bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk factors for postoperative spinal infection: A retrospective analysis of 5065 cases
Authors: El-Kadi Matt , Donovan Erin , Kerr Laurel , Cunningham Coby , Osio Victor , Abdallah Samah , Kazan Joseph
Published: August 2019

Background:

Multiple factors increase the risk for spinal surgical site infection (SSI): prior SSI, obesity, diabetes mellitus, advanced age, American Society of Anesthesiologists class, alcohol abuse, low prealbumin levels, smoking, history of cancer, chronic steroids, immunosuppressive drugs, rheumatoid arthritis, and hypothyroidism.

Methods:

Here, we performed a retrospective medical record review at one facility involving 5065 patients from 2010 to 2015. In 2011, there was an increase in the infection rate (1.07%) which prompted this analysis, resulting in the subsequent introduction of a protocol to reduce the infection risk.

Results:

The overall infection rate in this series was 0.59%. The lowest infection rate was 0.00% for anterior cervical discectomy and fusion. The highest rate of infections occurred among patients undergoing posterior cervical fusions, lumbar fusions, and tumor resections. Higher infection rates were also correlated with diabetes mellitus, obesity, and increased surgical time.

Conclusions:

Since 2011, we instituted a protocol to limit the risks of spinal SSIs, particularly for patients exhibiting increased medical comorbidities.
Multimodal treatment of an extremely rare desmoplastic small round cell tumor primary to the brachial plexus – A case report and review of literature
Authors: Guedes-Corrêa José Fernando , Amorim Rogério Pires , Pereira Maristella Reis da Costa , Cardoso Rodrigo Salvador Vivas , Costa Felipe D’Almeida , Bianchi Bruno de Souza , Siquara-de-Souza Ana Caroline
Published: August 2019

Background:

Desmoplastic small round cell tumor (DSRCT) is a rare and aggressive malignant neoplasm typically located in the abdomen or pelvis. Other possible locations are the chest, pleura, scrotum, and central nervous system. DSRCT originally arising from the brachial plexus (BP) is extremely rare, to the best of our knowledge, only two cases have been previously described in the English scientific literature.

Case Description:

The authors present one new case of DSRCT arising from the left BP, the first in this location with rapid progression and in a female patient. We also highlight the importance of multimodal therapy, which included resection and both adjuvant radiation and chemotherapy. Macroscopic and microscopic characteristics of the lesion are detailed, as well as the patient’s status at 56-month follow-up.

Conclusion:

For primary BP DSRCT, aggressive subtotal resection followed by radiation and chemotherapy can be satisfactory for disease control and for maintaining or improving the neurological status.
Stent-assisted coil embolization of unruptured vertebral artery dissecting aneurysms with the low-profile visualized intraluminal support stent, with five techniques: Technical note and case report
Authors: Maeoka Ryosuke , Nakagawa Ichiro , Omoto Koji , Wada Takeshi , Kichikawa Kimihiko , Nakase Hiroyuki
Published: August 2019

Background:

Intracranial vertebral artery dissecting aneurysm (VADA) is rare and shows high morbidity and mortality rates when the aneurysm ruptures. Endovascular treatment for VADA is one of the optimal treatments, but the dominant side VA and its branches or perforators need to be preserved. We report a novel and successful stent-assisted coil embolization technique using the low-profile visualized intraluminal support (LVIS) stent, with five technical notes in three consecutive cases of unruptured vertebral artery dissecting aneurysm (VADA).

Case Description:

We report three consecutive cases of unruptured VADA which involved a posterior inferior cerebellar artery (PICA), an anterior spinal artery, and perforators. Stent-assisted coil embolization with the LVIS stent was performed in all patients. The stent was carefully placed to obtain parent artery wall apposition at distal portion and with moderate pushing at aneurysm portion. The LVIS stent was placed with tailor-made wall apposition at perforating arterial side in the barrel view, and coil embolization was performed avoiding doughnut-like stent form to prevent perforator infarcts. All cases showed complete occlusion of the aneurysms with preservation of both parent artery and its branches and perforators patency. In three cases, clinical presentations were improved without ischemic complications. The median follow-up period was 1 year. At present, no recurrence and no complication have been observed.

Conclusion:

We demonstrate the coil embolization of VADA using LVIS stent with five techniques. Our techniques for the treatment of VADA using LVIS stent are safe and can minimize ischemic complications by creating suitable wall apposition to the orifices of branches or perforators.
Spinal cord stimulator failure: Migration of a thoracic epidural paddle to the cervical spine
Authors: Travers Sarah S. , Norregaard Thorkild V.
Published: August 2019

Background:

Spinal cord stimulators successfully treat a number of pain syndromes but carry a risk of hardware complications. Here, we present a case of cranial migration of a thoracic epidural paddle to the cervical spine.

Case Description:

A 53-year-old male underwent uncomplicated spinal cord stimulator placement at the T10– T11 with initially favorable results. However, postoperatively, he complained of paresthesias in his arms. An X-ray demonstrated cranial migration of the thoracic epidural paddle to the cervical spine. The stimulator/new paddle was placed again at the T10–T11 level, but the leads were now secured to the caudal lamina utilizing a cranial plating system. The patient subsequently did well without further sequelae.

Conclusions:

A thoracic epidural paddle (T10–T11) migrated postoperatively into the cervical spine. It was subsequently removed and replaced into the thoracic region, but the leads were now secured in place with a novel caudal lamina/cranial plating system.
Spinal cord compression by multiple cysticercosis
Authors: Lopez Sebastian , Santillan Franklin , Diaz Juan Jose , Mogrovejo Pedro
Published: August 2019

Background:

Neurocysticercosis (NCC) is the most common parasitic infection involving the central nervous system in endemic areas. Notably, spinal involvement occurs in only 0.7%–3% of patients.

Case Description:

A 58-year-old female presented with progressive spinal cord compression attributed to multiple cystic intradural extramedullary thoracic lesions. She underwent laminectomy at two separate thoracic levels; this involved excision of the upper T4–T6, and just exploration of the lower T9–T11 lesions. One year postoperatively, she exhibited a residual paraparesis.

Conclusion:

Spinal NCC must be considered among the differential diagnostic considerations for patients presenting with spinal intramedullary or subarachnoid/extramedullary cystic lesions. Although they are typically found in endemic regions, those who have traveled to these locations are also susceptible. Even though it is considered a benign condition, spinal NCC may cause permanent and irreversible neurological damage. Public health policies should, therefore, be developed to help control the spread and transmission of NCC.
When to stop anticoagulation, anti-platelet aggregates, and non-steroidal anti-inflammatories (NSAIDs) prior to spine surgery
Authors: Epstein Nancy E.
Published: August 2019

Background:

Based upon a select review of the literature, in my opinion, spine surgeons, not just our medical/cardiological colleagues, need to know when to stop anticoagulant, anti-platelet aggregates, and non-steroidal anti-inflammatory (NSAIDs) medications prior to spine surgery to avoid perioperative bleeding complications.

Methods:

Typically, medical/cardiological consultants, who “clear our patients” are not as aware as we are of the increased risks of perioperative bleeding if anticoagulant, anti-platelet, and NSAIDs are not stopped in a timely fashion prior to spine surgery (e.g. excessive intraoperative hemorrhage, and postoperative seromas, hematomas, and wound dehiscence).

Results:

Different medications need to be discontinued at varying intervals prior to spinal operations. The anticoagulants include; Warfarin (stop at least 5 preoperative days), and Xa inhibitors (Eliquis (Apixaban: stop for 2 days) and Xarelto (Rivaroxaban: stop for 3 days)); note presently data vary. The anti-platelet aggregates include: Aspirin/Clopidogrel (stop >7-10 days preoperatively). The multiple NSAIDs should be stopped for varying intervals ranging from 1-10 days prior to spine surgery, and increase bleeding risks when combined with any of the anticoagulants or anti-platelet aggregates. NSAIDs (generic name/commercial names should be stopped preoperatively for at least; 1 day- Diclofenac (Voltaran), Ibuprofen (Advil, Motrin), Ketorolac (Toradol); 2 days- Etodolac (Lodine), Indomethacin (Indocin); 4-days-Meloxicam (Mobic) and Naproxen (Aleve, Naprosyn, Anaprox); 4 days- Nabumetone (Relafen); 6 days - Oxaprozin (Daypro); and 10 days- Piroxicam (Feldene).

Conclusions:

Spine surgeons need to know when anti-platelet, anticoagulant, and NSAIDs therapies should be stopped prior to spine surgery to avoid perioperative bleeding complications.
Atypical teratoid/rhabdoid tumor presenting with subarachnoid and intraventricular hemorrhage
Authors: Siddiqui Mehdi , Thoms Dewey , Samples Derek , Caron Jean
Published: August 2019

Background:

Sellar masses comprise 14–18% of all intracranial tumors. Pituitary adenomas account for 85% of these lesions, while 15% of sellar masses stem from other etiologies. Intratumoral hemorrhage (apoplexy), while not exceptionally common, can be discovered at presentation. While the hemorrhage pattern is typically contained within the tumor, an extension of bleeding beyond the sella has been reported.

Case Description:

A 55-year-old female presented with an anterior interhemispheric subarachnoid hemorrhage and extensive intraventricular hemorrhage (IVH). Initially, the IVH was thought to be due to a ruptured aneurysm. After further workup, a hemorrhagic sellar mass was diagnosed. The patient underwent transsphenoidal resection of a pituitary adenoma. The patient returned to the emergency department6 weeks later with an atypical rapidly expanding sellar mass. After tumor debulking, the pathology revealed an atypical teratoid/rhabdoid tumor (ATRT). Here, we reviewed this and other such cases of sellar ATRT.

Conclusion:

The early diagnosis of sellar ATRT with lack of integrase interactor 1 expression and elevated Ki67 proliferation indices can prompt more aggressive attempted gross total resection, chemotherapy, and radiation treatments.
Understanding gamma ventral capsulotomy: Potential implications of diffusion tensor image tractography on target selectivity
Authors: Santos Bruno Fernandes de Oliveira , Gorgulho Alessandra , Saraiva Crystian W. C. , Lopes Antonio Carlos , Gomes João Gabriel Ribeiro , Pássaro Anderson M. , Hoexter Marcelo Q. , Miguel Eurípedes C. , De Salles Antonio A. F.
Published: August 2019

Background:

The role of tractography in gamma ventral capsulotomy (GVC) planning is still unclear. This paper aims to describe the spatial distribution of medial orbitofrontal cortex (OFC) and lateral OFC fibers passing through the anterior limb of the internal capsule (ALIC) and analyze quantitative tractography parameters that differentiate obsessive-compulsive disorder (OCD) individuals from other neurosurgery functional patients (morbid obesity and Parkinson’s disease [PD]).

Methods:

Twenty patients undergoing functional stereotactic procedures, between 2013 and 2016, were included in this study. OCD patients underwent GVC (single shot 150 Gy and 4-mm collimators). PD and morbid obesity patients were submitted to deep brain stimulation implants. Diffusion tensor image tractography was reconstructed using Brainlab Elements software (Brainlab AG, Munich, Germany).

Results:

Nine PD, six morbid obesity, and five OCD patients were included with a mean age of 65.4 ± 9.1, 41.0 ± 8.2, and 31.2 ± 5.5, respectively, which are statistically different from each other (P < 0.001). Fourteen patients (70%) were men. A total of 40 cerebral hemispheres were analyzed. Medial OFC fibers are localized more inferior in the ALIC than the lateral OFC fibers in all hemispheres, but the level of intersection and exact topography of fiber bundles are variable among individuals. Both medial and lateral OFC fiber tracts of PD and morbid obesity patients have lower volume than, respectively, medial and lateral counterparts of OCD patients (P < 0.001).

Conclusions:

Medial and lateral OFC tract fibers have a general standard distribution in the anterior internal capsule (lateral OFC higher than medial OFC fibers). There are differences between obesity, Parkinson, and OCD patients regarding fiber tract statistics.
Minimally invasive posterior fossa decompression with duraplasty in Chiari malformation type I with and without syringomyelia
Authors: Caffo Maria , Cardali Salvatore M. , Caruso Gerardo , Fazzari Elena , Abbritti Rosaria V. , Barresi Valeria , Germanò Antonino
Published: August 2019

Background:

Posterior fossa decompression (PFD), with and without duraplasty, represents a valid treatment in Chiari malformation Type I (CM-I) with and without syringomyelia. Despite a large amount of series reported in literature, several controversies exist regarding the optimal surgical approach yet. In this study, we report our experience in the treatment of CM-I, with and without syringomyelia, highlighting how the application of some technical refinements could lead to a good outcome and a lesser rate of complications.

Methods:

Twenty-six patients with CM-I, with and without syringomyelia, underwent PFD through a 3 cm × 3 cm craniectomy with the removal of the most median third of the posterior arch of C1 and duraplasty. Signs and symptoms included sensory deficits, motor deficits, neck pain, paresthesias, headache, dizziness, lower cranial nerve deficits, and urinary incontinence. Postoperative magnetic resonance (MR) was performed in all patients.

Results:

Signs and symptoms improved in 76.9% of cases. Postoperative MR revealed a repositioning of cerebellar tonsils and the restoration of cerebrospinal fluid circulation. In our experience, the rate of complication was 23% (fistula, worsening of symptoms, and respiratory impairment).

Conclusion:

PFD through a 3 cm × 3 cm craniectomy and the removal of the most median third of posterior arch of C1 with duraplasty represents a feasible and valid surgical alternative to treat patients with CM-I, with and without syringomyelia, achieving a good outcome and a low rate of complications.
Giant dumbbell C2C3 neurofibroma invading prebulbar cistern: Case report and literature review
Authors: Serrano Julia Pinheiro Martinez , Neves Maick Willen Fernandes , Marchi Cassiano , Nakasone Fabio Jundy , Maldaun Marcos Vinicius Calfat , Aguiar Paulo Henrique Pires de , Scappini Wilson
Published: August 2019

Background:

Neurofibromatosis 1 (NF1) has a broad spectrum of clinical manifestations, most typically involving café-au-lait spots and skin neurofibromas. Only 2% of patients with NF1 have symptomatic spinal tumors.

Case Description:

A patient with a previous diagnosis of NF1 presented with cervicalgia, dysphagia/mild dysphonia, gait alteration, and progressive hypoesthesia involving all four limbs. The magnetic resonance documented a giant dumbbell neurofibroma arising between the C2 and C3 levels which extended toward the foramen magnum, causing medullary and bulbar compression. The major challenge of surgical management was the enormous size and location this C2–C3 (5 cm × 4 cm × 5.1 cm) lesion.

Conclusions:

Compression of the foramen magnum attributed to a dumbbell giant spinal neurofibroma at the C2C3 level resulting in prebulbar cisterns should be among the differential diagnostic considerations for patients presenting with tetraparesis and underlying NF1.
A case of unilateral vertebral artery dissection progressing in a short time period to bilateral vertebral artery dissection
Authors: Tsuji Kiyoshi , Watanabe Akira , Nakagawa Nobuhiro , Kato Amami
Published: August 2019

Background:

Vertebral artery dissection (VAD) is an important cause of stroke in young and middle- aged people. Bilateral occurrence of VAD is generally considered rare, but the number of reports of bilateral VAD has been increasing in recent years. In this paper, we report a case of de novo VAD on the contralateral side presenting with subarachnoid hemorrhage in the acute stage of cerebral infarction due to unilateral VAD.

Case Description:

A 52-year-old man developed sudden-onset left occipital headache, dizziness, dysphagia, and right-sided hemiparesthesia and was admitted to our hospital. Head magnetic resonance imaging on admission showed a left lateral medullary infarction due to the left VAD. At this point, the right vertebral artery was normal. However, on day 9 after onset, he suddenly presented with subarachnoid hemorrhage due to the right VAD. Emergency endovascular treatment was performed for the dissecting aneurysm of the right vertebral artery. The patient’s condition improved gradually after the procedure, and he was discharged with a modified Rankin Scale score of 1.

Conclusion:

Bilateral occurrence of VAD may be more common than previously believed. Even in cases of unilateral VAD, we need to pay attention to the occurrence of de novo VAD on the contralateral side.
A rare case of an intramedullary metastasis of a myxopapillary ependymoma
Authors: Fonseca Lino , Cicuendez Marta , Martínez-Ricarte Francisco , Martínez-Saez Elena , Cordero Esteban , Bescos Agustín
Published: August 2019

Background:

Myxopapillary ependimoma (MPE) is a benign slow-growing tumor, and it has been designated histologically as a Grade I neoplasm according to the 2016 World Health Organization classification. Despite the benign character, dissemination and metastasis have occasionally been reported. The retrograde dissemination to other levels of the neuraxis is extremely rare, being more frequent to the intracranial compartment.

Case Description:

We hereby present a case of medullary metastasis of cauda equina MPE, with a history of having undergone a subtotal resection and postoperative adjuvant radiotherapy. The patient presents complaints of night dorsal pain attributable to intradural metastasis twenty-one years after the first surgical intervention.

Conclusion:

The case reported highlights the importance of long follow-up in patients with MPE, since the possibility of secondary seeding to distant craniospinal sites or local spinal sites after surgery, and radiotherapy should be considered in metastatic disease.
Intracranial anaplastic hemangiopericytoma presenting with simultaneous extra-cranial metastases: A case report and review of the literature
Authors: Reddy Sumanth , Plitt Aaron , Raisanen Jack , Patel Ankur R. , Gopal Purva , Timmerman Robert , Patel Toral R.
Published: August 2019

Background:

Intracranial solitary fibrous tumor/hemangiopericytoma (SFT/HPC) is a rare mesenchymal tumor with a propensity to recur and metastasize extracranially years after treatment. Accordingly, there are no reported cases of a patient presenting with a simultaneous intracranial primary and extracranial metastases. We present the case of a patient presenting with an intracranial SFT/HPC and simultaneous liver metastases and propose a treatment paradigm.

Case Description:

A 74-year-old male smoker presented with confusion. An MRI of the brain revealed a heterogeneously enhancing left frontal extra-axial mass. Systemic workup revealed multiple small liver lesions concerning for metastases. The patient underwent gross total resection (GTR) of the intracranial lesion with adjuvant CyberKnife stereotactic radiotherapy to the resection cavity. Pathology was consistent with a WHO Grade III SFT/HPC (previously known as anaplastic HPC). The liver lesions were biopsied and confirmed to be metastases. They were subsequently treated with stereotactic body radiation therapy, temozolomide, and bevacizumab. Eighteen months postoperatively, the patient is alive with no evidence of intracranial malignancy and regression of the hepatic lesions.

Conclusion:

Several studies support GTR and adjuvant radiotherapy to treat intracranial SFT/HPC. The role of adjuvant chemotherapy is less clear. Metastatic disease is typically detected several years after the initial diagnosis, and there is no consensus regarding the optimal treatment strategy. We propose that the rare presentation of intracranial SFT/HPC with simultaneous extracranial metastases should be treated in a multidisciplinary fashion with surgical resection, adjuvant radiotherapy, and chemotherapy.
X-rays and scans can fail to differentiate hip pathology from lumbar spinal stenosis: Two case reports
Authors: Singh Ravindra , Kim Hyeun-Sung , Adsul Nitin , Kashlan Osama Nezar , Woon Oh Sung , Noh Jung Hoon , Moon Soeng Cheol , Park Chang Hwan , Jang Il Tae , Hoon Oh Seong
Published: August 2019

Background:

Occasionally, hip pathologies may present alone or combined with lumbar spine pathology, especially lumbar stenosis. Although the history and clinical examination may help differentiate between the two, hip X-rays alone without accompanying magnetic resonance imaging (MRI) studies may prove unreliable.

Case Descriptions:

Case 1 – A 72-year-old male presented with the sudden onset of severe back and left posterior thigh pain. Straight leg raising test was positive at 70° (right) and 60° (left), and he had left lower extremity numbness and weakness. The lumbar MRI showed L5-S1 spinal stenosis. Although X-rays of both hips were negative, the MRI showed bilateral femoral neck fractures. He underwent screw fixation of the hip fractures and later underwent endoscopic decompression of the spinal stenosis. Case 2 – A 35-year-old male presented with low backache and right hip pain of 1 month’s duration. The neurological examination was normal, except for positive straight leg raising bilaterally at 60°. The spine MRI was normal. However, despite negative X-ray of both hips, the hip MRI revealed avascular necrosis (AVN) of both femoral heads requiring subsequent orthopedic management.

Conclusion:

Hip pathology may mimic lumbar spinal stenosis. In the two cases presented, plain X-rays failed to document hip fractures (case 1) and AVN (case 2), respectively, both of which were later diagnosed on MRI studies.
Penetrating spinal cord injury: A case report and literature review
Authors: Mackowsky Matthew , Hadjiloucas Nicole , Campbell Stuart , Bulauitan Constantine
Published: August 2019

Background:

Penetrating spinal cord injury (pSCI) is uncommon in civilian settings. However, there is a lack of consensus regarding perioperative management and thresholds for operative intervention. This review explores the various trends in the management of pSCI along with a literature review.

Case Description:

A 34-year-old male presented with a gunshot wound (GSW) to the left chest. Injuries included a pneumothorax, diaphragmatic injury, splenic injury, multiple small bowel injuries, transverse colon injury, and a bullet lodged at the L5 spinal level. The patient underwent chest tube placement, an exploratory laparotomy, splenectomy, diaphragmatic repair, multiple small bowel resections, and a transverse colon resection. Later on, the patient required a lumbar laminectomy for wound debridement and bullet excision.

Conclusion:

The standards for the surgical management of pSCI are poorly defined. Older studies suggested that >7 days of antibiotics decreased the risk of infection associated with HVI while shorter regimens correlated with higher rates of spinal and neurologic infections (meningitis, paraspinal abscess, and osteomyelitis). Newer studies fail to confirm the benefit of extended antimicrobial therapy, noting no increased infections with 48 h or less of antibiotic use while suggesting increased risks of long-term antibiotic prophylaxis (i.e., antimicrobial resistance and Clostridium difficile infection). There is no current role for steroids in the treatment of pSCI, and routine operative management is no longer necessarily indicated.
Cervical spondylodiscitis caused by Candida albicans in a non-immunocompromised patient: A case report and review of literature
Authors: Huang Shiwei , Kappel Ari D. , Peterson Catherine , Chamiraju Parthasarathi , Rajah Gary B. , Moisi Marc D.
Published: August 2019

Background:

Fungal cervical spondylodiscitis is rare and accounts for less than 1% of all cervical, thoracic, and lumbar vertebral osteomyelitis and discitis.

Case Description:

A 32-year-old non-immunocompromised male presented with persistent neck pain and paresthesias. The magnetic resonance imaging of the cervical spine demonstrated a contrast-enhancing erosive lesion involving the cervical C6 and C7 vertebral bodies accompanied by epidural phlegmon. Blood culture was negative. The patient underwent a C6 and C7 anterior corpectomy with instrumented fusion (e.g., expandable cage C5 to T1). Intraoperatively, frank pus was noted within the C6-C7 disc space and was accompanied by thick prevertebral and epidural phlegmon extending from C5 to T1. Intraoperative cultures grew Candida albicans. Three days later, a C6-C7 laminectomy with C4-T2 posterior instrumented fusion was performed; the cultures again grew C. albicans. The patient was treated with intravenous micafungin for 14 days followed by 6–12 months of 400 mg oral fluconazole daily.

Conclusion:

There are few cases in literature where non-immunocompromised patients developed fungal cervical spondylodiscitis. Prompt diagnosis and appropriate management are critical to effectively treat these patients. Surgical intervention may warrant corpectomy, discectomy, and operative debridement followed by long-term targeted antifungal therapy.
Rupture immediately after growth of unruptured intracranial aneurysms during follow-up
Authors: Yanagawa Taro , Harada Yoichi , Hatayama Toru , Kono Takuji
Published: August 2019

Background:

The annual rupture rate of small unruptured intracranial aneurysms (UIAs) <5 mm is generally low; further, small UIAs are often treated conservatively. While the growth of aneurysms during follow-up is associated with a high risk of rupture, the urgency for surgical treatment of asymptomatic enlarged UIAs remains controversial. We experienced two patients in whom UIAs ruptured shortly after asymptomatic growth during follow-up.

Case Description:

A 1-mm right middle cerebral artery aneurysm was incidentally found in a 63-year-old woman. Preventive surgery was planned because the aneurysm grew rapidly; however, the aneurysm ruptured preoperatively. A 68-year-old woman had a small (4 mm) aneurysm at the left internal carotid-posterior communicating artery. The aneurysm grew rapidly after many years. Several hours after magnetic resonance imaging was performed, she presented to the hospital with loss of consciousness, and a diagnosis of subarachnoid hemorrhage due to the ruptured aneurysm was made.

Conclusion:

UIAs that rapidly increase during follow-up may be regarded as impending ruptured aneurysms.
Minimally invasive lateral transpsoas approach for lumbar corpectomy and stabilization
Authors: Srikantha Umesh , Lokanath Yadhu Kasetti , Hari Akshay , Nirmala S. , Varma Ravi Gopal
Published: August 2019

Background:

Here, we present our experience with the minimally invasive (MI) transpsoas approach for lumbar corpectomy and stabilization. Transpsoas approach accesses the lumbar spine and includes both the direct lateral interbody fusion and extreme lateral interbody fusion techniques. Both procedures utilize a tubular retractor system which facilitates adequate retraction and direct visualization of the target, while supposedly reducing soft tissue trauma.

Case Description:

We evaluated two patients, one with a traumatic L2 wedge compression fracture and the other with an L3 pathological compression fracture due to multiple myeloma. Both patients underwent MI transpsoas lumbar corpectomy, anterior column reconstruction with an expandable cage, and posterior pedicle screw instrumentation to correct a kyphotic deformity. Both patients were mobilized on the 1st postoperative day and experienced significant postoperative pain relief.

Conclusion:

In two cases involving L2 and L3 compression fractures, MI transpsoas lumbar corpectomy was safely performed, with reduced perioperative and postoperative morbidity. Here, the transpsoas approach also allowed for early mobilization, adequate postoperative biomechanical stability, and resulted in immediate good outcomes.
A surgical case of cerebellar tuberculoma caused by a paradoxical reaction while on therapy for tuberculosis spondylitis
Authors: Ninomiya Atsuhiko , Saito Atsushi , Ishida Tomohisa , Inoue Tomoo , Inoue Takashi , Ezura Masayuki , Suzuki Shinsuke , Uenohara Hiroshi , Tominaga Teiji
Published: August 2019

Background:

A paradoxical reaction (PR) is a phenomenon in which the primary tuberculous lesion worsens or another de novo tuberculous lesion appears while on anti-tuberculosis therapy. Here, we report a rare case of cerebellar tuberculoma caused by a PR during therapy for lumbar tuberculous spondylitis (Pott’s disease).

Case Description:

A 47-year-old male with human immunodeficiency virus seronegative was diagnosed with lumber tuberculous spondylitis (Pott’s disease) and prescribed anti-tuberculous agents. His lower back pain and inflammatory condition recovered after initiation of anti-tuberculous therapy. Two months later, he complained of headache, nausea, and staggering. Magnetic resonance images revealed a ring-enhanced lesion located at the cerebellar hemisphere extending to the vermis, which caused perifocal edema and bilateral ventriculomegaly. These findings were consistent with his symptoms of hydrocephalus. He did not have preceding clinical findings of meningitis, and a PR was suggested to cause de novo aggregation of cerebellar tuberculoma. A lesionectomy was performed, and the surgical specimen was pathologically diagnosed as a tuberculoma. He recovered well from neurological disorders after the resection.

Conclusion:

De novo formation of intracranial tuberculoma alone caused by a PR without preceding meningitis is very rare. Lesionectomy is needed for intracranial tuberculoma, which manifests as a mass effect, as well as antituberculous therapy.
Which factors predict the loss of cervical lordosis following cervical laminoplasty? A review of various indices and their clinical implications
Authors: Sharma Ravi , Borkar Sachin A. , Goda Revanth , Kale Shashank S.
Published: August 2019

Background:

Many patients undergoing laminoplasty develop postoperative loss of cervical lordosis or kyphotic alignment of cervical spine despite sufficient preoperative lordosis. This results in poor surgical outcomes.

Methods:

Here, we reviewed the relationship between multiple radiological parameters of cervical alignment that correlated with postoperative loss of cervical lordosis in patients undergoing laminoplasty.

Results:

Patient with a high T1 slope (T1S) has more lordotic alignment of the cervical spine preoperatively and is at increased risk for the loss of cervical lordosis postlaminoplasty. Those with lower values of difference between T1S and Cobb’s angle (T1S-CL) and CL-T1S ratio have higher risks of developing a loss of the cervical lordosis postoperatively. Alternatively, C2-C7 lordosis, neck tilt, cervical range of motion, and thoracic kyphosis had no role in predicting the postlaminoplasty kyphosis.

Conclusion:

Among various radiological parameters, the preoperative T1S is the most important factor in predicting the postoperative loss of the cervical lordosis/alignment following laminoplasty.
Intraoperative imaging and navigation for C1-C2 posterior fusion
Authors: Harel Ran , Nulman Maya , Knoller Nachshon
Published: August 2019

Background:

Cervical axial spine fusion is challenging as the anatomy is extremely variable, and screw misplacement can lead to severe complications. C1 lateral mass screws and C2 pedicle screws are routinely placed under either fluoroscopic guidance or imaging-assisted navigation. Here, we compared the two for axial screw placement.

Methods:

We retrospectively evaluated patients’ treated from 2011–2016 utilizing the Harm’s procedure for C1-C2 screw fixation performed under either fluoroscopic guidance (nine patients) or image-assisted O-arm navigation (five patients). The groups had similar demographic and risk factors. Variables studied included operative time, estimated blood loss (EBL), accuracy of screw placement, screw reposition rates, and reoperation rates.

Results:

The mean EBL was 555CC and 260CC, respectively (not a significant difference) utilizing fluoroscopic versus O-arm navigation. Of interest, the mean surgical duration was 27 min longer in the O-arm versus fluoroscopy group (P = 0.03). Ten C2 pedicle screws were performed using O-arm navigation. Alternatively, as 9 of 18 C2 pedicles were considered “risky” for the placement of fluoroscopic-guided pedicle screws, laminar screws were utilized. Although the accuracy rate of C1 and C2 screw placement was higher for the navigated group, this finding was not significant. Similarly, despite complications involving two unacceptably placed screws from the fluoroscopic guidance group, there were no neurological sequelae.

Conclusion:

Axial cervical spine instrumentation is challenging. Utilization of Imaging-assisted navigation increases the accuracy and safety of screw placement.
Missed thoracic myelopathy: Do not throw the hammer away yet
Authors: Shields Lisa B. E. , Iyer Vasudeva G. , Zhang Yi Ping , Shields Christopher B.
Published: August 2019

Background:

Spinal stenosis may result in myelopathy, radiculopathy, and neurogenic claudication. It is often difficult to differentiate between these conditions. A comprehensive history and physical examination and a magnetic resonance imaging (MRI) of the entire spine accurately confirm the diagnosis.

Case Description:

Here, we report a patient with low back and progressive bilateral lower extremity pain, numbness, and weakness with bowel incontinence, urinary retention, and gait abnormalities. A lumbar MRI demonstrated multilevel severe spondylosis/stenosis from L3-S1. The patient underwent a decompressive lumbar laminectomy from L3-5. However, the patient continued to experience the same symptoms postoperatively along with flexor spasms of the left leg, dystonic posturing of the left foot, hyperactive bilateral patellar and Achilles deep tendon reflexes, and a Babinski sign. An NCV of the legs revealed no lumbar radiculopathy. The thoracic MRI, however, demonstrated severe spondylosis at the T11-12 level attributed to a large synovial cyst. Following decompression/cyst resection, the patient’s symptoms partially resolved within 1 postoperative month.

Conclusion:

Spinal surgeons should be alert to the potential for overlapping symptoms/signs of thoracic myelopathy and lumbar myeloradiculopathy. If there are features of upper and lower motor neuron disease, MR scans of the entire spine are necessary before lumbar surgical decompression to identify significant cephalad surgical pathology.
Computed tomography perfusion in detecting malignant middle cerebral artery infarct
Authors: Lee Chun Lin , Kandasamy Regunath , Mohammad Raffiq Mohammed Azman Bin
Published: August 2019

Background:

Computed tomography perfusion (CTP) is an emerging modality which produces maps of time-to- peak (TTP), cerebral blood flow (CBF), and cerebral blood volume (CBV), with a computerized automated map of the infarct and penumbra. This modality provides a better evaluation of the extent of infarction, making it a potential method for assessing patients suffering from large middle cerebral artery (MCA) infarctions.

Methods:

A prospective cohort study of all patients in Hospital Kuala Lumpur, Malaysia, who presented with the clinical diagnosis of a large MCA infarction within 48 h of onset were subjected to CT brain, and CTP scans on admission and were followed up to determine the development of malignant infarction requiring surgical decompression.

Results:

CTP parameters were generally lower in patients with malignant brain infarct (MBI) group compared to the nonMBI group. The largest mean difference between the group was noted in the TTP values (P = 0.005). CTP parameters had a comparable positive predictive value (83%–90%) and high net present value (88–93). CBF with cutoff value of >32.85 of the hemisphere could accurately predict malignant infarctions in 81.4% of cases. The National Institutes of Health Stroke Scale score of more than 13.5 was also found to be able to accurately determine malignant infarct (97.6%). Functional outcome of patients based on Glasgow outcome scale was similar on discharge, however, showed improvement at 6 months during reviewed base on modified Rankin scale (P < 0.001).

Conclusion:

CTP parameters should be included in the initial evaluation of patients to predict malignant brain infarction and facilitate surgical treatment of large MCA infarctions.

Key messages:

CT perfusion parameters have an important role in predicting malignant brain infarction and should be included in the initial evaluation of patients to facilitate the early identification and surgical treatment of large middle cerebral artery infarctions, to improve patient’s prognosis.
Preparation of herbal formulation and it’s application on nanoparticles synthesis and antibacterial activity
Authors: Srijan Sunar  , Rajeshkumar S  , Anitha Roy  , Lakshmi T
Published: August 2019

Copper nanoparticles makes important progress in the area of nanotechnology and nanomedicine due to their good optical, electrical and anti-fungal/bacterial application. It is prepared using some methods such as vacuum vapour deposition, microwave irradiation methods, chemical reduction and laser ablation. The chemical reduction method is simple, inexpensive and gives a liable control of geometrical nanoparticle characteristics like size and shape. 20 millimolar of 80 ml copper sulphate prepared using double distilled water. The plant extract is added with the metal solution and was made into 100 ml solution. The synthesised nanoparticles solution is preliminarily characterized by using UV- vis-spectroscopy, 3ml of the solution is taken in curette and scanned in double beam UV-vis- spectrophotometer from 300 nm to 700 nm wavelength. The agar well diffusion method is used. Different concentration of Cu NPs was tested against Staphylococcus aureus, Streptococcus mutans (gram +), Enterococcus sp and Pseudomonas sp. The result reveals that Moringa Oleifera mediated with copper nanoparticles show effective antibacterial activity. CuNPs ex significantly higher activity with an increase in the zone of inhibition diameter. The plant extract is observed to be dark green, and the copper nanoparticles are seen to be in light greenish in colour. They can be used in toothpaste and oral medicines due to their antibacterial activity. Nanoparticles are expected to be used in future for the effective drug systems and immunity against diseases.
Portales para la comunicación estratégica de las instituciones políticas
Authors: Navarro Victoria Martínez
Published: August 2019

Este artículo es una aproximación al estudio de las fuentes de información para la comunicación estratégica de las instituciones políticas. Con este objetivo las autoras presentan a la comunidad científica el escenario de trabajo de una investigación en curso, tendente a definir la panorámica de las fuentes de información ligadas al área de relaciones informativas y comunicativas de los ministerios del Estado Español. Mediante una revisión de las sedes web de prensa se define la tipología de las fuentes, se establece el nivel de desarrollo que presentan, y se concluye en su papel de intérpretes del proyecto institucional del gobierno. Palabras clave: Fuentes de información. Evaluación de la internet. Valor estratégico de la información. Comunicación estratégica. Comunicación política.
Leitura, alfabetização em informação e biblioteca escolar
Authors: Proença Déborah
Published: August 2019

x
Sociedad de la información y educación: contextos para la actividad gerencial
Authors: Ortiz Javier Tarango , Baca Gerardo Ascencio , Jáquez Patricia Murguía , González José Refugio Romo
Published: August 2019

Comprende un análisis de los conceptos básicos sobre la sociedad de la información y sus dimensiones, de lo cual se deriva el abordaje de los ámbitos educativos considerando la propia dimensión que éstos dan al tema aquí estudiado. Pone de manifiesto la importancia de establecer una concordancia entre los propósitos de los sistemas educativos nacionales con los mercados laborales, ya que ambos representan los mecanismos de culturización de sujetos de una forma más ordenada. Finalmente, incluye un listado de herramientas metodológicas por medio de las cuales los individuos, especialmente los relacionados con la ciencia de la información, pueden contribuir de forma directa al desarrollo de la sociedad de la información y otras más, que representan las competencias generales que se deben generalizar y cuya adquisición y aplicación tienen que ver más con las habilidades naturales de los individuos.
Requisitos funcionais para registros bibliográficos - FRBR: um estudo no catálogo da Rede Bibliodata
Authors: Moreno Fernanda Passini , Medeiros Marisa Brascher Basílio
Published: August 2019

Este estudo visou perceber os reflexos do modelo FRBR em um catálogo eletrônico, através do exame dos registros bibliográficos no formato Machine Readable Cataloging (MARC), buscando sistematizar os relacionamentos entre os elementos. Por meio da análise de literatura pertinente e das características consideradas como potenciais para realizar o estudo, foram selecionados registros a partir do Catálogo Coletivo da Rede Bibliodata, caracterizando um estudo de caso. Foi utilizada a ferramenta conversora FRBR Display Tool, da Library of Congress. Complementando o estudo, houve um retorno à literatura para atingir o objetivo de sistematizar os relacionamentos, dado o relativo insucesso da ferramenta neste aspecto. As etapas analíticas englobam os registros da amostra e dos registros convertidos no documento que contém os registros modelados. Os resultados encontrados apontam para a necessidade de normalização de registros e sugere-se o uso de campos MARC de ligação para uma possível melhor visualização do potencial do modelo.
La gestión de los números internacionales de identificación de documentos:estado de la cuestión
Authors: Orenes Pilar Beltran , Usero José Ángel Martínez Usero Ángel Martínez
Published: August 2019

La gestión de los estándares de los números internacionales de identificación de documentos está teniendo una serie de consecuencias derivadas directamente del carácter público o privado de la gestión realizada y de los intereses comerciales. En este texto se hace un análisis del estado actual de las gestiones de los principales números de identificación de documentos, de cara a establecer las bases de la, a nuestro juicio, necesaria reflexión que deberían hacer las instituciones públicas para poder llevar a cabo el control bibliográfico de la producción a escala mundial.
Colaboradores
Authors: Simeão Elmira
Published: August 2019

x
Recent progress in competitive intelligence, competitive technical intelligence and knowledge management
Authors: Henri Dou
Published: August 2019

This paper discusses the role of competitive intelligence and knowledge management to create, maintain and sustain competitive advantages. The triple helix model, based on the integration of the public sector (government), business models (private corporations) and universities to promote innovation is examined. Research trends in competitive intelligence are presented. It concludes that the systematic use of the technology monitoring should support the comparison between various business models of companies that hold the market best practices and form a basis to knowledge for the decision making process and strategies development.
A informação e o conhecimento como insumo ao processo de desenvolvimento
Authors: Borges Maria Alice Guimarães
Published: August 2019

As mudanças estruturais e conjunturais, das últimas décadas do século XX, trouxeram um novo paradigma econômico, social e tecnológico, onde a informação, o conhecimento e as tecnologias da informação e da comunicação (TIC) surgem como elementos potenciais de transformação, interferindo em diferentes aspectos da vida social, econômica, educacional, cultural, política e do cotidiano do cidadão. O surgimento da Sociedade da Informação e do Conhecimento, como sucessora da Sociedade Industrial, reforçou a importância e a necessidade da informação e do conhecimento em todos os aspectos da realidade atual, constituindo-se num dos principais insumos do processo de desenvolvimento de uma nação, de uma organização e de um povo. Essa nova sociedade revela-se como paradigma norteador no cenário da crise econômica mundial, demonstrando as tendências das relações entre as nações.
A representação na arquivística contemporânea
Authors: Tognoli Natália Bolfarini
Published: August 2019

O arranjo e a descrição dos documentos de arquivo podem ser considerados os dois processos nucleares da teoria e da prática arquivística que compartilham o mesmo objetivo: representar o conhecimento arquivístico. Esta representação está baseada fundamentalmente na aplicação do princípio da proveniência e no conceito de fundo documental. O presente artigo busca discutir especificamente a descrição arquivística, em face das mudanças e propostas de uma abordagem pós-moderna da disciplina que propõe o conceito de fundo e o princípio da proveniência como norteadores conceituais e não como entidades físicas – como até o momento se supunha – no processo de representação. Para tanto, são apresentadas as perspectivas teóricas dos estudos canadenses e australianos que se apresentam na vanguarda do movimento pós-moderno, discutindo as bases teóricas da Arquivística Moderna, face à realidade dinâmica da produção documental contemporânea. Ao final, concluí-se que a abordagem pós-moderna parece ser a mais capacitada para lidar com as questões contemporâneas, uma vez que vai mais fundo nas questões sobre a representação arquivística e sua relação entre o arquivista, o contexto de criação dos documentos e o usuário.
Aprendizagem Móvel da Física: uma experiência didática sobre eletromagnetismo no Ensino Médio da rede pública do Estado do Acre
Authors: Duarte Alejandro Fonseca , Nemer Karla Leite Vilas Boas
Published: August 2019

O presente trabalho visa mostrar a viabilidade da Aprendizagem móvel no Ensino Médio, mediante a reorganização de conteúdos e procedimentos na disciplina de Física. A didática é apropriada ao desenvolvimento de outras disciplinas e da interdisciplinaridade. Demonstra-se que a Aprendizagem móvel facilita a discussão em grupo e a transformação de informação em conhecimento, habilidades na solução de problemas e no estabelecimento de nexos entre teoria, prática e vida diária. O trabalho colaborativo sob a orientação professoral é fundamental. As possibilidades estendem os espaços da escola e permitem a interação à distância em qualquer momento.