Peripheral nerve repair by means of a flexible biodegradable glass fibre wrap: a comparison with microsurgical epineurial repair.

In this study, a new technique for the repair of divided peripheral nerves using a flexible controlled-release glass wrap is described and its successful use is reported. Corglaes is a biodegradable and biocompatible glass which, when used as a solid glass tube form as a nerve conduit, allows nerve regeneration. It is now produced as a flexible, porous wrap (CRG-wrap). In this study, the CRG-wrap was used to repair divided median nerves in the upper forelimb of sheep. The wrap was secured in place around the divided nerve ends using fibrin glue or 6/0 polyglactin sutures. Microsurgical epineurial suturing was used to repair the same injury in another group. Twelve sheep were used in each group. A control group of sheep, on which no operations had been carried out, was also examined. The outcome of each repair was assessed at 7 months by measuring transcutaneous stimulated jitter (TSJ), maximum conduction velocity (CVmax), wet muscle mass and morphometric measurements. Testing was carried out on the limb that had been operated upon and the normal contralateral forelimb. The ratio of the measurements taken in the operated and the normal limb (the right and left forelimbs in the control group) was used when carrying out statistical analyses on the results. The mean and variance of the ratios of each of the measured variables in the three repair groups were similar suggesting that nerve regeneration had occurred to a similar degree in all the repair groups (analyses were carried out using one-way ANOVA and Scheffé's test, with statistical significance assumed at p<0.05). The repair of peripheral nerves using the CRG-wrap is easy to learn, quicker and cheaper than microsurgical epineurial suturing, and can be carried out by any surgeon with basic surgical skills. It was concluded that CRG-wrap is a useful alternative to microsurgical epineurial suturing for the repair of peripheral nerves.     

Occult spinal dysraphism and urolithiasis: are patients at higher risk of stone disease?

BACKGROUND AND PURPOSE: Spinal dysraphism is associated with urinary-tract dysfunction in severe cases such as meningomyelocele, in part because of incomplete innervation of the lower urinary tract. Patients with meningomyelocele are at higher risk for stone formation, possibly secondary to stasis of urine from aberrant storage and emptying. However, minimal data exist on the risk of stone formation in patients with milder forms of spinal dysraphism. The purpose of this study was to examine whether an association exists between urolithiasis and occult spinal dysraphism (OSD). PATIENTS AND METHODS: All patients who underwent a non-contrast CT scan of the abdomen and pelvis during a 4-month period were included. The final dataset consisted of 374 consecutive patients (195 men, 179 women) with a mean age of 54.2 years (range 18-95 years). Scans were reviewed for evidence of urolithiasis and, independently, for skeletal abnormalities. Patients with urolithiasis included those with a kidney, ureteral, or bladder stone(s). Patients with OSD included those with bifid lumbosacral bony elements, posterior arch defects, or incomplete fusion or non-fusion of S1, S2, or S3. The association between urolithiasis and OSD was examined by calculating series of crude and adjusted odds ratios (ORs) with corresponding 95% confidence intervals (CIs). RESULTS: Of the 374 patients, 135 (36.1%) had urinary calculi, and 83 (22.2%) had OSD. No relation was found between the prevalence of OSD and stone disease (OR 1.22; 95% CI 0.72, 2.08), even after adjusting for potential confounders. CONCLUSION: Unlike severe spinal dysraphism, OSD does not appear to confer an increased risk of stone disease.     

Clearing the cervical spine in unconscious adult trauma patients: a survey of practice in specialist centres in the UK

A postal questionnaire survey of neurosurgery and spinal injury departments in the UK was conducted to determine how they assessed the cervical spine in unconscious, adult trauma patients, and at what point immobilisation was discontinued. Of the 32 units contacted, 27 responded (response rate, 84%). Most centres had no protocols to guide initial imaging or when immobilisation devices should be removed. Most responding centres performed fewer than three plain radiographs, and most did not use computerised tomography routinely. Routine use of magnetic resonance imaging or dynamic flexion-extension fluoroscopy was rare, and few units regarded the latter as safe in unconscious patients. There was no consensus on when immobilisation of the cervical spine should be discontinued. Most centres that terminated immobilisation immediately after imaging did so on the basis of plain radiographs alone. Unconscious adult trauma patients remain at risk of inadequate assessment of potential cervical spine injuries.