1/27. The risk of paraplegia through medical treatment.In the Orthopedic University Hospital of Heidelberg (section orthopedics II, treatment and rehabilitation of paraplegics), 21 patients with iatrogenic paraplegia were treated between 1968 and 1991. paraplegia occurred in nine cases after procedures close to the spinal cord. In 12 cases paraplegia complicated medical treatment. Procedures close to the spinal cord, such as laminectomy, vertebrotomy, spondylodesis, and peridural anaesthesia, involve the risk of mechanical damage to the spinal cord, the level of paraplegia depends on the area of treatment. Any previous damage to the spinal cord increases the risk of paraplegic complications. The main risks in procedures distant from the spinal cord, such as vascular surgery, angiography, radiotherapy, bronchial artery embolisation, and umbilical artery injection, are disturbances of the blood supply or toxic mechanisms. The ischaemic genesis of spinal cord damage is obvious in the case of vessel ligatures or cross-clamping of the aorta with resulting hypotonic discirculation. In radiomyelopathy as well, the damage to the spinal vessels outweighs the direct neuronal damage. Corresponding to the vascular cause, lesions are more likely to occur at the level of borderlines of blood supply in the middle thoracic cord or in the area of a non-anastomosed great radicular artery in the lumbar spinal cord. knowledge of the consequences and side effects of medical treatment is imperative. Knowing about the risk of a paraplegic lesion, we need a strict indication for diagnostic and therapeutic interventions. Due to progress in science some of the reasons of iatrogenic paraplegia have become manageable. Especially in radiotherapy, vascular surgery and angiography the risk of neurological complications has been lowered.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/27. Spinal angiolipoma: case report and review of literature.Spinal extradural angiolipomas are distinct, benign, and rare lesions composed of mature lipocytes admixed with abnormal blood vessels. They account for 0.14% of all spinal axis tumors. The case described here was a 72-year-old patient presenting with a history of paraparesis, hypoesthesia under the T2 level, hyperreflexia, and urinary overflow incontinence that appeared within 7 days after the administration of a coronary vasodilator drug regimen. The spinal magnetic resonance scan showed a lipomatous mass with signal void lesions, suggesting a vascular component of the tumor. The patient improved rapidly after surgical resection of the epidural tumor and decompression of the cord. According to the present literature, the duration of neurological symptoms ranges from 1 to 180 months (mean 28 months). But this patient's neurological deterioration took place 4 days before hospitalization. We believe that this can be explained by the increased tumor blood volume caused by vasodilator drugs, which in turn exerted a pulsatile compressive effect on the cord.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
3/27. Unusual consequences of heroin overdose: rhabdomyolysis, acute renal failure, paraplegia and hypercalcaemia.A 29-yr-old man, known to be a heroin addict, was found at home totally unrousable, bent on his hips in the lotus position. On admission, he required frequent ventricular defibrillation, external pacing and infusion of calcium. A diagnosis of rhabdomyolysis caused by heroin and cocaine overdose was made. He developed paraplegia below T12, acute renal failure, acute compartment syndrome in one leg and a coagulation defect. Despite a fasciotomy, a through-knee amputation of the leg was required. Haemodialysis was required for 26 days, and this period was complicated by increased serum calcium concentrations, which was treated with disodium pamindrate. calcium deposits were palpable in the muscles and could be seen in vessels on limb x-rays. After 34 days, he was eventually discharged to a general surgical ward and subsequently into the community.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
4/27. paraplegia as an unusual manifestation of aortic coarctation.In this report, we present an unusual case of a 20-year-old man whose first symptom of aortic coarctation was sudden paraplegia due to spinal epidural hemorrhage caused by rupture of an aneurysmal collateral vessel. Now, one year after surgical correction of coarctation, the patient has had no cardiac or neurological problems. To our knowledge, this is the only clearly documented case of such an aortic coarctation complication.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
5/27. Blood supply of hemipelvectomy flaps: the anterior flap hemipelvectomy.In posterior flap hemipelvectomy, preservation of the gluteus maximus with the flap guarantees its viability regardless of the level of ligation of the iliac vessels. In anterior flap hemipelvectomy with the quadriceps femoris attached to the flap, the dominant blood supply is through the lateral femoral circumflex branches of the profunda vessels, which is sufficient to maintain the flap.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/27. Extensive spinal epidural hematoma: a rare complication of aortic coarctation.Development of collateral circulation belongs among the typical signs of aortic coarctation. Cerebral or spinal artery aneurysm formation with increased risk of subarachnoid hemorrhage represent the most common neurovascular complication of this disease. We report a case of a 20-year-old sportsman who developed acute non-traumatic paraplegia as a result of extensive spinal epidural hemorrhage from collateral vessels accompanying aortic coarctation which was unrecognized up to that time. To the best of our knowledge, acute spinal epidural hematoma as a complication of aortic coarctation has not been previously reported.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
7/27. Microvascular changes in the lower extremities of paraplegics with heterotopic ossification.OBJECTIVES: To investigate the morphological aspects of blood microvasculature of the skin and subcutaneous tissues in subjects with paraplegia with heterotopic ossification (HO). methods: In two patients with traumatic spinal cord injury and HO, punch biopsies of skin and hypodermic soft tissue in the region of HO near the hip were studied with histological and ultrastructural methods. RESULTS: Alterations of endothelial cell and basement membrane of capillaries and small vessels were observed. Hyperactive endothelium, thickening and reduplication of the basement membrane, changes of the perivascular connective tissues and microcalcifications in the subcutaneous fat tissue were also seen. CONCLUSIONS: This present study indicates microvascular changes in the skin and subcutaneous tissue in the region of HO near the hip of two subjects with paraplegia. In our opinion the described vascular changes may induce hypoxiemic alterations of the soft para-articular tissues leading metabolic changes which may contribute to the development of HO. Therefore, it cannot be concluded whether these changes are directly responsible for HO induction.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
8/27. Electroejaculation of the paraplegic male followed by pregnancy.A method is described for the production of an ejaculate the paraplegic male by electrical stimulation from a probe placed in the rectum. A case is reported in which an ejaculate produced by this method was used to inseminate the wife of a paraplegic patient. pregnancy resulted, but the infant died. Post-mortem examination revealed the presence of transposition of the great vessels.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
9/27. Reconstruction of recurrent pressure sores using free flaps.The authors describe two successful reconstructions of recurrent pressure sores with free fasciocutaneous flaps. In Case 1, a free lateral thigh flap pedicled on the first and third direct cutaneous branches of the deep femoral vessels was used to cover a large recurrent sacral pressure sore. The vascular pedicle was dissected to the deep femoral trunk proximally and anastomosed to the inferior gluteal vessels. In Case 2, a free medial plantar flap was transferred to a recurrent ischial pressure sore. The vascular pedicle was dissected to the posterior tibial vessels proximally. The long vascular pedicle of the flap was passed through the femoral subcutaneous tunnel, and end-to-side microvascular anastomoses were performed to the superficial femoral trunk without any vein grafts. The authors advocate the use of free tissue transfer for recurrent pressure sore reconstruction.- - - - - - - - - - ranking = 1.5keywords = vessel (Clic here for more details about this article) |
10/27. Isolated granulomatous angiitis of the spinal cord.We describe a 31-year-old diabetic man, with granulomatous angiitis confined to the spinal cord, who developed rapidly progressive spastic paraplegia, clinically interpreted as being secondary to a spinal cord infarct. At the time of autopsy, vasculitis was limited to the spinal cord, without involvement of cerebral vessels. The inflammatory cells were predominantly CD4 T lymphocytes, with few CD8 T and B lymphocytes. The phenotypical composition of the inflammatory infiltrate is similar to that described in other granulomatous disorders such as sarcoidosis and tuberculin reaction.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
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