scholarly journals Evaluation of Outcome of Timing of Surgical Intervention on Cauda Equina Syndrome

2021 ◽  
Vol 20 (1) ◽  
pp. 19-23
Author(s):  
Rajesh Pratap Shah ◽  
Bishnu Babu Thapa ◽  
Sushil Rana Magar ◽  
Ritesh Sinha ◽  
Pankaj Chand ◽  
...  
Keyword(s):  
Cauda Equina Syndrome ◽  
Tertiary Care ◽  
Cauda Equina ◽  
Timing Of Surgery ◽  
Bladder Function ◽  
Delayed Presentation ◽  
Inclusion Criteria ◽  
Permanent Disability ◽  
Number Of Patients

Introduction: Cauda equina syndrome (CES) is a rare clinical entity caused by compression of lumbar and sacral nerve roots resulting in various neurological dysfunctions. Early diagnosis of the syndrome and timely intervention is required to prevent permanent disability. Methods: This is a retrospective study conducted from January 2013 to December 2017 in a tertiary care centre in Kathmandu, Nepal. All the cases meeting the inclusion criteria were included in the study. Patients were operated using posterior open discectomy and the outcome was evaluated at  two weeks , one month, three months, six months and one year. Result: Total number of patients meeting the inclusion criteria was 10, two females and eight males with a mean age of 40.30 + 6.58 years. The mean time for onset of symptom to timing of surgery was 142 hrs. VAS for leg improved from 5.90 + 0 .738 to 0.70 + 0.483 and VAS for back pain improved from 3.20 + 1.476 to 0.5 + 0.572 post operatively. There was improvement in sensory and motor function in all the cases. Bowel and bladder function improved in all the cases postoperatively at the time of final follow up. Sexual function was impaired in six patients preoperatively but postoperatively four had improved and two patients had poor result at the time of final follow up. Conclusions: Timing of surgery may not be the most important determining factor for the outcome of the CES. Surgical decompression in delayed presentation have good clinical outcome in CES.

scholarly journals Acute bilateral foot drop with or without cauda equina syndrome—a case series

2021 ◽  
Vol 163 (4) ◽  
pp. 1191-1198
Author(s):  
Andreas K. Demetriades ◽  
Marco Mancuso-Marcello ◽  
Asfand Baig Mirza ◽  
Joseph Frantzias ◽  
David A. Bell ◽  
...  
Keyword(s):  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Case Series ◽  
Foot Drop ◽  
Spinal Disease ◽  
Full Resolution ◽  
Degenerative Spinal Disease ◽  
The Mean ◽  
The One

Abstract Introduction Isolated acute bilateral foot drop due to degenerative spine disease is an extremely rare neurosurgical presentation, whilst the literature is rich with accounts of chronic bilateral foot drop occurring as a sequela of systemic illnesses. We present, to our knowledge, the largest case series of acute bilateral foot drop, with trauma and relevant systemic illness excluded. Methods Data from three different centres had been collected at the time of historic treatment, and records were subsequently reviewed retrospectively, documenting the clinical presentation, radiological level of compression, timing of surgery, and degree of neurological recovery. Results Seven patients are presented. The mean age at presentation was 52.1 years (range 41–66). All patients but one were male. All had a painful radiculopathic presentation. Relevant discopathy was observed from L2/3 to L5/S1, the commonest level being L3/4. Five were treated within 24 h of presentation, and two within 48 h. Three had concomitant cauda equina syndrome; of these, the first two made a full motor recovery, one by 6 weeks follow-up and the second on the same-day post-op evaluation. Overall, five out of seven cases had full resolution of their ankle dorsiflexion pareses. One patient with 1/5 power has not improved. Another with 1/5 weakness improved to normal on the one side and to 3/5 on the other. Conclusion When bilateral foot drop occurs acutely, we encourage the consideration of degenerative spinal disease. Relevant discopathy was observed from L2/3 to L5/S1; aberrant innervation may be at play. Cauda equina syndrome is not necessarily associated with acute bilateral foot drop. The prognosis seems to be pretty good with respect to recovery of the foot drop, especially if partial at presentation and if treated within 48 h.

178 Suspected Cauda Equina Syndrome in a District General Hospital

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
L Ellerton ◽  
H Benjamin-Laing ◽  
W J Harrison
Keyword(s):  
General Hospital ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
District General Hospital ◽  
Bladder Function ◽  
Mri Scan ◽  
Eligibility Criteria ◽  
Joint Project ◽  
Tertiary Centre ◽  
Patient Morbidity

Abstract Introduction Cauda Equina Syndrome (CES) is rare but when the diagnosis is delayed patient morbidity is significant. Recently, NICE Clinical Knowledge Summaries have updated their red flags on CES to be more explicit enabling earlier referral and diagnosis. A joint project between Orthopaedics and Radiology departments aimed to assess the current pathway of Cauda Equina Investigation at a District General Hospital. Method Data was collected from the local Radiology database for requests between July 2017 and August 2018. This included both direct requests to assess for CES and implied. Raw data revealed a potential of 600 patients, of which we have analysed 332 patients met the eligibility criteria. Results Only 58 patients had a documented complete bladder function assessment, of those 33% had incomplete or partial bladder emptying. Time to MRI scan ranged from 50mins – 23 hours & 52 mins. 47% had negative scans with CES or Cord compromise on MRI scan was demonstrated on 9%. 23 patients were transferred urgently to the receiving tertiary centre. Conclusions We found that nearly 90% of patients were being incompletely assessed and time to scan ranged significantly. We are producing a trust wide suspected CES pathway to improve patient assessment.

scholarly journals Interruzione del trattamento nei pazienti con schizofrenia che ricevono olanzapina o aripiprazolo: metanalisi degli studi clinici controllati

2005 ◽  
Vol 6 (1) ◽  
pp. 69-76
Author(s):  
Benedetta Santarlasci ◽  
Giovanni Biricolti ◽  
Cecilia Orsi
Keyword(s):  
Treatment Group ◽  
Literature Search ◽  
Drop Out ◽  
Inclusion Criteria ◽  
Antipsychotic Therapy ◽  
Therapy Discontinuation ◽  
Randomized Controlled ◽  
Drop Out Rate ◽  
Number Of Patients

BACKGROUND: In schizophrenia the drop-out rate can be used as proxy of effectiveness. The drop-out evaluation is also important considering the relevant economic impact for NHS of an antipsychotic therapy discontinuation in terms of patient hospitalization and other related healthcare resources consumption. OBJECTIVE: To analyze the differences in the rates of drop-out from clinical trials between olanzapine and aripiprazole. METHODS: Literature search was based on MEDLINE, on Iowa-IDIS and Drugdex databases (1966-Dec 2004). Analysis included 12 randomized controlled trials (3.778 patients), 8 for olanzapine (2.559 patients) and 4 for aripiprazole (1.219 patients). RCT inclusion criteria were: a) Patients affected by schizophrenia; b) Randomized assignment to olanzapine or aripiprazole treatment group; c) Number of patients included in the treatment group higher than 100; d) Drop-out frequency evaluation between 4th and 26th weeks of follow-up. RESULTS: The rate of treatment discontinuation was greater for aripiprazole than for olanzapine (42,2% vs. 31,6% respectively). The comparison between drop-out percentages is statistically significant (p

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>

scholarly journals EVALUATION AND SELECTION OF CANDIDATES FOR LIVER TRANSPLANTATION: AN ECONOMIC PERSPECTIVE

2020 ◽  
Vol 57 (1) ◽  
pp. 31-38 ◽  
Author(s):  
Santiago RODRÍGUEZ ◽  
Fabio Da MOTTA ◽  
Giacomo BALBINOTO NETO ◽  
Ajacio BRANDÃO
Keyword(s):  
Liver Transplantation ◽  
Care Center ◽  
Tertiary Care ◽  
Deceased Donor ◽  
Waiting List ◽  
Transplant Center ◽  
Number Of Patients ◽  
Common Problems ◽  
Selection Of

ABSTRACT BACKGROUND: Over the next 20 years, the number of patients on the waiting list for liver transplantation (LTx) is expected to increase by 23%, while pre-LTx costs should raise by 83%. OBJECTIVE: To evaluate direct medical costs of the pre-LTx period from the perspective of a tertiary care center. METHODS: The study included 104 adult patients wait-listed for deceased donor LTx between October 2012 and May 2016 whose treatment was fully provided at the study transplant center. Clinical and economic data were obtained from electronic medical records and from a hospital management software. Outcomes of interest and costs of patients on the waiting list were compared through the Kruskal-Wallis test. A generalized linear model with logit link function was used for multivariate analysis. P-values <0.05 were considered statistically significant. RESULTS: The costs of patients who underwent LTx ($8,879.83; 95% CI 6,735.24-11,707.27; P<0.001) or who died while waiting ($6,464.73; 95% CI 3,845.75-10,867.28; P=0.04) were higher than those of patients who were excluded from the list for any reason except death ($4,647.78; 95% CI 2,469.35-8,748.04; P=0.254) or those who remained on the waiting list at the end of follow-up. CONCLUSION: Although protocols of inclusion on the waiting list vary among transplant centers, similar approaches exist and common problems should be addressed. The results of this study may help centers with similar socioeconomic realities adjust their transplant policies.

scholarly journals Outcome of Surgical Treatment for Lumber Disc Herniation Causing Painful Incomplete Foot-Drop

2020 ◽  
Vol 24 (3) ◽  
Author(s):  
MUSAWER KHAN ◽  
AKRAM ULLAH ◽  
ADNAN AHMED ◽  
MUMTAZ ALI ◽  
MANSOOR AHMAD
Keyword(s):  
Surgical Treatment ◽  
Pain Relief ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Foot Drop ◽  
Disc Disease ◽  
Lumbar Disc Disease ◽  
Number Of Patients

Objective:  To determine the outcome of surgical treatment for lumder disc herniation causing the painful incomplete foot drop. Material and Methods:  This retrospective observational study was conducted at the Department of Neurosurgery Lady Reading Hospital, Peshawar. Both Male and female patients with lumbar disc disease causing unilateral incomplete painful foot drop were included in our study. Patients with complete or painless foot drop, bilateral foot-drop, Multiple level disc prolapse, cauda equina syndrome or sciatic neuropathy due to injection injury were excluded. Patients were followed was post-operatively in terms of power in foot dorsiflexion, medical research council (MRC) grade and pain relief  on a Visual Analogue Scale (VAS) after 1 month and then after 6 months. Results: Total number of patients included were 43. Age was ranging from 18 years to 54 years and mean age was 33 years. Before surgery,  power of MRC grade 3 or less, but greater than 1 in dorsiflexion was noted in all patients. The pain was scaled using VAS. Post peratively, at 1 month follow up, the foot-drop improved to MRC grade 4 or 5 along with pain relief of ≥ 2 points on VAS in 81. 4% (n = 35) patients and at 6 month follow-up, the figure rose to 93% (n = 40). Conclusion:  Lumbar disc disease can cause a debilitating foot-drop and pain. Improving or restoring a neurology early surgical intervention has proven benefits.

scholarly journals COVID 19 pandemic and cancer treatment: experience at a tertiary care centre

2020 ◽  
Vol 7 (7) ◽  
pp. 1055
Author(s):  
Abhishek Pathak ◽  
Anvesh Rathore ◽  
Rajan Kapoor ◽  
Subhash Ranjan ◽  
Alpana Gupta
Keyword(s):  
Cancer Treatment ◽  
Tertiary Care ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Average Delay ◽  
Treatment Experience ◽  
Exact Number ◽  
Number Of Patients ◽  
Working Principle

Background: In these era COVID Pandemic patients are missing their chemotherapy due to multiple reasons. This study was undertaken to quantify the exact number of patients who had missed their appointment for chemotherapy.Methods: All patients who had appointments for chemotherapy from 20th Mar to 20th Apr were included in the study. Details of malignancies, chemotherapy, duration of delay in patients coming for chemotherapy to be recorded.Results: The total number appointments given for chemotherapy for various malignancies were 301 patients for various malignancies for the duration 20th March to 20th April. The total number of appointments given were 301. Out of the total of 301 patients who had appointment for chemotherapy during this period 131 patients could be given chemotherapy and 170 could not be given chemotherapy. The average delay was of 9 days. The data was distributed into four weeks from 20th March to 20th April. Just before the country wide lock down in first week 20th, 70 patients receiving chemotherapy which drastically reduced in later weeks. Both the cases who could come for chemotherapy and those who could not have been kept under follow up, up to 6 months to reassess their response.Conclusions: This article has been written to highlight the number of patients who could not receive chemotherapy due to ongoing Pandemic with an intention to follow them up for 6 months. Since this pandemic is here to stay it is very important that formulate the working principle for administering chemotherapy.

Safety and tolerability of immune checkpoint therapies and related adverse effects at a tertiary care hospital in Saudi Arabia.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e14082-e14082
Author(s):  
Mohammed Al Nuhait ◽  
Yousef Al Awlah ◽  
Eshtyag Bajnaid
Keyword(s):  
Adverse Effects ◽  
Adverse Events ◽  
Immune Checkpoint ◽  
Adverse Drug Events ◽  
Tertiary Care ◽  
Adult Patients ◽  
Care Hospital ◽  
Inclusion Criteria ◽  
Number Of Patients ◽  
Grade 3

e14082 Background: Immunotherapies associated with many toxicities with a potential immune-mediated cause and has been associated with many adverse events in the literature. As the incidence of emergency room (ER) visits in adult patients receiving immune checkpoint therapies and most frequent immune-related adverse events are not yet established well for our population since this class of medications is newly introduced in the oncology field. This research is aimed to shed the light on this new class of medications. Methods: This is a single-center retrospective cohort study to determine incidence of ER visits in adult patients receiving immune checkpoint therapies and to explore most frequent related adverse events. The study involved adult patients who were treated at King Abdulaziz Medical City. Study participants were identified by identified using our electronic health care system to identify patients who were treated with immunotherapies during the study period (January 2016 to December 2018). Inclusion criteria was patients aged more than 18 years who had received immunotherapies. Results: A total of 53 patients met the specified inclusion criteria for our study. The number of patients in each treatment group were as follows: Nivolumab 37, Atezolizumab 10 and Pembrolizumab 6. Average age was 59 years. The percentages of cancer patients presenting to the ER with various related adverse effects after beginning immune checkpoint therapy were (65%) Nivolumab, (80%) Atezolizumab and (83%) Pembrolizumab. The average number of ER visits after beginning immune checkpoint therapy was 3 visits (SD = 2.8). Renal adverse events were occurred following the immunotherapy use, 9 patients (17%) and none of cases experienced a grade≧3 event. 13 patients (24.5%) experienced hepatic adverse event. Only one patient experienced a grade≧3 event that lead to discontinuation of treatment. For diarrhea, among all patients received the immunotherapies, 14 (26%) experience diarrhea and five of them experience grade≧3 event. Thyroxine abnormalities occurred in 7 patients (13%) after use of immunotherapies. (7.5 %) of patients had pneumonitis with immunotherapy. Other adverse events were noted with immune therapies (skin reaction, nausea, vomiting, thrombocytopenia, neutropenia and neurological adverse events). All others adverse events that is reported had a grade 1-2 adverse events. Conclusions: Patients treated with immunotherapies may have a spectrum of adverse drug events that might lead to discontinue the treatment and increase ER visits.

Percutaneous Endoscopic Lumbar Discectomy for Treating Cauda Equina Syndrome Due To Lumbar Disc Herniation

2021 ◽  
Author(s):  
Hai-Chao He ◽  
Xiao-qiang LV ◽  
Yong-Jin Zhang
Keyword(s):  
Back Pain ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Cauda Equina Syndrome ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Lumbar Discectomy ◽  
Leg Pain ◽  
Endoscopic Lumbar Discectomy

Abstract Background In recent decades, endoscopic techniques to treat lumbar disc herniation (LDH) have gained popularity in clinical practice. However, there is little literature on the use of percutaneous endoscopic lumbar discectomy (PELD) to treat cauda equina syndrome (CES) due to LDH. This study aims to evaluate the feasibility and clinical efficacy of PELD for treating CES caused by disc herniation, and as well as to report some technical strategies. Methods Between October 2012 and April 2018, 15 patients with CES caused by LDH at the early and intermediate stages of Shi’s classification were selected as the subjects of study, and underwent PELD. All patients were followed up for at least two years. The patients’ back pain and leg pain were evaluated using visual analogue scale (VAS) scores and the Oswestry Disability Index (ODI). Patient satisfaction was evaluated using the MacNab outcome scale. Clinical outcomes were measured preoperatively and at 3 days, 3 months, 6 months and the last follow-up. Results The VAS score for back pain, leg pain and ODI score significantly decreased from preoperatively scores of 6.67 ± 1.05, 7.13 ± 1.19 and 62.0 ± 6.85 respectively, to postoperatively cores of 1.80 ± 0.41, 1.47 ± 0.52 and 12.93 ± 1.03 at the last follow-up postoperatively. These postoperative scores were all significantly different compared with preoperative scores (P < 0.01). According to the modified MacNab outcome scale, 86.67% of these patients had excellent and good outcomes at the final follow-up. Complications included one patient with cerebrospinal fluid leakage and one patient who developed recurrent herniation; the latter patient finally achieved satisfactory results after reoperation. Conclusion PELD could be used as an alternative surgical method for the treatment of CES due to LDH in properly selected cases and appropriate patient selection. However, the operator should pay attention to foraminoplasty to enlarge the working space.

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