Nonspecific pyogenic spondylodiscitis: clinical manifestations, surgical treatment, and outcome in 24 patients

Object Pyogenic vertebral osteomyelitis is of special interest to neurosurgeons because it often results in acute neurological deterioration and requires a combination of adequate surgical and conservative treatment. The aim of the current study was to evaluate the strategy of a primary surgical approach to this disease. Methods A group of 24 patients with the clinical and radiological signs of acute pyogenic spondylodiscitis was prospectively followed from 1998 to 2004. Of these, 20 had underlying diseases such as diabetes mellitus, chronic alcoholism, and liver cirrhosis. The main causative organism was Staphylococcus aureus. Most infections were localized in the thoracic or lumbar spine (10 cases each); 15 infections were associated with epidural abscesses. Because of a delay in diagnosis, 13 patients presented with neurological deficits on admission. Patients with a complete or rapidly progressing neurological deficit underwent immediate surgery. In patients with minor or no deficits or in a stable neurological condition, surgery was delayed for 3 to 5 days. This group was treated with immobilization and intravenous antibiotic drugs before surgery. Surgical procedures included ventral, dorsal, and combined approaches in one- or two-stage operations. Antibiotic treatment included the use of broad-spectrum antibiotic drugs delivered intravenously for at least 10 days, followed by orally administered antibiotics for 3 months. Twenty patients were independent on follow-up review, 15 with no or minor handicaps. Severe septicemia and multiorgan failure developed in two patients, and these two died of their disease. Major complications were mainly due to long-term antibiotic therapy. Conclusions Surgical treatment is the modality of choice in patients with acute spinal osteomyelitis. It is especially indicated in patients with progressive or severe neurological deficits and spinal deformity. In experienced hands, surgery is safe and offers the advantages of spinal cord decompression, immediate mobilization, and correction of spinal deformity. The decision whether an anterior or posterior approach should be used must be made on an individual basis.

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IMMEDIATE RESULTS OF TREATMENT FOR PYOGENIC NONSPECIFIC SPINE DESEASE

Hirurgiâ pozvonočnika ◽

10.14531/ss2005.2.70-72 ◽

2005 ◽

pp. 070-072

Author(s):

Mikhail Yuryevich Goncharov ◽

Vladimir Petrovich Sacovich ◽

Evgeny Petrovich Danilov ◽

A. V. Cherepanov ◽

I. V. Volkov ◽

...

Keyword(s):

Surgical Treatment ◽

Conservative Treatment ◽

Neurological Deficit ◽

Multiorgan Failure ◽

Intravenous Antibiotic ◽

Results Of Treatment ◽

Antibiotic Drugs ◽

Time To Diagnosis ◽

Spine Diseases ◽

Spine Disease

Pyogenic nonspecific spine disease is of special interest to neurosurgeons because it often results in acute neurological deteriorations and requires a combination of adequate surgical and conservative treatment. A group of 81 patients with the clinical and radiological sings of pyogenic nonspecific spine infections was prospectively followed from 1999 to 2004. Time to diagnosis was less than 2 months in 62,96 % of patients. Patients without neurological deficit (n = 8; 9.88 %) were conservatively treated with immobilization and intravenous antibiotic drugs. Patients with complete or rapidly progressing neurological deficit, septicemia (n = 73; 90.12 %) underwent surgery. Good results were achieved in 42 (57,55 %) patients, satisfactory – in 16 (21,91 %) with minor neurologic deficit, unsatisfactory – in 14 (19,17 %) with severe neurological deficit. Severe septicemia and multiorgan failure developed in one patient who died of this disease. Conclusions: еarly diagnosis and surgical treatment is a technique of choice for treatment of patients with pyogenic nonspecific spine diseases.

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Surgical management of thoracic myelopathy from long-segment epidural lipomatosis with skip hemilaminotomies: illustrative case

Journal of Neurosurgery: Case Lessons ◽

10.3171/case21595 ◽

2021 ◽

Vol 2 (24) ◽

Keyword(s):

Adipose Tissue ◽

Surgical Treatment ◽

Surgical Management ◽

Spinal Deformity ◽

Neurological Deficits ◽

Illustrative Case ◽

Medical Conditions ◽

Thoracic Myelopathy ◽

Epidural Lipomatosis ◽

Thoracic Spinal

BACKGROUND Thoracic spinal epidural lipomatosis (SEL) involves the pathological overgrowth of histologically normal, unencapsulated adipose tissue that can compress the spinal cord and cause myelopathy. SEL has been associated with multiple medical conditions, including Scheuermann kyphosis (SK). Optimal treatment strategies for SEL, especially in the setting of a sagittal spinal deformity, remain unclear. OBSERVATIONS In this report, the authors discussed surgical management of a patient with thoracic SEL and SK using skip hemilaminotomies for resection of the epidural adipose tissue. To the authors’ knowledge, only one other report described a similar surgical technique in a patient who did not have a spinal deformity. LESSONS When conservative efforts fail, thoracic SEL may require surgical treatment. Surgical planning must account for co-medical conditions such as SK. The described approach involving skip laminotomies, which minimizes spine destabilization, is a viable option to treat SEL spanning multiple spinal segments. Prognosis after surgical treatment varies and is impacted by multiple factors, including severity of preoperative neurological deficits.

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THE SYNDROME OF NEUROLOGICAL DISORDERS AS A PREDICTOR OF EARLY DIAGNOSIS AND A CRITERION FOR THE EFFECTIVENESS OF SURGICAL TREATMENT OF NONSPECIFIC PURULENT DISEASES OF THE SPINE

Journal of Ural Medical Academic Science ◽

10.22138/2500-0918-2020-17-2-175-186 ◽

2020 ◽

Vol 17 (2) ◽

pp. 175-186

Author(s):

M.Yu. Goncharov ◽

◽

D.D. Masyutina ◽

Keyword(s):

Surgical Treatment ◽

Postoperative Period ◽

Neurological Disorders ◽

Primary Care Physicians ◽

High Risk Patient ◽

Clinical Manifestations ◽

Diagnostic Methods ◽

Neurological Deficits ◽

Neurosurgical Department

Nonspecific purulent diseases of the spine (NPDS) are a relatively rare pathology that is little known to a wide circle of doctors, as a result of which mistakes are often made in the tactics of patient management, the timing of diagnosis and the appointment of adequate therapy is delayed. Long-term «diagnostic trap» leads to the formation of persistent neurological deficits. Goal. The purpose is to study the structure of neurological manifestations in the diagnosis NPDS and the dynamics in assessing the quality of surgical treatment. Materials and methods. The article presents an analysis of a group of patients receiving treatment for NPDS in the neurosurgical department of State budgetary health institution in the Sverdlovsk region '‘Sverdlovsk Regional Clinical Hospital No. 1’' in Yekaterinburg for the period from 2005 to 2018 with an assessment of the dynamics of neurological disorders and vertebral pain syndrome in the early postoperative period. A significantly better result in assessing regression of neurological disorders and a decrease in the severity of pain in the postoperative period was observed in the group of patients who underwent decompression-sanitizing-stabilizing surgeries (DSS) in comparison with decompression-sanitizing (DS). Conclusions. The understanding by primary care physicians, neurologists, neurosurgeons of high-risk patient groups, the dynamics of clinical manifestations, and effective diagnostic methods contributes to the choice of the correct management tactics and timely surgical treatment, which significantly improves outcomes, reduces disability rates, and improves the quality of life of patients.

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Functional hemispherectomy for patients with adult-onset Rasmussen’s encephalitis

Acta Epileptologica ◽

10.1186/s42494-021-00045-1 ◽

2021 ◽

Vol 3 (1) ◽

Author(s):

Hong Xue ◽

Cuiping Xu ◽

Xiaoxia Zhou ◽

Duanyu Ni ◽

Xueyuan Wang ◽

...

Keyword(s):

Surgical Treatment ◽

Clinical Manifestations ◽

Neurological Deficits ◽

Seizure Freedom ◽

Adult Onset ◽

Rasmussen’S Encephalitis ◽

Functional Hemispherectomy ◽

Clonic Seizures

Abstract Background Surgical treatment for patients with adult-onset Rasmussen’s encephalitis (A-RE) is rarely reported. We investigated the clinical and surgical features of two patients with A-RE who underwent functional hemispherectomy. Case presentation The data of clinical manifestations, neuroimaging, surgical treatment and surgical outcomes of two patients with A-RE was reviewed. The two patients initially presented with recurrent partial seizures or secondly generalized tonic clonic seizures. Gradually, the patients showed unilateral limb paralysis as well as chronic focal epileptic status. Both patients underwent functional hemispherectomy and achieved seizure freedom in the follow-up. The contralateral neurological deficits improved gradually after rehabilitation and were acceptable for the self-care of daily living. The living quality improved prominently after surgery. Conclusions Despite the risk of hemiplegia, functional hemispherectomy may be a choice for patients with A-RE for favorable seizure control and improved quality of life in selected patients.

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Cesarean scar defects: diagnosis and treatment in non-pregnant women

GYNECOLOGY ◽

10.26442/20795696.2020.3.200189 ◽

2020 ◽

Vol 22 (3) ◽

pp. 6-10

Author(s):

Sergey A. Martynov

Keyword(s):

Magnetic Resonance Imaging ◽

Surgical Treatment ◽

Magnetic Resonance ◽

Genital Tract ◽

Conservative Therapy ◽

Clinical Manifestations ◽

Subsequent Pregnancy ◽

Resonance Imaging ◽

Diagnostic Features ◽

Pregnancy And Childbirth

The aim of the review was to summarize information on clinical manifestations, diagnostic features, as well as methods for correction of scar defects after cesarean section (CS) outside pregnancy. Lack of the scar after CS, niche, isthmocele are a myometrium defect in the area of scar after CS, which is most often detected by ultrasound, sonohysterography or magnetic resonance imaging and is manifested by postmenstrual bleeding from the genital tract. In some cases, it can cause menorrhagia, dyspareunia, pelvic pain, infertility, uterine rupture during subsequent pregnancy and childbirth. Conservative therapy or surgical treatment with laparoscopy, laparotomy or vaginal approach is carried out depending on the symptoms, size of the defect, the thickness of the residual myometrium, as well as the womans reproductive plans.

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Gasperini Syndrome: A Case Report and Systematic Review and Proposing a New Definition

Case Reports in Neurology ◽

10.1159/000510845 ◽

2020 ◽

Vol 12 (3) ◽

pp. 433-439

Author(s):

Riwaj Bhagat ◽

Siddharth Narayanan ◽

Marwa Elnazeir ◽

Thong Diep Pham ◽

Robert Paul Friedland ◽

...

Keyword(s):

Systematic Review ◽

Brain Mri ◽

Cranial Nerves ◽

Clinical Manifestations ◽

The Other ◽

Neurological Deficits ◽

Brainstem Stroke ◽

Neurological Features ◽

The Right ◽

Core Features

Gasperini syndrome (GS), a rare brainstem syndrome, is featured by ipsilateral cranial nerves (CN) V–VIII dysfunction with contralateral hemibody hypoesthesia. While there have been 18 reported cases, the GS definition remains ambiguous. We report a new case and reviewed the clinical features of this syndrome from all published reports to propose a new definition. A 57-year-old man with acute brainstem stroke had right CN V–VIII and XII palsies, left body hypoesthesia and ataxia. Brain MRI showed an acute stroke in the right caudal pons and bilateral cerebellum. After a systematic review, we classified the clinical manifestations into core and associate features based on the frequencies of occurring neurological deficits. We propose that a definitive GS requires the presence of ipsilateral CN VI and VII palsies, plus one or more of the other three core features (ipsilateral CN V, VIII palsies and contralateral hemibody hemihypalgesia). Additionally, GS, similar to Wallenberg’s syndrome, represents a spectrum that can have other associated neurological features. The revised definition presented in this study may enlighten physicians with the immediate recognition of the syndrome and help improve clinical localization of the lesions and its management.

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Managing the combined consequences of COVID-19 infection and lock-down policies on athletes: narrative review and guidelines proposal for a safe return to sport

BMJ Open Sport & Exercise Medicine ◽

10.1136/bmjsem-2020-000849 ◽

2020 ◽

Vol 6 (1) ◽

pp. e000849

Author(s):

Jean-Bernard Fabre ◽

Laurent Grelot ◽

William Vanbiervielt ◽

Julien Mazerie ◽

Raphael Manca ◽

...

Keyword(s):

Sports Medicine ◽

Acute Myocarditis ◽

Multiorgan Failure ◽

Clinical Manifestations ◽

Return To Sport ◽

Disease Spread ◽

Cardiac Complications ◽

Professional Soccer ◽

Physical Abilities ◽

Fitness And Health

COVID-19 pandemic is a global health matter. The disease spread rapidly across the globe and brought the world of sports to an unprecedented stoppage. Usual symptoms of the disease are fever, cough, myalgia, fatigue, slight dyspnoea, sore throat and headache. In more severe cases, dyspnoea, hypoxaemia, respiratory failure, shock and multiorgan failure occur. This appears to be a self-limiting phenomenon related to individuals with coexisting medical conditions, such as hypertension, diabetes and cardiovascular disorders. Nevertheless, cases have been reported in professional soccer players in extremely good fitness condition, demonstrating that athletes are not spared by the disease. Despite COVID-19 clinical manifestations are mainly respiratory, major cardiac complications are being reported, leading to acute myocarditis. One difficulty is that symptoms of COVID-19 vary among individuals, with athletes being affected with no apparent sign of the disease. This could be a real danger for amateur or professional athletes when returning to their usual training and thus to play. Another threat is that the lock-down policies did not allow most athletes to follow their usual training routines. There is thus a need for a careful approach by the sports medicine community to ensure safety of all athletes before they return to sport. Here, we propose evaluation guidelines of fitness and health of athletes to (1) reduce any lethal risk of practice, especially myocarditis and sudden cardiac death; (2) evaluate the combined consequences of the disease and detraining on the physical abilities and biological profile of athletes; and (3) monitor postinfection fatigue symptoms.

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Pathobiology of A/Chicken/Hong Kong/220/97 (H5N1) Avian Influenza Virus in Seven Gallinaceous Species

Veterinary Pathology ◽

10.1354/vp.38-2-149 ◽

2001 ◽

Vol 38 (2) ◽

pp. 149-164 ◽

Cited By ~ 190

Author(s):

L. E. L. Perkins ◽

D. E. Swayne

Keyword(s):

Hong Kong ◽

Avian Influenza ◽

Pulmonary Edema ◽

Multiorgan Failure ◽

Clinical Manifestations ◽

Highly Pathogenic ◽

H5n1 Avian Influenza Virus ◽

Multiple Organs ◽

H5n1 Avian Influenza ◽

Virus Localization

Direct bird-to-human transmission, with the production of severe respiratory disease and human mortality, is unique to the Hong Kong-origin H5N1 highly pathogenic avian influenza (HPAI) virus, which was originally isolated from a disease outbreak in chickens. The pathobiology of the A/chicken/Hong Kong/ 220/97 (H5N1) (HK/220) HPAI virus was investigated in chickens, turkeys, Japanese and Bobwhite quail, guinea fowl, pheasants, and partridges, where it produced 75-100% mortality within 10 days. Depression, mucoid diarrhea, and neurologic dysfunction were common clinical manifestations of disease. Grossly, the most severe and consistent lesions included splenomegaly, pulmonary edema and congestion, and hemorrhages in enteric lymphoid areas, on serosal surfaces, and in skeletal muscle. Histologic lesions were observed in multiple organs and were characterized by exudation, hemorrhage, necrosis, inflammation, or a combination of these features. The lung, heart, brain, spleen, and adrenal glands were the most consistently affected, and viral antigen was most often detected by immunohistochemistry in the parenchyma of these organs. The pathogenesis of infection with the HK/220 HPAI virus in these species was twofold. Early mortality occurring at 1-2 days postinoculation (DPI) corresponded to severe pulmonary edema and congestion and virus localization within the vascular endothelium. Mortality occurring after 2 DPI was related to systemic biochemical imbalance, multiorgan failure, or a combination of these factors. The pathobiologic features were analogous to those experimentally induced with other HPAI viruses in domestic poultry.

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