Variability of intraoperative electrostimulation parameters in conscious individuals: language cortex

OBJECTIVEElectrostimulation in awake brain mapping is widely used to guide tumor removal, but methodologies can differ substantially across institutions. The authors studied electrostimulation brain mapping data to characterize the variability of the current intensity threshold across patients and the effect of its variations on the number, type, and surface area of the essential language areas detected.METHODSOver 7 years, the authors prospectively studied 100 adult patients who were undergoing intraoperative brain mapping during resection of left hemisphere tumors. In all 100 cases, the same protocol of electrostimulation brain mapping (a controlled naming task—bipolar stimulation with biphasic square wave pulses of 1-msec duration and 60-Hz trains, maximum train duration 6 sec) and electrocorticography was used to detect essential language areas.RESULTSThe minimum positive thresholds of stimulation varied from patient to patient; the mean minimum intensity required to detect interference was 4.46 mA (range 1.5–9 mA), and in a substantial proportion of sites (13.5%) interference was detected only at intensities above 6 mA. The threshold varied within a given patient for different naming areas in 22% of cases. Stimulation of the same naming area with greater intensities led to slight changes in the type of response in 19% of cases and different types of responses in 4.5%. Naming sites detected were located in subcentimeter cortical areas (50% were less than 20 mm2), but their extent varied with the intensity of stimulation. During a brain mapping session, the same intensity of stimulation reproduced the same type of interference in 94% of the cases. There was no statistically significant difference between the mean stimulation intensities required to produce interfereince in the left inferior frontal lobe (Broca's area), the supramarginal gyri, and the posterior temporal region.CONCLUSIONSIntrasubject and intersubject variations of the minimum thresholds of positive naming areas and changes in the type of response and in the size of these areas according to the intensity used may limit the interpretation of data from electrostimulation in awake brain mapping. To optimize the identification of language areas during electrostimulation brain mapping, it is important to use different intensities of stimulation at the maximum possible currents, avoiding afterdischarges. This could refine the clinical results and scientific data derived from these mapping sessions.

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Clinical Results Of A Lamina With Spinous Process And An Iliac Graft As Bone Grafts In The Surgical Treatment Of Single-Segment Lumbar Pyogenic Discitis: A Retrospective Cohort Study

10.21203/rs.3.rs-49502/v1 ◽

2020 ◽

Author(s):

Weiyang Zhong ◽

Xinjie Liang ◽

Xiaolin Wang ◽

Ke Tang ◽

Tianji Huang ◽

...

Keyword(s):

Hospital Stay ◽

Spinous Process ◽

Bone Grafts ◽

Clinical Results ◽

Single Segment ◽

Significant Difference ◽

Group A ◽

The Mean ◽

Group B ◽

Segmental Angle

Abstract Background: A retrospective study investigated and compared the results of a lamina withspinous process (LSP) and an iliac graft (IG) as bone grafts in single-segment lumbar pyogenic discitis (LPD) through one-stage-posterior-only approach with radical debridement and internal instrumentation.Methods: Data from 37 patients were reviewed. A LSP was placed in 17 patients (group A), and an IG was implemented in 20 patients (group B). The surgery time, surgery hemorrhage, hospital stay, drainage, and follow-up (FU) were reviewed. The visual analogue scale (VAS), Oswestry Disability Index (ODI), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, segmental angle, intervertebral height and bony fusion time were compared preoperatively and at the final FU.Results: All patients were followed-up for a mean of 27.94±2.35 months in group A and 30.29±1.89 months in group B, without a difference. The mean age was younger in group A than in group B (P<0.05). The surgery time, surgery hemorrhage, and hospitalization cost were lower in group A than in group B (P<0.05), except for the hospital stay and drainage time. Fever occurred in 10 patients in group A and 12 patients in group B. The ESR, CRP level, and VAS and ODI scores were significantly decreased, and there were no significant differences between the groups at the final FU. The distribution of bacterial agents in blood culture was 1 case of Aerobacter cloacae, 2 of Staphylococcus aureus, 2 of Escherichia coli, and 1 of Streptococcus viridis in group A and 1 of S. aureus，1 of Staphylococcus warneri and 2 of Klebsiella pneumoniae in group B. Pyogenic infection was observed in the pathological findings of all patients. No significant difference was found in the mean segmental angle or mean intervertebral height preoperation and at the final FU between the groups.Conclusion: The use of LSP as a new bone graft is reliable, safe, and effective for surgical management for the LPD while surgery is proposed as a good management strategy for LPD in carefully selected patients.

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Comparison Of Medial Arch-Supporting Insoles And Heel Pads In The Treatment Of Plantar Fasciitis

Serbian Journal of Experimental and Clinical Research ◽

10.1515/sjecr-2015-0006 ◽

2015 ◽

Vol 16 (1) ◽

pp. 39-42 ◽

Cited By ~ 2

Author(s):

Melih Malkoc ◽

Ozgur Korkmaz ◽

Adnan Kara ◽

Ismail Oltulu ◽

Ferhat Say

Keyword(s):

Daily Activity ◽

Plantar Fasciitis ◽

Plantar Fascia ◽

Clinical Results ◽

Activity Score ◽

Vas Score ◽

Sporting Activity ◽

Significant Difference ◽

The Mean

ABSTRACTPlantar fasciitis is a disorder caused by inflammation of the insertion point of the plantar fascia over the medial tubercle of the calcaneus. Foot orthotics are used to treat plantar fasciitis. Heel pads medialise the centre of force, whereas medial arch supporting insoles lateralise the force. We assessed the clinical results of the treatment of plantar fasciitis with silicone heel pads and medial arch-supported silicone insoles.We retrospectively reviewed 75 patients with heel pain. A total of 35 patients in the first group were treated with medial arch supporting insoles, and 40 patients in the second group were treated with heel pads. The patients were evaluated with the Visual Analogue Scale (VAS) and the Foot and Ankle Ability Measure (FAAM) at the first and last examinations.The mean VAS score in the first group was 8.6±1,2 (6-10); the FAAM daily activity score was 66.2±16 (41.2-95.0), and the sporting activity score was 45.4±24,4 (0.1-81) before treatment. At the last follow-up in this group, the mean VAS score was 5.3±1,5 (0-9); the FAAM daily activity score was 83,0±15,1 (55,9-100), and the sporting activity score was 73,5±26,2 (25-100). The mean VAS score in the second group was 8,6±0,9 (7-10); the FAAM daily activity score was 66.4±17 (41.4-95.2), and the sporting activity score was 45.8±24,2 (0.8-81, 3) before the treatment. At the last follow-up in this group, the mean VAS score was 5.5±1,2 (0-9); the FAAM daily activity score was 83.4±14,9 (60, 2-100), and the sporting activity score was 73.8±26 (28-100).There was no significant difference in the clinical results of both groups. The force distribution by the use of silicone heel pads and medial arch-supported silicone insoles had no effect on the clinical results of the treatment of plantar fasciitis.

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Fexofenadine Treatment of Atopic Dogs: Preliminary Clinical Results

Acta Veterinaria Brno ◽

10.2754/avb200675040549 ◽

2006 ◽

Vol 75 (4) ◽

pp. 549-555 ◽

Cited By ~ 2

Author(s):

A. Plevnik ◽

T. Kotnik ◽

S. Kobal

Keyword(s):

Atopic Dermatitis ◽

Severity Index ◽

Clinical Results ◽

Efficacy And Safety ◽

Time Points ◽

The Third ◽

Study Results ◽

Significant Difference ◽

Severity Index Score ◽

The Mean

The purpose of our study was to investigate the efficacy and safety of the antihistamine fexofenadine versus methylprednisolone in dogs with atopic dermatitis. Eight dogs were included in the study and randomly allocated to two groups of four animals. The first group (F) received oral fexofenadine and the second group (M) received methylprednisolone. Over a period of 6 weeks, we evaluated the CADESI (Canine Atopic Dermatitis Extent Severity Index) score and the pruritus score and made measurements of biochemical blood indicators (AP, ALT, AST, urea, creatinine) on three occasions. The study results did not reveal any statistically significant differences compared to baseline in AST, ALT, AP, urea and creatinine values in any of the treated groups and at any of the time points during the treatment (p > 0.112). The mean CADESI values and the severity of pruritus were reduced by more than 50% in both groups during the treatment course. There were no statistically significant differences between group M and group F. A statistically significant difference compared to the baseline was found in the reduction of the CADESI score in group F in the sixth week of treatment (p = 0.011). There was also a significant reduction compared to the baseline in the severity of pruritus ingroup M in the third (p = 0.004) and sixth week of treatment (p = 0.022). Our results indicate the possible use of fexofenadine in the treatment of atopic dermatitis in dogs, as it was demonstrated safe and effective in comparison with methylprednisolone.

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Clinical results of percutaneous biportal endoscopic lumbar interbody fusion with application of enhanced recovery after surgery

Neurosurgical FOCUS ◽

10.3171/2019.1.focus18695 ◽

2019 ◽

Vol 46 (4) ◽

pp. E18 ◽

Cited By ~ 16

Author(s):

Dong Hwa Heo ◽

Choon Keun Park

Keyword(s):

Interbody Fusion ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Transforaminal Lumbar Interbody Fusion ◽

Clinical Results ◽

Fusion Rate ◽

Lumbar Interbody Fusion ◽

Estimated Blood Loss ◽

Significant Difference ◽

The Mean

OBJECTIVEThe aims of enhanced recovery after surgery (ERAS) are to improve surgical outcomes, shorten hospital stays, and reduce complications. The objective of this study was to introduce ERAS with biportal endoscopic transforaminal lumbar interbody fusion (TLIF) and to investigate the clinical results.METHODSPatients were divided into two groups based on the fusion procedures. Patients who received microscopic TLIF without ERAS were classified as the non-ERAS group, whereas those who received percutaneous biportal endoscopic TLIF with ERAS were classified as the ERAS group. The mean Oswestry Disability Index (ODI) and visual analog scale (VAS) scores were compared between the two groups. In addition, demographic characteristics, diagnosis, mean operative time, estimated blood loss (EBL), fusion rate, readmissions, and complications were investigated and compared.RESULTSForty-six patients were grouped into the non-ERAS group (microscopic TLIF without ERAS) and 23 patients into the ERAS group (biportal endoscopic TLIF with ERAS). The VAS score for preoperative back pain on days 1 and 2 was significantly higher in the non-ERAS group than in the ERAS group (p < 0.05). The mean operative duration was significantly higher in the ERAS group than in the non-ERAS group, while the mean EBL was significantly lower in the ERAS group than in the non-ERAS group (p < 0.05). There was no significant difference in fusion rate between the two groups (p > 0.05). Readmission was required in 2 patients who were from the non-ERAS group. Postoperative complications occurred in 6 cases in the non-ERAS group and in 2 cases in the ERAS group.CONCLUSIONSPercutaneous biportal endoscopic TLIF with an ERAS pathway may have good aspects in reducing bleeding and postoperative pain. Endoscopic fusion surgery along with the ERAS concept may help to accelerate recovery after surgery.

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Clinical results of Visian implantable collamer lens implantation according to various sizes and implantation angles

European Journal of Ophthalmology ◽

10.1177/11206721211033468 ◽

2021 ◽

pp. 112067212110334

Author(s):

Bu Ki Kim ◽

Young Taek Chung

Keyword(s):

Case Series ◽

Clinical Results ◽

Implantable Collamer Lens ◽

Retrospective Case ◽

Significant Difference ◽

Lens Implantation ◽

Group A ◽

The Mean ◽

Group B

Purpose: To investigate the clinical outcomes of Visian implantable collamer lens (ICL) implantation according to lens size and implantation angle. Setting: Onnuri Smile Eye Clinic, Seoul, Republic of Korea. Design: Retrospective case series. Methods: This study included 566 eyes of 283 patients treated with ICL implantation. Patients were divided into three groups: horizontally implanted same-sized ICL (group A), horizontally implanted different sized-ICL (group B: large ICL and small ICL) and same sized-ICL implanted with a different implantation angle (group C: horizontal and vertical). Results: At 12-month follow-up, the mean vault was 0.78 ± 17, 0.48 ± 0.13, 0.71 ± 0.18 and 0.44 ± 0.16 mm when large and small sized ICL was used in group B ( p < 0.001), and when ICL was horizontally and vertically implanted in group C ( p = 0.021), respectively. And the mean SE was −0.11 ± 0.30, −0.34 ± 0.42, −0.3 ± 0.56 and −0.64 ± 0.66 dioptres (D), when the large and the small sized ICL was used group B ( p = 0.039), and when the ICL was horizontally and vertically implanted in group C ( p = 0.036), respectively. No significant difference in UDVA, IOP and ECD between both eyes in groups B and C was observed. No statistical difference was found in the vault between both eyes for groups B and C. Conclusions: The vault was significantly higher and the SE was significantly more hyperopic when a larger-sized ICL was used or the ICL was horizontally implanted compared to when the ICL was vertically implanted.

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Cortical calculation localization using electrostimulation

Journal of Neurosurgery ◽

10.3171/2008.8.jns17649 ◽

2009 ◽

Vol 110 (6) ◽

pp. 1291-1299 ◽

Cited By ~ 26

Author(s):

Franck-Emmanuel Roux ◽

Leila Boukhatem ◽

Louisa Draper ◽

Oumar Sacko ◽

Jean-François Démonet

Keyword(s):

Brain Mapping ◽

Parietal Lobe ◽

Naming Task ◽

Brain Lesions ◽

Awake Surgery ◽

Mapping Procedure ◽

Cortical Areas ◽

Surgical Data ◽

Calculation Task ◽

Language Areas

Object A naming task has been used to spare cortical areas involved in language. In the present study, a calculation task was combined with electrostimulation mapping (awake surgery) to spare cortical areas involved in calculation in patients undergoing surgery for brain lesions. The organization of language and calculation areas was analyzed in relation to these surgical data. Methods Twenty patients with brain lesions close to areas possibly involved in calculation (dominant parietal lobe and F2) were prospectively studied over a 4-year period. Four patients had preoperative symptoms of acalculia and therefore were not included in the brain mapping procedure. Results In 16 patients, direct electrostimulation caused calculation interferences in localized small cortical areas (< 2 cm2). Of the 53 calculation interferences found, 23 were independent of language areas, especially those in the inferior left parietal lobule. Various patterns of interference were observed (11 complete acalculia, 5 acalculia with wrong answers, 2 hesitations, and 5 mixed responses), although error patterns were fairly similar across angular, parietal, and frontal stimulation sites. Calculation areas in 4 patients could not be spared for oncological reasons; postoperatively, 3 of these patients showed significant acalculia symptoms. In contrast, none of the patients whose calculation areas were spared had arithmetic difficulties 1 month after surgery. Improvements in acalculia symptoms after surgery were also found in 3 of the 4 patients with preoperative calculation difficulties. Conclusions To limit the risk of personal and professional disturbances caused by acquired anarithmetia in patients undergoing surgery for brain tumors or epilepsy, the authors think it is necessary to use a calculation task during brain mapping, especially when operating in the dominant parietal lobe.

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The Effectiveness of Scientific Stations Strategy in Achievement of the Seventh Grade Students in Dictation

Journal of Educational and Psychological Studies [JEPS] ◽

10.24200/jeps.vol14iss3pp558-571 ◽

2020 ◽

Vol 14 (3) ◽

pp. 558

Author(s):

Asia A. Al Rawahi ◽

Suliman S. Al Ghattami

Keyword(s):

Conventional Method ◽

Achievement Test ◽

Female Students ◽

Sultanate Of Oman ◽

Seventh Grade ◽

Significant Difference ◽

Post Test ◽

The Mean ◽

Language Areas ◽

Experimental Group

The study aims to examine the effectiveness of using the “scientific stations strategy” for grade seven students, achievement in dictation in the Sultanate of Oman. In order to achieve this, the researchers prepared an achievement test and a guideline for executing the strategy. The tool was checked for validity by a panel of area experts. The reliability of the test was 0.84 as determined by Cronbach’s Alpha. The study sample consisted of two groups, where 24 female students were taught dictation according to the scientific stations strategy, and 18 students were taught by the conventional method. The results of the post test showed that there is a statistically significant difference in the mean scores between the two groups, in favour of the experimental group. Based on these results, the researchers recommended making use of the science stations strategy by training teachers to use it in teaching dictation and in other language areas.

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Early postoperative treatment of mastectomy scars using a fractional carbon dioxide laser: a randomized, controlled, split-scar, blinded study

Archives of Plastic Surgery ◽

10.5999/aps.2020.02495 ◽

2021 ◽

Vol 48 (4) ◽

pp. 347-352

Author(s):

Hyun Woo Shin ◽

Sangwoo Suk ◽

Seoung Wan Chae ◽

Kun Chul Yoon ◽

Junekyu Kim

Keyword(s):

Carbon Dioxide Laser ◽

Clinical Results ◽

Postoperative Treatment ◽

Control Side ◽

Significant Difference ◽

Blinded Study ◽

Fractional Carbon Dioxide Laser ◽

Vas Scores ◽

The Mean ◽

Group B

Background Mastectomy leaves unsightly scarring, which can be distressing to patients. Laser therapy for scar prevention has been consistently emphasized in recent studies showing that several types of lasers, including fractional ablation lasers, are effective for reducing scar formation. Nonetheless, there are few studies evaluating the therapeutic efficacy of ablative CO2 fractional lasers (ACFLs).Methods This study had a randomized, comparative, prospective, split-scar design with blinded evaluation of mastectomy scars. Fifteen patients with mastectomy scars were treated using an ACFL. Half of each scar was randomized to “A,” while the other side was allocated to group “B.” Laser treatment was conducted randomly. Scars were assessed using digital photographs of the scar and Vancouver scar scale (VSS) scores. Histological assessments were also done.Results The mean VSS scores were 2.20±1.28 for the treatment side and 2.96±1.40 for the control side. There was a significant difference in the VSS score between the treatment side and the control side (P=0.002). The mean visual analog scale (VAS) scores were 4.13±1.36 for the treatment side and 4.67±1.53 for the control side. There was a significant difference in VAS score between the treatment side and the control side (P=0.02).Conclusions This study demonstrated that early scar treatment using an ACFL significantly improved the clinical results of the treatment compared to the untreated scar, and this difference was associated with patient satisfaction.

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COMPARACIÓN DE LOS RESULTADOS CLÍNICOS EN PACIENTES CON HIPERPLASIA PROSTÁTICA BENIGNA CON TRATAMIENTO INICIAL FARMACOLÓGICO, NO FARMACOLÓGICO Y QUIRÚRGICO, ATENDIDOS EN EL HOSPITAL PABLO ARTURO SUÁREZ DE ENERO 2014 A DICIEMBRE 2016.

Revista Medica Vozandes ◽

10.48018/rmv311.s1 ◽

2020 ◽

Vol 31 (1) ◽

Author(s):

Esteban Noroña Vásconez ◽

Patricia Páez Vargas

Keyword(s):

Surgical Treatment ◽

Benign Prostatic Hyperplasia ◽

Pharmacological Treatment ◽

Clinical Signs ◽

Clinical Results ◽

Scientific Data ◽

Prostatic Hyperplasia ◽

Urinary Symptoms ◽

Post Intervention ◽

Significant Difference

Background: Currently there are few scientific data comparing the three therapeutic modalities of Benign Prostatic Hyperplasia to determine the best clinical outcome, considering that it is a pathology whose incidence increases as population life expectancy arise. Objective: To compare the clinical results between the initial pharmacological, non-pharmacological and surgical treatment, based on clinical signs of prostatism in patients with benign prostatic hyperplasia during the period between January 2014 and December 2016. Study Design: Retrospective Cohort Study. Methods: 399 patients were divided according to the modality of treatment received: non-pharmacological, pharmacological and surgical. The decrease of the symptoms was compared with the first post-treatment consultation by using a matrix of evaluation of urinary symptoms elaborated by the authors, based on SPSS International Score; this tool stratified the patients by the severity of the symptomatology. SPSS ® software was used. Results: Within the non-pharmacological treatment, there was a mean difference of 1.67 (95% CI 0.49 - 2.85, p <0.05); for the pharmacological it was 0.21 (95% CI 0.92 - 1.34, p = 0.713) and for the surgical was 8.23 (95% CI 7.19 - 9.27, p <0.05). Significant differences were found between the three groups during the pretreatment phase, after stratifying them according to the degree of severity. Post-intervention, the clinical results of each treatment were compared, finding that in patients with mild symptoms there were no significant differences (p = 0.087), not so for patients with moderate and severe symptoms where a statistically significant difference was found. Conclusion: In patients with urinary symptoms classified as moderate and severe within this sample, surgical treatment decreased urinary symptomatology in greater proportion compared to pharmacological and non-pharmacological treatment.

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Ligamentoplasty with interposition of the proximal interphalangeal joint in the treatment of unicondylar osteochondral defects: a cadaveric feasibility study

Archives of Plastic Surgery ◽

10.5999/aps.2021.00220 ◽

2021 ◽

Vol 48 (6) ◽

pp. 635-640

Author(s):

Jean-Charles Hery ◽

Baptiste Picart ◽

Mélanie Malherbe ◽

Christophe Hulet ◽

Aude Lombard

Keyword(s):

Feasibility Study ◽

Proximal Phalanx ◽

Clinical Results ◽

Proximal Interphalangeal Joint ◽

Osteochondral Defects ◽

Joint Stability ◽

Significant Difference ◽

Pip Joint ◽

The Mean ◽

A New Technique

Background Injuries to the proximal interphalangeal (PIP) joint are common and complex. However, the treatment of osteochondral defects of the head of the proximal phalanx has rarely been described. Herein, we propose a new technique for the management of unicondylar defects of the proximal phalanx that can restore joint amplitudes and provide PIP stability.Methods In this cadaveric feasibility study, unicondylar defects were generated using striking wedges and chisels. First, a transverse tunnel measuring 2 mm in diameter passing through the head of the proximal phalanx was made. A second tunnel at the base of the middle phalanx with the same diameter was then created. The hemitendon of the flexor carpi radialis graft was passed through each of these tunnels. The proximal end of the graft was interposed in the area with a loss of bone substance. The ligamentoplasty was then tensed and fixed by two anchors on the proximal phalanx. Joint amplitudes and frontal stability were measured preoperatively and postoperatively.Results There was no significant change in the joint’s range of motion: preoperatively, the mean mobility arcs were –2° to 113.80°, and they were –2° to 110° after the procedure (P=0.999). There was no significant difference in joint stability (P>0.05).Conclusions Ligamentoplasty with PIP interposition appears to be a possible solution for the management of unicondylar defects of the proximal phalanx. An evaluation of clinical results is planned in order to definitively confirm the validity of this procedure.

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