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https://www.readbyqxmd.com/read/29138593/intrathecal-pain-management-a-team-based-approach
#1
REVIEW
Jeremy A Adler, Neona M Lotz
Objective: Physician assistants (PAs), nurse practitioners (NPs), and registered nurses (RNs) provide professional services on pain management teams. This review provides an overview of the practical management of chronic pain with intrathecal (IT) therapy using an interprofessional approach (eg, physicians and other health care professionals), with a focus on the contributions of PAs, NPs, and RNs. Methods: Narrative review based on literature searches of the Medline database and treatment guidelines on the use of IT therapy in the management of patients with chronic pain...
2017: Journal of Pain Research
https://www.readbyqxmd.com/read/29135525/intrathecal-baclofen-injection-to-avoid-withdrawal-in-a-multiple-sclerosis-patient-undergoing-lumbar-spine-surgery-a-case-report
#2
Mirsad Dupanovic, Robert P Devine, Sean R Jackson, Sharon G Lynch
Spasticity of spinal or cerebral origin is frequently treated with baclofen. Treatment interruption initially results in rebound spasticity; life-threatening withdrawal symptoms may follow. Severe rebound spasticity of leg muscles occurred in a multiple sclerosis patient after a 10-hour long perioperative pause of oral baclofen intake. In a subsequent spine surgery, recurrence was prevented by substituting a cumulative 12-hour oral baclofen dose with an intraoperative intrathecal injection. Administration of intrathecal baclofen during prolonged surgery in patients dependent on oral baclofen may improve patient comfort and prevent early withdrawal symptoms...
November 9, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/29130140/transforaminal-intrathecal-delivery-of-nusinersen-using-cone-beam-computed-tomography-for-children-with-spinal-muscular-atrophy-and-extensive-surgical-instrumentation-early-results-of-technical-success-and-safety
#3
John J Weaver, Niranjana Natarajan, Dennis W W Shaw, Susan D Apkon, Kevin S H Koo, Giri M Shivaram, Eric J Monroe
BACKGROUND: Nusinersen, the only treatment approved by the United States Food and Drug Administration for spinal muscular atrophy (SMA), is delivered intrathecally. Many children with SMA have extensive spinal instrumentation and deformities, often precluding the use of standard approaches for gaining intrathecal access. Furthermore the anatomical distortion that often occurs with rotoscoliosis can complicate the use of fluoroscopic guidance. Compared to fluoroscopy, CT affords superior guidance for complex needle placements...
November 13, 2017: Pediatric Radiology
https://www.readbyqxmd.com/read/29128611/intrathecal-administration-of-antisense-oligonucleotide-against-p38%C3%AE-but-not-p38%C3%AE-map-kinase-isoform-reduces-neuropathic-and-postoperative-pain-and-tlr4-induced-pain-in-male-mice
#4
Xin Luo, Bethany Fitzsimmons, Apoorva Mohan, Linlin Zhang, Niccolo Terrando, Holly Kordasiewicz, Ru-Rong Ji
p38 mitogen-activated protein kinase (MAPK) consists of two major isoforms: p38α and p38β; however, it remains unclear which isoform is more important for chronic pain development. Recently, we developed potent, long-lasting, and p38 MAPK subtype-specific antisense oligonucleotides (ASOs). We examined the therapeutic effects of isoform-specific ASOs in several chronic pain models following single intrathecal injection (300 μg/10 μl) in CD1 mice. In the chronic constriction injury (CCI) model, p38α MAPK ASO, given on post-operative day 5, reduced CCI-induced mechanical allodynia in male but not female mice...
November 8, 2017: Brain, Behavior, and Immunity
https://www.readbyqxmd.com/read/29127294/preventing-shivering-with-adjuvant-low-dose-intrathecal-meperidine-a-meta-analysis-of-randomized-controlled-trials-with-trial-sequential-analysis
#5
Yu-Cih Lin, Chien-Yu Chen, Yuan-Mei Liao, Alan Hsi-Wen Liao, Pi-Chu Lin, Chuen-Chau Chang
The aim of this systematic review and meta-analysis is to evaluate the pros and cons of adjuvant low dose intrathecal meperidine for spinal anaesthesia. We searched electronic databases for randomized controlled trials using trial sequential analysis (TSA) to evaluate the incidence of reduced rescue analgesics, shivering, pruritus, nausea and vomiting when applying adjuvant intrathecal meperidine. Twenty-eight trials with 2216 patients were included. Adjuvant intrathecal meperidine, 0.05-0.5 mg kg(-1), significantly reduced incidence of shivering (relative risk, RR, 0...
November 10, 2017: Scientific Reports
https://www.readbyqxmd.com/read/29124451/current-treatment-concepts-for-iatrogenic-ventriculitis-a-nationwide-survey-in-germany
#6
Niklas von Spreckelsen, Norma Jung, Sergej Telentschak, Jürgen Hampl, Roland Goldbrunner, Stefan Grau
BACKGROUND: Iatrogenic ventriculitis is a common complication of the external ventricular drainage. While the procedure and indications for external ventricular drains (EVD) are highly standardized, the treatment of ventriculitis is not clearly defined. OBJECTIVE: To depict the treatment of iatrogenic ventriculitis currently performed in German hospitals. METHODS: A standardized questionnaire consisting of 18 multiple choice questions, each with the ability to provide additional individual answers, covering the diagnosis and treatment of iatrogenic ventriculitis as well as general handling of EVDs, was sent to 121 neurosurgical hospitals registered in the German Society for Neurosurgery (DGNC)...
November 9, 2017: Acta Neurochirurgica
https://www.readbyqxmd.com/read/29123622/retrospective-analysis-of-the-financial-break-even-point-for-intrathecal-morphine-pump-use-in-korea
#7
Eun Kyoung Kim, Ji Yeon Shin, Anyela Marcela Castañeda, Seung Jae Lee, Hyun Kyu Yoon, Yong Chul Kim, Jee Youn Moon
Background: The high cost of intrathecal morphine pump (ITMP) implantation may be the main obstacle to its use. Since July 2014, the Korean national health insurance (NHI) program began paying 50% of the ITMP implantation cost in select refractory chronic pain patients. The aims of this study were to investigate the financial break-even point and patients' satisfaction in patients with ITMP treatment after the initiation of the NHI reimbursement. Methods: We collected data retrospectively or via direct phone calls to patients who underwent ITMP implantation at a single university-based tertiary hospital between July 2014 and May 2016...
October 2017: Korean Journal of Pain
https://www.readbyqxmd.com/read/29121822/investigation-of-efficacy-of-treatment-in-spinal-cord-injury-erythropoietin-versus-methylprednisolone
#8
Okan Ozkunt, Kerim Sariyilmaz, Halil Can Gemalmaz, Seren Gülsen Gürgen, Ulaş Yener, Fatih Dikici
BACKGROUND: Investigation of the expression of platelet-derived growth factor (PDGF)-β and glial fibrillary acidic protein (GFAP) in rats with spinal cord injury as a marker of neurologic recovery between groups treated with erythropoietin (EPO) and methylprednisolone (MP). METHODS: Thirty adult female rats were randomly divided into three even groups. A laminectomy was applied to thoracic ninth vertebra and contusion injury was induced by extradural application of an aneurysm clip...
September 2017: Journal of Orthopaedic Surgery
https://www.readbyqxmd.com/read/29121383/a-novel-etiology-for-pneumolabyrinth-after-temporal-bone-fracture-without-otic-capsule-involvement
#9
Thomas J Muelleman, Vidur Bhalla, Hinrich Staecker
Pneumolabyrinth has been considered an indicator of otic capsule involvement in temporal bone fractures. We present a novel theory for the etiology of pneumolabyrinth in a trauma patient without an otic capsule fracture: passage of intrathecal air into the labyrinth. Our patient experienced transient bilateral pneumolabyrinth after head trauma due to a motor vehicle collision. The patient was noted to have extensive pneumocephalus and a unilateral temporal bone fracture that spared the otic capsule. Initial computed tomography (CT) scans demonstrated air in the cochlea and both internal auditory canals...
October 2017: Ear, Nose, & Throat Journal
https://www.readbyqxmd.com/read/29119834/numerical-study-of-intrathecal-drug-delivery-to-a-permeable-spinal-cord-effect-of-catheter-position-and-angle
#10
G Pizzichelli, B Kehlet, Ø Evju, B A Martin, M E Rognes, K A Mardal, E Sinibaldi
Intrathecal delivery is a procedure involving the release of therapeutic agents into the cerebrospinal fluid (CSF) hrough a catheter. It holds promise for treating high-impact central nervous system pathologies, for which systemic administration routes are ineffective. In this study we introduce a numerical model able to simultaneously account for solute transport in the fluid and in the spinal cord. Using a Discontinuous Galerkin method and a three-dimensional patient-specific geometry, we studied the effect of catheter position and angle on local spinal cord drug concentration...
November 9, 2017: Computer Methods in Biomechanics and Biomedical Engineering
https://www.readbyqxmd.com/read/29117409/development-of-a-perfusion-based-cadaveric-simulation-model-integrated-into-neurosurgical-training-feasibility-based-on-reconstitution-of-vascular-and-cerebrospinal-fluid-systems
#11
Gabriel Zada, Joshua Bakhsheshian, Martin Pham, Mike Minneti, Eisha Christian, Jesse Winer, Aaron Robison, Bozena Wrobel, Jonathan Russin, William J Mack, Steven Giannotta
BACKGROUND: Novel methodologies providing realistic simulation of the neurosurgical operating room environment are currently needed, particularly for highly subspecialized operations with steep learning curves, high-risk profiles, and demands for advanced psychomotor skills. OBJECTIVE: To describe the development of a curriculum for using perfusion-based cadaveric simulation models in a "Mock Operating Room" for neurosurgical procedures. METHODS: At the USC Keck School of Medicine Fresh Tissue Dissection Laboratory between 2012 and 2016, 43 cadaveric specimens underwent cannulation of the femoral or carotid artery and artificial perfusion of the arterial system, and/or cannulation of the intradural cervical spine for intrathecal reconstitution of the cerebrospinal fluid (CSF) system...
May 13, 2017: Operative Neurosurgery (Hagerstown, Md.)
https://www.readbyqxmd.com/read/29116382/selective-dorsal-rhizotomy-for-the-treatment-of-severe-spastic-cerebral-palsy-efficacy-and-therapeutic-durability-in-gmfcs-grade-iv-and-v-children
#12
Daniel D'Aquino, Ahmad A Moussa, Amr Ammar, Harshal Ingale, Michael Vloeberghs
BACKGROUND: Selective dorsal rhizotomy (SDR) has been established as an effective surgical treatment for spastic diplegia. The applicability of SDR to the full spectrum of spastic cerebral palsy and the durability of its therapeutic effects remain under investigation. There are currently limited data in the literature regarding efficacy and outcomes following SDR in Gross Motor Function Classification System (GMFCS) IV and V patients. Intrathecal baclofen has traditionally been the surgical treatment of choice for these patients...
November 7, 2017: Acta Neurochirurgica
https://www.readbyqxmd.com/read/29115943/membrane-protein-nav1-7-contributes-to-the-persistent-post-surgical-pain-regulated-by-p-p65-in-dorsal-root-ganglion-drg-of-smir-rats-model
#13
Zhisong Li, Yaru Li, Jing Cao, Xuemin Han, Weihua Cai, Weidong Zang, Jitian Xu, Wei Zhang
BACKGROUND: Persistent post-surgical pain is a difficult clinical problem. In this study, we intend to explore the mechanism underlying the persistent post-surgical pain in SMIR (skin/muscle incision and retraction) rats. METHODS: First of all, the expression of membrane protein Nav1.7 and p-p65 (Phosphorylation of p65) were detected in ipsilateral L4-6 DRGs of SMIR rats by western-blot and immunostaining. Then with ProTx-II (Nav1.7 blocker) or PDTC (p65 inhibitor) were intrathecally injected while the change of Nav1...
November 7, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/29115915/neuromodulation-in-multiple-sclerosis
#14
Hesham Abboud, Eddie Hill, Junaid Siddiqui, Alessandro Serra, Benjamin Walter
Neuromodulation, or the utilization of advanced technology for targeted electrical or chemical neuronal stimulation or inhibition, has been expanding in several neurological subspecialties. In the past decades, immune-modulating therapy has been the main focus of multiple sclerosis (MS) research with little attention to neuromodulation. However, with the recent advances in disease-modifying therapies, it is time to shift the focus of MS research to neuromodulation and restoration of function as with other neurological subspecialties...
November 2017: Multiple Sclerosis: Clinical and Laboratory Research
https://www.readbyqxmd.com/read/29115173/role-of-gabab-receptors-and-p38mapk-nf-%C3%AE%C2%BAb-pathway-in-paclitaxel-induced-apoptosis-of-hippocampal-neurons
#15
Zhao Li, Peng Liu, Hailin Zhang, Shuang Zhao, Zi Jin, Rui Li, Yuexian Guo, Xiuli Wang
CONTEXT: The effects of the anticancer drug paclitaxel on learning and memory are rarely studied. OBJECTIVE: This study investigated changes in GABAB receptor expression during paclitaxel-induced apoptosis of hippocampal neurons and the role of the p38MAPK/NF-κB pathway in this process. MATERIALS AND METHODS: Hippocampal neurons isolated from neonatal Sprague-Dawley rats were divided into six groups: Control (C), SB (10 µL of 10-µmol/L SB203580), SN (53 µg/mL SN50), N (1 µmol/L paclitaxel), SB + N (10 µmol/L SB203580 + 1 µmol/L paclitaxel) and SN + N (53 µg/mL SN50 + 1 µmol/L paclitaxel)...
December 2017: Pharmaceutical Biology
https://www.readbyqxmd.com/read/29113923/effects-of-spinal-non-viral-interleukin-10-gene-therapy-formulated-with-d-mannose-in-neuropathic-interleukin-10-deficient-mice-behavioral-characterization-mrna-and-protein-analysis-in-pain-relevant-tissues
#16
Arden G Vanderwall, Shahani Noor, Melody S Sun, Jacob E Sanchez, Xuexian O Yang, Lauren L Jantzie, Nikolaos Mellios, Erin D Milligan
Studies show that spinal (intrathecal; i.t.) interleukin-10 (IL-10) gene therapy reverses neuropathic pain in animal models, and co-administration with the mannose receptor (MR; CD206) ligand d-mannose (DM) greatly improves therapeutic efficacy. However, the actions of endogenous IL-10 may be required for enduring pain control observed following i.t. IL-10 gene therapy, potentially narrowing the application of this non-viral transgene delivery approach. Here, we show that i.t. application of naked plasmid DNA expressing the IL-10 transgene co-injected with DM (DM/pDNA-IL-10) for the treatment of peripheral neuropathic pain in IL-10 deficient (IL-10 KO) mice results in a profound and prolonged bilateral pain suppression...
November 4, 2017: Brain, Behavior, and Immunity
https://www.readbyqxmd.com/read/29112460/opioid-neurotoxicity-treated-with-intrathecal-drug-delivery-system-implant
#17
Thomas P Pittelkow, Kelly L Wu, Jacob J Strand, Susan M Moeschler
No abstract text is available yet for this article.
November 7, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29112008/tlr4-deficiency-abrogated-widespread-tactile-allodynia-but-not-widespread-thermal-hyperalgesia-and-trigeminal-neuropathic-pain-following-partial-infraorbital-nerve-transection
#18
Ting-Ting Hu, Ran-Ran Wang, Ying-Ying Tang, Yu-Xing Wu, Jie Yu, Wei-Wei Hou, Guo-Dong Lou, Yu-Dong Zhou, Shi-Hong Zhang, Zhong Chen
Pain sensitization following partial infraorbital nerve transection (p-IONX) in mice not only presents in orofacial region, but also spreads to distant body parts. The roles of toll like receptor 4 (TLR4) in orofacial pain and the spreading process are still unclear. Here we found that mice with deficient TLR4 due to Tr4 gene point mutation (C3H/HeJ) or spontaneous deletion (C57BL/10ScNJ) developed tactile allodynia and thermal hyperalgesia in the vibrissal pad in a parallel way to their respective wild types (C3HeB/FeJ or C57BL/6J) following p-IONX...
November 3, 2017: Pain
https://www.readbyqxmd.com/read/29111148/effects-of-opioid-and-nonopioid-analgesics-on-canine-wheal-formation-and-cultured-human-mast-cell-degranulation
#19
Eric Schmidt-Rondon, Zhenping Wang, Shelle A Malkmus, Anna Di Nardo, Keith Hildebrand, Linda Page, Tony L Yaksh
Mast cell (MC) degranulation has been implicated in the side effect profile of a variety of clinically useful agents. Thus, after intrathecal delivery, formation of space-occupying, meningeally-derived masses may be related to local MC degranulation. We systematically characterized degranulating effects of opioid and nonopioid analgesics on cutaneous flares in the dog and in primary human MC (hMC) cultures. METHODS: Dogs were anesthetized with IV propofol and received intradermal (ID) injections (50μL)...
October 27, 2017: Toxicology and Applied Pharmacology
https://www.readbyqxmd.com/read/29110774/epilepsy
#20
Susanne Fauser, Hayrettin Tumani
Epilepsy is worldwide one of the most common neurologic diseases (prevalence 0.5-1%). The diagnostic procedure following a first epileptic seizure includes cerebral imaging, blood examinations, electroencephalography, and an investigation of the cerebrospinal fluid (CSF) in patients seen soon after a seizure in order to exclude dangerous causes which require immediate treatment. Basic CSF investigation comprises the determination of cell counts, glucose, and lactate levels in serum and CSF and of albumin, immunoglobulins, and their quotients...
2017: Handbook of Clinical Neurology
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