- Email: [email protected]
AN UNUSUAL CASE OF CERVICAL SPINA BIFIDA
26 with 46 times in this disease and is so extremely rare in any other. It occurs in the liver, spleen, gastrointestinal tract, kidneys, and nervous system. Some include the heart. The stomach may be huge in some cases and the intestines even twice the normal size." Theories to account for this curious condition have not been lacking. Amsler2 believes that " the posterior lobe of the hypophysis becomes excited mechanically by the enlarged anterior lobe or chemically from altered secretion or from both, so that backward pressure arises and thus an increased flow of blood to the organ and consequently enlargement." This, of course, cannot be true, for even supposing that an alteration in the pituitary does cause backpressure the result would be diminished rather than increased blood flow through the organs. Moreover, organs do not enlarge because of an increased blood flow, apart from the dilatation of the vessels within them. The view of Reinhardt and Creutzfeldt3 that it is due to an increase of the mesoblast as a result of hyperpituitarism is equally unconvincing. There appears, in fact, to be no adequate explanation of the condition. Defective secretion of pituitrin into the blood stream would explain the dilatation of the stomach and intestine, but not the enlargement of other organs such as the kidney. REFERENCES 1. Atkinson, F. R. B.: Acromegaly, London, 1932. 2. Amsler, C.: Berlin klin. Woch., 1912, xlix., 1600. 3. Reinhardt, A., and Creutzfeldt, H. G. : Zeiglers Beit. path. Anat. u.z. allg. Path., 1913, lvi., 465.
in an open furrow. The former condition unassociated with either protrusion or derangement of any of the spinal contents is often undetected and is called spina bifida occnlta. We believe that there is no satisfactory explanation for this defect of development which occurs most commonly in the lumbosacral region where the lamina fuse latest and which may
z.
AN UNUSUAL CASE OF CERVICAL SPINA BIFIDA BY S. G. ASKEY, M.D. Camb.; and
H. WARNER COLLINS, M.D. Lausanne, B.Sc. Lond., D.M.R.E.
(WITH
ILLUSTRATION ON
PLATE)
congenital defect in some part of posterior aspect of the spine, is associated commonly with a hernia of the dura mater, arachnoid, and cerebro-spinal fluid. Normally development of a vertebra takes place from three centres of ossificaSPINA BIFIDA,
a
the
one for the body and one for each lamina of the neural arch. These centres appearing about the end of the second month of fcetal life occasionally fail to fuse to form the root of the spinous process. According to the stage at which development is arrested there may be left a narrow fissure of little clinical importance or a wide gap leaving the cord
tion,
FIG.
II.—Complete spina bifida.
be associated with an increase in the cerebro-spinal fluid. Patient A. was discovered by one of us during a routine X ray examination of the cervical area to have bifid spines on the sixth and seventh cervical vertebrae. (See Fig. I. on Plate.) He is a healthy male, aged 45, and was suffering from rheumatic fibrositis in one side of his neck after exposure in a draught. There was no congenital sear or abnormal growth of hair, which is often found in the sacral area overlying bifid spinous processes. We have not been able to find reports of a similar case. Patient B. illustrates by way of contrast the relatively frequent condition of completely open
spine. (Fig. II.)
MEDICAL SOCIETIES MANCHESTER MEDICAL SOCIETY A MEETING was held on Dec. 5th, 1934, Dr. E. BosDiN LEECH, the president, being in the chair. A discussion on Diagnosis and Treatment of Bronchiectasis
opened by Dr. W. BROCKBANK and Mr. A. GRAHAM BRYCE. Dr. Brockbank pointed out that bronchiectasis is far more common than is generally recognised. From the classical type with cumulative fœtid sputum there existed all grades down to one simulating For instance, a dry type was a simple bronchitis.
was
the symptoms being cough with than half an ounce of sputum and haemoptysis which may be repeated and profuse. In these cases, he said, there is no sign of the typical bronchiectatic sputum, constitutional symptoms are mild or absent, while on examination there may be some slight dullness, impaired breath sounds and rales at the affected base, and in about half the cases clubbing of the fingers. In recent years the diagnosis had been rendered far easier by the use of lipiodol. The condition was bilateral in about 75 per cent. of the cases. Treatment was influenced by the fact that the cavities are surrounded by fibrous tissue which makes it impossible for them to be collapsed except by a major surgical operation.
recognised to-day, not
more
in an open furrow. The former condition unassociated with either protrusion or derangement of any of the spinal contents is often undetected and is called spina bifida occnlta. We believe that there is no satisfactory explanation for this defect of development which occurs most commonly in the lumbosacral region where the lamina fuse latest and which may
z.
AN UNUSUAL CASE OF CERVICAL SPINA BIFIDA BY S. G. ASKEY, M.D. Camb.; and
H. WARNER COLLINS, M.D. Lausanne, B.Sc. Lond., D.M.R.E.
(WITH
ILLUSTRATION ON
PLATE)
congenital defect in some part of posterior aspect of the spine, is associated commonly with a hernia of the dura mater, arachnoid, and cerebro-spinal fluid. Normally development of a vertebra takes place from three centres of ossificaSPINA BIFIDA,
a
the
one for the body and one for each lamina of the neural arch. These centres appearing about the end of the second month of fcetal life occasionally fail to fuse to form the root of the spinous process. According to the stage at which development is arrested there may be left a narrow fissure of little clinical importance or a wide gap leaving the cord
tion,
FIG.
II.—Complete spina bifida.
be associated with an increase in the cerebro-spinal fluid. Patient A. was discovered by one of us during a routine X ray examination of the cervical area to have bifid spines on the sixth and seventh cervical vertebrae. (See Fig. I. on Plate.) He is a healthy male, aged 45, and was suffering from rheumatic fibrositis in one side of his neck after exposure in a draught. There was no congenital sear or abnormal growth of hair, which is often found in the sacral area overlying bifid spinous processes. We have not been able to find reports of a similar case. Patient B. illustrates by way of contrast the relatively frequent condition of completely open
spine. (Fig. II.)
MEDICAL SOCIETIES MANCHESTER MEDICAL SOCIETY A MEETING was held on Dec. 5th, 1934, Dr. E. BosDiN LEECH, the president, being in the chair. A discussion on Diagnosis and Treatment of Bronchiectasis
opened by Dr. W. BROCKBANK and Mr. A. GRAHAM BRYCE. Dr. Brockbank pointed out that bronchiectasis is far more common than is generally recognised. From the classical type with cumulative fœtid sputum there existed all grades down to one simulating For instance, a dry type was a simple bronchitis.
was
the symptoms being cough with than half an ounce of sputum and haemoptysis which may be repeated and profuse. In these cases, he said, there is no sign of the typical bronchiectatic sputum, constitutional symptoms are mild or absent, while on examination there may be some slight dullness, impaired breath sounds and rales at the affected base, and in about half the cases clubbing of the fingers. In recent years the diagnosis had been rendered far easier by the use of lipiodol. The condition was bilateral in about 75 per cent. of the cases. Treatment was influenced by the fact that the cavities are surrounded by fibrous tissue which makes it impossible for them to be collapsed except by a major surgical operation.
recognised to-day, not
more