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2.
Medicine (Baltimore) ; 98(32): e16756, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31393392

RESUMO

RATIONALE: In some cases, surgery of cerebellopontine angle meningioma (CPAM) might result in multiple cranial nerve injury, which could bring serious impact on the patients, especially when it affects the function of facial muscles and eyeballs. This report describes a successful application of acupuncture for rehabilitation in a patient after surgery for CPAM. PATIENT CONCERNS: A 27-year-old patient presented with limitation of left eye abduction, accompanied with frontal and facial sensory disturbance on the left after resection of the pontocerebellar angle tumor. The patient also suffered from significant anxiety and depression as concomitant symptoms. DIAGNOSES: Based on medical history, clinical symptoms, and magnetic resonance imaging results, the patient was diagnosed with the fourth, fifth, sixth, and seventh cranial nerve injury after surgery for CPAM. INTERVENTIONS: Acupuncture treatment was applied for this patient. One acupuncture session was given every 2 days in 35 days, and the needles were retained for 30 minutes per session. OUTCOMES: After acupuncture treatment, the limitation of left eye abduction had totally recovered. The superficial sensory disturbance in the frontal and facial region was significantly relived. Besides, the scores of Hamilton Anxiety and Depression Scale showed a significant reduction. However, the superficial sensory of the alar and nasolabial groove on the left side still decreased mildly when compared with the right side. CONCLUSION: Acupuncture might be an option for rehabilitation after surgery for CPAM.


Assuntos
Terapia por Acupuntura/métodos , Neoplasias Cerebelares/cirurgia , Traumatismos dos Nervos Cranianos/reabilitação , Meningioma/cirurgia , Adulto , Neoplasias Cerebelares/patologia , Ângulo Cerebelopontino/patologia , Traumatismos dos Nervos Cranianos/etiologia , Humanos , Imagem por Ressonância Magnética , Masculino
3.
Curr Med Sci ; 39(3): 415-418, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31209812

RESUMO

The colon is an alternative graft organ for esophageal reconstruction. The present study reviewed our experience with the colon interposition for esophageal replacement following corrosive ingestion, to evaluate the outcomes of colon interposition based on our surgical experience. The clinical data of 119 patients who underwent colon interposition for esophageal replacement from January 2005 to March 2017 were retrospectively analyzed. The routes of the colon interposition were retrosternal in 119 (100%). The median operative time was 390 min (range: 290-610 min) and the median blood loss was 615 mL (range: 270-2500 mL). Of these 119 patients, the cervical anastomosis was performed at the hypopharynx (n=20, 16.8%), the larynx (n=3, 2.5%), and the cervical esophagus (n=96, 80.7%). Five patients experienced cervical anastomotic leakage (4 cases for esophagus-colon, and one for hypopharynx-colon). One patient experienced wound infection of the abdominal wall. Three patients had injury of recurrent laryngeal nerve and hoarseness. Three patients had stress ulcer with bleeding and treated with octreotide. Two patients suffered from incomplete intestinal obstruction. The postoperative follow-up was made for 12 months in all patients and all of them were alive. In conclusion, The colon is well-suited for esophageal reconstruction. The selection of the colon graft should be flexible and be based on the inspection of blood supply and the length needed. We must therefore make every effort to reduce the number of postoperative complications, and improve the quality of life for patients.


Assuntos
Colo/cirurgia , Estenose Esofágica/cirurgia , Esôfago/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante Autólogo/métodos , Adolescente , Adulto , Idoso , Anastomose Cirúrgica/métodos , Criança , Pré-Escolar , Colo/fisiologia , Traumatismos dos Nervos Cranianos/diagnóstico , Traumatismos dos Nervos Cranianos/etiologia , Traumatismos dos Nervos Cranianos/fisiopatologia , Estenose Esofágica/fisiopatologia , Esôfago/fisiopatologia , Feminino , Seguimentos , Hemorragia/diagnóstico , Hemorragia/etiologia , Hemorragia/fisiopatologia , Humanos , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/etiologia , Obstrução Intestinal/fisiopatologia , Nervos Laríngeos/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Resultado do Tratamento
4.
Int Angiol ; 38(4): 320-325, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31203595

RESUMO

BACKGROUND: Several techniques of carotid endarterectomy have been described and currently used in clinical practice. We describe and report the midterm results of short non-patch arteriotomy technique. METHODS: We analyzed patients treated at our Department for carotid artery stenosis. Main outcomes were mortality, stroke, restenosis and local complications. The technique consists in a short longitudinal arteriotomy from common carotid artery to internal (ICA), followed by thromboendarterectomy in carotid bulb with a blunt spatula, cutting the more proximal edge of the plaque. A semi-eversion is then performed in the ICA to fully remove carotid plaque. RESULTS: In the period between years 2011-2016 we performed 476 carotid endarterectomies of which 436 with short non-patch arteriotomy. Mean clamping time was 15.5±5.7 minutes. In-hospital complications were: three cases of stroke (0.7%), all with complete recovery, four transient cerebral ischemia (0.9%), 14 cervical hematomas (3.2%), and four cranial nerve injuries (0.9%), which was in all cases completely regressed. At two years, we report six cases of carotid restenosis (1.4%), all treated with carotid stenting. CONCLUSIONS: Short non-patch carotid endarterectomy technique resulted in a low mid-term rates of stroke, restenosis, and cranial nerve injuries compared to other surgical series in the literature.


Assuntos
Artéria Carótida Interna/cirurgia , Estenose das Carótidas/cirurgia , Endarterectomia das Carótidas , Stents , Idoso , Idoso de 80 Anos ou mais , Estenose das Carótidas/mortalidade , Angiografia por Tomografia Computadorizada , Traumatismos dos Nervos Cranianos/etiologia , Bases de Dados Factuais , Feminino , Humanos , Ataque Isquêmico Transitório/etiologia , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/mortalidade , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Taxa de Sobrevida , Fatores de Tempo , Resultado do Tratamento
6.
Eur J Vasc Endovasc Surg ; 57(4): 477-486, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30902606

RESUMO

OBJECTIVES: The aim was to determine the mode of presentation and 30 day procedural risks in 4418 patients with 4743 carotid body tumours (CBTs) undergoing surgical excision. METHODS: This is a systematic review and meta-analysis of 104 observational studies. RESULTS: Overall, 4418 patients with 4743 CBTs were identified. The mean age was 47 years, with the majority being female (65%). The commonest presentation was a neck mass (75%), of which 85% were painless. Dysphagia, cranial nerve injury (CNI), and headache were present in 3%, while virtually no one presented with a transient ischaemic attack (0.26%) or stroke (0.09%). The majority (97%) underwent excision, but only 21% underwent pre-operative embolisation. Overall, 27% were Shamblin I CBTs; 44% were Shamblin II; and 29% were Shamblin III. The mean 30 day mortality was 2.29% (95% CI 1.79-2.93). The mean 30 day stroke rate was 3.53% (95% CI 2.91-4.29), while the mean 30 day CNI rate was 25.4% (95% CI 24.5-31.22). The prevalence of persisting CNI at 30 days was 11.15% (95% CI 8.42-14.64). Twelve series (544 patients) correlated 30 day stroke with Shamblin status. Shamblin I CBTs were associated with a 1.89% stroke rate (95% CI 0.92-3.82), increasing to 2.71% (95% CI 1.43-5.07) for Shamblin II CBTs and 3.99% (95% CI 2.34-6.74) for Shamblin III tumours. Twenty-six series (1075 patients) correlated CNI rates with Shamblin status: 3.76% (95% CI 2.62-5.35) for Shamblin I CBTs, 14.14% (95% CI 11.94-16.68) for Shamblin II, and 17.10% (95% CI 14.82-19.65) for Shamblin III tumours. The prevalence of neck haematoma requiring re-exploration was 5.24% (95% CI 3.45-7.91). The proportion of patients with a neck haematoma requiring re-exploration was not reduced by pre-operative embolisation (5.92%; 95% CI 2.56-13.08) vs. no embolisation (5.82%; 95% CI 2.76-11.88). Pre-operative embolisation did not reduce drainage losses (639 mL vs. 653 mL). CONCLUSIONS: This is the largest meta-analysis of outcomes after CBT excision. Procedural risks associated with tumour excision were considerable, especially with Shamblin III tumours where 4% suffered a peri-operative stroke and 17% suffered a CNI.


Assuntos
Tumor do Corpo Carotídeo/cirurgia , Traumatismos dos Nervos Cranianos/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Tumor do Corpo Carotídeo/mortalidade , Tumor do Corpo Carotídeo/terapia , Traumatismos dos Nervos Cranianos/etiologia , Embolização Terapêutica/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Estudos Observacionais como Assunto , Complicações Pós-Operatórias/classificação , Acidente Vascular Cerebral/etiologia , Resultado do Tratamento , Carga Tumoral , Procedimentos Cirúrgicos Vasculares/mortalidade
7.
World Neurosurg ; 126: 656-663.e1, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30797928

RESUMO

BACKGROUND: Results from studies comparing carotid artery endarterectomy (CEA) with carotid artery stenting (CAS) in the elderly population are variable in the literature. The objective of this study was to investigate whether CEA or CAS is associated with a better safety profile in older adults (>80 years of age) for treatment of symptomatic and asymptomatic stenosis. METHODS: A random-effects meta-analysis was performed, and the I2 statistic was used to assess heterogeneity according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Subgroup analyses were performed as needed. RESULTS: Nine studies comprising 5955 patients were included in this meta-analysis. No differences were identified in terms of 30-day stroke (CEA: 5.8% [n = 257/4415]; CAS: 10.5% [n = 81/767]; odds ratio [OR], 0.57; 95% confidence interval [CI], 0.30-1.08; I2 = 26.1%), myocardial infarction (MI) (CEA: 1.1% [n = 4/357]; CAS: 0.5% [n = 2/355]; OR, 1.67; 95% CI, 0.37-7.46; I2 = 0%), transient ischemic attack (TIA) (CEA: 0% [n = 0/98]; CAS: 4.2% [n = 7/166]; OR, 0.28; 95% CI, 0.03-2.52; I2 = 0%), death (CEA: 1.5% [n = 8/523]; CAS: 0.9% [n = 4/431]; OR, 1.41; 95% CI, 0.43-4.58; I2 = 0%), and cranial nerve injury (CEA: 5.8% [n = 3/51]; CAS: 0% [n = 0/51]; OR, 4.74; 95% CI, 0.5-44.98; I2 =0%). A subgroup comparing CEA with transfemoral protected CAS showed that patients in the CEA group had a statistically significant lower risk of 30-day stroke (OR, 0.31; 95% CI, 0.17-0.57; I2 = 30.8%). CONCLUSIONS: This study shows that CEA is associated with a statistically significant lower risk of 30-day stroke in the elderly population compared with transfemoral CAS with distal or proximal protection. No differences were noted in the rates of periprocedural TIA, MI, death, and cranial nerve injury between CEA and CAS in the original pooled analysis.


Assuntos
Estenose das Carótidas/cirurgia , Revascularização Cerebral/métodos , Endarterectomia das Carótidas , Stents , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estenose das Carótidas/epidemiologia , Traumatismos dos Nervos Cranianos/epidemiologia , Feminino , Humanos , Complicações Intraoperatórias/epidemiologia , Masculino , Complicações Pós-Operatórias/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Análise de Sobrevida , Resultado do Tratamento
8.
J Clin Neurosci ; 61: 189-195, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30782318

RESUMO

BACKGROUND: Preservation of cranial nerve function in patients with benign tumors such as meningiomas and vestibular schwannomas remains difficult following microsurgery. METHODS: In this study, awake surgery was performed in 22 consecutive patients with meningiomas or vestibular schwannomas that compressed cranial nerves (I-XII). Improved, unchanged, or deteriorated cranial nerve function after surgery was evaluated. RESULTS: The function of 44 cranial nerves in 22 consecutive patients who underwent awake surgery for meningiomas or vestibular schwannomas improved, was unchanged, or deteriorated in eight, 35, and one nerves, respectively. Regarding the function of the olfactory (Ist) nerve, which is difficult to preserve, hyposmia improved after surgery in two patients with olfactory groove meningiomas. Regarding the auditory (VIIIth) nerve, which is also difficult to preserve, the function was improved, unchanged, or deteriorated after surgery in two, 11, and one patients, respectively, with cerebello-pontine angle meningiomas or vestibular schwannomas. In all patients with serviceable auditory function before surgery, function was preserved after surgery. In the same patients, the function of the facial (VIIth) nerve was also preserved after surgery in all patients. CONCLUSIONS: These results suggest that awake surgery for benign brain tumors such as meningiomas and vestibular schwannomas is associated with low patient morbidity regarding cranial nerve function.


Assuntos
Neoplasias Encefálicas/cirurgia , Meningioma/cirurgia , Neuroma Acústico/cirurgia , Procedimentos Neurocirúrgicos/métodos , Vigília , Adulto , Idoso , Idoso de 80 Anos ou mais , Traumatismos dos Nervos Cranianos/prevenção & controle , Nervos Cranianos , Descompressão Cirúrgica , Feminino , Humanos , Masculino , Neoplasias Meníngeas/cirurgia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos
9.
J Craniomaxillofac Surg ; 47(3): 431-437, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30638741

RESUMO

In this study, we aimed to measure the stresses both on the pterygoid plates and the cranial base during the down-fracture and at the time of pterygomaxillary osteotomy by using the finite element analysis method to have an idea about the possible causes of complications. Three different surgical approaches were applied to the obtained models. In the Model 1, Le Fort I cuts without pterygomaxillary separation was applied. In the Model 2, same standard Le Fort I cuts were applied with pterygomaxillary separation. Then both models were subjected to a force of 150 N over the anterior spina nasalis to simulate down-fracture. In the third model, same standard Le Fort I cuts were applied. Following this procedure, a force of 50 N was applied with a sharp osteotome to the pterygomaxillary junction to simulate osteotomy. According to the results of this experimental study, the cranial base stress values decreased during the down-fracture in the Model 2. Moreover, it was found that the force transmitted to the base of the skull is less when the height of the pterygomaxillary osteotome is limited to 1 cm as we applied in Model 3.


Assuntos
Traumatismos dos Nervos Cranianos/diagnóstico por imagem , Análise de Elementos Finitos , Imageamento Tridimensional , Maxila/lesões , Osteotomia de Le Fort/efeitos adversos , Complicações Pós-Operatórias/diagnóstico por imagem , Crânio/lesões , Traumatismos dos Nervos Cranianos/etiologia , Humanos , Processamento de Imagem Assistida por Computador , Complicações Intraoperatórias , Maxila/diagnóstico por imagem , Modelos Anatômicos , Modelos Biológicos , Osteotomia de Le Fort/métodos , Crânio/diagnóstico por imagem , Osso Esfenoide/diagnóstico por imagem , Osso Esfenoide/lesões , Estresse Mecânico
10.
Int J Oral Maxillofac Surg ; 48(5): 601-611, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30598335

RESUMO

The aim of this systematic review was to describe the anatomical and surgical factors related to cranial nerve injuries in Le Fort I osteotomy. The protocol of this systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO). Two independent reviewers performed an unrestricted electronic database search in the MEDLINE/PubMed, LILACS, Scopus, Web of Science, and Cochrane databases up to and including August 2018. Thirty-two articles were selected for data extraction and synthesis: 30 studies were identified in the main search and two by a manual search. The level of agreement between the reviewers was considered excellent (κ=0.779 for study selection and κ=0.767 for study eligibility). This study revealed that the main nerve affected was the trigeminal nerve, followed by the oculomotor, abducens, optic, facial, and vagus and accessory nerves. Cleft lip and palate patients presented the highest incidence of cranial nerve damage. Cranial nerve damage after Le Fort I osteotomy is not rare. Anatomical and structural knowledge of the patient are necessary in order to minimize the risks of cranial nerve injury in Le Fort I osteotomy.


Assuntos
Fenda Labial , Traumatismos dos Nervos Cranianos , Humanos , Maxila , Osteotomia Maxilar , Osteotomia de Le Fort , Estudos Prospectivos
11.
Laryngoscope ; 129(4): 943-951, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30450691

RESUMO

INTRODUCTION: Nimodipine is a calcium channel blocker that has been used to treat hypertension and vasospasm. Emerging evidence in the literature suggests that it is neuroprotective by reducing cellular apoptosis after neuronal injury and promoting axonal sprouting at the nodes of Ranvier. OBJECTIVES: To conduct a systematic review of the usage of nimodipine in cranial nerve injury and to perform a meta-analysis to estimate the efficacy of nimodipine on functional recovery of the injured cranial nerves. METHODS: Literature search was performed in eight databases using preferred reporting items for systematic reviews and meta analyses (PRISMA) guidelines. Human studies that used nimodipine as a monotherapy for treating cranial nerve injury were included for review. Cranial nerve function recovery was the primary outcome measure. RESULTS: 672 records were screened and 58 full texts in English were assessed. Nine studies were included in the final review. 5 of these, including 110 participants who received nimodipine for either recurrent laryngeal nerve or facial nerve injury and 556 controls, were used for meta-analysis. Nimodipine significantly increased the odds of vocal fold motion recovery (odds ratio [OR] 13.73, 95% confidence interval [CI] 6.21, 30.38, P < .01), and the odds of facial motion recovery (OR 2.78, 95% CI 1.20, 6.44, P = .02). Overall, nimodipine-treated patients had significantly higher odds of recovering vocal fold or facial motion compared with controls (OR 6.09, 95% CI 3.41, 10.87, P < .01). CONCLUSION: Existing evidence supports the positive effect of nimodipine on vocal fold and facial motion recovery after injury. Future research should focus on randomized clinical trials comparing recovery rates between nimodipine- and placebo-treated groups. Laryngoscope, 129:943-951, 2019.


Assuntos
Bloqueadores dos Canais de Cálcio/uso terapêutico , Traumatismos dos Nervos Cranianos/tratamento farmacológico , Nimodipina/uso terapêutico , Face/fisiologia , Humanos , Recuperação de Função Fisiológica , Resultado do Tratamento , Prega Vocal/fisiologia
12.
In. Maya Entenza, Carlos Manuel. Neurología clínica fundamental. Tomo I. La Habana, Editorial Ciencias Médicas, 2019. , ilus.
Monografia em Espanhol | CUMED | ID: cum-73778
13.
Facial Plast Surg ; 34(6): 579-587, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30593073

RESUMO

Technology impacts the lives of everyone nowadays and has had perhaps a greater impact on the lives of facial plastic surgeons and the patients they seek to help with both surgery and procedures. This article will discuss modern technology's impact on intervening in the aging process including technology used for facial and skin rejuvenation and reconstruction concentrating on the techniques and care to minimize complications as well as dealing with complication from the treatments.


Assuntos
Técnicas Cosméticas/efeitos adversos , Assistência Perioperatória , Complicações Pós-Operatórias/terapia , Pele/patologia , Tecnologia Biomédica , Cicatriz Hipertrófica/etiologia , Traumatismos dos Nervos Cranianos/etiologia , Face , Hematoma/etiologia , Hematoma/terapia , Humanos , Necrose/etiologia , Necrose/terapia , Seroma/etiologia , Seroma/terapia , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/terapia
14.
Head Neck ; 40(12): 2590-2595, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30387536

RESUMO

BACKGROUND: The purpose of this study was to investigate the outcomes of surgical resection of carotid body tumors with and without preoperative embolization. METHODS: There were 31 patients who underwent surgical resection combined with preoperative embolization (SRE group), and 27 patients who underwent conventional surgical resection (SR group); all clinical data were included and reviewed. RESULTS: There was no difference in the approach for carotid reconstruction in either group (P > .05). The mean surgical time (110.65 ± 35.77 minutes vs 188.33 ± 66.44 minutes) and intraoperative blood loss (140.32 ± 57.12 mL vs 396.43 ± 272.82 mL) were significantly less in the SRE group (P < .05). The volume of blood transfusions required (475 ± 301.18 mL vs 0 mL) and incidence rate of total complications (33.3% vs 9.7%) were higher in the SR group (P < .05). However, the length of hospital stay was similar in both groups (P > .05). CONCLUSION: Our results demonstrate that preoperative embolization of a carotid body tumor can reduce blood loss and complications and improve tumor excision.


Assuntos
Tumor do Corpo Carotídeo/cirurgia , Embolização Terapêutica , Adulto , Tumor do Corpo Carotídeo/terapia , Traumatismos dos Nervos Cranianos/etiologia , Embolização Terapêutica/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Cuidados Pré-Operatórios , Estudos Retrospectivos , Acidente Vascular Cerebral/etiologia , Procedimentos Cirúrgicos Vasculares/efeitos adversos
15.
Int J Pediatr Otorhinolaryngol ; 114: 36-43, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30262364

RESUMO

PURPOSE: Children with trisomy 21 are at a greater risk for craniocervical junction instability than the general population. These children frequently require administration of anesthesia due to surgical (including otolaryngological) interventions and are at risk for neurological injury. We reviewed the current literature describing iatrogenic neurological injury in children with trisomy 21 undergoing anesthesia in order to facilitate the development of safety recommendations. METHODS: A systematic review of the literature was performed using Medline, Embase, Scopus, and Google Scholar, following the PRISMA statement. All cases of perioperative neurological injury in children with trisomy 21, aged 18 and under were identified. Clinical and radiographic data were extracted for each report. The data were synthesized to develop recommendations regarding perioperative management. RESULTS: Of 348 articles screened, 16 cases of iatrogenic neurological injury (in children ages 0.7-18 years) were identified. Three injuries occurred during otolaryngological surgeries, nine during sedation for intubation for non-otolaryngological surgery, one during sedation for neuroimaging, one while restraining a child, and two were due to intraoperative head and neck positioning while anesthetized. Preoperative screening was reported in four cases. A diagnosis of atlantoaxial instability (AAI) or atlantooccipital instability (AOI) was made immediately following symptom presentation in three cases but was often delayed by a median (IQR) of 30(11.5-912.5) days. No cases resolved spontaneously, with 2 patients progressing to brain death and 12 requiring surgical stabilization. Of the latter, seven showed improvement, whereas one died 5 months later. No intraoperative precautions during the index procedure were reported in any of the 16 cases. CONCLUSION: Iatrogenic neurological injury in children with trisomy 21 are rare but severe and likely under reported. Although the role of preoperative screening remains controversial, all children with trisomy 21 undergoing surgery should be considered at risk for neurological injury due to confirmed or undiagnosed AAI or AOI and should be transferred and positioned with appropriate caution. Children with instability should be referred for neurosurgical attention for preoperative stabilization to mitigate perioperative risk. It is imperative to consider the possibility of neurological injury secondary to medical procedures, as it is clear that neck manipulation of any sort places these children at risk.


Assuntos
Anestesia/efeitos adversos , Traumatismos dos Nervos Cranianos/epidemiologia , Síndrome de Down/complicações , Doença Iatrogênica/epidemiologia , Adolescente , Criança , Pré-Escolar , Traumatismos dos Nervos Cranianos/etiologia , Feminino , Humanos , Lactente , Masculino
16.
Brain Behav ; 8(6): e00981, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-30106250

RESUMO

INTRODUCTION: Cranial nerve (CN) VII localization is a critical step during acoustic neuroma surgery because the nerve is generally hidden due to the tumor mass. The patient can suffer from Bell's palsy if the nerve is accidentally damaged during tumor removal. Surgeons localize CN VII by exploring the target area with a stimulus probe. Compound muscle action potentials (CMAPs) are elicited when the probe locates the nerve. However, false positives and false negatives are possible due to unpredictable tissue impedance in the operative area. Moreover, a single CMAP amplitude is not correlated with probe-to-nerve distance. OBJECTIVES: This paper presents a new modality for nerve localization. The probe-to-nerve distance is predicted by the proposed nerve location prediction model. METHODS: Input features are extracted from CMAP responses, tissue impedance, and stimulus current. The tissue impedance is calculated from the estimated resistance and capacitance of the tissue equivalent circuit. In this study, experiments were conducted in animals. A frog's sciatic nerve and gastrocnemius were used to represent CN VII and facial muscle in humans, respectively. Gelatin (2.8%) was used as a mock material to mimic an acoustic neuroma. The %NaCl applied to the mock material was used to emulate uncontrollable impedance of tissue in the operative area. RESULTS: The 10-fold cross-validation results revealed an average prediction accuracy of 86.71% and an average predicted error of 0.76 mm compared with the measurement data. CONCLUSION: The proposed nerve location prediction model could predict the probe-to-nerve distance across various impedances of the mock material.


Assuntos
Estimulação Elétrica/métodos , Neuroma Acústico/cirurgia , Pontos de Referência Anatômicos , Animais , Anuros , Paralisia de Bell/fisiopatologia , Paralisia de Bell/prevenção & controle , Traumatismos dos Nervos Cranianos/fisiopatologia , Traumatismos dos Nervos Cranianos/prevenção & controle , Impedância Elétrica , Nervo Facial/fisiologia , Paralisia Facial/prevenção & controle , Modelos Animais , Músculo Esquelético/fisiologia , Neuroma Acústico/fisiopatologia , Nervo Isquiático/fisiologia
17.
Med Sci Monit ; 24: 4982-4991, 2018 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-30018280

RESUMO

BACKGROUND Collapsin response mediator protein-2 (CRMP-2) is the first member of the CRMP family that has been identified in primary neuronal cells; it was originally found and identified in the regulation of microtubule dimerization into microtubules. MATERIAL AND METHODS In the present study, we aimed to investigate the roles and mechanisms of CRMP-2 in sevoflurane-induced neurocyte injury. Cell viability, proliferation, and apoptosis were measured by Cell Counting Kit-8 (CCK-8) assay and flow cytometry. Colorimetry was performed to measure the activity of caspase-3. Western blot and quantitative real-time reverse transcription assays were used to evaluate the related mRNAs and proteins expression. RESULTS We found that CRMP-2 reversed the inhibitory effect of sevoflurane on the viability of nerve cells. Moreover, CRMP-2 accelerated the proliferation and suppressed the apoptosis of sevoflurane-induced nerve cells. CRMP-2 modulated the expression levels of apoptosis-associated protein in sevoflurane-induced nerve cells. Furthermore, it was demonstrated that CRMP-2 impacted the PI3K-mTOR-S6K pathway. CONCLUSIONS CRMP2 ameliorated sevoflurane-mediated neurocyte injury by targeting the PI3K-mTOR-S6K pathway. Thus, CRMP2 might be an effective target for sevoflurane-induced neurocyte injury therapies.


Assuntos
Proteínas do Tecido Nervoso/metabolismo , Neurônios/efeitos dos fármacos , Animais , Apoptose/efeitos dos fármacos , Proliferação de Células/efeitos dos fármacos , Sobrevivência Celular/efeitos dos fármacos , Traumatismos dos Nervos Cranianos/tratamento farmacológico , Feminino , Hipocampo/efeitos dos fármacos , Éteres Metílicos/farmacologia , Proteínas do Tecido Nervoso/farmacologia , Neurônios/metabolismo , Fosfatidilinositol 3-Quinases/metabolismo , Fosforilação , Gravidez , Ratos , Ratos Sprague-Dawley , Proteínas Quinases S6 Ribossômicas/metabolismo , Sevoflurano , Serina-Treonina Quinases TOR/metabolismo
18.
BMJ Case Rep ; 20182018 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-30042100

RESUMO

Foreign bodies cause a remarkable number of otolaryngological emergency visits and occasionally result in life-threatening conditions and later-emerging complications. Patient recovery depends on the detection and proper extraction of all foreign materials. Despite various obtainable diagnostic tools, adequate anamnesis forms the basis of clinical reasoning and should direct later examinations and radiological imaging. This case report describes a challenging patient with a unique trauma mechanism: many pieces of a fragmented organic foreign body emerged within 1 year of the initial injury, leading to repeated operations, a long period in an intensive care unit and a long-term swallowing and speech dysfunction.


Assuntos
Abscesso/diagnóstico por imagem , Traumatismos dos Nervos Cranianos/diagnóstico por imagem , Corpos Estranhos/diagnóstico por imagem , Infecções por Klebsiella/diagnóstico por imagem , Lesões do Pescoço/diagnóstico por imagem , Abscesso/complicações , Abscesso/tratamento farmacológico , Abscesso/cirurgia , Idoso , Traumatismos dos Nervos Cranianos/complicações , Traumatismos dos Nervos Cranianos/tratamento farmacológico , Traumatismos dos Nervos Cranianos/cirurgia , Diagnóstico Diferencial , Corpos Estranhos/complicações , Corpos Estranhos/tratamento farmacológico , Corpos Estranhos/cirurgia , Humanos , Infecções por Klebsiella/complicações , Infecções por Klebsiella/tratamento farmacológico , Infecções por Klebsiella/cirurgia , Klebsiella pneumoniae/isolamento & purificação , Imagem por Ressonância Magnética , Masculino , Lesões do Pescoço/complicações , Lesões do Pescoço/tratamento farmacológico , Lesões do Pescoço/cirurgia , Tomografia Computadorizada por Raios X
19.
Aesthetic Plast Surg ; 42(5): 1394-1398, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29869228

RESUMO

BACKGROUND: One of the rare but serious complications observed with deoxycholic acid administration is damage to the marginal mandibular nerve. In this study, we evaluated if deoxycholic acid directly induces histologic damage to fresh cadaveric marginal mandibular nerve. METHODS: A segment of marginal mandibular nerve was harvested from 12 hemifaces of 6 fresh cadavers. The nerve specimen was exposed to either 0.9% sterile saline for 24 h, deoxycholic acid (10 mg/ml) for 20 min, or deoxycholic acid (10 mg/ml) for 24 h. The nerve specimens were then fixed in glutaraldehyde for a minimum of 24 h. Toluidine blue stained sections were evaluated for stain intensity using light microscopy and color deconvolution image analysis. Supraplatysmal fat was harvested as a positive control and exposed to the same treatments as the marginal mandibular nerve specimens, then evaluated using transmission electron microscopy. RESULTS: Toluidine blue staining was less in the marginal mandibular nerve exposed to deoxycholic acid when compared to saline. The specimen exposed to deoxycholic acid for 24 h showed less toluidine blue staining than that of the nerve exposed to deoxycholic acid for 20 min. Transmission electron microscopy of submental fat exposed to deoxycholic acid revealed disruption of adipocyte cell membrane integrity and loss of cellular organelles when compared to specimens only exposed to saline. CONCLUSIONS: Deoxycholic acid (10 mg/ml) damages the marginal mandibular nerve myelin sheath in fresh human cadaver specimens. Direct deoxycholic acid neurotoxicity may cause marginal mandibular nerve injury clinically. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .


Assuntos
Traumatismos dos Nervos Cranianos/induzido quimicamente , Ácido Desoxicólico/efeitos adversos , Ácido Desoxicólico/farmacologia , Nervo Mandibular/anatomia & histologia , Bainha de Mielina/efeitos dos fármacos , Biópsia por Agulha , Cadáver , Corantes , Traumatismos dos Nervos Cranianos/patologia , Dissecação/métodos , Humanos , Imuno-Histoquímica , Nervo Mandibular/efeitos dos fármacos , Microscopia , Bainha de Mielina/patologia , Sensibilidade e Especificidade , Cloreto de Tolônio
20.
Clin Implant Dent Relat Res ; 20(4): 531-534, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29624863

RESUMO

BACKGROUND: Anterior loop of the mental nerve is a very important anatomic landmark in implant placement and anterior mandibular osteotomies. PURPOSE: Two-dimensional imaging techniques are not competent enough to locate and measure the mental nerve loop in majority of the cases. Any injury to this loop results in pain/paresthesia/numbness in the region supplied by the mental nerve. The aim of this study is to analyze the prevalence and measure the length of the loop using cone beam computerized tomography (CBCT) and calculate the average length and prevalence so that a safe margin can be given while placing the implants or the osteotomy cuts in the premolar region. MATERIALS AND METHODS: A cross-sectional study was done using CBCT images of 85 patients taken for impaction surgery. The length of the loop was measured in mm using standardized lines drawn along specific anatomic landmarks. RESULTS: In our study 11.76% of patients had anterior loop in their mental nerve. Mean length of the mental nerve loop was calculated and found to be 2.79 mm. CONCLUSION: A margin of 4 mm anterior to the mental foramen should be safe to avoid any damage to the mental nerve loop bundle in majority of the cases where the loop is present.


Assuntos
Tomografia Computadorizada de Feixe Cônico/métodos , Mandíbula/anatomia & histologia , Mandíbula/diagnóstico por imagem , Mandíbula/inervação , Nervo Mandibular/anatomia & histologia , Nervo Mandibular/diagnóstico por imagem , Adulto , Pontos de Referência Anatômicos , Traumatismos dos Nervos Cranianos/prevenção & controle , Estudos Transversais , Implantação Dentária Endo-Óssea/efeitos adversos , Feminino , Humanos , Imageamento Tridimensional/métodos , Masculino , Mandíbula/cirurgia , Osteotomia/efeitos adversos , Osteotomia/métodos , Prevalência , Dente/inervação , Adulto Jovem
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