Conservative Management of Traumatic Brown-Séquard Syndrome: A Case Report

xlomafota13 shared this article with you from Inoreader Conservative Management of Traumatic Brown-Séquard Syndrome: A Case Report Via leak of cerebrospinal fluid Am J Case Rep. 2021 Jul 18;22:e930036. doi: 10.12659/AJCR.930036. ABSTRACT BACKGROUND Traumatic spinal cord injuries are quite common; however, a rare form of incomplete spinal cord injury is Brown-Sequard syndrome. Brown-Sequard syndrome is defined by the National Institute of Neurological Disorders and Strokes as "a rare neurological condition characterized by a lesion in the spinal cord which results in weakness or paralysis (hemiparaplegia) on one side of the body and a loss of sensation (hemianesthesia) on the opposite side." CASE REPORT A 33-year-old man was brought to the Emergency Department by Saudi Red Crescent with multiple stab wounds on the left upper thoracic and lower cervical regions. He was tachycardic, but otherwise vitally stable. His Glasgow Coma Scale score was 15. The patient presented with bilateral lower limb weakness, more on the ipsilateral (left) side, and contralateral (right) hypoesthesia from the level of the nip ple below. Cervical and thoracic magnetic resonance imaging revealed ligamentous injury defect at the posterior dura and indicating a dural tear with minor cerebrospinal fluid leak. Focal hyperintense signal intensity was noted on the left side of the spinal cord, representing contusion. The patient was managed conservatively with daily physical therapy. Strength had improved substantially by the time of discharge and sensation was improving. CONCLUSIONS Brown-Sequard syndrome is associated with good prognosis. These patients require a multidisciplinary approach because it provides the best chance of recovery to pre-injury status. These injuries may cause disastrous neurological deficits; therefore, preventive strategies should be designated to decrease the incidence of such injuries. PMID:34274937 | DOI:10.12659/AJCR.930036 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Outcome after surgical treatment of cerebrospinal fluid leaks in spontaneous intracranial hypotension-a matter of time

xlomafota13 shared this article with you from Inoreader Outcome after surgical treatment of cerebrospinal fluid leaks in spontaneous intracranial hypotension-a matter of time Via leak of cerebrospinal fluid J Neurol. 2021 Jul 18. doi: 10.1007/s00415-021-10710-7. Online ahead of print. ABSTRACT OBJECTIVE: Spinal cerebrospinal fluid (CSF) leaks cause spontaneous intracranial hypotension (SIH). Microsurgery can sufficiently seal spinal CSF leaks. Yet, some patients suffer from residual symptoms. Aim of the study was to assess predictors for favorable outcome after surgical treatment of SIH. METHODS: We included consecutive patients with SIH treated surgically from January 2013 to May 2020. Subjects were surveyed by a questionnaire. Primary outcome was resolution of symptoms as rated by the patient. Secondary outcome was postoperative headache intensity on the numeric rating scale (NRS). Association between variables and outcome was assessed using univariate and multivariate regression. A cut-off value for continuous variables was calculated by a ROC analysis. RESULTS: Sixty-nine out of 86 patients (80.2%) returned the questionnaire and were analyzed. Mean age was 46.7 years and 68.1% were female. A significant association with the primary and secondary outcome was found only for preoperative symptom duration (p = 0.001 and p < 0.001), whereby a shorter symptom duration was associated with a better outcome. Symptom duration remained a significant predictor in a multivariate model (p = 0.013). Neither sex, age, type of pathology, lumbar opening pressure, nor initial presentation were associated with the primary outcome. ROC analysis yielded treatment within 12 weeks as a cut-off for better outcome. CONCLUSION: Shorter duration of preoperative symptoms is the most powerful predictor of favorable outcome after surgical treatment of SIH. While an initial attempt of conservative treatment is justified, we advocate early definitive treatment within 12 weeks in case of persisting symptoms. PMID:34274993 | DOI:10.1007/s00415-021-10710-7 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

FACE-Q Craniofacial Module: Part 1 validation of CLEFT-Q scales for use in children and young adults with facial conditions

xlomafota13 shared this article with you from Inoreader FACE-Q Craniofacial Module: Part 1 validation of CLEFT-Q scales for use in children and young adults with facial conditions Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Jun 10:S1748-6815(21)00292-8. doi: 10.1016/j.bjps.2021.05.040. Online ahead of print. ABSTRACT BACKGROUND: The CLEFT-Q includes 12 independently functioning scales that measure appearance (face, nose, nostrils, teeth, lips, jaws), health-related quality of life (psychological, social, school, speech distress), and speech function, and an eating/drinking checklist. Previous qualitative research revealed that the CLEFT-Q has content validity in noncleft craniofacial conditions. This study aimed to examine the psychometric performance of the CLEFT-Q in an international sample of patients with a broad range of facial conditions. METHODS: Data were collected between October 2016 and December 2019 from 2132 patients aged 8 to 29 years with noncleft facial conditions. Rasch measurement theory (RMT) analysis was used to examine Differential Item Function (DIF) by comparing the original CLEFT-Q sample a nd the new FACE-Q craniofacial sample. Reliability and validity of the scales in a combined cleft and craniofacial sample (n=4743) were examined. RESULTS: DIF was found for 23 CLEFT-Q items when the datasets for the two samples were compared. When items with DIF were split by sample, correlations between the original and split person locations showed that DIF had negligible impact on scale scoring (correlations ≥0.995). In the combined sample, RMT analysis led to the retention of original content for ten CLEFT-Q scales, modification of the Teeth scale, and the addition of an Eating/Drinking scale. Data obtained fit with the Rasch model for 11 scales (exception School, p=0.04). Person Separation Index and Cronbach alpha values met the criteria. CONCLUSION: The scales described in this study can be used to measure outcomes in children and young adults with cleft and noncleft craniofacial conditions. PMID:34274246 | DOI:10.1016/j.bjps.2021.05.040 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The impact of closed incisional negative pressure therapy on anterior lateral thigh flap donor site healing and scarring: A retrospective case-control study

xlomafota13 shared this article with you from Inoreader The impact of closed incisional negative pressure therapy on anterior lateral thigh flap donor site healing and scarring: A retrospective case-control study Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Jun 13:S1748-6815(21)00300-4. doi: 10.1016/j.bjps.2021.05.049. Online ahead of print. ABSTRACT BACKGROUND: The objective of this study was to investigate whether closed incisional negative pressure therapy (cINPT) is suitable to improve anterior lateral thigh (ALT) flap donor site healing and scarring. METHODS: We identified 271 ALT free flaps of widths between 7 and 9 cm and primary donor site closure performed between January 2012 to December 2019. Patients were divided into cases of cINPT versus controls without cINPT as part of this retrospective case-control review. We compared the incidences of postoperative donor site complications (wound dehiscence, infection, seroma, hematoma) and the degree of scarring severity using the Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scales (POSAS). RESULTS: A total of 106 ALT donor sites received cINPT (39%), whereas th e remaining 165 donor sites received conventional dressings (61%). The distribution of gender, age, body mass index, comorbidities, and mean flap sizes were comparable between both groups. The occurrence of surgical wound dehiscence was significantly lower in the cINPT group (2.8%), when compared to controls (9.0%) (p = 0.04). Furthermore, the mean length of postoperative hospital stay was significantly shorter in the cINPT group (19 ± 8 days versus 21 ± 11 days; p = 0.03). CINPT was associated with a more favorable donor site scar quality when assessed by VSS (p = 0.03) and POSAS (p = 0.002). CONCLUSION: The use of cINPT was associated with significantly less ALT donor site complications and superior scar quality accelerating patients' postoperative recovery. PMID:34274247 | DOI:10.1016/j.bjps.2021.05.049 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Normothermic ex vivo perfusion of the limb allograft depletes donor leukocytes prior to transplantation

xlomafota13 shared this article with you from Inoreader Normothermic ex vivo perfusion of the limb allograft depletes donor leukocytes prior to transplantation Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Apr 11:S1748-6815(21)00172-8. doi: 10.1016/j.bjps.2021.03.071. Online ahead of print. ABSTRACT INTRODUCTION: The donor immune compartment plays a central role in graft rejection of the vascularised composite allograft (VCA) by contributing to 'direct presentation'. Using our limb ex vivo normothermic machine perfusion (EVNP) protocol designed for prolonged allograft preservation, this study aimed to assess whether donor leukocytes responsible for allograft rejection are mobilised from the donor compartment. METHODS: Five genetically different pig forelimbs underwent perfusion via the brachial and radial collateral artery for 6 h after 2 h of cold storage. Oxygenated haemodilute leucocyte-deplete blood was recirculated at normothermia using an extracorporeal perfusion system. Tissue perfusion was evaluated clinically and biochemically via blood perfusate. The temporal kinetics of donor leucocyte extravasation, cytokine secretion and cell-free DNA was characterised in the circulating perfusate. RESULTS: Flow cytometry revealed increasing populations of viable leukocytes over time, reaching 49 billion leukocytes by 6 h. T (3.0 × 109 cells) and B cells (3.1 × 108 cells) lymphocytes, monocytes (2.7 × 109 cells), granulocytes (8.1 × 109 cells), NK (6.3 × 108) and γδ (8.1 × 108) cells were all identified. Regulatory T cells comprised a minor population (1.6 × 107 cells). There was a cumulative increase in pro-inflammatory cytokines suggesting that the donor limb has the capacity to elicit significant inflammatory responses that could contribute to leucocyte activation and diapedesis. CONCLUSION: EVNP not only acts as a preservation tool, but could also be utilized to immunodeplete the VCA allograft prior to transplantation. This has clinical implications to mitigate acute rejection and prevent graft dysfunction and supports the future application of machine perfusion in graft preservation and immune modulation. PMID:34274245 | DOI:10.1016/j.bjps.2021.03.071 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A case of spontaneous middle cranial fossa cerebrospinal fluid leak presenting as recurrent bacterial meningitis

xlomafota13 shared this article with you from Inoreader A case of spontaneous middle cranial fossa cerebrospinal fluid leak presenting as recurrent bacterial meningitis Via leak of cerebrospinal fluid Rinsho Shinkeigaku. 2021 Jul 17. doi: 10.5692/clinicalneurol.cn-001606. Online ahead of print. ABSTRACT A 19-year-old man with a history of Chiari type I malformation was admitted to our hospital two times within a 2-month period because of bacterial meningitis. Cerebrospinal fluid (CSF) analysis showed neutrophilic pleocytosis and hypoglycorrhachia. During the second admission, we became aware of hearing loss on the right since age 15 years. High-resolution temporal bone CT showed soft tissue opacification of the right epitympanum and external auditory canal. Tissue biopsy resulted in CSF otorrhea and pneumocephalus. CT cisternography revealed a temporal bone CSF leak. Brain MRI showed a dural defect localized to the anterior petrous apex. Using a combined middle cranial fossa-transmastoid approach, the dural defect and associated arachnoid granulations were located along the superior side of the greater petrosal nerve and repaired. A CSF le ak without underlying pathology, such as trauma, surgery, or congenital abnormality, is defined as spontaneous. Spontaneous CSF leak should be considered as a cause of recurrent bacterial meningitis even when CSF otorrhea and fluid behind the tympanic membrane are clinically absent. PMID:34275956 | DOI:10.5692/clinicalneurol.cn-001606 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Analysis of 1430 hand fractures and identifying the 'Red Flags' for cases requiring surgery: Head: Hand Fracture Treatment

xlomafota13 shared this article with you from Inoreader Analysis of 1430 hand fractures and identifying the 'Red Flags' for cases requiring surgery: Head: Hand Fracture Treatment Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Jun 23:S1748-6815(21)00344-2. doi: 10.1016/j.bjps.2021.06.011. Online ahead of print. ABSTRACT BACKGROUND: Hand fractures constitute 20% of hand injury patients who apply to emergency services. Conservative approaches are satisfactory in the majority of the cases. However, the minority group in need of surgery reaches a serious number of patients considering the frequency of these injuries. Retrospective questioning of the indications of the performed surgeries is a proper way of understanding the decisional process for surgery. PATIENTS/METHODS: Patients treated for hand fractures were retrospectively reviewed. Patient gender, age, finger/fingers involved, soft tissue involvement, treatment method (conservative/surgery) and if operated, devices used for fixation were noted. Plain radiographs of the patient were evaluated. Descriptive statistics of these variables and the effect of each variabl e on the decision for surgery were analyzed. RESULTS: The study involved 1430 fractures of 1303 patients (1016 male and 287 female). Fifth finger was the most commonly injured digit (31%). Comminuted fractures (29%) followed by transverse fractures (29%) and spiral/oblique fractures (22%) were commonly diagnosed fracture types. Thirteen percent (13%) of the study group needed tendon/nerve/vessel repairs. Male patients, cases with soft tissue involvement, second, third and fourth finger fractures, fractures involving multiple digits, fractures with an intra-articular component, fractures with dislocation more than 4 mm and angulation more than 15° had a significantly higher rate of surgery. CONCLUSION: Less than half of the hand fractures require surgery, and conservative treatment is usually preferred. Certain variables that indicate surgical treatment were identified with our study. These findings may help to weigh the options and choose the right path in doubtful cond itions. LEVEL OF EVIDENCE: Level 4, Case-control study. PMID:34275778 | DOI:10.1016/j.bjps.2021.06.011 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.