Transpedicular screw fixation for the treatment of thoracolumbar spine fracture

One of the most popular procedures for treating the unstable thoracolumbar fracture is the short segment pedicle screw fixation. Due to lack of adequate neurological improvement, progressive kyphosis and hardware failure, the efficacy of different methods remain debatable. One hundred patients of thoracolumbar burst fractures were managed from January 2010 to December 2014 by  transforaminal thoracolumbar interbody fusion and short-segment pedicle screw stabilization. Each patient was followed-up for a minimum of 2 years. Bony fusion was done in each patient in between two vertebra along with transpedicular fixation. Follow-up radiological images showed good reduction and the fusion of the vertebral body was good. Excellent neurological improvement of the Frankel grade C and D was seen in 81 patients. Eight patients had  grade B, improvement which was not satisfactory. Fifteen patients with no paraplegia/hemiplegia on admission remained neurologically intact. For the management of thoracolumbar burst fractures short segment posterior transpedicular fixation with bone graft is very economic and safe procedure with good neurological improvement

Correlation between Glasgow coma scale on admission and clinical outcome of patients with unilateral chronic subdural hematoma after surgery

This study was undertaken to determine the influence of Glasgow coma scale (GCS) on admission on clinical outcome of patients with unilateral chronic subdural hematoma after surgery. A cross- sectional study was conducted on 33 consecutive patients, among them 28 were male, 5 were female with GCS 6 to 15. 19 patients out of 22 who had GCS 14-15 had favorable GOS at 24 hours as compared to 2 out of 7 in GCS 9-13 group and none in GCS ?8 group. All patients (22 out of 22) had favorable GOS at the time of discharge in GCS 14-15 group while 8 out of 9 had favorable GOS in GCS 9-14 group and 1 out of 2 patients had favorable GOS in GCS ?8 group. Chi square test showed significant difference in outcome between 14-15, 9-13 and ?8 GCS groups (p values 0.001, 0.015, 0.013 respectively). In conclusion, clinical outcome of patients with unilateral chronic subdural hematoma depends on Glasgow coma scale on admission.

Zinc(II) complexes of 3,10-C-meso-2,5,5,7,9,12,12,14- octamethyl-1,8-diaza-4,11-diazoniacyclotetradecane as its bis(acetate) trihydrate, [LBH2][CH3COO]2.3H2O: Synthesis, Characterization and antimicrobial studies

One isomeric ligand, LB among three isomers (LA, LB and LC) of 2,9- C-meso-2,5,5,7,9,12,12,14-octamethyl-1,4,8,11-tetraazacyclotetradecanes, differing in the orientation of methyl groups on the chiral carbon atoms) on interaction with vinyl acetate produces 2,9-C-meso-2,5,5,7,9,12,12,14- octamethyl-1,8-diaza-4,11-diazoniacyclotetradecane as its bis(acetate) trihydrate, [LBH2][OOCCH3]2.3H2O. This ligand salt trihydrate reacts with Zn(CH3COO)2.2H2O to produce square pyramidal monoacetatozinc(II) acetate complex [ZnLB(CH3COO)](CH3COO), which undergoes anion exchange reaction with NaClO4.6H2O to produce monoacetatozinc(II) perchlorate complex, [ZnLB(CH3COO)](ClO4). The complex, [ZnLB(CH3COO)](ClO4) undergoes axial substitution reactions with KSCN, NaNO2 and KNO3 to form the substitution products, [ZnLB(NCS)](NCS), [ZnLB(NO2)](ClO4) and [ZnLB(NO3)](ClO4) respectively where CH3COOis replaced by NCS- , NO3 - and NO2 - . All these complexes have been characterized on the basis of analytical, spectroscopic, conductometric and magnetochemical data. The antifungal and antibacterial activities of these compounds have been studied against some phytopathogenic fungi and bacteria

3,10-C-meso-3,5,7,7,10,12,14,14-Octa­methyl-4,11-diaza-1,8-diazo­niacyclo­tetra­decane bis­(perchlorate)

The structure determination of the title salt, C18H42N4 2+·2ClO4 −, reveals that protonation has occurred at diagonally opposite amine N atoms. Intra­molecular N—H⋯N hydrogen bonds stabilize the conformation of the dication. In the crystal, the dications are bridged by perchlorate ions via N—H⋯O hydrogen bonds into supra­molecular chains propagating along the c axis and weak C—H⋯O inter­actions cross-link the chains

Association between clinically diagnosed lumbar intervertebral disc prolapse and magnetic resonance image findings

There are contradictory reports on the findings of magnetic resonance image (MRI) in lumbar intervertebral disc prolapse. A study was conducted on 54 patients using 3 of 4 clinical criteria (low back pain with radiation down to the lower limbs, radicular pain along specific dermatomes, positive straight leg raising test, presence of neurological symptoms and signs e.g. motor or sensory deficit and MRI of lumbosacral spine of the respondent). Evaluation of MRI of lumbosacral spine was done based on extent of disc prolapse, disc degeneration, nerve root compression neural foramen compromise. The logistic regression analysis between the findings of MRI and the clinical features show that there was a significant association in the neural foramen or lateral recess (Odd's ratio 7.106, p<0.05), the root compression (p<0.01) as well as the disc extrusion (p<0.05). There was no statistical association between clinical levels and other MRI findings like disc protrusion and disc bulge (p value 0.21 and 0.14, respectively). The strength of agreement between clinical and MRI diagnosis level of disc prolapse was calculated using kappa statistics (k-value). The test revealed a very good agreement for L3/4 (k-value = 0.812) and good agreement for L4/5 and L5/SI  level (k-value 0.75 and 0.75 respectively) between these two procedures, suggesting that level of disc prolapse could be correctly  diagnosed without MRI findings.  In conclusion, clinically diagnosed levels associate well with MRI levels, but all MRI abnormalities do not have any clinical significance.

Analysis of Early Outcome of Surgery in Spontaneous Primary Intracerebral Haemorrahage in Relation to Preoperative Glasgow Coma Scale

Objectives : To correlate preoperative Glasgow coma scale with early outcome of surgery. Methods: This prospective study was done at the department of neurosurgery of Dhaka Medical College (from January 2009 to June 2010) on consecutively selected patients with a suspicion of intracerebral haemorrhage and subsequently confirmed by CT scan of brain. A total of 30 hypertensive patients with their age ranged from 41 to 80 years with Glasgow coma scale 6 to 12 were included in this study. Co-morbid patients like cardiac, respiratory and renal failure requiring artificial maintenance of blood pressure and respiration were excluded in this study. All these patients were evaluated on the basis of detailed history from attendants (as patients were stuporous and semicomatose), clinical examination and subsequently CT scan of brain (at presentation and at 7th postoperative day). All these patients were operated and followed up during hospital stay and at 30-day after operation, by observing Glasgow coma scale and Glasgow outcome scale. Results: 20 patients had Glasgow coma scale 6 to 8 on admission, among them Glasgow outcome scale was 5 in 4(20.0%) patients, was 3 in 4(20.0%) patients and was 1 in 12(60.0%) patients. 10 patients had Glasgow coma scale 9 to 12 on admission, among them Glasgow outcome scale was 5 in 6 (60.0%) patients, was 4 in 1(10.0%) patient and was 3 in 3(30.0%) patients. Conclusion: Surgery in relation to preoperative Glasgow coma scale (Glasgow coma scale) had a significant correlation with early outcome of surgery. From the current study removal of haematoma when Glasgow coma scale >8 lower the morbidity and mortality, which was statistically significant DOI: http://dx.doi.org/10.3329/bsmmuj.v4i2.8633 BSMMU J 2011; 4(2):70-7

(Acetato-κO)(2,5,5,7,9,12,12,14-octa­methyl-1,4,8,11-tetra­aza­cyclo­tetra­decane-κ4 N,N′,N′′,N′′′)zinc perchlorate

The ZnII atom in the cation of the title salt, [Zn(C2H3O2)(C18H40N4)]ClO4, is five-coordinated by the four N atoms of the macrocycle and the O atom of the monodentate acetate ligand. The N4O donor set is based on a trigonal bipyramid with two N atoms occupying axial positions [N—Zn—N = 170.89 (16)°]. The perchlorate anions are associated with the cations via N—H⋯O hydrogen bonds; intra­molecular N—H⋯O(acetate) inter­actions are also observed. The neutral aggregates are connected into an helical chain along the b axis via N—H⋯O(acetate) hydrogen bonds. The perchlorate anion was found to be disordered about a pseudo-threefold axis: the major component of the disorder had a site occupancy factor of 0.692 (11)

Study on clinical features and factors associated with thickness of chronic subdural hematoma in adult

Patients with chronic subdural hematoma encounter certain difficulties in diagnosis, especially in elderly, due to the characteristically non-specific symptoms and signs. Early diagnosis and proper operative treatment, on the other hand, results in complete recovery in most of the cases. In this study, the clinical features and factors of 31 patients with chronic subdural hematoma, associated with the thickness of chronic subdural hematoma were analyzed. The mean age was 62 ± 13.9 years. The maximum hematoma thickness in the axial CT scan was 25 mm. The thickness of hematoma obtained from axial plain CT had a positive relationship with the patient’s age where r=0.895 and p<0.001 signifies that the thickness of hematoma increased with the increasing age. But the hematoma thickness was not related to co-morbidity such as diabetes mellitus, hypertension and ischemic heart disease. The presentation of the patient with higher hematoma thickness with hemiparesis was statistically significant and with lower thickness with headache and vomiting