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1.
J Clin Neurosci ; 9(4): 425-8, 2002 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-12217672

RESUMO

Haemoglobin and adenosine 5'-triposphate (ATP) released from lysed erythrocytes have been postulated to be responsible for delayed cerebral vasospasm after subarachnoid haemorrhage (SAH). However, the concentrations of haemoglobin and ATP in cerebrospinal fluid (CSF) in patients or in an animal model of vasospasm have not been reported. In this study, 12 mongrel dogs underwent a double blood injection via the cisterna magna on day 0 and 2, after an initial collection of CSF. On day 3, 5 or 7, the dogs were sacrificed after a second collection of CSF. An angiogram was recorded on day 0 and on the day of sacrifice. Results showed that the diameter of the dog's basilar artery was reduced 20% on day 3 (P > 0.05), 35% on day 5 (P < 0.05) and 45% on day 7 (P < 0.05). The concentrations of OxyHb, deOxyHb and MetHb in CSF were increased (P < 0.05), and all peaked on day 3. OxyHb and MetHb remained significantly higher than control (day 0) from day 3 to day 7, while deOxyHb remained at a high level on day 5 but returned to normal on day 7. In contrast, ATP was decreased (P < 0.05) on days 5 and 7 after SAH compared with day 0. The results indicate that haemoglobin might be involved in the development of cerebral vasospasm. The possible role of ATP in vasospasm remains unclear.


Assuntos
Trifosfato de Adenosina/líquido cefalorraquidiano , Hemoglobinas/líquido cefalorraquidiano , Vasoespasmo Intracraniano/líquido cefalorraquidiano , Animais , Hemorragia Cerebral/líquido cefalorraquidiano , Modelos Animais de Doenças , Cães , Feminino , Masculino
2.
Acta Neurochir Suppl ; 81: 257-63, 2002.
Artigo em Inglês | MEDLINE | ID: mdl-12168320

RESUMO

OBJECTIVE: Even though cerebral vasospasm after subarachnoid hemorrhage (SAH) causes cerebral ischemia or infarction, the metabolic alterations in cerebrospinal fluids (CSF) after SAH have not been studied. This study was undertaken to measure the levels of glucose, lactate, pyruvate and glutamate in CSF from double hemorrhage dog models. METHOD: Thirty-two mongrel dogs of either sex, weighing 15-30 kg, underwent double hemorrhage by percutaneous needle puncture of the cisterna magna and injection of autologous blood on day 0 and day 2. The dogs were then sacrificed on day 3, 5 and 7, after collecting CSF. In another study, the dogs were treated with mitogen-activated protein kinase (MAPK) inhibitors PD98059 and U0126, and caspase-2 and caspase-3 inhibitors from day 3 to day 6 after initial blood injection. CSF was collected on day 7 before dogs were sacrificed. The concentration of glucose, lactate, pyruvate and glutamate in CSF was measured by photometrical method. RESULTS: Compared with CSF collected on day 0, glucose was decreased on days 5-7, lactate was increased on days 2-7, pyruvate was increased on days 2-7, and glutamate was increased on days 3-7 (P < 0.05). In the groups treated with MAPK or caspase inhibitors, most of the metabolic alterations remained unchanged as compared with CSF from untreated dogs. Clinically, caspase inhibitors-2 and -3, and MAPK inhibitor U0126 all failed to prevent vasospasm. MAPK inhibitor PD98059 partially prevented vasospasm. CONCLUSION: Our data demonstrated a metabolic alteration of glucose, glutamate, lactate and pyruvate in CSF during cerebral vasospasm. This metabolic change is consistent with the time course of cerebral vasospasm. This study suggests that brain energy metabolites and excitative amino acids are altered during cerebral vasospasm.


Assuntos
Hemorragia Cerebral/líquido cefalorraquidiano , Glucose/líquido cefalorraquidiano , Ácido Glutâmico/líquido cefalorraquidiano , Lactatos/líquido cefalorraquidiano , Ácido Pirúvico/líquido cefalorraquidiano , Vasoespasmo Intracraniano/líquido cefalorraquidiano , Análise de Variância , Animais , Inibidores de Caspase , Hemorragia Cerebral/complicações , Modelos Animais de Doenças , Cães , Inibidores Enzimáticos/farmacologia , Feminino , Flavonoides/farmacologia , Masculino , Proteínas Quinases Ativadas por Mitógeno/metabolismo , Fatores de Tempo , Vasoespasmo Intracraniano/etiologia
3.
Life Sci ; 70(16): 1901-8, 2002 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-12005175

RESUMO

This study was undertaken to investigate the role of p44/42 MAPK in a dog double hemorrhage model of subarachnoid hemorrhage (SAH), and whether MEK inhibitors can alter the degree of SAH-induced vasoconstriction. The diameter of the basilar artery, which was compared with day 0 angiogram, decreased gradually in a time-dependent manner from day 3 (80%), day 5 (68%) through day 7 (53.5%). The level of MAPK (p44/42) immunoprecipitation peaked on day 3 and remained enhanced through day 7 (P < 0.05). MEK inhibitor PD98059 significantly reduced p44/42 MAPK immunoprecipitation and significantly reversed vasospasm and increased residual diameter to 79.0% on day 7. These results demonstrated that p44/42 MAPK kinase is involved in the pathogenesis of cerebral vasospasm. The MEK inhibitor PD98059 might be useful in the treatment of vasospasm.


Assuntos
Proteína Quinase 1 Ativada por Mitógeno/fisiologia , Proteínas Quinases Ativadas por Mitógeno/fisiologia , Vasoespasmo Intracraniano/etiologia , Animais , Pressão Sanguínea , Doença Crônica , Dimetil Sulfóxido/farmacologia , Cães , Feminino , Flavonoides/farmacologia , Masculino , Proteína Quinase 3 Ativada por Mitógeno , Testes de Precipitina , Vasoconstrição , Vasoespasmo Intracraniano/fisiopatologia
4.
Brain Res ; 931(2): 168-75, 2002 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-11897102

RESUMO

Blood components such as oxyhemoglobin are believed to cause cerebral vasospasm by inducing contraction and cell death in cerebral arteries. We have observed previously that oxyhemoglobin produces apoptotic changes in cultured endothelial cells. This study was undertaken to explore if bilirubin, a bi-product of hemoglobin degradation, will produce similar cytotoxicity in endothelial cells. Cultured bovine brain microvascular endothelial cells were incubated in four concentrations of bilirubin (10, 25, 50, and 100 microM) for varying times (6, 12, and 24 h). Control cells were incubated in saline or vehicle (NaOH solution, <0.01% of 0.01 N) for similar time periods. The cultured cells were then observed microscopically for evidence of cellular alterations. Bilirubin (10-100 microM) produced apoptosis that appeared time-dependent but not clearly concentration-dependent. Biochemical markers for apoptosis such as DNA fragmentation and PARP cleavage were induced by bilirubin. We conclude that endothelial cells may undergo apoptosis after exposure to bilirubin.


Assuntos
Apoptose , Bilirrubina/toxicidade , Encéfalo/irrigação sanguínea , Endotélio Vascular/efeitos dos fármacos , Animais , Western Blotting , Bovinos , Adesão Celular/efeitos dos fármacos , Contagem de Células , Sobrevivência Celular/efeitos dos fármacos , Células Cultivadas , Fragmentação do DNA , Relação Dose-Resposta a Droga , Endotélio Vascular/citologia , Endotélio Vascular/ultraestrutura , Hemina/farmacologia , Microcirculação/citologia , Microscopia Eletrônica
8.
Neurol Res ; 23(1): 87-92, 2001 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-11210438

RESUMO

Even though cerebral vasospasm after subarachnoid hemorrhage (SAH) causes cerebral ischemia or infarction, the metabolic alterations in cerebrospinal fluids (CSF) after SAH have not been studied. This study was undertaken to measure the levels of glucose, lactate, pyruvate and glutamate in CSF from double hemorrhage dog models. Thirty-two mongrel dogs of either sex, weighing 18-24 kg, underwent double hemorrhage by percutaneous needle puncture of the cistema magna and injection of autologous blood on day 0 and day 2. The dogs were then sacrificed on day 3, 5 and 7, after collecting CSF. In another study, the dogs were treated with mitogen-activated protein kinase (MAPK) inhibitors PD98059 and U0126, and caspase-2 and caspase-3 inhibitors from day 3 to day 6 after initial blood injection. CSF was collected on day 7 before dogs were sacrificed. The concentration of glucose, lactate, pyruvate and glutamate in CSF was measured by photometrical method. Compared with CSF collected on day 0, glucose was decreased on days 5-7, lactate was increased on days 2-7, pyruvate was increased on days 2-7, and glutamate was increased on days 3-7 (p < 0.05). In the groups treated with MAPK or caspase inhibitors, most of the metabolic alterations remained unchanged as compared with CSF from untreated dogs. Clinically, caspase inhibitors-2 and -3, and MAPK inhibitor U0126 all failed to prevent vasospasm. MAPK inhibitor PD98059 partially prevented vasospasm. Our data demonstrated a metabolic alteration of glucose, glutamate, lactate and pyruvate in CSF during cerebral vasospasm. This metabolic change in consistent with the time course of cerebral vasospasm. This study suggests that brain energy metabolites and excitative amino acids are altered during cerebral vasospasm.


Assuntos
Líquido Cefalorraquidiano/metabolismo , Hemorragia Subaracnóidea/líquido cefalorraquidiano , Vasoespasmo Intracraniano/líquido cefalorraquidiano , Animais , Artéria Basilar/efeitos dos fármacos , Artéria Basilar/metabolismo , Artéria Basilar/fisiopatologia , Inibidores de Caspase , Caspases/metabolismo , Modelos Animais de Doenças , Cães , Inibidores Enzimáticos/farmacologia , Feminino , Glucose/metabolismo , Ácido Glutâmico/metabolismo , Ácido Láctico/metabolismo , Masculino , Proteínas Quinases Ativadas por Mitógeno/antagonistas & inibidores , Proteínas Quinases Ativadas por Mitógeno/metabolismo , Ácido Pirúvico/metabolismo , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/tratamento farmacológico , Fatores de Tempo , Vasoespasmo Intracraniano/tratamento farmacológico , Vasoespasmo Intracraniano/etiologia
10.
J Neurosurg ; 93(6): 1041-7, 2000 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-11117847

RESUMO

OBJECT: Mitogen-activated protein kinase (MAPK) may be involved in the pathogenesis of cerebral vasospasm after subarachnoid hemorrhage. This study was conducted to investigate the ability of the MAPK inhibitors PD-98059 and U-0126 to reverse vasospasm in a double-hemorrhage model in dogs. METHODS: Twenty-two adult mongrel dogs of either sex, each weighing 18 to 24 kg, were divided randomly into four groups: control SAH (four dogs), vehicle- (dimethyl sulfoxide, six dogs), PD-98059- (six dogs), and U-0126-treated groups (six dogs). The double-hemorrhage model was created by an autologous blood injection into the cisterna magna on Days 0 and 2. An intracisternal injection of MAPK inhibitors was administered once per day on Days 3 through 6. Cerebral angiography was performed on Days 0 and 7 before the animals were killed. Western blot analysis was used to study the effects of hemorrhage and drug treatment on the MAPK immunoprecipitation. Severe vasospasm developed in the dogs in the control and vehicle-treated groups (basilar artery [BA] diameter reduction 46.6 +/- 5.5% and 49.3 +/- 4.6%, respectively). In the PD-98059-treated group, most of the dogs developed mild vasospasm (18.9 +/- 6.2%). In the U-0126-treated group, severe vasospasm was observed despite treatment (39.6 +/- 6.4%). The PD-98059 but not the U-0126 abolished MAPK immunoprecipitation in the spastic BAs. However, treatment with either PD-98059 or U-0126 improved the clinical scores of the dogs. CONCLUSIONS: The present study is the first in which the effects of MAPK inhibitors on vasospasm have been investigated in vivo. The authors demonstrate that MAPK may play a role in vasospasm and that PD-98059 is a potential candidate for the treatment of cerebral vasospasm.


Assuntos
Butadienos/farmacologia , Angiografia Cerebral/efeitos dos fármacos , Flavonoides/farmacologia , Proteínas Quinases Ativadas por Mitógeno/antagonistas & inibidores , Nitrilas/farmacologia , Hemorragia Subaracnóidea/diagnóstico por imagem , Vasodilatadores/farmacologia , Vasoespasmo Intracraniano/diagnóstico por imagem , Animais , Artérias Cerebrais/efeitos dos fármacos , Artérias Cerebrais/patologia , Modelos Animais de Doenças , Cães , Hemorragia Subaracnóidea/patologia , Vasoespasmo Intracraniano/patologia
11.
Surg Neurol ; 54(3): 221-7; discussion 227-8, 2000 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-11118568

RESUMO

BACKGROUND: Vasospasm in the penetrating arteries contributes to ischemic neurological deficit. It may be as important as angiographic vasospasm because it would explain the discrepancies between angiographic vasospasm and clinical symptoms in some patients. It may also underlie the different effects of vasodilators. The present study examined this hypothesis by looking at the effect of the inhibitors of mitogen-activated protein kinase (MAPK) on vasospasm of the penetrating arteries. METHODS: Twenty-two adult mongrel dogs of either sex were used for the dog double-hemorrhage model. The dogs were randomly divided into four groups: control-hemorrhage, vehicle-treated, PD98059-treated, and U0126-treated groups. The drug injections were started on Day 3 after the first subarachnoid hemorrhage (SAH). The clinical status of the dogs was studied, based on their activity, appetite, and focal neurological symptoms. On Day 7, all the dogs were sacrificed, and the penetrating arteries from the brain stem were prepared for transmission electron microscopy. RESULTS: (1) Severe vasospasm developed in the basilar arteries in the SAH-without-treatment group (control), in the DMSO-treated group (DMSO), and in the U0126 treatment group with mean reduction of the basilar artery diameter of 46.57%, 49.3%, and 39.6%, respectively. In the PD98059-treatment group only a mild vasospasm was observed and the mean reduction of the basilar artery diameter was 18.9%. (2) All the dogs in the control SAH and vehicle-treated groups developed severe angiographic and clinical vasospasm. The penetrating arteries were contracted, and the endothelial and smooth muscle cells were dystrophic. (3) The dogs in the U0126-treated group developed severe angiographic, but not clinical, vasospasm. The penetrating arteries were not contracted, and the endothelial and smooth muscle cells were not dystrophic. (4) The dogs in the PD98059 group developed mild angiographic vasospasm. No dog developed clinical symptoms that could be attributed to vasospasm. In morphological studies, the penetrating arteries were slightly contracted, but the cells were not dystrophic. CONCLUSIONS: Vasospasm of the penetrating arteries, but not angiographic vasospasm, is consistent with the clinical symptoms and signs of vasospasm. MAPK may be important in maintaining vasospasm of both major and penetrating cerebral arteries. The correlation of the improvement in the clinical score with the reduction of vasospasm in the penetrating arteries demonstrated an important role of penetrating arteries in the morbidity and mortality caused by SAH.


Assuntos
Butadienos/uso terapêutico , Artérias Cerebrais/patologia , Inibidores Enzimáticos/uso terapêutico , Flavonoides/uso terapêutico , Proteínas Quinases Ativadas por Mitógeno/antagonistas & inibidores , Nitrilas/uso terapêutico , Vasoespasmo Intracraniano/prevenção & controle , Animais , Artéria Basilar/patologia , Butadienos/farmacologia , Cães , Inibidores Enzimáticos/farmacologia , Feminino , Flavonoides/farmacologia , Masculino , Modelos Animais , Nitrilas/farmacologia , Distribuição Aleatória , Hemorragia Subaracnóidea/etiologia , Hemorragia Subaracnóidea/prevenção & controle , Vasoespasmo Intracraniano/complicações
12.
Surg Neurol ; 54(3): 212-9; discussion 219-20, 2000 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-11118567

RESUMO

BACKGROUND: Morphological presentations of cerebral vasospasm, such as dystrophy and desquamation of endothelial cells, corrugation of the internal elastic layer, and necrotic changes in smooth muscle cells, are well defined in large cerebral arteries. This study was undertaken to examine pathological changes in cerebral penetrating arteries in a canine double hemorrhage model. METHODS: Eighteen mongrel dogs were subjected to an autologous arterial blood (0.4 mL/kg) injection into the cisterna magna on day 0 and day 2 after withdrawal of an equivalent amount of cerebrospinal fluid. Angiogram was performed on day 0 before the blood injection and on the day the dogs were sacrificed. The dogs were divided into four groups: control (day 0) (n = 4), hemorrhage and sacrificed on day 3 (n = 4), day 5 (n = 5), and day 7 (n = 5). The penetrating arteries were removed and found to be spastic on days 3, 5, and 7, but not in the control group. RESULTS: Endothelial dystrophy and partial desquamation were recorded in all dogs sacrificed on days 5 and 7. Condensation of chromatin, blebbing of the membrane, and condensation of cytoplasm were identified in many endothelial cells, features that are consistent with apoptosis. The morphological changes in the penetrating arteries were more pronounced on days 5 and 7. CONCLUSIONS: Vasospasm occurred in cerebral penetrating arteries in a canine double hemorrhage model. The morphological change in penetrating arteries, especially apoptosis in endothelial cells, is consistent with an early phase of vasospasm. Vasospasm in a penetrating artery may contribute to the cerebral ischemia that occurs during vasospasm.


Assuntos
Artérias Cerebrais/patologia , Hemorragia Subaracnóidea/patologia , Vasoespasmo Intracraniano/patologia , Animais , Encéfalo/irrigação sanguínea , Cães , Feminino , Masculino , Modelos Animais , Fatores de Tempo
13.
Anesth Analg ; 91(4): 798-803, 2000 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-11004029

RESUMO

Optison is a new echocardiographic contrast agent, designed for IV injection, that is very useful in delineating cardiac structures during ultrasound examination. Because Optison could be a valuable adjunct in the diagnosis and evaluation of congenital heart disease, this study was undertaken to assess its effects on the blood-brain barrier when introduced directly in the cerebral circulation, as might occur with some congenital lesions. In this study, Sprague-Dawley rats were anesthetized, and Optison, at various dosages, was injected into the carotid artery. After this, Evans blue dye, a marker for blood-brain barrier disruption, was injected at different time intervals. Gross and histologic examination of the animals' brains revealed disruption of the blood-brain barrier that appeared to be Optison-dosage-dependent. Although the mechanism for this disruption is unclear, it may be related to the use of octofluoropropane gas used in the Optison as a contrast medium. Further studies are necessary to determine the pathologic consequences of Optison's effects on the blood-brain barrier.


Assuntos
Albuminas/farmacologia , Barreira Hematoencefálica/efeitos dos fármacos , Meios de Contraste/farmacologia , Fluorocarbonos/farmacologia , Albuminas/administração & dosagem , Albuminas/farmacocinética , Análise de Variância , Animais , Pressão Sanguínea/efeitos dos fármacos , Encéfalo/irrigação sanguínea , Encéfalo/patologia , Capilares/efeitos dos fármacos , Capilares/patologia , Artérias Carótidas , Circulação Cerebrovascular/efeitos dos fármacos , Corantes , Meios de Contraste/administração & dosagem , Meios de Contraste/farmacocinética , Relação Dose-Resposta a Droga , Ecocardiografia , Azul Evans , Fluorocarbonos/administração & dosagem , Fluorocarbonos/farmacocinética , Gases , Cardiopatias Congênitas/diagnóstico por imagem , Injeções Intra-Arteriais , Masculino , Microesferas , Ratos , Ratos Sprague-Dawley
14.
Accid Emerg Nurs ; 7(2): 114-6, 1999 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-10578725

RESUMO

Resuscitation is a subject of topical interest and sometimes of controversy. This paper has been written following the personal experiences of the author who, although an academic also works in and has clinical links with Accident and Emergency, together with a specialist interest in resuscitation. Its aim is to promote discussion and reflection in order that clinical practice may be enhanced, rather than it being used as a tool to prevent the presence of relatives at resuscitation. The first incident reported relates to the writer delivering resuscitative care, whilst the second records the writer as a recipient of resuscitation. In the first instance the emotions experienced by the author are recorded together with an account of her subsequent resuscitative actions. Mention is made of the hospitalization of the casualty and the reactions to this incident by the wife of the casualty. In the second instance it is demonstrated how formed opinions can be changed due to experiential circumstances, 'do not resuscitate' instructions and the presence of relatives at resuscitation. Reflection has been introduced as an integral part of the article, to illustrate its value as a tool that can be supportive, positive, an initiator of change and that should lead to improved clinical care.


Assuntos
Atitude do Pessoal de Saúde , Atitude Frente a Saúde , Reanimação Cardiopulmonar/enfermagem , Reanimação Cardiopulmonar/psicologia , Enfermagem em Emergência/métodos , Docentes de Enfermagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/psicologia , Infarto do Miocárdio/terapia
15.
Pediatr Neurosurg ; 30(1): 23-9, 1999 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-10202303

RESUMO

The clinical course of spontaneous dural sinus thrombosis in children varies from indolent to fulminant. Although many different etiologies for the development of dural sinus thrombosis have been described, a full recovery can be anticipated in most children following rehydration and the administration of systemic antibiotics. Steroids, systemic anticoagulation and intrasinus thrombolysis may be beneficial in selected patients, although the efficacy of these therapies has not been established prospectively in children. We reviewed 12 pediatric patients with spontaneous dural sinus thrombosis (1978-1998) to determine the etiology, clinical course and best treatment options. In the absence of a hypercoagulable state, pediatric patients generally recover well with rehydration and antibiotics and do not require anticoagulation.


Assuntos
Dura-Máter , Osso Petroso/irrigação sanguínea , Trombose dos Seios Intracranianos/patologia , Trombose dos Seios Intracranianos/cirurgia , Adolescente , Anticoagulantes/uso terapêutico , Transtornos da Coagulação Sanguínea/complicações , Transtornos da Coagulação Sanguínea/tratamento farmacológico , Criança , Pré-Escolar , Dura-Máter/irrigação sanguínea , Dura-Máter/patologia , Dura-Máter/cirurgia , Feminino , Humanos , Lactente , Recém-Nascido , Imageamento por Ressonância Magnética , Masculino , Osso Petroso/diagnóstico por imagem , Estudos Prospectivos , Radiografia , Trombose dos Seios Intracranianos/complicações , Resultado do Tratamento , Membrana Timpânica/irrigação sanguínea , Membrana Timpânica/diagnóstico por imagem
16.
Neurosurgery ; 44(1): 221-3, 1999 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-9894986

RESUMO

OBJECTIVE AND IMPORTANCE: Tumors of the cauda equina and specifically the filum terminale are uncommon. We report the fourth case of a hemangioblastoma occurring in the filum terminale. CLINICAL PRESENTATION: This 35-year-old man presented with a 4-year history of low back pain that had been previously diagnosed as a bulging disc and exhibited severe pain in response to percussion of his lower back but was neurologically intact. He was found to have a large, enhancing mass filling the thecal sac at L2-L3. INTERVENTION: The tumor was found to be attached to the filum terminale and was cleanly dissected off en toto. Microscopically, the mass consisted of endothelial cells in addition to abundant fat-laden stromal cells and reticulum. CONCLUSION: We present a case report and a review of the literature. Our patient was the first to exhibit no radicular complaints. The diagnosis was delayed in all four cases and was not determined until the time of surgery. Complete excision offers the best chance for cure, and spinal angiography can aid in diagnosis. However, a high index of suspicion is needed for preoperative detection.


Assuntos
Cauda Equina/cirurgia , Hemangioblastoma/cirurgia , Neoplasias do Sistema Nervoso Periférico/cirurgia , Adulto , Cauda Equina/patologia , Diagnóstico por Imagem , Hemangioblastoma/patologia , Humanos , Dor Lombar/etiologia , Masculino , Neoplasias do Sistema Nervoso Periférico/patologia
18.
Anat Rec ; 253(6): 167-75, 1998 12.
Artigo em Inglês | MEDLINE | ID: mdl-9875986

RESUMO

Unintentional injury is the leading cause of death in children under the age of fourteen. The majority of these injuries/deaths occur when the child becomes airborne during an accident. The most common mechanisms by which children become airborne are motor vehicle collisions, bicycling accidents, and falls. A head injury is seen in a significant number of children in this setting. This includes injury to the scalp, skull, coverings of the brain, or the brain itself. These injuries are the most common cause of death in children resulting from unintentional injury. Other typical injuries include external bruises and abrasions, extremity fractures, and bruising or bleeding of internal organs. We propose to name this constellation of injuries the projectile child syndrome. This refers to those injuries occurring in infants and children as a result of becoming airborne during the events of an accident. The pattern of injuries seen as related to the anatomy of the child is stressed. A review of the impact to society and guidelines for prevention are presented.


Assuntos
Acidentes por Quedas , Acidentes de Trânsito , Movimento (Física) , Ferimentos e Lesões/etiologia , Acidentes por Quedas/prevenção & controle , Adolescente , Air Bags , Traumatismos em Atletas/etiologia , Traumatismos em Atletas/patologia , Traumatismos em Atletas/prevenção & controle , Automóveis , Ciclismo/lesões , Lesões Encefálicas/etiologia , Lesões Encefálicas/patologia , Lesões Encefálicas/prevenção & controle , Criança , Pré-Escolar , Traumatismos Craniocerebrais/etiologia , Traumatismos Craniocerebrais/patologia , Traumatismos Craniocerebrais/prevenção & controle , Feminino , Dispositivos de Proteção da Cabeça , Humanos , Lactente , Recém-Nascido , Masculino , Cintos de Segurança , Ferimentos e Lesões/patologia , Ferimentos e Lesões/prevenção & controle
19.
Neurosurgery ; 40(4): 848-55; discussion 855, 1997 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-9092862

RESUMO

OBJECTIVE: Von Hippel-Lindau (vHL) disease is an inherited disorder characterized by numerous cystic and solid neoplasms. Because of the recent identification of the vHL gene, other investigators have demonstrated genetic mutations in this gene in several of the neoplasms associated with the disease. We describe a patient with an endolymphatic sac (ELS) tumor and vHL disease. The purpose of this study was to identify a similar genetic mutation within the vHL gene of the ELS tumor. METHODS: Using the patient's archival pathological slides, neoplastic cells were microdissected to yield a purely neoplastic cell population. The deoxyribonucleic acid of these cells was then extracted and amplified via polymerase chain reaction. After sufficient amplification, the specimen was analyzed on a single-strand conformation polymorphism gel system to detect putative changes in the base sequence. RESULTS: Single-strand conformation polymorphism gel system analysis yielded two bands representing the two single strands of deoxyribonucleic acid that were amplified. The upper band of the specimen was shifted down (compared with controls), representing a conformational change as a result of genetic mutation. CONCLUSION: ELS tumors are uncommon, and, to our knowledge, only seven cases associated with vHL disease have been reported in the literature. Although this association has been previously mentioned, no definitive studies have linked the two together. We report the eighth case of ELS tumor and vHL disease. We have demonstrated through molecular biological techniques, that, in our patient's tumor, a genetic mutation occurred, and that this mutation is similar to mutations previously reported in other neoplasms associated with vHL. We therefore suggest that ELS tumors be considered among the neoplasms associated with vHL.


Assuntos
Neoplasias da Orelha/genética , Saco Endolinfático , Hemangioblastoma/genética , Ligases , Proteínas Supressoras de Tumor , Ubiquitina-Proteína Ligases , Doenças Vestibulares/genética , Doença de von Hippel-Lindau , Adenocarcinoma/diagnóstico , Adulto , Carcinoma de Células Renais/genética , Neoplasias Cerebelares/genética , Neoplasias Cerebelares/patologia , Ângulo Cerebelopontino , Criança , Fossa Craniana Posterior , Análise Mutacional de DNA , DNA de Neoplasias/genética , Erros de Diagnóstico , Neoplasias da Orelha/patologia , Neoplasias da Orelha/cirurgia , Saco Endolinfático/cirurgia , Éxons/genética , Feminino , Tumor Glômico/diagnóstico , Hemangioblastoma/diagnóstico , Hemangioblastoma/patologia , Humanos , Neoplasias Renais/genética , Masculino , Invasividade Neoplásica , Recidiva Local de Neoplasia , Neoplasias Primárias Múltiplas , Dor/etiologia , Paraplegia/etiologia , Polimorfismo Conformacional de Fita Simples , Proteínas/genética , Siringomielia/etiologia , Doenças Vestibulares/patologia , Doenças Vestibulares/cirurgia , Proteína Supressora de Tumor Von Hippel-Lindau , Doença de von Hippel-Lindau/diagnóstico , Doença de von Hippel-Lindau/patologia
20.
Skull Base Surg ; 7(1): 49-55, 1997.
Artigo em Inglês | MEDLINE | ID: mdl-17171008

RESUMO

Maffucci's syndrome is a rare, congenital mesenchymal dysplasia characterized by multiple enchondromata and hemangimata, both of which may undergo malignant degeneration. Intracranial involvement is uncommon. A literature review yielded only six cases of Maffucci's syndrome with intracranial chondrosarcoma and two cases of Ollier's disease (enchondromata alone) with intracranial chondrosarcoma. We report the seventh case of Maffucci's syndrome in a patient with a very large and extensive skull base chondrosarcoma requiring staged operations for removal.

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