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https://www.readbyqxmd.com/read/28512045/early-diagnosis-of-delayed-cerebral-ischemia-possible-relevance-for-inflammatory-biomarkers-in-routine-clinical-practice
#1
Bishwas Chamling, Stefan Gross, Birgit Stoffel-Wagner, Gerrit A Schubert, Hans Clusmann, Mark Coburn, Anke Höllig
BACKGROUND: Delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH) is one of the main causes of neurological deterioration. However, it frequently evades timely detection. Early identification and effective reversal may improve the clinical outcome. In this prospective study, we evaluate several serum inflammatory markers after aSAH with regard to the occurrence of DCI. METHODS: On days 1, 4, 7, 10 and 14 after SAH leucocyte count, C-reactive protein, interleukin-6, E-selectin, matrix metallopeptidase 9, intercellular adhesion molecule 1 and leukemia inhibitory factor were assessed in patients´ serum samples...
May 13, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28502692/what-factors-determine-treatment-outcome-in-aneurysmal-subarachnoid-haemorrhage-in-the-modern-era-a-post-hoc-stash-analysis
#2
Mario Teo, Mathew R Guilfoyle, Carole Turner, Peter J Kirkpatrick
INTRODUCTION: The management of aneurysmal SAH has changed dramatically in the last few decades with the publication of a few major studies including The International Cooperative Study on the Timing of Aneurysm Surgery Study, International Subarachnoid Aneurysm Trial (ISAT). The aim of this study is to analyse the outcome of patients with aSAH based on a contemporary series, identify the risk factors for poor outcome, and focusing on patients with good grades aSAH (to match the ISAT cohort)...
May 11, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28475749/ineffective-esophageal-motility-clinical-manometric-and-outcome-characteristics-in-patients-with-and-without-abnormal-esophageal-acid-exposure
#3
K P Shetler, S Bikhtii, G Triadafilopoulos
The etiology and clinical impact of ineffective esophageal motility (IEM) remain poorly understood. Unless gastroesophageal acid reflux (GERD) is identified, symptomatic patients with IEM are challenging to treat. We sought to determine whether any clinical or functional characteristics could distinguish those patients with IEM and either normal or abnormal esophageal acid exposure.In this retrospective cohort study, we identified 46 consecutive patients presenting with heartburn, and other GER symptoms who underwent clinical, endoscopic, and functional evaluation that included high-resolution manometry (HRM) and ambulatory pH monitoring...
June 1, 2017: Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus
https://www.readbyqxmd.com/read/28466506/bolus-clearance-in-esophagogastric-junction-outflow-obstruction-is-associated-with-strength-of-peristalsis
#4
A Jain, J R Baker, J H Rubenstein, J W Chen
BACKGROUND: A manometric diagnosis of esophagogastric junction outflow obstruction (EGJOO) without a mechanical cause creates a therapeutic conundrum. The aim of this study was to assess esophageal bolus clearance in EGJOO and assess manometric factors associated with clearance in EGJOO. METHODS: Bolus clearance was assessed using line-tracing method and contour method to determine Complete Bolus Transit (CBT) and Functional Clearance (FC), respectively, on combined High-Resolution Impedance Manometry (HRIM)...
May 3, 2017: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
https://www.readbyqxmd.com/read/28442458/circulating-micrornas-in-delayed-cerebral-infarction-after-aneurysmal-subarachnoid-hemorrhage
#5
Gang Lu, Man Sze Wong, Mark Zhi Qiang Xiong, Chi Kwan Leung, Xian Wei Su, Jing Ye Zhou, Wai Sang Poon, Vera Zhi Yuan Zheng, Wai Yee Chan, George Kwok Chu Wong
BACKGROUND: Delayed cerebral infarction (DCI) is a major cause of morbidities after aneurysmal subarachnoid hemorrhage (SAH) and typically starts at day 4 to 7 after initial hemorrhage. MicroRNAs (miRNAs) play an important role in posttranscriptional gene expression control, and distinctive patterns of circulating miRNA changes have been identified for some diseases. We aimed to investigate miRNAs that characterize SAH patients with DCI compared with those without DCI. METHODS AND RESULTS: Circulating miRNAs were collected on day 7 after SAH in healthy, SAH-free controls (n=20), SAH patients with DCI (n=20), and SAH patients without DCI (n=20)...
April 25, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28429454/scuba-diving-patent-foramen-ovale-and-heart-rhythm-disturbances-the-role-of-underwater-holter-monitoring-case-report
#6
Szymon Olędzki, Andrzej Wojtarowicz, Edyta Płońska-Gościniak, Maciej Lewandowski, Jarosław Gorący
Patent foramen ovale (PFO) is thought to be a risk factor for decompression illness (DCI). Catheter-based closure procedure reduces the risk of DCI in selected scuba divers with PFO. Major complication of invasive approach are rare, minor, especially heart rhythm disturbances are reported relatively often. We describe a case of 41-year-old diver, who underwent PFO closure due to recurrent DCI events. Afterward, he experienced no DCI symptoms; however, he complained about feeling of the heart beating during a submersion...
April 21, 2017: Annals of Noninvasive Electrocardiology
https://www.readbyqxmd.com/read/28419304/incorporating-a-modified-graeb-score-to-the-modified-fisher-scale-for-improved-risk-prediction-of-delayed-cerebral-ischemia-following-aneurysmal-subarachnoid-hemorrhage
#7
Matt E Eagles, Blessing N R Jaja, R Loch Macdonald
BACKGROUND: Delayed cerebral ischemia (DCI) is a cause of poor outcome after aneurysmal subarachnoid hemorrhage. Risk scales to predict DCI have scarcely been evaluated for predictive accuracy. Accounting for volume of intraventricular hemorrhage (IVH) in the modified Fischer scale (mFS) may improve its predictive accuracy. OBJECTIVE: To compare the modified Graeb score (mGS) to the mFS for risk prediction of DCI, and to investigate whether incorporating an mGS cut-point into the mFS could improve predictive accuracy...
April 17, 2017: Neurosurgery
https://www.readbyqxmd.com/read/28411929/updates-in-decompression-illness
#8
REVIEW
Neal W Pollock, Dominique Buteau
Decompression sickness and arterial gas embolism, collectively known as decompression illness (DCI), are rare but serious afflictions that can result from compressed gas diving exposures. Risk is primarily determined by the pressure-time profile but is influenced by several factors. DCI can present idiosyncratically but with a wide range of neurologic symptoms. Examination is critical for assessment in the absence of diagnostic indicators. Many conditions must be considered in the differential diagnosis. High-fraction oxygen breathing provides first aid but definitive treatment of DCI is hyperbaric oxygen...
May 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28408642/elevated-intrabolus-pressure-identifies-obstructive-processes-when-integrated-relaxation-pressure-is-normal-on-esophageal-high-resolution-manometry
#9
Farhan Quader, Chanakyaram Reddy, Amit Patel, C Prakash Gyawali
BACKGROUND: Elevated integrated relaxation pressure (IRP) on esophageal high resolution manometry (HRM) identifies obstructive processes at the esophagogastric junction (EGJ). AIM: To determine if intrabolus pressure (IBP) can identify structural EGJ processes when IRP is normal. METHODS: In this observational cohort study, adult patients with dysphagia and undergoing HRM were evaluated for endoscopic evidence of structural EGJ processes (strictures, rings, hiatus hernia) in the setting of normal IRP...
April 13, 2017: American Journal of Physiology. Gastrointestinal and Liver Physiology
https://www.readbyqxmd.com/read/28387139/intracortical-electrophysiological-correlates-of-blood-flow-after-severe-sah-a-multimodality-monitoring-study
#10
Brandon Foreman, David Albers, J Michael Schmidt, Cristina Maria Falo, Angela Velasquez, E Sander Connolly, Jan Claassen
Subarachnoid hemorrhage (SAH) is a devastating form of stroke. Approximately one in four patients develop progressive neurological deterioration and silent infarction referred to as delayed cerebral ischemia (DCI). DCI is a complex, multifactorial secondary brain injury pattern and its pathogenesis is not fully understood. We aimed to study the relationship between cerebral blood flow (CBF) and neuronal activity at both the cortex and in scalp using electroencephalography (EEG) in poor-grade SAH patients undergoing multimodality intracranial neuromonitoring...
January 1, 2017: Journal of Cerebral Blood Flow and Metabolism
https://www.readbyqxmd.com/read/28365434/ultra-early-angiographic-vasospasm-after-aneurysmal-subarachnoid-hemorrhage-a%C3%A2-systematic-review-and-meta-analysis
#11
REVIEW
Kevin Phan, Justin M Moore, Christoph J Griessenauer, Joshua Xu, Ian Teng, Adam A Dmytriw, Albert H Chiu, Christopher S Ogilvy, Ajith Thomas
OBJECTIVE: After aneurysmal subarachnoid hemorrhage (aSAH), prognosis is affected heavily by the presence of delayed cerebral ischemia (DCI). There is growing recognition of ultra-early angiographic vasospasm (UEAV) occurring within 48 hours of aSAH; however, its relationship with DCI and ultimately prognosis remains unclear. METHODS: Various databases limited to the English language through September 2016 were searched systematically. Eligible studies were those comparing UEAV with control non-UEAV outcomes and follow-up...
March 29, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28357826/anton-s-syndrome-as-a-presentation-of-decompression-illness
#12
Charles Paul Azzopardi, Lyubisa Matity, Stephen Muscat
We present a case of a patient with Anton's syndrome due to decompression illness (DCI) after recreational scuba diving. Visual anosognosia, or denial of loss of vision, which is associated with lack of awareness regarding visual loss in the setting of cortical blindness, is known as Anton's syndrome (also termed Anton-Babinski syndrome). Our patient presented with progressive neurological DCI treated with repeated recompression. The anosogosia resolved after 48 h. Subsequent echocardiography revealed a persistent (patent) foramen ovale...
March 2017: Diving and Hyperbaric Medicine: the Journal of the South Pacific Underwater Medicine Society
https://www.readbyqxmd.com/read/28351547/the-road-to-union-protocol-for-the-reconstruction-of-isolated-complex-high-energy-tibial-trauma
#13
Erik Hohmann, Franz Birkholtz, Vaida Glatt, Kevin Tetsworth
INTRODUCTION: The purpose of this study was to describe a standardized staged approach, "The Road to Union", for the reconstruction of isolated complex tibial trauma, both acute and chronic in nature. METHODS: This retrospective study included all patients treated for complex tibial trauma at a specialized limb reconstruction centre, including acute open fracture as well as infected and aseptic non-unions. This standardized approach includes eight specific steps, employed in sequence...
March 18, 2017: Injury
https://www.readbyqxmd.com/read/28336550/the-effect-of-intravenous-corticotropin-releasing-hormone-administration-on-esophageal-sensitivity-and-motility-in-health
#14
Charlotte Broers, Chloé Melchior, Lukas Van Oudenhove, Tim Vanuytsel, Brecht Van Houtte, Charlotte Scheerens, Nathalie Rommel, Jan Tack, Ans Pauwels
Esophageal hypersensitivity is important in gastroesophageal reflux disease (GERD) patients who are refractory to acid-suppressive therapy. Stress affects visceral sensitivity and exacerbates heartburn in GERD. Peripheral CRH is a key mediator of the gut stress response. We hypothesize that CRH increases esophageal sensitivity and alters esophageal motility in health. Esophageal sensitivity to thermal, mechanical, electrical, and chemical stimuli was assessed in 14 healthy subjects after administration of placebo or CRH (100 μg iv)...
May 1, 2017: American Journal of Physiology. Gastrointestinal and Liver Physiology
https://www.readbyqxmd.com/read/28325788/decompression-illness-with-hypovolemic-shock-and-neurological-failure-symptoms-after-two-risky-dives-a-case-report
#15
Sebastian Klapa, Johannes Meyne, Wataru Kähler, Frauke Tillmans, Henning Werr, Andreas Binder, Andreas Koch
Hypovolemia is known to be a predisposing factor of decompression illness (DCI) while diving. The typical clinically impressive neurological symptoms of DCI may distract from other symptoms such as an incipient hypovolemic shock. We report the case of a 61-year-old male Caucasian, who presented with an increasing central and peripheral neural failure syndrome and massive hypovolemia after two risky dives. Computed tomography (CT) scans of the chest and Magnetic resonance imaging scans of the head revealed multiple cerebral and pulmonary thromboembolisms...
March 2017: Physiological Reports
https://www.readbyqxmd.com/read/28323187/activation-of-cytotoxic-natural-killer-cells-after-aneurysmal-subarachnoid-hemorrhage
#16
Daniel Spitzer, Nina J Spitzer, Monika Deininger, Christian R Wirtz, Ralph König, Timo Burster, Thomas Kapapa
OBJECTIVE: Cell-mediated inflammation is critical in the development of cerebrovascular complications after aneurysmal subarachnoid hemorrhage. We analyzed the course for activated CD16(bright)CD56(dim) cytotoxic natural killer (NK) cells in cerebrospinal fluid of 15 patients. METHODS: Patients were classified by occurrence of cerebral vasospasm (CV) and delayed cerebral ischemia. NK were monitored by flow cytometry between day 1 and 14 after hemorrhage. RESULTS: Twelve patients (80%) developed CV with a mean day of detection at 3...
May 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28320890/a-biophysical-vascular-bubble-model-for-devising-decompression-procedures
#17
Ran Arieli, Abraham Marmur
Vascular bubble models, which present a realistic biophysical approach, hold great promise for devising suitable diver decompression procedures. Nanobubbles were found to nucleate on a flat hydrophobic surface, expanding to form bubbles after decompression. Such active hydrophobic spots (AHS) were formed from lung surfactants on the luminal aspect of ovine blood vessels. Many of the phenomena observed in these bubbling vessels correlated with those known to occur in diving. On the basis of our previous studies, which proposed a new model for the formation of arterial bubbles, we now suggest the biophysical model presented herein...
March 2017: Physiological Reports
https://www.readbyqxmd.com/read/28319954/comparison-of-initial-vasopressors-used-for-delayed-cerebral-ischemia-after-aneurysmal-subarachnoid-hemorrhage
#18
Bhaskar Roy, Louise D McCullough, Rajat Dhar, James Grady, Yu-Bo Wang, Robert J Brown
BACKGROUND: The main reason for morbidity after aneurysmal subarachnoid hemorrhage (aSAH) is delayed cerebral ischemia (DCI). The mainstay of medical therapy for treating DCI is induced hypertension with vasopressors to restore cerebral perfusion. Both phenylephrine (PE) and norepinephrine (NE) are commonly used for induced hypertension, but the impact of the initial choice of vasopressor on the efficacy, adverse effects, or outcome after hemodynamic therapy for DCI is unknown. METHODS: Sixty-three patients with aSAH between January 2012 and October 2014, who developed DCI (defined as new focal deficit or decline in Glasgow Coma Score) and in which PE (n = 45) or NE (n = 18) treatment was initiated were evaluated in this retrospective study...
March 21, 2017: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/28298035/effect-of-intrathecal-milrinone-injection-via-lumbar-catheter-on-delayed-cerebral-ischemia-after-aneurysmal-subarachnoid-hemorrhage
#19
Masaomi Koyanagi, Hitoshi Fukuda, Benjamin Lo, Minami Uezato, Yoshitaka Kurosaki, Nobutake Sadamasa, Akira Handa, Masaki Chin, Sen Yamagata
OBJECTIVE Delayed cerebral ischemia (DCI) is an important complication after aneurysmal subarachnoid hemorrhage (aSAH). Although intrathecal milrinone injection via lumbar catheter to prevent DCI has been previously reported to be safe and feasible, its effectiveness remains unknown. The goal of this study was to evaluate whether intrathecal milrinone injection treatment after aSAH significantly reduced the incidence of DCI. METHODS The prospectively maintained aSAH database was used to identify patients treated between January 2010 and December 2015...
March 3, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28277491/manometric-subtypes-of-ineffective-esophageal-motility
#20
Mirjam Hiestand, Ala' Abdel Jalil, Donald O Castell
OBJECTIVES: Ineffective esophageal motility (IEM) is characterized by well-defined manometric criteria. However, much variation exists within the diagnosis: Some patients exhibit exactly the required five weak swallows to make the diagnosis. Others show consistently ineffective swallows with total absence of any normal swallow. "We hypothesize" there are two different manometric subtypes of IEM; IEM Alternans (IEM-A) and IEM Persistens (IEM-P). METHODS: A total of 231 IEM patients were identified by high-resolution manometry (HRM)...
March 9, 2017: Clinical and Translational Gastroenterology
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