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NEWS

January/06/2007

Surgical treatment in paraplegia survey:

Cross-anastamosis in paraplegia below D9 started to give results. The last documented case operated 1 year ago in a patient from Israel came to the clinic 3 weeks ago. ECS and EMG performed showed that there is starting innervation of Th 11 and 12. The patient's lower limbs muscles became bulky and he could contract the lower abdominal muscles and some movements in the pelvic girdle. Crude sensation descended down to the inguinal level both sides. If you are more interested in this topic, click here! 

March/08/2007

Tuberculosis of the spine

In the last 2 years the incidence of tuberculosis of the spinal column is becoming more frequent and having different clinico-morphologic picture. This phenomenon is alarming sign as the residual of the use of dirty bombs and several radioactive materials in the surrounding dirty wars in the region. For demonstration click here! and here!

20-AUGUST-2007

SIEMENS Digital C-arm is implemented and functioning in the Shmaisani hospital.

30-AUGUST-2007

The Inomed ISIS Highline neurophysiologic navigation system start to work at the operating room.

28-November-2013

Magnetom Skyra 3 tesla with all clinical applications start to run.

 

 
 
 
 

8. 26-MAY-2007  INTISAR AHMAD GHOUSHEH  52 YEARS  EPIDURAL GRANULOMATOUS  MASS COMPRESSING THE SPINAL CORD AT D6 AND D7 LEVELS.

 
 

 
 

Anamnesis

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The patient came to the clinic 21-May-2007 complaining of right intrascapular region  40 days ago with edema of the right lower limb  and inability to walk the last 13 days. 

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MRI of the lumbar spine was performed 17-May-2007 showing PLD L4-5 and L5-S1  with first degree spondylolisthesis.

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The patient is a known hypertensive with recently recognized diabetes mellitus.

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The patient is wheel chaired and cannot stand for Romberg or scoliotic stance assessment.

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The abdominal reflexes were absent both sides  with SLRS 20 degrees in the right due to weakness and the left 60 degrees. Sensation was intact, but the patient claim numbness both lower limbs. There is gross weak all muscles both lower limbs more pronounced in the right side including the quadriceps muscles.

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MRI of the dorsal spine was requested and a huge extramedullary mass  was compressing the spinal cord at the D6-7 levels. It was reported to be a meningioma.

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There was a discussion with relatives that the histological verification is hard to tell even during the surgery, and they were told that tbc could have place and the final result will be after the surgery.

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Laminectomy of D6 and 7 was performed. The epidural fat was granulomatous and thick with loculations, some of them containing pus. The pus was sent for CXS and the mass was resected completely. It was adherent to the dura, but it was separable.

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Inspection of the dura for a mass intradural was negative. This was done by finger palpation. The dura was not open intentionally to avoid dissemination of the pathologic material intradurally.

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Routine closure of the wound with smooth postoperative recovery.

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The blood sent for tbc IgG which was very high confirming that the lesion was tuberculous granulomatous epiduritis.

Comments:

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This is another example of tbc of the spine, which could mimic any pathologic process.

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As seen in the left side of this window, the news section, where 08-March-2007 there was a n announcement that tbc of the spine is gaining a new clinical picture and is increasing in frequency.

 
     
 

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