New onset epilepsy following unintentional durotomy in a patient on anti-psychiatric medication.

We would like to present a rare case report describing a case in which new-onset tonic-clonic seizures occurred following an unintentional durotomy during lumbar discectomy and decompression. Unintentional durotomy is a frequent complication of spinal surgical procedures, with a rate as high as 17%. To our knowledge a case of new onset epilepsy has never been reported in the literature. Although dural tears during surgery and CSF hypovolaemia are thought to be the main contributing factors, one postulates on the effects of anti-psychiatric medication with epileptogenic properties. Amisulpride and Olanzapine can lower seizure threshold and should be used with caution in patients previously diagnosed with epilepsy. However manufacturers do not state that in cases where the seizure threshold is already lowered by CSF hypotension, new onset epilepsy might be commoner. Finally, strong caution and aggressive post-operative monitoring is advised for patients with CSF hypotension in combination with possible epileptogenic medication.

A rare presentation of sarcoidosis, back pain and spondylolisthesis.

A 48-year old man presented with back pain that was resistant to treatment. An MR scan showed spondylolisthesis at L4-5 and narrowing of the exit foraminae. He had a posterior fusion which did not relieve his symptoms. He continued to have back pain and developed subcutaneous nodules in both forearms. Biopsy from the skin revealed cutaneous sarcoidosis, and one from the lumbar spine showed sarcoidosis granuloma between the bone trabeculae. A CT scan of the abdomen and chest revealed axillary lymphadenopathy, mediastinal enlarged nodes, apical nodular nodes and splenomegaly. The patient was started on large doses of methotrexate and steroids. His angiotensin-converting enzyme and calcium levels returned to normal and the back pain resolved.

Aquaflo pump vs FMS 4 pump for shoulder arthroscopic surgery.

A prospective controlled trial was carried out to compare two different fluid delivery systems used for shoulder arthroscopy. One an advanced pump system that controls both pressure and flow of fluid delivered, the other an air-driven diaphragm pump that only controls fluid pressure. Blood loss, presence of bleeding vessels and visual clarity were parameters used to assess the pump systems. There was no difference between the pumps in straightforward shoulder procedures. However, complicated and prolonged procedures benefited from the use of the advanced pump system.