RESUMEN
Low back pain may be of local origin, referred to the spine, or associated with pain in the lower limbs. This review discusses the pathophysiology, clinical presentation, and differential diagnosis of acute low back pain and proposes an algorithmic approach to investigation and management. The proportion of patients with serious underlying causes (e.g., cancer, infection, fracture) increases with age, and clinical assessment is directed at identification of these disorders. Most patients have nonspecific findings, do not require special investigation, and respond well to conservative treatment. Patients with suspicious features on history and physical examination require further investigation and individualized management.
Asunto(s)
Algoritmos , Dolor de la Región Lumbar/terapia , Diagnóstico Diferencial , Humanos , Dolor de la Región Lumbar/clasificación , Dolor de la Región Lumbar/diagnóstico , Dolor de la Región Lumbar/etiologíaRESUMEN
Transpalatal trans-sphenoidal approaches to the sella turcica were described as early as 1900. Since the advent of effective trans-sphenoidal pituitary microsurgery in the 1960's, the sublabial transnasal approach became the most widely used. We reassessed the transoral transpalatal approach in 1978 and found the procedure to have distinct advantages over the transnasal operation. Between 1978 and 1992, 94 patients had transpalatal trans-sphenoidal explorations of the pituitary fossa at our institution. The detail of the operative technique, the results and the advantages are discussed.
Asunto(s)
Neurocirugia/métodos , Hipófisis/cirugía , Acromegalia/cirugía , Craneofaringioma/cirugía , Síndrome de Cushing/cirugía , Humanos , Neoplasias Hipofisarias/cirugía , Prolactinoma/cirugíaRESUMEN
Forty-seven patients were operated on for intracranial artery aneurysms at Tygerberg Hospital, Parowvallei, CP, between January 1980 and December 1982. Problems related to anaesthesia which are peculiar to this condition and the solution thereof are outlined. The importance of meticulous anaesthetic management in the successful recovery of these patients, the majority of whom are young and in the productive phase of their lives, is stressed. A plea is made for increased awareness, early diagnosis and surgical intervention to decrease the high mortality rate associated with this lethal condition.
Asunto(s)
Anestesia/métodos , Aneurisma Intracraneal/cirugía , Adulto , Circulación Cerebrovascular , Femenino , Fluidoterapia/métodos , Humanos , Hipotensión Controlada , Aneurisma Intracraneal/fisiopatología , Presión Intracraneal , Masculino , Monitoreo Fisiológico , Periodo Posoperatorio , Medicación Preanestésica , Respiración , Estudios Retrospectivos , RiesgoRESUMEN
A frequent complication of posterior fossa exploration with the patient in the sitting position is venous air embolism. Spinal cord deficits following such a mishap have rarely been reported. We report a case in which a patient who suffered venous air embolism developed quadriplegia from the C6 level. The mechanisms of passage of air into the arterial system are discussed.
Asunto(s)
Fosa Craneal Posterior/cirugía , Embolia Aérea/complicaciones , Cuadriplejía/etiología , Cráneo/cirugía , Adulto , Embolia Aérea/etiología , Femenino , Humanos , Complicaciones PosoperatoriasRESUMEN
The use of intravenous radio-isotope angiography in 3 cases of unilateral carotid-cavernous sinus fistula is described. The lesion gives a characteristic image pattern distinguishable from that of arteriovenous malformation in this region. An abnormal registration of intense radioactivity is seen in the early phases, accurately localised to the cavernous sinus, with a distinctive sigmoid-shaped configuration. Rapid disappearance by a paradoxical apparent increase in blood flow to the ipsilateral hemicranium. This is attributed to the massively arterialised venous drainage. This technique of demonstrating the cerebral circulation dynamically is considered a valuable diagnostic supplement to the static scintiscan and to conventional roentgen arteriography in this lesion.