One case report of adrenal crisis with difficulty in weaning after lumbar spinal canal decompression surgery / 中华内分泌外科杂志

Adrenocortical crisis (AC) is a kind of endocrine emergency, often occurs in infection, shock, trauma, or postoperative, if the processing is not handling timely, can endanger patient's life.But as the disease is not common and the clinical symptoms are not typical,so it is easy to be misdiagnosis and missed diagnosis.This case was a "lumbar spinal canal decompression surgery" patient, who appeared postoperative confusion, oxygenation decline,and could not seperated from breathing machine, clinical manifestations were atypical.

Study of brain cortical reorganization changes preoperatively andpostoperatively in cervical spondylotic myelopathy by fMRI / 安徽医科大学学报

Objective To study cerebral cortical activation preoperatively and postoperatively in patients with cervical spondylotic myelopathy (CSM), and discuss effect of the surgery on cortical reorganization in functional recovery.Methods 19 cases with CSM intrial group underwent cervical vertebra canal decompression surgery according to clinical routine.Cases in trial group completed clinical assessment using the modified Japanese Orthopaedic Association Scores (mJOA) prior to decompression and 12 months following surgery, and underwent cerebral functional MRI and conventional MRI in the same time.19 controls also carried out cerebral functional MRI and conventional MRI.All subjects performed a finger-tapping paradigm with right hand during processing functional MRI.The imagings and data of trial group were divided into preoperative group and postoperative group in accordance with the time of completed and than analysed.Results The mJOA score of postoperative group was increased significantly (P<0.001).Cortical volume of activation (VOA) of preoperative group was significantly higher than the control group (P<0.05).VOA was lower in the postoperative group, but still significantly higher than the control group (P<0.05).The preoperative group was able to detect and activate the signal only in the left precentral gyrus.The postoperative group was able to detect and activate the signal in the l left postcentral gyrus, the premotor area and the supplementary motor area, and the right cerebral cortex could also detect a small amount of activation signal.Conclusion CSM patients undergo cerebral cortical remodeling, causing sensory and motor function activation areas to expand and shift.The changes of cortical reorganization after cervical vertebra canal decompression surgery are associated with functional recovery.The surgical treatment may promote the compensating cortical reorganization.