Sample records for diagnosed spinal infection

  1. Rehabilitation in spinal infection diseases

    PubMed Central

    Nas, Kemal; Karakoç, Mehmet; Ayd?n, Abdulkadir; Öne?, Kadriye

    2015-01-01

    Spinal cord infections were the diseases defined by Hypocrite yet the absence of modern medicine and there was not a real protocol in rehabilitation although there were many aspects in surgical treatment options. The patients whether surgically or conservatively treated had a lot of neurological, motor, and sensory disturbances. Our clinic has quite experience from our previous researchs. Unfortunately, serious spinal cord infections are still present in our region. In these patients the basic rehabilitation approaches during early, pre-operation, post-operation period and in the home environment will provide significant contributions to improve the patients’ sensory and motor skills, develop the balance and proriocaption, increase the independence of patients in daily living activities and minimize the assistance of other people. There is limited information in the literature related with the nature of the rehabilitation programmes to be applied for patients with spinal infections. The aim of this review is to share our clinic experience and summarise the publications about spinal infection rehabilitation. There are very few studies about the rehabilitation of spinal infections. There are still not enough studies about planning and performing rehabilitation programs in these patients. Therefore, a comprehensive rehabilitation programme during the hospitalisation and home periods is emphasised in order to provide optimal management and prevent further disability. PMID:25621205

  2. Parasitic and rare spinal infections.

    PubMed

    do Amaral, Lázaro Luís Faria; Nunes, Renato Hoffmann; da Rocha, Antonio Jose

    2015-05-01

    The imaging features of spinal parasitic diseases and other rare infections are herein discussed. These diseases are distributed worldwide, with increased prevalence in areas with poor sanitary conditions and in developing countries. In nonendemic areas, sporadic cases may occur, consequent to increased international travel and immunocompromising conditions. Infectious diseases are usually treatable, and early detection is often crucial. A thorough comprehension of the imaging patterns associated with the clinical features, epidemiology, and laboratory results allows the radiologist to narrow down the options for differential diagnosis and facilitates the timely implementation of appropriate therapies. PMID:25952177

  3. Infection with spinal instrumentation: Review of pathogenesis, diagnosis, prevention, and management

    PubMed Central

    Kasliwal, Manish K.; Tan, Lee A.; Traynelis, Vincent C.

    2013-01-01

    Background: Instrumentation has become an integral component in the management of various spinal pathologies. The rate of infection varies from 2% to 20% of all instrumented spinal procedures. Every occurrence produces patient morbidity, which may adversely affect long-term outcome and increases health care costs. Methods: A comprehensive review of the literature from 1990 to 2012 was performed utilizing PubMed and several key words: Infection, spine, instrumentation, implant, management, and biofilms. Articles that provided a current review of the pathogenesis, diagnosis, prevention, and management of instrumented spinal infections over the years were reviewed. Results: There are multiple risk factors for postoperative spinal infections. Infections in the setting of instrumentation are more difficult to diagnose and treat due to biofilm. Infections may be early or delayed. C Reactive Protein (CRP) and Magnetic Resonance Imaging (MRI) are important diagnostic tools. Optimal results are obtained with surgical debridement followed by parenteral antibiotics. Removal or replacement of hardware should be considered in delayed infections. Conclusions: An improved understanding of the role of biofilm and the development of newer spinal implants has provided insight in the pathogenesis and management of infected spinal implants. This literature review highlights the mechanism, pathogenesis, prevention, and management of infection after spinal instrumentation. It is important to accurately identify and treat postoperative spinal infections. The treatment is often multimodal and prolonged. PMID:24340238

  4. Arteriovenous fistula stent infection diagnosed with radiolabelled leucocyte scintigraphy.

    PubMed

    Yoo, Jeong Rae; Heo, Sang Taek; Kim, Miyeon; Kim, Hyun Woo; Chang, Jee Won; Song, Heesung

    2015-07-01

    Infectious complications of haemodialysis in patients with arteriovenous fistula stent are rare. In addition, patients with low-grade infection are more difficult to diagnose. Here, we report the first case of low-grade infection of an arteriovenous fistula stent diagnosed using (99m)Tc-hexamethylpropylene amine oxime (HMPAO)-labelled leucocyte scintigraphy. A 62-year-old man with end-stage renal disease was referred for prolonged fever. We performed (99m)Tc-HMPAO-labelled leucocyte scintigraphy following a work-up according to fever of unknown origin. A focal uptake on the left forearm compatible with the arteriovenous fistula stent insertion site was shown, and the stent was removed. (99m)Tc-HMPAO-labelled leucocyte scintigraphy could be a suitable method for assessing vascular stent infection in low-grade fever. PMID:25768230

  5. Challenges in diagnosing infection in the diabetic foot.

    PubMed

    Glaudemans, A W J M; Uçkay, I; Lipsky, B A

    2015-06-01

    Diagnosing the presence of infection in the foot of a patient with diabetes can sometimes be a difficult task. Because open wounds are always colonized with microorganisms, most agree that infection should be diagnosed by the presence of systemic or local signs of inflammation. Determining whether or not infection is present in bone can be especially difficult. Diagnosis begins with a history and physical examination in which both classic and 'secondary' findings suggesting invasion of microorganisms or a host response are sought. Serological tests may be helpful, especially measurement of the erythrocyte sedimentation rate in osteomyelitis, but all (including bone biomarkers and procalcitonin) are relatively non-specific. Cultures of properly obtained soft tissue and bone specimens can diagnose and define the causative pathogens in diabetic foot infections. Newer molecular microbial techniques, which may not only identify more organisms but also virulence factors and antibiotic resistance, look very promising. Imaging tests generally begin with plain X-rays; when these are inconclusive or when more detail of bone or soft tissue abnormalities is required, more advanced studies are needed. Among these, magnetic resonance imaging is generally superior to standard radionuclide studies, but newer hybrid imaging techniques (single-photon emission computed tomography/computed tomography, positron emission tomography/computed tomography and positron emission tomography/magnetic resonance imaging) look to be useful techniques, and new radiopharmaceuticals are on the horizon. In some cases, ultrasonography, photographic and thermographic methods may also be diagnostically useful. Improved methods developed and tested over the past decade have clearly increased our accuracy in diagnosing diabetic foot infections. PMID:25765225

  6. Psychiatric Diagnoses among an HIV-Infected Outpatient Clinic Population.

    PubMed

    Shacham, Enbal; Onen, Nur F; Donovan, Michael F; Rosenburg, Neal; Overton, E Turner

    2014-10-27

    As individuals with HIV infection are living longer, the management of psychiatric disorders has increasingly been incorporated into comprehensive care. Individuals were recruited from an outpatient HIV clinic to assess the prevalence and related associations of current psychiatric disorders and biomarkers. Of the 201 participants who completed the interviews, the median age was 43.5 years, and the majority was male and African American. Most were receiving HIV therapy and 78% of those had achieved virologic suppression. Prevalent psychiatric diagnoses included major depressive disorder, generalized anxiety, and agoraphobia. Alcohol and cocaine/crack abuse and dependence were common substance use disorders. Current receipt of HIV therapy was less common among those diagnosed with generalized anxiety disorder. Agoraphobia was the only disorder associated with unsuppressed viral load. Psychiatric and substance use disorders are highly prevalent among an urban HIV clinic population, although we identified few associations between psychiatric diagnoses and HIV diseases status. PMID:25348798

  7. Risk factors for deep surgical site infections after spinal fusion.

    PubMed

    Schimmel, J J P; Horsting, P P; de Kleuver, M; Wonders, G; van Limbeek, J

    2010-10-01

    Surgical site infections (SSI) are undesired and troublesome complications after spinal surgery. The reported infection rates range from 0.7 to 11.9%, depending on the diagnosis and the complexity of the procedure. Besides operative factors, patient characteristics could also account for increased infection rates. Because the medical, economic and social costs of SSI are enormous, any significant reduction in risks will pay dividends. The purpose of this study is to compare patients who developed deep SSI following lumbar or thoracolumbar spinal fusion with a randomly selected group of patients who did not develop this complication in order to identify changeable risk factors. With a case-control analysis nested in a historical cohort of patients who had had a spinal fusion between January 1999 and December 2008, we identified 36 cases with deep SSI (CDC criteria). Information regarding patient-level and surgical-level risk factors was derived from standardized but routinely recorded data and compared with those acquired in a random selection of 135 uninfected patients. Univariate analyses and a multivariate logistic regression were performed. The overall rate of infection in 1,615 procedures (1,568 patients) was 2.2%. A positive history of spinal surgery was associated with an almost four times higher infection rate (OR = 3.7, 95% BI = 1.6-8.6). The risk of SSI increased with the number of levels fused, patients with diabetes had an almost six times higher risk and smokers had more than a two times higher risk for deep SSI. The most common organism cultured was Staphylococcus aureus. All infected patients underwent at least one reoperation, including an open débridement and received appropriate antibiotics to treat the organism. Patients who had had a previous spinal surgery are a high-risk group for infection compared with those that never had surgery. Total costs associated with preventive measures are substantial and should be compensated by health care insurance companies by means of separate clinical pathways. High-risk patients should be informed about the increased risk of complications. PMID:20445999

  8. Diagnosing and treating urinary tract infections in older people.

    PubMed

    Armstrong, Kirsty

    2015-05-01

    Even though diagnosing and treating urinary tract infections (UTIs) in older people can be difficult, it is essential to prevent reduction in the patients' wellbeing. Near-patient testing can be useful, but guidelines on this discuss the use of urine dipstick testing and laboratory culture in some detail. In addition, there are significant differences in the management of males and females, those with recurrent infections, and those with catheters. Community nurses are well placed to assess and manage this common condition, implementing correct treatment and resolution, owing to the close relationships they cultivate with service users. This article discusses the diagnosis and management of UTIs in older people, highlighting the differentials and red flags that need to be addressed urgently. PMID:25993370

  9. Previously diagnosed influenza infections and the risk of developing epilepsy.

    PubMed

    Wilson, J C; Toovey, S; Jick, S S; Meier, C R

    2015-08-01

    Several epidemiological studies suggest a possible involvement of viral infection in the development of epilepsy. While recent research from in vitro studies increasingly supports the role of herpes simplex virus type 1 (HSV-1) in the pathogenesis of epilepsy, little is known about the role of other viral infections such as influenza. Using data from the Clinical Practice Research Datalink (CPRD), we conducted a matched case-control analysis to assess the association between GP-diagnosed influenza infections and the risk of developing an incident diagnosis of epilepsy. During the study period 11 244 incident epilepsy cases and 44 976 matched control patients were identified. Prior exposure to influenza was reported in 7·5% of epilepsy cases and 6·7% of controls [adjusted odds ratio (aOR) 1·12, 95% confidence interval (CI) 1·03-1·22]. Prior history of 'complicated influenza', i.e. influenza associated with a possible super-infection, was associated with a slightly increased epilepsy risk (aOR 1·64, 95% CI 1·10-2·46), particularly if recorded within the 2 months preceding the epilepsy diagnosis (aOR 6·03, 95% CI 1·10-33·2). Our findings suggest that prior influenza exposure does not appear to materially alter the risk of developing epilepsy. By contrast, influenza episodes accompanied by complications were associated with a slightly increased epilepsy risk. PMID:25519212

  10. Evaluation of 10 serological assays for diagnosing Mycoplasma pneumoniae infection.

    PubMed

    Busson, Laurent; Van den Wijngaert, Sigi; Dahma, Hafid; Decolvenaer, Marc; Di Cesare, Lina; Martin, Agnes; Vasseur, Liesbet; Vandenberg, Olivier

    2013-06-01

    In this study, the performance of 10 serological assays for the diagnosis of Mycoplasma pneumoniae infection was evaluated. A total of 145 sera from 120 patients were tested. They were obtained from patients who were serologically positive for M. pneumoniae infection as well as from patients who were infected with micro-organisms that may cause interstitial pneumonia. The following assays were utilized: SeroMP IgM and IgG, SeroMP recombinant IgM, IgA and IgG, Liaison M. pneumoniae IgM and IgG and M. pneumoniae IgM, IgA and IgG ELISA Medac. The SeroMP Recombinant and Liaison assays both showed low IgM specificity, and crossreactivity was mainly observed in groups of patients with acute cytomegalovirus and Epstein-Barr virus infections. For IgA, the Medac assay was less specific than the SeroMP Recombinant assay. Discrepancies between the four tests were observed in IgG analyses, and due to the lack of a gold standard, 22 results were removed prior to determining the sensitivity and specificity. Therefore, the overall performance of IgG assays may be overstated; nevertheless, the SeroMP assay demonstrated a lack of sensitivity. The seroprevalence of IgG appears to be very low, raising concerns regarding whether the serological techniques can detect IgG levels over time. Serology remains a biological tool of choice for diagnosing M. pneumoniae infection, but improvement and standardization of the assays are needed, particularly for the determination of IgG. PMID:23537789

  11. Low-Cost Sensor Can Diagnose Bacterial Infections Copyright 2011 by Virgo Publishing.

    E-print Network

    Suslick, Kenneth S.

    Low-Cost Sensor Can Diagnose Bacterial Infections Copyright 2011 by Virgo Publishing. http diagnose bacterial infections in only a few hours. Photo by L. Brian Stauffer Bacterial infections really sensor. Led by University of Illinois chemistry professor Ken Suslick, the team published its results

  12. Safety of instrumentation and fusion at the time of surgical debridement for spinal infection.

    PubMed

    Talia, Adrian J; Wong, Michael L; Lau, Hui C; Kaye, Andrew H

    2015-07-01

    The present study aims to assess the results of single-stage instrumentation and fusion at the time of surgical debridement of spinal infections; vertebral osteomyelitis or epidural abscess. Nine patients with spinal infection were treated with instrumentation and fusion after radical debridement in a single-stage operation. Predisposing factors and comorbidities, pain, American Spinal Injury Association motor scores, primary pathologies, microbiology and perioperative markers were recorded. Seven patients with pyogenic and two with tuberculous spinal infection were encountered; the most common pathogen was Staphylococcus aureus. Five patients were predisposed to infection because of diabetes mellitus. Duration of antibiotic therapy lasted up to 12months. Six patients had thoracic infection, two lumbar and one cervical. No post-operative complications were encountered. There was a significant reduction in pain scores compared to pre-operatively. All patients with neurological deficits improved post-operatively. Despite introduction of hardware, no patients had a recurrence of their infection in the 12month follow up period. Single-stage debridement and instrumentation appeared to be a safe and effective method of managing spinal infections. The combination of debridement and fusion has the dual benefit of removing a focus of infection and stabilising the spine. The current series confirms that placing titanium cages into an infected space is safe in a majority of patients. Stabilisation and correction of spinal deformity reduces pain, aids neurologic recovery and improves quality of life. The small patient population and retrospective nature limit the present study. PMID:25911501

  13. Nursing diagnoses of most incidence on people with spinal cord injury in the context of outpatient care through an approach based on Orem Theory

    Microsoft Academic Search

    Maria Auxiliadora; Maria Márcia

    The complexity of health conditions presented by people with spinal cord injury requires planning and implementation of nursing systems that contribute to develop the capacity of self-care on this population. Due to this, the nursing diagnoses that happen on this group must be clear to nursing. The aim of this search was to analyze the Nursing Diagnoses that occurred in

  14. An enzyme linked immunosorbent assay to diagnose Babesia bovis infection in cattle

    Microsoft Academic Search

    D. J. Waltisbuhl; B. V. Goodger; I. G. Wright; M. A. Commins; D. F. Mahoney

    1987-01-01

    The optimum gel filtration fraction from lysate of Babesia bovis infected erythrocytes was determined for use as an antigen in an ELISA to diagnose B. bovis infection in cattle. Of four enzyme labels tested, horseradish peroxidase was the most suitable. The assay is both sensitive and specific in detecting antibody for 2–4 years after a single infection. False positive reactions

  15. Treating Bladder Infections and Catheter Encrustation in Spinal Cord Injury by Minimizing Biofilm Formation

    Microsoft Academic Search

    Spencer Long

    2009-01-01

    Bladder infections and their sequelae of stone formation, catheter blockage and pyelonephritis are common problems in patients with spinal cord injury and indwelling Foley catheters. The infections contribute to skin breakdown, debilitation and frequent hospitalizations. The use of recent improvements in catheter design, and a recognition of the importance of biofilm formation on indwelling catheters, have made possible a bladder

  16. [Imported systemic mycoses: are we prepared to diagnose these infections?].

    PubMed

    Tintelnot, Kathrin; Rickerts, Volker

    2015-06-01

    Although Histoplasma capsulatum obviously has been causing infections in animals in Northern Europe, there are no proven autochthonous histoplasmoses in humans. Possibly the increase of coccidioidomycosis (valley fever) in the USA may also lead to more frequently imported infections in Germany. It seems to be plausible that climate change will influence the distribution of obligate fungal pathogens. PMID:26069912

  17. How Well Do Discharge Diagnoses Identify Hospitalised Patients with Community-Acquired Infections? – A Validation Study

    PubMed Central

    Henriksen, Daniel Pilsgaard; Nielsen, Stig Lønberg; Laursen, Christian Borbjerg; Hallas, Jesper; Pedersen, Court; Lassen, Annmarie Touborg

    2014-01-01

    Background Credible measures of disease incidence, trends and mortality can be obtained through surveillance using manual chart review, but this is both time-consuming and expensive. ICD-10 discharge diagnoses are used as surrogate markers of infection, but knowledge on the validity of infections in general is sparse. The aim of the study was to determine how well ICD-10 discharge diagnoses identify patients with community-acquired infections in a medical emergency department (ED), overall and related to sites of infection and patient characteristics. Methods We manually reviewed 5977 patients admitted to a medical ED in a one-year period (September 2010-August 2011), to establish if they were hospitalised with community-acquired infection. Using the manual review as gold standard, we calculated the sensitivity, specificity, predictive values, and likelihood ratios of discharge diagnoses indicating infection. Results Two thousand five hundred eleven patients were identified with community-acquired infection according to chart review (42.0%, 95% confidence interval [95%CI]: 40.8–43.3%) compared to 2550 patients identified by ICD-10 diagnoses (42.8%, 95%CI: 41.6–44.1%). Sensitivity of the ICD-10 diagnoses was 79.9% (95%CI: 78.1–81.3%), specificity 83.9% (95%CI: 82.6–85.1%), positive likelihood ratio 4.95 (95%CI: 4.58–5.36) and negative likelihood ratio 0.24 (95%CI: 0.22–0.26). The two most common sites of infection, the lower respiratory tract and urinary tract, had positive likelihood ratios of 8.3 (95%CI: 7.5–9.2) and 11.3 (95%CI: 10.2–12.9) respectively. We identified significant variation in diagnostic validity related to age, comorbidity and disease severity. Conclusion ICD-10 discharge diagnoses identify specific sites of infection with a high degree of validity, but only a moderate degree when identifying infections in general. PMID:24663388

  18. Evaluating the incidence and utility of microscopic metastatic dissemination as diagnosed by lumbar cerebro-spinal fluid (CSF) samples in children with newly diagnosed intracranial ependymoma.

    PubMed

    Fangusaro, Jason; Van Den Berghe, Clark; Tomita, Tadanori; Rajaram, Veena; Aguilera, Dolly; Wang, Deli; Goldman, Stewart

    2011-07-01

    Ependymomas are the third most common central nervous system (CNS) tumor in childhood. After resection, the standard evaluation of intracranial ependymomas includes a post-contrast spine MRI and a lumbar CSF sample to evaluate for metastasis. Although it is estimated that 10-30% of patients will present with metastatic disease, it is unclear what percentage of metastatic disease is solely identified microscopically via lumbar cytology versus that identified as bulky disease on post-contrast spinal MRIs. We retrospectively evaluated all patients at our institution with intracranial ependymoma diagnosed between January 1991 and June 2008 in an effort to evaluate prognostic factors, survival outcomes and incidence of metastatic disease. Sixty-one evaluable patients were identified: 46% were male and the mean age at diagnosis was 64 months (2.04-196.92). The most common tumor location was the posterior fossa (77%) and 64% of patients achieved a gross total resection with initial surgery. Five-year event-free and overall survivals were 39 ± 7% and 87 ± 4%, respectively. Approximately 10% of patients presented with bulky metastatic disease as seen on post-contrast spine MRI. No patient whose spine MRI was negative for tumor had positive lumbar CSF cytology. These data highlight the rarity of patients who present with microscopic metastatic disease noted on lumbar cytology alone and suggest that evaluation of lumbar cytology may not be useful in patients with negative post-contrast spine MRIs. Future prospective trials may be helpful in validating this conclusion before eliminating this procedure as part of the standard evaluation in newly diagnosed ependymoma patients. PMID:21038109

  19. Is spinal instrumentation a risk factor for late-onset infection in cases of distant infection or surgery? Case report.

    PubMed

    Naderi, Sait; Acar, Feridun; Mertol, Tansu

    2003-09-15

    As a cause of revision spinal surgery, spinal epidural abscess after instrumentation-assisted fusion is rare in neurosurgical practice. Postoperative infections are frequently seen in the time period soon after surgery. The authors report on the case of a 45-year-old woman who had undergone posterior instrumentation-augmented fusion for L4-5 degenerative spondylolisthesis. Ten months after the operation she presented to the neurosurgery clinic with complaints of severe low-back pain and radicular right lower-extremity pain. She had undergone laparoscopic surgery for acute cholecystitis 1 month prior to readmission. Radiological study revealed a spinal epidural abscess in communication with a right psoas abscess at L4-5. The abscess was drained percutaneously with the aid of C-arm fluoroscopic guidance, and a 6-week course of parenteral antibiotic therapy was administered. Retrograde lymphatic bacterial translocation, hematopoietic spread, and the suitable characteristics in the host may facilitate the development of infection around the implant. Thus, distant surgery and infection may be a risk factor in cases in which spinal instrumentation is placed. In such cases a prolonged antibiotic therapy for distant infection after surgery is recommended. PMID:15347233

  20. Prevalence of Diagnosed and Undiagnosed HIV Infection - United States, 2008-2012.

    PubMed

    Hall, H Irene; An, Qian; Tang, Tian; Song, Ruiguang; Chen, Mi; Green, Timothy; Kang, Jian

    2015-06-26

    Persons unaware of their human immunodeficiency virus (HIV) infection contribute nearly one third of ongoing transmission in the United States. Among the estimated 1.2 million persons living with HIV in the United States in 2011, 14% had undiagnosed infections. To accelerate progress toward reducing undiagnosed HIV infection, CDC and its partners have pursued an approach that includes expanding HIV testing in communities with high HIV infection rates. To measure the prevalence of diagnosed and undiagnosed HIV infection for the 50 states and the District of Columbia (DC), CDC analyzed data from the National HIV Surveillance System. In 42 jurisdictions with numerically stable estimates, HIV prevalence in 2012 ranged from 110 per 100,000 persons (Iowa) to 3,936 per 100,000 (DC). The percentage of persons living with diagnosed HIV ranged from 77% in Louisiana to ?90% in Colorado, Connecticut, Delaware, Hawaii, and New York. In 39 jurisdictions with numerically stable estimates, the percentage of HIV cases with diagnosed infection among men who have sex with men (MSM) ranged from 75% in Louisiana to ?90% in Hawaii and New York. These data demonstrate the need for interventions and public health strategies to reduce the prevalence of undiagnosed HIV infection. Because the percentage of persons with undiagnosed HIV varies by geographic area, efforts tailored to each area's unique circumstances might be needed to increase the percentage of persons aware of their infection. PMID:26110835

  1. Behçet's disease diagnosed after acute HIV infection: viral replication activating underlying autoimmunity?

    PubMed

    Roscoe, Clay; Kinney, Rebecca; Gilles, Ryan; Blue, Sky

    2015-05-01

    Behçet's disease is an autoimmune systemic vasculitis that can occur after exposure to infectious agents. Behçet's disease also has been associated with HIV infection, including de novo development of this condition during chronic HIV infection and resolution of Behçet's disease symptoms following initiation of antiretroviral therapy. We describe a patient who presented with systemic vasculitis with skin and mucous membrane ulcerations in the setting of acute HIV infection, who was eventually diagnosed with Behçet's disease, demonstrating a possible link between acute HIV infection, immune activation and development of autoimmunity. PMID:24912539

  2. Spinal and paraspinal infections associated with contaminated methylprednisolone acetate injections - Michigan, 2012-2013.

    PubMed

    2013-05-17

    As of May 6, 2013, Michigan had reported 167 (52%) of the 320 paraspinal or spinal infections without meningitis associated with the 2012-2013 fungal meningitis outbreak nationally. Although the index patient had a laboratory-confirmed Aspergillus fumigatus infection, the fungus most often identified, including in unopened vials of methylprednisolone acetate (MPA), remains Exserohilum rostratum, a common black mold found on plants and in soil. Exposures have occurred through epidural, paraspinal, peripheral nerve, and intra-articular injection with MPA from contaminated lots compounded by the New England Compounding Center in Framingham, Massachusetts. The Michigan Department of Community Health and CDC conducted case ascertainment to describe epidemiologic and clinical characteristics of Michigan patients and to determine factors that might have contributed to the high percentage of spinal and paraspinal infections reported from Michigan. A distinct epidemiologic or clinical difference was not observed between patients with paraspinal or spinal infection with and without meningitis. Lengthy periods (range: 12-121 days) were observed from date of last injection with contaminated MPA to date of first magnetic resonance imaging (MRI) finding indicative of infection. Clinicians should continue to maintain a higher index of suspicion for patients who received injections with contaminated MPA but have not developed infection. PMID:23677044

  3. Getting Diagnosed

    MedlinePLUS

    ... also for those with related disorders. How is Marfan syndrome diagnosed? A Marfan diagnosis can often be ... spinal column). Is there a genetic test for Marfan syndrome? Genetic testing can provide helpful information in ...

  4. The Prevalence, Etiologic Agents and Risk Factors for Urinary Tract Infection Among Spinal Cord Injury Patients

    PubMed Central

    Togan, Turhan; Azap, Ozlem Kurt; Durukan, Elif; Arslan, Hande

    2014-01-01

    Background: Urinary tract infections (UTIs) are important causes of morbidity and mortality in patients with spinal cord injury and 22% of patients with acute spinal cord injury develop UTI during the first 50 days. Objectives: The aim of this study was to determine the prevalence, etiologic agents and risk factors for asymptomatic bacteriuria and symptomatic urinary tract infections in patients with spinal cord injury. Patients and Methods: This was a prospective investigation of spinal cord injury patients with asymptomatic bacteriuria and symptomatic urinary tract infections in Baskent University Medical Faculty Ayas Rehabilitation Center and Ankara Physical Therapy and Rehabilitation Center between January 2008 and December 2010. The demographic status, clinical and laboratory findings of 93 patients with spinal cord injury were analyzed in order to determine the risk factors for asymptomatic or symptomatic bacteriuria Results: Sixty three (67.7%) of 93 patients had asymptomatic bacteriuria and 21 (22.6%) had symptomatic urinary tract infection. Assessment of the frequency of urinary bladder emptying methods revealed that 57 (61.3%) of 93 patients employed permanent catheters and 24 (25.8%) employed clean intermittent catheterization. One hundred and thirty-five (48.0%) of 281 strains isolated form asymptomatic bacteriuria attacks and 16 (66.6%) of 24 strains isolated from symptomatic urinary tract infection attacks, totaling 151 strains, had multidrug resistance (P > 0.05). One hundred (70.4%) of 142 Escherichia coli strains and 19 (34.5%) of 55 Klebsiella spp strains proliferated in patients with asymptomatic bacteriuria; 8 (80%) of 10 E. coli strains and 4 (80%) of 5 Klebsiella spp. strains were multidrug resistant. Conclusions: The most common infectious episode among spinal cord injury patients was found to be urinary tract ?nfection. E. coli was the most common microorganism isolated from urine samples. Antibiotic use in the previous 2 weeks or 3 months, hospitalization during the last one-year and previous diagnosis of urinary tract ?nfection were the risk factors identified for the development of infections with multi-drug resistant isolates. Urinary catheterization was found to be the only independent risk factor contributing to symptomatic urinary tract infection. PMID:25147663

  5. Use of an electronic nose to diagnose Mycobacterium bovis infection in badgers and cattle.

    PubMed

    Fend, R; Geddes, R; Lesellier, S; Vordermeier, H-M; Corner, L A L; Gormley, E; Costello, E; Hewinson, R G; Marlin, D J; Woodman, A C; Chambers, M A

    2005-04-01

    It is estimated that more than 50 million cattle are infected with Mycobacterium bovis worldwide, resulting in severe economic losses. Current diagnosis of tuberculosis (TB) in cattle relies on tuberculin skin testing, and when combined with the slaughter of test-positive animals, it has significantly reduced the incidence of bovine TB. The failure to eradicate bovine TB in Great Britain has been attributed in part to a reservoir of the infection in badgers (Meles meles). Accurate and reliable diagnosis of infection is the cornerstone of TB control. Bacteriological diagnosis has these characteristics, but only with samples collected postmortem. Unlike significant wild animal reservoirs of M. bovis that are considered pests in other countries, such as the brushtail possum (Trichosurus vulpecula) in New Zealand, the badger and its sett are protected under United Kingdom legislation (The Protection of Badgers Act 1992). Therefore, an accurate in vitro test for badgers is needed urgently to determine the extent of the reservoir of infection cheaply and without destroying badgers. For cattle, a rapid on-farm test to complement the existing tests (the skin test and gamma interferon assay) would be highly desirable. To this end, we have investigated the potential of an electronic nose (EN) to diagnose infection of cattle or badgers with M. bovis, using a serum sample. Samples were obtained from both experimentally infected badgers and cattle, as well as naturally infected badgers. Without exception, the EN was able to discriminate infected animals from controls as early as 3 weeks after infection with M. bovis, the earliest time point examined postchallenge. The EN approach described here is a straightforward alternative to conventional methods of TB diagnosis, and it offers considerable potential as a sensitive, rapid, and cost-effective means of diagnosing M. bovis infection in cattle and badgers. PMID:15814995

  6. Use of an Electronic Nose To Diagnose Mycobacterium bovis Infection in Badgers and Cattle

    PubMed Central

    Fend, R.; Geddes, R.; Lesellier, S.; Vordermeier, H.-M.; Corner, L. A. L.; Gormley, E.; Costello, E.; Hewinson, R. G.; Marlin, D. J.; Woodman, A. C.; Chambers, M. A.

    2005-01-01

    It is estimated that more than 50 million cattle are infected with Mycobacterium bovis worldwide, resulting in severe economic losses. Current diagnosis of tuberculosis (TB) in cattle relies on tuberculin skin testing, and when combined with the slaughter of test-positive animals, it has significantly reduced the incidence of bovine TB. The failure to eradicate bovine TB in Great Britain has been attributed in part to a reservoir of the infection in badgers (Meles meles). Accurate and reliable diagnosis of infection is the cornerstone of TB control. Bacteriological diagnosis has these characteristics, but only with samples collected postmortem. Unlike significant wild animal reservoirs of M. bovis that are considered pests in other countries, such as the brushtail possum (Trichosurus vulpecula) in New Zealand, the badger and its sett are protected under United Kingdom legislation (The Protection of Badgers Act 1992). Therefore, an accurate in vitro test for badgers is needed urgently to determine the extent of the reservoir of infection cheaply and without destroying badgers. For cattle, a rapid on-farm test to complement the existing tests (the skin test and gamma interferon assay) would be highly desirable. To this end, we have investigated the potential of an electronic nose (EN) to diagnose infection of cattle or badgers with M. bovis, using a serum sample. Samples were obtained from both experimentally infected badgers and cattle, as well as naturally infected badgers. Without exception, the EN was able to discriminate infected animals from controls as early as 3 weeks after infection with M. bovis, the earliest time point examined postchallenge. The EN approach described here is a straightforward alternative to conventional methods of TB diagnosis, and it offers considerable potential as a sensitive, rapid, and cost-effective means of diagnosing M. bovis infection in cattle and badgers. PMID:15814995

  7. Brain and spinal cord haemorrhages associated with Angiostrongylus vasorum infection in four dogs

    Microsoft Academic Search

    A. Wessmann; D. Lu; C. R. Lamb; B. Smyth; P. Mantis; K. Chandler; A. Boag; G. B. Cherubini; R. Cappello

    2006-01-01

    Multifocal haemorrhages associated with Angiostrongylus vasorum infection were observed in the central nervous system of four dogs with neurological signs including depression, seizures, spinal pain and paresis. In magnetic resonance images the majority of the lesions were isointense or slightly hyperintense in T1-weighted images, hyperintense in T2-weighted images and hypointense in T2*-weighted (gradient echo) images, compatible with haemorrhages more than

  8. Expanding role of 18F-fluoro-d-deoxyglucose PET and PET/CT in spinal infections

    PubMed Central

    Rijk, Paul C.; Collins, James M. P.; Parlevliet, Thierry; Stumpe, Katrin D.; Palestro, Christopher J.

    2010-01-01

    18F-fluoro-d-deoxyglucose positron emission tomography ([18F]-FDG PET) is successfully employed as a molecular imaging technique in oncology, and has become a promising imaging modality in the field of infection. The non-invasive diagnosis of spinal infections (SI) has been a challenge for physicians for many years. Morphological imaging modalities such as conventional radiography, computed tomography (CT), and magnetic resonance imaging (MRI) are techniques frequently used in patients with SI. However, these methods are sometimes non-specific, and difficulties in differentiating infectious from degenerative end-plate abnormalities or postoperative changes can occur. Moreover, in contrast to CT and MRI, FDG uptake in PET is not hampered by metallic implant-associated artifacts. Conventional radionuclide imaging tests, such as bone scintigraphy, labeled leukocyte, and gallium scanning, suffer from relatively poor spatial resolution and lack sensitivity, specificity, or both. Initial data show that [18F]-FDG PET is an emerging imaging technique for diagnosing SI. [18F]-FDG PET appears to be especially helpful in those cases in which MRI cannot be performed or is non-diagnostic, and as an adjunct in patients in whom the diagnosis is inconclusive. The article reviews the currently available literature on [18F]-FDG PET and PET/CT in the diagnosis of SI. PMID:20052505

  9. Low prevalence of neurocognitive impairment in early diagnosed and managed HIV-infected persons

    PubMed Central

    Moore, David J.; Letendre, Scott; Poehlman Roediger, Mollie; Eberly, Lynn; Weintrob, Amy; Ganesan, Anuradha; Johnson, Erica; Del Rosario, Raechel; Agan, Brian K.; Hale, Braden R.

    2013-01-01

    Objective: To describe the prevalence of neurocognitive impairment (NCI) among early diagnosed and managed HIV-infected persons (HIV+) compared to HIV-negative controls. Methods: We performed a cross-sectional study among 200 HIV+ and 50 matched HIV-uninfected (HIV?) military beneficiaries. HIV+ patients were categorized as earlier (<6 years of HIV, no AIDS-defining conditions, and CD4 nadir >200 cells/mm3) or later stage patients (n = 100 in each group); both groups were diagnosed early and had access to care. NCI was diagnosed using a comprehensive battery of standardized neuropsychological tests. Results: HIV+ patients had a median age of 36 years, 91% were seroconverters (median window of 1.2 years), had a median duration of HIV of 5 years, had a CD4 nadir of 319, had current CD4 of 546 cells/mm3, and 64% were on highly active antiretroviral therapy (initiated 1.3 years after diagnosis at a median CD4 of 333 cells/mm3). NCI was diagnosed among 38 (19%, 95% confidence interval 14%–25%) HIV+ patients, with a similar prevalence of NCI among earlier and later stage patients (18% vs 20%, p = 0.72). The prevalence of NCI among HIV+ patients was similar to HIV? patients. Conclusions: HIV+ patients diagnosed and managed early during the course of HIV infection had a low prevalence of NCI, comparable to matched HIV-uninfected persons. Early recognition and management of HIV infection may be important in limiting neurocognitive impairment. PMID:23303852

  10. Spinal Cord Diseases

    MedlinePLUS

    Your spinal cord is a bundle of nerves that runs down the middle of your back. It carries signals back ... of the spine, this can also injure the spinal cord. Other spinal cord problems include Tumors Infections such ...

  11. Acquired lumbar spinal stenosis.

    PubMed

    Deasy, JoAnn

    2015-04-01

    Lumbar spinal stenosis is the most frequent reason for spinal surgery in patients over age 65 years. In this condition, narrowing of the lumbar spinal canal and nerve root canals leads to painful, debilitating compression of spinal nerves and blood vessels. As the population ages, an increasing number of patients will be diagnosed and treated for lumbar spinal stenosis by primary care providers. This article reviews the pathophysiology, diagnosis, and management of lumbar spinal stenosis in adults over age 50 years. PMID:25763664

  12. Cutaneous aseptic neutrophilic abscesses and Yersinia enterocolitica infection in a case subsequently diagnosed as Crohn's disease.

    PubMed

    Safa, G; Loppin, M; Tisseau, L; Lamoril, J

    2008-01-01

    We report the case of a man who presented cutaneous aseptic abscesses, a rare form of neutrophilic disease, associated with Yersinia enterocolitica infection and who was later diagnosed as having Crohn's disease (CD). Genetic analysis showed that the patient had a mutation in the caspase activation recruitment domain 15/nucleotide oligomerization domain 2 gene (R702W heterozygote). This case is in keeping with recent evidence in the literature which suggests that CD is a disease linked to abnormal immune responses to enteric bacteria in genetically susceptible individuals. Further understanding of the innate immune system should provide new insights into the pathogenesis of these inflammatory diseases. PMID:18799880

  13. Evaluation of some laboratory procedures in diagnosing infections with Schistosoma mansoni*

    PubMed Central

    Jachowski, Leo A.; Anderson, Robert I.

    1961-01-01

    This paper reports on a comparative evaluation carried out in Puerto Rico on the following procedures used in diagnosing bilharziasis: recovery of S. mansoni ova from stools; serological tests (complement-fixation tests with adult worm and cercarial antigens, slide flocculation test with cercarial antigens, cercarial agglutination test, and circumoval precipitin test) and intradermal tests with adult worm, cercarial and egg antigens. Stool examinations revealed infections in only 74% of 485 patients hospitalized for bilharziasis, but most of the serological and intradermal tests gave results which, when corrected for false negative reactions, suggested infections in 89%-94% of patients. Cercarial agglutination results were discounted because of weak reactions and low specificity; the intradermal test with egg antigen lacked specificity. From the results of their comparative studies, the authors suggest particular uses for the various serological and stool tests, but consider that the intradermal tests do not appear to have a definable role in the diagnosis or detection of bilharziasis. PMID:14036493

  14. Limited cross-border infections in patients newly diagnosed with HIV in Europe

    PubMed Central

    2013-01-01

    Background International travel plays a role in the spread of HIV-1 across Europe. It is, however, not known whether international travel is more important for spread of the epidemic as compared to endogenous infections within single countries. In this study, phylogenetic associations among HIV of newly diagnosed patients were determined across Europe. Results Data came from the SPREAD programme which collects samples of newly diagnosed patients that are representative for national HIV epidemics. 4260 pol sequences from 25 European countries and Israel collected in 2002–2007 were included. We identified 457 clusters including 1330 persons (31.2% of all patients). The cluster size ranged between 2 and 28. A number of 987 patients (74.2%) were part of a cluster that consisted only of patients originating from the same country. In addition, 135 patients (10.2%) were in a cluster including only individuals from neighboring countries. Finally, 208 patients (15.6%) clustered with individuals from countries without a common border. Clustering with patients from the same country was less prevalent in patients being infected with B subtype (P-value <0.0001), in men who have sex with men (P-value <0.0001), and in recently infected patients (P-value =0.045). Conclusions Our findings indicate that the transmission of HIV-1 in Europe is predominantly occurring between patients from the same country. This could have implications for HIV-1 transmission prevention programmes. Because infections through travelling between countries is not frequently observed it is important to have good surveillance of the national HIV-1 epidemics. PMID:23551870

  15. Prevalence of genital mycoplasmas in asymptomatic male partners of women diagnosed as having chlamydial infections.

    PubMed

    Ito, Shin; Kikuchi, Mina; Seike, Kensaku; Tsuchiya, Tomohiro; Yasuda, Mitsuru; Yokoi, Shigeaki; Nakano, Masahiro; Deguchi, Takashi

    2014-02-01

    We examined 209 asymptomatic male partners of women diagnosed as having chlamydial infections for the prevalence of Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma urealyticum, and Ureaplasma parvum in their first-voided urine (FVU) by nucleic acid amplification tests. Quantification of leukocytes in FVU was performed by automated urine particle analyzers. Two (1.0%) men were positive for N. gonorrhoeae, and 92 (44.0%) were positive for C. trachomatis. In men negative for these pathogens, prevalences of M. genitalium, M. hominis, U. urealyticum, and U. parvum were 0.9%, 29.6%, 27.8%, and 20.1%, respectively, and 58.3% were positive for at least one species of the genital mycoplasmas. Leukocyte counts in FVU from 92 men positive for C. trachomatis were significantly greater than those from 115 men negative for C. trachomatis (p < 0.0001). However, there was no significant difference in leukocyte counts between 66 men positive for at least one species of M. hominis, U. urealyticum, and U. parvum and 48 men negative for all the species (p = 0.1657). The present population of asymptomatic male partners of women diagnosed as having chlamydial infections showed a low prevalence of M. genitalium infections but would be at high risk of being infected by the other genital mycoplasmas. However, it was still unclear whether these genital mycoplasmas would contribute to the development of inflammation of the male urethra. When these partners are negative for C. trachomatis and N. gonorrhoeae, the recommendation to presumptively treat them to disrupt transmission networks of the genital mycoplasmas would seem premature. PMID:24486047

  16. Acute lower motor neuron syndrome and spinal cord gray matter hyperintensities in HIV infection

    PubMed Central

    Wilson, Michael R.; Chad, David A.; Venna, Nagagopal

    2015-01-01

    Objective: To describe a novel manifestation of lower motor neuron disease in patients with well-controlled HIV infection. Methods: A retrospective study was performed to identify HIV-positive individuals with acute, painful lower motor neuron diseases. Results: Six patients were identified with HIV and lower motor neuron disease. Two patients met the inclusion criteria of well-controlled, chronic HIV infection and an acute, painful, unilateral lower motor neuron paralytic syndrome affecting the distal portion of the upper limb. These patients had segmental T2-hyperintense lesions in the central gray matter of the cervical spinal cord on MRI. One patient stabilized and the second patient improved with immunomodulatory therapy. Conclusions: This newly described syndrome expands the clinical spectrum of lower motor neuron diseases in HIV. PMID:26015990

  17. Development of culture-based serological assays to diagnose Babesia divergens infections.

    PubMed

    Gabrielli, Simona; Galuppi, Roberta; Marcer, Federica; Marini, Carla; Tampieri, Maria Paola; Moretti, Annabella; Pietrobelli, Mario; Cancrini, Gabriella

    2012-02-01

    Babesioses are hematic tick-borne diseases that induce malaria-like disorders in domestic, wild animals, and humans. Although indirect fluorescent antibody test (IFAT) and enzyme-linked immunosorbent assay (ELISA) commercial kits are available to test the presence of antibodies against most Babesia species, no kit exists to serologically diagnose the infections due to Babesia divergens, one of the most important zoonotic species. To fill this gap and to develop assays to detect animal and human infections, in vitro cultures (microaerophilous stationary phase system) of B. divergens were organized. Infected erythrocytes were adsorbed as corpuscular antigen (CA) on IFAT slides and ELISA microwells. The supernatant medium of the cultures (metabolic antigen, MA) was collected and employed in ELISA and western blot (WB) assays. B. divergens was also used to produce positive sera in Meriones unguiculatus and to infect a calf. Serological tests were set up with sera from experimentally/naturally infected animals, and possible cross-reactions were evaluated using heterologous sera from cattle positive to other piroplasms. Sera from clinically healthy people at risk of infection were also tested. As expected, assays based on the purified MAs from in vitro cultures proved more sensitive and specific than CA-IFAT and CA-ELISA. In fact, MA-ELISA provided satisfactory performances (even if 8.4%-15.7% cross-reactions were evidenced), and the WB developed proved totally sensitive and specific. WB indicated as immunodominant antigens two major protein bands at 33 and 37?kDa, which were also evidenced in 2.2% of the human sera tested, proving the parasite transmission to humans also in Italy. PMID:21995263

  18. Analysis of the Host Transcriptome from Demyelinating Spinal Cord of Murine Coronavirus-Infected Mice

    PubMed Central

    Elliott, Ruth; Li, Fan; Dragomir, Isabelle; Chua, Ming Ming W.; Gregory, Brian D.; Weiss, Susan R.

    2013-01-01

    Persistent infection of the mouse central nervous system (CNS) with mouse hepatitis virus (MHV) induces a demyelinating disease pathologically similar to multiple sclerosis and is therefore used as a model system. There is little information regarding the host factors that correlate with and contribute to MHV-induced demyelination. Here, we detail the genes and pathways associated with MHV-induced demyelinating disease in the spinal cord. High-throughput sequencing of the host transcriptome revealed that demyelination is accompanied by numerous transcriptional changes indicative of immune infiltration as well as changes in the cytokine milieu and lipid metabolism. We found evidence that a Th1-biased cytokine/chemokine response and eicosanoid-derived inflammation accompany persistent MHV infection and that antigen presentation is ongoing. Interestingly, increased expression of genes involved in lipid transport, processing, and catabolism, including some with known roles in neurodegenerative diseases, coincided with demyelination. Lastly, expression of several genes involved in osteoclast or bone-resident macrophage function, most notably TREM2 and DAP12, was upregulated in persistently infected mouse spinal cord. This study highlights the complexity of the host antiviral response, which accompany MHV-induced demyelination, and further supports previous findings that MHV-induced demyelination is immune-mediated. Interestingly, these data suggest a parallel between bone reabsorption by osteoclasts and myelin debris clearance by microglia in the bone and the CNS, respectively. To our knowledge, this is the first report of using an RNA-seq approach to study the host CNS response to persistent viral infection. PMID:24058676

  19. Spinal Infections

    MedlinePLUS

    ... WBC) count, c-reactive protein (CRP) and an erythrocyte sedimentation rate (ESR). These values may be slightly ... along with your C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR) as markers of the response ...

  20. Expanding role of 18 F-fluoro- d -deoxyglucose PET and PET\\/CT in spinal infections

    Microsoft Academic Search

    Filip GemmelPaul; Paul C. Rijk; James M. P. Collins; Thierry Parlevliet; Katrin D. Stumpe; Christopher J. Palestro

    2010-01-01

    18F-fluoro-d-deoxyglucose positron emission tomography ([18F]-FDG PET) is successfully employed as a molecular imaging technique in oncology, and has become a promising imaging modality\\u000a in the field of infection. The non-invasive diagnosis of spinal infections (SI) has been a challenge for physicians for many\\u000a years. Morphological imaging modalities such as conventional radiography, computed tomography (CT), and magnetic resonance\\u000a imaging (MRI) are

  1. Brief Report: Recent Infection, Sexually Transmitted Infections, and Transmission Clusters Frequently Observed Among Persons Newly Diagnosed With HIV in San Francisco.

    PubMed

    Truong, Hong-Ha M; Pipkin, Sharon; O?Keefe, Kara J; Louie, Brian; Liegler, Teri; McFarland, Willi; Grant, Robert M; Bernstein, Kyle; Scheer, Susan

    2015-08-15

    There were 1311 newly diagnosed HIV cases in San Francisco between 2005 and 2011 that were linked to care at publicly funded facilities and had viral sequences available for analysis. Of the 214 cases characterized as recently infected with HIV at the time of diagnosis, 25% had a recent sexually transmitted infection diagnosis (vs. 10% among longer-standing HIV infections, P < 0.001) and 57% were part of a phylogenetic transmission cluster (vs. 42% among longer-standing HIV infection, P < 0.001). The association observed between recent HIV infection and having a sexually transmitted infection diagnosis during the interval overlapping likely HIV acquisition points to potential opportunities to interrupt HIV transmission. PMID:25967271

  2. Mycobacterium chelonae infection presenting as recurrent cutaneous and subcutaneous nodules--a presentation previously diagnosed as Weber Christian disease.

    PubMed

    Maverakis, Emanual; He, Yong; Patel, Forum B; Fitzmaurice, Sarah; Fung, Maxwell A

    2014-06-01

    Although the dermatologic community rarely uses "Weber-Christian Disease" as a diagnosis, it still appears in the internal medicine literature. Herein we present a patient with recurrent cutaneous and subcutaneous nodules who was initially treated with aggressive immunosupression for a presumptive diagnosis of Weber-Christian Disease. After more than a decade the patient was diagnosed with cutaneous Mycobacterium chelonea. This case is an excellent example of the difficulty in diagnosing mycobacterial infections and underscores the importance of having a high suspicion for infectious etiologies for unresponsive cutaneous eruptions in patients on immunosuppressive medications. PMID:24945648

  3. Obtaining Self-Samples to Diagnose Curable Sexually Transmitted Infections: A Systematic Review of Patients’ Experiences

    PubMed Central

    Paudyal, Priyamvada; Llewellyn, Carrie; Lau, Jason; Mahmud, Mohammad; Smith, Helen

    2015-01-01

    Background Routine screening is key to sexually transmitted infection (STI) prevention and control. Previous studies suggest that clinic-based screening programmes capture only a small proportion of people with STIs. Self-sampling using non- or minimally invasive techniques may be beneficial for those reluctant to actively engage with conventional sampling methods. We systematically reviewed studies of patients’ experiences of obtaining self-samples to diagnose curable STIs. Methods We conducted an electronic search of MEDLINE, EMBASE, CINAHL, PsychINFO, BNI, and Cochrane Database of Systematic Reviews to identify relevant articles published in English between January 1980 and March 2014. Studies were included if participants self-sampled for the diagnosis of a curable STI and had specifically sought participants’ opinions of their experience, acceptability, preferences, or willingness to self-sample. Results The initial search yielded 558 references. Of these, 45 studies met the inclusion criteria. Thirty-six studies assessed patients’ acceptability and experiences of self-sampling. Pooled results from these studies shows that self-sampling is a highly acceptable method with 85% of patients reporting the method to be well received and acceptable. Twenty-eight studies reported on ease of self-sampling; the majority of patients (88%) in these studies found self-sampling an “easy” procedure. Self-sampling was favoured compared to clinician sampling, and home sampling was preferred to clinic-based sampling. Females and older participants were more accepting of self-sampling. Only a small minority of participants (13%) reported pain during self-sampling. Participants were willing to undergo self-sampling and recommend others. Privacy and safety were the most common concerns. Conclusion Self-sampling for diagnostic testing is well accepted with the majority having a positive experience and willingness to use again. Standardization of self-sampling procedures and rigorous validation of outcome measurement will lead to better comparability across studies. Future studies need to conduct rigorous economic evaluations of self-sampling to inform policy development for the management of STI. PMID:25909508

  4. Comprehensive proteome analysis of hippocampus, brainstem, and spinal cord from paralytic and furious dogs naturally infected with rabies.

    PubMed

    Thanomsridetchai, Natthapaninee; Singhto, Nilubon; Tepsumethanon, Veera; Shuangshoti, Shanop; Wacharapluesadee, Supaporn; Sinchaikul, Supachok; Chen, Shui-Tein; Hemachudha, Thiravat; Thongboonkerd, Visith

    2011-11-01

    Paralytic and furious forms are unique clinical entities of rabies in humans and dogs. However, molecular mechanisms underlying these disorders remained unclear. We investigated changes in proteomes of the hippocampus, brainstem and spinal cord of paralytic and furious dogs naturally infected with rabies compared to noninfected controls. Proteins were extracted from these tissues and analyzed by two-dimensional gel electrophoresis (2-DE) (n = 6 gels/region in each group, a total of 54 gels were analyzed). From >1000 protein spots visualized in each gel, spot matching, quantitative intensity analysis, and ANOVA with Tukey's posthoc multiple comparisons revealed 32, 49, and 67 protein spots that were differentially expressed among the three clinical groups in the hippocampus, brainstem and spinal cord, respectively. These proteins were then identified by quadrupole time-of-flight mass spectrometry and tandem mass spectrometry (Q-TOF MS and MS/MS), including antioxidants, apoptosis-related proteins, cytoskeletal proteins, heat shock proteins/chaperones, immune regulatory proteins, metabolic enzymes, neuron-specific proteins, transcription/translation regulators, ubiquitination/proteasome-related proteins, vesicular transport proteins, and hypothetical proteins. Among these, 13, 17, and 41 proteins in the hippocampus, brainstem and spinal cord, respectively, significantly differed between paralytic and furious forms and thus may potentially be biomarkers to differentiate these two distinct forms of rabies. In summary, we report herein for the first time a large data set of changes in proteomes of the hippocampus, brainstem and spinal cord in dogs naturally infected with rabies. These data will be useful for better understanding of molecular mechanisms of rabies and for differentiation of its paralytic and furious forms. PMID:21942679

  5. Diagnosing Rhodococcus equi Infections in a Setting Where Tuberculosis Is Highly Endemic: a Double Challenge

    PubMed Central

    Cash-Goldwasser, Shama; Tho, Phan Vinh; Lan, Nguyen Phu Huong; Campbell, James I.; van Doorn, H. Rogier; Lam, Nguyen Tien; Trung, Nguyen Vu; Trinh, Dao Tuyet; Kinh, Nguyen Van; Wertheim, Heiman F. L.

    2015-01-01

    Rhodococcus equi infection is increasing in regions with high HIV prevalence worldwide. The microbiological features and clinical mimicry of tuberculosis infection pose diagnostic challenges in high-tuberculosis-incidence settings. We present two HIV-associated cases of R. equi infection from Vietnam and discuss the unique diagnostic challenges in such settings. PMID:25631800

  6. Transcriptional profiling of feline infectious peritonitis virus infection in CRFK cells and in PBMCs from FIP diagnosed cats

    PubMed Central

    2013-01-01

    Background Feline Infectious Peritonitis (FIP) is a lethal systemic disease, caused by the FIP Virus (FIPV); a virulent mutant of Feline Enteric Coronavirus (FECV). Currently, the viruses virulence determinants and host gene expressions during FIPV infection are not fully understood. Methods RNA sequencing of Crandell Rees Feline Kidney (CRFK) cells, infected with FIPV strain 79–1146 at 3 hours post infection (h.p.i), were sequenced using the Illumina next generation sequencing approach. Bioinformatic’s analysis, based on Felis catus 2X annotated shotgun reference genome, using CLC bio Genome Workbench mapped both control and infected cell reads to 18899 genes out of 19046 annotated genes. Kal’s Z test statistical analysis was used to analyse the differentially expressed genes from the infected CRFK cells. Real time RT-qPCR was developed for further transcriptional profiling of three genes (PD-1, PD-L1 and A3H) in infected CRFK cells and Peripheral Blood Mononuclear Cells (PBMCs) from healthy and FIP-diseased cats. Results Based on Kal’s Z-test, with False Discovery Rate (FDR) <0.05 and >1.99 fold change on gene expressions, a total of 61 genes were differentially expressed by both samples, where 44 genes were up-regulated and the remainder were down-regulated. Most genes were closely clustered together, suggesting a homogeneous expression. The majority of the genes that were significantly regulated, were those associated with monocytes-macrophage and Th1 cell functions, and the regulation of apoptosis. Real time RT-qPCR developed focusing on 2 up-regulated genes (PD-L1 and A3H) together with an apoptosis associated gene PD-1 expressions in FIPV infected CRFK cells and in PBMCs from healthy and FIP diagnosed cats produced concordant results with transcriptome data. Conclusion The possible roles of these genes, and their importance in feline coronaviruses infection, are discussed. PMID:24209771

  7. Persons Newly Diagnosed with HIV Infection are at High Risk for Depression and Poor Linkage to Care: Results from the Steps Study

    Microsoft Academic Search

    Ramona Bhatia; Christine Hartman; Michael A. Kallen; James Graham; Thomas P. Giordano

    2011-01-01

    Little is known about the prevalence and impact of depression in persons newly diagnosed with HIV infection. The Steps Study\\u000a is a prospective, observational cohort study of persons newly diagnosed with HIV infection. Participants were administered\\u000a a battery of instruments, including the CES-D. Linkage to care was defined as attending at least one clinic appointment in\\u000a each of the first

  8. Spinal tumor

    MedlinePLUS

    Tumor - spinal cord ... spinal tumors occur in the nerves of the spinal cord itself. Most often these are ependymomas and other ... gene mutations. Spinal tumors can occur: Inside the spinal cord (intramedullary) In the membranes (meninges) covering the spinal ...

  9. [A case of previous infection with schistosomiasis japonica diagnosed holistically on the basis of various clinical examination findings].

    PubMed

    Iwata, Tomoaki; Kondo, Yasuteru; Kimura, Osamu; Fujishima, Fumiyoshi; Morosawa, Tatsuki; Ninomiya, Masashi; Kakazu, Eiji; Kogure, Takayuki; Iwasaki, Takao; Shimosegawa, Tooru

    2014-05-01

    A 66-year-old male was referred to our hospital because of a high CRP level. CT and MRI revealed cord-like contrast effects along the periphery of the liver, and peripheral portal vein occlusion was suspected. Histopathological analysis revealed fibrotic occlusion and eosinophil and histiocytic infiltration of the portal vein. Taking into account various clinical imaging tests, blood tests, and histopathological tests and of his current clinical history, he was diagnosed with previous infection of schistosomiasis japonica. We believe that this case illustrates the importance of a comprehensive diagnosis; in addition, we implemented real-time virtual sonography and EOB-MRI that provided useful visual information. PMID:24806239

  10. Non-culture-based methods to diagnose bloodstream infection: Does it work?

    PubMed Central

    Skvarc, Miha; Stubljar, David; Rogina, Petra

    2013-01-01

    Bloodstream infections are a major cause of morbidity and mortality worldwide. Molecular methods for the detection of pathogens in blood have been developed. The clinical utility of these methods and their integration into the clinical workflow is discussed. PMID:24265925

  11. Foreign-Born Persons Diagnosed with HIV: Where are They From and Where Were They Infected?

    PubMed

    Wiewel, Ellen W; Torian, Lucia V; Hanna, David B; Bocour, Angelica; Shepard, Colin W

    2015-05-01

    We sought to calculate rates of HIV diagnoses by area of birth among foreign-born persons in a high-incidence US city with many immigrants, and determine probable place of HIV acquisition. Data from the New York City HIV surveillance registry and American Community Survey were used to calculate HIV diagnosis rates by area of birth and determine probable place of HIV acquisition among foreign-born diagnosed in 2006-2012. HIV diagnosis rates varied by area of birth and were highest among African-born persons; absolute numbers were highest among Caribbean-born persons. Probable place of acquisition was a foreign country for 23 % (from 9 % among Middle Easterners to 43 % among Africans), US for 61 % (from 34 % among Africans to 76 % among South Americans), and not possible to estimate for 16 %. HIV prevention and testing initiatives should take into account variability by foreign area of birth in HIV diagnosis rates and place of acquisition. PMID:25524308

  12. Increase in transmitted resistance to non-nucleoside reverse transcriptase inhibitors among newly diagnosed HIV-1 infections in Europe

    PubMed Central

    2014-01-01

    Background One out of ten newly diagnosed patients in Europe was infected with a virus carrying a drug resistant mutation. We analysed the patterns over time for transmitted drug resistance mutations (TDRM) using data from the European Spread program. Methods Clinical, epidemiological and virological data from 4317 patients newly diagnosed with HIV-1 infection between 2002 and 2007 were analysed. Patients were enrolled using a pre-defined sampling strategy. Results The overall prevalence of TDRM in this period was 8.9% (95% CI: 8.1-9.8). Interestingly, significant changes over time in TDRM caused by the different drug classes were found. Whereas nucleoside resistance mutations remained constant at 5%, a significant decline in protease inhibitors resistance mutations was observed, from 3.9% in 2002 to 1.6% in 2007 (p?=?0.001). In contrast, resistance to non-nucleoside reverse transcriptase inhibitors (NNRTIs) doubled from 2.0% in 2002 to 4.1% in 2007 (p?=?0.004) with 58% of viral strains carrying a K103N mutation. Phylogenetic analysis showed that these temporal changes could not be explained by large clusters of TDRM. Conclusion During the years 2002 to 2007 transmitted resistance to NNRTI has doubled to 4% in Europe. The frequent use of NNRTI in first-line regimens and the clinical impact of NNRTI mutations warrants continued monitoring. PMID:25047543

  13. Diagnosing of Herpes Simplex Virus Infections in Suspected Patients Using Real-Time PCR

    PubMed Central

    Aliabadi, Nasrin; Jamalidoust, Marzieh; Asaei, Sadaf; Namayandeh, Mandana; Ziyaeyan, Mazyar

    2015-01-01

    Background: Herpes simplex virus infections are very common worldwide. The virus can cause infection in various body parts, especially eyes and the nervous system. Therefore, an early diagnosis and highly sensitive method is very helpful. Objectives: The present study sought to investigate the efficiency of Real-time TaqMan probe PCR in the diagnosis of HSV infection in suspected patients. Patients and Methods: In this study, 1566 patients with suspected HSV infections were enrolled. They aged 17 days to 96 years. The collected specimens were classified into four groups; cerebrospinal fluid (CSF) from HSE suspected individuals, samples from eye epithelial scraping, tear fluid or aqueous humor from herpes simplex keratitis (HSK) suspected patients, plasma of immune compromised patients and mucocutaneous collected samples from different body parts. The samples were analyzed by Real-time PCR assays. Results: In total, 44 (5.6%), 118 (26.8%), 23 (11.7%), 13 (44.8%) and 65 (45.5%) of 791 HSE, 407 HSK, 29 skin HSV, 143 oropharyngeal suspected patients and 196 patients with systemic HSV infection HSV had positive results by Real-time PCR assays, respectively. Conclusions: Real-time PCR assay, due to its high sensitivity and specificity, can help in early diagnosis and more effective treatment for patients. Also, it requires shorter hospital stay and promotes patients' survival. PMID:25834711

  14. 18F-Fluorodeoxyglucose Positron Emission Tomography/CT Scanning in Diagnosing Vascular Prosthetic Graft Infection

    PubMed Central

    Saleem, Ben R.; Pol, Robert A.; Slart, Riemer H. J. A.; Reijnen, Michel M. P. J.; Zeebregts, Clark J.

    2014-01-01

    Vascular prosthetic graft infection (VPGI) is a severe complication after vascular surgery. CT-scan is considered the diagnostic tool of choice in advanced VPGI. The incidence of a false-negative result using CT is relatively high, especially in the presence of low-grade infections. 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) scanning has been suggested as an alternative for the diagnosis and assessment of infectious processes. Hybrid 18F-FDG PET/CT has established the role of 18F-FDG PET for the assessment of suspected VPGI, providing accurate anatomic localization of the site of infection. However, there are no clear guidelines for the interpretation of the uptake patterns of 18F-FDG as clinical tool for VPGI. Based on the available literature it is suggested that a linear, diffuse, and homogeneous uptake should not be regarded as an infection whereas focal or heterogeneous uptake with a projection over the vessel on CT is highly suggestive of infection. Nevertheless, 18F-FDG PET and 18F-FDG PET/CT can play an important role in the detection of VPGI and monitoring response to treatment. However an accurate uptake and pattern recognition is warranted and cut-off uptake values and patterns need to be standardized before considering the technique to be the new standard. PMID:25210712

  15. Novel application for ion mobility spectrometry: diagnosing vaginal infections through measurement of biogenic amines

    Microsoft Academic Search

    Zeev Karpas; Walter Chaim; Rachel Gdalevsky; Boris Tilman; Avi Lorber

    2002-01-01

    A method for diagnosis of bacterial vaginosis (BV) and other vaginal infections, based on measurement of biogenic amines present in a sample of vaginal fluid by ion mobility spectrometry (IMS) was developed. Sample introduction is through a two step procedure: addition of alkaline solution to release the volatile amines followed by heating and acid addition for emanation of the semi-volatile

  16. Accuracy of invasive and noninvasive tests to diagnose Helicobacter pylori infection

    Microsoft Academic Search

    Alan F. Cutler; Suzanne Havstad; Chen K. Ma; Martin J. Blaser; Guillermo I. Perez-Perez; Timothy T. Schubert

    1995-01-01

    Background & Aims: Multiple tests are available for determining Helicobacter pylori infection. Our aim was to compare the sensitivity, specificity, and negative and positive predictive value of the most widely available tests for diagnosis of H. pylori. Methods: A total of 268 patients (mean age, 53.7 ± 15.8 years; 142 male and 126 female; 125 white and 143 nonwhite) was

  17. Evaluation of the interferon-gamma (IFN-?) assay to diagnose Mycobacterium bovis infection in pigs.

    PubMed

    Pesciaroli, M; Russo, M; Mazzone, P; Aronica, V; Fiasconaro, M; Boniotti, M B; Corneli, S; Cagiola, M; Pacciarini, M; Di Marco, V; Pasquali, P

    2012-08-15

    Mycobacterium bovis recognizes as hosts a wide spectrum of animal species. In particular epidemiological situations, high prevalence of infection is found also in pigs. In the present study, we evaluated the capability of the interferon-gamma (IFN-?) assay to identify pigs infected with M. bovis. The results of the immune-diagnosis were correlated to the findings of the post mortem inspection and the bacterial culture of lymph nodes. Blood samples of 146 pigs, belonging to a local breed of Sicily reared in free or semi-free roaming conditions, were collected to assess the specificity and the sensibility of the IFN-? assay. Thirty-one pigs, from M. bovis free herds, did not react to the IFN-? assay, yielding a specificity of 100%. The IFN-? assay identified 15 out of 19 animals positive to the bacterial culture and 22 out of 26 animals with tuberculous lesions, with a sensibility of 78.9-84.6%, respectively. Out of 26 reactors to the test, 15 pigs (57.7%) confirmed to be infected after the bacterial culture and 22 (84.6%) had tuberculous lesions. The IFN-? assay was able to reveal 4 animals with no visible lesions (NVL). Together, these findings support the feasible use of the IFN-? assay as an intra vitam tool for the surveillance and management of M. bovis infection in swine populations. PMID:22771195

  18. Using small RNA sequences to diagnose, sequence, and investigate the infectivity characteristics of vegetable-infecting viruses

    Microsoft Academic Search

    Charles Hagen; Alessandra Frizzi; John Kao; Lijie Jia; Mingya Huang; Yuanji Zhang; Shihshieh Huang

    2011-01-01

    In a virus-infected plant, small interfering RNAs (siRNAs) corresponding to the viral genome form a large proportion of the\\u000a small RNA population. It is possible to reassemble significant portions of the virus sequence from overlapping siRNA sequences\\u000a and use these to identify the virus. We tested this technique with a resistance-breaking and a non-resistance-breaking strain\\u000a of tomato spotted wilt virus

  19. Evaluation of recombinant antigens of Trypanosoma cruzi to diagnose infection in naturally infected dogs from Chaco region, Argentina.

    PubMed

    Floridia-Yapur, N; Vega-Benedetti, A F; Rumi, M Monje; Ragone, P; Lauthier, J J; Tomasini, N; d'Amato, A M Alberti; Lopez-Quiroga, I; Diosque, P; Marcipar, I; Nasser, J R; Cimino, R O

    2014-12-01

    Dogs are considered the main mammal reservoir of Trypanosoma cruzi in domiciliary environments. Consequently, accurate detection of T. cruzi infection in canine populations is epidemiologically relevant. Here, we analysed the utility of the T. cruzi recombinant antigens FRA, SAPA, CP1, Ag1 and a SAPA/TSSA VI mixture, in an ELISA format. We used a positive control group of sera obtained from 38 dogs from the Chaco region in Argentina with positive homogenate-ELISA reaction, all of them also positive by xenodiagnosis and/or PCR. The negative group included 19 dogs from a nonendemic area. Sensitivity, specificity, area under the curve (AUC) of the receiver operating charactheristic (ROC) curve and Kappa index were obtained to compare the diagnostic efficiency of the tests. The SAPA/TSSA VI had the highest performance, with a sensitivity of 94.7% and an AUC ROC of 0.99 that indicates high accuracy. Among individual antigens, SAPA-ELISA yielded the highest sensitivity (86.8%) and AUC ROC (0.96), whereas FRA-ELISA was the least efficient test (sensitivity = 36.8%; AUC ROC = 0.53). Our results showed that the use of SAPA/TSSA VI in ELISAs could be a useful tool to study dogs naturally infected with T. cruzi in endemic areas. PMID:25201522

  20. Challenges in diagnosing latent tuberculosis infection in patients treated with tumor necrosis factor antagonists.

    PubMed

    Keystone, Edward C; Papp, Kim A; Wobeser, Wendy

    2011-07-01

    Reactivation of latent tuberculosis infection (LTBI) is well recognized as an adverse event associated with anti-tumor necrosis factor-? (anti-TNF-?) therapy. The strengths and weaknesses of current techniques for detecting LTBI in patients with chronic inflammatory diseases such as rheumatoid arthritis (RA) and psoriasis have not been fully examined. T cell hyporesponsiveness due to immunosuppression caused by illness or drugs, referred to as anergy, may produce false-negative tuberculin skin test (TST) and interferon-? release assay (IGRA) results. The literature suggests that anergy may influence screening performance of TST and IGRA tests in candidates for anti-TNF-? therapy. Conversely, the potential for false-positive TST and IGRA results must be considered, as treatment for LTBI may be associated with significant morbidity. This review examines the reliability issues related to LTBI diagnostic testing and provides practical direction to help prevent LTBI reactivation and facilitate successful anti-TNF-? treatment. PMID:21459944

  1. Posterior Reversible Encephalopathy Syndrome in a Patient with Newly Diagnosed HIV Infection and End Stage Renal Disease

    PubMed Central

    Kurukumbi, Mohankumar; Castellanos, Maria I.; Crawford, Amanda K.; Gowdar, Shreyas D.; Jayam-Trouth, Annapurni

    2013-01-01

    Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological syndrome in which patients present with an acute or subacute clinical presentation of seizures, visual disturbances, headache, and altered mental status. The pathophysiology of PRES may be explained by endothelial dysfunction that leads to transudation of fluids and protein, resulting in vasogenic cerebral edema. PRES is typically associated with many conditions such as hypertension, uremia, immunosuppressive drugs, and sepsis. This is a case report of a 39-year-old woman with untreated HIV infection and end-stage renal disease (ESRD) who developed PRES with a normal blood pressure and no other known causes of PRES. Untreated HIV is associated with known endothelial dysfunction and we believe that this, in combination with her untreated end-stage renal disease, contributed to her unique presentation of PRES. Although uncommon in HIV-infected patients and challenging to diagnose, prompt recognition of PRES is critical to provide appropriate care and ensure reversibility of the vasogenic edema seen in PRES. PMID:23738165

  2. Hemorrhage in the central canal of the cervical spinal cord in a coonhound diagnosed with canine juvenile polyarteritis (steroid responsive meningitis-arteritis).

    PubMed

    Hughes, Kelly L; Stieger-Vanegas, Susanne M; Valentine, Beth A

    2015-06-01

    Patchy meningeal and parenchymal contrast enhancement of the spinal cord with multifocal central canal dilations was noted in a computed tomography myelogram of the cervical spine of a 6-month-old intact female coonhound with a confirmed diagnosis of canine juvenile polyarteritis and associated hemorrhage within the central canal. PMID:26028675

  3. Comparing the economic and health benefits of different approaches to diagnosing Clostridium difficile infection.

    PubMed

    Bartsch, Sarah M; Umscheid, Craig A; Nachamkin, Irving; Hamilton, Keith; Lee, Bruce Y

    2015-01-01

    Accurate diagnosis of Clostridium difficile infection (CDI) is essential to effectively managing patients and preventing transmission. Despite the availability of several diagnostic tests, the optimal strategy is debatable and their economic values are unknown. We modified our previously existing C. difficile simulation model to determine the economic value of different CDI diagnostic approaches from the hospital perspective. We evaluated four diagnostic methods for a patient suspected of having CDI: 1) toxin A/B enzyme immunoassay, 2) glutamate dehydrogenase (GDH) antigen/toxin AB combined in one test, 3) nucleic acid amplification test (NAAT), and 4) GDH antigen/toxin AB combination test with NAAT confirmation of indeterminate results. Sensitivity analysis varied the proportion of those tested with clinically significant diarrhoea, the probability of CDI, NAAT cost and CDI treatment delay resulting from a false-negative test, length of stay and diagnostic sensitivity and specificity. The GDH/toxin AB plus NAAT approach leads to the timeliest treatment with the fewest unnecessary treatments given, resulted in the best bed management and generated the lowest cost. The NAAT-alone approach also leads to timely treatment. The GDH/toxin AB diagnostic (without NAAT confirmation) approach resulted in a large number of delayed treatments, but results in the fewest secondary colonisations. Results were robust to the sensitivity analysis. Choosing the right diagnostic approach is a matter of cost and test accuracy. GDH/toxin AB plus NAAT diagnosis led to the timeliest treatment and was the least costly. PMID:25636938

  4. Agreement among Healthcare Professionals in Ten European Countries in Diagnosing Case-Vignettes of Surgical-Site Infections

    PubMed Central

    Birgand, Gabriel; Lepelletier, Didier; Baron, Gabriel; Barrett, Steve; Breier, Ann-Christin; Buke, Cagri; Markovic-Denic, Ljiljana; Gastmeier, Petra; Kluytmans, Jan; Lyytikainen, Outi; Sheridan, Elizabeth; Szilagyi, Emese; Tacconelli, Evelina; Troillet, Nicolas; Ravaud, Philippe; Lucet, Jean-Christophe

    2013-01-01

    Objective Although surgical-site infection (SSI) rates are advocated as a major evaluation criterion, the reproducibility of SSI diagnosis is unknown. We assessed agreement in diagnosing SSI among specialists involved in SSI surveillance in Europe. Methods Twelve case-vignettes based on suspected SSI were submitted to 100 infection-control physicians (ICPs) and 86 surgeons in 10 European countries. Each participant scored eight randomly-assigned case-vignettes on a secure online relational database. The intra-class correlation coefficient (ICC) was used to assess agreement for SSI diagnosis on a 7-point Likert scale and the kappa coefficient to assess agreement for SSI depth on a three-point scale. Results Intra-specialty agreement for SSI diagnosis ranged across countries and specialties from 0.00 (95%CI, 0.00–0.35) to 0.65 (0.45–0.82). Inter-specialty agreement varied from 0.04 (0.00–0.62) in to 0.55 (0.37–0.74) in Germany. For all countries pooled, intra-specialty agreement was poor for surgeons (0.24, 0.14–0.42) and good for ICPs (0.41, 0.28–0.61). Reading SSI definitions improved agreement among ICPs (0.57) but not surgeons (0.09). Intra-specialty agreement for SSI depth ranged across countries and specialties from 0.05 (0.00–0.10) to 0.50 (0.45–0.55) and was not improved by reading SSI definition. Conclusion Among ICPs and surgeons evaluating case-vignettes of suspected SSI, considerable disagreement occurred regarding the diagnosis, with variations across specialties and countries. PMID:23874690

  5. Spinal Schistosomiasis: Differential Diagnosis for Acute Paraparesis in a US Resident

    PubMed Central

    Joshi, Tapan N; Yamazaki, Michael K; Zhao, Holly; Becker, Daniel

    2010-01-01

    Background: Spinal schistosomiasis is a severe presentation of Schistosoma mansoni infection, which is endemic in South America, the Middle East, and sub-Saharan Africa. With increasing international travel, a disease can spread from an endemic area to another part of the world easily. Objective: To present a case of a US resident who developed acute paraparesis due to spinal schistosomiasis after traveling to sub-Saharan Africa. Participant: A 45-year-old woman presented with abdominal pain radiating into the bilateral lower extremities. She was diagnosed with a pelvic mass and underwent an urgent hysterectomy with right salpingo-oopherectomy. Postoperatively, she developed progressive weakness with worsening pain in her bilateral lower extremities and neurogenic bladder. Magnetic resonance imaging showed an abnormal T2 hyperintense signal in the entire spinal cord below the T3 level with abnormal contrast enhancement from T9 through the conus medullaris. Spinal fluid analysis showed lymphocytic pleocytosis and elevated protein. The patient was diagnosed with transverse myelitis. Subsequently, a detailed history revealed a visit to Ethiopia 2 years earlier. Tests for S mansoni were positive. After treatment with praziquantel and prednisone, her neurologic function began to improve. Conclusions: An increasing incidence of international travel is increasing the likelihood of US physicians' encountering this treatable condition. Travelers with spinal schistosomiasis may not have symptoms of systemic infection. Therefore, it is important to include spinal schistosomiasis in the differential diagnosis of acute inflammatory myelopathy, particularly with a history of travel to endemic areas. PMID:20737799

  6. High Percentage of Recent HIV Infection Among HIV-Positive Individuals Newly Diagnosed at Voluntary Counseling and Testing Sites in Poland

    PubMed Central

    Marzec-Bogustawska, Anna; Janiec, Janusz; Smole?-Dzirba, Joanna; W?sik, Tomasz; Gniewosz, Joanna; Zalewska, Ma?gorzata; Murphy, Gary; McKinney, Elaine; Porter, Kholoud

    2013-01-01

    Abstract To gain insight into HIV transmission we estimated the proportion of those recently infected. We examined data from HIV-positive patients and a random 10% sample of HIV-negative patients tested at Voluntary Counseling and Testing sites in Poland in 2006. Archived samples from positive patients were tested by three assays to differentiate recent from long-standing infection. Using logistic regression, we examined the association of recent infection (at least one assay) with age, sex, HIV exposure category, and the interval between self-reported HIV exposure and previous HIV test. Of 13,511 tests, 154 (1.1%) were HIV positive, representing 19.7% (n=783) of new diagnoses in Poland in 2006. Demographic and behavioral data were linked for 95, of whom 45 (47%) were recently infected and 1,001 were HIV negative. New diagnoses were more likely to be injectors (17% vs. 2%), men who have sex with men (MSM) (37% vs. 12%), and less frequent condom users (7.8% vs. 14% always) compared to HIV negatives. The median number of partners during the past 12 months was one and two among positives and negatives, but was higher among MSM—four and three, respectively. Ever injectors were less likely to be recently infected (adjusted OR=0.15, 95%CI=0.03–0.73). Having two or more sexual partners in the past 12 months was an independent predictor of recent infection (4.01, 1.4–11.49). We found no evidence that age or sex predicted recent infection. These data reinforce health education campaigns for safe sex messages, especially among MSM. They also suggest, albeit based on a subset of new diagnoses, that interventions should not be limited to selected age/sex groups. PMID:23343475

  7. Medical ICU Admission Diagnoses and Outcomes in Human Immunodeficiency Virus–Infected and Virus–Uninfected Veterans in the Combination Antiretroviral Era

    PubMed Central

    Akgün, Kathleen M.; Tate, Janet P.; Pisani, Margaret; Fried, Terri; Butt, Adeel A.; Gibert, Cynthia L.; Huang, Laurence; Rodriguez-Barradas, Maria C.; Rimland, David; Justice, Amy C.; Crothers, Kristina

    2014-01-01

    Objectives Human immunodeficiency virus (HIV)–infected (HIV+) patients on combination antiretroviral therapy are living longer but have increased risk for aging-associated disease which may lead to increasing critical care requirements. We compare medical ICU admission characteristics and outcomes among HIV infected and demographically similar uninfected patients (uninfected) and considered whether an index which combines routine clinical biomarkers (the Veterans Aging Cohort Study Index) predicts 30-day medical ICU mortality. Design Observational data analyses (Veterans Aging Cohort Study). Setting Eight Veterans Affairs medical centers nationwide. Patients HIV infected and uninfected with a medical ICU admission between 2002 and 2010. Intervention None. Measurements and Main Results Medical ICU admission was determined using bedsection (Veterans Affairs) and revenue center codes (Medicare). For Veterans Affairs admissions, we used clinical data to calculate Veterans Aging Cohort Study Index scores and multivariable logistic regression to determine factors associated with 30-day mortality. Overall, 539 of 3,620 (15%) HIV infected and 375 of 3,639 (10%) uninfected had a medical ICU admission; 72% and 78%, respectively, were Veterans Affairs based. HIV+ patients were younger at admission (p < 0.0001). Although most HIV+ patients were on antiretroviral therapy (71%) with undetectable HIV-1 RNA (54%), compared with uninfected they were more commonly admitted with respiratory diagnoses or infections (21% vs. 12%), were more likely to require mechanical ventilation (17% vs. 9%; p = 0.001), and had a higher mortality rate (18.6% vs. 11.2%, p = 0.003). Cardiovascular diagnoses were less common among HIV infected (18% vs. 29%; p < 0.0001). In logistic regression (c-statistic 0.87), a 5-point increment in Veterans Aging Cohort Study Index was associated with an odds ratio of death of 1.22 (95% confidence interval 1.14–1.30) among HIV infected and of 1.50 (95% confidence interval 1.29–1.76) among uninfected; infection/sepsis and respiratory diagnoses were also associated with mortality. Conclusions Medical ICU admission was frequent, 30-day mortality higher, and mechanical ventilation more common in HIV infected compared with uninfected. The Veterans Aging Cohort Study Index calculated at medical ICU admission predicted 30-day mortality for HIV infected and uninfected. As more individuals age with HIV, their requirements for medical ICU care may be greater than demographically similar uninfected individuals. PMID:23507717

  8. Arachnoiditis ossificans after spinal surgery.

    PubMed

    Liu, Li-Di; Zhao, Song; Liu, Wan-Guo; Zhang, Shao-Kun

    2015-05-01

    This article presents an unusual case of arachnoiditis ossificans after spinal surgery. A case of arachnoiditis ossificans secondary to lumbar fixation and decompression surgery for the treatment of multilevel lumbar fractures is reported and the relevant literature is reviewed. A 29-year-old man who previously underwent posterior pedicle screw fixation and fusion for multiple lumbar spine fractures reported lower back stiffness and discomfort 23 months postoperatively. A laminectomy was performed at L2 and at L3-L4. At L2, bone fragments from the burst fracture had injured the dural sac and some nerve roots. A posterolateral fusion was performed using allogeneic bone. Postoperatively, there were no signs of fever, infection, or systemic inflammatory responses. Arachnoiditis ossificans of the thecal sac from L1-L5 was diagnosed by magnetic resonance imaging and computed tomography at the 2-year follow-up. His postoperative neurological status progressively improved and he regained motor and sensory functions. Because of neurological improvements, fixation hardware was removed without further decompression. The authors report a case of arachnoiditis ossificans secondary to lumbar fixation and decompression surgery, which involved a large region. Arachnoiditis ossificans is a relatively rare disorder with unclear etiologies and limited treatment options. Spinal surgical intervention of arachnoiditis ossificans should be carefully considered because it may lead to poor outcomes and multiple revision surgeries. [Orthopedics. 2015; 38(5):e437-e442.]. PMID:25970374

  9. Selective testing strategies for diagnosing group A streptococcal infection in children with pharyngitis: a systematic review and prospective multicentre external validation study

    PubMed Central

    Cohen, Jérémie F.; Cohen, Robert; Levy, Corinne; Thollot, Franck; Benani, Mohamed; Bidet, Philippe; Chalumeau, Martin

    2015-01-01

    Background: Several clinical prediction rules for diagnosing group A streptococcal infection in children with pharyngitis are available. We aimed to compare the diagnostic accuracy of rules-based selective testing strategies in a prospective cohort of children with pharyngitis. Methods: We identified clinical prediction rules through a systematic search of MEDLINE and Embase (1975–2014), which we then validated in a prospective cohort involving French children who presented with pharyngitis during a 1-year period (2010–2011). We diagnosed infection with group A streptococcus using two throat swabs: one obtained for a rapid antigen detection test (StreptAtest, Dectrapharm) and one obtained for culture (reference standard). We validated rules-based selective testing strategies as follows: low risk of group A streptococcal infection, no further testing or antibiotic therapy needed; intermediate risk of infection, rapid antigen detection for all patients and antibiotic therapy for those with a positive test result; and high risk of infection, empiric antibiotic treatment. Results: We identified 8 clinical prediction rules, 6 of which could be prospectively validated. Sensitivity and specificity of rules-based selective testing strategies ranged from 66% (95% confidence interval [CI] 61–72) to 94% (95% CI 92–97) and from 40% (95% CI 35–45) to 88% (95% CI 85–91), respectively. Use of rapid antigen detection testing following the clinical prediction rule ranged from 24% (95% CI 21–27) to 86% (95% CI 84–89). None of the rules-based selective testing strategies achieved our diagnostic accuracy target (sensitivity and specificity > 85%). Interpretation: Rules-based selective testing strategies did not show sufficient diagnostic accuracy in this study population. The relevance of clinical prediction rules for determining which children with pharyngitis should undergo a rapid antigen detection test remains questionable. PMID:25487666

  10. Diagnosing acute and prevalent HIV-1 infection in young African adults seeking care for fever: a systematic review and audit of current practice

    PubMed Central

    Prins, Henrieke A.B.; Mugo, Peter; Wahome, Elizabeth; Mwashigadi, Grace; Thiong'o, Alexander; Smith, Adrian; Sanders, Eduard J.; Graham, Susan M.

    2014-01-01

    Fever is a common complaint in HIV-1 infected adults and may be a presenting sign of acute HIV-1 infection (AHI). We investigated the extent to which HIV-1 infection was considered in the diagnostic evaluation of febrile adults in sub-Saharan Africa (SSA) through a systematic review of published literature and guidelines in the period 2003–2014. We also performed a detailed audit of current practice for the evaluation of febrile young adults in coastal Kenya. Our review identified 43 studies investigating the aetiology of fever in adult outpatients in SSA. While the guidelines identified recommend testing for HIV-1 infection, none mentioned AHI. In our audit of current practice at nine health facilities, only 189 out of 1173 (16.1%) patients, aged 18–29 years, were tested for HIV-1. In a detailed record review, only 2 out of 39 (5.1%) young adults seeking care for fever were tested for HIV-1, and the possibility of AHI was not mentioned. Available literature on adult outpatients presenting with fever is heavily focused on diagnosing malaria and guidelines are poorly defined in terms of evaluating aetiologies other than malaria. Current practice in coastal Kenya shows poor uptake of provider-initiated HIV-1 testing and AHI is not currently considered in the differential diagnosis. PMID:24842982

  11. Frequency and Determinants of Preventive Care Counseling by HIV Medical Care Providers during Encounters with Newly Diagnosed and Established HIV-Infected Patients.

    PubMed

    Mgbere, Osaro; Rodriguez-Barradas, Maria C; Bell, Tanvir K; Khuwaja, Salma; Arafat, Raouf; Essien, Ekere J; Singh, Mamta; Simmons, Paul; Aguilar, Jonathan

    2014-10-31

    This study evaluates the frequency and determinants of preventive care counseling by HIV medical care providers (HMCPs) during encounters with newly diagnosed and established HIV-infected patients. Data used were from a probability sample of HMCPs in Houston/Harris County, Texas, surveyed in 2009. Overall, HMCPs offered more preventive care counseling to newly diagnosed than the established patients (adjusted odds ratio [AOR] = 7.28; 95% confidence interval [CI] = 2.86-16.80). They were more likely to counsel newly diagnosed patients than the established ones on medication and adherence (AOR = 14.70; 95% CI = 1.24-24.94), HIV risk reduction (AOR = 5.91; 95% CI = 0.48-7.13), and disease screening (AOR = 7.20; 95% CI = 0.72-11.81). HIV medical care providers who were less than 45 years of age, infectious disease specialists, and had less than 30 minutes of encounter time were less likely to counsel patients regardless of the status. Our findings suggest the need for HMCPs to improve their preventive care counseling efforts, in order to help patients build skills for adopting and maintaining safe behavior that could assist in reducing the risk of HIV transmission. PMID:25361557

  12. Diagnostic accuracy of a point-of-care urine test for tuberculosis screening among newly-diagnosed hiv-infected adults: a prospective, clinic-based study

    PubMed Central

    2014-01-01

    Background A rapid diagnostic test for active tuberculosis (TB) at the clinical point-of-care could expedite case detection and accelerate TB treatment initiation. We assessed the diagnostic accuracy of a rapid urine lipoarabinomannan (LAM) test for TB screening among HIV-infected adults in a TB-endemic setting. Methods We prospectively enrolled newly-diagnosed HIV-infected adults (?18 years) at 4 outpatient clinics in Durban from Oct 2011-May 2012, excluding those on TB therapy. A physician evaluated all participants and offered CD4 cell count testing. Trained study nurses collected a sputum sample for acid-fast bacilli smear microscopy (AFB) and mycobacterial culture, and performed urine LAM testing using Determine™ TB LAM in the clinic. The presence of a band regardless of intensity on the urine LAM test was considered positive. We defined as the gold standard for active pulmonary TB a positive sputum culture for Mycobacterium tuberculosis. Diagnostic accuracy of urine LAM was assessed, alone and in combination with smear microscopy, and stratified by CD4 cell count. Results Among 342 newly-diagnosed HIV-infected participants, 190 (56%) were male, mean age was 35.6 years, and median CD4 was 182/mm3. Sixty participants had culture-positive pulmonary TB, resulting in an estimated prevalence of 17.5% (95% CI 13.7-22.0%). Forty-five (13.2%) participants were urine LAM positive. Mean time from urine specimen collection to LAM test result was 40 minutes (95% CI 34–46 minutes). Urine LAM test sensitivity was 28.3% (95% CI 17.5-41.4) overall, and 37.5% (95% CI 21.1-56.3) for those with CD4 count <100/mm3, while specificity was 90.1% (95% CI 86.0-93.3) overall, and 86.9% (95% CI 75.8-94.2) for those with CD4?diagnosed HIV-infected adults, but improved sensitivity when combined with sputum smear microscopy. PMID:24571362

  13. Spinal fusion

    MedlinePLUS

    ... the spine. Other surgery, such as a diskectomy , laminectomy , or a foraminotomy , is almost always done first. ... procedures for spinal stenosis , such as foraminotomy or laminectomy After diskectomy in the neck Spinal fusion may ...

  14. A comparison of psychiatric diagnoses among HIV-infected prisoners receiving combination antiretroviral therapy and transitioning to the community

    PubMed Central

    Di Paola, Angela; Altice, Frederick L; Powell, Mary Lindsay; Trestman, Robert L; Springer, Sandra A

    2014-01-01

    Background The criminal justice system (CJS), specifically prisons and jails, is ideally suited for uniform screening of psychiatric (PD) and substance use disorders (SUDs) among people living with HIV/AIDS (PLWHA), who are concentrated in these settings. By accurately diagnosing PDs and SUDs in these controlled settings, treatment can be initiated and contribute to improved continuity of care upon release. In the context of PLWHA, it may also improve combination antiretroviral treatment (cART) adherence, and reduce HIV transmission risk behaviors. Methods A retrospective data analysis was conducted by creating a cohort of PLWHA transitioning to the community from prison or jail enrolled who were enrolled in a controlled trial of directly administered antiretroviral (DAART). Participants were systematically assessed for PDs and SUDs using the Mini International Neuropsychiatric Interview (MINI), a standardized psychiatric assessment tool, and compared to diagnoses documented within the correctional medical record. Results Findings confirm a high prevalence of Axis I PDs (47.4%) and SUDs (67.1%) in PLWHA even after prolonged abstinence from alcohol and drugs. Although prevalence of PDs and SUDs were high in the medical record, there was fair to poor agreement among PDs using the MINI, making evident the potential benefit of more objective and concurrent PD assessments to guide treatment. Conclusions Additional PD diagnoses may be detected in PLWHA in CJS using supplementary and objective screening tools. By identifying and treating PDs and SUDs in the CJS, care may be improved and may ultimately contribute to healthier outcomes after community release if patients are effectively transitioned. PMID:25606368

  15. Spinal Manipulation

    Microsoft Academic Search

    Edzard Ernst; Elaine Harkness

    2001-01-01

    For many years, spinal manipulation has been a popular form of treatment. Yet the debate about its clinical efficacy continues. The research question remains: Does spinal manipulation convey more than a placebo effect? To summarize the evidence from sham-controlled clinical trials of spinal manipulation as a treatment of various conditions, and to assess the methodological quality of these studies, a

  16. A simplified algorithm for diagnosis of spinal cord lesions.

    PubMed

    Baruah, Dhiraj; Chandra, Tushar; Bajaj, Manish; Sonowal, Purabi; Klein, Andrew; Maheshwari, Mohit; Guleria, Saurabh

    2015-01-01

    Neuroimaging is indispensable for evaluation of Myelopathy not only for localization but also for etiologic determination. MRI is the preferred examination for further characterization of the majority of these conditions. These include traumatic, inflammatory, infections, compressive and neoplastic conditions. This article provides an overview of a variety of pathologies that afflict the spinal cord in an easy to understand format. Their respective imaging manifestations on MRI and differential diagnoses are focused in this review. Early diagnosis and treatment of Myelopathy is critical in preventing or arresting neurological morbidity. PMID:25801464

  17. Diagnosing malaria infected cells at the single cell level using focal plane array Fourier transform infrared imaging spectroscopy.

    PubMed

    Wood, Bayden R; Bambery, Keith R; Dixon, Matthew W A; Tilley, Leann; Nasse, Michael J; Mattson, Eric; Hirschmugl, Carol J

    2014-10-01

    New methods are needed to rapidly identify malaria parasites in blood smears. The coupling of a Focal Plane Array (FPA) infrared microscope system to a synchrotron light source at IRENI enables rapid molecular imaging at high spatial resolution. The technique, in combination with hyper-spectral processing, enables imaging and diagnosis of early stage malaria parasites at the single cell level in a blood smear. The method relies on the detection of distinct lipid signatures associated with the different stages of the malaria parasite and utilises resonant Mie extended multiplicative scatter correction to pre-process the spectra followed by full bandwidth image deconvolution to resolve the single cells. This work demonstrates the potential of focal plane technology to diagnose single cells in a blood smear. Brighter laboratory based infrared sources, optical refinements and higher sensitive detectors will soon see the emergence of focal plane array imaging in the clinical environment. PMID:25055796

  18. Schistosomiasis of the spinal cord: report of 5 cases from Sudan.

    PubMed

    Salim, A D; Arbab, M A; El Hassan, L A; El Hassan, M

    2012-03-01

    Schistosomiasis of the spinal cord is an uncommon but potentially curable form of schistosomiasis, if diagnosed and managed early. The spinal cord is more frequently affected in Schistosoma mansoni or S. haematobium infections. This paper describes the clinical manifestations, diagnosis and management of schistosomiasis of the spinal cord in 5 patients attending Shaab and Ibn Khuldoun Hospitals, Khartoum from 1997 to 2007. There were 4 males and 1 female aged 9-45 years. They presented with symptoms and signs due to cord compression at the lower thoracic and lumbar vertebrae. Imaging studies revealed intramedullary masses compressing the cord. Biopsy showed ova of S. mansoni with surrounding inflammatory reaction. The cord showed demyelination near the ova and an associated inflammatory reaction. Patients responded well to surgical ecompression and treatment with praziquantel and oral steroids. PMID:22574486

  19. Frequency of primary resistance to antiretroviral drugs and genetic variability of HIV-1 among infected pregnant women recently diagnosed in Luanda-Angola.

    PubMed

    Castelbranco, Emingarda Patrícia André Félix; da Silva Souza, Edvaldo; Cavalcanti, Ana Maria Salustiano; Martins, Angélica Nascimento; de Alencar, Luiz Claúdio Arraes; Tanuri, Amilcar

    2010-12-01

    The determination of the prevalence of primary resistance to antiretroviral therapy in different places of the world is of extreme importance in molecular epidemiology monitoring, and it can guide the initial patient therapy in a given geographical area. The frequency of drug resistance mutations (DRM) and the genetic variability of HIV-1 isolates from newly diagnosed HIV-infected pregnant women attending the antenatal clinics of the Lucrecia Paim and Augusto N'Gangula maternities, Luanda-Angola, were determined. Thirty five out of 57 samples (61.4%) were sequenced and one mutation associated with resistance to nucleoside reverse transcriptase inhibitors was detected. Additionally, two mutations associated with resistance to non-nucleoside reverse transcriptase inhibitors were also detected. No primary mutations associated with protease inhibitors (PI) were found. Subtypes A1, C, D, F1, G, H, CRF 13, CRF 37, and other mosaics were detected. PMID:20929349

  20. Epidemiological characteristics of Malassezia folliculitis and use of the May-Grünwald-Giemsa stain to diagnose the infection.

    PubMed

    Durdu, Murat; Güran, Mümtaz; Ilkit, Macit

    2013-08-01

    Various bacterial, fungal, parasitic, and viral pathogens can cause folliculitis, which is often mistakenly treated with antibiotics for months or even years. A laboratory diagnosis is required before therapy can be planned. Here, we describe the prevalence and risk factors, as well as the clinical, cytological, and mycological characteristics, of patients with Malassezia folliculitis (MF) in Adana, Turkey. We also report the treatment responses of the MF patients and describe the Malassezia spp. using culture-based molecular methods. Cytological examinations were performed in 264 folliculitis patients, 49 of whom (18.5%) were diagnosed with MF. The positivity of the May-Grünwald-Giemsa (MGG) smear was higher (100%) than that of the potassium hydroxide test (81.6%). Using Wood's light, yellow-green fluorescence was observed in 66.7% of the MF patients. Identification using the rDNA internal transcribed spacer region revealed that Malassezia globosa was the most common species, followed by Malassezia sympodialis, Malassezia restricta, and Malassezia furfur. The MF patients were treated with itraconazole capsules (200 mg/d) for 2 weeks. Complete recovery was observed in 79.6% of the patients. These novel findings help improve our current understanding of the epidemiological characteristics of MF and establish MGG as a practical tool for the diagnosis of MF. PMID:23706503

  1. Human Immunodeficiency Virus (HIV) Antibody Avidity Testing To Identify Recent Infection in Newly Diagnosed HIV Type 1 (HIV1)Seropositive Persons Infected with Diverse HIV1 Subtypes

    Microsoft Academic Search

    A. Chawla; G. Murphy; C. Donnelly; C. L. Booth; M. Johnson; J. V. Parry; A. Phillips; A. M. Geretti

    2007-01-01

    A guanidine-based antibody avidity assay for the identification of recently acquired human immunodefi- ciency virus type 1 (HIV-1) infection was evaluated. The kinetics of maturation of antibody avidity were determined prospectively in 23 persons undergoing acute seroconversion followed for up to 1,075 days. Avidity indices (AI) of <0.75 and <0.80 reproducibly identified seroconversion within the previous 125 (95% confi- dence

  2. Incremental cost per newly diagnosed HIV infection (NDHI): routine (RTS), targeted (TTS), and current clinical practice testing strategies (CPTS)

    PubMed Central

    Gomez-Ayerbe, Cristina; Jesús Pérez Elías, María; Muriel, Alfonso; Pérez Elías, Pilar; Cano, Agustina; Diaz, Alberto; Moreno, Ana; Luis Casado, Jose; Santos, Cristina; Martinez-Colubi, María; Uranga, Almudena; Dronda, Fernando; Moreno, Santiago

    2014-01-01

    Introduction Although RTS as HIV Diagnosis was considered cost effectiveness [1], overall budget may be unaffordable for some countries. We explore Incremental cost per NDHI associated with different TS. Materials and Methods From a health care perspective, using direct costs and Euros currency, we calculated budget and cost per NDHI of RTS (all patients were tested), TTS (Universal risk practices and clinical conditions-RP&CC - only positive were tested), and CPTS (Only patients physicians considered were tested). We considered DRIVE (Spanish acronym of HIV infection Rapid Diagnosis) study and clinical Practice outcomes. Population between 18–60 years, attending to a Hospital Emergency Room or to a Primary Care Center performed an HIV RP&CC questionnaire (Q) and an HIV rapid test (HIV RT). Unitary costs considered were: HIV RT, nurse, registry, transport and HIV confirmation when necessary, imputed to all population in RTS and CPTS and only in HIV RP&CC-Q positive in TTS analysis, while HIV RP&CC-Q costs were added to all population in TTS. Sensitivity analyses were performed with varying rates of NDHI and of positive HIV RP&CC-Q population, and different RP&CC Q sensitivity (SE) to predict HIV infection. Results 5,329 HIV RP&CC-Q and HIV RT were performed to 49.64% women, median age 37 years old, 74.9% Spaniards. In DRIVE and CP, NDHI were 4.1‰, and 1.6‰, while HIV RP&CC-Q was positive in 51.2%. HIV RP&CC-Q SE was 100%. Overall budget employed in HIV testing was in RTS 43,503€, in TTS 24,472€ and in CPTS 5,032€. Cost per 1 NDHI was 1,977€, 1,112€ and 5,032€, respectively. A reduction in cost of 865€, favouring TTS vs. RTS, while an increased cost of 824€ in CPTS vs. RTS was obtained. Considering NDHI rate of 2.6‰ saving costs increased to 1379€ in TTS, while were reduced to 576€ if NDHI rate increases 6.2‰. Effect of RP&CC-Q positivity rate was similar, if 25% saving costs were 1368€, while if 75% were reduced to 399€. Varying SE of RP&CC-Q to 95%, 91% and 50% cost saving was 810€, 754€, and 208€, and number of MHI one, two and 11. Conclusions In DRIVE study Targeted TS with universal screening of RP&CC before an HIV rapid test is cost saving, without missing NDHI, with respect to Routine TS. Lower rates of HIV infection and RP&CC in the population, increase costs savings. PMID:25394110

  3. Sensitivity of Perianal Tape Impressions to Diagnose Pinworm (Syphacia spp.) Infections in Rats (Rattus norvegicus) and Mice (Mus musculus)

    PubMed Central

    Hill, William Allen; Randolph, Mildred M; Mandrell, Timothy D

    2009-01-01

    We determined the sensitivity of perianal tape impressions to detect Syphacia spp. in rats and mice. We evaluated 300 rat and 200 mouse perianal impressions over 9 wk. Pinworm-positive perianal tape impressions from animals with worm burdens at necropsy were considered as true positives. Conversely, pinworm-negative perianal tape impressions from animals with worm burdens were considered false negatives. The sensitivity of perianal tape impressions for detecting Syphacia muris infections in rats was 100%, and for detecting Syphacia obvelata in mice was 85.5%. Intermittent shedding of Syphacia obvelata ova is the most probable explanation for the decreased sensitivity rate we observed in mice. We urge caution in use of perianal tape impressions alone for Syphacia spp. screening in sentinel mice and rats. PMID:19653945

  4. Macular cherry-red spot helps diagnose rare storage disorder in an infant with repeated respiratory tract infections: case report.

    PubMed

    Padhi, Tapas Ranjan; Pattnaik, Sibabrata; Kesarwani, Siddharth; Das, Taraprasad

    2015-05-01

    A seven-month-old male child was brought in for an eye test for poor vision and nystagmus noticed from four months of age. The child had delayed milestones of development and multiple (six times) episodes of unexplained lower respiratory tract infection (from two months of age) treated by pediatricians at different centers without complete cure. Fundus examination showed bilateral cherry-red spots at the macula. There were diffusely distributed hyper-pigmented patches (Mongolian spots) on the back and extensor aspect of the extremities. The case was sent back to the pediatricians for a re-evaluation to rule out storage disorder. Lysosomal enzyme assay in the leucocytes showed a significantly reduced ?-galactosidase level (15.6?nmol/hr/mg protein in contrast to a normal range of 79.6 to 480.0). This confirmed the patient to be a case of lysosomal storage disease, the GM1 gangliosidosis (type I). PMID:24124800

  5. Repeated Aspergillus isolation in respiratory samples from non-immunocompromised patients not selected based on clinical diagnoses: colonisation or infection?

    PubMed Central

    2012-01-01

    Background Isolation of Aspergillus from lower respiratory samples is associated with colonisation in high percentage of cases, making it of unclear significance. This study explored factors associated with diagnosis (infection vs. colonisation), treatment (administration or not of antifungals) and prognosis (mortality) in non-transplant/non-neutropenic patients showing repeated isolation of Aspergillus from lower respiratory samples. Methods Records of adult patients (29 Spanish hospitals) presenting ?2 respiratory cultures yielding Aspergillus were retrospectively reviewed and categorised as proven (histopathological confirmation) or probable aspergillosis (new respiratory signs/symptoms with suggestive chest imaging) or colonisation (symptoms not attributable to Aspergillus without dyspnoea exacerbation, bronchospasm or new infiltrates). Logistic regression models (step–wise) were performed using Aspergillosis (probable?+?proven), antifungal treatment and mortality as dependent variables. Significant (p?infections. PMID:23145899

  6. Molecular identification of Rickettsia parkeri infecting Amblyomma triste ticks in an area of Argentina where cases of rickettsiosis were diagnosed

    PubMed Central

    Cicuttin, Gabriel; Nava, Santiago

    2013-01-01

    Specimens of the hard tick Amblyomma triste were found infected with Rickettsia parkeri in an area of Argentina (General Lavalle, Buenos Aires Province) where cases of human illness attributed to this microorganism have been reported. Molecular detection of R. parkeri was based on polymerase chain reactions that amplify a ca. 400-bp fragment of the 23S-5S intergenic spacer and a ca. 500-bp fragment of the gene encoding a 190-kDa outer membrane protein. Three (6.97%) of 43 A. triste ticks were determined to be positive for R. parkeri. These results provide strong evidence that A. triste is the vector of R. parkeri in the study area. The findings of this work have epidemiological relevance because human parasitism by A. triste ticks has been frequently recorded in some riparian areas of Argentina and Uruguay and new cases of R. parkeri rickettsiosis might arise in the South American localities where humans are exposed to the bites of this tick species. PMID:23440128

  7. Newly Diagnosed?

    MedlinePLUS

    ... Suggestions Examine Your Skin Newly Diagnosed? Understanding Your Pathology Biopsy: The First Step Sentinel Node Biopsy Finding ... start this journey: Get a copy of your pathology report. We can help you understand the report ...

  8. [Epidemiology, clinical spectrum of ALS and differential diagnoses].

    PubMed

    Couratier, Philippe; Marin, Benoît; Lautrette, Géraldine; Nicol, Marie; Preux, Pierre-Marie

    2014-05-01

    Amyotrophic Lateral Sclerosis (ALS) is the most common motor neuron disease in adults. Its incidence in France is estimated at 2.5 per 100,000 population and its prevalence between 5 and 8 per 100,000 inhabitants. Good prognostic factors are age of early onset, a longer time to diagnosis, initial damage to the spinal onset, early management of undernutrition and restrictive respiratory failure. The diagnosis of ALS is primarily clinical and is based on the evidence of involvement of the central motor neuron and peripheral neuron (NMP) in different territories or spinal or bulbar. The EMG confirms the achievement of NMP, shows the extension to clinically preserved areas and allows to exclude some differential diagnoses. The clinical spectrum of ALS is broad: conventional forms beginning brachial, lower limb or bulbar onsets, rarer forms to start breathing, pyramidal forms, forms with cognitive and behavioural impairment. In 5-10% of cases, ALS is familial. In 15% of cases, it is associated with frontotemporal degeneration rather than orbito-frontal type. The main differential diagnoses are guided by the clinic: combining pure motor neuropathy with or without conduction block, post-polio syndrome, cramp-fasciculation syndrome, myasthenia gravis, paraneoplastic syndromes, Sjögren syndrome, retroviral infections, some endocrine disorders, some metabolic diseases, genetic diseases (Kennedy and SMA) and inclusion body myositis. PMID:24703738

  9. Cerebral and spinal schistosomiasis.

    PubMed

    Carod Artal, Francisco Javier

    2012-12-01

    Cerebral schistosomiasis and spinal schistosomiasis are severe underrecognized complications of Schistosoma sp. infection, and can occur at any time during the parasitic infection. Neuroschistosomiasis has been increasingly reported not only in endemic areas but also in Western countries owing to immigration and international travel. Immunogenic interaction between schistosome egg deposition and the delayed hypersensitivity reaction of the host are the main neuropathogenic mechanisms involved. Eggs induce a periovular granulomatous reaction in the tissues. In some cases, schistosome adult worms may aberrantly migrate to the central nervous system via the vertebral venous plexus and place the ova at an ectopic site. Headache and seizures are common in cerebral schistosomiasis, and intracranial hypertension and hydrocephalus may occur in tumour-like and cerebellar schistosomiasis. Spinal schistosomiasis may manifest itself as acute myelitis and/or myeloradiculopathy. Recognition of neuroschistosomiasis is important so that early treatment with praziquantel and steroids can be started in an attempt to prevent severe disability. PMID:22903225

  10. Real-Time PCR for Diagnosing Helicobacter pylori Infection in Patients with Upper Gastrointestinal Bleeding: Comparison with Other Classical Diagnostic Methods

    PubMed Central

    Saez, Jesús; Belda, Sofía; Santibáñez, Miguel; Sola-Vera, Javier; Galiana, Antonio; Ruiz-García, Montserrat; Brotons, Alicia; López-Girona, Elena; Girona, Eva; Sillero, Carlos; Royo, Gloria

    2012-01-01

    The aim of this study was to determine the diagnostic usefulness of quantification of the H. pylori genome in detection of infection in patients with upper gastrointestinal bleeding (UGB). A total of 158 consecutive patients with digestive disorders, 80 of whom had clinical presentation of UGB, were studied. The number of microorganisms was quantified using a real-time PCR system which amplifies the urease gene with an internal control for eliminating the false negatives. A biopsy sample from the antrum and corpus of each patient was processed. The rapid urease test, culture, histological study, stool antigen test, and breath test were done. The gold standard was a positive culture or positive results in at least two of the other techniques. When a positive result was defined as any number of microorganisms/human cell, the sensitivity of real-time PCR was greater in bleeding patients, especially in the gastric corpus: 68.4% (95% confidence interval [CI], 52.3 to 84.5%) in non-UGB patients versus 91.5% (95% CI, 79.6 to 97.6%) in UGB patients. When a positive result was defined as a number of microorganisms/human cell above the optimal value that maximizes the Youden index (>3.56 microorganisms/human cell in the antrum and >2.69 in the corpus), the sensitivity and specificity in UGB patients were over 80% in both antrum and corpus. Our findings suggest that some bleeding patients with infection caused by H. pylori may not be correctly diagnosed by classical methods, and such patients could benefit from the improved diagnosis provided by real-time PCR. However, the clinical significance of a small number of microorganisms in patients with negative results in classical tests should be evaluated. PMID:22837325

  11. Real-time PCR for diagnosing Helicobacter pylori infection in patients with upper gastrointestinal bleeding: comparison with other classical diagnostic methods.

    PubMed

    Saez, Jesús; Belda, Sofía; Santibáñez, Miguel; Rodríguez, Juan Carlos; Sola-Vera, Javier; Galiana, Antonio; Ruiz-García, Montserrat; Brotons, Alicia; López-Girona, Elena; Girona, Eva; Sillero, Carlos; Royo, Gloria

    2012-10-01

    The aim of this study was to determine the diagnostic usefulness of quantification of the H. pylori genome in detection of infection in patients with upper gastrointestinal bleeding (UGB). A total of 158 consecutive patients with digestive disorders, 80 of whom had clinical presentation of UGB, were studied. The number of microorganisms was quantified using a real-time PCR system which amplifies the urease gene with an internal control for eliminating the false negatives. A biopsy sample from the antrum and corpus of each patient was processed. The rapid urease test, culture, histological study, stool antigen test, and breath test were done. The gold standard was a positive culture or positive results in at least two of the other techniques. When a positive result was defined as any number of microorganisms/human cell, the sensitivity of real-time PCR was greater in bleeding patients, especially in the gastric corpus: 68.4% (95% confidence interval [CI], 52.3 to 84.5%) in non-UGB patients versus 91.5% (95% CI, 79.6 to 97.6%) in UGB patients. When a positive result was defined as a number of microorganisms/human cell above the optimal value that maximizes the Youden index (>3.56 microorganisms/human cell in the antrum and >2.69 in the corpus), the sensitivity and specificity in UGB patients were over 80% in both antrum and corpus. Our findings suggest that some bleeding patients with infection caused by H. pylori may not be correctly diagnosed by classical methods, and such patients could benefit from the improved diagnosis provided by real-time PCR. However, the clinical significance of a small number of microorganisms in patients with negative results in classical tests should be evaluated. PMID:22837325

  12. Primary spinal epidural lymphomas

    PubMed Central

    Cugati, Goutham; Singh, Manish; Pande, Anil; Ramamurthi, Ravi; Balasubramanyam, Mahalakshmi; Sethi, Sumer K.; Singh, Ajai Kumar

    2011-01-01

    An epidural location for lymphoma is observed in 0.1–6.5% of all the lymphomas. Primary spinal epidural lymphoma (PSEL) is a subset of lymphomas, where there are no other recognizable sites of lymphomas at the time of diagnosis. The incidence of this subset of lymphomas is much less. It, however, is increasingly diagnosed, due to the increased use of more sensitive imaging modalities. For the electronic search, Pubmed was used to identify journals that enlisted and enumerated PSEL from 1961 to January 2011. The following combination of terms: “primary,” “spinal,” “epidural,” and “lymphoma” were used. The most significant articles and their bibliographies were analyzed by the authors. The symptoms, pathogenesis, diagnostic workup, histopathology, treatment, and outcome have been analyzed in a systematic manner PMID:22013369

  13. Acute myelitis associated with HCV infection

    PubMed Central

    Suzuki, Kentaro; Takao, Masaki; Katayama, Yasuo; Mihara, Ban

    2013-01-01

    We report a case of acute myelitis associated with hepatitis C virus (HCV) infection. A Japanese woman developed left calf pain and weakness, but this quickly generalised to paraplegia. We diagnosed acute myelitis based on the results of clinical manifestations, an MRI examination and a cerebrospinal fluid (CSF) examination. The clinical condition and spinal cord lesions improved following intravenous administration of methylprednisolone. The patient had been diagnosed with HCV infection 11?years before the onset. We detected HCV RNA in the CSF, supporting the strong association of our patient's myelitis. However, it is difficult to conclude whether the neurological condition was caused directly by the viral load or indirectly by the immune response. We suggest that testing for HCV infection is important in patients with myelitis. In particular, anti-HCV antibody and HCV RNA should be measured in the patients’ serum as well as CSF. PMID:23771965

  14. Diagnosing Flu

    MedlinePLUS

    ... your symptoms and their clinical judgment. Will my health care provider test me for flu if I have flu-like ... flu symptoms do not require testing because the test results usually do not change how you are treated. Your health care provider may diagnose you with flu based on ...

  15. Spinal Tap

    MedlinePLUS

    ... the area. The sample is sent to a lab for analysis and testing. Your doctor might ask you to lie on your back for a few hours after the procedure. Safety A spinal tap is considered a safe procedure ...

  16. Spinal Stenosis

    MedlinePLUS

    ... the spinal cord and nerve roots pass. Ligaments. Elastic bands of tissue that support the spine by ... explanations from researchers, and links to how to search for a trial or enroll in a research- ...

  17. Spinal deformity.

    PubMed

    Bunnell, W P

    1986-12-01

    Spinal deformity is a relatively common disorder, particularly in teenage girls. Early detection is possible by a simple, quick visual inspection that should be a standard part of the routine examination of all preteen and teenage patients. Follow-up observation will reveal those curvatures that are progressive and permit orthotic treatment to prevent further increase in the deformity. Spinal fusion offers correction and stabilization of more severe degrees of scoliosis. PMID:3786010

  18. Tethered Spinal Cord Syndrome

    MedlinePLUS

    NINDS Tethered Spinal Cord Syndrome Information Page Table of Contents (click to jump to sections) What is Tethered Spinal Cord Syndrome? Is ... being done? Clinical Trials Organizations What is Tethered Spinal Cord Syndrome? Tethered spinal cord syndrome is a neurological ...

  19. A Census Tract–Level Examination of Social Determinants of Health among Black/African American Men with Diagnosed HIV Infection, 2005–2009—17 US Areas

    PubMed Central

    Gant, Zanetta; Gant, Larry; Song, Ruiguang; Willis, Leigh; Johnson, Anna Satcher

    2014-01-01

    Background HIV disproportionately affects black men in the United States: most diagnoses are for black gay, bisexual, and other men who have sex with men (collectively referred to as MSM). A better understanding of the social conditions in which black men live and work may better explain why HIV incidence and diagnosis rates are higher than expected in this population. Methods Using data from the National HIV Surveillance System and the US Census Bureau's American Community Survey, we examined the relationships of HIV diagnosis rates and 5 census tract–level social determinants of health variables for 21,948 black MSM and non-MSM aged ?15 years residing in 17 areas in the United States. We examined federal poverty status, marital status, education level, employment status, and vacancy status and computed rate ratios (RRs) and prevalence odds ratios (PORs), using logistic regression with zero-inflated negative binomial modeling. Results Among black MSM, HIV diagnosis rates decreased as poverty increased (RR: 0.54). At the time of HIV diagnosis, black MSM were less likely than black non-MSM to live in census tracts with a higher proportion below the poverty level (POR: 0.81) and with a higher proportion of vacant houses (POR: 0.86). In comparison, housing vacancy was positively associated with HIV diagnosis rates among black non-MSM (RR: 1.65). HIV diagnosis rates were higher for black MSM (RR: 2.75) and non-MSM (RR: 4.90) whose educational level was low. Rates were significantly lower for black MSM (RR: 0.06) and non-MSM (RR: 0.26) as the proportion unemployed and the proportion married increased. Conclusions This exploratory study found differences in the patterns of HIV diagnosis rates for black MSM and non-MSM and provides insight into the transmission of HIV infection in areas that reflect substantial disadvantage in education, housing, employment, and income. PMID:25268831

  20. Spinal accessory nerve injury.

    PubMed

    Wiater, J M; Bigliani, L U

    1999-11-01

    Injury to the spinal accessory nerve can lead to dysfunction of the trapezius. The trapezius is a major scapular stabilizer and is composed of three functional components. It contributes to scapulothoracic rhythm by elevating, rotating, and retracting the scapula. The superficial course of the spinal accessory nerve in the posterior cervical triangle makes it susceptible to injury. Iatrogenic injury to the nerve after a surgical procedure is one of the most common causes of trapezius palsy. Dysfunction of the trapezius can be a painful and disabling condition. The shoulder droops as the scapula is translated laterally and rotated downward. Patients present with an asymmetric neckline, a drooping shoulder, winging of the scapula, and weakness of forward elevation. Evaluation should include a complete electrodiagnostic examination. If diagnosed within 1 year of the injury, microsurgical reconstruction of the nerve should be considered. Conservative treatment of chronic trapezius paralysis is appropriate for older patients who are sendentary. Active and healthy patients in whom 1 year of conservative treatment has failed are candidates for surgical reconstruction. Studies have shown the Eden-Lange procedure, in which the insertions of the levator scapulae, rhomboideus minor, and rhomboideus major muscles are transferred, relieves pain, corrects deformity, and improves function in patients with irreparable injury to the spinal accessory nerve. PMID:10613148

  1. [Spinal muscular atrophies in the adult].

    PubMed

    Camu, W

    2004-02-01

    Spinal muscular atrophies are heterogeneous group. The diagnostic process should be careful to uncover the main differential diagnoses and to identify familial cases. Clinical phenotype is highly variable. In familial ALS cases with SOD1 mutation, the clinical scene may mimic spinal muscular atrophy. A careful questionning and a complete electroneuromyographic exam are warranted to allow the neurologist to choose among more invasive investigations for differential and positive diagnosis such as MRI, nerve or muscle biopsy, genetic analysis. PMID:15034481

  2. The changing pattern of spinal arachnoiditis.

    PubMed Central

    Shaw, M D; Russell, J A; Grossart, K W

    1978-01-01

    Spinal arachnoiditis is a rare condition. Eighty cases, diagnosed during a period when 7600 spinal contrast investigations were undertaken, have been reviewed. The majority had suffered a previous spinal condition, the most common being lumbar disc disease. There has been a change in the distribution of arahnoiditis with the lumbar region now most frequently involved. This accounts for the persistence of radicular symptoms and the relatively low incidence of paraplegia when compared with earlier series. Surgery does not appear to have any role in the treatment. Images PMID:632824

  3. Solitary spinal dural syphilis granuloma mimicking a spinal meningioma.

    PubMed

    Zhou, Heng-Jun; Zhan, Ren-Ya; Chen, Man-Tao; Cao, Fei; Zheng, Xiu-Jue

    2014-01-01

    Dural granuloma is extremely rare. To our knowledge, there has no case reported solitary spinal dural syphilis granuloma worldwide so far. Here we report our findings in a 49-year-old woman, who presented with 10-year progressive left lower-limb numbness and two weeks of right lower-limb numbness. Magnetic resonance imaging (MRI) suggested a homogeneous enhanced spindle-shaped lesion, 2.9 × 1.5 cm in size, occupying the spinal intradural extramedullary space, at the level of Thoracic (T)-2/3, which mimicked the appearance of spinal meningioma. The Treponema pallidum particle agglutination (TPPA) test titer of 1:8, and the venereal diseases research laboratory of cerebral spinal fluid (VDRL-CSF) was reactive, so confirmed neurosyphilis was considered. After formal anti-syphilis treatment, posterior laminectomy surgery was performed, and the lesion was completely separated and extirpated. Final histopathologic diagnosis of the lesion was confirmed as chronic granulomatous inflammation, combined with the neurosyphilis history, spinal dural syphilis granuloma was finally diagnosed. Postoperatively, the patient recovered without any further treatment. PMID:24831378

  4. Bacterial meningitis following spinal anaesthesia for caesarean section.

    PubMed

    Lee, J J; Parry, H

    1991-03-01

    We report a case of meningitis caused by inadvertent introduction of bacteria following spinal anaesthesia for Caesarean section. The technique of performing the spinal anaesthesia is reviewed. Meningitis may occur, although very rarely, despite meticulous aseptic techniques. It is vital that meningitis should be considered in the differential diagnoses of post-spinal headache when patients present with headaches, pyrexia and meningism in the postoperative or postpartum period. PMID:2015156

  5. Nocardia infection

    MedlinePLUS

    Nocardia infection is a disorder affecting the lungs, brain, or skin. It occurs mainly in people with weakened immune systems. ... infection should be suspected in people with lung, brain, or skin ... system. Nocardiosis is diagnosed using tests that identify ...

  6. Doxycycline plus streptomycin versus ciprofloxacin plus rifampicin in spinal brucellosis [ISRCTN31053647

    Microsoft Academic Search

    Emine Alp; Rahmi Kemal Koc; Ahmet Candan Durak; Orhan Yildiz; Bilgehan Aygen; Bulent Sumerkan; Mehmet Doganay

    2006-01-01

    BACKGROUND: The optimal treatment regimen and duration of the therapy is still controversial in spinal brucellosis. The aim of this study is to compare the efficacy, adverse drug reactions, complications and cost of ciprofloxacin plus rifampicin versus doxycycline plus streptomycin in the treatment of spinal brucellosis. METHODS: The patients diagnosed as spinal brucellosis between January 2002 to December 2004 were

  7. Long-Term Outcomes of Spinal Cord Stimulation With Percutaneously Introduced Paddle Leads in

    E-print Network

    O'Toole, Alice J.

    Long-Term Outcomes of Spinal Cord Stimulation With Percutaneously Introduced Paddle Leads for spinal cord stimulation. Methods: Twenty-one patients diagnosed with failed back surgery syndrome (FBSS of interest. OBJECTIVE Spinal cord stimulation (SCS) is an implantable, safe, reversible, and efficacious pain

  8. The Clinical Syndrome Associated with Lumbar Spinal Stenosis

    Microsoft Academic Search

    Khean Jin Goh; Waël Khalifa; Philip Anslow; Tom Cadoux-Hudson; Michael Donaghy

    2004-01-01

    Lumbar spinal stenosis is well defined in patho-anatomical terms but its clinical features are heterogeneous. We carried out a comprehensive retrospective review of the clinical features, radiological changes and outcome of 75 patients with radiologically diagnosed lumbar spinal stenosis in order to define its clinical spectrum. The presenting complaints were of weakness, numbness\\/tingling, radicular pain and neurogenic claudication in almost

  9. Sleep disordered breathing in spinal muscular atrophy.

    PubMed

    Mellies, Uwe; Dohna-Schwake, Christian; Stehling, Florian; Voit, Thomas

    2004-12-01

    Sleep disordered breathing is a common but under-diagnosed complication causing sleep disturbance and daytime symptoms in children with spinal muscular atrophy. Non-invasive (positive pressure) ventilation is an established treatment of respiratory failure; its role in treatment of sleep disordered breathing though remains controversial. Aim of this study was to verify the hypothesis that nocturnal non-invasive ventilation has beneficial impact on breathing during sleep, sleep quality and daytime complaints in children with spinal muscular atrophy. Twelve children with spinal muscular atrophy type I or II (7.8+/-1.9 years) underwent polysomnography and were asked to fill out a symptom questionnaire. Seven patients (six with spinal muscular atrophy I and one with spinal muscular atrophy II) had sleep disordered breathing and received non-invasive ventilation during sleep. Five less severely affected patients (one with spinal muscular atrophy I and four with spinal muscular atrophy II) had no sleep disordered breathing and served as reference group. Patients were restudied after 6-12 months. In patients with sleep disordered breathing both sleep architecture and disease related symptoms were significantly worse than in the reference-group. Non-invasive ventilation during sleep completely eliminated disordered breathing, normalized sleep architecture and improved symptoms (P<0.05 for all). In children with spinal muscular atrophy sleep disordered breathing may cause relevant impairment of sleep and well-being. Both can be highly improved by nocturnal non-invasive ventilation. PMID:15564035

  10. Spinal injury - resources

    MedlinePLUS

    Resources - spinal injury ... The following organizations are a good resource for information on spinal injury : National Institute of Neurological Disorders and Stroke - www.ninds.nih.gov The National Spinal Cord Injury Association - ...

  11. Spinal Cord Infarction

    MedlinePLUS

    ... Awards Enhancing Diversity Find People About NINDS NINDS Spinal Cord Infarction Information Page Table of Contents (click to ... is being done? Clinical Trials Organizations What is Spinal Cord Infarction? Spinal cord infarction is a stroke either ...

  12. Spinal Cord Injury

    MedlinePLUS

    ... Types of illnesses and disabilities Spinal cord injury Spinal cord injury Read advice from Dr. Jeffrey Rabin , a ... your health on a daily basis. Living with spinal cord injury — your questions answered top What are pediatric ...

  13. Spinal morphine anesthesia and urinary retention.

    PubMed

    Mahan, K T; Wang, J

    1993-11-01

    Spinal anesthetic is a common form of surgical anesthetic used in foot and ankle surgery. Spinal morphine anesthetic is less common, but has the advantage of providing postoperative analgesia for 12 to 24 hr. A number of complications can occur with spinal anesthesia, including urinary retention that may be a source of severe and often prolonged discomfort and pain for the patient. Management of this problem may require repeated bladder catheterization, which may lead to urinary tract infections or impairment of urethrovesicular function. This study reviews the incidence of urinary retention in 80 patients (40 after general anesthesia and 40 after spinal anesthesia) who underwent foot and ankle surgery at Saint Joseph's Hospital, Philadelphia, PA. Twenty-five percent of the patients who had spinal anesthesia experienced urinary retention, while only 7 1/2% of the group who had general anesthesia had this complication. Predisposing factors, treatment regimen, and recommendations for the prevention and management of urinary retention are presented. PMID:8258772

  14. Spinal subdural abscess following epidural steroid injection.

    PubMed

    Kraeutler, Matthew J; Bozzay, Joseph D; Walker, Matthew P; John, Kuruvilla

    2015-01-01

    The authors report the case of a 58-year-old man who presented with a cervicothoracolumbosacral spinal subdural abscess about a month after receiving an epidural steroid injection for management of low-back pain due to L5-S1 disc herniation. Although he presented with symptoms concerning for a spinal etiology, the subdural empyema was not evident on the initial MRI study and was observed on imaging 5 days later. This patient was successfully managed with surgical intervention and antibiotic treatment, and he is doing well more than 21 months after the operation. It is possible that a prior history of disc herniation or other spinal abnormality may increase a patient's risk of developing spinal subdural empyema. This case illustrates the risk of infection following spinal epidural steroid injections and the importance of early recognition and intervention to successfully treat an extensive subdural abscess. PMID:25343407

  15. Spinal Metastases

    Microsoft Academic Search

    Jonathan H. Sherman; Dawit G. Aregawi; Mark E. Shaffrey; David Schiff

    Spinal cord metastases are a common complication of systemic malignancy, most commonly from lung, breast, and prostate cancer.\\u000a Patients may present with a variety of symptoms, most notably pain and weakness. The ultimate goals in managing these patients\\u000a include maximizing neurologic function, length of survival, and quality of life. These goals can best be reached via early,\\u000a accurate diagnosis followed

  16. Spinal cord contusion

    PubMed Central

    Ju, Gong; Wang, Jian; Wang, Yazhou; Zhao, Xianghui

    2014-01-01

    Spinal cord injury is a major cause of disability with devastating neurological outcomes and limited therapeutic opportunities, even though there are thousands of publications on spinal cord injury annually. There are two major types of spinal cord injury, transaction of the spinal cord and spinal cord contusion. Both can theoretically be treated, but there is no well documented treatment in human being. As for spinal cord contusion, we have developed an operation with fabulous result. PMID:25206890

  17. Spinal cord infarction with cervical angina.

    PubMed

    Nakae, Yoshiharu; Johkura, Ken; Kudo, Yosuke; Kuroiwa, Yoshiyuki

    2013-01-15

    Cervical angina is defined as chest pain resembling true cardiac angina but originating from disorders of the cervical spine. Cervical angina is caused by cervical spondylosis in most cases. A 66-year-old man presented with bilateral arm palsy after chest pain resembling angina pectoris. Neurological examination revealed motor and sensory disturbances of the C7 to T1 level, and magnetic resonance imaging showed a hyperintense spinal cord lesion on T2-weighted imaging. Spinal cord infarction was diagnosed. Severe sinus bradycardia was identified on admission, and improved over the course of 5 weeks. Sympathetic afferent fibers from the heart and coronary arteries generally have their cell bodies in the dorsal root ganglia of the C8 to T9 spinal segments. Electrical stimulation of cardiopulmonary afferent fibers excites spinothalamic tract cells in the T1 to T6 segments of the spinal cord. Spinal cord injury can result in the loss of supraspinal control of the sympathetic system and can cause bradycardia, as commonly seen in patients with severe lesions of the cervical or high-thoracic (T6 or above) spinal cord. Bradycardia in the present case suggested impairment of the sympathetic system at the cervical and thoracic levels. These findings indicated that cervical angina in this case was mediated through the sympathetic nervous system. This represents only the second report of cervical angina caused by spinal cord infarction. PMID:23199591

  18. Characteristics of Patients Recently Infected with HIV-1 Non-B Subtypes in France: a Nested Study within the Mandatory Notification System for New HIV Diagnoses

    PubMed Central

    Brand, Denys; Moreau, Alain; Cazein, Françoise; Lot, Florence; Pillonel, Josiane; Brunet, Sylvie; Thierry, Damien; Le Vu, Stéphane; Plantier, Jean-Christophe; Semaille, Caroline

    2014-01-01

    The presence of HIV-1 non-B subtypes in Western Europe is commonly attributed to migration of individuals from non-European countries, but the possible role of domestic infections with non-B subtypes is not well investigated. The French mandatory anonymous reporting system for HIV is linked to a virological surveillance using assays for recent infection (<6 months) and serotyping. During the first semester of years 2007 to 2010, any sample corresponding to a non-B recent infection was analyzed by sequencing a 415-bp env region, followed by phylogenetic analysis and search for transmission clusters. Two hundred thirty-three recent HIV-1 infections with non-B variants were identified. They involved 5 subtypes and 7 circulating recombinant forms (CRFs). Ninety-two cases (39.5%) were due to heterosexual transmissions, of which 39 occurred in patients born in France. Eighty-five cases (36.5%) were identified in men having sex with men (MSM). Forty-three recent non-B infections (18.5%) segregated into 14 clusters, MSM being involved in 11 of them. Clustered transmission events included 2 to 7 cases per cluster. The largest cluster involved MSM infected by a CRF02_AG variant. In conclusion, we found that the spread of non-B subtypes in France occurs in individuals of French origin and that MSM are particularly involved in this dynamic. PMID:25232163

  19. Characteristics of patients recently infected with HIV-1 non-B subtypes in France: a nested study within the mandatory notification system for new HIV diagnoses.

    PubMed

    Brand, Denys; Moreau, Alain; Cazein, Françoise; Lot, Florence; Pillonel, Josiane; Brunet, Sylvie; Thierry, Damien; Le Vu, Stéphane; Plantier, Jean-Christophe; Semaille, Caroline; Barin, Francis

    2014-11-01

    The presence of HIV-1 non-B subtypes in Western Europe is commonly attributed to migration of individuals from non-European countries, but the possible role of domestic infections with non-B subtypes is not well investigated. The French mandatory anonymous reporting system for HIV is linked to a virological surveillance using assays for recent infection (<6 months) and serotyping. During the first semester of years 2007 to 2010, any sample corresponding to a non-B recent infection was analyzed by sequencing a 415-bp env region, followed by phylogenetic analysis and search for transmission clusters. Two hundred thirty-three recent HIV-1 infections with non-B variants were identified. They involved 5 subtypes and 7 circulating recombinant forms (CRFs). Ninety-two cases (39.5%) were due to heterosexual transmissions, of which 39 occurred in patients born in France. Eighty-five cases (36.5%) were identified in men having sex with men (MSM). Forty-three recent non-B infections (18.5%) segregated into 14 clusters, MSM being involved in 11 of them. Clustered transmission events included 2 to 7 cases per cluster. The largest cluster involved MSM infected by a CRF02_AG variant. In conclusion, we found that the spread of non-B subtypes in France occurs in individuals of French origin and that MSM are particularly involved in this dynamic. PMID:25232163

  20. Survival Outcomes and Effect of Early vs. Deferred cART Among HIV-Infected Patients Diagnosed at the Time of an AIDS-Defining Event: A Cohort Analysis

    PubMed Central

    Mussini, Cristina; Johnson, Margaret; d'Arminio Monforte, Antonella; Antinori, Andrea; Gill, M. John; Sighinolfi, Laura; Uberti-Foppa, Caterina; Borghi, Vanni; Sabin, Caroline

    2011-01-01

    Objectives We analyzed clinical progression among persons diagnosed with HIV at the time of an AIDS-defining event, and assessed the impact on outcome of timing of combined antiretroviral treatment (cART). Methods Retrospective, European and Canadian multicohort study.. Patients were diagnosed with HIV from 1997–2004 and had clinical AIDS from 30 days before to 14 days after diagnosis. Clinical progression (new AIDS event, death) was described using Kaplan-Meier analysis stratifying by type of AIDS event. Factors associated with progression were identified with multivariable Cox regression. Progression rates were compared between those starting early (<30 days after AIDS event) or deferred (30–270 days after AIDS event) cART. Results The median (interquartile range) CD4 count and viral load (VL) at diagnosis of the 584 patients were 42 (16, 119) cells/µL and 5.2 (4.5, 5.7) log10 copies/mL. Clinical progression was observed in 165 (28.3%) patients. Older age, a higher VL at diagnosis, and a diagnosis of non-Hodgkin lymphoma (NHL) (vs. other AIDS events) were independently associated with disease progression. Of 366 patients with an opportunistic infection, 178 (48.6%) received early cART. There was no significant difference in clinical progression between those initiating cART early and those deferring treatment (adjusted hazard ratio 1.32 [95% confidence interval 0.87, 2.00], p?=?0.20). Conclusions Older patients and patients with high VL or NHL at diagnosis had a worse outcome. Our data suggest that earlier initiation of cART may be beneficial among HIV-infected patients diagnosed with clinical AIDS in our setting. PMID:22043301

  1. The prevalence of transmitted drug resistance in newly diagnosed HIV-infected individuals in Croatia: the role of transmission clusters of men who have sex with men carrying the T215S surveillance drug resistance mutation.

    PubMed

    Grgic, Ivana; Lepej, Snjezana Zidovec; Lunar, Maja M; Poljak, Mario; Vince, Adriana; Vrakela, Ivana Baca; Planinic, Ana; Seme, Katja; Begovac, Josip

    2013-02-01

    The aim of this study was to determine the prevalence of transmitted drug resistance (TDR) in newly diagnosed and treatment-naive HIV-infected patients from Croatia and evaluate a possible contribution of transmission clusters to the spread of resistant virus. The study enrolled treatment-naive HIV-infected patients that entered clinical care at the Croatian Reference Center for HIV/AIDS between 2006 and 2008. The protease gene and a part of the reverse transcriptase gene of the HIV-1 genome were sequenced by using the Trugene HIV-1 Genotyping System. The prevalence of transmitted drug resistance was analyzed by using the surveillance drug resistance mutations (SDRM) list recommended by the WHO in 2009. We report findings for 118 of 180 eligible patients (65.6% coverage). SDRM were detected in 26 of 118 patients (22.0%) who were infected with subtype B and belonged mostly to the men having sex with men (MSM). The majority of patients with primary resistance carried SDRM associated with resistance to nucleoside analogues reverse transcriptase inhibitors (NRTIs, 23 of 118 patients, 19.5%). The most frequently found NRTI SDRM was T215S (17 of 118 patients, 14.4%). SDRM associated with resistance to nonnucleoside reverse transcriptase inhibitors were detected in three (2.5%) patients and primary resistance to protease inhibitors was not detected. Non-B subtypes were detected in 13/118 patients (11%). A total of 12 transmission pairs and eight distinct transmission clusters were identified with the largest cluster harboring sequences from 19 patients; among them all but two were carrying the T215S mutation. This study showed a high prevalence of TDR in newly diagnosed MSM from Croatia and is an important contribution concerning the relationship between local transmission clusters and the spread of resistant virus. PMID:22906365

  2. How Is Asthma Diagnosed?

    MedlinePLUS

    ... page from the NHLBI on Twitter. How Is Asthma Diagnosed? Your primary care doctor will diagnose asthma ... other disease may be causing your symptoms. Diagnosing Asthma in Young Children Most children who have asthma ...

  3. Expression and purification of Suid Herpesvirus-1 glycoprotein E in the baculovirus system and its use to diagnose Aujeszky’s disease in infected pigs

    PubMed Central

    Serena, María Soledad; Geisler, Christoph; Metz, Germán Ernesto; Corva, Santiago Gerardo; Mórtola, Eduardo Carlos; Larsen, Alejandra; Jarvis, Donald L.; Echeverría, María Gabriela

    2014-01-01

    Suid Herpesvirus 1 (SHV-1) is the etiological agent of Aujeszky’s disease (AD), which affects swine herds worldwide and causes substantial economic losses due to animal mortality and lost productivity. In order to eradicate SHV-1, vaccination programs using viruses lacking the gene encoding glycoprotein E (gE) are ongoing in several countries. These eradication programs have generated a currently unmet demand for affordable and sensitive tests that can detect SHV-1 infection, yet distinguish between infected and vaccinated pigs. To meet this demand, we used the baculovirus-insect cell system to produce immunologically authentic full-length recombinant gE protein for use in a serum ELISA assay. As previous efforts to clone the gE gene had failed due to its extremely high GC-content (75% average), we used betaine as a PCR enhancer to facilitate amplification of the entire gE gene from the Argentinian CL15 strain of SHV-1. The cloned gE gene was expressed at high levels in recombinant baculovirus-infected insect cells and reacted strongly with sera from SHV-1 infected pigs. We used the recombinant gE protein to develop a local indirect ELISA test with sensitivity and specificity comparable to currently available commercial tests. Thus, recombinant gE produced in baculovirus-infected insect cells is a viable source of antigen for the detection of SHV-1 in ELISA tests. We also provide evidence supporting a potential application of this recombinant form of gE as a SHV-1 subunit vaccine. PMID:23631926

  4. Diagnosing Aleutian mink disease infection by a new fully automated ELISA or by counter current immunoelectrophoresis: a comparison of sensitivity and specificity.

    PubMed

    Dam-Tuxen, Rebekka; Dahl, Jan; Jensen, Trine Hammer; Dam-Tuxen, Thomas; Struve, Tina; Bruun, Leif

    2014-04-01

    Aleutian disease (AD) is a severe disease characterized by hypergammaglobulinemia causing multiple symptoms such as acute renal failure, arteritis, reduced reproductive performance and pneumonia in mink. AD is caused by the parvovirus Aleutian mink disease virus (ADV) and diagnosed primarily based on ADV serology sometimes supplemented by organ PCR analysis. In Denmark, approximately 3.5-4 million serum samples are tested every year for the presence of anti ADV antibodies as part of a national eradication program. The present study compares the diagnostic performance of the two most commonly used assays for serological screening for Aleutian disease: counter current immunoelectrophoresis (CIEP) and ELISA. In total, 3810 mink were sampled in doublets and analyzed by CIEP and a newly developed fully automated ELISA. The results show that the two assays have a comparable diagnostic performance with the ELISA having a higher sensitivity but lower specificity than the CIEP assay. The ELISA has been approved by the Danish authorities for diagnosing Aleutian disease in mink. PMID:24462658

  5. An algorithm to diagnose influenza infection: evaluating the clinical importance and impact on hospital costs of screening with rapid antigen detection tests.

    PubMed

    González-Del Vecchio, M; Catalán, P; de Egea, V; Rodríguez-Borlado, A; Martos, C; Padilla, B; Rodríguez-Sanchez, B; Bouza, E

    2015-06-01

    Rapid antigen detection tests (RADTs) are immunoassays that produce results in 15 min or less, have low sensitivity (50 %), but high specificity (95 %). We studied the clinical impact and laboratory savings of a diagnostic algorithm for influenza infection using RADTs as a first-step technique during the influenza season. From January 15th to March 31st 2014, we performed a diagnostic algorithm for influenza infection consisting of an RADT for all respiratory samples received in the laboratory. We studied all the patients with positive results for influenza infection, dividing them into two groups: Group A with a negative RADT but positive reference tests [reverse transcription polymerase chain reaction (RT-PCR) and/or culture] and Group B with an initial positive RADT. During the study period, we had a total of 1,156 patients with suspicion of influenza infection. Of them, 217 (19 %) had a positive result for influenza: 132 (11 %) had an initial negative RADT (Group A) and 85 (7 %) had a positive RADT (Group B). When comparing patients in Group A and Group B, we found significant differences, as follows: prescribed oseltamivir (67 % vs. 82 %; p?=?0.02), initiation of oseltamivir before 24 h (89 % vs. 97 %; p?=?0.03), antibiotics prescribed (89 % vs. 67 %; p?=?<0.01), intensive care unit (ICU) admissions after diagnosis (23 % vs. 14 %; p?=?0.05), and need for supplementary oxygen (61 % vs. 47 %; p?=?0.01). An influenza algorithm including RADTs as the first step improves the time of administration of proper antiviral therapy, reduces the use of antibiotics and ICU admissions, and decreases hospital costs. PMID:25620782

  6. Surgical Treatment of Spinal Tuberculosis Complicated with Extensive ABSCESS

    PubMed Central

    Brito, Joaquim Soares Do; Tirado, António; Fernandes, Pedro

    2014-01-01

    Purpose Tuberculosis can be responsible for extensive spinal lesions. Despite the efficacy of medical treatment, surgery is indicated to avoid or correct significant deformity, treat spinal instability, prevent neurological compromise, and to eradicate an extensive tuberculous abscess. In this paper we present our experience in the surgical management of spinal tuberculosis complicated with large abscess. Patients and Methods Fifteen patients with spinal tuberculosis complicated with extensive abscess were identified; and nine of those patients had extension of the infection into the epidural space. The average age at treatment was 34 years old. Seven patients had thoracic infection, seven patients had lumbar infection and one had thoracolumbar infection. Six patients had neurological deficit at presentation. All patients were surgically treated with abscess debridement, spinal stabilization and concurrent antituberculous chemotherapy. A single anterior surgical approach was used in three cases, a posterior approach was used in four others and a combined approach was performed in eight patients. Results Surgical management allowed for effective abscess debridement and sspinal stabilization in this cohort. In combination with antituberculous drugs, surgical treatment resulted in infection eradication and bone fusion in all patients at 24 month average follow-up. Satisfactory neurological outcomes with improved American Spinal Injury Association (ASIA) scores were observed in 100% of patients. Conclusion Surgical treatment for spinal tuberculosis abscess can lead to satisfactory clinical outcomes. PMID:25328472

  7. History of spinal osteotomy.

    PubMed

    Meredith, Dennis S; Vaccaro, Alexander R

    2014-07-01

    Spinal deformity is one of the oldest known diseases with descriptions documented many of the earliest civilizations. Historical treatments have had little efficacy, especially in adults. However, in the modern era, there has been a rapid expansion of new technologies and surgical techniques aided by advances in supportive care that now allow the spinal surgeon to have powerful tools to correct spinal deformity. In this manuscript, we review the origins of spinal deformity surgery and the development of spinal instrumentation. The focus of the manuscript is to review the relationship of these developments to the implementation of spinal osteotomies for deformity correction. PMID:24390043

  8. Simplified Antibiotic Regimens for the Management of Clinically Diagnosed Severe Infections in Newborns and Young Infants in First-level Facilities in Karachi, Pakistan

    PubMed Central

    2013-01-01

    Background: Infection in young infants is a major cause of morbidity and mortality in low-middle income countries, with high neonatal mortality rates. Timely case management is lifesaving, but the current standard of hospitalization for parenteral antibiotic therapy is not always feasible. Alternative, simpler antibiotic regimens that could be used in outpatient settings have the potential to save thousands of lives. Methods: This trial aims to determine whether 2 simplified antibiotic regimens are equivalent to the reference therapy with 7 days of once-daily (OD) intramuscular (IM) procaine penicillin and gentamicin for outpatient management of young infants with clinically presumed systemic bacterial infection treated in primary health-care clinics in 5 communities in Karachi, Pakistan. The reference regimen is close to the current recommendation of the hospital-based intravenous ampicillin and gentamicin therapy for neonatal sepsis. The 2 comparison arms are (1) IM gentamicin OD and oral amoxicillin twice daily for 7 days; and (2) IM penicillin and gentamicin OD for 2 days, followed by oral amoxicillin twice daily for 5 days; 2250 “evaluable” infants will be enrolled. The primary outcome of this trial is treatment failure (death, deterioration or lack of improvement) within 7 days of enrollment. Results are expected by early 2014. Discussion: This trial will determine whether simplified antibiotic regimens with fewer injections in combination with high-dose amoxicillin are equivalent to 7 days of IM procaine penicillin and gentamicin in young infants with clinical severe infection. Results will have program and policy implications in countries with limited access to hospital care and high burden of neonatal deaths. PMID:23945571

  9. Expression of CD11b\\/CD18 adhesion molecules on circulating phagocytes—a novel aid to diagnose infection in patients with cancer

    Microsoft Academic Search

    R. Kallio; H. Aalto; A. Takala; P. Ohtonen; J. Collan; S. Siitonen; H. Joensuu; H. Syrjala; H. Repo

    2008-01-01

    Goals of work  No blood marker available to date is useful for distinguishing infection-related from neoplasm-related fever. We evaluated\\u000a the expression of the peripheral blood phagocyte CD11b\\/CD18 adhesion molecule complex for this purpose.\\u000a \\u000a \\u000a \\u000a Materials and methods  Neutrophil and monocyte CD11b\\/CD18 expression was assessed in two cohorts of patients with advanced solid cancer (n?=?120) and in healthy controls (n?=?63). The cancer series included

  10. Spinal cord stimulation

    MedlinePLUS

    Spinal cord stimulation is a treatment for pain that uses a mild electric current to block nerve impulses ... stretched into the space on top of your spinal cord. These wires will be connected to a small ...

  11. What Is Spinal Stenosis?

    MedlinePLUS

    ... Public 3 One type of spinal stenosis, cauda equine syndrome, is very serious. This type occurs when ... spinal stenosis, such treatments include chiropractic treatment and acupuncture. More research is needed on the value of ...

  12. Spinal cord metastasis in small cell carcinoma of the lung

    SciTech Connect

    Holoye, P.; Libnoch, J.; Cox, J.; Kun, L.; Byhardt, R.; Almagro, U.; McCelland, S.; Chintapali, K.

    1984-03-01

    Among 50 patients with small cell bronchogenic carcinoma who were placed on a protocol of combined chemotherapy and radiation therapy, seven patients developed recurrence in the spinal cord. Five cases terminated in paraplegia and death. One patient with pontine recurrence recovered with local radiation therapy. One patient, diagnosed early, responded to local radiation therapy and is ambulatory. Methods of diagnosis were myelogram, computerized axial tomography, cerebro spinal fluid, chemistry and cytologies. The poor prognosis and the difficulty of diagnosis suggest that prophylactic therapy of the entire cranio-spinal axis should be evaluated.

  13. Validation of real-time polymerase chain reaction tests for diagnosing feline immunodeficiency virus infection in domestic cats using Bayesian latent class models.

    PubMed

    Morton, John M; McCoy, Richard J; Kann, Rebecca K C; Gardner, Ian A; Meers, Joanne

    2012-04-01

    The objectives of the current study were to estimate the sensitivity and specificity of three real-time polymerase chain reaction (PCR) tests for diagnosis of feline immunodeficiency virus (FIV) infection in domestic cats, both individually and when interpreted in series with one of two serological tests, separately in populations of cats at low and high risk of being infected with FIV. One PCR test targeted the pol gene and two targeted the gag gene of FIV. For comparison, sensitivities and specificities of the individual serological tests (IDEXX SNAP(®) test and AGEN Simplify(®) test) were also estimated. The study populations consisted of domestic cats thought to be not vaccinated against FIV. Low-risk (males aged 4 years or less and females; n=128) and high-risk (males over 4 years; n=128) cats were selected from those where blood samples were submitted to a commercial clinical pathology service. Bayesian latent class models were used to obtain posterior probability distributions for sensitivity and specificity for each test, based on prior distributions obtained from three experts. Medians of the posterior sensitivity distributions for the PCR tests based on the pol gene and two regions of the gag gene tests ranged from 0.85 to 0.89, compared to 0.89-0.97 for the two serological tests. The medians of posterior specificity distributions for these PCR tests were 0.94-0.96, and 0.95-0.97 for the serological tests. In contrast, the PCR based on one region of the gag gene had lower median sensitivity. Sensitivities of combinations of these serological and PCR tests interpreted in series were low; medians of posterior sensitivity distributions ranged from 0.75 to 0.83. Relative to the low-risk population, median sensitivities in the high-risk population were lower for all tests other than the AGEN Simplify(®) test; specificities were similar in both populations. We conclude that the sensitivities of the two PCR tests based on the pol gene and two regions of the gag gene, respectively, in non-vaccinated cats are probably lower than the sensitivities of the two serological tests we assessed. We do not recommend screening cats whose FIV vaccination status is uncertain with one of these serological tests and then testing positives with one of these PCR tests because in non-vaccinates, the sensitivities of combinations of these serological and PCR tests interpreted in series are low. Assessment of the validity of these PCR assays in FIV-vaccinated cats is required. PMID:22098681

  14. Lumbar Spinal Stenosis

    PubMed Central

    Genevay, Stephane

    2009-01-01

    Lumbar spinal stenosis (LSS) is most commonly due to degenerative changes in older individuals. LSS is being more commonly diagnosed and may relate to better access to advanced imaging and to an aging population. This review focuses on radicular symptoms related to degenerative central and lateral stenosis and updates knowledge of LSS pathophysiology, diagnosis and management. Since patients with anatomic LSS can range from asymptomatic to severely disabled, the clinical diagnosis focuses on symptoms and examination findings associated with LSS. Imaging findings are helpful for patients with persistent, bothersome symptoms in whom invasive treatments are being considered. There is limited information from high quality studies about the relative benefits and harms of commonly used treatments. Interpreting and comparing results of available research is limited by a lack of consensus about the definition of LSS. Nevertheless, evidence supports decompressive laminectomy for patients with persistent and bothersome symptoms. Recommendations favor a shared decision making approach due to important trade-offs between alternative therapies and differences among patients in their preferences and values. PMID:20227646

  15. How Is Sarcoidosis Diagnosed?

    MedlinePLUS

    ... page from the NHLBI on Twitter. How Is Sarcoidosis Diagnosed? Your doctor will diagnose sarcoidosis based on ... Content: NEXT >> Featured Video Living With and Managing Sarcoidosis 05/18/2011 This video—presented by the ...

  16. How Is Vasculitis Diagnosed?

    MedlinePLUS

    ... page from the NHLBI on Twitter. How Is Vasculitis Diagnosed? Your doctor will diagnose vasculitis based on your signs and symptoms, your medical ... results. Specialists Involved Depending on the type of vasculitis you have and the organs affected, your doctor ...

  17. Spinal muscular atrophy in calves of the Red Danish dairy breed

    Microsoft Academic Search

    JS Agerholm; A Basse

    1994-01-01

    Pathological and genetic aspects of spinal muscular atrophy in Red Danish dairy cattle are described. A total of 312 calves suspected of having the condition was reported in the Danish Bovine Genetic Disease Programme, 162 of them were examined post mortem and spinal muscular atrophy was diagnosed in 82 of these. Seventy-five per cent of the affected calves had bronchopneumonia.

  18. Sensor Placement for Diagnosability

    Microsoft Academic Search

    Ethan Scarl

    1994-01-01

    The concept of diagnostic accuracy is examined and redefined to support specific criteria for sensor placement. If the correctness of diagnoser operation is assumed, then any failure to diagnose accurately must be attributable to an inadequacy of sensor data. Inaccuracy in diagnoses can be expressed solely in terms of additional candidates whose faults cannot be ruled out. With ambiguity as

  19. Symbolic Testing of Diagnosability

    Microsoft Academic Search

    Alban Grastien

    Diagnosability ensures that the occurrence of a failure on t he system can always be diagnosed by a diagnosis engine. In this paper, we explore symbolic techniques to test diagnosability of DES. We present several algorithms that can be implemented with symbolic tools, and show how to combine decentralised approach with symbolic approach. Finally, we discuss how to extract the

  20. The transformation of spinal curvature into spinal deformity: pathological processes and implications for treatment

    PubMed Central

    Hawes, Martha C; O'Brien, Joseph P

    2006-01-01

    Background This review summarizes what is known about the pathological processes (e.g. structural and functional changes), by which spinal curvatures develop and evolve into spinal deformities. Methods Comprehensive review of articles (English language only) published on 'scoliosis,' whose content yielded data on the pathological changes associated with spinal curvatures. Medline, Science Citation Index and other searches yielded > 10,000 titles each of which was surveyed for content related to 'pathology' and related terms such as 'etiology,' 'inheritance,' 'pathomechanism,' 'signs and symptoms.' Additional resources included all books published on 'scoliosis' and available through the Arizona Health Sciences Library, Interlibrary Loan, or through direct contact with the authors or publishers. Results A lateral curvature of the spine–'scoliosis'–can develop in association with postural imbalance due to genetic defects and injury as well as pain and scarring from trauma or surgery. Irrespective of the factor that triggers its appearance, a sustained postural imbalance can result, over time, in establishment of a state of continuous asymmetric loading relative to the spinal axis. Recent studies support the longstanding hypothesis that spinal deformity results directly from such postural imbalance, irrespective of the primary trigger, because the dynamics of growth within vertebrae are altered by continuous asymmetric mechanical loading. These data suggest that, as long as growth potential remains, evolution of a spinal curvature into a spinal deformity can be prevented by reversing the state of continuous asymmetric loading. Conclusion Spinal curvatures can routinely be diagnosed in early stages, before pathological deformity of the vertebral elements is induced in response to asymmetric loading. Current clinical approaches involve 'watching and waiting' while mild reversible spinal curvatures develop into spinal deformities with potential to cause symptoms throughout life. Research to define patient-specific mechanics of spinal loading may allow quantification of a critical threshold at which curvature establishment and progression become inevitable, and thereby yield strategies to prevent development of spinal deformity. Even within the normal spine there is considerable flexibility with the possibility of producing many types of curves that can be altered during the course of normal movements. To create these curves during normal movement simply requires an imbalance of forces along the spine and, extending this concept a little further, a scoliotic curve is produced simply by a small but sustained imbalance of forces along the spine. In fact I would argue that no matter what you believe to be the cause of AIS, ultimately the problem can be reduced to the production of an imbalance of forces along the spine [1]. PMID:16759413

  1. Incidence Density of Invasive Fungal Infections during Primary Antifungal Prophylaxis in Newly Diagnosed Acute Myeloid Leukemia Patients in a Tertiary Cancer Center, 2009 to 2011

    PubMed Central

    Mulanovich, Victor E.; Jiang, Y.; Lewis, Russell E.

    2014-01-01

    Although primary antifungal prophylaxis (PAP) is routinely administered in patients with acute myeloid leukemia (AML) during remission-induction and consolidation chemotherapy, the impact of PAP on the incidence of invasive fungal infections (IFIs) is not well described. We retrospectively analyzed the incidence of IFIs in 152 patients with AML who had been admitted to a tertiary cancer center between August 2009 and March 2011 and received PAP within 120 days after first remission-induction chemotherapy. We excluded patients who had undergone stem cell transplantation. Patients received a PAP drug with anti-Aspergillus activity during 72% (7,660/10,572) of prophylaxis-days. The incidence of documented IFIs (definite or probable according to revised European Organization for Research and Treatment of Cancer [EORTC] criteria) was 2.0/1,000 prophylaxis-days (95% confidence interval [CI], 1.23 to 3.04). IFIs due to molds were more common than IFIs due to yeasts (1.5/1,000 prophylaxis-days versus 0.4/1,000 prophylaxis-days; P = 0.01). Echinocandin-based PAP (8.6 and 7.1/1,000 prophylaxis-days, respectively) was associated with higher rates of documented IFIs than anti-Aspergillus azoles (voriconazole or posaconazole) (2.4 and 1.1/1,000 prophylaxis-days, respectively) at both 42 days (P = 0.03) and 120 days (P < 0.0001) after first remission-induction chemotherapy. The incidence of overall (documented and presumed) IFIs (P < 0.001), documented IFIs (P < 0.01), and empirical antifungal therapies (P < 0.0001) was higher during the first 42 days than after day 42. Despite the broad use of PAP with anti-Aspergillus activity, IFIs, especially molds, remain a significant cause of morbidity and mortality in AML patients, predominantly during the remission-induction phase. Patients receiving echinocandin-based PAP experienced higher rates of IFIs than did those receiving anti-Aspergillus azoles. PMID:24277033

  2. Advances in Imaging of Vertebral and Spinal Cord Injury

    PubMed Central

    Goldberg, Andrew L; Kershah, Sharif M

    2010-01-01

    Background/Objectives: Imaging technology is an important part of the diagnosis and management of spinal trauma. Indications and findings in post-traumatic imaging of the vertebral column and spinal cord are reviewed. Methods: An extensive literature review was performed on the imaging of vertebral and spinal cord injury. Relevant images from a Level I trauma center were included as examples. Results: Imaging plays an important role in the evaluation of acute and chronic spinal injury. Spinal cord and soft-tissue injuries are best evaluated by magnetic resonance imaging (MRI), whereas spinal fractures are better characterized by computed tomography (CT). Vascular injuries can be evaluated using CT or MR angiography. Conclusions: Imaging using CT and MRI is essential in the management of spinal cord injuries, both in the acute and in the chronic settings. MRI shows the status of ligamentous integrity and visualizes internal derangement of the spinal cord. Vascular compromise can be diagnosed by MR and CT angiography. Plain radiography now has a more limited, adjunctive role, and the need for higher risk myelography has been minimized. PMID:20486529

  3. Pregnancy following spinal cord injury.

    PubMed Central

    Cross, L. L.; Meythaler, J. M.; Tuel, S. M.; Cross, A. L.

    1991-01-01

    Each year about 2,000 women of childbearing age in the United States have a spinal cord injury. Only a few mostly anecdotal reports describe pregnancy after such an injury. In a retrospective study of 16 women with a spinal cord injury, half of whom have a complete injury and about half quadriplegia, 25 pregnancies occurred, with 21 carried to full term. The women delayed pregnancy an average of 6.5 years after their injury, with an average age at first pregnancy of 26.8 years. Cesarean section was necessary in 4 patients because of inadequate progress of labor. In 5 deliveries an episiotomy and local anesthesia were required, 7 required epidural anesthesia, including all cesarean sections, and 10 did not require anesthesia. Several complications have been identified in the antepartum, intrapartum, and postpartum periods including autonomic hyperreflexia, premature labor, pressure sores, urinary tract infections, abnormal presentation, and failure to progress. Ultrasonography and amniocentesis were used selectively. Women with spinal cord injuries can have healthy children, although there are significant risks and these women have special needs. PMID:1866960

  4. Low back pain due to spinal chronic subdural hematoma mimicking intradural tumor in the lumbar area: a case report and literature review

    Microsoft Academic Search

    Serdar Kahraman; Sait ?irin; Hakan Kayali; Ilker Solmaz; Altay Bedük

    2003-01-01

    Although magnetic resonance imaging has dramatically enhanced the ability to diagnose spinal mass lesions, some lesions remain difficult to diagnose. We report a spinal chronic subdural hematoma that comprised the cauda equina ventrally in the lumbar area in a 51-year-old man who was under anticoagulant therapy. Low back pain was the only symptom of the patient after sports activity. Surgical

  5. Normal intraoperative spinal sonography.

    PubMed

    Quencer, R M; Montalvo, B M

    1984-12-01

    The normal intraoperative sonographic features of the spinal canal, spinal cord, conus medullaris, and cauda equina are described and illustrated. Important observations concerning the normal spinal cord include its highly reflective dorsal and ventral surfaces, its uniform hypoechogenicity, and the presence of a central echo. Other easily identified structures within the spinal canal include the dura-arachnoid layer, subarachnoid space, denticulate ligament, dorsal arachnoid septations, and the roots of the cauda equina. In addition the sonographic appearance of commonly encountered iatrogenically introduced material including Gelfoam, Pantopaque, cottonoid pledgets, suture material, Harrington rods, and freeze-dried dura is also demonstrated. These normal images can serve as a baseline for the interpretation of various pathologic conditions of the spinal canal and its contents as seen with intraoperative spinal sonography. PMID:6388284

  6. Unusual Spinal Dysraphic Lesions

    PubMed Central

    Pacheco, Pollyana; Wanderley, Luiz Eduardo

    2013-01-01

    Human tail and multiple spinal dysraphism are unusual congenital malformations. Human tail appeared as a prominent lesion from the lumbosacrococcygeal region, generally without connection between the tail and the neurospinal axis. Spinal dysraphisms are usually isolated, reaching 0.038% of incidence of multiple spinal dysraphisms in the same child. There were three cases described of unusual spinal dysraphic lesions: two cases of human tail and a case of a multiple thoracic myelomeningocele. The literature about diagnosis and treatment was reviewed. Microsurgical technique was performed to provide better exploration of the lesions, and resection could be done in those congenital malformations, without morbidity. PMID:24194997

  7. Diagnosability and sensor reduction

    Microsoft Academic Search

    E. Scarl

    1991-01-01

    Device-centered model-based reasoning (MBR) models are used to determine the diagnosability of individual components and of the system as a whole. Given a satisfactory device-centered model that can be used dependably for diagnosis, the author first considers the specification of diagnosability for individual components. This is expressed through uniqueness requirements for the isolation of faults in those components. The diagnosability

  8. Neuroblastoma in a Patient With Spinal Muscular Atrophy Type I: Is It Just a Coincidence?

    PubMed

    Sag, Erdal; Sen, Hilal Susam; Haliloglu, Goknur; Yalcin, Bilgehan; Kutluk, Tezer

    2015-07-01

    Spinal muscular atrophy is an autosomal recessive disorder characterized by progressive degeneration of anterior horn cells of the spinal cord resulting in hypotonia, skeletal muscle atrophy, and weakness. Herein, we report a 4-month-old male infant who presented to our hospital with an abdominal mass that was diagnosed as neuroblastoma and spinal muscular atrophy type I. We would like to discuss the course and differential diagnosis with an algorithm leading to the diagnosis in this peculiar patient. To our knowledge, coexistence of spinal muscular atrophy type I and neuroblastoma is defined for the first time in the literature. PMID:25123529

  9. Descriptive Epidemiology of Spinal Muscular Atrophy Type I in Estonia

    Microsoft Academic Search

    Eve Vaidla; Inga Talvik; Andres Kulla; Tiina Kahre; Malle Hamarik; Aita Napa; Tuuli Metsvaht; Andres Piirsoo; Tiina Talvik

    2006-01-01

    Spinal muscular atrophy is the second most frequent autosomal-recessive disorder in Europeans. There are no published epidemiological data on SMA in Estonia and other Baltic countries. The aim of this study was to estimate the incidence of SMA I in Estonia. All patients with SMA I diagnosed between January 1994 and December 2003 were included in the study. The diagnosis

  10. Probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 may help downregulate TNF-Alpha, IL-6, IL-8, IL-10 and IL-12 (p70) in the neurogenic bladder of spinal cord injured patient with urinary tract infections: a two-case study.

    PubMed

    Anukam, Kingsley C; Hayes, Keith; Summers, Kelly; Reid, Gregor

    2009-01-01

    The management of urinary tract infection (UTI) in individuals with spinal cord injury (SCI) continues to be of concern, due to complications that can occur. An emerging concept that is a common underlying pathophysiological process is involved, wherein pathogens causing UTI have a role in inflammatory progression. We hypothesized that members of the commensal flora, such as lactobacilli, may counter this reaction through anti-inflammatory mediation. This was assessed in a pilot two-patient study in which probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri were administered to one patient and placebo to another, both along with antibiotics to treat acute UTI. Urinary TNF-alpha was significantly downregulated (P = .015) in the patient who received the probiotic and who used intermittent catheterization compared with patient on placebo and using an indwelling catheter. The extent to which this alteration resulted in improved well-being in spinal cord injured patients remains to be determined in a larger study. PMID:19753131

  11. How Is Anemia Diagnosed?

    MedlinePLUS

    ... page from the NHLBI on Twitter. How Is Anemia Diagnosed? Your doctor will diagnose anemia based on your medical and family histories, a ... exam, and results from tests and procedures. Because anemia doesn't always cause symptoms, your doctor may ...

  12. Les amyotrophies spinales distales

    Microsoft Academic Search

    P. Devic; P. Petiot

    2011-01-01

    IntroductionDistal hereditary motor neuropathy (dHMN), also known as spinal muscular atrophy, represents a group of clinically and genetically heterogeneous diseases caused by degenerations of spinal motor neurons and leading to distal muscle weakness and wasting. Nerve conduction studies reveal a pure motor axonopathy and needle examination shows chronic denervation.

  13. Spinal Muscular Atrophy

    Microsoft Academic Search

    Petur Ludvigsson; Elias Olafsson; W. Allen Hauser

    1999-01-01

    Spinal muscular atrophy (SMA) is among the commonest degenerative disorders of the nervous system in childhood. This is an inherited autosomal recessive disease which results in premature death of anterior horn cells of the spinal cord and is manifested by progressive weakness and atrophy of skeletal muscles. Few studies have looked at the frequency of the disease in a defined

  14. Spinal tuberculosis: A review

    PubMed Central

    Garg, Ravindra Kumar; Somvanshi, Dilip Singh

    2011-01-01

    Spinal tuberculosis is a destructive form of tuberculosis. It accounts for approximately half of all cases of musculoskeletal tuberculosis. Spinal tuberculosis is more common in children and young adults. The incidence of spinal tuberculosis is increasing in developed nations. Genetic susceptibility to spinal tuberculosis has recently been demonstrated. Characteristically, there is destruction of the intervertebral disk space and the adjacent vertebral bodies, collapse of the spinal elements, and anterior wedging leading to kyphosis and gibbus formation. The thoracic region of vertebral column is most frequently affected. Formation of a ‘cold’ abscess around the lesion is another characteristic feature. The incidence of multi-level noncontiguous vertebral tuberculosis occurs more frequently than previously recognized. Common clinical manifestations include constitutional symptoms, back pain, spinal tenderness, paraplegia, and spinal deformities. For the diagnosis of spinal tuberculosis magnetic resonance imaging is more sensitive imaging technique than x-ray and more specific than computed tomography. Magnetic resonance imaging frequently demonstrates involvement of the vertebral bodies on either side of the disk, disk destruction, cold abscess, vertebral collapse, and presence of vertebral column deformities. Neuroimaging-guided needle biopsy from the affected site in the center of the vertebral body is the gold standard technique for early histopathological diagnosis. Antituberculous treatment remains the cornerstone of treatment. Surgery may be required in selected cases, e.g. large abscess formation, severe kyphosis, an evolving neurological deficit, or lack of response to medical treatment. With early diagnosis and early treatment, prognosis is generally good. PMID:22118251

  15. Spinal Crawlers: Deformable Organisms for Spinal Cord Segmentation and Analysis

    E-print Network

    Hamarneh, Ghassan

    Spinal Crawlers: Deformable Organisms for Spinal Cord Segmentation and Analysis Chris Mc, Canada {cmcintos, hamarneh}@cs.sfu.ca Abstract. Spinal cord analysis is an important problem relating to the study of various neurological diseases. We present a novel approach to spinal cord segmentation

  16. Spinal nephroblastoma in an Irish wolfhound.

    PubMed

    Vaughan-Scott, T; Goldin, J; Nesbit, J W

    1999-03-01

    A 1-year-old Irish wolfhound was presented with a history of slowly progressive left pelvic limb paresis. A neurological examination demonstrated bilateral deficits referable to the thoracolumbar spinal cord. Lumbar cerebrospinal fluid contained neoplastic cells. An intradural, extramedullary mass was demonstrated by myelography at the caudal aspect of T13. Surgical excision was abandoned owing to severe macroscopic damage to, and apparent infiltration of, the cord, and the dog was euthanased. The tumour was diagnosed histologically as an extrarenal nephroblastoma. Nephroblastoma should be suspected in young, large-breed dogs with intradural extramedullary masses over spinal segments T10-L2. The prognosis for complete recovery after surgical excision is guarded to poor. PMID:10855819

  17. Metal levels in corrosion of spinal implants

    PubMed Central

    Beguiristain, Jose; Duart, Julio

    2007-01-01

    Corrosion affects spinal instrumentations and may cause local and systemic complications. Diagnosis of corrosion is difficult, and nowadays it is performed almost exclusively by the examination of retrieved instrumentations. We conducted this study to determine whether it is possible to detect corrosion by measuring metal levels on patients with posterior instrumented spinal fusion. Eleven asymptomatic patients, with radiological signs of corrosion of their stainless steel spinal instrumentations, were studied by performing determinations of nickel and chromium in serum and urine. Those levels were compared with the levels of 22 patients with the same kind of instrumentation but without evidence of corrosion and to a control group of 22 volunteers without any metallic implants. Statistical analysis of our results revealed that the patients with spinal implants without radiological signs of corrosion have increased levels of chromium in serum and urine (P < 0.001) compared to volunteers without implants. Corrosion significantly raised metal levels, including nickel and chromium in serum and urine when compared to patients with no radiological signs of corrosion and to volunteers without metallic implants (P < 0.001). Metal levels measured in serum have high sensibility and specificity (area under the ROC curve of 0.981). By combining the levels of nickel and chromium in serum we were able to identify all the cases of corrosion in our series of patients. The results of our study confirm that metal levels in serum and urine are useful in the diagnosis of corrosion of spinal implants and may be helpful in defining the role of corrosion in recently described clinical entities such as late operative site pain or late infection of spinal implants. PMID:17256156

  18. How Is Hemophilia Diagnosed?

    MedlinePLUS

    ... page from the NHLBI on Twitter. How Is Hemophilia Diagnosed? If you or your child appears to ... have bleeding problems. However, some people who have hemophilia have no recent family history of the disease. ...

  19. Diagnosing Abiotic Degradation

    EPA Science Inventory

    The abiotic degradation of chlorinated solvents in ground water can be difficult to diagnose. Under current practice, most of the ?evidence? is negative; specifically the apparent disappearance of chlorinated solvents with an accumulation of vinyl chloride, ethane, ethylene, or ...

  20. Diagnosing tandem cells

    SciTech Connect

    Hou, J.; Fonash, S.J. [Pennsylvania State Univ., University Park, PA (United States). Electronic Materials and Processing Research Laboratory; Ghosh, M.; Xi, J.; Liu, T.; Kampas, F. [Advanced Photovoltaic Systems Inc., San Bruno, CA (United States)

    1994-12-31

    In this paper the authors report three new diagnostic techniques for identifying problem areas in tandem cells. These techniques can be easily extended to diagnosing triple junction cells. They applied these techniques to diagnose an a-Si:H based tandem cell having an extraordinarily low Voc. As they demonstrated, the assessments of the problem in this cell produced by each of the diagnostic approaches agree well with each other.

  1. Diagnosing gestational diabetes

    Microsoft Academic Search

    E. A. Ryan

    2011-01-01

    The newly proposed criteria for diagnosing gestational diabetes will result in a gestational diabetes prevalence of 17.8%,\\u000a doubling the numbers of pregnant women currently diagnosed. These new diagnostic criteria are based primarily on the levels\\u000a of glucose associated with a 1.75-fold increased risk of giving birth to large-for-gestational age infants (LGA) in the Hyperglycemia\\u000a Adverse Pregnancy Outcome (HAPO) study; they

  2. We count but should we scrutinize? An unreported complication in spinal surgery

    PubMed Central

    Dabis, John; Abdul-Jabar, Hani B.; Smith, Matthew; Kotrba, Michael

    2015-01-01

    Complications following spinal surgery can range from simple wound infection to complete paralysis. Intraoperative checks have been introduced to account for all the instruments and materials used and help minimize surgeon-related complications. We report a case of a broken osteotome tip within the spinal canal following a routine posterior decompression of the lumbar spine.

  3. Rehabilitation of spinal cord injuries

    PubMed Central

    Nas, Kemal; Yazmalar, Levent; ?ah, Volkan; Ayd?n, Abdulkadir; Öne?, Kadriye

    2015-01-01

    Spinal cord injury (SCI) is the injury of the spinal cord from the foramen magnum to the cauda equina which occurs as a result of compulsion, incision or contusion. The most common causes of SCI in the world are traffic accidents, gunshot injuries, knife injuries, falls and sports injuries. There is a strong relationship between functional status and whether the injury is complete or not complete, as well as the level of the injury. The results of SCI bring not only damage to independence and physical function, but also include many complications from the injury. Neurogenic bladder and bowel, urinary tract infections, pressure ulcers, orthostatic hypotension, fractures, deep vein thrombosis, spasticity, autonomic dysreflexia, pulmonary and cardiovascular problems, and depressive disorders are frequent complications after SCI. SCI leads to serious disability in the patient resulting in the loss of work, which brings psychosocial and economic problems. The treatment and rehabilitation period is long, expensive and exhausting in SCI. Whether complete or incomplete, SCI rehabilitation is a long process that requires patience and motivation of the patient and relatives. Early rehabilitation is important to prevent joint contractures and the loss of muscle strength, conservation of bone density, and to ensure normal functioning of the respiratory and digestive system. An interdisciplinary approach is essential in rehabilitation in SCI, as in the other types of rehabilitation. The team is led by a physiatrist and consists of the patients’ family, physiotherapist, occupational therapist, dietician, psychologist, speech therapist, social worker and other consultant specialists as necessary. PMID:25621206

  4. Coexistence of osteopoikilosis with seronegative spondyloarthritis and spinal stenosis

    PubMed Central

    Demir, Saliha Eroglu; Özaras, Nihal; Poyraz, Emine; Toprak, Hüseyin; Güler, Mustafa

    2015-01-01

    [Purpose] Osteopoikilosis is a rare hereditary bone disease that is usually asymptomatic. It is generally diagnosed incidentally on plain radiography. The coexistence of osteopoikilosis with seronegative spondyloarthritis or spinal stenosis is rarely reported. Here, we report the case of a 27-year-old male patient with osteopoikilosis, seronegative spondyloarthritis, and spinal stenosis. [Subject] A 27-year-old male patient with buttock pain and back pain radiating to the legs. [Methods] A plain anteroposterior radiograph of the pelvis revealed numerous round and oval sclerotic bone areas of varying size. Investigation of the knee joints showed similar findings, and the patient was diagnosed with osteopoikilosis. Lumbar magnetic resonance images showed spinal stenosis and degenerative changes in his lumbar facet joints. Magnetic resonance images of the sacroiliac joints showed bilateral involvement with narrowing of both sacroiliac joints, nodular multiple sclerotic foci, and contrast enhancement in both joint spaces and periarticular areas. HLA B-27 test was negative. [Results] The patient was diagnosed with osteopoikilosis, seronegative spondyloarthritis, and spinal stenosis. Treatment included asemetasin twice daily and exercise therapy. [Conclusion] Symptomatic patients with osteopoikilosis should be investigated for other possible coexisting medical conditions; this will shorten the times to diagnosis and treatment.

  5. Spinal Cord Injury

    MedlinePLUS

    ... with spinal cord injuries and aggressive treatment and rehabilitation can minimize damage to the nervous system and ... given within the first 8 hours after injury. Rehabilitation programs combine physical therapies with skill-building activities ...

  6. How Is Pulmonary Embolism Diagnosed?

    MedlinePLUS

    ... Twitter. How Is Pulmonary Embolism Diagnosed? Pulmonary embolism (PE) is diagnosed based on your medical history, a ... emergency room often are the ones to diagnose PE with the help of a radiologist. A radiologist ...

  7. How Is Cardiogenic Shock Diagnosed?

    MedlinePLUS

    ... from the NHLBI on Twitter. How Is Cardiogenic Shock Diagnosed? The first step in diagnosing cardiogenic shock ... is cardiogenic shock. Tests and Procedures To Diagnose Shock and Its Underlying Causes Blood Pressure Test Medical ...

  8. How Is Heart Disease Diagnosed?

    MedlinePLUS

    ... page from the NHLBI on Twitter. How Is Heart Disease Diagnosed? Your doctor will diagnose coronary heart ... the artery walls. Tests Used To Diagnose Broken Heart Syndrome If your doctor thinks you have broken ...

  9. Teaching neuroimages: neuromyelitis optica misdiagnosed as spinal cord tumor.

    PubMed

    Tsivgoulis, Georgios; Kontokostas, Stefanos; Boviatsis, Efstathios; Bonakis, Anastasios; Stefanis, Leonidas; Voumvourakis, Konstantinos

    2014-01-28

    A 17-year-old girl presented with acute-onset cervical pain, followed by left arm weakness and gait disturbances. Spinal cord astrocytoma was diagnosed by MRI performed at an outpatient facility (figure, A and B). The patient was admitted to the neurosurgery department to undergo spinal cord biopsy. A second neurologic evaluation indicated neuromyelitis optica (NMO) as the most likely diagnosis, which was confirmed by NMO-immunoglobulin G seropositivity. The patient was treated with rescue plasmapheresis with substantial clinical and radiologic (figure, C) improvement. PMID:24470607

  10. Acute management of traumatic cervical spinal cord injury.

    PubMed

    Ropper, Alexander E; Neal, Matthew T; Theodore, Nicholas

    2015-08-01

    Patients with acute cervical spinal cord injury present complex clinical challenges. These injuries may result in motor and sensory deficits and also in cardiovascular and respiratory perturbations. Increased attention to critical care support has led to improved survival and recovery in many patients. The methods and technology used to diagnose and classify these injuries as well as medical and surgical treatments have evolved significantly in recent decades. We review important aspects of the diagnosis and acute care of patients with traumatic cervical spinal cord injuries, emphasising the recent evidence. PMID:25986457

  11. Spinal Subdural Abscess: A Rare Complication of Decubitus Ulcer

    PubMed Central

    Usoltseva, Natalia; Medina-Flores, Rafael; Rehman, Ateeq; Samji, Swetha; D’Costa, Matthew

    2014-01-01

    Spinal subdural abscess (SSA) is an uncommon entity. The exact incidence is unknown, with very few cases reported in the literature. This condition may result in spinal cord compression, thus constituting a medical and neurosurgical emergency. The pathogenesis of SSA is not well-described, and the available knowledge is based on case observations only. There is only one case report that describes direct seeding from decubitus ulcers as a possible mechanism for development of SSA. We report a case of subacute onset of quadriplegia in a male patient, age 55 years, due to spinal cord compression from SSA and superimposed spinal subdural hematoma. The direct seeding from decubitus ulcers is thought to be the cause of infection in our patient. We present this case of SSA to elucidate and review the predisposing factors, pathogenesis, clinical presentation, diagnostic modalities, and treatment regarding management of this rare disorder. PMID:24667217

  12. Understanding Prostate Cancer: Newly Diagnosed

    MedlinePLUS

    ... My Bridge 4 Life Clinical Trials Guides Newsletters Nutrition & Wellness PCF Spotlight Glossary African American Men Understanding Prostate Cancer Newly Diagnosed Newly Diagnosed Staging the Disease Issues ...

  13. Sexual behaviour, recreational drug use and hepatitis C co-infection in HIV-diagnosed men who have sex with men in the United Kingdom: results from the ASTRA study

    PubMed Central

    Daskalopoulou, Marina; Rodger, Alison; Thornton, Alicia; Phillips, Andrew; Sherr, Lorraine; Gilson, Richard; Johnson, Margaret; Fisher, Martin; Anderson, Jane; McDonnell, Jeffrey; Edwards, Simon; Perry, Nicky; Collins, Simon; Bhagani, Sanjay; Speakman, Andrew; Smith, Colette; Lampe, Fiona

    2014-01-01

    Introduction Transmission of Hepatitis C virus (HCV) among HIV-positive men who have sex with men (MSM) in the United Kingdom is ongoing. We explore associations between self-reported sexual behaviours and drug use with cumulative HCV prevalence, as well as new HCV diagnosis. Methods ASTRA is a cross-sectional questionnaire study including 2,248 HIV-diagnosed MSM under care in the United Kingdom during 2011–2012. Socio-demographic, lifestyle, HIV-related and sexual behaviour data were collected during the study. One thousand seven hundred and fifty two (?70%) of the MSM who consented to linkage of ASTRA and clinical information (prior to and post questionnaire) were included. Cumulative prevalence of HCV was defined as any positive anti-HCV or HCV-RNA test result at any point prior to questionnaire completion. We excluded 536 participants with clinical records only after questionnaire completion. Among the remaining 1,216 MSM, we describe associations of self-reported sexual behaviours and recreational drug use in the three months prior to ASTRA with cumulative HCV prevalence, using modified Poisson regression with robust error variances. New HCV was defined as any positive anti-HCV or HCV-RNA after questionnaire completion. We excluded 591 MSM who reported ever having a HCV diagnosis at questionnaire, any positive HCV result prior to questionnaire or did not have any HCV tests after the questionnaire. Among the remaining 1,195 MSM, we describe occurrence of new HCV diagnosis during follow-up according to self-reported sexual behaviours and recreational drug use three months prior to questionnaire (Fisher's exact test). Results Cumulative HCV prevalence among MSM prior to ASTRA was 13.3% (95% CI 11.5–15.4). Clinic- and age-adjusted prevalence ratios (95% CI) for cumulative HCV prevalence were 4.6 (3.1–6.7) for methamphetamine, 6.5 (3.5–12.1) for injection drugs, 2.3 (1.6–3.4) for gamma hydroxybutyrate (GHB), 1.6 (1.3–2.0) for nitrites, 1.7 (1.5–2.0) for all condom-less sex (CLS), 2.1 (1.7–2.5) for CLS-HIV-seroconcordant, 1.3 (0.9–1.9) for CLS-HIV-serodiscordant, 2.0 (1.6–2.5) for group sex, 1.5 (1.2–1.9) for more than 10 new sexual partners in the past year. Among 1,195 MSM with 2.2 years [IQR 1.5–2.4] median follow-up, there were 7 new HCV cases during 2,033 person-years at risk. Incidence was 3.5 per 1,000 person-years (95% CI 1.6–7.2). New HCV was recorded in 1.3% MSM who used methamphetamine versus 0.5% MSM who did not (p=0.385); 3.7% MSM who injected recreational drugs versus 0.5% MSM who did not (p=0.148); 2.9% MSM who used GHB versus 0.4% MSM who did not (p=0.003); 1.5% MSM who used nitrites versus 0.2% MSM who did not (p=0.019); 1.1% MSM having CLS versus 0.3% MSM who did not (p=0.084); 1.7% MSM having CLS-HIV-serodiscordant versus 0.4% MSM who did not (p=0.069); 0.9% MSM who had CLS-HIV-seroconcordant versus 0.5% MSM who did not (p=0.318); 0.8% MSM who had group sex versus 0.5% MSM who did not (p=0.463); and 1.6% MSM with =10 new sexual partners in the previous year versus 0.2% MSM with no or up to 9 new partners (p=0.015). Conclusions Self-reported recent use of recreational and injection drugs, condom-less sex and multiple new sexual partners are associated with pre-existing HCV infection and, with the exception of injection drugs, appear to be predictive of new HCV co-infection among HIV-diagnosed MSM. PMID:25394134

  14. [Nursing diagnoses for diabetic patients using insulin].

    PubMed

    Becker, Tânia Alves Canata; Teixeira, Carla Regina de Souza; Zanetti, Maria Lúcia

    2008-01-01

    This is a descriptive study with a qualitative approach that has as objective to identify the nursing diagnoses of diabetic patients using insulin, having as inquiry method the study of multiple cases. The data were obtained by the researcher by means of physical examination and the technique of interview directed in the instrument based on the Orem's Self-Care Theory. After data collection, the diagnostic indentification was proceeded from the nominated nursing diagnoses of NANDA Taxonomy II, using Risner's reasoning diagnostic process. The identified nursing diagnoses with a higher frequency than 50% were six: impaired skin integrity (100%), risk for infection (100%), behavior of health search (57,2%), disturbed sleep (57,2%), chronic pain (57,2%) and risk for peripheral neurovascular dysfunction (57,2%). The application of the nursing process based in Orem and the importance of the identified diagnostic for clients nursing care were evidenced. PMID:19142391

  15. Myelopathy Caused by Spinal Dural Arterio-Venous Fistula after First Lumbar Vertebral Body Fracture - A Case Report -

    PubMed Central

    Kang, Jin-Woo; Kim, Dong-Kyu; Joo, Young-Jin; Kim, Tae-Hoon; Song, Sun-Hong

    2011-01-01

    Spinal dural arteriovenous fistula is a rare vascular lesion of the spinal cord associated with progressive myelopathy. Symptoms include progressive gait dysfunction, weakness, sensory loss, and bowel and bladder dysfunction. Because these symptoms overlap with other common causes of myelopathy and the disease is rare, spinal dural arteriovenous fistula is often not suspected and the time to diagnosis is long. We report the case of a 60-year-old woman who presented with progressive lower limb weakness and gait disturbance diagnosed as spinal dural arteriovenous fistula involving a fractured L1 vertebral body. PMID:22506198

  16. Diagnosing and Managing Violence

    PubMed Central

    2011-01-01

    Available categorization systems for violence encountered in medical practice do not constitute optimal tools to guide management. In this article, 4 common patterns of violence across psychiatric diagnoses are described (defensive, dominance-defining, impulsive, and calculated) and management implications are considered. The phenomenologic and neurobiological rationale for a clinical classification system of violence is also presented. PMID:22295257

  17. Diagnosing ADHD in Adolescence

    ERIC Educational Resources Information Center

    Sibley, Margaret H.; Pelham, William E., Jr.; Molina, Brooke S. G.; Gnagy, Elizabeth M.; Waschbusch, Daniel A.; Garefino, Allison C.; Kuriyan, Aparajita B.; Babinski, Dara E.; Karch, Kathryn M.

    2012-01-01

    Objective: This study examines adolescent-specific practical problems associated with current practice parameters for diagnosing attention-deficit/hyperactivity disorder (ADHD) to inform recommendations for the diagnosis of ADHD in adolescents. Specifically, issues surrounding the use of self- versus informant ratings, diagnostic threshold, and…

  18. Diagnosing gestational diabetes.

    PubMed

    Ryan, E A

    2011-03-01

    The newly proposed criteria for diagnosing gestational diabetes will result in a gestational diabetes prevalence of 17.8%, doubling the numbers of pregnant women currently diagnosed. These new diagnostic criteria are based primarily on the levels of glucose associated with a 1.75-fold increased risk of giving birth to large-for-gestational age infants (LGA) in the Hyperglycemia Adverse Pregnancy Outcome (HAPO) study; they use a single OGTT. Thus, of 23,316 pregnancies, gestational diabetes would be diagnosed in 4,150 women rather than in 2,448 women if a twofold increased risk of LGA were used. It should be recognised that the majority of women with LGA have normal glucose levels during pregnancy by these proposed criteria and that maternal obesity is a stronger predictor of LGA. The expected benefit of a diagnosis of gestational diabetes in these 1,702 additional women would be the prevention of 140 cases of LGA, 21 cases of shoulder dystocia and 16 cases of birth injury. The reproducibility of an OGTT for diagnosing mild hyperglycaemia is poor. Given that (1) glucose is a weak predictor of LGA, (2) treating these extra numbers has a modest outcome benefit and (3) the diagnosis may be based on a single raised OGTT value, further debate should occur before resources are allocated to implementing this change. PMID:21203743

  19. Gender differences in the clinical characteristics of traumatic spinal fractures among the elderly.

    PubMed

    Wang, Hongwei; Xiang, Liangbi; Liu, Jun; Zhou, Yue; Ou, Lan

    2014-01-01

    In order to illustrate the epidemiology of traumatic spinal fractures among the elderly, with an emphasis on exploring gender differences in clinical characteristics, we retrospectively reviewed hospital records on all elderly patients with traumatic spinal fractures who were 60 years of age or older at two university-affiliated hospitals between January 2001 and December 2010. A total of 642 elderly patients with traumatic spinal fractures were identified, of whom 249 were male and 393 were female. Accidental falls from low heights were the most common cause of traumatic spinal fractures among the elderly (50.8%). Frequencies of falls from high heights and direct collisions with a blunt object were significantly higher in male than in female elderly patients (P<0.05). Frequencies of falls from low heights, daily life injuries and jolt injuries in female patients were significantly higher than in male patients (P<0.05). There were 984 vertebral body fractures, with the thoracolumbar segment involved in 60.3% of cases (227/984). Frequencies of cervical spinal fractures, spinal cord injuries, associated non-spinal injuries (ASOIs) and mean injury severity scores (ISSs) were significantly higher in males than in females (P<0.05). Frequencies of thoracic and thoracolumbar spinal fractures in females were significantly higher than in males (P<0.05). Clinicians should make their diagnoses and direct their injury prevention strategies according to gender differences in the clinical characteristics of traumatic spinal fractures among the elderly. PMID:25109809

  20. 17-Year-Delayed Fistula Formation After Elective Spinal Instrumentation: A Case Report

    PubMed Central

    Etemadrezaei, Hamid; Zabihyan, Samira; Shakeri, Aidin; Ganjeifar, Babak

    2015-01-01

    Introduction A late-developing infection after an uneventful initial spinal instrumentation procedure is rare. Delayed infection and new fistula formation have been reported from a few months to 13 years. Here we report an unusual 17-year-delayed fistula formation after primary spinal instrumentation. The patient underwent hardware removal surgery with antibiotic therapy as a definitive treatment. Case Presentation Here we report an unusual 17-year delayed fistula formation after primary spinal instrumentation due to spinal trauma. He was admitted to Ghaem General Hospital, a chief referral center, Mashhad, North-East of Iran in August 2014. The patient underwent hardware removal surgery with antibiotic therapy as a definitive treatment. Conclusions Late inflammation may occur around spinal instruments and results in cutaneous fistula formation. After oral or intravenous antibiotic treatment, total device extraction is the cornerstone of treatment.

  1. What Is Spinal Cord Injury?

    MedlinePLUS

    ... NICHD Research Information Clinical Trials Resources and Publications Spinal Cord Injury (SCI): Condition Information Skip sharing on social ... with SCI is the lowest point on the spinal cord below which sensory feeling and motor movement diminish ...

  2. Living with Spinal Cord Injury

    MedlinePLUS

    ... techniques that may prevent injury and disease. A spinal cord injury (SCI) can result from trauma, such as ... with daily living skills. What can persons with spinal cord injuries and their friends and families do? ? Get ...

  3. Spinal Cord Injury Prevention Tips

    MedlinePLUS

    Spinal Cord Injury Prevention Tips Preventing SCI Biking prevention tips While many cycling injuries are head injuries, the ... NeurosurgeryToday.org Every year, an estimated 11,000 spinal cord injury (SCI) accidents occur in the United States. ...

  4. Spinal surgery -- cervical - series (image)

    MedlinePLUS

    The cervical spinal column is made up of vertebral bodies which protect the spinal cord. ... Cervical spine disease is usually caused by herniated intervertebral discs, abnormal growth of bony processes on the ...

  5. Pediatric Spinal Cord Injury 101

    MedlinePLUS Videos and Cool Tools

    ... Injury 101 The Basics of Spinal Cord Injury Rehabilitation Preventing Pressure Sores Transition from Hospital to Home ... Cord Injury 101 The Basics of Pediatric SCI Rehabilitation Transitions for Children with Spinal Cord Injury What's ...

  6. Diagnosable discrete event systems design

    Microsoft Academic Search

    Yuanlin Wen; Pei-shu Fan; Muder Jeng

    2007-01-01

    This paper presents an approach using Petri nets for designing diagnosable discrete event systems such as complex semiconductor manufacturing machines. The concept is based on diagnosability analysis and enhancement. In this paper, we interpret and formulate the diagnosability problem as a binary integer linear programming problem that may have a feasible solution. If the system is predicted to be non-diagnosable,

  7. [A case of conversion disorder (hysteria) after spinal anesthesia].

    PubMed

    Sugimoto, Yumi; Makino, Shiho; Doi, Yumiko; Nishimura, Mitsuo; Baba, Miwa; Mizukawa, Shunichi; Kobayashi, Yoji

    2009-02-01

    We report a case of conversion disorder after spinal anesthesia. A 16-year-old healthy woman underwent arthroscopic surgery under spinal anesthesia. She showed tremor all over and it did not stop. We sedated her with propofol during the operation. After the operation, her involuntary tremble continued. We consulted with a pediatrician who diagnosed her as conversion disorder. Magnetic resonance imaging and computed tomography were performed to rule out some pathological changes and abnormality in her head. As a result, Rathke cleft cyst was suspected but it could not explain this episode. We consider that her stress for the operation under spinal anesthesia caused this episode. In a case of a younger patient, it is necessary to consider mental support. And we need to suspect conversion disorder when we see tremor during operation under regional anesthesia. PMID:19227180

  8. Historical perspective: the development and use of spinal disease categories.

    PubMed

    Weiner, Bradley K

    2008-04-15

    This historical perspective traces the history of the development of pathoanatomically based spinal disease diagnosis and the subsequent use of these diagnoses for scientific and social purposes. Spinal diagnostic categories have been used positively to guide both clinical (including their use as the primary units of investigation in many epidemiological and evidence-based projects) and basic science (studying the pathoanatomic disease outside of the patient) research programs--the aim being the improvement of patient care and outcomes. They are also used socially to confer/reject acceptability to patient behavior; to justify health policy decisions; to structure medical relationships; to shape medical/institutional infrastructure; to direct patient care via guideline establishment; and to manage health care. The positive and negative implications of the use of spinal disease categories are discussed. PMID:18404115

  9. Spinal muscular atrophy in childhood

    Microsoft Academic Search

    A. Moosa; V. Dubowitz

    1973-01-01

    A coarse tremor was noted in 13 children suffering from the childhood form of spinal muscular atrophy. Tremor has not been seen in any other condition producing proximal muscle weakness in childhood, and its presence should therefore suggest the diagnosis of spinal muscular atrophy.In addition, the feet of patients with spinal muscular atrophy tended to evert, whereas in Duchenne muscular

  10. Neurophysiological effects of spinal manipulation

    Microsoft Academic Search

    Joel G Pickar

    2002-01-01

    Background context: Despite clinical evidence for the benefits of spinal maniputation and the apparent wide usage of it, the biological mechanisms underlying the effects of spinal manipulation are not known. Although this does not negate the clinical effects of spinal manipulation, it hinders acceptance by the wider scientific and health-care communities and hinders rational strategies for improving the delivery of

  11. Neurophysiological effects of spinal manipulation

    Microsoft Academic Search

    Joel G. Pickar

    2002-01-01

    Background context: Despite clinical evidence for the benefits of spinal maniputation and the appar- ent wide usage of it, the biological mechanisms underlying the effects of spinal manipulation are not known. Although this does not negate the clinical effects of spinal manipulation, it hinders acceptance by the wider scientific and health-care communities and hinders rational strategies for improving the delivery

  12. [Rupture of intrascrotal epidermoid cyst complicated by bacterial infection: a case report].

    PubMed

    Nezasa, S; Ehara, H; Deguchi, T

    2001-06-01

    A 63-year-old male visited our hospital with the chief complaint of right scrotal pain. The right scrotum was swollen to the size of a small egg, and its skin was reddish. The mass was palpable independent of the right testis and epididymis. We diagnosed an intrascrotal abscess. The pus spontaneously issued from the scrotal mass. Sequentially, the abscess was extracted under spinal anesthesia. Membrane-like tissue assumed as the abscess wall was removed. Histologically, the abscess wall was composed of epidermal structure with epidermal keratinization, and horny material was found inside the wall. In the scrotal epidermis overlying the abscess, infiltration of neutrophils, lymphocytes, and multinucleated giant cells were observed. Anaerobic bacteria were detected in the pus of the abscess. Consequently, we diagnosed this case as rupture of an intrascrotal epidermoid cyst complicated by bacterial infection. PMID:11496404

  13. Six unaffected livebirths following preimplantation diagnosis for spinal muscular atrophy

    Microsoft Academic Search

    Graeme Daniels; Rachel Pettigrew; Alan Thornhill; Stephen Abbs; Alison Lashwood; Fiona O'Mahony; Christopher Mathew; Alan Handyside; Peter Braude

    2001-01-01

    Spinal muscular atrophy (SMA) is a severe neurodegenerative autosomal recessive disorder, second only in frequency to cystic fibrosis. In its most severe form, SMA type I (Werdnig-Hoffman), death invariably ensues before age 2 years from respiratory failure or infection. Around 98% of clinical cases of SMA are caused by the homozygous absence of a region of exons 7 and 8

  14. Brain and spinal tumour.

    PubMed

    Goh, C H; Lu, Y Y; Lau, B L; Oy, J; Lee, H K; Liew, D; Wong, A

    2014-12-01

    This study reviewed the epidemiology of brain and spinal tumours in Sarawak from January 2009 till December 2012. The crude incidence of brain tumour in Sarawak was 4.6 per 100,000 population/year with cumulative rate 0.5%. Meningioma was the most common brain tumour (32.3%) and followed by astrocytoma (19.4%). Only brain metastases showed a rising trend and cases were doubled in 4 years. This accounted for 15.4% and lung carcinoma was the commonest primary. Others tumour load were consistent. Primitive neuroectodermal tumour (PNET) and astrocytoma were common in paediatrics (60%). We encountered more primary spinal tumour rather than spinal metastases. Intradural schwannoma was the commonest and frequently located at thoracic level. The current healthcare system in Sarawak enables a more consolidate data collection to reflect accurate brain tumours incidence. This advantage allows subsequent future survival outcome research and benchmarking for healthcare resource planning. PMID:25934956

  15. Lumbar spinal stenosis.

    PubMed Central

    Ciricillo, S F; Weinstein, P R

    1993-01-01

    Lumbar spinal stenosis, the results of congenital and degenerative constriction of the neural canal and foramina leading to lumbosacral nerve root or cauda equina compression, is a common cause of disability in middle-aged and elderly patients. Advanced neuroradiologic imaging techniques have improved our ability to localize the site of nerve root entrapment in patients presenting with neurogenic claudication or painful radiculopathy. Although conservative medical management may be successful initially, surgical decompression by wide laminectomy or an intralaminar approach should be done in patients with serious or progressive pain or neurologic dysfunction. Because the early diagnosis and treatment of lumbar spinal stenosis may prevent intractable pain and the permanent neurologic sequelae of chronic nerve root entrapment, all physicians should be aware of the different neurologic presentations and the treatment options for patients with spinal stenosis. Images PMID:8434469

  16. Transverse myelitis and acute HIV infection: a case report

    PubMed Central

    2014-01-01

    Background Most HIV infected patients will develop some sort of neurologic involvement of the disease throughout their lives, usually in advanced stages. Neurologic symptoms may occur in acute HIV infection but myelopathy in this setting is rare. Up until this date, only two cases of transverse myelitis as a manifestation of acute HIV infection have been reported in the literature. Therapeutic approach in these patients is not well defined. Case presentation A 35 year-old male Caucasian recently returned from the tropics presented to our hospital with urinary retention and acute paraparesis. After extensive diagnostic workup he was diagnosed with acute HIV infection presenting as transverse myelitis. Full neurologic recovery was observed without the use of anti-retroviral therapy. Conclusion Acute spinal cord disorders are challenging, as they present a wide array of differential diagnosis and may lead to devastating sequelae. Timely and rigorous diagnostic workup is of the utmost importance when managing these cases. Clinicians should be aware of the protean manifestations of acute HIV infection, including central nervous system involvement, and have a low threshold for HIV screening. PMID:24646059

  17. Congenital spinal lipomatous malformations

    Microsoft Academic Search

    Natarajan Muthukumar

    2009-01-01

    Background  To report this author’s experience with patients with a congenital spinal lipomatous malformation with special emphasis on\\u000a variations in clinical presentation, operative findings, and outcome based on the classification scheme proposed in the first\\u000a part of this two part article.\\u000a \\u000a \\u000a \\u000a Methods  From January 1995 to July 2005, 80 patients with a congenital spinal lipomatous malformation were treated. All patients underwent\\u000a routine

  18. Spinal Cord Injury

    NSDL National Science Digital Library

    Patient Education Institute

    This patient education program discusses how spinal cord injuries are caused and their treatment options. It also includes tips on how to prevent spinal cord injuries. This resource is a MedlinePlus Interactive Health Tutorial from the National Library of Medicine, designed and developed by the Patient Education Institute. NOTE: This tutorial requires a special Flash plug-in, version 4 or above. If you do not have Flash, you will be prompted to obtain a free download of the software before you start the tutorial. You will also need an Acrobat Reader, available as a free download, in order to view the Reference Summary.

  19. Anterior spinal cord syndrome of unknown etiology

    PubMed Central

    Klakeel, Merrine; Thompson, Justin; McDonald, Frank

    2015-01-01

    A spinal cord injury encompasses a physical insult to the spinal cord. In the case of anterior spinal cord syndrome, the insult is a vascular lesion at the anterior spinal artery. We present the cases of two 13-year-old boys with anterior spinal cord syndrome, along with a review of the anatomy and vasculature of the spinal cord and an explanation of how a lesion in the cord corresponds to anterior spinal cord syndrome. PMID:25552812

  20. Multimodal Therapy for Localized Spinal Epidural Follicular Lymphoma

    Microsoft Academic Search

    Christoph Kahl; Carsten Hirt; Susanne Decker; Dietrich Gläser; Sebastian Rohde; Kirsten Jost; Inken Hilgendorf; Eva Respondek-Dryba; Malte Leithäuser; Christian Junghanss; Mathias Freund

    2010-01-01

    SummaryBackground: Myelopathy due to epidural spinal cord compression is rare in patients with malignant lymphoma and most of these patients are diagnosed with high-grade lymphoma. An epidural growth of low-grade lymphoma is even more unusual. Due to this low incidence, therapeutic experience for this entity is limited. Patients and Methods: We report the outcome of 3 consecutive patients with primary

  1. Surgical Treatment of Lumbar Spinal Stenosis in the Elderly

    Microsoft Academic Search

    A. Kalbarczyk; A. Lukes; R. W. Seiler

    1998-01-01

    Summary  ?148 elderly patients, aged 70 years or more, diagnosed as having lumbar spinal stenosis, were operated upon at our institution\\u000a during 1983 to 1995. Totally 161 operative procedures were performed. We analysed retrospectively the results of the surgical\\u000a treatment.\\u000a \\u000a ?The most frequently performed procedure was multisegmental laminectomy, in 32% interlaminar fenestration and laminotomy were\\u000a done. In 9 cases fusion was

  2. Project WIN: A Direct Service Program for Handicapped Children (Birth to Six) Who Are At Risk for or Diagnosed with HIV Infection and Their IV Drug Using Parents. Final Report.

    ERIC Educational Resources Information Center

    Woodruff, Geneva; Anson, Christopher R.

    This final report describes Project WIN, a 3-year demonstration project in Massachusetts which served children diagnosed as HIV (human immunodeficiency virus) positive and their intravenous drug using parents. The transagency community based model was designed to serve the educational, medical, therapeutic and social needs of 25 preschool children…

  3. Lumbar spinal stenosis: surgical considerations.

    PubMed

    Nasca, Richard J

    2002-01-01

    Spinal stenosis is an acquired or congenital narrowing of the spinal or nerve-root canals. Surgical treatment is often effective. Acquired spinal stenosis most commonly occurs in those with degenerative disk disease and arthritic facets. If the degenerative process stabilizes and there is adequate room to accommodate the neural contents, symptomatic patients become asymptomatic. Residual stability after decompression must be assessed in patients having multilevel decompression. Fusion maybe indicated. In women with osteoporosis coexisting with degenerative scoliosis and spinal stenosis, decompression for concave nerve-root compression and fusion are necessary. Spinal fusion is not indicated in patients with lumbar spinal stenosis having unilateral decompression for lateral stenosis. Patients with central-mixed stenosis may not need fusion. Patients with spinal stenosis after laminectomies and diskectomies had better results when arthrodesis was done in conjunction with repeated decompression. Arthrodesis with instrumentation and decompression is recommended for patients with degenerative spondylolisthesis. PMID:12539936

  4. Spinal Tuberculosis: Diagnosis and Management

    PubMed Central

    Rasouli, Mohammad R.; Mirkoohi, Maryam; Vaccaro, Alexander R.; Yarandi, Kourosh Karimi

    2012-01-01

    The spinal column is involved in less than 1% of all cases of tuberculosis (TB). Spinal TB is a very dangerous type of skeletal TB as it can be associated with neurologic deficit due to compression of adjacent neural structures and significant spinal deformity. Therefore, early diagnosis and management of spinal TB has special importance in preventing these serious complications. In order to extract current trends in diagnosis and medical or surgical treatment of spinal TB we performed a narrative review with analysis of all the articles available for us which were published between 1990 and 2011. Althoug h the development of more accurate imaging modalities such as magnetic resonance imaging and advanced surgical techniques have made the early diagnosis and management of spinal TB much easier, these are still very challenging topics. In this review we aim to discuss the diagnosis and management of spinal TB based on studies with acceptable design, clearly explained results and justifiable conclusions. PMID:23275816

  5. Management of spinal metastases

    Microsoft Academic Search

    Frank D Vrionis; Rafael Miguel

    2003-01-01

    Spinal metastasis is a frequent oncologic and neurosurgical emergency in patients with cancer. Most patients present with back pain and the diagnosis is established with a screening MRI of the spine. Treatment options include steroids, biphosphonates, radiation therapy, surgery and radiosurgery. Pain management is a very important aspect and includes opioids, anti-inflammatory agents, newer anticonvulsants and tricyclic anti-depressants, as well

  6. Spinal cord injury

    Microsoft Academic Search

    Bob Winter; Hina Pattani

    2008-01-01

    The annual incidence of acute spinal cord injury in the UK is 15–40 cases per million. More than half these injuries are the result of road traffic accidents, with falls, industrial accidents, sports or violence making up most of the remainder. Violent injury accounts for only a small percentage of cases in this country. The typical patient is male (male

  7. Spinal cord injury

    Microsoft Academic Search

    Bob Winter; Hina Pattani

    2011-01-01

    The annual incidence of acute spinal cord injury in the UK is 15–40 cases per million. More than half of these injuries are the result of road traffic accidents, with falls, industrial accidents, sports or violence making up most of the remainder. Violent injury accounts for only a small percentage of cases in the UK. The typical patient is male

  8. Spontaneous spinal epidural hematoma

    Microsoft Academic Search

    Weiying Zhong; Haifeng Chen; Chao You; Jin Li; Yi Liu; Siqing Huang

    2011-01-01

    Spontaneous spinal epidural hematoma (SSEH) is a rare emergent condition. It may result in paraplegia, quadriplegia and even death. Prompt diagnosis and emergent decompressive surgical management have been recommended to prevent mortality and morbidity. Although several factors have been associated with prognosis, controversy remains, partly due to its rarity. Thus, the history, clinical presentation, physical examination findings, radiological images, and

  9. Dorsal epidural spinal lipomatosis

    Microsoft Academic Search

    S Chibbaro; G Mirone; M Nouri; P Di Emidio; M Polivka; M Marsella; B George

    2011-01-01

    The authors report a case of a thoracic epidural spinal lipomatosis causing severe neurological deficits along the review of pertinent literature. The patient is a 56-year-old woman who presented with acute onset of severe paraparesis; she was investigated with cervical and thoracic MRI and then surgically managed because of an intraspinal mass compressing the cord. The operation consisted in the

  10. Posterior spinal anatomy (image)

    MedlinePLUS

    The vertebral column is divided into the cervical, thoracic, and lumbar region. It provides structural support for the trunk and surrounds and protects the spinal cord. The vertebral column also provides attachment points for the muscles of the back and ribs.

  11. Acute Spinal Cord Injury.

    PubMed

    Witiw, Christopher D; Fehlings, Michael G

    2015-07-01

    Our understanding of the pathophysiological processes that comprise the early secondary phases of spinal cord injury such as spinal cord ischemia, cellular excitotoxicity, ionic dysregulation, and free-radical mediated peroxidation is far greater now than ever before, thanks to substantial laboratory research efforts. These discoveries are now being translated into the clinical realm and have led to targeted upfront medical management with a focus on tissue oxygenation and perfusion and include avoidance of hypotension, induction of hypertension, early transfer to specialized centers, and close monitoring in a critical care setting. There is also active exploration of neuroprotective and neuroregenerative agents; a number of which are currently in late stage clinical trials including minocycline, riluzole, AC-105, SUN13837, and Cethrin. Furthermore, new data have emerged demonstrating that the timing of spinal cord decompression after injury impacts recovery and that early decompression leads to significant improvements in neurological recovery. With this review we aim to provide a concise, clinically relevant and up-to-date summary of the topic of acute spinal cord injury, highlighting recent advancements and areas where further study is needed. PMID:26098670

  12. How Is Cystic Fibrosis Diagnosed?

    MedlinePLUS

    ... from the NHLBI on Twitter. How Is Cystic Fibrosis Diagnosed? Doctors diagnose cystic fibrosis (CF) based on ... to see whether the baby has CF. Cystic Fibrosis Carrier Testing People who have one normal CFTR ...

  13. Retrospective review of 707 cases of spinal cord stimulation: indications and complications.

    PubMed

    Mekhail, Nagy A; Mathews, Manu; Nageeb, Fady; Guirguis, Maged; Mekhail, Mark N; Cheng, Jianguo

    2011-01-01

    Appropriate patient selection and minimizing complications are critical for successful spinal cord stimulation (SCS) therapy in managing intractable pain. We thus reviewed electronic medical records of 707 consecutive cases of patients who received SCS therapy in the Cleveland Clinic from 2000 to 2005 with an emphasis on indications and complications. SCS was used to treat complex regional pain syndrome (CRPS) (345 cases), failed back surgery syndrome (235 cases), peripheral vascular disease (20 cases), visceral pain in the chest, abdomen, and pelvis (37 cases), and peripheral neuropathy (70 cases). CRPS and failed back surgery syndrome accounted for 82% of the cases. The implant-to-trial ratio was 75% on average, with the highest for CRPS type 2 (83%) and the lowest for peripheral vascular diseases (65%). The only documented complication associated with SCS trials was lead migration in 5 of 707 patients (0.7%). There were no permanent neurological deficits or deaths as a result of SCS implant or its complications. Hardware-related complications were common (38%) and included lead migration (22.6%), lead connection failure (9.5%), and lead breakage (6%). Revisions or replacements were required in these cases. Biologically related complications included pain at the generator site (12%) and clinical infection (4.5%; 2.5% with positive culture). The rates of infection varied among the different diagnoses with the highest in failed back surgery syndrome (6.3%). Patients with diabetes had an infection rate of 9%, over the 4% in non-diabetics. Infections were managed successfully with explantation and antibiotic therapy without permanent sequela. PMID:21371254

  14. A paradigm for the evaluation and management of spinal coccidioidomycosis

    PubMed Central

    Martirosyan, Nikolay L.; Skoch, Jesse M.; Zaninovich, Orel; Zoccali, Carmine; Galgiani, John N.; Baaj, Ali A.

    2015-01-01

    Background: Coccidioidomycosis is a fungal infection that is endemic to parts of the Southwestern United States. When infection involves the spine, the treatment strategies can be challenging. We have devised a management protocol for spinal coccidioidomycosis based on a review of the literature and our experience. Methods: The electronic literature search of National Library of Medicine for publications from 1964 to 2014 was performed using the following keywords: Coccidioidomycosis and spine. The search yielded 24 papers. Treatment strategies were summarized into a treatment protocol. Results: A total of 164 cases of spinal coccidioidomycosis were identified, ranging in age from <10 to >80 years. Males (n = 131) and African-Americans (n = 79) were strikingly over-represented. Medical therapy: Once a diagnosis of spinal coccidioidomycosis is established, antifungal therapy should always be started. Antifungal therapy with amphotericin B or azoles like fluconazole. Medical therapy needs to be continued for many years and sometimes indefinitely to reduce disease recurrence or progression. Surgical management is indicated in cases with mechanical instability, neurologic deficit, medically intractable pain, or progression of infection despite antifungal therapy. Conclusions: This work provides a working protocol involving assessment and reassessment for the management of spinal coccidioidomycosis. Medical management with antifungal agents in some cases can provide satisfactory disease control. However, in patients with mechanical instability, neurologic deficit, medically intractable pain or disease progression disease control may only be achieved with surgical debridement and stabilization. PMID:26167359

  15. Hypothalamic paraventricular axons projecting to the female rat lumbosacral spinal cord contain oxytocin immunoreactivity.

    PubMed

    Puder, B A; Papka, R E

    2001-04-01

    Oxytocin-containing axons project from the hypothalamic paraventricular nucleus to the neurohypophysis and thoracic spinal cord to ultimately influence uterine contractions and autonomic activity, respectively. Whether or not oxytocin-immunoreactive axons project to the female rat lumbosacral spinal cord to influence autonomic outflow to pelvic organs has not been investigated. Thus, the present study was designed to investigate the presence, distribution, and origin of oxytocin-immunoreactive axons in the female rat lumbosacral spinal cord. Immunohistochemistry, spinal cord transections, and axonal tracing with Fluorogold, True Blue, and pseudorabies virus were used. Oxytocin-immunoreactive nerve fibers were present in the L6/S1 segments of the spinal cord. Prominent varicose axons were evident throughout the dorsal horn, along the lateral and medial collateral pathways, in the dorsal intermediate gray area, around the central canal in lamina X, and throughout the sacral parasympathetic nucleus. Injection of retrograde tracer into the L6/S1 spinal cord labeled neurons in the hypothalamic paraventricular nucleus. Transection of the thoracic spinal cord eliminated oxytocin-immunoreactive nerve axons in the L6/S1 spinal cord. In addition, transection of the thoracic spinal cord eliminated transport of retrograde axonal tracer from the L6/S1 spinal cord to the paraventricular nucleus. Pseudorabies virus, a transneuronal retrograde tracer, injected into the uterus and cervix marked uterine-related preganglionic neuronal cell bodies in the sacral parasympathetic nucleus and uterine-related neurons in the hypothalamic paraventricular nucleus. Double immuno-labeling of viral-infected spinal cord sections showed oxytocin-immunoreactive axons closely associated with viral labeled uterine-related preganglionic cell bodies of the sacral parasympathetic nucleus. The results of this study revealed that oxytocin-immunoreactive neurons of the hypothalamic paraventricular nucleus project axons to the lumbosacral spinal cord to areas involved in sensory processing and parasympathetic outflow to the uterus. PMID:11276051

  16. Spinal Arteriovenous Fistula with Progressive Paraplegia after Spinal Anaesthesia

    PubMed Central

    Argyrakis, Nikolaos; Matis, Georgios K.; Mpata-Tshibemba, Stephanie

    2014-01-01

    A case of an iatrogenic spinal arteriovenous fistula with progressive paraplegia in a young woman is reported. The fistula was eventually created after repetitive lumbar punctures performed in the process of spinal anaesthesia. Her symptoms were progressed to paraplegia over a period of 2 years. The digital subtraction angiography demonstrated a single-hole fistula, involving the anterior spinal artery and vein. The lesion was occluded by embolization with immediate improvement. The potential mechanism is discussed. PMID:24653807

  17. Diagnosable structured logic array

    NASA Technical Reports Server (NTRS)

    Whitaker, Sterling (Inventor); Miles, Lowell (Inventor); Gambles, Jody (Inventor); Maki, Gary K. (Inventor)

    2009-01-01

    A diagnosable structured logic array and associated process is provided. A base cell structure is provided comprising a logic unit comprising a plurality of input nodes, a plurality of selection nodes, and an output node, a plurality of switches coupled to the selection nodes, where the switches comprises a plurality of input lines, a selection line and an output line, a memory cell coupled to the output node, and a test address bus and a program control bus coupled to the plurality of input lines and the selection line of the plurality of switches. A state on each of the plurality of input nodes is verifiably loaded and read from the memory cell. A trusted memory block is provided. The associated process is provided for testing and verifying a plurality of truth table inputs of the logic unit.

  18. MASCIS Spinal Cord Contusion Model

    Microsoft Academic Search

    Wise Young

    The impactor is the most widely used rodent spinal cord injury model. The Multicenter Animal Spinal Cord Injury Study (MASCIS)\\u000a adopted the model in 1993 and standardized protocols for anesthesia, surgery, spinal cord contusion, and post-injury care\\u000a of rats, as well as specific outcome measures. The MASCIS model stipulates Long-Evan's hooded rats that are 77 ± 1-day old\\u000a and anesthetized

  19. Spinal muscular atrophy

    Microsoft Academic Search

    K. Talbot

    1999-01-01

    Spinal muscular atrophy is a common cause of disability in childhood and is characterized by weakness and wasting of voluntary\\u000a muscle. It is frequently fatal. The gene for this disorder has been identified as the SMN gene and is part of a highly complex\\u000a duplicated region of chromosome 5 that is subject to a high rate of gene deletion and

  20. Spinal muscular atrophy

    Microsoft Academic Search

    Susan T. Iannaccone; Stephen A. Smith; Louise R. Simard

    2004-01-01

    Spinal muscular atrophy is a common genetic disease of the motor neuron (frequency of eight cases per 100,000 live births)\\u000a with a high mortality during infancy and no known treatment. Death is caused by severe and progressive restrictive lung disease.\\u000a New information regarding the nature and function of the SMN protein and the availability of new pharmacologic agents now\\u000a make

  1. Malignant spinal cord compression

    Microsoft Academic Search

    Madhuri Yalamanchili; Glenn J. Lesser

    2003-01-01

    Opinion statement  Malignant spinal cord compression is one of the most dreaded complications of cancer. If untreated, it can lead to worsening\\u000a neurologic function culminating in paralysis and sphincter incontinence. The most challenging aspect in the management of\\u000a this complication is early diagnosis because the single most important factor determining outcome is the level of neurologic\\u000a function at initiation of therapy.

  2. Aspergillus spinal epidural abscess

    SciTech Connect

    Byrd, B.F. III (Vanderbilt Univ. School of Medicine, Nashville, TN); Weiner, M.H.; McGee, Z.A.

    1982-12-17

    A spinal epidural abscess developed in a renal transplant recipient; results of a serum radioimmunoassay for Aspergillus antigen were positive. Laminectomy disclosed an abscess of the L4-5 interspace and L-5 vertebral body that contained hyphal forms and from which Aspergillus species was cultured. Serum Aspergillus antigen radioimmunoassay may be a valuable, specific early diagnostic test when systemic aspergillosis is a consideration in an immunosuppressed host.

  3. Risk Factors for Chest Illness in Chronic Spinal Cord Injury

    PubMed Central

    Stolzmann, Kelly L.; Gagnon, David R.; Brown, Robert; Tun, Carlos G.; Garshick, Eric

    2011-01-01

    Objective Chest illnesses commonly cause morbidity in persons with chronic spinal cord injury. Risk factors remain poorly characterized because previous studies have not accounted for factors other than spinal cord injury. Design Between 1994 and 2005, 403 participants completed a respiratory questionnaire and underwent spirometry. Participants were contacted at a median of 1.7 yrs [interquartile range: 1.3–2.5 yrs] apart over a mean (SD) of 5.1 ± 3.0 yrs and asked to report chest illnesses that had resulted in time off work, spent indoors, or in bed since prior contact. Results In 97 participants, there were 247 chest illnesses (0.12/person-year) with 54 hospitalizations (22%). Spinal cord injury level, completeness of injury, and duration of injury were not associated with illness risk. Adjusting for age and smoking history, any wheeze (relative risk = 1.92; 95% confidence interval: 1.19, 3.08), pneumonia or bronchitis since spinal cord injury (relative risk = 2.29; 95% confidence interval: 1.40, 3.75), and physician-diagnosed chronic obstructive pulmonary disease (relative risk = 2.17; 95% confidence interval: 1.08, 4.37) were associated with a greater risk of chest illness. Each percent-predicted decrease in forced expiratory volume in 1 sec was associated with a 1.2% increase in risk of chest illness (P = 0.030). Conclusions In chronic spinal cord injury, chest illness resulting in time spent away from usual activities was not related to the level or completeness of spinal cord injury but was related to reduced pulmonary function, wheeze, chronic obstructive pulmonary disease, a history of pneumonia and bronchitis, and smoking. PMID:20463565

  4. Percutaneous radiofrequency ablation of spinal osteoid osteoma under CT guidance

    PubMed Central

    Morassi, L G; Kokkinis, K; Karargyris, O; Vlachou, I; Kalokairinou, K; Pneumaticos, S G

    2014-01-01

    Objective: Osteoid osteoma (OO) accounts for approximately 10–12% of all benign bone tumours and 3% of all bone tumours. Spinal involvement appears in 10–25% of all cases. The purpose of this study was to evaluate the safety and efficacy of CT-guided radiofrequency (RF) ablation in the treatment of spinal OOs and report our experience. Methods: 13 patients suffering from spinal OO and treated at the authors' institution using CT-guided RF ablation were retrospectively evaluated. The RF probe was introduced through a 11-G Jamshidi® needle, and the lesion was heated at 90?°C for 6?min. Results: All procedures were considered technically successful as the correct positioning of the probe was proven by CT. 11 of the 13 patients reported pain relief after RF ablation. In two cases, RF ablation was repeated 1 month after the first procedure. Pain relief was achieved in both cases after the second procedure. No recurrence was reported throughout the follow-up. No complications like skin burn, soft-tissue haematoma, infection, vessel damage or neurological deficit were reported. Conclusion: This study demonstrates that CT-guided percutaneous RF ablation is a safe and effective method for the treatment of spinal OOs. Advances in knowledge: The data of this study support the efficacy and safety of the recently applied CT-guided percutaneous RF ablation technique for the treatment of spinal OOs. PMID:24712322

  5. Does the Removal of Spinal Implants Reduce Back Pain?

    PubMed Central

    Ak, Hakan; Gulsen, Ismail; Atalay, Tugay; Gencer, Muzaffer

    2015-01-01

    Background The importance of the removal of spinal implants is known in the presence of infection. However, the benefits and/or risks of the removal of spinal implant for the management of back pain are not clear. Methods In this retrospective study, we aimed to evaluate the beneficial effects of the removal of spinal implants for back pain. Study included 25 patients with thoracolumbar instrumentation. Results Seventeen (68%) of them were male. Indications for spinal instrumentation were vertebra fracture (n = 9), iatrogenic instability due to multiple segment laminectomy (n = 12), and instrumentation after recurrent disk herniations (n = 4). Mean visual analog score (VAS) before the removal was 8.08. Mean VAS was 3.36 after the removal. Spinal instruments were removed after the observance of the presence of fusion. All patients were prescribed analgesics and muscle relaxants for 3 weeks before removal. Back pain did not decrease in five (20%) patients in total. Four of them had been instrumented due to recurrent lumbar disk herniation. None of the patients reported the complete relief of pain. Conclusion In conclusion, patients should be cautioned that their back pain might not decrease after a successful removal of their instruments. PMID:25883710

  6. Surgical treatment of pyogenic vertebral osteomyelitis with spinal instrumentation

    PubMed Central

    Chen, Wei-Hua; Jiang, Lei-Sheng

    2006-01-01

    Pyogenic vertebral osteomyelitis responds well to conservative treatment at early stage, but more complicated and advanced conditions, including mechanical spinal instability, epidural abscess formation, neurologic deficits, and refractoriness to antibiotic therapy, usually require surgical intervention. The subject of using metallic implants in the setting of infection remains controversial, although more and more surgeons acknowledge that instrumentation can help the body to combat the infection rather than to interfere with it. The combination of radical debridement and instrumentation has lots of merits such as, restoration and maintenance of the sagittal alignment of the spine, stabilization of the spinal column and reduction of bed rest period. This issue must be viewed in the context of the overall and detailed health conditions of the subjecting patient. We think the culprit for the recurrence of infection is not the implants itself, but is the compromised general health condition of the patients. In this review, we focus on surgical treatment of pyogenic vertebral osteomyelitis with special attention to the role of spinal instrumentation in the presence of pyogenic infection. PMID:17106664

  7. Campylobacter Prosthetic Joint Infection

    PubMed Central

    Vasoo, Shawn; Schwab, Jeramy J.; Cunningham, Scott A.; Robinson, Trisha J.; Cass, Joseph R.; Berbari, Elie F.; Walker, Randall C.; Osmon, Douglas R.

    2014-01-01

    A 75-year-old man was diagnosed with probable Campylobacter jejuni prosthetic knee infection after a diarrheal illness. Joint aspirate and operative cultures were negative, but PCR of prosthesis sonicate fluid was positive, as was stool culture. Nineteen additional cases of Campylobacter prosthetic joint infection reported in the literature are reviewed. PMID:24523462

  8. Muscle Biopsy and the Clinical Course of Infantile Spinal Muscular Atrophy

    Microsoft Academic Search

    Edwin L. Zalneraitis; John J. Halperin; Margaret L. Grunnet; Barry S. Russman; Nancy Peress

    1991-01-01

    Eight infants with severe early infantile spinal muscular atrophy diagnosed by clinical presentation and muscle biopsy were studied. The extent of alterations in muscle histology, histochemistry, and ultrastructure did not reflect the relative severity of the clinical presentation or the course of the illness. In seven biopsies, ultrastructural studies demonstrated empty sleeves of basal lamina projecting from the surface of

  9. Full Endoscopic Spinal Surgery Techniques: Advancements, Indications, and Outcomes

    PubMed Central

    Yue, James J.; Long, William

    2015-01-01

    Advancements in both surgical instrumentation and full endoscopic spine techniques have resulted in positive clinical outcomes in the treatment of cervical, thoracic, and lumbar spine pathologies. Endoscopic techniques impart minimal approach related disruption of non-pathologic spinal anatomy and function while concurrently maximizing functional visualization and correction of pathological tissues. An advanced understanding of the applicable functional neuroanatomy, in particular the neuroforamen, is essential for successful outcomes. Additionally, an understanding of the varying types of disc prolapse pathology in relation to the neuroforamen will result in more optimal surgical outcomes. Indications for lumbar endoscopic spine surgery include disc herniations, spinal stenosis, infections, medial branch rhizotomy, and interbody fusion. Limitations are based on both non spine and spine related findings. A high riding iliac wing, a more posteriorly located retroperitoneal cavity, an overly distal or proximally migrated herniated disc are all relative contra-indications to lumbar endoscopic spinal surgery techniques. Modifications in scope size and visual field of view angulation have enabled both anterior and posterior cervical decompression. Endoscopic burrs, electrocautery, and focused laser technology allow for the least invasive spinal surgical techniques in all age groups and across varying body habitus. Complications include among others, dural tears, dysesthsia, nerve injury, and infection.

  10. Effects of reversible spinalization on individual spinal neurons.

    PubMed

    Zelenin, Pavel V; Lyalka, Vladimir F; Hsu, Li-Ju; Orlovsky, Grigori N; Deliagina, Tatiana G

    2013-11-27

    Postural limb reflexes (PLRs) represent a substantial component of the postural system responsible for stabilization of dorsal-side-up trunk orientation in quadrupeds. Spinalization causes spinal shock, that is a dramatic reduction of extensor tone and spinal reflexes, including PLRs. The goal of our study was to determine changes in activity of spinal interneurons, in particular those mediating PLRs, that is caused by spinalization. For this purpose, in decerebrate rabbits, activity of individual interneurons from L5 was recorded during stimulation causing PLRs under two conditions: (1) when neurons received supraspinal influences and (2) when these influences were temporarily abolished by a cold block of spike propagation in spinal pathways at T12 ("reversible spinalization"; RS). The effect of RS, that is a dramatic reduction of PLRs, was similar to the effect of surgical spinalization. In the examined population of interneurons (n = 199), activity of 84% of them correlated with PLRs, suggesting that they contribute to PLR generation. RS affected differently individual neurons: the mean frequency decreased in 67% of neurons, increased in 15%, and did not change in 18%. Neurons with different RS effects were differently distributed across the spinal cord: 80% of inactivated neurons were located in the intermediate area and ventral horn, whereas 50% of nonaffected neurons were located in the dorsal horn. We found a group of neurons that were coactivated with extensors during PLRs before RS and exhibited a dramatic (>80%) decrease in their activity during RS. We suggest that these neurons are responsible for reduction of extensor tone and postural reflexes during spinal shock. PMID:24285903

  11. Ventral occipito-atlanto-axial fluid-filled lesion causing dynamic spinal cord compression in a cat.

    PubMed

    Gutierrez-Quintana, Rodrigo; Hammond, Gawain; Wessmann, Annette

    2014-06-01

    Cystic lesions affecting the vertebral canal or spinal cord have rarely been reported in cats. A 3-year-old female neutered domestic longhair cat presented for evaluation of a 2-year-history of episodes of ataxia and paresis affecting all limbs. Neurological examination was consistent with a lesion in the C1-C5 spinal cord segments. Magnetic resonance imaging (MRI) showed a fluid-filled lesion at the occipito-atlanto-axial region causing dynamic spinal cord compression on flexion of the neck. The imaging characteristics were compatible with a juxta-articular cyst. To our knowledge, this is the first report of a fluid-filled lesion causing dynamic cervical spinal cord compression in a cat and highlights the importance of performing flexion-extension MRI views in diagnosing cases with dynamic spinal cord compression. PMID:24101745

  12. Spinal muscular atrophy: MR evaluation

    Microsoft Academic Search

    G.-C. Liu; Y.-J. Jong; C.-H. Chiang; C.-W. Yang

    1992-01-01

    The neurogenic myopathy of spinal muscular atrophy (SMA) is degeneration of anterior horn cells of the spinal cord and associated muscle weakness. In three patients with the severe type, according to Dubowitz's classification, magnetic resonance imaging (MRI) of the lower extremity showed severe atrophy of the entire muscle bundles of the thigh and the calf. Nine intermediate type patients had

  13. Medication-assisted Spinal Manipulation

    Microsoft Academic Search

    Frank J Kohlbeck; Scott Haldeman

    2002-01-01

    Background context: The acceptance of spinal manipulation as a reasonable method of treating certain patients with spinal pain over the past decade has led to a renewed interest and increased use of these techniques performed in conjunction with commonly used medications and procedures. Manual therapy is increasingly being used in conjunction with anesthetics, sedatives or analgesics as well as local,

  14. Contemporary Management of Spinal Osteomyelitis

    Microsoft Academic Search

    Ali R. Rezai; Henry H. Woo; Thomas J. Errico; Paul R. Cooper

    1999-01-01

    OBJECTIVE: We review the results of treatment of a series of patients with spinal osteomyelitis, to formulate a systematic and comprehensive approach to the management of this disease in light of recent technical and conceptual advances in imaging, spinal biomechanics, and internal fixation.

  15. Use and Outcomes of Venous Thromboembolism Prophylaxis after Spinal Fusion Surgery

    PubMed Central

    Fang, Margaret C.; Maselli, Judith; Lurie, Jon D.; Lindenauer, Peter K.; Pekow, Penelope S.; Auerbach, Andrew D.

    2011-01-01

    Background The number of spinal fusion surgeries in the US is rapidly rising but little is known about optimal venous thromboembolism prophylaxis after spinal surgery. Objectives To examine the use and outcomes associated with venous thromboembolism prophylaxis after spinal fusion surgery in a cohort of 244 US hospitals. Patients/Methods We identified all patients with a principal procedure code for spinal fusion surgery in hospitals participating in the Premier Perspective database from years 2003 – 2005 and searched for receipt of pharmacologic prophylaxis (subcutaneous unfractionated heparin, low molecular weight heparin, or fondaparinux) and/or mechanical prophylaxis (compression devices and elastic stockings) within the first 7 days after surgery. We also searched for discharge diagnosis codes for venous thromboembolism and post-operative hemorrhage during the index hospitalization and within 30 days after surgery. Results Among 80,183 spinal fusion surgeries performed during the time period, cervical fusions were the most common (49.0%) followed by lumbar fusions (47.8%). Thromboembolism prophylaxis was administered to 60.6% of patients within the first week post-operatively, with the most frequent form being mechanical prophylaxis alone (47.6%). Of the 244 hospitals, 26.2% provided prophylaxis to ? 90% of their patients undergoing spinal fusion; however, 33.2% provided prophylaxis to fewer than 50% of their patients. The rate of diagnosed venous thromboembolism within 30 days after surgery was 0.45% and the rate of postoperative hemorrhage was 1.1%. Conclusions Substantial variation exists in the use of thromboembolism prophylaxis after spinal fusion surgery in the US. Nevertheless, overall rates of diagnosed thromboembolism after spinal fusion appear low. PMID:21535390

  16. Clinical characteristics and surgical outcomes of primary spinal paragangliomas.

    PubMed

    Yang, Chenlong; Li, Guang; Fang, Jingyi; Wu, Liang; Yang, Tao; Deng, Xiaofeng; Xu, Yulun

    2015-05-01

    Spinal paragangliomas are extremely rare tumors, most frequently involving the cauda equina and the filum terminale. We aimed to investigate the clinical manifestations, radiological features, management, and follow-up data of primary spinal paraganglioma. We present the clinical data and long-term outcomes from a consecutive surgical series of 19 patients with pathologically diagnosed spinal paragangliomas. All of the patients had undergone surgical resection. Pre- and postoperative magnetic resonance imaging was performed and follow-up data and neurological functional assessment are presented and discussed. The mean age at diagnosis was 47.7 years, with a significant male predominance. The primary clinical symptoms were low back pain and sciatica. Magnetic resonance images (MRI) showed characteristic signs that help differentiate paragangliomas from other spinal tumors, including a "salt & pepper" sign, serpiginous flow void, and a peripheral hypointense rim. Also, a well-encapsulated appearance can be found intraoperatively. During a mean follow-up period of 62.1 months, remnant tumor progression was noted on MRI in three patients with incomplete resection. Pain symptoms were relieved immediately after surgical intervention, while motor and sphincter dysfunction were much slower to improve. Differential diagnosis of paraganglioma based on MR images alone is challenging, but the presence of specific characteristic features provides suggestive clues; however, accurate diagnosis depends on pathological criteria. Despite the benign course, gross total resection is ideal, given an increased risk of recurrence in situ. Timely recognition and surgical treatment should be emphasized to avoid progressive neurological deficits. PMID:25720695

  17. Neuroblastoma in Children: Just Diagnosed Information

    MedlinePLUS

    ... Meet the Supporters Blog Donate Now Select Page Neuroblastoma in Children – Just Diagnosed Home > Understanding Children’s Cancer > ... Diagnosed Just Diagnosed In Treatment After Treatment Diagnosing Neuroblastoma Depending on the location of the tumor and ...

  18. Symbolic Testing of Diagnosability Alban Grastien ,

    E-print Network

    Grastien, Alban

    the minimal set of sensors that ensures diagnosability. Keywords: Discrete-Event Systems, DiagnosabilitySymbolic Testing of Diagnosability Alban Grastien , NICTA, Canberra Research Lab, Canberra University, Canberra, Australia Abstract: Diagnosability ensures that the occurrence of a failure

  19. Retraining the injured spinal cord

    NASA Technical Reports Server (NTRS)

    Edgerton, V. R.; Leon, R. D.; Harkema, S. J.; Hodgson, J. A.; London, N.; Reinkensmeyer, D. J.; Roy, R. R.; Talmadge, R. J.; Tillakaratne, N. J.; Timoszyk, W.; Tobin, A.

    2001-01-01

    The present review presents a series of concepts that may be useful in developing rehabilitative strategies to enhance recovery of posture and locomotion following spinal cord injury. First, the loss of supraspinal input results in a marked change in the functional efficacy of the remaining synapses and neurons of intraspinal and peripheral afferent (dorsal root ganglion) origin. Second, following a complete transection the lumbrosacral spinal cord can recover greater levels of motor performance if it has been exposed to the afferent and intraspinal activation patterns that are associated with standing and stepping. Third, the spinal cord can more readily reacquire the ability to stand and step following spinal cord transection with repetitive exposure to standing and stepping. Fourth, robotic assistive devices can be used to guide the kinematics of the limbs and thus expose the spinal cord to the new normal activity patterns associated with a particular motor task following spinal cord injury. In addition, such robotic assistive devices can provide immediate quantification of the limb kinematics. Fifth, the behavioural and physiological effects of spinal cord transection are reflected in adaptations in most, if not all, neurotransmitter systems in the lumbosacral spinal cord. Evidence is presented that both the GABAergic and glycinergic inhibitory systems are up-regulated following complete spinal cord transection and that step training results in some aspects of these transmitter systems being down-regulated towards control levels. These concepts and observations demonstrate that (a) the spinal cord can interpret complex afferent information and generate the appropriate motor task; and (b) motor ability can be defined to a large degree by training.

  20. Spinal deformity caused by hyperimmunoglobulin E syndrome: clinical article.

    PubMed

    Araya, Naoko; Inose, Hiroyuki; Kato, Tsuyoshi; Saito, Masanori; Sumiya, Satoshi; Yamada, Tsuyoshi; Yoshii, Toshitaka; Kawabata, Shigenori; Okawa, Atsushi

    2014-08-01

    Hyperimmunoglobulin E syndrome (HIES) is a rare primary immunodeficiency syndrome characterized by recurrent staphylococcal infections in the skin and lungs, with an incidence of less than one case per million persons. Skeletal and connective tissue abnormalities, such as scoliosis, osteoporosis, pathological fractures, and hyperextensive joints, are other manifestations of HIES. However, only one report documents the use of implants to treat spinal deformity caused by HIES, which was discovered following corrective surgery resulting in postoperative infection. In this case report, the authors describe a 16-year-old male with low-back pain and infections of the soft tissue. Radiological findings showed deteriorated kyphotic deformity due to the pathological compression fracture of T-11 with intensive conservative treatment. Anterior and posterior fixation surgery was performed. Thereafter, the patient showed no signs of infection. An investigation was conducted to avoid any postoperative infection. PMID:24836661

  1. How Is Aplastic Anemia Diagnosed?

    MedlinePLUS

    ... from the NHLBI on Twitter. How Is Aplastic Anemia Diagnosed? Your doctor will diagnose aplastic anemia based on your medical and family histories, a ... your primary care doctor thinks you have aplastic anemia, he or she may refer you to a ...

  2. Validation of nursing management diagnoses.

    PubMed

    Morrison, R S

    1995-01-01

    Nursing management diagnosis based on nursing and management science, merges "nursing diagnosis" and "organizational diagnosis". Nursing management diagnosis is a judgment about nursing organizational problems. The diagnoses provide a basis for nurse manager interventions to achieve outcomes for which a nurse manager is accountable. A nursing organizational problem is a discrepancy between what should be happening and what is actually happening that prevents the goals of nursing from being accomplished. The purpose of this study was to validate 73 nursing management diagnoses identified previously in 1992: 71 of the 72 diagnoses were considered valid by at least 70% of 136 participants. Diagnoses considered to have high priority for future research and development were identified by summing the mean scores for perceived frequency of occurrence and level of disruption. Further development of nursing management diagnoses and testing of their effectiveness in enhancing decision making is recommended. PMID:8530113

  3. Outcomes in Treatment for Intradural Spinal Cord Ependymomas

    SciTech Connect

    Volpp, P. Brian [Department of Radiation Oncology, Kaiser Permanente, Los Angeles, CA (United States)], E-mail: pvolpp@yahoo.com; Han, Khanh [Huntington Memorial Medical Center, Pasadena, CA (United States); Kagan, A. Robert; Tome, Michael [Department of Radiation Oncology, Kaiser Permanente, Los Angeles, CA (United States)

    2007-11-15

    Purpose: Spinal cord ependymomas are rare tumors, accounting for <2% of all primary central nervous system tumors. This study assessed the treatment outcomes for patients diagnosed with spinal cord ependymomas within the Southern California Kaiser Permanente system. Methods and Materials: We studied 23 patients treated with surgery with or without external beam radiotherapy (EBRT). The local and distant control rates and overall survival rates were determined. Results: The overall local control, overall recurrence, and 9-year overall survival rate was 96%, 17.4%, and 63.9%, respectively. Conclusions: The results of our study indicate that en bloc gross total resection should be the initial treatment, with radiotherapy reserved primarily for postoperative cases with unfavorable characteristics such as residual tumor, anaplastic histologic features, or piecemeal resection. Excellent local control and overall survival rates can be achieved using modern microsurgical techniques, with or without local radiotherapy.

  4. Intramedullary thoracic spinal metastasis from small-cell lung cancer.

    PubMed

    Katsenos, S; Nikolopoulou, M

    2013-01-01

    Lung cancer with intramedullary spinal cord metastasis (ISCM) is a rare event exhibiting dismal prognosis. In the present paper, we describe a 74-year-old male who developed bilateral leg weakness with associated backache and non-productive cough. Chest imaging evaluation demonstrated pronounced bilateral mediastinal lymphadenopathy and a nodular opacity in the right lower lobe. The patient was diagnosed with small cell lung cancer through bronchoscopic procedures. Magnetic resonance imaging of the spinal cord with contrast-enhancement revealed an intramedullary lesion consistent with metastasis at the T5-T6 level. Despite chemotherapy and thoracic spine radiotherapy, he eventually succumbed to the disease 3 months after diagnosis. A brief overview of the current literature is also provided laying emphasis on the therapeutic strategies of this unusual extrathoracic metastatic disease. PMID:24761534

  5. Potential Clinical Applications for Spinal Functional MRI

    PubMed Central

    Kornelsen, Jennifer; Mackey, Sean

    2010-01-01

    Functional MRI (fMRI) of the spinal cord is a noninvasive technique for obtaining information regarding spinal cord neuronal function. This article provides a brief overview of recent developments in spinal cord fMRI and outlines potential applications, as well as the limitations that must be overcome, for using spinal fMRI in the clinic. This technique is currently used for research purposes, but significant potential exists for spinal fMRI to become an important clinical tool. PMID:17504642

  6. Unusual presentation of spinal lipomatosis

    PubMed Central

    Stephenson, William; Kauflin, Matthew J

    2014-01-01

    Spinal epidural lipomatosis (SEL) is a rare condition characterized by overgrowth of normal adipose tissue in the extradural space within the spinal canal that can lead to significant spinal cord compression. It is most commonly reported in patients receiving chronic glucocorticoid therapy. Other causes can include obesity and hypercortisolism. Occasionally, idiopathic SEL will occur in patients with no known risk factors, but cases are more generally reported in obesity and males. We present the case of a 35 year-old non-obese woman found to have rapidly progressive SEL that was not associated with any of the common causes of the disorder. PMID:25285024

  7. Neurological Consequences of Cytomegalovirus Infection

    MedlinePLUS

    ... with altered immune function. Infection may affect the brain (encephalitis), spinal cord (myelitis), eye (retinitis), or other organs such as the lungs (pneumonia) or intestinal gract (gastritis, enteritis, or colitis). In addition, transplant recipients may develop organ rejection or graft-versus- ...

  8. Get a whiff of this: Low-cost sensor can diagnose bacterial April 27th, 2011 in Chemistry / Analytical Chemistry

    E-print Network

    Suslick, Kenneth S.

    Get a whiff of this: Low-cost sensor can diagnose bacterial infections April 27th, 2011 of a stretch." Page 1 of 3Get a whiff of this: Low-cost sensor can diagnose bacterial infections 4/28/2011http in Chemistry / Analytical Chemistry Enlarge A colorimetric sensor array is placed in an Petri dish

  9. Correlation between Serum Level of Monocyte Chemoattractant Protein-1 and Postoperative Recurrence of Spinal Tuberculosis in the Chinese Han Population

    PubMed Central

    He, Dan; Zhang, Xiaolu; Gao, Qile; Huang, Rongfu; Deng, Zhansheng; Guo, Chaofeng; Guo, Qiang; Huang, Jia; Zhang, Hongqi

    2015-01-01

    Objective To correlate serum level of monocyte chemoattractant protein-1 (MCP-1) with postoperative recurrence of spinal tuberculosis in the Chinese Han population. Methods Patients of Han nationality with newly diagnosed spinal tuberculosis were consecutively included in this study. At different time points postoperatively, serum level of MCP-1 was determined using an enzyme linked immunosorbent assay. Recurrence of spinal tuberculosis after surgery and during the follow-up period was recorded. The correlation between serum MCP-1 level and recurrence of spinal tuberculosis was analyzed. Results A total of 169 patients with spinal tuberculosis were included in the study and followed up for an average of2.2±1.3 years (range, 1–5 years). Of these patients, 11 had postoperative recurrence of spinal tuberculosis. The patients’ serum level of MCP-1 increased significantly after postoperative recurrence of spinal tuberculosis. Once the symptoms of recurrence were cured, the serum level of MCP-1 decreased significantly and it did not differ from patients without disease recurrence. Conclusion Postoperative recurrence of spinal tuberculosis is likely to increase the serum level of MCP-1. PMID:25962150

  10. Spinal Cord Stimulation in a Patient with Spinal Epidural Lipomatosis

    Microsoft Academic Search

    Yi Zhang; Monica J. Wood; Christopher Gilligan

    2011-01-01

    Background and ObjectiveSpinal cord stimulation is the most commonly used implantable neurostimulation modality for management of pain syndromes. For treatment of lower extremity pain, the spinal cord stimulator lead is typically placed in the thoracic epidural space, at the T10–T12 levels. Typically, satisfactory stimulation can be obtained relatively easily. Anatomical variability in the epidural space, such as epidural scarring, has

  11. Neurogenic bladder in spinal cord injury patients

    PubMed Central

    Taweel, Waleed Al; Seyam, Raouf

    2015-01-01

    Neurogenic bladder dysfunction due to spinal cord injury poses a significant threat to the well-being of patients. Incontinence, renal impairment, urinary tract infection, stones, and poor quality of life are some complications of this condition. The majority of patients will require management to ensure low pressure reservoir function of the bladder, complete emptying, and dryness. Management typically begins with anticholinergic medications and clean intermittent catheterization. Patients who fail this treatment because of inefficacy or intolerability are candidates for a spectrum of more invasive procedures. Endoscopic managements to relieve the bladder outlet resistance include sphincterotomy, botulinum toxin injection, and stent insertion. In contrast, patients with incompetent sphincters are candidates for transobturator tape insertion, sling surgery, or artificial sphincter implantation. Coordinated bladder emptying is possible with neuromodulation in selected patients. Bladder augmentation, usually with an intestinal segment, and urinary diversion are the last resort. Tissue engineering is promising in experimental settings; however, its role in clinical bladder management is still evolving. In this review, we summarize the current literature pertaining to the pathology and management of neurogenic bladder dysfunction in patients with spinal cord injury.

  12. Dorsal epidural spinal lipomatosis

    PubMed Central

    Chibbaro, S; Mirone, G; Nouri, M; Di Emidio, P; Polivka, M; Marsella, M; George, B

    2011-01-01

    The authors report a case of a thoracic epidural spinal lipomatosis causing severe neurological deficits along the review of pertinent literature. The patient is a 56-year-old woman who presented with acute onset of severe paraparesis; she was investigated with cervical and thoracic MRI and then surgically managed because of an intraspinal mass compressing the cord. The operation consisted in the excision of the mass confirmed to be a fibrolipoma by pathological analysis. The patient attained complete neurological recovery and at 18 months follow-up she reported a generalised well-being. Thoracic lipomas are rare lesions that presenting mostly with back pain; however, in rare instances they may cause progressive and/or abrupt neurological dysfunction. Appropriate imaging can help in the diagnosis and management of such cases. PMID:22707370

  13. Dorsal epidural spinal lipomatosis.

    PubMed

    Chibbaro, S; Mirone, G; Nouri, M; Di Emidio, P; Polivka, M; Marsella, M; George, B

    2011-01-01

    The authors report a case of a thoracic epidural spinal lipomatosis causing severe neurological deficits along the review of pertinent literature. The patient is a 56-year-old woman who presented with acute onset of severe paraparesis; she was investigated with cervical and thoracic MRI and then surgically managed because of an intraspinal mass compressing the cord. The operation consisted in the excision of the mass confirmed to be a fibrolipoma by pathological analysis. The patient attained complete neurological recovery and at 18 months follow-up she reported a generalised well-being. Thoracic lipomas are rare lesions that presenting mostly with back pain; however, in rare instances they may cause progressive and/or abrupt neurological dysfunction. Appropriate imaging can help in the diagnosis and management of such cases. PMID:22707370

  14. Relationship between Spinal Cord Volume and Spinal Cord Injury due to Spinal Shortening.

    PubMed

    Qiu, Feng; Yang, Jin-Cheng; Ma, Xiang-Yang; Xu, Jun-Jie; Yang, Qing-Lei; Zhou, Xin; Xiao, Yao-Sheng; Hu, Hai-Sheng; Xia, Li-Hui

    2015-01-01

    Vertebral column resection is associated with a risk of spinal cord injury. In the present study, using a goat model, we aimed to investigate the relationship between changes in spinal cord volume and spinal cord injury due to spinal shortening, and to quantify the spinal cord volume per 1-mm height in order to clarify a safe limit for shortening. Vertebral column resection was performed at T10 in 10 goats. The spinal cord was shortened until the somatosensory-evoked potential was decreased by 50% from the baseline amplitude or delayed by 10% relative to the baseline peak latency. A wake-up test was performed, and the goats were observed for two days postoperatively. Magnetic resonance imaging was used to measure the spinal cord volume, T10 height, disc height, osteotomy segment height, and spinal segment height pre- and postoperatively. Two of the 10 goats were excluded, and hence, only data from eight goats were analyzed. The somatosensory-evoked potential of these eight goats demonstrated meaningful changes. With regard to neurologic function, five and three goats were classified as Tarlov grades 5 and 4 at two days postoperatively. The mean shortening distance was 23.6 ± 1.51 mm, which correlated with the d-value (post-pre) of the spinal cord volume per 1-mm height of the osteotomy segment (r = 0.95, p < 0.001) and with the height of the T10 body (r = 0.79, p = 0.02). The mean d-value (post-pre) of the spinal cord volume per 1-mm height of the osteotomy segment was 142.87 ± 0.59 mm3 (range, 142.19-143.67 mm3). The limit for shortening was approximately 106% of the vertebral height. The mean volumes of the osteotomy and spinal segments did not significantly change after surgery (t = 0.310, p = 0.765 and t = 1.241, p = 0.255, respectively). Thus, our results indicate that the safe limit for shortening can be calculated using the change in spinal cord volume per 1-mm height. PMID:26001196

  15. Depression and Spinal Cord Injury

    MedlinePLUS

    ... colleagues, with an educational grant from Pfizer Inc. University of Washington-operated SCI Clinics: Harborview Medical Center ... Spinal Cord Injury Clinic nurses: 206-744-5862 University of Washington Medical Center Rehabilitation Medicine Clinic 1959 ...

  16. Herpesvirus infections in psittacine birds in Japan

    Microsoft Academic Search

    S. S. Tsai; J. H. Park; K. Hirai; C. Itakura

    1993-01-01

    Herpesvirus infection was diagnosed histologically and electron microscopically in 21 out of 241 pet birds examined. The infected birds included 14 parakeets (Psittacula krameri manillensis) with respiratory infection and three parrots (Ama?zona aestiva aestiva), two cockatiels (Nymphicus hollandicus) and two rosellas (Platycercus emimius) with Pacheco's disease. The consistent lesions of respiratory herpesvirus infection were the formation of syncytial cells associated

  17. Erythropoietin in spinal cord injury

    Microsoft Academic Search

    Georgios K. Matis; Theodossios A. Birbilis

    2009-01-01

    Spinal cord injury (SCI) is a devastating condition for individual patients and costly for health care systems requiring significant\\u000a long-term expenditures. Cytokine erythropoietin (EPO) is a glycoprotein mediating cytoprotection in a variety of tissues,\\u000a including spinal cord, through activation of multiple signaling pathways. It has been reported that EPO exerts its beneficial\\u000a effects by apoptosis blockage, reduction of inflammation, and

  18. [Clinically documented fungal infections].

    PubMed

    Kakeya, Hiroshi; Kohno, Shigeru

    2008-12-01

    Proven fungal infections are diagnosed by histological/microbiological evidence of fungi at the site of infection and positive blood culture (fungemia). However, invasive diagnosing examinations are not always applied for all of immunocompromised patients. Clinically documented invasive fungal infections are diagnosed by typical radiological findings such as halo sign on chest CT plus positive serological/molecular evidence of fungi. Serological tests of Aspergillus galactomannan antigen and beta-glucan for aspergillosis and cryptococcal glucuronoxylomannan antigen for cryptococcosis are useful. Hence, none of reliable serological tests for zygomycosis are available so far. In this article, risk factors, sign and symptoms, and diagnostic methods for clinically documented cases of invasive aspergillosis, pulmonary cryptococcosis, and zygomycosis with diabates, are reviewed. PMID:19069096

  19. Neurotrophins and spinal circuit function

    PubMed Central

    Boyce, Vanessa S.; Mendell, Lorne M.

    2014-01-01

    Work early in the last century emphasized the stereotyped activity of spinal circuits based on studies of reflexes. However, the last several decades have focused on the plasticity of these spinal circuits. These considerations began with studies of the effects of monoamines on descending and reflex circuits. In recent years new classes of compounds called growth factors that are found in peripheral nerves and the spinal cord have been shown to affect circuit behavior in the spinal cord. In this review we will focus on the effects of neurotrophins, particularly nerve growth factor (NGF), brain derived neurotrophic factor (BDNF) and neurotrophin-3 (NT-3), on spinal circuits. We also discuss evidence that these molecules can modify functions including nociceptive behavior, motor reflexes and stepping behavior. Since these substances and their receptors are normally present in the spinal cord, they could potentially be useful in improving function in disease states and after injury. Here we review recent findings relevant to these translational issues. PMID:24926235

  20. Isolated thoracic (D5) intramedullary epidermoid cyst without spinal dysraphism: A rare case report

    PubMed Central

    Mishra, Sudhansu Sekhar; Satapathy, Mani Charan; Deo, Rama Chandra; Tripathy, Soubhagya Ranjan; Senapati, Satya Bhusan

    2015-01-01

    Spinal epidermoid cyst, congenital or acquired, is mainly congenital associated with spinal dysraphism, rarely in isolation. Intramedullary epidermoid cysts (IECs) are rare with less than 60 cases reported so far; isolated variety (i.e., without spinal dysraphism) is still rarer. Complete microsurgical excision is the dictum of surgical treatment. A 14-year-old boy presented with 4-month history of upper backache accompanied with progressive descending paresthesia with paraparesis with early bladder and bowel involvement. His condition deteriorated rapidly making him bedridden. Neurological examination revealed upper thoracic myeloradiculopathy probably of neoplastic origin with sensory localization to D5 spinal level. Digital X-ray revealed no feature suggestive of spinal dysraphism. Contrast magnetic resonance imaging (MRI) characteristics clinched the presumptive diagnosis. Near-total microsurgical excision was done leaving behind a small part of the calcified capsule densely adhered to cord. Histopathological features were confirmative of an epidermoid cyst. Postoperatively, he improved significantly with a gain of motor power sufficient to walk without support within a span of 6 months. Spinal IECs, without any specific clinical presentation, are often diagnosed based upon intraoperative and histopathological findings, however early diagnosis is possible on complete MRI valuation. Complete microsurgical excision, resulting in cessation of clinical progression and remission of symptoms, has to be limited to sub-total or near-total excision if cyst is adherent to cord or its confines.

  1. 2-Octyl-cyanoacrylate for wound closure in cervical and lumbar spinal surgery

    PubMed Central

    Brückel, Anja; Stein, Marco; Oertel, Matthias F.; Christophis, Petros; Böker, Dieter-Karsten

    2010-01-01

    It is claimed that wound closure with 2-octyl-cyanoacrylate has the advantages that band-aids are not needed in the postoperative period, that the wound can get in contact with water and that removal of stitches is not required. This would substantially enhance patient comfort, especially in times of reduced in-hospital stays. Postoperative wound infection is a well-known complication in spinal surgery. The reported infection rates range between 0% and 12.7%. The question arises if the advantages of wound closure with 2-octyl-cyanoacrylate in spinal surgery are not surpassed by an increase in infection rate. This study has been conducted to identify the infection rate of spinal surgery if wound closure was done with 2-octyl-cyanoacrylate. A total of 235 patients with one- or two-level surgery at the cervical or lumbar spine were included in this prospective study. Their pre- and postoperative course was evaluated. Analysis included age, sex, body mass index, duration and level of operation, blood examinations, 6-week follow-up and analysis of preoperative risk factors. The data were compared to infection rates of similar surgeries found in a literature research and to a historical group of 503 patients who underwent wound closure with standard skin sutures after spine surgery. With the use of 2-octyl-cyanoacrylate, only one patient suffered from postoperative wound infection which accounts for a total infection rate of 0.43%. In the literature addressing infection rate after spine surgery, an average rate of 3.2% is reported. Infection rate was 2.2% in the historical control group. No risk factor could be identified which limited the usage of 2-octyl-cyanoacrylate. 2-Octyl-cyanoacrylate provides sufficient wound closure in spinal surgery and is associated with a low risk of postoperative wound infection. PMID:20440558

  2. Low-Grade Inflammation and Spinal Cord Injury: Exercise as Therapy?

    PubMed Central

    da Silva Alves, Eduardo; de Aquino Lemos, Valdir; Ruiz da Silva, Francieli; Lira, Fabio Santos; dos Santos, Ronaldo Vagner Thomathieli; Rosa, João Paulo Pereira; Caperuto, Erico; Tufik, Sergio; de Mello, Marco Tulio

    2013-01-01

    An increase in the prevalence of obesity in people with spinal cord injury can contribute to low-grade chronic inflammation and increase the risk of infection in this population. A decrease in sympathetic activity contributes to immunosuppression due to the lower activation of immune cells in the blood. The effects of physical exercise on inflammatory parameters in individuals with spinal cord injury have not been well described. We conducted a review of the literature published from 1974 to 2012. This review explored the relationships between low-grade inflammation, spinal cord injury, and exercise to discuss a novel mechanism that might explain the beneficial effects of exercise involving an increase in catecholamines and cytokines in people with spinal cord injury. PMID:23533315

  3. [Cytomegalovirus (CMV) congenital infection].

    PubMed

    Benoist, G; Jacquemard, F; Leruez-Ville, M; Ville, Y

    2008-03-01

    Human Cytomegalovirus (CMV) is the main cause of mental retardation and sensorineural hearing loss related to congenital infections. Justification of systematic screening for fetal CMV infection is still controversial and is not recommended in most developed countries. This is mainly justified by the paucity of antenatal prognostic factors and the lack of established intrauterine treatment when fetal infection has been diagnosed. Our aim was to review the current state of the knowledge about the CMV congenital infection and to highlight recent advances in the diagnosis as well as in the identification of prognostic factors. PMID:18337144

  4. Intraoperative sonography in spinal surgery: current state of the art

    Microsoft Academic Search

    B. M. Montalvo; R. M. Quencer

    1986-01-01

    Intraoperative spinal sonography (IOSS) has significant impact on the surgical management of spinal lesions. This paper describes the techniques involved, illustrates the sonographic anatomy of the spinal canal and its contents and discusses the role of IOSS in the surgical management of spinal trauma, spinal tumors, spinal stenosis and congenital anomalies.

  5. Pathophysiology of primary spinal syringomyelia

    PubMed Central

    Heiss, John D.; Snyder, Kendall; Peterson, Matthew M.; Patronas, Nicholas J.; Butman, John A.; Smith, René K.; DeVroom, Hetty L.; Sansur, Charles A.; Eskioglu, Eric; Kammerer, William A.; Oldfield, Edward H.

    2013-01-01

    Object The pathogenesis of syringomyelia in patients with an associated spinal lesion is incompletely understood. The authors hypothesized that in primary spinal syringomyelia, a subarachnoid block effectively shortens the length of the spinal subarachnoid space (SAS), reducing compliance and the ability of the spinal theca to dampen the subarachnoid CSF pressure waves produced by brain expansion during cardiac systole. This creates exaggerated spinal subarachnoid pressure waves during every heartbeat that act on the spinal cord above the block to drive CSF into the spinal cord and create a syrinx. After a syrinx is formed, enlarged subarachnoid pressure waves compress the external surface of the spinal cord, propel the syrinx fluid, and promote syrinx progression. Methods To elucidate the pathophysiology, the authors prospectively studied 36 adult patients with spinal lesions obstructing the spinal SAS. Testing before surgery included clinical examination; evaluation of anatomy on T1-weighted MRI; measurement of lumbar and cervical subarachnoid mean and pulse pressures at rest, during Valsalva maneuver, during jugular compression, and after removal of CSF (CSF compliance measurement); and evaluation with CT myelography. During surgery, pressure measurements from the SAS above the level of the lesion and the lumbar intrathecal space below the lesion were obtained, and cardiac-gated ultrasonography was performed. One week after surgery, CT myelography was repeated. Three months after surgery, clinical examination, T1-weighted MRI, and CSF pressure recordings (cervical and lumbar) were repeated. Clinical examination and MRI studies were repeated annually thereafter. Findings in patients were compared with those obtained in a group of 18 healthy individuals who had already undergone T1-weighted MRI, cine MRI, and cervical and lumbar subarachnoid pressure testing. Results In syringomyelia patients compared with healthy volunteers, cervical subarachnoid pulse pressure was increased (2.7 ± 1.2 vs 1.6 ± 0.6 mm Hg, respectively; p = 0.004), pressure transmission to the thecal sac below the block was reduced, and spinal CSF compliance was decreased. Intraoperative ultrasonography confirmed that pulse pressure waves compressed the outer surface of the spinal cord superior to regions of obstruction of the subarachnoid space. Conclusions These findings are consistent with the theory that a spinal subarachnoid block increases spinal subarachnoid pulse pressure above the block, producing a pressure differential across the obstructed segment of the SAS, which results in syrinx formation and progression. These findings are similar to the results of the authors' previous studies that examined the pathophysiology of syringomyelia associated with obstruction of the SAS at the foramen magnum in the Chiari Type I malformation and indicate that a common mechanism, rather than different, separate mechanisms, underlies syrinx formation in these two entities. Clinical trial registration no.: NCT00011245. (http://thejns.org/doi/abs/10.3171/2012.8.SPINE111059) PMID:22958075

  6. Fault Diagnosability of Arrangement Graphs

    E-print Network

    Zhou, Shuming

    2012-01-01

    The growing size of the multiprocessor system increases its vulnerability to component failures. It is crucial to locate and to replace the faulty processors to maintain a system's high reliability. The fault diagnosis is the process of identifying faulty processors in a system through testing. This paper shows that the largest connected component of the survival graph contains almost all remaining vertices in the $(n,k)$-arrangement graph $A_{n,k}$ when the number of moved faulty vertices is up to twice or three times the traditional connectivity. Based on this fault resiliency, we establishes that the conditional diagnosability of $A_{n,k}$ under the comparison model. We prove that for $k\\geq 4$, $n\\geq k+2$, the conditional diagnosability of $A_{n,k}$ is $(3k-2)(n-k)-3$; the conditional diagnosability of $A_{n,n-1}$ is $3n-7$ for $n\\geq 5$.

  7. Spinal Extradural Arachnoid Cyst

    PubMed Central

    Choi, Seung Won; Seong, Han Yu

    2013-01-01

    Spinal extradural arachnoid cyst (SEAC) is a rare disease and uncommon cause of compressive myelopathy. The etiology remains still unclear. We experienced 2 cases of SEACs and reviewed the cases and previous literatures. A 59-year-old man complained of both leg radiating pain and paresthesia for 4 years. His MRI showed an extradural cyst from T12 to L3 and we performed cyst fenestration and repaired the dural defect with tailored laminectomy. Another 51-year-old female patient visited our clinical with left buttock pain and paresthesia for 3 years. A large extradural cyst was found at T1-L2 level on MRI and a communication between the cyst and subarachnoid space was illustrated by CT-myelography. We performed cyst fenestration with primary repair of dural defect. Both patients' symptoms gradually subsided and follow up images taken 1-2 months postoperatively showed nearly disappeared cysts. There has been no documented recurrence in these two cases so far. Tailored laminotomy with cyst fenestration can be a safe and effective alternative choice in treating SEACs compared to traditional complete resection of cyst wall with multi-level laminectomy. PMID:24294463

  8. Spinal hydatid disease.

    PubMed

    I?lekel, S; Er?ahin, Y; Zileli, M; Oktar, N; Oner, K; Ovül, I; Ozdamar, N; Tunçbay, E

    1998-03-01

    Vertebral hydatid cysts are rare and found in less than 1% of all the cases of hydatidosis. Neural compression is common in vertebral hydatidosis. The prognosis is generally regarded as very poor. This paper examines the natural history and complications which may arise during the treatment of vertebral hydatid cyst, and discusses their treatment. Thirteen cases of hydatid disease affecting the vertebrae are presented. The patients were admitted with symptoms of spinal cord compression. Twelve were treated by laminectomy and one by costotransversectomy. Low back pain radiating to the legs and lower extremity weakness were the predominant symptoms. Different degrees of pareses were present in 12 patients. Nine patients had impaired sensation in lower extremities. In 13 patients, 27 operations were performed. The major complication of surgery was the death of one patient due to the formaline irrigation. The surgical goal should be an extensive removal of the cysts and affected bone. The surgical area needs to be irrigated with hypertonic saline. Mebendazole or albendazole therapy seems to retard the recurrences and control the disease. PMID:9554015

  9. Spinal muscular atrophies.

    PubMed

    Viollet, Louis; Melki, Judith

    2013-01-01

    Spinal muscular atrophies (SMA) are genetic disorders characterized by degeneration of lower motor neurons. The most frequent form is caused by mutations of the survival motor neuron 1 gene (SMN1). The identification of this gene greatly improved diagnostic testing and family-planning options of SMA families. SMN plays a key role in metabolism of RNA. However, the link between RNA metabolism and motor neuron degeneration remains unknown. A defect in mRNA processing likely generates either a loss of function of some critical RNA or abnormal transcripts with toxic property for motor neurons. Mutations of SMN in various organisms highlighted an essential role of SMN in motor axon and neuromuscular junction development or maintenance. The quality of life of patients has greatly improved over recent decades through the improvement of care and management of patients. In addition, major advances in translational research have been made in the field of SMA. Various therapeutic strategies have been successfully developed aiming at acting on SMN2, a partially functional copy of the SMN1 gene which remains present in patients. Drugs have been identified and some are already at preclinical stages. Identifying molecules involved in the SMA degenerative process should represent additional attractive targets for therapeutics in SMA. PMID:23622363

  10. Pain Management Following Spinal Cord Injury

    MedlinePLUS

    ... Center Spinal Cord Injury InfoSheet 10 Level - Consumer Pain Management following Spinal Cord Injury coming from somewhere other ... pain is described as burning, cramping and constant. PAIN MANAGEMENT Pain management usually includes treatment with medications, modified ...

  11. Spinal Cord Injury Model System Information Network

    MedlinePLUS

    ... Contact the UAB-SCIMS UAB Spinal Cord Injury Model System Newly Injured Health Daily Living Consumer Groups ... University of Alabama at Birmingham Spinal Cord Injury Model System (UAB-SCIMS) maintains this Information Network as ...

  12. Intramedullary spinal cord metastases (ISCM) and non-small cell lung carcinoma (NSCLC): clinical patterns, diagnosis and therapeutic considerations

    Microsoft Academic Search

    Anil Potti; Majdi Abdel-Raheem; Ralph Levitt; Debra A. Schell; Syed A. Mehdi

    2001-01-01

    Intramedullary spinal cord metastasis (ISCM) is an unusual occurrence in systemic cancer, occurring in as few as 2% of autopsy cases and also represents 8.5% of all cases of central nervous system metastases. Although ISCM from small cell lung carcinoma is well documented, ISCM from non-small cell lung carcinoma of the lung is rarely diagnosed prior to the patients’ demise

  13. Spinal Cord Injury—Past, Present, and Future

    PubMed Central

    Donovan, William H

    2007-01-01

    Summary: This special report traces the path of spinal cord injury (SCI) from ancient times through the present and provides an optimistic overview of promising clinical trials and avenues of basic research. The spinal cord injuries of Lord Admiral Sir Horatio Nelson, President James A. Garfield, and General George Patton provide an interesting perspective on the evolution of the standard of care for SCI. The author details the contributions of a wide spectrum of professionals in the United States, Europe, and Australia, as well as the roles of various government and professional organizations, legislation, and overall advances in surgery, anesthesia, trauma care, imaging, pharmacology, and infection control, in the advancement of care for the individual with SCI. PMID:17591221

  14. Spinal stimulator peri-electrode masses: case report.

    PubMed

    Scranton, Robert A; Skaribas, Ioannis M; Simpson, Richard K

    2015-01-01

    The authors describe a case of delayed spastic quadriparesis caused by a peri-electrode mass following the implantation of a minimally invasive percutaneous spinal cord stimulator (SCS). Prior reports with paddle-type electrodes are reviewed, and a detailed histological and pathophysiological comparison with the present case is made. The patient developed tolerance to a cervical percutaneous SCS 4 months after implantation, followed by the onset of spastic quadriparesis 9 months after implantation. The stimulator was removed, and contrast-enhanced MRI revealed an enhancing epidural mass where the system had been placed, with severe spinal cord compression. Decompression was carried out, and the patient experienced neurological improvement. Pathological examination revealed fibrotic tissue with granulomatous and multinucleated giant cell reactions. No evidence of infection or hemorrhage was found. Professionals treating patients with SCSs or contemplating their insertion should be aware of this delayed complication and associated risk factors. PMID:25380541

  15. 3D visualization of Thoraco-Lumbar Spinal Lesions in German Shepherd Dog

    SciTech Connect

    Azpiroz, J.; Krafft, J.; Cadena, M.; Rodriguez, A. O. [Centro de Investigacion en Imagenologia e Instrumentacion Medica, UAM Iztapalapa, Av. San Rafael Atlixco 186, Mexico, D. F. 09340 (Mexico)

    2006-09-08

    Computed tomography (CT) has been found to be an excellent imaging modality due to its sensitivity to characterize the morphology of the spine in dogs. This technique is considered to be particularly helpful for diagnosing spinal cord atrophy and spinal stenosis. The three-dimensional visualization of organs and bones can significantly improve the diagnosis of certain diseases in dogs. CT images were acquired of a German shepherd's dog spinal cord to generate stacks and digitally process them to arrange them in a volume image. All imaging experiments were acquired using standard clinical protocols on a clinical CT scanner. The three-dimensional visualization allowed us to observe anatomical structures that otherwise are not possible to observe with two-dimensional images. The combination of an imaging modality like CT together with imaging processing techniques can be a powerful tool for the diagnosis of a number of animal diseases.

  16. Evaluation of spinal cord injury animal models

    PubMed Central

    Zhang, Ning; Fang, Marong; Chen, Haohao; Gou, Fangming; Ding, Mingxing

    2014-01-01

    Because there is no curative treatment for spinal cord injury, establishing an ideal animal model is important to identify injury mechanisms and develop therapies for individuals suffering from spinal cord injuries. In this article, we systematically review and analyze various kinds of animal models of spinal cord injury and assess their advantages and disadvantages for further studies. PMID:25598784

  17. Intramedullary Astrocytoma Presenting as Spinal Muscular Atrophy

    Microsoft Academic Search

    Sabiha Aysun; Mine Cinbis; Osman Ekin Özcan

    1993-01-01

    We present a 6-year-old patient with a spinal cord tumor who had been followed with the diagnosis of spinal muscular atrophy since the age of 23 months. Reasons for reevaluating the diagnosis of spinal muscular atrophy were the early onset of scoliosis, the slight asymmetry in weakness of extremities, and the appearance of urinary retention in the last 3 days.

  18. Stem Cells for Spinal Cord Repair

    Microsoft Academic Search

    Fanie Barnabe; Jonas Frisen

    2008-01-01

    The spinal cord is the main relay for signals between the brain and the body. Spinal cord injury completely or partially deprives the individual of mobility and sensory input as well as autonomic nervous system control below the level of the lesion. The major- ity of spinal cord injuries affect the cervical segments, leaving the patient para- or tetraplegic depending

  19. Motorcycle-related spinal injury: crash characteristics.

    PubMed

    Zulkipli, Zarir Hafiz; Abdul Rahmat, Abdul Manap; Mohd Faudzi, Siti Atiqah; Paiman, Noor Faradila; Wong, Shaw Voon; Hassan, Ahamedali

    2012-11-01

    This study presents an analysis of crash characteristics of motorcyclists who sustained spinal injuries in motorcycle crashes. The aim of the study is to identify the salient crash characteristics that would help explain spinal injury risks for motorcyclists. Data were retrospectively collected from police case reports that were archived at MIROS from year 2005 to 2007. The data were categorized into two subcategories; the first group was motorcycle crashes with spinal injury (case) and the second group was motorcycle crashes without spinal injury (control). A total of 363 motorcyclists with spinal injury and 873 motorcyclists without spinal injury were identified and analyzed. Descriptive analysis and multivariate analysis were performed in order to determine the odds of each characteristic in contributing to spinal injury. Single vehicle crash, collision with fixed objects and crash configuration were found to have significant influence on motorcyclists in sustaining spinal injury (p<0.05). Although relatively few than other impact configurations, the rear-end impacted motorcyclist shows the highest risk of spinal injury. Helmets have helped to reduce head injury but they did not seem to offer corresponding protection for the spine in the study. With a growing number of young motorcyclists, further efforts are needed to find effective measures to help reduce the crash incidents and severity of spinal injury. In sum, the study provides some insights on some vital crash characteristics associated with spinal injury that can be further investigated to determine the appropriate counter-measures and prevention strategies to reduce spinal injury. PMID:23036400

  20. Morgagni hernia diagnosed by MRI

    Microsoft Academic Search

    Noriki Kamiya; Kohei Yokoi; Naoto Miyazawa; Shoichi Hishinuma; Yoshiro Ogata; Nobuhito Katayama

    1996-01-01

    We herein present a patient with Morgagni hernia which was diagnosed by magnetic resonance imaging (MRI). The patient had a progressively enlarging mass in the right cardiophrenic angle on chest roentgenogram. On computed tomography (CT) scans, the mass was revealed to have fat density and therefore was suspected to be either a lipoma or liposarcoma. MRI clearly demonstrated that the

  1. How Is Vaginal Cancer Diagnosed?

    MedlinePLUS

    ... present and, if so, what type it is. Imaging tests Chest x-ray If vaginal cancer is diagnosed, a plain x- ... possible metastases. Magnetic resonance imaging (MRI) Magnetic resonance imaging (MRI) scans use radio waves and strong magnets instead of x-rays to make images of the body. The energy ...

  2. Diagnoses and interventions in podiatry.

    PubMed

    Zuijderduin, W M; Dekker, J

    1996-01-01

    In the present study a quantitative description is given of diagnoses and interventions in podiatry. Data are used from a survey on podiatry practice in The Netherlands. Data have been recorded by 36 podiatrists on 897 patients. Information was gathered on patient characteristics, the medical diagnoses, the podiatry diagnoses (impairments and disabilities), treatment goals derived from these diagnoses, and interventions. Impairments were recorded in nearly all patients. The interrelationship among impairments was analysed. Four dimensions of highly interrelated impairments were found. Disabilities were recorded in about one-third of the patients. Only one dimension of interrelated disabilities was identified. Podiatric soles were applied in the treatment of two-thirds of the patients, silicone devices in one-fifth of the patients and nail braces in only a few patients. Advice, instruction and exercise was given in one-third of the patients, while basic foot care was given in a quarter of the patients. Significant relationships between treatment goals and the application of interventions were found. The main conclusions from this study are: (1) the podiatry diagnosis is primarily at the level of impairments; (2) treatment goals derived from impairments determine which interventions are applied. The implications of these findings with regard to the further development of the podiatry diagnosis and the design of studies on the outcome of podiatric interventions are discussed. PMID:8932742

  3. How Is Fanconi Anemia Diagnosed?

    MedlinePLUS

    ... from the NHLBI on Twitter. How Is Fanconi Anemia Diagnosed? People who have Fanconi anemia (FA) are born with the disorder. They may ... questions about: Any personal or family history of anemia Any surgeries you’ve had related to the ...

  4. Hemophilia A in a Senior Patient: A Case Report of Spinal Epidural Hematoma as First Presentation

    PubMed Central

    Jung, Woo Shik; Lee, Jae Il

    2015-01-01

    Hemophilia A is a hereditary coagulation disorder. Most cases are diagnosed at birth or at least during childhood. A spontaneous spinal epidural hematoma was developed in a 74-year-old male patient who hadn't had a family or past medical history of bleeding disorders. On magnetic resonance imaging, epidural hematoma at L1-2 was accompanied by spinal stenosis at L4-5 and spondylolytic spondylolisthesis at L5. Hematoma evacuation and surgery for distal lumbar lesions were performed at once. After transient improvement, complete paraplegia was developed due to redevelopment of large epidural hematomas at L1-2 and L4-S1 which blocked epidural canal completely. Emergency evacuation was performed and we got to know that he had a hemophilia A. Factor VIII was 28% of normal value. Mild type hemophilia A could have not been diagnosed until adulthood. Factor VIII should have been replaced before the surgical decompression.

  5. Melatonin lowers edema after spinal cord injury

    PubMed Central

    Li, Cheng; Chen, Xiao; Qiao, Suchi; Liu, Xinwei; Liu, Chang; Zhu, Degang; Su, Jiacan; Wang, Zhiwei

    2014-01-01

    Melatonin has been shown to diminish edema in rats. Melatonin can be used to treat spinal cord injury. This study presumed that melatonin could relieve spinal cord edema and examined how it might act. Our experiments found that melatonin (100 mg/kg, i.p.) could reduce the water content of the spinal cord, and suppress the expression of aquaporin-4 and glial fibrillary acidic protein after spinal cord injury. This suggests that the mechanism by which melatonin alleviates the damage to the spinal cord by edema might be related to the expression of aquaporin-4 and glial fibrillary acidic protein. PMID:25657743

  6. Chronic Fatigue Syndrome Patients Subsequently Diagnosed with Lyme Disease Borrelia burgdorferi: Evidence for Mycoplasma Species Coinfections

    Microsoft Academic Search

    Garth L. Nicolson; Nancy L. Nicolson; Joerg Haier

    2008-01-01

    Objective: We examined the blood of 48 North American Chronic Fatigue Syndrome (CFS) patients subsequently diagnosed with Lyme Disease Borrelia burgdorferi and compared these to 50 North American CFS patients without evidence of Borrelia burgdorferi infections for presence of Mycoplasma spp. co-infections using forensic polymerase chain reaction. Results: We found that 68.75% of CFS\\/Lyme patients show evidence of mycoplasma co-infections

  7. Spinal extradural angiolipoma: report of two cases and review of the literature

    PubMed Central

    García-Allut, Alfredo

    2009-01-01

    Spinal angiolipomas are benign uncommon neoplasm composed of mature lipocytes admixed with abnormal blood vessels. They account for only 0.04–1.2% of all spinal tumors. We report two cases of lumbar extradural angiolipoma and review previously reported cases. We found 118 cases of spinal epidural angiolipoma (70 females and 48 males; age range 1.5–85 years, mean 44.03) spanning from 1890 to 2006. Prior to diagnosis 40.6% of the patients had weakness of the lower limbs. The interval between the initial symptoms and tumor diagnosis ranged from 1 day to 17 years (mean 20.2 months). Except for four cases diagnosed at autopsy, 109 patients underwent surgery and gross-total resection was performed in 79 cases (72.4%). Spinal angiolipomas are tumors containing angiomatous and lipomatous tissue, predominantly located in the mid-thoracic region. All angiolipomas show iso- or hyperintensity on T1-weighted images and hyperintensity on T2-weighted images and most lesions enhance with gadolinium administration. The treatment for spinal extradural angiolipomas is total surgical resection and no adjuvant therapy should be administered. PMID:19127373

  8. Vestibulo-spinal reflex mechanisms

    NASA Technical Reports Server (NTRS)

    Reschke, M. F.

    1981-01-01

    The specific objectives of experiments designed to investigate postural reflex behavior during sustained weightlessness are discussed. The first is to investigate, during prolonged weightlessness with Hoffmann response (H-reflex) measurement procedures, vestibulo-spinal reflexes associated with vestibular (otolith) responses evoked during an applied linear acceleration. This objective includes not only an evaluation of otolith-induced changes in a major postural muscle but also an investigation with this technique of the adaptive process of the vestibular system and spinal reflex mechanisms to this unique environment. The second objective is to relate space motion sickness to the results of this investigation. Finally, a return to the vestibulo-spinal and postural reflexes to normal values following the flight will be examined. The flight experiment involves activation of nerve tissue (tibial N) with electrical shock and the recording of resulting muscle activity (soleus) with surface electrodes. Soleus/spinal H-reflex testing procedures will be used in conjuction with linear acceleration through the subject's X-axis.

  9. SPINAL CORD INJURY (SCI) DATABASE

    EPA Science Inventory

    The National Spinal Cord Injury Database has been in existence since 1973 and captures data from SCI cases in the United States. Since its inception, 24 federally funded Model SCI Care Systems have contributed data to the National SCI Database. Statistics are derived from this da...

  10. Acute hand infections.

    PubMed

    Osterman, Meredith; Draeger, Reid; Stern, Peter

    2014-08-01

    The continued emergence of antibiotic-resistant bacteria and the development of only a few new classes of antibiotics over the past 50 years have made the treatment of acute hand infections problematic. Prompt diagnosis and treatment are important, because hand stiffness, contractures, and even amputation can result from missed diagnoses or delayed treatment. The most common site of hand infections is subcutaneous tissue and the most common mechanism is trauma. An immunocompromised state, intravenous drug abuse, diabetes mellitus, and steroid use all predispose to infections. PMID:25070032

  11. Congenital spinal dermal tract: how accurate is clinical and radiological evaluation?

    PubMed

    Tisdall, Martin M; Hayward, Richard D; Thompson, Dominic N P

    2015-06-01

    OBJECT A dermal sinus tract is a common form of occult spinal dysraphism. The presumed etiology relates to a focal failure of disjunction resulting in a persistent adhesion between the neural and cutaneous ectoderm. Clinical and radiological features can appear innocuous, leading to delayed diagnosis and failure to appreciate the implications or extent of the abnormality. If it is left untreated, complications can include meningitis, spinal abscess, and inclusion cyst formation. The authors present their experience in 74 pediatric cases of spinal dermal tract in an attempt to identify which clinical and radiological factors are associated with an infective presentation and to assess the reliability of MRI in evaluating this entity. METHODS Consecutive cases of spinal dermal tract treated with resection between 1998 and 2010 were identified from the departmental surgical database. Demographics, clinical history, and radiological and operative findings were collected from the patient records. The presence or absence of active infection (abscess, meningitis) at the time of neurosurgical presentation and any history of local sinus discharge or infection was assessed. Magnetic resonance images were reviewed to evaluate the extent of the sinus tract and determine the presence of an inclusion cyst. Radiological and operative findings were compared. RESULTS The surgical course was uncomplicated in 90% of 74 cases eligible for analysis. Magnetic resonance imaging underreported the presence of both an intradural tract (MRI 46%, operative finding 86%) and an intraspinal inclusion cyst (MRI 15%, operative finding 24%). A history of sinus discharge (OR 12.8, p = 0.0003) and the intraoperative identification of intraspinal inclusion cysts (OR 5.6, p = 0.023) were associated with an infective presentation. There was no significant association between the presence of an intradural tract discovered at surgery and an infective presentation. CONCLUSIONS Surgery for the treatment of spinal dermal tract carries a low morbidity. While it seems intuitive that tracts without intradural extension carry a low risk of spinal cord tethering, it is not possible to reliably detect these cases using MRI. Similarly, intraspinal dermoid cannot be reliably excluded using MRI and carries an increased risk of infection. These points justify excision together with intradural exploration of all spinal dermal sinus tracts. PMID:26030333

  12. CT-guided percutaneous biopsy of spinal lesions

    PubMed Central

    Peh, WCG

    2006-01-01

    Accurate diagnosis of spine lesions is important for its successful management. Imaging–guided percutaneous biopsy is gaining increasing acceptance as a means for obtaining tissue for diagnosis. Most biopsies can be rapidly performed under local anaesthesia, with little patient discomfort and improved safety. Spinal anatomy is, however, complex with many adjacent vital structures. Good knowledge of anatomy and precise needling technique is, therefore, important. Today, biopsy of spinal lesions is best performed under computed tomography (CT) fluoroscopic guidance. Indications for imaging-guided biopsy include confirming metastasis in a patient with a known primary tumour, determining the nature of a solitary bone lesion, excluding malignancy in vertebral body compression, and investigating for infection. Among the various issues to be considered are site of lesion, location of adjacent vital structures, approach, and type and size of needle. Complications are rare, particularly when a meticulous technique is applied. In summary, CT-guided percutaneous biopsy is a safe and an effective technique for the evaluation of spinal lesions and useful in planning therapy. PMID:21614239

  13. Dynamic Compression of the Spinal Cord by Paraspinal Muscles following Cervical Laminectomy: Diagnosis Using Flexion-Extension MRI

    PubMed Central

    Evans, Linton T.; Lollis, S. Scott

    2015-01-01

    Introduction. Flexion-extension, or kinematic, MRI has been used to identify dynamic spondylotic spinal cord compression not seen with traditional static MRI. The use of kinematic MRI to diagnose postoperative complications, specifically dynamic compression, is not as well documented. The authors describe a case of dynamic spinal cord compression by the paraspinal muscles causing worsening myelopathy following cervical laminectomy. This was only diagnosed with flexion-extension MRI. Methods. The patient was a 90-year-old male presenting to the neurosurgery clinic with functional decline and cervical spondylotic myelopathy. Results. A multilevel laminectomy was performed. Following surgery the patient had progressive weakness and worsening myelopathy. No active cord compression was seen on multiple MRIs obtained in a neutral position, and flexion-extension X-rays did not show instability. A kinematic MRI demonstrated dynamic compression of the spinal cord only during neck extension, by the paraspinal muscles. To relieve the compression, the patient underwent an instrumented fusion, with cross-links used to buttress the paraspinal muscles away from the cord. This resulted in neurologic improvement. Conclusions. We describe a novel case of spinal cord compression by paraspinal muscles following cervical laminectomy. In individuals with persistent myelopathy or delayed neurologic decline following posterior decompression, flexion-extension MRI may prove useful in diagnosing this potential complication. PMID:25984378

  14. Cervicothoracic Spinal Epidural Hematoma after Anterior Cervical Spinal Surgery

    PubMed Central

    Lee, Sang-Ho

    2010-01-01

    The purpose of this case report is to describe a rare case of a cervicothoracic spinal epidural hematoma (SEH) after anterior cervical spine surgery. A 60-year-old man complained of severe neck and arm pain 4 hours after anterior cervical discectomy and fusion at the C5-6 level. Magnetic resonance imaging revealed a postoperative SEH extending from C1 to T4. Direct hemostasis and drainage of loculated hematoma at the C5-6 level completely improved the patient's condition. When a patient complains of severe neck and/or arm pain after anterior cervical spinal surgery, though rare, the possibility of a postoperative SEH extending to non-decompressed, adjacent levels should be considered as with our case. PMID:21430984

  15. Passive avoidance response in mice infected with Schistosoma mansoni

    Microsoft Academic Search

    Marco Fiore; Claudio Carere; Rolando Moroni; Luigi Aloe

    2002-01-01

    Schistosomiasis is a parasitic disease of humans and rodents affecting more than 200 million people worldwide. Following the onset of infection, the worms induce granulomas around schistosome eggs in the liver, intestine and central nervous system (both brain and spinal cord), which are likely to cause changes in cognitive functions. In the present study, CD-1 female mice were percutaneously infected

  16. Major Medical Outcomes with Spinal Augmentation versus Conservative Therapy

    PubMed Central

    McCullough, Brendan J.; Comstock, Bryan A.; Deyo, Richard A.; Kreuter, William; Jarvik, Jeffrey G.

    2014-01-01

    Importance The symptomatic benefits of spinal augmentation (vertebroplasty or kyphoplasty) for the treatment of osteoporotic vertebral compression fractures are controversial. Recent population-based studies using medical billing claims have reported significant reductions in mortality with spinal augmentation compared to conservative therapy, but in non-randomized settings such as these, there is the potential for selection bias to influence results. Objective To compare major medical outcomes following treatment of osteoporotic vertebral fractures with spinal augmentation or conservative therapy. Additionally, we will evaluate the role of selection bias using pre-procedure outcomes and propensity score analysis. Design, Setting, and Participants Retrospective cohort analysis of Medicare claims for 2002–2006. We compared 30-day and 1-year outcomes in patients with newly-diagnosed vertebral fractures treated with spinal augmentation (augmented; n=10 541) or conservative therapy (control; n=115 851). Outcomes were compared using traditional multivariate analyses adjusted for patient demographics and comorbid conditions. We also used propensity score matching to select 9017 pairs from the initial groups to compare the same outcomes. Main Outcomes and Measures Mortality, major complications, and healthcare utilization. Results Using traditional covariate adjustments, mortality was significantly lower in the augmented group compared to controls (5.2% vs 6.7% at one year; hazard ratio, 0.83; 95% CI, 0.75–0.92). However, patients in the augmented group who had not yet undergone augmentation (pre-procedure subgroup) had lower rates of medical complications 30 days post-fracture compared to controls (6.5% vs 9.5%; odds ratio, 0.66; 95% CI, 0.57–0.78), suggesting that the augmented group was less medically ill. After propensity score matching to better account for selection bias, one-year mortality was not significantly different between groups. Furthermore, one-year major medical complications were also similar between groups, and the augmented group had higher rates of healthcare utilization, including hospital and intensive care unit admissions and discharges to skilled nursing facilities. Conclusions and Relevance After accounting for selection bias, spinal augmentation did not improve mortality or major medical outcomes and was associated with greater healthcare utilization compared to conservative therapy. Our results also highlight how analyses of claims-based data that do not adequately account for unrecognized confounding can arrive at misleading conclusions. PMID:23836009

  17. How Is Carotid Artery Disease Diagnosed?

    MedlinePLUS

    ... Living With Clinical Trials Links Related Topics Atherosclerosis Carotid Endarterectomy Carotid Ultrasound Stents Stroke Send a link to ... page from the NHLBI on Twitter. How Is Carotid Artery Disease Diagnosed? Your doctor will diagnose carotid artery disease ...

  18. How Is Alpha-1 Antitrypsin Deficiency Diagnosed?

    MedlinePLUS

    ... from the NHLBI on Twitter. How Is Alpha-1 Antitrypsin Deficiency Diagnosed? Alpha-1 antitrypsin (AAT) deficiency usually is diagnosed after you ... Rate This Content: NEXT >> October 11, 2011 Alpha-1 Antitrypsin Deficiency Clinical Trials Clinical trials are research ...

  19. How Do Health Care Providers Diagnose Vulvodynia?

    MedlinePLUS

    ... Information Clinical Trials Resources and Publications How do health care providers diagnose vulvodynia? Skip sharing on social media ... been ruled out. To diagnose vulvodynia, 1 a health care provider may recommend that a woman have blood ...

  20. How Are Obesity and Overweight Diagnosed?

    MedlinePLUS

    ... Information Clinical Trials Resources and Publications How are obesity & overweight diagnosed? Skip sharing on social media links ... and Blood Institute. (2012). How are overweight and obesity diagnosed? Retrieved August 8, 2012, from http://www. ...

  1. 21 CFR 880.2500 - Spinal fluid manometer.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...2010-04-01 2010-04-01 false Spinal fluid manometer. 880.2500 Section 880.2500...Monitoring Devices § 880.2500 Spinal fluid manometer. (a) Identification. A spinal fluid manometer is a device used to measure...

  2. 21 CFR 880.2500 - Spinal fluid manometer.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...2011-04-01 2011-04-01 false Spinal fluid manometer. 880.2500 Section 880.2500...Monitoring Devices § 880.2500 Spinal fluid manometer. (a) Identification. A spinal fluid manometer is a device used to measure...

  3. 21 CFR 880.2500 - Spinal fluid manometer.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...2013-04-01 2013-04-01 false Spinal fluid manometer. 880.2500 Section 880.2500...Monitoring Devices § 880.2500 Spinal fluid manometer. (a) Identification. A spinal fluid manometer is a device used to measure...

  4. 21 CFR 880.2500 - Spinal fluid manometer.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...2014-04-01 2014-04-01 false Spinal fluid manometer. 880.2500 Section 880.2500...Monitoring Devices § 880.2500 Spinal fluid manometer. (a) Identification. A spinal fluid manometer is a device used to measure...

  5. 21 CFR 880.2500 - Spinal fluid manometer.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...2012-04-01 2012-04-01 false Spinal fluid manometer. 880.2500 Section 880.2500...Monitoring Devices § 880.2500 Spinal fluid manometer. (a) Identification. A spinal fluid manometer is a device used to measure...

  6. Genetics Home Reference: Spinal muscular atrophy with progressive myoclonic epilepsy

    MedlinePLUS

    ... catalog Conditions > Spinal muscular atrophy with progressive myoclonic epilepsy On this page: Description Genetic changes Inheritance Diagnosis ... What is spinal muscular atrophy with progressive myoclonic epilepsy? Spinal muscular atrophy with progressive myoclonic epilepsy (SMA- ...

  7. 21 CFR 888.3060 - Spinal intervertebral body fixation orthosis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...Spinal intervertebral body fixation orthosis. 888.3060 Section 888.3060...Spinal intervertebral body fixation orthosis. (a) Identification. A spinal intervertebral body fixation orthosis is a device intended to...

  8. 21 CFR 888.3060 - Spinal intervertebral body fixation orthosis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...Spinal intervertebral body fixation orthosis. 888.3060 Section 888.3060...Spinal intervertebral body fixation orthosis. (a) Identification. A spinal intervertebral body fixation orthosis is a device intended to...

  9. 21 CFR 888.3050 - Spinal interlaminal fixation orthosis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...false Spinal interlaminal fixation orthosis. 888.3050 Section 888.3050...3050 Spinal interlaminal fixation orthosis. (a) Identification. A spinal interlaminal fixation orthosis is a device intended to...

  10. 21 CFR 888.3050 - Spinal interlaminal fixation orthosis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...false Spinal interlaminal fixation orthosis. 888.3050 Section 888.3050...3050 Spinal interlaminal fixation orthosis. (a) Identification. A spinal interlaminal fixation orthosis is a device intended to...

  11. Testosterone Plus Finasteride Treatment After Spinal Cord Injury

    ClinicalTrials.gov

    2015-03-11

    Spinal Cord Injury; Spinal Cord Injuries; Trauma, Nervous System; Wounds and Injuries; Central Nervous System Diseases; Nervous System Diseases; Spinal Cord Diseases; Gonadal Disorders; Endocrine System Diseases; Hypogonadism; Genital Diseases, Male

  12. Diagnosability Enhancement of Discrete Event Systems

    Microsoft Academic Search

    YuanLin Wen; ChunHsi Li; MuDer Jeng

    2006-01-01

    This paper presents an iterative systematic methodology for enhancing diagnosability of discrete event systems by adding sensors. The methodology consists of the following steps. First, Petri nets are used to model the target system. Then, an algorithm of polynomial complexity is adopted to analyze a sufficient condition of diagnosability of the modeled system. Here, diagnosability is defined in the context

  13. Prenatally diagnosed cystic lymphangioma in infants

    Microsoft Academic Search

    Norio Suzuki; Yoshiaki Tsuchida; Atsushi Takahashi; Minoru Kuroiwa; Hitoshi Ikeda; Jun Mohara; Shinitsu Hatakeyama; Takenobu Koizumi

    1998-01-01

    Background\\/Purpose: Prenatally diagnosed cystic lymphangioma (CL) is often associated with chromosomal anomalies, hydrops fetalis, and, in the case of cervical CL, occasionally respiratory distress just after birth. Often it is difficult to treat prenatally diagnosed CL because of the large size and associated symptoms.Methods: Between 1988 and 1997, 11 cases of prenatally diagnosed CL were treated. Five pregnancies were terminated

  14. Pulmonary symptoms and diagnoses are associated with HIV in the MACS and WIHS cohorts

    PubMed Central

    2014-01-01

    Background Several lung diseases are increasingly recognized as comorbidities with HIV; however, few data exist related to the spectrum of respiratory symptoms, diagnostic testing, and diagnoses in the current HIV era. The objective of the study is to determine the impact of HIV on prevalence and incidence of respiratory disease in the current era of effective antiretroviral treatment. Methods A pulmonary-specific questionnaire was administered yearly for three years to participants in the Multicenter AIDS Cohort Study (MACS) and Women’s Interagency HIV Study (WIHS). Adjusted prevalence ratios for respiratory symptoms, testing, or diagnoses and adjusted incidence rate ratios for diagnoses in HIV-infected compared to HIV-uninfected participants were determined. Risk factors for outcomes in HIV-infected individuals were modeled. Results Baseline pulmonary questionnaires were completed by 907 HIV-infected and 989 HIV-uninfected participants in the MACS cohort and by 1405 HIV-infected and 571 HIV-uninfected participants in the WIHS cohort. In MACS, dyspnea, cough, wheezing, sleep apnea, and incident chronic obstructive pulmonary disease (COPD) were more common in HIV-infected participants. In WIHS, wheezing and sleep apnea were more common in HIV-infected participants. Smoking (MACS and WIHS) and greater body mass index (WIHS) were associated with more respiratory symptoms and diagnoses. While sputum studies, bronchoscopies, and chest computed tomography scans were more likely to be performed in HIV-infected participants, pulmonary function tests were no more common in HIV-infected individuals. Respiratory symptoms in HIV-infected individuals were associated with history of pneumonia, cardiovascular disease, or use of HAART. A diagnosis of asthma or COPD was associated with previous pneumonia. Conclusions In these two cohorts, HIV is an independent risk factor for several respiratory symptoms and pulmonary diseases including COPD and sleep apnea. Despite a higher prevalence of chronic respiratory symptoms, testing for non-infectious respiratory diseases may be underutilized in the HIV-infected population. PMID:24884738

  15. Spinal accessory neuropathy associated with the tumor located on the jugular foramen.

    PubMed

    Lee, Soyoung; Yang, Shimo; Lee, Jieun; Kim, Inhwan

    2013-02-01

    Spinal accessory neuropathy is commonly caused by iatrogenic injury or secondary to trauma or infection. Nevertheless, the tumor related palsy is rare. We present a case of an 18-year-old male patient suffering from paralysis of his right trapezius and sternocleidomastoid muscle. An electrophysiologic diagnostic study confirmed the spinal accessory neuropathy of the proximal segment. In addition, magnetic resonance imaging showed the location of tumor on the jugular foramen. However, the type of the tumor was not confirmed through biopsy because the patient refused surgical procedure. Based on the study, it is hypothesized that the tumor located on the jugular foramen should be considered as a cause of the spinal accessory nerve of the proximal segment. PMID:23526381

  16. International Spinal Cord Injury Data Sets

    Microsoft Academic Search

    F Biering-Sørensen; S Charlifue; M DeVivo; V Noonan; M Post; T Stripling; P Wing

    2006-01-01

    Study design:Discussion and development of final consensus.Objective:Present the background, purpose, and process for the International Spinal Cord Injury (SCI) Data Sets development.Setting:International.Methods:An international meeting on SCI data collection and analysis occurred at a workshop on May 2, 2002, before the combined meeting of the American Spinal Injury Association (ASIA) and the International Spinal Cord Society (ISCoS) in Vancouver, British Columbia,

  17. Intracranial metastasis of spinal intramedullary anaplastic astrocytoma.

    PubMed

    Kataria, Rashim; Bhasme, Vishal; Chopra, Sanjeev; Sinha, V D; Singhvi, Shashi

    2011-07-01

    Meningeal spread of spinal intramedullary astrocytoma into the cranium is rare. Only few case reports are available so far in the literature. We report a case of intramedullary high grade astrocytoma of the conus, developing intracranial metastasis after three months of partial excision of the spinal mass. The need for radical surgery, entire neuroaxis radiation, and adjuvant chemotherapy is suggested in the management of malignant spinal cord astrocytoma to prevent dissemination. PMID:22347337

  18. Intracranial metastasis of spinal intramedullary anaplastic astrocytoma

    PubMed Central

    Kataria, Rashim; Bhasme, Vishal; Chopra, Sanjeev; Sinha, V. D.; Singhvi, Shashi

    2011-01-01

    Meningeal spread of spinal intramedullary astrocytoma into the cranium is rare. Only few case reports are available so far in the literature. We report a case of intramedullary high grade astrocytoma of the conus, developing intracranial metastasis after three months of partial excision of the spinal mass. The need for radical surgery, entire neuroaxis radiation, and adjuvant chemotherapy is suggested in the management of malignant spinal cord astrocytoma to prevent dissemination. PMID:22347337

  19. The biopsychosocial model and spinal cord injury

    Microsoft Academic Search

    KM Mathew; G Ravichandran; K May; K Morsley

    2001-01-01

    Objective: To highlight the importance of taking the psychological, social and biological aspects into consideration when dealing with somatic complaints of spinal cord injured patients.Setting: Supra-regional Spinal Injury Unit in the UK.Study design: Case study series.Material and methods: The somatic complaints of four patients with spinal cord injury were assessed and their relationship to psychological and social issues were correlated.

  20. Biomechanical Aspects of Spinal Cord Injury

    Microsoft Academic Search

    Thomas R. Oxland; Timothy Bhatnagar; Anthony M. Choo; Marcel F. Dvorak; Wolfram Tetzlaff; Peter A. Cripton

    \\u000a Research into the biomechanics of spinal cord injury has progressed rapidly over the past decade via a number of research\\u000a approaches. Cadaveric experimentation, animal model development and computational simulations continue to contribute much\\u000a insight into the relation between spinal column injury (i.e. vertebrae, discs, ligaments) and spinal cord damage. Efforts\\u000a in this research field are directed towards providing clinicians information

  1. Indications for spine surgery: validation of an administrative coding algorithm to classify degenerative diagnoses

    PubMed Central

    Lurie, Jon D.; Tosteson, Anna N.A.; Deyo, Richard A.; Tosteson, Tor; Weinstein, James; Mirza, Sohail K.

    2014-01-01

    Study Design Retrospective analysis of Medicare claims linked to a multi-center clinical trial. Objective The Spine Patient Outcomes Research Trial (SPORT) provided a unique opportunity to examine the validity of a claims-based algorithm for grouping patients by surgical indication. SPORT enrolled patients for lumbar disc herniation, spinal stenosis, and degenerative spondylolisthesis. We compared the surgical indication derived from Medicare claims to that provided by SPORT surgeons, the “gold standard”. Summary of Background Data Administrative data are frequently used to report procedure rates, surgical safety outcomes, and costs in the management of spinal surgery. However, the accuracy of using diagnosis codes to classify patients by surgical indication has not been examined. Methods Medicare claims were link to beneficiaries enrolled in SPORT. The sensitivity and specificity of three claims-based approaches to group patients based on surgical indications were examined: 1) using the first listed diagnosis; 2) using all diagnoses independently; and 3) using a diagnosis hierarchy based on the support for fusion surgery. Results Medicare claims were obtained from 376 SPORT participants, including 21 with disc herniation, 183 with spinal stenosis, and 172 with degenerative spondylolisthesis. The hierarchical coding algorithm was the most accurate approach for classifying patients by surgical indication, with sensitivities of 76.2%, 88.1%, and 84.3% for disc herniation, spinal stenosis, and degenerative spondylolisthesis cohorts, respectively. The specificity was 98.3% for disc herniation, 83.2% for spinal stenosis, and 90.7% for degenerative spondylolisthesis. Misclassifications were primarily due to codes attributing more complex pathology to the case. Conclusion Standardized approaches for using claims data to accurately group patients by surgical indications has widespread interest. We found that a hierarchical coding approach correctly classified over 90% of spine patients into their respective SPORT cohorts. Therefore, claims data appears to be a reasonably valid approach to classifying patients by surgical indication. PMID:24525995

  2. New Directions in Spinal Surgery

    Microsoft Academic Search

    Ian F. Dunn; Marc E. Eichler

    Evolving technological sophistication has resulted in ongoing modifications of traditional surgical approaches to correct\\u000a disorders of the spinal axis. Advances in instrumentation and pre- and intraoperative imaging have fueled a move toward minimally\\u000a invasive, minimal access spine surgery (1), by which the same surgical goals of conventional open techniques are met through a smaller access corridor. An early and\\u000a now

  3. Erythropoietin in Spinal Cord Injury

    Microsoft Academic Search

    Michael Brines; Anthony Cerami

    Spinal cord injury (SCI) is a devastating condition lacking a clearly effective pharmacological treatment. The cytokine erythropoietin\\u000a (EPO), which mediates cytoprotection in a variety of tissues through activation of multiple signaling pathways, is markedly\\u000a effective in preclinical models of ischemic, traumatic and inflammatory SCI. The recent development of non-erythropoietic\\u000a derivatives of EPO with outstanding preclinical characteristics encourages evaluation of tissue-protective

  4. Focused review: spinal anesthesia in severe preeclampsia.

    PubMed

    Henke, Vanessa G; Bateman, Brian T; Leffert, Lisa R

    2013-09-01

    Spinal anesthesia is widely regarded as a reasonable anesthetic option for cesarean delivery in severe preeclampsia, provided there is no indwelling epidural catheter or contraindication to neuraxial anesthesia. Compared with healthy parturients, those with severe preeclampsia experience less frequent, less severe spinal-induced hypotension. In severe preeclampsia, spinal anesthesia may cause a higher incidence of hypotension than epidural anesthesia; however, this hypotension is typically easily treated and short lived and has not been linked to clinically significant differences in outcomes. In this review, we describe the advantages and limitations of spinal anesthesia in the setting of severe preeclampsia and the evidence guiding intraoperative hemodynamic management. PMID:23868886

  5. How often are gonorrhoea and genital yeast infection sexually transmitted?

    Microsoft Academic Search

    R N Thin; P Rendell; J Wadsworth

    1979-01-01

    Although gonorrhoea is often regarded as the sexually transmitted disease against which others are measured, its infectivity is not clearly understood. Estimates of the infection rate have varied from 5--90%. In this study, 50 couples with gonorrhoea were matched with 50 couples with genital yeast infection. Gonorrhoea was diagnosed in both partners of 32 couples and genital yeast infection in

  6. An attempt at clinically defining and assessing minimally invasive surgery compared with traditional “open” spinal surgery

    PubMed Central

    McAfee, Paul C.; Garfin, Steven R.; Rodgers, W. Blake; Allen, R. Todd; Phillips, Frank; Kim, Choll

    2011-01-01

    Background The goal of this editorial and literature review is to define the term “minimally invasive surgery” (MIS) as it relates to the spine and characterize methods of measuring parameters of a spine MIS technique. Methods This report is an analysis of 105,845 cases of spinal surgery in unmatched series and 95,161 cases in paired series of open compared with MIS procedures performed by the same surgeons to develop quantitative criteria to analyze the success of MIS. Results A lower rate of deep infection proved to be a key differentiator of spinal MIS. In unmatched series the infection rate for 105,845 open traditional procedures ranged from 2.9% to 4.3%, whereas for MIS, the incidence of infection ranged from 0% to 0.22%. For matched paired series with the open and MIS procedures performed by the same surgeons, the rate of infection in open procedures ranged from 1.5% to 10%, but for spine MIS, the rate of deep infection was much lower, at 0% to 0.2%. The published ranges for open versus MIS infection rates do not overlap or even intersect, which is a clear indication of the superiority of MIS for one specific clinical outcome measure (MIS proves superior to open spine procedures in terms of lower infection rate). Conclusions It is difficult, if not impossible, to validate that an operative procedure is “less invasive” or “more minimally invasive” than traditional surgical procedures unless one can establish a commonly accepted definition of MIS. Once a consensus definition or precise definition of MIS is agreed upon, the comparison shows a higher infection rate with traditional spinal exposures versus MIS spine procedures. PMID:25802679

  7. An uncommon infection in an uncommon host.

    PubMed

    Singh, Siddharth; Bundrick, John B

    2011-08-01

    We present the case of an international traveller who was eventually diagnosed with amoebiasis and autosomal dominant polycystic kidney disease (ADPKD) after she presented with recurring fevers. The patient was also diagnosed with non-amoebic bacterial hepatitis. Positron emission tomography (PET) can play an important role in locating the source of infection in patients with ADPKD when hepatic or renal infection is suspected. It can also be used to document clinical resolution of infection in difficult cases. Hepatic parenchymal infections in ADPKD patients may warrant a prolonged course of rotating antibiotics. PMID:21265585

  8. Spinal dysraphism: A challenge continued to be faced by neurosurgeons in developing countries

    PubMed Central

    Agrawal, Amit; Sampley, Sunil

    2014-01-01

    Objectives: The incidence of spinal dysraphism has significantly decreased over the last few decades, all over the world; however, still the incidence is much higher in developing countries with poor socioeconomic status. Materials and Methods: The present study includes all patients managed for spinal dysraphism over a period of one year (January 2011-December 2011). Details including demographics, antenatal care history, site and type of lesion, neurological examination, imaging finding, associated congenital anomalies, management offered, and outcome were recorded. Results: A total of 27 children were operated for spinal dysraphism during the study period (17 males and 11 females). Median age was 120 days (age range, 1 day to 6 years). Mothers of 15 children did not seek any regular antenatal checkup and only 13 mothers received folic acid supplementation during pregnancy. Fourteen children were delivered at home and 13 were at hospital. The most common site was lumbosacral region (67.8%). Seven patients had rupture of the sac at the time of presentation, one child had local infection, and four patients had hydrocephalus (requiring shunt before surgical repair). Two patients developed hydrocephalus at follow up, needing shunt surgery. The mean hospital stay was 7 days (range, 5 days to 31 days; median, 10 days). Conclusion: Spinal dysraphism is still a major public health problem in developing countries. Management of patients with spinal dysraphism is complex and needs close coordination between pediatrician, neurologist, neurosurgeon, and rehabilitation experts. A large number of factors influence the outcome. PMID:25126121

  9. Methods of diagnosing alagille syndrome

    DOEpatents

    Li, Linheng; Hood, Leroy; Krantz, Ian D.; Spinner, Nancy B.

    2004-03-09

    The present invention provides an isolated polypeptide exhibiting substantially the same amino acid sequence as JAGGED, or an active fragment thereof, provided that the polypeptide does not have the amino acid sequence of SEQ ID NO:5 or SEQ ID NO:6. The invention further provides an isolated nucleic acid molecule containing a nucleotide sequence encoding substantially the same amino acid sequence as JAGGED, or an active fragment thereof, provided that the nucleotide sequence does not encode the amino acid sequence of SEQ ID NO:5 or SEQ ID NO:6. Also provided herein is a method of inhibiting differentiation of hematopoietic progenitor cells by contacting the progenitor cells with an isolated JAGGED polypeptide, or active fragment thereof. The invention additionally provides a method of diagnosing Alagille Syndrome in an individual. The method consists of detecting an Alagille Syndrome disease-associated mutation linked to a JAGGED locus.

  10. [Differential diagnoses of Raynaud's phenomenon].

    PubMed

    Ahrazoglu, M; Moinzadeh, P; Hunzelmann, N

    2014-05-01

    Raynaud's phenomenon (RP) is characterized by repeated vasospastic attacks of the distal extremities induced by cold, humidity, vibrations or emotional stress. It typically presents a triphasic colour change from white (palor; vasoconstriction) to blue (cyanosis) and red (reactive hyperaemia). The symptoms are based on a primary RP in 90?%. Secondary RP is a symptom of an underlying disease. RP has to be distinguished from other colour changes of the distal extremities like acrocyanosis, erythromelalgia, perniosis and Chilblain-Lupus. Patients history, clinical examination, ANA, ESR/CRP and nailfold capillaroscopy are essential for the early diagnosis of an underlying disease. The initiation of angiologic tests is important in patients with digital ulcers, necrosis or gangrene. Important differential diagnoses in secondary RP are autoimmune rheumatic diseases like systemic sclerosis and systemic lupus erythematodes as well as vascular diseases like arterial occlusions and compression syndromes or concomitant medication (i.?e. beta-blocker). PMID:24801303

  11. Feasibility of 3.0 T diffusion-weighted nuclear magnetic resonance imaging in the evaluation of functional recovery of rats with complete spinal cord injury

    PubMed Central

    Zhang, Duo; Li, Xiao-hui; Zhai, Xu; He, Xi-jing

    2015-01-01

    Diffusion tensor imaging is a sensitive way to reflect axonal necrosis and degeneration, glial cell regeneration and demyelination following spinal cord injury, and to display microstructure changes in the spinal cord in vivo. Diffusion tensor imaging technology is a sensitive method to diagnose spinal cord injury; fiber tractography visualizes the white matter fibers, and directly displays the structural integrity and resultant damage of the fiber bundle. At present, diffusion tensor imaging is restricted to brain examinations, and is rarely applied in the evaluation of spinal cord injury. This study aimed to explore the fractional anisotropy and apparent diffusion coefficient of diffusion tensor magnetic resonance imaging and the feasibility of diffusion tensor tractography in the evaluation of complete spinal cord injury in rats. The results showed that the average combined scores were obviously decreased after spinal cord transection in rats, and then began to increase over time. The fractional anisotropy scores after spinal cord transection in rats were significantly lower than those in normal rats (P < 0.05); the apparent diffusion coefficient was significantly increased compared with the normal group (P < 0.05). Following spinal cord transection, fractional anisotropy scores were negatively correlated with apparent diffusion coefficient values (r = –0.856, P < 0.01), and positively correlated with the average combined scores (r = 0.943, P < 0.01), while apparent diffusion coefficient values had a negative correlation with the average combined scores (r = –0.949, P < 0.01). Experimental findings suggest that, as a non-invasive examination, diffusion tensor magnetic resonance imaging can provide qualitative and quantitative information about spinal cord injury. The fractional anisotropy score and apparent diffusion coefficient have a good correlation with the average combined scores, which reflect functional recovery after spinal cord injury. PMID:25878589

  12. Effect of locomotor training in completely spinalized cats previously submitted to a spinal hemisection.

    PubMed

    Martinez, Marina; Delivet-Mongrain, Hugo; Leblond, Hugues; Rossignol, Serge

    2012-08-01

    After a spinal hemisection in cats, locomotor plasticity occurring at the spinal level can be revealed by performing, several weeks later, a complete spinalization below the first hemisection. Using this paradigm, we recently demonstrated that the hemisection induces durable changes in the symmetry of locomotor kinematics that persist after spinalization. Can this asymmetry be changed again in the spinal state by interventions such as treadmill locomotor training started within a few days after the spinalization? We performed, in 9 adult cats, a spinal hemisection at thoracic level 10 and then a complete spinalization at T13, 3 weeks later. Cats were not treadmill trained during the hemispinal period. After spinalization, 5 of 9 cats were not trained and served as control while 4 of 9 cats were trained on the treadmill for 20 min, 5 d a week for 3 weeks. Using detailed kinematic analyses, we showed that, without training, the asymmetrical state of locomotion induced by the hemisection was retained durably after the subsequent spinalization. By contrast, training cats after spinalization induced a reversal of the left/right asymmetries, suggesting that new plastic changes occurred within the spinal cord through locomotor training. Moreover, training was shown to improve the kinematic parameters and the performance of the hindlimb on the previously hemisected side. These results indicate that spinal locomotor circuits, previously modified by past experience such as required for adaptation to the hemisection, can remarkably respond to subsequent locomotor training and improve bilateral locomotor kinematics, clearly showing the benefits of locomotor training in the spinal state. PMID:22875930

  13. Spinal arteriovenous malformation presenting as spastic monoplegic cerebral palsy in a child.

    PubMed

    Flett, Peter John; Baulderstone, David; Russo, Remo; Davies, Roger Philip

    2012-01-01

    A case of spinal arterio-venous malformation (AVM) initially diagnosed as unilateral cerebral palsy (CP) is reported. The presentation was of a long-standing spastic monoparesis of the left leg, with initial response to Botulinum toxin injections to the calf and tibialis posterior muscles. This was followed by progressive deterioration occurring over a 3-month period before further investigation and definitive diagnosis at 7 years. Imaging demonstrated a large extra-medullary spinal AVM compressing the mid-thoracic cord. This was successfully managed by embolisation with a non-adhesive polymer: ethylene-vinyl alcohol copolymer injected into the dominant feeding vessel. This case highlights the need to consider alternative diagnoses when a child with a diagnosis of CP presents with atypical clinical features such as monoparesis and has worsening or altered clinical signs. Moreover, a normal magnetic resonance imaging brain scan and the absence of ipsilateral upper limb neurological signs or functional impairment should raise suspicion even in the context of static lower limb signs. A literature review was performed on the management of spinal AVM in children and this will be is discussed. PMID:20546106

  14. Chronic spontaneous lumbar epidural hematoma simulating extradural spinal tumor: a case report.

    PubMed

    Matsui, Hiroki; Imagama, Shiro; Ito, Zenya; Ando, Kei; Hirano, Kenichi; Tauchi, Ryoji; Muramoto, Akio; Matsumoto, Tomohiro; Ishiguro, Naoki

    2014-02-01

    Spinal epidural hematoma (SEH) is an uncommon disorder, and chronic SEHs are rarer than acute SEHs. However, there is few reported involving the bone change of the vertebral body in chronic SEHs. We present a case report of lumbar epidural hematoma that required differentiation from extramedullary spinal tumors by a long process because the CT scan revealed scalloping of the vertebral body and review the relevant literature. A 78-year-old man had experienced a gradual onset of low back pain and excruciating pain in both legs. Lumbar MRI on T1-weighted images revealed a space-occupying lesion with a hyperintense signal relative to the spinal cord with no enhancement on gadolinium adminisration. Meanwhile, T2-weighted images revealed a heterogeneous intensity change, accompanying a central area of hyperintense signals with a hypointense peripheral border at the L4 vertebra. Moreover, the CT scan demonstrated scalloping of the posterior wall of the L4 vertebral body which is generally suspected as the CT finding of spainal tumor. During the epidural space exploration, we found a dark red-colored mass surrounded by a capsular layer, which was fibrous and adhered to the flavum and dura mater. Microscopic histological examination of the resected mass revealed a mixture of the relatively new hematoma and the hematoma that was moving into the connective tissue. Accordingly, the hematoma was diagnosed as chronic SEH. The particular MRI findings of chronic SEHs are helpful for making accurate preoperative diagnoses of this pathology. PMID:25130006

  15. Spinal Instrumentation With A Low Complication Rate

    Microsoft Academic Search

    Scott A Shapiro; William Snyder

    1997-01-01

    BackgroundSpinal instrumentation has become an increasing part of the armamentarium of neurosurgery and neurosurgical training. For noncontroversial indications for spine fusion the arthrodesis rate seems to be better. For both noncontroversial and controversial indications, the reported complication rate with spinal instrumentation tends to be greater than that with noninstrumented spine surgeries. These reported complications include a 2–3% neurologic injury rate,

  16. Spinal Cord Simulation for Chronic Pain Management

    E-print Network

    Kreinovich, Vladik

    Spinal Cord Simulation for Chronic Pain Management: Towards an Expert System Kenneth M. Al'o 1 , Richard Al'o 2 , Andre de Korvin 2 , and Vladik Kreinovich 3 1 Pain and Health Management Center 17270 Red@cs.utep.edu Abstract Chronic pain is a serious health problem affecting millions of people worldwide. Currently, spinal

  17. Injectable multifunctional scaffold for spinal cord repair

    Microsoft Academic Search

    Lauren Conova; Pamela Kubinski; Ying Jin; Jennifer Vernengo; Birgit Neuhuber; Itzhak Fischer; Anthony Lowman

    2010-01-01

    Spinal cord injury (SCI) affects thousands of Americans each year. The injury results in local cell loss in the spinal cord, interrupting the connections between brain and periphery. Current treatment options for SCI are limited due to the inability of adult neurons to regenerate in the inhibitory environment of the injured central nervous system (CNS). The primary goal of this

  18. Psychological Aspects of Spinal Cord Injury

    ERIC Educational Resources Information Center

    Cook, Daniel W.

    1976-01-01

    Reviewing literature on the psychological impact of spinal cord injury suggests: (a) depression may not be a precondition for injury adjustment; (b) many persons sustaining cord injury may have experienced psychological disruption prior to injury; and (c) indexes of rehabilitation success need to be developed for the spinal cord injured. (Author)

  19. Ergonomics, spinal injury, and industrial vehicle safety

    Microsoft Academic Search

    R. W. McLay; D. G. Wilder; M. K. Molloy

    1996-01-01

    Explores the mechanisms of spinal injury in industrial vehicle accidents. The biomechanics of balance, response to sudden loads, and impact and vibration are shown to influence the nature of trauma. A simulation of the occupant motion in a sit-down forklift shows the loads in a tipover. The packaging of the driver is discussed to reduce the probability of spinal injury

  20. The Development of Spinal Cord Anatomy

    Microsoft Academic Search

    J. M. S. Pearce

    2008-01-01

    A panel illustrating spinal cord injury in The Dying Lioness in the British Museum dates to 650 BC. This paper outlines the subsequent progression of knowledge of the anatomy of the spinal cord. The animal dissections of Galen are considered because his deductions persisted through the Dark Ages until the late 18th century. Anatomy advanced gradually to yield discoveries of

  1. Spinal stenosis subsequent to juvenile lumbar osteochondrosis

    Microsoft Academic Search

    Kaj Tallroth; Dietrich Schlenzka

    1990-01-01

    This paper describes eight patients with spinal stenosis associated with marked osteochondrous changes in the vertebral bodies due to juvenile lumbar osteochondrosis (Scheuermann's disease). In no case was the midsagittal or interpedicular diameter of the spinal canal indicative of bony stenosis. On the other hand, in the myelograms the sagittal diameter of the dural sac was in all cases significantly

  2. Spinal Cord Ischemia Secondary to Hypovolemic Shock

    PubMed Central

    Kapoor, Siddhant; Koh, Roy KM; Yang, Eugene WR; Hee, Hwan-Tak

    2014-01-01

    A 44-year-old male presented with symptoms of spinal cord compression secondary to metastatic prostate cancer. An urgent decompression at the cervical-thoracic region was performed, and there were no complications intraoperatively. Three hours postoperatively, the patient developed acute bilateral lower-limb paralysis (motor grade 0). Clinically, he was in class 3 hypovolemic shock. An urgent magnetic resonance imaging (MRI) was performed, showing no epidural hematoma. He was managed aggressively with medical therapy to improve his spinal cord perfusion. The patient improved significantly, and after one week, he was able to regain most of his motor functions. Although not commonly reported, spinal cord ischemia post-surgery should be recognized early, especially in the presence of hypovolemic shock. MRI should be performed to exclude other potential causes of compression. Spinal cord ischemia needs to be managed aggressively with medical treatment to improve spinal cord perfusion. The prognosis depends on the severity of deficits, and is usually favorable. PMID:25558328

  3. IL-12p40 Deficiency Leads to Uncontrolled Trypanosoma cruzi Dissemination in the Spinal Cord Resulting in Neuronal Death and Motor Dysfunction

    PubMed Central

    Bombeiro, André Luis; Gonçalves, Lígia Antunes; Penha-Gonçalves, Carlos; Marinho, Claudio Romero Farias; D’Império Lima, Maria Regina; Chadi, Gerson; Álvarez, José Maria

    2012-01-01

    Chagas’ disease is a protozoosis caused by Trypanosoma cruzi that frequently shows severe chronic clinical complications of the heart or digestive system. Neurological disorders due to T. cruzi infection are also described in children and immunosuppressed hosts. We have previously reported that IL-12p40 knockout (KO) mice infected with the T. cruzi strain Sylvio X10/4 develop spinal cord neurodegenerative disease. Here, we further characterized neuropathology, parasite burden and inflammatory component associated to the fatal neurological disorder occurring in this mouse model. Forelimb paralysis in infected IL-12p40KO mice was associated with 60% (p<0.05) decrease in spinal cord neuronal density, glutamate accumulation (153%, p<0.05) and strong demyelization in lesion areas, mostly in those showing heavy protein nitrosylation, all denoting a neurotoxic degenerative profile. Quantification of T. cruzi 18S rRNA showed that parasite burden was controlled in the spinal cord of WT mice, decreasing from the fifth week after infection, but progressive parasite dissemination was observed in IL-12p40KO cords concurrent with significant accumulation of the astrocytic marker GFAP (317.0%, p<0.01) and 8-fold increase in macrophages/microglia (p<0.01), 36.3% (p<0.01) of which were infected. Similarly, mRNA levels for CD3, TNF-?, IFN-?, iNOS, IL-10 and arginase I declined in WT spinal cords about the fourth or fifth week after infection, but kept increasing in IL-12p40KO mice. Interestingly, compared to WT tissue, lower mRNA levels for IFN-? were observed in the IL-12p40KO spinal cords up to the fourth week of infection. Together the data suggest that impairments of parasite clearance mechanisms in IL-12p40KO mice elicit prolonged spinal cord inflammation that in turn leads to irreversible neurodegenerative lesions. PMID:23152844

  4. IL-12p40 deficiency leads to uncontrolled Trypanosoma cruzi dissemination in the spinal cord resulting in neuronal death and motor dysfunction.

    PubMed

    Bombeiro, André Luis; Gonçalves, Lígia Antunes; Penha-Gonçalves, Carlos; Marinho, Claudio Romero Farias; D'Império Lima, Maria Regina; Chadi, Gerson; Álvarez, José Maria

    2012-01-01

    Chagas' disease is a protozoosis caused by Trypanosoma cruzi that frequently shows severe chronic clinical complications of the heart or digestive system. Neurological disorders due to T. cruzi infection are also described in children and immunosuppressed hosts. We have previously reported that IL-12p40 knockout (KO) mice infected with the T. cruzi strain Sylvio X10/4 develop spinal cord neurodegenerative disease. Here, we further characterized neuropathology, parasite burden and inflammatory component associated to the fatal neurological disorder occurring in this mouse model. Forelimb paralysis in infected IL-12p40KO mice was associated with 60% (p<0.05) decrease in spinal cord neuronal density, glutamate accumulation (153%, p<0.05) and strong demyelization in lesion areas, mostly in those showing heavy protein nitrosylation, all denoting a neurotoxic degenerative profile. Quantification of T. cruzi 18S rRNA showed that parasite burden was controlled in the spinal cord of WT mice, decreasing from the fifth week after infection, but progressive parasite dissemination was observed in IL-12p40KO cords concurrent with significant accumulation of the astrocytic marker GFAP (317.0%, p<0.01) and 8-fold increase in macrophages/microglia (p<0.01), 36.3% (p<0.01) of which were infected. Similarly, mRNA levels for CD3, TNF-?, IFN-?, iNOS, IL-10 and arginase I declined in WT spinal cords about the fourth or fifth week after infection, but kept increasing in IL-12p40KO mice. Interestingly, compared to WT tissue, lower mRNA levels for IFN-? were observed in the IL-12p40KO spinal cords up to the fourth week of infection. Together the data suggest that impairments of parasite clearance mechanisms in IL-12p40KO mice elicit prolonged spinal cord inflammation that in turn leads to irreversible neurodegenerative lesions. PMID:23152844

  5. Urinary Tract Infections

    Microsoft Academic Search

    Dimitri M. Drekonja; James R. Johnson

    \\u000a Urinary tract infection (UTI) is among the most commonly diagnosed and treated infectious disease in ambulatory practice.\\u000a Key principles in the management of UTI include empiric short-course therapy for appropriate patients, initiation of (or rapid\\u000a conversion to) effective oral therapy, implementing measures to prevent recurrent UTI, and avoiding antimicrobial therapy\\u000a for asymptomatic bacteriuria, aside from a few clearly indicated circumstances.

  6. Ochronosis diagnosed after knee arthroscopy

    PubMed Central

    Kara, Adnan; Celik, Haluk; Seker, Ali; Sezer, Hasan Basri; Kilinc, Eray; Uzun, Metin

    2014-01-01

    INTRODUCTION Ochronosis is a rare disorder which is defined as the deposition of metabolites of oxidation and polymerization of homogentisic acid, which have high affinity to collogen, in the connective tissues. It is a clinical condition characterized with ochronotic pigmentation of tissues, degenerative arthropathy of especially large joints and black discoloration of urine. In this paper we present a case of ochronosis diagnosed with biopsy and additional tests when a black discoloration of menisci and joint cartilage were detected during arthroscopic intervention for a degenerative meniscus tear. PRESENTATION OF CASE A forty two year-old male patient was operated for lateral meniscus tear of his right knee. The arthroscopic examination of right knee revealed black colored synovial hypertrophy and torn lateral meniscus. Partial meniscectomy was performed. The diagnosis of ochronosis was made after histopathologic examination. DISCUSSION Ochronotic pigment can accumulate in hyaline cartilage, tendon, skin, teeth, nail, sclera, tympanic membrane, heart valves, renal tubular cells, duramater, pancreas and walls of large arteries. In ochronosis the most frequently involved joints are knee and hip. In ochronotic arthropathy, articular cartilage become more sensitive to mechanical stresses. Our patient had meniscal tear, cartilage damage and black discoloration of synovial tissues and meniscus. CONCLUSION Arthroscopy may be helpful in diagnosis of ochronotic arthropathy. PMID:24993694

  7. PLASTICITY OF THE SPINAL NEURAL CIRCUITRY AFTER INJURY

    Microsoft Academic Search

    V. Reggie Edgerton; Niranjala J. K. Tillakaratne; Allison J. Bigbee; Ray D. de Leon; Roland R. Roy

    2004-01-01

    ? Abstract Motor function is severely disrupted following spinal cord injury (SCI). The spinal circuitry, however, exhibits a great degree of automaticity and plasticity after an injury. Automaticity implies that the spinal circuits have some,capacity to perform complex motor tasks following the disruption of supraspinal input, and evidence for plasticity suggests that biochemical,changes at the cellular level in the spinal

  8. [A universal stereotactic device for spinal cord surgery].

    PubMed

    Novák, Z; Kosík, E

    2001-07-01

    Technical description of a universal stereotactic system for spinal cord operations is presented after a short overview of the history of spinal cord stereotaxis. When combined with the topometric atlas of the cord, new era of spinal cord stereotaxis can be opened, which is going to expand the amount of knowledge about the physiology of the spinal cord. PMID:11505685

  9. Hereditary spinal neurofibromatosis: a rare form of NF1?

    Microsoft Academic Search

    M Poyhonen; E L Leisti; S Kytölä; J Leisti

    1997-01-01

    We describe a family in which seven members in three generations were affected with a rare spinal neurofibromatosis. The affected adults showed, at the ages of 32, 37, 38, and 61, respectively, multiple spinal neurofibromas symmetrically affecting all spinal roots. Two patients were operated on for histopathologically proven cervical spinal neurofibromas. All patients had café au lait spots, one had

  10. Treadmill training promotes spinal changes leading to locomotor recovery after partial spinal cord injury in cats.

    PubMed

    Martinez, Marina; Delivet-Mongrain, Hugo; Rossignol, Serge

    2013-06-01

    After a spinal hemisection at thoracic level in cats, the paretic hindlimb progressively recovers locomotion without treadmill training but asymmetries between hindlimbs persist for several weeks and can be seen even after a further complete spinal transection at T13. To promote optimal locomotor recovery after hemisection, such asymmetrical changes need to be corrected. In the present study we determined if the locomotor deficits induced by a spinal hemisection can be corrected by locomotor training and, if so, whether the spinal stepping after the complete spinal cord transection is also more symmetrical. This would indicate that locomotor training in the hemisected period induces efficient changes in the spinal cord itself. Sixteen adult cats were first submitted to a spinal hemisection at T10. One group received 3 wk of treadmill training, whereas the second group did not. Detailed kinematic and electromyographic analyses showed that a 3-wk period of locomotor training was sufficient to improve the quality and symmetry of walking of the hindlimbs. Moreover, after the complete spinal lesion was performed, all the trained cats reexpressed bilateral and symmetrical hindlimb locomotion within 24 h. By contrast, the locomotor pattern of the untrained cats remained asymmetrical, and the hindlimb on the side of the hemisection was still deficient. This study highlights the beneficial role of locomotor training in facilitating bilateral and symmetrical functional plastic changes within the spinal circuitry and in promoting locomotor recovery after an incomplete spinal cord injury. PMID:23554433

  11. Catheter-related Bloodstream Infections

    Microsoft Academic Search

    Antonio Sitges-Serra; Meritxell Girvent

    1999-01-01

    .   Catheter-related bloodstream infections (CBIs) rank among the most frequent and potentially lethal nosocomial infections.\\u000a Intravascular devices become contaminated on the outer surface during nonaseptic insertion or maintenance of the catheter\\u000a exit site or endoluminally during hub manipulation. CBI is heralded by spiking fever, malaise and rigors and should be promptly\\u000a diagnosed to prevent endocarditis and septic metastasis. In about

  12. Craniofacial arteriovenous metameric syndrome (CAMS) 3--a transitional pattern between CAM 1 and 2 and spinal arteriovenous metameric syndromes.

    PubMed

    Wong, I Y C; Batista, L L; Alvarez, H; Lasjaunias, P L

    2003-09-01

    We report a rare case of craniofacial arteriovenous metameric syndrome (CAMS) 3 arteriovenous malformations of the mandible, left VIII nerve and petrous bone. The patient, a 19-year-old girl, presented with profuse gingival bleeding during a dental procedure and we diagnosed CAMS 3 during a pre-embolisation angiogram. The distribution of the vascular lesions suggests that CAMS 3 is intermediate CAMS 1 and 2 and spinal arteriovenous metameric syndrome (SAMS). PMID:12898077

  13. Spinal Intradural Hematoma and Permanent Paraparesis after a Lumboperitoneal Shunt Operation: An Unusual Complication

    PubMed Central

    Efendioglu, Mustafa; Bolukbasi, Fatih Han; Aslan, Sahin; Isik, Nejat; Kaner, Tuncay

    2014-01-01

    Pseudotumor cerebri is a condition of increased intracranial pressure in the absence of clinical, laboratory or radiological pathology. Spinal intradural hematoma formation after lumboperitoneal shunt (LPS) implantation is very rare, but it can cause sudden and serious deterioration. In this report, we present a patient who developed an intradural hematoma following LPS operation. A 27-year-old male patient suffering from headaches and progressive vision loss was diagnosed with pseudotumor cerebri. He underwent LPS operation in January 2009. Four hours after the operation, he developed urinary and fecal incontinence with paraparesis (1/5). Lumbar magnetic resonance imaging identified an intradural hematoma at the level of L2-L3, and he was reoperated. The intradural hematoma was removed. Physical therapy was started because of paraparesis. Two months later, the patient's muscle strength had increased to 3/5. Surgeons must remember that, LPS implantation can cause a spinal intradural hematoma in a small percentage of patients, with catastrophic results. PMID:25187872

  14. Spinal Epidural Hematoma After Thrombolysis for Deep Vein Thrombosis with Subsequent Pulmonary Thromboembolism: A Case Report

    SciTech Connect

    Han, Young-Min, E-mail: ymhan@chonbuk.ac.kr; Kwak, Ho-Sung; Jin, Gong-Young; Chung, Gyung-Ho [Chonbuk National University Medical School, Departments of Radiology (Korea, Republic of); Song, Kyung-Jin [Chonbuk National University Medical School, Departments of Orthopedic Surgery (Korea, Republic of)

    2006-06-15

    A 38-year-old male was initially admitted for left leg swelling. He was diagnosed as having deep vein thrombosis (DVT) in the left leg and a pulmonary thromboembolism by contrast-enhanced chest computed tomography (CT) with delayed lower extremity CT. The DVT was treated by thrombolysis and a venous stent. Four hours later, he complained of severe back pain and a sensation of separation of his body and lower extremities; he experienced paraplegia early in the morning of the following day. Magnetic resonance imaging showed a spinal epidural hematoma between T11 and L2, which decompressed following surgery. We, therefore, report a case of a spinal epidural hematoma after thrombolysis in a case of DVT with a pulmonary thromboembolism.

  15. Dorsal spinal epidural cavernous hemangioma

    PubMed Central

    Sanghvi, Darshana; Munshi, Mihir; Kulkarni, Bijal; Kumar, Abhaya

    2010-01-01

    A 61-year-old female patient presented with diffuse pain in the dorsal region of the back of 3 months duration. The magnetic resonance imaging showed an extramedullary, extradural space occupative lesion on the right side of the spinal canal from D5 to D7 vertebral levels. The mass was well marginated and there was no bone involvement. Compression of the adjacent thecal sac was observed, with displacement to the left side. Radiological differential diagnosis included nerve sheath tumor and meningioma. The patient underwent D6 hemilaminectomy under general anesthesia. Intraoperatively, the tumor was purely extradural in location with mild extension into the right foramina. No attachment to the nerves or dura was found. Total excision of the extradural compressing mass was possible as there were preserved planes all around. Histopathology revealed cavernous hemangioma. As illustrated in our case, purely epidural hemangiomas, although uncommon, ought to be considered in the differential diagnosis of spinal epidural soft tissue masses. Findings that may help to differentiate this lesion from the ubiquitous disk prolapse, more common meningiomas and nerve sheath tumors are its ovoid shape, uniform T2 hyperintense signal and lack of anatomic connection with the neighboring intervertebral disk or the exiting nerve root. Entirely extradural lesions with no bone involvement are rare and represent about 12% of all intraspinal hemangiomas. PMID:21572634

  16. Newly Diagnosed Acute Promyelocytic Leukemia

    PubMed Central

    Avvisati, Giuseppe

    2011-01-01

    Acute promyelocytic leukemia (APL) represents a medical emergency with a high rate of early mortality. As a consequence, as soon as the diagnosis is suspected based upon cytologic criteria, it is necessary to start all- trans retinoic acid (ATRA) treatment without delay. For patients with newly diagnosed APL, induction therapy with ATRA plus anthracycline based chemotherapy is recommended. At present the combination of arsenic trioxide plus ATRA should be considered for patients who are not candidates for anthracycline-based therapy. For pediatric and adult patients with APL aged < 60 years who achieve a CR with induction, I recommend 3 intensive courses of consolidation chemotherapy associated to ATRA, targeted on the basis of the risk group at diagnosis. In patients treated with a very intensive consolidation chemotherapy maintenance treatment can be omitted. However If a maintenance treatment has to be adopted I suggest the use of intermittent ATRA for 15 days every 3 months for a period of 2 years, rather than ATRA associated to chemotherapy. Moreover, taking into account the medical literature, a reduced dosage of ATRA ( 25 mg/m2) in pediatric patients and a consolidation chemotherapy of reduced intensity in elderly patients is recommended. Furthermore, in order to maximize survival, careful attention should be reserved to the coagulopathy and to the appearance of the differentiation syndrome. Finally, PCR for the PML/RARA fusion gene on a bone marrow specimen every three months for two years, and then every six months for additional three years are needed during the follow-up. PMID:22220261

  17. Spinal circuits formation: a study of developmentally regulated markers in organotypic cultures of embryonic mouse spinal cord

    Microsoft Academic Search

    D Avossa; M. D Rosato-Siri; F Mazzarol; L Ballerini

    2003-01-01

    In this study, we have addressed the issue of neural circuit formation using the mouse spinal cord as a model system. Our primary objective was to assess the suitability of organotypic cultures from embryonic mouse spinal cord to investigate, during critical periods of spinal network formation, the role of the local spinal cellular environment in promoting circuit development and refinement.

  18. Learning from the spinal cord: How the study of spinal cord plasticity informs our view of learning

    E-print Network

    Grau, James

    Review Learning from the spinal cord: How the study of spinal cord plasticity informs our view o Article history: Available online xxxx Keywords: Spinal cord Instrumental conditioning Pavlovian training can induce a lasting change in spinal cord function. A framework for the study of learning

  19. Infective endocarditis due to Staphylococcus aureus involving three cardiac valves. A case study.

    PubMed

    Maglioni, E; Garosi, M; Marchetti, L; Galluzzi, P; Marri, D; Biagioli, B

    2003-06-01

    A 20-year-old woman, diagnosed with coarctation of the aorta, situs viscerum inversus, and bicuspid aortic valve, underwent corrective surgery for the coarctation. After a postoperative neurological state that suggested a spinal lesion, corticosteroid therapy was initiated and the patient was discharged early from the unit to begin a motor rehabilitation program. Following the dehiscence of the thoracotomy surgical wound, a severe infective clinical picture, sustained by methicillin-resistant S. Aureus (MRSA), became evident with a diagnosis of bacterial endocarditis involving the aortic, mitral and tricuspid valves and caused the patient's death due to septic shock complicated by ARDS. According to the authors, the early discharge of the patients after such a complex operation, the eccessive lengthening of the steroid therapy that would have contribuited to delay the diagnosis, causing the lack of preventing identification of the first signs of infection and the impossibility for the patient to have another operation (involving 3 valves) are conclusive elements that led to the above mentioned complications. PMID:14564255

  20. Spinal 2Chloroprocaine: The Effect of Added Fentanyl

    Microsoft Academic Search

    Julie S. Vath; Dan J. Kopacz

    2004-01-01

    Spinal 2-chloroprocaine is being investigated as an al- ternative short-acting spinal anesthetic to replace lido- caine for outpatient surgery. Adding dextrose increases the baricity of solutions and alters the characteristics of spinal anesthesia. In this study, we compared 2-chloroprocaine spinal anesthesia performed with or without the addition of dextrose (1.1%). Eight volun- teers underwent 2 spinal anesthetics, receiving 40 mg

  1. Early diagnosis and treatment of spinal epidural metastasis in breast cancer: a prospective study.

    PubMed Central

    Boogerd, W; van der Sande, J J; Kröger, R

    1992-01-01

    This prospective study evaluated the usefulness of myelography in breast cancer patients who present with radiculopathy or myelopathy. A total of 124 consecutive myelograms were performed in 100 patients. Epidural metastasis (EM) was diagnosed in 67 myelograms (54%). Multiple epidural metastases were diagnosed in 15 (22%) of those, resulting in a total of 87 epidural lesions. A complete block was found in 13 EM (15%) and an incomplete block in 14 EM (16%). Clinical data could not predict the site of EM in 29 cases (33%). Fifteen asymptomatic EM were detected in myelograms with multiple EM. Plain radiographs were of no value in determining the site of EM in 29 cases (33%), including 13 cases (15%) without vertebral metastasis at the site of EM. Treatment consisted of radiotherapy (RT) with or without systemic treatment in 52 cases (80%), systemic treatment alone in 11 cases (17%) and surgery in two patients (3%). Clinical improvement was noticed in 72%, no change in 13%, and deterioration in 15%. No difference in response was noticed between RT and systemic therapy. Before treatment 21% and after treatment 15% of the patients could not walk. The one year survival was 42%. The ambulatory status at presentation was the most important prognostic factor. Examination of the spinal fluid, obtained at myelography, disclosed meningeal carcinomatosis in 9% of the patients. Imaging of the whole spinal canal with cytological examination of the spinal fluid is recommended in breast cancer patients suspected of epidural tumour with features of radiculopathy or myelopathy, irrespective of further clinical data and plain spinal radiographs. PMID:1479399

  2. Clinical applications of electrical stimulation after spinal cord injury.

    PubMed

    Creasey, Graham H; Ho, Chester H; Triolo, Ronald J; Gater, David R; DiMarco, Anthony F; Bogie, Kath M; Keith, Michael W

    2004-01-01

    During the last one-half century, electrical stimulation has become clinically significant for improving health and restoring useful function after spinal cord injury. Short-term stimulation can be provided by electrodes on the skin or percutaneous fine wires, but implanted systems are preferable for long-term use. Electrical stimulation of intact lower motor neurons can exercise paralyzed muscles and reverse wasting; improve strength, endurance, and cardiovascular fitness; and may reduce the progression of osteoporosis. Other potential therapeutic uses being investigated include reduction of spasticity, prevention of deep vein thrombosis, and improvement of tissue health. Pacing of intact phrenic nerves in high tetraplegia can produce effective respiration without mechanical ventilation, allowing improved speech, increased mobility, and increased sense of well-being. Improvement of cough has also been demonstrated. Stimulation of intact sacral nerves can produce effective micturition and reduce urinary tract infection; it can also improve bowel function and erection. It is usually combined with posterior sacral rhizotomy to improve continence and bladder capacity, and the combination has been shown to reduce costs of care. Electroejaculation can now produce semen in most men with spinal cord injury. Significant achievements have also been made in restoring limb function. Useful hand grasp can be provided in C5 and C6 tetraplegia, reducing dependence on adapted equipment and assistants. Standing, assistance with transfers, and walking for short distances can be provided to selected persons with paraplegia, improving their access to objects, places, and opportunities that are inaccessible from a wheelchair. This review summarizes the current state of therapeutic and neuroprosthetic applications of electrical stimulation after spinal cord injury and identifies some future directions of research and clinical and commercial development. PMID:15484667

  3. Diagnosing network-wide traffic anomalies

    Microsoft Academic Search

    Anukool Lakhina; Mark Crovella; Christophe Diot

    2004-01-01

    Anomalies are unusual and significant changes in a network's traffic levels, which can often span multiple links. Diagnosing anomalies is critical for both network operators and end users. It is a difficult problem because one must extract and interpret anomalous patterns from large amounts of high-dimensional, noisy data.In this paper we propose a general method to diagnose anomalies. This method

  4. Nanomedicine for treating spinal cord injury

    NASA Astrophysics Data System (ADS)

    Tyler, Jacqueline Y.; Xu, Xiao-Ming; Cheng, Ji-Xin

    2013-09-01

    Spinal cord injury results in significant mortality and morbidity, lifestyle changes, and difficult rehabilitation. Treatment of spinal cord injury is challenging because the spinal cord is both complex to treat acutely and difficult to regenerate. Nanomaterials can be used to provide effective treatments; their unique properties can facilitate drug delivery to the injury site, enact as neuroprotective agents, or provide platforms to stimulate regrowth of damaged tissues. We review recent uses of nanomaterials including nanowires, micelles, nanoparticles, liposomes, and carbon-based nanomaterials for neuroprotection in the acute phase. We also review the design and neural regenerative application of electrospun scaffolds, conduits, and self-assembling peptide scaffolds.

  5. Spinal muscular atrophy variant with congenital fractures.

    PubMed

    Kelly, T E; Amoroso, K; Ferre, M; Blanco, J; Allinson, P; Prior, T W

    1999-11-01

    A single report of brothers born to first-cousin parents with a form of acute spinal muscular atrophy (SMA) and congenital fractures suggested that this combination represented a distinct form of autosomal recessive SMA. We describe a boy with hypotonia and congenital fractures whose sural nerve and muscle biopsies were consistent with a form of spinal muscular atrophy. Molecular studies identified no abnormality of the SMN(T) gene on chromosome 5. This case serves to validate the suggestion of a distinct and rare form of spinal muscular atrophy while not excluding possible X-linked inheritance. PMID:10528250

  6. [Lumbar spinal stenosis. Classification and clinical presentation].

    PubMed

    van Akkerveeken, P F

    1993-08-01

    A review is presented of the nomenclature, taxonomy and clinical presentation of the lumbar canal and lateral stenosis. A historical review of the literature illustrates the growing importance of this clinical entity in the narrow spinal canal. The definition of Verbiest is introduced and explained. It distinguishes two main groups of spinal stenosis: congenital and developmental stenosis. Developmental stenosis contains several subgroups. Special attention is paid to "central" lumbar canal stenosis and lateral spinal stenosis. Both entities are discussed with a description of the etiology, anatomy, and symptomatology. The importance of nerve root infiltration as a diagnostic tool in asymptomatic radiculopathy is emphasized. PMID:8414475

  7. Improved Diagnosis of Infection Associated with Osteosynthesis by Use of Sonication of Fracture Fixation Implants

    PubMed Central

    Yano, Maysa Harumi; Klautau, Giselle Burlamaqui; da Silva, Cely Barreto; Nigro, Stanley; Avanzi, Osmar; Mercadante, Marcelo Tomanink

    2014-01-01

    Previous studies have shown that sonication fluid cultures from removed orthopedic devices improved the microbiological diagnosis of orthopedic implant-associated infections; however, few of these investigations have applied sonication to the removed fracture fixation devices to evaluate its utility for the diagnosis of osteosynthesis-associated infection (OAI). We compared sonication fluid to conventional tissue cultures from 180 subjects with different sizes of plates and screws (n = 156), spinal implants (n = 26), and intramedullary nails (n = 3), of whom 125 and 55 subjects had OAI and noninfected osteosynthesis (NIO), respectively. The sensitivity for detecting OAI was 90.4% for sonication fluid culture and 56.8% for periprosthetic tissue cultures (P < 0.05), and the specificities were 90.9% and 96.4%, respectively. Sonication fluid culture detected more pathogens than peri-implant tissue culture (113 versus 71; P < 0.001), while polymicrobial infections were diagnosed by sonication fluid cultures and tissue cultures in 20.8% and 8% (P < 0.001), respectively. Microbiological diagnosis was achieved exclusively by sonication fluid cultures for 47 (90.4%) subjects, and among them, 18 (38.3%) had previously received antibiotics, whereas in five (9.6%) infected subjects, tissue culture was positive and the sonication fluid culture was negative. Among 39 (31.2%) OAI cases receiving antibiotics, the identification of the organisms occurred in 38.5% and 82.1% of the tissue and sonication fluid cultures, respectively (P < 0.049). We demonstrated that sonication fluid culture from removed osteosyntheses has the potential for improving the microbiological diagnosis of OAI. PMID:25232155

  8. Spinal and Paraspinal Ewing Tumors

    SciTech Connect

    Indelicato, Daniel J., E-mail: dindelicato@floridaproton.or [Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL (United States); University of Florida Proton Therapy Institute, Jacksonville, FL (United States); Keole, Sameer R. [Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL (United States); University of Florida Proton Therapy Institute, Jacksonville, FL (United States); Shahlaee, Amir H. [Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL (United States); Morris, Christopher G. [Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL (United States); University of Florida Proton Therapy Institute, Jacksonville, FL (United States); Gibbs, C. Parker; Scarborough, Mark T. [Department of Orthopedic Surgery, University of Florida College of Medicine, Gainesville, FL (United States); Pincus, David W. [Department of Neurosurgery, University of Florida College of Medicine, Gainesville, FL (United States); Marcus, Robert B. [Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL (United States); University of Florida Proton Therapy Institute, Jacksonville, FL (United States)

    2010-04-15

    Purpose: To perform a review of the 40-year University of Florida experience treating spinal and paraspinal Ewing tumors. Patients and Methods: A total of 27 patients were treated between 1965 and 2007. For local management, 21 patients were treated with radiotherapy (RT) alone and 6 with surgery plus RT. All patients with metastatic disease were treated with RT alone. The risk profiles of each group were otherwise similar. The median age was 17 years, and the most frequent subsite was the sacral spine (n = 9). The median potential follow-up was 16 years. Results: The 5-year actuarial overall survival, cause-specific survival, and local control rate was 62%, 62%, and 90%, respectively. For the nonmetastatic subset (n = 22), the 5-year overall survival, cause-specific survival, and local control rate was 71%, 71%, and 89%, respectively. The local control rate was 84% for patients treated with RT alone vs. 100% for those treated with surgery plus RT. Patients who were >14 years old and those who were treated with intensive therapy demonstrated superior local control. Of 9 patients in our series with Frankel C or greater neurologic deficits at presentation, 7 experienced a full recovery with treatment. Of the 27 patients, 37% experienced Common Toxicity Criteria Grade 3 or greater toxicity, including 2 deaths from sepsis. Conclusion: Aggressive management of spinal and paraspinal Ewing tumors with RT with or without surgery results in high toxicity but excellent local control and neurologic outcomes. Efforts should be focused on identifying disease amenable to combined modality local therapy and improving RT techniques.

  9. Integrating spinal codes into wireless systems

    E-print Network

    Iannucci, Peter Anthony

    2013-01-01

    Rateless spinal codes [47] promise performance gains for future wireless systems. These gains can be realized in the form of higher data rates, longer operational ranges, reduced power consumption, and greater reliability. ...

  10. Spinal cord implants for nerve regeneration

    E-print Network

    Abbaschian, Lara Suzanne, 1979-

    2004-01-01

    It has only been in the last couple decades that the potential for regeneration in the spinal cord became accepted. However, there is still no proven method for enabling this regeneration. An implant model was developed ...

  11. Genetics Home Reference: Spinal muscular atrophy

    MedlinePLUS

    ... children. Spinal muscular atrophy, lower extremity, dominant (SMA-LED) is characterized by leg muscle weakness that is ... to another. DYNC1H1 gene mutations that cause SMA-LED disrupt the function of the dynein complex. As ...

  12. Epidural Angiolipoma With Spinal Cord Compression

    PubMed Central

    Poon, Tung P.; Behbahani, M.; Matoso, Ivone M.; Katz, Marcia A.; Pearl, Marilyn

    1988-01-01

    A case of epidural angiolipoma is reported. This tumor rarely occurs in the spinal canal. The most common location is in the thoracic region, and its histogenesis is probably congenital. ImagesFigure 1Figure 2Figure 3 PMID:3351973

  13. Spinal cord dysfunction complicating meningococcal meningitis

    Microsoft Academic Search

    J. Khan; I. Altafullah; M. Ishaq

    1990-01-01

    A 29 year old male developed paraplegia during the acute phase of meningococcal meningitis. Possible mechanisms for this unusual complication are discussed and the literature regarding spinal cord complications of pyogenic meningitis is reviewed.

  14. Tuning of the spinal generators: modelling study.

    PubMed

    Zmys?owski, W; Kasicki, S

    1980-01-01

    To solve the problem of minimalization of the control (tuning) signals to the spinal generator organizing the locomotor pattern of limb movements a model of neuronal net, forming a part of spinal generator which coordinates limb movements was designed. The model net was constructed of analog inhibitory neurons. The model was verified on the basis of data obtained in electrophysiological and behavioral investigations of cat locomotion. The results support the hypothesis that limb coordination is due to supraspinal influences determining the level of excitation and the way of coupling of spinal subsystems. The control of model?s acting can be achieved by tonic excitatory signals only. It is proposed that the spinal structures taking part in a process of limb coordination form two subsystems, one generating the general cycle of limb movement and the second one controlling the activity of individual muscles. PMID:7234517

  15. Low-grade meningioma showing nearly equal density with spinal fluid on radiographic images

    PubMed Central

    Tamura, Ryota; Tomita, Hideyuki; Shimizu, Kazuhiko; Sugiyama, Kazutoshi

    2013-01-01

    A 61-year-old woman had an intracranial tumour that was located on the falx. Meningioma was suspected and the tumour rapidly grew over 1?year. It showed nearly equal density with spinal fluid showing almost no enhancement on radiographic images, like microcystic meningioma. Successful removal of the tumour was achieved. Histopathologically, the tumour was diagnosed as low-grade meningioma. The meningioma had variable sized microcysts and the appearance of solid area was meningothelial meningioma. This is a rare radiographic image for meningothelial meningioma. PMID:23813510

  16. [Adenovirus infection in immunocompromised patients].

    PubMed

    Rynans, Sylwia; Dzieci?tkowski, Tomasz; M?ynarczyk, Gra?yna

    2013-01-01

    Human adenoviruses belong to the Adenoviridae family and they are divided into seven species, including 56 types. Adenoviruses are common opportunistic pathogens that are rarely associated with clinical symptoms in immunocompetent patients. However, they are emerging pathogens causing morbidity and mortality in recipients of hematopoietic stem cell and solid organ transplants, HIV infected patients and patients with primary immune deficiencies. Clinical presentation ranges from asymptomatic viraemia to respiratory and gastrointestinal disease, haemorrhagic cystitis and severe disseminated illness. There is currently no formally approved therapy for the treatment of adenovirus infections. This article presents current knowledge about adenoviruses, their pathogenicity and information about available methods to diagnose and treat adenoviral infections. PMID:24088540

  17. Spinal inhibitory neurotransmission in neuropathic pain

    Microsoft Academic Search

    Bradley K. Taylor

    2009-01-01

    Nerve injury increases the spinal cord expression and\\/or activity of voltage- and ligand-gated ion channels, peptide receptors,\\u000a and neuroimmune factors, which then drive dorsal horn neuron hyperexcitability. The intensity and duration of this central\\u000a sensitization is determined by the net activity of local excitatory and inhibitory neurotransmitter systems, together with\\u000a ongoing\\/evoked primary afferent activity and descending supraspinal control. Spinal endogenous

  18. Embryology of the Spine and Spinal Cord

    Microsoft Academic Search

    Martin Catala

    \\u000a The spine and spinal cord form a couple of structures whose development is highly coordinated, explaining why abnormal development\\u000a of one structure is usually associated with the maldevelopment of the other. The spinal cord differentiates, as does the whole\\u000a central nervous system, from the neural tube. The spine is yielded by the somites, which form the so-called paraxial mesoderm.\\u000a The

  19. [Traumatic recurrence of idiopathic spinal cord herniation].

    PubMed

    Lorente-Muñoz, Asís; Cortés-Franco, Severiano; Moles-Herbera, Jesús; Casado-Pellejero, Juan; Rivero-Celada, David; Alberdi-Viñas, Juan

    2013-01-01

    Idiopathic spinal cord herniation is a rare cause of thoracic myelopathy and its recurrence is even more infrequent. Cord herniation is through an anterior dural defect in thoracic spine with unknown causes. Symptomatic cases must be surgically treated to reduce the hernia and seal the defect to prevent recurrences. We report a patient presenting a Brown-Séquard syndrome secondary to a D5 spinal cord herniation treated successfully and its posterior traumatic recurrence. PMID:23453309

  20. CGRP in Spinal Cord Pain Mechanisms

    Microsoft Academic Search

    Volker Neugebauer

    \\u000a Calcitonin gene-related peptide (CGRP) has emerged as an important molecule at different levels of the pain neuraxis. Anatomical,\\u000a neurochemical, electrophysiological and behavioral data strongly suggest that CGRP in the spinal cord enhances neurotransmission,\\u000a neuronal excitability, and nocifensive behaviors in preclinical pain models. Spinal CGRP also modulates the transmission of\\u000a nociceptive information to supraspinal sites, thus contributing to high integrated pain

  1. Review of spinal cord injuries in Ireland

    Microsoft Academic Search

    R J O'Connor; P C Murray

    2006-01-01

    Study Design:Prospective data collection on all patients with spinal cord injury (SCI) admitted for a comprehensive management programme.Objectives:To examine the epidemiology of SCI in Ireland over 1 year.Setting:Ireland's National Spinal Cord Injury Centre.Methods:Systematic data collection on all patients admitted with SCI for management.Results:A total of 46 patients (40 males) were admitted from January to December 2000; median age was 37

  2. Patterns and risks in spinal trauma

    Microsoft Academic Search

    B W Martin; E Dykes; F E Lecky

    2004-01-01

    population. Results: Of 19 538 on the database, 527 (2.7%) suffered spinal column fracture\\/dislocation without cord injury and 109 had cord injury (0.56% of all children; 16.5% of spine injured children). Thirty children (0.15% of all children; 4.5% of spine injured children) sustained spinal cord injury without radiological abnormality (SCIWORA). Cord injury and SCIWORA occurred more commonly in children aged

  3. The colon, anorectum, and spinal cord patient

    Microsoft Academic Search

    Walter E. Longo; Garth H. Ballantyne; Irvin M. Modlin

    1989-01-01

    As humans have become more mechanized, the number of persons sustaining spinal cord injuries resulting in quadriplegia or\\u000a paraplegia has increased. Because colorectal function is modulated by a combination of neural, hormonal, and luminal influences,\\u000a many of the normal regulatory mechanisms remain intact in patients with spinal cord injuries. Management of these patients,\\u000a however, requires an understanding of altered function

  4. Spinal Dysraphism: Trends in Northern India

    Microsoft Academic Search

    Raj Kumar; S. N. Singh

    2003-01-01

    Objective: To evaluate the clinical profiles, image findings and surgical outcome of 155 cases of spinal dysraphism. Methods: 155 patients were studied prospectively (143) or retrospectively (12). The male to female ratio was 1.5:1. Mean age at presentation was 5.7 years. Out of 155 cases of spinal dysraphism, 119 had open spina bifida [meningomyelocele (MMC) in 113 (72%), meningocele in

  5. Widespread spinal cord involvement in corticobasal degeneration

    Microsoft Academic Search

    Yasushi Iwasaki; Mari Yoshida; Manabu Hattori; Yoshio Hashizume; Gen Sobue

    2005-01-01

    We examined spinal cord lesions in eight patients with a pathological diagnosis of corticobasal degeneration (CBD). Using Gallyas-Braak (G-B) staining or AT-8 tau immunostaining, a few neuropil threads were identified in the white matter of the CBD spinal cords, mainly in the anterior funiculus, whereas the posterior funiculus was well preserved without threads. In the gray matter of the CBD

  6. Pulmonary Function in Spinal Muscular Atrophy

    Microsoft Academic Search

    F. J. Samaha; C. R. Buncher; B. S. Russman; M. L. White; S. T. Iannaccone; L. Barker; K. Burhans; C. Smith; B. Perkins; L. Zimmerman

    1994-01-01

    We present the first prospective study on pulmonary function in spinal muscular atrophy patients. Seventy-seven spinal muscular atrophy patients, ages 5 to 18 years, from three centers, were studied with regard to forced vital capacity, using height as a predictor. Patients were categorized into four motor function categories. The highest-functioning group had normal or near-normal values, and those who sat

  7. Ganglioside patterns in human spinal cord

    Microsoft Academic Search

    CK Vorwerk

    2001-01-01

    Objective: To examine the distribution of gangliosides in human cervical and lumbar spinal cord.Setting: Magdeburg, Germany.Methods: The ganglioside distribution of human cervical and lumbar spinal cord enlargements from 10 neurological normal patients was analyzed. Gangliosides were isolated from different areas corresponding to the columna anterior, columna lateralis and columna posterior.Results: Ganglioside GfD1b\\/GD1b and GD3 were the most abundant gangliosides in

  8. Uncommon Progression of an Extradural Spinal Meningioma

    PubMed Central

    Boughamoura, Mohamed; Mahmoudi, Houda; Kilani, Mohamed; Hattab, Nejib

    2014-01-01

    Extradural spinal meningiomas are rare. Our understanding of purely extradural spinal meningiomas is still incomplete and they may be easily confused with malignant neoplasms, much more common in this location. We report a rare case of a purely extradural thoracic spine meningioma in a 70-year-old man, with an unusual progression. In addition we discuss the pathogenesis of these tumors and the potential pitfalls in differential diagnosis and review the relevant literature concerning their treatment and outcome. PMID:25243091

  9. Opioid administration following spinal cord injury: Implications for pain and locomotor recovery

    PubMed Central

    Woller, Sarah A.; Hook, Michelle A.

    2013-01-01

    Approximately one-third of people with a spinal cord injury (SCI) will experience persistent neuropathic pain following injury. This pain negatively affects quality of life and is difficult to treat. Opioids are among the most effective drug treatments, and are commonly prescribed, but experimental evidence suggests that opioid treatment in the acute phase of injury can attenuate recovery of locomotor function. In fact, spinal cord injury and opioid administration share several common features (e.g. central sensitization, excitotoxicity, aberrant glial activation) that have been linked to impaired recovery of function, as well as the development of pain. Despite these effects, the interactions between opioid use and spinal cord injury have not been fully explored. A review of the literature, described here, suggests that caution is warranted when administering opioids after SCI. Opioid administration may synergistically contribute to the pathology of SCI to increase the development of pain, decrease locomotor recovery, and leave individuals at risk for infection. Considering these negative implications, it is important that guidelines are established for the use of opioids following spinal cord and other central nervous system injuries. PMID:23501709

  10. Spinal stenosis: pathophysiology, clinical and radiologic classification.

    PubMed

    Truumees, Eeric

    2005-01-01

    Stenosis is the narrowing of a hollow tube, in this case the central lumbar spinal canal, lateral recess, or foramen. Clinically, this narrowing produces neurovascular compression that may lead to pain. Lumbar spinal stenosis may be classified by etiology (for example, congenital or acquired) or by symptom complex (radiculopathy, neurogenic claudication, or mechanical back pain). Stenosis can also be classified radiographically, by the location of the stenosis (for example, central canal, lateral recess, or intervertebral foramen) or by the presence of deformity such as spondylolisthesis or scoliosis. Overlap occurs in these schemes of classification in that central stenosis with thecal sac compression typically leads to neurogenic claudication, whereas lateral recess compression is associated with compression of an individual nerve root and, therefore, radiculopathy. Because radiographic changes associated with stenosis are very common with aging, understanding the pathophysiology of lumbar spinal stenosis is critical in the assessment and management of related symptom complexes. Although symptoms may arise from narrowing of the spinal canal, not all patients with narrowing develop symptoms. The reason why some patients develop symptomatic stenosis and others do not is still unknown. Therefore, the term lumbar spinal stenosis refers not to the pathoanatomic finding of spinal canal narrowing, but rather to a clinical syndrome of lower extremity pain caused by mechanical compression on the neural elements or their blood supply. PMID:15948457

  11. Diffusion tensor MRI of spinal decompression sickness

    PubMed Central

    Hutchinson, Elizabeth B.; Sobakin, Aleksey S.; Meyerand, Mary E.; Eldridge, Marlowe; Ferrazzano, Peter

    2013-01-01

    In order to develop more sensitive imaging tools for clinical use and basic research of spinal decompression sickness (DCS), we used diffusion tensor MRI (DTI) validated by histology to assess DCS-related tissue injury in sheep spinal cords. DTI is based on the measurement of water diffusion indices, including fractional anisotropy (FA) and mean diffusion (MD) to detect tissue microstructural abnormalities. In this study, we measured FA and MD in white and gray matter spinal cord regions in samples taken from sheep following hyperbaric exposure to 60–132 fsw and 0–180 minutes of oxygen pre-breathing treatment before rapid decompression. The main finding of the study was that decompression from >60 fsw resulted in reduced FA that was associated with cell death and disrupted tissue microstructure in spinal cord white matter tracts. Additionally, animals exposed to prolonged oxygen pre-breathing prior to decompression demonstrated reduced MD in spinal cord gray matter regions regardless of dive depth. To our knowledge, this is the first study to demonstrate the utility of DTI for the investigation of DCS-related injury and to define DTI biomarkers of spinal DCS. PMID:23397865

  12. Patterns and risks in spinal trauma

    PubMed Central

    Martin, B; Dykes, E; Lecky, F

    2004-01-01

    Background: Spinal injury in children is rare, and poses many difficulties in management. Aims: To ascertain the prevalence of spinal injury within the paediatric trauma population, and to assess relative risks of spinal injury according to age, conscious level, injury severity score (ISS), and associated injuries. Methods: Spine injured children were identified from the UK Trauma Audit & Research Network Database from 1989 to 2000. Relative risks of injury were calculated against the denominator paediatric trauma population. Results: Of 19 538 on the database, 527 (2.7%) suffered spinal column fracture/dislocation without cord injury and 109 had cord injury (0.56% of all children; 16.5% of spine injured children). Thirty children (0.15% of all children; 4.5% of spine injured children) sustained spinal cord injury without radiological abnormality (SCIWORA). Cord injury and SCIWORA occurred more commonly in children aged ?8. The risk of spine fracture/dislocation without cord injury was increased with an ISS >25 and with chest injuries. The risk of cord injury was increased with reduced GCS, head injury, and chest injury. Conclusions: Spinal cord injury and SCIWORA occur more frequently in young children. Multiple injuries and chest injuries increase the risk of fracture/dislocation and of cord injury. Reduced GCS and head injuries increase the risk of cord injury. PMID:15321867

  13. Spinal Astrocytes Produce and Secrete Dynorphin Neuropeptides

    PubMed Central

    Wahlert, Andrew; Funkelstein, Lydiane; Fitzsimmons, Bethany; Yaksh, Tony; Hook, Vivian

    2013-01-01

    Dynorphin peptide neurotransmitters (neuropeptides) have been implicated in spinal pain processing based on the observations that intrathecal delivery of dynorphin results in proalgesic effects and disruption of extracellular dynorphin activity (by antisera) prevents injury evoked hyperalgesia. However, the cellular source of secreted spinal dynorphin has been unknown. For this reason, this study investigated the expression and secretion of dynorphin-related neuropeptides from spinal astrocytes (rat) in primary culture. Dynorphin A(1-17), dynorphin B, and -neoendorphin were found to be present in the astrocytes, illustrated by immunofluorescence confocal microscopy, in a discrete punctate pattern of cellular localization. Measurement of astrocyte cellular levels of these dynorphins by radioimmunoassays confirmed the expression of these three dynorphin-related neuropeptides. Notably, BzATP (3?-O-(4-benzoyl)benzoyl adenosine 5?-triphosphate) and KLA (di[3-deoxy-D-manno-octulosonyl]-lipid A) activation of purinergic and toll-like receptors, respectively, resulted in stimulated secretion of dynorphins A and B. However, -neoendorphin secretion was not affected by BzATP or KLA. These findings suggest that dynorphins A and B undergo regulated secretion from spinal astrocytes. These findings also suggest that spinal astrocytes may provide secreted dynorphins that participate in spinal pain processing. PMID:23290538

  14. New Aspects of Salmonella Infection in Broiler Production

    Microsoft Academic Search

    E. Nurmi; M. Rantala

    1973-01-01

    POULTRY are a considerable reservoir of salmonellae and a common source of infection in human Salmonella epidemics1. In 1971 a severe outbreak of Salmonella infantis infection occurred among Finnish broiler flocks, and 277 human cases2 were diagnosed as caused by the same serotype. The broiler industry suffered serious losses through confiscation of broiler meat and elimination of infected birds.

  15. Spinal Fixator for the Management of Spinal Injury (the Mechanical Rationale)

    Microsoft Academic Search

    S M Rezaian; E T Dombrowski; D N Ghista

    1983-01-01

    The goal of successful treatment of spinal injury is to achieve a stable pain-free spine with no deformity and also the complete anterior decompression of the cord for maximum neurological recovery, the minimum bed-ridden time and hospitalization, and reduction of complications and expenses. A special ‘spinal fixator’ has been developed to fulfill these aims. It is a small apparatus with

  16. Assessing small-volume spinal cord dose for repeat spinal stereotactic body radiotherapy treatments

    NASA Astrophysics Data System (ADS)

    Ma, Lijun; Kirby, Neil; Korol, Renee; Larson, David A.; Sahgal, Arjun

    2012-12-01

    Spinal cord biologically effective dose (BED) limits are critical to safe spine stereotactic body radiotherapy (SBRT) delivery. In particular, when repeating SBRT to the same site, the problem of adding non-uniform BED distributions within small volumes of spinal cord has yet to be solved. We report a probability-based generalized BED (gBED) model to guide repeat spine SBRT treatment planning. The gBED was formulated by considering the sequential damaging probabilities of repeat spine SBRT treatments. Parameters from the standard linear-quadratic model, such as ?/? = 2 Gy for the spinal cord, were applied. We tested the model based on SBRT specific spinal cord tolerance using a simulated and ten clinical repeat SBRT cases. The gBED provides a consistent solution for superimposing non-uniform dose distributions from different fractionation schemes, analogous to the BED for uniform dose distributions. Based on ten clinical cases, the gBED was observed to eliminate discrepancies in the cumulative BED of approximately 5% to 20% within small volumes (e.g. 0.1-2.0 cc) of spinal cord, as compared to a conventional calculation method. When assessing spinal cord tolerance for repeat spinal SBRT treatments, caution should be exercised when applying conventional BED calculations for small volumes of spinal cord irradiated, and the gBED potentially provides more conservative and consistently derived dose surrogates to guide safe treatment planning and treatment outcome modeling.

  17. Spinal Column and Spinal Cord Injuries in Mountain BikersA 13Year Review

    Microsoft Academic Search

    Emily R. Dodwell; Brian K. Kwon; Barbara Hughes; David Koo; Andrea Townson; Allan Aludino; Richard K. Simons; Charles G. Fisher; Marcel F. Dvorak; Vanessa K. Noonan

    2010-01-01

    Background: Multiple studies have described in general the injuries associated with mountain biking, and detailed accounts of spine injuries sustained in hockey, gymnastics, skiing, snowboarding, rugby, and paragliding have previously been published. However, no large-scale detailed assessment of mountain biking associated spinal fractures and spinal cord injuries has previously been published.Purpose: This study was undertaken to describe the patient demographics,

  18. The nature of spinal shock communication IV. Atony of the motor neuron in spinal shock

    Microsoft Academic Search

    G. N. Sorokhtin; O. P. Minut-Sorokhtina; Yu. B. Temper

    1960-01-01

    The condition of motorneurons was studied during spinal shock in experiments on frogs. The myotatic reflex of the gastrocnemius muscle was recorded by electromyograms in the first series of experiments. The disappearance of the initial impulses or an increase of the anelectrotonic “silence period” was noted in the monosynaptic and polysynaptic impulses in spinal shock. In the second series of

  19. DARPA challenge: developing new technologies for brain and spinal injuries

    NASA Astrophysics Data System (ADS)

    Macedonia, Christian; Zamisch, Monica; Judy, Jack; Ling, Geoffrey

    2012-06-01

    The repair of traumatic injuries to the central nervous system remains among the most challenging and exciting frontiers in medicine. In both traumatic brain injury and spinal cord injuries, the ultimate goals are to minimize damage and foster recovery. Numerous DARPA initiatives are in progress to meet these goals. The PREventing Violent Explosive Neurologic Trauma program focuses on the characterization of non-penetrating brain injuries resulting from explosive blast, devising predictive models and test platforms, and creating strategies for mitigation and treatment. To this end, animal models of blast induced brain injury are being established, including swine and non-human primates. Assessment of brain injury in blast injured humans will provide invaluable information on brain injury associated motor and cognitive dysfunctions. The Blast Gauge effort provided a device to measure warfighter's blast exposures which will contribute to diagnosing the level of brain injury. The program Cavitation as a Damage Mechanism for Traumatic Brain Injury from Explosive Blast developed mathematical models that predict stresses, strains, and cavitation induced from blast exposures, and is devising mitigation technologies to eliminate injuries resulting from cavitation. The Revolutionizing Prosthetics program is developing an avant-garde prosthetic arm that responds to direct neural control and provides sensory feedback through electrical stimulation. The Reliable Neural-Interface Technology effort will devise technologies to optimally extract information from the nervous system to control next generation prosthetic devices with high fidelity. The emerging knowledge and technologies arising from these DARPA programs will significantly improve the treatment of brain and spinal cord injured patients.

  20. Diagnosing Asthma in Very Young Children

    MedlinePLUS

    ... Listen Español Text Size Email Print Share Diagnosing Asthma in Babies & Toddlers Article Body One of the ... family with recurrent bronchitis or sinus problems. When Asthma is Not the Cause Your pediatrician will listen ...

  1. Diagnosing Diabetes and Learning about Prediabetes

    MedlinePLUS

    ... Size: A A A Listen En Español Diagnosing Diabetes and Learning About Prediabetes There are several ways ... mg/dl – 199 mg/dl Preventing Type 2 Diabetes You will not develop type 2 diabetes automatically ...

  2. How Do Health Care Providers Diagnose Hypoparathyroidism?

    MedlinePLUS

    ... Information Clinical Trials Resources and Publications How do health care providers diagnose hypoparathyroidism? Skip sharing on social media links Share this: Page Content A health care provider will order a blood test to determine ...

  3. How Do Health Care Providers Diagnose Pheochromocytoma?

    MedlinePLUS

    ... Information Clinical Trials Resources and Publications How do health care providers diagnose pheochromocytoma? Skip sharing on social media links Share this: Page Content A health care provider uses blood and urine tests that measure ...

  4. How Do Health Care Providers Diagnose Endometriosis?

    MedlinePLUS

    ... Information Clinical Trials Resources and Publications How do health care providers diagnose endometriosis? Skip sharing on social media ... under a microscope, to confirm the diagnosis. 1 Health care providers may also use imaging methods to produce ...

  5. How Are Congenital Heart Defects Diagnosed?

    MedlinePLUS

    ... from the NHLBI on Twitter. How Are Congenital Heart Defects Diagnosed? Severe congenital heart defects generally are ... imaging facility aims to improve treatment for congenital heart disease 07/30/2013 Google+ Hangout on the ...

  6. Diagnosing spatial variation patterns in manufacturing processes 

    E-print Network

    Lee, Ho Young

    2004-09-30

    This dissertation discusses a method that will aid in diagnosing the root causes of product and process variability in complex manufacturing processes when large quantities of multivariate in-process measurement data are ...

  7. Fungal Infections

    MedlinePLUS

    ... can be difficult to kill. For skin and nail infections, you can apply medicine directly to the infected area. Oral antifungal medicines are also available for serious infections. NIH: National Institute of Allergy and Infectious Diseases

  8. Bone Infections

    MedlinePLUS

    ... the bloodstream. People who are at risk for bone infections include those with diabetes, poor circulation, or recent ... risk if you are having hemodialysis. Symptoms of bone infections include Pain in the infected area Chills and ...

  9. Clinical Assessment Of Stereotactic IGRT: Spinal Radiosurgery

    SciTech Connect

    Gerszten, Peter C. [Departments of Neurological Surgery and Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA (United States)], E-mail: gersztenpc@upmc.edu; Burton, Steven A. [Departments of Neurological Surgery and Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA (United States)

    2008-07-01

    The role of stereotactic radiosurgery for the treatment of intracranial lesions is well established. Its use for the treatment of spinal lesions has been limited because of the availability of effective target immobilization devices. Recent advances in stereotactic IGRT have allowed for spinal applications. Large clinical experience with spinal radiosurgery to properly assess clinical outcomes has previously been limited. At our institution, we have developed a successful multidisciplinary spinal radiosurgery program in which 542 spinal lesions (486 malignant and 56 benign lesions) were treated with a single-fraction radiosurgery technique. Patient ages ranged from 18 to 85 years (mean 56 years). Lesion location included 92 cervical, 234 thoracic, 130 lumbar, and 86 sacral. The most common metastatic tumors were renal cell (89 cases), breast (74 cases), and lung (71 cases). The most common benign tumors were neurofibroma (24 cases), schwannoma (13 cases), and meningioma (7 cases). Eighty-nine cervical lesions were treated using skull tracking. Thoracic, lumbar, and sacral tumors were tracked relative to either gold or stainless steel fiducial markers. The maximum intratumoral dose ranged from 12.5 to 30 Gy (mean 20 Gy). Tumor volume ranged from 0.16 to 298 mL (mean 47 mL). Three hundred thirty-seven lesions had received prior external beam irradiation with spinal cord doses precluding further conventional irradiation. The primary indication for radiosurgery was pain in 326 cases, as a primary treatment modality in 70 cases, for tumor radiographic tumor progression in 65 cases, for post-surgical treatment in 38 cases, for progressive neurological deficit in 35 cases, and as a radiation boost in 8 cases. Follow-up period was at least 3 to 49 months. Axial and/or radicular pain improved in 300 of 326 cases (92%). Long-term tumor control was demonstrated in 90% of lesions treated with radiosurgery as a primary treatment modality and in 88% of lesions treated for radiographic tumor progression. Thirty of 35 patients (85%) with progressive neurological deficits experienced at least some improvement after treatment. Spinal stereotactic radiosurgery is now a feasible, safe, and clinically effective technique for the treatment of a variety of spinal lesions. The potential benefits of radiosurgical ablation of spinal lesions are short treatment time in an outpatient setting with essentially no recovery time and excellent symptomatic response. This technique offers a new therapeutic modality for the primary treatment of a variety of spinal lesions, including the treatment of neoplasms in medically inoperable patients, previously irradiated sites, for lesions not amenable to open surgical techniques, and as an adjunct to surgery.

  10. Tips to diagnose uncommon nail disorders.

    PubMed

    Schneider, Samantha L; Tosti, Antonella

    2015-04-01

    This article reviews 6 nail disorders that, although easy to diagnose, are misdiagnosed frequently by dermatologists and general practitioners. Diagnostic clues are emphasized to familiarize readers with features that indicate the correct diagnosis. We focus on two common tumors (onychomatricoma and onychopapilloma), two rare genetic conditions that can be diagnosed owing to nail changes (Darier disease and nail patella syndrome), and two uncommon acquired disorders (the yellow nail syndrome and lichen striatus). PMID:25828712

  11. Biofilms in periprosthetic orthopedic infections

    PubMed Central

    McConoughey, Stephen J; Howlin, Rob; Granger, Jeff F; Manring, Maurice M; Calhoun, Jason H; Shirtlif, Mark; Kathju, Sandeep; Stoodley, Paul

    2015-01-01

    As the number of total joint arthroplasty and internal fixation procedures continues to rise, the threat of infection following surgery has significant clinical implications. These infections may have highly morbid consequences to patients, who often endure additional surgeries and lengthy exposures to systemic antibiotics, neither of which are guaranteed to resolve the infection. Of particular concern is the threat of bacterial biofilm development, since biofilm-mediated infections are difficult to diagnose and effective treatments are lacking. Developing therapeutic strategies have targeted mechanisms of biofilm formation and the means by which these bacteria communicate with each other to take on specialized roles such as persister cells within the biofilm. In addition, prevention of infection through novel coatings for prostheses and the local delivery of high concentrations of antibiotics by absorbable carriers has shown promise in laboratory and animal studies. Biofilm development, especially in an arthoplasty environment, and future diagnostic and treatment options are discussed. PMID:25302955

  12. Biofilms in periprosthetic orthopedic infections.

    PubMed

    McConoughey, Stephen J; Howlin, Rob; Granger, Jeff F; Manring, Maurice M; Calhoun, Jason H; Shirtliff, Mark; Kathju, Sandeep; Stoodley, Paul

    2014-01-01

    As the number of total joint arthroplasty and internal fixation procedures continues to rise, the threat of infection following surgery has significant clinical implications. These infections may have highly morbid consequences to patients, who often endure additional surgeries and lengthy exposures to systemic antibiotics, neither of which are guaranteed to resolve the infection. Of particular concern is the threat of bacterial biofilm development, since biofilm-mediated infections are difficult to diagnose and effective treatments are lacking. Developing therapeutic strategies have targeted mechanisms of biofilm formation and the means by which these bacteria communicate with each other to take on specialized roles such as persister cells within the biofilm. In addition, prevention of infection through novel coatings for prostheses and the local delivery of high concentrations of antibiotics by absorbable carriers has shown promise in laboratory and animal studies. Biofilm development, especially in an arthoplasty environment, and future diagnostic and treatment options are discussed. PMID:25302955

  13. The effect of spinal osteotomies on spinal cord tension and dural buckling: a cadaveric study.

    PubMed

    Safain, Mina G; Burke, Shane M; Riesenburger, Ron I; Zerris, Vasilios; Hwang, Steven W

    2015-07-01

    OBJECT The standard surgical release of a tethered cord may result in recurrent scar formation and occasionally be associated with retethering. The application of spinal shortening procedures to this challenging problem potentially can reduce tension on the retethered spinal cord while minimizing the difficulties inherent in traditional lumbosacral detethering revision. Although spinal shortening procedures have proven clinical benefit in patients with a recurrent tethered cord, it is unclear how much shortening is required to achieve adequate reduction in spinal cord tension or what impact these osteotomies have on dural buckling. METHODS The authors calculated mean values from 4 human cadavers to evaluate the effect of 3 different spinal shortening procedures-Smith-Petersen osteotomy (SPO), pedicle subtraction osteotomy (PSO), and vertebral column resection (VCR)-on spinal cord tension and dural buckling. Three cadavers were dedicated to the measurement of spinal cord tension, and 3 other cadavers were devoted to myelography to measure dural buckling parameters. RESULTS The SPO was associated with a maximal decrease in spinal cord tension of 16.1% from baseline and no dural buckling with any degree of closure. The PSO led to a mean maximal decrease in spinal cord tension of 63.1% from baseline at 12 mm of closure and demonstrated a direct linear relationship between dural buckling and increasing osteotomy closure. Finally, VCR closure correlated with a mean maximal decrease in spinal cord tension of 87.2% from baseline at 10 mm of closure and also showed a direct linear relationship between dural buckling and increases in osteotomy closure. CONCLUSIONS In this cadaveric experiment, the SPO did not lead to appreciable tension reduction, while a substantial response was seen with both the PSO and VCR. The rate of tension reduction may be steeper for the VCR than the PSO. Adequate tension relief while minimizing dural buckling may be optimal with 12-16 mm of posterior osteotomy closure based on this cadaveric experiment. PMID:25884344

  14. Spinal metastasis in head and neck cancer

    PubMed Central

    2012-01-01

    Background The incidence of head and neck cancer is relatively low in developed countries and highest in South East Asia. Notwithstanding advances in surgery and radiotherapy over the past several decades, the 5-year survival rate for head and neck cancer has stagnated and remains at 50–55%. This is due, in large part, to both regional and distant disease spread, including spinal metastasis. Spinal metastasis from head and neck cancer is rare, has a poor prognosis and can significantly impede end-stage quality of life; normally only palliative care is given. This study aims to conduct a systematic review of the evidence available on management of spinal metastasis from head and neck cancer and to use such evidence to draw up guiding principles in the management of the distant spread. Methods Systematic review of the electronic literature was conducted regarding the management of spinal metastasis of head and neck malignancies. Results Due to the exceptional rarity of head and neck cancers metastasizing to the spine, there is a paucity of good randomized controlled trials into the management of spinal metastasis. This review produced only 12 case studies/reports and 2 small retrospective cohort studies that lacked appropriate controls. Conclusion Management should aim to improve end-stage quality of life and maintain neurological function. This review has found that radiotherapy +/? medical adjuvant is considered the principle treatment of spinal metastasis of head and neck cancers. There is an absence of a definitive treatment protocol for head and neck cancer spinal metastasis. Our failure to find and cite high-quality scientific evidence only serves to stress the need for good quality research in this area. PMID:22716187

  15. Pathology of fatal lineage 1 and 2 West Nile virus infections in horses in South Africa.

    PubMed

    Williams, June H; van Niekerk, Stephanie; Human, Stacey; van Wilpe, Erna; Venter, Marietjie

    2014-01-01

    Since 2007, West Nile virus (WNV) has been reported in South African horses, causing severe neurological signs. All cases were of lineage 2, except for one case that clustered with lineage 1 viruses. In the present study, gross and microscopic lesions of six South African lineage 2-infected horses and the one lineage 1 case are described. Diagnoses were confirmed by real-time reverse-transcriptase polymerase chain reaction (RT-PCR) of central nervous system (CNS) tissue and one by RT-PCR of a brain virus isolate. The CNS of all cases was negative by RT-PCR or immunohistochemistry (IHC) for African horse sickness (AHS), equine encephalosis virus, equine herpes viruses 1 and 4, other zoonotic flaviviruses, alphaviruses, and shunivirus, and either by immunofluorescence or IHC for rabies. Gross visceral lesions were nonspecific but often mimicked those of AHS. The CNS histopathology of WNV lineage 2 cases resembled the nonsuppurative polioencephalomyelitis reported in the Northern Hemisphere lineage 1 and recent Hungarian lineage 2 cases. Occasional meningitis, focal spinal ventral horn poliomalacia, dorsal and lateral horn poliomyelitis, leucomyelitis, asymmetrical ventral motor spinal neuritis and frequent olfactory region involvement were also seen. Lineage 2 cases displayed marked variations in CNS lesion severity, type and distribution, and suggested various viral entry routes into the CNS, based on findings in experimental mice and hamsters. Lineage 1 lesions were comparable to the milder lineage 2 cases. West Nile virus IHC on CNS sections with marked lesions from all cases elicited only two antigen-positive cells in the olfactory cortex of one case. The presence in the CNS of T-lymphocytes, B-lymphocytes, plasma cells and macrophage-monocytes was confirmed by cluster of differentiation (CD) 3, CD20, multiple myeloma oncogene 1 (MUM1) and macrophage (MAC) 387 IHC. PMID:25686260

  16. Bartonella quintana Aortitis in a Man with AIDS, Diagnosed by Needle Biopsy and 16S rRNA Gene Amplification.

    PubMed

    Lee, Sulggi A; Plett, Sara K; Luetkemeyer, Anne F; Borgo, Gina M; Ohliger, Michael A; Conrad, Miles B; Cookson, Brad T; Sengupta, Dhruba J; Koehler, Jane E

    2015-08-01

    A man with newly diagnosed AIDS presented with months of back pain and fever. Computed tomography (CT) results demonstrated aortitis with periaortic tissue thickening. DNA amplification of biopsy tissue revealed Bartonella quintana, and Bartonella serologies were subsequently noted to be positive. The patient improved with prolonged doxycycline and rifabutin treatment. This case illustrates how molecular techniques are increasingly important in diagnosing Bartonella infections. PMID:26063867

  17. Central line infections - hospitals

    MedlinePLUS

    Central line-associated bloodstream infection; CLABSI; Peripherally inserted central catheter - infection; PICC - infection; Central venous catheter - infection; CVC - infection; Central venous device - infection

  18. Effects of spinal manipulation versus therapeutic exercise on adults with chronic low back pain: a literature review

    PubMed Central

    Merepeza, Alban

    2014-01-01

    Background Context: Chronic low back pain (CLBP) is a prevalent disorder that has a significant burden to society in terms of loss of work time and increased economic cost. Two common treatment choices of intervention for CLBP are spinal manipulation and prescribed exercise. Purpose: The purpose of this systematic review was to examine the effectiveness of spinal manipulation vs prescribed exercise for patients diagnosed with CLBP. Studies that compared head-to-head spinal manipulation to an exercise group were included in this review. Methods: A search of the current literature was conducted using a keyword process in CINAHL, Cochrane Register of Controlled Trials Database, Medline, and Embase. The search was conducted on, and included studies available up to August 29th 2014. Studies were included based on PICOS criteria 1) individuals with CLBP defined as lasting 12 weeks or longer; 2) spinal manipulation performed by a health care practitioner; 3) prescribed exercise for the treatment of CLBP and monitored by a health care practitioner; 4) measurable clinical outcomes for reducing pain, disability or improving function; 5) randomized controlled trials. The quality of included articles was determined by the author using the criteria developed and used by the Physiotherapy Evidence Database (PEDro). Results: Three randomized controlled trials met the inclusion criteria of this systematic review and were included in this review. The outcomes used in these studies included Disability Indexes, Pain Scales and function improvement scales. The results included a mix of effects with one study finding spinal manipulation as more effective and another finding the exercises more so. The third study found both interventions offering equal effects in the long term. Conclusion: Based on the findings of this systematic review there is no conclusive evidence that clearly favours spinal manipulation or exercise as more effective in treatment of CLBP. More studies are needed to further explore which intervention is more effective. PMID:25550671

  19. Intramedullary Sarcoidosis Presenting with Delayed Spinal Cord Swelling after Cervical Laminoplasty for Compressive Cervical Myelopathy

    PubMed Central

    Kwon, Du Ho; Kim, Eun-Sang; Eoh, Whan

    2014-01-01

    Sarcoidosis is a systemic disease of unknown etiology that may affect any organ in the body. The nervous system is involved in 5-16% of cases of sarcoidosis. Here, we report a case of intramedullary sarcoidosis presenting with delayed spinal cord swelling after laminoplasty for the treatment of compressive cervical myelopathy. A 56-year-old woman was admitted to our hospital complaining of upper extremity pain and gait disturbance. The patient had undergone laminoplasty for compressive cervical myelopathy 3 months previously. Follow-up magnetic resonance imaging revealed a large solitary intramedullary lesion with associated extensive cord swelling, signal changes, and heterogeneous enhancement of spinal cord from C2 to C7. Spinal cord biopsy revealed non-necrotizing granulomas with signs of chronic inflammation. The final diagnosis of sarcoidosis was based upon laboratory data, imaging findings, histological findings, and the exclusion of other diagnoses. Awareness of such presentations and a high degree of suspicion of sarcoidosis may help arrive at the correct diagnosis. PMID:25535524

  20. Bone Cement Dislodgement: One of Complications Following Bone Cement Augmentation Procedures for Osteoporotic Spinal Fracture.

    PubMed

    Ha, Kee-Yong; Kim, Young-Hoon; Yoo, Sung-Rim; Molon, Jan Noel

    2015-05-01

    Bone cement augmentation procedures have been getting more position as a minimally invasive surgical option for osteoporotic spinal fractures. However, complications related to these procedures have been increasingly reported. We describe a case of bone cement dislodgement following cement augmentation procedure for osteoporotic spinal fracture by reviewing the patient's medical records, imaging results and related literatures. A 73-year-old woman suffering back and buttock pain following a fall from level ground was diagnosed as an osteoporotic fracture of the 11th thoracic spine. Percutaneous kyphoplasty was performed for this lesion. Six weeks later, the patient complained of a recurrence of back and buttock pain. Radiologic images revealed superior dislodgement of bone cement through the 11th thoracic superior endplate with destruction of the lower part of the 10th thoracic spine. Staged anterior and posterior fusion was performed. Two years postoperatively, the patient carries on with her daily living without any significant disability. Delayed bone cement dislodgement can occur as one of complications following bone cement augmentation procedure for osteoporotic spinal fracture. It might be related to the presence of intravertebral cleft, lack of interdigitation of bone cement with the surrounding trabeculae, and possible damage of endplate during ballooning procedure. PMID:26113965

  1. Bone Cement Dislodgement: One of Complications Following Bone Cement Augmentation Procedures for Osteoporotic Spinal Fracture

    PubMed Central

    Ha, Kee-Yong; Yoo, Sung-Rim; Molon, Jan Noel

    2015-01-01

    Bone cement augmentation procedures have been getting more position as a minimally invasive surgical option for osteoporotic spinal fractures. However, complications related to these procedures have been increasingly reported. We describe a case of bone cement dislodgement following cement augmentation procedure for osteoporotic spinal fracture by reviewing the patient's medical records, imaging results and related literatures. A 73-year-old woman suffering back and buttock pain following a fall from level ground was diagnosed as an osteoporotic fracture of the 11th thoracic spine. Percutaneous kyphoplasty was performed for this lesion. Six weeks later, the patient complained of a recurrence of back and buttock pain. Radiologic images revealed superior dislodgement of bone cement through the 11th thoracic superior endplate with destruction of the lower part of the 10th thoracic spine. Staged anterior and posterior fusion was performed. Two years postoperatively, the patient carries on with her daily living without any significant disability. Delayed bone cement dislodgement can occur as one of complications following bone cement augmentation procedure for osteoporotic spinal fracture. It might be related to the presence of intravertebral cleft, lack of interdigitation of bone cement with the surrounding trabeculae, and possible damage of endplate during ballooning procedure.

  2. Late spinal cord metastasis of fourth ventricle ependymoma appeared nineteen years after the initial treatment.

    PubMed

    Ochiai, Hidenobu; Yamakawa, Yuzo; Kawano, Hirokazu; Shimao, Yoshiya; Hayashi, Tohru

    2010-01-01

    Spinal cord dissemination (metastasis) of a fourth ventricle ependymoma more than ten years after surgical resection is extremely rare. In this report, we present an unusual case of a fourth ventricle ependymoma with metastasis to the thoracic spinal cord 19 years after the initial therapy, but without local recurrence. A 37 year-old patient underwent gross total resection of a fourth ventricle ependymoma and postoperative radiation therapy to the posterior fossa. Computed tomography (CT) scanning and/or magnetic resonance (MR) imaging performed during follow up examinations, conducted annually for ten years after the therapy, revealed no evidence of local tumor recurrence. However, 19 years after the initial treatment, the patient complained of back pain and gait disturbances. MR imaging revealed an intradural extramedullary tumor at the Th2-5 levels. MR imaging of the brain revealed no local tumor recurrence or intracranial tumor dissemination. Cerebrospinal fluid cytology revealed no presence of tumor cells. Total resection of the spinal cord tumor was performed, and the tumor was diagnosed as an ependymoma. We describe the clinical features of this rare lesion and particularly emphasize the need for long-term follow up, for more than ten years after the initial treatment, in patients with fourth ventricle ependymoma. PMID:19629395

  3. Learn About Spinal Muscular Atrophy

    NSDL National Science Digital Library

    2011-01-01

    What is spinal muscular atrophy (SMA)? It is an inherited disease that affects approximately 1 in 10,000 infants born in the United States each year. There are four types of SMA, which can cause the muscles to function improperly and become smaller and weaker over time. Visitors to this site, which was created by researchers at Cold Spring Harbor Laboratory, should start their journey here by clicking on the What is SMA? section. Here they can watch Dr. Darryl De Vivo provide an overview of the four types of SMA and then look through video clips from other professionals who provide additional insights into the genetics behind SMA. Moving on, the SMA Science area provides high-quality animations that illustrate the various processes involved with the SMN gene (mutations of which are responsible for SMA) and protein splicing. Visitors can also click on the SMA Therapies to learn more about what's being done for people living with SMA, along with potential new treatments.

  4. Bone and Spinal Muscular Atrophy.

    PubMed

    Vai, Silvia; Bianchi, Maria Luisa; Moroni, Isabella; Mastella, Chiara; Broggi, Francesca; Morandi, Lucia; Arnoldi, Maria Teresa; Bussolino, Chiara; Baranello, Giovanni

    2015-10-01

    Spinal Muscular Atrophy (SMA) is an autosomal recessive neuromuscular disease, leading to progressive denervation atrophy in the involved skeletal muscles. Bone status has been poorly studied. We assessed bone metabolism, bone mineral density (BMD) and fractures in 30 children (age range 15-171months) affected by SMA types 2 and 3. Eighteen children (60%) had higher than normal levels of CTx (bone resorption marker); 25-OH vitamin D was in the lower range of normal (below 20ng/ml in 9 children and below 12ng/ml in 2). Lumbar spine BMAD (bone mineral apparent density) Z-score was below -1.5 in 50% of children. According to clinical records, four children had sustained four peripheral fractures; on spine X-rays, we observed 9 previously undiagnosed vertebral fractures in 7 children. There was a significant inverse regression between PTH and 25-OH D levels, and a significant regression between BMC and BMAD values and the scores of motor-functional tests. Even if this study could not establish the pathogenesis of bone derangements in SMA, its main findings - reduced bone density, low 25OH vitamin D levels, increased bone resorption markers and asymptomatic vertebral fractures also in very young patients - strongly suggest that even young subjects affected by SMA should be considered at risk of osteopenia and even osteoporosis and fractures. PMID:26055105

  5. 21 CFR 888.3070 - Pedicle screw spinal system.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... “Warning: The safety and effectiveness of pedicle screw spinal systems have been established...requiring fusion with instrumentation. These conditions...pseudarthrosis). The safety and effectiveness of these...pedicle screw spinal systems should be...

  6. 21 CFR 888.3070 - Pedicle screw spinal system.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... “Warning: The safety and effectiveness of pedicle screw spinal systems have been established...requiring fusion with instrumentation. These conditions...pseudarthrosis). The safety and effectiveness of these...pedicle screw spinal systems should be...

  7. 21 CFR 888.3070 - Pedicle screw spinal system.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... “Warning: The safety and effectiveness of pedicle screw spinal systems have been established...requiring fusion with instrumentation. These conditions...pseudarthrosis). The safety and effectiveness of these...pedicle screw spinal systems should be...

  8. 21 CFR 888.3070 - Pedicle screw spinal system.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... “Warning: The safety and effectiveness of pedicle screw spinal systems have been established...requiring fusion with instrumentation. These conditions...pseudarthrosis). The safety and effectiveness of these...pedicle screw spinal systems should be...

  9. Genetics Home Reference: Spinal and bulbar muscular atrophy

    MedlinePLUS

    ... Spinal and bulbar muscular atrophy, also known as Kennedy disease, is a disorder of specialized nerve cells ... muscular atrophy? bulbospinal muscular atrophy, X-linked KD Kennedy disease Kennedy's disease Kennedy spinal and bulbar muscular ...

  10. Vocational Rehabilitation of Persons with Spinal Cord Injuries

    ERIC Educational Resources Information Center

    Poor, Charles R.

    1975-01-01

    Reviews historical development of organized vocational rehabilitation programming for the spinal cord injured in the United States. Significant factors that affect vocational rehabilitation outcomes with spinal cord injured persons are listed and discussed. (Author)

  11. What Are the Treatments for Spinal Cord Injury (SCI)?

    MedlinePLUS

    ... Resources and Publications What are the treatments for spinal cord injury (SCI)? Skip sharing on social media links ... no known ways to reverse damage to the spinal cord. However, researchers are continually working on new treatments, ...

  12. AMPA-receptor mediated plasticity within the rat spinal cord 

    E-print Network

    Hoy, Kevin Corcoran

    2009-05-15

    Previous research from our laboratory has demonstrated that the spinal cord is capable of a simple form of instrumental learning. In this instrumental learning paradigm, rats typically receive a complete spinal transection ...

  13. The localization of instrumental learning within the spinal cord 

    E-print Network

    Liu, Grace Alexandra Tsu-Chi

    2013-02-22

    Spinal neurons of surgically transected rats can support a simple form of instrumental learning. Rats learn to maintain leg flexion as a response to shock. The present experiments localized the region of the spinal cord that mediates this learning...

  14. Persistent paralysis after spinal anesthesia for cesarean delivery.

    PubMed

    Zaphiratos, Valerie; McKeen, Dolores M; Macaulay, Bruce; George, Ronald B

    2015-02-01

    Anterior spinal artery syndrome has rarely been reported as a cause of permanent neurologic complications after neuraxial anesthesia in obstetric patients. A parturient developed anterior spinal artery syndrome after spinal anesthesia for cesarean delivery. A healthy 32-year-old parturient presented at 41(2/7) weeks for primary elective caesarean delivery for breech presentation. Spinal anesthesia was easily performed with clear cerebrospinal fluid, and block height was T4 at 5 minutes. Intraoperative course was uneventful except for symptomatic bradycardia (37-40 beats per minute) and hypotension (88/44 mm Hg) 4 minutes postspinal anesthesia, treated with ephedrine and atropine. Dense motor block persisted 9 hours after spinal anesthesia, and magnetic resonance imaging of the lumbosacral region was normal, finding no spinal cord compression or lesion. Physical examination revealed deficits consistent with a spinal cord lesion at T6, impacting the anterior spinal cord while sparing the posterior tracts. PMID:25433726

  15. Serum and cerebral spinal fluid levels of chemokines and Th2 cytokines in Schistosoma mansoni myeloradiculopathy.

    PubMed

    Sousa-Pereira, S R; Teixeira, A L; Silva, L C S; Souza, A L S; Antunes, C M; Teixeira, M M; Lambertucci, J R

    2006-09-01

    Schistosomal myeloradiculopathy (SMR) is the most common neurological form of Schistosoma mansoni infection. In this study we investigated the expression of chemokines and Th2 cytokines in serum and cerebral spinal fluid (CSF) of SMR patients. SMR patients presented increased serum levels of CCL11/eotaxin and CCL24/eotaxin-2 when compared to controls. SMR patients also had higher levels of IL-13 in CSF. Thus, SMR patients present enhancement of both IL-13 and CCR3 acting chemokines, both of which may facilitate the expression of a Th2 response and Th2-dependent damage to the spinal cord. As this cytokine is responsible for promoting Th2 responses, this finding is in accordance to the view that Th2 cells are important in the immunological process against the S. mansoni. PMID:16916371

  16. Rehabilitation and treatment of spinal cord tumors

    PubMed Central

    Raj, Vishwa S.; Lofton, LaTanya

    2013-01-01

    Context Due to advances in acute oncological treatment, patients with spinal cord tumors exhibit improved survival. However, these patients have not received the full benefits of rehabilitation services to address their neurological deficits and rehabilitation goals. Objective To evaluate the epidemiology and pathophysiology of spinal cord tumors, address methods of acute oncological management, review treatment for neurological sequelae, and understand the implications as they relate to rehabilitation. Methods An extensive literature review was performed regarding the epidemiology, pathophysiology, acute oncological management, neurological sequelae, and rehabilitation for patients with spinal cord tumors. Databases used included pubmed.gov and OVID, as well as individual journal and textbook articles. Results Access to treatment should be increased given improved survival and functional deficits for patients with spinal cord tumors. Individuals can benefit from inpatient rehabilitation programs, in spite of increased medical co-morbidity and neurological deficits. Specific areas of improvement include functionality, mood, quality of life, and survival. Adjustments to treatment plans must incorporate medical complications from cancer and its treatment, perceived quality of life, and prognosis. Conclusions Patients with spinal cord tumors who participate in rehabilitation programs show general improvement in function, mood, quality of life, and survival. Adaptations to care plans should be made to accommodate medical co-morbidities from cancer and its treatment, patient perceptions, and prognosis. PMID:23433329

  17. [Diagnosis of maternofetal infections].

    PubMed

    Vauloup-Fellous, Christelle; Bouthry, Elise

    2015-06-01

    Prevention is an essential aspect of management of infections that can be transmitted from mother to fetus during pregnancy: The prescription and interpretation of serologic markers differ according to clinical context: screening, counts, clinical signs, or ultrasound signs. Testing for rubella IgG antibodies is recommended at the beginning of pregnancy, in the absence of written results proving either immunity or previous vaccination with two doses. Monthly serologic monitoring (IgG and IgM) is recommended for woman lacking immunity to toxoplasmosis. Diagnosis of a primary infection requires the concomitant detection of IgG and IgM. Nonetheless, the presence of specific IgM is not necessarily a marker of recent infection. IgG avidity must be measured to confirm or rule out a recent primary infection when IgM is positive. The observation of stable antibody titers is often inaccurately considered to be reassuring. In fact, depending on the individuals tested and especially the technique used, antibodies may reach a plateau several days or several weeks after the onset of the infection. Clinical diagnosis of rubella is not reliable, and its rarity today means that physicians are unlikely to recognize it or consider it as a possible differential diagnosis. Nonetheless, residual circulation of the rubella virus continues in France. A chickenpox rash is diagnosed clinically. For atypical eruptions, the virus can be sought directly in the vesicular fluid. Serology is not helpful in this case. PMID:26033555

  18. Surgical infection in art.

    PubMed

    Meakins, J L

    1996-12-01

    The earliest images of medicine and surgery in Western art are from the late Middle Ages. Although often attractive, at that time they were illustrative and mirrored the text on how to diagnose or treat a specific condition. These drawings in medieval manuscripts represent management of abscesses, perianal infection and fistulas, amputation, and wound dressings. With the Renaissance, art in all its forms flourished, and surgeons were represented at work draining carbuncles, infected bursae, and mastoiditis; managing ulcers, scrofula, and skin infections; and performing amputations. Specific diagnosis can be made, such as streptococcal infection in the discarded leg of the miraculous transplantation performed by Saints Cosmas and Damian and in the works of Rembrandt van Rijn and Frederic Bazille. Evocations of cytokine activity are evident in works by Albrecht Dürer, Edvard Munch, and James Tissot. The iconography of society's view of a surgeon is apparent and often not complimentary. The surgeon's art is a visual art. Astute observation leads to early diagnosis and better results in surgical infection and the septic state. Learning to see what we look at enhances our appreciation of the world around us but, quite specifically, makes us better clinicians. PMID:8956770

  19. Dynorphin Promotes Abnormal Pain and Spinal Opioid Antinociceptive Tolerance

    Microsoft Academic Search

    Todd W. Vanderah; Luis R. Gardell; Shannon E. Burgess; Mohab Ibrahim; Ahmet Dogrul; Cheng-Min Zhong; En-Tan Zhang; T. Philip; Michael H. Ossipov; Josephine Lai; Frank Porreca

    2000-01-01

    The nonopioid actions of spinal dynorphin may promote aspects of abnormal pain after nerve injury. Mechanistic similarities have been suggested between opioid tolerance and neuropathic pain. Here, the hypothesis that spinal dynorphin might mediate effects of sustained spinal opioids was explored. Possible abnormal pain and spinal antinociceptive tolerance were evaluated after intrathecal administration of (D-Ala 2, N-Me-Phe 4, Gly-ol 5)enke

  20. Reduced Pulmonary Function in Patients with Spinal Osteoporotic Fractures

    Microsoft Academic Search

    C. Schlaich; H. W. Minne; T. Bruckner; G. Wagner; H. J. Gebest; M. Grunze; R. Ziegler; G. Leidig-Bruckner

    1998-01-01

    :   Vertebral deformation in spinal osteoporosis results in spinal and thoracic deformation, causing pain, disability and an\\u000a overall decrease in quality of life. We sought to determine whether thoracic spinal deformation may lead to impaired pulmonary\\u000a function. We studied expiratory relaxed vital capacity (VC) and forced expiratory volume in 1 s (FEV1) in 34 patients with\\u000a spinal osteoporotic fractures and

  1. Parasitic Infections

    Microsoft Academic Search

    Rakesh K. Gupta; Kee-Hyun Chang

    Infection of the central nervous system (CNS) by different parasites is in endemic proportion in different parts of the world. The distribution of the type of infection depends on the food habits, prevalence of the type of infection in the region, and local hygienic conditions in many developing countries in Asia, Africa, Central and South America, and Mexico. These infections

  2. Early events in rabies virus infection of the central nervous system in skunks ( Mephitis mephitis )

    Microsoft Academic Search

    K. M. Charlton; G. A. Casey; A. I. Wandeler; S. Nadin-Davis

    1995-01-01

    Twenty-four striped skunks were inoculated intramuscularly (long digital extensor muscle of right pelvic limb) with street\\u000a rabies virus. Groups of two clinically normal skunks were killed at various times after inoculation; skunks that developed\\u000a rabies were killed in early stages of the clinical signs. Four clinically normal skunks (numbered 1–4) had slight infection\\u000a in lumbar spinal ganglia, spinal cord and

  3. Spinal Cord Tolerance in the Age of Spinal Radiosurgery: Lessons From Preclinical Studies

    SciTech Connect

    Medin, Paul M., E-mail: Paul.medin@utsouthwestern.ed [Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX (United States); Boike, Thomas P. [Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX (United States)

    2011-04-01

    Clinical implementation of spinal radiosurgery has increased rapidly in recent years, but little is known regarding human spinal cord tolerance to single-fraction irradiation. In contrast, preclinical studies in single-fraction spinal cord tolerance have been ongoing since the 1970s. The influences of field length, dose rate, inhomogeneous dose distributions, and reirradiation have all been investigated. This review summarizes literature regarding single-fraction spinal cord tolerance in preclinical models with an emphasis on practical clinical significance. The outcomes of studies that incorporate uniform irradiation are surprisingly consistent among multiple small- and large-animal models. Extensive investigation of inhomogeneous dose distributions in the rat has demonstrated a significant dose-volume effect while preliminary results from one pig study are contradictory. Preclinical spinal cord dose-volume studies indicate that dose distribution is more critical than the volume irradiated suggesting that neither dose-volume histogram analysis nor absolute volume constraints are effective in predicting complications. Reirradiation data are sparse, but results from guinea pig, rat, and pig studies are consistent with the hypothesis that the spinal cord possesses a large capacity for repair. The mechanisms behind the phenomena observed in spinal cord studies are not readily explained and the ability of dose response models to predict outcomes is variable underscoring the need for further investigation. Animal studies provide insight into the phenomena and mechanisms of radiosensitivity but the true significance of animal studies can only be discovered through clinical trials.

  4. MRI Evaluation of Spinal Length and Vertebral Body Angle During Loading with a Spinal Compression Harness

    NASA Technical Reports Server (NTRS)

    Campbell, James A.; Hargens, Alan R.; Murthy, G.; Ballard, R. E.; Watenpaugh, D. E.; Hargens, Alan, R.; Sanchez, E.; Yang, C.; Mitsui, I.; Schwandt, D.; Fechner, K. P.; Holton, Emily M. (Technical Monitor)

    1998-01-01

    Weight bearing by the spinal column during upright posture often plays a role in the common problem of low back pain. Therefore, we developed a non-ferromagnetic spinal compression harness to enable MRI investigations of the spinal column during axial loading. Human subjects were fitted with a Nest and a footplate which were connected by adjustable straps to an analog load cell. MRI scans of human subjects (5 males and 1 female with age range of 27-53 yrs) during loaded and unloaded conditions were accomplished with a 1.5 Tesla GE Signa scanner. Studies of two subjects undergoing sequentially increasing spinal loads revealed significant decreases (r(sup 2) = 0.852) in spinal length between T4 and L5 culminating in a 1.5 to 2% length decrease during loading with 75% body weight. Sagittal vertebral body angles of four subjects placed under a constant 50% body weight load for one hour demonstrated increased lordotic and kyphotic curvatures. In the lumbar spine, the L2 vertebral body experienced the greatest angular change (-3 deg. to -5 deg.) in most subjects while in the thoracic spine, T4 angles increased from the unloaded state by +2 deg. to +9 deg. Overall, our studies demonstrate: 1) a progressive, although surprisingly small, decrease in spinal length with increasing load and 2) relatively large changes in spinal column angulation with 50% body weight.

  5. Multiple Gaps in Care Common Among Newly Diagnosed HIV Patients

    PubMed Central

    Liu, Tao; Gillani, Fizza S.; Reece, Rebecca; Kojic, Erna M.; Zlotnick, Caron; Wilson, Ira B.

    2015-01-01

    The objective of this study was to identify frequency and predictors of gaps in care in a longitudinal cohort of HIV-infected patients in urban New England. We conducted a retrospective cohort study in Providence, RI of 581 newly diagnosed HIV-patients >18 entering into care from 2004-2010 and followed their care through the end of 2011. The outcome of interest was gaps in care, defined as an interruption of medical care for > 6 months. Time to the first gap was characterized using Kaplan-Meier (KM) curves. Anderson-Gill proportional hazards (AGPH) model was used to identify the risk factors of recurrent gaps in care. During the study period, 368 patients (63%) experienced at least 1 gap in care, 178 (30%) had ? 2 gaps, 84 (14.5%) had ? 3 gaps, and 21 (3.6%) died;77% of gaps were followed by a re-linkage with care The KM curves estimate that one quarter of patients (95%CI=22-29%) would experience ? 1 gap in care by year one; nearly one-half (CI=45-54%) by year two; and 90% (CI=93-96%) by year eight;. A prior gap was a strong predictor (HR=2.36; CI=2.16-2.58) of subsequent gaps; other predictors included age <25 (HR=1.29; CI=1.04-1.60), and no prescription of ART in first year of care (HR=1.23; CI=1.01-1.50). The results of this study suggest that a significant proportion of newly diagnosed HIV-infected patients will experience multiple gaps in care and yet re-engagement is possible. Interventions should focus on both prevention of gaps as well as re-engaging those lost to follow-up. PMID:25634492

  6. BDNF Facilitates Instrumental Learning and Spinal Plasticity In Vivo. 

    E-print Network

    Niemerski, Ashley

    2014-01-27

    of drug treatment was assessed by testing its effect on mechanical reactivity and spinal learning. Spinally transected rats had the BDNF-containing hydrogel applied over the lumbosacral spinal cord. Subjects were tested 3-24 hrs later. Prior work has shown...

  7. Compression behavior of porcine spinal cord white matter

    Microsoft Academic Search

    Carolyn J. Sparrey; Tony M. Keaveny

    2011-01-01

    Spinal cord injury often results from a compressive load; however, the compression behavior of spinal cord white matter has not been clearly established. Quantifying the compression behavior is important for advancing our understanding of spinal cord injury mechanics and facilitating the use of finite element models to study injury. The objective of this study was to characterize the unconfined compression

  8. Original Article Electrophysiological changes in isolated spinal cord white matter

    E-print Network

    Shi, Riyi

    Original Article Electrophysiological changes in isolated spinal cord white matter in response pig spinal cord white matter. Objectives: To determine whether lack of oxygen can cause irreversible of reoxygenation, mammalian spinal cord white matter can partially recover electrical impulse conduction. However

  9. Technical Note Functional MRI of the Thoracic Spinal Cord During

    E-print Network

    Smith, Stephen D.

    Technical Note Functional MRI of the Thoracic Spinal Cord During Vibration Sensation Jennifer functional magnetic resonance images from thoracic spinal cord neurons. Materials and Methods: The lower spinal cord using a HASTE sequence on a 3 Tesla MRI system. Results: Signal increases were observed

  10. Introduction In the developing dorsal spinal cord, different classes of

    E-print Network

    Kharasch, Evan

    2047 Introduction In the developing dorsal spinal cord, different classes of postmitotic neurons are commissural neurons and migrate to the intermediate region of the spinal cord. What promotes early- born is the projection of different classes of primary sensory afferents within the spinal cord (Brown, 1981; Ozaki

  11. NOCICEPTIVE PLASTICITY INHIBITS ADAPTIVE LEARNING IN THE SPINAL CORD

    E-print Network

    Grau, James

    NOCICEPTIVE PLASTICITY INHIBITS ADAPTIVE LEARNING IN THE SPINAL CORD A. R. FERGUSON,a * E. D in central neurogenic pain. Over the last 100 years researchers have found that the spinal cord is also (response­outcome) learning in the spi- nal cord, we use a preparation in which spinally transected rats

  12. Chronic cervical spinal cord injury and autonomic hyperreflexia in rats

    E-print Network

    Schramm, Lawrence P.

    Chronic cervical spinal cord injury and autonomic hyperreflexia in rats JOHN W. OSBORN, ROBERT F cervical spinal cord injury and autonomic hyperreflexia in rats. Am. J. Physiol. 258(Regulatory Integra spinal cord injury are proneto acute, marked,hypertensive episodes,i.e., autonomic hyperreflexia

  13. Peripheral Inflammation Undermines the Plasticity of the Isolated Spinal Cord

    E-print Network

    Grau, James

    Peripheral Inflammation Undermines the Plasticity of the Isolated Spinal Cord Michelle A. Hook demonstrate that capsaicin also undermines the adaptive plasticity of the spinal cord, rendering the system the spinal cord against the maladaptive effects. Rats pretrained with controllable stimulation do not display

  14. Towards Optimal Pain Relief: Acupuncture and Spinal Cord Stimulation

    E-print Network

    Kreinovich, Vladik

    Towards Optimal Pain Relief: Acupuncture and Spinal Cord Stimulation Richard Al'o 1 , Kenneth Al is a discrete optimization problem, e.g., for pain relief methodologies such as acupuncture and spinal cord problems related to pain relief: ffl problems of acupuncture, and ffl problems related to spinal cord

  15. Turkish Adaptation of Spinal Cord Independence Measure--Version III

    ERIC Educational Resources Information Center

    Kesiktas, Nur; Paker, Nurdan; Bugdayci, Derya; Sencan, Sureyya; Karan, Ayse; Muslumanoglu, Lutfiye

    2012-01-01

    Various rating scales have been used to assess ability in individuals with spinal cord injury. There is no specific functional assessment scale for Turkish patients with spinal cord injury. The Spinal Cord Independence Measure (SCIM) is a specific test, which has become popular in the last decade. A study was conducted to validate and evaluate the…

  16. Sexuality Counseling with Clients Who Have Spinal Cord Injuries.

    ERIC Educational Resources Information Center

    Farrow, Jeff

    1990-01-01

    Examines effects of spinal cord injury on sexuality. Discusses areas of sexual concern. Provides suggestions for treating clients with spinal cord injuries experiencing sexual difficulties. Concludes that major goal in working with clients with spinal cord injuries who have sexual difficulties should be the facilitation of a creative and…

  17. Lumbar disc herniation in patients with developmental spinal stenosis

    Microsoft Academic Search

    L. Y. Dai; B. Ni; L. S. Jia; H. K. Liu

    1996-01-01

    Lumbar spinal stenosis and lumbar disc herniation are usually regarded as two pathogenetically different conditions, but in the literature lumbar disc herniation in patients with developmental spinal stenosis has been rarely documented. In a clinical retrospective study, 42 lumbar disc herniations with developmental spinal stenosis were reported and analyzed. Discectomy was performed after laminotomy. The patients were followed-up for an

  18. MR of Leptomeningeal Spinal and Posterior Fossa Amyloid

    Microsoft Academic Search

    Sandra Horowitz; Chinnamma Thomas; Gregory Gruener; Sucha Nand; John F. Shea

    Summary: We report an unusual cause of leptomeningeal MR enhancement, amyloid, along the surfaces of the spinal cord and brain stem and in the spinal subarachnoid space, with sacral intradural and epidural deposition. Type I familial amyloid polyneuropathy may cause amyloid depo- sition along the leptomeninges of the spinal cord and brain in addition to the visceral organs and the

  19. Relationships between falls, spinal curvature, spinal mobility and back extensor strength in elderly people.

    PubMed

    Kasukawa, Yuji; Miyakoshi, Naohisa; Hongo, Michio; Ishikawa, Yoshinori; Noguchi, Hideaki; Kamo, Keiji; Sasaki, Hiroshi; Murata, Katsuyuki; Shimada, Yoichi

    2010-01-01

    Spinal mobility and back extensor strength (BES) are important in determining quality of life (QOL) for elderly people. However, the impact of spinal factors on falls remains unclear. The purpose of this study was to clarify spinal factors related to falls in elderly people, including deformity of spinal curvature, spinal mobility and BES. Subjects comprised 92 elderly people divided into 3 groups: subjects without a history of falls or fear of falls (Non-falls group, n = 40); subjects with a history of fear of falls or requiring any support when walking (Fear of falls group, n = 36); and subjects with a history of falls (Falls group, n = 16). Kyphotic angles and mobility of the thoracic and/or lumbar spine, and spinal inclination were measured using a computer-assisted device. Postural imbalance was evaluated using a computerized stabilometer. Isometric BES was also measured. Angle of lumbar kyphosis, spinal inclination, and postural imbalance were significantly higher in the Falls group (p < 0.05) compared to those in the Non-falls group. Mobility of the lumbar spine and BES were significantly lower in the Falls group (p < 0.05) than in the Non-falls group. Multiple logistic regression analysis after adjusting for age, gender, height, and body weight showed grip strength (p = 0.0028), BES (p = 0.0052), lumbar kyphosis (p = 0.0057), spinal inclination (p = 0.0378), mobility of lumbar spine (0.027), and mobility of spinal inclination (p = 0.0282) were significantly associated with presence/absence of falls in elderly individuals. PMID:19690799

  20. Spinal cord injury in the emergency context: review of program outcomes of a spinal cord injury rehabilitation program in Sri Lanka

    PubMed Central

    2014-01-01

    Background The final months of the conflict in Sri Lanka in 2009 resulted in massive displacement of the civilian population and a high volume of orthopedic trauma including spinal cord injury. In response to this need, Médecins Sans Frontières implemented a multidisciplinary rehabilitation program. Methods Patients were admitted to the program if they had a spinal cord injury, a stable spine and absence of a high-grade pressure ulcer. All patients were assessed on admission with a standardized functional scale the Spinal Cord Independence Measure II (SCIM) and the American Spinal Injury Association Impairment Scale (ASIA). A multidisciplinary team provided nursing care, physiotherapy, bowel and bladder training, mental health care, and vocational rehabilitation. Patients were discharged from the program when medically stable and able to perform activities of daily living independently or with assistance of a caregiver. The primary outcome measures were discharge to the community, and change in SCIM score on discharge. Secondary outcome measures were measured at 6-12 weeks post-discharge, and included SCIM score and presence of complications (pressure ulcers, urinary tract infections and bowel problems). Results 89 patients were admitted. The majority of injuries were to the thoracic region or higher (89%). The injuries were classified as ASIA grade A in 37 (43%), grade B in 17(20%), grade C in 15 (17%) and grade D in 17(20%). 83.2% met the criteria for discharge, with a further 7.9% patients requiring transfer to hospital for surgical care of pressure ulcers. There was a significant change in SCIM score from 55 on admission to 71 on discharge (p?spinal cord injury complications from those experienced either at or during admission. A further 79% of SCIM scores were stable or improved compared to the score on discharge. Conclusions Provision of effective rehabilitation for spinal cord injury is possible in complex humanitarian emergency situations. A multidisciplinary approach, including psychological support along with partnerships with local and international organizations with specialized expertise, was key to the program’s success. PMID:24650231

  1. Cross-reactivity of Nocardia spp. in the fungal (1-3)-?-d-glucan assay performed on cerebral spinal fluid.

    PubMed

    Koncan, Raffaella; Favuzzi, Vincenza; Ligozzi, Marco; Sorrentino, Annarita; Cornaglia, Giuseppe; Cascio, Giuliana Lo

    2015-02-01

    Cerebral spinal fluid from a patient affected by a brain abscess caused by Nocardia abscessus gave a positive result for (1-3)-?-d-glucan (BG) assay, in absence of any fungal infection. This study aimed to assess whether Nocardia spp. show cross-reactivity with BG assay. All Nocardia spp. analyzed provided positive reactions. PMID:25497418

  2. Spinal Textiloma (Gossypiboma): A Report of Three Cases Misdiagnosed as Tumour

    PubMed Central

    ?ahin, Soner; Atabey, Cem; ?im?ek, Mehmet; Naderi, Sait

    2013-01-01

    Background: Textile products commonly used in surgery (e.g., sponges or gauze) have been known to cause complications after spinal surgery. Associated complications usually arise months or even years after the primary surgery. In case of spine surgery, these bodies are often detected during neuroradiological evaluations to investigate reported back pain; however, this complication often remains asymptomatic. Aims: The research is intended to increase awareness among both spinal surgeons and neuroradiologists of this potential complication. Study Design: Retrospective study. Methods: This study is a retrospective case series of three patients with retained surgical textile products who had been misdiagnosed with spinal tumour. The medical records of the patients were reviewed and demographic data, clinical aspects, initial diagnosis, surgical procedures, time interval between previous operation and onset of symptoms, laboratory findings, radiological findings, treatment, and outcome were analysed. Results: The three patients included two women and one man aged between 64 and 67 years. All patients had a previous surgery for lumbar disc herniation. The time from the previous surgical procedures to presentation ranged from 3 to 17 years. All patients presented with non-specific lower back pain and/or radiculopathy without clinical findings of infection. Laboratory parameters were otherwise normal. All three cases had been misdiagnosed as a spinal tumor based on magnetic resonance imaging findings. During new surgical procedures, gauze bandages, i.e., surgical textiles left during a previous operation, were found. Conclusion: Textiloma is an important and rarely mentioned potential neurosurgical complication that may remain asymptomatic for years. They are more common in obese patients, after emergency surgery, and with unplanned changes in surgical procedure such as bleeding and unintended neurosurgical complications. Neuroradiological findings are variable and non-specific; thus, patients could be misdiagnosed with a spinal tumor or abscess. Likewise, in patients with a history of spinal surgery, spinal abscesses, haematomas, hypertrophic scars, fibrosarcomas, rhabdomyosarcomas, and schwannomas should definitely be considered in the differential diagnosis and considered when planning diagnostic procedures. Appropriate antibiotic therapy is recommended when a suppurative complication is present or suspected. Textiloma is a medico-legal complication that can be prevented by the education of surgical staff, the counting method (preoperatively, at closure, and at the end), and use of products with radiopaque barcodes. PMID:25207152

  3. Spinal muscular atrophy: manifestations and management.

    PubMed

    Mesfin, Addisu; Sponseller, Paul D; Leet, Arabella I

    2012-06-01

    Spinal muscular atrophy (SMA) is an autosomal recessive disorder caused by a homozygous deletion in the SMN1 gene and is manifested by loss of the anterior horn cells of the spinal cord. Classifications of the disorder are based on age of onset and the patient's level of function. Scoliosis and hip subluxation or dislocation are two musculoskeletal manifestations associated with SMA. Severity of scoliosis correlates with age at presentation. Bracing has been unsuccessful in halting curve progression and may interfere with respiratory effort. Early onset scoliosis associated with SMA has been successfully treated with growing rod constructs, and posterior spinal fusion can be used in older children. Hip subluxations and dislocations are best treated nonsurgically if the patient reports no pain because a high rate of recurrent dislocation has been reported with surgical intervention. PMID:22661569

  4. Vascular anatomy of the spinal cord

    SciTech Connect

    Thron, A.K.

    1988-01-01

    The book summarizes the anatomic guidelines of external blood supply to the spinal cord. The basic principles of arterial supply and venous drainage are illustrated by explicit schemes for quick orientation. In the first part of the book, systematic radiologic-anatomic investigations of the superficial and deep vessels of all segments of the spinal cord are introduced. The microvascular morphology is portrayed by numerous microradiographic sections in all three dimensions without overshadowing. The three-dimensional representation of the vascular architecture illustrates elementary outlines and details of arterial territories, anastomotic cross-linking as well as the capillary system, particularly the hitherto unknown structure of the medullary venous system with its functionally important anastomoses and varying regional structures. These often now radiologic-anatomic findings are discussed as to their functional and pathophysiologic impact and constitute the basic on which to improve one's understanding of vascular syndromes of the spinal cord.

  5. [Spinal granuloma in a patient receiving a spinal infusion of morphine and clonidine].

    PubMed

    Abejón, D; del Saz, J M; Ley, L; Sánchez, M R; del Pozo, C

    2009-01-01

    Patients treated with long-term spinal infusion of high doses of morphine develop a granuloma at the location of the catheter tip. Diagnosis is based on a steady increase in intrathecal morphine dosage after a relatively prolonged period of stability, on the gradual development of neurologic signs and symptoms suggesting radicular or spinal cord compression, and on magnetic resonance images. We describe a man with central neuropathic pain after removal of a tumor. The presence of all 3 of the aforementioned diagnostic criteria led to suspicion of a spinal granuloma. PMID:19725346

  6. Improving Multiple Fault Diagnosability using Possible Conflicts

    NASA Technical Reports Server (NTRS)

    Daigle, Matthew J.; Bregon, Anibal; Biswas, Gautam; Koutsoukos, Xenofon; Pulido, Belarmino

    2012-01-01

    Multiple fault diagnosis is a difficult problem for dynamic systems. Due to fault masking, compensation, and relative time of fault occurrence, multiple faults can manifest in many different ways as observable fault signature sequences. This decreases diagnosability of multiple faults, and therefore leads to a loss in effectiveness of the fault isolation step. We develop a qualitative, event-based, multiple fault isolation framework, and derive several notions of multiple fault diagnosability. We show that using Possible Conflicts, a model decomposition technique that decouples faults from residuals, we can significantly improve the diagnosability of multiple faults compared to an approach using a single global model. We demonstrate these concepts and provide results using a multi-tank system as a case study.

  7. The ICD diagnoses of fetishism and sadomasochism.

    PubMed

    Reiersøl, Odd; Skeid, Svein

    2006-01-01

    In this article we discuss psychiatric diagnoses of sexual deviation as they appear in the International Classification of Diseases (ICD-10), the internationally accepted classification and diagnostic system of the World Health Organization (WHO). Namely, we discuss the background of three diagnostic categories: Fetishism (F65.0), Fetishistic Transvestism (F65.1), and Sadomasochism (F65.5). Pertinent background issues regarding the above categories are followed by a critique of the usefulness of diagnosing these phenomena today. Specifically, we argue that Fetishism, Fetishistic Transvestism, and Sadomasochism, also labeled Paraphilia or perversion, should not be considered illnesses. Finally, we present the efforts of an initiative known as ReviseF65, which was established in 1997, to abolish these diagnoses. PMID:16803767

  8. Tampon Sampling for Diagnosis of Bacterial Vaginosis: a Potentially Useful Way To Detect Genital Infections?

    Microsoft Academic Search

    DAVID WILKINSON; NOMFANELO NDOVELA; AYESHA KHARSANY; CATHERINE CONNOLLY; A. WILLEM STURM

    1997-01-01

    Genital tract infections are important causes of ill health in developing countries, but diagnosis is difficult. Bacterial vaginosis (BV) was correctly diagnosed by using a vaginal specimen obtained by tampon sampling in 22 of 24 women (91.6%) for whom BV was diagnosed by Gram staining. The yield for other vaginal infections was higher (28% for Trichomonas vaginalis and 32.7% for

  9. Quantitative assessment of hemodynamic changes during spinal dural arteriovenous fistula surgery.

    PubMed

    Shi, Wei; Qiao, Guangyu; Sun, Zhenghui; Shang, Aijia; Wu, Chen; Xu, Bainan

    2015-07-01

    We aimed to evaluate the efficacy of FLOW 800 (Carl Zeiss Meditec, Jena, Thuringia, Germany) with indocyanine green (ICG) videoangiography for the quantitative assessment of flow dynamics in spinal dural arteriovenous fistula (dAVF) surgeries. We prospectively enrolled nine patients with spinal dAVF diagnosed within the past year and performed FLOW 800 analyses using ICG videoangiography before and after surgical obliteration of the fistula. A color-coded map was semi-automatically generated by FLOW 800 and used for high-resolution visualization of the vasculature and instant interpretation of the dynamic flow changes. The FLOW 800-specific hemodynamic parameters were employed for real-time measurements of parenchymal perfusion alterations. Overall, 18 intraoperative FLOW 800 analyses using ICG videoangiography were performed in nine patients. The color-coded map aided the detection and complete obliteration of the fistulas in all patients and the results were verified by postoperative spinal digital subtraction angiography. The transit time parameter was significantly shorter in the preobliteration phase than in the postobliteration phase (p<0.01), the rise time parameter exhibited the same pattern (p=0.08) and maximum intensity and blood flow index were not significantly different between these phases. FLOW 800 with ICG videoangiography provided an intuitive and objective understanding of blood flow dynamics intraoperatively and enabled easy and confident identification and treatment of this pathology. The FLOW 800-specific hemodynamic analyses provided additional perfusion information that enabled real-time measurements of parenchymal perfusion alterations. FLOW 800 with ICG videoangiography is useful for intraoperative quantitative assessment of flow dynamics, facilitating safety and confidence in the treatment of spinal dAVF. PMID:25934113

  10. Causes of Spinal Cord Injury

    PubMed Central

    2013-01-01

    Background: Knowledge of the causes of spinal cord injury (SCI) and associated factors is critical in the development of successful prevention programs. Objective: This study analyzed data from the National SCI Database (NSCID) and National Shriners SCI Database (NSSCID) in the United States to examine specific etiologies of SCI by age, sex, race, ethnicity, day and month of injury, and neurologic outcomes. Methods: NSCID and NSSCID participants who had a traumatic SCI from 2005 to 2011 with known etiology were included in the analyses (N=7,834). Thirty-seven causes of injury documented in the databases were stratified by personal characteristics using descriptive analysis. Results: The most common causes of SCI were automobile crashes (31.5%) and falls (25.3%), followed by gunshot wounds (10.4%), motorcycle crashes (6.8%), diving incidents (4.7%), and medical/surgical complications (4.3%), which collectively accounted for 83.1% of total SCIs since 2005. Automobile crashes were the leading cause of SCI until age 45 years, whereas falls were the leading cause after age 45 years. Gunshot wounds, motorcycle crashes, and diving caused more SCIs in males than females. The major difference among race/ethnicity was in the proportion of gunshot wounds. More SCIs occurred during the weekends and warmer months, which seemed to parallel the increase of motorcycle- and diving-related SCIs. Level and completeness of injury are also associated with etiology of injury. Conclusions: The present findings suggest that prevention strategies should be tailored to the targeted population and major causes to have a meaningful impact on reducing the incidence of SCI. PMID:23678280

  11. Vascular dysfunctions following spinal cord injury

    PubMed Central

    Popa, F; Grigorean, VT; Onose, G; Sandu, AM; Popescu, M; Burnei, G; Strambu, V; Sinescu, C

    2010-01-01

    The aim of this article is to analyze the vascular dysfunctions occurring after spinal cord injury (SCI). Vascular dysfunctions are common complications of SCI. Cardiovascular disturbances are the leading causes of morbidity and mortality in both acute and chronic stages of SCI. Neuroanatomy and physiology of autonomic nervous system, sympathetic and parasympathetic, is reviewed. SCI implies disruption of descendent pathways from central centers to spinal sympathetic neurons, originating in intermediolateral nuclei of T1–L2 cord segments. Loss of supraspinal control over sympathetic nervous system results in reduced overall sympathetic activity below the level of injury and unopposed parasympathetic outflow through intact vagal nerve. SCI associates significant vascular dysfunction. Spinal shock occurs during the acute phase following SCI and it is a transitory suspension of function and reflexes below the level of the injury. Neurogenic shock, part of spinal shock, consists of severe arterial hypotension and bradycardia. Autonomic dysreflexia appears during the chronic phase, after spinal shock resolution, and it is a life–threatening syndrome of massive imbalanced reflex sympathetic discharge occurring in patients with SCI above the splanchnic sympathetic outflow (T5–T6). Arterial hypotension with orthostatic hypotension occurs in both acute and chronic phases. The etiology is multifactorial. We described a few factors influencing the orthostatic hypotension occurrence in SCI: sympathetic nervous system dysfunction, low plasma catecholamine levels, rennin–angiotensin–aldosterone activity, peripheral alpha–adrenoceptor hyperresponsiveness, impaired function of baroreceptors, hyponatremia and low plasmatic volume, cardiovascular deconditioning, morphologic changes in sympathetic neurons, plasticity within spinal circuits, and motor deficit leading to loss of skeletal muscle pumping activity. Additional associated cardiovascular concerns in SCI, such as deep vein thrombosis and long–term risk for coronary heart disease and systemic atherosclerosis are also described. Proper prophylaxis, including non–pharmacologic and pharmacological strategies, diminishes the occurrence of the vascular dysfunction following SCI. Each vascular disturbance requires a specific treatment. PMID:20945818

  12. Percutaneous Radiofrequency Ablation of Painful Spinal Tumors Adjacent to the Spinal Cord with Real-Time Monitoring of Spinal Canal Temperature: A Prospective Study

    SciTech Connect

    Nakatsuka, Atsuhiro, E-mail: nakatuka@clin.medic.mie-u.ac.jp; Yamakado, Koichiro; Takaki, Haruyuki; Uraki, Junji; Makita, Masashi; Oshima, Fumiyoshi; Takeda, Kan [Mie University School of Medicine, Department of Radiology (Japan)

    2009-01-15

    PurposeTo prospectively evaluate the feasibility, safety, and clinical utility of bone radiofrequency (RF) ablation with real-time monitoring of the spinal canal temperature for the treatment of spinal tumors adjacent to the spinal cord.Materials and MethodsOur Institutional Review Board approved this study. Patients gave informed consent. The inclusion criteria were (a) a painful spinal metastasis and (b) a distance of 1 cm or less between the metastasis and the spinal cord. The thermocouple was placed in the spinal canal under CT fluoroscopic guidance. When the spinal canal temperature reached 45{sup o}C, RF application was immediately stopped. RF ablation was considered technically successful when the procedure was performed without major complications. Clinical success was defined as a fall in the visual analogue scale score of at least 2 points.ResultsTen patients with spinal tumors measuring 3-8 cm (mean, 4.9 {+-} 1.5 cm) were enrolled. The distance between the tumor and the spinal cord was 1-6 mm (mean, 2.4 {+-} 1.6 mm). All procedures were judged technically successful (100%). The spinal canal temperature did not exceed 45{sup o}C in 9 of the 10 patients (90%). In the remaining patient, the temperature rose to 48{sup o}C, resulting in transient neural damage, although RF application was immediately stopped when the temperature reached 45{sup o}C. Clinical success was achieved within 1 week in all patients (100%).ConclusionBone RF ablation with real-time monitoring of the spinal canal temperature is feasible, safe, and clinically useful for the treatment of painful spinal metastases adjacent to the spinal cord.

  13. Spinal Muscular Atrophy— Summary for Nutritional CareThe Consensus Statement for Standard of Care in Spinal Muscular Atrophy

    Microsoft Academic Search

    Donna DiVito; Susan Konek

    2010-01-01

    The Consensus Statement for Standard of Care in Spinal Muscular Atrophy was published in 2007 and provided guidance for interdisciplinary teams charged with the care of patients with spinal muscular atrophy (SMA). This standard was developed by the International Standard of Care Committee for Spinal Muscular Atrophy, which was formed in 2005. It was the goal of this committee to

  14. Movements elicited by electrical stimulation of muscles, nerves, intermediate spinal cord, and spinal roots in anesthetized and decerebrate cats

    Microsoft Academic Search

    Yoichiro Aoyagi; Vivian K. Mushahwar; Richard B. Stein; Arthur Prochazka

    2004-01-01

    Electrical stimulation offers the possibility of restoring motor function of paralyzed limbs after spinal-cord injury or stroke, but few data are available to compare possible sites of stimulation, such as muscle, nerve, spinal roots, or spinal cord. The aim of this study was to establish some characteristics of stimulation at these sites in the anesthetized and midcollicular decerebrate cat. The

  15. Spinal Prostaglandins Are Involved in the Development But Not the Maintenance of Inflammation-Induced Spinal Hyperexcitability

    Microsoft Academic Search

    Enrique Vasquez; Karl-Jürgen Bar; Andrea Ebersberger; Barbara Klein; Horacio Vanegas; Hans-Georg Schaible

    2001-01-01

    Prostaglandins (PGs) are local mediators of several functions in the CNS. Both primary afferent neurons and intrinsic cells in the spinal cord produce PGs, with a marked upregulation during peripheral inflammation. Therefore, the significance of spinal PGs in the neuronal processing of mechanosensory information was herein investigated. In anesthetized rats, the discharges of spinal nociceptive neurons with input from the

  16. Chronic spinal pain syndromes: A clinical pilot trial comparing acupuncture, a nonsteroidal anti-inflammatory drug, and spinal manipulation

    Microsoft Academic Search

    Lynton G. F. Giles; Reinhold Müller

    1999-01-01

    Objective: To compare needle acupuncture, medication (tenoxicam with ranitidine), and spinal manipulation for managing chronic (>13 weeks duration) spinal pain syndromes. Design: Prospective, randomized, independently assessed preintervention and postintervention clinical pilot trial. Setting: Specialized spinal pain syndrome outpatient unit at Townsville General Hospital, Queensland, Australia. Subjects: Seventy-seven patients (without contraindication to manipulation or medication) were recruited. Interventions: One of three

  17. Malignant Mesothelioma Diagnosed by Bronchoscopic Biopsy.

    PubMed

    Park, Yeon-Hee; Choi, Jae-Woo; Jung, Sang-Ok; Cho, Min-Ji; Kang, Da-Hyun; Chung, Chae-Uk; Park, Dong-Il; Moon, Jae-Young; Park, Hee-Sun; Jung, Sung-Soo; Kim, Ju-Ock; Kim, Sun-Young; Lee, Jeong-Eun

    2015-07-01

    Malignant mesothelioma is a rare malignant neoplasm that arises from mesothelial surfaces of the pleural cavity, peritoneal cavity, tunica vaginalis, or pericardium. Typically, pleural fluid cytology or closed pleural biopsy, surgical intervention (video thoracoscopic biopsy or open thoracotomy) is conducted to obtain pleural tissue specimens. However, endobronchial lesions are rarely seen and cases diagnosed from bronchoscopic biopsy are also rarely reported. We reported the case of a 77-year-old male who was diagnosed as malignant mesothelioma on bronchoscopic biopsy from obstructing masses of the endobronchial lesion. PMID:26175790

  18. Malignant Mesothelioma Diagnosed by Bronchoscopic Biopsy

    PubMed Central

    Park, Yeon-Hee; Choi, Jae-Woo; Jung, Sang-Ok; Cho, Min-Ji; Kang, Da-Hyun; Chung, Chae-Uk; Park, Dong-Il; Moon, Jae-Young; Park, Hee-Sun; Jung, Sung-Soo; Kim, Ju-Ock; Kim, Sun-Young

    2015-01-01

    Malignant mesothelioma is a rare malignant neoplasm that arises from mesothelial surfaces of the pleural cavity, peritoneal cavity, tunica vaginalis, or pericardium. Typically, pleural fluid cytology or closed pleural biopsy, surgical intervention (video thoracoscopic biopsy or open thoracotomy) is conducted to obtain pleural tissue specimens. However, endobronchial lesions are rarely seen and cases diagnosed from bronchoscopic biopsy are also rarely reported. We reported the case of a 77-year-old male who was diagnosed as malignant mesothelioma on bronchoscopic biopsy from obstructing masses of the endobronchial lesion.

  19. Remyelination of the injured spinal cord

    PubMed Central

    Sasaki, Masanori; Li, Bingcang; Lankford, Karen L.; Radtke, Christine; Kocsis, Jeffery D.

    2008-01-01

    Contusive spinal cord injury (SCI) can result in necrosis of the spinal cord, but often long white matter tracts outside of the central necrotic core are demyelinated. One experimental strategy to improve functional outcome following SCI is to transplant myelin-forming cells to remyelinate these axons and improve conduction. This review focuses on transplantation studies using olfactory ensheathing cell (OEC) to improve functional outcome in experimental models of SCI and demyelination. The biology of the OEC, and recent experimental research and clinical studies using OECs as a potential cell therapy candidate are discussed. PMID:17618995

  20. Spinal Angiolipoma: Case Report and Literature Review

    PubMed Central

    Hungs, Marcel; Paré, Laura S

    2008-01-01

    Background/Objective: Spinal angiolipoma (SAL) is an uncommon clinico-pathological entity. Design: Single case report. Methods: Retrospective data analysis. Findings: An obese woman with a 1-year history of progressive spastic paraparesis and acute deterioration underwent magnetic resonance imaging of the thoracic spine, the results of which suggested a tumor compressing the thoracic spinal cord. The histopathological examination of the completely resected tumor revealed an epidural angiolipoma. Conclusions: This case report offers a reminder that SAL should be considered in the differential diagnosis of long-standing, slowly progressive paraparesis. It remains unclear whether an increased body mass index might be a contributing factor to the development of SAL. PMID:18795485

  1. Spinal Stenosis with Paraparesis in a Korean Boy with Albright's Hereditary Osteodystrophy: Identification of a Novel Nonsense Mutation in the GNAS.

    PubMed

    Lee, Sang Heon; Mun, Seung Hyeon; Cho, Sung Yoon; Kim, Yeo Ju; Jin, Dong-Kyu; Ki, Chang-Seok; Lee, Ji-Eun

    2015-05-01

    Children with Albright's hereditary osteodystrophy (AHO) suffering from spinal cord compression are rarely reported worldwide. The association of compressive myelopathy with AHO is not still well known. AHO is a rare heterogeneous group of inherited disorders and results from the GNAS mutation. AHO manifests in two different phenotypes, pseudohypoparathyroidism type Ia (PHP-Ia) and pseudopsedohypoparthyroidim (PPHP), which may happen in the same family members. We present the case of a 15-year-old boy with AHO features, who was later diagnosed with PHP-Ia. He suffered from cervical myelopathy with paraparesis due to spinal stenosis. His mother with AHO phenotype was diagnosed with PPHP without spinal stenosis. Genetic analysis revealed a novel heterozygous nonsense mutation within exon 1 of GNAS(c.49A>T; p.Lys17*) in both of them. This is the first clinically, biochemically, and genetically identified child case of spinal stenosis and paraparesis associated with PHP-Ia, having a novel GNAS mutation in Korea. PMID:26116601

  2. Emerging options for treating hepatitis C infection.

    PubMed

    Fantasia, Heidi Collins

    2015-01-01

    Hepatitis C infection can cause chronic liver disease and liver carcinoma and can necessitate liver transplantation. Of the more than 3 million people infected with hepatitis C, more than two-thirds were born between 1945 and 1965. Many individuals are unaware that they're infected, which can delay treatment and lead to disease progression. Once infection is diagnosed, typical treatment regimens can involve multiple medications and side effects that can make it challenging for some people to complete therapy. In October 2014 the U.S. Food and Drug Administration (FDA) approved Harvoni®, a fixed dose combination pill of ledipasvir/sofosbuvir that provides a new option for treatment. PMID:25900589

  3. [Nursing diagnoses in patients after heart catheterization--contribution of Orem].

    PubMed

    de Lima, Luciano Ramos; Pereira, Sandra Valéria Martins; Chianca, Tânia Couto Machado

    2006-01-01

    Sectional study of multiple cases involving 30 patients after heart catheterization aiming to establish the nursing diagnoges according to the North American Nursing Diagnoses Association (NANDA). The method of data collection was the Nursing Process based on the Self-care Deficit Theory. Twenty-five different nursing diagnoses had been established. All patients presented Impaired tissue integrity, Risk of infection, Pain incisive in the area inguinal, Injured physical mobility, Self-care deficit related to personal hygiene, and Risk of organic renal lesion. It has been concluded that the Self-care Deficit theory allowed the classification of all nursing diagnoses according to NANDA. It contributed to the nursing assistance individualization, humanization, and qualification. Beyond advance self-knowledge, self-control and patient participation on his/her self-car. PMID:17175715

  4. Response to Pneumococcal Polysaccharide Vaccination in Newly Diagnosed HIV-Positive Individuals

    PubMed Central

    Leggat, David J; Iyer, Anita S; Ohtola, Jennifer A; Kommoori, Sneha; Duggan, Joan M; Georgescu, Claudiu A; Khuder, Sadik A; Khaskhely, Noor M; Westerink, MA Julie

    2015-01-01

    Background Newly diagnosed HIV-positive individuals are 35 to 100-fold more susceptible to Streptococcus pneumoniae infection compared to non-infected individuals. Therefore, the 23-valent pneumococcal polysaccharide vaccine (PPV23) has previously been recommended, though efficacy and effectiveness of vaccination remains controversial. Early severe B cell dysfunction is a central feature of HIV infection. The specific nature of the immune cells involved in the production of protective antigen-specific antibodies in HIV-positive individuals remains to be elucidated. Objectives Evaluate the antibody and antigen-specific B cell response to the 23-valent pneumococcal polysaccharide vaccine in newly diagnosed HIV-positive patients. Moreover, determine if newly diagnosed patients with CD4<200 cells/?l benefit from 6–12 months of HAART, allowing partial viral suppression and immune reconstitution, prior to immunization. Methods Newly diagnosed HIV-positive patients with CD4>200 cells/?l and CD4<200 cells/?l were immunized with PPV23. Patients with CD4<200 cells/?l received either immediate or delayed immunization following 6–12 months of HAART. Antibody responses, opsonophagocytic activity and phenotypic analysis of pneumococcal polysaccharide-specific B cells were studied. Results Newly diagnosed HIV-positive patients demonstrated CD4-dependent increases in antibody and opsonophagocytic titers thought to be commensurate with protection. Functional opsonophagocytic titers of patients with CD4<200 cells/?l immunized immediately compared to patients with CD4<200 cells/?l receiving HAART for 6–12 months were not significantly different. Pneumococcal polysaccharide-specific B cells were distributed evenly between IgM memory and switched memory B cells for all groups, but IgM memory B cells were significantly lower than in HIV-negative individuals. Conclusions Despite CD4-dependent pneumococcal polysaccharide-specific deficiencies in newly diagnosed HIV-positive patients, vaccination was beneficial based on opsonophagocytic titers for all newly diagnosed HIV-positive groups. In HIV-positive patients with CD4<200 cells/?l, 6–12 months of HAART did not improve opsonophagocytic titers or antibody concentrations. Based on these findings, immunization with the 23-valent pneumococcal polysaccharide vaccine should not be delayed in newly diagnosed HIV-positive patients with CD4<200 cells/?l. PMID:25908995

  5. [Management of sexually-transmitted diseases diagnosed in women in tropical Africa].

    PubMed

    Cazenave, J C; Breda, Y; Baquillon, G; Barnaud, P

    1987-01-01

    Taking into account their own experience and very numerous recent publications, the authors proposed an easy protocol towards diagnosed S.T.D., in African woman. Diseases are classified according to symptomatology: clear infection in case of cervico-vaginitis, ulcerations (painful or not), tumural formations, and also during salpingitis or infertility. They particularly emphasize cervico-vaginitis manifestations which represent one visit out of three in Gynecology Departments. For each infection, they recall its symptomatology, diagnosis and efficient treatment. They strongly recommend to keep in mind, in Africa, multi-microbial associations. PMID:3670025

  6. Seropositive Neuromyelitis Optica imitating an Intramedullary Cervical Spinal Cord Tumor: Case Report and Brief Review of the Literature

    PubMed Central

    Chiu, Jennifer Hiu-Fung; Leung, Kar-Ming; Chan, Kwong-Yau

    2014-01-01

    A 44-year-old woman with progressive cervical myelopathy and central cord syndrome was noted to have an extensive cervical intramedullary contrast-enhancing lesion on magnetic resonance imaging (MRI). The lesion resembled a spinal astrocytoma or ependymoma that required surgical intervention. She was subsequently diagnosed to have neuromyelitis optica (NMO), a rare idiopathic inflammatory demyelinating disorder, when the clinical examination revealed left optic atrophy. This was confirmed by a test showing seropositivity for NMO-immunoglobulin (IgG). Disease control was achieved with corticosteroids and immunosuppressive therapy. We report a rare case of a patient with NMO who had MRI features that could have easily led to the condition being misdiagnosed as a spinal cord tumor. The importance of careful history taking, awareness of typical radiological findings and the usefulness of serum NMO-IgG as a diagnostic tool are emphasized. PMID:25346824

  7. Aspergillus Infections in Transplant Recipients

    PubMed Central

    Singh, Nina; Paterson, David L.

    2005-01-01

    Aspergillus infections are occurring with an increasing frequency in transplant recipients. Notable changes in the epidemiologic characteristics of this infection have occurred; these include a change in risk factors and later onset of infection. Management of invasive aspergillosis continues to be challenging, and the mortality rate, despite the use of newer antifungal agents, remains unacceptably high. Performing molecular studies to discern new targets for antifungal activity, identifying signaling pathways that may be amenable to immunologic interventions, assessing combination regimens of antifungal agents or combining antifungal agents with modulation of the host defense mechanisms, and devising diagnostic assays that can rapidly and reliably diagnose infections represent areas for future investigations that may lead to further improvement in outcomes. PMID:15653818

  8. Autism Spectrum Disorder Diagnoses in Stockholm Preschoolers

    ERIC Educational Resources Information Center

    Fernell, Elisabeth; Gillberg, Christopher

    2010-01-01

    The aims of this study were to estimate prevalence rates of children with autism spectrum disorder (ASD) diagnoses in a cohort of 6-year-old children with birth year 2002, referred to the Autism Centre for Young Children, serving the whole of Stockholm county and on the basis of the available data discuss clinical aspects of assessment,…

  9. Diagnosability Analysis using Quasi-Static Models

    Microsoft Academic Search

    F. Nejjari; R. Perez; T. Escobet

    2006-01-01

    Diagnosability of faults relies on adequate sensors to provide redundancy relations so that the discrepancies of predictions and observations can be detected. This paper describes a model-based fault detection and diagnosis approach for dynamic systems. The approach uses the state space representation of a quasi static model to analyze fault discriminability. The methodology allows the identification of the set of

  10. Updated Diagnoses and Evidence-based Treatments

    E-print Network

    Hofmann, Hans A.

    . It is a brain disease over which the individual has no control. It is causedUpdated Diagnoses and Evidence-based Treatments for Addiction Carlton Erickson, Ph by brain dysregulaon iniated by drug use. #12;The main symptom of chemical

  11. How Is Mitral Valve Prolapse Diagnosed?

    MedlinePLUS

    ... page from the NHLBI on Twitter. How Is Mitral Valve Prolapse Diagnosed? Mitral valve prolapse (MVP) most often is detected during a routine ... heart. Rate This Content: NEXT >> July 1, 2011 Mitral Valve Prolapse Clinical Trials Clinical trials are research studies that ...

  12. Eating Disorder Diagnoses: Empirical Approaches to Classification

    ERIC Educational Resources Information Center

    Wonderlich, Stephen A.; Joiner, Thomas E., Jr.; Keel, Pamela K.; Williamson, Donald A.; Crosby, Ross D.

    2007-01-01

    Decisions about the classification of eating disorders have significant scientific and clinical implications. The eating disorder diagnoses in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) reflect the collective wisdom of experts in the field but are frequently not supported in…

  13. Hartshill rectangle: failure of spinal stabilisation in acute spinal cord injury

    Microsoft Academic Search

    Peter Ward; Adrian R. Harvey; James Ramos; John E. Carvell; David J. Grundy

    2000-01-01

    A high rate of failure of the internal fixation of unstable spinal fractures in complete cord injured patients was noted\\u000a in patients referred to the Salisbury Spinal Centre who had been stabilised with a Hartshill rectangle. This prompted a review\\u000a of the operative notes, radiographs and clinical outcomes of all patients referred to the centre with a Hartshill rectangle\\u000a in

  14. Pseudomonas aeruginosa infection in an intrathecal baclofen pump: successful treatment with adjunct intra-reservoir gentamicin

    Microsoft Academic Search

    A Galloway; FZ Falope

    2000-01-01

    Objective: To describe the use of intra-reservoir gentamicin for the treatment of a Pseudomonas aeruginosa infected baclofen pump.Setting: Regional Spinal Injuries Centre, Hexham, Northumberland, England.Subject: Male patient aged 32 years with progressive multiple sclerosis and severe bilateral spasticity.Results: Intra-reservoir gentamicin proved successful in treating infection with Pseudomonas aeruginosa.Conclusion: Intra-reservoir gentamicin may be successful in treating pump infection with Pseudomonas aeruginosa

  15. Emergence of Raoultella ornithinolytica on O‘ahu: A Case of Community-acquired R. ornithinolytica Urinary Tract Infection

    PubMed Central

    Nakasone, Elizabeth S; Kaneshiro, Ricky; Min, Kathleen

    2015-01-01

    Human infection with Raoultella ornithinolytica is rare, with only ten cases having been reported previously. This case report describes a local patient diagnosed with community-acquired R. ornithinolytica urinary tract infection in 2014. PMID:26019987

  16. Cutoff Values of Plasma D-Dimer Level in Patients with Diagnosis of the Venous Thromboembolism after Elective Spinal Surgery

    PubMed Central

    Riazi, Mahdieh

    2015-01-01

    Study Design A prospective clinical study. Purpose Our objective in the present study was twofold. First, we sought to evaluate the relationship between postoperative venous thromboembolism (VTE) development and concentration of D-dimer to determine the cutoff value in patients who underwent elective spinal surgery. Second, we identified the predictive risk factors for postoperative VTE. Overview of Literature VTE affects the general health of patients and may even cause death. Since the complications of VTE are difficult to predict, the safest and most cost effective diagnostic method should be used in order to confirm a suspected VTE event after spinal surgery. Methods This study was performed on 97 patients who underwent elective spinal surgery. The D-dimer assay was carried out on the day before surgery, and on days 1, 3, and 10 following surgery. VTE occurrence and D-dimer levels were compared between the VTE and the control groups. Results Four patients (4.1%) were diagnosed with deep vein thrombosis and one patient (1%) was diagnosed with a pulmonary embolism. The optimum D-dimer cutoff value on day 3 following surgery in the VTE group was determined to be more than 2.1 µg/mL with a sensitivity of 100% and a specificity of 80.7%. Moreover, the duration of postoperative recumbency was a significant risk factor for the development of VTE in this study. Conclusions We have demonstrated that postoperative D-dimer measurements in patients who underwent elective spinal surgery can provide a complementary diagnostic screening for VTE during the first week after surgery. PMID:25901235

  17. Radiology of intervertebral cages in spinal surgery

    Microsoft Academic Search

    S. D. Hanley; M. T. Gun; O. Osti; E. M. Shanahan

    1999-01-01

    This pictorial essay reviews the normal appearances and the post-operative complications of intervertebral cages. These are implants which are being more widely used in spinal surgery. The text outlines the background leading to their development, the clinical indications and surgical techniques for insertion of the cages. The normal post-operative appearance of fusion and the complications that can occur are emphasized.

  18. Sleep disordered breathing following spinal cord injury

    Microsoft Academic Search

    Fin Biering-Sørensen; Poul Jennum; Michael Laub

    2009-01-01

    Individuals with spinal cord injury (SCI) commonly complain about difficulty in sleeping. Although various sleep disordered breathing definitions and indices are used that make comparisons between studies difficult, it seems evident that the frequency of sleep disorders is higher in individuals with SCI, especially with regard to obstructive sleep apnea. In addition, there is a correlation between the incidence of

  19. Spinal anesthesia: Mechanisms, agents, methods, and safety

    Microsoft Academic Search

    Astrid Chiari; J. C. Eisenach

    1998-01-01

    Recent advances in our understanding of neurotransmitter and receptor pharmacology in the spinal cord have provided new directions for the development of novel analgesic compounds. Although IT opioids provide effective analgesia for most patients, limited duration of action, tolerance, and side effects represent a limitation. Nonopioids such as alpha-2 adrenergic and cholinergic agonists may be more suited as adjuvants rather

  20. Spinal cord compression due to brown tumor.

    PubMed

    Pikis, Stylianos; Cohen, José E; Vargas, Andres; Schroeder, Josh; Kaplan, Leon; Itshayek, Eyal

    2015-06-01

    We report a rare case of a vertebral brown tumor causing spinal cord compression and resulting in progressive paraparesis in a 27-year-old female with end-stage renal failure, managed with hemodialysis. Urgent neurosurgical intervention and gross total resection resulted in complete resolution of the symptoms. PMID:25769249