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Abstract
The purpose of this study was to evaluate the application of multimodal intraoperative monitoring (MIOM) system in patients with congenital scoliosis (CS) and adolescent idiopathic scoliosis (AIS).Twelve patients who underwent posterior surgical correction of scoliosis for CS and AIS from June 2014 to July 2018 were enrolled in this study. During the operation, we monitored the functional status of the spinal cord by MIOM. An abnormal somatosensory evoked potential was defined as a prolonged latency of more than 10% or a peak-to-peak amplitude decline of more than 50% when compared to baseline. An abnormal transcranial motor evoked potential (TcMEP) was defined as a TcMEP amplitude decrease of more than 50%. A normal triggered electromyography response, which presented with the absence of an electrical response on stimulation at 8.2 mA, indicated that the pedicle screw was not in contact with the spinal cord or nerve root.A total of 12 patients underwent MIOM surgery, of which 9 patients with negative MIOM had no significant deterioration of neurological function postoperatively, and exhibited satisfactory surgical correction of scoliosis during follow-ups. However, the remaining 3 patients suffered from MIOM events, 2 patients had normal neurological function, and 1 patient had deteriorated neurological function postoperatively.Using MIOM in CS and AIS surgery could promptly detect iatrogenic neurological injury at the early stage. Therefore, rapid response by appropriate intraoperative interventions can be taken to minimize the injury. Besides, stable MIOM recordings encourage surgeons to correct scoliosis even when the Cobb angle of scoliosis was extremely large.
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Affiliation(s)
| | | | - Xi-Wen Zhang
- Department of Gynaecology, The Second Hospital of Jilin University, Changchun, Jilin Province, China
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Yu T, Wang Y, Zhang XW, Jiang ZD, Zhu XJ, Jiang QY, Zhao JW. Multimodal intraoperative monitoring during reduction of spine burst fracture and dislocation prevents neurologic injury. Medicine (Baltimore) 2018; 97:e0066. [PMID: 29517666 PMCID: PMC5882445 DOI: 10.1097/md.0000000000010066] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study aims to evaluate the application of multimodal intraoperative monitoring (MIOM) in surgical treatment for spine burst fracture and dislocation (SBFD) patients.Eleven patients who underwent posterior reduction and instrumentation (PRI) for SBFD from June 2014 to July 2016 were included into the study. The function of the spinal cord was monitored by MIOM. The muscle strength of the lower extremities and American Spinal Injury Association (ASIA) scores were, respectively, evaluated (before surgery, and at 1, 3, 6, and 12 months after surgery). Furthermore, the extent of reduction was also assessed.Muscle strength recovery, ASIA score changes, and the extent of reduction were correlated with MIOM results. Among the 11 patients who received surgery under MIOM, 8 patients with negative MIOM results during the operation did not demonstrate neurological deterioration postoperatively and exhibited improvements in ASIA scores during follow-ups. However, among the 3 patients who encountered MIOM events (case 4, 7, and 8), 2 patients avoided nerve lesion and 1 patient suffered from neurologic deterioration postoperatively.The application of MIOM technology during PRI surgery may detect spinal cord impairment at the early stage, and operative schemes can be modified before permanent nerve compromise is triggered by surgical manipulation.
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Affiliation(s)
| | | | - Xi-Wen Zhang
- Department of Gynecology, The Second Hospital of Jilin University, Changchun, Jilin Province, China
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Goonewardene SS, Persad R, Gillatt D. Erectile function post robotic radical prostatectomy: technical tips to improve outcomes? J Robot Surg 2016; 10:267-9. [PMID: 27272758 DOI: 10.1007/s11701-016-0578-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 03/06/2016] [Indexed: 11/26/2022]
Abstract
Robotic surgery is becoming more and more commonplace. At the same time, so are complications, especially related to erectile function. The population being diagnosed with cancer is younger, with more aggressive cancers and higher expectations for good erectile function postoperatively. We conduct a retrospective analysis of literature over 20 years for Embase and Medline. Search terms used include (Robotic) AND (prostatectomy) AND (erectile function). There are a variety of multifactorial causes, resulting in worsening ED post-robotic radical prostatectomy; however, there are a number of treatments that can support this. There is much we can do to help prevent patients getting postoperative erectile dysfunction post-radical surgery. However, part of this is management of realistic patient expectations.
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Affiliation(s)
| | - R Persad
- North Bristol NHS Trust, Bristol, UK
| | - D Gillatt
- McQuarrie University, Sydney, Australia
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Carley A. Why Focus on Neonatal Neurointensive Care? Neonatal Netw 2016; 35:66. [PMID: 27052979 DOI: 10.1891/0730-0832.35.2.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Annette Carley
- University of California, San Francisco School of Nursing, UCSF School of Nursing, 2 Koret Way, Box 0606 San Francisco, CA 94143, USA
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Lee S, Park S, Won J, Lee SR, Chang KT, Hong Y. The Incremental Induction of Neuroprotective Properties by Multiple Therapeutic Strategies for Primary and Secondary Neural Injury. Int J Mol Sci 2015; 16:19657-70. [PMID: 26295390 PMCID: PMC4581318 DOI: 10.3390/ijms160819657] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 08/07/2015] [Accepted: 08/07/2015] [Indexed: 01/09/2023] Open
Abstract
Neural diseases including injury by endogenous factors, traumatic brain injury, and degenerative neural injury are eventually due to reactive oxygen species (ROS). Thus ROS generation in neural tissues is a hallmark feature of numerous forms of neural diseases. Neural degeneration and the neural damage process is complex, involving a vast array of tissue structure, transcriptional/translational, electrochemical, metabolic, and functional events within the intact neighbors surrounding injured neural tissues. During aging, multiple changes involving physical, chemical, and biochemical processes occur from the molecular to the morphological levels in neural tissues. Among many recommended therapeutic candidates, melatonin also plays a role in protecting the nervous system from anti-inflammation and efficiently safeguards neuronal cells via antioxidants and other endogenous/exogenous beneficial factors. Therefore, given the wide range of mechanisms responsible for neuronal damage, multi-action drugs or therapies for the treatment of neural injury that make use of two or more agents and target several pathways may have greater efficacy in promoting functional recovery than a single therapy alone.
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Affiliation(s)
- Seunghoon Lee
- Department of Physical Therapy, College of Biomedical Science & Engineering, Inje University, Gimhae 50834, Korea.
- Biohealth Products Research Center (BPRC), Inje University, Gimhae 50834, Korea.
- Ubiquitous Healthcare & Anti-aging Research Center (u-HARC), Inje University, Gimhae 50834, Korea.
| | - Sookyoung Park
- Ubiquitous Healthcare & Anti-aging Research Center (u-HARC), Inje University, Gimhae 50834, Korea.
- Department of Physical Therapy, College of Life Sciences, Kyungnam University, Changwon 51767, Korea.
| | - Jinyoung Won
- Biohealth Products Research Center (BPRC), Inje University, Gimhae 50834, Korea.
- Ubiquitous Healthcare & Anti-aging Research Center (u-HARC), Inje University, Gimhae 50834, Korea.
- Department of Rehabilitation Science, Graduate School of Inje University, Gimhae 50834, Korea.
| | - Sang-Rae Lee
- National Primate Research Center (NPRC), Korea Research Institute of Bioscience and Biotechnology (KRIBB), Ochang 28116, Korea.
| | - Kyu-Tae Chang
- National Primate Research Center (NPRC), Korea Research Institute of Bioscience and Biotechnology (KRIBB), Ochang 28116, Korea.
| | - Yonggeun Hong
- Department of Physical Therapy, College of Biomedical Science & Engineering, Inje University, Gimhae 50834, Korea.
- Biohealth Products Research Center (BPRC), Inje University, Gimhae 50834, Korea.
- Ubiquitous Healthcare & Anti-aging Research Center (u-HARC), Inje University, Gimhae 50834, Korea.
- Department of Rehabilitation Science, Graduate School of Inje University, Gimhae 50834, Korea.
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Cotero VE, Kimm SY, Siclovan TM, Zhang R, Kim EM, Matsumoto K, Gondo T, Scardino PT, Yazdanfar S, Laudone VP, Tan Hehir CA. Improved Intraoperative Visualization of Nerves through a Myelin-Binding Fluorophore and Dual-Mode Laparoscopic Imaging. PLoS One 2015; 10:e0130276. [PMID: 26076448 PMCID: PMC4468247 DOI: 10.1371/journal.pone.0130276] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 05/19/2015] [Indexed: 11/18/2022] Open
Abstract
The ability to visualize and spare nerves during surgery is critical for avoiding chronic morbidity, pain, and loss of function. Visualization of such critical anatomic structures is even more challenging during minimal access procedures because the small incisions limit visibility. In this study, we focus on improving imaging of nerves through the use of a new small molecule fluorophore, GE3126, used in conjunction with our dual-mode (color and fluorescence) laparoscopic imaging instrument. GE3126 has higher aqueous solubility, improved pharmacokinetics, and reduced non-specific adipose tissue fluorescence compared to previous myelin-binding fluorophores. Dosing and kinetics were initially optimized in mice. A non-clinical modified Irwin study in rats, performed to assess the potential of GE3126 to induce nervous system injuries, showed the absence of major adverse reactions. Real-time intraoperative imaging was performed in a porcine model. Compared to white light imaging, nerve visibility was enhanced under fluorescence guidance, especially for small diameter nerves obscured by fascia, blood vessels, or adipose tissue. In the porcine model, nerve visualization was observed rapidly, within 5 to 10 minutes post-intravenous injection and the nerve fluorescence signal was maintained for up to 80 minutes. The use of GE3126, coupled with practical implementation of an imaging instrument may be an important step forward in preventing nerve damage in the operating room.
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Affiliation(s)
- Victoria E. Cotero
- Diagnostics, Imaging and Biomedical Technologies, GE Global Research, Niskayuna, New York, United States of America
| | - Simon Y. Kimm
- Urology Service, Department of Surgery, Memorial Sloan—Kettering Cancer Center, New York, New York, United States of America
| | - Tiberiu M. Siclovan
- Diagnostics, Imaging and Biomedical Technologies, GE Global Research, Niskayuna, New York, United States of America
| | - Rong Zhang
- Diagnostics, Imaging and Biomedical Technologies, GE Global Research, Niskayuna, New York, United States of America
| | - Evgenia M. Kim
- Diagnostics, Imaging and Biomedical Technologies, GE Global Research, Niskayuna, New York, United States of America
| | - Kazuhiro Matsumoto
- Urology Service, Department of Surgery, Memorial Sloan—Kettering Cancer Center, New York, New York, United States of America
| | - Tatsuo Gondo
- Urology Service, Department of Surgery, Memorial Sloan—Kettering Cancer Center, New York, New York, United States of America
| | - Peter T. Scardino
- Urology Service, Department of Surgery, Memorial Sloan—Kettering Cancer Center, New York, New York, United States of America
| | - Siavash Yazdanfar
- Diagnostics, Imaging and Biomedical Technologies, GE Global Research, Niskayuna, New York, United States of America
| | - Vincent P. Laudone
- Urology Service, Department of Surgery, Memorial Sloan—Kettering Cancer Center, New York, New York, United States of America
| | - Cristina A. Tan Hehir
- Diagnostics, Imaging and Biomedical Technologies, GE Global Research, Niskayuna, New York, United States of America
- * E-mail:
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LaBotz M, Bernhardt D. Preparticipation Physical Evaluation. Adolesc Med State Art Rev 2015; 26:18-38. [PMID: 26514030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Preparticipation physical evaluations are often a challenge for physicians. A recent study examined the PPE in clinical practice among pediatricians and family physicians in the state of Washington. Unfortunately, many physicians in this study perceived significant barriers to effective performance of the PPE. These barriers included uncertainty about how to perform the PPE, the relative importance of each PPE component, and the lack of a standardized approach and time for appropriate performance of the PPE. Although these concerns are shared by physicians beyond the borders of Washington, those who are aware of the information contained in the PPE monograph are able to use current best practices to enhance the effectiveness and efficiency of this examination and report greater comfort and satisfaction with these evaluations.
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Giannetti S, Patricola AA, Stancati A, Santucci A. Intraoperative ultrasound assistance for percutaneous repair of the acute Achilles tendon rupture. Orthopedics 2014; 37:820-4. [PMID: 25437073 DOI: 10.3928/01477447-20141124-04] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 11/08/2013] [Indexed: 02/03/2023]
Abstract
Various methods have been used to treat the acute Achilles tendon rupture. Traditional open repair is associated with a higher rate of complications. Percutaneous methods avoid most of the disadvantages of open surgical treatment, but the degree of tendon regeneration cannot be ensured. The authors prospectively followed 40 patients with acute Achilles tendon rupture who underwent percutaneous repair with intraoperative ultrasound assistance an average of 13 months after the injury. No surgery-related complications, such as wounds or deep infections, sural nerve injury, or re-rupture, were detected at follow-up. This technique avoids injury to the sural nerve, minimizes wound complications, and provides a strong repair.
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Atilgan D, Parlaktas BS, Uluocak N, Erdemir F, Markoc F, Saylan O, Erkorkmaz U. The effects of trimetazidine and sildenafil on bilateral cavernosal nerve injury induced oxidative damage and cavernosal fibrosis in rats. ScientificWorldJournal 2014; 2014:970363. [PMID: 24782681 PMCID: PMC3977563 DOI: 10.1155/2014/970363] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 03/06/2014] [Indexed: 12/02/2022] Open
Abstract
AIM The aim of this study was to compare the effects of sildenafil and trimetazidine on bilateral cavernosal nerve injury-induced oxidative damage and fibrotic changes in cavernosal tissue in rat model. MATERIAL AND METHODS A total of 32 male Sprague-Dawley rats were randomly divided into 4 groups; each group consist 8 rats (control, BCI, BCI + TMZ, and BCI + sildenafil groups). Tissue superoxide dismutase (SOD), malondialdehyde (MDA), and protein carbonyl (PC) levels were determined biochemically and distribution of cavernosal fibrosis density among groups was performed histopathologically. RESULTS Tissue SOD levels in BCI group were significantly lower than the control group (P < 0.05). Tissue MDA and PC levels in BCI group were significantly higher than the control group (P < 0.05). TMZ and sildenafil administration significantly increased tissue SOD levels (P < 0.05) and reduced tissue MDA and PC levels (P < 0.05). Histologically, the degree of cavernosal fibrosis and collagen density was higher in BCI group in comparison to control, TMZ-treated, and sildenafil-treated groups. CONCLUSION BCI caused oxidative damage and increased cavernosal fibrosis in rat penis. TMZ and sildenafil treatment decreased oxidative damage and reduced the degree of fibrosis in penile tissue due to BCI.
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Affiliation(s)
- Dogan Atilgan
- Department of Urology, Medical Faculty, Gaziosmanpasa University, 60100 Tokat, Turkey
| | - Bekir S. Parlaktas
- Department of Urology, Medical Faculty, Gaziosmanpasa University, 60100 Tokat, Turkey
| | - Nihat Uluocak
- Department of Urology, Medical Faculty, Gaziosmanpasa University, 60100 Tokat, Turkey
| | - Fikret Erdemir
- Department of Urology, Medical Faculty, Gaziosmanpasa University, 60100 Tokat, Turkey
| | - Fatma Markoc
- Department of Pathology, Medical Faculty, Gaziosmanpasa University, 60100 Tokat, Turkey
| | - Oguzhan Saylan
- Department of Biochemistry, Medical Faculty, Gaziosmanpasa University, 60100 Tokat, Turkey
| | - Unal Erkorkmaz
- Department of Biostatistics, Medical Faculty, Gaziosmanpasa University, 60100 Tokat, Turkey
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Yang X, Zhang Y, Zhang T, Xu L, Ke J, Ma L, Lan G, Yao Z, Ouyang L, Huang H, Xia H, Yin Q. [Prevention and control strategies of common post-operative complications of microwave ablation in situ in treatment of bone tumors]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2012; 26:1473-1476. [PMID: 23316639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To analyze the common post-operative complications of microwave ablation in situ in the treatment of bone tumors and the prevention and control strategies. METHODS Between March 2009 and July 2012, 73 cases of bone tumors were treated with microwave ablation in situ, of which 54 cases met the inclusion criteria. There were 31 males and 23 females with a median age of 27 years (range, 9-74 years), including 37 malignant tumors and 17 benign tumors. In 49 primary bone tumors, 17 cases were in stage 3, 13 in stage IIA, and 19 in stage IIB according to Enneking grading system. The postoperative complications, managements, and outcomes in patients were analyzed. RESULTS After operation, 54 patients were followed up 12-40 months (mean, 24 months). Seven kinds of complications occurred in 21 patients (38.9%) with 3 cases suffered from more than one, including pathologic fracture in 4 cases (7.4%), deep infection in 2 cases (3.7%), nerve injury in 7 cases (13.0%), deep vein thrombosis of the lower extremity in 1 case (1.9%), medial collateral ligament heat injury of the knee in 1 case (1.9%), hematoma in 2 cases (3.7%), and fat liquefaction of incision and flap necrosis in 8 cases (14.8%). CONCLUSION Pathologic fracture is the primary complication which results in a second surgery. Deep infection is the main complication that often leads to failure of the limb salvage. Nerve injury and poor wound healing are the most common complications. Good control of microwave temperature is the key to successful operation, and the related preventive strategies could reduce complications.
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Affiliation(s)
- Xiaoming Yang
- Department of Bone Disease and Joint, Hospital of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou Guangdong, 510010, P.R.China
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Ram K, Dam L, in 't Hof KH, Nieveen van Dijkum EJMN. [Intraoperative neuromonitoring during endocrine surgery]. Ned Tijdschr Geneeskd 2012; 156:A4483. [PMID: 22748368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Recurrent laryngeal nerve (RLN) injury is a known complication of thyroid surgery. Patients undergoing reoperations or extensive resections of malignancies carry an increased risk of nerve damage. The gold standard for preventing RLN injury is identification of the RLN. The development of a new technique has enabled intraoperative testing of RLN function. Intraoperative neuromonitoring has an excellent specificity and negative predictive value in which an unchanged positive signal is highly predictive of intact nerve function. This technique facilitates RLN identification in altered anatomy as is found at reoperation and can prevent bilateral vocal cord palsy. Additionally the prognosis of patients with postoperative voice symptoms can be supported by the objective intraoperative measurements.
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Affiliation(s)
- Kim Ram
- Academisch Medisch Centrum, afd. Chirurgie, Amsterdam, the Netherlands.
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Silverstein J, Basra S. Waveform window #21. Anomaly during pedicle screw stimulation. Am J Electroneurodiagnostic Technol 2011; 51:296-300. [PMID: 22303779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Eager M, Shimer A, Jahangiri FR, Shen F, Arlet V. Intraoperative neurophysiological monitoring (IONM): lessons learned from 32 case events in 2069 spine cases. Am J Electroneurodiagnostic Technol 2011; 51:247-263. [PMID: 22303776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Intraoperative neurophysiological monitoring (IONM) is becoming the standard of care for many spinal surgeries, especially those with deformity correction and instrumentation. We reviewed 2069 spine cases with multimodality IONM including somatosensory evoked potentials (SSEP), transcranial electrical motor evoked potentials (TCeMEP), and spontaneous and triggered electromyography (s-EMG and t-EMG) in a University setting over a period of four years to examine perioperative clinical findings when an IONM event was noted and to ascertain how IONM has affected our ability to avoid potential neurological injury during spine surgery. We performed a retrospective analysis of cases from 2006 to 2010 to study the frequency and cause of intraoperative events detected via IONM and the clinical outcome of the patient. There were 32 cases (1.5%) with possible intraoperative events. There were 17 (53%) cases where IONM changes affected the course of the surgery and prevented possible postoperative neurological deficits. Seven cases (41%) were due to deformity correction, five (29%) due to hypotension, four (24%) due to patient positioning, and one (6%) due to a screw requiring repositioning. None of the 17 patients had postoperative motor or sensory deficits. There were four cases with false-positive IONM findings due to correctible technical issues. Three cases required surgical revision due to pedicle screw malposition. In each case, s-EMGs failed to exhibit intraoperative changes but the patient presented with postoperative radiculopathy. We believe that the use of t-EMGs may have prevented these complications. This review reinforces the importance of multimodality IONM for spinal surgery. The incidence of possible events in our series was 1.5%, and several likely postoperative neurologic deficits were avoided by intraoperative intervention.
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Affiliation(s)
- Matthew Eager
- University of Virginia Medical Center, Department of Orthopedic Surgery, Charlottesville, Virginia, USA
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Li F, Deshaies E, Allott G, Gorji R. Transcranial motor evoked potential changes induced by provocative testing during embolization of cerebral arteriovenous malformations in patients under total intravenous anesthesia. Am J Electroneurodiagnostic Technol 2011; 51:264-273. [PMID: 22303777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Cerebral motor evoked potential (MEP) monitoring during arteriovenous malformation (AVM) embolization is not well studied (Söderman et al. 2003). Alterations of cerebral blood flow (CBF) during cerebral embolization could cause ischemia/infarction to the cerebral cortex. Permanent loss of MEPs is correlated with a permanent motor deficit. We report a case of a patient undergoing AVM embolization during which transcranial electrical motor evoked potentials (TCeMEP) reliably predicted changes to CBF induced by selective methohexital testing. Our finding demonstrated that MEPs are a useful means of intraoperative monitoring of motor pathway integrity and predicting changes. The loss of MEP predicted and prevented severe postoperative motor deficits. Intraoperative neuromonitoring with SSEP, TCeMEP and continuous EEG revealed no changes until the posterior cerebral artery (PCA), but not the anterior cerebral artery (ACA), was injected. TCeMEP may be superior to somatosensory evoked potential (SSEP) and EEG monitoring in predicting motor impairment during AVM surgery.
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Affiliation(s)
- Fenghua Li
- Department of Anesthesiology, SUNY Upstate Medical University, Syracuse, New York, USA
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Ackermann DM, Bhadra N, Foldes EL, Kilgore KL. Separated interface nerve electrode prevents direct current induced nerve damage. J Neurosci Methods 2011; 201:173-6. [PMID: 21276819 PMCID: PMC3099145 DOI: 10.1016/j.jneumeth.2011.01.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Revised: 12/31/2010] [Accepted: 01/13/2011] [Indexed: 11/22/2022]
Abstract
Direct current, DC, can be used to quickly and reversibly block activity in excitable tissue, or to quickly and reversibly increase or decrease the natural excitability of a neuronal population. However, the practical use of DC to control neuronal activity has been extremely limited due to the rapid tissue damage caused by its use. We show that a separated interface nerve electrode, SINE, is a much safer method to deliver DC to excitable tissue and may be valuable as a laboratory research tool or potentially for clinical treatment of disease.
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Jahangiri FR, Holmberg A, Vega-Bermudez F, Arlet V. Preventing position-related brachial plexus injury with intraoperative somatosensory evoked potentials and transcranial electrical motor evoked potentials during anterior cervical spine surgery. Am J Electroneurodiagnostic Technol 2011; 51:198-205. [PMID: 21988038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The use of somatosensory evoked potentials (SSEPs) to monitor upper extremity nerves during surgery is becoming more accepted as a valid and useful technique to minimize intraoperative nerve injuries. We present a case illustrating the benefit of utilizing both SSEPs and transcranial electrical motor evoked potentials (TCeMEPs) for preventing position-related injury during surgery. The patient was a 43-year-old male with a history of neck pain, along with numbness and tingling of the upper extremities. While the patient was being draped, upper extremity SSEPs diminished significantly TCeMEP responses in the hands (abductor pollicus brevis-abductor digiti minimi; APB-ADM) vanished shortly after that, followed by the biceps and left deltoid. The surgeons were notified, and the tape on the shoulders was loosened. No improvements were noted in SSEPs nor TCeMEPs due to this intervention, so all tape was removed and the patient's arms were allowed to rest naturally upon the arm boards. Upper extremity TCeMEP responses could then be elicited and SSEPs improved shortly afterward. Surgery was completed with the arms on the arm boards. All signals remained stable for the remaining three hours of the procedure. At two months follow-up, the patient was well with total pain relief and normal upper extremity function when neurological examination was performed. This report demonstrates a case in which intraoperative neurophysiological monitoring was useful in identifying and reversing impending nerve injury during cervical spine surgery. Significant changes were seen in SSEPs as well as TCeMEPs, so we recommend that TCeMEP monitoring be considered as an adjunct to SSEPs for prevention of injury to the brachial plexus.
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Beavogi K, Suare IS, Barry AO, Diallo MS, Haba M, Camara AM, Beavogi P, Ture MS, Camara OK. [Investigation of epidemiology of neurotrauma in the Republic of Guinea]. Zh Vopr Neirokhir Im N N Burdenko 2011; 75:38-41. [PMID: 21698922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The paper focuses on analysis of incidence of neurotrauma in economically underdeveloped country such as Republic of Guinea. It is found that leading etiology of central nervous system injuries are road accidents and indoor traumatism. Investigation of system of medical care revealed its poor condition and severe defects which prevent practical application of evidence-based recommendations for management of traumatic brain injury in underdeveloped countries including Republic of Guinea. Development of multiplanar strategy of control of neurotrauma is required which can be achieved only in case of massive governmental and international aid.
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Jahangiri FR, Sherman JH, Holmberg A, Louis R, Elias J, Vega-Bermudez F. Protecting the genitofemoral nerve during direct/extreme lateral interbody fusion (DLIF/XLIF) procedures. Am J Electroneurodiagnostic Technol 2010; 50:321-335. [PMID: 21313792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A 77-year-old male presented with a history of severe lower back pain for 10 years with radiculopathy, positive claudication type symptoms in his calf with walking, and severe "burning" in his legs bilaterally with walking. Magnetic resonance imaging (MRI) revealed lumbar stenosis at the L3-L4 and L4-L5 levels. During the direct or extreme lateral interbody fusion (DLIF/XLIF) procedure, bilateral posterior tibial, femoral, and ulnar nerve somatosensory evoked potentials (SSEPs) were recorded with good morphology of waveforms observed. Spontaneous electromyography (S-EMG) and triggered electromyography (T-EMG) were recorded from cremaster and ipsilateral leg muscles. A left lateral retroperitoneal transpsoas approach was used to access the anterior disc space for complete discectomy, distraction, and interbody fusion. T-EMG ranging from 0.05 to 55.0 mA with duration of 200 microsec was used for identification of the genitofemoral nerve using a monopolar stimulator during the approach. The genitofemoral nerve (L1-L2) was identified, and the guidewire was redirected away from the nerve. Post-operatively, the patient reported complete pain relief and displayed no complications from the procedure. Intraoperative SSEPs, S-EMG, and T-EMG were utilized effectively to guide the surgeon's approach in this DLIF thereby preventing any post-operative neurological deficits such as damage to the genitofemoral nerve that could lead to groin pain.
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Kavallaris A, Banz C, Chalvatzas N, Hornemann A, Luedders D, Diedrich K, Bohlmann M. Laparoscopic nerve-sparing surgery of deep infiltrating endometriosis: description of the technique and patients' outcome. Arch Gynecol Obstet 2010; 284:131-5. [PMID: 20680309 DOI: 10.1007/s00404-010-1624-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2010] [Accepted: 07/12/2010] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The radical surgery of the deep infiltrating endometriosis of the rectovaginal septum and the uterosacral ligaments with or without bowel resection can cause a serious damage of the pelvic autonomic nerves with urinary retention and the need of self-catheterization. PATIENTS AND METHODS We introduce a case series report of 16 patients with laparoscopic nerve-sparing surgery of deep infiltrating endometriosis. We describe the technique step by step and compare the patients' outcome with patients who had undergone a non-nerve-sparing surgical technique. In 12 patients, a double-sided and in four patients, a single-sided identification of the inferior hypogastric nerve and plexus were performed. RESULTS In all patients at least single-sided resection of the uterosacral ligaments were performed. Postoperatively dysmenorrhoea, pelvic pain, and dyspareunia disappeared in all patients. The average operating time was 82 min (range 45-185). Postoperatively, the overall time to resume voiding function was 2 days. The residual urine volume was in all patients <50 ml at two ultrasound measurements. DISCUSSION Identification of the inferior hypogastric nerve and plexus was feasible. In comparison with non-nerve-sparing surgical technique, no cases of bladder self-catheterization for a long or even life time was observed, confirming the importance of the nerve-sparing surgical procedure.
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Affiliation(s)
- A Kavallaris
- Department of Obstetrics and Gynecology, University of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.
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Joshi AK, Singh S. Comment on An et al.: plating osteosynthesis of mid-distal humeral shaft fractures: minimally invasive versus conventional open reduction technique. Int Orthop 2010; 34:1069. [PMID: 20458479 DOI: 10.1007/s00264-010-1026-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Revised: 03/16/2010] [Accepted: 04/11/2010] [Indexed: 11/26/2022]
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Zheng ZH, Wei HB, Chen TF, Huang JL, Wei B, Hu BG, Zheng F, Guo WP, Huang Y, Situ J. [Urinary function after pelvic autonomic nerve preservation of laparoscopic radical resection for rectal cancer]. Zhonghua Yi Xue Za Zhi 2009; 89:2976-2979. [PMID: 20137707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To evaluate the protection of urinary function after laparoscopic radical resection with pelvic autonomic nerve preservation (PANP) for rectal cancer. METHODS Prospectively 139 patients with middle or low rectal cancer receiving surgery during November 2005 to October 2007 were divided into two groups (L-PANP, n = 63; O-PANP, n = 76). The radicalism and safety of L-PANP surgery were analyzed and the effects upon urinary function between the two groups assessed by follow-ups and urodynamic study. RESULTS Patients receiving subtypes I and II of L-PANP surgery had less decrease in contraction of bladder than those receiving the same subtype of O-PANP surgery at 10 days post-operation (Z = -2.358, P = 0.018; Z = -2.268, P = 0.033). And no difference was observed in patients receiving subtype III PANP surgery (Z = -1.302, P = 0.237). However, no matter which subtype of PANP surgery, patients of L-PANP group had a better contraction of bladder than those of O-PANP group at 1 month post-operation (P < 0.05). The 1-year survival rate was 98.0% (50/51) in L-PANP group and 96.6% (57/59) in O-PANP group. And no statistical difference was found between them (P = 0.898). Meanwhile, the 1-year relapse rate of pelvic cavity was 3.9% (2/52) in L-PANP group and 5.1% (3/59) in O-PANP group. And no statistical difference was found between them (P = 0.867). CONCLUSION As compared with O-PANP surgery, L-PANP surgery shows a superiority in protection of urinary function.
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Affiliation(s)
- Zong-heng Zheng
- Department of Gastrointestinal Surgery, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Cao J, Zhong ZP, Zhou L, Xu RM, Chen Q, Pen LR, Ren R. [Prevention of ulnar nerve injury during fixation of supracondylar fractures in children by a medial-lateral three-pin fixation technique]. Zhongguo Gu Shang 2008; 21:780-782. [PMID: 19105380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To expore the prevention of ulnar nerve injury during fixation of supracondylar fracture in children by a medial-lateral three-pin fixation technique. METHODS Eighty-one patients including 54 boys and 27 girls with average age of 6 years old (2.5 to 11 years)were treated by a three-pin fixation technique with insertion of two Kirscher wires from the lateral side and the third wire through the medial side. They were followed-up without any complications related to the ulnar nerve. According to Garland system, there were 25 cases of type II supracondylar fracture and 56 of type III. All patients were treated by a medial-lateral three-pin fixation technique, and external fixation with plaster for 3 weeks. RESULTS All cases achieved immediate stability and long-term bony fusion postoperatively and no iatrogenic ulnar nerve injury happen. CONCLUSION The technique is a stable and reliable methods for unstable supracondylar fracture and the iatrogenic injury ulnar nerve can be avoided completely.
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Affiliation(s)
- Jin Cao
- Department of Orthopaedics, Ningbo No.6 Hospital, Ningbo 315040, Zhejiasmg, China.
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Spiess PE, Hernandez MS, Pettaway CA. Contemporary inguinal lymph node dissection: minimizing complications. World J Urol 2008; 27:205-12. [PMID: 18762945 DOI: 10.1007/s00345-008-0324-6] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Accepted: 08/05/2008] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES This review describes the morbidity of inguinal lymph node dissection (ILND) performed as part of the management of penile cancer as well as recent modifications that may reduce the incidence of complications. METHODS A review of the literature was conducted using Pubmed for studies reporting complication outcomes of ILND for penile cancer. Furthermore, our contemporary results and patient related morbidity associated with ILND performed for penile cancer are reported and compared with prior series. RESULTS A review of the literature over the past 25 years identified 27 manuscripts discussing complications of ILND in the context of penile cancer. ILND has traditionally been associated with an 80-100% risk of surgical morbidity, with skin necrosis, wound dehiscence, infection, and lymphedema the predominant findings. Recent technical modifications and management strategies have reduced the associated risks of this surgical procedure. Most recently, we report a 19 and 27% rate of minor and major complications, respectively, for a diagnostic ILND (i.e., superficial ILND alone in the absence of nodal metastasis) and a 29 and 24% rate of minor and major complications, respectively, for a therapeutic ILND (superficial/deep ILND and pelvic lymph node dissection in the presence of nodal metastasis). In contrast, among clinically node negative patients undergoing dynamic sentinel lymph node biopsy as a staging procedure, the reported complication rate was 7%. CONCLUSIONS The incorporation of novel management strategies and surgical modifications have resulted in decreasing peri-operative morbidity associated with inguinal staging and therapy.
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Affiliation(s)
- Philippe E Spiess
- H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Office # 4035C, Tampa, FL 33612-9415, USA.
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Chabert C, Neill M, Eden C. Re: Seminal vesicle-sparing perineal radical prostatectomy improves early functional results in patients with low-risk prostate cancer. BJU Int 2008; 101:394. [PMID: 18184337 DOI: 10.1111/j.1464-410x.2007.07417_5.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pang JM, Civil I, Ng A, Adams D, Koelmeyer T. Is the trimodal pattern of death after trauma a dated concept in the 21st century? Trauma deaths in Auckland 2004. Injury 2008; 39:102-6. [PMID: 17880967 DOI: 10.1016/j.injury.2007.05.022] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2006] [Revised: 05/30/2007] [Accepted: 05/31/2007] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine whether the classical trimodal distribution of trauma deaths is still applicable in a contemporary urban New Zealand trauma system. METHODS All trauma deaths in the greater Auckland region between 1 January 2004 and 31 December 2004 were identified and reviewed. Data was obtained from hospital trauma registries, coroner autopsy reports and police reports. RESULTS There were 186 trauma deaths. The median age was 28.5 years and the median Injury Severity Score was 25. The predominant mechanisms of injury were hanging (36%), motor vehicle crashes (31.7%), falls (9.7%), pedestrian-vehicle injury (5.4%), stabbing (4.3%), motorcycle crashes (3.2%), and pedestrian-train injury (2.2%). Most deaths were from central nervous system injury (71.5%), haemorrhage (15.6%), and airway/ventilation compromise (3.8%). Multi-organ failure accounted for 1.6% of deaths. Most deaths occurred in the pre-hospital setting (80.6%) with a gradual decrease thereafter. CONCLUSION There was a skew towards early deaths. The trimodal distribution of trauma deaths was not demonstrated in this group of patients.
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Mantzaris G, Rodolakis A, Vlachos G, Athanasiou S, Theocharis S, Sotiripoulou CM, Antsaklis A. Magnifying lenses assisted nerve-sparing radical hysterectomy and prevention of nerve plexus trauma. Int J Gynecol Cancer 2007; 18:868-75. [PMID: 17892457 DOI: 10.1111/j.1525-1438.2007.01071.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The objectives of the study were to present a new approach for nerve-sparing radical hysterectomy (NSRH) with the assistance of magnifying lenses and to describe the differences in autonomic nerve plexus trauma between NSRH type III and conventional radical hysterectomy (RH) types II and III with the aid of immunohistochemistry. Eighteen women with FIGO stage IB(1)-IB(2) cervical cancer underwent loupes-assisted NSRH (n = 8), RH type II (n = 6), and RH type III (n = 4). Biopsies were taken intraoperatively from uterosacral ligament (USL) and cardinal ligament (CL), as well as from anterior vaginal wall (AVW) and posterior vaginal wall (PVW). Immunohistochemistry was approached with the use of S-100 protein, a general nerve marker. The percentage area of immunoreactivity (PAI) was used as an objective quantitative measure of nerve fibers within the ligaments. The PAI was greater in RH-III biopsies from both USL and CL (P < 0.001) when compared with RH-II and NSRH biopsies. For AVW and PVW, PAI differences were not statistically significant (AVW, P = 0.119; PVW, P = 0.067). Uterine-supporting ligaments represent a major pathway for autonomic nerves to the pelvic organs. As significantly more autonomic nerves are transected during the division of the uterine-supporting ligaments in RH type III, a more careful approach in the dissection of the ligaments through nerve-preserving techniques seems to be necessary in order to prevent iatrogenic intraoperative injury of the pelvic plexus and reduce or prevent postoperative complications.
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Affiliation(s)
- G Mantzaris
- 1st Department of Obstetrics and Gynecology, Gynecologic Oncology Unit and Urogynecology Unit, University of Athens, Alexandra Hospital, Athens, Greece.
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Albers P, Schäfers S, Löhmer H, de Geeter P. Seminal vesicle-sparing perineal radical prostatectomy improves early functional results in patients with low-risk prostate cancer. BJU Int 2007; 100:1050-4. [PMID: 17760889 DOI: 10.1111/j.1464-410x.2007.07123.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To report a new and improved seminal vesicle-sparing (SV) technique of radical perineal prostatectomy (RPP) as an option for patients with localized prostate cancer, which is currently competing with the retropubic RP (RRP), endoscopic and robotic approaches. PATIENTS AND METHODS From July 2003 to July 2006, 507 RPs were undertaken within a three-arm, unrandomized phase II trial. Patients were selected for RPP if they had a prostate-specific antigen (PSA) level of </=10 ng/mL, a Gleason sum of </=7 and a prostate volume of </=50 mL. This group was randomly divided in those having SV-RPP (147 men) and a classical RPP (171); men in the third group with adverse factors were offered a classical RRP (190). The main endpoint of the trial was the early continence rate at 4 weeks after surgery. RESULTS The oncological outcome of patients treated with SV-RPP was no different from that of RPP or RRP. Continence rates (0-1 pad/day) at 4 weeks and 12 months after SV-RPP were 61.7% and 96.3%, respectively, and significantly higher than with RPP (P < 0.023) and RRP (P < 0.005). The transfusion rates (3.4%), anastomotic leaks (6.6%) and mean operative duration (90 min) were significantly lower. CONCLUSIONS SV-RPP is a better technique in reducing complications during and after surgery for selected patients. Leaving the SV in place did not increase the short-term PSA relapse rates. As the operation was significantly faster and with better early recovery, SV-RPP might be justified if the long-term oncological data confirm the efficacy of the approach.
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Affiliation(s)
- Peter Albers
- Department of Urology, Klinikum Kassel GmbH, Kassel, Germany.
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Kampa RJ, Prasthofer A, Lawrence-Watt DJ, Pattison RM. The internervous safe zone for incision of the capsule of the hip. A cadaver study. J Bone Joint Surg Br 2007; 89:971-6. [PMID: 17673597 DOI: 10.1302/0301-620x.89b7.19053] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In order to determine the potential for an internervous safe zone, 20 hips from human cadavers were dissected to map out the precise pattern of innervation of the hip capsule. The results were illustrated in the form of a clock face. The reference point for measurement was the inferior acetabular notch, representing six o'clock. Capsular branches from between five and seven nerves contributed to each hip joint, and were found to innervate the capsule in a relatively constant pattern. An internervous safe zone was identified anterosuperiorly in an arc of 45 degrees between the positions of one o'clock and half past two. Our study shows that there is an internervous zone that could be safely used in a capsule-retaining anterior, anterolateral or lateral approach to the hip, or during portal placement in hip arthroscopy.
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Affiliation(s)
- R J Kampa
- Royal Sussex County Hospital, Brighton, UK.
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Xiong LZ. [Perioperative protection of nerve]. Zhonghua Yi Xue Za Zhi 2007; 87:1299-301. [PMID: 17727770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
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Abstract
PURPOSE OF REVIEW This article introduces the use of ultrasound to facilitate peripheral regional anesthesia. RECENT FINDINGS Regional anesthesia, despite its well known clinical benefits, has not gained the popularity of general anesthesia. This is secondary to multiple shortcomings including a defined failure rate, lack of simplicity, and the potential for patient discomfort or injury. Many of the negative aspects of regional anesthesia evolve from the reality that current nerve-localization techniques are unreliable. Given the great variation in human anatomy it is not surprising that even the most veteran clinician can be challenged by techniques that demand anatomical assumptions. The recent use of ultrasound imaging for nerve localization is an innovative application of an old technology which addresses many of the shortcomings of current techniques. Specifically, ultrasound imaging allows the operator to see neural structures, guide the needle under real-time visualization, navigate away from sensitive anatomy, and monitor the spread of local anesthetic. SUMMARY Ultrasound technology represents an ideal mechanism by which the regional anesthesiologist can attain the safety, speed, and efficacy of general anesthesia. Ultimately, it is the correct peri-neural spread of local anesthetic around a nerve that provides safe, effective, and efficient anesthetic conditions.
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Affiliation(s)
- Brian D Sites
- Department of Anesthesiology, Dartmouth Medical School, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA.
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Abstract
BACKGROUND Successful resuscitation from sudden cardiac death is frequently accompanied by severe and often fatal neurologic injury. Induced hypothermia (IH) may attenuate the neurologic damage observed in patients after cardiac arrest. HYPOTHESIS This study examined a population of nonselected patients presenting to a community hospital following successful resuscitation of sudden cardiac death. We sought to determine whether a program of induced hypothermia would improve the clinical outcome of these critically ill patients. METHODS We initiated a protocol of IH at the Oklahoma Heart Hospital in August of 2003. Study patients were consecutive adults admitted following successful resuscitation of out-of-hospital cardiac arrest. Moderate hypothermia was induced by surface cooling and maintained for 24 to 36 h in the Intensive Care Unit with passive rewarming over 8 h. RESULTS Forty-nine patients who were resuscitated and had the return of spontaneous circulation completed the hypothermia protocol. The cause of cardiac arrest was acute myocardial infarction in 24 patients and cardiac arrhythmias in 19 patients. Nineteen patients (39%) survived and were discharged. Sixteen of the patients discharged had no or minimal residual neurologic dysfunction and 3 patients had clinically significant residual neurologic injury. CONCLUSION A program of induced hypothermia based in a community hospital is feasible, practical, and requires limited additional financial and nursing resources. Survival and neurologic recovery compare favorably with clinical trial outcomes.
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Affiliation(s)
- Brook D Scott
- Department of Cardiovascular Disease, The Oklahoma Heart Hospital, USA.
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Spanknebel K, Chabot JA, DiGiorgi M, Cheung K, Curty J, Allendorf J, LoGerfo P. Thyroidectomy using monitored local or conventional general anesthesia: an analysis of outpatient surgery, outcome and cost in 1,194 consecutive cases. World J Surg 2006; 30:813-24. [PMID: 16547617 DOI: 10.1007/s00268-005-0384-3] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Critical appraisal of safety, feasibility, and economic impact of thyroidectomy procedures using local (LA) or general anesthesia (GA) is performed. METHODS Consecutive patients undergoing thyroidectomy procedures were selected from a prospective database from January 1996 to June 2003 of a single-surgeon practice at a tertiary center. Statistical analyses determined differences in patient characteristics, outcomes, operative data, and length of stay (LOS) between groups. A cohort of consecutive patients treated in 2002-2003 by all endocrine surgeons at the institution was selected for cost analysis. RESULTS A total of 1,194 patients underwent thyroidectomy, the majority using LA (n = 939) and outpatient surgery (65%). Female gender (76%), body mass index > or = 30 kg/m2 (29%), median age (49 years), and cancer diagnosis (45%) were similar between groups. Extent of thyroidectomy (59% total) and concomitant parathyroidectomy (13%) were similarly performed. GA was more commonly utilized for patients with comorbidity [15% vs. 10%, Anesthesia Society of America (ASA) > or = 3; P < 0.001], symptomatic goiter (13% vs. 7%; P = 0.004), reoperative cases (10% vs. 6%; P = 0.01), and concomitant lymphadenectomy procedures (15% vs. 3%; P < 0.001). GA was associated with significant increase in LOS > or = 24 hours (17 % vs. 4%) or overnight observation (49 % vs. 14%), P < 0.001. Operative room utilization was significantly associated with type of anesthesia (180 min vs. 120 min, GA vs. LA, P < .001) and impacted to a lesser degree by surgeon operative time (89 minutes vs. 76 minutes, GA vs. LA; P = .089). Overall morbidity rates were similar between groups (GA 5.8 % vs. LA 3.2%). The actual total cost (ATC) per case for GA was 48% higher than for LA and 30% higher than the ATC for all procedures (P = 0.006), with the combined weighted average impacted by more LA cases (n = 217 vs. 85). CONCLUSION These data from a large, unselected group of thyroidectomy patients suggest LA results in similar outcomes and morbidity rates to GA. It is likely that associated LA costs are lower.
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Affiliation(s)
- Kathryn Spanknebel
- Division of General Surgery, The New York Thyroid Center, College of Physicians and Surgeons, Columbia University, 177 Fort Washington Avenue, MHB-7SK, New York, NY 10032, USA.
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Barczynski M, Konturek A, Cichon S. [Value of the intraoperative neuromonitoring in surgery for thyroid cancer in identification and prognosis of function of the recurrent laryngeal nerves]. Endokrynol Pol 2006; 57:343-6. [PMID: 17006834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
INTRODUCTION The aim of this study was both, to evaluate the usefulness of the method of neuromonitoring in intraoperative identification of the RLN and to estimate its value in the prognosis of postoperative RLN function in patients operated for TC. MATERIAL AND METHODS Among 109 patients undergoing surgery for TC between 12/2004 and 12/2005 the neuromonitoring method was used in 69 (63.3%) individuals (including 5 operations of completion total thyroidectomy). A Neurosign 100 equipment with laryngeal electrodes was employed in identification and assessment of total number of 134 RLN. Intraoperative results were compared to the postoperative results of the ENT-specialist examination of vocal cords mobility in indirect laryngoscopy, in each patient. RESULTS Transient vs. permanent, unilateral RLN palsy was noted in 3 vs. 2 patients (2.2% vs. 1.4% of nerves at risk). The method of neuromonitoring facilitated identification of 123 (91.8%) RLN being not helpful in 11 (8.2%) cases. However, neuromonitoring was helpful in identification of the RLN, the value of the method in prognosis of posteoperative function of the RLN was limited. Results of indirect neurostimulation were more accurate than direct neurostimulation and were more accurate in prognosis of late rather than early RLN function after surgery (sensitivity 98.3%; specificity 100%; positive predictive value 100%; negative predictive value 50%, accuracy 98.4%). CONCLUSIONS Application of intraoperative neuromonitoring facilitates identification of the RLN during surgery for TC. However, the method is of limited value in prognosis of postoperative RLN dysfunction in cases of missing signal after nerve stimulation.
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Affiliation(s)
- Marcin Barczynski
- Department of Endocrine Surgery, 3rd Chair of General Surgery, Jagiellonian University College of Medicine, Krakov.
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Abstract
BACKGROUND Sural nerve injury is a reported risk during percutaneous repair of the Achilles tendon. HYPOTHESIS Exposure of the sural nerve during percutaneous repair can minimize the risk of nerve injury. STUDY DESIGN Case control study; Level of evidence, 3. METHODS The authors retrospectively examined the results of 84 patients who were treated for acute Achilles tendon rupture at 2 different hospitals. Both hospitals used the same percutaneous repair technique, except that the sural nerve was exposed in the 38 patients (mean age, 38 years; range, 23-68 years) of one hospital; the nerve was not exposed in the 46 patients (mean age, 42 years; range, 24-71 years) of the other hospital (the nonexposure group). RESULTS All patients recovered and returned to work after 44 days (range, 5-202 days). All patients returned to their previous sports levels within 1 year. On the 100-point Hannover Achilles Tendon Score, the mean score was 81 points (range, 44-100 points). The overall incidence of sural nerve related complications was 18%. All sural nerve lesions occurred in the nonexposure group. In the total study population, there were 3 cases of deep vein thrombosis, 1 rerupture, and 1 case of infection. CONCLUSION Sural nerve injuries can be minimized during surgery by carefully placing the stab incisions to expose the nerve so as to avoid it during repair. If the sural nerve is exposed, percutaneous repair of the ruptured Achilles tendon is a safe and reliable method of treating Achilles tendon ruptures.
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Affiliation(s)
- Martin Majewski
- Department of Orthopaedic Surgery, Kantonsspital Liestal, Rheinstrasse 26, CH-4410 Liestal, Switzerland.
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Abstract
INTRODUCTION Intraoperative neuromonitoring has been widely adopted to facilitate the identification and preservation of recurrent laryngeal nerve (RLN) function during thyroid surgery. The present prospective study validated the ability of this technique to predict postoperative RLN outcomes in a single endocrine surgical unit. METHODS Neuromonitoring was performed using Neurosign 100 with laryngeal surface electrodes in 171 patients with 271 nerves at risk during thyroidectomy. Vocal cord function was routinely documented perioperatively. Patients were also stratified to low risk (primary surgery for benign disease) and high risk (malignancy and recurrent disease) for subgroup analysis. RESULTS Unilateral vocal cord palsy occurred in 15 patients (5.5%) postoperatively. The incidence of postoperative nerve palsy in the low risk and high risk groups was 4.4% and 7.8%, respectively. All but two patients had recovery of function within a median period of 4 months after the operation. The rates of transient and permanent RLN palsy based on nerves at risk were 4.8% (n = 13) and 0.7% (n = 2), respectively. There were 241 true-negative (positive signal and no cord palsy), 15 false-positive (negative signal but no cord palsy), 8 true-positive (negative signal and cord palsy), and 7 false-negative (positive signal but cord palsy) results, as correlated with the postoperative assessment. The sensitivity, specificity, and positive and negative predictive values were 53%, 94%, 35%, and 97%, respectively. For the high risk group, the sensitivity and positive predictive value increased to 86% and 60%, respectively. CONCLUSIONS There are pitfalls associated with the use of intraoperative neuromonitoring during thyroid surgery. Routine application is not recommended except for selected high risk patients.
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Affiliation(s)
- Wai-Fan Chan
- Division of Endocrine Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Pokfulam, Hong Kong, China
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Zhang C, Li GX, Ding ZH, Wu T, Zhong SZ. [Preservation of the autonomic nerve in rectal cancer surgery: anatomical factors in ligation of the inferior mesenteric artery]. Nan Fang Yi Ke Da Xue Xue Bao 2006; 26:49-52. [PMID: 16495175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To evaluate the regional anatomy between the abdominal autonomic nerves including the abdominal aortic plexus (AAP) and the inferior mesenteric artery (IMA), and explore the safe ligation point on the IMA and the optimal dissection method to avoid autonomic nerve injuries. METHODS AND RESULTS Dissections and observation were carried out on 16 fixed male cadavers. The AAP located in the thin fascia layer covering the surface of the aorta and its branches. No autonomic nerves were found in the area around the root of the IMA, and the point where the IMA and the left trunk of the AAP intersected was highly variable. The left trunk of the AAP adhered more closely to the IMA than to the aorta. CONCLUSIONS In view of autonomic nerve preservation, the only safe site for ligation of the IMA is at its origin, and no other such sites are available along the IMA trunk and its branches. The IMA and the posterior fascia layer containing the autonomic nerves constitute the optimal surgical plane for IMA ligation, which should be performed following skeletonization of the IMA with careful preservation of the integrity of the posterior fascia layer.
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Affiliation(s)
- Ce Zhang
- Institute of Clinical Anatomy, Southern Medical University, Guangzhou 510515, China
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Dubert T, Racasan O. A reliable technique for avoiding the median nerve during carpal tunnel injections. Joint Bone Spine 2005; 73:77-9. [PMID: 16242987 DOI: 10.1016/j.jbspin.2005.02.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2004] [Accepted: 02/23/2005] [Indexed: 11/16/2022]
Abstract
Carpal tunnel injections are widely performed for diagnostic and therapeutic purposes. Injury to the median nerve is a serious and fairly common complication. There is no consensus regarding the safest injection site. The objective of this study was to determine the safest injection site based on anatomical data. During 124 endoscopic procedures for median nerve release at the carpal tunnel, we measured the distances separating the median nerve, palmaris longus (PL), flexor carpi radialis (FCR), and flexor carpi ulnaris 1 cm proximal to the wrist crease. The edge of the median nerve extended medially beyond the PL tendon in 82 (88%) hands. Thus, needle insertion within 1 cm of either edge of the PL tendon may cause median nerve injury; with injection sites located further toward the medial edge, the ulnar pedicle may be at risk. Consequently, we recommend that carpal tunnel injections be performed through the FCR tendon.
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Affiliation(s)
- Thierry Dubert
- Clinique La Francilienne, avenue de l'Hôtel de Ville, Pontault-Combault, France.
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Yasuda T, Watanabe G, Tomita S. A Novel Figure A-Shape Sternal Retractor for Off-Pump Coronary Artery Bypass Grafting. Heart Surg Forum 2005; 8:E196-7. [PMID: 16112930 DOI: 10.1532/hsf98.20051120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A novel figure A-shape sternal retractor was developed to avoid brachial plexus injury caused by sternal wide separation, and facilitate exposure of circumflex artery by elevating a rake and dropping the heart into the right pleural cavity during off-pump coronary artery bypass grafting. In addition, it has several notches to hold deep pericardial stitches in order to enhance the exposure.
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Affiliation(s)
- Tamotsu Yasuda
- Department of General and Cardiothoracic Surgery, Kanazawa University School of Medicine, Kanazawa, Ishikawa, Japan.
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Abstract
PURPOSE This study evaluated the ability of a novel intraoperative neurophysiologic monitoring method used to locate the axillary nerve, predict relative capsule thickness, and identify impending injury to the axillary nerve during arthroscopic thermal capsulorrhaphy of the shoulder. TYPE OF STUDY Prospective cohort study. METHODS Twenty consecutive patients with glenohumeral instability were monitored prospectively during arthroscopic shoulder surgery. Axillary nerve mapping and relative capsule thickness estimates were recorded before the stabilization portion of the procedure. During labral repair and/or thermal capsulorrhaphy, continuous and spontaneous electromyography recorded nerve activity. In addition, trans-spinal motor-evoked potentials of the fourth and fifth cervical roots and brachial plexus electrical stimulation, provided real-time information about nerve integrity. RESULTS Axillary nerve mapping and relative capsule thickness were recorded in all patients. Continuous axillary nerve monitoring was successfully performed in all patients. Eleven of the 20 patients underwent thermal capsulorrhaphy alone or in combination with arthroscopic labral repair. Nine patients underwent arthroscopic labral repair alone. In 4 of the 11 patients who underwent thermal capsulorrhaphy, excessive spontaneous neurotonic electromyographic activity was noted, thereby altering the pattern of heat application by the surgeon. In 1 of these 4 patients, a small increase in the motor latency was noted after the procedure but no clinical deficit was observed. There were no neuromonitoring or clinical neurologic changes observed in the labral repair group without thermal application. At last follow-up, no patient in either group had any clinical evidence of nerve injury or complications from neurophysiologic monitoring. CONCLUSIONS We successfully evaluated the use of intraoperative nerve monitoring to identify axillary nerve position, capsule thickness, and provide real-time identification of impending nerve injury and function during shoulder thermal capsulorrhaphy. The use of intraoperative nerve monitoring altered the heat application technique in 4 of 11 patients and may have prevented nerve injury. LEVEL OF EVIDENCE Level II, prospective cohort study.
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Affiliation(s)
- Adil N Esmail
- Department of Orthopaedic Surgery, Kaiser Permanente, Panorama City, California, USA
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Shi E, Kazui T, Jiang X, Washiyama N, Suzuki K, Yamashita K, Terada H. NS-7, a novel Na+/Ca2+ channel blocker, prevents neurologic injury after spinal cord ischemia in rabbits. J Thorac Cardiovasc Surg 2005; 129:364-71. [PMID: 15678048 DOI: 10.1016/j.jtcvs.2004.05.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE We investigated the neuroprotective effect of NS-7 (4-[4-fluorophenyl]-2-methyl-6- [5-piperidinopntyloxy] pyrimidine hydrochloride), a novel Na(+)/Ca(2+) channel blocker, on transient spinal cord ischemia in rabbits. METHODS Spinal cord ischemia was induced in New Zealand white rabbits by means of infrarenal aortic occlusion for 20 minutes. Four experimental groups were enrolled. A sham group (n = 3) underwent the same operation without aortic occlusion. A control group (n = 7) received only saline before occlusion. Group A (n = 8) received NS-7 (1 mg/kg) 15 minutes before ischemia, and group B (n = 8) received NS-7 (1 mg/kg) at the onset of reperfusion. Neurologic function was assessed 24 and 48 hours after the operation with modified Tarlov criteria. Spinal cords were harvested for histopathologic examination and in situ terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL staining). Spinal cord infarction was investigated with 2, 3, 5-triphenyltetrazonlium chloride staining. RESULTS Tarlov scoring demonstrated marked improvement in both group A and group B compared with the control group at 24 and 48 hours after the operation. Minimal histologic changes were found in lumbar spinal cords of the 2 NS-7-treated groups, whereas severe neuronal necrosis was shown in the control group. TUNEL-positive neurons and the infarct size of lumbar spinal cords were significantly reduced by NS-7 administered both before ischemia and at the onset of reperfusion. No significant difference was noted between group A and group B in terms of spinal cord protection. CONCLUSION These results indicate that NS-7 protects the spinal cord against ischemic injury by preventing both neuronal necrosis and apoptosis.
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Affiliation(s)
- Enyi Shi
- First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
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Affiliation(s)
- Wolfgang Horninger
- Medical University of Innsbruck, Department of Urology, Innsbruck, Austria.
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Yarbrough DE, Thompson GB, Kasperbauer JL, Harper CM, Grant CS. Intraoperative electromyographic monitoring of the recurrent laryngeal nerve in reoperative thyroid and parathyroid surgery. Surgery 2005; 136:1107-15. [PMID: 15657563 DOI: 10.1016/j.surg.2004.06.040] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Injury to the recurrent laryngeal nerve (RLN) is a rare complication of initial thyroid and parathyroid surgery, but the prevalence is much higher in the reoperative setting. The use of continuous, intraoperative electromyographic monitoring of the RLN has been suggested to improve the safety of cervical explorations. METHODS Outcomes of a group of reoperative thyroid and parathyroid cases that used EMG monitoring with endoscopically applied hook-wire electrodes were compared with a group of cervical reoperations without monitoring. Office laryngoscopy (indirect or fiberoptic) was used to evaluate and follow suspected RLN complications. RESULTS Electromyography was used in 52 cervical reexploration procedures. Patients averaged 1.8 previous explorations (range, 1-7 explorations) and underwent procedures for parathyroid (31%) and/or thyroid (77%) disease (overall, 72% malignant). The non-monitored group had 59 patients with similar characteristics. Only 1 permanent nerve complication in each group was unintended (electromyography, 1.9%; non-electromyography, 1.7%). Seven false-negative and 2 false-positive electromyographic findings occurred. No complications resulted from placement of the electromyography electrodes. CONCLUSIONS Intraoperative electromyographic monitoring of the RLN in reoperative neck surgery can be performed safely but did not decrease RLN complications in this study. Experience and routine nerve exposure remain crucial to the minimization of RLN complications.
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Affiliation(s)
- Donald E Yarbrough
- Department of Surgery, College of Medicine, Mayo Clinic, Mayo Building W6, 200 First Street SW, Rochester, MN 55905, USA
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Abstract
We present simple but effective retractors used in pairs to expose the sciatic notch during Salter innominate osteotomy. We have found them to be useful for a wide range of procedures requiring similar exposure. We present them here in tribute to the memory of the designer Mercer Rang.
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Affiliation(s)
- S Thomas
- Nuffield Orthopaedic Centre, Headington, Oxford, England, UK
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Beden DA. Re: Primary total hip replacement Surg J R Coll Surg Edinb Irel, 1: 2003; 332-341. Surgeon 2005; 3:55; author reply 55. [PMID: 15789799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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Kuniyoshi Y, Koja K, Miyagi K, Uezu T, Yamashiro S, Arakaki K. The prevention of nerve injury in aortic arch aneurysmal surgery. Asian Cardiovasc Thorac Ann 2004; 12:374-5. [PMID: 15585714 DOI: 10.1177/021849230401200422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In a case of aortic arch aneurysm associated with adhesion to the surrounding structures, we devised an operative technique to avoid nerve injury during the surgical procedure. By preserving the adventitial layer of the aortic arch aneurysm to which the phrenic and recurrent nerves were attached, injury to the nerves was avoided, and the aneurysmectomy was completed with the distal anastomosis being performed intraluminally.
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Affiliation(s)
- Yukio Kuniyoshi
- Second Department of Surgery, Faculty of Medicine, University of Ryukyus, 207 Uehara Nishihara-cho, Okinawa 903-0215, Japan.
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Abstract
The contribution of inflammation to the pathogenesis of several nervous system disorders has long been established. Other observations, however, indicate that both inflammatory cells and mediators may also have beneficial functions, assisting in repair and recovery processes. There is compelling evidence to indicate that in the injured nervous system, as in other tissues, macrophages are needed at an early stage after injury in order for healing to take place. Likewise, activated T cells of a particular specificity can reduce the spread of damage. This neuroprotective effect of T cells may be caused, at least in part, by the production of neurotrophic factors such as neurotrophin-3 or brain-derived neurotrophic factor. Interestingly, recent findings indicate that immune cells are able to produce a variety of neurotrophic factors which promote neuronal survival and may also mediate anti-inflammatory effects. Numerous cytokines are induced after nervous system injuries. Some cytokines, such as TNF-alpha, IL-1 and IFN-gamma, are well known for their promotion of inflammatory responses. However, these cytokines also have immunosuppressive functions and their subsequent expression also assists in repair or recovery processes, suggesting a dual role for some pro-inflammatory cytokines. This should be clarified, as it may be crucial in the design of therapeutic strategies to target specific cytokine(s). Finally, there is a growing body of evidence to show that autoreactive IgM antibodies may constitute an endogenous system of tissue repair, and therefore prove of value as a therapeutic strategy. Available evidence would appear to indicate that the inflammatory response observed in several neurological conditions is more complex than previously thought. Therefore, the design of more effective therapies depends on a clear delineation of the beneficial and detrimental effects of inflammation.
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Affiliation(s)
- Jorge Correale
- Raúl Carrea Institute for Neurological Research, FLENI, Montañeses 2325, 1428, Buenos Aires, Argentina.
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Abstract
Major neurovascular injury is the least common, but most distressing, complication of total hip arthroplasty (THA). The keys to minimizing the incidence of these complications are recognizing patients at risk and knowledge of the relevant anatomy. Partial sciatic palsy is the most common nerve injury. At least partial recovery can be expected in 70% to 80% of cases, with the remainder frequently displaying dissatisfaction with their surgery. Vascular injury is most frequently associated with the use of screws for fixation of structural grafts, acetabulur components, and protrusio rings or cages. An understanding of the acetabular quadrant system is crucial in minimizing these potentially catastrophic complications.
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Affiliation(s)
- Robert L Barrack
- Tulane University Health Sciences Center, Department of Orthopaedic Surgery, New Orleans, Louisiana 70112, USA
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Nano M, Dal Corso H, Ferronato M, Solej M, Hornung JP, Dei Poli M. Ligation of the inferior mesenteric artery in the surgery of rectal cancer: anatomical considerations. Dig Surg 2004; 21:123-6; discussion 126-7. [PMID: 15026607 DOI: 10.1159/000077347] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2003] [Accepted: 10/17/2003] [Indexed: 12/12/2022]
Abstract
BACKGROUND No agreement has been found in the literature concerning the safest point of ligation of the inferior mesenteric artery (ima) in order to avoid nerve damage during the surgery of rectal cancer. STUDY DESIGN The distance between the origin of the ima and the left paraortic trunk was measured, as was the distance between the left paraortic trunk and the origin of the left colic artery (lca). The measurements were carried out on 20 cadavers and during 22 operations for rectal cancer. RESULTS The left paraortic trunk always runs posterior to the ima: its distance from the origin of the ima is on average 1.2 cm; the distance of the left paraortic trunk from the origin of the lca is on average 0.4 cm. The point at which the ima and the left paraortic trunk cross varies greatly, but it is never near the origin of the ima. CONCLUSIONS From an anatomical point of view the safest point of ligation of the ima is at its origin. At this point, the left paraortic trunk never runs; so there isn't any risk to damage the nerve involving it during the ligation of the artery.
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Affiliation(s)
- Mario Nano
- Department of Clinical Pathophysiology, Section of General Surgery, University of Turin, Turin, Italy.
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