Lumboperitoneal shunt using fluoroscopy and a peel-away sheath

Background: After placement of the spinal catheter into the spinal canal during lumboperitoneal shunt (LPS) placement, the spinal catheter needs to be connected to the programmable valve. Although surgeons always try to secure the spinal catheter position during procedures, it may be accidentally pulled and displaced. This article aimed to introduce a “one-piece method” of LPS using fluoroscopy and peel-away sheath without connecting the spinal catheter to the programmable valve. Methods: An abdominal shunt catheter, valve, and spinal shunt catheter were connected and tunneled to the back for insertion into the lumbar spinal subarachnoid space. The spinal catheter was cut to a length of 15 cm. Lumbar puncture was performed using a 14-gauge Tuohy needle inserted at the L2-3 intervertebral space using an image-guided paramedian technique, and a 0.035-inch guidewire was passed gently through the Tuohy needle under fluoroscopic guidance. The Tuohy needle was withdrawn, and a 5-Fr peel-away sheath was advanced over the wire. The dilator and guide wire were removed, the distal end of the 5-Fr peel-away sheath was checked to ensure that the cerebrospinal fluid flowed out, and the spinal shunt catheter was passed down the sheath. After confirming under fluoroscopic guidance that the catheter was properly positioned, the peel-away sheath was removed. Results: LPS was performed using this method in seven patients without complications. Conclusion: This simple “one-piece method” using fluoroscopy and peel-away sheath is safe and effective for positioning the spinal catheter

Unilateral C1 Posterior Arch Screw-C2 Laminar Screw Posterior Fixation for Vertebral Artery Preservation in Bow Hunter’s Syndrome

Pedicle or lateral mass screws, which are usually used to fix atlantoaxial instability, increase the risk of vertebral artery (VA) injury in patients with bone or arterial anomalies or osteoporotic bone. Here, we report the use of a unilateral C1 posterior arch screw-C2 laminar screw posterior fixation with a contralateral C1 lateral mass screw for VA preservation in a patient with bow hunter’s syndrome (BHS). A 65-year-old male presented with recurrent loss of consciousness in the right rotational and backward-bending head positions for 1 year. Cerebral angiography in the same head position showed that the left VA was disrupted at C1/2 and the right VA was hypoplastic. The patient was diagnosed with BHS. C1-2 posterior fixation and iliac bone grafting were performed. The left VA was on the dominant side, and the VA was in a high position; thus, a C1 posterior arch screw was selected for the left side, a C1 lateral mass screw was selected for the right side, and a C2 laminar screw with O-arm navigation and a C-arm was used to prevent arterial injury. Intraoperative findings revealed no VA injury, and postoperative computed tomography showed the screw at the planned site. In a patient with BHS, posterior fixation with a unilateral C1 posterior arch screw-C2 laminar screw prevented VA injury because the screw could be inserted while avoiding the VA

Functional Blockage of S100A8/A9 Ameliorates Ischemia–Reperfusion Injury in the Lung

(1) Background: Lung ischemia–reperfusion (IR) injury increases the mortality and morbidity of patients undergoing lung transplantation. The objective of this study was to identify the key initiator of lung IR injury and to evaluate pharmacological therapeutic approaches using a functional inhibitor against the identified molecule. (2) Methods: Using a mouse hilar clamp model, the combination of RNA sequencing and histological investigations revealed that neutrophil-derived S100A8/A9 plays a central role in inflammatory reactions during lung IR injury. Mice were assigned to sham and IR groups with or without the injection of anti-S100A8/A9 neutralizing monoclonal antibody (mAb). (3) Results: Anti-S100A8/A9 mAb treatment significantly attenuated plasma S100A8/A9 levels compared with control IgG. As evaluated by oxygenation capacity and neutrophil infiltration, the antibody treatment dramatically ameliorated the IR injury. The gene expression levels of cytokines and chemokines induced by IR injury were significantly reduced by the neutralizing antibody. Furthermore, the antibody treatment significantly reduced TUNEL-positive cells, indicating the presence of apoptotic cells. (4) Conclusions: We identified S100A8/A9 as a novel therapeutic target against lung IR injury