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At least 1,063 records · Page 59Linked to original sources
PubMed2004

The development of eating pathology in Chinese-Australian women: acculturation versus culture clash.

OBJECTIVE: Recent research suggests there has been an increase in the incidence of eating pathology among Asian women residing in the West. Two alternate explanations for the development of this eating pathology have been proposed; acculturation versus culture clash. The current study was designed to further examine the influence of acculturation versus culture clash on the development of eating pathology in Chinese-Australian women. METHOD: Eighty-one Chinese-Australian women completed a questionnaire investigating their level of eating pathology, perceived sociocultural influences to lose weight, parental overprotection and care, self-perceptions of physical appearance, sociability and global self-worth, and the strength of their ethnic identity. RESULTS: It was found that, overall, low levels of satisfaction with physical appearance, high levels of parental overprotection, and high levels of perceived pressure from best female friends to lose weight predicted greater eating pathology in both acculturated and traditional women. However, acculturated women who perceived higher levels of pressure from their fathers and best male friends to lose weight and traditional women who experienced higher levels of parental care reported the greatest eating pathology. DISCUSSION: The findings suggest that there are both similarities and differences between the risk factors that correlate with eating pathology between acculturated and traditional women.

Acculturation↗
PubMed2004

CTLA-4-dependent mechanisms prevent T cell induced-liver pathology during the erythrocyte stage of Plasmodium berghei malaria.

During the course of malaria several organs develop pathology. Frequently also signs of hepatocyte damage are found. In the present work we studied the mechanisms leading to liver pathology during the erythrocyte stage of Plasmodium berghei malaria. During infection, mice developed an inflammation of the liver, associated with infiltration of T cells, although only little tissue damage could be observed. Histological analysis revealed the presence of CTL-associated antigen-4 (CTLA-4)-positive T cells in the liver parenchyma. To study the influence of CTLA-4 expression on liver inflammation, mice were treated with an antibody against CTLA-4. Treated mice suffered from a dramatically increased liver pathology. Using cytokine-deficient mice we found that pathology was dependent on the presence of IL-12 and IFN-gamma. To further study the mechanisms that lead to an enhanced pathology, we analyzed cytokine production from liver-derived T cells. In infected mice the frequency of IFN-gamma-producing cells in the liver was low. In contrast, in anti-CTLA-4-treated mice larger numbers of IFN-gamma-producing cells were detectable. Our results indicate that activated T cells during the erythrocyte stage of malaria can induce pathology due to secretion of pro-inflammatory cytokines. Moreover, these results provide evidence that CTLA-4 expression can restrict T cell function in inflamed organs and might therefore prevent pathology.

Animals↗
PubMed2001

Helper (CD4(+)) and cytotoxic (CD8(+)) T cells promote the pathology of dystrophin-deficient muscle.

Duchenne muscular dystrophy (DMD) and mdx mouse dystrophy result from mutations in the dystrophin gene. Although these mutations are primarily responsible for the defects that underlie the pathology of dystrophinopathies, other factors may contribute importantly to the pathology. In the present investigation, we tested whether T cells present in mdx muscles are activated and contribute significantly to the pathological process. Flow cytometric analyses showed a significantly higher frequency of activated CD44(high) T cells in the blood and muscle of mdx mice when compared to normal B10 mice. However, the frequency of activated T cells was not elevated in mdx lymph nodes, suggesting muscle-specific T cell activation. In vivo antibody-mediated depletions of CD4(+) T cells from mdx mice significantly reduced the amount of histologically discernible muscle pathology by 61% in mdx mice, while depletion of CD8(+) T cells resulted in a 75% decrease in pathology. Finally, adoptive transfer of mdx immune cells in combination with muscle extracts resulted in muscle pathology in healthy murine recipients. These results indicate that T cells promote the mdx pathology and suggest that immune-based therapies may provide benefit to DMD patients.

Adoptive Transfer↗
PubMed1994

Continuous tamoxifen treatment in asymptomatic, postmenopausal breast cancer patients does not cause aggravation of endometrial pathologies.

Adjuvant tamoxifen therapy for breast cancer patients has been found to be associated with various endometrial pathologic conditions, including endometrial cancer. This preliminary case control study evaluated whether prolonged and continuous exposure to tamoxifen in the menopause may aggravate existing endometrial pathologies. Two vaginal ultrasound evaluations of endometrial thickness and histologic findings of two endometrial biopsies, performed 18 months apart, were evaluated for 25 asymptomatic, postmenopausal breast cancer patients who were continuously treated with tamoxifen. In the first endometrial biopsy, 4 patients (16.0%) were found to have endometrial pathologies: 2 patients had proliferative endometrium, 1 had hyperplastic endometrium, and 1 had an endometrial polyp. In the second endometrial biopsy, none of these patients showed any endometrial pathologies. Another patient (4.0%) with no endometrial pathology in the first visit had endometrial hyperplasia in the second visit. None of the patients developed endometrial cancer, and generally there was no increase in ultrasonographically-measured endometrial widths. The results of this preliminary study may suggest that there is no increased risk of development of endometrial pathologies during an additional 18 months of continuous tamoxifen therapy nor is there aggravation of already existing endometrial pathologies.

Aged↗
PubMed1997

Pathological diagnostic criteria for dementia associated with cortical Lewy bodies: review and proposal for a descriptive approach.

In recent years dementia histologically characterised by the presence of cortical Lewy bodies has been increasingly recognised. There is now need for a scheme for an internationally acceptable scheme for pathological diagnosis and classification so that clinical, pathological and molecular features of disease can be correlated. Recent observations made by different groups in large patient series have used slightly different pathological criteria resulting in at least seven different diagnostic terms. In some patients the only cortical pathology is the presence of Lewy bodies, while in the majority of patients there are coexisting pathological changes which either overlap with those seen in Alzheimer's disease (AD). Cortical Lewy bodies can also be present in patients who do not have any obvious cognitive abnormality. A problem with equating studies from different groups is that different criteria have been used to define AD, so that establishing the relevance of cortical Lewy bodies themselves to cognitive decline and separating this from the contribution which may be related to the AD pathology is problematic. The lesions which appear to be of most relevance to potential cognitive decline in DLB are cortical Lewy bodies, Lewy-related neurites, senile plaques, neurofibrillary tangles, neuronal and synaptic loss, spongiform change, and cortical cholinergic deficits. It is possible to operationally classify patients with cognitive decline and cortical Lewy bodies into three main groups, Cortical Lewy body disease, Cortical Lewy body disease with plaques, and Cortical Lewy body disease with plaques and tangles. There are frequent cases which overlap these groups making operational classification difficult in practice. A descriptive classification, in which the severity of different pathological changes is rated, is easy to use in practice. As new molecular risk factors for AD or DLB are revealed they will need to be related to morphological and clinical features. A descriptive diagnostic assessment for DLB will facilitate such studies and makes no judgements as to what these relationships will be.

Aged↗
PubMed1994

A cohort study of point prevalence of eardrum pathology in children and teenagers from age 5 to age 16.

The aim of this prospective study was to estimate the prevalence of different types of eardrum pathology in a cohort of children and teenagers up to the age of 16. Among this initial group of 373 subjects, repetitive screening trials including otomicroscopy and tympanometry were performed from age 5 to 16 years. All clinical pathology of Shrapnell's membrane and the pars tensa was recorded systematically. At age 5 years, pathology of the eardrum was found in 19% of ears examined. At succeeding follow-ups until the age of 16 years, the prevalence of eardrum pathology increased to 33%. The tympanometric profile improved significantly from 49% of children with negative middle ear pressure at age 5 years to 4% at age 16 years. The patency of the eustachian tube was estimated in the group with eardrum pathology and compared to the group with no eardrum pathology. Our findings show that, despite improvement of middle ear ventilation through childhood, the prevalence of pathological changes of the eardrum seems to increase. The reason for this increase is discussed.

Acoustic Impedance Tests↗
PubMed1995

Prognostic factors in patients with pathological stage I non-seminomatous testicular germ cell tumors and tumor recurrence during follow-up.

Clinical staging in patients with stage I non-seminomatous germ cell tumors (NSGCTs) of the testis fails in 30% to correctly assess pathological stage since microscopic and small-volume retroperitoneal disease is not detectable on computed tomography of the abdomen. Patients staged by retroperitoneal lymph node dissection as pathological stage I incur a distant (chest or serological) tumor relapse rate of 7-15% during follow-up. Recently, we reported on new risk factors as predictors of pathological stage by flow cytometric DNA analysis in clinical stage I patients. These same methods were applied to a group of 14 pathological stage I patients who subsequently had either chest or serological recurrence. The findings in this group of patients were compared with those in a group of 47 pathological stage I patients who did not experience recurrence. In pathological stage I NSGCT patients with distant (chest or serological) tumor relapse, we found by histological evaluation and DNA analysis of the original orchiectomy specimen proliferative tumor activity to be significantly predictive of relapse. Much as proliferative activity of the primary tumor is predictive of retroperitoneal metastasis, it may be a predictor of recurrence in pathological stage I patients.

DNA, Neoplasm↗
PubMed1989

Pathological fear of death, panic attacks, and hypochondriasis.

The article has presented a concept of the pathological fear of death as a categorically defined phenomenon and outlined its distinguishing features. In an attempt to account for the origin of the pathological fear of death, most weight has been given to developmental and structural abnormalities in the regulation and control of the primary and disruptive forms of anxiety. The additional contributing factors have also been taken into consideration: a defect in the defensive and symbolic representation of death, and a general collapse of defensive functioning, with regression to a state of infantile helplessness and revival of the infantile death cognitions. A role of the cognitive abnormalities in the genesis of the pathological fear of death has been examined in the panic attacks and hypochondriasis, while a developmentally determined, pervasive mistrust in the bodily functioning and bodily worth has been stressed as a factor that crucially predisposes to the pathological fear of death in hypochondriasis, and to the respective type of hypochondriasis as well. A relationship between panic disorder and hypochondriasis has been examined in the light of the pathological fear of death that they often share. Finally, the article has briefly dealt with the relevance of the pathological fear of death for diagnostic assessment and psychotherapy of patients with panic disorder and hypochondriasis. The concept of the pathological fear of death requires further study and refinement in the area of its descriptive demarcation, psychogenesis, and clinical application.

Anxiety Disorders↗
PubMed2005

Feature analysis of pathological speech signals using local discriminant bases technique.

Speech is an integral part of the human communication system. Various pathological conditions affect the vocal functions, inducing speech disorders. Acoustic parameters of speech are commonly used for the assessment of speech disorders and for monitoring the progress of the patient over the course of therapy. In the last two decades, signal-processing techniques have been successfully applied in screening speech disorders. In the paper, a novel approach is proposed to classify pathological speech signals using a local discriminant bases (LDB) algorithm and wavelet packet decompositions. The focus of the paper was to demonstrate the significance of identifying the signal subspaces that contribute to the discriminatory characteristics of normal and pathological speech signals in a computationally efficient way. Features were extracted from target subspaces for classification, and time-frequency decomposition was used to eliminate the need for segmentation of the speech signals. The technique was tested with a database of 212 speech signals (51 normal and 161 pathological) using the Daubechies wavelet (db4). Classification accuracies up to 96% were achieved for a two-group classification as normal and pathological speech signals, and 74% was achieved for a four-group classification as male normal, female normal, male pathological and female pathological signals.

Algorithms↗
PubMed1999

Improvement in the intestinal processes of hydroelectrolytic absorption and secretion in abdominal pathologies of surgical interest treated with SMS 201-995: experimental protocol.

The hypothesis that octreotide can improve the intestinal absorption and secretion processes in a mixed group of intestinal pathologies, and that this effect varies according to the pathology in question, was tested. One hundred and twenty Wistar rats were randomly assigned to six pathology groups consisting of three intestinal occlusions including (1) complete, (2) partial, and (3) complete with strangulation, and three mesenteric vascular occlusions including (4) partial permanent, (5) total permanent, and (6) total temporary. Each group contained ten control and ten treated rats. The treated animals received octreotide (100 microg/kg body weight) while the controls were given the same quantity of saline solution every 8 h. After the observation period, the contents of the small intestine were extracted and its volume measured before and after centrifugation; the concentration and total content of Na, K, Cl, and bicarbonate was then analyzed. Samples of all the intestines at specific distances from the lesion zone were treated and stained, and then evaluated according to a specific score to quantify the lesions. The concentration and contents of electrolytes in the intestine and its volume (before and after centrifugation) were lower in the treated animals, but varied according to the pathology. There was a nonadditive influence between the type of pathology and treatment for the four electrolytes and intestinal volume. The effects of the drug make it directly or indirectly possible to decrease the intestinal lesions to improve the absorption-secretion processes. Octreotide acts on intestinal secretion and absorption in all the pathologies analyzed except for total permanent intestinal ischemia. Its action also varies according to the type of pathology involved.

Animals↗
PubMed2006

Assessing the cognitive impact of Alzheimer disease pathology and vascular burden in the aging brain: the Geneva experience.

The progressive development of Alzheimer disease (AD)-related lesions, such as neurofibrillary tangles (NFT), amyloid deposits and synaptic loss, and the occurrence of microvascular and small macrovascular pathology within the cerebral cortex are conspicuous neuropathologic features of brain aging. Recent neuropathologic studies strongly suggested that the clinical diagnosis of dementia depends more on the severity and topography of pathological changes than on the presence of a qualitative marker. However, several methodological problems, such as selection biases, case-control design, density-based measures and masking effects, of concomitant pathologies persisted. In recent years, we performed several clinicopathologic studies using stereological counting of AD lesions. In order to define the cognitive impact of lacunes and microvascular lesions, we also analyzed pure vascular cases without substantial AD pathology. Our data revealed that total NFT numbers in the CA1 field, cortical microinfarcts and subcortical gray matter lacunes were the stronger determinants of dementia. In contrast, the contribution of periventricular and subcortical white matter demyelinations had a modest cognitive effect even in rare cases with isolated microvascular pathology. Importantly, in cases with pure AD pathology, more than 50% of Clinical Dementia Rating scale variability was not explained by NFT, amyloid deposits and neuronal loss in the hippocampal formation. In cases with microvascular pathology or lacunes, this percentage was even lower. The present review summarizes our data in this field and discusses their relevance within the theoretical framework of the functional neuropathology of brain aging and with particular reference to the current efforts to develop standardized neuropathological criteria for mixed dementia.

Aging↗
PubMed2002

T-level downstaging and complete pathologic response after preoperative chemoradiation for advanced rectal cancer result in decreased recurrence and improved disease-free survival.

PURPOSE: Preoperative chemoradiation therapy is used widely in the treatment of rectal cancer. The predictive value of response to neoadjuvant remains uncertain. We retrospectively evaluated the impact of response to preoperative and, specifically, of T-level downstaging, nodal downstaging, and complete pathologic response after chemoradiation therapy on oncologic outcome of patients with locally advanced rectal cancer. METHODS: There were 88 patients with ultrasound Stage T3/T4 midrectal (n = 37) and low rectal (n = 51) cancers (63 males; mean age 62.6 years). All patients were treated by preoperative 5-fluorouracil-based chemotherapy and pelvic radiation followed by surgical resection in six weeks or longer (56 sphincter-preserving resections). RESULTS: T-level downstaging after neoadjuvant treatment was demonstrated in 36 (41 percent) of 88 patients, and complete pathologic response was observed in 16 (18 percent) of the 88. Of the 42 patients with ultrasound-positive nodes, 27 had no evidence of nodal involvement on pathologic evaluation (64 percent). The overall response rate (T-level downstaging or nodal downstaging) was 51 percent. At a median follow-up of 33 months, 86.4 percent of patients were alive. The overall recurrence rate was 10.2 percent (three patients had local and six had metastatic recurrences). Patients with T-level downstaging and complete pathologic response were characterized by significantly better disease-free survival (P = 0.03, P = 0.04) and better overall survival (P = 0.07, P = 0.08), according to Wilcoxon's test comparing Kaplan-Meier survival curves. None of the patients with complete pathologic response developed recurrence or died during the follow-up period. CONCLUSION: T-level downstaging and complete pathologic response after preoperative chemoradiation therapy followed by definitive surgical resection for advanced rectal cancer resulted in decreased recurrence and improved disease-free survival. Advanced rectal cancers that undergo T-level downstaging and complete pathologic response after chemoradiation therapy may represent subgroups that are characterized by better biologic behavior.

Adenocarcinoma↗
PubMed1990

Clinical implications of exercise-induced chest pain: comparison of patients with and without pathologic Q waves in coronary artery disease.

We attempted to determine whether exercise-induced silent myocardial ischemia has different clinical implications in patients with and without pathologic Q waves. We studied 152 patients (121 men and 31 women) who had ischemic ST depression (greater than or equal to 0.05 mV) during exercise tests and greater than or equal to 70% narrowing in the three major coronary arteries. According to the presence or absence of chest pain during exercise, they were divided into symptomatic patients and asymptomatic patients: 104 patients without pathologic Q waves (Q(-) group) and 48 patients with pathologic Q waves (Q(+) group). In the Q(-) group, symptomatic patients (n = 56) had a significantly greater number of leads showing ST depression (p less than 0.0002), a greater maximum voltage of ST depression (p less than 0.005), a higher incidence of negative U waves (p less than 0.001), and a poorer blood pressure response (p less than 0.005) than asymptomatic patients (n = 48). However, in the Q(+) group, there were no significant differences between symptomatic (n = 24) and asymptomatic patients (n = 24) with regard to these parameters. We concluded that symptomatic patients without pathologic Q waves had more severe ischemia. On the other hand, in patients with pathologic Q waves, the severity of myocardial ischemia in asymptomatic patients might be equal to that in symptomatic patients. Chest pain during exercise testing is not a good predictor of myocardial ischemia in patients with pathologic Q waves. The presence or absence of pathologic Q waves is an important factor in the analysis of exercise-induced myocardial ischemia.

Chest Pain↗
PubMed1981

The classification of continuous replicator pathologies.

A framework for the classification of continuous replicator (CR) pathologies expressed by cell kinetic changes, is presented. Each CR (e.g. GI mucosa or epidermis) is characterized by an origin, a periphery and a trajectory (called tissue radius) along which cells are displaced. The state of a cell on the radius is defined by two coordinates. Its distance from tissue origin 'x' expressed in cell locations, and its cruising velocity v(x), proportional to the cell production among cells separating it from origin. S(x) = x integral of o v(t)dt, represents further the net cell production associated with cell displacement from origin up to location x. The cell is regarded as a point advancing in a rectlinear motion defined by two coordinates (x,S(x)), tracing an S(x) graph outlining the proliferation differentiation states of a CR system. The S(x) graph is treated as a geometrical figure and the comparison of different CR pathologies reduces to the formulation of congruence laws. Three CR pathological entities are outlined: 1) Hemolytic pathologies e.g. hemolytic anemia, psoriasis, celiac disease and cervical erosion. 2) Hyperplastic pathologies e.g. polycythemia, papilloma and adenomatous polyp and 3) Hypoplastic pathologies e.g. aplastic anemia, skin and endometrial atrophy. Each pathology is marked by a typical S(x) graph.

Cell Transformation, Neoplastic↗
PubMed1994

A multivariable analysis of clinical factors predicting for pathological features associated with local failure after radical prostatectomy for prostate cancer.

PURPOSE: A multivariate analysis is used to determine the predictive value of pretreatment clinical indicators on pathologic features associated with local failure after radical prostatectomy in patients with prostate cancer. METHODS AND MATERIALS: A retrospective review of the pathologic findings of 235 patients with adenocarcinoma of the prostate treated between 1990 and 1993 with a radical retropubic prostatectomy was performed. The preoperative clinical data including the serum prostate specific antigen, clinical stage, Gleason sum, and endorectal magnetic resonance scan findings are used to identify patients prior to definitive treatment who would be at high risk for having pathologic features associated with local failure at radical prostatectomy. Outcome prediction curves are constructed from a logistic regression multivariate analysis displaying the probability of pathologic involvement of the seminal vesicle, extracapsular disease, or positive surgical margins as a function of the preoperative prostate specific antigen and Gleason sum for the cases when the endorectal magnetic resonance scan is positive, negative, or not included in the multivariate analysis. RESULTS: Factors identified on multivariate analysis as significant predictors of seminal vesicle invasion include endorectal magnetic resonance scan findings (p < 0.0001), and preoperative prostate specific antigen (p = 0.017). Endorectal magnetic resonance scan findings (p = 0.0016), preoperative prostate specific antigen (p = 0.0002), and Gleason sum (p < 0.0001) were significant predictors of extracapsular extension and preoperative prostate specific antigen (p < 0.0001) and Gleason sum (p = 0.03) were significant predictors of disease extending to the margins of resection. Clinical stage was not a significant predictor (p > 0.05) of pathologic features associated with local failure on multivariate analysis. As a single modality, endorectal surface coil magnetic resonance imaging was accurate 93%, 69%, and 72% of the time for predicting seminal vesicle invasion, transcapsular disease, and final pathologic stage, respectively. Failure to recognize microscopic penetration of the capsule found at the time of pathologic evaluation in a prostate gland with a grossly intact capsule accounts for the majority (70%) of the staging inaccuracies. CONCLUSIONS: The use of the endorectal surface coil magnetic resonance scan findings in conjunction with both the serum prostate specific antigen and Gleason sum improves the clinical accuracy of predicting those patients at high risk for clinically unsuspected extraprostatic disease. In particular, for the subgroup of patients with moderately elevated prostate specific antigen (> 10-20 ng/mL) and intermediate grade clinically organ confined prostate cancer [Gleason sum: 5-7] where the specificity of these tests to predict for occult extraprostatic disease is suboptimal, the additional information obtained from the endorectal coil magnetic resonance scan allows the physician to definitively subgroup these patients into low and high risk for seminal vesicle invasion or transcapsular disease.

Adenocarcinoma↗
PubMed1994

Traumatic compared to non-traumatic clinical-pathologic associations in temporal lobe epilepsy.

This study determined differences in clinical-pathologic characteristics of intractable temporal lobe epilepsy (TLE) patients whose mechanism of cerebral injury and chronic seizures involved a prior history of cerebral trauma compared to those with non-traumatic initial injuries. TLE patients (n = 120) from a single epilepsy center were retrospectively and blindly catalogued into pathogenic groups (independent variables) based on if there was a significant Birth injury (n = 11) or Cerebral trauma (n = 26). These two 'trauma' categories were compared to TLE patients with non-seizure non-trauma histories (Non-Sz/Non-Trauma; n = 17), or a first Prolonged seizure (n = 66). The four groups were compared for differences in the time course of their clinical injuries and seizures, quantified hippocampal neuron counts, other temporal neocortical pathologies, and seizure outcomes (dependent variables). Between group statistically significant (at least P < 0.05) results showed: (1) In Birth injury, 33% had Ammon's Horn (AH) neuron loss under 50%, 54% had other temporal neocortical pathologies, they showed the most CA4 neuron loss, and the worse seizure outcomes. (2) Cerebral trauma were older when injured, 29% had AH loss under 50%, 50% showed other pathologies, and they had the best seizure outcomes. (3) Non-Sz/Non-Trauma showed the least AH and CA4 neuron losses, only 12% had other temporal pathologies, and they had seizure outcomes that were intermediate. (4) Prolonged seizure showed the youngest age of habitual TLE onsets, the greatest AH, CA1, and prosubiculum neuron loss, only 11% had other temporal pathologies, and their seizure outcomes were excellent. These results indicate that in intractable surgically treated TLE, a history of cerebral trauma or birth injury as the pathogenic mechanism of their seizures show different clinical-pathologic features and seizure outcomes compared to non-trauma patients. This supports the notion that in TLE there are different pathogenic mechanisms associated with different types of initial injuries and that patients will have different responses to surgical therapy.

Birth Injuries↗
PubMed2004

Risk factors for pathological gambling.

To better understand pathological gambling, potential risk factors were assessed within three domains--gambling behaviors, substance abuse and other problem behaviors, and sociodemographic factors. A random-digit-dial telephone survey was conducted in 1999-2000 with a representative sample of the U.S. population aged 18 or older. The current analyses uses data from the 2168 respondents who gambled in the year before the interview. Gambling measures included the Diagnostic Interview Schedule (DIS)-IV for pathological gambling, frequency of 15 types of gambling, and size of win or loss on the last occasion. Other measures included the quantity and frequency of alcohol consumption, frequency of illicit drug use and criminal offending, and the DIS-IV for alcohol and drug abuse and dependence. Results showed that casino gambling is associated with a high risk of gambling pathology. Lottery, cards, and bingo are associated with a moderately high risk of gambling pathology. Participation in a greater number of types of gambling is strongly predictive of gambling pathology, even after frequency of gambling and size of win or loss are taken into account. Alcohol abuse is strongly predictive of gambling pathology, even with gambling behaviors held constant. Minority and low socioeconomic status (SES) group members have higher levels of gambling pathology than other groups after all other factors are considered.

Adolescent↗
PubMed2005

Factors of morbidity in hemispherectomies: surgical technique x pathology.

OBJECTIVE: The objective of this paper is to evaluate factors of surgical morbidity from different techniques of hemispherectomy with emphasis on causative pathology. PATIENTS AND METHODS: Thirty patients underwent hemispherectomy in our institution from 1987 to 2003, two presented with Sturge-Weber Syndrome (SWS), sixteen with Rasmussen's Syndrome (RS), eight with established hemispheric lesions (EHL), and four with cortical development malformations (CDM). Six surgeons operated on three patients using anatomical hemispherectomies (AH), 11 patients using functional hemispherectomy (FH), and 16 patients employing hemispherotomy (HT). Surgical technique and causative pathology were studied independently as factors of morbidity in hemispherectomy. RESULTS: Overall mean surgical time was 11:50+/-3:20 h and increased proportionately in pathologies with larger hemispheres. Blood transfusion was particularly influenced by the approach adopted by our team of anesthesiologists, independently of technique or pathology. Pathology was the most important factor related to hydrocephalus as two out of four patients with CDM needed ventriculoperitoneal shunt whilst none with EHL or SWS. Four patients undergoing HT and one FH presented residual bridges connecting the hemispheres, three were reoperated and are seizure free. Two patients with CDM did not improve their seizures worthwhile with surgery and other two (one with RS and other with CDM) were waiting a second procedure due to incomplete inter-hemispheric disconnection. Five patients presented infection and one died after developing meningoencephalitis. CONCLUSION: Hemispherectomies are procedures where pathology and surgical technique interact narrowly. Therefore, in order to study surgical morbidity or outcome, both pathology and technique have to be analyzed independently.

Adolescent↗