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Chang H, Silva M, Giner A, Diaz Y, Sosa MA, Knudsen G, Mahavadi AK, Ellis J, Cameron A, Núñez CAQ, Wynter MA, O'Phelan K, Komotar RJ, Cajigas I. Ventriculostomy supply cart decreases time-to-external ventricular drain placement in the emergency department. Surg Neurol Int 2021; 12:362. [PMID: 34350056 PMCID: PMC8330128 DOI: 10.25259/sni_371_2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 05/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Minimizing time-to-external ventricular drain (EVD) placement in the emergency department (ED) is critical. We sought to understand factors affecting time-to-EVD placement through a quality improvement initiative. Methods: The use of process mapping, root cause analyses, and interviews with staff revealed decentralized supply storage as a major contributor to delays in EVD placement. We developed an EVD “crash cart” as a potential solution to this problem. Time-to-EVD placement was tracked prospectively using time stamps in the electronic medical record (EMR); precart control patients were reviewed retrospectively. Results: The final cohorts consisted of 33 precart and 18 postcart cases. The mean time-to-EVD in the precart group was 99.09 min compared to 71.88 min in the postcart group (two-tailed t-test, P = 0.023). Median time-to-EVD was 92 min in the precart group compared to 64 min in the postcart group (rank sum test, P = 0.0165). Postcart patients trended toward improved outcomes with lower modified Rankin score scores at 1 year, but this did not reach statistical significance (two-tailed t-test, P = 0.177). Conclusion: An EVD “crash cart” is a simple intervention that can significantly reduce time-to-EVD placement and may improve outcomes in patients requiring an EVD.
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Affiliation(s)
- Henry Chang
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Michael Silva
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Alexander Giner
- Department of Emergency, Jackson Memorial Hospital, Miami, Florida, United States
| | - Yvonne Diaz
- Department of Medicine, Jackson Memorial Hospital, Miami, Florida, United States
| | - Marie Ann Sosa
- Department of Medicine, Jackson Memorial Hospital, Miami, Florida, United States
| | - Grace Knudsen
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Anil K Mahavadi
- Department of Neurosurgery, University of Alabama Birmingham School of Medicine, Birmingham, Alabama, United States
| | - June Ellis
- Department of Medicine, Jackson Memorial Hospital, Miami, Florida, United States
| | - Arlene Cameron
- Department of Orthopedic, Division of Neurology and Surgery, Jackson Memorial Hospital, Miami, Florida, United States
| | | | - Millicent A Wynter
- Department of Nursing Education, Jackson Memorial Hospital, Miami, Florida, United States
| | - Kristine O'Phelan
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Ricardo J Komotar
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Iahn Cajigas
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, United States
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Esteban Garcia JM, Mato Mañas D, Marco De Lucas E, Garcia Catalan G, Lopez Gomez P, Santos Jimenez C, Laez RM. Invisible compression, anterior fossa tumor causing trigeminal neuralgia. Surg Neurol Int 2021; 12:106. [PMID: 33880211 PMCID: PMC8053474 DOI: 10.25259/sni_371_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 02/20/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Trigeminal neuralgia secondary to posterior and middle fossae tumors, whether ipsilateral or contralateral, has been well described. However, this disabling disease has never been reported in the context of anterior fossa neoplasms. Case Description: A 75-year-old female with right hemifacial pain was diagnosed with an anterior clinoid meningioma. Despite neuroimaging did not show any apparent anatomical or neurovascular conflict, a detailed MRI analysis revealed a V3 hyperintensity. Not only symptoms completely resolved after surgical resection but also this radiological sign disappeared. Nowadays, the patient remains asymptomatic and V3 hyperintensity has not reappeared during her follow-up. Conclusion: A surgical definitive treatment can be offered to patients suffering from trigeminal neuralgia secondary to lesions adjacent to Gasserian ganglion or trigeminal branches. In this respect, posterior and middle fossae tumors are well-reported etiologies. Nevertheless, in the absence of evident compression, other neoplasms located in the vicinity of these critical structures and considered as radiological findings may be involved in trigeminal pain. Microvascular and pressure gradient changes could be an underlying cause of these symptoms in anterior skull base lesions. Here, we report the case of a patient with uncontrollable hemifacial pain resolved after anterior clinoid meningioma removal.
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Affiliation(s)
| | - David Mato Mañas
- Department of Neurosurgery, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Enrique Marco De Lucas
- Department of Neurosurgery, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Guillermo Garcia Catalan
- Department of Neurosurgery, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Patricia Lopez Gomez
- Department of Neurosurgery, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Carlos Santos Jimenez
- Department of Neurosurgery, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Ruben Martin Laez
- Department of Neurosurgery, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
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Lin H, Wang Z, Shen J, Xu J, Li H. Intravenous anesthetic ketamine attenuates complete Freund's adjuvant-induced arthritis in rats via modulation of MAPKs/NF-κB. Inflamm Res 2018; 68:147-155. [PMID: 30506262 DOI: 10.1007/s00011-018-1202-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 11/13/2018] [Accepted: 11/15/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The current study was intended to investigate the effect of ketamine (KET) on complete Freund's adjuvant (CFA)-induced arthritis in rats. METHODS The CFA was administered in the hind paw of the rats for the induction of adjuvant-induced arthritis. The paw swelling of experimental animals was measured as hind paw volume. Hematoxylin and eosin staining was estimated and pathological changes in the joint tissues were observed under a light microscope. Furthermore, the bicinchoninic acid assay was used for protein quantification. The antibody-reactive bands were visualized using enhanced chemiluminescence. RESULTS The present study showed that KET significantly reduces the severity of arthritis in CFA mice. The therapeutic effects were linked with reduced joint swelling and destruction, as evidenced by analyzing rat paws. The KET also revealed to attenuate the expression of pro-inflammatory cytokines (TNF-α, IL-1β, IL-6). In western blot analysis, KET inhibit phosphorylation of MAPKs, IκBα and nuclear translocation NF-κB in the inflammatory joints of AIA rats. Moreover, KET showed to induce apoptosis via mitochondrial signalling pathways (Bcl2, Bax, cytochrome C, cleaved caspase-3 and cleaved caapse-9). CONCLUSION Taken together, KET show significant anti-rheumatoid arthritis activity via multiple mechanisms and may thus have therapeutic benefits for RA.
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Affiliation(s)
- Hui Lin
- Department of Anesthesiology, The Second Xiangya Hospital, Central South University, 139 Ren-Min Road, Changsha, 410011, China.,Department of Anesthesiology, Hainan General Hospital, Haikou, 570311, Hainan, China
| | - Zhe Wang
- Department of Anesthesiology, The Second Xiangya Hospital, Central South University, 139 Ren-Min Road, Changsha, 410011, China
| | - Jinmei Shen
- Department of Anesthesiology, The Second Xiangya Hospital, Central South University, 139 Ren-Min Road, Changsha, 410011, China
| | - Junmei Xu
- Department of Anesthesiology, The Second Xiangya Hospital, Central South University, 139 Ren-Min Road, Changsha, 410011, China
| | - Hui Li
- Department of Anesthesiology, The Second Xiangya Hospital, Central South University, 139 Ren-Min Road, Changsha, 410011, China.
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