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Biomedical subjects

J Sahuquillo

Publications and source records attributed to J Sahuquillo.

87 records · Page 5Linked to original sources
PubMed1983

Giant calcified aneurysm on the posterior cerebral artery in a nine-year-old child.

We report the case of a 9-year-old child in whom, after a plain x-ray examination of the skull was performed for a suppurating otitis in the left ear, a calcified lesion was discovered in the left temporal region. Angiographic study showed it to be an aneurysm of the left posterior cerebral artery. The rarity of these lesions is discussed, as well as the successful surgical treatment in this case.

Calcinosis↗
PubMed1983

Unusual penetrating craniocerebral injury.

We report a 29-year-old patient who was operated on for a penetrating craniocerebral injury caused by an underwater fishing harpoon. It had penetrated through the roof of the left orbit, upward toward the calvaria. The patient was immediately operated upon and the foreign body was easily removed through a small left parietal craniectomy. In spite of the spectacular appearance of the injury on admission to the hospital, neurological impairment before and after the operation was minimal.

Adult↗
PubMedDate not supplied

[Value of brain perfusion SPECT in the follow-up of patients surgically treated for chronic adult hydrocephalus syndrome].

OBJECTIVE: The aim of this study was to characterize regional cerebral blood flow in patients with Adult Hydrocephalus Syndrome (AHS) and to evaluate the changes in brain perfusion after surgical derivation treatment. PATIENTS AND METHODS: 20 patients with AHS (age: 72 +/- 14, 12 men) were studied before and six months after surgery. All patients underwent a brain perfusion SPECT (99mTc-HMPAO) prior to surgery and at 6 months post-surgery. Semi-quantitative analysis was done for brain uptake: 0=Normal, 1=Mild, 2=Moderate, 3= Severe, 4=No uptake. The severity of ventricular dilatation was assessed by classifying the intensity and extension of subcortical defects: 0=Normal, 1=Mild, 2=Moderate, 3=Severe. The scores of the pre- and post-surgical studies were compared using the Student-t test. RESULTS: A global reduction of brain uptake was observed (mean score 12.85), mainly in frontal, parietal and temporal lobes, with a significant improvement in post surgical studies (mean score 6, p<0,001). After surgery, 16 (80%) of the 20 patients improved brain uptake. In relationship to subcortical uptake, 5 patients showed mild defects, 9 moderate defects and 6 patients presented severe uptake reduction. In post-surgical studies 15 (75%) patients improved almost one degree in the subcortical score and 65% of the patients showed a normal or mild subcortical uptake reduction. CONCLUSIONS: Brain perfusion SPECT is useful in patients with AHS, detecting brain perfusion defects and evaluating cerebral blood flow improvement after shunt operation.

Adolescent↗
PubMedDate not supplied

[A controlled, double-blind, randomized pilot clinical trial of nicardipine as compared with a placebo in patients with moderate or severe head injury].

INTRODUCTION: One of the factors involved in the occurrence of ischemic cerebral lesions following head injury is cerebral vasospasm. We analyze the effect of intravenous nicardipine on the prevention and treatment of posttraumatic cerebral vasospasm. PATIENTS AND METHODS: We made a placebo-controlled, randomised, double-blind pilot study of the effect of nicardipine (intravenously 5 mg/hour for one week) on patients with moderate or severe head injury who presented with cerebral vasospasm, defined as an average Doppler flow velocity (DFV) of 100 cm/second or more. The main variable assessed was the evolution of the DFV and the secondary criteria were the evolution of the arterial blood pressure, coma scales, the findings on the Glasgow Coma Scale and the safety of the drug. RESULTS: Eleven patients were included in each homogeneous group. The DFV was found to have become normal on the first day of treatment with nicardipine and on the third day with the placebo (p = 0.023). During the first day of treatment the percentage of cerebral hemispheres diagnosed as having suspected spasm was 11.1% for nicardipine and 64.3% for the placebo (p = 0.02881). The average time for recovery (DFV < 100 cm/second) was 3.33 days with the placebo and 1.22 days with nicardipine (p = 0.0039). The patients treated with nicardipine had 8.89 times more chance of recovery from vasospasm. The incidence of adverse effects was greater with the placebo (p = 0.014). CONCLUSION: Nicardipine is effective in the reversal and prevention of increased Doppler flow velocity in patients with moderate or severe head injury.

Adult↗
PubMedDate not supplied

[Importance of morphostructural changes observed in cortical micro-vessels in patients who died after a severe head injury].

INTRODUCTION: The development of secondary lesions in traumatic head injuries seems to be a determinative factor for the survival of these patients. Endothelium damage of cortical microvessels could be fundamental in the main secondary lesions as cerebral ischemia and intracranial hypertension. OBJECTIVES: To investigate which are the main morphological changes that can be observed in cortical microvessels from these patients. MATERIAL AND METHODS: We have studied 15 fresh human brains from subjects died after a severe head injury. The study has been carried out by scanning electron microscopy of vascular corrosion casts and confocal microscopy of histological sections after immunocytochemistry, as well as detection of apoptosis by TUNEL technique. RESULTS AND CONCLUSIONS: The most significant structural alterations were observed mainly on arterioles and capillaries of the middle and deep vascular zones of the cerebral cortex. Corrosion casts showed vessels with longitudinal folds, sunken surface with craters and flattened vessels with reduced lumen. Histological sections immunostained with MAS-336 also showed vessels with longitudinal folds and thinning of their vascular lumen, the presence of cytoplasmic round bodies and a thickening of endothelial cell membrane. TUNEL method revealed a positive staining of some endothelial cells. The structural alterations observed seem to reveal a situation of cellular damage of endothelium in the human cortical microvessels from these patients. It can be thought that this kind of lesions, as well as the secondary functional injury of the blood brain barrier, could play an important role in the development of secondary damage.

Adult↗
PubMedDate not supplied

[Intracranial pressure monitoring and CSF dynamics in patients with neurological disorders: indications and practical considerations].

The study of cerebrospinal fluid (CSF) dynamics is central to the diagnosis of adult chronic hydrocephalus (ACH). At present, many neurology and neurosurgery departments use one or more tests to guide diagnosis of this syndrome and to predict patient response to shunting. In specialised centres, the study of CSF dynamics is combined with continuous intracranial pressure (ICP) monitoring. Determination of several variables of CSF dynamics and definitions of qualitative and quantitative characteristics of ICP can be used to establish whether the hydrocephalus is active, compensated or arrested. CSF dynamics and ICP monitoring can also be used to check the correct functioning of the shunt and can be of use in the clinical management of patients with pseudotumor cerebri. Moreover, ICP monitoring is used to guide the treatment of several acute neurological processes. The aim of this review is to describe the fundamentals of CSF dynamics studies and the bases of continuous ICP monitoring. The advantages and disadvantages of several hydrodynamic tests that can be performed by lumbar puncture, as well as the normal and abnormal characteristics of an ICP recording, are discussed.

Adult↗
PubMedDate not supplied

[Treatment of cerebrospinal fluid shunt infections using the Perrin and McLaurin technique. Analysis of 11 cases].

Eleven patients with shunt infection (SI) of the cerebrospinal fluid in whom the SI was withdrawn and replaced by a new SI system with reservoir and intraventricular and parenteral antibiotic treatment were reported. The diagnosis was made by culture of the components of the SI and, or, the cerebrospinal fluid. In 9 cases the agent was a staphylococcus. The different therapeutic trials to treat SI infections can be summarized as follows: a) replacement of the SI by an external drainage, antibiotics, and reinsertion of the SI when the cerebrospinal fluid was sterilized; b) withdrawal of the SI and placement of a new SI in the same surgical procedure associated with intraventricular and systemic antibiotic treatment; and c) treatment with intraventricular and, or, systemic antibiotics. It has been demonstrated that the surgical approach (a and b) is more effective. In our series the procedure indicated in B was followed by the control of the infection in all cases. The follow-up of the surgical treatment was 1-3 years. The most currently used SI was the ventriculoperitoneal bypass. Their main complications are pseudocysts which are easily recognized by of abdominal echography and frequently revealed SI infection. Diagnosis and treatment of SI infections should take into account the type of complications and the most appropriate collaboration with other clinical departments.

Adolescent↗
PubMedDate not supplied

[Evaluation of post-traumatic coma using evoked potentials].

In 130 cases of post-traumatic coma a study of multimodality evoked potentials (MEP) was carried out shortly after the traumatism (within 72 h). According to the morphology of the records they were classified in grades (I-IV) in agreement with Greenberg et al. The worst grade of EP in the different types was related to the outcome at 6 months, distinguishing between focal lesions and diffuse lesions. Only a group (22.9%) of the 109 patients in which the auditory brain-stem evoked potentials (ABEP) could be studied, showed severe disorders (grade III-IV). There was a significant correlation between the ABEP grades and the outcome in the focal lesions (p less than 0.001). In the diffuse lesions the ABEP grades did not show significant differences with the outcome. A 22.4% of the patients with diffuse lesions had some visual evoked potentials (VEP) in grades III-IV against almost the double (41.6%) in the focal lesions. The grades of the VEP in the focal lesions did not have differences with outcome and in the diffuse lesions they did (p less than 0.05). Approximately half of the cases with focal lesions and one third of the diffuse lesions showed severe disorders (grades III-IV) of the somatosensory evoked potentials (SEP). In the two types of lesions there were significant differences with the outcome (p less than 0.001) and (p less than 0.01). The multimodality evoked potentials (MEP) are useful for predicting the outcome, especially in the patients where the neurological examination is impossible. Among the different modalities, the SEP were shown to be more predictive.(ABSTRACT TRUNCATED AT 250 WORDS)

Brain Injuries↗