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Acta Neurochirurgica Sep 2021Hyperosmotic therapy is a mainstay treatment for cerebral edema. Although often effective, its disadvantages include mainly acting on the normal brain region with...
BACKGROUND
Hyperosmotic therapy is a mainstay treatment for cerebral edema. Although often effective, its disadvantages include mainly acting on the normal brain region with limited effectiveness in eliminating excess fluid in the edema region. This study investigates how to configure our previously proposed novel electroosmosis based edema treatment as a complement to hyperosmotic therapy.
METHODS
Three electrode configurations are designed to drive the excess fluid out of the edema region, including 2-electrode, 3-electrode, and 5-electrode designs. The focality and directionality of the induced electroosmotic flow (EOF) are then investigated using the same patient-specific head model with localized edema.
RESULTS
The 5-electrode design shows improved EOF focality with reduced effect on the normal brain region than the other two designs. Importantly, this design also achieves better directionality driving excess edema tissue fluid to a larger region of surrounding normal brain where hyperosmotic therapy functions better. Thus, the 5-electrode design is suggested to treat edema more efficiently via a synergic effect: the excess fluid is first driven out from the edema to surrounding normal brain via EOF, where it can then be treated with hyperosmotic therapy. Meanwhile, the 5-electrode design drives 2.22 mL excess fluid from the edema region in an hour comparable to the other designs, indicating a similar efficiency of EOF.
CONCLUSIONS
The results show that the promise of our previously proposed novel electroosmosis based edema treatment can be designed to achieve better focality and directionality towards a complement to hyperosmotic therapy.
Topics: Brain; Brain Edema; Edema; Electrodes; Electroosmosis; Humans
PubMed: 34291383
DOI: 10.1007/s00701-021-04938-5 -
Radiation Oncology (London, England) Jan 2015Recently, we characterized a Gamma Knife® radiation necrosis mouse model with various magnetic resonance imaging (MRI) protocols to identify biomarkers useful in...
BACKGROUND
Recently, we characterized a Gamma Knife® radiation necrosis mouse model with various magnetic resonance imaging (MRI) protocols to identify biomarkers useful in differentiation from tumors. Though the irradiation was focal to one hemisphere, a contralateral injury was observed that appeared to be localized in the white matter only. Interestingly, this injury was identifiable in T2-weighted images, apparent diffusion coefficient (ADC), and magnetization transfer ratio (MTR) maps, but not on post-contrast T1-weighted images. This observation of edema independent of vascular changes is akin to the perilesional edema seen in clinical radiation necrosis.
FINDINGS
The pathology underlying the observed white-matter MRI changes was explored by performing immunohistochemistry for healthy axons and myelin. The presence of both healthy axons and myelin was reduced in the contralateral white-matter lesion.
CONCLUSIONS
Based on our immunohistochemical findings, the contralateral white-matter injury is most likely due to axonal degeneration.
Topics: Animals; Axons; Brain; Diffusion Magnetic Resonance Imaging; Edema; Female; Mice; Mice, Inbred BALB C; Necrosis; Radiation Injuries
PubMed: 25636531
DOI: 10.1186/s13014-015-0335-6 -
Wiener Klinische Wochenschrift Feb 2005In this issue of the WKW, Aigner et al have published that, for the first time, a conservative approach with iloprost has shown to be equally successful as the... (Review)
Review
In this issue of the WKW, Aigner et al have published that, for the first time, a conservative approach with iloprost has shown to be equally successful as the well-documented core decompression surgical approach in patients with BMES of the hip joint. The BME pattern on MR-imaging of the hip joint represents a common but unspecific finding, which may be associated with several diseases requiring different therapeutic strategies (Table 1). It is still controversial, whether BMES of the hip represents a distinct self-limiting disease also known as transient osteoporosis, transient marrow edema, or algodystrophy, or merely reflects a subtype of ON. Since prognosis and therapeutic consequences vary significantly, differential diagnosis between BMES, CRPS and ON is of clinical interest (Table 2). Both, BMES and ON show similar ON risk factors and a male prevalence, while classical CRPS has a history of trauma and a prevalence among females. Clinical presentation of BMES and ON is similar with typical mechanical pain and prevalence of the hip joint. In contrast, classical CRPS shows a diffuse and burning pain in combination with trophic and vasomotor signs, mainly in the hands and feet. Imaging patterns of BMES are more diffuse, across the entire femoral head, while focal and subchondral in ON. In both, the patterns are limited to the femoral head. In contrast to classical CRPS, the imaging changes are located in all periarticular bones, and the soft tissues are always affected. The histological bone marrow changes are similar in all three diseases, but with abundant new bone formation in BMES and CRPS, whereas in ON only limited new bone formation surrounds the focal necrosis with a sclerotic rim. Protected weight-bearing and treatment with iloprost for BMES, but operative treatment for ON, and a sophisticated physiotherapy for CRPS in combination with iloprost are the preferred treatment strategies in our institution.
Topics: Arthralgia; Bone Marrow Diseases; Edema; Hip Joint; Humans; Radiography; Syndrome
PubMed: 15847189
DOI: 10.1007/s00508-005-0322-2 -
Kidney International Mar 2003
Review
Topics: Crush Syndrome; Diuretics, Osmotic; Edema; Humans; Muscle, Skeletal; Renal Dialysis
PubMed: 12631101
DOI: 10.1046/j.1523-1755.2003.00822.x -
Ophthalmology Jul 1986Diabetic macular edema can be classified into a focal variety, characterized by focal leakage from microaneurysms, often with accumulation of extravascular lipoprotein... (Clinical Trial)
Clinical Trial
Diabetic macular edema can be classified into a focal variety, characterized by focal leakage from microaneurysms, often with accumulation of extravascular lipoprotein in a circinate pattern around the focal leakage, and a diffuse variety, with diffuse leakage from retinal vessels often accompanied by cystoid macular changes. Laser photocoagulation is directed at microaneurysms for focal leakage and is applied in a grid pattern for diffuse leakage. Several prospective randomized clinical trials have shown that laser-treated eyes fare better than untreated eyes: there is a higher rate of modest visual improvement and a lower rate of visual deterioration in eyes treated with laser photocoagulation. In patients with diabetic macular edema, especially the diffuse variety, systemic factors also may play a pathogenic role. Fluid retention and hypertension due to cardiovascular and renal disease exacerbate retinal capillary leakage. Correction of systemic abnormalities (reduced blood pressure, diuresis) may reduce macular edema and should be included as part of the total management of patients with diabetic macular edema.
Topics: Clinical Trials as Topic; Diabetic Retinopathy; Edema; Fluorescein Angiography; Humans; Ischemia; Laser Therapy; Light Coagulation; Macula Lutea; Macular Edema; Retinal Vessels
PubMed: 3531959
DOI: 10.1016/s0161-6420(86)33650-9 -
Clinical Science (London, England :... Dec 2018Hypertonic Na accumulation in peripheral tissues is a recently described phenomenon: it has been associated with ageing, hypertension, diabetes, chronic kidney disease... (Review)
Review
Hypertonic Na accumulation in peripheral tissues is a recently described phenomenon: it has been associated with ageing, hypertension, diabetes, chronic kidney disease and heart failure, but its clinical meaning has yet to be determined. This concept conflicts with the classic physiological paradigm of constant balance between salt intake and excretion, and its water-independent nature is still a matter of debate.We developed a theoretical model explaining changes in the chemical composition of tissues as a function of extracellular volume fraction and excess extracellular fluid, i.e. oedema. The model suggests that the proportional increase in absolute Na content and concentration due to different degrees of oedema is higher than the parallel increase in water content, thus making Na a more sensitive index to detect this oedema.Our model would explain some of the recent findings of high tissue Na content in pathological conditions. More importantly, it prompts the reappraisal of tissue Na analysis from being a topic of niche interest to a potential diagnostic tool with broad applicability in the investigation of subclinical systemic and localized oedema.
Topics: Animals; Asymptomatic Diseases; Biomarkers; Body Water; Edema; Fluid Shifts; Humans; Models, Biological; Severity of Illness Index; Sodium
PubMed: 30545897
DOI: 10.1042/CS20180575 -
The Journal of Rheumatology Sep 2023
Topics: Humans; Adolescent; Shoulder Pain; Shoulder; Knee Joint; Musculoskeletal Diseases; Edema; Shoulder Joint
PubMed: 36792113
DOI: 10.3899/jrheum.221291 -
Pediatric Emergency Care May 2019Hair-thread tourniquet syndrome is a rare, painful condition that occurs when a strand of hair or thread becomes wrapped around toes, fingers, or other appendages. This... (Review)
Review
Hair-thread tourniquet syndrome is a rare, painful condition that occurs when a strand of hair or thread becomes wrapped around toes, fingers, or other appendages. This causes focal edema, which eventually reduces arterial blood flow and can lead to ischemia and necrosis. A thorough physical examination and assessment of risk factors are important. Treatment involves depilatory agents or targeted incision at the bedside or in the operating room. Successfully treated cases can be discharged with local wound care. Parents should be advised on prevention strategies and ensure close follow-up for reexamination.
Topics: Constriction, Pathologic; Edema; Hair; Humans; Infant; Ischemia; Syndrome; Tourniquets
PubMed: 31045982
DOI: 10.1097/PEC.0000000000001827 -
Radiology Jul 1994To report four cases of leg pain resembling transient bone marrow edema (TBME).
PURPOSE
To report four cases of leg pain resembling transient bone marrow edema (TBME).
MATERIALS AND METHODS
Four women aged 51-71 years had lower leg pain that regressed over 3-13 months. All patients underwent physical examination, clinical testing, radiography, scintigraphy, and magnetic resonance (MR) imaging. One patient underwent computed tomography; two underwent biopsy.
RESULTS
All patients had tenderness at physical examination, and one had erythema and mild swelling over part of the leg. No laboratory results suggested systemic illness or infection. All had normal radiographs and abnormal bone scans, with increased radiopharmaceutical uptake in the tibial diaphyses. MR imaging showed decreased signal intensity with T1-weighting and increased signal intensity with inversion recovery. There were also signal intensity changes consistent with edema in the surrounding soft tissues. Biopsies showed focal marrow fibrosis and new bone formation with foci of devitalized bone.
CONCLUSION
These cases resemble TBME but are unusual in their distribution. Whether they represent a previously undescribed clinical syndrome or a variant of TBME remains to be clarified.
Topics: Aged; Bone Marrow Diseases; Edema; Female; Humans; Magnetic Resonance Imaging; Middle Aged; Osteoporosis, Postmenopausal; Pain; Radionuclide Imaging; Tibia
PubMed: 8208937
DOI: 10.1148/radiology.192.1.8208937 -
Journal Des Maladies Vasculaires Jul 2012Lipedema is a clinical entity frequently misdiagnosed or confound with primary lymphedema. Lipedema is a disorder of adipose tissue that occurs almost exclusively in... (Review)
Review
Lipedema is a clinical entity frequently misdiagnosed or confound with primary lymphedema. Lipedema is a disorder of adipose tissue that occurs almost exclusively in obese women. It is characterized by bilateral enlargement from hip to ankle due to abnormal depositions of subcutaneous fat associated with often mild edema, usually sparing the feet. Disease onset is usually at or soon after puberty. Lipedema results in considerable frustration and distress resulting from the cosmetic appearance. Patients may complain of pain, tenderness, easy bruising of the affected areas with moderate to severe sensitivity to digital pressure or pinching. Imaging studies using computed tomography, magnetic resonance imaging, ultrasound, lymphoscintigraphy are not indicated, except if the diagnosis is atypic or doubtful. Long-term evolution may alter lymphatic system and lead to a lipo-lymphedema with specific complications such as cellulitis. Lipedema management is not codified and included weight loss (poorly improving leg appearance or discomfort), psychological counselling and compression therapy. Liposuction, especially using tumescent local anaesthesia, may reduce edema, spontaneous pain, sensitivity to pressure, bruising and improve appearance resulting in a important increase in quality of life.
Topics: Diagnosis, Differential; Diagnostic Imaging; Ecchymosis; Edema; Esthetics; Female; Humans; Lipectomy; Lymphedema; Lymphoscintigraphy; Male; Obesity; Pain; Physical Therapy Modalities; Sex Factors; Subcutaneous Fat
PubMed: 22698628
DOI: 10.1016/j.jmv.2012.05.002