ABSTRACT
[Abstrict]Objective To explore the key points and clinical value of combined direct and indirect extracranial-in?tracranial (EC-IC) bypass in patients with adult moyamoya disease. Methods Retrospective analysis of combined revas?cularization surgery in 25 adult patients with moyamoya disease. The frontal branch and parietal branch of the superficial temporal artery (STA) were dissected. Combined revascularization surgery consisted of direct (anastomosis between the su?perficial temporal artery and cortical branch of the middle cerebral artery) and indirect (encephalodurogaleosynan-giosis EDAS) surgeries. Clinical status was evaluated using the modified Rankin Scale and NIHSS score at 1 day before, 1 week and 3 months after surgery. Results Thirty lateralities were successfully performed on 25 patients. Postoperative angiogra?phy or CTA and cranial computer tomography perfusion imaging(CTP) were conducted to examine the patency of the di?rect anastomosis and cerebral blood flow in 23 patientswithin 1 weeks after surgery . The results showed that the anasto?motic vascular patency was excellent and the cerebral blood flow increased in parallel to the relief of the patients’s isch?emic symptoms. The median mRS scores were 3 (1,3) before surgery, 2 (1,3) 1 week and 1 (0,3) 1 month after surgery.The median mRS scores were significantly improved (Z=15.14, P<0.01). The median NIHSS scores was 5 (4,8) preopera?tively and 4(2,7) postoperation 1 week and 3(1,4) 3 months. The median NIHSS scores were also significantly improved (Z=11.36, P<0.01). Unfortunately, two patients had complication and left hemiparesis. One patient complicated with con?tralateral hemisphere infarction and the another one complicated with ipsilateral hemispheric hemorrhage after operation. Conclusions Combined revascularization surgery may result in satisfying improvement in clinical, angiographic, and he?modynamic states and prevention of recurrent stroke. The stabilized hemodynamic is the key point in peroperative period for moyamoya patients.
ABSTRACT
El presente trabajo de investigación tiene como objetivo determinar las características de la terapia utilizada por los pobladores del centro poblado de Moche para el tratamiento de las Enfermedades Diarreicas agudas (EDAS) en niños de 1 a 10 años en el periodo de Enero Febrero 2014, para ello se aplicó una encuesta como técnica de recolección de datos utilizando un cuestionario previamente validado y se obtuvieron los siguientes resultados; de la población encuestada se encontró que el 72% optó por el uso de medicamentos de los cuales el 83% acudió a un centro de salud, el 15% acudió al farmacéutico y el 2% se automedicó; el 23% de los encuestados eligió el consumo de plantas medicinales y el 5% restante los productos naturales. Con respecto a la terapia farmacológica, se encontró que el 83% utilizó antibióticos y el 17% Sales de rehidratación oral; los antibióticos más utilizados fueron Bactrim con un 76%, siendo el mayor uso en la forma de suspensión oral, el siguiente en uso fue la Furazolidona con 12% del total seguido por Ciprofloxacino y Amikacina (Amikin) con 10% y 2% respectivamente. Por parte de la terapia tradicional, las plantas medicinales más utilizadas fueron las hojas de matico con 26%, con 12% la manzanilla (flores y planta entera) y el té cargado, y en menor porcentaje el fruto de membrillo, entre otros. En cuanto al uso de productos naturales en el cuadro diarreico el 67% de las madres (o tutores) opinaron que éstos no poseen beneficio alguno para diarrea en niños y el 33% cree que puede ser beneficioso pero no los utilizaron
Subject(s)
Humans , Child, Preschool , Child , Pharmacists , Plants, Medicinal , Dysentery , Peru , Self Medication , Health CentersABSTRACT
An 11-year-old child presented with left hemiparesis and a seizure caused by fibromuscular dysplasia of the right internal carotid artery with cerebral infarction is presented. On conventional angiography, the authors found the classical `beaded' lesions. These pathognomic changes were most important to diagnosis. On brain single-photon emission computed tomography, we found the impaired vascular reserve of right basal ganglia, frontal and temporal area. We tried an antiplatelet agent and an encephaloduroarterio-synangiosis on the right hemisphere.
Subject(s)
Child , Humans , Angiography , Basal Ganglia , Brain , Carotid Artery, Internal , Cerebral Infarction , Diagnosis , Fibromuscular Dysplasia , Paresis , Seizures , Tomography, Emission-ComputedABSTRACT
Indirect revascularization procedures were performed on 50 hemispheres of 33 patients with moyamoya disease from January 1986 to August 1994. There were 23 females and 10 males, ranging from 1.4 to 58 years in age(mean 14.1 years). The interval from the onset of symptoms to surgery was 3 months and less in fourteen, and more than 3 months in nineteen patients(mean 1.2 years). The types of progression were variable: TIA-infarction type in 15 patients, infarction type in ten, ruptured type in five. TIA/frequent TIA type in two and infarction-TIA type in one patient. Bilateral Encephalo-duro-arterio-synangiosis(EDAS) was performed in 16 patients, unilateral EDAS in twelve, unilateral encephalo-myo-arterio-synangiosis(EMAS) in two, unilateral encephaloduroarteriomyosynangiosis(EDAMS) in two, and bilateral EDAMS in one patient. The patients were followed postoperatively for periods between 7 to 79 months(mean 31 months). The Activity of daily living(ADL) on admission was not good in patients below the age of 6 years at onset and showing repeated ischemic attacks before operation. The result of operation with regard to prevention of ischemic or hemorrhagic attack was excellent on 38 hemispheres(76%), good on five(10%), fair on two and poor on five hemispheres. The operations were done on the 39 symptomatic hemispheres and 11 asymptomatic hemispheres, which resulted in excellent or good results in thirty three(84.6%) and ten hemisphers(90.9%), respectively. The patients in which the interval between onset of symptoms and operation was more than 3 months showed more severe neurological deficit due to poorer neurological status at the time of operation compared with the group who underwent operation before 3 months from the onset. Three patients suffered perioperative cerebral infarction caused by hyperventilation during anesthesia or severe crying. It is concluded that the indirect revascularization procedures are effective for the prevention of ischemic or hemorrhagic attack in patients with moyamoya disease. If surgery is performed before permanent deficits have developed, the patient may be spared of neurological disability.