scholarly journals Management of subdural chronic hematoma in Colombia: national survey

2017 ◽  
Vol 31 (2) ◽  
pp. 197-202
Author(s):  
Marticela Morales-Cabeza ◽  
Amit Agrawal ◽  
Gabriel Alcala-Cerra ◽  
Huber S. Padilla-Zambrano ◽  
Andres M. Rubiano ◽  
...  
Keyword(s):  
Adjuvant Therapy ◽  
Older People ◽  
Chronic Subdural Hematoma ◽  
Central Tendency ◽  
Microsoft Excel ◽  
External Drainage ◽  
Initial Management ◽  
Multiple Choice Items ◽  
Neurological Pathology ◽  
Chronic Hematoma

Abstract Chronic subdural hematoma is a growing neurological pathology, especially in older people. Thus, describing how this entity is approached in Colombia is of great importance because it allows to evaluate and contrast this approach with that of other countries, comparing the techniques used, therapeutic management and additional measures. In this study, this comparison was carried out using a self-administered survey with 16 multiple-choice items. The results were evaluated in Microsoft Excel, determining measures of central tendency accompanied by frequencies and percentages. As an initial management, 75.5% preferred to use 1Burr Hole and, in cases of recurrence, craniotomy is the choice in 50% of cases. Regarding the placement of drainage, its use was estimated to be 83.3%, especially the subdural system closed to external drainage, with a preference of 85.2%, and without use of corticosteroids as adjuvant therapy in 88.9 % of respondents. These data are consistent with the results of studies in other countries regarding the management of this pathology.

scholarly journals Comparative Study of Surgical Outcome of Chronic Subdural Hematoma Treated with and without External Drainage

2020 ◽  
Vol 2 (1) ◽  
pp. 30-34
Author(s):  
Suresh Sapkota ◽  
Kiran Niraula ◽  
Subash Lohani ◽  
Shikher Shrestha ◽  
Bibhusan Shrestha ◽  
...  
Keyword(s):  
Local Anesthesia ◽  
Subdural Hematoma ◽  
Surgical Outcome ◽  
Chronic Subdural Hematoma ◽  
Burr Hole ◽  
Midline Shift ◽  
External Drainage ◽  
Presenting Symptoms ◽  
Number Of Patients ◽  
Significant Difference

Background and purpose: Chronic subdural hematoma (cSDH) poses a significant morbidity and mortality risk particularly in elderly population. It can be treated with simple surgical techniques like burr hole drainage under local anesthesia, however it often recurs after surgical evacuation in significant number of patients. Material and methods: A randomized controlled trial was designed at Mayo Hospital/KEMU in 2013 to 2016. Total number of 98 patients who met the inclusion and exclusion criteria were randomized into ‘with drain’ and ‘without drain’ arm. All of them were treated with burr hole drainage under local anesthesia. Half of them had subdural drain while the remaining half did not. Recurrence of hematoma and surgical outcome was compared. Result: Among 98 patients included in the study(54 males and 44 females) met the inclusion criteria. Mean age of presentation was 63 years ± 12.4 (range 40-100). There was left sided preponderance in hematoma location (53.1%). Mean midline shift was 2.7 mm ± 1.5. Owing to drainage of cSDH, post-operative MRC score of patients along with midline shift in the CT brain showed statistically significant improvement. However, irrespective of insertion of drainage system, there was no significant difference noted in recurrence of cSDH, midline shift and improvement in presenting symptoms (hemiparesis or monoparesis) considering all post-operative days. Conclusion: There is no significant difference in recurrence rate depending on weather a postoperative external drainage is placed or not.

scholarly journals Differential diagnostic problems in elderly chronic subdural hematoma patients

2016 ◽  
Vol 30 (2) ◽  
pp. 195-199
Author(s):  
Valentin Munteanu ◽  
Ionut Luca-Husti ◽  
Teodora Camelia Coman ◽  
Alexandru Vlad Ciurea
Keyword(s):  
Differential Diagnosis ◽  
Older People ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Cognitive Disorders ◽  
Memory Disorders ◽  
Favorable Prognosis ◽  
Brain Ct Scan ◽  
Minor Injuries ◽  
Neurosurgical Intervention

Abstract Chronic subdural hematomas (CSDH) are recognized as common in older people (over 70 years). They are produced in minor injuries (falls on the same level). These CSDH have minor symptoms (headache, memory disorders, balance disorders, cognitive disorders, etc. and are classified as signs for the onset of dementia, circulatory failure - basilar vertebra, Alzheimer, etc. A simple brain CT scan can highlight these hematomas and a neurosurgical intervention will achieve extremely favorable prognosis. There are many pitfalls in the differential diagnosis of CSH especially with strokes being so common at this age.

scholarly journals An Automatic Quantification of the Randomness of Answering Correctly in Taking Traditional Multiple-choice Tests

2018 ◽  
Vol 8 (9) ◽  
pp. 1152
Author(s):  
Qingsong Gu ◽  
Michael W. Schwartz
Keyword(s):  
Multiple Choice ◽  
Choice Test ◽  
Multiple Choice Test ◽  
Microsoft Excel ◽  
Automatic Quantification ◽  
Multiple Choice Tests ◽  
Choice Tests ◽  
Multiple Choice Items ◽  
Passing Score ◽  
Random Guessing

In taking traditional multiple-choice tests, random guessing is unavoidable yet nonnegligible. To uncover the “unfairness” caused by random guessing, this paper designed a Microsoft Excel template with the use of relevant functions to automatically quantify the probability of answering correctly at random, eventually figuring out the least scores a testee should get to pass a traditional multiple-choice test with different probabilities of answering correctly at random and the “luckiness” for passing it. This paper concludes that, although random guessing is nonnegligible, it is unnecessary to remove traditional multiple-choice items from all testing activities, because it can be controlled through changing the passing score and the number of options or reducing its percentage in a test.

Peritoneal drainage of chronic subdural hematomas in older patients

1988 ◽  
Vol 68 (6) ◽  
pp. 908-911 ◽  
Author(s):  
Charles Probst
Keyword(s):  
Older Patients ◽  
Reliable Method ◽  
Chronic Subdural Hematoma ◽  
Major Surgery ◽  
External Drainage ◽  
Shunt System ◽  
Content Type ◽  
Neurological Improvement ◽  
Peritoneal Drainage ◽  
Fine Print

✓ Most patients with chronic subdural hematoma are successfully treated with trephination and external drainage. However, hematomas with thick membranes may persist or recur, needing reoperation or major surgery such as craniotomy with membranectomy. In 14 patients aged over 60 years, internal peritoneal drainage of the hematoma by a low-pressure shunt system proved to be a reliable method of treatment with the following advantages: rapid neurological improvement; immediate postoperative mobilization; little stress for the patient; no recurrence; disappearance of the membranes; and slow and well-tolerated cerebral reexpansion without hypotension. Successful use of this method has been reported previously in children, but not in adults.

scholarly journals Mortality of older patients with dementia after surgery for chronic subdural hematoma: a nationwide study

2020 ◽  
Author(s):  
Pihla Tommiska ◽  
Miikka Korja ◽  
Jari Siironen ◽  
Jaakko Kaprio ◽  
Rahul Raj
Keyword(s):  
Older People ◽  
Subdural Hematoma ◽  
Older Persons ◽  
Significant Risk ◽  
Chronic Subdural Hematoma ◽  
Case Fatality ◽  
Case Control ◽  
Risk Of Death ◽  
People With Dementia ◽  
Diagnosis Of Dementia

Abstract Background dementia is associated with an excess risk of death but mortality after chronic subdural hematoma (CSDH) evacuation in older people with dementia is unknown. We assessed the association between dementia and 1-year case-fatality in older persons undergoing CSDH evacuation. Methods we conducted a nationwide Finnish cohort study including all older persons (≥60 years) undergoing CSDH evacuation during 1997–2014 (referred to as cases). We identified controls, without a diagnosis of CSDH, that were matched for age, sex and year of first hospitalisation with a new dementia diagnosis. We identified cases and controls with a pre-existing diagnosis of dementia. Outcome was 12-month mortality. Mortality was compared in case-only and case–control analyses. Results of 7,621 included cases, 885 (12%) had a pre-existing diagnosis of dementia. The proportion of cases increased from 9.7% in 1997–2002 to 12.2% in 2012–2014 (P = 0.038 for trend). In the case-analysis, dementia independently associated with 1-year case-fatality (dementia vs. no dementia odds ratio [OR] 1.50, 95% confidence interval [CI] 1.26–1.78). Sensitivity analysis suggested the association to be strongest for those 60–69 years old (OR 3.21, 95% CI 1.59–6.47). In the case–control matched analysis, 1-year mortality was 26% in the dementia CSDH surgery group compared to 16% in the dementia non-CSDH controls (P < 0.001). Conclusion dementia is a significant risk factor for 1-year mortality after CSDH surgery in older people. The proportion of older CSDH patients having a pre-existing diagnosis of dementia is increasing. Thus, there is a need for improved evidence regarding the indications and benefits of CSDH evacuation among older persons.

Adjuvant Therapy of Colorectal Cancer in Older People

2013 ◽  
pp. 111-127
Author(s):  
Aimery de Gramont ◽  
Leila Bengrine-Lefevre ◽  
May Mabro ◽  
Elisabeth Carola
Keyword(s):  
Colorectal Cancer ◽  
Adjuvant Therapy ◽  
Older People

Sedimentation level in chronic subdural hematoma visible on computerized tomography

1983 ◽  
Vol 58 (2) ◽  
pp. 246-251 ◽  
Author(s):  
Ming-Chien Kao
Keyword(s):  
Computerized Tomography ◽  
Subdural Hematoma ◽  
Clinical Manifestations ◽  
Chronic Subdural Hematoma ◽  
Ct Scans ◽  
Content Type ◽  
Ct Examination ◽  
History Of ◽  
Chronic Hematoma ◽  
Fine Print

✓ A clear interface dividing subdural hematoma into an upper hypodense and a lower hyperdense part was seen on computerized tomography (CT) scan in seven of 140 patients with chronic subdural hematoma. All except one of the seven patients had a definite history of head trauma more than 1 month before they developed acute disturbances of consciousness and pronounced hemiparesis. Consequently, they remained bed-ridden until they underwent drainage of the subdural hematoma. This group was compared to seven chronic subdural hematoma patients with mild clinical manifestations who were selected and intentionally confined to bed for a period before CT examination and craniotomy. The CT scans in this latter group did not show the clear interface in the subdural hematoma seen in the first group. Based on this study, it is hypothesized that this sedimentation level occurred as a result of rebleeding into a chronic hematoma that was sufficiently old to result in its contents being homogenous prior to the rebleed. In cases of rebleeding, a sufficient period of bed confinement in the brow-up position before CT examination allows development of a gravitational sedimentation in the hematoma. This clear level of sedimentation is seen in only a small portion of patients, but this finding may be specific for a significant amount of rebleeding and may herald acute deterioration.

Current Issues: Advanced Digital Technology for Supervising Graduate Clinicians

2010 ◽  
Vol 20 (1) ◽  
pp. 9-13 ◽  
Author(s):  
Glenn Tellis ◽  
Lori Cimino ◽  
Jennifer Alberti
Keyword(s):  
Real Time ◽  
Digital Technology ◽  
Clinical Training ◽  
State Of The Art ◽  
Clinical Skills ◽  
Slow Motion ◽  
Video Capture ◽  
Microsoft Excel ◽  
Clinical Supervisors ◽  
Training And Supervision

Abstract The purpose of this article is to provide clinical supervisors with information pertaining to state-of-the-art clinic observation technology. We use a novel video-capture technology, the Landro Play Analyzer, to supervise clinical sessions as well as to train students to improve their clinical skills. We can observe four clinical sessions simultaneously from a central observation center. In addition, speech samples can be analyzed in real-time; saved on a CD, DVD, or flash/jump drive; viewed in slow motion; paused; and analyzed with Microsoft Excel. Procedures for applying the technology for clinical training and supervision will be discussed.

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