Monoblock external ventricular drainage system in the treatment of patients with acute hydrocephalus: a pilot study.

BACKGROUND: Infection is a major complication in patients undergoing external ventricular drainage (EVD). Our study aimed to evaluate the incidence of infection in a series with the monoblock EVD system. MATERIAL AND METHODS: 46 patients treated with EVD at our emergency department were analyzed prospectively to research the incidence of infections with a new EVD system. RESULTS: The average rate of infection was 8.7%. When we stratified the patients according to the exclusive use of EVD without craniotomies, we identified a reduction in the overall incidence of ventriculitis from 8.7% to 2.3%. Age, etiology, and the presence of ventricular bleeding were not statistically significant risk factors. CONCLUSIONS: Despite the small sample examined in this study, we believe that the monoblock system is a simple, inexpensive device that reduces accidental disconnection of the system.

Treatment of Parkinson's disease by deep brain stimulation: a bibliometric analysis.

BACKGROUND: For more than 30 years, deep brain stimulation (DBS) has been a therapeutic tool for Parkinson's disease (PD) treatment. DBS can ameliorate several motor and non-motor symptoms and improve the patients' quality of life. OBJECTIVES: To analyze the global scientific production of original and review articles on Parkinson's disease treatment using deep brain stimulation. DESIGN AND SETTING: Descriptive, bibliometric study with a quantitative approach. METHOD: The research protocol was conducted in March 2023 using the Web of Science database. Six hundred eighty-four articles were included in the analysis. Data were imported into RStudio Desktop Software, linked to R Software. The Bibliometrix R package, its Biblioshiny web interface, and VOSviewer software were used for the analysis. RESULTS: The international production began in 1998. Movement Disorders is the journal with the largest number of published articles and the most cited. Michael Okun and Andres Lozano are the authors who produced the most in this area. The University of Florida is the most active affiliated institution in Brazil. The United States has the largest number of collaborations and is mainly published by local researchers. In contrast, countries such as the United Kingdom and Canada have a high number of multi-country publications. The 15 most cited studies predominantly investigated subthalamic nucleus stimulation. CONCLUSION: DBS for Parkinson's disease is a relatively novel therapeutic approach, with studies that have expanded over the last twenty-five years. Most scientific production was quantitative and restricted to specialized journals. The United States, Europe, and China held the most articles.

Different morphology, stage and treatment affect immune cell infiltration and long-term outcome in patients with non-small-cell lung carcinoma.

AIMS: Development of effective immune-based therapies for patients with non-small-cell lung carcinoma (NSCLC) depends on an accurate characterization of complex interactions that occur between immune cells and the tumour environment. METHODS AND RESULTS: Innate and adaptive immune responses were evaluated in relation to prognosis in 65 patients with surgically excised NSCLC. Immunohistochemistry and morphometry were used to determine the abundance and distribution of immune cells. We found low numbers of immune cells and levels of cytokines in the tumour environment when compared with surrounding parenchyma. Smoking was associated inversely with the adaptive immune response and directly with innate immunity. We observed a prominent adaptive immune response in squamous cell carcinomas (SCC) but greater innate immune responses in adenocarcinomas and large cell carcinomas. Cox model analysis showed a low risk of death for smoking <41 packs/year, N0 tambour stage, squamous carcinoma, CD4(+) > 16.81% and macrophages/monocytes >4.5%. Collectively, the data indicate that in NSCLC there is not a substantive local immune cell infiltrate within the tumour. CONCLUSION: Although immune cell infiltration is limited in NSCLC it appears to have an impact on prognosis and this may be of relevance for new immunotherapeutic approaches.

Treatment of Parkinson's disease by deep brain stimulation: a bibliometric analysis

ABSTRACT BACKGROUND: For more than 30 years, deep brain stimulation (DBS) has been a therapeutic tool for Parkinson's disease (PD) treatment. DBS can ameliorate several motor and non-motor symptoms and improve the patients' quality of life. OBJECTIVES: To analyze the global scientific production of original and review articles on Parkinson's disease treatment using deep brain stimulation. DESIGN AND SETTING: Descriptive, bibliometric study with a quantitative approach. METHOD: The research protocol was conducted in March 2023 using the Web of Science database. Six hundred eighty-four articles were included in the analysis. Data were imported into RStudio Desktop Software, linked to R Software. The Bibliometrix R package, its Biblioshiny web interface, and VOSviewer software were used for the analysis. RESULTS: The international production began in 1998. Movement Disorders is the journal with the largest number of published articles and the most cited. Michael Okun and Andres Lozano are the authors who produced the most in this area. The University of Florida is the most active affiliated institution in Brazil. The United States has the largest number of collaborations and is mainly published by local researchers. In contrast, countries such as the United Kingdom and Canada have a high number of multi-country publications. The 15 most cited studies predominantly investigated subthalamic nucleus stimulation. CONCLUSION: DBS for Parkinson's disease is a relatively novel therapeutic approach, with studies that have expanded over the last twenty-five years. Most scientific production was quantitative and restricted to specialized journals. The United States, Europe, and China held the most articles.

Experimental model of intracranial hypertension with continuous multiparametric monitoring in swine.

OBJECTIVE: Intracranial hypertension (IH) develops in approximately 50% of all patients with severe traumatic brain injury (TBI). Therefore, it is very important to identify a suitable animal model to study and understand the pathophysiology of refractory IH to develop effective treatments. METHODS: We describe a new experimental porcine model designed to simulate expansive brain hematoma causing IH. Under anesthesia, IH was simulated with a balloon insufflation. The IH variables were measured with intracranial pressure (ICP) parenchymal monitoring, epidural, cerebral oximetry, and transcranial Doppler (TCD). RESULTS: None of the animals died during the experiment. The ICP epidural showed a slower rise compared with parenchymal ICP. We found a correlation between ICP and cerebral oximetry. CONCLUSION: The model described here seems useful to understand some of the pathophysiological characteristics of acute IH.

[Lung donor profile in the State of São Paulo, Brazil, in 2006]. / Perfil do doador de pulmão disponibilizado no estado de São Paulo, Brasil, em 2006.

OBJECTIVE: To analyze the rate at which lungs available for transplantation in the State of São Paulo in 2006 were utilized and to determine the lung donor profile in the same period. METHODS: A retrospective study of 497 clinical charts of lung tissue donors from January to December of 2006. RESULTS: According to the clinical charts, lungs were not offered for transplant in 149 cases (30%), which were therefore excluded from the study. Among the 348 lung donors eligible for inclusion in the study, the mean age was 37.4 +/- 16.1 years, and 56.9% were males. The main causes of brain death among the donors were stroke (in 40.5%), skull-brain trauma (in 34.2%) and subarachnoid hemorrhage (in 10.9%). The great majority of these lung donors (90.5%) received vasoactive agents, and 13.5% presented cardiopulmonary arrest. The mean donor leukocyte count was 15,008 +/- 6,467 cells/mm(3), 67.8% of the donors received anti-bacterial agents, and 26.1% presented lung infection. Nearly 40% of the lung donors presented chest X-ray abnormalities. Only 4.9% of the lung donors were accepted, representing 28 lungs (allograft utilization rate of 4%). The causes for donor exclusion were gas exchange alterations (in 30.1%), infection (in 23.7%) and distance (in 10.9%). CONCLUSIONS: The lung utilization rate in the State of São Paulo is low when compared to mean rates worldwide. In addition, more than half of the donor pool was excluded due to altered gas exchange or pulmonary infection. The combination of better care of the potential donor and more flexible selection criteria could increase allograft utilization.

Experimental model of intracranial hypertension with continuous multiparametric monitoring in swine / Modelo Experimental de Hipertensao Intracraniana com monitorizacao multiparametrica continua em suinos

Objective Intracranial hypertension (IH) develops in approximately 50% of all patients with severe traumatic brain injury (TBI). Therefore, it is very important to identify a suitable animal model to study and understand the pathophysiology of refractory IH to develop effective treatments. Methods We describe a new experimental porcine model designed to simulate expansive brain hematoma causing IH. Under anesthesia, IH was simulated with a balloon insufflation. The IH variables were measured with intracranial pressure (ICP) parenchymal monitoring, epidural, cerebral oximetry, and transcranial Doppler (TCD). Results None of the animals died during the experiment. The ICP epidural showed a slower rise compared with parenchymal ICP. We found a correlation between ICP and cerebral oximetry. Conclusion The model described here seems useful to understand some of the pathophysiological characteristics of acute IH. .

Objetivo A hipertensão intracraniana (HIC) ocorre em até 50% de todos os pacientes com traumatismo cranioencefálico (TCE). Por isso, é importante estabelecer um modelo animal adequado para estudar a fisiopatologia da HIC refratária, com a perspectiva de desenvolver tratamentos eficazes. Métodos Os animais foram submetidos a um protocolo padrão de anestesia. A hipertensão intracraniana foi estabelecida através de insuflação de um balão. As variáveis HIC foram medidas com a pressão intracraniana (PIC) do parênquima, oximetria, epidural e doppler transcraniano. Resultados A PIC epidural apresentou elevação mais lenta, comparada com a PIC parenquimal. Houve correlação entre a PIC e a oximetria cerebral. O registro da PIC, oximetria e índice de pulsatilidade foi realizado em todos os animais sem dificuldade. Conclusão O modelo descrito parece ser útil para a compreensão de algumas características fisiopatológicas na HIC aguda. .

Perfil do doador de pulmão disponibilizado no estado de São Paulo, Brasil, em 2006 / Lung donor profile in the state of São Paulo, Brazil, in 2006

OBJETIVO: Analisar a taxa de aproveitamento de pulmões disponibilizados em São Paulo no ano de 2006, bem como caracterizar o perfil dos doadores de pulmão deste período. MÉTODOS: Estudo retrospectivo de 497 prontuários de doadores de pulmão, no período de janeiro a dezembro de 2006. RESULTADOS: Não houve oferta de doação de pulmões para transplante em 149 (30 por cento) dos prontuários analisados, sendo excluídos do estudo. A idade média dos 348 doadores eleitos para o estudo foi de 37,4 ± 16,1 anos, e 56,9 por cento deles eram do sexo masculino. As principais causas da morte cerebral dos doadores foram: acidente vascular cerebral (40,5 por cento); trauma cranioencefálico (34,2 por cento); e hemorragia subaracnóidea (10,9 por cento). A grande maioria dos doadores recebia drogas vasoativas (90,5 por cento), sendo que 13,5 por cento haviam apresentado parada cárdio-respiratória. Do ponto de vista infeccioso, o leucograma médio foi de 15.008 ± 6.467 células/mm³, 67,8 por cento recebiam antibioticoterapia e 26,1 por cento apresentavam infecção pulmonar. Quase 40 por cento dos doadores apresentavam alterações radiográficas. Apenas 4,9 por cento dos doadores foram aceitos, representando 28 pulmões (taxa de aproveitamento de órgãos de 4 por cento). Os motivos de recusa foram: alteração gasométrica (30,1 por cento); infecção (23,7 por cento); e distância (10,9 por cento). CONCLUSÕES: A taxa de aproveitamento de pulmões em nosso meio é baixa quando comparada às taxas médias de aproveitamento mundial. Além disso, mais de 50 por cento das recusas deveram-se à gasometria arterial inadequada e infecção pulmonar. Aliar melhor cuidado ao potencial doador à menor rigidez nos critérios de seleção poderia aumentar a utilização dos órgãos doados.

OBJECTIVE: To analyze the rate at which lungs available for transplantation in the state of São Paulo in 2006 were utilized and to determine the lung donor profile in the same period. METHODS: A retrospective study of 497 clinical charts of lung tissue donors from January to December of 2006. RESULTS: According to the clinical charts, lungs were not offered for transplant in 149 cases (30 percent), which were therefore excluded from the study. Among the 348 lung donors eligible for inclusion in the study, the mean age was 37.4 ± 16.1 years, and 56.9 percent were males. The main causes of brain death among the donors were stroke (in 40.5 percent), skull-brain trauma (in 34.2 percent) and subarachnoid hemorrhage (in 10.9 percent). The great majority of these lung donors (90.5 percent) received vasoactive agents, and 13.5 percent presented cardiopulmonary arrest. The mean donor leukocyte count was 15,008 ± 6,467 cells/mm³, 67.8 percent of the donors received anti-bacterial agents, and 26.1 percent presented lung infection. Nearly 40 percent of the lung donors presented chest X-ray abnormalities. Only 4.9 percent of the lung donors were accepted, representing 28 lungs (allograft utilization rate of 4 percent). The causes for donor exclusion were gas exchange alterations (in 30.1 percent), infection (in 23.7 percent) and distance (in 10.9 percent). CONCLUSIONS: The lung utilization rate in the state of São Paulo is low when compared to mean rates worldwide. In addition, more than half of the donor pool was excluded due to altered gas exchange or pulmonary infection. The combination of better care of the potential donor and more flexible selection criteria could increase allograft utilization.

Análise das características dos pulmões disponibilizados para transplante no Estado de São Paulo / Analysis of the characteristics of lungs available fot transplantation in São Paulo State

Analisar a taxa de aproveitamento de pulmões disponibilizados em São Paulo em 2006, bem como caracterizar o perfil dos doadores de pulmão, no peródo...

Objectives: To analyze the utilization rate of lungs available for transplantation in São Paulo State during 2006, as well as to determine the lung donor profile in this same period. Methods: Retrospective study of 497 lung-donor's medical records during jan/ 2006 to dec/2006...