A 56-year-old man presented with a rare spinal epidural abscess manifesting as attacks of back pain associated with fever, weight loss, generalized weakness and fatigability, and constipation. He had multiple skin pustules in the last 4 months treated with oral amoxicillin. He had suffered diabetes mellitus for the last 5 years and was insulin dependent. Physical examination found slight paraparesis with sensory loss around the nipple and sphincteric urgency, and diabetic retinopathy. Magnetic resonance imaging showed edematous T2, T3, and T4 vertebral bodies, and narrow enhanced T3-4 disk space with a soft tissue enhanced mass mostly anterior to the spinal cord and indenting the cord. T3-4 costotransversectomy was performed to remove the extradural mass and evacuate the intradiscal material. Histological examination of the bone found osteomyelitis, and culture of the soft tissue showed Salmonella typhi sensitive to ceftriaxone and ciprofloxacin. Intravenous ceftriaxone administration was started, and the patient was discharged after 6 days in good condition. The outcome of spinal epidural abscess is devastating unless recognized and treated early. The present case of spinal epidural abscess in the thoracic spine caused by Salmonella typhi infection illustrates the importance of cultures to assess the drug sensitivity of the specific strain detected and adjusting the treatment accordingly.
The peel-away sheath in neuroendoscopic surgery offers numerous advantages and has many potential applications. However, currently available nontransparent sheaths have a critical disadvantage in that disorientation can occur, given the limited visible operative field. To overcome this obstacle, the authors have developed and clinically applied a new transparent sheath with "navigational orientation markers." The clear peel-away sheath provides a transparenchymal route, parenchymal protection, and, most importantly, direct visualization of the surroundings along the whole trajectory and at the distal edge. The navigational orientation markers add further benefits in terms of facilitating orientation in the endoscope trajectory, making this tool extremely useful in neuroendoscopic surgery.
In the presented research, design of functional electrical stimulation (FES) based muscle stimulator device has been described which is used to correct and enhance the gait activity of foot drop patients. The device mainly comprises of FES unit for electrical pulse generation, an electromyography (EMG) sensor V3 for feedback system and insole force-sensitive resistive sensors (FSR) to control ON/OFF timing of device. The device controls the ankle flexion without excessive eversion or inversion of foot (i.e. balanced flexion) by stimulation of common peroneal nerve and tibialis anterior muscle (TA). The efficiency of device is assessed by evaluating gait temporal and spatial parameters (TSP's) and 3-dimensional gait kinematics (ankle flexion) of footdrop patients by "Peak Motus Motion Measurement System". It has been found that use of FES stimulator increases the walking speed by 19%, cadence by 7%, step length by 11% and stride length by 15.5%. In addition, it is also observed that stride time, stance time, step time, single support time and double support time is decreased by 5%, 17%, 22%, 15% and 18% respectively. Moreover, kinematics analysis of foot shows that the device prevented the footdrop up to 30° by controlling the ankle flexion and extension magnitude. Thus, the obtained results suggest that the proposed FES based stimulator device provides enough stimulation to peroneal nerve required for stable gait activity of footdrop patients.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.