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98 NORTH CAROLINA MEDICAL JOURNAL February, 1940 of an epidural injection, which is disastrous to the contemplated study or to any future lipiodal investigation. At least 5 cc. of the opaque substance should be used, inasmuch as the characteristic defect is quite small. We have had no experience with the use of air as a contrast media nor have we experienced over the past ten years any untoward sequelae with iodized oil. Unfavorable reactions may occur with lipiodol not especially prepared for subarachnoid injection. Clinical observations by Globus(12) failed to demonstrate neurologic sequelae in ninety patients. It is our feeling that careful choice of patients for lipiodol injections will greatly reduce unnecessary examinations and potential danger from untoward reactions. The equipment for the examination consists of a tilting fluoroscopic table with a suitable switch, so that instantaneous roentgenograms may be made of suspicious defects noted on the fluoroscopic screen. Before the study is commenced, the patient should be allowed to sit up for at least thirty minutes, so that the lipiodol may collect as a single mass in the cul-de-sac. Since the lesion to be demonstrated is a small, anteriorly and most often laterally placed mass opposite the intervertebral space, the patient is placed face down on the tilting table, and the lipiodol as a unified mass is directed rostrally by suitable manipulation of the table. A constant filling defect is at once recorded in the anterior-posterior projection, and lateral views with each side down in turn are recorded by repeated manipulation of the contrast media. (Fig. 1.) Occasional resumption of the sitting posture for an additional thirty minutes may be necessary if the iodized oil shows a tendency to fragment into globular masses. Similar fluoroscopic study is next carried out wTith the patient resting on his back, in order to explore the posterior aspect of the subarachnoid space, and to rule out the possibility of a spinal cord tumor in this general location. Finally, all studies are repeated and suspicious areas re-examined twenty-four hours later; for it has been demonstrated that small defects may be more clearly demarcated at that time by the lipiodol column as it traverses the dural reflexions of the roots. (Fig 2.) 12. Globus, J. H.: Contributions Made by Roent-genographic Evidence After the Injection of Iodized Oil, Arch. Neurol, and Psychiat. 37: 1077 (May) 1937. B. A. Fig. 1. (A.) Lipiodol injection localizing ruptured intervertebral disc at Lumbar IV, right—anterior-posterior projection. (B.) Lateral projection, with defect marked by arrow. The differential diagnosis of a rupture of the intervertebral disc must consider tumor of the cauda eguina, hypertrophy of the liga-mentum flavum, arachnoiditis with radiculitis of the cauda equina, and those ill-defined and poorly understood cases of “sciatica” that fulfill the requirements of the clinical picture of a ruptured disc but fail to show the characteristic defect in the lipiodol study. Two tumors of the cauda equina, three examples of hypertrophied ligamenta flava, one chronic arachnoiditis, and eight cases of obscure sciatica were encountered among the patients without typical ruptured discs. The number of patients in this group has expanded rapidly, and it furnishes a wide field for further clinical research. In our experience, the various disturbances that simulate a rupture of the intervertebral disc may be readily and accurately differentiated only by lipiodol injection. The ruptured portion of the intervertebral
Object Description
Rating | |
Fixed Title * | NCHH-17: North Carolina Medical Journal [1940-2001] |
Document Title | North Carolina Medical Journal [1940-2001] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1940 |
Identifier | NCHH-17-001 |
Form General | Periodicals |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 1 |
Health Discipline | Medicine |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-001.pdf |
Document Sort | all; nchh-17 |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-001 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Revision History | done |
Description
Fixed Title * | Page 98 (image) |
Document Title | North Carolina Medical Journal [1940-2001] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1940 |
Identifier | NCHH-17-001-0112 |
Form General | Periodicals |
Page Type | all; all images; x-ray; article |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Filename | northcarolinamed11940medi_0112.jp2 |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 1 |
Issue Number | 2 |
Page Number | 98 |
Health Discipline | Medicine |
Full Text | 98 NORTH CAROLINA MEDICAL JOURNAL February, 1940 of an epidural injection, which is disastrous to the contemplated study or to any future lipiodal investigation. At least 5 cc. of the opaque substance should be used, inasmuch as the characteristic defect is quite small. We have had no experience with the use of air as a contrast media nor have we experienced over the past ten years any untoward sequelae with iodized oil. Unfavorable reactions may occur with lipiodol not especially prepared for subarachnoid injection. Clinical observations by Globus(12) failed to demonstrate neurologic sequelae in ninety patients. It is our feeling that careful choice of patients for lipiodol injections will greatly reduce unnecessary examinations and potential danger from untoward reactions. The equipment for the examination consists of a tilting fluoroscopic table with a suitable switch, so that instantaneous roentgenograms may be made of suspicious defects noted on the fluoroscopic screen. Before the study is commenced, the patient should be allowed to sit up for at least thirty minutes, so that the lipiodol may collect as a single mass in the cul-de-sac. Since the lesion to be demonstrated is a small, anteriorly and most often laterally placed mass opposite the intervertebral space, the patient is placed face down on the tilting table, and the lipiodol as a unified mass is directed rostrally by suitable manipulation of the table. A constant filling defect is at once recorded in the anterior-posterior projection, and lateral views with each side down in turn are recorded by repeated manipulation of the contrast media. (Fig. 1.) Occasional resumption of the sitting posture for an additional thirty minutes may be necessary if the iodized oil shows a tendency to fragment into globular masses. Similar fluoroscopic study is next carried out wTith the patient resting on his back, in order to explore the posterior aspect of the subarachnoid space, and to rule out the possibility of a spinal cord tumor in this general location. Finally, all studies are repeated and suspicious areas re-examined twenty-four hours later; for it has been demonstrated that small defects may be more clearly demarcated at that time by the lipiodol column as it traverses the dural reflexions of the roots. (Fig 2.) 12. Globus, J. H.: Contributions Made by Roent-genographic Evidence After the Injection of Iodized Oil, Arch. Neurol, and Psychiat. 37: 1077 (May) 1937. B. A. Fig. 1. (A.) Lipiodol injection localizing ruptured intervertebral disc at Lumbar IV, right—anterior-posterior projection. (B.) Lateral projection, with defect marked by arrow. The differential diagnosis of a rupture of the intervertebral disc must consider tumor of the cauda eguina, hypertrophy of the liga-mentum flavum, arachnoiditis with radiculitis of the cauda equina, and those ill-defined and poorly understood cases of “sciatica” that fulfill the requirements of the clinical picture of a ruptured disc but fail to show the characteristic defect in the lipiodol study. Two tumors of the cauda equina, three examples of hypertrophied ligamenta flava, one chronic arachnoiditis, and eight cases of obscure sciatica were encountered among the patients without typical ruptured discs. The number of patients in this group has expanded rapidly, and it furnishes a wide field for further clinical research. In our experience, the various disturbances that simulate a rupture of the intervertebral disc may be readily and accurately differentiated only by lipiodol injection. The ruptured portion of the intervertebral |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-001.pdf |
Document Sort | all; nchh-17 |
Article Title | Low Back Pain And Sciatica With Special Reference To Rupture Of The Intervertebral Disc |
Article Author | Barnes Woodhall; R Beverly Raney; W W Vaughan |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-001 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Revision History | done |
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