BackgroundTo investigate the changes of cross sectional area (CSA) in paraspinal muscles upon magnetic resonance imaging (MRI) and bone mineral density (BMD) in postmenopausal osteoporotic spinal compression fractures.MethodsWe reviewed 81 postmenopausal women with osteoporosis, who had underwent MRI examination. The patients were divided into 51 patients who had osteoporotic spinal compression fractures (group I), and 30 patients who without fractures (group II). Group I were subdivided into IA and IB, based on whether they were younger (IA) of older (IB) than 70 years of age. We additionally measured body mass index and BMD. The CSA of multifidus, erector spinae, paraspinal muscles, psoas major (PT), and intervertebral (IV) discs were measured. The degree of fatty atrophy was estimated using three grades.ResultsThe BMD and T-score of group I were significantly lower than those of group II. The CSA of erector spinae, paraspinal muscles, and PT in the group I was significantly smaller than that of group II. The CSA of paraspinal muscles in group IB were significantly smaller than those of group IA. The CSA of erector spinae, mutifidus, and PT in group IB were smaller than those of group IA, but the difference was not statistically significant. Group 1 exhibited greater fat infiltration in the paraspinal muscle than group II.ConclusionsPostmenopausal osteoporotic spinal compression fracture is associated with profound changes of the lumbar paraspinal muscle, reduction of CSA, increased CSA of IV disc, and increased intramuscular fat infiltration.
Bone lesions resembling tertiary syphilis caused by Treponema pallidum or another of the treponematoses have been observed in nearly every Andean culture from Peru and Chile, dating back nearly 8000 years (Gerstzen et al., 1998). The lesions are similar in each case, with periostitis, osteitis, and osteomyelitis attacking the skull and the long bone, particularly the tibia. This tibial involvement results in the classic "saber shin". Several of the skulls observed with such lesions had been "treated" during life by repeated trephination using a scraping technique. 2.1.2 Greek and early Byzantine period The intellectual evolution of neurological surgery originated in the golden age of Greece with the founding of the Alexandrian school in 300 BC. Because of both sporting injuries, in particular gladiator injuries, and wars, head injuries appear to have been plentiful, and provided opportunities to develop neurosurgical skills (Goodrich & Flamm, 2011). In this early era of medicine, the risk of infection, lack of antiseptic technique, and minimal anesthesia prevented generations of surgeons from performing any serious or aggressive surgical intervention for head injury (Goodrich & Flamm, 2011). Galen of Pergamon (AD 129-200) detailed a safer and more reliable use of the trephine, and in particular argued for continuous irrigation during trephination to avoid delivering excessive heat and injury to the underlying brain (Goodrich, 2005). Paul of Aegina (AD 625-690), trained in the Alexandrian school, was the last great Byzantine physician. His wound management was quite sophisticated for prevention of infection. He used wine (helpful in antisepsis, although this concept was then unknown) (Goodrich, 2005). 2.1.3 Medieval Europe Inventive medieval surgeon Theodoric Borgognoni of Cervia (1205-1298) is remembered as a pioneer in the use of the aseptic technique-not the "clean" aseptic technique of today, but rather a method based on avoidance of "laudable pus". He attempted to discover the ideal conditions for good wound healing, and concluded that they comprised control of bleeding, removal of contaminated or necrotic material, avoidance of dead space, and careful application of a wound dressing bathed in wine (Goodrich & Flamm, 2011). Control of bleeding, removal of contaminated or necrotic material, and avoidance of dead space are principles that can also apply in today's neurosurgical operations. He also argued for primary closure of all wounds when possible and avoiding "laudable pus" (Goodrich & Flamm, 2011). Lanfranchi of Milan (1250-1306) noted that the head should be shaved prior to surgery to prevent hair from getting into the wound and interfering with primary healing. Today, most neurosurgeons also shave hair before an operation. However, the time of shaving is currently controversial. When dealing with depressed skull fractures, Lanfranchi advocated putting wine into the depression to assist healing (Goodrich & Flamm, 2011). Guy de Chauliac (1300-1368) was clearly the most influential European surgeon of the ...
Background: Wound healing process is a tissue response to trauma which leads to tissue repair through complex biological stages. Sevoflurane is a widely used inhalation anesthetic for surgery, but there has been no study about its effect on wound healing process. This study was undertaken to evaluate the effect of sevoflurane on wound healing process.Methods: Male Sprague-Dawley rats (200−300 g) were used. Two circular full-thickness skin defects of 8 mm in diameter were made on dorsum of rats. After wound formation, the animals were divided into 4 groups: 1, 2, 4, 8 hr exposure to sevoflurane, respectively. Wound sizes and regional blood flow around the wounds were measured. The expression of basic fibroblast growth factor (bFGF), transforming growth factor β1 (TGFβ1), collagen 1, and collagen 3 mRNA were detected 7 days after wound formation by real-time reverse transcriptase-polymerase chain reaction (RT-PCR).Results: Wound size was significantly increased in 8 hr group at 3 and 7 days after wound formation. Regional blood flow was significantly decreased in 4 hr and 8 hr groups at 3 days after wound formation. The bFGF, collagen 1 and 3 mRNA expressions were significantly decreased in 8 hr exposure group.Conclusions: These results suggest that sevoflurane exposure influences the regional blood flow, wound size, expression of bFGF, and production of collagen 1 and 3 during the wound healing process.
Insufficiency fracture is a type of stress fracture, which is the result of normal stresses on abnormal bone. Postmenopausal osteoporosis is the most common cause of insufficiency fractures. An early diagnosis is best made with a bone scan or magnetic resonance imaging, as radiographs may initially appear normal. Insufficiency fractures of the lower leg and ankle are less common. Furthermore, reports of medial malleolar insufficiency fracture without any history of trauma in elderly patients are extremely rare. Thus, we report a case with a medial malleolar insufficiency fracture of the ankle in an elderly patient with osteoporosis. This case shows that we should be aware of the possibility of encountering an uncommon medial malleolar insufficiency fracture as a cause of pain in the ankle region of an elderly patient with osteoporosis.
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