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The aim of this study was to compare the intra and postoperative analgesic effects of sacrococcygeal epidural levobupivacaine with those of lumbosacral levobupivacaine in feline ovariohysterectomy. Thirty-six cats were premedicated with intramuscular acepromazine (0.05 mg/kg) and meperidine (6 mg/kg). Anesthesia was induced with intravenous propofol and maintained with isoflurane in oxygen. The cats were randomly assigned one of the three treatments receiving 0.33% levobupivacaine (0.3 mL/kg) into the sacrococcygeal (S-C group, n=12) or lumbosacral (L-S group, n=12) epidural space, or the same volume of 0.9% saline solution into one of the epidural approaches (Control group, n=12). Intraoperatively, cardiorespiratory variables, end-tidal isoflurane concentration (FE'ISO), and fentanyl requirements were recorded. Postoperative pain was assessed by the UNESP (Universidade Estadual Paulista)-Botucatu multidimensional composite pain scale and the Glasgow feline composite measure pain scale up to 8 hr post-extubation. Morphine was administered as rescue analgesia. Overall FE'ISO and fentanyl requirements were lower in the L-S and S-C compared to the Control (P=0.002-0.048, respectively). There was no significant difference in the cardiorespiratory variables during anesthesia, postoperative pain and rescue analgesia among groups. The time to standing after anesthesia was prolonged in the L-S and S-C groups than in the Control (P<0.001). Lumbosacral and sacrococcygeal epidural levobupivacaine resulted in similar decreases in isoflurane requirements and intraoperative fentanyl supplementation in the cats, with no postoperative benefits. [ABSTRACT FROM AUTHOR]

Background: Postpartum depression (PPD) is the most common complication after childbirth, affecting 10-15% of women. It is associated with serious long-term consequences for the mother and family. Whether or not neuraxial labor analgesia mitigates the risk is uncertain and controversial. The purpose of this review was to summarize studies investigating the association between neuraxial labor analgesia and the incidence of PPD.Methods: A systematic literature search for randomized controlled trials and cohort studies reporting the incidence of PPD among parturients who received neuraxial analgesia compared with non-neuraxial or no analgesia. The primary outcome was the incidence of PPD between 5 and 12 weeks' postpartum. Depression was diagnosed using a cutoff score of ≥10 on the Edinburgh Postnatal Depression scale, a validated screening tool. The risk of bias of each study was evaluated, and odds ratios and 95% confidence intervals calculated from raw data or reported as adjusted odds ratios.Results: Eleven observational studies involving 5717 patients were included. Three studies had a critical risk, three a serious risk, and five a moderate risk of bias. Two studies reported significantly lower odds for PPD associated with neuraxial analgesia compared with non-neuraxial or no analgesia, whereas the odds ratios in the remaining nine studies were not significantly different.Conclusions: Our systematic review did not find compelling evidence for an association between PPD and labor analgesia. Studies were heterogenous in nature and had a high risk of bias. Further research controlling for confounding factors is recommended to determine if a relationship exists. [ABSTRACT FROM AUTHOR]

• Primary intraosseous meningiomas are confined to bone, without dural attachment. • Calvarial PIMs presented with headaches, enlarging subcutaneous masses, or incidentally. • Skull base PIMs presented with neurologic deficits. • Radiographic diagnosis of PIMs can be challenging. • Skull X-ray plain films can be sensitive for detecting expansile PIMs. • Maximal resection of both calvarial and skull base PIMs was safely tolerated. Primary intraosseous meningioma (PIM) is a rare subtype of extradural meningiomas that originates within bone. We aimed to characterize the clinical, radiographic, and pathologic features of PIM and the resulting outcomes following resection. Herein we examined a retrospective case series of all patients with a pathologically confirmed WHO grade I PIM that were managed at one of three tertiary care centers. Patients with tumors that demonstrated extraosseous extension or involvement of the dura mater were excluded. The main outcomes included surgical safety and duration of local tumor control. Nine patients were identified with benign PIMs, presenting with headaches or painless enlarging subcutaneous masses if involving the calvarium or with neurologic deficits if involving the skull base, or otherwise incidentally identified. Surgery was pursued for symptomatic relief and/or tissue diagnosis. Lesions were evaluated by radiographic imaging – including sensitive detection by plain X-ray films – and definitive diagnosis ascertained by histopathological examination. Maximal resection of both calvarial and skull base lesions was safely tolerated. PIM represents a rare benign skull lesion, whose identification depends on the integration of radiographic findings with intraoperative findings and histopathological confirmation; it should be considered in the differential for slow-growing expansile intraosseous lesions of the skull. [ABSTRACT FROM AUTHOR]

• Surgery for extradural meningeal cysts is reserved for symptomatic patients. • Hypointense lesion on T1-weighted and a hyperintense lesion on T2-weighted imaging. • Complete resection and closure of fistulous connection to prevent recurrence. • Conservative approaches are associated with high recurrence rates. • An illustration depicts the management of the patient in the case described. Extradural spinal meningeal cysts are rare lesions in the adult spine and are an uncommon cause of neurologic deficits. We present the case of an adult who presented with myelopathic symptoms related to a dorsally based extradural thoracic meningeal cyst in the absence of any defect in the posterior spinal elements and no history of spinal dysraphism or trauma. We also performed a review of the literature to evaluate the surgical techniques for extradural meningeal cysts. Most thoracic cysts are intradural arachnoid cysts, yet this lesion is an extradural meningeal cyst, not an intradural arachnoid cyst. Because of the rarity of this lesion, its anatomic characterization can be difficult to conceptualize. An artist's illustration helps illustrate the anatomic characteristics of this cyst and our surgical management. [ABSTRACT FROM AUTHOR]

Extradural hematoma (EDH) is a rare but serious complication of brain injury. The supra- and infra-tentorial EDH is even rarer and only a few articles focusing on this topic have been published. The clinical manifestations are nonspecific but early diagnosis of supra- and infra-tentorial EDH and prompt treatment are mandatory to avoid complications. We report this case of a supra- and infra-tentorial subacute EDH on a 4 years old child. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Ultrasound is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Background: Ritonavir inhibition of cytochrome P450 3A4 decreases the elimination clearance of fentanyl by 67%. We used a pharmacokinetic model developed from published data to simulate the effect of sample patient-controlled epidural labor analgesic regimens on plasma fentanyl concentrations in the absence and presence of ritonavir-induced cytochrome P450 3A4 inhibition. Methods: Fentanyl absorption from the epidural space was modeled using tanks-in-series delay elements. Systemic fentanyl disposition was described using a three-compartment pharmacokinetic model. Parameters for epidural drug absorption were estimated by fitting the model to reported plasma fentanyl concentrations measured after epidural administration. The validity of the model was assessed by comparing predicted plasma concentrations after epidural administration to published data. The effect of ritonavir was modeled as a 67% decrease in fentanyl elimination clearance. Plasma fentanyl concentrations were simulated for six sample patient-controlled epidural labor analgesic regimens over 24h using ritonavir and control models. Simulated data were analyzed to determine if plasma fentanyl concentrations producing a 50% decrease in minute ventilation (6.1ng/mL) were achieved. Results: Simulated plasma fentanyl concentrations in the ritonavir group were higher than those in the control group for all sample labor analgesic regimens. Maximum plasma fentanyl concentrations were 1.8ng/mL and 3.4ng/mL for the normal and ritonavir simulations, respectively, and did not reach concentrations associated with 50% decrease in minute ventilation. Conclusion: Our model predicts that even with maximal clinical dosing regimens of epidural fentanyl over 24h, ritonavir-induced cytochrome P450 3A4 inhibition is unlikely to produce plasma fentanyl concentrations associated with a decrease in minute ventilation. [Copyright &y& Elsevier]

Abstract: We report a 66-year-old man with a spinal, extradural solitary fibrous tumor showing unique retiform and papillary architecture. The patient presented in May 2008 with worsening right-sided lower back pain and urinary frequency. Magnetic resonance imaging of the spine documented a heterogeneously enhancing dumbbell-shaped extradural lesion causing cord compression at T11/12 level. The tumor extended to the paravertebral soft tissue and invaded the right adjacent vertebral pedicles and laminae. An angiogram showed prominent vascular supply mainly from the right T11 radicular artery. The patient underwent surgery to relieve cord compression in May 2008 and a second operation following embolization with coils in October 2009. No recurrence was observed at the last neuroimaging follow-up in June 2012. The tumor was composed of vimentin, CD34, Bcl-2, and CD99-positive rounded or slightly elongated cells with scant cytoplasm and oval to spindle nuclei. Several pseudovascular spaces reminiscent of the rete testis were present, and several of them contained papillary projections. Cytologic atypia was minimal, and mitotic activity was low. Focal infiltration of the paraspinal adipose tissue was seen at microscopic level. To our knowledge, retiform and papillary features have never been reported in a solitary fibrous tumor. [Copyright &y& Elsevier]

Facial nerve schwannoma (FNS) are rare tumors usually presenting as a cerebellopontine angle (CPA) mass. Rarely, FNS can present as significant mass in the middle cranial fossa. They are usually approached using intradural procedures; however, we decompressed the tumor through an extradural procedure and could decompress it significantly without any morbidity.A 15-year-old female presented with progressive right-sided facial weakness, followed by left-sided hearing loss since the last 1 year. She was evaluated and it was found that she had an FNS involving the posterior and middle cranial fossa, with a significant tumor in the middle cranial fossa.Extradural subtemporal combined with a transpetrosal approach was used for tumor decompression; some of the residual tumor in the left cerebellopontine cistern was managed by a postoperative gamma knife surgery to preserve the facial nerve functions.FNS can be one of the rare differential diagnoses of a tumor in the middle cranial fossa base and can be managed effectively by an extradural approach. [ABSTRACT FROM AUTHOR]

Abstract: Despite being a well-understood pathology, patients with an extradural spinal abscess (ESA) still experience delays in diagnosis, with associated morbidity and mortality. This 10-year retrospective audit aimed to define the presentation, findings and prognosis of ESA in a New Zealand tertiary referral centre. Forty-two patients were diagnosed and treated between 1 May 1997 and 30 June 2007. The mean age was 55 years, with a male predominance of 1.6:1. Staphylococcus aureus was identified in 67% of patients. On presentation, 27/38 patients with back pain were afebrile and 2/37 patients had a normal C-reactive protein (CRP) level in the first 24 hours. Ten patients were discharged with neurological dysfunction and one died. One reason for the delays in diagnosis and appropriate referral could be the lack of “red flag” symptoms at the time of presentation. Attention needs to be paid to the history and nature of a patient’s back pain. We recommend routine CRP and full blood count to help raise clinical suspicion. [Copyright &y& Elsevier]

Recent advances in ultrasound (US) imaging have significantly improved our understanding of spinal sonoanatomy. Today, US imaging has been used to assist or guide central neuraxial blocks, and it appears to be a promising alternative to traditional landmark-based technique. US is noninvasive, safe, simple to use, can be quickly performed, does not involve exposure to radiation, provides real-time images, and is free from adverse effects. Currently, the majority of the outcome data are from its application in the lumbar region. A scout (prepuncture) scan allows the operator to preview the spinal anatomy, identify the midline, accurately predict the depth to the epidural space, and determine the optimal site and trajectory for needle insertion. When used for central neuraxial blocks, it also improves the success rate of epidural access on the first attempt, reduces the number of puncture attempts or the need to puncture multiple levels, and improves patient comfort during the procedure. Preliminary data suggest that US may also offer technical advantages in patients with abnormal spinal anatomy. It is also an excellent teaching tool and improves the learning curve of epidural blocks in parturients. However, the use of US for central neuraxial blocks is still in its infancy, and there is a need for more research in this state of the art regional anesthesia before it can become a standard of care. [Copyright &y& Elsevier]

The article describes the case of a pet domestic rabbit diagnosed with spinal lymphoma and concurrent pulmonary filariasis. The physical examination of the rabbit revealed adequate hydration. The pelvic limb examination revealed bilateral loss of motor control, proprioceptive deficits, and the absence of superficial and deep pain.

Primary extraosseous Ewing sarcoma is a rare entity, especially in the spinal epidural site. Less than 20 cases have been reported in the literature. Here, we present a previously healthy 12-year-old boy who complained of low back pain, progressive gait disturbance and weakness of right lower extremity for nearly one month before admission. Magnetic resonance imaging showed one solitary posterior extradural mass, measuring 4 × 2.2 × 2.1 cm, with severe cord compression at the level from T7 to T9. The mass appeared hypo-intense on both T1-weighted and T2-weighted images and homogeneous contrast enhancement after injection of gadolinium. He underwent laminectomies of T8 and T9 and complete resection of the tumor. The pathology confirmed a diagnosis of Ewing sarcoma after immunohistochemical staining. His profound neurological deficits recovered well and no recurrence was discovered after adjuvant chemotherapy and radiotherapy. The relevant literature is reviewed and the limited cases are also analyzed. [ABSTRACT FROM AUTHOR]

Copyright of West African Journal of Medicine is the property of West African Journal of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Hydatid disease of the spine is rare and has a poor prognosis, presenting both diagnostic and therapeutic challenges. Paraplegia is the most serious complication of the disease and is caused by compression of the spinal cord by the cysts. We report a 30-year-old woman with an isolated primary hydatid cyst that responded to treatment with albendazole. She presented with back and right leg pain. MRI of the lumbar spine showed a solitary cyst measuring 2.2×2.7cm, with an intraspinal extension at L4–L5. Physical examination did not reveal any focal deficit and the patient was treated with albendazole drug therapy (400mg daily). After 7months’ treatment, she had improved both clinically and radiologically. Albendazole drug therapy appears to be effective for conservative treatment of patients with primary solitary hydatid disease in the lumbar spine. [Copyright &y& Elsevier]

Abstract: Acute biphenotypic leukaemia (BAL) is an uncommon haematological malignancy with features of myeloid and lymphoid origin and poor overall prognosis. We report a 68-year-old man who presented with rapidly progressive upper thoracic spinal cord compression secondary to an extradural lesion. A T2–3 decompressive laminectomy with tumour excision was performed. Histopathology confirmed the diagnosis of acute biphenotypic (B/myeloid) leukaemia. The patient had only minor post-operative improvement in pyramidal lower limb weakness. He succumbed to the disease three months post-diagnosis after failing induction chemotherapy. While central nervous system involvement with acute leukaemia is well recognised, this is the first reported patient with spinal cord compression secondary to this leukaemia subtype. [Copyright &y& Elsevier]

Abstract: Capillary haemangiomas are well-circumscribed aggregates of closely packed, thin-walled capillaries separated by connective tissue stroma. In subcutaneous tissue they are termed pyogenic granuloma and commonly follow trauma. They rarely occur in the spine. We present a 43-year-old woman with a 6-week history of thoracic myelopathy and back pain on a background of T7 and T8 vertebral compression fractures from a motor vehicle accident 10years previously. MRI demonstrated a posteriorly based extradural homogeneously enhancing mass at this level. The lesion was resected and diagnosed histopathologically as a capillary haemangioma. The patient’s symptoms resolved and she made an uneventful recovery. The literature is reviewed and the possible pathogenesis is discussed. [Copyright &y& Elsevier]

Abstract: Extradural arachnoid cysts of the spine are a rare cause of spinal cord and nerve root compression, usually in the mid to lower thoracic spine and at the thoraco-lumbar junction in a posterior position. Local pain and myelopathy occur predominantly in young adults, and MRI reveals a well-demarcated extradural lesion, iso-intense to cerebrospinal fluid. We report a 33-year-old woman with an extradural arachnoid cyst from T11 to L1 and review the surgical techniques reported in the literature. [Copyright &y& Elsevier]