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https://www.readbyqxmd.com/read/28538591/intrathecal-morphine-and-oral-analgesics-provide-safe-and-effective-pain-control-after-posterior-spinal-fusion-for-adolescent-idiopathic-scoliosis
#1
Ying Li, Rebecca A Hong, Christopher B Robbins, Kathleen M Gibbons, Ashlee E Holman, Michelle S Caird, Frances A Farley, Matthew D Abbott, Michelle C Burke
STUDY DESIGN: Retrospective comparative study. OBJECTIVE: To demonstrate that intrathecal morphine (ITM) and oral analgesics provide effective pain control after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS), and this protocol has a low complication rate so patients can be admitted to a general care floor. SUMMARY OF BACKGROUND DATA: Previous studies have shown that ITM combined with intravenous patient-controlled analgesia or epidural infusion (EPI) provides effective pain control after PSF for AIS...
May 23, 2017: Spine
https://www.readbyqxmd.com/read/28535569/reinstituting-the-bolus-new-reasoning-for-an-existing-technique
#2
Porter W McRoberts, Jason E Pope, Catalina Apostol
Improved intrathecal (IT) pump technology is increasing the accuracy of IT opioid bolus dosing and promising advances in pain therapy. Opioid bolus dosing can be used with a minimal continuous infusion or it can function as the sole therapy. Bolus-only dosing is characterized by minimal use of opioid (often less than 1 mg of IT morphine). It achieves adequate pain control while reducing tolerance and possibly opioid-induced hyperalgesia. It may prevent receptor saturation, and provide a "washing out" of the opioid receptor that prevents the observed dose escalation resulting from continuous infusions...
May 2017: Pain Physician
https://www.readbyqxmd.com/read/28535565/ephrinb-ephb-signaling-induces-hyperalgesia-through-erk5-creb-pathway-in-rats
#3
Li-Na Yu, Li-Hong Sun, Min Wang, Lie-Ju Wang, Ying Wu, Jing Yu, Wen-Na Wang, Feng-Jiang Zhang, Xue Li, Min Yan
BACKGROUND: There are numerous studies implicating that EphB receptors and ephrinB ligands play important roles in modulating the transduction of spinal nociceptive information. EphrinB-EphB signaling may contribute to hyperalgesia via various kinds of downstream molecules, the mechanisms of which have not been completely understood. OBJECTIVE: The aim of the present study was to identify whether ephrinB-EphB signaling could contribute to hyperalgesia through ERK5/CREB pathway...
May 2017: Pain Physician
https://www.readbyqxmd.com/read/28535095/managing-cns-disease-in-adults-with-acute-lymphoblastic-leukemia
#4
Richard A Larson
The central nervous system (CNS) is an important site of involvement by acute lymphoblastic leukemia (ALL) in adults. The prevalence is sufficiently high that prophylactic treatment is routinely given to this sanctuary site in order to eradicate occult disease that might otherwise lead to a relapse. A lumbar puncture should be routinely performed in all newly diagnosed patients with ALL. The risks of CNS leukemia vary by phenotype and genotype. Preventive treatment of the CNS during post-remission therapy has become an integral part of all current ALL treatment protocols...
May 23, 2017: Leukemia & Lymphoma
https://www.readbyqxmd.com/read/28535084/impact-of-initial-csf-findings-on-outcome-among-patients-with-national-cancer-institute-standard-and-high-risk-b-cell-acute-lymphoblastic-leukemia-a-report-from-the-children-s-oncology-group
#5
Naomi Winick, Meenakshi Devidas, Si Chen, Kelly Maloney, Eric Larsen, Leonard Mattano, Michael J Borowitz, Andrew Carroll, Julie M Gastier-Foster, Nyla A Heerema, Cheryl Willman, Brent Wood, Mignon L Loh, Elizabeth Raetz, Stephen P Hunger, William L Carroll
Purpose To determine the prognostic significance of blasts, and of white and red blood cells, in CSF samples at diagnosis of acute lymphoblastic leukemia (ALL), a uniform CSF and risk group classification schema was incorporated into Children's Oncology Group B-cell ALL (B-ALL) clinical trials. Methods CSF status was designated as follows: CNS1, no blasts; CNS2a to 2c, < 5 WBCs/μL and blasts with/without ≥ 10 RBCs/μL or ≥ 5 WBCs/μL plus blasts, with WBCs ≥ 5 times the number of RBCs; CNS3a to 3c, ≥ 5 WBCs/μL plus blasts with/without ≥ 10 RBCs/μL or clinical signs of CNS disease...
May 23, 2017: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28534039/alemtuzumab-and-intrathecal-methotrexate-failed-in-the-therapy-of-rasmussen-encephalitis
#6
Zuzana Liba, Petr Sedlacek, Vera Sebronova, Alice Maulisova, Bertil Rydenhag, Josef Zamecnik, Martin Kyncl, Pavel Krsek
No abstract text is available yet for this article.
July 2017: Neurology® Neuroimmunology & Neuroinflammation
https://www.readbyqxmd.com/read/28533993/bilateral-external-ventricular-drain-placement-and-intraventricular-irrigation-combined-with-concomitant-serial-prone-patient-positioning-a-novel-treatment-for-gravity-dependent-layering-in-bacterial-ventriculitis
#7
Andrew K Chan, Harjus S Birk, John K Yue, Ethan A Winkler, Michael W McDermott
A feared complication of ventricular access for drainage or shunting is ventriculitis. Early diagnosis and treatment is vital to prevent morbidity and mortality. Efficacy of directed antibiotic therapy in ventriculitis is limited by increasing multidrug resistant microorganisms and insufficient systemic antibiotic absorption into the cerebrospinal fluid. Treatment may involve intravenous and/or intrathecal antibiotics as well as external ventricular drainage. We present the first case report suggesting a potential role of a novel technique - direct ventricular catheter-mediated continuous saline irrigation and serial prone patient positioning - to treat a fulminant bacterial ventriculitis...
April 18, 2017: Curēus
https://www.readbyqxmd.com/read/28533694/the-improved-quality-of-postoperative-analgesia-after-intrathecal-morphine-does-not-result-in-improved-recovery-and-quality-of-life-in-the-first-6-months-after-orthopedic-surgery-a-randomized-controlled-pilot-study
#8
Nilufar Foadi, Matthias Karst, Anika Frese-Gaul, Niels Rahe-Meyer, Stefan Krömer, Christian Weilbach
OBJECTIVE: In orthopedic surgery, it is well known that the use of intrathecal morphine (ITM) leads to an improved quality of postoperative analgesia. Little is known how this improved analgesia affects the long-term course after surgery. STUDY DESIGN: A randomized, double-blind trial. SETTING: Academic medical center. SUBJECTS: Forty-nine patients undergoing total hip or knee replacement surgery in spinal anesthesia...
2017: Journal of Pain Research
https://www.readbyqxmd.com/read/28532680/decreased-spinal-endomorphin-2-contributes-to-mechanical-allodynia-in-streptozotocin-induced-diabetic-rats
#9
Le Niu, Guang-Hai Dai, Gao-Le He, Ming Yang, Hui-Min Hu, Zhong-Kai Liu, Nian-Song Qian, Yong-Liang Chen
Diabetic neuropathic pain (DNP) plays a major role in decreased life quality of diabetes patients, however, the neural mechanisms underlying DNP remain unclear. Endomorphins are the endogenous ligands for mu-opioid receptor. There is increasing evidence implicating the involvement of spinal endomorphin-2 (EM2) in neuropathic pain. In this study, using a streptozotocin induced diabetic rat model that displayed obvious mechanical allodynia, it was found that the expression of spinal EM2 was significantly decreased in DNP rats...
May 19, 2017: Neurochemistry International
https://www.readbyqxmd.com/read/28532673/-neuraxial-anesthesia-in-patients-with-multiple-sclerosis-a-systematic-review
#10
Helmar Bornemann-Cimenti, Nikki Sivro, Frederike Toft, Larissa Halb, Andreas Sandner-Kiesling
BACKGROUND AND OBJECTIVES: Current guidelines for neuraxial analgesia in patients with multiple sclerosis are ambiguous and offer the clinician only a limited basis for decision making. This systematic review examines the number of cases in which multiple sclerosis has been exacerbated after central neuraxial analgesia in order to rationally evaluate the safety of these procedures. METHODS: A systematic literature search with the keywords "anesthesia or analgesia" and "epidural, peridural, caudal, spinal, subarachnoid or intrathecal" in combination with "multiple sclerosis" was performed in the databases PubMed and Embase, looking for clinical data on the effect of central neuraxial analgesia on the course of multiple sclerosis...
May 19, 2017: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/28530107/leptomeningeal-carcinomatosis-in-a-young-patient-with-obstructive-colorectal-signet-ring-cell-adenocarcinoma
#11
Alejandro Lusilla, Jorge de Tomás
We present the case report of a twenty-five-year-old Moroccan male patient who suffered from leptomeningeal carcinomatosis related to a signet-ring cell carcinoma of the rectum. He presented to the emergency department with abdominal pain, constipation, weight loss and rectal bleeding. The rectal examination showed a rectal tumor and a CT scan revealed a large bowel obstruction due to rectal diffuse thickening. An emergency transverse colostomy was performed, with a rectal biopsy and a cytological sample collection...
May 22, 2017: Revista Española de Enfermedades Digestivas
https://www.readbyqxmd.com/read/28529158/evaluation-of-direct-and-cell-mediated-triple-gene-therapy-in-spinal-cord-injury-in-rats
#12
Rustem Robertovich Islamov, Andrey Alexandrovich Izmailov, Mikhail Evgenyevich Sokolov, Philip Olegovich Fadeev, Farid Vagizovich Bashirov, Anton Alexandrovich Eremeev, Gulnara Ferdinantovna Shaymardanova, Maxim Michaylovich Shmarov, Boris Savelyevich Naroditskiy, Yuri Alexandrovich Chelyshev, Igor Aleksandrovich Lavrov, András Palotás
Current treatment options for spinal cord injury (SCI) are scarce. One of the most promising innovative approaches include gene-therapy, however no single gene has so far been shown to be of clinical relevance. This study investigates the efficacy of various combinations of vascular endothelial growth factor (VEGF), glial cell-derived neurotrophic factor (GDNF), angiogenin (ANG) and neuronal cell adhesion molecule (NCAM) in rats. Multiple therapeutic genes were administered intrathecally either via adenoviral vectors or by using genetically modified human umbilical cord blood mononuclear cells (hUCBMCs)...
May 18, 2017: Brain Research Bulletin
https://www.readbyqxmd.com/read/28529027/management-of-postneurosurgical-meningitis-narrative-review
#13
REVIEW
Khetam Hussein, Roni Bitterman, Ben Shofty, Mical Paul, Ami Neuberger
BACKGROUND: Infections complicating neurosurgery pose unacceptable mortality and morbidity. AIMS: To summarize what is known about the epidemiology, diagnosis and treatment of post-neurosurgical meningitis (PNM). SOURCES: PubMed, references of identified studies and reviews, and personal experience when evidence was lacking. CONTENT: The incidence and pathogen distribution of PNM is highly variable. A shift towards Gram-negative bacteria has been observed with use of antibiotic prophylaxis and antibiotic-coated devices directed mainly against Gram-positive bacteria...
May 18, 2017: Clinical Microbiology and Infection
https://www.readbyqxmd.com/read/28525360/role-of-sigma-1-receptor-in-high-fat-diet-induced-peripheral-neuropathy
#14
Tieying Song, Jianhui Zhao, Xiaojing Ma, Zaiwang Zhang, Bo Jiang, Yunliang Yang
The neurobiological mechanisms of obesity-induced peripheral neuropathy are poorly understood. We evaluated the role of Sigma-1 receptor (Sig-1R) and NMDA receptor (NMDARs) in the spinal cord in peripheral neuropathy using an animal model of high fat diet-induced diabetes. We examined the expression of Sig-1R and NMDAR subunits GluN2A and GluN2B along with postsynaptic density protein 95 (PSD-95) in the spinal cord after 24- week HFD treatment in both wild-type and Sig-1R-/- mice. Finally, we examined the effects of repeated intrathecal administrations of selective Sig-1R antagonists BD1047 in HFD-fed wild-type mice on peripheral neuropathy...
May 19, 2017: Biological Chemistry
https://www.readbyqxmd.com/read/28524215/-novel-therapies-in-neurometabolic-diseases-the-importance-of-early-intervention
#15
L G Gutierrez-Solana
INTRODUCTION: Individually, neurometabolic diseases are ultra rare, but for some of them there is an effective treatment. DEVELOPMENT: Several recent therapeutic advances are reviewed. Today, the possibilities of treatment for lysosomal diseases have improved. In recent years the use of enzyme replacement therapy has become more widely extended to treat mucopolysaccharidosis type IVA (Morquio A), mucopolysaccharidosis type VII (Sly syndrome), lysosomal acid lipase deficiency and alpha-mannosidosis...
May 17, 2017: Revista de Neurologia
https://www.readbyqxmd.com/read/28521018/stereotactic-radiosurgery-for-the-treatment-of-chronic-intractable-pain-a-systematic-review
#16
Dustin G Roberts, Nader Pouratian
BACKGROUND: Since the advent of neuromodulation, the role and efficacy of stereotactic radiosurgery (SRS) for chronic pain has not been carefully scrutinized. OBJECTIVE: To perform a systematic review to evaluate the clinical efficacy, both short- and long-term, of SRS for the treatment of chronic intractable pain. METHODS: A systematic search in PubMed, Web of Science, and PsycINFO was performed using keywords and controlled vocabulary. The search included peer-reviewed articles reporting clinical outcomes of SRS for chronic pain with a minimum 3-mo follow-up for nonmalignant and 1 mo for malignant pain...
May 17, 2017: Operative Neurosurgery (Hagerstown, Md.)
https://www.readbyqxmd.com/read/28520955/effect-of-intrathecally-administered-ketamine-morphine-and-their-combination-added-to-bupivacaine-in-patients-undergoing-major-abdominal-cancer-surgery-a-randomized-double-blind-study
#17
Ahmad M Abd El-Rahman, Ashraf A Mohamed, Sahar A Mohamed, Mohamed A M Mostafa
Objective. : Effective postoperative pain control reduces postoperative morbidity. In this study, we investigated the effects of intrathecal morphine, ketamine, and their combination with bupivacaine for postoperative analgesia in major abdominal cancer surgery. Study Design. : Prospective, randomized, double-blind. Setting. : Academic medical center. Patients and Methods.:  Ninety ASA I-III patients age 30 to 50 years were divided randomly into three groups: the morphine group (group M) received 10 mg of hyperbaric bupivacaine 0...
May 17, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28520565/use-of-a-tilting-orthopedic-fracture-table-to-facilitate-proper-patient-positioning-during-intrathecal-neurolysis-with-hyperbaric-phenol-a-case-report
#18
Nathaniel H Loo, Gerald Matchett
We describe the case of a 41-year-old woman with metastatic cervical cancer and a large mass eroding into the pelvis and left lumbosacral plexus. The patient had intractable left lower extremity pain refractory to standard therapies, and she elected to undergo intrathecal neurolysis. A diagnostic intrathecal block was performed at the T11-12 interspace followed by intrathecal neurolysis with 6% phenol in glycerin on a subsequent date. During both procedures, we used a tilting radiolucent orthopedic fracture table to maintain strict left lateral-supine positioning...
May 17, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28520273/efficacy-of-a-targeted-drug-delivery-on-demand-bolus-option-for-chronic-pain
#19
Robert B Bolash, Tariq Niazi, Meera Kumari, Gerges Azer, Nagy Mekhail
BACKGROUND AND OBJECTIVES: Intrathecal targeted drug delivery systems historically required a physician's office visits for dose adjustment to manage fluctuating pain. A wireless device now enables patients to supplement their basal intrathecal infusion with a programmed on-demand bolus dose. We sought to quantify the change in oral breakthrough opioid need associated with the use of an intrathecal bolus in comparison to those treated with the basal infusion alone. METHODS: Demographic, dosage, bolus usage and longevity data were extracted from the historical medical record of 69 patients (18/51 bolus/non-bolus) followed continuously at our center...
May 18, 2017: Pain Practice: the Official Journal of World Institute of Pain
https://www.readbyqxmd.com/read/28515516/changes-in-cardiac-index-during-labour-analgesia-a-double-blind-randomised-controlled-trial-of-epidural-versus-combined-spinal-epidural-analgesia-a-preliminary-study
#20
Stephanie Yacoubian, Corrina M Oxford, Bhavani Shankar Kodali
BACKGROUND AND AIMS: Combined spinal-epidural (CSE) analgesia for labour and delivery is occasionally associated with foetal bradycardia. Decreases in cardiac index (CI) and/or uterine hypertonia are implicated as possible aetiological factors. No study has evaluated CI changes following combined spinal analgesia for labour and delivery. This prospective, double-blind, randomised controlled trial evaluates haemodynamic trends during CSE and epidural analgesia for labour. METHODS: Twenty-six parturients at term requesting labour analgesia were randomised to receive either epidural (E) or CSE analgesia...
April 2017: Indian Journal of Anaesthesia
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