STUDY DESIGN: A retrospective study. OBJECTIVES: We report the efficacy of the entry point and approach angle of a working cannula using preoperative prone abdominal computer tomography (PACT). SUMMARY OF LITERATURE REVIEW: To date, there are no reports on the entry point and approach angle of a working cannula when performing transforaminal percutaneous endoscopic lumbar discectomy (TPELD) with consideration of the individual anatomic variations and characteristics of herniated disc and surgical instruments. MATERIALS AND METHODS: Cases of herniated intervertebral discs from L4-5, who have previously undergone PACT before TPELD, were included. A total of 25 patients were observed over a 1 year period. The entry point and approaching angle of the working cannula with PACT were calculated, and the results were applied to the TPELD. The clinical results were assessed 1 month after surgery using the VAS, ODI and MacNab criteria, and were confirmed by a radiology and MRI examination. RESULTS: The preoperative measured data using PACT showed that the mean approaching distance and mean approaching angle of the working cannula were 12.4 cm and 75.4 degree, respectively. The VAS improved from a mean of 8.1 preoperatively to a mean of 2.3 12 months after surgery. The ODI improved from a mean of 59 preoperatively to a mean of 24 at 12 months after surgery. According to the MacNab criteria, all patients were classified as either excellent and good during the follow up periods. The extruded disc of all patients had been well removed according to the MRI scan performed 1 month after surgery. CONCLUSIONS: The scientific approach method using PACT based on the characteristics of patients and surgical instruments can be performed easily and accurately, and access and decompress the extruded disc directly.
Catheters ; Diskectomy ; Follow-Up Studies ; Humans ; Intervertebral Disc ; Intervertebral Disc Displacement ; Magnetic Resonance Imaging ; Retrospective Studies ; Surgical Instruments

Down's syndrome (trisomy 21) has been frequently associated with thyroid disease, mainly subclinical hypothyroidism (12.5-32.5%). The occurrence of Downs syndrome in conjunction with hyperthyroidism is rare (0.6-2.5%). The mechanism that Down's syndrome was frequently associated with autoimmune thyroid disease is not clear, but T cell maturation defects and overexpression of chromosome 21 products in Down's syndrome have been suggested. A 19-year-old female was transferred because of generalized weakness. She was born to a 42-year-old mother, She had been suffered from heat intolerance, weight loss, palpitation, dyspnea on exertion and neck swelling and had intermittently taken some medication since her age 9. She had mental retardation (IQ 41) and underdeveloprnent. Exophthalmos, upward-outward slant of palpabral fissures, epicanthal folds, lowset ears, and large, protruding, fissured tongue were identified. Short fifth middle phalanges, clinodactyly and small-sized interventricular septal defect were also detected. Thyroid gland was diffusely enlarged four times the normal size, firm in consistency and had a bruit. Serum T concentration was 7.8ug/dL, T2 306ng/dL, and TSH 0.01ulU/mL. She was positive for thyroid autoantibodies (antimicosomal antibody 1,867 IU/mL, antithyroglobulin antibody 106 IU/mL, and TBII 79.6%). Twenty-four hours radioactive iodine uptake was 64%. Chromosomal analysis with T cell culture stimulated by phytohemagglutinin revealed 47XX, 21 trisomy. Pituitary hormones except TSH were fully stimulated by combined pituitary stimulation. She was finally diagnosed as Down's syndrome with Graves' disease and controlled with use of methimazole.
Adult ; Autoantibodies ; Cell Culture Techniques ; Chromosomes, Human, Pair 21 ; Down Syndrome* ; Dyspnea ; Ear ; Exophthalmos ; Female ; Graves Disease* ; Hot Temperature ; Humans ; Hyperthyroidism ; Hypothyroidism ; Intellectual Disability ; Iodine ; Methimazole ; Mothers ; Neck ; Pituitary Hormones ; Thyroid Diseases ; Thyroid Gland ; Tongue, Fissured ; Trisomy ; Weight Loss ; Young Adult

PURPOSE: In radiotherapy for cervix cancer, both 3-dimensioal radiotherapy (3D-CRT) and intensity-modulated radiation therapy (IMRT) could reduce the dose to the small bowel (SB), while the small bowel displacement system (SBDS) could reduce the SB volume in the pelvic cavity. To evaluate the effect of the SBDS on the dose to the SB in 3D-CRT and IMRT plans, 3D-CRT and IMRT plans, with or without SBDS, were compared. MATERIALS AND MEHTODS: Ten consecutive uterine cervix cancer patients, receiving curative radiotherapy, were accrued. Ten pairs of computerized tomography (CT) scans were obtained in the prone position, with or without SBDS, which consisted of a Styrofoam compression device and an individualized custom-made abdominal immobilization device. Both 3D-CRT, using the 4-field box technique, and IMRT plans, with 7 portals of 15 MV X-ray, were generated for each CT image, and prescribed 50 Gy (25 fractions) to the isocenter. For the SB, the volume change due to the SBDS and the DVHs of the four different plans were analyzed using paired t-tests. RESULTS: The SBDS significantly reduced the mean SB volume from 522 to 262 cm3 (49.8% reduction). The SB volumes that received a dose of 10~50 Gy were significantly reduced in 3D-CRT (65~80% reduction) and IMRT plans (54~67% reduction) using the SBDS. When the SB volumes that received 20~50 Gy were compared between the 3D-CRT and IMRT plans, those of the IMRT without the SBDS were significantly less, by 6~7%, than those for the 3D-CRT without the SBDS, but the volume difference was less than 1% when using the SBDS. CONCLUSION: The SBDS reduced the radiation dose to the SB in both the 3D-CRT and IMRT plans, so could reduce the radiation injury of the SB.
Cervix Uteri* ; Female ; Humans ; Immobilization ; Prone Position ; Radiation Injuries ; Radiotherapy ; Uterine Cervical Neoplasms*