Intradural disc herniation (IDH) is an extremely rare condition. The authors report the case of a 53-year-old female who had neck and right shoulder pain associated with right-sided hemiparesis and hyperesthesia. Magnetic resonance imaging (MRI) of the cervical spine (C-spine) revealed central mass-like lesions that caused the; compression of the right side of the spinal cord. The posterior surgical approach was used to remove two pieces of IDH. After surgery, the muscle strength in the right upper limb improved from Grade 0/5 to 4+/5 without surgery-related complications. Although there are some reports in literature on the radiologic features of cervical IDH (including the Halo sign, Y-sign, hawk-beak sign, and crumble disc sign), it can be difficult to diagnose radiologically. We present the clinical image of the case along with a review of the literature to remind surgeons to consider IDH as a differential diagnosis when patients are affected by anterior intradural lesions.
Actinomycosis is a rare anaerobic bacterial infection of humans generally caused by Actinomyces israelii and other anaerobic filaments. Owing to slow growth over long periods of time, it usually presents as a mass lesion mimicking a tumor. Genitourinary actinomycosis is rare, and renal actinomycosis is often misdiagnosed as renal cancer. Diagnosis of actinomycosis mostly relies on demonstrating sulfur granules in pus or histologic analysis of a surgical specimen. Here, we present a case of actinomycosis of the kidney with the clinical presentation of acute emphysematous pyelonephritis.
Osteoporotic spinal fractures commonly occur in elderly patients with low bone mineral density. In these cases, percutaneous vertebroplasty or percutaneous kyphoplasty can provide significant pain relief and improve mobility. However, studies have reported both the recurrence of vertebral compression fractures at the index level after vertebroplasty and the development of new vertebral fractures at the adjacent level that occur without any additional trauma. Pedicle screw fixation combined with percutaneous vertebroplasty has been proposed as an effective procedure for addressing osteoporotic thoracolumbar fractures. However, in osteoporotic populations, pedicle screws can loosen, pullout, or migrate. Currently, the efficacy of cortical bone trajectory screw fixation for osteoporotic fractures remains unclear. Thus, we assessed the effects of using cortical bone trajectory instrumentation with vertebroplasty on patient outcomes.We retrospectively reviewed data from 12 consecutively sampled osteoporotic thoracolumbar fracture patients who underwent cortical bone trajectory instrumentation with vertebroplasty. Patients were enrolled beginning in October 2015 and were followed for >24 months.The average age was 74 years, and the average dual-energy x-ray absorptiometry T-score was -3.6. The average visual analog scale pain scores improved from 8 to 2.5 after surgery. The average blood loss was 36.25 mL. All patients regained ambulation and experienced reduced pain post-surgery. No recurrent fractures or instrument failures were recorded during follow-up.Our findings suggest that cortical bone trajectory instrumentation combined with percutaneous vertebroplasty may be a good option for treating osteoporotic thoracolumbar fractures, as it can prevent recurrent vertebral fractures or related kyphosis in sagittal alignment.
BACKGROUND Ventriculoperitoneal (VP) shunt surgery is a widely used procedure for managing hydrocephalus; however, postoperative infections remain a serious complication, increasing morbidity and mortality. Known risk factors include prior surgeries, steroid use, and concurrent procedures. However, the role of liver cirrhosis, a condition that compromises immune function and predisposes patients to infections, has not been fully investigated in the context of neurosurgery. Current literature lacks large-scale studies evaluating whether liver cirrhosis increases infection risk after VP shunt surgery. This study aims to address this gap using a nationally representative database, to compare the risk of postoperative infections in patients with and without liver cirrhosis following VP shunt surgery, utilizing data from the Taiwan National Health Insurance Research Database (NHIRD). MATERIAL AND METHODS A retrospective cohort study analyzed 1766 patients with and 37 995 patients without liver cirrhosis who underwent their first VP shunt surgery between January 2010 and December 2019. Infection risk was assessed at 6 months and 1 year after surgery. Additional factors, such as cerebral hemorrhage, aneurysm, brain tumors, decompressive craniectomy, and cranioplasty, were considered. Fine and Gray regression accounted for death as a competing risk. RESULTS After we adjusted for potential confounders, patients with cirrhosis showed a 1.41-fold increased risk of infection at 6 months (95% CI: 1.10-1.81, P=0.007) and 1.39-fold at 1 year (95% CI: 1.12-1.73, P=0.003) compared with patients without cirrhosis. CONCLUSIONS Liver cirrhosis significantly elevates infection risk following VP shunt surgery, highlighting the need for tailored perioperative strategies to improve outcomes for these patients.
Frozen section Not performed; gossypiboma detected ( Figure 5) Retained surgical gauze following a surgical procedure or endoscopic examination is referred to as a gauzoma, textiloma, or gossypiboma. Such foreign materials can cause foreign body reactions in the surrounding tissues, but do not cause symptoms in most cases. Gossypibomas have been reported in many locations, including the maxillary sinus [1], head [2], thorax [3], frontal bone [4], abdomen [5], groin [6], bronchus [7], abdominal wall [8], pleural cavity [9], spine [10], pelvis [11], spleen [12], and legs [13]. Gossypibomas can occur after surgery in any cavity or organ (abdomen, 56%; pelvis, 18%; thorax, 11%; orthopedic; neurosurgical; and cardiovascular), in patients of all ages and both sexes [14]. Retained intra-abdominal surgical gauze is an uncommon surgical error in daily practice, with the requirement of accurate sponge counts. Surgeons worldwide have reported this incident since the first report by Wilson in 1884. Different terms have been used for retained textile foreign bodies, with gossypiboma the currently preferred term [14]. The incidence of gossypibomas has been reported to be as high as 1 in 1000e15,000 intra-abdominal operations, but the definite incidence is not known exactly because of under-reporting of cases. If not treated carefully, gossypibomas may cause serious morbidity and lead to mortality. Imaging studies including sonography, plain abdominal Xray, computed tomography, magnetic resonance imaging, and positron emission tomography, can demonstrate the location of the gossypiboma [15e19], and laparotomy is required for definitive diagnosis. Surgical removal is the preferred treatment [19]. A 68-year-old gravida 1 para 1 (normal spontaneous delivery) complained of abdominal fullness, constipation, and a palpable protruding mass from the rectum for >1 month
Background: Liver cancer and notably hepatocellular carcinoma (HCC), results in significantly high mortality rates worldwide. Chronic hepatitis and fatty liver, recognized precursors, underscore the imperative need for effective preventive strategies. This study explores colchicine, traditionally acknowledged for its anti-inflammatory properties and investigates its potential in liver cancer prevention. Methods: Utilizing the iHi Data Platform of China Medical University Hospital, Taiwan, this study analyzed two decades of medical data, incorporating 10,353 patients each in the Colchicine and Non-Colchicine cohorts, to investigate the association between colchicine use and liver cancer risk. Results: The study identified that colchicine users exhibited a 19% reduction in liver cancer risk, with a multivariable-adjusted odds ratio of 0.81 after accounting for confounding variables. Additionally, the influence of gender and comorbidities like diabetes mellitus on liver cancer risk was identified, corroborating the existing literature. A notable finding was that the prolonged use of colchicine was associated with improved outcomes, indicating a potential dose-response relationship. Conclusions: This study proposes a potential new role for colchicine in liver cancer prevention, extending beyond its established anti-inflammatory applications. While the findings are promising, further research is essential to validate these results. This research may serve as a foundation for future studies, aiming to further explore colchicine's role via clinical trials and in-depth investigations, potentially impacting preventive strategies for liver cancer.
Introduction: The effects of Gassless single port retroperitoneoscopic surgery with urologic diseaseremain unclear. In this retrospective review, we aim to elucidate the effect of the Gassless retroperitoneoscopy for urologic disease.
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