The Lancet Paper on "Spinal Cord Damage" -some improvement in Movements of Paralyzed Patients

The patient seems to have had the following type of spinal cord damage:
 The Lancet Quote "An individual three years post C7-T1 subluxation presented with a complete loss of clinically detectable voluntary motor function and partial preservation of sensation below the T1 cord segment" end of Quote.

In this interesting Lancet paper on neuronal recovery/functional recovery, the authors claims they have noticed significant improvement of Paralyzed patients after implant and electrical stimulation. This new positive results was not achieved by the same group in their own earlier clinical studies,  authors say "we have not seen such a result in their earlier research studies". 

Spinal cord stimulation studies been done both in lab rats as well as paralyzed patients. This is the latest report on paralyzed patients responding to stimulation with visible movements, it is interesting but we have long way to go to have a wholesome or meaningful treatment of spinal cord damages, it all comes to the extent of damage, and severity of neural paths that are severed by accidents......if the integrity of both afferent and efferent pathways are preserved with mild or minor damages, the recovery can be significant, in cases were more than 50% percent damages or even more severe, that determines the possibility of any recovery. In either case, it is good to read some results. And, when it is published in The Lancet, got to be little credible to listen to the news?..

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Lancet. 2011 June 4; 377(9781): 1938–1947.

Published online 2011 May 19. doi:  10.1016/S0140-6736(11)60547-3

Effect of Epidural stimulation of the lumbosacral spinal cord on voluntary movement, standing, and assisted stepping after motor complete paraplegia: a case study

Findings

Epidural stimulation enabled the human lumbosacral spinal circuitry to dynamically elicit full weight-bearing standing with assistance provided only for balance for 4·25 minutes in a subject with a clinically motor complete SCI. This occurred when using stimulation at parameters optimized for standing while providing bilateral load-bearing proprioceptive input. Locomotor-like patterns were also observed when stimulation parameters were optimized for stepping. In addition, seven months after implantation, the subject recovered supraspinal control of certain leg movements, but only during epidural stimulation.

Orthopedic Surgeon Spyros Pranos Medical Fraud, 250 Law suits?. a Doctor who Faked and Botched Surgery, what an Evil?

Latest Update:
ABC News:  
Judgment Day for Surgeon Who Admitted to Fake Surgeries

March 7, 2014

By LIZ NEPORENTLiz Neporent More from Liz »via Good Morning America

Dr. Spyros Panos pleaded guilty to performing fake and negligent surgeries more than 250 times.

Handout

An orthopedic surgeon who admitted to botching and faking thousands of surgeries over a five-year period was sentenced today to four-and-a-half years in federal prison for one count of health care fraud.

Dr. Spyros Panos, who practiced medicine in Poughkeepsie, N.Y., pleaded guilty to one count of health care fraud last October. In addition to his sentence, he was fined $250,000 and ordered to pay the government $5 million as restitution for false and overstated Medicare charges. He was also ordered to surrender all licenses to practice medicine in states where it had not already been suspended. 

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Orthopedic surgeon Dr.Pranos seems to have  had detailed OP notes about treatments to his patients but that never took place?, hmmm....it seems he scheduled as large as 22 surgeries in a single day?, now he is under scrutiny and more than 250 law suits been filed.

Orthopedic Surgeon Sued Over Fraudulent Cases

Spyros Panos, MD, who practiced in suburban Dutchess County, N.Y., north of New York City, is said to have scheduled as many as 22 surgeries in a day, according to his former patients' attorneys. He has reportedly failed to adequately cement joint replacement components, implanted incorrect components and carried out an unneeded rotators cuff repair while ignoring a fractured clavicle.

Full Article: Link

Nerve Conduction Tests (NCV) in Guillian- Barre Syndrome, what is new?.

Clinical Neurophysiology
Journal Article in Press

Two sets of nerve conduction studies may suffice in reaching a reliable electrodiagnosis in Guillain–Barré syndrome

Nortina Shahrizaila et al..
► The existing electrodiagnostic criteria in Guillain–Barré syndrome are unreliable when applied at the initial stages of disease onset. ► Nerve conduction studies performed at two time courses, within 2weeks and 3–8weeks, may better reflect the final electrodiagnosis of Guillain–Barré syndrome. ► The pattern of recovery in Guillain–Barré syndrome is heterogeneous and validation of the current Erasmus Guillain–Barré syndrome outcome score in different patient populations is required.

 

Abstract :Recent studies have advocated the use of serial nerve conduction studies (NCS) in the electrodiagnosis of Guillain–Barré syndrome (GBS). The current study aims to elucidate when and how frequent NCS can be performed to reflect the disease pathophysiology.

No more LinkedIn, No Facebook or other social sites, Beware their Breach is a yet another fraud and drama to sell you!?

Beware of LinkedIn, Facebook, Twitter, Yahoo, Google and for that matter even Microsoft:

These companies constantly sell and buy contacts, all the so called breach is not really a breach, or hacking or cyber security issue starts and end with them, they use these to con, sell things, create fake news for promotional purposes etc, you know what that means?:

I have been monitoring all these so called social and professional networking websites such as LinkedIn, Facebook, google and others. I am sure you all noticed the number of such websites reporting breach and leak of members details or hacking of their sites and it continues without any end to this menace.

I realized, our personal information and connections are at serious risk in these bottom feeding companies hands, so as of today, I will be terminating my LinkedIn, two days ago, I have seen lots of contacts been either stolen from other sites and LinkedIn published it on my page. Do you remember on the top right corner a streaming lists will show up everyday, "You may Know these People", have you ever noticed how they get and from where they get those lists, every time you visit or spent few min, you will see several of them are your friends, or colleagues or you know personally?, how do you think LinkedIn get those details, think?.

In my case, I believe either they breached and stolen contacts from my google or outlook contacts or the google would have sold them for a handsome bucks, so do the facebooks leak. Most of this so called breach or leaks are not really leaks but they purposefully create news awareness so that they can get away from any law suits or Feds going after them, because leak or breach is an accident?. wow..

So keep my email contacts, please do not use any of the google, facebook or linked in, use these following secure emails to get in touch with me or network with me. Thanks

Contact: use the contact form to get in touch with me on this topic or any other in this Blog.
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IONM: Neurological Testing or Neurophysiological Divining? J. G. Salamy, Ph.D.

Editorial Link:

Dr Joe Salamy writes a thought provoking and insightful Editorial Review about Intraoperative NeuroMonitoring, where do we stand?, what do we have to do to bring in new approach and newer technologies to avoid the IONM field become a stagnant one?..

IONM: Neurological Testing or Neurophysiological Divining? 

J. G. Salamy, Ph.D.  

VERTECz: surgical neurophysiology, Las Vegas, Nevada 

2012 All Rights Reserved

Email: 

Summary

During the last three decades IONM has followed an objective probability-based clinical model whichfocused attention almost exclusively upon the detection of specific events.  IONM practices, however, donot neatly conform to those of conventional clinical testing procedures.  It is suggested herein that futureefforts be directed toward developing additional models which elucidate the dynamic and subjectivequalities of IONM and recognize the importance of sequences and their influence upon decision making. Heretofore, the temporal and linguistic aspects of IONM have been largely ignored.  It is proposed that weexamine IOMN as an ongoing interactive process, and develop new tools to help accomplish this task.

For full Article , visit this Special Editorial column under the tabs: or click the following link

http://neuromonitoring1.blogspot.com/p/special-editorials.html

Etomidate during surgical procedures, a clinical study?.

A study about Etomidate usage in patients undergoing certain surgical procedures?.

The authors of this clinical study made a claim that Etomidate is linked worst post surgical outcomes and including risks of death? but other expert anesthesiologist argued that the study is not conclusive (not a definitive study?), well a combination of anesthetics when used caution must be exercised, this is for anesthesiologists to keep in mind when they make their decision to use what anesthesia combination or regiment can make a safe outcome.

Etomidate Linked to Worse Post-op Outcomes vs. Propofol

Risk for death more than doubled for critically ill in retrospective study

by Michael Vlessides

Washington—Anesthesiologists tempted to use etomidate instead of propofol to induce anesthesia in critically ill patients might think twice after considering the results of a retrospective analysis by researchers at Cleveland Clinic. The analysis concluded that noncardiac patients given etomidate were two to three times more likely than those given propofol to die within 30 days.
“Although etomidate is sometimes used for general anesthesia induction in critically ill patients, the drug is known to cause prolonged adrenal impairment by blocking cortisol release,” said Ryu Komatsu, MD, a resident at the Ohio institution. “As we might suspect, worse outcomes have been reported in association with etomidate use in critically ill patients. However, the potential link between etomidate and worsened postoperative outcomes has not been systematically studied in general surgical patients.”

Spine Journal: Article on Safe Thoracic Pedicle screw placedment

Thoracic pedicle screw placements especially the upper thoracic levels do not have specific  muscle innervation making it difficult to test pedicle screws, in other words it is not as discrete as you can do a test on for example Deltoid (Cervical) or Tibialis anterior (lumbar). The following article though

Spine (Phila Pa 1976). 2012 

Safe pedicle screw placement in thoracic scoliotic curves using t-EMG: stimulation threshold variability at concavity and convexity in apex segments.

de Blas G, Barrios C, Regidor I, Montes E, Burgos J, Pizá-Vallespir G, Hevia E.

Source

Department of Clinical Neurophysiology, Hospital Ramón y Cajal, Madrid, Spain.

Abstract

STUDY DESIGN:

A cross-sectional study of nonconsecutive cases (level III evidence).

OBJECTIVE:

In a series of young patients with thoracic scoliosis who were treated with pedicle screw constructs, data obtained from triggered electromyography (t-EMG) screw stimulation and postoperative computed tomographic scans were matched to find different threshold limits for the safe placement of pedicle screws at the concavity (CC) and convexity (CV) of the scoliotic curves. The influence of the distance from the medial pedicle cortex to the spinal cord on t-EMG threshold intensity was also investigated at the apex segment.

SUMMARY OF BACKGROUND DATA:

Whether the t-EMG stimulation threshold depends on pedicle bony integrity or on the distance to neural tissue remains elusive. Studying pedicle screws at the CC and CV at the apex segments of scoliotic curves is a good model to address this issue because the spinal cord is displaced to the CC in these patients.

Mar 15;37(6):E387-95. doi: 10.1097/BRS.0b013e31823b077b.

IONM news

Some updates:  http://drmunisneuromonitoring.blogspot.com/

Benefit of Intraoperative IONM and Expenses?...

The risks are minimal but they are real, and when you are not using the advanced technology and knowledge available to assess and safeguard the patients from risks of nerve damage or paralysis, your care is flawed and pretty dangerous, if you can spent 25 thousands for surgery and do not use Neuromonitoring that might cost another thousand or two, and you think that is cost effective, then something wrong with such ideas. Bringing safety inside OR must be the top priority of an operating surgeon (performing surgeon). There are several vascular or neurological complications happen during spine surgical procedures that may not be identified timely if you do not use neuromonitoring techniques, and when you find out after the surgery, it is too late.  

How to be a Better Surgeon, apart from Surgereries what else can play important role to be the best surgeon?.

Professor Steve Bogdewic talks about Surgeons and how to be a better surgeon!...

Watch the video:  Link

Dr. George W. Copeland Professor of Family Medicine

Indiana University, Indianapolis

Dr. Stephen P. Bogdewic is the Dr. George W. Copeland Professor of Family Medicine and the Executive Associate Dean for Faculty Affairs and Professional Development at Indiana University School of Medicine. Dr. Bogdewic received his Ph.D. in Adult Education and Organizational Development from the University of North Carolina. Dr. Bogdewic has served as President of the Society of Teachers of Family Medicine (STFM) and was the recipient of the Society’s highest teaching award, the Excellence in Education Award.

Dr. Bogdewic’s scholarly interests include faculty development, leadership development, and qualitative research methodologies. Office: (317) 278-5461; E-mail: bogdewic@iupui.edu

Electrocautery and Spinal Cord damage- loss of motor activities..!

Nerve damages or spinal cord damage during brain and spine surgical procedures depends upon various myraids of factors, one of them is mechanical. However, how many of you even thought of an electrocautery can produce spinal cord damage resulting EMGs and motor activity loss?. This report published in an porcine model discusses a case. I have not read a human case yet, but it is a real possibility, it can happen during surgery.  If anyone knows a human case or clinical scenario's, please post a comment below.

Spinal cord injury from electrocautery: observations in a porcine model using electromyography and motor evoked potentials. Stanley A. Skinner, et al  Journal of Clinical Monitoring and Computing November 2012

Abstract

We have previously investigated electromyographic (EMG) and transcranial motor evoked potential (MEP) abnormalities after mechanical spinal cord injury. We now report thermally generated porcine spinal cord injury, characterized by spinal cord generated hindlimb EMG injury activity and spinal cord motor conduction block (MEP loss). Electrocautery (EC) was delivered to thoracic level dural root sleeves within 6–8 mm of the spinal cord (n = 6). Temperature recordings were made near the spinal cord. EMG and MEP were recorded by multiple gluteobiceps intramuscular electrodes before, during, and after EC. Duration of EC was titrated to an end-point of spinal motor conduction block (MEP loss). In 5/6 roots, ipsilateral EMG injury activity was induced by EC. In 4/5 roots, EMG injury activity was identified before MEP loss. In all roots, a minimum of 20 s EC and a temperature maximum of at least 57 °C at the dural root sleeve were required to induce MEP loss. Unexpectedly, conduction block was preceded by an enhanced MEP in 4/6 trials. EMG injury activity, preceding MEP loss, can be seen during near spinal cord EC. Depolarization and facilitation of lumbar motor neurons by thermally excited descending spinal tracts likely explains both hindlimb EMG and an enhanced MEP signal (seen before conduction block) respectively. A thermal mechanism may play a role in some unexplained MEP losses during intraoperative monitoring. EMG recordings might help to detect abnormal discharges and forewarn the monitorist during both mechanical and thermal injury to the spinal cord.

Full PDF: click on the top right corner of the journal for pdf article. Link:

Brain Awarness Week- Spread the Word..!

Best Wishes to Brain Awareness Week Program, the people behind and to Sharp Brains, Thanks, DrMuni Muni,      How will you be cel­e­brat­ing Brain Aware­ness Week next week (March 11th-17th , 2013)? Here's a sug­ges­tion: you can start watching, at a spe­cial 95% pric­ing dis­count, more than 25 hours of exclu­sive pre­sen­ta­tions from over 40 lead­ing minds as they discuss the latest on applied neu­ro­plas­tic­ity and brain health. These pre­sen­ta­tions, which took place dur­ing the 2012 Sharp­Brains Vir­tual Sum­mit, shed light on some of the most impor­tant ques­tions about the cur­rent and future state of brain health and wellness: How can the health indus­try bet­ter incor­po­rate the body's most vital organ -- the brain? How are con­sumer beliefs and behav­iors towards brain health and brain train­ing evolving? Which pro­fes­sional groups are ide­ally posi­tioned to become "brain fit­ness coaches"? How can neu­ro­science inform spe­cial education? How can Big Data and global inter­net access trans­form brain health practices?   -> You can ORDER A $15 PASS NOW (reg­u­lar price is $295). Pass hold­ers receive two-month log-in access to the online pre­sen­ta­tions begin­ning on March 11th.  What Speak­ers and Par­tic­i­pants say about the 2012 Sharp­Brains Summit: "The Sharp­Brains Sum­mit is a rare vehi­cle for get­ting mul­ti­ple expert per­spec­tives on cur­rent devel­op­ments in improv­ing brain func­tion in a con­cise and clear way."  -  Dr. Michael Pos­ner, Pro­fes­sor Emer­i­tus, Uni­ver­sity of Oregon "Great exam­ple of how bring­ing sci­en­tific lead­ers and inno­va­tors together can spur thought­ful dis­cus­sion about our most vital organ - the brain." - Dr. San­dra Bond Chap­man, Direc­tor, Cen­ter for Brain­Health at The Uni­ver­sity of Texas at Dallas "The Sharp­Brains Sum­mit pro­vides com­mon ground for prac­ti­tion­ers, sci­en­tists and indus­try lead­ers to work towards the com­mon goal of dri­ving brain health and fit­ness for­ward with a thought­ful, ana­lyt­i­cal and prac­ti­cal approach." - Kate Sul­li­van, Direc­tor of the Brain Fit­ness Cen­ter at Wal­ter Reed National Mil­i­tary Med­ical Center An impres­sive vir­tual con­vo­ca­tion of lead­ing sci­en­tists and devel­op­ers and adopters of cog­ni­tive enhance­ment tech­nol­ogy." - Dr. Robert Bilder, Chief of Med­ical Psychology-Neuropsychology, UCLA Semel Insti­tute for Neuroscience "A very time-efficient man­ner to get a state of the art update on the lat­est inno­va­tions in assess­ing and pro­mot­ing brain health, and from the com­fort of your own office." - Dr. Keith Wesnes, Prac­tice Leader, Bracket/ United BioSource Corporation A con­ve­nient and sur­pris­ingly com­pelling forum for catch­ing up on applied cog­ni­tive research from lead­ers in the field and for help­ing shape future brain health care." - Dr. Yaakov Stern, Cog­ni­tive Neu­ro­science Divi­sion Leader, Colum­bia University Have a very stimulating Brain Awareness Week! The SharpBrains Team

App for remote Neurominotoring (IONM)?

 APP for biking track, app for walking, app for finding what song it is and now an App for remote neuromontioring?, interesting!.

inomed Remote Viewer by Netop Supports Neuromonitoring,  February 26, 2013New app enables physicians and clinical staff to remotely monitor real-time data from intraoperative neurophysiological monitoring (IONM) devices via an iPad.

COPENHAGEN – inomed, a leading medical technology provider based in Germany, has announced the availability of an app that enables hospital staff to remotely monitor the signals of a patient’s intraoperative nerve activity during surgery. The app, Remote Viewer, was developed for inomed by Netop and is based on their remote access application, Netop Remote Control Mobile for iOS. With inomed Remote Viewer, doctors and hospital personnel can securely and remotely track neuromonitoring signals - recorded on an inomed IONM device - in real-time.

“We’re pleased to be working with inomed on the Remote Viewer,” said Kurt Bager, CEO, Netop. “This is not only an example of how our remote access solutions can be leveraged across industry verticals to serve the evoling needs of our customers and partners, but also how our solutions perform in critical environments where reliability is an absolute necessity.”

With Netop’s remote access software solution now preinstalled on all inomed neuromonitoring devices, the app allows inomed to expand its product offerings and provide its customers with additional service levels. To activate the functionality users will need to purchase an inomed license for the company’s neuromonitoring device, but the Remote Viewer app is free and available for iOS devices at the App Store.

Full read: