The warning signs of stress and depression

2000 ◽  
Keyword(s):  
Warning Signs

Intraoperative facial motor evoked potential monitoring for pontine cavernous malformation resection

2020 ◽  
Vol 132 (1) ◽  
pp. 265-271
Author(s):  
Ridzky Firmansyah Hardian ◽  
Tetsuya Goto ◽  
Yu Fujii ◽  
Kohei Kanaya ◽  
Tetsuyoshi Horiuchi ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Cavernous Malformation ◽  
Motor Evoked Potentials ◽  
Motor Evoked Potential ◽  
Warning Signs ◽  
Constant Current ◽  
Karnofsky Performance Scale ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Cavernous Malformations

OBJECTIVEThe aim of this study was to predict postoperative facial nerve function during pontine cavernous malformation surgery by monitoring facial motor evoked potentials (FMEPs).METHODSFrom 2008 to 2017, 10 patients with pontine cavernous malformations underwent total resection via the trans–fourth ventricle floor approach with FMEP monitoring. House-Brackmann grades and Karnofsky Performance Scale (KPS) scores were obtained pre- and postoperatively. The surgeries were performed using one of 2 safe entry zones into the brainstem: the suprafacial triangle and infrafacial triangle approaches. Six patients underwent the suprafacial triangle approach, and 4 patients underwent the infrafacial triangle approach. A cranial peg screw electrode was used to deliver electrical stimulation for FMEP by a train of 4 or 5 pulse anodal constant current stimulation. FMEP was recorded from needle electrodes on the ipsilateral facial muscles and monitored throughout surgery by using a threshold-level stimulation method.RESULTSFMEPs were recorded and analyzed in 8 patients; they were not recorded in 2 patients who had severe preoperative facial palsy and underwent an infrafacial triangle approach. Warning signs appeared in all patients who underwent the suprafacial triangle approach. However, after temporarily stopping the procedures, FMEP findings during surgery showed recovery of the thresholds. FMEPs in patients who underwent the infrafacial triangle approach were stable during the surgery. House-Brackmann grades were unchanged postoperatively in all patients. Postoperative KPS scores improved in 3 patients, decreased in 1, and remained the same in 6 patients.CONCLUSIONSFMEPs can be used to monitor facial nerve function during surgery for pontine cavernous malformations, especially when the suprafacial triangle approach is performed.

Overcoming the Paradox of Conflict Prevention

2018 ◽  
Author(s):  
Edward Newman ◽  
Eamon Aloyo
Keyword(s):  
Violence Prevention ◽  
Social Economic ◽  
Driving Forces ◽  
Crisis Response ◽  
Warning Signs ◽  
Violent Conflict ◽  
Policy Implications ◽  
Conflict Prevention ◽  
Political Factors ◽  
Structural Conflict

Progress in conflict prevention depends upon a better understanding of the underlying circumstances that give rise to violent conflict and mass atrocities, and of the warning signs that a crisis is imminent. While a substantial amount of empirical research on the driving forces of conflict exists, its policy implications must be exploited more effectively, so that the enabling conditions for violence can be addressed before it occurs. Violence prevention involves a range of social, economic, and political factors; the chapter highlights challenges—many of them international—relating to deprivation, inequality, governance, and environmental management. Prevention also requires overcoming a number of acute political obstacles embedded within the values and institutions of global governance. The chapter concludes with a range of proposals for structural conflict prevention and crisis response, as well as the prevention of mass atrocities.

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