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Bowel management for spinal patient

Salah G Aoun, Mary Ashley Liu, Megan Still, Tarek Y El Ahmadieh, Mazin Al Tamimi, Wayne Gluf
BACKGROUND: The management of dermoid cysts can be tedious as they have a tendency to recur, and respond poorly to chemotherapy and radiation. Management is especially difficult for tumors involving highly eloquent areas such as the conus medullaris. OBJECTIVE: We aim to provide a summary of the pathology, clinical presentation, and operative management strategies of dermoid cysts involving the conus medullaris. METHODS: Two clinical cases of dermoid cysts of the conus are presented, as well as a commented surgical video...
February 10, 2018: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Tej D Azad, Anand Veeravagu, Amy Li, Michael Zhang, Venkatesh Madhugiri, Gary K Steinberg
BACKGROUND: Intramedullary spinal cord cavernous malformations (CMs) account for 5% of all CMs in the central nervous system and 5% to 12% of all spinal cord vascular lesions, yet their optimal management is controversial. OBJECTIVE: To identify factors associated with the clinical progression of spinal cord CMs and quantify the range of surgical outcomes. METHODS: Retrospective observational cohort study of 32 patients who underwent open surgical resection for spinal CMs, the majority of which presented to a dorsal or lateral pial surface, from 1996 to 2017 at a single institution...
February 6, 2018: Neurosurgery
Ziev B Moses, Gabriel N Friedman, David L Penn, Isaac H Solomon, John H Chi
OBJECTIVE Optimal diagnosis and management strategies for intradural spinal arachnoid cysts (SACs) are still unresolved given the rare nature of this entity, with few large case series and virtually no statistical analyses of patient characteristics in the literature. Here, the authors studied a large patient cohort with these lesions to determine whether pre- or postoperative attributes could be used to aid in either diagnosis or prognosis. METHODS A chart review was completed at a single institution for the period from 2002 to 2016 to determine the preoperative characteristics and postoperative outcomes of 21 patients with exclusively intradural SACs...
February 9, 2018: Journal of Neurosurgery. Spine
Ralph D Cabigon, Elizabeth Wojciechowski, Lisa Rosen, David Miller, Cristina Mix, David Chen
BACKGROUND: Evidence shows that having a bowel management program prevents rehospitalization postacute rehabilitation discharge for persons with a spinal cord injury (SCI). Peer mentors have been used to assist patients in managing their care. PURPOSE: The aim of the study was to illustrate how interprofessional collaboration led to utilizing resources of the inpatient rehabilitation facility's peer mentor program and incorporating peer mentors into bowel education for persons with SCI...
December 13, 2017: Rehabilitation Nursing: the Official Journal of the Association of Rehabilitation Nurses
Tomasz Nikodemski, Agnieszka Biskup, Aleksandra Taszarek, Małgorzata Albin, Anita Chudecka-Głaz, Aneta Cymbaluk-Płoska, Janusz Menkiszak
Aim of the study: An ERAS protocol provides the latest perioperative care principles, whose primary aim is to reduce complication rates, and therefore mortality. The aim of this study is to establish the progress of the ERAS pathway implementation in our gynaecology department. Material and methods: This was a retrospective analysis of two sets of 100 consecutive medical records: patients treated before (PRE-ERAS) and after (ERAS) introduction of the ERAS protocol...
2017: Contemporary Oncology Współczesna Onkologia
Joseph E Tanenbaum, Stephanie T Kha, Edward C Benzel, Michael P Steinmetz, Thomas E Mroz
BACKGROUND CONTEXT: The United States Centers for Disease Control and Prevention estimates the prevalence of inflammatory bowel disease (IBD) at more than 3.1 million people. As diagnostic techniques and treatment options for IBD improve, the prevalence of IBD is expected to increase. For spine surgeons, patients with IBD have a unique complication profile because patients with IBD may present with poor nutritional status and because the medications used to manage IBD have been associated with poor vertebral bone mineralization and immunosuppression...
November 15, 2017: Spine Journal: Official Journal of the North American Spine Society
John K Yue, Ethan A Winkler, Jonathan W Rick, Hansen Deng, Carlene P Partow, Pavan S Upadhyayula, Harjus S Birk, Andrew K Chan, Sanjay S Dhall
Traumatic spinal cord injury (SCI) often occurs in patients with concurrent traumatic injuries in other body systems. These patients with polytrauma pose unique challenges to clinicians. The current review evaluates existing guidelines and updates the evidence for prehospital transport, immobilization, initial resuscitation, critical care, hemodynamic stability, diagnostic imaging, surgical techniques, and timing appropriate for the patient with SCI who has multisystem trauma. Initial management should be systematic, with focus on spinal immobilization, timely transport, and optimizing perfusion to the spinal cord...
November 2017: Neurosurgical Focus
Ombretta Martinelli, Federico Faccenna, Alban Malaj, Jihad Jabbour, Salvatore Venosi, Roberto Gattuso, Bruno Gossetti, Luigi Irace
Thoracic endovascular aortic repair (TEVAR) is a less invasive option for managing traumatic injuries of the descending aorta in polytraumatized patients. Concerns arise when treating young patients with TEVAR. A 22-year-old male was admitted to the emergency department following a high-impact road traffic collision. Whole-body computed tomography (CT) scan documented multiple injuries, including rupture of descending thoracic aorta just below the isthmus. There was no evidence of paraplegia or stroke. We decided to treat him in an endovascular fashion with a Zenith Cook (Cook Incorporated, Bloomington, IN) endograft...
February 2018: Annals of Vascular Surgery
Azam Basheer, Mohamed Macki, Morenikeji Buraimoh, Asim Mahmood
BACKGROUND: Spinal cord abscesses and spinal subdural empyemas are rare and difficult to treat. CASE DESCRIPTION: A 35-year-old male presented to an outside institution with 2 months of progressive low back pain, weakness, and bowel incontinence; he was diagnosed with an L4 epidural abscess that was poorly managed. When the patient presented to our institution, magnetic resonance imaging (MRI) revealed a well-organized chronic subdural abscess at the thoracolumbar junction...
2017: Surgical Neurology International
Robert D Vining, Donna M Gosselin, Jeb Thurmond, Kimberlee Case, Frederick R Bruch
RATIONALE: This report describes interdisciplinary rehabilitation for a 51-year-old male recovering from incomplete cervical spinal cord injury (SCI) and multiple comorbidities following an automobile accident. PATIENT CONCERNS: The patient was admitted to a rehabilitation specialty hospital approximately 2 months post SCI and 2 separate surgical fusion procedures (C3-C6). DIAGNOSES: Clinical presentation at the rehabilitation hospital included moderate to severe motor strength loss in both upper and lower extremities, a percutaneous endoscopic gastronomy tube (PEG), dysphagia, bowel/bladder incontinence, dependence on a mechanical lift and tilting wheelchair due to severe orthostatic hypotension, and pre-existing shoulder pain from bilateral joint degeneration...
August 2017: Medicine (Baltimore)
Justin M Haller, John A Heflin, David A Hulet, Qian Ding, Angela P Presson, John T Smith
BACKGROUND: Despite clinical reports of improved pulmonary function and reduced spinal deformity with rib-based distraction surgery in early-onset scoliosis (EOS) patients, infection remains a common complication, reported as high as 32% in some studies. The purpose of this study was to evaluate intrawound vancomycin powder in pediatric patients managed with rib-based distraction for EOS. METHODS: This was a single institution retrospective cohort study of EOS patients treated with rib-based distraction...
August 2, 2017: Journal of Pediatric Orthopedics
N Brownrigg, L H Braga, M Rickard, F Farrokhyar, B Easterbrook, A Dekirmendjian, K Jegatheeswaran, J DeMaria, A J Lorenzo
INTRODUCTION: Bladder and bowel dysfunction (BBD) can negatively impact the quality of life (QoL) of children. Urotherapy is an accepted treatment option for BBD; however, literature that examines the impact of management options on QoL in this population is scarce. OBJECTIVE: To determine whether a bladder training video (BTV) is non-inferior to standard urotherapy (SU) in improving QoL in children with BBD. METHODS: Children aged 5-10 years and who scored ≥11 on the Vancouver Non-Neurogenic Lower Urinary Tract Dysfunction/Dysfunctional Elimination Syndrome Questionnaire (NLUTD/DES) were recruited from a pediatric tertiary care center...
August 2017: Journal of Pediatric Urology
Paholo G Barboglio Romo, Priyanka Gupta
Sacral and peripheral neuromodulation are minimally invasive surgical procedures that are third-line therapy options for the treatment of patients with idiopathic overactive bladder syndrome. There has been interest in their efficacy in the management of neurogenic lower urinary tract dysfunction (NLUTD). Contemporary data suggest promising outcomes for urinary and bowel symptoms in carefully selected patients with spinal cord injury and/or multiple sclerosis. This article reviews the current literature regarding urinary and bowel outcomes in patients with NLUTD and also discusses contemporary studies that suggest that treatment during particular stages of neurologic injury may prevent long-term urinary sequelae...
August 2017: Urologic Clinics of North America
Michael Absoud, Peter Brex, Olga Ciccarelli, Onyinye Diribe, Gavin Giovannoni, Jennifer Hellier, Rosemary Howe, Rachel Holland, Joanna Kelly, Paul McCrone, Caroline Murphy, Jackie Palace, Andrew Pickles, Michael Pike, Neil Robertson, Anu Jacob, Ming Lim
BACKGROUND: Transverse myelitis (TM) is an immune-mediated disorder of the spinal cord that affects adults and children and that causes motor, sensory and autonomic dysfunction. There is a prolonged recovery phase, which may continue for many years. Neuromyelitis optica (NMO) is an uncommon relapsing inflammatory central nervous system condition in which TM can be the first presenting symptom. As TM and NMO affect many patients in the prime of their working life, the disorder can impose a significant demand on health resources...
May 2017: Health Technology Assessment: HTA
Kai Zheng, Ming Xu, Bing Wang, Xiu-Chun Yu, Yong-Cheng Hu
Giant cell tumor (GCT) is a benign, locally aggressive tumor that rarely occurs in the spine. They usually occur in patients between 20 and 40 years of age; some patients with GCT present in hospital with pregnancy. The management of these patients can be challenging. The current study reports a case of GCT located in the sixth thoracic vertebra of a 31-year-old female at 34 weeks of gestation. An osteolytic lesion, 3.5 cm × 3.5 cm in diameter, was identified on CT. An MRI test of the lesion revealed a soft tissue mass involving the T 6-7 vertebrae, extending to the right pedicle of the T 6 vertebra and causing significant spinal cord compression...
May 2017: Orthopaedic Surgery
Mark D Bevill, Kristine Bonnett, Angela Arlen, Christopher Cooper, Cheryl Baxter, Douglas W Storm
INTRODUCTION: Patients with spina bifida and other spinal dysraphisms commonly suffer from fecal incontinence and constipation, which can be treated with antegrade continence enemas. Currently, information regarding outcomes and satisfaction in children who have Chait cecostomy tubes is lacking. The aim of our study was to evaluate the effectiveness of Chait cecostomy tubes in management of constipation in children with spinal dysraphisms. MATERIALS AND METHODS: A questionnaire was completed by patients and/or their families during office visits at the University of Iowa or Nationwide Children's Hospital during follow-up pediatric urology office visits...
August 2017: Journal of Pediatric Urology
Panayiotis D Megaloikonomos, Thekla Antoniadou, Leonidas Dimopoulos, Marcos Liontos, Vasilios Igoumenou, Georgios N Panagopoulos, Efthymia Giannitsioti, Andreas Lazaris, Andreas F Mavrogenis
Graft infection following aortic aneurysms repair is an uncommon but devastating complication; its incidence ranges from <1% to 6% (mean 4%), with an associated perioperative and overall mortality of 12% and 17.5-20%, respectively. The most common causative organisms are Staphylococcus aureus and Escherichia coli; causative bacteria typically arise from the skin or gastrointestinal tract. The pathogenetic mechanisms of aortic graft infections are mainly breaks in sterile technique during its implantation, superinfection during bacteremia from a variety of sources, severe intraperitoneal or retroperitoneal inflammation, inoculation of bacteria during postoperative percutaneous interventions to manage various types of endoleaks, and external injury of the vascular graft...
2017: Journal of Bone and Joint Infection
Michael George Zaki Ghali, Visish M Srinivasan, Marc J Kim, Archana Malik
BACKGROUND: Tuberculous involvement of the spinal cord parenchyma is an exceedingly rare clinical entity; even more so is concurrent intracranial tuberculosis (TB). Spinal intramedullary TB presents with a characteristic subacute myelopathy, with slowly progressive paraplegia, sensory deficits, and/or bowel and bladder dysfunction. Diagnosis is strongly suspected with a clinical history of known TB in conjunction with characteristic findings on magnetic resonance imaging. Management involves multiagent antitubercular chemotherapy without or with operative intervention...
October 2017: World Neurosurgery
Christopher S Ahuja, Jefferson R Wilson, Satoshi Nori, Mark R N Kotter, Claudia Druschel, Armin Curt, Michael G Fehlings
Traumatic spinal cord injury (SCI) has devastating consequences for the physical, social and vocational well-being of patients. The demographic of SCIs is shifting such that an increasing proportion of older individuals are being affected. Pathophysiologically, the initial mechanical trauma (the primary injury) permeabilizes neurons and glia and initiates a secondary injury cascade that leads to progressive cell death and spinal cord damage over the subsequent weeks. Over time, the lesion remodels and is composed of cystic cavitations and a glial scar, both of which potently inhibit regeneration...
April 27, 2017: Nature Reviews. Disease Primers
Chris Yin Wei Chan, Shweh Fern Loo, Jun Yin Ong, Kulathunga Arachchige Lisitha, M Shahnaz Hasan, Chee Kean Lee, Chee Kidd Chiu, Mun Keong Kwan
STUDY DESIGN: A prospective cohort study. OBJECTIVE: The aim of this study was to determine the feasibility of an accelerated recovery protocol for Asian adolescent idiopathic scoliosis (AIS) patients undergoing posterior spinal fusion (PSF). SUMMARY OF BACKGROUND DATA: There has been successful implementation of an accelerated recovery protocol for AIS patients undergoing PSF in the western population. No similar studies have been reported in the Asian population...
December 15, 2017: Spine
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