Keep Your Head when Dealing with Concussion
- Read more about Keep Your Head when Dealing with Concussion
- Log in or register to post comments
Michael S. Taccone,1 Markian Pahuta,2 Darren M.Roffey,3,4 Mohammed F. Shamji,5 Eugene K. Wai,2,3,4
1Division of Neurosurgery, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.
2Division of Orthopedic Surgery, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.
3Ottawa Combined Adult Spinal Surgery Program, The Ottawa Hospital, Ottawa, ON, Canada.
4Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
5Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada.
| Abstract: Vertebral metastatic disease afflicts a significant proportion of cancer patients, most commonly those with breast and lung disease. Symptoms can include tumor-related pain, neurological deficit from spinal cord or nerve compression and pathological fracture with mechanical instability. Appropriate workup includes identifying the primary disease, defining the extent of spinal and extra-spinal pathology and classifying spinal stability based on the pattern of osseous involvement. Specific therapy for the vertebral metastatic disease can include pharmacologic therapy to deliver analgesia, steroids, bisphosphonate, anti-neoplastic therapy, radiation therapy as either primary or adjuvant therapy and surgical intervention for mechanical or neurologic instability. |
| Key Words: Vertebral metastatic disease, metastatic epidural spinal cord compression, spinal instability, spine surgery, spinal radiation therapy, pathologic fracture. |
| Red flags are non-specific and unreliable means of determining spinal malignancy in patients with back pain. Clinical suspicion combined with history and physical exam are best for increasing pre-test probability of imaging studies. |
| Initial evaluation and referral to definitive management should be made within 24 hours of detection of significant neurological deficit, significant metastatic epidural spinal cord compression or instability. |
| MRI is the imaging modality of choice for initial evaluation and assessment of overall spinal tumor burden. |
| Vertebral metastatic disease is very common in patients with cancer. |
| SINS, ESCCS, Tomita score, Tokuhashi score and the Modified Bauer scores are all important tools for determining the most appropriate referral. |
| In eligible candidates, surgery with adjuvant radiotherapy yields faster and more sustainable neurologic stability and recovery. |
| To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $19.99 per year and you will gain full access to the all the premium app content as well as full access to www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and conference reports. Please note that in order for us to activate your online account, you will need to provide your email address when prompted during the subscription purchase through iTunes. | |
| SUBSCRIBE » | |
I have for many years enjoyed my family name, Gordon, and all the connections I can make with it. I learned when I was quite young, from my paternal grandfather that the name had been ours for many generations and had not been changed as had those of my childhood friends. I had stored that knowledge deep into the recesses of my memory. When I decide to study medicine in Scotland, the name became a talking point, as everyone assumed that with that name I must in fact have Scottish ancestry.
Members of the College of Family Physicians of Canada may claim one non-certified credit per hour for this non-certified educational program.
Mainpro+® Overview
Christian A. Murray MD, FRCPC, Assistant Professor, Division of Dermatology, University of Toronto, Women's College Hospital, Toronto, ON,
Nowell Solish MD, FRCPC, Assistant Professor, Division of Dermatology, University of Toronto, Women's College Hospital, Toronto, ON
Abstract
Focal hyperhidrosis is a disorder of idiopathic excessive sweating that typically affects the axillae, soles, palms, and face. This common problem may be associated with considerable physical, psychosocial, and occupational impairments. Current therapeutic strategies include topical aluminum salts, tap-water iontophoresis, oral anticholinergic agents, local surgical approaches, and sympathectomies. Although non-surgical treatment complications are typically transient, surgical adverse events may be permanent and significant. Considerable evidence suggests that botulinum toxin type A (BTX-A) injections into hyperhidrotic areas can considerably reduce focal sweating in multiple areas without major side effects. BTX-A has therefore shown promise as a potential replacement for more invasive treatments if topical options have failed.
Keywords: hyperhidrosis, botulinum toxin, axilla.