Fecaloma is a rare complication of chronic constipation with fecal impaction, which usually is underestimated. The megacolon would be noted as a result of that the harden stool commonly obstructs the rectum and sigmoid colon. So far, numerous cases about obstructive uropathy caused by fecaloma have been reported. We present the case of a 63-year-old female with a history of hemorrhagic stroke, who experienced acute bilateral hydronephrosis and fecaloma. She was successfully treated by colonoscopy irrigation and manual manipulation. In this literature, we focus on the association with the change of bowel movement after brain injury and remind neurosurgeons the clinical care about bowel program.

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The placement of cervical spine pedicle screws and lateral mass screws are technically demanding due to their proximity to vital structures such as the spinal cord and the vertebral arteries. In the case of multilevel cervical spine trauma, the fracture location and the size of the pedicle often limits the choice of the pedicle screw. This case report analyses the possibility of pedicle screw placement in the upper cervical spine with the help of a three-dimensional (3D)-image model as preoperative planning. Here, we present a 29-year-old patient who suffered from a motor vehicle accident. He had a cervical injury for which we designed a reduction plan with the help of 3D models shaped from his computed tomography image. The operation of reduction and fixation was performed from the level of C5 to T1 smoothly and no complication occurred through to follow-up. As shown in this case, 3D reconstruction technology can help us plan for reduction surgery in a highly complicated case of cervical spine fracture and provide the operator with a better way to visualize the surgical anatomy. 3D reconstruction technology can help us plan for reduction surgery and perform the preoperative surgical simulation. The surgeon can select the size of the pedicle screw correctly and save the operative time.

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Background: The study addressed the compared effects of adding dexmedetomidine (DEX), ketamine (KET), neostigmine (NEO), and magnesium sulfate (MS) to ropivacaine on pain relief and hemodynamic changes in intravenous regional anesthesia (IVRA) during distal radius surgery. Materials and Methods: This randomized, double blinded clinical trial recruited the following five groups of patients (n = 150) undergoing forearm surgery under IVRA, hospitalized at Valiasr Hospital (Arak, Iran): DEX, KET, NEO, MS, and placebo, in which ropivacaine 0.2% was used along with all the drugs. Subsequently, we measured the onset and duration of sensory motor block, pain score, arterial oxygen saturation (SaO₂), mean arterial pressure (MAP), and heart rate (HR), as well as the quantity of opioid administration throughout the 24 h postoperatively. Results: In each group, thirty patients were randomized and included in the analysis. The time to the onset of sensory motor block was shorter in the DEX group (P = 0.001) who had a longer duration of sensory motor block (P = 0.001), lower pain score at all times (P = 0.001), and the lowest opioid use (P = 0.001). There was no statistically significant difference between the five groups in terms of MAP (P = 0.148), HR (P = 0.642), and SaO₂(P = 0.990), but the time trend of MAP (P = 0.001) and SaO₂(P = 0.001) was statistically significant and also the interaction of time and groups was statistically significant for MAP (P = 0.001) and HR (P = 0.001). Conclusion: DEX demonstrated the least amount of postoperative pain and opioid use, as well as a rapid onset and a longer duration of sensory motor block than other drugs used. Moreover, it could be thought to be an excellent recommendation to use as an adjuvant in IVRA. Trial registration: Clinical trial registration number in Iranian randomized clinical trial: IRCT20141209020258N113.

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Background: Hybrid operating room (OR) allows a combination of three-dimensional (3D) robotic fluoroscopy with navigation to be performed intraoperatively for minimally invasive surgery (MIS) of the spine. We aimed to investigate the accuracy and radiation exposure of surgeons and OR staffs when the navigation system is engaged for percutaneous pedicle screws (PPSs) placement. Materials and Methods: This was a retrospective nonrandomized study involving patients who were all clinically and radiologically compatible with lumbar spondylolisthesis. The Gertzbein and Robbins (G and R) scale was used to define the screw placement accuracy in the navigated group, and the mean numbers of C-arm fluoroscopic images taken for screw positioning verification were recorded. Dichotomous and numerical variables were analyzed with the Chi-square test and t-test, respectively. Results: Between July 2015 and July 2016, a total of 103 patients were treated, which consisted of 38 patients or 164 PPSs under navigation and 65 patients or 282 PPSs under freehand technique. We found that all navigated PSSs were satisfactorily placed under G and R Grade A and Grade B. The mean fluoroscopic images taken were significantly lower in the navigated two-level and three-level surgeries group. The operation time was longer in navigated two-level surgeries, while there is an insignificant difference in three-level surgeries in both navigated and nonnavigated surgeries. Conclusion: Intraoperative 3D robotic fluoroscopy with a navigation system for MIS of the spine ensures safe PPS placement and can significantly reduce the radiation exposure of surgeons and medical staffs. The duration of surgeries performed under navigation will improve with a smooth workflow.

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Background: This study explored the outcome of older adults with severe head injury after 1-year follow-up. Materials and Methods: Data were collected from the hospital medical information system. The patients who suffered from severe head injury met with the disease classification system, traumatic statistics, with or without brain surgery, and patient medical records of a regional teaching hospital were included in the study. Patients were followed with telephone contact 1 year after discharge. The Glasgow Outcome Scale and the Functional Independence Measure were used as tools for prognostic evaluation. This study protocol was approved by the institutional review board of the hospital. Results: Patients who were 65 years of age and older diagnosed with severe head injury (Injury Severity Score [ISS] ≥16) were included. Between January 2009 and September 2015, a total of 142 patients were collected with 88 men (62%) and 54 women (38%). The mean age was 76.6 ± 6.6 years. Head injury was caused by traffic accidents for 73 patients (51.4%) and by falls for 69 patients (48.6%). There were 122 patients with subdural hemorrhage, 82 with intracerebral hemorrhage, 71 with subarachnoid hemorrhage, and 11 with epidural hemorrhage. Forty-one patients (28.9%) had simple head injury and 101 patients had multiple head injuries. The mean Glasgow Coma Scale was 5.4 ± 1.9, and the mean ISS was 24.3 ± 9.2. Thirty-eight patients (26.8%) refused surgery and 104 patients (73.2%) underwent brain surgery. Among 142 patients, 70 (49.3%) died and 72 (50.7%) survived, with 16 patients (11.3%) classified as good condition and 126 (88.7%) as poor condition. After 1 year, those who underwent brain surgery had a better prognosis than those who refused surgery (P = 0.01). Conclusion: Older adults with severe head injuries often face disability, a vegetative state, or death. In this study, those who underwent brain surgery had better survival, and 27.6% (16/58) of those who survived were able to live independently after 1 year.

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Background: In the past decade, accidents have been one of the top 10 causes of death in Taiwan. Head trauma caused by accidents has been an issue of concern in Taiwan. Although serious long-term effects have been documented, research on mild traumatic brain injury (mTBI) remains scarce. Thus, the main purpose of this study was to analyze post-concussion symptome (PCS) and the relevant impact on physical, emotional, and cognitive functions. Materials and Methods: During 2012–2013, 105 patients with mTBI in a single hospital were surveyed based on the Rivermead postconcussion symptoms questionnaire in 1 week, and their postinjury status was followed 1 month later. The collected data were analyzed using the paired t-test and descriptive statistics. Results: The collected data were included patient demographics and pretrauma risk factors. A total of 101 patients were subject to mTBI. The rate increased among males and the population aged from 21 to 44 years old. The most common cause of injury was the motorcycle accident, where half of the patients had an initial loss of consciousness and posttraumatic amnesia. Partial resolution of symptoms was noted within 1 month for all participants, but some symptoms persisted (P < 0.0001). In general, patients (especially females) recovered faster from physical impairment. The analysis provides information about the impacts and shows the increased risk of neurocranial traumas related to mTBI. Conclusion: This study presents patients' PCS symptoms in different periods. Those symptoms improved gradually in 1 month, but some symptoms persisted, especially those affecting emotional and cognitive functions. Most patients in this study were young, and the illness had impact on the patients' daily life. As shown by the results, the risk factors were associated with prolonged PCS among females. Aside from physical symptoms, special attention should be paid to mental care as well. More predictors for mTBI may improve medical care quality and reduce losses of medical resources.

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