Awake Craniotomy for Tumour Excision

Background

Craniotomy and excision of tumours can produce neurological deficits if the tumour is located close to eloquent areas of the brain. One technique of overcoming this problem is to keep the patient ‘awake’ during surgery.

Methods

Eight patients with intra cranial space occupying lesions (ICSOL) were operated ‘awake’, using a combination of skull block with sedation and analgesia. A mixture of 0.125% bupivacaine and 0.5% lignocaine was used for various nerve and field blocks. Midazolam, fentanyl and propofol in titrated doses were used to achieve conscious sedation.

Result

The procedure was successful in all the patients. They tolerated the procedure well and were able to follow the commands intraoperatively as desired. There were no significant complications.

Conclusion

Awake craniotomy with skull blocks with sedation and analgesia is a well established procedure. It requires a good rapport between surgeon, anaesthesiologist and the patient.Key Words: Awake craniotomy, Skull block, Sedation, Analgesia     

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胆道系统恶性肿瘤包括胆管癌和胆囊癌 ,前者主要指原发于肝内、肝门部和远端肝外胆管的恶性肿瘤。至今胆系肿瘤仍依ＴＮＭ分类法分为 0～Ⅳ期。 0期 :为原位癌 ;Ⅰ期 :肿瘤局限于粘膜层、肌层 ;Ⅱ期 :出现局部浸润 ;Ⅲ期 :在Ⅰ或Ⅱ期基础上肿瘤累及邻近组织或肝十二指肠韧带上淋巴结 ;Ⅳ期 :出现肝脏等器官受累或远处转移或出现以下之一区域的淋巴结转移 ,如胰周、十二指肠周、肝门周、腹腔及肠系膜。1　诊断胆系恶性肿瘤的诊断 ,主要依靠临床表现、实验室检查以及影象学检查。临床表现特异性不强 ,其中最基本的表现为胆道梗阻症状 ,同时可…     

国际脊髓损伤脊柱损伤基础数据集

收集脊柱损伤的信息对于脊髓损伤患者的诊断和治疗非常重要,设立脊髓损伤患者脊柱损伤基础数据集是为了规范脊柱损伤相关信息的收集方式和报告内容,学习并使用国际脊髓损伤脊柱损伤基础数据集,有助于规范和统一我国脊髓损伤患者脊柱损伤信息的收集,为相关治疗提供依据。本文将介绍国际脊髓损伤脊柱损伤基础数据集的研发过程,数据元素的内容以及数据编码的应用实例。     

Dental anxiety reduction and dental attendance after treatment in a dental fear clinic: a follow-up study

OBJECTIVES: The aim of the present study was to assess treatment outcome in terms of dental anxiety reduction at a post-treatment assessment and dental anxiety reduction and dental attendance one year later. Furthermore, it was determined to what extent psychopathological characteristics were related to treatment outcome. METHODS: Questionnaires were sent to 280 patients treated with one of three treatment modes (i.e., behavioral management (BM), nitrous oxide sedation (NOS), and intravenous sedation (IVS)) at a dental fear clinic in The Netherlands. Dental anxiety before (T1) and after (T2) treatment was assessed using the Dental Anxiety Scale (DAS) and the Short version of the Dental Anxiety Inventory (S-DAI); the Symptom Checklist 90 (SCL-90) was used to assess general psychopathology. Dental anxiety was assessed again a year later and patients were questioned about their dental attendance pattern (T3). RESULTS: ANOVA showed that the DAS and S-DAI scores at T2 and T3 were statistically significant lower than the initial scores. In addition, IVS patients showed less anxiety reduction than BM patients at both T2 and T3. Of the 145 patients whose last visit to the clinic was at least one year ago, 62% had visited a GDP at T3. A regression analysis revealed that, beside treatment mode, somatization, number of visits to clinic for dental treatment, and number of months between first and last visit to the clinic predicted dental anxiety at follow-up. CONCLUSIONS: It is concluded that, although a reduction in dental anxiety level was present, a relatively large proportion of patients did not improve, in terms of both dental anxiety and dental attendance.     

The role of ascorbic acid in oral cancer and carcinogenesis

L-ascorbic acid is an essential dietary vitamin in humans, primates and certain mammals and is endogenously syn-thesised in some species. Epidemiological and ecological studies have shown that L-ascorbic acid has a protective effect against cancer, in particular non-hormone-dependent malignancies, such as oropharyngeal neoplasms. Experimental in vivo and in vitro studies, however, have yielded more controversial results, suggesting that the effects of L-ascorbic acid are dose- and perhaps, time-dependent with different effects depending on the species or organ studied. An update of the epidemiological and experimental evidence linking L-ascorbic acid to oral cancer and carcinogenesis is discussed together with a brief review of the possible mechanisms of action of L-ascorbic acid.     

Beverage consumption and anthropometric outcomes among schoolchildren in Guatemala

This analysis explores the clustering of beverage patterns in a single day in private vs. public school children in urban Guatemala. This study is based on measurements taken from 356 third- and fourth-grade pupils from the highland city of Quetzaltenango. Height, weight and body mass index were assessed, and one day's intake of all foods and beverages using a pictorial workbook and dietician assisted recall. Mean differences in beverage consumption were compared for private vs. public school children and by anthropometric outcomes (stunting, overweight and obesity). Plain water was consumed by 30.9% of the children on the day intakes were measured, with higher proportions of water drinkers among private school children. Children having reported water intake on that day consumed 154 fewer kcal (-7.7%) compared with the energy intake of children not having reported water intake (P = 0.02). Significantly more children of high socio-economic status (SES) consumed dairy, fruit juice, commercial fruit juice, fruit drink and soda whereas low SES children consumed thin gruels and infusions. A key result from this study is the finding of a lower energy intake shown by children reporting water intake.     

Influence of repression upon the measurement of dental anxiety

Using a non-linear, multivariate analysis, the resistance against admitting to being dentally anxious was studied. Dental anxiety was found to be repressed by a subgroup, among them more men than women, of a sample, who also repressed the feeling of low self esteem about tooth loss. Based on the results, regular and irregular dental attenders can be separated almost perfectly. The relationship with other anxiety measurements, i.e. Corah's Dental Anxiety Scale and three components discernible in Weiner's Anticipation Anxiety Level Chart, was studied.     

Naratriptan: biological profile in animal models relevant to migraine

The biological profile of naratriptan (N-methyl-3-(1-methyl-4-piperidinyl)-1H-indole-5-ethane-sulphona-mide), a novel 5HT_1B/1D receptor agonist, was investigated in a variety of experimental models of relevance to migraine. Naratriptan has high affinity for human recombinant 5HT_1B and 5HT_1D receptors (pKi = 8.70.03 and 8.30.1, respectively) and causes contractions of dog isolated basilar and middle cerebral artery (EC₅₀ values of 0.11 and 0.07 M, respectively). Naratriptan causes small contractions of human isolated coronary arteries (EC₅₀ value of 0.17 M; maximum contraction equivalent to 33% of 5HT maximum). In anaesthetized dogs, naratriptan causes selective vasoconstriction of the carotid arterial bed (CD₅₀ dose = 193 g kg⁻¹) and, in anaesthetized rats, naratriptan selectively inhibits neurogenic plasma protein extravasation in the dura (ID₅₀ = 4.1 g kg⁻¹). In a variety of antinociceptive tests, naratriptan has no effect even at high doses. In conscious rats and dogs, naratriptan has high oral bioavailability (71% and 95%, respectively). The data show that naratriptan is a selective agonist at 5HT_1B/1D receptors, with a pharmacological profile very similar to that of sumatriptan, albeit 2-3 fold more potent. These observations, coupled with high oral bioavailability in animals, suggest that naratriptan has the profile of an orally effective anti-migraine drug.