Spinal endoscopy combined with selective CT myelography for dural closure of the spinal dural defect with superficial siderosis: technical note.

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Arishima, Hidetaka; Higashino, Yoshifumi; Yamada, Shinsuke; Akazawa, Ayumi; Arai, Hiroshi; Tsunetoshi, Kenzo; Matsuda, Ken; Kodera, Toshiaki; Kitai, Ryuhei; Awara, Kousuke; Kikuta, Ken-Ichiro

2018-01-01

The authors describe a new procedure to detect the tiny dural hole in patients with superficial siderosis (SS) and CSF leakage using a coronary angioscope system for spinal endoscopy and selective CT myelography using a spinal drainage tube. Under fluoroscopy, surgeons inserted the coronary angioscope into the spinal subarachnoid space, similar to the procedure of spinal drainage, and slowly advanced it to the cervical spine. The angioscope clearly showed the small dural hole and injured arachnoid membrane. One week later, the spinal drainage tube was inserted, and the tip of the drainage tube was located just below the level of the dural defect found by the spinal endoscopic examination. This selective CT myelography clarifies the location of the dural defect. During surgery, the small dural hole could be easily located, and it was securely sutured. It is sometimes difficult to detect the actual location of the small dural hole even with thin-slice MRI or dynamic CT myelography in patients with SS. The use of a coronary angioscope for the spinal endoscopy combined with selective CT myelography may provide an effective examination to assess dural closure of the spinal dural defect with SS in cases without obvious dural defects on conventional imaging.

Trombose de seios venosos cerebrais: Estudo de 15 casos e revisão de literatura Cerebral venous thrombosis: Study of fifteen cases and review of literature

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Paulo Pereira Christo

2010-01-01

Full Text Available OBJETIVO: Analisar uma série de 15 pacientes com trombose venosa cerebral (TVC e comparar os resultados com dados da literatura. MÉTODOS: Foram avaliados, por meio de estudo retrospectivo, transversal e descritivo, as características epidemiológicas, o quadro clínico, os fatores de risco e o prognóstico de 15 pacientes com TVC admitidos no serviço de Neurologia da Santa Casa de Belo Horizonte no período de abril de 2007 a Dezembro de 2008. RESULTADOS: O diagnóstico de TVC foi confirmado por exame de ressonância nuclear magnética de encéfalo em 14 casos e por angiografia cerebral em um caso. Os principais fatores de risco identificados foram o uso do anticoncepcional oral (40% e uma história prévia ou familiar de trombose venosa profunda. Trombofilia foi encontrada em dois pacientes (13%. O seio mais acometido foi o transverso (73%, seguido pelo sagital superior, em 53%. Quatro pacientes apresentaram acidente vascular cerebral e outros 5 apresentaram-se apenas com cefaleia isolada. Doze pacientes foram tratados com heparina e anticoagulação oral sequencial. CONCLUSÃO: A terapêutica com heparina na fase aguda seguida do anticoagulante oral demonstrou-se segura e eficaz na prevenção da progressão da doença, de sua recidiva e na rápida recuperação do quadro neurológico de todos os pacientes tratados. A TVC deve ser considerada no diagnóstico de cefaleia secundária mesmo em pacientes com ausência de outros sinais ou sintomas.OBJECTIVE: To analyze a series of 15 patients with cerebral venous thrombosis (CVT who had follow-ups at the neurology service of Santa Casa de Belo Horizonte Hospital from April, 2007 to December, 2008. These results were compared with data in literature. METHODS: Cases were evaluated by retrospective study of the epidemiologic characteristics, signs and symptoms, risk factors and prognosis of 15 patients with cerebral venous thrombosis. RESULTS: Diagnoses were reached through magnetic resonance

Dural sinus filling defect: intrasigmoid encephalocele

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Karatag, Ozan; Cosar, Murat; Kizildag, Betul; Sen, Halil Murat

2013-01-01

Filling defects of dural venous sinuses are considered to be a challenging problem especially in case of symptomatic patients. Many lesions have to be ruled out such as sinus thrombosis, arachnoid granulations and tumours. Encephalocele into dural sinus is also a rare cause of these filling defects of dural sinuses. Here, we report an extremely rare case with spontaneous occult invagination of temporal brain tissue into the left sigmoid sinus and accompanying cerebellar ectopia. PMID:24311424

Mesenteric thrombosis in patient victim of blunt abdominal trauma Trombose mesentérica em vítima de trauma abdominal fechado

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Iwan Augusto Collaço

2008-06-01

para procedimento cirúrgico, encontrou-se extensa necrose de cólon ascendente e parte terminal do íleo. Realizou-se hemicolectomia direita com ileotransversostomia. Em cuidados de UTI, evoluiu com oliguria, miose, convulsão e atividade elétrica sem pulso, falecendo três dias após. CONCLUSÃO: Embora incomum, isquemia mesentérica com trombose venosa pode ser secundária a trauma abdominal fechado.

DURAL CAROTID-CAVERNOUS FISTULAS

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Barbara Cvenkel

2002-12-01

Full Text Available Background. Dural carotid-cavernous sinus fistulas (CCF are communications fed by meningeal branches of the intracavernous internal carotid artery (ACI or/and external carotid artery (ACE. In contrast to typical CCF, the arteriovenous shunting of blood is usually low flow and low pressure. Spontaneous dural CCF are more common in postmenopausal women. Aetiology is unknown, but congenital malformation or rupture of thin-walled dural arteries within venous sinuses is believed to be the cause.Case reports. 3 cases lacking the typical clinical signs of CCF who had been treated as chronic conjunctivitis, myositis of the extraocular muscle and orbital pseudotumour are presented. Clinical presentation depends on the direction and magnitude of fistular flow and on the anatomy of the collateral branches. If increased blood flow is directed anteriorly in ophthalmic veins the signs of orbito-ocular congestion are present (»redeyed shunt syndrome«. Drainage primarly in the inferior petrosal sinus may cause painful oculomotor and abducens palsies without signs of ocular congestion (»white-eyed shunt syndrome«. Also different therapeutic approaches as well as possible complications are described.Conclusions. For definite diagnosis angiography is obligatory and is also therapeutic as one third to one half of dural CCF close spontaneously. Because of potential severe eye and systemic complications, surgical intervention is indicated only in cases with uncontrolled secondary glaucoma and hypoxic retinopathy.

Complicações tromboembólicas no paciente cirúrgico e sua profilaxia Thromboembolic complications in surgical patients and its prophylaxis

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Eric Rassam

2009-03-01

Full Text Available INTRODUÇÃO: Complicações tromboembólicas tornam-se mais frequentes à medida que a população envelhece, pois o idoso apresenta com maior frequência fatores de risco como a imobilidade, procedimentos cirúrgicos, insuficiência venosa crônica, insuficiência cardíaca congestiva, neoplasias e outras doenças. O tromboembolismo venoso, causa de óbito hospitalar evitável mais comum no pós-operatório, engloba duas complicações principais: trombose venosa profunda e tromboembolismo pulmonar. Os fatores ligados à etiologia e patogenia do trombo compõem a Tríade de Rudolf Virchow que inclui lesão vascular endotelial, hipercoagulabilidade e estase venosa. Este artigo de revisão tem como objetivo evidenciar a importância de se conhecer as complicações tromboembólicas no paciente cirúrgico a fim de evitá-las. MÉTODOS: Foram selecionados os artigos com informações mais atualizadas sobre o assunto no Medline/PubMed, os quais mostraram que a tromboprofilaxia constitui a estratégia mais eficaz para reduzir morbidade e mortalidade por tromboembolismo venoso em pacientes cirúrgicos. A incidência de trombose venosa profunda proximal sem profilaxia encontra-se em torno de 25% a 32% e, com profilaxia, de 10% a 18%. CONCLUSÃO: Conhecer riscos de trombose venosa profunda pode aumentar a atenção em relação aos problemas de tromboembolismo pulmonar em pacientes hospitalizados e formar as bases de estratégias de profilaxia.INTRODUCTION: Thromboembolic complications become more frequent in elderly, because they present risk factors more frequently, such as immobility, surgeries, chronic venous insufficiency, congestive heart failure, cancer and other diseases. The venous thromboembolism (VTE, the cause of preventable hospital death more common in post-operative, includes two main complications: deep vein thrombosis (DVT and pulmonary thromboembolism (PTE. The factors linked to the etiology and pathogenesis of thrombus up the Triad

Força e arquitetura muscular do gémeo interno na bomba muscular venosa

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Peixoto, Flávia; Pinto, Ângela; Kozlova, Veronika; Crisóstomo, Rute

2015-01-01

Objetivo: Avaliar e comparar a Força Muscular (FM), Amplitude de Movimento (ADM) e Arquitetura Muscular da bomba muscular venosa em sujeitos com e sem Insuficiência Venosa Crónica (IVC). Relevância: A IVC provoca alterações na função da bomba muscular venosa, no entanto, pouco se conhece acerca das suas repercussões físicas e funcionais. Amostra: Sujeitos com IVC (alterações da tróficas, e úlcera ativa/cicatrizada) e saudáveis. Foram avaliados 33 sujeitos dos quais foram analis...

Fat in the dural sinus

International Nuclear Information System (INIS)

Tokiguchi, S.; Ando, K.; Tsuchiya, T.; Ito, J.

1986-01-01

Fat density in the dural sinus on computed tomography (CT) is described in eight cases. Of the eight cases, five had fat deposit in the torcular Herophili, and three in the superior sagittal sinus. This finding was incidentally found by CT and there was no common underlying disease in these cases. It is suggested that this finding represents normal adipose tissue in the dural sinus. (orig.)

Mesenteric thrombosis in patient victim of blunt abdominal trauma with fatal outcome Trombose mesentérica em vítima de trauma abdominal fechado com desfecho fatal

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Iwan Augusto Collaço

2010-03-01

, evoluiu com oligúria, miose, convulsão e atividade elétrica sem pulso, falecendo três dias após dar entrada no hospital. CONCLUSÃO: Embora incomum, isquemia mesentérica com trombose venosa pode ser secundária à hipotensão sistêmica, com desfecho fatal.

Tentorial artery embolization in tentorial dural arteriovenous fistulas

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Rooij, Willem Jan van; Sluzewski, Menno [St. Elisabeth Ziekenhuis, Department of Radiology, Tilburg (Netherlands); Beute, Guus N [St. Elisabeth Ziekenhuis, Department of Neurosurgery, Tilburg (Netherlands)

2006-10-15

The tentorial artery is often involved in arterial supply to tentorial dural fistulas. The hypertrophied tentorial artery is accessible to embolization, either with glue or with particles. Six patients are presented with tentorial dural fistulas, mainly supplied by the tentorial artery. Two patients presented with intracranial hemorrhage, two with pulsatile tinnitus and one with progressive tetraparesis, and in one patient the tentorial dural fistula was an incidental finding. Different endovascular techniques were used to embolize the tentorial artery in the process of endovascular occlusion of the fistulas. All six tentorial dural fistulas were completely occluded by endovascular techniques, confirmed at follow-up angiography. There were no complications. When direct catheterization of the tentorial artery was possible, glue injection with temporary balloon occlusion of the internal carotid artery at the level of the tentorial artery origin was effective and safe. Different endovascular techniques may be successfully applied to embolize the tentorial artery in the treatment of tentorial dural fistulas. (orig.)

Tentorial artery embolization in tentorial dural arteriovenous fistulas

International Nuclear Information System (INIS)

Rooij, Willem Jan van; Sluzewski, Menno; Beute, Guus N.

2006-01-01

The tentorial artery is often involved in arterial supply to tentorial dural fistulas. The hypertrophied tentorial artery is accessible to embolization, either with glue or with particles. Six patients are presented with tentorial dural fistulas, mainly supplied by the tentorial artery. Two patients presented with intracranial hemorrhage, two with pulsatile tinnitus and one with progressive tetraparesis, and in one patient the tentorial dural fistula was an incidental finding. Different endovascular techniques were used to embolize the tentorial artery in the process of endovascular occlusion of the fistulas. All six tentorial dural fistulas were completely occluded by endovascular techniques, confirmed at follow-up angiography. There were no complications. When direct catheterization of the tentorial artery was possible, glue injection with temporary balloon occlusion of the internal carotid artery at the level of the tentorial artery origin was effective and safe. Different endovascular techniques may be successfully applied to embolize the tentorial artery in the treatment of tentorial dural fistulas. (orig.)

Dural ectasia and conventional radiography in the Marfan lumbosacral spine

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Ahn, N.U.; Nallamshetty, L.; Ahn, U.M.; Buchowski, J.M.; Kebaish, K.M.; Sponseller, P.D.; Rose, P.S.; Garrett, E.S.

2001-01-01

Objective. To determine how well conventional radiographic findings can predict the presence of dural ectasia in Marfan patients.Design and patients. Twelve Marfan patients without dural ectasia and 21 Marfan patients with dural ectasia were included in the study. Five radiographic measurements were made of the lumbosacral spine: interpediculate distance, scalloping value, sagittal canal diameter, vertebral body width, and transverse process width.Results. The following measurements were significantly larger in patients with dural ectasia: interpediculate distances at L3-L4 levels (P 38.0 mm, sagittal diameter at S1 >18.0 mm, or scalloping value at L5 >5.5 mm.Conclusion. Dural ectasia in Marfan syndrome is commonly associated with several osseous changes that are observable on conventional radiographs of the lumbosacral spine. Conventional radiography can detect dural ectasia in patients with Marfan syndrome with a very high specificity (91.7%) but a low sensitivity (57.1%). (orig.)

DIAGNÓSTICO CLÍNICO Y MANEJO DE LA TROMBOSIS VENOSA CEREBRAL. PRESENTACIÓN DE UN CASO CLÍNICO.

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Yorman Rafael Flores Molina

2011-01-01

Full Text Available La Trombosis de los Senos Durales y/o Trombosis Venosa Cerebral, se considera una entidad poco frecuente de accidente cerebro vascular que usualmente ocurre en individuos jóvenes. Cada año, afecta a 5 personas por millón a nivel mundial y representa el 0.5 al 1% de todos los episodios de enfermedad cerebrovascular. Se describe el caso de un paciente masculino de 31 años, sin antecedentes patológicos conocidos, que consultó en el servicio de urgencias por cefalea holocraneana y movimientos tónico-clónicos generalizados; se le practicó Tomografía Axial Computarizada Cerebral y Arteriografía de 4 vasos, descartándose malformaciones arteriovenosas y/o aneurismas cerebrales. Se solicita Angioresonancia, que revela Imágenes de defecto sugestivas a Trombosis del Seno Longitudinal Superior, por lo que se indica anticoagulación con Heparina de Bajo Peso Molecular y Warfarina Sódica, obteniéndose una evolución favorable. A propósito de este caso, se realiza una revisión de la literatura, haciendo especial énfasis en su diagnóstico, factores de riesgo y controversias terapéuticas.

Evaluation of three different measurement methods for dural ectasia in Marfan syndrome

International Nuclear Information System (INIS)

Weigang, E.; Ghanem, N.; Chang, X.-C.; Richter, H.; Frydrychowicz, A.; Szabo, G.; Dudeck, O.; Knirsch, W.; Samson, P. von; Langer, M.; Beyersdorf, F.

2006-01-01

Aim: Dural ectasia is a major diagnostic criterion for Marfan syndrome using the Ghent nosology. Our aim was to evaluate the efficacy of three different radiological methods previously proposed for the assessment of dural sac diameter in Marfan syndrome. Methods: Marfan syndrome was diagnosed in our study using the Ghent criteria, disregarding dural ectasia as a criterion. Three proposed radiological methods were applied to measure dural sac diameter, examined for 41 patients (18 patients with and 23 without Marfan syndrome) by computed tomography or magnetic resonance imaging. Results: Using Oosterhof's method, 94% of the patients with and 44% of the patients without Marfan syndrome fulfilled the criteria of dural ectasia. According to Villeirs, dural ectasia was diagnosed in 18% of the patients with and in none of the patients without Marfan syndrome. With Ahn's method, dural ectasia was found in 72% of the patients with and in 44% of the patients without Marfan syndrome. In only two patients with Marfan syndrome was dural ectasia diagnosed by all three methods. Conclusion: Our results reveal overt discrepancy between the three methods of assessing dural ectasia. Considering the key role played by dural ectasia in reinforcing the diagnosis of Marfan syndrome according to the Ghent nosology, a standardized and reliable method should be sought

Evaluation of three different measurement methods for dural ectasia in Marfan syndrome

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Weigang, E.; Ghanem, N.; Chang, X.-C.; Richter, H.; Frydrychowicz, A.; Szabo, G.; Dudeck, O.; Knirsch, W.; Samson, P. von; Langer, M.; Beyersdorf, F

2006-11-15

Aim: Dural ectasia is a major diagnostic criterion for Marfan syndrome using the Ghent nosology. Our aim was to evaluate the efficacy of three different radiological methods previously proposed for the assessment of dural sac diameter in Marfan syndrome. Methods: Marfan syndrome was diagnosed in our study using the Ghent criteria, disregarding dural ectasia as a criterion. Three proposed radiological methods were applied to measure dural sac diameter, examined for 41 patients (18 patients with and 23 without Marfan syndrome) by computed tomography or magnetic resonance imaging. Results: Using Oosterhof's method, 94% of the patients with and 44% of the patients without Marfan syndrome fulfilled the criteria of dural ectasia. According to Villeirs, dural ectasia was diagnosed in 18% of the patients with and in none of the patients without Marfan syndrome. With Ahn's method, dural ectasia was found in 72% of the patients with and in 44% of the patients without Marfan syndrome. In only two patients with Marfan syndrome was dural ectasia diagnosed by all three methods. Conclusion: Our results reveal overt discrepancy between the three methods of assessing dural ectasia. Considering the key role played by dural ectasia in reinforcing the diagnosis of Marfan syndrome according to the Ghent nosology, a standardized and reliable method should be sought.

Neck massage induced dural sinus thrombosis

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Verma Ashish

2007-01-01

Full Text Available Thrombosis of the intracranial dural sinuses and internal jugular veins may occur as a complication of head and neck infections, surgery, central venous access, local malignancy, polycythemia, hyperhomocysteinemia, neck massage and intravenous drug abuse. A high degree of clinical suspicion followed by adequate imaging is prerequisite to early diagnosis and management. We report a young man who had dural sinus thrombosis with jugular venous thrombosis following neck massage.

Dural ectasia and conventional radiography in the Marfan lumbosacral spine

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Ahn, N U [Dept. of Orthopaedic Surgery, Johns Hopkins Univ. School of Medicine, Baltimore (United States); Johns Hopkins Outpatient Center, Dept. of Orthopaedic Surgery, Baltimore, MD (United States); Nallamshetty, L; Ahn, U M; Buchowski, J M; Kebaish, K M; Sponseller, P D [Dept. of Orthopaedic Surgery, Johns Hopkins Univ. School of Medicine, Baltimore (United States); Rose, P S [Dept. of Orthopaedic Surgery, Johns Hopkins Univ. School of Medicine, Baltimore (United States); National Human Genome Research Institute, National Institutes of Health, Bethesda, MD (United States); Garrett, E S [Dept. of Oncology, Division of Biostatistics, Johns Hopkins University School of Medicine, Baltimore (United States)

2001-06-01

Objective. To determine how well conventional radiographic findings can predict the presence of dural ectasia in Marfan patients.Design and patients. Twelve Marfan patients without dural ectasia and 21 Marfan patients with dural ectasia were included in the study. Five radiographic measurements were made of the lumbosacral spine: interpediculate distance, scalloping value, sagittal canal diameter, vertebral body width, and transverse process width.Results. The following measurements were significantly larger in patients with dural ectasia: interpediculate distances at L3-L4 levels (P<0.03); scalloping values at the L1 and L5 levels (P<0.05); sagittal diameters of the vertebral canal at L5-S1 (P<0.03); transverse process to width ratios at L2 (P<0.03). Criteria were developed for diagnosis of dural ectasia in Marfan patients. These included presence of one of the following: interpediculate distance at L4 >38.0 mm, sagittal diameter at S1 >18.0 mm, or scalloping value at L5 >5.5 mm.Conclusion. Dural ectasia in Marfan syndrome is commonly associated with several osseous changes that are observable on conventional radiographs of the lumbosacral spine. Conventional radiography can detect dural ectasia in patients with Marfan syndrome with a very high specificity (91.7%) but a low sensitivity (57.1%). (orig.)

Traumatic dural venous sinus thrombosis: A Mini Review

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Moscote-Salazar Luis Rafael

2016-09-01

Full Text Available The dural venous sinus thrombosis is a benign disease, representing about 1% of cerebral vascular events. In some cases the development of the disease increased intracranial pressure or symptomatic epilepsy. The development towards a dural venous sinus thrombosis is rare, but is a condition to be considered before the development of ischemic vascular events and a history of recent head trauma. Intracranial hematomas or skull fractures can lead to the establishment of obstructive pathology of the dural venous sinuses. The knowledge of this entity is necessary for the critical care staff and neurosurgery staff.

Symptomatic hemorrhagic complications associated with dural substitutes

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Po-Yuan Chen

2018-01-01

Conclusion: The increased risk of hemorrhagic complications associated with craniotomy is modified by choice of dural replacement. Our results could assist clinicians in their decision-making with respect to the optimal timing for synthetic dural substitutes in patients with tumor infiltration of the patient's dura, severe brain swelling in traumatic brain injury, or a result of shrinkage from exposure and electrocautery.

Bilateral subdural hematoma secondary to accidental dural puncture

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Sofía Ramírez

2015-07-01

Full Text Available We report the case of a 25-year-old woman, who received epidural analgesia for labor pain and subsequently presented post-dural puncture headache. Conservative treatment was applied and epidural blood patch was performed. In the absence of clinical improvement and due to changes in the postural component of the headache, a brain imaging test was performed showing a bilateral subdural hematoma.The post-dural puncture headache is relatively common, but the lack of response to established medical treatment as well as the change in its characteristics and the presence of neurological deficit, should raise the suspicion of a subdural hematoma, which although is rare, can be lethal if not diagnosed and treated at the right time. Resumo: Apresentamos o caso clínico de uma paciente de 25 anos de idade, na qual uma técnica peridural foi realizada durante o trabalho de parto e posteriormente apresentou cefaleia com características de cefaleia pós-punção dural. Foi iniciado tratamento conservador e tampão de sangue peridural. Devido a ausência de melhora clínica e à mudança do componente postural da cefaleia, decidiu-se realizar um exame de imagem cerebral que demostrou a presença de hematoma subdural bilateral.A cefaleia pós-punção dural é relativamente frequente, mas a falta de resposta ao tratamento médico instaurado, assim como a mudança em suas características e a presença de foco neurológico, devem levantar a suspeita de presença de um hematoma subdural que, embora infrequente, pode chegar a ser devastador se não for diagnosticado e tratado oportunamente. Keywords: Accidental dural puncture, Epidural analgesia, Post-dural puncture headache, Subdural hematoma, Epidural blood patch, Palavras chave: Dura-Máter, Analgesia epidural, Cefaleia pós-punção dural, Hematoma subdural, Placa de sangue epidural

Dural ectasia and FBN1 mutation screening of 40 patients with Marfan syndrome and related disorders: role of dural ectasia for the diagnosis.

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Attanasio, Monica; Pratelli, Elisa; Porciani, Maria Cristina; Evangelisti, Lucia; Torricelli, Elena; Pellicanò, Giannantonio; Abbate, Rosanna; Gensini, Gian Franco; Pepe, Guglielmina

2013-07-01

Marfan syndrome is an autosomal dominant disorder of connective tissue caused by mutations in the gene encoding fibrillin-1 (FBN1), a matrix component of microfibrils. Dural ectasia, i.e. enlargement of the neural canal mainly located in the lower lumbar and sacral region, frequently occurs in Marfan patients. The aim of our study was to investigate the role of dural ectasia in raising the diagnosis of Marfan syndrome and its association with FBN1 mutations. We studied 40 unrelated patients suspected for MFS, who underwent magnetic resonance imaging searching for dural ectasia. In all of them FBN1 gene analysis was also performed. Thirty-seven patients resulted affected by Marfan syndrome according to the '96 Ghent criteria; in 30 of them the diagnosis was confirmed when revaluated by the recently revised criteria (2010). Thirty-six patients resulted positive for dural ectasia. The degree of dural ectasia was grade 1 in 19 patients, grade 2 in 11 patients, and grade 3 in 6 patients. In 7 (24%) patients, the presence of dural ectasia allowed to reach a positive score for systemic feature criterion. Twenty-four patients carried an FBN1 mutation, that were represented by 13 missense (54%), and 11 (46%) mutations generating a premature termination codon (PTC, frameshifts and stop codons). No mutation was detected in the remaining 16 (6 patients with MFS and 10 with related disorders according to revised Ghent criteria). The prevalence of severe (grade 2 and grade 3) involvement of dura mater was higher in patients harbouring premature termination codon (PTC) mutations than those carrying missense-mutations (8/11 vs 2/13, P = 0.0111). Our data emphasizes the importance of dural ectasia screening to reach the diagnosis of Marfan syndrome especially when it is uncertain and indicates an association between PTC mutations and severe dural ectasia in Marfan patients. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Aspectos ultra-sonográficos da trombose da veia porta Ultrasonographic features of portal vein thrombosis

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Márcio Martins Machado

2006-04-01

Full Text Available A trombose da veia porta pode estar associada a várias alterações, como a presença de tumores (por exemplo: hepatocarcinoma, doença metastática hepática e carcinoma do pâncreas, pancreatite, hepatite, septicemia, trauma, esplenectomia, derivações porto-cava, estados de hipercoagulabilidade (por exemplo: gravidez, em neonatos (por exemplo: onfalite e cateterização da veia umbilical e desidratação aguda. Os autores discutem, neste artigo, os aspectos ultra-sonográficos da trombose de veia porta e alguns aspectos de relevância clínica.Portal vein thrombosis may be associated with many alterations, such as the presence of tumors (for example, hepatocellular carcinoma, metastatic liver disease and carcinoma of the pancreas as well as pancreatitis, hepatitis, septicemia, trauma, splenectomy, portacaval shunts, hypercoagulable conditions (for example, pregnancy, in neonates (for example, omphalitis and umbilical vein catheterization and in acute dehydration. The authors discuss herein the sonographic features of portal vein thrombosis as well as some aspects of clinical relevance.

A New Classification for Pathologies of Spinal Meninges, Part 1: Dural Cysts, Dissections, and Ectasias.

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Klekamp, Jörg

2017-07-01

The clinical significance of pathologies of the spinal dura is often unclear and their management controversial. To classify spinal dural pathologies analogous to vascular aneurysms, present their symptoms and surgical results. Among 1519 patients with spinal space-occupying lesions, 66 patients demonstrated dural pathologies. Neuroradiological and surgical features were reviewed and clinical data analyzed. Saccular dural diverticula (type I, n = 28) caused by defects of both dural layers, dissections between dural layers (type II, n = 29) due to defects of the inner layer, and dural ectasias (type III, n = 9) related to structural changes of the dura were distinguished. For all types, symptoms consisted of local pain followed by signs of radiculopathy or myelopathy, while one patient with dural ectasia presented a low-pressure syndrome and 10 patients with dural dissections additional spinal cord herniation. Type I and type II pathologies required occlusion of their dural defects via extradural (type I) or intradural (type II) approaches. For type III pathologies of the dural sac no surgery was recommended. Favorable results were obtained in all 14 patients with type I and 13 of 15 patients with type II pathologies undergoing surgery. The majority of dural pathologies involving root sleeves remain asymptomatic, while those of the dural sac commonly lead to pain and neurological symptoms. Type I and type II pathologies were treated with good long-term results occluding their dural defects, while ectasias of the dural sac (type III) were managed conservatively. Copyright © 2017 by the Congress of Neurological Surgeons

Adherencia a la terapia compresiva en los pacientes con úlceras venosas

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María del Carmen Folguera Álvarez

Full Text Available Objetivo: Analizar la bibliografía publicada en relación con los factores que influyen en la adherencia al tratamiento de la terapia compresiva en las personas con úlceras venosas. Método: Se ha realizado una revisión bibliográfica, consultando PubMed, BioMed Central, Library Cochrane Plus, CUIDEN, LILACS, IBECS, IME, SciELO, CINAHL, desde enero del 2003 a mayo de 2013. Resultados: Se han encontrado dieciséis documentos que cumplen los criterios de inclusión. Existen factores que influyen en la adherencia al tratamiento relacionados con los pacientes, profesionales e instituciones. Conclusiones: Se debe considerar el carácter crónico de las úlceras venosas y realizar las intervenciones, teniendo en cuenta las preferencias, conocimientos y habilidades tanto propias como de los pacientes.

Uso de contraceptivos orais induzindo trombose mesentérica Use of oral contraceptives causing mesenteric thrombosis

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Josiane L. Simão

2008-02-01

Full Text Available A trombose mesentérica é causa rara de dor abdominal em jovens, sendo responsável por cerca de 5% a 10% de todos os eventos de isquemia mesentérica. Contraceptivos hormonais orais têm sido associados a dezenas de casos de trombose mesentérica. Os autores relatam o caso de paciente com diagnóstico de trombose mesentérica após uso de contraceptivos e descrevem a relação entre ambos. M.R.F.S., sexo feminino, 19 anos, branca, deu entrada no Pronto Socorro do Hospital das Clínicas de Marília com quadro de dor abdominal há três dias associada ao uso de cinco comprimidos de anticoncepcional hormonal oral um dia antes de iniciar o quadro. Apresentava-se em regular estado geral, com abdome tenso, enrijecido, com ruídos hidroaéreos hipoativos, doloroso difusamente à palpação, sinal de Jobert e Blumberg positivos. A maioria das causas de trombose mesentérica são devidas a estados pró-trombóticos derivados de desordens da coagulação herdadas ou adquiridas. Portanto, uma vez confirmado este diagnóstico, os pacientes devem ser investigados para trombofilias hereditárias ou adquiridas com testes para deficiência de proteínas C e S, fator V de Leiden, hiperhomocisteinemia e hemoglobinúria paroxística noturna.Mesenteric thrombosis is a rare cause of abdominal pain in the young and is responsible for about 5-10% of all mesenteric ischemic events. Oral contraceptives are associated to many cases of mesenteric thrombosis. The case of a woman with mesenteric thrombosis after taking a high dose of contraceptives is reported. M.R.F.S., a 19-year-old caucasian woman, arrived in the Emergency Service of the Hospital das Clínicas in Marília reporting abdominal pain over 3 days associated with the use of 5 tablets of oral contraceptives one day earlier. An examination identified the abdominal wall was hardened and tense, with hypoactive bowel sounds, generalized pain on palpation , and Jobert and Blumberg signs. Most causes of mesenteric

Dural opening/removal for combined petrosal approach: technical note.

Science.gov (United States)

Terasaka, Shunsuke; Asaoka, Katsuyuki; Kobayashi, Hiroyuki; Sugiyama, Taku; Yamaguchi, Shigeru

2011-03-01

Detailed descriptions of stepwise dural opening/removal for combined petrosal approach are presented. Following maximum bone work, the first dural incision was made along the undersurface of the temporal lobe parallel to the superior petrosal sinus. Posterior extension of the dural incision was made in a curved fashion, keeping away from the transverse-sigmoid junction and taking care to preserve the vein of Labbé. A second incision was made perpendicular to the first incision. After sectioning the superior petrosal sinus around the porus trigeminus, the incision was extended toward the posterior fossa dura in the middle fossa region. The tentorium was incised toward the incisura at a point just posterior to the entrance of the trochlear nerve. A third incision was made longitudinally between the superior petrosal sinus and the jugular bulb. A final incision was initiated perpendicular to the third incision in the presigmoid region and extended parallel to the superior petrosal sinus connecting the second incision. The dural complex consisting of the temporal lobe dura, the posterior fossa dura, and the freed tentorium could then be removed. In addition to extensive bone resection, our strategic cranial base dural opening/removal can yield true advantages for the combined petrosal approach.

Extrasinusal dural arteriovenous malformations

International Nuclear Information System (INIS)

Piske, R.L.; Lasjaunias, P.

1988-01-01

Of 60 cases of dural arteriovenous malformations (DAVM) explored and treated in the Vascular Neuroradiology Unit of the Hospital of Bicetre between 1980 and 1986, 3 presented in an extrasinusal location: intraorbital, middle cerebral fossa and the region of the superior orbital fissure. We have not found any prior description of DAVMs in these regions in the literature. The classic concept that DAVMs rise in direct relationship with the dural sinuses is limited. We believe that these lesions may also developed in relationship with the venous drainage system of the sinuses and the venous drainage of the peripheral nervous system. We note that the superior ophthalmic vein which drains DAVMs of the orbit and the olfactory vein which drains DAVMs of the anterior cranial fossa and other veins that accompany the cranial nerves through the skull base have the characteristics of emissary veins. It may be that DAVMs can develop wherever veins follow a transosseous trajectory. (orig.)

Effectiveness of a new gelatin sealant system for dural closure.

Science.gov (United States)

Kawai, Hisashi; Nakagawa, Ichiro; Nishimura, Fumihiko; Motoyama, Yasushi; Park, Young-Su; Nakamura, Mitsutoshi; Nakase, Hiroyuki; Suzuki, Shuko; Ikada, Yoshito

2014-10-01

Watertight dural closure is imperative after neurosurgical procedures because inadequately treated leakage of cerebrospinal fluid (CSF) can have serious consequences. In this study, the authors test the use of a new gelatin glue as a dural sealant in in vitro and in vivo canine models of transdural CSF leakage. The in vitro model was sutured semicircles of canine dura mater and artificial dural substitute. The sutures were sealed with gelatin glue (n  =  20), fibrin glue (n  =  20), or a polyethylene glycol (PEG)-based hydrogel sealant (n  =  20). Each sample was set in a device to measure water pressure, and pressure was increased until leakage occurred. Bonding strength was subjectively evaluated. The in vivo model was dogs who underwent dural excision and received either no sealant (control group; n  =  5) or gelatin glue sealant (n  =  5) before dural closure. Twenty-eight days post-surgery, the maximum intracranial pressure was measured at the cisterna magna using Valsalva maneuver and tissue adhesion was evaluated. The water pressure at which leakage occurred in the in vitro model was higher with gelatin glue (76·5 ± 39·8 mmHg) than with fibrin glue (38·3 ± 27·4 mmHg, P control group (13·8 ± 4·0 mmHg, P control group (P  =  0·005). The new gelatin glue provides an effective watertight closure when used as an adjunct to sutured dural repair.

A Multicenter Study of the Presentation, Treatment, and Outcomes of Cervical Dural Tears.

Science.gov (United States)

O'Neill, Kevin R; Fehlings, Michael G; Mroz, Thomas E; Smith, Zachary A; Hsu, Wellington K; Kanter, Adam S; Steinmetz, Michael P; Arnold, Paul M; Mummaneni, Praveen V; Chou, Dean; Nassr, Ahmad; Qureshi, Sheeraz A; Cho, Samuel K; Baird, Evan O; Smith, Justin S; Shaffrey, Christopher; Tannoury, Chadi A; Tannoury, Tony; Gokaslan, Ziya L; Gum, Jeffrey L; Hart, Robert A; Isaacs, Robert E; Sasso, Rick C; Bumpass, David B; Bydon, Mohamad; Corriveau, Mark; De Giacomo, Anthony F; Derakhshan, Adeeb; Jobse, Bruce C; Lubelski, Daniel; Lee, Sungho; Massicotte, Eric M; Pace, Jonathan R; Smith, Gabriel A; Than, Khoi D; Riew, K Daniel

2017-04-01

Retrospective multicenter case series study. Because cervical dural tears are rare, most surgeons have limited experience with this complication. A multicenter study was performed to better understand the presentation, treatment, and outcomes following cervical dural tears. Multiple surgeons from 23 institutions retrospectively identified 21 rare complications that occurred between 2005 and 2011, including unintentional cervical dural tears. Demographic data and surgical history were obtained. Clinical outcomes following surgery were assessed, and any reoperations were recorded. Neck Disability Index (NDI), modified Japanese Orthopaedic Association (mJOA), Nurick classification (NuC), and Short-Form 36 (SF36) scores were recorded at baseline and final follow-up at certain centers. All data were collected, collated, and analyzed by a private research organization. There were 109 cases of cervical dural tears among 18 463 surgeries performed. In 101 cases (93%) there was no clinical sequelae following successful dural tear repair. There were statistical improvements ( P < .05) in mJOA and NuC scores, but not NDI or SF36 scores. No specific baseline or operative factors were found to be associated with the occurrence of dural tears. In most cases, no further postoperative treatments of the dural tear were required, while there were 13 patients (12%) that required subsequent treatment of cerebrospinal fluid drainage. Analysis of those requiring further treatments did not identify an optimum treatment strategy for cervical dural tears. In this multicenter study, we report our findings on the largest reported series (n = 109) of cervical dural tears. In a vast majority of cases, no subsequent interventions were required and no clinical sequelae were observed.

Comparación de cambios clínicos y hemodinámicos en pacientes con insuficiencia venosa mixta según tipo de manejo.

OpenAIRE

Escobar Diaz, Alejandro

2015-01-01

Existen varias causas de la insuficiencia venosa profunda, la insuficiencia venosa superficial es una de ellas; por tal motivo, una intervención activa de la insuficiencia superficial ya sea cirugía convencional, esclerosis o radiofrecuencia mejora el reflujo del sistema venoso profundo. En nuestro medio no se acostumbra a intervenir los pacientes con insuficiencia venosa mixta bajo la creencia de exacerbar la enfermedad o generar complicaciones. Se pretende documentar los cambios clínicos y ...

Trombose venosa profunda e suspeita de tromboembolismo pulmonar: avaliação simultânea por meio de angiotomografia pulmonar e venotomografia combinadas Deep venous thrombosis with suspected pulmonary embolism: simultaneous evaluation using combined CT venography and pulmonary CT angiography

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Laura de Moraes Gomes

2006-02-01

Full Text Available OBJETIVO: Avaliar a ocorrência e a correlação de tromboembolismo pulmonar (TEP e trombose venosa profunda (TVP por meio de um protocolo único de angiotomografia computadorizada. MATERIAIS E MÉTODOS: Estudo prospectivo realizado de julho de 2003 a junho de 2004 no Hospital Copa D'Or, Rio de Janeiro, RJ. Foram analisadas 116 angiotomografias de pacientes com suspeita clínica de TEP. Após o estudo do tórax, com um intervalo de três minutos e sem injeção adicional de contraste, foram obtidos cortes do diafragma até os joelhos, a fim de pesquisar TVP. RESULTADOS: De 116 pacientes, 23 (19,8% cursaram com TEP, 24 com TVP (20,7%, 15 (12,9% apresentaram tanto TEP quanto TVP e 9 (7,8% apresentaram TVP na ausência de TEP. Dos 23 casos positivos de TEP, 15 apresentaram concomitantemente TVP (65,2%, enquanto em 8 (34,8% foi visto apenas TEP. Dos 24 casos positivos de TVP, 15 (62,5% apresentaram TEP associado, enquanto em 9 (37,5% foi encontrada TVP isolada. CONCLUSÃO: Os resultados demonstraram a forte relação entre TEP e TVP, a importância de pesquisar TVP nos casos com suspeita de TEP e a utilidade do uso combinado da angiotomografia de tórax e da venotomografia como alternativa de único exame de investigação de TEP e TVP simultaneamente.OBJECTIVE: To evaluate the occurrence and the correlation between pulmonary embolism (PE and deep venous thrombosis (DVT using a single CT angiography protocol. MATERIALS AND METHODS: This was a prospective study performed at Hospital Copa D'Or, Rio de Janeiro, Brazil from July 2003 to June 2004. We analyzed 116 CT angiography examinations of patients with clinical suspicion of PE. After an interval of approximately three minutes, venous phase images from the diaphragm to the knees were acquired without additional contrast injection in order to determine the presence of DVT. RESULTS: From the 116 patients studied, 23 (19.8% had PE, 24 (20.7% had DVT, 15 (12.9% had both PE and DVT and 9 (7.8% had DVT

ANSIEDAD, DEPRESIÓN Y RASGOS DE PERSONALIDAD EN PACIENTES CON INSUFICIENCIA VENOSA CRÓNICA PERIFÉRICA

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L A Carmona-López

2016-07-01

Full Text Available Introducción: La Insuficiencia Venosa Crónica Periférica (IVCP es un cambio clínico que se produce como resultado de la dilatación patológica de las venas en los miembros inferiores, de la incompetencia de sus válvulas y de la hipertensión venosa resultante. Pudiera cursar dentro de la categoría de trastornos sistémicos que producen depresión y ansiedad, las cuales a su vez son alteraciones psiquiátricas relacionadas con toda la esfera cardiovascular. Objetivo: Determinar la frecuencia de ansiedad, depresión y su relación con los rasgos de personalidad, en pacientes con Insuficiencia Venosa Crónica Periférica. Metodología: Se realizó un trabajo de tipo descriptivo, de corte transversal. Se utilizó la escala de Hamilton para ansiedad y depresión; la personalidad fue evaluada con el cuestionario Factorial de Personalidad 16 FP de Catell además de otras variables sociodemográficas. Resultados: Se evaluaron 30 pacientes; 93% (N=28 de sexo femenino, 7% (N=2 de sexo masculino diagnosticados. Con edades entre 25 y 74 años; encontrándose 36,7% (N=11 ansiedad severa, seguida de ansiedad menor en 33,3% (N=10. 50% de los pacientes no presentó depresión, y 50% se distribuyó de forma homogénea en leve, moderada y severa. Predominando personalidad que se le dificulta manejar las frustraciones, suelen ser nerviosos o ansiosos ante ciertas circunstancias, suspicaces, inteligentes y leales a nivel grupal. El rasgo de personalidad que predominó en el grupo de estudio es el de tipo ansioso. Conclusión: Los pacientes con insuficiencia venosa crónica periférica tienen inclinación a la ansiedad con dificultades para manejar la frustración. Palabras claves: Insuficiencia venosa, Ansiedad, Depresión, Personalidad

Efficacy and safety of small intestinal submucosa in dural defect repair in a canine model

Energy Technology Data Exchange (ETDEWEB)

He, Shu-kun [Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041 (China); Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041 (China); Guo, Jin-hai [Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041 (China); Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041 (China); Department of Orthopedics, The Third People' s Hospital of Chengdu, Chengdu, Sichuan 610031 (China); Wang, Zhu-le [Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041 (China); Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041 (China); Zhang, Yi [Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041 (China); Tu, Yun-hu [Department of Neurosurgery, Chengdu Military General Hospital, Chengdu, Sichuan 610083 (China); Wu, Shi-zhou [Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041 (China); Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041 (China); Huang, Fu-guo [Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041 (China); Xie, Hui-qi, E-mail: xiehuiqi@scu.edu.cn [Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041 (China)

2017-04-01

Dural defects are a common problem, and inadequate dural closure can lead to complications. Several types of dural substitute materials have recently been discarded or modified owing to poor biocompatibility or mechanical properties and adverse reactions. The small intestinal submucosa (SIS) is a promising material used in a variety of applications. Based on the limitations of previous studies, we conducted an animal study to evaluate the efficacy and safety of the SIS in preclinical trials. Twenty-four male beagle dogs were subjected to surgical resection to produce dural defects. SIS or autologous dural mater was patched on the dural defect. Gross and histological evaluations were carried out to evaluate the efficacy and safety of the therapy. Our findings demonstrated that the SIS, which stimulated connective and epithelial tissue responses for dural regeneration and functional recovery without immunological rejection, could provide prolonged defect repair and prevent complications. The mechanical properties of the SIS could be adjusted by application of multiple layers, and the biocompatibility of the material was appropriate. Thus, our data suggested that this material may represent an alternative option for clinical treatment of dural defects. - Highlights: • SIS stimulates dura regeneration without immunological rejection. • SIS has adjustable mechanical properties and appropriate biocompatibility. • SIS may be an effective alternative option for clinical treatment of dural defects.

Efficacy and safety of small intestinal submucosa in dural defect repair in a canine model

International Nuclear Information System (INIS)

He, Shu-kun; Guo, Jin-hai; Wang, Zhu-le; Zhang, Yi; Tu, Yun-hu; Wu, Shi-zhou; Huang, Fu-guo; Xie, Hui-qi

2017-01-01

Dural defects are a common problem, and inadequate dural closure can lead to complications. Several types of dural substitute materials have recently been discarded or modified owing to poor biocompatibility or mechanical properties and adverse reactions. The small intestinal submucosa (SIS) is a promising material used in a variety of applications. Based on the limitations of previous studies, we conducted an animal study to evaluate the efficacy and safety of the SIS in preclinical trials. Twenty-four male beagle dogs were subjected to surgical resection to produce dural defects. SIS or autologous dural mater was patched on the dural defect. Gross and histological evaluations were carried out to evaluate the efficacy and safety of the therapy. Our findings demonstrated that the SIS, which stimulated connective and epithelial tissue responses for dural regeneration and functional recovery without immunological rejection, could provide prolonged defect repair and prevent complications. The mechanical properties of the SIS could be adjusted by application of multiple layers, and the biocompatibility of the material was appropriate. Thus, our data suggested that this material may represent an alternative option for clinical treatment of dural defects. - Highlights: • SIS stimulates dura regeneration without immunological rejection. • SIS has adjustable mechanical properties and appropriate biocompatibility. • SIS may be an effective alternative option for clinical treatment of dural defects.

Efectividad de la electromagnetoterapia en el tratamiento de la insuficiencia venosa crónica

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María Onelia Díaz Rivadeneira

2015-03-01

Full Text Available Se realizó un estudio experimental prospectivo, con el objetivo de evaluar la efectividad de la electromagnetoterapia en pacientes con insuficiencia venosa crónica, atendidos en el Hospital Universitario “Manuel Ascunce Doménech” de Camagüey, en la etapa comprendida desde febrero hasta agosto de 2012. El universo estuvo constituido por 135 pacientes que acudieron al servicio de Angiología con insuficiencia venosa crónica y la muestra se formó con 42 pacientes mayores de 18 años diagnosticados, seleccionados según muestreo aleatorio simple. Se aplicó magnetoterapia en los puntos E36 (+, E41 (-, Vb34 (+, Vb39 (-, el tiempo de duración fue de quince minutos cada sesión, una vez al día durante quince sesiones. La totalidad de los pacientes presentaron pesadez, prurito y edema. Predominó la desaparición del prurito a partir de la quinta sesión de magnetoterapia; la pesadez, el edema y el dolor fueron disminuyendo en el transcurso del tratamiento. La calidad de vida al finalizar el tratamiento fue buena. No se encontraron reacciones adversas. El tratamiento con electromagnetoterapia fue efectivo en los pacientes con insuficiencia venosa crónica

Profilaxia para tromboembolismo venoso em um hospital de ensino Venous thromboembolism prophylaxis at a teaching hospital

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Rafael de Melo Franco

2006-06-01

Full Text Available OBJETIVO: Verificar se a profilaxia da trombose venosa profunda está sendo utilizada de maneira correta e rotineira em um hospital de ensino. MÉTODOS E CASUÍSTICA: Foi realizado um estudo transversal de pacientes internados em sete setores (enfermarias do Conjunto Hospitalar de Sorocaba (Hospital de Ensino, no período de agosto de 2004 a agosto de 2005. Para estratificação do risco de trombose venosa profunda de cada paciente, foram pesquisados fatores clínicos e cirúrgicos, segundo o protocolo preconizado pela Sociedade Brasileira de Angiologia e Cirurgia Vascular. No período estudado, foram analisados 216 prontuários, dos quais 30 eram da cirurgia abdominal, 30 da cirurgia vascular, 30 da urologia, 31 da clínica médica, 31 da unidade de terapia intensiva, 31 da ortopedia e 33 da ginecologia/obstetrícia. RESULTADOS: Do total de pacientes, foi efetuada profilaxia para trombose venosa profunda em 57 (26%, sendo que, em 51 (89%, a execução foi de maneira correta e, em 6 (11%, não-preconizada. O método profilático mais utilizado foi o medicamentoso; 49 de 57 pacientes fizeram uso de heparina de baixo peso molecular. Também foi verificada a utilização de meias elásticas em cinco pacientes e deambulação precoce em sete. Já a compressão pneumática intermitente não foi utilizada em nenhum deles. CONCLUSÃO: De acordo com os resultados e com base no protocolo, concluiu-se que, no período da pesquisa, a profilaxia para trombose venosa profunda, no Conjunto Hospitalar de Sorocaba, foi executada rotineiramente e de forma adequada em apenas 23,6% (51 do total de 216 pacientes.OBJECTIVE: To verify whether deep venous thrombosis prophylaxis is being correctly and routinely used at a teaching hospital. METHODS: A cross-sectional study of hospitalized patients on seven sectors at Conjunto Hospitalar de Sorocaba (Hospital de Ensino was performed from August 2004 to August 2005. For the deep venous thrombosis risk stratification of

''Dural tail'' adjacent to acoustic neuroma on MRI: a case report

International Nuclear Information System (INIS)

Lunardi, P.; Mastronardi, L.; Nardacci, B.; Acqui, M.; Fortuna, A.

1993-01-01

A 'dural tail' on Gd-DTPA-enhanced MRI has been often observed adjacent to meningiomas and considered to be useful in distinguishing meningioma of the cerebellopontine angle from acoustic neuroma. However, demonstration of a dural tail adjacent to an acoustic neuroma indicates that this sign is not specific. (orig.)

How I do it: surgical ligation of craniocervical junction dural AV fistulas.

Science.gov (United States)

Sorenson, Thomas J; La Pira, Biagia; Hughes, Joshua; Lanzino, Giuseppe

2017-08-01

Dural arteriovenous fistulas (DAVFs) of the craniocervical junction are uncommon vascular lesions, which often require surgical treatment even in the endovascular era. Most commonly, the fistula is placed laterally, and surgical ligation is performed through a lateral suboccipital craniotomy. After dural opening, the area is inspected, and the arterialized vein is identified emerging from the dura, often adjacent to the entry point of the vertebral artery, and ligated. A far lateral craniotomy is the authors' preferred surgical approach for accessing and treating dural arteriovenous fistulas of the craniocervical junction that cannot be reached endovascularly.

Prevalence of dural ectasia in Loeys-Dietz syndrome: comparison with Marfan syndrome and normal controls.

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Atsushi K Kono

Full Text Available BACKGROUND AND PURPOSE: Dural ectasia is well recognized in Marfan syndrome (MFS as one of the major diagnostic criteria, but the exact prevalence of dural ectasia is still unknown in Loeys-Dietz syndrome (LDS, which is a recently discovered connective tissue disease. In this study, we evaluated the prevalence of dural ectasia in LDS according by using qualitative and quantitative methods and compared our findings with those for with MFS and normal controls. MATERIAL AND METHODS: We retrospectively studied 10 LDS (6 males, 4 females, mean age 36.3 years and 20 MFS cases (12 males, 8 females, mean age 37.1 years and 20 controls (12 males, 8 females, mean age 36.1 years both qualitatively and quantitatively using axial CT images and sagittal multi-planar reconstruction images of the lumbosacral region. For quantitative examination, we adopted two methods: method-1 (anteroposterior dural diameter of S1> L4 and method-2 (ratio of anteroposterior dural diameter/vertebral body diameter>cutoff values. The prevalence of dural ectasia among groups was compared by using Fisher's exact test and the Tukey-Kramer test. RESULTS: In LDS patients, the qualitative method showed 40% of dural ectasia, the quantitative method-1 50%, and the method-2 70%. In MFS patients, the corresponding prevalences were 50%, 75%, and 85%, and in controls, 0%, 0%, and 5%. Both LDS and MFS had a significantly wider dura than controls. CONCLUSIONS: While the prevalence of dural ectasia varied depending on differences in qualitative and quantitative methods, LDS as well as MFS, showed, regardless of method, a higher prevalence of dural ectasia than controls. This finding should help the differentiation of LDS from controls.

Intracranial Dural Metastasis of Ewing's Sarcoma: a Case Report

International Nuclear Information System (INIS)

Kim, Eung Yeop; Lee, Seung Koo; Kim, Dong Joon; Kim, Jin Na; Lee, Kyu Sung; Jung, Woo Hee; Kim, Dong Ik

2008-01-01

Ewing's sarcoma is a malignant bone tumor that can occur anywhere in the body, but it is most commonly observed in the long bones of the arms and legs, the pelvis and in the chest. The predominant sites of metastasis include the lung (38%), bone (including the spine; 31%), and the bone marrow (11%). Metastasis of Ewing's sarcoma to the central nervous system (CNS) is relatively rare, and most of the previous reports have demonstrated involvement of the bony calvarium or brain parenchyma. We describe here the imaging findings of dural metastasis of Ewing's sarcoma, and these imaging findings have not been previously reported on in the medical literature. In conclusion, dural metastasis of Ewing's sarcoma is very rare and its imaging characteristics are similar to those of a primary tumor, which mimic the findings of a schwannoma or meningioma. Despite its rarity, secondary Ewing's sarcoma may be included in the differential diagnosis of extra-axial dural masses

Comparison of the efficiency, side effects and complications of the synthetic dural grafts: Beriplast and Tissudura

OpenAIRE

HAMZAOĞLU, Vural; ÖZALP, Hakan; KARKUCAK, Ahmet; ÇOKLUK, Cengiz

2015-01-01

The purpose of this study was to compare human fibrinogen-thrombin-based liquid dural graft; Beriplast® (Behring, Malburg, Germany) and collagen-based dural graft; Tissudura® (Baxter, Heidelberg, Germany) in terms of efficiency, side effects and complications. Thirty Spraque Dawley rats were used in this experimental study. A burrhole was opened on the left parietal bone of each subject and experimental dural defect was created. While 10 subjects were in sham group without any dural defect re...

Bacterial Cellulose Membranes Used as Artificial Substitutes for Dural Defection in Rabbits

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Chen Xu

2014-06-01

Full Text Available To improve the efficacy and safety of dural repair in neurosurgical procedures, a new dural material derived from bacterial cellulose (BC was evaluated in a rabbit model with dural defects. We prepared artificial dura mater using bacterial cellulose which was incubated and fermented from Acetobacter xylinum. The dural defects of the rabbit model were repaired with BC membranes. All surgeries were performed under sodium pentobarbital anesthesia, and all efforts were made to minimize suffering. All animals were humanely euthanized by intravenous injection of phenobarbitone, at each time point, after the operation. Then, the histocompatibility and inflammatory effects of BC were examined by histological examination, real-time fluorescent quantitative polymerase chain reaction (PCR and Western Blot. BC membranes evenly covered the surface of brain without adhesion. There were seldom inflammatory cells surrounding the membrane during the early postoperative period. The expression of inflammatory cytokines IL-1β, IL-6 and TNF-α as well as iNOS and COX-2 were lower in the BC group compared to the control group at 7, 14 and 21 days after implantation. BC can repair dural defects in rabbit and has a decreased inflammatory response compared to traditional materials. However, the long-term effects need to be validated in larger animals.

Evaluation of venous congestion in dural arteriovenous fistulae using the acetazolamide test

International Nuclear Information System (INIS)

Deguchi, Jun; Yamada, Makoto; Kobata, Hitoshi; Kuroiwa, Toshihiko

2002-01-01

The pattern of venous drainage determines the clinical presentation of dural arteriovenous fistulas (AVFs). We assessed the degree of venous congestion in dural AVFs using acetazolamide test and stable Xenon-CT. In 11 patients (8 sigmoid-transverse dural AVFs, 3 cavernous dural AVFs) before treatment and in 8 patients 6 months after treatment, cerebral hemodynamics were studied by stable Xenon-CT. Regions of interest (ROI) were placed in the temporo-occipital region in cases of sigmoid-transverse AVFs, and in the frontal operculum in cases of cavernous AVFs. Patients were classified into 5 groups according to Cognard's classification. In the groups without venous reflux (Cognard type I) and reflux only to the venous sinus (type IIa), regional cerebral blood flow (rCBF) at rest and after acetazolamide challenge were normal. In the group showing reflux to the cortical vein (type IIb), the increase in rCBF after acetazolamide challenge on the lesion side was less than that on the opposite side. In the group showing reflux to both cortical vein and sinus (type IIa+b), rCBF did not increase after acetazolamide challenge. The CBF and increase in rCBF after acetazolamide in the symptomatic group were significantly lower than those in the asymptomatic group. After embolization, the increase in rCBF by acetazolamide improved in all except for type III cases. Cerebral venous hypertension in dural AVFs causes weak response to acetazolamide challenge. The degree of venous hypertension can be evaluated quantitatively by acetazolamide challenge and stable Xenon-CT. Therefore acetazolamide challenge is useful for determination of the embolization of dural AVFs. (author)

Prevalência de deficiência de vitamina D em pacientes com úlceras de perna de etiologia venosa

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Claudine Juliana C Burkievcz

Full Text Available OBJETIVO: Estudar se a prevalência da deficiência de vitamina D em indivíduos com úlcera de perna de causa venosa é maior do que em população controle. MÉTODOS: Estudaram-se os níveis séricos de 25-OH-vitamina D por quimioluminescência em 27 portadores de úlcera venosa crônica e 58 controles do Hospital Universitário Evangélico de Curitiba. RESULTADOS: Os níveis de 25-OH-vitamina D3 eram inferiores a 8 ng/dl em 11,1% dos pacientes com úlcera e 3,4% dos controles; entre 8 e 20 ng/dl em 46,1% dos pacientes com úlcera e 25,8% dos controles; entre 21 e 30 ng/dl em 22.2% dos pacientes com úlcera e 27,5% dos controles e acima de 30 ng/dl em 43,1% dos controles e 18,5% dos pacientes com úlcera (p=0,04. CONCLUSÃO: Existe aumento de prevalência de deficiência de vitamina D em pacientes com úlceras venosas crônicas de pernas.

A dural metastatic small cell carcinoma of the gallbladder as the first manifestation: a case report.

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Tonomura, Shuichi; Kitaichi, Tomoko; Onishi, Rina; Kakehi, Yoshiaki; Shimizu, Hisao; Shimada, Keiji; Kanemasa, Kazuyuki; Fukusumi, Akio; Takahashi, Nobuyuki

2018-03-16

A dural metastasis is one of the essential differential diagnoses of meningioma. In general, carcinomas of the breast and lung in females and prostate in males have been the most commonly reported primary lesions of dural metastases. However, dural metastasis of gallbladder carcinoma is extremely rare. Here, we report a unique case of a dural matter metastasis of gallbladder carcinoma as the first manifestation, which was autopsy-defined as small cell carcinoma. A 78-year-old man came to our hospital complaining of left hemianopia. Brain computed tomography (CT) revealed a sizeable parasagittal dural-based extra-axial tumor. However, the findings for meningioma were atypical by magnetic resonance imaging, suggesting a meningioma mimic. A contrast-enhanced CT scan of the abdomen revealed a large gallbladder carcinoma. The patient opted for the best supportive care and died 2 months later. The post-mortem examination revealed small cell carcinoma in gallbladder carcinoma. Moreover, an immunologically similar carcinoma was detected in the dural metastasis. To the best of our knowledge, this is the first case of a dural metastasis of gallbladder small cell carcinoma. A systemic examination is essential for clinicians when atypical findings of meningioma are observed, suggesting a meningioma mimic. We present this rare case with a review of the literature.

Surgical management of dural arteriovenous fistulas with transosseous arterial feeders involving the jugular bulb.

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Tirakotai, W; Benes, L; Kappus, C; Sure, U; Farhoud, A; Bien, S; Bertalanffy, H

2007-01-01

Dural arteriovenous fistulas located in the vicinity of the jugular foramen are complex vascular malformations and belong to the most challenging skull base lesions to treat. The authors comprehensively analyze multiple features in a series of dural arteriovenous fistulas with transosseous arterial feeders involving the jugular bulb. Four patients who underwent surgery via the transcondylar approach to treat dural arteriovenous fistulas around the jugular foramen were retrospectively reviewed. Previously, endovascular treatment was attempted in all patients. The success of the surgical treatment was examined with postoperative angiography. Complete obliteration of the dural arteriovenous fistulas (DAVFs) was achieved in three patients, and significant flow reduction in one individual. All patients had a good postoperative outcome, and only one experienced mild hypoglossal nerve palsy. Despite extensive bone drilling, an occipitocervical fusion was necessary in only one patient with bilateral lesions. The use of an individually tailored transcondylar approach to treat dural arteriovenous fistulas at the region of the jugular foramen is most effective. This approach allows for complete obliteration of the connecting arterial feeders, and removal of bony structures containing pathological vessels.

Phase-contrast MR angiography of intracranial dural arteriovenous fistulae

International Nuclear Information System (INIS)

Cellerini, M.; Mascalchi, M.; Mangiafico, S.; Ferrito, G.P.; Scardigli, V.; Pellicano, G.; Quilici, N.

1999-01-01

MRI and phase-contrast MR angiography (PC MRA) were obtained in 13 patients with angiographically confirmed intracranial dural arteriovenous fistulae (DAVF). Three- and two-dimensional PC MRA was obtained with low (6-20 cm/s) and high (>40 cm/s) velocity encoding along the three main body axes. MRI showed focal or diffuse signal abnormalities in the brain parenchyma in six patients, dilated cortical veins in seven, venous pouches in four with type IV DAVF and enlargement of the superior ophthalmic vein in three patients with DAVF of the cavernous sinus. However, it showed none of the fistula sites and did not allow reliable identification of feeding arteries. 3D PC MRA enabled identification of the fistula and enlarged feeding arteries in six cases each. Stenosis or occlusion of the dural sinuses was detected in six of eight cases on 3D PC MRA with low velocity encoding. In six patients with type II DAVF phase reconstruction of 2D PC MRA demonstrated flow reversal in the dural sinuses or superior ophthalmic vein. (orig.)

Cranial dural arteriovenous fistula as a rare cause of tinnitus – case report

International Nuclear Information System (INIS)

Kuśmierska, Małgorzata; Gać, Paweł; Nahorecki, Artur; Szuba, Andrzej; JaŸwiec, Przemysław

2013-01-01

Tinnitus, occurring at least once in a lifetime in about 10–20% of the population, is an important clinical problem with complex etiology. Rare causes of tinnitus include cranial dural arteriovenous fistulas (DAVFs), which are usually small lesions consisting of abnormal connections between branches of dural arteries and venous sinuses or veins. Authors present a case of a 44-year-old woman with persistent, unilateral, treatment-resistant pulsatile tinnitus caused by a small dural arteriovenous fistula revealed in computed tomography angiography. Computed tomography angiography is a useful diagnostic method that in some cases allows for establishing the cause of unilateral, pulsatile tinnitus

Cranial dural arteriovenous fistula as a rare cause of tinnitus – case report

Energy Technology Data Exchange (ETDEWEB)

Kuśmierska, Małgorzata; Gać, Paweł [Department of Medical Radiology and Imaging Diagnostics, 4th Military Clinical Hospital, Wrocław (Poland); Nahorecki, Artur [Department of Internal Diseases, 4th Military Clinical Hospital, Wrocław (Poland); Szuba, Andrzej [Department of Internal Diseases, 4th Military Clinical Hospital, Wrocław (Poland); Medical University, Wrocław (Poland); JaŸwiec, Przemysław [Department of Medical Radiology and Imaging Diagnostics, 4th Military Clinical Hospital, Wrocław (Poland)

2013-07-01

Tinnitus, occurring at least once in a lifetime in about 10–20% of the population, is an important clinical problem with complex etiology. Rare causes of tinnitus include cranial dural arteriovenous fistulas (DAVFs), which are usually small lesions consisting of abnormal connections between branches of dural arteries and venous sinuses or veins. Authors present a case of a 44-year-old woman with persistent, unilateral, treatment-resistant pulsatile tinnitus caused by a small dural arteriovenous fistula revealed in computed tomography angiography. Computed tomography angiography is a useful diagnostic method that in some cases allows for establishing the cause of unilateral, pulsatile tinnitus.

Meningeal norepinephrine produces headache behaviors in rats via actions both on dural afferents and fibroblasts.

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Wei, Xiaomei; Yan, Jin; Tillu, Dipti; Asiedu, Marina; Weinstein, Nicole; Melemedjian, Ohannes; Price, Theodore; Dussor, Gregory

2015-10-01

Stress is commonly reported to contribute to migraine although mechanisms by which this may occur are not fully known. The purpose of these studies was to examine whether norepinephrine (NE), the primary sympathetic efferent transmitter, acts on processes in the meninges that may contribute to the pain of migraine. NE was applied to rat dura using a behavioral model of headache. Primary cultures of rat trigeminal ganglia retrogradely labeled from the dura mater and of rat dural fibroblasts were prepared. Patch-clamp electrophysiology, Western blot, and ELISA were performed to examine the effects of NE. Conditioned media from NE-treated fibroblast cultures was applied to the dura using the behavioral headache model. Dural injection both of NE and media from NE-stimulated fibroblasts caused cutaneous facial and hindpaw allodynia in awake rats. NE application to cultured dural afferents increased action potential firing in response to current injections. Application of NE to dural fibroblasts increased phosphorylation of ERK and caused the release of interleukin-6 (IL-6). These data demonstrate that NE can contribute to pro-nociceptive signaling from the meninges via actions on dural afferents and dural fibroblasts. Together, these actions of NE may contribute to the headache phase of migraine. © International Headache Society 2015.

Detector location selection based on VIP analysis in near-infrared detection of dural hematoma

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Qiuming Sun

2018-03-01

Full Text Available Detection of dural hematoma based on multi-channel near-infrared differential absorbance has the advantages of rapid and non-invasive detection. The location and number of detectors around the light source are critical for reducing the pathological characteristics of the prediction model on dural hematoma degree. Therefore, rational selection of detector numbers and their distances from the light source is very important. In this paper, a detector position screening method based on Variable Importance in the Projection (VIP analysis is proposed. A preliminary modeling based on Partial Least Squares method (PLS for the prediction of dural position μa was established using light absorbance information from 30 detectors located 2.0–5.0 cm from the light source with a 0.1 cm interval. The mean relative error (MRE of the dural position μa prediction model was 4.08%. After VIP analysis, the number of detectors was reduced from 30 to 4 and the MRE of the dural position μa prediction was reduced from 4.08% to 2.06% after the reduction in detector numbers. The prediction model after VIP detector screening still showed good prediction of the epidural position μa. This study provided a new approach and important reference on the selection of detector location in near-infrared dural hematoma detection. Keywords: Detector location screening, Epidural hematoma detection, Variable importance in the projection

Caracterização dos pacientes com úlcera venosa acompanhados no Ambulatório de Reparo de Feridas

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Beatriz Guitton Renaud Baptista de Oliveira

2012-03-01

Full Text Available Objetivos: caracterizar os pacientes que apresentam úlcera venosa atendidos no ambulatório de um hospital universitário, avaliar as características das úlceras venosas e citar os produtos utilizados para o seu tratamento. Trata-se de um estudo clínico observacional, aprovado pelo Comitê de Ética em Pesquisa, realizado no Ambulatório de Reparo de Feridas, no período de janeiro a dezembro de 2008. O instrumento de coleta de dados abordou: informações clínicas do paciente e dados específicos da lesão e do tratamento tópico. Participaram do estudo 49 pacientes com úlcera venosa crônica; 55% eram mulheres entre 51-70 anos. Os participantes apresentavam 67 úlceras, a maioria localizada na porção inferior da perna (68,6%, com tempo de evolução menor de cinco anos (53,8%, apresentando leito com tecido de granulação e áreas desvitalizadas (49% e bordas apresentavam com epitelizacão em 58% dos casos. Os produtos disponíveis na instituição eram os ácidos graxos essenciais e a colagenase.

Trombosis Venosa Retiniana y Trombosis Venosa Profunda; ¿hablamos de dos manifestaciones de una misma enfermedad? Estudio comparativo de 2 cohortes.

OpenAIRE

Guirado Torrecillas, Leticia

2018-01-01

La oclusión venosa retiniana (OVR) es un trastorno vascular retiniano muy frecuente (la 2ª en frecuencia tras la retinopatía diabética), poco conocida y una importante causa de pérdida de visión. Su prevalencia varía de un 0,3-1,6% y aumenta con la edad, sobre todo a partir de los 65 años. Su etiopatogenia está poco aclarada, ya que no parece que hay una relación estrecha con la triada clásica de trombogénesis de Virchow, y si con la proximidad anatómica entre las venas y las arterias retini...

Anestesia venosa total para timectomia em paciente com Miastenia Gravis: relato de caso

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Rezer Gabrielle

2003-01-01

Full Text Available JUSTIFICATIVA E OBJETIVOS: Pacientes com doenças neuromusculares, como Miastenia Gravis, respondem de maneira anormal aos anestésicos, conforme a técnica e as drogas administradas. O objetivo deste relato é mostrar um caso de paciente portadora de Miastenia Gravis, submetida a timectomia sob anestesia venosa total com propofol e remifentanil. RELATO DO CASO: Paciente feminina, 52 anos, 72 kg, com história de Miastenia Gravis submetida a timectomia transesternal, sob anestesia venosa total, com o uso de propofol em infusão alvo controlada (3 g.ml-1 e remifentanil contínuo (0,3 µg.kg-1.min-1. Para a intubação traqueal foi utilizada succinilcolina (50 mg, sendo realizada sem dificuldade. Com a finalidade de realizar a analgesia pós-operatória, foram utilizados tramadol (50 mg, cetoprofeno (100 mg e dipirona (1 g, no per-operatório. Após a cirurgia, a infusão de propofol e remifentanil foi encerrada e, 15 minutos depois, a paciente foi extubada. A paciente apresentava-se eupnéica, acordada, sem dor, movimentando membros, com freqüência respiratória de 14 mpm e mantendo saturação de oxigênio de 97%. Permaneceu com cateter nasal de O2 a 2 L.min-1 na UTI intermediária, durante 36 horas, e recebeu alta hospitalar no 4º dia do pós-operatório. CONCLUSÕES: A anestesia venosa total, com agentes anestésicos de curta duração e sem metabólitos ativos, favoreceu a recuperação e a extubação precoce da paciente

Dural AVM supplied by the ophthalmic artery.

LENUS (Irish Health Repository)

Flynn, T H

2012-02-03

Dural arteriovenous malformations in the anterior cranial fossa are rare and are especially prone to haemorrhage. These lesions are usually treated by surgical excision. We report the embolization of an anterior cranial fossa DAVM using an endovascular approach via the ophthalmic artery.

Trombose de veia porta em crianças e adolescentes Portal vein thrombosis in children and adolescents

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Graziela C. M. Schettino

2006-06-01

Full Text Available OBJETIVO: Apresentar uma revisão atualizada de trombose de veia porta na infância e adolescência, enfatizando o diagnóstico, suas complicações e tratamento. FONTE DOS DADOS: Foi realizada revisão da literatura, dos últimos 10 anos, através de pesquisa bibliográfica na Internet nos principais sites de busca médica, como o PubMed e MEDLINE, com enfoque na doença trombose de veia porta e suas repercussões clínicas. As principais palavras-chave e expressões pesquisadas foram: portal vein thrombosis, extra-hepatic portal vein obstruction, prognosis, children, portal hypertension, esophagogastric varices. Além disso, foram consultados os artigos citados nas referências dos trabalhos selecionados na pesquisa inicial e dos livros textos. SÍNTESE DOS DADOS: A trombose de veia porta é uma das causas mais comuns de hipertensão porta na infância. A apresentação clínica inicial pode ser através de episódios de hemorragia digestiva ou da presença de esplenomegalia em exame clínico de rotina. As principais complicações são a hemorragia digestiva, hiperesplenismo secundário à esplenomegalia, retardo de crescimento e biliopatia portal. O diagnóstico é realizado através da ultra-sonografia abdominal com Doppler. O tratamento é direcionado para as complicações, incluindo profilaxia primária e secundária de hemorragia digestiva, conseqüente à ruptura de varizes esofágicas, e derivações porto-sistêmicas, em casos selecionados. CONCLUSÕES:A trombose de veia porta é uma das causas mais importantes de hemorragia digestiva em crianças. Esses episódios acarretam impacto importante na qualidade de vida dos pacientes acometidos. Dessa forma, uma abordagem diagnóstica e terapêutica adequada é desejável na tentativa de se reduzir a morbimortalidade.OBJECTIVE: To review the literature on portal vein thrombosis in children and adolescents, focusing on its diagnosis, complications and treatment. SOURCE OF DATA: The medical

Preclinical characterization and safety of a novel hydrogel for augmenting dural repair

International Nuclear Information System (INIS)

Strong, Michael J; Carnahan, Michael A; D’Alessio, Keith; Butlin, Jared D G; Butt, Mark T; Asher, Anthony L

2015-01-01

Cerebrospinal fluid (CSF) leakage is a potentially serious complication in surgical procedures involving opening of the dura mater. Although several materials have been developed to help achieve watertight dural closures, CSF leakages persist. The goal of this study was to evaluate the performance of a novel hydrogel designed to provide augmentation to standard methods of dural repair. Performance measures such as polymerization time, dimensional swelling, burst strength, and elasticity were examined in laboratory situations. Additionally, biocompatibility in an in vivo rat model was examined. The results demonstrate that this novel hydrogel has superior mechanical strength and tissue adherence with enhanced flexibility, reduced swelling, and quicker set time compared with existing hydrogel dural sealants approved for intra-cranial use. Furthermore, biocompatibility studies demonstrate that this compound is both non-toxic and non-immunogenic. (paper)

Spontaneous acute subdural hematoma: A rare presentation of a dural intracranial fistula.

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de Aguiar, Guilherme Brasileiro; Veiga, José Carlos Esteves; Silva, João Miguel de Almeida; Conti, Mario Luiz Marques

2016-03-01

Dural arteriovenous fistulas are acquired lesions between the meningeal arteries and their associated draining veins. They may have highly variable clinical presentations and evolution, from severe neurological deficit to no or trivial symptoms. Intracranial hemorrhage occurs in less than 24% of all dural fistulas, and the bleeding is usually subarachnoid, more infrequently intracerebral, and rarely in the subdural space. Here, we present a rare case of a patient who presented with a subdural spontaneous hemorrhage. After investigation by cerebral angiography, the diagnosis of a dural arteriovenous fistula was made. The patient underwent uneventful endovascular treatment. As there are with only a few reports in the literature of such a presentation, we present this patient and perform a brief review of the literature. Copyright © 2015 Elsevier Ltd. All rights reserved.

Dural sinus thrombosis - A rare manifestation of internal jugular venous occlusion

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Pooja Binnani

2012-01-01

Full Text Available The dural sinus thrombosis is an uncommon complication of a commonly done procedure of central venous catheterisation. We present a case of massive hemorrhagic venous infarct with gross cerebral edema due to dural sinus thrombosis along with right internal jugular vein thrombus. A 21-year-old male patient presented to the emergency department with fever and swelling of the right neck four days following discharge after his prior hospitalization two weeks ago for acute renal failure due to severe gastroenteritis, when he underwent hemodialysis through right internal jugular access. On presentation, he was conscious, with swelling on right side of the neck, which was diagnosed as right internal jugular vein occlusion. However, he rapidly dete-riorated and developed signs of raised intracranial pressure despite being on treatment with heparin. He was diagnosed as having massive hemorrhagic cerebral venous infarct with gross cerebral edema complicated with shift of the ventricles to the left due to dural sinus thrombosis. Despite emergency decompressive craniotomy, he succumbed in the next two days due to coning. Asymptomatic catheter-related thrombosis is frequent in the intensive care units, but major complications like retrograde extension into dural sinus causing thrombosis is rare. A high index of suspicion is required to diagnose this major catastrophe for an early and meaningful intervention.

Cefalea secundaria a punción dural Headache as a result of dural puncture

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Ariadna García Rodríguez

2005-03-01

Full Text Available Se realizó una revisión bibliográfica sobre cefalea pospunción en el Hospital "Abel Santamaría", de Pinar del Río, en el período comprendido de febrero a junio del 2004, con el objetivo de ampliar los conocimientos de los profesionales de la salud encargados de diagnosticar y tratar esta complicación. La cefalea secundaria a punción dural se debe al escape persistente de LCR (líquido cefalorraquídeo a través del desgarro hecho en la duramadre, causado por la penetración de la aguja; se presenta cuando el paciente adopta la posición erecta y se alivia con el decúbito, característica esta que de no aparecer debe hacer dudar el diagnóstico. La elección de un trocar fino para realizar la punción y la dirección del bisel paralelo a las fibras de la duramadre son los factores determinantes en la profilaxis de la cefalea. Aún existen controversias en cuanto a su tratamiento, pero si hay un consenso unido en que el parche de sangre epidural es el tratamiento definitivo de esta complicación.A review of the most updated literature on dural post-puncture headache was made at Abel Santamaría University Hospital in February - June 2004 aimed at spreading the awareness to health professionals at diagnosing and treating this condition. The headache secondary to dural puncture is caused by the persistent leakage of cerebrospinal fluid through the dura tear because of the needle insertion; it presents when the patient adopts the erect position and it alleviates with the supine position; if this characteristic is not present it may appear some doubts on diagnosis. The selection of a fine trocar for puncture and guiding the bevel parallel to the fibers of dura are the main factors for profilaxis of headache. Its treatment is controversial, but it does exist a consensus in that the epidural blood patch is the definitive treatment for this condition.

Anterior dural ectasia mimicking a lytic lesion in the posterior vertebral body in ankylosing spondylitis.

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Bele, Keerthiraj; Pendharkar, Hima Shriniwas; Venkat, Easwer; Gupta, Arun Kumar

2011-12-01

Anterior dural ectasia is an extremely rare finding in ankylosing spondylitis (AS). The authors describe a unique case of AS in which the patient presented with cauda equina syndrome as well as an unusual imaging finding of erosion of the posterior aspect of the L-1 (predominantly) and L-2 vertebral bodies due to anterior dural ectasia. Symptomatic patients with long-standing AS should be monitored for the presence of dural ectasia, which can be anterior in location, as is demonstrated in the present case.

Insuficiencia venosa crónica en trabajadores sin factores de riesgo que permanecen horas prolongadas en bipedestación

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Paula Astudillo

Full Text Available La insuficiencia venosa crónica (IVC es una patología prevalente en la sociedad actual. Los problemas derivados de ella, son una causa importante de gasto económico y absentismo laboral. Las condiciones laborales actuales, como jornadas de larga duración, con largas horas en bipedestación, inadecuada carga de pesos y malas condiciones de humedad y temperatura, contribuyen al desarrollo de esta patología. En este trabajo se ha realizado una revisión sistemática de la bibliografía existente en relación a la insuficiencia venosa crónica y el tiempo en bipedestación de las jornadas laborales. Para determinar el nivel de evidencia de los estudios evaluados, se han seguido los criterios del Scottish Intercollegiate Guidelines Network (SIGN. En particular, se ha concluido que existe una asociación significativamente positiva entre el tiempo prolongado en bipedestación y el riesgo de padecer insuficiencia venosa crónica. Sin embargo, la literatura actual no permite establecer un umbral que determine el número de horas considerado como bipedestación prolongada. Para poder valorar si la insuficiencia venosa crónica debería considerarse una enfermedad profesional, es necesario diseñar y llevar a cabo nuevos estudios de investigación en esta dirección. Estos estudios son necesarios para poder establecer evidencias de cara a concienciar a la sociedad y generar campañas de prevención y promoción de la salud que disminuyan los costes económicos y mejoren la calidad de vida de la población.

Refractory seizures due to a dural-based cavernoma masquerading as a meningioma.

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Zeng, Xianwei; Mahta, Ali; Kim, Ryan Y; Saad, Ali G; Kesari, Santosh

2012-04-01

A 37-year-old female presented with medically intractable complex partial seizures with secondary generalization. She was found to have a dural-based lesion with radiologic features of meningioma. A gross total resection was performed and pathology confirmed a diagnosis of cavernous angioma and she became seizure free after the surgical resection. Cavernous angioma should be considered in differential diagnosis of a dural-based lesion manifesting with refractory seizures.

Evaluation of the effect of hemoglobin or hematocrit level on dural sinus density using unenhanced computed tomography.

Science.gov (United States)

Lee, Seung Young; Cha, Sang-Hoon; Lee, Sung-Hyun; Shin, Dong-Ick

2013-01-01

To identify the relationship between hemoglobin (Hgb) or hematocrit (Hct) level and dural sinus density using unenhanced computed tomography (UECT). Patients who were performed UECT and had records of a complete blood count within 24 hours from UECT were included (n=122). We measured the Hounsfield unit (HU) of the dural sinus at the right sigmoid sinus, left sigmoid sinus and 2 points of the superior sagittal sinus. Quantitative measurement of dural sinus density using the circle regions of interest (ROI) method was calculated as average ROI values at 3 or 4 points. Simple regression analysis was used to evaluate the correlation between mean HU and Hgb or mean HU and Hct. The mean densities of the dural sinuses ranged from 24.67 to 53.67 HU (mean, 43.28 HU). There was a strong correlation between mean density and Hgb level (r=0.832) and between mean density and Hct level (r=0.840). Dural sinus density on UECT is closely related to Hgb and Hct levels. Therefore, the Hgb or Hct levels can be used to determine whether the dural sinus density is within the normal range or pathological conditions such as venous thrombosis.

A Rare Case of Composite Dural Extranodal Marginal Zone Lymphoma and Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma

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Mark Bustoros

2018-04-01

Full Text Available BackgroundPrimary extranodal marginal zone lymphoma (MZL of the dura is a rare neoplastic entity in the central nervous system (CNS.MethodsWe used literature searches to identify previously reported cases of primary dural MZL. We also reviewed clinical, pathologic, and radiographic data of an adult patient with concurrent dural MZL and chronic lymphocytic leukemia (CLL/small lymphocytic lymphoma (SLL.ResultsWe identified 104 cases of dural MZL in the literature. None of them presented concurrently with another type of non-Hodgkin lymphoma. This is the first report of composite lymphoma consisting of dural MZL and CLL/SLL in the bone marrow and lymph nodes.ConclusionPrimary dural MZL is a rare, indolent low-grade CNS lymphoma, with a relatively good prognosis. Its treatment is multidisciplinary and often requires surgical intervention due to brain compression, along with low to moderate doses of radiotherapy and/or systemic chemotherapy.

Spontaneous Resolution of a Fetal Dural Sinus Thrombosis: One Case Report and Review of the Literatures

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Chen Wang

2012-01-01

Full Text Available Fetal dural sinus thrombosis is a rare finding. Most cases have been terminated without long-term follow-ups. Recently some reports have indicated the potentially favorable evolution of fetal dural sinus thrombosis. Most of the fetuses showing symptoms have been delivered with normal neurologic outcome. We report a case of fetal dural sinus thrombosis. Serial ultrasound and magnetic resonance images (MRI showed the shrinkage of the thrombosis which indicated good prognosis. No physical or neurological abnormality was observed at 8-months follow-up. Conservative treatment is appropriate to prenatally diagnosed dural sinus thrombosis with favorable prognostic factors. Serial MRI or ultrasound should be taken every 1-2 months to monitor the thrombosis development and fetal well-beings.

A dural lymphatic vascular system that drains brain interstitial fluid and macromolecules.

Science.gov (United States)

Aspelund, Aleksanteri; Antila, Salli; Proulx, Steven T; Karlsen, Tine Veronica; Karaman, Sinem; Detmar, Michael; Wiig, Helge; Alitalo, Kari

2015-06-29

The central nervous system (CNS) is considered an organ devoid of lymphatic vasculature. Yet, part of the cerebrospinal fluid (CSF) drains into the cervical lymph nodes (LNs). The mechanism of CSF entry into the LNs has been unclear. Here we report the surprising finding of a lymphatic vessel network in the dura mater of the mouse brain. We show that dural lymphatic vessels absorb CSF from the adjacent subarachnoid space and brain interstitial fluid (ISF) via the glymphatic system. Dural lymphatic vessels transport fluid into deep cervical LNs (dcLNs) via foramina at the base of the skull. In a transgenic mouse model expressing a VEGF-C/D trap and displaying complete aplasia of the dural lymphatic vessels, macromolecule clearance from the brain was attenuated and transport from the subarachnoid space into dcLNs was abrogated. Surprisingly, brain ISF pressure and water content were unaffected. Overall, these findings indicate that the mechanism of CSF flow into the dcLNs is directly via an adjacent dural lymphatic network, which may be important for the clearance of macromolecules from the brain. Importantly, these results call for a reexamination of the role of the lymphatic system in CNS physiology and disease. © 2015 Aspelund et al.

Normal measurement of spinal cord and dural sac by CT myelography

International Nuclear Information System (INIS)

Yun, Ku Sub; Choi, Yo Won; Han, Moon Hee; Chang, Kee Hyun

1988-01-01

The data on the normal measurement of spinal cord are essential for an objective assessment of equivocal change of spinal cord size in the various clinical settings. The present study was therefore undertaken to evaluate normal range of spinal cord dimensions in Koreas. CT myelography of the cervical and thoracic region was performed in 60 patients who had symptoms referable to lumbosacral region and then computed tomographic measurement of spinal cord and dural sac was performed. The results are as follows: 1. The anteroposterior diameter of spinal cord was maximum at C1 level (8.6±1.4mm) and minimum at T6 level (6.4±1.7mm). 2. The transverse diameter of spinal cord was maximum at C4 and C5 levels (13.3±1.6mm) and minimum at T8 (8.1±1.9mm) and T10 (8.1±1.3mm) levels. 3. The area of spinal cord was maximum at C5 level (76±16mm 2 ) and minimum at T6 (40±24mm 2 ) and T8 (40±23mm 2 ) levels. 4. The ratio of anteroposterior diameter/transverse diameter of spinal cord was smallest at C4 (0.57±0.11) and C5 (0.57±0.09) levels and largest at T12 (0.9±0.17) level. 5. The ratio of anteroposterior diameter of spinal cord/dural sac was maximum at C4 level (0.73±0.14) and minimum at T12 level (0.52±0.15). The ratio of transverse diameter of spinal cord/dural sac was maximum at C3 (0.66±0.10) and C4 (0.66±0.14) levels and minimum at T12 level (0.46±0.18). The ratio of area of spinal cord/dural sac was maximum at C3 level (0.48±0.13) and minimum at T12 level (0.29±0.20). 6. The location of cervical cord in dural sac was mainly ventral (56%) at C1 level, middle (40-73%) from C2 to C6 level and dorsal (44%) at C7 level. The location of thoracic cord in dural sac was chiefly middle (61%) at T2 level and lower thoracic level (T10: 60% and T12: 51%) and mainly ventral (59-84%) at other levels.

Imaging diagnosis of dural and direct cavernous carotid fistulae

Energy Technology Data Exchange (ETDEWEB)

Santos, Daniela dos; Monsignore, Lucas Moretti; Nakiri, Guilherme Seizem; Cruz, Antonio Augusto Velasco e; Colli, Benedicto Oscar; Abud, Daniel Giansante, E-mail: danisantos2404@gmail.com [Universidade de Sao Paulo (HCFMRP/USP), Ribeirao Preto, SP (Brazil). Faculdade de Medicina. Hospital das Clinicas

2014-07-15

Arteriovenous fistulae of the cavernous sinus are rare and difficult to diagnose. They are classified into dural cavernous sinus fistulae or direct carotid-cavernous fistulae. Despite the similarity of symptoms between both types, a precise diagnosis is essential since the treatment is specific for each type of fistula. Imaging findings are remarkably similar in both dural cavernous sinus fistulae and carotid-cavernous fistulae, but it is possible to differentiate one type from the other. Amongst the available imaging methods (Doppler ultrasonography, computed tomography, magnetic resonance imaging and digital subtraction angiography), angiography is considered the gold standard for the diagnosis and classification of cavernous sinus arteriovenous fistulae. The present essay is aimed at didactically presenting the classification and imaging findings of cavernous sinus arteriovenous fistulae. (author)

Comparison of Porcine and Bovine Collagen Dural Substitutes in Posterior Fossa Decompression for Chiari I Malformation in Adults.

Science.gov (United States)

Lee, Christine K; Mokhtari, Tara; Connolly, Ian D; Li, Gordon; Shuer, Lawrence M; Chang, Steven D; Steinberg, Gary K; Hayden Gephart, Melanie

2017-12-01

Posterior fossa decompression surgeries for Chiari malformations are susceptible to postoperative complications such as pseudomeningocele, external cerebrospinal fluid (CSF) leak, and meningitis. Various dural substitutes have been used to improve surgical outcomes. This study examined whether the collagen matrix dural substitute type correlated with the incidence of postoperative complications after posterior fossa decompression in adult patients with Chiari I malformations. A retrospective cohort study was conducted of 81 adult patients who underwent an elective decompressive surgery for treatment of symptomatic Chiari I malformations, with duraplasty involving a dural substitute derived from either bovine or porcine collagen matrix. Demographics and treatment characteristics were correlated with surgical outcomes. A total of 81 patients were included in the study. Compared with bovine dural substitute, porcine dural substitute was associated with a significantly higher risk of pseudomeningocele occurrence (odds ratio, 5.78; 95% confidence interval, 1.65-27.15; P = 0.01) and a higher overall complication rate (odds ratio, 3.70; 95% confidence interval, 1.23-12.71; P = 0.03) by univariate analysis. There was no significant difference in the rate of meningitis, repeat operations, or overall complication rate between the 2 dural substitutes. In addition, estimated blood loss was a significant risk factor for meningitis (P = 0.03). Multivariate analyses again showed that porcine dural substitute was associated with pseudomeningocele occurrence, although the association with higher overall complication rate did not reach significance. Dural substitutes generated from porcine collagen, compared with those from bovine collagen, were associated with a higher likelihood of pseudomeningocele development in adult patients undergoing Chiari I malformation decompression and duraplasty. Copyright © 2017 Elsevier Inc. All rights reserved.

Prognosis of cerebral vein and dural sinus thrombosis - Results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT)

NARCIS (Netherlands)

Ferro, José M.; Canhão, Patrícia; Stam, Jan; Bousser, Marie-Germaine; Barinagarrementeria, Fernando

2004-01-01

Background and Purpose - The natural history and long-term prognosis of cerebral vein and dural sinus thrombosis (CVT) have not been examined previously by adequately powered prospective studies. Methods - We performed a multinational ( 21 countries), multicenter ( 89 centers), prospective

Trombosis venosa profunda masiva de miembro superior secundaria a fractura de tercio medio de clavícula. Caso clínico

OpenAIRE

Úbeda-Pérez de Heredia, Í.; Sobrá-Hidalgo, G.Á.

2016-01-01

Resumen Objetivo: La trombosis venosa profunda del miembro superior es una entidad rara que se asocia con el uso de catéteres, estados de hipercoagulabilidad, anticonceptivos orales, neoplasias, síndrome de costilla cervical o de los escalenos, fracturas de clavícula y trombosis inducida por el esfuerzo. Método: Varón de 53 años que desarrolló una trombosis venosa de las venas axilar, cefálica y basílica tres días después de sufrir una fractura de tercio medio de clavícula que se inmovilizó...

Trombosis venosa profunda masiva de miembro superior secundaria a fractura de tercio medio de clavícula. Caso clínico

OpenAIRE

Í. Úbeda-Pérez de Heredia; G.Á. Sobrá-Hidalgo

2016-01-01

Objetivo: La trombosis venosa profunda del miembro superior es una entidad rara que se asocia con el uso de catéteres, estados de hipercoagulabilidad, anticonceptivos orales, neoplasias, síndrome de costilla cervical o de los escalenos, fracturas de clavícula y trombosis inducida por el esfuerzo. Método: Varón de 53 años que desarrolló una trombosis venosa de las venas axilar, cefálica y basílica tres días después de sufrir una fractura de tercio medio de clavícula que se inmovilizó inicia...

Intracranial Dural Metastasis of Ewing's Sarcoma: a Case Report

Energy Technology Data Exchange (ETDEWEB)

Kim, Eung Yeop; Lee, Seung Koo; Kim, Dong Joon; Kim, Jin Na; Lee, Kyu Sung; Jung, Woo Hee; Kim, Dong Ik [Yonsei University College of Medicine, Seoul (Korea, Republic of)

2008-02-15

Ewing's sarcoma is a malignant bone tumor that can occur anywhere in the body, but it is most commonly observed in the long bones of the arms and legs, the pelvis and in the chest. The predominant sites of metastasis include the lung (38%), bone (including the spine; 31%), and the bone marrow (11%). Metastasis of Ewing's sarcoma to the central nervous system (CNS) is relatively rare, and most of the previous reports have demonstrated involvement of the bony calvarium or brain parenchyma. We describe here the imaging findings of dural metastasis of Ewing's sarcoma, and these imaging findings have not been previously reported on in the medical literature. In conclusion, dural metastasis of Ewing's sarcoma is very rare and its imaging characteristics are similar to those of a primary tumor, which mimic the findings of a schwannoma or meningioma. Despite its rarity, secondary Ewing's sarcoma may be included in the differential diagnosis of extra-axial dural masses.

Dural diverticulum with a symptomatic cerebrospinal fluid leak

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Nicholas Armstrong, MD

2016-03-01

Full Text Available A case report of a 63-year-old female patient with a cervical spinal dural diverticulum and intracranial hypotension secondary to a symptomatic CSF leak after minor trauma. The patient responded well after the cervical approach epidural blood patch procedure.

Role of penumbra mechanical thrombectomy device in acute dural sinus thrombosis

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Suraj Mammen

2017-01-01

Full Text Available Background: In dural venous sinus thrombosis (DVST, the mortality ranges 5–30%. Deep venous system involvement and septic dural sinus thrombosis have a higher mortality rate. In acute occlusion, collateral flow may not be established, which may result in significant edema and mass effect. Endovascular interventions may be considered as a treatment option in appropriate high-risk patients with DVST. Materials and Methods: Eight patients with magnetic resonance imaging (MRI-confirmed dural sinus thrombosis, who did not respond to the conventional standard medical treatment, were subsequently treated with mechanical thrombectomy using the Penumbra System®. In all cases, medical treatment including anticoagulants were continued following the procedure for a minimum period of 1 year. Results: Recanalization of the dural sinus thrombosis was achieved in all 8 cases. There were no immediate or late endovascular-related complications. One death occurred due to an unrelated medical event. At 6 months, there was notable improvement in the modified Rankin Score (mRS, with 5/8 (62% patients achieving mRS of 2 or less. The follow-up ranged between 3 months and 26 months (mean: 14.5 months, and there were no new neurological events during the follow-up period. Conclusion: Cerebral venous sinus thrombosis is a rare but life-threatening condition that demands timely diagnosis and therapy. In cases of rapidly declining neurological status despite standard therapy with systemic anticoagulation and anti-edema measures, mechanical thrombectomy could be a lifesaving and effective option. In this study, good outcomes were observed in the majority of patients at long-term follow up.

In utero magnetic resonance imaging for diagnosis of dural venous sinus ectasia with thrombosis in the fetus

Energy Technology Data Exchange (ETDEWEB)

Fanou, Evgenia Maria [University Hospital of North Staffordshire, Stoke-on-Trent (United Kingdom); Reeves, Mike J.; Griffiths, Paul D. [Royal Hallamshire Hospital, University of Sheffield, Academic Unit of Radiology, Sheffield (United Kingdom); Howe, David T. [Princess Anne Hospital, Wessex Fetal Medicine Unit, Southampton (United Kingdom); Joy, Harriet [University Hospital of Southampton, Department of Radiology, Southampton (United Kingdom); Morris, Susan [University Hospital of Wales, Radiology Department, Cardiff, Wales (United Kingdom); Russell, Sarah [St. Mary' s Hospital, Radiology Department, Manchester (United Kingdom)

2013-12-15

Dural venous sinus ectasia with thrombosis (DVSET) in the fetus is a rare condition that can be diagnosed prenatally with the use of fetal MR imaging, yet with limited indication of long-term clinical significance. To describe and evaluate the diagnostic value of fetal MR imaging in the prenatal diagnosis of dural venous sinus ectasia with thrombosis and its clinical significance. We report a series of nine fetuses with dural venous sinus ectasia with thrombosis. The mothers, located in four feto-maternal centres, were referred for fetal MR imaging due to space occupying lesions identified on second-trimester antenatal ultrasound. In all but one case the dural venous sinus ectasia with thrombosis was in the vicinity of the venous confluence (VC) with various extension in the posterior dural sinuses. Antenatal follow-up imaging was performed in seven cases and showed progression in one, stable appearances in one and regression in five cases. Three pregnancies were terminated. In the remaining six cases there was no reported neurological deficit at up to 44 months of clinical follow-up. This is among the largest series of postnatal clinical follow-up in cases of prenatal diagnosis of dural venous sinus ectasia with thrombosis in the literature. Clinical follow-up suggests a good prognosis when antenatal follow-up shows partial or complete thrombus resolution. (orig.)

Performance of a new quantitative method for assessing dural ectasia in patients with FBN1 mutations and clinical features of Marfan syndrome

International Nuclear Information System (INIS)

Soeylen, Bahar; Schmidtke, Joerg; Arslan-Kirchner, Mine; Hinz, Kerstin; Prokein, Jana; Becker, Hartmut

2009-01-01

This study presents a comparison of established methods for measuring dural ectasia with a new quantitative method of assessing this clinical feature. Seventeen patients with an identified mutation in FBN1 were examined for dural ectasia. The results were compared with 17 age- and sex-matched controls. Our images were also evaluated using the two methods of quantifying dural ectasia, namely those of Ahn et al. and of Oosterhof et al. With our method, 80% MFS1 patients and 7% controls fulfilled the criterion for dural ectasia. Using the method of Oosterhof et al., dural ectasia was found in 88% patients with MFS1 and in 47% controls. Using the method of Ahn et al. 76% patients with Marfan syndrome and 29% controls showed dural ectasia. We present a novel quantitative method of evaluating MRT images for dural ectasia, which, in our own patient cohort, performed better than those previously described. (orig.)

Performance of a new quantitative method for assessing dural ectasia in patients with FBN1 mutations and clinical features of Marfan syndrome

Energy Technology Data Exchange (ETDEWEB)

Soeylen, Bahar; Schmidtke, Joerg; Arslan-Kirchner, Mine [Hannover Medical School, Institute of Human Genetics, Hannover (Germany); Hinz, Kerstin [Hannover Medical School, Institute of Diagnostic and Interventional Neuroradiology, Hannover (Germany); Vivantes Klinikum Neukoelln, Institut fuer Radiologie und Interventionelle Therapie, Berlin (Germany); Prokein, Jana [Hannover Medical School, Institute for Biometrics, Hannover (Germany); Becker, Hartmut [Hannover Medical School, Institute of Diagnostic and Interventional Neuroradiology, Hannover (Germany)

2009-06-15

This study presents a comparison of established methods for measuring dural ectasia with a new quantitative method of assessing this clinical feature. Seventeen patients with an identified mutation in FBN1 were examined for dural ectasia. The results were compared with 17 age- and sex-matched controls. Our images were also evaluated using the two methods of quantifying dural ectasia, namely those of Ahn et al. and of Oosterhof et al. With our method, 80% MFS1 patients and 7% controls fulfilled the criterion for dural ectasia. Using the method of Oosterhof et al., dural ectasia was found in 88% patients with MFS1 and in 47% controls. Using the method of Ahn et al. 76% patients with Marfan syndrome and 29% controls showed dural ectasia. We present a novel quantitative method of evaluating MRT images for dural ectasia, which, in our own patient cohort, performed better than those previously described. (orig.)

Dural metastasis of Ewing's sarcoma.

Science.gov (United States)

Ben Nsir, Atef; Boughamoura, Mohamed; Maatouk, Mezri; Kilani, Mohamed; Hattab, Nejib

2013-01-01

Metastatic Ewing's sarcoma to the central nervous system is an uncommon condition and debate concerning the true origin of its metastases is still up to date. To the best of our knowledge, only two cases of dural metastatic Ewing's sarcoma have been published in the English medical literature. We present an additional case in a 24-year-old female and discuss the pathogenesis of these unusual tumors with review of the relevant literature concerning their treatment and outcome. A 24-year-old female with previous history of pelvis Ewing's sarcoma and recently discovered lung metastases, presented with moderate headache for the past 2 weeks and weakness in her left leg for the past 2 days. Computed tomography scan and magnetic resonance imaging revealed an extra-axial right frontoparietal mass invading the superior sagittal sinus but with clear delineation with brain parenchyma. Imaging features were suggestive of a meningioma as no abnormalities in the skull abutting to the tumor were noted. The patient underwent surgical removal of her tumor. Near total resection was achieved and histological examination showed evidence of metastatic Ewing's sarcoma. Postoperative adjuvant radiation and chemotherapy were administered. The patient improved well postoperatively with full recovery of her motor weakness. She is symptom free with no signs of progression, at most recent follow-up, 8 months after surgery. Despite its rarity, metastatic Ewing's sarcoma must be considered in the differential diagnosis of extra-axial dural masses particularly meningiomas.

Spinal movement and dural sac compression during airway management in a cadaveric model with atlanto-occipital instability.

Science.gov (United States)

Liao, Shiyao; Schneider, Niko R E; Weilbacher, Frank; Stehr, Anne; Matschke, Stefan; Grützner, Paul A; Popp, Erik; Kreinest, Michael

2017-12-01

To analyze the compression of the dural sac and the cervical spinal movement during performing different airway interventions in case of atlanto-occipital dislocation. In six fresh cadavers, atlanto-occipital dislocation was performed by distracting the opened atlanto-occipital joint capsule and sectioning the tectorial membrane. Airway management was done using three airway devices (direct laryngoscopy, video laryngoscopy, and insertion of a laryngeal tube). The change of dural sac's width and intervertebral angulation in stable and unstable atlanto-occipital conditions were recorded by video fluoroscopy with myelography. Three-dimensional overall movement of cervical spine was measured in a wireless human motion track system. Compared with a mean dural sac compression of - 0.5 mm (- 0.7 to - 0.3 mm) in stable condition, direct laryngoscopy caused an increased dural sac compression of - 1.6 mm (- 1.9 to - 0.6 mm, p = 0.028) in the unstable atlanto-occipital condition. No increased compression on dural sac was found using video laryngoscopy or the laryngeal tube. Moreover, direct laryngoscopy caused greater overall extension and rotation of cervical spine than laryngeal tube insertion in both stable and unstable conditions. Among three procedures, the insertion of a laryngeal tube took the shortest time. In case of atlanto-occipital dislocation, intubation using direct laryngoscopy exacerbates dural sac compression and may cause damage to the spinal cord.

A method of posterior fossa dural incision to minimize hemorrhage from the occipital sinus: the "mosquito" method.

Science.gov (United States)

Lee, Hee Chang; Lee, Ji Yeoun; Ryu, Seul Ki; Lim, Jang Mi; Chong, Sangjoon; Phi, Ji Hoon; Kim, Seung-Ki; Wang, Kyu-Chang

2016-12-01

The posterior fossa dural opening requires the ligation of the occipital sinus to gain successful exposure. However, there could be a prominent occipital sinus which is functioning as the main drainage route and is harboring the risk of unpredictable massive hemorrhage during the dural opening. We introduce a safe method of posterior fossa dural incision to minimize hemorrhage from the occipital sinus using four curved hemostat clamps. For the dural incision at the midline part of the posterior cranial fossa, we used four curved hemostat clamps to occlude the prominent occipital sinus: one pair of clamps at the proximal part and the other pair at the distal part to occlude the occipital sinus. Dural incision was made between the two pairs of the curved hemostat clamps. By clamping of the sinus, it allows observation of possible brain swelling after occlusion of the occipital sinus as well as minimizes hemorrhage during incision of the midline dura of the posterior fossa. This method allows observation of brain swelling after occipital sinus occlusion and is an easy and safe incision of the midline dura minimizing hemorrhage in selected cases with a prominent occipital sinus.

Malformação venosa associada a hiperelasticidade cutânea e atrofia do tecido subcutâneo

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Ana Julia de Deus Silva

2016-01-01

Full Text Available Resumo A rigidez da parede venosa pode aumentar em síndromes em que há uma redução da quantidade de elastina, ocasionando malformações venosas mesmo em indivíduos que possuem mosaicismo para tais síndromes. Casos com apresentação de afecções colagenosas em áreas delimitadas não foram descritos na literatura. O paciente apresentava lesão bem delimitada em região anteromedial da coxa com aumento de elasticidade e presença de vasos tortuosos apenas no local da lesão, não apresentando nenhuma síndrome colagenosa. Foi realizada uma biópsia que evidenciou alterações em relação ao padrão das fibras elásticas e proliferação de vasos sanguíneos. A malformação venosa foi tratada satisfatoriamente com embolização. As doenças do colágeno causam hiperextensibilidade cutânea, o que provoca flacidez e propicia traumas. As colagenoses bem delimitadas são raras, pois geralmente esse grupo de doenças envolve acometimento sistêmico. As malformações vasculares podem ocorrer em diversas doenças do colágeno, mas de forma generalizada e não localizada, e uma explicação para isso seria o mosaicismo genético.

Comparison of dural puncture epidural technique versus conventional epidural technique for labor analgesia in primigravida

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Pritam Yadav

2018-01-01

Full Text Available >Background: Dural puncture epidural (DPE is a method in which a dural hole is created prior to epidural injection. This study was planned to evaluate whether dural puncture improves onset and duration of labor analgesia when compared to conventional epidural technique.Methods and Materials: Sixty term primigravida parturients of ASA grade I and II were randomly assigned to two groups of 30 each (Group E for conventional epidural and Group DE for dural puncture epidural. In group E, epidural space was identified and 18-gauge multi-orifice catheter was threaded 5 cm into the epidural space. In group DE, dura was punctured using the combines spinal epidural (CSE spinal needle and epidural catheter threaded as in group E followed by 10 ml of injection of Ropivacaine (0.2% with 20 mcg of Fentanyl (2 mcg/ml in fractions of 2.5 ml. Later, Ropivacaine 10 ml was given as a top-up on patient request. Onset, visual analouge scale (VAS, sensory and motor block, haemodynamic variables, duration of analgesia of initial dose were noted along with mode of delivery and the neonatal outcome.Results: Six parturients in group DE achieved adequate analgesia in 5 minutes while none of those in group E (P 0.05.Conclusions: Both techniques of labor analgesia are efficacious; dural puncture epidural has the potential to fasten onset and improve quality of labor analgesia when compared with conventional epidural technique.

Imaging findings in patients with ventral dural defects and herniation of neural tissue

International Nuclear Information System (INIS)

Baur, A.; Staebler, A.; Reiser, M.; Psenner, K.; Hamburger, C.

1997-01-01

The aim of this paper is to describe clinical and imaging findings in three patients with ventral dural defects and herniation of the spinal cord or cauda equina. The literature is reviewed and the clinical, radiological and operative findings are compared. Three patients with ventral dural defects of different etiologies are presented. One patient gave a longstanding history of ankylosing spondylitis, the second patient presents 37 years after spinal trauma, and the third patient presents with spontaneous spinal cord herniation. All patients had typically slowly progressive neurological symptoms with multiple hospitalizations until diagnosis was made. Characteristic findings in postmyelographic CT included a ventral or ventrolateral displacement with deformation of the spinal cord or the cauda equina. Sagittal MRI showed this abrupt and localized anterior deviation of the spinal cord or the cauda equina to the posterior portions of a vertebral body with or without a bony vertebral defect optimally. Additionally, due to the ventral displacement of the spinal cord, the dorsal subarachnoid space was relatively enlarged without evidence of an arachnoid cyst, in all patients. Magnetic resonance imaging and postmyelographic CT can diagnose ventral dural defects with spinal cord herniation or nerve root entrapment. Dural defects must be considered in the presence of neurological symptoms in cases of longstanding ankylosing spondylitis, late sequelae of fractures of vertebral bodies, and without history of spinal trauma or surgery. (orig.). With 3 figs

MR inflow angiography for the evaluation of dural sinus patency

International Nuclear Information System (INIS)

Poncelet, B.; Baleriaux, D.; Grand, C.; Van Dijk, P.; De Graaf, R.; Segebarth, C.

1990-01-01

This paper assesses dural sinus patency with two-dimensional inflow MR angiography. Twelve patients with potential dural sinus (superior sagittal and transverse sinus) involvement related to tumors of the falx or the convexity (meningiomas, metastasis) were examined with digital subtraction angiography (DSA), Mr imaging (1.5-T Gyroscan system), including T1-weighted (pre- and post-agadolinium) and T2-weighted spin-echo imaging, and MR angiography. For the MR angiographic study, a gradient-echo fast field echo sequence with flow compensation was used. Thin (2-mm), contiguous coronal or transverse sections were acquired sequentially. Three-dimensional reconstruction with MIP processing was then performed. CT, DSA, and MR imaging were performed for presurgical evaluation. Surgical confirmation of sinus patency was obtained for all patients

Neural-Dural Transition at the Thoracic and Lumbar Spinal Nerve Roots: A Histological Study of Human Late-Stage Fetuses

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Kwang Ho Cho

2016-01-01

Full Text Available Epidural blocks have been used extensively in infants. However, little histological information is available on the immature neural-dural transition. The neural-dural transition was histologically investigated in 12 late-stage (28–30 weeks fetuses. The dural sheath of the spinal cord was observed to always continue along the nerve roots with varying thicknesses between specimens and segments, while the dorsal root ganglion sheath was usually very thin or unclear. Immature neural-dural transitions were associated with effective anesthesia. The posterior radicular artery was near the dorsal root ganglion and/or embedded in the nerve root, whereas the anterior radicular artery was separated from the nearest nerve root. The anterior radicular artery was not associated with the dural sheath but with thin mesenchymal tissue. The numbers of radicular arteries tended to become smaller in larger specimens. Likewise, larger specimens of the upper thoracic and lower lumbar segments did not show the artery. Therefore, elimination of the radicular arteries to form a single artery of Adamkiewicz was occurring in late-stage fetuses. The epidural space was filled with veins, and the loose tissue space extended ventrolaterally to the subpleural tissue between the ribs. Consequently, epidural blocks in infants require special attention although immature neural-dural transitions seemed to increase the effect.

Transcutaneous Drainage of Gel-Like Substance after Application of Hydrogel Dural Sealant: Report of Two Cases.

Science.gov (United States)

Siman, Homayoun; Techy, Fernando

2016-02-01

Study Design Case report. Objective Incidental durotomy (IDT) is a common complication of spinal surgery. The use of collagen matrix graft along with hydrogel dural sealant is a common method of IDT repair. With this method, there have been several reported cases of detrimental dural sealant expansion in the literature. One case study reported an expansion rate greater than 300%; many report neurologic damage. This article reports the clinical course of two patients who developed postoperative transcutaneous drainage of a gel-like substance after the use of a dural sealant, which is a previously unreported complication. Methods The clinical course and treatment outcome of two patients is presented. Results Both patients experienced postoperative transcutaneous drainage of a gel-like substance at the surgical site. Case one began draining this substance on postoperative day 14. This patient required no further intervention, and the drainage ended after 3 mL of a gel-like substance was expressed from his incision while in the clinic. Case two began draining the gel on postoperative day 16. This patient underwent two washout procedures and resolution of the drainage. No infection was ever detected. Conclusions To our knowledge, our patients are the first reported cases of transcutaneous drainage of expanded dural sealant. It is important to take into consideration the unexpected expansion of a dural sealant when using it for the repair of IDT.

A sazonalidade do tromboembolismo venoso no clima subtropical de São Paulo Seasonal variation of venous thromboembolism in the subtropical climate of São Paulo, Brazil

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Daniela Kleinfelder

2009-03-01

Full Text Available CONTEXTO: Os fatores desencadeantes da doença tromboembólica venosa vêm sendo cada vez melhor identificados. Causas externas podem influir na sua ocorrência, e algum destaque tem sido dado a fatores climáticos. Nada se sabe quanto a essa interferência em nossa latitude. OBJETIVOS: Analisar se há diferença na incidência do tromboembolismo venoso de acordo com as estações do ano, num hospital da cidade de São Paulo, Brasil, cujo clima é categorizado como subtropical. MÉTODOS: Foi realizado trabalho retrospectivo de levantamento de dados a partir de prontuários de pacientes cujo diagnóstico de internação ou óbito foi de trombose venosa profunda ou tromboembolismo pulmonar, no período de janeiro de 1996 a outubro de 2003, no Hospital da Beneficência Portuguesa de São Paulo. Para comparação e estudo, os casos foram agrupados em trimestres (primeiro trimestre = janeiro, fevereiro e março; segundo trimestre = abril, maio e junho; terceiro trimestre = julho, agosto e setembro; e quarto trimestre = outubro, novembro e dezembro e conforme sua ocorrência nos chamados meses quentes e frios, de acordo com a média de temperatura mensal (meses quentes = outubro a abril; meses frios = maio a setembro. RESULTADOS: Foram encontrados 955 casos de tromboembolismo venoso no período analisado. Foi utilizado o teste ANOVA para análise, que não revelou diferença estatisticamente significativa na incidência do tromboembolismo venoso de acordo com os trimestres. Quando analisados separadamente, também não se evidenciou significância estatística em relação ao tromboembolismo pulmonar e à trombose venosa profunda. Quando comparados os meses quentes e frios, observou-se aumento da incidência de trombose venosa profunda nos meses quentes (p BACKGROUND: The triggering factors of venous thromboembolic disease have been increasingly clarified. External causes may influence its occurrence, and some climactic factors have stood out. Nothing

Iatrogene duralæsioner ved dekompressionskirurgi i lumbalcolumna

DEFF Research Database (Denmark)

Thomsen, Frederik; Amtoft, Ole; Andersen, Mikkel

2010-01-01

at the Private Hospital Hamlet. The study covers cases from the 10-month period from September 1, 2007 to June 30, 2008. Data was collected after this period and consists of surgeon-documented dural tears. At the time of surgery, the surgeon was unaware that there would be a subsequent registration. A total...

Trombose de artéria carótida interna relacionada a trauma de palato em criança

OpenAIRE

Almeida,Fernando de Souza; Hossotani,Márcia Harumi; Moura,Juliana Del Grossi

2012-01-01

OBJETIVO: Relatar um caso de trombose de artéria carótida interna secundária relacionada a trauma de palato mole em criança. DESCRIÇÃO DO CASO: Criança admitida com quadro de alteração do nível de consciência, sonolência, afasia e hemiplegia direita; tinha antecedente de trauma corto contuso leve em palato mole há oito horas. A investigação tomográfica evidenciou acidente vascular isquêmico secundário à interrupção do fluxo sanguíneo em território de artéria cerebral média esquerda. A arterio...

Existe associação entre doenças venosas e nível de atividade física em jovens?

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Júlio César Oliveira Pena

Full Text Available INTRODUÇÃO: A associação dos benefícios da prática regular da atividade física a indicadores de saúde encontra-se amplamente discutida na literatura evidenciando a relação de um estilo de vida sedentário com as doenças crônicas degenerativas. OBJETIVO: Descrever a prevalência de doenças venosas entre jovens e sua associação com a atividade física. MATERIAIS E MÉTODOS: Corte transversal. Amostra: jovens voluntários. Os indivíduos responderam a uma ficha clínica e foram examinados por meio do sistema de classificação clínica, etiológica, anatômica e patofisiológica (CEAP, que classifica a gravidade e a incapacidade para o trabalho de pessoas com doenças venosas; eles responderam também ao questionário internacional de atividade física (IPAQ. RESULTADOS: Participaram 95 indivíduos, sendo 57,9% (55 mulheres, tendo como média de idade 26,12 ± 4,5 (18H35. De acordo com o IPAQ, os indivíduos foram classificados em categoria 1 (inativos: 41,1%; categoria 2 (moderadamente ativos: 49,5%; e categoria 3 (ativos: 9,5%. Houve diferença entre os níveis de atividade física entre homens e mulheres (p = 0,02. Na classificação da CEAP foram encontrados: classe 0 = 43,2%; classe 1 = 45,3%; classe 2 = 11,6%, já as demais classes não apareceram na amostra. Mulheres apresentaram maior frequência de doenças vasculares que homens (p < 0,001. O maior nível de atividade física esteve associado com a menor prevalência de doenças venosas periféricas (p = 0,02. CONCLUSÕES: Na amostra foi encontrada prevalência elevada de doenças venosas, maior entre mulheres. Foi elevado o número de indivíduos considerados sedentários pelo IPAQ, sendo os homens mais ativos quando comparados às mulheres. Os indivíduos com maior nível de atividade física apresentaram menor frequência de doenças venosas.

PROTOCOLO DE ASSISTÊNCIA A PESSOAS COM ÚLCERAS VENOSAS: VALIDAÇÃO DE CONTEÚDO

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Daniele Vieira Dantas

2013-01-01

Full Text Available Las úlceras venosas requieren tratamiento complejo y son responsables por morbilidad y mortalidad significativas. El objetivo fue identificar aspectos validados por jueces para preparación de protocolo para personas con úlceras venosas. Investigación descriptiva y cuantitativ a, con 39 profesionales (30 enfermeros, 7 médicos y 2 fisioterapeutas, en el Hospital Universitario Onofre Lopes, entre abril y julio/2010. La recolección de datos a través de lista de verificación cuestionario. Análisis se realizó en Statistical Package for Social Science 15.0 evaluando directrices de cumplimiento. Los resultados fueron aspectos compositivos del protocolo: evaluación del paciente y lesión de registro/documentación, cuidado de herida/piel perilesional, cobertura de sentencias, uso de antibióticos y tratamiento del dolor, tratamiento quirúrgico/medicación, mejorando retorno venoso y prevención repetición, derivación de pacientes, formación, referencia/contra-referencia. Para componer el protocolo, son aspectos necesarios diagnóstico, tratamiento y prevención de lesiones.

A case report of spinal dural arteriovenous fistula: origins, determinants, and consequences of abnormal vascular malformations.

Science.gov (United States)

Zakhary, Sherry M; Hoehmann, Christopher L; Cuoco, Joshua A; Hitscherich, Kyle; Alam, Hamid; Torres, German

2017-06-01

A spinal dural arteriovenous fistula is an abnormally layered connection between radicular arteries and venous plexus of the spinal cord. This vascular condition is relatively rare with an incidence of 5-10 cases per million in the general population. Diagnosis of spinal dural arteriovenous fistula is differentiated by contrast-enhanced magnetic resonance angiography or structural magnetic resonance imaging, but a definitive diagnosis requires spinal angiography methods. Here, we report a case of a 67-year-old female with a spinal dural arteriovenous fistula, provide a pertinent clinical history to the case nosology, and discuss the biology of adhesive proteins, chemotactic molecules, and transcription factors that modify the behavior of the vasculature to possibly cause sensorimotor deficits.

Cavernous sinus invasion by pituitary adenomas. Relationship between magnetic resonance imaging findings and histologically verified dural invasion

Energy Technology Data Exchange (ETDEWEB)

Daita, Go; Yonemasu, Yukichi; Nakai, Hirofumi; Takei, Hidetoshi; Ogawa, Katsuhiro [Asahikawa Medical Coll., Hokkaido (Japan)

1995-01-01

The relationship between magnetic resonance (MR) imaging findings and histologically verified invasion of the cavernous sinus by tumor cells was studied in 26 patients treated surgically for pituitary adenoma. Dural invasion of the sellar floor by tumor cells was found in 10 cases (38%). All patients were classified according to MR imaging findings into three types. Type I showed a gadolinium-enhanced stripe medial to the carotid artery (5 patients), none of which showed dural invasion. Type II showed no enhanced stripe (17 patients), six of which showed dural invasion. Within this type, tumor size and dural invasion showed no correlation. Type III showed displacement or encasement of the carotid artery by the tumor with or without extracranial extension (4 patients), all of which showed massive infiltration of the tumor cells into the dura mater. This study shows that preoperative MR imaging can provide information for assessment of invasion into the cavernous sinus in patients with pituitary adenoma. (author).

Dural arteriovenous fistula as a treatable dementia.

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Enofe, Ikponmwosa; Thacker, Ike; Shamim, Sadat

2017-04-01

Dementia is a chronic loss of neurocognitive function that is progressive and irreversible. Although rare, dural arteriovenous fistulas (DAVFs) could present with a rapid decline in neurocognitive function with or without Parkinson-like symptoms. DAVFs represent a potentially treatable and reversible cause of dementia. Here, we report the case of an elderly woman diagnosed with a DAVF after presenting with new-onset seizures, deteriorating neurocognitive function, and Parkinson-like symptoms.

Contribution of dynamic contrast MR imaging to the differentiation between dural metastasis and meningioma

International Nuclear Information System (INIS)

Kremer, S.; Grand, S.; Le Bas, J.F.; Remy, C.; Pasquier, B.; Benabid, A.L.; Bracard, S.

2004-01-01

To determine the perfusion-sensitive characteristics of cerebral dural metastases and compare them with the data on meningiomas. Twenty-two patients presenting with dural tumor underwent conventional and dynamic susceptibility-contrast MR imaging: breast carcinoma metastases, two patients; colorectal carcinoma metastasis, one patient; lung carcinoma metastasis, one patient; Merkel carcinoma metastasis, one patient; lymphoma, one patient; meningiomas, 16 patients. The imaging characteristics were analyzed using conventional MR imaging. The cerebral blood volume (CBV) maps were obtained for each patient and the relative CBV (rCBV) in different areas was calculated using the ratio between the CBV in the pathological area (CBVp) and in the contralateral white matter (CBVn). The differentiation between a meningioma and a dural metastasis can be difficult using conventional MR imaging. The rCBVs of lung carcinoma metastasis (1 case: 1.26), lymphoma (1 case: 1.29), breast carcinoma metastasis (2 cases: 1.50,1.56) and rectal carcinoma metastasis (1 case: 3.34) were significantly lower than that of meningiomas (16 cases: mean rCBV = 8.97±4.34, range 4-18). Merkel carcinoma metastasis (1 case: 7.56) showed an elevated rCBV, not different from that of meningiomas. Dural metastases are sometimes indistinguishable from meningiomas using conventional MR imaging. rCBV mapping can provide additional information by demonstrating a low rCBV which may suggest the diagnosis of metastasis. (orig.)

Apresentação pediátrica da síndrome antifosfolípide Paediatric antiphospholipid syndrome presentation

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Juliana de Oliveira Sato

2008-12-01

Full Text Available OBJETIVO: Descrever as características clínicas, laboratoriais e de desfecho de uma série de casos com diagnóstico definido de síndrome antifosfolípide (SAF pediátrica. MÉTODOS: Estudo observacional-retrospectivo de referência pediátrica terciária, que identificou os casos por meio de evento vascular, trombose venosa ou oclusão arterial, determinação de anticorpos anticardiolipina (IgG e IgM e teste do anticoagulante lúpico. RESULTADOS: Foram identificados cinco casos atendidos nos últimos cinco anos, sendo dois meninos e três meninas. A trombose venosa ocorreu em seios venosos cerebrais (2, fibular (2, poplítea (1, femoral (1, intestinal (1, renal (1, acompanhados por oclusão arterial intestinal (1, de artéria renal (1 e artéria digital (1, esta resultando gangrena periférica como evento recorrente durante anticoagulação com warfarina. Um abortamento espontâneo ocorreu em uma adolescente em vigência de púrpura trombocitopênica, evoluindo com anemia hemolítica (síndrome de Evans e desfecho fatal por hemorragia. A investigação laboratorial em todos os casos resultou, pelo menos, uma determinação positiva de anticardiolipina IgG e/ou IgM, sendo considerados como SAF primária. Três dos casos estão em seguimento com anticoagulação oral. CONLUSÃO: A trombose venosa cerebral e de extremidades foram os eventos mais freqüentes. A presente série alerta para a investigação e o diagnóstico precoces, com abordagem multidisciplinar para o tratamento.OBJECTIVE: To describe clinical and laboratorial features as well as outcome in a paediatric series with defined diagnosis of antiphospholipid syndrome. METHODS: A descriptive-retrospective report from a pediatric tertiary referral, with case ascertainment by vascular events identification, either venous thrombosis or arterial occlusion, anti-cardiolipin antibodies (IgG and IgM titres and lupus anticoagulant tests. RESULTS: Five cases, being two boys and three girls

A case report of spinal dural arteriovenous fistula: origins, determinants, and consequences of abnormal vascular malformations

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Sherry M. Zakhary, DO

2017-06-01

Full Text Available A spinal dural arteriovenous fistula is an abnormally layered connection between radicular arteries and venous plexus of the spinal cord. This vascular condition is relatively rare with an incidence of 5–10 cases per million in the general population. Diagnosis of spinal dural arteriovenous fistula is differentiated by contrast-enhanced magnetic resonance angiography or structural magnetic resonance imaging, but a definitive diagnosis requires spinal angiography methods. Here, we report a case of a 67-year-old female with a spinal dural arteriovenous fistula, provide a pertinent clinical history to the case nosology, and discuss the biology of adhesive proteins, chemotactic molecules, and transcription factors that modify the behavior of the vasculature to possibly cause sensorimotor deficits.

Retrograde flow in the dural sinuses detected by three-dimensional time-of-flight MR angiography

International Nuclear Information System (INIS)

Uchino, Akira; Nomiyama, Keita; Takase, Yukinori; Nakazono, Takahiko; Tominaga, Yukiko; Imaizumi, Takeshi; Kudo, Sho

2007-01-01

Retrograde flow in the left dural sinuses is sometimes detected by three-dimensional time-of-flight (3D-TOF) magnetic resonance (MR) angiography. The purpose of this study was to evaluate the incidence of this phenomenon and its characteristic features on 3D-TOF MR angiograms. We retrospectively reviewed cranial MR angiography images of 1,078 patients examined at our institution. All images were obtained by the 3D-TOF technique with one of two 1.5-T scanners. Maximum intensity projection (MIP) images in the horizontal rotation view were displayed stereoscopically. We reviewed the source images, inferosuperior MIP images, and horizontal MIP images and identified retrograde flow in the dural sinuses. We found retrograde flow in the dural sinuses of 67 patients on the source images from 3D-TOF MR angiography; the incidence was 6.2%. In 47 of the 67 patients, retrograde flow was identified in the left inferior petrosal sinus, in 13, it was seen in the left sigmoid sinus, and in 6, it was seen in the left inferior petrosal and left sigmoid sinuses. The remaining patient had retrograde flow in the left inferior petrosal and left and right sigmoid sinuses. The mean age of the patients with retrograde flow was slightly greater than that of the patients without this phenomenon (70 years vs 63 years). Retrograde flow in the dural sinuses frequently occurs on the left side in middle-aged and elderly patients during 3D-TOF MR angiography performed with the patient in the supine position. This phenomenon should not be misdiagnosed as a dural arteriovenous fistula. (orig.)

Radiographic anatomy of the distal dural SAC

International Nuclear Information System (INIS)

Larsen, J.L.; Olsen, K.O.

1991-01-01

A radio-anatomical study was performed of the distal dural sac (DS) in 121 patients subjected to myelography. In 83.4% the termination of the DS was located from the upper half of the S1-segment to the lower half of the S2-segment. In the remaining patients the dural terminations were more distally located. The average location of the DS-termination was higher than that found in a previous anatomic study. The inference is that in patients with low-back pain and sciatica, the DS tends to terminate at a higher spinal level than in a non-selected anatomic material. The caudal reduction in sagittal diameter of the DS was less than that of the frontal diameter of the sac. The linear diminution in cross-sectional area of the DS from the level of L3 towards the lumbosacral junction was not correlated with the degree of caudal extension of the DS into the sacrum. Thus the length of the DS and its transverse diameters are independent of each other. These results supported the view that the location of the termination of the DS (and hence that of the spinal cord) is not related to stenosis of the central spinal canal. (orig.)

Formações venosas superficiais da fossa cubital: aspectos de interesse para a prática da Enfermagem

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Nilton Alves

Full Text Available O objetivo deste estudo é contribuir para o conhecimento que auxilie o profissional de enfermagem na identificação dos tipos mais comuns de formações venosas da região da fossa cubital e, ainda, enfocar a importância de estar sempre atento aos casos pouco comuns como o aqui relatado. Através de uma revisão bibliográfica, constatamos que as formações venosas dessa região podem ser classificadas em 5 tipos mais comuns, sendo o tipo II o mais frequente. Constatamos ainda, que a VICo é o local de punção mais indicado, seguido pela VIB. Descrevemos também uma variação anatômica, onde observamos ausência de comunicação entre VC e VB no nível da fossa cubital e VIA drenando na VB, estando presente a VCA.

Cranial dural arteriovenous shunts. Part 4. Clinical presentation of the shunts with leptomeningeal venous drainage.

Science.gov (United States)

Baltsavias, Gerasimos; Spiessberger, Alex; Hothorn, Torsten; Valavanis, Anton

2015-04-01

Cranial dural arteriovenous fistulae have been classified into high- and low-risk lesions mainly based on the pattern of venous drainage. Those with leptomeningeal venous drainage carry a higher risk of an aggressive clinical presentation. Recently, it has been proposed that the clinical presentation should be considered as an additional independent factor determining the clinical course of these lesions. However, dural shunts with leptomeningeal venous drainage include a very wide spectrum of inhomogeneous lesions. In the current study, we correlated the clinical presentation of 107 consecutive patients harboring cranial dural arteriovenous shunts with leptomeningeal venous drainage, with their distinct anatomic and angiographic features categorized into eight groups based on the "DES" (Directness and Exclusivity of leptomeningeal venous drainage and features of venous Strain) concept. We found that among these groups, there are significant angioarchitectural differences, which are reflected by considerable differences in clinical presentation. Leptomeningeal venous drainage of dural sinus shunts that is neither direct nor exclusive and without venous strain manifested only benign symptoms (aggressive presentation 0%). On the other end of the spectrum, the bridging vein shunts with direct and exclusive leptomeningeal venous drainage and venous strain are expected to present aggressive symptoms almost always and most likely with bleeding (aggressive presentation 91.5%). Important aspects of the above correlations are discussed. Therefore, the consideration of leptomeningeal venous drainage alone, for prediction of the clinical presentation of these shunts appears insufficient. Angiographic analysis based on the above concept, offers the possibility to distinguish the higher- from the lower-risk types of leptomeningeal venous drainage. In this context, consideration of the clinical presentation as an additional independent factor for the prediction of their clinical

Quantifying the Cerebral Hemodynamics of Dural Arteriovenous Fistula in Transverse Sigmoid Sinus Complicated by Sinus Stenosis: A Retrospective Cohort Study.

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Guo, W-Y; Lee, C-C J; Lin, C-J; Yang, H-C; Wu, H-M; Wu, C-C; Chung, W-Y; Liu, K-D

2017-01-01

Sinus stenosis occasionally occurs in dural arteriovenous fistulas. Sinus stenosis impedes venous outflow and aggravates intracranial hypertension by reversing cortical venous drainage. This study aimed to analyze the likelihood of sinus stenosis and its impact on cerebral hemodynamics of various types of dural arteriovenous fistulas. Forty-three cases of dural arteriovenous fistula in the transverse-sigmoid sinus were reviewed and divided into 3 groups: Cognard type I, type IIa, and types with cortical venous drainage. Sinus stenosis and the double peak sign (occurrence of 2 peaks in the time-density curve of the ipsilateral drainage of the internal jugular vein) in dural arteriovenous fistula were evaluated. "TTP" was defined as the time at which a selected angiographic point reached maximum concentration. TTP of the vein of Labbé, TTP of the ipsilateral normal transverse sinus, trans-fistula time, and trans-stenotic time were compared across the 3 groups. Thirty-six percent of type I, 100% of type IIa, and 84% of types with cortical venous drainage had sinus stenosis. All sinus stenosis cases demonstrated loss of the double peak sign that occurs in dural arteriovenous fistula. Trans-fistula time (2.09 seconds) and trans-stenotic time (0.67 seconds) in types with cortical venous drainage were the most prolonged, followed by those in type IIa and type I. TTP of the vein of Labbé was significantly shorter in types with cortical venous drainage. Six patients with types with cortical venous drainage underwent venoplasty and stent placement, and 4 were downgraded to type IIa. Sinus stenosis indicated dysfunction of venous drainage and is more often encountered in dural arteriovenous fistula with more aggressive types. Venoplasty ameliorates cortical venous drainage in dural arteriovenous fistulas and serves as a bridge treatment to stereotactic radiosurgery in most cases. © 2017 by American Journal of Neuroradiology.

Dynamic subtraction magnetic resonance venography: a new real time imaging technique for the detection of dural sinus thrombosis

International Nuclear Information System (INIS)

Mandel, C.; Birchall, D.; Connolly, D.; English, P.

2002-01-01

Full text: Requests for imaging suspected dural sinus thrombosis are increasing. Conventional magnetic imaging (MRI) and magnetic resonance venography (MRV) are often used to detect venous sinus thrombosis, but these techniques are prone to technical problems. Catheter angiography is sometimes required as the final arbiter in the evaluation of the dural venous sinuses. Recent technical developments in MR scanning have allowed the development of dynamic subtraction MRA. This technique is beginning to be applied to the assessment of intracranial vascular malformations. We have recently applied the technique to the imaging of the dural venous sinuses, and describe our early experience with the technique. Imaging was performed on a Philips Intera 1.5T scanner with gradient strength 33 mT and slew rate 130 T/m/sec. T1-weighed fast field echo imaging was performed (flip angle 400, TR 1.5 msec) during bolus injection of gadolinium (5ml gadolinium followed by a 10 ml saline chaser) at 5-6 ml/sec using a MRI-compatible pump injector. Slice thickness depended on the plane of acquisition, but was between 100- 150 mm. Images were acquired in three orthogonal projections in each case, using 3 separate contrast injections. Mask images were obtained before the arrival of contrast, and subtracted reconstructed images were obtained in real time, providing a dynamic display of the intracranial circulation including the dural venous sinuses. Frame rate was 1 frame per 0.8 seconds. We will present dynamic MR angiographic images in a number of patients. Normal appearances and those seen in venous sinus thrombosis will be presented in the video display. Dynamic MR venography is a new technique for the imaging of dural venous sinuses. In our practice, it has proved a valuable adjunct for the imaging of patients with dural venous sinus thrombosis. Copyright (2002) Blackwell Science Pty Ltd

A case report of spinal dural arteriovenous fistula: origins, determinants, and consequences of abnormal vascular malformations

OpenAIRE

Zakhary, Sherry M.; Hoehmann, Christopher L.; Cuoco, Joshua A.; Hitscherich, Kyle; Alam, Hamid; Torres, German

2017-01-01

A spinal dural arteriovenous fistula is an abnormally layered connection between radicular arteries and venous plexus of the spinal cord. This vascular condition is relatively rare with an incidence of 5–10 cases per million in the general population. Diagnosis of spinal dural arteriovenous fistula is differentiated by contrast-enhanced magnetic resonance angiography or structural magnetic resonance imaging, but a definitive diagnosis requires spinal angiography methods. Here, we report a cas...

Histology of the distal dural ring.

Science.gov (United States)

Graffeo, Christopher S; Perry, Avital; Copeland, William R; Raghunathan, Aditya; Link, Michael J

2017-09-01

The distal dural ring (DDR) is a conserved intracranial anatomic structure marking the boundary point at which the internal carotid artery (ICA) exits the cavernous sinus (CS) and enters the subarachnoid space. Although the CS has been well described in a range of anatomic studies, to our knowledge no prior study has analyzed the histologic relationship between the ICA and DDR. Correspondingly, our objective was to assess the relationship of the DDR to the ICA and determine whether the DDR can be dissected from the ICA and thus divided, or can only be circumferentially trimmed around the artery. The authors examined ten fresh-frozen, adult cadaveric specimens. A standard frontotemporal craniotomy, orbito-optic osteotomy, and extradural anterior clinoidectomy was performed bilaterally. The cavernous ICA, DDR, and supraclinoid ICA were harvested as an en bloc specimen. Specimens formalin-fixed and paraffin-embedded prior to routine histochemical staining with hematoxylin and eosin and Masson trichrome. In all specimens, marked microscopic investment of the DDR throughout the ICA adventitia was noted. Dural collagen fibers extensively permeated the arterial layers superficial to the muscularis propria, with no evidence of a clear separation between the DDR and arterial adventitia. Histologic analysis suggests that the ICA and DDR are highly interrelated, continuous structures, and therefore attempted intraoperative dissection between these structures may carry an elevated risk of injury to the ICA. We correspondingly recommend careful circumferential trimming of the DDR in lieu of direct dissection in cases requiring mobilization of the clinoidal ICA. Clin. Anat. 30:742-746, 2017. © 2017Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Use of collagen film as a dural substitute: preliminary animal studies.

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Collins, R L; Christiansen, D; Zazanis, G A; Silver, F H

1991-02-01

Cadaver grafts, laminated metallic materials, and synthetic fabrics have been evaluated as dural substitutes. Use of cadaver tissues is limited by fear of transmission of infectious disease while use of synthetic materials is associated with implant encapsulation and foreign body reactions. The purpose of this study is to evaluate the use of collagen film as a dural substitute. Collagen films prepared from bovine skin were used to replace the dura of rabbits and histological observations were made at 16, 28, 42, and 56 days postimplantation. Controls consisted of dura that was removed and then reattached. Control dura showed no signs of inflammation or adhesion to underlying tissue at 16 and 28 days postimplantation. By 56 days postimplantation, extensive connective tissue deposition was observed in close proximity to adjacent bone as well as pia arachnoid adhesions. Implanted collagen film behaved in a similar manner to control dura showing minimal inflammatory response at all time periods. At 56 days postimplantation collagen film appeared strongly infiltrated by connective tissue cells that deposited new collagen. The results of this study suggest that a reconstituted type I collagen film crosslinked with cyanamide acts as a temporary barrier preventing loss of fluid and adhesion formation. It is replaced after approximately 2 months with host collagen with limited inflammatory and fibrotic complications. Further studies are needed to completely characterize the new connective tissue formed as well as long-term biocompatibility and functioning of a reconstituted collagen dural substitute.

''Dural tail'' adjacent to a giant posterior cerebral artery aneurysm: case report and review of the literature

International Nuclear Information System (INIS)

Good, C.D.; Kingsley, D.P.E.; Taylor, W.J.; Harkness, W.F.

1997-01-01

The ''dural tail'' sign on gadolinium (Gd-DTPA)-enhanced MRI has been described in association with meningiomas. Various series with histopathological correlation have shown that in some cases there is tumour invasion into the dura mater, but in the majority of cases it represents a hypervascular, non-neoplastic reaction. While this sign was originally thought to be specific for meningioma, subsequent case reports have described the presence of a dural tail in other intra- and extra-axial lesions. We present a patient with a giant aneurysm arising from the P2 segment of the right posterior cerebral artery, adjacent to the tentorium, with a prominent dural tail on Gd-DTPA-enhanced MRI. In this location, differentiation of an aneurysm from a meningioma was critical. (orig.). With 2 figs

Índice de congestão portal e a ocorrência de trombose portal pós-dape Portal congestion and thrombosis after EDS

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Fabio Gonçalves Ferreira

2005-08-01

Full Text Available OBJETIVO: Comparar os dados obtidos pela ultra-sonografia com doppler no pré-operatório de esquistossomóticos submetidos à desconexão ázigo-portal com esplenectomia (DAPE, calculando o índice de congestão portal, e sua correlação com a trombose portal no pós-operatório. MÉTODOS: Foram estudados 65 pacientes submetidos à DAPE por hipertensão portal esquistossomótica com antecedente de hemorragia digestiva, divididos em dois grupos: Grupo A (28 pacientes que não desenvolveram trombose portal pós-operatória e Grupo B (37 pacientes com trombose portal no pós-operatório. Analisaram-se através de ultra-sonografia com doppler no pré-operatório os seguintes parâmetros da veia porta: diâmetro, área, velocidade média de fluxo do sangue, fluxo de sangue, e estabeleceu-se o índice de congestão portal. RESULTADOS: O diâmetro, área e o fluxo da veia porta foram maiores no grupo B (média de 1,52 cm; 1,77 cm² e 2533,12 ml/min em relação ao grupo A (média de 1,33 cm; 1,44 cm² e 1609,03 ml/min com p = 0,03; 0,03 e 0,04 respectivamente. O índice de congestão portal não foi estatisticamente significativo na comparação dos dois grupos (p = 0,07. CONCLUSÃO: O índice de congestão portal obtido no pré-operatório através da ultra-sonografia com doppler não se mostrou preditivo de trombose portal no pós-operatório dos doentes estudados.BACKGROUND: The study compared the preoperative portal vein congestion index estimated by Doppler ultrasound and the postoperative portal vein thrombosis of patients submitted to esophagogastric devascularization and splenectomy (EDS. METHODS: 65 patients with portal hypertension due to schistosomiasis and previous gastrointestinal bleeding submitted to EDS were divided into two groups: GROUP A (28 patients without postoperative portal vein thrombosis and GROUP B (37 patients with postoperative portal vein thrombosis. The following parameters of preoperative Doppler ultrasound of the

Transcutaneous Drainage of Gel-Like Substance after Application of Hydrogel Dural Sealant: Report of Two Cases

OpenAIRE

Siman, Homayoun; Techy, Fernando

2015-01-01

Study Design?Case report. Objective?Incidental durotomy (IDT) is a common complication of spinal surgery. The use of collagen matrix graft along with hydrogel dural sealant is a common method of IDT repair. With this method, there have been several reported cases of detrimental dural sealant expansion in the literature. One case study reported an expansion rate greater than 300%; many report neurologic damage. This article reports the clinical course of two patients who developed postoperativ...

Cerebral venous thrombosis after spinal anesthesia: case report

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Flora Margarida Barra Bisinotto

2017-05-01

. Descrevemos um caso de um paciente submetido à raquianestesia que apresentou cefaleia no período pós-operatório complicada com TVC. Relato de caso: Paciente de 30 anos, ASA 1, submetido à cirurgia de artroscopia de joelho sob raquianestesia, sem intercorrências. Quarenta e oito horas após o procedimento apresentou cefaleia frontal, ortostática, que melhorava com o decúbito. Foi feito diagnóstico de sinusite em pronto socorro geral e recebeu medicação sintomática. Nos dias subsequentes teve pioria da cefaleia, que passou a ter localização holocraniana e mais intensa e com pequena melhora com o decúbito dorsal. Evoluiu com hemiplegia esquerda seguida de convulsões tônico-clônicas generalizadas. Foi submetido à ressonância magnética com venografia que fez o diagnóstico de TVC. A pesquisa para fatores pró-coagulantes identificou a presença de anticorpo lúpico. Recebeu como medicamentos anticonvulsivantes e anticoagulantes e teve alta hospitalar em oito dias, sem sequelas. Discussão: Qualquer paciente que apresente cefaleia postural após uma raquianestesia, e que intensifica após um platô, perca sua característica ortostática ou se torne muito prolongada, deve ser submetido a exames de imagem para excluir complicações mais sérias como a TVC. A perda de líquido cefalorraquidiano leva à dilatação e à estase venosa, que, associadas à tração provocada pela posição ereta, podem, em alguns pacientes com estados protrombóticos, levar à TVC. Keywords: Spinal anesthesia, Complications post-dural puncture headache, Cerebral venous thrombosis, Palavras-chave: Raquianestesia, Complicações cefaleia pós-punção da dura-máter, Trombose venosa cerebral

Suitability of cerebrospinal fluid as a signal-intensity reference on MRI: evaluation of signal-intensity variations in the lumbosacral dural sac

International Nuclear Information System (INIS)

Luoma, E.K.; Luukkonen, R.; Riihimaeki, H.A.; Raininko, R.; Manninen, H.I.; Nummi, P.J.

1997-01-01

The suitability of the cerebrospinal fluid (CSF) in the lumbosacral dural sac as an internal signal-intensity reference was studied on magnetic resonance imaging (MRI) of the lumbar spine using a surface coil and motion artefact suppression technique. A signal-intensity reference is needed when signal is compared between images, studies or subjects. Homogeneity of the CSF was estimated visually on T2-weighted images of 60 subjects at 1.5 T and of another 60 subjects at 0.1 T. Spines with a severely narrowed dural sac or marked scoliosis were excluded from the study to avoid partial volume effect. CSF was homogeneous in 82% and 73% of the examinations at 1.5 T and 0.1 T, respectively. The type and location of the local inhomogeneities did not relate to local narrowings of the dural sac. The signal intensity of CSF was measured in 108 examinations at 0.1 T after correcting the spatially-dependent signal-intensity nonuniformities with a phantom-based method. The signal-intensity difference between the CSF in the upper and lower lumbar dural sac was less than 10% in 73% of the examinations. The CSF in the lumbosacral dural sac can be a useful signal-intensity reference for estimation of the signal of the adjacent structures in patients without severe narrowing of the dural sac or marked scoliosis. It may contribute to assessing spinal disease processes. (orig.). With 1 fig., 3 tabs

Documented development of a dural arteriovenous fistula in an infant subsequent to sinus thrombosis: case report and review of the literature

International Nuclear Information System (INIS)

Morales, Humberto; Jones, Blaise V.; Leach, James L.; Abruzzo, Todd A.

2010-01-01

Controversy exists as to whether sinus thrombosis is the cause or the result of dural arteriovenous fistula (DAVF) and to whether DAVF are congenital or acquired lesions, especially in children. An infant presented with rupture of an anterior communicating artery aneurysm diagnosed with computed tomography angiography and catheter angiography. Pretreatment hospital course was complicated by extensive dural sinus thrombosis. Subsequent arteriography showed a new adult-type dural arteriovenous fistula to the previously thrombosed right sigmoid sinus. This is the first report of definitive angiographic documentation of the development of an adult-type DAVF after recanalization of a thrombosed dural sinus in a child. This case confirms the acquired etiology of at least one type of DAVF in children, even at this young age. We review the previously documented cases of formation of DAVF subsequent to sinus thrombosis with serial angiography in adults. (orig.)

Experiência obtida em 100 transplantes de pâncreas

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João Eduardo Leal Nicoluzzi

Full Text Available OBJETIVO: Relatar nossa experiência com 100 transplantes de pâncreas realizados em um período de sete anos. MÉTODOS: Entre janeiro de 2001 e janeiro de 2008, 100 pacientes foram submetidos a transplante de pâncreas em nosso serviço, sendo 88 transplantes de pâncreas e rim simultâneo (TPRS e 12 transplantes de pâncreas isolado (TPI. Todos foram transplantes primários. O manejo da porção exócrina do enxerto pancreático envolveu drenagem entérica em oito casos (todos TPRS e a bexiga em 92 casos. O sistema venoso sistêmico do receptor foi utilizado para a drenagem venosa do enxerto em todos os casos. Nossos últimos 30 pacientes submetidos à TPRS não receberam terapia de indução independentemente do painel imunológico.Os pacientes TPRS receberam basiliximab e TPI receberam timoglobulina nos casos induzidos. Imunossupressão de manutenção foi realizada com tacrolimus, micofenolato mofetil e corticóides. O volume de perfusão do enxerto pancreático foi limitado a 800ml da solução de Celsior ou UW. RESULTADOS: Demonstram que os enxertos ainda funcionantes são atualmente 64 dos 100 realizados. Perda do enxerto foi causada por: rejeição (oito pacientes, trombose venosa (nove pacientes, trombose arterial (um paciente Complicações cirúrgicas encontradas: fístula anastomótica (tres pacientes, infecção peri-enxerto (10 pacientes, pancreatite do enxerto (cinco pacientes. A Rejeição foi observada com menos freqüência nos TPRS (5/92 que nos TPI (3/12. A morte ocorreu em 24 pacientes. CONCLUSÃO: Nossa impressão é que o transplante de pâncreas é altamente efetivo como terapia para o diabetes mellitus apesar da morbidade do procedimento.

Successful Ablation for Atrial Tachycardia Originated from Sinus Venosa with Tachycardia-Induced Cardiomyopathy

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Sou Takenaka

2016-01-01

Full Text Available A 74-year-old male suffering from congestive heart failure with atrial tachycardia (AT with 2 : 1 atrioventricular conduction was admitted to our hospital. After the therapy with diuretics and β-blocker, his rapid AT was still sustained. He took the catheter ablation for his AT. Postpacing interval mapping from entrainment and noncontact mapping system revealed the mechanism of his AT, originated from sinus venosa. His AT was successfully terminated and eliminated by radiofrequency catheter ablation. After the successful ablation, he has been free from any AT, and his cardiac function was also improved.

Epistaxis caused by a dural AV-fistula at the cribriform plate

NARCIS (Netherlands)

van Dijk, J. Marc C.; Korsten-Meijer, Astrid G. W.; Mazuri, Aryan

2014-01-01

Objectives/HypothesisA dural arteriovenous fistula (DAVF) with cortical venous reflux (CVR) is a dangerous neurovascular entity. A DAVF at the cribriform plate is typically silent until its inevitable presentation with intracranial hemorrhage. Case SummaryA 67-year-old male presented with severe

Dural ectasia of the optic nerve sheath: is it always benign?

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Berker Bakbak

2009-11-01

Full Text Available Berker Bakbak1, Hava Dönmez2, Tülay Kansu3, Hayyam Kiratli41Hacettepe University Institute of Neurological Sciences and Psychiatry, Neuro-ophthalmology Unit, Ankara, Turkey; 2Diskapi Yildirim Beyazid Education and Research Hospital Neurology Clinic, Ankara, Turkey; 3Hacettepe University Medical Faculty, Department of Neurology, Neuro-Ophthalmology Unit, Ankara, Turkey; 4Hacettepe University Medical Faculty, Department of Ophthalmology, Ocular Oncology Unit, Ankara, TurkeyAbstract: A 36-year-old woman with a 3-month history of progressive visual loss had papilledema, dilatation of the optic nerve sheaths and normal cerebrospinal fluid pressures. She was diagnosed as dural ectasia of the optic nerve sheaths and surgical decompression was performed. In this case report, severe visual loss is described as a serious complication of this rare disease and the importance of early surgical intervention is emphasized.Keywords: optic nerve, dural ectasia, meningocele

Experimental inflammation following dural application of complete Freund's adjuvant or inflammatory soup does not alter brain and trigeminal microvascular passage

DEFF Research Database (Denmark)

Lundblad, Cornelia; Haanes, Kristian A; Grände, Gustaf

2015-01-01

, following dural application of complete Freund's adjuvant (CFA) or inflammatory soup (IS) on brain and trigeminal microvascular passage. METHODS: In order to address this issue, we induced local inflammation in male Sprague-Dawley-rats dura mater by the addition of CFA or IS directly on the dural surface...

Trombose venosa profunda em idade pediátrica – estudo retrospetivo de 10 anos

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Ana Isabel Sequeira

2016-09-01

Discussão e Conclusão: A TVP na criança tem sido reconhecida como uma patologia rara, mas importante causa de morbilidade. A maior incidência de TVP foi documentada na adolescência com compromisso do membro inferior, tal como referido na literatura. Verificamos uma conjugação de fatores de risco que, provavelmente, se potenciaram entre si levando à ocorrência do TEV e colocamos a possibilidade do Pediatra se estar a deparar com uma nova realidade anteriormente excluída do atendimento pediátrico. O aumento na incidência desta patologia levanta a questão do acréscimo de risco trombótico nos adolescentes do sexo feminino devido à utilização de contracetivos orais combinados. Salientamos a importância de um consenso nacional no diagnóstico, tratamento e prevenção desta entidade em Pediatria.

Contracepção hormonal e sistema cardiovascular

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Milena Bastos Brito

2011-04-01

Full Text Available A contracepção hormonal é o método mais utilizado para prevenção de gestações não planejadas. A literatura tem demonstrado associação entre risco cardiovascular e uso de hormonioterapia. A fim de melhorar a orientação contraceptiva para mulheres com fatores de risco para doença cardiovascular, realizamos uma revisão da literatura em relação ao assunto. Esta revisão descreve os dados mais recentes da literatura científica acerca da influência dos contraceptivos hormonais em relação a trombose venosa, arterial e hipertensão arterial sistêmica, doenças cada dia mais prevalentes na população feminina jovem.

Microneurografia e pletismografia de oclusão venosa na insuficiência cardíaca: correlação com prognóstico Microneurografía y pletismografía de oclusión venosa en la insuficiencia cardiaca: correlación con pronóstico Microneurography and venous occlusion plethysmography in heart failure: correlation with prognosis

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Robinson Tadeu Munhoz

2009-01-01

Full Text Available FUNDAMENTO: Microneurografia e pletismografia de oclusão venosa podem ser considerados métodos de avaliação da atividade simpática. OBJETIVO: Avaliar a intensidade da atividade simpática através da microneurografia e da pletismografia de oclusão venosa em pacientes com insuficiência cardíaca, e correlacionar essa intensidade com prognóstico. MÉTODOS: 52 pacientes com insuficiência cardíaca (FE 53,5 impulsos/min para ANSM (S=90,55. E=73,68% e 1,81 ml/min/100gr (PFUNDAMENTO: Microneurografía y pletismografía de oclusión venosa se pueden considerar como métodos de evaluación de la actividad simpática. OBJETIVO: Evaluar la intensidad de la actividad simpática a través de la microneurografía y de la pletismografía de oclusión venosa en pacientes con insuficiencia cardiaca, y correlacionar esa intensidad con pronóstico. MÉTODOS: Un total de 52 pacientes con insuficiencia cardiaca (FE 53,5 impulsos/min para ANSM (S=90,55. E=73,68% y 1,81 ml/min/100gr (PBACKGROUND: Microneurography and venous occlusion plethysmography can be considered methods of assessment of the sympathetic activity. OBJECTIVE: To evaluate the intensity of the sympathetic activity through microneurography and venous occlusion plethysmography in patients with heart failure (HF and correlate this intensity with prognosis. METHODS: 52 patients with HF (ejection fraction 53.5 impulses/min for MSNA (S=90.55. E=73.68% and 1.81 ml/min/100gr (P<0.001. Logistic regression analysis: the higher the MSNA and the lower the MBF, the higher is the probability of death. CONCLUSION: The intensity of the MSNA and the MBF can be considered prognostic markers in advanced HF.

Normal values of the sagittal diameter of the lumbar spine (vertebral body and dural sac) in children measured by MRI

International Nuclear Information System (INIS)

Knirsch, Walter; Kurtz, Claudia; Langer, Mathias; Haeffner, Nicole; Kececioglu, Deniz

2005-01-01

The definition of normal values is a prerequisite for the reliable evaluation of abnormality in the lumbar spine, such as spinal canal stenosis or dural ectasia in patients with Marfan syndrome. Values for vertebral body diameter (VBD) and dural sac diameter (DSD) for the lumbar spine have been published in adults. In children, normal values have been established using conventional radiography or myelography, but not by MRI. To define normal values for the sagittal diameter of the vertebral body and dural sac, and to calculate a dural sac ratio (DSR) in the lumbosacral spine (L1-S1) in healthy children using MRI. A total of 75 healthy children between 6 years and 17 years of age were examined using a sagittal T2-weighted sequence. Sagittal VBD and DSD were measured and a DSR was calculated. This was a retrospective and cross-sectional study. With increasing age there is a significant increase of VBD, a slight increase of DSD, and a slight decrease of DSR. There is no significant sex difference. DSR in healthy children is higher than in healthy adults. MRI is a reliable method demonstrating the natural shape of the lumbosacral spine and its absolute values. These normal values compare well with those established by conventional radiological techniques. Our data may serve as a reference for defining dural ectasia in children with Marfan syndrome. (orig.)

Normal values of the sagittal diameter of the lumbar spine (vertebral body and dural sac) in children measured by MRI

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Knirsch, Walter [University Children' s Hospital Freiburg, Department of Pediatric Cardiology, Freiburg (Germany); University Children' s Hospital Zurich, Division of Paediatric Cardiology, Zurich (Switzerland); Kurtz, Claudia; Langer, Mathias [University Hospital Freiburg, Department of Radiology, Freiburg (Germany); Haeffner, Nicole; Kececioglu, Deniz [University Children' s Hospital Freiburg, Department of Pediatric Cardiology, Freiburg (Germany)

2005-04-01

The definition of normal values is a prerequisite for the reliable evaluation of abnormality in the lumbar spine, such as spinal canal stenosis or dural ectasia in patients with Marfan syndrome. Values for vertebral body diameter (VBD) and dural sac diameter (DSD) for the lumbar spine have been published in adults. In children, normal values have been established using conventional radiography or myelography, but not by MRI. To define normal values for the sagittal diameter of the vertebral body and dural sac, and to calculate a dural sac ratio (DSR) in the lumbosacral spine (L1-S1) in healthy children using MRI. A total of 75 healthy children between 6 years and 17 years of age were examined using a sagittal T2-weighted sequence. Sagittal VBD and DSD were measured and a DSR was calculated. This was a retrospective and cross-sectional study. With increasing age there is a significant increase of VBD, a slight increase of DSD, and a slight decrease of DSR. There is no significant sex difference. DSR in healthy children is higher than in healthy adults. MRI is a reliable method demonstrating the natural shape of the lumbosacral spine and its absolute values. These normal values compare well with those established by conventional radiological techniques. Our data may serve as a reference for defining dural ectasia in children with Marfan syndrome. (orig.)

A rare case of spinal dural arteriovenous fistula

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Mariya Apostolova

2012-12-01

Full Text Available Spinal dural arteriovenous fistula (SDAVF is a rare vascular malformation of the spine. Only a limited number of cases of SDAVF have been reported in the current literature. We describe the case of a 74 year old male who presented with gradually progressive bilateral lower extremity weakness and bladder dysfunction and was subsequently diagnosed with SDAVF affecting both the thoracic and lumbar spine. The patient later underwent embolization with some improvement in his neurologic symptoms.

Use of computer-assisted design and manufacturing to localize dural venous sinuses during reconstructive surgery for craniosynostosis.

Science.gov (United States)

Iyer, Rajiv R; Wu, Adela; Macmillan, Alexandra; Musavi, Leila; Cho, Regina; Lopez, Joseph; Jallo, George I; Dorafshar, Amir H; Ahn, Edward S

2018-01-01

Cranial vault remodeling surgery for craniosynostosis carries the potential risk of dural venous sinus injury given the extensive bony exposure. Identification of the dural venous sinuses can be challenging in patients with craniosynostosis given the lack of accurate surface-localizing landmarks. Computer-aided design and manufacturing (CAD/CAM) has allowed surgeons to pre-operatively plan these complex procedures in an effort to increase reconstructive efficiency. An added benefit of this technology is the ability to intraoperatively map the dural venous sinuses based on pre-operative imaging. We utilized CAD/CAM technology to intraoperatively map the dural venous sinuses for patients undergoing reconstructive surgery for craniosynostosis in an effort to prevent sinus injury, increase operative efficiency, and enhance patient safety. Here, we describe our experience utilizing this intraoperative technology in pediatric patients with craniosynostosis. We retrospectively reviewed the charts of children undergoing reconstructive surgery for craniosynostosis using CAD/CAM surgical planning guides at our institution between 2012 and 2016. Data collected included the following: age, gender, type of craniosynostosis, estimated blood loss, sagittal sinus deviation from the sagittal suture, peri-operative outcomes, and hospital length of stay. Thirty-two patients underwent reconstructive cranial surgery for craniosynostosis, with a median age of 11 months (range, 7-160). Types of synostosis included metopic (6), unicoronal (6), sagittal (15), lambdoid (1), and multiple suture (4). Sagittal sinus deviation from the sagittal suture was maximal in unicoronal synostosis patients (10.2 ± 0.9 mm). All patients tolerated surgery well, and there were no occurrences of sagittal sinus, transverse sinus, or torcular injury. The use of CAD/CAM technology allows for accurate intraoperative dural venous sinus localization during reconstructive surgery for craniosynostosis and

Endovascular management of dural carotid-cavernous sinus fistulas in 141 patients

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Kirsch, M. [Alfried Krupp Krankenhaus, Klinik fuer Radiologie und Neuroradiologie, Essen (Germany); Universitaetsklinikum Greifswald, Institut fuer Diagnostische Radiologie und Neuroradiologie, Greifswald (Germany); Henkes, H.; Liebig, T.; Weber, W.; Golik, S.; Kuehne, D. [Alfried Krupp Krankenhaus, Klinik fuer Radiologie und Neuroradiologie, Essen (Germany); Esser, J. [Universitaetsklinikum Essen, Zentrum fuer Augenheilkunde, Essen (Germany)

2006-07-15

Introduction: The purpose of this study was to evaluate the single-centre experience with transvenous coil treatment of dural carotid-cavernous sinus fistulas. Methods: Between November 1991 and December 2005, a total of 141 patients (112 female) with dural carotid-cavernous sinus fistula underwent 161 transvenous treatment sessions. The patient files and angiograms were analysed retrospectively. Clinical signs and symptoms included chemosis (94%), exophthalmos (87%), cranial nerve palsy (54%), increased intraocular pressure (60%), diplopia (51%), and impaired vision (28%). Angiography revealed in addition cortical drainage in 34% of the patients. Partial arterial embolization was carried out in 23% of the patients. Transvenous treatment comprised in by far the majority of patients complete filling of the cavernous sinus and the adjacent segment of the superior and inferior ophthalmic vein with detachable coils. Complete interruption of the arteriovenous shunt was achieved in 81% of the patients. A minor residual shunt (without cortical or ocular drainage) remained in 13%, a significant residual shunt (with cortical or ocular drainage) remained in 4%, and the attempted treatment failed in 2%. There was a tendency for ocular pressure-related symptoms to resolve rapidly, while cranial nerve palsy and diplopia improved slowly (65%) or did not change (11%). The 39 patients with visual impairment recovered within the first 2 weeks after endovascular treatment. After complete interruption of the arteriovenous shunt, no recurrence was observed. The transvenous coil occlusion of the superior and inferior ophthalmic veins and the cavernous sinus of the symptomatic eye is a highly efficient and safe treatment in dural carotid-cavernous sinus fistulas. In the majority of patients a significant and permanent improvement in clinical signs and symptoms can be achieved. (orig.)

Headache in the parturient: Pathophysiology and management of post-dural puncture headache

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Gita Nath

2011-01-01

Full Text Available Headache in the postpartum period is common and multifactorial in origin. Apart from primary causes such as tension headaches and migraine, secondary headaches such as post-dural puncture headache (PDPH are increasingly common because of increasing use of regional anaesthesia and analgesia during childbirth. Preventive measures for PDPH include the use of smaller gauge pencil-point needles for spinal blocks; epidural needles of 18 G or less; using saline rather than air for epidural space identification and the use of ultrasound guidance, especially for difficult cases such as morbid obesity and spinal deformities. In case of accidental dural puncture (ADP, the choice is between inserting the catheter in an adjacent space or intrathecal catheterization. Current evidence seems to be in favour of inserting the epidural catheter into the subarachnoid space and using the intrathecal catheter for analgesia/anaesthesia after prominently labelling it as intrathecal, to prevent misuse. It should be removed after at least 24 hours and a 10 ml bolus of saline injected before removal of catheter may be helpful. Either way, having written protocols for the management of accidental dural puncture helps to reduce the incidence of PDPH. PDPH can be disabling in severity and can mar the whole experience of childbirth. In addition, severe untreated PDPH can cause complications such as nerve palsies, subdural hematoma and cerebral venous thrombosis. Conservative methods of treatment should be tried first such as adequate hydration, paracetamol, caffeine, sumatriptan or ACTH/hydrocortisone. Epidural blood patching is the most effective treatment for PDPH. It is more effective if done 24-48 hours after dural puncture. It is an invasive procedure with its own complications as well as a failure rate of up to 30%, so that a second or even third patch may be necessary. Both these facts should be intimated to the patient beforehand. Meticulous follow-up and evaluation

Preservation of Frontal Sinus Anatomy and Outflow Tract Following Frontal Trauma with Dural Defect

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James Wei Ming Kwek, MBBS, MRCS

2015-02-01

Full Text Available Summary: Our case report describes a young male mechanic who was hit in his face by a spring while repairing a car, resulting in traumatic injury to the frontal sinus, with fractures of both the anterior and the posterior tables with dural defect and cerebrospinal fluid leak. Current guidelines recommend that comminuted and/or displaced fractures of the posterior table of the frontal sinus with dural defects should be either cranialized or obliterated. In this patient, instead of cranializing or obliterating the frontal sinus, we managed to preserve the frontal sinus anatomy and its outflow tract using a combined open bicoronal and nasoendoscopic approach. This avoids the long-term complications associated with cranialization or obliteration including mucocele formation and frontocutaneous fistula.

Systematic review of topic treatment for venous ulcers Revisión sistemática del tratamiento tópico de la úlcera venosa Revisão sistemática do tratamento tópico da úlcera venosa

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Eline Lima Borges

2007-12-01

Full Text Available Venous ulcer patients can experience this situation for several years without achieving healing if treatment is inadequate. Evidence-based professional practice generates effective results for patients and services. This research aimed to carry out a systematic review to assess the most effective method to improve venous return and the best topic treatment for these ulcers. Studies were collected in eight databases, using the following descriptors: leg ulcer, venous ulcer and similar terms. The sample consisted of 33 primary studies and two Meta-analyses. A wide range of treatments was identified, grouped in compression therapy (54.3% and topical treatment (45.7%. It was evidenced that compression therapy increases ulcer healing rates and should be used in patients with intact arteries. There is no consensus about the best topical treatment, although different options should be associated with compression therapy.Pacientes con úlcera venosa pueden convivir con esta situación durante varios años, sin obtener la cicatrización de la herida caso el tratamiento no sea adecuado. La práctica profesional basada en evidencias produce resultados efectivos para el paciente y para los servicios. La finalidad del estudio fue realizar una revisión sistemática para evaluar el método más eficaz para mejorar el retorno venoso y el mejor tratamiento tópico de la úlcera. Se buscaron estudios indexados en ocho bases de datos, mediante los descriptores úlcera de pierna, úlcera venosa y similares. La muestra incluyó 33 estudios primarios y 2 estudios de metanálisis. Se identificó una diversidad de tratamientos que fueron agrupados en terapia compresiva (54,3% y tratamiento tópico (45,7%. Fue evidenciado que la terapia compresiva aumenta la tasa de cicatrización de la úlcera y que debe ser usado en pacientes sin comprometimiento arterial. No queda claro cual es la mejor terapia tópica. Sin embargo, las diferentes opciones deben ser asociadas a la

USO DE VENDAS ELÁSTICAS EN EL PRE Y TRANSOPERATORIO EN COLECISTECTOMIA PARA PREVENIR TROMBOSIS VENOSA PROFUNDA

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Carlos Mario Marín Rodríguez

2012-04-01

Full Text Available Una de las intervenciones realizadas por el profesional de Enfermería para prevenir sucesos adversos en los pacientessometidos a intervención quirúrgica, como es el caso de la colescistectomía, es la aplicación de vendas elásticas en losmiembros inferiores en el pre y transoperatorio para prevenir la Trombosis Venosa Profunda (TVP. Sin embargo, estapráctica no ha sido fundamentada con la mejor evidencia disponible, por ello el objetivo de esta revisión es obtener unrespaldo científico que avale esta práctica. Inicialmente, para recabar la mejor evidencia posible, se estableció una preguntaclínica en formato PICO; luego, se indagó en distintas bases de datos como PUBMED de las cual se obtuvieron 136artículos siete de ellos de gran importancia clínica, ya que se halló, inclusive, una guía de práctica clínica. Luego se aplicó elanálisis crítico mediante la plantilla CASPe y AGREE. Por último, a partir de los resultados encontrados se analizó lapráctica que se desarrolla en el nosocomio con el fin de ser divulgados posteriorrmente y, así, mejorar la práctica clínica.Existe escasa o nula bibliografía específica que respalde el uso de vendas elásticas en el pre y transoperatorio de unacolecistectomía, lo que puede deberse a que no hay evidencia suficiente respecto de sufrir trombosis venosa profunda poresta intervención. Por otro lado, cabe recordar que existen diferentes factores que afectan la colocación de las vendaselásticas, dígase la pericia del profesional que las aplica, su nivel profesional y la ausencia de métodos para medir la presiónque se ejerce al colocar este tratamiento. Conclusión: no existe evidencia científica aparente que respalde el uso de vendaselásticas en los miembros inferiores aplicadas en el pre, trans y postoperatorio de una colecistectomía con la finalidad deprevenir la Trombosis Venosa Profunda, práctica que se lleva a cabo en el Hospital de La Anexión, Guanacaste.

The interperiosteo-dural concept applied to the perisellar compartment: a microanatomical and electron microscopic study.

Science.gov (United States)

François, Patrick; Travers, Nadine; Lescanne, Emmanuel; Arbeille, Brigitte; Jan, Michel; Velut, Stéphane

2010-11-01

The dura mater has 2 dural layers: the endosteal layer (outer layer), which is firmly attached to the bone, and the meningeal layer (inner layer), which directly covers the brain. These 2 dural layers join together in the middle temporal fossa or the convexity and separate into the orbital, lateral sellar compartment (LSC), or spinal epidural space to form the extradural neural axis compartment (EDNAC). The aim of this work was to anatomically verify the concept of the EDNAC by using electron microscopy. The authors studied the cadaveric heads obtained from 13 adults. Ten of the specimens (or 20 perisellar areas) were injected with colored latex and fixed in formalin. They carefully removed each brain to allow a superior approach to the perisellar area. The 3 other specimens were studied by microscopic and ultrastructural methods to describe the EDNAC in the perisellar area. Special attention was paid to the dural layers surrounding the perisellar area. The authors studied the anatomy of the meningeal architecture of the LSC, the petroclival venous confluence, the orbit, and the trigeminal cave. After dissection, the authors took photographs of the dural layers with the aid of optical magnification. The 3 remaining heads, obtained from fresh cadavers, were prepared for electron microscopic study. The EDNAC is limited by the endosteal layer and the meningeal layer and contains fat and/or venous blood. The endosteal layer and meningeal layer were not identical on electron microscopy; this finding can be readily related to the histology of the meninges. In this study, the authors demonstrated the existence of the EDNAC concept in the perisellar area by using dissected cadaveric heads and verified the reality of the concept of the meningeal layer with electron microscopy. These findings clearly demonstrated the existence of the EDNAC, a notion that has generally been accepted but never demonstrated microscopically.

MR diagnosis of dural sinus thrombosis. Diagnostico por RM de las trombosis de senos durales

Energy Technology Data Exchange (ETDEWEB)

Rovira Caellas, A.; Turon Estrada, A.; Alvarez Sabin, J.; Lozano Sanchez, M.; Castao Duque, Ch.; Grive Isern, E.; Sumalla Sue, J. (Hospital General Vall d' Hebron Barcelona (Spain))

1994-01-01

Four adult patients were diagnosed as having dural sinus thrombosis (DST) by means of magnetic resonance (MR). In the three cases of acute thrombosis, MR disclosed diffuse or segmental hyperintensity in the sinuses involved, which persisted regardless of the sequence and orientation of the plane selected. MR angiography (MRA) provided diagnostic information that proved useful in the chronic case, as well as in the two cases in which follow-up was carried out to determine the degree to which permeability was restored to the sinuses involved. MR diagnosis of DST can produce false positives and negatives, the causes of which should be known, as well as the ways to avoid them, in order to prevent diagnostic errors. MR, when applied and interpreted correctly, can be considered the first, and in many cases the only, choice as a diagnostic method in DST. (Author)

The dural entrance of cerebral bridging veins into the superior sagittal sinus: an anatomical comparison between cadavers and digital subtraction angiography

International Nuclear Information System (INIS)

Han, Hui; Tao, Wei; Zhang, Ming

2007-01-01

Intracranial venous structures have received increasing attention due to improved neuroimaging techniques and increased awareness of cerebral venous disease. To date, few studies have attempted to investigate the dural entrance of the cerebral bridging vein (BV). The aim of this study was to use the superior sagittal sinus (SSS) as an example to identify anatomical features of the dural entrance of the BVs into the SSS in both human cadavers and digital subtraction angiography (DSA) images. A total of 30 adult and 7 fetal human cadavers and 36 patients were examined with anatomical dissections, vascular casting and DSA. The number, diameter and angle of the BVs entering the SSS were measured and compared between the cadavers and DSA images. The results demonstrated that (1) the way a BV entered the SSS varied in three dimensions, and thus the BV dural entrance was difficult to precisely localize by DSA, (2) the distribution pattern of the dural entrance of the BVs into the SSS was relatively constant and a nontributary segment of the SSS was centered at the coronal suture and was identifiable by DSA, and (3) nearly all the BVs (97%, 561/581) entered the SSS at an angle opposite to the direction of blood flow. Unique anatomical features of the dural entrance of a BV into the SSS should be considered in neuroimaging interpretation of the sinus and its associated veins. (orig.)

Dural metastases from prostate carcinoma: A systematic review of the literature apropos of six patients

International Nuclear Information System (INIS)

Vasconcelos Sobreira Guedes, Bruno de; Rocha, Antonio Jose da; Pereira Pinto Gama, Hugo; Silva, Carlos Jorge da

2011-01-01

Intracranial metastases are a rare manifestation of prostate carcinoma and the dura mater is the most affected site. We report a series of six patients with dural prostate metastases (DPM) and perform a systematic review of the current literature in order to depict imaging trademarks of this condition. This review points to a magnetic resonance imaging (MRI) pattern of meningeal involvement characterized by a diffuse smooth thickening, nodular appearance or dural-based masses. We also demonstrate an osteoblastic pattern of lesions, particularly in sphenoid wing, by computed tomography (CT) scans. We suggest that these imaging findings may support an elevated index of suspicion of DPM in elderly men, including those patients without urologic symptoms.

Papel da lidocaína por via venosa no tratamento da dor na esclerodermia: relato de caso Papel de la lidocaína por vía venosa en el tratamiento del dolor en la esclerodermia: relato de un caso Intravenous lidocaine to treat scleroderma pain: case report

Directory of Open Access Journals (Sweden)

Durval Campos Kraychete

2003-12-01

Full Text Available JUSTIFICATIVA E OBJETIVOS: A esclerodermia ou esclerose sistêmica progressiva é uma doença sistêmica do tecido conjuntivo, de causa desconhecida, que costuma cursar com microangiopatia, isquemia de extremidades e dor intensa. O objetivo deste relato é descrever um caso do emprego de lidocaína por via venosa no tratamento da dor no curso de isquemia e enfatizar a possível ação antiinflamatória dos anestésicos locais nos pacientes com esclerodermia. RELATO DO CASO: Paciente do sexo feminino, 34 anos, auxiliar de enfermagem, portadora de esclerodermia há aproximadamente 8 anos, apresentava dor de elevada intensidade (escala numérica =10 nos membros superiores e inferiores, contínua, diária, acompanhada de alterações tróficas, da cor e da temperatura e pequenas úlceras nas extremidades. A paciente foi submetida a uma sessão semanal de lidocaína a 2% (400 mg sem vasoconstritor por via venosa durante 10 semanas com alívio da dor, do turgor, da elasticidade da pele e da perfusão periférica. CONCLUSÕES: O alívio da dor e de outros sintomas após a administração de lidocaína por via venosa sugere que os anestésicos locais podem modular a resposta inflamatória em vários estágios da esclerodermia.JUSTIFICATIVA Y OBJETIVOS: La esclerodermia o esclerosis sistémica progresiva es una enfermedad sistémica del tejido conjuntivo, de causa desconocida, que acostumbra acontecer con microangiopatía, isquemia de extremidades y dolor intenso. El objetivo de este relato es describir un caso del empleo de lidocaína por vía venosa en el tratamiento del dolor en el curso de isquemia y dar énfasis a una posible acción antiinflamatoria de los anestésicos locales en los pacientes con esclerodermia. RELATO DE CASO: Paciente del sexo femenino, 34 anos, auxiliar de enfermera, portadora de esclerodermia hace aproximadamente 8 años, presentaba dolor de elevada intensidad (escala numérica =10 en los miembros superiores e inferiores

Large capillary hemangioma of the temporal bone with a dural tail sign: A case report

KAUST Repository

YANG, GUANG

2014-05-13

The present study reports a rare case of large capillary hemangioma of the temporal bone with a dural tail sign. A 57-year-old female presented with pulsatile tinnitus and episodic vertigo associated with a ten-year history of an intermittent faint headache. Magnetic resonance imaging revealed a mass in the right petrous bone, which was hypointense on T1-weighted images and heterogeneously hyperintense on T2-weighted images, and showed a dural tail sign following gadolinium administration. Pre-operatively, this tumor was believed to be a meningioma. During surgery, the vascular tumor was removed by a modified pterional approach. A histopathological examination indicated that the tumor was a capillary hemangioma. Although intraosseous capillary hemangiomas are rare, they most frequently affect the temporal bone. Hemangiomas of the temporal bone may mimic other more common basal tumors. The diagnosis is most often made during surgical resection. The dural tail sign is not specific for meningioma, as it also occurs in other intracranial or extracranial tumors. The treatment of intratemporal hemangiomas is complete surgical excision, with radiotherapy used for unresectable lesions. To the best of our knowledge, the present study is the fourth case of intraosseous intracranial capillary hemangioma, but the largest intratemporal hemangioma to be reported in the literature to date.

Large capillary hemangioma of the temporal bone with a dural tail sign: A case report

KAUST Repository

YANG, GUANG; LI, CHENGUANG; CHEN, XIN; LIU, YAOHUA; HAN, DAYONG; Gao, Xin; KAWAMOTO, KEIJI; ZHAO, SHIGUANG

2014-01-01

The present study reports a rare case of large capillary hemangioma of the temporal bone with a dural tail sign. A 57-year-old female presented with pulsatile tinnitus and episodic vertigo associated with a ten-year history of an intermittent faint headache. Magnetic resonance imaging revealed a mass in the right petrous bone, which was hypointense on T1-weighted images and heterogeneously hyperintense on T2-weighted images, and showed a dural tail sign following gadolinium administration. Pre-operatively, this tumor was believed to be a meningioma. During surgery, the vascular tumor was removed by a modified pterional approach. A histopathological examination indicated that the tumor was a capillary hemangioma. Although intraosseous capillary hemangiomas are rare, they most frequently affect the temporal bone. Hemangiomas of the temporal bone may mimic other more common basal tumors. The diagnosis is most often made during surgical resection. The dural tail sign is not specific for meningioma, as it also occurs in other intracranial or extracranial tumors. The treatment of intratemporal hemangiomas is complete surgical excision, with radiotherapy used for unresectable lesions. To the best of our knowledge, the present study is the fourth case of intraosseous intracranial capillary hemangioma, but the largest intratemporal hemangioma to be reported in the literature to date.

Standardization and validation of a novel and simple method to assess lumbar dural sac size

International Nuclear Information System (INIS)

Daniels, M.L.A.; Lowe, J.R.; Roy, P.; Patrone, M.V.; Conyers, J.M.; Fine, J.P.; Knowles, M.R.; Birchard, K.R.

2015-01-01

Aim: To develop and validate a simple, reproducible method to assess dural sac size using standard imaging technology. Materials and methods: This study was institutional review board-approved. Two readers, blinded to the diagnoses, measured anterior–posterior (AP) and transverse (TR) dural sac diameter (DSD), and AP vertebral body diameter (VBD) of the lumbar vertebrae using MRI images from 53 control patients with pre-existing MRI examinations, 19 prospectively MRI-imaged healthy controls, and 24 patients with Marfan syndrome with prior MRI or CT lumbar spine imaging. Statistical analysis utilized linear and logistic regression, Pearson correlation, and receiver operating characteristic (ROC) curves. Results: AP-DSD and TR-DSD measurements were reproducible between two readers (r = 0.91 and 0.87, respectively). DSD (L1–L5) was not different between male and female controls in the AP or TR plane (p = 0.43; p = 0.40, respectively), and did not vary by age (p = 0.62; p = 0.25) or height (p = 0.64; p = 0.32). AP-VBD was greater in males versus females (p = 1.5 × 10 −8 ), resulting in a smaller dural sac ratio (DSR) (DSD/VBD) in males (p = 5.8 × 10 −6 ). Marfan patients had larger AP-DSDs and TR-DSDs than controls (p = 5.9 × 10 −9 ; p = 6.5 × 10 −9 , respectively). Compared to DSR, AP-DSD and TR-DSD better discriminate Marfan from control subjects based on area under the curve (AUC) values from unadjusted ROCs (AP-DSD p < 0.01; TR-DSD p = 0.04). Conclusion: Individual vertebrae and L1–L5 (average) AP-DSD and TR-DSD measurements are simple, reliable, and reproducible for quantitating dural sac size without needing to control for gender, age, or height. - Highlights: • DSD (L1-L5) does not differ in the AP or TR plane by gender, height, or age. • AP- and TR-DSD measures correlate well between readers with different experience. • Height is positively correlated to AP-VBD in both males and females. • Varying

Embolization of intracranial dural arteriovenous fistulas using PHIL liquid embolic agent in 26 patients

DEFF Research Database (Denmark)

Lamin, S.; Chew, H. S.; Chavda, S.

2017-01-01

BACKGROUND AND PURPOSE: The introduction of liquid embolic agents has revolutionized endovascular approach to cranial vascular malformations. The aim of the study was to retrospectively assess the efficacy and safety of Precipitating Hydrophobic Injectable Liquid (PHIL), a new nonadhesive liquid......: This was a retrospective multicenter study. Twenty-six consecutive patients with dural arteriovenous fistulas (de novo or previously treated) treated by injection of PHIL only or with PHIL in combination with other embolization products (such as Onyx or detachable coils) were included in the study. Recruitment started......, 3 were retreated with PHIL and 1 achieved angiographic cure. An adverse event was seen in 1 patient who developed worsening of preexisting ataxia due to acute thrombosis of the draining vein. CONCLUSIONS: PHIL appears to be safe and effective for endovascular treatment of cranial dural arteriovenous...

Guía de práctica clínica para la prevención, diagnóstico y tratamiento de la enfermedad tromboembólica venosa en el deporte

OpenAIRE

Drobnic, Franchek; Pineda, Antoni; Román Escudero, José; Soria, José Manuel; Souto, Joan Carles

2015-01-01

  El término enfermedad tromboembólica venosa se refiere a varios procesos patológicos, entre los que destacan la trombosis venosa profunda, el tromboembolismo pulmonar, la hipertensión pulmonar tromboembólica crónica y el síndrome postrombótico. La importancia en nuestro medio reside en que es una patología que precisa un periodo de recuperación largo, de 3 a 6 meses, y que un diagnóstico tardío o no bien realizado puede ocasionar una enfermedad más grave e incluso un desenlace fatal. Es dif...

Comparação entre nifedipina por via sublingual e clonidina por via venosa no controle de hipertensão arterial peri-operatória em cirurgias de catarata

Directory of Open Access Journals (Sweden)

Stocche Renato Mestriner

2002-01-01

Full Text Available JUSTIFICATIVA E OBJETIVOS: Estudo recente mostra que a clonidina por via venosa apresenta-se eficaz e segura no tratamento de crises hipertensivas durante cirurgia de catarata. Este estudo visa comparar o uso de nifedipina, droga amplamente utilizada por via sublingual, e clonidina por via venosa no controle da hipertensão arterial em cirurgias de catarata. MÉTODO: Setenta e cinco pacientes submetidos à facectomia foram distribuídos de forma aleatória e encoberta em: Grupo A, que recebeu nifedipina e Grupos C2 e C3, que receberam, respectivamente, 2 e 3 µg.kg-1 de clonidina por via venosa. Todos os pacientes apresentavam hipertensão arterial (PAS > 170 mmHg ou PAD > 110 mmHg. As PAS, PAD e freqüência cardíaca (FC foram medidas e comparadas nos momentos: 0 (antes do tratamento e de 2 em 2 minutos até o final do procedimento. Os eventos adversos foram anotados. RESULTADOS: Após o tratamento ocorreram diminuições da PAS e PAD nos 3 grupos (p <0,001. Houve controle da pressão arterial (<160 mmHg em 32%, 64% e 72% dos pacientes nos grupos A, C2 e C3, respectivamente (p < 0,05. No grupo C3 ocorreu maior incidência de efeitos colaterais que nos grupos C2 e A (p < 0,05. CONCLUSÕES:A clonidina por via venosa é mais eficaz que a nifedipina, por via sublingual, no controle de crises hipertensivas no peri-operatório de cirurgias de catarata. Contudo, a dose de 3 µg.kg-1 pode estar relacionada a efeitos colaterais, devendo-se iniciar o tratamento com 2 µg.kg-1.

Intracranial dural arterio-venous fistula presenting with progressive myelopathy.

LENUS (Irish Health Repository)

Ogbonnaya, Ebere Sunny

2011-01-01

Spinal dural arterio-venous fistula (DAVF) is rare and usually involves the thoracic segments. The classical presentation is a slowly progressive ataxia. Clinical presentation of intracranial DAVF depends on the site of the DAVF, as well as the vessels involved. Patients may present with pulsatile tinnitus, occipital bruit, headache, dementia, visual impairment as well as neurological deterioration distant from the DAVF as a result of venous hypertension and cortical haemorrhage. The authors present a rare case of progressive myelopathy secondary to an intracranial DAVF.

Four-dimensional computed tomography angiographic evaluation of cranial dural arteriovenous fistula before and after embolization.

Science.gov (United States)

Tian, Bing; Xu, Bing; Lu, Jianping; Liu, Qi; Wang, Li; Wang, Minjie

2015-06-01

This study aimed to evaluate the usefulness of four-dimensional CTA before and after embolization treatment with ONYX-18 in eleven patients with cranial dural arteriovenous fistulas, and to compare the results with those of the reference standard DSA. Eleven patients with cranial dural arteriovenous fistulas detected on DSA underwent transarterial embolization with ONYX-18. Four-dimensional CTA was performed an average of 2 days before and 4 days after DSA. Four-dimensional CTA and DSA images were reviewed by two neuroradiologists for identification of feeding arteries and drainage veins and for determining treatment effects. Interobserver and intermodality agreement between four-dimensional CTA and DSA were assessed. Forty-two feeding arteries were identified for 14 fistulas in the 11 patients. Of these, 36 (85.71%) were detected on four-dimensional CTA. After transarterial embolization, one patient got partly embolized, and the fistulas in the remaining 10 patients were completely occluded. The interobserver agreement for four-dimensional CTA and intermodality agreement between four-dimensional CTA and DSA were excellent (κ=1) for shunt location, identification of drainage veins, and fistula occlusion after treatment. Four-dimensional CTA images are highly accurate when compared with DSA images both before and after transarterial embolization treatment. Four-dimensional CTA can be used for diagnosis as well as follow-up of cranial dural arteriovenous fistulas in clinical settings. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Fate of the three embryonic dural sinuses in infants: the primitive tentorial sinus, occipital sinus, and falcine sinus.

Science.gov (United States)

Mizutani, Katsuhiro; Miwa, Tomoru; Akiyama, Takenori; Sakamoto, Yoshiaki; Fujiwara, Hirokazu; Yoshida, Kazunari

2018-03-01

The primitive tentorial, occipital, and falcine sinuses are thought to attain the adult pattern or regress between the fetal stage and adulthood. The anatomy of these three primitive dural sinuses has seldom been studied in the infant population, and it remains unclear when these dural sinuses reach the adult condition. Using computed tomography digital subtraction venography (CT-DSV), we analyzed the anatomy of these embryonic dural sinuses in infants. We included 13 infants who underwent CT-DSV prior to neurosurgery and 35 cases with unruptured cerebral aneurysms as normal adult controls. Three embryonic dural sinuses, i.e., the primitive tentorial, occipital, and falcine sinuses, were retrospectively analyzed in CT-DSV images of infants and adults. We also analyzed the drainage patterns of the superficial middle cerebral vein (SMCV), determined by the connection between the primitive tentorial sinus and the cavernous sinus. The primitive tentorial, occipital, and falcine sinuses were present in 15.4%, 46.2%, and none of the infants, respectively, and in 10.0, 8.6, and 2.9% of the adults, respectively. The difference in SMCV draining pattern between infants and adults was insignificant. The incidence of the occipital sinus was significantly higher in infants than in adults. The connection between the primitive tentorial sinus and the cavernous sinus appears to be established before birth. The occipital sinus is formed at the embryonic stage and mostly regresses after infancy. The falcine sinus is usually obliterated prenatally. Our findings form the basis for interventions by pediatric interventional neuroradiologists and neurosurgeons.

Progressive subcortical calcifications secondary to venous hypertension in an intracranial dural arteriovenous fistula.

Science.gov (United States)

Pascoe, Heather M; Lui, Elaine H; Mitchell, Peter; Gaillard, Frank

2017-05-01

Intracranial dural arteriovenous fistulas (dAVF) are acquired lesions, with the most commonly reported findings on CT haemorrhage or focal oedema. We describe a case of progressive subcortical calcification on CT secondary to venous hypertension from a high grade dAVF. Copyright © 2017 Elsevier Ltd. All rights reserved.

Anestesia venosa total (AVT) em lactente com doença de Werdnig-Hoffmann: relato de caso

OpenAIRE

Resende, Marco Antonio Cardoso de; Silva, Elizabeth Vaz da; Nascimento, Osvaldo José Moreira; Gemal, Alberto Esteves; Quintanilha, Giseli; Vasconcelos, Eliana Maria

2010-01-01

JUSTIFICATIVA E OBJETIVOS: A doença de Werdnig-Hoffmann é a causa mais comum de hipotonia no lactente e quando presente logo após o nascimento tem pior prognóstico. Fraqueza muscular simétrica, arreflexia e fasciculações da língua são característicos. A maioria dos lactentes morre antes dos dois anos por insuficiência respiratória. O presente relato apresenta um caso com técnica venosa total durante anestesia. RELATO DO CASO: Paciente feminina, branca, um ano, 10 kg, estado físico ASA III, co...

Aneurisma y fístula arterio-venosa renal: manejo quirúrgico laparoscópico asistido por robot

OpenAIRE

CASTILLO C,OCTAVIO A; CUENTAS J,MARIANO; VIDANGOS V,RUBÉN; GUTIÉRREZ,RODRIGO; PALAVECINO R,PATRICIO

2013-01-01

Introducción: Los aneurismas de la arteria renal constituyen una patología infrecuente, y plantean dificultades en la decisión terapéutica. Objetivo: Presentar un caso de un aneurisma complejo intrarenal, asociado a una fístula arterio-venosa de alto flujo, el cual fue resuelto con asistencia robótica. Caso clínico: Paciente de 51 años, con historia prolongada de hipertensión arterial, al cual, en estudio radiológico de rutina, se le diagnostica 3 aneurismas intrarenales derechos, asociado a ...

MR diagnosis of dural sinus thrombosis

International Nuclear Information System (INIS)

Rovira Canellas, A.; Turon Estrada, A.; Alvarez Sabin, J.; Lozano Sanchez, M.; Castano Duque, Ch.; Grive Isern, E.; Sumalla Sune, J.

1994-01-01

Four adult patients were diagnosed as having dural sinus thrombosis (DST) by means of magnetic resonance (MR). In the three cases of acute thrombosis, MR disclosed diffuse or segmental hyperintensity in the sinuses involved, which persisted regardless of the sequence and orientation of the plane selected. MR angiography (MRA) provided diagnostic information that proved useful in the chronic case, as well as in the two cases in which follow-up was carried out to determine the degree to which permeability was restored to the sinuses involved. MR diagnosis of DST can produce false positives and negatives, the causes of which should be known, as well as the ways to avoid them, in order to prevent diagnostic errors. MR, when applied and interpreted correctly, can be considered the first, and in many cases the only, choice as a diagnostic method in DST. (Author)

The influence of age on positions of the conus medullaris, Tuffier's line, dural sac, and sacrococcygeal membrane in infants, children, adolescents, and young adults.

Science.gov (United States)

Jung, Ji-Yun; Kim, Eun-Hee; Song, In-Kyung; Lee, Ji-Hyun; Kim, Hee-Soo; Kim, Jin-Tae

2016-12-01

The purpose of this study was to analyze the distances between the conus medullaris and the Tuffier's line, and between the dural sac and the sacrococcygeal membrane (SCM) in the same pediatric population. Spinal magnetic resonance images and simple X-ray images of 350 patients aged from 1 month to 20 years were reviewed. Positions of the conus medullaris, Tuffier's line, the dural sac, and the SCM were identified. Each position was recorded in relation to the corresponding vertebral body segments. The distances between the conus medullaris and Tuffier's line, and between the dural sac and the SCM, were measured and then assessed according to age using an analysis of variance and a linear regression analysis. The median levels of the conus medullaris and Tuffier's line were in the lower third of L1 [the first lumbar vertebral body] and the middle third of L5, respectively. The levels of the conus medullaris and Tuffier's line were lower in younger populations. The distance between the conus medullaris and Tuffier's line ranged from 1.5 to 4.75 vertebral body height. However, a narrow range of 1.5-2.5 vertebral height was observed only in children younger than 2 years. The level of the dural sac did not differ greatly by age, but the upper limit of the SCM was lower in older populations. The distance between the dural sac and the upper limit of the SCM increased with age. In children, there is a distance of 1.5-4.75 vertebral body height between the conus medullaris and the Tuffier's line. However, these distances were narrower among younger populations. The distance between the dural sac and the upper limit of the SCM increased with age. © 2016 John Wiley & Sons Ltd.

Anestesia venosa total para laringectomia parcial em paciente na 28ª semana de gestação: relato de caso Anestesia venosa total para laringectomía parcial en paciente en la 28ª semana de embarazo: relato de caso Total intravenous anesthesia for partial laryngectomy in 28 weeks pregnant patient: case report

Directory of Open Access Journals (Sweden)

José Costa

2005-04-01

Full Text Available JUSTIFICATIVA E OBJETIVOS: Uma anestesia para paciente gestante constitui um desafio ao anestesiologista em virtude dos riscos para a mãe e para o feto. São muitas as complicações descritas pela literatura como malformações fetais, parto prematuro, instabilidade hemodinâmica materna e até morte fetal. O objetivo deste caso é mostrar uma paciente gestante de 28 semanas, submetida a laringectomia parcial sob anestesia geral venosa total com propofol, remifentanil e cisatracúrio. RELATO DO CASO: Paciente com 29 anos, 59 kg, primigesta de 28 semanas com diagnóstico prévio de carcinoma epidermóide próximo à corda vocal direita, sendo indicada laringectomia. A monitorização inicial constituiu-se de pressão arterial não-invasiva e invasiva, cardioscopia, oxicapnografia e cardiotocografia contínua realizada pela obstetra. Punção venosa no membro superior direito e membro superior esquerdo com cateter 16G e 18G, respectivamente. Foram administrados por via venosa midazolam (1 mg, cefazolina (1 g, metoclopramida (10 mg e dipirona (1 g. A paciente recebeu oxigênio a 100% sob máscara por 3 minutos e indução venosa foi feita com o uso de propofol em infusão na dose alvo de 3 µg.mL-1 e remifentanil contínuo (1 µg.kg-1 em bolus e 0,2 µg.kg-1.min-1 de manutenção. Como bloqueador neuromuscular, foi administrado cisatracúrio (13 mg e procedeu-se a intubação traqueal com tubo 6,5 mm aramado com balonete. Foi mantida em plano anestésico com propofol e remifentanil em bomba, além de complementações de cisatracúrio. O feto permaneceu monitorizado continuamente com cardiotocografia realizada e analisada pela obstetra. Após o término da cirurgia foram desligadas as bombas infusoras de propofol e remifentanil, tendo a paciente despertado 10 minutos depois. Acordou sem dor e hemodinamicamente estável, sendo então encaminhada à sala de recuperação pós-anestésica. CONCLUSÕES: A anestesia venosa total com propofol e

Avaliação da memória sob anestesia venosa total

Directory of Open Access Journals (Sweden)

Gulistan Aktas

2013-06-01

Full Text Available JUSTIFICATIVA E OBJETIVOS: Neste estudo, objetivamos avaliar a memória implícita e explícita em pacientes submetidos à cirurgia abdominal sob anestesia venosa total (AVT com propofol e remifentanil, na qual o nível de anestesia foi controlado pelo monitoramento do índice bispectral (BIS. MÉTODO: Anestesia venosa total foi administrada a 60 pacientes adultos para obter níveis de BIS de 40-60. Os pacientes foram randomicamente divididos em três grupos, de acordo com as gravações que ouviram. Os pacientes do grupo categoria (CT ouviram uma fita gravada contendo cinco nomes de animais. Os pacientes do grupo recordar palavras (RP ouviram uma fita gravada contendo cinco palavras de frequência média na língua turca, depois de adaptadas. Os pacientes do grupo controle (GC ouviram os sons do mar até o fim da cirurgia. Duas horas após a cirurgia, os testes foram administrados a cada paciente na sala de recuperação para avaliar a memória. RESULTADOS: Houve uma diferença entre os escores dos grupos CT e GC no Miniexame do Estado Mental (MMSE; todos os escores foram > 20. Os resultados dos testes de categoria e recordar palavras, aplicados para avaliar a memória implícita, não foram estatisticamente diferentes entre os grupos. Não houve evidência de memória implícita em nenhum dos pacientes. Um paciente lembrou-se de ouvir "o som de água" como uma prova de memória explícita. Onze pacientes declararam não ter sonhado. CONCLUSÕES: Apesar de não termos encontrado nenhuma evidência de memória implícita sob anestesia adequada com AVT, um paciente apresentou memória explícita. Embora a profundidade adequada da anestesia fornecida pelo monitoramento do BIS corrobore nossos resultados para a memória implícita, ela não explica os resultados para a memória explícita.

The internal vertebral venous plexus prevents compression of the dural sac during atlanto-axial rotation

Energy Technology Data Exchange (ETDEWEB)

Reesink, E.M.; Lataster, L.M.A.; Mameren, H. van [Dept. of Anatomy/Embryology, Maastricht Univ. (Netherlands); Wilmink, J.T. [Dept. of Radiology, University Hospital Maastricht (Netherlands); Kingma, H. [Dept. of ENT, University Hospital Maastricht (Netherlands)

2001-10-01

Deformation of the extradural space and the possibility of impression upon the dural sac during atlanto-axial rotation are investigated. Atlanto-axial rotation leads to a reduction in the cross-sectional area of the bony spinal canal of approximately 40 %. Atlanto-axial rotation was recorded by endocanalar views from a video camera fixed inside the skull of six unembalmed cadavers. Axial thin-section T1-weighted MRI slice sets were acquired from three volunteers (mid-position and maximal left and right rotation of the head and cervical spine). The axial cross-sectional areas of the bony spinal canal, dural sac and spinal cord were measured. In two other persons post-gadolinium contrast-enhanced T1-weighted MRI volume scans with fat-suppression prepulse were acquired (mid-position and rotation) to determine venous contents of the extradural space. The 50:50 ratio between left and right extradural halves in mid-position changed to an ipsilateral:contralateral ratio of 20:80 in maximum rotation at the level just above the lateral C1-C2 joints. Directly below these joints the opposite occurred. The post-contrast studies showed an enhancing internal vertebral venous plexus (IVVP), which almost completely occupied the extradural space at the atlanto-axial level. This could not be shown in the cadaver experiments, because of absence of blood and cerebrospinal fluid (CSF) pressure. During atlanto-axial rotation blood displacement in the IVVP allows major deformations of the extradural space. This prevents dural sac impression. (orig.)

Dural Ectasia of the Optic Nerve and Unilateral Proptosis-Two Rare Comorbidities Associated with Idiopathic Intracranial Hypertension

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Serkan Dağdelen

2013-08-01

Full Text Available A 24-year-old woman with a recent history of visual abnormality (obscurations had bilateral optic disc swellings, dilatation of the optic nerve sheaths, monocular proptosis, and increased cerebrospinal fluid pressures. She was diagnosed as idiopathic intracranial hypertension (IIH. IIH can present with both papilledema and dural ectasia although the latter is usually seen as an isolated entity. Various conditions also have been implicated in IIH. However, apart from female sex, recent weight gain and obesity, there are no proven associations. In this case report, we present a case of IHH associated with two different pathologies: dural ectasia of the optic nerve sheaths and monocular proptosis. (Turk J Ophthalmol 2013; 43: 297-300

Anastomose entre artéria carótida externa e artéria vertebral em dois casos de trombose de artéria carótida interna

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Pedro H. Longo

1958-12-01

Full Text Available São apresentados dois casos com trombose de carótida interna, com anastomose entre as artérias occipital e vertebral. São tecidas considerações sôbre a possível eficácia da suplência por essa via e sôbre o estabelecimento dessa anastomose, particularmente em relação ao primeiro dos casos em que foi feito estudo angiográfico bastante extenso. Revendo a bibliografia até a presente data, os autores só encontraram o registro de três casos semelhantes, documentados angiográficamente.

The entire dural sinus tree is compressed in patients with idiopathic intracranial hypertension: a longitudinal, volumetric magnetic resonance imaging study

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Rohr, Axel; Bindeballe, Jan; Riedel, Christian; Jansen, Olav [University Clinic of Schleswig-Holstein Campus Kiel, Department of Neuroradiology, Kiel (Germany); Baalen, Andreas van [University Clinic of Schleswig-Holstein Campus Kiel, Department of Neuropediatrics, Kiel (Germany); Bartsch, Thorsten [University Clinic of Schleswig-Holstein Campus Kiel, Department of Neurology, Kiel (Germany); Doerner, Lutz [University Clinic of Schleswig-Holstein Campus Kiel, Department of Neurosurgery, Kiel (Germany)

2012-01-15

The objective of this study was to explore the volumetric alterations of dural sinuses in patients with idiopathic intracranial hypertension (IIH). Standardized cranial magnetic resonance imaging (MRI) was used in 17 patients prior to and following treatment of IIH and in seven controls. Magnetic resonance venographies (MRV) were employed for (a) judgement of circumscript dural sinus stenoses and (b) computation of sinus volumes. Cross-sectional areas (CSA) of the superior sagittal sinuses (SSS) were measured on T2-weighted images. Results of the initial MRIs were compared to those on follow-up MRIs and to results of controls. Stenoses of the transverse sinuses (TS) resulting in cranial venous outflow obstruction (CVOO) were present in 15/17 (88%) patients, normalizing in 7/15 cases (47%) after treatment of IIH. CVOO was not detected in the control group. Segmentation of MRV revealed decreased dural sinus volumes in patients with IIH as compared to controls (P = 0.018). Sinus volumes increased significantly with normalization of intracranial pressure independent from disappearing of TS stenoses (P = 0.007). The CSA of the SSS were normal on the initial MRIs of patients with IIH and increased on follow-up after treatment (P < 0.001). However, volumetries displayed overlap in patients and controls. Patients with IIH not only exhibit bilateral stenoses of the TS as has been reported, but volume changes of their entire dural sinus system also occur. The potential etiopathological and diagnostic roles of these changes are discussed. (orig.)

Anestesia venosa total (AVT em lactente com doença de Werdnig-Hoffmann: relato de caso Anestesia venosa total (AVT en lactante con enfermedad de Werdnig-Hoffmann: relato de caso Total intravenous anesthesia (TIVA in an infant with Werdnig-Hoffmann disease: case report

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Luis Otavio Esteves

2010-10-01

Full Text Available Foi com grande interesse que li o artigo "Anestesia Venosa Total (AVT em Lactente com Doença de Werdnig-Hoffmann. Relato de Caso", de Resende e col. ¹, publicado nesta revista. Gostaria, em primeiro lugar, de parabenizar os autores pela iniciativa. Entretanto, dois pontos me chamaram a atenção. O primeiro refere-se à definição de lactente, a qual compreende o período de 1 a 12 meses de idade. A partir de 12 meses, define-se como pré-escolar ou apenas criança. No artigo, o autor coloca a idade do paciente como 1 ano, mas não especifica meses ou dias. Provavelmente, esse paciente tem mais de 12 meses, sendo, dessa forma, a definição de lactente inadequada. O segundo e mais importante ponto diz respeito à técnica usada e ao título do artigo. No título, utilizou-se a expressão "anestesia venosa total", mas no relato foi dito que, além de propofol e remifentanil, a anestesia foi mantida com oxigênio e N2O. Se foi usado um gás com propriedades anestésicas (N2O, não seria correto classificar essa técnica como venosa total. Além disso, ele cita o artigo de Crawford e col. ², que definiu doses de remifentanil para intubação em crianças. Esse estudo foi realizado utilizando-se oxigenação na concentração de 100%, pois os autores provavelmente entendem que a adição de gases com propriedades anestésicas interferiria nos resultados obtidosFue con un gran interés que leí el artículo "Anestesia Venosa Total (AVT en Lactante con Enfermedad de Werdnig-Hoffmann. Relato de Caso", de Resende y col. ¹, publicado en esta revista. Y de hecho quiero, en primer lugar, felicitar a los autores por la iniciativa. Sin embargo, dos puntos me llamaron la atención. El primero, se refiere a la definición de lactante, la cual abarca el período de 1 a 12 meses de edad. A partir de los 12 meses, se define como preescolar o apenas como niño. En el artículo, el autor coloca la edad del paciente como de 1 año, pero no especifica meses o d

Vena cava filters in cancer patients: experience with 50 patients Filtros de veia cava inferior em pacientes com câncer: experiência em 50 casos

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Antonio Eduardo Zerati

2005-10-01

Full Text Available OBJECTIVE: To study the immediate and late results obtained from the implantation of vena cava filters in cancer patients with deep vein thrombosis concomitant with neoplasia. METHODS: This was a retrospective evaluation of 50 patients with an association of cancer and deep venous thrombosis who underwent interruption of the inferior vena cava and the insertion of permanent vena cava filters. The indications for the procedure, filter implantation technique, early and late complications related to the operation, and the clinical evolution were evaluated. RESULTS: The most frequent indication for filter implantation was the contraindication for full anticoagulant treatment (80%. The femoral vein was the preferred access route (86% of the patients. There were no complications related to the surgical procedure. During the follow-up, the following complications were observed: 1 episode of nonfatal pulmonary thromboembolism, 2 cases of occlusion of the inferior vena cava, and 1 case of thrombus retained in the device. Twenty patients (40% died due to progression of the neoplasm. CONCLUSIONS: Interruption of the inferior cava vein using an endoluminal filter is a procedure with a low rate of complications. It is a safe and efficient measure for preventing pulmonary embolism in cancer patients who have deep vein thrombosis of the lower limbs.OBJETIVO: Estudar os resultados imediatos e tardios obtidos com a implantação de filtros de veia cava inferior em pacientes com trombose venosa profunda concomitante a neoplasia. MÉTODOS: Avaliamos retrospectivamente 50 pacientes com câncer e trombose venosa profunda associada submetidos a interrupção de veia cava inferior com filtros intraluminais definitivos. Foram estudados aspectos referentes à indicação do procedimento, à técnica de implante dos dispositivos, complicações precoces e tardias relacionadas à operação e à evolução dos pacientes. RESULTADOS: A indicação mais freqüente para o

Dural arteriovenous fistula presenting with exophthalmos and seizures.

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Feyissa, Anteneh M; Ponce, Lucido L; Patterson, Joel T; Von Ritschl, Rudiger H; Smith, Robert G

2014-03-15

Concomitant seizures and exophthalmos in the context of a temporal dural arteriovenous fistula (dAVF) has not been described before. Here, we report a 55-year-old-male who presented with an 8-month history of progressive painless exophthalmos of his left eye, conjunctival chemosis, reduced vision and new onset complex partial seizures. Cerebral angiography demonstrated Cognard Type IIa left cerebral dAVF fed by branches from the left occipital artery and an accessory meningeal artery, with drainage to the superior ophthalmic vein. Following surgical obliteration of dAVF feeding vessels, our patient had dramatic improvement in visual acuity, proptosis and chemosis along with cessation of clinical seizures. Published by Elsevier B.V.

Formações venosas superficiais da fossa cubital: aspectos de interesse para a prática da Enfermagem Formaciones venosas superficiales de la fosa cubital: aspectos de interés para la práctica de Enfermería Superficial venous formation of the cubital fossa: aspects of interest for nursing practice

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Nilton Alves

2012-12-01

Full Text Available O objetivo deste estudo é contribuir para o conhecimento que auxilie o profissional de enfermagem na identificação dos tipos mais comuns de formações venosas da região da fossa cubital e, ainda, enfocar a importância de estar sempre atento aos casos pouco comuns como o aqui relatado. Através de uma revisão bibliográfica, constatamos que as formações venosas dessa região podem ser classificadas em 5 tipos mais comuns, sendo o tipo II o mais frequente. Constatamos ainda, que a VICo é o local de punção mais indicado, seguido pela VIB. Descrevemos também uma variação anatômica, onde observamos ausência de comunicação entre VC e VB no nível da fossa cubital e VIA drenando na VB, estando presente a VCA.El objetivo de esta investigación es contribuir al conocimiento que auxilie al profesional de enfermería en la identificación de los tipos más comunes de formaciones venosas de la fosa cubital, además de advertir sobre la importancia de fijar la atención a los casos poco comunes, como lo aquí reportado. A través de la revisión bibliográfica, clasificamos las formaciones venosas de esta región en cinco tipos más comunes, siendo lo más frecuente el Tipo II. La utilización de la VICo se recomienda como el mejor sitio de punción, seguido por la VIB. Además, describimos una variación anatómica, donde se observó la ausencia de comunicación entre VC y VB a nivel de fosa cubital y VIA drenando en VB, con presencia de la VCA.The aim of this study is to contribute to the knowledge to assists the nursing staff to identify the most common types of venous formations of the cubital fossa region, and also focus on the importance of always being alert to unusual cases as that reported here. Through a literature review, we found that the venous formations of this region can be classified into five common types, bring the Type II the was most frequent. We also found that MCV is considered the best puncture site, followed by MBV

Controversias sobre la enfermedad tromboembólica venosa no provocada en ancianos

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Mónica Ríos-Prego

2016-12-01

Full Text Available La forma no provocada de enfermedad tromboembólica venosa (ETV representa aproximadamente la mitad de los casos de esta patología en ancianos. Como lo demuestran de forma reiterada diferentes trabajos epidemiológicos, es en mayores de 80 años donde la incidencia de la ETV es mayor. Ante la falta de estudios sobre ETV no provocada en ancianos, las recomendaciones sobre tratamiento de esta patología se extrapolan a partir de pacientes más jóvenes. Lo mismo sucede con las reglas de predicción de sangrado y recurrencias. Se dispone en la actualidad de nuevos fármacos anticoagulantes con igual efectividad y mayor seguridad que el tratamiento convencional; aunque la experiencia en ancianos es escasa. Esperamos que los estudios que se publicarán en el futuro (TEVIS, ExACT, ETV-GA nos ayuden a resolver dudas que aún tenemos en este campo.

Dural attachment of intracranial meningiomas: evaluation with contrast-enhanced three-dimensional fast imaging with steady-state acquisition (FIESTA) at 3 T

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Yamamoto, Junkoh; Takahashi, Mayu; Aoyama, Yuichi; Soejima, Yoshiteru; Saito, Takeshi; Akiba, Daisuke; Nishizawa, Shigeru [University of Occupational and Environmental Health, Department of Neurosurgery, Kitakyusyu (Japan); Kakeda, Shingo; Korogi, Yukunori [University of Occupational and Environmental Health, Department of Radiology, Kitakyusyu (Japan)

2011-06-15

The purpose of this study was to evaluate the role of contrast-enhanced fast imaging with steady-state acquisition (CE-FIESTA) for assessing whether dural attachment in intracranial meningiomas is adhesive or not by correlation with intraoperative findings. Fourteen consecutive patients who were candidates for surgical treatment of meningiomas were prospectively analyzed with preoperative magnetic resonance imaging, including CE-FIESTA at 3 T. First, two neuroradiologists assessed several characteristics of the attachment of the meningioma to the dura mater or skull base on CE-FIESTA images. Second, the surgical findings of adhesion at the dural attachment of meningiomas were evaluated by two neurosurgeons. Finally, the CE-FIESTA findings were correlated with the surgical findings by one neurosurgeon and one neuroradiologist by consensus. CE-FIESTA clearly depicted a hypointense marginal line at the attachment site of the meningioma. When CE-FIESTA revealed smooth marginal lines or hyperintense zones along the marginal lines, tumors were detached easily from the dura mater. On the contrary, when CE-FIESTA showed an irregularity, such as partial disruption of the marginal lines, vessels, or bony hyperostosis, the tumors tended to adhere firmly to the dura mater, which was found to contain small vessels and fine fibrous tissues. There seems to be an excellent correlation between the characteristics of dural attachment of meningiomas on CE-FIESTA images and intraoperative findings. Therefore, for operative planning, CE-FIESTA may provide useful information regarding the adhesiveness of dural attachment. (orig.)

Dural attachment of intracranial meningiomas: evaluation with contrast-enhanced three-dimensional fast imaging with steady-state acquisition (FIESTA) at 3 T

International Nuclear Information System (INIS)

Yamamoto, Junkoh; Takahashi, Mayu; Aoyama, Yuichi; Soejima, Yoshiteru; Saito, Takeshi; Akiba, Daisuke; Nishizawa, Shigeru; Kakeda, Shingo; Korogi, Yukunori

2011-01-01

The purpose of this study was to evaluate the role of contrast-enhanced fast imaging with steady-state acquisition (CE-FIESTA) for assessing whether dural attachment in intracranial meningiomas is adhesive or not by correlation with intraoperative findings. Fourteen consecutive patients who were candidates for surgical treatment of meningiomas were prospectively analyzed with preoperative magnetic resonance imaging, including CE-FIESTA at 3 T. First, two neuroradiologists assessed several characteristics of the attachment of the meningioma to the dura mater or skull base on CE-FIESTA images. Second, the surgical findings of adhesion at the dural attachment of meningiomas were evaluated by two neurosurgeons. Finally, the CE-FIESTA findings were correlated with the surgical findings by one neurosurgeon and one neuroradiologist by consensus. CE-FIESTA clearly depicted a hypointense marginal line at the attachment site of the meningioma. When CE-FIESTA revealed smooth marginal lines or hyperintense zones along the marginal lines, tumors were detached easily from the dura mater. On the contrary, when CE-FIESTA showed an irregularity, such as partial disruption of the marginal lines, vessels, or bony hyperostosis, the tumors tended to adhere firmly to the dura mater, which was found to contain small vessels and fine fibrous tissues. There seems to be an excellent correlation between the characteristics of dural attachment of meningiomas on CE-FIESTA images and intraoperative findings. Therefore, for operative planning, CE-FIESTA may provide useful information regarding the adhesiveness of dural attachment. (orig.)

[Ropivacaine use in transnasal sphenopalatine ganglion block for post dural puncture headache in obstetric patients - case series].

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Furtado, Inês; Lima, Isabel Flor de; Pedro, Sérgio

2018-02-02

Sphenopalatine ganglion block is widely accepted in chronic pain; however it has been underestimated in post dural puncture headache treatment. The ganglion block does not restore normal cerebrospinal fluid dynamics but effectively reduces symptoms associated with resultant hypotension. When correctly applied it may avoid performance of epidural blood patch. The transnasal approach is a simple and minimally invasive technique. In the cases presented, we attempted to perform and report the ganglion block effectiveness and duration, using ropivacaine. We present four obstetrics patients with post dural puncture headache, after epidural or combined techniques, with Tuohy needle 18G that underwent a safe and successful Sphenopalatine ganglion block. We performed the block 24-48h after dural puncture, with 4mL of ropivacaine 0.75% in each nostril. In three cases pain recurred within 12-48h, although less intense. In one patient a second block was performed with complete relief and without further recurrence. In the other two patients a blood patch was performed without success. All patients were asymptomatic within 7 days. The average duration of analgesic effect of the block remains poorly defined. In the cases reported, blocking with ropivacaine was a simple, safe and effective technique, with immediate and sustained pain relief for at least 12-24h. Copyright © 2017 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

Anestesia venosa total para laringectomia parcial em paciente na 28ª semana de gestação: relato de caso

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Costa, José; Mendes, Dalva Maria Carvalho; Lobo, José Eduardo de Oliveira; Furuguem, Adriana Barrozo Ribeiro; Santos, Gabriel Gilberto

2005-01-01

JUSTIFICATIVA E OBJETIVOS: Uma anestesia para paciente gestante constitui um desafio ao anestesiologista em virtude dos riscos para a mãe e para o feto. São muitas as complicações descritas pela literatura como malformações fetais, parto prematuro, instabilidade hemodinâmica materna e até morte fetal. O objetivo deste caso é mostrar uma paciente gestante de 28 semanas, submetida a laringectomia parcial sob anestesia geral venosa total com propofol, remifentanil e cisatracúrio. RELATO DO CASO:...

Uso do ultra-som para punção venosa central em paciente obeso com adenomegalia cervical

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Jaderson Wollmeister

2008-08-01

Full Text Available JUSTIFICATICA E OBJETIVOS: As técnicas clássicas para punção venosa central são realizadas com base em referências anatômicas de superfície e conhecimento da anatomia vascular da região em que se realizará a punção. O uso do ultra-som permite a realização da punção sob visão direta das estruturas vasculares, peri-vasculares e da agulha de punção. O objetivo deste relato foi descrever o uso do ultra-som no auxílio de acesso venoso central em paciente obeso e com adenomegalias. RELATO DO CASO: Paciente do sexo masculino, branco, 28 anos, 1,70 m, 120 kg, com diagnóstico de linfoma de Hodgkin esclerose nodular. Solicitado ao Serviço de Anestesiologia do Hospital Governador Celso Ramos, punção de veia jugular interna direita guiada por ultra-som devido à presença de gânglio supraclavicular que prejudicava a referência anatômica de punção e à obesidade do paciente. Após a obtenção da melhor imagem a veia jugular interna esquerda foi puncionada e colocado um cateter venoso de triplo lúmen. A punção foi única, com progressão fácil do cateter e realizada sem complicações. CONCLUSÕES: O uso da ultra-sonografia para punção venosa central pode evitar complicações tornando o procedimento mais seguro para o paciente.

Utility of the magnetic resonance in the evaluation of the dural sinus occlusive disease

International Nuclear Information System (INIS)

Delgado, Jorge Andres; Toro, Nancy; Bolivar, Guillermo; Pulgarin, Luis German

1998-01-01

The dural sinus occlusive disease is potentially fatal (20-78% cases) and of unspecific clinical symptoms. CT sensibility is only 75% and angiography is invasive. The MRI offers several advantages in the diagnosis due to its high sensibility to flow, high intrinsic contrast and no invasively. The MRI findings in 7 cases are described

Widening of the spinal canal and dural ectasia in Marfan's syndrome: assessment by CT

International Nuclear Information System (INIS)

Villeirs, G.M.; Verstraete, K.L.; Kunnen, M.F.; Tongerloo, A.J. van; Paepe, A.M. de

1999-01-01

We describe a method for diagnosing dural ectasia (DE) and spinal canal widening (SCW) using CT. We examined 23 patients with Marfan's syndrome (MFS), 17 with Ehlers-Danlos syndrome (EDS) and 29 normal subjects, using six axial slices at the level of the L1-S1 pedicles. Transverse diameters of the vertebral bodies, spinal canal and dural sac were measured and indices were defined to differentiate patients with DE and SCW from normal. Statistical significance was assessed using Student's t -test, χ 2 -test and Pearson's correlation coefficient. DE and SCW occurred in 69.6 % and 60.9 % of cases of MFS and in 23.5 % and 35.3 % of EDS respectively. In MFS, prevalence was significantly higher than in the control group. DE was significantly more frequent in MFS than in EDS. A strong correlation existed between DE and SCW in MFS and the control group, but not in EDS. Our system enables quantitative assessment of SCW and DE. The latter is particularly important in subjects suspected of having MFS, in whom it is a common and characteristic sign. (orig.)

A importância de reconhecer a síndrome antifosfolípide na medicina vascular

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Andreas Funke

Full Text Available Resumo A síndrome antifosfolipíde (SAF é uma doença autoimune sistêmica caracterizada por trombose arterial ou venosa recorrente e/ou morbidade gestacional e pela presença dos anticorpos antifosfolipídeos, podendo apresentar outras manifestações vasculares, como microangiopatia, arteriopatia crônica e SAF catastrófica. Determinados testes laboratoriais para a síndrome (por exemplo, o anticoagulante lúpico podem sofrer interferência do uso de medicações anticoagulantes, dificultando o diagnóstico. A fisiopatologia da SAF é complexa, sendo enumerados no texto diversos mecanismos patogênicos relacionados à coagulação, ao endotélio e às plaquetas. Por fim, discutimos o tratamento da SAF de acordo com a presença e o tipo de manifestações clínicas, o uso dos anticoagulantes orais diretos e o manejo perioperatório de pacientes com SAF.

Indocyanine green videoangiography "in negative": definition and usefulness in intracranial dural arteriovenous fistulae.

Science.gov (United States)

Simal Julián, Juan Antonio; Miranda Lloret, Pablo; Aparici Robles, Fernando; Beltrán Giner, Andrés; Botella Asunción, Carlos

2013-09-01

Indocyanine green videoangiography (IGV) raises important limitations when we use it in vascular pathology, especially in cases with arterialization of the venous system such as arteriovenous malformations and fistulae. Our objective was to provide a simple procedure that overcomes the limitations of conventional IGV. We define IGV in negative (IGV-IN), so-called because, in its first phase, the vessel to analyze is clipped, and we report 3 cases of intracranial dural arteriovenous fistulae treated with this procedure. In 2011, we applied IGV-IN to 3 patients at our center with Borden type III intracranial arteriovenous fistulae. In all 3 cases, IGV-IN enabled both diagnosis and post-dural arteriovenous fistula exclusion control in 1 integrated procedure no longer than 1 minute, requiring only 1 visualization. IGV-IN is an improvement over the conventional IGV method and is able to provide more information in a shorter period of time. It is an intuitive and highly visual procedure, and, more importantly, it is reversible. Studies with larger samples are necessary to determine whether IGV-IN can further reduce the need for postoperative digital subtraction angiography.

Dural venous sinuses distortion and compression with supratentorial mass lesions: a mechanism for refractory intracranial hypertension?

Science.gov (United States)

Qureshi, Adnan I.; Qureshi, Mushtaq H.; Majidi, Shahram; Gilani, Waqas I.; Siddiq, Farhan

2014-01-01

Objective To determine the effect of supratentorial intraparenchymal mass lesions of various volumes on dural venous sinuses structure and transluminal pressures. Methods Three set of preparations were made using adult isolated head derived from fresh human cadaver. A supratentorial intraparenchymal balloon was introduced and inflated at various volumes and effect on dural venous sinuses was assessed by serial intravascular ultrasound, computed tomographic (CT), and magnetic resonance (MR) venograms. Contrast was injected through a catheter placed in sigmoid sinus for both CT and MR venograms. Serial trasluminal pressures were measured from middle part of superior sagittal sinus in another set of experiments. Results At intraparenchymal balloon inflation of 90 cm3, there was attenuation of contrast enhancement of superior sagittal sinus with compression visualized in posterior part of the sinus without any evidence of compression in the remaining sinus. At intraparenchymal balloon inflation of 180 and 210 cm3, there was compression and obliteration of superior sagittal sinus throughout the length of the sinus. In the coronal sections, at intraparenchymal balloon inflations of 90 and 120 cm3, compression and obliteration of the posterior part of superior sagittal sinus were visualized. In the axial images, basal veins were not visualized with intraparenchymal balloon inflation of 90 cm3 or greater although straight sinus was visualized at all levels of inflation. Trasluminal pressure in the middle part of superior sagittal sinus demonstrated a mild increase from 0 cm H2O to 0.4 cm H2O and 0.5 cm H2O with inflation of balloon to volume of 150 and 180 cm3, respectively. There was a rapid increase in transluminal pressure from 6.8 cm H2O to 25.6 cm H2O as the supratentorial mass lesion increased from 180 to 200 cm3. Conclusions Our experiments identified distortion and segmental and global obliteration of dural venous sinuses secondary to supratentorial mass lesion and

The anterior medullary-anterior pontomesencephalic venous system and its bridging veins communicating to the dural sinuses: normal anatomy and drainage routes from dural arteriovenous fistulas

International Nuclear Information System (INIS)

Kiyosue, Hiro; Tanoue, Shuichi; Sagara, Yoshiko; Okahara, Mika; Kashiwagi, Junji; Mori, Hiromu; Hori, Yuzo; Nagatomi, Hirofumi

2008-01-01

We evaluated the normal venous anatomy of the anterior medullary/anterior pontomesencephalic venous (AMV/APMV) system and bridging veins connected to the dural sinuses using magnetic resonance (MR) imaging and demonstrated cases of dural arteriovenous fistulas (DAVFs) with bridging venous drainage. MR images obtained using a 3D gradient echo sequence in 70 patients without lesions affecting the deep or posterior venous channels were reviewed to evaluate the normal anatomy of the AMV/APMV system and bridging veins. MR images and digital subtraction angiography in 80 cases with intracranial or craniocervical junction DAVFs were reviewed to evaluate the bridging venous drainage from DAVFs. MR images clearly revealed AMV/APMV in 35 cases. Fifteen cases showed a direct connection between AMV and APMV, while 15 cases showed an indirect communication via the transverse pontine vein or the bridging vein. In the five remaining cases, the AMV and APMV end separately to the bridging vein or the transverse pontine vein. Bridging veins were identified in 34 cases, connecting to the cavernous sinus in 33, to the suboccipital cavernous sinus in 11, and the inferior petrosal sinus in five cases. In 80 DAVF cases, seven of 40 cavernous sinus DAVFs, two craniocervical junction DAVFs, and one inferior petrosal sinus DAVF drained via bridging veins to the brain stem. The AMV/APMV and bridging veins showed various anatomies and frequently showed a connection to the cavernous sinus. Knowledge of the venous anatomy is helpful for the diagnosis and intravascular treatment of DAVFs. (orig.)

Is there a dural wall between the cavernous sinus and the pituitary fossa? Anatomical and MRI findings

International Nuclear Information System (INIS)

Dietemann, J.L.; Diniz, R.; Reis, M. Jr.; Neugroschl, C.; Vinclair, L.; Maillot, C.

1998-01-01

We compared MRI studies of the sellar area and embryological and adult histological studies of the cavernous sinuses and pituitary fossa. MRI studies were performed in 50 normal subjects with coronal sections using a fast inversion-recovery sequence to demonstrate the dural walls of the cavernous sinus and pituitary fossa. With this sequence, dura mater appears as a high-signal linear structure. The lateral and superior walls of the cavernous sinus was easily identified on all studies, but demonstration of a dural wall separating the cavernous sinus from the pituitary fossa was not possible. These results correlated well with embryological and adult histological studies obtained from 14 specimens. The absence of a strong separation between the pituitary fossa and the cavernous sinus explains the high incidence of extension of pituitary tumours to the cavernous sinuses and vice versa. (orig.) (orig.)

Protocolo de preparo da criança pré-escolar para punção venosa, com utilização do brinquedo terapêutico Protocolo de preparación de niños en edad preescolar para la punción venosa con utilización del juguete terapeutico Protocol for the preparation of preschool children to venous puncture using therapeutic play

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Maria do Rosário Martins

2001-04-01

Full Text Available Este trabalho, do tipo exploratório descritivo, consiste na elaboração de um protocolo utilizando brinquedo terapêutico para preparar crianças pré-escolares que seriam submetidas à punção venosa, assim como testá-lo em algumas crianças para verificar sua aplicabilidade e eficiência. As crianças submetidas à sessão do brinquedo, tornaram-se mais cooperativas durante a punção venosa; compreenderam a necessidade e a técnica dos procedimentos; exteriorizaram sentimentos; elaboraram situações familiares e hospitalares, passando a relacionar-se melhor com as outras crianças e com a equipe de enfermagem. Consideramos que este protocolo é factível e útil; sugerimos que integre o plano de assistência de enfermagem a crianças hospitalizadas.Este trabajo de tipo exploratorio descriptivo consiste en la elaboración de un protocolo utilizando el juguete terapéutico para preparar niños preescolares para la punción venosa y su aplicación en algunos niños, con el sentido de verificar su aplicabilidad. Los niños que fueron sometidos a la sesión del juguete, se tornaron más cooperativos durante la punción venosa; comprendieron la necesidad y la técnica de los procedimientos; exteriorizaron sentimientos; elaboraron situaciones familiares y hospitalarias y empezaron a relacionarse mejor con los otros niños y con el equipo de enfermería. Consideramos que éste protocolo es factible y util; sugerimos que el mismo pase a integrar el plan de atención de enfermería a los niños hospitalizados.This exploratory - descriptive study aims at elaborating a protocol, using therapeutic play, for the preparation of preschool children to venous puncture and also at testing its efficiency and applicability. The children that attended the play session were more cooperative when they were punctured. They understood the need and technical aspects of this clinical procedure; manifested their feelings, elaborated familiar and hospital situations

Trombosis del seno sagital en un neonato

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Lisett Hernández León

2012-12-01

Full Text Available La trombosis de los senos venosos durales es una rara y devastadora enfermedad. Se presenta generalmente en mujeres y ancianos, y no es frecuente en niños, aunque se reconoce ya como una causa de morbilidad y mortalidad en la población pediátrica. Se han reportado pocos casos en el mundo de neonatos afectados por esta entidad, en su mayoría fatales e insuficientemente investigados. A continuación se presenta el caso de un recién nacido con una trombosis del seno sagital que sobrevivió. Los factores predisponentes para la aparición de la enfermedad en este caso fueron la asfixia neonatal, la deshidratación severa unida al uso de una línea venosa central, y la inmovilización prolongada. Aunque la TAC contrastada no es el estudio ideal para su diagnóstico, permitió realizarlo oportunamente en este caso. El tratamiento temprano con anticoagulantes permitió una rápida recuperación y favoreció la recanalización venosa del seno involucrado. Hasta el momento no se han detectado secuelas neurológicas y el paciente tiene buen desarrollo psicomotor.

Four-dimensional computed tomography angiographic evaluation of cranial dural arteriovenous fistula before and after embolization

International Nuclear Information System (INIS)

Tian, Bing; Xu, Bing; Lu, Jianping; Liu, Qi; Wang, Li; Wang, Minjie

2015-01-01

Highlights: • 4D CTA showed excellent agreement with DSA with regard to identification of feeding arteries and drainage veins. • The most important finding was 4D CTA in determining the impact of DAVF treatment with transarterial embolization. • 4D CTA provides images similar to those obtained with DSA both before and after treatment. - Abstract: Purpose: This study aimed to evaluate the usefulness of four-dimensional CTA before and after embolization treatment with ONYX-18 in eleven patients with cranial dural arteriovenous fistulas, and to compare the results with those of the reference standard DSA. Patients and Methods: Eleven patients with cranial dural arteriovenous fistulas detected on DSA underwent transarterial embolization with ONYX-18. Four-dimensional CTA was performed an average of 2 days before and 4 days after DSA. Four-dimensional CTA and DSA images were reviewed by two neuroradiologists for identification of feeding arteries and drainage veins and for determining treatment effects. Interobserver and intermodality agreement between four-dimensional CTA and DSA were assessed. Results: Forty-two feeding arteries were identified for 14 fistulas in the 11 patients. Of these, 36 (85.71%) were detected on four-dimensional CTA. After transarterial embolization, one patient got partly embolized, and the fistulas in the remaining 10 patients were completely occluded. The interobserver agreement for four-dimensional CTA and intermodality agreement between four-dimensional CTA and DSA were excellent (κ = 1) for shunt location, identification of drainage veins, and fistula occlusion after treatment. Conclusion: Four-dimensional CTA images are highly accurate when compared with DSA images both before and after transarterial embolization treatment. Four-dimensional CTA can be used for diagnosis as well as follow-up of cranial dural arteriovenous fistulas in clinical settings

Acute Tetraparesis with Respiratory Failure after Steroid Administration in a Patient with a Dural Arteriovenous Fistula at the Craniocervical Junction

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Takahashi, Hisashi; Ueshima, Taiki; Goto, Daiki; Kimura, Tadashi; Yuki, Natsuko; Inoue, Yasuo; Yoshioka, Akira

2017-01-01

A 63-year-old man developed vomiting, paraparesis, dysuria, bulbar palsy, and orthostatic hypotension over a period of 5 months. Neuroradiological examinations showed a swollen lower brainstem with a dural arteriovenous fistula at the craniocervical junction (DAVF-CCJ). A steroid was administered intravenously in the hospital to relieve brainstem edema. A few hours later, however, the patient developed acute tetraparesis with respiratory failure. Recently, there have been several reports describing the acute worsening of paraparesis in patients with a spinal dural arteriovenous fistula after steroid treatment. In addition to these reports, the present case suggests the risk of administering steroids to patients with DAVF-CCJ, especially those with brainstem dysfunction. PMID:29225249

Effect of Hemoconcentration on Dural Sinus Computed Tomography Density in a Pediatric Population.

Science.gov (United States)

Yurttutan, Nursel; Kizildag, Betul; Sarica, Mehmet Akif; Baykara, Murat

2016-10-01

Unenhanced brain computed tomography (CT) is inexpensive, easily available, and the first-choice imaging modality for patients presenting with various neurologic symptoms. Venous thrombosis is not rare in childhood, but diagnosis can be difficult. In some cases, only denser vessels can be used to highlight an issue. The aim of this study was to retrospectively evaluate the relationship between X-ray attenuation and hemoconcentration in a pediatric population. This study enrolled 99 pediatric patients who had been referred radiology department for unenhanced brain CT. Images were retrospectively evaluated for measurement of dural sinus densities from four distinct dural sinus locations. Correlation between mean Hounsfield unit (HU) values and hemoglobin/hematocrit (Hb/Htc) levels, as well as age and gender were further analyzed. There was a strong correlation between mean HU and Hb levels (r = 0.411; standard deviation: 0.001) and also between mean HU and Htc levels (r = 0.393; p pediatric group. In conclusion, before deciding between a diagnosis of thrombosis and a determination of normal findings during an evaluation of unenhanced CT in a pediatric population, radiologists should consider complete blood count results as well as H:H ratios. Georg Thieme Verlag KG Stuttgart · New York.

Induced dural lymphangiogenesis facilities soluble amyloid-beta clearance from brain in a transgenic mouse model of Alzheimer's disease

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Ya-Ru Wen

2018-01-01

Full Text Available Impaired amyloid-β clearance from the brain is a core pathological event in Alzheimer's disease. The therapeutic effect of current pharmacotherapies is unsatisfactory, and some treatments cause severe side effects. The meningeal lymphatic vessels might be a new route for amyloid-β clearance. This study investigated whether promoting dural lymphangiogenesis facilitated the clearance of amyloid-β from the brain. First, human lymphatic endothelial cells were treated with 100 ng/mL recombinant human vascular endothelial growth factor-C (rhVEGF-C protein. Light microscopy verified that rhVEGF-C, a specific ligand for vascular endothelial growth factor receptor-3 (VEGFR-3, significantly promoted tube formation of human lymphatic endothelial cells in vitro. In an in vivo study, 200 μg/mL rhVEGF-C was injected into the cisterna magna of APP/PS1 transgenic mice, once every 2 days, four times in total. Immunofluorescence staining demonstrated high levels of dural lymphangiogenesis in Alzheimer's disease mice. One week after rhVEGF-C administration, enzyme-linked immunosorbent assay results showed that levels of soluble amyloid-β were decreased in cerebrospinal fluid and brain. The Morris water maze test demonstrated that spatial cognition was restored. These results indicate that the upregulation of dural lymphangiogenesis facilities amyloid-β clearance from the brain of APP/PS1 mice, suggesting the potential of the VEGF-C/VEGFR-3 signaling pathway as a therapeutic target for Alzheimer's disease.

Treinamento de sobrecarga muscular não afeta o diâmetro das principais veias dos membros inferiores em mulheres adultas com insuficiência venosa

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Gigliola Cibele Cunha da Silva

2010-12-01

Full Text Available O exercício físico pode promover benefícios na funcionalidade do sistema venoso. Contudo, tratando-se de exercício com sobrecargas musculares, observa-se contraindicações quanto à sua prática diante da possibilidade da mesma estar relacionada ao agravamento das disfunções venosas. OBJETIVO: Analisar os efeitos da prática do exercício com sobrecargas musculares sobre o diâmetro venoso de mulheres fisicamente inativas portadoras de insuficiência venosa crônica de membros inferiores. MÉTODOS: Vinte e duas mulheres com idades entre 21 e 58 anos (34,27 ± 12 anos foram divididas aleatoriamente em dois grupos: experimental (n = 12 e controle (n = 10. O treinamento com cargas foi realizado por 16 semanas, e o diâmetro venoso foi medido nas veias safenas magna (em nível da coxa e perna e parva no membro inferior esquerdo por meio de ecodoppler colorido. Utilizou-se a ANOVA por dois fatores para avaliar as possíveis modificações dos diâmetros entre os grupos e ao longo do tempo (p < 0,05. RESULTADOS: Não foram encontradas alterações significativas nos diâmetros das veias safenas parva (porções superior, média e inferior: p = 0,80, 0,32 e 0,20, respectivamente, magna em nível da perna (p = 0,17, 0,74 e 0,96 e magna em nível da coxa (p = 0,57, 0,67 e 0,52. CONCLUSÃO: A prática do exercício com sobrecargas musculares pode ser considerada um meio de intervenção ou tratamento, uma vez que não promoveu alterações no diâmetro venoso de mulheres que apresentaram insuficiência venosa crônica nos membros inferiores.

Uso de terapias alternativas en la cicatrización de úlceras de etiología venosa: La cromoterapia Colour therapy in venous ulcers healing: chromoteraphy

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Sandra Alexandre Lozano

2012-12-01

Full Text Available La úlcera de etiología venosa es la más prevalente de las úlceras de extremidad inferior. Entre el 75 y el 80% de las úlceras de la extremidad inferior son de esta etiología. De acuerdo con las evidencias disponibles, el tratamiento de las úlceras de etiología venosa tiene como base dos grandes pilares: el manejo de la úlcera como una herida crónica y el control de la hipertensión venosa crónica (HTV, su causa primordial, mediante sistemas de alta compresión decreciente y mantenida. De todos los métodos de control de la HTV, el sistema multicapa ha demostrado clínicamente que permite alcanzar un 80% de tasa de cicatrización de lesiones a las doce semanas de tratamiento, erigiéndose como el tratamiento más efectivo de los existentes hasta el momento. Por otro lado, a menudo, una compresión de 40 mm Hg en el tobillo no es bien tolerada por todas las personas afectadas de HTV crónica. Para esos casos rebeldes en los que debemos utilizar recursos alternativos, nosotros hemos utilizado la cromoterapia ya que ha demostrado, mediante varios estudios, ser útil en la curación de heridas consiguiendo, entre otros beneficios, estimular el aporte sanguíneo al lecho de la herida, favoreciendo así la oxigenación. En base a estos hechos, nos planteamos la aplicabilidad de la cromoterapia en la cura de las úlceras venosas, como tratamiento complementario a las curas habituales, cuando estos no son lo suficientemente efectivos o cuando el paciente no tolera el vendaje elástico multicapa.Venous ulcers are the most prevalent ulcers of the lower extremity. They account for 75%-80% of ulcers of the lower extremity. According to the evidence available, there are two main strands to therapy: treatment of the ulcer as a chronic wound, and management of venous hypertension (VHT, the prime cause of venous ulcers. VHT is managed using decreasing and sustained high-compression systems. According to the literature, the multilayer system has been

Uso de ácidos graxos essenciais no tratamento de úlcera venosa: relato de caso

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Nayana Nobre

2012-05-01

Full Text Available Nesse estudo relata-se o uso de ácidos graxos essenciais (AGE no tratamento de úlcera venosa em membro inferior esquerdo de um paciente do sexo masculino de 60 anos. O tratamento foi realizado nas Clínicas Integradas Izabela Hendrix.  A coleta dos dados foi realizada por meio de anamnese  e exame físico do paciente. Na avaliação da lesão foram realizadas medidas geométricas desde o momento em que o paciente procurou o serviço, bem como foram feitos registros fotográficos ao longo do atendimento. Ao final de três meses a lesão obteve sua completa cicatrização. Não houve relato de desconforto ou qualquer complicação durante o uso do AGE, o que permite afirmar que o produto apresentou eficácia terapêutica para esse caso em particular.   

Measurement of the cross-sectional area of the dural tube in the lumbar spine on magnetic resonance imaging. Comparison between normal, pre- and post-discectomy conditions

International Nuclear Information System (INIS)

Matsubayashi, Yasutomo

1997-01-01

This study evaluated the usefulness of pre- and postoperative magnetic resonance imaging (MRI) of lumbar disc hernia with special attention to measurement of the cross-sectional area of the dural tube. Twenty-five patients (20 men and 5 women; 25 discs) who underwent posterior lumbar discectomy and 73 normal individuals (44 men and 29 women; 219 discs) of a similar age distribution were studied. Axial MRI was mainly used for the measurement of the dural tube. In the patient group, MRI examination was performed 1, 3, 6, and 12 months postoperatively. Assessment of the clinical symptoms was also included and used for comparison with the MRI evaluation. The cross-sectional area was significantly reduced to about 50% of the normal preoperatively. One month postoperatively, there was no significant increase in the size of the area, but after three months, the area increased significantly and progressed to the normal size within a year. One-month postoperatively, MRI examination was not considered useful because of postoperative hematoma and/or edema at the surgical site. The increase in the size of the cross-sectional area of the dural tube correlated well with the improvement in clinical symptoms. Three-months postoperatively, MRI evaluation of the lumbar disc seemed useful and measurement of the cross-sectional area of the dural tube appeared to serve as an indicator of the effectiveness of the surgery. (author)

Measurement of the cross-sectional area of the dural tube in the lumbar spine on magnetic resonance imaging. Comparison between normal, pre- and post-discectomy conditions

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Matsubayashi, Yasutomo [Juntendo Univ., Tokyo (Japan). School of Medicine

1997-07-01

This study evaluated the usefulness of pre- and postoperative magnetic resonance imaging (MRI) of lumbar disc hernia with special attention to measurement of the cross-sectional area of the dural tube. Twenty-five patients (20 men and 5 women; 25 discs) who underwent posterior lumbar discectomy and 73 normal individuals (44 men and 29 women; 219 discs) of a similar age distribution were studied. Axial MRI was mainly used for the measurement of the dural tube. In the patient group, MRI examination was performed 1, 3, 6, and 12 months postoperatively. Assessment of the clinical symptoms was also included and used for comparison with the MRI evaluation. The cross-sectional area was significantly reduced to about 50% of the normal preoperatively. One month postoperatively, there was no significant increase in the size of the area, but after three months, the area increased significantly and progressed to the normal size within a year. One-month postoperatively, MRI examination was not considered useful because of postoperative hematoma and/or edema at the surgical site. The increase in the size of the cross-sectional area of the dural tube correlated well with the improvement in clinical symptoms. Three-months postoperatively, MRI evaluation of the lumbar disc seemed useful and measurement of the cross-sectional area of the dural tube appeared to serve as an indicator of the effectiveness of the surgery. (author)

Persistent dural cerebrospinal fluid leak shown by retrograde radionuclide myelography: case report

International Nuclear Information System (INIS)

Kadrie, H.; Driedger, A.A.; McInnis, W.

1976-01-01

Following inadvertent spinal anesthesia for delivery, a patient developed incapacitating post-lumbar puncture headache that persisted for 9 weeks. Scintigrams of the lumbar region, obtained after injection of /sup 99m/Tc-human serum albumin into the cisterna magna, showed the cerebrospinal fluid leak. Blood patch repair was carried out, with immediate relief of all symptoms. Because of subsequent atypical headaches, a second cisternogram was done by the same technique. This study confirmed that there was no further dural leak, and other evidence indicated that the recurrent headache was related to functional problems

Radiographic anatomy of the distal dural SAC; A myelographic investigation of dimensions and termination

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Larsen, J.L.; Olsen, K.O. (Haukeland Sykehus, Bergen (Norway). Dept. of Diagnostic Radiology)

1991-05-01

A radio-anatomical study was performed of the distal dural sac (DS) in 121 patients subjected to myelography. In 83.4% the termination of the DS was located from the upper half of the S1-segment to the lower half of the S2-segment. In the remaining patients the dural terminations were more distally located. The average location of the DS-termination was higher than that found in a previous anatomic study. The inference is that in patients with low-back pain and sciatica, the DS tends to terminate at a higher spinal level than in a non-selected anatomic material. The caudal reduction in sagittal diameter of the DS was less than that of the frontal diameter of the sac. The linear diminution in cross-sectional area of the DS from the level of L3 towards the lumbosacral junction was not correlated with the degree of caudal extension of the DS into the sacrum. Thus the length of the DS and its transverse diameters are independent of each other. These results supported the view that the location of the termination of the DS (and hence that of the spinal cord) is not related to stenosis of the central spinal canal. (orig.).

Management of intracranial dural arteriovenous shunts in adults

International Nuclear Information System (INIS)

Sarma, Dipanka; Brugge, Karel ter

2003-01-01

Dural arteriovenous shunts are abnormal arteriovenous communications within the dura. They are thought to be an acquired condition in adults and can present with a variety of clinical features, ranging from benign bruits to intracranial hemorrhage and neurological deficits. The presentation and natural history of these shunts is largely determined by the pattern of venous drainage. Knowledge of natural history and careful study of the angioarchitexture by angiography is therefore mandatory for correct management of these lesions. In this review, principles of management in adults and the various factors that influence treatment decisions are discussed, with a focus on endovascular therapy. Retrograde leptomeningeal or cortical venous drainage has a strong correlation with adverse clinical events and the requirement for aggressive management in this situation is highlighted. Indications for endovascular treatment, therapeutic goals, approaches and techniques are reviewed. The role of surgical treatment is also briefly discussed

Growth increments of the recent brachiopod Magellania venosa mechanically marked in Paso Comau and Comau Fjord, Chile, 2011/2012, supplement to: Baumgarten, Sebastian; Laudien, Jürgen; Jantzen, Carin; Häussermann, Verena; Försterra, Günter (2013): Population structure, growth and production of a recent brachiopod from the Chilean fjord region. Marine Ecology, 35(4), 401-413

KAUST Repository

Baumgarten, Sebastian

2015-01-01

Magellania venosa, the largest recent brachiopod, occurs in clusters and banks in population densities of up to 416 ind/m**2 in Comau Fjord, Northern Chilean fjord region. Below 15 m, it co-occurs with the mytilid Aulacomya atra and it dominates the benthic community below 20 m. To determine the question of why M. venosa is a successful competitor, the in situ growth rate of the brachiopod was studied and its overall growth performance compared with that of other brachiopods and mussels. The growth in length was measured between February 2011 and March 2012 after mechanical tagging and calcein staining. Settlement and juvenile growth were determined from recruitment tiles installed in 2009 and from subsequent photocensus. Growth of M. venosa is best described by the general von Bertalanffy growth function, with a maximum shell length (Linf) of 71.53 mm and a Brody growth constant (K) of 0.336/year. The overall growth performance (OGP index = 5.1) is the highest recorded for a rynchonelliform brachiopod and in the range of that for Mytilus chilensis (4.8-5.27), but lower than that of A. atra (5.74). The maximal individual production (PInd) is 0.29 g AFDM/ind/year at 42 mm shell length and annual production ranges from 1.28 to 89.25 g AFDM/year/m**2 (1-57% of that of A. atra in the respective fjords). The high shell growth rate of M. venosa, together with its high overall growth performance may explain the locally high population density of this brachiopod in Comau Fjord. However, the production per biomass of the population (P/B-ratio) is low (0.535) and M. venosa may play only a minor role in the food chain. Settling dynamics indicates that M. venosa is a pioneer species with low juvenile mortality. The coexistence of the brachiopod and bivalve suggests that brachiopod survival is affected by neither the presence of potential brachiopod predators nor that of space competitors (i.e. mytilids).

Diagnóstico angiográfico dos hematomas subdurais: valor da fase venosa em incidência sagital

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José Zaclis

1955-12-01

Full Text Available Êste trabalho tem por fim demonstrar o valor da fase venosa em incidência sagital no diagnóstico angiográfico dos hematomas subdurais. Êle é baseado em 8 casos verificados cirürgicamente, dois dos quais com hematoma bilateral, compreendendo um total de 10 hematomas subdurals demonstrados pela angiografia cerebral. Em 9 exemplares a elipse avascular que caracteriza essa entidade nosológica só apareceu na fase venosa; sòmente em um caso êsse sinal patognomônico foi claramente revelado na fase arterial em incidência ântero-posterior. O arteriograma mostra, apenas, às mais das vêzes, deslocamento da artéria cerebral anterior e seus ramos para o lado oposto àquele em que se encontra o hematoma, como acontece nos casos de lesões expansivas em geral. Menos freqüentemente os principais troncos arteriais do encéfalo não sofrem modificações no seu trajeto, apesar do espaço intracraniano ocupado pelos hematomas. A existência de hematoma subdural no interior de um hemicrânio sem desvio da artéria cerebral anterior, embora não implique necessàriamente na existência de outra coleção sangüínea do lado oposto, é altamente sugestiva dessa dupla lesão. A exploração bilateral nesses casos é, portanto, obrigatória. Dos três casos desta série em que a angiografia em um dos lados revelou a elipse avascular característica e artéria cerebral anterior com trajeto normal, a angiografia do lado oposto resultou positiva em dois dêles e negativa em um. Pôsto que alguns Serviços especializados não sejam dotados de equipamento para angiografia em séries, o autor recomenda o flebograma em incidência sagital como tempo obrigatório, mesmo que para tanto seja necessária nova injeção de contraste.

Anestesia venosa total para laringectomia parcial em paciente na 28ª semana de gestação: relato de caso Anestesia venosa total para laringectomía parcial en paciente en la 28ª semana de embarazo: relato de caso Total intravenous anesthesia for partial laryngectomy in 28 weeks pregnant patient: case report

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José Costa; Dalva Maria Carvalho Mendes; José Eduardo de Oliveira Lobo; Adriana Barrozo Ribeiro Furuguem; Gabriel Gilberto Santos

2005-01-01

JUSTIFICATIVA E OBJETIVOS: Uma anestesia para paciente gestante constitui um desafio ao anestesiologista em virtude dos riscos para a mãe e para o feto. São muitas as complicações descritas pela literatura como malformações fetais, parto prematuro, instabilidade hemodinâmica materna e até morte fetal. O objetivo deste caso é mostrar uma paciente gestante de 28 semanas, submetida a laringectomia parcial sob anestesia geral venosa total com propofol, remifentanil e cisatracúrio. RELATO DO CASO:...

Late-presenting dural tear: incidence, risk factors, and associated complications.

Science.gov (United States)

Durand, Wesley M; DePasse, J Mason; Kuris, Eren O; Yang, JaeWon; Daniels, Alan H

2018-04-18

Unrecognized and inadequately repaired intraoperative durotomies may lead to cerebrospinal fluid leak, pseudomeningocele, and other complications. Few studies have investigated durotomy that is unrecognized intraoperatively and requires additional postoperative management (hereafter, late-presenting dural tear [LPDT]), although estimates of LPDT range from 0.6 to 8.3 per 1,000 spinal surgeries. These single-center studies are based on relatively small sample sizes for an event of this rarity, all with <10 patients experiencing LPDT. This investigation is the largest yet conducted on LPDT, and sought to identify incidence, risk factors for, and complications associated with LPDT. This observational cohort study employed the American College of Surgeons National Surgical Quality Improvement Program dataset (years 2012-2015). Patients who underwent spine surgery were identified based on presence of primary listed Current Procedural Terminology (CPT) codes corresponding to spinal fusion or isolated posterior decompression without fusion. The primary variable in this study was occurrence of LPDT, identified as reoperation or readmission with durotomy-specific CPT or International Classification of Diseases, Ninth Revision, Clinical Modification codes but without durotomy codes present for the index procedure. Descriptive statistics were generated. Bivariate and multivariate analyses were conducted using chi-square tests and multiple logistic regression, respectively, generating both risk factors for LPDT and independent association of LPDT with postoperative complications. Statistical significance was defined as p<.05. In total, 86,212 patients were analyzed. The overall rate of reoperation or readmission without reoperation for LPDT was 2.0 per 1,000 patients (n=174). Of LPDT patients, 97.7% required one or more unplanned reoperations (n=170), and 5.7% of patients (n=10) required two reoperations. On multivariate analysis, lumbar procedures (odds ratio [OR] 2.79, p

Avaliação das limitações de úlcera venosa em membros inferiores Evaluation of limitations of venous ulcers in legs

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Célia Regina Lopes

2013-03-01

Full Text Available CONTEXTO: A insuficiência venosa crônica tem um impacto socioeconômico considerável nos países ocidentais devido à alta prevalência, custo das investigações e tratamento e à perda de dias trabalhados. O questionário de qualidade de vida Short Form Health Survey (SF-36, bem como a análise da ativação muscular e mobilidade da articulação tibiotársica, é um instrumento utilizado para a sua mensuração. OBJETIVO: Avaliar as limitações osteomusculares e as alterações na qualidade de vida em portadores de úlcera venosa em membros inferiores. MÉTODOS: Foram estudados dez pacientes com úlceras classificadas com Classificação de Doença Venosa Crônica (CEAP: Clinica, Eliologia, Anatomia e Fisiopatologia 6, que responderam ao questionário SF36 e à escala analógica de dor e realizaram a goniometria, força muscular e eletromiografia. RESULTADOS: A idade média do grupo estudado foi 67,4 (±11,7, sendo 70% dos casos do sexo feminino. Não houve correlação significativa entre dor amplitude do movimento (ADM, força muscular, eletromiografia (EMG e o tamanho da lesão. Entretanto, houve correlação entre o perfil psicológico do SF-36 e o domínio de atividades motoras, bem como do perfil psicológico com as atividades sociais e percepção de si mesmo. Também houve diferença significativa na avaliação eletromiográfica dos músculos estudados. CONCLUSÃO: A presença de úlcera venosa em membros inferiores pode gerar limitações e alterações na qualidade de vida destes indivíduos. O aspecto psicossocial demonstrou-se preponderante sobre o aspecto motor, aumentando as restrições nas atividades de vida diária.BACKGROUND: : The chronic venous insufficiency has a considerable socioeconomic impact in western countries because of high prevalence, treatment and research cost, and loss of days worked. The health survey questionnaire Short Form Health Survey (SF36, as well as the analysis of muscle activation and mobility

Condiciones de trabajo en la producción de comidas como factores de riesgo para la enfermedad venosa de miembros inferiores

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Clarissa Medeiros da Luz Bertoldi

2007-03-01

Full Text Available El presente estudio tiene por objetivo identificar los factores que pueden desencadenar o, según el caso, empeorar el desarrollo de enfermedades venosas en los miembros inferiores en operarios de una cocina colectiva, denominada Unidad de Alimentación y Nutrición. Se ha realizado un estudio cualitativo descriptivo de las condiciones de trabajo de los operarios de la cocina del Hospital Universitario de Florianópolis, al sur de Brasil. Se ha utilizado la metodología del Análisis Ergonómico del Trabajo. Como técnicas para la recopilación de datos se han realizado entrevistas con cuestionario aplicado por el observador, evaluación del Índice de Masa Corporal, examen clínico específico, volumetría por desplazamiento de agua de miembros inferiores, observación directa de las actividades desarrolladas en el ambiente de trabajo, con registro de imágenes y utilización de material como podómetro, cronómetro y termo-higrómetro digital. Tras la realización del estudio se ha podido observar la presencia de distintos grados de enfermedad venosa en un 78,57% de los casos, con una variación media para volumetría del 5,13%. Se han encontrado factores de riesgo para enfermedad venosa en el ambiente investigado, tales como, la postura de bipedestación por largos periodos de tiempo, temperatura y humedad elevados, la carga inadecuada de peso y el sobrepeso de los operarios.The present study evaluates which factors may influence the appearance or severity of lower limb venous disease on workers of a Unit of Food Service. A qualitative research, in the form of a case study, was carried out at a hospital Unit of Food Service located in Florianópolis, Santa Catarina, Brazil. The followed methodology was the Ergonomic Analysis of Work. As for data collection, the following were used: interviews and Body Mass Index (BMI assessment; specific clinical examination, water displacement volumetry of the lower extremities, in addition, on site direct

Dural afferents express acid-sensing ion channels: a role for decreased meningeal pH in migraine headache.

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Yan, Jin; Edelmayer, Rebecca M; Wei, Xiaomei; De Felice, Milena; Porreca, Frank; Dussor, Gregory

2011-01-01

Migraine headache is one of the most common neurological disorders. The pathological conditions that directly initiate afferent pain signaling are poorly understood. In trigeminal neurons retrogradely labeled from the cranial meninges, we have recorded pH-evoked currents using whole-cell patch-clamp electrophysiology. Approximately 80% of dural-afferent neurons responded to a pH 6.0 application with a rapidly activating and rapidly desensitizing ASIC-like current that often exceeded 20nA in amplitude. Inward currents were observed in response to a wide range of pH values and 30% of the neurons exhibited inward currents at pH 7.1. These currents led to action potentials in 53%, 30% and 7% of the dural afferents at pH 6.8, 6.9 and 7.0, respectively. Small decreases in extracellular pH were also able to generate sustained window currents and sustained membrane depolarizations. Amiloride, a non-specific blocker of ASIC channels, inhibited the peak currents evoked upon application of decreased pH while no inhibition was observed upon application of TRPV1 antagonists. The desensitization time constant of pH 6.0-evoked currents in the majority of dural afferents was less than 500ms which is consistent with that reported for ASIC3 homomeric or heteromeric channels. Finally, application of pH 5.0 synthetic-interstitial fluid to the dura produced significant decreases in facial and hind-paw withdrawal threshold, an effect blocked by amiloride but not TRPV1 antagonists, suggesting that ASIC activation produces migraine-related behavior in vivo. These data provide a cellular mechanism by which decreased pH in the meninges following ischemic or inflammatory events directly excites afferent pain-sensing neurons potentially contributing to migraine headache. Copyright © 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Massive granular cell ameloblastoma with dural extension and atypical morphology

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Vandana Raghunath

2014-01-01

Full Text Available Ameloblastomas are rare histologically benign, locally aggressive tumors arising from the oral ectoderm that occasionally reach a gigantic size. Giant ameloblastomas are a rarity these days with the advent of panoramic radiography in routine dental practice. Furthermore, the granular cell variant is an uncommon histological subtype of ameloblastoma where the central stellate reticulum like cells in tumor follicles is replaced by granular cells. Although granular cell ameloblastoma (GCA is considered to be a destructive tumor with a high recurrence rate, the significance of granular cells in predicting its biologic behavior is debatable. However, we present a rare case of giant GCA of remarkable histomorphology showing extensive craniofacial involvement and dural extension that rendered a good prognosis following treatment.

Úlcera venosa: seis años de existencia por 92 días de cicatrización

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Maísa Mara Lopes Macêdo

Full Text Available Objetivo: Describir la evolución del tratamiento de úlcera venosa con el uso de coberturas avanzadas y presentar las respuestas del paciente frente a los cuidados dispensados en la atención primaria de salud. Método: Estudio realizado con planteamiento metodológico de relato del caso, con consentimiento informado por parte del paciente. Resultados: Rápida respuesta con disminución del dolor, alcance de la cicatrización y mejoría de los impactos negativos con uso de coberturas apropiadas, cuidados sistemáticos y profesional capacitado. Conclusión: el tratamiento ha sido posible gracias a la disponibilidad de coberturas adecuadas y el conocimiento de los profesionales para la conducción del caso.

Widening of the spinal canal and dural ectasia in Marfan's syndrome: assessment by CT

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Villeirs, G.M.; Verstraete, K.L.; Kunnen, M.F. [Dept. of Radiology, Univ. Hospital, Gent (Belgium); Tongerloo, A.J. van; Paepe, A.M. de [Dept. of Medical Genetics, Univ. Hospital, Gent (Belgium)

1999-11-01

We describe a method for diagnosing dural ectasia (DE) and spinal canal widening (SCW) using CT. We examined 23 patients with Marfan's syndrome (MFS), 17 with Ehlers-Danlos syndrome (EDS) and 29 normal subjects, using six axial slices at the level of the L1-S1 pedicles. Transverse diameters of the vertebral bodies, spinal canal and dural sac were measured and indices were defined to differentiate patients with DE and SCW from normal. Statistical significance was assessed using Student's t -test, {chi} {sup 2}-test and Pearson's correlation coefficient. DE and SCW occurred in 69.6 % and 60.9 % of cases of MFS and in 23.5 % and 35.3 % of EDS respectively. In MFS, prevalence was significantly higher than in the control group. DE was significantly more frequent in MFS than in EDS. A strong correlation existed between DE and SCW in MFS and the control group, but not in EDS. Our system enables quantitative assessment of SCW and DE. The latter is particularly important in subjects suspected of having MFS, in whom it is a common and characteristic sign. (orig.)

Preparo e administração venosa de medicamentos e soros sob a ótica da Resolução COFEN n° 311/07 Preparación y administración venosa de medicamentos y sueros bajo la óptica de la Resolución COFEN n° 311/07 Preparation and administration of intravenous drugs and serums from the perspective of Resolution No. 311/07 COFEN

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Elaine Antunes Cortez

2010-01-01

Full Text Available OBJETIVOS: Levantar na literatura os procedimentos cabíveis ao enfermeiro quanto ao preparo e administração venosa de medicamentos e soros e relacioná-los com os aspectos éticos estabelecidos pela Resolução COFEN n° 311/07. MÉTODOS: Pesquisa do tipo revisão bibliográfica realizada nas bases de dados Medline, Lilacs, SciELO e Bdenf. Uma análise temática foi realizada em 13 artigos e emergiram as categorias: Procedimentos realizados pelo enfermeiro no preparo e na administração venosa; Responsabilidades éticas do enfermeiro: atuação do Poder Judiciário frente às decisões administrativas de natureza disciplinar proferidas pelo Conselho Federal de Enfermagem e Conselhos Regionais da Enfermagem. RESULTADOS: O enfermeiro deve realizar o preparo e administração venosa observando os requisitos básicos que garantam a ausência de danos ao cliente, e em conformidade com o Código de Ética dos profissionais de Enfermagem. CONCLUSÃO: O conhecimento da ética é essencial para a profissão da enfermagem, porque subsidia o embasamento teórico e propicia um fazer com resultados efetivos de forma a proteger o ser humano.OBJETIVOS: Levantar en la literatura los procedimientos que le caben al enfermero en lo que se refiere a la preparación y administración venosa de medicamentos y sueros; y, relacionarlos con los aspectos éticos establecidos por la Resolución COFEN n° 311/07. MÉTODOS: Se trata de una investigación del tipo revisión bibliográfica, realizada en las bases de datos Medline, Lilacs, SciELO y Bdenf. Se realizó un análisis temático en 13 artículos de los que surgieron las categorías: 1 procedimientos realizados por el enfermero en la preparación y en la administración venosa; 2 responsabilidades éticas del enfermero (actuación del Poder Judicial frente a las decisiones administrativas de naturaleza disciplinar proferidas por el Consejo Federal de Enfermería y Consejos Regionales de la Enfermería. RESULTADOS

Avaliação da memória sob anestesia venosa total Evaluación de la memoria bajo anestesia venosa total The assessment of memory under total intravenous anesthesia

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Gulistan Aktas

2013-06-01

Full Text Available JUSTIFICATIVA E OBJETIVOS: Neste estudo, objetivamos avaliar a memória implícita e explícita em pacientes submetidos à cirurgia abdominal sob anestesia venosa total (AVT com propofol e remifentanil, na qual o nível de anestesia foi controlado pelo monitoramento do índice bispectral (BIS. MÉTODO: Anestesia venosa total foi administrada a 60 pacientes adultos para obter níveis de BIS de 40-60. Os pacientes foram randomicamente divididos em três grupos, de acordo com as gravações que ouviram. Os pacientes do grupo categoria (CT ouviram uma fita gravada contendo cinco nomes de animais. Os pacientes do grupo recordar palavras (RP ouviram uma fita gravada contendo cinco palavras de frequência média na língua turca, depois de adaptadas. Os pacientes do grupo controle (GC ouviram os sons do mar até o fim da cirurgia. Duas horas após a cirurgia, os testes foram administrados a cada paciente na sala de recuperação para avaliar a memória. RESULTADOS: Houve uma diferença entre os escores dos grupos CT e GC no Miniexame do Estado Mental (MMSE; todos os escores foram > 20. Os resultados dos testes de categoria e recordar palavras, aplicados para avaliar a memória implícita, não foram estatisticamente diferentes entre os grupos. Não houve evidência de memória implícita em nenhum dos pacientes. Um paciente lembrou-se de ouvir "o som de água" como uma prova de memória explícita. Onze pacientes declararam não ter sonhado. CONCLUSÕES: Apesar de não termos encontrado nenhuma evidência de memória implícita sob anestesia adequada com AVT, um paciente apresentou memória explícita. Embora a profundidade adequada da anestesia fornecida pelo monitoramento do BIS corrobore nossos resultados para a memória implícita, ela não explica os resultados para a memória explícita.JUSTIFICATIVA Y OBJETIVOS: En este estudio evaluamos la memoria implícita y explícita en pacientes sometidos a la cirugía abdominal bajo anestesia venosa total

Atitudes atuais de anestesiologistas e médicos em especialização com relação à anestesia venosa total Actitudes actuales de anestesiólogos y médicos en especialización con relación a la anestesia venosa total Current attitude of anesthesiologists and anesthesiology residents regarding total intravenous anesthesia

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Fernando Squeff Nora

2006-08-01

Full Text Available JUSTIFICATIVA E OBJETIVOS: No passado, tempo, custos, informações, treinamento e avaliação da profundidade da anestesia limitavam a aceitação da anestesia venosa total (TIVA. O objetivo deste estudo foi determinar atitudes de anestesiologistas e médicos em especialização com relação à anestesia venosa total. MÉTODO: Um questionário foi enviado a 150 anestesiologistas e 102 residentes. A concordância (C e discordância (D em cada item foram comparadas por testes z (consenso, se p JUSTIFICATIVA Y OBJETIVOS: Antiguamente, tiempo, costes, informaciones, capacitación y evaluación de la profundidad de la anestesia limitaban la aceptación de la anestesia venosa total (TIVA. El objetivo de este estudio fue el de determinar las actitudes de anestesiólogos y médicos en especialización con relación a la anestesia venosa total. MÉTODO: Un cuestionario fue enviado a 150 anestesiólogos y 102 residentes. La concordancia (C y discordancia (D en cada ítem se compararon por pruebas z (consenso, si p BACKGROUND AND OBJECTIVES: In the past, time, cost, information, training, and the evaluation of the plane of anesthesia limited the acceptance of total intravenous anesthesia (TIVA. The objective of this study was to determine the attitude of anesthesiologists and other anesthesiology residents regarding total intravenous anesthesia. METHODS: A questionnaire was sent to 150 anesthesiologists and 102 residents. The concordance (C and disaccord (D of each item were compared by z tests (consensus if p < 0.05. RESULTS: There were 98 responses. The data represent the number of answers for each category. The majority of the participants agreed that the quality of the awakening stimulates the use of the TIVA (C/D = 86/8; p < 0.05; that the future depends on the development of drugs with a fast onset of action and immediate recovery (C/D = 88/5; p < 0.05; that they would like to use TIVA more often (C/D = 72/21; p < 0.05; and to have more information

Spinal Dural Arteriovenous Fistula (SDAVF in a Patient with Progressive Paraparesia: A Case Report

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Mehrdokht Mazdeh

2016-07-01

Full Text Available Background: Spinal dural arteriovenous fistula (SDAVF is a known cause of nontraumatic slow progressive araparesia and is frequently overlooked because its clinical features overlap with more common causes of myelopathy and also neuroimaging may be normal. Case Report: A 53 year-old man with developed weakness of both lower limbs had symptoms begun spontaneously 3.5 month before admission and progressed from 1 month ago with bowel and bladder incontinence. The patient's physical examination was normal and neurologic testing revealed lower extremity motor strength of 3/5. Deep tendon reflexes were decreased and superficial abdominal reflexes were absent. Sensation of pinprick and temperature was absent distal to the T4-T5 level. Vibration and proprioception were decreased to the ankle and saddle anesthesia and the patient was non ambulatory. Laboratory routine and specific tests for vitamin B12 level, hepatitis, HIV, HTLV1, 2 were negative. MRI of spine with and without contrast raised the possibility of dural arteriovenous malformation extended from T3 level to conus medullaris which was confirmed by angiography. The patient referred to neurosurgeon for deciding route of treatment. Conclusion: SDAVF can be a significant non traumatic slowly progressive cause of myelopathy. The majority of the affected patients are males older than 50 years of age. Rapid diagnosis in these patients leads to significant improvement.

Dural sinus malformation (DSM) in fetuses. Diagnostic value of prenatal MRI and follow-up

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Merzoug, Valerie; Drissi, Cyrine; Adamsbaum, Catherine [Hopital Saint Vincent de Paul, Service de Radiopediatrie, Paris (France); Flunker, Sabrina; Couture, Alain [Hopital Arnaud de Villeneuve, Service de Radiopediatrie, Montpellier cedex 5 (France); Eurin, Danielle [Hopital Charles Nicolle, Service de Radiopediatrie, Rouen (France); Grange, Gilles [Hopital Cochin, Service de Gyneco-Obstetrique, Maternite Port-Royal, Paris (France); Garel, Catherine [Hopital Armand Trousseau, Service de Radiopediatrie, Paris (France); Richter, Brigitte [Hopital Clemenceau, Service de Radiopediatrie, Caen (France); Geissler, Frederic [Centre Hospitalier Universitaire, Service de Radiopediatrie, Clermont Ferrand (France)

2008-04-15

Dural sinus malformations (DSM) are rare malformations mainly reported after birth. The objectives of this study are to describe their prenatal patterns and to focus on their possible favorable outcome. This multicenter retrospective study reported 13 cases of DSM prenatally diagnosed. The admission criterion was a dural mass posterior to the vermis. In 12 patients, MRI was performed after US. Follow-up in 10 born babies (mean: 8 months) and three neuropathological examinations were available. In all fetuses, DSM presented as a well-delimited round mass involving the torcular. The follow-up examinations (n = 10) revealed progressive thrombosis of the DSM marked by a heterogeneous pattern (US and MRI) with concentric rings. The volume of the mass decreased, with complete regression in seven patients (five before and two after birth). One child died at the age of 5 months in the context of major hydrocephalus and another developed atrophy of the frontal lobes. The eight other babies were doing well (5 days to 3 years) without any treatment (n = 6) or following treatment for hydrocephalus (n = 2). Prenatal DSM may have a typical MR pattern, and the prognosis might not be as bad as has previously been reported. In the absence of criterion to predict the hydrovenous cerebral imbalance, it is mandatory to check the parenchyma and the ventricles during the pregnancy. (orig.)

Dural sinus malformation (DSM) in fetuses. Diagnostic value of prenatal MRI and follow-up

International Nuclear Information System (INIS)

Merzoug, Valerie; Drissi, Cyrine; Adamsbaum, Catherine; Flunker, Sabrina; Couture, Alain; Eurin, Danielle; Grange, Gilles; Garel, Catherine; Richter, Brigitte; Geissler, Frederic

2008-01-01

Dural sinus malformations (DSM) are rare malformations mainly reported after birth. The objectives of this study are to describe their prenatal patterns and to focus on their possible favorable outcome. This multicenter retrospective study reported 13 cases of DSM prenatally diagnosed. The admission criterion was a dural mass posterior to the vermis. In 12 patients, MRI was performed after US. Follow-up in 10 born babies (mean: 8 months) and three neuropathological examinations were available. In all fetuses, DSM presented as a well-delimited round mass involving the torcular. The follow-up examinations (n = 10) revealed progressive thrombosis of the DSM marked by a heterogeneous pattern (US and MRI) with concentric rings. The volume of the mass decreased, with complete regression in seven patients (five before and two after birth). One child died at the age of 5 months in the context of major hydrocephalus and another developed atrophy of the frontal lobes. The eight other babies were doing well (5 days to 3 years) without any treatment (n = 6) or following treatment for hydrocephalus (n 2). Prenatal DSM may have a typical MR pattern, and the prognosis might not be as bad as has previously been reported. In the absence of criterion to predict the hydrovenous cerebral imbalance, it is mandatory to check the parenchyma and the ventricles during the pregnancy. (orig.)

Complicações na rede venosa de mulheres com câncer de mama durante tratamento quimioterápico Complicaciones en la red venosa de mujeres con cáncer de mama durante tratamiento quimioterapéutico Complications in the venous network of women with breast cancer during chemotherapy treatment

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Elga Zacharias Martins

2010-01-01

Full Text Available OBJETIVOS: Identificar as reações da rede venosa, investigar a frequência e as características dessas reações em mulheres com câncer de mama durante o tratamento quimioterápico. MÉTODOS: Foram avaliados 339 prontuários de mulheres submetidas à quimioterapia, de 2003 a 2007. RESULTADOS: Durante os tratamentos neoadjuvantes e adjuvantes 17,1% e 22,4% mulheres apresentaram intercorrências registradas no prontuário, sendo as frequentes: extravasamento, dor e alteração na coloração da pele. As condutas mais citadas na neoadjuvância foram: utilização de compressas frias (2,9% e aplicação de glicocorticoide subcutâneo no local (3,5% e na adjuvância foram: aplicação de hidrocortisona subcutâneo no local (3,2%, aplicação do protocolo de extravasamento (6,2% e utilização de compressas de gelo (7,1%. CONCLUSÃO: O registro das intercorrências e o relato da equipe de enfermagem são essenciais para o acompanhamento dos sítios de punções venosas utilizados durante o tratamento quimioterápico, além de mensuração e registro fotográfico do local.OBJETIVOS: Identificar las reacciones de la red venosa e investigar la frecuencia y las características de esas reacciones en mujeres con cáncer de mama durante el tratamiento quimioterapéutico. MÉTODOS: Fueron evaluadas 339 fichas de mujeres sometidas a quimioterapia, de 2003 a 2007. RESULTADOS: Durante los tratamientos neo-adyuvantes y adyuvantes (17,1% y 22,4% las mujeres presentaron ocurrencias registradas en fichas, siendo las más frecuentes: infiltración externa, dolor y, alteración en la coloración de la piel. Las conductas neo-adyuvantes más citadas fueron: utilización de compresas frías (2,9% y aplicación de glucocorticoide subcutáneo en el local (3,5%, y las adyuvantes fueron: aplicación de hidrocortisona subcutánea en el local (3,2%, aplicación del protocolo de infiltración externa (6,2% y utilización de compresas de hielo (7,1%. CONCLUSIÓN: El

Microcurrent application as analgesic treatment in venous ulcers: a pilot study La aplicación de microcorriente como tratamiento en las úlceras venosas: un estudio piloto Aplicação da microcorrente como recurso para tratamento de úlceras venosas: um estudo piloto

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Raciele Ivandra Guarda Korelo

2012-08-01

Full Text Available This study aimed to evaluate the effect of microcurrent electrical stimulation on pain and area of venous ulcers. In a pilot study for a single-blind controlled clinical trial, carried out at an outpatient clinic during four weeks, 14 subjects with venous ulcers (mean age 62±9 years were divided in two groups: microcurrent (n=8 and control group (n=6. Pain (by Visual Analogue Scale and the ulcer area were measured by planimetry. There was a significant difference between the two groups with respect to pain (microcurrent group from 8.5 (6.5-9.75 to 3.5 (1-4.75 and control group from 7.5 (5.75-10 to 8.5 (5.5-10, pEste estudio objetivó evaluar el efecto de la estimulación eléctrica por microcorriente sobre el dolor y el área de superficie de úlceras venosas. En un estudio piloto para un ensayo clínico controlado simple ciego, realizado en una clínica durante 4 semanas, se dividieron 14 individuos (62±9 años de edad en dos grupos: grupo microcorriente (n=8 y grupo control (n=6. Se evaluaron el dolor (por medio de la Escala Visual Analógica y el área de superficie de la úlcera por medio de la Planimetría. Hubo diferencia significativa entre los dos grupos con relación al dolor (grupo de microcorriente de 8,5 (6,5-9,75 para 3,5 (1-4,75 y grupo control de 7,5 (5,75-10 para 8,5 (5,5-10, pO objetivo neste estudo foi avaliar o efeito da estimulação elétrica, por microcorrente, sobre a dor e a área de superfície de úlceras venosas. Em estudo-piloto para um ensaio clínico controlado simples-cego, realizado em uma clínica durante 4 semanas, dividiram-se 14 indivíduos (62±9 anos de idade em dois grupos: grupo microcorrente (n=8 e grupo-controle (n=6. Avaliaram-se a dor (por meio da Escala Visual Analógica e a área de superfície da úlcera por meio da Planimetria. Houve diferença significativa entre os dois grupos em relação à dor (grupo de microcorrente de 8,5 (6,5-9,75 para 3,5 (1-4,75 e grupo-controle de 7,5 (5,75-10 para 8

Trombose séptica de seios cavernosos, transverso e sigmóide e de veia jugular, associada à meningite, secundária a furúnculo nasal: Relato de Caso Septic thrombosis of cavernous, transverse, sigmoid sinuses and jugular vein, associated with meningitis, secondary to nasal furuncle: Case report

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Hélio Utida

2002-06-01

Full Text Available Os autores descrevem um caso de furúnculo nasal que evoluiu com trombose séptica de seio cavernoso, bilateral e assimétrica, e de seios transverso e sigmóide e de veia jugular interna a esquerda, associada à meningite bacteriana, em um paciente previamente hígido. Apesar da trombose séptica extensa de seios venosos, o paciente apresentou boa evolução, após tratamento clínico agressivo com antibióticos, corticosteróides e anticoagulantes. Porém, manteve como seqüela: paresia de VI nervo à esquerda e lesão parcial de nervo óptico homolateral.The authors report a case of nasal furuncle that progressed to septic bilateral and asymmetric thrombosis of cavernous, transverse, sigmoid sinus and internal jugular vein, associated with bacterial meningitis, in a previously healthy patient. In spite of the extensive thrombosis, the patient presented a good evolution, after an aggressive clinical treatment with antibiotics, corticosteroids and anticoagulants. However, there remained paresis of the VI nerve on the left and partial lesion of the homolateral optic nerve.

Hipertensão venosa episcleral idiopática unilateral em mulher jovem

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Marcelo Mendes Lavezzo

2013-02-01

Full Text Available O objetivo é relatar o caso de uma paciente de 33 anos, que veio ao Pronto Socorro de Oftalmologia apresentando queixa de redução da acuidade visual à esquerda, de caráter insidioso e progressivo, há dois anos. Ao exame oftalmológico, apresentava ingurgitamento dos vasos da conjuntiva bulbar, pressão intraocular muito elevada e nervo óptico com escavação total à esquerda. Foi submetida à campimetria computadorizada 24:2 WW e SITA-SWAP do olho direito, ambas com resultados dentro da normalidade. As tomografias de crânio e órbitas, bem como ultrassonografia com doppler do globo ocular, artérias oftálmicas e veias supraorbitárias não apresentavam anormalidades. Diante disso, aventou-se a hipótese diagnóstica de hipertensão venosa episcleral idiopática, um diagnóstico de exclusão, visto que patologias intracranianas e intraorbitárias haviam sido excluídas. Paciente foi tratada clinicamente com colírios hipotensores, com redução importante da pressão intraocular à esquerda, porém não o suficiente, evoluindo para trabeculectomia.

Single-Session Hematoma Removal and Transcranial Coil Embolization for a Cavernous Sinus Dural Arteriovenous Fistula: A Technical Case Report.

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Akamatsu, Yosuke; Sato, Kenichi; Endo, Hidenori; Matsumoto, Yasushi; Tominaga, Teiji

2017-08-01

Patients with cavernous sinus dural arteriovenous fistulas (CS dAVFs) with cortical venous varix are indicated for aggressive treatment because of the associated risk for intracranial hemorrhage. We present a case of surgical transvenous embolization in an 84-year-old woman with CS dAVF who presented with massive intracerebral hematoma. Cerebral angiograms revealed the dural AVF drained only into the superficial middle cerebral vein. Because an emergent mass reduction and prevention of rebleeding were necessary, single-session hematoma removal and transcranial embolization of a CS dAVF were performed in the neurosurgical operating room, using a mobile C-arm fluoroscopy. After the right frontotemporal craniotomy, intracerebral hematoma was removed and coil packing of the affected cavernous sinus was successfully performed via the dilated superficial middle cerebral vein. The transcortical vein approach enables occlusion of CS dAVF with isolated cortical venous drainage and may be a valuable alternative approach for some cases needed emergency craniotomy. Copyright © 2017 Elsevier Inc. All rights reserved.

Chronic changes in pituitary adenylate cyclase-activating polypeptide and related receptors in response to repeated chemical dural stimulation in rats.

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Han, Xun; Ran, Ye; Su, Min; Liu, Yinglu; Tang, Wenjing; Dong, Zhao; Yu, Shengyuan

2017-01-01

Background Preclinical experimental studies revealed an acute alteration of pituitary adenylate cyclase-activating polypeptide in response to a single activation of the trigeminovascular system, which suggests a potential role of pituitary adenylate cyclase-activating polypeptide in the pathogenesis of migraine. However, changes in pituitary adenylate cyclase-activating polypeptide after repeated migraine-like attacks in chronic migraine are not clear. Therefore, the present study investigated chronic changes in pituitary adenylate cyclase-activating polypeptide and related receptors in response to repeated chemical dural stimulations in the rat. Methods A rat model of chronic migraine was established by repeated chemical dural stimulations using an inflammatory soup for a different numbers of days. The pituitary adenylate cyclase-activating polypeptide levels were quantified in plasma, the trigeminal ganglia, and the trigeminal nucleus caudalis using radioimmunoassay and Western blotting in trigeminal ganglia and trigeminal nucleus caudalis tissues. Western blot analysis and real-time polymerase chain reaction were used to measure the protein and mRNA expression of pituitary adenylate cyclase-activating polypeptide-related receptors (PAC1, VPAC1, and VPAC2) in the trigeminal ganglia and trigeminal nucleus caudalis to identify changes associated with repetitive applications of chemical dural stimulations. Results All rats exhibited significantly decreased periorbital nociceptive thresholds to repeated inflammatory soup stimulations. Radioimmunoassay and Western blot analysis demonstrated significantly decreased pituitary adenylate cyclase-activating polypeptide levels in plasma and trigeminal ganglia after repetitive chronic inflammatory soup stimulation. Protein and mRNA analyses of pituitary adenylate cyclase-activating polypeptide-related receptors demonstrated significantly increased PAC1 receptor protein and mRNA expression in the trigeminal ganglia, but not

Enfermedad tromboembólica venosa y cirrosis hepática Venous thromboembolism and liver cirrhosis

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M. J. García-Fuster

2008-05-01

Full Text Available Objetivos: la enfermedad tromboembólica venosa (ETV es poco frecuente en la cirrosis hepática, no estando su tratamiento contemplado en las guías del American College of Chest Physicians. El objetivo del presente trabajo es aportar la experiencia de pacientes cirróticos con ETV hospitalizados en nuestro centro en los últimos 15 años. Material y método: de enero de 1992 a diciembre de 2007 fueron hospitalizados en nuestro centro 2.074 pacientes con cirrosis hepática. Presentaron una ETV no esplácnica 17, siendo ellos la población a estudio. Se recogen datos epidemiológicos y analíticos: hemograma, VSG, química hemática, coagulación, trombofilia congénita, anticuerpos antifosfolípidos (AAFL y homocisteinemia. Se valoran factores de riesgo adquiridos, características de la trombosis, el tratamiento y las complicaciones. Resultados y conclusiones: la ETV no esplácnica se observa en el 0,8% de pacientes cirróticos. En ellos es frecuente observar hipoalbuminemia, disminución de factores anticoagulantes (ATIII, PC, y PS, presencia de AAFL e hiperhomocisteinemia, así como la presencia de factores de riesgo adquiridos: intervenciones quirúrgicas, insuficiencia venosa, inmovilización e infecciones. Tras la anticoagulación, se observan complicaciones hemorrágicas mayores en el 35% de los pacientes.Objective: despite the endogenous coagulopathy of cirrhosis, some patients do experience thrombophilic states. The American College of Chest Physicians failed to address the prevention and treatment of venous thromboembolism (VTE occurring among these patients. This study aims to describe the characteristics of cirrhotics patients hospitalized in the last 15 years, and to use the experience gained. Material and method: we retrospectively reviewed all admissions for cirrhosis in our hospital from 1992 to 2007. A total of 17 patients had non-portal venous thromboembolic disease. We recorded risk factors, epidemiological and laboratory data

Experimental inflammation following dural application of complete Freund's adjuvant or inflammatory soup does not alter brain and trigeminal microvascular passage.

Science.gov (United States)

Lundblad, Cornelia; Haanes, Kristian A; Grände, Gustaf; Edvinsson, Lars

2015-01-01

Migraine is a paroxysmal, disabling primary headache that affects 16 % of the adult population. In spite of decades of intense research, the origin and the pathophysiology mechanisms involved are still not fully known. Although triptans and gepants provide effective relief from acute migraine for many patients, their site of action remains unidentified. It has been suggested that during migraine attacks the leakiness of the blood-brain barrier (BBB) is altered, increasing the passage of anti-migraine drugs. This study aimed to investigate the effect of experimental inflammation, following dural application of complete Freund's adjuvant (CFA) or inflammatory soup (IS) on brain and trigeminal microvascular passage. In order to address this issue, we induced local inflammation in male Sprague-Dawley-rats dura mater by the addition of CFA or IS directly on the dural surface. Following 2, 24 or 48 h of inflammation we calculated permeability-surface area product (PS) for [(51)Cr]-EDTA in the trigeminal ganglion (TG), spinal trigeminal nucleus, cortex, periaqueductal grey and cerebellum. We observed that [(51)Cr]-EDTA did not pass into the central nervous system (CNS) in a major way. However, [(51)Cr]-EDTA readily passed the TG by >30 times compared to the CNS. Application of CFA or IS did not show altered transfer constants. With these experiments we show that dural IS/CFA triggered TG inflammation, did not increase the BBB passage, and that the TG is readily exposed to circulating molecules. The TG could provide a site of anti-migraine drug interaction with effect on the trigeminal system.

Diagnosis of deep venous thrombosis by radioisotopic phlebography; Valor da flebografia radioisotopica no diagnostico da trombose venosa profunda

Energy Technology Data Exchange (ETDEWEB)

Araujo, Antonio Luiz de [Universidade do Rio de Janeiro (UNIRIO), RJ (Brazil)

1993-10-01

The author studied 20 patients with deep venous thrombosis of members (one of them attacked on both arms), from various etiologies, by mean radioisotopic phlebography, in the Vascular Diseases, Radiology and Nuclear Medicine Services of Army Central Hospital (Rio de Janeiro, Brazil) from january 1988 to june 1990. The years old was 18 to 72. The cause most frequency of deep venous thrombosis was idiopathic (seven cases 33.3%). The presence of clot by radionuclide marker in all cases, 16 observations (76.2%) in the lower members and five in the upper extremities (23.9%); 17 cases (85%) also were a conventional venography and his images were confirmed. The diagnostic of deep venous thrombosis from {sup 99m} T{sub c}MAA (macro aggregate of albumin tagged with technetium) should always de complemented by pulmonary mapping, tracking possible silent emboli. Permit as well repetitions evolutionary until daily and using in patients with history of allergy to radiologic contrast because has not complication. (author)

Dural invasion of meningiomas adjacent to the tumor margin on Gd-DTPA-enhanced MR images: histopathologic correlation

International Nuclear Information System (INIS)

Hutzelmann, A.; Palmie, S.; Freund, M.; Heller, M.; Buhl, R.

1998-01-01

In intracranial meningiomas a flat, contrast-enhancing, dural structure adjacent to the tumor can occasionally be observed on gadolinium-DTPA-enhanced MR images. We wished to evaluate whether there is a correlation between MR images and meningeal invasion of intracranial meningiomas. The study included 54 patients with intracranial meningioma and the meningeal sign. MR studies included T2-weighted and gadolinium-DTPA-enhanced T1-weighted images in axial, coronal, and sagittal planes. Histopathologic examinations were done on the meningiomas adjacent to the dura mater. The meningeal sign on MRI was observed from 2 up to 35 mm from the main tumor mass in 31 (57 %) of the 54 patients. In 20 of these 31 the histopathologic examination showed tumor invasion, while 11 patients had no tumor invasion but tissue proliferation, hypervascularity, and vascular dilatation. Seven of the 23 meningiomas without the meningeal sign had histologically proven infiltration of the adjacent dura. MR imaging is not able to determine definitive whether or not there is dural infiltration of the meningiomas. In conclusion, resection of the tumor with a wide margin is necessary to achieve complete excision of meningioma and to avoid recurrence. (orig.)

Anestesia venosa total com infusão alvo-controlada de remifentanil e propofol para ablação de fibrilação atrial Anestesia venosa total con infusión objeto-controlada de remifentanil y propofol para ablación de la fibrilación atrial Total intravenous anesthesia with target-controlled infusion of remifetanil and propofol for ablation of atrial fibrillation

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Fernando Squeff Nora

2009-12-01

Full Text Available JUSTIFICATIVA E OBJETIVOS: A ablação de fibrilação atrial (FA é um procedimento novo em nosso meio, embora seja comum em outros centros. A escolha da anestesia, monitores e cuidados anestesiológicos para esse procedimento, realizado fora do bloco cirúrgico, não tem sido descrita. O objetivo deste relato foi descrever uma técnica de anestesia para a realização de ablação de FA. RELATO DO CASO: Paciente feminina, 49 anos, 73 kg, 155 cm, ASA II por hipertensão arterial sistêmica. A monitorização constou de eletrocardiograma com 12 derivações, oximetria de pulso, frequência cardíaca, eletroencefalografia bispectral para medidas de BIS, taxa de supressão (SR e SEF95 e pressão arterial média (PAM. A indução anestésica foi realizada com propofol por via venosa, em infusão alvo-controlada (IAC, com alvo regulado em 4 µg.mL-1, remifentanil por via venosa, em IAC, com alvo de 3 ng.mL¹, e rocurônio por via venosa em bolus na dose de 0,2 mg.kg-1. O modelo farmacocinético de propofol utilizado foi o descrito por Marsh e incorporado à bomba de propofol PFS®. O modelo farmacocinético de remifentanil utilizado foi o descrito por Minto e incorporado à bomba de infusão Alaris PK®. As concentrações, no local efetor ou biofase, corresponderam às informações obtidas através das bombas de infusão e representaram medidas preditivas das concentrações de ambos os fármacos nos respectivos locais de ação. As concentrações de propofol e de remifentanil foram reguladas de acordo com o BIS e a PAM, respectivamente. CONCLUSÕES: A anestesia venosa total para ablação de FA pode ser uma opção segura, levando-se em conta que não há alteração da eletrofisiologia das vias acessórias. A literatura é escassa a este respeito e novas publicações poderão ou não justificar esta modalidade de anestesia durante ablação de FA.JUSTIFICATIVA Y OBJETIVOS: La ablación de fibrilación atrial (FA es un procedimiento nuevo en

Fetal MR imaging of posterior intracranial dural sinus thrombosis: a report of three cases with variable outcomes

International Nuclear Information System (INIS)

Byrd, Sharon E.; Elias, Dean; Abramowicz, Jacques S.; Kent, Paul; Kimura, Robert E.; Heydeman, Peter T.

2012-01-01

Thrombosis of fetal intracranial dural sinuses is a rare entity. A specific type of midline dural sinus thrombosis (DST) at the torcular Herophili with extension into the superior sagittal sinus (SSS) was initially seen on fetal US and was referred to fetal MRI for definite diagnosis and better delineation. Retrospective comparison to medical literature of three cases, diagnosed at our institution, of midline fetal DST with MR imaging findings and clinical outcomes. We reviewed MRI findings on T2-weighted images of our three cases of fetal midline DST and clinical outcomes of these fetuses and compared our findings to medical literature. The MR imaging and clinical findings of our cases extend over 6 years. They consist of three pregnant women, 31-39 years of age each with a single fetus, with fetal MR imaging performed at different gestational ages (GA). Case 1 the MR imaging was performed at 21 5/7 weeks' GA, case 2 at 24 and 33 4/7 weeks' GA, and case 3 at 22 and 25 weeks' GA. Postnatal MRI was performed in case 2 at 6 months of life and case 3 at 1 day of life. Clinical follow-up occurred during the last 6 years. In all of our cases, T2-W MR imaging demonstrated ballooned midline torcular Herophili with iso- to hypointense mass with or without focal eccentric area of greater hypointensity occupying the torcular Herophili with extension into the SSS. Case 3 had associated leptomeningeal dural vascular malformation overlying the left cerebral hemisphere with development of migrational disorder in the left cerebral hemisphere. Clinical outcome consisted of fetal demise in case 1, normal postnatal outcome in case 2 and severe brain damage with poor postnatal outcome in case 3. Our findings of large iso-hypointense thrombus with or without a focal eccentric area more hypointense to thrombus in a dilated torcular Herophili with extension into the SSS on T2-W images corresponds to the majority of cases of this rare type of DST in the medical literature. (orig.)

Fetal MR imaging of posterior intracranial dural sinus thrombosis: a report of three cases with variable outcomes

Energy Technology Data Exchange (ETDEWEB)

Byrd, Sharon E.; Elias, Dean [Rush Medical College and Rush University Medical Center, Department of Diagnostic Radiology and Nuclear Medicine Section of Neuroradiology, Chicago, IL (United States); Abramowicz, Jacques S. [Rush Medical College and Rush University Medical Center, Department of Obstetrics and Gynecology, Rush Fetal and Neonatal Medicine Center, Chicago, IL (United States); Kent, Paul [Rush Medical College and Rush University Medical Center, Department of Pediatrics, Division of Hematology and Oncology, Chicago, IL (United States); Kimura, Robert E. [Rush Medical College and Rush University Medical Center, Department of Pediatrics, Division of Neonatology, Chicago, IL (United States); Heydeman, Peter T. [Rush Medical College and Rush University Medical Center, Department of Pediatrics, Division of Pediatric Neurology, Chicago, IL (United States)

2012-05-15

Thrombosis of fetal intracranial dural sinuses is a rare entity. A specific type of midline dural sinus thrombosis (DST) at the torcular Herophili with extension into the superior sagittal sinus (SSS) was initially seen on fetal US and was referred to fetal MRI for definite diagnosis and better delineation. Retrospective comparison to medical literature of three cases, diagnosed at our institution, of midline fetal DST with MR imaging findings and clinical outcomes. We reviewed MRI findings on T2-weighted images of our three cases of fetal midline DST and clinical outcomes of these fetuses and compared our findings to medical literature. The MR imaging and clinical findings of our cases extend over 6 years. They consist of three pregnant women, 31-39 years of age each with a single fetus, with fetal MR imaging performed at different gestational ages (GA). Case 1 the MR imaging was performed at 21 5/7 weeks' GA, case 2 at 24 and 33 4/7 weeks' GA, and case 3 at 22 and 25 weeks' GA. Postnatal MRI was performed in case 2 at 6 months of life and case 3 at 1 day of life. Clinical follow-up occurred during the last 6 years. In all of our cases, T2-W MR imaging demonstrated ballooned midline torcular Herophili with iso- to hypointense mass with or without focal eccentric area of greater hypointensity occupying the torcular Herophili with extension into the SSS. Case 3 had associated leptomeningeal dural vascular malformation overlying the left cerebral hemisphere with development of migrational disorder in the left cerebral hemisphere. Clinical outcome consisted of fetal demise in case 1, normal postnatal outcome in case 2 and severe brain damage with poor postnatal outcome in case 3. Our findings of large iso-hypointense thrombus with or without a focal eccentric area more hypointense to thrombus in a dilated torcular Herophili with extension into the SSS on T2-W images corresponds to the majority of cases of this rare type of DST in the medical literature

Úlcera venosa e terapia compressiva para enfermeiros: desenvolvimento de curso online Úlcera venosa y terapia compresiva para enfermeros: desarrollo de un curso online Venous ulcer and compression therapy for nurses: development of online course

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Fernanda Mateus Queiroz

2012-01-01

Full Text Available OBJETIVO: Descrever a elaboração de um curso on-line sobre úlcera venosa, com enfoque em terapia compressiva, para capacitação de enfermeiros. MÉTODOS: O desenvolvimento do curso on-line seguiu as fases de análise, design, desenvolvimento, implementação e avaliação, baseadas no design instrucional contextualizado. RESULTADOS: O curso dividiu-se em dez módulos estruturados no ambiente virtual de aprendizagem Moodle. Caracterizou-se por uma proposta construtivista, visando ampliar a participação do aluno, disponibilizar as principais referências, revisões e consensos, bem como utilizar objetos multimídia e recursos didáticos interativos. CONCLUSÃO: O curso possibilita a capacitação profissional do enfermeiro em terapia compressiva de maneira inovadora, flexível, interativa em diversos ambientes de cuidado.OBJETIVO: Describir la elaboración de un curso online sobre úlcera venosa, con enfoque en terapia compresiva, para la capacitación de enfermeros. MÉTODOS: El curso online se desarrolló siguiendo las fases de análisis, diseño, desarrollo, implementación y evaluación, basadas en el diseño instruccional contextualizado. RESULTADOS: El curso se dividió en diez módulos estructurados en el ambiente virtual de aprendizaje Moodle. Se caracterizó por una propuesta constructivista, pretendiendo ampliar la participación del alumno, poner a disposición las principales referencias, revisiones y consensos, así como utilizar objetos multimedia y recursos didácticos interactivos. CONCLUSIÓN: El curso permite la capacitación profesional del enfermero en terapia compresiva de manera innovadora, flexible, interactiva en diversos ambientes de cuidado.OBJECTIVE: To describe the development of an online course about venous ulcer, with a focus on compression therapy, for the educating of nurses. METHODS: The development of an online course followed the phases of analysis, design, development, implementation and evaluation, based

Sensitization of dural afferents underlies migraine-related behavior following meningeal application of interleukin-6 (IL-6

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Yan Jin

2012-01-01

Full Text Available Abstract Background Migraine headache is one of the most common neurological disorders, but the pathophysiology contributing to migraine is poorly understood. Intracranial interleukin-6 (IL-6 levels have been shown to be elevated during migraine attacks, suggesting that this cytokine may facilitate pain signaling from the meninges and contribute to the development of headache. Methods Cutaneous allodynia was measured in rats following stimulation of the dura with IL-6 alone or in combination with the MEK inhibitor, U0126. The number of action potentials and latency to the first action potential peak in response to a ramp current stimulus as well as current threshold were measured in retrogradely-labeled dural afferents using patch-clamp electrophysiology. These recordings were performed in the presence of IL-6 alone or in combination with U0126. Association between ERK1 and Nav1.7 following IL-6 treatment was also measured by co-immunoprecipitation. Results Here we report that in awake animals, direct application of IL-6 to the dura produced dose-dependent facial and hindpaw allodynia. The MEK inhibitor U0126 blocked IL-6-induced allodynia indicating that IL-6 produced this behavioral effect through the MAP kinase pathway. In trigeminal neurons retrogradely labeled from the dura, IL-6 application decreased the current threshold for action potential firing. In response to a ramp current stimulus, cells treated with IL-6 showed an increase in the numbers of action potentials and a decrease in latency to the first spike, an effect consistent with phosphorylation of the sodium channel Nav1.7. Pretreatment with U0126 reversed hyperexcitability following IL-6 treatment. Moreover, co-immunoprecipitation experiments demonstrated an increased association between ERK1 and Nav1.7 following IL-6 treatment. Conclusions Our results indicate that IL-6 enhances the excitability of dural afferents likely via ERK-mediated modulation of Nav1.7 and these responses

Reflexões sobre o trauma cardiovascular civil a partir de um estudo prospectivo de 1000 casos atendidos em um centro de trauma de nível I: a prospective study from 1000 cases

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Ricardo Costa-Val

Full Text Available OBJETIVO: Analisar os dados referentes a uma grande série de casos de traumas cardiovasculares exclusivamente civil operados em um único centro de trauma brasileiro. MÉTODO: Trata-se de um estudo de coorte, prospectivo, descritivo e analítico registrados entre os anos de 1998 - 2005. RESULTADOS: No período foram operados 1000 casos que acometeram principalmente homens jovens devido a armas de fogo, armas brancas/vidros e trauma contuso e cuja topografia das lesões se deu na seguinte ordem: abdominais, cervicais, torácicas e extremidades. As três síndromes mais comuns a admissão foram: hemorrágica, isquêmica e hemorrágica/isquêmica. No entanto, 34.6% dos pacientes estavam em choque hipovolêmico grave e em 85% da casuística havia lesões não cardiovasculares associadas. A maioria dos pacientes foi submetida a tratamento cirúrgico sem propedêutica específica, mas 14% destes foram reoperados devido à síndrome compartimental, trombose aguda e/ou hemorragia grave. A taxa de amputação foi de 5.5% e da mortalidade de 7.5%, estando correlacionada com choque hipovolêmico grave ou síndrome da resposta inflamatória sistêmica. Lesões CCV isoladas ocorreram em 15% dos casos com taxa de letalidade global de 41%, sendo 22% venosa, 47% arterial e 81% cardíaca, proporcionando diferença significativa entre lesões cardíacas versus arteriais e venosas associadas (p = 0,01; odds ratio de 7.37 e lesões arteriais versus venosas (p = 0,01; odds ratio de 3.17. CONCLUSÃO: Esta grande série de casos demonstrou ser o homem jovem o mais acometido devido principalmente à violência interpessoal e os acidentes automobilísticos, que envolvem na maioria das vezes as extremidades, associadas com lesões em outros órgãos ou sistemas. Os fatores preditivos de mau prognóstico foram choque hipovolêmico, lesão de grandes vasos arteriais e lesão cardíaca.

Morphological analysis of the cervical spinal canal, dural tube and spinal cord in normal individuals using CT myelography

International Nuclear Information System (INIS)

Inoue, H.; Ohmori, K.; Takatsu, T.; Teramoto, T.; Ishida, Y.; Suzuki, K.

1996-01-01

To verify the conventional concept of ''developmental stenosis of the cervical spinal canal'', we performed a morphological analysis of the relations of the cervical spinal canal, dural tube and spinal cord in normal individuals. The sagittal diameter, area and circularity of the three structures, and the dispersion of each parameter, were examined on axial sections of CT myelograms of 36 normal subjects. The spinal canal was narrowest at C4, followed by C5, while the spinal cord was largest at C4/5. The area and circularity of the cervical spinal cord were not significantly correlated with any parameter of the spinal canal nor with the sagittal diameter and area of the dural tube at any level examined, and the spinal cord showed less individual variation than the bony canal. Compression of the spinal cord might be expected whenever the sagittal diameter of the spinal canal is below the lower limit of normal, that is about 12 mm on plain radiographs. Thus, we concluded that the concept of ''developmental stenosis of the cervical spinal canal'' was reasonable and acceptable. (orig.). With 2 figs., 3 tabs

Conduta na lesão dural intraoperatória em artrodese da coluna lombar

OpenAIRE

Grandese, Fabiano de Mendonça; Yamazato, Clóvis; Oliveira, Fábio Mastromauro de; Ribeiro, Iberê; Bastos Júnior, José Olympio Catão; Kusabara, René

2010-01-01

OBJETIVO: estudo retrospectivo de pacientes com lesão dural intraoperatória de cirurgia da coluna vertebral lombar, conduzido por meio de um protocolo independente da extensão da lesão, complicações associadas e resultados após seguimento mínimo de um ano. MÉTODOS: um total de 10 pacientes com durotomia acidental em cirurgias de descompressão e artrodese da coluna vertebral lombar, no período de Janeiro de 2007 a Janeiro de 2009, para tratamento de doença degenerativa, tiveram seus prontuário...

Doença venosa e sua relação com as condições de trabalho no setor de produção de refeições Venous insufficiency and its relation with work conditions in the foodservice sector

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Clarissa Medeiros da Luz Bertoldi

2008-08-01

Full Text Available A doença venosa crônica é um problema de saúde pública importante, podendo promover inaptidão para o trabalho, tendo também uma repercussão indireta sobre a qualidade da produção e conseqüente perda de eficiência operacional. Embora ainda não haja evidência da relação direta causa-efeito de doença venosa com o trabalho, existe consenso científico de que o trabalho pode agravar o desenvolvimento da mesma. O presente estudo relata os fatores que podem influenciar o aparecimento ou agravamento de doenças venosas de membros inferiores em operadores de Unidades Produtoras de Refeições, ressaltando a importância e a possibilidade de aprofundamento do tema, o que poderia evoluir para o estabelecimento de um protocolo de prevenção e tratamento de doenças venosas em função do posto de trabalho executado. Reflete-se sobre o início de um processo de identificação deste distúrbio como uma doença de caráter ocupacional, o que contribuiria, portanto, para a reformulação conceitual dos encargos decorrentes dessa atividade profissional.Chronic venous disease is an important public health problem which may greatly impair the quality of one's work, generate absenteeism and hospital admittances. Although, so far, no evidence exists of the direct cause-effect relation between venous disease and work output, there is a scientific consensus that certain working conditions may increase the risk of developing the condition. The present study evaluates which factors may influence the onset or severity of lower limb venous disease in workers of a Unit of Food Service, pointing out the importance and the possibility of deepening the discussions around this subject and suggest that a protocol be established to prevent and treat venous diseases stemming from working conditions. It could be the start of a process to identify this condition as an occupational disease, therefore contributing for a conceptual reformulation of the obligations

Hemoglobin measured by Hemocue and a reference method in venous and capillary blood: a validation study Hemoglobina medida por Hemocue y por un método de referencia en sangre venosa y capilar: estudio de validación

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Lynnette Neufeld

2002-06-01

Full Text Available Objective. To assess the comparability of hemoglobin concentration (Hb in venous and capillary blood measured by Hemocue and an automated spectrophotometer (Celldyn and to document the influence of type of blood (capillary or venous and analysis method on anemia prevalence estimates. Material and Methods. Between February and May 2000, capillary and venous samples were collected from 72 adults and children at Hospital del Niño Morelense (Morelos State Children's Hospital in Cuernavaca, Morelos, Mexico, and assessed for Hb using the Hemocue and Celldyn methods. Estimated Hb levels were compared using the concordance correlation coefficient and Student's t test for paired data. The sensitivity and specificity for anemia diagnosis were estimated and compared between type of blood and method of assessment. Results. Capillary blood had higher Hb (+0.5g/dl than venous blood in adults and children, as did samples assessed by Celldyn compared to Hemocue (+0.3g/dl. Specificity to detect anemia was adequate (>0.90 but sensitivity was low for capillary blood assessed by Hemocue (Objetivo. Evaluar la comparabilidad de la concentración de hemoglobina (Hb en sangre venosa y capilar medida por Hemocue y por espectrofotómetro automatizado (Celldyn, así como documentar la influencia del tipo de sangre (capilar o venosa y del método de análisis sobre la prevalencia de anemia. Material y métodos. De febrero a mayo de 2000, se recolectaron muestras de sangre capilar y venosa en 72 adultos y niños en el Hospital del Niño Morelense, Cuernavaca, Morelos, México. Se determinaron los niveles de Hb con los métodos Hemocue y Celldyn. Las cifras de Hb estimadas se compararon con el coeficiente de concordancia y la prueba pareada de t de Student. También se comparó la sensibilidad y especificidad para el diagnóstico de anemia, utilizando sangre de los dos tipos y métodos de análisis. Resultados. La Hb fue mayor en sangre capilar comparada con sangre venosa

Embolia gasosa venosa inadvertida durante cesariana: bolsas retráteis ​​para líquidos intravenosos sem saídas autovedantes oferecem riscos. Relato de caso

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Mefkur Bakan

2013-08-01

Full Text Available O anestesiologista deve estar ciente das causas, do diagnóstico e do tratamento de embolia venosa e adotar padrões de prática para prevenir sua ocorrência. Embora a embolia gasosa seja uma complicação conhecida da cesariana, descrevemos um caso raro de desatenção que causou embolia gasosa iatrogênica quase fatal durante uma cesariana sob raquianestesia. uma das razões para o uso de bolsas autorretráteis para infusão em vez dos frascos convencionais de vidro ou plástico é a precaução contra embolia gasosa. Também demonstramos o risco de embolia venosa com o uso de dois tipos de bolsas plásticas retráteis (à base de cloreto de polivinil [PVC] e de polipropileno para líquidos intravenosos. As bolsas para líquidos sem saídas autovedantes apresentam risco de embolia gasosa se o sistema de fechamento estiver quebrado, enquanto a flexibilidade da bolsa limita a quantidade de entrada de ar. bolsas à base de pvc, que têm mais flexibilidade, apresentam risco significativamente menor de entrada de ar quando o equipo de administração intravenosa (IV é desconectado da saída. usar uma bolsa pressurizada para infusão rápida sem verificar e esvaziar todo o ar da bolsa IV pode ser perigoso.

Dural carotid cavernous sinus fistula presenting as isolated oculomotor nerve palsy: Case report

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Şehnaz Arıcı

2015-04-01

Full Text Available Indirect (dural carotid cavernous fistula is formed by the connection between meningeal branches of the internal carotid artery and the cavernous sinüs, and low flow circulation with low pressure is occured. Proptosis, ophtalmoplegia, headache, scleral and conjuctival hyperemia expanding around the eyeball can be observed. A forty-eight year old female patient with a background of diabetes mellitus and hypertension was admitted with complaints of double vision. Isolated oculomotor nerve palsy was found in neurological examination and an indirect carotid cavernous fistula was revealed by digital subtraction angiography. Our case with carotid cavernous fistula as a rare cause of isolated oculomotor nerve palsy is worth to be reported.

MR imaging of the lumbar disk herniation : relationship between the direction of herniated disc and pressure effect on nerve root and dural sac

International Nuclear Information System (INIS)

Cha, B. H.; Shon, M. Y.; Kim, K. W.; Lim, M. A.; Kwon, K. R; Kim, S. S.

1996-01-01

To evaluate the relationship between the direction of herniated disc and pressure effect on nerve root and dural sac, as seen on MRI. We retrospectively reviewed lumbar spine MR images of 122 cases of lumbar disk herniation 75 patients MRI findings were analyzed with regard to the relationship between the direction of the herniated disc and pressure effect on nerve root and dural sac. Pressure effect on nerve root and dural sac was arbitrarily divided into three types. Type I was defined as zero or minimal compression of nerve roots or thecal sac by the herniated disc ; type II was defined as mild to moderate compression, while III was defined as severe compression or displacement of nerve roots and/or thecal sac. Of the 122 cases seen in these 75 patients, 97(80%) were observed at L4-5 and L5-S1. The central type(71cases ; 58%) was more frequently observed than the posterolateral type(48cases ; 40%) or lateral type(3cases ; 2%). The totals of types I, II, and III were 44(36%), 43(35%) and 35 cases(29%), respectively. Seventy-seven %(34/44) of type I and 65%(28/43) of type II were of the central type but for type III, the corresponding figure was only 26%(9/35). On MR imaging, most of lumbar disk herniations were observed at L4-5 and L5-S1, with a predominance of the central type rather than the posterolateral one. Most of the central types were either type I or type II

Malformación arterio-venosa cerebral causante de insuficiencia cardiaca congestiva en un neonato Cerebral arteriovenous malformation as a cause of congestive heart failure in a newborn

OpenAIRE

R. Fernández Montes; S. Bueno Pardo; M. Montes Granda; S. Lareu Vidal; M. González Sánchez; G. Solís Sánchez

2013-01-01

La malformación arterio-venosa de la vena de Galeno representa una anomalía congénita vascular muy infrecuente. Esta patología se presenta de forma preferente en el periodo neonatal pudiendo causar una importante morbi-mortalidad. La forma de presentación clínica es muy variable, siendo la asociación de soplo craneal e insuficiencia cardiaca la forma de presentación más frecuente en el periodo neonatal. El grado de insuficiencia cardiaca asociada constituye el principal factor pronóstico y co...

Diagnostic performance of CT and MRI on the detection of symptomatic intracranial dural arteriovenous fistula: a meta-analysis with indirect comparison

Energy Technology Data Exchange (ETDEWEB)

Lin, Yen-Heng [National Taiwan University, Institute of Epidemiology and Preventive Medicine, Taipei (China); National Taiwan University Hospital in Taipei and Yuan-Lin Branch, Department of Medical Imaging and Radiology, Hospital and Medical College, Taipei (China); Lin, Hsien-Ho [National Taiwan University, Institute of Epidemiology and Preventive Medicine, Taipei (China); Liu, Hon-Man; Lee, Chung-Wei; Chen, Ya-Fang [National Taiwan University Hospital in Taipei and Yuan-Lin Branch, Department of Medical Imaging and Radiology, Hospital and Medical College, Taipei (China)

2016-08-15

This study aims to review the diagnostic performance of computed tomography (CT) and magnetic resonance imaging (MRI) in symptomatic dural arteriovenous fistula (DAVF). EMBASE, PubMed, and Cochrane Library were searched until April 2015 for studies which compared CT, MRI, or both with angiography for the detection of DAVF. The diagnostic performances of MRI and CT were indirectly compared using modality as a covariate in the analysis. Thirteen studies met our inclusion criteria. MRI had a sensitivity of 0.90 (95 % confidence interval (CI) = 0.83-0.94) and specificity of 0.94 (95 % CI = 0.90-0.96). CT had a sensitivity of 0.80 (95 % CI = 0.62-0.90) and specificity of 0.87 (95 % CI = 0.74-0.94). MRI showed better diagnostic performance than CT (p = 0.02). Contrast medium use and time-resolved MR angiography did not improve MRI diagnostic performance (p = 0.31 and 0.44, respectively). Both CT and MRI had good diagnostic performance. MRI was better than CT on the detection of symptomatic intracranial dural arteriovenous fistula in the indirect comparison. (orig.)

Dural arteriovenøs fistel er en sjælden, men behandlelig årsag til transversal myelopati

DEFF Research Database (Denmark)

Hansen, Julie Richter; Poulsgaard, Lars; Holtmannspötter, Markus

2017-01-01

This is a case report of a 60-year-old male admitted on suspicion of relapse of idiopathic transverse myelitis (TM), who after further diagnostic workup underwent successful closure of a dural arteriovenous fistula (DAVF). Magnetic resonance imaging in DAVF usually shows longitudinal TM, which, u......, unlike DAVF, is also seen with the more common inflammatory or infectious causes usually showing inflammation in the cerebrospinal fluid. The natural history of DAVF is progressive. Since curable options exist, timely diagnosis is most important....

Haemocyanins from Rapana venosa and Helix vulgaris display an antitumour activity via specific activation of spleen lymphocytes

International Nuclear Information System (INIS)

Iliev, I.; Toshkova, R.; Yossifova, L.; Zacharieva, S.; Dolashka-Angelova, P.; Hristova, R.; Yaneva, J.

2008-01-01

We have determined and analysed some immuno-adjuvant properties of haemocyanins isolated from the haemolymph of the snails Rapana venosa (RvH) and Helix vulgaris (HvH) acting via activation of cell-mediated immunity. As a result of nonspecific activation of the immune system in tumour-bearing animals treated with RvH and HvH, an increased resistance against Guerin ascites tumour progression was observed in comparison with controls (non-immunized animals). The investigations were focused on elucidation of the different mechanisms of immune response of spleen lymphocytes from experimental animals preliminary immunized with vaccines supplemented with either RvH or HvH. Experimental data showed significant immune activation, much higher than that in the control group immunized with Keyhole limpet haemocyanin (KLH). Supporting these data are the results on the survival rate determination of tumour-bearing animals immunized with each of the haemocyanins or conjugates haemocyanin/tumour antigen showing highest survival in animals treated with HvH, RvH and KLH in comparison with non immunized animals. (authors)

Veias soleares: bases anatômicas e seu papel na origem da trombose venosa profunda em membro inferior Soleus veins: anatomic basis and their role in the origin of deep venous lower limb thrombosis

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Carlos Miguel Gomes Sequeira

2007-08-01

Full Text Available OBJETIVO: Estudar o número, a setorização e a terminação das veias soleares. MÉTODOS: Em 100 pernas de 50 cadáveres, excluídos aqueles com alterações congênitas ou adquiridas dos membros inferiores, foram realizadas, a fresco, na região crural posterior, dissecções anatômicas minuciosas, estratigráficas. Após o rebatimento da pele, foram realizadas a individualização das veias superficiais e perfurantes, rebatimento da tela subcutânea e da fáscia, individualização e rebatimento dos músculos gastrocnêmio e plantar, desinserção tibial do músculo sóleo, individualização das veias soleares e o estudo morfométrico. A região foi dividida em seis setores: súpero-medial, súpero-lateral, médio-medial, médio-lateral, ínfero-medial e ínfero-lateral. No estudo estatístico utilizaram-se os testes não-paramétricos Wilcoxon e Friedman. RESULTADOS: Foram encontradas 4.679 veias soleares. O setor com maior número de veias soleares foi o súpero-lateral com 1.529 veias (32,7%, seguido do médio-medial com 1.256 veias (26,8% e do médio-lateral com 975 veias (20,8%. As terminações ocorreram em veias comunicantes (1.207 veias - 25,8%, veias tibiais posteriores (964 veias - 20,6%, veias fibulares (709 veias - 15,2% e em mais 32 tipos (1799 veias - 38,4%. CONCLUSÃO: A drenagem venosa do músculo sóleo é realizada por um grande número de veias soleares, freqüentemente localizadas nos setores súpero-lateral, médio-medial e médio-lateral, terminando comumente em veias tibiais posteriores e fibulares e, em veias comunicantes.OBJECTIVE: Study of the number, sectorization and termination of the soleus veins. METHODS: Meticulous, stratigraphical, anatomical dissections were carried out in the posterior crural region of 100 legs of 50 fresh cadavers. Those belonging to subjects with congenital or acquired pathologies in the lower limbs were disregarded. After the skin was reflected on both sides, dissection of superficial

Dynamic changes in the dural space and spinal cord cross-sectional area during flexion and extension in patients with cervical spondylotic myelopathy

International Nuclear Information System (INIS)

Machino, Masaaki; Yukawa, Yasutsugu; Ito, Keigo; Nakashima, Hiroaki; Kato, Fumihiko

2009-01-01

The number of patients with cervical spondylotic myelopathy (CSM) is increasing with the aging of the population. The patients' during spinal cord tends to be compressed neck extension, because the yellow ligaments and intervertebral discs protrude into the spinal canal during neck extension (pincer mechanism). A total of 100 patients with CSM were prospectively enrolled in this study. After preoperative myelography, multi-detector-row CT (MDCT) scans were acquired in flexion and extension, and the dural space and spinal cord cross-sectional area at each disc level from C2/3 to C7/Th1 were measured by using Scion imaging software. The average dural space and average spinal cord cross-sectional area were smaller in extension than in flexion from the C3/4 to C7/Th1 disc level, and the greatest dynamic changes were seen at the C5/6 level. MDCT demonstrated dynamic factors in patients with CSM. The spinal cord cross-sectional area became narrower during extension in patients with CSM. (author)

Efeitos do ultra-som de baixa intensidade na veia auricular de coelhos Effects of low intensity ultrasound in the auricular vein of rabbits

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Marcelo Araújo

2003-01-01

Full Text Available OBJETIVO: Estudar a ação do ultra-som na veia auricular de coelhos. MÉTODOS: Vinte coelhos foram divididos em dois grupos de dez animais diferindo com relação ao local da aplicação, do ultra-som, o modo e o intervalo de tempo para a análise histopatológica (3 e 7 dias. Os animais foram submetidos à aplicação de ultra-som contínuo e pulsado em dois segmentos venosos da orelha previamente determinados. Cada animal foi o seu próprio controle. Empregou-se a freqüência de 3MHz, intensidade de 3W/cm² nos ciclos pulsado e contínuo por 10 minutos, de forma estacionária. O grupo I foi submetido a eutanásia após 3 dias e o grupo II em 7 dias contemplando a fase aguda do processo inflamatório. Empregou-se o teste exato de Fisher e o teste de Mc Nemar para análise estatística. RESULTADOS: Obteve-se trombose venosa e aumento de linfócitos de forma significativa (p= 0,032 nos grupos tratados com o modo contínuo. O modo pulsado não provocou efeitos deletérios. Outros achados foram congestão, edema, hemorragia e lesão da parede vascular. CONCLUSÕES: O ultra-som pulsado não provoca qualquer alteração na parede vascular nas condições do experimento.O ultra-som contínuo induz a trombose venosa e aumento dos linfócitos de forma significativa.PURPOSE: The purpose of this experimental work was evaluate the effects of low intensity in the auricular vein of rabbits. METHODS: Twenty rabbits were divided in two groups of ten animals. The groups differed about the place where the continuous and pulsed ultrasound were applied and the period that the material was collected for the morphologic examination (3 and 7 days. Acoustic coupling gel was used on marginal ear vein, each animal underwent continuous and pulsed ultrasound treatment, in segments previously marked with indelible ink. Each animal provided its own control. Ultrasound was used in the frequency of 3MHz, intensity of 3W/cm² in the pulsed and continuous modes during 10min

CT and MR imaging of non-cavernous cranial dural arteriovenous fistulas: Findings associated with cortical venous reflux

Energy Technology Data Exchange (ETDEWEB)

Letourneau-Guillon, Laurent; Cruz, Juan Pablo; Krings, Timo, E-mail: Timo.Krings@uhn.ca

2015-08-15

Highlights: • The conventional neuroimaging manifestations of dural arteriovenous fistulas are highly variable. • Identification of cortical venous reflux is important to prevent complications. • Tortuous and dilated vessels without a nidus are associated with cortical venous reflux. • Digital subtraction angiography remains the gold standard for DAVF diagnosis. - Abstract: Purpose: To compare the conventional CT and MR findings of DAVFs in relation to the venous drainage pattern on digital subtraction angiography (DSA). Materials and Methods: Cross-sectional imaging findings (CT and/or MR) in 92 patients were compared to the presence of cortical venous reflux (CVR) on DSA. Results: Imaging features significantly more prevalent in patients with CVR included: abnormally dilated and tortuous leptomeningeal vessels (92% vs. 4%, p < 0.001) or medullary vessels (69% vs. 0%, p < 0.001), venous ectasias (45% vs. 0%, p < 0.001) and focal vasogenic edema (38% vs. 0%, p < 0.001). The following findings trended towards association but did not reach the p value established following Bonferroni correction: dilated external carotid artery branches (71% vs. 38%, p = 0.005), cluster of vessels surrounding dural venous sinus (50% vs. 19%, p = 0.009), presence of hemorrhage (33 vs. 12%, p = 0.040), and parenchymal enhancement (21% vs. 0%, p = 0.030). Conclusion: In the appropriate clinical setting, recognition of ancillary signs presumably related to venous arterialization and congestion as well as arterial feeder hypertrophy should prompt DSA confirmation to identify DAVFs associated with CVR.

Optic pathway glioma associated with orbital rhabdomyosarcoma and bilateral optic nerve sheath dural ectasia in a child with neurofibromatosis-1

International Nuclear Information System (INIS)

Nikas, Ioannis; Theofanopoulou, Maria; Lampropoulou, Penelope; Hadjigeorgi, Christiana; Pourtsidis, Apostolos; Kosmidis, Helen

2006-01-01

Neurofibromatosis-1 (NF-1) is a multisystem disorder presenting with a variety of clinical and imaging manifestations. Neural and non-neural tumours, and unusual benign miscellaneous conditions, separately or combined, are encountered in variable locations. We present a 21/2-year-old boy with NF-1 who demonstrated coexisting optic pathway glioma with involvement of the chiasm and optic nerve, orbital alveolar rhabdomyosarcoma and bilateral optic nerve sheath dural ectasia. (orig.)

Trombosis del seno sagital en un neonato Sagittal sinus thrombosis in a newborn

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Lisett Hernández León

2012-12-01

Full Text Available La trombosis de los senos venosos durales es una rara y devastadora enfermedad. Se presenta generalmente en mujeres y ancianos, y no es frecuente en niños, aunque se reconoce ya como una causa de morbilidad y mortalidad en la población pediátrica. Se han reportado pocos casos en el mundo de neonatos afectados por esta entidad, en su mayoría fatales e insuficientemente investigados. A continuación se presenta el caso de un recién nacido con una trombosis del seno sagital que sobrevivió. Los factores predisponentes para la aparición de la enfermedad en este caso fueron la asfixia neonatal, la deshidratación severa unida al uso de una línea venosa central, y la inmovilización prolongada. Aunque la TAC contrastada no es el estudio ideal para su diagnóstico, permitió realizarlo oportunamente en este caso. El tratamiento temprano con anticoagulantes permitió una rápida recuperación y favoreció la recanalización venosa del seno involucrado. Hasta el momento no se han detectado secuelas neurológicas y el paciente tiene buen desarrollo psicomotor.Dural venous sinus thrombosis is a rare devastating disease. It is generally found in females and old people, but is infrequent in children; however, it is already recognized as a morbidity and mortality cause in the pediatric population. Few cases of newborns with this disease have been reported worldwide; most of them were poorly studied and had fatal outcomes. Here is the presentation of a newborn with sagittal sinus thrombosis, who managed to survive. The predisposing factors for the disease were neonatal asphyxia, severe dehydration together with the use of central venous line and extended immobilization. Although contrast CAT is not the ideal study, it helped to promptly arrive at the right diagnosis in this case. The early treatment based on anticoagulants allowed rapid recovery and facilitated venous retaking of the involved venous sinus. No neurological sequels have been so far

Conduta na lesão dural intraoperatória em artrodese da coluna lombar Conducta en lesión de duramadre intraoperatoria en artrodesis de la columna lumbar Management of intraoperatory dural tear in lumbar spine arthrodesis

OpenAIRE

Fabiano de Mendonça Grandese; Clóvis Yamazato; Fábio Mastromauro de Oliveira; Iberê Ribeiro; José Olympio Catão Bastos Júnior; René Kusabara

2010-01-01

OBJETIVO: estudo retrospectivo de pacientes com lesão dural intraoperatória de cirurgia da coluna vertebral lombar, conduzido por meio de um protocolo independente da extensão da lesão, complicações associadas e resultados após seguimento mínimo de um ano. MÉTODOS: um total de 10 pacientes com durotomia acidental em cirurgias de descompressão e artrodese da coluna vertebral lombar, no período de Janeiro de 2007 a Janeiro de 2009, para tratamento de doença degenerativa, tiveram seus prontuário...

The Termination Level of the Dural Sac Relevant to Caudal Epidural Block in Lumbosacral Transitional Vertebrae: A Comparison between Sacralization and Lumbarization Groups.

Science.gov (United States)

Jeon, Ji Young; Jeong, Yu Mi; Lee, Sheen-Woo; Kim, Jeong Ho; Choi, Hye-Young; Ahn, Yong

2018-01-01

Lumbosacral transitional vertebrae (LSTV) are a relatively common variant and have been considered as one of the reasons for back pain. It is not unusual for clinicians to encounter patients with LSTV who require caudal epidural block (CEB) for pain management. We investigated the termination level of the dural sac (DS) and anatomical features of the lumbosacral region relevant to CEB in patients with LSTV and compared these findings between sacralization and lumbarization groups. A retrospective evaluation. A university hospital with inpatient and outpatient LSTV cases presenting low back pain. Four hundred ninety-four LSTV patients were included and categorized into sacralization (n = 201) or lumbarization groups (n = 293). Magnetic resonance imaging (MRI) of all of the LSTV patients were reviewed to determine the level of DS termination, the shortest distance between the apex of the sacral hiatus and DS, and the presence and the caudal level of sacral perineural cysts. Each lumbosacral vertebra column was divided into 3 equal portions (upper, middle, and lower thirds). The MRI findings in both of the groups were compared and analyzed. The distribution frequency of the levels of DS termination demonstrated a significant difference between the 2 groups. The mean caudal DS level in the lumbarization group was significantly lower than the sacralization group (lower third of the S2 [131 {44.7%} of 293 patients] vs. lower third of the S1 [78 {38.8%} of 201 patients]). The DS terminated at the S3 in more than 19% of the lumbarization group, whereas in only one case of the sacralization group. Although the incidence of perineural cysts was not significantly different between the 2 groups, the mean level of caudal margin of perineural cysts in the lumbarization group was significantly lower than the sacralization group (middle third of the S3 [10 {35.7%} of 28 cases] vs. middle third of the S2 [11 {44%} of 25 cases]). This study reveals several limitations including the

Gamma Knife radiosurgery for intracranial meningiomas : Do we need to treat the dural tail? A single-center retrospective analysis and an overview of the literature

NARCIS (Netherlands)

Bulthuis, Vincent J; Hanssens, Patrick E J; Lie, Suan Te; van Overbeeke, Jacobus J

2014-01-01

BACKGROUND: The dural tail (DT) has been described as a common feature in meningiomas. There is a great variation of tumor invasion and extent of tumor cells in the DT. Therefore, the necessity to include the whole DT in Gamma Knife radiosurgery is not clear, since inclusion increases the target

Angio-OCT de la zona avascular foveal en ojos con oclusión venosa de la retina.

Science.gov (United States)

Wons, Juliana; Pfau, Maximilian; Wirth, Magdalena A; Freiberg, Florentina J; Becker, Matthias D; Michels, Stephan

2017-07-11

Objetivo: El objetivo del estudio comprendía visualizar y cuantificar las alteraciones patológicas de la zona avascular foveal (ZAF) mediante angio-OCT en ojos con oclusión venosa de la retina (OVR) en comparación con el ojo contralateral sano. Procedimientos: La angio-OCT se llevó a cabo mediante el sistema Avanti® RTVue 100 XR (Optovue Inc., Fremont, Calif., EE. UU.). Los bordes de la capa vascular superficial (CVS) se definieron como 3 μm por debajo de la membrana limitante interna y 15 μm por debajo de la capa plexiforme interna y, para la capa vascular profunda (CVP), como 15 y 70 μm por debajo de la membrana limitante interna y de la capa plexiforme interna, respectivamente. La longitud de la ZAF horizontal, vertical y máxima de la CVS y la CVP en cada ojo se midió de forma manual. Además, se midió el ángulo entre el diámetro máximo de la ZAF y el plano papilomacular. Resultados: La angio-OCT representó los defectos dentro de la vasculatura en el área perifoveal en ojos con oclusión de rama venosa de la retina (ORVR; n = 11) y con oclusión de la vena central de la retina (OVCR; n = 8). Esto resultó en un crecimiento del diámetro máximo de la ZAF en ojos con OVR (n = 19) en comparación con el ojo contralateral (n = 19; 921 ± 213 frente a 724 ± 145 µm; p = 0,008). Además, se observó una correlación significativa entre la mejor agudeza visual corregida (MAVC) y el diámetro máximo de la ZAF en la CVP (ρ de Spearman = -0,423, p < 0,01). Por último, en los ojos con OVR, el ángulo entre el plano papilomacular y el diámetro máximo de la ZAF se dio tan solo en el 21,05% (CVS) y en el 15,79% (CVP) de los casos a 0 ± 15 ó 90 ± 15°, respectivamente. En ojos sanos, estos ángulos (que supuestamente representan una configuración de la ZAF regular) fueron más prevalentes (CVS 68,42 frente a 21,05%, p = 0,003; CVP 73,68 frente a 15,79%, p < 0,001). Conclusiones: La angio-OCT muestra alteraciones morfológicas de la ZAF en ojos con

Prevalência de insuficiência venosa superficial dos membros inferiores em pacientes obesos e não obesos Prevalence of lower limbs superficial venous insufficiency in obese and non-obese patients

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Amélia Cristina Seidel

2011-06-01

Full Text Available CONTEXTO: A insuficiência venosa crônica dos membros inferiores é a mais prevalente das doenças venosas. Muito se discute sobre sua etiologia e fisiopatologia. Vários fatores de risco têm sido associados ao seu desenvolvimento, como idade, sexo, dieta, entre outros. A obesidade é um problema de saúde pública e sua incidência tem aumentado. O ecocolor Doppler é um método útil para avaliar a presença de refluxo e/ou obstrução no sistema venoso. OBJETIVO: Comparar a prevalência de insuficiência venosa superficial e sintomas associados em pacientes obesos e não obesos. MÉTODOS: Após pesagem, medição da estatura e exame físico, os pacientes com índice de massa corpórea (IMC 35 kg/m² e queixas compatíveis com insuficiência venosa foram distribuídos nos grupos I e II, respectivamente. Foram submetidos à realização do ecocolor Doppler dos membros inferiores para avaliação da presença ou não de refluxo. RESULTADOS: Foram examinados 311 membros de 168 pacientes com 25-72 anos. Para análise estatística, foram consideradas queixas de varizes, dor, edema, dermatite, eczema e úlcera, associados ou não. Foi obtido um total de 109 e 104 membros com varizes nos grupos I e II, respectivamente. Queixas de varizes visíveis (pBACKGROUND: Chronic venous insufficiency of the lower limbs is the most prevalent venous disease. There is an ongoing debate about its etiology and pathophysiology. Several risk factors have been associated with its development, such as age, sex and diet. Obesity is a public health problem and its prevalence has been increasing. Color Doppler ultrasonography is a useful method to evaluate the presence of reflux and/or obstruction of the venous system. OBJECTIVE: To compare the prevalence of superficial venous insufficiency and associated symptoms in obese and non-obese patients. METHODS: After weighing, height measurement and physical examination, patients with body mass index (BMI 35 kg/m² and

Trombose aguda de aneurisma de artéria femoral isolado: relato de caso Acute thrombosis of isolated femoral artery aneurysm: case report

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André Hideo Motoki

2008-12-01

Full Text Available Aneurismas de artéria femoral são raros, porém são o segundo tipo mais freqüente de aneurismas periféricos, sendo o aneurisma de artéria poplítea o mais comum. Normalmente, são de etiologia aterosclerótica. As complicações deste aneurisma são representadas por embolia, trombose e, mais raramente, a rotura. O objetivo deste trabalho é relatar um caso de um paciente com 59 anos, masculino, com queixa de dor súbita em membro inferior esquerdo associado à frialdade, palidez e ausência de pulsos. O ecocolordoppler evidenciou a presença de aneurisma trombosado da artéria femoral comum. O paciente foi submetido, com sucesso, à ressecção do aneurisma, com reconstrução do leito arterial.Common femoral artery aneurysms are rare; however, they are the second most frequent type of peripheral aneurysm, popliteal artery aneurysms being the most common. They usually have atherosclerotic ethiology. The complications of this aneurysm are thromboembolism and, more rarely, rupture. This article aimed at reporting the case of a 59-year-old male patient with complaint of sudden pain in his left leg associated with coldness, paleness and absence of pulses. Color Doppler ultrasound showed a thrombosed aneurysm of the common femoral artery. The patient was successfully submitted to aneurysm resection with reconstruction of the arterial bed.

Trombosis venosa subclavia asociada a electrodo de marcapasos y síndrome de la plaqueta pegajosa

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Carolina Ocampo-Salgado

2018-03-01

Full Text Available Resumen: El síndrome de la plaqueta pegajosa en un trastorno cualitativo plaquetario en el que bajas concentraciones de epinefrina y adenosina difosfato producen hiperagregabilidad plaquetaria considerable. Se ha especulado mucho sobre la etiología de este trastorno sin que sean claros sus mecanismos fisiopatológicos. Desde el punto de vista clínico, se asocia a trombosis arteriales y venosas recurrentes en pacientes jóvenes, pérdidas gestacionales, otras complicaciones obstétricas y cefalea recurrente.En la literatura se ha descrito su presentación familiar, lo que hace sospechar su comportamiento hereditario autosómico dominante; también se ha reportado un fenotipo adquirido de la enfermedad en algunas poblaciones especiales como pacientes con enfermedad renal crónica en terapia de reemplazo renal o posterior al trasplante renal y en pacientes con cuadros inflamatorios o inmunosupresión. Se expone el caso de una paciente con antecedente de cefalea de difícil manejo, síndrome hipertensivo asociado al embarazo y mortinato, con síndrome del nodo enfermo y disautonomía manejadas con implantación de marcapasos definitivo bicameral con sensor CLS, que desarrolló trombosis de la vena subclavia, asociada al electrodo de marcapasos, recurrente a pesar de anticoagulación con warfarina y rivaroxabán e incluso a pesar de antiagregación con ácido acetilsalicílico, con posterior diagnóstico de síndrome de la plaqueta pegajosa. Abstract: Sticky platelet syndrome is a qualitative platelet disorder in which low concentrations of adrenaline and adenosine diphosphate produce considerable platelet hyperaggregability. There has been much speculation on the origin of this disorder as its pathophysiological mechanisms of action are not yet clear. From a clinical point of view, it is associated with recurrent arterial and venous thrombosis in young patients, miscarriages, other obstetric complications and recurrent headaches.Its familial

[Dural arteriovenous fistula involving the superior sagittal and transverse-sigmoid sinuses, treated by thrombolysis: case report].

Science.gov (United States)

Arai, T; Ohno, K; Yoshino, Y; Tanaka, Y; Nariai, T; Hirakawa, K; Nemoto, S

1997-07-01

A rare case of dural arteriovenous fistula (DAVF) in the superior sagittal sinus (SSS), the transverse sinus and the sigmoid sinus is reported. A 64-year-old man, who had had an episode of temporary visual disturbance after moderate fever for a week about 20 years before, was aware of loss of visual acuity and reduced field of view in the right eye. When he was introduced to our outpatient service, increased intracranial pressure (ICP) was detected by lumbar puncture. Cerebral angiograms showed bilateral DAVFs both in the posterior fossa and the SSS concomitant with thrombosis in the transverse sinus, sigmoid sinus and SSS. Afterwards, endovascular transarterial embolization through bilateral occipital, posterior auricular and left middle meningeal, superior temporal arteries was carried out. In addition, transvenous thrombolytic therapy using a catheter inserted into SSS resulted in the improvement of his visual problems. Although he was discharged at once, he was readmitted to our department with Foster Kennedy syndrome and increased ICP. Cerebral angiograms showed recurrence of both DAVF and sinus thrombosis. Transarterial embolization was performed again resulting in a significant reduction of DAVF, and his visual acuity was recovered to a moderate degree. The origin of DAVF is still controversial. Although two theories, "congenital" and "acquired", are put forward, it has been thought that both factors play important roles. In our case, the patient had stenosis in the jugular canal portions of the sigmoid sinus. In addition, sinus thrombosis seemed to have occurred. It is thought that increased intrasinus pressure may have lead to communication with surrounding arteries through existing dural vessels. We applied transvenous thrombolytic therapy in this case. Our result suggests that we should consider this therapy for some cases of DAVF.

Síndrome de Rendu-Osler-Weber: presentación de un caso clínico

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Freyli Bustamante

2016-08-01

Full Text Available El síndrome de Rendu-Osler-Weber (SROW, conocido también como Telangiectasia Hemorrágica Hereditaria (THH, es un desorden vascular infrecuente. Se trata de una alteración vascular displásica multisistémica de carácter autosómico dominante, con diversas complicaciones, siendo las malformaciones arterio-venosas (MAV responsables de la morbi-mortalidad de los pacientes cuando no son diagnosticadas ni tratadas a tiempo. Muchas veces este síndrome presenta síntomas sutiles, por lo que puede pasar desapercibida clínicamente. Presentamos un caso de una paciente femenina de 51 años, con historia de epistaxis frecuentes quien acude a nuestro hospital por presentar cefalea de fuerte intensidad, meningismo y pérdida de la consciencia. La tomografía axial computada (TAC de cráneo identificó hemorragia sub aracnoidea (HSA difusa. La angiografía cerebral permitió identificar aneurisma arteria comunicante anterior (AcoA roto que fue tratado por vía endovascular, sin eventualidades. Además, se observó telangectasias mucosas nasales múltiples y fistula arterio-venosa (FAV dural occipital izquierda. Estudios ulteriores permitieron identificar MAV pulmonares múltiples. Se confirmó el diagnóstico de SROW, con criterios de diagnóstico vigentes (criterios de Curazao. Durante los tres meses posteriores a su egreso el paciente presentó hemoptisis severa y disnea, que no pudo ser tratada a tiempo por lo que falleció.

Screen for intracranial dural arteriovenous fistulae with carotid duplex sonography.

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Tsai, L-K; Yeh, S-J; Chen, Y-C; Liu, H-M; Jeng, J-S

2009-11-01

Early diagnosis and management of intracranial dural arteriovenous fistulae (DAVF) may prevent the occurrence of stroke. This study aimed to identify the best carotid duplex sonography (CDS) parameters for screening DAVF. 63 DAVF patients and 170 non-DAVF patients received both CDS and conventional angiography. The use of seven CDS haemodynamic parameter sets related to the resistance index (RI) of the external carotid artery (ECA) for the diagnosis of DAVF was validated and the applicability of the best CDS parameter set in 20 400 patients was tested. The CDS parameter set (ECA RI (cut-off point = 0.7) and internal carotid artery (ICA) to ECA RI ratio (cut-off point = 0.9)) had the highest specificity (99%) for diagnosis of DAVF with moderate sensitivity (51%). Location of the DAVF was a significant determinant of sensitivity of detection, which was 70% for non-cavernous DAVF and 0% for cavernous sinus DAVF (pdetected abnormality in 92 of 20 400 patients. These abnormalities included DAVF (n = 25), carotid stenosis (n = 32), vertebral artery stenosis (n = 7), intracranial arterial stenosis (n = 6), head and neck tumour (n = 3) and unknown aetiology (n = 19). Combined CDS parameters of ECA RI and ICA to ECA RI ratio can be used as a screening tool for the diagnosis of DAVF.

Enfermedad tromboembólica venosa en el embarazo y puerperio. Enfoque de riesgo y diagnóstico Venous thromboembolic disease in pregnancy and puerperium. Risk and diagnosis approach

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Danilo Nápoles Méndez

2011-10-01

Full Text Available La enfermedad tromboembólica venosa es la primera causa no obstétrica de morbilidad materna, con un aporte importante a la mortalidad. En este artículo no solo se describen los factores de riesgo relacionados con esta entidad clínica en la gravidez vinculados a trombofilia, sino también con las afecciones previas de la gestación y los concernientes a embarazo y puerperio, así como los medios para su diagnóstico precoz, incluidas las principales manifestaciones clínicas y los mecanismos más fiables para confirmar la presencia de trombosis venosa profunda y tromboembolismo pulmonar. Sobre la base de lo anterior y de los valores del test de probabilidad se decidió agrupar los elementos favorecedores de su ocurrencia en 3 categorías: alto, mediano y bajo riesgo, con vistas a poder diagnosticar clínicamente con certeza su cuadro sintomático, adoptar la conducta médica expedita y emplear la profilaxis adecuada en cada caso.Venous thromboembolic disease is the first non-obstetric cause of maternal morbidity with an important contribution to mortality. In this article, not only risk factors related to this clinical disorder of gravidity involving thrombophilias are described, but also previous pregnancy conditions and those concerning pregnancy and puerperium as well as resources for its early diagnosis, including main clinical manifestations and the most reliable mechanisms to assure the presence of deep venous thrombosis and pulmonary thromboembolism. Taking into account all the aforementioned data and the probability test values, elements favoring its occurrence were grouped into three categories: high risk, mild risk, and low risk; thus, diagnosis can be clinically made having the certainty of the symptomatic chart, assuming a clear medical behavior, and applying the appropriate prophylaxis in each case.

Endovascular treatment of a cavernous sinus dural arteriovenous fistula by transvenous embolisation through the superior ophthalmic vein via cannulation of a frontal vein

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Venturi, C.; Bracco, S.; Cerase, A.; Gennari, P.; Lore, F.; Polito, E.; Casasco, A.E.

2003-01-01

We describe a new approach for transvenous embolisation of cavernous sinus dural arteriovenous fistulae through the superior ophthalmic vein (SOV), i.e., via percutaneous cannulation of a frontal vein. Modern neurointerventional angiographic materials make it possible to reach the SOV in this way without puncturing it in the orbit or a surgical exposure. Orbital phlebography should still be in the repertoire of interventional neuroradiology units in large centres. (orig.)

The effect of intravenous propofol on the incidence of post-dural puncture headache following spinal anesthesia in cesarean section

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Parisa Golfam

2016-09-01

Full Text Available Introduction: Post Dural puncture headache is still a common complication among young women undergone cesarean section, although use of small size spinal needles reduced its prevalence. Several methods have been suggested for prevention and treatment of this side effect; such as complete bed rest, hydration, non-opioid analgesics, caffeine, codeine, which none of them proved to be totally effective. The last option would be epidural blood patch, if headache persist. The aim of this study was evaluation the efficacy of intravenous propofol on post dural puncture headache incidence after cesarean section. Methods: In a randomized clinical trial 120 patients aged 18-45 years old in American Society of Anesthesiologist (ASA class I or II, who had no history of headache, analgesic consumption, substance abuse and drug addiction, candidate for elective cesarean section, were randomly assigned into intervention (propofol and control groups. The anesthesia method for both groups was precisely the same. After spinal anesthesia in the first group 30µg/kg/min of intravenous propofol have been infused slowly. Then at 1, 6, 18, 24 hours and 2nd to 7th days after surgery, anesthesiologist asked groups for presence or absence of headache. The data analyzed with SPSS 16.0 software. Results: Headache incidence rate in the group who receiving propofol was significantly reduced (P.V=0.001. Conclusion: This study showed that 30µg/kg/min of intravenous propofol caused reduced the incidence of post spinal headache in young women undergone elective cesarean section.

Angio-Architectural Features of High-Grade Intracranial Dural Arteriovenous Fistulas: Correlation With Aggressive Clinical Presentation and Hemorrhagic Risk.

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Della Pepa, Giuseppe Maria; Parente, Paolo; D'Argento, Francesco; Pedicelli, Alessandro; Sturiale, Carmelo Lucio; Sabatino, Giovanni; Albanese, Alessio; Puca, Alfredo; Fernandez, Eduardo; Olivi, Alessando; Marchese, Enrico

2017-08-01

High-grade dural arteriovenous fistulas (dAVFs) can present shunts with very different angio-architectural characteristics. Specific hemodynamic factors may affect clinical history and determine very different clinical courses. To evaluate the relationship between some venous angio-architectural features in high-grade dAVFs and clinical presentation. Specific indicators of moderate or severe venous hypertension were analyzed, such as altered configurations of the dural sinuses (by a single or a dual thrombosis), or overload of cortical vessels (restrictions of outflow, pseudophlebitic cortical vessels, and venous aneurysms). The institutional series was retrospectively reviewed (49 cases), and the pattern of venous drainage was analyzed in relationship with clinical presentation (benign/aggressive/hemorrhage). Thirty-five of 49 cases displayed cortical reflux (high-grade dAVFs). This subgroup displayed a benign presentation in 31.42% of cases, an aggressive in 31.42%, and hemorrhage in 37.14%. Our data confirm that within high-grade dAVFs, 2 distinct subpopulations exist according to severity of clinical presentation. Some indicators we examined showed correlation with aggressive nonhemorrhagic manifestations (outflow restriction and pseudophlebitic cortical vessels), while other showed a correlation with hemorrhage (dual thrombosis and venous aneurysms). Current classifications appear insufficient to identify a wide range of conditions that ultimately determine the organization of the cortical venous drainage. Intermediate degrees of venous congestion correlate better with the clinical risk than the simple definition of cortical reflux. The angiographic aspects of venous drainage presented in this study may prove useful to assess dAVF hemodynamic characteristics and identify conditions at higher clinical risk. Copyright © 2017 by the Congress of Neurological Surgeons

Timing, severity of deficits, and clinical improvement after surgery for spinal dural arteriovenous fistulas.

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Safaee, Michael M; Clark, Aaron J; Burkhardt, Jan-Karl; Winkler, Ethan A; Lawton, Michael T

2018-04-20

OBJECTIVE Spinal dural arteriovenous fistulas (dAVFs) are rare vascular abnormalities caused by arteriovenous shunting. They often form at the dural root sleeve between a radicular feeding artery and draining medullary vein causing venous congestion and edema, decreased perfusion, and ischemia of the spinal cord. Treatment consists of either surgical ligation of the draining vein or selective embolization via an endovascular approach. There is a paucity of data on which modality provides more durable and effective outcomes. METHODS The authors performed a retrospective review of a prospectively maintained database by the senior author to assess clinical outcomes in patients undergoing surgical treatment of spinal dAVFs. Preoperative and postoperative motor and Aminoff-Logue Scale (ALS) scores were collected. RESULTS A total of 41 patients with 44 spinal dAVFs were identified, with a mean patient age of 64 years. The mean symptom duration was 14 months, with weakness (82%), urinary symptoms (47%), and sensory symptoms (29%) at presentation. The fistula locations were as follows: 30 thoracic, 9 lumbar, 3 sacral, and 2 cervical. Five patients had normal motor and ALS scores at presentation. Among the remaining 36 patients with motor deficits or abnormal gait and micturition at presentation, 78% experienced an improvement while the remaining 22% continued to be stable. There was a trend toward improved outcomes in patients with shorter symptom duration; mean symptom duration among patients with clinical improvement was 13 months compared with 22 months among those without improvement. Additionally, rates of improvement were higher for lower thoracic and lumbosacral dAVFs (85% and 83%) compared with those in the upper thoracic spine (57%). No patient developed recurrent fistulas or worsening neurological deficits. CONCLUSIONS Surgery is associated with excellent outcomes in the treatment of spinal dAVFs. Early diagnosis and treatment are critical, with a trend toward

The pill and thrombosis

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van Vlijmen, Elizabeth Femma Willemien

2016-01-01

Bij pilgebruik wordt het tromboserisico vooral bepaald door de aanwezigheid van additionele risicofactoren Het gebruik van orale gecombineerde anticonceptiva, beter bekend als de ‘Pil’, is geassocieerd met trombose. Het betreft gelukkig een zeldzame bijwerking. Het risico op trombose kan echter

Reversibility of cognitive disorder after treatment of dural arteriovenous fistulae

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Kai, Yutaka; Ito, Koichi; Kinjo, Tatsuya; Hokama, Youhei; Nagamine, Hideki; Kushi, Sukemitsu; Kinjo, Shigemasa; Tsuchida, Yukihiro; Sugimoto, Kouichi; Yoshii, Yoshihiko; Morioka, Motohiro; Yano, Shigetoshi; Ohmori, Yuki; Kawano, Takayuki; Nakamura, Hideo; Makino, Keishi; Kuratsu, Jun-ichi; Hamada, Jun-ichiro

2009-01-01

Dural arteriovenous fistulae (DAVF) occasionally lead to cognitive disorders whose reversibility after DAVF treatment remains unclear. We studied changes on pre- and post-treatment magnetic resonance imaging (MRI) and single photon emission computed tomography (SPECT) scans in ten patients with cognitive disorder due to DAVF. We studied the symptoms, pre- and post-treatment MRI scans, SPECT findings, and mini-mental state examination (MMSE) and treatment results in ten patients with cognitive disorder due to DAVF. They were divided into two groups; the post-treatment MMSE score exceeded 25 points in group 1 (n = 6) and was lower than 24 points in group 2 (n = 4). In the six group 1 patients, pretreatment diffusion-weighted images (DWI) showed hyperintense areas, and SPECT scans demonstrated the preservation of vasoreactivity after acetazolamide challenge. In the four group 2 patients, pretreatment SPECT demonstrated hypoperfusion areas that coincided with the hyperintense areas seen on DWI; there were areas with marked disturbance in vasoreactivity. The post-treatment MMSE score in groups 1 and 2 improved by 13.7 ± 2.4 and 3.8 ± 1.0 points, respectively; the difference was significant at p < 0.01. In patients with cognitive disorder due to DAVF, the preservation of vasoreactivity on SPECT after acetazolamide challenge indicates that their cognitive disorder may be reversible by DAVF treatment. (orig.)

Medullary Venous Hypertension Secondary to a Petrous Apex Dural Arteriovenous Fistula: A Case Report

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Meghan Murphy

2012-11-01

Full Text Available Background: Dural arteriovenous fistulae (dAVF are common intracranial vascular lesions typically becoming symptomatic with cortical venous hypertension and possible hemorrhage. Here, we present a case illustration of a petrous apex dAVF with marked medullary venous hypertension and a unique clinical presentation. Methods: Case report. Results: A 72-year-old female, whose clinical progression was significant for altered mental status and progressive weakness, presented with diplopia, right leg paresis, and ataxia. Magnetic resonance imaging revealed edema involving the medulla. On digital subtraction cerebral angiogram, the patient was found to have a petrous apex dAVF, Cognard type IV. Following treatment with Onyx embolization, her symptoms rapidly improved, with complete resolution of diplopia and drastic improvement of her ataxia. Conclusion: The importance of this case is in the presentation and deterioration of the clinical exam, resembling an acute ischemic event. Further, this case illustrates that dAVF may cause venous hypertension with rapid onset of focal neurologic symptoms not exclusive to cortical locations.

The MR imaging and DSA features and embolization therapy of spinal dural arteriovenous fistulae

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Zhang Hua; Hu Jinqing; Lin Dong; Wu Daming; Wang Dengbin; Yang Yanmin; Cheng Kemin

2005-01-01

Objective: To investigate the MR imaging and DSA features together with endovascular embolization of spinal dural arteriovenous fistulae (SDAVF). Methods: Twelve patients with SDAVF underwent both MR imaging and angiography of spinal cord, 4 of them received endovascular embolization. The imaging findings of MRI and angiography in all patients were analyzed. Results: Among 12 cases with SDAVF, 11 cases showed diffuse long T 2 signal, 2 cases demonstrated inhomogeneous maculate enhancement in the spinal cord and 6 cases revealed abnormal vessels in the dorsal spaces of spinal cord on MRI. Angiography of spinal cord showed orifices of all fistulae, draining veins, the extent of lesions, amount of feeding vessels and the angiographic features in all the 12 cases. 4 cases with embolization treatment showed improvement clinically. Conclusions: Angiography of spinal cord is the main method and MRI provides important assistance for diagnosing SDAVF while endovascular embolization is an effective method for the treatment. (authors)

Endovascular and surgical treatment of spinal dural arteriovenous fistulas

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Andres, Robert H.; University of Berne; Stanford University Medical Center, Department of Neurosurgery, Stanford, CA; University of Berne; Barth, Alain; Medical University of Graz, Department of Neurosurgery, Graz; University of Berne; Guzman, Raphael; Stanford University Medical Center, Department of Neurosurgery, Stanford, CA; University of Berne; Remonda, Luca; El-Koussy, Marwan; Schroth, Gerhard; University of Berne; Seiler, Rolf W.; Widmer, Hans R.; University of Berne

2008-01-01

The aim of this retrospective study was to evaluate the clinical outcome of patients with spinal dural arteriovenous fistulas (SDAVFs) that were treated with surgery, catheter embolization, or surgery after incomplete embolization. The study included 21 consecutive patients with SDAVFs of the thoracic, lumbar, or sacral spine who were treated in our institution from 1994 to 2007. Thirteen patients were treated with catheter embolization alone. Four patients underwent hemilaminectomy and intradural interruption of the fistula. Four patients were treated by endovascular techniques followed by surgery. The clinical outcome was assessed using the modified Aminoff-Logue scale (ALS) for myelopathy and the modified Rankin scale (MRS) for general quality of life. Patient age ranged from 44 to 77 years (mean 64.7 years). Surgical as well as endovascular treatment resulted in a significant improvement in ALS (-62.5% and -31.4%, respectively, p<0.05) and a tendency toward improved MRS (-50% and -32%, respectively) scores. Patients that underwent surgery after endovascular treatment due to incomplete occlusion of the fistula showed only a tendency for improvement in the ALS score (-16.7%), whereas the MRS score was not affected. We conclude that both endovascular and surgical treatment of SDAVFs resulted in a good and lasting clinical outcome in the majority of cases. In specific situations, when a secondary neurosurgical approach was required after endovascular treatment to achieve complete occlusion of the SDAVF, the clinical outcome was rather poor. The best first line treatment modality for each individual patient should be determined by an interdisciplinary team. (orig.)

The importance of venous hypertension in the formation of dural arteriovenous fistulas: a case report of multiple fistulas remote from sinus thrombosis

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Kusaka, N.; Sugiu, K.; Katsumata, A.; Nakashima, H.; Tamiya, T.; Ohmoto, T.

2001-01-01

Various hypotheses have been reported concerning the pathogenesis of dural arteriovenous fistulas (DAVFs). However, it is still controversial whether sinus thrombosis or venous hypertension has a greater influence on the formation of DAVFs. We present a rare case of multiple DAVFs that developed after sinus thrombosis. Chronic venous hypertension secondary to sinus thrombosis in the left transverse-sigmoid sinus induced the multiple DAVFs, including one in the right cavernous sinus, which was remote from the occluded sinus. This case indicates the importance of venous hypertension in the formation of DAVFs. (orig.)

Deep electrical resistivity tomography and geothermal analysis of Bradano foredeep deposits in Venosa area (Southern Italy: preliminary results

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V. Lapenna

2008-06-01

Full Text Available Geophysical surveys have been carried out to characterize the stratigraphical and structural setting and to better understand the deep water circulation system in the Venosa area (Southern Italy located in the frontal portion of the southern Appenninic Subduction. In this area there are some deep water wells from which a water conductivity of about 3 mS/cm and a temperature of about 35°C was measured. A deep geoelectrical tomography with dipole-dipole array has been carried out along a profile of 10000 m and an investigation depth of about 900 m. Furthermore a broad band magnetotelluric profile consisting of six stations was performed to infer the resistivity distribution up to some kilometres of depth. The MT profile was almost coincident with the geoelectrical outline. The applied methods allow us to obtain a mutual control and integrated interpretation of the data. The high resolution of the data was the key to reconstruct the structural asset of buried carbonatic horst whose top is located at about 600 m depth. The final results coming from data wells, geothermal analysis and geophysical data, highlighted a horst saturated with salted water and an anomalous local gradient of 60°C/km. The proposed mechanism is that of a mixing of fossil and fresh water circulation system.

Cost survey of procedure with Unna boot in patients with venous ulcer Levantamento del costo del procedimiento com bota de Unna en pacientes com úlcera venosa (UV Levantamento do custo do procedimento com bota de Unna em pacientes com úlcera venosa

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Cleide Maria Caetano Baptista

2006-12-01

Full Text Available Aims was to identify the social-demographic characteristics and the lesions of patients with venous ulcer (VU, as well as to estimate the total direct cost of materials and nursing personnel necessary for the procedure with unna boot, by the average total direct cost (ATDC and the observed cost (OTDC. The theoretical referential adopted for cost calculation was the costing system by absorption of procedure or product. This study was conducted at the University Hospital of Sao Paulo University (HU Ambulatory. The sample was constituted by 65 procedures in nine patients with VU. The results show that the predominant age groups were 49 to 56 years (33,33% and 65 to 72 years (33,33%, in female patients (77,78%. Regarding associated diseases, there was a predominance of Systemic Arterial Hypertension (33,33% and Diabetes Mellitus (22,22%. The ATDC was R$ 107,99 and the OTDC was R$ 96,47.El objetivo fue identificar características sócio-demográficas y de las lesiones de los pacientes con úlcera venosa (UV, y calcular el costo total directo de los materiales y de personal de enfermería utilizados en del procedimiento con bota de unna, por el costo total directo medio (CTDM y por lo observado (CTDO. El referencial teórico adoptado para la medición de los costos fue el sistema de costeo por absorción por procedimiento o producto. El estudio fue realizado en el Consultorio Externo el Hospital Universitario de la Universidad de Sao Paulo (HUUSP. La muestra fue constituida por 65 procedimientos en nueve pacientes con UV. Los resultados muestran que la faja etária predominante fue 49 a 56 años (33,33% y de 65 a 72 años (33,33% y del sexo femenino (77,78%. Cuanto a la enfermedad asociada, hubo predominio de Hipertensión Arterial Sistemática (33,33% y Diabetes Mellitus (22,22%. El CTDM fue de R$ 107,99 y el CTDO fue de R$ 96,47.O objetivo foi identificar características sociodemográficas e das lesões dos pacientes com úlcera venosa (UV e

Maternal-infant bonding and the mother's participation during venipuncture: a psychoanalytic perspective Vínculo materno infantil y la participación de la madre durante la realización de la punción venosa: la ótica del psicoanálisis Vínculo materno-infantil e participação da mãe durante a realização da punção venosa: a ótica da psicanálise

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Júlia Peres Pinto

2007-02-01

Full Text Available Professionals discuss accompanying mothers' participation during painful procedures as a possibility of care to mother and child, but there is no consensus on this subject. To contribute to this topic, this study addresses the child's needs during venipuncture in a hospital environment and the mother's participation in this procedure, based on authors from psychoanalysis and mother-child bonding.La participación de la madre acompañante junto al niño durante la realización de procedimientos dolorosos es discutida por profesionales como una posibilidad de cuidado al binomio, pero no hay un consenso sobre este tema. Para contribuir con esta discusión, el texto trata de las necesidades del niño durante la realización de la punción venosa en un ambiente de hospital y la participación de la madre en el procedimiento, tomando como base autores del psicoanálisis y el vínculo madre y hijo.A participação da mãe acompanhante junto à criança durante a realização de procedimentos dolorosos é discutida pelos profissionais como uma possibilidade de cuidado ao binômio, porém, não há consenso quanto a esse tema. Para contribuir com essa discussão, o texto aborda as necessidades da criança durante a realização da punção venosa no ambiente hospitalar e a participação da mãe no procedimento, tendo como base autores da psicanálise e o vínculo na relação mãe e filho.

Endovascular management of sigmoid sinus dural arteriovenous fistula associated with sinus stenosis in an infant.

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Cohen, José E; Gomori, John M; Benifla, Moni; Itshayek, Eyal; Moscovici, Samuel

2013-01-01

A 4-month-old female presented with a dural arteriovenous fistula (DAVF), which was successfully managed using endovascular techniques. There are very few case series reporting DAVF in infants younger than 12 months and, to our knowledge, only 60 pediatric patients with DAVF have been reported to date. Although most DAVF have a benign course, they can result in life-threatening hemorrhage. Endovascular therapies are usually indicated in the management of these neurosurgical vascular malformations. Endovascular therapy of DAVF in neonatal patients presents some major issues. Gaining arterial access may be problematic in femoral arteries too small for the introduction of a sizeable guiding catheter. The volumes of contrast and infused fluids must be carefully monitored to prevent fluid overload. Radiation exposure should be restricted as far as possible. This report contributes to the limited body of evidence on neonatal DAVF and its endovascular management. Copyright © 2012 Elsevier Ltd. All rights reserved.

The accessory super-selective techniques in performing the transarterial embolization of intracranial dural arteriovenous fistulas

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Zhao Wenyuan; Liu Jianmin; Li Qiang; Fang Yibin; Xu Yi; Hong Bo; Huang Qinghai

2010-01-01

Objective: To evaluate the assistant techniques in performing transarterial embolization of intracranial dural arteriovenous fistulas (DAVF) when routine super-selective catheterization with microcatheter fails. Methods: Temporary balloon occlusion of the parent artery was adopted in 4 cases of anterior fossa DAVF and in one case of tentorial DAVF, and permanent occlusion of the distal main trunk with coils was carried out in one tentorial DAVF in order to help the super-selective catheterization. Results: The microcatheter was successfully advanced to, or near, the nidus with the help of these assistant techniques and all 6 cases were cured with single session. After the surgery no operation-related complications occurred. Conclusion: Our preliminary results indicate that the assistant techniques, including temporary balloon occlusion of the parent artery and permanent occlusion of the distal main trunk with coils, are a safe and effective method which can reliably help the successful performance of microcatheter catheterization, it can be safely used in complex cases when routine super-selective catheterization fails. (authors)

Fisioterapia vascular no tratamento da doença venosa crônica

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Flávia de Jesus Leal

2015-09-01

Full Text Available ResumoContextoA aplicação da fisioterapia vascular através dos exercícios terapêuticos e da drenagem linfática manual (DLM na Doença Venosa Crônica (DVC contribui para a minimização das alterações vasculares, com melhora do retorno venoso, diminuindo a estase sanguínea e contribuindo para a melhora do quadro clínico.ObjetivoVerificar a eficácia da fisioterapia vascular no tratamento da DVC.MétodosEstudo-piloto prospectivo longitudinal, que avaliou dez pacientes com DVC, com classificação CEAP (1-5, que responderam aos questionários de qualidade de vida (QV SF-36 e AVVQ, sendo submetidos a pletismografia a água e goniometria dos membros inferiores. Finalizada a avaliação inicial, receberam tratamento fisioterapêutico vascular, com exercícios terapêuticos e DLM, em dez sessões de 60 minutos. Após tratamento, foram novamente avaliadas pela aplicação dos questionários iniciais e realização dos métodos de mensuração volumétrica e de amplitude de movimento articular (ADM.ResultadosPacientes do gênero feminino, com idade média de 43,1 anos. Nas atividades de vida prática (AVPs, a posição predominante foi ortostatismo prolongado. Na classificação CEAP, a maioria das pacientes apresentou C3 e apenas 10% delas eram C2. Nos questionamentos sobre suas principais queixas, relataram sensação de peso e cansaço nos membros, dor nas pernas, prurido e edema. Após as sessões de fisioterapia vascular, todas as pacientes encontravam-se sem queixas. A ADM e a QV apresentaram melhora significativa após intervenção da fisioterapia vascular.ConclusãoA fisioterapia vascular contribui para o controle do quadro clínico da DVC, melhorando edema e ADM, e favorecendo a melhora da QV dos acometidos pela doença.

Superior cerebellar artery infarction in endovascular treatment for tentorial dural arteriovenous fistulas

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Zhang Jingbo; Lv Xianli; Jiang Chuhan; Li Youxiang [Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, 6, Tiantan, Xili, Chongwen, 100050, Beijing (China); Wu Zhongxue, E-mail: ttyyzjb@sina.co [Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, 6, Tiantan, Xili, Chongwen, 100050, Beijing (China)

2010-06-15

Background: Superior cerebellar artery (SCA) syndrome shows ipsilateral cerebellar ataxia and Horner's syndrome, contralateral superficial sensory disturbance, as well as nystagmus toward the impaired side, vertigo, and nausea. Occasionally, unilateral lesions may produce bilateral hypogeusia and contralateral hypoacusia. Objective: To report 2 patients with unilateral lower midbrain ischemic lesions of the inferior colliculus level caused by transarterial embolization for tentorial dural arteriovenous fistulas (TDAVFs). Methods: Hospital records for 21 patients with TDAVFs mainly treated by endovascular techniques between 2005 and 2008 were reviewed. Two patients with MRI evidence of unilateral SCA territory infarction were investigated. Results: Of 21 patients, 2 treated transarterially with Onyx-18 (a nonahesive liquid embolic agent) developed infarctions in the territory of SCA. One patient had lateral SCA infarction characterized by ipsilateral gait ataxia, contralateral hemihypoesthesia, with additional ipsilateral ocular motor palsy and bilateral gustatory loss. And the other patient had medial SCA infarction characterized by ipsilateral ataxia contralateral hemihypoesthesia with additional contralateral hypoacusia. Conclusion: SCA infarction can be caused by transarterial injection of Onyx-18 via SCA or the posterior cerebral artery (PCA) for TDAVFs and additionally presented with gustatory loss and deafness, which is generally not a feature of the SCA syndrome.

Embolization of cranial dural arteriovenous fistulae with ONYX: Indications, techniques, and outcomes

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Saraf Rashmi

2010-01-01

Full Text Available Objectives: The purpose of this study was to establish the role of the liquid embolic agent, ONYX, in the treatment of cranial dural arteriovenous fistulae (DAVFs and to redefine the indications, techniques and outcomes of treatment with ONYX. Materials and Methods: This is a retrospective study of 25 DAVF patients who underwent endovascular treatment with ONYX between February 2006 and July 2008. All patients of DAVF presenting in this period were treated with ONYX. Results: Anatomic cure (i.e., complete angiographic closure of the fistula was achieved in a single session and through a single arterial pedicle injection in 21 out of 25 patients (cure rate of 84%. Out of four patients with residual fistulae, one achieved cure that was evident on a control angiogram obtained at 3 months while three had no vascular access for further embolization and so were referred for radiosurgery. There was only one recurrence seen in angiograms obtained at the end of one year and this patient was re-embolized successfully with ONYX. Complications were seen in two patients. Conclusion: ONYX embolization of DAVFs has revolutionized the endovascular treatment of DAVFs, achieving high cure rates in a single session with minimal complications. Transarterial ONYX embolization should be the first option for all locations, except cavernous DAVFs.

Effectiveness of autologous epidural blood patch to relieve post dural puncture headache

International Nuclear Information System (INIS)

Iqbal, L.A.A.; Naqvi, E.H.

2013-01-01

Background: Post-dural puncture headache (PDPH) is a common problem in anaesthesia practice especially in obstetric anaesthesia. Autologous epidural blood patch (AEBP) is the main stay of treatment of PDPH when it is not relieved with conservative management. Objective: To describe the efficacy of AEBP in treatment of PDPH. Study Design: Prospective descriptive study. Setting and Duration: The study was conducted at departments of Anaesthesia and Intensive Care, Military Hospital, Rawalpindi and Combined Military Hospital, Malir, from July 2008 to July 2011. Methodology: All patients who received AEBP during study period secondary to PDPH were included. Up to 20 ml of autologous blood was injected in epidural space. Effectiveness of AEBP was judged by relief of symptom; any complications associated with AEBP i.e. backache and paresthesia were also noted. Data was interpreted as mean and percentages. Results: A total of 30 AEBP were performed during the study period in predominantly female patients (n=27) with mean age of 27.8 years. AEBP was performed after a mean 3.83 days of lumbar puncture. Complete relief was observed in 29 (96%) patients; one patient required a second patch. During the follow-up, 7 (23%) patients complained of backache and 2(6%) of paresthesias. conclusion: AEBP is an effective way of providing relief from PDPH. (author)

Cerebral venous thrombosis: treatment with local fibrinolysis plus alteplase; Trombosis venosa cerebral. Tratamiento mediante fibrinolisis local con alteplasa

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Asis Bravo, F. de; Delgado, F.; Cano, A.; Bautista, D.

2002-07-01

Cerebral venous thrombosis is a rare entity with widely variable clinical signs: thus, a high degree of suspicion is required for diagnosis. It affects the dural sinuses and may or may not invade cerebral veins. The diagnosis has usually been based on an angiographic study although, at the present time, new noninvasive imaging techniques, such as computed tomography, magnetic resonance and magnetic resonance angiography are being employed in a growing number of cases. Treatment should involve symptomatic and etiologic therapy. Although anti coagulation would appear to be a reasonable option in these patients, it remains controversial. As in other processes such as pulmonary embolism and coronary thrombosis, the introduction of novel and increasingly safe fibrinolytic drugs, together with technical innovations in the field of interventional neuroradiology, is changing the perspectives for the management of these patients. We present the case of a 43-year-old woman with right sinus thrombosis who was treated with local thrombolysis plus alteplase (tissue plasminogen activator). The authors describe the technique employed and review the literature. (Author) 16 refs.

Automated Cross-Sectional Measurement Method of Intracranial Dural Venous Sinuses.

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Lublinsky, S; Friedman, A; Kesler, A; Zur, D; Anconina, R; Shelef, I

2016-03-01

MRV is an important blood vessel imaging and diagnostic tool for the evaluation of stenosis, occlusions, or aneurysms. However, an accurate image-processing tool for vessel comparison is unavailable. The purpose of this study was to develop and test an automated technique for vessel cross-sectional analysis. An algorithm for vessel cross-sectional analysis was developed that included 7 main steps: 1) image registration, 2) masking, 3) segmentation, 4) skeletonization, 5) cross-sectional planes, 6) clustering, and 7) cross-sectional analysis. Phantom models were used to validate the technique. The method was also tested on a control subject and a patient with idiopathic intracranial hypertension (4 large sinuses tested: right and left transverse sinuses, superior sagittal sinus, and straight sinus). The cross-sectional area and shape measurements were evaluated before and after lumbar puncture in patients with idiopathic intracranial hypertension. The vessel-analysis algorithm had a high degree of stability with <3% of cross-sections manually corrected. All investigated principal cranial blood sinuses had a significant cross-sectional area increase after lumbar puncture (P ≤ .05). The average triangularity of the transverse sinuses was increased, and the mean circularity of the sinuses was decreased by 6% ± 12% after lumbar puncture. Comparison of phantom and real data showed that all computed errors were <1 voxel unit, which confirmed that the method provided a very accurate solution. In this article, we present a novel automated imaging method for cross-sectional vessels analysis. The method can provide an efficient quantitative detection of abnormalities in the dural sinuses. © 2016 by American Journal of Neuroradiology.

Trombose de artéria carótida interna relacionada a trauma de palato em criança Internal carotid artery thrombosis related to trauma of palate in a child

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Fernando de Souza Almeida

2012-01-01

Full Text Available OBJETIVO: Relatar um caso de trombose de artéria carótida interna secundária relacionada a trauma de palato mole em criança. DESCRIÇÃO DO CASO: Criança admitida com quadro de alteração do nível de consciência, sonolência, afasia e hemiplegia direita; tinha antecedente de trauma corto contuso leve em palato mole há oito horas. A investigação tomográfica evidenciou acidente vascular isquêmico secundário à interrupção do fluxo sanguíneo em território de artéria cerebral média esquerda. A arteriografia mostrou oclusão da artéria carótida interna imediatamente distal à sua origem, com aspecto radiológico de "ponta de lápis", obstruindo o fluxo sanguíneo na região. A paciente foi submetida à investigação para doença pró-trombótica e cardíaca, contudo, não foi detectada nenhuma alteração. A administração de enoxaparina em dose terapêutica por três semanas conduziu à melhora clínica progressiva. Após três semanas de seguimento, a paciente não mostrava sequelas motoras. COMENTÁRIOS: As lesões intraorais são frequentes em crianças e a maioria evolui sem complicações. A trombose da artéria carótida interna é uma complicação rara, mas bem documentada destas lesões e decorre da compressão do vaso com trombogênese localizada. A taxa de mortalidade relatada é de 30% e as sequelas ocorrem em 85% dos casos.OBJECTIVE: To describe a child with internal carotid artery thrombosis secondary to trauma of the soft palate. CASE DESCRIPTION: Child presented with altered level of consciousness, drowsiness, aphasia, right hemiplegia, and a history of trauma, with mild concussion of the soft palate eight hours prior to admission. CT scan showed ischemic stroke secondary to interruption of blood flow in the area of the left middle cerebral artery. Arteriography showed occlusion of the carotid artery just distal to its origin, with radiological appearance of "pencil tip", obstructing blood flow in the region

La Cateterización Venosa Central en la Fundación Santafé de Bogotá.

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Sonia Echeverry de Pimiento

2003-03-01

Full Text Available

De Seguimiento Asistencial a Indicador de Gestión.

La introducción del catéter venoso central (CVC ha significado un gran avance en la medicina moderna y su uso generalizado ha permitido el desarrollo de nuevas técnicas diagnósticas y tratamientos especializados. La cateterización intravascular es uno de los procedimientos más comunes en la actualidad; se utiliza para la monitoria hemodinámica, hemodiálisis, el soporte metabólico y nutricional,
la administración de líquidos, quimioterapia y antibioticoterapia prolongada, sangre y derivados, entre otros.
A pesar de que se lleva casi 50 años de experiencia con estos accesos vasculares, se continúa buscando y aplicando nuevos métodos que permitan prevenir, diagnosticar y tratar las complicaciones relacionadas. Es de conocimiento general que la inserción de accesos venosos centrales y de lineas
arteriales implica un riesgo reconocido de complicaciones mecánicas o técnicas (neumotórax, trombosis venosa, fístulas arteriovenosas, etc. e infecciosas locales o sistémicas, tales como tromboflebitis séptica, endocarditis, bacteriemia e infecciones metastásicas.

Según el consenso del Hospitallnfection Control Practices Advisory Committee (HICPAC, las infecciones del torrente sanguíneo relacionadas con catéteres se asocian con incremento en las tasas de morbilidad y mortalidad del 10 al 20%, con estancias prolongadas y aumento en los costos de hospitalización, principalmente por la terapia antibiótica...

A traumatic dural arteriovenous fistula between the inferolateral trunk of the internal carotid artery and the ophthalmic vein: A case of transvenous coil embolization via the facial vein

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Kim, Jun Young; Hong, Chang Ki; Suh, Sang Hyun [Dept. of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Kim, Dong Ik [Dept. of of Radiology, CHA Bundang Medical Center, CHA University, Seongnam (Korea, Republic of)

2017-05-15

A 31-year-old man was admitted with exophthalmos. He suffered from progressive exophthalmos, bruit and conjunctival chemosis 7 days after head trauma caused by falling down. Cerebral angiography showed a dural arteriovenous fistula (DAVF) draining into the ophthalmic vein caused by tear in the inferolateral trunk, which is a rare presentation of traumatic DAVF. Selective transvenous coil embolization was performed via the facial vein without neurologic complications.

Warmed intravenous infusion for controlling intraoperative hypothermia Infusión venosa calentada en el control de la hipotermia durante el período intraoperatorio Infusão venosa aquecida no controle da hipotermia no período intraoperatório

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Ana Lúcia De Mattia

2013-06-01

Full Text Available OBJECTIVE: to verify the effectiveness of warmed intravenous infusion for hypothermia prevention in patients during the intraoperative period. METHOD: experimental, comparative, field, prospective and quantitative study undertaken at a federal public hospital. The sample was composed of 60 adults, included based on the criteria of axillary temperature between 36ºC and 37.1ºC and surgical abdominal access, divided into control and experimental groups, using the systematic probability sampling technique. RESULTS: 22 patients (73.4% from both groups left the operating room with hypothermia, that is, with temperatures below 36ºC (p=1.0000. The operating room temperature when patients arrived and patients' temperature when they arrived at the operating room were statistically significant to affect the occurrence of hypothermia. CONCLUSION: the planning and implementation of nursing interventions carried out by baccalaureate nurses are essential for preventing hypothermia and maintaining perioperative normothermia. OBJETIVO: verificar la eficacia de la intervención de infusión venosa calentada en la prevención de la hipotermia en pacientes en el período intraoperatorio. MÉTODO: estudio experimental, comparativo, de campo, prospectivo y cuantitativo, en un hospital público federal. La muestra abarcó a 60 adultos, que tuvieron como uno de los criterios de inclusión la temperatura axilar entre 36ºC y 37,1ºC y acceso quirúrgico abdominal, divididos en grupos control y experimental, compuestos utilizándose la técnica de muestreo probabilístico sistemático. RESULTADOS: en los 2 grupos, 22 pacientes (73,4% salieron del quirófano con hipotermia, o sea, temperatura inferior a 36ºC (p=1,0000. La temperatura del quirófano cuando de la entrada del paciente y la temperatura del paciente cuando de la entrada en el quirófano fueron estadísticamente significativas para influir en la ocurrencia de hipotermia. CONCLUSÍON: la planificación e

Management of a case with misdiagnosed spinal dural arterio-venous fistula.

Science.gov (United States)

Lien, Chia-Yi; Lui, Chun-Chung; Lu, Cheng-Hsien; Chang, Wen-Neng

2014-03-01

Spinal dural arterio-venous fistula (SDAVF) is an uncommon and easily misdiagnosed vascular malformation. We aimed to report the diagnosis and management of a case with SDAVF. A 62-year-old man suffered from acute paraparesis about 15 months before this study. He underwent a neurosurgical procedure for herniated discs of the cervical spine at that time but there was no relief and the symptoms worsened despite the surgery. Neurologically, he had spastic paraparesis and decreased vibration sensation of the lower limbs. Spinal magnetic resonance imaging (MRI) revealed intra-medullary hyper-intensity lesion at T8 to T10 levels and tubular-like signal void structures in the corresponding posterior sub-arachnoid space. Further trans-arterial angiography through right T6 intercostal artery catheterization revealed engorged veins, thereby confirming the diagnosis of SDAVF. The patient was treated via endovascular embolization (18% Onyx, EV3TM MIT, Bonn, Germany) through spinal angiography and the results showed a marked decrease in engorged veins. After a 4-month follow-up, the patient was symptomatic but stable. Follow-up MRI showed a complete disappearance of the hyper-intensity change of the spinal cord. Spinal MR angiography did not reveal any recurrence of SDAVF. This case study demonstrated the easily misdiagnosed state of SDAVF. Serial neuroimage studies including spinal MRI, endovascular embolization through spinal angiography and MR angiography can be useful tools for its diagnostic confirmation, management and follow-up study.

Contracepção hormonal e sistema cardiovascular Contracepción hormonal y sistema cardiovascular Hormonal contraception and cardiovascular system

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Milena Bastos Brito

2011-04-01

Full Text Available A contracepção hormonal é o método mais utilizado para prevenção de gestações não planejadas. A literatura tem demonstrado associação entre risco cardiovascular e uso de hormonioterapia. A fim de melhorar a orientação contraceptiva para mulheres com fatores de risco para doença cardiovascular, realizamos uma revisão da literatura em relação ao assunto. Esta revisão descreve os dados mais recentes da literatura científica acerca da influência dos contraceptivos hormonais em relação a trombose venosa, arterial e hipertensão arterial sistêmica, doenças cada dia mais prevalentes na população feminina jovem.La contracepción hormonal es el método más utilizado para la prevención de los embarazos no planificados. La literatura ha venido demostrando la asociación que existe entre el riesgo cardiovascular y el uso de la hormonoterapia. Con el objetivo de mejorar la orientación en la contracepción en mujeres con factores de riesgo para el desarrollo de enfermedad cardiovascular, realizamos una revisión de la literatura con relación a ese asunto. Esa revisión describe los datos más recientes de la literatura científica acerca de la influencia de los anticonceptivos hormonales con relación a la trombosis venosa, arterial e hipertensión arterial sistémica, enfermedades cada día más prevalentes en la población femenina joven.Hormonal contraception is the most widely used method to prevent unplanned pregnancies. The literature has shown an association between cardiovascular risk and use of hormone therapy. With the purpose of providing better guidelines on contraception methods for women with risk factors for cardiovascular disease, we have reviewed the literature on the subject. This review describes the latest data from the scientific literature concerning the influence of hormonal contraceptives on arterial thrombosis, venous thrombosis and systemic high blood pressure, which are diseases that have become

Análise dos efeitos dos exercícios aquáticos na qualidade de vida de indivíduos com doença venosa crônica

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Michael Augusto dos Santos Aquino

2016-03-01

Full Text Available Resumo Contexto O uso dos exercícios aquáticos se tornou uma modalidade terapêutica muito importante na doença venosa crônica (DVC. Tais exercícios têm sido apontados pela literatura como um mecanismo favorável ao retorno venoso, sendo importantes na reeducação vascular. Também contribuem para a diminuição da hipertensão venosa ocasionada pela doença, melhorando a qualidade de vida dos indivíduos acometidos. Objetivos Analisar os efeitos dos exercícios aquáticos na qualidade de vida de pacientes com DVC. Métodos Trata-se de um estudo-piloto, interventivo prospectivo longitudinal, composto por 16 indivíduos com DVC classificados de C1 a C5. Os participantes foram avaliados através de um formulário de coleta de dados e instruídos a responder dois questionários sobre qualidade de vida: SF-36 (Geral e AVVQ-Brasil (específico para DVC, além da Escala Visual Analógica da dor (EVA. Em seguida, foram submetidos a 10 sessões de exercícios aquáticos, três vezes por semana, tendo respondido novamente aos questionários de qualidade de vida e EVA após o termino de todas as sessões. Resultados Os dados coletados foram tratados estatisticamente, com nível de significância de p < 0,05. Os pacientes apresentaram melhora na qualidade de vida medida pelo SF-36 nos domínios capacidade funcional, limitação e dor (p < 0,05. O nível de dor nos pacientes tratados reduziu segundo a EVA (p = 0,007. Em relação ao questionário AVVQ-Brasil, apenas o domínio Dor e Disfunção apresentou melhora significativa (p = 0,013. Conclusão Os exercícios aquáticos foram capazes de melhorar aspectos da qualidade de vida e de reduzir a dor, demonstrando trazer benefícios para pacientes com DVC.

Recovery of opthalmoplegia associated with cavernous sinus dural arteriovenous fistulas after transvenous cavernous sinus packing

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Xianli, Lv; Chuhan, Jiang; Youxiang, Li; Xinjian, Yang [Beijing Neurosurgical institute, Beijing Tiantan Hospital, Capital Medical University, 6, Tiantan Xili, Chongwen, Beijing (China); Wu Zhongxue, E-mail: ttyyzjb@sina.co [Beijing Neurosurgical institute, Beijing Tiantan Hospital, Capital Medical University, 6, Tiantan Xili, Chongwen, Beijing (China)

2010-08-15

Background: We report the recovery of ophthalmoplegia in 11 patients with cavernous sinus dural arteriovenous fistula (CSDAVF) after sinus packing at follow-up. Methods: Of 18 patients with CSDAVF treated with transvenous cavernous sinus packing between August 2002 and December 2007 at Beijing Tiantan Hospital, there were 9 patients with initial CNIII or CNVI dysfunction and 2 patients with CNVI dysfunction immediately after cavernous sinus packing selected and reevaluated. Results: Of 11 patients with CNIII or CNVI palsy, recovery was complete in 10. In 1 patient, complete CNVI palsy was unchanged because the CSDAVF was not cured. There were 6 men and 5 women with a mean age of 52.9 years. In 5 patients, CNVI palsy was associated with chemosis, proptosis and pulsatile tinnitus. Timing of treatment after onset of symptoms was from 4 to 35 days in 9 patients. All CSDAVFs were Barrow type D. Mean follow-up after treatment was 17.7 months (range, 2-54 months). Conclusion: CSDAVF-induced CNIII or CNVI palsies can be cured after cavernous sinus packing transvenously in most patients.

Recovery of opthalmoplegia associated with cavernous sinus dural arteriovenous fistulas after transvenous cavernous sinus packing

International Nuclear Information System (INIS)

Lv Xianli; Jiang Chuhan; Li Youxiang; Yang Xinjian; Wu Zhongxue

2010-01-01

Background: We report the recovery of ophthalmoplegia in 11 patients with cavernous sinus dural arteriovenous fistula (CSDAVF) after sinus packing at follow-up. Methods: Of 18 patients with CSDAVF treated with transvenous cavernous sinus packing between August 2002 and December 2007 at Beijing Tiantan Hospital, there were 9 patients with initial CNIII or CNVI dysfunction and 2 patients with CNVI dysfunction immediately after cavernous sinus packing selected and reevaluated. Results: Of 11 patients with CNIII or CNVI palsy, recovery was complete in 10. In 1 patient, complete CNVI palsy was unchanged because the CSDAVF was not cured. There were 6 men and 5 women with a mean age of 52.9 years. In 5 patients, CNVI palsy was associated with chemosis, proptosis and pulsatile tinnitus. Timing of treatment after onset of symptoms was from 4 to 35 days in 9 patients. All CSDAVFs were Barrow type D. Mean follow-up after treatment was 17.7 months (range, 2-54 months). Conclusion: CSDAVF-induced CNIII or CNVI palsies can be cured after cavernous sinus packing transvenously in most patients.

Influência da anestesia venosa total, entropia e laparoscopia sobre o estresse oxidativo

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Rogean Rodrigues Nunes

2012-08-01

Full Text Available JUSTIFICATIVA E OBJETIVOS: Estudos recentes correlacionam mortalidade pós-operatória e anestésica, especialmente a profundidade anestésica e pressão arterial sistólica (PAS. O objetivo deste estudo foi avaliar os efeitos da profundidade da anestesia venosa total (AVT realizada com remifentanil e propofol com monitoração da entropia de resposta (RE sobre as concentrações sanguíneas dos marcadores do estresse oxidativo: TBARS e glutationa, durante operações pelo acesso vídeolaparoscópico. MÉTODO: Vinte pacientes adultas, ASA I, IMC 20-26 kg.m-2, idades entre 20 e 40 anos, foram aleatoriamente distribuidas em dois grupos iguais: Grupo I - submetidas a procedimento anestésico-cirúrgico com RE mantida entre 45 e 59 e Grupo II - submetidas a procedimento anestésico-cirúrgico com RE entre 30 e 44. Em ambos os grupos, a infusão de remifentanil e propofol foi controlada pelo sitio efetor (Se, ajustados para manter RE nos valores desejados (Grupos I e II e avaliando-se sempre a taxa de supressão (TS. As pacientes foram avaliadas em seis momentos: M1(imediatamente antes da indução anestésica, M2 (antes da intubação traqueal [IT], M3 (5 minutos após IT, M4 (imediatamente antes do pneumoperitônio-PPT, M5 (1 minuto após o PPT e M6 (uma hora após a operação. Em todos os momentos foram avaliados os seguintes parâmetros: PAS, PAD, FC, RE, TS, TBARS e glutationa. RESULTADOS: Observaram-se aumentos no TBARS e glutationa em M5, tanto no Grupo I como no Grupo II (p GI em M5 - p < 0,05% sugerem interferência de mais um fator (anestesia profunda, como responsável pelo aumento no MA, provavelmente como resultados de maior depressão do sistema nervoso autônomo e menor autorregulação esplâncnica.

Oligomeric stability of Rapana venosa hemocyanin (RvH) and its structural subunits.

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Dolashka-Angelova, Pavlina; Schwarz, Heinz; Dolashki, Aleksandar; Stevanovic, Stefan; Fecker, Miriam; Saeed, Muhammad; Voelter, Wolfgang

2003-03-21

The two structural subunits RvH1 and RvH2 were separated after overnight dialysis of Rapana venosa Hc against 130 mM Gly/NaOH buffer, pH 9.6, on an ion exchange column Hiload 26/10 Sepharose Q using a fast performance liquid chromatography (FPLC) system. The reassociation characteristics of these two RvH isoforms and the native molecule were studied in buffers with different pH values and concentrations of Ca(2+) and Mg(2+). Reassociation of mixed RvH subunits was performed over a period of several days using a stabilizing buffer (SB) of pH 7.0 containing different concentrations of Ca(2+) and Mg(2+) ions. After 2 days of dialysis, an RvH subunit mixture of didecamers and multidecamers was observed in the presence of 100 mM CaCl(2) and MgCl(2), though RvH1 and RvH2 are biochemically and immunologically different and have also different dissociation properties. The reassociation, performed at pH 9.6 with 2 mM CaCl(2) and MgCl(2) at 4 degrees C over a period of one to several weeks, led to the formation of decameric oligomers, while didecamers formed predominantly in the SB at pH 7.0. Higher concentrations of calcium and magnesium ions led to a more rapid reassociation of RvH1 resulting in long stable multidecamers and helical tubules, which were stable and slowly dissociated into shorter multidecamers and decamers at higher pH values. The reassociation of the RvH2 structural subunit in the same buffers processed slowly and yielded didecamers, shorter tubule polymers and long multidecamers which are less stable at higher pH values. The stability of RvH isoforms under varying ionic conditions is compared with the stability of keyhole limpet (KLH, Megathura crenulata) hemocyanin (KLH) and Haliotis tuberculata hemocyanin (HtH) isoforms. The process of dissociation and reassociation is connected with changes of the fluorescence intensity at 600 nm, which can be explained by differences in opalescence of the solutions of these two isoforms. The solutions of longer tubule

Resolution of clinical symptoms after reopening of an occluded inferior petrosal sinus in a patient with a cavernous sinus dural arteriovenous fistula. A case report.

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Kojima, A; Onozuka, S; Kinoshita, Y

2013-03-01

We describe a rare case with a cavernous sinus (CS) dural arteriovenous fistula (DAVF) in which the clinical symptoms disappeared after the patient underwent reopening of an occluded inferior petrosal sinus (IPS). A 66-year-old woman presented with increased intraocular pressure, chemosis, and proptosis on the left side. Angiography demonstrated a left CS DAVF supplied by the dural branches of bilateral internal carotid arteries. The shunt flow was directed to the superior and inferior ophthalmic veins, while the bilateral IPSs were not opacified. Accordingly, a transvenous embolization of the fistula was attempted. Although the microcatheter was navigated to the cavernous sinus through the occluded left IPS, obliteration of the fistula was unsuccessful because of the failure of superselective catheterization at the fistulous point. However, the final image demonstrated the development of an antegrade shunt flow through the left IPS to the internal jugular vein and disappearance of the retrograde reflux to the superior and inferior ophthalmic veins. The patient's clinical symptoms immediately resolved after the operation, and the symptoms have not recurred during a one-year follow-up period. Inappropriate transvenous embolization of CS DAVFs can result in vascular complications arising from the unintentional redistribution of shunt flow. The present case illustrates that the disappearance of retrograde shunt flow to the ophthalmic veins after reopening of the occluded IPS may be sufficient if a superselective approach fails or is anticipated to result only in an incomplete embolization of the fistulous point.

Gamma Knife surgery for clival epidural-osseous dural arteriovenous fistulas.

Science.gov (United States)

Lee, Cheng-Chia; Chen, Ching-Jen; Chen, Shao-Ching; Yang, Huai-Che; Lin, Chung Jung; Wu, Chih-Chun; Chung, Wen-Yuh; Guo, Wan-Yuo; Hung-Chi Pan, David; Shiau, Cheng-Ying; Wu, Hsiu-Mei

2018-05-01

OBJECTIVE Clival epidural-osseous dural arteriovenous fistula (DAVF) is often associated with a large nidus, multiple arterial feeders, and complex venous drainage. In this study the authors report the outcomes of clival epidural-osseous DAVFs treated using Gamma Knife surgery (GKS). METHODS Thirteen patients with 13 clival epidural-osseous DAVFs were treated with GKS at the authors' institution between 1993 and 2015. Patient age at the time of GKS ranged from 38 to 76 years (median 55 years). Eight DAVFs were classified as Cognard Type I, 4 as Type IIa, and 1 as Type IIa+b. The median treatment volume was 17.6 cm 3 (range 6.2-40.3 cm 3 ). The median prescribed margin dose was 16.5 Gy (range 15-18 Gy). Clinical and radiological follow-ups were performed at 6-month intervals. Patient outcomes after GKS were categorized as 1) complete improvement, 2) partial improvement, 3) stationary, and 4) progression. RESULTS All 13 patients demonstrated symptomatic improvement, and on catheter angiography 12 of the 13 patients had complete obliteration and 1 patient had partial obliteration. The median follow-up period was 26 months (range 14-186 months). The median latency period from GKS to obliteration was 21 months (range 8-186 months). There was no intracranial hemorrhage during the follow-up period, and no deaths occurred. Two adverse events were observed following treatment, and 2 patients required repeat GKS treatment with eventual complete obliteration. CONCLUSIONS Gamma Knife surgery offers a safe and effective primary or adjuvant treatment modality for complex clival epidural-osseous DAVFs. All patients in this case series demonstrated symptomatic improvement, and almost all patients attained complete obliteration.

Implante de filtro em veia cava inferior dupla: relato de caso e revisão da literatura Filter placement in duplicated inferior vena cava: case report and review of the literature

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Rafael Demarchi Malgor

2008-06-01

Full Text Available Veia cava inferior dupla é uma variação anatômica rara cuja prevalência é de 0,2-3%. O implante de filtro de veia cava, quando indicado em casos com duplicidade da veia cava inferior, pode ser realizado de diferentes formas: em ambas as veias cavas; em uma delas, embolizando a anastomose entre ambas; em somente uma delas; ou por implante supra-renal. Relatamos um caso de trombose venosa profunda no pós-operatório de implante de prótese de quadril com contra-indicação para tratamento anticoagulante e cuja cavografia evidenciou duplicidade de veia cava inferior. O implante de filtro de veia cava inferior realizado em posição supra-renal mostrou-se opção adequada e segura.Double inferior vena cava is a rare anatomic variation with prevalence ranging between 0.2-3.0%. In cases of duplication, inferior vena cava filter placement options include placing it in both vena cava, coil-embolization of the intervenous segment plus placing a filter in the right inferior vena cava, or suprarenal filter placement. We report a case of deep venous thrombosis after unilateral primary total hip replacement, presenting with contraindications for anticoagulant therapy, in which cavography showed inferior vena cava duplication. Inferior vena cava filter placement was performed in the supra-renal portion and was proved to be an adequate and safe procedure.

硬脑膜动静脉瘘Onyx栓塞术后三叉神经与面神经损伤一例%The report of multiple cranial nerve injury of dural arteriovenous fistulas treated with Onyx embolization

Institute of Scientific and Technical Information of China (English)

陈俊敏; 王晓鹏; 王晓阳; 王林静; 姚园园; 闫妍; 陈蕾

2016-01-01

Objective To explore the cause of multiple cranial nerve injury after dural arteriovenous fistulas treated with Onyx embolization.Methods Communicate with pathogenesis,clinical symptom,arterial anastomosis,analysis of clinical data that multiple cranial nerve injury after dural arteriovenous fistulas(cavernous sinus) treated with Onyx embolization.Results The patient treated with Onyx embolization who developed trigeminal nerve and facial nerve injury.Conclusion The multiple cranial nerve injury after dural arteriovenous fistulas treated with Onyx embolization maybe attributed to some reflux of Onyx interruption of the nutrient vessel and dimethyl sulfoxide which exhibited high local toxicity.%目的：探讨硬脑膜动静脉瘘（DAVFs）Onyx栓塞术后并发三叉神经与面神经损伤的原因。方法分析1例DAVFs（海绵窦区）Onyx栓塞术后多发三叉神经与面神经损伤的临床资料，结合病因、临床表现、相应血管吻合。结果患者Onyx栓塞术后出现三叉神经及面神经损伤。结论硬脑膜动静脉瘘Onyx栓塞术后三叉神经与面神经的损伤与Onyx逆流阻塞相应脑神经的滋养动脉及二甲基亚砜的局部毒性有关。

Gamma Knife radiosurgery for the treatment of intracranial dural arteriovenous fistulas

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Dmytriw, Adam A; Schwartz, Michael L; Cusimano, Michael D; Mendes Pereira, Vitor; Krings, Timo; Tymianski, Michael; Radovanovic, Ivan

2016-01-01

Background Intracranial dural arteriovenous fistulae (DAVF) may present a treatment challenge. Endovascular embolization is in most cases the first line of treatment but does not always achieve cure. Gamma Knife (GK) radiosurgery represents an alternative treatment option, and the purpose of this study was to further evaluate its utility. Methods We reviewed all cases of DAVF treated between 2009 and 2016 at our institution with GK radiosurgery independently, or following failed/refused endovascular or surgical management. Patients’ clinical files, radiological images, catheter angiograms, and surgical DAVF disconnection reports were retrospectively reviewed. Results Sixteen DAVF (14 patients) treated by GK radiosurgery were identified. Eleven fistulae were aggressive and five were benign. Marginal doses ranged from 15 to 25 Gy. Target volumes ranged from 0.04 to 4.47 cm3. In all symptomatic patients, GK treatment resulted in symptom palliation. In 13/15 lesions, cure of symptoms (86.0%) was reported. One lesion was asymptomatic. Angiographic cure was achieved in eight cases (50%), small residual DAVF occurred in four, and four were unchanged. One patient developed headache that resolved at one year. No hemorrhage occurred during the follow-up period. There was no significant association between Borden type and cure rate. Prior failed endovascular treatment and small target volume were associated with lower rates of cure. Conclusions Stereotactic radiosurgery is viable treatment for DAVF. It is very effective in palliating symptoms as a de novo approach or adjunctive to endovascular therapy. In our experience it is only somewhat effective in achieving complete angiographic cure. PMID:28156167

Anestesia venosa total (AVT) em lactente com doença de Werdnig-Hoffmann: relato de caso Anestesia general intravenosa (AVT) en lactante con enfermedad de Werdnig-Hoffmann: relato de caso Total intravenous anesthesia (TIVA) in an infant with Werdnig-Hoffmann disease: case report

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Marco Antonio Cardoso de Resende; Elizabeth Vaz da Silva; Osvaldo José Moreira Nascimento; Alberto Esteves Gemal; Giseli Quintanilha; Eliana Maria Vasconcelos

2010-01-01

JUSTIFICATIVA E OBJETIVOS: A doença de Werdnig-Hoffmann é a causa mais comum de hipotonia no lactente e quando presente logo após o nascimento tem pior prognóstico. Fraqueza muscular simétrica, arreflexia e fasciculações da língua são característicos. A maioria dos lactentes morre antes dos dois anos por insuficiência respiratória. O presente relato apresenta um caso com técnica venosa total durante anestesia. RELATO DO CASO: Paciente feminina, branca, um ano, 10 kg, estado físico ASA III, co...

Tratamento da síndrome de Budd-Chiari por meio da colocação de tips e de "stent" venoso supra-hepático Transjugular intrahepatic portosystemic shunt (TIPS and suprahepatic venous stenting in the management of Budd-Chiari syndrome

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Jurandi A. Bettio

2002-11-01

Full Text Available OBJETIVOS: Descrever o uso do "shunt" intra-hepático portossistêmico (TIPS e do "stent" venoso supra-hepático no manejo da síndrome de Budd-Chiari, enfocando suas indicações, aspectos técnicos e benefícios do procedimento. MATERIAIS E MÉTODOS: De janeiro de 1999 a março de 2002, nove casos de síndrome de Budd-Chiari foram encaminhados ao Serviço de Hemodinâmica do Hospital São Lucas, Porto Alegre, RS. A obstrução venosa supra-hepática foi constatada em todos os casos por meio de ultra-sonografia com Doppler em cores. A criação de TIPS foi realizada entre o sistema venoso supra-hepático ou a veia cava inferior e a veia porta, posicionando-se a endoprótese entre as duas abordagens. Doppler em cores pós-procedimento foi efetuado em todos os pacientes em períodos seriados. RESULTADOS: Três casos foram tratados inicialmente com inserção de "stent" venoso por apresentarem estenose preponderante em veias supra-hepáticas. Em dois desses casos ocorreu trombose do "stent", sendo necessária colocação de TIPS. Os demais seis casos foram tratados primariamente com TIPS. Dos oito "shunts" criados, trombose da endoprótese foi constatada em três casos, resolvidas com limpeza dos trombos e dilatação com balão em um caso e inserção de novas próteses nos demais. Embolização com molas de colaterais venosas ectasiadas foi efetuada em um paciente. CONCLUSÕES: A colocação de TIPS constitui-se numa estratégia terapêutica segura e efetiva na síndrome de Budd-Chiari, promovendo uma significativa melhora clínica e hemodinâmica dos pacientes, evitando procedimentos mais invasivos e podendo, em casos sem cirrose estabelecida, servir de tratamento definitivo da hipertensão portal.OBJECTIVE: To evaluate the use of transjugular intrahepatic portosystemic shunt (TIPS and suprahepatic venous stenting in the management of Budd-Chiari syndrome, emphasizing the indications, technical aspects and the advantages of the procedure

Avaliação clínico-laboratorial de pacientes com síndrome antifosfolípide primária segundo a frequência de anticorpos antinucleares (FAN Hep-2 Clinical and laboratory evaluation of patients with primary antiphospholipid syndrome according to the frequency of antinuclear antibodies (ANA Hep-2

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Jozélio Freire de Carvalho

2010-06-01

Full Text Available OBJETIVO: Avaliar a frequência de manifestações clínicas e laboratoriais em pacientes com síndrome antifosfolípide primária (SAFP com anticorpos antinucleares positivos (FAN Hep-2+, comparados àqueles com esses anticorpos negativos (FAN Hep-2 -. PACIENTES E MÉTODOS: Estudo transversal em 58 pacientes (82,8% mulheres com SAFP. Foram avaliados os dados demográficos, clínicos, comorbidades, medicações e anticorpos antifosfolípides. RESULTADOS: Dos 58 pacientes incluídos no estudo, vinte (34,5% apresentaram presença de FAN Hep-2. Comparando-se o grupo de pacientes FAN Hep-2+ com aqueles FAN Hep-2 -, verificou-se que ambos os grupos de pacientes com SAFP não diferiram estatisticamente em relação aos dados demográficos, bem como em relação ao tempo de doença. Em relação às manifestações clínicas e laboratoriais, o grupo com FAN Hep-2 + apresentou maior frequência de trombose venosa profunda (85 versus 52,6%, P = 0,04, uma frequência estatística e significativamente maior de anticardiolipina IgG (85 versus 52,6%, P = 0,02 e uma tendência para anticardiolipina IgM (80% versus 52,6%, P = 0,05, bem como maiores medianas desses anticorpos [33 (0-128 versus 20 (0-120 GPL, P = 0,008] e [33 (0-120 versus 18,5 (0-120 MPL, P = 0,009]. Tal diferença não foi observada no que se refere a outras manifestações da SAF, presença de comorbidades, estilo de vida e uso de medicações. CONCLUSÃO: Pacientes com SAFP que apresentam FAN Hep-2+ têm maior frequência de trombose venosa profunda e anticardiolipinas IgG e IgM.OBJECTIVE: To evaluate the frequency of clinical and laboratory manifestations in patients with primary antiphospholipid syndrome (PAPS with positive antinuclear antibodies (ANA Hep-2+ compared to those in whom this antibody is negative (ANA Hep-2-. PATIENTS AND METHODS: This is a transversal study with 58 patients (82.8% females with PAPS. Demographic and clinical data, comorbidities, medications, and

Clinical presentation, imaging findings, and prognosis of spinal dural arteriovenous fistula.

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Lee, Jookyung; Lim, Young-Min; Suh, Dae Chul; Rhim, Seung Chul; Kim, Sang Joon; Kim, Kwang-Kuk

2016-04-01

Spinal dural arteriovenous fistula (SDAVF) is a relatively common acquired vascular malformation of the spinal cord. Assessment of a SDAVF is often difficult because of non-specific findings on non-invasive imaging modalities. Diagnosis of a SDAVF is often delayed, and some patients receive unnecessary treatment and treatment delays, often resulting in a poor outcome. The aim of this study was to characterize the clinical presentation, typical imaging findings, and long-term outcome of SDAVF. Forty patients (13 women, 27 men; mean age 58.18 ± standard deviation 14.75 years) who were treated at our hospital from June 1992 to March 2014 were retrospectively reviewed. We investigated the baseline characteristics, clinical presentation, imaging findings, treatment modalities, and outcome of the patients. The most common clinical presentation was a sensory symptom (80%), followed by motor weakness (70%), and sphincter dysfunction (62.5%). Roughly one-third (32.5%) of patients had a stepwise progression of fluctuating weakness and sensory symptoms, but the most common presentation was chronic progressive myelopathic symptoms (47.5%). Thirty-four patients (85%) had T2 signal change on the spinal cord MRI, indicative of cord edema. Thirty-eight patients had typical perimedullary vessel flow voids on T2-weighted MRI. Twenty-eight patients were treated with endovascular embolization, five patients underwent surgery, and four patients underwent both. Clinical outcome was determined by severity of initial deficit (p=0.008), extent of cord edema (p=0.010), treatment failure (p=0.004), and a residual fistula (p=0.017). SDAVF causes a treatable myelopathy, so early diagnosis and intervention is essential. Copyright © 2015 Elsevier Ltd. All rights reserved.

Brinquedo terapêutico no preparo da criança para punção venosa ambulatorial: percepção dos pais e acompanhantes El juego terapéutico en la preparación del niño para una punción venosa en ambulatorio: percepción de los padres y acompañantes Therapeutic play when preparing the child for venipuncture outpatient: perception from the parents and attendants

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Caroline Monteiro Conceição

2011-06-01

Full Text Available Estudo descritivo qualitativo com o objetivo de compreender a percepção de pais e acompanhantes sobre o emprego do Brinquedo Terapêutico no preparo da criança para a punção venosa ambulatorial, realizado em um ambulatório da cidade de São Paulo. Os dados foram coletados por meio de entrevistas semiestruturadas realizadas com oito pais ou acompanhantes de crianças preparadas para a punção venosa com o Brinquedo Terapêutico e, após, submetidos à análise qualitativa de conteúdo. Os resultados evidenciaram que eles aprovam essa estratégia de preparo e acreditam que esta favorece o conhecimento sobre o procedimento, diminui o medo, acalma e promove a segurança deles e da criança, além de constituir-se em um atendimento de enfermagem humanizado e de qualidade à criança e família. Reitera-se a importância da implementação do Brinquedo Terapêutico na assistência à criança em ambulatórios e unidades básicas de saúde.Estudio descriptivo cualitativo realizado con el objetivo de comprender la percepción de los padres y acompañante a respecto de la utilización del Juego Terapéutico en la preparación de sus hijos para la punción venosa previa a la recolección de sangre. Fue realizado en un ambulatorio de la ciudad de São Paulo. Los datos fueron recolectados por medio de entrevistas seme-estructuradas realizadas con ocho padres o acompañantes de niños preparados con el juego para la recolección de sangre, y que, después, fueron sometidos al análisis cualitativo del contenido. Los resultados evidenciaron que los padres aprueban esa estrategia de preparación y consideran que la misma favorece al conocimiento sobre el procedimiento, disminuye el miedo, tranquiliza y promueve la seguridad de los adultos y de los niños, además de ser una atención de enfermería humanizada y de calidad al niño y a la familia. Se reitera la importancia de la implementación del Juego Terapéutico en la asistencia al niño en

Laboratory investigation in normal and pathologic coagulation

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Bakhtiari, K.

2013-01-01

Kamran Bakhtiari deed onderzoek naar het gebruik en het belang van hemostase-testen in verschillende situaties, bij gezonde personen en patiënten met bloedingen of trombose. Hemostase is het proces dat zorgt voor de vloeibaarheid van het bloed en het voorkomen van bloedverlies na beschadiging van een bloedvat. Verstoring van dit delicate proces kan leiden tot bloedingen of trombose (bloedklontering). Voor het vaststellen van afwijkingen in de hemostase zijn er veel laboratoriumtesten beschikb...

Saturação venosa central e mista de oxigênio no choque séptico: existe diferença clinicamente relevante? Central and mixed venous oxygen saturation in septic shock: is there a clinically relevant difference?

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Flavia Ribeiro Machado

2008-12-01

Full Text Available INTRODUÇÃO: A medida da saturação venosa central de oxigênio (SvcO2 tem sido proposta como alternativa a saturação venosa mista (SvO2, com grau de concordância variável nos dados atualmente disponíveis. Esse estudo objetivou avaliar as possíveis diferenças entre a SvO2 e a SvcO2 ou saturação venosa atrial de oxigênio (SvaO2, com ênfase na interferência do débito cardíaco, e o impacto delas no manejo clínico do paciente séptico. MÉTODOS: Estudo prospectivo observacional em pacientes com choque séptico monitorizados com cateter de artéria pulmonar. Foi obtido sangue simultaneamente para determinação da SvcO2, SvO2 e SvaO2. Realizado testes de correlação linear (significativos se pINTRODUCTION: Central venous oxygen saturation (SvcO2 has been proposed as an alternative for mixed venous oxygen saturation (SvO2, with a variable level of acceptance according to available data. This study aimed to evaluate possible differences between SvO2 and SvcO2 or atrial venous saturation (SvaO2, with emphasis on the role of cardiac output and their impact on clinical management of the septic patient. METHODS: This is an observational, prospective study of patients with septic shock monitored by pulmonary artery catheter. Blood was obtained simultaneously for SvcO2, SvO2 and SvaO2 determination. Linear correlation (significant if p<0.05 and agreement analysis (Bland-Altman were performed with samples and subgroups according to cardiac output. Moreover, agreement about clinical management based on these samples was evaluated. RESULTS: Sixty one measurements from 23 patients were obtained, median age of 65.0 (49.0-75.0 years and mean APACHE II of 27.7±6.3. Mean values of SvO2, SvcO2 and SvaO2 were 72.20±8.26%, 74.61±7.60% and 74.64±8.47%. Linear correlation test showed a weak correlation between SvO2 and SvcO2 (r=0.61, p<0.0001 and also between SvO2 and SvaO2 (r=0.70, p<0.0001. Agreements between SvcO2/SvO2 and SvaO2/SvO2 were -2.40�

Trombose da artéria renal e síndrome do anticorpo antifosfolípide: um relato de caso Renal arterial thrombosis and the antiphospholipid antibody syndrome: a case report

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Célia S. Macedo

2001-12-01

Full Text Available OBJETIVO: descrever um caso clínico raro na infância, com achados clínicos da síndrome do anticorpo antifosfolípide. DESCRIÇÃO: criança, sexo masculino, com 2 anos e 6 meses de idade, com insuficiência renal, trombose da artéria renal e diagnóstico de síndrome do anticorpo antifosfolípide, foi internada com dor abdominal, palidez, letargia e anúria há 36 horas. Ao exame físico, apresentava-se desnutrida, com hipertensão arterial severa, edema moderado e dor em hipocôndrio. Os achados laboratoriais incluíram: uréia=112mg/dl; creatinina plasmática=4,5 mg/dl; pH sangüíneo=7,47; bicarbonato sangüíneo=12,8 mmol/L; K=7,2 mEq/L. A diálise peritoneal foi iniciada e mantida por 11 dias. Após 7 semanas de evolução, o paciente ainda necessitava de droga anti-hipertensiva e a função renal estava anormal. A biópsia renal revelou infarto renal anêmico; ultra-sonografia renal com doppler, fluxo sangüíneo renal ausente no lado direito, e a arteriografia mostrou oclusão total da artéria renal direita. A pesquisa de doenças do colágeno foi negativa. Foi realizada nefrectomia à direita obtendo-se normalização da pressão arterial. Aos 5 anos e 8 meses, foi novamente hospitalizada com quadro de crises de ausência e dores abdominais e precordiais. A dosagem do anticorpo anticardiolipina foi positiva. Atualmente aos 7 anos, está em seguimento ambulatorial, assintomática e com dosagens negativas do anticorpo anticardiolipina. COMENTÁRIOS: as observações deste caso mostram que crianças com quadro de trombose arterial, mesmo na ausência de doenças do colágeno, devem ser investigadas para uma possível associação com a síndrome do anticorpo antifosfolípide.OBJECTIVE: to describe an unusual case with clinical features of the antiphospholipid syndrome. DESCRIPTION: white child, two years and six months old, with renal failure, renal arterial thrombosis, and diagnosis of antiphospholipid syndrome was hospitalized with

Padrões de refluxo nas veias safenas em homens com insuficiência venosa crônica

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Carlos Alberto Engelhorn

Full Text Available Resumo Contexto A insuficiência venosa crônica (IVCr é frequente e predomina nas mulheres, mas ainda há poucas informações sobre o refluxo nas veias safenas na população masculina. Objetivos Identificar os diferentes padrões de refluxo nas veias safenas magnas (VSMs e parvas (VSPs em homens, correlacionando esses dados com a apresentação clínica conforme a classificação Clínica, Etiológica, Anatômica e Fisiopatológica (CEAP. Métodos Foram avaliados 369 membros inferiores de 207 homens pela ultrassonografia vascular (UV com diagnóstico clínico de IVCr primária. As variáveis analisadas foram a classificação CEAP, o padrão de refluxo nas VSMs e VSPs e a correlação entre os dois. Resultados Nos 369 membros avaliados, 72,9% das VSMs apresentaram refluxo com predominância do padrão segmentar (33,8%. Nas VSPs, 16% dos membros inferiores analisados apresentaram refluxo, sendo o mais frequente o padrão distal (33,9%. Dos membros classificados como C4, C5 e C6, 100% apresentaram refluxo na VSM com predominância do refluxo proximal (25,64%, e 38,46% apresentaram refluxo na VSP com equivalência entre os padrões distal e proximal (33,3%. Refluxo na junção safeno-femoral (JSF foi detectado em 7,1% dos membros nas classes C0 e C1, 35,6% nas classes C2 e C3, e 64,1% nas classes C4 a C6. Conclusões O padrão de refluxo segmentar é predominante na VSM, e o padrão de refluxo distal é predominante na VSP. A ocorrência de refluxo na JSF é maior em pacientes com IVCr mais avançada.

A enfermagem no manejo da dor em pessoas com úlcera venosa: revisão integrativa Nursing in the management of pain in people with venous ulcer: integrative review

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Samilly Márjore Dantas Liberato

2016-04-01

Full Text Available Objetivo: sintetizar o conhecimento produzido sobre as intervenções utilizadas para o manejo da dor em pessoas com úlcera venosa. Métodos: revisão integrativa da literatura realizada em junho de 2013 nas bases de dados PubMed, CINAHL, ISI Web of Knowledge, SCOPUS, The Cochrane Library e LILACS. Para o levantamento das publicações foram utilizados descritores do vocabulário MeSH – Medical Subject Headings: “Venous ulcers”; “Pain Management” e “Nursing”.  Resultados: foram selecionados sete artigos e estes apresentaram intervenções do tipo farmacológicas - curativos contendo ibuprofeno, técnicas como musicoterapia, aromoterapia e laserterapia e participação em grupos de apoio. Conclusão: concluiu-se que existe um déficit de estudos sobre o manejo da dor, contudo sugere-se a implementação das atividades de intervenção encontradas para realização de uma assistência eficaz e holística.

Pessoas com úlceras venosas: estudo do modo psicossocial do modelo adaptativo de Roy Personas con úlceras venosas: estudio de los aspectos psicosociales del modelo de adaptación de Roy People with venous ulcers: a study of the psychosocial aspects of the adaptive model of Roy

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Isabelle Katherinne Fernandes Costa

2011-09-01

Full Text Available Estudo transversal, descritivo, quantitativo, realizado com 50 pessoas com úlcera venosa (UV em um Hospital Universitário, que objetivou verificar o nível de adaptação psicossocial do Modelo de Roy das pessoas com UV. A pesquisa foi aprovada pelo Comitê de Ética da instituição. Os dados foram coletados com formulário estruturado e após a organização dos dados das alterações ocorridas na vida das pessoas com UV classificamos segundo o modo psicossocial de Roy. Verificamos que no modo autoconceito, 36% sentiam-se insatisfeitos com aparência física, 18% apresentavam sentimentos negativos; no modo desempenho de papéis: alteração no papel laboral (52,0%, atividades domésticas (34,0%, conjugal (6,0%, restrições de lazer, dor, social, escolar e locomoção (82,0%; no modo de interdependência: apoio no tratamento (82,0%, discriminação (58,0%. A identificação do modo psicossocial direciona as ações de enfermagem abrangendo a pessoa que recebe o cuidado considerando-a no todo em suas relações com ambiente promovendo melhor nível de adaptação.Estudio transversal, descriptivo, cuantitativo realizado con 50 personas con úlcera venosa (UV en el Hospital Universitario que objetivó conocer nivel de adaptación psicosocial del modelo de Roy de las personas con UV. Estudio aprobado por el Comité de Ética (nº 279/09. Los datos fueron recogidos mediante formulario y después de organizar los datos de los cambios en la vida de las personas con UV, fueron clasificados de acuerdo con los aspectos psicosociales de Roy. Verificamos en el modo de auto-concepto: 36% insatisfacción con apariencia física, 18% sentimientos negativos, desempeño de papel: cambio en el papel de trabajo (52,0%, tareas domésticas (34,0%, estado civil (6,0%, restricción de ocio, dolor, sociales, educativos y transporte (82,0%; modo de interdependencia: apoyo en el tratamiento (82,0%, discriminación (58,0%. La identificación de aspectos psicosociales

Diagnóstico diferencial de trombose aortoilíaca e mieloencefalite protozoária equina: relato de caso Differential diagnosis between aorto-iliac thrombosis and equine protozoal myeloencephalitis: case report

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P.B. Escodro

2010-10-01

Full Text Available Relata-se o caso de uma égua de atividade de polo, que apresentou inicialmente claudicação leve no membro posterior esquerdo, a qual evoluiu para ataxia e atrofia da musculatura glútea do lado esquerdo, com diagnóstico de trombose aortoilíaca (TAI. A paciente foi tratada com suspeita de mieloencefalite protozoária equina, devido à semelhança dos sinais clínicos com essa doença, porém o líquido cefalorraquidiano apresentou-se negativo para anticorpos anti-Sarcocystis neurona. A palpação transretal indicou uma massa na bifurcação aortoilíaca esquerda. Na avaliação ultrassonográfica, visualizou-se imagem hiperecoica aderida ao endotélio vascular, sugerindo TAI atingindo a estenose de 70% da luz arterial.The case of a mare used for polo is reported. The animal showed clinical signs of soft lameness of the hindlimb, evolving to ataxia and gluteal muscle atrophy, with aorto-iliac thrombosis (AIT. The patient was treated with the suspect of equine protozoal myeloencephalitis (EPM, due to the resemblance of clinical signs. Cerebrospinal fluid analysis was negative for antibodies against Sarcocystis neurona. The transrectal examination indicated a mass in the left aorto-iliac bifurcation. In the ultrasonographic evaluation, a hyperechoic image adhered to the vascular endothelium was observed, suggesting (AIT, occupying 70% of arterial lumen. The present article has the objective of pointing out the importance of the differential diagnosis between AIT and EPM in horses with ataxia in hindlimbs and muscular atrophy.

Indocyanine green videoangiography "in negative": definition and usefulness in spinal dural arteriovenous fistulae.

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Simal Julián, Juan Antonio; Miranda Lloret, Pablo; López González, Antonio; Evangelista Zamora, Rocío; Botella Asunción, Carlos

2013-05-01

Indocyanine green videoangiography (IGV) has proven its effectiveness in the field of exovascular neurosurgery, both in the intracranial and spinal compartment, but is necessary to define a systematic process for the performance of the IGV to facilitate its interpretation during the procedure. We have defined and applied the concept of videoangiography "in negative" (INIGV) to spinal dural arteriovenous fistulae (dAVF) for the detection and treatment of arteriovenous shunts, so called because the first phase is performed with the vessel suggestive of being pathological occluded. A Pentero-operating microscope with near-infrared IGV-integrated system (Carl Zeiss Co., Germany) was used. At our institution, 24 patients were treated for a spinal dAVF between 1995 and 2011, only in the last 4 cases, INIGV was performed. We describe the IGV in negative procedure and show the most illustrative cases. In all cases, the fistula occlusion was confirmed by postoperative selective digital subtraction angiography (DSA). INIGV demonstrate its capacity in detecting vessels not actually arterialized that should be respected and avoid some of the main limitations of the conventional IGV. This is a technical description about an Indocyanine green (ICG) videoangiographic procedure modification that is superior to merely performing ICG before and after clipping of a dAVF. The INIGV results are rapid and easy to interpret procedure and provide great advantages to the dAVF treatment. Nevertheless, further studies are needed with a larger sample size to determine if INIGV may reduce the need to perform immediate postoperative DSA.

Acroangiodermatite (pseudossarcoma de Kaposi: uma condição raramente reconhecida. Um caso na planta do pé associado a insuficiência venosa crônica Acroangiodermatitis (pseudo-Kaposi sarcoma: a rarely-recognized condition. A case on the plantar aspect of the foot associated with chronic venous insufficiency

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Maria Inês Fernandes Pimentel

2011-08-01

Full Text Available A acroangiodermatite ou pseudossarcoma de Kaposi é entidade angioproliferativa incomum relacionada a insuficiência venosa crônica, fístulas arteriovenosas, membros paralisados, cotos de amputação, síndromes vasculares e condições trombóticas. Apresenta-se, em geral, como máculas, pápulas ou placas purpúricas no dorso dos pés (especialmente hálux e maléolos. Relatamos um caso de acroangiodermatite afetando a região plantar, por dois anos sem diagnóstico, para o qual a coloração histológica por hematoxilina-eosina e a marcação imuno-histoquímica com CD34 foram decisivas. A paciente tinha insuficiência venosa crônica e a lesão respondeu bem ao uso de bandagens elásticas e repouso com a perna elevadaAcroangiodermatitis, often known as pseudo-Kaposi sarcoma, is an uncommon angioproliferative entity related to chronic venous insufficiency, arteriovenous fistulae, paralysed limbs, amputation stumps, vascular syndromes and conditions associated with thrombosis. It presents most frequently as purple macules, papules or plaques in the dorsal aspects of the feet, especially the toes, and the malleoli. We report a case of acroangiodermatitis in the plantar aspect of the foot, misdiagnosed for two years, in which haematoxylin-eosin hystopathological stain and immunolabeling with CD34 histochemistry examination were decisive for diagnosis. Patient had chronic venous insufficiency. The lesion responded well to the treatment with a combination of leg elevation and compression

Expenditure survey on continued veno-venous hemodialysis procedure in the intensive care unit Levantamiento del costo del procedimiento de hemodiálisis vena-venosa continua en unidades de terapia intensiva Levantamento do custo do procedimento de hemodiálise veno-venosa contínua em unidades de terapia intensiva

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Lígia Maria dal Secco

2007-12-01

Full Text Available This study aimed to characterize patients submitted to dialytic treatment with CVVHD in ICUs; monitor procedure time duration; estimate nurses' labor wages and; estimate the direct procedures mean costs. The study was developed in a public teaching hospital located in São Paulo, Brazil. A total of 93 procedures performed in 50 patients composed the sample. The results showed the predominance of male patients (62%; mean age was 60.8 years old; ICU hospitalization time was 19.2 days; 86% of the patients died; 76% of the patients presented acute renal insufficiency and, mean procedure time per patient was 1.9. The mean procedure duration was 26.6 hours. The mean cost of nurses' wages were R$ 592.04 which represented 28.7% of the total cost. The mean total expenditure was R$ 2,065.36 ranging from R$ 733.65 to R$ 6,994.18.El objetivo de este estudio fue identificar características sócio-demográficas de los pacientes sometidos al tratamiento de Hemodiálisis Vena-Venosa Continua (CVVHD en Unidades de Terapia Intensiva (UTIs; identificar el tiempo de duración de los procedimientos; calcular el costo del tiempo de los enfermeros y evaluar el costo promedio directo de los procedimentos. El estudio fue realizado en un hospital escuela público en la ciudad de São Paulo. La muestra fue constituida por 93 procedimientos realizados en 50 pacientes. Los resultados mostraron la predominancia del sexo masculino (62%; la edad promedia fue de 60,8 años; el tiempo promedio de permanencia en la UTI fue de 19,2 días; el 86% evolucionó a óbito y el promedio del número de los procedimientos por paciente fue de 1,9 días. La insuficiencia renal aguda (IRA está presente en el 76% de los pacientes. La duración promedia fue de 26,6 horas. El costo del tiempo del enfermero fue en promedio R$ 592,04 y representó el 28,7% del costo total. El costo total promedio del procedimiento fue de R$ 2.065,36, con variación de R$ 733,65 a R$ 6.994,18.Os objetivos deste

Brain herniations into the dural venous sinus or calvarium: MRI findings, possible causes and clinical significance

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Battal, Bilal; Hamcan, Salih; Akgun, Veysel; Sari, Sebahattin; Tasar, Mustafa [Gulhane Military Medical School, Department of Radiology, Ankara (Turkey); Oz, Oguzhan [Gulhane Military Medical School, Department of Neurology, Ankara (Turkey); Castillo, Mauricio [University of North Carolina School of Medicine, Division of Neuroradiology, Department of Radiology, Chapel Hill, NC (United States)

2016-06-15

To determine frequency, imaging features and clinical significance of herniations of brain parenchyma into dural venous sinuses (DVS) and/or calvarium found on MRI. A total of 6160 brain MRI examinations containing at least one high-resolution T1- or T2-weighted sequence were retrospectively evaluated to determine the presence of incidental brain herniations into the DVS or calvarium. MRI sequences available for review were evaluated according to their capability to demonstrate these herniations. Patients' symptoms and clinical findings were recorded. Twenty-one (0.32 %) brain parenchyma herniations into the DVS (n = 18) or calvarium (n = 3) in 20 patients were detected. The most common locations of the herniations were the transverse sinuses (n = 13) and those involving inferior gyrus of the temporal lobe (n = 9). High-resolution T1- and T2-weighted sequences were equally useful in the detection of these brain herniations. According to clinical symptoms, brain herniations were considered to be incidental but headaches were present in nine patients. Brain herniations with surrounding cerebrospinal fluid (CSF) into the DVS and/or calvarium are incidental findings and not proven to be associated with any symptoms. Although rare, these herniations are more common than previously recognized and should not be confused with arachnoid granulations, clots or tumours. (orig.)

Determining the Level of the Dural Sac Tip: Magnetic Resonance Imaging in an Adult Population

International Nuclear Information System (INIS)

Binokay, F.; Akgul, E.; Bicakci, K.; Soyupak, S.; Aksungur, E.; Sertdemir, Y.

2006-01-01

Purpose: To determine the variation in the location of the dural sac (DS) in a living adult population and to correlate this position with age and sex. Material and Methods: T2-weighted, midline, sagittal, spin-echo magnetic resonance imaging (MRI) studies of 743 patients were assessed to identify the tip of the DS. This location was recorded in relation to the upper, middle, or lower third of the adjacent vertebral body or the adjacent intervertebral disk. Results: Frequency distribution for levels of termination of the DS on MRI demonstrated that the end of the DS was usually located at the upper one-third of S2 (25.2%). The mean level in females was also the upper one-third of S2 (26.5%) and in males the lower one-third of S2 (24.1%). The overall mean DS position was mostly at the upper one-third of S2. No significant differences in DS position were seen between male and female patients or with increasing age. Conclusion: It is important to know the possible range for the termination level of the DS when performing caudal anesthesia and craniospinal irradiation in some clinical situations. The distribution of DS location in a large adult population was shown to range from the L5-S1 intervertebral disk to the upper third of S3 vertebrae

Endovascular management of dural arteriovenous fistulas of the transverse and sigmoid sinus in 150 patients

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Kirsch, M [Ernst-Moritz-Arndt-Universitaet Greifswald, Institut fuer Diagnostische Radiologie und Neuroradiologie, Greifswald (Germany); Liebig, T [TU Muenchen, Institut fuer Neuroradiologie, Klinikum Rechts der Isar, Munich (Germany); Kuehne, D [Klinik fuer Radiologie und Neuroradiologie, Alfried-Krupp-Krankenhaus, Essen (Germany); Henkes, H [Katharinenhospital-Klinikum Stuttgart, Klinik fuer Neuroradiologie, Stuttgart (Germany)

2009-07-15

This study aimed to evaluate the safety and efficiency of the endovascular treatment of transverse-sigmoid sinus dural arteriovenous fistulas (TS{sub d}AVF). A total of 150 consecutive patients and 348 procedures were evaluated. Pulsatile tinnitus (81%), headache (15%), and intracranial hemorrhage (10%) were the most frequent manifestations of the TS{sub d}AVFs. More than half of the affected sinuses were partially or completely thrombosed. Access-wise treatment was performed transarterial (n = 33), transvenous (n = 21), or a combination thereof (n = 96). A mean of 2.4 procedures per patient was required. Immediate postprocedural occlusion rate after transarterial embolization was 30% only. Transvenous treatment alone resulted in an early occlusion rate of 81%, with delayed complete obliteration of half of the remaining fistulas. After combined transarterial/transvenous treatment, the angiographic cure rate was 54%. At follow-up, 88% of patients with residual shunt after the treatment showed complete occlusion. The cumulative complication rate was 9% (n = 13), with minor adverse events in ten patients (7%) and major complications in three patients (2%). Transvenous coil occlusion of the sinus segment with the adjacent dAVF site, eventually combined with transarterial occlusion of supplying arteries, is a very effective and well-tolerated treatment method. In selected patients, variations of these methods (e.g., sinus stenting, compartmental sinus occlusion) can be useful. (orig.)

Endovascular management of dural arteriovenous fistulas of the transverse and sigmoid sinus in 150 patients

International Nuclear Information System (INIS)

Kirsch, M.; Liebig, T.; Kuehne, D.; Henkes, H.

2009-01-01

This study aimed to evaluate the safety and efficiency of the endovascular treatment of transverse-sigmoid sinus dural arteriovenous fistulas (TS d AVF). A total of 150 consecutive patients and 348 procedures were evaluated. Pulsatile tinnitus (81%), headache (15%), and intracranial hemorrhage (10%) were the most frequent manifestations of the TS d AVFs. More than half of the affected sinuses were partially or completely thrombosed. Access-wise treatment was performed transarterial (n = 33), transvenous (n = 21), or a combination thereof (n = 96). A mean of 2.4 procedures per patient was required. Immediate postprocedural occlusion rate after transarterial embolization was 30% only. Transvenous treatment alone resulted in an early occlusion rate of 81%, with delayed complete obliteration of half of the remaining fistulas. After combined transarterial/transvenous treatment, the angiographic cure rate was 54%. At follow-up, 88% of patients with residual shunt after the treatment showed complete occlusion. The cumulative complication rate was 9% (n = 13), with minor adverse events in ten patients (7%) and major complications in three patients (2%). Transvenous coil occlusion of the sinus segment with the adjacent dAVF site, eventually combined with transarterial occlusion of supplying arteries, is a very effective and well-tolerated treatment method. In selected patients, variations of these methods (e.g., sinus stenting, compartmental sinus occlusion) can be useful. (orig.)

[Feasibility and efficiency of embolization of spinal dural arteriovenous fistula].

Science.gov (United States)

Zhang, Hong-qi; Liu, Jiang; Wang, Jian-sheng; Zhi, Xing-long; Zhang, Peng; Bian, Li-song; He, Chuan; Ye, Ming; Wang, Zhi-chao; Li, Meng; Ling, Feng

2013-03-01

To evaluate the feasibility and efficiency of embolization of spinal dural arteriovenous fistula (SDAVF). From December 2010 to May 2012, there were 104 cases of SDAVF were treated, and 26 cases were selected to be treated with embolization. The inclusion criteria was as follows: (1) No anterior or posterior spinal artery originated from the fistula segment; (2) The segmental artery can be catheterized with guiding or micro catheter; (3) High flow in fistula; (4) Patient's situation was not suitable for surgery or general anesthesia. Among 26 cases, there were 22 male and 4 female patients, the average age was 55.9 years (ranged from 34 to 81 years). The locations of SDAVF were 10 cases in thoracic, 9 in lumbar and 7 in sacral segment. The main symptoms were progressive numbness and weakness in both lower extremities, most cases accompanied with difficulties in urination and defecation. The average history was 17.1 months (from 1 to 156 months). ONYX-18 liquid embolic agent or Glubran-2 surgical glue were used as embolic material. The patients not cured with embolization were treated with surgery in the following 1 - 2 weeks. Follow-up evaluation was done with MRI after 3 months and DSA after 6 months, besides physical examination. Fifteen from 26 cases achieved immediate angiographic cure results: 14 in 20 cases which embolized with ONYX-18; only 1 in 6 cases with Glubran-2. Three in 10 cases of thoracic SDAVF and 12 in 16 cases of lumbar/sacral SDAVF were cured with embolization. Partially embolized cases were treated with surgical obliteration of drainage veins within 2 weeks. Cured patients experienced immediate improvement after embolization and kept getting better in the follow-up. All the patients had MRI follow-up after 3 months and DSA follow-up after 6 months. In 6 month's follow-up, MRI showed the edema and flow void signal in the spinal cord disappeared. DSA showed no fistula recurrence or remnant. There was no deterioration case in all of the embolized

Diagnosis of spinal dural arteriovenous fistula using 3D T2-weighted imaging

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Kralik, Stephen F.; Murph, Daniel; Mehta, Peter; O' Neill, Darren P. [Indiana University School of Medicine, Department of Radiology and Imaging Sciences, Indianapolis, IN (United States)

2017-10-15

To evaluate spinal MRIs without and with 3D T2W imaging among patients without and with spinal dural arteriovenous fistula (SDAVF) confirmed by spinal digital subtraction angiography (DSA). A retrospective case-control study was performed among patients without and with SDAVF who had both spinal MRIs and gold standard spinal DSA. Two neuroradiologists independently reviewed spinal MRIs that were performed with either sagittal T2W turbo spin echo (2D group) or sagittal 3D T2W sampling perfection with application-optimized contrasts using different flip-angle evolutions (SPACE) (3D group) and documented the presence or absence of SDAVF. Using spinal DSA diagnosis as a gold standard, the sensitivity, specificity, and interobserver agreement for the 2D-group and 3D-group MRI diagnosis were calculated. The 2D group consisted of 21 patients and the 3D group consisted of 16 patients. For both radiologists, the 2D group demonstrated a sensitivity of 100% and specificity of 100%. Interobserver agreement in the 2D group was perfect (k = 1.0). For both radiologists, the 3D group demonstrated sensitivity of 100.0% and specificity of 92.3%. Interobserver agreement in the 3D group was perfect (k = 1.0). While flow voids were considered more conspicuous, spinal cord signal abnormality was considered less conspicuous with 3D T2W SPACE compared with conventional 2D STIR sequence. 3D T2W SPACE should be used in conjunction with 2D T2W sequences to more accurately detect abnormal cord signal and determine when perimedullary flow voids are pathologically abnormal for the radiologic diagnosis of SDAVF. (orig.)

Posterior reversible encephalopathy syndrome following an inadvertent dural puncture during an emergency laparotomy for ischemic colitis – a case report

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Shah R

2014-01-01

Full Text Available Reena Shah, Agnieszka Kubisz-Pudelko, Jeremy Reid Yeovil District Hospital, Yeovil, UK Abstract: Posterior reversible encephalopathy syndrome (PRES is a clinico-neuroradiological syndrome characterized by various symptoms of neurological disease. It has commonly been reported in association with acute hypertension, pre-eclampsia, eclampsia, sepsis, and exposure to immunosuppressants. Here, we report on a normotensive woman who developed a severe frontal headache, visual disturbances, and hypertension 3 days after undergoing an emergency laparotomy for ischemic colitis during which she suffered an inadvertent dural puncture. Neuro-imaging revealed features consistent with PRES. The patient went on to make a good recovery, being discharged 21 days postoperatively, with only minor visual disturbances and memory problems. This case highlights the importance of awareness of PRES to all specialties. On reviewing the literature, we feel that PRES may be a potential differential diagnosis to post-procedural neurological symptoms in those patients undergoing routine procedures such as spinal anesthetics or lumbar punctures. Keywords: PRES, neurological disease, lumbar puncture, spinal anesthetic

Predictability of the future development of aggressive behavior of cranial dural arteriovenous fistulas based on decision tree analysis.

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Satomi, Junichiro; Ghaibeh, A Ammar; Moriguchi, Hiroki; Nagahiro, Shinji

2015-07-01

The severity of clinical signs and symptoms of cranial dural arteriovenous fistulas (DAVFs) are well correlated with their pattern of venous drainage. Although the presence of cortical venous drainage can be considered a potential predictor of aggressive DAVF behaviors, such as intracranial hemorrhage or progressive neurological deficits due to venous congestion, accurate statistical analyses are currently not available. Using a decision tree data mining method, the authors aimed at clarifying the predictability of the future development of aggressive behaviors of DAVF and at identifying the main causative factors. Of 266 DAVF patients, 89 were eligible for analysis. Under observational management, 51 patients presented with intracranial hemorrhage/infarction during the follow-up period. The authors created a decision tree able to assess the risk for the development of aggressive DAVF behavior. Evaluated by 10-fold cross-validation, the decision tree's accuracy, sensitivity, and specificity were 85.28%, 88.33%, and 80.83%, respectively. The tree shows that the main factor in symptomatic patients was the presence of cortical venous drainage. In its absence, the lesion location determined the risk of a DAVF developing aggressive behavior. Decision tree analysis accurately predicts the future development of aggressive DAVF behavior.

Cranial Nerve Dysfunction Associated with Cavernous Dural Arteriovenous Fistulas After Transvenous Embolization with Onyx

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Li, Chuanhui; Wang, Yang; Li, Youxiang; Jiang, Chuhan; Wu, Zhongxue; Yang, Xinjian, E-mail: yang-xj@163.net [Capital Medical University, Beijing Neurosurgical Institute and Beijing Tiantan Hospital (China)

2015-10-15

PurposeCranial nerve dysfunction (CND) is not uncommon in patients with cavernous dural arteriovenous fistulas (cDAVFs), and may represent an initial manifestation or a complication after endovascular treatment. This study evaluated the outcome of CND associated with cDAVFs after transvenous embolization (TVE) using Onyx.Materials and MethodsForty-one patients with cDAVFs were treated with TVE in our department between April 2009 and October 2013. For each patient, clinical and radiologic records were retrospectively reviewed and evaluated, with an emphasis placed on evaluating the outcomes of the pre-existing cDAVF-induced CND and the TVE-induced CND.ResultsOf the 41 cases, 25 had a history of preoperative CND. Postoperatively, gradual remission to complete recovery (CR) within 8 months was observed in 17 of these cases, transient aggravation in 7, and significant improvement to be better than preoperative function but no CR in 1. All aggravation of CND occurred immediately or within 1 day after TVE and resolved completely within 5 months. Nine patients developed new CND after TVE. New CND occurred during the perioperative period in 8 cases, but all cases resolved completely within 15 days–6 months. Delayed CND was observed in 3 cases with a time lag of 3–25 months after TVE. Two of these completely resolved within 20 days–1 month and the remaining case significantly improved.ConclusionBoth the pre-existing cDAVF-induced CND and the TVE-induced new or aggravated CND completely resolved in almost all cases after embolization with Onyx.

Characteristics, diagnosis and treatment of hypoglossal canal dural arteriovenous fistula: report of nine cases

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Manabe, Shinji; Satoh, Koichi; Matsubara, Shunji; Satomi, Junichiro; Hanaoka, Mami; Nagahiro, Shinji [University of Tokushima, Department of Neurosurgery, Tokushima (Japan)

2008-08-15

We report the characteristics, diagnosis and treatment of dural arteriovenous fistula (DAVF) of the hypoglossal canal in nine patients with this relatively rare vascular disorder. Of 248 patients with intracranial DAVFs managed at our institution, nine patients (3.6%; four men, five women; mean age 62 years) were diagnosed with hypoglossal canal DAVF. We investigated patient characteristics with respect to clinical symptoms, neuroradiological findings, efficacy and complications related to endovascular treatment. Seven patients had experienced head injury. All patients presented with pulsatile tinnitus. One patient displayed ipsilateral hypoglossal nerve palsy before treatment. MR angiography showed a 'magic wand' appearance between the affected hypoglossal canal and the internal jugular vein in four patients. Angiography demonstrated an AV fistula on the medial aspect of the superior jugular bulb, mostly arising from the bilateral occipital, ascending pharyngeal and vertebral arteries with drainage to the internal jugular vein via the anterior condylar vein. Contralateral carotid injection accurately clarified the shunting point. Five patients underwent endovascular treatment: transarterial embolization (TAE; n=2), transvenous embolization (TVE; n=2), and TAE/TVE (n=1). Complete shunt obliteration was achieved in four patients and shunt reduction in one. The remaining four patients were treated conservatively and the shunt had disappeared at follow-up. Postoperative hypoglossal nerve palsy occurred in one patient after TVE, possibly due to coil overpacking. The incidence of hypoglossal canal DAVF was not very low in our series. Contralateral carotid injection is an essential examination to provide an accurate diagnosis. TVE should be considered when access is available, although TAE is also appropriate for shunt reduction. (orig.)

Characteristics, diagnosis and treatment of hypoglossal canal dural arteriovenous fistula: report of nine cases

International Nuclear Information System (INIS)

Manabe, Shinji; Satoh, Koichi; Matsubara, Shunji; Satomi, Junichiro; Hanaoka, Mami; Nagahiro, Shinji

2008-01-01

We report the characteristics, diagnosis and treatment of dural arteriovenous fistula (DAVF) of the hypoglossal canal in nine patients with this relatively rare vascular disorder. Of 248 patients with intracranial DAVFs managed at our institution, nine patients (3.6%; four men, five women; mean age 62 years) were diagnosed with hypoglossal canal DAVF. We investigated patient characteristics with respect to clinical symptoms, neuroradiological findings, efficacy and complications related to endovascular treatment. Seven patients had experienced head injury. All patients presented with pulsatile tinnitus. One patient displayed ipsilateral hypoglossal nerve palsy before treatment. MR angiography showed a ''magic wand'' appearance between the affected hypoglossal canal and the internal jugular vein in four patients. Angiography demonstrated an AV fistula on the medial aspect of the superior jugular bulb, mostly arising from the bilateral occipital, ascending pharyngeal and vertebral arteries with drainage to the internal jugular vein via the anterior condylar vein. Contralateral carotid injection accurately clarified the shunting point. Five patients underwent endovascular treatment: transarterial embolization (TAE; n=2), transvenous embolization (TVE; n=2), and TAE/TVE (n=1). Complete shunt obliteration was achieved in four patients and shunt reduction in one. The remaining four patients were treated conservatively and the shunt had disappeared at follow-up. Postoperative hypoglossal nerve palsy occurred in one patient after TVE, possibly due to coil overpacking. The incidence of hypoglossal canal DAVF was not very low in our series. Contralateral carotid injection is an essential examination to provide an accurate diagnosis. TVE should be considered when access is available, although TAE is also appropriate for shunt reduction. (orig.)

Reconstructive treatment of dural arteriovenous fistulas of the transverse and sigmoid sinus: transvenous angioplasty and stent deployment

International Nuclear Information System (INIS)

Liebig, T.; Henkes, H.; Brew, S.; Miloslavski, E.; Kuehne, D.; Kirsch, M.

2005-01-01

Various techniques for the endovascular treatment of dural arteriovenous fistulas (dAVFs) of the transverse and sigmoid sinus have recently evolved. Transvenous coil occlusion of the involved segment and transarterial embolization of the feeding arteries with liquid agents are the commonest treatments utilized. However, with respect to venous hypertension as the probable pathogenic cause of this disorder, a nonocclusive or remodeling technique might be preferable. We will present a series involving four patients, treated with transvenous angioplasty and stent deployment as a definitive treatment of dAVFs of the transverse and sigmoid sinus. This method was used as a primary treatment or as an adjunct to previous noncurative transarterial n-butyl cyanoacrylate and particle embolization. In three of the four cases, complete occlusion of the fistula was achieved with confirmation of occlusion seen on follow-up angiographical studies. In one case a negligible and nonsymptomatic remnant of the fistula fed by the tentorial artery was left untreated. From our experience, we conclude that transvenous stent deployment is an alternative to traditional concepts. Additionally, the pathological theory of dAVFs in this region located in venous pouches of the sinus wall is supported by the fact that they can be occluded by mechanical compression during angioplasty and subsequently maintained by a stent. (orig.)

Biological parameters and feeding behaviour of invasive whelk Rapana venosa Valenciennes, 1846 in the south-eastern Black Sea of Turkey

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Hacer Saglam

2014-06-01

Full Text Available Objective: To determine length-weight relationships, growth type and feeding behavior of the benthic predator Rapa whelk at the coast of Camburnu, south-eastern Black Sea. Methods: Rapa whelk was monthly collected by dredge sampling on the south-eastern Black Sea at 20 m depth. The relationships between morphometric parameters of Rapa whelk were described by linear and exponential models. The allometric growth of each variable relative to shell length (SL was calculated from the function Y=aSLb or logY=loga+blogSL. The functional regression b values were tested by t-test at the 0.05 significance level if it was significantly different from isometric growth. The total time spent on feeding either on mussel tissue or live mussels was recorded for each individual under controlled conditions in laboratory. Results: The length-weight relationships showed positive allometric growth and no inter-sex variability. Body size in the male population was significantly higher than in the individuals of the female. All characters in males and females showed a trend towards allometry rather than isometry. While the total time spent feeding increased with increasing prey size the total time that Rapana venosa spent feeding decreased with increasing Rapa whelk size. The total average feeding time needed by Rapa whelks was 160 min. But they took 310 min on live mussels in 27-28 °C in the laboratory conditions. Conclusions: Length and weight relationships, growth type, total time spent feeding of this species were explained in details for this region. It would be useful to sustainable management in the south-eastern Black Sea of Turkey. The results about the feeding behaviour of this species will contribute to the understanding of the role of this species within the ecosystem.

Hemoglobinúria paroxística noturna: da fisiopatologia ao tratamento Paroxysmal nocturnal hemoglobinuria: from physiopathology to treatment

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Martha Mariana de Almeida Santos Arruda

2010-01-01

Full Text Available Hemoglobinúria paroxística noturna (HPN é uma anemia hemolítica crônica adquirida rara, de curso clínico extremamente variável. Apresenta-se frequentemente com infecções recorrentes, neutropenia e trombocitopenia, e surge em associação com outras doenças hematológicas, especialmente com síndromes de falência medular, como anemia aplásica e síndrome mielodisplásica. É considerada ainda um tipo de trombofilia adquirida, apresentando-se com tromboses venosas variadas, com especial predileção por trombose de veias hepáticas e intra-abdominais, sua maior causa de mortalidade. A tríade anemia hemolítica, pancitopenia e trombose faz da HPN uma síndrome clínica única, que deixou de ser encarada como simples anemia hemolítica adquirida para ser considerada um defeito mutacional clonal da célula-tronco hematopoética (CTH. A mutação ocorre no gene da fosfaditilinositolglicana classe-A, e resulta no bloqueio precoce da síntese de âncoras de glicosilfosfaditilinositol (GPI, responsáveis por manter aderidas à membrana plasmática dezenas de proteínas com funções específicas. A falência em sintetizar GPI madura gera redução de todas as proteínas de superfície normalmente ancoradas por ela. Dentre elas estão o CD55 e o CD59, que controlam a ativação da cascata do complemento. Assim, na HPN há aumento da susceptibilidade de eritrócitos ao complemento, gerando hemólise. Revisa-se aqui sua fisiopatologia, curso clínico, os tratamentos disponíveis com ênfase para o transplante de células-tronco hematopoéticas alogênicas e para o eculizumab, um anticorpo monoclonal humanizado que bloqueia a ativação do complemento terminal no nível C5 e previne a formação do complexo de ataque à membrana, a primeira droga a demonstrar eficácia no tratamento da HPN.Paroxysmal nocturnal hemoglobinuria (PNH is a rare disorder, an acquired chronic hemolytic anemia, often associated with recurrent nocturnal exacerbations

Lesión cerebral hipóxico-isquémica secundaria a parada cardiaca en un lesionado medular agudo

OpenAIRE

Francisco Ramón Pampín-Huerta; Beatriz Muíño-Vidal; Antonio Montoto-Marqués; Sebastián Salvador-de la Barrera; María Elena Ferreiro-Velasco; Antonio Rodríguez-Sotillo

2016-01-01

Resumen. La lesión medular es un factor de riesgo importante para la enfermedad tromboembólica venosa, entidad que engloba la trombosis venosa profunda y el tromboembolismo pulmonar, siendo este una causa potencialmente reversible de parada cardíaca. Presentamos el caso de un varón joven con lesión medular completa (grado ASIA A) con nivel C6 que sufre una parada cardíaca por tromboembolismo pulmonar masivo secundario a trombosis venosa profunda en extremidad inferior izquierda en la 6...

Avaliação das pressões venosa e arterial em cães submetidos a diferentes tipos de hipotensão Evaluation of venous and arterial blood pressures in dogs submitted to hypotension

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R.C. Rabelo

2005-12-01

Full Text Available Estabeleceram-se a pressão venosa periférica (PVP, a pressão venosa central (PVC, a pressão arterial invasiva (PAI e a pressão arterial não invasiva (PANI em cães após diferentes eventos de hipotensão. Foram utilizados 15 cães adultos, distribuídos aleatoriamente em três grupos (G com cinco animais cada, submetidos aos seguintes eventos hipotensores: GI - cloridrato de xilazina a 2%, GII - choque hipovolêmico agudo e GIII - veneno da serpente Bothrops moojeni. Os animais, avaliados durante 30 minutos após o início do evento hipotensor, foram tratados com cloridrato de ioimbina (GI, amido hidroxietílico a 6% (GII e cetoprofeno (GIII e reavaliados por mais 30 minutos. Somente os animais do GII apresentaram redução da PVP após o evento hipotensor e aumento, 25 minutos após tratamento. Os cães dos grupos II e III mostraram redução da PVC após o evento hipotensor, e somente os animais do GII exibiram discreto aumento cinco minutos imediatamente após o tratamento. Houve diminuição da PAI e PANI nos dos grupos II e III após o evento hipotensor, com recuperação gradativa imediata, após o tratamento, somente da PAI.The peripheral venous pressure (PVP, the central venous pressure (CVP, the invasive (IAP and non-invasive blood pressure (NIAP in dogs submitted to different hypotensive events were studied. Fifteen adult mongrel dogs were randomly divided in three groups with five animals each, and submitted to hypotensive event as follow: GI - xylazine chloride 2%, GII - acute hypovolemic shock and GIII - snake venom (Bothrops moojeni. All animals were evaluated for 30 minutes after starting hypotensive event, treated with yoimbine chloride (GI, colloid hetastarch 6% (GII and ketoprofen (GIII and reevaluated for more 30 minutes. Only the group II dogs showed PVP decrease after hypotensive event, and increase 25 minutes after treatment. In animals of groups II and III, the CVP decreased after hypotensive event and only in GII

Long-term outcome of a multidisciplinary concept of spinal dural arteriovenous fistulae treatment

International Nuclear Information System (INIS)

Sherif, Camillo; Gruber, Andreas; Bavinzski, Gerhard; Standhardt, Harald; Widhalm, Georg; Knosp, Engelbert; Gibson, Daniel; Richling, Bernd

2008-01-01

The optimal treatment of spinal dural arteriovenous fistulae (SDAVF) remains controversial and long-term follow-up data, especially data from multidisciplinary treatment, are rarely available. Thus, long-term outcomes following a multidisciplinary approach to the treatment of SDAVF were investigated. The investigation included 26 patients with SDAVF treated at the authors' department over a 15-year period including a follow-up of more than 2 years. The treatment strategy when occlusion of the draining vein could be achieved was to embolize the fistula with Histoacryl, with surgery reserved for those patients unsuitable for embolization. Posttreatment angiography followed by MRI was performed in all patients. Clinical follow-up was performed using the gait and micturition Aminoff-Logue scale scores and the modified Rankin scale score. Embolization was performed in 19 patients (73.1%), and direct surgery in 7 patients (26.9%). Follow-up angiography (at a mean of 21.7 months) showed occlusion of the SDAVF in 24 patients (92.3%). Of the 19 embolized patients, 2 (10.5%) developed recurrence secondary to insufficient occlusion of the SDAVF draining vein, and one of these two patients underwent re-embolization and one re-operation. No negative effects of SDAVF recurrence on the final clinical outcome were identified in either patient. MRI after angiography (at a mean of 91.5 months) demonstrated occlusion of all SDAVFs. After a mean clinical follow-up of 103.4 months there was a statistically significant improvement in both the modified Rankin scale score and the Aminoff-Logue gait scale score (P < 0.05). The present multidisciplinary study showed for the first time that embolization leads to stable neuroradiological results and favourable clinical outcomes even for very long follow-up times of more than 100 months. Microsurgery remains the treatment of choice when safe embolization of the draining vein cannot be achieved. (orig.)

A microcontroller-based simulation of dural venous sinus injury for neurosurgical training.

Science.gov (United States)

Cleary, Daniel R; Siler, Dominic A; Whitney, Nathaniel; Selden, Nathan R

2018-05-01

OBJECTIVE Surgical simulation has the potential to supplement and enhance traditional resident training. However, the high cost of equipment and limited number of available scenarios have inhibited wider integration of simulation in neurosurgical education. In this study the authors provide initial validation of a novel, low-cost simulation platform that recreates the stress of surgery using a combination of hands-on, model-based, and computer elements. Trainee skill was quantified using multiple time and performance measures. The simulation was initially validated using trainees at the start of their intern year. METHODS The simulation recreates intraoperative superior sagittal sinus injury complicated by air embolism. The simulator model consists of 2 components: a reusable base and a disposable craniotomy pack. The simulator software is flexible and modular to allow adjustments in difficulty or the creation of entirely new clinical scenarios. The reusable simulator base incorporates a powerful microcomputer and multiple sensors and actuators to provide continuous feedback to the software controller, which in turn adjusts both the screen output and physical elements of the model. The disposable craniotomy pack incorporates 3D-printed sections of model skull and brain, as well as artificial dura that incorporates a model sagittal sinus. RESULTS Twelve participants at the 2015 Western Region Society of Neurological Surgeons postgraduate year 1 resident course ("boot camp") provided informed consent and enrolled in a study testing the prototype device. Each trainee was required to successfully create a bilateral parasagittal craniotomy, repair a dural sinus tear, and recognize and correct an air embolus. Participant stress was measured using a heart rate wrist monitor. After participation, each resident completed a 13-question categorical survey. CONCLUSIONS All trainee participants experienced tachycardia during the simulation, although the point in the simulation

Characteristics, diagnosis and treatment of hypoglossal canal dural arteriovenous fistula: report of nine cases

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Manabe, Shinji; Satoh, Koichi; Matsubara, Shunji; Satomi, Junichiro; Hanaoka, Mami; Nagahiro, Shinji [University of Tokushima, Department of Neurosurgery, Tokushima (Japan)

2008-08-15

We report the characteristics, diagnosis and treatment of dural arteriovenous fistula (DAVF) of the hypoglossal canal in nine patients with this relatively rare vascular disorder. Of 248 patients with intracranial DAVFs managed at our institution, nine patients (3.6%; four men, five women; mean age 62 years) were diagnosed with hypoglossal canal DAVF. We investigated patient characteristics with respect to clinical symptoms, neuroradiological findings, efficacy and complications related to endovascular treatment. Seven patients had experienced head injury. All patients presented with pulsatile tinnitus. One patient displayed ipsilateral hypoglossal nerve palsy before treatment. MR angiography showed a 'magic wand' appearance between the affected hypoglossal canal and the internal jugular vein in four patients. Angiography demonstrated an AV fistula on the medial aspect of the superior jugular bulb, mostly arising from the bilateral occipital, ascending pharyngeal and vertebral arteries with drainage to the internal jugular vein via the anterior condylar vein. Contralateral carotid injection accurately clarified the shunting point. Five patients underwent endovascular treatment: transarterial embolization (TAE; n=2), transvenous embolization (TVE; n=2), and TAE/TVE (n=1). Complete shunt obliteration was achieved in four patients and shunt reduction in one. The remaining four patients were treated conservatively and the shunt had disappeared at follow-up. Postoperative hypoglossal nerve palsy occurred in one patient after TVE, possibly due to coil overpacking. The incidence of hypoglossal canal DAVF was not very low in our series. Contralateral carotid injection is an essential examination to provide an accurate diagnosis. TVE should be considered when access is available, although TAE is also appropriate for shunt reduction. (orig.)

KYNA analogue SZR72 modifies CFA-induced dural inflammation- regarding expression of pERK1/2 and IL-1β in the rat trigeminal ganglion

DEFF Research Database (Denmark)

Lukács, M; Warfvinge, K; Kruse, L S

2016-01-01

modify the neurogenic inflammatory response in the trigeminal ganglion. METHODS: Inflammation in the trigeminal ganglion was induced by local dural application of Complete Freunds Adjuvant (CFA). Levels of phosphorylated MAP kinase pERK1/2 and IL-1β expression in V1 region of the trigeminal ganglion were...... investigated using immunohistochemistry and Western blot. FINDINGS: Pretreatment with one dose of SZR72 abolished the CFA-induced pERK1/2 and IL-1β activation in the trigeminal ganglion. No significant change was noted in case of repeated treatment with SZR72 as compared to a single dose. CONCLUSIONS......: This is the first study that demonstrates that one dose of KYNA analog before application of CFA can give anti-inflammatory response in a model of trigeminal activation, opening a new line for further investigations regarding possible effects of KYNA derivates....

Efeitos do tratamento prévio com lidocaína, paracetamol e lidocaína-fentanil por via venosa na dor causada pela injeção de propofol: estudo comparativo Efectos del tratamiento previo con lidocaína, paracetamol y lidocaína-fentanil intravenosos en el dolor causado por la inyección de propofol: estudio comparativo Effect of pretreatment with lidocaine, intravenous paracetamol and lidocaine-fentanyl on propofol injection pain: comparative study

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Khaled M. El-Radaideh

2007-02-01

Full Text Available JUSTIFICATIVA E OBJETIVOS: Foi realizado estudo duplamente encoberto, aleatório, para avaliar a eficácia do tratamento prévio, por via venosa, com lidocaína, paracetamol (Perfalgan® ou lidocaína associada ao fentanil na redução da dor causada pela injeção de propofol. MÉTODOS: Imediatamente após a oclusão venosa com torniquete de borracha foi feita a administração venosa de 4 mL de lidocaína a 1% (Grupo L, n = 50, 4 mL de paracetamol (Perfalgan® (40 mg (Grupo R, n = 50, lidocaína a 2% associada a 100 µg de fentanil (Grupo LF, n = 50 ou 4 mL de solução fisiológica a 0,9% (Grupo P, n = 50; grupo-controle com placebo a 200 adultos. A liberação da obstrução venosa foi feita após 60 segundos, sendo seguida da administração venosa de propofol, 2,5 mg.kg-1 a uma velocidade de 0,5 mg.s-1 através de cateter 20G inserido na veia do dorso da mão. A avaliação da dor foi feita durante a injeção de propofol. Ela incluiu movimentos da mão, expressão verbal espontânea de dor, caretas e gemidos durante a injeção de propofol. RESULTADOS: Lidocaína-fentanil (70% sem dor e lidocaína (68% sem dor foram mais eficazes na redução da dor causada pela injeção de propofol do que o paracetamol (54% sem dor e o placebo (36% sem dor (p JUSTIFICATIVA Y OBJETIVOS: Se realizó estudio doblemente encubierto, aleatorio, para evaluar la eficacia del tratamiento previo, intravenoso (IV, con lidocaína, paracetamol (Perfalgan® o lidocaína asociada con fentanil en la reducción del dolor causado por la inyección de propofol. MÉTODOS: Inmediatamente después de la oclusión venosa con un torniquete de goma, se hizo la administración intravenosa de 4 mL de lidocaína a 1% (Grupo L, n = 50, 4 mL de paracetamol (Perfalgan® (40 mg (Grupo R, n = 50, lidocaína a 2% asociada con 100 µg de fentanil (Grupo LF, n = 50 o 4 mL de solución fisiológica (Grupo P, n = 50; grupo control con placebo a 200 adultos. La liberación de la obstrucci

Guía de recomendaciones para la profilaxis de la enfermedad tromboembólica venosa en adultos en la Argentina

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Fernando Javier Vázquez

2013-10-01

Full Text Available La enfermedad tromboembólica venosa (ETV en adultos posee elevada morbimortalidad y puede asociarse a complicaciones crónicas invalidantes. Sin embargo, la adherencia a estándares de cuidado no es óptima. Se analizó la evidencia disponible en tromboprofilaxis y se generaron recomendaciones (1 o sugerencias (2 con diferentes grados de evidencia (A, B o C para diferentes escenarios y métodos de tromboprofilaxis. En cirugías ortopédicas mayores se recomienda la profilaxis farmacológica con heparinas de bajo peso molecular, HBPM (1B, fondaparinux, dabigatrán y rivaroxaban (1B que deben iniciarse durante la internación y mantenerse hasta 35 días después de la cirugía de cadera y hasta 10 días posteriores a la artroplastia de rodilla. La artroscopia de rodilla y la cirugía de columna programada no requieren profilaxis farmacológica (2B salvo que posean factores de riesgo adicionales, en cuyo caso se recomiendan las HBPM. En pacientes con internación clínica y movilidad reducida esperable mayor a tres días, que posean factores de riesgo adicionales, se recomienda tromboprofilaxis con HBPM, HNF o fondaparinux (1B hasta el alta. Aquellos pacientes neuroquirúrgicos o con HIC deberán recibir inicialmente tromboprofilaxis mecánica (2C y dependiendo del caso, iniciar HBPM o HNF entre las 24-72 horas posteriores (2C. Estas últimas dos drogas son recomendadas para pacientes críticos. Los pacientes sometidos a cirugías no ortopédicas con bajo riesgo de ETV deberán realizar deambulación precoz (2C y tromboprofilaxis mecánica (2C, mientras que aquellos en los que el riesgo de ETV sea elevado deberán recibir HBPM y HNF (1B o 2C según su riesgo de sangrado.

3D MR cisternography to identify distal dural rings. Comparison of 3D-CISS and 3D-SPACE sequences

International Nuclear Information System (INIS)

Watanabe, Yoshiyuki; Makidono, Akari; Nakamura, Miho; Saida, Yukihisa

2011-01-01

The distal dural ring (DDR) is an anatomical landmark used to distinguish intra- and extradural aneurysms. We investigated identification of the DDR using 2 three-dimensional (3D) magnetic resonance (MR) cisternography sequences-3D constructive interference in steady state (CISS) and 3D sampling perfection with application optimized contrasts using different flip angle evolutions (SPACE)-at 3.0 tesla. Ten healthy adult volunteers underwent imaging with 3D-CISS, 3D-SPACE, and time-of-flight (TOF) MR angiography (TOF-MRA) sequences at 3.0T. We analyzed DDR identification and internal carotid artery (ICA) signal intensity and classified the shape of the carotid cave. We identified the DDR using both 3D-SPACE and 3D-CISS, with no significant difference between the sequences. Visualization of the outline of the ICA in the cavernous sinus (CS) was significantly clearer with 3D-SPACE than 3D-CISS. In the CS and petrous portions, signal intensity was lower with 3D-SPACE, and the flow void was poor with 3D-CISS in some subjects. We identified the DDR with both 3D-SPACE and 3D-CISS, but the superior contrast of the ICA in the CS using 3D-SPACE suggests the superiority of this sequence for evaluating the DDR. (author)

The accuracy and utility of contrast-enhanced MR angiography for localization of spinal dural arteriovenous fistulas: the Toronto experience

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Lindenholz, Arjen [University Medical Center Groningen, Department of Neurosurgery AB71, PO Box 30001, Groningen (Netherlands); Toronto Western Hospital, Department of Medical Imaging, Division of Neuroradiology, Toronto, ON (Canada); TerBrugge, Karel G.; Farb, Richard I. [Toronto Western Hospital, Department of Medical Imaging, Division of Neuroradiology, Toronto, ON (Canada); Dijk, J.M.C. van [University Medical Center Groningen, Department of Neurosurgery AB71, PO Box 30001, Groningen (Netherlands)

2014-11-15

The purpose of this study was to determine the accuracy and utility of contrast-enhanced MR angiography (CE-MRA) in spinal dural arteriovenous fistulas (SDAVF). A retrospective analysis from 1999-2012 identified 70 patients clinically suspected of harboring a SDAVF. Each patient underwent consecutive conventional MR-imaging, CE-MRA, and digital subtraction angiography (DSA). The presence or absence of serpentine flow voids, T2-weighted hyperintensity, and cord enhancement were evaluated, as well as location of the fistula as predicted by CE-MRA. DSA was used as the reference standard. Of the 70 cases, 53 were determined to be a SDAVF, 10 cases were shown to be other forms of vascular malformation, and 7 were DSA-negative. On MRI, all reported cases of SDAVF showed serpentine flow voids (100 %). T2-weighted hyperintensity was seen in 48 of 50 cases (96 %), extending to the conus in 41 of 48 cases (85 %). Cord enhancement was seen in 38 of 41 cases (93 %). CE-MRA correctly localized the SDAVF in 43 of the 53 cases (81 %). CE-MRA is a useful non-invasive examination for the detection and localization of SDAVF. CE-MRA facilitates but does not replace DSA as confirmation of location, fistula type, and arterial detail, which are required before treatment. (orig.)

Total dural irradiation: RapidArc versus static-field IMRT: A case study

Energy Technology Data Exchange (ETDEWEB)

Kelly, Paul J., E-mail: paulj.kelly@hse.ie [Department of Radiation Oncology, Dana Farber/Brigham and Women' s Cancer Center, Harvard Medical School, Boston, MA (United States); Mannarino, Edward; Lewis, John Henry; Baldini, Elizabeth H.; Hacker, Fred L. [Department of Radiation Oncology, Dana Farber/Brigham and Women' s Cancer Center, Harvard Medical School, Boston, MA (United States)

2012-07-01

The purpose of this study was to compare conventional fixed-gantry angle intensity-modulated radiation therapy (IMRT) with RapidArc for total dural irradiation. We also hypothesize that target volume-individualized collimator angles may produce substantial normal tissue sparing when planning with RapidArc. Five-, 7-, and 9-field fixed-gantry angle sliding-window IMRT plans were generated for comparison with RapidArc plans. Optimization and normal tissue constraints were constant for all plans. All plans were normalized so that 95% of the planning target volume (PTV) received at least 100% of the dose. RapidArc was delivered using 350 Degree-Sign clockwise and counterclockwise arcs. Conventional collimator angles of 45 Degree-Sign and 315 Degree-Sign were compared with 90 Degree-Sign on both arcs. Dose prescription was 59.4 Gy in 33 fractions. PTV metrics used for comparison were coverage, V{sub 107}%, D1%, conformality index (CI{sub 95}%), and heterogeneity index (D{sub 5}%-D{sub 95}%). Brain dose, the main challenge of this case, was compared using D{sub 1}%, Dmean, and V{sub 5} Gy. Dose to optic chiasm, optic nerves, globes, and lenses was also compared. The use of unconventional collimator angles (90 Degree-Sign on both arcs) substantially reduced dose to normal brain. All plans achieved acceptable target coverage. Homogeneity was similar for RapidArc and 9-field IMRT plans. However, heterogeneity increased with decreasing number of IMRT fields, resulting in unacceptable hotspots within the brain. Conformality was marginally better with RapidArc relative to IMRT. Low dose to brain, as indicated by V5Gy, was comparable in all plans. Doses to organs at risk (OARs) showed no clinically meaningful differences. The number of monitor units was lower and delivery time was reduced with RapidArc. The case-individualized RapidArc plan compared favorably with the 9-field conventional IMRT plan. In view of lower monitor unit requirements and shorter delivery time, Rapid

Efecto de un suplemento nutricional específico (Balnimax® en la cicatrización de úlceras de la extremidad inferior de etiología venosa y úlceras por presión

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José Verdú Soriano

Full Text Available Objetivo: evaluar un suplemento nutricional específico, Balnimax® (ácido alfa-lipoico, L-arginina, L-metionina, complejo de vitamina B, vitamina E y selenio junto con la práctica clínica diaria en la cicatrización de las úlceras por presión y úlceras de etiología venosa. Material y método: se llevó a cabo un estudio multicéntrico, prospectivo, de medidas repetidas en un solo grupo y postautorización en pacientes con úlceras por presión y úlceras de etiología venosa sin signos clínicos de infección local, que fueron tratados durante 8 semanas. Las medidas se registraron al inicio y en las semanas 2, 4, 6 y 8. Los pacientes recibieron una cápsula oral dos veces al día, con las comidas. La medida de resultado principal fue el porcentaje de reducción en el tamaño de la herida. Además, se estudió la cicatrización completa. El tamaño de la muestra se determinó para comparar los resultados frente a un valor de referencia. Se requería un total de 127 pacientes para detectar una diferencia igual o superior al 15% en la reducción del área. Se asumió como porcentaje de reducción de referencia un 57%. Además, se estimó un 10% de pérdidas en el seguimiento. Resultados: Se incluyeron y finalizaron el estudio 112 pacientes con 133 heridas (un 16,0% tuvieron dos o más lesiones, con una media de edad de 74,2 ± 12,0 (mediana: 77, extremos: 35-94. Un 69,8% eran mujeres, la mayoría pacientes ambulatorios (98,4%. En un 9% se utilizaron moduladores de las proteasas y solo en un 27,2% se aplicó un vendaje compresivo multicapa. Un total de 58 (43,6% úlceras cicatrizaron durante el periodo del estudio. La evolución del tamaño de la herida y su porcentaje de reducción fueron estadísticamente significativos (p ≤ 0,001, disminuyendo a lo largo del tiempo. Hubo diferencias estadísticamente significativas entre los resultados del estudio y el valor de referencia (p ≤ 0,001. Conclusiones: a pesar de las posibles limitaciones

Rabdomiossarcoma aveolar de parede abdominal: estratégia terapêutica

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Mateus Calixto Colturato

2015-10-01

Full Text Available O rabdomiossarcoma (RMS é um tumor maligno da infância de origemmesenquimatosa, sendo o sarcoma de partes moles mais comum e o quartotumor sólido mais comum na pediatria. O fato do tumor surgir em uma ampla variedade de locais, alguns associados a padrões de invasão local específicos, disseminação linfonodal regional, e resposta terapêutica, requerem médicos familiarizados com o estadiamentoespecífico do local e detalhes de tratamento. A terapia multifatorial que incluicirurgia, quimioterapia e frequentemente radioterapia podem ser associadas,visando a melhor abordagem para otimizar a chance de cura e manter aqualidade de vida. O resumo relata um paciente que foi admitido por uma massa na paredeabdominal com imunohistoquímica confirmando o diagnóstico, D33 e F5Dpositivos. Estadiamento clínico III. O tumor surgiu no músculo reto abdominalesquerdo, estendendo-se ao assoalho pélvico, deslocando a bexiga e o reto.Hidronefrose bilateral, trombose venosa profunda e linfedema do membroinferior esquerdo e inchaço da genitália externa estavam presentes. Aquimioterapia usada foi Ifosfamide, Vincristine e Dactinomycin e foi observado uma resposta terapêutica significativa. A abordagem cirúrgica consistiu em linfadenectomia da cadeia periaórtica e ilíaca, além da ressecção completa do tumor. Foi usada tela flexível de dupla face na reconstrução da paredeabdominal. Foi realizada radio e quimioterapia. O objetivo de cura é real e depende do estágio dos tumores. O manejo destes  pacientes ainda continua desafiador. Com a terapia multidisciplinar, o cirurgião desempenha um papel vital em determinar a estratificação do risco para o tratamento e o controle local do tumor primário para o RMS

Trombose de veia central da retina em paciente usuária de interferon e ribavirina: relato de caso Central vein occlusion in a patient using interferon and ribavirin: case report

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John Helal Jr.

2006-08-01

Full Text Available O interferon alfa (INF alfa é droga atualmente utilizada no tratamento de várias doenças sistêmicas, como a hepatite C crônica. A ribavirina quando associada ao interferon alfa aumenta muito a resposta ao tratamento. Estima-se que a infecção crônica pelo vírus da hepatite C afete 170 milhões de pessoas no mundo, muitas delas em uso dessas medicações. A forma típica da retinopatia associada ao interferon alfa apresenta exsudatos algodonosos e hemorragias intra-retinianas. Há vários relatos de alterações oculares associadas ao uso do interferon alfa. Este trabalho descreve um caso de oclusão de veia central da retina em olho direito, com hemorragias no olho contralateral, em paciente usuária dessas medicações por dois anos. O caso descrito expõe em um dos olhos o quadro mais freqüente da retinopatia associada ao uso de interferon alfa (hemorragias de fundo e no olho contralateral, uma apresentação muito mais atípica (trombose de veia central da retina. O quadro fundoscópico apresentou melhora com a interrupção da medicação.Interferon and ribavirin are medications widely used in the treatment of some systemic diseases, mainly hepatitis C. Ribavirin when associated with interferon increases the rate of success of this treatment. There are about 170 million patients with chronic hepatitis C in the world, many in use of these medications. The classic associated retinopathy is described as cotton wool exudates and hemorrhages. Since the first reports, several different ocular disturbances were described in association with interferon. The present case shows a patient whose right eye presented with central retinal vein occlusion and whose left eye presented the typical findings of hemorrhages; prompt resolution after the medications were discontinued.

Parenchymal abnormalities in cerebral venous thrombosis: findings of magnetic resonance imaging and magnetic resonance angiography; Alteracoes parenquimatosas na trombose venosa cerebral: aspectos da ressonancia magnetica e da angiorressonancia

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Ferreira, Clecia Santos; Pellini, Marcos [Universidade Federal, Rio de Janeiro, RJ (Brazil). Faculdade de Medicina. Dept. de Radiologia]. E-mail: csferreira@superig.com.br; Boasquevisque, Edson [Universidade do Estado do Rio de Janeiro, (UERJ), RJ (Brazil). Faculdade de Medicina. Dept. de Patologia; Souza, Luis Alberto M. de [Hospital da Beneficencia Portuguesa do Rio de Janeiro, RJ (Brazil). Servico de Imagem. Setor de Ressonancia Magnetica

2006-09-15

Objective: to determine the frequency and localization of parenchymal abnormalities in cerebral venous thrombosis on magnetic resonance imaging and magnetic resonance angiography as well as their correlation with the territory and affected venous drainage. Materials and methods: retrospective analysis (1996 to 2004) of 21 patients (3 male and 18 female) age range between 3 and 82 years (mean 40 years, median 36 years) with clinical and radiological diagnosis of cerebral venous thrombosis on magnetic resonance imaging and magnetic resonance angiography in 2D PC, 3D PC and contrast-enhanced 3D TOF sequences. The statistical analysis was performed with the qui-square test. Four patients had follow-up exams and three patients underwent digital subtraction angiography. Results: main predisposing factors were: infection, use of oral contraceptives, hormone replacement therapy and collagenosis. Predominant symptoms included: focal deficit, headache, alteration of consciousness level and seizures. Most frequent parenchymal manifestations were: cortical/subcortical edema or infarct, venous congestion and collateral circulation, meningeal enhancement and thalamic and basal ganglia edema or infarct. Occlusion occurred mainly in superior sagittal, left transverse, left sigmoid and straight sinuses. Cavernous sinus and cortical veins thrombosis are uncommon events. Conclusion: cerebral venous thrombosis is an uncommon cause of stroke, with favorable prognosis because of its reversibility. Diagnosis is highly dependent on the radiologist capacity to recognize the presentations of this disease, principally in cases where the diagnosis is suggested by parenchymal abnormalities rather than necessarily by visualization of the thrombus itself. An accurate and rapid diagnosis allows an immediate treatment, reducing the morbidity and mortality rates. (author)

Fluorescence Behavior and Dural Infiltration of Meningioma Analyzed by 5-Aminolevulinic Acid-Based Fluorescence: Operating Microscope Versus Mini-Spectrometer.

Science.gov (United States)

Knipps, Johannes; Beseoglu, Kerim; Kamp, Marcel; Fischer, Igor; Felsberg, Joerg; Neumann, Lisa M; Steiger, Hans-Jakob; Cornelius, Jan F

2017-12-01

To compare fluorescence intensity of tumor specimens, as measured by a fluorescence-guided surgery microscope and a spectrometer, to evaluate tumor infiltration of dura mater around meningiomas with help of these 2 different 5-aminolevulinic acid (5-ALA)-based fluorescence tools, and to correlate fluorescence intensity with histopathologic data. In a clinical series, meningiomas were resected by 5-ALA fluorescence-guided surgery. Fluorescence intensity was semiquantitatively rated by the surgeon at predefined points. Biopsies were harvested and fluorescence intensity measured by a spectrometer and histopathologically analyzed. Sampling was realized at the level of the dura in a centrifugal direction. A total of 104 biopsies (n = 13 tumors) were analyzed. Specificity and sensitivity of the microscope were 0.96 and 0.53 and of the spectrometer 0.95 and 0.93, respectively. Fluorescence intensity as measured by the spectrometer was correlated to histologically confirmed tumor burden. In a centrifugal direction, tumor burden and fluorescence intensity continuously decreased (along the dural tail). Below a threshold value of 639 arbitrary units no tumor was histologically detectable. At the level of the dura the spectrometer was highly sensitive for detection of meningioma cells. The surgical microscope showed false negative results and missed residual tumor cells in more than one half of the cases. The complementary use of both fluorescence tools may improve resection quality. Copyright © 2017 Elsevier Inc. All rights reserved.

Expression of the transient receptor potential channels TRPV1, TRPA1 and TRPM8 in mouse trigeminal primary afferent neurons innervating the dura

Science.gov (United States)

2012-01-01

Background Migraine and other headache disorders affect a large percentage of the population and cause debilitating pain. Activation and sensitization of the trigeminal primary afferent neurons innervating the dura and cerebral vessels is a crucial step in the “headache circuit”. Many dural afferent neurons respond to algesic and inflammatory agents. Given the clear role of the transient receptor potential (TRP) family of channels in both sensing chemical stimulants and mediating inflammatory pain, we investigated the expression of TRP channels in dural afferent neurons. Methods We used two fluorescent tracers to retrogradely label dural afferent neurons in adult mice and quantified the abundance of peptidergic and non-peptidergic neuron populations using calcitonin gene-related peptide immunoreactivity (CGRP-ir) and isolectin B4 (IB4) binding as markers, respectively. Using immunohistochemistry, we compared the expression of TRPV1 and TRPA1 channels in dural afferent neurons with the expression in total trigeminal ganglion (TG) neurons. To examine the distribution of TRPM8 channels, we labeled dural afferent neurons in mice expressing farnesylated enhanced green fluorescent protein (EGFPf) from a TRPM8 locus. We used nearest-neighbor measurement to predict the spatial association between dural afferent neurons and neurons expressing TRPA1 or TRPM8 channels in the TG. Results and conclusions We report that the size of dural afferent neurons is significantly larger than that of total TG neurons and facial skin afferents. Approximately 40% of dural afferent neurons exhibit IB4 binding. Surprisingly, the percentage of dural afferent neurons containing CGRP-ir is significantly lower than those of total TG neurons and facial skin afferents. Both TRPV1 and TRPA1 channels are expressed in dural afferent neurons. Furthermore, nearest-neighbor measurement indicates that TRPA1-expressing neurons are clustered around a subset of dural afferent neurons. Interestingly, TRPM

MRI findings of giant plasmacytoma of the calvarium

International Nuclear Information System (INIS)

Ishii, Norihiro; Suzuki, Yasuo; Ishii, Ryoji

2007-01-01

We report two cases of giant plasmacytoma of the calvarium with the dural tail sign. Though the dural tail sign has been reported as a highly specific finding of meningiomas, the recent literature has described its appearance with other tumors, such as schwannomas, lymphomas, and metastatic brain tumors. Therefore, we reviewed 10 cases of plasmacytomas with a dural tail sign including our two cases and discussed the origin of dural tail signs. It was concluded that giant plasmacytoma of the calvarium is one of the entities that produces a dural tail sign. (author)

Automated double-cone-beam CT fusion technique. Enhanced evaluation of glue distribution in cases of spinal dural arteriovenous fistula (SDAVF) embolisation

International Nuclear Information System (INIS)

Farago, Giuseppe; Caldiera, V.; Antozzi, C.; Bellino, A.; Innocenti, A.; Ciceri, E.

2017-01-01

Spinal dural arteriovenous fistulas (SDAVFs) are acquired diseases that represent the majority of all arteriovenous spinal shunts, leading to progressive and disabling myelopathy. Treatment is focused on accurately disconnecting the fistula point. We present our experience with the double-cone-beam CT fusion technique successfully applied to evaluate treatment results in a series of SDAVFs. Between November 2011 and December 2015 we performed double-DynaCT acquisition (pre- and post-embolisation) in 12 cases of SDAVF. A successful DynaCT fusion technique was only achieved in the group of patients with pre- and post-treatment images acquired at the same time as the treatment session, under general anaesthesia (4/12). DynaCT performed on different days proved to be inadequate for the automated fusion technique because of changes in the body position (8/12). A pre-treatment flat-panel cone-beam CT with contrast, at the time of diagnostic angiography, can be very helpful to detect the correct level of the fistula and the relationship between the fistula and the surrounding structures. In case of the endovascular approach, additional post-treatment native acquisition merged with the pre-treatment acquisition (double-cone-beam CT fusion technique) permits to immediately evaluate the distribution of the glue cast and to confirm the success of the procedure. (orig.)

Automated double-cone-beam CT fusion technique. Enhanced evaluation of glue distribution in cases of spinal dural arteriovenous fistula (SDAVF) embolisation

Energy Technology Data Exchange (ETDEWEB)

Farago, Giuseppe [Foundation Neurological Institute ' ' C. Besta' ' , Department of Interventional Neuroradiology, Milan (Italy); Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Interventional Neuroradiology, Milan (Italy); Caldiera, V. [Foundation Neurological Institute ' ' C. Besta' ' , Department of Interventional Neuroradiology, Milan (Italy); Antozzi, C.; Bellino, A. [Foundation Neurological Institute ' ' C. Besta' ' , Department of Neuroimmunology and Neuromuscular Diseases, Milan (Italy); Innocenti, A. [Foundation Neurological Institute ' ' C. Besta' ' , Department of Neuro-Oncology, Milan (Italy); Ciceri, E. [Foundation Neurological Institute ' ' C. Besta' ' , Department of Interventional Neuroradiology, Milan (Italy); Azienda Ospedaliera Universitaria Integrata Borgo Trento, Department of Neuroradiology, Verona (Italy)

2017-05-15

Spinal dural arteriovenous fistulas (SDAVFs) are acquired diseases that represent the majority of all arteriovenous spinal shunts, leading to progressive and disabling myelopathy. Treatment is focused on accurately disconnecting the fistula point. We present our experience with the double-cone-beam CT fusion technique successfully applied to evaluate treatment results in a series of SDAVFs. Between November 2011 and December 2015 we performed double-DynaCT acquisition (pre- and post-embolisation) in 12 cases of SDAVF. A successful DynaCT fusion technique was only achieved in the group of patients with pre- and post-treatment images acquired at the same time as the treatment session, under general anaesthesia (4/12). DynaCT performed on different days proved to be inadequate for the automated fusion technique because of changes in the body position (8/12). A pre-treatment flat-panel cone-beam CT with contrast, at the time of diagnostic angiography, can be very helpful to detect the correct level of the fistula and the relationship between the fistula and the surrounding structures. In case of the endovascular approach, additional post-treatment native acquisition merged with the pre-treatment acquisition (double-cone-beam CT fusion technique) permits to immediately evaluate the distribution of the glue cast and to confirm the success of the procedure. (orig.)

Avaliação da pressão venosa periférica na esclerose sistêmica Peripheral venous pressure in systemic sclerosis

Directory of Open Access Journals (Sweden)

João Potério-Filho

2004-02-01

Full Text Available OBJETIVO: Estabelecer a utilidade da medida indireta da pressão venosa periférica (PVP na avaliação de pacientes com esclerose sistêmica (ES, comparando com uma população controle normal. MÉTODOS: Estudo prospectivo avaliando 18 pacientes esclerodérmicas do sexo feminino (sendo oito delas com úlcera cutânea isquêmica submetidas à medida indireta da PVP (por pletismografia. Os dados foram comparados a um grupo controle normal de 18 mulheres hígidas, pareadas para idade. RESULTADOS: Os níveis de pressão arterial foram semelhantes nos dois grupos. Os valores de PVP estavam significativamente diminuídos nos pacientes com ES (58.9 ± 11.6 mmHg no grupo ES e 96.9 ± 7.1 mmHg no grupo controle; p OBJECTIVE: The aim of this prospective study was to establish the usefulness of indirect measurement of peripheral venous pressure (PVP in the evaluation of patients with systemic sclerosis (SSc, comparing them with a normal control population. METHODS: Eighteen female SSc patients (eight patients presenting cutaneous ischemic ulcers were submitted to indirect measurement of the PVP (by plethysmography, and data were compared with a control group of 18 healthy women, paired by age. RESULTS: Arterial pressure levels were similar in both groups. PVP levels were significantly decreased in the SSc patients (58.9 ± 11.6 mmHg in the SSc group and 96.9 ± 7.1 mmHg in the control group; p < 0.0001; in the SSc group, patients with ischemic ulcers presented PVP levels significantly decreased compared with those patients without ulcers (50.6 ± 10.8 mmHg in the ulcer group and 65.5 ± 7.2 mmHg in the group without ulcers; p = 0.006. CONCLUSIONS: It can be concluded that decreased PVP in SSc is associated with a decrease in the blood flow of these patients, predisposing them to cutaneous ischemic ulcers.

Deficiencia combinada de proteínas c y s

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Yaneth Zamora-González

Full Text Available Las trombofilias son un grupo de enfermedades que favorecen la formación de trombosis, tanto arteriales como venosas, que han sido asociadas con diferentes complicaciones durante el embarazo, como: aborto recurrente, preclampsia, crecimiento intrauterino retardado y muerte fetal intraútero, entre otras. La deficiencia congénita o adquirida de proteínas de la coagulación, como las proteínas C y S, se asocia con eventos trombóticos antes de los 30 o 40 años. La trombosis venosa profunda es considerada la manifestación clínica más frecuente, aunque también puede verse asociada con enfermedad cerebro vascular, pérdidas recurrentes de embarazos y otros estados isquémicos. En la actualidad, las enfermedades trombóticas constituyen una de las primeras causas de fallecimiento en el mundo; la morbimortalidad anual por trombosis, ya sea arterial o venosa, es de aproximadamente dos millones de personas. Presentamos un caso con antecedentes de pérdidas recurrentes de embarazos y trombosis venosa profunda en miembros inferiores con deficiencia combinada de proteínas C y S.

Safety of Pregnancy After Cerebral Venous Thrombosis: Results of the ISCVT (International Study on Cerebral Vein and Dural Sinus Thrombosis)-2 PREGNANCY Study.

Science.gov (United States)

Aguiar de Sousa, Diana; Canhão, Patrícia; Crassard, Isabelle; Coutinho, Jonathan; Arauz, Antonio; Conforto, Adriana; Béjot, Yannick; Giroud, Maurice; Ferro, José M

2017-11-01

Pregnancy is associated with increased risk of venous thrombotic events, including cerebral venous thrombosis. We aimed to study the complications and outcome of subsequent pregnancies in women with previous cerebral venous thrombosis. Follow-up study of women with acute cerebral venous thrombosis at childbearing age included in a previously described cohort (International Study of Cerebral Vein and Dural Sinus Thrombosis). Patients were interviewed by local neurologists to assess rate of venous thrombotic events, pregnancy outcomes, and antithrombotic prophylaxis during subsequent pregnancies. A total of 119 women were included, with a median follow-up of 14 years. Eighty-two new pregnancies occurred in 47 women. In 83% (68 of 82), some form of antithrombotic prophylaxis was given during at least 1 trimester of pregnancy or puerperium. Venous thrombotic events occurred in 3 pregnancies, including 1 recurrent cerebral venous thrombosis. Two of the 3 women were on prophylactic low-molecular-weight heparin at the time of the event. Outcomes of pregnancies were 51 full-term newborns, 9 preterm births, 2 stillbirths, and 20 abortions (14 spontaneous). In women with prior cerebral venous thrombosis, recurrent venous thrombotic events during subsequent pregnancies are infrequent. © 2017 American Heart Association, Inc.

Onyx embolization as a first line treatment for intracranial dural arteriovenous fistulas with cortical venous reflux

International Nuclear Information System (INIS)

Panagiotopoulos, V.; Forsting, M.; Wanke, I.; Moeller-Hartmann, W.; Asgari, S.; Sandalcioglu, I.E.

2009-01-01

Our purpose was to present our experience regarding embolization of intracranial dural arteriovenous fistulas (DAVFs) with cortical venous reflux using Onyx, a non-adhesive liquid embolic agent. From January 2006 to December 2007, 16 patients (12 men and 4 women) with a mean age of 61 years (range 42 - 78) with an intracranial DAVF with cortical venous reflux underwent at least one transarterial embolization using Onyx. According to the Cognard classification, 2 lesions were grade V, 5 were grade IV, 6 were grade III, 2 were grade IIa+b, and 1 was grade IIb. The clinical presentation included 5 hemorrhagic deficits, 10 non-hemorrhagic manifestations, and 1 patient was asymptomatic. Twenty-four embolization sessions were performed in 16 patients with an average of 3 arterial feeders (range 1 - 9) embolized per DAVF. Immediately after embolization, complete occlusion was achieved in 9 / 16 (56 %) patients after the first session. Further postembolization surgical treatment was performed in 3 patients. Partial reperfusion occurred in 1 patient at the time of mean follow-up of 3.7 months (range 0 - 12). Treatment has been completed for 11 / 16 patients with angiographic cure in 10 / 11 (91 %). An infratentorial bleeding complication related to embolization occurred in one patient with temporary worsening of the patient's gait disturbance. At the time of mean clinical follow-up of 4.5 months (range 0 - 12), no procedure-related permanent morbidity was added to our cohort. According to our experience, embolization of intracranial DAVFs with cortical venous drainage using Onyx is feasible with promising results, indicating stability at the time of mid-term follow-up. In very complex DAVFs additional embolization material might be necessary, and in some cases surgery is warranted. (orig.)

Balans in beweging

NARCIS (Netherlands)

F.W.G. Leebeek (Frank)

2010-01-01

textabstractRede, Rede uitgesproken bij de aanvaarding van het ambt van bijzonder hoogleraar met als leeropdracht hemostase en trombose aan het Erasmus MC, faculteit van de Erasmus Universiteit Rotterdam op 5 februari 2010

KYNA analogue SZR72 modifies CFA-induced dural inflammation- regarding expression of pERK1/2 and IL-1β in the rat trigeminal ganglion.

Science.gov (United States)

Lukács, M; Warfvinge, K; Kruse, L S; Tajti, J; Fülöp, F; Toldi, J; Vécsei, L; Edvinsson, L

2016-12-01

Neurogenic inflammation has for decades been considered an important part of migraine pathophysiology. In the present study, we asked the question if administration of a novel kynurenic acid analogue (SZR72), precursor of an excitotoxin antagonist and anti-inflammatory substance, can modify the neurogenic inflammatory response in the trigeminal ganglion. Inflammation in the trigeminal ganglion was induced by local dural application of Complete Freunds Adjuvant (CFA). Levels of phosphorylated MAP kinase pERK1/2 and IL-1β expression in V1 region of the trigeminal ganglion were investigated using immunohistochemistry and Western blot. Pretreatment with one dose of SZR72 abolished the CFA-induced pERK1/2 and IL-1β activation in the trigeminal ganglion. No significant change was noted in case of repeated treatment with SZR72 as compared to a single dose. This is the first study that demonstrates that one dose of KYNA analog before application of CFA can give anti-inflammatory response in a model of trigeminal activation, opening a new line for further investigations regarding possible effects of KYNA derivates.

Peso do baço como fator prognóstico do tratamento cirúrgico de pacientes portadores de esquistossomose mansônica

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Álvaro Antônio Bandeira Ferraz

Full Text Available OBJETIVO: Analisar pré-operatoriamente o peso do baço como fator prognóstico do tratamento cirúrgico de pacientes portadores de esquistossomose mansônica. MÉTODOS: Foram analisados 114 pacientes, portadores de esquistossomose mansônica com antecedentes de hemorragia digestiva, submetidos a tratamento cirúrgico. Os pacientes foram divididos em três grupos: Grupo 1 - baço menor que 500 gramas (17; Grupo 2 - baço entre 500 e 1.000 gramas (58; Grupo 3 - baço acima de 1.000 gramas (39. RESULTADOS: No Grupo 1 a recidiva hemorrágica foi de 17,6%, trombose da veia porta de 5,9% e não houve mortalidade. A incidência de hiperesplenismo pré-operatório foi de 29,4% e o calibre da veia porta foi de 1,1cm. No Grupo 2 a recidiva hemorrágica foi de 15,5%, trombose da veia porta de 10,3% e a mortalidade de quatro pacientes (6,9% (dois pacientes no período pós-operatório e dois no seguimento tardio, hepatocarcinoma e hemorragia digestiva. A incidência de hiperesplenismo foi de 53,4% e o calibre médio da veia porta foi de 1,4cm. No Grupo 3 a recidiva hemorrágica foi de 12,8%, trombose da veia porta de 5,1% e uma mortalidade tardia de dois pacientes (linfoma e infarto agudo do miocárdio. A incidência de hiperesplenismo foi de 76,9% e o calibre da veia porta foi de 1,5cm. CONCLUSÕES: O peso do baço apresenta relação com o hiperesplenismo pré-operatório, calibre da veia porta e permanência hospitalar pós-operatória. Não encontramos relação com a incidência de varizes de fundo gástrico, recidiva de sangramento digestivo, trombose da veia porta, grau de fibrose periportal e dados bioquímicos.

Population structure, growth and production of a recent brachiopod from the Chilean fjord region

KAUST Repository

Baumgarten, Sebastian

2013-12-04

Magellania venosa, the largest recent brachiopod, occurs in clusters and banks in population densities of up to 416 ind m-2 in Comau Fjord, Northern Chilean fjord region. Below 15 m, it co-occurs with the mytilid Aulacomya atra and it dominates the benthic community below 20 m. To determine the question of why M. venosa is a successful competitor, the in situ growth rate of the brachiopod was studied and its overall growth performance compared with that of other brachiopods and mussels. The growth in length was measured between February 2011 and March 2012 after mechanical tagging and calcein staining. Settlement and juvenile growth were determined from recruitment tiles installed in 2009 and from subsequent photocensus. Growth of M. venosa is best described by the general von Bertalanffy growth function, with a maximum shell length (L∞) of 71.53 mm and a Brody growth constant (K) of 0.336 year-1. The overall growth performance (OGP index = 5.1) is the highest recorded for a rynchonelliform brachiopod and in the range of that for Mytilus chilensis (4.8-5.27), but lower than that of A. atra (5.74). The maximal individual production (PInd) is 0.29 g AFDM ind-1 year-1 at 42 mm shell length and annual production ranges from 1.28 to 89.25 g AFDM year-1 m-2 (1-57% of that of A. atra in the respective fjords). The high shell growth rate of M. venosa, together with its high overall growth performance may explain the locally high population density of this brachiopod in Comau Fjord. However, the production per biomass of the population (P/B--ratio) is low (0.535) and M. venosa may play only a minor role in the food chain. Settling dynamics indicates that M. venosa is a pioneer species with low juvenile mortality. The coexistence of the brachiopod and bivalve suggests that brachiopod survival is affected by neither the presence of potential brachiopod predators nor that of space competitors (i.e. mytilids).

Tratamiento de las malformaciones venosas con alambres de cobre Treatment of venous malformations with cooper wires

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F. Coiffman

2011-06-01

Full Text Available Las lesiones vasculares de la piel constituyen la anomalía congénita más frecuente. Van desde una simple mácula rosada, hasta tumores deformantes e incapacitantes. La gran mayoría desaparece en el primer año de vida. Otras involucionan espontáneamente en los primeros 6 años. Son más frecuentes en la mujer y en la raza blanca. Hay múltiples tratamientos, pero ninguno da garantías absolutas de curación. En base a las observaciones de los campesinos que notan que una lesión de este tipo, cuando es puncionada o se ulcera reduce de tamaño, Wang en China, recomendó puncionar las malformaciones venosas con agujas de cobre y aplicar sobre ellas ligeras descargas eléctricas. Nosotros modificamos el método: implantamos simples alambres de cobre usando una aguja recta larga y bajo anestesia local ambulatoriamente, creando un emparrillado de alambres en la lesión. A la semana los extraemos. La irritación que producimos estimula la coagulación intravascular y al reabsorberse los coágulos, la malformación desaparece o por lo menos reduce considerablemente de tamaño. Si es necesario, después resecamos la piel sobrante bajo anestesia local también de forma ambulatoria. Este método resulta muy efectivo, es sencillo, económico y puede ser practicado por cualquier cirujano. En 68 casos tratados en los últimos 15 años, no hemos tenido complicaciones serias, excepto dolor y edema en el postoperatorio inmediato.Vascular injuries of the skin constitute the most frequent congenital anomaly. They go from a simple pink stain, up to tumors that can cause great deformities. Most of them disappears in the first year of life. Other, suffers spontaneous involution in the first 6 years. They are more frequent in woman and in white race. There are multiple treatments, but none gives absolute guarantees. On the basis of the observations of rural people, who notice that an injury of this type, when it is punctioned or sore reduces its size, Wang in

Avaliação do volume de fluxo venoso da bomba sural por ultra-sonografia Doppler durante cinesioterapia ativa e passiva: um estudo piloto Evaluation of venous flow volume of the calf muscle pump by Doppler ultrasound during active and passive kinesiotherapy: a pilot study

Directory of Open Access Journals (Sweden)

Carmindo Carlos Cardoso Campos

2008-12-01

Full Text Available CONTEXTO: O fisioterapeuta na unidade hospitalar atua sobre os efeitos da hipoatividade ou inatividade do paciente acamado. Na prática diária, a contração do músculo da panturrilha é difundida entre os profissionais de saúde no ambiente hospitalar, principalmente nos períodos de pré e pós-operatório, como forma de diminuir a estase venosa e os riscos de trombose venosa profunda nos membros inferiores. OBJETIVO: Avaliar o volume de fluxo venoso na bomba sural, através de ultra-sonografia doppler, durante cinesioterapia ativa e passiva (flexão plantar do tornozelo. MÉTODOS: A amostra foi constituída por 30 indivíduos escolhidos aleatoriamente e submetidos a ultra-sonografia doppler da veia poplítea direita, visando mensurar o volume de fluxo sanguíneo em quatro momentos: repouso, compressão manual da panturrilha, movimentação passiva e ativa do tornozelo em flexão plantar. Na análise dos resultados, utilizou-se o teste t, sendo utilizado um valor de p BACKGROUND: In-hospital physical therapists work on the effects of hypoactivity or inactivity of bedridden patients. In daily practice, contraction of the calf muscle is commonly performed by health professionals in hospitals, especially in pre- and post-operative periods as a form of reducing venous stasis and risk of deep venous thrombosis in the lower limbs. OBJECTIVE: To assess venous flow volume at the calf muscle pump using color Doppler ultrasound during active and passive kinesiotherapy (ankle plantar flexion. METHODS: The sample consisted of 30 individuals randomly selected and submitted to color Doppler ultrasound of the right popliteal vein, aiming to measure blood flow volume in four periods: rest, manual calf compression, active and passive ankle movement in plantar flexion. The t test was used for statistical analysis, and p < 0.05 was used as an index of statistical significance. RESULTS: The sample consisted of 16 females and 14 males. Means were as follows: age

Utility of time-resolved three-dimensional magnetic resonance digital subtraction angiography without contrast material for assessment of intracranial dural arterio-venous fistula

International Nuclear Information System (INIS)

Hori, Masaaki; Aoki, Shigeki; Nakanishi, Atsushi; Shimoji, Keigo; Kamagata, Koji; Houshito, Haruyoshi; Kuwatsuru, Ryohei; Oishi, Hidenori; Arai, Hajime

2011-01-01

Background: Intracranial dural arteriovenous fistula (DAVF) is an arteriovenous shunting disease of the dura. Magnetic resonance angiography (MRA) is expected to be a safer alternative method in evaluation of DAVF, compared with invasive intra-arterial digital subtraction angiography (IADSA). Purpose: To evaluate the diagnostic use of time-spatial labeling inversion pulse (Time-SLIP) three-dimensional (3D) magnetic resonance digital subtraction angiography (MRDSA) without contrast material in six patients with DAVF. Material and Methods: Images for 3D time-of-flight MRA, which has been a valuable tool for the diagnosis of DAVF but provide little or less hemodynamic information, and Time-SLIP 3D MRDSA, were acquired for each patient. The presence, side, and grade of the disease were evaluated according to IADSA. Results: In all patients, the presence and side of the DAVF were correctly identified by both 3D time-of-flight MRA and Time-SLIP 3D MRDSA. Cortical reflux present in a patient with a grade 2b DAVF was not detected by Time-SLIP 3D MRDSA, when compared with IADSA findings. Conclusion: Time-SLIP 3D MRDSA provides hemodynamic information without contrast material and is a useful complementary tool for diagnosis of DAVF

The road less traveled: transarterial embolization of dural arteriovenous fistulas via the ascending pharyngeal artery.

Science.gov (United States)

Gross, Bradley A; Albuquerque, Felipe C; Moon, Karam; McDougall, Cameron G

2017-01-01

With the introduction of Onyx, transarterial embolization has become the most common endovascular approach to treating dural arteriovenous fistulas (dAVFs), often via the middle meningeal or occipital arteries. The ascending pharyngeal artery (APA) is a less frequently explored transarterial route because of its small caliber, potential anastomoses to the internal carotid and vertebral arteries, and vital supply to lower cranial nerves. To review our institutional experience and highlight the prevalence of APA supply to dAVFs and cases where it is a safe and effective pedicle for embolization. We reviewed our endovascular database (January 1, 1996 to March 1, 2016) for cranial dAVFs, evaluating dAVF characteristics and embolization results for those treated transarterially via the APA. Of 267 endovascularly treated dAVFs, 68 had APA supply (25%). Of these 68 dAVFs, embolization was carried out via this pedicle in 8 (12%) and 7 were ultimately occluded. No complications, including post-treatment cranial neuropathies or radiographic evidence of non-target embolization, were found. For 5 dAVFs, the APA was selected as the initial pedicle for embolization (two marginal sinus, one distal sigmoid, one cavernous, one tentorial). In four of these five cases, dAVF occlusion was achieved via the initial APA feeding artery pedicle. In one case, near-complete, stagnant occlusion was achieved after APA embolization; complete occlusion was achieved after adjunctive embolization of a single additional middle meningeal artery pedicle. In three other cases of complex transverse/sigmoid dAVFs, the APA was used after multiple attempts via middle meningeal and occipital artery pedicles. Occlusion was not achieved transarterially; two of these three dAVFs were ultimately occluded transvenously. In rare, select cases, the APA is an excellent route for transarterial embolization of cranial dAVFs. Published by the BMJ Publishing Group Limited. For permission to use (where not already

Thyroid disease and haemostasis: a relationship with clinical implications?

NARCIS (Netherlands)

Squizzato, A.

2010-01-01

Alessandro Squizzato onderzocht de relatie tussen schildklierziekte, hemostase en klinische manifestaties van trombose en bloedingen. In verschillende studies bewees hij dat een teveel aan schildklierhormoon leidt tot een verhoging van stollingseiwitten en remming van fibrinolyse (het

Comparison of the efficacy of epidural autologous blood patch in the treatment of spontaneous intracranial hypotension and post-dural puncture headache

Energy Technology Data Exchange (ETDEWEB)

Yoon, Sung Hyun; Lee, Jon Woo; Lee, Geun Young; Lee, Eu Gene; Kang, Heung Sik [Dept. of Radiology, Seoul National University Bundang Hospital, Seongnam (Korea, Republic of)

2014-04-15

To evaluate and compare the effectiveness of fluoroscopy-guided epidural blood patch (EBP) in patients with post-dural puncture headache (PDPH) and spontaneous intracranial hypotension (SIH). Between August 2012 and September 2013, 16 patients (12 with PDPH, 4 with SIH; 5 males, 11 females; age range 19-58 years, mean age 32.8 years) who underwent EBP in the Department of Radiology were included in this study. Pain relief within three days after EBP was evaluated based on medical record and classified on a 3-level scale: complete relief; incomplete relief; and failure. Recurrence is defined as aggravated postural headache after three days. We evaluated and compared treatment outcome between PDPH and SIH, using Fisher's exact test (considered as significant when p < 0.05). In 12 PDPH patients, the EBP provided complete relief in 5 patients (41.7%), and incomplete relief in 7 patients (58.3%). In 4 SIH patients, the EBP provided complete relief in 1 patient (25%), and incomplete relief in 3 patients (75%). There was no significant difference (p = 0.511) of pain relief rate between PDPH and SIH. There was recurrence in 5 patients with PDPH and 1 patient with SIH. Five PDPH patients were retreated by EBP with incomplete relief. Fluoroscopy-guided EBP provides effective treatment of postural headache for both SIH and PDPH patients.

Comparison of the efficacy of epidural autologous blood patch in the treatment of spontaneous intracranial hypotension and post-dural puncture headache

International Nuclear Information System (INIS)

Yoon, Sung Hyun; Lee, Jon Woo; Lee, Geun Young; Lee, Eu Gene; Kang, Heung Sik

2014-01-01

To evaluate and compare the effectiveness of fluoroscopy-guided epidural blood patch (EBP) in patients with post-dural puncture headache (PDPH) and spontaneous intracranial hypotension (SIH). Between August 2012 and September 2013, 16 patients (12 with PDPH, 4 with SIH; 5 males, 11 females; age range 19-58 years, mean age 32.8 years) who underwent EBP in the Department of Radiology were included in this study. Pain relief within three days after EBP was evaluated based on medical record and classified on a 3-level scale: complete relief; incomplete relief; and failure. Recurrence is defined as aggravated postural headache after three days. We evaluated and compared treatment outcome between PDPH and SIH, using Fisher's exact test (considered as significant when p < 0.05). In 12 PDPH patients, the EBP provided complete relief in 5 patients (41.7%), and incomplete relief in 7 patients (58.3%). In 4 SIH patients, the EBP provided complete relief in 1 patient (25%), and incomplete relief in 3 patients (75%). There was no significant difference (p = 0.511) of pain relief rate between PDPH and SIH. There was recurrence in 5 patients with PDPH and 1 patient with SIH. Five PDPH patients were retreated by EBP with incomplete relief. Fluoroscopy-guided EBP provides effective treatment of postural headache for both SIH and PDPH patients.

Profilaxia para tromboembolia venosa em um hospital geral Venous thromboembolism prophylaxis in a general hospital

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Fernanda Fuzinatto

2011-04-01

Full Text Available OBJETIVO: Avaliar a prática de profilaxia para tromboembolia venosa (TEV em pacientes em um hospital geral. MÉTODOS: Estudo de coorte transversal conduzido no Hospital Nossa Senhora da Conceição, localizado na cidade de Porto Alegre (RS, com uma amostra constituída de pacientes internados selecionados randomicamente entre outubro de 2008 e fevereiro de 2009. Foram incluídos pacientes maiores de 18 anos e internados por mais de 48 h. Os critérios de exclusão foram pacientes em uso de anticoagulantes, história de doença tromboembólica, gestação e puerpério. A adequação da profilaxia foi avaliada seguindo as recomendações de um protocolo criado pela instituição e tendo como base principal a diretriz da American College of Chest Physician, oitava edição. RESULTADOS: Foram incluídos 262 pacientes com média de idade de 59,1 ± 16,6 anos. Os fatores de risco mais comuns foram imobilização (70,6%, infecção (44,3%, câncer (27,5%, obesidade (23,3% e cirurgia maior (14,1%. Na avaliação do nível de risco para TEV, 143 (54,6% e 117 pacientes (44,7%, respectivamente, foram classificados como de risco alto e moderado. No geral, 46,2% dos pacientes tiveram profilaxia adequada, assim como 25% dos pacientes com três ou mais fatores de risco e 18% dos pacientes com câncer, e houve diferenças estatisticamente significativas entre esses grupos quando comparados àqueles com menos de três fatores de risco e sem câncer (p OBJECTIVE: To evaluate the use of venous thromboembolism (VTE prophylaxis in a general hospital. METHODS: A cross-sectional cohort study at the Hospital Nossa Senhora da Conceição, located in the city of Porto Alegre, Brazil, involving a random sample of patients admitted between October of 2008 and February of 2009. We included patients over 18 years of age and hospitalized for more than 48 h. The exclusion criteria were anticoagulant use, pregnancy, puerperium, and a history of thromboembolic disease. The

Conduta na lesão dural intraoperatória em artrodese da coluna lombar Conducta en lesión de duramadre intraoperatoria en artrodesis de la columna lumbar Management of intraoperatory dural tear in lumbar spine arthrodesis

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Fabiano de Mendonça Grandese

2010-12-01

Full Text Available OBJETIVO: estudo retrospectivo de pacientes com lesão dural intraoperatória de cirurgia da coluna vertebral lombar, conduzido por meio de um protocolo independente da extensão da lesão, complicações associadas e resultados após seguimento mínimo de um ano. MÉTODOS: um total de 10 pacientes com durotomia acidental em cirurgias de descompressão e artrodese da coluna vertebral lombar, no período de Janeiro de 2007 a Janeiro de 2009, para tratamento de doença degenerativa, tiveram seus prontuários revisados, após terem sido tratados por meio de um protocolo embasado em reparo primário da lesão, drenagem subaracnoidea fechada, subfascial e subcutânea aspirativa realizados por cirurgião experiente, associado a repouso relativo com mobilidade precoce e terapia medicamentosa. Suas anotações e exames radiológicos foram verificados com seguimento pós-operatório e direcionados para identificação de sintomas sugestivos de complicações. RESULTADOS: todos os pacientes apresentaram boa evolução, sem ocorrência de fístula liquórica ou infecção pós-operatória; três deles apresentaram cefaleia pós-operatória de leve intensidade. Não houve necessidade de reoperação em nenhum desses pacientes. CONCLUSÃO: concluiu-se que a conduta adotada é segura e de bom resultado para os pacientes quando ocorre esse tipo de lesão, independentemente da extensão da mesma.OBJETIVO: un estudio retrospectivo de pacientes con lesión de la duramadre intraoperatoria de cirugía en la columna lumbar, llevada a cabo por medio de un protocolo independiente de la extensión de la lesión, complicaciones asociadas y los resultados de seguimiento después de un mínimo de un año. MÉTODOS: 10 pacientes con durotomía accidental en la descompresión quirúrgica y artrodesis de la columna vertebral lumbar, en el período de enero de 2007 a enero de 2009, para el tratamiento de enfermedades degenerativas, tuvieron sus registros revisados después de

Hipertensão venosa episcleral idiopática unilateral em mulher jovem Unilateral idiopathic elevated episcleral venous pressure in a young woman

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Marcelo Mendes Lavezzo

2013-02-01

Full Text Available O objetivo é relatar o caso de uma paciente de 33 anos, que veio ao Pronto Socorro de Oftalmologia apresentando queixa de redução da acuidade visual à esquerda, de caráter insidioso e progressivo, há dois anos. Ao exame oftalmológico, apresentava ingurgitamento dos vasos da conjuntiva bulbar, pressão intraocular muito elevada e nervo óptico com escavação total à esquerda. Foi submetida à campimetria computadorizada 24:2 WW e SITA-SWAP do olho direito, ambas com resultados dentro da normalidade. As tomografias de crânio e órbitas, bem como ultrassonografia com doppler do globo ocular, artérias oftálmicas e veias supraorbitárias não apresentavam anormalidades. Diante disso, aventou-se a hipótese diagnóstica de hipertensão venosa episcleral idiopática, um diagnóstico de exclusão, visto que patologias intracranianas e intraorbitárias haviam sido excluídas. Paciente foi tratada clinicamente com colírios hipotensores, com redução importante da pressão intraocular à esquerda, porém não o suficiente, evoluindo para trabeculectomia.The objective is to report a 33 year old female who came to the emergency room of Ophthalmology complaining of reduced visual acuity on the left eye, in a progressive and insidious way, about two years ago. In the ophthalmological examination, she presented dilated tortuous vessels in her left bulbar conjunctiva, very high intraocular pressure and increased cupping of the optic disc. SITA-SWAP and 24:2 computed perimetry were performed on the right eye, both within normal limits. CT scans of the skull and orbits, and ultrasonography of the eyeball and doppler of the ophthalmic artery and the supra-orbital veins had no abnormalities. Thus, it was suggested the possibility of idiopathic elevated episcleral venous pressure, an exclusion diagnosis, since intra-cranial and intraorbital pathologies were excluded. The patient was treated medically with hypotensive eyedrops, with significant reduction

Associations between cardiovascular risk factors, hyper- and hypocoagulability

NARCIS (Netherlands)

Rafi, S.

2011-01-01

Sara Rafi beschrijft verbanden tussen risicofactoren voor hart- en vaatziekten (HVZ) en bloedstolling. Uit calciumneerslag op de aortaboog blijkt dat patiënten met veneuze trombose een verhoogde kans hebben op HVZ. Ook schildklieraandoeningen en het gebruik van ontstekingsremmers en

Estudio vascular renal por TC multidetector de 64 canales 64-Multidetector row CT for the Renal Vascular Study

OpenAIRE

Daniela Stoisa; Fabrizzio E. Galiano; Andrés Quaranta; Roberto L. Villavicencio

2009-01-01

Objetivo: Mostrar las diversas variantes anatómicas vasculares tanto arteriales como venosas en el estudio angiográfico renal por tomografìa computada multidetector (TCMD) de 64 canales, dada su implicancia en un eventual planeamiento quirúrgico. Material y métodos: Evaluamos retrospectivamente 26 estudios realizados con tomógrafo Philips Brilliance de 64 canales. Se obtuvieron secuencias sin contraste y postcontraste e.v. en fases arterial y venosa, administrado con bomba inyectora doble cab...

Tratamento endovascular da síndrome da veia cava superior: relato de caso e revisão da literatura Endovascular treatment of superior vena cava syndrome: case report and review of the literature

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Marco Aurélio Cardozo

2006-12-01

Full Text Available Relatamos o caso de uma paciente portadora de síndrome da veia cava superior sintomática de origem benigna tratada pela técnica endovascular. A angiorressonância magnética pré-angioplastia evidenciou extensa trombose do tronco braquiocefálico esquerdo, da veia subclávia esquerda e obstrução da veia cava superior junto ao tronco braquiocefálico direito. A paciente realizou mastectomia radical 2 anos antes, associada à quimioterapia e radioterapia do tórax. Foram realizados angioplastia venosa e implante de stent expansível por balão. O resultado foi satisfatório, com alívio imediato dos sintomas devido à recanalização da veia cava superior e do tronco braquiocefálico direito. Foi instituída anticoagulação oral. A paciente permanece sem recidiva dos sintomas após 8 meses de acompanhamento. O tratamento endovascular é uma alternativa terapêutica com baixa morbidade e resultado satisfatório a médio prazo que pode ser oferecida aos pacientes portadores de síndrome da veia cava superior.We report a case of a patient with symptomatic benign superior vena cava syndrome treated by the endovascular technique. The angiographic resonance before angioplasty showed extensive thrombosis of the left brachiocephalic trunk, left subclavian vein and superior vena cava obstruction close to the right brachiocephalic trunk. The patient underwent radical mastectomy 2 years ago with adjuvant chemotherapy and chest radiotherapy. Venous angioplasty and balloon-expandable stenting were performed. Satisfactory result was obtained with immediate relief of symptoms due to recanalization of the right brachiocephalic trunk and superior vena cava. Oral anticoagulation was initiated. The patient is still asymptomatic after 8 months of follow-up. The endovascular treatment is a therapeutic alternative with low morbidity and satisfactory mid-term results that can be offered to patients with superior vena cava syndrome.

Pivotal pathways in haemostasis and thrombosis

NARCIS (Netherlands)

Löwenberg, E.C.

2011-01-01

Ester Löwenberg onderzocht de rol van stollingsfactor FXI in hemostase en trombose. Ze keek bij proefdieren naar effectiviteit en veiligheid van FXI-remming via anti-sensetechnologie, waarbij medicijnen worden gebruikt om de vorming van een specifiek eiwit te remmen. De nieuwe behandeling tegen

Laboratory investigation in normal and pathologic coagulation

NARCIS (Netherlands)

Bakhtiari, K.

2013-01-01

Kamran Bakhtiari deed onderzoek naar het gebruik en het belang van hemostase-testen in verschillende situaties, bij gezonde personen en patiënten met bloedingen of trombose. Hemostase is het proces dat zorgt voor de vloeibaarheid van het bloed en het voorkomen van bloedverlies na beschadiging van

Intra-osseous vascular malformation in the maxilla

OpenAIRE

Naveenjayakumar,; Vivek, N.; Pradeep,; Nithin,; Salins, P.; Subhashraj,

2009-01-01

Las malformaciones arterio-venosas intraóseas (MAVs) en la región maxilofacial son entidades clínicas poco frecuentes. Ofrecen una amplia gama de presentación clínica y no siempre se diagnostican sin sorpresa. El tratamiento de estas lesiones siempre ha representado un reto para el cirujano debido a su intensa vascularización y a la elevada incidencia de recurrencia. Se presenta el caso de una malformación arterio-venosa intraósea en el maxilar superior que se manifiesta como sangrado gingiva...

Tratamiento endovascular con estent de síndrome de vena cava superior asociado a cables de marcapasos. Revisión de la literatura

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Andrés Reyes Valdivia

2017-09-01

Full Text Available La aparición de trombosis venosa asociada a cables de marcapasos no es una entidad infrecuente, cursando habitualmente de forma asintomática o con síntomas leves debido a la dificultad del retorno venoso. Esto debido a la colateralidad secundaria y progresiva que compensa dicho componente mecánico obstructivo. La presentación sintomática como síndrome de vena cava superior no es habitual y su aparición por tanto, poco frecuente; dada la extensa colateralidad venosa que asocian estos pacientes.

Enfermería; canalizaciones periféricas, atención, cuidados, mantenimiento y complicaciones.

OpenAIRE

Loro Sancho, N.; Sancho Sánchez, M.J.; Sancho Sánchez, M.T.; Martínez Hernández, E.; Peiró Andrés, A.

2005-01-01

La canalización de vías venosas es una de las técnicas realizadas por el personal de enfermería que mayor incidencia presenta sobre los pacientes. En nuestro hospital, con un número de urgencias diarias que oscila entre 500-600, se confirma que la técnica de más incidencia es la canalización venosa. En nuestro Servicio de urgencias, con una plantilla de 78 enfermeros/as, hay un número considerable de enfermeros/as de nueva incorporación en la plantilla fija, enfermeros/as ...

Inner Ear Conductive Hearing Loss and Unilateral Pulsatile Tinnitus Associated with a Dural Arteriovenous Fistula: Case Based Review and Analysis of Relationship between Intracranial Vascular Abnormalities and Inner Ear Fluids

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Ettore Cassandro

2015-01-01

Full Text Available While pulsatile tinnitus (PT and dural arteriovenous fistula (DAVF are not rarely associated, the finding of a conductive hearing loss (CHL in this clinical picture is unusual. Starting from a case of CHL and PT, diagnosed to be due to a DAVF, we analyzed relationship between intracranial vascular abnormalities and inner ear fluids. DAVF was treated with endovascular embolization. Following this, there was a dramatic recovery of PT and of CHL, confirming their cause-effect link with DAVF. We critically evaluated the papers reporting this association. This is the first case of CHL associated with PT and DAVF. We describe the most significant experiences and theories reported in literature, with a personal analysis about the possible relationship between vascular intracranial system and labyrinthine fluids. In conclusion, we believe that this association may be a challenge for otolaryngologists. So we suggest to consider the possibility of a DAVF or other AVMs when PT is associated with CHL, without alterations of tympanic membrane and middle ear tests.

Uso do sulfato de magnésio por via venosa e nebulização para o tratamento da asma aguda na emergência Use of the intravenous and nebulized magnesium sulfate for the treatment of the acute asthma in the emergence

Directory of Open Access Journals (Sweden)

Fabiano Timbó Barbosa

2007-09-01

Full Text Available JUSTIFICATIVA E OBJETIVOS: Tem sido mostrado que o sulfato de magnésio apresenta benefícios em adultos e crianças asmáticos, com fraca resposta aos agentes beta-agonistas e corticóides sistêmicos no departamento de emergência. O objetivo deste estudo foi realizar uma revisão não sistemática acerca do tratamento da asma aguda com sulfato de magnésio por via venosa e nebulização na emergência. CONTEÚDO: As primeiras investigações que demonstraram benefício no uso do sulfato de magnésio na asma são de 1938. Os efeitos do sulfato de magnésio podem ser mediados através da ação antagonista do cálcio ou através da função de co-fator em sistemas enzimáticos envolvendo o fluxo iônico através da membrana celular. Foi realizada uma revisão de literatura através da base de dados MedLine nos últimos seis anos (2000 a 2006 e incluídos os artigos publicados na língua inglesa, através do cruzamento dos unitermos asma e sulfato de magnésio. CONCLUSÕES: A administração de rotina do sulfato de magnésio por via venosa e nebulização em pacientes com asma aguda grave que se apresentam no serviço de emergência não é recomendado; entretanto, como um tratamento adjuvante obtém-se algum benefício.BACKGROUND AND OBJECTIVES: Magnesium sulfate has been shown to benefit asthmatic children and adults with poor responses to initial beta-agonist therapy and systemic corticoids in the emergency department. The aim of this study was to realize a no systematic review about the treatment of the acute asthma with intravenous and nebulized magnesium sulfate in the emergence. CONTENTS: The first investigations that demonstrate the benefit in the use of the magnesium sulfate in asthma date to 1938. The effects of magnesium sulfate may be mediated through its action as a calcium antagonist or through its function as a cofactor in enzyme systems involving ion flux across cell membranes. We realized a literature review using Med

Early Postoperative Magnetic Resonance Imaging in Detecting Radicular Pain After Lumbar Decompression Surgery: Retrospective Study of the Relationship Between Dural Sac Cross-sectional Area and Postoperative Radicular Pain.

Science.gov (United States)

Futatsugi, Toshimasa; Takahashi, Jun; Oba, Hiroki; Ikegami, Shota; Mogami, Yuji; Shibata, Syunichi; Ohji, Yoshihito; Tanikawa, Hirotaka; Kato, Hiroyuki

2017-07-01

A retrospective analysis. To evaluate the association between early postoperative dural sac cross-sectional area (DCSA) and radicular pain. The correlation between postoperative magnetic resonance imaging (MRI) findings and postoperative neurological symptoms after lumbar decompression surgery is controversial. This study included 115 patients who underwent lumbar decompression surgery followed by MRI within 7 days postoperatively. There were 46 patients with early postoperative radicular pain, regardless of whether the pain was mild or similar to that before surgery. The intervertebral level with the smallest DCSA was identified on MRI and compared preoperatively and postoperatively. Risk factors for postoperative radicular pain were determined using univariate and multivariate analyses. Subanalysis according to absence/presence of a residual suction drain also was performed. Multivariate regression analysis showed that smaller postoperative DCSA was significantly associated with early postoperative radicular pain (per -10 mm; odds ratio, 1.26). The best cutoff value for radicular pain was early postoperative DCSA of 67.7 mm. Even with a cutoff value of surgery. The best cutoff value for postoperative radicular pain was 67.7 mm. Absence of a suction drain at the time of early postoperative MRI was related to smaller DCSA.

MR imaging of postoperative change of dura mater of rabbits; Effect of contrast enhancement of dura mater and correlation with pathological findings

Energy Technology Data Exchange (ETDEWEB)

Ueda, Fumiaki (Kanazawa Univ. (Japan). School of Medicine)

1993-01-01

To explain the mechanism of benign postoperative dural enhancement, the author made experimental model of rabbit's subdual hematoma and performed magnetic resonance (MR) imaging with gadolinium-diethylenetriaminepentaacetic acid (Gd-DTPA). On plain T1-weighted images, infused blood or blood cells could not be detected immediately after surgery. On follow up plain T1-weighted images, the infused blood could be identified in only a case with 1 cc blood infusion. Marked dural enhancement could be seen immediately after surgery and continued three to fourteen days after 1 cc or 0.1 cc blood or 0.1 cc red blood cells infusion. To the contrary, no definite dural enhancement could be seen in the cases with plasma or saline infusion. Subdural red blood cells were required for dural enhancement immediately after surgery. Pathological findings revealed three types of reaction to infused blood: newly formed capillarization with fresh hemorrhage from the capillaries; subdural hematoma and no reaction. After vanishment of dural enhancement, pathological findings of the specimens were identical to that of normal dura. Dural enhancement may be induced by increased permeability of the dura associated with subdural hematoma and/or the extravasation of the contrast from newly formed capillaries. (author).

Diagnostic accuracy of CTA and MRI/MRA in the evaluation of the cortical venous reflux in the intracranial dural arteriovenous fistula DAVF

Energy Technology Data Exchange (ETDEWEB)

Lin, Yen-Heng [National Taiwan University, Department of Medical Imaging and Radiology, Hospital and Medical College, Taipei (China); National Taiwan University Hospital, Department of Medical Imaging, Douliu City (China); Wang, Yu-Fen; Lee, Chung-Wei; Chen, Ya-Fang [National Taiwan University, Department of Medical Imaging and Radiology, Hospital and Medical College, Taipei (China); Liu, Hon-Man [National Taiwan University, Department of Medical Imaging and Radiology, Hospital and Medical College, Taipei (China); Fu Jen Catholic University, Department of Medical Imaging and Radiology, Hospital and Medical College, New Taipei City (China); Fu Jen Catholic University Hospital, Department of Medical Imaging, New Taipei City (China); Hsieh, Hong-Jen [National Taiwan University Hospital, Department of Medical Imaging, Douliu City (China)

2018-01-15

Computed tomography angiography (CTA) and magnetic resonance imaging/angiography (MRI/MRA) are used for the diagnosis of intracranial dural arteriovenous fistulas (DAVFs). The purpose of this study was to compare the diagnostic accuracy of CTA and magnetic resonance imaging/angiography (MRI/MRA) for detection of cortical venous reflux (CVR) in intracranial DAVFs. The records of patients with angiography-confirmed intracranial DAVFs who also received CTA and MRI/MRA from January 2008 to July 2016 were reviewed. CTA and MRI/MRA were reviewed for signs of CVR, and the diagnostic accuracy of individual signs was evaluated by receiver operating curve (ROC) analysis. A total 108 patients were included in this study. CTA signs of CVR included abnormal dilatation, early enhancement, and the presence of a medullary or pial vein. MRI/MRA signs of CVR included abnormal dilatation, early enhancement, flow-related enhancement, flow void, and medullary or pial venous collaterals. The sensitivity of individual CTA signs ranged from 62 to 96%, and specificities from 79 to 94%. The sensitivities of individual MRI/MRA signs ranged from 58 to 83%, and specificities from 77 to 93%. The area under ROC curve (AUC) of CTA and MRI/MRA were 0.91 and 0.87, respectively (P = 0.04 in direct comparison). In subgroup analysis, CTA had better diagnostic accuracy for higher grade disease (P = 0.05) and non-aggressive manifestation (P = 0.04). Both CTA and MRI/MRA have good diagnostic accuracy for detection of CVR in patients with intracranial DAVFs. There is modest evidence that CTA is better than MRI/MRA. (orig.)

Fast imaging employing steady-state acquisition (FIESTA) MRI to investigate cerebrospinal fluid (CSF) within dural reflections of posterior fossa cranial nerves.

Science.gov (United States)

Noble, David J; Scoffings, Daniel; Ajithkumar, Thankamma; Williams, Michael V; Jefferies, Sarah J

2016-11-01

There is no consensus approach to covering skull base meningeal reflections-and cerebrospinal fluid (CSF) therein-of the posterior fossa cranial nerves (CNs VII-XII) when planning radiotherapy (RT) for medulloblastoma and ependymoma. We sought to determine whether MRI and specifically fast imaging employing steady-state acquisition (FIESTA) sequences can answer this anatomical question and guide RT planning. 96 posterior fossa FIESTA sequences were reviewed. Following exclusions, measurements were made on the following scans for each foramen respectively (left, right); internal acoustic meatus (IAM) (86, 84), jugular foramen (JF) (83, 85) and hypoglossal canal (HC) (42, 45). A protocol describes measurement procedure. Two observers measured distances for five cases and agreement was assessed. One observer measured all the remaining cases. IAM and JF measurement interobserver variability was compared. Mean measurement difference between observers was -0.275 mm (standard deviation 0.557). IAM and JF measurements were normally distributed. Mean IAM distance was 12.2 mm [95% confidence interval (CI) 8.8-15.6]; JF was 7.3 mm (95% CI 4.0-10.6). The HC was difficult to visualize on many images and data followed a bimodal distribution. Dural reflections of posterior fossa CNs are well demonstrated by FIESTA MRI. Measuring CSF extension into these structures is feasible and robust; mean CSF extension into IAM and JF was measured. We plan further work to assess coverage of these structures with photon and proton RT plans. Advances in knowledge: We have described CSF extension beyond the internal table of the skull into the IAM, JF and HC. Oncologists planning RT for patients with medulloblastoma and ependymoma may use these data to guide contouring.

Clinical and radiological profile of Hirayama disease: A flexion myelopathy due to tight cervical dural canal amenable to collar therapy

Directory of Open Access Journals (Sweden)

K M Hassan

2012-01-01

Full Text Available Background: Hirayama disease (HD is benign focal amyotrophy of the distal upper limbs, often misdiagnosed as motor neuron disease. Routine magnetic resonance imaging (MRI is often reported normal. Objective: To study the clinicoradiological profile of hand wasting in young males. Materials and Methods: Patients presenting with insidious-onset hand wasting from March 2008 to May 2011 were evaluated electrophysiologically. Cervical MRI in neutral position was done in 11 patients and flexion contrast imaging was done in 10 patients. Results: All patients were males less than 25 years of age, with median age 23 years, except one patient who was 50 years old. Duration of illness was 3 months to 3 years. All (100% had oblique amyotrophy, four (36% cold paresis, 10 (91% minipolymyoclonus and three (27% had fasciculations. Regional reflexes were variably absent. Two patients (18% had brisk reflexes of lower limbs with flexor plantars. Electromyography (EMG showed chronic denervation in the C7-T1 myotomes. Neutral position MRI showed loss of cervical lordosis in 10/11 (91%, localized lower cervical cord atrophy in 9/11 (82%, asymmetric cord flattening in 11/11 (100% and intramedullary hyperintensity in 2/11 (18%; flexion study showed loss of dural attachment, anterior displacement of dorsal dura, epidural flow voids in 9/10 (90% and enhancing epidural crescent in 10/10 (100%. Clinical profile, imaging and electrophysiological findings of the patient aged 50 years will be described in detail as presentation at this age is exceptional. Collar therapy slowed progression in most cases. Conclusion: Clinical features of HD corroborated well with electrophysiological diagnosis of anterior horn cell disease of lower cervical cord. While dynamic contrast MRI is characteristic, routine studies have a high predictive value for diagnosis. Prompt diagnosis is important to institute early collar therapy.

MRI in the liquor hypotension syndrome: a case report and review of literature

International Nuclear Information System (INIS)

Costa Machado Junior, Marcos Alberto da; Barbosa, Veronica Aline Oliveira; Taglietti, Isabella; D'Almeida Filho, Fernando.

1996-01-01

The case of a man is presented, who suddenly suffered headaches, with no other neurological disorder or clinical symptom, that partially remitted only in horizontal decubitus. The magnetic resonance imaging (MRI) investigation showed isointense dural thickening or detachment of the convexity in T1, that was hyperintense in T2. After contrast medium i.v. injection, MRI images showed diffuse and marked dural enhancement of the convexity, along the tentorium, at the base, in the upper cervix. Liquor hypotension, accompanied by dural thickening and enhancement visible by MRI have been reported in the literature. In this case, no loss of cerebrospinal fluid was identified as a possible cause for its reduced pressure. Within the frame work of essential liquor hypotension, the authors underline the postural nature of headaches, and hypothesizes the dural alterations are the expression of traction inducing tears in the dural border cell layer with consequent blood extravasation. The correlation of the radiological aspects with these alterations and their changes are discussed. (author). 11 refs., 2 figs

Fatal Klippel-Trenaunay syndrome in a child with pulmonary embolism

DEFF Research Database (Denmark)

Pedersen, Rie Skovgaard; Hedelund, Lene; Poulsen, Lone H

2013-01-01

Klippel-Trénaunays syndrom (KTS) er en sjælden, medfødt sygdom, der er kendetegnet ved venøse malformationer (VM), kutane kapillære malformationer og overvækst af bløddele og/eller knogler [1]. Forekomst af hyperkoagulabilitet, trombosering og lungeemboli er tidligere beskrevet hos patienter med ...

Compression of the posterior fossa venous sinuses by epidural hemorrhage simulating venous sinus thrombosis: CT and MR findings

Energy Technology Data Exchange (ETDEWEB)

Singh, Sumit; Ramakrishnaiah, Raghu H.; Hegde, Shilpa V.; Glasier, Charles M. [University of Arkansas for Medical Sciences, Pediatric Radiology, Little Rock, AR (United States)

2016-01-15

Posterior fossa dural venous sinus thrombus is a well-described complication of head trauma, especially when fracture crosses the dural sinus grooves or in association with epidural hemorrhage. We have found that post-traumatic posterior fossa epidural hematoma compressing a dural venous sinus can mimic dural venous thrombus. To discuss the CT and MRI findings of posterior fossa epidural hemorrhages simulating sinus thrombosis, to make radiologists aware of this important imaging pitfall. We describe radiologic findings in four children in whom a posterior fossa epidural hemorrhage mimicked dural venous sinus thrombus. Routine CT head and CT venography were obtained on Toshiba volume and helical CT scanners. MRI and MR venography were performed on a Philips scanner. In all cases there was medial displacement and compression of the posterior fossa dural venous sinuses without intraluminal thrombosis. The epidural hemorrhage was seen tracking along sinus grooves in the occipital bone, peeling the dura containing the sinuses from the calvarium and compressing the sinus, simulating thrombosis on axial CT views. Both venous sinus thrombosis and posterior fossa epidural hemorrhages in children are well-described complications of head trauma. Posterior fossa epidural hemorrhage can mimic a sinus thrombus by compressing and displacing the sinuses. It is important to recognize this pitfall because treatment of a suspected thrombus with anticoagulation can worsen epidural hemorrhage. (orig.)

Compression of the posterior fossa venous sinuses by epidural hemorrhage simulating venous sinus thrombosis: CT and MR findings

International Nuclear Information System (INIS)

Singh, Sumit; Ramakrishnaiah, Raghu H.; Hegde, Shilpa V.; Glasier, Charles M.

2016-01-01

Posterior fossa dural venous sinus thrombus is a well-described complication of head trauma, especially when fracture crosses the dural sinus grooves or in association with epidural hemorrhage. We have found that post-traumatic posterior fossa epidural hematoma compressing a dural venous sinus can mimic dural venous thrombus. To discuss the CT and MRI findings of posterior fossa epidural hemorrhages simulating sinus thrombosis, to make radiologists aware of this important imaging pitfall. We describe radiologic findings in four children in whom a posterior fossa epidural hemorrhage mimicked dural venous sinus thrombus. Routine CT head and CT venography were obtained on Toshiba volume and helical CT scanners. MRI and MR venography were performed on a Philips scanner. In all cases there was medial displacement and compression of the posterior fossa dural venous sinuses without intraluminal thrombosis. The epidural hemorrhage was seen tracking along sinus grooves in the occipital bone, peeling the dura containing the sinuses from the calvarium and compressing the sinus, simulating thrombosis on axial CT views. Both venous sinus thrombosis and posterior fossa epidural hemorrhages in children are well-described complications of head trauma. Posterior fossa epidural hemorrhage can mimic a sinus thrombus by compressing and displacing the sinuses. It is important to recognize this pitfall because treatment of a suspected thrombus with anticoagulation can worsen epidural hemorrhage. (orig.)

Bioremediation protocols

National Research Council Canada - National Science Library

Sheehan, David

1997-01-01

.... . .. . . . .. . . . ,. . . . .. . . . .. . . . .. . . . . . . .. . .. .. . ., . .. . 45 3 Screemng of Bacterial Products for Their Biodegradation Effectiveness, Albert D. Venosa, John R. Haines, and B. Loye Eberhart.. Measurement of Btosurfactant...

MRI determination of the vertebral termination of the dural sac tip in a South African population: clinical significance during spinal irradiation and caudal anaesthesia

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A Cilliers

2010-08-01

Full Text Available Abstract Knowing where the dural sac (DS ends is important, especially when placing the portal fields during craniospinal irradiation (CSI and performing caudal anesthesia. The purpose of this investigation was to determine the level of termination of the DS in relation to the spine in a group of South African patients using magnetic resonance imaging (MRI. We retrospectively reviewed the lumbosacral MR Imaging of 309 patients in each case identifying the tip of the DS. This level was recorded in relation to the adjacent vertebral body i.e. upper-, middle- and lower third and adjacent intervertebral disc. The overall mean of the DS position was at the middle third of S2. A notable percentage (13.9% of patients had a DS level lower than the lower third of S2 and (15.2% patients had a DS level higher than the S1-S2 intervertebral disc. This study failed to demonstrate a difference in the DS termination level, compared to the levels reported in various international studies; nor is there a statistical difference between gender, race and age. Our study shows that routine placement of the portal field at the lower border of S2 adequately treats the majority of CSI patients. However some patients (13.9% will be undertreated and some patients (15.2% will be overradiated. Using spinal MRI to establish the lower border of the CSI portal field will however benefit patients by ensuring adequate coverage of the entire neuroaxis as well as minimizing late gonadal toxicity due to overradiation.

Intra-Arterial MR Perfusion Imaging of Meningiomas: Comparison to Digital Subtraction Angiography and Intravenous MR Perfusion Imaging.

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Mark A Lum

Full Text Available To evaluate the ability of IA MR perfusion to characterize meningioma blood supply.Studies were performed in a suite comprised of an x-ray angiography unit and 1.5T MR scanner that permitted intraprocedural patient movement between the imaging modalities. Patients underwent intra-arterial (IA and intravenous (IV T2* dynamic susceptibility MR perfusion immediately prior to meningioma embolization. Regional tumor arterial supply was characterized by digital subtraction angiography and classified as external carotid artery (ECA dural, internal carotid artery (ICA dural, or pial. MR perfusion data regions of interest (ROIs were analyzed in regions with different vascular supply to extract peak height, full-width at half-maximum (FWHM, relative cerebral blood flow (rCBF, relative cerebral blood volume (rCBV, and mean transit time (MTT. Linear mixed modeling was used to identify perfusion curve parameter differences for each ROI for IA and IV MR imaging techniques. IA vs. IV perfusion parameters were also directly compared for each ROI using linear mixed modeling.18 ROIs were analyzed in 12 patients. Arterial supply was identified as ECA dural (n = 11, ICA dural (n = 4, or pial (n = 3. FWHM, rCBV, and rCBF showed statistically significant differences between ROIs for IA MR perfusion. Peak Height and FWHM showed statistically significant differences between ROIs for IV MR perfusion. RCBV and MTT were significantly lower for IA perfusion in the Dural ECA compared to IV perfusion. Relative CBF in IA MR was found to be significantly higher in the Dural ICA region and MTT significantly lower compared to IV perfusion.

Factores de riesgo de la enfermedad tromboembólica en puérperas

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Yudelca Esperanza Abelino Castillo

2013-12-01

Full Text Available Introducción: la enfermedad tromboembólica es una de las principales causas de morbilidad y mortalidad materna en los países desarrollados. Objetivo: determinar los factores de riesgo de la enfermedad tromboembolia durante el puerperio en gestantes con riesgo ingresadas en el Hospital General "Abel Santamaría Cuadrado" en el período de enero a diciembre del año 2011 para disminuir su incidencia. Material y método: se realizó un estudio observacional, longitudinal, analítico y aplicado. De un universo total de 5598 paridas o cesareadas, la muestra definitiva quedó constituida por 47 casos y 23 controles aleatoriamente. La información se obtuvo de las historias clínicas individuales. Para analizar las variables utilizamos el porcentaje y la determinación del odds ratio (OR, el intervalo de confianza (IC, así como la prueba estadística X2. Resultados: el riesgo de la enfermedad tromboembólica fue independiente de la edad materna y la paridad, pero fue 23,57 veces mayor en las que usaron anticonceptivos orales, así como en el 31,9 % de las pacientes con insuficiencia venosa, y en el 73,4% de las pacientes cesareadas y con trombosis venosa superficial, donde predominaron el dolor, el edema y la taquicardia. Conclusiones: la condición de estado trombofílico obliga a su vigilancia estrecha durante el puerperio para detectar los factores de riesgo más frecuentes de la enfermedad tromboembólica venosa (uso de anticonceptivos orales, pacientes con insuficiencia venosa y cesareadas, siendo su tratamiento profiláctico la piedra angular para prevenir los episodios trombóticos.

Chronic subdural haematoma complicating spinal anaesthesia: A ...

African Journals Online (AJOL)

Subdural haematoma is a rare but serious complication of dural puncture. We report a case of chronic subdural haematoma, which occurred following spinal anaesthesia for elective caesarean section. A 34-year-old multiparous woman presented with a post-dural puncture headache (PDPH) following spinal anaesthesia.

Trombosis venosa en el embarazo

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DR. M. Fernando Ferrer

2014-11-01

El uso de anticoagulantes en pacientes obstétricas requiere de un plan de interrupción del embarazo lo más controlado posible. En la práctica clínica cotidiana esto no siempre es posible, debido a la incapacidad de predecir el momento de inicio del trabajo de parto. Por este motivo las recomendaciones relativas al manejo analgésico y anestésico del parto están basadas en el conocimiento de los cambios fisiológicos, farmacocinético y farmacodinámico de los anticoagulantes utilizados, lo que se analiza en extenso en esta revisión.

Immunohistochemical profile of neurotrophins in human cranial dura mater and meningiomas.

Science.gov (United States)

Artico, Marco; Bronzetti, Elena; Pompili, Elena; Ionta, Brunella; Alicino, Valentina; D'Ambrosio, Anna; Santoro, Antonio; Pastore, Francesco S; Elenkov, Ilia; Fumagalli, Lorenzo

2009-06-01

The immunohistochemical profile of neurotrophins and their receptors in the human cranial dura mater was studied by examining certain dural zones in specimens harvested from different regions (frontal, temporal, parietal and occipital). Dural specimens were obtained during neurosurgical operations performed in ten patients for surgical treatment of intracranial lesions (meningiomas, traumas, gliomas, vascular malformations). The dural fragments were taken from the area of the craniotomy at least 8 cm from the lesion as well as from the area in which the meningioma had its dural attachment. Immunohistochemical characterization and distribution of neurotrophins, with their receptors, were analyzed. The concrete role played by these neurotrophic factors in general regulation, vascular permeability, algic responsivity and release of locally active substances in the human dura mater is still controversial. Our study revealed a general structural alteration of dural tissue due to the invasivity of meningiomatous lesions, together with an improved expression of brain derived neurotrophic factor (BDNF) in highly proliferating neoplastic cells and an evident production of nerve growth factor (NGF) in inflammatory cells, suggesting that BDNF has a role in supporting the proliferation rate of neoplastic cells, while NGF is involved in the activation of a chronic inflammatory response in neoplastic areas.

Hipoxemia por fístulas artério-venosas pulmonares em criança: relato de caso Hipoxemia por fístulas artério-venosas pulmonares en niño: relato de caso Hypoxemia by pulmonary arteriovenous fistulae in childhood: case report

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Aleksandra Paula Lima

2004-08-01

Full Text Available JUSTIFICATIVA E OBJETIVOS: A presença de fístulas artério-venosas pulmonares (FAVP deve ser investigada em pacientes com cianose sem causa esclarecida. O objetivo é relatar um caso de lobectomia pulmonar em criança portadora de FAVP. RELATO DO CASO: Paciente do sexo masculino, 3 anos, com história de cianose sem dispnéia desde 8 meses, com baqueteamento digital e ausculta cardíaca normal. ECG e ecocardiografia eram normais e a radiografia de tórax mostrou condensação na metade superior do pulmão esquerdo. A gasometria arterial mostrou PaO2 de 28 mmHg, em ar ambiente, e PaO2 de 31,5 mmHg com cateter nasal de O2. Foi feito diagnóstico de FAVP através de ressonância nuclear magnética, sem possibilidade de embolização. O paciente foi submetido a lobectomia superior esquerda sob anestesia geral associada à anestesia subaracnóidea com morfina e bupivacaína. Foi realizada ventilação monopulmonar com introdução do tubo traqueal seletivo para o pulmão direito. A SaO2 era: em ar ambiente de 59%; à admissão à sala de operações, 69% (FiO2 = 1,0; após indução da anestesia geral, 65% (FiO2 = 1,0; durante a ventilação monopulmonar, 58% (FiO2 = 1,0; após a lobectomia e 98% (FiO2 = 0,6 ao final da cirurgia, com extubação traqueal uma hora após o final do procedimento. A partir do 5º dia de pós-operatório, começou a apresentar progressiva diminuição da SpO2 (até 83% devido aumento de outra FAVP, tratada com embolização sob anestesia geral. A alta hospitalar ocorreu no 15º do pós-operatório. CONCLUSÕES: Neste caso, havia refratariedade à suplementação com O2 e houve melhora imediata com o tratamento cirúrgico. Entretanto, após ressecção da FAVP de maior tamanho ocorreu aumento de outra fístula, que contribuiu para a diminuição da SpO2 no pós-operatório, revertida com a embolização. Com o crescimento da criança, outras fístulas pulmonares ou em outros órgãos poderão surgir, caracterizando a s

Endovascular management of massive pulmonary embolism with clot fragmentation and suction Tratamento endovascular de embolia pulmonar maciça com fragmentação e aspiração de trombos

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Sergio Quilici Belczak

2013-03-01

Full Text Available Massive pulmonary embolism with right ventricular dysfunction may be treated with thrombolysis, embolectomy, or percutaneous mechanical thrombectomy. This study describes our experience with two patients that had massive pulmonary embolism and were treated with percutaneous mechanical thrombectomy and reports on the mid-term results of this procedure. A 28-year-old man and a 70-year-old woman were diagnosed with deep venous thrombosis and massive pulmonary embolism. They first had lower limb edema followed by sudden onset of dyspnea. Their physical examination revealed edema, tachypnea, chest discomfort and jugular turgescence. Both needed to receive oxygen using a nasal cannula. Doppler ultrasound, echocardiography, and computed tomography angiography were used to establish the diagnoses. Patients underwent percutaneous mechanical thrombectomy using the Aspirex® system (Straub Medical, and their clinical condition and imaging study findings improved substantially. At mid-term follow-up, patient conditions were improving satisfactorily.A embolia pulmonar maciça com disfunção do ventrículo direito pode ser tratada com trombólise, embolectomia ou trombectomia mecânica percutânea. Este estudo descreve nossa experiência com dois pacientes com embolia pulmonar maciça tratados com trombectomia mecânica percutânea e relata os resultados a médio prazo desse procedimento. Um homem de 28 anos e uma mulher de 70 anos foram diagnosticados com trombose venosa profunda e embolia pulmonar maciça. Inicialmente, eles tiveram edema de membros inferiores seguido por início súbito de dispneia. O exame físico revelou edema, taquipneia, desconforto torácico, turgência jugular. Em ambos havia sinais de hipóxia e precisaram receber oxigênio usando uma cânula nasal. A ultrassonografia Doppler ecocardiograma e angiotomografia foram utilizadas para estabelecer os diagnósticos. Os pacientes foram submetidos à trombectomia mecânica percut

Hemoglobinúria paroxística noturna: revisão bibliográfica e relatos de casos de pacientes em tratamento com eculizumabe no ambulatório de hematologia do Conjunto Hospitalar de Sorocaba

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Antonianna Furtado Cavalcante Vecina

2015-10-01

Full Text Available A Hemoglobinúria Paroxística Noturna (HPN é uma desordem hematológica rara causada por mutações somáticas adquiridas no gene PIG-A e que levam à deficiência na síntese de âncoras de GPI, responsáveis por manter aderidas à membrana plasmática proteínas como a CD55 e a CD59, expressas em todas as células hematopoiéticas. Por provocar, caracteristicamente, anemia hemolítica, pancitopenia e trombose venosa, a expressão “tríade da HPN” é utilizada a fim de se fazer referência a essas condições apresentadas com frequência no curso clínico da doença. O Eculizumabe, um anticorpo monoclonal, é a mais recente forma de tratamento para HPN. O objetivo dessa pesquisa é caracterizar a população portadora de HPN atendida no ambulatório de Hematologia do Conjunto Hospitalar de Sorocaba (CHS, realizar revisão bibliográfica sobre o tema e avaliar a resposta ao tratamento com Eculizumabe. Trata-se de estudo retrospectivo observacional dos pacientes portadores de HPN, diagnosticada através de Imunofenotipagem, atendidos no ambulatório de Hematologia do CHS, entre 2006 e 2015. Sete pacientes foram identificados como portadores de HPN. A mediana de idade foi de 49 anos, com discreto predomínio do sexo masculino. Os sintomas apresentados com maior frequência foram os relacionados à anemia. Todos os pacientes, além de anemia severa, também evidenciavam leucopenia e plaquetopenia. A maioria apresentava DHL elevado. Os pacientes em tratamento com Eculizumabe (n=4 apresentaram melhora dos sintomas, normalização da hemoglobina (p= 0,0092 e diminuição dos níveis de DHL (p=0,2378. Assim, todos pacientes com HPN apresentavam anemia severa e DHL como principal marcador de hemólise. O uso do Eculizumabe se provou eficaz na melhora do nível de hemoglobina dos pacientes, deixando-os livres de anemia e de transfusões.

Anticorpos antifosfolípides em 66 pacientes com infarto cerebral entre 15 e 40 anos Antiphospholipid antibodies in 66 patients with cerebral infarction between 15 and 40 years old

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José Ibiapina Siqueira Neto

1996-12-01

Full Text Available Os anticorpos antifosfolípides (aFLs constituem grupo heterogêneo de imunoglobulinas que tem sido relacionado com alterações na coagulabilidade. Indivíduos com títulos elevados teriam maior probabilidade de desenvolver tromboses de repetição, tanto arterial como venosa, e por conseguinte infarto cerebral (IC. Os testes para detecção mais utilizados em estudos clínicos são o inibidor lúpico e a anticardiolipina. Têm-se relatado maiores percentuais de positividade nesses testes em pacientes jovens com IC. Neste estudo procuramos investigar a prevalência desses anticorpos em pacientes com IC entre 15 e 40 anos em nosso Serviço. Examinamos 66 pacientes para presença de aFLs e obtivemos 16,65% de resultados positivos. Confirmamos diagnóstico de síndrome do anticorpo antifosfolípide primária em três (4,55% casos. Concluímos que a pesquisa de rotina para aFLs em pacientes jovens com IC está indicada neste grupo de pacientes, mas correlacioná-los com o episódio isquêmico nem sempre é possível.The antiphospholipid antibodies (aPLs are a heterogenous group of immunoglobulins that have been related with alterations in blood coagulability in recent years. Patients with elevated titers of these antibodies have a high probability to develop thrombotic events, including cerebral infarct (CI. The tests currently used to detect these antibodies are the lupus anticoagulant and ELISA for anticardiolipin antibodies which have a larger proportion of positivity among young patients with CI. In our study we tested 66 patients with cerebral infarcts whose ages ranged from 15 to 40 years for the presence of lupus anticoagulant and anticardiolipin antibodies. The results showed that eleven (16.65% patients were positive for aPLs and three (4.55% of them fulfilled the diagnostic criteria for primary antiphospholipid syndrome. These data point out to the importance of investigating aPLs in young patients with CI and its high prevalence in this

Radicular dysfunction due to spinal deformities in Marfan syndrome at older age: three case reports.

NARCIS (Netherlands)

Voermans, N.C.; Hosman, A.J.F.; Alfen, N. van; Bartels, R.H.M.A.; Kleuver, M. de; Akker, J.W. op den; Engelen, B.G.M. van

2010-01-01

Marfan syndrome is a inherited connective tissue disorder due to mutations in fibrillin-1. It presents with cardiovascular, ocular, skeletal, pulmonary and dural signs and symptoms. Some of the symptoms of later onset are those associated with scoliosis and dural ectasia. This is the enlargement of

The use of lumbar X-rays to facilitate neuraxial anaesthesia during ...

African Journals Online (AJOL)

2012-05-10

May 10, 2012 ... anaesthesia in patients who had undergone previous lumbar spinal surgery. Method ... the ease and safety of the neuraxial anaesthesia procedure. The study group ... There were three dural taps without any post-dural puncture headaches .... methods or aids used during the performance of neuraxial.

Análise dos fatores de risco relacionados ao tromboembolismo venoso em mulheres de idade fértil em Itajubá – Minas Gerais / Analysis of risk factors related to venous thromboembolism in women of childbearing age in Itajubá – Minas Gerais

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Melissa Andreia de Moraes Silva,

2017-09-01

Full Text Available Introdução: O tromboembolismo venoso (TEV incide em mulheres de idade fértil e a identificação dos fatores de risco é ponto crucial para sua prevenção. Objetivos: Identificar e correlacionar os fatores de risco mais comuns para o desencadeamento de TEV em mulheres de 14 a 50 anos. Métodos: Analisadas 30 mulheres com diagnóstico recente de trombose venosa profunda (TVP de membros inferiores por meio de ultrassonografia com Doppler colorido e de seus prontuários, no período de julho de 2011 a julho de 2016. Os fatores de risco foram descritos em proporções e comparados através de teste exato de Fisher. Resultados: A média de idade foi de 37,4 anos. O índice de massa corpórea médio foi de 27,4 kg/m2 e a média de gestações foi de 2,3 por paciente. Setenta por cento apresentaram TVP, e a prevalência em ambos os membros foi igual. Cirurgias recentes, história familiar de TEV, doenças associadas e uso de contraceptivos orais (CO foram os mais prevalentes na população estudada (53,8%, 42,3%, 42,3% e 38,5%, respectivamente. Uso de CO, cirurgia recente e varizes de grosso calibre foram os fatores mais relacionados à recorrência da trombose (p<0,05. Conclusão: Pode-se concluir que a presença de varizes, cirurgia recente e história familiar são os fatores de risco mais associados à presença de TVP em mulheres de idade fértil. Uso de CO, cirurgia recente e presença de varizes são os fatores de risco mais estatisticamente relacionados à recorrência da TVP. Introduction: Venous thromboembolism (VTE affects women of childbearing age and the identification of risk factors is a key point for preventing its development. Aims: To identify and correlate the most common risk factors for the development of VTE in women aged 14-50 years. Meth-ods: We analyzed 30 women with recent diagnosis of deep venous thrombosis (DVT of the lower limbs using Doppler color ultrasonography and their medical records from July 2011 to July 2016

Trombosering af mekanisk mitralklapprotese under behandling med dabigatran

DEFF Research Database (Denmark)

Thomsen, Jakob Hartvig; Kjaergaard, Jesper; Saust, Laura Trolle

2014-01-01

Dabigatran has been approved for prevention of thromboembolic complications in nonvalvular atrial fibrillation. We present a case of thrombosis of a mechanical prosthetic mitral valve during anticoagulation with dabigatran, switched from warfarin. The patient presented with cardiogenic shock, was...

Venøse tromboser hos børn

DEFF Research Database (Denmark)

Tuckuviene, Ruta; Johnsen, Søren Paaske; Helgestad, Jon

2008-01-01

Venous thromboembolism is a rare condition in children, but the incidence appears to be increasing. Newborns and teenagers are at the highest risk of thrombosis, which is often triggered by a combination of risk factors, in particular: infection, central venous line or chemotherapy. The impact...... of thrombophilia is uncertain. International guidelines recommend screening for thrombophilia as part of the diagnostic set-up in children with thrombosis. Treatment of paediatric thrombosis with low-molecular-weight heparin appears safe, but the effectiveness remains to be established. Udgivelsesdato: 2008-Oct-20...

post-operative morbidity of the obese patient undergoing posterior

African Journals Online (AJOL)

urinary tract infection, neurological injury and dural tears. Methods: One hundred consecutive patients undergoing ... muscle mass in the human body, in which weight in kilograms is divided by height in meters2). The current .... complications with the exception of one dural tear occurred in the obese patient group. Table 3.

Effect of the period of extrinsic mechanical compression following sclerotherapy in veins in rabbit ears Efeito do tempo da compressão mecânica extrínseca após escleroterapia em veias de orelhas de coelhos

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Cláudio Santana Ivo

2011-06-01

� suficiente para evitar reperfusão nas veias tratadas; se há relação entre a intensidade inflamatória na parede venosa e tecidos adjacentes e o tamanho do trombo venoso; se a intensidade da inflamação pós-escleroterapia varia com o tempo de compressão; se há relação entre a presença de hemossiderina nos tecidos adjacentes ao vaso esclerosado e coágulo venoso. MÉTODOS: Utilizaram-se 28 coelhos, machos, distribuídos em quatro grupos (0, 24, 72 e 120. Em todos os animais foram administrados 0,25 ml de solução de polidocanol 1% e, como controle, 0,25 ml de solução de cloreto de sódio 0,9% na veia marginal dorsal das orelhas direita e esquerda, respectivamente. Realizou-se compressão mecânica em trecho da veia perfundida, exceto nos animais do grupo 0. O tempo de compressão variou de 0 a 120 horas nos grupos. Realizou-se exame anatomopatológico de trecho das veias marginais dorsais direita e esquerda de todos os animais. RESULTADOS: Não houve diferenças significativas nos diversos tempos de compressão, tanto no grau de trombose venosa como na intensidade inflamatória, em ambas as orelhas, nos diversos grupos. Observou-se correlação positiva e significativa entre intensidade inflamatória e tamanho do trombo e na ocorrência de trombos e hemossiderina. CONCLUSÕES: O tempo de até 120 horas de compressão não é suficiente para evitar reperfusão nos vasos esclerosados. A intensidade da inflamação nos tecidos tem relação com o tamanho do trombo, mas não com o tempo de compressão. A presença de hemossiderina nos tecidos adjacentes ao vaso submetido à esclerose está relacionada com a presença de coágulo venoso.

Landmarks for Sacral Debridement in Sacral Pressure Sores.

Science.gov (United States)

Choo, Joshua H; Wilhelmi, Bradon J

2016-03-01

Most cases of sacral osteomyelitis arising in the setting of sacral pressure ulcers require minimal cortical debridement. When faced with advanced bony involvement, the surgeon is often unclear about how much can safely be resected. Unfamiliarity with sacral anatomy can lead to concerns of inadvertent entry into the dural space and compromise of future flap options. A cadaveric study (n = 6), in which a wide posterior dissection of the sacrum, was performed. Relationships of the dural sac to bony landmarks of the posterior pelvis were noted. The termination of the dural sac was found in our study to occur at the junction of S2/S3 vertebral bodies, which was located at a mean distance of 0.38 ± 0.16 cm distal to the inferior-most extent of the posterior superior iliac spine (PSIS). The mean thickness of the posterior table of sacrum at this level was 1.7 cm at the midline and 0.5 cm at the sacral foramina. The PSIS is a reliable landmark for localizing the S2/S3 junction and the termination of the dural sac. Sacral debridement medial to the sacral foramina above the level of PSIS must be conservative whenever possible. If aggressive debridement is necessary above this level, the surgeon must be alert to the possibility of dural involvement.

Temporalis myofascial repair of traumatic defects of the anterior fossa. Technical note.

Science.gov (United States)

Gillespie, R P; Shagets, F W; de los Reyes, R A

1986-06-01

Bilateral temporalis myofascial flaps in continuity with frontal periosteum can be used in repairing extensive dural and bone defects of the anterior cranial fossa floor. The technique of preserving and using this flap is described and offers an alternative to the use of frontal pericranial tissue for repair of anterior dural defects.

Nuevos antitrombóticos. ¿Qué debe conocer el cirujano cardiovascular?

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José A. Páramo

2011-01-01

Full Text Available La trombosis es una de las causas de muerte más importante en los países industrializados. La trombosis arterial es responsable del infarto de miocardio y de los accidentes cerebrovasculares y se genera en zonas de daño arterial. Los antiplaquetarios y anticoagulantes desempeñan un papel fundamental en la prevención y tratamiento. La enfermedad tromboembólica venosa, a través de la trombosis venosa profunda y la embolia pulmonar, es la tercera causa de muerte después de los eventos arteriales. Ésta suele tratarse con anticoagulantes. En este trabajo se revisan los nuevos fármacos antiplaquetarios y anticoagulantes y su impacto en la cirugía cardiovascular.

Microwave hematoma detector

Science.gov (United States)

Haddad, Waleed S.; Trebes, James E.; Matthews, Dennis L.

2001-01-01

The Microwave Hematoma Detector is a non-invasive device designed to detect and localize blood pooling and clots near the outer surface of the body. While being geared towards finding sub-dural and epi-dural hematomas, the device can be used to detect blood pooling anywhere near the surface of the body. Modified versions of the device can also detect pneumothorax, organ hemorrhage, atherosclerotic plaque in the carotid arteries, evaluate perfusion (blood flow) at or near the body surface, body tissue damage at or near the surface (especially for burn assessment) and be used in a number of NDE applications. The device is based on low power pulsed microwave technology combined with a specialized antenna, signal processing/recognition algorithms and a disposable cap worn by the patient which will facilitate accurate mapping of the brain and proper function of the instrument. The invention may be used for rapid, non-invasive detection of sub-dural or epi-dural hematoma in human or animal patients, detection of hemorrhage within approximately 5 cm of the outer surface anywhere on a patient's body.

Brain MRI findings of spontaneous intracranial hypotension

Energy Technology Data Exchange (ETDEWEB)

Park, Won Kyu; Byun, Woo Mok; Cho, Jae Ho; Cho Kil Ho; Hwang, Mi Soo; Park, Bok Hwan [Yeungnam Univ. College of Medicine, Taegu (Korea, Republic of); Joo, Yang Gu [Keimyoung Univ. College of Medicine, Taegu (Korea, Republic of); Lee, Sang Jin [Soonchunhyang Univ. College of Medicine, Seoul (Korea, Republic of)

1997-09-01

To evaluate brain MRI findings of spontaneous intracranial hypotension. A retrospective review of MRI findings was conducted on six patients with clinically proven spontaneous intracranial hypotension; no patient had a history of previous spinal puncture. Follow-up MRI was available in two patients, and to detect CSF leakage, radio-nuclide cisternography(n=3D5), myelography(n=3D1), and MR myelography(n=3D1) were performed. On contrast-enhanced T1WI, diffuse dural enhancement was seen in all cases, subdural hematoma or hygroma was seen in four cases, pituitary gland prominence in four, dural sinus dilatation in four, downward displacement of the cerebellar tonsil in two, downward displacement of the iter in one, and suprasellar and prepontine cistern effacement in two. In no patient was abnormal CSF leakage found. Although dural enhancement, as seen on MRI, is not specific, diffuse enhancement of the dura mater accompanied by subdural hematoma, hygroma, pituitary gland prominence, dural sinus dilatation, downward displacement of the cerebellar tonsil, or suprasellar and prepontine cistern effacement can strongly suggest intracranial hypotension.=20.

[The application of computer aided design and computer aided engineering technique in separation of Pygopagus conjoined twins].

Science.gov (United States)

Zhang, Zhi-cheng; Sun, Tian-sheng; Li, Fang; Tang, Guo-lin

2009-05-19

To explore the effect of CAD and CAE related technique in separation of Pygopagus Conjoined Twins. CT images of Pygopagus conjoined twins were obtained and reconstructed in three-dimensional by Mimics software. 3D entity model of skin and spine of conjoined twins were made by fast plastic technique and equipment according to 3D data model. The circumference and area of fused and independent dural sac were measured by software of AutoCAD. The entity model is real reflection of skin and spine of Pygopagus. It was used in the procedures of discussion, sham operation, skin flap design and informed consent. In the measure of MRI, the circumference and area of fused dural sac was more than of independent dural sac, that is to say, the defect of dural sac can be repaired by direct suture. The intraoperative finding match with imaging measure results. The application of CAD and CAE in the procedure of preoperative plan have gave big help to successful separation of Pygopagus Conjoined Twins.

Describable ability of blood vessels in head and neck by intravenous digital subtraction angiography

International Nuclear Information System (INIS)

Minakuchi, Kazuo; Takada, Keiji; Nakamura, Kenji

1989-01-01

Ninety-four patients with various symptoms of the head and neck were studied by intravenous digital subtraction angiography (IV-DSA). Abnormal findings were obesrved in 12 patients; one with aneurysm in the left internal carotid artery, and 11 with obstruction in the right middle cerebral artery (2), the right internal carotid artery (one), the left subclavian artery (one), the right vertebral artery (6), and the left vertebral artery (one). Motion artifacts were observed in 2 patients. The vertebral arteries were bilaterally equal in size in 42%, and the left vertebral artery was bigger than the right one in 38%. The superior sagittal dural sinus was clearly imaged in 94%. The incidence of excellent images was higher in the right sided than the left sided vein -- 85% vs 50% for the transverse dural sinus, 84% vs 54% for the sigmoid dural sinus, and 88% vs 57% for the jugular vein. Sites of excellent images were all of the dural sinuses and veins (37 cases), confined to the right side (37), confined to the left side (8), and undefined (12). (N.K.)

Hematomas na fossa craniana posterior Haematomata in the posterior fossa

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Mário S. Cademartori

1969-09-01

Full Text Available São relatados 6 casos de hematomas sub-tentorias (um de hematoma subdural crônico, quatro de hematomas intra-cerebelares, um de hematoma extra-dural. Salientando a pequena freqüência dos hematomas da fossa craniana posterior, o autor mostra a necessidade de vários exames complementares para o diagnóstico exato, indispensável para a aplicação de terapêutica cirúrgica adequada.Six cases of sub-tentorial haematomata (one chronic sub-dural, four intra-cerebellar, one extra-dural are reported. Emphasizing the relative rarity of haematomata in the posterior cranial fossa, the author claims the necessity of complementary examinations for proper diagnosis, indispensable for adequate surgical treatment.

Spontaneous herniation of the thoracic spinal cord : a case report

International Nuclear Information System (INIS)

Jin, Sung Chan; Lee, Seong Ro; Park, Dong Woo; Joo, Kyung Bin

2001-01-01

Spontaneous herniation of the spinal cord is a rare disease entity in which spinal cord substance is herniated through a previously uninjured and/or untouched dural. It is a cause of myelopathy that is treatable but difficult to diagnose. We report the CT and MR findings of a case of spontaneous thoracic spinal cord through a dural defect

Tromboprofilaxis en pacientes no quirúrgicos internados en un hospital general

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Marcelo J. Melero

2012-10-01

Full Text Available Los pacientes adultos internados por una enfermedad no quirúrgica tienen un riesgo alto de padecer una tromboembolia venosa y pueden desarrollar alguna forma de esta enfermedad cuando no reciben un tratamiento preventivo adecuado. Los objetivos de este estudio prospectivo, analítico, observacional y transversal, fueron: 1 determinar cuál es el porcentaje de pacientes adultos internados por una enfermedad aguda no quirúrgica en el Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, que tienen indicación de tromboprofilaxis, 2 establecer cuántos de ellos reciben un tratamiento preventivo para la tromboembolia venosa, y 3 comprobar cuántos estaban medicados con alguna forma de tromboprofilaxis sin tener causas que justificaran este tratamiento. Se estudiaron 93 pacientes durante un lapso de 72 horas consecutivas. Se encontró que el 90.3% de ellos necesitaba un tratamiento preventivo para la tromboembolia venosa y el 76.2% de estos enfermos recibían tromboprofilaxis farmacológica. Un 33.3% de los pacientes internados tenía indicado un tratamiento farmacológico preventivo sin tener una causa que justificara esta prescripción. El porcentaje encontrado de pacientes tratados con tromboprofilaxis es más alto que el comunicado en otros estudios observacionales.

Assessment and treatment planning of lateral intracranial dural arteriovenous fistulas in 3 T MRI and DSA: A detailed analysis under consideration of time-resolved imaging of contrast kinetics (TRICKS) and ce-MRA sequences

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Ertl, L.; Brueckmann, H.; Patzig, M.; Brem, C.; Forbrig, R.; Fesl, G. [Ludwig-Maximilians-University, Grosshadern Campus, Department of Neuroradiology, Institute of Clinical Radiology, Munich (Germany); Kunz, M. [Ludwig-Maximilians-University, Grosshadern Campus, Department of Neurosurgery, Munich (Germany)

2016-12-15

The current gold standard in the assessment of lateral intracranial dural arteriovenous fistulas (LDAVF) is digital subtraction angiography (DSA). However, magnetic resonance imaging (MRI) is a non-invasive emerging tool for the evaluation of such lesions. The aim of our study was to compare the DSA to our 3 T MR-imaging protocol including a highly spatial resolved (ce-MRA) and a temporal resolved (''time-resolved imaging of contrast kinetics'', TRICKS) contrast-enhanced MR angiography to evaluate if solely DSA can remain the gold-standard imaging modality for the treatment planning of LDAVF. We retrospectively reviewed matched pairs of DSA and 3 T MRI examinations of 24 patients with LDAVF (03/2008-04/2014) by the same list of relevant criteria for an endovascular LDAVF treatment planning. In particular, we determined intermodality agreement for the Cognard classification, the identifeication of arterial feeders, and the detailed assessment of each venous drainage pattern. Intermodality agreement for the Cognard classification was excellent (k = 1.0). Whereas MRI failed in identifying small arterial feeders, it was superior to the DSA in the assessment of the sinus and the venous drainage pattern. The combination of MRI and DSA is the new gold standard in LDAVF treatment planning. (orig.)

Regeneração do fígado de ratos após oclusão parcial da drenagem venosa hepática Hepatic regeneration after parcial oclusion of hepatic vein drainage in rats

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Luiz Roberto Farion de Aguiar

2009-06-01

Full Text Available INTRODUÇÃO: A regeneração hepática é um mecanismo para superar a perda de tecido funcional do fígado. Este processo é estudado através de diferentes métodos. OBJETIVO: Avaliar o efeito da oclusão parcial da drenagem venosa hepática sobre a regeneração do fígado remanescente de ratos submetidos à hepatectomia parcial. MÉTODO: Foram colhidas biópsias de fígado em 30 ratos Wistar machos, e a seguir realizada hepatectomia a dois terços. Os animais foram divididos em três grupos: um grupo controle e dois grupos de estudo, submetidos a diferentes graus de estenose da veia hepática direita. Após 96 horas do estímulo para regeneração hepática, todos submeteram-se à outra biópsia hepática. Analisaram-se os fragmentos por imunoistoquímica para os marcadores Ki-67 e fator de von Willebrand. Para a leitura das amostras utilizou-se o sistema SAMBA 4000. A deposição de colágeno foi avaliada pela coloração tricrômico de Masson. RESULTADOS: A proliferação celular dos animais submetidos à hepatectomia parcial e estenose moderada ou severa da veia hepática direita persistiu mais elevada quando comparada ao grupo controle. O Índice de Marcação para o Ki-67 foi significativamente mais elevado após a hepatectomia nos grupos submetidos à oclusão parcial da veia hepática, tanto moderada quanto severa. A expressão de fator de von Willebrand estava diminuída após a hepatectomia parcial nos três grupos. Houve pouco depósito de colágeno no tecido hepático nos animais dos dois grupos com estenose da veia hepática direita. CONCLUSÃO: A oclusão parcial da drenagem venosa hepática em ratos submetidos à hepatectomia parcial prolonga o tempo de proliferação de células hepáticas quando comparado aos animais com veias de calibre normal. Como consequência, também houve atraso na restauração da matriz extracelular e na formação de novos vasos sinusoidais.BACKGROUND: Hepatic regeneration is a mechanism to overcome

A patient with C protein deficiency and multiple thromboses. case report Paciente con deficiencia de proteína C y múltiples trombosis: reporte de caso

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Alejandro Román González

2007-08-01

Full Text Available Inherited thrombophilias are an important group of diseases that should be taken into account in the study of patients with thromboembolic disease, particularly in those whose clinical presentation includes frequent and recurrent thrombotic episodes at young age, in unusual sites, and a familial history of thrombosis. We report the case of a patient with C protein deficiency which developed deep venous thromboses of both legs when he was 36 and 37 years old. At 51 years of age he suffered from mesenteric thrombosis requiring surgical treatment and small intestine transplantation. His father had deep venous thrombosis. This is the first report of C protein deficiency in the Colombian literature. Other inherited thrombophilias such as the G20210A mutation in the prothrombin gene and actor V Leiden were absent. Se debe considerar un estado de hipercoagulabilidad primaria o trombofilia heredada en los pacientes con enfermedad tromboembólica venosa. La sospecha clínica se debe dirigir a los pacientes con presentación temprana, recurrente, familiar o en sitios anatómicos poco usuales. En este reporte se describe el caso de un paciente con déficit de proteína C de la coagulación, quien desarrolló trombosis venosa profunda del miembro inferior derecho a los 36 años y un año después, trombosis venosa profunda del miembro inferior izquierdo. A la edad de 51 años presentó trombosis de vasos mesentéricos que condujo a una resección intestinal extensa lo que obligó a un trasplante de intestino delgado. Su padre había presentado trombosis venosa de los miembros inferiores. Se descartó la presencia asociada de la mutación G20210A de la protrombina y del Factor V Leiden. Hasta donde sabemos, es el primer caso de deficiencia de proteína C de la coagulación informado en la literatura colombiana.

Non-contrast-enhanced 4D MR angiography with STAR spin labeling and variable flip angle sampling: a feasibility study for the assessment of Dural Arteriovenous Fistula

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Jang, Jinhee; Kim, Bom-yi; Choi, Hyun Seok; Jung, So-Lyung; Ahn, Kook-Jin; Kim, Bum-soo [The Catholic University of Korea, Department of Radiology, Seoul St. Mary' s Hospital, College of Medicine, Seoul (Korea, Republic of); Schmitt, Peter [Siemens AG, Healthcare Sector, Erlangen (Germany); Kim, Inseong; Paek, Munyoung [Siemens AG, Healthcare, Seoul (Korea, Republic of)

2014-04-15

This study aimed to evaluate the feasibility of non-contrast-enhanced 4D magnetic resonance angiography (NCE 4D MRA) with signal targeting with alternative radiofrequency (STAR) spin labeling and variable flip angle (VFA) sampling in the assessment of dural arteriovenous fistula (DAVF) in the transverse sinus. Nine patients underwent NCE 4D MRA for the evaluation of DAVF in the transverse sinus at 3 T. One patient was examined twice, once before and once after the interventional treatment. All patients also underwent digital subtraction angiography (DSA) and/or contrast-enhanced magnetic resonance angiography (CEMRA). For the acquisition of NCE 4D MRA, a STAR spin tagging method was used, and a VFA sampling was applied in the data readout module instead of a constant flip angle. Two readers evaluated the NCE 4D MRA data for the diagnosis of DAVF and its type with consensus. The results were compared with those from DSA and/or CEMRA. All patients underwent NCE 4D MRA without any difficulty. Among seven patients with patent DAVFs, all cases showed an early visualization of the transverse sinus on NCE 4D MRA. Except for one case, the type of DAVF of NCE 4D MRA was agreed with that of reference standard study. Cortical venous reflux (CVR) was demonstrated in two cases out of three patients with CVR. NCE 4D MRA with STAR tagging and VFA sampling is technically and clinically feasible and represents a promising technique for assessment of DAVF in the transverse sinus. Further technical developments should aim at improvements of spatial and temporal coverage. (orig.)

Non-contrast-enhanced 4D MR angiography with STAR spin labeling and variable flip angle sampling: a feasibility study for the assessment of Dural Arteriovenous Fistula

International Nuclear Information System (INIS)

Jang, Jinhee; Kim, Bom-yi; Choi, Hyun Seok; Jung, So-Lyung; Ahn, Kook-Jin; Kim, Bum-soo; Schmitt, Peter; Kim, Inseong; Paek, Munyoung

2014-01-01

This study aimed to evaluate the feasibility of non-contrast-enhanced 4D magnetic resonance angiography (NCE 4D MRA) with signal targeting with alternative radiofrequency (STAR) spin labeling and variable flip angle (VFA) sampling in the assessment of dural arteriovenous fistula (DAVF) in the transverse sinus. Nine patients underwent NCE 4D MRA for the evaluation of DAVF in the transverse sinus at 3 T. One patient was examined twice, once before and once after the interventional treatment. All patients also underwent digital subtraction angiography (DSA) and/or contrast-enhanced magnetic resonance angiography (CEMRA). For the acquisition of NCE 4D MRA, a STAR spin tagging method was used, and a VFA sampling was applied in the data readout module instead of a constant flip angle. Two readers evaluated the NCE 4D MRA data for the diagnosis of DAVF and its type with consensus. The results were compared with those from DSA and/or CEMRA. All patients underwent NCE 4D MRA without any difficulty. Among seven patients with patent DAVFs, all cases showed an early visualization of the transverse sinus on NCE 4D MRA. Except for one case, the type of DAVF of NCE 4D MRA was agreed with that of reference standard study. Cortical venous reflux (CVR) was demonstrated in two cases out of three patients with CVR. NCE 4D MRA with STAR tagging and VFA sampling is technically and clinically feasible and represents a promising technique for assessment of DAVF in the transverse sinus. Further technical developments should aim at improvements of spatial and temporal coverage. (orig.)

Epidural Anesthesia Complicated by Subdural Hygromas and a Subdural Hematoma

OpenAIRE

Vien, Christine; Marovic, Paul; Ingram, Brendan

2016-01-01

Inadvertent dural puncture during epidural anesthesia leads to intracranial hypotension, which if left unnoticed can cause life-threatening subdural hematomas or cerebellar tonsillar herniation. The highly variable presentation of intracranial hypotension hinders timely diagnosis and treatment. We present the case of a young laboring adult female, who developed subdural hygromas and a subdural hematoma following unintentional dural puncture during initiation of epidural anesthesia.

Embolia pulmonar na sala de cirurgia: relato de caso Embolia pulmonar en sala operatoria: relato de caso Pulmonary embolism in the operating room: case report

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Karina Bernardi Pimenta

2002-04-01

Full Text Available JUSTIFICATIVA E OBJETIVOS: Embolia pulmonar é uma complicação freqüente no período pós-operatório. O objetivo deste relato é apresentar um caso de embolia pulmonar ocorrida na sala de operação e chamar a atenção para a importância da profilaxia de trombose venosa em pacientes cirúrgicos. RELATO DO CASO: Trata-se de um paciente do sexo masculino, 55 anos e 83 kg com diagnóstico de câncer de próstata, submetido a prostatectomia supra-púbica sob anestesia geral. Ao final da cirurgia, o paciente já extubado e logo após sua passagem para a maca de transporte apresentou instabilidade hemodinâmica e diminuição da SpO2 para 80%. Foi reintubado e encaminhado para a UTI. A tomografia computadorizada mostrou imagens com aspecto de embolia pulmonar. O paciente evoluiu para óbito no 5º dia de pós-operatório. CONCLUSÕES: O elevado índice de suspeita não é suficiente para firmar o diagnóstico pois a embolia pulmonar é uma doença silenciosa e a rotina de investigação não possui elevada sensibilidade. A profilaxia precoce e adequada é a melhor estratégia.JUSTIFICATIVA Y OBJETIVOS: Embolia pulmonar es una complicación frecuente en el período pós-operatorio. El objetivo de este relato es presentar un caso de embolia pulmonar ocurrida en la sala de operación y llamar la atención para la importancia de la profilaxis de trombosis venosa en pacientes cirúrgicos. RELATO DE CASO: Se trata de un paciente del sexo masculino, 55 años y 83 kg con diagnóstico de cáncer de próstata, sometido a prostatectomia supra-púbica bajo anestesia general. Al final de la cirugía, el paciente ya entubado y luego después de pasar para la camilla de transporte presentó inestabilidad hemodinámica y diminución de la SpO2 para 80%. Fue reintubado y encaminado para la UTI. La tomografía computadorizada mostró imágenes con aspecto de embolia pulmonar. El paciente evolucionó para óbito en el 5º día de pós-operatorio. CONCLUSIONES: El

Evaluation of pelvic varicose veins using color Doppler ultrasound: comparison of results obtained with ultrasound of the lower limbs, transvaginal ultrasound, and phlebography Avaliação de varizes pélvicas por Doppler colorido: comparação dos resultados obtidos com ultrassom dos membros inferiores, ultrassom transvaginal e flebografia

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Fanilda Souto Barros

2010-06-01

étodos diagnósticos não-invasivos mais comumente usados para avaliar a insuficiência venosa pélvica, enquanto a flebografia ainda é considerada como o padrão-ouro. Objetivos: Determinar a prevalência de varizes dos membros inferiores originadas na pélvis em um grupo de pacientes do sexo feminino e determinar a concordância entre os resultados obtidos por Doppler colorido dos membros inferiores, ultrassom transvaginal e flebografia. Métodos: A AMOstra incluiu pacientes do sexo feminino encaminhadas para o laboratório vascular para triagem dos membros inferiores. As pacientes diagnosticadas com trombose venosa profunda foram excluídas. A análise dos dados incluiu o coeficiente de concordância kappa, o teste de McNemar e os valores de sensibilidade e especificidade. Resultados: De um total de 1.020 pacientes, 124 (12.2% tiveram achados compatíveis com refluxo de origem pélvica. Entre essas pacientes, 51 (41.2% eram casos recorrentes. Um total de 249 foram submetidas a ultrassom transvaginal. Houve concordância significativa entre os achados ultrassonográficos dos membros inferiores e os achados transvaginais. A flebografia foi realizada em 54 pacientes. A comparação entre o ultrassom transvaginal e a flebografia foi associada a 96.2% de sensibilidade e 100% de especificidade. Conclusões: OS AUTores chamam a atenção para a prevalência relativamente alta de varizes dos membros inferiores originadas na pélvis, sugerindo uma importante, embora subdiagnosticada, causa de varizes recorrentes.

Post dural puncture headache after spinal anaesthesia for caesarean section: a comparison of 25G quince, 27G quince and 27G whitacre spinal needles

International Nuclear Information System (INIS)

Shaikh, J.M.; Memon, M.; Khan, M.

2008-01-01

To compare the frequency and severity of post dural puncture headache in obstetric patients using 25G Quincke, 27G Quincke and 27G Whitacre spinal needles. Comparative, randomized, double-blind, interventional study. 480 ASA I-II full term pregnant women, 18 to 45 years of age, scheduled for elective Caesarean section, under spinal anaesthesia, were randomized into three groups: Group I (25G Quincke spinal needle: n=168), Group II (27G Quincke spinal needle: n=160) and Group III (27G Whitacre spinal needle: n=152). Spinal anaesthesia was performed with 1.5-2.0 ml 0.75% hyperbaric bupivacaine using 25G Quincke spinal needle (Group I), 27G Quincke spinal needle (Group II) and 27G Whitacre spinal needle (Group III) at L3-4 inter-vertebral space. Each patient was assessed daily for four consecutive days following Caesarean section. Frequency and severity and of postdural puncture headache (PDPH) were recorded. Data were analyzed using SPSS-11. Frequency of PDPH following the use of 25G Quincke (Group I), 27G Quincke (Group II) and 27G Whitacre (Group III) spinal needles was 8.3% (14/168), 3.8% (6/160) and 2.0% (3/152) respectively. In Group I, PDPH was mild in 5 patients, moderate in 7 patients and severe in 2 patients. In Group II, it was mild in 2, moderate in 3 and severe in 1 patient. In group III, it was mild in 2 and moderate in 1 patient. Severe PDPH did not occur in Group III. Most of the patients with PDPH developed it on 1st and 2nd postoperative day. When using a 27G Whitacre spinal needle, the frequency and severity of PDPH was significantly lower than when a 25G Quincke or 27G Quincke needle was used. (author)

A study of measurement of the spinal cord of cervical myelopathy with CT-myelography and forecast of operative result from the size of the spinal cord

International Nuclear Information System (INIS)

Oosawa, Yoshimitsu

1985-01-01

The antero-posterior (AP) and transverse (T) diameter and the T area of the spinal canal, dural canal, and spinal cord were measured using CT-myelography (CT-M) in 44 patients with cervical myelopathy (CM) and 20 control subjects. The AP diameter of these canals and cord and the T diameter of the spinal canal were smaller in the CM group than in the control group. Postoperative CT-M showed that the dural canal and spinal cord had an increase in the AP diameter and T area and a decrease in the T diameter. Preoperative symptoms were well correlated with the AP diameter and the T area of the spinal canal, dural canal, and spinal cord, and spinal cord compression. The symptoms tended to be milder with larger AT diameter and T area of the spinal canal, dural canal, and spinal cord and with smaller spinal cord compression and deformity. Functional damage was reversible in patients with slight spinal cord compression. Favorable operative outcome tended to be achieved when the preoperative AP diameter and T area of the spinal cord were ≥ 5 mm and ≥ 50 mm 2 , respectively. (Namekawa, K.)

Central nervous system mast cells in peripheral inflammatory nociception

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Ellmeier Wilfried

2011-06-01

Full Text Available Abstract Background Functional aspects of mast cell-neuronal interactions remain poorly understood. Mast cell activation and degranulation can result in the release of powerful pro-inflammatory mediators such as histamine and cytokines. Cerebral dural mast cells have been proposed to modulate meningeal nociceptor activity and be involved in migraine pathophysiology. Little is known about the functional role of spinal cord dural mast cells. In this study, we examine their potential involvement in nociception and synaptic plasticity in superficial spinal dorsal horn. Changes of lower spinal cord dura mast cells and their contribution to hyperalgesia are examined in animal models of peripheral neurogenic and non-neurogenic inflammation. Results Spinal application of supernatant from activated cultured mast cells induces significant mechanical hyperalgesia and long-term potentiation (LTP at spinal synapses of C-fibers. Lumbar, thoracic and thalamic preparations are then examined for mast cell number and degranulation status after intraplantar capsaicin and carrageenan. Intradermal capsaicin induces a significant percent increase of lumbar dural mast cells at 3 hours post-administration. Peripheral carrageenan in female rats significantly increases mast cell density in the lumbar dura, but not in thoracic dura or thalamus. Intrathecal administration of the mast cell stabilizer sodium cromoglycate or the spleen tyrosine kinase (Syk inhibitor BAY-613606 reduce the increased percent degranulation and degranulated cell density of lumbar dural mast cells after capsaicin and carrageenan respectively, without affecting hyperalgesia. Conclusion The results suggest that lumbar dural mast cells may be sufficient but are not necessary for capsaicin or carrageenan-induced hyperalgesia.

Spontaneous thrombosis of internal carotid artery: a natural history of giant carotid cavernous aneurysms Trombose espontânea da artéria carótida interna: a história natural dos aneurismas gigantes intracavernosos

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Lucas Perez de Vasconcellos

2009-06-01

Full Text Available OBJECTIVE: To describe five cases of giant carotid cavernous aneurysms which evolved with spontaneous thrombosis of internal carotid artery (STICA, with emphasis at epidemiology, clinical presentation, natural history, related factors and neurological outcome. METHOD: There were 711 consecutives patients with 802 aneurysms with and without surgical treatment during a period of 19 years. We selected 35 patients with 40 carotid cavernous aneurysms (5% of which 20 (50% were giant aneurysms. Among those cases, 5 patients evolved with STICA (25%. Symptoms and findings at presentation were recorded and compared with those at outcome. RESULTS: Clinical presentation was commonly related to atherosclerotic factors such as elevated blood pressure (80%, diabetes mellitus (40% and dislipidemy (40%. All patients presented with hemicranial headache, ophthalmparesy and retro bulbar pain, and after STICA all presented improvement of symptoms. After STICA, 4 patients had regression of deficit, 2 partial and 2 complete. Four patients had sensorial trigeminal neuropathy in V1 and V2 territories, also showing improvement of symptoms after STICA. CONCLUSION: STICA is a common outcome in giant carotid cavernous aneurysms, and is related with significant improvement of symptoms; however, it may be catastrophic for those patients without efficient collateral circulation.OBJETIVO: Relatar cinco casos de aneurismas gigantes intracavernosos que evoluíram com trombose espontânea da artéria carótida interna (TEACI, estudando-se: prevalência, apresentação clínica, história natural, fatores associados e prognóstico neurológico. MÉTODO: Análise de 711 pacientes consecutivos com diagnóstico de 802 aneurismas cerebrais submetidos a tratamento clínico ou cirúrgico num período de 19 anos. Foram identificados 40 aneurismas intracavernosos, sendo que 20 desses eram gigantes. Dentre esses, 5 pacientes com aneurismas gigantes intracavernosos que evoluíram com TEACI

Autoestima de pessoas com úlcera venosa

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Amanda Jéssica Gomes de Souza

2017-01-01

Full Text Available to verify the level of self-esteem of people with venous ulcer and its relationship with sociodemographic, care and clinical characteristics. Methods: cross-sectional study with 44 patients with venous ulcers assisted in primary health care and evaluated using the Rosenberg Self-Esteem Scale. Descriptive and inferential statistics were performed. The t-test was to compare means of the scale scores in relation to sociodemographic, care and clinical characteristics. Results: the mean self-esteem was 9.3 (± 5.1. The variables that showed association with self-esteem were: married/common-law married patients (p=0.016, with occupation (p=0.023, using compressive therapy (p=0.040, under less than six months of treatment (p=0.014, and with small ulcers (p=0.010. Conclusion: the self-esteem of patients with venous ulcers was satisfactory/high, and it was especially higher among those with partner, with occupational activity, making use of compressive therapy, at the initial phase of the treatment and who had small ulcers.

Epidural Anesthesia Complicated by Subdural Hygromas and a Subdural Hematoma

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Christine Vien

2016-01-01

Full Text Available Inadvertent dural puncture during epidural anesthesia leads to intracranial hypotension, which if left unnoticed can cause life-threatening subdural hematomas or cerebellar tonsillar herniation. The highly variable presentation of intracranial hypotension hinders timely diagnosis and treatment. We present the case of a young laboring adult female, who developed subdural hygromas and a subdural hematoma following unintentional dural puncture during initiation of epidural anesthesia.

Alternative technique in atypical spinal decompression: the use of the ultrasonic scalpel in paediatric achondroplasia

Science.gov (United States)

Woodacre, Timothy; Sewell, Matthew; Clarke, Andrew J; Hutton, Mike

2016-01-01

Spinal stenosis can be a very disabling condition. Surgical decompression carries a risk of dural tear and neural injury, which is increased in patients with severe stenosis or an atypical anatomy. We present an unusual case of symptomatic stenosis secondary to achondroplasia presenting in a paediatric patient, and highlight a new surgical technique used to minimise the risk of dural and neural injury during decompression. PMID:27288205

Diffuse pachymeningeal enhancement on brain MRI: spontaneous intracranial hypotension and head trauma

International Nuclear Information System (INIS)

Ryu, Chang Woo; Lee, Byung Hee; Lee, Seung Ik; Kim, Young A; Kim, Hee Jin; Ko, Young Sik

1998-01-01

We evaluated the MRI finding of pachymeningeal enhancement in patients with intracranial hypotension and head trauma with particular attention to differential findings and change in follow-up study, and in order to support the knowledge about the pathophysiology of dural enhancement. The findings of enhanced brain MRI of fifteen patients who showed diffuse pachymeningeal enhancement were retrospectively examined. Seven of fifteen patients were finally diagnosed as spontaneous intracranial hypotension (SIH). Eight of fifteen patients had a recent history of head trauma. We analyzed the shape, thickness, continuity and extent of dural enhancement, and the others concerned with positive MR findings. We also analyzed findings suggested displacement of brain parenchyma-displacement of the iter and cerebellar tonsil, and flattening of the anterior aspect of the pons-. Four of seven patients with SIH and four of eight patients with head trauma, underwent follow-up MRI. In the follow-up study, the presence of resolving pachymeningeal enhancement and symptom improvement was investigated. In all cases of SIH, the dura showed diffuse, even 3(1mm thick, global and contiguous enhancement along both cerebral convexities, both tentoria, and the falx. Displacement of the iter was noted in six cases and flattening of the anterior aspect of the pons in five. Displacement of the cerebellar tonsil was noted in one case. Five of seven cases showed small amount of subdural fluid collection. In all cases of head trauma, the dura was enhanced diffusely and asymmetrically, and showed no contiguity. Its distribution was consistent with the locations of traumatic lesions. Displacement of the iter was noted in one case. In four cases of SIH, clinical symptoms had improved, and three showed complete resolution of dural enhancement, in one patient continuously showed partial dural enhancement. Four cases of head trauma showed complete resolution of dural enhancement. Reversible diffuse

Management of cerebrospinal fluid leak during endoscopic pituitary surgery.

Science.gov (United States)

Berker, Mustafa; Aghayev, Kamran; Yücel, Taşkın; Hazer, Derya Burcu; Onerci, Metin

2013-08-01

Dural opening and closures are major steps in endoscopic pituitary surgery. Restoring the normal anatomy at the end of the procedure creates a natural barrier between the intrasellar compartment and the sinonasal cavity. In this study, we present a relatively simple dural opening and closure technique for endoscopic pituitary surgery. This technique provides a better alternative to the use of a more complex nasoseptal flap or the multilevel closure with artificial materials as it restores the normal anatomy after the tumor removal and provides a better physiological barrier between the sinonasal cavity and the intrasellar compartment. Incision is performed in circular or horseshoe fashion leaving a small peduncle, and then the dura is reflected. Of the 733 endoscopic transsphenoidal procedures in 667 patients conducted between January 2006 and May 2012, we used this described technique in 50 cases (7.4%). In these 50 cases with dural flap, there was no postoperative CSF leakage. Intraoperative CSF leakage was observed in 135 (20.2%) of the 667 patients. In 15 (11.1%) of these 135 patients we used the dural flap technique accompanied with fat and/or fascia lata support. There was no postoperative leakage in these patients. In the remaining 120 (89.9%) patients who had intraoperative CSF leakage, we used fat and/or fascia lata for the reconstruction of the sella floor. But we observed postoperative CSF leakage in 12 (10%) of the 120 patients without the dural flap which were reoperated. The dural flap technique we employ has several advantages. First of all, it allows optimal physiological reconstruction after the surgery. Secondly, the bridge between the flap and the main dura helps maintain the vascular supply, which in turn can radically shorten the healing time. Thirdly, this technique is obviously a better alternative to the time consuming and expensive multilevel closures with tissue sealants and artificial grafts. Copyright © 2012 Elsevier Ireland Ltd. All

Mechanisms of glyceryl trinitrate provoked mast cell degranulation

DEFF Research Database (Denmark)

Pedersen, Sara Hougaard; Ramachandran, Roshni; Amrutkar, Dipak Vasantrao

2015-01-01

inflammation and dural mast cell degranulation is supported by the effectiveness of prednisolone on glyceryl trinitrate-induced delayed headache. METHODS: Using a newly developed rat model mimicking the human glyceryl trinitrate headache model, we have investigated the occurrence of dural mast cell...... glyceryl trinitrate-induced mast cell degranulation whereas the calcitonin gene-related peptide-receptor antagonist olcegepant and the substance P receptor antagonist L-733,060 did not affect mast cell degranulation. However, topical application of two different nitric oxide donors did not cause mast cell...... degranulation ex vivo. CONCLUSIONS: Direct application of an exogenous nitric oxide donor on dural mast cells does not cause mast cell degranulation ex vivo. In vivo application of the nitric oxide donor glyceryl trinitrate leads to a prominent level of degranulation via a yet unknown mechanism. This effect can...

Valoración del comportamiento de los apósitos de espuma polimérica Skinfoam® en el tratamiento de pacientes con úlceras vasculares venosas y análisis farmacoeconómico Valuation of hydrophilic polymeric foam dressing Skinfoam's® behavior in the patients' treatment with vascular venous ulcers and pharmaceutical-economic analysis

Directory of Open Access Journals (Sweden)

S. Riera

2009-12-01

Full Text Available Introducción: Las úlceras de origen vascular de las extremidades inferiores constituyen un problema de salud, con importantes repercusiones socioeconómicas y sanitarias, así como conllevan un gran consumo de recursos humanos y materiales. El objetivo del presente estudio fue valorar el comportamiento de los apósitos poliméricos hidrófilos de espuma Skinfoam® en el tratamiento de pacientes con úlcera vascular de etiología venosa, así como valorar los costes de la actividad sanitaria de dicho tratamiento. Material y métodos: Estudio observacional de series de casos clínicos, prospectivo y abierto, realizado en pacientes de ambos sexos y edad superior a los 18 años que presentaran, al menos, una úlcera vascular de etiología venosa susceptible de ser tratada con un apósito polimérico hidrófilo y que dieran su consentimiento informado por escrito. Las variables analizadas fueron la evolución de las características de la lesión durante el tratamiento, los datos de los cambios de apósito, la valoración global del comportamiento del apósito, y el análisis de costes totales, por día y por cm². Los resultados del estudio se analizaron mediante una estadística descriptiva, expresando los resultados en medias y desviaciones estándar, y en porcentajes. Resultados: Se incluyeron 14 pacientes evaluables, con una edad media de 68 años y un 64,3% eran mujeres. El 71,4% de los pacientes presentaba úlcera vascular venosa de tipo II. Se aplicaron apósitos de espuma Skinfoam® no adhesivos en el 92,9% de los pacientes, siendo adhesivos en el 7,1% de casos restantes. En el 85,7% de los pacientes se consiguió la cicatrización de la úlcera en un promedio de dos meses, mientras que en el 14,3% restante no hubo cicatrización de la úlcera, y abandonó el estudio. La valoración global del tratamiento con los apósitos de espuma Skinfoam® fue mayoritariamente de excelente o muy buena (78,6%. En los 12 pacientes que finalizaron el

MR Findings of Desmoplastic Cerebral Astrocytoma of Infancy. A case report

International Nuclear Information System (INIS)

Kim, J.H.; Kim, I.O.; Kim, W.S.; Kim, K.H.; Park, C. M.; Yeon, K.M.

2003-01-01

Desmoplastic cerebral astrocytoma of infancy (DCAI) presents as a large supratentorial mass consisting of a central cystic component and an enhancing solid component associated with peripheral dural attachment. We report the unusual MR findings of a DCAI that differed from previously reported cases in terms of the presence of calcification, which is not considered a feature of this tumor, and the absence of an enhancing peripheral dural component

Four cases of intracranial AVM successfully treated by radiation therapy

International Nuclear Information System (INIS)

Chen, Mau-Nan; Imaya, Hisatoshi; Nakazawa, Shozo.

1990-01-01

We have treated three patients with conventional radiotherapy and one with stereotactic radiosurgery and report the follow-up results. A 63-year-old woman had a dural arteriovenous malformation (AVM) in the right cavernous sinus. She was irradiated using 10 MV X-ray with a total of 30 Gy. Post irradiation angiography showed a complete absence of dural AVM. A 62-year-old woman had a dural AVM fed by the left external carotid artery in the right cavernous sinus. Embolization by gelfoam was performed before irradiation. The irradiation was given with a total dose of 30 Gy. Post irradiation angiography showed disappearance of the dural AVM. A 26-year-old woman had a small AVM (about 20 x 15 x 15 mm) in the posterior corpus callosum. An operation was performed but the AVM was not excised completely. We irradiated to the residual AVM with a total of 30 Gy. The follow-up angiography one year after treatment, showed disappearance of the AVM. She had no neurological deficit two years after the treatment. A 14-year-old boy had a small AVM (about 20 x 15 x 10 mm) in the left anterior wall of the fourth ventricle. The AVM was located deeply, so an operation was not performed. Radiosurgery was undertaken four months after onset in Buenos Aires. The total dose was 36 Gy. The follow-up angiography one year after treatment, showed disappearance of the AVM. He also had no neurological deficit two years after the treatment. These four cases of AVM (two dural AVMs) were successfully treated by radiation therapy. No side effect was observed. (author)

Posterior fossa reconstruction using titanium plate for the treatment of cerebellar ptosis after decompression for Chiari malformation.

Science.gov (United States)

Udani, Vikram; Holly, Langston T; Chow, Daniel; Batzdorf, Ulrich

2014-01-01

We describe our use of a perforated titanium plate to perform a partial posterior fossa cranioplasty in the treatment of cerebellar ptosis and dural ectasia after posterior fossa decompression (PFD). Twelve patients who had undergone PFD underwent posterior fossa reconstruction using a titanium plate. Symptoms were related to either descent of the cerebellum into the decompression or to dural ectasia into the craniectomy defect. Twelve patients who had undergone large suboccipital craniectomies and who presented with persistent headaches and some with neurological symptoms related to syringomyelia, underwent reoperation with placement of a small titanium plate. Ten of 12 patients showed symptomatic improvement after reoperation. Placement of a titanium plate appears to be an effective method of treatment of cerebellar ptosis and dural ectasia after PFD for Chiari malformation. Copyright © 2014 Elsevier Inc. All rights reserved.

Sildenafil vs. Nitroprussiato de Sódio durante Teste de Reatividade Pulmonar pré-transplante cardíaco

Directory of Open Access Journals (Sweden)

Aguinaldo Figueiredo Freitas Jr

2012-09-01

Full Text Available FUNDAMENTO: A hipertensão pulmonar é associada ao pior prognóstico no pós-transplante cardíaco. O teste de reatividade pulmonar com Nitroprussiato de Sódio (NPS está associado a elevados índices de hipotensão arterial sistêmica, disfunção ventricular do enxerto transplantado e elevadas taxas de desqualificação para o transplante. OBJETIVO: Neste estudo, objetivou-se comparar os efeitos do Sildenafil (SIL e NPS sobre variáveis hemodinâmicas, neuro-hormonais e ecocardiográficas durante teste de reatividade pulmonar. MÉTODOS: Os pacientes foram submetidos, simultaneamente, ao cateterismo cardíaco direito, ao ecocardiograma e à dosagem de BNP e gasometria venosa, antes e após administração de NPS (1 - 2 µg/Kg/min ou SIL (100 mg, dose única. RESULTADOS: Ambos reduziram a hipertensão pulmonar, porém o nitrato promoveu hipotensão sistêmica significativa (Pressão Arterial Média - PAM: 85,2 vs. 69,8 mmHg, p < 0,001. Ambos reduziram as dimensões cardíacas e melhoraram a função cardíaca esquerda (NPS: 23,5 vs. 24,8 %, p = 0,02; SIL: 23,8 vs. 26 %, p < 0,001 e direita (SIL: 6,57 ± 2,08 vs. 8,11 ± 1,81 cm/s, p = 0,002; NPS: 6,64 ± 1,51 vs. 7,72 ± 1,44 cm/s, p = 0,003, medidas pela fração de ejeção ventricular esquerda e Doppler tecidual, respectivamente. O SIL, ao contrário do NPS, apresentou melhora no índice de saturação venosa de oxigênio, medido pela gasometria venosa. CONCLUSÃO: Sildenafil e NPS são vasodilatadores que reduzem, de forma significativa, a hipertensão pulmonar e a geometria cardíaca, além de melhorar a função biventricular. O NPS, ao contrário do SIL, esteve associado a hipotensão arterial sistêmica e piora da saturação venosa de oxigênio.

Sarcoma granulocítico multicêntrico como recidiva de leucemia mieloide aguda Multicentric granulocytic sarcoma as relapse of acute myelogenous leukemia

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Taciana G. S. Aguiar

2009-01-01

Full Text Available Sarcoma granulocítico (SG é um tumor sólido extramedular, constituído por células precursoras de granulócitos. É geralmente associado a leucemia mieloide aguda ou raramente a outras desordens mieloproliferativas. O tumor geralmente ocorre precedendo uma leucemia mieloide aguda, durante o seu curso ou após a remissão ter sido alcançada. O prognóstico é pobre e tem como principais modalidades terapêuticas a quimioterapia e a radioterapia. Relata- se um caso de SG multicêntrico, de evolução rápida, com acometimento difuso de pele, mamas, gânglios linfáticos, tecido celular subcutâneo e líquor, em mulher de 45 anos, fora de tratamento para leucemia mieloide aguda e em remissão hematológica há 18 meses. A paciente apresentava dor intensa em membro inferior direito há uma semana e estava em anticoagulação oral há seis meses por trombose venosa profunda neste membro. Diagnosticado o SG, a paciente foi tratada com radioterapia e quimioterapia com boa resposta. Após três meses de seguimento, em vigência do tratamento quimioterápico, evoluiu com recidiva do SG neste membro, associado ao acometimento das mamas e posteriormente do sistema nervoso central, evoluindo para óbito em aplasia e sepses.Granulocytic sarcoma is an extramedullary solid tumor consisting of immature granulocytic cells. It is often associated with acute myelogenous leukemia and more rarely with other myeloproliferative disorders. The tumor generally occurs before acute myeloid leukemia, during its course or after disease remission. It has a poor prognosis with the main therapeutic options being chemotherapy and radiotherapy. A multicentric accelerated case of granulocytic sarcoma of a 45- year- old woman with diffuse skin, breast, lymphatic ganglia and subcutaneous tissue presentations no longer undergoing treatment for acute myeloid leukemia and in hematologic remission for 18 months is reported. The patient presented with severe pain of right lower

Estudo anatômico da veia braquial comum como via de drenagem colateral do membro superior Anatomic study of the common brachial vein as a collateral drainage channel of the upper limb

Directory of Open Access Journals (Sweden)

Carlos Adriano Silva dos Santos

2011-03-01

Full Text Available CONTEXTO: Traumatismos ou tromboses que possam evoluir com alterações da drenagem venosa do membro superior, dependendo do território interrompido, podem ter como mecanismo compensatório uma via colateral de drenagem sem que haja prejuízo para o retorno venoso desse membro. A veia braquial comum apresenta-se como uma alternativa plausível e pouco conhecida. OBJETIVO: Descrever a anatomia da veia braquial comum como via de drenagem colateral no membro superior. MÉTODOS: Utilizamos 30 cadáveres do sexo masculino, cujos membros superiores estavam articulados ao tronco, não importando a raça, formolizados e mantidos em conservação com solução de formol a 10%. Utilizamos como critérios de exclusão cadáveres com um dos membros desarticulado ou alterações deformantes em topografia das estruturas estudadas. RESULTADOS: A veia braquial comum esteve presente em 73% (22/30 dos cadáveres estudados, sendo que em 18% (04/22 dos casos drenou para a veia basílica no seguimento proximal do braço e em 82% (18/22, para a veia axilar. CONCLUSÃO: A veia braquial comum está frequentemente presente e, na maior parte das vezes, desemboca na veia axilar.BACKGROUND: Trauma and thrombosis that can result in changes in the venous drainage of the upper limb, depending on the vascular territory interrupted, may have as a compensatory mechanism a collateral drainage channel that prevents damage to the venous return of that limb. The common brachial vein is a plausible and little known collateral channel for this purpose. OBJECTIVE: To describe the anatomy of the common brachial vein as a collateral drainage channel of the upper limb. METHODS: We have dissected 30 cadavers of people of different races, whose upper limbs were articulated to the trunk and preserved in a 10% formaldehyde solution. The exclusion criteria were disarticulated limbs or deformities in the topography of the studied structures. RESULTS: The common brachial vein was present in 73

Pancreatite aguda devida a hematoma intramural do duodeno por uso de anticoagulante Acute pancreatitis due to intramural hematoma of the duodenum by use of anticoagulant therapy

Directory of Open Access Journals (Sweden)

Samer FARHOUD

2001-01-01

Full Text Available Racional - A hemorragia intramural espontânea do duodeno causada por complicações da terapêutica anticoagulante é rara e seu tratamento controverso. Objetivo -- Apresentar a experiência advinda do tratamento de doente com essa condição clínica. Relato do caso - Expõe-se o caso de uma mulher de 71 anos de idade, que há 3 meses fazia uso de anticoagulante oral para tratamento de trombose venosa profunda dos membros inferiores. Apresentou-se com cefaléia e dores abdominais intensas no andar superior do abdome, associadas a náuseas e vômitos. Os exames laboratoriais e de imagem comprovaram o diagnóstico de surto agudo de pancreatite, decorrente de hematoma intramural de duodeno. Os valores de protrombina (49,7 s e o sangramento de tecidos moles cervicais e urinário, sugeriam complicação da terapêutica anticoagulante. Resultados - A terapêutica conservadora foi efetiva, tendo a doente recebido alta, assintomática, no 10º dia de internação. Conclusão - É recomendado o emprego do anticoagulante em doses menores nos doentes de risco e adequado controle dos parâmetros da coagulação. Acredita-se ser ideal a conduta conservadora e recomenda-se a cirurgia somente nos casos que evoluem com complicações.Background - Spontaneous intramural hemorrhage of the duodenum due to anticoagulant therapy is rare and the treatment is controversial. Objective - To present the acquired knowledge with the treatment of these disease. Case report - A 71-year-old women receiving for a 3 month period an anticoagulant therapy presented cervical bleeding of soft tissues and symptoms of acute pancreatitis and high small bowel obstruction. Early noninvasive diagnosis by computed tomographic scan was possible and conservative therapy proved successful in complete resolution of the pancreatitis and obstructive symptoms, with resumption of oral intake in the fourth day of treatment. The frequency of bleeding in high risk patients during warfarin therapy

Molecular characterization and phylogenetic relationships among ...

African Journals Online (AJOL)

Molecular characterization and phylogenetic relationships among and within species of Phalaenopsis (Epidendroideae: Orchidaceae) based on RAPD analysis. ... Ph. parishii, Ph. labbi nepal, Ph. speciosa, Ph. lobbi yellow, Ph. venosa, Ph. hieroglyphica, and Ph. maculata; the third group consisted of Ph. minho princess, ...

Population structure, growth and production of a recent brachiopod from the Chilean fjord region

KAUST Repository

Baumgarten, Sebastian; Laudien, Jü rgen; Jantzen, Carin; Hä ussermann, Verena; Fö rsterra, Gü nter

2013-01-01

-57% of that of A. atra in the respective fjords). The high shell growth rate of M. venosa, together with its high overall growth performance may explain the locally high population density of this brachiopod in Comau Fjord. However, the production per biomass

Post dural puncture headache after spinal anaesthesia for caesarean section: a comparison of 25 g Quincke, 27 g Quincke and 27 g Whitacre spinal needles.

Science.gov (United States)

Shaikh, Jan Muhammad; Memon, Amna; Memon, Muhammad Ali; Khan, Majida

2008-01-01

To compare the frequency and severity of post dural puncture headache in obstetric patients using 25G Quincke, 27G Quincke and 27G Whitacre spinal needles. Comparative, randomized, double-blind, interventional study. Liaquat University Hospital Hyderabad from October 2005 to December 2006. 480 ASA I-II full term pregnant women, 18 to 45 years of age, scheduled for elective Caesarean section, under spinal anaesthesia, were randomized into three groups: Group I (25G Quincke spinal needle: n=168), Group II (27G Quincke spinal needle: n=160) and Group III (27G Whitacre spinal needle: n=152). Spinal anaesthesia was performed with 1.5-2.0 ml 0.75% hyperbaric bupivacaine using 25G Quincke spinal needle (Group I), 27G Quincke spinal needle (Group II) and 27G Whitacre spinal needle (Group III) at L3-4 inter-vertebral space. Each patient was assessed daily for four consecutive days following Caesarean section. Frequency and severity and of postdural puncture headache (PDPH) were recorded. Data were analyzed using SPSS-11. Frequency of PDPH following the use of 25G Quincke (Group I), 27G Quincke (Group II) and 27G Whitacre (Group III) spinal needles was 8.3% (14/168), 3.8% (6/160) and 2.0% (3/152) respectively. In Group I, PDPH was mild in 5 patients, moderate in 7 patients and severe in 2 patients. In Group II, it was mild in 2, moderate in 3 and severe in 1 patient. In group III, it was mild in 2 and moderate in 1 patient. Severe PDPH did not occur in Group III. Most of the patients with PDPH developed it on 1st and 2nd postoperative day. When using a 27G Whitacre spinal needle, the frequency and severity of PDPH was significantly lower than when a 25G Quincke or 27G Quincke needle was used.

Osseous anatomy of the lumbosacral spine in Marfan syndrome.

Science.gov (United States)

Sponseller, P D; Ahn, N U; Ahn, U M; Nallamshetty, L; Rose, P S; Kuszyk, B S; Fishman, E K

2000-11-01

This study examines pedicle widths, laminar thicknesses, and scalloping values for lumbosacral spine elements in Marfan volunteers. Comparisons were made between these measurements and norms as well as measurements between Marfan patients with and without dural ectasia. To determine if the lumbosacral vertebral elements are altered in the patient with Marfan syndrome. Several abnormalities have been noted in Marfan lumbar spine, including pedicular attenuation and widened interpediculate distances. This may be due to abnormalities of growth or presence of dural ectasia. Given the large numbers of Marfan patients requiring spinal surgery and the high postoperative failure rate, better understanding of the bony anatomy of Marfan lumbar spine is necessary, especially if use of instrumentation is anticipated. Thirty-two volunteers with Marfan syndrome based on the Ghent criteria underwent spiral computed tomography of the lumbosacral spine. Images were evaluated for dural ectasia, and measurements of pedicle width, laminar thickness, and vertebral scalloping were made. Pedicle widths and laminar thicknesses were significantly smaller in Marfan patients at all levels (Plaminar thickness from L5-S2 and pedicle widths at all lumbar levels were significantly reduced (Plaminar thickness are significantly reduced in Marfan individuals. Those with dural ectasia demonstrate increased bony erosion of anterior and posterior elements of lumbosacral spine. Preoperative planning and routine computed tomography scans are recommended when operating on Marfan lumbosacral spine.

Remoção cirúrgica de trombos em próteses valvulares mecânicas Surgical removal of thrombi in mechanical valvular prostheses

Directory of Open Access Journals (Sweden)

Pablo M. A Pomerantzeff

1993-03-01

Full Text Available É relatada a retirada cirúrgica de trombos em próteses mecânicas em dois pacientes, manobra rara e inédita em nossa Instituição. O primeiro paciente, do sexo masculino, de 19 anos de idade, com história de doença reumática na infância, tendo sido submetido a duas duplas trocas mitro-aórticas, com duas próteses metálicas na última operação, realizada em 1988. Tendo descontinuado o uso de anticoagulantes por conta própria, deu entrada no pronto-socorro em edema agudo dos pulmões, com diagnóstico de trombose nas próteses. Foi levado ao centro cirúrgico, optando-se pela limpeza cirúrgica das próteses, diminuindo, desta forma, o tempo de circulação extracorpórea em paciente de extrema gravidade. Outra paciente, de 2 anos e 6 meses de idade, com diagnóstico de insuficiência mitral por degeneração mixomatosa, foi submetida a troca da valva mitral por prótese mecânica em 13/10/92. Apesar de bem anticoagulada, apresentou trombose da prótese e, no dia 12/1/93, foi submetida a trombectomia cirúrgica. Os dois pacientes apresentaram boa evolução pós-operatória, sendo que a segunda paciente, 3 meses após a trombectomia, apresentou nova trombose aguda, sendo administrada estreptoquinase, com sucesso. A trombectomia cirúrgica pode ser uma boa opção em pacientes com alto risco e portadores de trombose de próteses metálicas.We report the surgical procedure which was adopted in two patients exhibiting thrombosis of mechanical prosthesis, a rare procedure and unprecedent in our Institution. A 19 years old male patient with a history of rheumatic fever in childhood, who had been submitted to two mitro-aortic substitutions, two metalic prostheses, having been introduced in the last surgery, which occurred in 1988. The patient, having of his own free will discontinued taking the anticoagulant, was admitted into the Emergency Department whith a condition of acute pulmonary oedema, with a diagnosis of thrombosis of the

Giant arachnoid granulation in a patient with benign intracranial hypertension

Energy Technology Data Exchange (ETDEWEB)

Kiroglu, Yilmaz; Yaqci, Baki; Cirak, Bayram; Karabulut, Nevzat [Pamukkale University, Department of Radiology, School of Medicine, Denizli (Turkey)

2008-10-15

We report magnetic resonance (MR), computed tomography (CT) and angiographic imaging of an unusual giant arachnoid granulation in the superior sagittal sinus in a man with headache and vertigo. Intrasinus pressure measurements revealed a significant pressure gradient across the lesion. MR imaging is useful to identify giant arachnoid granulation and dural sinus thrombosis, whereas dural sinus pressure measurement in certain cases of giant arachnoid granulations can be used to evaluate the lesion as the cause of the patient's symptoms. (orig.)

Giant arachnoid granulation in a patient with benign intracranial hypertension

International Nuclear Information System (INIS)

Kiroglu, Yilmaz; Yaqci, Baki; Cirak, Bayram; Karabulut, Nevzat

2008-01-01

We report magnetic resonance (MR), computed tomography (CT) and angiographic imaging of an unusual giant arachnoid granulation in the superior sagittal sinus in a man with headache and vertigo. Intrasinus pressure measurements revealed a significant pressure gradient across the lesion. MR imaging is useful to identify giant arachnoid granulation and dural sinus thrombosis, whereas dural sinus pressure measurement in certain cases of giant arachnoid granulations can be used to evaluate the lesion as the cause of the patient's symptoms. (orig.)

Unusual Neuroimaging Presentation of Cerebral Venus Sinus Thrombosis in 40 Patients

OpenAIRE

Gh. Bakhshandepour; H. Abdolhusseinpour; S. Shahbaygi; J. Jalal Shokouki

2008-01-01

Background/Objective: This study has been per-formed to investigate the unusual imaging presenta-tion of the cerebral venous sinus thrombosis."nPatients and Methods: The data was analyzed retro-spectively from all patients with evidences of dural vein thrombosis in MRI, referred to two medical im-aging centers in Tehran during four years period (2002 to 2006)."nResults: Thirty-three women and seven men (22 to 70 years old) with imaging findings of Dural vein thrombosis were relative...

Síndrome de Hughes-Stovin

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Sonia Pankl

2015-04-01

Full Text Available El síndrome de Hughes-Stovin es una entidad infrecuente caracterizada por trombosis venosa profunda y aneurismas de la arteria pulmonar, siendo su etiología y patogenia desconocida. Algunos autores la consideran una variante de la enfermedad de Behcet. Su curso natural es generalmente fatal. Se presenta con tos, disnea, hemoptisis, dolor torácico y fiebre. El tratamiento es con esteroides y agentes citotóxicos hasta la cirugía. Presentamos el caso de un hombre de 41 años que consultó por disnea, hemoptisis y dolor torácico, llegándose al diagnóstico de trombosis venosa profunda de miembro inferior derecho, trombo-embolismo de pulmón y aneurismas de arterias pulmonares. Recibió tratamiento con corticoides en altas dosis y 6 pulsos de ciclofosfamida de 1 gramo durante 6 meses, con regresión completa de los aneurismas y de la sintomatología.

Analysis of the best therapeutic alternative for intracranial dural arteriovenous malformations Análise da melhor alternativa terapêutica para malformações arteriovenosas durais intracranianas

Directory of Open Access Journals (Sweden)

César de Paula Lucas

2005-09-01

Full Text Available The material for this research consisted of 93 patients with dural arteriovenous malformations (DAVMs who were studied retrospectively with regards to therapeutic success and failure, who had undergone either neurosurgery, or embolization or a combination of both methods and whose disease was located in the cavernous sinus, the superior sagittal sinus, the transverse-sigmoid sinus of the anterior fossa and the tentorium. Thus, it was possible to arrive at the following conclusions: treatment of the DAVMs must be indicated, jointly, by an interventionist neuroradiologist and a neurosurgeon; DAVMs of the transverse-sigmoid sinus were better treated when a combination of both methods was used; DAVMs of the tentorium were also better treated with a combined method; the endovascular method ensured only a 50% chance of therapeutic success for DAVMs of the superior sagittal sinus; DAVMs of the cavernous sinus are better treated when the endovascular method was used with a transvenous approach, relative to the transarterial approach.O material utilizado consistiu de 93 pacientes portadores de malformações arteriovenosas durais (MAVDs estudados retrospectivamente em relação ao sucesso e ao fracasso terapêutico submetidos aos métodos neurocirúrgico ou endovascular ou, ainda, combinação entre ambos, em que a doença se localizou nas regiões do seio cavernoso, do seio sagital superior, do seio transverso-sigmóide, da fossa anterior e do tentório. As conclusões foram as seguintes: o tratamento das MAVDs deve ser indicado pelo neurorradiologista intervencionista e pelo neurocirurgião, conjuntamente; as MAVDs do seio transverso-sigmóide foram melhor tratadas através do método combinado; as MAVDs do tentório foram melhor tratadas através do método combinado; as MAVDs do seio sagital superior tratadas por método endovascular asseguraram apenas 50% de sucesso terapêutico; as MAVDs do seio cavernoso são melhor tratadas por m

A randomised controlled trial using the Epidrum for labour epidurals.

LENUS (Irish Health Repository)

Deighan, M

2015-03-01

The aim of our study was to determine if using the Epidrum to site epidurals improves success and reduces morbidity. Three hundred parturients requesting epidural analgesia for labour were enrolled. 150 subjects had their epidural sited using Epidrum and 150 using standard technique. We recorded subject demographics, operator experience, number of attempts, Accidental Dural Puncture rate, rate of failure to site epidural catheter, rate of failure of analgesia, Post Dural Puncture Headache and Epidural Blood Patch rates. Failure rate in Epidrum group was 9\\/150 (6%) vs 0 (0%) in the Control group (P = 0.003). There were four (2.66%) accidental dural punctures in the Epidrum group and none in the Control group (P = 0.060), and 2 epidurals out of 150 (1.33%) in Epidrum group were re-sited, versus 3\\/150 (2%) in the control group (P = 1.000). The results of our study do not suggest that using Epidrum improves success or reduces morbidity.

CT recognition of lateral lumbar disk herniation

International Nuclear Information System (INIS)

Williams, A.L.; Haughton, V.M.; Daniels, D.L.; Thornton, R.S.

1982-01-01

Although computed tomography (CT) has been shown to be useful in diagnosing posterolateral and central lumbar disk herniations, its effectiveness in demonstrating lateral herniated disks has not been emphasized. The myelographic recognition of those herniations may be difficult because root sheaths or dural sacs may not be deformed. A total of 274 CT scans interpreted as showing lumbar disk herniation was reviewed. Fourteen (5%) showed a lateral disk herniation. The CT features of a lateral herniated disk included: (1) focal protrusion of the disk margin within or lateral to the intervertebral foramen: (2) displacement of epidural fat within the intervertebral foramen; (3) absence of dural sac deformity; and (4) soft-tissue mass within or lateral to the intervertebral foramen. Because it can image the disk margin and free disk fragments irrespective of dural sac or root sheath deformity, CT may be more effective than myelography for demonstrating the presence and extent of lateral disk herniation

[Posterior reversible encephalopathy syndrome and cerebrovascular constriction syndrome in the differential diagnosis of post-partum headaches].

Science.gov (United States)

Ruiz López, N; Cano Hernández, B; Balbás Álvarez, S

2016-02-01

Postpartum headache can be due to many causes. In a patient with previous epidural analgesia, the headache can be attributed to post-dural puncture headache, even if the symptoms are not typical of this clinical entity. We report a case of a post-partum with accidental dural tap during the insertion of an epidural catheter for labour analgesia, and who referred to headaches in the third post-partum day. Initially, a post-dural puncture headache was suspected, but the subsequent onset of seizures and visual impairment meant that the diagnosis had to be reconsidered. In this case report, the clinical and pathophysiological features of posterior reversible encephalopathy syndrome and reversible cerebral vasoconstriction syndrome, as well as the differential diagnosis of post-partum headaches are described. Copyright © 2014 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

Evaluation of two different epidural catheters in clinical practice. narrowing down the incidence of paresthesia!

Science.gov (United States)

Bouman, E A C; Gramke, H F; Wetzel, N; Vanderbroeck, T H T; Bruinsma, R; Theunissen, M; Kerkkamp, H E M; Marcus, M A E

2007-01-01

Although epidural anesthesia is considered safe, several complications may occur during puncture and insertion of a catheter. Incidences of paresthesia vary between 0.2 and 56%. A prospective, open, cohort-controlled pilot study was conducted in 188 patients, ASA I-III, age 19-87 years, scheduled for elective surgery and epidural anesthesia. We evaluated a 20 G polyamide (standard) catheter and a 20 G combined polyurethane-polyamide (new) catheter. Spontaneous reactions upon catheter-insertion, paresthesia on questioning, inadvertent dural or intravascular puncture, and reasons for early catheter removal were recorded. The incidence of paresthesia reported spontaneously was 21.3% with the standard catheter and 16.7% with the new catheter. Systematically asking for paresthesia almost doubled the paraesthesia rate. Intravascular cannulation occurred in 5%. No accidental dural punctures occurred. An overall incidence of 13.3% of technical problems led to early catheter removal. The new catheter was at least equivalent to the standard regarding epidural success rate and safety : rate of paresthesia, intravascular and dural cannulation.

Tumefactive immunoglobulin G4-related disease involving the dura mater: A case report and literature review

International Nuclear Information System (INIS)

Lee, Jeong Hoon; Lee, Ji Hoon; Ko, Yong; Paik, Seoung Sam; Lee, Young Jun; Park, Dong Woo

2015-01-01

Immunoglobulin G4 (IgG4)-related disease is a well-known disorder characterized by an inflammatory reaction with an increase in the number of IgG4-positive plasma cells associated with sclerosis. IgG4-related disease often affects the dura mater with a pattern of diffuse thickening when the central nervous system is involved. However, some nodular dural thickening requires discrimination from tumors because of obviously different treatment options. We report of a case of IgG4-related disease with tumefactive dural involvement

CBO-richtlijn 'Diepveneuze trombose en longembolie'; herziening van eerdere richtlijnen

NARCIS (Netherlands)

Büller, H. R.; van der Meer, J.; Oudkerk, M.

2000-01-01

Diagnosis of clinically suspected deep venous thrombosis is based on a clinical score, serial compression ultrasonography and D-dimer assay. For the diagnosis of pulmonary embolism perfusion scintigraphy, ventilation scintigraphy, echography of the leg veins and pulmonary angiography in that order

Mutações predisponentes à trombofilia em indivíduos de Minas Gerais - Brasil com suspeita clínica de trombose Predisposing thrombophilic mutations in individuals with clinical suspicion of thrombosis from Minas Gerais, Brazil

Directory of Open Access Journals (Sweden)

Sabrina P. Guimarães

2009-02-01

Full Text Available A trombose é reconhecidamente uma doença de caráter multifatorial. Sua ocorrência está intimamente relacionada à presença de fatores genéticos e adquiridos que concorrem isoladamente ou em associação para o seu desencadeamento. No entanto, a frequência dos fatores genéticos pode variar de acordo com a origem étnica e com outros aspectos epidemiológicos dos grupos de indivíduos e populações estudadas. No Brasil, dados referentes a indivíduos brasileiros e em especial do estado de Minas Gerais são escassos. O objetivo do presente estudo foi investigar a frequência das mutações fator V Leiden e G20210A no gene protrombina em 1.103 indivíduos com suspeita clínica de trombofilia, empregando a técnica da reação em cadeia da polimerase seguida de restrição enzimática (PCR-RFLP. Os dados foram analisados usando-se o programa Epi Info versão 6.04. A amostra consistiu de 76,16% mulheres e 23,84% homens, com média de idade de 43,06± 14,65. A mutação fator V Leiden foi observada em heterozigose em 7,52% dos indivíduos e em 0,36% em homozigose. A mutação G20210A no gene da protrombina apresentou-se em heterozigose em 5,90% dos indivíduos e em homozigose em 0,18%. O presente trabalho mostra a importância dos testes genéticos conforme o perfil da população analisada, ressaltando informações epidemiológicas da população brasileira e benefícios clínicos.Thrombosis is known to be a multifactorial disease. Its incidence is directly related to the presence of genetic and acquired factors that concur separately or in association to its appearance. However, the frequency of genetic factors can vary according to ethnic background and with other epidemiological aspects of populations. Data from Brazilian individuals and especially those from the State of Minas Gerais are scarce. The present study aims at investigating the frequencies of the factor v Leiden and the G20210G prothrombin gene mutations of 1103 individuals

Mechanical properties of the human lumbar dura mater Propriedades mecânicas da dura máter lombar humana

Directory of Open Access Journals (Sweden)

Edmundo Zarzur

1996-09-01

Full Text Available BACKGROUND AND OBJECTIVES: This study aimed to evaluate the transverse and longitudinal distensibility of the posterior human lumbar dura mater. Results are compared with previous literature on biomechanical property studies. Possible clinical implications were also examined. METHODS:Samples of human dural sac were obtained from autopsy studies in three adult male cadavers. Dural sac samples were sectioned longitudinally to measure transverse and longitudinal distensibility, thickness and circumference. RESULTS:It was recorded that the posterior lumbar dura mater was easily distensible only in the transverse direction. The longitudinal force required to distend and rupture the posterior lumbar dura mater samples is 3.5 to 6.7 times greater than the force to produce a transversal rupture. CONCLUSION: Depending on the local cerebrospinal fluid pressure, the documented easier transverse distensibility of the posterior lumbar dura mater may allow greater contact of the lumbar dural sac with the wall of the lumbar verterbral canal. This fact may affect the diffusion of solutions introduced into epidural space.Este estudo procura avaliar as distensibilidades transversal e longitudinal da dura máter lombar na sua porção posterior. Os resultados são comparados com os de outras investigações publicadas sobre as propriedades biomecânicas da dura máter. MÉTODOS: Amostras de dura máter foram obtidas de autópsias realizadas em três cadáveres de homens adultos. As amostras do saco dural foram secionadas longitudinalmente para permitir as seguintes medições: distensibilidade transversal e longitudinal, espessura da dura máter e circunferência do saco dural. RESULTADOS:Foi constatado que a dura máter lombar na sua porção posterior é facilmente distensível. Para distender e romper longitudinalmente esta mesma dura máter, necessita-se de 3,5 a 6,7 vezes mais força do que a necessária para a sua distensão e rompimento na dire

Efeito preemptivo da morfina por via venosa na analgesia pós-operatória e na resposta ao trauma cirúrgico Efecto preemptivo de la morfina por vía venosa en la analgesia pós-operatoria y en la respuesta al trauma quirúrgico The effect of preemptive intravenous morphine on postoperative analgesia and surgical stress response

Directory of Open Access Journals (Sweden)

Levent Kiliçkan

2001-12-01

Full Text Available JUSTIFICATIVA E OBJETIVOS: Embora os primeiros estudos sobre analgesia preemptiva tenham demonstrado que o bloqueio pré-operatório com anestésicos locais ou a medicação pré-anestésica com opióides sistêmicos eram mais eficazes no alívio da dor pós-operatória do que qualquer outro tratamento, o resultado de outros estudos comparando os efeitos do tratamento pré operatório ao mesmo tratamento iniciado após a cirurgia, produziram efeitos inconsistentes. As razões para essa falta de consistência não são claras. São poucos os estudos sobre a relação entre analgesia preemptiva e o consumo de analgésicos e a resposta ao trauma cirúrgico. O objetivo deste estudo foi avaliar o efeito preemptivo da morfina por via venosa preemptiva no consumo pós-operatório de analgésicos e na resposta ao trauma cirúrgico. MÉTODO: Participaram deste estudo 60 pacientes, estado físico ASA I ou II, com idades entre 20 e 60 anos, escalados para histerectomia abdominal total e salpingo-ooferectomia bilateral, que foram aleatoriamente distribuídos em três grupos de 20 pacientes. Grupo I (n=20 - 0,15 mg.kg-1 de morfina após a indução anestésica e soro fisiológico durante o fechamento do peritônio. Grupo II (n=20 - soro fisiológico após a indução e 0,15 mg.kg-1 de morfina durante o fechamento do peritônio. Grupo III (n=20 soro fisiológico durante a indução e o fechamento do peritônio. Foram medidos os níveis sangüíneos de cortisol e de glicose e feita a contagem de leucócitos nos períodos pré e pós-operatórios. RESULTADOS: O consumo total de morfina pós-operatória foi significativamente mais baixo no grupo I comparado ao grupo III (p JUSTIFICATIVA Y OBJETIVOS: No obstante los primeros estudios sobre analgesia preemptiva hayan demostrado que el bloqueo pré-operatorio con anestésicos locales o la medicación pré-anestésica con opioides sistemicos eran mas eficaces en el alivio del dolor pós-operatorio de que cualquier

Anterior atlantodental and posterior atlantodental intervals on plain radiography, multidetector CT, and MRI

Energy Technology Data Exchange (ETDEWEB)

Cha, Seung Woo; Ryu, Jeong Ah; Park, Dong Woo [Dept. of Radiology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri (Korea, Republic of); Yoon, Ki Bo; Lee, Seung Hun; Joo, Kyung Bin [Dept. of Radiology, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul(Korea, Republic of)

2015-01-15

To determine the normal values of the anterior atlantodental interval (AADI) and posterior atlantodental interval (PADI) on plain radiography, multidetector CT (MDCT) and MRI, as well as the dural sac width and spinal cord diameter at the atlantoaxial joint level on MRI. In total, 60 subjects underwent plain radiography, MRI and MDCT. We obtained values for AADI and PADI on plain radiography, MDCT, and MRI, and for dural sac width and spinal cord diameter on MRI. Two radiologists independently measured each value and a consensus was reached. The average AADI was 1.5 +/- 0.5 mm on plain radiography, 1.4 +/- 0.3 mm on MDCT, and 1.6 +/- 0.5 mm on MRI. The average PADI was 20.6 +/- 2.4 mm on plain radiography, 18.0 +/- 2.1 mm on MDCT, and 17.7 +/- 1.9 mm on MRI. The dural sac width was 13.7 +/- 1.8 mm, and the spinal cord diameter was 7.8 +/- 0.7 mm. Interobserver agreement was 0.701-0.927 and intraobserver agreement was 0.681-0.937. AADI values obtained on MDCT are significantly lower than those obtained on plain radiography or MRI. PADI values obtained on plain radiography are significantly higher than those obtained on MDCT or MRI. The dural sac width is most closely correlated with PADI values on MDCT. PADI seems to be easier to measure, more relevant, and clinically useful than AADI.

Anterior atlantodental and posterior atlantodental intervals on plain radiography, multidetector CT, and MRI

International Nuclear Information System (INIS)

Cha, Seung Woo; Ryu, Jeong Ah; Park, Dong Woo; Yoon, Ki Bo; Lee, Seung Hun; Joo, Kyung Bin

2015-01-01

To determine the normal values of the anterior atlantodental interval (AADI) and posterior atlantodental interval (PADI) on plain radiography, multidetector CT (MDCT) and MRI, as well as the dural sac width and spinal cord diameter at the atlantoaxial joint level on MRI. In total, 60 subjects underwent plain radiography, MRI and MDCT. We obtained values for AADI and PADI on plain radiography, MDCT, and MRI, and for dural sac width and spinal cord diameter on MRI. Two radiologists independently measured each value and a consensus was reached. The average AADI was 1.5 +/- 0.5 mm on plain radiography, 1.4 +/- 0.3 mm on MDCT, and 1.6 +/- 0.5 mm on MRI. The average PADI was 20.6 +/- 2.4 mm on plain radiography, 18.0 +/- 2.1 mm on MDCT, and 17.7 +/- 1.9 mm on MRI. The dural sac width was 13.7 +/- 1.8 mm, and the spinal cord diameter was 7.8 +/- 0.7 mm. Interobserver agreement was 0.701-0.927 and intraobserver agreement was 0.681-0.937. AADI values obtained on MDCT are significantly lower than those obtained on plain radiography or MRI. PADI values obtained on plain radiography are significantly higher than those obtained on MDCT or MRI. The dural sac width is most closely correlated with PADI values on MDCT. PADI seems to be easier to measure, more relevant, and clinically useful than AADI.

Managing Rapana in the Black Sea: stakeholder workshops on both sides

NARCIS (Netherlands)

Janssen, R.; Knudsen, S.; Todorova, V.; Gündüz Hosgör, A.

2014-01-01

Rapana venosa is a non-indigenous invasive predator on bivalves in the Black Sea. A Rapana fishery has developed in the Black Sea since the 1980s, primarily in Turkey and Bulgaria. The Rapana fishery provides a complex management problem with three groups of objectives: 1. Good economic status; 2.

Measurement of the area of venous ulcers using two software programs.

Science.gov (United States)

Eberhardt, Thaís Dresch; Lima, Suzinara Beatriz Soares de; Lopes, Luis Felipe Dias; Borges, Eline de Lima; Weiller, Teresinha Heck; Fonseca, Graziele Gorete Portella da

2016-12-19

to compare the measurement area of venous ulcers using AutoCAD(r) and Image Tool software. this was an assessment of reproducibility tests conducted in a angiology clinic of a university hospital. Data were collected from 21 patients with venous ulcers, in the period from March to July of 2015, using a collection form and photograph of wounds. Five nurses (evaluators) of the hospital skin wound study group participated. The wounds were measured using both software programs. Data were analyzed using intraclass correlation coefficient, concordance correlation coefficient and Bland-Altman analysis. The study met the ethical aspects in accordance with current legislation. the size of ulcers varied widely, however, without significant difference between the measurements; an excellent intraclass and concordance correlation was found between both software programs, which seem to be more accurate when measuring a wound area >10 cm². the use of both software programs is appropriate for measurement of venous ulcers, appearing to be more accurate when used to measure a wound area > 10 cm². comparar a mensuração de área de úlceras venosas por meio dos softwares AutoCAD(r) e Image Tool. trata-se de um estudo de avaliação de reprodutibilidade de testes, realizado em um ambulatório de angiologia de um hospital universitário. Os dados foram coletados de 21 pacientes com úlceras venosas, no período de março a julho de 2015, por meio de formulário de coleta e fotografia das feridas. Cinco enfermeiros (avaliadores) do Grupo de Estudos de Lesões de Pele do hospital participaram da pesquisa. As feridas foram mensuradas em ambos os softwares. Os dados foram analisados por meio do Coeficiente de correlação intraclasse, Coeficiente de correlação de concordância e procedimento de Bland e Altman. A pesquisa respeitou os aspectos éticos de acordo com a legislação vigente. os tamanhos das úlceras apresentaram grande amplitude, porém, sem diferença significativa entre

Gamma Knife radiosurgery for intracranial meningiomas: Do we need to treat the dural tail? A single-center retrospective analysis and an overview of the literature.

Science.gov (United States)

Bulthuis, Vincent J; Hanssens, Patrick E J; Lie, Suan Te; van Overbeeke, Jacobus J

2014-01-01

The dural tail (DT) has been described as a common feature in meningiomas. There is a great variation of tumor invasion and extent of tumor cells in the DT. Therefore, the necessity to include the whole DT in Gamma Knife radiosurgery is not clear, since inclusion increases the target volume and therefore increases the risk of complications. In this analysis, we evaluated whether the complete tail should be included as part of the target in Gamma Knife radiosurgery for meningiomas. Between June 2002 and December 2010, Gamma Knife radiosurgery was performed in 160 patients with 203 meningiomas with a DT. In 105 tumors, the diagnosis was based on magnetic resonance imaging (MRI) characteristics, and in 98 tumors, the diagnosis was confirmed by histopathologic examination after surgery. The median volume of the tumors was 3.55 cc. All tumors were treated with Gamma Knife radiosurgery with a median prescribed dose of 13 Gy (range 11-15), resulting in a median marginal dose of 11 Gy (range 10-15). Only the part of the DT closely related to the tumor mass was included in the target. The median follow-up period was 41 months (range 12-123). In image-based meningiomas, the overall local control rate was 96.2% with 2- and 5-year control rates of 98.0% and 95.1%, respectively. In WHO grade I tumors, the overall local control rate was 85.9% with 2- and 5-year control rates of 94.5% and 88.0%, respectively. The overall local control rate in World Health Organization (WHO) grade II tumors was 70.6% with control rates of 83.4% and 64.4% after 2 and 5 years, respectively. The growth of all new tumors was found in the radiation target area. No tumor growth was observed in the part of the DT that had been excluded from the target volume. We found in this study that routinely excluding the DT from the target does not lead to out-of-field tumor progression. Given the possibility that the DT is infiltrated with tumor cells, regular follow-up is needed.

Importance of an intact dura in management of compound elevated fractures; a short series and literature review.

Science.gov (United States)

Mohindra, Sandeep; Singh, Harnarayan; Savardekar, Amey

2012-01-01

To describe compound elevated fractures (CEFs) of the skull vault, with radiological pictures, management problems and prognosticative factors. The authors describe three cases of CEFs of the cranium, their mode of injury, clinical findings, radiological images and management problems. The authors have reviewed the existing literature regarding epidemiological data, neurological status, dural breech, methods of management and final outcome, in respect of CEFs. The first case had no dural breech, the second case had completely shattered dura, with extruding brain matter from the wound, while the third case had an elevated bone flap in consequence to large extradural haematoma. The patients with intact dura had relatively favourable outcome, when compared to patients with shattered dura. Three cases are added to the existing 10 such cases described in English literature. The major cause of unfavourable outcome remains sepsis and the presence of intact dura places these cases in the relatively safe category, regarding infective complications. The authors attempt at highlighting the importance of intact dura with such an injury. The review of literature supports favourable outcomes in patients having no dural breech.

Metastatic Breast Lesion to the Falx Detected with PET/CT

Energy Technology Data Exchange (ETDEWEB)

Harrison, Chester; Schuster, David M. [Emory Univ., Atlanta (United States)

2012-06-15

Intracranial dural metastasis is increasingly encountered in imaging. Autopsies conducted on patients with advanced metastatic disease demonstrate dural involvement in 9% of cases, with breast and prostate cancer the most common primaries. Awareness of this entity and imaging appearances is especially important in evaluating malignancies prone to dural metastasis. A 57-year-old woman with a strong family history of breast cancer initially presented after self-detection of a right breast lump. Subsequent mammogram and biopsies yielded a diagnosis of right infiltrating ductal carcinoma with a positive lymph node as well as left invasive lobular carcinoma. Initial staging PET-CT (not shown) at the time of diagnosis demonstrated no abnormal FDG uptake remote from the breast. Neoadjuvant chemotherapy was instituted, and a PET-CT was obtained to evaluate disease response, demonstrating an approximately 1.8 cm hypermetabolic intra-cranial mass, localized to the region of the anterior corpus callosum on axian PET (Fig. 1a), axial fused PET-CT (Fig. 1b), and sagittal fused PET-CT (Fig. 1c) with a maximum SUV of 15.9. There was associated bifrontal vasogenic edema (Fig. 1d) on the CT demonstrated on brain windows. Marked progression of disease was noted elsewhere, including hypermetabolic adenopathy and skeletal disease. A contrast-enhanced MRI of the brain was obtained demonstrating extensive T1 hypointensity, T2, and FLAIR (Fig. 2a) hyperintensity in the bilateral paramedian frontallobes representing vasogenic edema. Post-contrast imaging demonstrated three solidly enhancing masses in the areas of described vasogenic edema, one large extra-axial and two sub-centimeter parenchymal lesions. The large extra-axial and two sub-centimeter parenchymal lesions. The large extra-axial mass demonstrated homogeneous solid enhancement, in the midline anteriorly centered on the falx, just superior to the anterior corpus callosum. This measured 1.7cm transverse x 3.1cm AP x 2.4cm

Hemorrhagic lumbar facet cysts accompanying a spinal subdural hematoma at the same level.

Science.gov (United States)

Ikeda, Osamu; Minami, Norihiko; Yamazaki, Masashi; Koda, Masao; Morinaga, Tatsuo

2015-03-01

We present a rare and interesting case of hemorrhagic lumbar facet cysts accompanying a spinal subdural hematoma at the same level suggesting a possible mechanism by which spinal subdural hematomas can arise. A 71-year-old man presented with persistent sciatic pain and intermittent claudication. Magnetic resonance imaging demonstrated a multilocular mass lesion that showed high signal intensity in both T1- and T2-weighted images, and was located both inside and outside of the spinal canal. Computed tomographic myelography showed a cap-shaped block of the dural tube at L5 and computed tomography with L5-S facet arthrography demonstrated cystic masses. The patient was diagnosed with lumbar radiculopathy caused by hemorrhagic facet cysts, and then progressed to surgical treatment. Surgery revealed that the cysts contained blood clots, and intraoperative findings that the inside of the dural tube appeared blackish and that the dural tube was tensely ballooned after removal of the cysts led us to explorative durotomy. The durotomy demonstrated concentrated old blood pooling both in the dorsal and ventral subdural space, and these spaces were subsequently drained. After surgery, his sciatic pain and intermittent claudication resolved. There was no evidence of cyst mass recurrence at 2 years of follow-up. We propose a newly described mechanism for the formation of spinal subdural hematomas. We recommend surgeons be alert to epidural lesions causing repeated acute compression of the dural tube, which can cause spinal subdural hematoma, and consider the possible coexistence of these lesions in diagnosis and strategic surgical decisions.

Biochemical biomarker responses to pollution in selected sentinel organisms across the Eastern Mediterranean and the Black Sea

KAUST Repository

Tsangaris, Catherine; Moschino, Vanessa; Strogyloudi, Evangelia; Coatu, Valentina; Ramšak, Andreja; Abu Alhaija, Rana; Carvalho, Susana; Felline, Serena; Kosyan, Alisa; Lazarou, Yiota; Hatzianestis, Ioannis; Oros, Andra; Tiganus, Daniela

2015-01-01

Pollution effects were assessed by means of biochemical biomarkers (catalase, glutathione S-transferase and acetylcholinesterase activities, and metallothioneins content) in five species at selected coastal sites across the Eastern Mediterranean and the Black Sea. The mussel Mytilus galloprovincialis, a well-established sentinel species, was investigated in the Adriatic Sea, Aegean Sea, and Black Sea. The mussel Brachidontes pharaonis and the striped red mullet Mullus surmuletus were used in the Levantine Sea where M. galloprovincialis is not present. The white seabream Diplodus sargus sargus and the gastropod Rapana venosa were additionally sampled in the Adriatic and the Black Sea, respectively. Mussels showed catalase, glutathione S-transferase, and acetylcholinesterase responses to pollution in most geographical areas while the response of metallothioneins was restricted to a few sites. R. venosa showed marked responses of catalase and metallothioneins whereas both fish species did not generally exhibit variations in biomarker values among sites. The approach based on the reference deviation concept using the “Integrated Biological Responses version 2” index was useful for the interpretation of overall biomarker responses.

Biochemical biomarker responses to pollution in selected sentinel organisms across the Eastern Mediterranean and the Black Sea

KAUST Repository

Tsangaris, Catherine

2015-09-23

Pollution effects were assessed by means of biochemical biomarkers (catalase, glutathione S-transferase and acetylcholinesterase activities, and metallothioneins content) in five species at selected coastal sites across the Eastern Mediterranean and the Black Sea. The mussel Mytilus galloprovincialis, a well-established sentinel species, was investigated in the Adriatic Sea, Aegean Sea, and Black Sea. The mussel Brachidontes pharaonis and the striped red mullet Mullus surmuletus were used in the Levantine Sea where M. galloprovincialis is not present. The white seabream Diplodus sargus sargus and the gastropod Rapana venosa were additionally sampled in the Adriatic and the Black Sea, respectively. Mussels showed catalase, glutathione S-transferase, and acetylcholinesterase responses to pollution in most geographical areas while the response of metallothioneins was restricted to a few sites. R. venosa showed marked responses of catalase and metallothioneins whereas both fish species did not generally exhibit variations in biomarker values among sites. The approach based on the reference deviation concept using the “Integrated Biological Responses version 2” index was useful for the interpretation of overall biomarker responses.

Biochemical biomarker responses to pollution in selected sentinel organisms across the Eastern Mediterranean and the Black Sea.

Science.gov (United States)

Tsangaris, Catherine; Moschino, Vanessa; Strogyloudi, Evangelia; Coatu, Valentina; Ramšak, Andreja; Alhaija, Rana Abu; Carvalho, Susana; Felline, Serena; Kosyan, Alisa; Lazarou, Yiota; Hatzianestis, Ioannis; Oros, Andra; Tiganus, Daniela

2016-01-01

Pollution effects were assessed by means of biochemical biomarkers (catalase, glutathione S-transferase and acetylcholinesterase activities, and metallothioneins content) in five species at selected coastal sites across the Eastern Mediterranean and the Black Sea. The mussel Mytilus galloprovincialis, a well-established sentinel species, was investigated in the Adriatic Sea, Aegean Sea, and Black Sea. The mussel Brachidontes pharaonis and the striped red mullet Mullus surmuletus were used in the Levantine Sea where M. galloprovincialis is not present. The white seabream Diplodus sargus sargus and the gastropod Rapana venosa were additionally sampled in the Adriatic and the Black Sea, respectively. Mussels showed catalase, glutathione S-transferase, and acetylcholinesterase responses to pollution in most geographical areas while the response of metallothioneins was restricted to a few sites. R. venosa showed marked responses of catalase and metallothioneins whereas both fish species did not generally exhibit variations in biomarker values among sites. The approach based on the reference deviation concept using the "Integrated Biological Responses version 2" index was useful for the interpretation of overall biomarker responses.

Anestesia venosa total (AVT em lactente com doença de Werdnig-Hoffmann: relato de caso Anestesia general intravenosa (AVT en lactante con enfermedad de Werdnig-Hoffmann: relato de caso Total intravenous anesthesia (TIVA in an infant with Werdnig-Hoffmann disease: case report

Directory of Open Access Journals (Sweden)

Marco Antonio Cardoso de Resende

2010-04-01

Full Text Available JUSTIFICATIVA E OBJETIVOS: A doença de Werdnig-Hoffmann é a causa mais comum de hipotonia no lactente e quando presente logo após o nascimento tem pior prognóstico. Fraqueza muscular simétrica, arreflexia e fasciculações da língua são característicos. A maioria dos lactentes morre antes dos dois anos por insuficiência respiratória. O presente relato apresenta um caso com técnica venosa total durante anestesia. RELATO DO CASO: Paciente feminina, branca, um ano, 10 kg, estado físico ASA III, com doença de Werdnig-Hoffmann diagnosticada desde os dois meses de idade. Candidata à gastrostomia e fundogastroplicatura na técnica aberta e traqueostomia. Monitorização com cardioscópio, pressão arterial não invasiva, oxímetro de pulso, estetoscópio precordial e temperatura retal após venóclise. Foi préoxigenada e após bolus de atropina (0,3 mg foi realizada indução anestésica com remifentanil bolus (20 µg e propofol (30 mg. Após intubação traqueal foi ventilada de forma controlada manual, em sistema sem absorvedor de CO2, Baraka (sistema Mapleson D, FGF de 4 L.min-1, FiO2 0,5 (0(2/N(20. Mantida sob anestesia com propofol 250 µg.kg-1.min-1 e remifentanil 0,3 µg.kg-1.min-1 em infusão contínua manual. O tempo cirúrgico foi de 150 minutos. O despertar ocorreu 8 minutos após o término da infusão, com ventilação espontânea. Duas horas depois foi transferida para unidade pediátrica e recebeu alta hospitalar no 4º dia de pós-operatório. CONCLUSÕES: A escolha da técnica anestésica prioriza a segurança que advém da familiaridade do manuseio dos fármacos existentes. Em crianças com doenças neuromusculares, a anestesia venosa total com remifentanil e propofol em sistemas de infusão, pela duração de ação extremamente curta, pode influenciar a evolução da doença favoravelmente.JUSTIFICATIVA Y OBJETIVOS: La enfermedad de Werdnig-Hoffmann es la causa más común de hipotonía en el lactante y cuando est

Posterior extradural migration of extruded thoracic and lumbar disc fragments: role of MRI

International Nuclear Information System (INIS)

Neugroschl, C.; Dietemann, J.L.; Kehrli, P.; Ragragui, O.; Maitrot, D.; Gigaud, M.; Manelfe, C.

1999-01-01

We report three patients with a sequestrated disc fragment posterior to the thecal sac. The affected disc was lumbar in two cases and thoracic in the third. Disc fragment migration is usually limited to the anterior extra dural space. Migration of a disc fragment behind the dural sac is seldom encountered. MRI appears to be the method of choice to make this diagnosis. The disc fragments gave low signal on T1- and slightly high signal on T2-weighted images and showed rim contrast enhancement. The differential diagnosis includes abscess, metastatic tumour and haematoma. (orig.)

197. Trombosis masiva biauricular intervenida mediante cirugía cardíaca con circulación extracorpórea

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R. Sánchez Pérez

2012-04-01

Conclusión: Destacamos la importancia del diagnóstico precoz y preciso de la trombosis biauricular con embolismo paradójico en aurícula izquierda a través de fosa oval, en el contexto de trombosis venosa profunda, debido a que puede beneficiarse de la cirugía cardíaca como tratamiento inicial.

Normal morphology of the cervical spinal cord and spinal canal using MRI in Japanese

International Nuclear Information System (INIS)

Kato, Fumihiko; Yukawa, Yasutsugu; Suda, Kota; Yamagata, Masatsune; Ueta, Takayoshi

2010-01-01

The purpose of this study was to establish standard MRI values for the cervical spinal canal, dural tube, and spinal cord in healthy Japanese subjects and to define developmental stenosis of the cervical spinal canal based on MRI data. To establish standard values for ''finger grip and release in 10 seconds (G and R test)'' and ''10 second step test'' in healthy Japanese subjects. There were approximately 100 volunteers representing each gender and generation, including persons aged in their 20s to 70s. The sagittal diameter of the spinal canal, and the sagittal diameter and axial area of the dural tube and spinal cord were measured on MRIs of 1,211 subjects. From this data, we calculated the spinal cord occupation rate in the dural tube for defining developmental stenosis of the cervical spinal canal. ''Finger grip and release in 10 seconds (G and R test)'' and ''10 second step test'' were also examined on 1,211 subjects. The spinal canal diameter in sagittal images for all ages at the C5/6 intervertebral disc level was 11.7±1.6 mm in males and 11.6±1.5 mm in females, while that at the C5 vertebral body level was 12.9±1.4 mm in males and 12.5±1.3 mm in females. Dural tube diameter in sagittal images for all ages at the C5/6 intervertebral disc level was 9.5±1.8 mm in males and 9.6±1.6 mm in females, while that at the C5 vertebral body level was 11.2±1.4 mm in males and 11.1±1.4 mm in females. Dural tube area in axial images for all ages at the C5/6 intervertebral disc level was 155.7±32.1 mm 2 in males and 149.6±29.0 mm 2 in females, while that at the C5 vertebral body level was 187.4±32.6 mm 2 in males and 177.0±32.7 mm 2 in females. Spinal cord diameter in sagittal images for all ages at the C5/6 intervertebral disc level was 5.9±1.0 mm in males and 5.8±0.9 mm in females, while that at the C5 vertebral body level was 6.5±0.7 mm in males and 6.4±0.7 mm in females. Spinal cord area in axial images for all ages at the C5/6 intervertebral disc level

Artroplastia total do quadril não cimentada em pacientes com artrite reumatóide Uncemented total hip arthroplasty in patients with rheumatoid arthritis

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Bruno Tavares Rabello

2008-08-01

Full Text Available OBJETIVO: Analisar os resultados clínico-funcional e radiográfico das artroplastias totais do quadril não cimentadas em pacientes com artrite reumatóide. MÉTODOS: Estudo retrospectivo de 24 pacientes (28 quadris portadores de artrite reumatóide submetidos à artroplastia total do quadril, utilizando-se a prótese femoral não cimentada Secur Fit Osteonics®, com seguimento mínimo de dois anos. Clinicamente, os pacientes foram avaliados utilizando os critérios de Merle D'Aubigné, e os critérios de Engh, na avaliação radiográfica. RESULTADOS: O tempo médio de seguimento foi de 5,6 anos (dois anos a oito anos e 11 meses. Clinicamente, resultados bons e excelentes foram observados em 22 pacientes, com destaque para a melhora do parâmetro dor. Não foi evidenciado qualquer caso de afrouxamento. Complicações foram observadas em dois casos, um paciente apresentou trombose venosa profunda (TVP, comprovada com doppler, e um caso de fratura peroperatória distal ao calcar, tratada com cerclagem, sem repercussão na qualidade dos resultados clínico e radiográfico do paciente. CONCLUSÃO: Os resultados sugerem, após seguimento médio de 5,6 anos, que a artroplastia total do quadril não cimentada pode ser opção satisfatória nas coxartroses de pacientes portadores de artrite reumatóide.OBJECTIVE: To analyze clinical, functional, and radiographic results of uncemented total hip arthroplasties in patients with rheumatoid arthritis. METHODS: Retrospective study of 24 patients (28 hips with rheumatoid arthritis submitted to total hip arthroplasty, using uncemented femoral prosthesis Secur Fit Osteonics®, with minimum follow-up of two years. The patients were clinically evaluated using the Merle D'Aubigné criteria and the Engh criteria in radiographic evaluation. RESULTS: Mean follow-up time was 5.6 years (two years to eight years and 11 months. Clinically, good and excellent results were observed in 22 patients, with emphasis on pain

Liver disease associated with intestinal failure in the small bowel syndrome Doença hepática associada à falência intestinal na síndrome do intestino curto

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Rafael Kemp

2006-01-01

Full Text Available The introduction of the Total Parenteral Nutrition (TPN has given rise to a new hope in the treatment of intestinal failure (LF associated with the Short Bowel Syndrome (SBS. However, together with the TPN and the increase of survival of these patients, new problems and questions have emerged, as well as new therapeutical procedures. Taking into consideration this emerging reality, this paper has the purpose to undertake a review of current concepts and available treatments for patients with IF associated-liver disease. Although TPN provides an increase of survival of patients with intestinal failure, it is a potential source of complication such as: septicemia, hyperglycemia, venous thrombosis and liver disease. There are several hypothesis conceived to explain the liver disease associated to intestinal failure, however the only definite treatment as a potential to reverse the non-cirrhotic liver disease is the small intestine transplantation. Despite indications for intestine transplantation are not entirely defined in literature, the trend is its early indication in high-risk patients, preserving the liver integrity and preventing the eventual need of both liver and intestine transplantations altogether.A introdução da Nutrição Parenteral Total (NPT despertou uma nova esperança para o tratamento da falência intestina (FI associada a Síndrome do Intestino Curto (SIC. No entanto, junto com a NPT e o aumento da sobrevida destes pacientes, novos problemas e perguntas emergiram, assim como novas terapêuticas. Tendo em vista esta realidade emergente, o intuito deste artigo é realizar uma revisão dos conceitos atuais e dos tratamentos disponíveis para pacientes com doença hepática associada a FI. A NPT apesar de proporcionar aumento da sobrevida nos pacientes com falência intestinal é fonte potencial de complicações, como: septicemia, hiperglicemia, trombose venosa e doença hepática. Diversas são as hipóteses aventadas para

Hematome Extra - Dural Rachidien Spontane

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Cl. Gros

1967-01-01

Full Text Available Four personal cases of Spontaneous Spinal Epidurdl Hemerrhage are Reported. And 29 additional cases have been analysed by reviewing the literature. The clinical radiologcal and surgical aspects were discussed.

Policitemia vera: a propósito de um caso clínico

OpenAIRE

Joana Macedo; Emília Costa; José Barbot; Cláudia Neto

2015-01-01

A policitemia vera (PV) é um transtorno mieloproliferativo das células hematopoiéticas, caracterizada por uma produção anormal e acentuada de eritrócitos, leucócitos e plaquetas. Outras características da doença incluem esplenomegalia, complicações trombo-hemorrágicas, distúrbios vasomotores, prurido e um pequeno risco de progressão da doença para leucemia mielóide aguda ou mielofibrose. A trombose é o sintoma de apresentação em 20% dos pacientes com PV. É uma doença rara, com uma incidência ...

Reparación de la duramadre con poliesteruretano Repair of dura mater with polyesterurethane

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K Barbosa

2005-03-01

Full Text Available Objetivo: El propósito de este estudio fue comprobar el uso del poliesteruretano como material de injerto dural e informar los resultados posoperatorios. Métodos: Se realizó una duraplastia con poliesteruretano como material de injerto a 30 pacientes que precisaban de implantes durales. El poliesteuretano empleado se extrajo de la poliespuma protectora de las cajas de medicamentos. Excluimos a los pacientes con signos de infección en el sitio donde se aplicó el procedimiento neuroquirúrgico. Se hicieron las observaciones clínicas un día después de la operación, a los 15 y a los 90 días posteriores, para buscar indicios de filtración de líquido cefalorraquídeo, infección de la herida y meningitis. Resultados: No se encontró filtración de líquido cefaloraquídeo ni infección en ninguno de los 30 pacientes (craneotomía - 53,3 %; cranectomía - 3,3 %; reparación de fracturas deprimidas del cráneo - 20 %; reparación de mielomeningocele lumbar - 6,7 %; instrumentación y fusión de la espina toracolumbar - 3,3 %; laminectomía torácica - 3,3 %; laminectomías lumbares - 6,7 % y discectomía lumbar - 3,3 %. En un paciente reintervenido quirúrgicamente (recaída por metástasis cerebral, no se observaron adherencias del injerto a la superficie cortical. Conclusiones: Al parecer el poliesteruretano es un sustituto dural apropiado, de fácil manipulación (y en este caso, sin costo alguno, que produce un cierre hermético de la duramadre, sin complicaciones o adherencias a la superficie corticalThe purpose of this study was to prove the use of polyesterurethane as a dural graft material and to inform the postoperative results. Methods: A duraplasty with polyesterurethane as a graft material was performed in 30 patients that required dural implants. The polyesterurethane used was extracted from the protective polyfoam of the drug boxes. Patients with signs of infection in the site where the neurosurgical procedure was carried out

Formações císticas epidurais relacionadas a bursite interespinhosa, cisto sinovial e cisto discal Epidural cystic masses associated with interspinous bursitis, synovial and discal cysts

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Frederico Guilherme de Paula Lopes Santos

2009-04-01

Full Text Available Os autores apresentam casos de cistos epidurais, dentre eles os cistos sinoviais, discais, do ligamento amarelo e relacionados a bursite interespinhosa, todas essas condições determinando compressão radicular, do saco dural ou estenose do canal vertebral. Descrevem as características de imagem e localização na ressonância magnética nessas diferentes afecções.The authors describe some cases of epidural cysts, namely synovial, discal, ligamentum flavum cysts, and cysts secondary to interspinous bursitis, all of these conditions determining radicular, dural sac compression or spinal canal stenosis. Magnetic resonance imaging findings and localization of these entities are described.

Rapid cognitive decline: not always Creutzfeldt-Jakob disease.

Science.gov (United States)

Randall, A; Ellis, R; Hywel, B; Davies, R R; Alusi, S H; Larner, A J

2015-01-01

A patient with rapidly progressive cognitive decline over an approximately four month period was suspected to have sporadic Creutzfeldt-Jakob disease. Features thought to support this diagnosis included psychiatric symptoms (anxiety and depression), visual hallucinations and a visual field defect. However, the finding of papilloedema broadened the differential diagnosis. Although standard brain imaging and electroencephalography had shown only non-specific abnormalities, subsequent cerebral angiography disclosed an intracranial dural arteriovenous fistula. Following embolisation, the patient made a good functional recovery. Intracranial dural arteriovenous fistula merits consideration in any patient with subacute cognitive decline, and should be included in the differential diagnosis of sporadic Creutzfeldt-Jakob disease.

Zumbido pulsátil: tratamento com clonazepan e propranolol Pulsatile tinnitus: treatment with clonazepam and propranolol

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Sergio Albertino

2005-02-01

Full Text Available O zumbido pulsátil sincrônico com os batimentos cardíacos é pouco freqüente, sendo de etiologia tanto vascular arterial (malformações, fístulas artério-venosas ou venosa (anormalidades do bulbo jugular, tumor glômico jugular ou timpânico. A identificação precoce da etiologia é essencial para que a terapêutica adequada possa ser instituída. A angioressonância possibilita a identificação de alterações vasculares com maior precisão. Relatamos um caso onde, após o diagnóstico de uma alteração vascular arterial, foi instituído o tratamento com propranolol e clonazepam, com melhora da sintomatologia.Pulsatile tinnitus synchronous with heartbeat is rare and normally has vascular origin: arterial (malformation, arterial anatomical variation or venous (aberrant jugular bulb, glomus tumors, tympanic glomus tumor. Early etiology identification is essential for appropriate treatment to be established. Magnetic angioresonance makes the vascular identification possible and precise. We report a case of arterial anatomical variation in which the treatment was propranolol and clonazepam, showing tinnitus improvement.

Ruolo delle nuove tecnologie basate sugli ultrasuoni nella valutazione dell'ipertensione portale nei pazienti con epatopatia cronica

OpenAIRE

Allegretti, Giulia

2017-01-01

Introduzione – Nei pazienti con epatopatia cronica, l'ipertensione portale rappresenta la causa delle principali complicanze (sanguinamento da varici, ascite, encefalopatia epatica) che, insieme all’epatocarcinoma, costituiscono la causa più importante di ospedalizzazione e mortalità. Le metodiche gold-standard per la valutazione dell’ipertensione portale sono la misurazione del gradiente di pressione venosa epatica (HVPG) mediante cateterismo delle vene sovraepatiche e l’esofagogastroduodeno...

Combined spinal–epidural anesthesia for an elderly patient with proportionate dwarfism for laparotomy

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Teena Bansal

2016-01-01

Full Text Available Anesthesia in a dwarf patient may be challenging as various anatomical anomalies make both general and regional anesthesia difficult. These patients may have atlantoaxial instability, potential for airway obstruction, and associated respiratory problems that may pose problems for general anesthesia. Spinal stenosis, osteophytes, short pedicles, or a small epidural space could complicate regional anesthesia in dwarfs which could lead to difficulties in locating the epidural space and increase the risk of dural puncture. Spinal stenosis may impair cerebrospinal fluid flow such that identification of dural puncture is difficult. This elderly dwarf patient had history of bronchial asthma with restriction of neck extension, managed successfully using combined spinal–epidural anesthesia.

Giant pseudomeningocele causing urinary obstruction in a patient with Marfan syndrome.

Science.gov (United States)

Stone, Jeremy G; Bergmann, Liisa L; Takamori, Ryan; Donovan, Daniel J

2015-07-01

Defective collagen biosynthesis in Marfan syndrome predisposes to dural defects such as dural ectasia, meningocele, and pseudomeningocele; thus, an increased index of suspicion for these conditions should be present in the clinical setting of Marfan syndrome. The authors describe a young woman with Marfan syndrome who was being treated with anticoagulants for a prosthetic heart valve and who presented with a spontaneous retroperitoneal hemorrhage requiring surgical evacuation. No CSF leak was encountered at surgery, but she developed progressively more severe positional headaches over the following year. She then experienced the sudden onset of acute urinary obstruction, at which time CT revealed a 17 × 15 × 13-cm presacral pseudomeningocele communicating with the thecal sac through a sacral bone defect. An anterior surgical approach was used for drainage of the pseudomeningocele as well as for primary closure of the dural defect with a bovine pericardial patch and autologous subcutaneous fat graft. After a short period of lumbar subarachnoid drainage of the CSF, the patient was able to resume normal activity without recurrent symptoms. To the authors' knowledge, such a pseudomeningocele in a patient with Marfan syndrome has been reported only twice, and this case features the largest pseudomeningocele to date. They also review the pertinent literature regarding presentation, diagnosis, and management of these lesions.

Macroscopic Innervation of the Dura Mater Covering the Middle Cranial Fossa in Humans Correlated to Neurovascular Headache.

Science.gov (United States)

Lee, Shin-Hyo; Hwang, Seung-Jun; Koh, Ki-Seok; Song, Wu-Chul; Han, Sang-Don

2017-01-01

The trigeminovascular system within the cranial dura mater is a possible cause of headaches. The aim of this study is to investigate macroscopically dural innervation around the middle meningeal artery (MMA) in the middle cranial fossa. Forty-four sides of the cranial dura overlying the skull base obtained from 24 human cadavers were stained using Sihler's method. Overall, the nervus spinosus (NS) from either the maxillary or mandibular trigeminal divisions ran along the lateral wall of the middle meningeal vein rather than that of the MMA. Distinct bundles of the NS running along the course of the frontal branches of the MMA were present in 81.8% of cases ( N = 36). Others did not form dominant nerve bundles, instead giving off free nerve endings along the course of the MMA or dural connective tissue. The distribution of these nerve endings was similar to that of the course of the frontal, parietal and petrosal branches of the MMA (11.4%). The others were not restricted to a perivascular plexus, crossing the dural connective tissues far from the MMA (6.8%). These findings indicate that the NS generally travels alongside the course of the frontal branches of the MMA and terminates in the vicinity of the pterion.

Macroscopic Innervation of the Dura Mater Covering the Middle Cranial Fossa in Humans Correlated to Neurovascular Headache

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Shin-Hyo Lee

2017-12-01

Full Text Available The trigeminovascular system within the cranial dura mater is a possible cause of headaches. The aim of this study is to investigate macroscopically dural innervation around the middle meningeal artery (MMA in the middle cranial fossa. Forty-four sides of the cranial dura overlying the skull base obtained from 24 human cadavers were stained using Sihler’s method. Overall, the nervus spinosus (NS from either the maxillary or mandibular trigeminal divisions ran along the lateral wall of the middle meningeal vein rather than that of the MMA. Distinct bundles of the NS running along the course of the frontal branches of the MMA were present in 81.8% of cases (N = 36. Others did not form dominant nerve bundles, instead giving off free nerve endings along the course of the MMA or dural connective tissue. The distribution of these nerve endings was similar to that of the course of the frontal, parietal and petrosal branches of the MMA (11.4%. The others were not restricted to a perivascular plexus, crossing the dural connective tissues far from the MMA (6.8%. These findings indicate that the NS generally travels alongside the course of the frontal branches of the MMA and terminates in the vicinity of the pterion.

Herpes Zoster oftálmico e posterior acidente vascular cerebral: relato de caso

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Carlos A. M. Guerreiro

1984-12-01

Full Text Available Um caso de acidente vascular cerebral (AVC 14 semanas após a instalação de herpes zoster oftálmico (HZO é apresentado. A tomografia computadorizada craniana documentou comprometimento em território de artéria cerebral média ipsilateral ao HZO. O diagnóstico de probabilidade é o de arterite por herpes zoster com posterior trombose. Os autores reviram a literatura e enfatizam o longo intervalo entre o HZO e a instalação da hemiplegia. Citam as novas drogas antivirais que tornam esta causa de AVC potencialmente passível de ser prevenida.

Advanced magnetic resonance imaging and neuropsychological assessment for detecting brain injury in a prospective cohort of university amateur boxers

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M.G. Hart

2017-01-01

Conclusion: While this neuroimaging and neuropsychological assessment protocol could not detect any evidence of brain injury, one boxer developed seizures and another developed a chronic sub-dural haematoma.

Indicaciones y control de la medicación anticoagulante

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Armando Solano Puerto

1954-09-01

Full Text Available Considero importante el tratar de hacer un balance de nuestros conocimientos actuales en materia de medicación anticoagulante. En primer lugar, porque los avances realizados en estos últimos años, debidos en buena parte a la labor de investigadores canadienses y franceses, han llevado a un alto grado de perfeccionamiento la terapéutica, tanto preveritiva como curativa, de trombosis arteriales y venosas.

Estudio prospectivo de la cefalea en pacientes con hemopatías malignas

OpenAIRE

Marín Lahoz, Juan

2013-01-01

Objetivo: describir las cefaleas en pacientes ingresados con neoplasias hematológicas, identificar los factores asociados a cefaleas secundarias graves. Estudio observacional prospectivo. Se incluyen 30 casos de cefalea correspondientes a 23 pacientes. Ocho cefaleas son primarias y 22 secundarias. Diez de estas, son secundarias a patología grave o potencialmente grave: encefalopatía hipertensiva, neoplasia intracraneal, hemorragia intracraneal, infección cefálica, trombosis venosa, fiebre tum...

Avaliação não invasiva da pressão venosa central por ecocardiografia em cuidados intensivos – Particularidades nos doentes com dilatação do ventrículo direito e exacerbação de doença pulmonar crónica

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Paulo Marcelino

2006-11-01

Full Text Available Resumo: Objectivos: Determinar a possibilidade de avaliação não invasiva da pressão venosa central (PVC através da análise da veia cava inferior (VCI, obtida por ecocardiografia transtorácica (ETT.Desenho: Estudo prospectivo com 3 anos de duração.Local: Unidade de Cuidados Intensivos Polivalente (UCIP de 16 camas.Métodos: Estudados doentes admitidos numa UCIP nos quais se avaliou a PVC em simultâneo com exame ETT que, para além da visualização da VCI, consistiu na obtenção da dimensão das cavidades cardíacas e função sistólica do ventrículo esquerdo. Para a correlação foram utilizados testes estatísticos paramétricos e não paramétricos.Resultados: Admitidos 560 doentes com registo simultâneo de PVC e ETT e incluídos 477 doentes em que foi possível visualizar a VCI, com idade média de 62,6±±17,3 anos, média de internamento de 11,9±18,7 dias, um índice APACHE II médio de 23,9±8,9 e SAPS II médio de 55,7±20,4. Por análise de regressão linear verificou-se uma relação entre a PVC e a dimensão máxima da VCI (p=0,013, o índice da VCI (p=0,001 e a presença de ventilação mecânica (p=0,002. A correlação linear entre a PVC e a dimensão máxima da VCI e respectivo índice foi de 0,34 e 0,44. Por teste de qui-quadrado, verificou-se uma relação estatisticamente significativa entre os seguintes intervalos de valores: índice da VCI >25% e PVC7 mmHg e a dimensão máxima da VCI >10 mm; nos doentes admitidos por exacerbação de doença pulmonar crónica verificou-se uma correlação fraca entre a PVC >7 mmHg e o índice da VCI25% and a CVP 7 mmHg; an IVC maximum dimension10 mmHg and CVP>7 mmHg. Patients with right ventricle enlargement presented a lack of agreement between IVC maximum dimension and CVP7 mmHg was also observed.Conclusions: IVC

tropical OCTOBER

African Journals Online (AJOL)

Anaesthesia in obstetric patients remains a procedure with special risks .... dural puncture during epidural technique. ... commonly used drugs for postoperative pain during the period of ... intramuscular opioid administration when necessary.

Comparative evaluation of the effect of silicone and teflon in prevention of epidural fibrosis after laminectomy in rat

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Sheikh Rezaei A

2001-08-01

Full Text Available There are many studies about epidural fibrosis after surgical manipulation of the spine. We have studied formation of the post laminectomy epidural fibrosis after application of two materials (Silicone and Teflon in this report. This expriment is on two groups of rats. Two separated laminectomies were done in each rat, one serving as control while in the other laminectomy spaces Silicone was used in group A and Teflon in group B. Laminectomy spaces were evaluated with gross dissection and histologic studies after 6 weeks. Silicone decreased intermuscular scar, deep scar, dural adhesion and collagen fiber density in epidural space. Teflon decreased dural adhesion and collagen fiber density but did not decrease intermuscular and deep scar formation in epidural space.

Anaesthetic Management of Caesarean Section in an Achondroplastic Dwarf

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Kirti N Saxena

2008-01-01

A twenty year old parturient with short stature presented to the hospital in early labour. An elective lower segment caesarean section(LSCS was planned in view of cephalopelvic disproportion. She had papers which suggested that she had been diagnosed as a case of achondroplasia though details were not available. Combined spinal epidural(CSE anaesthesia was planned in the patient in view of the death of her first baby following caesarean section under general anaesthesia. Repeatedly dry taps were achieved on attempting dural puncture. Dural puncture was abandoned and an 18 G epidural catheter was threaded via the Tuohy needle. Sensory block till T 6 was achieved with 6ml of local anaesthetic solution. The patient was stable during the intraoperative and postoperative period.

Massive Cerebrospinal Fluid Leak of the Temporal Bone

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Giannicola Iannella

2016-01-01

Full Text Available Cerebrospinal fluid (CSF leakage of the temporal bone region is defined as abnormal communications between the subarachnoidal space and the air-containing spaces of the temporal bone. CSF leak remains one of the most frequent complications after VS surgery. Radiotherapy is considered a predisposing factor for development of temporal bone CSF leak because it may impair dural repair mechanisms, thus causing inadequate dural sealing. The authors describe the case of a 47-year-old man with a massive effusion of CSF which extended from the posterior and lateral skull base to the first cervical vertebrae; this complication appeared after a partial enucleation of a vestibular schwannoma (VS with subsequent radiation treatment and second operation with total VS resection.