RESUMO
A 36-year-old female with delayed endolymphatic hydrops (ELH) after acoustic tumor removal of the same ear is reported. She presented at our clinic with pressure, fullness, and tinnitus involving her right ear. She had an abnormal auditory brainstem response (ABR), and a computed tomography showed a right acoustic tumor. She underwent a complete tumor removal from a suboccipital incision with significant intraoperative and postoperative ABR improvements. Preoperatively, there was no fluctuation in her hearing and her electrocochleography (ECoG) was normal. She did well postoperatively, but 18 months after the tumor surgery she complained of noticeable fluctuating hearing loss with increased tinnitus and aural fullness of her right operated ear and nausea but no vertigo. Neurotological examinations showed a positive right urea dehydration and positive right ECoG for enhanced summating potential to clicks. She was diagnosed as cochlear Meniere's disease with delayed ELH, failed medical management and then underwent a valved shunt surgery for ELH to stabilize her hearing. Eight years after her acoustic tumor surgery and 6 and a half years after her ELH surgery she has stabilized hearing with normal ABR and ECoG. Her clinical course is presented and a pathogenesis of ELH is discussed.
Assuntos
Edema/fisiopatologia , Endolinfa/fisiologia , Potenciais Evocados Auditivos do Tronco Encefálico/fisiologia , Neuroma Acústico/cirurgia , Complicações Pós-Operatórias/fisiopatologia , Adulto , Audiometria de Resposta Evocada , Tronco Encefálico/fisiopatologia , Edema/diagnóstico , Feminino , Humanos , Imageamento por Ressonância Magnética , Neuroma Acústico/diagnóstico , Neuroma Acústico/fisiopatologia , Complicações Pós-Operatórias/diagnóstico , Tomografia Computadorizada por Raios XRESUMO
The efficacy of chemoprophylaxis in the treatment of basilar skull fractures was studied in 129 patients over a 2-year period; antibiotics were found ineffective in preventing central nervous system infections, and in some cases may have proved harmful. It is suggested that a more rational approach to the treatment of basilar skull fractures includes close observation of the patient for early signs of meningitis, and if these should develop, treatment with antibiotics appropriate to the organism involved.
Assuntos
Antibacterianos/uso terapêutico , Osso Occipital/lesões , Fraturas Cranianas/tratamento farmacológico , Ampicilina/uso terapêutico , Abscesso Encefálico/prevenção & controle , Cefalotina/uso terapêutico , Humanos , Meningite/prevenção & controle , Nasofaringe/microbiologia , Estudos Prospectivos , Estudos Retrospectivos , Fraturas Cranianas/complicaçõesRESUMO
Transcutaneous electrical stimulation as a means of relieving acute pain was evaluated in 100 patients who underwent abdominal or thoracic operative procedures. Transcutaneous electrical stimulation proveded pain relief in 77 per cent of test patients as opposed to 17 per cent of control patients. Transcutaneous electrical stimulation is an effective method of treatment that has many advantages over analgesic drugs.
Assuntos
Estimulação Elétrica/métodos , Dor Pós-Operatória/terapia , Adolescente , Adulto , Idoso , Ensaios Clínicos como Assunto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , PeleRESUMO
Of 100 consecutive patients with acute subdural hematoma, 53 survived. Blood pressure and heart rate changes were not reliable indicators of increased intracranial pressure or cerebral disaster. Electrocardiographic changes in these patients were dramatic. Forty-one patients developed a new cardiac arrhythmia. Increased intracranial pressure and brain lesions adversely affect the heart. These effects must be recognized and appropriately treated.
Assuntos
Arritmias Cardíacas/etiologia , Hematoma Subdural/complicações , Doença Aguda , Adolescente , Adulto , Idoso , Alcoolismo/complicações , Fibrilação Atrial/etiologia , Pressão Sanguínea , Bradicardia/etiologia , Complexos Cardíacos Prematuros/etiologia , Criança , Pré-Escolar , Feminino , Bloqueio Cardíaco/etiologia , Frequência Cardíaca , Humanos , Hipertensão/complicações , Lactente , Pressão Intracraniana , Masculino , Pessoa de Meia-Idade , Prognóstico , Taquicardia/etiologia , Fibrilação Ventricular/etiologiaRESUMO
The authors describe a case of human cerebral mucormycosis following open head trauma and craniotomy, and discuss possible roles of steroids and antibiotic therapy in its pathogenesis. They suggest that the common usage of prolonged broad-spectrum chemoprophylaxis in head trauma may require critical review.
Assuntos
Encefalopatias/etiologia , Traumatismos Craniocerebrais/complicações , Mucormicose/etiologia , Anfotericina B/uso terapêutico , Antibacterianos/efeitos adversos , Encefalopatias/tratamento farmacológico , Encefalopatias/patologia , Líquido Cefalorraquidiano/microbiologia , Criança , Craniotomia , Fungos/isolamento & purificação , Humanos , Masculino , Mucormicose/tratamento farmacológico , Mucormicose/patologia , Complicações Pós-Operatórias , Esteroides/efeitos adversosAssuntos
Círculo Arterial do Cérebro/cirurgia , Aneurisma Intracraniano/cirurgia , Adolescente , Adulto , Idoso , Encéfalo/irrigação sanguínea , Círculo Arterial do Cérebro/patologia , Feminino , Hematoma/complicações , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/mortalidade , Aneurisma Intracraniano/patologia , Masculino , Transtornos Mentais/etiologia , Métodos , Pessoa de Meia-Idade , Neurocirurgia/efeitos adversos , Complicações Pós-Operatórias , Espasmo , Inconsciência/complicaçõesAssuntos
Traumatismos dos Nervos Cranianos , Síndrome de Horner/etiologia , Fraturas Cranianas/complicações , Osso Esfenoide/lesões , Traumatismo do Nervo Abducente , Adolescente , Adulto , Fístula Arteriovenosa/etiologia , Doenças das Artérias Carótidas/etiologia , Lesões das Artérias Carótidas , Seio Cavernoso , Angiografia Cerebral , Criança , Paralisia Facial/etiologia , Feminino , Humanos , Masculino , Oftalmoplegia/etiologia , Fraturas Cranianas/diagnóstico por imagem , Osso Temporal/lesões , Traumatismos do Nervo TrigêmeoRESUMO
Although the most common aetiology of transient vertebrobasilar insufficiency is atherosclerosis, a similar syndrome may occasionally be produced by cervical osteophytes. The possibility of such a remedial lesion makes further investigation mandatory in such patients-especially if symptoms are associated with sudden movements of the head or neck. When vertebral compression results from osteophytes, it can be easily relieved by a minor modification of the usual anterior cervical fusion technique. This method has proved to be quite efficacious in two patients whose case histories are reported.