A Compendium of Modern Minimally Invasive Intracerebral Hemorrhage Evacuation Techniques

2019 ◽  
Author(s):  
Jonathan Pan ◽  
Alexander G Chartrain ◽  
Jacopo Scaggiante ◽  
Alejandro M Spiotta ◽  
Zhouping Tang ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Minimally Invasive ◽  
Intracerebral Hemorrhage ◽  
The Other ◽  
Technical Description ◽  
Evacuation Strategy ◽  
Improved Outcomes ◽  
The World ◽  
Early Phase Clinical Trials ◽  
The Brain

Abstract Background Minimally invasive intracerebral hemorrhage (ICH) evacuation has gained popularity with success in early-phase clinical trials. This procedure, however, is performed in very different ways around the world. Objective To provide a technical description of these strategies that facilitates comparison and aids decisions in which surgery to perform, and to inform further improvements in minimally invasive ICH evacuation. Methods Major authors of clinical trials evaluating each of the main techniques were contacted and asked to supply a case example and technical description of their respective surgeries. Results Five major techniques are presented including stereotactic thrombolysis, craniopuncture, endoscopic, endoscope-assisted, and endoport-mediated. Techniques differ in numerous ways including the size of the cranial access, the size of the access corridor through the brain to the hematoma, and the evacuation strategy. Regarding cranial access, a burr hole is created in stereotactic thrombolysis and craniopuncture, a small craniectomy in endoscopic, and a small craniotomy in the other 2. Access corridors through the parenchyma range from 3 mm in craniopuncture to 13.5 mm in the endoport-mediated evacuation. Regarding evacuation strategies, stereotactic thrombolysis and craniopuncture rely on passive drainage from a catheter placed during surgery that remains in place for multiple days, while the other 3 techniques rely on active evacuation with suction and bipolar cautery. Conclusion Future comparative clinical trials may identify the advantageous components of each strategy and contribute to improved outcomes in this patient population.

scholarly journals Diminazene aceturate-concentrations in tissues of dogs co-treated with oxtetracycline long acting

2021 ◽  
pp. 41-46
Keyword(s):  
Skeletal Muscles ◽  
Post Treatment ◽  
The Other ◽  
Canine Babesiosis ◽  
Diminazene Aceturate ◽  
Normal Dose ◽  
Drug Of Choice ◽  
The World ◽  
Long Acting ◽  
The Brain

Diminizene aceturate (DA) is the drug of choice for treating Canine Trypanosomosis and Canine Babesiosis in many countries of the world. However, co-administration of the drug with long acting Oxytetracycline (OXY-LA) has been associated with nervous signs suggestive of its toxicity, in treated dogs, even at the normal dose. To investigate what causes this toxicity, fourteen Nigerian indigenous dogs were randomly selected into two groups that comprised six dogs each and the remaining untreated two dogs were used for preparation of tissue standards. One group was treated with DA (3.5mg/kg) alone while the other was, additionally, treated with OXY-LA, 10 minutes post treatment (PT) with DA. Two dogs from each group were sacrificed at 240, 360 and 480 hours, PT and their livers, brains, kidneys, hearts and skeletal muscles were harvested and assayed for DA. Mean DA-concentrations in brains of the DA-OXY-LA group (19.71± 1.31a; 15.86± 2.96a; 9.11± 3.31a) were higher (P≤ 0.05) than 1.39 ± 0.45b; 1.05± 0.29b; 0.71 ± 0.30b of the DA-alone group at 240, 360 and 480 hours, PT, respectively. Also, mean-DA concentration in kidneys (8.00 ±0.46a) of the DA-OXY-LA group was significantly (P≤ 0.05) higher than 3.76±0.32b of the DA-alone group at 360 hours PT. These results suggest that OXY-LA enhances DA-accumulation in the brain and reduces its kidney-elimination, thus making the normal dose to act as overdose, which causes the nervous signs often manifested by treated dogs.

scholarly journals Laparoscopic transthoracic liver resection

2014 ◽  
Vol 27 (4) ◽  
pp. 288-290 ◽  
Author(s):  
Jaime Arthur Pirola KRÜGER ◽  
Fabrício Ferreira COELHO ◽  
Marcos Vinícius PERINI ◽  
Paulo HERMAN
Keyword(s):  
Liver Resection ◽  
Minimally Invasive ◽  
Liver Surgery ◽  
Wedge Resection ◽  
The Other ◽  
Laparoscopic Liver Surgery ◽  
Transthoracic Approach ◽  
Technical Description ◽  
Abdominal Interventions ◽  
Segment 8

INTRODUCTION: Minimally invasive laparoscopic liver surgery is being performed with increased frequency. Lesions located on the anterior and lateral liver segments are easier to approach through laparoscopy. On the other hand, laparoscopic access to posterior and superior segments is less frequent and technically demanding. AIM: Technical description for laparoscopic transthoracic access employed on hepatic wedge resection. TECHNIQUE: Laparoscopic transthoracic hepatic wedge resection on segment 8. CONCLUSION: Transthoracic approach allows access to the posterior and superior segments of the liver, and should be considered for oddly located tumors and in patients with numerous previous abdominal interventions.

scholarly journals The Pathogenesis of Memory and Its Causes

2020 ◽  
Vol 5 (4) ◽  
Keyword(s):  
Literature Review ◽  
Temporal Lobe ◽  
Memory Consolidation ◽  
Genetic Material ◽  
External Environment ◽  
Infectious Agent ◽  
The Other ◽  
Amyloid Aggregates ◽  
The World ◽  
The Brain

Objective: to evaluate the memory phenomenon when synchronizing an area of the brain interacting with the external environment. Introduction: Dr. Dale Bredesen estimates that there will be more than 160 million individuals with Alzheimer’s dementia in the world by 2050. Amnesia in temporal lobe epilepsy indicates that the hyperactive excitability generated in this temporal lobe impairs the ability to memorize, destabilizing the rhythm in relative to the other brain lobes. Methodology: through literature review it is assessed that there is a working relationship between the region on the cortical side of the brain and the contralateral homotopic cortex. Results and discussion: the types of amnesia are classified in a first group whose organic causes predominate. We must not forget the danger of the accumulation of non-functional proteins that can precede the formation of beta-amyloid aggregates. They replicate more intensely than an infectious agent does, because they do not need genetic material for their multiplication. Conclusion: the first group may also be due to the lack of memory consolidation (sleep disorders, lack of mnemic exercise, malnutrition, infection or other conditions). There is a second group whose psychological causes predominate. Studies on the hormone DHEA (dehydroepiandrosterone) can help improve these neurodegenerative processes.

scholarly journals Herbal Home Remedies for Toothache during the COVID-19 Pandemic: A Review

2021 ◽  
pp. 18-29
Author(s):  
Abhishek Kumar ◽  
Akash Kumar Giri ◽  
Bibek Kattel
Keyword(s):  
Clinical Trials ◽  
Side Effects ◽  
Dental Care ◽  
Symptomatic Treatment ◽  
Dental Pain ◽  
The Other ◽  
Commercial Products ◽  
Plant Products ◽  
Home Remedies ◽  
The World

The COVID-19 pandemic resulted in the halt of proper dental care in most of the world, except for emergency cases. And, this resulted in a lot of people seek some home remedies for relieve in dental pain. So, this article aims to list down herbal home remedies which can be very helpful in such conditions. The use of medicinal herbs for dental pain can be traced back to history in some form or the other in almost every country. These herbal home remedies have no significant side effects as compared to other chemical-based alternatives, are also easy to obtain and cheaper as well. Clove, Olive, Miswak, Babool and other herbs listed in the article have significant dental properties which have been validated scientifically through various researches. These plant products can be hence used in commercial products as well but only after proper clinical trials. Further research should be encouraged in this field as herbal alternatives can be very beneficial with no such side effects. However, these home remedies are only useful for symptomatic treatment and undergoing proper dental care is advised.

scholarly journals Roles of Oxytocin in Stress Responses, Allostasis and Resilience

2021 ◽  
Vol 23 (1) ◽  
pp. 150
Author(s):  
Yuki Takayanagi ◽  
Tatsushi Onaka
Keyword(s):  
Clinical Trials ◽  
Stress Responses ◽  
Oxytocin Receptor ◽  
The Other ◽  
Set Point ◽  
Coping Responses ◽  
Therapeutic Benefits ◽  
Psychosocial Behavior ◽  
The Brain

Oxytocin has been revealed to work for anxiety suppression and anti-stress as well as for psychosocial behavior and reproductive functions. Oxytocin neurons are activated by various stressful stimuli. The oxytocin receptor is widely distributed within the brain, and oxytocin that is released or diffused affects behavioral and neuroendocrine stress responses. On the other hand, there has been an increasing number of reports on the role of oxytocin in allostasis and resilience. It has been shown that oxytocin maintains homeostasis, shifts the set point for adaptation to a changing environment (allostasis) and contributes to recovery from the shifted set point by inducing active coping responses to stressful stimuli (resilience). Recent studies have suggested that oxytocin is also involved in stress-related disorders, and it has been shown in clinical trials that oxytocin provides therapeutic benefits for patients diagnosed with stress-related disorders. This review includes the latest information on the role of oxytocin in stress responses and adaptation.

Abstract WMP103: Comparative Impact of Extent of Lobar Intracerebral Hemorrhage Removal on Outcome in the MISTIE III and STICH II Trials

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Sean P Polster ◽  
Julian Carrion-Penagos ◽  
Barbara A Gregson ◽  
Ying Cao ◽  
Richard E Thompson ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Clinical Outcome ◽  
Minimally Invasive ◽  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Phase Iii ◽  
Surgical Interventions ◽  
Hematoma Evacuation ◽  
Functional Benefit ◽  
End Of Treatment

Introduction: The Minimally Invasive Surgery Plus Recombinant Tissue Plasminogen Activator for Intracerebral Hemorrhage Evacuation Phase III trial (MISTIE III) concluded that the extent of hematoma reduction confers a mortality and functional benefit. It is unclear if a minimum extent of evacuation is needed for mortality and functional outcome benefit in lobar cases with MISTIE and with open surgical interventions. Objective: We analyzed the effect of extent of lobar ICH evacuation on clinical outcome at 180 days after undergoing the MISTIE procedure and open craniotomy, in the context of the MISTIE III and STICH II clinical trials, respectively. Methods: Patients randomized to the surgical arm with lobar ICH, who underwent the procedure in the MISTIE III trial (n=84) and the STICH II trial (n=266) were analyzed, excluding cases crossing over to surgery. We assessed end of treatment ICH volume on post procedure CT scans and % hematoma evacuation, in relation to survival and likelihood of mRS 0-3. Cubic spline modeling with dichotomized outcome was used to compare the extent of hematoma evacuation on clinical outcome. Results: End of treatment volume of < 28 mL in lobar ICH MISTIE III patients and < 30 mL in STICH II trial patients showed a significantly increased probability of achieving an mRS of 0-3 at 180 days (p<0.03, p<0.006, respectively). This threshold was achieved in 83.1% of lobar cases undergoing MISTIE and in 92.1% of surgical cases in STICH II. Achieving survival benefit at 180 days trended towards improved probability with further hematoma volume reduction without a threshold value in MISTIE III, and was significant per mL reduction in STICH II (p<0.001). Analysis by percent of hematoma evacuation trended toward better probabilities of survival and improved functional outcome but were not significant. Conclusion: This analysis confirms that extent of hematoma evacuation is important in attaining the benefits of both minimally invasive and open surgical interventions in non-herniating lobar ICH patients randomized in clinical trials. Extent of ICH evacuation must be considered in the analysis of comparative effectiveness of various techniques and in the design of future trials.

scholarly journals Potential specific therapies in COVID-19

2020 ◽  
Vol 14 ◽  
pp. 175346662092685 ◽  
Author(s):  
Muhammad Hamdan Gul ◽  
Zin Mar Htun ◽  
Nauman Shaukat ◽  
Muhammad Imran ◽  
Ahmad Khan
Keyword(s):  
Clinical Trials ◽  
Severe Acute Respiratory Syndrome ◽  
Randomized Clinical Trials ◽  
Middle Eastern ◽  
The Other ◽  
Potential Treatment ◽  
Blood Products ◽  
Material Section ◽  
Global Pandemic ◽  
The World

COVID-19 has grown into a global pandemic that has strained healthcare throughout the world. There is a sense of urgency in finding a cure for this deadly virus. In this study, we reviewed the empiric options used in common practice for COVID-19, based on the literature available online, with an emphasis on human experiences with these treatments on severe acute respiratory syndrome-associated coronavirus (SARS-COV-1) and other viruses. Convalescent blood products are the most promising potential treatment for use in COVID-19. The use of chloroquine or hydroxychloroquine (HCQ), remdesivir, and tocilizumab are some of the other promising potential therapies; however, they are yet to be tested in randomized clinical trials (RCTs). The use of lopinavir-ritonavir did not prove beneficial in a large RCT. The use of corticosteroids should be avoided in COVID-19 pneumonia unless used for other indications, based on the suggestion of harm in patients with SARS-COV-1 and Middle Eastern Respiratory Syndrome (MERS) infection. The reviews of this paper are available via the supplemental material section.

Quantum Models of the Recognition Process — On a Convergence Theorem

2010 ◽  
Vol 17 (02) ◽  
pp. 161-187 ◽  
Author(s):  
Karl-Heinz Fichtner ◽  
Lars Fichtner ◽  
Wolfgang Freudenberg ◽  
Masanori Ohya
Keyword(s):  
Hilbert Space ◽  
Quantum Theory ◽  
Statistical Model ◽  
Convergence Theorem ◽  
The Other ◽  
Complex Signals ◽  
Recognition Process ◽  
General Conception ◽  
The World ◽  
The Brain

One of the main activities of the brain is the recognition of signals. As it was pointed out in [22, 25] the procedure of recognition can be described as follows: There is a set of complex signals stored in the memory. Choosing one of these signals may be interpreted as generating a hypothesis concerning an "expected view of the world". Then the brain compares a signal arising from our senses with the signal chosen from the memory. That changes the state of both signals in such a manner that after the procedure the signals coincide in a certain sense. Furthermore, measurements of that procedure like EEG or MEG are based on the fact that recognition of signals causes a certain loss of excited neurons, i.e. the neurons change their state from "excited" to "nonexcited". For that reason a statistical model of the recognition process should reflect both — the change of the signals and the loss of excited neurons. Now, [5] represents the first attempt to explain the process of recognition in terms of quantum statistics. According to the general conception of quantum theory, the procedure of recognition should be described by an operator on a certain Hilbert space. In [5] we proposed two candidates for such an operator. One of them reflects in a clear sense the mentioned change of the signals. The other one reflects the loss of excited neurons. We will prove (cf. Theorem 4) that for sufficiently high intensities of the signals both operators are approximately equal.

scholarly journals Minimally Invasive Intracerebral Hemorrhage Evacuation Techniques: A Review

Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 576
Author(s):  
Theodore C. Hannah ◽  
Rebecca Kellner ◽  
Christopher P. Kellner
Keyword(s):  
Clinical Trials ◽  
Minimally Invasive ◽  
Intracerebral Hemorrhage ◽  
Functional Outcomes ◽  
Surgical Intervention ◽  
Neuronal Damage ◽  
High Morbidity ◽  
Edema Formation ◽  
Stereotactic Aspiration ◽  
Rapid Removal

Intracerebral hemorrhage (ICH) continues to have high morbidity and mortality. Improving ICH outcomes likely requires rapid removal of blood from the parenchyma and restraining edema formation while also limiting further neuronal damage due to the surgical intervention. Minimally invasive surgery (MIS) approaches promise to provide these benefits and have become alluring options for management of ICH. This review describes six MIS techniques for ICH evacuation including craniopuncture, stereotactic aspiration with thrombolysis, endoport-mediated evacuation, endoscope-assisted evacuation, adjunctive aspiration devices, and the surgiscope. The efficacy of each modality is discussed based on current literature. The largest clinical trials have yet to demonstrate definitive effects of MIS intervention on mortality and functional outcomes for ICH. Thus, there is a significant need for further innovation for ICH treatment. Multiple ongoing trials promise to better clarify the potential of the newer, non-thrombolytic MIS techniques.

scholarly journals Prendersi cura del mondo

2021 ◽  
pp. 103-124
Author(s):  
Iain McGilchrist
Keyword(s):  
Left Hemisphere ◽  
Right Hemisphere ◽  
The Other ◽  
Social Implications ◽  
Brain Level ◽  
The World ◽  
The One ◽  
The Right ◽  
The Brain

Discusses the role that attention plays in constituting the world, rather than reducing phenomena to the brain level. Discusses the different kinds of attention delineated by the divided hemispheres of the brain. On the one hand the left hemisphere specialised in grasping and manipulating the world, whereas the right hemisphere specialises in relat-ing to and understanding the world. Discusses how reliance on one or the other kind of attention has cultural, psychological and social implications.

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