Background: Despite advances in pain management, several patients continue to experience severe acute pain after lumbar spine surgery. The aim of this study was to assess the safety and effectiveness of single ultra–low-dose intrathecal (IT) naloxone in combination with IT morphine for reducing pain intensity, pruritus, nausea, and vomiting in patients undergoing lumbar laminectomy with spinal fusion. Materials and Methods: In this double-blind trial, patients scheduled for lumbar laminectomy with spinal fusion were randomly assigned to receive single ultra–low-dose IT naloxone (20 μg) and IT morphine (0.2 mg) (group M+N) or IT morphine (0.2 mg) alone (group M). The severity of postoperative pain, pruritus and nausea, and frequency of vomiting were assessed at recovery from anesthesia and, subsequently, at 1, 3, 6, 12, and 24 hours postoperatively using an 11-point (0-10) visual analogue scale. Results: A total of 77 patients completed the study, and there were significant differences in postoperative pain, pruritus, and nausea visual analogue scale between the groups (P<0.05). After adjusting for body mass index and surgery duration, IT naloxone administration reduced the pain score (coefficient=1.84; 95% confidence interval [CI], 1.05-2.63; P<0.001), and the scores of pruritus and nausea (coefficient=0.9; 95% CI, 0.44-1.37; P<0.001 and coefficient=0.71; 95% CI, 0.12-1.31; P=0.02, respectively) compared with IT morphine alone. No serious adverse effects were observed. Conclusions: The addition of ultra–low-dose IT naloxone to IT morphine provides excellent postoperative pain management and effectively controls pruritus and nausea in patients undergoing laminectomy with spinal fusion.

Background: Anterior sacral meningocele (ASM) is a rare congenital anomaly. It is characterized by herniation of the dura through a defect in the anterior sacrum. Rarely, however, it may extend to the rectal area through a rectothecal fistula with or without rectorrhea. Case Description: Here, we present a case of ASM associated with a rectothecal fistula and rectorrhea. Surgical closure of the ostium of the cyst through a posterior approach resulted in long-term improvement Conclusion: An ASM with both rectothecal fistula and rectorrhea is extremely rare.

Introduction: Despite the availability of many imaging and clinical criteria for diagnosis of lumbar spinal stenosis (LSS), its correct diagnosis is a challenge for clinicians and radiologists. Aim: The aim of this study was to examine the relationship between magnetic resonance imaging (MRI) findings and clinical symptoms in symptomatic and asymptomatic patients with suspected LSS in MRI. Methods: This study is a case-control study. Two groups of 100 symptomatic and asymptomatic individuals (aged 20 to 84 years) with suspected lumbar spinal canal stenosis who referred to the imaging unit for lumbosacral MRI were included. The clinical symptoms and radiological parameters in MRI for all patients were recorded and relationship between them were evaluated. Results: Among the quantitative imaging findings, only the anterior-posterior diameter of the canal at the level of the intervertebral disc, the central spinal canal cross-section area and lateral recesses cross-sectional area were valuable. Coefficient of stenosis was calculated for the case and control groups which had statistically significant difference (p<0.001). The difference between qualitative findings such as disc protrusion, extrusion, sequestration and Cauda Equine serpain or redundant was significant between the two groups. Conclusion: According to the results, among the quantitative criteria of MRI imaging findings, central spinal canal cross-section (less than 77.5 mm2 for central stenosis) and lateral recesses cross-section (less than 22.5 mm2 for lateral stenosis) had the highest sensitivity and specificity for LSS diagnosis in symptomatic and asymptomatic patients with suspected LSS. Strongest observed correlation was between neurogenic claudication and LSS diagnostic radiological markers.

SUMMARY Infusions of metaraminol and angiotensin were used to test the effect of increased perfusion pressure on tissue metabolism and oedema after induction of regional cerebral ischaemia in the rat and the gerbil. An increase of mean arterial blood pressure of 30-40 mmHg in the rat over the first 2 hours after diathermy of the middle cerebral artery prevented the 100% rise in hemisphere lactate seen in normotensive control animals. Angiotensin infusion also prevented early hemispheric oedema in this model. In the gerbil, 4 hours after placing a clip on one carotid artery, metaraminolinduced increases in blood pressure had no such protective effect on the metabolic changes or on oedema. When the clip was removed after 3 hours to permit 1 hour of reperfusion, lactate levels returned to normal but the degree of oedema was unchanged. Hypertension in this reperfusion model caused a slight but not statistically significant increase in oedema. The evidence suggests that moderate increases in blood pressure may be protective against the early metabolic sequelae of focal cerebral ischaemia, but there are potential problems with oedema formation. It is argued that a clinical trial should study the potentially beneficial effects of a brief early increase in blood pressure in the acute aftermath of ischaemic stroke.

SUMMARY The possibility that the ability of bezafibrate to lower the oxygen affinity of haemoglobin might lead to an increased oxygen delivery to ischaemic cerebral tissue was explored in preliminary studies in two animal models. The combined morbidity and mortality of unilateral carotid ligation in the gerbil appeared to be reduced at two hours in bezafibrate treated animals. By four hours and thereafter the outcome was unaffected. Two hours after MCA occlusion bezafibrate-treated rats showed a significantly reduced rise in tissue lactate concentration (p < 001) suggesting less anaerobic metabolism had occurred in the ischaemic tissue. RatsTwelve male Sprague-Dawley rats (370-620 g) were allowed free access to food and water before induction of anaesthesia with ether. Surgical anaesthesia was maintained with intraperitoneal urethane 1-25 g/kg as a 25% solution in normal saline. The right femoral artery was cannulated for arterial sampling and blood pressure recording, and the left femoral vein cannulated for infusions. A tracheostomy was performed and the left common carotid artery ligated. Body temperature was monitored by a rectal probe and maintained by a heat lamp. After physiological baseline values were established for arterial blood pressure, PO2, pCO2, pH, glucose and haematocrit, and core temperature, the left middle cerebral artery (MCA) was occluded by diathermy as previously described.'2 13One hour before MCA occlusion, six animals received an intraperitoneal injection of bezafibrate similar to the gerbils (10 mg/kg) and the other six were untreated controls. Both groups received an intravenous infusion of 2 ml of normal 432 Protected by copyright. on 12 May 2018 by guest.