Neurologic complications are relatively common after solid organ transplantation and affect 15%-30%of liver transplant recipients.Etiology is often related to immunosuppressant neurotoxicity and opportunistic infectio...Neurologic complications are relatively common after solid organ transplantation and affect 15%-30%of liver transplant recipients.Etiology is often related to immunosuppressant neurotoxicity and opportunistic infections.Most common complications include seizures and encephalopathy,and occurrence of central pontine myelinolysis is relatively specific for liver transplant recipients.Delayed allograft function may precipitate hepatic encephalopathy and neurotoxicity of calcineurin inhibitors typically manifests with tremor,headaches and encephalopathy.Reduction of neurotoxic immunosuppressants or conversion to an alternative medication usually result in clinical improvement.Standard preventive and diagnostic protocols have helped to reduce the prevalence of opportunistic central nervous system(CNS)infections,but viral and fungal CNS infections still affect 1%of liver transplant recipients,and the morbidity and mortality in the affected patients remain fairly high.Critical illness myopathy may also affect up to 7%of liver transplant recipients.Liver insufficiency is also associated with various neurologic disorders which may improve or resolve after successful liver transplantation.Accurate diagnosis and timely intervention are essential to improve outcomes,while advances in clinical management and extended post-transplant survival are increasingly shifting the focus to chronic post-transplant complications which are often encountered in a community hospital and an outpatient setting.展开更多
Neuraxial anaesthesia is widely used in surgical procedures;overall, epidural and intrathecal techniques. Nevertheless, several outcomes should be considered. The incidence of neurologic complications after neuraxial ...Neuraxial anaesthesia is widely used in surgical procedures;overall, epidural and intrathecal techniques. Nevertheless, several outcomes should be considered. The incidence of neurologic complications after neuraxial anaesthesia is not perfectly clear (0% - 0.08%), although there are several described cases of spinal cord ischemia. We present a case of thoracic unilateral spinal cord syndrome following lumbar spinal anaesthesia for periprosthetic knee fracture. Our patient suffered monoparesis in her left lower limb as well as decreasing of muscle strength and loss of tendon reflexes. The MNR showed left hyperintense intra-cord images from T7 to T12 attributed to spinal cord oedema and a lineal hypointensity related to minimal haematic component. What made this case surprising was the fact that spinal anaesthesia was performed between L3 and L4 and the patient did not suffer paraesthesia associated with local anaesthetic injection. She was treated with glucocorticoids, gabapentin and amitriptyline. She also was checked by physical rehabilitators, neurologists and Pain Unit physicians. We have found another case reported in the literature about thoracic cord injury after lumbar spinal puncture. In this paper, we report possible aetiologies according to a review and neurological evolution of the patient seven months later.展开更多
AIM: To compare minimally invasive(MIS) and open techniques for MIS lumbar laminectomy, direct lateral and transforaminal lumbar interbody fusion(TLIF) surgeries with respect to length of surgery, estimated blood loss...AIM: To compare minimally invasive(MIS) and open techniques for MIS lumbar laminectomy, direct lateral and transforaminal lumbar interbody fusion(TLIF) surgeries with respect to length of surgery, estimated blood loss(EBL), neurologic complications, perioperative transfusion, postoperative pain, postoperative narcotic use, and length of stay(LOS).METHODS: A systematic review of previously published studies accessible through Pub Med was performed. Only articles in English journals or published with English language translations were included. Level of evidence of the selected articles was assessed. Statistical data was calculated with analysis of variance with P < 0.05 considered statistically significant.RESULTS: A total of 11 pertinent laminectomy studies, 20 direct lateral studies, and 27 TLIF studies were found. For laminectomy, MIS techniques resulted in a significantly longer length of surgery(177.5 min vs 129.0 min, P = 0.04), shorter LOS(4.3 d vs 5.3 d, P = 0.01) and less perioperative pain(visual analog scale: 16 ± 17 vs 34 ± 31, P = 0.04). There is evidence of decreased narcotic use for MIS patients(postoperative intravenous morphine use: 9.3 mg vs 42.8 mg), however this difference is of unknown significance. Direct lateral approaches have insufficient comparative data to establish relative perioperative outcomes. MIS TLIF had superior EBL(352 mL vs 580 mL, P < 0.0001) and LOS(7.7 d vs 10.4 d, P < 0.0001) and limited data to suggest lower perioperative pain.CONCLUSION: Based on perioperative outcomes data, MIS approach is superior to open approach for TLIF. For laminectomy, MIS and open approaches can be chosen based on surgeon preference. For lateral approaches, there is insufficient evidence to find noninferior perioperative outcomes at this time.展开更多
BACKGROUND Patients undergoing liver transplantation can develop posterior reversible encephalopathy syndrome(PRES)and acute heart failure(HF)in the postoperative period.But PRES with HF caused by tacrolimus has rarel...BACKGROUND Patients undergoing liver transplantation can develop posterior reversible encephalopathy syndrome(PRES)and acute heart failure(HF)in the postoperative period.But PRES with HF caused by tacrolimus has rarely been described.CASE SUMMAR A 40-year-old female patient who had a normal preoperative cardiac and neural evaluation developed PRES with acute heart failure tacrolimus-induced after liver transplantation.The challenges associated with both diagnosis and management in the setting of a newly implanted graft are discussed.CONCLUSION Tacrolimus can induce neurotoxicity and then cardiac toxicity.Magnetic resonance imaging,echocardiography,and increased brain natriuretic peptide may be predictive of post-operative PRES with acute heart failure.Further investigations are necessary to verify this finding.展开更多
目的:采用双源CT血管造影(CT angiography,CTA)对急性A型主动脉夹层(acute type A aortic dissection,ATAAD)患者进行术前评价头颈动脉扫描的可行性及对临床治疗的指导价值。方法 :连续收集243例临床拟诊为ATAAD患者,将其分成2组:实验组...目的:采用双源CT血管造影(CT angiography,CTA)对急性A型主动脉夹层(acute type A aortic dissection,ATAAD)患者进行术前评价头颈动脉扫描的可行性及对临床治疗的指导价值。方法 :连续收集243例临床拟诊为ATAAD患者,将其分成2组:实验组(120例)患者行头顶—盆腔CTA扫描;对照组(123例)患者行胸廓入口—盆腔CTA扫描。对实验组进行图像主观质量评分并分析与手术相关的头颈血管CTA征象。比较2组患者的辐射剂量、手术方式、脑保护方式及术后ICU时间、住院时间、术后神经系统并发症(neurologic dysfunction,ND)和全因死亡率。结果:实验组头颈部血管均满足诊断。13例患者术前依照CTA提供的头颈血管阳性特征由常规单侧脑保护改为双侧脑保护。实验组的辐射剂量、术后ND、ICU时间和住院时间均少于对照组,差异有统计学意义(P<0.05)。术后全因死亡率2组相比无统计学差异(P>0.05)。结论:采用CTA对ATAAD患者进行术前头颈血管扫描是可行的,头颈动脉CTA信息可为临床提供重要依据。展开更多
目的:分析经皮椎间孔镜BEIS技术对老年腰椎间盘突出症(LDH)患者应激反应及神经功能恢复的影响。方法:选择皖南医学院第二附属医院骨科2016年6月~2020年6月84例老年LDH患者,以双盲随机抽样法分为两组(各42例),观察组采用经皮椎间孔镜BEI...目的:分析经皮椎间孔镜BEIS技术对老年腰椎间盘突出症(LDH)患者应激反应及神经功能恢复的影响。方法:选择皖南医学院第二附属医院骨科2016年6月~2020年6月84例老年LDH患者,以双盲随机抽样法分为两组(各42例),观察组采用经皮椎间孔镜BEIS技术治疗,对照组采用传统椎板开窗减压髓核摘除术(FD)治疗,对比两组手术指标、应激反应指标、视觉模拟评分量表(VAS)评分、JOA评分、并发症发生率。结果:观察组术中出血量及住院时间均优于对照组,但手术时间长于对照组(P<0.05)。观察组术后3 d血清ACTH、INS、Cor水平均低于对照组,差异有统计学意义(P<0.05)。两组术后3 d VAS评分均低于术前,而JOA评分均高于术前;且观察组评分优于对照组,差异有统计学意义(P<0.05)。观察组并发症发生率(2.38%)虽低于对照组(16.67%),但差异无统计学意义(P>0.05)。结论:经皮椎间孔镜BEIS技术治疗老年LDH虽然手术时间较长,但术后应激反应、疼痛感较轻,神经功能恢复良好,并发症少,值得借鉴。展开更多
文摘Neurologic complications are relatively common after solid organ transplantation and affect 15%-30%of liver transplant recipients.Etiology is often related to immunosuppressant neurotoxicity and opportunistic infections.Most common complications include seizures and encephalopathy,and occurrence of central pontine myelinolysis is relatively specific for liver transplant recipients.Delayed allograft function may precipitate hepatic encephalopathy and neurotoxicity of calcineurin inhibitors typically manifests with tremor,headaches and encephalopathy.Reduction of neurotoxic immunosuppressants or conversion to an alternative medication usually result in clinical improvement.Standard preventive and diagnostic protocols have helped to reduce the prevalence of opportunistic central nervous system(CNS)infections,but viral and fungal CNS infections still affect 1%of liver transplant recipients,and the morbidity and mortality in the affected patients remain fairly high.Critical illness myopathy may also affect up to 7%of liver transplant recipients.Liver insufficiency is also associated with various neurologic disorders which may improve or resolve after successful liver transplantation.Accurate diagnosis and timely intervention are essential to improve outcomes,while advances in clinical management and extended post-transplant survival are increasingly shifting the focus to chronic post-transplant complications which are often encountered in a community hospital and an outpatient setting.
文摘Neuraxial anaesthesia is widely used in surgical procedures;overall, epidural and intrathecal techniques. Nevertheless, several outcomes should be considered. The incidence of neurologic complications after neuraxial anaesthesia is not perfectly clear (0% - 0.08%), although there are several described cases of spinal cord ischemia. We present a case of thoracic unilateral spinal cord syndrome following lumbar spinal anaesthesia for periprosthetic knee fracture. Our patient suffered monoparesis in her left lower limb as well as decreasing of muscle strength and loss of tendon reflexes. The MNR showed left hyperintense intra-cord images from T7 to T12 attributed to spinal cord oedema and a lineal hypointensity related to minimal haematic component. What made this case surprising was the fact that spinal anaesthesia was performed between L3 and L4 and the patient did not suffer paraesthesia associated with local anaesthetic injection. She was treated with glucocorticoids, gabapentin and amitriptyline. She also was checked by physical rehabilitators, neurologists and Pain Unit physicians. We have found another case reported in the literature about thoracic cord injury after lumbar spinal puncture. In this paper, we report possible aetiologies according to a review and neurological evolution of the patient seven months later.
文摘AIM: To compare minimally invasive(MIS) and open techniques for MIS lumbar laminectomy, direct lateral and transforaminal lumbar interbody fusion(TLIF) surgeries with respect to length of surgery, estimated blood loss(EBL), neurologic complications, perioperative transfusion, postoperative pain, postoperative narcotic use, and length of stay(LOS).METHODS: A systematic review of previously published studies accessible through Pub Med was performed. Only articles in English journals or published with English language translations were included. Level of evidence of the selected articles was assessed. Statistical data was calculated with analysis of variance with P < 0.05 considered statistically significant.RESULTS: A total of 11 pertinent laminectomy studies, 20 direct lateral studies, and 27 TLIF studies were found. For laminectomy, MIS techniques resulted in a significantly longer length of surgery(177.5 min vs 129.0 min, P = 0.04), shorter LOS(4.3 d vs 5.3 d, P = 0.01) and less perioperative pain(visual analog scale: 16 ± 17 vs 34 ± 31, P = 0.04). There is evidence of decreased narcotic use for MIS patients(postoperative intravenous morphine use: 9.3 mg vs 42.8 mg), however this difference is of unknown significance. Direct lateral approaches have insufficient comparative data to establish relative perioperative outcomes. MIS TLIF had superior EBL(352 mL vs 580 mL, P < 0.0001) and LOS(7.7 d vs 10.4 d, P < 0.0001) and limited data to suggest lower perioperative pain.CONCLUSION: Based on perioperative outcomes data, MIS approach is superior to open approach for TLIF. For laminectomy, MIS and open approaches can be chosen based on surgeon preference. For lateral approaches, there is insufficient evidence to find noninferior perioperative outcomes at this time.
文摘BACKGROUND Patients undergoing liver transplantation can develop posterior reversible encephalopathy syndrome(PRES)and acute heart failure(HF)in the postoperative period.But PRES with HF caused by tacrolimus has rarely been described.CASE SUMMAR A 40-year-old female patient who had a normal preoperative cardiac and neural evaluation developed PRES with acute heart failure tacrolimus-induced after liver transplantation.The challenges associated with both diagnosis and management in the setting of a newly implanted graft are discussed.CONCLUSION Tacrolimus can induce neurotoxicity and then cardiac toxicity.Magnetic resonance imaging,echocardiography,and increased brain natriuretic peptide may be predictive of post-operative PRES with acute heart failure.Further investigations are necessary to verify this finding.
文摘目的:采用双源CT血管造影(CT angiography,CTA)对急性A型主动脉夹层(acute type A aortic dissection,ATAAD)患者进行术前评价头颈动脉扫描的可行性及对临床治疗的指导价值。方法 :连续收集243例临床拟诊为ATAAD患者,将其分成2组:实验组(120例)患者行头顶—盆腔CTA扫描;对照组(123例)患者行胸廓入口—盆腔CTA扫描。对实验组进行图像主观质量评分并分析与手术相关的头颈血管CTA征象。比较2组患者的辐射剂量、手术方式、脑保护方式及术后ICU时间、住院时间、术后神经系统并发症(neurologic dysfunction,ND)和全因死亡率。结果:实验组头颈部血管均满足诊断。13例患者术前依照CTA提供的头颈血管阳性特征由常规单侧脑保护改为双侧脑保护。实验组的辐射剂量、术后ND、ICU时间和住院时间均少于对照组,差异有统计学意义(P<0.05)。术后全因死亡率2组相比无统计学差异(P>0.05)。结论:采用CTA对ATAAD患者进行术前头颈血管扫描是可行的,头颈动脉CTA信息可为临床提供重要依据。
文摘目的:分析经皮椎间孔镜BEIS技术对老年腰椎间盘突出症(LDH)患者应激反应及神经功能恢复的影响。方法:选择皖南医学院第二附属医院骨科2016年6月~2020年6月84例老年LDH患者,以双盲随机抽样法分为两组(各42例),观察组采用经皮椎间孔镜BEIS技术治疗,对照组采用传统椎板开窗减压髓核摘除术(FD)治疗,对比两组手术指标、应激反应指标、视觉模拟评分量表(VAS)评分、JOA评分、并发症发生率。结果:观察组术中出血量及住院时间均优于对照组,但手术时间长于对照组(P<0.05)。观察组术后3 d血清ACTH、INS、Cor水平均低于对照组,差异有统计学意义(P<0.05)。两组术后3 d VAS评分均低于术前,而JOA评分均高于术前;且观察组评分优于对照组,差异有统计学意义(P<0.05)。观察组并发症发生率(2.38%)虽低于对照组(16.67%),但差异无统计学意义(P>0.05)。结论:经皮椎间孔镜BEIS技术治疗老年LDH虽然手术时间较长,但术后应激反应、疼痛感较轻,神经功能恢复良好,并发症少,值得借鉴。
