Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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A highly selected cohort of nine women and five men (mean age±standard error of the mean, 39.6±10.2 years) with discogenic low-back pain (duration: 75.4±97.5 months) and radiculopathy due to disc herniation (duration: 9.4±11.8 months) underwent anterior microdiscectomy and ProDisc-L II arthroplasty (Synthes, Oberdorf, Switzerland) (L5/S1 in 13 patients, L4/5 in one). As reported earlier, initial results were excellent in 11 and good in three patients at 17.8±4.7 months. At an average of 6.5 years after surgery, all were reassessed using the SWISSDISC-questionnaire, which involves the EuroQol-5D and North American Spine Society evaluations (general health, low-back and lower limb status), and a telephone call. ⋯ Results were excellent for 10, good for two, satisfactory for one, and poor for one patient. Visual analog scores for back and leg pain at 6.5 years had improved significantly relative to preoperative values (p<0.01), and were only slightly higher than at 1.48 years (p=0.3). This study confirms the initial favorable results.
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Patients with spontaneous non-aneurysmal subarachnoid hemorrhage (non-aSAH) are considered to have a benign illness in contrast to patients with aSAH. The occurrence of the systemic inflammatory response syndrome has been linked to worse outcomes in patients with aSAH. We analyzed systemic interleukin (IL)-6, a proinflammatory cytokine, to determine whether its concentration differs between patients with non-aSAH and those with aSAH, reflecting the more benign illness. ⋯ A subgroup analysis revealed a higher mean IL-6 concentration in patients with non-pmSAH compared to patients with pm-SAH (p=0.001). We concluded that systemic IL-6 concentration reflects the severity of the inflammatory stress response and course of the illness. The more benign illness and good prognosis of patients with pmSAH or non-pmSAH in contrast to patients with aSAH is reflected by the lower concentrations of IL-6.
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Case Reports
Anesthesia for cerebral revascularization for adult moyamoya syndrome associated with sickle cell disease.
We report the anesthetic management of an adult patient undergoing cerebral revascularization surgery for moyamoya syndrome complicating sickle-cell disease (SCD). We present a 25 year-old male of African ethnicity with homozygous SCD who was experiencing worsening ischemic neurologic symptoms culminating in intraventricular hemorrhage from rupture of moyamoya vessels. Despite an extracranial-intracranial superficial temporal artery-middle cerebral artery bypass that was angiographically patent postoperatively, he subsequently required an intracranial omental transplant to improve cerebral blood flow to the anterior cerebral artery territory. ⋯ We conclude that the safe and efficacious operative treatment of moyamoya disease, using both direct and indirect revascularization procedures, is being increasingly described, and therefore anesthesiologists are likely to encounter similar cases in the future and need to be aware of the surgical procedures and perioperative implications. The overall principles of safe anesthesia (normotension, normocarbia, good oxygenation, normothermia, normovolemia) for patients with SCD also applies to patients with moyamoya. During a craniotomy, certain deviations from these are needed (hyperventilation and mannitol diuresis for brain volume reduction, induced hypothermia or manipulations of arterial blood pressures) but they can be safely used with careful monitoring of the patient.