Anterior spinal cord syndrome from a spinal epidural hematoma following removal of an epidural catheter.

PURPOSE: Spinal epidural hematoma (SEH) is a rare yet significant complication associated with neuraxial anesthesia. Here, we present the case of a 74-yr-old male who underwent open repair of an abdominal aortic aneurysm. Following the removal of an epidural catheter, the patient developed anterior spinal cord syndrome due to an SEH despite having a normal coagulation profile. CLINICAL FEATURES: This patient's neurologic presentation was marked by a loss of motor function while maintaining fine touch sensation distal to the spinal cord injury. Initial truncal computed tomography (CT) angiography failed to detect vascular compromise or diagnose the SEH. Subsequently, delayed magnetic resonance imaging (MRI) revealed a multilevel thoracic epidural hematoma, spinal cord infarction, and ischemia. Immediate surgical decompression was performed, but unfortunately, the patient had a poor outcome. CONCLUSION: Anterior spinal cord syndrome (ASCS) represents an uncommon neurologic manifestation of SEH, which is typically characterized by a triad of back pain and sensory and motor deficits. Although the initial CT scan was necessary to diagnose the postvascular surgery complication, it did not immediately detect the SEH. In cases of ASCS subsequent to thoracic epidural placement and removal, MRI is the preferred imaging modality for precise diagnosis and assessment of the need for surgical intervention. Despite adherence to anticoagulation guidelines, patients undergoing neuraxial anesthesia may face an elevated risk of developing SEH. Health care professionals should remain vigilant in monitoring for neurologic abnormalities following epidural catheter insertion or removal, particularly in the context of vascular surgery.

RéSUMé: OBJECTIF: L'hématome péridural rachidien est une complication rare mais importante associée à l'anesthésie neuraxiale. Nous présentons ici le cas d'un homme de 74 ans qui a bénéficié d'une réparation ouverte d'un anévrisme de l'aorte abdominale. Après le retrait d'un cathéter péridural, le patient a développé un syndrome médullaire antérieur dû à un hématome péridural rachidien malgré un profil de coagulation normal. CARACTéRISTIQUES CLINIQUES: La présentation neurologique de ce patient était marquée par une perte de la fonction motrice tout en conservant une sensation de toucher fine distale à la lésion médullaire. L'angiographie initiale par tomodensitométrie (TDM) n'a pas permis de détecter d'atteinte vasculaire ni de diagnostiquer un hématome péridural rachidien. Par la suite, une imagerie par résonance magnétique (IRM) retardée a révélé un hématome péridural thoracique à plusieurs niveaux, un infarctus médullaire et une ischémie. Une décompression chirurgicale immédiate a été réalisée, mais malheureusement, l'issue a été mauvaise pour le patient. CONCLUSION: Le syndrome médullaire antérieur représente une manifestation neurologique peu fréquente de l'hématome péridural rachidien, qui se caractérise généralement par une triade de maux de dos et de déficits sensoriels et moteurs. Bien que la tomodensitométrie initiale ait été nécessaire pour diagnostiquer la complication chirurgicale post-vasculaire, elle n'a pas immédiatement détecté l'hématome péridural rachidien. Dans les cas de syndromes médullaires antérieurs consécutifs à la pose et au retrait d'un cathéter péridural thoracique, l'IRM est la modalité d'imagerie privilégiée pour un diagnostic précis et une évaluation de la nécessité d'une intervention chirurgicale. Malgré le respect des directives d'anticoagulation, les patient·es bénéficiant d'une anesthésie neuraxiale peuvent faire face à un risque élevé de développer un hématome péridural rachidien. Les professionnel·les de la santé doivent demeurer vigilant·es dans le monitorage des anomalies neurologiques à la suite de l'insertion ou du retrait d'un cathéter péridural, en particulier dans le contexte d'une chirurgie vasculaire.

Treatment of chronic musculoskeletal pain with electron modulation procedure.

Aim: To assess the efficacy of the electron modulation procedure (EMP) in reducing chronic musculoskeletal pain acutely over distinct anatomical areas. Materials & methods: We performed a retrospective analysis of 223 patients who received a single EMP treatment for various chronic musculoskeletal pain issues. Pain levels, recorded before and after receiving EMP, were analyzed at distinct anatomical musculoskeletal areas. Results & conclusion: The effect of the EMP treatments in reducing musculoskeletal pain was statistically significant at the 5% level. Those with hip/gluteal and ankle pain had the highest (92%) and lowest (58%) pain elimination rate, respectively. Statistical evidence supported the idea that EMP treatment can quickly reduce musculoskeletal pain. Distinct anatomical musculoskeletal areas responded differently to EMP treatment.

The physiology of Venezillo arizonicus: water balance and the cuticular water barrier.

This study investigated the water balance physiology of Venezillo arizonicus, a land isopod endemic to the Southwest Desert Ecoregion of North America. Evaporative water losses were measured in two ways: gravimetric in dry air, and by perfusing animals with dry air in a respirometry chamber and monitoring downstream relative humidity (RH). The respective mean loss flux estimates were 0.140 and 0.177 µg h-1 cm-2 Pa-1, lower than other N. American Oniscidea described to date (≥0.491 µg h-1 cm-2 Pa-1). Humidity monitoring revealed intermittent sharp peaks in RH, attributed to the release of maxillary urine. Whole-animal flux increased as a function of temperature, with a critical temperature (Tc) between 38 and 42 °C identifiable by a clear Arrhenius break point. Hexane-rinsed whole animals yielded straight-chain, saturated hydrocarbons (C21-C33). The surface density of extracted alkanes (0.64 µg cm-2) was somewhat higher than previously determined values for mesic species, although modest compared to insects and arachnids. Dehydrated animals exposed to high RH (>88%) demonstrated active water vapor absorption (WVA) like other Crinocheta, with an extrapolated uptake threshold of approximately 85% RH (Aw = 0.85), the lowest value reported for Oniscidea. The maximum uptake flux increased linearly as a function of ambient RH. Mass-specific uptake in 100% RH was 49% d-1, similar to values determined previously for Armadillidium vulgare and Porcellio scaber. The low WVA threshold of V. arizonicus, and the species' low permeability, are consistent with its known range in the arid desert southwest and the desiccation stress of its typical aeolian sand and seasonal wash habitats.

Nitrogen excretion during marsupial development in the terrestrial isopod Armadillidium vulgare.

Marsupial embryos of Armadillidium vulgare (Isopoda: Oniscidea) were collected at different stages of development and assayed for products of nitrogen excretion. Stages were classified as early stage one, late stage one (clear embryo and somite differentiation), early stage two (chorion shed, prior to blastokinesis), late stage two (following blastokinesis), and mancae (vitelline membrane shed; second embryonic molt). Stage one and stage two embryos were primarily ammonotelic. Mancae showed a significant increase in stored uric acid and decrease in ammonia production, in most cases to undetectable levels. The increased metabolic rate of mancae, and the fact that they imbibe marsupial fluid prior to exiting the marsupium, may have favored a switch from ammonotely to uricotely to avoid ammonia toxicity. Protein metabolism, estimated from ammonia production, accounted for 7% of the measured catabolic rate in Stage 2 embryos. Newly emerged juveniles showed a >2-fold increase in metabolism relative to mancae, accompanying the transition from aquatic to aerial respiration. Following 48 h post-emergence, juveniles resumed ammonia excretion, volatilizing the base (NH3) as in later instars. Elevated ammonia excretion in early juveniles may derive from the catabolism of remaining yolk protein. A sharp increase in whole-animal glutamine in juveniles is consistent with its role as an intermediary nitrogen store during periodic ammonia excretion. Total ammonia concentration in the marsupial fluid fluctuated but did not increase significantly over time and ammonia was not volatilized across the oostegites, indicating that embryo ammonia is transported into the maternal hemolymph for excretion.