Analysing the effect of early acetazolamide administration on patients with a high risk of permanent cerebrospinal fluid leakage

In this study, we examined the role of early acetazolamide administration in reducing the risk of cerebrospinal fluid [CSF] leakage in patients with a high risk of permanent CSF leakage. In a randomised clinical trial, 57 patients with a high risk of permanent CSF leakage [rhinorrhea, otorrhea, pneumatocele or imaging-based evidence of severe skull-base fracture] were analysed. In the experimental group, acetazolamide, at 25 mg/kg/day, was started in the first 48 hours after admission. In the control group, acetazolamide was administered after the first 48 hours at the same dose administered to the patients in the experimental group. The following factors were compared between the two groups: duration of CSF leakage, duration of hospital stay, incidence of meningitis, need for surgical intervention and need for lumbar puncture [LP] and lumbar drainage [LD]. All of the patients in the experimental group stopped having CSF leakage less than 14 days after the first day of admission, but 6 out of 21 patients [22%] in the control group continued having CSF leakage after 14 days of admission, which was a significant difference [P=0.01]. This study showed that early acetazolamide administration can prevent CSF leakage in patients with a high risk of permanent CSF leak

Analyzing the effects of intra-operation video-clip display on hemodynamic and satisfaction of patients during lumbar discectomy under spinal anesthesia

Most neurosurgeons and anesthesiologists prefer the less invasive intervention for most surgeries; recently, the lumbar anesthesia is more popular method. In this study we have tried to distract the attention of the patients to their favorite video-clip instead of their surrounding operating room background to evaluate the hemodynamic as well as their satisfaction during the operation. 80 patients who were scheduled for an elective one level discectomy under the regional spinal anesthesia enrolled in this prospective randomized clinical trial. The patients were randomized with sealed envelope method and each envelope was randomly assigned from this set of envelops to be either in case group one [video group] or control groups two [no audio and video and only head phone on their ears] group. In all patients, systolic and diastolic blood pressure, pulse rate and SPO2 were measured and recorded in the questionnaire charts. Of the 80 patients with Lumbar disk herniation, 53 patients were male and 27 female. The mean age for all patients was 44 year. Systolic and diastolic blood pressure at the end of surgery was significantly lower in video group [P=0.045 and 0.004]. Systolic Blood pressure differences between 3[rd] and 5[th] and the end of the surgery with minute zero was significantly less in the video group. [P=0.025, 0.018 and 0.030]. Diastolic blood pressure differences between 3[rd] and 5[th] and the end of the surgery with minute zero was significantly less in the video group. [P=0.051, 0.019 and 0.15]. Pulse rate differences between first, 3[rd], 5[th] and exactly before leaving the recovery room with minute zero was significantly less in the video group. [P=0.015, 0.028, 0.030 and 0.008]. According to our study, by displaying patient's favorite video clip during the surgical intervention we could highly reduce the patient's attention to what is happening in operating room and therefore, decrease their anxiety and stress

Effects of intraoperative-intrathecal sufentanil injection on postoperative pain management after single level lumbar discectomy

For lumbar disc operation a chain of painful procedures including skin incision, muscle dissection and sometimes laminectomy should be performed. The combination of these manoeuvres results in significant post-operative pain. The standard way to reduce post-operative pain consist of intra-operative injection of local anaesthetic [Bupivicaine or Lidocaine] to the superficial tissues and intravenous, oral or rectal prescription of Opioid analgesics or other analgesics after operation, but inadequate analgesia, constipation and delayed mobilisation are frequent side effect of those treatments. The goal of this study was to reduce postoperative pain of patients which causes a reduction in analgesic consumption and eventually shortened hospital stay and acceleration in physical therapy programs and ambulation. After ethical comitte approval, patients allocated in two groups A and B. Each group consisted 30 patients which all of them underwent general anesthesia. All of operations performed by same surgeon... After discectomy and at the end of surgerybased on patients odd or even number of hospital admission, one group [group-A] received sufentanil [Iranian pharmaceutic company] 0.05/kg intrathecaly injected in surgical level and the placebo group [group-B] normal saline was injected. In recovery room when patients were sufficiently awake for pain assessment, patients were asked to score pain on the verbal pain assessment score In both groups we compaired pain scores pre and postoperativly. The total dose of opioid requirement for patients and its time after operation was recorded

Spironolactone in preventing hypokalemia following traumatic brain injury / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>Hypokalemia is a frequent complication observed after traumatic brain injury (TBI). We evaluated the effect of spironolactone on preventing hypokalemia following moderate to severe TBI.</p><p><b>METHODS</b>Patients with moderate to severe TBI, whose Glasgow Coma Scale (GCS) scores of 9-12 and less than 9, respectively, were equally randomized into intervention and control groups, matching with severity of trauma and baseline serum level of potassium. For the intervention group, we administrated spironolactone (1 mg/kg per day) on the second day of admission or the first day of gavage tolerance and continued it for seven days. No additional intervention was done for controls. Hypokalemia (mild: 3-3.5 mg/L, moderate: 2.5-3 mg/L, and severe: less than 2.5 mg/L serum K+) and other electrolyte abnormalities were compared between the two groups at the end of the intervention.</p><p><b>RESULTS</b>Sixty-eight patients (58 males and 10 females) were included with mean age equal to (33.1+/-11.8) years, and GCS equal to 7.6+/-2.8. The two groups were similar in baseline characteristics. Patients who received spironolactone were significantly less likely to experience mild, moderate, or severe hypokalemia (8.8%, 2.9%, and 0) compared with controls (29.4%, 11.7%, and 2.9%, respectively, P less than 0.05). No significant difference was observed between the two groups in the occurrence of other electrolyte abnormalities, hyperglycemia or oliguria.</p><p><b>CONCLUSION</b>Spironolactone within the first week of head injury could prevent the occurrence of late hypokalemia with no severe side effects.</p>

[Single level cervical disc herniation: guideline on when and how use anterior fusion and instrumentation]

Background: Single level cervical disc herniation causing neck pain or neurological compromise is not an uncommon affliction. Sophisticated and different techniques have been developed throughout the twentieth century and were largely successful. The main question that still remains is about the criteria for performing fusion [with or without instrumentation]

Methods: In this study we tried to use the experience of some of the neurosurgeons with at least 12 years practice on single level cervical disc herniation with anterior approach. All of the participated neurosurgeons were asked to complete our questionnaire according to their previous experiences. For completing 120 questionnaires, 148 neurosurgeons were incorporated

Results: Neurosurgeons were 51 years old averagely and have 16.9 years experience. Ten [8%] of neurosurgeons always prefer fusion with or without instrumentation and six [5%] never use fusion techniques, but 104 [87%] of neurosurgeons had their own criteria based on their experiences for performing fusion with graft and instrumentation [FGI]. Most of the participators prefer auto-graft with cage 85 [75%]

Conclusion: Most of neurosurgeons recommend FGI for the pationts under 40. In age range between 41-70, they believed it is better to consider other criteria such as job [heavier job], physical examination [especially myelopathy] and imaging findings [mild degenerative change on X-ray and signal change on spinal cord on MRI] to perform FGI

effectiveness of computed tomography scans versus magnetic resonance imaging for decision making in patients with low back pain and radicular leg pain

Low back pain [LBP] and radicular leg pain [RLP] are among the most common types of pain in human beings. Although magnetic resonance imaging [MRI] is very sensitive for diagnosis of discopathy, some factors, such as overestimation of pathology, expensiveness, unavailability, and using it for patients with cardiac pacemaker or metal foreign bodies, limit the utility. The present study is designed to evaluate the efficacy of computed tomography scan [CTS] in patients with disc herniation in each level of lumbar spine versus MRI findings at the same level. In a prospective trial, 100 consecutive patients with LBP and RLP and signs and symptoms of discopathy referred to our private clinic from September 2004 to April 2005 were studied. CTS and MRI and their data were compared level by level; i.e. CTS of the patients analyzed according to clinical signs and symptoms and compared with MRI at the same level in axial view. Thirty-two patients had clinically S1 root signs and symptoms, in all of them CTS and MRI showed disc herniation at L5/S1 level in axial view. For L5/S1 level, positive predictive value [PPV] of CTS was 100%. In upper lumbar region, CTS findings were less reliable than MRI. CTS showed the pathology at 14.2% of upper lumbar, 27.2% at L3/L4 and 46.3% at L4/L5. In nine cases with more than one level involved, CTS confirmed the diagnosis in 11.1% of the cases. MRI is the gold standard for diagnosis of lumbar disc herniation, but CTS is sensitive in 100% for L5/S1, 68% for L4/L5, 60% for L3/L4, 0% for upper lumbar discopathies and finally 78% for multilevel involvement. Therefore, the higher the level of disc herniation is, the lower the sensitivity of CTS

[Analysis of the etiology and mortality in the ICU of Kashani General Hospital of Shahrekord between 1998 until 2001]

Background and aim: the rate of mortality in an intensive care unit [ICU] is one of the most important criteria for evaluation of a hospital. In this article the moralities of the ICU of Kashani General Hospital of Shahrekord from 23 Sept 1998, until 23 Sep 2001 have been analyzed

Method: a cross-sectional survey was performed on all the patients admitted to the ICU during this period

Results: in this period 296 patients were admitted and 79 patients [27.9%] died. 35.8% of the patients were females, 60.5% were males and 3.7% were neonates. The main reasons of mortality were respiratory failure [37.9%] and brain trauma [27.8%].There was no difference between the times of death during 24 hours. Most of the patients were expired or discharged from the ICU during the first four days. Mortality was more prevalent in the patients older than 55 years and in neonates

Conclusion: more attention during the first four days of the admission to the ICU is necessary