Smaller cerebral aneurysms producing more extensive subarachnoid hemorrhage following rupture: a radiological investigation and discussion of theoretical determinants

OBJECT: The goal of this study was to determine the relationship between aneurysm size and the volume of subarachnoid hemorrhage (SAH). METHODS: One hundred consecutive patients who presented with acute SAH, which was diagnosed on the basis of a computerized tomography (CT) scan within 24 hours postictus and, subsequently, confirmed to be aneurysmal in origin by catheter angiography, were included in this study. The data were collected prospectively in 32 patients and retrospectively in 68. The volume of SAH on the admission CT scan was scored in a semiquantitative manner from 0 to 30, according to a previously published method. The mean aneurysm size was 8.3 mm (range 1-25 mm). The mean SAH volume score was 15 (range 0-30). Regression analysis revealed that a smaller aneurysm size correlated with a more extensive SAH (r(2) = 0.23, p < 0.0001). Other variables including patient sex and age, intraparenchymal or intraventricular hemorrhage, multiple aneurysms, history of hypertension, and aneurysm location were not statistically associated with a larger volume of SAH. CONCLUSIONS: Smaller cerebral aneurysm size is associated with a larger volume of SAH. The pathophysiological basis for this correlation remains speculative.     

Improvement of chronic hearing loss after shunt revision. A case report

BACKGROUND: Hearing loss after intracranial and spinal procedures involving cerebrospinal fluid loss is rarely reported in the literature. We report a patient who suffered from delayed hearing loss after cerebrospinal fluid shunting that improved after revising the shunt to a higher-pressure valve. CASE DESCRIPTION: A 32-year-old woman presented with bilateral hearing loss 4 years after ventriculoperitoneal shunting for communicating hydrocephalus. Her otologic work-up revealed sensorineural hearing loss. In an attempt to improve her hearing, 6 years after the hearing loss began (10 years after the shunt was placed), she underwent a shunt revision in which her valve was changed to a higher-pressure device. After the procedure, she had a significant improvement in her speech discrimination and a mild improvement in her pure tone recognition. These changes were documented with serial audiograms. CONCLUSION: Hearing loss after cerebrospinal shunting procedures is not always limited to the immediate postoperative period. It may be a late complication of cerebrospinal fluid diversion. Chronic hearing loss after ventriculoperitoneal shunting may be treatable by changing the valve to a higher-pressure device. The etiology of hearing loss from intracranial hypotension is briefly discussed.     

Screw fixation mentoplasty

A technique of transoral screw fixation mentoplasty is described for management of facial disproportion due to microgenia. One hundred and fifty-two patients followed for an average of 5.3 years revealed that screw fixation mentoplasty serves well to reduce perioperative morbidity and ensure a long-term improvement in facial balance and aesthetics.     

A ratiometric fluorescent sensor for detection of metformin based on terbium–1,10-phenanthroline–nitrogen-doped-graphene quantum dots

Metformin (MTF), an effective biguanide and oral antihyperglycemic agent, is utilized to control blood glucose levels in patients with type II diabetes mellitus, and the determination of its concentration in biological fluids is one of the main issues in pharmacology and medicine. In this work, highly luminescent nitrogen-doped graphene quantum dots (N-GQDs) were modified using terbium (Tb³⁺)–1,10-phenanthroline (Phen) nanoparticles (NPs) to develop a dual-emission ratiometric fluorescent sensor for the determination of MTF in biological samples. The synthesized N-GQDs/Tb–Phen NPs were characterized using different techniques to confirm their physicochemical properties. The N-GQDs/Tb–Phen NPs showed two characteristic emission peaks at 450 nm and 630 nm by exciting at 340 nm that belong to N-GQDs and Tb–Phen NPs, respectively. The results indicated that the emission intensity of both N-GQDs and Tb–Phen NPs enhanced upon interaction with MTF in a concentration-dependent manner. Also, a good linear correlation between the enhanced fluorescence intensity of the system and MTF concentration was observed in the range of 1.0 nM–7.0 μM and the limit of detection (LOD) value obtained was 0.76 nM. In addition, the prepared probe was successfully used for the estimation of MTF concentration in spiked human serum samples. In conclusion, the reported dual-emission ratiometric fluorescent sensor can be used as a sensitive and simple fluorimetric method for the detection of MTF in real samples.

Shcematic representation of the MTF detection by an enhancing mechanism.     

Adolescence spinal epidural abscess with neurological symptoms: case report,a lesson to be re-learnt

Epidural abscess of the spinal column is a rare condition that can be fatal if left untreated. It promptly progresses and can cause neurologic paralysis, urinary retention or cauda equina syndrome. Compromised immune system that occurs in patients with diabetes mellitus, AIDS, chronic renal failure, alcoholism, or cancer is a predisposing factor. It mostly occurs in adults. Here we would like to report a case of spontaneous pyogenic lumbar epidural abscess with neurological deficit diagnosed in a 15 year old boy. We treated this case successfully with surgical microscopic decompression and drainage.     

Endometrial resection mandates reliable contraception thereafter - a case report of placenta increta following endometrial ablation.

Placenta increta complicated pregnancy in a woman with a history of endometrial resection. Placentation in women with prior endometrial ablation carries a high risk for placenta accreta, increta and percreta. Contraceptive measures must be implemented after endometrial ablation and pursued until proven menopause, even in women who develop amenorrhoea postoperatively.     

Frame-based stereotactic resection of subcentimeter arteriovenous malformations in deep or eloquent regions of the brain: indications and technique with eight consecutive operations.

Subcentimeter arteriovenous malformations (AVMs) located in deep or eloquent cortex can be difficult to localize intraoperatively and safely remove with surgery. Nevertheless, surgical resection may be the optimal definitive treatment option available for select patients. In this communication, we describe our experience using a framed-based stereotactic approach for resecting these AVMs. The operative records of all AVMs treated at our institution over an 8-year period (1996-2004) were reviewed. 180 surgically treated AVMs were identified. From this group of patients, frame-based stereotaxy was used for 8 AVMs (4.4%) in 7 patients. The angiograms, operative reports, and medical records for these 7 patients were retrospectively reviewed with attention to neurological outcome, extent of AVM obliteration, and anatomic factors that impacted the decision to employ a frame-based stereotactic approach. All AVMs removed with this technique were less than 1 cm in diameter. Angiography confirmed complete resection in all cases. No new neurological deficits occurred in any patient. By providing highly accurate three-dimensional nidus localization and minimizing approach-related brain manipulation, frame-based stereotaxy reduces the morbidity associated with resection of subcentimeter AVMs located in deep or eloquent regions of the brain. This technique makes a definitive surgical cure available to patients who otherwise would only be considered for radiosurgery.     

Case-management for Patients with Schizophrenia in Iran: A Comparative Study of the Clinical Outcomes of Mental Health Workers and Consumers’ Family Members as Case Managers

The objective of this study was to evaluate the effectiveness of case-management services and the feasibility of considering the Consumers’ Family Members (CFM) as service providers in Iran as a developing country. Three trained case-managers were allocated into each group (Mental Health Worker-MHW and CFM), providing 12 months of home-visit services for 129 individuals with schizophrenia. Burden, knowledge, quality of life and the general health condition of the caregivers, as well as positive/negative symptoms and social skills of the consumers were evaluated. Most clinical variables were improved without significant differences between groups. The hospitalization rate was reduced by 67%.     

Anti-Vibriocholerae IgY Antibody Inhibits Mortality in Suckling Mice Model

Background

Regarding to the importance of cholera in Iran and the potential advantages of egg yolk antibody (IgY) for immunotherapy, the aim of this study was to produce IgY antibody against V. cholerae Lipopolysaccharide (LPS) and determine its potential for V. cholerae treatment.