Abstract Neoadjuvant chemotherapy (NC) may be utilized for treatment of various tumors, and a proportion of patients on active NC may require resection of a primary or secondary brain tumor. The ...objective of this study is to examine the impact of NC on postoperative neurosurgical outcomes. Elective cranial neurosurgical patient data was obtained from the American College of Surgeons National Surgical Quality Improvement Program database between 2006 and 2012. The impact of NC on 30 day stroke, all-cause postoperative morbidity, and mortality were assessed. Adjusted odds ratios (OR) were estimated for stroke, overall morbidity, and mortality using a multivariable logistic regression model, accomplished in stepwise fashion, for patients receiving NC versus those not receiving NC. This study analyzed 3812 patients undergoing elective cranial surgery, with 152 on concurrent NC. NC patients had a complication rate of 23.68%, while patients not receiving NC had a lower complication rate at 17.65% ( p = 0.057). Multivariable regression analysis revealed that patients who received NC had significantly increased odds of developing a stroke with neurological deficit (OR 3.39; 95% confidence interval CI 1.37–8.40) and all-cause postoperative morbidity (OR 1.57; 95% CI 1.04–2.37) over the control group. Finally, the NC cohort demonstrated higher odds of mortality following surgery than their non-NC counterparts (OR 3.81; 95% CI 1.81–8.02). Ninety-two patients (2.41%) died within 30 days, of whom 10 (6.58%) were receiving NC versus 82 non-NC (2.24%) patients ( p = 0.001). Concurrent NC is associated with an increased risk of short-term stroke with neurological deficit, all-cause morbidity, and mortality in patients undergoing brain tumor resection.
Abstract Panic is commonly co-morbid with schizophrenia. Panic may emerge prodromally, contribute to specific psychotic symptoms, and predict medication response. Panic is often missed due to ...agitation, impaired cognition, psychotic symptom overlap and limited clinician awareness. Carbon dioxide exposure has been used reliably to induce panic in non-psychotic panic subjects, but has not been systematically studied in schizophrenia. Eight inpatients with schizophrenia, recent auditory hallucinations, none preselected for panic, all on antipsychotic medication, received a structured Panic and Schizophrenia Interview (PaSI), assessing DSM-IV panic symptoms concurrent with paroxysmal auditory hallucinations. On that interview, all eight subjects reported panic concurrent with auditory hallucinations. At one sitting, subjects were exposed, in random order, to 35% carbon dioxide and to placebo room air, blinded to condition. All subjects experienced panic to carbon dioxide, one with limited symptoms. Only one subject panicked to placebo. One subject (one of only two without antipanic medication) had paroxysmal voices concurrent with induced panic. With added adjunctive clonazepam, that patient had marked clinical improvement and no response to carbon dioxide re-challenge. This first systematic examination offers preliminary evidence that carbon dioxide safely induces panic symptoms in schizophrenia. Panic may be prevalent and pathophysiologically significant in schizophrenia with auditory hallucinations.
We present a unique application of the gold fiducial as a preoperative, radiographic marker placed in the thoracic spine and used for intraoperative localization. In comparison to percutaneous ...vertebroplasty marking of thoracic spinal levels with polymethyl methacrylate (PMMA) cement, implantation of the gold fiducial is technically facile with a minimal learning curve. The fiducial markers are also associated with significantly less financial resources. Following 2013 Current Procedural Terminology (CPT) coding, the cost of vertebroplasty under fluoroscopic guidance, $3195·43, or under computed tomography (CT) guidance, $3232·54, is more than double the cost of the gold fiducial implantation - $1237·55 and $1267·03, under similar imaging techniques, respectively. In the first description of gold fiducials in the thoracic spine, we conclude that the marker is a safe and cost-effective method for preoperative localization of the thoracic levels.
18 For servicemembers serving in the Central Command (CENTCOM) area of operations (AO), which includes Kuwait, Iraq, or Afghanistan, creating pornography or sexually explicit photographs constitutes ...a violation of General Order 1 (GO 1).19 A commander in the CENTCOM AO may charge the servicemember who takes a sexually explicit photograph of another person, as well as the servicemember posing in the picture, with a violation of UCMJ Article 92, section one, as a violation of or failure to obey a lawful general order.20 For servicemembers serving in the Continental United States or in other areas of the world, a commander may charge a Soldier for violating Article 120, of the UCMJ for indecent exposure.21 If a service member intentionally exposes his or her genitalia, anus, buttocks, or female areola or nipple, in an indecent manner, in any place where the conduct involved may reasonably be expected to be viewed by people other than the servicemember's family or household, then the servicemember violated Article 120 and may be found guilty of indecent exposure.22 Although the UCMJ does not specifically prohibit making sexually explicit photos for public viewing, it can be argued that the elements of the offense include posing nude for pictures with the intent that those photographs will be made public.23 A commander may also elect to create a specification under Article 134, clause two, for a general violation of service discrediting conduct, but the case law currently differs among the services as to what actually constitutes service discrediting.
Background: Posterior, atlantoaxial (AA) fusions of the cervical spine may include either standard (26 mm) or short (16 mm) C2 pedicle screws. This manuscript focused on an in vitro biomechanical ...comparison of standard versus short C2 pedicle screws to perform posterior C1-C2 AA fusions. Methods: Twelve human cadaveric spines underwent C1 lateral mass screw and standard C2 pedicle screw (n = 6) versus short C2 pedicle screw (n = 6) fixation. Six additional controls were not instrumented. The peak torque, peak rotational interval, and peak stiffness of the constructs were analyzed to failure levels. Results: The peak torque to construct failure was not statistically significantly different among the control spine (12.2 Nm), short pedicle fixation (15.5 Nm), or the standard pedicle fixation (11.6 Nm), P = 0.79. While the angle at the peak rotation statistically significantly differed between the control specimens (47.7 of relative motion) and the overall instrumented specimens (P < 0.001), the 20.7 of relative rotation in the short C2 pedicle screw specimens was not statistically significantly higher than the 13.7 of relative rotation in the standard C2 pedicle screw specimens (P = 0.39). Similarly, although the average stiffness was statistically significantly lower in control group (0.026 Nm/degree) versus the overall instrumented specimens (P = 0.001), the standard C2 pedicle screws (2.54 Nm/degree) did not differ from the short C2 pedicle screws (1.69 Nm/degree) (P = 0.30). Conclusions: Both standard and short C2 pedicle screws allow for equally rigid fixation of C1 lateral mass-C2 AA fusions. Usage of a short C2 pedicle screw may be an acceptable method of stabilization in carefully selected patient populations.
Twentieth-century Irish culture—shaped by, for instance, the Catholic Church, nationalist narratives of blood sacrifice for "Mother Ireland," and the experience of emergence from colonialism—put ...special pressure on the meanings attached to bodies in narratives of both individual and national maturation. This dissertation examines the human body's role in Irish novels of development, tracing specifically how Irish authors deploy the growing body in relation to the self-cultivating subject of a Bildungsroman (or "coming of age" novel). This project shows that Irish social conditions provoked urgent reworkings of generic conventions, and impelled Irish authors to develop sophisticated strategies for representing growing bodies in narrative. Through close examinations of four novels, this project identifies four facets of the role the growing body can take in fictions of development. The introduction provides an overview of the absent body, the body that grows in passing, the body growing sideways, and the unnarratable body. Individual chapters examine these respective facets as they manifest in James Joyce's highly influential Portrait of the Artist as a Young Man (1916), John McGahern's The Dark (1965), Éilís Ní Dhuibhne's The Dancers Dancing (1999), and Anne Enright's The Wig My Father Wore (1995). Chapter one describes how Joyce largely reserves Stephen Dedalus's body from representation so that other developmental aspects feature more prominently. Chapter two examines McGahern's representations of the real, material growing body's volatility and entanglement with forces beyond the subject's autonomous control as a strategic response to the post-Independence Irish social environment. Chapter three asserts that Ní Dhuibhne depicts a female protagonist filling out and experiencing lateral, or "sideways" modes of growth to expand the possibilities for narrating Irish female identity and to denaturalize nationalist representational strategies, while chapter four identifies the protagonist's growing body as an unsayable and indeterminate thing at the center of Enright's experimental text. The coda considers the contemporary moment of instability and recession against claims that Ireland "came of age" in the 1990s, taking stock of the growing body in the "Celtic Tiger" literary moment and grounding this stock-taking in earlier representations of development that mobilized bodily growth to tell stories.
ABSTRACT
BACKGROUND:
Adjacent segment disease (ASD) has not been described after laminectomy without fusion.
OBJECTIVE:
To determine the incidence of ASD after a 1- or 2-level lumbar laminectomy.
...METHODS:
We retrospectively reviewed medical records of all patients who underwent 1- or 2-level, bilateral lumbar laminectomy without fusion for degenerative spinal disease (all follow-up ≥1 year). ASD was defined as clinical and/or radiographic evidence of degenerative spinal disease that required reoperation at the level above or below the index laminectomy.
RESULTS:
Of the 398 patients, the incidence of ASD requiring reoperation was 10%. The 39 ASD cases were almost equally distributed at L2-L3 (31%), L3-L4 (26%), and L5-S1 (31%), and to a lesser extent at L4-L5 (15%) (P = .51). The ASD incidences of 10% and 9% were equivalent after a 1- and 2-level laminectomy, respectively (P = .76). Rostral ASD was statistically more common than caudal ASD after both the 1- (P < .001) and 2- (P < .001) level laminectomy. Of the 39 ASD cases, 95% required laminectomy, 26% discectomy, and 49% fusion. Average time to ASD was 4 years. After a Kaplan-Meier analysis, time to reoperation for ASD was equivalent among the 1- and 2-level laminectomy cohorts (log-rank test, P = .13).
CONCLUSION:
The cumulative incidence of ASD requiring reoperation was 10% over a mean of 4 years. Both the 1- and 2-level laminectomy cohorts experienced equivalent incidences and rates of ASD. Of the 39 operations for ASD, about half required a fusion.
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