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Liana Beni-Adani Naresh Biani Liat Ben-Sirah Shlomi Constantini 《Child's nervous system》2006,22(12):1543-1563
Background and objective The classification of hydrocephalus in newborns and in infants is different from the classification in adulthood. This difference
exists due to disparity in the source pathologies that produce the hydrocephalus, and the practical distinctions in prognosis
and treatment choices. The objective of this paper is to present the spectrum of obstructive-communicating hydrocephalus,
which is more complex in the pediatric group, and to propose the relevance of this particular classification to treatment
options.
Materials and methods The authors categorized infants with active hydrocephalus at time of presentation into the following four groups along the
spectrum of communicating vs obstructive HCP. Group 1: patients with a purely absorptive (communicating) HCP. In these patients,
tetraventricular dilatation is usually observed with occasional extraaxial fluid accumulation. An extracranial CSF diversion
(shunt) is the treatment of choice. Group 2: patients with an obstructive component together with a persistent absorptive
component. In these patients, a technically successful endoscopic procedure will not prevent progression of clinical symptoms
of HCP. An extracranial CSF diversion (shunt) should be the treatment of choice even though some of these patients are currently
treated by endoscopy. Group 3: patients with an obstructive component together with a temporary absorptive component. In these
patients, a technically successful ETV should be followed by temporary CSF drainage [via LP, continuous spinal drainage (CLD),
or ventriculostomy] with or without supplemental medical treatment (i.e., Diamox) for several days. Such temporary drainage
may decrease failure rate in this subgroup. Group 4: patients with a purely obstructive HCP. In these patients, an endoscopic
procedure (ETV) is the treatment of choice. According to this spectrum classification, the authors classify different entities
with representative cases and discuss relevancy to treatment options and prognosis.
Results The data suggest that obstructive hydrocephalus in the very young population may be rather a combination of obstructive and
absorptive problem. The outcome of the patient depends mainly not only on the basic pathology causing the hydrocephalus but
also on the treatment that is chosen and its complications. While bleeding and infection represent the major causes for communicating
hydrocephalus, patients with complex pathologies of congenital type and intra- or interventricular obstructions may reflect
obstructive hydrocephalus. Treatment of these patients may be successful by shuntless procedures if the absorptive problem
is not the major component. In transient absorptive hydrocephalus, temporary measures were effective in many cases leading
to successful procedures of ETV and/or posterior-fossa decompression in selected cases.
Conclusions Shuntless procedures are the dream of a pediatric neurosurgeon provided it solves the problem and does not imply unacceptable
risk. However, the benefit has to be evaluated years after the procedure is performed, as only prospective multicenter studies
will truly show which procedure may have the best overall results in the developing child. Until such studies are available,
understanding the basic pathology or the combination of pathologies leading to hydrocephalus in a given child may open the
window of opportunities for other than shunt surgery in many hydrocephalic children with major obstructive component. 相似文献
4.
Adherence to continuous positive airway pressure treatment in patients with Alzheimer's disease and obstructive sleep apnea. 总被引:2,自引:0,他引:2
Liat Ayalon Sonia Ancoli-Israel Carl Stepnowsky Matthew Marler Barton W Palmer Lianqi Liu Jose S Loredo Jody Corey-Bloom Deborah Greenfield Jana Cooke 《The American journal of geriatric psychiatry》2006,14(2):176-180
OBJECTIVE: This analysis examined whether patients with Alzheimer disease (AD) tolerate continuous positive airway pressure (CPAP). METHOD: Thirty patients with AD were randomized to CPAP or sham CPAP and completed sleep, depression, and quality-of-life questionnaires. Participants could choose to continue treatment after the trial. RESULTS: Patients wore CPAP for 4.8 hours per night. More depressive symptoms were associated with worse adherence (rS=-0.37; N=30, p<0.04). Patients who continued using CPAP had fewer depressive symptoms (t [19]=2.45, p=0.02) and better adherence (t [19]=2.32, p=0.03) during the trial. CONCLUSION: Patients with AD with obstructive sleep apnea can tolerate CPAP. Adherence and long-term use may be more difficult among those patients with more depressive symptoms. 相似文献
5.
R Jaffe J Abramowicz N Eckstein I Vagman M Fejgin D Ayalon 《Journal of ultrasound in medicine》1988,7(4):203-206
Polycystic ovarian disease is characterized by menstrual disorders, infertility, obesity, and large ovaries. Large ovaries with multiple cysts are the direct cause of the high incidence of ovarian hyperstimulation during ovulation induction. Lately, gonadotropin-releasing hormone (GnRH) analogues have been employed to decrease ovarian steroidogenesis and thus reduce the incidence of ovarian hyperstimulation. In this study the ovarian size was ultrasonographically assessed during chronic GnRH analogue treatment, revealing a significant reduction in ovarian volume. This decrease in volume results in a reduced incidence of hyperstimulation, and we think the ultrasonic scanning can be effectively used to assess the success of GnRH treatment. 相似文献
6.
The study examined differences in division of household tasks and spousal support among a sample of educated dual‐earner families from two national groups in Israel: Jews (n = 116), and Arabs (n = 163). The contribution of the spousal interaction variables (household roles and spousal support) toward explaining two dimensions of psychological well‐being (burnout and life satisfaction) was also examined. The research findings indicate that in general, the Arabs maintain a more traditional orientation toward gender roles than their Jewish counterparts. Arab men showed a greater tendency to perform outside tasks than their Jewish counterparts who participate more in domestic chores. By contrast, no differences were found between the two groups with regard to the mutual support provided by spouses. Gender role attitudes were found to be a key predictor of the two psychological well‐being dimensions in both national groups. Regarding sex differences, men of both nationalities were more likely than women to report that they perform all types of household tasks. Concomitantly, the women reported higher levels of burnout, while no differences between the sexes were found with respect to life satisfaction. © 2003 Wiley Periodicals, Inc. 相似文献
7.
Alon Peled Ofer Sarig Guangping Sun Liat Samuelov Chi A. Ma Yuan Zhang Tom Dimaggio Celeste G. Nelson Kelly D. Stone Alexandra F. Freeman Liron Malki Lucia Seminario Vidal Latha M. Chamarthy Valeria Briskin Janan Mohamad Mor Pavlovsky Jolan E. Walter Joshua D. Milner Eli Sprecher 《The Journal of allergy and clinical immunology》2019,143(1):173-181.e10
8.
9.
Large-scale protein annotation through gene ontology 总被引:1,自引:0,他引:1
Xie H Wasserman A Levine Z Novik A Grebinskiy V Shoshan A Mintz L 《Genome research》2002,12(5):785-794
10.
The neural basis of the psychomotor vigilance task 总被引:1,自引:0,他引:1
STUDY OBJECTIVE: To identify brain regions underlying the fastest and slowest reaction times on the Psychomotor Vigilance task (PVT) under well-rested conditions, as well as brain regions related to particularly poor performance after sleep deprivation. DESIGN: Subjects took the PVT twice while undergoing functional magnetic resonance imaging: once 12 hours after waking from a normal night of sleep and once after 36 hours of total sleep deprivation (TSD). Session order was counterbalanced. SETTING: UCSD J. Christian Gillin Laboratory for Sleep and Chronobiology (the sleep core of the General Clinical Research Center) and UCSD Magnetic Resonance Institute. PATIENTS OR PARTICIPANTS: Twenty right-handed healthy adults (8 women; age = 27.4 +/- 6.7 years; education = 15.6 +/- 1.5 years). MEASUREMENTS AND RESULTS: After a normal night of sleep, optimal performance was related to greater cerebral responses within a cortical sustained attention network and the cortical and subcortical motor systems. Slow reaction times, particularly after TSD, were associated with greater activity in the "default mode network" consisting of frontal and posterior midline regions. CONCLUSIONS: Optimal performance on the PVT appears to rely on activation both within the sustained attention system and within the motor system. Poor performance following TSD may result from a disengagement from the task and related inattention, and brain regions responsible for this localize within midline structures shown to be involved in the brain's "default mode." Finally, particularly poor performance after TSD may elicit a subsequent attentional recovery that manifests as greater activation within the same regions normally responsible for fast reaction times. 相似文献