1/24. Treatment of severe low back pain with opioids during pregnancy in a patient with incomplete tetraplegia.We report a case of severe low back pain during pregnancy in a woman with incomplete tetraplegia due to viral myelitis. The pain was interpreted as a radiculopathy in the presence of multiple herniated discs. Surgical intervention was not indicated and physiotherapy failed; therefore, a symptomatic drug treatment with oral analgesics was initiated. To minimise the total daily opioid dosage and the potential risk of a neonatal withdrawal syndrome due to opioids, the route of administration was changed from oral to epidural. Adequate pain relief was maintained with this regimen until caesarean section was necessary. The neonatal withdrawal symptoms after delivery were mild. Residual pain slowly diminished after delivery and the patient was able to discontinue opioid therapy. The aetiology of low back pain remains unclear and may be multifactorial.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
2/24. Systemic lupus erythematosus related transverse myelitis presenting longitudinal involvement of the spinal cord.Lupus-related transverse myelitis is a rare but serious complication. A 25-year-old Japanese woman with systemic lupus erythematosus (SLE) was admitted because of numbness of the face and left upper extremity, headache, and intermittent fever. Six days later, she developed tetraplegia. MRI of the spinal cord showed longitudinal high intensity signals from medulla oblongata to C5, and from Th12 to conus medullaris on T2-weighted image. These MRI findings were consistent with acute catastrophic neurological abnormalities. Despite administration of the combination of methylprednisolone and cyclophosphamide pulse therapies, as well as plasmapheresis, her condition did not improve. Any vasculopathy in addition to the autoimmune pathogenesis, and narrow therapeutic window may relate to the present refractory case.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
3/24. Spinal cord edema: unusual magnetic resonance imaging findings in cervical spondylosis.OBJECT: Spinal cord edema is a rare radiological finding in chronic degenerative disorders of the spine. Between 1997 and 2001, the authors treated six patients with cervical spondylotic myelopathy in whom postoperative spinal cord edema was demonstrated. The authors describe the radiological and clinical features of this unusual condition. methods: The six patients were all men, and ranged in age from 44 to 72 years. All patients presented with mild quadriparesis and underwent laminoplasty or anterior fusion. Preoperative magnetic resonance (MR) imaging revealed marked spinal cord compression with intramedullary hyperintensity on T2-weighted sequences and spinal cord enhancement at the compression level after administration of Gd. After surgery, spinal cord edema was observed in all patients; the spinal cord appeared swollen on the postoperative MR images. Preoperative and postoperative Gd-enhanced MR imaging demonstrated clear enhancement of the white matter at the compressed segment Neurologically, five of six patients experienced good improvement of symptoms; however, the spinal cord edema as documented on follow-up MR imaging persisted for several months after surgery. CONCLUSIONS: The radiological characterization of spinal cord edema was based on the reversible white matter lesion most likely caused by disturbed local venous circulation induced by chronic spinal cord compression. Such unusual MR findings in cervical spondylotic myelopathy should be differentiated from intramedullary spinal cord tumors, demyelinating disorders, or inflammatory processes.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
4/24. Cervicothoracolumbar spinal epidural abscess with tetraparesis. Good recovery after non-surgical treatment with antibiotics and dexamethasone. Case report and review of the literature.We report the conservative treatment of a spinal epidural abscess (SEA) caused by escherichia coli and affecting the anterior epidural space from C2 to L4 in a diabetic, obese patient presenting with tetraparesis. The favourable clinical response to the administration of dexamethasone and antibiotics is described. We review the literature on non-surgical treatment of SEA with special regard to the use of corticosteroids.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
5/24. Acute motor axonal polyneuropathy after a cisatracurium infusion and concomitant corticosteroid therapy.A 40-yr-old male was admitted to the intensive care unit following blunt chest trauma. He had multiple rib fractures, bilateral pneumothoraces, and acute respiratory failure requiring mechanical ventilation. Sedation was achieved with midazolam and morphine, and later with propofol. The patient was paralysed with a continuous infusion of cisatracurium 1.42-5.75 micro g kg(-1) min(-1). methylprednisolone 125 mg i.v. every 12 h was also started. After discontinuation of the cisatracurium infusion 7 days later, the patient manifested a flaccid quadriplegia with absence of deep-tendon reflexes. No sensory deficits were observed. electromyography (EMG), repetitive nerve stimulation testing, and single fibre EMG (SFEMG) were performed at regular intervals after stopping cisatracurium. Clinical symptoms and electrophysiological examinations supported the diagnosis of acute motor axonal polyneuropathy related to concomitant administration of cisatracurium and corticosteroid therapy.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
6/24. dantrolene and pleural effusion: case report and review of literature.STUDY DESIGN: Single-subject case (a quadriplegic female, 56 years). OBJECTIVES: To describe a new case of eosinophilic pleural effusion induced by dantrolene chronic administration. SETTING: Physical medicine and rehabilitation unit in a teaching hospital, france. methods: diagnosis of an eosinophilic pleural effusion induced by dantrolene without any respiratory symptoms, except a decrease of breath sounds on the right lung base. RESULTS: Chest radiograph revealed a right-sided pleural effusion, and blood cell count a significant peripheral eosinophilia. Thoracenthesis contained 85% of eosinophils. The other explorations eliminated other causes of pleural effusion. The diagnosis of drug-induced effusion was almost sure and led us to discontinue the dantrolene. After 3 months, she had completely recovered. These characteristics, similar to the eight other cases described in the literature, are essential for the diagnosis of pleural effusion induced by dantrolene. CONCLUSION: dantrolene, a long-acting skeletal muscle relaxant, is well known to induce liver side effects but it can also induce pleural pericarditis. The pathogenesis is still not clearly identified, but similarities of chemical structures of dantrolene and nitrofurantoine make us think that it could be the same mechanism. The association between dantrolene and nitrofurantoine may have contributed to the expression of the pleural effusion.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
7/24. Spontaneous spinal hematomas and low-molecular-weight heparin. Report of four cases and review of the literature.The purpose of this article is to raise awareness of spontaneous spinal hematomas that develop after administration of low-molecular-weight heparin therapy. The authors describe four patients in whom these hematomas developed without precipitating events while receiving a treatment dose of enoxaparin (Clexane) (approximately 1 mg/kg). Spontaneous spinal hematomas (not related to trauma, surgery, or lumbar puncture) are a rare clinical entity. Several causes have been identified, including acquired and congenital clotting abnormalities and underlying vascular lesions. aspirin, warfarin, tissue plasminogen activator, and heparin have all been implicated in causing spinal hematomas. Concerns regarding the use of low-molecular-weight heparin agents in neuraxis anesthesia have been well documented. Their possible contribution to nontraumatic spinal hematomas has been less well described. The authors believe that low-molecular-weight heparin agents present a small but significant risk of spinal hematoma. This should be considered when prescribing therapy because such a complication may be catastrophic.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
8/24. carbamazepine toxicity following Oxybutynin and dantrolene administration: a case report.OBJECTIVE: To report a case of carbamazepine toxicity following the administration of Oxybutynin and dantrolene. STUDY DESIGN: A case report. SETTING: The Spinal rehabilitation Department, Loewenstein Hospital, Raanana, israel. methods: A patient with C6D tetraplegia who sustained intoxication because of drug interaction is presented. She had been treated by carbamazepine 1000 mg/day for neuropathic pain for 2 years without clinical or laboratory signs of toxicity. After administration of Oxybutynin concomitantly with an increase in the dose of dantrolene, she presented the clinical symptoms and laboratory finding of carbamazepine intoxication. Trying to adjust the treatment to the patient's requirements, carbamazepine together with Oxybutynin and dantrolene was readministrated in lower doses. RESULTS: The combination of these drugs, even small doses, caused toxicity. Adding dantrolene and Oxybutynin elevated the blood level of carbamazepine, possibly by inhibition of cytochrome P450. CONCLUSION: A possible pharmacokinetic interaction between dantrolene and Oxybutynin should be borne in mind when considering carbamazepine medication for a patient with a spinal cord lesion.- - - - - - - - - - ranking = 6keywords = administration (Clic here for more details about this article) |
9/24. Effect of acute aminophylline administration on diaphragm function in high cervical tetraplegia: a case report.theophylline has been shown to have beneficial effects on phrenic nerve and diaphragm activation. This case report involves a C5-C6 chronic tetraplegic patient with acute respiratory failure and ventilator dependence. IV aminophylline was administered in increasing doses (2 mg/kg, 4 mg/kg, and 6 mg/kg) over the course of 1 day. diaphragm surface electromyography (sEMG), measures of respiration (tidal volume, minute ventilation, and frequency), and serum theophylline levels were captured. diaphragm sEMG activity increased by a maximum of 50% at therapeutic levels. The rapid shallow breathing index dropped from 112 to 86. The subject was successfully weaned from ventilatory support. We conclude that administration of aminophylline facilitated weaning from ventilatory support in this tetraplegic patient.- - - - - - - - - - ranking = 5keywords = administration (Clic here for more details about this article) |
10/24. Management of the helpless patient after radioiodine ablation therapy - are we being too strict?BACKGROUND: A helpless patient was administered 1 GBq of I to ablate thyroid remnants post-thyroidectomy. The patient was quadriplegic, doubly incontinent and unable to swallow. Published data suggest that nursing staff may receive a total effective dose of 3400 microSv when dealing with such a patient for one 8 h shift per day for 7 days post-treatment. AIM: To quantify the effective doses received by nursing staff on dealing with a helpless patient undergoing radioiodine ablation therapy. methods: After intravenous administration of 131I, the whole-body doses received by nursing staff were measured using electronic personal dosemeters for 7 days. The nursing staff recorded the times spent in contact with the patient and the activities performed during these times. RESULTS: The total effective dose received by nursing staff over 7 days was 148 microSv. A nurse working alone for one 8 h shift per day for 7 days could receive an effective dose of 91 microSv. The nursing staff spent an average of 23 min (standard deviation, 15 min) per 8 h shift dealing with the patient. Nursing duties were performed at a contact distance of approximately 0.5 m from the patient. CONCLUSIONS: The nursing contact times required for the management of a helpless patient post-radioiodine therapy are lower than previously estimated. It is possible to successfully treat such a patient whilst keeping the effective doses to nursing staff within appropriate constraints. The measured nursing contact times provide an up-to-date summary of current nursing practice and will be a useful aid in the planning of future treatments.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
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