Antibiotic–polymethylmethacrylate strut: an option for treating cervical pyogenic spondylitis

2006 ◽  
Vol 5 (1) ◽  
pp. 90-95 ◽  
Author(s):  
Jyi-Feng Chen ◽  
Shih-Tseng Lee
Keyword(s):  
Neurological Deficits ◽  
Local Drug Delivery ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Pyogenic Spondylitis ◽  
Spine Stabilization ◽  
Spinal Reconstruction ◽  
Effective System ◽  
Vancomycin Powder ◽  
Antibiotic Agents

✓ Antibiotic–polymethylmethacrylate (PMMA) cement and beads constitute an effective system of local drug delivery of antibiotic agents in patients with bone and soft-tissue infections. Debridement followed by implantation of antibiotic–PMMA beads and systemic administration of antibiotic agents has achieved a 100% success rate in treating chronic osteomyelitis; however, there have been no reports of an antibiotic–PMMA strut for treating spinal pyogenic spondylitis. In this case report we describe a 57-year-old woman with C5–6 pyogenic spondylitis, progressive kyphotic deformity, and neurological deficits. The patient underwent anterior C-5 and C-6 corpectomy and spinal reconstruction in which we used an antibiotic–PMMA strut. The strut was 14 mm in diameter and contained PMMA and vancomycin powder. The operation was technically successful, and no complication related to anesthesia or the surgical procedure occurred. At the 12-month follow-up examination, dynamic radiographs revealed cervical spine stabilization. The patient’s neck pain subsided and she recovered neurologically with no residual infection. No antibiotic–PMMA strut dislodgment or failure was identified; however, 9.8% subsidence of the strut into the vertebrae was observed. The long-term outcome in this case requires further evaluation.

Drug-coated Balloons – History and Peripheral Vascular Opportunities

2010 ◽  
Vol 5 (1) ◽  
pp. 70
Author(s):  
Bruno Scheller ◽  
Bodo Cremers ◽  
Stephanie Schmitmeier ◽  
Beatrix Schnorr ◽  
Yvonne Clever ◽  
...  
Keyword(s):  
Arterial Disease ◽  
Local Drug Delivery ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Late Lumen Loss ◽  
Short Term Exposure ◽  
History Of ◽  
Area Of Concern ◽  
Peripheral Arterial ◽  
Drug Coated Balloon

One of the most innovative fields of modern medical research is the percutaneous transluminal treatment of vascular disease. During recent decades considerable advances have been made in intravascular interventions for the treatment of coronary and peripheral arterial disease. Despite these advances, the long-term outcome remains an area of concern in many applications. Restenosis is still a challenge in endovascular medicine and has thus been referred to as the Achilles’ heel of percutaneous intervention. Therefore, novel strategies have been developed to overcome this problem. These include drug-eluting stents and the more recently introduced non-stent-based local drug delivery systems (in particular the drug-coated balloon). Results from several pre-clinical and clinical studies indicate that short-term exposure of injured arteries to paclitaxel delivered from regular angioplasty balloons may be sufficient to reduce late lumen loss and restenosis rates during a critical period of time after the angioplasty of diseased coronary and peripheral arteries. Although the number of published trials and patients treated is still limited, data available seem to prove that restenosis inhibition by immediate drug release is feasible. This article reviews the history of the drug-coated balloon and then focuses on peripheral artery trials.

scholarly journals Cavernous Malformation of Brainstem, Thalamus, and Basal Ganglia

Neurosurgery ◽  
2012 ◽  
Vol 72 (4) ◽  
pp. 573-589 ◽  
Author(s):  
Paritosh Pandey ◽  
Erick M. Westbroek ◽  
Peter A. Gooderham ◽  
Gary K. Steinberg
Keyword(s):  
Basal Ganglia ◽  
Neurological Deficits ◽  
Term Outcome ◽  
Cavernous Malformations ◽  
Long Term Outcome ◽  
Brain Malformations ◽  
Hemorrhage Risk ◽  
Clinical Records

Abstract BACKGROUND: Cavernous malformations (CMs) in deep locations account for 9% to 35% of brain malformations and are surgically challenging. OBJECTIVE: To study the clinical features and outcomes following surgery for deep CMs and the complication of hypertrophic olivary degeneration (HOD). METHODS: Clinical records, radiological findings, operative details, and complications of 176 patients with deep CMs were reviewed retrospectively. RESULTS: Of 176 patients with 179 CMs, 136 CMs were in the brainstem, 27 in the basal ganglia, and 16 in the thalamus. Cranial nerve deficits (51.1%), hemiparesis (40.9%), numbness (34.7%), and cerebellar symptoms (38.6%) presented most commonly. Hemorrhage presented in 172 patients (70 single, 102 multiple). The annual retrospective hemorrhage rate was 5.1% (assuming CMs are congenital with uniform hemorrhage risk throughout life); the rebleed rate was 31.5%/patient per year. Surgical approach depended on the proximity of the CM to the pial or ependymal surface. Postoperatively, 121 patients (68.8%) had no new neurological deficits. Follow-up occurred in 170 patients. Delayed postoperative HOD developed in 9/134 (6.7%) patients with brainstem CMs. HOD occurred predominantly following surgery for pontine CMs (9/10 patients). Three patients with HOD had palatal myoclonus, nystagmus, and oscillopsia, whereas 1 patient each had limb tremor and hemiballismus. At follow-up, 105 patients (61.8%) improved, 44 (25.9%) were unchanged, and 19 (11.2%) worsened neurologically. Good preoperative modified Rankin Score (98.2% vs 54.5%, P = .001) and single hemorrhage (89% vs 77.3%, P < .05) were predictive of good long-term outcome. CONCLUSION: Symptomatic deep CMs can be resected with acceptable morbidity and outcomes. Good preoperative modified Rankin Score and single hemorrhage are predictors of good long-term outcome.

Prognostic Markers in Term Infants with Hypoxic–Ischemic Encephalopathy: Comparative Analysis of MRI, EEG, and Apgar Scores

2017 ◽  
Vol 16 (01) ◽  
pp. 008-014 ◽  
Author(s):  
Elissa Yozawitz ◽  
Ajay Goenka
Keyword(s):  
Hypoxic Ischemic Encephalopathy ◽  
Neurological Deficits ◽  
Term Infants ◽  
Term Outcome ◽  
Apgar Scores ◽  
Long Term Outcome ◽  
Perinatally Acquired ◽  
Magnetic Resonance Imaging Mri ◽  
Poor Outcomes ◽  
Ischemic Encephalopathy

AbstractHypoxic–ischemic encephalopathy (HIE) is a frequent cause of perinatally acquired brain injury resulting in abnormal neurological consequences. In this retrospective study, we evaluated 68 neonates with clinical evidence of HIE to investigate the utility of magnetic resonance imaging (MRI), electroencephalography (EEG), and Apgar scores, individually and in combination, as predictors of long-term outcome. Six infants died during treatment, and 46 of the remaining 62 infants (74%) received follow-up neurological assessments at ages 6 to 24 months. The outcome was dichotomously classified as good (reflecting “normal development”) or as poor (reflecting “neurological deficits” based upon attainment of developmental milestones or death). Abnormal Apgar scores, MRIs, and EEGs had sensitivities of 50, 84, and 95% for predicting “neurological deficit.” Corresponding specificities were 85, 66, and 18%. However, the combination of abnormal Apgar scores, MRIs, and EEGs in predicting poor outcomes (i.e., “neurological deficits” or death) had sensitivity and specificity of 100%. In addition, the combination of abnormal Apgar scores, MRIs, and EEGs provided a positive predictive value of 100% in assessing poor outcome as compared with 73% (p = 0.2) for Apgar scores, 71% (p = 0.01) for MRIs, and 56% (p = 0.001) for EEGs.

Compressive vertebral hemangiomas with neurological deficits: diagnosis, surgical strategies and long term outcome

2021 ◽  
pp. 1-11
Author(s):  
Krishnakumar Kesavapisharady ◽  
Ganesh Divakar ◽  
Tobin George ◽  
Jayadevan E. R. ◽  
Easwer Venkat Hariharan
Keyword(s):  
Neurological Deficits ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Surgical Strategies ◽  
Vertebral Hemangiomas

Drug-coated Balloons – Potential Coronary Vascular Applications

2011 ◽  
Vol 7 (2) ◽  
pp. 122
Author(s):  
Bruno Scheller ◽  
Bodo Cremers ◽  
Stephanie Schmitmeier ◽  
Beatrix Schnorr ◽  
Yvonne Clever ◽  
...  
Keyword(s):  
Vascular Disease ◽  
Arterial Disease ◽  
Local Drug Delivery ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Late Lumen Loss ◽  
Short Term Exposure ◽  
Area Of Concern ◽  
Peripheral Arterial ◽  
Drug Coated Balloon

One of the most innovative fields in modern medical research is the percutaneous transluminal treatment of vascular disease. During the last few decades considerable advances have been made in intravascular interventions for the treatment of coronary and peripheral arterial disease. However, long-term outcome remains an area of concern in many applications. Restenosis is still a challenge in endovascular medicine and has thus been referred to as the Achilles’ heel of percutaneous intervention. Therefore, novel strategies have been developed to overcome this problem. These include drug-eluting stents and the more recently introduced non-stent-based local drug delivery systems, in particular the drug-coated balloon. The results of several pre-clinical and clinical studies indicate that short-term exposure of injured arteries to paclitaxel delivered from regular angioplasty balloons may be sufficient to reduce late lumen loss and restenosis rates during the critical period after angioplasty of diseased coronary and peripheral arteries. Although the number of published trials and patients treated is still limited, the available data seem to prove that restenosis inhibition by immediate drug release is feasible. This article reviews the potential applications of the drug-coated balloon in coronary vascular disease.

scholarly journals A Retrospective Observational Analysis on the Outcome of Microlumbar Discectomy among 70 Consecutive Cases in the Tertiary Care Spine Center in Nepal

2019 ◽  
Vol 16 (3) ◽  
pp. 34-39
Author(s):  
Binod Bhattarai ◽  
Shashi Bhushan Sah
Keyword(s):  
Wound Infection ◽  
Lumbar Disc ◽  
Tertiary Care ◽  
Lumbar Discectomy ◽  
Neurological Deficits ◽  
Disc Disease ◽  
Term Outcome ◽  
Lumbar Disc Disease ◽  
Long Term Outcome

Lumbar disc disease is a commonly encountered spine problem. There have been various modalities of treatment that have evolved over the years. The objective of our study is to analyze safety, efficacy, and complications following Micro-lumbar discectomy. All the cases admitted in our spine clinic with symptomatic lumbar disc and who underwent Micro-lumbar discectomy between February2013 to February 2018 were included in our study. Seventy cases were operated during this period. Total operative time, immediate and long term outcome with regards to pain and neurological deficits were tabulated and analyzed for each patient. Furthermore, short and long term complications including wound infection, discit is, instability and recurrence at the same level were also studied and compared with similar studies from the literature. None of our cases had complications related to wound infection, instability or post-operativediscitis. Immediate relief from the radicular pain experienced in the pre-operative period was seen in all patients (Visual analog scale) though benign tingling sensation persisted in a few of them that improved in a short span of time. Recurrence was seen in only one case. Micro-lumbar discectomy is a minimally invasive spine procedure conferring high benefits to the patients. While compared to other methods of intervention, it has a low risk of complications as well as chances of disc recurrences.

scholarly journals Long-Term Survival and Outcome in Children Admitted to Kilifi District Hospital with Convulsive Status Epilepticus

2014 ◽  
Vol 2014 ◽  
pp. 1-7
Author(s):  
Agnes Prins ◽  
Eddie Chengo ◽  
Victor Mung'ala Odera ◽  
Manish Sadarangani ◽  
Claire Seaton ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Neurological Deficits ◽  
Control Group ◽  
Convulsive Status Epilepticus ◽  
Term Outcome ◽  
Term Survival ◽  
Long Term Outcome ◽  
Neurodevelopmental Impairment ◽  
Active Epilepsy

Objectives. The incidence of convulsive status epilepticus (CSE) is high in Africa but the long-term outcome is unknown. We examined the neurocognitive outcome and survival of children treated for CSE in a Kenyan hospital 3 to 4 years after discharge. Methods. The frequency and nature of neurological deficits among this group of children were determined and compared to a control group. The children were screened with the Ten Questions Questionnaire for neurodevelopmental impairment if alive and those that screened positive were invited for further assessment to determine the pattern and extent of their impairment. A verbal autopsy was performed to determine the cause of death in those that died. Results. In the 119 cases followed-up, 9 (8%) died after discharge, with the majority having seizures during their fatal illness. The 110 survivors (median age 5 years) had significantly more neurological impairments on the screening compared to 282 controls (34/110 (30.9%) versus 11/282 (3.9%), OR = 11.0, 95% CI 5.3–22.8). Fifteen percent of the cases had active epilepsy. Conclusions. This study demonstrates the considerable burden of CSE in African children. Strategies to manage children with CSE that are acceptable to the community need to be explored to improve the longer-term outcome.

scholarly journals History before diagnosis in childhood craniopharyngioma: associations with initial presentation and long-term prognosis

2015 ◽  
Vol 173 (6) ◽  
pp. 853-862 ◽  
Author(s):  
Anika Hoffmann ◽  
Svenja Boekhoff ◽  
Ursel Gebhardt ◽  
Anthe S Sterkenburg ◽  
Anna M M Daubenbüchel ◽  
...  
Keyword(s):  
Tumor Size ◽  
Age At Diagnosis ◽  
Neurological Deficits ◽  
Term Outcome ◽  
Specific Symptom ◽  
Long Term Outcome ◽  
Long Term Prognosis ◽  
Prospective Longitudinal

ObjectiveChildhood craniopharyngiomas (CP) are often diagnosed after a long duration of history (DOH). Tumor size, hypothalamic involvement (HI), and obesity are associated with reduced overall survival (OS) and functional capacity (FC). The effect of DOH and specific symptoms in history on presentation at initial diagnosis and long-term prognosis are unknown.DesignRetrospective analysis of patients' records and prospective longitudinal follow-up.MethodsHistories of 411 CP patients recruited in HIT Endo, KRANIOPHARYNGEOM 2000 were retrospectively evaluated for DOH, symptoms, and characteristics. The effect of specific manifestations and DOH on clinical presentation and tumor characteristics at time of initial CP diagnosis and long-term outcome were analyzed. Main outcome measures were 10-year OS and progression-free survival (PFS), FC, and BMI during longitudinal follow-up.ResultsMedian DOH was 6 months (range: 0.1–108 months) and correlated with age at diagnosis. Tumor size, HI, degree of resection, and BMI at diagnosis were not related to DOH. In multivariate analysis adjusted for age at diagnosis, only hydrocephalus was found to have a relevant influence on DOH. Visual and neurological deficits were associated with larger initial tumor size and impaired 10-year OS. Weight gain and growth failure were observed with longest DOH. PFS and FC were not related to any specific symptom. Endocrine deficits at diagnosis were associated with long DOH.ConclusionsCP is frequently diagnosed after long DOH, especially in older children. However, DOH was not associated with tumor size, HI, survival, or FC. Visual and neurological deficits necessitate rapid diagnostic workup.

Long-term outcome of lumbar disc surgery: an experience from Pakistan

2010 ◽  
Vol 12 (6) ◽  
pp. 666-670 ◽  
Author(s):  
Ahmed Bakhsh
Keyword(s):  
Pain Relief ◽  
Lumbar Disc ◽  
Foot Drop ◽  
Neurological Deficits ◽  
Leg Pain ◽  
Lumbar Disc Surgery ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Disc Surgery

Object The author conducted a study to determine the long-term outcome of lumbar disc surgery on relief of sciatic leg pain. Methods This was a retrospective observational study conducted at Fauji Foundation Hospital, Rawalpindi, Pakistan. The author reviewed medical records of 68 patients who underwent lumbar disc surgery for sciatic pain during the period 1995–2004. All patients were physically examined and interviewed. Results Lumbar disc surgery yielded complete pain relief in 79.41% of the cases. In 14.7% of the cases surgery failed to give any pain relief, and in 5.88% it yielded partial pain relief. At up to 10 years postoperatively, 27.77% of patients remained absolutely pain free. Pain recurred in 12.82% of cases after 1 year, in 35.89% during the first 5 years, and in 51.28% after 10 years. Pain recurred in the same leg in 63.88%, in the contralateral leg in 19.44%, and in both legs in 16.66%. Neurological deficits did not improve in any case except in 1 case of foot drop. New neurological deficits developed postoperatively in 8.82% of cases in the form of foot drop and calf muscle weakness. Conclusions Surgery provided immediate pain relief in 79.41% of cases, but the long-term outcome of lumbar disc surgery was not satisfactory.

Abstract WMP113: Genetic Influences on Early Neurological Instability After Acute Ischemic Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Laura Ibanez ◽  
Laura Heitsch ◽  
Caty Carrera ◽  
Israel Fernandez ◽  
Joan Montaner ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Neurological Outcome ◽  
Cohort Analysis ◽  
Neurological Deficits ◽  
Genetic Influences ◽  
Common Variants ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Genome Wide

Following acute ischemic stroke (AIS) onset, neurological deficits can be highly unstable. Early neurological change within the first 24 hours, defined here as ΔNIHSS24h (NIHSSbaseline-NIHSS24hours), substantially influences long-term outcome. While several mechanisms, such as hemorrhagic transformation and recanalization, may impact ΔNIHSS24h, little is known about genetic influences. Genetic variants associated with ΔNIHSS24h may identify genes involved in mechanisms of early neurological outcome after AIS. AIS patients were prospectively enrolled between 2008-2014 at two sites (St Louis and BCN; Table 1). NIHSS scores were obtained within 6 hours and again at 24 hours after stroke onset. Genome-wide genotyping was generated for rare and common variants, imputing up to 6 million single nucleotide polymorphisms (SNPs) for all subjects (N=891). ΔNIHSS24h was used as a quantitative trait to measure early improvement/deterioration. Genome-wide complex trait analysis (GCTA) was performed. An association model was done, using NIHSSbaseline, age, gender, glucose, PCA1 and PCA2 as covariates. All samples were analyzed together and then separately by ethnicity (Spanish, European-American (EA), and African-American (AA)). GCTA indicates that common variants account for 23-28% of ΔNIHSS24h variability. VAV3 rs72689643 (p=8.21x10-8) was associated with ΔNIHSS24h in the whole cohort analysis (Figure 1). Three additional suggestive SNPs were found: 2 intergenic SNPs (rs139950151 and rs73706194 - both p=6.1x10-7) in high LD and SNP rs10431426 (p=1.71x10-7) located in an intron. When analyzed by ethnicity, these findings did not reach GWAs significance, likely due to lack of power. Early neurological outcome after AIS is strongly influenced by genetics. Vav3 shows association with ΔNIHSS24h in the whole cohort while several other SNPs are suggestive. Rare variant analysis is underway, and we will also have an additional 800 genotypes analyzed by ISC.

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