Post thoracotomy spinal cord compression in a child. A word of caution

AbstractINTRODUCTIONOxidised regenerated cellulose is a commonly used haemostatic agent in surgery which, in rare cases, has been held responsible for severe complications.PRESENTATION OF CASEA 6-year-old girl developed flaccid paraplegia following the excision of a large thoracic ganglioneuroblastoma. Magnetic resonance imaging revealed spinal cord compression at the T10–11 level and the patient underwent emergency decompression via the previous thoracotomy. At operation the causative factor was found to be a mass consisted of cellulose used at the original procedure to control local bleeding in the vicinity of the intervertebral foramen.DISCUSSIONThe accessibility of the spinal canal from the thoracic cavity through the opening of the intervertebral foramen may allow migration of material and in this case oxidized regenerated cellulose, commonly used during cardiothoracic procedures, can cause rare but severe complications such as compression of the spinal cord.CONCLUSIONThe value of hemostatic gauze is well established in cardiothoracic surgery. However, surgeon should be cautious with the application of material in the proximity of the intervertebral foramen, especially if this is to leave behind after the completion of the procedure

Contribution to the diagnosis and surgical treatment of the aortic arch syndrome

Occlusive lesions of the brachiocephalic arteries manifests a syndrome characterized by reduced perfusion and consequent ischaemia of the brain, face and upper limbs known as Aortic Arch Syndrome.This retrospective clinical study conducted at the 1st Surgical Clinic, University of Athens, includes 32 patients admitted and treated at the Clinic during the period 1973-1988. Twenty three of these patients had atherosclerosis, 5 non-specific aortoarteritis (Takayasu’s disease), 1 giant cell arteritis, 1 congenital abnormality, 1 luetic aneurysm and 1 extravascular compression. Intermittent claudication of the upper limbs, dizziness, absent or reduced radial pulse, discrepancy in arterial pressure between the arms and bruits over lower neck and upper thorax were the prevalent symptoms.All patients underwent aortography which proved to be the most reliable method for scanning the aortic arch. Digital plethysmography was used for long term follow-up of these patients with the supplementary use of angiography whenever this was indicated. The development of adequate collateral circulation and the ability to easily adjust the upper limbs’s activities to a lower level resulted in a significant improvement in a number of patients treated conservatively. Surgical treatment was reserved for patients with severe symptoms, severe disability or at high risk of serious consequences. The results of the surgical treatment were excellent offering immediate relief from symptoms to 83.3% of patients undergoing surgery, maintained long term in 87.5% of them. The low operative mortality (0%) and the acceptable rate of complications (15.7%) render surgery as an excellent treatment for patients with aortic arch syndrome.Concurrent treatment of the underlying disease is expected to improve furthermore the results of surgery.Οι αποφρακτικές αλλοιώσεις των εκφύσεων των μεγάλων βραχιοκεφαλικών κλάδων του αορτικού τόξου, εκδηλώνουν σύνδρομο χαρακτηριζόμενο από ισχαιμία του εγκεφάλου, του προσώπου και των άνω άκρων, που είναι γνωστό ως Σύνδρομο του Αορτικού Τόξου.Στην Α’ Χειρουργική Κλινική του Πανεπιστημίου Αθηνών μελετήσαμε αναδρομικά από 1973-1988, 32 περιπτώσεις συνδρόμου του αορτικού τόξου. Από τους ασθενείς αυτούς 23 έπασχαν από αθηροσκλήρωση, 5 από μη ειδική αορτοαρτηριίτιδα (νόσο Takayasu), 1 από γιγαντοκυτταρική αρτηριίτιδα, 1 άρρωστος είχε συγγενή ανωμαλία, 1 συφιλιδικό ανεύρυσμα και 1 εξωαγγειακή απόφραξη. Τα κύρια συμπτώματα των αρρώστων ήταν διαλείπουσα «χωλότητα» άνω άκρων και ζάλη, ενώ τα πιο συχνά εμφανιζόμενα κλινικά σημεία ήταν απουσία ή ελάττωση κερκιδικών σφύξεων, διαφορά στην αρτηριακή πίεση μεταξύ των άνω άκρων και τα φυσήματα στη βάση του τραχήλου. Το σύνολο των αρρώστων μελετήθηκε με αγγειογραφία του αορτικού τόξου που αποτελεί την πιο αξιόπιστη μέθοδο για τον έλεγχο του. Η μακροχρόνια παρακολούθηση των αρρώστων στηρίχθηκε στην δακτυλική πληθυσμογραφία και όπου υπήρχε ένδειξη και στην αγγειογραφία.Η ανάπτυξη ικανοποιητικής παράπλευρης κυκλοφορίας και η εύκολη προσαρμογή στις δραστηριότητες των άνω άκρων επέτρεψαν την συντηρητική αντιμετώπιση μερικών από αυτούς τους αρρώστους. Η χειρουργική θεραπεία επιφυλάχθηκε για αρρώστους με σοβαρή συμπτωματολογία, σοβαρό κίνδυνο επιπλοκών, ή σοβαρή αναπηρία των άνω άκρων, αποτέλεσμα της πάθησης τους. Τα αποτελέσματα της χειρουργικής θεραπείας ήταν εξαιρετικά, προσφέροντας άμεση ανακούφιση στο 83,3% των χειρουργημένων που διατηρήθηκε για μεγάλο χρονικό διάστημα στο 87,5% από αυτούς. Η χαμηλή θνησιμότητα (0%) και το παραδεκτό ποσοστό επιπλοκών (15,7%) την ανάγει σε εξαιρετική θεραπεία ασθενών με σύνδρομο του αορτικού τόξου.Η ταυτόχρονη αντιμετώπιση εξ άλλου της υποκείμενης πάθησης και η επιβράδυνση της εξέλιξης της προβλέπεται να συμβάλει στην ακόμη παραπέρα βελτίωση των αποτελεσμάτων της χειρουργικής θεραπείας

Video for the cases A13 to A16 for an observer that moves with the ground

Motion of the body for an observer that moves with the ground for the scenarios A13, A14, A15 and A16 described in Example 1 of the paper. The wheels are numbered from 1 to 4 clockwise, with wheel 1 being the wheel closest to the camera. Wheels 3 and 4 cannot swivel in all scenarios. If activating the brake on a wheel or not is signified by 1 and 0 respectively the scenarios A13 to A16 are described as:, A13=[0,1,1,1], A14=[0,0,1,0], A15=[0,0,1,1], A16=[0,0,0,1]

Video for the cases A9 to A12 for an observer that moves with the ground

Motion of the body for an observer that moves with the ground, for the scenarios A9, A10, A11 and A12 described in Example 1 of the paper. The wheels are numbered from 1 to 4 clockwise, with wheel 1 being the wheel closest to the camera. Wheels 3 and 4 cannot swivel in all scenarios. If activating the brake on a wheel or not is signified by 1 and 0 respectively the scenarios A9 to A12 are described as: A9=[1,0,1,1], A10=[0,1,0,0], A11=[0,1,1,0], A12=[0,1,0,1]

Video for the cases A5 to A8 for an observer that moves with the ground

Motion of the body for an observer that moves with the ground for the scenarios A5, A6, A7 and A8 described in Example 1 of the paper. The wheels are numbered from 1 to 4 clockwise, with wheel 1 being the wheel closest to the camera. Wheels 3 and 4 cannot swivel in all scenarios. If activating the brake on a wheel or not is signified by 1 and 0 respectively the scenarios A5 to A8 are described as: A5=[1,0,0,1], A6=[1,1,1,0], A7=[1,1,0,1], A8=[1,1,1,1]

Video for the cases A1 to A4 for an observer that moves with the ground

Motion of the body for an observer that moves with the ground for the scenarios A1, A2, A3 and A4 described in Example 1 of the paper. The wheels are numbered from 1 to 4 clockwise, with wheel 1 being the wheel closest to the camera. Wheels 3 and 4 cannot swivel in all scenarios. If activating the brake on a wheel or not is signified by 1 and 0 respectively the scenarios A1 to A4 are described as: A1=[0,0,0,0], A2=[1,0,0,0], A3=[1,1,0,0], A4=[1,0,1,0]

Video for the cases A1 to A4 for a still observer

Motion of the body for a still observer for the scenarios A1, A2, A3 and A4 described in Example 1 of the paper. The wheels are numbered from 1 to 4 clockwise, with wheel 1 being the wheel closest to the camera. Wheels 3 and 4 cannot swivel in all scenarios. If activating the brake on a wheel or not is signified by 1 and 0 respectively the scenarios A1 to A4 are described as: A1=[0,0,0,0], A2=[1,0,0,0], A3=[1,1,0,0], A4=[1,0,1,0]

Video for the cases A5 to A8 for a still observer

Motion of the body for a still observer for the scenarios A5, A6, A7 and A8 described in Example 1 of the paper. The wheels are numbered from 1 to 4 clockwise, with wheel 1 being the wheel closest to the camera. Wheels 3 and 4 cannot swivel in all scenarios. If activating the brake on a wheel or not is signified by 1 and 0 respectively the scenarios A5 to A8 are described as: A5=[1,0,0,1], A6=[1,1,1,0], A7=[1,1,0,1], A8=[1,1,1,1]