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At least 1,603 records · Page 89Linked to original sources
PubMed2001

Open-heart endocardial radiofrequency ablation: an alternative to incisions in Maze surgery.

BACKGROUND: Radiofrequency (RF) ablation produces transmural atrial lesions in vitro, and may provide advantages over incisions currently used in maze surgery. This study examines the feasibility, safety, and efficacy of open-heart endocardial RF ablation. METHODS: Eighteen sheep (42.8 +/- 4.4 kg, age < 2 years) underwent left thoracotomy with placement of pacing leads on a pulmonary vein and the left atrial dome. On cardiopulmonary bypass, lesions were made using incision and suture or a novel RF ablation device in three sites: PVC = circle excluding pulmonary veins, IAB = line across the interatrial bundle, SVC = line from the superior to the inferior vena cava. Pacing across the PVC lesion was attempted to assess the completeness of each lesion. Preselected animals (incision n = 4, RF n = 5) were recovered and pacing attempts were repeated at 1 month. After sacrifice, hearts were sectioned and measured for lesion size and completeness. RESULTS: RF ablation lesions took less time to create (total bypass time: RF 51.8 min vs incision 106 min, P < 0.001). No evidence of thromboembolism, atrial rupture, or coronary sinus thrombosis was seen. All PVC lesions were complete as demonstrated by the inability to pace across them. Stained sections demonstrated that acutely studied incision lesions were thinner than RF lesions; however, all lesions were transmural and similar in width at 1 month. CONCLUSIONS: RF ablation consistently created transmural lesions more quickly than the incision and suture method and without additional complications. Endocardial RF ablation appears to be a simple and effective alternative to surgical incisions during open-heart atrial Maze procedures.

Animals↗
PubMed1987

The Foerster-Dandy operation for the treatment of spasmodic torticollis.

The short-term results of the Foerster-Dandy operation in 9 patients with spasmodic torticollis had been studied retrospectively. A good result was obtained for dyskinetic movement, but less for head tilt. Neck pains improved in 4 patients, but developed in 2 other patients postoperatively. Limitation of neck motility and abduction of the arms was seen in all patients. One patient died following a cerebral sinus thrombosis. Other surgical procedures are discussed and the results of studies of anterior rhizotomy are compared. The Foerster-Dandy procedure is indicated for severe disability or pain of more than 2 years duration not responding to other treatments.

Adult↗
PubMed1990

Pseudotumour cerebri-neurosurgical considerations.

Pseudotumour was diagnosed in six patients aged 3-38 years during an 8 years period. The diagnosis was based on headache, papilloedema, normal CT scan and cerebrospinal fluid (CSF) composition. Additional clinical symptoms were nausea, VIth nerve palsy, ataxia, blurred vision and frank visual reduction over time. Sagittal sinus thrombosis was ruled out by angiography or magnetic resonance imaging. In five of the six patients lumbar steady state infusion tests were performed to evaluate intracranial hydrodynamics and CSF resorbtion. All patients demonstrated a markedly increased opening pressure (range 13 to 48 mm Hg). CSF outflow resistance ranged from upper normal to pathologically increased levels (8-19 mm Hg/ml/min). Combined epidural intracranial pressure/middle cerebral artery blood velocity monitoring in 3 patients revealed a great number of B waves and a labile cerebral vasomotor state. Pharmacological treatment was tried with digitoxin, acetazolamide, furosemide and/or corticosteroids. Two patients did well on long-term treatment with digitoxin and furosemide, respectively. In the other four patients the clinical development was unsatisfactory on medical treatment alone. They were subsequently operated with implantation of a lumboperitoneal, cisternoatrial or cisternoperitoneal shunt. Shunting rapidly reversed clinical signs and symptoms, except for a partial persistent visual loss in an 18 years old boy who had experienced symptoms for 3 years resistant to pharmacological treatment.

Adolescent↗
PubMed1992

MRI white matter hyperintensity in neuroleptic malignant syndrome (NMS)--a clue to pathogenesis?

The case of a young female patient with neuroleptic malignant syndrome (NMS) and extended MRI white matter hyperintensity in the left parietal and both occipital lobes is reported. MRI lesions resembled findings in hypertensive encephalopathy, they were not readily compatible with CNS vasculitis. Venous sinus thrombosis could be ruled out. Vascular encephalopathy with transient white matter edema and a small residual left parietal lesion is suggested. Neurochemical implications are discussed with particular reference to a possible involvement of excitatory amino acids in NMS pathogenesis.

Adult↗
PubMed1989

Life-threatening inflammations of the orbita.

In spite of improved methods for the diagnosis of orbital inflammation (for example, computerized tomography), final decision for an adequate therapy is often made too late. Because of modern antibiotics surgical intervention is often not the first treatment even though it is imperative when an orbital inflammation changes from periostitis to a subperiostitic abscess. The symptoms of these changes have to be watched carefully. Complications like visual loss, persisting protrusion, and motility disorders can result from too long confidence in conservative therapy. Furthermore hematogenous conduction can cause long lasting disorders in the brain such as cavernous sinus thrombosis and cerebral abscesses. The goals of the therapy have to be reconstruction of an inflammatory focus, adequate therapy of orbital inflammations and the prevention of tertiary lesions.

Adult↗
PubMed1991

Neurological cause of late postpartum seizures.

A 32-year-old primigravida showed signs of pre-eclampsia before delivery of a healthy boy at term. The CSF-space was accidentally punctured during epidural anaesthesia in labour. One day later hypertension was noted and the patient had a single generalized fit. For the next three weeks she had postural headaches, fluctuating hypertension, intermittent hearing loss and double-vision. On the 22nd day of postpartum, the patient had the first of a series of partial and later generalized seizures, followed by hemiparesis, alteration of consciousness, and finally slow recovery with corticosteroid therapy. Bilateral subdural effusions and generalized meningeal thickening were found on MR scans. Repeated MRI excluded sinus thrombosis and documented the response to treatment.

Adrenal Cortex Hormones↗
PubMed2002

Management of diarrhoea in practice.

Diarrhoea, a major cause of morbidity and mortality can be produced by a variety of etiological factors. Management protocol includes assessment of the child, physical examination, lab-evaluation, assessment of severity of dehydration and rehydration therapy using either of the following - WHO - ORS, Home available fluids (HAF), sugar salt solution (SSS), improve WHO-ORS, Amino acid fortified ORS, rice based ORS, low osmolarity ORS. Intravenous fluids are required if patients can't accept orally. Commonly observed electrolyte disturbances are hypernatremia, hyponatremia and hypokalemia. Concussion is a common problem and can result due to electrolyte imbalance, cavernous sinus thrombosis, associated meningitis, shigella encephalopathy and hypoglycemia in undernourished children. Treatment includes i.v. diazepam and i.v. glucose and correction of electrolyte imbalance. Additional treatment interventions include antimicrobial drugs including antibiotics, antimotility drugs, absorbents, nutritional and micro and macro nutrient supplementation.

Child↗
PubMed2004

[Sepsis and multiple organ failure after BCG-instillation for bladder cancer].

Local Bacillus Calmette-Guérin (BCG) immunotherapy is an effective and widely used treatment for superficial bladder carcinoma. Local side effects are frequent, whereas systemic side effects are rare, but more serious. Systemic BCG infection as a life-threatening complication of intravesical BCG instillation should be suspected in any patient who presents with persistent fever after BCG instillation for bladder cancer. A 62-year-old patient had been treated with 6 intravesical BCG instillations for recurrent, multifocal bladder carcinoma. 4 weeks after the last instillation, he presented with fever, malaise and scleral icterus. Laboratory tests revealed abnormal liver function tests, panzytopenia and signs of coagulation disorder. Bone marrow biopsy and liver biopsy showed noncaseating granulomas. Systemic BCG infection was suspected and antituberculous therapy combined with steroids was started. The patient developed severe sepsis and suffered from multiple organ failure. Despite partial improvement, the course was complicated by intracranial sinus thrombosis, and the patient died two month after admission.

Adjuvants, Immunologic↗
PubMed2000

[Clinico-neurologic aspects of acute inflammatory brain diseases].

Despite the progress, which has been made in diagnosis and therapy of encephalitis and bacterial meningitis, these acute inflammatory diseases of the brain still display a certain amount of morbidity and mortality. History, physical examination, analysis of serum and cerebrospinal fluid and radiological examination are the mainstay for the diagnosis of these diseases. With respect to the acute inflammatory diseases of the brain computed tomography and magnetic resonance imaging fulfill three purposes: 1. They can be used to clarify the diagnosis and to rule out other diseases. 2. They can identify the focus from which a bacterial meningitis can evolve. 3. Complications like edema, cerebral vasculitis, septic sinus thrombosis, hydrocephalus or abscess can be visualized. If the diagnosis is made early, the possible complications are recognized in good time and the appropriate therapy is started immediately, then morbidity and mortality can be kept at a minimum.

Brain↗
PubMed2000

[Magnetic resonance angiography in inflammatory brain diseases].

In this review, we discuss the diagnostic potential of time of flight (TOF) MRA and contrast enhanced (CE) MRA in inflammatory disorders of the meninges and the brain. Cerebrovascular complications are frequently observed during infectious meningoencepalitis. 3D TOF-MRA and CE-MRA are complementary for the detection of basal intracranial artery stenosis and septic cerebral vein and sinus thrombosis due to secondary vasculitis. MRA reveals stenosis and occlusion as indirect signs of vasculitis, whereas MRI shows the inflammation of the brain and meninges and occasionally the vessel wall, together with the ischemic or hemorrhagic complication. In case of septic emboli MRA can detect peripheral occlusions and "mycotic" aneurysms. For the diagnosis of noninfectious vasculitides of the intracranial vessels, high resolution 3D TOF-MRA is superior to CE-MRA for the detection of multiloculated segmental stenoses. However, there are presently no prospective studies on the sensitivity and specificity of MRA for these indications. Therefore, only positive MRA results can directly influence clinical management. In case of normal MRA, confirmation by catheder angiography may still be required.

Cerebrovascular Disorders↗
PubMed2004

[Sepsis and multiple organ failure after BCG instillation in bladder cancer].

Local Bacillus Calmette-Guerin (BCG) immunotherapy is an effective and widely used treatment for superficial bladder carcino-ma. Local side effects are frequent, where-as systemic side effects are rare, but more serious. Systemic BCG infection as a life-threatening complication of intravesical BCG instillation should be suspected in any patient who presents with persistent fever after BCG instillation for bladder cancer.A 62-year-old patient had been treated with 6 intravesical BCG instillations for recurrent, multifocal bladder carcinoma.4 weeks after the last instillation, he presented with fever, malaise and scleral icterus. Laboratory tests revealed abnormal li-ver function tests, panzytopenia and signs of coagulation disorder. Bone marrow biopsy and liver biopsy showed non-caseating granulomas. Systemic BCG infection was suspected and antituberculous therapy combined with steroids was started. The patient developed severe sepsis and suffered from multiple organ failure. Despite partial improvement, the course was complicated by intracranial sinus thrombosis, and the patient died two month after admission.

Adjuvants, Immunologic↗
PubMed2001

Anatomic relationship between arachnoid granulations in the transverse sinus and the termination of the vein of Labbé: an angiographic study.

We studied the anatomic relationship between arachnoid granulations in the transverse sinus and the termination of the vein of Labbé in 57 consecutive angiograms. Patients with pathology in intracranial venous structures or with inadequate image quality of the venous system were excluded. Arachnoid granulations were found in 12 of the 57 patients (21.1%), always at the junction of the vein of Labbé and the transverse sinus; the vein of Labbé was present in 55 patients (96.5%), most often without associated arachnoid granulations; the latter, however, were not observed in the absence of a vein of Labbé. This study confirms the close, constant anatomic relationship between arachnoid granulations in the transverse sinus and the termination of the vein of Labbé. This observation may help to differentiate arachnoid granulations from pathologic conditions involving the transverse sinus such as dural sinus thrombosis. The constant character of this relationship suggests a developmental role of afferent veins in the formation of arachnoid granulations.

Arachnoid↗
PubMed2001

High-resolution blood oxygen-level dependent MR venography (HRBV): a new technique.

Our purpose of this study was to demonstrate the clinical potential and spatial resolution of a new MRI technique: high-resolution blood oxygen-level dependent venography (HRBV), in well-known intracranial vascular lesions, such as cavernous and venous angiomas, and venous sinus thrombosis. HRBV provides unique high-resolution information on veins without administration of contrast medium. The data are independent of conventional findings on MRI and potentially useful in characterising and demonstrating the architecture of vascular lesions of the brain.

Adult↗
PubMed2003

The paediatric overview.

Stroke in children, both ischaemic and haemorrhagic, is increasingly recognised as an important paediatric illness. This review looks at the wide number of causes, highlighting the fact that often no single factor is causative on its own. There has been an increased recognition worldwide of the importance of sickle cell disease and of the importance of venous sinus thrombosis. Radiology is mandatory in diagnosis and management. Unfortunately, it is not always possible to extrapolate experience from adult stroke in terms of management of these children, and further detailed trials are necessary to understand the natural history, outcome and best forms of management.

Child↗
PubMed2004

Transcranial Doppler imaging in children: sickle cell screening and beyond.

Transcranial Doppler (TCD) is widely accepted as the modality of choice for screening intracranial vessels in children with sickle cell disease. Its advantages are that it is noninvasive (no need for sedation, contrast material, or radiation), portable, easily repeated, and it provides information about the intracranial vessels that is otherwise unavailable. These positive attributes explain why in recent years the applications for TCD have grown beyond sickle cell screening to almost any disease process that involves the major intracranial vessels. The objective of this manuscript is to discuss key points on how to perform and interpret TCD, and discuss imaging features of various pathological processes such as sickle cell, asphyxia, brain trauma, brain death, hydrocephalus, enlarged subarachnoid spaces, vasospasm, vasculitis, venous sinus thrombosis, and vein of Galen malformation.

Adolescent↗
PubMed2005

Pulmonary thromboembolism in children.

Pulmonary thromboembolism (PTE) is uncommonly diagnosed in the pediatric patient, and indeed often only discovered on autopsy. The incidence of pediatric PTE depends upon the associated underlying disease, diagnostic tests used, and index of suspicion. Multiple risk factors can be found including: peripartum asphyxia, dyspnea, haemoptysis, chest pain, dehydration, septicemia, central venous lines (CVLs), trauma, surgery, ongoing hemolysis, vascular lesions, malignancy, renal disease, foreign bodies or, uncommonly, intracranial venous sinus thrombosis, burns, or nonbacterial thrombotic endocarditis. Other types of embolism can occur uncommonly in childhood and need to be recognized, as the required treatment will vary. These include pulmonary cytolytic thrombi, foreign bodies, tumor and septic emboli, and post-traumatic fat emboli. No single noninvasive test for pulmonary embolism is both sensitive and specific. A combination of diagnostic procedures must be used to identify suspect or confirmed cases of PTE. This article reviews the risk factors, clinical presentation and treatment of pulmonary embolism in children. It also highlights the current diagnostic tools and protocols used to evaluate pulmonary embolism in pediatric patients.

Child↗
PubMed2004

Head and neck lesions in the immunocompromised host.

Head and neck lesions are encountered in more than 40-50% in patients with immunosuppression (HIV-infected individuals, diabetes mellitus, transplant recipients, patients treated with immunosuppressive drugs or post-radiotherapy). The organs affected are the salivary glands, the lymph nodes, the sinonasal tract, the orbits, the temporal bones, and the pharyngo-laryngeal mucosa. They are mainly involved by granulation tissue, perivascular and perineural inflammation, and neoplasms. In the pediatric population the temporal bone is the most frequent target organ. The most common clinical manifestation of salivary gland involvement is non-specific bilateral painless enlargement of the parotid gland and xerostomia. Lymphoepithelial cyst, sialosis, and lymphoma may be present. The high rate of salivary gland involvement is probably related to the presence of the human immunodeficiency virus within the saliva. Surgery, sclerotherapy by doxycycline, or low-dose radiotherapy may prevent further growth of tumoral lesions. Sinonasal diseases are the most frequent lesions which manifest in immunosuppressed adult patients (66%). They are associated with a trend of decreased survival rate. Invasive aspergillosis is defined by hyphae in the submucosa, and tumor necrosis without host inflammatory response; it may be lethal in 50-80%, especially when the skull base is involved. Computed tomography shows erosion of bone and extrasinonasal extension. The hypointensity of the lesion on T2-weighted images may suggest the diagnosis. Fungal sinus disease can affect 1-10% of transplant recipients and should be suspected when organ rejection is considered. The temporal bone is the most frequent target organ in the immunosuppressed pediatric population due to Eustachian,tube dysfunction. Otomastoïditis, necrotizing external otitis, and otosyphilis are reported. Prompt treatment may avoid lateral sinus thrombosis. Epithelial neoplasms, lymphomas, and Kaposi's sarcoma may also be considered. Kaposi's sarcoma, the most common neoplasm encountered in patients with AIDS, is an indicator of the progression of human immunodeficiency virus infection to AIDS. The lesions are often multifocal at presentation and may affect the skin, the mucosa, and visceral organs. The pathogenesis is unclear, but cytokines and growth factors may play a role. In conclusion, immunosuppressed patients are likely to develop virulent infection with vascular complications.

AIDS-Related Opportunistic Infections↗
PubMed2004

Three-dimensional MR digital subtraction angiography using parallel imaging and keyhole data sampling in cerebrovascular diseases: initial experience.

We assessed the feasibility of MR digital subtraction angiography (DSA) using parallel imaging and keyhole data sampling in the diagnosis of cerebrovascular diseases (CVDs) in 11 patients. Their diseases included arterial trunk stenosis/occlusion ( n=4), aneurysm ( n=3), arteriovenous malformation ( n=2), venous angioma ( n=1), and sinus thrombosis ( n=1). The technique depicted not only anatomical features, comparably to MR angiography ( n=10/11), but also hemodynamics such as collateral flow at a temporal resolution of 1.68 s/frame. When compared with conventional angiograms ( n=7), details were missed in four patients (incomplete demonstration of aneurysmal neck in two and poor separation of AVM components in two). Although inferior to conventional angiography, this technique can provide both anatomical and hemodynamic information of CVDs.

Adolescent↗