THE VALUE OF PERCUTANEOUS NEEDLE BIOPSY IN THE DIAGNOSIS OF LYTIC LESIONS OF THE SPINE

The aim of this paper is to evaluate the value of percutaneous needle biopsy in the diagnosis of lytic lesions in the spine. Over a five-year period, 47 percutaneous needle biopsies were performed on 45 patients for lytic lesions shown by plain radiography in one or more vertebrae. There were 24 lesions in the dorsal, 19 in the lumbar and 4 in the cervical spine. A variety of pathological conditions were found which included tuberculosis, brucellosis, tumour metastasis, myeloma and non-specific infections. Of the 47 biopsies, there were 39 positive results, 6 unreliable and 2 were negative where no pathology was found. The reliability of the biopsy was assessed either by further specimens taken during the operation for treatment of the lesion or by the result of the treatment during the follow-up period

Selective Serotonin Reuptake Inhibitors Are Associated with Increased Bleeding Related Complications Following Primary Total Hip and Total Knee Arthroplasty

Introduction: Approximately 10-22% of patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA) are diagnosed with depression. Pre-operative depression is associated with poorer patient reported outcomes, costs and increased complications. Selective serotonin-reuptake inhibitors (SSRIs) are first-line treatment for depression due to their efficacy and low side effect profile. There are conflicting studies regarding SSRI-related bleeding complications. This study compares the rate of bleeding-related complications in THA and TKA patients taking SSRI’s to a control group of non-SSRI users. Methods: A retrospective single institution study of 16,407 primary THA and TKA’s from 2008 to 2018 was performed. Patients with THA for fracture, conversion arthroplasty with existing hardware, revision TJA, and uni-compartmental knee arthroplasty. Patients taking SSRIs (2,588) were compared to non-SSRI users (13,819). Patient demographics were reviewed and matched at a 3:1 ratio. Multivariate logistic regression analysis was performed and adjusted to control for potential confounders. Results: Patients on SSRI had a significant increase in transfusion, post-operative anemia, irrigation and debridement (I&D) and superficial infection. There was a trend towards increased hematoma and revision. There was a significantly higher rate of pulmonary embolism for SSRI users compared to non-SSRI. Rates of 1-year PJI, hematoma removal or calculated blood loss did not differ. Discussion: The rate of bleeding related complications is significantly greater in SSRI users undergoing TKA and THA. Poorer outcomes in depression may be due to the intrinsic nature of the disease; however, increased pain due to swelling and wound complications may be due to increased rates of bleeding in SSRI users

Tranexamic acid use in severely injured civilian patients and the effects on outcomes

Objective: To characterize the relationship between tranexamic acid (TXA) use and patient outcomes in a severely injured civilian cohort, and to determine any differential effect between patients who presented with and without shock. Background: TXA has demonstrated survival benefits in trauma patients in an international randomized control trial and the military setting. The uptake of TXA into civilian major hemorrhage protocols (MHPs) has been variable. The evidence gap in mature civilian trauma systems is limiting the widespread use of TXA and its potential benefits on survival. Methods: Prospective cohort study of severely injured adult patients (Injury severity score > 15) admitted to a civilian trauma system during the adoption phase of TXA into the hospital's MHP. Outcomes measured were mortality, multiple organ failure (MOF), venous thromboembolism, infection, stroke, ventilator-free days (VFD), and length of stay. Results: Patients receiving TXA (n = 160, 42%) were more severely injured, shocked, and coagulopathic on arrival. TXA was not independently associated with any change in outcome for either the overall or nonshocked cohorts. In multivariate analysis, TXA was independently associated with a reduction in MOF [odds ratio (OR) = 0.27, confidence interval (CI): 0.10-0.73, P = 0.01] and was protective for adjusted all-cause mortality (OR = 0.16 CI: 0.03-0.86, P = 0.03) in shocked patients. Conclusions: TXA as part of a major hemorrhage protocol within a mature civilian trauma system provides outcome benefits specifically for severely injured shocked patients

Tranexamic acid use in severely injured civilian patients and the effects on outcomes

Objective: To characterize the relationship between tranexamic acid (TXA) use and patient outcomes in a severely injured civilian cohort, and to determine any differential effect between patients who presented with and without shock. Background: TXA has demonstrated survival benefits in trauma patients in an international randomized control trial and the military setting. The uptake of TXA into civilian major hemorrhage protocols (MHPs) has been variable. The evidence gap in mature civilian trauma systems is limiting the widespread use of TXA and its potential benefits on survival. Methods: Prospective cohort study of severely injured adult patients (Injury severity score > 15) admitted to a civilian trauma system during the adoption phase of TXA into the hospital's MHP. Outcomes measured were mortality, multiple organ failure (MOF), venous thromboembolism, infection, stroke, ventilator-free days (VFD), and length of stay. Results: Patients receiving TXA (n = 160, 42%) were more severely injured, shocked, and coagulopathic on arrival. TXA was not independently associated with any change in outcome for either the overall or nonshocked cohorts. In multivariate analysis, TXA was independently associated with a reduction in MOF [odds ratio (OR) = 0.27, confidence interval (CI): 0.10-0.73, P = 0.01] and was protective for adjusted all-cause mortality (OR = 0.16 CI: 0.03-0.86, P = 0.03) in shocked patients. Conclusions: TXA as part of a major hemorrhage protocol within a mature civilian trauma system provides outcome benefits specifically for severely injured shocked patients

(iv) Managing bone loss of the femur and tibia in revision total knee arthroplasty

The number of primary and revision knee arthroplasty procedures performed yearly is steadily increasing. The management of bone loss at the time of revision surgery will play an integral role in the longevity and function of these knees into the future. There are a variety of options for addressing these defects varying from the use of polymethylmethacrylate bone cement, metal augments, sleeves, cones and large allograft replacements. This manuscript discusses the evaluation, classification and management of bone loss of the distal femur and proximal tibia

Current Trends in High-Grade Gliomas

This is an overview of the current trends in the management of high-grade gliomas based on the current evidence available at the time of compiling this chapter in the first quarter of 2016, by a dedicated, high-volume Neurosurgical Oncology team of clinical and surgical Neuro-Oncologists based in central Pennsylvania

Postoperative Urinary Retention (POUR): What Are The Risk Factors?

Introduction Total hip arthroplasty (THA) is a successful procedure alleviating pain in patients with debilitating arthritis. Postoperative urinary retention (POUR) is a common complication following surgery and is managed with intermittent or continued urinary catheterization. POUR has been estimated in retrospective literature to be on the order of 5% – 70% of surgical cases with early catheter removal or without a catheter. At our institution, and based on a Level 1 study here, urinary catheter is not used routinely in patients undergoing THA under regional anesthesia. The purpose of this study was to evaluate the incidence of POUR and risk factors leading to urinary retention in patients undergoing THA using regional anesthesia who did not receive urinary catheterization

Evaluation of the use of BioGlue â in neurosurgical procedures

Summary Objective: Post-operative cerebrospinal fluid (CSF) fistula following neurosurgery is associated with increased morbidity and mortality. This prospective study evaluates the efficacy of a new bioadhesive -BioGlue, as a dural sealant in preventing CSF fistula. The complications associated with its use are investigated and the literature regarding dural closure reviewed. Methods: BioGlue was applied to the dura mater as a sealant in 210 patients undergoing 216 neurosurgical procedures over a period of 22 months at the Royal Melbourne Hospital. It was used where watertight closure of the dura mater could not be ensured by primary suture alone and for reconstruction of the sellar floor following transsphenoidal adenohypophysectomy. It was used in 114 supratentorial (52.7%), 53 infratentorial (24.5%) craniotomies, 41 (18.9%) transsphenoidal adenohypophysectomies and 8 spinal (3.7%) procedures. The incidence of CSF fistula as a complication of surgery with intradural exposure was analysed. Results: The incidence of CSF fistula post-operatively was significantly low. Two patients (0.93%), both having undergone posterior fossa craniotomy -for evacuation of a cerebellar haematoma and redo excision of a metastasis respectively and both complicated by hydrocephalus, developed CSF fistula. There were no complications associated with the use of BioGlue. Conclusion: BioGlue reduced the incidence of complications associated with neurosurgery. It is an effective adjunct in dural closure to prevent CSF fistula with enhanced bonding properties and is simple to use. In this study there were no complications associated with its use.