scholarly journals Is jugular bulb stenosis in vein of Galen aneurysmal malformation associated with bony remodeling of the jugular foramina?

2016 ◽  
Vol 18 (1) ◽  
pp. 92-96
Author(s):  
Guillaume Saliou ◽  
Peter Dirks ◽  
Lee-Anne Slater ◽  
Timo Krings
Keyword(s):  
Jugular Vein ◽  
Jugular Foramen ◽  
Jugular Bulb ◽  
Age Group ◽  
Vein Of Galen ◽  
Male Predominance ◽  
Surgical Bypass ◽  
History Of ◽  
Sick Children

OBJECTIVE The etiology of jugular bulb stenosis (JBS) or occlusion in the context of vein of Galen aneurysmal malformations (VGAMs) is unknown. It can lead to decompensation of a lesion that was previously clinically stable. The aim of this study was to describe the natural history of JBS or occlusion in VGAM and to determine whether there is an association with bony remodeling of the jugular foramina. METHODS The authors identified all cases of JBS greater than 70% bilaterally involving patients seen at The Hospital for Sick Children between January 2007 and June 2014. The foramen diameters were measured on sagittal CT imaging, on a slice passing at the level of the jugular vein. The jugular foramen diameters were also compared to measurements obtained in a matched population of the same age group who had no VGAM and had undergone cerebral CT for a reason other than vascular disease. RESULTS Eight patients (6 male and 2 female) with bilateral JBS were included in this series. The median duration of clinical follow-up was 2.5 years (IQR 1.7–4.2 years). JBS was associated with bony narrowing the jugular foramina in 7 of the 8 patients over time. Between 1 and 2 years of age, patients with a VGAM demonstrated jugular foramen narrowing in comparison with a matched population (p = 0.015). CONCLUSIONS Jugular bulb stenosis or occlusion in VGAM may be associated with narrowing of the jugular foramina. These conditions seem to have a male predominance. If treatment is required, bony narrowing of the jugular foramina should be taken into account when deciding whether angioplasty and stent placement or surgical bypass might be appropriate therapeutic options.

scholarly journals A Prospective Study on Changes in Nutritional Status and Growth Following Two Years of Ketogenic Diet (KD) Therapy in Children with Refractory Epilepsy

Nutrients ◽  
2019 ◽  
Vol 11 (7) ◽  
pp. 1596 ◽  
Author(s):  
Marisa Armeno ◽  
Antonella Verini ◽  
Mariana del Pino ◽  
Maria Beatriz Araujo ◽  
Graciela Mestre ◽  
...  
Keyword(s):  
Nutritional Status ◽  
Prospective Study ◽  
Ketogenic Diet ◽  
Refractory Epilepsy ◽  
Growth Monitoring ◽  
Male Predominance ◽  
History Of ◽  
A Prospective Study ◽  
Growth Deceleration

Introduction: Epilepsy is a neurological disorder characterized by an increased susceptibility to seizures. The ketogenic diet (KD) is currently the most important alternative non-pharmacological treatment. Despite its long history of clinical use, it is not clear how this diet affects longitudinal growth in children. Methods: A prospective study was designed to evaluate growth and nutritional status in 45 children on KD. Growth was assessed by measuring weight, height, and body mass index (BMI). Standard deviation scores (SDS) were calculated for all measurement parameters at KD initiation and at a two-year follow-up. Results: Overall, 45 patients who completed 24 months on KD were enrolled. Median age was 6.6 years (0.8 to 17.3), with a male predominance (n = 23); 74% of the 45 patients were responders on seizure reduction at three months; 26% of patients were non-responders. In our study, using −1 SDS as a cut-off point, growth deceleration was observed in 9% (n: 4) of the patients; however, the nutritional status was maintained or even improved. No correlation with age, sex, or ambulatory status was found. Conclusions: The nutritional follow-up of these patients was helpful to improve overweight and thinness but could not avoid growth deceleration in some of them. These findings confirm that children with refractory epilepsy on KD treatment require careful growth monitoring.

scholarly journals Virological and Clinical Outcome of DAA Containing Regimens in a Cohort of Patients in Calabria Region (Southern Italy)

Medicina ◽  
2020 ◽  
Vol 56 (3) ◽  
pp. 101
Author(s):  
Vincenzo Scaglione ◽  
Maria Mazzitelli ◽  
Chiara Costa ◽  
Vincenzo Pisani ◽  
Giuseppe Greco ◽  
...  
Keyword(s):  
Southern Italy ◽  
Liver Stiffness ◽  
Age Group ◽  
Intention To Treat ◽  
Liver Decompensation ◽  
End Of Treatment ◽  
History Of ◽  
Lost To Follow Up ◽  
Treat Analysis

Background and objectives: In Italy, Hepatitis C Virus (HCV) infections are most prevalent in people older than 50 years of age, who often experience multi-morbidities, take co-medications, and have a long history of liver disease. These characteristics could potentially affect tolerability of HCV treatments and adherence in this subgroup. After achievement of sustained virological response (SVR), retention into care is very important both to detect the onset of possible complications and prevent further infections. In this study, SVR rates and retention into care of patients treated with directly acting antivirals (DAAs) of a single-center cohort in Southern Italy were evaluated. Materials and Methods: Patients treated with directly acting antivirals from 2014 to 2018 were included. Patients were stratified by age (i.e., <65 vs. ≥65 years) and by cirrhosis presence (i.e., liver stiffness >14.6 KPa or clinical/ultrasound cirrhosis vs. absence of these criteria). Primary outcome was availability of SVR at Weeks 12–24 after the end of treatment. Inter- and intra-group comparisons were performed along the follow-up for significant laboratory parameters. Results: In total, 212 patients were treated; 184 (87%) obtained SVR after the first treatment course and 4 patients after retreatment. Twenty-two (10.4%) patients were lost to follow-up before assessment of SVR, and two patients died before the end of treatment for liver decompensation. Considering only the first treatment episode, per protocol analysis (i.e., excluding patients lost to follow-up) showed the following rates of SVR: 97% (overall), 97% (older age group), 96% (age group <65 years), 94% (cirrhotics), and 100% (non-cirrhotics). By contrast, at the intention to treat analysis (i.e., patients lost were computed as failures), SVR percentages were significantly lower for patients <65 years of age (80%) and for non-cirrhotics (85%). Conclusions: High rates of SVR were obtained. However, younger patients and those without cirrhosis displayed an apparent high risk of being lost to follow-up. This may have important implications: since those who are lost may transmit HCV in case SVR is not achieved, these subpopulations should receive appropriate counselling during treatment.

Risk factors of colorectal adenoma recurrence among individuals under 50 years of age compared to those 50 years of age or older.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 1554-1554
Author(s):  
Christine Louise Sardo Molmenti ◽  
Jingyan Yang ◽  
Cynthia A Thomson ◽  
Elizabeth A Hibler ◽  
Gloria Ho ◽  
...  
Keyword(s):  
Risk Factors ◽  
Colorectal Adenoma ◽  
Colorectal Adenomas ◽  
Age Group ◽  
Current Smoking ◽  
Adenoma Recurrence ◽  
Younger Age ◽  
History Of ◽  
Colorectal Adenoma Recurrence

1554 Background: Colorectal cancer incidence and mortality are increasing among individuals < 50 years of age. Data are limited regarding the epidemiology of colorectal adenomas in this younger age group. This study investigated and compared risk factors associated with recurrence of adenomas in individuals under and over 50 years of age. Methods: Pooled analyses from the Wheat Bran Fiber and Ursodeoxycholic Acid phase III, randomized, controlled clinical trials included 1,623 participants, aged 40-80 years. Each completed baseline questionnaires related to family history and lifestyle habits, had one or more colorectal adenomas removed at baseline, and had a follow-up colonoscopy during the trial (mean follow up 36 months). Univariate and multivariate logistic regression modeling estimated the association between age and colorectal adenoma recurrence, and evaluate multiple risk factors, while controlling for confounding factors. Results: A statistically significant increased trend was found for colorectal adenoma recurrence with increasing age ( Ptrend= < 0.001). Multivariate logistic regression revealed that risk factors significantly associated with adenoma recurrence in the ≥50 age group (n = 1,523) included history of previous polyps, characteristics of adenomas removed at baseline (multiple adenomas and villous feature), current smoking, and an increased waist circumference. Although risk profile in the < 50 age group (n = 95) shared similarities with that in the ≥50 age group (e.g., current smoking), there were a few notable differences: history of previous polyps was a more prominent predictor for recurrence for the < 50 (OR< 50 = 4.76 and OR≥50 = 1.33, Pinteraction = 0.042), whereas baseline characteristics of adenomas were more important for the ≥50 (multiple adenomas: OR< 50 = 0.40 and OR≥50 = 2.28, Pinteraction = 0.043). Conclusions: Predisposition to colorectal adenoma is a more important risk factor for recurrence in the < 50 as compared to the ≥50. Future studies need to identify susceptibility factors contributing to the increasing incidence of colorectal cancer in this younger age group.

scholarly journals Prevalence of Hepatitis B and C among Tuberculosis Patients at Local Community of Sindh, Pakistan

2021 ◽  
Vol 15 (7) ◽  
pp. 1794-1797
Author(s):  
Khalil Ahmed Memon ◽  
M. Khan ◽  
Sarah Azhar ◽  
Jai Kershan ◽  
Partab Puri ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Hepatitis B ◽  
Urban Areas ◽  
Local Community ◽  
Age Group ◽  
Tuberculosis Patients ◽  
Key Words Hepatitis ◽  
History Of ◽  
N 93

Objective: To assess the prevalence rate of Hepatitis B and C among those patients who had tuberculosis in local community of Sindh, Pakistan. Study Design:Survey-based study Place and Duration of Study: Department of Pathology, Liaquat University of Medical & health Sciences Jamshoro from 1stJanuary 2020 to 31stDecember 2020. Methodology: Five hundred and eighty nine confirmed cases of tuberculosis patients were enrolled. The patients were further analyzed to assess either HBV, HCV or both are present or absent. Results: Three hundred and forty one (57.8%) were males and 248 (42.1%) were females. The majority of participants were in the age group of 45-54 years 147 (24.9%).The residence detail showed that 167 (28.3%) belonged to urban areas. Further 143 (24.2%) had sickness history of 2-6 months, 239 (40.5%) had history of 6-12 months, The prevalence of hepatitis B and C among tuberculosis patients showed, 17.8% (n=105) with Hepatitis B, 26.3% (n=155) were diagnosed with hepatitis C, 15.7% (n=93) had Both Hepatitis B and C, however 236 (40.0%) had no history with hepatitis. Hepatitis C was most frequently found age of above 54 years, 55 (9.3%). Conclusion:The control of tuberculosis has remained one of the greatest goals globally till date, the higher risk of liver complications, along with the Hepatitis B and Hepatitis C. Although the complications of Tuberculosis patients remain unsolved yet the possible efforts can be made to identify the earlier problems for the clinical prospective and a complete follow up of the records can optimize the management of Tuberculosis in co-existing conditions of hepatitis B and C. Key Words: Hepatitis B, Hepatitis C, Tuberculosis, Liver diseases

scholarly journals Neck Swelling in A Child: Now You See it, Now You Don’t?

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Ikram Hakim ◽  
Goh Bee See ◽  
Hamzaini Abd Hamid
Keyword(s):  
Early Diagnosis ◽  
Doppler Ultrasonography ◽  
Jugular Vein ◽  
Valsalva Maneuver ◽  
Focal Lesion ◽  
Neck Swelling ◽  
Left Internal Jugular Vein ◽  
History Of ◽  
The Right

Jugular Ectasia is a rare benign swelling due to dilatation of jugular vein, which can occur in the internal, external or an anterior jugular vein. It is characterized by painless, soft, compressible unilateral swelling appeared on Valsalva maneuver. A 3-year-old boy presented with 2 months history of prominent mass over the right side of the neck on Valsalva maneuver is subjected to Doppler ultrasonography (USG) of the neck. Doppler Ultrasonography (USG) of the neck revealed prominent right jugular dilatation during Valsalva without any focal lesion with the normal caliber of the left internal jugular vein. Jugular ectasia should be included in the differentials of a benign neck swelling in children despite infrequently encountered. Dilated jugular vein on ultrasound Doppler on Valsalva maneuver is pathognomic of jugular ectasia. Early diagnosis with serial follow up can reduce parent’s anxiety and will reduce complications.

Variations in the Structure of the Jugular Foramen of Human Skull

2013 ◽  
Vol 10 (2) ◽  
pp. 45-49 ◽  
Author(s):  
SM Akram Hossain ◽  
SM Moshadeq Hossain ◽  
Fakhrul Amin Mohammad Hasanul Banna
Keyword(s):  
Internal Jugular Vein ◽  
Jugular Vein ◽  
Jugular Foramen ◽  
Jugular Bulb ◽  
Cross Sectional ◽  
Medical College ◽  
Geographical Variations ◽  
Pass Through ◽  
The Right ◽  
Study Type

Context: The jugular foramen is one of the most fascinating foramen present at the base of the skull attracting the imagination of many Anatomists worldwide as many important structures pass through it, and amongst them the intriguing structure is the internal jugular vein. The shape and size of the jugular foramen is related to the size of the internal jugular vein and the presence or absence of a prominent superior bulb. As most of the textbooks of Anatomy describe that the right jugular foramen is usually larger than the left jugular foramen. Henceforth the present study was undertaken in 55 skulls from the dept. of Anatomy. Measurements were taken with the help of sliding vernier caliper. Study type: Cross-sectional descriptive type. Place and period of study: Department of Anatomy, Rajshahi Medical College, Rajshahi and Pabna Medical College, Pabna from April 2010 to June 2011. Materials and Methods: Total fifty five (55) human adult skulls were collected from the Anatomy department of Rajshahi Medical College, Rajshahi and Pabna Medical College, Pabna at different times of the study period. The study was conducted to observe variations in the structure of the jugular foramen of the human’s skull. Result: Out of 55 skulls (110 foramina) studied, the presence of dome indicating the presence of jugular bulb was found bilaterally in 100% of cases. 58.18% of cases showed that the size of right foramina were larger than the left foramina whereas 20% of cases showed that right foramina were equal to the left and in 21.82% of cases the left foramina were larger than the right side foramina. An important observation in the present study was the presence of either complete or partial septation in the jugular foramen. Conclusion: The findings of the study reveals that there are some differences among some parameters. The variations are might be due to the geographical variations of the skeletons. It needs further study with larger sample size from different geographical areas of Bangladesh. DOI: http://dx.doi.org/10.3329/bja.v10i2.17281 Bangladesh Journal of Anatomy, July 2012, Vol. 10 No. 2 pp 45-49

Management of Jugular Bulb Stenosis in Pediatric Vein of Galen Malformation: A Novel Management Paradigm

2021 ◽  
Vol 56 (6) ◽  
pp. 584-590
Author(s):  
Gaurav Gupta ◽  
Michael S. Rallo ◽  
David Y. Goldrich ◽  
Vinayak Narayan ◽  
Neil Majmundar ◽  
...  
Keyword(s):  
Jugular Foramen ◽  
Jugular Bulb ◽  
Venous Hypertension ◽  
Cerebral Injury ◽  
Vein Of Galen ◽  
Microsurgical Decompression ◽  
Venous Stenosis ◽  
Initial Reduction ◽  
Treatment Paradigm ◽  
Angioplasty And Stenting

<b><i>Introduction:</i></b> Pediatric vein of Galen malformations (VOGMs) are fistulous intracranial malformations arising congenitally within the choroidal fissure that can present with an array of neurological and cardiac sequelae. Associated venous stenosis may result in intracranial venous hypertension and ischemia leading to severe, irreversible cerebral injury. Management of neonatal VOGMs typically involves staged embolization and angioplasty/stenting for relief of venous stenosis. Rarely, jugular foraminal narrowing has been identified as causing jugular bulb stenosis. <b><i>Case Presentation:</i></b> We present the case of a 22-month-old female diagnosed with VOGM prenatally who displayed persistent intracranial venous hypertension despite multiple neuroembolization procedures during the neonatal period. Following initial reduction in arteriovenous shunting, she once again developed venous hypertension secondary to jugular bulb stenosis for which angioplasty was attempted. Failure of angioplasty to relieve the venous hypertension prompted skull base imaging, which revealed jugular foraminal ossification and stenosis. Microsurgical jugular foraminotomy followed by balloon angioplasty and stenting significantly reduced jugular pressure gradients. Restenosis requiring re-stenting developed postoperatively at 9 months, but the patient has remained stable with significant improvement in cortical venous congestion. <b><i>Discussion/Conclusion:</i></b> This case demonstrates the efficacy of microsurgical decompression of the jugular foramen and endovascular angioplasty/stenting as a novel treatment paradigm for the management of intracranial venous hypertension in the setting of VOGM.

The Implications of Increasing Age on Erectile Dysfunction

2012 ◽  
Vol 6 (4) ◽  
pp. 273-279 ◽  
Author(s):  
Kamal C. Wagle ◽  
Maurita H. Carrejo ◽  
Robert S. Tan
Keyword(s):  
Erectile Dysfunction ◽  
Well Being ◽  
Older Men ◽  
Age Group ◽  
Self Administration ◽  
Waiting Room ◽  
Penile Artery ◽  
Younger Men ◽  
History Of

Erectile dysfunction (ED) has long been correlated with psychological well-being. More recently, an understanding has developed of ED being, in some cases, a vascular condition of the penile artery. Given the narrowness of the penile artery, a small amount of atherosclerosis may result in ED before any other manifestations are evident, making ED a useful marker for other vascular conditions with potentially greater clinical implications. In light of this, possible underreporting of ED takes on added significance. A questionnaire regarding ED prevalence and management was distributed for self-administration to men in the waiting room of primary care clinics; the data were analyzed with a focus on the relationship between ED and age. The study had a remarkable response rate of >95%. The prevalence of ED in the ≥70-year age-group was 77%, compared with 61% in the 40- to 69-year age-group ( p = .0001). ED correlated linearly with age ( R2 = .80, p < .0001). Among those who had ED, more than half had not discussed it with any provider; the likelihood of discussing ED did increase with the reported severity of symptoms ( p < .0001). Older men had more severe ED than younger men ( p < .0001). Furthermore, 72% of men with a history of ED were never treated. Younger men were more likely to be treated than older men ( p = .004). Given the potential implications of underreporting ED, and the willingness of the men in this study to complete the questionnaire, further work may be merited on new models for ED assessment and follow-up.

scholarly journals Gross Total Resection of a Jugular Foramen Thyroid Medullary Metastasis via a Transjugular Transsigmoid Approach

2018 ◽  
Vol 79 (S 05) ◽  
pp. S424-S425
Author(s):  
Ilhan Aydin ◽  
Sima Sayyahmelli ◽  
Mark Pyle ◽  
Mustafa Baskaya
Keyword(s):  
Surgical Resection ◽  
Jugular Foramen ◽  
Jugular Bulb ◽  
Magnetic Resonance Images ◽  
Sigmoid Sinus ◽  
Gross Total Resection ◽  
Histopathological Diagnosis ◽  
Total Resection ◽  
Lower Cranial Nerve

Surgical resection of jugular foramen tumors poses a significant challenge to skull base surgeons with the selection of an appropriate surgical approach, a matter of some debate. Jugular foramen metastatic tumors may mimic paragangliomas, and in some selected cases surgical resection is needed. In this video, we demonstrate the microsurgical gross total resection of a jugular foramen tumor via a postauricular trans-jugular trans-sigmoid approach. The patient is a 61-year-old man with a 7-year history of medullary thyroid cancer, who underwent three neck operations and radiation to the neck. He developed lower cranial nerve palsies (IX, X, and XI) with preoperative aspiration deficits, dysphonia, status post phonosurgery for vocal cord paralysis, profound sensorineural hearing loss, and muscle atrophy of the left shoulder. He initially received stereotactic radiation of the jugular foramen tumor at an outside hospital without histopathological diagnosis. Follow-up magnetic resonance images (MRIs) showed progressive enlargement of the tumor over the postradiation year. The decision was made to resect this tumor to enable histopathological diagnosis, and to provide local tumor control, since his primary disease has been stable. He underwent microsurgical gross total resection via a transjugular transsigmoid approach. After skeletonizing the sigmoid sinus and jugular bulb, the sigmoid sinus was ligated and rolled toward the jugular bulb, where the major part of the tumor was. Then, using the transjugular route, the tumor was removed en bloc. The surgery and postoperative course were uneventful. The histopathology was a thyroid medullary cancer metastasis. He was followed with serial MRIs, and there was no recurrent tumor at 2 years follow-up. In this video, microsurgical techniques and important steps for the resection of a jugular foramen metastatic tumor are demonstrated.The link to the video can be found at: https://youtu.be/oXC6fX2CC84.

scholarly journals Age-specific incidence of injury-related hospital contact after release from prison: a prospective data-linkage study

2019 ◽  
Vol 26 (3) ◽  
pp. 204-214
Author(s):  
Jesse T Young ◽  
Rohan Borschmann ◽  
David B Preen ◽  
Matthew J Spittal ◽  
Lisa Brophy ◽  
...  
Keyword(s):  
Mental Illness ◽  
Early Adulthood ◽  
Injury Rate ◽  
Age Difference ◽  
Age Group ◽  
Risk Of Injury ◽  
Increased Risk ◽  
History Of ◽  
Hospital Contact

BackgroundIn population studies, the risk of injury declines after early adulthood. It is unclear if a similar age difference in the risk of injury exists among people released from prison.MethodsPrerelease survey data collected between 1 August 2008 and 31 July 2010, from a representative cohort of sentenced adults (≥18 years) in Queensland, Australia, were linked prospectively and retrospectively to person-level emergency department, inpatient hospital and correctional records. To ascertain predictors of injury-related hospital contact, we fit a multivariate Andersen-Gill model and tested the interactions between age group (<25 years, ≥25 years) and each variable.ResultsIn 1307 adults released from prison, there were 3804 person-years of follow-up. The crude injury rate was 385 (95% CI 364 to 407) per 1000 person-years and did not differ according to age group. Factors associated with increased injury-related hospital contact included a history of mental illness, preincarceration injury, a history of incarceration, release from a short prison sentence (<90 days), being reincarcerated during follow-up and identifying as Indigenous. The effect of mental illness, risky alcohol use, prior incarceration and intellectual disability differed across age group and predicted increased risk of injury among people aged ≥25 years compared with their counterparts without these characteristics.ConclusionsUnlike in the general population where the risk of injury declines with age, older adults released from prison are at similar risk compared with their younger peers. Adults released from prison with mental illness, a history of injury-related hospital contact and who identify as Indigenous are particularly indicated groups for injury prevention.

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