In a prospective, consecutive study of patients with lumbar back pain and sciatica, various clinical features and surgical findings were evaluated in order to analyse the predictive value regarding (1) level of diseased interspace (2) presence and type of lesion responsible for root compression (3) outcome after surgery. One hundred patients underwent surgery solely on clinical grounds. Fifty-eight had disc herniation. The level of disc herniation was correctly predicted in three quarters of patients with a prolapsed disc. The outcome after surgery was good in 77 patients. Only few clinical features, namely male sex and scoliosis were predictors of a good outcome. Lasegue's sign was indicative of root compression in 90%, but only two-thirds had disc herniation. Conversely one-third had disc herniation in spite of a "negative" test. Lasegue's sign was not superior to other clinical tests in predicting outcome. The most important indicator of a good outcome was the presence of disc herniation at surgery. Patients with disc pathology other than true disc herniation fared equally with patients, who had normal discs disclosed at surgery. Myelography was undertaken in all patients prior to surgery, the results of which are analysed in the following paper. (Espersen et al.: Predictive value of radiculography in patients with lumbago-sciatica. A prospective study (Part II, Acta Neurochirurgica 73 (1984), 213-221.
The irradiation dose to the lens of the eye during CT scanning has been measured in 16 patients. The dose is greatly influenced by changes in gantry angulation, the position of the patient, the thickness and number of slices, KV, and milliamperage. The total lens dose has been measured to be higher than previously reported. Repeated CT scans imply the risk of irradiation cataract, especially in infants and children.
One hundred patients with symptoms of lumbo-sacral root compression were prospectively and consecutively assigned to operation based alone on clinical findings. A preoperative myelogram was performed in all patients and described without a knowledge of the clinical features. All patients were explored for the clinically and myelographically relevant disc. When the myelogram was normal (16 patients) both lower lumbar interspaces were exposed. In 58 patients a herniated disc was revealed at surgery. Only "myelographic herniation" with indentation of the contrast column was accompanied by a high frequency of disc herniation at surgery (73-87%). In cases with normal myelograms only 5% had a disc herniation. The severity of the myelographic finding was clearly correlated to the frequency of positive surgical findings and good outcomes. The preoperative radiculogram gives a high degree of certainty in the preoperative evaluation whether a surgical lesion is present or not and reveals a precise prediction of the outcome of surgery.
Twelve histologically verified choroidal melanomas, 15 normal fellow eyes and 4 simulating lesions (vitreous haemorrhage, choroidal haemorrhage, retinal detachment and choroidal detachment) were CT-scanned before and after intravenous contrast media (maximal attenuation in the tumours were estimated from a computerized curve corresponding to a line placed from the center of the eye, through the tumour to the outside of the bulb). The melanomas showed significantly higher precontrast attenuation (54 HU) than the control eyes (17 HU) measured in symmetrical points. Enhancement was registered in all the tumours (mean = 22 HU, P less than 0.01), but not in the control eyes. Among the simulating lesions, the retinal detachment enhanced after contrast. Indications for CT-scan of intraocular processes are diagnostic doubt in opaque media and suspected extrabulbar extension. A patient with verified, disciform organised subretinal haemorrhage scanned after the primary series showed contrast enhancement comparable to the malignant melanoma series. Also 'CT-positive' tumour eyes have to be observed over a period.
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