Lumbar Spinal Stenosis and Lateral Recess Syndrome

Bolni sindrom leđa jedno je od najčešćih bolesnih stanja i nerijetko prelazi u ishialgičnu formu kojoj uzrok može biti , osim diskalne hernije, i stenoza lateralnog recesusa. Ta stenoza je čest oblik degenerati vne spinalne stenoze koja se može pojaviti samostalno ili u kombinaciji s centralnom stenozom. Sindrom lateralnog recesusa oboljenje je koje nažalost zna ostati neprepoznato, pa liječenje ostaje na razini konzervati vne terapije. Kvalitetno uzeti anamnesti čki podaci uz ciljane neuroradiološke pretrage razlučit će sindrom lateralnog recesusa od ostalih sličnih oboljenja. Upotreba mikrokirurške i minimalno invazivne operacijske tehnike, kao i mogućnost da se operacijski zahvati izvedu u spinalnom bloku, omogućavaju uspješno liječenje i kod bolesnika visoke životne dobi. Na vrijeme uočen sindrom lateralnog recesusa može se uspješno liječiti i poboljšati kvalitetu života.Low back pain is one of the most common diseases and oft en transforms to ischialgic form which can be caused by herniated disc and lateral recess stenosis. The lateral recess stenosis is a common form of degenerati ve spinal stenosis which can occur either alone or in combinati on with central stenosis. Lateral recess syndrome is a disease which oft en remains unrecognized and treatment conservati ve. Well taken anamnestic data together with diagnostic neuroradiologic methods will help distinguish the syndrome of lateral recess from other similar diseases. The use of microsurgical and minimally invasive operating techniques as well as the ability to perform surgery in the spinal block, enables successful treatment of elderly pati ents. At the ti me treated, the lateral recesuss syndrome can be successfully cured and the quality of life improved

Effect of Hyperbaric Oxygen Treatment on Myogenic Transcriptional Factors in Regenerating Rat Masseter Muscle

Hyperbaric oxygen (HBO) treatment was shown to be beneficial as an additional treatment for ischemic muscles in crush injuries and ischemia-reperfusion injuries. The purpose of this study was to assess the influence of hyperbaric oxygen treatment on transcriptional myogenic factors during muscle regeneration. Those factors (MyoD, myf5, myogenin, mrf4) are essential for determination and differentiation of skeletal muscle tissue and together with several other factors control gene expression during myogenesis. The process of regeneration in rat masseter muscle was provoked with injection of local anesthetic bupivacaine hydrochloride. Following injection, the animals were treated once daily in hyperbaric chamber from one to ten days and than sacrificed. Immunohistochemical and Western blot analysis of frozen masseter muscle samples showed a transient upregulation of myoD and myogenin transcriptional factors in the muscles of hyperbaric oxygen treated rats and of rats that have not been treated after the injury. HBO treatment had no effect on the expression of MyoD and myogenin transcriptional factors in the regenerating rat masseter muscle

Influence of Hyperbaric Oxygen Treatment on Myogenic Transcriptional Factors of Denervated Rat Muscle

The aim of this study was to determine whether hyperbaric oxygen (HBO2) treatment influences the expression of transcriptional myogenic factors in denervated rat’s extensor digitorum longus muscle. Thus, expressing regulatory myogenic factors MyoD and myogenin were analyzed in denervated muscles (up to 30 days). Second group of denervated rats were afterwards treated with HBO2. Normal, innervated muscles were used as controls. Western blot analysis showed a significant upregulation of MyoD and myogenin proteins in denervated muscle during this period. Denervated muscles of rats exposed to HBO2 treatment had also significant upregulation of both transcriptional factors but the treatment had not altered their expression. The immunohistochemical analysis showed MyoD and myogenin protein expression through this period in the denervated, untreated muscles and in denervated muscles of rats treated with HBO2, too. One month denervation caused a reduction in muscle fiber cross-sectional area. The treatment with HBO2 had not reduced the degree of atrophy. The protocol of hyperbaric oxygenation (HBO) applied in this study had no beneficial effect either on transcriptional myogenic factors or on atrophy of denervated rat muscle

Histomorphological Analysis of the Osteophytic Appositions in Patients with Lumbar Lateral Recess Syndrome

Patients with lumbar lateral recess syndrome (LRS) can be successfully cured by removing osseous excrescences that grow on the peripheral edge of articular surface of the facet joint. They cause narrowing of the lateral recess and compress a root of the spinal nerve. Their appearance is related to the instability of respective dynamic vertebral segment. The aim of this study was to analyze the osteophytic composition morphohistochemically and elucidate cellular processes that lead to this new formation appearance. It is necessary to find a possible causative-consequential relation between the osteophyte and instability. The ideal object to explore was the osteophyte in the lateral recess because it had to be removed during operative treatment. The group of 30 patients with clinical feature of LRS was chosen. Each patient had clinically verified LRS with consequential radiculopathy. Bony outgrowths were removed surgically and analyzed by histological and immunohistochemical methods: toluidine blue, Goldner trichrome, TRAP, indirect peroxidase with antibodies against BMP 3 and BMP 7. The outgrowths that caused lateral recess stenosis were composed of fibrous and hyaline cartilage and cancellous bone. The changes in cartilage and bone, and occurrence of intramembranous bone formation in sense of enlargement of trabeculae, leads to the conclusion that marginal osteophytic formations could be an adaptation to changed conditions in the dynamic vertebral segment and an attempt to stabilize this segment by enlargement of articular surface

The Importance of Anatomical Topography in Nasolacrimal Duct Stenosis

In our previous study the inclination of nasolacrimal canal in relation to Frankfurt horizontal plane has been analysed on 71 anatomically preparated human skulls by introducing the probe through canal. The results of that study showed that the alpha angle in the frontal plane was greater than 91° in 27% of cases, i.e. nasolacrimal canals descend diverging in relation to the median plane and both probes are intersected on glabella. In 55% of cases, the alpha angle was less than 89° and probes diverge on glabella, and in 18% of cases the canals were parallel to the median plane. In this study nasolacrimal ducts in patients were visualised with Omnipaque contrast that was injected with probe through the superior lacrimal punctum. Thereafter radiography was performed. These in vivo results confi rm our previous results obtained on the skulls. Minimal individual variations of values of the angle were observed. These fi ndings are very important in probing of stenosis of nasolacrimal duct in infants, as the operator would not have to forcefully probe with rigid instrument through gentle infant nasolacrimal duct. Diffi cult and serious consequences for infants arise when directing the probe »via falsa« and that often happened in practice. The authors therefore suggest when using this old method of probing, that this »surgical« act should be performed with »soft« probe made of nylon or silver that is very pliable and does not lead to nasal or temporal rupture of the canal

Dilemma of Antiepileptic Drugs Withdrawal in Symptomatic Epilepsy

A successful treatment of epilepsy depends on numerous factors such as etiology, genetics and environmental impact. An exact diagnosis, treatment and an adequate selection of antiepileptic drugs (AED) are important from the very beginning. The patient with symptomatic epilepsy caused by the brain tumor (low-grade astrocytoma in the left parietal lobe, surgically removed 17 years after the first manifestation of illness) is presented in this study. He has been seizure free for 6 years. The represented case study deals with the risk-benefit analysis of the discontinuation of the prescribed antiepileptic treatment that has lasted for 23 years

Dilemma of Antiepileptic Drugs Withdrawal in Symptomatic Epilepsy

A successful treatment of epilepsy depends on numerous factors such as etiology, genetics and environmental impact. An exact diagnosis, treatment and an adequate selection of antiepileptic drugs (AED) are important from the very beginning. The patient with symptomatic epilepsy caused by the brain tumor (low-grade astrocytoma in the left parietal lobe, surgically removed 17 years after the first manifestation of illness) is presented in this study. He has been seizure free for 6 years. The represented case study deals with the risk-benefit analysis of the discontinuation of the prescribed antiepileptic treatment that has lasted for 23 years

Efficancy of Decompressive Craniectomy in Treatment of Severe Brain Injury at the Rijeka University Hospital Centre

Decompressive Craniectomy (DC) is a treatment option for severe brain injury (SBI). This method is applied when the growth of intracranial pressure (ICP) can no longer be controlled with conservative methods. DC belongs to class III »Guidelines« – »option« which has not clear clinical certainty. They do not correspond to »Standards« (class I) in treatment protocol for SBI, which is common in most neurotraumatological centers. We have analyzed retrospectively 95 patients with SBI who were admitted to the Clinical Hospital Centre Rijeka. All patients were managed based on a protocol of current Brain Trauma Foundations (BTF) Guidelines. 39 patients underwent DC while 34 patients underwent standard craniotomy. 22 patients did not undergo any surgical procedures. In each patient we analyzed ICP changes within the first 11 days and in that way we correlated them statistically with the initial Glasgow Coma Scale (GCS) and then with Glasgow Outcome Scale (GOS), after the end of the treatment. We particularly analyzed the outcome with reference to the time of the operation and the size of DC. The standard measurement of ICP shows statistical significance in recovery in the group without DC after 5 days of intensive treatment, when the pressure is stabilized between 20–25 mm Hg. The stabilization of ICP in the DC group is observed already after 3 days of intensive treatment. Furthermore, better functional recovery according to GOS, which is statistically significant, was observed in patients who underwent DC where the area of craniectomy was larger than 25 cm2, within the first 24 hours from the time of injury. The use of DC considerably reduces the need for CT check-ups. Increase in the number of encephalocele was noted, which is to be expected considering that dural decompression is used in DC procedure. The results of our study indicate that the utilization of DC is characterized with lower mortality and better functional recovery if it is applied at an early stage of treatment and if the size of DC is satisfactory

Is the Term »Fasciculus Opticus Cerebralis« more Justifiable Than the Term »Optic Nerve«?

The terminology of the optic nerve had already been changed three times, since 1895 until 1955 when the term »nervus opticus« was introduced in the »Terminologia Anatomica«. Following our study we claim that, from the aspect of phylogenetic evolution of binocular vision development as well as optical embryogenesis where opticus is evidently presented as a product of diencephalic structures, the addition of the term »nervus« to opticus is not adequate and justified. From the clinical aspect the term »nervus opticus« is also inadequate, both as a »nerve« that has no functional regenerative properties, unlike other cranial nerves, as well as from a pedagogical and didactical aspect of educating future physicians. We suggest that the term »Fasciculus Opticus Cerebralis« should be used as it much better explains the origin as well as its affiliation to the central nervous system

Effect of Hyperbaric Oxygen Treatment on Myogenic Transcriptional Factors in Regenerating Rat Masseter Muscle

Hyperbaric oxygen (HBO) treatment was shown to be beneficial as an additional treatment for ischemic muscles in crush injuries and ischemia-reperfusion injuries. The purpose of this study was to assess the influence of hyperbaric oxygen treatment on transcriptional myogenic factors during muscle regeneration. Those factors (MyoD, myf5, myogenin, mrf4) are essential for determination and differentiation of skeletal muscle tissue and together with several other factors control gene expression during myogenesis. The process of regeneration in rat masseter muscle was provoked with injection of local anesthetic bupivacaine hydrochloride. Following injection, the animals were treated once daily in hyperbaric chamber from one to ten days and than sacrificed. Immunohistochemical and Western blot analysis of frozen masseter muscle samples showed a transient upregulation of myoD and myogenin transcriptional factors in the muscles of hyperbaric oxygen treated rats and of rats that have not been treated after the injury. HBO treatment had no effect on the expression of MyoD and myogenin transcriptional factors in the regenerating rat masseter muscle