Thoracic intradural disc herniation Almond, L. M.; Hamid, N. A.; Wasserberg, J.
British journal of neurosurgery,
02/2007, Letnik:
21, Številka:
1
Journal Article
Recenzirano
Intradural disc herniation is a well-recognized entity in the lumbar region, where over 90% of all intradural herniations are seen.1 By contrast, fewer than 5% occur in either the cervical or ...thoracic regions.1 We describe a case of a sudden onset neurological deficit caused by an intradural thoracic disc herniation at the T11 - T12 level, the intradural nature of which was not diagnosed on preoperative MRI. To the best of our knowledge this is the first description of an intradural disc herniation at this level.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The course of dilated cardiomyopathy (DCM) leading to heart failure in children varies; survival with conventional treatment is 64% at 5 years. Heart transplantation (HTx) enables improved survival; ...however, outcomes from listing for transplant are not well described. This study reports survival of patients with DCM from listing with the availability of mechanical bridge to transplant.
Patients with a primary diagnosis of DCM (n = 1,098) were identified from a multi-institutional, prospective, registry of patients aged < 18 years listed for HTx from January 1, 1993, to December 31, 2006.
Characteristics of DCM patients at listing included a mean age of 7.3 years; 51% male, 64% white ethnicity, 77% United Network for Organ Sharing status I, 66% on inotropic support, 28% mechanically ventilated, and 15% on mechanical support. Waitlist mortality was 11%, and 75% underwent HTx at 2 years after listing. Overall 10-year survival after listing was 72%, with higher risk of death associated with arrhythmias, mechanical ventilation, and extracorporeal membrane oxygenation (ECMO) support, but not ventricular assist device (VAD) support. Survival at 10 years post-HTx was 72%, with a higher risk of death associated with black race, older age, mechanical ventilation, longer ischemic time, and earlier era of transplant.
Transplantation for DCM in the pediatric population offers enhanced survival compared with the natural history. Overall waitlist mortality for DCM is low, with the exception of patients on ECMO, mechanically ventilated, or with arrhythmias. DCM patients fared well after transplant, making HTx a key therapeutic intervention.
Abstract
Background
Textbook outcomes are composite outcome measures that reflect the ideal overall experience for patients. There are many of these in the elective surgery literature but no textbook ...outcomes have been proposed for patients following emergency laparotomy. The aim was to achieve international consensus amongst experts and patients for the best Textbook Outcomes for non-trauma and trauma emergency laparotomy.
Methods
A modified Delphi exercise was undertaken with three planned rounds to achieve consensus regarding the best Textbook Outcomes based on the category, number and importance (Likert scale of 1–5) of individual outcome measures. There were separate questions for non-trauma and trauma. A patient engagement exercise was undertaken after round 2 to inform the final round.
Results
A total of 337 participants from 53 countries participated in all three rounds of the exercise. The final Textbook Outcomes were divided into ‘early’ and ‘longer-term’. For non-trauma patients the proposed early Textbook Outcome was ‘Discharged from hospital without serious postoperative complications (Clavien–Dindo ≥ grade III; including intra-abdominal sepsis, organ failure, unplanned re-operation or death). For trauma patients it was ‘Discharged from hospital without unexpected transfusion after haemostasis, and no serious postoperative complications (adapted Clavien–Dindo for trauma ≥ grade III; including intra-abdominal sepsis, organ failure, unplanned re-operation on or death)’. The longer-term Textbook Outcome for both non-trauma and trauma was ‘Achieved the early Textbook Outcome, and restoration of baseline quality of life at 1 year’.
Conclusion
Early and longer-term Textbook Outcomes have been agreed by an international consensus of experts for non-trauma and trauma emergency laparotomy. These now require clinical validation with patient data.
We propose novel Textbook Outcomes for emergency laparotomy (for trauma and non-trauma) based on a large international Delphi exercise
Conclusions An abbreviated course of γT supplementation reduced inflammatory cytokine production following LPS challenge ex vivo. ...γT /γ-CEHC serum concentrations negatively correlated with ...LPS-induced cytokine production.
Nucleoside analogues are activated to their triphosphates, which compete with endogenous deoxynucleoside triphosphate (dNTP) pools to inhibit HIV reverse transcriptase. Hydroxyurea has been ...administered with nucleoside analogues to modulate intracellular dNTP pools and thus the ratio of drug triphosphate:endogenous triphosphate.
To examine changes in drug activation over time and investigate the effects of hydroxyurea on intracellular phosphorylation of antiretroviral nucleoside analogues.
A total of 229 HIV-infected individuals receiving abacavir, lamivudine and zidovudine were randomly assigned to receive or not nevirapine and hydroxyurea. Twenty-four patients were recruited to an observational substudy measuring intracellular drug triphosphate and dNTP concentrations at 0, 2, 6, 12, 24 and 48 weeks.
Drugs were extracted from isolated peripheral blood mononuclear cells before analysis of endogenous dNTP and drug triphosphates by primer extension assays.
Twenty-two out of 24 patients were followed to completion of the substudy. Hydroxyurea had no demonstrable effect on endogenous dNTP or drug triphosphate levels at any timepoint. However, the ratio of zidovudine triphosphate to endogenous deoxythymidine triphosphate was significantly increased with hydroxyurea. A significant decrease in lamivudine triphosphate (3TCTP) and the 3TCTP:endogenous deoxycytidine triphosphate ratio was seen over 48 weeks. In five patients who failed therapy in the first 24 weeks, significantly reduced 3TCTP was seen.
Hydroxyurea does not affect measurable pools of endogenous nucleosides in vivo. Decreased lamivudine phosphorylation over time may provide a novel pharmacological explanation for the mechanism of resistance to this drug.
Beginning in 2000 and accelerating in 2004, the Berlin Heart EXCOR (Berlin Heart Inc Woodlands, TX) became the first pediatric-specific ventricular assist device (VAD) applied throughout North ...America for children of all sizes. This retrospective study analyzed the initial Berlin Heart EXCOR pediatric experience as a bridge to transplantation.
Between June 2000 and May 2007, 97 EXCOR VADs were implanted in North America at 29 different institutions. The analysis is limited to 73 patients (75%) from 17 institutions, for which retrospective data were available.
Median age and weight at VAD implant were 2.1 years (range, 12 days-17.8 years) and 11 kg (range, 3-87.6 kg), respectively. The primary diagnoses were dilated cardiomyopathy in 42 (58%), congenital heart disease in 19 (26%), myocarditis in 7 (10%), and other cardiomyopathies in 5 (7%). Pre-implant clinical condition was critical cardiogenic shock in 38 (52%), progressive decline in 33 (45%), or other in 2 (3%). Extracorporeal membrane oxygenation was used as a bridge to EXCOR in 22 patients (30%). Device selection was left VAD (LVAD) in 42 (57%) and biventricular assist devices (BiVAD) in 31 (43%). The EXCOR bridged 51 patients (70%) to transplant and 5 (7%) to recovery. Mortality on the EXCOR was 23% (n = 17) overall, including 35% (11 of 31) in BiVAD vs 14% (6 of 42) in LVAD patients (p = 0.003). Multivariate analysis showed younger age and BiVAD support were significant risk factors for death while on the EXCOR.
This limited but large preliminary North American experience with the Berlin Heart EXCOR VAD as a bridge to cardiac transplantation for children of all ages and sizes points to the feasibility of this approach. The prospective investigational device evaluation trial presently underway will further characterize the safety and efficacy of the EXCOR as a bridge to pediatric cardiac transplantation.
Introduction: Appropriate alerting of patients with trauma and informative handover are necessary to allow a smooth transition of care between the prehospital and hospital teams. Aim: To identify ...current practice and areas that need to be improved to facilitate the transition from prehospital care to emergency department resuscitation. Methods: A questionnaire postal study of 100 emergency departments and all 32 ambulance service trusts in England and Wales. Results: Emergency departments returned 34 (34%) completed questionnaires, and ambulance trusts returned 16 (50%) completed questionnaires. In all, 56.8% of emergency department responders stated that trauma alert information was relayed through ambulance control, 48.5% stated that alert messages were standardised and 18.5% felt that ambulance crews used the trauma severity scoring system during alerting. 64.7% stated that handover was broadcast to the trauma team and 9.1% routinely received digital photographic images. All ambulance service responders included injury mechanism in their alerting criteria and 53.3% used a standard handover structure with 86.7% familiar with the mnemonic ASHICE (Age, Sex, History, Injuries, Condition, Expected time of arrival) for rapid information transmission. Discussion: Greater cooperation between regional emergency departments and ambulance services is necessary to refine the alerting and handover process, producing a pathway through which vital information is collected by trained personnel and communicated without distortion to the resuscitation room, where it may be utilised to inform life-saving decisions.
Summary
BACKGROUND: Pancreatic injury is uncommon and often presents with subtle clinical and radiological signs. For this reason, diagnosis may be delayed, or inappropriate surgery may be attempted, ...leading to significant morbidity and mortality. METHODS: We performed a thorough investigation of the literature between 1963 and 2008 in order to review the diagnosis and management of pancreatic trauma. RESULTS: In unstable patients and in cases of penetrating injury, immediate surgical exploration is usually essential. In these cases damage control surgery should be performed and major pancreatic resections with primary anastamoses should not be attempted, particularly in non-specialist units. In stable patients, imaging modalities are vital to grade the degree of injury and crucially identify signs of major pancreatic duct disruption, which is a key indicator of prognosis. Management may then be tailored to the degree of injury identified. CONCLUSIONS: Pancreatic injury is uncommon but must be suspected following trauma to the epigastrium. In stable patients urgent radiological investigations should be performed prior to planning treatment. Early consultation with specialist units is essential.
Under hydrothermal reaction conditions, two new uranyl tellurites, Tl2UO2(TeO3)2 (1) and Na8(UO2)6(TeO3)10 (2), have been prepared. These compounds display unusual bonding characteristics in that 1 ...contains Te2O64− ions formed from two TeO32− ions, and 2 (see picture) possesses a chiral three‐dimensional network structure. The bonding and physical properties of these compounds are discussed.
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