scholarly journals Study the Neurological Improvement after Surgical Management of Traumatic Paraplegia in Traumatic Thoracolumbar Fractures

2020 ◽  
Vol 7 (3) ◽  
pp. 70-76
Author(s):  
Subarna Misra ◽  
Subhankar Mukherjee ◽  
Upal Banerjee ◽  
Abhishek Chattopadhyay ◽  
Anindya Sasmal ◽  
...  
Keyword(s):  
Surgical Management ◽  
Tertiary Care ◽  
Lateral View ◽  
Sensory Function ◽  
Thoracolumbar Fractures ◽  
Posterior Stabilization ◽  
Neurological Improvement ◽  
Cord Injury ◽  
Sensory Recovery ◽  
Grade 3

Background: Traumatic paraplegia is an unanticipated catastrophe in an individual’s life, posing a huge economic as well as social burden. We evaluated all the patients for neurological improvement after surgical management of traumatic paraplegia in traumatic thoracolumbar fractures. Materials and Methods: The prospective study was conducted in the department of orthopedics of a tertiary care teaching institute in Kolkata, West Bengal, India. The patients were evaluated by X-ray of spine (anteroposterior and lateral view) and sometimes computed tomography scan. In most cases, pedicle screw with plate or rod was used and posterior stabilization and posterior fusion with corticocancellous bone graft from posterior iliac crest were done. Pre-operative and post-operative neurological charts (according to Frankel’s grade and American Spinal Cord Injury Association score [motor and sensory]) were maintained with regular assessment for proper post- operative neurological recovery assessment. Results: Forty-six patients in whom posterior stabilization of the spine was done in this institution and followed up for a period ranging from 6 months to 2 years, 4 of 46 patients lost follow-up. Remaining 42 patients were considered for the study. When decompression done within the 1st week in incomplete paraplegia, 80% of the patients show Grade 3 power return, whereas 25% of the patients show return of Grade 3 power when decompression done in the 3rd week in incomplete paraplegia cases. In complete paraplegia cases, 11% of the patients had return of power up to Grade 3 when decompression done within the 1 week, where no cases showed return of Grade 3 power when decompression done after the 2nd or 3rd week. In incomplete paraplegia, 80% of the patients had onset of sensory recovery within 1 week, when the decompression done within the 1st week. In complete paraplegia, 11% of the patients had sensory recovery within 2 weeks when decompression done within 1 week. Conclusion: Hence, our conclusion is that early decompression definitely has some role regarding motor and sensory function return, both in complete and incomplete paraplegia.

scholarly journals An observation of the clinical efficacy of combining Riluzole with mannitol and hyperbaric oxygen in treating acute spinal cord injury

2021 ◽  
Vol 37 (2) ◽  
Author(s):  
Huan-xia Li ◽  
Jing Cui ◽  
Jing-shi Fan ◽  
Jian-zhou Tong
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Hyperbaric Oxygen ◽  
Clinical Efficacy ◽  
Acute Spinal Cord Injury ◽  
Sensory Function ◽  
Control Group ◽  
Thoracolumbar Fractures ◽  
Cord Injury ◽  
Experimental Group

Objective: To examine the clinical efficacy of combining Riluzole with mannitol and hyperbaric oxygen therapy in treating thoracolumbar vertebral fracture-induced acute spinal cord injury (ASCI). Methods: From June 2015 to May 2018, 80 patients with thoracolumbar fractures and ASCI who were treated at Baoding First Central Hospital were selected. All patients underwent posterior laminectomy and screw fixation, and they were randomly divided into two groups using a random number table method. The control group received conventional postoperative treatment, while the experimental group was treated with riluzole combined with mannitol and hyperbaric oxygen on the basis of conventional treatment. The recovery of nerve function which included motor function and sensory function, and the changes of serum IL-6, CRP, BDNF, BFGF and other factors before treatment and four weeks after treatment of the two groups of patients were observed and evaluated. Results: After treatment, the motor function scores and sensory function scores of the two groups of patients were improved compared with those before treatment (p<0.05). Compared with the control group, the experimental group improved significantly, and the difference was statistically significant (p<0.05). The levels of IL-6, BDNF and NFGF in the experimental group were significantly lower than those in the control group (p<0.05). Conclusions: For patients with thoracolumbar fractures and ASCI undergoing laminar decompression and fixation, the comprehensive treatment plan of riluzole combined with mannitol and hyperbaric oxygen has certain advantages. Compared with the conventional therapy, it may significantly improve the movement and sensory functions of patients, relieve the inflammatory response of spinal cord, and promote recovery from the injury. doi: https://doi.org/10.12669/pjms.37.2.3418 How to cite this:Li H, Cui J, Fan J, Tong J. An observation of the clinical efficacy of combining Riluzole with mannitol and hyperbaric oxygen in treating acute spinal cord injury. Pak J Med Sci. 2021;37(2):---------. doi: https://doi.org/10.12669/pjms.37.2.3418 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Analysis of the results of surgical management of traumatic paraplegia

2016 ◽  
Vol 3 (1) ◽  
pp. 35
Author(s):  
Kumar Nitesh ◽  
Ajay Kumar Mahto
Keyword(s):  
Surgical Management ◽  
Tertiary Care ◽  
Thoracolumbar Spine ◽  
Neurological Status ◽  
Bladder Function ◽  
Outcome Analysis ◽  
Mri Findings ◽  
Thoracolumbar Spine Fractures ◽  
Grade 3

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Thoracolumbar spine fractures are common injuries that can result in significant disability, deformity and neurological deficit. Aim of this study was to evaluate the results of surgical management of traumatic paraplegia, complete or incomplete as classified by Frankel scoring.</span></p><p class="abstract"><strong>Methods:</strong> A prospective study was conducted in patients attending outdoor and emergency department of orthopaedics of a tertiary care teaching institute in Katihar Medical College, Katihar (Bihar) with traumatic paraplegia involving the dorsolumbar spine. The duration of the study was July 2014 to July 2016. The important objectives are the time for recovery of various functions like sensory, motor and bowel and bladder function, comparison between early and late decompression, results of posterolateral fusion and time taken for solid bony fusion after operation. Cases selected for these studies were those treated surgically between July 2014 to July 2016. Total 46 cases were selected within a minimum of 6 month post-operative follow up of which 4 cases lost in follow up. Data collected from patients records including age, sex, time from injury to hospitalization, initial neurological status as per Frankel score, MRI findings, surgery performed, postoperative course and neurological status at the time of discharge and latest follow up. Patients lost to follow up were not studied for outcome analysis.<strong></strong></p><p class="abstract"><strong>Results:</strong> When decompression done within 1<sup>st</sup> week in incomplete paraplegia 80% of the patients showed return of grade 3 power. In complete paraplegia cases, 11% of the patients had return to power upto grade 3 when decompression done within 1 week where no cases return of grade 3 power when decompression done after2nd and 3<sup>rd</sup> week<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> After recovery from spinal shock, the earlier the surgical decompression done, the better the neurological and bowel/bladder function recovery both in complete and incomplete paraplegic cases. Reduction is better and easy and less time consuming in early decompression than in late. Motor recovery can continue for over 6 month after decompression<span lang="EN-IN">.</span></p><p> </p>

Olfactory Mucosal Auto-transplantation in Spinal Cord Injury: A Clinical Trial, Saudi Arabia

2021 ◽  
pp. 11
Author(s):  
Ahmad Najib Ashraf ◽  
Abdulaziz Shebreen
Keyword(s):  
Clinical Trial ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Sensory Function ◽  
Cell Transplant ◽  
Loss Of Function ◽  
Neurological Improvement ◽  
Cord Injury ◽  
Distinctive Property ◽  
Independent Life

Introduction: Spinal cord injury (SCI) results in loss of nervous tissue and consequently loss of motor and sensory function. Despite significant improvements in the early medical and surgical management of SCI, there is no effective treatment available that restores the injury-induced loss of function to a degree that an independent life can be guaranteed. Restoration of function and reversal of paralysis following SCI is among the most daunting challenges in all of neuroscience research. Methodology: We decided to study the outcomes in chronic SCI (CSCI) after autologous olfactory mucosal transplantation into the spinal cord following detethering of the cord. The human surgical procedure of autologous olfactory mucosal transplantation was first developed by Carlos Lima and his colleagues. These investigators provided guidance for the surgical procedures in this study and the procedures on the first six participants were performed in their presence. Result: Patients were screened at different centers in the kingdom. A stringent inclusion and exclusion criteria were applied. Patients for this clinical trial were selected from individuals that suffered an SCI at least 12 months before their assessment and were chronically paraplegic or tetraplegic. The final twenty participants were selected after screening more than 125 patients.  While some of them were rejected for medical reasons, some refused to participate upon receiving a full briefing and some of them were unable to fulfill the required psychosocial criteria. Conclusion: The details of the patients and the changes observed in their conditions post olfactory mucosal auto-transplantation will be discussed in detail in oral presentation with graphic results with marked significant improvement in motor and sensory levels of SCI patients as compared to before transplantation of olfactory mucosa. Olfactory unsheathing cells (OECs) are glia cells and continuous axon extension and successful topographic targeting of the olfactory receptor neurons responsible for the sense of smell (olfaction). Due to this distinctive property, OECs have been trialed in human cell transplant therapies to assist in the repair of central nervous system injuries, particularly those of the spinal cord. Although many studies have reported neurological improvement, therapy remains inconsistent and requires further improvement.

EVALUATION OF GRADING OF BREAST MALIGNANCIES ON FINE NEEDLE ASPIRATES AND COMPARISON OF TWO GRADING SYSTEMS AT A TERTIARY CARE HOSPITAL OF NORTH INDIA

2021 ◽  
pp. 192-194
Author(s):  
Shazia Bashir ◽  
Aamir Hussain ◽  
Irm Yasmeen
Keyword(s):  
Tertiary Care ◽  
North India ◽  
Care Hospital ◽  
Breast Cancers ◽  
Cross Sectional ◽  
Fine Needle Aspirates ◽  
Grading Systems ◽  
Grade Ii ◽  
Grade 3 ◽  
High Degree

AIM: To evaluate and compare the cytograding of breast cancers using Robinson's and Moriquand's grading methods MATERIAL AND METHODS: This study was a cross-sectional retrospective study conducted over a period of three years w. e .f October 2014 to October 2017 and includes diagnosed or highly suspicious malignant cases of breast carcinoma. Slides were retrieved from the cytology section of Department of Pathology, GMC Jammu. A total of 84 cases of breast cancers were studied and grading was done using Robinson's and Mouriquand's methods and the two grading methods were then compared. RESULTS: Out of 84 cases of breast cancers , on using Robinson's grading method , 11 cases [13.10%] were graded as grade 1, 65 cases [77.38%] were graded as grade 2 and 8 cases [9.52%] cases as grade 3. 9 (10.71%) cases are graded as Grade I by Mouriquand's method with score less than 5. 68(80.95%) cases were graded as Grade II with score 5-9 and 7 (8.33%) were graded ad Grade III with score ≥10. On doing comparison between the two cytograding methods, we found a high degree of concordance between the two systems [ 96.42% ] . The relationship observed between the scores obtained by the two methods was also seen to be highly signicant. CONCLUSION: There is possibility of comprehensive cytograding of breast cancers by using the two different methods proposed by Robinson's and Moriquand's but out of the two methods inspite of a high degree of concordance between the two methods , the grading system of Robinson's because of its more objective set of criterias and easy reproducibility has been found to be easier and better.

scholarly journals Traumatic Spondyloptosis: Neurological, Surgical, and Outcome Perspectives in a Tertiary Care Center

2021 ◽  
Author(s):  
Rahul Singh ◽  
Ravi Shankar Prasad ◽  
Ashvamedh Singh ◽  
Kulwant Singh ◽  
Anurag Sahu
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Neuropathic Pain ◽  
Sagittal Plane ◽  
Care Center ◽  
Tertiary Care ◽  
International Standards ◽  
Surgical Approaches ◽  
Severity Of Injury ◽  
Cord Injury

Abstract Objective To evaluate traumatic spondyloptosis cases for neurological, surgical, and outcome perspectives. Materials and Methods This retrospective study includes 17 patients of spondyloptosis admitted in our department between August 2016 and January 2020. Each patient was evaluated in terms of demographic profile, clinical presentation, duration of injury, mode of injury, associated injuries, level and type of spondyloptosis, spinal cord status, nociceptive and neuropathic pain severity, severity of injury based on International Standards for Neurological Classification of Spinal Cord Injury (ISNCSI) assessment, surgical approaches, complications, and outcome. Unpaired t- test and Chi-square test were used for statistical analysis. Values with p < 0.05 were considered statistically significant. Results Fall from height (58.8%) was the most common mode of injury. Most common level of spondyloptosis was T12–L1 (41.1%). Sagittal–plane spondyloptosis (76.5%) were more common than coronal–plane spondyloptosis (23.5%). Most common associated injury was musculoskeletal (64.7%). Neurological status of the patient at presentation (p = 0.0007) was significantly associated with outcome after 3 months of surgery/conservative management. Residual listhesis was present in 53.3% of patients postoperatively. Postoperative nociceptive pain (p = 0.0171) and neuropathic pain (0.0329) were significantly associated with residual listhesis. Duration of injury (p = 0.0228) was also significantly associated with postoperative residual listhesis. Conclusion Complete reduction of spondyloptosis should be the goal of surgery. Overall prognosis of spinal cord injury (SCI) due to traumatic spondyloptosis is poor.

scholarly journals HEPATITIS “C”

2016 ◽  
Vol 23 (09) ◽  
Author(s):  
Muhammad Iqbal ◽  
Adnan Ahmed ◽  
Muhammad Rafique Hingoro
Keyword(s):  
Hepatitis C ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
University Hospital ◽  
Age Group ◽  
Sectional Study ◽  
Cross Sectional ◽  
Grade 3 ◽  
Chronic Hcv ◽  
Study Setting

Objectives: To determine incidence of steatosis in non-responder casesof chronic HCV. Study Design: Cross-sectional study. Setting: Tertiary Care Sanatorium inMedicine Department of LIAQUAT University Hospital Hyderabad/Jamshoro. Period: 26-9-2011to 25 August 2012. Material & Methods: Total 144 non-responders cases of Hepatitis C wereintegrated. Both gender, age 18 to 50 yrs, chronic HCV non-responder cases as well as cases fitfor hepatic biopsy were integrated in study. Grading of Inflammation was carried out as indicatedby histopathological measures. Results: Mean age was 48.5 + 5.2years. Uppermost prevalenceof chronic HCV disease was 65(45.13%) at 41 to 50 years age interval whereas 42(29.1%) caseswere noticed in 31 to 40 yrs age group and 25(17.3%) cases were observed in 20 to 30 yearsof young age group. In this study hepatic steatosis occurrence was observed in 103 (71.5%)cases and these were categories as: grade 1, grade 2, grade 3, as (<33%) 45/103(43.68%), (33to 66%) 35/103(33.98%), (>66%) 23/103(22.33%) respectively. Conclusion: Hepatic steatosisis a important risk factor the cases of HCV to decreased response to antiviral therapy and forprogression toward fibrosis as observed in cases related to metabolic steatosis.

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