Magnesium Sulfate Effect on the Clinical Course and GCS of Patients with a Severe Diffuse Axonal Injury

Based on a number of studies, magnesium sulfate (MgSO4) given after a diffuse axonal injury has gained attention as a useful neuroprotective agent .The present study was conducted to examine if magnesium sulfate has a therapeutic efficacy and safety in patients with a severe diffuse axonal injury. Adult patients admitted within 1 hour of a closed Traumatic Brain Injury (TBI) with a severe diffuse axonal injury that met eligibility criteria were randomized into two groups. Our treatment guidelines consisted of an initial loading dose of 50 mg/kg magnesium sulfate and then 50 mg/kg QID up to 24 hours after the trauma. The outcome measures were mortality, GCS, and motor function scores which were assessed up to 2 months after the trauma. Magnesium showed a significant positive effect on GCS 2 months (P=0.03).  Among those in MgSO4 group, motor functioning score improved more than control group but this was not statistically significant (P = 0.51). At the end, we have demonstrated that administration of magnesium sulfate can have neuroprotective role following severe DAI.

The effect of epidural morphine sponge in postoperative pain control after Microdiscectomy

Opiates such as morphine are one of the most effective classes of medication prescribed to treat both acute and chronic pain.They act to suppress pain through mu-receptor activation on primary afferent nerve fibers, dorsal horn neurons and supraspinal pain center neorons. When morphine is administered epidurally, it diffuses to the cord substance, producing analgesia [1],The aim of this study was to check the efficacy of this method for controling postoperative lumbar pain after microdiscectomy. In a randomized clinical trial, numbers of 100 patients were included into two equal groups due to low back radicular pain and underwent microdiscectomy. In study group, an absorbable gelatin sponge (Gelfoam) is contoured to the epidural space, placed in methylprednisolone acetate (40-80 mg), and then injected with 2 mg/ml morphine and control group received an absorbable gelatin, placed in methylprednisolone acetate (40-80 mg) and were injected with normal saline (5mL) as a placebo. The main outcome to be compared between trial and placebo groups were: Patient comfort rate in recovery room and ward, amount of analgesics used, postoperative ambulation time, post operative hospitalization days. The restlessness and agitation during recovery in study group was lower than control group. Mean systolic blood pressure increment was lower in morphine group. Only 6% of patients in study group compared to 98% in placebo group had either moderate or severe pain six hours after operation. Mean morphine dose used for study group was 10.75 mg compared to 21.4 mg among control group patients (P < 0.0001). Mean ambulation time was 2 days among study group patients compared to 2.6 days in control group. Mean hospitalization length was 4.7 and 7 days in study and control group respectively. By means of the technique assigned to the patient (an epidural morphine sponge) during Lumbar microdiscectomy the results were: Better controlled postoperative pain, early ambulation of patients and decreased hospitalization length.

Effects of Atorvastatin in Patients with Acute Spinal Cord Injury

Study DesignClinical trial study.PurposeThe aim of this study was to evaluate the effect of atorvastatin on sensory and motor function in patients with acute spinal cord injury.Overview of LiteratureThe prevalence and incidence of traumatic spinal cord injury are increasing. Statins are well established for use in hypercholesterolemia as well as during anti-inflammatory events.MethodsThis clinical trial study included 60 patients with acute spinal cord injury. These were randomly divided into two groups: the case group which received atorvastatin and also underwent surgical therapy and the control group which only underwent surgical therapy.ResultsThe severity of spinal cord lesions was evaluated based on the Frankel grade at three periods; this showed no significant difference between the two groups. Comparisons of the levels of pain between the groups based on a Visual Analog Scale system showed no significant difference at the three periods.ConclusionsWe observed no improvement at the 3- and 6-month follow-up in patients who were administered atorvastatin. However, a comparison of the two groups based on pain severity demonstrated a significant difference, suggesting that atorvastatin had a positive effect on patients with spinal cord injury

Minimal Dose of Tranexamic Acid Is Effective in Reducing Blood Loss in Complex Spine Surgeries: A Randomized Double-Blind Placebo Controlled Study

Study Design A randomized double-blind placebo controlled study. Purpose In the present study, we aimed to assess the efficacy of tranexamic acid (TXA) in reducing blood loss after laminectomy and posterolateral fusion of the spine. Overview of Literature Blood loss is the most significant complication involved with surgery, especially in spinal surgery. Multilevel laminectomy and laminectomy with instrumentation (pedicle screws and rods) are complex spine surgeries and are considered as medium-risk procedures for bleeding. Recent reports have demonstrated that the use of antifibrinolytic drugs during surgery may reduce the risk of postoperative bleeding and one of the most frequently used antifibrinolytics is TXA. Methods In this randomized clinical trial, 50 patients eligible for laminectomy (for ≥2 level) with postero-lateral fusion with a pedicular screw (laminectomy and posterior spinal fusion) were randomly assigned to receive preoperative single doses of intravenous TXA (15 mg/kg) or 0.9% normal saline. Results Of the 50 patients, 30 (60%) were female and 20 (40%) were male. Between-group difference with respect to the total volume of blood loss during surgery was statistically significant. Conclusions The findings of this study suggest that TXA can reduce both intraoperative and immediate postoperative blood loss, decrease the need for packed cell transfusion, and reduce the duration of hospitalization after complex spinal surgeries. No adverse events related to the use of TXA were encountered in this study

Effect of Intravenous Injection of Erythropoietinon Hospitalization Period in Patients with Acute Spinal Cord Trauma

Background & Aim: Spinal cord injury (SCI) has a very long history, and its cases form a large proportion of patients admitted to trauma centers in Iran. Studies show that repair after spinal cord injury can be done. In fact, many pharmaceutical agents, such as erythropoietin (EPO), are applied to reduce secondary injury following the initial disorder and to maintain the nerve tissue. Methods & Materials/Patients: In this clinical trial, 60 patients with acute spinal cord injury classified as A to C according to Frankel classification grading system were selected and matched with regard to the Frankel classes, the cervical and dorsal levels and then divided into two groups A and B (each containing 30 patients). Group A, in addition to receive conventional treatment, took EPO and was evaluated in terms of hospitalization period outcomes (mean length of stay, lower extremity thrombosis, intubation, bedsores) and was compared with group B (receiving conventional medicines, such as methylprednisolone). Results: Of the 60 patients, 15 patients were female and 45 were male, with the age range of 19-72 years. The mean length of stay in the case and control group was 10.6±6.52 and 13.8±10.37 days, respectively. Six patients died during hospitalization, including three patients in the case group and three patients in the control group. 12 patients were intubated during this period, including five patients in the case group and seven patients in the control group. Of the 29 patients with bedsores, 14 patients were in the case group and 15 patients were in the control group. None of the patients had lower extremity venous thrombosis during hospitalization. Conclusion: No significant difference was found between the case and control group in the hospital stay length, intubation, bedsores and lower extremities venous thrombosis

Hydatid cyst in children: A 10-year experience from Iran

Background: Hydatid disease is one of the major world-wide health problems especially in endemic countries. Due to lack of statistics about this disease, various aspects of hydatidosis in children in North-West of Iran have been studied in this study. Materials and Methods: We studied 59 children with hydatidosis referring Tabriz Children Hospital, Tabriz, Iran from 2001 up to 2011. We surveyed chief complaint of patients, number, size and location of cysts in children and also we studied cysts as if they are infected or ruptured or not. Results: Average age of 59 patients (32 [54.2%] males and 27 [45.8%] females) was 7.93 ± 3.0. The most common chief complaints were cough and pain. Number of cysts was higher in females (2.00 ± 2.8 vs. 1.52 ± 1.0). The most common locations of cysts are lung and liver (52 patients); however, other organs had been also affected. Conclusions: Lung hydatidosis is more common than hepatic hydatidosis in children than adults and it is more frequent in males. Hydatid disease should be considered in differential diagnoses of liver and lung cystic lesions in children