Magnesium sulfate effect on the clinical course and GCS of patients with a severe diffuse axonal injury

Based on a number of studies, magnesium sulfate [MgSO4] given after a diffuse axonal injury has gained attention as a useful neuroprotective agent. The present study was conducted to examine if magnesium sulfate has a therapeutic efficacy and safety in patients with a severe diffuse axonal injury. Adult patients admitted within 1 hour of a closed Traumatic Brain Injury [TBI] with a severe diffuse axonal injury that met eligibility criteria were randomized into two groups. Our treatment guidelines consisted of an initial loading dose of 50 mg/kg magnesium sulfate and then 50 mg/kg QID up to 24 hours after the trauma. The outcome measures were mortality, GCS, and motor function scores which were assessed up to 2 months after the trauma. Magnesium showed a significant positive effect on GCS 2 months [P=0.03]. Among those in MgSO4 group, motor functioning score improved more than control group but this was not statistically significant [P = 0.51]. At the end, we have demonstrated that administration of magnesium sulfate can have neuroprotective role following severe DAI

Cerebral echinococcosis in children

Echinococcosis or hydatid disease is caused by the larval stage of taneia echinococcus. Brain involvement in hydatid disease occurs in 1-3% of all echinococcus granulous infections. Fifty to seventy percent of intracranial hydatid disease are seen in children and account for up to 3.9% of all intracranial space-occupying lesions. In our retrospective study, we have reviewed 15 cases of intracranial hydatid disease operated on in our hospital over a 10-year period. Presenting clinical symptoms and signs and radiological findings on computed tomography and magnetic resonance imaging [MRI] were documented. Twelve [80%] of our patients were children [7 boys and 5 girls], aged from 11 to 18 [mean 14.1 years]. Headache and vomiting due to increased intracranial pressure and papilloedema were the predominant findings in this group. Computed tomography and MRI revealed a spherical cystic lesion, isodense and iso-intense respectively to cerebrospinal fluid, with no rim enhancement or perifocal oedema. Associated systemic hydatidosis in 2 of our patients involved the liver. Extirpation of the cyst without rupture was achieved in all patients. We had no recurrence or death. Intracranial hydatid cysts should always be surgically removed without rupture. The outcome remains excellent in these cases and correct preoperative diagnosis is vital for the successful outcome of surgery. Cerebral echinococcosis should be kept in mind in the differential diagnosis of cystic lesions

Interaoperative use of epidural methylprednisolone or bupivacaine for postsurgical lumbar discectomy pain relief: a randomized, placebo-controlled trial

Many patients with lumbar disc surgery experience postoperative back and radicular pain, delaying hospital discharge and resumption of normal activity. Some surgeons have used intraoperative epidural corticosteroids and local anesthetics to decrease pain following surgery for a herniated lumbar disc. Controversies still exist regarding the benefits of these drugs. The present study was meant to compare the effects of the intraoperative administration of epidural methylprednisolone and bupivacaine with that of normal saline [placebo] in lumbar disc surgery for postoperative pain control. One hundred fifty patients with single level herniated nucleus pulposus [L4-L5 or L5-S1], which was refractory to 6 weeks of conservative management, were divided randomly in three groups. A standard hemipartial lamimectomy and discectomy was performed on all patients. At the end of the surgery, before the closure of fascia, 40 mg methylprednisolone with 3 mL normal saline for group 1, 2 mL bupivacaine 5% with 2 mL normal saline for group 2 and 4 mL normal saline for group 3 were instilled onto the epidural and exposed nerve root. Postoperative back and radicular pain intensity was assessed by a visual analogue scale [VAS] before and at 24, 48, 72, and 96 hours after surgery. There was no significant difference in back and radicular pain intensity between the three groups. Intraoperative administration of epidural methylprednisolone or bupivacaine does not relieve postoperative back and radicular pain