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https://www.readbyqxmd.com/read/28340495/residents-learning-curve-of-lumbar-transforaminal-epidural-steroid-injections
#1
Holger Joswig, Sarah Roberta Haile, Gerhard Hildebrandt, Martin Nikolaus Stienen
Background and Study Aims There is a paucity of literature on beginners' training and on its connection with patient safety for transforaminal epidural steroid injections (TFESIs). This study retrospectively assessed the learning curves and associated complications of neurosurgery residents never previously exposed to TFESI and compared them with experienced board-certified faculty neurosurgeons (BCFNs). Material and Methods Procedure time in minutes, dose-area product (DAP) in cGy*cm(2), periprocedural observations, and complications in 354 TFESIs for radicular pain secondary to lumbar disk herniation or lumbar spinal stenosis were extracted from operative notes and the electronic infiltration logbook in the per-injection format...
March 24, 2017: Journal of Neurological Surgery. Part A, Central European Neurosurgery
https://www.readbyqxmd.com/read/28340257/cd8-positive-t-cell-leukoencephalitis-with-astrocytopathy-clinically-presenting-as-neuromyelitis-optica
#2
Diana L Thomas, Jody Manners, Daniel Marker, Joseph Mettenburg, Geoffrey Murdoch, Bryan Stevens, Guoji Wang, Clayton Wiley
We describe a novel disease entity with the clinical and radiologic presentation of neuromyelitis optica (NMO) and widespread CD8-positive T-cell leukoencephalitis and astrocytopathy. The 59-year-old female patient had a complex 2-year neurological history that included early changes in cognition and memory, progressive lower extremity motor dysfunction, and multimodal sensory involvement. MRI of the spinal cord showed increased T2 signal in the central cord extending from C2 through T4. MRI of the brain showed symmetric radial enhancement in periventricular deep white matter without evidence of demyelinating lesions...
March 16, 2017: Journal of Neuropathology and Experimental Neurology
https://www.readbyqxmd.com/read/28316941/acute-kidney-injury-following-spinal-instrumentation-surgery-in-children
#3
Jasper J Jöbsis, Abdullah Alabbas, Ruth Milner, Christopher Reilly, Kishore Mulpuri, Cherry Mammen
AIM: To determine acute kidney in jury (AKI) incidence and potential risk factors of AKI in children undergoing spinal instrumentation surgery. METHODS: AKI incidence in children undergoing spinal instrumentation surgery at British Columbia Children's Hospital between January 2006 and December 2008 was determined by the Acute Kidney Injury Networ classification using serum creatinine and urine output criteria. During this specific time period, all patients following spinal surgery were monitored in the pediatric intensive care unit and had an indwelling Foley catheter permitting hourly urine output recording...
March 6, 2017: World Journal of Nephrology
https://www.readbyqxmd.com/read/28303752/bone-morphogenetic-proteins-and-dickkopf-1-in-ankylosing-spondylitis
#4
H-T Liao, Y-F Lin, C-Y Tsai, T-C Chou
OBJECTIVES: To determine bone morphogenetic proteins (BMPs) and Dickkopf homologue-1 (Dkk-1) levels in ankylosing spondylitis (AS). METHOD: Serum BMPs and Dkk-1 were measured in 72 AS patients and 30 healthy controls. For AS patients, we recorded the demographic data, disease activity, functional index, and global assessment with questionnaires, and image changes with roentgenography. We also measured human leucocyte antigen-B27 and systemic inflammatory reactants...
March 17, 2017: Scandinavian Journal of Rheumatology
https://www.readbyqxmd.com/read/28302996/spinal-cord-ischemia-secondary-to-epidural-metastasis-from-small-cell-lung-carcinoma
#5
Hirotoshi Yasui, Naoya Ozawa, Satoshi Mikami, Kenji Shimizu, Takahiro Hatta, Nami Makino, Mayu Fukushima, Satoshi Baba, Yasushi Makino
BACKGROUND Spinal cord ischemia is an uncommon event that is mainly caused by dissociation of the ascending aorta as a complication after aortic surgery. Spinal arteries can develop collateral circulation; therefore, the frequency of spinal infarction is about 1% of that in the brain. Few cases of spinal cord ischemia developing in the course of lung cancer have been reported. CASE REPORT We presented the case of a 56-year-old man with small cell lung carcinoma, cT4N2M1a (stage IV). He was treated with irradiation and 2 courses of platinum and etoposide combination chemotherapy...
March 17, 2017: American Journal of Case Reports
https://www.readbyqxmd.com/read/28298799/case-of-neurological-complication-following-subarachnoid-block-in-a-patient-with-unsuspected-coagulopathy
#6
Arun Mathur, C Venkatesh Nagappa
Subarachnoid block (SAB) is an extensively used regional anesthesia technique for many surgeries. Neurological complications are rare following spinal anesthesia. We are reporting neurological complication in a patient the following appendectomy under SAB with unsuspected coagulopathy. The complication was noticed early and managed conservatively with a high dose of intravenous steroid and improved drastically in a short period.
January 2017: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/28291411/the-impact-of-preoperative-epidural-injections-on-postoperative-infection-in-lumbar-fusion-surgery
#7
Anuj Singla, Scott Yang, Brian C Werner, Jourdan M Cancienne, Ali Nourbakhsh, Adam L Shimer, Hamid Hassanzadeh, Francis H Shen
OBJECTIVE Lumbar epidural steroid injections (LESIs) are performed for both diagnostic and therapeutic purposes for a variety of indications, including low-back pain, the leading cause of disability and expense due to work-related conditions in the US. The steroid agent used in epidural injections is reported to relieve nerve root inflammation, local ischemia, and resultant pain, but the injection may also have an adverse impact on spinal surgery performed thereafter. In particular, the possibility that preoperative epidural injections may increase the risk of surgical site infection after lumbar spinal fusion has been reported but has not been studied in detail...
March 14, 2017: Journal of Neurosurgery. Spine
https://www.readbyqxmd.com/read/28289637/ultrasonography-evaluation-of-vulnerable-vessels-around-cervical-nerve-roots-during-selective-cervical-nerve-root-block
#8
Hoon Hoon Lee, Donghwi Park, Yoongul Oh, Ju Seok Ryu
OBJECTIVE: To evaluate the prevalence of vulnerable blood vessels around cervical nerve roots before cervical nerve root block in the clinical setting. METHODS: This retrospective study included 74 patients with cervical radiculopathy who received an ultrasonography-guided nerve block at an outpatient clinic from July 2012 to July 2014. Before actual injection of the steroid was performed, we evaluated the vulnerable blood vessels around each C5, C6, and C7 nerve root of each patient's painful side, with Doppler ultrasound...
February 2017: Annals of Rehabilitation Medicine
https://www.readbyqxmd.com/read/28284341/mog-antibody-associated-demyelinating-disease-of-the-cns-a-clinical-and-pathological-study-in-chinese-han-patients
#9
Lei Zhou, Yongheng Huang, Haiqing Li, Jie Fan, Jingzi Zhangbao, Hai Yu, Yuxin Li, Jiahong Lu, Chongbo Zhao, Chuanzhen Lu, Min Wang, Chao Quan
We aim to evaluate the clinical relevance of MOG-ab in a cohort of Chinese Han adults with CNS inflammatory demyelinating diseases (IDDs). MOG-ab and AQP4-ab were examined through a fixed cell based indirect immune-fluorescence assay in 86 patients with CNS-IDDs. MOG-ab was positive in 12 patients, while AQP4-ab was positive in 31 patients; none double positives. Optic neuritis (ON) was the most frequent symptom at onset (75.0%) or during the whole disease course (83.3%) of MOG-ab associated IDDs (MOG-IDDs); 79...
April 15, 2017: Journal of Neuroimmunology
https://www.readbyqxmd.com/read/28283838/the-effect-of-nsaids-on-spinal-fusion-a-cross-disciplinary-review-of-biochemical-animal-and-human-studies
#10
REVIEW
Ahilan Sivaganesan, Silky Chotai, Gabrielle White-Dzuro, Matthew J McGirt, Clinton J Devin
PURPOSE: Non-steroidal anti-inflammatory drugs (NSAIDs) play an important role in postoperative pain management. However, their use in the setting of spine fusion surgery setting has long been a topic of controversy. In this review we examined relevant research, including in vivo, animal, and clinical human studies, with the aim of understanding the effect of NSAIDs on spinal fusion. STUDY DESIGN/SETTING: Systematic review of study designs of all types from randomized controlled trials and meta-analyses to single-institution retrospective reviews...
March 10, 2017: European Spine Journal
https://www.readbyqxmd.com/read/28283819/neurological-complications-of-beh%C3%A3-et-s-syndrome
#11
D P Kidd
In this review of the neurological complications of Behçet's syndrome, the clinical features and epidemiology of the systemic disease are summarised before a discussion of the neurological syndromes which may develop is made. Neurological involvement occurs in 9% of cases, and is equally prevalent in each geographical area. Vascular complications occur in 14%, in whom thrombosis of the venous sinuses or cerebral veins occurs, and intracranial hypertension, venous infarction and parenchymal haemorrhage may develop...
March 10, 2017: Journal of Neurology
https://www.readbyqxmd.com/read/28281033/a-treatable-cause-of-myelopathy-and-vision-loss-mimicking-neuromyelitis-optica-spectrum-disorder-late-onset-biotinidase-deficiency
#12
Sanem Yilmaz, Mine Serin, Ebru Canda, Cenk Eraslan, Hande Tekin, Sema Kalkan Ucar, Sarenur Gokben, Hasan Tekgul, Gul Serdaroglu
Biotinidase deficiency is characterized by severe neurological manifestations as hypotonia, lethargy, ataxia, hearing loss, seizures and developmental retardation in its classical form. Late-onset biotinidase deficiency presents distinctly from the classical form such as limb weakness and vision problems. A 14-year-old boy presented with progressive vision loss and upper limb weakness. The patient was initiated steroid therapy with a preliminary diagnosis of neuromyelitis optica spectrum disorder due to the craniospinal imaging findings demonstrating optic nerve, brainstem and longitudinally extensive spinal cord involvement...
March 9, 2017: Metabolic Brain Disease
https://www.readbyqxmd.com/read/28278160/hyperleptinemia-in-children-with-autosomal-recessive-spinal-muscular-atrophy-type-i-iii
#13
Heike Kölbel, Berthold P Hauffa, Stefan A Wudy, Anastasios Bouikidis, Adela Della Marina, Ulrike Schara
BACKGROUND: Autosomal-recessive proximal spinal muscular atrophies (SMA) are disorders characterized by a ubiquitous deficiency of the survival of motor neuron protein that leads to a multisystemic disorder, which mostly affects alpha motor neurons. Disease progression is clinically associated with failure to thrive or weight loss, mainly caused by chewing and swallowing difficulties. Although pancreatic involvement has been described in animal models, systematic endocrinological evaluation of the energy metabolism in humans is lacking...
2017: PloS One
https://www.readbyqxmd.com/read/28260120/long-term-outcomes-of-refractory-neurosarcoidosis-treated-with-infliximab
#14
Fleur Cohen Aubart, Diane Bouvry, Damien Galanaud, Caroline Dehais, Guillaume Mathey, Dimitri Psimaras, Julien Haroche, Corinne Pottier, Miguel Hie, Alexis Mathian, Hervé Devilliers, Hilario Nunes, Dominique Valeyre, Zahir Amoura
Central nervous system localizations of sarcoidosis may be refractory to conventional treatment such as steroids and immunosuppressive drugs. Infliximab, a TNF-α antagonist chimeric antibody, has been shown to be effective for treatment of these localizations. The aim of this study was to evaluate the efficacy and safety, in particular the long-term outcomes, of the use of infliximab for the treatment of neurosarcoidosis. We retrospectively reviewed medical records of patients with neurosarcoidosis who had been treated with infliximab between 2009 and 2015...
March 4, 2017: Journal of Neurology
https://www.readbyqxmd.com/read/28260098/identification-of-crucial-genes-associated-with-rat-traumatic-spinal-cord-injury
#15
Zibin Yang, Qiao Lv, Zhengxiang Wang, Xiliang Dong, Rongxin Yang, Wei Zhao
The aim of the present study was to investigate the key genes associated with traumatic spinal cord injuries (TSCI). The dataset GSE52763 was downloaded from the Gene Expression Omnibus, for which lumbar spinal cord samples were obtained from rats at 1 and 3 weeks following contusive spinal cord injury and 1 week subsequent to a sham laminectomy, and used to identify differentially expressed genes (DEGs). Functional enrichment analysis, co‑expression analysis and transcription factor (TF) identification were performed for DEGs common to the 1 and 3 week injury samples...
April 2017: Molecular Medicine Reports
https://www.readbyqxmd.com/read/28259071/epidural-lipomatosis-with-cauda-equina-syndrome-in-chronic-alcoholic-patient-a-case-report
#16
Sung-Soo Kim, Dong-Ju Lim
INTRODUCTION: Epidural lipomatosis of the lumbar spine is a rare condition, which is described as the accumulation of fat in the extradural territory. PRESENTATION OF CASE: We report the case of a 60-year-old, non-obese, and chronic alcoholic man who was transferred to our spine department with cauda equina syndrome (CES) for 4 months. On magnetic resonance imaging (MRI), spinal epidural lipomatosis (SEL) was confirmed in the multilevel lumbar lesion. A decompression surgery was performed and the patient recovered significantly...
February 20, 2017: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/28209578/intraforaminal-location-of-thoracolumbar-radicular-arteries-providing-an-anterior-radiculomedullary-artery-using-flat-panel-catheter-angiotomography
#17
L Gregg, D E Sorte, P Gailloud
BACKGROUND AND PURPOSE: Flat panel catheter angiotomography performed during the selective injection of intersegmental arteries offers a multiplanar assessment of the intraforaminal course of the radicular arteries providing an anterior radiculomedullary artery. Injury of anterior radiculomedullary arteries during transforaminal epidural steroid injections can result in spinal cord damage. Evaluations of the intraforaminal location of these arteries have so far been limited to anteroposterior views or the examination of cadaveric material...
February 16, 2017: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/28203184/spinal-cord-infarction-after-cervical-transforaminal-epidural-steroid-injection-case-report-and-literature-review
#18
Jangsup Moon, Hyung-Min Kwon
INTRODUCTION: Transforaminal epidural steroid injection (TFESI) is a widely used nonsurgical procedure in the treatment of patients with radiculopathy. It is efficacious in relieving pain, but a number of complications are being reported. Recently, increasing frequency of major complications, such as spinal cord infarction and cerebral infarction, has been reported with the use of a particulate steroid within fluoroscopic-guided procedures. METHODS: We report a 49-year-old man with a history of chronic cervical radiculopathy, who experienced a devastating complication after TFESI...
January 2017: Case Reports in Neurology
https://www.readbyqxmd.com/read/28176966/efficacy-and-safety-of-non-pharmacological-and-non-biological-pharmacological-treatment-a-systematic-literature-review-informing-the-2016-update-of-the-asas-eular-recommendations-for-the-management-of-axial-spondyloarthritis
#19
COMMENT
Andrea Regel, Alexandre Sepriano, Xenofon Baraliakos, Désirée van der Heijde, Jürgen Braun, Robert Landewé, Filip Van den Bosch, Louise Falzon, Sofia Ramiro
To assess the efficacy and safety of non-biological therapies in patients with axial spondyloarthritis (axSpA) to inform the update of the Assessment of SpondyloArthritis international Society (ASAS)/European League Against Rheumatism (EULAR) recommendations for the management of axSpA. A systematic literature review (2009-2016) of all non-pharmacological treatments, non-biological drugs (except targeted synthetic disease-modifying antirheumatic drugs (DMARDs)) and surgical therapies was performed. Randomised controlled trials (RCTs) and clinical controlled trials were assessed for efficacy and safety, while observational studies with a comparator were assessed for safety...
2017: RMD Open
https://www.readbyqxmd.com/read/28174631/medication-related-osteonecrosis-of-the-jaws-caused-lethal-sepsis-in-an-edentulous-patient-with-multiple-systemic-factors
#20
Keisuke Yamashiro, Aki Sato, Fumihiko Okazaki, Makoto Nakano, Koichi Sawaki, Yasuhisa Hirata, Eiki Yamachika, Seiji Iida, Shogo Takashiba
Medication-related osteonecrosis of the jaw (MRONJ) is developed even in the patients who are edentulous and treated with short-term bisphosphonate therapy and oral administration. It sometimes causes lethal sepsis in patients who have multiple health problems such as diabetes, cirrhosis, steroid use for interstitial pneumonia, sepsis, and spinal disk herniation.
February 2017: Clinical Case Reports
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