Dynamic cervical plate designs provide less implant complications (no patient) compared with rigid plate designs (4 patients). Speed of fusion was faster in the presence of a dynamic plate. However, loss of segmental lordosis is significantly higher if dynamic plates are used, which did not result in differences regarding clinical outcome between dynamic and constrained plates after 2 years. Thus, dynamic plates should be considered to be the preferred treatment option because of the lower risk for implant failure-related revision surgery.
Lateral disc herniation causing compression of a thoracic root associated with unilateral segmental paresis of the abdominal wall is a rare condition. Despite EMG documentation of axonal root lesion, however, a purely conservative therapeutic approach may be considered treatment of choice in cases without spinal cord involvement.
We describe a patient with sudden onset (29 hours postpartum) pain originating at C-Th level of the spinal cord followed by impaired movement of all limbs. An urgent MRI of the cervical and thoracic spine was performed and showed an extensive epidural haematoma at level C5-Th7 localised dorsally from the spinal cord and inducing its compression, which was treated via hemilaminectomy and evacuation of haematoma. A subsequent MRI showed evidence of the development of myelopathy probably ischaemic in aetiology at level C6–C7 measuring approximately 7 × 3 × 17 mm. Neurologic investigation disclosed spastic paraparesis mainly in the lower limbs. The neurological deficit was improved by a six month intensive rehabilitation program. The prognosis of such a severe complication is always dependent upon the localisation of the haematoma and time between onset of the haematoma and spinal cord decompression.
Přijato 18. března 2019. Akceptováno 10. září 2019. Zveřejněno 6. prosince 2019. Ústav leteckého zdravotnictví Praha, Generála Píky 1, 160 00 Praha 6 -Dejvice, Česká republika chmatal@seznam.cz Since 1925Souhrn V předkládané kazuistice autoři dokumentují kazuistiku velmi vzácné anomálie žlučových cest. 57-letá pacientka podstoupila elektivní laparoskopickou cholecystektomii. Zdvojený duktus cystikus byl příčinou nejasné anatomie a konverze na otevřený výkon. Nález byl ověřen peroperační cholangiografií a histologickým nálezem. Vzácné anomálie extrahepatálních žlučových cest mohou být příčinou operačních nehod i trvalého poškození pacienta. Naši kazuistiku jsme uvedli pro připomenutí rizik rutinní laparoskopické cholecystektomie.
Klíčová slova: zdvojený duktus cystikus; žlučový strom; laparoskopická cholecystektomie
SummaryThe case report presents a case of a very rare anomaly of bile ducts. A 57-year-old patient underwent elective laparoscopic cholecystectomy. The double duct cysticus was the reason of conversion to open surgery. The findings was confirmed due perioperative cholangiography and histological conclusion. This rare abnormality can cause serious surgical accidents. We present our case to point out possible risks of routine laparoscopic cholecystectomy.
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