51 research outputs found
Pure cervical radiculopathy due to spontaneous spinal epidural haematoma (SSEH): report of a case solved conservatively
Abstract Introduction: Spontaneous
spinal epidural haematoma (SSEH)
is widely recognised throughout the
literature as a cause of myelopathy,
radicular compression being very
rarely reported. Surgical management
is almost always recommended,
especially in the cases of
spinal cord compression. Conservative
treatment is reported as a curiosity
and only in the case of
spontaneous improvement. This
report presents the particular case of
a 64-year-old patient undergoing
anticoagulant therapy that had a
cervical radiculopathy due to a
SSEH confirmed by MRI. The
patient improved spontaneously and
symptoms were solved with unconventional
conservative treatment
and without stopping the anticoagulant
therapy. Conclusions: Spontaneous
epidural haematoma must be
kept in mind when patients undergoing
anticoagulant therapy have a
sudden onset of cervicobrachialgia.
Even though most spinal surgeons
advocate surgical treatment, a conservative
approach may lead to a
complete recovery and may be considered
as a good option in the case
of radicular involvement. Discontinuation
of the anticoagulant therapy
may not always be needed,
especially when the clinical
syndrome improves spontaneously
Symptomatic Medial Exostosis of the Great Toe Distal Phalanx: A Complication Due to Over-correction Following Akin Osteotomy for Hallux Valgus Repair
The authors present the case of a 54-year-old female who developed a painful
compression lesion localized to the medial aspect of the base of the distal
phalanx of the great toe as a complication of hallux valgus surgery. Preoperative
radiographic evaluation of the patient's foot revealed the first ray to be longer
than the second, a 12 degrees first intermetatarsal angle, a 33 degrees hallux
abductus angle, and an exostosis at the medial aspect of the base of the hallux
that was not considered by the surgeon to be important. Correction of the hallux
valgus deformity was performed with a combination of scarf and Akin osteotomies,
and the intermetatarsal and hallux abductus angles reduced to 2 degrees and 8
degrees , respectively. By 2 months postoperative, the patient was complaining of
pain at the medial aspect of the distal phalanx of the hallux associated with
shoe pressure. The pain correlated both clinically and radiologically with the
exostosis at the base of the distal phalanx, and had become symptomatic only
after the hallux had been operatively realigned. At 6 months postoperative,
percutaneous exostectomy was undertaken to remove the exostosis. Pain relief was
complete, thereafter, and after 2 years of postoperative follow-up the patient
remained pain free. The clinical importance of a medial exostosis localized to
the base of the distal phalanx of the hallux must be taken into consideration
whenever hallux valgus correction is undertaken, and this is particularly
important whenever an Akin osteotomy is being considered. Level of Clinical
Evidence: 4
Eficacia de la Terapia Psicoeducativa Motivacional Breve Dual (TPMB-D) en pacientes hospitalizados con trastorno por uso de sustancias y patología dual
Introducción: El término patología dual (PD) se refiere a la comorbilidad de los trastornos
por uso de sustancias (TUS) con trastornos mentales graves. Se asocia con peores
resultados de tratamiento que cada uno de estos trastornos por separado, por lo que es
importante desarrollar terapias específicas para estos pacientes. En este sentido, el Hospital
Provincial de Castellón adaptó la Terapia Psicoeducativa Motivacional Breve (efectiva en
pacientes con TUS en Unidad de Desintoxicación Hospitalaria) para ser usada también
con pacientes con PD (TPMB-D), incluyendo a pacientes con TUS y con PD en los mismos
grupos terapéuticos. Método: Estudio experimental doble ciego con dos grupos aleatorios
que evaluó la eficacia de la TPMB-D comparada con terapia ocupacional (TO) en pacientes
hospitalizados con TUS y con PD. Ciento sesenta y tres pacientes completaron el estudio,
de los que el 68.7% presentaban PD y el 31,3% TUS. El 55,8% fueron asignados al grupo
TPMB-D y el 44,2% al grupo TO. Se evaluaron en el pretest el nivel de conocimientos
sobre adicciones y PD (cuestionario ad hoc) y la motivación para el cambio (cuestionario
SOCRATES 8D de Miller y Tonigan). Después de recibir tres sesiones de TPMB-D o TO
se volvieron a evaluar postest estas variables y la satisfacción con la terapia recibida (Cuestionario
de Percepciones del Tratamiento de Marsden et ál.). Resultados: La TPMB-D
aumenta la motivación para el cambio y los conocimientos sobre adicciones y PD más que
la TO, generando también niveles más altos de satisfacción
Infected Vertebroplasty Due to Uncommon Bacteria Solved Surgically: A Rare and Threatening Life Complication of a Common Procedure
Case report. OBJECTIVE: The aim of this work is to describe a case
of infected vertebroplasty due to uncommon bacteria solved surgically with 2
years of follow-up and to discuss 6 other cases found in literature. SUMMARY OF
BACKGROUND DATA: Vertebroplasty is a well-known and useful technique for the
treatment of painful osteoporotic vertebral fractures. Complications, such as
cord or root compression or pulmonary embolisms, are infrequent and are mainly
related with the frequent escape of cement throughout the vertebral veins.
Infection is even more rare, but when it occurs is difficult to manage and can be
a life-threatening complication. METHODS: A 63-year-old-man had a spondylitis of
L2 after vertebroplasty. The patient was initially managed with antibiotics
without clinical improvement. Surgical treatment by anterior debridement and
anterior and posterior stabilization was done. The bacteria isolated from the
intraoperative cultures were Serratia marcescens, Stenotrophomonas maltophilia,
and Burkholderia cepacia. After surgery, the patient was treated with antibiotics
for 3 month. RESULTS: After 2 years of follow-up, the patient was free of pain,
without signs of infection, and a correct fusion was achieved. CONCLUSION: When
facing an infected vertebroplasty, initial conservative treatment with needle
biopsy culture and antibiotic administration are a rational option to start. If
this treatment fails, surgical debridement is then indicated in order to remove
the infected tissue and the acrylic cement and to stabilize the spine. Although
this can be an effective treatment, it could be a difficult and hazardous
surgical procedure
Mechanical barriers and transforming growth factor beta inhibitor on epidural fibrosis in a rabbit laminectomy model
Background: TGF-β has been described as a mediator of fibrosis and scarring. Several studies achieved reduction
in experimental scarring through the inhibition of TGF-β. Fibroblasts have been defined as the cell population
originating fibrosis, blocking fibroblast invasion may impair epidural fibrosis appearance. For this purpose,
biocompatible materials used as mechanical barriers and a TGF-β inhibitor peptide were evaluated in the reduction
of epidural fibrosis.
Methods: A L6 laminectomy was performed in 40 New Zealand white rabbits. Divided into four groups, each
rabbit was assigned to receive either collagen sponge scaffold (CS group), gelatin-based gel (GCP group), P144®
(iTGFβ group), or left untreated (control group). Four weeks after surgery, cell density, collagen content, and new
bone formation of the scar area were determined by histomorphometry. Two experienced pathologists scored dura
mater adhesion, scar density, and inflammatory infiltrate in a blinded manner.
Results: In all groups, laminectomy site was filled with fibrous tissue and the dura mater presented adhesions. Only
GCP group presented a significant reduction in collagen content and scar density.
Conclusion: GCP treatment reduces epidural fibrosis although did not prevent dura mater adhesion completely
Atenuación del artefacto metálico post cirugía de columna lumbar mediante protocolo de obtención de imagen en tomografía computarizada multicorte. Estudio de cohortes.
Fundamento. Las imágenes obtenidas mediante estudios
con TC pueden ser alteradas por la presencia de artefactos
metálicos, induciendo en ocasiones a malinterpretación
en la correcta ubicación de los tornillos pediculares en columna lumbar. El objetivo de este trabajo es desarrollar un
protocolo de atenuación del artefacto metálico con el propósito de reducir el artefacto generado por los tornillos
pediculares de titanio en aquellos pacientes a los que se
ha requerido instrumentación lumbar, permitiendo a los
cirujanos de columna realizar un diagnóstico preciso de la
ubicación del tornillo pedicular instrumentado.
Material y métodos. En la primera parte del trabajo se
realizó un estudio observacional, analítico, longitudinal y
retrospectivo en 23 pacientes (103 tornillos pediculares) a
los que se requirió artrodesis lumbar por patología degenerativa. En el postoperatorio se les realizó un estudio con
TC secuencial evaluando la sobredimensión generada por
el artefacto del tornillo, aplicando un protocolo estándar
de obtención de imágenes. En la segunda parte del estudio
se diseñó un estudio observacional, analítico, longitudinal
y prospectivo empleando un equipo de TCMC de 64 coronas aplicando un protocolo específico de adquisición
de imagen sobre 18 pacientes (104 tornillos pediculares)
intervenidos mediante artrodesis lumbar.
Resultados. En la primera parte del estudio el artefacto
medio a ambos lados del tornillo que se genera tras el estudio de TC es de 1,045 mm (DE: 0,45). En el grupo en el
que se aplica el protocolo de atenuación del artefacto tras
la TCMC la sobredimensión fue de 0,005 en la porción proximal del tornillo y de 0,025 en la parte distal del tornillo.
Conclusiones. Los resultados obtenidos sugieren que tras
la aplicación del protocolo de atenuación del artefacto en
equipo de TCMC de 64 coronas el artefacto es reducido a
unas dimensiones similares a la dimensión real del tornillo
pedicular.Background. In postoperative patients with metallic implants, CT scans can become less effective due to metal-related artifacts. The purpose of our study was to evaluate
the effectiveness of a specific metal artifact reduction image protocol, in order to reduce the metal artifact caused
by titanium pedicular screws in patients undergoing lumbar pathology by lumbar fusion. This enables surgeons
to make an accurate diagnosis of the exact placement of
inserted pedicle screws, making this the preferred image
modality for assessing screw position after surgery.
Methods. In the first part of the study, CT scans were performed on 23 patients (103 titanium alloy pedicle screws)
undergoing a lumbar instrumented fusion for treatment for
degenerative disease with a standard image acquisition
protocol evaluating the possible overdimension caused
by the artifact. In the second part, a prospective study
was performed using 64-slice multidetector-row computed tomography (MDCT) on 18 patients (104 titanium alloy
pedicle screws) undergoing a lumbar instrumented fusion
using a specific image acquisition protocol.
Results. Our results show that in the sequential CT scan
group, mean overdimension (on each side) due to brightness was 1.045 mm (SD 0.45). In the 64-slice multichannel
CT group, mean overdimension (on each side) due to
brightness was 0.005 mm at the proximal part of the screw
and 0.025 mm at the distal part of the screw.
Conclusions. The use of a specific metal artifact reduction
image protocol in MDCT produces a minimal artifact following lumbar fusion with pedicle screws
Positive culture in allograft ACL-reconstruction: what to do?
The transmission of disease or infection from the donor to the recipient is always a risk with the use of allografts. We carried out a research study on the behavioural pattern of implanted allografts, which were initially stored in perfect conditions (all cultures being negative) but later presented positive cultures at the implantation stage. Because there is no information available on how to deal with this type of situation, our aim was to set guidelines on the course of action which would be required in such a case. We conducted a retrospective study of 181 patients who underwent an ACL reconstruction using BPTB allografts. All previous bone and blood cultures and tests for hepatitis B and C, syphilis and HIV were negative. An allograft sample was taken for culture in the operating theatre just before its implantation. The results of the cultures were obtained 3-5 days after the operation. We had 24 allografts with positive culture (13.25%) after the implantation with no clinical infection in any of these patients. Positive cultures could be caused by undetected contamination while harvesting, storing or during manipulation before implantation. The lack of clinical signs of infection during the follow-up of our patients may indicate that no specific treatment-other than an antibiotic protocol-would be required when facing a case of positive culture of a graft piece after its implantation
Aplicación del aprendizaje automático para predecir la recuperación de pacientes con desórdenes prolongados de conciencia: reporte preliminar
Comprender el pronóstico a largo plazo y predecir la recuperación de pacientes con Desórdenes Prolongados de Conciencia (DPC) continúa siendo un desafío en la actualidad. Nos proponemos explorar la viabilidad del uso de la tecnología de Aprendizaje Automático (AA) para predecir la recuperación de la conciencia en pacientes con DPC que participaron de un programa de neurorehabilitación. Se incluyeron 90 pacientes de los cuales el 26% (23/90) recuperaron la conciencia. Con 63 pacientes se entrenaron 7 tipos de modelos de AA observándose mejores desempeños al incluir variables recolectadas en el seguimiento. En la validación con el conjunto de test (n=27) la red neuronal entrenada con 37 variables logró la mejor exactitud balanceada (EB): 0.95 (Área Bajo la Curva: 0.96, Sensibilidad: 100%, Especificidad: 90%).
Con la tecnología del aprendizaje automático fue posible predecir con alta exactitud, sensibilidad y especificidad la recuperación de la conciencia de pacientes con DPC incluyendo variables recolectadas durante el primer mes de internación. A pesar de las limitaciones dadas por la pequeña cantidad de pacientes, el enfoque demostró resultados iniciales prometedores que ameritan mayor investigación.Sociedad Argentina de Informática e Investigación Operativ
Frozen cancellous bone allografts: positive cultures of implanted grafts in posterior fusions of the spine
We have carried out a study on the behaviour pattern of implanted allografts
initially stored in perfect conditions (aseptically processed, culture-negative
and stored at -80 degrees C) but which presented positive cultures at the
implantation stage. There is no information available on how to deal with this
type of situation, so our aim was to set guidelines on the course of action which
would be required in such a case. This was a retrospective study of 112 patients
who underwent a spinal arthrodesis and in whom a total of 189 allograft pieces
were used. All previous bone and blood cultures and tests for hepatitis B and C,
syphilis and HIV (via PCR techniques) were negative. The allografts were stored
by freezing them at -80 degrees C. A sample of the allograft was taken for
culture in the operating theatre just before its implantation in all cases. The
results of the cultures were obtained 3-5 days after the operation. There were 22
allografts with positive culture results (12%) after implantation. These
allografts were implanted in 16 patients (14%). Cultures were positive for
staphylococci coagulase negative (ECN) in 10 grafts (46%), Pseudomonas stutzeri
in two grafts (9%), Corynebacterium jeikeium in two grafts (9%), staphylococci
coagulase positive in two grafts (9%) and for each of the following organisms in
one case each (4%): Corynebacterium spp., Actinomyces odontolyticus,
Streptococcus mitis, Peptostreptococcus spp., Rhodococcus equi and Bacillus spp.
No clinical infection was seen in any of these patients. Positive cultures could
be caused by non-detected contamination at harvesting, storing or during
manipulation before implantation. The lack of clinical signs of infection during
the follow-up of our patients may indicate that no specific treatment different
from our antibiotic protocol is required in the case of positive culture results
of a graft piece after implantation
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