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Eangoor P, Indapurkar AS, Vakkalanka M, Yeh JS, Knaack JS. Rapid and Sensitive ELISA Screening Assay for Several Paralytic Shellfish Toxins in Human Urine. J Anal Toxicol 2017; 41:755-759. [PMID: 28977469 DOI: 10.1093/jat/bkx072] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Indexed: 11/13/2022] Open
Abstract
Paralytic shellfish poisoning is caused by a group of paralytic shellfish toxins that are produced by dinoflagellates. Toxins in this group include saxitoxin, neosaxitoxin and gonyautoxins. A rapid diagnostic test to identify poisoning by these toxins can be helpful in guiding the appropriate treatment of victims. Additionally, quick receipt of diagnostic results can provide timely proof that shellfish harvesting should be stopped in a given area, thereby preventing additional exposures. We have developed and validated a rapid urinary enzyme-linked immunosorbent assay-based screening test to diagnose exposure to several major paralytic shellfish toxins. The lower limit of detection (LLOD) for multiple paralytic shellfish toxins was characterized as 0.02, 0.10, 0.10, 1.0, 1.0 and 15 ng/mL for saxitoxin, gonyautoxin 2,3, decarbamoyl gonyautoxin 2,3, decarbamoyl saxitoxin, neosaxitoxin and gonyautoxin 1,4, respectively. No interferences were identified in unspiked pooled urine or in specimens collected from unexposed individuals indicating that this method is specific for the paralytic shellfish toxins tested. The accuracy of this test was demonstrated in 10 individual urine specimens with osmolalities ranging from 217 to 1,063 mOsmol/kg and pHs ranging between 5.06 and 7.45. These specimens were spiked with toxins at their LLODs and the presence of toxins at these concentrations was accurately identified in all cases. These results indicate that this diagnostic test can be used to rapidly and accurately screen urine for paralytic shellfish toxins.
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Affiliation(s)
- P Eangoor
- Department of Pharmaceutical Sciences, Mercer University, 3001 Mercer University Dr, Atlanta, GA-30341, USA
| | - A S Indapurkar
- Department of Pharmaceutical Sciences, Mercer University, 3001 Mercer University Dr, Atlanta, GA-30341, USA
| | - M Vakkalanka
- Department of Pharmaceutical Sciences, Mercer University, 3001 Mercer University Dr, Atlanta, GA-30341, USA
| | - J S Yeh
- Department of Pharmaceutical Sciences, Mercer University, 3001 Mercer University Dr, Atlanta, GA-30341, USA
| | - J S Knaack
- Department of Pharmaceutical Sciences, Mercer University, 3001 Mercer University Dr, Atlanta, GA-30341, USA
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Yeh JS, Sung SH, Huang HM, Yang HL, You LK, Chuang SY, Huang PC, Hsu PF, Cheng HM, Chen CH. Hypoglycemia and risk of vascular events and mortality: a systematic review and meta-analysis. Acta Diabetol 2016; 53:377-92. [PMID: 26299389 DOI: 10.1007/s00592-015-0803-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Accepted: 08/03/2015] [Indexed: 12/18/2022]
Abstract
AIMS Hypoglycemia has been associated with adverse outcomes in patients with diabetes and critical illness. However, such associations in these populations have not been systematically examined. METHODS We conducted a systematic review and meta-analysis of longitudinal follow-up cohort studies to investigate the associations between hypoglycemia and various adverse outcomes. RESULTS After removing duplicates and critically appraising all screened citations, a total of 19 eligible studies were included. As demonstrated by random-effects meta-analysis, hypoglycemia was strongly associated with a higher risk of adverse events (HR 1.90, 95 % CI 1.63-2.20; P < 0.001). Comparable risk ratios were shown in prespecified stratified analyses investigating above association for different study endpoints, in patients with or without critical illness, in patients with and without diabetes (from 1.47 to 3.31; p for interaction or heterogeneity >0.1). Additionally, a dose-dependent relationship between the severity of hypoglycemia and adverse vascular events and mortality (HR for mild hypoglycemia: 1.68, 95 % CI 1.25-2.26; P < 0.001 and HR for severe hypoglycemia: 2.33, 95 % CI 2.07-2.61; P < 0.001; p for trend 0.02) was observed. Suggested by a bias analysis, the above observations were unlikely to have resulted from unmeasured confounding parameters. CONCLUSIONS This is the first study demonstrating that hypoglycemia was associated with comparable risk ratios in different study populations and various study endpoints, and a trend of a dose-dependent relationship between hypoglycemia severity and adverse events. The findings of this systematic review support the speculation that hypoglycemia is a risk factor for adverse vascular events and mortality.
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Affiliation(s)
- Jong Shiuan Yeh
- Cardiology Division, Internal Medicine Department, Taipei Medical University Wan-Fang Hospital, Taipei, Taiwan
| | - Shih-Hsien Sung
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hui-Mei Huang
- Nursing Department, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Huei-Ling Yang
- Nursing Department, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Li-Kai You
- Department of Medical Education, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Beitou District, Taipei, 111, Taiwan, Roc
| | - Shao-Yuan Chuang
- Division of Preventive Medicine and Health Service, Research Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Po-Chieh Huang
- Department of Medical Education, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Beitou District, Taipei, 111, Taiwan, Roc
| | - Pai-Feng Hsu
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hao-Min Cheng
- Department of Medical Education, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Beitou District, Taipei, 111, Taiwan, Roc.
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan.
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Chen-Huan Chen
- Department of Medical Education, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Beitou District, Taipei, 111, Taiwan, Roc
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan
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Yeh JS, Cheng HM, Hsu PF, Sung SH, Liu WL, Fang HL, Chuang SY. Synergistic effect of gestational hypertension and postpartum incident hypertension on cardiovascular health: a nationwide population study. J Am Heart Assoc 2014; 3:e001008. [PMID: 25389282 PMCID: PMC4338688 DOI: 10.1161/jaha.114.001008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Gestational hypertension (GH) is a common complication of pregnancy and is associated with increased risk of incident hypertension in later life (IH) and cardiovascular events. However, the interactive effect of GH and IH on postpartum cardiovascular health remains unclear. METHODS AND RESULTS A nationwide population-based study was conducted using 1 million individuals from the Taiwan National Health Insurance database. Records from 1998 to 2009 were used to identify 1260 pregnant women with GH and without previous cardiovascular disease. The control group comprised 5040 pregnant women without GH, matched for age and date of delivery. During the follow-up period (median duration, 5.8 years), 182 cardiovascular events developed. Women with GH had significantly higher risk of cardiovascular events (hazard ratio [95% CI], 2.44 [1.80 to 3.31]) and IH (8.29 [6.30 to 10.91]) than controls. Compared with women without GH and IH, there was a significantly higher risk of cardiovascular events for women without GH but with IH (relative risk [95% CI], 2.89 [1.27-6.58]), women with GH but without IH (1.66 [1.16-2.39]), and women with GH and IH (8.11 [5.36-12.30]). The synergy index was 2.91 (95% CI 1.11 to 7.59), suggesting a positive interaction between GH and IH. CONCLUSIONS GH increased the risk of subsequent IH. Women with both GH and IH were at a substantially higher cardiovascular risk than were women with either GH or IH. The synergistic adverse effect of GH and IH on postpartum cardiovascular health indicates that more attention should be paid to this special population.
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Affiliation(s)
- Jong Shiuan Yeh
- Cardiology Division, Internal Medicine Department, Taipei Medical University Wan-Fang Hospital, Taipei, Taiwan (J.S.Y.) Department of Medicine, Taipei Medical University, Taipei, Taiwan (J.S.Y.)
| | - Hao-Min Cheng
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan (H.M.C., S.H.S.) Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan (H.M.C.) Department of Medicine, National Yang-Ming University, Taipei, Taiwan (H.M.C., P.F.H., S.H.S.)
| | - Pai-Feng Hsu
- Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan (P.F.H.) Department of Medicine, National Yang-Ming University, Taipei, Taiwan (H.M.C., P.F.H., S.H.S.)
| | - Shih-Hsien Sung
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan (H.M.C., S.H.S.) Department of Medicine, National Yang-Ming University, Taipei, Taiwan (H.M.C., P.F.H., S.H.S.)
| | - Wen-Ling Liu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan (W.L.L., H.L.F., S.Y.C.)
| | - Hsin-Ling Fang
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan (W.L.L., H.L.F., S.Y.C.)
| | - Shao-Yuan Chuang
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan (W.L.L., H.L.F., S.Y.C.)
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Yeh JS, Cheng HM, Hsu PF, Sung SH, Liu WL, Fang HL, Chuang SY. Hysterectomy in young women associates with higher risk of stroke: A nationwide cohort study. Int J Cardiol 2013; 168:2616-21. [DOI: 10.1016/j.ijcard.2013.03.042] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 01/01/2013] [Accepted: 03/17/2013] [Indexed: 10/27/2022]
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Afari M, Tellez A, Cheng Y, Oh SJ, Buszman P, Milewski K, Yeh JS, Granada J, Kaluza G. TCT-592 Familial Hypercholesterolemic Swine In-Stent Restenosis Model, But Not Contemporaneous Injury+Treatment Model, Predicts Efficacy of Drug Coated Balloon in Peripheral Arteries. J Am Coll Cardiol 2012. [DOI: 10.1016/j.jacc.2012.08.628] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Afari M, Tellez A, Oh SJ, Buszman P, Cheng Y, Yeh JS, Conditt G, Kaluza G, Granada J. TCT-171 Paclitaxel Balloon Delivery Results In Homogeneous In-Stent Neointimal Distribution and Reduction of Stent Edge Stenosis Progression in the Peripheral Swine Model. J Am Coll Cardiol 2012. [DOI: 10.1016/j.jacc.2012.08.191] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Oh SJ, Yeh JS, Buszman P, Afari M, Tellez A, Cheng Y, Conditt G, McGregor J, Kaluza G, Granada J. TCT-538 Predictors of Stent Fracture and Impact on Neointimal Proliferation: Experimental Insights into the Mechanisms of Drug Eluting Stent Failure. J Am Coll Cardiol 2012. [DOI: 10.1016/j.jacc.2012.08.571] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Afari M, Oh SJ, Buszman P, Tellez A, Peppas A, Rate W, Yeh JS, Kaluza G, Granada J. TCT-293 Neointimal Tissue Characteristics Based on Optical Coherence Tomography Analysis Following Paclitaxel Coated Balloon Treatment in a Porcine Iliofemoral Vascular Territory. J Am Coll Cardiol 2012. [DOI: 10.1016/j.jacc.2012.08.317] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Afari ME, Tellez A, Buszman P, Yeh JS, Oh SJ, Cheng Y, Yi G, Kaluza G, Granada J. PERI-STRUT LOW INTENSITY AREAS BY OCT CORRELATE WITH NEOINTIMAL THICKNESS AND INFLAMMATION IN A HYPERCHOLESTEROLEMIC SWINE MODEL. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)60118-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Phenytoin is often used to prevent postcraniotomy seizures, but is not always effective. We investigate changes in plasma phenytoin level ([phenytoin]) following craniotomy. The [phenytoin] in 28 patients who were receiving phenytoin (oral/ intravenous) and undergoing a craniotomy were prospectively measured 24 h preoperatively, immediately pre- and postcraniotomy, 24 and 48 h postoperatively. Factors examined included patients' age, sex, pathology, preoperative [phenytoin], operative duration and blood loss. Fifteen patients had [phenytoin] concentrations outside the therapeutic range. Twenty-five patients experienced a decrease in [phenytoin] immediately postcraniotomy: pre-, post- and 24 h postcraniotomy mean [phenytoin] were 13.4, 10.0 and 12.9 mg/l, respectively. Preoperative [phenytoin], operative duration and blood loss had significant correlation with the decrease in [phenytoin] (p < 0.05). In conclusion, < 50% of the patients had therapeutic preoperative [phenytoin]. In most patients, [phenytoin] decreases by 26% after craniotomy and returns to preoperative level within 24 h. These may contribute to early postoperative seizure development.
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Affiliation(s)
- J S Yeh
- Department of Neurosurgery, University Hospital of North Staffordshire, Stoke-on-Trent, UK
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Affiliation(s)
- A L Green
- Department of Neurosurgery, North Staffordshire Royal Infirmary, Stoke-on-Trent, UK
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Abstract
BACKGROUND/OBJECTIVE As prior studies analysed predictive factors for various post-laminectomy spinal deformities in mixed spinal regions, age groups or pathologies, their validity and conclusions were unclear. The objective of this study was to determine predictive factors for worsened cervical or thoracic spinal sagittal alignment following laminectomy or laminotomy for primary intramedullary spinal cord tumours in children. METHODS In this retrospective study, patients treated between 1980 and 1998 were reviewed. Changes in spinal alignment at the last follow-up compared to the pre-operative state were studied. Factors analysed were age, pre-operative spinal alignment, procedure types (laminectomy or laminoplasty), number of laminae operated, surgery of C2 or T1 laminae, histological grade, presence of post-operative neurological deficit and post-operative radiotherapy. RESULTS There were 27 patients. The mean age was 5.6 years (range 1.3-14.0 years), and the mean duration of follow-up was 3.7 years (range 0.075-9.9 years). In the cervical-cervicothoracic surgical group (n = 12), alignment worsened post-operatively in 3 patients. The number of laminae operated upon had a statistically significant impact on the development of post-operative kyphosis (p = 0.07). In the thoracic-thoracolumbar surgical group (n = 15), alignment worsened in 9 patients. Procedure types were statistically significantly different, with laminectomy associated with an increased risk of post-operative kyphosis (p = 0.01). All 5 patients who had spinal fusion for worsened post-operative alignment were in the thoracic-thoracolumbar group; no patients in the cervical-cervicothoracic group required spinal fusion (p = 0.047). Other predictive factors did not reach statistical significance (p > 0.05). CONCLUSIONS Worsened spinal sagittal alignment following laminectomy or laminoplasty and the need for spinal fusion is more common in the thoracic-thoracolumbar region than in the cervical-cervicothoracic region. In the cervical-cervicothoracic region, operation on a greater number of laminae tends to increase the risk of worsened alignment. In the thoracic-thoracolumbar region, laminectomy is associated with worsened alignment, while laminoplasty reduces this risk; also, pre-operative kyphotic deformity tends to increase the risk of worsened alignment post-operatively.
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Affiliation(s)
- J S Yeh
- Department of Paediatric Neurosurgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK
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Abstract
OBJECTIVE To investigate whether not shaving hair in neurosurgical operations carries an increased infection rate. METHODS Taking advantage of different practices among neurosurgeons in a single institution, we embarked upon a prospective non-randomised study of 100 consecutive neurosurgical procedures involving 90 paediatric patients aged 7 days to 16.8 years. The patients were split into two groups ('hair shave' and 'no hair shave'). The differences with respect to wound complications, positive microbiology on wound culture swabs and wound infection rates were analysed. Other factors considered were the cleansing solution, prophylactic antibiotic regime, duration of the operation, the surgeon's experience and the patient's age. RESULTS The only complications observed were 4 incidences of wound dehiscence (2 in the hair shave and 2 in the no hair shave group) and 3 shunt infections (2 in the hair shave and 1 in the no hair shave group). We did not find any significant difference between the two arms for any of the factors assessed. Age was a significant factor in shunt infection, as all shunt infections were seen in patients aged less than 6 months, regardless of whether the hair was shaved or not (p = 0.024, Fisher's exact test). CONCLUSION This study confirms our clinical experience that no hair shave is a good alternative to the traditional hair shaving approach, allowing patients to enjoy the psychological benefits of undisturbed body image while recovering from major surgery.
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Affiliation(s)
- K Tang
- Department of Neurosurgery, Birmingham Children's Hospital, Birmingham, UK
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Yeh JS, Munn SE, Plunkett TA, Harper PG, Hopster DJ, du Vivier AW. Coexistence of acanthosis nigricans and the sign of Leser-Trélat in a patient with gastric adenocarcinoma: a case report and literature review. J Am Acad Dermatol 2000; 42:357-62. [PMID: 10640933 DOI: 10.1016/s0190-9622(00)90112-9] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The association of acanthosis nigricans (AN) with the sign of Leser-Trélat (LT) and gastric carcinoma is rare. Our patient was a 69-year-old man, who presented with hematemesis; a stage-IV poorly differentiated, diffuse-type, adenocarcinoma of the gastric antrum was diagnosed. The AN was striking, with florid cutaneous papillomatosis that also involved the mucous membranes of the mouth and eyelids, and keratoderma. AN and the sign of LT predated tumor detection by 6 months and regressed after chemotherapy in parallel with reduction of the tumor load, demonstrating the dermatoses as paraneoplastic phenomena. The patient died 7 months after completion of chemotherapy. The coexistence of AN and the sign of LT should prompt a search for underlying malignancy. The pathogenesis of both dermatoses is discussed.
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Affiliation(s)
- J S Yeh
- Department of Dermatology, King's College Hospital, London, United Kingdom
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Affiliation(s)
- R V Singh
- Department of Neurosurgery, North Stafforshire Hospital Centre, Hartshill, Stoke-on-Trent, UK
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Abstract
A case of a primary ectopic intramuscular meningioma of the thigh in a 20-year-old male patient is presented. The possible histogenesis of primary ectopic meningiomas is summarized.
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Affiliation(s)
- R V Singh
- Department of Neurosurgery, North Staffordshire Hospital Centre, Hartshill, Stoke-on-Trent, UK
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Abstract
This case report describes a paraganglioma of the cauda equina in a 57-year-old man. The clinical and pathological features of the 70 cases reported to date are reviewed. The importance of total surgical removal is stressed.
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Affiliation(s)
- R V Singh
- Department of Neurosurgery, North Staffordshire Hospital Centre, Stoke-on-Trent, UK
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Abstract
A rare case of cervical intramedullary cavernous angioma in a 30-year-old man with Down's syndrome is presented. A review of the literature showed this to be the first reported case. Magnetic resonance imaging was diagnostic. A myelotomy was done and multiple biopsies were taken. The patient deteriorated neurologically and later died due to severe chest infection. The presentation, management and prognosis of this condition are discussed.
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Affiliation(s)
- R V Singh
- Department of Neurosurgery, North Staffordshire Hospital Center, Stoke-on-Trent, U.K
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Abstract
We report a case of postoperative wound infection and meningitis with Salmonella typhimurium in a 66-year-old woman who had been operated on for a cerebral meningioma. The diagnostic, therapeutic and prognostic implications are discussed.
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Affiliation(s)
- R V Singh
- Department of Neurosurgery, North Staffordshire Hospital Centre, Stoke-on-Trent, UK
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