MRI and muscle enzymes do not support the diagnosis of local anesthetic myotoxicity: a descriptive case series

2021 ◽  
pp. rapm-2021-102772
Author(s):  
Lauren Mahyar ◽  
Joseph M Neal ◽  
C Craig Blackmore ◽  
Dane W Jackson ◽  
Neil A Hanson ◽  
...  
Keyword(s):  
Local Anesthetic ◽  
Case Series ◽  
Diagnostic Value ◽  
Thigh Muscle ◽  
Muscle Enzymes ◽  
Muscle Enzyme ◽  
Postoperative Mri ◽  
Registration Number ◽  
Total Knee ◽  
Muscle Edema

BackgroundThe presence of thigh muscle edema as characterized by increased signal intensity on MRI has been used to support the diagnosis of presumed local anesthetic-induced myotoxicity reported after total knee arthroplasty (TKA) with continuous adductor canal block (CACB). However, neither postoperative baseline imaging appearance nor muscle enzyme values have been described in conjunction with this clinical scenario. Thus, the usefulness of MRI or enzymatic biomarkers of muscle injury for supporting the diagnosis of local anesthetic myotoxicity is unknown.MethodsThis descriptive case series documents postoperative MRI appearance of the ipsilateral upper leg, plus preoperative and postoperative creatine phosphokinase and aldolase values in volunteer patients who underwent uncomplicated TKA with CACB.ResultsIn 27 volunteer patients with no postsurgical evidence of clinically relevant myotoxicity, anterior thigh muscle edema was universally evident on imaging (n=12) and muscle enzyme values (n=19) were normal or only slightly elevated.ConclusionsThe non-specificity of these findings suggests that MRI and near normal muscle enzyme levels are of limited diagnostic value when there is clinical suspicion of local anesthetic myotoxicity in the setting of TKA with CACB.Trial registration numberNCT04821245.

scholarly journals First experience with augmented reality neuronavigation in endoscopic assisted midline skull base pathologies in children

2021 ◽  
Author(s):  
Valentina Pennacchietti ◽  
Katharina Stoelzel ◽  
Anna Tietze ◽  
Erwin Lankes ◽  
Andreas Schaumann ◽  
...  
Keyword(s):  
Augmented Reality ◽  
Skull Base ◽  
Skull Base Surgery ◽  
Morphological Variability ◽  
Case Series ◽  
Relevant Information ◽  
Navigation Systems ◽  
Postoperative Mri ◽  
The Mean ◽  
Clinical Conditions

Abstract Introduction Endoscopic skull base approaches are broadly used in modern neurosurgery. The support of neuronavigation can help to effectively target the lesion avoiding complications. In children, endoscopic-assisted skull base surgery in combination with navigation systems becomes even more important because of the morphological variability and rare diseases affecting the sellar and parasellar regions. This paper aims to analyze our first experience on augmented reality navigation in endoscopic skull base surgery in a pediatric case series. Patients and methods A retrospective review identified seventeen endoscopic-assisted endonasal or transoral procedures performed in an interdisciplinary setting in a period between October 2011 and May 2020. In all the cases, the surgical target was a lesion in the sellar or parasellar region. Clinical conditions, MRI appearance, intraoperative conditions, postoperative MRI, possible complications, and outcomes were analyzed. Results The mean age of our patients was 14.5 ± 2.4 years. The diagnosis varied, but craniopharyngiomas (31.2%) were mostly represented. AR navigation was experienced to be very helpful for effectively targeting the lesion and defining the intraoperative extension of the pathology. In 65% of the oncologic cases, a radical removal was proven in postoperative MRI. The mean follow-up was 89 ± 79 months. There were no deaths in our series. No long-term complications were registered; two cerebrospinal fluid (CSF) fistulas and a secondary abscess required further surgery. Conclusion The implementation of augmented reality to endoscopic-assisted neuronavigated procedures within the skull base was feasible and did provide relevant information directly in the endoscopic field of view and was experienced to be useful in the pediatric cases, where anatomical variability and rarity of the pathologies make surgery more challenging.

scholarly journals Quantitative T2 mapping accelerated by GRAPPATINI for evaluation of muscles in patients with myositis

2019 ◽  
Vol 92 (1102) ◽  
pp. 20190109 ◽  
Author(s):  
Fengdan Wang ◽  
Haiping Zhang ◽  
Chanyuan Wu ◽  
Qian Wang ◽  
Bo Hou ◽  
...  
Keyword(s):  
T2 Mapping ◽  
Quantitative Information ◽  
Thigh Muscle ◽  
Mapping Technique ◽  
Acquisition Time ◽  
T2 Relaxation ◽  
Muscle Enzymes ◽  
Scanning Time ◽  
Conventional Mri ◽  
Thigh Muscles

Objective: Dermatomyositis (DM) and polymyositis (PM) make up the largest group of potentially treatable myopathies and require early diagnosis. This study investigates whether the edema of thigh muscles in DM/PM can be quantitatively assessed by a novel accelerated T2 mapping technique—GRAPPATINI. Methods: Three conventional MR sequences and GRAPPATINI accelerated T2 mapping of bilateral thighs from 20 patients (7 DM and 13 PM) and 10 healthy volunteers were prospectively carried out on a 3 T MR scanner. Afterwards, T2 values of 477 thigh muscles from the patients and the healthy controls were manually measured. In addition, the correlations between T2 values and serum muscle enzymes in patients were also analyzed. Results: The new GRAPPATINI technique made quantitative T2 mapping of bilateral thighs feasible with a scanning time of only 2 min 18 s. Moreover, GRAPPATINI-generated T2 values of muscles from patients were markedly higher than those from healthy subjects (p < 0.001). GRAPPATINI accelerated T2 mapping appeared a more sensitive technique in that some DM/PM muscles appearing normal per conventional MRI had increased T2 relaxation time. Furthermore, GRAPPATINI-generated T2 values of DM/PM thigh muscles positively correlated with serum enzyme levels (p < 0.001), which reflected the severity of myopathy. Conclusion: GRAPPATINI can significantly shorten acquisition time of T2 mapping and may potentially be applied clinically in DM and PM. Advances in knowledge: GRAPPATINI acceleration makes T2 mapping feasible in clinical practice in providing quantitative information regarding thigh muscle inflammation in DM and PM.

The Effects of Tourniquet Application in Total Knee Arthroplasty on the Recovery of Thigh Muscle Strength and Clinical Outcomes

2020 ◽  
Author(s):  
Omer Ayik ◽  
Mehmet Demirel ◽  
Fevzi Birisik ◽  
Ali Ersen ◽  
Halil I. Balci ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Muscle Strength ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Peak Torque ◽  
Thigh Muscle ◽  
Controlled Study ◽  
Total Work ◽  
Isokinetic Muscle Strength ◽  
Total Knee

AbstractThe present randomized controlled study aims to evaluate whether tourniquet application during total knee arthroplasty (TKA) has an effect on (1) thigh muscle strength (quadriceps and hamstring muscle strength) and (2) clinical outcomes (postoperative knee range of motion [ROM], postoperative pain level, and Knee Society Score [KSS]). The effects of tourniquet application during TKA were investigated in 65 patients randomly allocated to one of two groups: TKA with a tourniquet and TKA without a tourniquet. Patients in both groups were comparable in terms of the demographic and clinical data (p > 0.05 for age, number of patients, sex, radiographic gonarthrosis grade, American Society of Anesthesiologists [ASA] classification, and body mass index [BMI]). All patients in both groups were operated by the same surgeon using one type of prosthesis. Isokinetic muscle strength (peak torque and total work) of knee extensors (quadriceps) and flexors (hamstrings) was measured in Newton meters (Nm) using a CYBEX 350 isokinetic dynamometer (HUMAC/CYBEX 2009, Stoughton, MA). The combined KSS (knee score + function score), visual analog scale (VAS), and knee ROM were measured preoperatively and at 1 and 3 months postoperatively to evaluate clinical outcomes. There were no significant differences between the two groups in preoperative and postoperative values of isokinetic muscle strength (peak torque and total work) and aforementioned clinical outcomes (p < 0.05). The present study has shown that quadriceps strength and clinical outcomes were not improved in the early postoperative period (3 months) when a tourniquet was not used during TKA.

Sealing of superior semicircular canal dehiscence is associated with improved balance outcomes postoperatively versus plugging of the canal in middle fossa craniotomy repairs: a case series

2020 ◽  
Vol 133 (2) ◽  
pp. 462-466
Author(s):  
Vivian Wung ◽  
Prasanth Romiyo ◽  
Edwin Ng ◽  
Courtney Duong ◽  
Thien Nguyen ◽  
...  
Keyword(s):  
Semicircular Canal ◽  
Chart Review ◽  
Case Series ◽  
Superior Semicircular Canal Dehiscence ◽  
Superior Semicircular Canal ◽  
Postoperative Mri ◽  
Mri Scans ◽  
Postoperative Symptoms ◽  
Fluid Signal ◽  
Canal Dehiscence

OBJECTIVEThe authors compared postoperative symptoms between patients with sealed and those with plugged semicircular canal dehiscence repairs.METHODSIn total, 136 ears from 118 patients who underwent surgical repair for semicircular canal dehiscence were identified via chart review. Data from postoperative MRI scans showing preservation or loss of semicircular canal fluid signal and postoperative reports of autophony, amplification, aural fullness, tinnitus, hyperacusis, hearing loss, vertigo, dizziness, disequilibrium, oscillopsia, and headache were amalgamated and analyzed.RESULTSPatients with preservation of fluid signal were far less likely to have dizziness postoperatively (p = 0.007, OR 0.158, 95% CI 0.041–0.611). In addition, these patients were more likely to have tinnitus postoperatively (p = 0.028, OR 3.515, 95% CI 1.145–10.787).CONCLUSIONSThe authors found that superior semicircular canal dehiscence patients who undergo sealing without plugging have improved balance outcomes but show more tinnitus postoperatively than patients who undergo plugging.

scholarly journals A randomised controlled trial comparing venous stenting with conservative treatment in patients with deep venous obstruction: research protocol

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e017233 ◽  
Author(s):  
Timme MAJ van Vuuren ◽  
Jorinde H H van Laanen ◽  
Maaike de Geus ◽  
Patty J Nelemans ◽  
Rick de Graaf ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Conventional Treatment ◽  
Short Form ◽  
Randomised Trial ◽  
Case Series ◽  
Interventional Treatment ◽  
Venous Obstruction ◽  
Venous Stenting ◽  
Link Type ◽  
Registration Number

IntroductionDeep venous obstruction (DVO) has a great impact on quality of life (QoL) comparable to angina pectoris or chronic pulmonary disease. Post-thrombotic scar formation and May-Thurner syndrome (MTS) are the most common causes of DVO. Conventional treatment of DVO focuses on reducing pain or leg swelling by use of (pain) medication and therapeutic elastic stockings. In the past, a venous bypass was offered in severe post-thrombotic cases, but this procedure showed bad clinical and patency outcomes. With the introduction of percutaneous angioplasty and dedicated venous stents new opportunities were created. Deep venous stenting has been shown to be effective in retrospective case series. However, there is no prior research in which QoL after interventional treatment is compared with QoL after conventional treatment. Currently, there is a debate about the true additional value of interventional treatment. We investigate whether those patients who are treated with stenting experience a change in short form 36 (SF-36) and the Veines-QoL/Sym questionnaires compared with conventionally treated patients.Methods and analysisThis is a randomised trial comparing conservative deep venous management to interventional treatment. A total of 130 patients with post-thrombotic syndrome (PTS) or MTS, eligible for interventional percutaneous treatment, who did not have previous deep venous intervention will be included. Patients will be randomised to conservative treatment or venous stenting and stratified for the PTS or MTS subgroup. Conservative treatment consists of either one or a combination of pain medications, manual lymphatic drainage, compression stockings and regular post-thrombotic anticoagulant therapy.The primary outcome is the QoL change after 12 months compared with baseline QoL. Secondary outcomes are QoL changes at 6 weeks, clinical assessment of DVO, recurrence rate of deep venous thrombosis at 6 weeks and 12 months, and the total amount of working days lost. Intervention-specific outcomes include complications and patency.Ethics and disseminationThe protocol is approved by the Medical Ethics Committee of Academisch ziekenhuis Maastricht/Universiteit Maastricht, The Netherlands (protocol number NLNL55641.068.15 / METC 161008).We aim to publish the results of this study in a peer reviewed journal and present our findings at national or international conferences.Trial registration numberThe study protocol was registered atwww.clinicaltrials.gov(registration number:NCT03026049) on 17 January 2017.

Difficult Cases in Robotic Arm-Assisted Total Knee Arthroplasty: A Case Series

2017 ◽  
Vol 31 (01) ◽  
pp. 027-037 ◽  
Author(s):  
Robert Marchand ◽  
Anton Khlopas ◽  
Nipun Sodhi ◽  
Caitlin Condrey ◽  
Nicolas Piuzzi ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Case Series ◽  
Valgus Deformity ◽  
Robotic Assisted ◽  
Surgical Technology ◽  
Flexion Contractures ◽  
Total Knee ◽  
Robotic Devices ◽  
Sagittal Deformity

AbstractSagittal deformity of the knee is commonly corrected to neutral biomechanical axis (±3 degrees) during total knee arthroplasty (TKA), which is a widely accepted goal. Recent advances in surgical technology have made it possible to accurately plan and fulfill these goals. One of these is robotic-assisted TKA, which has been noted to help increase accuracy and precision of restoring a neutral mechanical axis. While there are data confirming the ability of robotic devices to better correct knee alignment than the manual technique, there is a lack of data concerning the use of the robotic devices in more complex cases, such as those in patients with severe varus or valgus deformity, as well as in flexion contractures. Therefore, the purpose of this case study is to present three cases in which the robotic-assisted TKA device was used to correct a severe varus and severe valgus deformities. Based on this case series, it should be noted that the robotic device can also help correct severe varus/valgus deformities and flexion contractures.

scholarly journals Safety and Efficacy of Two Trabecular Micro-Bypass Stents as the Sole Procedure in Japanese Patients with Medically Uncontrolled Primary Open-Angle Glaucoma: A Pilot Case Series

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Daisuke Shiba ◽  
Shingo Hosoda ◽  
Saori Yaguchi ◽  
Naoki Ozeki ◽  
Kenya Yuki ◽  
...  
Keyword(s):  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Case Series ◽  
Japanese Patients ◽  
Early Postoperative Period ◽  
Open Angle ◽  
Corrected Visual Acuity ◽  
Stent System ◽  
Registration Number ◽  
Favorable Safety

Purpose. To evaluate efficacy and safety of a trabecular micro-bypass stent system when used as the sole procedure in Japanese patients with medically uncontrolled primary open-angle glaucoma (POAG). Design. Prospective nonrandomized interventional pilot study. Methods. Ten eyes of 10 Japanese patients with medically uncontrolled POAG taking three ocular hypotensive medications were treated using only the implantation of two iStent trabecular micro-bypass stents. Each patient continued to take the same ocular hypotensive medications used preoperatively throughout the study. Intraocular pressure (IOP) and endothelial cell density (ECD) were determined at baseline and at 1, 3, and 6 months postoperatively. Best-corrected visual acuity (BCVA) was measured at baseline and 6 months after surgery. Results. Mean IOP was 22.0±3.0 mmHg at baseline and 16.9±3.6 mmHg at 6 months, which represented a mean reduction of 5.1 mmHg or 23.2%. No significant changes were observed in the ECD and BCVA. Complications that occurred during the early postoperative period included hyphema, peripheral anterior synechiae, and occlusion of the stent by the iris. Conclusion. Implantation of two trabecular micro-bypass stents as the sole procedure in Japanese POAG patients effectively reduced IOP and exhibited a favorable safety profile. Clinical Trials Registration number is UMIN000004002.

Cryoneurolysis for Digital Neuralgia in Professional Baseball Players: A Case Series

Neurology ◽  
2021 ◽  
Vol 98 (1 Supplement 1) ◽  
pp. S7.3-S8
Author(s):  
Johnathon Patrick Shaffer ◽  
Vernon B. Williams ◽  
Steven Shin
Keyword(s):  
Local Anesthetic ◽  
Ultrasound Guidance ◽  
Sensory Nerve ◽  
Case Series ◽  
Nerve Tissue ◽  
Professional Baseball ◽  
Digital Nerve ◽  
Baseball Players ◽  
Small Probe ◽  
Skin Marker

ObjectiveWe describe a non-surgical approach to refractory digital neuralgia using cryoneurolysis in a series of 3 professional baseball players.BackgroundThumb injuries are common in baseball players and can sometimes be challenging to effectively manage. Depending on the injury, current treatments include anti-inflammatories, immobilization, physical therapy, corticosteroid injections, and/or surgery. A subset of patients, however, fail nonoperative management yet do not have a clear indication for surgery. Cryoneurolysis or cyroanalgesia is an FDA-approved form of neuromodulation, which has been used safely and effectively on a variety of peripheral nerves. The mechanism of action involves percutaneous introduction of a small probe under local anesthetic to nerve tissue using ultrasound guidance. The probe is then cooled to −88°C using nitrous oxide, which results in secondary Wallerian degeneration. Axonal and myelin regeneration occurs completely in 3–6 months.Design/MethodsVisualization of the superficial radial sensory and ulnar digital nerve were obtained under ultrasound. The skin was prepared in sterile fashion. A 22-gauge 1-½ inch needle was then advanced with ultrasound guidance, and local anesthetic was applied. Both treatment sites were marked with skin marker. Cryoneurolysis was employed using a 5 mm tip. 60-second treatment cycles were performed at each site. Each of the cycles resulted in a 5 × 7 mm lesion visible as hypoechoic signal.ResultsAll 3 players endorsed significant and prolonged relief and were able to return to an elite level of play.ConclusionsThis manuscript is subject to all of the limitations of a case series, and larger rigorous studies are needed to illuminate causal inferences. Novel, complex technologies may also be more susceptible to placebo effect. Nonetheless, we are able to report marked efficacy and safety from cryoneurolysis of the ulnar digital nerve and the superficial radial sensory nerve in a small group of elite baseball players with refractory digital neuralgia.

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