RESUMEN
BACKGROUND: Subarachnoid hemorrhage (SAH) has been associated with electrocardiographic (ECG) changes, arrhythmias, and release of cardiac enzymes. Recently, Takotsubo cardiomyopathies, presenting typical ECG changes and left ventricular (LV) regional wall-motion abnormalities (RWMAs), have been reported and considered to be a result of high norepinephrine (NE) levels. We hypothesized that ST-T-wave changes in patients with SAH may be manifestations of Takotsubo cardiomyopathy and associated with RWMAs. METHODS: We instituted consecutive echocardiographic screening of all patients with acute aneurysmal SAH. A standard 12-lead ECG and blood samples for creatine kinase (CK) MB isoenzyme and troponin-T (Tn-T) were obtained. To evaluate sympathetic nervous activity, we obtained blood samples and urine samples for NE. RESULTS: Of 42 patients with acute aneurysmal SAH, 26 had abnormal ECG including rhythm abnormalities. Ten of 12 patients with ST-T-wave changes had severe neurologic deficits, but 1 patient had RWMAs on echocardiography. Another patient with LV dysfunction showed a normal ST-T wave. In patients with ST-T-wave changes, elevated Tn-T (8.3 vs. 3.3%), CK-MB (8.3 vs. 10.0%), plasma and urine NE (16.7 and 33.3% vs. 16.7 and 50.0%), and mortality (8.3 vs. 13.3%) were not significantly higher. All 5 deaths resulted from noncardiac causes. High plasma and urine NE levels were not related to neurologic severity or mortality. CONCLUSIONS: Although ECG abnormalities are frequently seen in SAH patients, the incidence of RWMAs is very low. Electrocardiographic manifestations in patients with SAH and Takotsubo cardiomyopathy are similar, but ECG abnormalities in patients with SAH are mostly not related to LV dysfunction.
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Norepinefrina/sangre , Hemorragia Subaracnoidea/etiología , Cardiomiopatía de Takotsubo/complicaciones , Disfunción Ventricular Izquierda , Adulto , Anciano , Anciano de 80 o más Años , Ecocardiografía , Electrocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Hemorragia Subaracnoidea/sangre , Hemorragia Subaracnoidea/diagnóstico , Hemorragia Subaracnoidea/fisiopatología , Sistema Nervioso Simpático/fisiopatologíaRESUMEN
We report a case of abdominal compartment syndrome occurring due to uterine perforation while the patient was undergoing hysteroscopic uterine adhesiolysis for uterine synechia. The cause of the patient's abdominal compartment syndrome was irrigation fluid moving from the uterine cavity into the peritoneal space via defects in the uterus. Anesthesiologists must be alert for these complications during hysteroscopy procedures.
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Síndromes Compartimentales/etiología , Histeroscopía/efectos adversos , Perforación Uterina/complicaciones , Cavidad Abdominal , Adulto , Síndromes Compartimentales/terapia , Femenino , Humanos , Histeroscopía/métodos , Resultado del TratamientoRESUMEN
A 57-year-old woman presented with a progressive deterioration of vision. She had previously undergone clipping for a ruptured small anterior communicating artery (Acom) aneurysm 7 years prior to admission and additional coiling for recurrence 2 years prior to admission. Angiography showed regrown out-pouching of the sac, which measured 27 x 18 mm. A decision was made to perform surgical treatment to alleviate the mass effect of the aneurysm. Unique techniques for revision of the scarred surgical corridor, removal of old clips, resection of the coiled mass, thrombectomy, and intra-aneurysmal endarterectomy were required to allow placement of the final clips. The patient recovered uneventfully, and her vision was satisfactorily restored.
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Aneurisma Intracraneal/patología , Aneurisma Intracraneal/cirugía , Procedimientos Neuroquirúrgicos/instrumentación , Procedimientos Neuroquirúrgicos/métodos , Procedimientos Quirúrgicos Vasculares/instrumentación , Procedimientos Quirúrgicos Vasculares/métodos , Arteria Cerebral Anterior/diagnóstico por imagen , Arteria Cerebral Anterior/patología , Arteria Cerebral Anterior/cirugía , Angiografía Cerebral , Circulación Cerebrovascular/fisiología , Círculo Arterial Cerebral/diagnóstico por imagen , Círculo Arterial Cerebral/patología , Círculo Arterial Cerebral/cirugía , Embolización Terapéutica/instrumentación , Embolización Terapéutica/métodos , Femenino , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Persona de Mediana Edad , Quiasma Óptico/patología , Quiasma Óptico/fisiopatología , Prótesis e Implantes/efectos adversos , Recurrencia , Reoperación/instrumentación , Reoperación/métodos , Instrumentos Quirúrgicos/efectos adversos , Resultado del Tratamiento , Baja Visión/etiologíaRESUMEN
BACKGROUND: Ruptured blister-like aneurysms arising at non-branching sites of the internal carotid artery (BLICAA's) sometimes cause disaster during aneurysm repair because of their characteristic configurations. Our study was designed to establish the best surgical strategies for such aneurysms. METHOD: Eighteen BLICAA's (0.9% of all treated aneurysms) treated at our institute from January 1994 to July 2006 were retrospectively analysed using the database and imaging studies. We assessed the management outcome with the modified Rankin Scale (mRS). The average follow-up period was 17 months. FINDINGS: Their ages ranged from 30 to 68 years with a mean age of 50. There were 16 females, and two males). The angiographic diameter of the aneurysmal sac sranged from 1.4 to 5 mm with a mean diameter of 2.5 mm. The common origins were dorso-medial (n = 7) or dorsal (n = 6) wall of the ICA. Fifteen patients underwent wrapping with cellulose fabric and clipping. Of the remainder, each underwent direct clipping, suturing, or trapping. The overall outcome was mRS 1 in 11 patients (78.0%), two in three patients, three in one patient, one in one patient, and five in two patients. Intra-operative premature rupture occurred in six patients. There was no rebleeding during the follow-up period. Cerebral infarctions following carotid trapping after premature rupture and stenosis after suturing of perforated carotid wall were causes of mortality. The causes of morbidity included initial brain insult and vasospasm. CONCLUSIONS: The surgeon should be ware of the high risk of premature rupture during dissection of BLICAA's. Wrapping with cellulose fabric (Bemsheet) and holding clipping technique could be chosen as the optimal surgical modality for prevention of rebleeding from these lesions.
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Disección de la Arteria Carótida Interna/cirugía , Aneurisma Intracraneal/cirugía , Procedimientos Neuroquirúrgicos/métodos , Procedimientos Quirúrgicos Vasculares/métodos , Adulto , Anciano , Arteria Carótida Interna/diagnóstico por imagen , Arteria Carótida Interna/patología , Arteria Carótida Interna/cirugía , Disección de la Arteria Carótida Interna/mortalidad , Disección de la Arteria Carótida Interna/patología , Femenino , Humanos , Aneurisma Intracraneal/mortalidad , Aneurisma Intracraneal/patología , Complicaciones Intraoperatorias/etiología , Complicaciones Intraoperatorias/prevención & control , Masculino , Persona de Mediana Edad , Mortalidad , Procedimientos Neuroquirúrgicos/mortalidad , Procedimientos Neuroquirúrgicos/estadística & datos numéricos , Hemorragia Posoperatoria/etiología , Hemorragia Posoperatoria/prevención & control , Prótesis e Implantes/normas , Radiografía , Estudios Retrospectivos , Prevención Secundaria , Hemorragia Subaracnoidea/prevención & control , Hemorragia Subaracnoidea/cirugía , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares/mortalidad , Procedimientos Quirúrgicos Vasculares/estadística & datos numéricosRESUMEN
BACKGROUND: Malpositioned coils can provoke abrupt occlusion of the parent vessels and/or neighboring branches causing stroke during coil embolization (CE) of intracranial aneurysms. The authors describe a series of cases in which urgent surgical recanalization of the vessels clogged with herniated or migrated coils rescued the patients. METHODS: A total of six patients with aneurysms who underwent surgical management for parent artery occlusion linked with inadvertent coil herniation were selected. Their medical-surgical records and operative video recordings were reviewed retrospectively. RESULTS: There were five females and one male whose ages ranged from 44 to 59 years. Occluded vessels associated with CE were three A2 segments of the anterior cerebral artery (ACA), two M2 segments of the middle cerebral artery (MCA) and one superior cerebellar artery (SCA). Surgical management included securing control of both the proximal and distal parent artery, making small openings, safe removal of coils, thorough cleaning of debris and thrombus, and subsequent closure of the opening, which was successful in five of patients and resulted in excellent clinical outcome. However, in the SCA case, surgical retrieval of coils failed due to technical difficulties and yielded untoward results. CONCLUSIONS: This report demonstrates that timely surgical intervention could be considered as a safe and effective option to solve serious thromboembolic complications of CE associated with herniated coils.
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Embolización Terapéutica/efectos adversos , Aneurisma Intracraneal/cirugía , Microcirugia/métodos , Prótesis e Implantes/efectos adversos , Tromboembolia/etiología , Tromboembolia/cirugía , Adulto , Arteria Cerebral Anterior/diagnóstico por imagen , Arteria Cerebral Anterior/patología , Arteria Cerebral Anterior/cirugía , Embolización Terapéutica/instrumentación , Embolización Terapéutica/métodos , Femenino , Hernia/etiología , Herniorrafia , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/patología , Masculino , Persona de Mediana Edad , Arteria Cerebral Media/diagnóstico por imagen , Arteria Cerebral Media/patología , Arteria Cerebral Media/cirugía , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Radiografía , Reoperación/métodos , Estudios Retrospectivos , Tromboembolia/patologíaRESUMEN
Oxcarbazepine, an antiepileptic drug, has been reported to modulate voltage-dependent sodium channels, and it is commonly used in epilepsy treatment. In this study, we investigated the neuroprotective effect of oxcarbazepine in the hippocampus after transient ischemia in gerbils. Gerbils randomly received oxcarbazepine 100 or 200 mg/kg before and after transient ischemia. We examined its neuroprotective effect in the cornu ammonis 1 subfield of the gerbil hippocampus at 5 days after transient ischemia by using cresyl violet staining, neuronal nuclei immunohistochemistry and Fluoro-Jade B histofluorescence staining for neuroprotection, and by using glial fibrillary protein and ionized calcium-binding adapter molecule 1 immunohistochemistry for reaction of astrocytes and microglia, respectively. Pre- and post-treatment with 200 mg/kg of oxcarbazepine, but not 100 mg/kg of oxcarbazepine, protected pyramidal neurons of the cornu ammonis 1 subfield from transient ischemic damage. In addition, pre- and post-treatment with oxcarbazepine (200 mg/kg) significantly ameliorated astrocytes and microglia activation in the ischemic cornu ammonis 1 subfield. In brief, our current results indicate that post-treatment as well as pre-treatment with 200 mg/kg of oxcarbazepine can protect neurons from ischemic insults via attenuation of the glia reaction.
RESUMEN
BACKGROUND: Because DACA aneurysms are located in the narrow interhemispheric space surrounded by the corpus callosum and bilateral cingulate gyri with intervening falx cerebri, they are considered some of the most difficult anterior circulation aneurysms to surgically treat. Moreover, because of their rare occurrence and the emerging nonsurgical treatment options, neurosurgeons are limited in their ability to surgically treat DACA aneurysms due to their lack of experience. This article describes details of the preoperative considerations, operative techniques, and surgical results for DACA aneurysms. METHODS: Medical records, including imaging studies, surgeon's hand drawings and descriptions of microsurgical findings, microphotographs, and video records of operative procedures, were reviewed. RESULTS: Among 3577 patients with intracranial aneurysms treated since 1975, 126 (3.5%) patients with DACA aneurysms were identified. They were treated either by surgery (117 patients) or endovascular treatment (9 patients). The results of surgical treatment for the 117 patients with DACA aneurysms were favorable in 94% (90.6% good and 3.4% fair) and unfavorable in 6% (5.1% poor and 0.9% dead). All unfavorable outcomes occurred in patients who were of preoperative grades 4 or 5. CONCLUSIONS: Successful surgical management of DACA aneurysms depends on precise understanding of their unique microsurgical anatomy, avoidance of pitfalls, and the surgeon's experience. Sufficient brain relaxation, accurate localization of the aneurysm, early identification of the proximal A2 segment, and preservation of the major draining veins are necessary for a safe surgery.
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Arteria Cerebral Anterior/cirugía , Aneurisma Intracraneal/cirugía , Microcirugia/métodos , Procedimientos Neuroquirúrgicos/métodos , Hemorragia Subaracnoidea/cirugía , Arteria Cerebral Anterior/diagnóstico por imagen , Arteria Cerebral Anterior/patología , Angiografía Cerebral , Cuerpo Calloso/irrigación sanguínea , Cuerpo Calloso/cirugía , Giro del Cíngulo/irrigación sanguínea , Giro del Cíngulo/cirugía , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/patología , Microcirugia/instrumentación , Procedimientos Neuroquirúrgicos/instrumentación , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/fisiopatología , Complicaciones Posoperatorias/prevención & control , Cuidados Preoperatorios/métodos , Hemorragia Subaracnoidea/fisiopatología , Hemorragia Subaracnoidea/prevención & control , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Formation of cerebral de novo aneurysms (CDNA) is rare, and the pathogenesis remains obscure. In this study, we investigated the factors that contribute to the formation of CDNA and suggest guidelines for following patients treated for cerebral aneurysms. We retrospectively reviewed 2,887 patients treated for intracranial aneurysm at our institute from January of 1976 to December of 2005. Of those patients, 12 were readmitted due to recurrent rupture of CDNA, which was demonstrated by cerebral angiography. We assessed clinical characteristics, such as gender, size and site of rupture, past history, and the time to CDNA rupture. Of the 12 patients, 11 were female and 1 was male, with a mean age at rupture of the first aneurysm of 44.7 years (range: 30-69 years). The mean time between the first episode of subarachnoid hemorrhage (SAH) and the second was 8.9 years (range: 1.0-16.7 years). The most common site of ruptured CDNA was the internal carotid artery (5 patients, 41.7%), followed by basilar artery bifurcation (3 patients, 25.0%). In the remaining 4 patients, rupture occurred in the anterior communicating, middle cerebral, anterior cerebral (A1), or posterior cerebral (P1) arteries. In 5 cases (41.7%), the CDNA occurred contralateral to the initial aneurysm. Eleven patients (91.7%) had a past history of arterial hypertension. There was no history of habitual smoking or alcohol abuse in any of the patients. Eight patients underwent clipping for CDNA and three patients were treated with coiling. One patient who had multiple aneurysms was treated with clipping following intra-aneurysmal coiling. Assessment according to the Glasgow Outcome Scale (GOS) of the patients after the treatment was good in 10 cases (83.3%) and fair in 2 cases (16.7%). Although formation of CDNA after successful treatment of initial aneurysm is rare, several factors may contribute to recurrence. In our study, female patients with a history of arterial hypertension were at higher risk for ruptured CDNA. We recommend follow-up imaging studies every five years after treatment of the initial aneurysm, especially in women and those with a history of arterial hypertension.
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Aneurisma Roto/patología , Aneurisma Intracraneal/patología , Adulto , Anciano , Aneurisma Roto/etiología , Aneurisma Roto/terapia , Femenino , Humanos , Hipertensión/complicaciones , Aneurisma Intracraneal/etiología , Aneurisma Intracraneal/terapia , Masculino , Persona de Mediana Edad , Factores de RiesgoRESUMEN
PURPOSE: Pathogenesis and treatment of spontaneous dissecting aneurysm of the intracranial vertebral artery (VA) remain controversial. This study was designed to provide management strategies and to improve management outcome in patients with these aneurysms. MATERIALS AND METHODS: Among a total of 1,990 patients treated for intracranial aneurysms from February 1992 to June 2005, 28 patients (1.4%) were treated either by surgery (8 patients) or neurointervention (20 patients) for spontaneous dissecting aneurysms of the intracranial VA. Twenty-two patients had ruptured aneurysms. We analyzed indications of surgery or neurointervention for each case, and assessed the management outcome at a 6-month follow-up. RESULTS: For selection of therapeutic options, patients were initially evaluated as possible candidates for neurointervention using the following criteria: 1) poor clinical grade; 2) advanced age; 3) medical illness; 4) unruptured aneurysm; 5) equal or larger opposite VA; 6) anticipated surgical difficulty due to a deep location of the VA-posterior inferior cerebellar artery (PICA) junction. Surgery was considered for patients with: 1) high-risk aneurysms (large or irregular shaped); 2) smaller opposite VA; 3) failed neurointervention; or 4) dissection involving the PICA. Management outcomes were favorable in 25 patients (89.3%). Causes of unfavorable outcome in the remaining 3 patients were the initial insult in 2 patients, and medical complications in one patient. CONCLUSION: Ruptured aneurysms must be treated to prevent rebleeding. For unruptured aneurysms, follow-up angiography would be necessary to detect growth of the aneurysm. Treatment modality should be selected according to the clinical characteristics of each patient and close collaboration between neurosurgeons and neurointerventionists is essential.
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Disección Aórtica/patología , Aneurisma Intracraneal/patología , Arteria Vertebral/patología , Adulto , Anciano , Disección Aórtica/cirugía , Disección Aórtica/terapia , Aneurisma Roto/patología , Aneurisma Roto/cirugía , Aneurisma Roto/terapia , Femenino , Estudios de Seguimiento , Humanos , Aneurisma Intracraneal/cirugía , Aneurisma Intracraneal/terapia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Arteria Vertebral/cirugíaRESUMEN
We reviewed 12 patients with pituitary tumour and cranial nerve palsy to analyse the clinical characteristics, the radiographic appearances, and the outcome after surgery. All patients had pathologically nonfunctioning macroadenomas with evidence of apoplexy. The third cranial nerve was the most frequently affected, followed by the sixth and fourth cranial nerves. Third cranial nerve palsy manifested as a symptom sequence comprising mydriasis, followed by limitation of gaze and ptosis. These symptoms recovered in reverse order of development. The time taken for recovery of cranial nerve palsy after surgery was significantly correlated with the length of time between the onset of symptoms and surgery. Pituitary apoplexy appears to be the primary cause of cranial nerve palsy with pituitary tumour. Early surgical intervention is most likely to bring about rapid recovery from cranial nerve dysfunction.
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Enfermedades de los Nervios Craneales/etiología , Neoplasias Hipofisarias/complicaciones , Enfermedades del Nervio Abducens/etiología , Adulto , Anciano , Angiografía Cerebral , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Enfermedades del Nervio Oculomotor/etiología , Neoplasias Hipofisarias/cirugía , Estudios Retrospectivos , Resultado del Tratamiento , Enfermedades del Nervio Troclear/etiologíaAsunto(s)
Cateterismo Periférico/efectos adversos , Catéteres/efectos adversos , Cuerpos Extraños/etiología , Arteria Radial , Anciano , Anestesia General , Apendicectomía , Remoción de Dispositivos , Falla de Equipo , Cuerpos Extraños/diagnóstico por imagen , Cuerpos Extraños/cirugía , Humanos , Laparoscopía , Masculino , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
The position of the ventricular shunt catheter is by far most important factor in the long-term patency of a cerebrospinal fluid shunt. However, standard technique, which relies on surface anatomic landmarks and the surgeon's sense of spatial orientation, is not consistently accurate in the positioning the ventricular shunt catheter. Image guidance provides not only a three-dimensional reconstruction of the ventricular system, but also a real-time virtual trajectory for the catheterization. The authors, using a neuronavigation system, describe the ideal trajectory and target for accurate placement of a ventricular shunt catheter. Seventeen consecutive trials of image-guided placement of the ventricular shunt catheter resulted in excellent positioning of the catheter, within the free cerebrospinal fluid space just anterior to the foramen of Monro. This positioning was accurate in each case, even if the ventricles were distorted or shifted.
Asunto(s)
Diagnóstico por Imagen/métodos , Neuronavegación , Hemorragia Subaracnoidea/cirugía , Derivación Ventriculoperitoneal/métodos , Adulto , Anciano , Ventriculografía Cerebral/métodos , Diseño de Equipo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos VascularesRESUMEN
The need for repeat angiography in patients with subarachnoid haemorrhage (SAH) who initially present with a negative angiogram is still debated. The aim of this study was to provide a management protocol for 'angiogram-negative SAH'. From January 1986 to June 2004, 143 patients with SAH were admitted to our institution with negative initial angiograms. We classified the 143 patients into three groups: group I, with no SAH on CT scan, but confirmed by cerebrospinal fluid analysis; group II, with a perimesencephalic pattern of SAH; and group III, with a non-perimesencephalic pattern of SAH. Out of the 143 patients, 103 underwent repeat angiography, and 18 were found to have ruptured aneurysms that were not detected on the initial angiogram (false negative rate: 17.5% overall, 0% in group I, 1.5% in group II, and 45.9% in group III). Repeat angiography should be performed, particularly in patients who have a non-perimesencephalic SAH pattern, for detection of initially unrecognised ruptured aneurysms.
Asunto(s)
Angiografía Cerebral/normas , Arterias Cerebrales/diagnóstico por imagen , Errores Diagnósticos/prevención & control , Hemorragia Subaracnoidea/diagnóstico por imagen , Espacio Subaracnoideo/diagnóstico por imagen , Adulto , Distribución por Edad , Anciano , Angiografía Cerebral/métodos , Arterias Cerebrales/patología , Arterias Cerebrales/fisiopatología , Reacciones Falso Negativas , Femenino , Humanos , Masculino , Mesencéfalo/diagnóstico por imagen , Mesencéfalo/patología , Mesencéfalo/fisiopatología , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Distribución por Sexo , Hemorragia Subaracnoidea/líquido cefalorraquídeo , Hemorragia Subaracnoidea/fisiopatología , Espacio Subaracnoideo/patología , Espacio Subaracnoideo/fisiopatología , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: The purpose of this study was to evaluate the effect of dexamethasone or dexmedetomidine added to ropivacaine on the onset and duration of ultrasound-guided axillary brachial plexus blocks (BPB). METHODS: Fifty-one ASA physical status I-II patients with elective forearm and hand surgery under axillary brachial plexus blocks were randomly allocated to receive 20 ml of 0.5% ropivacaine with 2 ml of isotonic saline (C group, n = 17), 20 ml of 0.5% ropivacaine with 2 ml (10 mg) of dexamethasone (D group, n = 17) or 20 ml of 0.5% ropivacaine with 2 ml (100 µg) of dexmedetomidine (DM group, n = 17). A nerve stimulation technique with ultrasound was used in all patients. The onset time and duration of sensory blocks were assessed. RESULTS: The duration of the sensory block was extended in group D and group DX compared with group C (P < 0.05), but there was no significant difference between group D and group DX. However, there were no significant differences in onset time in all three groups. CONCLUSIONS: Dexamethasone 10 mg and dexmedetomidine 100 µg were equally effective in extending the duration of ropivacaine in ultrasound-guided axillary BPB with nerve stimulation. However, neither drug has significantly effects the onset time.
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BACKGROUND: Postoperative nausea and vomiting (PONV), postanesthetic shivering and pain are common postoperative patient complaints that can result in adverse physical and psychological outcomes. Some antiemetics are reported to be effective in the management of postoperative pain and shivering, as well as PONV. We evaluated the efficacy of dexamethasone added to ramosetron on PONV, shivering and pain after thyroid surgery. METHODS: One hundred and eight patients scheduled for thyroid surgery were randomly allocated to three different groups: the control group (group C, n = 36), the ramosetron group (group R, n = 36), or the ramosetron plus dexamethasone group (group RD, n = 36). The patients were treated intravenously with 1 and 2 ml of 0.9% NaCl (group C); or 2 ml of 0.15 mg/ml ramosetron plus 1 ml of 0.9% NaCl (group R); or 2 ml of 0.15 mg/ml ramosetron plus 1 ml of 5 mg/ml dexamethasone (group RD) immediately after anesthesia. RESULTS: Incidence of nausea and the need for rescue antiemetics, verbal rating scale (VRS) 1 hour pain value, ketorolac consumption, and incidence of shivering were significantly lower in group R and group RD, than in group C (P < 0.05). Moreover, these parameters were significantly lower in group RD than in group R (P < 0.05). CONCLUSIONS: Combination of ramosetron and dexamethasone significantly reduced not only the incidence of nausea and need for rescue antiemetics, but also the VRS 1 hour pain value, ketorolac consumption, and the incidence of shivering compared to ramosetron alone in patients undergoing thyroid surgery.
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BACKGROUND AND PURPOSE: The purpose of this study was to compare clinical outcomes and treatment-related complications between coiling and clipping for ruptured distal anterior cerebral artery (DACA) aneurysms. METHODS: Eighty-four consecutive patients (M:F = 36:48; mean 53.8 years) with ruptured DACA aneurysms were treated by either clipping (n = 46, 54.8%) or coiling (n = 38, 45.2%). The clinical outcomes and procedure-related complications were evaluated and compared between the two groups. RESULTS: Procedure-related complications tend to occur more frequently in the clipping (n = 6, 13.0%) than coiling group (n = 1, 2.6%) (P = .121). At discharge, 51 patients (60.7%) had favorable outcomes (Glasgow outcome scale [GOS], 4 or 5). There was no significant difference between the two groups in favorable outcome (63.2% vs. 58.7%; P = .677). Hunt and Hess (HH) grade (P < .001; 95% CI, 3.354-29.609) and treatment modality (P = .044; 95% CI, 1.039-16.325) were independent risk factors for poor outcome (GOS, 1-3). CONCLUSIONS: Coiling was more favorable to clipping in clinical outcomes and incidence of treatment-related complications for ruptured DACA aneurysms.
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Aneurisma Roto/cirugía , Revascularización Cerebral/métodos , Procedimientos Endovasculares/métodos , Aneurisma Intracraneal/cirugía , Adulto , Anciano , Aneurisma Roto/diagnóstico por imagen , Angiografía Cerebral/métodos , Femenino , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Cirugía Asistida por Computador/métodos , Resultado del TratamientoRESUMEN
The most common site of internal carotid artery (ICA) aneurysms is at the posterior communicating artery (PComA) junction. Although ICA aneurysm surgery carries substantial risk, the ultimate outcome of patients with PComA aneurysms is better than those with aneurysms in other locations. The rate of successful surgical outcome increases when precise knowledge of the anatomy and understanding of the hazards associated with aneurysms in this region are combined with a well organized plan for the surgical approach. This article will describe details of the preoperative considerations, operative techniques, and surgical results for aneurysms arising at the ICA-PComA junction based on the 25-year personal experience of the senior author, comprising a total of 424 surgical cases.
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Aneurisma Intracraneal/cirugía , Procedimientos Neuroquirúrgicos/métodos , Arteria Carótida Interna/fisiología , Angiografía Cerebral , Craneotomía/métodos , Potenciales Evocados Somatosensoriales/fisiología , Humanos , Hipertensión/prevención & control , Aneurisma Intracraneal/complicaciones , Aneurisma Intracraneal/diagnóstico , Enfermedades del Nervio Oculomotor/etiología , Cuidados Preoperatorios , Posición Supina , Instrumentos Quirúrgicos , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Increasing use of the nail gun has led to higher injury rates from the use of tools with sequential actuation. Nail gun injury can occur to various parts of the body. Very deep penetration in the brain can have fatal results. A 46-year-old male fired shots from a nail gun into his brain in a suicide attempt. This case demonstrated successful surgical management of the resultant open head injury.
RESUMEN
Fluoroscopic images for comparison (FICs) can be easily obtained for follow-up on an outpatient basis. This study retrospectively assessed the diagnostic performance of a set of FICs for evaluation of recanalization after stent-assisted coiling, with digital subtraction angiography (DSA) as the reference standard. A total of 124 patients harboring 144 stent-assisted coiled aneurysms were included. At least one month postembolization they underwent follow-up angiograms comprising a routine frontal and lateral DSA and a working-angle DSA. For analysis, FICs should be compared with the mask images of postprocedural DSAs to find recanalization. Instead of FIC acquisition, the mask images of follow-up DSAs were taken as a substitute because of the same view-making processes as FICs, full availability, and perfect coincidence with follow-up DSAs. Two independent readers evaluated a set of 169 FICs and DSA images for the presence of recanalization one month apart. Sensitivity, specificity, and interreader agreement were determined. Recanalization occurred in 24 (14.2%) cases. Of these, nine (5.3%) cases were found to have significant recanalization in need of retreatment. Sensitivity and specificity rates were 79.2% (19 of 24) and 95.9% (139 of 145) respectively for reader 1, and 66.7% (16 of 24) and 97.9% (142 of 145) for reader 2. Minimal recanalization was identified in seven out of all eight false negative cases. Excluding minimally recanalized cases in no need for retreatment from the recanalization group, calculation resulted in high sensitivity and specificity of over 94% for both readers. Interreader agreement between the two readers was excellent (96.4%; κ = 0.84). FICs may be a good imaging modality to detect significant recanalization of stent-assisted coiled aneurysms.
Asunto(s)
Fluoroscopía/métodos , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/terapia , Stents , Adulto , Anciano , Angiografía de Substracción Digital , Angiografía Cerebral , Procedimientos Endovasculares/métodos , Reacciones Falso Negativas , Femenino , Estudios de Seguimiento , Humanos , Procesamiento de Imagen Asistido por Computador , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Reproducibilidad de los Resultados , Retratamiento , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: In the present study, we compared changes in body temperature and the occurrence of shivering in elderly patients undergoing total knee arthroplasty under spinal anesthesia during warming with either a forced-air warming system or a circulating-water mattress. METHODS: Forty-six patients were randomly assigned to either the forced-air warming system (N = 23) or circulating-water mattress (N = 23) group. Core temperature was recorded using measurements at the tympanic membrane and rectum. In addition, the incidence and intensity of post-anesthesia shivering and verbal analogue score for thermal comfort were simultaneously assessed. RESULTS: Core temperature outcomes did not differ between the groups. The incidence (13.0 vs 43.5%, P < 0.05) and intensity (20/2/1/0/0 vs 13/5/3/2/0, P < 0.05) of post-anesthesia shivering was significantly lower in the forced-air system group than in the circulating-water mattress group. CONCLUSIONS: The circulating-water mattress was as effective as the forced-air warming system for maintaining body temperature. However, the forced-air warming system was superior to the circulating-water mattress in reducing the incidence of post-anesthesia shivering.