ABSTRACT
Dural metastases of prostate adenocarcinoma are an extremely rare complication and may mimic intracranial hematoma. Preoperatively diagnosis may be difficult due to similarities in symptoms and radiological appearance. We present a 65-year-old man admitted to the ED with a history of headache, nausea, vomiting, vertigo, diplopia, as well as numbness of his left lower extremity. Past medical history confirmed metastatic prostate cancer disease. After computed tomography and contrast computed tomography, the consulting radiologist diagnosed a chronic subdural hematoma. After burr hole trephination and dural opening, tumorous mass was detected. Histopathologic samples were taken. Histopathological examination was consistent with metastatic adenocarcinoma of the prostate. Although rare, dural metastases need to be included in oncological patients presenting in the ED with symptoms and radiological imaging suggesting hematoma. Both neurooncological and neurosurgical consultations are essential in order to apply the best treatment strategy.
ABSTRACT
(1) Background: Pediatric spinal surgery is a blood-intensive procedure. In order to introduce a rational blood management program, identifying the risk factors for transfusions is mandatory. (2) Methods: Data from the national database covering the period from January 2015 to July 2017 were analyzed. The available data included the demographics, characteristics of the surgeries performed, length of stay, and in-house mortality. (3) Results: The total number of patients used for the analysis was 2302. The primary diagnosis was a spinal deformity (88.75%). Most fusions were long, with four levels or more (89.57%). A total of 938 patients received a transfusion; thus, the transfusion rate was 40.75%. The present study identified several risk factors; the most significant was a number of levels fused greater than 4 (RR 5.51; CI95% 3.72-8.15; p < 0.0001), followed by the deformity as the main diagnosis (RR 2.69; CI95% 1.98-3.65; p < 0.0001). These were the two most significant factors increasing the odds of a transfusion. Other factors associated with an increased risk of transfusion were elective surgery, the female sex, and an anterior approach. The mean length of stay in days was 11.42 (SD 9.93); this was greater in the transfused group (14.20 vs. 9.50; p < 0.0001). (4) Conclusions: The rate of transfusions in pediatric spinal surgery remains high. A new patient blood management program is necessary to improve this situation.
ABSTRACT
Despite the frequent use of orthopedic braces or spine stabilizers in diseases such as kyphosis, lordosis, and scoliosis, as well as in the case of injuries and rehabilitation after surgeries, there is no clear evidence of their proper stabilization of the spine while carrying out daily activities. This study sought to assess the spine's mobility while wearing three different orthopedic braces while performing basic tasks. Ten healthy subjects were enrolled. Three Inertial Measurement Units (IMUs) were attached superficially along the spine at approximate levels: cervical (C7), between thoracic (T8) and lumbar (L3), and sacrum. The angle between sensors was monitored to provide data on the sagittal profile. In addition, the displacement of the spine's longitudinal axis was measured (rotation). There are three types of orthopedic braces: the semi-rigid Hohmann corset, the Jewett brace, and the Thoracolumbar Fixed Spinal Orthosis (TLSO). Four tasks were monitored: standing, sitting, walking, and picking up an item from the floor with one hand. All braces provided a similar level of stability in both the sagittal plane and rotational axis while lifting an object. On the other hand, while walking and sitting, the TLSO was the only orthosis providing a statistically significant rigidity in the sagittal plane. When performing a more voluntary task, the measured rigidity of softer braces was significantly increased when compared with more involuntary tasks. A certain degree of motion restriction with spinal orthoses may come from the feedback pressure, which stimulates paraspinal muscles to contract and thus increases the overall rigidity of the trunk.
Subject(s)
Lordosis , Scoliosis , Humans , Orthotic Devices , Braces , Spine , RotationABSTRACT
YouTube (YT) has become a popular health information reservoir. In this study, we aimed to evaluate the content and quality of YT videos as a source of patient information for meningiomas. A YT search was conducted for the following terms: "meningioma", "meningiomas", "meningeal tumor", and "psammoma". A total of 119 videos were examined by five independent raters, using validated quality criteria, including the Quality Criteria for Consumer Health Information (DISCERN), the Journal of the American Medical Association instrument (JAMA), and the Global Quality Score (GQS). The mean DISCERN score was 35.6 points, while the mean GQS and JAMA scores were 2.4 and 1.8, respectively. The majority of the videos were produced in the United States (37.82%). Moreover, 47.9% of the evaluated videos were graded as "poor" and only 9.24% were "good". Statistically higher scores in all three scoring systems were associated with the following information: tumor localization, clinical manifestations, indications for surgery, treatment options, risks, adjuvant therapies, results, follow up, diagrams, and those that featured a doctor as the speaker. Misleading information was presented in 35 productions. Our findings show that the overall quality of YT on the topic of meningiomas is defective, and requires further improvement and evaluation.
