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1.
J Neurol Surg A Cent Eur Neurosurg ; 78(3): 255-259, 2017 May.
Artículo en Inglés | MEDLINE | ID: mdl-27684061

RESUMEN

Objective To compare the resolution rate of hydrocephalus after endoscopy (predominantly endoscopic third ventriculostomy [ETV]) using flexible endoscopes during a 5-year period in patients with a permeable and a nonpermeable subarachnoid space (SAS). Material and Methods We conducted a retrospective cohort study of the videos and records of 150 hydrocephalic patients chosen randomly who underwent ETV (and other endoscopic procedures) with a flexible endoscope. The patients were classified into two groups based on the neuroendoscopic findings. The first group included patients with a permeable SAS, and the second group included patients with a nonpermeable SAS. A normal SAS or one with slight arachnoiditis was considered permeable. Adhesive arachnoiditis and immature or mechanically obliterated SASs were considered nonpermeable. Results We found a success rate of 70% in patients with a permeable SAS versus 33% in patients with a nonpermeable SAS. The baseline characteristics of both groups were homogeneous. We obtained a statistically significant difference (p < 0.0001) with hazard ratio (HR) 3.42 (95% confidence interval [CI], 1.88-6.22). Another important factor involved was age that showed a statistically significant difference (p < 0.0018) with HR 3.28 (95% CI, 1.55-6.93). Conclusion The permeability of the SAS is an important prognostic factor in the resolution rate of hydrocephalus after ETV (and other endoscopic procedures) using flexible neuroendoscopes. Therefore we recommend that the characteristics of the SAS be examined following every endoscopic procedure for hydrocephalus to identify patients at risk of recurrence.


Asunto(s)
Hidrocefalia/fisiopatología , Hidrocefalia/cirugía , Neuroendoscopía , Base del Cráneo , Espacio Subaracnoideo/fisiopatología , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Adulto Joven
2.
Neurol Res ; 38(7): 593-9, 2016 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-27236905

RESUMEN

OBJECTIVES: The purpose of this work is to elucidate the efficacy of endoscopic basal cisterns exploration, biopsy, and third ventriculostomy (ETV) in patients with basal cistern meningitis and arachnoiditis. MATERIALS AND METHODS: The cases and videos of all patients in whom flexible neuroendoscopy was performed during the period of January 2005-June 2012 at the University Hospital 'Dr. Ignacio Morones Prieto' in San Luis Potosí, México. A group of 47 patients with radiological diagnosis of basal meningitis, arachnoiditis, and negative cerebrospinal fluid analysis were included. RESULTS: From the 28 (60%) patients with histological diagnosis, 22 (47%) were made from biopsy from the arachnoid membranes of the basal cisterns only, 4 (9%) only from the cerebral cortex, and 2 (4%) from both sites. There were no complications related to the endoscopic procedure. In 23 patients from the 42 with hydrocephalus, ETV was successful. The grade of diagnostic accuracy of both biopsies in detect etiology was 68% (28 of 47 patients), the diagnostic accuracy of arachnoid biopsy was 60%, and diagnostic accuracy of convexity brain biopsy was 21% with 24 and 6 patients, respectively. DISCUSSION: Endoscopic transventricular biopsy of the basal cisterns seems to be a safe and a relatively accurate procedure. As longs as frozen subarachnoid space was not seen, the possibilities of performing ETV in hydrocephalus condition are elevated depending on the causal micro-organism.


Asunto(s)
Endoscopía/métodos , Hidrocefalia/cirugía , Meningitis/cirugía , Tercer Ventrículo/cirugía , Ventriculostomía/métodos , Adolescente , Adulto , Anciano , Biopsia , Corteza Cerebral/diagnóstico por imagen , Corteza Cerebral/patología , Niño , Preescolar , Erradicación de la Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Lactante , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Espacio Subaracnoideo/patología , Espacio Subaracnoideo/cirugía , Tercer Ventrículo/diagnóstico por imagen , Adulto Joven
3.
Neurol Res ; 36(2): 102-6, 2014 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-24139087

RESUMEN

OBJECTIVES: Our main objective was to evaluate whether serum hypocalcaemia on the third day [defined as < 2.1 mmol/l (8.5 mg/dl)] is a prognostic factor for early mortality after moderate and severe traumatic brain injury (TBI). METHODS: We developed an ambispective comparative case control study. We evaluated clinical profiles from included patients from January 2005 to July 2009 and we prospectively recruited additional patients from August 2009 to July 2011. Patients were between 1 and 89 years old and had a Glasgow Coma Scale of 3-12 points following TBI. RESULTS: We calculated an Odds Ratio of 5.2 (Confidence Intervals 95%: 4.48 to 6.032) for hypocalcaemia on day three, which was associated with death. Retrospectively (January 2005 to July 2009) we compiled data from 81 patients. Prospectively (August 2009 to July 2011) we recruited 41 patients. The adjusted variables in the logistic regression final model were: serum calcium on day three (Odds Ratio 3.5, Confidence Intervals 95%: 1·12 to 13·61, P < 0·028) and anisocoria (Odds Ratio 8·24, Confidence Intervals 95%: 1·3 to 67·35, P < 0·019) obtaining an adjusted R2 of 0·22 (P < 0·005). DISCUSSION: The serum levels of calcium on day three could be useful for the prediction of mortality in patients with moderate and severe TBI.


Asunto(s)
Lesiones Encefálicas/diagnóstico , Lesiones Encefálicas/mortalidad , Calcio/sangre , Hipocalcemia/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Adulto Joven
4.
World Neurosurg ; 79(2): 340-6, 2013 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-23044003

RESUMEN

OBJECTIVE: To propose a scoring system using endoscopy for assessment of the inflammatory alterations caused by neurocysticercosis (NCC) inside the ventricular cavities and the basal subarachnoid space. METHODS: Video recordings of the endoscopic procedures in patients with hydrocephalus secondary to NCC were assessed in a two-phase study. In the first phase (n = 10), the assigned score of each patient was correlated with the cerebrospinal fluid values obtained by lumbar and ventricular puncture. Reproducibility was determined using an intraclass correlation coefficient. In the second phase (n = 30), the prognostic value of the score was tested by comparing it with the patient's Karnofsky performance score (KPS) 3 months after endoscopy. RESULTS: The score included four main components: ependymal findings, number of involved sites, abnormalities in the subarachnoid space, and other alterations. These values were summed to produce a total score, which correlated strongly with both protein and cell counts from ventricular cerebrospinal fluid. The intraclass correlation coefficient of the global score was 0.85. In the second phase, the scores were divided into mild, moderate, and severe categories (6, 15, and 9 patients). The initial KPS was similar between the groups (P = 0.56); however, when measured 3 months later, there were significant differences (P = 0.02). The logistic regression analysis of patients with a score in the severe range (odds ratio = 0.09; 95% confidence interval, 0.06-0.64) showed a reduced chance for achieving a good outcome (KPS ≥90) after 3 months. CONCLUSIONS: Our scoring system enables endoscopic classification of the damage caused by NCC in the ventricular and basal subarachnoid space. The score has a biologic basis and a good internal reproducibility. The score seems to be useful for determining the short-term prognosis, and patients with high scores require additional therapeutic measures to improve their outcomes.


Asunto(s)
Endoscopía , Hidrocefalia/patología , Neurocisticercosis/diagnóstico , Neurocisticercosis/cirugía , Índice de Severidad de la Enfermedad , Ventrículos Cerebrales/patología , Estudios de Cohortes , Humanos , Hidrocefalia/parasitología , Hidrocefalia/cirugía , Neurocisticercosis/complicaciones , Pronóstico , Reproducibilidad de los Resultados , Espacio Subaracnoideo/patología
5.
J Neurosurg ; 118(3): 669-75, 2013 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-23289819

RESUMEN

OBJECT: The favorable effect of statin treatment after traumatic brain injury (TBI) has been shown in animal studies and is probably true in humans as well. The objective of this study was to determine whether acute statin treatment following TBI could reduce inflammatory cytokines and improve functional outcomes in humans. METHODS: The authors performed a double-blind randomized clinical trial in patients with moderate to severe TBI. Exclusion criteria were as follows: prior severe disability; use of modifiers of statin metabolism; multisystem trauma; prior use of mannitol, barbiturates, corticosteroids, or calcium channel blockers; isolated brainstem lesions; allergy to statins; previous hepatopathy or myopathy; previous treatment at another clinic; and pregnancy. Patients were randomly selected to receive 20 mg of rosuvastatin or placebo for 10 days. The main goal was to determine the effect of rosuvastatin on plasma levels of tumor necrosis factor-α, interleukin (IL)-1ß, IL-6, and IL-10 after 72 hours of TBI. Amnesia, disorientation, and disability were assessed 3 and 6 months after TBI. RESULTS: Thirty-six patients were analyzed according to intention-to-treat analysis; 19 patients received rosuvastatin and 17 received placebo. The best-fit mixed model showed a significant effect of rosuvastatin on the reduction of tumor necrosis factor-α levels (p = 0.004). Rosuvastatin treatment did not appear to affect the levels of IL-1ß, IL-6, and IL-10. The treatment was associated with a reduction in disability scores (p = 0.03), indicating a favorable functional outcome. Life-threatening adverse effects were not observed. CONCLUSIONS: The authors' data suggest that statins may induce an antiinflammatory effect and may promote recovery after TBI. The role of statins in TBI therapy should be confirmed in larger clinical trials.


Asunto(s)
Antiinflamatorios/farmacología , Lesiones Encefálicas/metabolismo , Citocinas/sangre , Citocinas/efectos de los fármacos , Fluorobencenos/farmacología , Inhibidores de Hidroximetilglutaril-CoA Reductasas/farmacología , Pirimidinas/farmacología , Sulfonamidas/farmacología , Adulto , Anciano , Amnesia/etiología , Antiinflamatorios/uso terapéutico , Lesiones Encefálicas/complicaciones , Lesiones Encefálicas/fisiopatología , Confusión/etiología , Evaluación de la Discapacidad , Método Doble Ciego , Femenino , Fluorobencenos/uso terapéutico , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Interleucina-10/sangre , Interleucina-1beta/sangre , Interleucina-1beta/efectos de los fármacos , Interleucina-6/sangre , Masculino , Persona de Mediana Edad , Pirimidinas/uso terapéutico , Rosuvastatina Cálcica , Sulfonamidas/uso terapéutico , Factores de Tiempo , Factor de Necrosis Tumoral alfa/sangre , Factor de Necrosis Tumoral alfa/efectos de los fármacos
6.
Pathog Glob Health ; 106(4): 245-8, 2012 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-23265426

RESUMEN

BACKGROUND: Toxic or fulminant colitis due to Entamoeba histolytica infrequently presents but is very serious. Unfortunately, there are numerous contradictory factors related to mortality. METHODS: We analyzed several cases of E. histolytica infection to determine the factors related to mortality. We included patients >15 years of age who were histopathologically diagnosed with amoebic toxic colitis and treated from January 2000 through December 2006. We evaluated demographic, clinical, laboratorial, surgical, and histopathological characteristics. RESULTS: We examined 24 patients and recorded 12 deaths (50%). Twenty patients underwent surgery within a mean time of 24 hours (range: 8-120 hours). Tenesmus and intestinal perforation were determined to be statistically significant (P<0·05) by univariate analysis. Three models of logistic regression were able to determine three statistically significant factors that affected mortality: (1) tenesmus and a lymphocyte count <1·5×10(3) cell/µl; 2) depth of invasion beyond the mucosa and a lymphocyte count <1·5×10(3) cell/µl; 3) time spent with symptoms and perforation. CONCLUSIONS: The mortality rate determined in this study is similar to previously reported series. A low lymphocyte count, significant depth of invasion, and intestinal perforation were determined to be the factors related to increased mortality, while tenesmus and limited amount of time spent with symptoms were associated with survival. Quick diagnosis and appropriate treatment are important factors that reduce mortality.


Asunto(s)
Disentería Amebiana/mortalidad , Disentería Amebiana/patología , Entamoeba histolytica/patogenicidad , Adolescente , Adulto , Anciano , Disentería Amebiana/complicaciones , Disentería Amebiana/inmunología , Femenino , Humanos , Perforación Intestinal/diagnóstico , Perforación Intestinal/mortalidad , Linfopenia/diagnóstico , Linfopenia/mortalidad , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Análisis de Supervivencia , Adulto Joven
7.
Pathog Glob Health ; 106(4): 232-7, 2012 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-23265424

RESUMEN

OBJECTIVES: To identify the variables that predict the failure to treat amoebic liver abscesses. METHODS: We prospectively carried out a case-control study on a cohort of patients who had been diagnosed with amoebic liver abscesses using clinical, ultrasonic, and serologic methods. Patients with pyogenic abscesses, negative ELISA tests for amoebiasis, immunosuppression status, or previous abdominal surgery were excluded. All patients received metronidazole, and those who demonstrated 4 days of unfavorable clinical responses received percutaneous or surgical draining of the abscess. Demographic, laboratory, and ultrasonographic characteristics were assessed as prognostic indications of failure. RESULTS: Of 40 patients with amoebic liver abscess, 24 (mean age: 36·7±11·2 years) responded to medical treatment and 16 (41·8±11·6 years) required drainage, including 14 patients who underwent percutaneous drainage and two patients who required surgery. The albumin level, abscess volume, abscess diameter, and alkaline phosphatase level were all statistically significant (P<0·05) on the bivariate analysis. The highest (>99%) sensitivity and negative predictive value were observed for an abscess volume >500 ml and diameter >10 cm, while the best specificity and positive predictive value were achieved with the combination of low serum albumin level, high alkaline phosphatase level, and large abscess volume or diameter. CONCLUSIONS: The prognostic indications of the failure to treat amoebic liver abscesses include low albumin, high alkaline phosphatase, and large abscess volume or diameter. The combination of these variables is a useful and easy tool for determining appropriate therapy.


Asunto(s)
Antiprotozoarios/administración & dosificación , Absceso Hepático Amebiano/tratamiento farmacológico , Absceso Hepático Amebiano/cirugía , Metronidazol/administración & dosificación , Succión , Adulto , Estudios de Casos y Controles , Estudios de Cohortes , Femenino , Humanos , Absceso Hepático Amebiano/patología , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Insuficiencia del Tratamiento
8.
Clin Neurol Neurosurg ; 112(1): 11-6, 2010 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-19767141

RESUMEN

OBJECTIVE: Hydrocephalus due to neurocysticercosis usually shows poor prognosis and shunt failure is a common complication. Neuroendoscopy has been suggested as treatment, but the indications remain unclear. METHODS: A cohort of patients with clinical/radiological diagnosis of hydrocephalus due to NCC, treated between January 2002 and September 2006, were the subjects of the study. We excluded patients with tumors or those in whom diagnosis was not confirmed (histology/positive ELISA in CSF). Neuroendoscopy was offered as the first line of treatment. Shunt failure rate and Karnofsky index at 12 months were assessed. RESULTS: Eighty-six patients (47 male) with a median age of 38 (9-79) were included in the study. Of them, 36.1% had a shunt before endoscopy and 97.7% had a Karnofsky index <80. We did not find the parasite in 18.6%, extraction was achieved in 79%, and in 87.2% an endoscopic third ventriculostomy (ETV) was performed. The median follow-up time was 43 months (1-72). Shunt failure was seen in 6.6% of patients with ETV in comparison to 27.2% in those without ETV. A hazard ratio of 0.22 (95% CI, 0.05-0.93) for shunt failure after ETV was calculated. At 12 months, 20.9% had a Karnofsky index <80. CONCLUSION: Early extraction of parasite plus ETV might allow improving outcome and reducing shunt failure. Limitation of inflammatory stimulation by parasite antigens and improvement of CSF dynamics could be an explanation for these findings.


Asunto(s)
Endoscopía , Hidrocefalia/etiología , Hidrocefalia/cirugía , Neurocisticercosis/complicaciones , Procedimientos Neuroquirúrgicos , Adolescente , Adulto , Anciano , Algoritmos , Anestesia General , Acueducto del Mesencéfalo/cirugía , Niño , Estudios de Cohortes , Progresión de la Enfermedad , Ensayo de Inmunoadsorción Enzimática , Femenino , Estudios de Seguimiento , Humanos , Hidrocefalia/líquido cefalorraquídeo , Estado de Ejecución de Karnofsky , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Neurocisticercosis/líquido cefalorraquídeo , Neurocisticercosis/parasitología , Neuroendoscopía , Análisis de Supervivencia , Tomografía Computarizada por Rayos X , Ventriculostomía , Adulto Joven
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