Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Diffuse idiopathic skeletal hyperostosis (DISH) is a non-inflammatory, systemic skeletal disease. The associated formation of anterior cervical osteophytes can cause severe dysphagia, so the osteophytes have to be surgically removed. Because the clinical syndrome is rare, long-term outcome after surgical therapy is likewise scarce. ⋯ The patient with the slightest improvement and clinical deterioration in the course had an initially incomplete resection of osteophytes. Imaging showed a re-increase of ossifications 2.5 years after the surgery. Resection of symptomatic anterior osteophytes in DISH is a safe and promising procedure to improve dysphagia in the long-term, but the recurrence of osteophytes is possible years after initial treatment.
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Perioperative stroke in non-vascular, non-neurological surgery is a potential cause of high levels of in-hospital morbidity and mortality. Although, perioperative stroke following non-vascular and non-neurological surgery is a relatively infrequent event; high surgical volume results in thousands of patients experiencing neurological deficits. We aim to determine if perioperative stroke is an independent risk factor for 30-day in-hospital morbidity and mortality following common non-vascular non-neurological surgery. ⋯ Multivariable analysis revealed perioperative stroke to be a significant independent predictor (p < 0.001) of length of stay exceeding 14 days (OR = 4.55, 95% CI: 4.21-4.91), cardiovascular complications (OR = 1.96, 95% CI: 1.75-2.19), pulmonary complications (OR = 2.07, 95% CI: 1.89-2.27). The impact of perioperative stroke on in-hospital mortality was (OR = 8.53, 95% CI: 7.87-9.25), whereas cardiovascular complications impact on in-hospital mortality was (OR = 8.36, 95% CI = 7.67-9.10, p < 0.001). This study identified perioperative stroke as an independent predictor of 30-day in-hospital morbidity and mortality following non-vascular, non-neurological surgery.
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The aim of this study was to demonstrate the techniques of modified lateral lumbar interbody fusion and investigate its approach related complications. Fifty-two patients underwent with modified lateral lumbar interbody fusion (LLIF) in our center were studied retrospectively. There were 20 males and 32 females, aged from 45 to 82 years old (averaged at 66.0 ± 11.2). ⋯ Only one case had residual numbness in anterior thigh at the last follow-up. The incidence rate of complications increased significantly in patients underwent three or more levels interbody fusion compared to patients underwent one or two levels interbody fusion (X2 = 5.163, P = 0.023). The modified lateral lumbar interbody fusion may reduce the approach related complications of traditional lateral lumbar interbody fusion through the operation under the direct visualization, the improved transpsoas approach and the novel designed retractor.
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Antiplatelet therapy at the time of spontaneous intracerebral hemorrhage (sICH) may increase risk for hemorrhage expansion and mortality. Current guidelines recommend considering a single dose of desmopressin in sICH associated with cyclooxygenase-1 inhibitors or adenosine diphosphate receptor inhibitors. Adult subjects with sICH and concomitant antiplatelet therapy admitted to a large, tertiary care center were included. ⋯ Multiple logistic regression controlling for significant covariates did not reveal a significant effect of desmopressin on relative or absolute hematoma expansion (OR 0.65 [95% CI 0.18-2.43] and OR 1.55 [0.48-4.99], respectively). We failed to find evidence that desmopressin administration for antiplatelet reversal in sICH reduces the incidence of hematoma expansion. Larger studies, focusing on the early phase of sICH, are needed to characterize the clinical efficacy and safety of desmopressin for antiplatelet reversal before widespread implementation.
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Clinical Trial
Can aberrant spinal nociception be a marker of chronicity of pain in fibromyalgia syndrome?
Pain sensitivity is a recognized feature of fibromyalgia syndrome (FMS) but the contribution of spinal nociceptive circuitry to this phenomenon is unknown. Therefore, the objectives were to study the changes in spinal nociception i.e. nociceptive flexion reflex (NFR) in patients with FMS and to investigate correlation if any, between NFR threshold, pain duration and tender points in FMS. One hundred and three patients with FMS and 74 healthy volunteers participated in the study. ⋯ No significant correlation was found among NFR threshold and pain duration or tender points. On the basis of results of present study, it may be concluded that the functional deficit of the spinal nociceptive system can contribute to hyperalgesia in FMS. This is first study that correlates a marker of central hyper-excitability (NFR threshold) with clinical symptoms (pain duration and tender points) of FMS.