scholarly journals Thoracic Epidural Abscesses: A Systematic Review

2018 ◽  
Vol 8 (4_suppl) ◽  
pp. 68S-84S ◽  
Author(s):  
Benjamin A. Howie ◽  
Iyooh U. Davidson ◽  
Joseph E. Tanenbaum ◽  
Markian A. Pahuta ◽  
Avery L. Buchholz ◽  
...  
Keyword(s):  
Systematic Review ◽  
Complete Blood Count ◽  
Significant Risk ◽  
Past Research ◽  
Neurological Deficits ◽  
Thoracic Epidural ◽  
Reactive Protein ◽  
Thoracic Level ◽  
Ovid Medline ◽  
Spinal Epidural

Study Design: Systematic review. Objectives: Past research has demonstrated increased speed and severity of progression for spinal epidural abscesses (SEAs) of the thoracic level, specifically, when compared with SEAs of other spinal cord levels. Untreated, this infection can result in permanent neurological sequelae with eventual progression to death if inadequately managed. Despite the seriousness of this disease, no articles have focused on the presentation, diagnosis, and treatment of SEAs of the thoracic level. For this reason, specific focus on SEAs of the thoracic level occurred when researchers designed and implemented the following systematic review. Methods: A query of Ovid-Medline and EMBASE, Cochrane Central, and additional review sources was conducted. Search criteria focused on articles specific to thoracic epidural abscesses. Results: Twenty-five articles met inclusion criteria. The most commonly reported symptoms present on admission included back pain, paraparesis/paraplegia, fever, and loss of bowel/bladder control. Significant risk factors included diabetes, intravenous drug use, and advanced age ( P = .001). Patients were most often treated surgically with either laminectomy, hemilaminectomy, or radical decompression with debridement. Patients who presented with neurological deficits and had delayed surgical intervention following a failed antibiotic course tended to do worse compared with their immediate surgical management counterparts ( P < .005). Conclusions: For the first time researchers have focused specifically on SEAs of the thoracic level, as opposed to previously published general analysis of SEAs as a whole. Based on the results, investigators recommend early magnetic resonance imaging of the spine, laboratory workup (sedimentation rate/C-reactive protein, complete blood count), abscess culture followed by empiric antibiotics, and immediate surgical decompression when neurological deficits are present.

scholarly journals Biotic Supplements for Renal Patients: A Systematic Review and Meta-Analysis

Nutrients ◽  
2018 ◽  
Vol 10 (9) ◽  
pp. 1224 ◽  
Author(s):  
Anna Pisano ◽  
Graziella D’Arrigo ◽  
Giuseppe Coppolino ◽  
Davide Bolignano
Keyword(s):  
Systematic Review ◽  
Large Scale ◽  
Meta Analysis ◽  
Outcome Data ◽  
Reactive Protein ◽  
Surrogate Outcomes ◽  
Ovid Medline ◽  
Primary Endpoints ◽  
Intestinal Dysbiosis ◽  
Secondary Endpoints

Intestinal dysbiosis is highly pervasive among chronic kidney disease (CKD) patients and may play a key role in disease progression and complications. We performed a systematic review and meta-analysis to evaluate effects of biotic supplements on a large series of outcomes in renal patients. Ovid-MEDLINE, PubMed and CENTRAL databases were searched for randomized controlled trials (RCTs) comparing any biotic (pre-, pro- or synbiotics) to standard therapy or placebo. Primary endpoints were change in renal function and cardiovascular events; secondary endpoints were change in proteinuria/albuminuria, inflammation, uremic toxins, quality of life and nutritional status. Seventeen eligible studies (701 participants) were reviewed. Biotics treatment did not modify estimated glomerular filtration rate (eGFR) (mean difference (MD) 0.34 mL/min/1.73 m2; 95% CI −0.19, 0.86), serum creatinine (MD −0.13 mg/dL; 95% confidence interval (CI) −0.32, 0.07), C-reactive protein (MD 0.75 mg/dL; 95% CI −1.54, 3.03) and urea (standardized MD (SMD) −0.02; 95% CI −0.25, 0.20) as compared to control. Outcome data on the other endpoints of interest were lacking, sparse or in an unsuitable format to be analyzed collectively. According to the currently available evidence, there is no conclusive rationale for recommending biotic supplements for improving outcomes in renal patients. Large-scale, well-designed and adequately powered studies focusing on hard rather than surrogate outcomes are still awaited.

Spontaneous Ventral Spinal Epidural Hematoma with Anterior Cord Syndrome

Neurosurgery ◽  
1981 ◽  
Vol 9 (4) ◽  
pp. 440-443 ◽  
Author(s):  
Timothy W. Phillips ◽  
Thomas F. Kling ◽  
John E. McGillicuddy
Keyword(s):  
Spinal Canal ◽  
Epidural Hematoma ◽  
Neurological Deficits ◽  
Posterolateral Approach ◽  
Spinal Epidural Hematoma ◽  
Disseminated Intravascular Coagulopathy ◽  
Thoracic Epidural ◽  
Intravascular Coagulopathy ◽  
Spinal Epidural

Abstract The authors report a case of spontaneous ventral thoracic epidural hematoma presenting as an anterior cord syndrome. The epidural hematoma ws evacuated through a posterolateral approach to the spinal canal. A disseminated intravascular coagulopathy appeared intraoperatively. By 3 months after operation the neurological deficits had cleared.

A Case of a Spinal Epidural Capillary Hemangioma: Case Report

Neurosurgery ◽  
2011 ◽  
Vol 68 (3) ◽  
pp. E850-E853 ◽  
Author(s):  
Alya Hasan ◽  
Marie-Christine Guiot ◽  
Carlos Torres ◽  
Judith Marcoux
Keyword(s):  
Thoracic Spine ◽  
Thoracolumbar Spine ◽  
Vascular Tumor ◽  
Capillary Hemangioma ◽  
Neurological Deficits ◽  
Thoracic Epidural ◽  
Spine Pain ◽  
Appropriate Treatment ◽  
The Right ◽  
Spinal Epidural

Abstract BACKGROUND AND IMPORTANCE: Spinal hemangiomas usually arise from the vertebral body. Epidural hemangiomas are rare lesions, and most reported cases are cavernous. We report a case of a capillary hemangioma in the thoracic epidural space. CLINICAL PRESENTATION: The 57-year-old male patient initially presented with low thoracic spine pain. A magnetic resonance image of the thoracolumbar spine demonstrated an avidly enhancing epidural mass lesion in the lower thoracic spine with extension into the adjacent foramina at 2 levels on the right side. The patient developed progressive myelopathy over the course of 2.5 years despite minimal radiological changes. Surgical treatment resulted in good recovery. Histopathologically, the lesion corresponded to a vascular tumor composed of vessels of various calibers with fibrous septa between them. CONCLUSION: Early treatment of this type of lesion should be advocated to prevent deterioration and permanent neurological deficits. Appropriate treatment appears to be gross total resection.

scholarly journals Clinical Profile and Treatment Outcome of Spinal Epidural Arachnoid Cysts: A Systematic Review of Case Studies and Reports

2022 ◽  
Author(s):  
Aditya K. Patil ◽  
Srikant K. Swain ◽  
Suresh Sharma ◽  
Rajnish Kumar Arora ◽  
Achal Sharma ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Outcome ◽  
Literature Search ◽  
Cochrane Library ◽  
Symptom Duration ◽  
Dural Defect ◽  
Good Clinical Outcome ◽  
Ovid Medline ◽  
Compressive Myelopathy ◽  
Spinal Epidural

Abstract Background A spinal epidural arachnoid cyst (SEAC) is a rare clinical entity. We performed a systematic review of the literature to obtain information regarding demographics, clinical presentation, treatment modalities, and outcome of SEACs. Methods A literature search was performed by using the databases PubMed/Medline, PubMed Central, Embase, Cochrane Library, Ovid MEDLINE, and Ovid Medline In-Process. A total of 170 articles were found on literature search. We found 575 cases of SEAC since 1904 for inclusion in the review including three cases which were operated by us. We studied the patient characteristics, clinical features, and management strategies, and evaluated their outcome. Results The average age of presentation was 30 years with a male:female ratio of 1.03:1. They are commonly seen in the thoracic region (42.3%). The length of cyst was more than two vertebral levels in 85.81%. Mean symptom duration was 29 months, with most common presentation being that of compressive myelopathy. A good clinical outcome was present in symptomatic patients who had a shorter symptom duration and underwent complete surgical excision of the SEAC. Age, sex, length of lesion, and presence of dural defect did not have a bearing on the surgical outcome. Conclusion For thoracic compressive myelopathy in a young patient, SEAC should be kept as a differential diagnosis. Surgical complete excision of the cyst with meticulous closure of the dural defect is the standard in management for a good clinical outcome.

C-Reactive Protein for Prediction or Early Detection of Pre-Eclampsia: A Systematic Review

2021 ◽  
pp. 1-14
Author(s):  
Rola Hamadeh ◽  
Amani Mohsen ◽  
Firas Kobeissy ◽  
Ali Karouni ◽  
Hikmat Akoum
Keyword(s):  
Systematic Review ◽  
Quality Assessment ◽  
Meta Analysis ◽  
Significant Risk ◽  
Positive Association ◽  
High Sensitivity ◽  
C Reactive Protein ◽  
Cross Sectional ◽  
Reactive Protein ◽  
Statistical Heterogeneity

<b><i>Objective:</i></b> Pre-eclampsia (PE) is a serious disease of pregnancy and one of the major causes of morbidity and mortality for both the mother and baby. This systematic review aims to detect the role of high-sensitivity C-reactive protein (CRP) in the detection of PE. <b><i>Methods:</i></b> Thirty-four articles published between 2001 and 2019 were included in this review. The articles were extracted from OVID Medline and Embase. The study designs of these articles are randomized controlled, cohort, case-control, and cross-sectional studies evaluating CRP as a marker to predict or early diagnose PE. The quality assessment of these articles is made by the modified Quality Assessment of Diagnostic Accuracy Studies 2 tool. Meta-analysis was not done because of clinical and statistical heterogeneity. <b><i>Results:</i></b> A positive association between CRP levels and the development of PE was confirmed in 18 studies. This positive effect was addressed in patients with normal BMI (&#x3c;25 kg/m<sup>2</sup>) in 3 studies and in overweight patients in 2 studies. One study addressed this positive association in patients with a BMI ranging between 28 and 31 kg/m<sup>2</sup>. Three studies determined a cutoff level of CRP above which a significant risk of PE development should be suspected. These levels ranged between 7 and 15 mg/L. <b><i>Conclusion:</i></b> CRP is a promising cost-effective biomarker that may be used in the prediction of PE. A CRP level higher than 15 mg/L may suggest initiation of low-dose aspirin in low-risk pregnancies.

Spinal Epidural Abscesses: Clinical Manifestations, Prognostic Factors, and Outcomes

Neurosurgery ◽  
2002 ◽  
Vol 51 (1) ◽  
pp. 79-87 ◽  
Author(s):  
Martin Soehle ◽  
Thomas Wallenfang
Keyword(s):  
Prognostic Factors ◽  
Clinical Manifestations ◽  
Neurological Deficits ◽  
Motor Deficits ◽  
C Reactive Protein ◽  
Computed Tomographic ◽  
Protein Levels ◽  
Reactive Protein ◽  
Outcome Group ◽  
Spinal Epidural

Abstract OBJECTIVE This study was performed to evaluate the clinical manifestations and prognostic factors for outcomes among patients with nontuberculous spinal epidural abscesses. METHODS The records and magnetic resonance imaging/computed tomographic results for patients treated between 1994 and 2000 were retrospectively evaluated. Outcomes were assessed after 11 months, using scores ranging from 0 (dead) to 4 (no neurological deficits). RESULTS All 25 patients (mean age, 62 yr) underwent surgery and subsequently received antibiotics. Back/neck pain (72% of patients), leukocytosis (64%), fever (60%), and motor deficits (56%) were the most common symptoms at admission. Outcomes were assessed as poor for 40% of the patients and as good (no deficit or independently ambulatory) for 60%. Low leg muscle strength grades (r = 0.68, P &lt; 0.001) and high white blood cell (WBC) counts (r = −0.56, P = 0.006) at admission were significantly correlated with low outcome scores. From the time of admission until 14 days after surgery, the poor-outcome group exhibited significantly (P &lt; 0.005) higher WBC counts, compared with the good-outcome group. The same was true for C-reactive protein levels, with the exception that no differences between groups were observed until 8 days after surgery. Factors such as cervicothoracic abscess locations (P = 0.041), lower limb motor deficits (P = 0.005), complete paralysis (P = 0.005), and WBC counts of more than 14,000 cells/μl (P = 0.049) at admission were observed to be prognostic for poor outcomes. CONCLUSION Surgical decompression combined with antimicrobial therapy remains the recommended treatment. In addition to abscess locations and motor deficits, inflammatory markers such as WBC counts and C-reactive protein levels are prognostic for outcomes.

scholarly journals Spinal Epidural Abscess: A Review with Special Emphasis on Earlier Diagnosis

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Allison Bond ◽  
Farrin A. Manian
Keyword(s):  
Epidural Abscess ◽  
Significant Proportion ◽  
Simple Algorithm ◽  
Neurological Deficits ◽  
Spinal Epidural Abscess ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Erythrocyte Sedimentation ◽  
Objective Evidence ◽  
Spinal Epidural

Spinal epidural abscess (SEA) is an uncommon but serious condition with significant morbidity and mortality. The prognosis of SEA is highly dependent on the timeliness of its diagnosis before neurological deficits develop. Unfortunately, often due to its nonspecific presentation, such as back pain, the diagnosis of SEA may be delayed in up to 75% of cases. Although many risk factors for SEA can be found in the published literature, their utility is limited by their frequent lack of objective evidence, numerousness, and absence in a significant proportion of cases. In this review, we call for a more discriminate evidence-based use of the term “risk factor” when discussing SEA and explore several approaches to its earlier diagnosis, including a simple algorithm based on its pathophysiology and serum C-reactive protein or erythrocyte sedimentation rate.

scholarly journals Awake craniotomy for resection of supratentorial glioblastoma: a systematic review and meta-analysis

2020 ◽  
Vol 2 (1) ◽  
Author(s):  
John J Y Zhang ◽  
Keng Siang Lee ◽  
Mathew R Voisin ◽  
Shawn L Hervey-Jumper ◽  
Mitchel S Berger ◽  
...  
Keyword(s):  
Systematic Review ◽  
Tumor Volume ◽  
Meta Analysis ◽  
Extent Of Resection ◽  
Neurological Complications ◽  
Awake Craniotomy ◽  
Neurological Deficits ◽  
Current Evidence ◽  
Low Grade ◽  
Ovid Medline

Abstract Background The goal of glioblastoma (GBM) surgery is to maximize the extent of resection (EOR) while minimizing postoperative neurological complications. Awake craniotomy (AC) has been demonstrated to achieve this goal for low-grade gliomas in or near eloquent areas. However, the efficacy of AC for GBM resection has not been established. Therefore, we aimed to investigate the outcomes of AC for surgical resection of GBM using a systematic review and meta-analysis of published studies. Methods Systematic searches of Ovid MEDLINE, Embase, Cochrane Controlled Register of Controlled Trials, and PubMed were performed from database inception to September 14, 2019 for published studies reporting outcomes of AC for GBM resection. Outcome measures analyzed included EOR and the event rate of postoperative neurological deficits. Results A total of 1928 unique studies were identified. Fourteen studies reporting 278 patients were included in our meta-analysis. Mean age of patients was 46.9 years (95% confidence interval [CI]: 43.9–49.9). Early and late postoperative neurological deficits occurred in 34.5% (95% CI: 21.9–48.2) and 1.9% (95% CI: 0.0–9.2) of patients, respectively. Pooled percentage of gross total resection (GTR) was 74.7% (95% CI: 66.7–82.1), while the pooled percentage reduction in tumor volume was 95.3% (95% CI: 92.2–98.4). Conclusions Limited current evidence suggests that the use of AC for resection of supratentorial GBM is associated with a low rate of persistent neurological deficits while achieving an acceptable rate of GTR. Our findings demonstrate the potential viability of AC in GBM resection and highlight the need for further research on this topic.

scholarly journals Spontaneous epidural hematoma of the cervical spine in two patients with sarcoidosis

2021 ◽  
Vol 12 ◽  
pp. 168
Author(s):  
Anastasios Nasios ◽  
George Alexiou ◽  
Andreas Zygouris ◽  
Spyridon Voulgaris
Keyword(s):  
Surgical Intervention ◽  
Significant Risk ◽  
Cord Compression ◽  
Acute Onset ◽  
Neurological Deficits ◽  
Cervical Pain ◽  
Increased Risk ◽  
Neurologic Sequelae ◽  
Hematological Abnormalities ◽  
Spinal Epidural

Background: Sarcoidosis is correlated with hematological abnormalities that can result in spontaneous spinal epidural hematomas (EDH). As there is significant risk for permanent neurologic sequelae due to acute cord compression, these lesions often warrant emergent surgical intervention. Case Description: Two females, 56 and 62 years of age, respectively, both with sarcoidosis on corticosteroids, presented with the spontaneous acute onset of cervical pain, and progressive myeloradiculopathy. Emergent MR scans revealed cervical EDHs with cord compression, respectively, from C5-T1, and C6-C7. Following emergent laminectomies in both cases, patients’ neurological deficits resolved. Conclusion: Two patients with sarcoidosis at increased risk for spontaneous hemorrhages, presented with cervical EDHs warranting emergent decompressive laminectomies.

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