Long segment spinal reconstruction of C3-T1 utilizing single strut fibula free flap following debridement and corpectomy for chronic osteomyelitis.

Cervical vertebral osteomyelitis (CVO) is a complex destructive pathology that presents as a significant challenge to reconstructive surgeons. Advanced cases of CVO involving neurologic deficits, spinal column instability, or refractory infection require surgical intervention with bony debridement and decompression followed by spinal reconstruction, realignment, and stabilization. Reconstruction of the spine is typically performed through an anterior approach with or without posterior instrumentation. Restoration of the anterior spinal column can be performed with titanium or PEEK cages, allograft bone or vascularized autograft bone. Anterior spine reconstruction using vascularized osseous free flaps has been well documented in the medical literature; however, to our knowledge, we report the largest osteomyelitic anterior cervical spine defect that has been reconstructed using a single strut osseous free flap. This was a complex case of cervical osteomyelitis in a patient with prior C4-C7 anterior cervical corpectomy and fusion who presented with instrumentation failure and septicemia. Anterior column reconstruction required a vascularized fibular strut spanning six vertebral levels from C3-T1, as well as a trapezius myocutaneous pedicled flap for posterior soft tissue coverage.

A Rare Case of Cervical Charcot After Spinal Cord Injury: A Case Report.

CASE: We present a rare case of cervical Charcot disease that was diagnosed in a paraplegic patient by loss of function caudal to the original level of spinal cord injury. Clinical imaging, diagnosis, differentials, and operative management are discussed. CONCLUSIONS: Charcot disease of the cervical spine is rare and very difficult to diagnose in the paraplegic patient population. High clinical suspicion should be maintained in these patients who demonstrate any form of neurologic deterioration, mechanical instability, or change in spinal alignment. It is often necessary to rule out infection. Spinal decompression and surgical stabilization is the treatment of choice.

Variabilidad de la frecuencia cardiaca como factor predictor de las enfermedades cardiovasculares / Heart rate variability as a predictive factor of cardiovascular diseases

Resumen La variabilidad de la frecuencia cardiaca se conoce como la variación en el tiempo que transcurre entre los intervalos RR del electrocardiograma y refleja la actividad del sistema nervioso autónomo sobre la función cardiaca. Su aumento se considera un factor protector para el corazón y su medición podría ser una herramienta predictiva temprana o diagnóstica en enfermedades cardiovasculares. El sistema nervioso autónomo genera efectos inotrópicos y cronotrópicos en la función cardiaca, que pueden aumentar o disminuir esta variabilidad. Existen diversos métodos de medición de la variabilidad de la frecuencia cardiaca; el más común es el Holter seguido por el sistema POLAR, además se han desarrollado programas de software clínico (Kubios®, Sinus Core®) que han demostrado validez en estas mediciones. La variabilidad de la frecuencia cardiaca puede emplearse como factor predictor en la aparición de eventos coronarios, accidentes cerebrovasculares y muerte súbita, entre otros.

Abstract Heart rate variability is defined as the variation in time between the RR intervals of the electrocardiogram, and reflects the activity of the autonomous nervous system over cardiac function. Its increase is considered as a protective factor for the heart, and its measurement could be used as a tool for the early prediction or diagnosis of cardiovascular diseases. The autonomous nervous system generates inotropic and chronotropic effects on cardiac function, which can increase or decrease this variability. There are several methods for measuring heart rate variability. The most common is the Holter device, followed by the Polar system. Clinical computer programs have also been developed (Kubios®, Sinus Core®) that have shown to be valid in the measurements. Heart rate variability may be used as a predictive factor for the appearance of coronary events, including among others, cerebrovascular accidents and sudden death.

Attention deficit/hyperactivity disorder and medication with stimulants in young children: a DTI study.

The relationship between attention deficit/hyperactivity disorder (ADHD) and white matter connectivity has not been well established yet, specially for children under 10 years of age. In addition, the effects of treatment on brain structure have not been sufficiently explored from a Diffusion Tensor Imaging (DTI) perspective. In this study, the influence of treatment with methylphenidate in the white matter of children with ADHD was investigated using two different and complementary DTI analysis methods: Tract-Based Spatial Statistics (TBSS) and a robust tractography selection method. No significant differences were found in Fractional Anisotropy (FA) between medicated, drug-naïve patients and healthy controls, but a reduced Mean Diffusivity (MD) was found in ADHD patients under treatment with respect to both healthy controls and drug-naïve ADHD patients. Also, correlations were found between MD increases and performance indicators of ADHD. These findings may help elucidate the nature of white matter alterations in ADHD, their relationship with symptoms and the effects of treatment with psychostimulants.

Preoperative risk stratification reduces the incidence of perioperative complications after total knee arthroplasty.

The purpose of this study was to validate a screening and management protocol to identify and reduce risk of renal, pulmonary, and delirium complications. A cohort study comparing incidence of perioperative complications on a consecutive series of patients undergoing total knee arthroplasty with a historical control group was conducted. The study cohort was evaluated prospectively to identify and reduce noncardiac medical complications. Medical records were reviewed for in-hospital complications. There were 623 patients in the study cohort and 493 patients in the control population. There was a statistically significant decrease in the incidence of delirium (control, 10.4% vs study, 0.8%; P = .0001), renal (4.9% vs 0.6%, P = .0001), cardiac (16.3% vs 2.1%, P = .0001), and pulmonary complications (5.7% vs 0.8%, P = .0001) in the screened patients vs control. Preoperative screening and management for medical complications resulted in a significant decrease in renal, pulmonary, delirium, and cardiac complications.

Characterization of anatomic fiber bundles for diffusion tensor image analysis.

In this paper we deal with the problem of quantification of diffusion tensor (DT) data sets. A set of measures and a 2D tract mapping technique are proposed to analyze the fiber structures in brain white matter and to allow for comparisons between different subjects, either patients or controls. Features such as integrity, discontinuity and connectivity of the fiber bundles are proposed and analyzed, taking into account longitudinal and transverse information of the fiber bundle under study. The performance of the proposed characterization framework is shown analyzing the corticospinal tracts of control data sets and pathological cases, comparing the measures between controls and patients and also between the right and left hemispheres. A reproducibility study is also performed to show the robustness of the proposed measures.

Molecular architecture of glycinergic synapses.

Synapses can be considered chemical machines, which are optimized for fast and repeated exocytosis of neurotransmitters from presynaptic nerve terminals and the reliable electrical or chemical transduction of neurotransmitter binding to the appropriate receptors in the postsynaptic membrane. Therefore, synapses share a common repertoire of proteins like, e.g., the release machinery and certain cell adhesion molecules. This basic repertoire must be extended in order to generate specificity of neurotransmission and allow plastic changes, which are considered the basis of developmental and/or learning processes. Here, we focus on these complementary molecules located in the presynaptic terminal and postsynaptic membrane specializations of glycinergic synapses. Moreover, as specificity of neurotransmission in this system is established by the specific binding of the neurotransmitter to its receptor, we review the molecular properties of glycine receptor subunits and their assembly into functional glycine receptors with different functional characteristics. The past years have revealed that the molecular machinery underlying inhibitory and especially glycinergic postsynaptic membrane specializations is more complex and dynamic than previously anticipated from morphological studies. The emerging features include structural components as well as signaling modules, which could confer the plasticity required for the proper function of distinct motor and sensory functions.