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Dural puncture epidural technique provides better anesthesia quality in repeat cesarean delivery than epidural technique:Randomized controlled study

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World Journal of Clinical Cases 2022年第20期10卷 6890-6899页

作者： Sheng-You Wang Yan He Hai-Juan Zhu Bo Han Department of Anesthesiology Hefei Maternal and Child Health Care HospitalHefei 230001Anhui ProvinceChina Department of Anesthesiology Maternal and Child Health Care Hospital of Anhui Medical UniversityHefei 230001Anhui ProvinceChina

BACKGROUND Repeat cesarean deliverys involve a longer surgery and more severe visceral traction than primary cesarean deliverys.The dural puncture epidural(DPE)technique provides faster and more effective analgesia for labor,but there is no sufficient evidence to indicate whether it is suitable for parturients undergoing repeat cesarean delivery.AIM To determine the efficacy and safety of the DPE anesthesia technique in patients undergoing repeat cesarean delivery.METHODS Patients undergoing repeat cesarean delivery were randomly divided into the DPE and epidural anesthesia(EA)groups.A 25-G spinal needle was used for dural puncture via a 19-G epidural needle.The patients in the two groups were injected with 5 mL of 2%lidocaine followed by 15 mL of a mixture of 1%lidocaine+0.5%ropivacaine as the epidural dosage.The primary outcome was the onset time of sensory block to the T6 dermatome level and the sensory and motor block degree.RESULTS A total of 115 women were included(EA:57,DPE:58).The mean time to sensory block to the T6 Level was significantly shorter in the DPE group than in the EA group(14.7 min vs 16.6 min;95%confidence interval,13.9 to 15.4 vs 15.8 to 17.4;P=0.001).The cranial sensory block level was significantly higher at 5,10,and 15 min after the initial dose in the DPE group than in the EA group(P0.05).CONCLUSION The DPE technique provided higher-quality anesthesia than the EA technique,with a rapid onset of surgical anesthesia,better cranial and sacral sensory block spread and a higher motor block degree,without increasing the incidence of maternal or fetal side effects in patients undergoing repeat cesarean delivery.

关键词： Parturients Repeat cesarean delivery epidural Dural puncture epidural Anesthesia Onset time

epidural Spinal Cord Stimulation Promotes Motor Functional Recovery by Enhancing Oligodendrocyte Survival and Differentiation and by Protecting Myelin after Spinal Cord Injury in Rats

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Neuroscience Bulletin 2020年第4期36卷 372-384页

作者： Gang Li Zhong-Kai Fan Guang-Fei Gu Zhi-Qiang Jia Qiang-Qiang Zhang Jun-Yu Dai Shi-Sheng He Department of Orthopedics Shanghai Tenth People's HospitalTongji University School of MedicineShanghai 200072China Spinal Pain Research Institute Tongji University School of MedicineShanghai 200072China Department of Orthopaedics The First Affiliated HospitalJinzhou Medical UniversityJinzhou 121001China Department of Spinal Surgery The Second Affiliated HospitalHenan University of Science and TechnologyLuoyang 471003China

epidural spinal cord stimulation (ESCS) markedly improves motor and sensory function after spinal cord injury (SCI), but the underlying mechanisms are unclear.Here, we investigated whether ESCS affects oligodendrocyte differentiation and its cellular and molecular mechanisms in rats with SCI. ESCS improved hindlimb motor function at 7 days, 14 days, 21 days, and 28 days after SCI.ESCS also significantly increased the myelinated area at 28days, and reduced the number of apoptotic cells in the spinal white matter at 7 days. SCI decreased the expression of 20,30-cyclic-nucleotide 30-phosphodiesterase (CNPase,an oligodendrocyte marker) at 7 days and that of myelin basic protein at 28 days. ESCS significantly upregulated these markers and increased the percentage of Sox2/CNPase/DAPI-positive cells (newly differentiated oligodendrocytes) at 7 days. Recombinant human bone morphogenetic protein 4 (rh BMP4) markedly downregulated these factors after ESCS. Furthermore, ESCS significantly decreased BMP4 and p-Smad1/5/9 expression after SCI,and rh BMP4 reduced this effect of ESCS. These findings indicate that ESCS enhances the survival and differentiation of oligodendrocytes, protects myelin, and promotes motor functional recovery by inhibiting the BMP4-Smad1/5/9 signaling pathway after SCI.

关键词： Spinal cord injury epidural spinal cord stimulation Oligodendrocyte Differentiation Remyelination

epidural chloroma and spinal cord compression

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Chinese Medical Journal 2019年第7期132卷 853-855页

作者： Hyun Jung Koh Jungwon Baek Min Soo Lee Hue Jung Park Department of Anesthesiology and Pain Medicine Seoul St.Mary's HospitalCollege of MedicineThe Catholic University of KoreaSeoul 06591Korea

To the Editor:Chloroma is a rare solid tumor that was formed sometimes from malignant myeloid blast cells outside the hematopoietic system;these are known as chloroma or granulocytic sarcoma[1]Chloroma can be diagnosed anywhere outside of the hematopoietic system,such as the head and neck,skeletal system,breast,uterus,and central nervous system.[2]This tumor is common in leukemic patients.[3]Chloroma presents as an epidural mass resulting in spinal cord compression with neurologic symptoms.[4]Spinal lesions occur most frequently at the thoracic level;however,the most common primary symptoms are low back pain and radiating pain in the legs[5].

关键词： epidural chloroma spinal cord compression hematopoietic system

Concerned topics of epidural labor analgesia:labor elongation and maternal pyrexia:a systematic review

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Chinese Medical Journal 2020年第5期133卷 597-605页

作者： Cai-Juan Li Fan Xia Shi-Qin Xu Xiao-Feng Shen Department of Anesthesiology Women’s Hospital of Nanjing Medical UniversityNanjing Maternity and Child Health Care HospitalNanjingJiangsu 210004China

Objective:Labor is a complex process and labor pain presents challenges for analgesia.epidural analgesia(EA)has a well-known analgesic effect and is commonly used during labor.This review summarized frequently encountered and controversial problems surrounding EA during labor,including the labor process and maternal intrapartum fever,to build knowledge in this area.Data sources:We searched for relevant articles published up to 2019 in PubMed using a range of search terms(eg,“labor pain,”“epidural,”“analgesia,”“labor process,”“maternal pyrexia,”“intrapartum fever”).Study selection:The search returned 835 articles,including randomized control trials,retrospective cohort studies,observational studies,and reviews.The articles were screened by title,abstract,and then full-text,with a sample independently screened by two authors.Thirty-eight articles were included in our final analysis;20 articles concerned the labor process and 18 reported on maternal pyrexia during EA.Results:Four classic prospective studies including 14,326 participants compared early and delayed initiation of EA by the incidence of cesarean delivery.Early initiation following an analgesia request was preferred.However,it was controversial whether continuous use of EA in the second stage of labor induced adverse maternal and neonatal outcomes due to changes in analgesic and epidural infusion regimens.There was a high incidence of maternal pyrexia in women receiving EA and women with placental inflammation or histologic chorioamnionitis compared with those receiving systemic opioids.Conclusions:Early EA(cervical dilation≥1 cm)does not increase the risk for cesarean section.Continuous epidural application of low doses of analgesics and programmed intermittent epidural bolus do not prolong second-stage labor duration or impact maternal and neonatal outcomes.The association between EA and maternal pyrexia remains controversial,but pyrexia is more common with EA than without.A non-infectious inflammatory process is an accepted mechanism of epidural-relat

关键词： epidural analgesia Labor process Maternal pyrexia Intrapartum fever Mechanism

epidural abscess after multiple lumbar punctures for labour epidural catheter placement

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The Journal of Biomedical Research 2010年第4期24卷 332-335页

作者： Sundeep S.Tumber Department of Anaesthesiology and Pain Medicine University of California

epidural catheterization is routinely used by anaesthesiologists to provide labour and post-operative analgesia. In most cases, catheter placement is without serious side effects and uneventful. However, epidural abscess is a rare complication that may result in severe morbidity. We present a case of epidural abscess after labour epidural catheter placement in a healthy 36-year-old female who presented on post-partum d 10 with complaints of fever and back pain. She was treated with intravenous antibiotics and fully recovered.

关键词： labour epidural abscess catheters analgesia

Survival and clinical outcomes in patients with metastatic epidural spinal cord compression after spinal surgery:a prospective,multicenter,observational cohort study

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Chinese Journal of Cancer 2016年第4期35卷 157-159页

作者： Anick Nater Michael G.Fehlings Department of Surgery Division of NeurosurgeryUniversity of Toronto Division of Neurosurgery Toronto Western HospitalUniversity Health Network

Background:High quality studies have been challenging to undertake in patients with metastatic epidural spinal cord compression.Nonetheless,in the article "Survival and Clinical Outcomes in Surgically Treated Patients With Metastatic epidural Spinal Cord Compression:Results of the Prospective Multicenter AOSpine Study" recently published in the Journal of Clinical Oncology,our team provided convincing evidence that spinal surgery improves overall quality of life in patients with this potentially devastating complication of cancer.Considering that metastatic spinal lesions treated with surgery have the highest mean cost among all oncological musculo-skeletal issues,it is essential to provide high quality data to optimize the therapeutic approaches and cost-effective use of health care resources.Main body:Although the AOSpine Study provided high quality prospective data,it was primarily limited by the lack of non-operative controls and the relatively small sample size.Given the dearth of medical equipoise and the fundamental difference between patients deemed to be adequate surgical candidates and those who are not amenable to operative intervention,conducting a randomized controlled trial in this patient population was not felt to be ethically or medically feasible.Consequently,the optimal option to overcome limitations of both the lack of controls and the relatively small sample size is through collection of large prospective datasets through rigorously developed and maintained registries.Conclusions:With the alarming increase in the incidence of cancer in China and China's parallel growing cancer control efforts,China would offer a fantastic platform to set up a national metastatic spinal lesion registry.Such registry would not only enhance metastatic epidural spinal cord compression translational research but also optimize patient care.

关键词： Metastatic epidural spinal cord compression Prospective study Cohort study Surgery Clinical outcomes

Impact of sorafenib on epidural fibrosis: An immunohistochemical study

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World Journal of Clinical Cases 2018年第9期6卷 249-258页

作者： Osman Tanriverdi Uzay Erdogan Canan Tanik Ilhan Yilmaz Omur Gunaldi Huseyin Utku Adilay Ayca Arslanhan Metehan Eseoglu Department of Neurosurgery and Psychiatry University of Health Sciences Bak?rky Prof. Dr. Mazhar Osman Training and Research Hospital for Neurology Department of Pathology University of Health Sciences ?i?li Hamidiye Etfal Training and Research Hospital Department of Neurosurgery University of Health Sciences ?i?li Hamidiye Etfal Training and Research Hospital Department of Neurosurgery Medical Faculty Bal?kesir University Institute of Neurological Science Marmara University Department of Neurosurgery Medical Faculty Medipol University

AIM To determine if sorafenib, an antineoplastic agent, could prevent the development of spinal epidural fibrosis(EF). METHODS The study used CD105 and osteopontin antibodiesin an immunohistochemical approach to quantify EF that occurred as a consequence of laminectomy in rats. Wistar albino rats(n = 16) were divided into two groups: control(L1-2 level laminectomy only) and sorafenib treatment(L1-2 level laminectomy + topical sorafenib). The animals were euthanatized after 6 wk, and the EF tissues were examined for histopathological changes after immunohistochemical staining. The EF grades were assigned to the tissues, and the treatment and control groups were compared. RESULTS The EF thickness, inflammatory cell density, and arachnoid adherences determined by light microscopy were significantly higher in the control group compared to the sorafenib-treated group. Based on fibrosis scores, the extent of EF in the treatment group was significantly lower than in the controls. Immunohistochemical staining for CD105 to identify microvessels revealed that the EF grades based on vessel count were significantly lower in the treatment group. Staining for osteopontin did not show any significant differences between the groups in terms of the extent of EF. The staging of EF based on vascular counts observed after immunohistochemical staining for CD105, but not for osteopontin, was compatible with conventional staging methods. Neither toxic effects on tissues nor systemic side effects were observed with the use of sorafenib. CONCLUSION Local administration of sorafenib significantly reduced post-laminectomy EF. Decreased neovascularization in spinal tissue may be due to the sorafenib-induced inhibition of vascular endothelial growth factor.

关键词： Vascular endothelial growth factor CD105 Osteopontin Sorafenib Spinal epidural fibrosis

Post traumatic dural sinus thrombosis following epidural hematoma: Literature review and case report

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World Journal of Clinical Cases 2017年第7期5卷 292-298页

作者： Lorenzo Pescatori Maria Pia Tropeano Cristina Mancarella Emiliano Prizio Giorgio Santoro Maurizio Domenicucci DAI Neurology and Psichiatry-Department of Neurosurgery Policlinico Umberto I-Sapienza University of Rome

Dural sinus thrombosis following a head trauma is a rare condition,described in literature along with the lack of consensus regarding diagnosis and management.We present a case of a fifty-year-old man with a head injury and combined supratentorial-subtentorial epidural hematoma who was treated conservatively through the administration of low molecular weight heparin.The diagnosis and management of this condition are discussed based on a literature review.The early diagnosis may prevent potentially treatable poor outcomes.

关键词： Dural sinus thrombosis epidural hematoma Low molecular weight heparin

An unusual biconvex epidural lesion:acutely presenting extraosseous intracranial Ewing's sarcoma

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Chinese Neurosurgical Journal 2019年第1期5卷 60-63页

作者： Kalimullah Jan Eraj Khursheed Khan Inamullah Khan Department of Neurosurgery Aga Khan University HospitalKarachiPakistan Present Address:Department of Medicine(Neurology) Changi General Hospital SingaporeSimeiSingapore Singapore Singapore Department of Orthopedic Surgery Aga Khan University HospitalStadium RoadKarachi 74800Pakistan Aga Khan University Medical College Stadium RoadKarachi 74800Pakistan

Background:Ewing's sarcoma family of tumors consists of small round cell neoplasms,inclusive of primitive neuroectodermal tumor(PNET),Askin's tumor,and PNET of the bone.Extraosseous Ewing's sarcoma occurs commonly at bones of lower extremities and paravertebral region of the spine.It rarely presents as a primary intracranial lesion.When intracranial,it can be misdiagnosed as central PNET(e.g.,medulloblastoma,pinealoblastoma,or supratentorial PNET),other intracranial lesions,or even as an epidural hematoma.Case presentation:We report the case of a 20-year-old patient who presented to the emergency department with complaints of drowsiness,headache,and fever for 1 day.On initial computed tomography(CT)scan of the brain,a right temporal biconvex epidural lesion involving squamous-temporal bone with periosteal reaction was noted.The patient underwent urgent craniotomy,and a tumor was found and excised.Biopsy report confirmed Ewing's sarcoma.Conclusion:Ewing's sarcoma is a rare intracranial malignancy with only a few cases reported in literature.In a young patient with a biconvex epidural lesion,in the absence of trauma or ongoing infection,the possibility of Ewing's sarcoma should be considered as well.

关键词： Brain neoplasm Ewing's sarcoma epidural Biconvex Extra osseous Molecular analysis