A survey on current practice in the neurosurgical management of preterm infants with posthemorrhagic hydrocephalus in Germany

BACKGROUND AND STUDY AIMS

Different approaches to the management of preterm infants with posthemorrhagic hydrocephalus (PHH) are described in the literature. Likewise, neurosurgical and pediatric surgical departments in German hospitals use different methods to treat these patients. The aim of this study was therefore to assess the current situation regarding the management of PHH, which is a first and essential step toward the development of standards of practice.

PATIENTS AND METHODS

In the second half of 2009, we sent standardized questionnaires to 139 neurosurgical departments (number of returned questionnaires: 98) and 73 pediatric surgical departments (returned questionnaires: 62) to identify the principles of PHH management. Preterm infants with PHH are treated in 61 of the neurosurgical and in 20 of the pediatric surgical departments.

RESULTS

43 of the 61 neurosurgical departments and 17 of the 20 pediatric surgical departments providing care for preterm infants with PHH treat less than 10 preterm infants with PHH per year. Reservoir placement is performed as the initial treatment in 48 neurosurgical and in 14 pediatric surgical departments.The criteria for the placement of ventriculoperitoneal shunts and the implantation procedure itself are highly variable. Moreover, the percentage of children who require a CSF shunt after initial treatment for PHH ranges between 5 and 95%.

CONCLUSIONS

In Germany, the type of treatment of infants with PHH differs from institution to institution. Clear and consistent guidelines must be established in an interdisciplinary approach to improve and better coordinate the management of infants with PPH.

[Concept for a German national birth cohort for environmental health research]

The German Federal Environment Agency has commissioned the conceptual work for a birth cohort study to investigate environmental health problems in children. The recruitment is intended to start as early as possible in pregnancy and to take place in several regions of Germany. To detect health risks for exposures and outcomes with low prevalence as well as gene-environment interactions, a cohort size of 100,000-200,000 parent-child pairs is needed. The concept focuses on five health issues: neurodevelopment; reproductive development; pregnancy and birth outcomes; asthma, allergies and respiratory disease; obesity, insulin resistance and diabetes. The examination of additional health conditions will be possible. The exposure assessment will cover chemical, biological and physical exposures; psychosocial factors and genetics will be assessed as well. Biological and environmental samples will be stored in a repository for future analyses. The birth cohort study will contribute to the detection of associations between environmental exposures and health conditions over the course of life, which in turn will have an impact on environmental and health policies.

Long-term quality of life in patients with permanent sigmoid colostomy

AIM

The study aimed to assess quality of life (QoL) in patients with a sigmoid colostomy using a simple general and disease-specific instrument. A subgroup not doing well was identified and examined further.

METHOD

The Short Health Scale (SHS) is a four-item instrument exploring severity of symptoms, function in daily life, worry, and general well-being, using visual analogue scales ranging from 0 to 100 where 100 is the worst possible situation. The SHS was delivered to 206 patients with a sigmoid colostomy. It was returned by 181 (87.9%) patients [88 men; median age 73 (33-91) years]. Follow-up was 61 (10-484) months for 178 (86.4%) patients returning usable questionnaires. A subgroup of 16 patients scoring more than 50 in all four items of the SHS was further examined with StomaQOL where 100 is best possible.

RESULTS

The median score for severity of symptoms was 18 (2-95), function in daily life 21 (0-95), worry 17 (3-98) and general well-being 22 (0-99). A score of < 50 in the SHS was recorded in 84.9%, 82.1%, 79.9% and 70.5% respectively. In the group scoring more than 50 in all four items patients diagnosed with irritable bowel syndrome constituted 43.8% to compare with 5.6% in the entire study group (P < 0.001). Median score for StomaQOL was 37 (22-62) in this group.

CONCLUSION

Most patients with a permanent sigmoid colostomy have a good QoL consistent with previous findings. However, this is reduced in a subgroup of patients diagnosed with irritable bowel syndrome.

Sciatica and incomplete paraplegia after spontaneous haematoma of the spinal cord due to a cumarine - induced coagulopathy: case report

Spontaneous spinal haematoma is a rare cause of sciatica. We present a case of a 73 year old patient, who was admitted to our department and suffered from spontaneous sciatica over 24 hours. During the examination, the patient presented undulating symptoms of paraplegia, varying from incomplete loss of power in the left lower limb to complete plegia. The patient presented multiple diseases like biological aortic valve replacement, diabetes, hypertonia in her medical history, etc. Due to an additional absolute arrhythmia she ingested a cumarine medication. The tomographic imaging revealed a spontaneous lumbar and cranial subarachnoidal haematoma.

Intraoperative image guidance in neurosurgery: development, current indications, and future trends

Introduction. As minimally invasive surgery becomes the standard of care in neurosurgery, it is imperative that surgeons become skilled in the use of image-guided techniques. The development of image-guided neurosurgery represents a substantial improvement in the microsurgical treatment of tumors, vascular malformations, and other intracranial lesions. Objective. There have been numerous advances in neurosurgery which have aided the neurosurgeon to achieve accurate removal of pathological tissue with minimal disruption of surrounding healthy neuronal matter including the development of microsurgical, endoscopic, and endovascular techniques. Neuronavigation systems and intraoperative imaging should improve success in cranial neurosurgery. Additional functional imaging modalities such as PET, SPECT, DTI (for fiber tracking), and fMRI can now be used in order to reduce neurological deficits resulting from surgery; however the positive long-term effect remains questionable for many indications. Method. PubMed database search using the search term "image guided neurosurgery." More than 1400 articles were published during the last 25 years. The abstracts were scanned for prospective comparative trials. Results and Conclusion. 14 comparative trials are published. To date significant data amount show advantages in intraoperative accuracy influencing the perioperative morbidity and long-term outcome only for cerebral glioma surgery.

Endobronchial ultrasound-guided transbronchial needle aspiration in routine care - plenty of benign results and follow-up tests

BACKGROUND

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a widespread technique for tissue sampling from hilar and mediastinal lymph nodes (LN). The diagnostic yield of this method is reported to be very high even outside clinical trials. We aimed to assess the diagnostic accuracy of EBUS-TBNA after its implementation at a University hospital.

METHODS

We analysed the first 100 consecutive patients who underwent an EBUS-TBNA procedure at our institution with respect to indication and cytological results. Sensitivity and negative predictive value (NPV) were calculated on the basis of histological confirmation or follow-up.

RESULTS

From 03/2007 to 03/2008, EBUS-TBNA of 218 LNs was performed on the basis of chest computed tomography. The primary indication for EBUS-TBNA was lymphadenopathy of unknown cause with (44%) or without (37%) pulmonary nodule(s). Only 19% of patients had known cancer and underwent the procedure for (re-)staging. In 73% of patients a non-diagnostic cytology was reported. A diagnosis could be established in only 27% by EBUS-TBNA including four patients with sarcoidosis. Sensitivity and NPV were low with 61.4% and 76.7%, respectively. Diagnostic yield increased over time and was better in cancer patients than in patients with incidental lymphadenopathy.

CONCLUSION

Although EBUS-TBNA is reported to have a very high diagnostic yield in selected patients, the predominant finding in routine care, depending on the patient population, can be a non-diagnostic cytology result with the need for surgical procedures or follow-up studies. This should be considered in the approach to patients with mediastinal or hilar lymphadenopathy.

[Postoperative course after acute traumatic subdural hematoma in the elderly. Does the extent of craniotomy influence outcome?]

AIM

The goal of the study was to analyze the short-term outcome after surgical treatment of acute subdural hematomas in two treatment groups in a patient population >65 years. Whether there are disadvantages from invasive treatment or whether advantages can be achieved with the less invasive treatment has not been previously examined in a prospective study.

METHODS

A prospective, nonrandomized study of 50 patients >65 years with acute traumatic subdural hematoma was performed, comparing the short-term outcome after two different primary surgical procedures: limited craniotomy (group A, n=25) and large decompressive craniectomy (group B, n=25).

RESULTS

There were no differences of hematoma volume, degree of midline structure shift, and time from trauma to operation between the two groups. Initial Glasgow coma scale and short-term outcome after 4 weeks measured by the Glasgow outcome score in both groups showed no significant differences.

CONCLUSION

No significant differences between short-term outcome after limited craniotomy versus large decompressive craniectomy were found for patients >65 years, and the results indicate that decompressive craniectomy can be accepted as a surgical treatment option for acute traumatic subdural hematoma even in elderly patients.

[Periinterventional antiplatelet therapy: from bench to bedside]

The recruitment and activation of blood platelets initiate ischemic events in patients with coronary artery diseases (myocardial infarction). Moreover, platelet activation and aggregation are key events triggering early and late thrombotic complications (stent thromboses) in patients successfully treated with coronary stent implantation. Hence, the inhibition of the thromboxane A2 synthesis by aspirin and the ADP-receptor pathway by clopidogrel have drastically reduced the risk of ischemic complications following coronary stenting. However, clopidogrel has several inherent limitations, including the high incidence of non- or low-responders and the increased risk of bleeding due to the prolonged persistence of its anti-platelet effect. The latter is of particular concern in patients who require non-deferrable surgery. In recent years, novel anti-platelet substances have been clinically evaluated and are now approved for use in patients. These substances offer several potential advantages over the previous strategies and could pave the way for more individualized anti-platelet regimens. In this review, we give an overview on the available clinical data evaluating the benefits of these novel anti-platelet substances.

Three years of neurosurgical experience in a multinational field hospital in northern Afghanistan

BACKGROUND

Since July 2007, neurosurgical services have been continuously available in a multinational Role 3 field hospital in Mazar-e-Sharif (MeS), Afghanistan. In this paper, we analyse a 3-year neurosurgical caseload experience.

METHODS

We retrospectively analysed the neurosurgical caseload at a Role 3 medical treatment facility in northern Afghanistan between October 2007 and October 2010. The cases were divided into acute, urgent and elective procedures and into cranial, spinal, peripheral nerve and miscellaneous surgeries.

RESULTS

A total of 190 surgeries were performed. Of these, 50 operations (26.3%) were acute procedures that were conducted to save lives or preserve neurological function. In addition, operations included 47 urgent (24.7%) and 93 elective (49%) procedures. There were 58 cranial surgeries (30.5%), 113 spinal surgeries (59.5%), 11 peripheral nerve surgeries (5.8%), and 8 miscellaneous surgeries (4.2%). Surgical treatment was provided to 13 International Security Assistance Force (ISAF) soldiers (6.8%), 22 members of the Afghan National Security Forces (11.6%), and 155 Afghan civilians (81.6%).

CONCLUSIONS

The primary mission of the field hospital is to provide sick, injured or wounded ISAF personnel with medical and surgical care, the outcome of which must correspond to standards prevailing in Germany. Only a very small number of neurosurgical operations performed in MeS met the criteria established by this mission statement and by the modern principles of damage-control wartime surgery. This is completely different from the experience reported by other ISAF nations in eastern and southern Afghanistan.

Gas-Temperature Imaging in a Microwave-Plasma Nanoparticle-Synthesis Reactor Using Multi-Line NO-LIF Thermometry

Multi-line NO-LIF thermometry is used to determine the two-dimensional temperature distribution inside a low-pressure plasma reactor. The applicability of multi-line temperature measurements to non-equilibrium plasma environments was evaluated. Temperatures between 300 and 3000 K have been observed, while microwave power, and pressure show a strong effect on the temperature distribution. Metal-organic precursors added for particle synthesis additionally influence the temperature through the heat release during particle formation and the oxidation of organic ligands.

Helicobacter pylori and other gastric bacteria

The discovery of Helicobacter pylori opened a new field for extensive research on the interactions of this bacterium with the gastric mucosa in the past decades. Basic principles of infection, virulence factors, and treatment options have been identified and recognized. New questions have emerged concerning possible interactions of H. pylori with other bacteria in the human stomach. Herein we discuss hallmark findings in relation to H. pylori infection and the new evidence on other bacteria in the human stomach. Probiotic bacteria seem to interfere with colonizing H. pylori bacteria and thus influence the inflammatory response of the gastric mucosa to H. pylori infection.