ABSTRACT
The main purpose of this study was to assess the relation between cognitive behavioral therapy and possible changes in illness perceptions and anxiety in patients diagnosed with unruptured intracranial aneurysm. An observational study of an intervention with 67 patients with an unruptured intracranial aneurysm from two medical centers in a Colombian city (n = 35 on the intervention group) was carried out. To assess changes, measurements were taken at baseline and at one-year follow-up with the Beck Anxiety Inventory and the Illness Perception Questionnaire, brief version, taking into account the importance of perceptions in the process of adjusting to illness and acquiring healthy life habits. Hypotheses were tested by a structural model. The results obtained from this study showed that illness perceptions were related to anxiety levels at both time points; however, the relations were stronger before cognitive behavioral therapy (ßt0 = 0.61, p < 0.01; ßt1 = 0.37, p < 0.01). Cognitive behavioral therapy was found to be a moderator of changes in both illness perceptions and anxiety at the time of follow-up (ß = -0.31, p < 0.01; ß = -0.26, p < 0.01). The structural model suggests that cognitive behavioral therapy is associated with less anxiety (ß = -0.17, p < 0.05) and better illness perceptions (ß = -0.35, p < 0.01) in patients diagnosed with unruptured intracranial aneurysms.
Subject(s)
Anxiety/etiology , Anxiety/therapy , Cognitive Behavioral Therapy/methods , Intracranial Aneurysm/psychology , Aged , Female , Humans , Male , Middle Aged , PerceptionABSTRACT
BACKGROUND: Personality traits and mental health problems have been previously reported in unruptured intracranial aneurysm (UIA) patients; however, few studies have clarified the relations between these variables and health-related quality of life (HRQoL). This study was designed to characterize the personality traits, HRQoL and mental health of patients with UIA and to evaluate whether personality has an influence on HRQoL and whether this is mediated by the patients' emotional symptoms. METHODS: Sixty-three patients with UIAs (mean age 62.6 years, 83.9% women) answered questionnaires for depression, anxiety, HRQoL and personality traits between June 2016 and May 2019. RESULTS: Eight percent of the sample had depression, and 27.4% had anxiety. Participants showed high levels of responsibility, kindness and neuroticism and low levels of extraversion and openness. HRQoL scores were normal compared with the Colombian population. Structural equation analysis showed that patients' HRQoL was negatively affected by anxiety levels and that the latter are associated with the patient's personality, where neuroticism is directly associated with symptomatology and inversely associated with extraversion. CONCLUSIONS: The results of this study showed the importance of personality and emotional symptoms in the HRQoL of UIA patients. These results are important for developing strategies for psychological counseling in patients with UIAs.
Subject(s)
Anxiety/psychology , Depression/psychology , Intracranial Aneurysm/psychology , Personality/physiology , Quality of Life/psychology , Adaptation, Psychological , Adult , Aged , Aged, 80 and over , Cross-Sectional Studies , Extraversion, Psychological , Female , Health Status , Humans , Male , Middle Aged , Neuroticism/physiology , Surveys and QuestionnairesABSTRACT
OBJECTIVE: To determine risk factors for intracranial infection secondary to penetrating craniocerebral gunshot wounds (PCGWs) in civilian practice, in patients who underwent surgery with removal of bullet fragments, wound debridement, and watertight dural closure. METHODS: An observational, analytical, prospective, cohort-type study was conducted with follow-up in a group of patients with PCGWs caused by a low-velocity projectile admitted between January 2000 and November 2010. There were 160 patients, 59 of whom were administered prophylactic antibiotics based on the decision of the treating neurosurgeon. Average follow-up time was 39 months (range, 3-92 months). RESULTS: Infection occurred in 40 patients (25%); 20 patients received antibiotics (20 of 59 [33.9%]), and 20 patients did not receive antibiotics (20 of 101 [19.8%]). Three variables were independent risk factors for infection: (i) persistence of parenchymal osseous or metallic fragments after surgery (P < 0.0001, relative risk [RR] 7.45); (ii) projectile trajectory through a natural cavity with contaminating flora (P = 0.03, RR 2.84); and (iii) prolonged hospitalization time (P < 0.0001, RR 3.695). CONCLUSIONS: Administration of prophylactic antibiotics was not associated with the incidence of intracranial infection secondary to PCGWs. Projectile trajectory through potentially contaminating cavities, persistence of intraparenchymal osseous or metallic fragments after surgery, and prolonged hospital stay were independent risk factors for intracranial infection.
Subject(s)
Head Injuries, Penetrating/diagnosis , Head Injuries, Penetrating/surgery , Surgical Wound Infection/diagnosis , Surgical Wound Infection/surgery , Wounds, Gunshot/diagnosis , Wounds, Gunshot/surgery , Adolescent , Adult , Antibiotic Prophylaxis , Cohort Studies , Debridement , Female , Follow-Up Studies , Foreign Bodies/diagnosis , Foreign Bodies/surgery , Humans , Length of Stay , Male , Middle Aged , Prospective Studies , Risk Factors , Suture Techniques , Young AdultABSTRACT
Se presenta la técnica de compresión percutánea del ganglio de Gasser en la neuralgia idiopática del trigémino, en cualquiera de sus ramas; en paciente sin respuesta al tratamiento médico adecuado, por más de seis meses. La técnica es sencilla y de bajo riesgo y produce poca morbilidad con resultados ampliamente satisfactorios constituyéndose en una buena alternativa al manejo quirúrgico del nervio trigémino
Subject(s)
Trigeminal NeuralgiaABSTRACT
Los seudoaneurismas de la arteria vertebral extracraneana son extremadamente raros, dada la localización profunda en el cuello de esta arteria y la protección que ejercen sobre ella varias estructuras anatómicas, óseas y musculares. La oclusión con balón desprendible de la arteria vertebral por técnica endovascular se usó para tratar un paciente que presentaba infartos múltiples y repetitivos en territorio de la circulación cerebral posterior, progresivos en el tiempo, originados en un seudoaneurisma gigante postraumático de la arteria vertebral derecha en su porción extracraneana. El procedimiento fue llevado a cabo bajo máxima anticoagulación con heparina, no tuvo complicaciones y se consideró exitoso, tanto por control clínico como arteriográfico. Se presenta el uso exitoso de la técnica y se discute su evolución
