Disseminated Cysticercosis

Cysticercosis is a parasitic infection caused by larval cysts of the tapeworm Taenia solium. It is highly prevalent in rural areas of developing countries with poor sanitary conditions. We report a rare case of extensive disseminated cysticercosis in a 98-year-old woman who was brought to the emergency department following a fall. The x-ray revealed numerous ‘rice grain’ calcifications predominantly oriented in the plane of muscle fibres. A broad review revealed pelvic, chest and inferior limb involvement. The findings were consistent with cysticercosis.

Benefits of Botulinum Toxin type A in post-stroke neurorehabilitation

Background: Stroke can injure the upper motor neuron, and may develop spasticity, a speed-dependent excessive contraction that makes muscle extension difficult. The botulinum toxin type A make contraction difficult, by inhibiting acetylcholine liberation by the lower motor neuron. Thus, it is hypothesized that the botulinum toxin has benefits in post-stroke spasticity. Objective: To evaluate the benefits of botulinum toxin in post-stroke spasticity. Methods: This is a literature review, which articles were searched via PubMed, with MeSH descriptors, using the formula: (“Botulinum toxin type A”) AND (“stroke”) AND (“spasticity”). Clinical trials, systematics reviews and metanalysis, that used botulinum toxin type A as intervention were included. Results: The search resulted in 16 articles, and 5 were selected. A metanalysis, that included 10 clinical trials, evaluated 950 patients and the botulinum toxin type A in superior limbs spasticity has not shown benefits. Yet, another metanalysis which evaluated 27 clinical trials with 2793 patien ts, with both superior and inferior limbs spasticity, demonstrated improvement in levels of tonicity and deficiency evaluation scales. A prospective cohort whose outcome was based in doctor-patient goals has shown great improvement in mobility (87%), positioning (100%), pain relief and spasms (>80%). A clinical trial has also shown improvement on inferior limb function after 3 months of botulinum toxin use. Conclusions: The botulinum toxin use for improvement in inferior limbs spasticity is well described on the literature. However, its use for superior limbs is still controversial, requiring more studies.

Thoracolumbar progressive myelopathy due to extra-dural arteriovenous fistula

Context: Arteriovenous dural fistulas are the most common spinal vascular malformations and constitute a reversible cause of progressive myelopathy. This disease affects elderly men and are classically found at the thoracolumbar region. Case report: A 69year-old man was admitted to the Neurology outpatient clinic with weakness in his left inferior limb for the past 10 years; 2 years before the evaluation, the weakness progressed also to the right inferior limb, causing inability to walk, and 1 year after the patient noticed urinary incontinence and sexual dysfunction. Physical evaluation showed grade-II paraparesis with spastic hypertonia; hypoesthesia below T-10 dermatome; hyperreflexia with clonus and Babinski sign in inferior limbs. Investigation with MRI showed abnormal hypersignal within spinal cord from T6-T7 to the medullary cone; CSF sample had hyper protein count without pleocytosis. Before the hypothesis of non- compressive, non-inflammatory and non-infectious myelopathy, we performed a spinal angiography – which diagnosed a dural arteriovenous fistula at the level of T8 connecting spinal with extradural vessels. The patient was then treated by endovascular therapy with fistula embolization. Conclusion: Although being the most common vascular spinal malformation, arteriovenous dural fistulas are rare and underdiagnosed because of their nonspecific symptoms. The aim of treatment is the shunt occlusion but its prognosis depends on the duration and intensity of symptoms before treatment. This report’s aim is to exemplify a typical case of this condition.

Pethidine’s Half-life Alterations following Orthopedic Surgery: Is Available Literature Always Compatible with the Data Obtained at the Bedside?

Background: It is suggested that surgery results in changes in kinetic profile of some medication. The aim of this study was to investigate possible alterations in pethidine’s half-life in postoperative pain management following orthopedic surgery of the inferior limb. Methods: Twelve patients, who were classified as class I patients according to the American society of anesthesiologists physical status classification, were enrolled. Following the surgery of the lower limb, 25 mg of pethidine was injected intravenously. After that, 5, 30, 60 and 180 minutes following the injection, blood samples were taken and concentration of pethidine in blood samples was measured by High Performance Liquid Chromatography method. Moreover, patients’ pain levels were assessed on visual analogue scales. Results: The average half-life of pethidine was measured to be 29.68 minutes. Thirty minutes after the injection, significant relationship between plasma levels of pethidine and pain scale was reported (p= 0.041, r= 0.595). Moreover, men were found to perceive more pain than women. Pain scale was considerably different between smokers and non-smokers (p= 0.006), although blood concentration of pethidine was not significantly different between these two groups (p=0.09). Conclusions: The average half-life of pethidine was shorter compared to the established half-life in literature. Orthopedic surgery most probably results in alterations in pharmacokinetic profile of pethidine. Moreover, gender and smoking status of the patients influence pain perception. Thus, pharmacokinetic alterations due to inferior limb orthopedic surgery, gender-related factors and smoking status of the patients should be considered in pain management in clinical settings. J Pharm Care 2019; 7(4): 82-86.

A Case of Bilateral Acute Inferior Limb Ischemia in a Patient With Ulcerative Colitis

A patient was diagnosed with ulcerative colitis (UC) in 2010. In March 2015, she had abdominal pain, diarrhea, bloody stool, and UC has relapsed. In June 2015, pain and sensory disturbance of both lower limbs appeared. Blood flow at the distal femoral artery was not confirmed with magnetic resonance angiography, and it was diagnosed as bilateral acute inferior limb ischemia. Arterial thrombolectomy with Fogarty’s balloon catheter was performed and blood flow was improved. The severity of UC was moderate with Mayo score 8. Thrombosis is considered to be a complication with a high incidence in inflammatory bowel disease. Reports of arterial thrombosis are very rare. It is important to evaluate the risk of bleeding and thrombosis in active or severe cases in UC and need to do thrombotic prophylactic treatment simultaneously with UC treatment.

Customizable Patient-Specific Cutting Guide for High Tibial Osteotomy

The paper is an interdisciplinary medical and engineering approach that aims to optimize the accuracy of the High Tibial Osteotomy surgical intervention. The axial deviations of the human inferior limb are presented in the first part of the paper. Without altering the shape of the bones, these deviations cause the wear of the knee’s articular cartilage by gonarthrosis. One of the most common and effective treatment modalities for eliminating axial deviations is High Tibial Osteotomy. Because the surgical procedure involves 3D spatial bone cutting, the accuracy of the procedure and thus the success of the operation and the recovery of the patient is dependent on the execution of these cuts. Within this paper, a specialized device is proposed that makes it possible to guide the surgical saw and to accurately perform the correction angles. In the last part of the paper, customization possibilities and fabrication of the main elements of the cutting device using Additive Manufacturing processes are presented.

Heterotopic Brain Tissue in the Spinal Canal: a Report of an Unusual Case with a Review of the Literature

Heterotopia refers to cells displaced from normal sites, when they are in an aberrant location within their organ of origin. Heterotopic neuroglial tissues are usually located in the nasal region. We present acase of a 69-year-old man with a long history of lumbosacral pain with paresis of the inferior limb. MRI examination detected a cystic tumor located at the L1-L2 level. Histologic examination revealed presence of heterotopic neuroglial tissues, containing synaptophysin, glial cells, and meninges.

Care management of the patient with amputation in the inferior limb

Lower limb amputation is a therapeutic solution for peripheral vascular disease that affects more and more people on long term, both socially and emotionally.Changing the appearance and shape of the body requires changes in the patient's life and his environment. Most patients are afraid of these changes, the help of professionals and family being essential for solving medical and social issues. According to the recommendations of the World Health Organization, patients’ evaluation should be extended from deficiencies caused by segmentation to structural deficiencies, through all functional, educational and professional aspects of human life. The purpose of the article is to present the complex way of care and rehabilitation of the patient with amputation at the level of the inferior limb, starting from qualified medical care to social and occupational care. Successful rehabilitation of patients with amputation in the inferior limb is a major objective of the multidisciplinary team.