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Ajmera S, Motiwala M, Weeks M, Oravec CS, Hersh DS, Fraser BD, Vaughn B, Klimo P. What Variables Correlate With Different Clinical Outcomes of Abusive Head Injury? Neurosurgery 2021. [DOI: 10.1093/neuros/nyaa058_s022] [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: 11/13/2022] Open
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2
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Nguyen V, Khan N, Diaz JL, Klimo P, Choudhri A, Vaughn B, Hersh DS, Elijovich L, Motiwala M. Identifying At-Risk Patients with Pediatric Intracranial Steno-Occlusive Arterial Disease. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_285] [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: 11/13/2022] Open
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3
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Ajmera S, Motiwala M, Weeks M, Oravec CS, Hersh DS, Fraser BD, Vaughn B, Klimo P. What Variables Correlate With Different Clinical Outcomes of Abusive Head Injury? Neurosurgery 2020; 87:803-810. [PMID: 32243538 DOI: 10.1093/neuros/nyaa058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 01/29/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The spectrum of injury severity for abusive head trauma (AHT) severity is broad, but outcomes are unequivocally worse than accidental trauma. There are few publications that analyze different outcomes of AHT. OBJECTIVE To determine variables associated with different outcomes of AHT. METHODS Patients were identified using our AHT database. Three different, but not mutually exclusive, outcomes of AHT were modeled: (1) death or hemispheric stroke (diffuse loss of grey-white differentiation); (2) stroke(s) of any size; and (3) need for a neurosurgical operation. Demographic and clinical variables were collected and correlations to the 3 outcomes of interest were identified using bivariate and multivariable analysis. RESULTS From January 2009 to December 2017, 305 children were identified through a prospectively maintained AHT database. These children were typically male (60%), African American (54%), and had public or no insurance (90%). A total of 29 children (9.5%) died or suffered a massive hemispheric stroke, 57 (18.7%) required a neurosurgical operation, and 91 (29.8%) sustained 1 or more stroke. Death or hemispheric stroke was statistically associated with the pupillary exam (odds ratio [OR] = 45.7) and admission international normalized ratio (INR) (OR = 17.3); stroke was associated with the pupillary exam (OR = 13.2), seizures (OR = 14.8), admission hematocrit (OR = 0.92), and INR (9.4), and need for surgery was associated with seizures (OR = 8.6). CONCLUSION We have identified several demographic and clinical variables that correlate with 3 clinically applicable outcomes of abusive head injury.
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Affiliation(s)
- Sonia Ajmera
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Mustafa Motiwala
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | | | - Chesney S Oravec
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - David S Hersh
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Brittany D Fraser
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | | | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee.,Le Bonheur Children's Hospital, Memphis, Tennessee.,Semmes Murphey Clinic, Memphis, Tennessee
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4
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Hersh DS, Kumar R, Moore KA, Smith LGF, Tinkle CL, Chiang J, Patay Z, Gajjar A, Choudhri AF, Lee-Diaz JA, Vaughn B, Klimo P. Safety and efficacy of brainstem biopsy in children and young adults. J Neurosurg Pediatr 2020; 26:552-562. [PMID: 32736346 DOI: 10.3171/2020.4.peds2092] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/29/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Biopsies of brainstem lesions are performed to establish a diagnosis in the setting of an atypical clinical or radiological presentation, or to facilitate molecular studies. A better understanding of the safety and diagnostic yield of brainstem biopsies would help guide appropriate patient selection. METHODS All patients who underwent biopsy of a brainstem lesion during the period from January 2011 to June 2019 were reviewed. Demographic, radiological, surgical, and outcome data were collected. RESULTS A total of 58 patients underwent 65 brainstem biopsies during the study period. Overall, the median age was 7.6 years (IQR 3.9-14.2 years). Twenty-two of the 65 biopsies (34%) were open, 42 (65%) were stereotactic, and 1 was endoscopic. In 3 cases (5%), a ventriculoperitoneal shunt was placed, and in 9 cases (14%), a posterior fossa decompression was performed during the same operative session as the biopsy. An intraoperative MRI (iMRI) was performed in 28 cases (43%). In 3 of these cases (11%), the biopsy was off target and additional samples were obtained during the same procedure. New neurological deficits were noted in 5 cases (8%), including sensory deficits, ophthalmoparesis/nystagmus, facial weakness, and hearing loss; these deficits persisted in 2 cases and were transient in 3 cases. A pseudomeningocele occurred in 1 patient; no patients developed a CSF leak or infection. In 8 cases (13%) an additional procedure was needed to obtain a diagnosis. CONCLUSIONS Brainstem biopsies are safe and effective. Target selection and approach should be a collaborative effort. iMRI can be used to assess biopsy accuracy in real time, thereby allowing any adjustment if necessary.
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Affiliation(s)
- David S Hersh
- 1Division of Neurosurgery, Connecticut Children's, Hartford.,2Department of Surgery, UConn School of Medicine, Farmington, Connecticut
| | - Rahul Kumar
- 3Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Kenneth A Moore
- 3Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Luke G F Smith
- 4Department of Neurosurgery, The Ohio State University, Columbus, Ohio; Departments of
| | | | | | | | - Amar Gajjar
- 8Division of Neuro-oncology, St. Jude Children's Research Hospital, Memphis
| | - Asim F Choudhri
- 3Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee.,9Department of Radiology, University of Tennessee Health Science Center, Memphis.,10Division of Neuroradiology, Le Bonheur Neuroscience Institute, Memphis.,11Le Bonheur Children's Hospital, Memphis; and
| | - Jorge A Lee-Diaz
- 3Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee.,9Department of Radiology, University of Tennessee Health Science Center, Memphis.,10Division of Neuroradiology, Le Bonheur Neuroscience Institute, Memphis.,11Le Bonheur Children's Hospital, Memphis; and
| | | | - Paul Klimo
- 3Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee.,11Le Bonheur Children's Hospital, Memphis; and.,12Semmes Murphey, Memphis, Tennessee
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Roy A, Davis CW, Vaughn B, Dayno JM, Dauvilliers Y, Schwartz J. 0768 Time Course Of Improvement In Excessive Daytime Sleepiness And Cataplexy During Treatment With Pitolisant In Patients With Narcolepsy. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
This analysis evaluated the efficacy of pitolisant over time in three 7- to 8-week, randomized, placebo-controlled studies of adults with narcolepsy.
Methods
Patients in all 3 studies (HARMONY-1, HARMONY-1bis, HARMONY-CTP) experienced excessive daytime sleepiness (EDS) at study baseline; patients in HARMONY-CTP also experienced ≥3 cataplexy attacks/week. Pitolisant was titrated to a maximum dose of 35.6 mg/day (HARMONY-1, HARMONY-CTP) or 17.8 mg/day (HARMONY-1bis). Change from baseline in mean Epworth Sleepiness Scale (ESS) score (3 studies) and mean weekly rate of cataplexy (WRC; 1 study) was compared for pitolisant versus placebo.
Results
In the higher-dose HARMONY-1 (pitolisant, n=31; placebo, n=30) and HARMONY-CTP (pitolisant, n=54; placebo, n=51) studies, ESS score improvement was significantly greater with pitolisant versus placebo beginning at Week 2 (LS mean difference, -2.8; P=0.015) and Week 3 (LS mean difference, -2.0; P=0.005), respectively. In the lower-dose HARMONY-1bis study (pitolisant, n=66; placebo, n=32), significant separation from placebo was first observed at Week 7 (LS mean difference, -2.3; P=0.044). At end-of-treatment, LS mean difference in ESS score change from baseline was -3.1 (P=0.022) in HARMONY-1, -3.4 (P<0.001) in HARMONY-CTP, and -2.2 (P=0.030) in HARMONY-1bis. In HARMONY-CTP, LS mean WRC with pitolisant was 11.7 at baseline, 4.6 at end-of-treatment, and 5.1 after a 1-week, placebo-washout period. Improvement in WRC was significantly greater with pitolisant versus placebo beginning at Week 2 (LS mean difference, -5.3; P=0.004) and continued through end-of-treatment (LS mean difference, -6.2; P<0.001); there was no evidence of rebound cataplexy after placebo-washout (LS mean difference, -4.9; P=0.027).
Conclusion
During pitolisant treatment, improvement in EDS occurred sooner (within first few weeks) and was more robust in studies that permitted titration to the maximum recommended dose (35.6 mg/day). The rate of cataplexy attacks decreased early during treatment, with no evidence of rebound when pitolisant was withdrawn.
Support
Bioprojet Pharma and Harmony Biosciences, LLC.
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Affiliation(s)
- A Roy
- Ohio Sleep Medicine Institute, Dublin, OH
| | - C W Davis
- Harmony Biosciences, LLC, Plymouth Meeting, PA
| | | | - J M Dayno
- Harmony Biosciences, LLC, Plymouth Meeting, PA
| | - Y Dauvilliers
- National Reference Center for Narcolepsy, Montpellier, FRANCE
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6
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Davis CW, Kallweit U, Krahn LE, Vaughn B, Thorpy MJ. 0762 Efficacy Of Pitolisant In Patients With High Burden Of Narcolepsy Symptoms. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Recent literature suggests that histamine may play an important role in narcolepsy. This post hoc analysis evaluates the efficacy of pitolisant, a histamine 3 (H3)-receptor antagonist/inverse agonist, in patients with high burden of the main narcolepsy symptoms.
Methods
Data were pooled from 2 randomized, placebo-controlled, 7- and 8-week studies of pitolisant (individually titrated; maximum dose, 35.6 mg/day) in adults with narcolepsy. Analyses included 3 independent patient subgroups: baseline score of >16 on the Epworth Sleepiness Scale (ESS), sleep latency of ≤8 minutes on the Maintenance of Wakefulness Test (MWT), and ≥15 cataplexy attacks per week.
Results
The analysis populations included 108 patients for the ESS (pitolisant, n=54; placebo, n=54), 105 for the MWT (pitolisant, n=59; placebo, n=46), and 31 for cataplexy (pitolisant, n=20; placebo, n=11). Mean change in ESS from baseline was significantly greater for pitolisant (-6.1) compared with placebo (-2.6; P=0.0002). A significantly greater percentage of pitolisant-treated patients were classified as treatment responders: for ESS score reduction ≥3, 68.5% in the pitolisant group versus 35.2% in the placebo group (P=0.0006); for final ESS score ≤10, 35.2% versus 9.3%, respectively (P=0.0026). Mean increase in sleep latency on the MWT was significantly greater for pitolisant (7.0 minutes) compared with placebo (3.4 minutes; P=0.0089). Decrease in mean weekly rate of cataplexy was significantly greater for pitolisant (baseline, 21.8; final, 3.9) compared with placebo (baseline, 20.9; final, 18.2); the rate ratio was 0.35 (95% CI, 0.26‒0.47; P<0.001). The adverse event profile in the analysis populations was consistent with the known safety profile for pitolisant; headache was the most common adverse event in pitolisant-treated patients (10.0%-20.4%).
Conclusion
In patients with severe symptom burden, pitolisant produced significantly greater improvements in excessive daytime sleepiness and cataplexy compared with placebo, highlighting the important role of histamine in narcolepsy.
Support
Bioprojet Pharma and Harmony Biosciences, LLC.
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Affiliation(s)
- C W Davis
- Harmony Biosciences, LLC, Plymouth Meeting, PA
| | - U Kallweit
- Universität Witten/Herdecke, Center for Narcolepsy and Hypersomnias, Institute of Immunology, and Center for Biomedical Education and Research, Witten, GERMANY
| | | | | | - M J Thorpy
- Albert Einstein College of Medicine, Bronx, NY
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7
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Khan NR, Saad H, Oravec CS, Norrdahl SP, Fraser B, Wallace D, Lillard JC, Motiwala M, Nguyen VN, Lee SL, Jones AV, Ajmera S, Kalakoti P, Dave P, Moore KA, Akinduro O, Nyenwe E, Vaughn B, Michael LM, Klimo P. An Analysis of Publication Productivity During Residency for 1506 Neurosurgical Residents and 117 Residency Departments in North America. Neurosurgery 2020; 84:857-867. [PMID: 29850872 DOI: 10.1093/neuros/nyy217] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 04/30/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Bibliometrics is defined as the study of statistical and mathematical methods used to quantitatively analyze scientific literature. The application of bibliometrics in neurosurgery continues to evolve. OBJECTIVE To calculate a number of publication productivity measures for almost all neurosurgical residents and departments within North America. These measures were correlated with survey results on the educational environment within residency programs. METHODS During May to June 2017, data were collected from departmental websites and Scopus to compose a bibliometric database of neurosurgical residents and residency programs. Data related to authorship value and study content were collected on all articles published by residents. A survey of residency program research and educational environment was administered to program directors and coordinators; results were compared with resident academic productivity. RESULTS The median number of publications in residency was 3; median h-index and Resident index were 1 and 0.17 during residency, respectively. There was a statistically significant difference in academic productivity among male neurosurgical residents compared with females. The majority of articles published were tier 1 clinical articles. Residency program research support was significantly associated with increased resident productivity (P < .001). Scholarly activity requirements were not associated with increased resident academic productivity. CONCLUSION This study represents the most comprehensive bibliometric assessment of neurosurgical resident academic productivity during training to date. New benchmarks for individual and department academic productivity are provided. A supportive research environment for neurosurgical residents is associated with increased academic productivity, but a scholarly activity requirement was, surprisingly, not shown to have a positive effect.
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Affiliation(s)
- Nickalus R Khan
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Hassan Saad
- Arkansas Neuroscience Institute, CHI St. Vincent Infirmary, Little Rock, Arkansas
| | - Chesney S Oravec
- University of Tennessee Health Science Center, Memphis, Tennessee
| | | | - Brittany Fraser
- University of Tennessee Health Science Center, Memphis, Tennessee
| | - David Wallace
- University of Tennessee Health Science Center, Memphis, Tennessee
| | - Jock C Lillard
- University of Tennessee Health Science Center, Memphis, Tennessee
| | - Mustafa Motiwala
- University of Tennessee Health Science Center, Memphis, Tennessee
| | - Vincent N Nguyen
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Siang Liao Lee
- Department of Neurosurgery, Louisiana State University, Shreveport, Louisiana
| | - Anna V Jones
- The University of Alabama at Birmingham, Birmingham, Alabama
| | - Sonia Ajmera
- University of Tennessee Health Science Center, Memphis, Tennessee
| | | | | | - Kenneth A Moore
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Olutomi Akinduro
- University of Tennessee Health Science Center, Memphis, Tennessee
| | | | - Brandy Vaughn
- Department of Neurosurgery, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee.,Semmes Murphey, Memphis, Tennessee
| | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee.,Department of Neurosurgery, Le Bonheur Children's Hospital, Memphis, Tennessee.,Semmes Murphey, Memphis, Tennessee
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8
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Nguyen VN, Wallace D, Ajmera S, Akinduro O, Smith LJ, Giles K, Vaughn B, Klimo P. Management of Subdural Hematohygromas in Abusive Head Trauma. Neurosurgery 2020; 86:281-287. [PMID: 31321424 DOI: 10.1093/neuros/nyz076] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 02/16/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The optimal management of nonacute subdural fluid collections in infantile abusive head trauma (AHT) remains controversial. OBJECTIVE To review the outcomes and costs of the various treatments for symptomatic subdural fluid collections in children with AHT at a single center. METHODS Our AHT database was queried to identify children requiring any intervention for hematohygromas. Demographic, hospital course, radiologic, cost, readmission, and follow-up information were collected. RESULTS From January 2009 to March 2018, the authors identified 318 children with AHT, of whom 210 (66%) had a subdural collection of any type (blood or cerebrospinal fluid). A total of 50 required some form of intervention specifically for chronic hematohygromas. The initial management consisted of transfontanelle percutaneous aspiration (n = 31), burr holes with (n = 12) or without (n = 3) external subdural drainage, and mini-craniotomy (n = 4). Of those who were initially managed with 1 or more needle aspiration, 23 (74%) required further intervention-12 subduroperitoneal shunts and 11 nonshunt procedures. No patient who underwent burr holes/external drainage required further intervention (n = 16). Overall, the average number of interventions needed in these 50 children for definitive treatment was 1.8 (range, 1-4). A total of 15 children ultimately required a subduroperitoneal shunt. Complications (infectious, hemorrhagic, and thrombotic) were significant and occurred in all treatment groups except burr holes without drainage (n = 3). The average hospital charge for the entire cohort was $166 300.25 (range, $19 126-$739 248). CONCLUSION Based on our experience to date, burr hole with controlled external subdural drainage is an effective and preferred treatment for traumatic hematohygromas; complications and need for additional intervention is low.
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Affiliation(s)
- Vincent N Nguyen
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - David Wallace
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Sonia Ajmera
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Oluwatomi Akinduro
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Lydia J Smith
- Neuroscience Institute, LeBonheur Children's Hospital, Memphis, Tennessee
| | - Kim Giles
- Neuroscience Institute, LeBonheur Children's Hospital, Memphis, Tennessee
| | - Brandy Vaughn
- Neuroscience Institute, LeBonheur Children's Hospital, Memphis, Tennessee
| | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee.,Neuroscience Institute, LeBonheur Children's Hospital, Memphis, Tennessee.,Semmes Murphey, Memphis, Tennessee
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9
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Norrdahl SP, Jones TL, Dave P, Hersh DS, Vaughn B, Klimo P. A hospital-based analysis of pseudomeningoceles after elective craniotomy in children: what predicts need for intervention? J Neurosurg Pediatr 2020; 25:462-469. [PMID: 32005010 DOI: 10.3171/2019.11.peds19227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 11/06/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In pediatric patients, the development of a postoperative pseudomeningocele after an elective craniotomy is not unusual. Most will resolve with time, but some may require intervention. In this study, the authors analyzed patients who required intervention for a postoperative pseudomeningocele following an elective craniotomy or craniectomy and identified factors associated with the need for intervention. METHODS An institutional operative database of elective craniotomies and craniectomies was queried to identify all surgeries associated with development of a postoperative pseudomeningocele from January 1, 2010, to December 31, 2017. Demographic and surgical data were collected, as were details regarding postoperative events and interventions during either the initial admission or upon readmission. A bivariate analysis was performed to compare patients who underwent observation with those who required intervention. RESULTS Following 1648 elective craniotomies or craniectomies, 84 (5.1%) clinically significant pseudomeningoceles were identified in 82 unique patients. Of these, 58 (69%) of the pseudomeningoceles were diagnosed during the index admission (8 of which persisted and resulted in readmission), and 26 (31%) were diagnosed upon readmission. Forty-nine patients (59.8% of those with a pseudomeningocele) required one or more interventions, such as lumbar puncture(s), lumbar drain placement, wound exploration, or shunt placement or revision. Only race (p < 0.01) and duraplasty (p = 0.03, OR 3.0) were associated with the need for pseudomeningocele treatment. CONCLUSIONS Clinically relevant pseudomeningoceles developed in 5% of patients undergoing an elective craniotomy, with 60% of these pseudomeningoceles needing some form of intervention. The need for intervention was associated with race and whether a duraplasty was performed.
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Affiliation(s)
| | - Tamekia L Jones
- Departments of2Pediatrics and
- 3Preventive Medicine, University of Tennessee Health Science Center, Memphis
- 4Children's Foundation Research Institute, Memphis
| | | | - David S Hersh
- 6Department of Neurosurgery, University of Tennessee Health Science Center, Memphis
- 7Le Bonheur Children's Hospital, Memphis; and
| | | | - Paul Klimo
- 6Department of Neurosurgery, University of Tennessee Health Science Center, Memphis
- 7Le Bonheur Children's Hospital, Memphis; and
- 8Semmes Murphey, Memphis, Tennessee
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10
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Hersh DS, Smith LGF, Jones TL, Fraser BD, Kumar R, Vaughn B, Klimo P. Predictors of an Extended Length of Stay following an Elective Craniotomy in Children and Young Adults. Pediatr Neurosurg 2020; 55:259-267. [PMID: 33099552 DOI: 10.1159/000511090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/24/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Length of stay (LOS) is now a generally accepted clinical metric within the USA. An extended LOS following an elective craniotomy can significantly impact overall costs. Few studies have evaluated predictors of an extended LOS in pediatric neurosurgical patients. OBJECTIVE The aim of the study was to determine predictors of an extended hospital LOS following an elective craniotomy in children and young adults. METHODS All pediatric patients and young adults undergoing an elective craniotomy between January 1, 2010, and April 1, 2019, were retrospectively identified using a prospectively maintained database. Demographic, clinical, radiological, and surgical data were collected. The primary outcome was extended LOS, defined as a postsurgical stay greater than 7 days. Bivariate and multivariable analyses were performed. RESULTS A total of 1,498 patients underwent 1,720 elective craniotomies during the study period over the course of 1,698 hospitalizations with a median LOS of 4 days (interquartile range 3-6 days). Of these encounters, 218 (12.8%) had a prolonged LOS. Multivariable analysis demonstrated that non-Caucasian race (OR = 1.9 [African American]; OR = 1.6 [other]), the presence of an existing shunt (OR = 1.8), the type of craniotomy (OR = 0.3 [vascular relative to Chiari]), and the presence of a postoperative complication (OR = 14.7) were associated with an extended LOS. CONCLUSIONS Inherent and modifiable factors predict a hospital stay of more than a week in children and young adults undergoing an elective craniotomy.
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Affiliation(s)
- David S Hersh
- Division of Neurosurgery, Connecticut Children's, Hartford, Connecticut, USA, .,Department of Surgery, UConn School of Medicine, Farmington, Connecticut, USA,
| | - Luke G F Smith
- Department of Neurosurgery, The Ohio State University, Columbus, Ohio, USA
| | - Tamekia L Jones
- Departments of Pediatrics and Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, Tennessee, USA
| | - Brittany D Fraser
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Rahul Kumar
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Brandy Vaughn
- Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, Tennessee, USA
| | - Paul Klimo
- Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, Tennessee, USA.,Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Semmes Murphey, Memphis, Tennessee, USA
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11
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Davis C, Krahn L, Vaughn B, Thorpy M. Efficacy of pitolisant in patients with high burden of narcolepsy symptoms. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.238] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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12
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Erwood A, Rindler RS, Motiwala M, Ajmera S, Vaughn B, Klimo P, Chern JJ. Management of sterile abdominal pseudocysts related to ventriculoperitoneal shunts. J Neurosurg Pediatr 2019; 25:57-61. [PMID: 31604319 DOI: 10.3171/2019.7.peds19305] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 07/29/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE There are many known complications associated with CSF shunts. One of the more rare ones is a sterile abdominal pseudocyst due to decreased peritoneal absorption. This study was undertaken to detail the presentation, evaluation, and management of this unusual shunt-related event. METHODS Patients presenting with ventriculoperitoneal shunt (VPS)-related sterile abdominal pseudocysts treated at two institutions between 2013 and 2018 were included. Patients who had undergone abdominal surgery or shunt revisions within a 12-month period preceding presentation were excluded. Information was collected regarding clinical characteristics; hospital course, including surgical intervention(s); and any subsequent complications. Special attention was given to the eventual surgery after pseudocyst resolution, including the use of laparoscopy for peritoneal catheter placement, distal shunt conversion (i.e., in the atrium or pleural cavity), endoscopic third ventriculostomy, or shunt removal. The timing and nature of any subsequent shunt failures were also noted. RESULTS Twenty-eight patients met the study criteria, with a mean age of 10 years. The most common etiology of hydrocephalus was intraventricular hemorrhage of prematurity. All shunts were externalized at presentation. One shunt was removed without subsequent internalization. Distal catheters were re-internalized back into the peritoneal cavity in 11 patients (laparoscopy was used in 8 cases). Fourteen shunts were converted to a ventriculoatrial shunt (VAS), and two to a ventriculopleural (VPlS). Two VPSs failed due to a recurrent pseudocyst. The total all-cause failure rates at 1 year were as follows: 18% for VPSs and 50% for VASs. CONCLUSIONS Following treatment of a VPS-related sterile abdominal pseudocyst, laparoscopy-assisted placement of the distal catheter in the peritoneum is a viable and safe option for select patients, compared to a VAS or VPlS.
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Affiliation(s)
- Andrew Erwood
- 1Pediatric Neurosurgery Associates at Children's Healthcare of Atlanta
- 2Department of Neurosurgery, Emory University Hospital, Atlanta, Georgia
| | - Rima S Rindler
- 1Pediatric Neurosurgery Associates at Children's Healthcare of Atlanta
- 2Department of Neurosurgery, Emory University Hospital, Atlanta, Georgia
| | - Mustafa Motiwala
- 3College of Medicine, University of Tennessee Health Science Center
| | - Sonia Ajmera
- 3College of Medicine, University of Tennessee Health Science Center
| | | | - Paul Klimo
- 4Le Bonheur Children's Hospital
- 5Semmes Murphey; and
| | - Joshua J Chern
- 1Pediatric Neurosurgery Associates at Children's Healthcare of Atlanta
- 2Department of Neurosurgery, Emory University Hospital, Atlanta, Georgia
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Hersh DS, Moore K, Nguyen V, Elijovich L, Choudhri AF, Lee-Diaz JA, Khan RB, Vaughn B, Klimo P. Evaluation and treatment of children with radiation-induced cerebral vasculopathy. J Neurosurg Pediatr 2019; 24:680-688. [PMID: 31629322 DOI: 10.3171/2019.7.peds19188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 07/02/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Stenoocclusive cerebral vasculopathy is an infrequent delayed complication of ionizing radiation. It has been well described with photon-based radiation therapy but less so following proton-beam radiotherapy. The authors report their recent institutional experience in evaluating and treating children with radiation-induced cerebral vasculopathy. METHODS Eligible patients were age 21 years or younger who had a history of cranial radiation and subsequently developed vascular narrowing detected by MR arteriography that was significant enough to warrant cerebral angiography, with or without ischemic symptoms. The study period was January 2011 to March 2019. RESULTS Thirty-one patients met the study inclusion criteria. Their median age was 12 years, and 18 (58%) were male. Proton-beam radiation therapy was used in 20 patients (64.5%) and photon-based radiation therapy was used in 11 patients (35.5%). Patients were most commonly referred for workup as a result of incidental findings on surveillance tumor imaging (n = 23; 74.2%). Proton-beam patients had a shorter median time from radiotherapy to catheter angiography (24.1 months [IQR 16.8-35.4 months]) than patients who underwent photon-based radiation therapy (48.2 months [IQR 26.6-61.1 months]; p = 0.04). Eighteen hemispheres were revascularized in 15 patients. One surgical patient suffered a contralateral hemispheric infarct 2 weeks after revascularization; no child treated medically (aspirin) has had a stroke to date. The median follow-up duration was 29.2 months (IQR 21.8-54.0 months) from the date of the first catheter angiogram to last clinic visit. CONCLUSIONS All children who receive cranial radiation therapy from any source, particularly if the parasellar region was involved and the child was young at the time of treatment, require close surveillance for the development of vasculopathy. A structured and detailed evaluation is necessary to determine optimal treatment.
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Affiliation(s)
| | | | | | - Lucas Elijovich
- Departments of1Neurosurgery and
- 2Neurology, University of Tennessee Health Science Center
- 3Semmes Murphey Clinic
| | - Asim F Choudhri
- Departments of1Neurosurgery and
- 4Department of Radiology, University of Tennessee Health Science Center
- 5Division of Neuroradiology, Le Bonheur Neuroscience Institute
- 6Le Bonheur Children's Hospital; and
| | - Jorge A Lee-Diaz
- Departments of1Neurosurgery and
- 4Department of Radiology, University of Tennessee Health Science Center
- 5Division of Neuroradiology, Le Bonheur Neuroscience Institute
- 6Le Bonheur Children's Hospital; and
| | - Raja B Khan
- 7Division of Neurology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | - Paul Klimo
- Departments of1Neurosurgery and
- 3Semmes Murphey Clinic
- 6Le Bonheur Children's Hospital; and
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Motiwala M, Ajmera S, Akinduro O, Wallace D, Norrdahl SP, Schultz A, Fraser B, Saad H, Justo M, Dave P, Nguyen V, Vaughn B, Michael LM, Klimo P. How Does the Media Portray Neurosurgeons? World Neurosurg 2019; 122:e598-e605. [PMID: 31108076 DOI: 10.1016/j.wneu.2018.10.110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 10/15/2018] [Accepted: 10/17/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND It is not unusual to find neurosurgeons in the news and entertainment. The present study examined the portrayal of neurosurgeons by major print and online media sources. METHODS Two search strategies identified articles from October 1, 2012 to October 1, 2017 containing the keyword "neurosurgeon." The top 25 newspapers in the United States, determined by their circulation, were searched using the LexisNexis Academic or NewsBank databases; a layman's Google News search was used to collect online stories. Each identified article was evaluated to confirm the relevance and then examined for content. Relevant characteristics for each article and neurosurgeon were determined and analyzed. RESULTS Our searches returned 1005 articles comprising 561 unique stories about 203 different neurosurgeons. One particular neurosurgeon had 459 reports (45.7%). More articles were reported in 2015 (405; 40.3%) than any other single year. Most articles featured male neurosurgeons (879; 87.1%) and neurosurgeons who had been practicing for >20 years (636; 63.0%), with just 10 institutions accounting for the training of most of them (733; 72.6%). The articles were classified as positive (270; 26.9%), negative (356; 35.4%), or neutral (379; 37.7%) in terms of their reflection on the field of neurosurgery. The odds of a negative story were greater for male neurosurgeons, within 10 years of residency completion, and in a nonacademic position. CONCLUSIONS Neurosurgeons are naturally subject to media coverage, and we must be cognizant that this predilection can serve as both an occupational advantage and an occupational hazard.
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Affiliation(s)
- Mustafa Motiwala
- University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Sonia Ajmera
- University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Olutomi Akinduro
- University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - David Wallace
- University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | | | - Andrew Schultz
- University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Brittany Fraser
- University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Hassan Saad
- Arkansas Neuroscience Institute, CHI St. Vincent Infirmary, Little Rock, Arkansas, USA
| | - Melissa Justo
- University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | | | - Vincent Nguyen
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Brandy Vaughn
- Le Bonheur Children's Hospital, Memphis, Tennessee, USA
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA; Semmes Murphey, Memphis, Tennessee, USA
| | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA; Le Bonheur Children's Hospital, Memphis, Tennessee, USA; Semmes Murphey, Memphis, Tennessee, USA.
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Patel P, Wallace D, Boop FA, Vaughn B, Robinson GW, Gajjar A, Klimo P. Reoperation for Medulloblastoma Prior to Adjuvant Therapy. Neurosurgery 2019; 84:1050-1058. [PMID: 29660028 DOI: 10.1093/neuros/nyy095] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 04/04/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Surgery remains an integral part of the treatment of medulloblastoma. We present our experience with repeat surgery for this tumor before initiation of adjuvant therapy. OBJECTIVE To report what was found intraoperatively and where at time of second-look surgery and detail any postoperative events or readmissions within 90 days of surgery. METHODS Two separate institutional databases were queried to identify patients who underwent repeat resection of suspected residual medulloblastoma from January 2003 to January 2017. RESULTS We identified 51 patients (36 male, 15 female) who underwent repeat surgery. Average age at diagnosis was 8.31 years (range, 1.3-21.2). Imaging prior to repeat surgery demonstrated unequivocal residual tumor in 37 patients, but indeterminate in 14 patients. All but 1 patient had histopathologically confirmed residual tumor (50/51, 98%). The fourth ventricle was the primary site in 39 (76%) cases, compared with hemispheric in 12 cases (24%). Thirty (59%) tumors were non-WNT/non-SHH. All indeterminate cases (except for 1 patient) had residual tumor. Hemostatic agents were found within the resection cavity in 80% of indeterminate cases. The most common sites of residual tumor were lateral (26/39, 67%, lateral recess and/or foramen of Luschka) and roof (25/39, 64%); the superior medullary velum was the most common region of the roof (19/25, 76%). Eight (16%) patients developed new neurological deficits: cranial nerve palsies in 5 patients and posterior fossa syndrome in 3 patients. CONCLUSION Meticulous inspection of the resection cavity is necessary, paying particular attention to the roof and lateral recess. Hemostatic agents can conceal residual tumor.
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Affiliation(s)
- Prayash Patel
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - David Wallace
- College of Medicine, University of Tennessee Health Sciences, Memphis, Tennessee
| | - Frederick A Boop
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee.,Le Bonheur Children's Hospital, Memphis, Tennessee.,Semmes Murphey, Memphis, Tennessee
| | | | - Giles W Robinson
- Division of Neuro-oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Amar Gajjar
- Division of Neuro-oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee.,Le Bonheur Children's Hospital, Memphis, Tennessee.,Semmes Murphey, Memphis, Tennessee
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Ajmera S, Motiwala M, Khan NR, Smith LJ, Giles K, Vaughn B, Klimo P. Image Guidance for Ventricular Shunt Surgery: An Analysis of Hospital Charges. Neurosurgery 2019; 85:E765-E770. [DOI: 10.1093/neuros/nyz090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 03/04/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Image guidance for shunt surgery results in more accurate proximal catheter placement. However, reduction in shunt failure remains unclear in the literature. There have been no prior studies evaluating the cost effectiveness of neuronavigation for shunt surgery.
OBJECTIVE
To perform a cost analysis using available hospital charges of hypothetical shunt surgery performed with/without electromagnetic neuronavigation (EMN).
METHODS
Hospital charges were collected for physician fees, radiology, operating room (OR) time and supplies, postanesthesia care unit, hospitalization days, laboratory, and medications. Index shunt surgery charges (de novo or revision) were totaled and the difference calculated. This difference was compared with hospital charges for shunt revision surgery performed under 2 clinical scenarios: (1) same hospital stay as the index surgery; and (2) readmission through the emergency department.
RESULTS
Costs for freehand de novo and revision shunt surgery were $23 946.22 and $23 359.22, respectively. For stealth-guided de novo and revision surgery, the costs were $33 646.94 and $33 059.94, a difference of $9700.72. The largest charge increase was due to additional OR time (34 min; $4794), followed by disposable EMN equipment ($2672). Total effective charges to revise the shunt for scenarios 1 and 2 were $34 622.94 and $35 934.94, respectively. The cost ratios between the total revision charges for both scenarios and the difference in freehand vs EMN-assisted shunt surgery ($9700.72) were 3.57 and 3.70, respectively.
CONCLUSION
From an economic standpoint and within the limitations of our models, the number needed to prevent must be 4 or less for the use of neuronavigation to be considered cost effective.
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Affiliation(s)
- Sonia Ajmera
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Mustafa Motiwala
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Nickalus R Khan
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | | | | | | | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
- Semmes Murphey, Memphis, Tennessee
- Le Bonheur Children's Hospital, Memphis, Tennessee
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Ajmera S, Motiwala M, Lingo R, Khan NR, Smith LJ, Giles K, Vaughn B, Klimo P. Emergent and Urgent Craniotomies in Pediatric Patients: Resource Utilization and Cost Analysis. Pediatr Neurosurg 2019; 54:301-309. [PMID: 31401624 DOI: 10.1159/000501042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 05/19/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Pediatric neurosurgeons are occasionally tasked with performing surgery expeditiously to preserve a child's neurologic faculties and life. OBJECTIVE This study examines the etiologies, outcomes, and costs for urgent or emergent craniotomies at a Level I Pediatric Trauma center over a 7-year time period. METHODS A retrospective review was conducted for each patient who underwent an emergent or urgent craniotomy within 24 hours of presentation between January 2010 and April 2017. Demographic, clinical, and surgical details were recorded for a total of 48 variables. Any readmission within 90 days was analyzed. Hospital charges for each admission and readmission were collected and adjusted for inflation to October 2018 values. RESULTS Among the 223 children who underwent urgent or emergent craniotomies, the majority were admitted for traumatic injuries (n = 163, 73.1%). The most common traumatic mechanism was fall (n = 51, 22.9%), and the most common non-traumatic cause was tumor (n = 21, 9.4%). Overall, craniotomies were typically performed for hematoma evacuation of one type or combination (n = 115, 51.6%) during off-peak times (n = 178, 79.8%). Seventy-seven (34.5%) subjects experienced 1 or more postoperative events, 22 of whom returned to the operating room. There were 13 (5.8%) and 33 (14.8%) readmissions within 30 days and 90 days of discharge, respectively. Non-trauma patients (compared with trauma patients) and polytrauma (compared with isolated head injury) had greater healthcare needs, resulting in higher charges. CONCLUSION Most urgent or emergent pediatric craniotomies were performed for the treatment of traumatic injuries involving hematoma evacuation, but non-traumatic patients were more complex requiring greater resources.
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Affiliation(s)
- Sonia Ajmera
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Mustafa Motiwala
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Ryan Lingo
- Neurological & Spine Institute, Savannah, Georgia, USA
| | - Nickalus R Khan
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Lydia J Smith
- Le Bonheur Children's Hospital, Memphis, Tennessee, USA
| | - Kim Giles
- Le Bonheur Children's Hospital, Memphis, Tennessee, USA
| | - Brandy Vaughn
- Le Bonheur Children's Hospital, Memphis, Tennessee, USA
| | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA, .,Le Bonheur Children's Hospital, Memphis, Tennessee, USA, .,Semmes Murphey, Memphis, Tennessee, USA,
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18
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Khan NR, Moore K, Basma J, Hersh DS, Choudhri AF, Vaughn B, Klimo P. Ischemic stroke following elective craniotomy in children. J Neurosurg Pediatr 2018; 23:355-362. [PMID: 30579265 DOI: 10.3171/2018.10.peds18491] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 10/04/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVE An ischemic stroke following an elective craniotomy in a child is perceived to be a rare event. However, to date there are few papers on this topic. The purpose of this study was to investigate the occurrence of stroke following elective intracranial surgery at a children’s hospital. METHODS The authors performed a retrospective review of all patients who developed a perioperative stroke following an elective craniotomy from 2010 through 2017. Data were collected using an institutional database that contained demographic, medical, radiological, and outcome variables. RESULTS A total of 1591 elective craniotomies were performed at the authors’ institution during the study period. Of these, 28 (1.8%) were followed by a perioperative stroke. Radiographic diagnosis of the infarction occurred at a median of 1.7 days (range 0–9 days) from the time of surgery, and neurological deficits were apparent within 24 hours of surgery in 18 patients (62.5%). Infarcts tended to occur adjacent to tumor resection sites (86% of cases), and in a unilateral (89%), unifocal (93%), and supratentorial (93%) location. Overall, 11 (39.3%) strokes were due to a perforating artery, 10 (35.7%) were due to a large vessel, 4 (14.3%) were venous, and 3 (10.7%) were related to hypoperfusion or embolic causes. Intraoperative MRI (iMRI) was used in 11 of the 28 cases, and 6 (55%) infarcts were not detected, all of which were deep. CONCLUSIONS The incidence of stroke following an elective craniotomy is low, with nearly all cases (86%) occurring after tumor resection. Perforator infarcts were most common but may be missed on iMRI. ABBREVIATIONS ACA = anterior cerebral artery; AChA = anterior choroidal artery; ACS NSQIP-P = American College of Surgeons National Surgical Quality Improvement Program–Pediatric; CVA = cerebrovascular accident; DWI = diffusion weighted imaging; iMRI = intraoperative MRI; MCA = middle cerebral artery; mRS = modified Rankin Scale; PCA = posterior cerebral artery.
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Affiliation(s)
| | | | | | | | - Asim F Choudhri
- Departments of1Neurosurgery and.,2Radiology, University of Tennessee Health Science Center
| | | | - Paul Klimo
- Departments of1Neurosurgery and.,3Le Bonheur Children's Hospital; and.,4Semmes Murphey, Memphis, Tennessee
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Reinecke K, Vaughn B, Fan Z, Perry M, Roth H. 0818 Sleep and ADHD in Children: Are Pediatric Residents Considering Sleep Problems When Diagnosing ADHD? Sleep 2018. [DOI: 10.1093/sleep/zsy061.817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K Reinecke
- University of North Carolina, Chapel Hill, NC
| | - B Vaughn
- University of North Carolina, Chapel Hill, NC
| | - Z Fan
- University of North Carolina, Chapel Hill, NC
| | - M Perry
- University of North Carolina, Chapel Hill, NC
| | - H Roth
- University of North Carolina, Chapel Hill, NC
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Dewan MC, Lim J, Gannon SR, Heaner D, Davis MC, Vaughn B, Chern JJ, Rocque BG, Klimo P, Wellons JC, Naftel RP. Comparison of hydrocephalus metrics between infants successfully treated with endoscopic third ventriculostomy with choroid plexus cauterization and those treated with a ventriculoperitoneal shunt: a multicenter matched-cohort analysis. J Neurosurg Pediatr 2018; 21:339-345. [PMID: 29393809 DOI: 10.3171/2017.10.peds17421] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE It has been suggested that the treatment of infant hydrocephalus results in different craniometric changes depending upon whether ventriculoperitoneal shunt (VPS) placement or endoscopic third ventriculostomy with choroid plexus cauterization (ETV/CPC) is performed. Without an objective and quantitative description of expected changes to the infant cranium and ventricles following ETV/CPC, asserting successful treatment of hydrocephalus is difficult. By comparing infants successfully treated via ETV/CPC or VPS surgery, the authors of this study aimed to define the expected postoperative cranial and ventricular alterations at the time of clinical follow-up. METHODS Patients who underwent successful treatment of hydrocephalus at 4 institutions with either VPS placement or ETV/CPC were matched in a 3:1 ratio on the basis of age and etiology. Commonly used cranial parameters (including head circumference [HC], HC z-score, fontanelle status, and frontooccipital horn ratio [FOHR]) were compared pre- and postoperatively between treatment cohorts. First, baseline preoperative values were compared to ensure cohort equivalence. Next, postoperative metrics, including the relative change in metrics, were compared between treatment groups using multivariate linear regression. RESULTS Across 4 institutions, 18 ETV/CPC-treated and 54 VPS-treated infants with hydrocephalus were matched and compared at 6 months postoperatively. The most common etiologies of hydrocephalus were myelomeningocele (61%), followed by congenital communicating hydrocephalus (17%), aqueductal stenosis (11%), and intraventricular hemorrhage (6%). The mean age at the time of CSF diversion was similar between ETV/CPC- and VPS-treated patients (3.4 vs 2.9 months; p = 0.69), as were all preoperative cranial hydrocephalus metrics (p > 0.05). Postoperatively, the ventricle size FOHR decreased significantly more following VPS surgery (-0.15) than following ETV/CPC (-0.02) (p < 0.001), yielding a lower postoperative FOHR in the VPS arm (0.42 vs 0.51; p = 0.01). The HC percentile was greater in the ETV/CPC cohort than in the VPS-treated patients (76th vs 54th percentile; p = 0.046). A significant difference in the postoperative z-score was not observed. With both treatment modalities, a bulging fontanelle reliably normalized at last follow-up. CONCLUSIONS Clinical and radiographic parameters following successful treatment of hydrocephalus in infants differed between ETV/CPC and VPS treatment. At 6 months post-ETV/CPC, ventricle size remained unchanged, whereas VPS-treated ventricles decreased to a near-normal FOHR. The HC growth control between the procedures was similar, although the final HC percentile may be lower after VPS. The fontanelle remained a reliable indicator of success for both treatments. This study establishes expected cranial and ventricular parameters following ETV/CPC, which may be used to guide preoperative counseling and postoperative decision making.
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Affiliation(s)
- Michael C Dewan
- 1Department of Neurosurgery, Vanderbilt University, Division of Pediatric Neurosurgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Jaims Lim
- 1Department of Neurosurgery, Vanderbilt University, Division of Pediatric Neurosurgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Stephen R Gannon
- 1Department of Neurosurgery, Vanderbilt University, Division of Pediatric Neurosurgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - David Heaner
- 2Department of Neurosurgery, Children's Healthcare of Atlanta, Georgia
| | - Matthew C Davis
- 3Department of Neurosurgery, University of Alabama at Birmingham, Alabama; and
| | - Brandy Vaughn
- 4Semmes Murphey Clinic.,6Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Joshua J Chern
- 2Department of Neurosurgery, Children's Healthcare of Atlanta, Georgia
| | - Brandon G Rocque
- 3Department of Neurosurgery, University of Alabama at Birmingham, Alabama; and
| | - Paul Klimo
- 4Semmes Murphey Clinic.,6Le Bonheur Children's Hospital, Memphis, Tennessee
| | - John C Wellons
- 1Department of Neurosurgery, Vanderbilt University, Division of Pediatric Neurosurgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Robert P Naftel
- 1Department of Neurosurgery, Vanderbilt University, Division of Pediatric Neurosurgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
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Ewing T, Ahn M, Kumar K, Vaughn B, Roth H, Fan Z. 0865 SLEEP PARAMETERS OF PATIENTS WITH DUCHENNE MUSCULAR DYSTROPHY. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.864] [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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Kamieniecki R, Vaughn B, Danielson J, Bonnie K, Carter M, Mihic T, Williams S, Puyat J. Characterizing the inpatient care of young adults experiencing early psychosis. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.02.409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Introduction/objectivesThe available literature suggests that treatments and health services for psychosis are considered to be poorly organized and highly variable. Little is known, however, about how inpatient care is provided to individuals experiencing early psychosis. To facilitate quality improvement activities, we characterized the care this patient group receives in an inner city hospital.MethodsWe performed chart reviews of individuals admitted to psychiatric inpatient units at St. Paul's Hospital, Vancouver, British Columbia between 01/04/2014 and 31/03/2016. Those who were 17–25 years of age and hospitalized for psychotic symptoms at the time of admission were included. Demographic and health service use were summarized using descriptive characteristics.ResultsWe identified 73 inpatients (mean age = 22; males = 78%; Caucasian = 41%) that met study inclusion criteria, having a combined total of 102 care episodes and an average length of stay of 30.7 days (median = 18; min = 3; max = 268). Half of the care episodes were repeat admissions, with up to 30% of the patients readmitted within 28 days of discharge. Physical and mental status examinations (MSE) were performed in virtually all care episodes, although frequency is low (31.4% had daily physical examinations and 18.6% had MSE every nursing shift). In 49% and 50% of care episodes, patients were given oral antipsychotics and discharged on depot medications. Even when indicated, not all care episodes had follow-up appointments (60%) or referrals to income assistance (35%), community mental health teams (61%), and housing support (38%).ConclusionsSpecific programs are needed to address current gaps in inpatient care for patients with early psychosis.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Gendreau R, Arnold L, Clauw D, Gendreau J, Vaughn B, Daugherty B, Lederman S. THU0560 TNX-102 SL for The Treatment of fibromyalgia: Comparison of 30% Pain Responder Analysis with Omeract Draft Composite Responder Endpoint Analyses:. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1327] [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: 11/04/2022]
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Frohlich F, Sellers K, Boyle M, Ali M, Cordle A, Vaughn B, Gilmore J. OP 9. Tailoring transcranial current stimulation to modulate cortical oscillations in computer simulations, ferrets, and humans. Clin Neurophysiol 2013. [DOI: 10.1016/j.clinph.2013.04.076] [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: 11/16/2022]
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Tian L, Yao T, MacClune K, White JWC, Schilla A, Vaughn B, Vachon R, Ichiyanagi K. Stable isotopic variations in west China: A consideration of moisture sources. ACTA ACUST UNITED AC 2007. [DOI: 10.1029/2006jd007718] [Citation(s) in RCA: 370] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Lide Tian
- Laboratory of Land Surface Processes Monitoring; Institute of Tibetan Plateau Research; Beijing China
- Stable Isotope Laboratory, Institute of Arctic and Alpine Research; University of Colorado; Boulder Colorado USA
- Key Laboratory of Cryosphere and Environment, Cold and Arid Regions Environment and Engineering Research Institute; Chinese Academy of Science; Lanzhou China
| | - Tandong Yao
- Laboratory of Land Surface Processes Monitoring; Institute of Tibetan Plateau Research; Beijing China
| | - K. MacClune
- Stable Isotope Laboratory, Institute of Arctic and Alpine Research; University of Colorado; Boulder Colorado USA
| | - J. W. C. White
- Stable Isotope Laboratory, Institute of Arctic and Alpine Research; University of Colorado; Boulder Colorado USA
| | - A. Schilla
- Stable Isotope Laboratory, Institute of Arctic and Alpine Research; University of Colorado; Boulder Colorado USA
| | - B. Vaughn
- Stable Isotope Laboratory, Institute of Arctic and Alpine Research; University of Colorado; Boulder Colorado USA
| | - R. Vachon
- Stable Isotope Laboratory, Institute of Arctic and Alpine Research; University of Colorado; Boulder Colorado USA
| | - K. Ichiyanagi
- Institute of Observational Research for Global Change; Yokosuka Japan
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Sever M, Arbes S, Zeldin D, Schal C, Santangelo R, Gore J, Vaughn B, Mitchell H. Cockroach Allergen Reduction by Extermination Alone in Low-Income, Urban Homes-A Randomized Control Trial. J Allergy Clin Immunol 2007. [DOI: 10.1016/j.jaci.2006.11.554] [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: 11/16/2022]
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Sever M, Arbes S, Gore J, Santangelo R, Vaughn B, Mitchell H, Schal C, Zeldin D. Cockroach Allergen Reduction by Extermination Alone in Low-Income, Urban Homes-A Randomized Control Trial. J Allergy Clin Immunol 2006. [DOI: 10.1016/j.jaci.2005.12.112] [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: 10/24/2022]
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Sever M, Arbes S, Vaughn B, Mehta J, Lynch J, Mitchell H, Hoppin J, Spencer H, Sandler D, Zeldin D. Feasibility of using subject-collected dust samples in epidemiological and clinical studies of indoor allergens. J Allergy Clin Immunol 2005. [DOI: 10.1016/j.jaci.2004.12.400] [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: 11/25/2022]
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Masarie KA, Langenfelds RL, Allison CE, Conway TJ, Dlugokencky EJ, Francey RJ, Novelli PC, Steele LP, Tans PP, Vaughn B, White JWC. NOAA/CSIRO Flask Air Intercomparison Experiment: A strategy for directly assessing consistency among atmospheric measurements made by independent laboratories. ACTA ACUST UNITED AC 2001. [DOI: 10.1029/2000jd000023] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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DeGiorgio CM, Schachter SC, Handforth A, Salinsky M, Thompson J, Uthman B, Reed R, Collins S, Tecoma E, Morris GL, Vaughn B, Naritoku DK, Henry T, Labar D, Gilmartin R, Labiner D, Osorio I, Ristanovic R, Jones J, Murphy J, Ney G, Wheless J, Lewis P, Heck C. Prospective long-term study of vagus nerve stimulation for the treatment of refractory seizures. Epilepsia 2000; 41:1195-200. [PMID: 10999559 DOI: 10.1111/j.1528-1157.2000.tb00325.x] [Citation(s) in RCA: 315] [Impact Index Per Article: 13.1] [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: 11/26/2022]
Abstract
PURPOSE To determine the long-term efficacy of vagus nerve stimulation (VNS) for refractory seizures. VNS is a new treatment for refractory epilepsy. Two short-term double-blind trials have demonstrated its safety and efficacy, and one long-term study in 114 patients has demonstrated a cumulative improvement in efficacy at 1 year. We report the largest prospective long-term study of VNS to date. METHODS Patients with six or more complex partial or generalized tonic-clonic seizures enrolled in the pivotal EO5 study were prospectively evaluated for 12 months. The primary outcome variable was the percentage reduction in total seizure frequency at 3 and 12 months after completion of the acute EO5 trial, compared with the preimplantation baseline. Subjects originally randomized to low stimulation (active-control group) were crossed over to therapeutic stimulation settings for the first time. Subjects initially randomized to high settings were maintained on high settings throughout the 12-month study. RESULTS The median reduction at 12 months after completion of the initial double-blind study was 45%. At 12 months, 35% of 195 subjects had a >50% reduction in seizures, and 20% of 195 had a >75% reduction in seizures. CONCLUSIONS The efficacy of VNS improves during 12 months, and many subjects sustain >75% reductions in seizures.
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Affiliation(s)
- C M DeGiorgio
- Olive View/UCLA Medical Center and UCLA Department of Neurology, Los Angeles, California 91342, USA.
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Johnson MM, Vaughn B, Triggiani M, Swan DD, Fonteh AN, Chilton FH. Role of arachidonyl triglycerides within lipid bodies in eicosanoid formation by human polymorphonuclear cells. Am J Respir Cell Mol Biol 1999; 21:253-8. [PMID: 10423409 DOI: 10.1165/ajrcmb.21.2.3489] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [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: 11/24/2022] Open
Abstract
Increasing evidence suggests that the subcellular and glycerolipid localization of esterified arachidonic acid (AA) is a key factor in regulating its availability to lipases. The goal of the current study was to determine the potential of AA stored in triglycerides (TG) to serve as a substrate for lipases and 5-lipoxygenase during neutrophil (polymorphonuclear leukocytes, PMN) activation. PMN containing high concentrations of AA in TG were generated by culturing PMN in vitro with high concentrations of exogenous AA (eAA) for 12 h. Cellular AA increased 2- and 4-fold in PMNs incubated with 5 and 20 microM AA, respectively, and this increase was almost exclusively observed in neutral lipids (NL). Further analysis revealed that 88% of the AA in the NL fraction was associated with TG. Subsequent experiments were designed to determine whether this AA in TG could be mobilized and metabolized to eicosanoids during cell activation. TG pools of AA were increased as previously described and then PMN were stimulated with ionophore, A23187. In contrast to the 43-fold increase in TG AA after eAA loading (20 microM), free AA increased by only 1.9-fold after cell stimulation. Similarly, leukotriene (LT)B(4) production increased only 2-fold after loading TG with large quantities of AA. The magnitude of increase in free AA released and in LTB(4) formation was similar to the magnitude of increase in AA mass in phospholipase (PL), suggesting that PL, and not TG, served as the source of released AA and subsequent product generation. To confirm that AA in TG did not serve as a source for eicosanoid production, cellular pools of AA were differentially labeled with [(14)C]AA and [(3)H]AA, and the [(3)H]AA-to-[(14)C]AA ratio of LTB(4) and 20-hydroxyl LTB(4) produced during cell stimulation was measured. The [(3)H]AA/[(14)C]AA ratios of LTs were markedly different from the ratios in TG, thus providing further evidence that AA pools in TG are not a major source of AA for LT generation.
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Affiliation(s)
- M M Johnson
- Department of Medicine, Mayo Clinic Jacksonville, Jacksonville, Florida, USA.
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Vaughn B. Clinical review of 1996. Nurs Stand 1996; 11:39. [PMID: 9000942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Verdi CJ, Garewal HS, Koenig LM, Vaughn B, Burkhead T. A double-blind, randomized, placebo-controlled, crossover trial of pentoxifylline for the prevention of chemotherapy-induced oral mucositis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995; 80:36-42. [PMID: 7552860 DOI: 10.1016/s1079-2104(95)80014-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Oral mucositis is a frequent side effect of cancer therapy. No effective method of prophylaxis is currently available. We conducted a randomized, double-blind, placebo-controlled, crossover trial of pentoxifylline to evaluate its potential in preventing mucositis in cancer patients receiving chemotherapy. Ten cancer patients were randomized for treatment with a 15-day course of 400 mg of pentoxifylline given orally four times daily. Concurrent chemotherapy consisted of bolus cisplatin and infusional 5-fluorouracil. Mucositis was evaluated with the use of the Oral Assessment Guide developed at the University of Nebraska. Patients completing two cycles of chemotherapy--one with pentoxifylline and one with placebo--were evaluated for prophylaxis efficacy. Comparison of the oral assessment scores of the two cycles with a two-sided Student's t test failed to demonstrate a cytoprotective effect for pentoxifylline over placebo. We conclude that pentoxifylline as given in this study is ineffective for preventing mucositis in patients receiving cisplatin and 5-FU.
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Affiliation(s)
- C J Verdi
- Section of Hematology/Oncology, Tucson Veteran's Affairs Medical Center, Ariz., USA
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Abstract
Freud (1905, 1917, 1937) throughout his lifetime sought empirical scientific confirmation of the validity of his discoveries. In pursuit of this goal, he persistently emphasized the importance of establishing agreement between analytic reconstructions and the results of naturalistic child observation. The same objective lead Lichtenberg (1983), Emde (1981, 1985), and Stern (1985) to produce detailed evaluations of the impact of infant research findings on analytic developmental propositions. The present paper examines the relation among clinical reconstructions from an analysis developed through transference interpretations, empirical observations originating in the analytic patient's daughter's psychotherapy, and the results of empirical infant research that was being concurrently conducted by two of the authors. The findings from the clinical analysis of the mother, the psychotherapy of the daughter, and empirical infant research all converged on the same larger causative factor for the daughter's psychopathology--a type of maternal deprivation. Such a confluence of different sources of evidence, each identified by a different method of investigation, provides one kind of validation for psychoanalytic reconstructions, making it possible to provide that "satisfactory degree of certainty" which Freud (1937) called for in the attempt to integrate the patient's "psychic truth" with "actual" or historical truth.
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Affiliation(s)
- P Barglow
- Department of Psychiatry, Michael Reese Hospital, Chicago
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Vaughn B, Seifer R, Lefever G, Smith C. Relations among mastery assessed during problem solving, attachment security, and free-play behavior. Infant Behav Dev 1986. [DOI: 10.1016/s0163-6383(86)80395-2] [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: 11/25/2022]
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Cartwright PS, Vaughn B, Tuttle D. Culdocentesis and ectopic pregnancy. J Reprod Med 1984; 29:88-91. [PMID: 6708032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Seventy-seven patients with ectopic pregnancy underwent culdocentesis; the tap was positive in 70%, negative in 10% and inadequate in 20%. A positive tap was significantly associated with a low hematocrit but was often obtained in patients without hypotension, tachycardia, peritoneal irritation or tubal rupture. While patients with peritoneal irritation were significantly more likely to have a large hemoperitoneum, many with 500 ml or more of hemoperitoneum did not have peritoneal irritation, hypotension, tachycardia, low hematocrit or tubal rupture. Culdocentesis is valuable for evaluating the patient suspected of having an ectopic pregnancy, and the absence of tachycardia, hypotension, low hematocrit or peritoneal irritation should not dissuade one from performing the test. A positive tap does not indicate tubal rupture, and a large hemoperitoneum may accumulate in its absence.
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Redmond SR, Spitz S, Vaughn B. Mumps, bumps, and vaccination policy. Lancet 1983; 2:1311-2. [PMID: 6139657 DOI: 10.1016/s0140-6736(83)91195-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Farber EA, Vaughn B, Egeland B. The relationship of prenatal maternal anxiety to infant behavior and mother-infant interaction during the first six months of life. Early Hum Dev 1981; 5:267-77. [PMID: 7261990 DOI: 10.1016/0378-3782(81)90034-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The IPAT Anxiety Scale was administered to a large sample of primiparous women from an economically disadvantaged population in their third trimester of pregnancy. At birth and at three and six months postpartum, the infants and mothers were assessed using a variety of behavioral and standardized procedures. Results indicate that anxiety was not a factor in the incidence of pregnancy and delivery complications or infant anomalies. Neonatal behavior and mother-infant interaction did differ among the high anxious and the low anxious groups. These differences, however, were only significant for female infants. Results are discussed in terms of practical implications and future research.
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Abstract
The present study reports data concerning the discriminant validity of the Carey Infant Temperament Questionnaire. Subjects were 187 primiparous women who completed a battery of psychologic tests prior to the births of their infants. They also filled out the ITQ at three and six months after the baby was born. Nine of the 20 variables derived from the prenatal test battery discriminated mothers whose babies were diagnosed as temperamentally "difficult" from those whose infants were diagnosed as temperamentally "easy" based on three-month ITQ scores. Seven of the prenatal variables similarly discriminated these two groups on the six-month ITQ. The implications of these findings for uses of the ITQ are discussed.
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Vaughn B, Egeland B, Sroufe LA, Waters E. Individual differences in infant-mother attachment at twelve and eighteen months: stability and change in families under stress. Child Dev 1979; 50:971-5. [PMID: 535447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
100 economically disadvantaged mothers and their infants were observed in the Ainsworth and Wittig "strange situation" at 12 and 18 months. Infants were classified as secure, anxiously attached/avoidant, or anxiously attached/resistant. In addition, mothers reported occurrence of stressful events related to the stability of the caretaking environment during the 12--18 month period by completing a 44-item checklist concerning work, finances, family, neighbors, health, etc. 62 infants were assigned to the same attachment classification at both 12 and 18 months (p less than .01). Despite this stability, significantly more infants changes classification than in a recent study of stable middle-class families. With the present sample, anxious attachment was associated with less stable caretaking environments than secure attachment; change from secure to anxious attachment was associated with higher stressful-event scores than stable secure attachment.
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Vaughn B, Sroufe LA. The temporal relationship between infant heart rate acceleration and crying in an aversive situation. Child Dev 1979; 50:565-7. [PMID: 487890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The temporal relationship between heart rate (HR) acceleration and crying was examined in 16 8-16-month-old infants. Consistently, the HR acceleration began well before the onset of crying, suggesting that such acceleration is not merely a by-product of crying. The accelerations observed were above and beyond a return to baseline following orienting. The crying itself validates the association between these instances of HR acceleration and negative effect.
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