Postoperative spinal infection mimicking systemic vasculitis with titanium-spinal implants

<p>Abstract</p> <p>Background</p> <p>Secondary systemic vasculitis after posterior spinal fusion surgery is rare. It is usually related to over-reaction of immune-system, to genetic factors, toxicity, infection or metal allergies.</p> <p>Case Description</p> <p>A 14 year-old girl with a history of extended posterior spinal fusion due to idiopathic scoliosis presented to our department with diffuse erythema and nephritis (macroscopic hemuresis and proteinuria) 5 months post surgery. The surgical trauma had no signs of inflammation or infection. The blood markers ESR and CRP were increased. Skin tests were positive for nickel allergy, which is a content of titanium alloy. The patient received corticosteroids systematically (hydrocortisone 10 mg) for 6 months, leading to total recess of skin and systemic reaction. However, a palpable mass close to the surgical wound raised the suspicion of a late infection. The patient had a second surgery consisting of surgical debridement and one stage revision of posterior spinal instrumentation. Intraoperative cultures were positive to Staphylococcus aureus. Intravenous antibiotics were administered. The patient is now free of symptoms 24 months post revision surgery without any signs of recurrence of either vasculitis or infection.</p> <p>Literature Review</p> <p>Systemic vasculitis after spinal surgery is exceptionally rare. Causative factors are broad and sometimes controversial. In general, it is associated with allergy to metal ions. This is usually addressed with metal on metal total hip bearings. In spinal surgery, titanium implants are considered to be inert and only few reports have presented cases with systemic vasculitides. Therefore, other etiologies of immune over-reaction should always be considered, such as drug toxicity, infection, or genetic predisposition.</p> <p>Purposes and Clinical Relevance</p> <p>Our purpose was to highlight the difficulties during the diagnostic work-up for systemic vasculitis and management in cases of posterior spinal surgery.</p

Διδασκαλία κοινωνικών δεξιοτήτων σε παιδί με ΔΑΦ με σκοπό την ένταξη σε ομάδα συνομηλίκων.

Οι κοινωνικές δεξιότητες αποτελούν έναν τομέα εξ ορισμού ελλειμματικό σε άτομα με διαταραχή αυτιστικού φάσματος. Τα κοινωνικά ελλείμματα οδηγούν τα παιδιά με ΔΑΦ σε συμπεριφορές που δεν συνάδουν με την ηλικία τους και τις συμπεριφορές των συνομηλίκων τους, όπως τα ατομικά παιχνίδια, την προτίμηση για παρέα ενηλίκων, την παθητική επικοινωνία και την εκδήλωση απρόβλεπτων αντιδράσεων. Σκοπός της παρούσας έρευνας ήταν η αξιολόγηση και η διδασκαλία κοινωνικών δεξιοτήτων και πιο συγκεκριμένα της έκφρασης συναισθήματος χαράς, των δεξιοτήτων συμβολικού παιχνιδιού και της διαχείρισης ήττας σε ένα παιδί με ΔΑΦ, στα πλαίσια ομάδας συνομηλίκων. Ο συμμετέχων είναι ένα αγόρι ηλικίας 8 ετών και 4 μηνών με διάγνωση ΔΑΦ, ο οποίος φοιτά στο γενικό σχολείο με παράλληλη στήριξη. Η αποτελεσματικότητα της παρέμβασης – η οποία βασίστηκε στο θεωρητικό πλαίσιο της Ανάλυσης της Συμπεριφοράς,- αξιολογήθηκε μέσω άμεσης παρατήρησης και χρήσης του πειραματικού σχεδιασμού πολλαπλών γραμμών βάσεων ανά κατηγορία αντιδράσεων. Η αξιοπιστία των ευρημάτων ελέγχθηκε από ανεξάρτητους παρατηρητές. Ο συνδυασμός των τεχνικών που προαναφέρθηκαν είχε ως αποτέλεσμα σημαντική βελτίωση στις κοινωνικές δεξιότητες του συμμετέχοντα. Εφόσον επετεύχθησαν τα αναμενόμενα αποτελέσματα μπορούμε να θεωρήσουμε ότι οι κοινωνικές δεξιότητες συνιστούν συντελεστική συμπεριφορά, δηλαδή συμπεριφορά που εξαρτάται όχι μόνο από αναπτυξιακούς αλλά και από περιβαλλοντικούς παράγοντες.A considerable body of research has demonstrated impairments in social and communicative abilities as well as difficulties in having friends among children with ASD. Impairments in these abilities have been linked to children’s difficulty to become friends. Aim To assess and establish social skills to a child with ASD such as emotion expression and cooperative play. Method Social skills have been taught in a child with ASD in a multiple-baseline design across response categories. Results It is proved that reinforcement; prompting and modeling is effective in teaching social skills. Conclusion Teaching social skills may be viewed as a factor that leads to successful communication with other children and belonging to peer groups

Rocuronium antagonized by sugammadex for series of electroconvulsive therapy (ECT) in a patient with pseudocholinesterase deficiency

We report the anesthetic management of a patient with catatonic schizophrenia and pseudocholinesterase deficiency, using the nondepolarizing neuromuscular blocking drug, rocuronium, reversed by its specific reversal agent, sugammadex, for a series of electroconvulsive therapy sessions. Rocuronium and sugammadex were used every 48 hours for 8 consecutive times and proved to be an effective and safe combination in a situation where succinylcholine was contraindicated. © 2011 Lippincott Williams &amp; Wilkins, Inc

Can pulsed radiofrequency of the occipital nerves cause sedation? A new perspective of existing knowledge

Background: Pulsed radiofrequency stimulation (PRF) of the greater and lesser occipital nerves (GON and LON) has neuromodula-tive and analgesic properties. Objectives: The aim of this study was to investigate whether the PRF of the occipital nerves can cause sedation. Methods: This is an observational case series study in Pain Management Unit of Attikon University Hospital. Patients suffering from primary headaches were scheduled for PRF of occipital nerves following a standardized protocol. The Bispectral Index device was applied and recorded every minute throughout the procedure. Results: 22 patients were studied. BIS values were lowered in all but three patients during GON stimulation, and in all patients during LON stimulation. Values of decline compared to baseline ranged between 0-23 (median 8.5) for GON and 1-27 (median 14) for LON, with LON decline being significantly lower. Conclusions: PRF at the occipital nerves led to mild sedation in all patients. Further studies are required to investigate this effect and clarify the exact mode of action of pulsed radiofrequency. © 2020, Author(s)