scholarly journals 3D printed customised external cranial plate in a patient with syndrome of trephined: ‘a case report’

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Mee H. ◽  
Greasley S. ◽  
Whiting G. ◽  
Harkin C. ◽  
Oliver G. ◽  
...  
Keyword(s):  
Cognitive Disorders ◽  
Severe Case ◽  
Clinical Engineering ◽  
Patient Treatment ◽  
Invasive Squamous Cell Carcinoma ◽  
Motor Impairments ◽  
Engineering Teams ◽  
Neurological Improvement ◽  
Motor Component ◽  
Syndrome Of The Trephined

Abstract Background Syndrome of the trephined is a well-recognised phenomenon that occurs in patients following a craniectomy. It is associated with several symptoms, including headaches, motor impairments, cognitive disorders and reduced consciousness. Treatment for the syndrome usually involves replacing the skull defect. Case Study A 71-year-old male underwent a left-sided craniectomy after being diagnosed with biopsy-confirmed invasive squamous cell carcinoma with associated skull erosion. Subsequently, he developed a severe case of syndrome of the trephined (SoT,) resulting in having to lie flat to prevent the motor component of the Glasgow Coma Score (GCS) falling from M5/6 (E3/4 Vt M5/6) to M1 (E3/4 Vt M1) on sitting to 30 degrees. Unfortunately, due to ongoing chest sepsis and physical frailty, he was unable to undergo a cranioplasty. Therefore, to aid in clinical stabilisation, the treating physicians and clinical engineering teams designed and manufactured a prosthesis on-site, allowing rapid patient treatment. The prosthesis led to the patient being able to sit up to 30 degrees without the motor component of the GCS falling from M6 to M1 (E4 VT M6). Conclusion Clinical improvements were demonstrated with definitive neurological improvement after applying the external cranial plate in clinical outcome measures and radiographically. Furthermore, we have shown that rapid prototyping technology provides a flexible solution to synthesise bespoke medical prostheses with the correct expertise and regulatory framework.

scholarly journals Asymmetric optic nerve sheath diameter as an outcome factor following cranioplasty in patients harboring the 'syndrome of the trephined'

2013 ◽  
Vol 71 (12) ◽  
pp. 963-966 ◽  
Author(s):  
Antonio Santos de Araujo Junior ◽  
Pedro Alberto Arlant ◽  
Arnaldo Salvestrini Jr ◽  
Carlos Eduardo Altieri ◽  
Jasper Guimaraes Santos ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Rare Complication ◽  
Brain Mri ◽  
Optic Nerve Sheath Diameter ◽  
Optic Nerve Sheath ◽  
Neurological Improvement ◽  
Nerve Sheath ◽  
Neurosurgical Treatment ◽  
Intracranial Pressures ◽  
Syndrome Of The Trephined

Decompressive craniectomy (DC) is gaining an increasing role in the neurosurgical treatment of intractable intracranial hypertension, but not without complications. A rare complication is the “syndrome of the trephined” (ST). It occurs when the forces of gravity overwhelm intracranial pressures, leading the brain to become sunken. Objective To determine the usefulness of asymmetric optic nerve sheath diameter (ONSD) as an outcome factor after cranioplasty. Method We followed-up 5 patients submitted to DC and diagnosed with ST. All were submitted to brain MRI to calculate the ONSD. Results Only two patients presented an asymmetric ONSD, being ONSD larger at the site of craniectomy. Surprisingly these patients had a marked neurological improvement after cranioplasty. They became independent a week after and statistically earlier than others. Conclusion It is presumed that the presence of an asymmetric ONSD in trephined patients is an independent factor of good outcome after cranioplasty.

scholarly journals Assessment of functional recovery after cranioplasty

2021 ◽  
Vol 8 (7) ◽  
pp. 2119
Author(s):  
Girish K. Madhavan ◽  
Philip Issac ◽  
Balakrishnan P. Kunjan ◽  
Tom Jose ◽  
Ajax John
Keyword(s):  
Quality Of Life ◽  
Functional Recovery ◽  
Daily Living ◽  
Cognitive Domains ◽  
Neurological Improvement ◽  
Barthel Score ◽  
Level 1 ◽  
A Prospective Study ◽  
Syndrome Of The Trephined

Background: Cranioplasty is done after decompressive craniectomy surgeries either for cosmetic reasons or to afford protection against the development of the syndrome of the trephined which is deterioration after cranial decompression procedures. The aim of the study was to study functional recovery after cranioplasty based on improvement of Barthel activities of daily living (ADL) score.Methods: This was a prospective study done over 6 months period, December 2020 to May 2021. The functional recovery following cranioplasty was assessed based on improvement in Barthel ADL score. Pre-operative and post-operative Barthel ADL score after 3 months after cranioplasty of patients are found out. The change in Barthel score is analyzed and significance found out using paired t test.Results: In this study, 62 patients were included. 42 patients had improvement of ADL score. 14 patients had no change and 6 patients had worsening of score. After cranioplasty, ADL score has improved and it was statistically significant (p<0.001). Also, patients with low level of dependency (level 1, 2 and 3) have decreased in number and patients with higher levels of dependency (level 4 and 5) have increased in number after the surgery, suggesting that there is shift of patients from lower level of dependency to higher levels.Conclusions: Cranioplasty seems to offer patients clear benefits in terms of neurological improvement in many cognitive domains as well as in quality of life. Hence, cranioplasty advocated for functional/neurological recovery rather than cosmetic reasons.

scholarly journals Medical Device Risk Management from a Human Factors Perspective

2018 ◽  
Vol 1 (1) ◽  
pp. 4-8
Author(s):  
Anthony Easty
Keyword(s):  
Risk Management ◽  
Patient Safety ◽  
Human Factors ◽  
Medical Devices ◽  
Error Reduction ◽  
Clinical Engineering ◽  
Natural Evolution ◽  
Engineering Teams ◽  
Adoption And Implementation

This paper describes the ways in which human factors methods can help to enhance the work of established clinical engineering teams by placing a new emphasis on error reduction and patient safety. This approach in many ways represents a natural evolution for departments that are looking to enhance their usefulness and relevance to healthcare. Several examples are given of points at which the introduction of human factors methods can reveal issues related to the safe use of medical devices that are not easily accessible by other means. Adoption and implementation of these methods offers the potential for clinical engineering departments to enhance their role of helping to ensure optimal patient safety.

scholarly journals Flow Analyzer for Blood Pump

2020 ◽  
Vol 3 (1) ◽  
pp. 44-49
Author(s):  
MARCELO ANTUNES MARCIANO ◽  
Rodrigo Rezer ◽  
Anderson Santos
Keyword(s):  
Low Cost ◽  
Flow Analysis ◽  
Cost Effective ◽  
Clinical Engineering ◽  
Blood Pump ◽  
Engineering Teams ◽  
Control Practice ◽  
Analysis Measurement ◽  
Flow Information ◽  
Operational Failures

Medical equipment that supports life, relieves diseases, and overcomes disabilities can also cause damage and death due to operational failures, user failures, and misuse. Hemodialysis machines include roller pumps that control the flow of blood, and these pumps have to be calibrated accurately to ensure they are working properly. This article describes the development of a low-cost, open source prototype that automates the flow analysis (measurement and recording) of the blood pumps in hemodialysis machines. Being able to accurately inspect the machine’s operation improves the quality and safety of its use. Through this technology (this process automation), it is believed equipment downtime and total tests cost will be reduced. This device has a system that collects data in real time, generated by the blood pump dialysis. Mathematical calculations are used to present flow information, including the standard deviation of the measurement, which is reported at the end of the test in an objective and simple way. Through a software and human machine interface (HMI), the test can be monitored and generate a report that contains the name and model of the equipment, the quantitative results of the flows, and the standard deviations of the measurements. The device can be used by clinical engineering teams in preventive maintenance and after corrective maintenance, as a control practice, making the calibration process easier and more cost-effective.

Abstract P197: Impact of Cranioplasty on Neurological Recovery in Syndrome of the Trephined: A Prospective Longitudinal Study

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Lukas Sveikata ◽  
Lana Vasung ◽  
Amir El Rahal ◽  
Andrea Bartoli ◽  
Armin Schnider ◽  
...  
Keyword(s):  
Risk Factors ◽  
Brain Injury ◽  
A Priori ◽  
Neurological Recovery ◽  
Secondary Outcome ◽  
A Posteriori ◽  
Neurological Improvement ◽  
Good Outcome ◽  
The Impact ◽  
Syndrome Of The Trephined

Introduction: Syndrome of the Trephined (SoT) is a common and underdiagnosed complication after decompressive craniectomy (DC). This study aimed to address the knowledge gap in SoT incidence, risk factors, and the impact of cranioplasty timing on neurological recovery. Methods: In a prospective single-center study we examined 40 consecutive patients that underwent a large DC and cranioplasty for diverse etiologies. The participants underwent a cognitive, motor, and radiological evaluation 1-4 days before and after cranioplasty. SoT was diagnosed when neurological symptoms worsened before cranioplasty (’a priori’) or a neurological improvement was observed after cranioplasty without previous overt symptoms (’a posteriori’). The primary outcome was the occurrence of SoT, and secondary outcome was improvement of disability after cranioplasty (mRS 0-3 as good outcome). We used logistic regression models to assess risk factors for SoT and the impact of cranioplasty timing on neurological recovery. Hemorrhagic lesions were defined as initial brain injury or DC-related intraparenchymal or subarachnoid hemorrhage. Radiologic signs were sinking skin flap, paradoxical midline shift, or slit-like ventricle. Results: Of 40 patients enrolled, 14 (35%) developed ’a priori’ and 12 (30%) ’a posteriori’ SoT. Cranioplasty resulted in mRS improvement in 7 (18%) patients 1-4 days after surgery. A shift towards good outcome was observed 1-4 days post-cranioplasty (62% vs. 42%, p=0.025) and at 90 days (73% vs. 42%, p=0.005) compared to 1-4 days pre-cranioplasty in the SoT group, but not in the non-SoT group. A composite score (0-3) of traumatic brain injury, hemorrhagic lesions, and radiologic markers had 92% sensitivity and 86% specificity to predict SoT. Increasing delay to cranioplasty was associated with decreased odds of disability improvement after cranioplasty, when adjusting for age and baseline disability (OR 0.96, p=0.03). Conclusions: In this prospective study, SoT occurred more frequently than previously reported after DC. Earlier cranioplasty was associated with neurological improvement. A proposed 3-variable score could help predict SoT and better allocate scarce rehabilitation resources by warranting an earlier cranioplasty.

scholarly journals Asymmetric optic nerve sheath diameter as an outcome fator following cranioplasty in ‘syndrome of the trephined’ patients

2018 ◽  
Vol 24 (2) ◽  
pp. 113-117
Author(s):  
Antônio Santos De Araújo Junior ◽  
Pedro Alberto Arlani ◽  
Arnaldo Salvestrini Jr. ◽  
Carlos Eduardo Altieri ◽  
Jasper Guimarães Santos ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Rare Complication ◽  
Brain Mri ◽  
Optic Nerve Sheath Diameter ◽  
Optic Nerve Sheath ◽  
Neurological Improvement ◽  
Nerve Sheath ◽  
Neurosurgical Treatment ◽  
Intracranial Pressures ◽  
Syndrome Of The Trephined

Background: Decompressive craniectomy (DC) is gaining an increasing role in the neurosurgical treatment of intractable intracranial hypertension, but not without complications. A rare complication is the “syndrome of the trephined” (ST). It occurs when the forces of gravity overwhelm intracranial pressures, leading the brain to become sunken. Methods: We followed-up 5 patients submitted to DC and diagnosed with ST. All were submitted to brain MRI to calculate the optic nerve sheath diameter (ONSD). Our goal was to determine the usefulness of asymmetric ONSD as an outcome factor after cranioplasty. Results: Only two patients presented an asymmetric ONSD, being ONSD larger at the site of craniectomy. Surprisingly these patients had a marked neurological improvement after cranioplasty. They became independent a week after and statistically earlier than others. Conclusion: It is presumed that the presence of an asymmetric ONSD in trephined patients is an independent factor of good outcome after cranioplasty.

scholarly journals Course Of Post-Infarction Depression Taking Into Account The Time Of Its Once

2020 ◽  
Vol 02 (12) ◽  
pp. 111-117
Author(s):  
Mukhtorova H.K. ◽  
◽  
Mukhamadieva N.B. ◽  
Rustamov U.T. ◽  
◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Depressive Disorders ◽  
Cognitive Disorders ◽  
Affective Component ◽  
Symptoms Of Depression ◽  
Somatic Condition ◽  
Motor Component ◽  
Somatic Status ◽  
Depressive Episodes

A study of 341 patients with an established diagnosis of acute myocardial infarction was carried out. The patients are divided into 2 groups. The first, main, included 233 patients with acute myocardial infarction, who subsequently developed depressive disorders, confirmed clinically and using diagnostic scales; the second group consisted of 108 patients who also had acute myocardial infarction, but did not subsequently suffer from symptoms of depression. Clinical and dynamic observation of patients in the postinfarction period was carried out with control of the condition in a month, three months, six months, 12 months after myocardial infarction. Clinical observation was used to detect the presence of symptoms of depression. Among patients with MI with DS in the first days after MI, more than half (51.1%) reported a permanent decrease in mood more often than other symptoms, i.e. these patients showed an affective component of depression, while the ideator component of depression, which manifested itself in thinking retardation to one degree or another, was in 27.5% of patients, motor retardation (motor component) was detected in 21.5% of those observed. In patients with almost the same frequency, the anxious and melancholic type of affect was noted (47.0% and 41.2%, respectively), the dysphoric type of affect was found in 11.8% of cases, which is 4 times less than anxious and 3.5 times less than the melancholic type. In cases of prolonged depression, the severity of affective disorders more often directly correlated with the severity of the physical condition. If not so long-term depressive episodes were largely due to "their own vision of the disease", the severity of their symptoms depended on the conversation with the doctor and the information received from him, the degree of awareness of his diagnosis, possible complications, and not very much depended on the general somatic status itself. then the course of prolonged depression in patients worsened with the aggravation of the cardiological and general somatic condition of patients. Psychosomatic parallelism in the majority of protracted depressions was manifested by the generalization of asthenic symptom complexes (increased general weakness, intolerance to exertion, lethargy, adynamia, severe daytime sleepiness in combination with early insomnia) with deterioration of the somatic state. At the same time, it was noted that with prolonged depression, there were always more or less pronounced cognitive disorders (reduced memory for past events, limited ability to comprehend what was happening around, remember new information, impaired concentration). Postinfarction depressive episodes lasting up to six months can be attributed to nosogenies; depressive episodes of postinfarction genesis with a protracted course, probably with a high degree of confidence can be attributed to somatogenias.

Dental students' payment for patient treatment

1983 ◽  
Vol 47 (12) ◽  
pp. 774-776
Author(s):  
JF Gardiner ◽  
MM Lee ◽  
BJ Legett ◽  
T Kretchun ◽  
E Herschaft ◽  
...  
Keyword(s):  
Dental Students ◽  
Patient Treatment

Hybrid Telecoaching for Corporate Speech Training and Potential Applications to Clinical Practice

2019 ◽  
Vol 4 (2) ◽  
pp. 322-324
Author(s):  
Thomas F. Burke
Keyword(s):  
Clinical Practice ◽  
Engineering Teams ◽  
Corporate Strategies ◽  
Corporate Speech ◽  
Phone Calls ◽  
Future Clinical Practice ◽  
Fortune 100 ◽  
Potential Applications ◽  
Language Pathology ◽  
Development Engineering

Purpose The purpose of this article was to describe a model for “hybrid speech telecoaching” developed for a Fortune 100 organization and offer a “thought starter” on how clinicians might think of applying these corporate strategies within future clinical practice. Conclusion The author contends in this article that corporate telecommunications and best practices gleaned from software development engineering teams can lend credibility to e-mail, messaging apps, phone calls, or other emerging technology as viable means of hybrid telepractice delivery models and offer ideas about the future of more scalable speech-language pathology services.

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