Synovial Cysts of the Spine

Neurosurgery ◽  
1988 ◽  
Vol 22 (4) ◽  
pp. 642-647 ◽  
Author(s):  
Burton M. Onofrio ◽  
Alexander D. Mih
Keyword(s):  
Degenerative Change ◽  
Degenerative Spondylolisthesis ◽  
Signs And Symptoms ◽  
Positive Contrast ◽  
Surgical Excision ◽  
Anatomical Location ◽  
Computed Tomographic ◽  
Presenting Symptoms ◽  
Dural Sac ◽  
Synovial Cysts

Abstract A series of 13 patients with synovial or ganglion cysts of the spinal facet joints causing nerve root compression is reported. These cysts were found in both the cervical and the lumbar spine, and the anatomical location of each cyst corresponded to the patient's signs and symptoms. In no case was there evidence of intervertebral disc abnormality found at operation. The patients ranged from 49 to 77 years of age and included 4 men and 9 women. Radiographic evidence of facet degenerative change and degenerative spondylolisthesis was frequently but not invariably noted. The extradural defects defined with positive contrast myelography or postmyelography computed tomographic scanning were usually posterior or posterolateral to the common dural sac and were misinterpreted as extruded discs in the majority of cases. Treatment consisted of laminectomy and surgical excision of cysts. All patients reported improvement or resolution of their presenting symptoms.

Microsurgical Resection of a Lumbar Synovial Cyst: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Brian J A Gill ◽  
Kyle Lindsey McCormick ◽  
Paul C McCormick
Keyword(s):  
Degenerative Spondylolisthesis ◽  
Synovial Cyst ◽  
Radicular Pain ◽  
Surgical Anatomy ◽  
Neurogenic Claudication ◽  
Presenting Symptoms ◽  
Patient Consent ◽  
Synovial Cysts ◽  
Cyst Recurrence ◽  
Microsurgical Resection

Abstract Lumbar spine synovial cysts develop from degenerated zygapophyseal joints. Symptomatic patients present with radicular pain and weakness or neurogenic claudication.1 In the absence of significant concomitant degenerative spondylolisthesis, symptomatic patients can be managed with a laminectomy and microsurgical resection of the cyst, without the need for instrumented fusion.2,3 In this video, we present the microsurgical resection of a left-sided L4-5 synovial cyst in a 68-yr-old man with radicular pain refractory to conservative management. The radiographical features, relevant surgical anatomy, and salient operative steps are reviewed, and strategies for preventing cyst recurrence are emphasized. There were no complications, the postoperative course was unremarkable, and the patient was discharged on postoperative day 1 with significant improvement in his presenting symptoms. No identifying information is present, and patient consent was obtained for the procedure and for publishing the material included in this video.

scholarly journals 526. Clinical Presenting Characteristics of Pediatric COVID-19 Infection in a Tertiary Care Children’s Hospital in Detroit

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S330-S330
Author(s):  
Jocelyn Y Ang ◽  
Nirupama Kannikeswaran ◽  
Basim Asmar
Keyword(s):  
Mechanical Ventilation ◽  
Severe Disease ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Signs And Symptoms ◽  
Pediatric Emergency ◽  
Study Cohort ◽  
Mild Disease ◽  
Presenting Symptoms ◽  
Patient Disposition

Abstract Background There is limited data regarding the presenting clinical characteristics of COVID-19 in children. Our objective is to describe the clinical presentations and outcomes of COVID-19 infection early in the pandemic at our institution. Methods We performed a retrospective chart review of children up to 18 years who underwent testing for SARS CoV-2 from March 1st to May 10th 2020 at our pediatric emergency department. We abstracted patient’s demographics, clinical presentation, diagnostic studies and patient disposition. We classified the severity of clinical illness based on published criteria. We excluded patients diagnosed with Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19. Results SARS CoV-2 testing was performed on 481 patients of whom 43 (8.9%) tested positive. Of these, 4 were diagnosed with MIS-C. Data of 39 patients were analyzed. Patients’ demographics, co-morbidities, presenting signs and symptoms and disposition are shown in Table 1. Age range was 47 days – 18 years. Infants representing one third (14/39; 35.9%) of our study cohort. There was equal sex distribution. Asthma or obesity was present in 17 (44%). The most common presenting symptoms included fever, cough, shortness of breath and diarrhea. Chest radiograph showed pneumonia in 12 (30.8%) patients. Two thirds (27/39; 69.2%) were asymptomatic or had mild disease; six patients (15.4%) had severe or critical illness (Figure 1). Nineteen (48%) patients were admitted to the general pediatric service. Eleven (28%) were admitted to the Intensive Care Units (ICU). The characteristics, presenting symptoms and interventions performed in the PICU cohort are shown in Table 2. Half of these patients required mechanical ventilation. There was one death in a 3 month old infant unrelated to SARS CoV-2. Majority of the infants required hospitalization (12/14; 85.7%), including 4 to the PICU (one each for non accidental trauma, ingestion, seizure and pneumonia). Table 1. Patient demographics, signs and symptoms of COVID-19 infection in Children Table 2: PICU patients: Characteristics, Interventions and pharmacotherapy Figure 1: Severity of Ill ness in the study cohort Conclusion Majority (17; 43%) of our children with COVID-19 had a mild disease. Eleven (28%) including 4 infants required critical care; 5 required mechanical ventilation. There was no COVID-19 related mortality. Larger studies are needed to further define the spectrum of COVID- 19 and risk factors associated with severe disease in children. Disclosures All Authors: No reported disclosures

Stereotactic Intratumoral Photodynamic Therapy for Recurrent Malignant Brain Tumors

Neurosurgery ◽  
1991 ◽  
Vol 29 (5) ◽  
pp. 688-696 ◽  
Author(s):  
Stephen K. Powers ◽  
Sharon S. Cush ◽  
Diana L. Walstad ◽  
Lester Kwock
Keyword(s):  
Photodynamic Therapy ◽  
Magnetic Resonance ◽  
Malignant Gliomas ◽  
Signs And Symptoms ◽  
Resonance Spectroscopy ◽  
Normal Brain ◽  
Hematoporphyrin Derivative ◽  
Neurological Sequelae ◽  
Computed Tomographic ◽  
Before And After

Abstract Photodynamic therapy (PDT) using purified hematoporphyrin derivative and stereotactic intratumorally implanted optical laser fiber(s) was used to treat patients with recurrent malignant gliomas and metastatic melanoma of the brain. Tumor response to PDT was evaluated by recording changes in the volume and pattern of tumor enhancement between computed tomographic and magnetic resonance imaging scans done before and after PDT, metabolic changes in tumor tissue by31 P magnetic resonance spectroscopy, and patient outcome. Toxicity of PDT to brain was evaluated on the basis of changes in the patients' neurological examinations and correlated with changes in brain adjacent to tumor seen on postoperative imaging studies. Dramatic tumor responses to PDT were seen in all gliomas, but no response of tumor to treatment was seen with melanoma. Transient signs and symptoms of increased peritumoral cerebral edema caused by PDT were seen in all patients. Two patients suffered permanent neurological sequelae, monocular blindness and a partial visual field defect, as a result of treatment. Two patients with recurrent anaplastic astrocytomas remain in remission at 45 and 35 weeks after PDT. We conclude that intratumoral photoradiation therapy of hematoporphyrin derivative-photosensitized malignant gliomas effectively produces necrosis of the solid component of malignant gliomas: however, intratumoral photoradiation may not reach the portion of tumor that invades normal brain.

scholarly journals A case of retroperitoneal tumor – clinical and therapeutic considerations

2016 ◽  
Vol 22 (3) ◽  
pp. 203-207
Author(s):  
R. Osman ◽  
V. Sarbu ◽  
S. Osman
Keyword(s):  
Rare Condition ◽  
Surgical Excision ◽  
Retroperitoneal Tumor ◽  
Lumbar Pain ◽  
Pathological Examination ◽  
Nerve Sheath Tumor ◽  
Abdominal Girth ◽  
Computed Tomographic ◽  
Appropriate Treatment ◽  
History Of

Abstract Introduction: The aim of this paper is to present a case of rare retroperitoneal tumor. Material and Methods. A 72 year old man presented with six month history of abdominal girth, lumbar pain and occasional episodes of constipation was admitted in our clinic. A computed tomographic abdominal scan revealed a retroperitoneal solid mass. Surgical exploration performed later displayed solid and well delimited mass throughout retroperitoneal space followed by excision of lesion and multiple drainages. Microscopic pathological examination was benign nerve sheath tumor. Conclusion. These tumors are characteristically firm, smooth, and asymptomatic. They range in size from 1-2 mm to over 20 cm. Awareness of this indolent and rare condition is an important prerequisite for early diagnosis and appropriate treatment. Surgical excision can usually be accomplished by enucleating of the tumor without damage to the adjacent nerve.

scholarly journals HRIDROGA – AN OUTLOOK THROUGH SAMANYA LAKSHANA

2021 ◽  
Vol 9 (9) ◽  
pp. 2084-2087
Author(s):  
Ashwini P K ◽  
Geetha B Markande ◽  
Prashanth Jain
Keyword(s):  
Chest Pain ◽  
Cardiovascular Diseases ◽  
Causes Of Death ◽  
Signs And Symptoms ◽  
Presenting Symptoms ◽  
Unique Approach ◽  
Cardiac Disorders ◽  
Proper Analysis

Hridroga (cardiovascular diseases) are the major causes of death globally, taking an estimated 17.9 million lives each year. In view of increasing incidence of cardiac disorders in the present era, there is a need to understand the disease more elaborately. Ayurveda has a unique approach towards understanding and diagnosing diseases. Diag- nosis must be done by proper analysis of presenting symptoms of a disease. By the thorough knowledge regarding these signs and symptoms, right diagnosis can be done before planning any treatment. Ayurveda has given utmost importance for diagnosis with due consideration of Lakshanas. Hritshoola (chest pain), Vaivarnya (cyanosis), Moorcha (syncope), Shwasa (dyspnea), Kasa (cough) are the cardinal features of Hridroga. By knowing the whole concept of Lakshanas, diagnosis can be done at an earlier stage. Keywords: Hridroga, Cardiovascular diseases, Samanya Lakshanas

Appendicitis

2019 ◽  
Author(s):  
James Creswell Simpson ◽  
Sarah Sebbag
Keyword(s):  
Age Groups ◽  
Signs And Symptoms ◽  
Vermiform Appendix ◽  
The United States ◽  
Likelihood Ratios ◽  
Lower Quadrant Pain ◽  
Lower Quadrant ◽  
Right Lower Quadrant Pain ◽  
Computed Tomographic ◽  
High Index Of Suspicion

Appendicitis is defined as inflammation of the vermiform appendix. It is the most common abdominal surgical emergency and occurs at an annual rate of approximately one in 10,000 in the United States. The lifetime risk of appendicitis is about 9% for males and 7% for females; approximately 80% of cases occur before 45 years of age. Appendicitis rarely occurs in infants; it increases in frequency between 2 and 4 years of age and reaches a peak between the ages of 10 and 19 years. However, clinicians must maintain a high index of suspicion in patients of all age groups. This review covers the pathophysiology, stabilization and assessment, and diagnosis and treatment of complicated and uncomplicated appendicitis. The disposition and outcomes are also reviewed. Figures show an image of appendicitis on a bedside sonogram, and a computed tomographic image of appendicitis. Tables list likelihood ratios of signs and symptoms of appendicitis, the sonographic appearance of appendicitis, the Alvarado scoring system, and the differential diagnosis of appendicitis.  This review contains 2 figures, 7 tables, and 36 references. Key words: appendicitis, obstructed appendiceal lumen, rebound abdomen, right lower quadrant pain, ruptured appendix

scholarly journals Orbital metastasis as presenting symptom from a prostatic adenocarcinoma

2019 ◽  
Vol 30 (1) ◽  
pp. NP29-NP32
Author(s):  
Marco R Pastore ◽  
Rossella D’Aloisio ◽  
Gabriella Cirigliano ◽  
Chiara De Giacinto ◽  
Daniele Tognetto
Keyword(s):  
Computed Tomography ◽  
Specific Antigen ◽  
Signs And Symptoms ◽  
Infiltration Rate ◽  
Prostatic Adenocarcinoma ◽  
Cytokeratin 20 ◽  
Orbital Metastasis ◽  
Primary Tumor Site ◽  
Presenting Symptoms ◽  
Kinetic Perimetry

Purpose: To report a 72-year-old man with orbital metastasis as presenting symptoms from a prostatic adenocarcinoma. Methods: A complete ophthalmological evaluation with ultrasonography examination, kinetic perimetry, fluorescein angiography, and visually evoked potentials were performed. The patient underwent computed tomography, magnetic resonance imaging of the orbit, and blood test for confirmation of the diagnosis. Bone infiltration rate of the cancer was evaluated with bone scintigraphy. Type of the tumor was assessed with orbital incision biopsy and histological analysis. The patient received systemic chemotherapy. Due to poor patient compliance, radiotherapy was not performed. Results: Ultrasonography showed a hypoechoic retrobulbar lesion. At computed tomography examination of the orbit an expansive oval intraconical solid lesion with enhancement after medium contrast was found. Biopsy findings revealed a moderately differentiated adenocarcinoma with immunohistochemical profile supporting prostate as the primary tumor site: negative for cytokeratin-7 and cytokeratin-20 and positive for prostate-specific antigen, prostate-specific acid phosphatase, and alpha-methylacyl-CoA-racemase. Conclusions: Ocular signs and symptoms as first clinical presentation of a prostate cancer are relatively rare. Despite its very poor prognosis, a correct management and therapy can improve visual acuity, ocular symptoms, and median survival of cancer patients.

scholarly journals Synovial Sarcoma of the Head and Neck: A Single Institution Review

Sarcoma ◽  
2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Vancheswaran Gopalakrishnan ◽  
Behrang Amini ◽  
Michael J. Wagner ◽  
Erica N. Nowell ◽  
Alexander J. Lazar ◽  
...  
Keyword(s):  
Head And Neck ◽  
Tumor Size ◽  
Soft Tissues ◽  
Local Therapy ◽  
Retrospective Chart Review ◽  
Progression Free Survival ◽  
Surgical Excision ◽  
Distant Recurrence ◽  
Anatomical Location ◽  
Synovial Sarcomas

Background. The prognosis and clinical characteristics of head and neck synovial sarcomas (HNSS) are unclear. Herein, we present an update using a cohort of patients treated at our institution. Methods. We performed a retrospective chart review of 44 patients diagnosed with primary HNSS between March 1990 and June 2012. Overall survival (OS) and progression-free survival (PFS) curves were estimated and hazard ratios (HRs) were calculated. Results. The entire cohort’s median PFS was 4.6 years, and 20 of the 44 (45%) patients developed either local or distant recurrence. Tumor size ≥ 5 cm (p=0.008, HR = 4.69; 95% CI = 1.34–16.38) and a primary presentation in the soft tissues of the neck (p=0.04, HR = 2.41; 95% CI = 1.003–5.82) were associated with significantly worse PFS. The OS and PFS of patients who received definitive local therapy versus those who received additional adjuvant systemic therapy did not differ significantly. Conclusion. Despite the treatment challenges associated with HNSS, our cohort of patients had a better prognosis than one might expect in this unfavorable anatomical location. Our findings suggest that tumor size and site are predictive of PFS and that wide surgical excision is of vital importance, since traditional cytotoxic chemotherapy has limited efficacy at this site.

OUTCOME OF BRAIN ABSCESS BY CLOSTRIDIUM PERFRINGENS

Neurosurgery ◽  
2007 ◽  
Vol 61 (6) ◽  
pp. E1339-E1339 ◽  
Author(s):  
Chaim B. Colen ◽  
Mahmoud Rayes ◽  
Setti Rengachary ◽  
Murali Guthikonda
Keyword(s):  
Brain Abscess ◽  
Clostridium Perfringens ◽  
Soft Tissues ◽  
Severe Infection ◽  
Surgical Excision ◽  
Penicillin G ◽  
Necrotic Tissue ◽  
Excellent Outcome ◽  
Computed Tomographic ◽  
Antibiotic Coverage

Abstract OBJECTIVE Despite the aggressive infection of soft tissue caused by Clostridium perfringens (gas gangrene-necrotizing fasciitis), a brain abscess with this bacteria treated by early surgical excision, debridement of necrotic tissue, and antibiotic coverage may be expected to have a good recovery. Long-term follow-up has not been well established in this group of patients. We report this case to show the outcome at 3 years post surgical and antibiotic treatment for C. perfringens brain abscess and stress the need for urgent intervention to achieve good outcome. We also present a literature review of Clostridial brain abscesses since the 1960s. CLINICAL PRESENTATION A 53-year-old man was brought to the emergency room after having a witnessed seizure status postassault 3 days before admission. On presentation, he was febrile, disoriented, lethargic, and demonstrated right upper extremity weakness. A computed tomographic scan of the head showed a left frontoparietal depressed cranial fracture complicated with gas and intraparenchymal air fluid level cavity. INTERVENTION Emergent surgery for debridement and excision of necrotic tissue was performed. Empiric intravenous antibiotic therapy was started and penicillin G was added for 6 weeks after C. perfringens was demonstrated. CONCLUSION Despite the severe infection and effect of C. perfringens in soft tissues in the brain, it appears that emergent surgical debridement and antibiotic coverage will yield an excellent outcome for these patients.

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