Lumbar discectomy is one of the most commonly performed neurosurgical procedure. Far lateral disc herniations (FLDH) make up a minor portion of the total discectomy workload for spine surgeons. Due to their lower incidence, as well as their different anatomical positioning compared to the more common para-median disc herniation, the surgical procedures involved in releasing the neural compression caused by FLDHs are often challenging and at times frustrating to most spine surgeons, resulting in suboptimal outcomes for the patient related to the higher risk of spinal instability from facet joint disruption and may even be associated with nerve root injury. We discuss here a safe and simple approach to tackle FLDH.
HLA-A*31:01 and HLA-B*15:02 have been widely reported to confer genetic susceptibility to carbamazepine (CBZ)-induced severe cutaneous adverse reactions (SCARs). Accordingly, the screening for these alleles has been highly recommended to prevent SCAR prior to introducing CBZ therapy. Although a number of methods are available for screening of HLA-A*31:01 or HLA-B*15:02 alleles separately, developing an assay that can detect both these alleles would be more clinically practical, cost-effective and less time-consuming. Therefore, in this study, a multiplex polymerase chain reaction (PCR) using TaqMan Probe was designed and validated to be able to detect HLA-A*31:01 and HLA-B*15:02. In comparison with Luminex-SSO/SBT/SSB, the multiplex PCR assay for detection of HLA-A*31:01 and HLA-B*15:02 had a perfect agreement in the validation group of 125 samples. The method was able to detect the target genes at the DNA concentration of 0.037 ng/μL. The unit cost of this assay is less than $5 USD with total time of 110 minutes.
Sympathetic acceleration of ABP using PE resulted in surges in IOP and OPA. In contrast, increased venous pressure resulted in a more sustained rise in IOP but to a lesser extent. These responses were more pronounced in eyes with experimental glaucoma compared with control eyes, which may reflect the higher starting IOP contributing to a reduced ocular compliance. Our results suggest that eyes with ocular hypertension are more susceptible to IOP variability induced by hemodynamic fluctuations.
NNBL is a subset of neuroblastoma with apparent excellent outcome irrespective of the time of diagnosis. Clinical features and outcomes of ADNB are no different to PDNB.
This study aims to provide a national benchmark rate of post-tonsillectomy haemorrhage (PTH) in Australia. Using data from Australia’s National Hospital Morbidity Database (NHMD) from 1 July 2000 to 30 June 2020, we have conducted a nation-wide population-based study to estimate a reference rate of PTH. Outcomes of interest included the overall rate and time-trend of PTH, the relationship between PTH rates with age and gender as well as the epidemiology of tonsillectomy procedures. A total of 941,557 tonsillectomy procedures and 15,391 PTH episodes were recorded for the study period. Whilst the incidence of tonsillectomy procedures and the number of day-stay tonsillectomy procedures have increased substantially over time, the overall rate of PTH for all ages has remained relatively constant (1.6% [95% CI: 1.61 to 1.66]) with no significant association observed between the annual rates of PTH and time (year) (Spearman correlation coefficient, Rs = 0.24 (95% CI: -0.22 to 0.61), P = 0.3). However, the rate of PTH in adults (aged 15 years and over) experienced a statistically significant mild to moderate upward association with time (year) Rs = 0.64 (95% CI: 0.28 to 0.84), P = 0.003. Analysis of the odds of PTH using the risk factors of increasing age and male gender showed a unique age and gender risk pattern for PTH where males aged 20 to 24 years had the highest risk of PTH odds ratio 7.3 (95% CI: 6.7 to 7.8) compared to patients aged 1 to 4 years. Clinicians should be mindful of the greater risk of PTH in male adolescents and young adults. The NHMD datasets can be continually used to evaluate the benchmark PTH rate in Australia and to facilitate tonsillectomy surgical audit activities and quality improvement programs on a national basis.
Behçet disease is a multisystem vasculitis characterised by recurrent oral ulceration in conjunction with other manifestations. Neurological involvement or neuro-Behçet disease is not common, but typically affects young men at its onset between the ages of 20 and 40 with significant long-term morbidity and mortality. There is substantial case literature to support the use of tumour necrosis factor antagonists, notably infliximab, in the treatment of neuro-Behçet disease.
Objective: To investigate the incidence of middle ear cholesteatoma surgery and assess trends in mastoidectomy procedures in Australia. Study design: Cross-sectional population-based study using data from the National Hospital Morbidity Database. Methods: Admitted care episodes containing the principal diagnosis of middle ear cholesteatoma were analyzed for two 12-month periods of 2007-2008 and 2017-2018. Surgical admissions involving mastoidectomy were identified by procedure codes. Incidence rate per 100,000 person-years were compared between study periods.Results: Of the 3855 middle ear cholesteatoma admissions, 3558 (92.3%) involved surgery, with the incidence rate for cholesteatoma surgical admissions estimated at
Introduction: Total en bloc spondylectomy (TES) is gaining increasing favour as a treatment of choice for cancers of the spine that are resistant to radiological and chemotherapeautic intervention such as renal cell carcinoma (RCC). Until recently, RCC of the lumbar spine has presented a surgical challenge due to anatomical and vascular constraints. The development of the combined posterior-anterior en bloc spondylectomy offers improved access to the lumbar region. This case report and review of the literature presents a combined posterior-anterior lumbar en bloc spondylectomy for RCC involving L3 vertebra, which we believe is the first reported in Australia. Methods: A 46-year-old male with a seven-year history of renal cell carcinoma resulting in a left nephrectomy presented with a lytic lesion involving the L3 vertebral body, extending to the epidural space and compressing the cauda equina and left L3 and L4 nerve roots on MRI. A literature review revealed ten previous cases of the posterior-anterior TES in the lumbar spine for cancerous lesions but none from Australia. Results: A posterior-anterior TES and L2-L4 fusion was performed to remove a cancerous renal cell carcinoma of L3 with wide margins. Blood loss was the major complication. The patient remains recurrence free at nineteen months post procedure. Conclusion: Despite being an aggressive and invasive procedure, TES is rapidly becoming the treatment of choice for curative and palliative care in select patients with isolated metastatic tumours of the lumbar spine.
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