Résumé
Therapeutic hypothermia (TH) improves the neurological outcome in patients after cardiac arrest and neonatal hypoxic brain injury. We studied the safety and feasibility of mild TH in patients with poor-grade subarachnoid hemorrhage (SAH) after successful treatment. Patients were allocated randomly to either the TH group (34.5°C) or control group after successful clipping or coil embolization. Eleven patients received TH for 48 hours followed by 48 hours of slow rewarming. Vasospasm, delayed cerebral ischemia (DCI), functional outcome, mortality, and safety profiles were compared between groups. We enrolled 22 patients with poor-grade SAH (Hunt & Hess Scale 4, 5 and modified Fisher Scale 3, 4). In the TH group, 10 of 11 (90.9%) patients had a core body temperature of 95% of the 48-hour treatment period. Fewer patients in the TH than control group (n = 11, each) had symptomatic vasospasms (18.1% vs. 36.4%, respectively) and DCI (36.3% vs. 45.6%, respectively), but these differences were not statistically significant. At 3 months, 54.5% of the TH group had a good-to-moderate functional outcome (0–3 on the modified Rankin Scale [mRS]) compared with 9.0% in the control group (P = 0.089). Mortality at 1 month was 36.3% in the control group compared with 0.0% in the TH group (P = 0.090). Mild TH is feasible and can be safely used in patients with poor-grade SAH. Additionally, it may reduce the risk of vasospasm and DCI, improving the functional outcomes and reducing mortality. A larger randomized controlled trial is warranted.
Sujets)
Humains , Anévrysme , Température du corps , Lésions encéphaliques , Encéphalopathie ischémique , Embolisation thérapeutique , Arrêt cardiaque , Hypothermie provoquée , Mortalité , Projets pilotes , Études prospectives , Réchauffement , Hémorragie meningée , Vasospasme intracrânienRésumé
Migration of coils during endovascular procedures is a rare, but well-known complication. We are reporting two cases of successfully retrieving migrated coil using detachable intracranial stent. In both of our cases there was distal migration of coil during the intracranial aneurysm coiling procedure. The Solitaire® AB stent (Covidien, Irvine, CA, USA) was used to retrieve those coils. The stent was passed distal to the migrated coil using standard technique. It was then partially deployed and gradually withdrawn along with the entangled coil. Coil retrieval using the fully retrievable intracranial stent is a very simple, safe and easily available alternative for retrieval of distally migrated coil.
Sujets)
Embolisation thérapeutique , Procédures endovasculaires , Anévrysme intracrânien , EndoprothèsesRésumé
Abutment screw loosening of implant restorations is a common problem in the treatment of dental implant. The purpose of this study was to calculate stress and preload from the elongation measurements and to determine maximum tightening torque without plastic deformation of the screw. The length of each gold alloy UCLA screw was measured after tightening to the manufacturer's recommended torque of 32 N-cm. Similarily, titanium UCLA screws were measured after tightening to the manufacturer's recommended torque of 20 N-cm. Loosening torque was also measured after tightening to 32 N-cm torque for gold alloy abutment screws and 20 N-cm for titanium abutment screws. The results were as follows ; 1. There was a regressive relationship between screw elongation and tightening torque (gold alloy : r2 = 0.987, titanium : r2 = 0.978), and the mean preload calculated from elongation measurements was 501.11 +/- 26.85 N (gold alloy) and 399.43 +/- 7.61 N (titanium). 2. Stress calculated for the gold alloy and titanium screws at maximum recommended tightening torque was less than 60% of their respective yield strengths and within the elastic range. Maximum tightening torque without plastic deformation was 61 N-cm(gold alloy) and 39 N-cm(titanium). 3. For titanium screws, there was a significant difference between loosening after trial 1 and loosening after trials 2 to 5 (p<0.05). No statistically significant difference was seen in mean loosening torques between the first and subsequent trials for gold alloy screws.
Sujets)
Alliages , Implants dentaires , Matières plastiques , Titane , Moment de torsionRésumé
BACKGROUND: Lipids in the stratum corneum which acts as a barrier prevents transepidermal water loss and percutaneous absorption of a substance differs at different anatomic sites of skin. No study has yet been done on the recovery rate of the skin barrier after its destruction in relation to anatomic sites. OBJECTIVES: The purpose of this study was to measure the recovery rate of the skin barrier after its disruption in relation to anatomic sites and also to examine the lipid composition of skin surface lipids at different anatomic sites of skin. METHODS: The study population consisted of 20 healthy male subjects. We used 3M Scotch tapes to remove the stratum corneum and examined the recovery rate by measuring the TEWL using an evaporimeter after 2.5, 6, 10, 24, 48 and 72 hours at eight different anatomic sites consisting of the post-auricular area, chest, abdomen, back, forearm, thigh and calf. The skin surface lipids were extracted using 99% ethanol at ten different anatomic sites including the face, chest, abdomen, back, upper arm, forearm, palm, thigh, shin and sole. The composition of skin surface lipids was determined by thin layer chromatography. RESULTS: 1. The transepidermal water loss was highest in the post-auricular area and ahdomen, back, thigh, forearm, upper arm, thieh and chest in a decreasing order, although there was no statistical significance(p>0.05). 2. The recovery rate was highest in the post-auricular area after 2.5 hours with a statistical significance compared to other sites except for the abdomen(p<0.05). 3. The recovery rate was also highest in the post-auricular area after 6, 10, 24, 48 and 72hrs compared with other sites with a statistical significance (p<0.01). 4. Lipid analysis of ten anatomic sites demonstrated that the concentration of cholesterol sulfate was highest on the face, that of cholesterol was highest on the back and that of sphingolipid was highest on the abdomen but there was no statistical significance. CONCLUSION: The post-auricular area showed the fastest recovery rate after its barrier disruption which can be applied in the percutaneous absorption of substances. Also the composition of human skin surface lipids, especially epidermal lipids at different anatomic sites was not statistically different.
Sujets)
Humains , Mâle , Abdomen , Bras , Cholestérol , Chromatographie sur couche mince , Éthanol , Avant-bras , Absorption cutanée , Peau , Cuisse , ThoraxRésumé
BACKGROUND: Lipids in the stratum corneum which acts as a barrier prevents transepidermal water loss and percutaneous absorption of a substance differs at different anatomic sites of skin. No study has yet been done on the recovery rate of the skin barrier after its destruction in relation to anatomic sites. OBJECTIVES: The purpose of this study was to measure the recovery rate of the skin barrier after its disruption in relation to anatomic sites and also to examine the lipid composition of skin surface lipids at different anatomic sites of skin. METHODS: The study population consisted of 20 healthy male subjects. We used 3M Scotch tapes to remove the stratum corneum and examined the recovery rate by measuring the TEWL using an evaporimeter after 2.5, 6, 10, 24, 48 and 72 hours at eight different anatomic sites consisting of the post-auricular area, chest, abdomen, back, forearm, thigh and calf. The skin surface lipids were extracted using 99% ethanol at ten different anatomic sites including the face, chest, abdomen, back, upper arm, forearm, palm, thigh, shin and sole. The composition of skin surface lipids was determined by thin layer chromatography. RESULTS: 1. The transepidermal water loss was highest in the post-auricular area and ahdomen, back, thigh, forearm, upper arm, thieh and chest in a decreasing order, although there was no statistical significance(p>0.05). 2. The recovery rate was highest in the post-auricular area after 2.5 hours with a statistical significance compared to other sites except for the abdomen(p<0.05). 3. The recovery rate was also highest in the post-auricular area after 6, 10, 24, 48 and 72hrs compared with other sites with a statistical significance (p<0.01). 4. Lipid analysis of ten anatomic sites demonstrated that the concentration of cholesterol sulfate was highest on the face, that of cholesterol was highest on the back and that of sphingolipid was highest on the abdomen but there was no statistical significance. CONCLUSION: The post-auricular area showed the fastest recovery rate after its barrier disruption which can be applied in the percutaneous absorption of substances. Also the composition of human skin surface lipids, especially epidermal lipids at different anatomic sites was not statistically different.