scholarly journals Incidence and management of subdural hematoma/hygroma with variable- and fixed-pressure differential valves: a randomized, controlled study of programmable compared with conventional valves

1999 ◽  
Vol 7 (4) ◽  
pp. E8 ◽  
Author(s):  
Peter W. Carmel ◽  
A. Leland Albright ◽  
P. David Adelson ◽  
Alexa Canady ◽  
Peter Black ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Subdural Hematoma ◽  
Control Valve ◽  
Treatment Modalities ◽  
Controlled Study ◽  
Opening Pressure ◽  
Programmable Valve ◽  
Significant Difference ◽  
Fluid Collections ◽  
Programmable Valves

Shunt systems with differential pressure valves are prone to the complications of overdrainage. A programmable valve permits adjustment of the opening pressure of the valve. In this paper the authors report the incidence of subdural fluid collections in a randomized trial of programmable compared with conventional valves, and they describe methodologies used in management of this complication. A multiinstitutional, prospective, randomized trial of the Codman Hakim programmable valve and conventional fixed-pressure valves was undertaken. Two classes were defined: “new” and “replacement” valves. Randomization of the type of valve in each group was performed at each study site. Clinical and radiological studies were required at fixed intervals over a 104-week period. All complications were reported. The experimental valves were required to be reprogrammed after magnetic resonance imaging studies, but all other decisions regarding pressure setting were left to each investigator. Three hundred seventy-seven patients were randomized; 194 were treated with a programmable valve and 183 with a fixed-pressure valve. The two groups were statistically similar in demographic composition, as were the “new” and “replacement” categories. The investigators made 540 valve pressure changes (five per patient; range one-41 changes). More than half of the reprogramming adjustments were made in the first 3 months postplacement; 70% were made within 6 months. More than half of all reprogramming adjustments were required in a group of 30 patients. Four treatment modalities were observed: 1) 30% of the fluid collections resolved spontaneously (25% in the patients with programmable valves and 36.3% in those with conventional valves) and were largely found to be hygromas in infants and children; 2) four subdural fluid collections were unresolved and under observation; 3) the subdural hematoma was drained and the shunt removed (in 8.3% of patients with the programmable valve and 36.3% of those with the control valve); 4) the pressure of programmable valve was raised in 58% of patients (seven of 12), and this increase in opening pressure was a feature used by investigators to affect treatment. There was no significant difference in the incidence of subdural fluid collections between the programmable and fixed-pressure valve treatment groups. The programmable feature provided a considerable advantage in treatment when subdural collections occurred.

scholarly journals Chronic subdural hematoma treatment with adjustment of programmable valve in idiopathic normal pressure hydrocephalus patient: a case report

2014 ◽  
Vol 33 (02) ◽  
pp. 139-141
Author(s):  
Matheus Fernandes de Oliveira ◽  
Rodolfo Casimiro Reis ◽  
Fernando Campos Gomes Pinto ◽  
José Marcus Rotta
Keyword(s):  
Cerebrospinal Fluid ◽  
Normal Pressure Hydrocephalus ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Benign Condition ◽  
Programmable Valve ◽  
Programmable Valves ◽  
Normal Pressure Hydrocephalus Patient

AbstractChronic subdural hematoma (CSDH) is a common entity in daily neurosurgical practice. It is considered a benign condition. Idiopathic normal pressure hydrocephalus (INPH) is characterized by gait disturbance, dementia and/or urinary incontinence added to dilation of ventricular system due to disturbance of cerebrospinal fluid (CSF) circulation with normal CSF pressure. We describe an experience of a conservative treatment of subdural hematoma based in the physiopathology and ability to control the pressure in programmable valves. The adjustment of programmable valves in the treatment of INPH allow us the therapeutic control of hydrocephalus and an important tool to manage complications, especially overshunting and undershunting.

scholarly journals Efficacy and safety of iontophoresis combined sodium salicylate in acquired plantar keratoderma-a randomized controlled study

2021 ◽  
Vol 8 (1) ◽  
pp. 101
Author(s):  
Shreya P. Somani ◽  
Bhavsh N. Astik ◽  
Hita H. Mehta ◽  
Milan D. Jhavar
Keyword(s):  
Sodium Salicylate ◽  
Randomized Controlled Study ◽  
Treatment Modalities ◽  
Controlled Study ◽  
Mean Values ◽  
Randomized Controlled ◽  
Number Of Patients ◽  
Significant Difference ◽  
Group A ◽  
Group B

<p><strong>Background</strong>: Palmoplantar keratoderma is a heterogenous group of disorders, hereditary or acquired, characterized by thickening of palms and soles. Though it is not a life-threatening condition, it affects individual’s quality of life. As treatment of keratoderma has always been troublesome, upgraded treatment modalities which improves keratoderma efficiently are always encouraged.</p><p><strong>Methods</strong>: In this randomized controlled study, patients of plantar keratoderma of age group of 18-65 years were randomly divided in group A and group B. In group A, iontophoresis combined sodium salicylate was offered to patients twice weekly for 8 weeks of duration, during which DC current was supplied at 5-15 mA for 10 min of duration. Whereas, in group B patients applied topical salicylic acid 12% ointment at home twice a day for 8 weeks.</p><p><strong>Results</strong>: Our study of 70 patients of keratoderma, revealed diffuse (94%) pattern of involvement with female preponderance (55.7%) and occupation wise, most common among laborers (54.2%) followed by housewives (27.1%). Statistically significant number of patients showed reduction in severity grading of parameters, in both groups at end of 8 weeks. Same way, mean values of parameter grading significantly reduced at 8 weeks in both the groups. But intergroup values showed no significant difference. Mean EASI (Eczema Area Severity Index) score showed statistically significant reduction in group B as compared to group A at 8<sup>th</sup> week. Percentage of reduction of EASI score was also significantly higher in group B at end of treatment.</p><p><strong>Conclusions:</strong> Here both treatment modalities are safe and effective, topical being slightly more efficacious than iontophoresis. So, we can conclude that no additional privilege of drug delivery through iontophoresis.</p>

scholarly journals The prognostic and diagnostic significance of the neutrophil-to-lymphocyte ratio in hepatocellular carcinoma: a prospective controlled study

2021 ◽  
Author(s):  
Philip J. Johnson ◽  
Sofi Dhanaraj ◽  
Sarah Berhane ◽  
Laura Bonnett ◽  
Yuk Ting Ma
Keyword(s):  
Hepatocellular Carcinoma ◽  
Regression Analysis ◽  
Prognostic Factor ◽  
Cox Regression ◽  
Prognostic Models ◽  
Controlled Study ◽  
Cox Regression Analysis ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Significant Difference

Abstract Background The neutrophil–lymphocyte ratio (NLR), a presumed measure of the balance between neutrophil-associated pro-tumour inflammation and lymphocyte-dependent antitumour immune function, has been suggested as a prognostic factor for several cancers, including hepatocellular carcinoma (HCC). Methods In this study, a prospectively accrued cohort of 781 patients (493 HCC and 288 chronic liver disease (CLD) without HCC) were followed-up for more than 6 years. NLR levels between HCC and CLD patients were compared, and the effect of baseline NLR on overall survival amongst HCC patients was assessed via multivariable Cox regression analysis. Results On entry into the study (‘baseline’), there was no clinically significant difference in the NLR values between CLD and HCC patients. Amongst HCC patients, NLR levels closest to last visit/death were significantly higher compared to baseline. Multivariable Cox regression analysis showed that NLR was an independent prognostic factor, even after adjustment for the HCC stage. Conclusion NLR is a significant independent factor influencing survival in HCC patients, hence offering an additional dimension in prognostic models.

Impact of Treatment on Vestibular Schwannoma–Associated Symptoms: A Prospective Study Comparing Treatment Modalities

2021 ◽  
pp. 019459982098656
Author(s):  
Jason H. Barnes ◽  
Neil S. Patel ◽  
Christine M. Lohse ◽  
Nicole M. Tombers ◽  
Michael J. Link ◽  
...  
Keyword(s):  
Vestibular Schwannoma ◽  
Median Number ◽  
Treatment Modalities ◽  
Baseline Survey ◽  
Limited Attention ◽  
Subjective Symptoms ◽  
Prospective Survey ◽  
Significant Difference ◽  
Associated Symptoms ◽  
A Prospective Study

Objective The degree to which various treatment modalities modify vestibular schwannoma (VS)–associated symptoms has received limited attention. The purpose of this study was to determine how different treatment modalities affect subjective symptoms in those presenting with VS. Study Design Prospective survey. Setting Tertiary neurotology referral center. Methods Patients with sporadic VS who received treatment at our institution were prospectively surveyed with a VS symptom questionnaire. Those who completed a baseline survey prior to treatment and at least 1 posttreatment survey were included. The prospective survey evaluated the severity of self-reported symptoms (Likert scale, 1-10), including tinnitus, dizziness or imbalance, headaches, and hearing loss. Results A total of 244 patients were included (mean age, 57 years). The mean duration of follow-up was 2.1 years, and the median number of surveys completed was 2 (interquartile range, 1-3). Seventy-eight (32%) cases were managed with observation, 118 (48%) with microsurgery, and 48 (20%) with radiosurgery. Multivariable analyses revealed no statistically significant difference in the change in tinnitus ( P = .15), dizziness or imbalance ( P = 0.66), or headaches ( P = .24) among treatment groups. Evaluation of clinically important differences demonstrated that microsurgery leads to significant bidirectional changes in headaches. Conclusions Limited prospective data exist regarding the progression or resolution of subjective symptoms in those presenting with VS. This study suggests that tinnitus, dizziness or imbalance, and headaches are unlikely to be significantly modified by treatment modality and generally should not be used to direct treatment choice.

scholarly journals In vitro testing of explanted shunt valves in hydrocephalic patients with suspected valve malfunction

2021 ◽  
Author(s):  
Christoph Bettag ◽  
Christian von der Brelie ◽  
Florian Baptist Freimann ◽  
Ulrich-Wilhelm Thomale ◽  
Veit Rohde ◽  
...  
Keyword(s):  
Flow Rate ◽  
Clinical Symptoms ◽  
Obstructive Hydrocephalus ◽  
Flow Characteristics ◽  
Normal Pressure ◽  
Diagnostic Tools ◽  
Programmable Valve ◽  
Significant Difference ◽  
Valve Malfunction

AbstractDiagnosis of symptomatic valve malfunction in hydrocephalic patients treated with VP-Shunt (VPS) might be difficult. Clinical symptoms such as headache or nausea are nonspecific, hence cerebrospinal fluid (CSF) over- or underdrainage can only be suspected but not proven. Knowledge concerning valve malfunction is still limited. We aim to provide data on the flow characteristics of explanted shunt valves in patients with suspected valve malfunction. An in vitro shunt laboratory setup was used to analyze the explanted valves under conditions similar to those in an implanted VPS. The differential pressure (DP) of the valve was adjusted stepwise to 20, 10, 6, and 4 cmH2O. The flow rate of the explanted and the regular flow rate of an identical reference valve were evaluated at the respective DPs. Twelve valves of different types (Codman CertasPlus valve n = 3, Miethke Shuntassistant valve n = 4, Codman Hakim programmable valve n = 3, DP component of Miethke proGAV 2.0 valve n = 2) from eight hydrocephalic patients (four male), in whom valve malfunction was assumed between 2016 and 2017, were replaced with a new valve. Four patients suffered from idiopathic normal pressure (iNPH), three patients from malresorptive and one patient from obstructive hydrocephalus. Post-hoc analysis revealed a significant difference (p < 0.001) of the flow rate between each explanted valve and their corresponding reference valve, at each DP. In all patients, significant alterations of flow rates were demonstrated, verifying a valve malfunction, which could not be objectified by the diagnostic tools used in the clinical routine. In cases with obscure clinical VPS insufficiency, valve deficiency should be considered.

A randomized trial of levamisole versus placebo as adjuvant therapy in malignant melanoma.

1991 ◽  
Vol 9 (5) ◽  
pp. 736-740 ◽  
Author(s):  
L E Spitler
Keyword(s):  
Malignant Melanoma ◽  
Adjuvant Therapy ◽  
Randomized Trial ◽  
Control Groups ◽  
Disease Free Interval ◽  
Significant Difference ◽  
Long Term Follow Up ◽  
And Control

We conducted a long-term follow-up (median, 10.5 years) of patients included in a randomized trial of levamisole versus placebo as surgical adjuvant therapy in 203 patients with malignant melanoma. Of the patients randomized, 104 received levamisole, and 99 received placebo. The results show that there is no difference between the treatment and control groups with regard to any of the three end points analyzed. These included disease-free interval, time to appearance of visceral metastasis, and survival. Moreover, there was no significant difference between the treatment and control groups after adjusting for age, sex, or stage of disease.

scholarly journals Effects of Surface Protein Adsorption on the Distribution and Retention of Intratumorally Administered Gold Nanoparticles

Pharmaceutics ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 216
Author(s):  
Rossana Terracciano ◽  
Aobo Zhang ◽  
E. Brian Butler ◽  
Danilo Demarchi ◽  
Jason H. Hafner ◽  
...  
Keyword(s):  
Treatment Modalities ◽  
Emission Spectrometry ◽  
Limiting Factor ◽  
High Resolution Computed Tomography ◽  
Quantitative Ct ◽  
Heterogeneous Distribution ◽  
Significant Difference ◽  
Intratumoral Distribution

The heterogeneous distribution of delivery or treatment modalities within the tumor mass is a crucial limiting factor for a vast range of theranostic applications. Understanding the interactions between a nanomaterial and the tumor microenvironment will help to overcome challenges associated with tumor heterogeneity, as well as the clinical translation of nanotheranostic materials. This study aims to evaluate the influence of protein surface adsorption on gold nanoparticle (GNP) biodistribution using high-resolution computed tomography (CT) preclinical imaging in C57BL/6 mice harboring Lewis lung carcinoma (LLC) tumors. LLC provides a valuable model for study due to its highly heterogenous nature, which makes drug delivery to the tumor challenging. By controlling the adsorption of proteins on the GNP surface, we hypothesize that we can influence the intratumoral distribution pattern and particle retention. We performed an in vitro study to evaluate the uptake of GNPs by LLC cells and an in vivo study to assess and quantify the GNP biodistribution by injecting concentrated GNPs citrate-stabilized or passivated with bovine serum albumin (BSA) intratumorally into LLC solid tumors. Quantitative CT and inductively coupled plasma optical emission spectrometry (ICP-OES) results both confirm the presence of particles in the tumor 9 days post-injection (n = 8 mice/group). A significant difference is highlighted between citrate-GNP and BSA-GNP groups (** p < 0.005, Tukey’s multiple comparisons test), confirming that the protein corona of GNPs modifies intratumoral distribution and retention of the particles. In conclusion, our investigations show that the surface passivation of GNPs influences the mechanism of cellular uptake and intratumoral distribution in vivo, highlighting the spatial heterogeneity of the solid tumor.

Exploring the Impact of Interaction Modality on Students’ Learning Performance

2021 ◽  
pp. 073563312110272
Author(s):  
Neila Chettaoui ◽  
Ayman Atia ◽  
Med Salim Bouhlel
Keyword(s):  
User Interfaces ◽  
Teaching Method ◽  
Learning Performance ◽  
Controlled Study ◽  
Embodied Interaction ◽  
Multimodal Learning ◽  
Tangible User Interfaces ◽  
Embodied Learning ◽  
Significant Difference ◽  
The Impact

Embodied learning pedagogy highlights the interconnections between the brain, body, and the concrete environment. As a teaching method, it provides means of engaging the physical body in multimodal learning experiences to develop the students’ cognitive process. Based on this perspective, several research studies introduced different interaction modalities to support the implementation of an embodied learning environment. One such case is the use of tangible user interfaces and motion-based technologies. This paper evaluates the impacts of motion-based, tangible-based, and multimodal interaction merging between tangible interfaces and motion-based technology on improving students’ learning performance. A controlled study was performed at a primary school with 36 participants (aged 7 to 9), to evaluate the educational potential of embodied interaction modalities compared to tablet-based learning. The results highlighted a significant difference in the learning gains between all groups, as determined by one-way ANOVA [F (3,32) = 6.32, p = .017], in favor of the multimodal learning interface. Findings revealed that a multimodal learning interface supporting richer embodied interaction that took advantage of affording the power of body movements and manipulation of physical objects might improve students’ understanding of abstract concepts in educational contexts.

scholarly journals THU0521 EVALUATION OF LIVER FIBROSIS IN PATIENTS WITH RHEUMATOID ARTHRITIS UNDER METHOTREXATE TREATMENT. UTILITY OF FIBROSCAN AND BIOMARKERS IN ROUTINE CLINICAL PRACTICE.

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 499.2-500
Author(s):  
A. De Diego Sola ◽  
M. Vaamonde Lorenzo ◽  
A. Castiella Eguzkiza ◽  
M. J. Sánchez Iturri ◽  
N. Alcorta Lorenzo ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Metabolic Syndrome ◽  
Liver Fibrosis ◽  
Controlled Study ◽  
Type I ◽  
Concomitant Treatment ◽  
Duration Of Treatment ◽  
Significant Difference ◽  
Apri Score ◽  
The Mean

Background:Despite therapeutic advances in recent years, methotrexate (MTX) remains the gold standard for the treatment of rheumatoid arthritis (RA). Among the side effects that have been blamed on it are liver fibrosis (LF) and cirrhosis, although late studies have failed to show such a relation1,2. The only validated test in the diagnosis of LF is biopsy. Given the relevance of MTX in the treatment of RA, it is important to evaluate non-invasive diagnostic options for LF such as transitional elastography (FibroScan, FS).Objectives:To evaluate the percentage of LF in RA patients treated with MTX. Secondly, to assess the correlation between altered liver function, RA activity, and LF. To determine whether dose and/or duration of treatment with MTX may affect the development of LF in such patients.Methods:We did a prospective study between February 2019 and January 2020. Patients affected of RA treated with MTX were included. Patients with basal liver disease (hepatitis B, hepatitis C and steatohepatitis), alcohol consumption, type I diabetes mellitus, chronic renal failure, heart failure, obesity and concomitant treatment with leflunomide or antiretrovirals were excluded. Demographic, clinical, analytical and therapeutic variables were collected. Liver fibrosis was assessed by FS in kilopascals (kpa) and using the APRI score. RA activity was assessed by DAS28 score. Continuous variables are described with mean and standard deviation (SD), and qualitative variables are shown with absolute value and percentage. Spearman’s and Mann-Whitney’s U tests were used for the bivariate analysis.Results:Fifty patients were included (Table 1 and 2). Of these, 38 were women (76%) with mean age of 61.8 years (SD 11.7) and mean RA evolution time of 13.7 years (SD 8.2). The mean DAS28 at the visit was 2.39 (SD 1.1). The FS showed an average of 4.8 kpa (SD 2). The mean duration of treatment with MTX was 85.8 months (SD 93.3) and that of AD-MTX was 5414.6mg (SD 5011). Patients were divided into those with DA-MTX greater than 4000mg (21, 42%) and less than 4000mg (29, 58%) and no significant differences were found in terms of LF in FS (p 0.637) or APRI scale (p 0.806). No significant differences were found in terms of treatment duration either. Six patients (12%) had elevated aspartate aminotransferase (AST) and 9 (18%) had elevated alanine aminotransferase (ALT). No significant difference was found in FS values in relation to ALT, but it was with elevated AST (p 0.021). Similarly, differences were found in APRI based on AST (p 0.045). Metabolic syndrome was collected in 4 patients (8%) without significant differences with FS or APRI values. There were no significant differences in LF depending on gamma-glutamyl transpeptidase (GGT) values.Conclusion:FS and APRI score are useful for the determination of LF in RA patients treated with MTX. There is no evidence of a relationship between AD-MTX and LF by FS or APRI. AST values may be related to the presence of fibrosis as determined by FS or APRI. and the presence of the metabolic syndrome are not.References:[1]G.L. Erre, et al. Methotrexate therapy is not associated with increased liver stiffness and significant liver fibrosis in rheumatoid arthritis patients: A cross-sectional controlled study with real-time two-dimensional shear wave elastography. European Journal of Internal Medicine 69 (2019) 57–63. Internet.[2]R. Conway et al. Risk of liver injury among methotrexate users: a meta-analysis of randomised controlled trials. Semin Arthritis Rheum 2015 Oct;45(2):156–62. Internet.Disclosure of Interests:None declared

The Percutaneous Surgical Approach for Repairing Acute Achilles Tendon Rupture

2010 ◽  
Vol 100 (4) ◽  
pp. 270-275 ◽  
Author(s):  
Shay Tenenbaum ◽  
Niv Dreiangel ◽  
Ayal Segal ◽  
Amir Herman ◽  
Amnon Israeli ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Demographic Data ◽  
Achilles Tendon Rupture ◽  
Treatment Modalities ◽  
Main Concern ◽  
Complication Rates ◽  
Percutaneous Surgery ◽  
Significant Difference ◽  
The Mean

Background: Treatment modalities for acute Achilles tendon rupture can be divided into operative and nonoperative. The main concern with nonoperative treatment is the high incidence of repeated ruptures; operative treatment is associated with risk of infection, sural nerve injury, and wound-healing sequelae. We assessed our experience with a percutaneous operative approach for treating acute Achilles tendon rupture. Methods: The outcomes of percutaneous surgery in 29 patients (25 men; age range, 24–58 years) who underwent percutaneous surgery for Achilles tendon rupture between 1997 and 2004 were retrospectively evaluated. Their demographic data, subjective and objective evaluation findings, and isokinetic evaluation results were retrieved, and they were assessed with the modified Boyden score and the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale. Results: All 29 patients demonstrated good functional outcome, with no- to mild-limitations in recreational activities and high patient satisfaction. Mean follow-up was 31.8 months. Changes in ankle range of motion in the operated leg were minimal. Strength and power testing revealed a significant difference at 90°/sec for plantarflexion power between the injured and healthy legs but no difference at 30° and 240°/sec or in dorsiflexion. The mean modified Boyden score was 74.3, and the mean Ankle-Hindfoot Scale score was 94.5. Conclusions: Percutaneous surgery for Achilles tendon rupture is easily executed and has excellent functional results and low complication rates. It is an appealing alternative to either nonoperative or open surgery treatments. (J Am Podiatr Med Assoc 100(4): 270–275, 2010)

Sign in / Sign up

Export Citation Format

Share Document