RESUMEN
BACKGROUND: The T2 hypointensity has been suggested to be associated with intracranial metastatic adenocarcinomas (IMA). The purpose of our study was to determine the association of T2 hypointensity with IMA. METHODS: All patients with pathologically confirmed metastatic brain tumors who had a magnetic resonance imaging (MRI) at our institution in the last 10 years were retrospectively assessed. Qualitative assessment of the lesions on MRI was done by two separate readers who were blinded to the pathological diagnosis. For qualitative assessment, the T2 hypointensity in the lesion was compared with the contralateral normal appearing white matter. Odds ratio, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. RESULTS: Of 107 patients with intracranial metastasis, only 73 (40 females; 33 males; mean age 61 years) had MRI available for review. Of these, only 46 (25 females; 21 males; mean age 61 years) had pathologically proven IMA. T2 hypointensity was seen in 20% of IMA. The odds ratio of T2 hypointensity in IMA was 3 compared to nonadenocarcinomas but was not statistically significant (p = 0.16). Intralesional hemorrhage was seen in 20. When controlled for hemorrhage, the odds ratio for T2 hypointensity in IMA was 4.7. The specificity, sensitivity, PPV, and NPV for T2 hypointensity to diagnose IMA were 92%, 19%, 81%, and 40%, respectively. CONCLUSION: T2 hypointensity was seen only in 20% of IMA with an odds ratio of 4.7. T2 hypointensity showed a high specificity and PPV for diagnosis of IMA.
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Adenocarcinoma/diagnóstico por imagen , Neoplasias Encefálicas/diagnóstico por imagen , Hemorragias Intracraneales/diagnóstico por imagen , Adenocarcinoma/secundario , Adulto , Anciano , Neoplasias Encefálicas/secundario , Neoplasias de la Mama/patología , Calcinosis/diagnóstico por imagen , Neoplasias Cerebelosas/diagnóstico por imagen , Neoplasias Cerebelosas/secundario , Neoplasias del Colon/patología , Femenino , Humanos , Neoplasias Renales/patología , Neoplasias Pulmonares/patología , Linfoma/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Masculino , Melanoma/diagnóstico por imagen , Melanoma/secundario , Persona de Mediana Edad , Tumores Neuroendocrinos/diagnóstico por imagen , Tumores Neuroendocrinos/secundario , Valor Predictivo de las Pruebas , Sensibilidad y Especificidad , Neoplasias Cutáneas/patologíaRESUMEN
PURPOSE: A preliminary survey of pediatric neurosurgeons working at different centers around the world suggested differences in clinical practice resulting in variation in the risk of pediatric cerebellar mutism (CM) and cerebellar mutism syndrome (CMS) after posterior fossa (PF) tumor resection. The purposes of this study were (1) to determine the incidence and severity of CM and CMS after midline PF tumor resection in children treated at these centers and (2) to identify potentially modifiable factors related to surgical management (rather than tumor biology) that correlate with the incidence of CM/CMS. METHODS: Attending pediatric neurosurgeons at British Columbia's Children's Hospital (BCCH) and neurosurgeons who completed a pediatric neurosurgery fellowship at BCCH were invited to provide data from the center where they currently practiced. Children aged from birth to less than 18 years who underwent initial midline PF tumor resection within a contemporary, center-selected 2-year period were included. Data was obtained by retrospective chart and imaging review. Modifiable surgical factors that were assessed included pre-resection surgical hydrocephalus treatment, surgical positioning, ultrasonic aspirator use, intraoperative external ventricular drain (EVD) use, surgical access route to the tumor, and extent of resection. CM was defined as decreased or absent speech output postoperatively and CMS as CM plus new or worsened irritability. RESULTS: There were 263 patients from 11 centers in 6 countries (Canada, Germany, the Netherlands, India, Indonesia, and the USA). Median age at surgery was 6 years (range < 1 to 17 years). The overall incidence of postoperative CM was 23.5% (range 14.7-47.6% for centers with data on ≥ 20 patients). The overall incidence of CMS was 6.5% (range 0-10.3% for centers contributing data on ≥ 20 patients). A multivariate logistic regression on the full data set showed no significant association between pre-resection surgical hydrocephalus treatment, prone position, ultrasonic aspirator use, EVD use, telovelar approach, complete or near total resection, or treating center and either postoperative CM or CMS. CONCLUSIONS: While there was variation in surgical management of midline PF tumors among centers participating in this study, the factors in management that were examined did not predict postoperative CM or CMS.
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Neoplasias Cerebelosas , Neoplasias Infratentoriales , Mutismo , Adolescente , Canadá , Niño , Preescolar , Alemania , Humanos , India , Indonesia , Lactante , Neoplasias Infratentoriales/cirugía , Mutismo/epidemiología , Mutismo/etiología , Países Bajos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios RetrospectivosRESUMEN
Cerebellopontine angle (CPA) tumours account for 6-10% of intracranial tumours. The most common CPA tumours are vestibular schwannomas (VS), also known as acoustic neuromas, benign tumours of the vestibulocochlear nerve. Less common but symptomatic skull base lesions are glomus jugulare tumours (GJT), of which approximately 40% are identified as CPA tumours. Initial symptoms for GJT may include hearing loss and tinnitus and progress to various cranial nerve dysfunctions. Three well-accepted treatment modalities for such tumours include surgical resection, radiotherapy and/or conservative management employing serial MR or CT imaging. Patients' quality of life may be impacted by different treatment methods, so treatment decisions should be client centered.
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Tumor del Glomo Yugular/cirugía , Calidad de Vida , Adulto , Anciano , Neoplasias Cerebelosas , Ángulo Pontocerebeloso , Enfermedades de los Nervios Craneales/etiología , Mareo/etiología , Femenino , Tumor del Glomo Yugular/complicaciones , Tumor del Glomo Yugular/diagnóstico por imagen , Pérdida Auditiva/etiología , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Neuroma Acústico , Equilibrio Postural , Trastornos de la Sensación/etiología , Acúfeno/etiología , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
Patients with vestibular schwannomas (VS) typically present with hearing loss and tinnitus as well as variable cranial nerve dysfunctions. Surgical resection, stereotactic radiotherapy and/or conservative management employing serial magnetic resonance or computed tomography imaging serve as the main treatment options. Quality of life (QoL) may be impacted by the extent of tumour burden and exacerbated or relieved by treatment. Subjective assessment and quality of life inventories provide valuable information in client centered approaches with important implications for treatment. The intention of QoL measurements affecting VS patients within a clinical setting is to facilitate discussions regarding treatment options and objectively evaluate patient- centered clinical outcomes in a naturalistic setting.
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Neoplasias de los Nervios Craneales/fisiopatología , Neoplasias de los Nervios Craneales/terapia , Neuroma Acústico/fisiopatología , Neuroma Acústico/terapia , Calidad de Vida , Enfermedades del Nervio Vestibulococlear/fisiopatología , Enfermedades del Nervio Vestibulococlear/terapia , Adulto , Tratamiento Conservador , Neoplasias de los Nervios Craneales/diagnóstico , Neoplasias de los Nervios Craneales/psicología , Femenino , Audición , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Neuroma Acústico/diagnóstico , Neuroma Acústico/psicología , Procedimientos Quirúrgicos Otológicos , Radiocirugia , Estudios Retrospectivos , Encuestas y Cuestionarios , Tomografía Computarizada por Rayos X , Vestíbulo del Laberinto , Enfermedades del Nervio Vestibulococlear/diagnóstico , Enfermedades del Nervio Vestibulococlear/psicologíaRESUMEN
Flanged ventricular catheters are now used infrequently. Many patients with longstanding hydrocephalus still harbor these catheters, either as their current ventricular catheter, or as a retained catheter from a prior implant. The removal of flanged ventricular catheters is sometimes necessary, and may be challenging due to intraventricular adhesions. We describe the use of an endoscopic technique for the successful retrieval of flanged ventricular catheters in two patients. The technique described in this report may be helpful for patients that have flanged ventricular catheters that must be removed.
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Encéfalo/cirugía , Catéteres , Hidrocefalia/cirugía , Neuroendoscopía , Adolescente , Encéfalo/diagnóstico por imagen , Humanos , Hidrocefalia/diagnóstico por imagen , Masculino , Neuroendoscopía/métodos , Resultado del Tratamiento , Ventriculostomía/métodosRESUMEN
Bicycle-related injuries are a leading cause of child and youth hospitalizations in Canada. The use of helmets while bicycling reduces the risk of brain injuries. This study investigated the long-term effect of legislation coupled with enforcement to improve helmet use rates. We conducted a longitudinal observational study of helmet use at 9, 11, and 14 years after bicycle helmet legislation was enacted. Data were compared to baseline observations collected after legislation was passed in 1997. A comprehensive enforcement and educational diversion program, Operation Headway-Noggin Knowledge (OP-NK), was developed and implemented in partnership with regional police during the study period. Helmet use was sustained throughout the post-legislation period, from 75.3 % in the year legislation was enacted to 94.2 % 14 years post-legislation. The increase in helmet use was seen among all age groups and genders. Helmet legislation was not associated with changes in bicycle ridership over the study years. OP-NK was associated with improved enforcement efforts as evidenced by the number of tickets issued to noncompliant bicycle riders. This observational study spans a 16-year study period extending from pre-legislation to 14 years post all-age bicycle helmet legislation. Our study results demonstrate that a comprehensive approach that couples education and awareness with ongoing enforcement of helmet legislation is associated with long-term sustained helmet use rates. The diversion program described herein is listed among best practices by the Public Health Agency of Canada.
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Ciclismo/estadística & datos numéricos , Dispositivos de Protección de la Cabeza/estadística & datos numéricos , Adolescente , Adulto , Factores de Edad , Ciclismo/educación , Ciclismo/legislación & jurisprudencia , Canadá , Niño , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Estudios Longitudinales , Masculino , Factores Sexuales , Adulto JovenRESUMEN
BACKGROUND: Glioblastoma multiforme (GBM) is known to have poor prognosis, with no available imaging marker that can predict survival at the time of diagnosis. Diffusion weighted images are used in characterisation of cellularity and necrosis of GBM. The purpose of this study was to assess whether pattern or degree of diffusion restriction could help in the prognostication of patients with GBM. MATERIAL AND METHODS: We retrospectively analyzed 84 consecutive patients with confirmed GBM on biopsy or resection. The study was approved by the institutional ethics committee. The total volume of the tumor and total volume of tumor showing restricted diffusion were calculated. The lowest Apparent Diffusion Coefficient (ADC) in the region of the tumor and in the contralateral Normal Appearing White Matter were calculated in order to calculate the nADC. Treatment and follow-up data in these patients were recorded. Multivariate analsysis was completed to determine significant correlations between different variables and the survival of these patients. RESULTS: Patient survival was significantly related to the age of the patient (p<0.0001; 95% CI-1.022-1.043) and the nADC value (p=0.014; 95% CI-0.269-0.860) in the tumor. The correlation coefficients of age and nADC with survival were -0.335 (p=0.002) and 0.390 (p<0.001), respectively. Kaplan Meier survival function, grouped by normalized Apparent Diffusion Coefficient cut off value of 0.75, was significant (p=0.007). CONCLUSION: The survival of patients with GBM had small, but significant, correlations with the patient's age and nADC within the tumor.
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Neoplasias Encefálicas/patología , Imagen de Difusión por Resonancia Magnética/métodos , Glioblastoma/patología , Adolescente , Adulto , Factores de Edad , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Análisis de Supervivencia , Adulto JovenRESUMEN
BACKGROUND: Nova Scotia is the first jurisdiction in the world to mandate ski and snowboard helmet use for all ages at ski hills in the province. This study represents a longitudinal examination of the effects of social marketing, educational campaigns and the introduction of helmet legislation on all-age snow sport helmet use in Nova Scotia. METHODS: A baseline observational study was conducted to establish the threshold of ski and snowboarding helmet use. Based on focus groups and interviews, a social marketing campaign was designed and implemented to address factors influencing helmet use. A prelegislation observational study assessed the effects of social marketing and educational promotion on helmet use. After all-age snow sport helmet legislation was enacted and enforced, a postlegislation observational study was conducted to determine helmet use prevalence. RESULTS: Baseline data revealed that 74% of skiers and snowboarders were using helmets, of which 80% were females and 70% were males. Helmet use was high in children (96%), but decreased with increasing age. Following educational and social marketing campaigns, overall helmet use increased to 90%. After helmet legislation was enacted, 100% compliance was observed at ski hills in Nova Scotia. CONCLUSIONS: Results from this study demonstrate that a multifaceted approach, including education, legislation and enforcement, was effective in achieving full helmet compliance among all ages of skiers and snowboarders.
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Traumatismos en Atletas/prevención & control , Lesiones Traumáticas del Encéfalo/prevención & control , Adhesión a Directriz/estadística & datos numéricos , Dispositivos de Protección de la Cabeza , Educación en Salud/legislación & jurisprudencia , Educación en Salud/organización & administración , Promoción de la Salud , Deportes de Nieve/lesiones , Adolescente , Adulto , Anciano , Niño , Preescolar , Comportamiento del Consumidor/estadística & datos numéricos , Femenino , Dispositivos de Protección de la Cabeza/estadística & datos numéricos , Dispositivos de Protección de la Cabeza/provisión & distribución , Promoción de la Salud/métodos , Humanos , Masculino , Medios de Comunicación de Masas , Persona de Mediana Edad , Nueva Escocia/epidemiología , Formulación de Políticas , Evaluación de Programas y Proyectos de Salud , Mercadeo Social , Adulto JovenRESUMEN
BACKGROUND: Transitioning from medical school to residency is difficult and stressful, necessitating innovation in easing this transition. In response, a Canadian neurosurgical Rookie Camp was designed and implemented to foster acquisition of technical, cognitive and behavioral skills among incoming Canadian post graduate year one (PGY-1) neurosurgery residents. METHODS: The inaugural Rookie Camp was held in July 2012 in Halifax. The curriculum was developed based on a national needs-assessment and consisted of a pre-course manual, 7 case-based stations, 4 procedural skills stations and 2 group discussions. The content was clinically focused, used a variety of teaching methods, and addressed multiple CanMEDS competencies. Evaluation included participant and faculty surveys and a pre-course, post-course, and 3-month retention knowledge test. RESULTS: 17 of 23 PGY-1 Canadian neurosurgical residents participated in the Camp. All agreed the course content was relevant for PGY-1 training and the experience prepared them for residency. All participants would recommend the course to future neurosurgical residents. A statistically significant improvement was observed in knowledge related to course content (F(2,32) = 7.572, p<0.002). There were no significant differences between post-test and retention-test scores at three months. CONCLUSION: The inaugural Canadian Neurosurgery Rookie Camp for PGY-1 residents was successfully delivered, with engagement from participants, training programs, the Canadian Neurosurgical Society, and the Royal College. In addition to providing fundamental knowledge, which was shown to be retained, the course eased junior residents' transition to residency by fostering camaraderie and socialization within the specialty.
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Educación de Postgrado en Medicina/métodos , Internado y Residencia , Neurocirugia/educación , Procedimientos Neuroquirúrgicos/métodos , Adulto , Canadá , Competencia Clínica/normas , Curriculum , Educación de Postgrado en Medicina/normas , Femenino , Humanos , Internado y Residencia/métodos , Internado y Residencia/normas , Conocimiento Psicológico de los Resultados , Masculino , Procedimientos Neuroquirúrgicos/normasRESUMEN
Ice skaters sustain a significant number of head injuries each winter. We are the first to implement an all-ages helmet policy at a university-based Canadian arena. We report our experience from a cross-sectional observational study as well as the policy's consequences on helmet use and skating participation. Educational programming was provided prior to policy implementation. Observations of helmet use, falls and skater demographics were conducted prior to education/implementation and after policy implementation. The number of skaters observed was essentially unchanged by the policy; 361 skaters were observed pre-implementation, while 358 were observed post-implementation during the same number of observation-hours. Pre-implementation, helmet use ranged from 97% among children under 12 to 10% among adults; post-implementation use in all skaters was 99%. Falls were observed among all age groups, with preponderance among those aged 4-12. An all-ages helmet policy was successful both in achieving helmet use among all skaters and in maintaining participation rates.
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Accidentes por Caídas/estadística & datos numéricos , Traumatismos en Atletas/prevención & control , Traumatismos Craneocerebrales/prevención & control , Dispositivos de Protección de la Cabeza/estadística & datos numéricos , Patinación/lesiones , Adolescente , Adulto , Factores de Edad , Anciano , Traumatismos en Atletas/epidemiología , Traumatismos en Atletas/etiología , Canadá/epidemiología , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
OBJECTIVE: To compare hearing preservation between stereotactic radiotherapy (SRT) and conservative treatment of patients with unilateral vestibular schwannoma. DATA SOURCES: Retrospective case series comparing hearing outcomes of patients with a unilateral vestibular schwannoma managed conservatively or with stereotactic radiotherapy in a tertiary care academic centre. PATIENTS: Tumor database patients with American Academy of Otolaryngology Head and Neck Surgery Class A or B hearing at the onset of study. Stereotactic radiotherapy patients were predominantly those who failed conservative management. INTERVENTIONS: Audiometric pure tone averages and speech discrimination scores as well as patient demographics, tumor location, size and growth were extracted. MAIN OUTCOME MEASURES: Hearing outcome measures were: 1) Hearing Preservation, i.e. no drop from Class A/B to Class C/D hearing, 2) Hearing Survival of Class A/B hearing in months, 3) Audiometric Pure Tone Averages, Difference between post-treatment and pre-treatment, and 4) Speech Discrimination Score Difference (pre-treatment-post treatment). Survival analysis and non-parametric tests were used for hearing outcome measures, with multiple covariates tested. RESULTS: Overall, serviceable hearing preservation among the 123 patients was 51%. The median hearing survival time was 46 months (mean 59 months). The Pure Tone averages and Speech Discrimination score differences were 16 dB and 82% respectively over a median follow-up time of 43 months. No significant difference was found between the conservative and SRT groups in any hearing outcome. Class A patients showed far better hearing survival than Class B patients. CONCLUSIONS: No significant difference was demonstrated as to measures of hearing outcomes between stereotactic radiotherapy and conservative management. Excellent existing hearing appears to be the best predictor of long term hearing survival in the cohort studied.
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Audición/fisiología , Neuroma Acústico/cirugía , Radiocirugia/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Audiometría de Tonos Puros , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Neuroma Acústico/fisiopatología , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
Atrial fibrillation (A-fib) is the most common cardiac arrhythmia which is associated with an increased risk of mortality secondary to stroke and coronary artery disease. Intravenous glucocorticoid therapy (such as dexamethasone and hydrocortisone) is frequently used peri-operatively in patients undergoing cardiac surgery to prevent A-fib. Dexamethasone is also frequently used in patients with single or bilateral vestibular schwannomas (VS), to reduce tumor swelling both before and after radiation treatment. We describe a case of A-fib in a 50 year-old female patient with neurofibromatosis type 2 (NF-2), who was prescribed dexamethasone for post-radiation tumor edema.
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Fibrilación Atrial/inducido químicamente , Dexametasona/efectos adversos , Glucocorticoides/efectos adversos , Neuroma Acústico/radioterapia , Administración Oral , Adulto , Terapia Combinada , Dexametasona/administración & dosificación , Electrocardiografía , Femenino , Glucocorticoides/administración & dosificación , Humanos , Imagen por Resonancia MagnéticaRESUMEN
OBJECTIVES: Off-road vehicle (ORV) and motorcycle use is common in Canada; however, risk of serious injury is heightened when these vehicles are operated without helmets and under the influence of alcohol. This study evaluated the impact of alcohol intoxication on helmet non-use and mortality among ORV and motorcycle crashes. METHODS: Using data collected from the Nova Scotia Trauma Registry, a retrospective analysis (2002-2017) of ORV and motorcycle crashes resulting in major traumatic brain injury was performed. Patients were grouped by blood alcohol concentration (BAC) as negative (< 2 mmol/L), legally intoxicated (2-17.3 mmol/L) or criminally intoxicated (> 17.3 mmol/L). Logistic regression models were constructed to test for helmet non-use and mortality. RESULTS: A total of 424 trauma patients were included in the analysis (220 ORV, 204 motorcycle). Less than half (45%) of patients involved in ORV crashes were wearing helmets and 65% were criminally intoxicated. Most patients involved in motorcycle crashes were helmeted at time of injury (88.7%) and 18% were criminally intoxicated. Those with criminal levels of intoxication had 3.7 times the odds of being unhelmeted and were 3 times more likely to die prehospital compared to BAC negative patients. There were significantly increased odds of in-hospital mortality among those with both legal (OR = 5.63), and criminal intoxication levels (OR = 4.97) compared to patients who were BAC negative. CONCLUSION: Alcohol intoxication is more frequently observed in ORV versus motorcycle crashes. Criminal intoxication is associated with helmet non-use. Any level of intoxication is a predictor of increased in-hospital mortality.
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BACKGROUND: Radiation therapy (RT) is the major component of glioblastoma treatment; however, the time to initiate RT after surgical intervention varies between institutions. Our study examined the time from diagnosis to the initiation of RT and its effects on overall patient survival. METHODS: We retrospectively examined 267 patients with glioblastoma who received RT as part of their therapy in two Canadian tertiary care centers. The primary goal of the study is to assess if time to RT can predict/impact survival in glioblastoma patients. RESULTS: The following variables were associated with an increased risk of death: hazard ratio (HR) of time to RT was 0.95 [95% confidence interval (CI), 0.910.99] for every extra week. HRs for the type of surgery (resection or biopsy) and type of management received (standard of care in comparison with RT regardless of chemotherapeutic agents other than concomitant and adjuvant temozolomide) were 0.50 (95% CI, 0.370.66) and 0.53 (95% CI, 0.380.75), respectively. HR for age was 1.02 (95% CI, 1.011.03) for every extra year. Standard 60 Gy RT HR was 0.70 [95% confidence interval (CI), 0.510.97] in younger patients. CONCLUSIONS: The time from diagnosis to the initiation of RT was found to be a significant prognostic factor for overall patient survival. The addition of temozolomide to the treatment protocol, age, standard RT dose in younger patients and extent of surgery are others factors associated with longer survival periods.Impact potentiel de la radiothérapie différée chez les patients atteints d'un glioblastome.
Asunto(s)
Antineoplásicos Alquilantes , Glioblastoma , Antineoplásicos Alquilantes/uso terapéutico , Neoplasias Encefálicas/cirugía , Canadá , Glioblastoma/tratamiento farmacológico , Humanos , Estudios RetrospectivosRESUMEN
OBJECTIVE: To examine whether adjuvant temozolomide treatment improved glioblastoma patients` survival in a large Canadian cohort. METHODS: We retrospectively studied 364 glioblastoma patients who received different modalities of treatment in 2 Canadian tertiary care centers in Edmonton and Halifax, Canada, between January 2000 and December 2006. The primary outcome was survival following the treatment protocol. RESULTS: The following variables were associated with an increased risk of death: The hazard risk (HR) of on-gross total resection was 0.50 (95% confidence interval [CI]: 0.39-0.64). The HR for the surgery-only group was 5.2 (95% CI: 3.85-7.06). The standard treatment group (surgery, radiation therapy [RT], and temozolomide) had an HR of 0.52 (95% CI: 0.37-0.74). The HR for patients who presented with seizure or whose presentation included seizures was 0.88 (95% CI: 0.55-0.89). Patient entry into trials had an HR of 0.74 (95% CI: 0.57-0.96). Finally, the HR for age was 1.02 (95% CI: 1.01-1.03) for every extra year. CONCLUSION: Concomitant temozolomide with RT and surgery was associated with longer survival compared with RT with surgery alone. We also found that younger age, surgical resection, seizure presence, and entry into trials are important prognostic factors for longer survival.
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Antineoplásicos/administración & dosificación , Neoplasias Encefálicas/terapia , Dacarbazina/análogos & derivados , Glioblastoma/terapia , Anciano , Neoplasias Encefálicas/mortalidad , Canadá , Quimioterapia Adyuvante/métodos , Dacarbazina/administración & dosificación , Femenino , Glioblastoma/mortalidad , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos , Radioterapia , Estudios Retrospectivos , Temozolomida , Resultado del TratamientoRESUMEN
We describe reconstruction of a sternal cleft in a neonate using acellular dermal matrix, full-thickness calvarial bone graft and myocutaneous pectoralis flaps.
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Dermis Acelular , Anomalías Musculoesqueléticas , Esternón , Humanos , Recién Nacido , Esternón/anomalíasRESUMEN
Due to resource restrictions related to the COVID-19 pandemic, many pediatric patients are facing substantial delays for surgery, potentially resulting in additional distress for caregivers. We aimed to assess the experiences and psychosocial distress of parents during COVID-19 as they relate to the pandemic, waiting for surgery, and the combined effects of both events. The was a cross-sectional qualitative study. Parents with children who faced treatment delays during the initial wave of the COVID-19 pandemic for elective, non-emergent procedures across a variety of surgical specialties were recruited. Semi-structured telephone interviews and thematic analysis were utilized. Thematic saturation was reached with eighteen participants. Four themes were identified: coping with COVID-19, distress levels, quality and nature of communication with the surgical team, and the experience of COVID-19 related hospital restrictions. Participants reported varying levels of distress due to the delay in surgery, such as the fear of developmental delay or disease progression for their child. They also indicated their own physical and mental health had been impacted by emotional distress related to both COVID-19 and delays in treatment. Most participants experienced the COVID-19-related hospital restrictions as distressing. This related predominantly to limiting in-hospital caregivers to only one caregiver. Participants were found to have substantial levels of psychosocial distress. Targeted social and emotional support may be helpful in reducing parental distress as the pandemic timeframe continues. Within the limits of individual health systems, reducing restrictions to the number of allowed care givers may help allay distress felt by parents.
RESUMEN
OBJECTIVE: To test the hypothesis that de novo genetic variants are responsible for moyamoya disease (MMD) in children with unaffected relatives, we performed exome sequencing of 28 affected children and their unaffected parents. METHODS: Exome sequencing was performed on 28 trios of affected patients with MMD and unaffected parents. RESULTS: We identified 3 novel rare de novo RNF213 variants, 1 in the RING domain and 2 in a highly conserved region distal to the RING domain (4,114-4,120). These de novo cases of MMD present at a young age with aggressive MMD and uniquely have additional occlusive vascular lesions, including renal artery stenosis. Two previously reported cases had de novo variants in the same limited region and presented young with aggressive MMD, and 1 case had narrowing of the inferior abdominal aorta. CONCLUSIONS: These results indicate a novel syndrome associated with RNF213 rare variants defined by de novo mutations disrupting highly conserved amino acids in the RING domain and a discrete region distal to the RING domain delimited by amino acids 4,114 to 4,120 leading to onset of severe MMD before 3 years of age and occlusion of other arteries, including the abdominal aorta, renal, iliac, and femoral arteries.
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Adenosina Trifosfatasas/genética , Enfermedad de Moyamoya/genética , Ubiquitina-Proteína Ligasas/genética , Adulto , Edad de Inicio , Enfermedades de la Aorta/genética , Enfermedades de la Aorta/fisiopatología , Arteriopatías Oclusivas/genética , Arteriopatías Oclusivas/fisiopatología , Preescolar , Femenino , Arteria Femoral , Humanos , Arteria Ilíaca , Masculino , Enfermedad de Moyamoya/fisiopatología , Mutación , Obstrucción de la Arteria Renal/genética , Obstrucción de la Arteria Renal/fisiopatologíaAsunto(s)
Neoplasias del Ventrículo Cerebral/complicaciones , Neoplasias del Ventrículo Cerebral/cirugía , Plexo Coroideo/cirugía , Cuarto Ventrículo/cirugía , Hidrocefalia/etiología , Neoplasias del Ventrículo Cerebral/diagnóstico , Humanos , Hidrocefalia/cirugía , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
OBJECTIVES: Craniosynostosis is typically diagnosed and surgically corrected within the first year of life. The diagnosis and surgical correction of the condition can be a very stressful experience for families. Despite this, there is little research exploring the impact that craniosynostosis has on families, especially in the period immediately following diagnosis and correction. In this study, the authors aimed to qualitatively examine the psychosocial experience of families with a child diagnosed with craniosynostosis. DESIGN: Qualitative study. SETTING: Tertiary care paediatric health centre. PARTICIPANTS: Mothers of children newly diagnosed with single-suture, non-syndromic craniosynostosis. INTERVENTION: Semistructured interviews regarding parental experience with the initial diagnosis, their decision on corrective surgery for their child, the operative experience, the impact of craniosynostosis on the family and the challenges they encountered throughout their journey. PRIMARY AND SECONDARY OUTCOME MEASURES: Thematic analysis, a type of qualitative analysis that provides an in-depth account of participant's experiences, was used to analyse the interview data. RESULTS: Over a 4-year period, 12 families meeting eligibility criteria completed the study. Three main themes (six subthemes) emerged from the preoperative interviews: frustration with diagnostic delays (parental intuition and advocacy, hope for improved awareness), understanding what to expect (healthcare supports, interest in connecting with other families) and justifying the need for corrective surgery (influence of the surgeon, struggle with cosmetic indications). Two main themes (four subthemes) were drawn from the postoperative interviews: overcoming fear (the role of healthcare professionals, transition home) and relief (reduction in parental anxiety, cosmetic improvements). CONCLUSIONS: Overall, the diagnosis of craniosynostosis has a profound impact on families, leading them to face many struggles throughout their journey. A better understanding of these experiences will help to inform future practice, with a hope to improve this experience for other families moving forward.