scholarly journals Spinal cord deformity with aggravation of tethering in saccular limited dorsal myeloschisis during the first 2 months of life

2021 ◽  
Vol 12 ◽  
pp. 476
Author(s):  
Takafumi Shimogawa ◽  
Nobutaka Mukae ◽  
Akiko Kanata ◽  
Haruhisa Tsukamoto ◽  
Nobuya Murakami ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Normal Skin ◽  
Postnatal Period ◽  
Early Surgery ◽  
Optimal Timing ◽  
Lumbar Region ◽  
Delayed Surgery ◽  
Mri Examination ◽  
Risk Of Rupture ◽  
Untethering Surgery

Background: Although the optimal timing of prophylactic untethering surgery for limited dorsal myeloschisis (LDM) with intact or subtle neurological findings diagnosed at birth remains undetermined, intentional delayed surgery is commonly used for flat and tail-like LDM. Conversely, for saccular LDM, early surgery is indicated during the postnatal period because it prevents rupture of the sac. We treated a saccular LDM patient, in whom intentional delayed surgery was selected because the sac was thickly covered with normal skin. We describe the clinical course of the case and discuss the optimal timing of the surgery. Case Description: The patient had a dorsal midline sac in the upper lumbar region. Initial magnetic resonance imaging (MRI) after birth revealed a tethering tract that began at the dome of the sac and joined the lumbar cord. Dorsal bending of the cord at the stalk-cord union and invagination of the cord into the sac were noted. At 2 months, he was neurologically normal; however, the second MRI examination revealed that the cord tethering was aggravated. The cord was markedly displaced dorsally and to the left, with deviation of the cord to the sac out of the spinal canal. Following untethering surgery, the spinal cord deformity markedly improved. Conclusion: Early surgery may be recommended for saccular LDM when tethering is present, including dorsal bending of the cord at the stalk-cord union and invagination of the cord into the sac observed on detailed MRI examination, even if the sac has no risk of rupture.

A Meta-Analysis of Early versus Delayed Surgery for Valvular Infective Endocarditis Complicated by Embolic Ischemic Stroke

2016 ◽  
Vol 11 (3) ◽  
pp. 187-192 ◽  
Author(s):  
Christos G. Mihos ◽  
Andres M. Pineda ◽  
Orlando Santana
Keyword(s):  
Ischemic Stroke ◽  
Infective Endocarditis ◽  
Operative Mortality ◽  
Meta Analysis ◽  
Early Surgery ◽  
Optimal Timing ◽  
Delayed Surgery ◽  
Increased Risk ◽  
Time Of Operation ◽  
Risk Ratios

Objective An embolic ischemic stroke occurs in 10% to 40% of patients with valvular infective endocarditis (IE) and confers significant morbidity. The optimal timing of valve surgery in this population is not well defined. Methods With the use of PubMed, EMBASE, Ovid, and Cochrane databases, a systematic review identified 14 studies through October 2015 that compared early versus delayed surgery for valvular IE complicated by an ischemic stroke. Early surgery was defined as 3 days or less in one, 7 days or less in eight, and 14 days or less in five studies. Risk ratios (RRs) were calculated by the Mantel-Haenszel method under a fixed- or random-effects model, for the outcomes of perioperative stroke, operative mortality, and 1-year survival. Results A total of 833 patients (early surgery, 330; delayed surgery, 503) were included. The majority of operations were for aortic and/or mitral valve IE, with prosthetic valve IE present in 0% to 60%. Infection with Staphylococcus aureus ranged from 19% to 66%, and heart failure prevalence at the time of operation was 24% to 66%. Early surgery was associated with an increased risk of operative mortality (RR, 1.72; 95% confidence interval [CI], 1.27–2.34; P = 0.0005), which was significant regardless of surgery within the first 7 days (RR, 2.19; 95% CI, 1.45–3.31; P = 0.0002) or 14 days (RR, 1.72; 95% CI, 1.12–2.64; P = 0.01) after stroke. Surgical timing did not affect the risk of perioperative ischemic or hemorrhagic stroke or 1-year survival. Conclusions In patients with valvular IE complicated by ischemic stroke, early surgery is associated with an increased risk of operative mortality, with no observed benefit in 1-year survival.

Early surgery of multiligament knee injuries may yield better results than delayed surgery: a systematic review

2018 ◽  
Vol 4 (1) ◽  
pp. 26-32 ◽  
Author(s):  
Ujash Sheth ◽  
Jhase Sniderman ◽  
Daniel B Whelan
Keyword(s):  
Systematic Review ◽  
Range Of Motion ◽  
Functional Outcomes ◽  
Knee Injury ◽  
Knee Injuries ◽  
Early Surgery ◽  
Optimal Timing ◽  
Level Of Evidence ◽  
Delayed Surgery ◽  
Multiligament Knee Injuries

ImportanceMultiligament knee injuries are rare, but can lead to significant functional limitations. Surgery has been shown to improve outcomes, however, there remains considerable debate regarding the optimal timing of surgery.ObjectiveWe aimed to determine whether early surgery in the setting of a multiligamentous knee injury was associated with superior functional outcomes when compared with surgery on a delayed basis.Evidence reviewA comprehensive literature search of the MEDLINE, EMBASE and PubMed databases was conducted up to March 2018. We identified studies with a sample size greater than 10 that included subjects with an injury to at least two of the four major knee ligaments and compared outcomes between early and delayed surgery. We assessed the methodological quality of each included study using the Newstead-Ottawa Scale.FindingsWe identified 11 eligible studies, including a total of 320 patients (195 early and 125 delayed). The mean time to surgery among patients treated early was 11.2 days in comparison to 294.8 days for the delayed group. Early surgery was found to have a statistically significantly higher Lysholm score (p<0.0001) and Meyers rating (p=0.02) when compared with delayed surgery. No statistically significant differences in International Knee Documentation Committee, Tegner Activity Scale, total arc of motion, loss of extension or loss of flexion were demonstrated between early and delayed surgery. Early surgery was noted to have a statistically significantly higher odds of requiring a manipulation under anaesthesia or arthrolysis (p=0.04), however, subsequent subgroup analysis showed no difference between early and delayed surgery when only studies employing an early range of motion protocol were pooled.Conclusions and relevanceBased on the current body of literature, which primarily consists of level IV evidence, early surgery in the setting of multiligament knee injury may provide better functional outcomes without compromising range of motion when using early postoperative mobilisation protocols. Further studies of higher quality are required to corroborate these findings.Level of evidenceLevel IV, systematic review.

Acute Traumatic Cervical Facet Fractures

2018 ◽  
Vol 1 (2) ◽  
pp. 5
Author(s):  
Shankar Gopinat
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Early Surgery ◽  
Initial Assessment ◽  
Trauma Patients ◽  
Spinal Stability ◽  
Fracture Patterns ◽  
Spine Ct ◽  
Cervical Facet

Acute cervical facet fractures are increasingly being detected due to the use of cervical spine CT imaging in the initial assessment of trauma patients. For displaced cervical facet fractures with dislocations and subluxations, early surgery can decompress the spinal cord and stabilize the spine. For patients with non-displaced cervical facet fractures, the challenge in managing these patients is the determination of spinal stability. Although many of the patients with non-displaced cervical facet fractures can be managed with a cervical collar, the imaging needs to be analyzed carefully since certain fracture patterns may be better managed with early surgical stabilization.

scholarly journals Development of priorities for a Canadian strategy to advance activity-based therapies after spinal cord injury

Spinal Cord ◽  
2021 ◽  
Author(s):  
Kristin E. Musselman ◽  
Kristen Walden ◽  
Vanessa K. Noonan ◽  
Hope Jervis-Rademeyer ◽  
Nancy Thorogood ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Stroke Rehabilitation ◽  
Participatory Design ◽  
Best Practice ◽  
Optimal Timing ◽  
Activity Levels ◽  
Cord Injury ◽  
Healthcare Administrators ◽  
Psychosocial Benefits

Abstract Study Design Participatory design. Objectives Activity-based therapies (ABT) have physical and psychosocial benefits for individuals with spinal cord injury (SCI). A Canadian ABT summit was held to: (1) identify methods used in stroke rehabilitation that may be appropriate for SCI; (2) understand the current state of ABT activities in Canada; and (3) identify priorities for ABT research and care for the next five years. Setting Stakeholder-engaged meeting at a tertiary rehabilitation hospital. Methods Thirty-nine stakeholders, including individuals with SCI, frontline clinicians, healthcare administrators, researchers, funders and health policy experts, attended. Two participants were note-takers. Priority identification occurred through input from stakeholder groups, followed by individual voting. Conventional content analysis was used to synthesize the information in the meeting notes. Results The strengths of ABT in stroke rehabilitation included clear and clinically feasible definitions, measurements and interventions, and recognized requirements for implementation (e.g. behavior change, partnerships). Knowledge gaps concerning ABT activities in Canada were identified for acute and community settings, non-traumatic populations, and the interventions, equipment and standardized measures (i.e. upper limb, activity levels) used. Five priorities for ABT across the continuum of care were identified: (1) Identify current ABT activities; (2) Create a network to facilitate dialog; (3) Track engagement in ABT activities; (4) Develop and implement best practice recommendations; and (5) Study optimal timing, methods, and dose of ABT. Working groups were formed to address priorities 1–3. Conclusions The priorities will guide SCI research and care activities in Canada over the next five years. Sponsorship Praxis Spinal Cord Institute.

scholarly journals The need to study human milk as a biological system

2021 ◽  
Author(s):  
Parul Christian ◽  
Emily R Smith ◽  
Sun Eun Lee ◽  
Ashley J Vargas ◽  
Andrew A Bremer ◽  
...  
Keyword(s):  
Human Milk ◽  
Biological System ◽  
System Development ◽  
Full Range ◽  
Milk Composition ◽  
Postnatal Period ◽  
Research Strategy ◽  
Optimal Timing ◽  
Conceptual Approach ◽  
Technological Advances

ABSTRACT Critical advancement is needed in the study of human milk as a biological system that intersects and interacts with myriad internal (maternal biology) and external (diet, environment, infections) factors and its plethora of influences on the developing infant. Human-milk composition and its resulting biological function is more than the sum of its parts. Our failure to fully understand this biology in a large part contributes to why the duration of exclusive breastfeeding remains an unsettled science (if not policy). Our current understanding of human-milk composition and its individual components and their functions fails to fully recognize the importance of the chronobiology and systems biology of human milk in the context of milk synthesis, optimal timing and duration of feeding, and period of lactation. The overly simplistic, but common, approach to analyzing single, mostly nutritive components of human milk is insufficient to understand the contribution of either individual components or the matrix within which they exist to both maternal and child health. There is a need for a shift in the conceptual approach to studying human milk to improve strategies and interventions to support better lactation, breastfeeding, and the full range of infant feeding practices, particularly for women and infants living in undernourished and infectious environments. Recent technological advances have led to a rising movement towards advancing the science of human-milk biology. Herein, we describe the rationale and critical need for unveiling the multifunctionality of the various nutritional, nonnutritional, immune, and biological signaling pathways of the components in human milk that drive system development and maturation, growth, and development in the very early postnatal period of life. We provide a vision and conceptual framework for a research strategy and agenda to change the field of human-milk biology with implications for global policy, innovation, and interventions.

scholarly journals CTNI-03. IMAGING FEATURES OF LEPTOMENINGEAL METASTASES OF NON-SMALL CELL LUNG CANCER: A SINGLE-CENTER REAL-WORLD STUDY

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii41-ii41
Author(s):  
Junjie Zhen ◽  
Lei Wen ◽  
Shaoqun Li ◽  
Mingyao Lai ◽  
Changguo Shan ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Type A ◽  
Brain Parenchyma ◽  
Imaging Features ◽  
Type B ◽  
Type D ◽  
Mri Examination ◽  
Mri Features ◽  
Brain And Spinal Cord ◽  
The Brain

Abstract BACKGROUND According to EANO-ESMO clinical practice guidelines, the MRI findings of LM are divided into 4 types, namely linear enhancement (type A), nodular enhancement (type B), linear combined with nodular enhancement (type C), and sign of hydrocephalus (type D). METHODS The MRI features of brain and spinal cord in patients diagnosed with NSCLC-LM in Guangdong Sanjiu Brain Hospital from 2010 until 2019 were investigated, and then were classified into 4 types. The imaging features were analyzed. RESULTS A total of 80 patients were enrolled in the study. The median age of the patients was 53.5 years old, and the median time from the initial diagnosis to the confirmed diagnosis of LM was 11.6 months. The results of enhanced MRI examination of the brain in 79 cases showed that the number of cases with enhancements of type A, B, C and D were 50 (63.3%), 0, 26 (32.9%) and 3 (3.8%), respectively, and that LM with metastases to the brain parenchyma was found in 42 cases (53.2%). The results of enhanced MRI examination of spinal cord in 59 cases showed that there were only enhancements of type A and C in 40 cases (67.8%) and 3 cases (5.0%), and no enhancement sign in the other 16 cases (27.2%). CONCLUSION MRI examination of brain and spinal cord will improve the detection rate of LM. The MRI features of NSCLC-LM in real world are mainly characterized by the linear enhancements of brain and spinal cord, followed by linear combined with nodular enhancement. The enhancements of type B and type D are rare in clinic. Almost half of the patients have LM and metastases to the brain parenchyma. Therefore, the differentiation of tumor metastases is needed to be paid attention to for the early diagnosis and the formulation of reasonable treatment plans.

scholarly journals Effects of Cultured Adrenal Chromaffin Cell Implants on Hindlimb Reflexes of the6-OHDA Lesioned Rat

1994 ◽  
Vol 5 (2) ◽  
pp. 89-102 ◽  
Author(s):  
Bruce E. Pulford ◽  
Andrea R. Mihajlov ◽  
Howard O. Nornes ◽  
L. Ray Whalen
Keyword(s):  
Spinal Cord ◽  
Glyoxylic Acid ◽  
Reflex Activity ◽  
Emg Activity ◽  
Lumbar Region ◽  
Adrenal Chromaffin Cell ◽  
Electrophysiological Testing ◽  
Withdrawal Reflexes ◽  
6 Hydroxydopamine ◽  
Adrenal Chromaffin

The effects of implantation of cultured adrenal medullary cells on the recovery of neurotransmitter specific reflex activity were studied in the rat spinal cord using electrophysiological testing methods. Cell suspensions of cultured neonatal adrenal medullary chromaffin (AM) cells (which produce catecholamines), or Schwann (Sc) cells (controls) were implanted into the lumbar region of the spinal cord 2 weeks after catecholamine (CA) denervation by intracisternal injection of 6-hydroxydopamine (6-OHDA). All cells were taken from 7 day neonates and cultured for 10 days in the presence of nerve growth factor (NGF). Three months after implantation, the extent of implant-associated recovery of reflex activity was determined by measuring electromyogram (EMG) activity and force associated with the long latency component of the hindlimb withdrawal reflex (which is CA modulated). After the electrophysiological testing, rats were anesthetized, and the spinal cords were rapidly removed and frozen. Spinal cords were sectioned longitudinally, and implanted cells were visualized using glyoxylic acid techniques. Labelled sections were examined to determine cell survival. Results indicate that 1) chromaffin cells survive for 3 months in the segments of the cord into which they have been implanted and 2) rats implanted with AM cells have significantly more forceful withdrawal reflexes than those that received Sc cells or received no implant after lesioning.

The volume of true heterotopies of the spinal cord

1902 ◽  
Vol 2 (11-12) ◽  
pp. 612-630
Author(s):  
V. Methodiev
Keyword(s):  
Spinal Cord ◽  
Lumbar Region ◽  
Normal Spine ◽  
Lower Lumbar

Here it is necessary to disassemble separately the doubling of the spinal cord in the normal spine and the doubling that sometimes accompanies the so-called. spinam bifidam (mainly in the lower lumbar region).

Abstract 12572: Early Surgical Treatment versus Initial Conservative Management for Asymptomatic Severe and Very Severe Aortic Stenosis: A Meta-analysis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Yujiro Yokoyama ◽  
Hisato Takagi ◽  
Toshiki Kuno
Keyword(s):  
Aortic Stenosis ◽  
Cardiovascular Mortality ◽  
Severe Aortic Stenosis ◽  
Meta Analysis ◽  
Early Surgery ◽  
Optimal Timing ◽  
Aortic Valve Area ◽  
Conservative Strategy ◽  
Subgroup Analyses ◽  
All Cause Mortality

Background: Although current guidelines generally recommend watchful waiting strategy for patients with asymptomatic severe aortic stenosis (AS) until symptoms develop, the optimal timing of surgical intervention remains controversial. Objective: This study aimed to compare the outcomes of early surgery vs. conservative strategy for patients with asymptomatic severe AS. Methods: MEDLINE and EMBASE were searched through February, 2020 to identify clinical trials that investigatedearly surgery and conservative strategy for patients with asymptomatic severe AS. From each study, we extracted the hazard ratio (HR) of all-cause mortality and cardiovascular mortality. Subgroup analyses were conducted by dividing into severe AS (peak aortic jet velocity [Vmax] ≥4.0 m/s, mean aortic pressure gradient [PG] ≥40 mmHg, or aortic valve area [AVA] ≤1.0 cm 2 ) and very severe AS (Vmax ≥4.5 m/s, mean PG ≥50 mmHg, or AVA ≤0.75 cm 2 ) groups. Results: 1 randomized controlled, 7 observational trials were identified. Pooled analyses demonstrated that all-cause mortality and cardiovascular mortality for early surgery were significantly lower compared to conservative strategy (HR [95% Confidence Interval [CI]] =0.49 [0.36-0.68]; P <0.0001, HR [95% CI] =0.42 [0.22-0.82]; P =0.01, respectively). Subgroup analyses showed significant reduction for early surgery in all-cause mortality (severe AS: HR [95% CI] =0.52 [0.35-0.78]; P =0.001, very severe AS: HR [95% CI] =0.38 [0.17-0.85]; P =0.02). Conclusions: We demonstrated that early surgery was associated with significant reduction in all-cause and cardiovascular mortality in patients with severe AS. Further randomized trials are warranted to confirm our findings.

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