Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Minimally invasive modalities have demonstrated efficacy in the treatment of neurogenic claudication. Direct comparisons, however, between complication rates of these newer techniques with open surgical techniques for lumbar decompression are lacking. This single-institution study examined neurogenic claudicants between August 2007 and June 2009. ⋯ Morbidity was divided into major and minor categories as defined by degree of requisite intervention and adverse impact on hospital stay. Average age, number of surgical levels, and pre-operative American Society of Anesthesiologists Physical Status Index scores were similar in each group (p>0.05). While minimally invasive surgery may be associated with slightly longer operative times, there is decreased blood loss, shorter hospital stays, and likely decreased requirements for ancillary support services upon discharge.
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Studies have shown that spinal cord stimulation (SCS) can reduce chronic pain by at least 50% over prolonged periods, improve function and quality-of-life, reduce requirements for healthcare resources and enable return to work in appropriately selected patients. However, SCS does not provide pain relief in all patients and is an expensive, labor intensive and invasive procedure with complications and ongoing management that requires specialists with specific skills and judgment. ⋯ The aim of the article is to provide a clinical practice guide to the likely effectiveness of SCS in treating various types of chronic pain, as supported by the literature. The article will summarize indications and contraindications for SCS, provide guidance on the selection and timing for referral, and highlight the benefits and complications associated with the procedure.
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Review
Current status of computational fluid dynamics for cerebral aneurysms: the clinician's perspective.
The ultimate management goal for unruptured intracranial aneurysms is to select the aneurysms at risk of rupture and treat them. Computational fluid dynamics (CFD) utilizes mechanical engineering principles to explicate what occurs in tubes (vessels) and bulges (aneurysms). CFD parameters have been related to the biological processes that occur in the aneurysm wall, and models have been developed to predict the risk of aneurysm rupture. ⋯ All relevant articles were then reviewed by a vascular neurosurgeon, who found that the hemodynamic parameters of wall shear stress (WSS), WSS gradient, inflow jet, impingement zone, and aneurysm inflow-angle (IA) lack the predictive values required for clinical practice. CFD study can now be simulated and reproduced in a simple and fast analysis of steady, non-pulsatile flow with phase contrast magnetic resonance-derived volumetric inflow rate but the key question of whether a patient-specific CFD model can predict the rupture risk of unruptured intracranial aneurysms remains to be determined in future studies incorporating multivariate analysis. CFD models will become available for routine clinical practice as the computational power of computers further improves.
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The present study investigates the histological alterations and expression of matrix metalloproteinase 9 (MMP-9) in disc specimens of 43 patients who underwent surgery for lumbar disc herniation. The immunostaining for MMP-9 was evaluated semi-quantitatively. Histologic degeneration was scored between 0 and 12 depending on the degree of chondrocyte proliferation and presence of tears and clefts, granular changes and mucous degeneration. ⋯ MMP-9 expression was related to histologic degenerative score in all age groups (p=0.0065). MMP-9 was also related to herniation grade in patients younger than 30 years of age (p=0.0037). No significant association was found between MMP-9 expression and herniation grade in patients who were 30-60 years or over 60 years of age.
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The aims of this study were to assess the clinical characteristics of myasthenic crisis after thymectomy (MCAT) and to identify predictors affecting the occurrence of MCAT. Of 66 patients with myasthenia gravis (MG), MCAT occurred in 20 patients (30.3%). The median time interval from thymectomy to MCAT was 3.4 months. ⋯ However, a history of MCBT was the only independent factor affecting the occurrence of MCAT on multivariate logistic regression analysis (odds ratio, 17.9; 95% confidence interval, 4.019-79.873; p<0.001). Thus, the occurrence of MCAT may be correlated only with a history of MCBT rather than with factors reflecting perioperative clinical severity. MG patients with a history of MCBT are more susceptible to MCAT, particularly within the first 6 months of thymectomy.