C5 Palsy After Cervical Spine Surgery: A Multicenter Retrospective Review of 59 Cases.

STUDY DESIGN: A multicenter, retrospective review of C5 palsy after cervical spine surgery. OBJECTIVE: Postoperative C5 palsy is a known complication of cervical decompressive spinal surgery. The goal of this study was to review the incidence, patient characteristics, and outcome of C5 palsy in patients undergoing cervical spine surgery. METHODS: We conducted a multicenter, retrospective review of 13 946 patients across 21 centers who received cervical spine surgery (levels C2 to C7) between January 1, 2005, and December 31, 2011, inclusive. P values were calculated using 2-sample t test for continuous variables and χ(2) tests or Fisher exact tests for categorical variables. RESULTS: Of the 13 946 cases reviewed, 59 patients experienced a postoperative C5 palsy. The incidence rate across the 21 sites ranged from 0% to 2.5%. At most recent follow-up, 32 patients reported complete resolution of symptoms (54.2%), 15 had symptoms resolve with residual effects (25.4%), 10 patients did not recover (17.0%), and 2 were lost to follow-up (3.4%). CONCLUSION: C5 palsy occurred in all surgical approaches and across a variety of diagnoses. The majority of patients had full recovery or recovery with residual effects. This study represents the largest series of North American patients reviewed to date

Cardiopulmonary Bypass in Patients With Pre-existing Coagulopathy

Patients with pre-existing coagulopathies who undergo surgical interventions are at increased risk for bleeding complications. This risk is especially true in cardiac surgical procedures with cardiopulmonary bypass (CPB) because of the necessity for heparinization and the use of the extracorporeal circuits, which have destructive effects on most of the blood components. In this review, cases of cardiac surgeries in patients with certain pre-existing coagulopathies are summarized, which could shed a light on future managements of such patients undergoing cardiac procedures with CPB. Pre-existing coagulopathies include antithrombin III deficiency, heparin-induced thrombocytopenia, cancer, factor XII deficiency, hemophilia, idiopathic thrombocytopenic purpura, protein S deficiency, and drug-induced platelet inhibition. In summary, pre-existing coagulopathy in patients undergoing open-heart surgeries, if not recognized and appropriately managed, can cause serious complications. Management of patients undergoing cardiac procedures should include a routine coagulation work-up and a thorough past medical history examination. If any of the foregoing is abnormal, further evaluation is warranted. Proper diagnosis and management of the pre-existing coagulopathy disorders is of crucial importance to the surgical outcome and long-term morbidity

(Endo)Cannabinoids and Gynaecological Cancers

Gynaecological cancers can be primary neoplasms, originating either from the reproductive tract or the products of conception, or secondary neoplasms, representative of metastatic disease. For some of these cancers, the exact causes are unknown; however, it is recognised that the precise aetiopathogeneses for most are multifactorial and include exogenous (such as diet) and endogenous factors (such as genetic predisposition), which mutually interact in a complex manner. One factor that has been recognised to be involved in the pathogenesis and progression of gynaecological cancers is the endocannabinoid system (ECS). The ECS consists of endocannabinoids (bioactive lipids), their receptors, and metabolic enzymes responsible for their synthesis and degradation. In this review, the impact of plant-derived (Cannabis species) cannabinoids and endocannabinoids on gynaecological cancers will be discussed within the context of the complexity of the proteins that bind, transport, and metabolise these compounds in reproductive and other tissues. In particular, the potential of endocannabinoids, their receptors, and metabolic enzymes as biomarkers of specific cancers, such as those of the endometrium, will be addressed. Additionally, the therapeutic potential of targeting selected elements of the ECS as new action points for the development of innovative drugs will be presented

Conversion of Dilute Pump Blood to Whole Blood by Single Pass Ultrafiltration

Ultrafiltration (UF) effectively reverses hemodilution. However, when used to concentrate pump blood post-bypass, the recirculation method does not make concentrated blood available until all the blood has been processed. To make concentrated whole blood immediately available, we have investigated the use of a single pass ultrafiltration (SPUF) technique in 7 patients. By reducing the blood flow, the concentration of the blood components at the outlet of the ultrafilter (UF) was sufficient to allow direct transfusion. After bypass, the blood in the oxygenator (1664 ± 112 ml) was pumped (153 ± 12 mllmin) through an UF device and into a transfusion bag. Suction (- 480 torr) applied to the device extracted plasma water (82 ± 3 ml/min). SPUF concentrated the diluted pump blood as follows (mean ± standard error of the means): WBC from 8.5 ± 1.2 to 16.3 ± 2.5 × 103/ul, hemoglobin (6.5 ± 0.2 to 13.2 ± 0.5 gr/dl), platelets (135 ± 14 to 224 ± 32 × 103/ul), albumin (2.9 ± 0.2 to 7.6 ± 0.6 gr/dl) and fibrinogen (114 ± 9 to 274 ± 26 mg/dl). For heparin neutralized plasma, there was a decrease towards normal in prothrombin time (17.9 ± 0.6 to 14.1 ± 0.3 sec) and activated partial thromboplastin time (46 ± 2 to 32 ± 2 sec). There was no net increase in plasma free homoglobin. Red cell indices tended to normalize. Following transfusion of the concentrated blood there were increases in albumin (3.4 ± 0.2 to 3.9 ± 0.2 gr/dl) and hemoglobin (8.5 ± 0.6 to 9.5 ± 0.6 gr/dl). There were no statistically significant changes in white blood cells, platelets, prothrombin and activated partial thromboplastin time. Conclusion: SPUF is an efficient, useful, safe, simple and rapid method for obtaining whole blood for immediate transfusion

Concentration of Blood in the Extracorporeal Circuit Using Ultrafiltration

During cardiopulmonary bypass (CPB) the concentration of blood components is controlled by fluid administration and diuresis. However, diuresis is not always adequate and at the end of CPB the diluted pump blood, unless processed by expensive and cumbersome RBC saving techniques, is usually discarded. To control “diuresis” during CPB and to concentrate all blood components of the diluted pump blood post CPB, we evaluated ultrafiltration as a technique to extract plasma water from the extracorporeal circuit in 17 patients. At the end of each case, the blood left in the CPB circuit was circulated through a hollow fiber dialyzer (TriEx-3, Extracorporeal). At a transmembrane pressure of 430 torr, plasma water was extracted at 29 cc/min. Extracting plasma water decreased the initial pump volume by 50% causing the initial concentration of blood components to increase as follows: hemoglobin 80%, platelets 53%, fibrinogen 79%, total protein 75%, and plasma hemoglobin 294%. Following concentration, the high activated partial thromboplastin, prothrombin and thrombin times obtained for the pump blood decreased towards normal. There were no clinically significant changes in the plasma concentration of electrolytes. The concentrated blood was transfused to the patient within 2 hours of collection without any adverse effects. As compared to the increase in hemoglobin, the smaller increase in platelets and larger increase in plasma hemoglobin indicates that the dialyser caused some platelet loss and red blood cell damage. However, the concentrated blood did provide whole blood for the patient without the risks associated with donor blood