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Putzer D, Brawanski K, Verius M, Oberherber H, Thome C, Gizewski ER, Gruber H. Noninvasive CSF shunt patency evaluation by superb microvascular imaging. Neurosurg Rev 2023; 46:190. [PMID: 37526749 PMCID: PMC10393836 DOI: 10.1007/s10143-023-02090-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/07/2023] [Accepted: 07/13/2023] [Indexed: 08/02/2023]
Abstract
Occlusion of a ventriculoperitoneal shunt system is a potentially life-threatening complication in patients suffering from hydrocephalus. However, there is no imaging established as standard approach in this acute setting. In the present study, we evaluate the use of superb microvascular imaging for investigation of the patency of ventriculoperitoneal shunt systems. Simulation of low flow rates of cerebrospinal fluid through a small diameter CSF shunt system was performed in a dedicated phantom in order to proof the principle of superb microvascular imaging (SMI) being feasible for the measurement of slow CSF flow through the dedicated CSF shunt system. SMI is able to detect low flow rates in CSF shunt systems effectively and fast. Visualization of a Duplex ultrasound flow and Doppler wave pattern in the VP shunt system after the reservoir has been pressed confirms patency. SMI is an effective method for evaluating CSF shunt patency and diagnosing shunt obstruction. This bears the potential to facilitate evaluation of clinically symptomatic VP shunt patients in an acute setting. Further evaluation of ultrasound flow patterns is granted.
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Affiliation(s)
- D Putzer
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - K Brawanski
- Department of Neurosurgery, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - M Verius
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - H Oberherber
- Canon Medical Systems GmbH, IZ-NÖ Süd, Ricoweg 40, Wiener Neudorf, Austria
| | - C Thome
- Department of Neurosurgery, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - E R Gizewski
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - H Gruber
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
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Thome C, Hoertdoerfer WS, Bendorf JR, Lee JG, Shields CW. Electrokinetic Active Particles for Motion-Based Biomolecule Detection. Nano Lett 2023; 23:2379-2387. [PMID: 36881680 PMCID: PMC10038089 DOI: 10.1021/acs.nanolett.3c00319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/23/2023] [Indexed: 06/18/2023]
Abstract
Detection of biomolecules is essential for patient diagnosis, disease management, and numerous other applications. Recently, nano- and microparticle-based detection has been explored for improving traditional assays by reducing required sample volumes and assay times as well as enhancing tunability. Among these approaches, active particle-based assays that couple particle motion to biomolecule concentration expand assay accessibility through simplified signal outputs. However, most of these approaches require secondary labeling, which complicates workflows and introduces additional points of error. Here, we show a proof-of-concept for a label-free, motion-based biomolecule detection system using electrokinetic active particles. We prepare induced-charge electrophoretic microsensors (ICEMs) for the capture of two model biomolecules, streptavidin and ovalbumin, and show that the specific capture of the biomolecules leads to direct signal transduction through ICEM speed suppression at concentrations as low as 0.1 nM. This work lays the foundation for a new paradigm of rapid, simple, and label-free biomolecule detection using active particles.
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Affiliation(s)
- Cooper
P. Thome
- Department of Chemical and
Biological Engineering, University of Colorado
Boulder, Boulder, Colorado 80303, United States
| | - Wren S. Hoertdoerfer
- Department of Chemical and
Biological Engineering, University of Colorado
Boulder, Boulder, Colorado 80303, United States
| | - Julia R. Bendorf
- Department of Chemical and
Biological Engineering, University of Colorado
Boulder, Boulder, Colorado 80303, United States
| | - Jin Gyun Lee
- Department of Chemical and
Biological Engineering, University of Colorado
Boulder, Boulder, Colorado 80303, United States
| | - C. Wyatt Shields
- Department of Chemical and
Biological Engineering, University of Colorado
Boulder, Boulder, Colorado 80303, United States
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Mathiesen T, Arraez M, Asser T, Balak N, Barazi S, Bernucci C, Bolger C, Broekman MLD, Demetriades AK, Feldman Z, Fontanella MM, Foroglou N, Lafuente J, Maier AD, Meyer B, Niemelä M, Roche PH, Sala F, Samprón N, Sandvik U, Schaller K, Thome C, Thys M, Tisell M, Vajkoczy P, Visocchi M. A snapshot of European neurosurgery December 2019 vs. March 2020: just before and during the Covid-19 pandemic. Acta Neurochir (Wien) 2020; 162:2221-2233. [PMID: 32642834 PMCID: PMC7343382 DOI: 10.1007/s00701-020-04482-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 06/30/2020] [Indexed: 11/30/2022]
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or Covid-19), which began as an epidemic in China and spread globally as a pandemic, has necessitated resource management to meet emergency needs of Covid-19 patients and other emergent cases. We have conducted a survey to analyze caseload and measures to adapt indications for a perception of crisis. Methods We constructed a questionnaire to survey a snapshot of neurosurgical activity, resources, and indications during 1 week with usual activity in December 2019 and 1 week during SARS-CoV-2 pandemic in March 2020. The questionnaire was sent to 34 neurosurgical departments in Europe; 25 departments returned responses within 5 days. Results We found unexpectedly large differences in resources and indications already before the pandemic. Differences were also large in how much practice and resources changed during the pandemic. Neurosurgical beds and neuro-intensive care beds were significantly decreased from December 2019 to March 2020. The utilization of resources decreased via less demand for care of brain injuries and subarachnoid hemorrhage, postponing surgery and changed surgical indications as a method of rationing resources. Twenty departments (80%) reduced activity extensively, and the same proportion stated that they were no longer able to provide care according to legitimate medical needs. Conclusion Neurosurgical centers responded swiftly and effectively to a sudden decrease of neurosurgical capacity due to relocation of resources to pandemic care. The pandemic led to rationing of neurosurgical care in 80% of responding centers. We saw a relation between resources before the pandemic and ability to uphold neurosurgical services. The observation of extensive differences of available beds provided an opportunity to show how resources that had been restricted already under normal conditions translated to rationing of care that may not be acceptable to the public of seemingly affluent European countries. Electronic supplementary material The online version of this article (10.1007/s00701-020-04482-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- T Mathiesen
- Department of Neurosurgery, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - M Arraez
- Department of Neurosurgery, Carlos Haya University Hospital,, University of Malaga, Malaga, Spain
| | - T Asser
- University of Tartu, Tartu, Estonia
| | - N Balak
- Department of Neurosurgery, Istanbul Medeniyet University, Göztepe Education and Research Hospital, Istanbul, Turkey
| | - S Barazi
- King's College Hospital, London, UK
| | - C Bernucci
- Department of Neuroscience and Surgery of the Nervous System, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - C Bolger
- National Centre for Neurosurgery, Beaumont Hospital, Dublin, Ireland
| | - M L D Broekman
- Departments of Neurosurgery, Haaglanden Medical Center and Leiden University Medical Center, Leiden University, Leiden, Zuid-Holland, the Netherlands
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - A K Demetriades
- Department of Neurosurgery, Western General Hospital, Edinburgh, UK
| | - Z Feldman
- Department of Neurosurgery, Sheba Medical Center, Ramat Gan, Israel
| | - M M Fontanella
- Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Spedali Civili di Brescia, Brescia, Italy
| | - N Foroglou
- Department of Neurosurgery, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - J Lafuente
- Neurosurgery, Hospital Del Mar, Barcelona, Spain
| | - A D Maier
- Department of Neurosurgery, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - B Meyer
- Department of Neurosurgery, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - M Niemelä
- Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - P H Roche
- Department of Neurosurgery, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Aix Marseille Université, Marseille, France
| | - F Sala
- Section of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, University Hospital, Verona, Italy
| | - N Samprón
- Servicio de Neurocirugía, Hospital Universitario Donostia, San Sebastián, Spain
| | - U Sandvik
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurosurgery, Karolinska University Hospital, Solna, Sweden
| | - K Schaller
- Department of Neurosurgery, Geneva University Medical Center & Faculty of Medicine, Geneva, Switzerland
| | - C Thome
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | - M Thys
- Neurosciences Department, Grand Hopital de Charleroi, Charleroi, Belgium
| | - M Tisell
- Department of Neurosurgery, Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - P Vajkoczy
- Department of Neurosurgery, Charite Universitätsmedizin Berlin, Berlin, Germany
| | - M Visocchi
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
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Krieg SM, Vajkoczy P, Eicker SO, Rohde V, Thome C, Stoffel M, Ringel F, Meyer B. [Surgical treatment of adult spinal deformities]. Nervenarzt 2018; 89:648-657. [PMID: 29679126 DOI: 10.1007/s00115-018-0515-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Adult spinal deformity (ASD) is mostly a progressive disease which usually leads to chronic pain. Due to increased prevalence in older people many patients suffer from comorbidities, which make conservative and surgical treatment even more complex. OBJECTIVE This article provides an overview on the current conservative and surgical treatment options. MATERIAL AND METHODS An extensive literature search was carried out via Medline plus an additional evaluation of the authors' personal experiences was performed. RESULTS The current conservative and surgical treatments are outlined and potential risk factors and predictors which may lead to inferior clinical outcome are discussed. CONCLUSION Patients for whom even conservative treatment leads to success should be identified earlier and better. The surgical treatment ranges from minimally invasive decompression to multilevel fusions. Complications in large corrective interventions can be substantial but if the indications are correctly assessed, such complex surgical treatment has excellent clinical results in terms of pain and quality of life.
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Affiliation(s)
- S M Krieg
- Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar der TU München, München, Deutschland
| | - P Vajkoczy
- Klinik und Poliklinik für Neurochirurgie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - S-O Eicker
- Klinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - V Rohde
- Klinik für Neurochirurgie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - C Thome
- Universitätsklinik für Neurochirurgie, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - M Stoffel
- Klinik für Neurochirurgie, Helios Klinikum Krefeld, Krefeld, Deutschland
| | - F Ringel
- Neurochirurgische Klinik und Poliklinik, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland.
| | - B Meyer
- Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar der TU München, München, Deutschland
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Liao Y, Berghoff AS, Osswald M, Ilhan-Mutlu A, Gil B, Thome C, Ratliff M, Steeg P, Wick W, Winkler F. OS7.1 Identification and characterization of brain metastasis initiating cells. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now188.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Fabricius M, Schiefecker A, Friberg C, Beer R, Pfausler B, Lackner P, Broessner G, Sohm F, Mulino M, Thome C, Schmutzhard E, Helbok R. Electrocorticographic(ECoG) monitoring in spontaneous intracerebral hemorrhage(sICH): Metabolic profile of cortical spreading depolarizations(CSD). Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2015.11.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Sreetharan S, Thome C, Mitz C, Eme J, Mueller CA, Hulley EN, Manzon RG, Somers CM, Boreham DR, Wilson JY. Embryonic development of lake whitefish Coregonus clupeaformis: a staging series, analysis of growth and effects of fixation. J Fish Biol 2015; 87:539-558. [PMID: 26184490 DOI: 10.1111/jfb.12725] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 05/15/2015] [Indexed: 06/04/2023]
Abstract
A reference staging series of 18 morphological stages of laboratory reared lake whitefish Coregonus clupeaformis is provided. The developmental processes of blastulation, gastrulation, neurulation as well as development of the eye, circulatory system, chromatophores and mouth are included and accompanied by detailed descriptions and live imaging. Quantitative measurements of embryo size and mass were taken at each developmental stage. Eggs were 3·19 ± 0·16 mm (mean ± s.d.) in diameter at fertilization and embryos reached a total length (LT ) of 14·25 ± 0·41 mm at hatch. Separated yolk and embryo dry mass were 0·25 ± 0·08 mg and 1·39 ± 0·17 mg, respectively, at hatch. The effects of two common preservatives (formalin and ethanol) were examined throughout development and post hatch. Embryo LT significantly decreased following fixation at all points in development. A correction factor to estimate live LT from corresponding fixed LT was determined as live LT = (fixed LT )(1·025) . Eye diameter and yolk area measurements significantly increased in fixed compared with live embryos up to 85-90% development for both measurements. The described developmental stages can be generalized to teleost species, and is particularly relevant for the study of coregonid development due to additionally shared developmental characteristics. The results of this study and staging series are therefore applicable across various research streams encompassing numerous species that require accurate staging of embryos and descriptions of morphological development.
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Affiliation(s)
- S Sreetharan
- Department of Biology, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada
| | - C Thome
- Department of Medical Physics and Applied Radiation Sciences, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada
| | - C Mitz
- Department of Medical Physics and Applied Radiation Sciences, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada
| | - J Eme
- Department of Biology, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada
| | - C A Mueller
- Department of Biology, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada
| | - E N Hulley
- Department of Medical Physics and Applied Radiation Sciences, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada
| | - R G Manzon
- Department of Biology, University of Regina, 3737 Wascana Parkway, Regina, Saskatchewan, S4S 0A2, Canada
| | - C M Somers
- Department of Biology, University of Regina, 3737 Wascana Parkway, Regina, Saskatchewan, S4S 0A2, Canada
| | - D R Boreham
- Department of Medical Physics and Applied Radiation Sciences, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada
- Northern Ontario School of Medicine, 935 Ramsey Lake Road, Sudbury, Ontario, P3E 2C6, Canada
| | - J Y Wilson
- Department of Biology, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada
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Schiefecker AJ, Beer R, Kofler M, Pfausler B, Unterberger I, Lackner P, Broessner G, Rhomberg P, Sohm F, Mulino M, Thome C, Fabricius M, Schmutzhard E, Helbok R. Cortical spreading depolarizations in patients with intracerebral hemorrhage: preliminary data. Crit Care 2015. [PMCID: PMC4472272 DOI: 10.1186/cc14548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Leistner DM, Fichtlscherer S, Thome C, Boeckel N, Roexe T, Ardogan M, Lehmann R, Seeger FH, Dimmeler S, Zeiher AM. OCT-derived coronary plaque morphology and transcoronary concentration gradients of vessel wall-associated microRNAs. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p5445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Czech T, Götsch C, Thome C, Brezinka C, Wildt L. Kinderwunschbehandlung bei sekundärer Ovarialinsuffizienz nach postpartaler lymphozytärer Hypophysitis. Geburtshilfe Frauenheilkd 2011. [DOI: 10.1055/s-0031-1278579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Seiz M, Pechlivanis I, Bag S, Schmieder K, Thome C, Tuettenberg J. Translaminäre Fensterung bei nach kaudal sequestriertem lumbalem Bandscheibenvorfall – Technische Mitteilung. Z Orthop Unfall 2009; 147:597-9. [DOI: 10.1055/s-0029-1186107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hinkelbein J, Thome C, Genzwürker H, Ellinger K. [Prehospital use of hypertonic solutions for traumatic brain injury]. Anasthesiol Intensivmed Notfallmed Schmerzther 2003; 38:143-50. [PMID: 12635039 DOI: 10.1055/s-2003-37777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Hypertonic solutions efficaciously lower increased intracranial pressure and improve cerebral hemodynamics in particular at the level of microcirculation. Therefore hypertonic solutions have been introduced to the in-hospital intensive care treatment of brain-injured patients. In view of the disturbed cerebral perfusion and oxygenation in the acute phase following traumatic brain injury, early initiation of treatment is desirable to improve long-term outcome and to minimize secondary brain damage. Two different hypertonic isooncotic solutions are licensed in Germany for prehospital and in-hospital treatment of acute hypotension due to hypovolaemia and haemorrhagic shock. Both solutions offer interesting therapeutic options for treatment of patients with increased intracranial pressure. Limitation of license to the treatment of shock in Germany does not allow routine prehospital use in isolated head trauma at the moment. In other European countries, the approval for the prehospital use of hypertonic isooncotic solutions has been modified.
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Affiliation(s)
- J Hinkelbein
- Institut für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum, Mannheim.
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Vajkoczy P, Horn P, Bauhuf C, Munch E, Hubner U, Ing D, Thome C, Poeckler-Schoeninger C, Roth H, Schmiedek P. Effect of intra-arterial papaverine on regional cerebral blood flow in hemodynamically relevant cerebral vasospasm. Stroke 2001; 32:498-505. [PMID: 11157189 DOI: 10.1161/01.str.32.2.498] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE It remains controversial whether the intra-arterial administration of papaverine (IAP) is effective in reversing vasospasm-associated cerebral hypoperfusion after aneurysmal subarachnoid hemorrhage. The aim of the present study was to continuously assess regional cerebral blood flow (rCBF) during and after IAP with the use of quantitative, bedside thermal diffusion flowmetry. METHODS Eight patients with cerebral vasospasm after subarachnoid hemorrhage (mean flow velocity >120 cm/s; angiographic vessel constriction >33%; hemispheric cerebral blood flow [CBF] <32 mL/100 g per minute) were prospectively entered into the study. Before IAP, thermal diffusion microprobes were implanted into the white matter of each affected vascular territory (n=10) for rCBF monitoring. During and after IAP (300 mg papaverine/50 mL saline over 1 hour), mean arterial blood pressure, intracranial pressure, cerebral perfusion pressure, thermal diffusion rCBF (TD-rCBF), and cerebrovascular resistance (CVR) were recorded continuously. RESULTS IAP significantly increased TD-rCBF from 7.3+/-1.6 to 37.9+/-6.6 mL/100 g per minute (mean+/-SEM), indicating reversal of cerebral hypoperfusion. This TD-rCBF response was dependent on the degree of cerebral vasospasm and reduced perfusion within the vascular territory. Long-term analysis of TD-rCBF, however, demonstrated that this beneficial effect of IAP on cerebral hypoperfusion was only transient: within 3 hours after treatment, TD-rCBF and CVR returned to baseline values. Furthermore, a lack of correlation between transcranial Doppler sonography and thermal diffusion flowmetry suggested that transcranial Doppler sonography is not suited for CBF-based neuromonitoring after IAP. CONCLUSIONS IAP is not effective in permanently reversing cerebral hypoperfusion in patients with cerebral vasospasm. The need to validate alternative therapeutic strategies that seek to improve cerebral perfusion in vasospasm warrants continued development of CBF-based neuromonitoring strategies.
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Affiliation(s)
- P Vajkoczy
- Department of Neurosurgery, Klinikum Mannheim, University of Heidelberg, Mannheim, Germany.
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Vajkoczy P, Hubner U, Horn P, Bauhuf C, Thome C, Schilling L, Schmiedek P, Quintel M, Thomas JE. Intrathecal sodium nitroprusside improves cerebral blood flow and oxygenation in refractory cerebral vasospasm and ischemia in humans. Stroke 2000; 31:1195-7. [PMID: 10797186 DOI: 10.1161/01.str.31.5.1194-b] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
PURPOSE Gracilis muscle transposition for treatment of fecal incontinence gives variable results. Electric stimulation of transposed muscle recently brought this technique to the surface. METHODS We reviewed patients who had gracilis muscle transposition for fecal incontinence to determine who might benefit from electrostimulation. RESULTS Between 1979 and 1991, 22 patients underwent gracilis muscle transposition. At six months, 18 patients had improved continence, but 12 of the 18 were stable with time, and only 1 was fully continent. Six patients were candidates for electrostimulation; four had a contractile but fatigable transposed muscle, and two had ineffective transposed muscle with a gaping nonfibrotic anus. CONCLUSION Gracilis muscle transposition should be used first for severe incontinent patients, and electrostimulation should be used if there are unsatisfactory results.
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Affiliation(s)
- J L Faucheron
- Department of Alimentary Tract Surgery, Hôpital Saint-Antoine, Paris, France
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