Search

Despite the relatively low prevalence of metastatic cervical spinal tumor, these entities give rise to more profound complications than thoracic and lumbar spinal tumor. However, it is regrettable that experimental investigation has thus far shown a dearth of attention to metastatic cervical spinal tumor.

To investigate the extent of asbestos exposure among patients with primary lung cancer in Japan. A retrospective estimation of potential asbestos‐exposed individuals, as determined by the presence of pleural plaques identified on chest computed tomography (CT), was conducted on 885 pathologically confirmed primary lung cancer patients (mean age 71.3 years, 641 males). All patients were diagnosed at 29 hospitals across Japan between 2006 and 2007. Since these hospitals belong to the Japan Federation of Democratic Medical Institutions (MINIREN), an organization of medical institutions for workers, the study subjects may contain a higher proportion of workers than the general population. Pleural plaques were identified in 12.8% of subjects (15.8% in males and 4.9% in females), consisting exclusively of cases older than 50 years. They were found most frequently on the chest wall pleura (96.5%), followed by the diaphragm (23.9%) and mediastinum (9.7%). Calcifications were seen in 47 cases (41.6%). The highest prevalence of pleural plaques was seen among workers from construction‐related fields (37.7%). No distinct lung cancer histology was observed in patients with pleural plaques. Coexistence of pleural plaques and small irregular opacities was observed in 2.5% of subjects. In a Japanese population representing more workers than general Japanese, 12.8% of patients with primary lung cancer may have experienced asbestos exposure at some time in the past. Special medical attention should be paid to individuals with a history of employment in construction‐related occupations, as workers in this sector showed the highest prevalence of pleural plaques.

Study Design Surgeon survey.Objective To analyze multimodal intraoperative monitoring (MIOM) for different combinations of methods based on the collected data and determine the best combination.Methods A questionnaire was sent to 72 training institutions to analyze and compile data about monitoring that had been conducted during the preceding 5 years to obtain data on the following: (1) types of monitoring; (2) names and number of diseases; (3) conditions of anesthesia; (4) condition of stimulation, the monitored muscle and its number; (5) complications; and (6) preoperative and postoperative manual muscle testing, presence of dysesthesia, and the duration of postoperative motor deficit. Sensitivity and specificity, false-positive rates, and false-negative rates were examined for each type of monitoring, along with the relationship between each type of monitoring and the period of postoperative motor deficit.Results Comparison of the various combinations showed transcranial electrical stimulation motor evoked potential (TcMEP)?+?cord evoked potential after stimulation to the brain (Br-SCEP) combination had the highest sensitivity (90%). The TcMEP?+?somatosensory evoked potential (SSEP) and TcMEP?+?spinal cord evoked potential after stimulation to the spinal cord (Sp-SCEP) combinations each had a sensitivity of 80%, exhibiting little difference between their sensitivity and that obtained when TcMEP alone was used. Meanwhile, the sensitivity was as low as 50% with Br-SCEP?+?Sp-SCEP (i.e., the cases where TcMEP was not included).Conclusions The best multimodality combination for intraoperative spinal cord monitoring is TcMEP?+?Br-SCEP, which had the highest sensitivity (90%), the lowest false-positive rate (6.1%), and the lowest false-negative rate (0.2%).

The purpose of this study was to compare nonbridging external fixators (group NB) with bridging external fixators (group B) in the treatment for unstable distal radius fractures. The subjects consisted of 84 patients, 42 in each group. Mean patient age was 64.0 years in group NB and 59.6 years in group B. According to Saito’s classification, most fractures were of the comminuted Colles type. No bone graft was made in group NB. Patients of group B showed serious reflex sympathetic dystrophy (RSD). On Saito’s evaluation criteria, the proportion of patients evaluated as “good” or better was 100% in group NB and 95.6% in group B. This finding can be taken as evidence that group NB patients showed better results.

Spinal epidural hematoma is a relatively rare condition in children. We report the case of a 6-year-old girl who presented to a regional hospital with the complaints of severe thoracic back pain, neck stiffness, and gait disturbance of sudden onset. Clinical examination revealed no obvious cause for the symptoms. Spinal magnetic resonance imaging (MRI) revealed the presence of an epidural mass lesion extending from T1 to T3, compressing the spinal cord; the findings suggested a diagnosis of idiopathic spinal epidural hematoma. Twelve days after admission, the patient was transferred to our hospital for further observation. Blood tests, including a coagulation profile, were normal. At 22 days after the initial presentation, repeat MRI revealed resolution of the hematoma, with the mass showing an appreciable decrease in size. The patient became symptom-free and was walking normally at the time of discharge 28 days after her initial presentation. At 59 days after the initial presentation, she was readmitted with complaints of a sudden recurrence of back pain and weakness of both legs. Repeat MRI at this time revealed reappearance of the spinal epidural hematoma at the same level. Operative evacuation of the hematoma was performed 3 days after the diagnosis of the recurrence, with laminoplasty from T1 to T3. At a clinical review conducted 30 months after the operation, the patient remained symptomfree. Idiopathic resolution of a spinal epidural hematoma has previously been reported in 36 patients. However, we found no record in the literature of any case in which an epidural hematoma recurred following earlier MRI-confirmed idiopathic resolution.

The purpose of this study was to compare nonbridging external fixators (group NB) with bridging external fixators (group B) in the treatment for unstable distal radius fractures. The subjects consisted of 84 patients, 42 in each group. Mean patient age was 64.0 years in group NB and 59.6 years in group B. According to Saito’s classification, most fractures were of the comminuted Colles type. No bone graft was made in group NB. Patients of group B showed serious reflex sympathetic dystrophy (RSD). On Saito’s evaluation criteria, the proportion of patients evaluated as “good” or better was 100% in group NB and 95.6% in group B. This finding can be taken as evidence that group NB patients showed better results.

Spinal epidural hematoma is a relatively rare condition in children. We report the case of a 6-year-old girl who presented to a regional hospital with the complaints of severe thoracic back pain, neck stiffness, and gait disturbance of sudden onset. Clinical examination revealed no obvious cause for the symptoms. Spinal magnetic resonance imaging (MRI) revealed the presence of an epidural mass lesion extending from T1 to T3, compressing the spinal cord; the findings suggested a diagnosis of idiopathic spinal epidural hematoma. Twelve days after admission, the patient was transferred to our hospital for further observation. Blood tests, including a coagulation profile, were normal. At 22 days after the initial presentation, repeat MRI revealed resolution of the hematoma, with the mass showing an appreciable decrease in size. The patient became symptom-free and was walking normally at the time of discharge 28 days after her initial presentation. At 59 days after the initial presentation, she was readmitted with complaints of a sudden recurrence of back pain and weakness of both legs. Repeat MRI at this time revealed reappearance of the spinal epidural hematoma at the same level. Operative evacuation of the hematoma was performed 3 days after the diagnosis of the recurrence, with laminoplasty from T1 to T3. At a clinical review conducted 30 months after the operation, the patient remained symptom-free. Idiopathic resolution of a spinal epidural hematoma has previously been reported in 36 patients. However, we found no record in the literature of any case in which an epidural hematoma recurred following earlier MRI-confirmed idiopathic resolution.

Six cases of spontaneous fracture of the odontoid process in rheumatoid arthritis are presented. Fifty–one patients with atlantoaxial subluxation in rheumatoid arthritis underwent surgery between 1981 and 1990. This included six patients (in 10 ) who had subluxation accompanied by fracture of the odontoid without apparent trauma. The mean patient age was 58 years and all had a long history of rheumatoid arthritis. No trauma was considered to be the cause of the fracture. This is a fracture caused by arosion and osteoporosis of the odontoid process due to rheumatoid synovitis, aging and steroid therapy. In addition, another cause is a dynamic load produced from the instability accompanying atlantoaxial subiuxation working on the odontoid in cervical extension. It is important remember that the odontoid process is susceptible to spontaneous fracture.

The authors experienced unique cases of spinal cord herniation. Only eight cases of spinal cord herniation have been reported formerly. The authors report two cases of spinal cord herniation accompanied with double structure of dura mater (duplicated dura mater). The causes of their condition are discussed in this report.

The transverse area and flattening ratio of the spinal cord were determined with preoperative computed tomographic myelography in 103 patients with cervical compression myelopathy: cervical spondylotic myelopathy (n = 44); ossification of the posterior longitudinal ligament (n = 39); and cervical disc herniation (n = 20). With these values and other clinical items (eg, age, duration of symptoms, preoperative severity), a linear model to predict postoperative recovery was attempted by multiple regression analysis. In cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament, the transverse area of the spinal cord and the duration of symptoms were accepted as effective explanatory variables to predict recovery. In cervical disc herniation, regardless of the transverse area or duration, the recovery was good, and pathologic state was considered essentially different.