Yu-Duan Tsai

Sacroiliac Joint Pain after Lumbar and Lumbosacral Fusion: Findings Using Dual Sacroiliac Joint Blocks

OBJECTIVE The present study was performed to ascertain whether sacroiliac joint (SIJ) pain represents a potential source of pain in patients who have undergone lumbar or lumbosacral fusions. DESIGN Prospective cohort study. PATIENTS AND METHODS Between June 2007 and June 2009, 130 patients who underwent lumbar or lumbosacral fusions were evaluated for SIJ pain. Fifty-two patients for whom positive findings were obtained on at least three of the provocating tests for SIJ pain were selected to receive dual diagnostic blocks. OUTCOME MEASURES A positive response was defined as characteristic pain reduction of 75% for 1-4 hours following the SIJ blocks. Predictive factors for a positive response to the SIJ blocks were also investigated. RESULTS Among the 52 patients, 21 were considered to have SIJ pain on the basis of two positive responses to diagnostic blocks. Univariate analysis revealed that the predictive factors related to positive responses were unilateral pain (P = 0.002), more than three positive responses to provocating maneuvers (P = 0.02), and postoperative pain with characteristics different from those of preoperative pain (P = 0.04). CONCLUSIONS SIJ pain is a potential source of pain after lumbar and lumbosacral fusion surgeries. Provocating SIJ maneuvers represent reliable tests for SIJ pain. The characteristics of postoperative SIJ pain frequently differ from those of preoperative pain.

Post-neurosurgical nosocomial bacterial meningitis in adults: microbiology, clinical features, and outcomes

The clinical data of 62 adult patients who suffered post-neurosurgical nosocomial bacterial meningitis, retrospectively collected over a 16-year period, were studied. Cases were divided into two groups based on the date of presentation, the first period being 1986-1993 and the second 1994-2001. Fever and progressive consciousness disturbance were the most consistent clinical features - signs that may also be attributed to other postoperative neurosurgical problems. The common pathogens included Staphylococcus aureus, coagulase negative Staphylococcus, Pseudomonas aeruginosa, Escherichia coli, and Acinetobacter baumannii. An increase in polymicrobial infections and multi-antibiotic resistance during the second period was identified. In the first half of the study, mortality was 22%, and in the second half 36%. Adult post-neurosurgical nosocomial bacterial meningitis has become an important clinical problem. The choice of appropriate empirical antibiotics is challenging and must be guided by an awareness of the relative frequency of various pathogens and the increasing incidence of resistant strains. Although high mortality rates may, in part, be related to the primary brain pathology, early diagnosis and the timely use of antibiotics based on antimicrobial susceptibility testing are essential for survival.

Pulsed Radiofrequency Lesioning of the Suprascapular Nerve for Chronic Shoulder Pain : A Preliminary Report

OBJECTIVE Chronic shoulder pain is difficult to treat, and the efficacy of most interventions is limited. This study was conducted to evaluate pulsed mode radiofrequency (PRF) lesioning of the suprascapular nerve for treating chronic shoulder pain. Interventions. Thirteen procedures using PRF lesioning of suprascapular nerve were performed under fluoroscopic guide in 11 patients (13 shoulder joints) with chronic shoulder pain for at least 3 months. OUTCOME MEASURES The patients were evaluated for pain, shoulder disability function, and medication requirements prior to and after treatment. RESULTS At 1-month follow-up assessment, 10 (76.9%) shoulder joints had significant pain relief (visual analog scale >or= 50% reduction), and at 6-month follow-up assessment, nine (69.2%) still had significant pain relief. The mean VAS score of 11 patients before PRF was 7.5 +/- 1.0, and the scores at 1-month and 6-month follow-up were 2.8 +/- 2.6 and 2.5 +/- 2.8, respectively. A significant pain reduction (P < 0.001) was observed. The mean Shoulder Pain and Disability Index scores at 6-month follow-up also showed a significant decrease compared with pre-PRF (P < 0.001). Medication requirements were evaluated 1 month and 6 months after the PRF. Nine (81.8%) patients had their medication requirement decreased. CONCLUSIONS Pulsed mode radiofrequency lesioning to suprascapular nerve is a potential treatment option for patients suffering chronic shoulder pain. It provides long-lasting pain relief and decreases pain medication requirements.

Pretreatment circulating monocyte count associated with poor prognosis in patients with oral cavity cancer

The purpose of this study was to investigate whether the pretreatment total and differential leukocyte counts can predict the prognosis of patients with oral cavity cancer.

Multiloculated pyogenic brain abscess: experience in 25 patients.

OBJECTIVE To report our experience in treating multiloculated pyogenic brain abscess and determine whether there are differences in the bacteriology, predisposing factors, treatment choices, and outcomes between multiloculated and uniloculated brain abscesses. METHODS We studied clinical data collected during a 16-year period from 124 patients with pyogenic brain abscess, including 25 cases of multiloculated abscess. RESULTS The incidence of multiloculated brain abscess was 20%. In these 25 patients, hematogenous spread from a remote infectious focus was the most common cause of infection, as it was for the cases of uniloculated abscess. Headache and hemiparesis were the most common symptoms in patients with multiloculated abscess. In patients with uniloculated abscess, fever was the most common symptom. Viridans streptococci were the most commonly isolated pathogens. Bacteroides fragilis was the most common anaerobe in multiloculated abscess, and aerobic gram-negative bacilli were the most common pathogens in patients with uniloculated abscess. Of the patients with multiloculated abscess, 21 were treated surgically and 4 were treated with antibiotics only. Overall, eight patients (38%) needed another operation because of abscess recurrence after the initial operation. In uniloculated abscess, the rate of abscess recurrence after initial surgery was 13.1%. Mortality was 16% in multiloculated abscess and 17.1% in uniloculated abscess. CONCLUSION Multiloculated abscesses accounted for 20% of our patients with pyogenic brain abscess. Excision seems to be the more appropriate surgical choice in multiloculated abscess. Prognosis for patients with multiloculated abscess can be as good as that for patients with uniloculated abscess. However, clinicians must carefully monitor these patients because the possibility of recurrence after surgery is significantly higher in patients with multiloculated abscess than in those with uniloculated abscess.

Percutaneous Vertebroplasty Improves Pain and Physical Functioning in Elderly Osteoporotic Vertebral Compression Fracture Patients

Background: Osteoporotic vertebral compression fractures are being recognized increasingly often in the elderly. They frequently cause severe and prolonged back pain and physical decline. Bed rest, narcotic analgesia, and external bracing were the only therapeutic modalities available in the past and had limited success. Objective: The purpose of our study was to determine the efficacy of percutaneous vertebroplasty in treating osteoporotic vertebral compression fractures in the elderly. Methods: Twenty-two vertebroplasties were performed in 16 elderly patients. Pain relief, medication requirements, and physical functioning were evaluated before and 24 h and 6 months after vertebroplasty. Results: There was 81% improvement in pain intensity 24 h after operation, and 94% improvement was noted at the 6-month follow-up checkup. Physical functioning improved 69% 24 h after vertebroplasty and 63% 6 months later. Medication requirements also decreased in 75% of the patients. Conclusion: Percutaneous vertebroplasty for osteoporotic vertebral compression fractures is safe and effective and should not be withheld from the elderly.

Anterior spinal artery syndrome following vertebroplasty: a case report.

Study Design. Case report. Objective. To report a rare case of anterior spinal cord syndrome caused by a cement embolism in the anterior spinal artery after vertebroplasty. Summary of Background Data. Vertebroplasty is commonly performed for the management of pain associated with benign compression fractures, multiple myelomas, lymphomas, vertebral metastatic lesions, and hemangiomas. Here, we describe a severe complication associated with this procedure; a similar complication has not been reported previously. Methods. A 63-year-old woman suffered from persistent severe back pain that radiated to both sides of the chest wall 1 week before medical consultation. Magnetic resonance imaging analysis of the thoracolumbar spine revealed a pathologic fracture in the body of the T9 and T10 vertebrae, with retropulsion into the spinal canal and compression of the spinal cord at the T10 level. We performed decompressive laminectomy of the T9–10 vertebrae with tumor biopsy and vertebroplasty. Results. Immediately after the operation, the patient experienced paraplegia and loss of sensitivity to pain/temperature; however, deep pressure sensation and 2-point discrimination below the umbilicus (T10 level) were preserved. Computed tomography scans showed the presence of PMMA in T9 and T10, with opacification of the paravertebral vessels, the left intercostal artery at the T10 level, and a segment of the anterior spinal artery at the T10–11 level. Conclusion. We present the first report describing a case of anterior spinal cord syndrome caused by a cement embolism in the anterior spinal artery after vertebroplasty. The severity of this complication warrants that surgeons should inform patients of the same while obtaining their consent for vertebroplasty.

Risk Factors of Subsequent Vertebral Compression Fractures After Vertebroplasty

OBJECTIVE To elucidate the risk factors for a subsequent vertebral compression fracture following percutaneous vertebroplasty, we analyzed the potential predictors of vertebral compression fractures adjacent to or remote from fractures previously treated with percutaneous vertebroplasty. DESIGN This is a retrospective cohort study. BACKGROUND A major concern after percutaneous vertebroplasty in patients with osteoporosis is the occurrence of subsequent vertebral compression fractures in the untreated vertebral bodies. The risk factors for the development of subsequent vertebral compression fractures after percutaneous vertebroplasty are unclear. METHODS Two hundred four consecutive patients underwent percutaneous vertebroplasty for acute vertebral compression fractures between January 2007 and December 2008. Forty-nine patients were excluded. Subsequent vertebral compression fractures were diagnosed by bone edema changes on magnetic resonance imaging. Patients demographic data were used for univariate and multivariable binary logistic regression analyses. RESULTS Forty-three (27.7%) of the 155 patients had subsequent vertebral compression fractures within 2 years of percutaneous vertebroplasty, with 21 (48.8%) of these patients having fractures detected within 3 months. Adjacent vertebral compression fractures tended to occur sooner, although not significantly (log-rank test, P = 0.112). On multivariate analyses, only the T-score of bone mineral density was significantly associated with subsequent vertebral compression fractures (P < 0.0001; odds ratio = 0.27; 95% confidence interval, 0.15-0.49). CONCLUSIONS The only risk factor significantly associated with subsequent vertebral compression fractures following percutaneous vertebroplasty was a low bone mineral density T-score. Patients with lower bone mineral density have a higher incidence of vertebral compression fractures and thus need more intensive clinical and radiological follow-up.

Contralateral subdural effusion related to decompressive craniectomy performed in patients with severe traumatic brain injury

BACKGROUND Contralateral subdural effusion caused by decompressive craniectomy (DC) is not uncommon. However, it has rarely been reported. METHOD From 2004 to 2008, 123 severe traumatic brain injury (TBI) patients were identified as having undergone DC for increased intracranial pressure (IICP) with or without removal of a blood clot or contused brain. Of these 123 patients, nine developed delayed contralateral subdural effusion. Demographics, clinical presentations, treatment and outcome were reported. RESULTS The overall incidence of contralateral subdural effusion was 7.3%. On average, this complication was found 23 days after DC. Of the nine patients, six had neurological deterioration and received drainage through a burr hole. One patient needed a subsequent subduro-peritoneal shunting because of recurrent subdural effusion. CONCLUSION Contralateral subdural effusions may be not uncommon and need more aggressive treatment because of their tendency to cause midline shift. Surgical intervention may be warranted if the patients develop deteriorating clinical manifestations or if the subdural effusion has an apparent mass effect.

Simvastatin Combined with Antioxidant Attenuates the Cerebral Vascular Endothelial Inflammatory Response in a Rat Traumatic Brain Injury

Traumatic brain injury (TBI) leads to important and deleterious neuroinflammation, as evidenced by indicators such as edema, cytokine production, induction of nitric oxide synthase, and leukocyte infiltration. After TBI, cerebral vascular endothelial cells play a crucial role in the pathogenesis of inflammation. In our previous study, we proved that simvastatin could attenuate cerebral vascular endothelial inflammatory response in a rat traumatic brain injury. This purpose of this study was to determine whether simvastatin combined with an antioxidant could produce the same effect or greater and to examine affected surrogate biomarkers for the neuroinflammation after traumatic brain injury in rat. In our study, cortical contusions were induced, and the effect of acute and continuous treatment of simvastatin and vitamin C on behavior and inflammation in adult rats following experimental TBI was evaluated. The results demonstrated that simvastatin combined with an antioxidant could provide neuroprotection and it may be attributed to a dampening of cerebral vascular endothelial inflammatory response.