Treatment of a symptomatic posterior fossa subdural effusion in a child

We describe the first observation of a child with a posterior fossa subdural effusion with secondary hydrocephalus and tonsillar herniation. We diagnosed this entity in a 14-month-old girl with no history of trauma or coagulation disorder. The patient presented in our emergency department with opisthotonus and raised intracranial pressure resulting from supratentorial hydrocephalus. An emergency ventriculo-peritoneal shunt was placed, which resolved the symptoms only temporarily. Eventually external drainage of the subdural fluid was performed. The collection gradually disappeared, and both the external subdural shunt and the ventriculo-peritoneal shunt were removed. The patient made a complete neurological recovery. We review the physiopathology and treatment of subdural effusions in general, and propose some guidelines for the manage-ment of symptomatic effusions occurring in the posterior fossa in particular. Received: 18 June 1998     

脑室内血肿对丘脑背侧神经元的毒性损伤

目的：探讨脑室内血肿对丘脑背侧神经元是否具有毒性损伤作用。方法：在鼠脑室内注血后６小时,观察丘脑背侧神经元的病理组织学改变,检测丘脑背侧组织ＡＴＰ酶活性Ｎａ＾＋、Ｋ＾＋、Ｃａ＾２＋含量。结果：脑室内注血后６小时,丘脑背侧神经元虽未见明显坏死,但胞内结构已开始发生变化,Ｎａ＾＋－Ｋ＾＋－ＡＴＰ酶、Ｃａ＾２＋－ＡＴＰ酶活性明显降低,Ｎａ＾＋、Ｃａ＾２＋含量则明显增高。结论：脑室内血肿对丘脑背侧神经元具     

喜辽妥与硫酸镁治疗PCI术后皮下血肿疗效观察

目的 观察喜辽妥(多磺酸黏多糖乳膏)对治疗经皮冠状动脉介入治疗(PCI)术后相关血肿的疗效.方法 选择43例PCI术后皮下淤血、血肿的患者,随机分为喜辽妥治疗组及硫酸镁治疗组,观察治疗24、48、72 h后患者疼痛缓解及瘀斑、血肿消失情况.结果 喜辽妥组与硫酸镁组在72 h时有同样的疗效,但在显效及治愈的时间上喜辽妥组明显优于硫酸镁组.结论 喜辽妥能有效治疗PCI术后相关血肿,并比硫酸镁更能迅速地缓解症状.     

An Inexpensive and Easy Simulation Model of Ocular Ultrasound That Mimics Normal Anatomy as Well as Abnormal Ophthalmologic Conditions

We have constructed a simple and inexpensive simulation model for the educational instruction of health care providers to detect normal and abnormal ocular conditions in the bedside emergency setting. Such a training model serves to increase the comfort level in performing ocular ultrasound examinations and can increase the accuracy of examination interpretation. Ophthalmologic examinations can be difficult in the emergency setting, and ultrasound has become a useful tool in the diagnosis of emergent ocular conditions.     

An unusual subdural empyema: Case report

Abstract

Subdural empyema in a 38-year-old patient with congenital hemangioma, suppurative parotitisis, soft tissue phlegmonia and osteomyelitis is reported. The clinical, radiological and surgical features are outlined. A review of the literature reveals the uniqueness of this case. [Neurol Res 2000; 22: 597-600]     

Tiny but risky: The reasons why the Caspar pin distractor causes suffocating cervical hematoma-Two cases and a literature review

Symptomatic cervical hematoma (CH) after cervical spine surgery through an anterolateral approach is a feared complication. In up to 60% of CH cases, no source of bleeding is detected during drainage. Bleeding from the pin holes of the Caspar distractor is a known complication, briefly mentioned in the patent, but harmfulness has never been thoroughly assessed. Our team experienced two consecutive postoperative acute CHs, in which the origin of active bleeding obviously came from pin holes, despite careful obturation. The aim of this study was to report these two cases and provide a comprehensive assessment of the dangers of Caspar pin distractors. The intrabody vascularization was well organized and there was a central pedicle arising from the center of the posterior wall. The pedicle penetrated deeply into the body and constituted Batson's channel posteriorly. Retrospectively, it was well-identified in both cases on preoperative imaging. Given the morphological features of the vertebral cervical bodies and Caspar pin, the pin may reach the center of the posterior wall where the pedicle arises. Comparison between vertebral body volumes and the volume of the screwable part of the pins revealed that the pin could occupy up to 7.3% of the total body if randomly inserted. However, pins are in fact inserted into a particular place that contains the pedicle. Epidural bleeding is variable and may be undetected before closure. This also depends on blood pressure variations and changes in the patient's position. Even though Caspar pins are tiny, the likelihood of intrabody vascularization damage appears to be significant. Caspar pins should not be used systematically. Pin hole obturation must be solid and deep. Alternative options such as an interbody distractor and a microscope for the discectomy should be considered.     

脑膜中动脉栓塞治疗难治性慢性硬膜下血肿的Meta分析

目的研究脑膜中动脉(MMA)栓塞治疗难治性慢性硬膜下血肿(CSDH)的有效性及安全性。方法应用系统评价的方法,检索知网、维普、PubMed、Embase等中英文数据库收录的脑膜中动脉栓塞治疗慢性硬膜下血肿的相关文献,采用RevMan 5.3软件进行Meta分析。结果共纳入14篇文献,其中5篇为对照研究,9篇为病例系列研究;将5篇对照研究的栓塞组和传统手术组患者进行Meta分析。结果显示,栓塞组患者的血肿复发率(3.0%)明显低于传统手术组(23.5%),差异有统计学意义(OR=0.12;95%CI0.05～0.25;P<0.000 01;I2=47%);两组患者手术并发症发生率(3.4%,5.3%)的差异无统计学意义(OR=0.51;95%CI0.23～1.15;P=0.11;I2=0%)。合并14篇文献,栓塞治疗患者的术后血肿复发率为3.9%,手术并发症发生率为2.4%,均低于传统手术治疗患者;其中难治性慢性硬膜下血肿患者栓塞术后的复发率及手术并发症发生率均为4.5%。结论脑膜中动脉栓塞治疗慢性硬膜下血肿安全、有效,尤其适用于多次复发或存在高复发风险的难治性硬膜下血肿。     

输尿管镜碎石术后肾包膜下或肾周血肿危险因素的meta分析

目的:分析输尿管镜术后肾包膜下或肾周血肿的危险因素.方法:通过计算机检索万方、知网、维普、中国生物医学文献数据库、Pubmed、EMbase和Web of Science等数据库.检索从建库至2020年12月所有公开发表的关于输尿管镜术后继发肾包膜下或肾周血肿危险因素的研究文献,采用Revman 5.3软件进行统计分析...     

小儿外伤性迟发性脑内血肿的观察与护理

目的 探讨小儿外伤性迟发性脑内血肿的临床特点及观察护理要点。方法 回顾性分析我院1987年1月-1998年12月收治的27例小儿外伤性迟发性脑内血肿的，16床资料。结果 27例小儿外伤性迟发性脑内血肿中，行血肿清除术13例，颅骨钻孔血管内置管 增强尿激酶外引流术6例，非手术治疗8例。26例治愈，1例死亡。结论 进行性意识障碍、头痛、呕吐、贫血加重和生命体征不稳定是小儿外伤性迟发性脑内血肿的基本临床特征，伤后72小时这段时间是护理观察的重点。伤后72小时仔细观察以上症状、体征，为小儿外伤性迟发性脑内血肿的早期诊断提供依据。