Advancing insights into recurrent lumbar disc herniation: A comparative analysis of surgical approaches and a new classification.

Background: The management of recurrent lumbar disc herniation (rLDH) lacks a consensus. Consequently, the choice between repeat microdiscectomy (MD) without fusion, discectomy with fusion, or endoscopic discectomy without fusion typically hinges on the surgeon's expertise. This study conducts a comparative analysis of postoperative outcomes among these three techniques and proposes a straightforward classification system for rLDH aimed at optimizing management. Patients and Methods: We examined the patients treated for rLDH at our institution. Based on the presence of facet resection, Modic-2 changes, and segmental instability, they patients were categorized into three groups: Types I, II, and III rLDH managed by repeat MD without fusion, MD with transforaminal lumbar interbody fusion (TLIF) (MD + TLIF), and transforaminal endoscopic discectomy (TFED), respectively. Results: A total of 127 patients were included: 52 underwent MD + TLIF, 50 underwent MD alone, and 25 underwent TFED. Recurrence rates were 20%, 12%, and 0% for MD alone, TFED, and MD + TLIF, respectively. A facetectomy exceeding 75% correlated with an 84.6% recurrence risk, while segmental instability correlated with a 100% recurrence rate. Modic-2 changes were identified in 86.7% and 100% of patients experiencing recurrence following MD and TFED, respectively. TFED exhibited the lowest risk of durotomy (4%), the shortest operative time (70.80 ± 16.5), the least blood loss (33.60 ± 8.1), and the most favorable Visual Analog Scale score, and Oswestry Disability Index quality of life assessment at 2 years. No statistically significant differences were observed in these parameters between MD alone and MD + TLIF. Based on this analysis, a novel classification system for recurrent disc herniation was proposed. Conclusion: In young patients without segmental instability, prior facetectomy, and Modic-2 changes, TFED was available should take precedence over repeat MD alone. However, for patients with segmental instability, MD + TLIF is recommended. The suggested classification system has the potential to enhance patient selection and overall outcomes.

Complex treatment of multiple high-output enterocutaneous fistulas (gastric, jejunum, transversum) after bariatric surgery.

Multiply high-output enterocutaneous fistulas (ECF) is a tragic postoperative complication. This report describes complex treatment of patient with multiple enterocutaneous fistulas after bariatric surgery, including a comprehensive preoperative preparation for 3 months (sepsis control, nutritional support and wound care) and reconstructive surgery (laparotomy, distal gastrectomy, resection of the small bowel with fistulas, Roux-gastrojejunostomy, transversostomy).

Degenerative Grade 3 Spondylolisthesis Management: A Case Report and Literature Review.

Degenerative spine disorders are very common in the aging population. Degenerative spondylolisthesis is a relatively uncommon cause of chronic back pain in these patients. We present a case of high-grade spondylolisthesis managed with posterior lumbar interbody fusion (PLIF) and reduction of the listhesis with excellent results. A 56-year-old woman presented with chronic lower back pain managed as an outpatient for over 5 months with no relief. She had no history of trauma or risk factors for malignancy. Lumbosacral CT showed Meyerding grade 3 anterolisthesis of the fifth lumbar vertebra with complete L5-S1 disc collapse and bilateral spondylolysis. An MRI confirmed the findings. There was no spinal canal stenosis. The patient was managed with L4-L5-S1 transpedicular fixation and L5-S1 interbody cage with reduction of the listhesis. The patient had an incidental intraoperative dural tear which was repaired primarily and a wound drain was kept for 5 days without complications. The patient was ambulating by day 5 and was discharged without complications on day 10. Degenerative spondylolisthesis can cause chronic back pain with or without a history of trauma. Although no specific clinical features exist for this condition, it should be suspected in elderly patients even in the absence of a history of trauma. Surgical management in high-grade spondylolisthesis is indicated with interbody fixation and reduction.

Fourier analysis of peripheral blood pressure and flow in intraoperative assessment of infrainguinal arterial reconstructions.

AIM: To assess infrainguinal arterial reconstructions by intraoperative flowmetry under the distal anastomosis using a fast Fourier transformation; calculate and compare the amplitude ratios of peripheral arterial blood pressure and volume flow before and after drug-induced vasodilation of occluded bypass grafts and bypass grafts that have been patent at least for 1 year. To find what magnitude of the change of these ratios indicate a long-term patency of the bypass grafting. PATIENTS AND METHODS: We compared the results of the intraoperative flowmetry tests of 97 patients with infrainguinal arterial reconstructions. The patients were divided into two groups based on the graft status: the grafts in 49 patients were patent for at least a year, and 48 patients had failed bypass. We used a fast Fourier transform (FFT) of the pressure and blood flow waves and compared the ratios of their amplitudes before and after administration of a vasodilator drug into the graft. Comparing the ratios obtained before and those after administration of the drug we quantified their change in each group and analysed them. RESULTS: After a drug-induced vasodilation, the blood pressure and flow amplitude ratios for the group with compromised reconstructions were less than 1.9 times smaller than those before drug infusion, while for the group with bypass grafts that had been functional for at least 12 months the ratios declined by more than 1.9 approximately 2 times. CONCLUSION: The magnitude of the change of amplitude ratios of the peripheral pressure and volume flow after drug-induced vasodilation can be used to make an assessment of the bypass graft and the distal arterial segment.

Arginase inhibitor in the pharmacological correction of endothelial dysfunction.

THIS PAPER IS ABOUT A WAY OF CORRECTION OF ENDOTHELIAL DYSFUNCTION WITH THE INHIBITOR OF ARGINASE: L-norvaline. There is an imbalance between vasoconstriction and vasodilatation factors of endothelium on the basis of endothelial dysfunction. Among vasodilatation agents, nitrogen oxide plays the basic role. Amino acid L-arginine serves as a source of molecules of nitrogen oxide in an organism. Because of the high activity of arginase enzyme which catalyzes the hydrolysis of L-arginine into ornithine and urea, the bioavailability of nitrogen oxide decreases. The inhibitors of arginase suppress the activity of the given enzyme, raising and production of nitrogen oxide, preventing the development of endothelial dysfunction.

The role of peripheral vascular resistance in determining the infrainguinal arterial reconstruction patency.

OBJECTIVE: To find if there is any correlation between the peripheral vascular resistance, its change following an intragraft prostaglandin infusion and the infrainguinal reconstruction patency. PATIENTS AND METHODS: Ninety-seven patients with infrainguinal reconstructions were included in the study: in 48 patients they were compromised (32 with graft thrombosis and 16 with stenosis of the distal anastomoses); 49 patients had their bypasses patent for no less than 12 months. Intraoperative flowmetry was performed on the target artery under the distal anastomosis, after declamping, and after a five-minute intragraft prostaglandin infusion. We measured the peripheral vascular resistance (PVR) by two methods - as a ratio of the invasively measured average pressure to the average blood flow volume (mmHg/ml/min. = peripheral resistance unit [PRU]) and by using the readings by the flowmeter (ohms). RESULTS: The decrease of peripheral resistance was calculated in the functioning and the compromised reconstructions after administration of prostaglandin. We found that if PVR decreases 4.5 times (in ohms) the prognosis is good; we can make the same positive prognosis when the ratio of the mean invasively measured pressure to the mean blood flow volume (Pmean/Qmean) decreases more than four times. Values greater than 1.07 ohms, after peripheral vasodilatation, are indicative of high peripheral vascular resistance, at a level of specificity of 86%, and values greater than 0.57 PRU - at a level of specificity of 87%. CONCLUSION: Although PVR measurements cannot predict with absolute certainty that bypasses under the inguinal ligament shall stay patent for a long time, it is a valuable indicator showing the immediate outcome of reconstruction work carried out with the patient on the operating table. Finding Any technical errors and dealing with them saves time and money, as well as prevents the stress on the part of patients caused by the required additional revisions and multiple operations.

Alkaline earth metal ions mediated self-assembly in the presence of 1,10-phenanthroline, nitrate and tetrafluoroborate anions.

1,10-Phenanthroline (phen) was reacted with various combinations of two and in one of the cases with three alkaline earth metal cations taken in equimolar ratio. In all the competitive reactions it was obtained only one product free of any impurities, which is in accordance with the theory of self-assembly processes. The compound [Ca(phen)2(H2O)2(NO3)]NO3 was synthesized in all the reactions where Ca(2+) was involved. In contrast, none of the reactions led to the preparation of a strontium complex. Two of the reactions, in which participated Be(2+), resulted in the compound (phen)3(H+)2(NO(-)(3))2. The second group of competitive reactions was carried out with 1,10-phenanthroline and a given alkaline earth metal cation in the presence of the anions NO(3)(-) and BF(4)(-). These led to the compounds Mg(phen)4(BF4)2(H2O)3, [Ca(phen)2(H2O)2(NO3)]BF4, Sr(phen)4(OH)(BF4)(H2O) and Ba(phen)3.5(BF4)2(H2O). All the newly synthesized substances were characterized by elemental analysis, IR- and FAB-mass-spectra.

[The incidence of influenzal, para-influenzal and adenoviral antigens in keratoconjunctivitis patients during immunization with NIVGRIP vaccine]. / Incidence des antigènes grippal, paragrippal et adénoviral chez des sujets à kérato-conjonctivite durant l'immunisation avec du vaccin NIVGRIP.

Repeated intranasal administrations of NIVGRIP, influenza inactivated vaccine, to patients with chronic recurrent keratoconjunctivitis, led to a significant reduction of respiratory virus incidence, as revealed by the immunofluorescence test in the conjunctive epithelial cells. The effect is probably due to endogenous interferon stimulation by the vaccine, at the nasopharyngeal level.

[Simultaneous detection by immunofluorescence of several viral infections and Mycoplasma, Chlamydia and Rickettsia burneti infections localized at the level of the conjunctival, nasal and pharyngeal mucosae of patients with recurring chronic keratoconjunctivitis]. / Détection simultanée par l'immunofluorescence de quelques infections à virus, Mycoplasma, Chlamydia et Rickettsia burneti, localisées au niveau des muqueuses conjonctivale, nasale et pharyngienne, chez des malades atteints de kérato-conjonctivite chronique récidivante.

A study was conducted of the viral and inframicrobial populations present in the conjunctival, nasal and pharyngeal mucous membranes by immunofluorescence techniques, using a twelve hyperimmune serum kit, in 120 patients with chronic, relapsing keratoconjunctivitis. Qualitative and quantitative differences were noted in the antigen levels in the three investigated mucous membranes. The number of antigens in the conjunctival and nasal epithelial cells was higher than in the pharyngeal ones: 117 and 113 positive IF tests for the first two against 95 for the third. Incidence of each of the individual antigens was two or three times higher in the conjunctival and nasal mucous membranes, excepting, however, the parainfluenza viruses which were equally frequent in all the three mucous membranes.

[Detection of type 1 and 2 herpetic antigens by immunofluorescence in patients with chronic or recurrent keratoconjunctivitis receiving therapy based on etiology]. / Incidence des antigènes herpétiques des types 1 et 2 décelés en immunofluorescence chez des malades souffrant de kérato-conjonctivite chronique ou récidivante, soumis à une thérapeutique étiologique.

Immunofluorescence (IF) techniques were used to evaluate the therapeutical efficiency of moroxidine hydrochloride against herpes virus (HSV) induced keratoconjunctivitis. In 56 out of the 77 followed-up and treated patients, the IF reactions revealed the presence of both types 1 and 2 of herpes virus, while in 21 only type 1 was found. The treatment with moroxidine hydrochloride led to a reduction of 63% and 92%, respectively, of the incidence of herpes virus type 1 and 2 antigens in the conjunctival cells, coincident with the improvement of clinical symptoms or persistent recovery.