We report a case of spinal epidural hematoma after removal of an epidural catheter. The patient had no background of anticoagulant therapy or coagulopathy; sudden severe back pain occurred immediately after removal of the catheter. The chance of this occurring is estimated to be between 1:150,000 and 1:190,000. We studied 40 previous reports from 1952 to 2000, and we also investigated anticoagulant therapy and pathologic states, puncture difficulties and bleeding at the point of insertion, and its onset. In 23 cases (57.5%), anticoagulant therapy had been performed, and in 5 cases (12.5%), coagulopathy or liver dysfunction had been recognized. In 20 cases (50%), the initial symptoms were recognized within 24 hours after removal of the epidural catheter. Although spinal epidural hematoma is a very rare condition, it is a serious complication of continuous epidural anesthesia.
Purpose: To investigate the value of MR imaging for preoperative diagnosis of paraganglioma of the cauda equina.
Material and Methods: A retrospective review of 2 cases of paraganglioma of the cauda equina examined with MR imaging was undertaken. Features assessed included the homogeneity of the lesions, presence or absence of serpiginous flow void and thin hypointense margins.
Results: In case 1, the tumor was hyperintense on the postcontrast examination and serpiginous flow void suggested vessels in the upper pole of the tumor. In case 2, the tumor was encapsulated by a thin hypointense margin on both T1‐ and T2‐weighted images, which suggested hemosiderin.
Conclusion: The MR appearance may be of great value in the preoperative diagnosis of paraganglioma of the cauda equina.
We treated 15 patients with malignant bone and soft-tissue tumours of the shoulder girdle using limb salvage operations involving resection of the proximal humerus, scapula and clavicle. The oncological and functional outcomes were evaluated in all patients after an average of 5 (1-13) years. Oncological evaluation revealed that in 11 patients with adequate surgical margins six were continuously disease free and two had no evidence of disease. Three patients with marginal surgical margins had all died. We suggest that only where adequate surgical margins can be obtained should operations be performed. Forequarter amputation is still indicated in patients with complicated neurovascular involvement. Functional evaluation showed that scapular resections, especially glenoid resections, provided poor results (mean score 54%) in comparison with patients without such resection (mean score 82%). Résumé Nous avons traité 15 malades atteints de tumeurs malignes osseuses ou des parties molles de la ceinture scapulaire en utilisant des opérations du sauvetage du membre qui impliquent une résection de l'humérus proximal, de l'omoplate et de la clavicule. Les résultats oncologiques et fonctionnels ont été évalués pour tous les malades après une moyenne de 5 (1-13) années. L'évaluation oncologique a montré que chez 11 malades avec des marges chirurgicales adéquates six étaient libre de maladie et deux sans évidences de maladie. Trois malades avec une chirurgie marginale sont décédés. Nous pensons que seules les opérations ou une chirurgie à marge adéquate peut être réalisée doivent être faites. L'amputation du membre supérieur est encore indiquée chez les malades avec atteinte neurovasculaire compliquée. L'évaluation fonctionnelle a montré que les résections scapulaires, surtout résections de la glène, don-naient de mauvais résultats (score moyen 54%) en comparaison de malades sans telle résection (score moyen 82%).
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