Concurrent Placement of Bilateral Suboccipital and Supraorbital Nerve Stimulators Using On-Q* Tunneler: Technical Note

2018 ◽  
Vol 15 (6) ◽  
pp. 720-724 ◽  
Author(s):  
Lara Massie ◽  
Rushna Ali ◽  
Konstantin V Slavin ◽  
Jason M Schwalb
Keyword(s):  
Technical Note ◽  
Full Time ◽  
Unilateral Approach ◽  
Infectious Risk ◽  
First Case ◽  
Alternative Approach ◽  
Patient Reported ◽  
Cosmetic Effect ◽  
Purulent Drainage ◽  
Stimulation Of

Abstract BACKGROUND Stimulation of the occipital and supraorbital nerves is used to treat chronic migraine refractory to medical management. Placement of cranial leads is often challenging due to the rigid Touhy needle included in the kit for its placement. OBJECTIVE To report the first case of concurrent placement of bilateral supraorbital (SNS) and occipital nerve stimulators (ONS) from a unilateral approach using the On-Q* Tunneler, (Halyard Health, Alpharetta, Georgia) a flexible, blunt tipped plastic tunneler with a tear-away sheath. METHODS We present the case of a 49-yr-old female with debilitating daily holocephalic headaches who underwent placement of SNS and ONS through a cervical and left temporal incision at an outside hospital. She presented to our institution with purulent drainage from the temporal incision and the system was removed. We describe an alternative approach to bilateral SNS and ONS placement with a soft flexible tunneling device, which facilitated placement of the entire system through a right temporal incision, thereby avoiding her previously infected surgical sites. RESULTS The patient reported complete resolution of her daily headaches and was able to resume her activities as a full-time student. CONCLUSION The flexibility of the On-Q tunneler device (Halyard Health) allows the placement of bilateral SNS and ONS from a unilateral incision, thereby minimizing the cosmetic effect and infectious risk of this procedure.

scholarly journals B.05 Hemi-laryngopharyngeal spasm (HELPS) syndrome: The discovery, cure, and characterization of a new neurological condition

2017 ◽  
Vol 44 (S2) ◽  
pp. S11-S11
Author(s):  
C Honey ◽  
M Morrison
Keyword(s):  
Surgical Care ◽  
Review Of The Literature ◽  
The Past ◽  
First Case ◽  
Patient Reported ◽  
Operative Outcome ◽  
Small Cohort ◽  
The Common ◽  
Similar Motor

Background: We published the world’s first case of hemi-laryngpharyngeal spasm (HELPS) syndrome cured by microvascular decompression (MVD) of the Xth cranial nerve in 2016. We now present a small cohort of patients (n=3) successfully treated with surgery in order to better delineate the common characteristics of this syndrome, diagnostic tests of choice, nuances of their surgical care and outcomes of their treatment. Methods: The history and physical examination of three patients with HELPS syndrome are presented. Pre-operative laryngoscopy, neuroimaging, response to botox and intra-operative videos are detailed. Post-operative outcome and complications are presented. Results: Each patient reported similar motor (choking) and sensory (coughing) features in their history. Episodic choking relentlessly progressed over the years until it occurred while sleeping and with frightening severity prompting tracheostomy in one patient and intubation in another. A “tickling” sensation deep in the throat triggered episodic coughing that worsened over the years until it occurred while sleeping and with frightening severity (syncope and incontinence). Conclusions: A review of the literature suggests that patients with similar symptoms, often called episodic laryngospasm in the past, have been treated with psychotherapy or antacids. With the recognition that a clearly defined subset of these patients have HELPS syndrome, we can offer them the potential of a neurosurgical cure.

Anterior Communicating Artery Aneurysm Clipped Via an Endoscopic Endonasal Approach: Technical Note

2011 ◽  
Vol 68 (suppl_2) ◽  
pp. ons310-ons316 ◽  
Author(s):  
Sebastien Froelich ◽  
Helene Cebula ◽  
Christian Debry ◽  
Patrick Boyer
Keyword(s):  
Artery Aneurysm ◽  
Technical Note ◽  
Endoscopic Biopsy ◽  
Anterior Communicating Artery ◽  
Endonasal Approach ◽  
Best Interest ◽  
Endoscopic Endonasal ◽  
Endoscopic Techniques ◽  
First Case ◽  
On The Road

Abstract Background: The anterior communicating artery (AcoA) aneurysm is one of the most challenging aneurysms. As endovascular techniques evolve, a remaining challenge is the reduction of complications related to the surgical approach. Although the endonasal approach is widely used for pituitary adenomas and is increasingly popular for suprasellar tumors, only 2 aneurysm cases have been reported. Objective: To the best of our knowledge, we are reporting the first case of successful endoscopic endonasal clipping of an unruptured ACoA aneurysm. Methods: An ACoA aneurysm was discovered in a 55-year-old man before he was to undergo an endoscopic biopsy of an orbital lesion. Because of the operative corridor formed during this first operation and ideal conformation of the aneurysm for this line of sight, we formulated an endoscopic route for this ACoA aneurysm. Results: An endoscopic endonasal transplanum-transtuberculum approach was performed. Proximal and distal control was obtained, and the AcoA aneurysm was successfully clipped. The postoperative course was uneventful with a rapid recovery. Conclusion: On the road of innovation in the treatment of intracranial aneurysms, the endoscopic approach provided another option whose value must be weighed in terms not only of feasibility but in the patient’s best interest. We caution extreme prudence if considering this procedure as an alternative to well-established techniques. Yet its upward route offers limited retraction for deep-seated lesions. Rapid progress of endoscopic techniques may prove promising for well-selected cases of ACoA aneurysms.

scholarly journals Lack of impact of nil-per-os (NPO) time on goal-directed fluid delivery in first case versus afternoon case starts: a retrospective cohort study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
R. Ryan Field ◽  
Tuan Mai ◽  
Samouel Hanna ◽  
Brian Harrington ◽  
Michael-David Calderon ◽  
...  
Keyword(s):  
Operating Room ◽  
Medical Center ◽  
Fluid Administration ◽  
Fluid Replacement ◽  
Primary Study ◽  
Start Time ◽  
Fluid Delivery ◽  
First Case ◽  
Patient Reported ◽  
The Impact

Abstract Background Goal Directed Fluid Therapy (GDFT) represents an objective fluid replacement algorithm. The effect of provider variability remains a confounder. Overhydration worsens perioperative morbidity and mortality; therefore, the impact of the calculated NPO deficit prior to the operating room may reach harm. Methods A retrospective single-institution study analyzed patients at UC Irvine Medical Center main operating rooms from September 1, 2013 through September 1, 2015 receiving GDFT. The primary study question asked if GDFT suggested different fluid delivery after different NPO periods, while reducing inter-provider variability. We created two patient groups distinguished by 0715 surgical start time or start time after 1200. We analyzed fluid administration totals with either a 1:1 crystalloid to colloid ratio or a 3:1 ratio. We performed direct group-wise testing on total administered volume expressed as total ml, total ml/hr., and total ml/kg/hr. between the first case start (AM) and afternoon case (PM) groups. A linear regression model included all baseline covariates that differed between groups as well as plausible confounding factors for differing fluid needs. Finally, we combined all patients from both groups, and created NPO time to total administered fluid scatterplots to assess the effect of patient-reported NPO time on fluid administration. Results Whether reported by total administered volume or net fluid volume, and whether we expressed the sum as ml, ml/hr., or ml/kg/hr., the AM group received more fluid on average than the PM group in all cases. In the general linear models, for all significant independent variables evaluated, AM vs PM case start did not reach significance in both cases at p = 0.64 and p = 0.19, respectively. In scatterplots of NPO time to fluid volumes, absolute adjusted and unadjusted R2 values are < 0.01 for each plot, indicating virtually non-existent correlations between uncorrected NPO time and fluid volumes measured. Conclusions This study showed NPO periods do not influence a patient’s volume status just prior to presentation to the operating room for surgical intervention. We hope this data will influence the practice of providers routinely replacing calculated NPO period volume deficit; particularly with those presenting with later surgical case start times.

scholarly journals Endovascular Management of Right Subclavian Artery Pseudoaneurysm due to War Injury in Adolescent Patient

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Onur Saydam ◽  
Deniz Şerefli ◽  
Mehmet Atay ◽  
Cengiz Sert
Keyword(s):  
Stent Graft ◽  
Subclavian Artery ◽  
Dual Antiplatelet Therapy ◽  
Vascular Injuries ◽  
Endovascular Management ◽  
Artery Pseudoaneurysm ◽  
Nitinol Stent ◽  
First Case ◽  
Alternative Approach ◽  
Residual Lesions

Today there is a widespread use of endovascular treatment (EVT) for traumatic vascular injuries in adults, but there is lack of evidence of its use in adolescent patients with vascular injuries. With this case, we present successful EVT of 14-year-old adolescent with a right subclavian artery pseudoaneurysm (SAP) due to war injury. SAP was successfully excluded with deployment of 6×50 mm flexible, self-expanding covered nitinol stent graft (The GORE® VIABAHN® Endoprosthesis (W.L. Gore & Associates, Flagstaff, AZ)). Patient was discharged from hospital 2 days after the procedure with dual antiplatelet therapy (clopidogrel and aspirin). 3 months after discharge control DUS showed patent stent graft without any residual lesions. As a result, EVT is an alternative approach to treatment of SAP. It is safe, effective, and less invasive therapy for SAP in adults as well as in adolescents. We aim to contribute to the literature with this first case report.

scholarly journals Antibody response of C3H in equilibrium (CKB X CWB)F1 tetraparental mice to poly-L(Tyr,Glu)-poly-D,L-Ala-poly-L-Lys immunization.

1976 ◽  
Vol 144 (1) ◽  
pp. 123-144 ◽  
Author(s):  
K B Bechtol ◽  
H O McDevitt
Keyword(s):  
B Cells ◽  
Antibody Response ◽  
High Responder ◽  
Low Responders ◽  
First Case ◽  
Low Responder ◽  
Specific Stimulation ◽  
Stimulation Of

To test whether the antigen-specific stimulation of low responder-genotype B cells in tetraparental mice is due to a histoincompatibility reaction (allogeneic effect) against these B cells, tetraparental mice were constructed (a) between an Ir-1A low responder to the antigen poly-L(Tyr,Glu)-poly-D,L-Ala--poly-L-Lys. [(T,G)-A--L] and an Ir-1A F1 high responder and (b) between two histoincompatible Ir-lA low responders. In the first case the F1 high responder embryo shares the whole of the H-2 complex, including Ir, with the low responder embryo.

scholarly journals Smile — one of the important elements of face aesthetics

2019 ◽  
Vol 2 (2) ◽  
pp. 101-110
Author(s):  
Patrycja Przybylska ◽  
Tomasz Siniecki ◽  
Teresa Matthews‑Brzozowska
Keyword(s):  
Botulinum Toxin ◽  
Maximum Effect ◽  
Upper Lip ◽  
First Case ◽  
Patient Reported ◽  
Levator Labii Superioris ◽  
The Face ◽  
Gummy Smile

The harmony of the smile depends not only on the dentition, but also on the gum tissue, which excessively exposed can negatively affect aesthetics of the smile. Exposure of a small amount of gum during a smile is acceptable however a smile in which the exposure of the gum is more than 2 mm is considered an aesthetic defect called gummy smile. Among the causes of gingival smile listed are: shortened or hyperactive upper lip muscles (levator labii superioris, levator labii superioris alaeque nasi, zygomatic minor muscles), vertical maxillary excess, extrusion of alveolar ridges, altered passive eruption. In the case of hyperactive upper lip muscles, botulinum toxin can be used — this procedure was used in the described cases, and the effects were assessed using the FotoMedicus system and measurements of gingival exposure. In first case Bocouture botulinum toxin was administered on both sides, 4 units bilaterally in the levator labii superioris muscle and 2 units into levator anguli oris muscle. In total, 12 units were given. During the follow‑up the patient reported the start of the effect from the 5th day after the supply with the maximum effect after 12 days. A 6 mm correction of gummy smile was achieved. In the second case 4 units of botulinum toxin were applicated bilaterally into levator labii superioris alaeque nasi muscle. A 3 mm correction of gummy smile was achieved. The aesthetics of the face in a smile definitely improved in both men.

scholarly journals Lack of Impact of Nil-Per-Os (NPO) Time on Goal-Directed Fluid Delivery in First Case versus Afternoon Case Starts: A Retrospective Cohort Study

2019 ◽  
Author(s):  
R Ryan Field ◽  
Tuan Mai ◽  
Samouel Hanna ◽  
Brian Harrington ◽  
Michael-David Calderon ◽  
...  
Keyword(s):  
Operating Room ◽  
Medical Center ◽  
Fluid Administration ◽  
Fluid Replacement ◽  
Primary Study ◽  
Start Time ◽  
Fluid Delivery ◽  
First Case ◽  
Patient Reported ◽  
The Impact

Abstract Background: Goal Directed Fluid Therapy(GDFT) represents an objective fluid replacement algorithm. The effect of provider variability remains a confounder. Overhydration worsens perioperative morbidity and mortality; therefore, the impact of the calculated NPO deficit prior to the operating room may reach harm. Methods: A retrospective single-institution study analyzed patients at UC Irvine Medical Center main operating rooms from September 1, 2013 through September 1, 2015 receiving GDFT. The primary study question asked if GDFT suggested different fluid delivery after different NPO periods, while reducing inter-provider variability. We created two patient groups distinguished by 0715 surgical start time or start time after 1200. We analyzed fluid administration totals with either a 1:1 crystalloid to colloid ratio or a 3:1 ratio. We performed direct group-wise testing on total administered volume expressed as total ml, total ml/hr, and total ml/kg/hr between the first case start (AM) and afternoon case (PM) groups. A linear regression model included all baseline covariates that differed between groups as well as plausible confounding factors for differing fluid needs. Finally, we combined all patients from both groups, and created NPO time to total administered fluid scatterplots to assess the effect of patient-reported NPO time on fluid administration. Results: Whether reported by total administered volume or net fluid volume, and whether we expressed the sum as ml, ml/hr, or ml/kg/hr, the AM group received more fluid on average than the PM group in all cases. In the general linear models, for all significant independent variables evaluated, AM vs PM case start did not reach significance in both cases at p=0.64 and p=0.19, respectively. In scatterplots of NPO time to fluid volumes, absolute adjusted and unadjusted R2 values are < 0.01 for each plot, indicating virtually non-existent correlations between uncorrected NPO time and fluid volumes measured. Conclusions: This study showed NPO periods do not influence a patient’s volume status just prior to presentation to the operating room for surgical intervention. We hope this data will influence the practice of providers routinely replacing calculated NPO period volume deficit; particularly with those presenting with later surgical case start times.

Sets of synaptic currents paired by common presynaptic or postsynaptic neurons

1989 ◽  
Vol 61 (4) ◽  
pp. 845-853 ◽  
Author(s):  
D. Gardner
Keyword(s):  
Synaptic Currents ◽  
Mean Values ◽  
First Case ◽  
Postsynaptic Cell ◽  
Intracellular Stimulation ◽  
The Common ◽  
The Mean ◽  
Cell Networks ◽  
Stimulation Of ◽  
Presynaptic Neurons

1. In the buccal ganglia of Aplysia, presynaptic neurons B4 and B5 produce similar inhibitory postsynaptic currents (PSCs) in several postsynaptic follower cells. Previous work has shown that both duration and amplitude of these PSCs vary, that each parameter may be altered transiently by manipulating presynaptic activity, and that these variations affect synaptic efficacy. 2. To permit synapse-to-synapse comparisons, the mean and coefficient of variation (CV) of both peak conductance (gpeak) and time constant of decay (tau) were determined for sets of synaptic currents evoked by direct intracellular stimulation of presynaptic neurons. For 56 synapses, gpeak = 0.40 +/- 0.33 (SD) microS for a CV of 0.83, and tau = 19.7 +/- 4.0 ms for a CV of 0.20. The synapse-to-synapse variability was within 5% of values obtained from a previous population. 3. The relative contributions of presynaptic and postsynaptic factors to efficacy and variability of PSCs were examined by recordings from two classes of three-cell networks and by comparing values of gpeak and tau at synapses sharing a common presynaptic or postsynaptic neuron. 4. In the first case, paired presynaptic inputs from B4 and B5 converged on a common postsynaptic cell. For 16 examples of this case, mean values of both gpeak and tau recorded in a single follower cell, but produced by different presynaptic neurons, were significantly closer than those recorded in different followers (P less than 0.001). The common postsynaptic cell did not constrain variability of these parameters; CVs for paired synapses were not significantly different from the population (P greater than 0.1).(ABSTRACT TRUNCATED AT 250 WORDS)

Understanding patient distress on day +100 of allogeneic stem cell transplant.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 204-204
Author(s):  
Leslie Jane Padrnos ◽  
Heidi Kosiorek ◽  
James L. Slack ◽  
Nandita Khera
Keyword(s):  
College Graduates ◽  
Hematopoietic Cell Transplantation ◽  
Emotional Problem ◽  
Hematologic Malignancies ◽  
Outcome Data ◽  
Cell Transplant ◽  
Full Time ◽  
Stress Monitoring ◽  
Post Transplant ◽  
Patient Reported

204 Background: Allogeneic hematopoietic cell transplantation (HCT) is a medically complicated treatment modality used for various hematologic malignancies. Patterns and predictors of distress in post- transplant setting in a contemporary cohort of patients are not well-understood. Methods: 67 patients transplanted between 12/5/12- 4/21/15 completed National Comprehensive Cancer Network Distress Thermometer as part of their long term follow up clinic evaluation on day+100 after HCT. Demographic, socioeconomic and clinical outcome data were analyzed. A score ≥ 4 was considered distressed. Results: Mean age of patients was 50.8 years (range 20-72). Most patients were married or living with their significant other (83%), half were college graduates (58%), and half were employed full time (50%). 21 patients (31%) reported a distress score ≥ 4. Distressed patients reported increased problems with treatment decisions (15% vs 2%, p<0.05) and ability to have children (16% vs 0%, p<0.05). Physically, distressed patients were more likely to report fatigue (85% vs 44%, p <0.05), pain (60% vs 24%, p<0.05) and difficulty getting around (25% vs 7% p<0.05) Distressed patients were likely to report at least 1 emotional problem (N=16, 76%), and nearly a quarter reported ≥ 4 emotional problems (N=5, 24%). Specifically, sadness (25% vs 7%, p<0.05) and worry (64% vs 26%, p <0.01) were more common in distressed patients. Distressed patients had a longer length of hospitalization for transplant (30.8 days vs 24.9 p<0.001) and more hospitalized days during the first 100 days (34.9 vs 28.7 p<0.01). Conclusions: Approximately 30% of allogeneic HCT patients suffer significant distress at Day100 post-transplant. Distressed patients report problems with a variety of factors, including emotional, physical, family and practical issues that may impact function, compliance and quality of life. Higher number of hospitalized days is associated with increased distress and could be used to identify patients who may benefit from stress monitoring. Periodic screening of distress in HCT patients can help identify interventions to help improve patient reported outcomes.

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