1,721,113 research outputs found
Brainstem cavernous angioma in an octagenarian cardiopathic patient: anesthesiologic and neurosurgical challanges
No full textLearning Track: 6. Neuroanaesthesiology
Title: Brainstem cavernous angioma in an octogenarian cardiopathic patient: anesthesiologic and neurosurgical challenges
Author(s): Urli T.1, Nicolini F.2, Giulioni M.2, Sturiale C.2, Zanello M.1
Institute(s): 1IRCCS Istituto delle Scienze Neurologiche, Bellaria Hospital, Anesthesia and Intensive Care, Bologna, Italy, 2IRCCS Istituto delle Scienze Neurologiche, Bellaria Hospital, Neurosurgery, Bologna, Italy
Text: Background: Cerebral cavernous angiomas are uncommon diseases mostly affecting young and middle-aged people. Brainstem location can be related to severe complications both in cases of conservative or surgical management. Anesthesiologic concern is the hemodynamic instability due to manipulation of brainstem (dysrhythmias, hypertension, hypotension), and the risk of cranial nerves dysfunction.
Case report: A 81-year-old male presented painful dysesthesias and gait instability. The Magnetic Resonance Imaging revealed a large hemorrhagic multicystic lesion in the medulla oblongata. The patient had a cardiac disease with previous heart surgery (biological prosthesis, Bentall procedure); the artificial aortic valve was degenerating with moderate regurgitation. According to patient will, surgical intervention was scheduled for reducing the brainstem compression and the risk of rebleeding. Preoperative anesthesiologic evaluation pointed out the high risk of the procedure. The anesthetic plan included: prone position, balanced anesthesia with midazolam, sevoflurane and remifentanil, endocarditis prophylaxis, and a hemodynamic management fit for a patient with aortic regurgitation. External pacemaker-defibrillator pads were applied in advance. Surgical resection was carried out until occurrence of sudden bradycardia with hypotension, managed with atropine. After a short stay in ICU, the patient was transferred to the ward and then to the rehabilitation unit. Postoperatively he presented hemiparesis, slowly improving after physical therapy. The histopathological analysis confirmed the diagnosis of cavernoma.
Discussion: We found no previous report of brainstem cavernoma surgery in octogenarian cardiopathic patients, but advanced age is not a sufficient reason to deny surgical treatment if the patient may benefit. In this case the usual concern about intraoperative hemodynamic instability was increased by the type of cardiac valvulopathy: intraoperative dysrhythmias, especially bradycardia, can worsen the degree of aortic regurgitation and can precipitate left ventricular failure. The medical team weighted carefully risk benefit ratio as well as the patient wish.
Learning points: Neurosurgery of brainstem cavernomas can be performed in selected elderly patients in Hospitals with specific neurosurgical and anesthesiologic experience. The presence of serious comorbidities should not rule out the possibility of anesthesiologic and surgical treatment.
Preferred Presentation Type: Case report
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Conference: Euroanaesthesia 2017 · Abstract: A-805-0061-00727 · Status: Draf
Relationship between body temperature and neurological outcome in patients with acute brain injury: systematic review of clinical evidence (06AP03-11)
No full textBackground and Goal of Study: Temperature alterations in neurocritical care setting are common and have striking effect on brain metabolism leading or exacerbating neuronal injury. Fever (T >38,3°C) also negatively impact on acute brain injury (ABI) patients outcome. Conclusive evidence linking temperature control to improved outcome is still lacking. Aim of this review article is to evaluate the relationship between changes in body temperature in ABI and outcome.
Materials and Methods: A literature search of 2 medical database was accomplished: PubMed Medline. Only complete studies (no abstracts), published in English in peer-reviewed journals were included. Two authors (M.P and P.S) independently screened and assessed titles, abstracts, and the full-text papers, using inclusion and exclusion criteria. A total of 32401 papers were screened and 32354 were excluded. We present 47 articles into 5 subchapters: mixed acute brain injury (7), brain trauma (6), intracranial hemorrhage (5), subarachnoid hemorrhage (12); ischemic stroke (17).
Results and Discussion:
ABI: fever correlates with increased inhospital mortality and functional outcome increasing brain metabolism and reducing blood flow.
Brain trauma: fever in the first 48 hours after trauma did not predict mortality. Both the degree and duration of early post-trauma hyperthermia were strongly related with outcome.Intracranial hemorrhage: fever determines prognosis. Also subacute fever in large volume hematoma is a driver of neurological deterioration.
Subarachnoid hemorrhage: the impact of fever on poor outcome is related to cerebral inflammatory response initiated at the time of aneurysm rupture, increased rate of vasospasm and delayed ischemic neurological deficits (DIND), increased ICP related to metabolic distress.
Ischemic stroke: delayed hyperthermia is adverse associated with long-term outcomes and mortality compared with early period after an ischemic stroke. In patients treated with recanalization the role of hyperthermia on outcome is still controversial.
Conclusion(s): Fever, infectious or central, is strongly correlated with poor neurological and functional outcome. Optimal patient temperature management and optimal method to recognise and treat infections in absence of fever remain still to define.
References: Greer DM, Funk SE, Reaven NL, Ouzunelli M, Uman GC, Impact of Fever on Outcome in Patients With Stroke and Neurologic Injury A Comprehensive Meta-Analysis, Stroke. 2008;39: 3029-303
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Unicornuate uterus with noncommunicating functional horn: diagnostic workup and laparoscopic horn amputation
No full textObjective: To describe the diagnosis and the management of hematometra in a patient with unicornuate uterus with noncommunicating functional horn (hemi uterus and rudimentary uterine hemicavity). Design: Video case report. Setting: Minimally invasive gynaecology unit. Patient(s): Sixteen-year-old nulliparous woman admitted to the gynaecologic emergency department with pelvic pain during menses. Intervention(s): Two-dimensional transvaginal ultrasound, magnetic resonance imaging, and laparoscopic rudimentary horn resection. Main Outcome Measure(s): Description of a case of anomaly of the female reproductive tract treated by laparoscopy. Result(s): After pain reduction and stabilization of clinical condition, ultrasound and magnetic resonance were performed, which detected a hemi uterus with a right rudimentary uterine hemicavity and a hematosalpinx. The removal of the right rudimentary uterine horn was successfully performed. The patient was in good health at the 3-month follow-up visit. Conclusion(s): Laparoscopic amputation of a functional rudimentary horn is considered the basic and traditional surgical option for women with hemiuterus. A detailed diagnostic evaluation should be performed to avoid misdiagnoses of other anomalies with blind hemicavity, which may be treated by hysteroscopy. Laparoscopic surgery with minimally invasive approach could be an essential tool to treat these cases, achieving optimal results with low postsurgical pain and a short hospital stay
Management to optimize organ procurement in brain dead donors
No full textThe demand for donor organs continues to exceed the number of organs available for transplantation. Many reasons may account for this discrepancy, such as the lack of consent, the absence of an experienced coordinator team able to solve logistical problems, the use of strict donor criteria, and suboptimal, unstandardized critical care management of potential organ donors. This has resulted in efforts to improve the medical care delivered to potential organ donors, so as to reduce organ shortages, improve organ procurement, and promote graft survival. The physiological changes that follow brain death entail a high incidence of complications jeopardizing potentially transplantable organs. Adverse events include cardiovascular changes, endocrine and metabolic disturbances, and disruption of internal homeostasis. Brain death also upregulates the release of pro-inflammatory molecules. Recent findings support the hypothesis that a preclinical lung injury characterized by an enhanced inflammatory response is present in potential donors and may predispose recipients to an adverse clinical prognosis following lung transplantation. In clinical practice, hypotension, diabetes insipidus, relative hypothermia, and natremia are more common than disseminated intravascular coagulation, cardiac arrhythmias, pulmonary oedema, acute lung injury, and metabolic acidosis. Strategies for the management of organ donors exist and consist of the normalization of donor physiology. Management has been complicated by the recent use of ''marginal'' donors and donors of advanced age or with ''extended'' criteria. Current guidelines suggest that the priority of critical care management for potential organ donors should be shifted from a ''cerebral protective'' strategy to a multimodal strategy aimed to preserve peripheral organ function
Experimental hemorrhagic shock and the reticuloendothelial system
No full textExperimental hemorrhagic shock and the reticuloendothelial syste
Optic nerve sheath diameter (ONSD) in sovratentorial brain tumor surgery: an option for non invasive raised ICP detection and management. Preliminary results and feasibility assessment (06AP04-9)
No full textBackground and Goal of Study: Increase in optic nerve sheath diameter (ONSD) in transorbital sonography has been proven to be able to non-invasively detect elevated intracranial pressure in different clinical scenarios. The aim of this study is to assess the feasibility of ONSD sonography method detecting changes in intracranial pressure in patients with sovratentorial brain tumors.
Materials and Methods: After a learning curve of 25 cases, for two intensivists, high-frequency linear probes 7 Mhz are used to measure ONSD (ophthalmic artery - optic nerve cross point) in a patients population with sovratentorial brain solid tumors scheduled to elective neurosurgery.
A convenience small sample of patients’ cohort with sovratentorial brain tumors scheduled to elective neurosurgery was analyzed.
ONSD was measured, also, in preoperative RMN and/or CT scan and compared with postoperative CT scan in another small cohort of patients.
Results and Discussion: A total of 25 encounters were completed. ONSD was enlarged in 94.3% of patients bilaterally (cut off > 5.5 mm). The mean ultrasound ONSD before surgery was 6,64 +/- 0,33 mm preoperatively and 5,31 +/- 0,10 mm postoperatively. Mean ONSD on CT/MRI scan was respectively 5,62 +/- 0,51 mm preoperatively and 5,42 +/- 0,46 mm postoperatively. We also found a good correlation between the side of lesion and rasied ONSD.
Conclusion(s): ONSD ultrasound measurement in sovratentorial tumors patient population could be an optional non invasive method, beside CT or MRI to detect changes in intracranial pressure even if the paucity of the sample can’t allow us to make a precise assessment.
References:
Moretti R, Pizzi B Ultrasonography of the optic nerve in neurocritically ill patients, Acta Anaesthesiol Scand 2011; 55: 644-652.
Bekerman I, Sigal T, Kimiagar I, Almer ZE, Vaiman M., Diagnostic value of the optic nerve sheath diameter in pseudotumor cerebri. J Clin Neurosci. 2016 Aug;30:106-9.
Frederick A. Zeiler, Markus T.Ziesmann, Patrick Goeres, Bertram Unger, Jason Park1, Dimitrios Karakitsos, Michael Blaivas, Ashley Vergis and Lawrence M. Gillman - A unique method for estimating the reliability learning curve of optic nerve sheath diameter ultrasound measurement - Crit Ultrasound J (2016) 8:
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