RESUMO
A 71-year-old woman with progressive hemiparesis had a large cerebral calculus (brain stone) removed from the temporal lobe. Her condition thereafter improved remarkably. The differential diagnosis and specific methods to determine the angiomatous nature of this almost acellular mass are discussed. Reticulin impregnation, elastic tissue stain, and electron microscopy were of greatest value.
Assuntos
Neoplasias Encefálicas/diagnóstico , Hemangioma/diagnóstico , Idoso , Neoplasias Encefálicas/patologia , Calcinose/diagnóstico , Calcinose/patologia , Feminino , Hemangioma/patologia , HumanosRESUMO
Four pediatric neurosurgical patients with Gram-negative meningitis and ventriculitis were treated with parenteral and intraventricular amikacin, a new aminoglycoside. The organisms infecting these patients were resistant to multiple antimicrobial drugs but were sensitive to amikacin. Treatment was continued for 14 days after cerebrospinal fluid cultures became negative. All four patients were cured and have demonstrated no nephrotoxicity, ototoxicity, or evidence of persistent infection on follow-up examination.
Assuntos
Infecções por Acinetobacter/tratamento farmacológico , Amicacina/administração & dosagem , Encefalite/tratamento farmacológico , Infecções por Enterobacteriaceae/tratamento farmacológico , Canamicina/análogos & derivados , Meningite/tratamento farmacológico , Pré-Escolar , Infecções por Escherichia coli/tratamento farmacológico , Feminino , Humanos , Lactente , Recém-Nascido , Injeções Intraventriculares , Infecções por Klebsiella/tratamento farmacológico , Klebsiella pneumoniae , Masculino , Meningite/etiologia , Serratia marcescensAssuntos
Aracnoide-Máter/diagnóstico por imagem , Craniofaringioma/diagnóstico por imagem , Neoplasias Hipofisárias/diagnóstico por imagem , Aracnoide-Máter/cirurgia , Ventriculografia Cerebral , Craniofaringioma/cirurgia , Feminino , Humanos , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/cirurgia , Lactente , Neoplasias Hipofisárias/cirurgia , Tomografia Computadorizada por Raios XRESUMO
Postoperative wound infections following spinal fusion with instrumentation often present diagnostic and therapeutic difficulties. This article reviews 34 such infections. An infection rate of 3.7% was noted. Depending on various clinical indicators, treatment strategies included short-course antibiotics, prolonged intravenous antibiotics, or intravenous antibiotics followed by suppressive antibiotics and eventual hardware removal. To eradicate these infections, removal of instrumentation is often required; this option, however, may result in an unstable spine. Treatment algorithms were developed for treatment of postoperative spinal surgical site infections and to minimize the possibility of spine instability. All patients were cured of their infections.
Assuntos
Dispositivos de Fixação Ortopédica , Fusão Vertebral , Infecção da Ferida Cirúrgica/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibioticoprofilaxia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Infecção da Ferida Cirúrgica/microbiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Resultado do TratamentoRESUMO
The use of ketorolac was studied in patients undergoing lumbar laminectomy and those receiving lumbar fusion with or without instrumentation. Laminectomy patients in the ketorolac group used significantly less narcotic analgesic than did those in the narcotic treatment group. Ketorolac patients in both surgical categories experienced better pain control than narcotic group patients did. Laminectomy ketorolac patients experienced less sedation than did those in the narcotic group, and a similar trend was noted for fusion patients. A significant improvement in postoperative ambulation was demonstrated in the fusion ketorolac group. Postoperative total drug costs were significantly greater in both ketorolac treatment groups. A one-half day decrease in hospitalization was noted for laminectomy ketorolac patients. The overall annual financial impact of the use of ketorolac in lumbar spine patients is a net savings of $211,095.