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Journal of Applied Physiology... Feb 2021Spaceflight-associated neuro-ocular syndrome (SANS) involves unilateral or bilateral optic disc edema, widening of the optic nerve sheath, and posterior globe...
Spaceflight-associated neuro-ocular syndrome (SANS) involves unilateral or bilateral optic disc edema, widening of the optic nerve sheath, and posterior globe flattening. Owing to posterior globe flattening, it is hypothesized that microgravity causes a disproportionate change in intracranial pressure (ICP) relative to intraocular pressure. Countermeasures capable of reducing ICP include thigh cuffs and breathing against inspiratory resistance. Owing to the coupling of central venous pressure (CVP) and intracranial pressure, we hypothesized that both ICP and CVP will be reduced during both countermeasures. In four male participants (32 ± 13 yr) who were previously implanted with Ommaya reservoirs for treatment of unrelated clinical conditions, ICP was measured invasively through these ports. Subjects were healthy at the time of testing. CVP was measured invasively by a peripherally inserted central catheter. Participants breathed through an impedance threshold device (ITD, -7 cmHO) to generate negative intrathoracic pressure for 5 min, and subsequently, wore bilateral thigh cuffs inflated to 30 mmHg for 2 min. Breathing through an ITD reduced both CVP (6 ± 2 vs. 3 ± 1 mmHg; = 0.02) and ICP (16 ± 3 vs. 12 ± 1 mmHg; = 0.04) compared to baseline, a result that was not observed during the free breathing condition (CVP, 6 ± 2 vs. 6 ± 2 mmHg, = 0.87; ICP, 15 ± 3 vs. 15 ± 4 mmHg, = 0.68). Inflation of the thigh cuffs to 30 mmHg caused no meaningful reduction in CVP in all four individuals (5 ± 4 vs. 5 ± 4 mmHg; = 0.1), coincident with minimal reduction in ICP (15 ± 3 vs. 14 ± 4 mmHg; = 0.13). The application of inspiratory resistance breathing resulted in reductions in both ICP and CVP, likely due to intrathoracic unloading. Spaceflight causes pathological changes in the eye that may be due to the absence of gravitational unloading of intracranial pressure (ICP) under microgravity conditions commonly referred to as spaceflight-associated neuro-ocular syndrome (SANS), whereby countermeasures aimed at lowering ICP are necessary. These data show that impedance threshold breathing acutely reduces ICP via a reduction in central venous pressure (CVP). Whereas, acute thigh cuff inflation, a popular known spaceflight-associated countermeasure, had little effect on ICP and CVP.
Topics: Central Venous Pressure; Humans; Intracranial Pressure; Male; Space Flight; Tonometry, Ocular; Weightlessness
PubMed: 33270516
DOI: 10.1152/japplphysiol.00786.2020 -
Srpski Arhiv Za Celokupno Lekarstvo 2013Intraventricular hemorrhage occurs in almost one fifth of prematurely born children. Due to present complications, such as hydrocephalus and neurological deficit, it...
INTRODUCTION
Intraventricular hemorrhage occurs in almost one fifth of prematurely born children. Due to present complications, such as hydrocephalus and neurological deficit, it endangers the child's life, therefore there is the need for understanding and prevent risk factors as well as the need for finding most optimal methods of treatment.
OBJECTIVE
The aim of the study was to point out the current therapeutic modalities of the treatment of posthemorrhagic hydrocephalus in prematurely born children.
METHODS
The study included 60 patients divided into two groups of 30 patients treated at the University Children's Hospital of Belgrade in the period 2003-2008.
RESULTS
Treatment outcome of the control group of patients treated by standard methods was influenced by gestational age (p=0.024), head circumference on birth (p = 0.043), body mass on birth (p = 0.006), Apgar score on birth (p < 0.001), peripartum asphyxia (p < 0.001), cardiorespiratory arrest (p < 0.001), respiratory distress (p = 0.002) and intraventricular hemorrhagic grade (p < 0.001). As statistically significant predictors of the poor treatment outcome of the experimental group of patients treated by using Ommaya reservoir were identified: low body mass on birth (p < 0.05), low Apgar score (p < 0.05), prolonged number of days on assisted ventilation (p < 0.05), presence of peripartum asphyxia (p < 0.05) and cardiorespiratory arrest (p < 0.05).
CONCLUSION
No statistically significant difference was detected in the outcome between the patients treated by the standard method and those with installed Ommaya reservoir. However, the difference of 10% in mortality between the two groups may be clinically significant so that further studies of larger samples are necessary.
Topics: Animals; Cerebral Hemorrhage; Humans; Hydrocephalus; Infant, Newborn; Infant, Premature, Diseases; Ventriculoperitoneal Shunt
PubMed: 23539903
DOI: 10.2298/sarh1302008m -
World Neurosurgery Sep 2016Ommaya reservoirs are used for administration of intrathecal chemotherapy and cerebrospinal fluid sampling. Ventricular catheter placement for these purposes requires a... (Comparative Study)
Comparative Study
OBJECTIVE
Ommaya reservoirs are used for administration of intrathecal chemotherapy and cerebrospinal fluid sampling. Ventricular catheter placement for these purposes requires a high degree of accuracy. Various options exist to optimize catheter placement. We analyze a cohort of patients receiving catheters using 2 different technologies.
METHODS
Retrospective chart review was performed on patients undergoing Ommaya reservoir placement between 2011 and 2014. Most procedures were assisted by either frameless stereotactic neuronavigation or fluoroscopic guidance with pneumoencephalogram. Catheter accuracy, revision rates, perioperative complications, and operative time were measured. Preoperative similarities and differences in diagnosis, demographics, and ventricular size were also recorded to avoid a biased assessment of our results.
RESULTS
One-hundred and forty-five patients were included, 57 using fluoroscopic guidance and 88 using frameless stereotaxy. Common diagnoses in both groups were lymphoma and leptomeningeal disease. Qualitative measures of catheter placement accuracy showed no significant difference between the 2 groups. Proximity to the foramen of Monro favored fluoroscopy by a small margin (8.6 mm vs. 10.2 mm, P = 0.03). Overall revision rates were not significantly different between the groups (3.5% vs. 4.5%, P = 1.00). Early surgical complications occurred in 6.8% of the frameless stereotaxy group and 1.8% of the fluoroscopy group (P = 0.25).
CONCLUSIONS
Ommaya reservoirs can be placed accurately using different methods. Although there are slight differences between fluoroscopy and frameless stereotaxy in quantitative accuracy and procedure time, there is no significant advantage of 1 method over the other when evaluating revision or complication rates. Technique familiarity and surgeon preference may dictate the preferred procedure.
Topics: Adult; Aged; Catheterization, Peripheral; Catheters; Cerebral Ventricles; Equipment Design; Equipment Failure Analysis; Female; Fluoroscopy; Humans; Male; Middle Aged; Neuronavigation; New York; Postoperative Complications; Prevalence; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Surgery, Computer-Assisted; Treatment Outcome
PubMed: 27292205
DOI: 10.1016/j.wneu.2016.04.090 -
Journal of Community Hospital Internal... 2019: Burkitt lymphoma is a rare, aggressive and rapidly fatal, B-cell non-Hodgkin's lymphoma. It has an incidence of 0.4/100,000 age-adjusted to the USA standard...
: Burkitt lymphoma is a rare, aggressive and rapidly fatal, B-cell non-Hodgkin's lymphoma. It has an incidence of 0.4/100,000 age-adjusted to the USA standard population. Here we describe the case of a 77-year-old patient who presented with Burkitt lymphoma. : A 77-year-old male presented to his primary care physician with fatigue and listlessness and was referred to the hospital with a white blood cell count (WBC)-23.7 K/uL (neutrophils 37%, lymphocyte 11%, blasts 9%) and platelets-19 K/uL. During his stay in the hospital, repeat investigations revealed WBC-29.9 K/uL (neutrophils 22%, lymphocyte 27%, atypical lymphocytes 5%, blasts 20%) and platelets-10 K/uL with no evidence of mucosal bleeds, neck or abdominal masses or generalized lymphadenopathy. Bone marrow aspirate revealed the presence of MYC rearrangements (8q24) on flow cytometry and fluorescent in-situ hybridization (FISH), indicative but not typical of BL. He was transfused with platelets due to a rapidly deteriorating platelet count and episodes of epistaxis. He was discharged after four days with a plan of outpatient chemotherapy over a period of 4 months. An Ommaya reservoir was placed in the right ventricle for intrathecal chemotherapy. After four months of chemotherapy, computerized tomography of the chest, abdomen, and pelvis confirmed remission. A magnetic resonance imaging of the brain a month after completion of chemotherapy revealed metastatic lymphoma in the temporal, parietal and occipital lobes. He was discharged to hospice for palliative care. : Unconventional presentations, as seen in our case of a leukemia-like picture in the absence of a bulky disease, are the quagmire that might delay aggressive management and result in poorer outcomes.
PubMed: 30788071
DOI: 10.1080/20009666.2019.1574545 -
Journal of Neurosurgery. Pediatrics Nov 2015OBJECT The aim of the study was to document postoperative cerebral glucose distribution before proton therapy using F-18 fluorodeoxyglucose positron emission tomography...
OBJECT The aim of the study was to document postoperative cerebral glucose distribution before proton therapy using F-18 fluorodeoxyglucose positron emission tomography (FDG PET) in children with craniopharyngioma. METHODS Between August 2011 and April 2014, 50 patients (20 males, 30 females) enrolled in a prospective trial for craniopharyngioma underwent FDG PET imaging before proton therapy. Proton therapy was delivered using doublescattered beams with a total prescribed dose of 54 cobalt gray equivalent. Tracer uptake in each of 63 anatomical regions was computed after warping PET images to a 3D reference template in Talairach coordinates. Regional uptake was deemed significantly low or high if it exceeded age-corresponding 95% prediction intervals of the normal population. The reference group included 132 children with non-CNS-related diseases and normal-appearing cerebral FDG PET scans. RESULTS Median patient age at diagnosis was 8.5 years (range 2-18 years). Forty-eight patients underwent 1-4 tumor-related surgeries before proton therapy, including placement of an Ommaya reservoir in 14 patients. Sixteen patients had symptomatic hydrocephalus that was treated with temporary (external ventricular drain, n = 16) or permanent CSF shunting (ventriculoperitoneal shunt, n = 1). The most commonly seen PET abnormalities in patients before proton therapy were significantly reduced uptake in subregions of the frontal lobe (often involving more than 1 gyrus), medial and ventral portions of the temporal lobe, cingulate gyrus, and caudate nucleus. A significantly high uptake was frequently observed on the contralateral side, including the superior, medial, and inferior temporal gyri and a large portion of the parietal lobe. Statistically significant predictor variables identified in the multivariate analysis for the extent of hypometabolism were sex (p = 0.005), hydrocephalus (p = 0.026), and the number of tumor-related surgeries (p = 0.017). CONCLUSIONS Postoperative FDG PET of patients with craniopharyngioma revealed metabolic abnormalities in specific regions of the brain. The ability to identify anatomical metabolic defects in individual patients facilitates the investigation of brain injury in children with craniopharyngioma.
PubMed: 26295365
DOI: 10.3171/2015.4.PEDS159 -
Frontiers in Oncology 2022Olfactory neuroblastoma is a rare neoplasm that usually presents in the upper nasal cavity. Although its prognosis is highly unfavorable, effective treatment options are...
Olfactory neuroblastoma is a rare neoplasm that usually presents in the upper nasal cavity. Although its prognosis is highly unfavorable, effective treatment options are still lacking. Moreover, there is no standard treatment for patients with olfactory neuroblastoma that progressed to leptomeningeal carcinomatosis. Here we report an uncommon case of a 59-year-old woman who was diagnosed with olfactory neuroblastoma and leptomeningeal carcinomatosis. For a direct delivery of the drugs to the tumor, and to avoid the impact of lumbar puncture on the patient's quality of life, the intravenous chemotherapy plus intrathecal administration of MTX an Ommaya reservoir was chosen. The results were striking, with the disappearance of tumor cells in the cerebrospinal fluid and the relief of the patient's symptoms with PR. Our result indicates that chemotherapy an Ommaya reservoir offers a new potential therapy for patients with meningeal metastases.
PubMed: 36713576
DOI: 10.3389/fonc.2022.1060575 -
Therapeutics and Clinical Risk... 2018Preterm newborns, due to many factors, are at increased risk for poor neural development, intraventricular hemorrhages, infections, and higher rate of mortality. The aim...
PURPOSE
Preterm newborns, due to many factors, are at increased risk for poor neural development, intraventricular hemorrhages, infections, and higher rate of mortality. The aim of this study was to evaluate the risk factors associated with poor outcome in preterm neonates with late-onset neonatal sepsis (LONS) who had posthemorrhagic hydrocephalus and underwent neurosurgical procedures for treatment of the hydrocephalus.
PATIENTS AND METHODS
Preterm neonates who had undergone insertion of ventriculoperitoneal shunt or Ommaya reservoir, during the 10-year period at University Children's Hospital, were retrospectively analyzed. According to the presence or absence of LONS, patients were divided into LONS group and non-LONS group. In both groups, we analyzed demographic and clinical data as well as nondependent factors. Additionally, we evaluated the patients who had lethal outcome in respect to all the analyzed factors.
RESULTS
A total of 74 patients were included in the study, 35 in LONS group and 39 in control group. Patients in LONS group were born significantly earlier with lower birth weight, needed significantly higher O inspiratory concentration, and had longer duration of mechanical ventilation when compared to the nonseptic group. Five patients in LONS group had lethal outcome, and for these patients we identified a grade American Society of Anaesthesiologists score of 4 (=0.000), ductus arteriosus persistens (=0.000), bronchopulmonary dysplasia (=0.003), and pneumothorax (=0.003) as independent preoperative risk factors for lethal outcome.
CONCLUSION
Neurosurgical procedures are relatively safe in neonates with posthemorrhagic hydrocephalus without LONS after birth. However, if LONS is present, various conditions such as preoperative high grade American Society of Anaesthesiologists score, ductus arteriosus persistens, bronchopulmonary dysplasia, and pneumothorax markedly increase the risk for a lethal outcome after the operation.
PubMed: 30349275
DOI: 10.2147/TCRM.S177535 -
Pediatric Blood & Cancer Jul 2009Although radiation therapy is a primary treatment for craniopharyngioma, it can exacerbate existing problems related to the tumor and pre-irradiation management....
BACKGROUND
Although radiation therapy is a primary treatment for craniopharyngioma, it can exacerbate existing problems related to the tumor and pre-irradiation management. Survival is often marked by neurologic deficits, panhypopituitarism, diabetes insipidus, cognitive deficiencies, and behavioral and social problems.
PROCEDURE
The Achenbach Child Behavior Checklist (CBCL) was used to evaluate behavioral and social problems during the first 5 years of follow-up in 27 patients with craniopharyngioma treated with conformal radiation therapy.
RESULTS
All group averages for the CBCL scales were within the age-typical range at pre-irradiation baseline. Extent of surgical resection was implicated in baseline differences for the internalizing, externalizing, behavior problem and social scores. Significant longitudinal changes were found in internalizing, externalizing, behavior problem and school scores that correlated with tumor and treatment-related factors.
CONCLUSIONS
The most common variables implicated in post-irradiation behavioral and social problems were CSF shunting, presence of an Ommaya reservoir, diabetes insipidus, and low pre-irradiation growth hormone levels.
Topics: Adolescent; Child; Child Behavior Disorders; Clinical Trials, Phase II as Topic; Craniopharyngioma; Female; Follow-Up Studies; Humans; Longitudinal Studies; Male; Pituitary Neoplasms; Predictive Value of Tests; Prospective Studies; Radiotherapy, Conformal; Social Behavior; Survivors
PubMed: 19191345
DOI: 10.1002/pbc.21947 -
Brain Sciences Jun 2022Leptomeningeal carcinomatosis (LMC) is a rare but devastating complication of advanced cancer. Breast cancer, lung cancer, and melanoma are the three most common causes...
Leptomeningeal carcinomatosis (LMC) is a rare but devastating complication of advanced cancer. Breast cancer, lung cancer, and melanoma are the three most common causes of LMC, whereas it is rare in ovarian cancer. Here, we report the case of a 59-year-old woman who was diagnosed with LMC from ovarian cancer and was successfully treated with intrathecal chemotherapy via Ommaya reservoir and radiation therapy. The patient had an amelioration of symptoms and prolonged survival. Though LMC from ovarian cancer is thought to be rare, it is not going to remain a rare entity because the incidence of LMC in general is thought to be increasing, which is also the case with ovarian cancer. According to 31 cases whose treatment course is reported in literature, despite the absence of an established treatment for LMC, intrathecal (IT) chemotherapy whose survival benefit has been suggested in past studies might also prolong survival in patients with LMC from ovarian cancer. IT chemotherapy via Ommaya reservoir may be preferred to the lumbar puncture route. The presentation of non-specific symptoms of LMC in patients may hinder its diagnosis; however, early diagnosis and treatment induction is the key for patients' prolonged survival and restored useful life.
PubMed: 35741633
DOI: 10.3390/brainsci12060748 -
Zhurnal Voprosy Neirokhirurgii Imeni N.... 2017Placement of a ventricular catheter is the most common and easiest procedure in neurosurgery. Usually, the procedure is performed using anatomical landmarks. However,...
UNLABELLED
Placement of a ventricular catheter is the most common and easiest procedure in neurosurgery. Usually, the procedure is performed using anatomical landmarks. However, despite the apparent ease of this manipulation, its results are not always satisfactory. According to the literature data, the rate of improperly placed ventricular catheters amounts to 10-40%, which is directly correlated with the risk of shunt dysfunction. The use of special equipment, such as ultrasound scanners, endoscopes, stereotactic devices, and neuronavigation systems, significantly increases success of surgery. However, the high cost and complexity of equipment confine its use at neurosurgical centers, and increased surgery time limits routine use of the equipment. A Thomale guide provides the accuracy comparable to that of modern navigation systems and, at the same time, is a cheap and easy-to-use device.
AIM
To determine capabilities and master a technique of using the Thomale guide during placement of ventricular catheters.
MATERIAL AND METHODS
Twenty seven surgeries wich Thomale guide were performed at the Rogachev Federal Research Center of Pediatric Hematology, Oncology, and Immunology in the period from April 2015 to November 2016. The Ommaya reservoir was placed in 23 cases; there were 2 ventriculoperitoneal shunting procedures; external ventricular drainage was placed in 2 cases. In 19 cases, the catheter was placed into narrow lateral ventricles.
RESULTS
In all 27 cases, the ventricular catheter was successfully placed, at the first attempt, into the anterior horn of the lateral ventricle.
CONCLUSION
The Thomale guide is a simple but reliable device for accurate and quick placement of a ventricular catheter into the lateral ventricles, regardless of their size.
Topics: Catheters, Indwelling; Equipment Design; Humans; Hydrocephalus; Lateral Ventricles; Magnetic Resonance Imaging; Neuronavigation; Ventriculoperitoneal Shunt
PubMed: 28524128
DOI: 10.17116/neiro201781272-76