Simpsonthomasen6078

Part 2 of this 2-part CME introduces dermatologists to non-infectious inflammatory skin diseases associated with pulmonary involvement. In many cases, dermatologists may be the first physicians recognizing respiratory complications associated with these diagnoses. Because pulmonary involvement is often the leading cause of morbidity and mortality, dermatologists should be comfortable screening and monitoring for lung disease in high-risk patients, recognizing cutaneous stigmata of lung disease in these patients and referring to pulmonary specialists, when appropriate, for prompt treatment initiation. Some treatments used for skin disease may not be appropriate in the context of lung disease and hence, choosing a holistic approach is important. Interstitial lung disease (ILD) and pulmonary hypertension (PH) are the most common pulmonary complications and a significant cause of mortality in autoimmune connective tissue diseases (CTD), especially systemic sclerosis (SSc), dermatomyositis (DM), and mixed connective tissue disease (MCTD). Pulmonary complications, notably ILD, are also common and life-threatening in sarcoidosis and vasculitis, while they are variable in neutrophilic and auto-immune blistering diseases.Cerebellar arteriovenous malformations (AVMs) are associated with higher risk of rupture compared with cerebral AVMs.1 Microsurgical resection of a ruptured AVM, measuring 3 cm in its largest dimension, within the cerebellar vermis and right parasagittal cerebellar lobe is demonstrated in Video 1. Cerebral angiography showed major supply from both superior cerebellar arteries and minor supply from a right anterior inferior cerebellar artery-posterior inferior cerebellar artery variant. Venous drainage was through a single ectatic vermian vein draining toward the torcula. Intraoperatively, a second, thrombosed, draining vein connected to the vein of Galen was identified. A right interhemispheric occipital transtentorial approach was elected over the supracerebellar infratentorial approach for early access to the superior cerebellar artery feeding arteries and for an orthogonal rather than a tangential view. The patient was positioned in an ipsilateral lateral position with the head turned 45° toward the floor allowing for gravity retraction of the ipsilateral occipital lobe. An external ventricular drain was also inserted to allow for further relaxation of the occipital lobe. Under neuronavigation guidance, the tentorium was opened allowing immediate visualization of the AVM with early control of the superior cerebellar artery arterial feeders. The AVM was removed using standard microsurgical technique, and hematoma was evacuated. Postoperative cerebral angiography demonstrated no AVM residual. The patient was discharged to a rehabilitation institute with minor residual cerebellar deficits. The patient provided written informed consent for the procedure, video recording, and publication.

Hydrocephalus is a common complication of intra- and paraventricular tumors both before and after tumor resection. see more We investigated the risk factors for postoperative hydrocephalus and established a predictive nomogram to improve surgical planning and adjust the frequency of postoperative clinical and radiographic monitoring.

A retrospective study of 196 intra- and paraventricular tumor patients with follow-up data was conducted to investigate the risk factors for postoperative hydrocephalus via univariate and multivariate Cox regression analyses. We developed a nomogram incorporating these factors based on multivariate analysis and according to scores calculated by the predictive model; a hazard function curve was used to compared risk of hydrocephalus.

Among the 196 patients, 33 had postoperative hydrocephalus. Intraventricular tumor (P= 0.005), glioblastoma (P= 0.010), preoperative hydrocephalus (P= 0.007), and radiotherapy (P= 0.033) were independent risk factors for postoperative hydrocephalus. The - and paraventricular tumors, plan surgical treatment and adjust the frequency of postoperative clinical and radiographic monitoring.

Hydrocephalus and increased intracranial pressure secondary to human immunodeficiency virus-related cryptococcal meningitis are rare in children. The role and outcomes of cerebrospinal fluid (CSF) shunting in children are not well reported. We report our experience with CSF shunting in the management of this condition in children over a 14-year period.

This was a retrospective review of data collected from a single neurosurgery unit. Data collected included demographics, clinical characteristics, Glasgow Coma Scale score, lumbar puncture opening pressure, antiretroviral therapy, laboratory results, neuroimaging findings, shunting procedures, complications, and mortality.

Seventeen children underwent CSF shunting. Median age was 10 years (range, 6-13), most being male (76%). All children were on antiretroviral therapy. Median Glasgow Coma Scale score was 15 (interquartile range [IQR], 14-15). Clinical characteristics included headaches (100%), visual impairment (82%), and seizures (47%). Lumbar puncture en with human immunodeficiency virus-related cryptococcal meningitis. Treatment with ventriculoperitoneal shunt and lumboperitoneal shunt regardless of the CD4 count is an important option in suitable children to reduce mortality.Video 1 demonstrates the microsurgical resection of petrous apex meningioma. Even small lesions by general rules are regarded as large due to the delicate nature of anatomic localization. The intricate relationship between the tumor and vascular supply of the brainstem and interposition of cranial nerves makes them challenging lesions to resect.1 A 67-year-old female patient presented with a 6-month history of trigeminal neuralgia in the V2 and V3 branches. She underwent gross total resection of an extraaxial homogenously enhancing dural-based tumor in the right petroclival region, consistent with a large (3-4.5 cm) petrous apex meningioma, the least frequently reported subtype of petroclival meningiomas.2,3 Skull base approaches for surgical resection of these tumors include high-speed drilling of petrous bone to create a corridor that facilitates access to the lesion.1 Preserved hearing with suprameatal extension of the infratentorial component and absence of a tumor laterally and inferiorly to the internal auditory canal provided the rationale for selecting a subtemporal approach combined with anterior petrosectomy.1,4,5 Identification of anatomic landmarks of the Kawase triangle is the key first step for determining the bony removal corridor, outlined by the greater superficial petrosal nerve, the arcuate eminence, and the petrous ridge.1,6 An important step in surgical removal is the devascularization of feeding arteries arising from the meningohypophyseal trunk.7,8 Subsequent piecemeal removal and circumferential detachment while making sure to preserve major vascular and nerve elements is crucial for successful removal. The patient consented to the procedure. The postoperative course was uneventful. The patient's trigeminal neuralgia completely regressed with no new neurologic deficit.

Postoperative ileus (POI) is a known complication after spine surgery. This study comprehensively reviews the existing literature and evaluates the risk factors associated with POI after thoracolumbar and lumbar fusion surgeries.

In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, a comprehensive search was conducted for articles on ileus after the surgical treatment of spinal pathologies. Variables including gender, age, body mass index, comorbidities, approach, type of surgery performed, levels fused, anesthesia time, and length of stay were considered as the main outcomes of measurement. Meta-analyses were conducted using random models according to the between-study heterogeneity, estimated with I

. Sensitivity analysis was performed with heterogeneity greater than 50%.

Ten articles compromising a total of 297,809 patients met the inclusion criteria. POI after lumbar surgery had a statistically significant association with increased age, surgical time, a longer surgical times, higher estimated blood loss, longer lengths of stay, greater numbers of levels of fusion, and anterior surgical approach.

To evaluate the prognostic value of the buffer coefficient, calculated as the ratio of the buffer volume (volume of intracranial cerebrospinal fluid) at the peak of brain edema to the baseline brain volume, and some other parameters in patients with massive cerebral infarction (MCI).

The cohort comprised 161 patients with MCI who were divided into good and poor prognosis groups according to modified Rankin Scale score at 90 days after onset. Differences in clinical and imaging parameters between these groups were analyzed by univariate analysis, and multifactorial binary logistic regression analysis was used to further identify influencing factors that were significantly different. Receiver operating characteristic curve was used to evaluate the diagnostic performance between the buffer volume and the buffer coefficient.

The findings showed that a history of atrial fibrillation, intravenous tissue-type plasminogen activator administration, successful reperfusion, successful craniectomy, low-density lesin brain edema.

Chiari I malformation (CM-1), traditionally defined as a descent of the cerebellar tonsils by 5 mm or more, is surgically managed via posterior fossa decompression. However, there is currently no clear radiologic or symptomatic selection criteria for surgical intervention to indicate which patients may see the most improvement following decompression.

This retrospective pilot study included 22 patients who had symptomatic CM-1 managed via surgical decompression and 22 patients who had nonoperative management of CM-1. Tonsillar motion was assessed using phase-contrast magnetic resonance imaging and 2-dimensional fast imaging employing steady-state acquisition. Both quantitative and qualitative results that best described the CM-1 anatomy, radiologic measurements, and tonsillar motion were obtained and analyzed.

Statistical analysis suggested that clinical symptoms differ based on tonsillar motion (P= 0.0044). Surgical patients had significantly more tonsillar motion than nonsurgical patients (P= 0.0010).t manifested in increased clinical symptoms. We recommend use of 2-dimensional fast imaging employing steady-state acquisition and assessment of cerebrospinal fluid flow as an adjunct to both clinical judgement and magnetic resonance imaging when selecting patients with CM-1 who would best benefit from surgical decompression.The last couple of decades have witnessed a rapid accumulation of studies implicating oxytocin (OT) in several neurobiological underpinnings of human behaviour and their impairment in psychiatric illness. Specifically, a neuroimaging genetics approach is helping elucidate the impact of variations in OT pathway genes on the human brain. In this review, we provide the first systematic account and discussion of all previous findings arising from human neuroimaging (epi)genetic studies of OT-related genes. To improve our mechanistic interpretation of such findings, we used data from the Genotype-Tissue Expression project to explore the functional impact the genetic variations may have on the human transcriptome. As a result, we provide an up-to-date summary of brain circuits found to be impacted by OT-relevant (epi)genetic variability, map brain pathways linking OT genes to disease, and highlight several (epi)genetic factors that modulate brain responses to intranasal OT. Finally, we provide some suggestions we believe might improve future research in the field.