. Ultrasonography of the abdomen showed an irregularly shaped, dilated urinary bladder with hyperechoic serosa. Magnetic resonance imaging revealed discospondylitis of the fourth and fifth lumbar vertebrae and herniation of the intervertebral disc between these vertebrae and the spinal cord. Postmortem examination confirmed severe chronic purulent discospondylitis with ventral spondylosis and narrowing of the spinal canal. Urolithiasis could not be verified. Although rare, diseases of the spinal cord should be considered as a differential diagnosis for impaired micturition in camelids.

  16. [Clinical evaluation of adolescent lumbar disc herniation misdiagnosed as idiopathic scoliosis].

    Science.gov (United States)

    Zhu, Ze-zhang; Qiu, Yong; Wang, Bin; Yu, Yang; Qian, Bang-ping; Zhu, Feng; Ma, Wei-wei; Sun, Xu

    2008-07-15

    To retrospectively review the clinical features and treatment strategy of lumbar disc herniation in adolescents initially misdiagnosed as idiopathic scoliosis. From 1998 to 2007, nineteen adolescents with lumbar disc herniation were admitted to our hospital. All of them presented a scoliotic curve as their first complaint. There were 10 males and 9 females with the age ranged from 14 to 20 years. The disc herniation located at L(4,5) in 10 patients, at L(5)S(1) in 7, and at L(4)-S(1) in 2. The Cobb angle ranged from 23 degrees to 38 degrees . The distance from the C(7) plumb line to the central sacral line averaged 4.7 cm. All the patients underwent conventional open discectomy, followed by a pelvic traction for 3 weeks. A cast fixation for one month was recommended for further correction of scoliosis if the curve improvement was not obvious. Fourteen (73.7%) patients had a disc herniation at the convex side of lumbar curve, and 5 (26.3%) patients had a disc herniation at the concave side, which showed a marginal statistical correlation between the side of the disc herniation and the direction of lumbar curve (P = 0.07). Leg pain and numbness disappeared in the 19 patients after surgical decompression. After the pelvic traction for 3 weeks postoperatively, the Cobb angle reduced to 14 degrees, with the mean distance from the C(7) plumb line to the central sacral line of 2.2 cm. At a mean follow-up of 21 months, neither the recurrence of back pain and leg pain nor the loss of spontaneous scoliosis correction was found. Care should be taken to the diagnosis of lumbar disc herniation in adolescents with spine deformity as their chief complaint. Satisfactory clinical results can be achieved by early diagnosis and proper treatment.

  17. CT of lumbar disc herniation: correlation with surgical findings

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Suk Yl; Lee, Dong Jin; Sung, Kyu Bo; Woo, Won Hyung [Korea General Hospital, Seoul (Korea, Republic of)

    1986-10-15

    CT from forty nine patients with 53 surgical disc explorations were reviewed and correlated with surgical findings. The results were as follows: 1. Frequent locations of HNP were in L4-5 (65%) and L5-S1 (31%). The most common type of HNP was paramidine type (71%). 2. Focal protrusion of the posterior margin of disc and obliteration of epidural fat pad were observed in all of cases (100%) and other common findings were indentation of epidural sac in 46 cases (96%) and compression of nerve root sleeve in 33 cases (69%). 3. Cephalad and caudad extension of protruded soft tissue density in the spinal canal was observed in 15 cases (31%) with variable degree. And more than 6mm extension were provided to be extruded disc in 9 cases. 4. Vacuum phenomenon was demonstrated in 5 cases (10%) and was accompanied with bulging annulus. 5. Forty eight herniated nucleus (HNP) were confirmed surgically in 44 patients. Misinterpretations were made in 4 instances (4 patients); 1 because of lumbar scoliosis, 1 because of spondylolisthesis, and the other 2 because of calcified posterior longitudinal ligament and bulging annulus. One case of true negative examination was central and foraminal stenosis in spinal CT. Thus, sensitivity, specificity and overall accuracy of lumbar spine CT in HNP were 92%, 100% and 92%, respectively.

  18. Predictors of vocational prognosis after herniated lumbar disc

    DEFF Research Database (Denmark)

    Jensen, Lone Donbæk; Frost, Poul; Schiøttz-Christensen, Berit

    2011-01-01

    Study Design. A register study with 2 years of follow up. Objective. To identify predictors of an unfavorable vocational prognosis after hospital contact for herniated lumbar disc (HLD). Summary of Background Data. There is sparse information about vocational prognosis among HLD patients diagnosed...... were lumbar fusion alone HR 1.4 (CI = 1.1–1.8) and in combination with discectomy HR 1.6 (CI = 1.2–2.2) as compared with nonsurgical treatment, ethnicity other than Danish HR 1.55 (CI = 1.2–1.8), and female gender HR 1.2 (CI = 1.1–1.4). Discectomy, age, and year of inclusion were not associated...... with the outcome. Conclusion. The risk of an unfavorable vocational prognosis after hospital contact for HLD was substantial. Nonacademic work and less than 40 weeks of employment within year two before hospital contact were the strongest prognostic factors, but also lumbar fusion alone and in combination...

  19. Unloaded treadmill training therapy for lumbar disc herniation injury.

    Science.gov (United States)

    Simpson, S; Bettis, B; Herbertson, J

    1996-01-01

    The low back region is an area that is very susceptible to injury in athletes. Running is an activity that can be significantly affected by chronic overuse stress. The athlete presented in this case report suffered a herniation of the disc between L-4 and L-5 while training for and racing in a national championship marathon. The athlete was placed on a treatment program of heat, electrical muscle stimulation, and strength and flexibility exercises. The athlete also continued to train by unloaded treadmill training therapy. Unloaded treadmill training therapy produced an effect that reduced stress on injured joints and tissue. This enabled the athlete to maintain fitness while running pain-free on this specialized equipment. The athlete trained twice a week for 16 weeks and training runs ranged from 3 miles to a half-marathon (13.1 miles). Unloaded amounts decreased from 20 to 3 pounds. Training times improved at all distances and were maintained following resumption of normal training.

  20. MR imaging of the lumbar disk herniation : relationship between the direction of herniated disc and pressure effect on nerve root and dural sac

    Energy Technology Data Exchange (ETDEWEB)

    Cha, B. H.; Shon, M. Y.; Kim, K. W.; Lim, M. A.; Kwon, K. R; Kim, S. S. [Sunlin Presbyterian Hospital, Pohang (Korea, Republic of)

    1996-04-01

    To evaluate the relationship between the direction of herniated disc and pressure effect on nerve root and dural sac, as seen on MRI. We retrospectively reviewed lumbar spine MR images of 122 cases of lumbar disk herniation 75 patients MRI findings were analyzed with regard to the relationship between the direction of the herniated disc and pressure effect on nerve root and dural sac. Pressure effect on nerve root and dural sac was arbitrarily divided into three types. Type I was defined as zero or minimal compression of nerve roots or thecal sac by the herniated disc ; type II was defined as mild to moderate compression, while III was defined as severe compression or displacement of nerve roots and/or thecal sac. Of the 122 cases seen in these 75 patients, 97(80%) were observed at L4-5 and L5-S1. The central type(71cases ; 58%) was more frequently observed than the posterolateral type(48cases ; 40%) or lateral type(3cases ; 2%). The totals of types I, II, and III were 44(36%), 43(35%) and 35 cases(29%), respectively. Seventy-seven %(34/44) of type I and 65%(28/43) of type II were of the central type but for type III, the corresponding figure was only 26%(9/35). On MR imaging, most of lumbar disk herniations were observed at L4-5 and L5-S1, with a predominance of the central type rather than the posterolateral one. Most of the central types were either type I or type II.

  1. Availability of Gd-DTPA enhanced MRI for lumbar disc herniation; Mechanism enhancing scar tissue around herniated disc and its meaning

    Energy Technology Data Exchange (ETDEWEB)

    Morita, Chisato; Yoshizawa, Hidezo; Nakai, Sadaaki; Kobayashi, Shigeru; Morita, Tomofumi; Kojima, Motohiro (Fujita Health Univ., Toyoake, Aichi (Japan))

    1994-05-01

    Extradural scar tissue arising between the herniated disk in the lumbar spine and its surrounding tissue was examined in 44 patients with lumbar disc herniation, using Gd-DTPA enhanced magnetic resonance imaging (MRI). Findings of enhanced MRI were divided into three types: that is, type 1 in which the surrounding of the herniated disk was not enhanced; type 2 in which it was partially enhanced; type 3 in which it was entirely enhanced. Of these 44 patients, 15 (34.1%) had type I, 22 (50.0%) had type 2 and 7 (15.9%) had type 3. Extradural scar tissue was seen as high signal intensity on T1-weighted images in 66%, revealing the extent of nerve root compression. Furthermore, 18 of the 44 patients underwent surgery and surgical findings were compared with types of MRI findings. According to MRI findings, these 18 patients consisted of 2 with type 1, 11 with type 2, and 5 with type 3. The two type 1 patients had subligamentous type; 9 type 2 patients had subligamentous type and the other 2 had transligamentous type; and the 5 type 3 patients had all sequestration type. Extradural scar tissue was microscopically shown to be composed of collagenic fibers containing many vessels and to be leakily neovascular structure associated with gap junction and fenestra. Enhanced MRI was capable of delineating the proliferation of extradural scar tissue surrounding the herniated disk easily, thus allowing the determination of pathological changes arising between the herniated disc and nerve root. (N.K.).

  2. Lumbar disk herniation: do MR imaging findings predict recurrence after surgical diskectomy?

    Science.gov (United States)

    Dora, Claudio; Schmid, Marius R; Elfering, Achim; Zanetti, Marco; Hodler, Juerg; Boos, Norbert

    2005-05-01

    To retrospectively evaluate if the degree of disk degeneration and disk herniation volume at magnetic resonance (MR) imaging are risk factors for recurrent disk herniation. The institutional review board permits such retrospective studies, and individual informed consent was not required. MR imaging findings obtained before initial diskectomy in 30 patients (mean age, 42.8 years; 10 women, 20 men) with recurrent disk herniation (study group) and 30 patients (mean age, 42.2 years; nine women, 21 men) without recurrence for at least 2 years after surgery (control group) were compared. Disk degeneration was assessed on T2-weighted sagittal MR images with a five-point grading system (grade I indicated no degeneration; grade II, horizontal hypointense bands within disk; grade III, inhomogeneous disk with intermediate signal intensity; grade IV, no distinction between inner and outer parts of disk; and grade V, collapsed hypointense disk). Disk herniation was classified as representing protrusion, extrusion, or sequestration. The volume of both the affected intervertebral disk and the herniated disk material was measured. Qualitative and quantitative analyses were performed by two readers. The chi(2) test was used for comparison of categorical variables. For comparison of disk degeneration and volumes between patients with and those without recurrence, a paired two-tailed t test was used. Odds ratios based on the extent of disk degeneration were calculated for the entire sample. Advanced disk degeneration (grades IV and V) was significantly less frequent in the study group than in the control group (P < .006). The risk of recurrent disk herniation decreased by a factor of 3.4 for each increase in grade of disk degeneration (odds ratio: 3.58; 95% confidence interval: 1.3, 9.6; P = .011). Mean disk herniation volume as a percentage of intervertebral disk volume was 10.59% +/- 3.41 in the study group and 11.56% +/- 3.84 in the control group. This difference was not

  3. Clinical study on diagnostic value of CT-myelography in herniated lumbar disc and related disorders

    Energy Technology Data Exchange (ETDEWEB)

    Endo, Tohru

    1984-06-01

    In order to evaluate the diagnostic value of CT-myelography (CTM) in herniated lumbar disc and related disorders, myelography and CTM were performed on 60 patients with sciatic pain and the findings obtained were compared. Among these patients, operation was undertaken in 30 including 5 reoperated patients, and preoperative findings on CTM were compared with the grades of herniated disc observed at operation. Agreement between myelographic and CTM findings was found in 85.1% of the cases. While myelography permitted only an indefinite diagnosis of lumbar disc lesion, CTM permitted an accurate diagnosis in 8 intervertebral discs. In cases of reoperation, CTM provided useful information for an analysis of the pathological changes including disc herniation. A comparative study of CTM and surgical findings revealed that the morphological changes in CTM were closely related with the grades of herniated discs. Consequently, CTM may be performed after myelography. If findings by the two techniques are synthesized, the diagnostic rate of herniated lumbar disc and related disorders will be considerably improved. Furthermore, it is concluded that CTM is an important technique for observing bony and neural changes inside the spinal canal in the axial transverse plane.

  4. The probability of spontaneous regression of lumbar herniated disc: a systematic review.

    Science.gov (United States)

    Chiu, Chun-Chieh; Chuang, Tai-Yuan; Chang, Kwang-Hwa; Wu, Chien-Hua; Lin, Po-Wei; Hsu, Wen-Yen

    2015-02-01

    To determine the probability of spontaneous disc regression among each type of lumbar herniated disc, using a systematic review. Medline, Cochrane Library, CINAHL, and Web of Science were searched using key words for relevant original articles published before March 2014. Articles were limited to those published in English and human studies. Articles had to: (1) include patients with lumbar disc herniation treated conservatively; (2) have at least two imaging evaluations of the lumbar spine; and (3) exclude patients with prior lumbar surgery, spinal infections, tumors, spondylolisthesis, or spinal stenosis. Two reviewers independently extracted study details and findings. Thirty-one studies met the inclusion criteria. Furthermore, if the classification of herniation matched the recommended classification of the combined Task Forces, the data were used for combined analysis of the probability of disc regression of each type. Nine studies were applicable for probability calculation. The rate of spontaneous regression was found to be 96% for disc sequestration, 70% for disc extrusion, 41% for disc protrusion, and 13% for disc bulging. The rate of complete resolution of disc herniation was 43% for sequestrated discs and 15% for extruded discs. Spontaneous regression of herniated disc tissue can occur, and can completely resolve after conservative treatment. Patients with disc extrusion and sequestration had a significantly higher possibility of having spontaneous regression than did those with bulging or protruding discs. Disc sequestration had a significantly higher rate of complete regression than did disc extrusion. © The Author(s) 2014.

  5. Herniation pits in the femoral neck: a radiographic indicator of femoroacetabular impingement?

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jin Ah; Park, Ji Seon; Ryu, Kyungnam [Kyung Hee University, Department of Radiology, Kyung Hee University Medical Center, Seoul (Korea, Republic of); Jin, Wook [Kyung Hee University, Department of Radiology, East-West Neo Medical Center, Seoul (Korea, Republic of)

    2011-02-15

    The purpose was to assess the significance of herniation pits in the femoral neck for radiographic diagnosis of femoroacetabular impingement (FAI). Eighty hips in 62 patients (bilateral in 18) with neutral pelvic orientation were enrolled. Herniation pits were diagnosed when they were located at the anterosuperior femoral neck, close to the physis, and with a diameter of >3 mm. The five radiographic signs of FAI were used: lateral center edge angle (LCE) >39 , acetabular index (AI) {<=}0, extrusion index (EI) <25%, acetabular retroversion, and pistol-grip deformity. Patients with radiographs suggesting FAI were retrospectively correlated with their clinical symptoms. Positive radiographic signs were observed in 7 hips with LCE, 7 with AI, and 80 with EI criteria. Only 3 hips out of 80 (3.8%) showed all of the signs. The acetabular retroversion and pistol-grip deformity were seen in 12/80 and 3/80 hips, respectively. The total number of hips that met radiographic criteria for FAI, including pincer type and cam type, was 18 (23%). However, none of these hips were clinically diagnosed with FAI. All symptomatic hips (11/80) presented only with nonspecific pain, and 2 hips out of 11 showed radiographic signs of FAI. The low frequency of positive radiographic signs suggesting FAI with related symptoms among patients with herniation pits suggests that herniation pits have limited significance in the diagnosis of FAI. Therefore it can be concluded that an incidental finding of herniation pits does not necessarily imply a correlation with FAI. (orig.)

  6. [The clinical research of the relation between the pain and the disc herniation type].

    Science.gov (United States)

    He, Ming; Wang, Guang-bin; Wang, Jia-shi

    2011-07-01

    To evaluate the preoperative pain degree of lumbar intervertebral disc herniation and analyzed its reason. From January 2002 to December 2008,265 patients with lumbar intervertebral disc herniation were operated by single segment, of which site in L4,5 was 128 cases and in L5S1 was 137 cases. There were 162 males and 103 female, ranging in age from 21 to 78 years, with an average of 46.3 years. Oswestry index of all patients was observed before operation. The patients were divided into five groups based on Carragee system (according to degree of nucleus pulposus herniation and degree of fibrous ring cleavage to group, prolapse and liberation of nucleus pulposus with small ring cleavage was group I; prolapse and liberation with large ring cleavage was group II; contained fragment with integrated fibrous ring was group III; no contained fragment with integrated fibrous ring was group IV; calcified nucleus pulposus with degenerative fibrous ring was group V). The associativity between five types of lumbar intervertebral disc herniation and preoperative pain degree was analyzed. The preoperative pain in group I and group II was more severe than that of other groups (Plumbar intervertebral disc herniation accompanies with fibrous ring cleavage; and freed materials can aggravate the nerve root pain by the chemical factor.

  7. Is Leg Length Discrepancy Associated With the Side of Radiating Pain in Patients With a Lumbar Herniated Disc?

    NARCIS (Netherlands)

    ten Brinke, Albert P.T.; van der Aa, Hans E.; van der Palen, Jacobus Adrianus Maria; Oosterveld, Frits P.T.

    1999-01-01

    Study Design. The association between leg length discrepancy and the side of the radiating pain in lumbar disc herniation was investigated in a case series. Objectives. To investigate whether pain tends to radiate into the longer or shorter leg in patients with a lumbar herniated disc. Summary of

  8. Cervical spine disc herniation at C2-C3 level: Study of a Clinical Observation and Literature Review

    Directory of Open Access Journals (Sweden)

    Oka Dominique N'Dri

    2015-12-01

    Full Text Available Cervical C2-C3 herniated disc is rare. It is characterized by its clinical polymorphism. Several surgical approaches have been described for the discectomy of a herniated disc. This work aims at discussing through personal observations and literature review clinical semiology and surgical treatment.

  9. Reduced hindbrain herniation after intrauterine myelomeningocele repair: A report of four cases.

    Science.gov (United States)

    Tulipan, N; Hernanz-Schulman, M; Bruner, J P

    1998-11-01

    It has been theorized that fetal myelomeningocele repair may reduce ongoing intrauterine injury and perhaps allow healing and regeneration of dysplastic neural tissue. We report on the postnatal imaging studies of the first 4 patients to have undergone intrauterine myelomeningocele repair at our institution. Each of the 4 patients underwent postnatal sonographic and MRI. In addition, the postnatal ultrasounds of these 4 were compared to a group of retrospective controls. MRI scans of the 4 experimental subjects revealed no evidence of hindbrain herniation while other stigmata of the Chiari-II malformation persisted. In comparison to the retrospective controls this absence of herniation was distinctly unusual. Intrauterine myelomeningocele repair may reduce the degree of hindbrain herniation normally seen in patients with myelomeningocele. This raises the possibility that intrauterine repair may decrease the morbidity associated with the Chiari type-II malformation including brainstem dysfunction, hydrocephalus and syringomyelia.

  10. Spontaneous Remission of a Big Subligamentous Extruded Disc Herniation: Case Report and Review of the Literature

    Science.gov (United States)

    İbrahimoğlu, Muhammet

    2015-01-01

    Spontaneous Regression of a Big Subligamentous Extruded Disc Herniation: Case Report And Review of The Literature The most efficient method for the treatment of lumbar disc herniation is still controversial. The most important aspect is the application of the suitable conservative or surgical treatment to the right patient at the right time. In lumbar disc herniation patients, one must not precipitate except for cases that require surgical indications as in cauda equina syndrome, evolutive motor deficit and persistence of pain in spite of the narcotics. However, the spontaneous regression mechanism has not been completely determined yet. The proposed hypotheses are; dehydration, retraction of the disc to the hernia in the annulus fibrosis, enzymatic catabolism and phagocytosis. In this study, the case of a patient with huge lumbar disc hernia regressing by itself has been presented and the potential mechanisms of disc regression have been discussed. PMID:25883664

  11. Lung herniation: an uncommon presentation of Poland's syndrome in a neonate at birth

    Science.gov (United States)

    Chandran, Suresh; Revanna, Krishna Gopagondanahalli; Ari, Dinesh; Rana, Aftab Ahmed

    2013-01-01

    A term male infant was admitted to the neonatal intensive care unit with an asymmetric chest wall and a herniating mass through the left fourth intercostal space. While crying, the left fourth intercostal space revealed a mass which herniated on expiration and receded on inspiration. On auscultation, the heart sounds were audible on the right side of the chest. Systemic examination was otherwise unremarkable. A roentgenogram of the chest revealed dextrocardia and hyperlucent left lung fields. Echocardiogram showed dextrocardia with a structurally normal heart. A clinical diagnosis of Poland's syndrome was made based on the hypoplasia of the left pectoral muscles, ribs and nipple, dextrocardia and lung herniation. He was thriving well when reviewed at 2 years of age. PMID:23921692

  12. Associations of Caspase-3 gene polymorphism with lumbar disc herniation

    Directory of Open Access Journals (Sweden)

    Yi Fang

    2016-11-01

    Full Text Available To investigate Caspase-3 gene polymorphisms (rs4647693 G/A, rs4647610 A/G, and rs12108497 T/C and susceptibility to lumbar intervertebral disc herniation (LDH. The genotype frequency distributions of the polymorphisms were detected by polymerase chain reaction–restriction fragment length polymorphism in 107 LDH patients (case group and 121 healthy individuals (control group. SHEsis software was used to conduct gene linkage disequilibrium and haplotype analysis. Regression analysis was used to analyze possible risk factors for LDH. Statistically significant differences in family history of LDH, amateur sports, leisure activities, bed types, and spine load grade were found between the case and control groups. The distribution of allele and genotype frequencies of rs4647693 G/A, rs4647610 A/G, and rs12108497 T/C polymorphisms of Caspase-3 were significantly different between the case and control groups. Haplotype analysis showed that the G-G-C (rs4647693-rs4647610-rs12108497 haplotype might be a risk factor for LDH, whereas the A-A-T haplotype might be a protective factor (p < 0.05. Binary logistic regression analysis showed that the GA+AA genotype of rs4647693 was negatively associated with the risk of LDH, whereas high spine load grade was positively associated with the risk of LDH. These findings revealed that rs4647693 G/A, rs4647610 A/G, and rs12108497 T/C polymorphisms of Caspase-3 may be associated with susceptibility to LDH and that interaction and modification effects may exist between Caspase-3 polymorphisms.

  13. Outcomes After Lumbar Disc Herniation in the National Basketball Association

    Science.gov (United States)

    Minhas, Shobhit V.; Kester, Benjamin S.; Hsu, Wellington K.

    2016-01-01

    Background: Professional basketball players are at risk for lumbar disc herniation (LDH), yet the evidence guiding treatment after operative or nonoperative management of this condition in the National Basketball Association (NBA) is limited. Hypothesis: NBA players with LDH will have different performance outcomes based on treatment type. Study Design: Case-control study. Level of Evidence: Level 4. Methods: Athletes in the NBA with an LDH were identified through team injury reports, transaction records, and public sports archives. A 1:2 case-control study was performed in which LDH players and players without LDH were matched for player variables. Statistical analysis was employed to compare pre- and postindex season performance (games played and player efficiency rating [PER]) and career longevity between test subjects and controls in the operatively treated (OT) and nonoperatively treated (NOT) cohorts. Results: A total of 61 NBA players with LDH were included, of whom 34 underwent discectomy and 27 were managed nonoperatively. Return-to-play (RTP) rates did not differ between NOT and OT players (77.8% vs 79.4%). When compared with controls, OT players played significantly fewer games and had a lower PER than controls during the first postoperative season, but no difference was seen 2 and 3 years after surgery, with no difference in postoperative career length. In contrast, no difference in games played or PER was seen between NOT players and controls, although NOT players played significantly fewer postindex seasons. Conclusion: NBA players have a high RTP rate regardless of type of treatment for LDH; however, postindex performance differs between surgically and nonoperatively managed patients when compared with players without an LDH. However, further studies with a larger sample size are required for more definitive recommendations. Clinical Relevance: There is a high RTP rate after LDH in the NBA, although postindex performance may differ based on operative

  14. Value of spinal computed tomography in diagnosis of herniated lumbar discs

    Energy Technology Data Exchange (ETDEWEB)

    Sachsenheimer, W.; Hamer, J. (Heidelberg Univ. (Germany, F.R.). Abt. fuer Neurochirurgie); Mueller, H.A. (Deutsches Krebsforschungszentrum, Heidelberg (Germany, F.R.). Abt. fuer spez. onkologische Diagnostik)

    1982-01-01

    In this study the diagnostic value and topographical accuracy of spinal computed tomography (CT) in the preoperative diagnosis of lumbar disc herniations were tested in 36 patients with surgically proven herniated discs. All patients also underwent metrizamide myelography. CT findings and myelograms were compared and correlated with the surgical observations. Especially in demonstrating exact diagnosis (lateral or more medial protrusion), and in showing the extent of upward and downward displacement of free disc material, CT provides valuable preoperative information. As a non-invasive diagnostic procedure, spinal CT scan may replace lumbar myelography in many patients with radicular lumbar pain.

  15. Sacroiliac joint dysfunction in patients with herniated lumbar disc: a cross-sectional study.

    Science.gov (United States)

    Madani, Seyed Pezhman; Dadian, Mohammad; Firouznia, Keykavous; Alalawi, Salah

    2013-01-01

    To determine the relative frequency of sacroiliac joint dysfunction in a sample of patients with image proven lumbar disc herniation. A single group cross-sectional study was conducted in a three year period from 2007 in an outpatient clinic at a university hospital. Overall, 202 patients aged more than or equal to 18 years with image proven herniated lumbar disc and with physical findings suggestive of lumbosacral root irritation were included. Overall, 146 (72.3%) participants had sacroiliac joint dysfunction. The dysfunction was significantly more prevalent in females (pdisc pathology, sacroiliac joint dysfunction must be considered in clinical decision making.

  16. Cough induced rib fracture, rupture of the diaphragm and abdominal herniation

    Directory of Open Access Journals (Sweden)

    Wurl Peter

    2006-11-01

    Full Text Available Abstract Cough can be associated with many complications. In this article, we present a 59 year old male patient with a very rare combination of a cough related stress fracture of the ninth rib, a traumatic rupture of the diaphragm, and an abdominal wall herniation. The hernia was repaired through surgical treatment without bowel resection, the diaphragm and the internal and oblique abdominal muscle were adapted, and the abdomen was reinforced with a prolene net. Although each individual injury is well documented in the literature, the combination of rib fracture, abdominal herniation and diaphragm rupture has not been reported.

  17. The Inguinal Herniation of the Ovary in the Newborn: Ultrasound and Color Doppler Ultrasound Findings

    Directory of Open Access Journals (Sweden)

    Omer Kaya

    2014-01-01

    Full Text Available Inguinal hernias in the newborn age group are seldom encountered. In the affected female patient, the ovaries, fallopian tubes, and the intestines may settle in the hernia sac. The early diagnosis of torsion in cases in which the ovary is herniated into the inguinal canal is of utmost importance in order to give surgery the chance of reduction and correction. In this paper, a case of an ovarian herniation into the inguinal canal without the presence of torsion is being presented, and the place of US and CDUS in the differential diagnosis of the situation is being discussed.

  18. Igniter heater EMI transient test

    Science.gov (United States)

    Cook, M.

    1989-01-01

    Testing to evaluate Redesigned Solid Rocket Motor igniter heater electromagnetic interference (EMI) effects on the Safe and Arm (S and A) device was completed. It was suspected that EMI generated by the igniter heater and it's associated electromechanical relay could cause a premature firing of the NASA Standard Initiators (NSIs) inside the S and A. The maximum voltage induced into the NSI fire lines was 1/4 of the NASA specified no-fire limit of one volt (SKB 26100066). As a result, the igniter heaters are not expected to have any adverse EMI effects on the NSIs. The results did show, however, that power switching causes occasional high transients within the igniter heater power cable. These transients could affect the sensitive equipment inside the forward skirt. It is therefore recommended that the electromechanical igniter heater relays be replaced with zero crossing solid state relays. If the solid state relays are installed, it is also recommended that they be tested for EMI transient effects.

  19. L5-S1 Achromobacter xylosoxidans infection secondary to oxygen-ozone therapy for the treatment of lumbosacral disc herniation: a case report and review of the literature.

    Science.gov (United States)

    Fort, Nicholas M; Aichmair, Alexander; Miller, Andy O; Girardi, Federico P

    2014-03-15

    Case report and literature review. To present a unique case of Achromobacter xylosoxidans infection secondary to oxygen-ozone therapy for the treatment of L5-S1 disc herniation. Oxygen-ozone therapy is a minimally invasive technique for the treatment of lumbar disc herniations, with unproven efficacy and few reported complications. Achromobacter xylosoxidans is an opportunistic pathogen that inhabits aquatic environments and is a rare cause of osteomyelitis. To the best of our knowledge, this is the first report of A. xylosoxidans spondylodiscitis in the lumbar spine and the third report of spinal infection after intradiscal oxygen-ozone chemonucleolysis in the English literature. The medical records, operative reports, and radiographical imaging studies of a single patient were retrospectively reviewed. A 29-year-old female patient who previously underwent oxygen-ozone therapy for L5-S1 disc herniation presented to our institution with a 5-month history of intractable back and leg pain. The patient's laboratory studies were within normal limits and did not indicate signs of an active infection. Her physical examination revealed globally decreased muscle strength (4/5) and hyperesthesia in the lower extremities. Magnetic resonance imaging and computed tomography revealed severe disc degeneration and vertebral body endplate changes at L5-S1, in addition to paravertebral soft tissue swelling consistent with a previous infection. Given the severity of symptoms, the patient underwent anterior lumbar interbody fusion and posterior segmental instrumentation at L5-S1. Histopathological evaluation of the disc material confirmed the diagnosis of chronic osteomyelitis and septic discitis at L5-S1. Intraoperative cultures grew A. xylosoxidans and Propionibacterium acnes. The patient had prompt improvement in her level of pain and was discharged on a 6-week course of piperacillin-tazobactam without complication. This first report of A. xylosoxidans vertebral infection

  20. Clinical outcomes of percutaneous plasma disc coagulation therapy for lumbar herniated disc diseases.

    Science.gov (United States)

    Kim, Sang Hyun; Kim, Sung Chul; Cho, Ki Hong

    2012-01-01

    This is prospective study of clinical outcomes of percutaneous plasma disc coagulation Therapy (PDCT) in patients with herniated lumbar disc disease (HLD) to evaluate the safety and efficacy in its clinical application and usefulness as a reliable alternative to microscopic discectomy. Forty-six patients were enrolled in this study from April 2006 to June 2010. All patients had one-level HLD. Disc degeneration was graded on routine T2-weighted magnetic resonance Image (MRI) using the Pfirrmann's grading system and all index levels were grade 3 and grade 4. Indications for surgery were radiculopathy caused by disc protrusion with soft consistency. MRI was done at one month after the procedure in all patients to check post-PDCT change. The clinical outcomes were evaluated using Visual Analog Scales (VAS) score and MacNab's criteria. This study was approved by the Institutional Review Board of our institution. The age of the study population ranged from 16 to 59 years with a mean age of 37.2 years. There were 29 males and 17 females in this study. The mean period of clinical follow-up was 21 months. The average preoperative VAS score for radiculopathy was 7.4±1.4, while the final follow-up VAS score was 1.4±0.7 (p<0.001). In MacNab's criteria, 41 patients (89.1%) had achieved favorable improvement (excellent and good) until later follow-up. There were one patient from infection and two patients who needed to convert to open discectomy. PDCT is a safe and efficient treatment modality in a selective patient with HLD.

  1. Characteristics of lumbar disc herniation with exacerbation of presentation due to spinal manipulative therapy.

    Science.gov (United States)

    Huang, Sheng-Li; Liu, Yan-Xi; Yuan, Guo-Lian; Zhang, Ji; Yan, Hong-Wei

    2015-03-01

    The aim of this article was to delineate the characteristics of lumbar disc herniation (LDH) in patients with exacerbation of symptoms caused by spinal manipulative therapy (SMT). The main emphasis should be on the prevention of this condition by identifying relevant risk factors. Detailed clinico-radiological profiles of a total number of 10 LDH patients with exacerbation of presentation after SMT were reviewed. All the patients underwent neurological and magnetic resonance imaging examinations. Laminectomy and discectomy were performed, and follow-up was carried out in all patients. The duration of symptoms in the patients before SMT was 4-15 years. After the therapy, an acute exacerbation of back and radicular pain was observed within 24 h. Magnetic resonance imaging showed that L4-L5 was the most frequently affected level observed (7 patients), and each patient had a large disc fragment in the spinal canal. The disc fragments were classified into 3 types according to their localizations. The time internal between the exacerbation of presentation and surgery was 23.1 days. No perioperative complications were noted. All the patients were relieved of radicular pain a few days after surgery. During postoperative follow-up, all patients regained the ability to walk; one patient received catheterization for 1 month and another for 6 months. Eight patients reported a complete resolution of presentation and the rest 2 patients were significantly improved. SMT should be prohibited in some LDH patients to prevent neurological damages, in whom there are 5 possible risk factors. Surgical results for these patients are encouraging.

  2. Transient trimethylaminuria related to menstruation

    Science.gov (United States)

    Shimizu, Makiko; Cashman, John R; Yamazaki, Hiroshi

    2007-01-01

    Background Trimethylaminuria, or fish odor syndrome, includes a transient or mild malodor caused by an excessive amount of malodorous trimethylamine as a result of body secretions. Herein, we describe data to support the proposal that menses can be an additional factor causing transient trimethylaminuria in self-reported subjects suffering from malodor and even in healthy women harboring functionally active flavin-containing monooxygenase 3 (FMO3). Methods FMO3 metabolic capacity (conversion of trimethylamine to trimethylamine N-oxide) was defined as the urinary ratio of trimethylamine N-oxide to total trimethylamine. Results Self-reported Case (A) that was homozygous for inactive Arg500stop FMO3, showed decreased metabolic capacity of FMO3 (i.e., ~10% the unaffected metabolic capacity) during 120 days of observation. For Case (B) that was homozygous for common [Glu158Lys; Glu308Gly] FMO3 polymorphisms, metabolic capacity of FMO3 was almost ~90%, except for a few days surrounding menstruation showing 90%) metabolic capacity, however, on days around menstruation the FMO3 metabolic capacity was decreased to ~60–70%. Conclusion Together, these results indicate that abnormal FMO3 capacity is caused by menstruation particularly in the presence, in homozygous form, of mild genetic variants such as [Glu158Lys; Glu308Gly] that cause a reduced FMO3 function. PMID:17257434

  3. Posterior epidural migration of herniated lumbar disc fragment.

    Science.gov (United States)

    Sengoz, Ahmet; Kotil, Kadir; Tasdemiroglu, Erol

    2011-03-01

    Posterior epidural migration of a free disc fragment in the lumbar region is a very rare condition that has only been reported in isolated cases to date. Patients with this condition present with radiculopathy or major neurological deficits. Difficulties in diagnosis and the choice and timing of surgical treatment are important in these cases. In this clinical case series, features of cases with posterior epidural migration of free lumbar disc fragments accompanied by cauda equina syndrome are discussed. Eight cases (0.27%) of posterior epidural migration of disc fragments were detected among 2880 patients surgically treated for lumbar disc herniation between 1995 and 2008. Seven of these patients had cauda equina syndrome. The mean duration of symptoms in the 8 cases was 4.2 days (range 1-10 days). The group included 6 men and 2 women, with a mean age of 48 years (range 34-72 years). The sequestered disc fragments were at the L3-4 level in 6 patients (75%) and the L4-5 level in 2 (25%). Magnetic resonance imaging showed tumor-like ring contrast enhancement around sequestered fragments in 5 patients. The patients' motor, sensory, sexual, and urological functions were evaluated postoperatively, and modified Odom criteria and a visual analog scale were used in the assessment of postoperative outcomes. A microsurgical approach was used in all cases. Sequestrectomy with minimal hemilaminotomy and removal of the free segments were performed. The patients were followed up for a mean period of 28.5 months. Three patients (37.5%) had excellent results, 3 (37.5%) had good results, 1 patient (12.5%) had fair results, and only 1 patient had poor results according to the Odom criteria. The main factors affecting the long-term outcomes were the presence of cauda equina syndrome and the time period between onset of symptoms and surgery. Patients with posterior migration of a disc fragment present with severe neurological deficits such as cauda equina syndrome. Because the

  4. Economic value of treating lumbar disc herniation in Brazil.

    Science.gov (United States)

    Falavigna, Asdrubal; Scheverin, Nicolas; Righesso, Orlando; Teles, Alisson R; Gullo, Maria Carolina; Cheng, Joseph S; Riew, K Daniel

    2016-04-01

    Lumbar discectomy is one of the most common surgical spine procedures. In order to understand the value of this surgical care, it is important to understand the costs to the health care system and patient for good results. The objective of this study was to evaluate for the first time the cost-effectiveness of spine surgery in Latin America for lumbar discectomy in terms of cost per quality-adjusted life year (QALY) gained for patients in Brazil. The authors performed a prospective cohort study involving 143 consecutive patients who underwent open discectomy for lumbar disc herniation (LDH). Patient-reported outcomes were assessed utilizing the SF-6D, which is derived from a 12-month variation of the SF-36. Direct medical costs included medical reimbursement, costs of hospital care, and overall resource consumption. Disability losses were considered indirect costs. A 4-year horizon with 3% discounting was applied to health-utilities estimates. Sensitivity analysis was performed by varying utility gain by 20%. The costs were expressed in Reais (R$) and US dollars ($), applying an exchange rate of 2.4:1 (the rate at the time of manuscript preparation). The direct and indirect costs of open lumbar discectomy were estimated at an average of R$3426.72 ($1427.80) and R$2027.67 ($844.86), respectively. The mean total cost of treatment was estimated at R$5454.40 ($2272.66) (SD R$2709.17 [$1128.82]). The SF-6D utility gain was 0.044 (95% CI 0.03197-0.05923, p = 0.017) at 12 months. The 4-year discounted QALY gain was 0.176928. The estimated cost-utility ratio was R$30,828.35 ($12,845.14) per QALY gained. The sensitivity analysis showed a range of R$25,690.29 ($10,714.28) to R$38,535.44 ($16,056.43) per QALY gained. The use of open lumbar discectomy to treat LDH is associated with a significant improvement in patient outcomes as measured by the SF-6D. Open lumbar discectomy performed in the Brazilian supplementary health care system provides a cost-utility ratio of R$30

  5. Efficacy of Warm Needle Moxibustion on Lumbar Disc Herniation: A Meta-Analysis.

    Science.gov (United States)

    Li, Xinhua; Han, Yingchao; Cui, Jian; Yuan, Ping; Di, Zhi; Li, Lijun

    2016-10-01

    Clinical studies on the efficacy of warm needle moxibustion to treat lumbar disc herniation are increasing, while studies on the assessment of its efficacy are still lacking. To assess the clinical effect of warm needle moxibustion on lumbar disc herniation. We searched relevant trials that compared warm needle moxibustion with other methods for lumbar disc herniation from 9 databases. Warm needle moxibustion showed statistical significance efficiency rate compared with acupuncture and manipulation but had a similar rate with nonsteroidal anti-inflammatory drugs (NSAIDs). It showed a statistically significanty excellent rate when compared with acupuncture and manipulation but had a similar rate with NSAIDs. Regarding Japanese Orthopedic Association scores, it showed statistical significance with acupuncture and manipulation, but the rate was similar with Chinese medicine and NSAIDs. Regarding visual analog scale score, it demonstrated statistical significance when compared with acupuncture, manipulation, and NSAIDs but had a similar rate with Chinese medicine. Warm needle moxibustion is superior to acupuncture and manipulation in terms of efficiency rate, excellent rate, and controlling of pain for lumbar disc herniation, but it is similar when compared with NSAIDs and Chinese medicine. © The Author(s) 2015.

  6. Herniated disks unchanged over time: Size reduced after oxygen-ozone therapy.

    Science.gov (United States)

    Bonetti, Matteo; Zambello, Alessio; Leonardi, Marco; Princiotta, Ciro

    2016-08-01

    The spontaneous regression of disk herniation secondary to dehydration is a much-debated topic in medicine. Some physicians wonder whether surgical removal of the extruded nucleus pulposus is really necessary when the spontaneous disappearance of a herniated lumbar disk is a well-known phenomenon. Unfortunately, without spontaneous regression, chronic pain leads to progressive disability for which surgery seems to be the only solution. In recent years, several studies have demonstrated the utility of oxygen-ozone therapy in the treatment of disk herniation, resulting in disk shrinkage. This retrospective study evaluates the outcomes of a series of patients with a history of herniated disks neuroradiologically unchanged in size for over two years, treated with oxygen-ozone therapy at our center over the last 15 years. We treated 96 patients, 84 (87.5%) presenting low back pain complicated or not by chronic sciatica. No drug therapy had yielded significant benefits. A number of specialists had been consulted in two or more years resulting in several neuroradiological scans prior to the decision to undertake oxygen-ozone therapy. Our study documents how ozone therapy for slipped disks "unchanged over time" solved the problem, with disk disruption or a significant reduction in the size of the prolapsed disk material extruded into the spinal canal. © The Author(s) 2016.

  7. Physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain

    NARCIS (Netherlands)

    Van Der Windt, Daniëlle A.W.M.; Simons, Emmanuel; Riphagen, Ingrid; Ammendolia, Carlo; Verhagen, Arianne P.; Laslett, Mark; Devillé, Walter; Aertgeerts, Bert; Deyo, Rick A.; Bouter, Lex M.; De Vet, Henrica C.W.

    2008-01-01

    Of all patients with back pain, less than 2% will undergo surgery for a herniated disc in the lumbar spine. In back pain patients who also have leg pain (sciatica), doctors and therapists use a physical examination to estimate the probability that the p...

  8. Is the surgical outcome for lumbar disc herniation related to the duration of symptoms?

    DEFF Research Database (Denmark)

    Støttrup, Christian; Ernst, Carsten; Clemmensen, Dorte

    Background: Lumbar disc herniation (LDH) is associated with great morbidity and significant socio-economic impact in many parts of the world. Studies have shown that most LDH can be treated effectively with conservative management and the passage of time. However for the group of patients where...

  9. Percutaneous thoracic intervertebral disc nucleoplasty: technical notes from 3 patients with painful thoracic disc herniations

    NARCIS (Netherlands)

    Chua Hai Liang, N.; Gultuna, I.; Riezebos, P.; Beems, T.; Vissers, K.C.P.

    2011-01-01

    Symptomatic thoracic disc herniation is an uncommon condition and early surgical approaches were associated with significant morbidity and even mortality. We are the first to describe the technique of percutaneous thoracic nucleoplasty in three patients with severe radicular pain due to thoracic

  10. Spontaneous Cervical Intradural Disc Herniation Associated with Ossification of Posterior Longitudinal Ligament

    Directory of Open Access Journals (Sweden)

    Dachuan Wang

    2014-01-01

    Full Text Available Intradural herniation of a cervical disc is rare; less than 35 cases have been reported to date. A 52-year-old man with preexisting ossification of posterior longitudinal ligament developed severe neck pain with Lt hemiparesis while asleep. Neurological exam was consistent with Brown-Séquard syndrome. Magnetic resonance images showed a C5-6 herniated disc that was adjacent to the ossified ligament and indenting the cord. The mass was surrounded by cerebrospinal fluid signal intensity margin, and caudally the ventral dura line appears divided into two, consistent with the “Y-sign” described by Sasaji et al. Cord edema were noted. Because of preexisting canal stenosis and spinal cord at risk, a laminoplasty was performed, followed by an anterior C6 corpectomy. Spot-weld type adhesions of the posterior longitudinal ligament to the dura was noted, along with a longitudinal tear in the dura. An intradural extra-arachnoid fragment of herniated disc was removed. Clinical exam at 6 months after surgery revealed normal muscle strength but persistent mild paresthesias. It is difficult to make a definite diagnosis of intradural herniation preoperatively; however, the clinical findings and radiographic signs mentioned above are suggestive and should alert the surgeon to look for an intradural fragment.

  11. A predictive model for disability in patients with lumbar disc herniation.

    Science.gov (United States)

    Chen, Hsin-Ni; Tsai, Yun-Fang

    2013-03-01

    Lumbar disc herniation may influence patients' daily activities and social interactions; however, no predictive models of disability could be found for patients with lumbar disc herniation. We aimed to explore predictive factors for disability in patients with lumbar disc herniation. The sample included 216 patients recruited from the orthopedic outpatient clinics at a medical center in northern Taiwan. Data were collected on patients' pain, fatigue, depression, disability, and demographics. Hierarchical multiple regression analysis was used in model verification. Path analysis was used to investigate causal relationships between disability and other factors. In path analysis, the most influential factor affecting the disability level was the pain level (standardized regression coefficient, b = 0.746), followed by the fatigue level (b = 0.138) and depression level (b = 0.100). The depression level was directly affected by the fatigue level (b = 0.416) and the pain level (b = 0.367), the fatigue level was directly affected by the pain level (b = 0.538), and the pain level was directly affected by age (b = 0.140) and previous surgery (b = 0.260). We recommend that health-care providers regularly assess and treat pain and depression to reduce/prevent disability among patients with lumbar disc herniation, even among those who are apparently functioning well in the community.

  12. Posttraumatic refractory intracranial hypertension and brain herniation syndrome: cerebral hemodynamic assessment before decompressive craniectomy.

    Science.gov (United States)

    Bor-Seng-Shu, Edson; Paiva, Wellingson Silva; Figueiredo, Eberval G; Fujimoto, Yasunori; de Andrade, Almir Ferreira; Fonoff, Erich Talamoni; Teixeira, Manoel Jacobsen

    2013-01-01

    The pathophysiology of traumatic brain swelling remains little understood. An improved understanding of intracranial circulatory process related to brain herniation may have treatment implications. To investigate the cerebral hemodynamic changes associated with brain herniation syndrome due to traumatic brain swelling. Nineteen head-injured patients with evidence of refractory intracranial hypertension and transtentorial herniation were prospectively studied. Cerebral hemodynamic assessment by transcranial Doppler (TCD) ultrasonography was performed prior to decompressive craniectomy. Patients and their cerebral hemispheres were classified according to TCD-hemodynamic patterns, and the data correlated with neurological status, midline shift on CT scan, and Glasgow outcome scale scores at 6 months after injury. A wide variety of cerebral hemodynamic findings were observed. Ten patients (52.7%) presented with cerebral oligoemia, 3 patients (15.8%) with cerebral hyperemia, and 6 patients with nonspecific circulatory pattern. Circulatory disturbances were more frequently found in the side of maximal cerebral swelling than in the opposite side. Pulsatility index (PI) values suggested that ICP varied from acceptable to considerably high; patients with increased PI, indicating higher microvascular resistance. No correlation was found between cerebral hemodynamic findings and outcome. There is a marked heterogeneity of cerebral hemodynamic disturbances among patients with brain herniation syndrome.

  13. Endoscopic Transforaminal Thoracic Foraminotomy and Discectomy for the Treatment of Thoracic Disc Herniation

    Directory of Open Access Journals (Sweden)

    Hong-Fei Nie

    2013-01-01

    Full Text Available Thoracic disc herniation is a relatively rare yet challenging-to-diagnose condition. Currently there is no universally accepted optimal surgical treatment for symptomatic thoracic disc herniation. Previously reported surgical approaches are often associated with high complication rates. Here we describe our minimally invasive technique of removing thoracic disc herniation, and report the primary results of a series of cases. Between January 2009 and March 2012, 13 patients with symptomatic thoracic disc herniation were treated with endoscopic thoracic foraminotomy and discectomy under local anesthesia. A bone shaver was used to undercut the facet and rib head for foraminotomy. Discectomy was achieved by using grasper, radiofrequency, and the Holmium-YAG laser. We analyzed the clinical outcomes of the patients using the visual analogue scale (VAS, MacNab classification, and Oswestry disability index (ODI. At the final follow up (mean: 17 months; range: 6–41 months, patient self-reported satisfactory rate was 76.9%. The mean VAS for mid back pain was improved from 9.1 to 4.2, and the mean ODI was improved from 61.0 to 43.8. One complication of postoperative spinal headache occurred during the surgery and the patient was successfully treated with epidural blood patch. No other complications were observed or reported during and after the surgery.

  14. Clinical outcomes after percutaneous transforaminal endoscopic discectomy for lumbar disc herniation: A prospective case series

    NARCIS (Netherlands)

    P.S. Gadjradj (Pravesh S.); M.W. van Tulder (Maurits); C.M.F. Dirven (Clemens); W.C. Peul (Wilco); B.S. Harhangi (Biswadjiet)

    2016-01-01

    markdownabstract__Objective__ Throughout the last decades, full-endoscopic techniques to treat lumbar disc herniation (LDH) have gained popularity in clinical practice. To date, however, no Class I evidence on the efficacy of percutaneous transforaminal endoscopic discectomy (PTED) has been

  15. Herniated disks unchanged over time: Size reduced after oxygen–ozone therapy

    Science.gov (United States)

    Bonetti, Matteo; Zambello, Alessio; Princiotta, Ciro

    2016-01-01

    The spontaneous regression of disk herniation secondary to dehydration is a much-debated topic in medicine. Some physicians wonder whether surgical removal of the extruded nucleus pulposus is really necessary when the spontaneous disappearance of a herniated lumbar disk is a well-known phenomenon. Unfortunately, without spontaneous regression, chronic pain leads to progressive disability for which surgery seems to be the only solution. In recent years, several studies have demonstrated the utility of oxygen–ozone therapy in the treatment of disk herniation, resulting in disk shrinkage. This retrospective study evaluates the outcomes of a series of patients with a history of herniated disks neuroradiologically unchanged in size for over two years, treated with oxygen–ozone therapy at our center over the last 15 years. We treated 96 patients, 84 (87.5%) presenting low back pain complicated or not by chronic sciatica. No drug therapy had yielded significant benefits. A number of specialists had been consulted in two or more years resulting in several neuroradiological scans prior to the decision to undertake oxygen–ozone therapy. Our study documents how ozone therapy for slipped disks “unchanged over time” solved the problem, with disk disruption or a significant reduction in the size of the prolapsed disk material extruded into the spinal canal. PMID:27066816

  16. Fulminating septicemia secondary to oxygen-ozone therapy for lumbar disc herniation: case report.

    Science.gov (United States)

    Gazzeri, Roberto; Galarza, Marcelo; Neroni, Massimiliano; Esposito, Stefano; Alfieri, Alex

    2007-02-01

    A case report and clinical discussion. To describe a rare but fatal complication secondary to oxygen-ozone therapy for the treatment of herniated lumbar disc. Previously reported complications secondary to oxygen-ozone therapy are rarely reported. Septic discitis and epidural abscesses have been reported after myelography, lumbar puncture, paravertebral injections, epidural anesthesia, acupuncture, and intradiscal therapy with chymopapain. We report the first case of a local infection with systemic fatal dissemination secondary to this treatment. A 57-year-old man previously treated with oxygen-ozone therapy presented low back and bilateral pain. The lumbar computed tomography revealed the presence of L4-L5 and L5-S1 herniated discs. Three days after admission in the hospital, the patient developed a fulminant septicemia. An abdominal-pelvic and chest computed tomography and blood culture led to the diagnosis of pyogenic lumbar muscle involvement, accompanied with septic pulmonary embolism secondary to Escherichia coli infection. This case report identifies a rare and fatal complication of oxygen-ozone therapy in the treatment of a herniated lumbar disc. Acute fatal septicemia should be considered among the major complications of the oxygen-ozone therapy in the treatment of a herniated lumbar disc.

  17. Posttraumatic Refractory Intracranial Hypertension and Brain Herniation Syndrome: Cerebral Hemodynamic Assessment before Decompressive Craniectomy

    Directory of Open Access Journals (Sweden)

    Edson Bor-Seng-Shu

    2013-01-01

    Full Text Available Background. The pathophysiology of traumatic brain swelling remains little understood. An improved understanding of intracranial circulatory process related to brain herniation may have treatment implications. Objective. To investigate the cerebral hemodynamic changes associated with brain herniation syndrome due to traumatic brain swelling. Methods. Nineteen head-injured patients with evidence of refractory intracranial hypertension and transtentorial herniation were prospectively studied. Cerebral hemodynamic assessment by transcranial Doppler (TCD ultrasonography was performed prior to decompressive craniectomy. Patients and their cerebral hemispheres were classified according to TCD-hemodynamic patterns, and the data correlated with neurological status, midline shift on CT scan, and Glasgow outcome scale scores at 6 months after injury. Results. A wide variety of cerebral hemodynamic findings were observed. Ten patients (52.7% presented with cerebral oligoemia, 3 patients (15.8% with cerebral hyperemia, and 6 patients with nonspecific circulatory pattern. Circulatory disturbances were more frequently found in the side of maximal cerebral swelling than in the opposite side. Pulsatility index (PI values suggested that ICP varied from acceptable to considerably high; patients with increased PI, indicating higher microvascular resistance. No correlation was found between cerebral hemodynamic findings and outcome. Conclusions. There is a marked heterogeneity of cerebral hemodynamic disturbances among patients with brain herniation syndrome.

  18. Inguinal Herniation of a Transplant Ureter: Lessons Learned From a Case of "Water Over the Bridge".

    Science.gov (United States)

    Hakeem, Abdul R; Gopalakrishnan, Palanivel; Dooldeniya, Mohantha D; Irving, Henry C; Ahmad, Niaz

    2016-02-01

    Inguinal herniation of the transplant ureter is rare, and there is a paucity of reports in the literature. Herniation is usually secondary to implanting a long redundant ureter and may be precipitated by its course over the spermatic cord. Most often, there is loss of the allograft owing to delayed presentation and chronic ureteric obstruction. Here, we report a case of inguinal herniation of a transplant ureter with obstruction and graft dysfunction. A 72-year-old man presented 9 years after deceased-donor kidney transplant, with progressive graft dysfunction and a symptomatic right inguinal hernia. A nephrostogram and subsequent surgery confirmed herniation of a loop of transplant ureter into the inguinal canal with a proximal dilated ureter and hydronephrosis. A long and redundant ureter had been anastomosed "over" the spermatic cord to the bladder during the original operation. The ureter was shortened by excising the distal segment, and the proximal dilated ureter was anastomosed to the bladder passing it "underneath" the spermatic cord. We used a Vicryl (polyglactin 910) mesh to repair the hernia. The graft function improved to baseline levels after the nephrostomy and remained stable after the surgery. This case emphasizes the need to keep the ureter short, and the importance of passing it underneath the spermatic cord before anastomosing to the bladder. Transplant and general surgeons should be aware of such presentations of graft dysfunction with inguinal hernia to avoid delayed diagnosis and graft loss.

  19. [Acupuncture combined with traction therapy for lumbar disc herniation: a systematic review].

    Science.gov (United States)

    Li, Xiu-zhen; Chen, Hai-yong; Zheng, Xiao; Liu, Nong-yu

    2014-09-01

    To evaluate the efficacy and safety of acupuncture combined with traction therapy for lumbar disc herniation, providing the basis for future research strategies. Randomized control trials. (RCT) of acupuncture combined with traction therapy for lumber disc herniation at home and abroad from 2000 to 2013 were searched, analysis and evaluation of literature and strength of evidence were based on the principles and methods of Evidence-based Medicine. The total effective rate and curative rate were considered as primary outcome measures; pain improvement, quality of life, relapse rate and adverse effects were considered as secondary outcome measures. Seventeen RCTs were identified, Meta-analysis showed that (1) total effective rate and curative rate: acupuncture combined with traction therapy was better than single therapy (acupuncture or traction); (2) pain improvement: acupuncture combined with traction therapy was better than traction therapy; (3) relapse rate: current evidence could not support the conclusion that acupuncture combined with traction therapy was better than traction therapy. Acupuncture combined with traction therapy for lumbar disc herniation was effective. However, the included studies were with high risk of bias, important outcome measures such as quality of life, relapse rate and adverse effects were not found in most of the studies. Current evidence has not yet been able to fully reflect acupuncture combined with traction therapy for lumbar disc herniation is better than single therapy, so more RCTs of higher quality are needed to further confirm its efficacy and safety.

  20. [Effectiveness of manual therapy and traction for lumbar disc herniation: a meta-analysis].

    Science.gov (United States)

    Bu, Jiang-Hui; Kong, Ling-Jun; Guo, Chao-Qing; Yang, Xiao-Cun; Cheng, Ying-Wu

    2014-05-01

    To evaluate the effectiveness of manual therapy and traction for lumbar disc herniation and analyze the current status of this kind of randomized clinical trial (RCT). Database of CNKI, VIP, WANFANG, PubMed and OVID were searched. Some relevant journals were manually retrieved. A total of 2 874 literatures on manual therapy and traction for lumbar disc herniation were collected, of which 17 articles met the inclusion criteria. The Jadad score scale was used to evaluate the quality,and RevMan5.0 was used for meta-analysis of literatures. The results of the meta-analysis of all trials involved were as followed:the combined effect of the effective rate was RR = 1.10, 95% CI [1.06, 1.14], the combined effect of the cure rate was RR = 1.36, 95% CI [1.21,1.52], the combined effect of the VAS was RR = 1.37, 95% CI [1.28, 1.45], the combined effect of the JOA was RR = 4.75, 95% CI [4.40, 5.09]. The overall quality of the current RCT researches about manual therapy for lumbar disc herniation was lower,and did not support the conclusion that manual therapy was more effective than traction for lumbar disc herniation.

  1. Bilateraly Diaphragmatic Traumatic Rupture with Delayed and Liver Herniation of Right Diaphragmatic Rupture

    OpenAIRE

    Hatice Öztürkmen Akay; Refik Ülkü

    2004-01-01

    Bilateraly diyafragmatic rupture is a rare pathology. The incidence isregarded 0.8-5%. Here we reported a bilateraly diyafragmatic rupture withdelayed right diyafragmatic liver herniation. We review the literature andwe mentioned the important radiologic findings of the patology withultrasonoghraphy, Computed tomography, and magnetic resonanceimaging.

  2. Bilateraly Diaphragmatic Traumatic Rupture with Delayed and Liver Herniation of Right Diaphragmatic Rupture

    Directory of Open Access Journals (Sweden)

    Hatice Öztürkmen Akay

    2004-01-01

    Full Text Available Bilateraly diyafragmatic rupture is a rare pathology. The incidence isregarded 0.8-5%. Here we reported a bilateraly diyafragmatic rupture withdelayed right diyafragmatic liver herniation. We review the literature andwe mentioned the important radiologic findings of the patology withultrasonoghraphy, Computed tomography, and magnetic resonanceimaging.

  3. Cervical disc herniation presenting with neck pain and contralateral symptoms: a case report

    Directory of Open Access Journals (Sweden)

    Yeung Jacky T

    2012-06-01

    Full Text Available Abstract Introduction Cervical disc herniation often results in neck and arm pain in patients as a result of direct impingement of nerve roots and associated inflammatory processes. The clinical presentation usually corresponds with the side of herniation and ipsilateral symptoms predominate the clinical picture. Case presentation A 35-year-old Caucasian man presented to our facility with neck pain and left-sided upper and lower extremity pain. A magnetic resonance imaging scan revealed a right paramedian herniated disc at the C5 to C6 level. All other cervical levels were normal without central canal stenosis or neural foraminal stenosis. Results from magnetic reasonance imaging scans of the brain and lumbar spine were negative. An anterior cervical discectomy was performed at the C5 to C6 level, and an inter-body graft and plate were placed. Our patient had complete resolution of his neck and left arm pain. Conclusions Anterior discectomy and fusion of the cervical spine resulted in complete resolution of our patient’s neck and left arm symptoms and improvement of his contralateral left leg pain. Cervical disc herniation may present with contralateral symptoms that are different from the current perception of this disease.

  4. Lumbar apophyseal ring fracture and disc herniation: CT and MRI manifestations

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hyeon Kyeong; Kang, Heung Sik [Seoul National University College of Medicine, Seoul (Korea, Republic of); Song, Chi Sung [Young-Deung-Po City Hospital, Seoul (Korea, Republic of)

    1991-07-15

    To understand CT and MR findings and, furthermore, the pathophysiology of the lumbar apophyseal ring fracture (LARF) associated with lumbar disc herniation in 31 cases of LARF (CT was performed in 23, MRI in 18, and both CT and MRI in 12), we studied the age and sex distribution of the patients, history of trauma, shape of bony fragment, number of lesions, lesion sites, associated lumbar disc herniations, and evidence of Scheuermann's disease. Twenty-three out of 31 patients were male, 6 were adolescents, 21 were young adults, and 4 were middled-aged. Arcuate or nodular bone fragment and/or bone defects were detected at the posterior margin of L1 in 2, L2 in 1, L3 in 1, L4 in 10, L5 in 20 and S1 in 7 patients. Eight patients showed multiple LARF, and 13 showed multiple lumbar disc herniations. Radiologic evidence of Scheuermann's disease was obvious in 9 patients. Only 6 patients had a history of evident trauma. CT and MRI showed a similar detection rate of bone fragments and defects. We concluded that LARF would be encountered in young male patients with multiple lumbar disc herniations and evidence of Scheuermann's disease.

  5. Usefulness of gadolinium in MRI evaluation of non surgically treated herniated disk.

    Science.gov (United States)

    Motta, E; Boniotti, V; Miserocchi, L; Caudana, R

    2005-01-01

    The rationale for the use of Gadolinium (Gd) in the MRI evaluation of non surgically treated herniated disk is based on the known presence of inflammatory granulation tissue and neoangiogenesis which plays an important role in both pain and the spontaneous resorption of the hernia. of this study was to determine the usefulness of Gd in MRI examination for detecting the inflammatory reaction around the discal hernia. Thirty-eight patients (mean age 45 years; range 20-70 years) with non surgically treated herniated disk were evaluated with MRI between January 2000 and July 2004. T2w-FAST-SE sagittal and T1w-SE transaxial and sagittal images were acquired before and after the administration of Gd. Twenty out of 22 patients with acute sciatic pain (symptoms =/discal hernia in the spinal canal. In the remaining 16 with chronic sciatic pain (symptoms > 6 months) the discal hernia did not show peri-hernial enhancement. In MRI evaluation of the herniated disk, peri-hernial enhancement is correlated with inflammatory reaction around the hernia which is associated with acute symptoms. The absence of peri-hernial enhancement in chronic herniated disk is due to the poorly vascular fibrotic tissue. Therefore, peri-hernial enhancement facilitates the differential diagnosis in uncertain cases and represents a reliable prognostic index of response to non-surgical therapy and of the possible spontaneous resorption of discal hernia.

  6. Switching transients in a superconducting coil

    Energy Technology Data Exchange (ETDEWEB)

    Owen, E.W.; Shimer, D.W.

    1983-11-18

    A study is made of the transients caused by the fast dump of large superconducting coils. Theoretical analysis, computer simulation, and actual measurements are used. Theoretical analysis can only be applied to the simplest of models. In the computer simulations two models are used, one in which the coil is divided into ten segments and another in which a single coil is employed. The circuit breaker that interrupts the current to the power supply, causing a fast dump, is represented by a time and current dependent conductance. Actual measurements are limited to measurements made incidental to performance tests on the MFTF Yin-yang coils. It is found that the breaker opening time is the critical factor in determining the size and shape of the transient. Instantaneous opening of the breaker causes a lightly damped transient with large amplitude voltages to ground. Increasing the opening time causes the transient to become a monopulse of decreasing amplitude. The voltages at the external terminals are determined by the parameters of the external circuit. For fast opening times the frequency depends on the dump resistor inductance, the circuit capacitance, and the amplitude on the coil current. For slower openings the dump resistor inductance and the current determine the amplitude of the voltage to ground at the terminals. Voltages to ground are less in the interior of the coil, where transients related to the parameters of the coil itself are observed.

  7. Nucleus pulposus cells derived IGF-1 and MCP-1 enhance osteoclastogenesis and vertebrae disruption in lumbar disc herniation

    Science.gov (United States)

    Zhu, Zhongjiao; Huang, Peng; Chong, Yanxue; George, Suraj K; Wen, Bingtao; Han, Na; Liu, Zhiqiang; Kang, Lixin; Lin, Nie

    2014-01-01

    Study design: Chronic strained lumbar disc herniation (LDH) cases were classified into bulging LDH, herniated LDH and prolapse LDH types according to imaging examination, and vertebrae disruptions were evaluated. Cytokines derived from the nucleus pulposus cells were detected, and their effects on osteoclastogenesis, as well as the mechanisms involved, were studied via an in vitro osteoclast differentiation system. Objective: To clarify the mechanisms of lumbar vertebrae resorption induced by lumbar herniation. Summary and background data: Chronic strained lumbar disc herniation induced vertebrae erosion exacerbates quality of patients’ life and clinical outcome. Although nucleus pulposus cells derived cytokines were reported to play an important role in this pathogenesis, the fundamental mechanisms underlying this process are still unclear. Methods: Chronic strained lumbar disc herniation patients were diagnosed with CT scan and T2-weighted magnetic resonance imaging. RNA was extracted from 192 surgical specimens of the herniated lumbar disc and 29 surgical excisions of the lumbar disc from spinal injury patients. The expressions of osteoclastogenesis related cytokines and chemokines were examined using real time PCR. Monocytes were induced into osteoclast with M-CSF and RANKL in vitro, while the IGF-1 and MCP-1 were added into the differentiation procedure in order to evaluate the effects and explore the molecular mechanisms. Results: Vertebrae erosion had a positive relationship with lumbar disc herniation severity types. In all of the osteoclastogenesis related cytokines, the IGF-1 and MCP-1 were the most highly expressed in the nucleus pulposus cells. IGF-1 enhances activation of NF-kB signaling directly, but MCP-1 upregulated the expression of RANK, so that enhanced cellular sensitivity to RANKL resulted in increasing osteoclastogenesis and activity. Conclusion: Lumbar herniation induced overexpression of IGF-1 and MCP-1 in nucleus pulposus cells aggravated

  8. Topical vancomycine and bacterial culture from intervertebral herniated disc prevent postoperative osteodiscitis

    Directory of Open Access Journals (Sweden)

    Adam1 Danil

    2014-12-01

    Full Text Available Osteodiscitis represents a serious complication of lumbar disc herniation operations. The treatment of osteodiscitis is controversial and expensive to society. It extends over a period of several months from diagnosis. Reducing postoperative osteodiscitis by using simple measures may limit patient's suffering and reduce costs. The purpose of this study is to evaluate the early diagnosis of bacterial infections of the intervertebral disc by isolating germs located in the herniated disc fragment and topical Vancomycine powder application, along with the conventional anti-infective therapy. Medical files of patients who were operated on for lumbar disc herniations during 01.01.2013 - 30.06.2014 were reviewed. The diagnosis of lumbar disc herniation was established based on the clinical evaluation, confirmed by MRI results. The surgical intervention was performed by mini-open approach: fenestration and foraminotomy completed with removal of the herniated disc fragment and disc remnants from the intervertebral space. A group of 162 patients (group A received conventional therapy for prevention of post-operative infections with 2 doses of cephalosporin. In the second group of 137 patients (group B, after the removal of the herniated disc fragments, 1g of Vancomycine powder was topically applied and the disc fragments were bacteriologically analyzed. They received the conventional treatment of preventing post-operative infections with cephalosprin - 2 doses. The two groups of patients were similar in terms of demographic characteristics: age, sex, operative level. Out of the 162 patients of group A, one patient developed postoperative osteodiscitis and was treated for 3 months with antibiotics. Regarding patients in group B, in four cases Staphylococcus was isolated from the disc fragments. Postoperative treatment for these patients with prolonged antibiotic therapy over the standard period avoided the developement of the clinical picture of

  9. Far caudally migrated extraforaminal lumbosacral disc herniation treated by a microsurgical lateral extraforaminal transmuscular approach: case report.

    Science.gov (United States)

    Tschugg, Anja; Tschugg, Sebastian; Hartmann, Sebastian; Rhomberg, Paul; Thomé, Claudius

    2016-03-01

    A 33-year-old man presented with moderate low-back pain and L-5 radiculopathy that progressed to severe paresis of L-5. On initial imaging, a corresponding spinal lesion was overlooked. Further CT and contrast-enhanced MRI demonstrated a presacral mass along the L-5 root far extraforaminally. A herniated disc was suspected, but with standard imaging a schwannoma could not be ruled out. The presacral L-5 root was explored via a microsurgical lateral extraforaminal transmuscular approach. To the best of the authors' knowledge, there have been no reports of sequestered extraforaminal lumbosacral disc herniations that herniated into the presacral region.

  10. Transient Ischemic Attack

    Medline Plus

    Full Text Available ... TIA , or transient ischemic attack, is a "mini stroke" that occurs when a blood clot blocks an ... a short time. The only difference between a stroke and TIA is that with TIA the blockage ...

  11. Transient Ischemic Attack

    Medline Plus

    Full Text Available ... Ischemic Attack TIA , or transient ischemic attack, is a "mini stroke" that occurs when a blood clot blocks an artery for a short time. The only difference between a stroke ...

  12. Transient Microcavity Sensor

    CERN Document Server

    Shu, Fang-Jie; Özdemir, Şahin Kaya; Yang, Lan; Guo, Guang-Can

    2015-01-01

    A transient and high sensitivity sensor based on high-Q microcavity is proposed and studied theoretically. There are two ways to realize the transient sensor: monitor the spectrum by fast scanning of probe laser frequency or monitor the transmitted light with fixed laser frequency. For both methods, the non-equilibrium response not only tells the ultrafast environment variance, but also enable higher sensitivity. As examples of application, the transient sensor for nanoparticles adhering and passing by the microcavity is studied. It's demonstrated that the transient sensor can sense coupling region, external linear variation together with the speed and the size of a nanoparticle. We believe that our researches will open a door to the fast dynamic sensing by microcavity.

  13. MR findings of degenerative changes of nucleus pulposus in lumbar spine: sequential changes after disc herniation

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sang Joon [Choong-Ang Gil Hospital, Seoul (Korea, Republic of); Cha, Yoo Mi; Hwang, Hee Young [College of Medicine, Dankook University, Chenoan (Korea, Republic of)

    1994-04-15

    To evaluate the relationship between MR changes of the nucleus pulposus and the time interval after traumatic disc herniation. T2-weighted MR images of 132 patients with back pain and/or sciatica were reviewed. The changes of signal intensity, central cleft and height of the nucleus pulposus were used as criteria of disc degeneration and they were graded as normal, mild, moderate and severe degree of degeneration. Putting these criteria together we provided integrated grade of degeneration of the nucleus pulposus(grade 0-3). To get the preliminary data for normal and age-related disc degeneration, we measured the disc height by age groups and disc levels and analyzed the relationship between the age of the patients and the signal intensity, cleft and height in normal disc levels of the 132 patients. In 68 patients of 88 levels disc herniation, we analyzed the relationship between symptom duration and the degree of degeneration. Among these 68 patients we selected 14 patients(16 levels) who were under 30 years of age and had history of recent trauma to minimize data distortion from age related degeneration and ambiguity of initiation point of degeneration. In this group we analyzed the relationship between the time period after traumatic disc herniation and the degree of degeneration. The age of the patient had close relationship with the grade of signal intensity, central cleft, and disc height and grade of degeneration of the nucleus pulposus in normal discs. In 88 levels of herniated discs, the duration of symptom and degree of degeneration showed moderate correlation. In 14 patients of disc herniation who were under 30 years old and had trauma history in recent 2 years, grade 1 disc degeneration occurred in average 3.7 months after trauma. Although it was difficult to proceed statistical analysis in the last group because of small patients number, the degree of degeneration of nucleus pulposus had close relationship with the duration after traumas or duration of

  14. Comparison of Myelography and computed tomography in establishing lumbar disc herniation

    Energy Technology Data Exchange (ETDEWEB)

    Fagerlund, M.K.J.; Thelander, U.E.

    The results of lumbar myelography and computed tomography (CT) were compared in 51 consecutive patients with clinically suggested lumbar disc herniation. A total of 100 intervertebral levels were examined. At 62 levels, either L4/L5 or L5/S1, myelography was normal. CT showed no pathologic changes at 55 levels. The results concurred between myelography and CT in 89% of the patients with normal findings. Four cases of disc herniation and one bulging disc, which had been missed at myelography because of a large epidural space at L5/S1, were picked up by CT. Two of these were verified by surgery and two were treated conservatively. There was one possible false negative case with CT as well. Abnormalities were shown at 38 intervertebral levels, 22 in the bulging and 16 in the herniated disc group. The pathologic changes concurred in 84% between the two investigations. For intervertebral disc herniation the true negative rate was, for myelography 88% and for CT 97%. The treatment strategy could have been based on CT alone at 37 out of 38 levels (97%), and on myelography alone at 34 out of 38 levels (89%). Furthermore, at CT the imaging of soft tissues and intervertebral joints was superior to that at myelography. It is concluded that CT should be the primary examination method of imaging for lumbar disc herniation. Myelography is, however, to be preferred where the level of the lesion is clinically unclear or when the entire lumbar region and thoraco-lumbar junction are to be examined. (orig.).

  15. 'Hard discs' associated with lumbar disc herniation: CT analysis

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Il Kwon; Bang, Dae Hong; Yim, Jung Ik; Lee, Jae Mun; Bahk, Yong Whee [Catholic University Medical College, Seoul (Korea, Republic of)

    1989-02-15

    Thirty cases showing hard discs were collected from 206 consecutive cases of posterior disk herniation during the past one and a half years period. According to the shape of hard disk and the presence of marginal bone defect (MBD) of vertebral end plate, 30 cases could be categorized into 4 distinct groups. They were small hard disc with focal MBD (group 1), large hard disc with broad based MBD (group 2), hard disc separated from vertebral body without MBD (group 3) and hard disc fused with vertebral body without MBD (group 4). There were 14 patients in group 1. In all but one case, the hard disc and MBDs were located at the paramedial aspect of the posterior margin of the end plate. Ten (76.9%) of these had Schmorl's nodes and these were considered to represented an avulsion from the weakened bone margin as the disk herniated acutely. The posterior longitudinal ligament seemed to have prevented detachment of the bony fragment. Group 2 included 2 patients and CT findings as well as plain X-ray features were identical to a limbus vertebra. This was considered to represent passive displacement of bony fragment by the intravertebral herniation of the disk. Nine patients belonged to group 3 and represent dystrophic calcifications of herniated disk. Group 4 included 5 patients and was disclosed as a simple osteophyte. From our study, it was concluded; (1) that the hard disc seen in lumbar CT scan was probably the results of the detachment of a bone fragment from the vertebral end plate which has an underlying weak area due to the herniated disc as well as a calcification or osteophyte formation and (2) specific terms (avulsed fragment, limbus vertebra, calcification or spur formation) is more preferable to use than hard disc which is inaccurate.

  16. Oxygen-ozone therapy for herniated lumbar disc in patients with subacute partial motor weakness due to nerve root compression.

    Science.gov (United States)

    Dall'Olio, Massimo; Princiotta, Ciro; Cirillo, Luigi; Budai, Caterina; de Santis, Fabio; Bartolini, Stefano; Serchi, Elena; Leonardi, Marco

    2014-10-31

    Intradiscal oxygen-ozone (O2-O3) chemonucleolysis is a well-known effective treatment for pain caused by protruding disc disease and nerve root compression due to bulging or herniated disc. The most widely used therapeutic combination is intradiscal injection of an O2-O3 mixture (chemonucleolysis), followed by periradicular injection of O2-O3, steroid and local anaesthetic to enhance the anti-inflammatory and analgesic effect. The treatment is designed to resolve pain and is administered to patients without motor weakness, whereas patients with acute paralysis caused by nerve root compression undergo surgery 24-48h after the onset of neurological deficit. This paper reports on the efficacy of O2-O3 chemonucleolysis associated with anti-inflammatory foraminal injection in 13 patients with low back pain and cruralgia, low back pain and sciatica and subacute partial motor weakness caused by nerve root compression unresponsive to medical treatment. All patients were managed in conjunction with our colleagues in the Neurosurgery Unit of Bellaria Hospital and the IRCCS Institute of Neurological Sciences, Bologna. The outcomes obtained are promising: 100% patients had a resolution of motor weakness, while 84.6% had complete pain relief. Our results demonstrate that O2-O3 therapy can be considered a valid treatment option for this category of patients.

  17. Sudden onset of cauda equina syndrome resulting from posterior migration of lumbar herniated disc without significant previous neurological signs.

    Science.gov (United States)

    Ju, Jeong-Hyuk; Kim, Hyun-Woo; Jung, Chul-Ku; Ha, Ho-Gyun

    2012-09-01

    While extruded disc fragments are known to migrate anteriorly, posteriorly, or laterally to the theca sac, posterior migration of the fragments is relatively rare and sudden onset of cauda equina syndrome (CES) caused by the migration is extremely rare. The authors experienced a case of CES that was manifested abruptly with sudden paraplegia caused by posterior migration of the lumbar intervertebral disc. A 74-year old man, who had no prior significant neurologic signs or trauma history, visited our emergency center with paraplegia of both lower extremities occurring suddenly when awakened. On magnetic resonance image (MRI) findings, we could detect ruptured disc herniation with severe lumbar stenosis at the L2-3 level. We performed an emergent decompression, and the right posterior migrated disc fragments at L2-3 were intraoperatively observed. The patient was fully recovered himself on the follow up after 3 months of the operation. In conclusion, early operation can result in better outcome in acute paraplegia caused by the posterior migrated disc fragments.

  18. Transient multivariable sensor evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Vilim, Richard B.; Heifetz, Alexander

    2017-02-21

    A method and system for performing transient multivariable sensor evaluation. The method and system includes a computer system for identifying a model form, providing training measurement data, generating a basis vector, monitoring system data from sensor, loading the system data in a non-transient memory, performing an estimation to provide desired data and comparing the system data to the desired data and outputting an alarm for a defective sensor.

  19. Comparison of 3 physical therapy modalities for acute pain in lumbar disc herniation measured by clinical evaluation and magnetic resonance imaging.

    Science.gov (United States)

    Unlu, Zeliha; Tasci, Saliha; Tarhan, Serdar; Pabuscu, Yuksel; Islak, Serap

    2008-03-01

    This study measures and compares the outcome of traction, ultrasound, and low-power laser (LPL) therapies by using magnetic resonance imaging and clinical parameters in patients presenting with acute leg pain and low back pain caused by lumbar disc herniation (LDH). A total of 60 patients were enrolled in this study and randomly assigned into 1 of 3 groups equally according to the therapies applied, either with traction, ultrasound, or LPL. Treatment consisted of 15 sessions over a period of 3 weeks. Magnetic resonance imaging examinations were done before and immediately after the treatment. Physical examination of the lumbar spine, severity of pain, functional disability by Roland Disability Questionnaire, and Modified Oswestry Disability Questionnaire were assessed at baseline, immediately after, and at 1 and 3 months after treatment. There were significant reductions in pain and disability scores between baseline and follow-up periods, but there was not a significant difference between the 3 treatment groups at any of the 4 interview times. There were significant reductions of size of the herniated mass on magnetic resonance imaging after treatment, but no differences between groups. This study showed that traction, ultrasound, and LPL therapies were all effective in the treatment of this group of patients with acute LDH. These results suggest that conservative measures such as traction, laser, and ultrasound treatments might have an important role in the treatment of acute LDH.

  20. Compression of the superior mesenteric vein - a sign of acute internal herniation in patients with antecolic laparoscopic Roux-en-Y gastric bypass

    Energy Technology Data Exchange (ETDEWEB)

    Maier, Jens; Herrasti Gallego, Amaya [Koege Sygehus, Department of Radiology, Koege (Denmark); Floyd, Andrea K. [Holbaek Sygehus, Department of Abdominal Surgery, Holbaek (Denmark)

    2017-04-15

    To investigate whether compression of the superior mesenteric vein (SMV) on computed tomography (CT) can serve as a valid sign of internal herniation (IH) in patients with antecolic laparoscopic Roux-en-Y gastric bypass (LRYGBP). With institutional review board approval, we performed a retrospective analysis of 41 patients with antecolic LRYGBP referred for acute CT of the abdomen with suspicion of IH or another cause of acute abdomen. CT scans were randomly reviewed for signs of IH by two radiologists in a blinded manner, and the findings were correlated with the results of the patients' bariatric workup. Sensitivity, specificity, and inter-observer agreement were calculated for each sign. Five patients were classified as having intermittent IH and were excluded. Eighteen patients were found to have IH at laparoscopy and served as the study group; 18 patients served as the control group. SMV compression had the best sensitivity (67 % for both reviewers) and inter-observer agreement (kappa = 0.82) of all investigated signs. The swirl sign showed a lower sensitivity (39 and 50 % respectively) and kappa (0.37). SMV compression is a reliable sign of IH in patients with antecolic LRYGBP. circle CT can help detect internal herniation after laparoscopic Roux-en-Y gastric bypass. (orig.)

  1. Intervertebral disc cells produce tumor necrosis factor alpha, interleukin-1beta, and monocyte chemoattractant protein-1 immediately after herniation: an experimental study using a new hernia model.

    Science.gov (United States)

    Yoshida, Masakazu; Nakamura, Takafumi; Sei, Akira; Kikuchi, Taro; Takagi, Katsumasa; Matsukawa, Akihiro

    2005-01-01

    A new hernia model that simulates human disc herniations was developed in rabbits. The herniated discs were examined by gross appearance and histology and production of tumor necrosis factor alpha, interleukin-1beta, and monocyte chemoattractant protein-1 was investigated. To clarify the early mechanism of spontaneous herniated disc resorption. Macrophage infiltration in herniated discs is essential for disc resorption. However, surgically removed human herniated disc tissues and existing animal hernia models are not suitable for analyzing the mechanism of macrophage infiltration. Recently, we have demonstrated that intervertebral disc cells are capable of producing monocyte chemoattractant protein-1, a potent macrophage chemoattractant, after stimulation with tumor necrosis factor alpha and interleukin-1beta. Intervertebral disc herniations were surgically developed in rabbits using a new technique. The herniated discs were excised at appropriate time intervals after the surgery, and the size and histologic findings were examined. Expressions of tumor necrosis factor alpha, interleukin-1beta, and monocyte chemoattractant protein-1 in herniated discs were investigated immunohistochemically. A new rabbit model of disc herniation was established. The herniated discs spontaneously reduced in size by 12 weeks postsurgery. Infiltrating cells, mainly composed of macrophages, were observed from day 3. Immunohistochemically, intervertebral disc cells in the herniated discs produced tumor necrosis factor alpha and interleukin-1beta on day 1, followed by monocyte chemoattractant protein-1 on day 3. The new hernia model appears to be very useful for studying herniated disc resorption. Intervertebral disc cells may produce inflammatory cytokines/chemokine immediately after the onset of disc herniation, possibly triggering subsequent macrophage infiltration that leads to disc resorption.

  2. Transforaminal Epidural Steroid Injections Followed by Mechanical Diagnosis and Therapy to Prevent Surgery for Lumbar Disc Herniation

    NARCIS (Netherlands)

    van Helvoirt, H.; Apeldoorn, A.T.; Ostelo, R.W.J.G.; Knol, D.L.; Arts, M.P.; Kamper, S.J.; van Tulder, M.W.

    2014-01-01

    Study Design: Prospective cohort study. Objective: To report the clinical course of patients with MRI-confirmed lumbar disc herniation-related radicular noncentralizing pain who received transforaminal epidural steroid injections (TESIs) and mechanical diagnosis and therapy (MDT). Summary of

  3. Hérnia discal: procedimentos de tratamento Disc herniation: treatments process

    Directory of Open Access Journals (Sweden)

    Wilson Fábio Negrelli

    2001-12-01

    Full Text Available A hérnia de disco é um processo em que ocorre a ruptura do anel fibroso, com subsequente deslocamento da massa central do disco nos espaços intervertebrais. É considerada uma patologia extremamente comum, que causa séria inabilidade em seus portadores. Estima-se que 2 a 3 % da população sejam acometidos desse processo, cuja prevalência é de 4,8% em homens e 2,5% em mulheres, acima de 35 anos. São fatores de risco, causas ambientais, posturais, desequilíbrios musculares e possivelmente, a influência genética. A terapia conservadora tem sido a preferida como a primeira escolha de tratamento, cujos objetivos são o alívio da dor, o aumento da capacidade funcional e o retardamento da progressão da doença. Nesta revisão, são abordadas as principais metodologias, de acordo com a literatura, dando ênfase ao uso de fármacos analgésicos e anti-inflamatórios, o uso de órteses, a acupuntura, o repouso e a adoção de um programa de exercícios adequados.The disc herniation is a process where the fibrous ring disrupts, with subsequent central disc mass dislocation. It is considered a extremely common pathology, which causes disability. It is estimated that 2 to 3% of the population have taken with this process whose prevalence is 4.8% in males and 2.5% in female, over 35 years old. Environmental causes, posture, muscular imbalance and possibly genetic influence have been considered as risk factors. The conservative therapy has been preferred as the first choice treatment, aiming pain relief, increase of functional capacity and avoidment of disease progression. In this review, it is approached the main methodologies, according to the literature, focusing on drugs prescriptions, orthesis indication, acupunture, rest and a suitable exercise program.

  4. Molecular profile of major growth factors in lumbar intervertebral disc herniation: Correlation with patient clinical and epidemiological characteristics.

    Science.gov (United States)

    Tsarouhas, Alexandros; Soufla, Giannoula; Tsarouhas, Konstantinos; Katonis, Pavlos; Pasku, Dritan; Vakis, Antonis; Tsatsakis, Aristides M; Spandidos, Demetrios A

    2017-04-01

    The involvement of growth factors (GFs) in the pathogenesis of lumbar intervertebral disc (ID) herniation and the spontaneous resorption of herniated ID fragments remains only partially elucidated. A simultaneous assessment of the transcript levels of numerous GFs and their association with clinical and epidemiological profiles of human ID herniation would provide valuable insight into the biology and clinical course of the disease. In the present study, we examined simultaneously the transcript levels of vascular endothelial growth factor (VEGF), transforming growth factor β1 (TGF‑β1), basic fibroblast growth factor 2 (bFGF2), platelet derived growth factor (PDGF) isoforms and receptors, epidermal growth factor (EGF) and insulin growth factor‑1 (IGF‑1) in herniated and control ID specimens and investigated their correlation with the clinicopathological profiles of patients suffering from symptomatic lumbar ID herniation. GF mRNA expression levels were determined by RT-qPCR in 63 surgical specimens from lumbar herniated discs and 10 control ID specimens. Multiple positive correlations were observed between the transcript levels of the GFs examined in the ID herniation group. VEGF mRNA expression was significantly increased in the protruding compared with the extruded discs. Intense and acute pain significantly upregulated the PDGF transcript levels. Significant negative correlations were observed between the patient body mass index and the transcript levels of VEGF and PDGF receptors. Our findings support the hypothesis of the involvement of GFs in the natural history of ID herniation. GFs synergistically act in herniated IDs. Increased VEGF expression possibly induces the neovascularization process in the earliest stages of ID herniation. PDGF‑C and ‑D play a role in the acute phase of radiculopathy in a metabolic response for tissue healing. A molecular effect, in addition to the biomechanical effect of obesity in the

  5. Reoperations after first lumbar disc herniation surgery; a special interest on residives during a 5-year follow-up

    Directory of Open Access Journals (Sweden)

    Kautiainen Hannu

    2007-01-01

    Full Text Available Abstract Background The overall rate of operations after recurrent lumbar disc herniation has been shown to be 3–11%. However, little is known about the rate of residives. Thus the aim of this study was to explore the cumulative rates of re-operations and especially residive disc herniations at the same side and level as the primary disc herniation after first lumbar disc herniation surgery and the factors that influence the risk of re-operations over a five year follow-up study. Methods 166 virgin lumbar disc herniation patients (mean age 42 years, 57% males were studied. Data on patients' initial disc operations and type and timing of re-operations during the follow-up were collected from patient files. Back and leg pain on visual analog scale and employment status were collected by questionnaires. Results The cumulative rate of re-operations for lumbar disc herniation was 10.2% (95% Cl 6.0 to 15.1. The rate of residives at initial site was 7.4% (95% Cl 3.7 to 11.3 and rate of lumbar disc herniations at other sites was 3.1% (95% Cl 0.6 to 6.2. The occurrence of residive lumbar disc herniations was evenly distributed across the 5 years. Neither age, gender, preoperative symptoms, physical activity nor employment had effect on the probability of re-operation. Conclusion Seven percent of the lumbar disc patients had a residive lumbar disc operation within five years of their first operation. No specific factors influencing the risk for re-operation were found.

  6. Increase of nerve growth factor levels in the human herniated intervertebral disc: can annular rupture trigger discogenic back pain?

    Science.gov (United States)

    Aoki, Yasuchika; Nakajima, Arata; Ohtori, Seiji; Takahashi, Hiroshi; Watanabe, Fusako; Sonobe, Masato; Terajima, Fumiaki; Saito, Masahiko; Takahashi, Kazuhisa; Toyone, Tomoaki; Watanabe, Atsuya; Nakajima, Takayuki; Takazawa, Makoto; Nakagawa, Koichi

    2014-07-28

    Nerve growth factor (NGF) has an important role in the generation of discogenic pain. We hypothesized that annular rupture is a trigger for discogenic pain through the action of NGF. In this study, the protein levels of NGF in discs from patients with disc herniation were examined and compared with those from discs of patients with other lumbar degenerative disc diseases. Patients (n = 55) with lumbar degenerative disc disease treated by surgery were included. Nucleus pulposus tissue (or herniated disc tissue) was surgically removed and homogenized; protein levels were quantified using an enzyme-linked immunosorbent assay (ELISA) for NGF. Levels of NGF in the discs were compared between 1) patients with herniated discs (herniated group) and those with other lumbar degenerative disc diseases (non-herniated group), and 2) low-grade and high-grade degenerated discs. Patient's symptoms were assessed using a visual analog scale (VAS) and the Oswestry disability index (ODI); the influence of NGF levels on pre- and post-operative symptoms was examined. Mean levels of NGF in discs of patients were significantly higher in herniated discs (83.4 pg/mg total protein) than those in non-herniated discs (68.4 pg/mg). This study reports that NGF increased in herniated discs, and may play an important role in the generation of discogenic pain. Analysis of patient symptoms revealed that pre-operative NGF levels were related to post-operative residual lower extremity pain and LBP in motion. The results suggest that NGF in the disc is related to pain generation, however, the impact of NGF on generation of LBP varies in individual patients.

  7. Feasibility and Efficacy of Percutaneous Lateral Lumbar Discectomy in the Treatment of Patients with Lumbar Disc Herniation: A Preliminary Experience

    OpenAIRE

    Wenjin Jiang; Bolin Sun; Qirui Sheng; Xuepeng Song; Yanbo Zheng; Ligang Wang

    2015-01-01

    Objective. This study was aimed at evaluating the effectiveness and safety of percutaneous lateral lumbar discectomy (PLLD) in treating patients with lumber disc herniation. Methods. A total of 183 patients with lumbar disc herniation were recruited to receive PLLD surgery from April 2006 to October 2011. All the adverse effects were recorded during the follow-up at 1, 3, 6, and 12 months after PLLD. The clinical outcomes were determined by visual analog scale and Japanese Orthopaedic Associa...

  8. Diagnosis and management of symptomatic muscle herniation of the extremities: a retrospective review.

    Science.gov (United States)

    Kramer, Dennis E; Pace, J Lee; Jarrett, Delma Y; Zurakowski, David; Kocher, Mininder S; Micheli, Lyle J

    2013-09-01

    There is a paucity of published literature on diagnosis and surgical management of muscle herniation of the extremities, with most reported cases involving military personnel and men aged 18 to 40 years. Hypothesis/ The purpose of this study is to describe the presentation, diagnosis, and results of fasciotomy for symptomatic muscle herniation in young athletes. We hypothesize that fasciotomy can be a safe and effective treatment option that allows the majority of athletes to return to sports. Case series; Level of evidence, 4. From 2001 to 2011, 26 athletes (19 women; 11 runners) with a mean age 19.0 ± 4.0 years (range, 14.2-28.4 years) underwent fasciotomy for symptomatic muscle herniation at the authors' institution. Retrospective chart review recorded pertinent patient data and clinical course. Questionnaires were sent to all patients to assess satisfaction with surgery, ability to return to sports, and residual symptoms. Muscle hernias were classified as primary (n = 8, 31%), postsurgical (n = 8, 31%), and associated with underlying untreated chronic exertional compartment syndrome (n = 10, 38%). The tibialis anterior muscle (n = 12, 46%) was most commonly involved. The mean time from onset of symptoms to surgery was 15.1 ± 8.6 months (range, 3-38 months). Dynamic ultrasound (5/6 patients, 83%) was more accurate than magnetic resonance imaging (3/18, 17%) at identifying the hernia. At median follow-up of 28 months (range, 12-127 months), 17 patients (65%) had returned to sports. Seventeen patients (65%) completed the postoperative questionnaire; 14 reported being satisfied with their results (82%). Mild residual symptoms were common (9 of 17 respondents, 53%), especially in runners (5 of 7, 71%), all of whom were satisfied with surgery. Patients with a postsurgical muscle herniation took the longest to return to sports and were the least likely to return to sports, had the highest rate of dissatisfaction with surgery, and were most likely to have persistent

  9. Surgical treatment of thoracic disc herniations using a modified transfacet approach

    Directory of Open Access Journals (Sweden)

    Xizhong Yang

    2014-01-01

    Full Text Available Background: Ideal surgical treatment for thoracic disc herniation (TDH is controversial due to variations in patient presentation, pathology, and possible surgical approach. Althougth discectomy may lead to improvements in neurologic function, it can be complicated by approach related morbidity. Various posterior surgical approaches have been developed to treate TDH, but the gold standard remains transthoracic decompression. Certain patients have comorbidities and herniation that are not optimally treated with an anterior approach. A transfacet pedicle approach was first described in 1995, but outcomes and complications have not been well described. The aim of this work was to evaluate the clinical effect and complications in a consecutive series of patients with symptomatic thoracic disc herniations undergoing thoracic discectomy using a modified transfacet approach. Materials and Methods: 33 patients with thoracic disc herniation were included in this study. Duration of the disease was from 12 days to 36 months, with less than 1 month in 13 patients. Of these, 15 patients were diagnosed with simple thoracic disc herniation, 6 were associated with ossified posterior longitudinal ligament, and 12 with ossified or hypertrophied yellow ligament. A total of 45 discs were involved. All the herniated discs and the ossified posterior longitudinal ligaments were excised using a modified transfacet approach. Laminectomy and replantation were performed for patients with ossified or hypertrophied yellow ligament. The screw-rod system was used on both sides in 14 patients and on one side in l9 patients. Results: 29 patients were followed up for an average of 37 months (range 12-63 months and 4 patients were lost to followup. Evaluation was based on Epstein and Schwall criteria.5 15 were classified as excellent and 10 as good, accounting for 86.21% (25/29; 2 patients were classified as improved and 2 as poor. All the patients recovered neurologically after

  10. Efficacy of infliximab for disc herniation-induced sciatica: one-year follow-up.

    Science.gov (United States)

    Korhonen, Timo; Karppinen, Jaro; Malmivaara, Antti; Autio, Reijo; Niinimäki, Jaakko; Paimela, Leena; Kyllönen, Eero; Lindgren, Karl-August; Tervonen, Osmo; Seitsalo, Seppo; Hurri, Heikki

    2004-10-01

    An open-label trial. To test the long-term efficacy of infliximab, a monoclonal antibody against tumor necrosis factor-alpha (TNF-alpha), in disc herniation-induced sciatica. Our recent trial indicated that a single infusion of 3 mg/weight-kg of infliximab produced a rapid curative effect in disc herniation-induced sciatica. Here, we describe the 1-year effect of a 3 mg/kg of infliximab in these 10 patients and our experience with a lower dose of 1 mg/kg of infliximab for the same indication in 2 additional patients. Patients with severe sciatica were treated with a single infusion of infliximab, 3 mg/weight-kg in 10 patients and 1 mg/kg in 2 patients, intravenously over 2 hours. The outcomes (leg and back pain on a 100-mm visual scale, Oswestry disability, clinical signs) were assessed at 1 week, 2 weeks, 1 month, 3 months, 6 months, and 1 year after the infusion. The outcomes with 3 mg/kg of infliximab were compared to 62 patients who received periradicular saline for sciatica in a previous trial. The resorption rate of disc herniations from baseline to 1 year was compared between infliximab and control groups. The response to 1 mg/kg of infliximab for leg pain was good only in 1 of the 2 patients treated, whereas the response to 3 mg/kg of infliximab for leg pain was sustained in most patients over the 1-year follow-up. The 1-year response significantly favored 3 mg/kg of infliximab over periradicular saline in leg pain (P = 0.005) and disability (P = 0.003). Neurologic abnormalities normalized more comprehensively in the infliximab group (P = 0.001). Reduction in disc herniation volume did not differ between the infliximab-treated patients and controls. The results showed that the beneficial effect of a single infusion of 3 mg/kg of infliximab for herniation-induced sciatica is sustained in most patients over a 1-year follow-up period. Furthermore, infliximab does not seem to interfere with the spontaneous resorption of disc herniations.

  11. Recurrence of disk herniation following percutaneous laser disk ablation in dogs with a history of thoracolumbar intervertebral disk herniation: 303 cases (1994-2011).

    Science.gov (United States)

    Dugat, Danielle R; Bartels, Kenneth E; Payton, Mark E

    2016-12-15

    OBJECTIVE To determine rate of recurrence of disk herniation in dogs that underwent percutaneous laser disk ablation (PLDA) because of a previous episode of suspected or confirmed thoracolumbar intervertebral disk herniation (IVDH). DESIGN Retrospective case series. ANIMALS 303 dogs that underwent PLDA and for which a minimum of 3 years of follow-up information was available (n = 294) or for which recurrence was documented within 3 years after the procedure (9). PROCEDURES Information on signalment, previous episodes of IVDH, specifics of the PLDA procedure, and recurrence was obtained from the medical records. Owners were contacted to complete a questionnaire regarding outcome and recurrence. RESULTS 60 of the 303 (19.8%) dogs had an episode of suspected or confirmed IVDH after undergoing PLDA, but only 11 of the 303 (3.6%) dogs had a recurrence of IVDH confirmed by means of CT or MRI and hemilaminectomy. Recurrence rate following PLDA was not significantly different between dogs that had been treated medically for previous episodes of IVDH and dogs that had been treated surgically. Overall, 270 of 286 (94.4%) owners reported that their dog was the same (109 [38.1%]) or improved (161 [56.3%]) immediately after PLDA, and 265 (92.7%) owners rated their satisfaction with the procedure as ≥ 9 on a scale from 1 (completely dissatisfied) to 10 (completely satisfied). CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that PLDA was a relatively safe, minimally invasive procedure associated with a low rate of recurrence of disk herniation when performed in dogs with a history of previous episodes of suspected or confirmed IVDH.

  12. RESULTS OF TREATMENT OF ACUTE LUMBAR DISC HERNIATION WITH TRANSFORAMINAL NERVE ROOT BLOCK

    Directory of Open Access Journals (Sweden)

    EMILIANO NEVES VIALLE

    Full Text Available ABSTRACT Objective: To determine the efficacy of anesthetic transforaminal nerve root block in patients with sciatica secondary to lumbar disc herniation through a prospective observational study. Methods: The study included 176 patients from a private clinic undergoing transforaminal injection performed by a single spinal surgeon. The patients were assessed after two weeks, three months and six months regarding to the improvement of the pain radiating to the lower limbs. In case of persistent symptoms, patients could choose to perform a new nerve root block and maintenance of physical therapy or be submitted to conventional microdiscectomy. Results: By the end of six-month follow-up of the 176 patients, 116 had a favorable outcome (95 after one block and 21 after two blocks, and only 43 required surgery. Conclusion: The results of our study suggest a positive effect of transforaminal block for the treatment of sciatica in patients with lumbar disc herniation.

  13. Spontaneous regression of herniated lumbar discs: Report of one illustrative case and review of the literature.

    Science.gov (United States)

    Yang, Xiaohui; Zhang, Qin; Hao, Xiaoning; Guo, Xinghua; Wang, Liping

    2016-04-01

    Lumbar disc herniation (LDH) is a common disease that induces back pain and radicular pain. The most efficient method for the treatment of lumbar disc herniation is still controversial. Spontaneous regression of LDH has been recognized with the advancement of radiological diagnostic tools and can explain the reason of spontaneous relief of symptoms without treatment. The proposed hypotheses are; dehydration, retraction of the disc to the hernia in the annulus fibrosis, enzymatic catabolism and phagocytosis. In this study, the case of a patient with huge lumbar disc hernia regressing by itself has been presented and the potential mechanisms of disc regression have been discussed. Copyright © 2016 Elsevier B.V. All rights reserved.

  14. Regression of a symptomatic thoracic disc herniation with a calcified intervertebral disc component

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    Hidayet Sari

    2016-12-01

    Full Text Available There were only a few cases describing spontaneous regression of calcified thoracic disc herniation in the literature. We present a 38-year-old male office worker who had left paramedian-foraminal extruded disc at T7–T8 with calcifications of the T7–T8 and T8–T9 intervertebral discs. This case was unique in that the non-calcified extruded disc material regressed almost completely in 5 months while the calcified intervertebral discs remained the same during the process of regression. This report stresses that regression of the herniated material of the thoracic discs with subsidence of the symptoms is still possible even if the disc material is calcified.

  15. Automated percutaneous lumbar discectomy for the contained herniated lumbar disc: a systematic assessment of evidence.

    Science.gov (United States)

    Hirsch, Joshua A; Singh, Vijay; Falco, Frank J E; Benyamin, Ramsin M; Manchikanti, Laxmaiah

    2009-01-01

    Lumbar disc prolapse, protrusion, and extrusion account for less than 5% of all low back problems, but are the most common causes of nerve root pain and surgical interventions. The typical rationale for traditional surgery is an effort to provide more rapid relief of pain and disability. It should be noted that the majority of patients will recover with conservative management. The primary rationale for any form of surgery for disc prolapse associated with radicular pain is to relieve nerve root irritation or compression due to herniated disc material. The primary modality of treatment continues to be either open or microdiscectomy, but several alternative techniques including automated percutaneous lumbar discectomy (APLD) have been described. However, there is a paucity of evidence for all decompression techniques, specifically alternative techniques including automated and laser discectomy. A systematic review of the literature. To determine the effectiveness of APLD. A comprehensive evaluation of the literature relating to automated lumbar disc decompression was performed. The literature was evaluated according to Cochrane review criteria for randomized controlled trials (RCTs), and Agency for Healthcare Research and Quality (AHRQ) criteria was utilized for observational studies. A literature search was conducted of English language literature through PubMed, EMBASE, the Cochrane library, systematic reviews, and cross references from reviews and systematic reviews. The level of evidence was classified as Level I, II, or III with 3 subcategories in Level II based on the quality of evidence developed by the United States Preventive Services Task Force (USPSTF). Pain relief was the primary outcome measure. Other outcome measures were functional improvement, improvement of psychological status, opioid intake, and return to work. Short-term effectiveness was defined as one year or less, whereas, long-term effectiveness was defined as greater than one year. Based on

  16. Lung herniation into pericardial cavity: A case of partial congenital absence of right pericardium

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    Sadashiv B Tamagond

    2012-01-01

    Full Text Available Congenital absence of pericardium is rarely seen, often diagnosed intraoperatively during cardiac and thoracic surgeries. Left-sided pericardial defects are more common than right-sided ones. We present a case of an incidentally detected congenital absence of right pericardium with herniation of part of the right lung during ventricular septal defect closure surgery in a male child aged 4 years.

  17. Comparison of preoperative neuroradiographic findings and surgical findings in lumbar disc herniation

    Energy Technology Data Exchange (ETDEWEB)

    Takahara, Kazuhiro; Sera, Keisuke; Nakamura, Masakazu; Uchida, Takeshi [Nagasaki Mitsubishi Hospital (Japan); Ito, Nobuyuki

    1997-09-01

    Surgical findings in lumbar disc hernia were compared to pre-operative MRI, CTM and myelogram findings. Ninety-one cases were studied using Love`s method. The accuracy of hernia diagnosis in MRI was 59.3%, 41.2% in CTM, and 35.2% in myelogram. At the L5/S1 disc level, the accuracy of hernia diagnosis by CTM and myelogram was decreased. MRI was useful for the diagnosis and cure of lumbar disc herniation. (author)

  18. Effectiveness of epidural steroid injection for the management of symptomatic herniated lumbar disc.

    Science.gov (United States)

    Baral, B K; Shrestha, R R; Shrestha, A B; Shrestha, C K

    2011-12-01

    Low-back pain is a common clinical presentation of herniated lumbar disc. This is the most common presenting complain of the young adults. The incidence of low back pain is high in our part of the world. The reason may be hilly terrain, difficult working and living environment. The initial treatment of low back pain is conservative. Epidural steroid injection (ESI) is being slowly established as a simple, effective and minimally invasive treatment modality. The aim of this study is to assess the effectiveness of epidural steroid injection for low back and radicular pain. This is a Prospective observational study. It was carried out on the patients presenting with the complain of low back and radicular pain due to herniated lumbar disc not responding to conservative treatment. All the patients of herniated lumbar disc were proven by Magnetic Resonance Imaging (MRI). Injection Methyl prednisolone 80 mg and 2 ml of 0.5% bupivacaine was diluted in 8 ml of normal saline and injected into the affected lumbar epidural space. The functional status of the patient and the severity of pain were evaluated before injection and after injection during the follow-up period by using Ostrewy disability index and visual analogue score. Sixty two patients received the epidural steroid injections, but only fifty patients came for regular follow up till six months. Among the fifty patients, 26 were male and 24 were female. The functional status and pain response of the patients were improved significantly during all the follow-up periods (p herniated discs.

  19. Demographic Characteristics of 796 Patients Operated for Lumbar Disc Herniation in Thrace Region, Turkey

    Directory of Open Access Journals (Sweden)

    Emre Delen

    2016-09-01

    Full Text Available Aim: This study was designed was to determine the demographic characteristics of patients operated for lumbar disc herniation in Thrace Region, Turkey. Material and Method: We retrospectively searched our data to find out patients who had one sided, one level and only one spinal surgical intervention for herniated lumbar disc. Results: Among 796 cases, 336 (42% were men and 460 (58% were women. The level of the pathology is determined as L1 - 2 for 4 cases (0.5%, L2 - 3 for 15 cases (1.9%, L3 - 4 for 51 cases (6.4%, L4 - 5 for 412 cases (51.8% and as L5 - S1 on 314 cases (39.4%. While a total of 70 cases (8.9% were identified on upper-levels ( L1 %u2013 2, L2 %u2013 3, L3 %u2013 4; 726 cases (91.1% were found to be on lower-levels ( L4 %u2013 5, L5 - S1. A mild positive correlation between the pathology level and physical activity intensity (P < 0.05, P = 0.103 has been demonstrated; as well as a strong negative correlation between pathology level and mean age (P < 0.05, P = -0.404. Discussion: The demographic characteristics are consistent with the literature. Physical activity intensity influence on lower-level herniations might have significance due to the large sample size. The strong negative correlation between pathology level and mean age suggests that the degeneration raises the frequency of upper-level herniations.

  20. Static axial overloading primes lumbar caprine intervertebral discs for posterior herniation

    OpenAIRE

    Paul, Cornelis P. L.; Magda de Graaf; Arno Bisschop; Holewijn, Roderick M.; van de Ven, Peter M.; van Royen, Barend J; Mullender, Margriet G.; Smit, Theodoor H.; Helder, Marco N.

    2017-01-01

    Introduction Lumbar hernias occur mostly in the posterolateral region of IVDs and mechanical loading is an important risk factor. Studies show that dynamic and static overloading affect the nucleus and annulus of the IVD differently. We hypothesize there is also variance in the effect of overloading on the IVD?s anterior, lateral and posterior annulus, which could explain the predilection of herniations in the posterolateral region. We assessed the regional mechanical and cellular responses o...

  1. Percutaneous endoscopic lumbar discectomy: minimally invasive technique for multiple episodes of lumbar disc herniation

    OpenAIRE

    Choi, Kyung-Chul; Kim, Jin-Sung; Lee, Dong Chan; Park, Choon-Keun

    2017-01-01

    Backgrounds Although open lumbar discectomy is a gold standard surgical technique for lumbar disc herniation (LDH), surgery-induced tissue injury may actually become a source of postsurgical pain. Percutaneous endoscopic lumbar discectomy (PELD) is introduced as a minimal invasive spinal technique for LDH. The PELD has gained popularity and shown successful results. The authors report the clinical usefulness of the PELD technique in two patients with the serial multilevel LDHs. Case presentat...

  2. Poland syndrome involving the left hemithorax with dextrocardia and herniation of the spleen.

    Science.gov (United States)

    Panda, Shasanka Shekhar; Bajpai, Minu; Singh, Amit; Jana, Manisha

    2014-02-23

    Poland syndrome is characterised by unilateral absence of the large pectoral muscle, ipsilateral symbrachydactyly and occasionally other malformations of the anterior chest wall and breast. The condition is more frequent among men and usually occurs on the right hemithorax in the unilateral form. This case is unique because we believe it is a rare case of Poland syndrome involving the left hemithorax along with dextrocardia and herniation of the spleen from the left subcostal region.

  3. Transient Heat Conduction

    DEFF Research Database (Denmark)

    Rode, Carsten

    1998-01-01

    Analytical theory of transient heat conduction.Fourier's law. General heat conducation equation. Thermal diffusivity. Biot and Fourier numbers. Lumped analysis and time constant. Semi-infinite body: fixed surface temperature, convective heat transfer at the surface, or constant surface heat flux...

  4. Transient cavitation in pipelines

    NARCIS (Netherlands)

    Kranenburg, C.

    1974-01-01

    The aim of the present study is to set up a one-dimensional mathematical model, which describes the transient flow in pipelines, taking into account the influence of cavitation and free gas. The flow will be conceived of as a three-phase flow of the liquid, its vapour and non-condensible gas. The

  5. Variants of ACAN are associated with severity of lumbar disc herniation in patients with chronic low back pain

    Science.gov (United States)

    Dissanayake, Poruwalage Harsha; Senarath, Upul; Wijayaratne, Lalith Sirimevan; Karunanayake, Aranjan Lional; Dissanayake, Vajira Harshadeva Weerabaddana

    2017-01-01

    Introduction Disc herniation is a complex spinal disorder associated with disability and high healthcare cost. Lumbar disc herniation is strongly associated with disc degeneration. Candidate genes of the aggrecan metabolic pathway may associate with the severity of lumbar disc herniation. Objectives This study evaluated the association of single nucleotide variants (SNVs) of the candidate genes of the aggrecan metabolic pathway with the severity of lumbar disc herniation in patients with chronic mechanical low back pain. In addition, we assessed the in-silico functional analysis of the significant SNVs and association of their haplotypes with the severity of lumbar disc herniation. Methods A descriptive cross sectional study was carried out on 106 patients. Severity of disc herniation and disc degeneration were assessed on T2-weighted mid sagittal lumbar MRI scan. Sixty two exonic SNVs of ten candidate genes of aggrecan metabolic pathway (ACAN, IL1A, IL1B, IL6, MMP3, ADAMTS4, ADAMTS5, TIMP1, TIMP2 and TIMP3) were genotyped on a Sequenom MassARRAY iPLEX platform. Multivariable linear regression analysis was carried out using PLINK 1.9 software adjusting for age, gender, body mass index and severity of disc degeneration. Four online bioinformatics tools (Provean, SIFT, PolyPhen and Mutation Taster) were used for in-silico functional analysis. Results Mean age was 52.42 ± 9.42 years and 69.8% were females. The mean severity of disc herniation was 2.81 ± 1.98. The rs2272023, rs35430524, rs2882676, rs2351491, rs938609, rs3825994, rs1042630, rs698621 and rs3817428 variants and their haplotypes of ACAN were associated with the severity of lumbar disc herniation. However, only the rs35430524, rs938609 and rs3817428 variants of ACAN were detected as pathogenic by in-silico functional analysis. Conclusions SNVs of ACAN and their haplotypes are associated with the severity of lumbar disc herniation. Functional genetic studies are necessary to identify the role of these

  6. Impact of Obesity and Underweight on Surgical Outcome of Lumbar Disc Herniation

    Directory of Open Access Journals (Sweden)

    Farzad Omidi-Kashani

    2014-01-01

    Full Text Available Background. The relationship between underweight and lumbar spine surgery is still unknown. Aim. To evaluate the effect of underweight versus obesity based on surgical outcome of lumbar disc herniation. Material and Method. In this retrospective study, we evaluated 206 patients (112 male and 94 female with a mean age of 37.5±3.1 years old (ranged 20–72 who have been surgically treated due to the refractory simple primary L4-L5 disc herniation. We followed them up for a mean period of 42.4±7.2 months (ranged 24–57. We used Body Mass Index (BMI, Oswestry Disability Index (ODI, and Visual Analogue Scale (VAS for categorization, disability, and pain assessment, respectively. We used Wilcoxon and Mann-Whitney U tests for statistics. Results. Surgical discectomy in all weight groups was associated with significant improvement in pain and disability, but intergroup comparison showed these improvements in both underweight and obese groups and they were significantly lower than in normal weight group. Excellent and good satisfaction rate was also somewhat lower in both these ends of weight spectrum, but statistically insignificant. Conclusion. Both obesity and underweight may have adverse prognostic influences on the surgical outcome of lumbar disc herniation, although their impact on subjective satisfaction rate seems to be insignificant.

  7. Comparison of discectomy versus sequestrectomy in lumbar disc herniation: a meta-analysis of comparative studies.

    Directory of Open Access Journals (Sweden)

    Jisheng Ran

    Full Text Available Lumbar disc removal is currently the standard treatment for lumbar disc herniation. No consensus has been achieved whether aggressive disc resection with curettage (discectomy versus conservative removal of the offending disc fragment alone (sequestrectomy provides better outcomes. This study aims to compare the reherniation rate and clinical outcomes between discectomy and sequestrectomy by literature review and a meta-analysis.A systematic search of PubMed, Medline, Embase and the Cochrane Library was performed up to June 1, 2014. Outcomes of interest assessing the two techniques included demographic and clinical baseline characteristics, perioperative variables, complications, recurrent herniation rate and post-operative functional outcomes.Twelve eligible trials evaluating discectomy vs sequestrectomy were identified including one randomized controlled study, five prospective and six retrospective comparative studies. By contrast to discectomy, sequestrectomy was associated with significantly less operative time (p<0.001, lower visual analogue scale (VAS for low back pain (p<0.05, less post-operative analgesic usage (p<0.05 and better patients' satisfaction (p<0.05. Recurrent herniation rate, reoperation rate, intraoperative blood loss, hospitalization duration and VAS for sciatica were without significant difference.According to our pooled data, sequestrectomy entails equivalent reherniation rate and complications compared with discectomy but maintains a lower incidence of recurrent low back pain and higher satisfactory rate. High-quality prospective randomized controlled trials are needed to firmly assess these two procedures.

  8. The value of MRI and CT in the pre-operative diagnosis of lumbar disc herniation

    Energy Technology Data Exchange (ETDEWEB)

    Hirabayashi, Shigeru; Kumano, Kiyoshi; Takahashi, Soichiro; Ishii, Jun (Kanto Rosai Hospital, Kawasaki, Kanagawa (Japan))

    1991-05-01

    A prospective analysis of computed tomography (CT) and magnetic resonance imaging (MRI) scans in 51 patients with lumbar disc herniation was made to determine the height of hernia for operation and, if impossible, the indications of myelography. Among the 51 patients, 40 (78%) received surgery based on these imaging modalities (Group A); and the remaining 11 (22%) underwent myelography for the confirmation of the height of hernia or detailed examination (Group B). Satisfactory or excellent surgical outcome was achieved in 95% in Group A and in 91% in Group B. Twenty seven patients had multiple disc herniation on CT and MRI; in 17 patients surgery was performed for one disc hernia that was radiologically found to compress the spinal nerve root; and in the other 10 hernia-related disc was not determined by either radiological or neurological manifestations. Satisfactory or excellent surgical outcome could, however, be achieved in 26 patients (96%). Myelography should be indicated when there is no neurological radicular sign in the lower extremities, and when there is no radiological evidence of the compressed spinal nerve root in spite of the presence of multiple disc herniation. The height of hernia may be determined when compression of the spinal nerve root is visualized on CT or MRI. (N.K.).

  9. The debate on most ideal technique for managing recurrent lumbar disc herniation: a short review.

    Science.gov (United States)

    Onyia, Chiazor U; Menon, Sajesh K

    2017-12-01

    Though different techniques have been successfully employed in the treatment of recurrent lumbar disc herniation, the one which should be considered most ideal has remained a controversy, particularly since there are currently no generally accepted guidelines for surgical care. To review previous publications comparing the available operative options, with the aim of determining if any of the available interventions gives better outcomes compared to others. A systematic literature review of previous publications comparing various techniques employed in the surgical treatment of recurrent disc herniation. All publications investigated in this review clearly demonstrated quite comparable outcomes, with no superiority of one method over the other. In view of the currently available data and evidence, minimally invasive techniques for revision of recurrent disc herniation do not really appear to be superior to the conventional open surgical approaches and vice-versa. We suggest the management strategy for surgical treatment of each case of recurrence to be simply based on the experience of the surgeon, the available facilities and equipment. Fusion should not be undertaken in all recurrences but should only be considered as an option for revision when spinal instability, spinal deformity or associated radiculopathy is present.

  10. The Relationship Between Morphology of Lumbar Disc Herniation and MRI Changes in Adjacent Vertebral Bodies

    Directory of Open Access Journals (Sweden)

    Hamed Reyhani Kermani

    2013-12-01

    Full Text Available   Background: Intervertebral disc herniation has two common types, extrusion and protrusion, which may affect the adjacent vertebrae.In addition, it is associated with significant signal changes in T1 MRI (short TR/TE and T2 MRI (long TR/TE.   Methods: The present study is a cross-sectional analytic one, in which sampling was performed retrospectively. Cases were randomly selected from the patients undergoing discectomy in our department in a one-year period. Before surgery, MRI images, T1-weighted and T2-weighted sagittal cuts were interpreted by an expert radiologist. Signal intensity of the upper and the lower adjacent vertebra and the operated herniated disc were compared with the normal discs, both in T1-weighted and T2-weighted. Changes in signal intensity were recorded in qualitative variables. Statistical analysis was then performed between two groups. Results: In the present study, we have evaluated 170 patients undergoing lumbar disc herniation surgery, which included 97 protruded and 86 extruded discs. The patients’ age ranged from 21 to 78 years old, with an average of 43.03 ±11.4 years. Evaluating the type of discopathy with the presence of signal changes (hypo or hyper signal changes demonstrated more signal changes in upper adjacent vertebrae in T2-weighted MRI (45.3%. However, patients with protruded discs showed less changes (30.9%. It showed that the difference was statistically significant (P

  11. Psychometric evaluation of a decision quality instrument for treatment of lumbar herniated disc.

    Science.gov (United States)

    Sepucha, Karen R; Feibelmann, Sandra; Abdu, William A; Clay, Catharine F; Cosenza, Carol; Kearing, Stephen; Levin, Carrie A; Atlas, Steven J

    2012-08-15

    Retrospective and prospective patient surveys and a physician survey using a sample from American Medical Association master file. To evaluate the performance of a new instrument designed to measure the quality of decisions about treatment of herniated disc. There is growing consensus on the importance of engaging and informing patients to improve the quality of significant medical decisions, yet there are no instruments currently available to measure decision quality. The herniated disc-decision quality instrument (HD-DQI) was developed with input from clinical experts, survey research experts, and patients. The HD-DQI produces 2 scores each scaled to 0% to 100%, with higher scores indicating better quality: (1) a total knowledge score and (2) a concordance score (indicating the percentage of patients who received treatments that matched their goals). We examined hypotheses relating to the acceptability, feasibility, validity, and reliability of the instrument, using data from 3 samples. The HD-DQI survey was feasible to implement and acceptable to patients, with good response rates and low missing data. The knowledge score discriminated between patients who had seen a decision aid or no decision aid (55% vs. 38%, P herniated disc. More work is needed to examine acceptability for use as part of routine patient care.

  12. CT-discography; diagnostic accuracy in lumbar disc herniation and significance of induced pain during procedure

    Energy Technology Data Exchange (ETDEWEB)

    Jin, En Hao [Yan Bian Medical College, Beijing (China); Chung, Tae Sub; Jeong, Mi Gyoung; Kim, Young Soo; Roh, Sung Woo [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of)

    1996-01-01

    To evaluate the usefulness and the accuracy of CT-discography in lumbar disc disease by analyzing the findings of CT-discogram and types of evoked pain during the procedure. CT-discograms were retrospectively evaluated in 47 intervertebral discs of 20 patients with multilevel involvement of lumbar disc diseases. In 28 herniated discs confirmed at surgery, the findings of CT-discogram (28 disc levels/20 patients), MRI(23/16) and CT(21/15) were comparatively analysed. The type of pain after infusion of contrast media during CT-discography was compared with that prior to the procedure. The accuracy for determining types of the herniated lumbar disc when compared with post-operative results was 96.4%(27 discs/28 discs) in the CT-discogram, 82.6%(19 discs/23 discs) in MRI and 71.4%(15 discs/21 discs) in the CT scan. Pains encountered during discography were radiating pain in 12 discs and back pain in 24 discs. CT-discography was especially helpful in 10 patients with multilevel involvement of the lumbar disc diseases to evaluate the exact location of diseased disc(s) that provoked the pain. CT-discography is a highly accurate method in diagnosis of the herniated lumbar intervertebral discs and is very useful in determining the precise location related to the development of pain in such cases.

  13. Gd-enhanced MR imaging of the herniated lumbar disc: patterns of enhancement

    Energy Technology Data Exchange (ETDEWEB)

    Kwag, Hyon Joo; Choi, Hye Young; Kim, Hyae Young; Kim, Yoo Kyung; Kim, Ah Young; Chung, Eun Chul [College of Medicine, Ewah Womans University, Seoul (Korea, Republic of)

    1995-07-15

    The purpose of this study is to describe the patterns of enhancement of the herniated lumbar disc with Gd-DTPA enhanced MR imaging. Out of 65 patients, 103 lumbar discs diagnosed to be herniated by MR image were retrospectively analyzed. The MR imaging was performed with 1.5 T MR unit, using T1-and T2-weighted sagittal and axial spin echo techniques. Contrast-enhanced T1 weighted sagittal and axial images were performed after intravenous injection of Gadopentetate-dimeglumine(Magnevist, Shering) (0.1 mmol/kg). Contrast enhancement was seen in 66 cases(64%). Thirteen cases of bulging disc were not enhanced. Twenty-eight cases of protruded disc showed intraannular enchantment in 23 cases, peripheral linear and irregular enhancement in each of one case, and nonenhancement in three cases. Fifty-seven cases of extruded disc showed irregular enhancement in 14 cases, peripheral linear enhancement in 12 cases, peripheral ring enhancement in five cases and intraannular enhancement in five cases. All five cases of sequestered disc showed peripheral ring enhancement. Protruded discs show intraannular enhancement frequently and sequestered discs usually show peripheral ring enhancement. Enhanced MR imaging may be helpful to evaluate the type of herniated lumbar disc and relationship among disc material, nerve root and thecal sac.

  14. Using geographical information system for spatial evaluation of canine extruded disc herniation

    Directory of Open Access Journals (Sweden)

    Constantin Daraban

    2014-11-01

    Full Text Available Disc herniation is one of the most common pathologies of the vertebral column in dogs. The aim of this study was to develop a geographical information system (GIS-based vertebral canal (VC map useful for spatial evaluation of extruded disc herniation (EDH in dogs. ArcGIS® was used to create two-dimensional and three-dimensional maps, in which the VC surface is divided into polygons by lines representing latitude and longitude. Actual locations and directions of the herniated disc material were assessed by a series of 142 computer tomographies of dogs collected between 2005 and 2013. Most EDHs were located on the cervical and transitional regions (thoraco-lumbar and lumbo-sacral and shown at the level of the ven- tro-cranial and ventro-central polygons created. Choropleth maps, highlighting the distribution and the location/direction patterns of the EDHs throughout the VC, were produced based on the frequency of the ailment. GIS proved to be a valuable tool in analysing EDH in dogs. Further studies are required for biomechanical analysis of EDH patterns.

  15. The Relationship Between Morphology of Lumbar Disc Herniation and MRI Changes in Adjacent Vertebral Bodies

    Directory of Open Access Journals (Sweden)

    Hamed Reyhani Kermani

    2013-12-01

    Full Text Available Background: Intervertebral disc herniation has two common types, extrusion and protrusion, which may affect the adjacent vertebrae.In addition, it is associated with significant signal changes in T1 MRI (short TR/TE and T2 MRI (long TR/TE.   Methods: The present study is a cross-sectional analytic one, in which sampling was performed retrospectively. Cases were randomly selected from the patients undergoing discectomy in our department in a one-year period. Before surgery, MRI images, T1-weighted and T2-weighted sagittal cuts were interpreted by an expert radiologist. Signal intensity of the upper and the lower adjacent vertebra and the operated herniated disc were compared with the normal discs, both in T1-weighted and T2-weighted. Changes in signal intensity were recorded in qualitative variables. Statistical analysis was then performed between two groups. Results: In the present study, we have evaluated 170 patients undergoing lumbar disc herniation surgery, which included 97 protruded and 86 extruded discs. The patients’ age ranged from 21 to 78 years old, with an average of 43.03 ±11.4 years. Evaluating the type of discopathy with the presence of signal changes (hypo or hyper signal changes demonstrated more signal changes in upper adjacent vertebrae in T2-weighted MRI (45.3%. However, patients with protruded discs showed less changes (30.9%. It showed that the difference was statistically significant (P

  16. Diagnostics and therapy of spinal disc herniation; Diagnostik und Therapie des Bandscheibenvorfalls

    Energy Technology Data Exchange (ETDEWEB)

    Zimmer, A.; Reith, W. [Universitaetsklinikum des Saarlandes, Klinik fuer Diagnostische und Interventionelle Neuroradiologie, Homburg/Saar (Germany)

    2014-11-15

    Degenerative processes in a movement segment of the vertebral column, which can potentially give rise to herniation of elements of the nucleus pulposus, are complex and of variable clinical and radiological dimensions; however the mere assumption that degenerative changes precede disc herniation remains a matter of debate. By definition, spinal disc herniation (SDH) refers to components of the gelatinous nucleus pulposus protruding beyond the dorsal level of the vertebral body margin through tears in the annulus fibrosus. Clinical presentation may include pain, paresis and sensory disturbances. Magnetic resonance imaging (MRI) is considered the gold standard in the diagnosis of SDH. In the majority of patients a conservative approach with physical therapy exercises and adequate analgesic and antiphlogistic medical treatment results in a substantial improvement of symptoms. (orig.) [German] Degenerative Prozesse eines Bewegungssegments, die in einem Prolaps des Nucleus pulposus resultieren koennen, sind vielschichtig und von unterschiedlicher klinischer und radiologischer Auspraegung. Selbst die Annahme, dass Bandscheibenvorfaellen eine Degeneration vorangeht, ist keineswegs unumstritten. Definitionsgemaess spricht man von einem Bandscheibenvorfall (BSV), wenn das Gewebe des gelatinoesen Nucleus pulposus durch eine Dehiszenz im Anulus fibrosus ueber das Niveau der normalen dorsalen Begrenzung des Bandscheibenfachs hinaus prolabiert. Klinisch kann dies mit Schmerzen, Paresen und Sensibilitaetsstoerungen einhergehen. Die Magnetresonanztomographie gilt als Goldstandard in der Diagnostik eines BSV. In der Mehrzahl der Faelle fuehrt ein konservatives Vorgehen zu einer deutlichen Besserung der Symptomatik im Verlauf. (orig.)

  17. [The delayed OP--indications for surgery of lumbar disc herniations].

    Science.gov (United States)

    Mayer, H M

    2005-01-01

    In Germany, lumbar disc herniations require surgical treatment in about 50,000 patients/year. The clinical and socio-economical results are determined by the preoperative duration of symptoms and preoperative time out of work (highly predictive). Other parameters such as severity of neurological deficits, morphology of disc herniation, age, associated diseases, type of surgery, working conditions or litigation processes are only weak predictors of outcome. Postoperative improvement of clinical symptoms as well as professional reintegration is strongly determined by the time period between onset of symptoms and surgery. Surgery performed "too early" diminishes the chance for improvement by conservative therapy. If surgery is performed "too late" the risk of a bad result is high, and the reintegration of the patient into his preoperative social and professional activities may be prevented. The duration of conservative therapy including so-called semi-invasive procedures is critical in this sense. If a therapeutic success (= professional and social reintegration) cannot be achieved by conservative measures and if there is a clear morphological correlate (= disc herniations with corresponding clinical symptoms) of the clinical symptoms an early change of the strategy towards surgical therapy is recommended.

  18. Brain herniation in a patient with apparently normal intracranial pressure: a case report

    Directory of Open Access Journals (Sweden)

    Dahlqvist Mats B

    2010-08-01

    Full Text Available Abstract Introduction Intracranial pressure monitoring is commonly implemented in patients with neurologic injury and at high risk of developing intracranial hypertension, to detect changes in intracranial pressure in a timely manner. This enables early and potentially life-saving treatment of intracranial hypertension. Case presentation An intraparenchymal pressure probe was placed in the hemisphere contralateral to a large basal ganglia hemorrhage in a 75-year-old Caucasian man who was mechanically ventilated and sedated because of depressed consciousness. Intracranial pressures were continuously recorded and never exceeded 17 mmHg. After sedation had been stopped, our patient showed clinical signs of transtentorial brain herniation, despite apparently normal intracranial pressures (less than 10 mmHg. Computed tomography revealed that the size of the intracerebral hematoma had increased together with significant unilateral brain edema and transtentorial herniation. The contralateral hemisphere where the intraparenchymal pressure probe was placed appeared normal. Our patient underwent emergency decompressive craniotomy and was tracheotomized early, but did not completely recover. Conclusions Intraparenchymal pressure probes placed in the hemisphere contralateral to an intracerebral hematoma may dramatically underestimate intracranial pressure despite apparently normal values, even in the case of transtentorial brain herniation.

  19. Diagnostic accuracy of contemporary multidetector computed tomography (MDCT) for the detection of lumbar disc herniation

    Energy Technology Data Exchange (ETDEWEB)

    Notohamiprodjo, S.; Stahl, R.; Braunagel, M.; Kazmierczak, P.M.; Thierfelder, K.M.; Treitl, K.M.; Wirth, S. [University Hospital of Munich, LMU Munich, Institute for Clinical Radiology, Munich (Germany); Notohamiprodjo, M. [University Hospital Tuebingen, Eberhard Karls University Tuebingen, Diagnostic and Interventional Radiology, Tuebingen (Germany)

    2017-08-15

    To evaluate the diagnostic accuracy of multidetector CT (MDCT) for detection of lumbar disc herniation with MRI as standard of reference. Patients with low back pain underwent indicated MDCT (128-row MDCT, helical pitch), 60 patients with iterative reconstruction (IR) and 67 patients with filtered back projection (FBP). Lumbar spine MRI (1.5 T) was performed within 1 month. Signal-to-noise ratios (SNR) of cerebrospinal fluid (CSF), annulus fibrosus (AF) and the spinal cord (SC) were determined for all modalities. Two readers independently rated image quality (IQ), diagnostic confidence and accuracy in the diagnosis of lumbar disc herniation using MRI as standard of reference. Inter-reader correlation was assessed with weighted κ. Sensitivity, specificity, precision and accuracy of MDCT for disc protrusion were 98.8%, 96.5%, 97.1%, 97.8% (disc level), 97.7%, 92.9%, 98.6%, 96.9% (patient level). SNR of IR was significantly higher than FBP. IQ was significantly better in IR owing to visually reduced noise and improved delineation of the discs. κ (>0.90) was excellent for both algorithms. MDCT of the lumbar spine yields high diagnostic accuracy for detection of lumbar disc herniation. IR improves image quality so that the provided diagnostic accuracy is principally equivalent to MRI. (orig.)

  20. Imaging findings in patients with ventral dural defects and herniation of neural tissue

    Energy Technology Data Exchange (ETDEWEB)

    Baur, A.; Staebler, A.; Reiser, M. [Department of Diagnostic Radiology, Klinikum Grosshadern, Ludwig-Maximilians-Universitaet, Marchioninistrasse 15, D-81 377 Munich (Germany); Psenner, K. [Department of Diagnostic Radiology, Allgemeines Regionalkrankenhaus Bozen (Italy); Hamburger, C. [Department of Neurosurgery, Klinikum Grosshadern, Ludwig-Maximilians-Universitaet, Marchioninistrasse 15, D-81 377 Munich (Germany)

    1997-10-01

    The aim of this paper is to describe clinical and imaging findings in three patients with ventral dural defects and herniation of the spinal cord or cauda equina. The literature is reviewed and the clinical, radiological and operative findings are compared. Three patients with ventral dural defects of different etiologies are presented. One patient gave a longstanding history of ankylosing spondylitis, the second patient presents 37 years after spinal trauma, and the third patient presents with spontaneous spinal cord herniation. All patients had typically slowly progressive neurological symptoms with multiple hospitalizations until diagnosis was made. Characteristic findings in postmyelographic CT included a ventral or ventrolateral displacement with deformation of the spinal cord or the cauda equina. Sagittal MRI showed this abrupt and localized anterior deviation of the spinal cord or the cauda equina to the posterior portions of a vertebral body with or without a bony vertebral defect optimally. Additionally, due to the ventral displacement of the spinal cord, the dorsal subarachnoid space was relatively enlarged without evidence of an arachnoid cyst, in all patients. Magnetic resonance imaging and postmyelographic CT can diagnose ventral dural defects with spinal cord herniation or nerve root entrapment. Dural defects must be considered in the presence of neurological symptoms in cases of longstanding ankylosing spondylitis, late sequelae of fractures of vertebral bodies, and without history of spinal trauma or surgery. (orig.). With 3 figs.

  1. [Clinical observation of post-extension pulling massage in treating lumbar disc herniation].

    Science.gov (United States)

    Lü, Li-Jiang; Ke, Xue-Ai; Mao, Xu-Dan; Chen, Xiao-Jie; Wu, Fang-Chao; Tong, Hong-Jie

    2010-10-01

    To observe the clinical effect of post-extension pulling massage in treating lumbar disc herniation. From January 2008 to December 2008, 61 patients with lumbar disc herniation, 34 males and 27 females, ranging in age from 17 to 67 years with an average of 42.6 years, were treated with post-extension pulling massage after continued traction for 30 minutes (on alternate days one time, 3 times as a course of treatment). There was bulging type in 9 cases, hernia type in 22, free type in 30. After a course of treatment, the clinical effects were evaluated according to standard of Macnab, the items included pain, lumbar activity, normal work and life of patients. All patients were followed up from 1 to 9 months with an average of 4.6 months. After treatment, the symptoms and signs of patients had obviously improved in above aspects. According to standard of Macnab, 48 cases got excellent result, 10 good, 2 fair, 1 poor. The post-extension pulling massage in treating lumbar disc herniation can obtain satisfactory results, which have localized site of action, small compression for vertebral body and can reduce accidental injury.

  2. [Observation on therapeutic effect of electroacupuncture under continuous traction for treatment of lumbar disc herniation].

    Science.gov (United States)

    Chen, Wen; Yang, Ai-tang; Dai, Mei-tang; Fu, Qin-li

    2009-12-01

    To observe the clinical effect of electroacupuncture under continuous traction in prone position for treatment of lumbar disc herniation, to search a better clinical treatment for lumbar disc herniation. The patients were randomly divided into group A (42 cases), group B (39 cases) and group C (38 cases). The acupuncture methods of three groups were the same, Jiaji (EX B 2), Weizhong (BL 40) and Chengshan (BL 57) etc. were selected, and the electroacupuncture was applied as a basic treatment. Continuous traction in prone position and electroacupuncture treatment were used at the same time in group A, group B was treated with supine position traction first and then electroacupuncture treatment, while group C was treated with electroacupuncture only, the therapeutic effects were observed and compared. The effective rate of 95.2% in group A was superior to that of 79.5% in group B and 65.8% in group C (P traction in prone position is a better treatment for lumbar disc herniation.

  3. Right sided traumatic diaphragmatic hernia repair with intrathoracic herniation of liver, stomach and transverse colon

    Directory of Open Access Journals (Sweden)

    Surendra Patel

    2015-07-01

    Full Text Available Traumatic rupture of the right dome of the diaphragm is an uncommon clinical entity. The diagnosis is difficult due to lack of specificity in clinical signs and chest film findings. Clinical incidence of rupture of the right dome of the diaphragm due to blunt trauma is much less common (10% compared to the left (90% and usually associated with more grievous injuries with very high pre hospital mortality thus accounting for rare clinical diagnosis. We report a case of 26 year old male who had the blunt trauma chest referred to us after 7 days of injury with complaints of shortness of breath and vomiting. On investigations the patient was diagnosed as a case of the ruptured right dome of the diaphragm with intrathoracic herniation of the stomach. The patient also had fracture pelvis. Surgical exploration was done through right 6th intercostal space which revealed intrathoracic herniation of the stomach, liver and transverse colon, which were healthy. Contents reduced into the abdomen and diaphragm was repaired. Post operative chest X-ray suggested complete expansion of the right lung with no residual herniation of abdominal contents. Post operative recovery was uneventful with the patient discharged on 14th post operative day.

  4. [Manipulative reduction for lumbar intervertebral disc herniation: a controlled clinical trial].

    Science.gov (United States)

    Zhang, Wei-bin; Cao, Yu; Sun, Yong-an; Wang, Chun-sheng; Wang, Ying; Dong, Shi-long; Ren, Guo-zhong; Yang, Ying-xin; Zhang, Jing-zhong

    2008-04-01

    To investigate the effects of manipulative reduction on pain and clinical curative effect in patients with lumbar intervertebral disc herniation. Eleven thousands one hundred and twenty-eight patients with lumbar intervertebral disc herniation from our hospital were enrolled from November 1986 to June 2007. They were randomly divided into control group and treatment group. Patients of the control group received lumbar traction and various physiotherapies. Patients of the treatment group received manipulative reduction, besides the treatment in the control group. The treatment was performed once a day,ten times as a course. Curative effects were assessed three courses later. Pain was evaluated by visual analogue scale before and after the treatment. No significant difference in the score of visual analogue scale was found before the treatment in the two groups (P > 0.05). As compared with the score before treatment,it was decreased by 4.73 points after treatment in the control group, and decreased by 6.37 points in the treatment group. The decrease was more significant in the treatment group than the control group (P Manipulative reduction for lumbar intervertebral disc herniation can remarkably relieve lumbar pain and improve clinical curative effect.

  5. Compressive Transient Imaging

    KAUST Repository

    Sun, Qilin

    2017-04-01

    High resolution transient/3D imaging technology is of high interest in both scientific research and commercial application. Nowadays, all of the transient imaging methods suffer from low resolution or time consuming mechanical scanning. We proposed a new method based on TCSPC and Compressive Sensing to achieve a high resolution transient imaging with a several seconds capturing process. Picosecond laser sends a serious of equal interval pulse while synchronized SPAD camera\\'s detecting gate window has a precise phase delay at each cycle. After capturing enough points, we are able to make up a whole signal. By inserting a DMD device into the system, we are able to modulate all the frames of data using binary random patterns to reconstruct a super resolution transient/3D image later. Because the low fill factor of SPAD sensor will make a compressive sensing scenario ill-conditioned, We designed and fabricated a diffractive microlens array. We proposed a new CS reconstruction algorithm which is able to denoise at the same time for the measurements suffering from Poisson noise. Instead of a single SPAD senor, we chose a SPAD array because it can drastically reduce the requirement for the number of measurements and its reconstruction time. Further more, it not easy to reconstruct a high resolution image with only one single sensor while for an array, it just needs to reconstruct small patches and a few measurements. In this thesis, we evaluated the reconstruction methods using both clean measurements and the version corrupted by Poisson noise. The results show how the integration over the layers influence the image quality and our algorithm works well while the measurements suffer from non-trival Poisson noise. It\\'s a breakthrough in the areas of both transient imaging and compressive sensing.

  6. The Effect of Lumbar Disc Herniation on Musculoskeletal Loadings in the Spinal Region During Level Walking and Stair Climbing.

    Science.gov (United States)

    Kuai, Shengzheng; Liao, Zhenhua; Zhou, Wenyu; Guan, Xinyu; Ji, Run; Zhang, Rui; Guo, Daiqi; Liu, Weiqiang

    2017-08-10

    BACKGROUND People with low back pain (LBP) alter their motion patterns during level walking and stair climbing due to pain or fear. However, the alternations of load sharing during the two activities are largely unknown. The objective of this study was to investigate the effect of LBP caused by lumbar disc herniation (LDH) on the muscle activities of 17 main trunk muscle groups and the intradiscal forces acting on the five lumbar discs. MATERIAL AND METHODS Twenty-six healthy adults and seven LDH patients were recruited to perform level walking and stair climbing in the Gait Analysis Laboratory. Eight optical markers were placed on the bony landmarks of the spinous process and pelvis, and the coordinates of these markers were captured during the two activities using motion capture system. The coordinates of the captured markers were applied to developed musculoskeletal model to calculate the kinetic variables. RESULTS LDH patients demonstrated higher muscle activities in most trunk muscle groups during both level walking and stair climbing. There were decreases in anteroposterior shear forces on the discs in the pathological region and increases in the compressive forces on all the lumbar discs during level walking. The symmetry of mediolateral shear forces was worse in LDH patients than healthy adults during stair climbing. CONCLUSIONS LDH patients exhibited different kinetic alternations during level walking and stair climbing. However, both adaptive strategies added extra burdens to the trunk system and further increased the risk for development of LDH.

  7. The Effect of Lumbar Disc Herniation on Musculoskeletal Loadings in the Spinal Region During Level Walking and Stair Climbing

    Science.gov (United States)

    Kuai, Shengzheng; Liao, Zhenhua; Zhou, Wenyu; Guan, Xinyu; Ji, Run; Zhang, Rui; Guo, Daiqi; Liu, Weiqiang

    2017-01-01

    Background People with low back pain (LBP) alter their motion patterns during level walking and stair climbing due to pain or fear. However, the alternations of load sharing during the two activities are largely unknown. The objective of this study was to investigate the effect of LBP caused by lumbar disc herniation (LDH) on the muscle activities of 17 main trunk muscle groups and the intradiscal forces acting on the five lumbar discs. Material/Methods Twenty-six healthy adults and seven LDH patients were recruited to perform level walking and stair climbing in the Gait Analysis Laboratory. Eight optical markers were placed on the bony landmarks of the spinous process and pelvis, and the coordinates of these markers were captured during the two activities using motion capture system. The coordinates of the captured markers were applied to developed musculoskeletal model to calculate the kinetic variables. Results LDH patients demonstrated higher muscle activities in most trunk muscle groups during both level walking and stair climbing. There were decreases in anteroposterior shear forces on the discs in the pathological region and increases in the compressive forces on all the lumbar discs during level walking. The symmetry of mediolateral shear forces was worse in LDH patients than healthy adults during stair climbing. Conclusions LDH patients exhibited different kinetic alternations during level walking and stair climbing. However, both adaptive strategies added extra burdens to the trunk system and further increased the risk for development of LDH. PMID:28796755

  8. Transient ischemic attack: definition and natural history.

    Science.gov (United States)

    Caplan, Louis R

    2006-07-01

    The standard definition of a transient ischemic attack--"a cerebral dysfunction of an ischemic nature lasting no longer than 24 hours with a tendency to recur"--was arrived at arbitrarily and is no longer tenable. Experience shows that attacks are much briefer, usually less than an hour, and many are associated with brain infarction. A newer definition, more consonant with the data, is preferred--"transient ischemic attack is a brief episode of neurological dysfunction caused by focal brain or retinal ischemia, with clinical symptoms typically lasting less than an hour, and without evidence of acute infarction." Patients with transient ischemic attacks require urgent evaluation that includes brain and vascular imaging, blood tests, and often cardiac investigations. Treatment will depend on the nature of the causative cervico-cranial vascular, cardiac, and hematologic abnormalities found on investigation.

  9. Transient Exciplex Formation Electron Transfer Mechanism

    Directory of Open Access Journals (Sweden)

    Michael G. Kuzmin

    2011-01-01

    Full Text Available Transient exciplex formation mechanism of excited-state electron transfer reactions is analyzed in terms of experimental data on thermodynamics and kinetics of exciplex formation and decay. Experimental profiles of free energy, enthalpy, and entropy for transient exciplex formation and decay are considered for several electron transfer reactions in various solvents. Strong electronic coupling in contact pairs of reactants causes substantial decrease of activation energy relative to that for conventional long-range ET mechanism, especially for endergonic reactions, and provides the possibility for medium reorganization concatenated to gradual charge shift in contrast to conventional preliminary medium and reactants reorganization. Experimental criteria for transient exciplex formation (concatenated mechanism of excited-state electron transfer are considered. Available experimental data show that this mechanism dominates for endergonic ET reactions and provides a natural explanation for a lot of known paradoxes of ET reactions.

  10. Transient effects in friction fractal asperity creep

    CERN Document Server

    Goedecke, Andreas

    2013-01-01

    Transient friction effects determine the behavior of a wide class of mechatronic systems. Classic examples are squealing brakes, stiction in robotic arms, or stick-slip in linear drives. To properly design and understand mechatronic systems of this type, good quantitative models of transient friction effects are of primary interest. The theory developed in this book approaches this problem bottom-up, by deriving the behavior of macroscopic friction surfaces from the microscopic surface physics. The model is based on two assumptions: First, rough surfaces are inherently fractal, exhibiting roughness on a wide range of scales. Second, transient friction effects are caused by creep enlargement of the real area of contact between two bodies. This work demonstrates the results of extensive Finite Element analyses of the creep behavior of surface asperities, and proposes a generalized multi-scale area iteration for calculating the time-dependent real contact between two bodies. The toolset is then demonstrated both...

  11. Transient Growth of Ekman-Couette Flow

    CERN Document Server

    Shi, Liang; Tilgner, Andreas

    2013-01-01

    Coriolis force effects on shear flows are important in geophysical and astrophysical contexts. We here report a study on the linear stability and the transient energy growth of the plane Couette flow with system rotation perpendicular to the shear direction. External rotation causes linear instability. At small rotation rates, the onset of linear instability scales inversely with the rotation rate and the optimal transient growth in the linearly stable region is slightly enhanced, ~Re^2. The corresponding optimal initial perturbations are characterized by roll structures inclined in the streamwise direction and are twisted under external rotation. At large rotation rates, the transient growth is significantly inhibited and hence linear stability analysis is a reliable indicator for instability.

  12. Retrolisthesis and lumbar disc herniation: a postoperative assessment of patient function.

    Science.gov (United States)

    Kang, Kevin K; Shen, Michael S; Zhao, Wenyan; Lurie, Jon D; Razi, Afshin E

    2013-04-01

    The presence of retrolisthesis has been associated with the degenerative changes of the lumbar spine. However, retrolisthesis in patients with L5-S1 disc herniation has not been shown to have a significant relationship with worse baseline pain or function. Whether it can affect the outcomes after discectomy, is yet to be established. The purpose of this study was to determine the relationship between retrolisthesis (alone or in combination with other degenerative conditions) and postoperative low back pain, physical function, and quality of life. This study was intended to be a follow-up to a previous investigation that looked at the preoperative assessment of patient function in those with retrolisthesis and lumbar disc herniation. Cross-sectional study. Patients enrolled in SPORT (Spine Patient Outcomes Research Trial) who had undergone L5-S1 discectomy and had a complete magnetic resonance imaging scan available for review (n=125). Individuals with anterolisthesis were excluded. Time-weighted averages over 4 years for the Short Form (SF)-36 bodily pain scale, SF-36 physical function scale, Oswestry Disability Index (ODI), and Sciatica Bothersomeness Index (SBI). Retrolisthesis was defined as a posterior subluxation of 8% or more. Disc degeneration was defined as any loss of disc signal on T2 imaging. Modic changes were graded 1 to 3 and collectively classified as vertebral end plate degenerative changes. The presence of facet arthropathy and ligamentum flavum hypertrophy was classified jointly as posterior degenerative changes. Longitudinal regression models were used to compare the time-weighted outcomes over 4 years. Patients with retrolisthesis did significantly worse with regard to bodily pain and physical function over 4 years. However, there were no significant differences in terms of ODI or SBI. Similarly, retrolisthesis was not a significant factor in the operative time, blood loss, lengths of stay, complications, rate of additional spine surgeries, or

  13. Transient FDTD simulation validation

    OpenAIRE

    Jauregui Tellería, Ricardo; Riu Costa, Pere Joan; Silva Martínez, Fernando

    2010-01-01

    In computational electromagnetic simulations, most validation methods have been developed until now to be used in the frequency domain. However, the EMC analysis of the systems in the frequency domain many times is not enough to evaluate the immunity of current communication devices. Based on several studies, in this paper we propose an alternative method of validation of the transients in time domain allowing a rapid and objective quantification of the simulations results.

  14. Transient Astrophysics Probe

    Science.gov (United States)

    Camp, Jordan

    2017-08-01

    Transient Astrophysics Probe (TAP), selected by NASA for a funded Concept Study, is a wide-field high-energy transient mission proposed for flight starting in the late 2020s. TAP’s main science goals, called out as Frontier Discovery areas in the 2010 Decadal Survey, are time-domain astrophysics and counterparts of gravitational wave (GW) detections. The mission instruments include unique imaging soft X-ray optics that allow ~500 deg2 FoV in each of four separate modules; a high sensitivity, 1 deg2 FoV soft X-ray telescope based on single crystal silicon optics; a passively cooled, 1 deg2 FoV Infrared telescope with bandpass 0.6-3 micron; and a set of ~8 small NaI gamma-ray detectors. TAP will observe many events per year of X-ray transients related to compact objects, including tidal disruptions of stars, supernova shock breakouts, neutron star bursts and superbursts, and high redshift Gamma-Ray Bursts. Perhaps most exciting is TAP’s capability to observe X-ray and IR counterparts of GWs involving stellar mass black holes detected by LIGO/Virgo, and possibly X-ray counterparts of GWs from supermassive black holes, detected by LISA and Pulsar Timing Arrays.

  15. Advanced PFBC transient analysis

    Energy Technology Data Exchange (ETDEWEB)

    White, J.S. [Parsons Power Group, Inc., Reading, PA (United States); Bonk, D.L.; Rogers, L. [USDOE Morgantown Energy Technology Center, WV (United States)

    1996-12-31

    Transient modeling and analysis of Advanced Pressurized Fluidized Bed Combustion (PFBC) systems is a research area that is currently under investigative study by the United States Department of Energy`s Morgantown Energy Technology Center (METC). The object of the effort is to identify key operating parameters affecting plant performance and then quantify the basic response of major sub-systems to changes in operating conditions. PC-TRAX, a commercially available dynamic software program, was chosen and applied in this modeling and analysis effort. This paper summarizes and describes the development of a series of TRAX-based transient models of Advanced PFBC power plants. These power plants generate a high temperature flue gas by burning coal or other suitable fuel in a PFBC. The high temperature flue gas supports low-Btu fuel gas or natural gas combustion in a gas turbine topping combustor. When utilized, low-Btu fuel gas is produced in a bubbling bed carbonizer. High temperature, high pressure combustion products exiting the topping combustor are expanded in a modified gas turbine to generate electrical power. Waste heat from the system is used to generate and superheat steam for a reheat steam turbine bottoming cycle that generates additional electrical power. Basic control/instrumentation models were developed and modeled in PC-TRAX and used to investigate off-design plant performance. System performance for various transient conditions and control philosophies was studied.

  16. Advanced PFBC transient analysis

    Energy Technology Data Exchange (ETDEWEB)

    White, J.S. [Parsons Power Group, Inc., Reading, PA (United States); Bonk, D.L. [USDOE Federal Energy Technology Center, Morgantown, WV (United States)

    1997-05-01

    Transient modeling and analysis of advanced Pressurized Fluidized Bed Combustion (PFBC) systems is a research area that is currently under investigation by the US Department of Energy`s Federal Energy Technology Center (FETC). The object of the effort is to identify key operating parameters that affect plant performance and then quantify the basic response of major sub-systems to changes in operating conditions. PC-TRAX{trademark}, a commercially available dynamic software program, was chosen and applied in this modeling and analysis effort. This paper describes the development of a series of TRAX-based transient models of advanced PFBC power plants. These power plants burn coal or other suitable fuel in a PFBC, and the high temperature flue gas supports low-Btu fuel gas or natural gas combustion in a gas turbine topping combustor. When it is utilized, the low-Btu fuel gas is produced in a bubbling bed carbonizer. High temperature, high pressure combustion products exiting the topping combustor are expanded in a modified gas turbine to generate electrical power. Waste heat from the system is used to raise and superheat steam for a reheat steam turbine bottoming cycle that generates additional electrical power. Basic control/instrumentation models were developed and modeled in PC-TRAX and used to investigate off-design plant performance. System performance for various transient conditions and control philosophies was studied.

  17. Analysis and treatment of surgical complications after percutaneous transforaminal endoscopic discectomy for treating lumbar disc herniation and lumbar intervertebral foraminal stenosis

    Directory of Open Access Journals (Sweden)

    Guang HAN

    2016-04-01

    Full Text Available Objective To analyze the causes of surgical complications after treatment of lumbar disc herniation (LDH and lumbar intervertebral foraminal stenosis by percutaneous transforaminal endoscopic discectomy (PTED.  Methods From December 2009 to December 2014, 286 patients with LDH (N = 201 and lumbar intervertebral foraminal stenosis (N = 85 were confirmed by X-ray, CT or MRI and treated by PTED in our hospital. Visual Analogue Scale (VAS was used to evaluate the degree of pain in each paitent before and after operation. The curative effect was evaluated by Macnab score. Surgical complications were recorded to find out the causes and methods to prevent them.  Results All cases were followed up for 3 months, and the VAS score decreased significantly compared with preoperation [1.00 (0.00, 1.05 vs 8.50 (7.75, 9.25; Z = 2.825, P = 0.050]. According to Macnab score, the rate of excellent and good functional recovery was 95.45% (273/286. Procedure-related complications included nerve injury in 8 cases (2.80%, hemorrhage at the operation site and hematoma formation around nerve root in 6 cases (2.10%, rupture of dural sac in one case (0.35%, muscle cramps in 3 cases (1.05%, surgical infection in one case (0.35%, postoperative recurrence in 4 cases (1.40%. All patients with complications were cured after symptomatic treatment. Conclusions The overall effect of percutaneous transforaminal endoscopic discectomy for treating lumbar disc herniation and lumbar intervertebral foraminal stenosis is satisfactory, which has a low incidence rate of postoperative complications. Some tips can effectively reduce the rate of surgical complications such as preoperative evaluation, precise performance, careful hemostasis, shortening the operation time and postoperatively symptomatic treatment, etc. DOI: 10.3969/j.issn.1672-6731.2016.04.007

  18. Effects of six-week exercise training protocol on pain relief in patients with lumbar disc herniation

    Directory of Open Access Journals (Sweden)

    Amir Hossein Yazdani

    2016-02-01

    Full Text Available Introduction: Paraspinal, abdominal, and core muscles are playing the main role in lumbar disc herniation. The aim of the present study was to investigate the efficacy of a 6 weeks exercise training protocol on pain relief in males and females with lumbar disc herniation. Methods: In this before-after trial study, 64 patients with lumbar disc herniation were assigned to a 6 weeks exercise training program. Training protocol included leg press, trunk lateral flexion, trunk rotation, trunk flexion/extension, and stretching exercises in two sessions a week with 25-30 minutes each. Pain was measured with visual analog scale (VAS at 1st, 6th, and 12th sessions. Results: A total of 64 patients (13 males with mean age 47.53 ± 11.71 years and 51 females with mean age 46.50 ± 11.76 years completed the protocol. The pain was significantly reduced in both males and females during sessions 6 and 12 in comparison with the first session (P = 0.001. The amount of pain relief in males was higher than females (P = 0.047. Conclusion: About 6 weeks exercise training program could reduce more pain in males with lumbar disc herniation compared to females. This core stabilizing exercise protocol could be a good recommendation for patients with disk herniated low back pain (LBP.

  19. A Novel Combination of Percutaneous Endoscopic Lumbar Discectomy and Epiduroscopic Laser Neural Decompression for Down-migrated Disc Herniation.

    Science.gov (United States)

    Choi, Kyung-Chul; Lee, Dong Chan; Park, Choon-Keun

    2017-05-01

    Although percutaneous endoscopic lumbar discectomy (PELD) is an effective treatment for herniated discs, its application in a disc with extensive migration is still challenging. As such, epiduroscopic laser neural decompression (ELND) provides a new view of the epidural space as well as an alternative treatment for a herniated disc and epidural fibrosis. In this paper the authors introduce the novel combination of PELD and ELND for high grade down-migrated disc herniation.An 87-year old woman presented with severe pain radiating down her leg due to high grade down-migrated disc herniation at L4-5. The therapeutic plan was organized into 3 steps. First, the patient underwent PELD to remove the paracentral extruded disc and open the epidural space between the traversing nerve root and disc space. Second, ELND was performed to remove the down-migrated disc and simultaneously push the free fragment to the L4-5 disc space. Lastly, repetitive free fragments were picked up and streamed upward using ELND. The patient reported significant reduction of pain after surgery. Postoperative magnetic resonance imaging (MRI) showed complete removal of the ruptured disc fragment. A combination of PELD and ELND may be an option of treatments for down-migrated disc herniation.

  20. Radiographic Markers of Femoroacetabular Impingement: Correlation of Herniation Pit and Femoral Bump with a Positive Cross-Over Ratio

    Directory of Open Access Journals (Sweden)

    Max J. Scheyerer

    2014-01-01

    Full Text Available Introduction. The goal of this study was to research the association of femoral bumps and herniation pits with the overlap-ratio of the cross-over sign. Methods. Pelvic X-rays and CT-scans of 2925 patients with good assessment of the anterior and the posterior acetabular wall and absence of neutral pelvic tilt were enrolled in the investigation. Finally pelvic X-rays were assessed for the presence of a positive cross-over sign, and CT-scans for a femoral bump or a herniation pit. Additionally, if a positive cross-over sign was discovered, the overlap-ratio was calculated. Results. A femoral bump was found in 53.3% (n=1559, and a herniation pit in 27.2% (n=796 of all hips. The overlap-ratio correlated positively with the presence of a femoral bump, while a negative correlation between the overlap-ratio and the presence of a herniation pit was found. The latter was significantly more often combined with a femoral bump than without. Conclusions. We detected an increased prevalence of femoral bump with increasing overlap-ratios of the cross-over sign indicating a relation to biomechanical stress. The observed decreased prevalence of herniation pits with increasing overlap-ratios could be explained by reduced mechanical stress due to nontightened iliofemoral ligament in the presence of retroversion of the acetabulum.

  1. Granulocytic sarcoma: a rare cause of sciatica.

    Science.gov (United States)

    Valsamis, Epaminondas Markos; Glover, Thomas Edward

    2017-02-15

    We describe a case report of a man aged 56 years with a 4-month history of right-sided sciatica-type pain with subclinical disc prolapse evident on MRI. Worsening pain together with the appearance of a tender mass in his right buttock prompted further imaging, which demonstrated an infiltrative mass engulfing the lumbosacral plexus. This was later shown to be a granulocytic sarcoma on biopsy. Intervertebral disc herniation can be an incidental finding and is not always the cause of sciatica. 2017 BMJ Publishing Group Ltd.

  2. Idiopathic Lumbar Epidural Lipomatosis Mimicking Disc Herniation: A Case Report

    Directory of Open Access Journals (Sweden)

    EFE Duran

    2016-05-01

    Full Text Available Spinal epidural lipomatosis is a rare condition which is described as the accumulation of fat in the extradural territory and often causes dural impingement. Spinal epidural lipomatosis has been implicated in causing a variety of neurologic impairments ranging from back pain, radiculopathy, claudication, myelopathy or even cauda equina syndrome. We report a 46-year-old female with obesity and a history of chronic back pain and radiculopathy who developed idiopathic Spinal epidural lipomatosis diagnosed by magnetic resonance imaging. The purpose of this report is to present a case of spinal epidural lipomatosis presenting with symptomatic cord compression and also remind this rare condition as a the differential diagnosis of epidural lesions in patients with risk factors.

  3. Modelling and transient simulation of water flow in pipelines using WANDA Transient software

    Directory of Open Access Journals (Sweden)

    P.U. Akpan

    2017-09-01

    Full Text Available Pressure transients in conduits such as pipelines are unsteady flow conditions caused by a sudden change in the flow velocity. These conditions might cause damage to the pipelines and its fittings if the extreme pressure (high or low is experienced within the pipeline. In order to avoid this occurrence, engineers usually carry out pressure transient analysis in the hydraulic design phase of pipeline network systems. Modelling and simulation of transients in pipelines is an acceptable and cost effective method of assessing this problem and finding technical solutions. This research predicts the pressure surge for different flow conditions in two different pipeline systems using WANDA Transient simulation software. Computer models were set-up in WANDA Transient for two different systems namely; the Graze experiment (miniature system and a simple main water riser system based on some initial laboratory data and system parameters. The initial laboratory data and system parameters were used for all the simulations. Results obtained from the computer model simulations compared favourably with the experimental results at Polytropic index of 1.2.

  4. Familial Transient Global Amnesia

    Directory of Open Access Journals (Sweden)

    R.Rhys Davies

    2012-12-01

    Full Text Available Following an episode of typical transient global amnesia (TGA, a female patient reported similar clinical attacks in 2 maternal aunts. Prior reports of familial TGA are few, and no previous account of affected relatives more distant than siblings or parents was discovered in a literature survey. The aetiology of familial TGA is unknown. A pathophysiological mechanism akin to that in migraine attacks, comorbidity reported in a number of the examples of familial TGA, is one possibility. The study of familial TGA cases might facilitate the understanding of TGA aetiology.

  5. Studies on an Electromagnetic Transient Model of Offshore Wind Turbines and Lightning Transient Overvoltage Considering Lightning Channel Wave Impedance

    Directory of Open Access Journals (Sweden)

    Li Zhang

    2017-12-01

    Full Text Available In recent years, with the rapid development of offshore wind turbines (WTs, the problem of lightning strikes has become more and more prominent. In order to reduce the failure rate caused by the transient overvoltage of lightning struck offshore WTs, the influencing factors and the response rules of transient overvoltage are analyzed. In this paper, a new integrated electromagnetic transient model of offshore WTs is established by using the numerical calculation method of the electromagnetic field first. Then, based on the lightning model and considering the impedance of the lightning channel, the transient overvoltage of lightning is analyzed. Last, the electromagnetic transient model of offshore WTs is simulated and analyzed by using the alternative transients program electro-magnetic transient program (ATP-EMTP software. The influence factors of lightning transient overvoltage are studied. The main influencing factors include the sea depth, the blade length, the tower height, the lightning flow parameters, the lightning strike point, and the blade rotation position. The simulation results show that the influencing factors mentioned above have different effects on the lightning transient overvoltage. The results of the study have some guiding significance for the design of the lightning protection of the engine room.

  6. Dorsal Cervical Spinal Cord Herniation Precipitated by Kyphosis Deformity Correction for Spinal Cord Tethering.

    Science.gov (United States)

    Heller, Robert S; Hwang, Steven W; Riesenburger, Ron I

    2017-04-01

    Cervical spinal cord herniation is a rare clinical entity. Reported after previous intradural surgery or surgery complicated by durotomy, patients return several months to years later with symptoms of worsening myelopathy. Herein is presented a case of a 51-year-old female patient with spinal cord herniation in the cervical spine after kyphosis deformity correction. A 51-year old female patient presented to the neurosurgery clinic with worsening cervical myelopathy due to cervical spinal cord tethering and adhesions from previous intradural surgery for Chiari malformation. Conservative treatment initially was recommended but ultimately unsuccessful, as her neurologic function continued to deteriorate. Follow-up imaging demonstrated progressive cervical kyphotic deformity with stability of the tethered spinal cord. The patient underwent cervical deformity correction to reduce tension on the spinal cord, after which her neurologic symptoms stabilized and began to improve with physical therapy. Four months after surgery, she returned to clinic with recurrence of cervical myelopathy. Repeat imaging demonstrated herniation of the cervical spinal cord through a dorsal defect, and the patient was treated successfully with a wide cervical duraplasty to recreate an intact thecal sac. The inability of the spinal cord to compensate for changes in spinal alignment in cases of tethering makes it susceptible to increased pressure and tension at the point of tethering. Caution is urged when attempting deformity correction in the presence of spinal cord tethering, which may limit the capacity of the spinal cord and surrounding tissue to compensate for alterations in spinal alignment. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. [Lumbar disc herniation treated with Shu-needle therapy and ozone injection of low concentration].

    Science.gov (United States)

    Zhang, Yin-Chuan; Xu, Ying-Ying; Yang, Shuang-E; Bao, Shou-Qian; Zhang, Ling

    2012-09-01

    To verify the efficacy on lumbar disc herniation treated with Shu-needle therapy in combination with ozone injection of low concentration. One hundred and thirty cases of lumbar disc herniation were randomized into a Shu-needle therapy group and an acupotomy group, 65 cases in each one. In the Shu-needle therapy group, Shu-needle therapy was used in combination with ozone injection of low concentration. In the acupotomy group, the conventional acupotomy therapy was applied in combination with ozone injection of low concentration. The treatment was given once every 10 days, 3 treatments made one session. After one session treatment, the clinical efficacy of two groups was observed, scores of visual analogue scale (VAS) and Oswestry disability index (ODI) were counted before and after treatment. The long-term efficacy was followed up in half a year. The clinical curative rate was 69.2% (45/65) and the total effective rate was 96.9% (63/65) in the Shu-needle therapy group. The curative rate was 43.1% (28/65) and the total effective rate was 84.6% (55/65) in the acupotomy group. In comparison, the efficacy of the Shu-needle therapy group was superior to that of the acupotomy group (P therapy group were superior to those in the acupotomy group (both P therapy group was lower than that in the acupotomy group [17.8% (8/45) vs 46.4% (13/28), P therapy in combination with ozone injection of low concentration achieves the superior efficacy on lumbar disc herniation as compared with the acupotomy group.

  8. Identifying predisposing factors for recurrence after successful surgical treatment of lumbar disc herniation

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    Farzad Omidi-Kashani

    2016-01-01

    Full Text Available Background: Recurrent lumbar disc herniation (rLDH comprises one of the most common complications of lumbar discectomy occurring in about 1-21% of the operated patients. Aim: This study aims to elucidate the role of predisposing factors in producing rLDH in the patients with previous successful lumbar discectomy. Materials and Methods: In this retrospective study, we reviewed 213 patients (133 male; 62% who underwent simple primary lumbar discectomy in our Orthopedic Department from August 2009 to January 2014. Mean age and follow-up period were 38.1 ± 9.8 years and 48.2 ± 7.3 months, respectively. The term of rLDH referred to those cases who have suffered a relapsed sciatalgia after a primary pain improvement period. We repeated magnetic resonance imaging (MRI scanning only in those cases with recurrent complaints. Chi-square, Fisher, and Student's t-tests were used for statistics. Results: Recurrent sciatalgia occurred in 39 patients (18.3%, while true rLDH on MRI scanning was detected in 32 patients (15%. Younger age, heavier smoking, and less severity of herniation on primary MRI scanning (protrusion vs. sequestration play as predisposing roles in creating rLDH, while gender, level or side of LDH, the presence of Modic changes, or body mass index (BMI have no significant effect. The most common sites of rLDH were same level same side, different level, and same level contra-lateral side, respectively. Conclusion: In the patients who had been successfully treated by simple primary lumbar discectomy, younger age, heavier smoking state, and less protrusion of the herniated disc at the time of the index surgery, were all correlated with more probability of the future rLDH, while BMI, Modic change, sex, level, and side of LDH had no significant role.

  9. MR findings of the transligamentous type of the herniated lumbar disc

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    Kang, Byung Chul; Kim, Dong Ik; Yoon, Choon Sik; Suh, Jung Ho [College of Medicine, Yonsei University, Seoul (Korea, Republic of)

    1994-03-15

    The purpose of this study is to describe the findings of the transligamnetous type of the herniated lumbar disc (HLD) with magnetic resonance MR imaging. We retrospectively analyzed the MR images of surgically proven 20 cases of transligamentous type of HLD from January 1, 1992 to August 20, 1992. The MR imaging was performed with 1.0T MR unit, using sagittal spin echo (SE) and axial gradient echo (GE) techniques. The results were as follows; 1) the interruption of black line of the posterior longitudinal ligament (PLL) was identified in 19 levels and 17 levels in sagittal SE and axial GE images, retrospectively; 2) the widening of adjacent epidural fat space was demonstrated in 16 cases of central or posterolateral HLD. The herniated disc material, as compared with the parent intervertebral disc, showed intermediate signal intensity (SI) in 19 and low SI in 1 level on T1WI, high SI in 10, intermediate SI in 7, low SI in levels on T2WI, and high SI in 10, intermediate SI in 9, low SI in 1 level on GE images. The most important sign of the transligamentous type HLD on MRI was the interruption of the black line with additional finding of the widening of adjacent epidural fat space. The MR signal intensity of the herniated disc was variable. Axial GE image was valuable for the evaluation of the direction of HLD and it relationship with neural structure, but had no addiational information for the degree and biochemical change of HLD over SE image.

  10. Treatment of Contained Herniated Lumbar Discs With Ozone and Corticosteroid: A Pilot Clinical Study.

    Science.gov (United States)

    Murphy, Kieran; Muto, Mario; Steppan, Jim; Meaders, Thomas; Boxley, Chett

    2015-11-01

    The primary objective of this pilot study was to compare pain and function scores from patients before and after an ozone injection in combination with steroids and bupivacaine to treat herniated discs. A secondary objective was to correct some of the methodological weaknesses of some previously published ozone studies. Fifty patients were enrolled; 1-3 mL of 2 wt% ozone in 98 wt% oxygen was delivered into the nucleus pulposus, and 7-9 mL into the adjacent paravertebral tissues. The oxygen/ozone treatment was followed by a periganglionic injection of corticosteroid and bupivacaine. All patients were evaluated 1 month after the treatment to quantify improvement in pain and function, and to monitor for potential adverse events. Forty-four patients had intradiscal injections and were included in the analysis. After 1 treatment, 75.0% showed significant improvement in pain based on the visual analog scale (improvement >1.8), 72.7% showed significant improvement in function based on the Oswestry disability index (improvement >15%), and 79.5% showed improvement based on the modified MacNab criteria. There were no adverse events associated with the treatment. Patients showed significant improvement in pain and function after receiving ozone injections in combination with steroids and bupivacaine for the treatment of herniated discs. Because of the lack of a control group and short follow-up times, conclusions about the safety and efficacy of ozone injections for the treatment of herniated discs are not warranted. However, the results provide sufficient evidence that the risk and expense of an additional randomized controlled study is merited. Copyright © 2015 Canadian Association of Radiologists. Published by Elsevier Inc. All rights reserved.

  11. Radiological analysis of upper lumbar disc herniation and spinopelvic sagittal alignment.

    Science.gov (United States)

    Bae, Junseok; Lee, Sang-Ho; Shin, Sang-Ha; Seo, Jin Suk; Kim, Kyeong Hwan; Jang, Jee-Soo

    2016-05-01

    A retrospective cross-sectional study was designed to explore the role of spinopelvic sagittal alignment in upper lumbar disc herniation (ULD) development. A total of 207 consecutive patients who underwent surgery for single-level lumbar disc herniation [24 with ULD and 183 with lower lumbar disc herniation (LLD)] and 40 asymptomatic volunteers were enrolled. Full-length radiographs of the spine were taken to evaluate pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), thoracic kyphosis (TK), lumbar lordosis (LL), and sagittal vertical axis (SVA). The Roussouly classification was utilized to categorize all subjects according to their sagittal alignment. Spinopelvic parameters and Roussouly classification results were compared between groups. There were significant differences in PI, SS, PT, LL, and SVA between the ULD, LLD, and control groups. PI in the ULD (40.9°) was significantly lower than in the LLD and control groups (48.8° and 47.6°, respectively). LL was significantly lower in the ULD than in the LLD (-32.4° and -40°, respectively). There were significant differences between the three groups in Roussouly types. The LLD had a significantly higher proportion (62.6 %) of type 2 lordosis (flat back), and the ULD had a higher proportion (33.3 %) of type 1 lordosis than the other groups. This study demonstrated the importance of PI and lumbar curvature in the pathogenesis of ULD. The higher prevalence of short LL and long TK with low PI in the ULD group implies that an increased mechanical stress at this level may be one of the risk factors of ULD.

  12. Assessment of sexual dysfunction before and after surgery for lumbar disc herniation.

    Science.gov (United States)

    Akbaş, Naz B; Dalbayrak, Sedat; Külcü, Duygu G; Yilmaz, Mesut; Yilmaz, Tevfik; Naderi, Sait

    2010-11-01

    Object Sexuality is an important aspect of human life. Sexual activity may be affected in lumbar disc herniation through different mechanisms. The aim of this study is to evaluate patients' sexual problems and sexual behavior patterns before and after surgical treatment of lumbar disc herniation. Methods Forty-three patients were included in the study (mean age 41.4 years). A visual analog scale, the Oswestry Disability Index, the Hospital Anxiety and Depression Scale, and a sexuality assessment questionnaire developed for this study were administered to the patients to evaluate pain and sexual dysfunction. Results Fifty-five percent of the men and 84% of the women reported experiencing sexual problems after the onset of low-back pain. The most common sexual problems were decreased sexual desire (18%) and premature ejaculation together with erectile dysfunction (18%) for the male patients, and decreased sexual desire (47%) for the female patients. The frequency of sexual intercourse before the operation was reduced in 78% of cases compared with the pain-free period. Postoperatively, the patients first attempted sexual intercourse a mean of 26.5 days after surgery. The frequency of intercourse was found to have increased (p = 0.01), while description of any type of sexual problem had decreased (p = 0.005) significantly. Conclusions Lumbar disc herniation has negative effects on sexual life, and not enough attention is given to the patients' sexual problems by the physicians. Decreased sexual desire and decreased sexual intercourse are the most commonly reported problems. Taking time during examination and giving simple recommendations may improve sexuality and life quality of the patients.

  13. Effectiveness of lumbar traction with routine conservative treatment in acute herniated disc syndrome.

    Science.gov (United States)

    Rattanatharn, Rattana; Sanjaroensuttikul, Nopawan; Anadirekkul, Preeyanuch; Chaivisate, Rungtip; Wannasetta, Wanthanee

    2004-09-01

    To assess the effectiveness of lumbar traction with routine conservative treatment in acute herniated disc syndrome. Randomized double-blind controlled trial. Outpatient clinic of physical medicine and rehabilitation. 120 participants who met the diagnostic criteria of acute herniated disc syndrome were randomized into two groups. The study group received treated traction, and the control group received sham traction. All patients had routine conservative treatments (consisting of NSAIDs, instruction of proper back activity and precaution, back exercise, and heat modality). The main outcome measurement was the Oswestry score, which was collected on the first day and at the 4th week of the treatment. At the end of the study, all patients recorded global improvement and satisfaction. Of 120 patients divided into two groups equally, 12 and 6 cases in the control and intervention groups dropped out of the study. The mean (SD) change of the Oswestry score were 19.25 (15.9) and 25.25 (16.68) in control and intervention groups respectively. There was no significant difference between the two groups with the p-value of 0.067 and 95%CI of - 0.42-12.43. Approximately 89% of patients in each group had improvement of their symptoms, and 90% in each group were satisfied with lumbar traction. Co-intervention with heat modality, NSAIDs use and back exercise did not differ between the two groups. The data do not support the benefit of traction for patients with acute herniated disc syndrome. The patient can be conservatively treated at home with proper instruction.

  14. The occurrence and regional distribution of DR4 on herniated disc cells: a potential apoptosis pathway in lumbar intervertebral disc.

    Science.gov (United States)

    Zhang, Liang; Niu, Tao; Yang, Shang-You; Lu, Zhenhua; Chen, Bohua

    2008-02-15

    Intervertebral discs surgically obtained from 60 herniated patients and 5 normal individuals were examined to correlate the regional distribution of DR4-receptor and apoptosis. To explore the role of a tumor necrosis factor superfamily member DR4 and the TRAIL/DR4 mediated apoptosis in the human lumbar intervertebral disc. The pathogenesis of lumbar degenerative intervertebral discs remains not completely understood. In herniated lumbar disc tissues, increased apoptosis and higher expression of Fas/Fas ligand and caspase-3 have been reported, suggesting a pivotal role of apoptotic mechanisms in intervertebral disc degeneration. However, it is not clear that apoptosis mediators such as TRAIL and Death Receptor 4 (DR4), which often represent different apoptosis signal pathways, contribute to the apoptosis process during the development of the degenerated intervertebral discs. Apoptosis was determined by poly(ADP-ribose) polymerase (PARP) p85 immunohistochemistry. Expression of DR4 was revealed by immunohistochemistry analysis. Statistical difference among groups was analyzed using one-way ANOVA with LSD post hoc multiple comparisons and the bivariate correlations. Apoptotic cells were detected in the nucleus pulposus and anulus fibrosus of all samples. However, the number of apoptotic cells was significantly higher in the nucleus compared with the anulus. Further, there were significantly more apoptotic cells in the herniated discs compared with the normal discs. Within herniated discs, a remarkably higher percentage of positive staining cells were detected in the uncontained discs than the contained ones. Strong expression of DR4 was detected in all samples of degenerative herniated discs, whereasmuch weaker expression was sporadically identified in normal discs. In addition, the prevalence of apoptosis positively correlated with the severity of disc degeneration. The concomitant increase of DR4 expression in the regions of heavy apoptotic cell aggregation suggests

  15. Acute gastric incarceration from thoracic herniation in pregnancy following laparoscopic antireflux surgery

    DEFF Research Database (Denmark)

    Brygger, Louise; Fristrup, Claus Wilki; Severin Gråe Harbo, Frederik

    2013-01-01

    in the index pregnancy, she had undergone laparoscopic antireflux surgery (ARS) for a hiatus hernia because of severe gastro-oesophageal reflux. Owing to increasing epigastric pain a CT scan was carried out which diagnosed wrap disruption with gastric herniation into the thoracic cavity and threatened......Diaphragmatic hernia is a rare complication in pregnancy which due to misdiagnosis or management delays may be life-threatening. We report a case of a woman in the third trimester of pregnancy who presented with sudden onset of severe epigastric and thoracic pain radiating to the back. Earlier...

  16. Pulmonary sequestration mimicking a pancreas herniation in a case of recurrent Bochdalek hernia.

    Science.gov (United States)

    Joliat, Gaëtan-Romain; Perentes, Jean Yannis; Ris, Hans-Beat; Halkic, Nermin

    2017-01-01

    In the reported scenario, the patient known for a history of operated Bochdalek hernia or congenital diaphragmatic hernia (CDH) presented with new abdominal pain. The CT-scan suspected the presence of pancreas herniation through a recurrent CDH. Intraoperatively, the patient was found to have a recurrent CDH containing greater omentum concomitantly with a pulmonary sequestration (PS). This case report highlights the fact that intraoperative findings can be different from preoperative radiological diagnosis. In this patient the unusual diaphragmatic hernia content was not identified on preoperative CT.

  17. Herniated lumbar disc surgery in triathlon athletes with intraoperative neurophysiologic monitoring

    Directory of Open Access Journals (Sweden)

    Luciano Miller Reis Rodrigues

    2011-12-01

    Full Text Available Intraoperative neurophysiologic monitoring was performed in a patient by somatosensory evoked potential, motor evoked potential and free-running electromyography with intraoperative stimulation. It was verified that after decompression, there was an increase in the amplitude of motor evoked potential responses, showing an immediate improvement of the treated levels. Intraoperative neurophysiologic monitoring for surgical lumbar disc herniation in an athlete allowed a dynamic neurophysiological diagnosis, differentiation of the involvement of compression at the central or foraminal levels, and clinical awareness of the iatrogenic damage, thereby increasing safety.

  18. Conus medullaris syndrome due to an intradural disc herniation: A case report

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    Chaudhary Kshitij

    2008-01-01

    Full Text Available A 70-year-old male patient developed acute paraplegia due to conus medullaris compression secondary to extrusion of D12-L1 disc. After negative epidural examination intraoperatively, a durotomy was performed and an intradural disc fragment was excised. Patient did not regain ambulatory status at two-year follow-up. Intraoperative finding of negative extradural compression, tense swollen dura and CSF leak from ventral dura should alert the surgeon for the possibility of intradural disc herniation. A routine preoperative MRI is misleading and a high index of suspicion helps to avoid a missed diagnosis.

  19. Transient dimers of allergens.

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    Juha Rouvinen

    Full Text Available BACKGROUND: Allergen-mediated cross-linking of IgE antibodies bound to the FcepsilonRI receptors on the mast cell surface is the key feature of the type I allergy. If an allergen is a homodimer, its allergenicity is enhanced because it would only need one type of antibody, instead of two, for cross-linking. METHODOLOGY/PRINCIPAL FINDINGS: An analysis of 55 crystal structures of allergens showed that 80% of them exist in symmetric dimers or oligomers in crystals. The majority are transient dimers that are formed at high protein concentrations that are reached in cells by colocalization. Native mass spectrometric analysis showed that native allergens do indeed form transient dimers in solution, while hypoallergenic variants of them exist almost solely in the monomeric form. We created a monomeric Bos d 5 allergen and show that it has a reduced capability to induce histamine release. CONCLUSIONS/SIGNIFICANCE: The results suggest that dimerization would be a very common and essential feature for allergens. Thus, the preparation of purely monomeric variants of allergens could open up novel possibilities for specific immunotherapy.

  20. Transient regional osteoporosis

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    F. Trotta

    2011-09-01

    Full Text Available Transient osteoporosis of the hip and regional migratory osteoporosis are uncommon and probably underdiagnosed bone diseases characterized by pain and functional limitation mainly affecting weight-bearing joints of the lower limbs. These conditions are usually self-limiting and symptoms tend to abate within a few months without sequelae. Routine laboratory investigations are unremarkable. Middle aged men and women during the last months of pregnancy or in the immediate post-partum period are principally affected. Osteopenia with preservation of articular space and transitory edema of the bone marrow provided by magnetic resonance imaging are common to these two conditions, so they are also known by the term regional transitory osteoporosis. The appearance of bone marrow edema is not specific to regional transitory osteoporosis but can be observed in several diseases, i.e. trauma, reflex sympathetic dystrophy, avascular osteonecrosis, infections, tumors from which it must be differentiated. The etiology of this condition is unknown. Pathogenesis is still debated in particular the relationship with reflex sympathetic dystrophy, with which regional transitory osteoporosis is often identified. The purpose of the present review is to remark on the relationship between transient osteoporosis of the hip and regional migratory osteoporosis with particular attention to the bone marrow edema pattern and relative differential diagnosis.

  1. Transient central diabetes insipidus following ischemic stroke

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    Muthukrishnan Jayaraman

    2013-01-01

    Full Text Available Central Diabetes Insipidus (CDI following ischemic infarction of the brain has been described as a rare presentation. Posterior pituitary ischemia has also been postulated as a possible cause of idiopathic CDI. We encountered a young male with bilateral extensive ischemic infarction sustained at high altitude, who had transient polyuria due to central diabetes insipidus, requiring desmopressin therapy. DI completely resolved during the course of his neurological recovery.

  2. Interlaminar discectomy in lumbar disc herniation: shorten postoperative return to work period in recruits undergoing military training.

    Science.gov (United States)

    Celik, Haydar; Derincek, Alihan; Arslanoglu, Atilla

    2008-09-01

    The operative treatment of lumbar disc disease has long challenged spine surgeons. In this study, we aimed to show that recruits with lumbar disc herniation managed by the interlaminar approach could return to work after 6 weeks. Forty male recruits were included in this study and interlaminar discectomy was adequate in 40 cases. Early postoperative rehabilitation had a positive effect on early return to work. We believe that interlaminar lumbar discectomy is an effective technique for treating patients with herniated lumbar discs; with early postoperative rehabilitation, recruits can return to work 6 weeks after surgery.

  3. Experience in Nonsurgical Treatment of Patients with Intervertebral Disc Protrusions and Herniated Discs Combined with Lumbar Instability

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    O.Ye. Pashkov

    2015-02-01

    Full Text Available An analysis of the data from 40 patients with instability and herniated disc in the lumbar spine has been carried out. The short-term (1 month and long-term (1.5 years results of conservative treatment were analyzed, and also the nature and characteristics of their course in the early and late periods were examined. Combined use of manual therapy and traction is not allowed as a method of conservative treatment for disc herniation associated with instability. Rehabilitation of the patient (targeted recovery of reliability of the spine functioning under physiological, common and industrial loads is advisable.

  4. Single Event Transients in Linear Integrated Circuits

    Science.gov (United States)

    Buchner, Stephen; McMorrow, Dale

    2005-01-01

    On November 5, 2001, a processor reset occurred on board the Microwave Anisotropy Probe (MAP), a NASA mission to measure the anisotropy of the microwave radiation left over from the Big Bang. The reset caused the spacecraft to enter a safehold mode from which it took several days to recover. Were that to happen regularly, the entire mission would be compromised, so it was important to find the cause of the reset and, if possible, to mitigate it. NASA assembled a team of engineers that included experts in radiation effects to tackle the problem. The first clue was the observation that the processor reset occurred during a solar event characterized by large increases in the proton and heavy ion fluxes emitted by the sun. To the radiation effects engineers on the team, this strongly suggested that particle radiation might be the culprit, particularly when it was discovered that the reset circuit contained three voltage comparators (LM139). Previous testing revealed that large voltage transients, or glitches appeared at the output of the LM139 when it was exposed to a beam of heavy ions [NI96]. The function of the reset circuit was to monitor the supply voltage and to issue a reset command to the processor should the voltage fall below a reference of 2.5 V [PO02]. Eventually, the team of engineers concluded that ionizing particle radiation from the solar event produced a negative voltage transient on the output of one of the LM139s sufficiently large to reset the processor on MAP. Fortunately, as of the end of 2004, only two such resets have occurred. The reset on MAP was not the first malfunction on a spacecraft attributed to a transient. That occurred shortly after the launch of NASA s TOPEX/Poseidon satellite in 1992. It was suspected, and later confirmed, that an anomaly in the Earth Sensor was caused by a transient in an operational amplifier (OP-15) [KO93]. Over the next few years, problems on TDRS, CASSINI, [PR02] SOHO [HA99,HA01] and TERRA were also attributed

  5. Transient Neonatal Zinc Deficiency Caused by a Heterozygous G87R Mutation in the Zinc Transporter ZnT-2 (SLC30A2 Gene in the Mother Highlighting the Importance of Zn2+ for Normal Growth and Development

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    Maria Consolata Miletta

    2013-01-01

    Full Text Available Suboptimal dietary zinc (Zn2+ intake is increasingly appreciated as an important public health issue. Zn2+ is an essential mineral, and infants are particularly vulnerable to Zn2+ deficiency, as they require large amounts of Zn2+ for their normal growth and development. Although term infants are born with an important hepatic Zn2+ storage, adequate Zn2+ nutrition of infants mostly depends on breast milk or formula feeding, which contains an adequate amount of Zn2+ to meet the infants’ requirements. An exclusively breast-fed 6 months old infant suffering from Zn2+ deficiency caused by an autosomal dominant negative G87R mutation in the Slc30a2 gene (encoding for the zinc transporter 2 (ZnT-2 in the mother is reported. More than 20 zinc transporters characterized up to date, classified into two families (Slc30a/ZnT and Slc39a/Zip, reflect the complexity and importance of maintaining cellular Zn2+ homeostasis and dynamics. The role of ZnTs is to reduce intracellular Zn2+ by transporting it from the cytoplasm into various intracellular organelles and by moving Zn2+ into extracellular space. Zips increase intracellular Zn2+ by transporting it in the opposite direction. Thus the coordinated action of both is essential for the maintenance of Zn2+ homeostasis in the cytoplasm, and accumulating evidence suggests that this is also true for the secretory pathway of growth hormone.

  6. Minimally invasive surgical procedures for the treatment of lumbar disc herniation

    Directory of Open Access Journals (Sweden)

    Raspe, Heiner

    2005-11-01

    as an intermediate therapeutical option between conservative and operative management of small lumbar disc herniations or protrusions causing sciatica. Two RCT comparing transforaminal endoscopic procedures with microdiscectomy in patients with sciatica and small non-sequestered disc herniations show comparable short and medium term overall success rates. Concerning speed of recovery and return to work a trend towards more favourable results for the endoscopic procedures is noted. It is doubtful though, whether these results from the eleven and five years old studies are still valid for the more advanced procedures used today. The only RCT comparing the results of automated percutaneous lumbar discectomy to those of microdiscectomy showed clearly superior results of microdiscectomy. Furthermore, success rates of automated percutaneous lumbar discectomy reported in the RCT (29% differ extremely from success rates reported in case series (between 56% and 92%. The literature search retrieves no controlled trials to assess efficacy and/or effectiveness of laser-discectomy, percutaneous manual discectomy or endoscopic procedures using a posterior approach in comparison to the standard procedures. Results from recent case series permit no assessment of efficacy, especially not in comparison to standard procedures. Due to highly selected patients, modi-fications of operative procedures, highly specialised surgical units and poorly standardised outcome assessment results of case series are highly variable, their generalisability is low. The results of the five economical analyses are, due to conceptual and methodological problems, of no value for decision-making in the context of the German health care system. Discussion: Aside from low methodological study quality three conceptual problems complicate the interpretation of results. 1. Continuous further development of technologies leads to a diversity of procedures in use which prohibits generalisation of study results

  7. [Comparative research of lumbar disc herniation treated with acupuncture and snake moxibustion].

    Science.gov (United States)

    Ma, Sheng; Ma, Jun; Pan, Jing-Nian; Zhang, Xiao-Su

    2010-07-01

    To compare the effects on lumbar disc snake herniation between acupuncture in combination of snake moxibustion with simple acupuncture or snake moxibustion. One hundred and twenty cases of lumbar disc herniation patients were randomly divided into an acupuncture and snake moxibustion group (group A, 60 cases), a acupuncture control group (group B, 30 cases) and a snake moxibustion control group (group C, 30 cases). In group A, acupuncture was applied to Shenshu (BL 23), Dachangshu (BL 25) and tender points bilateral to the spine, once a day. Additionally, at the end of acupuncture on the 1st day of a week, snake moxibustion was applied for one time. In group B and group C, acupuncture or snake moxibustion was applied respectively. The excellent rate was 95.0% (57/60) in group A, which was superior to that of 70.0% (21/30) in group B and 66.7% (20/30) in group C (both P efficiency on lumbar disc hernation treated with acupuncture and snake moxibustion is superior to that with either acupuncture or snake moxibustion.

  8. Herniated lumbar disc treated with Global Postural Reeducation. A middle-term evaluation.

    Science.gov (United States)

    Di Ciaccio, E; Polastri, M; Bianchini, E; Gasbarrini, A

    2012-08-01

    Herniated lumbar intervertebral disc (HLID) is a pathological condition frequently seen in rehabilitation medicine that is characterized by the compression of one or more nerve roots. The aim of this study was to describe the effects of Global Postural Reeducation on function and pain in patients with herniated disc at levels L4-L5 and/or L5-S1. Twenty-four consecutive subjects were treated with Global Postural Reeducation. Before treatment, patients reported median average pain duration of 180 days. At the beginning of treatment and on days 15, 45, 120, and 180, all completed the Quebec Back Pain Disability Scale and the Numeric Pain Rating Scale. The median value of the Quebec Back Pain Disability Scale score decreased from 49 points at baseline to 22 points at 45 days. Moreover, the median Numeric Pain Rating Scale score decreased from 6 points at baseline to 2 points at 45 days. The present study indicates that Global Postural Reeducation is suitable for the conservative management of HLID. Moreover, patients gained a therapeutic benefit from being active participants in their recovery.

  9. Percutaneous Treatment of Herniated Lumbar Discs with Ozone: Investigation of the Mechanisms of Action.

    Science.gov (United States)

    Murphy, Kieran; Elias, Gavin; Steppan, Jim; Boxley, Chett; Balagurunathan, Kuberan; Victor, Xylophone; Meaders, Thomas; Muto, Mario

    2016-08-01

    To elucidate the mechanism of action of intradiscal oxygen-ozone therapy for herniated intervertebral disc therapy. Ozone's mechanism of action was investigated using 3 approaches: mathematical models of intervertebral disc space to explore the relationship between disc pressure and volume; ozonolysis experiments using glycosaminoglycans (GAGs) from a Chinese hamster ovary cell line that were similar in composition to GAGs found in human nucleus pulposus; and experiments in which live Yucatan miniature pigs received various concentrations of percutaneous, image-guided intradiscal oxygen-ozone treatment and were examined (after sacrifice) with histology and semiquantitative analysis of disc cytokine concentrations. Engineering calculations support observations that a small (6%) disc volume reduction can result in considerable (9.84%) intradiscal pressure reduction. Porcine disc histology and Chinese hamster ovary GAG ozonolysis results showed that administered ozone reacted with and fragmented disc proteoglycans, reducing disc volume through disc dehydration. Cytokine analysis of porcine discs found that each of 4 cytokines measured (interleukin [IL]-1β, IL-6, IL-8, and tumor necrosis factor α) increased in concentration after 2 wt% ozone treatment. Oxygen-ozone therapy breaks down proteoglycan GAGs that maintain disc osmotic pressure, dehydrating the nucleus pulposus and reducing intervertebral disc volume. This is likely a primary mechanism by which ozone relieves nerve root compression and alleviates herniated disc-related pain. Additionally, 2 wt% ozone appears to interact with intradiscal cytokines, generating an antiinflammatory response that may contribute to symptom improvement. Copyright © 2016 SIR. Published by Elsevier Inc. All rights reserved.

  10. Percutaneous endoscopic transpedicle approach for herniated nucleus pulposus in the lumbar hidden zone.

    Science.gov (United States)

    Wang, Dong; Pan, Hao; Hu, Qinfeng; Zhu, Hang; Zhu, Li; He, Yongjiang; Wang, Jian; Jia, Gaoyong

    2017-02-01

    Although endoscopic procedures for lumbar disc diseases have improved greatly, treating migrated disc herniation is still a challenging task. Because of anatomic limitations, a rigid endoscope cannot effectively reach the herniated nucleus pulposus (HNP) in the hidden zone. The purpose of this study was to describe the transpedicle approach for HNP in the hidden zone using the percutaneous endoscopic lumbar discectomy system and to demonstrate the clinical results. Materials and Surgical Technique: Under fluoroscopy, the percutaneous endoscopic lumbar discectomy cannula is placed on the superior articular process, and a trephine with a diameter of 7.3 mm is used to make a bone hole. Through the bone hole, an HNP in the hidden zone can be detected with a rongeur for percutaneous endoscopic lumbar discectomy, the HNP can be removed, and then the decompressed nerve root is verified. We have treated two cases of hidden-zone HNP using the transpedicle approach. In all cases, the HNP was successfully removed, as confirmed by postoperative MRI. Clinical outcomes were acceptable. The percutaneous endoscopic transpedicle approach is an effective technique for managing HNP in the lumbar hidden zone. © 2016 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and John Wiley & Sons Australia, Ltd.

  11. Does opioid pain medication use affect the outcome of patients with lumbar disc herniation?

    Science.gov (United States)

    Radcliff, Kristen; Freedman, Mitchell; Hilibrand, Alan; Isaac, Roman; Lurie, Jon D; Zhao, Wenyan; Vaccaro, Alex; Albert, Todd; Weinstein, James N

    2013-06-15

    Subgroup analysis of prospective, randomized cohort. To review the results of patients who received opioid pain medications during treatment compared with that of patients who did not receive opioid medications. The Spine Patient Outcomes Research Trial (SPORT) is a prospective, multicenter study of surgical treatment versus nonoperative treatment for lumbar intervertebral disc herniation. The study population includes patients enrolled in SPORT for treatment of intervertebral disc herniation in combined randomized and observational cohorts. Patients who received opioid medications at baseline (opioid) were compared with those who did not (nonopioid). There were 520 patients in the nonopioid group and 542 patients in the opioid group. Among the opioid medication group, there were significantly (P opioid medication group with the perception of worsening symptoms and neurological deficit (P opioid group patients received surgery (P opioid and nonopioid medication group patients. Opioid medications were associated with increased crossover to surgical treatment (P = 0.005) and decreased surgical avoidance (P = 0.01). The incidence of opioid use at 4 years was 16% among patients who were using opioids at baseline and 5% among patients who were not using opioids at baseline. Patients who were treated with opioids had significantly worse baseline pain and quality of life. At final follow-up, there was no long-term difference in outcome associated with opioid pain medication use. Opioid medications were not associated with surgical avoidance. The majority of patients who use opioids during the study did not continue usage at 4 years. 2.

  12. Cerebrospinal fluid tau protein as a biomarker for severity of spinal cord injury in dogs with intervertebral disc herniation.

    Science.gov (United States)

    Roerig, A; Carlson, R; Tipold, A; Stein, V M

    2013-08-01

    Intervertebral disc herniation (IVDH) is a common cause of spinal cord injury (SCI) in dogs. Microtubule-associated protein tau derives predominantly from neurons and axons, making it a potential marker of neuronal injury. A retrospective study, including 51 dogs with thoracolumbar or cervical IVDH and 12 clinically normal dogs, was designed to describe associations between cerebrospinal fluid (CSF) tau concentration, degree of neurological signs and motor functional recovery in dogs with IVDH. Signalment, degree of neurological dysfunction and outcome were recorded. Cisternal CSF tau values were determined by ELISA. Associations between CSF tau concentration and various clinical parameters were evaluated. Receiver-operating characteristics curve (ROC) analyses were performed to assess the validity of protein tau measurements. CSF tau concentrations were significantly higher in dogs showing plegia (median, 79.9 pg/mL; range, 0-778.7 pg/mL; P=0.016) compared to healthy dogs and dogs with paresis (median, 30.1 pg/mL; range, 0-193.1 pg/mL; P=0.025). Plegic dogs that improved by one neurological grade within 1 week had significantly lower tau protein levels compared to plegic dogs that needed more time for recovery or did not show an improvement (P=0.008). A CSF tau concentration >41.3 pg/mL had a sensitivity of 86% and specificity of 83% to predict an unsuccessful outcome in plegic dogs based on ROC analysis (area under the curve, 0.887; P=0.007, 95% confidence interval [CI] 0.717-1.057). CSF protein tau levels are positively associated with the severity of spinal cord damage and may serve as a prognostic indicator in dogs with IVDH. Copyright © 2013 Elsevier Ltd. All rights reserved.

  13. Acquired hemophilia a in a patient with lumbar disc herniation: a case report and review of the literature.

    Science.gov (United States)

    Li, Jingfeng; Shen, Hongxing; Hou, Tiesheng; Li, Ming; He, Shisheng; Zhang, Hailong

    2009-04-15

    To summarize the clinical manifestations and treatment of acquired hemophilia A in a patient with lumbar disc herniation. Acquired hemophilia A is a rare but potentially life-threatening hemorrhagic disorder. It is caused by the development of autoantibodies directed against coagulation factor VIII (F VIII) in adults or elderly patients, who do not have a personal or family history of bleeding episodes. The mortality is high if the diagnosis was missed or delays, especially after a surgery. A case was investigated retrospectively and the relevant literature was reviewed. A 59-year-old man with a 1-year history of lower back and leg pain was admitted to the hospital. He has no family medical history of hemophilia A and the routine laboratory examination did not find abnormality on blood coagulation function. He underwent decompression by laminectomy and discectomy. Seven hours after operation, it was found that the incision was oozing profusely and hemoglobin was reduced gradually, though platelet count was within the normal range. He was diagnosed with acquired factor VIII (FVIII) deficiency based on a prolonged activated partial-thromboplastin time (61.0 seconds), reduced FVIII activity (4.2%), and FVIII inhibitor (8 BU). After treatment with hemodynamic stabilization and immunosuppression therapies (including transfusion of packed red blood cells, fresh frozen plasma, and cryoprecipitate) and administration of human antihemophilic globulin, corticosteroid, and cyclophosphamide, bleeding was stopped gradually. The clinical and biologic condition of the patient improved, though neurological deficit was left. Surgical operation may be a factor contributing to acquired hemophilia A, which, to our knowledge, has not been reported in the literature. Diagnosis of acquired hemophilia requires clinical acumen and any patient who presents with bleeding and a prolonged activated partial-thromboplastin time should be considered. Initial hemodynamic stabilization followed by

  14. Transient Go: A Mobile App for Transient Astronomy Outreach

    Science.gov (United States)

    Crichton, D.; Mahabal, A.; Djorgovski, S. G.; Drake, A.; Early, J.; Ivezic, Z.; Jacoby, S.; Kanbur, S.

    2016-12-01

    Augmented Reality (AR) is set to revolutionize human interaction with the real world as demonstrated by the phenomenal success of `Pokemon Go'. That very technology can be used to rekindle the interest in science at the school level. We are in the process of developing a prototype app based on sky maps that will use AR to introduce different classes of astronomical transients to students as they are discovered i.e. in real-time. This will involve transient streams from surveys such as the Catalina Real-time Transient Survey (CRTS) today and the Large Synoptic Survey Telescope (LSST) in the near future. The transient streams will be combined with archival and latest image cut-outs and other auxiliary data as well as historical and statistical perspectives on each of the transient types being served. Such an app could easily be adapted to work with various NASA missions and NSF projects to enrich the student experience.

  15. Twenty-five years of transient counting experience in French PWR units

    Energy Technology Data Exchange (ETDEWEB)

    Barthelet, B. [Electricite de France (EDF DPN), 93 - Saint-Denis (France); Savoldelli, D.; Fritz, R. [Electricite de France (EDF DPN), 93 - Noisy le Grand (France)

    2001-07-01

    For nearly twenty five years, EDF has been checking that the actual operating transients are neither more severe nor more numerous than the design basis transients. This activity of transient cycle counting and bookkeeping has enabled EDF to own a database of more than 800 reactor.years for the PWR units. The current method of transient cycle counting is presented. In the paper, we will point out the main results of transient cycle counting and lessons learned. In general, the frequencies of transients are lower than the design frequencies. In few cases, they are higher, such as the transient frequencies of the RCS lines connected to auxiliary systems often due to operating procedures or particular periodic testing. Few periodic tests were not taken into account in the design basis transient file ; they have been detected thanks to the transient cycle counting. In the last 1980's, we achieved the first updating of the design basis transient file for the PWR 900 MWe series. In the early 1990's, we updated the design basis transient file of the PWR 1300 MWe series. In fact, since design and start-up, the operating conditions have been modified (fuel cycle with stretch-out, modification of the hot leg and cold leg temperatures for the PWR 1300 MWe,...). This was the cause of many unclassified transients. In the new design basis transient file, we have created new transients and increased the frequencies of some of them. This has enabled to consider the updated design basis transient file more representative of actual operating transients. For some years, we have increasingly associated the operators with the transient cycle counting concern. We noticed progress (decreased frequencies of most transients). (authors)

  16. Transient flow characteristics in a rocket engine nozzle

    OpenAIRE

    Takahashi, Masahiro; Ueda, Shuichi; Tomita, Takeo; Takahashi, Mamoru; Tamura, Hiroshi; Aoki, Kenji; 高橋 政浩; 植田 修一; 冨田 健夫; 高橋 守; 田村 洋; 青木 賢治

    2002-01-01

    Transient flow characteristics in convergent-divergent nozzles with cold gaseous nitrogen were studied using axisymmetric Navier-Stokes computation. A mechanism which possibly causes serious side-load during the start-up transient of the rocket engine nozzle is discussed. The numerical results are compared with the experimental results for validation. In case of the nozzle, with which remarkable side-load peaks were observed in the experiment and the transition from the Free Shock Separation ...

  17. Measuring voltage transients with an ultrafast scanning tunneling microscope

    DEFF Research Database (Denmark)

    Keil, Ulrich Dieter Felix; Jensen, Jacob Riis; Hvam, Jørn Märcher

    1997-01-01

    We use an ultrafast scanning tunneling microscope to resolve propagating voltage transients in space and time. We demonstrate that the previously observed dependence of the transient signal amplitude on the tunneling resistance was only caused by the electrical sampling circuit. With a modified......-gating photoconductive switch with a rigidly attached fiber, the probe is scanned without changing the probe characteristics. (C) 1997 American Institute of Physics....

  18. Transforaminal epidural steroid injections followed by mechanical diagnosis and therapy to prevent surgery for lumbar disc herniation.

    Science.gov (United States)

    van Helvoirt, Hans; Apeldoorn, Adri T; Ostelo, Raymond W; Knol, Dirk L; Arts, Mark P; Kamper, Steven J; van Tulder, Maurits W

    2014-07-01

    Prospective cohort study. To report the clinical course of patients with MRI-confirmed lumbar disc herniation-related radicular noncentralizing pain who received transforaminal epidural steroid injections (TESIs) and mechanical diagnosis and therapy (MDT). Noncentralizing symptoms in patients with lumbar disc herniation are associated with poor outcome. Commonly used treatments for these patients include TESIs and MDT. No study has evaluated the outcome of combining both strategies. Consecutive candidates for herniated lumbar disc surgery with noncentralizing chronic pain were eligible. Patients received TESIs followed by MDT. The primary outcomes were pain severity in the leg, disability (Roland-Morris Disability Questionnaire for Sciatica), and global perceived effect (GPE). Outcomes were measured at baseline, discharge, and 12 months. Linear mixed-models and McNemar's tests were used to analyze outcome data. Sixty-nine patients receive TESIs. After TESIs, symptoms were resolved completely in 11 patients (16%). In these patients, symptom resolution was maintained at 12 months. A second subgroup of 32 patients (46%) reported significantly less pain after TESIs and showed centralization with MDT reassessment (significant reductions in leg pain and disability [P TESIs but still showed noncentralization with MDT reassessment (significant reductions in leg pain and disability [P TESIs and received an operative intervention. The results indicate that a course of TESIs followed by MDT may be able to avoid surgery in a substantial proportion of candidates for herniated lumbar disc surgery. Wiley Periodicals, Inc.

  19. The effect of infliximab, a monoclonal antibody against TNF-alpha, on disc herniation resorption - A randomized controlled study

    NARCIS (Netherlands)

    Autio, Reijo A.; Karppinen, Jaro; Niinimaki, Jaakko; Ojala, Risto; Veeger, Nic; Korhonen, Timo; Hurri, Heikki; Tervonen, Osmo

    2006-01-01

    Study Design. Randomized, controlled study. Objective. To evaluate the effect of infliximab on herniated nucleus pulposus (HNP) resorption. Summary of Background Data. Although the effects of tumor necrosis factor alpha (TNF-alpha) on HNP resorption are not fully understood, TNF-alpha appears to be

  20. Effective Range of Percutaneous Posterior Full-Endoscopic Paramedian Cervical Disc Herniation Discectomy and Indications for Patient Selection

    Directory of Open Access Journals (Sweden)

    Hongquan Wen

    2017-01-01

    Full Text Available The objective was to investigate the effective and safe range of paramedian CDH by percutaneous posterior full-endoscopy cervical intervertebral disc nucleus pulposus resection (PPFECD to provide a reference for indications and patient selection. Sixteen patients with CDH satisfied the inclusion criteria. Before surgery the patients underwent cervical spine MRI, and the distance between the dural sac and herniated disc was measured. An assessment was performed by MRI immediately after surgery, measuring the distance between dural sac and medial border of discectomy (DSMD. The preoperative average distance between the dural sac and peak of the herniated disc (DSPHD was 3.87 ± 1.32 mm; preoperative average distance between dural sac and medial border of herniated disc (DSMHD was 6.91 ± 1.21 mm and an average distance of postoperative DSMD was 5.41 ± 1.40 mm. Postoperative VAS of neck and shoulder pain was significantly decreased but JOA was significantly increased in each time point compared with preoperative ones. In summary, the effective range of PPFECD to treat paramedian CDH was 5.41 ± 1.40 mm, indicating that DSMHD and DSPHD were within 6.91 ± 1.21 mm and 3.87 ± 1.32 mm, respectively. PPFECD surgery is, therefore, a safe and effective treatment option for patients with partial paramedian cervical disc herniation.

  1. Gastrocnemius muscle herniation as a rare differential diagnosis of ankle sprain: case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Bergmann Greta

    2012-03-01

    Full Text Available Abstract Background Muscle herniation of the leg is a rare clinical entity. Yet, knowing this condition is necessary to avoid misdiagnosis and delayed treatment. In the extremities, muscle herniation most commonly occurs as a result of an acquired fascial defect, often due to trauma. Different treatment options for symptomatic extremity muscle herniation in the extremities, including conservative treatment, fasciotomy and mesh repair have been described. Case presentation We present the case of a patient who presented with prolonged symptoms after an ankle sprain. The clinical picture showed a fascial insufficiency with muscle bulging under tension. Ultrasound and MRI imaging confirmed the diagnosis of muscle hernia of the medial gastrocnemius on the right leg. Conservative treatment did not lead to success. Therefore, the fascial defect was treated surgically by repairing the muscle herniation using a synthetic vicryl propylene patch. Conclusions Muscle hernias should be taken into consideration as a rare differential diagnosis whenever patients present with persisting pain or soft tissue swelling after ankle sprain. Diagnosis is mainly based on clinical aspect and physical examination, but can be confirmed by radiologic imaging techniques, including (dynamic ultrasound and MRI. If conservative treatment fails, we recommend the closure with mesh patches for large fascial defects.

  2. Intrathoracic major duodenal papilla with transhiatal herniation of the pancreas and duodenum: A case report and review of the literature.

    Science.gov (United States)

    Jäger, Tarkan; Neureiter, Daniel; Nawara, Clemens; Dinnewitzer, Adam; Ofner, Dietmar; Lamadé, Wolfram

    2013-06-27

    Transhiatal herniation of the pancreas is an extremely rare condition. In the published literature we found only eleven cases reported in the period of 1958 to 2011. A coincidental hiatal herniation of the duodenum is described in two cases only. To our knowledge, we report the first case with a hiatal herniation of the complete duodenum and proximal pancreas presenting an intrathoracic major duodenal papilla with consecutive intrahepatic and extrahepatic cholestasis. A 72-year-old Caucasian woman was admitted to our department with a hiatal hernia grade IV for further evaluation. According to our recommendation of surgical hernia repair soon after the diagnosis of a transhiatal herniation of the proximal pancreas and entire duodenum, we had to respect the declared intention of the patient for a conservative procedure. So we were forced to wait for surgical repair within an emergency situation complicated by a myocardial infarction and reduced general condition. We discuss the therapeutic decision making process and a complete literature review of this rare entity.

  3. Correlation between radiculalgia and counts of T lymphocyte subsets in the peripheral blood of patients with lumbar disc herniation.

    Science.gov (United States)

    Tian, Peng; Ma, Xin-long; Wang, Tao; Ma, Jian-xiong; Yang, Xue

    2009-11-01

    To determine the correlation between the degree of radiculalgia and counts of T lymphocyte subsets in the peripheral blood of patients with lumbar disc herniation. Forty-nine patients with lumbar disc herniation (group A) were divided into three subgroups according to Visual Analogue Scale (VAS) pain scores (group A(1): n= 12, VAS 0-4.0; A(2): n= 24, VAS 4.1-7.0; A(3): n= 13, VAS 7.1-10.0. Twenty health blood donors who volunteered to be involved in the study comprised the control group (group B). Peripheral blood counts of various T lymphocyte subsets were measured in each group. (i) The counts of CD4+ T and CD4+/CD8+ lymphocytes were higher in group A than in group B, and the difference between the two groups was statistically significant (P 0.05). A strong significant correlation was observed between the VAS scores and counts of CD4+ T lymphocytes (r= 0.542, P prolapse of lumbar intervertebral discs. The current results may provide support for involvement of immunologic mechanisms in low back pain secondary to herniation of the lumbar disc. T lymphocytes may play an important role in the development of symptoms in patients with lumbar intervertebral disc herniation. © 2009 Tianjin Hospital and Blackwell Publishing Asia Pty Ltd.

  4. The Pathogenesis of Ventral Idiopathic Herniation of the Spinal Cord: A Hypothesis Based on the Review of the Literature

    NARCIS (Netherlands)

    Bartels, R.H.M.A.; Brunner, H.G.; Hosman, A.J.; Alfen, N. van; Grotenhuis, J.A.

    2017-01-01

    Idiopathic ventral herniation of the spinal cord (SC) is not often encountered in daily practice. Its clinical prevalence, however, will increase through increasing awareness and more frequent use of MRI. A clear explanation of its pathophysiology has never been formulated. It was hypothesized that

  5. Anterior lumbar discectomy and fusion for acute cauda equina syndrome caused by recurrent disc prolapse: report of 3 cases.

    Science.gov (United States)

    Tan, Kimberly-Anne; Sewell, Mathew D; Markmann, Yma; Clarke, Andrew J; Stokes, Oliver M; Chan, Daniel

    2017-10-01

    There is a lack of information and consensus regarding the optimal treatment for recurrent disc herniation previously treated by posterior discectomy, and no reports have described an anterior approach for recurrent disc herniation causing cauda equina syndrome (CES). Revision posterior decompression, irrespective of the presence of CES, has been reported to be associated with significantly higher rates of dural tears, hematomas, and iatrogenic nerve root damage. The authors describe treatment and outcomes in 3 consecutive cases of patients who underwent anterior lumbar discectomy and fusion (ALDF) for CES caused by recurrent disc herniations that had been previously treated with posterior discectomy. All 3 patients were operated on within 12 hours of presentation and were treated with an anterior retroperitoneal lumbar approach. Follow-up ranged from 12 to 24 months. Complete retrieval of herniated disc material was achieved without encountering significant epidural scar tissue in all 3 cases. No perioperative infection or neurological injury occurred, and all 3 patients had neurological recovery with restoration of bladder and bowel function and improvement in back and leg pain. ALDF is one option to treat CES caused by recurrent lumbar disc prolapse previously treated with posterior discectomy. The main advantage is that it avoids dissection around epidural scar tissue, but the procedure is associated with other risks and further evaluation of its safety in larger series is required.

  6. Pressure transients in pipeline systems

    DEFF Research Database (Denmark)

    Voigt, Kristian

    1998-01-01

    This text is to give an overview of the necessary background to do investigation of pressure transients via simulations. It will describe briefly the Method of Characteristics which is the defacto standard for simulating pressure transients. Much of the text has been adopted from the book Pressure...

  7. Diuretics for transient tachypnoea of the newborn.

    Science.gov (United States)

    Kassab, Manal; Khriesat, Wadah M; Anabrees, Jasim

    2015-11-21

    Transient tachypnoea of the newborn (TTN) results from delayed clearance of lung liquid and is a common cause of admission of full-term infants to neonatal intensive care units. The condition is particularly common after elective caesarean section. Conventional treatment involves appropriate oxygen administration and continuous positive airway pressure in some cases. Most infants receive antibiotic therapy. Hastening the clearance of lung liquid may shorten the duration of the symptoms and reduce complications. To determine whether diuretic administration reduces the duration of oxygen therapy and respiratory symptoms and shortens hospital stay in term infants presenting with transient tachypnoea of the newborn. An updated search was carried out in September 2015 of the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library issue 9, 2015), MEDLINE via Ovid, EMBASE, PubMed, and CINAHL via OVID. We included randomised and quasi-randomised controlled trials that compared the effect of diuretics administration versus placebo or no treatment in infants of less than seven days of age, born at 37 or more weeks of gestation with the clinical picture of transient tachypnoea of the newborn. We extracted and analysed data according to the methods outlined in the latest Cochrane Handbook for Systematic Reviews of Interventions. Two review authors assessed trial quality in each potentially eligible manuscript and two review authors extracted data. Our previous systematic review included two trials enrolling a total of 100 infants with transient tachypnoea of the newborn (Wiswell 1985; Karabayir 2006). The updated search revealed no new trials. Wiswell 1985 randomised 50 infants to receive either oral furosemide (2 mg/kg body weight at time of diagnosis followed by a 1 mg/kg dose 12 hours later if the tachypnoea persisted) or placebo. Karabayir 2006 randomised 50 infants to receive either intravenous furosemide (2 mg/kg body

  8. Changes in expression of mRNA for interleukin-8 and effects of interleukin-8 receptor inhibitor in the spinal dorsal horn in a rat model of lumbar disc herniation.

    Science.gov (United States)

    Kim, Su-Jeong; Park, Sung-Min; Cho, Yun-Woo; Jung, Yong-Jae; Lee, Dong-Gyu; Jang, Sung-Ho; Park, Hea-Woon; Hwang, Se-Jin; Ahn, Sang-Ho

    2011-12-01

    Autologous nucleus pulposus obtained from coccygeal intervertebral discs was grafted on the proximal of L5 dorsal root ganglion. Pain behavior, mRNA expression of Interleukin-8 (IL-8), and immunohistochemical changes were assessed. The purpose of this study is to investigate temporal changes of IL-8 expression in the spinal cord and dorsal root ganglion and the pain-related behaviors with time course and to elucidate whether repertaxin (IL-8 receptor inhibitor) attenuates pain-related behaviors in a rat model of lumbar disc herniation. Inflammatory mediators like cytokines and chemokines have been implicated in radicular pain because of disc herniation. IL-8, known as CXCL8, is a chemokine, which has been reported to be associated with painful degenerative disc disorders and chronic inflammatory pain states. Lumbar disc herniated rat model was made by implantation of the autologous nucleus pulposus, harvested from the coccygeal vertebra of each tail, on the left L5 nerve root just proximal to the dorsal root ganglion. Rats were tested for mechanical allodynia and thermal hyperalgesia at 2 days before surgery, and on days 1, 5, 10, 20, 30, 40, 50, and 60 postoperatively. Experimental group was intrathecally injected with the IL-8 receptor inhibitor at L5 level on postoperative day 10. Mechanical allodynia of the plantar surface of both hindpaw was tested on 30 minutes, 1, 3 hours, 1, 3, 5, and 10 days after administration. For the staining of astrocytes and microglia, immunohistochemical study was done 20 days after surgery. Mechanical allodynia in ipsilateral hindpaw developed 1 day after surgery and lasted until 60 days and thermal withdrawal latency decreased significantly on the ipsilateral side 10 days after surgery and gradually increased through day 60. The IL-8 receptor inhibitor attenuated the mechanical allodynia caused by nucleus pulposus when it was administered on postoperative day 10 and reduced microglial activation and phosphorylated form of mitogen

  9. Transient Diabetes Insipidus Following Cardiopulmonary Bypass.

    Science.gov (United States)

    Ekim, Meral; Ekim, Hasan; Yilmaz, Yunus Keser; Bolat, Ali

    2015-04-01

    Diabetes insipidus (DI) results from inadequate output of Antidiuretic Hormone (ADH) from the pituitary gland (central DI) or the inability of the kidney tubules to respond to ADH (nephrogenic DI). ADH is an octapeptide produced in the supraoptic and paraventricular nuclei of the hypothalamus and stored in the posterior lobe of the pituitary gland. Cardiopulmonary Bypass (CPB) has been shown to cause a six-fold increased circulating ADH levels 12 hours after surgery. However, in some cases, ADH release may be transiently suppressed due to cardioplegia (cardiac standstill) or CPB leading to DI. We present the postoperative course of a 60-year-old man who developed transient DI after CPB. He was successfully treated by applying nasal desmopressin therapy. Relevant biochemical parameters should be monitored closely in patients who produce excessive urine after open heart surgery.

  10. Virtopsy post-mortem multi-slice computed tomography (MSCT) and magnetic resonance imaging (MRI) demonstrating descending tonsillar herniation: comparison to clinical studies.

    Science.gov (United States)

    Aghayev, Emin; Yen, Kathrin; Sonnenschein, Martin; Ozdoba, Christoph; Thali, Michael; Jackowski, Christian; Dirnhofer, Richard

    2004-07-01

    Descending cerebellar tonsillar herniation is a serious and common complication of intracranial mass lesions. We documented three cases of fatal blunt head injury using post-mortem multi-slice computed tomography (MSCT) and magnetic resonance imaging (MRI). The results showed massive bone and soft-tissue injuries of the head and signs of high intracranial pressure with herniation of the cerebellar tonsils. The diagnosis of tonsillar herniation by post-mortem radiological examination was performed prior to autopsy. This paper describes the detailed retrospective evaluation of the position of the cerebellar tonsils in post-mortem imaging in comparison to clinical studies.

  11. Virtopsy post-mortem multi-slice computed tomograhy (MSCT) and magnetic resonance imaging (MRI) demonstrating descending tonsillar herniation: comparison to clinical studies

    Energy Technology Data Exchange (ETDEWEB)

    Aghayev, Emin; Yen, Kathrin; Thali, Michael; Jackowski, Christian; Dirnhofer, Richard [Institute of Forensic Medicine, University of Bern, IRM-Buehlstrasse 20, 3012, Bern (Switzerland); Sonnenschein, Martin [Institute of Diagnostic Radiology, Inselspital, 3010, Bern (Switzerland); Ozdoba, Christoph [Department of Neuroradiology, Inselspital, 3010, Bern (Switzerland)

    2004-07-01

    Descending cerebellar tonsillar herniation is a serious and common complication of intracranial mass lesions. We documented three cases of fatal blunt head injury using post-mortem multi-slice computed tomography (MSCT) and magnetic resonance imaging (MRI). The results showed massive bone and soft-tissue injuries of the head and signs of high intracranial pressure with herniation of the cerebellar tonsils. The diagnosis of tonsillar herniation by post-mortem radiological examination was performed prior to autopsy. This paper describes the detailed retrospective evaluation of the position of the cerebellar tonsils in post-mortem imaging in comparison to clinical studies. (orig.)

  12. Correlation between intervertebral disc degeneration, paraspinal muscle atrophy, and lumbar facet joints degeneration in patients with lumbar disc herniation.

    Science.gov (United States)

    Sun, Dong; Liu, Peng; Cheng, Jie; Ma, Zikun; Liu, Jingpei; Qin, Tingzheng

    2017-04-20

    To assess the correlation between lumbar disc degeneration (LDD), multifidus muscle atrophy (LMA), and facet joints degeneration in patients with L4-L5 lumbar disc herniation (LDH). Sixty patients with L4-L5 LDH diagnosed by a 1.5 T MRI scanner were enrolled in the study group and another 60 patients with non-specific back pain were enrolled in the control group. LDD, LMA, and facet joints degeneration were examined and analyzed independently by two independent orthopedic surgeons using T2-weighted images. Wilcoxon test was used for analyzing the difference of LDD and facet joints degeneration between L3-L4 and L5-S1 and difference of LMA between the herniated and control groups. Correlation analysis of the three degeneration grades at the same level was determined by Spearman rank correlation test. In the herniated group, most LMA at L3-L4 level was grade 1 (42, 70.0%); grade 2 (33, 55.0%) at L4-L5 level; and grade 3 (27, 45.0%) at L5-S1 level. LMA and LDD grading were significantly different between L3-L4 and L5-S1 levels (P herniation group, the Spearman value for LDD and LMA grading were 0.352 (P  0.05) at the L5-S1 level. The differences in LMA between the herniated and control groups at the three levels were significant (P Disc degeneration and multifidus muscles atrophy were positively correlated at the L3-L4 disc level. A lumbar extension muscle strengthening program could be helpful in preventing muscle atrophy and lumbar spinal degeneration.

  13. Intraoperative herniation of an L5-S1 disc during microdiscectomy and transforaminal lumbar interbody fusion: a case report.

    Science.gov (United States)

    Berlin, Connor D; Seshan, Thirumoorthi V; Abrahams, John M; Kornel, Ezriel E

    2015-11-27

    We report the progression of an intraoperative L5-S1 lumbar disc herniation that occurred during a routine microdiscectomy and transforaminal lumbar interbody fusion, which, to the best of our knowledge, has never been previously reported in the literature. The objective of this report is to bring to light the possibility of a lumbar disc herniating intraoperatively, and to demonstrate that accompanying neurologic involvement can be detected and subsequently addressed with the aid of neurophysiologic monitoring. A 36-year-old African American woman, who had previously undergone minimally invasive microdiscectomy for a right L5-S1 herniated nucleus pulposus with full recovery, presented with a large reherniation of the L5-S1 disc on the right side. During her operation, while a tap was followed into the L5 left pedicle, there was a sudden profound spasm of our patient's legs and back that lasted for the duration of 15 seconds, culminating in the loss of all somatosensory evoked potentials in our patient's lower extremities. Exploration of this previous microlaminotomy site revealed a massive disc extrusion protruding through the microlaminotomy. Immediate removal of this extruded disc material restored all somatosensory evoked potentials and our patient awoke with no neurologic deficits. An intraoperative disc herniation in the lumbar spine, though very rare, can occur and can result in neurologic compromise as evidenced by the loss of somatosensory evoked potentials. By identifying the event, it can be remedied by evaluating the disc visually, removing extruded fragments and decompressing nerve roots with recovery of somatosensory evoked potentials and normal neurologic function postoperatively. If neurophysiological monitoring shows there is a sudden loss of response, then consideration should be given to the possibility of an acute intraoperative herniation.

  14. Applied hydraulic transients

    CERN Document Server

    Chaudhry, M Hanif

    2014-01-01

    This book covers hydraulic transients in a comprehensive and systematic manner from introduction to advanced level and presents various methods of analysis for computer solution. The field of application of the book is very broad and diverse and covers areas such as hydroelectric projects, pumped storage schemes, water-supply systems, cooling-water systems, oil pipelines and industrial piping systems. Strong emphasis is given to practical applications, including several case studies, problems of applied nature, and design criteria. This will help design engineers and introduce students to real-life projects. This book also: ·         Presents modern methods of analysis suitable for computer analysis, such as the method of characteristics, explicit and implicit finite-difference methods and matrix methods ·         Includes case studies of actual projects ·         Provides extensive and complete treatment of governed hydraulic turbines ·         Presents design charts, desi...

  15. Transient Ischemic Attack (TIA)

    Science.gov (United States)

    ... Workplace Giving Fundraise Planned Giving Corporate Giving Cause Marketing Join your team, your way! The Stroke Challenge team is a great way to get active in ... to Expect at the Hospital Key Questions to Ask Learn More About Stroke ...

  16. TIA (Transient Ischemic Attack)

    Science.gov (United States)

    ... should be rushed to the emergency room. When stroke symptoms are first noticed, it isn't safe to ... the cause of a TIA or any brief symptoms of stroke. These images can be seen using an magnetic ...

  17. Usefulness of dynamic contrast enhanced lumbar spine MR imaging postoperative herniated lumbar disc

    Energy Technology Data Exchange (ETDEWEB)

    Nam, Ji Eun; Chung, Tae Sub; Kim, Young Soo; Cho, Yong Eun; Park, Mi Suk [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    1999-02-01

    To compare the usefulness of dynamic contrast enhanced lumbar spine MR imaging with that of conventional delayed contrast enhanced MR imaging in the assessment of postoperative herniated lumbar disc. Forty-one postoperative herniated lumbar disc (HLD) lesions of 32 patients with back pain were examined with MR imaging (1.5T, Vision, Siemens, Germany). Five-phase dynamic 2D FLASH sagittal images (TR/TE = 118.1msec/4.1msec) were obtained every 19 seconds with a 4 minutes delayed image after contrast injection. As seen on delayed images, the discs were assessed as recurred, fibrosis, or no change. On dynamic images, the pattern of enhancement was evaluated as follows : Type 1 (no change in peripheral disc enhancement between the early and late phases) ; or Type 2 (minimal internal extension of marginal smooth enhancement during the late phase) ; or Type 3 (marked internal extension of peripheral irregular enhancement). Dynamic and delayed imaging were compared, and early epidural space enhancement with rapid wash-out was also evaluated. Of 41 postoperative HLDs, 39 lesions showed peripheral contrast enhancement. Evaluation depended on delayed imaging, and was as follows : recurred HLD (n=27) ; fibrosis (n=5) ; no change in postoperative disc (n=7). On dynamic contrast-enhanced imaging, enhancement patterns were Type 1 (n=29), Type 2 (n=7), and Type 3 (n=3). In 29 Type 1 lesions, there were no significant differences in image findings between dynamic and delayed images. However, in ten lesions (type 2 : n=7, type 3 : n=3), findings additional to those revealed by delayed images were demonstrated by dynamic contrast-enhanced MR imaging. Nine of the ten Type 2 and 3 lesions were diagnosed as recurred HLD. On dynamic images, five lesions showed early epidural space enhancement. Dynamic contrast-enhanced lumbar spine MR imaging provided additional findings such as increased peripheral disc enhancement, and epidural space enhancement, which cannot be detected on

  18. Transient T cell depletion causes regression of melanoma metastases

    National Research Council Canada - National Science Library

    Rasku, Mary Ann; Clem, Amy L; Telang, Sucheta; Taft, Beverly; Gettings, Kelly; Gragg, Hana; Cramer, Daniel; Lear, Sheron C; McMasters, Kelly M; Miller, Donald M; Chesney, Jason

    2008-01-01

    .... We administered DAB/IL2 (12 microg/kg; four daily doses; 21 day cycles) to 16 patients with metastatic melanoma and measured the effects on the peripheral blood concentration of several T cell subsets and on tumor burden...

  19. An important cause of tetraparesis: Cervical spondylotic myelopathy

    Directory of Open Access Journals (Sweden)

    Cüneyt Göçmez

    2013-09-01

    Full Text Available Cervical spondylotic myelopathy which is a neurologicdisorder caused by degenerative changes in the cervicalspines related to narrowing in the spinal channel. Spondylosismay cause myelopathy effecting spinal cord or nerveroots in one or more segments. It is most common causeof myelopathy over the 55 years of age in developedcountries. As well as it is most commonly seen acquiredspastic paraparesis in medium and late times of life. Wediscuss diagnosis and alternative treatment options incervical spondylotic myelopathy in the current studyKey words: Myelopathy, cervical disc herniation, cervicalspondylosis, tetraparesis

  20. Herniated Disk

    Science.gov (United States)

    ... and Sugar Substitutes Exercise and Fitness Exercise Basics Sports Safety Injury Rehabilitation Emotional Well-Being Mental Health Sex and Birth ... and Sugar Substitutes Exercise and Fitness Exercise Basics Sports Safety Injury Rehabilitation Emotional Well-Being Mental Health Sex and Birth ...