For medically refractory partial epilepsy, resective surgical pro

For medically refractory partial epilepsy, resective surgical procedures CH5424802 supplier should be considered. If the patient is not a surgical candidate, the vagus nerve stimulator or ketogenic diet may improve seizure control in selected cases. Emerging therapies include medications with novel mechanisms of action, deep brain stimulators, and cortical stimulators that respond to neural patterns of seizure activity.”
“We report the case of a 15-month-old critically ill child with stimulus-induced diffuse voltage attenuation, a previously unreported electroencephalogram pattern. No clinical evidence of seizure activity was associated with these EEG changes.

The patient went on to have a full recovery. This case suggests that critically ill children have distinct stimulus induced electrographic patterns from those seen

in adults. Additional research is needed to define the significance of these patterns.”
“Background: The dissemination of methicillin resistant staphylococcus aureus (MRSA) is an increasing challenge in medical care. Apart from hospital Epacadostat chemical structure acquired MRSA, there has also been an increase in community acquired and livestock associated MRSA. While the risks of MRSA (e. g. wound infections) and consequences (e. g. rejection of patients) are well known, there are little data on the effectiveness of eradication procedures. Patients and methods: 32 patients with proven MRSA colonization were monitored during eradication for the following aspects: (1) localization of MRSA (swabs from hairline, anterior nares, throat, axillae, groins, perineum, and wounds, if present), (2) presence of eradication-impairing factors, (3) length of time needed for eradication, (4) cost of eradication, (5) molecular fingerprint and risk assessment (spa-types). Results: We describe the successful eradication of MRSA MX69 chemical structure in all 32 patients. Most positive nasal swabs were obtained from the anterior nares and the throat

and only rarely from the hairline or axillae. The greater the number of positive swabs, the more time was needed for eradication. In most patients (37.5 %), eradication with topical antiseptics was successful. The average time for eradication was 12.97 (+/- 7.6) days. Twelve patients required systemic antibiotic therapy. Treatment costs associated with the use of systemic antibiotics were significantly higher. The most frequent spa types were t032 and t003. Conclusions: We report successful MRSA eradication in outpatients. Systemic antibiotics are unnecessary in the majority of patients. A combined anti-MRSA strategy for inpatients and outpatients is recommended.”
“Many patients with epilepsy are on lifelong therapy with antiepileptic drugs (AEDs), and AEDs are used for other conditions such as mood stabilization and headache prophylaxis.

At forty-eight hours, imaging showed a rebound in bacterial count

At forty-eight hours, imaging showed a rebound in bacterial counts in every group. The highest rebound was measured in the castile soap group, which rebounded to 120% of the pretreatment level. The benzalkonium chloride group experienced a rebound to 94% of the pretreatment A-1331852 cost level. These were followed by bacitracin solution (89%) and normal saline solution

(68%). In Study 2, both treatment methods were effective in removing 75% of the bacteria initially. At forty-eight hours, the bacterial levels in the pulsed lavage group rebounded to 94% of the original levels (compared with 48% in the bulb syringe group). The difference in the mean photon count ratios at forty-eight hours was significant (p = 0.048).

Conclusions: Approaches used to remove bacteria from wounds, such as irrigants other than saline solution or high-pressure devices, may not have the best clinical outcome.”
“The method proposed in this study was used to isolate fungi grown under anaerobic conditions and to reveal distinctions in their abundance and species composition in different habitats. The ability of micromycetes of different taxa to grow under anaerobic conditions and ensure alcohol

fermentation was determined for a representative sample (344 strains belonging to more than 60 species). The group of fungi growing under anaerobic conditions included species with high, moderate, and low fermentation activity. The ability for anaerobic growth and fermentation depended on the taxonomic affiliation Selleck I-BET151 of fungi. In some cases, the expression of these characteristics depended on the habitat from which the strain was isolated. The maximum level of ethanol accumulation in culture liquid (1.2-4.7%) was detected for Absidia spinosa, Aspergillus sp. of group flavus, Aspergillus terreus, Acremonium sp., Mucor circinelloides,

Mucor sp., Fusarium oxysporum, F. solani, F. sambucinum, Rhizopus arrhizus var. arrhizus, Trichoderma atroviride, and Trichoderma sp.”
“Objective: Otogenic lateral sinus thrombosis (LST) in children represents a serious condition with potential long-lasting morbidity. The role of adjunct anticoagulation therapy and the benefit of an analysis of prothrombotic factors are unclear. The aim of the study was to report therapeutic management and outcome, analyze prothrombotic factors in B-Raf assay children with otogenic LST treated with mastoidectomy/antibiotics/anticoagulation and to evaluate the results with a review of the literature.

Methods: Retrospective chart review of 9 children with otogenic LST (2000-2009) and literature search in PubMed.

Results: The most frequent sign was fever in 88%, while neurologic findings were seen in 55%. Streptococci was the most common bacteria (55%). Prothrombotic factors were normal in all children. All patients received therapeutic anticoagulation, without experiencing bleeding complications.

Eleven days after treatment, tumors were harvested for histologic

Eleven days after treatment, tumors were harvested for histologic and immunohistochemical analysis. Animals demonstrating complete tumor regression were rechallenged in the contralateral flank.

Results: Animals treated with subtotal RF ablation showed significant increases in tumor-specific class I and II responses to HY antigens and tumor regression. RF ablation, ITDC, and combined groups demonstrated similar FRAX597 inhibitor levels of antigen-presenting cell infiltration; all groups demonstrated greater levels of infiltration compared with untreated controls. ITDC injection also resulted in tumor regression. However,

combination therapy did not enhance tumor regression when compared with either treatment alone. Rechallenged mice in RF ablation, ITDC, and combination groups demonstrated significant tumor growth inhibition compared with controls.

Conclusion: Subtotal RF ablation treatment results in enhanced systemic antitumor T-cell immune responses and tumor regression that is associated with increased dendritic cell infiltration. ITDC injection mimics the RF ablation effect but does not increase immune responses when injected immediately after RF ablation. (c) RSNA, 2009″
“We

have studied a longitudinal polymer liquid crystal selleck compound consisting of poly(ethylene terephthalate) (PET) and p-hydroxybenzoic acid, namely PET/0.6PHB, where 0.6 is the mole fraction of the second component. The material was injection 获悉更多 molded with systematic variations of the melt and mold temperatures and injection flow rate using design of experiments

based on a Taguchi orthogonal array. Thermomechanical environment defined by local melt temperatures and shear rates and stresses imposed during processing was estimated by computer simulations of the mold-filling phase. The morphology of the moldings was characterized by optical and scanning electronic microscopy, wide- and small-angle X-ray scattering, and differential scanning calorimetry. An analysis of variance approach identified the significant processing variables and their contributions to variations of morphological parameters. The processing environment affects strongly the melt viscosity, and there is a strong thermomechanical coupling. The result is a complex multilaminated and hierarchical microstructure, whose morphological features are very sensitive to the processing conditions. Relationships between local thermomechanical variables (rather than global ones) and the morphological parameters are established. (C) 2009 Wiley Periodicals, Inc. J Appl Polym Sci 115: 2991-3004, 2010″
“We compared the daily rhythms of body core temperature and surface temperature in 10 Comisana ewes housed at thermoneutrality (25 degrees C) and in the cold (9 degrees C).

Experimental Young’s moduli were well predicted by the Tsai-Pagan

Experimental Young’s moduli were well predicted by the Tsai-Pagano model for the three types of fibers. Data of specific mechanical energy consumed upon processing, contact angle measurements and observations of cryo-fractured surfaces allowed to demonstrate that the adhesion at the interface wheat straw fiber/wheat gluten was improved by (i) an increased hydrophobicity of wheat straw fibers, which was induced by successive grinding, and (ii) a higher specific surface of fibers which was favoured in the case of small fibers. The interfacial adhesion was SC75741 improved in the order BM > IM > CM whereas the fiber aspect ratio decreased

in the order CM > IM > BM. Thus, a competition between these parameters could occur, explaining why no significant difference in reinforcing effect was achieved between the three types of fibers. Finally, the reinforcing effect of wheat straw fibers was also ascribed to a deplasticizing effect, which was particularly pronounced for BM wheat straw fibers. (C) 2012 Elsevier B.V. All rights reserved.”
“Objectives: The hypothesis

that use of beta-blockers causes depression has been proposed more than 40 years ago. However, despite the publication of numerous studies, the issue remains unresolved. The aim of this article is to describe a publication pattern in these studies, which may explain why Ulixertinib solubility dmso the controversy persists.

Study Design and Setting: A literature search was performed in Embase, Medline, and references of relevant articles. Studies that tested whether patients using beta-blockers for cardiovascular conditions had an increased

risk of depression compared with nonusers were included.

Results: The search yielded 22 observational studies. A specific publication pattern recurred several times in these studies. Each study that presented statistically significant findings was followed by several studies that refuted those findings. This publication cycle arose in cross-sectional studies, longitudinal studies, and meta-analyses, as well as for beta-blockers in general, propranolol, and nonselective INCB28060 beta-blockers. Some underpowered nonsignificant findings were published in high-impact journals.

Conclusion: The publication cycle clearly illustrates that significant findings are published ahead of nonsignificant findings, and that significant findings seem to provide an incentive to publish nonsignificant studies. Therefore, studies that may have correctly shown that beta-blockers increase the risk of depression will have been refuted too. Publication bias because of false nonsignificant studies may obstruct scientific progress. (c) 2012 Elsevier Inc. All rights reserved.”
“In diagnostic pathology, the use of immunohistochemical stains and other ancillary procedures is of immense help. However, indiscriminate use of these tests often adds to unnecessary expense.

The cause of the observed increase in mortality is uncertain, but

The cause of the observed increase in mortality is uncertain, but it is likely due in part to malnutrition-induced immune system dysfunction, a higher burden of opportunistic infections, and metabolic derangements. In this article, we describe the epidemiology of HIV infection and malnutrition in sub-Saharan Africa, potential causes of increased

mortality after ART initiation among patients with a low BMI, recent studies on post-ART weight gain and treatment outcome, and trials of macro-nutrient supplementation from the region. We close by highlighting priority areas for future research. Am J Clin Nutr 2010;91(suppl):1138S-42S.”
“Monocyte recruitment to the endothelium is a crucial step in the inflammatory response that precedes the development of atherosclerosis. check details We assessed the effect of Porphyromonas gingivalis on monocyte adhesion to endothelial cells, cytokine production during monocyte/endothelial cell co-culture, and the expression of cell adhesion molecules on human umbilical vein endothelial cells (HUVEC) and their ligands on monocytes. Porphyromonas gingivalis challenge significantly increased the adhesion of THP-1 monocytes

to HUVEC, the production of interleukin (IL)-6, IL-8, and monocyte chemoattractant protein 1 (MCP-1) in co-cultures of HUVEC and THP-1 cells, and the transcription and translation of intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), and E-selectin in HUVEC. The transcription histone deacetylase activity of tumor necrosis factor receptor-associated factor 1 was also increased in HUVEC and THP-1 cells by P. gingivalis infection. Moreover, the stimulation of monocyte adhesion to HUVEC by P. gingivalis infection was partially inhibited by pretreatment with a mixture of anti-ICAM-1, -VCAM, and -E-selectin monoclonal antibodies. These data suggest that adherence between HUVEC SNS-032 ic50 and THP-1 cells, followed by the production

of cytokines and chemokines, was enhanced by increased expression of cell adhesion molecules on P. gingivalis-sensitized HUVEC, which in turn led to inflammatory atherogenesis.”
“Study Design. Systematic review and meta-analysis.

Objective. To assess how confidently low back pain (LBP) can be attributed to abnormalities on magnetic resonance imaging (MRI), and thereby explore the potential value of MRI abnormalities in refining case definition for mechanical LBP in epidemiological research.

Summary of Background Data. Most epidemiological studies of mechanical LBP have defined cases only by reported symptoms, but it is possible that the potency of causes differs depending on whether there is demonstrable underlying spinal pathology.

Methods. We reviewed the published data on MRI abnormalities, looking for data on the repeatability of their assessment, their prevalence in people free from LBP, and their association with LBP.

The data are simulated by calculating the diffraction pattern fro

The data are simulated by calculating the diffraction pattern from LiF(100) with a model microstructure consisting of coherently diffracting domains. The lattice orientation and longitudinal strain is assumed uniform within domains, but they vary from domain to domain with Gaussian distributions. Simulations using

such a model are in good agreement with the measured diffraction patterns. The principal finding from the present work is that synchrotron x-rays can provide real-time data regarding microstructure changes SBE-β-CD accompanying shock-induced deformation and structural changes.”
“SETTING: The Fujian District in China has a high migrant worker population. Although tuberculosis (TB) among migrants is a serious threat to public health in Fujian, little is known about the molecular characteristics of TB isolates in this population.

OBJECTIVE: MAPK inhibitor To investigate the genetic profile of TB among the migrant population in Fujian.

RESULTS: Our study enrolled 243 pulmonary TB patients registered in Fujian. Our data demonstrated that the Beijing genotype was the most common genotype in Fujian, and that the proportion of migrants with the Beijing genotype was significantly higher than that of permanent

residents. Furthermore, the population structure of Mycobacterium tuberculosis strains in Fujian was diverse, with no difference in the distribution of mycobacterial interspersed repetitive units-variable number of tandem repeat (MIRU-VNTR) subgroups between the migrant and permanent populations. In addition, the discriminatory power of MIRU-VNTR in this study was higher than that found in other regions of China, possibly due to the high

percentage of migrants in Fujian.

CONCLUSION: The Beijing genotype was the predominant genotype in Fujian. TB strains isolated from this migrant population revealed a genetic profile similar to that of the permanent population. Improvement in public medical and insurance Trk receptor inhibitor programmes for migrants might be crucial in the effective control of TB in Fujian.”
“Vacancy-type defects in AlN grown by metal-organic vapor phase epitaxy (MOVPE) and lateral epitaxial overgrowth (LEO) using halide vapor phase epitaxy were probed by a monoenergetic positron beam. Doppler broadening spectra of the annihilation radiation were measured and compared to the spectra calculated using the projector augmented-wave method. For MOVPE-AlN, the concentration of vacancy-type defects was high near the interface between AlN and the GaN buffer layer, and the defect-rich region expanded from the interface toward the surface when the NH(3) flow rate increased. For the sample grown on the AlN buffer layer, however, the introduction of such defects was suppressed. For LEO-AlN, distinct deep emission peaks at 3-6 eV were observed in cathodoluminescence spectra.

Polyacrylamide (PAL) samples with different extents of chain enta

Polyacrylamide (PAL) samples with different extents of chain entanglement were prepared

by spray drying and solution casting. We found that the glass transition temperature increases as the extent of chain entanglement decreases upon the MEK inhibitor sub-T(g) annealing. The water content in the PAL matrix is found with no direct correlation to T(g). However, the observation of a faster diffusion process of water in the disentangled PAL matrix offers an evidence of a faster relaxation process of disentangled PAL molecules. The T(g) increase of the disentangled PAL samples is believed to be associated with the increased molecular interaction during the chain relaxation process upon the sub-T(g) annealing. A macroscopic evidence is the fact that the density of the hot-laminated samples increases as the extent of chain entanglement decreases. A thermodynamic analysis suggests that enthalpy more than entropy favors an elevated T(g) of a disentangled hydrophilic polymer upon the sub-T(g) annealing. We believe that this research provides new CB-839 purchase understanding of T(g) of the hydrophilic polymers, which are being extensively used in bio-related studies. (C) 2010 Wiley Periodicals, Inc. J Appl Polym

Sci 119:2310-2317, 2011″
“Highly transparent and conducting Al-doped ZnO (AZO) films are prepared via sol-gel method with a broad range of nominal Al-doping. The film porosity and morphology is determined by the rate of temperature ramping during the drying of the gel phase. The minimum resistivity is observed to occur around 1.5-2 at. % Nirogacestat order Al-doped films, irrespective of the morphology and microstructure. It is found by local chemical analysis that Al tends to segregate at the grain boundaries and above a critical concentration, the segregated Al starts to dominate the electronic transport in nanocrystalline AZO. The optical measurements corroborate these

findings showing a systematic increase in carrier density only up to 1.5-2 at. % Al-doping. It is concluded that the presence of the resistivity minimum is not merely determined by a solubility limit but is a result of the interplay between the changing carrier concentration and carrier scattering at the segregated Al. (C) 2010 American Institute of Physics. [doi: 10.1063/1.3511346]“
“The role of hypertension in the late onset of hemifacial spasm (HFS) is evaluated in a family, spanning four generations. Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) revealed a variable anatomical relationship between nervous and vascular structures in the symptomatic cerebello-pontine angle. In one case, showing neurovascular conflict (NVC), microvascular surgical decompression was followed by clinical resolution of HFS. Neuroimaging suggesting NVC was found in all symptomatic patients of the last two generations and in three younger subjects not affected by HFS.

48 and 471 17 mg/kg body weight respectively The extract at 500

48 and 471.17 mg/kg body weight respectively. The extract at 500 and 1000 mg extract\kg body weight doses produced significant (P < 0.05) decrease in fluid and feed intake, as well as body weight. The haematological parameters were normal except a significant (P < 0.05) increase

learn more in platelet counts observed at all dose levels used. At 1000 mg extract/kg body weight dose, the extract exerted a significant (P < 0.05) decrease that lies within the normal range values of serum aspartate, alanine transaminase and creatinine levels for this animal species. Histological findings indicated possible toxicity in the Liver, Lungs, Kidney, Testes and Uterus At 1000 mg/kg. These results suggest that oral administration of C. Febrifuga may not produce severe toxic effects at doses lower than 500mg extract/kg body weight.”
“The interactions between wine yeasts and wine lactic acid bacteria were evaluated The double-layer

plate-growth method showed bacterial inhibition by yeasts as the most common interaction being Oenococcus oeni more sensitive than Lactobacillus hilgardu During sequential inoculations in the media fermented by Saccharomyces cerevisiae mc2 or Candida pulchemma 3 showed strongest inhibition by S cerevisiae The inhibitory effect exerted by S cerevistae mc2 on O oeni X(2)L and L hilgardu 5w growth could be due to a synergistic effect between fermentation metabolites and another compound(s) with a molecular size of 3-10 kDa The last compound (s) was partially sensitive to ITF2357 cell line protease and heat treatments suggesting a peptidic nature structure Although this yeast inhibited O oeni growth did not affect the malolactic activity The peptic: inhibitory compound(s) heat and protease sensitive showed a molecular weight between 3 and 10 kDa Flow cytometry revealed different physiological responses of O oeni and L hilgardu to peptidic fraction C pulchemma would exert Its inhibitory effect on bacteria through low molecular weight metabolites (C) 2010 Elsevier Ltd All rights reserved”
“The objective of this study was to evaluation antiviral activities

of the extracts from the seed, fruit skin and aerial parts of ten registered varieties Cicer arietinum (Chickpea) against Herpes simplex type 1 (HSV-1) and Parainfluenza-3 (PI-3) viruses. Madin-Darby I-BET151 manufacturer Bovine Kidney and Vero cell lines were employed for antiviral assessment of the Cicer arientinum L. extracts, in which acyclovir for HSV-1 and oseltamivir for PI-3 were tested as reference drugs. This is the first report showing that C. arietinum seed extracts of Cse-5 possesses significant antiviral activity both of DNA (32 – 4 mu g ml(-1)) and RNA (32 16 mu g ml(-1)) viruses compared to the fruit skin and aerial part extracts as well as the controls. Besides, the extracts of fruit skin (Cfs-4) and aerial parts (Cap-5) showed remarkable activity against DNA viruses at 32 – 1 mu g ml-(1).

The aim of this study was to assess retrospectively the character

The aim of this study was to assess retrospectively the characteristics and medical management of patients needing hospitalization for the treatment of odontogenic infections. The personal data, symptoms presented, and therapeutic procedures adopted were analyzed. The predominant age group was from 0 to 10 years (30%), and a sex relation of 1:1 was found, but there was no significant difference (P = 0.337). The most frequent diagnosis was of dentoalveolar abscess (86.3%). Pain (47.1%) was the prevailing reason for hospitalization, with pulpal necrosis (67.5%) as the main cause. There was a prevalence of involvement

of the lower permanent teeth (41.4%) and lower deciduous teeth (23%). The prevalent clinical aspect was submandibular MK5108 manufacturer or facial swelling (61.4%). The most administered antibiotic was penicillin G associated with metronidazole (25.3%). Most cases (58.7%) presented regression with antibiotic therapy, and in some cases, surgical drainage was necessary selleck kinase inhibitor (18.7%). One case of Ludwig angina resulted in death. The mean length of hospital stay was 4.4 days, being higher in the cases of Ludwig

angina. It was concluded that most cases of odontogenic infections requiring hospitalization were of dentoalveolar abscess occurring in young people of both sexes, associated to the lower permanent molar teeth, presenting with swelling, with regression of the symptoms after antibiotic therapy and hospitalization for some days, with some of the cases requiring drainage.”
“Objectives: To evaluate the characteristics www.sellecn.cn/products/ag-120-Ivosidenib.html of head shaking nystagmus in various peripheral vestibular diseases.

Study Design: Retrospective case series.

Setting: Tertiary referral center.

Materials and Methods: Data of 235 patients with peripheral vestibular diseases including vestibular neuritis, Meniere’s disease, and benign

paroxysmal positional vertigo, were retrospectively analyzed. All subjects presented between August 2009 and July 2010. Patients were tested for vestibular function including head shaking nystagmus and caloric information. Regarding vestibular neuritis, all tests were again performed during the 1-month follow-up. Head shaking nystagmus was classified as monophasic or biphasic and, according to the affected ear, was divided as ipsilesional or contralesional.

Results: Of the 235 patients, 87 patients revealed positive head shaking nystagmus. According to each disease, positive rates of head shaking nystagmus were as follows: 35 (100%) of 35 cases of vestibular neuritis, 11 (68.8%) of 16 cases of Meniere’s disease, and 41 (22.2%) of 184 cases of benign paroxysmal positional vertigo. All cases of vestibular neuritis initially presented as a monophasic, contralesional beating, head shaking nystagmus. However, 1 month after first visit, the direction of nystagmus was changed to biphasic (contralesional first then ipsilesional beating) in 25 cases (72.5%) but not in 10 cases (27.5%).

The package was administered twice; 2 weeks before and at the arr

The package was administered twice; 2 weeks before and at the arrival to the clinic.

Results. Reproducibility of the ODI was 0.90 (95% confidence interval [CI] = 0.85-0.94) and the internal consistency was 0.86 (95% CI = 0.81-0.90). Factor analysis showed that the ODI was loaded on 2 factors, which explained 51% of the total variance. In testing convergent validity ODI correlated with Million-VAS, r = 0.75 (95% CI = 0.64-0.84); VAS(back), r = 0.48 (95% CI = 0.32-0.62); and VAS(leg), r = 0.41 (95% CI = 0.23-0.57).

Conclusion. The Finnish ODI version 2.0 proved to be a valid and reliable instrument that showed psychometric properties Cl-amidine ic50 comparable with the original

English version. Therefore, it can be used in assessing the disability among Finnish-speaking patients with back pain for both clinical Z-VAD-FMK and scientific purposes.”
“Splenectomy has been reported to have a beneficial effect in treating Acute antibody-mediated rejection (ABMR). This reason for this often rapid and profound beneficial effect is not readily apparent from what is known about normal splenic immunoarchitecture. While the spleen is rich in mature B cells, it has not been noted to be a repository for direct antibody-secreting cells. We present a case of a Native American female who received a renal transplant and developed

a severe episode of ABMR. The patient was initially refractory to both plasmapheresis and IVIG. The patient underwent an emergent splenectomy with almost immediate improvement in her renal function and a rapid drop in her DR51 antibodies. Immunohistochemical stains of the spleen demonstrated abundant clusters of CD138+ plasma cells (> 10% CD138 cells as opposed to 1% CD138 cells as seen in traumatic controls). Though this is a single case, these findings offer a rationale for the rapid

ameliorative effect of splenectomy in cases of antibody rejection. It is possible that the spleen during times of excessive AP24534 antigenic stress may rapidly turn over B cells to active antibody-secreting cells or serve as a reservoir for these cells produced at other sites.”
“The incidence of pelvic organ prolapse is 18% in women with bladder exstrophy. A vaginal technique to correct the prolapse may be preferable in these women with multiple abdominal operations in their histories. We have performed a modified Prolift (TM) procedure for the repair of severe uterine prolapse in two young women. A review of the literature is presented.”
“Study Design. Case report and review of the literature.

Objective. To describe a case of multiple supra- and infratentorial hemorrhages after spinal surgery presenting with seizure.

Summary of Background Data. Cerebrospinal fluid overdrainage is a well-documented factor associated with remote cerebellar hemorrhage, but supratentorial hemorrhages after spinal surgery have been reported rarely.