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Therapeutic hypothermia (TH) has been part of the standard care of postresuscitation patients for more than a decade. Multiple cooling methods are available, including the administration of cold intravenous (IV) fluids. Although this method is widely used, the safety of administration of large volumes of cold IV fluids has not been clearly demonstrated in the literature, and recent evidence points to potential deleterious effects associated with administration of large IV fluid volumes. We conducted a retrospective cohort study among patients who have been treated with TH after cardiac arrest between November 2011 and November 2013 at a tertiary care hospital in Sherbrooke, Quebec, Canada. The primary outcome was the effect of IV fluid quantity on the 28-day survival rate. We reviewed 29 cases, with a total 28-day surviving rate of 51.7%. After adjusting for confounding variables, 28-day surviving rate was not significantly associated with the amount of fluids administrated (odds ratio = 1.034; confidence interval 95% [0.741-1.464]; p = 0.85). The amount of fluids did not influence the variation of the pulmonary component of the sequential organ failure assessment score between days 1 and 3 (ρ = -0.2, p = 0.34). Despite a small sample of patients, cold IV fluids in TH appear safe in the postcardiac arrest population. These findings should be reproduced in a larger, prospective study.

Objective: The objective of our study was to evaluate the effectiveness of ultrasound-guided corticosteroid injection for the treatment of gluteus medius tendinopathy., Subjects and Methods: We prospectively evaluated 54 consecutive patients (48 women, six men; mean age, 54.7 years; mean body mass index, 26 kg/m2) with a clinical diagnosis of gluteus medius tendinopathy. Pain assessment using a 10-cm visual analog scale (VAS) was obtained as part of the initial clinical evaluation of all patients. A hip ultrasound study was performed followed by a gluteus medius peritendinous ultrasound-guided injection of 30 mg of triamcinolone combined with 3 mL of bupivacaine 0.5% using an anterior oblique coronal plane. One month after treatment, participants were reassessed clinically, and they were asked to quantify their pain using the VAS pain score and their satisfaction with the outcome of the injection using a 4-point rating scale (very satisfied, somewhat satisfied, somewhat dissatisfied, or very dissatisfied). Statistical analysis included a paired Student's t test (comparison of pain levels before and after treatment, p=0.05) and a multivariate analysis of covariance., Results: There was a 55% average reduction of pain level before versus after treatment (mean VAS pain score, 6.4 vs 2.9 cm, respectively; p<0.001). One month after treatment, 72% of the patients showed a clinically significant improvement in pain level, which was defined as a reduction in the VAS pain score of >or=30%. Seventy percent of patients were satisfied with the results of the intervention. No correlation was shown between treatment outcome and any of the clinical variables or ultrasound findings., Conclusion: Our study shows that a peritendinous ultrasound-guided corticosteroid injection may be an effective treatment of gluteus medius tendinopathy.

Quantitative discomanometry is a study of intradiscal pressure changes during quantitative injection. The purpose of this study was to determine if correlations exist between discomanometric parameters and disk injuries. Sixteen three-vertebrae porcine spine segments, with two intervening disks, were subjected to standardized high-speed trauma. The injuries were documented by a radiographic injury score (RIS), using pre- and posttrauma lateral radiographs. An anatomic injury score (AIS) also was obtained, based on an anatomic dissection and mid-sagittal plane cuts of the frozen specimen. Before the cutting, each of the disks was subjected to quantitative discomanometry, providing pressure/volume curves. Significant negative correlations were found between the RIS and the maximum pressure sustained (R = -0.60, p < 0.001), and pressure/volume slope (R = -0.60, p < 0.001). Similar relationships were found between the AIS and the maximum pressure (R = -0.71, p < 0.001), and pressure/volume slope (R = -0.63, p < 0.001). This study suggests that quantitative discomanometry can be used to quantify disk injuries. Because the intradiscal pressurization mimics the physiology with weight bearing, its use as a measure of integrity of the end-plate-annulus-end-plate enclosure might be justified.

This study provides the quantitative three-dimensional surface anatomy of the articular facets for the entire human vertebral column based on a study of 276 vertebrae. Means and standard errors of the means for linear, angular, and area dimensions of the superior and inferior articular facets were measured for all vertebrae from C2 to L5. Facet orientations were described as angles with respect to the sagittal and transverse planes and also as card angles. The plane angles are similar to the angles seen on traditional radiographic views--radiographs and computed tomographic scans. The card angles, a new concept, are better at helping visualize the three-dimensional orientations of the facets. Excluding the superior C2 facet, the following minimum and maximum dimensions were found for the facets from C3 to L5: width = 9.6-16.3 mm; height = 10.2-18.4; surface area = 72.3-211.9 mm2; interfacet width = 20.8-40.6; interfacet height = 12.2-33.0 mm; transverse plane angle = 41.0-86.0; sagittal plane angle = 67.4-154.8; X-card angle = 41.0-86.0; and Y-card angle = 5.8-66.1. The quantitative anatomy of the facets may improve the understanding of the spinal anatomy, help improve the clinical diagnosis and treatment, and provide the necessary data for constructing more realistic mathematical models of the spine.

In this study, the three-dimensional quantitative anatomy of middle and lower cervical vertebrae was determined. The three-dimensional coordinates of various marked points on the surface of the vertebra were measured with a specially designed morphometer instrument. From these coordinates, linear dimensions, angulations, and areas of surfaces and cross-sections of most vertebral components were calculated. The results showed two distinct transition regions: 1) toward the thoracic spine by the wider C7 vertebra but narrower spinal canal; and 2) toward the upper cervical region with the larger pedicle and spinous process of C2. Based on the study of 72 human cervical vertebrae, mean and standard error of the mean values of some clinically important dimensions of vertebral body, spinal canal, pedicles, transverse processes, spinous process, and uncovertebral joints are given for C2-C7 vertebrae. The areas of the end plates, spinal canal, and pedicles were modeled by elliptical and triangular shapes, and results were compared with the actual measurements.

This study details the quantitative three-dimensional surface anatomy of thoracic vertebrae based on a study of 144 vertebrae. The thoracic spine was found to have three distinct regions: upper, middle, and lower segments. The two end segments appear to be transitional zones toward cervical and lumbar regions. The middle zone (T3 to T9) is of utmost importance due to the presence of the combination of narrow spinal canal and critical vascular supply. Means and standard errors of the means for linear, angular, and area dimensions of vertebral bodies, spinal canal, pedicle, pars articularis, spinous and transverse processes, and rib articulations are provided for all thoracic vertebrae. This information is necessary for constructing accurate mathematical models of the human spine. It will also provide a better understanding of the spine, and allow for a more precise clinical and surgical management of spinal problems.

The three-dimensional (3-D) morphology of lumbar spinal ligaments was studied using 22 functional spinal units. A specially constructed 3-D morphometer instrument was used for quantitative measurements of each ligament's attachment point locations, origins and insertions, and attachments to the lower and upper vertebral bodies, respectively. Lengths and orientations of the ligaments according to the vertebral level were then computed and presented in reference to a local anatomic coordinate system. Associated cross-sectional areas are also obtained.

The three-dimensional rotational biomechanical properties of several different types of posterior stabilizing procedures are reported. A severe ligamentous and bony injury was simulated with three vertebral body human cervical spine segments. Good stabilization was noted for all of the repairs in flexion loading. Without polymethylmethacrylate supplementation, none of the repairs was stable in extension. All of the repairs provided reasonable stabilization for lateral bending except for the posterior wiring without methacrylate, and all but the posterior wiring and facet fusion provided reasonable stabilization against axial rotation loading. The supplementation of all of these repairs with polymethylmethacrylate added considerably to the stability of all the constraints. These findings may be useful in clinical decision-making for determining the kind of repairs and postoperative brace protection to use.

Cervical spine fractures and dislocations account for a large number of deaths and disabilities in the United States each year. More knowledge of the anatomic injuries produced by known trauma may yield practical information regarding injury mechanisms and treatment alternatives. In this experiment, 16 porcine cervical spine three-vertebrae segments were subjected to flexion-compression, extension-compression, and compression-alone trauma modes. The resultant injuries were scored by anatomic dissection. The results were analyzed for variance with trauma mode using nonparametric analysis. The three modes of trauma were found to have statistically significant differences in the degree of injury to the spine and its structural components. Extension-compression trauma produced the greatest injury scores to the whole spine and to the anterior structures. Flexion-compression trauma produced the highest posterior element injury scores. Compression trauma alone produced the lowest injury scores and no definitive pattern of anatomic injuries. The severity of anatomic injuries in this model relates most to the addition of bending moments to high-speed axial compression of the spine segment.

The three-dimentional stability provided by six spinal fixation devices with or without interbody bone graft has been studied in an in vitro biomechanical model using five-vertebral (T11-L3) fresh cadaveric thoracolumbar specimens. An injury was created at T12-L1 by complete transection of the posterior elements and posterior half of the intervertebral disc, leaving the anterior half of the intervertebral disc and anterior longitudinal ligament intact. The three-dimensional rotations and translations, measures of biomechanical instabilities, were determined under physiologic loads for the intact spine and the spinal constructs, ie, injured spine plus instrumentation. The tested devices were: Harrington reverse ratchet rods (HR); Luque rectangle rod (LR); Kaneda device without transverse fixator (KD); Kaneda device with transverse fixators (KT); transpedicular external fixator (EF). In addition, stability tests were performed for KT, EF, and Harrington compression rods with interbody bone graft following a corpectomy (KTB, EFB, and HCB). The constructs were more stable than the intact spine under the four loads in the following order: flexion: EFB, HCB, EF, HR, LR, KTB, and KT; extension: EFB, LR, EF, KTB, HR, and KT; lateral bending: KTB, KT, EFB, KD, EF, HCB, and HR; and axial rotation: EFB.

Sixty patients (42 men and 18 women between the ages of 18 and 37 years) with grade 2 or grade 3 sprains or elongations participated in a seven-day double-blind study. By random determination, they were treated with either 100 mg of ketoprofen or placebo TID. Pain evaluation, vital signs, concomitant medication, and side effects were determined on days 1,3, and 7. Compared with placebo, ketoprofen produced statistically significant reductions (P less than 0.05) in investigator-rated pain at rest (day 3), on palpation (days 1, 3, and 7), on motion (days 1 and 3), and on the subject-rated analog scale (days 1 and 3). It also achieved a greater relief of pain (days 1 and 3) and greater overall efficacy, as expressed by the statistically significant improvements in the total pain scores on motion and on palpation, on the total pain relief score, on the total pain analog score, and on the sum of pain intensity differences for pain at rest, on palpation, and on motion. Tolerance to the seven-day ketoprofen treatment was excellent. Results from the study indicate that ketoprofen is efficacious in relieving pain following sprains and strains.

The three-dimensional stability provided by eight spinal fixation devices has been studied in an in vitro biomechanical model using seven-vertebrae (T9-L3) fresh cadaveric thoracolumbar specimens. An injury was created at T12-L1 by complete transection of the posterior elements and posterior half of the intervertebral disc, leaving the anterior half of the intervertebral disc and anterior longitudinal ligament intact. The three-dimensional rotational and translational motions, measures of biomechanical instabilities, were determined under physiologic loads for the intact specimen after injury and instrumentation with each of the eight fixation devices. The tested devices were: Dunn's anterior device (DD); Harrington distraction (HD); Harrington compression (HC); Harrington distraction-compression combination (HDC); Harrington distraction with sleeves (HDS); Luque rods (LQ); Luque rectangle (LR); and Luque short rectangle (LSR). The following devices were stable under the four loads: Flexion: HC, HD, HDC, HDS, LQ, and LR; Extension: HD, HDC, HDS, LQ, and LR; Lateral Bending: LQ and LR; and Axial Rotation: none.

The human spinal column, devoid of musculature, is incapable of carrying normal physiologic loads. In an in vitro experiment, the effect of simulated intersegmental muscle forces on spinal instability was investigated. Intact and sequentially injured fresh lumbar functional spinal units were subjected to three-dimensional biomechanical tests with increasing muscle forces. With the application of muscle forces, range of motion (ROM) increased and neutral zone (NZ) decreased in flexion loading, while both ROM and NZ decreased in extension loading. In lateral bending, ROM and NZ were unaffected by the application of the muscle forces. In axial rotation, ROM decreased significantly, while NZ decrease was statistically insignificant. It was concluded that the action of the intersegmental muscle forces is to maintain or decrease intervertebral motions after injury, with the exception of the flexion ROM, which increased with the application of muscle forces. In addition, the study suggested that Neutral Zone is a better indicator of spinal instability than Range of Motion.