بسم الله الرحمن الرحيم
2017-03-25 16:57:51 dun: Mahammad A. Tafida
Cardiac arrest attributable to dysfunction of the autonomic nervous system after traumatic cervical spinal cord injury.
Chin J Traumatol. 2017 Feb 24;:
Authors: Kim SW, Park CJ, Kim K, Kim YC
Bradycardia is the most common form of dysrhythmia developing after disruption of the sympathetic pathway by a spinal cord injury (SCI), and it can have fatal consequences, including cardiac arrest. Here, we report a case of cardiac arrest developing after cervical SCI attributable to sympathetic hypoactivity. A 26-year-old male pedestrian was admitted after a traffic accident. Radiologically, fractures were apparent at the C6-7 bilateral articular facets, and cord contusion with hemorrhage was evident at C4-7. During his stay in ICU, intermittent bradycardia was noted, but the symptoms were not specific. On the 22nd postoperative day, the patient was taken to the computed tomography suite for further evaluation and experienced cardiac arrest during a positional change. After immediate cardiac massage, the patient was resuscitated. We scheduled Holter monitoring, which detected 26 pauses, the longest of which was 17.9 s. The patient underwent cardiac pacemaker insertion. No further cardiac events were noted.
PMID: 28330804 [PubMed - as supplied by ...
Male and female WorldSID and post mortem human subject responses in full-scale vehicle tests.
Traffic Inj Prev. 2017 Mar 23;:0
Authors: Yoganandan N, Humm J, Pintar F, Rhule H, Moorhouse K, Suntay B, Stricklin J, Rudd R, Craig M
Structured ABSTRACT Objective: To compare the responses of male and female WorldSID dummies with post mortem human subject (PMHS) responses in full-scale vehicle tests.
METHODS: Tests were conducted according to the FMVSS-214 protocols and using the United States Side impact New Car Assessment Program change in velocity to match PMHS experiments, published earlier. Moving deformable barrier (MDB) tests were conducted with the male and female surrogates in the left front and left rear seats. Pole tests were performed with the male surrogate in the left front seat. Three-point belt restraints were used. Sedan-type vehicles were used from the same manufacturer with side airbags. The PMHS head was instrumented with a pyramid-shaped nine-axis accelerometer package, angular velocity transducers on the head. Accelerometers and angular velocity transducers were secured to T1, T6 and T12 spinous processes, and sacrum. Three chestbands were secured around the upper, middle, and lower thoraces. Dummy instrumentation included five InfraRed Telescoping Rods for Assessment of Chest Compression (IR-TRACC) and a chestband at the first abdomen rib, head angular velocity transducer, and head, T1, T4, T12 and pelvis accelerometers.
RESULTS: Morphological responses of the kinematics of the head, thoracic spine, and pelvis matched in both surrogates for each pair. The peak magnitudes of the torso accelerations were lower for the dummy than the biological surrogate. The brain rotational injury criterion (BrIC) response was the highest in the male dummy for the MDB test and PMHS. The probability of AIS3+ injuries, based on the head injury criterion, ranged from 3% to ...
Clinical characteristics of bladder cancer in patients with spinal cord injury: the experience from a single centre.
Int Urol Nephrol. 2017 Mar 22;:
Authors: Böthig R, Kurze I, Fiebag K, Kaufmann A, Schöps W, Kadhum T, Zellner M, Golka K
INTRODUCTION: Life expectancy for people with spinal cord injury has shown a marked increase due to modern advances in treatment methods and in neuro-urology. However, since life expectancy of people with paralysis increases, the risk of developing of urinary bladder cancer is gaining importance.
MATERIALS AND METHODS: Single-centre retrospective evaluation of patient data with spinal cord injuries and proven urinary bladder cancer and summary of the literature.
RESULTS: Between 1998 and 2014, 24 (3 female, 21 male) out of a total of 6599 patients with spinal cord injury were diagnosed with bladder cancer. The average age at bladder cancer diagnosis was 57.67 years, which is well below the average for bladder cancer cases in the general population (male: 73, female: 77). All but one patient had a latency period between the onset of the spinal paralysis and tumour diagnosis of more than 10 years. The median latency was 29.83 years. The median survival for these patients was 11.5 months. Of the 24 patients, 19 (79%) had muscle invasive bladder cancer at ≥T2 at the time of diagnosis. The type of neurogenic bladder (neurogenic detrusor overactivity or acontractility) and the form of bladder drainage do not appear to influence the risk. Long-term indwelling catheter drainage played only a minor role in the investigated patients.
CONCLUSIONS: The significantly younger age at onset and the frequency of invasive tumours at diagnosis indicate that spinal cord injury influences bladder cancer risk and prognosis as well. Early detection of bladder cancer in patients with spinal cord injury remains a challenge.
PMID: 28332134 ...
Asymmetrical pedicle subtraction osteotomy for progressive kyphoscoliosis caused by a pediatric Chance fracture: a case report.
Scoliosis Spinal Disord. 2017;12:8
Authors: Suzuki S, Fujita N, Hikata T, Iwanami A, Ishii K, Nakamura M, Matsumoto M, Watanabe K
BACKGROUND: Although most pediatric Chance fractures (PCFs) can be treated successfully with casting and bracing, some PCFs cause progressive spinal deformities requiring surgical treatment. There are only few reports of asymmetrical osteotomy for PCF-associated spinal deformities.
CASE PRESENTATION: We here report a case of a 10-year-old girl who suffered an L2 Chance fracture from an asymmetrical flexion-distraction force, accompanied by abdominal injuries. She was treated conservatively with a soft brace. However, a progressive spinal deformity became evident, and 10 months after the injury, examination showed segmental kyphoscoliosis with a Cobb angle of 36°, a kyphosis angle of 31°, and a coronal imbalance of 30 mm. Both the coronal and sagittal deformities were successfully corrected by asymmetrical pedicle subtraction osteotomy.
CONCLUSIONS: Initial kyphosis and posterior ligament complex should be evaluated at some point when treating PCFs. Asymmetrical pedicle subtraction osteotomy can be a useful surgical option when treating rigid kyphoscoliosis associated with a PCF.
PMID: 28331905 [PubMed - in ...
Urothelial proliferation and regeneration after spinal cord injury.
Am J Physiol Renal Physiol. 2017 Mar 22;:ajprenal.00592.2016
Authors: Kullmann FA, Clayton DR, Ruiz WG, Wolf-Johnson A, Gauthier C, Kanai AJ, Birder LA, Apodaca G
The basal, intermediate, and superficial cell layers of the urothelium undergo rapid and complete recovery following acute injury; however, the effects of chronic injury on urothelial regeneration have not been well defined. To address this discrepancy, we employed a mouse model to explore urothelial changes in response to spinal cord injury (SCI), a condition characterized by life-long bladder dysfunction. One-day post SCI there was a focal loss of umbrella cells, which are large cells that populate the superficial cell layer and normally express uroplakins (UPKs) and KRT20, but not KRT5, KRT14, or TP63. In response to SCI, regions of urothelium devoid of umbrella cells were replaced with small superficial cells that lacked KRT20 expression and appeared to be derived in part from the underlying intermediate cell layer, including cells positive for KRT5 and TP63. We also observed KRT14-positive basal cells that extended thin cytoplasmic extensions, which terminated in the bladder lumen. Both KRT14-positive and KRT14-negative urothelial cells proliferated one-day post SCI, and by seven-days, cells in the underlying lamina propria, detrusor, and adventitia were also dividing. At 28-days post SCI, the urothelium appeared morphologically patent, and the number of proliferative cells decreased to baseline levels; however, patches of small superficial cells were detected that co-expressed UPKs, KRT5, KRT14, and TP63, but failed to express KRT20. Thus, unlike the rapid and complete restoration of the urothelium that occurs in response to acute injuries, regions of incompletely differentiated urothelium were observed even 28-days-post SCI.
PMID: 28331065 ...