扫二维码下载作业帮
2亿+学生的选择
下载作业帮安装包
扫二维码下载作业帮
2亿+学生的选择
辩论赛 现实比理想更重要 怎么说啊 求具体😖😖
小2b7壪663p
扫二维码下载作业帮
2亿+学生的选择
着重点放在现实打败理想,计划赶不上变化,对方说出一个观点,用现实反对他
为您推荐：
其他类似问题
人活在现实里面，你能活在理想里面吗？
扫描下载二维码N?yt? viite
JavaScript is disabled for your browser. Some features of this site may not work without it.
Osallistuva alkoholivalistus - mit? se voisi olla?
ap-1982-6-heinonen.pdf
Formaatti:
Lataukset:
Osallistuva alkoholivalistus - mit? se voisi olla?
Heinonen, Jarmo
Lehden/teoksen nimi:
Alkoholipolitiikka
47(1982) : 6
Avainsanat:百度拇指医生
&&&普通咨询
您的网络环境存在异常，
请输入验证码
验证码输入错误，请重新输入PMCID: PMC3980560Unilateral lateral mass hypertrophy: An extremely rare congenital anomaly of atlas, , , , , and
Corresponding author: Dr. A. K. Srivastava, Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India. E-mail:
A wide variety of congenital anomalies are observed around the craniovertebral junctional area. However, hypertrophied unilateral lateral mass of atlas in association with chiari-1 malformation leading to myelopathy is extremely uncommon. Herein we report a case of 28-year-old female who presented to us with a high cervical compressive myelopathy. Imaging revealed bony hypertrophy involving right sided C1 lateral mass along with chiari malformation-type 1. She underwent transoral as well as posterior decompression followed by occipito-cervical fusion. The authors discuss their case in light of other such reported cases and present a review of the literature.Keywords: C1 lateral mass, chiari malformation type 1, compressive myelopathy, hypertrophy, unilateral, surgeryA host of congenital anomalies are observed around the craniovertebral junction (CVJ) in general and the atlas in particular. Some of these include various grades of C1 arch hypoplasia, assimilation of atlas, anomalies involving the odontoid process, congenital atlanto axial dislocations, basilar invagination etc.[,,,,,] In addition to these bony anomalies, various vascular and soft-tissue anomalies are also very frequent in this crucial area harboring the transition of brain into the spinal cord. However, hypertrophied unilateral lateral mass of atlas in association with chiari-1 malformation leading to myelopathy is extremely uncommon. Herein we report a 28-year-old female who presented to us with high cervical compressive myelopathy. Imaging revealed bony hypertrophy involving right sided C1 lateral mass along with chiari malformation-type 1. She underwent transoral as well as posterior decompression followed by occipito-cervical fusion. The authors discuss their case in light of other such reported cases and present a review of the literature.The present case report is about a 28-year-old female patient who presented with posterior cervical pain of 2 years duration along with ascending spastic quadriparesis for 1 year. On examination, she had subtle quadriparesis (power 4/5 on the right upper and lower limbs with 4+/5 power on the left side). Deep tendon reflexes were uniformly exaggerated and plantars were bilaterally up going. There was graded sensory impairment below C4 dermatome (30-50%) and posterior column impairment was noted in upper and lower limbs. She had left sided torticollis and neck movements, particularly rotation, were restricted toward the right side. There were no lower cranial nerve dysfunction and no stigmata pertaining to the CVJ anomalies were found on general examination.She was investigated with computed tomography (CT) scan and magnetic resonance imaging (MRI) of the CVJ. On CT scan, there was hypertrophy involving the right lateral mass of atlas causing impingement into the bony cervical canal and consequent narrowing of the transverse canal diameter. The bony overgrowth was similar in density as the rest of the C1 ring. Posterior arch of C1 was hypoplastic and left hemi-arch was absent. There was no evidence of atlanto axial dislocation or basilar invagination [Figure –]. MRI of this area showed compression of the spinal cord from right lateral aspect with distortion of the cord. Cerebellar tonsils were seen impacted at the foramen magnum with obliteration of the cistern magna. The tonsilar descent was seen up to the level of C1. There was T2 hyperintensity inside the substance of the cord at the level of C2 body [Figure
and ].Hypoplastic C1 posterior arch with normal atlanto dental interval on flexion (a) and extension (b) sagittal computed tomography images. Axial section through the C1 shows hypertrophy affecting right sided lateral mass with deficient left half of the posterior ...As the patient had both lateral and posterior compression on the spinal cord, we performed transoral decompression of the hypertrophied lateral mass followed by removal of posterior lip of foramen magnum, excision of hypoplastic posterior arch of atlas and occipito-cervical (C2) fusion with titanium cable. The histopathological examination of the hypertrophied lateral mass revealed the presence of fibro-osseous tissue and no evidence of malignancy was found.Post-operatively, the patient had relief of the neck pain and reduction in severity of spasticity. Post-operative reconstructed CT of CVJ revealed adequate bony decompression and the posterior construct in situ [Figure –]. The patient had an uneventful post-operative period and was discharged in stable condition. At the time of writing this report, she had completed 12 months follow-up and she had complete recovery of power in her limbs.Post-operative computed tomography scans of the craniovertebral junction shows evidence of anterior transoral decompression with removal of lateral mass hypertrophy on the right side (a-c). A capacious lateral gutter is seen and O-C2 sublaminar cable ...Myelopathy due to extramedullary compression at the level of CVJ is very common in clinical practice. Most such cases are due to atlanto axial dislocation, basilar invagination, os odontoideum, hypertrophied odontoid, chiari malformation, primary atlantal hypoplasia etc.[,,,,,,,]In this report, we have presented a case of myelopathy due to a rare combination of CVJ anomaly consisting of unilateral lateral mass hypertrophy, deficient atlantal hemiarch and tonsilar ectopia. Such a combination of CVJ anomaly presenting with compressive myelopathy has not probably been described earlier. The hypertrophied lateral mass impinged on the bony cervical canal and led to C1 stenosis in the transverse plane. In addition to this static element, motion of the spinal cord within the narrowed cervical canal during neck movements might also have perpetuated the cord damage in our patient. In addition, our patient had soft-tissue anomaly in the form of tonsilar ectopia and crowded posterior fossa. This anomaly also probably contributed to the myelopathy and impending syringomyelia.Various congenital anomalies are known to involve the atlas.[,,,] Embryologically, proatlas as well as the first cervical sclerotome contribute to the genesis of the atlas. Although proatlas contributes to the upper part of the posterior arch, remaining portion of C1 is derived from the first cervical sclerotome. The anterior arch ossifies from a separate center and two separate ossification centers give rise to the lateral masses and the posterior arch. Progressive spread of the ossification dorsomedially gives rise to the posterior arch. Although both hemiarches unite in the midline at birth, final ossification is usually delayed until 5-7 years of life.[] As a result, bifid posterior arch is the most common anomaly involving the atlas (90% of all C1 anomalies, overall incidence 3-4%), whereas the anomalies involving the anterior arch are extremely uncommon.[] Curranino studied hypoplasias affecting the atlas and classified them into five different types [].[] Our patient had Curranino type B hypoplasia (affecting one posterior hemiarch). There are various reports of primary atlantal stenosis and myelopathy due to intact, but hypoplastic posterior atlantal arch, also called primary C1 stenosis (Normal sagittal diameter of C1 16-22 mm, symptoms appear with a diameter below 10 mm).[,] Although the absence of C1 hemiarch in our patient appeared to compensate for the lateral mass hypertrophy by natural posterior decompression, in actuality, there remained fibrous constricting bands in place of the actual arch, which needed to be divided during posterior decompression.Currarino et al. classification of C1 posterior arch hypoplasiaTo the best of our knowledge, only 4 other cases of unilateral C1 lateral mass hypertrophy have been described in the literature.[] All of these patients presented with progressive myelopathy and torticollis. The patients ranged from 21 to 54 years of age and were distributed equally in both sexes. Two of these patients had associated syringomyelia and one patient had bifid C1 posterior arch. The authors have also argued that this unilateral atlantal lateral mass hypertrophy could be a defined clinical entity and developmental in origin. Similar to theirs, our patient also presented with myelopathy and torticollis. In addition to C1 lateral mass hypertrophy and syringomyelia, our patient also had associated chiari-I malformation and unilateral absent C1 hemiarch. Hence, the constellation of anomalies in our patient is different than those reported by Goel et al. We also encountered one case report of isolated C1 posterior arch hypertrophy leading to myelopathy.[] However, there was no lateral mass hypertrophy in that patient. The authors suggested a possibility of prior injury with subsequent periosteal reaction and bony growth as an explanation for the isolated posterior arch hypertrophy. However, we agree with Goel et al. who believe that this rare condition could be developmental in origin. Presence of other anomalies in the CVJ in our case further fostered our assumption as to the etiology of this extremely rare atlantal anomaly. There are reports of compensatory hypertrophy of C1 anterior arch or C2 spinous process in cases of C1 posterior arch hypoplasia.[] Such findings have been attributed to the increased muscular attachments and attendant increased vascularity. This possibility remained strong in our patient as the C1 lateral mass hypertrophy was on the right side whereas the C1 posterior arch was deficient on the left side. However such compensatory lateral mass hypertrophy has not been described previously.As far as the treatment is concerned, all four patients reported by Goel et al. were operated from posterior approach only.[] Although only posterior decompression was done in three patients, direct excision of the hypertrophied lateral mass was done in the remaining patient. The last patient was reported to have improved most among 4 and hence Goel et al. maintained that direct excision of the hypertrophied bone is the ideal treatment in such cases. In our patient, we aimed to excise the hypertrophied bone transorally. The transoral route was chosen because it allowed us to drill the hypertrophied bone under direct vision. Moreover, presence of the transverse ligament acted as a safeguard for the cord during the procedure. After dealing with the hypertrophy anteriorly, we did posterior decompression. The remaining C1 hemiarch was removed followed by posterior fusion (O-C2 wiring). We do concede that, the bony hypertrophy probably could have been decompressed from a posterior only approach as mentioned by Goel et al.[] However the transverse ligament would anyway have become incompetent considering the fact that the inner surface of the lateral mass provides attachment to the ligament. Hence, iatrogenic instability was anyway going to occur whether anterior elements were removed or not. Rather removing the anterior arch and odontoid allowed wider working space in order to drill the impinging hypertrophied lateral mass. Moreover, the transverse ligament, lying anterior to the cord, provided a safeguard against retraction and drill bit related injury to the anterolateral aspect of the cord whereas no such protection is available posteriorly.Unilateral lateral mass hypertrophy of the atlas is an extremely uncommon developmental anomaly and may cause myelopathy either on its own or in combination with other anomalies like tonsillar ectopia. Decompression of the bony overgrowth impinging the cord is the most effective treatment and can be accomplished either anteriorly or posteriorly. More such cases need to be reported for having further insight into this rare anomaly and formulating a uniform management plan for such patients.Source of Support: Nil Conflict of Interest: None declared.1. Shoda N, Anamizu Y, Yonezawa N, Ishibashi H, Yamamoto S. Ossification of the posterior atlantoaxial membrane and the transverse atlantal ligament. Spine (Phila Pa 1976) 2005;30:E248–50.
[]2. Okada K, Sato K, Abe E. Hypertrophic dens resulting in cervical myelopathy: Histologic features of the hypertrophic dens. Spine (Phila Pa 1976) 2000;25:1303–7.
[]3. Kasliwal MK, Traynelis VC. Hypertrophic posterior arch of atlas causing cervical myelopathy. Asian Spine J. 2012;6:284–6. []
[]4. Currarino G, Rollins N, Diehl JT. Congenital defects of the posterior arch of the atlas: A report of seven cases including an affected mother and son. AJNR Am J Neuroradiol. 1994;15:249–54.
[]5. Goel A, Bonde V, Menon R. Unilateral atlantal lateral mass hypertrophy. Report of four cases. J Neurosurg Spine. 2006;4:334–7.
[]6. Chang H, Cho WJ, Park JB, Moon MS, Chae JW, Ryu JS, et al.
Cervical myelopathy secondary to atlas hypoplasia - Reports of 3 adult cases — Asian Spine J. 2007;1:48–52. []
[]7. Tokiyoshi K, Nakagawa H, Kadota T. Spinal canal stenosis at the level of the atlas: Case report. Surg Neurol. 1994;41:238–40.
[]8. Tubbs RS, Oakes WJ, Blount JP. Isolated atlantal stenosis in a patient with idiopathic growth hormone deficiency, and Klippel-Feil and Duane's syndromes. Childs Nerv Syst. 2005;21:421–4.
[]9. Logan WW, Stuard ID. Absent posterior arch of the atlas. Am J Roentgenol Radium Ther Nucl Med. 1973;118:431–4.
[]Articles from Journal of Craniovertebral Junction & Spine are provided here courtesy of Wolters Kluwer -- Medknow Publications&1<input type="button" value="GO" onclick ="var val = Number(jQuery(this).parent().children(':text').val()); if (isNaN(val) || val
3){val = 3;}window.location.href = '/500-500020-detail--0-__id__.html'.replace('__id__', val); ">
卖了深圳的房子，在惠州再买一套，合适吗
注册时间： -
注册时间：
点击标签查看相关内容
卖了深圳的房子，在惠州再买一套，合适吗
目前情况，在深圳宝中有一套小两房，出租出去收租5000一个月。惠州有一套4房自住，老公在惠州上班，月供两边一起6000多。因为现在不景气，老公因为性格脾气问题，待遇几年了都没有什么上升，人也已经快40了。年轻时把握不了的机会现在更不可能把握的到，只求工作稳定！目前他年收入在18到20。家有两个孩子，一个马上上小学了，另一个准备上幼儿园，本人自己带孩子顺便帮朋友打理店铺，每月赚点零花钱。。。背景完毕
注册时间： -
注册时间：
这个可以的，惠城有新楼盘，很便宜
注册时间： -
注册时间：
现在想法是，把宝中的房子卖了，因为买的早，卖完到手还有400万，在惠州南附近买多一套房子，那里配套好，离高铁也近。但是我们两个都不懂投资，股票这东西貌似也不敢。。。剩下的钱不去投资贬值太厉害，所以一直纠结。。。我是不赞同卖的，老公觉得生活压力大，身体也不怎么好，也怕深圳房价会跌。。。
注册时间： -
注册时间：
回深圳的可能性比较低，生活压力太大，回去的话惠州的房子会空着。再加上深圳房子朝北，一到冬天家里冷得不行，夏天又暴晒，真心没有惠州朝南的房子舒服。现在就想问，大家觉得深圳的房子有必要卖吗？还是保持现状就好？为什么想买多一套房子？是因为现在这边对口的小学不怎么好，好的学校离现住的房子太远了。想买的房子那边有好的学校，社区也大，周边配套好很多😖😖请各位给建议。。。
xihuxiaoyu
注册时间： -
注册时间：
把惠州的换掉试试？引用3楼楼主的发言:回深圳的可能性比较低，生活压力太大，回去的话惠州的房子会空着。再加上深圳房子朝北，一到冬天家里冷得不行，夏天又暴晒，真心没有惠州朝南的房子舒服。现在就想问，大家觉得深圳的房子有必要卖吗？还是保持现状就好？为什么想买多一套房子？是因为现在这边对口的小学不怎么好，好的学校离现住的房子太远了。想买的房子那边有好的学校，社区也大，周边配套好很多😖😖请各位给建议。。。
xihuxiaoyu
注册时间： -
注册时间：
千万不要卖深圳的去买惠州的引用4楼xihuxiaoyu的发言:把惠州的换掉试试？引用3楼楼主的发言:回深圳的可能性比较低，生活压力太大，回去的话惠州的房子会空着。再加上深圳房子朝北，一到冬天家里冷得不行，夏天又暴晒，真心没有惠州朝南的房子舒服。现在就想问，大家觉得深圳的房子有必要卖吗？还是保持现状就好？为什么想买多一套房子？是因为现在这边对口的小学不怎么好，好的学校离现住的房子太远了。想买的房子那边有好的学校，社区也大，周边配套好很多😖😖请各位给建议。。。
注册时间： -
注册时间：
麻烦中介不要给我发悄悄，因为我自己住惠州，这边的情况比较了解。不用给我介绍楼盘，我只是需要大家给我建议分析，不是选房子。说的比较直白，不好意思哈
或许该离开
注册时间： -
注册时间：
每个人都有不一样的生活追求，我觉得深圳房子可以卖掉，再全款买一套300万的两房，省得以后孩子要回深圳，还可以收租，剩下100万还惠州60万贷款，余下40万理财放手里做生活备用金
注册时间： -
注册时间：
惠州这边的刚住一两年，买了之后一直没升值有动过这个念头，可是目前存款为零（刚换了车）所以卖了这边的也换不起[xihuxiaoyu]( 10:34:55)把惠州的换掉试试？引用3楼楼主的发言:回深圳的可能性比较低，生活压力太大，回去的话惠州的房子会空着。再加上深圳房子朝北，一到冬天家里冷得不行，夏天又暴晒，真心没有惠州朝南的房子舒服。现在就想问，大家觉得深圳的房子有必要卖吗？还是保持现状就好？为什么想买多一套房子？是因为现在这边对口的小学不怎么好，好的学校离现住的房子太远了。想买的房子那边有好的学校，社区也大，周边配套好很多😖😖请各位给建议。。。
注册时间： -
注册时间：
如果考虑自住可以出手深圳的，深圳的好处在于医疗教育配套完善优质于惠州，房产贬值这个东西现在不好说，前景不好判断，但现在租金可观，如果月供加家庭开销能够维持建议不卖，深圳房产价值大于惠州
注册时间： -
注册时间：
说到底都是没本事，收入在深圳这边看来真是太低了没本事回深圳生活。[或许该离开]( 10:40:17)每个人都有不一样的生活追求，我觉得深圳房子可以卖掉，再全款买一套300万的两房，省得以后孩子要回深圳，还可以收租，剩下100万还惠州60万贷款，余下40万理财放手里做生活备用金
或许该离开
注册时间： -
注册时间：
没注意学位，惠州的房子卖掉重新置换一套学位好的
注册时间： -
注册时间：
生活没有问题，压力也不太大，只是想在惠州想买多一套学位房，没资金，老公就动了卖深圳房子的念头。。。我自己还是倾向于留住深圳的房子[方楠楠]( 10:43:43)如果考虑自住可以出手深圳的，深圳的好处在于医疗教育配套完善优质于惠州，房产贬值这个东西现在不好说，前景不好判断，但现在租金可观，如果月供加家庭开销能够维持建议不卖，深圳房产价值大于惠州
或许该离开
注册时间： -
注册时间：
楼主挺不错喽，比深圳大多数人都好呀[希望345]( 10:45:05)说到底都是没本事，收入在深圳这边看来真是太低了没本事回深圳生活。[或许该离开](&10:40:17)每个人都有不一样的生活追求，我觉得深圳房子可以卖掉，再全款买一套300万的两房，省得以后孩子要回深圳，还可以收租，剩下100万还惠州60万贷款，余下40万理财放手里做生活备用金
注册时间： -
注册时间：
虽说深圳房产长线看好，但能够在高位套现也未尝不可。再者惠州地段好配套成熟的房产，如果是买来自住使用，不但提升了生活和教育质量而且风险相对较低，知足常乐最重要！
注册时间： -
注册时间：
建议惠州，一是你们手中有些现金，压力很小了，二是惠州接下来也会有不错发展，投资可期[希望345]( 10:47:23)生活没有问题，压力也不太大，只是想在惠州想买多一套学位房，没资金，老公就动了卖深圳房子的念头。。。我自己还是倾向于留住深圳的房子[方楠楠](&10:43:43)如果考虑自住可以出手深圳的，深圳的好处在于医疗教育配套完善优质于惠州，房产贬值这个东西现在不好说，前景不好判断，但现在租金可观，如果月供加家庭开销能够维持建议不卖，深圳房产价值大于惠州
xihuxiaoyu
注册时间： -
注册时间：
你是用来住的管什么升值不升值唉思路不能清晰点？惠州多好要是我老婆在惠州能找到工作，毫不犹豫去惠州了深圳房子出租多happy的生活引用8楼楼主的发言:惠州这边的刚住一两年，买了之后一直没升值有动过这个念头，可是目前存款为零（刚换了车）所以卖了这边的也换不起[xihuxiaoyu](&10:34:55)把惠州的换掉试试？引用3楼楼主的发言:回深圳的可能性比较低，生活压力太大，回去的话惠州的房子会空着。再加上深圳房子朝北，一到冬天家里冷得不行，夏天又暴晒，真心没有惠州朝南的房子舒服。现在就想问，大家觉得深圳的房子有必要卖吗？还是保持现状就好？为什么想买多一套房子？是因为现在这边对口的小学不怎么好，好的学校离现住的房子太远了。想买的房子那边有好的学校，社区也大，周边配套好很多😖😖请各位给建议。。。
注册时间： -
注册时间：
在惠州住就会想念深圳给你带来的便利，这边配套差深圳不知几个等级。当然，这些是相互的[xihuxiaoyu]( 11:08:39)你是用来住的管什么升值不升值唉思路不能清晰点？惠州多好要是我老婆在惠州能找到工作，毫不犹豫去惠州了深圳房子出租多happy的生活引用8楼楼主的发言:惠州这边的刚住一两年，买了之后一直没升值有动过这个念头，可是目前存款为零（刚换了车）所以卖了这边的也换不起[xihuxiaoyu](0:34:55)把惠州的换掉试试？引用3楼楼主的发言:回深圳的可能性比较低，生活压力太大，回去的话惠州的房子会空着。再加上深圳房子朝北，一到冬天家里冷得不行，夏天又暴晒，真心没有惠州朝南的房子舒服。现在就想问，大家觉得深圳的房子有必要卖吗？还是保持现状就好？为什么想买多一套房子？是因为现在这边对口的小学不怎么好，好的学校离现住的房子太远了。想买的房子那边有好的学校，社区也大，周边配套好很多😖😖请各位给建议。。。
mathlenovo
注册时间： -
注册时间：
深圳怎么可能跌，跌也影响不了你们什么，东莞都有快三万的房价了。。。。。宝中。。。抗跌，不建议卖
mathlenovo
注册时间： -
注册时间：
你租出去租一个舒服的也可以啊，，，不能理解，除非你不再回深圳了。要不然怎么会想着卖掉深圳唯一住房？又不是急用钱什么的。。。
注册时间： -
注册时间：
你把下蛋的母鸡卖掉，你还想吃鸡蛋不
1<input type="button" value="GO" onclick ="var val = Number(jQuery(this).parent().children(':text').val()); if (isNaN(val) || val
3){val = 3;}window.location.href = '/500-500020-detail--0-__id__.html'.replace('__id__', val); ">
链接网址：
链接文字：
添加家在水印
不添加家在水印
支持一次选择9张图片上传（使用Ctrl、Shift选中）；
支持jpg、png、gif，单张图片不超过10M，png不超过1M，gif不超过300K。
选 择 字 号
大家都在看
（新房业务）
（二手房业务）
（家居装修业务）
（亲子教育业务）
（家在广告业务）
