Interbody fusion. is it has a rule in broken screws in surgical management of lumbar spondylolisthesis?

Background: for many years, posterolateral fixation for lumbar spondylolisthesis by using pedicle screw has been the standard procedure for lumbar spondylolisthesis. For increasing fusion and anterior support, the interbody fusion, either with cage or bone, were used by many surgeons, one of the most disappointing complications of pedicle screw fixation is broken screw

Aim: it was to compare the number of cases with a broken screw in case of interbody fusion and control group

Patients and Methods: This is retrospective cohort study in six years comparing between two groups: Group I posterolateral fixation [PLF], Group II posterolateral interbody fusion [PLIF]. it analyzed 26 cases of broken screw occurred in six years from 2010 to 2016 which were done in Nasser Institute by the same surgeon and same system

Results: twenty-six cases were reviewed, the mean age was 44.6 years, female : 6/26 [23%], male : 20/26 [77%],mean weight: 74.8 kg, site for broken screw: [L1: 4 patients - L2: 2 patients - L3: 2 patients - L4: 4 patients - L5: 6 patients - S1: 8 patients], 6 patients had broken screws following trauma, while 20 patients were found spontaneous, all patients were found intraoperatively to have posterolateral fixation, they underwent redo screw fixation,18 patients underwent redo screw fixation with posterolateral interbody fusion [PLIF] while the other 8 patients underwent redo screws fixation with posterolateral fixation. All patients with PLIF didn't come back with broken screws, while 2 patients with posterolateral fixation came back with broken screws again

Conclusion: posterolateral interbody fusion [PLIF] may have a rule in preventing broken screw in the management of lumbar spondylolisthesis

Bilateral foraminal stenosis in patient with dandy-walker malformation: hiding pathology

Background: Etiologies of hydrocephalus are many and sometimes it can be attributed to be multifactorial in origin. Presence of known cause of hydrocephalus like fourth ventricular pathology may mask foramenal stenosis. Diagnosis of unilateral and bilateral stenosis of foramen of Monro should be included in the treatment plan in hydrocephalus. A case report of a 9 months-old boy presented with delayed milestones of development and an increase in head circumference. The patient has been diagnosed as hydrocephalus and associated Dandy-Walker malformation. Ventriculoperitoneal shunt was inserted successfully but drained only one lateral ventricle. The association of isolated lateral ventricle with Dandy-Walker malformation is due to stenosis of foramen of Monro. Our case report is unique due to association between foramen occlusion and Dandy-Walker malformation

Expression of osteopontin in synovial tissue of rheumatoid arthritis: its relation to disease activity and severity

To demonstrate the expression of osteopontin in synovial tissue of patients with rheumatoid arthritis and to correlate it with disease activity and severity in order to find out its possible role in the pathogenesis of the disease. This study was conducted on 30 RA patients and 10 control subjects with post traumatic knee injury. All patients were subjected to full medical history taking, thorough clinical examination with special attention to articular manifestations [Modified disease activity score] [DAS], and spread severity index [SSI]. Laboratory investigations included: CBC, ESR, CRP and RF. Radiological investigations included: plain x-ray of the affected knee joint using Larsen's score for assessment of joint damage and expression of osteopontin [OPN] in synovial tissues of both patients and controls was determined by immunohistochemical staining of formalin fixed, paraffin embedded synovial tissues. We demonstrated by immunohistochemistry that OPN was detected as brown cytoplasmic staining expressed predominantly in the lining layer of rheumatoid synovium rather than the sublining layer and it was absent in the lymphoid aggregates. In contrast, synovial tissue of the control group showed weak scattered staining for OPN. We found a highly statistical significant difference between RA patients and controls regarding the synovial expression of OPN which was highly associated with the activity. Also, percentage of OPN positive cells was highly associated with the severity of RA assessed clinically by SSI and radiological [p<0.01]. Osteopontin is critically involved in the pathogenesis of both inflammatory and joint-destructive processes in rheumatoid arthritis. OPN may reflect disease activity and can be used as a marker of disease severity

Myxopapillary ependymoma of the filum terminale: treatment and outcome in 11 cases

Myxopapillary ependymomas are the most common primary tumours of the spinal cord, recurrence-free survival depends on local control of the tumour. The value of additional radiotherapy is still a matter of debate. The aim of this study was to analyze radiotherapy, surgery and the preoperative state with regards to recurrence rate and postoperative neurological outcome. Eleven patients with filum terminale tumours who have been operated upon and their pathology was quite uniform, of a nyxopapillary type, were included in the study. Preoperative state and neurological outcome was assessed according to the McCormick scale, total resection of the primary tumour was achieved in 6 of the 11 patients in our series [54.5%] and partial resection was achieved in 5 patients 45.5%. Adjuvant radiotherapy was administered only in 40% of patients with partial tumour resection. No recurrences occurred after macroscopic total resection and only one patient showed tumour recurrence after subtotal resection. Gross total resection of filum teminale ependymomas whenever feasible is the modality of choice in treatment of such tumours and a strong predictor in recurrence-free survival. Furthermore, Radiotherapy for partially resected myxopaillary filum ependymoma lesions does not appear to be of a beneficial effect on recurrence free survival and is more controversial. Preoperative neurological condition is the main prognostic factor for the postoperative neurological outcome and is not different for patients with totally resected tumours as compared to those with partially resected tumours

Surgical management of uniocular proptosis

Fifteen patients [five males and 10 females age range, 8- 67 years] with uniocular proptosis due to primary intracranial tumors were included in our study, we present our surgical experience in the management of these tumors as per their anatomical location within the orbit, utilizing the lateral microsurgical orbital approach and the transcranial [fronto-orbital route]. Amongst the 15 primary orbital tumors in this series eight cases were operated upon by lateral orbitotomy while, seven masses were approached by fronto-orbital transcranial approach. Complete gross total removal was achieved in 80% of the patients while subtotal resection and/or biopsy was achieved in three cases those patients had remission of proptosis in due course of time. Complications were seen in five patients and included lateral gaze palsy, worsening of vision postoperative enophthalmos

Nurses' perception and management of post operative abdominal pain among school age children

Pain defines as unpleasant sensory and emotional experience associated with actual or potential tissue damage. Many factors may distort the nurses' perception of children's pain which creates an intense need for assessing nurses' perception and management of children during post operative pain. This study aims to identify nurses' perception and management practices of children's pain after abdominal surgery. The study was conducted at the Pediatric Surgery Department at Tanta University Hospitals and Surgery Department at Damanhour National Medical Institution. Convenient sample of 90 nurses working with school age children with post abdominal surgery pain. Two tools were used to collect the necessary data. The first tool was a questionnaire sheet, which included demographic data In addition questions for assessment of nurses' perception of children's postoperative, methods used for assessment and management of children's pain. The second tool was observation checklists to assess nurses' identification of behavioral clauses of pain, nurses' performances during assessment of pain intensity and during management of post operative pain in children by pharmacological and non pharmacological measures. The present study revealed that the nurses' perception of children's postoperative pain is lacking and inadequate for providing effective nursing care for children during pain experience and children were poorly managed for postoperative pain in the studied hospitals. It can be concluded that nurses did not play any role in the decision regarding pain management just they were carrying out the physician's prescriptions. The study recommended in service training and continuing education should be provided for all nursing personnel working in the pediatric surgical department