Neuromodulation in the treatment of postoperative epidural fibrosis: comparison of the extent of epidural fibrosis and the effect of stimulation.

The goal was to prove that when a cohort of patients is chosen precisely, dorsal column stimulation provides significant improvement to quality of life. We studied a cohort of 50 patients with the history of failed back surgery syndrome coupled with epidural fibrosis (EF). A percutaneous implantation technique was used in each of the 50 patients. The study group was composed of 20 women and 28 men aged 26-67 years (mean age 49). A prospective observational questionnaire-based study was used. According to the methods, Ross's classification was adjusted to four degrees of scar size for our study objective. Despite this adjustment, it was not possible to statistically evaluate our research, due to very similar results in Groups I, III and IV. Patients without epidural fibrosis were assigned to Group 0, and patients with EF of different ranges were assigned to Group 1. The mean change in visual analogue scale DeltaVAS after our division into Group 0 was 4.82; for Group 1 it was 6.13. Evaluation of EF and DeltaVAS correlation by paired t-test shows a statistically higher effect of spinal cord stimulation (SCS) in the epidural fibrosis group, compared to group 0 without postoperative epidural fibrosis (p=0.008). The extent of epidural fibrosis is an important factor for Failed back surgery syndrome (FBSS). FBSS is the basis for the existence of neuropathic pain after lumbar spinal surgery. There is clear evidence of a correlation between patients with epidural scar formation on MR scan and the effect of dorsal column stimulation.

Electrode movement prevention - an animal model.

Electrode migration is the most common complication of spinal cord stimulation (SCS). The problem of longitudinal migration has already been solved, but lateral migration remains the most common current complication. The present article describes new electrodes fixation opportunities for the reduction of lateral migration in SCS. The pig was chosen as an animal model to illustrate a new protocol of electrode fixation for the control of lateral and longitudinal migration. The displacement of the electrode was measured using two different optical methods: the digital image stereo-correlation and the digital image processing methods. Fixation with two anchors has always considerably reduced electrode displacement and when fixation is done with two anchors and a loop then lateral migration is reduced by 62.5 % and longitudinal migration is reduced by 94.1 %. It was shown that the results are significantly different at the alpha=0.001 significance level. Based on a statistical evaluation it is possible to state that the differences between experimental results obtained for three different protocols of lead fixation are statistically significant and we can recommend the new fixation method for common practice.

[Delivery of macrosomic fetus]. / Porod velkého plodu.

UNLABELLED: Fetal macrosomia is associated with an increased risk of perinatal mortality and morbidity for both, mother and fetus. The frequency of these births is between 1.3 to 1.5%. Macrosomic fetuses are defined with a weight of 4500 g and more. Diagnosis and prediction of macrosomia or fetal birth weight is key to determine the tactics of delivery. It is based on the combination and assessment of medical history, clinical parameters and ultrasound biometry. The limit for elective caesarean section is considered the estimated fetal weight in healthy mothers of more than 5000 g. For mothers with diabetes an indication of the caesarean section should be considered for fetal weight of more than 4000 g. DESIGN: A review of the literature.

[Hormonal changes in open-angle glaucoma. I. Levels of immunoreactive insulin in serum]. / Hormonální zmeny u glaukomu s otevreným úhlem. I. Sledování hladiny imunoreaktivního inzulínu v séru.

This paper deals with the relation of disorders of carbohydrate metabolism to etiopathogenesis of glaucoma. 102 patients with primary glaucoma of an open angle were examined and it was discovered that 80 patients from this group (78%) had an abnormal immuno-reactive insulin curve, in particular of the hypersecretory type. Standard gauge test for abnormal glucose level was administered with 31 glaucomatous patients (30%). From this point of view screening for immuno-reactive insulin is a more sensitive and reliable method than the glucose standard gauge test. It is recommended that testing for immuno-reactive insulin should be introduced for all glaucomatous patients because this can help both in the detection of early stages of diabetes and in the administration of primary prevention of atherosclerosis among the population.

[Hormonal changes in open-angle glaucoma. II. Levels of cortisol and somatotropin in serum]. / Hormonální zmeny u glaukomu s otevren m úhlem. II. Sledování hladin kortizolu a somatotropního hormonu v séru.

Observing interrelation between carbohydrate metabolism disorders and contrainsular mechanisms in a group of 102 glaucomatous patients, a higher level of cortisol in plasma was detected in 40.2% of glaucomatous patients of whom 31% had increased levels of cortisol together with IRI. In isolation the increased level of cortisol occurred in 8.9%. The frequency of increased cortisol level in glaucomatous patients is substantially lower (40.2%) than the frequency of abnormal insulin curves (78%). Increased levels of growth hormone in the group of patients occurred in 9.3% of cases and these were almost always associated with an abnormal immuno-reactive insulin curve (IRI curve). Accordingly, it is evident that hormonal disorders are a major factor in the onset of both diabetes and glaucoma.