Jochen Obernauer

What is new

Coming from Crimea, the spread to Western Europe and North Africa during the 1340s. From 1346 to 1352, the plague Black Death killed an estimated 25 40 of Europeans of all age-groups , . 30 to 60 of Europe population. One of the earliest and most widely – % [1 ] i.e % accepted explanations was that God was punishing humanity for their sins. One remedy for the curse was to do penitence. Thus in 1348 there rapidly arose a mass movement of flagellation . In fact flagellation could not really help against such threat. The or [2 ] Black Death is caused by , a Eubacteria discovered in 1894 by Alexandre Yersin. It is transmitted by the bite of the flea Bubonic plague Yersinia pestis . This flea lives by feeding the blood of many species besides man but its most preferred relationship is with the black Xenopsylla cheopsis rat ( ). Fossilized remains of the plague flea have been found in large numbers in Amarna, Egypt , about 1350 BC, and Rattus rattus [3 4 ] thus could be directly linked to the events described in the Book of , . During the epidemic of Bubonic plague in London in Samuel [5 6 ] 1665 1666, the known treatments were made use of, . the so-famous Theriac or Venice Treacle which is used from the time of ancient – e.g Rome as a remedy against poison . Since then, more specialized and novel treatments have been developed. However, since the [7 ] characterization of , numerous drugs have been developed against it, . gentamicin or doxycycline .. These researches Yersinia pestis e.g [8 ] had been carried out using more elaborated biochemical, biophysical and biological approaches.

A New Simplified Sonographic Approach for Pararadicular Injections in the Lumbar Spine: A CT-Controlled Cadaver Study

BACKGROUND AND PURPOSE: Injection therapies play a major role in the treatment of lower back pain and are to date performed mainly under CT or fluoroscopic guidance. The benefits of US-guided instillation procedures have been shown in many studies. We conducted this study to simplify an US-guided approach to the lumbar spinal nerves and to assess the feasibility and preliminary accuracy by means of CT and anatomic dissection. MATERIALS AND METHODS: Ten US-guided injections at 5 different levels (L1-L5) were performed on 1 embalmed cadaver. Images in 3 sagittal/parasagittal scanning planes were obtained at each lumbar level: 1) the plane of the spinous processes, 2) the plane of the lumbar arches/zygapophyseal-joints, and 3) the plane of the transverse processes. The PAP was then defined by positioning the transducer perpendicularly over the medial part of the respective transverse processes, depicting the hyperechoic intertransverse ligament. In the “in-plane technique,” spinal needles were advanced through the respective segmental intertransverse ligament. A solution consisting of a contrast agent and a pigmented dispersion was subsequently injected into the pararadicular compartment. An anatomic dissection of the specimen and CT scans were performed to verify the exact placement of the needle tips and to evaluate fluid dispersion in the punctured compartment. RESULTS: CT examination confirmed that each needle tip was correctly placed within the intended compartment with sufficient contrast accumulation around the respective proximal segment of the spinal nerve. On each anatomic section, dye was identified in the correct compartment and directly around each targeted spinal nerve with needles shown in the correct position. CONCLUSIONS: This modified US approach for therapeutic root injections in the lumbar spine by using the intertransverse ligament as a new anatomic landmark allows an easy and correct needle placement within the pararadicular compartment.

A Sandwich Technique for Prevention of Cerebrospinal Fluid Rhinorrhea and Reconstruction of the Sellar Floor after Microsurgical Transsphenoidal Pituitary Surgery.

BACKGROUND Cerebrospinal fluid (CSF) leaks are a well-known complication of transsphenoidal surgery. Several autologous and artificial grafts have been used to close the sellar floor in an attempt to prevent postoperative CSF rhinorrhea. OBJECTIVE To evaluate and describe a sandwich technique to close the sellar floor using autologous bone, absorbable gelatin sponge, and coated collagen fleece. METHODS We reviewed 50 consecutive patients between April 2010 and August 2011 who underwent transsphenoidal surgery ending with reconstruction of the sellar floor with a particular sandwich technique. Patients with an intraoperative CSF leak received an additional lumbar drain. RESULTS There were no cases of CSF rhinorrhea at postoperative follow-up after 6 weeks and no revision surgery. CONCLUSION The proposed sandwich technique for closure of the sellar floor to the sphenoid sinus is a suitable alternative to autologous grafts and seems to be effective in preventing CSF rhinorrhea.

Pedicle-Based Non-fusion Stabilization Devices: A Critical Review and Appraisal of Current Evidence

Over the last decades, spinal fusion has become one of the most important principles in surgical treatment of spinal pathologies. Despite the undoubted benefits of fusion surgery, there are several drawbacks associated with this technique, including adjacent segment degeneration and pseudoarthrosis. Based on biomechanical data, dynamic stabilization of the spine is intended to ameliorate adjacent level degeneration by stabilizing vertebral motion in defined planes and mimicking natural spine movements.In this paper, we review the literature and discuss past and present pedicle-based non-fusion dynamic stabilization devices. Although there is a paucity of high-quality prospective trials, studies have indicated both promising and disappointing results. In comparison to 360° fusion surgery, the perioperative risk seems to be lower. Other complications like screw loosening, however, have been reported with various systems, while a reduction of adjacent segment disease has not yet been demonstrated. The necessary degree of restabilization to achieve pain-free motion seems to vary greatly between patients and current systems are far from perfection. If these problems can be solved, dynamic stabilization may nevertheless be an important option of spinal surgery in the future.

Ultrasound-guided Injections in the Spine

Injection therapies play a major role in the treatment of back pain and radiculopathy and are becoming integral parts of a multidisciplinary approach in treatment and rehabilitation of pain patients. Pararadicular and facet-joint injections in the spine are preferentially performed under computed tomography or fluoroscopy guidance. In this article we present alternative, simple, and easy to learn step by step ultrasound-guided techniques for injection therapies in the cervical and lumbar spine.