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Niryana IW, Tombeng MA, Lauren C, Maliawan S, Golden N, Mahadewa TGB, Maliawan MGD. Secondary Trigeminal Neuralgia Caused by Cerebellopontine Angle Arachnoid Cyst in A 27-Year-Old Female: A Case Report. Acta Neurol Taiwan 2024; 33(2):76-80. [PMID: 37968093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
PURPOSE Secondary (TN) caused by an arachnoid cyst in the (CPA) region is a rare finding. Based on the reported literature, there are only 5 cases of secondary trigeminal neuralgia caused by an arachnoid cyst in the cerebellopontine angle region. CASE REPORT A 27-year-old female presented to our neurosurgery clinic with a 2-year history of brief episodes of paroxysm pain in the left cheek. The pain was described as an electric shock-like pain triggered by simple stimuli. The magnetic resonance imaging (MRI) showed a well-confined cystic lesion in the left CPA, which compresses the left pons and the cisternal segment of the left trigeminal nerve. The patient was managed operatively to fenestrate the cyst and decompress the trigeminal nerve. The histopathological result of the cyst wall was consistent with an arachnoid cyst. Six months after surgery, the patient is in good health condition and symptom-free without medication. CONCLUSION Arachnoid cyst in the CPA region is one of the rare causes of secondary TN. Preoperative imaging with MRI is important to provide better results to differentiate the pathology. Surgical treatment to fenestrate the arachnoid cyst and decompress the trigeminal nerve have a good result and can improve the patient's quality of life.
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Affiliation(s)
- I Wayan Niryana
- Neurosurgery Division, Department of Surgery, Faculty of Medicine, Universitas Udayana, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - Marthinson Andrew Tombeng
- Neurosurgery Division, Department of Surgery, Faculty of Medicine, Universitas Udayana, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - Christopher Lauren
- Neurosurgery Division, Department of Surgery, Faculty of Medicine, Universitas Udayana, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - Sri Maliawan
- Neurosurgery Division, Department of Surgery, Faculty of Medicine, Universitas Udayana, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - Nyoman Golden
- Neurosurgery Division, Department of Surgery, Faculty of Medicine, Universitas Udayana, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - Tjokorda Gde Bagus Mahadewa
- Neurosurgery Division, Department of Surgery, Faculty of Medicine, Universitas Udayana, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - Made Gemma Daniswara Maliawan
- Neurosurgery Division, Department of Surgery, Faculty of Medicine, Universitas Udayana, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
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Golden N, Awyono S, Prakoso DT, Lauren C. Complete resection versus functional preservation in resection of cystic vestibular schwannoma in a 56-year-old female: case report and literature review. J Surg Case Rep 2023; 2023:rjad655. [PMID: 38111494 PMCID: PMC10725791 DOI: 10.1093/jscr/rjad655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/17/2023] [Indexed: 12/20/2023] Open
Abstract
Surgery for vestibular schwannoma presents unique challenges to the surgeon, given that the primary objectives are achieving complete resection while preserving both facial nerve and hearing function. Consequently, a comprehensive preoperative and perioperative assessment of the tumor is essential to determine its extent, particularly in cases involving dumbbell-shaped lesions. This case report describes our experience in managing a patient with a dumbbell-shaped vestibular schwannoma, where we achieved near-total resection while successfully preserving the patient's facial nerve and hearing function. The early postoperative evaluation revealed no morbidity, and the patient experienced a significant improvement in their symptoms.
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Affiliation(s)
- Nyoman Golden
- Neurosurgery Division, Department of Surgery, Faculty of Medicine, Universitas Udayana, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - Steven Awyono
- Neurosurgery Division, Department of Surgery, Faculty of Medicine, Universitas Udayana, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - Dicky T Prakoso
- Neurosurgery Division, Department of Surgery, Faculty of Medicine, Universitas Udayana, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - Christopher Lauren
- Neurosurgery Division, Department of Surgery, Faculty of Medicine, Universitas Udayana, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
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Maliawan S, Awyono S, Eufrata Silvestris Junus, Golden N. Massive subdural empyema secondary to infectious parotitis: a case report. Bali Med J 2022. [DOI: 10.15562/bmj.v11i3.3582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: Subdural empyema is an intracranial focal collection of purulent material between the dura and arachnoid mater. The most common causes are purulent meningitis in infants and sinusitis and otitis media in older children through a direct extension of the infection. Although it is very rare, parotitis may also cause subdural empyema. This report presents our case of subdural empyema due to infectious parotitis in a pediatric patient.
Case report: A 1-year-old boy was referred from other hospitals for multiple seizure episodes. He also had a complaint of vomit and fever 3 weeks ago. On the neurological examination, we found that he had a GCS of 8, no meningeal sign was found, and with dilated pupil on the right side. A contrast-enhanced head computed tomography (CT) scan revealed multiple hypodense masses with ring enhancement over the right hemisphere, and a severe midline shift suggested as subdural empyema. We then performed a craniotomy to evacuate the empyema. Two weeks after surgery, he was fully alert without any surgical morbidity.
Conclusion: Although parotitis is the less likely disease that can cause subdural empyema, we should also include the disease as the possible cause before we examine the patient more thoroughly and exclude them as the disease that can cause subdural empyema.
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Mahadewa TGB, Awyono S, Maliawan S, Golden N, Niryana IW. Comparison between Dura-Splitting Technique with Duraplasty in Symptomatic Patients with Chiari Malformation Type I: A Systematic Review and Meta-analysis. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: There are many surgical procedures for CIM patients, posterior fossa decompression with fibrous band excision, with additional duraplasty, or syringosubdural shunt for syringomyelia related CIM. Prospective studies have been carried out but yet no conclusion, on which one is the best option. The objective of this study was to assess qualitatively the outcome of posterior fossa decompression with dura-splitting (PFDDS) technique compared to posterior fossa decompression with duraplasty (PFDDP) for treating CIM patients.
AIM: This study aimed to give us a preference while conducting surgery in a patient with Chiari malformation type I (CIM) between posterior fossa decompression with incision of the fibrous band of the dura (dura-splitting/DS) technique and duraplasty (DP) technique.
METHODS: The analysis conducted using PRISMA flowchart with PICO framework (Patient: Chiari malformation type I patient over preschool age; Intervention: Dura-splitting; Comparison: Duraplasty; and Outcome: Complication rate, length of stay, reoperation rate, syrinx reduction, symptomatic improvement, and operation time) and already registered for meta-analysis study with database searching from PubMed, the Cochrane Library, and Google Scholar that following inclusion criteria: (1) Original study; (2) study that compares DS and DP in CM- I; and (3) patient age over preschool age.
RESULTS: A review of five included studies involving 458 patients met the inclusion criteria, in which 319 patients treated with DS surgery and 139 for DP surgery for this study. Significantly DS technique correlated lower rate of complication (RR = 0.20; p < 0.0001), shorter length of stay (MD = −3.53; p = 0.0002), and shorter operation time (MD = −58.59; p = 0.0004). No significant differences in reoperation rate (RR = 1.90; p = 0.22), symptom improvement (RR = 1.12; p = 0.44), and syrinx reduction (RR = 1.11; p = 0.56) were noted.
CONCLUSIONS: Posterior fossa decompression using the DS technique is associated with a lower rate of complication, shorter length of stay, and shorter operation time. However, no significant differences were found in the reoperation rate, symptom improvement, and syringomyelia reduction between these two techniques.
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Sueta MAD, Golden N, Prawira MD. Risk Factors for Post-operative Ileus: A Retrospective Study in Tertiary Referral Hospital in Indonesia. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Postoperative ileus is a complication that may result in the longer duration of stay and decreases the quality of life of patients. Previous studies have found some factors related to postoperative ileus. This study aimed to determine the risk factor of postoperative ileus in laparotomic resection and anastomosis surgery.
Methods: Patients who underwent laparotomic resection and anastomosis surgery during January 2019 – July 2020 were included. Postoperative ileus was diagnosed in fourth day after surgery. The variables included in this study are age, gender, BMI, pathology site, duration of surgery, type of anastomosis, length of resection.
Result: Fifty laparotomic resection and anastomosis surgery patients were included in this study, 50% of subjects is patients with postoperative ileus. Patient aged 65 years old or older had a higher incidence postoperative ileus (68% vs 28%; RR 2.3 95% CI: 1.23-4.33; p value: 0.010). Study also found duration of surgery 180 minutes or longer also had higher incidence postoperative ileus (79% vs 36%; RR: 2.49 95% CI: 1.20-5.15; p value: 0.010).
Conclusion: This study concludes that age 65 years old or older and duration of surgery 180 minutes or longer are significant risk factor to postoperative ileus in laparotomic resection and anastomosis surgery patients.
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Marques Mendes A, Golden N, Bermejo R, Morrison L. Distribution and abundance of microplastics in coastal sediments depends on grain size and distance from sources. Mar Pollut Bull 2021; 172:112802. [PMID: 34371343 DOI: 10.1016/j.marpolbul.2021.112802] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 06/13/2023]
Abstract
Microplastic deposition in marine sediments is a geographically widespread problem. This study examines microplastics in intertidal and subtidal sediments at 87 locations in habitats designated as Special Areas of Conservation (SACs) and Special Protection Areas (SPAs) on the coastline of Ireland. Established methodological approaches including, organic matter digestion, density separation, particle extraction and polymer identification were applied. Microplastic abundance was closely related with distance from known sources and concentrations were greater in intertidal as opposed to subtidal sediments. Colourless, polyethylene fibres and polypropylene fragments were the most abundant MP recorded and finer grained sediments were shown to entrap more MPs than coarser sediments. The results demonstrate that an understanding of potential sources of pollution, sediment type and hydrodynamic conditions are very important in terms of MP abundance and distribution in marine sediments and also in terms of effective waste management strategies and policy aimed at reducing the global plastics problem.
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Affiliation(s)
- A Marques Mendes
- Earth and Ocean Sciences, School of Natural Sciences and Ryan Institute, National University of Ireland Galway, Ireland
| | - N Golden
- Earth and Ocean Sciences, School of Natural Sciences and Ryan Institute, National University of Ireland Galway, Ireland
| | - R Bermejo
- Earth and Ocean Sciences, School of Natural Sciences and Ryan Institute, National University of Ireland Galway, Ireland; Departamento de Biologia, Facultad de Ciencias del Mar y Ambientales, Universidad de Cádiz, Spain
| | - L Morrison
- Earth and Ocean Sciences, School of Natural Sciences and Ryan Institute, National University of Ireland Galway, Ireland.
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Lumintang L, Adnyana IMS, Hamid AR, Sanjaya H, Golden N, Astawa P, Darmajaya M, Sumadi IWJ. The Effect of Topical Corticosteroid Time of Application on Fibroblast and Type III Collagen Expression in Oryctolagus cuniculus with Deep Dermal Burn Wound (As an Indicator for the Best Time to Start Topical Corticosteroid Application in Preventing Hypertrophic Scar). Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Hypertrophic scar is an abnormal scar that causes physical deteriorations, psychological problems, and aesthetic issues. An excessive number of fibroblasts and collagen III expressions are histopathology indicators for the hypertrophic scar. The role of topical corticosteroids in suppressing inflammation and hypergranulation had widely demonstrated in previous studies. However, there is no study related to the application of topical corticosteroids as prevention of hypertrophic scars from burn wound found. Hence, this study aimed to examine the evidence of the effects of corticosteroid topical in decreasing the number of fibroblasts and type III collagen expression and the best time to start its application in preventing hypertrophic scars.
Methods: This randomized experimental post-test only study involved 54 deep dermal burn wounds on the ventral ear of female Oryctolagus cuniculus that distributed into three groups based on the healing phases. Each group consisted of treatments and controls. Corticosteroid topical application on the first treatment group (inflammatory phase group), the second group (proliferation phase group), and the third group (remodelling phase group) was started on day 3, on day 10, and day 21, respectively. Specimens taken on day 35. Haematoxylin-Eosin and Immunohistochemically staining performed to measure the number of fibroblasts and type III collagen and to observe the epithelization and inflammation process.
Results: The number of fibroblasts significantly decreased in the second treatment group (p =0.001) and followed by the first group (p = 0.016), but no significant decrease found in the third group (p = 0.430). The type III collagen decreased significantly in the second treatment group (p = 0.000) and followed by the third group (p = 0.019), but no significant decrease found in the first group. There was no statistically different number of fibroblast and type III collagen discovered between the controls. Complete epithelization found in all groups. Also, no ongoing inflammation found in all groups.
Conclusion
: Topical corticosteroids on deep dermal burn wound revealed to be effective in reducing the number of fibroblasts and type III collagen with no healing disruption. The proliferation phase found to be the best time to start the application of topical corticosteroids.
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Golden N, Niryana W, Awyono S, Mardhika PE, Putra MB, Biondi MS. Transcranial approach as surgical treatment for giant pituitary adenoma during COVID 19 pandemic - What can we learn?: A case report. Interdiscip Neurosurg 2021; 25:101153. [PMID: 33654658 PMCID: PMC7906516 DOI: 10.1016/j.inat.2021.101153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 02/13/2021] [Accepted: 02/15/2021] [Indexed: 11/18/2022]
Abstract
Introduction In the COVID 19 pandemic, pituitary surgery is one of challenging surgical treatment, especially the involving transsphenoid approach. It was reported that the aerosolisation and mucosal involvement increase the risk of viral transmission during operation. Therefore, transcranial is a safer surgical approach during COVID-19 pandemic. This study aimed to reported transcranial approach to treat giant pituitary adenoma with aggressive visual disturbance which require urgent surgical management. Case presentation We reported a 21-year old male, who required urgent surgery because of progressive visual disturbance due to giant pituitary adenoma. On brain MRI with contrast, it was revealed an extraaxial tumor extending anteriorly over plannum sphenoidal with the greatest diameter was 5.34 cm. Transcranial approach was chosen to resect the tumor. Near total removal of the tumor was achieved without damaging vital neurovascular structure. The visual acuity was improved and no significant postoperative complication. Pathology examination revealed pituitary adenoma. Conclusion Transcranial surgery for pituitary adenoma is still an armamentarium in neurosurgical practice, especially in the COVID 19 pandemic to provide safer surgical approach.
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Affiliation(s)
- Nyoman Golden
- Department of Neurosurgery, Faculty of Medicine, Sanglah Hospital, Universitas Udayana, Bali, Indonesia
| | - Wayan Niryana
- Department of Neurosurgery, Faculty of Medicine, Sanglah Hospital, Universitas Udayana, Bali, Indonesia
| | - Steven Awyono
- Department of Neurosurgery, Faculty of Medicine, Sanglah Hospital, Universitas Udayana, Bali, Indonesia
| | - Putu Eka Mardhika
- Department of Neurosurgery, Faculty of Medicine, Sanglah Hospital, Universitas Udayana, Bali, Indonesia
| | - Made Bhuwana Putra
- Department of Neurosurgery, Faculty of Medicine, Sanglah Hospital, Universitas Udayana, Bali, Indonesia
| | - Made Stefanus Biondi
- Department of Neurosurgery, Faculty of Medicine, Sanglah Hospital, Universitas Udayana, Bali, Indonesia
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Golden N, Shahab A, Mahadewa TGB, Mardhika PE, Awyono S, Putra MB, Tombeng M. Scalenus Syndrome: A Literature Review. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.5571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Scalenus syndrome is often diagnosed as thoracic outlet syndrome (TOS). We performed literature searching reporting scalenus syndrome and we narratively describe the finding in this review. Scalenus syndrome is a unique clinical entity and commonly occurred. This syndrome can be classified into neurogenic TOS (nTOS) on the interscalene triangle, which also related to myofascial pain syndrome. There are three factors that contribute to scalenus syndrome, which are congenital anomaly, trauma, traumatic myositis, and hypertrophy of scalenus anterior muscle. The symptoms of scalenus syndrome can be divided into two types, which are neurologic and vascular symptoms. The neurologic manifestation can originate from the somatic and sympathetic nervous system. There is microscopic evidence of inflammation, hypertrophy, degeneration, and fibrosis of scalenus anterior muscle in scalenus syndrome cases. Scalenus syndrome can be treated surgically or conservatively. Non-surgical or conservative treatment can be applied to mild scalenus syndrome, especially nTOS, in the initial phase. Surgical management should be performed in persistent symptoms of nTOS or involving subclavian artery manifesting as arterial TOS (aTOS). Scalenus syndrome has quite similar clinical manifestation as nTOS and aTOS. However, this clinical syndrome should be considered as different entity because of different pathophysiology compared to TOS. Scalenus syndrome is caused by dynamic pathology of anterior scalenus muscle.
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Fahlberg MD, Blair RV, Doyle-Meyers LA, Midkiff CC, Zenere G, Russell-Lodrigue KE, Monjure CJ, Haupt EH, Penney TP, Lehmicke G, Threeton BM, Golden N, Datta PK, Roy CJ, Bohm RP, Maness NJ, Fischer T, Rappaport J, Vaccari M. Cellular events of acute, resolving or progressive COVID-19 in SARS-CoV-2 infected non-human primates. Nat Commun 2020; 11:6078. [PMID: 33247138 PMCID: PMC7695721 DOI: 10.1038/s41467-020-19967-4] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/03/2020] [Indexed: 01/08/2023] Open
Abstract
Understanding SARS-CoV-2 associated immune pathology is crucial to develop pan-effective vaccines and treatments. Here we investigate the immune events from the acute state up to four weeks post SARS-CoV-2 infection, in non-human primates (NHP) with heterogeneous pulmonary pathology. We show a robust migration of CD16 expressing monocytes to the lungs occurring during the acute phase, and we describe two subsets of interstitial macrophages (HLA-DR+CD206-): a transitional CD11c+CD16+ cell population directly associated with IL-6 levels in plasma, and a long-lasting CD11b+CD16+ cell population. Trafficking of monocytes is mediated by TARC (CCL17) and associates with viral load measured in bronchial brushes. We also describe associations between disease outcomes and high levels of cell infiltration in lungs including CD11b+CD16hi macrophages and CD11b+ neutrophils. Accumulation of macrophages is long-lasting and detectable even in animals with mild or no signs of disease. Interestingly, animals with anti-inflammatory responses including high IL-10:IL-6 and kynurenine to tryptophan ratios show less severe illness. Our results unravel cellular mechanisms of COVID-19 and suggest that NHP may be appropriate models to test immune therapies.
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Affiliation(s)
- M D Fahlberg
- Tulane National Primate Research Center, Covington, LA, USA
| | - R V Blair
- Tulane National Primate Research Center, Covington, LA, USA
- Department of Pathology and Laboratory Animal Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - L A Doyle-Meyers
- Tulane National Primate Research Center, Covington, LA, USA
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - C C Midkiff
- Tulane National Primate Research Center, Covington, LA, USA
| | - G Zenere
- Tulane National Primate Research Center, Covington, LA, USA
| | - K E Russell-Lodrigue
- Tulane National Primate Research Center, Covington, LA, USA
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - C J Monjure
- Tulane National Primate Research Center, Covington, LA, USA
| | - E H Haupt
- Tulane National Primate Research Center, Covington, LA, USA
| | - T P Penney
- Tulane National Primate Research Center, Covington, LA, USA
| | - G Lehmicke
- Tulane National Primate Research Center, Covington, LA, USA
| | - B M Threeton
- Tulane National Primate Research Center, Covington, LA, USA
| | - N Golden
- Tulane National Primate Research Center, Covington, LA, USA
| | - P K Datta
- Tulane National Primate Research Center, Covington, LA, USA
- Department of Pathology and Laboratory Animal Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - C J Roy
- Tulane National Primate Research Center, Covington, LA, USA
- Department of Microbiology and Immunology, Tulane University School of Medicine, New Orleans, LA, USA
| | - R P Bohm
- Tulane National Primate Research Center, Covington, LA, USA
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - N J Maness
- Tulane National Primate Research Center, Covington, LA, USA
- Department of Microbiology and Immunology, Tulane University School of Medicine, New Orleans, LA, USA
| | - T Fischer
- Tulane National Primate Research Center, Covington, LA, USA
- Department of Microbiology and Immunology, Tulane University School of Medicine, New Orleans, LA, USA
| | - J Rappaport
- Tulane National Primate Research Center, Covington, LA, USA
- Department of Microbiology and Immunology, Tulane University School of Medicine, New Orleans, LA, USA
| | - M Vaccari
- Tulane National Primate Research Center, Covington, LA, USA.
- Department of Microbiology and Immunology, Tulane University School of Medicine, New Orleans, LA, USA.
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Mahadewa TGB, Mardhika PE, Maliawan S, Golden N, Awyono S, Ryalino C. Comparison of Clinical Outcome between Craniectomy and Craniotomy as Surgical Management of Traumatic Acute Subdural Hematoma: A Systematic Review and Meta-analysis. Open Access Maced J Med Sci 2020. [DOI: 10.3889/oamjms.2020.4282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Acute subdural hematoma (ASDH) is a major problem in traumatic brain injury. Surgical techniques for treating ASDH are varied, including cranioplastic craniotomy and large decompressive craniectomy. The superiority of craniectomy and craniotomy for treating ASDH is still controversial.
AIM: The aim of this study was to compare the clinical outcome between craniectomy and craniotomy for treating traumatic ASDH through systematic review and meta-analysis.
METHODS: This study used electronic articles published in PubMed, EBSCO, Google Scholar, and Directory of Open Access Journal. Articles included were full-text observational studies in Indonesian or English. Clinical outcome using the Glasgow Outcome Scale was compared between craniectomy and craniotomy. Statistical analysis was done using Review Manager 5.3.
RESULTS: Six articles met our inclusion and exclusion criteria. We performed random effect model analysis because of high heterogeneity between studies (I2 = 77%; X2 = 21.98). The pooled risk ratio between craniectomy and craniotomy on poor outcomes was 1.41 (p = 0.02; 95% CI: 1.06–1.88).
CONCLUSION: Craniectomy increases the risk of poor clinical outcomes in treating a traumatic ASDH.
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Golden N, Putra JA, Niryana W, Mardhika PE. The relationship between cerebral salt wasting syndrome and clinical outcome in severe and moderate traumatic brain injury patient at Sanglah Hospital, Bali, Indonesia. Bali Med J 2020. [DOI: 10.15562/bmj.v9i2.1774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Wirawan AAPB, Golden N, Niryana IW. Faktor-faktor yang mempengaruhi penambahan lesi intrakranial pada pasien cedera kepala di RSUP Sanglah periode Januari-Desember 2017. Medicina (B Aires) 2020. [DOI: 10.15562/medicina.v51i1.468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Tambayong EF, Atmadjaya NK, Golden N, Wiargitha K, Tjokorda GBM. Facial Injury Severity Scale Score as a Predictor of Length of Stay for Maxillofacial Fracture at Sanglah General Hospital, Denpasar, Bali, Indonesia. Open Access Maced J Med Sci 2020. [DOI: 10.3889/oamjms.2020.4231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION: Maxillofacial fracture is the most common trauma that happened in the developing countries. One of the methods to evaluate the severity of maxillofacial fracture is by using the Facial Injury Severity Scale (FISS) score. Maxillofacial trauma causes multiple injuries, thus resulted in various periods of hospitalization.
AIM: The aim of this study is to use the employment of the FISS score to predict a patient’s length of stay.
METHODS: This research was a retrospective cohort and cross-sectional study on maxillofacial fracture patients whom treated in Sanglah General Hospital, Denpasar, Bali. As much as 89 subjects were included in this study and information about their age, gender, mechanism of injury, FISS score, treatments, and length of stay was collected. The data were statistically analyzed using bivariate, receiver operating characteristics (ROC), and linear regression analysis.
RESULTS: A total of 89 subjects were included in this study. Among them, 50 subjects had a high FISS score, and 39 subjects had low FISS score. The average age was 28.9 ± 13.3 years with a mean length of stay 6.39 ± 4.29 days. Bivariate analysis showed that the patients with high FISS score have 5.3 times higher risk to get a longer length of stay compared to those with low FISS score (95% CI: 2.289–12.289; p = 0.001). The mean of length of stay in subjects with a high FISS score was significantly higher compared to subjects with a low FISS score (mean for subjects with high score: 8.46 ± 4.63; mean for subjects with low score: 3.74 ± 1.46; p = 0.001) with a correlation value r = 0.718 (p = 0.001). ROC analysis represented that FISS score ˂4 was categorized as mild. The linear regression analysis showed that the length of stay for maxillofacial fracture patients was able to be predicted by LOS = 1.476 + 1.032 × FISS score.
CONCLUSION: The FISS score can predict the length of stay for patients with maxillofacial fracture.
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Sudartana K, Winarka E, Golden N, Ryalino C. Perbedaan kadar serum imunoglobulin G, A, dan M pada tikus wistar yang dilakukan splenektomi dengan dan tanpa tandur lien. Medicina (B Aires) 2019. [DOI: 10.15562/medicina.v50i3.898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Mahendra KYF, Niryana IW, Golden N. Perbandingan jumlah sel mononuklear, jumlah sel fibroblas, ukuran fibrosis, dan perlengketan klinis jaringan peridural pasca prosedur kraniektomi dekompresi dengan dan tanpa proceed surgical mesh pada kelinci new zealand cedera otak traumatik. Medicina (B Aires) 2019. [DOI: 10.15562/medicina.v50i2.805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Wiradana AGAA, Duarsa GWK, Oka AAG, Golden N, Santosa KB, Yudiana W, Tirtayasa PMW, Pramana IBP. Correlation between testosterone level, serum prostate-specific antigen level, and diabetes mellitus with grade inflammation of the prostate. Indonesia Journal of Biomedical Science 2019. [DOI: 10.15562/ijbs.v13i1.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Golden N, Asih MW. Traumatic Subacute Spinal Subdural Hematoma Concomitant with Symptomatic Cranial Subdural Hematoma: Possible Mechanism. World Neurosurg 2019; 123:343-347. [DOI: 10.1016/j.wneu.2018.12.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 12/11/2018] [Accepted: 12/13/2018] [Indexed: 10/27/2022]
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Yasa IMWDP, Golden N, Niryana IW. Faktor-faktor yang berhubungan dengan tindakan operasi pada pasien cedera kepala ringan dan cedera kepala sedang di RSUP Sanglah Denpasar periode Januari-Desember 2017. Medicina (B Aires) 2019. [DOI: 10.15562/medicina.v50i1.471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Golden N, Mahadewa TGB, Ryalino C. Surgical outcome of orbital cavernous hemangioma: a case series. OAS 2018. [DOI: 10.2147/oas.s186268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Golden N, Mahadewa TGB, Aryanti C, Widyadharma IPE. S100B Serum Level as a Mortality Predictor for Traumatic Brain Injury: A Meta-Analysis. Open Access Maced J Med Sci 2018; 6:2239-2244. [PMID: 30559895 PMCID: PMC6290435 DOI: 10.3889/oamjms.2018.432] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/21/2018] [Accepted: 10/22/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND: The pathogenesis of inflammatory neuronal cell damage will continue after traumatic brain injury in which contributed to subsequent mortality. Serum S100B levels were shown to be an early predictor of mortality due to traumatic brain injury. AIM: This Meta-Analysis will analyse the mean and diagnostic strength of serum S100B levels between survived and died subjects with head injuries based on the various follow-up times of nine studies. METHODS: We conducted a meta-anelysis in accordance with PRISMA guidelines and adhering to Cochrane Handbook for Systematic Review of Interventions. Literature search was conducted on March 16, 2018 from Medline and Scopus in the past 10 years, using various keywords related to S100, brain injury, and outcome. Duplicate journals were sorted out via EndNote. Included articles were as follows: original data from the group, clinical trials, case series, patients undergoing serum S100B levels with both short- and long-term follow-up mortality. Data were collected for mortality, serum S100B levels, and its diagnostic strength. All data were analyzed using Review Manager 5.3 (Cochrane, Denmark). RESULTS: The results of the meta-analysis showed a significant difference in S100B levels between survived and died subjects with head injuries on overall follow-up timeline (0.91, 95.9% CI 0.7-1.12, I2 = 98%, p < 0.001), during treatment (1.43, 95% CI 0.97 to 1.89, I2 = 98%, p < 0.001), or 6 months (0.19; 95%CI 0.1-0.29, I2 = 76%, p < 0.001) with an average threshold value that varies according to the study method used. The mean diagnostic strength was also promising to predict early mortality (sensitivity of 77.18% and 92.33%, specificity of 78.35% and 50.6%, respectively). CONCLUSION: S100B serum levels in the future will be potential biomarkers, and it is expected that there will be standardised guidelines for their application.
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Affiliation(s)
- Nyoman Golden
- Department of Neurosurgery, Faculty of Medicine, Udayana University, Sanglah General Hospital, Bali, Indonesia
| | - Tjokorda Gde Bagus Mahadewa
- Department of Neurosurgery, Faculty of Medicine, Udayana University, Sanglah General Hospital, Bali, Indonesia
| | - Citra Aryanti
- Department of Neurosurgery, Faculty of Medicine, Udayana University, Sanglah General Hospital, Bali, Indonesia
| | - I Putu Eka Widyadharma
- Department of Neurology, Faculty of Medicine, Udayana University, Sanglah General Hospital, Bali, Indonesia
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Mahadewa TGB, Golden N, Saputra A, Ryalino C. Modified Revised Trauma-Marshall score as a proposed tool in predicting the outcome of moderate and severe traumatic brain injury. Open Access Emerg Med 2018; 10:135-139. [PMID: 30349408 PMCID: PMC6183729 DOI: 10.2147/oaem.s179090] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Traumatic brain injury (TBI) is a common healthcare problem related to disability. An easy-to-use trauma scoring system informs physicians about the severity of trauma and helps to decide the course of management. The purpose of this study is to use the combination of both physiological and anatomical assessment tools that predict the outcome and develop a new modified prognostic scoring system in TBIs. Patients and methods A total of 181 subjects admitted to the emergency department (ED) of Sanglah General Hospital were documented for both Marshall CT scan classification score (MCTC) and Revised Trauma Score (RTS) upon admission. Glasgow Outcome Scale (GOS) was then documented at six months after brain injury. A new Modified Revised Trauma–Marshall score (m-RTS) was developed using statistical analytic methods. Results The total sample enrolled for this study was 181 patients. The mean RTS upon admission was 10.2±1.2. Of the 181 subjects, 110 (60.8%) were found to have favorable GOS (GOS score >3). Best Youden’s index results were obtained with any of the RTS of ≤10 with area under receiver operating characteristic (ROC) curve of 0.2542 and with risk ratio of 2.9 (95% CI=1.98−4.28; P=0.001); and Marshall score ≤2 with area under ROC curve of 0.2249 with risk ratio of 3.9 (95% CI=2.52−5.89; P=0.001). The RTS–Marshall combination has higher sensitivity with risk ratio of 4.5 (CI 95%=2.55−8.0; P=0.001) for screening tools of unfavorable outcome. The Pearson’s correlation between RTS and Marshall classification is 0.464 (P<0.001). Conclusion Combination of physiological and anatomical score improves the prognostic of outcome in moderate and severe TBI patients, formulated in this accurate, simple, applicable and reliable m-RTS prognostic score model.
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Affiliation(s)
- Tjokorda Gde Bagus Mahadewa
- Department of Surgery, Division of Neurosurgery, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia,
| | - Nyoman Golden
- Department of Surgery, Division of Neurosurgery, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia,
| | - Anne Saputra
- Department of Surgery, Division of Neurosurgery, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia,
| | - Christopher Ryalino
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia
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Nyoman M, Wiargitha IK, Golden N. Faktor-faktor risiko terjadinya maloklusi pada pasien fraktur maksilofasial yang menjalani operasi di RSUP Sanglah Denpasar. Medicina (B Aires) 2018. [DOI: 10.15562/medicina.v49i2.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Golden N. Surgical Outcomes of the Leading Symptoms of Sphenoorbital Meningiomas in a Series of 46 Patients. Skull Base Surg 2016. [DOI: 10.1055/s-0036-1592510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Golden N, Tjokorda MGB, Sri M, Niryana W, Herman S. Management of unusual dysplastic gangliocytoma of the cerebellum (Lhermitte-Duclos disease) in a developing country: Case report and review of the literature. Asian J Neurosurg 2016; 11:170. [PMID: 27057227 PMCID: PMC4802942 DOI: 10.4103/1793-5482.145091] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Dysplastic cerebellar gangliocytoma or Lhermitte-Duclos disease (LDD) especially in children are extremely rare. In this report we add one further case to this rare entity. A three year old boy with a history of cerebellar and brain stem compression signs was presented in unconscious condition. Computerized tomography (CT) scan revealed a well defined lesion mixed with area of calcification in the right cerebellum and severe obstructive hydrocephalus. Ventricular shunting was performed followed by gross total tumor removal three days after shunting. In the follow up period, the patient showed almost total resolution of all neurological deficits. MRI has been an imaging tool to preoperatively diagnose this disease; otherwise it would be uncertain preoperative diagnosis. However, in this report we would like to emphasize that not all uncertain diagnosis of LDD leads to palliative treatment. Well demarcated lesion may account for the safe surgical resection of this disease.
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Affiliation(s)
- Nyoman Golden
- Department of Neurosurgery, Sanglah General Hospital, School of Medicine, Udayana University, Denpasar, Bali, Indonesia
| | - Mahadewa G B Tjokorda
- Department of Neurosurgery, Sanglah General Hospital, School of Medicine, Udayana University, Denpasar, Bali, Indonesia
| | - Maliawan Sri
- Department of Neurosurgery, Sanglah General Hospital, School of Medicine, Udayana University, Denpasar, Bali, Indonesia
| | - Wayan Niryana
- Department of Neurosurgery, Sanglah General Hospital, School of Medicine, Udayana University, Denpasar, Bali, Indonesia
| | - Saputra Herman
- Department of Pathology, Sanglah General Hospital, School of Medicine, Udayana University, Denpasar, Bali, Indonesia
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Golden N, Agus Bagiada N, Darmadipura S. LIPID PEROXIDATION AFTER INTRACORTICAL INJECTION OF FERRIC CHLORIDE INCREASES THE INCIDENCE OF SEIZURES IN YOUNG RATS. IJBS 2012. [DOI: 10.15562/ijbs.v3i2.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Clinical studies have shown that the incidence of early posttraumatic seizures ishigher in children than in adults and it has been proposed that iron-induced lipidperoxidation has an important role in the development of epileptogenic foci. In this study,we examined some of the hypothesized reasons for the difference in the incidence ofearly posttraumatic seizures between young and adult rats. Twelve young and twelveadult rats were randomized into 4 groups. Group 1 and 2 were control groups, eachcomprising of 6 young rats and 6 adult rats respectively and were given intracorticalinjections of normal saline. Group 3 and 4 were injury groups, again comprising 6 youngrats and 6 adult rats respectively and were given intracortical injections of FeCl3. All ratswere observed for 6 hours post injection for the occurrence of seizures and were thenkilled. The injected hemispheres were extirpated and tested for malondialdehyde (MDA)level and superoxide dismutase (SOD) activity as indices of oxidative damage. Resultsshowed that seizures were observed only in Group 3. Increased MDA level and decreasedSOD activity were observed in Group 3 (ANOVA, p<0.001). Increased MDA levels anddecreased SOD activity were significantly higher in rats with seizures (Group 3) than inthose without seizures (independent t-test, p<0.001). We conclude was that differentlevels of lipid peroxidation induced by intracortical ferric chloride injection may accountfor the different seizure incidence between young and adult rats
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Golden N, Darmadipura S, Bagiada NA. The difference in seizure incidences between young and adult rats related to lipid peroxidation after intracortical injection of ferric chloride. Singapore Med J 2010; 51:105-109. [PMID: 20358147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
INTRODUCTION Clinical studies have shown that the incidence of early post-traumatic seizures is higher in children than in adults. It has been proposed that iron-induced lipid peroxidation plays an important role in the development of epileptogenic foci. This study examined some of the hypothesised reasons for the difference in the incidence of early post-traumatic seizures between children and adults. METHODS 12 young rats and 12 adult rats were randomised into four groups. Groups 1 and 2 were control groups, comprising six young rats and six adult rats, respectively, and they were administered an intracortical injection of saline. Groups 3 and 4 were injury groups, comprising six young rats and six adult rats, respectively, and they were administered an intracortical injection of FeCl3. All the rats were observed for six hours post-injection for the occurrence of seizures, and were then killed. The injected hemispheres were extirpated and tested for the malondialdehyde (MDA) levels and superoxide dismutase (SOD) activity as indices of oxidative damage. RESULTS Seizures were observed only in Group 3. Increased MDA levels and decreased SOD activity were observed in Group 3 (ANOVA, p-value is less than 0.001). Increased MDA levels and decreased SOD activity were significantly higher in rats with seizures (Group 3) than in those without seizures (independent t-test, p-value is less than 0.001). CONCLUSION Different levels of lipid peroxidation induced by an intracortical ferric chloride injection may account for the different incidence rates of seizures between young and adult rats.
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Affiliation(s)
- N Golden
- Department of Neurosurgery, Sanglah General Hospital, School of Medicine, Udayana University, Denpasar, Bali, Indonesia.
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Edwards P, Arango M, Balica L, Cottingham R, El-Sayed H, Farrell B, Fernandes J, Gogichaisvili T, Golden N, Hartzenberg B, Husain M, Ulloa MI, Jerbi Z, Khamis H, Komolafe E, Laloë V, Lomas G, Ludwig S, Mazairac G, Muñoz Sanchéz MDLA, Nasi L, Olldashi F, Plunkett P, Roberts I, Sandercock P, Shakur H, Soler C, Stocker R, Svoboda P, Trenkler S, Venkataramana NK, Wasserberg J, Yates D, Yutthakasemsunt S. Final results of MRC CRASH, a randomised placebo-controlled trial of intravenous corticosteroid in adults with head injury-outcomes at 6 months. Lancet 2005; 365:1957-9. [PMID: 15936423 DOI: 10.1016/s0140-6736(05)66552-x] [Citation(s) in RCA: 433] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
MRC CRASH is a randomised controlled trial (ISRCTN74459797) of the effect of corticosteroids on death and disability after head injury. We randomly allocated 10,008 adults with head injury and a Glasgow Coma Scale score of 14 or less, within 8 h of injury, to a 48-h infusion of corticosteroid (methylprednisolone) or placebo. Data at 6 months were obtained for 9673 (96.7%) patients. The risk of death was higher in the corticosteroid group than in the placebo group (1248 [25.7%] vs 1075 [22.3%] deaths; relative risk 1.15, 95% CI 1.07-1.24; p=0.0001), as was the risk of death or severe disability (1828 [38.1%] vs 1728 [36.3%] dead or severely disabled; 1.05, 0.99-1.10; p=0.079). There was no evidence that the effect of corticosteroids differed by injury severity or time since injury. These results lend support to our earlier conclusion that corticosteroids should not be used routinely in the treatment of head injury.
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Abstract
We present the clinical features, radiological findings and outcome of infants with non-accidental head injury presenting to our department between 2001 and 2003. There were 26 male and 13 female infants, aged between 7 days and 5 months. Presenting symptoms included seizures, vomiting, bulging fontanel, decreased level of consciousness, focal neurological signs, anemia and respiratory distress. We classified the patients into three groups: mild head injury (8 patients), moderate head injury (11 patients) and severe head injury (20 patients). Detailed history taking and thorough physical examination, did not reveal obvious injury or abuse (by the parents), other external visible injury or significant incidence of retinal bleeding. CT scan showed intracranial hemorrhage in all patients, most commonly including acute or acute on chronic subdural hematoma (SDH) and subarachnoid hemorrhage (SAH) in the parafalcine and tentorial regions and over the brain convexity, associated with focal or diffuse hypodensity of the parenchyma. Intracranial lesions were mostly bilateral (80%). These patients generally had a poor outcome; 31% died, 23% had a good outcome, and the remainder recovered with neurological impairment of varying types and degrees. After comprehensive assessment, we concluded that all the cases in our series were "non-accidental" head injuries. However, the absence of retinal bleeding, visible external injury and recognised abuse in our series differed from reports by other investigators. In our opinion these features are not absolute requirements in diagnosing "non-accidental" injury and detailed history taking, thorough clinical examination and radiological studies were the key indicators of the diagnosis.
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Affiliation(s)
- N Golden
- Department of Neurosurgery, School of Medicine, Sanglah General Hospital, Udayana University, Bali, Indonesia.
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Abstract
A case of a 28 year old woman with an intracranial cellular blue naevus (CBN) which was believed to be the extension from a pigmented skin/scalp lesion is reported. There was no similar pigmented skin lesion noted on other parts of her body. Radical intervention, including wide excision of the affected skin of the scalp, removal of the underlying pigmented skull bone and wide excision of the pigmented dura, together with wide excision of the intracranial mass, were performed. The skin defect was covered by rotation flap and free skin graft. The dura was closed by grafting with fascia lata. The skull defect was left open and would be repaired later at a second planned surgery.
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Affiliation(s)
- N Golden
- Sanglah General Public Hospital, Denpasar, Bali, Indonesia
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Cullen W, Golden N, Bury G, Fitzpatrick N. A one year prospective census of workload and process at a community hospital casualty room. Ir Med J 1999; 92:274-7. [PMID: 10360112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
A prospective census of patients attending the casualty room of Wicklow District Hospital (a general practitioner operated service) for one year was performed. A total of 1564 attendances were recorded, of which 904 (58%) were male and 953 (61%) were eligible for free medical care. Almost half, 735 (47%) attended outside daytime hours. Concerning type of presentation, 637 (41%) attended with acute trauma, 450 (29%) attended with acute medical and 477 (30%) attended with elective problems. Repeat visits accounted for 5% of the total. Concerning outcome of consultation, 409 (26%) were given a prescription, 307 (20%) had blood tests, 263 (17%) received dressings, 183 (12%) were referred to secondary care, 168 (11%) were followed up by their GP, 146 (9%) had minor surgery, and 86 (5%) had no intervention. This study indicates that the hospital is responsible for a considerable workload, with a significant out of hours component.
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Affiliation(s)
- W Cullen
- Department of General Practice, University College, Dublin
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Abstract
Clinical, laboratory, and sonographic data were collected prospectively from 100 female adolescents hospitalized with acute pelvic inflammatory disease (PID). The endocervical isolation rates for Chlamydia trachomatis and Neisseria gonorrhoeae were 44.7% and 36.4%, respectively. In comparison with adolescents with chlamydia-associated PID, those with gonococcus-associated PID had a shorter duration of pain before admission (p less than 0.05), higher mean maximum temperatures (p less than 0.01), and higher leukocyte counts (p less than 0.01). Pelvic ultrasound studies showed adnexal enlargement or tubo-ovarian abscess (TOA) in 85.2% of the patients. Of the 88 adolescents in whom adequate sonograms were obtained, 17 (19.3%) had TOA. In 12 of the 17 adolescents, the abscesses were identified sonographically before being diagnosed clinically. With clinical criteria alone, only the leukocyte count and prior history of PID differed significantly between those with TOA and those with uncomplicated PID. These findings support a more liberal use of pelvic ultrasound studies in teenagers with PID. Our high detection rate of C. trachomatis and the difficulty in predicting the cause of the infection in an individual patient support treating all adolescents with PID with agents effective against both C. trachomatis and N. gonorrhoeae.
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Affiliation(s)
- N Golden
- Department of Pediatrics, Brookdale Hospital Medical Center, Brooklyn, NY 11212
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Golden N, Cohen H, Gennari G, Neuhoff S. The use of pelvic ultrasonography in the evaluation of adolescents with pelvic inflammatory disease. Am J Dis Child 1987; 141:1235-8. [PMID: 3314478 DOI: 10.1001/archpedi.1987.04460110105035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
To evaluate the use of pelvic ultrasonography in the diagnosis and management of female adolescents with pelvic inflammatory disease (PID), sonograms of 60 patients with PID were compared with those of 40 age-matched controls. Sonograms were evaluated for adnexal volume, adnexal adherence, uterine size, and the presence of cul-de-sac fluid. Eleven (19.3%) of the 57 patients with PID, in whom adequate sonograms were obtained, had tubo-ovarian abscesses; in seven of these patients, the abscesses were diagnosed ultrasonographically before suspected clinically. Even in those patients without tubo-ovarian abscesses, the mean (+/- SD) adnexal volume in the PID group was significantly larger than that of the control group (11.0 +/- 6.8 cm3 vs 5.2 +/- 2.7 cm,3 respectively). Adnexal adherence, uterine size, and the presence of cul-de-sac fluid were not useful in differentiating patients with PID from normal controls. Pelvic ultrasonography can be a useful adjunct in the diagnosis and management of PID in adolescents and may, in some instances, provide diagnoses in the absence of clinical findings.
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Affiliation(s)
- N Golden
- Department of Pediatrics, Brookdale Hospital Medical Center, Brooklyn, NY 11212
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Abstract
A 14-year-old boy presenting with a chest wall mass, pulmonary infiltrate, and scoliosis was found to have thoracic actinomycosis with distal vertebral involvement. Review of the medical literature for the past 25 years revealed only 23 other pediatric cases of thoracic actinomycosis. Clinical, standard radiological, and microbiological findings can be nonspecific. The diagnosis is dependent on a high index of suspicion. A long course of penicillin is the treatment of choice. Body computed tomography is a useful diagnostic aid and is helpful also in evaluating response to therapy.
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Golden N, Hammerschlag M, Neuhoff S, Gleyzer A. Prevalence of Chlamydia Trachomatis Cervical Infection in Female Adolescents. J Urol 1984. [DOI: 10.1016/s0022-5347(17)49890-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- N. Golden
- Department of Pediatrics, Division of Adolescent Medicine and Department of Obstetrics and Gynecology, The Brookdale Hospital Medical Center, Brooklyn, New York
- Department of Pediatrics, Division of Immunology and Infectious Diseases, Downstate Medical Center, State University of New York, Brooklyn, New York
| | - M. Hammerschlag
- Department of Pediatrics, Division of Adolescent Medicine and Department of Obstetrics and Gynecology, The Brookdale Hospital Medical Center, Brooklyn, New York
- Department of Pediatrics, Division of Immunology and Infectious Diseases, Downstate Medical Center, State University of New York, Brooklyn, New York
| | - S. Neuhoff
- Department of Pediatrics, Division of Adolescent Medicine and Department of Obstetrics and Gynecology, The Brookdale Hospital Medical Center, Brooklyn, New York
- Department of Pediatrics, Division of Immunology and Infectious Diseases, Downstate Medical Center, State University of New York, Brooklyn, New York
| | - A. Gleyzer
- Department of Pediatrics, Division of Adolescent Medicine and Department of Obstetrics and Gynecology, The Brookdale Hospital Medical Center, Brooklyn, New York
- Department of Pediatrics, Division of Immunology and Infectious Diseases, Downstate Medical Center, State University of New York, Brooklyn, New York
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Abstract
To determine the prevalence of infection with Chlamydia trachomatis in young girls with the same socioeconomic background from New York City, 186 sexually active female adolescents (age range, 12 to 17 years; mean age, 15.5 years) were screened. One third of the patients were pregnant. Papanicolaou smears, endocervical cultures for C trachomatis and Neisseria gonorrhoeae, and syphilis serologic tests were obtained prospectively. Chlamydia trachomatis was isolated from 10.2% of the subjects, and N gonorrhoeae was isolated from 9.7% of the subjects; 3.2% of the subjects had syphilis. At least one sexually transmitted disease was found in 17.2% of the subjects. Eight (44%) of 18 patients with N gonorrhoeae also harbored Chlamydia. The high rate of multiple infection should have significant implications with regard to treatment. High isolation rates of C trachomatis and other sexually transmitted pathogens suggested that routine screening may be warranted in even the very young, sexually active female adolescent, and especially in pregnant girls.
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38
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Abstract
The incidence of anorexia nervosa is increasing in adolescents. The pediatrician caring for teenagers is often the first professional confronted with the early signs and symptoms of this disorder. Clinical features and available literature on the psychological, nutritional, and family disorganization found in patients with anorexia nervosa are reviewed. Different therapeutic approaches are discussed, and current data on outcome are presented.
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