Management of pediatric brainstem cavernous malformations: experience over 20 years at the Hospital for Sick Children

2009 ◽  
Vol 4 (5) ◽  
pp. 458-464 ◽  
Author(s):  
Ratan D. Bhardwaj ◽  
Kurtis I. Auguste ◽  
Abhaya V. Kulkarni ◽  
Peter B. Dirks ◽  
James M. Drake ◽  
...  
Keyword(s):  
Conservative Management ◽  
Biological Behavior ◽  
Prior History ◽  
Pial Surface ◽  
Cavernous Malformations ◽  
Maximal Diameter ◽  
History Of ◽  
The Mean ◽  
Sick Children ◽  
The Right

Object Because of their location and biological behavior, brainstem cavernous malformations (CMs) pose a formidable clinical challenge to the neurosurgeon. The optimal management of these lesions requires considerable neurosurgical judgment. Accordingly, the authors reviewed their experience with the management of pediatric brainstem CMs at the Hospital for Sick Children. Methods The authors performed a retrospective chart review of pediatric patients who had received diagnoses of a brainstem CM at the Hospital for Sick Children over the past 20 years. Results Twenty patients were diagnosed with brainstem CMs. The mean age at diagnosis was 10.1 ± 5.4 years, and the patients included 13 boys and 7 girls. The mean maximal diameter of the CM was 14.3 ± 11.2 mm. The lesions were evenly distributed on the right and left sides of the brainstem with 4 midbrain, 13 pontine, and 3 medullary lesions. Seven patients underwent surgery for the management of their CMs, with a mean age at presentation of 5.2 years, and a mean CM size of 21.0 mm. Of note from the surgical group, 2 patients had a family history of CMs, 2 lesions were medullary, the CM reached a pial surface in 6 of 7 patients, and 6 of 7 lesions were located on the right side. The mean age at presentation among the 13 patients in the nonsurgical group was 12.7 years, and the mean CM size was 10.6 mm. Seven of these patients had a prior history of radiation for tumor, and only 3 had lesions that reached a pial surface. Conclusions The management of brainstem CMs in children is influenced by multiple factors. The majority of patients received conservative management and tended to be asymptomatic with smaller lesions. Patients with larger lesions and direct pial contact, in whom symptoms arose at a younger age were more likely to undergo surgical management. A history of familial CM was also a predictor for receiving surgical treatment. No patients with a prior history of radiation therapy underwent surgery for CMs. The presence of multiple lesions seemed to have no impact on the type of management chosen. Patients who underwent surgery did suffer morbidity related to the procedure, and tended to improve clinically over time. Conservative management was associated with new deficits arising in children, some of which improved with time. Consideration of many clinical and radiological parameters is thus prudent when managing the care of children with brainstem CMs.

scholarly journals Acute Testicular Torsion in Children: A Tertiary Hospital Experience in a Developing Country

2021 ◽  
Vol 2 (4) ◽  
pp. 01-03
Author(s):  
Chukwubuike Kevin Emeka
Keyword(s):  
Pediatric Surgery ◽  
Testicular Torsion ◽  
Undescended Testis ◽  
Tertiary Hospital ◽  
Prior History ◽  
Testicular Pain ◽  
History Of ◽  
The Mean ◽  
Urological Emergency ◽  
The Right

Background: Testicular torsion is a urological emergency in which there is a race against time to salvage the testis. The aim of this study was to evaluate our experience in the management of children who presented with acute testicular torsion. Materials and Methods: This was a retrospective study of children aged 15 years and below who had surgery for acute testicular torsion between January 2013 and December 2017 at the pediatric surgery unit of a teaching hospital in Enugu, Nigeria. Results: Sixty-four children were managed during the study period. The ages of the patients ranged from 2 months to 14 years with a median of 6 years. The right testis was mostly affected and the mean duration from the onset of symptom to presentation was 4 hours. All the patients presented with testicular pain and half of the patients had a prior history of intermittent testicular pain. Four (6.3%) patients had a history of trauma precipitating the testicular torsion and 3 (4.7%) patients had undescended testis. Detorsion and Orchidopexy was the most performed surgical procedure and wound infection was the most common post-operative complication. There was no mortality. Conclusion: Testicular torsion is not uncommon in children and may be associated with testicular loss. The right testis is mostly involved in children. Prior history of intermittent testicular pain, trauma and undescended testis are important considerations. Prompt detorsion and orchidopexy remains the cornerstone of treatment.

scholarly journals THE USE OF HYDROXYETHYL STARCH 200/0,5 AS PLASMA SUBTITUTES IS SAFE IN HYPOVOLEMIC PATIENTS AS INDICATED IN CHANGES OF N-ACETYL--GLUCOSAMINIDASE AND CREATININ SERUM PARAMETERS

2016 ◽  
Vol 51 (4) ◽  
pp. 228
Author(s):  
Dewi Wara Shinta ◽  
Junaidi Khotib ◽  
Eddy Rahardjo ◽  
Mahardian Rahmadi ◽  
Budi Suprapti
Keyword(s):  
Hydroxyethyl Starch ◽  
Elective Surgery ◽  
Prior History ◽  
Creatinine Ratio ◽  
Urine Creatinine ◽  
Tissue Edema ◽  
History Of ◽  
The Mean ◽  
Baseline Characteristics ◽  
Two Parameters

Hydroxyethyl Starch (HES) is a compound that improves intravascular volume effectively and rapidly without causing tissue edema. However, HES also has renal safety profile which is still being debated. Based on clinical experience in Dr. Soetomo Hospital, the frequency of acute renal failure following HES 200/0.5 administration at a dose of less than 20 ml/kg (maximum dose) is very rare. The purpose of this study was to evaluate the effect of HES 200/0.5 at a dose of less than 20 ml/kg in patients undergoing surgery. N-acetyl-b-D-Glucosaminidase (NAG) per urine creatinine ratio and creatinine serum were used as main parameter to assess renal injury. This research was observational and prospective design in patients undergoing elective surgery at Gedung Bedah Pusat Terpadu, Dr. Soetomo Hospital, who requiring resuscitation therapy with HES 200/0.5 and met the inclusion and exclusion criteria. NAG was measured prior to surgery and 12 hours after administration of fluid therapy, while creatinine serum was observed before surgery and 48 hours after resuscitation. This study was conducted for three months, and obtained 50 subjects divided into 2 groups, crystalloid group and HES 200/0.5 group. Demographic and baseline characteristics did not differ between groups, except the total bleeding volume. Total bleeding in HES 200/0.5group was higher than crystalloid group (p <0.0001). The mean volume of fluid received in HES 200/0.5 group was 2042.0 ± 673.9 mL, higher when compared with that of crystalloid group (910.0 ± 592.0 ml). Doses of HES 200/0.5 received was 8.31 ± 4.86 ml/kg. Measurement of the of NAG/creatinine ratio and creatinine serum showed significant increase in both groups, but still within the normal range. In addition, the value of these two parameters did not differ between groups. In conclusion, HES 200/0.5 in a dose of less than 20 ml/kg is safe to use in patients who suffered from hypovolemic hemorrhage, without prior history of renal impairment.

Rectal carcinoma metastatic to the thyroid gland

1996 ◽  
Vol 110 (2) ◽  
pp. 192-195 ◽  
Author(s):  
Thomas W. Mesko ◽  
Julie Friedman ◽  
Harry Sendzischew ◽  
Daniel D. Nixon
Keyword(s):  
Thyroid Gland ◽  
Rectal Carcinoma ◽  
Secondary Malignancy ◽  
Prior History ◽  
Low Back ◽  
Metastatic Adenocarcinoma ◽  
History Of ◽  
Right Lobe ◽  
The Right ◽  
History Of Cancer

AbstractClinically evident metastases to the thyroid gland are rarely found antemortem. A case of a 59-year-old woman with a history of rectal carcinoma, who presented with low back pain and a mass in the right lobe of her thyroid gland, is presented. The tumour of the thyroid was found to be metastatic adenocarcinoma from her previous rectal cancer. Other synchronous metastases were noted in her lumbar spine and kidneys.The clinical finding of metastases to the thyroid gland is rare, particularly from a colorectal primary. One must consider, however, the possibility of a tumour of the thyroid gland representing a secondary malignancy in any patient with a prior history of cancer.

scholarly journals Resistance to Boscalid Fungicide in Alternaria alternata Isolates from Pistachio in California

Plant Disease ◽  
2007 ◽  
Vol 91 (10) ◽  
pp. 1345-1350 ◽  
Author(s):  
Herve F. Avenot ◽  
Themis J. Michailides
Keyword(s):  
Spore Germination ◽  
Alternaria Alternata ◽  
Hyphal Growth ◽  
Conidial Germination ◽  
Prior History ◽  
In Vitro Tests ◽  
Fitness Parameters ◽  
History Of ◽  
The Mean

Boscalid is a new carboxamide fungicide recently introduced in a mixture with pyraclostrobin in the product Pristine for the control of Alternaria late blight of pistachio. In all, 108 isolates of Alternaria alternata were collected from pistachio orchards with (59 isolates) and without (49 isolates) prior exposure to boscalid. The sensitivity to boscalid was determined in conidial germination assays. The majority of isolates from two orchards without a prior history of boscalid usage had effective fungicide concentration to inhibit 50% of spore germination (EC50) values ranging from 0.089 to 3.435 μg/ml, and the mean EC50 was 1.515 μg/ml. Out of 59 isolates collected from an orchard with a history of boscalid usage, 52 isolates had EC50 values ranging from 0.055 to 4.222 μg/ml, and the mean EC50 was 1.214 μg/ml. However, in vitro tests for conidial germination and mycelial growth also revealed that seven A. alternata isolates, originating from the orchard exposed to boscalid were highly resistant (EC50 > 100 μg/ml) to this fungicide. Furthermore, in vitro tests showed no significant differences between wild-type and boscalid-resistant mutants in some fitness parameters such as spore germination, hyphal growth, sporulation, or virulence on pistachio leaves. Experiments on the stability of the boscalid-resistant phenotype showed no reduction of the resistance after the mutants were grown on fungicide-free medium. Preventative applications of a commercial formulation of boscalid (Endura) at a concentration which is effective against naturally sensitive isolates failed to control disease caused by the boscalid-resistant isolates in laboratory tests. To our knowledge, this is first report of field isolates of fungi resistant to boscalid.

Saltation and suspension trajectories of solid grains in a water stream

1977 ◽  
Vol 284 (1321) ◽  
pp. 225-254 ◽  
Keyword(s):  
Velocity Gradient ◽  
High Speed ◽  
Prior History ◽  
Water Stream ◽  
The Past ◽  
The Coefficient Of Friction ◽  
Conservation Of Momentum ◽  
History Of ◽  
The Mean ◽  
Exposure Technique

This paper continues the investigation of the motion of solitary grains in a water stream, reported by Francis (1973)- The trajectories of solid grains are photographed by a multi-exposure technique as they are propelled by water streams along the bed of a laboratory channel. Many thousands of photographs were taken and analysed to determine the positions, velocities and accelerations of the grain. The technique does not take into account the possible effect, in multi-grain transport, of intergranular collisions. The three different modes of transport of grains were all observed — rolling, saltation and suspension, and the proportion of each found for a variety of transport stage w*/w*0. The development of suspension is much less rapid than the development of saltation from rolling, but even at the highest stage used, about 3.0, there is still a small amount of rolling. The trajectory dimensions and geometry are shown in relation to the stage which uniquely determines the geometry. Experiments where the grain is suddenly entrained from a stationary position show that several features of the subsequent trajectory are the same as those of a trajectory with a prior history of movement: thus it is inferred that the start of a trajectory is by way of hydrodynamic forces rather than by the conservation of momentum of previous trajectories. Impacts and trajectories were analysed for the coefficient of friction tan cc and for the height of the effective thrust. While tan a is shown to be rather larger than has been suspected in the past, the variation of yn throws light upon predominance of slow fluid near the bed rather than high speed inrushes of fast fluid. Better information is now available for finding the mean forward speed of grains compared to that presented in the earlier paper. There are grounds for believing the existence of a * shear-drift ’ force on grains when they are in a velocity gradient, giving a force opposing gravity: but there is no evidence of a proximity effect of the bed independent of the velocity gradient.

scholarly journals Cytomorphologic findings of SMARCA4-deficient thoracic sarcoma/carcinoma: Report of two cases

2021 ◽  
Vol 156 (Supplement_1) ◽  
pp. S39-S39
Author(s):  
A K Abu-Salah ◽  
S Segura ◽  
H M Cramer
Keyword(s):  
Tumor Cells ◽  
Single Cells ◽  
Main Pulmonary Artery ◽  
Prior History ◽  
Napsin A ◽  
Complex Deficiency ◽  
History Of ◽  
Mitotic Figures ◽  
The Right ◽  
Age Range

Abstract Introduction/Objective SMARCA4-deficient thoracic sarcoma/carcinoma is a highly aggressive neoplasm characterized by SMARCA4 (chromatin remodeling complex) deficiency. It affects mostly smokers (85%) with a broad age range of presentation (mean age: 50 years). Most patients present with advanced disease and extensive involvement of thoracic structures. The cytomorphologic features of this entity have not been fully described. Methods/Case Report A 59-year-old female, former smoker, with a prior history of lung adenocarcinoma, presented with a new 2.8 cm right infrahilar nodule concerning for recurrence. The second patient, a 54-year-old male who is a smoker, presented with an 8.0 cm right perihilar mass extending into the right lung and mediastinum with encasement of the right main pulmonary artery. Cytologically, the smears from both aspirates were comprised of single cells and loosely cohesive clusters of ovoid to spindle cells with scant to moderate cytoplasm, stippled chromatin, and focally prominent nucleoli. Numerous mitotic figures were appreciated. Necrosis was present within the smear background. The cell block sections showed tumor cells arranged in glandular and focal papillary architecture with a myxoid background. In one case, intermediate to large-sized cells with focal cytoplasmic clearing and patchy extracellular metachromatic material were also noted. Rhabdoid morphology was not appreciated. Immunohistochemically, the tumor cells were at least focally positive for vimentin, TLE-1, SALL4, CK AE1/AE3 and TTF-1, while being negative for CK7, CK20, Napsin-A, SOX-10, p40 and neuroendocrine markers. Both tumors showed SMARCA4 (BRG1) loss of expression. Results (if a Case Study enter NA) N/A Conclusion While the cytomorphologic findings of SMARCA4-deficient thoracic sarcomas/carcinomas are not specific, the FNA diagnosis should be considered for any poorly differentiated neoplasm involving the lungs or mediastinum which should prompt an appropriate immunocytochemical work-up that includes SMARCA4/BRG1 assessment

scholarly journals Angioarchitecture of the coronary arteries in Mazama gouazoubira (G. Fischer, 1814)

2021 ◽  
Vol 15 (4) ◽  
pp. 297-303
Author(s):  
Milena Sorban Zaniboni ◽  
Wilson Viotto-Souza ◽  
Drielly Gomes Assis Samora ◽  
Fernanda Coelho Simas Bernardes ◽  
André Luiz Quagliatto Santos ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Left Coronary Artery ◽  
South American ◽  
Myocardial Bridges ◽  
History Of ◽  
The Mean ◽  
Mazama Gouazoubira ◽  
The Right ◽  
South American Continent ◽  
Coronary Dominance

Mazama gouazoubira is a widely distributed deer in the South American continent. However, studies on its anatomical characteristics are still scarce. The objective of this study was to elucidate the coronary circulation of M. gouazoubira. With this aim, after collecting cadavers on highways, twenty-four hearts injected with latex and preserved in formaldehyde at 10% were dissected. The dissections revealed that all specimens presented left coronary dominance, characterized by the origin of the subsinuous interventricular branch from the circumflex branch of the left coronary artery. The number of ventricular branches originated from branches of the left coronary artery was approximately five times higher than that of the right coronary artery. The occurrence of myocardial bridges was registered in 91.7% of the individuals, with bridges predominating over the paraconal interventricular branch. The mean length of the paraconal interventricular sulcus was significantly higher in males (p = 0.02). The number of atrial branches and ventricular branches, length of myocardial bridges and length of subsinuous interventricular sulcus did not vary significantly between sex. Left coronary dominance and high frequency of myocardial bridges in M. gouazoubira are preponderant anatomical traits also present in different species of Ruminantia suborder. Coronary dominance studies in other South American deer species may confirm the correlation of this trait with the evolutionary history of these animals.

Balamuthia mandrillaris Meningoencephalitis in an Immunocompetent Patient: An Unusual Clinical Course and a Favorable Outcome

2004 ◽  
Vol 128 (4) ◽  
pp. 466-468 ◽  
Author(s):  
Sungmi Jung ◽  
Robert L. Schelper ◽  
Govinda S. Visvesvara ◽  
Howard T. Chang
Keyword(s):  
Clinical Course ◽  
Immunocompetent Patient ◽  
Favorable Outcome ◽  
Prior History ◽  
Neurological Sequelae ◽  
Early States ◽  
Balamuthia Mandrillaris ◽  
History Of ◽  
Combination Antibiotics ◽  
The Right

Abstract Balamuthia mandrillaris meningoencephalitis is a rare but often fatal infection; only 2 survivors have been reported to date worldwide. We report the case of an apparently immunocompetent patient (72-year-old woman) who developed several episodes of seizures without prior history of respiratory or skin infections. Magnetic resonance imaging with contrast revealed 2 ring-enhancing lesions, one in the right precentral region and the other in the left posterotemporal region. Open biopsy revealed Balamuthia encephalitis. The patient was treated with combination antibiotics (pentamidine, 300 mg intravenously once a day; sulfadiazine, 1.5 g 4 times a day; fluconazole, 400 mg once a day; and clarithromycin, 500 mg 3 times a day) and was discharged home. There have been no significant neurological sequelae at this writing (6 months after biopsy). We present this case with unusual clinical course to raise awareness of this infectious disease, which may have a more favorable outcome if diagnosed and treated in its early states.

Immunogenicity of Subcutaneous Versus Intramuscular Oka/Merck Varicella Vaccination in Healthy Children

PEDIATRICS ◽  
1991 ◽  
Vol 88 (3) ◽  
pp. 604-607
Author(s):  
Penelope H. Dennehy ◽  
Keith S. Reisinger ◽  
Mark M. Blatter ◽  
Barbara A. Veloudis
Keyword(s):  
Geometric Mean ◽  
Varicella Vaccine ◽  
Varicella Vaccination ◽  
Prior History ◽  
Healthy Children ◽  
Geometric Mean Titer ◽  
Clinical Events ◽  
History Of ◽  
The Mean ◽  
To Receive

To compare the immunogenicity and safety of varicella vaccine by either subcutaneous or intramuscular injection, 166 healthy children aged 12 months to 10 years old who had no prior history of varicella were enrolled from two pediatric practices and randomly assigned to receive 0.5 mL of a single lot of varicella vaccine. Sera from the day of and 6 weeks postvaccination were tested for varicella antibody by gpELISA. Parents recorded clinical events occurring in the 6 weeks following vaccination. In the 132 evaluable children, the mean prevaccination titer was 0.3 gpELISA units for both groups. Sixty-three (97%) of the 65 receiving varicella vaccine by the subcutaneous route seroconverted compared with 67 (100%) of 67 immunized intramuscularly. Postvaccination geometric mean titer in the subcutaneous group was 6.9 ± 7.0 gpELISA units and did not differ significantly from the geometric mean titer of 10.5 ± 4.4 in the intramuscular group. Varicella vaccine was generally well tolerated by either route; 21% of both groups complained of reactions at the injection site and 7% had a varicella-like rash. Although varicella vaccine is recommended to be given subcutaneously, the results of this study indicate that inadvertent intramuscular administration of varicella vaccine is not reason for revaccination.

scholarly journals Frontal plane knee alignment among normal northern Nigerian adults: A radiographic study

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Abdullahi Suleiman Gwani ◽  
Eduitem Sunday Otong ◽  
Sani Abubakar Bello ◽  
Hamza Mustapha Ahmed ◽  
Dlama Zira Joseph ◽  
...  
Keyword(s):  
Frontal Plane ◽  
Equal Weight ◽  
Knee Alignment ◽  
Male Population ◽  
Female Population ◽  
Significant Difference ◽  
History Of ◽  
The Mean ◽  
Mean Differences ◽  
The Right

Studies have shown that knee alignment parameters differ among races. However, to our knowledge, radiographic frontal plane knee alignment has not been studied in normal northern Nigerian adults. The objective of this study was therefore to determine the frontal plane knee alignment in normal northern Nigerian adults. This study recruited a total of 59 consented subjects (44 males, 15 females). The entire subjects are without any history of lower extremity deformity. Anteroposterior radiographs of both knees with the patella positioned straight ahead were obtained from each participant while standing in a relaxed bipedal stance and placing equal weight on each limb. Alignment was assessed by measuring the tibiofemoral angle (TFA), distal femoral angle (DFA) and proximal tibial angle (PTA). The angles were measured with the aid of a universal plastic goniometre and a plastic ruler. Descriptive statistics of the alignment parameters, independent and paired t-test were computed. In the male population, the mean (standard deviation) obtained were 179.06 (3.87)o for the TFA, 85.94 (3.03 o for the DFA and 89.27 (3.26)o for the PTA. In the female population, the values were 179.53 (3.38)o for the TFA, 86.40 (2.97)o for the DFA and 89.27 (2.15)o for the PTA. No significant mean difference was observed between genders in all the parameters. The TFA does not show any significant difference between the right and left angle regardless of gender. However, significant mean differences were observed in the DFA and PTA of males and combined population. No significant difference was observed in the DFA and PTA of females. Accordingly, northern Nigerian adults may have varus knee alignment compared to other races. Thus, this pre-existing varus alignment should be taken into consideration during clinical examination, preoperative planning and postoperative evaluations of knee deformities in this population.

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