Percutaneous epidural stimulation of the low thoracic spinal cord was carried out in 41 patients with pain from peripheral arterial disease of the lower limbs. Results are reported relating to pain, claudication distance, peripheral blood flow, and trophic lesion changes. Following a trial period of stimulation, 37 patients had stimulators permanently implanted. After a mean poststimulation follow-up period of 25 months, substantial pain relief (75% to 100%) was obtained in 29 cases; claudication distance significantly increased in 15 cases; Doppler ultrasound recordings of lower-limb distal arteries showed a tendency toward normalization of pulse-wave morphology, with increase of amplitude in 12 of the 23 patients studied; a rise in skin temperature was also detected by thermography. Distal arterial blood pressure remained unchanged with stimulation. Ischemic cutaneous trophic lesions of less than 3 sq cm healed, but gangrenous conditions were not benefited. A placebo effect or the natural history of the disease can be excluded as the reason for these improvements. It is concluded that spinal cord stimulation is a valid alternative treatment for moderate peripheral arterial disorders when direct arterial surgery is not possible or has been unsuccessful.
An experimental study on rats showing the arterial lesions caused by the beams of gamma irradiation used in stereotactic radiosurgery is presented. The common carotid artery of the rat was irradiated with a single narrow-beam of gamma radiation with a maximum dose of 30 and 60 Gy. The results were evaluated at 4, 12 and 24 weeks after irradiation. Several focal changes in the arterial walls were observed in all periods of study with a predominance of hyperplastic (proliferative) alterations at doses of 30 Gy, and hyaline degeneration at doses of 60 Gy. Total occlusion was not observed in any case. In conclusion, vascular hyperplasia is more prominent with the lower doses evaluated.
This case of a pharyngoesophageal diverticulum was diagnosed 3 years after a corpectomy and fusion for a cervical fracture. The diverticulum was excised, the plate and screws were removed, and the patient was asymptomatic 3 years later. The dense scar tissue around the hardware probably caused traction on the posterior pharyngoesophageal region, followed by development of the diverticulum. The authors speculate that the malpositioning of the hardware was an irritative factor promoting such a scar. To the best of their knowledge, this is the first reported case of pharyngoesophageal diverticulum following cervical corpectomy and plating.
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