Demographic and anatomical comparison of ruptured and unruptured intracranial aneurysms: a case control study.

BACKGROUND: Our understanding of the pathophysiology and management of intracranial aneurysms (IAs) continuously advances. This case-control study analyzed the demographics of patients with IAs and the morphological Digital Subtraction Angiography (DSA) characteristics of ruptured and unruptured IAs. METHODS: Two patient groups with saccular ruptured and unruptured IAs eligible for coiling were prospectively analyzed during a 3-year period. Patient groups were compared regarding gender, age, arterial vasculature side, anatomical location, diameter, preoperative DSA appearance, aneurysmal and anatomical Circle of Willis variations (CWV) co-existence. RESULTS: One hundred and three patients with ruptured and eighty-six patients with unruptured IAs were studied. Anterior communicating and internal carotid artery IAs were the dominant locations: 42.7 % and 23.3 % in ruptured and 29 % and 41.9 % in unruptured IAs, respectively. The female-to-male ratio was 1.78 in ruptured and 2.44 in unruptured IAs (p =0.317), while the rupture was more frequent in younger patients (p =0.034). Angiographically, smaller diameter (p =0.01), abnormal morphology (p =0.0001), and co-existence of CWV (p =0.016) were reported in ruptured IAs. Location at bifurcation/trifurcation (p =0.487) and the co-existence of additional or mirror IA did not differ significantly (p =0.879). CONCLUSIONS: On DSA, ruptured and unruptured IAs differed in size, morphology, and co-existence of CWV; findings that may favor the treatment of specific unruptured IAs. However, a higher level of evidence is needed to include all these factors in the treatment decision process, provide patient-oriented treatment and reliably identify unruptured IAs at greater risk. HIPPOKRATIA 2021, 25 (3):100-107.

Demographic profile and outcome analysis of pediatric intensive care patients.

BACKGROUND: Demographic profile and outcome can vary in pediatric intensive care unit (PICU) patients. The aim of our study was to analyze demographic profile and outcome in a Greek PICU. METHODS: Prospective observational study. DATA COLLECTED: demographic profile; co morbidities; source and diagnosis at admission; Pediatric Risk of Mortality (PRISM III-24); Glasgow Coma Scale (GCS, pediatric); Injury Severity Score (ISS); procedures; treatment; mechanical ventilation (MV); MV days; length of stay (LOS) and the outcome at PICU discharge. STATISTICAL ANALYSIS: Student's t-test; Mann-Whitney U test; Kruskall-Wallis test; χ(2) criterion with relative risk (RR) estimation; Cox regression analysis; as appropriate. Values are mean ± SD, p < 0.05. RESULTS: 300 patients (196 boys/104 girls), aged 54.26 ± 49.93 months, were admitted due to respiratory failure (22.3%), head trauma (15.3%), seizures (13.7%), coma (9.7%), postoperative care (7.7%), polytrauma (7%), accidents (5.3%), sepsis-septic shock (5.3%), cardiovascular diseases (4.7%), metabolic diseases (3.3%), multiple organ failure syndrome (3%) and miscellaneous diseases (2.7%). PRISM III-24 score was 8.97 ± 7.79 and predicted mortality rate was 11.16% ± 18.65. MV rate was 67.3% (58.3% at admission) for 6.54 ± 14.45 days, LOS 8.85 ± 23.28 days and actual PICU mortality rate 9.7%. Patients who died had statistically worse severity scores. Significant mortality risk factors were inotropic use, PRISM III-24 > 8, MV, arterial and central venous catheterization, nosocomial infections, complications, and cancer. COX regression analysis showed that PRISM III-24 score and inotropic use were independent predictors of mortality. CONCLUSIONS: Demographic profile followed similar patterns to relevant studies while there were major differences in case mix and the severity of the disease. Mortality rate (9.7%) was relatively high but better than predicted and in accordance with the characteristics of our population.

Spondylolysis: a review and reappraisal.

The aim of this review was to provide of the current knowledge in pathophysiology, diagnosis and management of spondylolysis based on the authors' experience and the pertinent medical literature. Spondylolysis represents a weakness or stress fracture in one of the bony bridges that connect the upper with the lower facet joints of the vertebra. It is the most common cause of low back pain in young athletes. One-half of all paediatric and adolescent back pain in athletic patients is related to various disturbances in the posterior elements including spondylolysis. The most common clinical presentation of spondylolysis is low back pain. This is aggravated by activity and is frequently accompanied by minimal or no physical findings. A pars stress fracture or early spondylolysis are common and a misdiagnosis is often made. Plain radiography with posteroanterior (P-A), lateral and oblique views have proved very useful in the initial diagnostics of low back pain, but imaging studies such as Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) scans are more sensitive in the establishment of the diagnosis. Several treatment options are available. Surgical treatment is indicated only for symptomatic cases when conservative methods fail. The fact that early and multiple imaging studies may have a role in the diagnosis of pars lesions and the selection of the optimal treatment approaches is also highlighted.

An immunohistochemical study of mechanoreceptors in lumbar spine intervertebral discs.

There are limited data concerning mechanoreceptors in normal human lumbar intervertebral discs. The aim of our study was to determine the types of mechanoreceptors in the two lower intervertebral discs in normal adult cadaveric donors and to review the literature. Twenty-five lumbar (L4-5 and L5-S1) intervertebral discs were retrieved from 15 fresh cadavers. We utilized immunoreactivity against the S-100 protein to localize specialized nerve endings. Immunoreactivity showed receptors in 92% of discs. The most frequent type had morphology resembling the Ruffini type receptor (88%), followed by the Golgi type. Free nerve fibers were frequently present. All neural structures were found in the superficial layers of the annulus fibrosus, in longitudinal ligaments, or between these two. The anterior part of the L5-S1 disc had a greater frequency of encapsulated receptors than the other parts (p=0.022), which may be correlated with the high shear forces to which the lumbosacral junction is subjected.

Dermatomal SEPs--a complementary study in evaluating patients with lumbosacral disc prolapse.

We investigated the value of Dermatomal Somatosensory Evoked Potentials in 24 patients with unilateral radiculopathy due to lumbosacral disk prolapse. All patients had clinical signs and symptoms of disk prolapse and positive findings on neuroradiologic testing. We assessed the latency and the amplitude of the first positive waveform of Dermatomal SEPs, as well as conducting peripheral nerve conduction studies and electromyography. Our studies showed a clear correlation of Dermatomal SEP abnormalities and radiculopathy in up to 83.3% of subjects studied. Use of electromyography testing provided this correlation in about 62.5% of the same subjects. On the basis of these results, we propose that Dermatomal SEPs have value in complementing the routine electrophysiological testing of the patients with radiculopathy and provide a sensitive non-invasive technique for defining the level of disk prolapse.

Comparison of dermatomal SEPs and operative findings in lumbar disc disease.

This report deals with an estimation of the diagnostic value of dermatomal somatosensory evoked potentials (SEPs), by correlating the neurophysiological data to clinical, neuroradiological and operative findings in lumbar disc protrusion. Our material consists of 12, surgically treated patients with lumbar disc protrusion in which diagnostic work up included history, neurological examination, routine lumbar spine films, computerised tomography and MRI of the lumbar spine, in addition to neurophysiological investigation, especially conduction velocity studies, and SEPs recorded by the standard methods, as well as after dermatomal stimulation. The retrospective analysis disclosed a correlation for the SEPs after dermatomal stimulation and surgical findings, in 83% of our cases.

Microsurgical Study of the Dorello's Canal.

The microsurgical anatomy of Dorello's canal was examined in 20 cadaver specimens. The study included dissections of this anatomic structure, under operative microscope and using microsurgical instruments. The detailed microanatomy of the canal was defined, as well as its relation to the sixth nerve, the clivus, the petrous apex, and the adjacent neurovascular elements.

The effect of radicular arteries ligation on the spinal cord blood supply in cats.

In order to study the contribution of the radicular arteries to the blood supply of the spinal cord, we performed experimental occlusion of these arteries in cats. In 43 cats, under thiopental anaesthesia, unilateral, bilateral, single or multiple ligations of dorsal radicular arteries were carried out. The animals were killed at the 1st, 2nd and 7th postoperative day. The spinal cords were removed and preserved in formalin solution for 1 month and then examined, using light microscopy. We conclude that bilateral or multiple ligations are capable of producing ischaemic lesions in the spinal cord, more profound by the seventh postoperative day, while single ligations do not produce such lesions, unless a medullary artery is involved. The ischaemic lesions which were observed were associated with clinical neurological deficits.

Unusual course of an epidural rhabdomyosarcoma of the upper thoracic spine.

This report deals with a case of rhabdomyosarcoma in the upper thoracic spine. It is of particular interest, not only for the rarity of type and location of this tumour, but for its clinical course, which presented fluctuations of neurological status, included an acute demonstration of complete paraplegia followed by full recovery after conservative treatment, and gradual relapsing of neurological deficit, one year later.

An unusual case infection following spinal surgery.

A case of extensive subcutaneous inflammation infection four months after a spinal operation is presented. The patient had had an extensive laminectomy and foraminotomy for lumbar canal stenosis and protruded discs at L3/L4 and L4/L5 levels. Four months postoperatively, bilateral gluteal abscesses developed and were treated by surgical evacuation. Three months after the evacuation of the abscesses, extensive inflammation and purulent infiltration of the laminectomy wound together with recurrence of the gluteal abscesses were noticed. In spite of reevacuation of the abscesses the inflammation persisted. A syringography disclosed communication of the gluteal abscesses with the laminectomy wound. Eventually this complication was treated by surgical reexploration of the laminectomy wound, during which it was found that the inflammation, although longstanding, did not spread to the intervertebral spaces.