Serum cytokines, a diagnostic tool for herniated lumbar disc type

Inflammatory mediators such as cytokines have been suggested to be important in the pathophysiology of disc herniation. However, few studies have been ever conducted for evaluating the serum levels of these cytokines. This study aimed at assessing the agreement of serum and operation-field cytokines in diagnosis of herniated lumbar disc type. In this study, 43 patients with lumbar disc herniation were recruited in Tabriz Imam Reza Hospital during a 12-month period. According to the type of herniation, the patients were categorized in two groups: with excursion or sequestration (group A) and with bulging (group B) of disc, with 22 and 21 cases, respectively. The level of interleukin (IL)-1α, IL-6 and tumor necrosis factor (TNF)-α was determined in nucleus pulposus (NP) and serum of the patients by employing enzyme-linked immunosorbent assay (ELISA) method. Agreement rate between the two readings was determined. There was full agreement between the serum and NP readings for all the studied parameters. The optimal cut-off points for serum IL-1α, IL-6 and TNFα were ≤0.25, ≤0.05 and ≤0.7 pg/ml, respectively, for discrimination between the extrusion and bulging discs. Serum levels of IL-1α, IL-6 and TNFα may be applicable for preoperative diagnosis of the type of the herniated lumbar disc, especially TNFα, and IL-6 parameters which have a high sensitivity and specificity for differentiation between bulging and extrusion or sequestration discus.Key words: Intervertebral disk displacement, IL-1α, IL-6, TNFα, serum

Interaoperative use of epidural methylprednisolone or bupivacaine for postsurgical lumbar discectomy pain relief : A randomized, placebo-controlled trial

<b>Background: </b> Many patients with lumbar disc surgery experience postoperative back and radicular pain, delaying hospital discharge and resumption of normal activity. Some surgeons have used intraoperative epidural corticosteroids and local anesthetics to decrease pain following surgery for a herniated lumbar disc. Controversies still exist regarding the benefits of these drugs. The present study was meant to compare the effects of the intraoperative administration of epidural methylprednisolone and bupivacaine with that of normal saline (placebo) in lumbar disc surgery for postoperative pain control. <b>Patients and Methods: </b>One hundred fifty patients with single level herniated nucleus pulposus (L4-L5 or L5-S1), which was refractory to 6 weeks of conservative management, were divided randomly in three groups. A standard hemipartial lamimectomy and discectomy was performed on all patients. At the end of the surgery, before the closure of fascia, 40 mg methylprednisolone with 3 mL normal saline for group 1, 2 mL bupivacaine 5&#x0025; with 2 mL normal saline for group 2 and 4 mL normal saline for group 3 were instilled onto the epidural and exposed nerve root. Postoperative back and radicular pain intensity was assessed by a visual analogue scale (VAS) before and at 24, 48, 72, and 96 hours after surgery. <b> Results: </b> There was no significant difference in back and radicular pain intensity between the three groups. <b> Conclusion: </b> Intraoperative administration of epidural methylprednisolone or bupivacaine does not relieve postoperative back and radicular pain

Prognostic Serum Factors in Traumatic Brian Injury: A Systematic Review

Background & Aim: Traumatic brain injury is one of the main causes of death and disability. The aim of this study is to systematically review the articles which assessed some serum factors of traumatic brain injury patients in relation to their outcomes. Methods & Materials/Patients: Databases were searched for relevant publications from 2005 to 2014. Selection criteria were:Studies which evaluate the factors affecting the outcome after TBI, TBI defined as “acute changes in brain function resulting in a strong external force to the head”.Resultswere measured by Glasgow Outcome Score or a comparable measure.Factors were measured in first month after injury and the prognosis was addressed. All papers were checked and approved by a specialist and expert in that field. A systematic review was performed for prognostic factors. Results: Sixty-three studies were included. Most studies used Glasgow Outcome Score at 6 months post-injury as outcome measure, sometimes in combination with other outcome measures. Strong evidence for predicting outcome was found for serum concentration of S100 protein, NSE, MBP, NF-H, GFAP, UCH-L1, blood glucose levels, serum levels of LDH, sodium level, prothrombin time, partial thromboplastin time, platelet count, D.dimer, HSP 70, serum levels of IL-8, number of circulating EPCs, and  DNA levels in serum. Moderate evidence for predicting outcome was found for high serum MMP9. Strong evidence of no association was found for WBC count and serum cortisol levels. Moderate evidence of no association was found for serum total cholesterol for other determinants, inconclusive or no evidence or limited evidence was found. Conclusion: S100 protein, NSE, MBP, NF-H, GFAP, UCH-L1, blood glucose levels, serum levels of LDH, sodium level, prothrombin time, Partial thromboplastin time, platelet count, D.dimer, HSP 70, serum levels of IL-8, number of circulating EPCs, and  DNA levels in serum predicted outcome after traumatic brain injury. WBC count, serum cortisol levels, total cholesterol and MMP9 did not have predictive value