Role of External Ventricular Drainage (EVD) in Treating Spontaneous Intraventricular Haemorrhage

Background: There is no consensus in the literature on the effects of the development of hydrocephalus on survival and disability after intracerebral haemorrhage (ICH) and the benefits of external ventricular drainage (EVD). This study is planned to describe the role of external ventricular drainage in treating patients of spontaneous, either primary or secondary, intraventricular haemorrhage with hydrocephalus.Material & Methods:A hospital based prospective interventional study was conducted in the Department of Neurosurgery of Dhaka Medical College Hospital, which is a tertiary level hospital, from April 2016 to September 2017.Total 42 patients of spontaneous intraventricular haemorrhage, either primary or secondary, with hydrocephalus were selected for this study. All the collected data were entered into IBM SPSS software, Version 24. For statistical analysis, paired t-test to compare the preoperative GCS with postoperative GCS at 24 hours was done.Results:Among 42 patients, age range was 26-75 years with the mean age 65.2 � 10.87 years. Male were 26 (61.9%) and female were 16 (38.1%). Male-Female ratio was 1.625:1. No patient needed conversion of EVD into VP shunt. EVD drain became blocked in 5 cases which were managed accordingly. 5 patients developed ventriculitis among which 2 patients died and rest 3 improved with antibiotics.Conclusions:The results of present study shows that EVD has a good role in the treatment of spontaneous IVH with hydrocephalus when ICH volume is low (<30ml) and modified Graeb Score is low (?10 found in this in this study. Preoperative higher GCS or initial improvement in GCS or initial improvement in GCS at 24 hours positively correlates with Glasgow outcome scale which is an indication of good function outcome.

Análise das necessidades de ajuda de homens com HIV que fazem sexo com homens / Análisis de las necesidades de asistencia para hombres con VIH que tienen relaciones sexuales con personas del mismo sexo / Analysis of the needs for help of men who have sex with men and live with HIV

RESUMO Objetivo Compreender as necessidades de ajuda de homens com HIV que fazem sexo com homens à luz de uma Teoria Prescritiva. Método Estudo descritivo e qualitativo, realizado com homens com HIV que fazem sexo com homens atendidos por um Serviço Ambulatorial Especializado de uma capital no Nordeste do Brasil, entre os meses de novembro de 2017 e maio de 2018. A pesquisa utilizou a análise do discurso do sujeito coletivo. Resultados Participaram do estudo 49 homens com HIV, que se autodenominaram homem que faz sexo com homem. Ajuda foi descrita como apoio, acolhimento, suporte psicossocial e familiar. O desejo de receber auxílio foi relacionado à aceitação e ao esquecimento do diagnóstico. Os problemas enfrentados aludiram à aceitação do diagnóstico, ao medo e ao preconceito. Destacaram-se como fonte de amparo os profissionais e familiares. O cuidado de enfermagem foi citado como significativo, e a principal ajuda requerida foi do tipo psicológica. Conclusão As necessidades de ajuda identificadas relacionaram-se principalmente ao suporte psicológico, proveniente dos profissionais de saúde e dos familiares. Os participantes são receptivos ao recebimento de ajuda, sobretudo, no que se refere ao enfrentamento do diagnóstico.

RESUMEN Objetivo Entender las necesidades de asistencia de hombres con VIH que tienen relaciones sexuales con hombres, a la luz de una Teoría Prescriptiva Método: Se trata de un estudio descriptivo y cualitativo, realizado entre noviembre de 2017 y mayo de 2018, entre hombres con VIH que tienen relaciones sexuales con personas de su mismo sexo y se atienden en una Clínica Ambulatoria Especializada de una capital del noreste de Brasil. La investigación utilizó el análisis del discurso del sujeto colectivo. Resultados Participaron 49 hombres con VIH que declararon tener relaciones sexuales con personas del mismo sexo. La asistencia pretendida fue descripta como soporte, refugio, apoyo psicosocial y familiar. El deseo de recibir apoyo estaba relacionado con la aceptación y el olvido del diagnóstico. Los problemas enfrentados aludían a la aceptación del diagnóstico, al miedo y a los prejuicios. Se destacaron, como fuente de apoyo, los profesionales y los familiares. La atención de enfermería se citó como significativa, y la principal ayuda requerida fue la psicológica. Conclusión Las necesidades de ayuda identificadas eran, principalmente, de apoyo psicológico de los profesionales de la salud y de los miembros de la familia. Los participantes están abiertos a recibir ayuda, sobre todo, en lo tocante al enfrentamiento del diagnóstico.

ABSTRACT Objective To understand the needs for help of men who have sex with men and live with HIV in the light of a Prescriptive Theory. Method Descriptive and qualitative study, conducted with men who have sex with men and live with HIV who were treated in a Specialized Outpatient Service in a capital in Northeastearn Brazil, between the months of November 2017 and May 2018. The study used the analysis of the discourse of the collective subject. Results 49 men with HIV who self-identified as men who have sex with men participated in the study. Help was described as support, welcoming, psychosocial and family support. The desire to receive assistance was related to accepting and forgetting the diagnosis. The problems experienced were related to the acceptance of the diagnosis, fear and prejudice. Professionals and family members stood out as sources of support. Nursing care was cited as significant and the main help required was psychological. Conclusion The needs for help identified were mainly related to psychological support coming from health professionals and family members. Participants were willing to receive help, especially to cope with the diagnosis.

The incidence of periventricular/intraventricular haemorrhages among premature infants in a tertiary care hospital in Sri Lanka.

Objectives: To describe the incidence and associated risk factors for periventricular/intraventricular haemorrhages (PVH/IVH) among premature infants in the neonatal intensive care unit (NICU) at Sri Jayewardenepura General Hospital (SJGH). Method: A prospective descriptive study was conducted on all babies <37weeks with birth weights <2500g managed in NICU at SJGH over a period of 6 months. Data was collected using a pre-tested form. Previously defined ultrasound findings were used to diagnose and categorize the PVH/IVH. Birth weight, gestational age, hypocarbia, mechanical ventilation, vasopressor infusions and use of antenatal steroids were assessed as risk factors for PVH/IVH. Results: A total of 126 babies was studied. The overall incidence of PVH/IVH was 12 (9.5%), 92% being grade 1. The incidence of PVH/IVH according to gestational age was 24.5% for <32 week old babies and 3.5% for 32-36 week old babies. Incidences according to birth weights were 43% (<1000g), 22% (1000-1500g) and 7% (1501-2000g). Of the babies with PVH/IVH 8% had been ventilated with CPAP mode whilst 92% had been given IPPV (p<0.0001); 83% had hypocarbia (p<0.0001) and 75% had been given vasopressors (p<0.0001). PVH/IVH was seen in 8% and 13% of those receiving and not receiving antenatal steroids respectively (p>0.05). Conclusions: Incidence of PVH/IVH was inversely proportional to birth weight and gestational age. It was significantly higher (p<0.0001) in babies requiring IPPV, in those with hypocarbia and in those treated with vasopressors but was not significantly associated with administration of antenatal steroids (p>0.05).

A Case of Moyamoya Disease with Severe Preeclampsia / 대한주산의학회잡지

Moyamoya disease is a rare progressive cerebrovascular disorder caused by blocked arteries at the base of the brain in an area called the basal ganglia. The etiology and pathogenesis are unknown. Clinically, this disease is found with a higher incidence in young female, but there are few cases of moyamoya disease in pregnancy. The disease primarily affects children, but it can also occur in adults. in children. The first symptom of moyamoya disease is often stroke, or recurrent transient ischemic attack, frequently accompanied by muscular weakness or paralysis affecting one side of the body, or seizures. Adults most often experience a hemorrhagic stroke due to recurring blood clots in the affected brain vessels. The diagnosis of moyamoya disease is made on the basis of angiographic findings and threatment of Moyamoya disease is surgery, or conservative management. We report a case of moyamoya disease that presented as intracerebral hemorrhage and intraventricular hemorrhage during pregnancy complicating severe preeclampsia.

A Case of Moyamoya Disease with Severe Preeclampsia / 대한주산의학회잡지

Moyamoya disease is a rare progressive cerebrovascular disorder caused by blocked arteries at the base of the brain in an area called the basal ganglia. The etiology and pathogenesis are unknown. Clinically, this disease is found with a higher incidence in young female, but there are few cases of moyamoya disease in pregnancy. The disease primarily affects children, but it can also occur in adults. in children. The first symptom of moyamoya disease is often stroke, or recurrent transient ischemic attack, frequently accompanied by muscular weakness or paralysis affecting one side of the body, or seizures. Adults most often experience a hemorrhagic stroke due to recurring blood clots in the affected brain vessels. The diagnosis of moyamoya disease is made on the basis of angiographic findings and threatment of Moyamoya disease is surgery, or conservative management. We report a case of moyamoya disease that presented as intracerebral hemorrhage and intraventricular hemorrhage during pregnancy complicating severe preeclampsia.

Hemorragia intraventricular en el neonato prematuro / Intraventricular hemorrage in preterm infants

La hemorragia intraventricular (HIV) es la principal complicación neurológica en los prematuros; consiste en sangrado de la matriz germinal y las regiones periventriculares del cerebro. Su frecuencia y gravedad aumentan en la medida en que es menor el peso al nacimiento; se la halla entre 10 y 20 por ciento de los neonatos de 1.000-1.500 gramos y hasta en 70 por ciento en los menores de 700 gramos; se presenta en 85 por ciento de las veces en las primeras 72 horas posparto y en 95 por ciento ya es evidente al finalizar la primera semana; son múltiples los factores maternos y fetales que se han encontrado asociados con el aumento o disminución de su frecuencia, además del uso de algunos medicamentos.Se han propuesto diversos mecanismos fisiopatogénicos asociados a la inmadurez neurológica para explicar la aparición de la HIV.Las manifestaciones clínicas son variables en cuanto a presentación y evolución. La confirmación diagnóstica, la clasificación y el pronóstico se basan en la ecografía transfontanelar.La principal medida preventiva es la disminución de la frecuencia del parto prematuro; los resultados de otras medidas como el uso prenatal y posnatal de algunos medicamentos para evitarla y tratarla han sido variables.El pronóstico depende de la extensión de la hemorragia, del desarrollo de leucomalacia periventricular y del grado de dilatación ventricular.

Neonatal intraventricular hemorrage (IVH) is the main neurological complication in preterm infants involving bleeding into the germinal matrix and the periventricular brain areas. Its incidence and severity are greater with lower birthweigth: from 10-20% in 1.000-1.500 g babies to 70% in those less than 700 g. Most often (85%) it appears during the first 72 hours after birth and almost 95% of the cases are evident by the end of the first week of life. Many maternal and fetal risk factors are associated with the risk of neonatal IVH. Diferent pathogenic mechanisms associated with an immature central nervous system have been proposed to explain IVH. Clinical manifestations and evolution are variable. Transfontanelar cranial ultrasonography permits diagnosis, classification and prognosis of HIV. The main preventive intervention is the reduction of the frequency of preterm delivery; treatment with different drugs before and after delivery to prevent IVH has had variable results. Prognosis depends on the severity of IVH, the development of periventricular leukomalacia and ventriculomegaly.

A Case Report of Intrafacial Vaginal Hysterectomy Performed in Patient of Adenomyosis with Cystocele and Rectocele / 대한산부인과학회잡지

The modified supracervical hysterectomy with intrafascial cylindriform enucleation of cervix via endoscopy or vaginal approach enables to do an minimal invasive and organ preserving surgery. The pelvic floor support is maintained and sexual sensation is preserved, and there may be nearly little concern of cancer on cervix. The physical stress to the patient is minimized. But, Intrafascial Vaginal Hysterectomy is rarely performed in case of large uterus size. We performed Intrafascial Vaginal Hysterectomy in patient of adenomyosis with cystocele and rectocele and then report that with review of journal and text book.

Detection of Acute Intraventricular Hemorrhage: Comparison of FLAIR MR Imaging with Unenhanced CT

PURPOSE: To compare the usefulness of fluid-attenuated inversion recovery (FLAIR) MR imaging with that of unenhanced CT in the detection of acute intraventricular hemorrhage (IVH). MATERIALS AND METHODS: Thirty-four patients with acute IVH underwent FLAIR MR imaging and unenhanced CT within three days of the onset of symptoms. Except in one patient, all MR studies were performed after CT. The mean time intervals between CT and symptom onset and between CT and MR examinations were six and five hours, respectively. Two radiologists evaluated the detectability and conspicuity of acute IVH at FLAIR MR imaging and unenhanced CT. Positive imaging criteria in the detection of acute IVH were intraventricular hyperintensity at FLAIR MRI and hyperattenuation at CT. RESULTS: Acute IVH was detected in all patients at FLAIR MR imaging and in 30 (88%) of 34 patients at unenhanced CT. In 32 patients (94%), the conspicuity of IVH at FLAIR MR imaging was as good as or better than that at unenhanced CT. CONCLUSION: FLAIR MR imaging was superior to unenhanced CT in the detection of acute IVH.

Comparison of Intraventricular Hemorrhagic Findings in Preterm Infants Between Brain Ultrasonogram and Magnetic Resonance Imaging at Discharge

PURPOSE: It has been customary to perform brain ultrasonogram (brain US) for the early detection of intraventricular hemorrhage (IVH) during intensive care of neonates. On the other hand magnetic resonance imaging (MRI) has been greatly restrictioned due to its complicated procedures. This study was conducted to identify changes in neonates' brain structure and to gain basic data for the long-term follow-up of neurologic sequelae in the future. For this purpose, the findings obtained from both brain US performed within one postnatal week and MRI at the time of discharge were compared and analysed. METHODS: Brain US within one postnatal week and MRI at discharge were carried out on 67 neonates who were discharged from the neonatal intensive care unit of Fatima Hospital from July 01, 1996 to June 30, 1998. We compared and analysed IVH found in the brain US, and focal parenchymal hemorrhage, periventricular leukomalacia (PVL), basal ganglia hemorrhage, and encephalomalacia revealed the MRI performed at discharge. RESULTS: It was found that out of 67 cases from the brain US, there were 13 with IVH of Grade l & ll, 11 with IVH of Grade lll or higher, one with focal parenchymal hemorrhage, and three with PVL. Also the MRI found seven with focal parenchymal hemorrhage, one with basal ganglia hemorrhage, six with PVL, three with encephalomalacia, and one with ventricular dilatation. CONCLUSION: For infants with IVH of Grade lll or higher, MRI performed at discharge is considered to be very useful in identifying structural parenchymal abnormality and the presence or absence of its associated lesions as well as in carrying out long-term follow-up.

The Intrafascial Vaginal Hystrectomy ( IVH ) Technique / 대한산부인과학회잡지

OBJECTIVE: Intrafascial vaginal hystrectomy(IVH) is an intrafascial cylindriform enucleation of the cervix and supracervical amputation of the uterus through vagina, leaving the highly vascularized extrafascial cervical tissue and corresponding nerves intact. The supracervical amputation of the uterus through vagina and intrafascial cylindriform enucleation of cervix enable to perform an minimal invasive surgery and organ-preserving surgery. Pelvic floor support is maintained and sexual sensation is preserved. Physical stress to the patient is minimalized. Our purpose is to evaluate the outcomes of IVH. METHOD: 21 patients were performed IVH from January 1996 to July 1998. RESULT: The mean age was 43.4+7.2 years and the mean parity was 2.6+0.8. The mean operation time was 116.1+21.4 minutes and the mean postoperative hemoglobin change was 2.0+1.6gm/dL. The mean postoperative hopitalization time was 8.2 + 2.7days. CONCLUSION: The IVH is an operation technique for the patients who are sexually active and want to remain their uterus.

Predicting Intraventricular Hemorrhage by the Nucleated Erythrocytes Counts in Preterm Neonates

PURPOSE: Prolonged fetal hypoxia stimulates erythropoiesis in fetal life and induces increased nucleated erythrocytes(NRBC) counts at the early newborn period. To evaluate the relationship between prolonged fetal hypoxia and neonatal intraventricular hemorrhage (IVH), and the prediction of neonatal IVH by neonatal NRBC. METHODS: We compared the daily courses of the absolute NRBC count in preterm new- boms at 34 weeks' gestation or earlier with(n=17) and without(n=20) IVH for 7 days of life. RESULTS: Absolute NRBC counts at birth were higher in neonates with IVH than in control neonates(2,499/mm3+/-3,748 and 412/mm3+/-272, respectively, P=0.0022). The cut-off value of 1,000/mm3 for absolute NRBC counts at birth showed the best parameter estimate of the predictive model for IVH at early newborn period with 100% of positive predictive value and 74.1% of negative predictive value. CONCLUSION: Prolonged fetal hypoxia inducing fetal erythropoiesis near labor is closely related to IVH at early newborn period. Thabsolute NRBC counts at birth is the very important predictable marker for the condition.

The Analysis of Prognostic Factors of IVH with EVD Treatment

The author analyzed retrospectively 94 cases of spontaneous intraventricular hemorrhage(IVH) which were treated with external ventricular drainage(EVD) at the Department of Neurosurgery. Chungnam National University Hospital from January 1990 to June 1994. In all cases, infusion of urokinase was attemped for effective drainage. The peak age group of IVH patients were those in their sixth decade, but in primary IVH, younger patients were more frequently affected. The order of causes of primary IVH are hypertension, arteriovenous malformation, Moyamoya disease, and cerebral aneurysm, however, secondary IVH are mostly associated with hypertension and aneurysm. The overall mortality rate was 38%. A low initial Glasgow coma scale(under 5)(p<0.01), a high Graeb score(over 10)(p=0.001), fourth ventricular hemorrhagic dilation(p=0.001), secondary IVH(p=0.009), unilateral or bilateral pupil fixation at the preoperative stage(p<0.001) and long duration of EVD(p=0.045) are all poor prognostic factors associated with higher mortality.

Clinical Analysis of the Effect of the Continuous External Ventricular Drainage with Urokinase Irrigation for the Treatment of Intraventricular Hemorrhage

The mortality and morbidity of the intraventricular hemorrhage(IVH) has been decreased since the introduction of external ventricular drainage(EVD) and direct intraventricular infusion of urokinase as an effective therapeutic method. In 1989, we already reported a series of 54 cases of IVH treated with simple EVD or EVD with urokinase irrigation in a few cases. Authors analyzed again a series of 50 cases of IVH treated by EVD with direct intraventricular urokinase irrigation after the pervious report. The mortality rate was 55.5% in former occasion, however 18% in this study and the complications were considerably low. We experienced again that the EVD with urokinase irrigation is an effective method and convenient, simple technique in the management of IVH even though there is no ICP monitoring. So we prefer EVD with urokinase irrigation therapy in managing the IVH even if the patient is moribund state.

Clinical Analysis of Hypertensive Intracranial Hemorrhage

367 patients with hypertensive intracranial hemorrhage, admitted to Masan Koryo neurosurgical department from Jan. 1988 to Dec. 1991, have been clinically analyzed. The results were as follows: 1) The group consisted of 176 males and 191 females. The peak age of the patients was at their 6th decade. Seasonal distribution of the incidence was peaked at spring and autumn. 2) 51.0% of these hemorrhage was located in putamen, 19.9% in thalamus, 12.5% in subcortex, 8.7% in cerebellum and 7.9% in brain stem. Patients with brain stem hemorrhage showed relatively poor prognosis compared with subcortex or cerebellar hemorrhage. 3) The level of consciousness at admission has significant relation to prognosis especially in non-operative group. 4) 130 patients underwent surgical treatment. In delayed operation group which was performed after at least 3 days from attack, good prognosis was obtained. 5) In 146 patients(39.8%), IVH was accompanied, which lead to poor prognosis. Especially in patients with thalamic hemorrhage, the incidence of IVH reached to 71.2%. 6) Overall outcome of 367 patients was good in 40.9%, and poor in 25.9%. Total motality rate was 33.2%.

Clinical Analysis of Hypertensive Intracranial Hemorrhage

367 patients with hypertensive intracranial hemorrhage, admitted to Masan Koryo neurosurgical department from Jan. 1988 to Dec. 1991, have been clinically analyzed. The results were as follows: 1) The group consisted of 176 males and 191 females. The peak age of the patients was at their 6th decade. Seasonal distribution of the incidence was peaked at spring and autumn. 2) 51.0% of these hemorrhage was located in putamen, 19.9% in thalamus, 12.5% in subcortex, 8.7% in cerebellum and 7.9% in brain stem. Patients with brain stem hemorrhage showed relatively poor prognosis compared with subcortex or cerebellar hemorrhage. 3) The level of consciousness at admission has significant relation to prognosis especially in non-operative group. 4) 130 patients underwent surgical treatment. In delayed operation group which was performed after at least 3 days from attack, good prognosis was obtained. 5) In 146 patients(39.8%), IVH was accompanied, which lead to poor prognosis. Especially in patients with thalamic hemorrhage, the incidence of IVH reached to 71.2%. 6) Overall outcome of 367 patients was good in 40.9%, and poor in 25.9%. Total motality rate was 33.2%.

The Analysis of Intraventricular Hemorrhage Treated with Simple EVD or Infusion of Urokinase

Among all of the spontaneous TCH(intracerebral hemorrhage), the presence of IVH(intraventricular hemorrhage) is showing higher mortality and morbidity. Since the introduction of EVD(extraventricular drainage) and direct intraventricular infusion of Urokinase as a effective therapeutic methods of IVH, it's mortality and morbidity has been decreased. But, in cases of hemorrhage extended into all ventricular chambers showes poor prognosis even the EVD and infusion of Urokinase. Authors analyzed 40 cases of IVH treated with simple EVD or direct intraven-tricular infusion of Urokinase. The results were as follows: 1) The most common age groups of IVH patients were 5th and 6th decades and 22 patients were male, 18 patients were female. 2) All 15 cases of Urokinase treated group revealted over the 7 point of Graeb score. 3) On admission, Glasgow coma scale scores were under the 8 at the 11 cases(73%) of Urokinase treated group and 18 cases(72%) of simple EVD group. 4) Time of cleared ventricles showed fast at the Urokinase treated group than simple EVD group. 5) Incidence of complications were similar on both groups. 6) Prognosis revealed lower morbidity and mortality at the Urokinase treated group than simple EVD group. 7) In cases of high Graeb score and low Glasgow coma scale on admission showed poor prognosis in both groups.

Clinical Analysis of Surgical Results in Moyamoya Disease Associated with Intraventricular Hemorrhage

Moyamoya disease is an unusual vascular disorder highlighted by progressive bilateral internal carotid artery occlusion and collateralization of intracranial blood flow. The purposes of the bypass procedures : 1) reduce or arrest of the chance of repeated ischemic attack by making the additional collateral blood flow, 2) decrease the chance of repeated bleeding by reducing the number of moyamoya vessels. During the period from June 1989 through February 1991, 8 moyamoya diseases associated with intraventricular hemorrhage were operated by STA-MCA anastomosis plus EMS. Results are as follows : 1) Slightly female dominancy in incidence(5 : 3), and all of the patients were middle aged(range 32 to 55 years). 2) All of the patients had sudden onset of headache, and most patients whad neck stiffness and vomiting. 3) In all of the patients, confirmatory diagnosis could be done by angiography, and all of the patients had gypical angiographic findings of moyamoya disease. 4) All of the patients had IVH in brain CT scan. 5) All of the patients were surgically treated : STA-MCA anastomosis plus EMS. 6) The postoperative revascularization rate was 89%(8 sides in 9 sides). 7) The postoperative results were excellent in 5, good in 1, and death in 2. The rarity of such lesions in KOrea and their surgical results are reviewed briefly.