17 4 K Ngoai TK Multiple bur hole surgery for the treatment of Moyamoya Disease

17 4 K Ngoai TK Multiple bur hole surgery for the treatment of Moyamoya Disease tài liệu, giáo án, bài giảng , luận văn,...

Int. J. Med. Sci. 2009, 6 http://www.medsci.org 143IInntteerrnnaattiioonnaall JJoouurrnnaall ooff MMeeddiiccaall SScciieenncceess 2009; 6(4):143-155 © Ivyspring International Publisher. All rights reserved Research Paper Comparison of a Two-Lead, Computerized, Resting ECG Signal Analysis De-vice, the MultiFunction-CardioGramsm or MCG (a.k.a. 3DMP), to Quantitative Coronary Angiography for the Detection of Relevant Coronary Artery Stenosis (>70%) - A Meta-Analysis of all Published Trials Performed and Analyzed in the US John E. Strobeck, Joseph T. Shen, Binoy Singh, Kotaro Obunai, Charles Miceli, Howard Sacher, Franz Ritucci, and Michael Imhoff The Valley Hospital, Ridgewood, NJ and Columbia University College of Physicians and Surgeons, New York, NY, USA  Correspondence to: John E. Strobeck, MD, PhD, Director, Heart Failure Program, The Valley Hospital, Ridgewood, NJ 07450. Received: 2009.01.19; Accepted: 2009.04.06; Published: 2009.04.07 Abstract Background: Accurate, non-invasive diagnosis of, and screening for, coronary artery disease (CAD) and restenosis after coronary revascularization has been a challenge due to either low sensitivity/specificity or relevant morbidity associated with current diagnostic modalities. Methods: To assess sensitivity and specificity of a new computerized, multiphase, resting electrocardiogram analysis device (MultiFunction-CardioGramsm or MCG a.k.a. 3DMP) for the detection of relevant coronary stenosis (>70%), a meta-analysis of three published pro-spective trials performed in the US on patient data collected using the US manufactured de-vice and analyzed using the US-based software and New York data analysis center from pa-tients in the US, Germany, and Asia was completed. A total of 1076 patients from the three trials (US - 136; Germany - 751; Asia - 189) (average age 62 ± 11.5, 65 for women, 60 for men) scheduled for coronary angiography, were included in the analysis. Patients enrolled in the trials may or may not have had prior angiography and/or coronary intervention. An-giographic results in all studies were classified for hemodynamically relevant stenosis (> 70%) by two US based angiographers independently. Results: Hemodynamically relevant stenosis was diagnosed in 467 patients (43.4%). The de-vice, after performing a frequency-domain, computational analysis of the resting ECG leads and computer-database comparison, calculated a coronary ischemia “severity” score from 0 to 20 for each patient. The severity score was significantly higher for patients with relevant coronary stenosis (5.4 ± 1.8 vs. 1.7 ± 2.1). The study device (using a cut-off score for rele-vant stenosis of 4.0) correctly classified 941 of the 1076 patients with or without relevant stenosis (sensitivity-91.2%; specificity-84.6%; NPV 0.942, PPV 0.777). Adjusted positive and negative predictive values (PPV and NPV) were 81.9% and 92.6%, respectively (ROC AUC = 0.881 [95% CI: 0.860-0.903]). Subgroup analysis showed no significant influence of sex, age, race/nationality, previous revascularization procedures, resting ECG morphology, or par-ticipating MULTIPLE BUR HOLES SURGERY FOR THE TREATMENT OF MOYAMOYA DISEASE IN CHILDREN Bs Nguyễn Ngọc Pi Doanh Bs Nguyễn Thành Đô Pediatric Neurosurgery DepartmentDepartment Children Hospital No.2 INTRODUCTION INTRODUCTION Japan • 1957, Takeuchi & Shimizu -Japan • “something hazy, like a puff of cigarette smoke” EPIDEMIOLOGY • The high incidence: Japanese and Asian population • Annual incidence: 0.35 to 0.94 per 100,000 • Prevalence: 3.2 to 10.5 per 100,000 • M:F = 1:1.8 to 1:2.2 40-49 yrs ) • All ages : 1995 ( 10-14 yrs & 40 2008 ( 45-49 yrs & 55-9 yrs ) ASSOCIATED CONDITIONS PATHOLOGY Hyperproliferation of the vessel wall components and abundant intraluminal thrombi CLINICAL FEATURES • In children, symptomatic episodes of ischemia may be triggered by exercise, crying, coughing, straining, fever, or hyperventilation IMAGING • CT- CTA • MRI- MRA • DSA NATURAL HISTORY AND PROGNOSIS • Tends to be progressive, bilateral: Progressive neurologic deficits and poor outcome: 50 to 66 percent Two thirds of patients with moyamoya have symptomatic progression over a 5-year period More rapid progression and a worse prognosis in younger than in older children Prognosis: Poor without treatment SUZUKI STAGE Medical treatment STA-MCA bypass Direct Treatment Encephalo… synangiosis Surgery Indirect Multiple burr Endovascular Therapy holes MUTIPLE BURR HOLES SURGERY • 1984, Masataka Endo – • Neovascularization occurring across a frontal burr hole / external drainage of intraventricle hemorrhage CASE REPORTS L Girl, 13 year-olds R CASE REPORT CASE REPORTS • Girl, 13 month- olds R L CASE REPORTS Multiple Bur Hole Surgery For The Treatment Of Moyamoya Disease In Children Children (http://www.ncbi.nlm.nih.gov/pubmed/17184074 (http://www.ncbi.nlm.nih.gov/pubmed/17184074) CHRISTIAN SAINTE-ROSE, ROSE, M.D., RICARDO OLIVEIRA, M.D., STÉPHANIE PUGET, M.D., LIANA BENI-ADANI, M.D., NATHALIE BODDAERT, M.D., JOHN THORNE, F.R.C.S., ALISON WRAY, F.R.A.C.S., MICHEL ZERAH, M.D., AND MARIE BOURGEOIS, M.D • 14 patients ( mean age 6.5yr ) – France & Australia • Post-op MRI: restoration of cortical perfusion as early as months safe • Conclusion: effective and safe Furthermore,, it is effective as a sole treatment without supplementary revascularization procedures Multiple Burr Hole Surgery As A Treatment Modality For Pediatric Moyamoya Disease (http://www.ncbi.nlm.nih.gov/pubmed/21559155) RAVINDRANATH KAPU,, NIGEL PETER SYMSS, [ ], AND RAVI RAMAMURTHI • 10 year- old boy - India • Bilateral multiple burr holes op, excellent cerebral revascularization • DSA months post-op, around the burr hole sites • Conclusion: effective and safe, revascularization procedures without supplementary Effect Of Multiple Cranial Burr Hole Surgery On Prevention Of Recurrent Ischemic Attacks In Children With Moyamoya disease (http://www.ncbi.nlm.nih.gov/pubmed/20446218 http://www.ncbi.nlm.nih.gov/pubmed/20446218) OLIVEIRA RS1, AMATO MC, SIMÃO GN, ABUD DG DG, AVIDAGO EB, SPECIAN CM, MACHADO HR • Brasil – pts • No recurrence of ischemic attacks postoperatively • Neoangiogenesis was observed in both hemispheres • Conclusion: simple procedure, relatively low risk of complications, effective for preventing cerebral ischemic attacks Long Time Follow Up Of Patients With Moyamoya Disease Treated By Multiple Burr Hole Surgery (http://stroke.ahajournals.org/cgi/content/meeting_abstract/44/2_meetingabstracts/awp170) YOSHITO UCHIHASHI1; KOHKICHI HOSODA1; TETSURO KAWAGUCHI2; MITSUGU NAKAMURA3; EIJI KOHMURA • Japan- 46 pts ( mean age 40) • Average Follow up period: 10,8 yrs • Conclusion: - similar long-term term results compared with direct bypass - easily done, performed in any place Hemodynamic Change Of Childhood Moyamoya Disease After Multiple Burr Burr-hole Operation (http://manu22.magtech.com.cn/Jweb_zzzz/EN/volumn/current.shtml) SUN JIAN*, WANG LI-SHU, SHU, ZHANG DONG, ET AL • pts – China (Chinese Journal of Stroke ) • Using multicolor ultraphonic power Doppler + SPECT op: neovascularization • 1st week post-op: • 3rd month:: rich neovascularization • Conclusion: The burr-hole hole operation can improve the ischemia of childhood moyamoya disease Effectiveness Of Burr Holes For Indirect Revascularization In Patients With Moyamoya Disease— a Review Of The Literature 01/2013 Pubmed and Medline, 19701970 2012 Conclusion: Burr hole surgery is an important and versatile tool in the armamentarium of surgeons treating children and adults with MMD, allowing tailoring of the revascularization CONCLUSION • Moyamoya disease- chronic progressive cerebrovascular diseasebilateral stenosis or occlusion of the arteries around the circle of Willis • Patients often suffer cognitive and neurologic decline due to repeated ischemic stroke or hemorrhage • Outcome: poor without treatment • MBHO: effective and safe, and can be used as the only treatment without supplementary revascularization procedures • In children, symptomatic episodes of ischemia may be triggered by exercise, crying, coughing, straining, ...Multiple vulnerabilities Qualitative data for the study of orphans and vulnerable children in South Africa Alicia Davids, Nkululeku Nkomo, Sakhumzi Mfecane, Donald Skinner & Kopano Ratele Edited by Donald Skinner & Alicia Davids Free download from www.hsrcpress.ac.za Compiled by the Social Aspects of HIV/AIDS and Health Research Programme, Human Sciences Research Council Published by HSRC Press Private Bag X9182, Cape Town, 8000, South Africa www.hsrcpress.ac.za © 2006 Human Sciences Research Council First published 2006 All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. ISBN 0-7969-2139-3 Production management by comPress Distributed in Africa by Blue Weaver PO Box 30370, Tokai, Cape Town, 7966, South Africa Tel: +27 (0) 21 701 4477 Fax: +27 (0) 21 701 7302 email: orders@blueweaver.co.za www.oneworldbooks.com Distributed in Europe and the United Kingdom by Eurospan Distribution Services (EDS) 3 Henrietta Street, Covent Garden, London, WC2E 8LU, United Kingdom Tel: +44 (0) 20 7240 0856 Fax: +44 (0) 20 7379 0609 email: orders@edspubs.co.uk www.eurospanonline.com Distributed in North America by Independent Publishers Group (IPG) Order Department, 814 North Franklin Street, Chicago, IL 60610, USA Call toll-free: (800) 888 4741 All other enquiries: +1 (312) 337 0747 Fax: +1 (312) 337 5985 email: frontdesk@ipgbook.com www.ipgbook.com Free download from www.hsrcpress.ac.za CONTENTS List of tables and figures v List of authors vi Acknowledgements vii Acronyms and abbreviations viii Executive summary ix Chapter 1 Introduction — Donald Skinner and Alicia Davids 1 Defining orphanhood and vulnerability 1 The situation of OVC in South Africa 2 Chapter 2 Background and aims of the project — Donald Skinner and Alicia Davids 5 Aims of the research 5 Chapter 3 Methodology — Donald Skinner and Alicia Davids 7 Semi-structured interviews 7 Research instrument 7 Sampling method 7 Sample Kopanong 8 Sample Kanana 8 Observations 9 Analysis 9 Chapter 4 Qualitative Report Of Ovc Living Conditions And Services In The Kopanong Municipality, Free State Province — Sakhumzi Mfecane, Donald Skinner and Alicia Davids 11 Geographical context 12 Economic situation 14 Poverty and unemployment 14 Situation of youth 15 Situation of HIV/AIDS 17 Context of people living with HIV/AIDS 21 Context of OVC 24 Support systems for OVC 30 Challenges facing government departments 35 NGO, CBO and FBO support structures 37 Challenges facing NGOS/CBOS 39 Discussion 40 Free download from www.hsrcpress.ac.za Chapter 5 Qualitative Report Regarding The Situation Of Orphans And Vulnerable Children (Ovc) In Kanana And Umuzimuhle Townships, North West Province — Kopano Ratele, Donald Skinner and Nkululeku Nkomo 43 Distinctive and common elements between the two townships 43 Umuzimuhle 43 Kanana 44 Major problems in the target areas: unemployment, poverty and shortages of food 45 HIV/AIDS: impact on the community 49 The situation of OVC 54 Situation of households caring for OVC 61 Support structures for ovc in the community 73 Conclusion 78 Chapter 6 Overall Conclusions And Recommendations — Donald Skinner and Alicia Davids 81 Care of OVC 82 Support for [...]... pain—Don't give your daughters patent medicines, or "Female Regulators"—Take your daughter to the doctor—Leucorrhea in girls—Bathing when menstruating—Constipation and displaced wombs—Dress and menstruation—Absence of menstruation, or amenorrhea—Treatment of amenorrhea—Painful menstruation, or dysmenorrhea—Causes of dysmenorrhea —Treatment of dysmenorrhea—Sterility in the female—Conditions which affect the. .. is threatened— Treatment of threatened miscarriage— Treatment of inevitable miscarriage— After treatment of miscarriage The tendency to miscarriage Page 187 The Baby CHAPTER XVI HYGIENE AND DEVELOPMENT OF THE BABY What to prepare for the coming baby— Care of the newly-born baby The first bath—Dressing the cord—Treatment after the cord falls off—A pouting navel —Bathing baby—Clothing the baby— Baby's... baby Page 22 3 CHAPTER XVIII BABY'S GOOD AND BAD HABITS —FOOD FORMULAS Baby's bed The proper way to lay baby in bed—Baby should sleep by itself—How long should a baby sleep— Why a baby cries The habitual crier— The habit of feeding baby every time it cries The habit of walking the floor with baby every time it cries—Jouncing, or hobbling baby—Baby needs water to drink The evil habit of kissing baby—... fertility of women—Climate, station in life, season of the year, age, the tendency to miscarry—Causes of sterility in the female—Displacement of womb—Diseases of womb, ovaries, or tubes—Malformations—Lacerations— Tumors— Leucorrhea—Physical debility—Obesity—Special poisons —"Knack of miscarrying"—Miscarriage —Cause of miscarriage The course and symptoms of miscarriage—What to do when a miscarriage is. .. merely temporary incidents, but that they may be regarded as practically incurable in the vast majority, because of antagonistic social conditions and ignorance, and that they are highly infectious, we may begin to realize how important they are from the standpoint of race regeneration Statistics of these conditions are never reliable because much of the evil is hidden and lied about It is quite probable,—if... requirements of good health The cost of constipation— Constipation and social exigencies— One of the important duties of mothers— Constipation and diseases of women— Constipation is always harmful— Constipation and pregnancy— Explanation of incomplete constipation —Causes of constipation—Negligence —Lack of exercise—Lack of water— Lack of bulk in the food taken—Abuse of cathartic drugs and aperient waters—... of venereal disease, it would seem justifiable to assume that the boys who are informed of the facts in time are the boys who constitute the percentage who escape This, of course, may not be literally true, but it is a reasonable assumption While self-abuse is a pernicious habit and may be attended with serious consequences, it is not a disease and, as will be explained later, RESEARC H Open Access Adaptive robot training for the treatment of incoordination in Multiple Sclerosis Elena Vergaro 1*† , Valentina Squeri 1,2† , Giampaolo Brichetto 3 , Maura Casadio 1,2 , Pietro Morasso 1,2 , Claudio Solaro 4 , Vittorio Sanguineti 1,2 Abstract Background: Cerebellar symptoms are extremely disabling and are common in Multiple Sclerosis (MS) subjects. In this feasibility study, we developed and tested a robot therapy protocol, aimed at the rehabilitation of incoordination in MS subjects. Methods: Eight subjects with clinically defined MS performed planar reaching movements while grasping the handle of a robotic manipulandum, which generated forces that either reduced (error-reducing, ER) or enhanced (error-enhancing, EE) the curvature of their movements, assessed at the beginning of each session. The protocol was designed to adapt to the individual subjects’ impairments, as well as to improvements between sessions (if any). Each subject went through a total of eight training sessions. To compare the effect of the two variants of the training protocol (ER and EE), we used a cross-over design consisting of two blocks of sessions (four ER and four EE; 2 sessions/week), separated by a 2-weeks rest period. The order of application of ER and EE exercises was randomized across subjects. The primary ou tcome measure was the modification of the Nine Hole Peg Test (NHPT) score. Other clinical scales and movement kinematics were taken as secondary outcomes. Results: Most subjects revealed a preserved ability to adapt to the robot-generated forces. No significant differences were observed in EE and ER training. However over sessions, subjects exhibited an average 24% decrease in their NHPT score. The other clinical scales showed small improvements for at least some of the subjects. After training, movements became smoother, and their curvature decreased significantly over sessions. Conclusions: The results point to an improved coordination over sessions and suggest a potential benefit of a short-term, customized, and adaptive robot therapy for MS subjects. Background Multiple Sclerosis (MS) is associated with a variety of symptoms and functional deficits, in proportions that change widely from patient to patient. About 30% of subjects show functionally relevant cerebellar deficits [1]. The most common symptoms are tremor [2,3] and ataxia [4]. Cognitive deficits have been reported as well [5]. Ataxia in particular implies an inability to perform coordinated movements that involve multiple joints [6]. In these subjects, movements typically result in curved trajectories and prolonged durations. All these symp- toms are highly disabling and resistant to treatment. Even though evidence for efficacy of rehabilitation came from studies with subjects with chronic progres- sive MS [7], there is growing evidence that subjects with relapsing-remitting MS may benefit from rehabilitation interventions [8]. Recent reviews suggest that exercise therapy can be beneficial for subject s with MS [9] and that multi-disciplinary rehabilitation programs may improve their experience in terms of activity and partici- pation, but cannot change the level of impairm ent [10] . Due to the different degrees of impairments in different MS su bjects, it is crucial that in these subjects the tim- ing and mode of rehabilitation treatment are set individually. As regards cerebellar symptoms in MS subjects, there is no 54 L.C. Semelhage and WJ. Keon. ,' /j / / FlgnreZ ErtAnt-*,» iU> ^>hi n h ,fp<in technique ofJaiem narrow cavitj Further if the septum is mvolved, a. paradoxical area will add to these problenis?-''- lncx?ri»ratiiig the concepts -of Daggett et al, Jatene dewteped. a teetmi-qiie to address these issues:"^'-'" Following resectioa of the .aneuiysin, leaving a nm of scar for suturing, the orifice' of the aiieiiiysm is reduced concentrisally with U shaped stitches externally anchored on Teflon pledgets. An unstetcliable Dacron patch \vhose: shape duplicates that'ofihc' original infarclcd'area isiixed over the redijced oiifice.^^ To determine the size- and shape of Ihe Dacron patch to be used -one of two piB-se-stiifif sutures are placed •at thC' transition -/.one between normal and fibrous tissue and the piirse.^stnng sutures are careftiily pulled to rebttild thedeft vejitricular cavity. To address septal distension Jatcae. recoirimendcd the use of two or three matfress stitches with pledgets placed, posterior to anterior to reduce elongation of the septal wall and prevent septal distensionr^^ EndoventriculgrRepair rjfD'or (h'fgure 3) In 1984, almost simultaneous with the work of Jatene, Dor de¥ete;ped the technique- of endoventricular circular patch plasty CEVGPP),^' '* Al>er opemng tlie aneLir>'sm through Left Ventricular Aneiujmn Repair for Management Left Ventricular Dysfunction 55 Figure 3. Endoven"t, I.'LI. . fcular patch plasty (EVCPP) of Dor the apex the junction between the endocardial scar and riomial inyocardioum is identified Ihroughoul tlic entire circumference of the aneuiysni, A contmuous 2-0 monofilament suture IS placed aroiMid the entire circumference of tlie base of the aiiemysin at tlie junction of scar and noirnal myocardiuriL The degi^ee of tigblening of this suture will detenmne the final size of the remaining opening in the ventricle and the size of the endocardia! patch to be used. The patch is usually 2-3 em in diameter and can be Daeron or perieardium. The patch is sutured at the level of the purscstring and glue is applied to the suture line to secure the closure. Finally the excluded sides of the ventricle beyond (he endocardial patch can be resected or closed to one another In the presence of large aneuiysms, which is the usual ease, the excluded edges should not be sutured together but rather should be tacked down to the edges of the patch. This prevents distortion of the right ventricle and ventricular . 38 septum. ' '. 'iiipariM.fi ,)/ liu i c. Iiiiiijt.c:' •>! .hin.'fic utfJ iJur in elodV Uie NiHiiliKi 111! \ f.r./d liiliei.iiL^s heiweeu liicsc lu.i ;i|)[iio;iit!es io ihe rciiair Dfiei! > cTiir:cuidi aiieM\-iiiis '.'n% iees-uilv pnblHlicd a s_.imp,ii"iv)ri ' I rh luo ieciiiiii[ue> ' LnUli 56 L.C. Semelhago and W.J. Keon. the Dor and Jatene techniques emphasize the importance of addressing the dysfunctional distal septum which frequently moves paradoxically during ventricular systole. However the two techniques address this issue in different ways. The Jatene procedure imbricates the aneui^smal portion of the distal septum in a posterior to anterior direction.'^" Ihcse sutures stabilize the septum and restore the normal taper of the distal septum and the stabilized septum subsequently remains as part of the wall of the left ventricular wall. The technique of Dor however excludes the aneurysmal portion of the distal ventricular septum by placing the endocai'dial patch at the junction of the septal endocardial scar and the ntirmal ... treatment SUZUKI STAGE Medical treatment STA-MCA bypass Direct Treatment Encephalo… synangiosis Surgery Indirect Multiple burr Endovascular Therapy holes MUTIPLE BURR HOLES SURGERY • 19 84, Masataka Endo... relatively low risk of complications, effective for preventing cerebral ischemic attacks Long Time Follow Up Of Patients With Moyamoya Disease Treated By Multiple Burr Hole Surgery (http://stroke.ahajournals.org/cgi/content/meeting_abstract /44 /2_meetingabstracts/awp170)... operation can improve the ischemia of childhood moyamoya disease Effectiveness Of Burr Holes For Indirect Revascularization In Patients With Moyamoya Disease a Review Of The Literature 01/2013