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1.
Osteoarthritis Cartilage ; 27(7): 1011-1017, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30922982

RESUMO

BACKGROUND: Data on the economic consequences of hip and knee osteoarthritis (OA) are scarce. We aimed to estimate the annual direct and indirect costs for patients followed for hip and/or knee OA in the Knee and Hip Osteoarthritis Long term Assessment (KHOALA) cohort. METHODS: The KHOALA cohort, set up from 2007 to 2009, is a French multicenter study of 878 individuals with symptomatic knee/hip OA who were 40-75 years old. Resources used were collected annually for 5 years. Costs were assigned by using official sources and expressed in 2018 euros per patient. RESULTS: The mean annual total costs per patient over the 5-year study period were 2,180 ± 5,305€. The mean annual direct medical costs per patient were 2,120 ± 5,275€ and mean annual indirect costs per patient 180 ± 1,735€ for people of working age. Costs increased slightly over the study period. Drugs were the largest cost share, representing over 50% of all direct costs. However, the proportion attributable to OA drugs accounted for only 10.5% of drug costs. The second cost share was hospitalizations; hip and knee prosthetic surgery accounted for 27% of surgery hospitalization costs. Health professional visits were the third cost share, accounting for 3% of direct medical costs. The median costs induced could be as high as 2 billion €/year (IQR 0.7-4.3) in France. CONCLUSION: Hip and knee OA costs were substantial and increased over the study period in France. However, the costs attributable to OA represented only a small fraction of overall costs.


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Osteoartrite do Quadril/economia , Osteoartrite do Joelho/economia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto , Idoso , Artroplastia de Quadril/economia , Artroplastia de Quadril/estatística & dados numéricos , Artroplastia do Joelho/economia , Artroplastia do Joelho/estatística & dados numéricos , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/terapia , Osteoartrite do Joelho/terapia
2.
Rheumatol Int ; 37(7): 1203-1206, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28447208

RESUMO

Antisynthetase syndrome is a heterogeneous idiopathic inflammatory myopathy. Anti-Jo1 is the most common antibody found in this condition. Dermatomyositis is known to be associated with malignancy, but the association between antisynthetase syndrome and malignancy is not clearly established. We report a case of an association of squamous cell carcinoma of the lung and anti-Jo1 antisynthetase syndrome. A 67-year-old man presented with polyarthritis, muscle weakness of the pelvic girdle, "mechanic's hands," and weight loss. A diagnosis of antisynthetase syndrome was considered based on the clinical features and the presence of anti-Jo1 antibodies. Positron emission tomography was performed because of weight loss and revealed a pulmonary hypermetabolic lesion. Histological findings revealed squamous cell carcinoma. The patient underwent lobectomy and is currently free of symptoms with regular monitoring. This unusual presentation of squamous cell carcinoma of the lung illustrates the need of a systematic approach to the diagnosis of antisynthetase syndrome. Positron emission tomography can be a useful imaging modality in the diagnosis of paraneoplastic syndromes associated with antisynthetase syndrome especially in the presence of warning signs/symptoms.


Assuntos
Anticorpos Antinucleares/sangue , Carcinoma de Células Escamosas/complicações , Neoplasias Pulmonares/complicações , Miosite/complicações , Idoso , Biomarcadores/sangue , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Masculino , Miosite/sangue , Miosite/diagnóstico , Miosite/imunologia , Pneumonectomia , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X , Resultado do Tratamento
3.
Orthop Traumatol Surg Res ; 102(5): 555-8, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27460650

RESUMO

PURPOSE: Patient-reported outcome measures (PROMs) have been gaining in popularity over the last decade. The Oxford Shoulder Score (OSS) is a well-established self-administered questionnaire for shoulder evaluation adapted for the English-speaking population. The aim of the present study was to develop a translation and a transcultural adaptation of the OSS and to assess its validity in native French-speaker patients with shoulder pain. METHODS: The translation process was carried out following a translation/back-translation methodology by two translators. All patients completed the French OSS, the Subjective Shoulder Value (SSV), and the Constant score. Internal consistency was tested using Cronbach's α coefficient. Validity was assessed by calculating the Pearson correlation coefficient between the OSS and the Constant score and the SSV. RESULTS: One hundred forty-four patients suffering from degenerative or inflammatory diseases of the shoulder were included in this study. The average time required to complete the French OSS was 2min and 45s. Seventy patients were asked to complete the questionnaire twice (test/retest reliability). Internal consistency was high with Cronbach's α coefficient=0.93. The intraclass correlation coefficient was 0.91 (95% CI: 0.88-0.94) for test/retest reliability. The French OSS score was significantly correlated with the Constant-Murley score (r=0.73 and P<0.0001) and with the SSV (r=0.68 and P<0.0001). CONCLUSIONS: The present study shows that the French version of the OSS is reliable, valid, and reproducible. The sensitivity to change now needs to be evaluated. This score was adapted to the French-speaking population for the self-assessment of patients with degenerative or inflammatory disorders of the shoulder. LEVEL OF EVIDENCE: Level 1, Test of previously developed criteria, diagnostic test study.


Assuntos
Indicadores Básicos de Saúde , Medidas de Resultados Relatados pelo Paciente , Dor de Ombro/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Comparação Transcultural , Feminino , França , Humanos , Idioma , Masculino , Pessoa de Meia-Idade , Psicometria , Reprodutibilidade dos Testes , Autorrelato , Traduções
4.
Osteoarthritis Cartilage ; 24(9): 1500-8, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27034093

RESUMO

OBJECTIVE: An overview of the economic consequences - overall costs as well as cost breakdown (direct and indirect) - of hip and knee osteoarthritis (OA) worldwide. METHODS: A systematic literature search of EMBASE, MEDLINE, Scopus and Cochrane databases for articles was performed independently by two rheumatologists who used the same predefined eligible criteria. Papers without abstracts and in languages other than English or French were excluded. Extracted costs were converted to an annual cost and to 2013 euros (€) by using the Consumer Price Index of the relevant countries and the 2013 Purchasing Power Parities between these countries and the European Union average. RESULTS: A total of 45 abstracts were selected, and 32 articles were considered for the review. The studied populations were heterogeneous: administrative, hospital and national health survey data. Annual total costs per patient ranged from 0.7 to 12 k€, direct costs per patient from 0.5 to 10.9 k€ and indirect costs per patient from 0.2 to 12.3 k€. The weighted average annual costs per patient living with knee and hip OA were 11.1, 9.5 and 4.4 k€ for total, direct and indirect costs, respectively. CONCLUSIONS: This review highlights the heterogeneity of studies and lack of methodologic consensus to obtain reliable cost-of-illness estimates for lower-limb OA. However, costs induced by the disease seem substantial and deserve to be more extensively explored.


Assuntos
Osteoartrite do Joelho , Efeitos Psicossociais da Doença , Inquéritos Epidemiológicos , Humanos , Articulação do Joelho , Osteoartrite do Quadril
5.
Ann Rheum Dis ; 75(6): 1108-13, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26048170

RESUMO

OBJECTIVES: Little data are available regarding the rate and predicting factors of serious infections in patients with rheumatoid arthritis (RA) treated with abatacept (ABA) in daily practice. We therefore addressed this issue using real-life data from the Orencia and Rheumatoid Arthritis (ORA) registry. METHODS: ORA is an independent 5-year prospective registry promoted by the French Society of Rheumatology that includes patients with RA treated with ABA. At baseline, 3 months, 6 months and every 6 months or at disease relapse, during 5 years, standardised information is prospectively collected by trained clinical nurses. A serious infection was defined as an infection occurring during treatment with ABA or during the 3 months following withdrawal of ABA without any initiation of a new biologic and requiring hospitalisation and/or intravenous antibiotics and/or resulting in death. RESULTS: Baseline characteristics and comorbidities: among the 976 patients included with a follow-up of at least 3 months (total follow-up of 1903 patient-years), 78 serious infections occurred in 69 patients (4.1/100 patient-years). Predicting factors of serious infections: on univariate analysis, an older age, history of previous serious or recurrent infections, diabetes and a lower number of previous anti-tumour necrosis factor were associated with a higher risk of serious infections. On multivariate analysis, only age (HR per 10-year increase 1.44, 95% CI 1.17 to 1.76, p=0.001) and history of previous serious or recurrent infections (HR 1.94, 95% CI 1.18 to 3.20, p=0.009) were significantly associated with a higher risk of serious infections. CONCLUSIONS: In common practice, patients treated with ABA had more comorbidities than in clinical trials and serious infections were slightly more frequently observed. In the ORA registry, predictive risk factors of serious infections include age and history of serious infections.


Assuntos
Abatacepte/efeitos adversos , Antirreumáticos/efeitos adversos , Artrite Reumatoide/tratamento farmacológico , Imunossupressores/efeitos adversos , Infecções Oportunistas/induzido quimicamente , Abatacepte/uso terapêutico , Adulto , Fatores Etários , Idoso , Antirreumáticos/uso terapêutico , Artrite Reumatoide/epidemiologia , Artrite Reumatoide/imunologia , Comorbidade , Feminino , França/epidemiologia , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Infecções Oportunistas/epidemiologia , Infecções Oportunistas/imunologia , Sistema de Registros , Fatores de Risco
6.
RMD Open ; 1(1): e000034, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26509060

RESUMO

OBJECTIVES: To evaluate the prevalence of late-onset neutropenia and its complications in patients treated with rituximab (RTX) for rheumatoid arthritis (RA) and other autoimmune diseases (AIDs) in a prospective registry. METHODS: The AutoImmunity and Rituximab registry is an independent 7-year prospective registry promoted by the French Society of Rheumatology. For each episode of neutropenia, data were validated by the clinician in charge of the patient. RESULTS: Among 2624 patients treated with RTX for refractory AIDs, and at least 1 follow-up visit (a total follow-up of 4179 patient-years in RA and 987 patient-years in AIDs), late-onset neutropenia was observed in 40 patients (25 RA (1.3% of patients with RA, 0.6/100 patient-years), and AIDs in 15 (2.3% of patients with AIDs, 1.5/100 patient-years)). 6 patients (15%) had neutrophils <500/mm(3), 8 (20%) had neutrophils between 500 and 1000/mm(3), and 26 (65%) had neutrophils between 1000 and 1500/mm(3). Neutropenia occurred after a median period of 4.5 (3-6.5) months after the last RTX infusion in patients with RA, and 5 (3-6.5) months in patients with AIDs. 5 patients (12.5%), 4 of them with neutrophils lower than 500/mm(3), developed a non-opportunistic serious infection and required antibiotics and granulocyte colony-stimulating factor injections, with a favourable outcome. After resolution of their RTX-related neutropenia, 19 patients (47.5%) were re-treated, and neutropenia reoccurred in 3 of them. CONCLUSIONS: Late-onset neutropenia might occur after RTX and may result in serious infections. Thus, monitoring of white cell count should be performed after RTX. However, in this large registry of patients with AIDs, the frequency of RTX-induced neutropenia was much lower than that previously reported in patients treated for blood malignancies or AIDs.

7.
Vaccine ; 33(46): 6152-5, 2015 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-26458794

RESUMO

Revaxis(®) is a vaccine against diphtheria, tetanus and poliomyelitis (dT-IPV). This vaccine should not be administered by the intradermal or intravenous route. Poor injection techniques and related consequences are rare. We report a case of bursitis associated with reactive glenohumeral effusion complicated by bone erosion occurring after injection of the dT-IPV vaccine. A 26 year old patient was admitted for painful left shoulder causing functional impairment. Control magnetic resonance imaging showed bone oedema on the upper outer part of the humeral head, with a slight cortical irregularity, indicating that the vaccine was injected in contact with the bone at this location, causing erosion. Outcome was favourable after intra-articular corticosteroids. Reports of articular or periarticular injury after vaccination are extremely rare, in view of the substantial number of vaccines administered every year. The potential complications of vaccination are well known to general practitioners but under-reported in the literature.


Assuntos
Reabsorção Óssea/induzido quimicamente , Reabsorção Óssea/epidemiologia , Bursite/induzido quimicamente , Bursite/epidemiologia , Vacina contra Difteria e Tétano/efeitos adversos , Vacina Antipólio de Vírus Inativado/efeitos adversos , Adulto , Vacina contra Difteria e Tétano/administração & dosagem , Feminino , Humanos , Úmero/patologia , Vacina Antipólio de Vírus Inativado/administração & dosagem , Articulação do Ombro/patologia , Vacinas Combinadas/administração & dosagem , Vacinas Combinadas/efeitos adversos
8.
Rev Med Interne ; 34(1): 42-6, 2013 Jan.
Artigo em Francês | MEDLINE | ID: mdl-23036779

RESUMO

INTRODUCTION: The prevalence of vertebral sarcoidosis is highly variable (1 to 36% of reported case series). Because of limited clinical expression, its frequency is probably underestimated. Its proper management is not clearly defined. CASE REPORT: A 42-year-old woman who had a past medical history of cutaneous and pulmonary sarcoidosis presented with low back pain that was refractory to usual medical treatment. A diagnosis of vertebral localisation of sarcoidosis was considered on the history of proven sarcoidosis, radiological features, and the absence of evidence of an alternative diagnosis. In the absence of other clinical or biological evidence of active sarcoidosis, a simple follow-up was planned. MRI control at 1 year showed the resolution of vertebral sarcoidosis lesions. CONCLUSION: Spontaneous regression is a possible outcome of vertebral sarcoidosis. Initiation of a specific treatment should be discussed in the absence of other visceral involvement.


Assuntos
Vértebras Lombares/patologia , Sarcoidose/diagnóstico , Doenças da Coluna Vertebral/diagnóstico , Adulto , Feminino , Seguimentos , Humanos , Dor Lombar/diagnóstico , Remissão Espontânea , Sarcoidose Pulmonar/diagnóstico , Dermatopatias/diagnóstico , Conduta Expectante
9.
Rev Med Interne ; 32(12): e116-8, 2011 Dec.
Artigo em Francês | MEDLINE | ID: mdl-21277658

RESUMO

The association of positive cytoplasmic antineutrophil antibody (ANCA) necrotizing crescentic glomerulonephritis with endocarditis raises diagnostic issues. Indeed, it is often difficult to determine if the kidney injury is either secondary to an infectious disease or caused by an ANCA-associated small vessel vasculitis. We report a 59-year-old man admitted in nephrology for acute glomerular syndrome in whom the renal biopsy showed a crescentic necrotizing glomerulonephritis. A diagnosis of vasculitis was initially considered in the presence of high titer of ANCA (anti-proteinase 3). Because of associated Staphyloccocus aureus endocarditis the patient received both corticosteroids and antibiotics that allowed remission of both kidney injury and endocarditis. The renal presentation and the disappearance of ANCA support the infectious etiology of this glomerulonephritis rather than an ANCA-associated small vessel vasculitis. It is important to be cautious in the presence of ANCA positive extracapillary glomerulonephritis and endocarditis should be ruled out before initiation of corticosteroids that may be nevertheless necessary in severe acute glomerulonephritis.


Assuntos
Anticorpos Anticitoplasma de Neutrófilos/metabolismo , Endocardite/diagnóstico , Glomerulonefrite/diagnóstico , Anticorpos Anticitoplasma de Neutrófilos/sangue , Doenças Autoimunes/sangue , Doenças Autoimunes/complicações , Doenças Autoimunes/diagnóstico , Doenças Autoimunes/imunologia , Diagnóstico Diferencial , Progressão da Doença , Endocardite/sangue , Endocardite/complicações , Glomerulonefrite/sangue , Glomerulonefrite/etiologia , Glomerulonefrite/patologia , Humanos , Masculino , Pessoa de Meia-Idade
10.
Vet Ophthalmol ; 11 Suppl 1: 15-9, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19046265

RESUMO

OBJECTIVE: To determine ocular distribution and toxicity of a single injection of intravitreal triamcinolone acetonide (TA) in normal horses. ANIMALS STUDIED: Six adult horses, donated to North Carolina State University. PROCEDURES: Six horses were injected intravitreally with either 10, 20, or 40 mg (n = 2 each) of TA. The opposite eye of each horse was injected with balanced salt solution (BSS). Ocular toxicity was assessed by biomicroscopy, tonometry, indirect ophthalmoscopy, and electroretinogram. Aqueous humor (AH), vitreous humor (VH), and plasma samples were collected. Horses were euthanized 7 or 21 days after injection and eyes enucleated for histopathology. TA concentrations in AH, VH, and plasma were measured by HPLC. RESULTS: Three control eyes and one TA eye developed inflammation after injection or collection of AH. Positive bacterial cultures (Corynebacterium spp., Staphylococcus spp., and Streptococcus spp.) were obtained from three of these eyes. Other than transient corneal edema in TA injected eyes, which resolved by 7 days after injection, no other changes were observed. TA crystals were visible within the vitreous body. No evidence of TA toxic effect was noted on histopathology. TA was detected in all AH and VH samples from treated eyes following injection. Drug was not detected in the plasma. CONCLUSIONS: There was no evidence of overt toxicity from intravitreal TA in normal horses and a single intravitreal injection resulted in TA ocular levels for 21 days. However, the risk for bacterial infections with intravitreal injection or anterior chamber aspirations in horses is high. Use of topical and systemic antibiotics after injection is recommended.


Assuntos
Anti-Inflamatórios/toxicidade , Humor Aquoso/química , Cavalos , Triancinolona Acetonida/toxicidade , Corpo Vítreo/química , Animais , Anti-Inflamatórios/farmacocinética , Cromatografia Líquida de Alta Pressão/métodos , Cromatografia Líquida de Alta Pressão/veterinária , Relação Dose-Resposta a Droga , Eletrorretinografia/veterinária , Cavalos/sangue , Cavalos/metabolismo , Injeções/efeitos adversos , Injeções/veterinária , Retina/efeitos dos fármacos , Distribuição Tecidual , Triancinolona Acetonida/farmacocinética
11.
J Vet Pharmacol Ther ; 31(6): 511-6, 2008 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19000272

RESUMO

In vitro photosensitivity of rapamycin (RAPA) and ocular toxicity and distribution of intravitreal and subconjunctival RAPA was evaluated in normal horses. RAPA (2.5 mg, 5 mg, and 10 mg) was placed in 10 mL of PBS and maintained in a water bath at 37 degrees C, kept in the dark or subjected to room light, and sampled for up to 3 months for RAPA levels. Six normal adult horses received either 5 mg (n = 2) or 10 mg (n = 2) of RAPA intravitreally or 10 mg (n = 2) subconjunctivally. Ophthalmic exams and electroretinography (ERG) were performed prior to injection and on days 1, 7, 14, and 21 post-injection. Eyes were enucleated and samples were collected for RAPA concentrations and histopathology. No difference in light vs. dark RAPA concentrations was observed, suggesting a lack of RAPA phototoxicity. No evidence of ocular toxicity was noted on ophthalmic examination or histopathology. RAPA was not detected intraocularly 7 days post-injection in eyes receiving subconjunctival RAPA, but was detected in the vitreous at 21 days post-injection. Drug could be detected in both the aqueous and vitreous humor after intravitreal injection. Further study is needed to determine the efficacy of intravitreal RAPA.


Assuntos
Antibacterianos/uso terapêutico , Sirolimo/farmacocinética , Sirolimo/uso terapêutico , Uveíte/veterinária , Animais , Antibacterianos/efeitos adversos , Antibacterianos/farmacocinética , Cromatografia Líquida de Alta Pressão , Dermatite Fototóxica , Cavalos , Sirolimo/efeitos adversos , Distribuição Tecidual , Uveíte/tratamento farmacológico
12.
J Vet Pharmacol Ther ; 28(5): 425-31, 2005 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-16207304

RESUMO

The purpose of this study was to determine the pharmacokinetics and tissue fluid distribution of cephalexin in the adult horse following oral and i.v. administration. Cephalexin hydrate (10 mg/kg) was administered to horses i.v. and plasma samples were collected. Following a washout period, cephalexin (30 mg/kg) was administered intragastrically. Plasma, interstitial fluid (ISF) aqueous humor, and urine samples were collected. All samples were analyzed by high-pressure liquid chromatography (HPLC). Following i.v. administration, cephalexin had a plasma half-life (t(1/2)) of 2.02 h and volume of distribution [V(d(ss))] of 0.25 L/kg. Following oral administration, the average maximum plasma concentration (C(max)) was 3.47 mug/mL and an apparent half-life (t(1/2)) of 1.64 h. Bioavailability was approximately 5.0%. The AUC(ISF):AUC(plasma) ratio was 80.55% which corresponded to the percentage protein-unbound drug in the plasma (77.07%). The t(1/2) in the ISF was 2.49 h. Cephalexin was not detected in the aqueous humor. The octanol:water partition coefficient was 0.076 +/- 0.025. Cephalexin was concentrated in the urine with an average concentration of 47.59 microg/mL. No adverse events were noted during this study. This study showed that cephalexin at a dose of 30 mg/kg administered orally at 8 h dosage intervals in horses can produce plasma and interstitial fluid drug concentrations that are in a range recommended to treat susceptible gram-positive bacteria (MIC < or = 0.5 microg/mL). Because of the low oral bioavailability of cephalexin in the horse, the effect of chronic dosing on the normal intestinal bacterial flora requires further investigation.


Assuntos
Antibacterianos/farmacocinética , Cefalexina/farmacocinética , Cavalos/metabolismo , Administração Oral , Animais , Antibacterianos/administração & dosagem , Antibacterianos/sangue , Área Sob a Curva , Cefalexina/administração & dosagem , Cefalexina/sangue , Estudos Cross-Over , Feminino , Injeções Intravenosas/veterinária , Masculino , Distribuição Tecidual
13.
Am J Dis Child ; 135(6): 502, 1981 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-7234781
15.
Childs Brain ; 5(2): 109-15, 1979.
Artigo em Inglês | MEDLINE | ID: mdl-436563

RESUMO

10 premature infants were found to have posthemorrhagic hydrocephalus (PHH) over a 4-year period. All weighed less than 2,500 g. The diagnosis was established by ventricular puncture and ventriculogram. Ventriculo-peritoneal (V-P) shunt placement was done in each infant soon after establishing the diagnosis, while the cerebrospinal fluid (CSF) was bloody. The mean age of infants at surgery was 21.4 days (range 16-33 days). Shunt obstruction occurred in 3 infants and infection in 1. No other complication was observed. All infants improved markedly in the immediate postoperative period, especially respirator-dependent infants. All survived; preliminary follow-up revealed that 3 were severely retarded and 2 mildly retarded; 5 infants were normal. Our preliminary experience with early V-P shunt procedure in the treatment of PHH has been favorable and follow-up appears encouraging.


Assuntos
Hemorragia Cerebral/complicações , Hidrocefalia/cirurgia , Doenças do Prematuro/cirurgia , Derivações do Líquido Cefalorraquidiano , Humanos , Hidrocefalia/etiologia , Lactente , Recém-Nascido , Deficiência Intelectual/etiologia , Cavidade Peritoneal , Prognóstico
16.
Surg Neurol ; 9(6): 349-52, 1978 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-307825

RESUMO

Acute obstruction of a shunt may occur when the ventricular space becomes slitlike. Four patients with collapsed ventricles were treated by adding a higher pressure valve to the system. The ventricles enlarged and the patients became asymptomatic. Twelve children who had been shunted in the neonatal period had a higher pressure valve added as an elective procedure to prevent ventricular collapse. There were no episodes of shunt obstruction in the subsequent seven to 38 months.


Assuntos
Ventrículos Cerebrais/cirurgia , Derivações do Líquido Cefalorraquidiano , Hidrocefalia/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Ventriculografia Cerebral , Criança , Feminino , Humanos , Hidrocefalia/diagnóstico por imagem , Lactente , Masculino , Meningomielocele/cirurgia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
17.
Hosp Pract ; 13(4): 80-8, 1978 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-658954

RESUMO

Correction of hydrocephalus by means of a ventriculoperitoneal shunt incorporating a pericranial reservoir is demonstrated in a five-day-old infant. The reservoir affords access to the ventricle and shunt for pressure determinations and for administration of antibiotics should infection occur. The initial shunt is revised at about one year of age to permit intraventricular pressure to rise to adult levels and to provide for growth.


Assuntos
Derivações do Líquido Cefalorraquidiano/métodos , Hidrocefalia/cirurgia , Fatores Etários , Ventrículos Cerebrais , Feminino , Humanos , Hidrocefalia/etiologia , Recém-Nascido , Região Lombossacral , Meningomielocele/complicações , Peritônio
18.
Childs Brain ; 4(2): 114-9, 1978.
Artigo em Inglês | MEDLINE | ID: mdl-639599

RESUMO

Very high intraventricular chloramphenicol levels can be obtained if the standard systemic dose is supplemented with a small intraventricular dose. Chloramphenicol sodium succinate can be hydrolyzed to the microbiologically active chloramphenicol in the ventricular fluid. Daily injections are ordinarily adequate to maintain a high concentration of antibiotic. Initial dosage should vary with ventricular volume. The brain does not tolerate repeated needle puncture and the use of a ventriculostomy reservoir is recommended.


Assuntos
Cloranfenicol/administração & dosagem , Meningite/tratamento farmacológico , Animais , Cloranfenicol/sangue , Cães , Humanos , Hidrocefalia/complicações , Lactente , Recém-Nascido , Doenças do Recém-Nascido/tratamento farmacológico , Injeções Intraventriculares
19.
Pediatrics ; 60(5): 721-5, 1977 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-917635

RESUMO

The applanation transducer was used to measure intracranial pressure (ICP) through the intact fontanel. The method is painless, rapid, and accurate. The pressures recorded with this fontogram were correlated with direct measurements of ICP. The correlation coefficient of the 21 paired determinations was .98--a very good correlation. Fontanel pressure was determined in 35 normal newborn infants. The mean pressure was 7.37 mm Hg with an SD of +/- 1.45 (range, 3.5 to 9.5 mm Hg). Three clinical cases are presented to illustrate the usefulness of this apparatus in the detection of increased ICP and in monitoring the effectiveness of treatment.


Assuntos
Pressão Intracraniana , Monitorização Fisiológica , Crânio , Edema Encefálico/diagnóstico , Feminino , Humanos , Lactente , Recém-Nascido , Transdutores
20.
J Neurosurg ; 47(4): 596-8, 1977 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-903812

RESUMO

A teen-age girl became comatose after the sudden onset of headache. Initial angiography did not reveal the site of bleeding. The subsequent onset of ocular bobbing directed attention to the region of the pons. Repeated angiography showed an aneurysm of the superior cerebellar artery. At surgery, the fundus of the aneurysm was adherent to the pons and there was a small hematoma within the pons. Ocular bobbing is rare, but is most commonly seen in association with destructive lesions of the pontine tegmentum, and is a useful localizing sign.


Assuntos
Movimentos Oculares , Aneurisma Intracraniano/fisiopatologia , Adolescente , Feminino , Humanos , Aneurisma Intracraniano/complicações , Hemorragia Subaracnóidea/etiologia
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