Intracerebral pneumocephalus and hemiparesis as a complication of a halo vest in a patient with multiple myeloma

2004 ◽  
Vol 100 (4) ◽  
pp. 367-371 ◽  
Author(s):  
Yasushi Hashimoto ◽  
Minoru Doita ◽  
Keiichiro Hasuda ◽  
Kazuyoshi Korosue
Keyword(s):  
Multiple Myeloma ◽  
Parietal Lobe ◽  
Late Onset ◽  
Term Treatment ◽  
Short Term Treatment ◽  
Halo Vest ◽  
Content Type ◽  
Increased Risk ◽  
Pin Site ◽  
The Right

✓ A halo orthosis is often used to immobilize the cervical spine after severe injury in patients who cannot tolerate surgery. Although complications such as pin loosening or brain abscess have been reported, there are no reported cases of hemiparesis following pneumocephalus associated with halo use. The authors report the case of a 77-year-old man with multiple myeloma who, after undergoing halo vest therapy and chemotherapy, suddenly developed hemiparesis and speech disturbance. Diagnostic neuroimaging demonstrated penetration of the inner table at the right posterior pin site and intracerebral pneumocephalus at the parietal lobe. Intraoperative inspection revealed only air and no purulent materials or cerebrospinal fluid in the cystic lesion. When a halo device is used, attention to detail in pin application, maintenance, and proper pin-site care must be undertaken to minimize complications. The tightening of the pin in cases in which late-onset loosening has occurred should not be performed. Additionally, because late loosening of the pin and pin-site infection increase the risks of complications, a halo vest should be used only as a short-term treatment, and the clinician should be aware of the possible increased risk of serious complications such as pneumocephalus or subdural abscess formation.

Possible significance of juvenile oral venous angioma as marker of intracerebral vascular lesion

1983 ◽  
Vol 59 (2) ◽  
pp. 348-350 ◽  
Author(s):  
Henryk Majchrzak ◽  
Tadeusz Wencel ◽  
Grazyna Bierzyńska-Macyszyn ◽  
Janina Bielska
Keyword(s):  
Early Life ◽  
Parietal Lobe ◽  
Vascular Lesion ◽  
Venous Angioma ◽  
Lower Lip ◽  
Content Type ◽  
Arteriovenous Angioma ◽  
Cerebral Angioma ◽  
The Right ◽  
Fine Print

✓ This 10-year-old child suffered a hemorrhage into the right parietal lobe, the result of a ruptured arteriovenous angioma. From birth, the boy had a venous angioma of the mucous membrane of the cheek, lower lip, and hypoglossal area on the right side. The coexistence of these two vascular defects is most unusual, and venous angioma in early life may suggest the presence of cerebral angioma.

The effect of nimodipine on intracranial pressure

1987 ◽  
Vol 67 (3) ◽  
pp. 387-393 ◽  
Author(s):  
Mark N. Hadley ◽  
Robert F. Spetzler ◽  
Mary S. Fifield ◽  
William D. Bichard ◽  
John A. Hodak
Keyword(s):  
Blood Pressure ◽  
Intracranial Pressure ◽  
Systemic Blood Pressure ◽  
Artery Occlusion ◽  
Content Type ◽  
Arterial Blood ◽  
Increased Risk ◽  
Before And After ◽  
The Right ◽  
Cerebral Artery Occlusion

✓ Nimodipine was administered by intravenous infusion to six male baboons before, during, and after 6 hours of middle cerebral artery occlusion. Intracranial pressure (ICP) and systemic blood pressure were monitored continuously. An epidural balloon was inflated at regular intervals at three levels of arterial CO2 tension (25, 35, and 50 mm Hg) before and after the administration of nimodipine, and volume-pressure curves were generated. In every case, curves generated after intravenous nimodipine infusion were lower and shifted more to the right than the same set of curves generated before nimodipine administration, regardless of the baseline ICP. The reduction in ICP following nimodipine infusion was not due to a reduction in mean arterial blood pressure and was statistically significant at all three levels of pCO2 (p < 0.01). These results suggest that, in the presence of elevated ICP due to cerebral infarction, there is no increased risk of exacerbating intracranial hypertension with the addition of nimodipine.

scholarly journals Effectiveness of a Short-Term Treatment of Oxygen-Ozone Therapy into Healing in a Posttraumatic Wound

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Irene Degli Agosti ◽  
Elena Ginelli ◽  
Bruno Mazzacane ◽  
Gabriella Peroni ◽  
Sandra Bianco ◽  
...  
Keyword(s):  
Oxygen Free Radicals ◽  
Antibacterial Properties ◽  
Term Treatment ◽  
Ozone Therapy ◽  
Short Term ◽  
Short Term Treatment ◽  
Case Presentation ◽  
Appropriate Treatment ◽  
The Right ◽  
Free Radicals Scavenging

Introduction. A number of studies suggest that oxygen-ozone therapy may have a role in the treatment of chronic, nonhealing, or ischemic wounds for its disinfectant and antibacterial properties. Nonhealing wounds are a significant cause of morbidity. Here we present a case of subcutaneous oxygen-ozone therapy used to treat a nonhealing postoperative wound in a young man during a period of 5 weeks.Case Presentation. A 46-year-old man had a motorcycle accident and underwent amputation of the right tibia and fibula. At the discharge he came to our attention to start rehabilitation treatment. At that time the wound was ulcerated but it was afebrile with no signs of inflammation and negativity to blood tests. At 2 months from the trauma despite appropriate treatment and dressing, the wound was slowly improving and the patient complained of pain. For this reason in addition to standard dressing he underwent oxygen-ozone therapy. After 5 weeks of treatment the wound had healed.Conclusion. In patients with nonhealing wounds, oxygen-ozone therapy could be helpful in speeding the healing and reducing the pain thanks to its disinfectant property and by the increase of endogenous oxygen free radicals’ scavenging properties. Compared to standard dressing and other treatments reported in the literature it showed a shorter time of action.

scholarly journals Pharmacological Approaches to Controlling Cardiometabolic Risk in Women with PCOS

2020 ◽  
Vol 21 (24) ◽  
pp. 9554
Author(s):  
Andrea Cignarella ◽  
Roberto Mioni ◽  
Chiara Sabbadin ◽  
Francesca Dassie ◽  
Matteo Parolin ◽  
...  
Keyword(s):  
Cardiometabolic Risk ◽  
Polycystic Ovary ◽  
Density Lipoprotein ◽  
Hdl Cholesterol ◽  
Later Life ◽  
Term Treatment ◽  
Hypoglycemic Agents ◽  
Short Term Treatment ◽  
Aldosterone Antagonists ◽  
Increased Risk

Polycystic ovary syndrome (PCOS) is characterized by elevated androgen production and subclinical changes in cardiovascular and metabolic risk markers. Total cholesterol, high-density lipoprotein (HDL) cholesterol, fasting glucose, and fasting insulin appear to increase specifically in PCOS compared with fertile women. PCOS also confers an increased risk of cardiometabolic disease in later life. Novel biomarkers such as serum’s cholesterol efflux capacity and blood-derived macrophage activation profile may assist in more accurately defining the cardiometabolic risk profile in these women. Aldosterone antagonists, androgen receptor antagonists, 5α-reductase inhibitors, and synthetic progestogens are used to reduce hyperandrogenism. Because increased insulin secretion enhances ovarian androgen production, short-term treatment with metformin and other hypoglycemic agents results in significant weight loss, favorable metabolic changes, and testosterone reduction. The naturally occurring inositols display insulin-sensitizing effects and may be also used in this context because of their safety profile. Combined oral contraceptives represent the drug of choice for correction of androgen-related symptoms. Overall, PCOS management remains focused on specific targets including assessment and treatment of cardiometabolic risk, according to disease phenotypes. While new options are adding to established therapeutic approaches, a sometimes difficult balance between efficacy and safety of available medications has to be found in individual women.

Treatment of Probable Vogt-Koyanagi-Harada with Single Intravitreal Triamcinolone Acetonide

2020 ◽  
Author(s):  
Meghana Kalavar ◽  
Nimesh A Patel ◽  
Hasenin Al-Khersan ◽  
Anibal Ale ◽  
Nicolas A Yannuzzi ◽  
...  
Keyword(s):  
Triamcinolone Acetonide ◽  
Subretinal Fluid ◽  
Term Treatment ◽  
Short Term Treatment ◽  
Intravitreal Triamcinolone ◽  
Full Field ◽  
Intravitreal Triamcinolone Acetonide ◽  
Ocular Manifestations ◽  
History Of ◽  
The Right

Abstract Background A 36-year-old woman with a history of poorly controlled diabetes was diagnosed with probable Vogt-Koyanagi-Harada (VKH). We are reporting the use of intravitreal triamcinolone acetonide (0.4 mg) to both eyes to successfully treat the ocular manifestations of VKH.Findings Nine days after injection, subretinal fluid in the right eye improved and 13 days later, the serous detachment had almost completely resolved. One month after injections, both the right and left eye showed decreased leakage and fewer punctate lesions on fluorescein angiography. Ocular examination remained stable other than development of ocular hypertension bilaterally, which was treated with topical hypertensive drops. Two years later, patient developed a cataract in the right eye, for which the patient underwent phacoemulsification. Three years after treatment, visual acuity remains 20/20 while imaging studies and bilateral full field electroretinogram remained normal.Conclusion Intravitreal steroids can be considered as treatment in VKH in situations where systemic corticosteroids are contraindicated, such as patients with a history of poorly controlled diabetes. Complications of local steroids need to be carefully considered, even after a single injection. In some patients short-term treatment of VKH with local corticosteroid may result in long-term visual stability.

National risk assessment – the Croatian features

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Sonja Cindori
Keyword(s):  
Risk Assessment ◽  
Money Laundering ◽  
Financial Sector ◽  
International Standards ◽  
Due Diligence ◽  
Content Type ◽  
Increased Risk ◽  
Beneficial Ownership ◽  
Inductive Methods ◽  
The Right

Purpose The purpose of this paper is to present the risk of the non-financial sector in Croatia concerning the threats of money laundering through the prism of national and supranational risk assessment. In addition to a brief overview of the financial sector, the specifics of the non-financial sector have been highlighted. This paper aims to emphasize the peculiarities of the non-financial sector, focusing on the consequences of arbitrary application on the right to professional secrecy and independence. Design/methodology/approach Specifics of the national risk assessment in Croatia have been analyzed using deductive and inductive methods. To provide an overview of the non-financial sector, the risk assessment at the supranational level has been discussed and compared with the national one. Particular attention has been paid to the areas of increased risk. Findings The effectiveness of risk assessment depends on several factors such as the characteristic of the sector being observed, the specifics of each profession or business, changes at the level of awareness-raising and efficient and coherent supervision. Most deficiencies were observed in the area of beneficial ownership identification, conducting due diligence, awareness of the risk exposure and permanent education. Originality/value By recognizing the risk profile faced by the non-financial sector, this paper seeks to point out their role as “Gatekeepers” that is far from being negligible. By analyzing the risk of money laundering in Croatia, the tendencies of harmonization with international standards are pointed out along with the occurrences indicated by the practice.

Abstract 15082: Repolarization Vulnerability is Rarely Observed in COVID-19 Patients With Low Comorbidity Treated With a Combination of Hydroxychloroquine Azithromycin

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
David E Goldgrab ◽  
Sokol Kalaveshi ◽  
Ruifang Yang ◽  
Mauricio Gomez ◽  
Jearim Craig ◽  
...  
Keyword(s):  
Torsades De Pointes ◽  
Term Treatment ◽  
Chronic Obstructive ◽  
Healthy Population ◽  
Close Monitoring ◽  
Qtc Interval ◽  
Short Term Treatment ◽  
Obstructive Pulmonary Disease ◽  
Artery Disease ◽  
The Right

Background: Global pandemic of COVID-19 has attracted a number of proposed treatment therapies. Hydroxychloroquine/Azithromycin (HA) combination has been reported to potentially affect repolarization by prolonging the QTc and causing torsades de pointes (TdP). Methods: We prospectively followed hospitalized patients with PCR confirmed COVID-19. Hydroxychloroquine was administered 400mg twice daily on day 1 and daily for the last 4 days plus daily Azithromycin 250mg. QTc interval was measured via 12 lead ECG prior to initiation of therapy, 3 hours post second dose of hydroxychloroquine, and subsequent daily QTc evaluation via telemetry. Potassium and magnesium were checked daily and replaced accordingly. QTc prolonging medications were discontinued when possible. Results: Sixteen patients were followed for 5 days, 56% were male with average age of 67. Comorbidities were 31% coronary artery disease, 31% diabetes mellitus, 13% congestive heart failure, 69% hypertension, 19% chronic obstructive pulmonary disease, 25% atrial fibrillation, and average BMI of 29. Average Tisdale score was 11/21. Mean QTc prior to HA therapy was 442 ms, 3 hours post second dose 429 ms and on day 5 was 441 ms with a change of (-)3ms compared to prior starting therapy as seen in figures below. Fifteen patients recovered and 1 patient expired. Twenty five percent of patients required ET intubation and mechanical ventilation. Zero patients required stopping of HA therapy. Only 1 patient required 2 extra days of QTc monitoring due to 5th day QTc being 504ms. Conclusion In acutely infected COVID-19 patients with limited comorbidities, repolarization/risk for TdP appears to be low in the presence of HA. With close monitoring and the right patient population, this combination therapy for short term treatment appears to be safe in regards to QTc and the risk for TdP. Although larger published studies have shown repolarization risk, we did not find that to be the case in our relatively healthy population.

Impact Of Novel Agents To The Additional-Chromosomal Abnormalities In Patients With Multiple Myeloma

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 3225-3225
Author(s):  
Kenshi Suzuki ◽  
Yu Abe ◽  
Kanji Miyazaki ◽  
Rieko Sekine ◽  
Nobuhiro Tsukada ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Chromosomal Abnormalities ◽  
Conflicts Of Interest ◽  
Term Treatment ◽  
Novel Agents ◽  
Increased Risk ◽  
Long Term Treatment ◽  
Before And After ◽  
Additional Chromosomal Abnormalities ◽  
Therapy Strategies

Abstract Objective It is well known that myelodysplastic syndrome (MDS) and acute myeloid leukemia(AML) would develop in patients with multiple myeloma. Many of them are considered as therapy-related MDS/AML (t-MDS/AML). Use of novel agents (NAs) such as bortezomib (Bor), thalidomide (Thal), and lenalidomide (Len) has extended survival of patients with multiple myeloma (MM). However, it is concerned whether a long-term treatment with NAs may increase the risk of the t-MDS/AML. So, we explore whether NAs increase the additional-chromosomal abnormalities in patients with multiple myeloma. Methods Sequential 350 patients with MM have been treated at JRCMC from 1998 to 2013. 169 patients have been treated with at least one of the NAs (NAs user); namely Bor was administered to 154 patients, Thal 70, and Len 38. The rest of 181 patients had never been treated with either one of the NAs (NAs non-user). Some patients had additional-chromosomal abnormalities (Ad-CAs) associated with t-MDS/AML by -5/5q-, -7/7q-, der(1;7), +8, 13q-, 20q-, inv(3)/t(3;3), t(11q23), der(12p), 11q-, 16q-, t(3;21), der(1;14). We compared the frequency of Ad-CAs detected by total 1112 bone marrow G-banding findings between NAs users and non-users. Results Patients' background is not significantly different between NAs users and non-users in terms of age, sex, M-protein type, and ISS stage. 5 patients showed t-AML and 30 patients revealed t-MDS. Ad-CAs was observed in 13 out of 169 NAs users (7.7%): (Bor 11 cases, Thal 10, and Len 5), while 38 out of 181 NAs non-users (21.0%). A cumulative incidence of appearance of Ad-CAs was significantly higher in non-users (P=0.02). In addition, dose and treatment period of Thal and Len was not different between Ad-CAs-positive and negative patients, but not Melphalan (Mel). -7/7q- was the most frequent Ad-CAs (26.3%) of the 38 cases of Ad-CAs in NAs non-users. In contrast, 13q-, 20q-, and +8 were observed in 10 patients (77%), 6 (46%), and 4 (31%) of the 13 cases of Ad-CAs in NAs users, respectively. Discussion Higher dose administration of Mel was observed amongst patients who represented Ad-CAs. Treatment progress is represented in the Figure. Upper 13 patients were administered NAs, lower 38 patients were not. The time of Ad-CAs is Point 0 year, before and after treatment years are summarized in the Figure. All the patients who developed t-AML died within 2 years of development. t-MDS/AML which develops in patients with multiple myeloma has a poor prognosis and resistance to treatment. We must select chemotherapy regimen taking into account of the risk of developing t-MDS/AML. Conclusion The results of the present study demonstrated no evidence of increased risk of Ad-CAs using NAs including Len was observed. It is suggested that Ad-CAs were associated with therapy strategies that were the previous standard before NAs emerged. However, the possibility of an association between +8,13q-,20q- and the use of NAs cannot be excluded. There were drug lag of the approval of NAs issue in Japan; Bor in 2006, Thal in 2008, Len in 2010. Therefore, longer follow-up periods are necessary for an accurate assessment of the risk. Disclosures: No relevant conflicts of interest to declare.

Radiosurgery-induced brain tumor

2001 ◽  
Vol 95 (4) ◽  
pp. 710-713 ◽  
Author(s):  
Takanobu Kaido ◽  
Tohru Hoshida ◽  
Ryunosuke Uranishi ◽  
Nobuhisa Akita ◽  
Akihira Kotani ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Gamma Knife ◽  
Parietal Lobe ◽  
Radiation Necrosis ◽  
Gamma Knife Radiosurgery ◽  
Clonic Seizure ◽  
Content Type ◽  
One Year ◽  
The Right ◽  
Fine Print

✓ The authors describe a case of glioblastoma multiforme (GBM) associated with previous gamma knife radiosurgery for a cerebral arteriovenous malformation (AVM). A 14-year-old boy had undergone radiosurgery for an AVM, which was performed using a 201-source 60Co gamma knife system at another institution. The maximum and margin radiation doses used in the procedure were 40 and 20 Gy, respectively. One year after radiosurgery, the patient noticed onset of mild left hemiparesis due to radiation necrosis. Six and one-half years after radiosurgery, at the age of 20 years, the patient experienced an attack of generalized tonic—clonic seizure. Magnetic resonance (MR) imaging revealed the existence of a brain tumor in the right parietal lobe. The patient underwent an operation and the histological diagnosis of the lesion was GBM. Ten months following the operation, that is, 99 months postradiosurgery, this patient died. To the best of the authors' knowledge, this is the first reported case of a neoplasm induced by radiosurgery for an AVM and the second case in which it occurred following radiosurgery for intracranial disease.

Intracranial sparganosis: an uncommon infection

1984 ◽  
Vol 60 (6) ◽  
pp. 1282-1286 ◽  
Author(s):  
Karl Anders ◽  
Kevin Foley ◽  
W. Eugene Stern ◽  
W. Jann Brown
Keyword(s):  
United States ◽  
Lower Extremity ◽  
Parietal Lobe ◽  
The United States ◽  
Pathological Features ◽  
Content Type ◽  
First Case ◽  
The Right ◽  
Clinical And Pathological Features ◽  
Fine Print

✓ The first case of intracranial sparganosis to be reported from the United States is presented. The patient, a 27-year-old woman, complained of focal seizures involving the right lower extremity. A left parietal parasagittal craniotomy was performed, and a granuloma containing a sparganum was excised from the parietal lobe. The clinical and pathological features of sparganosis are reviewed. Only five cases of intracranial sparganosis have previously been described.

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