Suprapiamadre: Análisis Etimológico y Propuesta Terminológica para la Cuarta Meninge en Terminologia Anatomica, Terminologia Neuroanatomica y Terminologia Histologica / Suprapiamadre: Etymological Analysis and Terminological Proposal for the Fourth Meninge in Terminologia Anatomica, Terminologia Neuroanatomica and Terminologia Histologica

A lo largo de la historia, el conocimiento sobre las meninges ha evolucionado desde los primeros registros en el papiro de Edwin Smith hasta la actualidad, donde se ha descrito SLYM, una cuarta meninge que separa el espacio subaracnoideo en un compartimiento superficial y otro profundo, a la que se le atribuyen funciones de barrera semipermeable y de nicho de células inmunes para la vigilancia y protección del sistema nerviosos central. La FIPAT contiene un grupo de terminologías que son mundialmente aceptadas para la descripción de las estructuras del cuerpo humano, sin embargo, en Terminologia Anatomica, Ter- minologia Neuroanatomica y Terminologia Histologica, aún no se encuentra incluido el término SLYM para representar una cuarta meninge, quizás porque sea un reciente descubrimiento. El objetivo de este estudio fue sugerir un nuevo término que concuerde con los lineamientos de la FIPAT y con las reglas de Terminología Anatómica Regular (RAT) en reemplazo de SLYM, además de proponer su inclusión en Terminologia Anatomica, Terminologia Neuroanatomica y Terminologia Histologica, previa revisión y aprobación por parte del comité respectivo de la FIPAT. Se revisó el acrónimo SLYM y los elementos que lo conforman (membrana subaracnoidea de tipo linfática), desde un enfoque etimológico, este análisis estuvo acompañado de una revisión a las reglas RAT aceptadas por la FIPAT, que fueron consideradas para examinar su cumplimiento por parte del acrónimo SLYM. Se encontró que SLYM, al igual que los términos que lo componen no cumplen totalmente con las reglas RAT. El acrónimo SLYM no proporciona una descripción adecuada de la estructura que representa, lo que contradice las reglas RAT. Se propone el término Suprapiamater como alternativa, para su inclusión en Terminologia Anatomica, Terminologia Neuroanatomica y Terminologia Histologica, basado en elementos latinos que describen su ubicación y función, mejorando la precisión y claridad en la comunicación científica.

SUMMARY: Throughout history, knowledge about the meninges has evolved from the first records in the Edwin Smith papyrus to the present, where SLYM, a fourth meninge that separates the subarachnoid space into a superficial compartment and another, has been described deep, to which semipermeable barrier and immune cell niche functions are attributed for the surveillance and protection of the central nervous system. The FIPAT contains a group of terminologies that are globally accepted for the description of the structures of the human body, however, in Terminologia Anatomica, Terminologia Neuroanatomica and Terminologia Histologica, the term SLYM to represent a fourth meninge is not yet included, perhaps because be a recent discovery. The objective of this study was to suggest a new term that agrees with the FIPAT guidelines and with the Regular Anatomical Terminology (RAT) rules to replace SLYM, in addition to proposing its inclusion in Terminologia Anatomica, Terminologia Neuroanatomica and Terminologia Histologica, previously review and approval by the respective FIPAT committee. The acronym SLYM and the elements that make it up (Subarachnoid Lymphatic-like Membrane) were reviewed from an etymological approach. This analysis was accompanied by a review of the RAT rules accepted by FIPAT, which were considered to examine their compliance by the acronym SLYM. It was found that SLYM, like the terms that compose it, do not fully comply with the RAT rules. The SLYM acronym does not provide an adequate description of the structure it represents, which contradicts the RAT rules. The term suprapiamater is proposed as an alternative, for inclusion in Terminologia Anatomica, Terminologia Neuroanatomica and Terminologia Histologica, based on Latin elements that describe its location and function, improving precision and clarity in scientific communication.

Higher Concentration of Taenia Antigens in the CSF is Related to Slight Ventricle Enlargement and Periventricular Neuronal Decrease in Young Rats

Purpose Experimental models might help understand the pathophysiology of neurocysticercosis-associated hydrocephalus. The present study aimed to compare the extent of hydrocephalus and tissue damage in rats with subarachnoid inoculation of different concentrations of Taenia crassiceps cyst proteins. Methods Sixty young rats were divided into two groups: low- and high-concentration groups. The animals in the low concentration group received 0.02ml of 2.4mg/ml T. crassiceps cyst proteins while those in the high concentration group received 0.02 ml of 11.6mg/ml T. crassiceps cyst proteins. The animals underwent magnetic resonance imaging at 1, 3, and 6 months postinoculation to assess the ventricle volume. Morphological assessment was performed at the end of the observation period. Results Repeated measures of ventricle volumes at 1, 3, and 6 months showed progressive enlargement of the ventricles. At 1 and 3 months, we observed no differences in ventricle volumes between the 2 groups. However, at 6 months, the ventricles were larger in the high concentration group (median » 3.86mm3, range: 2.37­12.68) compared with the low concentration group (median » 2.00mm3, range: 0.37­11.57), p » 0.003. The morphological assessment revealed a few inflammatory features in both groups. However, the density of oligodendrocytes and neurons within the periventricular region was lower in the high concentration group (5.18 versus 9.72 for oligodendrocytes and 15.69 versus 21.00 for neurons; p < 0.001 for both). Conclusion Our results suggest that, in rats, a higher concentration of T. crassiceps cyst proteins in the subarachnoid space could induce ventricle enlargement and reduce the number of neurons within the periventricular area.

A Simple Method to Avoid Brain Shift during Neuronavigation: Technical Note

Introduction The precise identification of anatomical structures and lesions in the brain is the main objective of neuronavigation systems. Brain shift, displacement of the brain after opening the cisterns and draining cerebrospinal fluid, is one of the limitations of such systems. Objective To describe a simple method to avoid brain shift in craniotomies for subcortical lesions. Method We used the surgical technique hereby described in five patients with subcortical neoplasms. We performed the neuronavigation-guided craniotomies with the conventional technique. After opening the dura and exposing the cortical surface, we placed two or three arachnoid anchoring sutures to the dura mater, close to the edges of the exposed cortical surface. We placed these anchoring sutures under microscopy, using a 6­0 mononylon wire. With this technique, the cortex surface was kept close to the dura mater, minimizing its displacement during the approach to the subcortical lesion. In these five cases we operated, the cortical surface remained close to the dura, anchored by the arachnoid sutures. All the lesions were located with a good correlation between the handpiece tip inserted in the desired brain area and the display on the navigation system. Conclusion Arachnoid anchoring sutures to the duramater on the edges of the cortex area exposed by craniotomy constitute a simple method to minimize brain displacement (brain-shift) in craniotomies for subcortical injuries, optimizing the use of the neuronavigation system.

Inyección intratecal inadvertida de ácido tranexámico / Inadverted intrathecal injection of tranexamic acid / Injeção intratecal inadvertida de ácido tranexâmico

Resumen: Se realiza una revisión descriptiva sobre la inyección de ácido tranexámico en el espacio subaracnoideo. Se destaca que un error puede tener consecuencias catastróficas sobre el paciente, con un alto porcentaje de mortalidad. Se analizan las posibles causas que pueden llevar a la inyección errónea. Se advierte sobre la existencia de preparaciones de ácido tranexámico de similar apariencia a las de la bupivacaína de uso intratecal. Se describe el cuadro clínico de la complicación, el mecanismo de toxicidad, los tratamientos utilizados, y la evolución de los casos relatados en las referencias encontradas. Se discuten estrategias para evitar la complicación, señalando que la seguridad no debe basarse en la perfección humana, sino en medidas que dificulten cometer errores.

Summary: A descriptive review of tranexamic acid injection in the subarachnoid space is performed. A point is made that this error may have catastrophic consequences on the patient with a high percentage of mortality. Possible causes that can lead to an erroneous injection are analyzed. A warning is made about tranexamic acid preparations being similar in appearance to those of bupivacaine for intrathecal use. The study describes the clinical manifestation of this complication, the toxicity mechanism, treatments used, and the evolution of the cases reported in the references found. Strategies to avoid complications are discussed, pointing out that safety should not be based on human perfection, but on measures that make it difficult for humans to make mistakes.

Resumo: Faz-se uma revisão descritiva sobre a injeção de ácido tranexâmico no espaço subaracnóideo. Ressalta-se que é um erro que pode ter consequências catastróficas para o paciente com um elevado percentual de mortalidade. Faz-se uma análise das possíveis causas que podem levar ao uso equivocado de ácido tranexâmico devido a existência de preparações semelhantes em aparência às da bupivacaína para uso intratecal. Descreve-se o quadro clínico da complicação, o mecanismo de toxicidade, os tratamentos utilizados e a evolução dos casos relatados nas referências encontradas. Discute-se estratégias para evitar complicações, ressaltando que a segurança não deve ser baseada na perfeição humana, mas em medidas que dificultem o erro do ser humano.

Comparison among subarachnoid opioid mix for cesarean section - An observational study / Comparación de mezcla de Opioides subaracnoideos para cesárea. Estudio observacional

Abstract Introduction Classically, the local anesthetic (LA) has been combined with one lipophilic and another hydrophilic opioid for neuraxial anesthesia in cesarean section. In Colombia, the practice has been the use of morphine hydrochloride with fentanyl, but the occasional shortage of the former triggered an interest in new options. In response to the shortage of morphine in 2017-2018, a contingency plan was developed at the SES Hospital in Caldas, prefilling syringes at the hospital compounding central, with: bupivacaine, morphine and fentanyl (BMF); bupivacaine, fentanyl and hydromorphone (BFH); and bupivacaine and hydromorphone (BH). Hydromorphone has a rapid onset of action, long-lasting effect and is indicated for spinal administration in the safety data sheet; therefore, the advantages of adding fentanyl to this mix are questionable. Objective To compare the clinical analgesic efficacy at the time of the incision and during the first 12 hours after surgery. Methods An observational, analytical study was conducted, using the mixtures BMF, BFH and BH in patients receiving subarachnoid anesthesia for cesarean section. Pain was assessed at the time of the incision, as well as any adverse effects and the pain visual analogue scale over the following 12 hours. Results Of the 71 patients participating in the study, 40.9 % received BMF; 22.5 %, BFH; and 36.6 %, BH. None of the patients experienced pain at the time of the incision. There was no difference in terms of adverse effects among the three groups. The mean difference in the visual analogue scale (VAS) for postoperative pain at 3, 6 and 12 hours was lower in the groups in which hydromorphone was used. Conclusion BFH and BH combinations are comparable to the original preparation in terms of adverse effects, with the advantage of being more effective in controlling postoperative pain.

Resumen Introducción Para anestesia neuroaxial en cesárea, se ha combinado clásicamente el anestésico local (AL) con un opioide lipofílico y otro hidrofílico. En Colombia se ha usado clorhidrato de morfina con fentanilo, pero el ocasional desabastecimiento del primero despertó el interés por nuevas alternativas. En SES Hospital de Caldas se generó un plan de contingencia frente a la escasez de morfina en 2017-2018, pre llenando jeringas en su central de mezclas con: bupivacaína, morfina y fentanilo (BMF); bupivacaína, fentanilo e hidromorfona (BHF); y bupivacaína e hidromorfona (BH). La hidromorfona tiene inicio rápido de acción, efecto prolongado e indicación en ficha técnica por vía espinal, por lo tanto, las ventajas que pudiera generar la adición del fentanilo a esta mezcla son cuestionables. Objetivo Comparar la eficacia analgésica clínica al momento de la incisión y en las primeras 12 horas postoperatorias. Métodos Se realizó un estudio observacional analítico, empleando las mezclas BMF, BHF y BH en pacientes que recibieron anestesia subaracnoidea para cesárea. Se evaluó el dolor a la incisión, los efectos adversos y la escala visual análoga de dolor en las 12 horas siguientes. Resultados De las 71 pacientes del estudio, 40,9 % recibieron BMF; 22,5 %, BHF; y 36,6 %, BH. En ninguna paciente se observó dolor a la incisión. No hubo diferencia en efectos adversos entre los 3 grupos. La diferencia de medias de la escala visual analógica (EVA) para dolor postoperatorio a las 3, 6 y 12 horas, fue menor en los grupos en los que se usó hidromorfona. Conclusiones Las mezclas BHF y BH son equiparables a la preparación tradicional en cuanto a efectos adversos, con la ventaja de ser más efectivas para el control del dolor postoperatorio.

Análise de duas técnicas anestésicas no aparecimento do delirium pós-operatório de pacientes oncológicos submetidos a cirurgias de videolaparoscopia em posição de Trendelenburg / Analysis of two anesthetic techniques in the appearance of postoperative delirium of oncological patients underwent to surgeries of videolaparoscopy in Trendelenburg position

Introdução: O delirium no pós-operatório é a complicação neurológica pós-cirúrgica mais comum. A cirurgia laparoscópica, quando associada à posição de Trendelenburg (PT), traz inúmeras alterações na fisiologia e pode aumentar o risco para o aparecimento de alterações neurocognitivas. A associação de anestesia geral com bloqueio subaracnóideo permite utilizar uma dose menor de agentes anestésicos para a manutenção da anestesia e proporciona melhor controle da dor pós-operatória. Objetivos: Avaliar se o bloqueio subaracnóideo pode influenciar na incidência de delirium no pós-operatório em pacientes oncológicos após cirurgia laparoscópica em PT. Analisar outros fatores associados. Métodos: Estudo prospectivo randomizado e controlado, realizado com pacientes oncológicos submetidos a cirurgias eletivas laparoscópicas em PT. Alocamos 150 pacientes em 2 grupos: G1 - anestesia geral; G2 - anestesia geral associada ao bloqueio subaracnóideo com 15 mg de bupivacaína. Ambos os grupos receberam 50 mcg de morfina intratecal. Os pacientes foram avaliados no pós-operatório imediato até a alta hospitalar para descartar delirium no pós-operatório. Resultados: Foram avaliados 130 pacientes e a incidência de delirium no pós-operatório foi 29 (22,3%), G1 (30,8%) e G2 (13,8%). Os pacientes que receberam apenas anestesia geral apresentaram maior risco de delirium no pós-operatório do que os pacientes que receberam anestesia geral associada ao bloqueio subaracnóideo (OR 3,4 IC 1,2-9,6 p = 0,020). Os pacientes com maior risco foram aqueles com ausência de ensino superior (OR 6,2 IC 1,8-21,5 p = 0,003), idade> 65 anos (OR 3,3 IC 1,2-9,2 p = 0,017) e maior pressão de pneumoperitônio (OR 1,7 IC 1,1-2,5 p = 0,008). Conclusões: O bloqueio subaracnóideo foi associado à redução da incidência de delirium no pós-operatório em pacientes oncológicos submetidos a cirurgias eletivas laparoscópicas em PT. Ausência de ensino superior, idade avançada e maior pressão de pneumoperitônio foram outros fatores de risco identificados e associados a um aumento na incidência de delirium no pós-operatório

Background: Postoperative delirium is the most common post-surgical neurological complication. Laparoscopic surgery, when associated with Trendelenburg position, brings innumerable changes in physiology and could increase the risk for the appearance of neurocognitive changes. The association of general anesthesia with spinal anesthesia allows to use a lower dose of anesthetic agents for the maintenance of anesthesia and provides a better control of postoperative pain. Objectives: The primary outcome was to evaluate if spinal block could influence in the incidence of postoperative delirium in oncologic patients after laparoscopic surgery in Trendelenburg position. The secondary outcome was to analyze if there were factors associated. Methods: A randomized controlled trial was realized with oncologic patients underwent to elective laparoscopic surgeries in Trendelenburg position. We allocated 150 patients in 2 groups. G1 - general anesthesia; G2 - general anesthesia associated with a spinal anesthesia with 15 mg of bupivacaine. Both groups received 50 mcg of spinal morphine. Patients were evaluated in immediate postoperative until discharge from hospital to rule out neurocognitive disorders. Results: We evaluated 130 patients and the incidence of postoperative delirium was 29 (22,3%), G1 (30,8%) and G2 (13,8%). Patients who received only general anesthesia had higher risk for postoperative delirium than patients who received general anesthesia associated with spinal block (OR 3,4 CI 1,2-9,6 p=0,020). Patients at a higher risk were those with absence higher education (OR 6,2 CI 1,8-21,5 p=0,003), age > 65 years (OR 3,3 CI 1,2-9,2 p=0,017) and higher pneumoperitoneum pressure (OR 1,7 CI 1,1-2,5 p=0,008). Conclusions: Spinal block was associated with a reduced incidence of postoperative delirium with oncologic patients underwent to elective laparoscopic surgeries in Trendelenburg position. Low educational level, advanced age and higher pneumoperitoneum pressure were other risk factors identified and associated with an increase in the incidence of postoperative delirium

Pseudo-Subarachnoid Hemorrhage; Chronic Subdural Hematoma with an Unruptured Aneurysm Mistaken for Subarachnoid Hemorrhage / 대한신경손상학회지

Subarachnoid hemorrhage (SAH) usually occurs due to aneurysmal rupture of intracranial arteries and its typical computed tomography (CT) findings are increased attenuation of cisterns and subarachnoid spaces. However, several CT findings mimicking SAH are feasible in diverse conditions. They are so-called as pseudo-SAH, and this report is a case of pseudo-SAH which is misdiagnosed as aneurysm rupture accompanied by bilateral chronic subdural hematoma (cSDH). A 42-year-old male with severe headache visited our institute. Non-contrast brain CT images showed increased attenuation on basal cistern, and cSDH on both fronto-temporo-parietal convexity with midline shifting. Trans-femoral cerebral angiography was done and we confirmed small aneurysm at right M1 portion of middle cerebral artery. Under diagnosis of SAH, we planned an operation in order to clip aneurysmal neck and remove cSDH. cSDH was removed as planned, however, there was no SAH and we also couldn't find the rupture point of aneurysm. Serial follow-up CT showed mild cumulative cSDH recurrence, but the patient was tolerant and had no neurologic deficit during hospitalization. We have checked the patient via out-patient department for 6 months, there are no significant changes in volume and density of cSDH and the patient also have no neurologic complications.

Cervical Cerebrospinal Fluid Leakage Concomitant with a Thoracic Spinal Intradural Arachnoid Cyst / 대한신경손상학회지

We encountered a very rare case of spontaneous spinal cerebrospinal fluid (CSF) leakage and a spinal intradural arachnoid cyst (AC) that were diagnosed at different sites in the same patient. These two lesions were thought to have interfered with the disease onset and deterioration. A 30-year-old man presented with sudden neck pain and orthostatic headache. Diplopia, ophthalmic pain, and headache deteriorated. CSF leakage was confirmed in C2 by radioisotope cisternography, and an epidural blood patch was performed. While his symptoms improved gradually, paraparesis suddenly progressed. Thoracolumbar magnetic resonance imaging (MRI) revealed an upper thoracic spinal intradural AC, which was compressing the spinal cord. We removed the outer membrane of the AC and performed fenestration of the inner membrane after T3-4 laminectomy. Postoperative MRI showed complete removal of the AC and normalized lumbar subarachnoid space. All neurological deficits including motor weakness, sensory impairment, and voiding function improved to normal. We present a case of spontaneous spinal CSF leakage and consecutive intracranial hypotension in a patient with a spinal AC. Our report suggests that if spinal CSF leakage and a spinal AC are diagnosed in one patient, even if they are located at different sites, they may affect disease progression and aggravation.

Disappearance of Arachnoid Cyst after Burrhole Trephination: Case Series / 대한신경손상학회지

We report 3 cases of arachnoid cysts (ACs) that completely disappeared after burr hole drainage, without cyst fenestration into the subarachnoid space or cystoperitoneal shunt. The first patient was a 21-year-old female with an AC of the right cerebral convexity, found incidentally. After endoscopic AC fenestration was performed, the patient complained of persistent headache. Two-month postoperative brain imaging revealed reaccumulated AC and associated multi-stage subdural hematoma. Burr hole drainage was performed to resolve the chronic subdural hematoma (CSDH). Three months later, brain computed tomography showed that the CSDH and the AC had disappeared. The second patient was an 11-year-old male who had a history of trauma 1 month prior to presentation at the clinic. Brain magnetic resonance imaging revealed an AC in the left sylvian fissure with CSDH. We performed burr hole drainage to treat the CSDH first. Subsequently, the AC as well as the CSDH disappeared. The third case was an AC of the right parietal convexity, found incidentally. Only burr hole drainage was performed, following which, the AC disappeared. This case series shows that an AC can disappear naturally after rupture into the subdural space by trauma or the burr hole procedure.

Severe C8 or T1 Symptoms after Cervical Laminoplasty and Related Factors: Are There Any Differences between C3–C6 Laminoplasty and C3–C7 Laminoplasty?

STUDY DESIGN: Retrospective study. PURPOSE: We experienced the situation wherein some patients had new-onset pain or dysesthesia around the ring and little fingers (C8 symptom) or ulnar aspect of the forearm (T1 symptom) after cervical laminoplasty (LP). We investigated the incidence and the cause of new C8 or T1 symptoms and the clinical outcomes after C3–C6 LP or C3–C7 LP. OVERVIEW OF LITERATURE: There were some reports regarding complications after cervical LP. However, there was no report regarding C8 or T1 symptoms after cervical LP. METHODS: Among the 33 patients enrolled in this study, 11 and 22 patients were treated with C3–C6 LP and C3–C7 LP, respectively. We prospectively evaluated C8 or T1 symptoms daily postoperatively for 1 week. The distance of the posterior spinal cord shifting and posterior subarachnoid space from C2 to T1 was measured by T2-weighted midsagittal magnetic resonance imaging (MRI). We evaluated pre- and postoperative axial neck pain, Japanese Orthopaedic Association (JOA) score, and JOA score improvement rate. RESULTS: C8 or T1 symptoms occurred in five and three patients with C3–C6 LP (45.5%) and C3–C7 LP (13.6%), respectively. The distance of the posterior subarachnoid space in C3–C6 LP at C7 was significantly shorter than that in C3–C7 LP at T1 on MRI 24 hours postoperatively (p=0.0448). Postoperative axial neck pain, pre- and postoperative JOA scores, and JOA score improvement rate were not significantly different. CONCLUSIONS: The incidence of C8 or T1 symptoms in C3–C6 LP was higher than that in C3–C7 LP. C8 or T1 symptoms would be caused by the posterior fila radicularia and spinal cord impingement on the intact lower end of the lamina.

Cauda Equina Syndrome Occurred by Adhesive Arachnoiditis of the Lumbar Spine with an Unknown Cause / 대한정형외과학회잡지

Spinal adhesive arachnoiditis is an inflammation and fibrosis of the subarachnoid space and pia mater caused by infection, trauma, spinal vascular anomalies, and iatrogenic (surgery and/or puncture). Adhesive arachnoiditis develops various symptoms and signs (gait disturbances, radiating pain, paralysis, and incontinence). On the other hand, adhesive arachnoiditis associated with cauda equina syndrome has not been reported in Korea until now. The authors experienced cauda equina syndrome caused by adhesive arachnoiditis of the lumbar spine with satisfactory results following decompression. We report this case with a review of the relevant literature.

Ectopic migration of Dirofilaria immitis in a Eurasian otter (Lutra lutra) in Korea / 대한수의학회지

An 8-year-old female Eurasian otter (Lutra lutra) reared in a wetland center, died 2 h after sudden onset of astasia and dyspnea despite medical treatment. Gross examination of internal organs revealed 10 adult filarioid nematodes in the right ventricle of the heart and three between the left and right cerebral hemispheres. All nematodes were identified as Dirofilaria immitis by direct microscopy and polymerase chain reaction assay. Histopathological observation revealed multifocal hemorrhage in the cerebral subarachnoid space and focal necrosis with hemorrhagein the cerebellar parenchyma. Although rare, veterinarians should consider cerebral dirofilariasis as a differential diagnosis in unexplained neurological cases.

Superficial Siderosis with Peripheral Dizziness: Report of 2 Cases / 대한평형의학회지

Superficial siderosis (SS) of the central nervous system is a rare disease, which is caused by the accumulation of iron from the hemoglobin in the superficial layer of the brain, spinal cord, and central parts of cranial nerves. The etiology of SS is the accumulation of hemosiderin in the subarachnoid space due to chronic or repeated hemorrhage resulting in progressive and irreversible neurological dysfunction. The cause of the disease is aneurysm, trauma, tumor, and vascular malformation. In most cases, the cause of bleeding is unknown. Clinical features include sensorineural hearing loss, cerebellar ataxia, and myelopathy. Until now, magnetic resonance imaging (MRI) has only been diagnosed and there is no standardized treatment. We will investigate clinical features and MRI findings of SS disease in the central nervous system using 2 patient cases.

Establishment of a rat model of premature ejaculation with 8-OH-DPAT / 中华男科学杂志

Objective@#To explore the feasibility and practicability of establishing a rat model of premature ejaculation (PE) by injection of 8-OH-DPAT into the subarachnoid space of the lumbosacral spinal cord segments.@*METHODS@#Twenty-four male Wistar rats were equally randomized into a PE model and a blank control group. The PE model was established by injection of 8-OH-DPAT in 10 ml normal saline at 0.8 mg per kg of the body weight per day into the subarachnoid space of the lumbosacral spinal cord segments and the control rats were injected with the same volume of normal saline only, both for 4 weeks. Another 24 female Wistar rats were injected subcutaneously with benzoic acid estradiol at 20 μg to induce estrus at 36 hours before mated with the male animals. At 2 and 4 weeks, the male rats were mated with the female ones for 30 minutes each time and meanwhile observed for their mating behavior indicators, such as mount latency, intromission latency, ejaculation latency, mount frequency, intromission frequency, and ejaculation frequency.@*RESULTS@#Compared with the controls, the PE model rats showed a significantly lower ejaculation latency (［712.35 ± 36.77］ vs ［502.35 ± 46.72］ s, P0.05).@*CONCLUSIONS@#A rat model of premature ejaculation was successfully established by injection of 8-OH-DPAT into the subarachnoid space of the lumbosacral spinal cord segments, which is of great significance for further study of the mechanism of premature ejaculation.

Craniopharyngioma with Intratumoral Hemorrhage and Superficial Siderosis

Superficial siderosis of the central nervous system (CNS) is a progressive and debilitating neurological disease manifesting sensorineural hearing loss, cerebellar ataxia, and pyramidal tract signs. Chronic extravasation of blood into the subarachnoid space results in the accumulation of hemoglobin derivate in the subpial layer of the CNS, which is toxic to the neural tissues. Craniopharyngioma is a benign third ventricle tumor, which rarely presents with tumor bleeding. We report a rare case of superficial siderosis associated with craniopharyngioma with intratumoral hemorrhage in a patient with no history of prior trauma or CNS surgery.

Symptomatic Relief of Idiopathic Infratentorial Superficial Siderosis with Maintaining Supine Position

Superficial siderosis results from the deposition of hemosiderin in subpial layers of the central nervous system following hemorrhage in subarachnoid spaces. Infratentorial superficial siderosis (ISS) presents with unique clinical features including progressive hearing loss, ataxia, and myelopathy, and the most common cause of idiopathic ISS is dural abnormality. Here we report a case of idiopathic ISS with radiological findings of spontaneous intracranial hypotension, whose clinical symptoms of ISS including cerebellar dysfunction improved after supine position was maintained for 2 months.

Randomized clinical study on the analgesic effect of local infiltration versus spinal block for hemorrhoidectomy / Estudo clínico randomizado do efeito analgésico da infiltração local versus bloqueio espinal para hemorroidectomia

ABSTRACT BACKGROUND AND OBJECTIVES: Postoperative analgesia and early recovery are important for hospital discharge. The primary objective of this study was to compare the analgesic effectiveness of perianal infiltration and subarachnoid anesthesia for hemorrhoidectomy. The secondary objective was to compare time to discharge, adverse effects and complications. DESIGN AND SETTING: Randomized, prospective and comparative study at Dr. Mário Gatti Hospital. METHODS: Forty patients aged 18-60, in American Society of Anesthesiologists physical status category 1 or 2, were included. The local group (LG) received local infiltration (0.75% ropivacaine) under general anesthesia; the spinal group (SG) received subarachnoid block (2 ml of 0.5% bupivacaine). Analgesic supplementation consisted of fentanyl for LG and lidocaine for SG. Postoperative pain intensity, sphincter relaxation, lower-limb strength, time to discharge, analgesic dose over one week and adverse effects were assessed. RESULTS: Eleven LG patients (52.4%) required supplementation, but no SG patients. Pain intensity was higher for LG up to 120 min, but there were no differences at 150 or 180 min. There were no differences in the need for paracetamol or tramadol. Times to first analgesic supplementation and hospital discharge were longer for SG. The adverse effects were nausea, dizziness and urinary retention. CONCLUSIONS: Pain intensity was higher in LG than in SG over the first 2 h, but without differences after 150 and 180 min. Time to first supplementation was shorter in LG. There were no differences in doses of paracetamol and tramadol, or in adverse effects. REGISTRATION: ClinicalTrials.gov NCT02839538.

RESUMO CONTEXTO E OBJETIVO: A analgesia pós-operatória e a recuperação precoce são relevantes para a alta hospitalar. O objetivo primário deste estudo foi comparar a eficácia analgésica da infiltração perianal e da anestesia subaracnóidea para hemorroidectomia. O objetivo secundário foi comparar o tempo para alta, efeitos adversos e complicações. TIPO DE ESTUDO E LOCAL: Estudo randomizado prospectivo e comparativo, no Hospital Dr. Mário Gatti. MÉTODOS: Foram incluídos 40 pacientes com idades 18-60 anos, na categoria 1 ou 2 de status físico da Sociedade Americana de Anestesiologistas. O grupo local (LG) recebeu infiltração local (ropivacaína a 0,75%) sob anestesia geral; o espinal (SG) recebeu bloqueio subaracnóideo (2 ml de bupivacaína a 0,5%). A suplementação analgésica foi com fentanil para LG e lidocaína para SG. Foram avaliados: intensidade da dor no pós-operatório, relaxamento do esfíncter, força dos membros inferiores, tempo de alta, dose de analgésico em uma semana e efeitos adversos. RESULTADOS: Onze (52,4%) pacientes em LG necessitaram de complementação, e nenhum em SG. A intensidade da dor foi maior para LG até 120 minutos, sem diferenças em 150 ou 180 minutos. Não houve diferenças na necessidade de paracetamol ou tramadol. O tempo para a primeira complementação analgésica e a alta hospitalar foram maiores para SG. Os efeitos adversos foram náuseas, tonturas e retenção urinária. CONCLUSÕES: A intensidade da dor foi maior na LG que na SG nas primeiras 2 horas, porém sem diferenças após 150 e 180 minutos. O tempo para a primeira suplementação foi menor na LG; sem diferenças nas doses de paracetamol e tramadol e efeitos adversos. REGISTRO: ClinicalTrials.gov NCT02839538.

Eficácia e efeitos hemodinâmicos da anestesia raquidiana com ropivacaína isobárica, hipobárica ou hiperbárica em cães anestesiados com isofluorano / Efficacy and hemodynamic effects of spinal anesthesia with isobaric, hypobaric or hyperbaric ropivacaine in dogs anesthetized with isoflurane

O presente estudo objetivou avaliar a anestesia raquidiana com ropivacaína em cães alterando a baricidade do anestésico local, investigando as alterações hemodinâmicas e complicações. Foram utilizados seis cães, Beagle, 4 anos, submetidos a anestesia inalatória com isofluorano e aos tratamentos: Ghipo = anestesia raquidiana hipobárica (0,5 mL NaCl 0,9% + 0,5 mL ropivacaína 0,75%); Giso = anestesia raquidiana isobárica (0,5 mL NaCl 1,53% + 0,5 mL ropivacaína 0,75%); Ghiper = anestesia raquidiana hiperbárica (0,5 mL glicose 10% + 0,5 mL ropivacaína 0,75%). Após indução anestésica e manutenção com isofluorano, os animais foram posicionados em decúbito lateral direito para a passagem de um cateter de artéria pulmonar pela veia jugular esquerda. Após esse procedimento, a punção subaracnóide foi realizada entre L5-L6 com uma agulha espinhal 22G, seguida da administração de 1 mL de anestésico local em 1 min. Os animais foram mantidos por 60 minutos anestesiados em decúbito ventral. A FC, f, PAM, DC, PAPm e TºC apresentaram aumento progressivo em todos os grupos enquanto que a PCPm, apenas no GHIPO, aumentou ao longo de todos os momentos. O IRPT no GISO apresentou valores significativamente superiores no M1, M5 e M10 comparado aos demais grupos, exceto no M5, em que o GISO diferiu somente do GHIPER. O IRVP no GISO aumentou no M5 em comparação ao MB. Foram observados efeitos adversos como déficit motor unilateral, atonia vesical, excitação, dor aguda e quemose. De acordo com os dados obtidos no presente estudo pode-se concluir que os animais que receberam anestesia raquidiana com as soluções hiperbárica e isobárica apresentaram maior bloqueio motor comprovando que a baricidade influencia diretamente o tipo de fibra a ser bloqueada. A utilização de solução isobárica resulta em um bloqueio misto (motor e sensitivo). As alterações hemodinâmicas descritas na literatura como, bradicardia e hipotensão, não puderam ser evidenciadas neste estudo embora o volume de anestésico tenha sido baixo associado a influência dos efeitos do isofluorano. Em relação às complicações evidenciadas, sugere-se acompanhamento pós-anestésico dos animais submetidos à anestesia raquidiana a fim de que quaisquer alterações possam ser identificadas precocemente e tratadas.(AU)

The aim of the study was to assess hemodynamic changes and complications of spinal anesthesia with ropivacaine at different baricities. Six beagle dogs aged four years. The dogs were anesthetized with isoflurane and subjected to the following treatments: Ghypo = spinal anesthesia with hypobaric ropivacaine (0.5mL of 0.9% NaCl+0.5mL ropivacaine at 0.75%); Giso = isobaric spinal anesthesia (0.5mL of 0,906% NaCl+0.5mL ropivacaine at 0.75%); Ghyper = hyperbaric spinal anesthesia (0.5mL of 10% glucose+0.5mL ropivacaine at 0.75%). After induction to anesthesia and maintenance with isoflurane, animals were positioned in right lateral recumbency for pulmonary artery catheterization through the left jugular vein. Spinal anesthesia was carried out with injection of 1mL of local anesthetic using a 22G Quincke tip needle in the L5-L6 space along 1 minute. Dogs were maintained under inhalation anesthesia for 60 minutes in ventral recumbency. HR, FR, MAP, CO, mPAP and body temperature progressively increased in all groups, whereas PCWP increased only in GHYPO at all time points. The TPRI showed significantly higher values in GISO at M1, M5 and M10 compared to the other groups, except for M5, during which GISO differed only from GHYPER. The PVRI increased at M5 compared to MB in GISO. Side effects such as unilateral motor deficit, bladder atony, excitation, acute pain and chemosis were observed. The hemodynamic changes were not relevant, although inhalation anesthesia with isoflurane might have influenced the results. The changes observed in the study demonstrate that motor blockade is likely to be obtained with isobaric and hyperbaric ropivacaine, thereby confirming the influence of baricity on the type of nerve fibers on the spinal cord. The isobaric solution results in a mixed blockade (motor and sensory blockade). Hemodynamic changes such as hypotension and bradycardia were not evidenced in this study, although local anesthetics were administered in low volumes and together with isoflurane anesthesia. Regarding complications, post-anesthetic observation is warranted in order to identify and treat possible changes. Spinal anesthesia in the conditions studied did not cause hemodynamic changes in isoflurane-anesthetized dogs and is thus considered safe for routine practice, although a few complications are prone to occur.(AU)