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Surgical Treatment of Cerebral cavernous Malformations: Report of 6 Cases and pertinent Literature review 脑海绵状血管瘤的外科治疗:附6例报告并文献复习
Pub Date : 2023-07-30 DOI: 10.3126/nmmj.v4i1.57139
G. Sharma, Prasanna Karki, Sumit Joshi, D. B. Shah, P. Paudel, B. Gyawali, Baburam Pokharel, R. Panth
Cerebral cavernous Malformation (CCM) is a rare neurovascular malformation accounting 0.5% to 4% of all intracranial vascular malformations. People harboring CCM may be symptomatic or may present with seizure, hemorrhage or progressive neurological deficit. Asymptomatic CCM needs no treatment. The symptomatic CCM may or may not require intervention. The best treatment for symptomatic CCM is microsurgical excision. Over a period of five years we have been managing I2 patients with CCM, and out of them 6 patients who were symptomatic required microsurgical excision. Here, we discuss these 6 surgically managed patients and appropriate literature related to CCMs would be reviewed.
脑海绵状血管瘤是一种罕见的神经血管畸形,占颅内血管畸形的0.5% ~ 4%。患有CCM的人可能有症状,也可能表现为癫痫发作、出血或进行性神经功能障碍。无症状CCM无需治疗。症状性CCM可能需要也可能不需要干预。治疗症状性CCM的最佳方法是显微手术切除。在5年的时间里,我们治疗了2例CCM患者,其中6例有症状的患者需要显微手术切除。在这里,我们讨论这6例手术治疗的患者,并复习与CCMs相关的相关文献。
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引用次数: 0
Annulling an Annulled Annular Pancreas: A Case Report 切除环形胰腺一例报告
Pub Date : 2023-07-30 DOI: 10.3126/nmmj.v4i1.57138
S. Ghimire, Sunil Dhakal, P. Rai, Nirvan Rai, R. Mishra
Annular Pancreas (AP) is a rare congenital developmental anomaly which results from failure of the ventral bud to rotate to fuse with the dorsal bud, resulting in a ring of pancreatic parenchyma that surrounds the second portion of the duodenum. This rare entity can be partial or complete and the partial is even rarer. Most cases manifest in the infancy but may remain asymptomatic and various nonspecific clinical manifestations are seen in adults. We report a rare case of partial annular pancreas with atrophy of body and tail of pancreas which presented with upper gastrointestinal bleeding and obstruction. The challenge in this case was the annular pancreas was the only functioning pancreatic tissue.
环状胰腺(AP)是一种罕见的先天性发育异常,是由于腹侧芽未能旋转与背侧芽融合,导致胰腺实质环包围十二指肠第二部分。这种罕见的实体可以是部分的,也可以是完全的,部分的更罕见。大多数病例表现在婴儿期,但可能仍然无症状,各种非特异性临床表现见于成人。我们报告一例罕见的部分环状胰腺伴胰体及胰尾萎缩,并表现为上消化道出血及梗阻。这个病例的挑战在于环状胰腺是唯一有功能的胰腺组织。
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引用次数: 0
Silver Diamine Fluoride: A Review 二胺氟化银:综述
Pub Date : 2023-07-30 DOI: 10.3126/nmmj.v4i1.57150
Obehi O Osadolor, A. Osadolor
BACKGROUND The burden of untreated dental caries among African children is high. Silver diamine fluoride (SDF) is a simple, non- technique sensitive intervention to stop the progression of active untreated carious lesion in primary teeth among children. Silver diamine fluoride (SDF) 38% solution contains 44,800 ppm fluoride ions and its stains teeth after use. METHOD An electronic literature search in Web of science, Scopus, PubMed, Google Scholar, African journal online, Researchgate and Google was done in May,2023. Search terms and keywords were combined by Boolean operators. Two independent investigators (research assistants) screened titles, abstracts and full text of publications. The inclusion criteria were original research articles, case report, case series related to silver diamine fluoride ( human studies) conducted in African region and in electronic databases. RESULTS Ten articles were included as they were assessed to meet the aim of the review. The study design of the articles were four invitro studies, three randomized controlled clinical trial, one randomized clinical trial, one split-mouth, self-controlled clinical trial and one split-mouth, randomized controlled clinical study. 90 % of the studies identified was conducted in Egypt, while 10 % of the studies was conducted in Nigeria. CONCLUSION Studies on silver diamine fluoride (SDF) identified in African countries were few and restricted to few countries. Silver diamine fluoride can be used as an intervention for active and progressing untreated carious lesion in primary teeth among children though it stains teeth after use. More studies from the diverse ethnic population in Africa will contribute to the existing literature.
背景:在非洲儿童中,未经治疗的龋齿负担很高。二胺氟化银(SDF)是一种简单、无技术敏感性的干预措施,可阻止儿童乳牙未治疗的活动性龋齿病变的发展。二胺氟化银(SDF) 38%溶液含44,800 ppm氟离子,使用后会染色牙齿。方法于2023年5月在Web of science、Scopus、PubMed、Google Scholar、African journal online、Researchgate和Google进行电子文献检索。搜索词和关键字由布尔运算符组合。两名独立调查人员(研究助理)筛选出版物的标题、摘要和全文。纳入标准是在非洲区域和电子数据库中进行的与氟化二胺银(人体研究)有关的原始研究文章、病例报告、病例系列。结果:10篇文章被纳入,因为它们被评估达到了综述的目的。文章的研究设计为4项体外研究、3项随机对照临床试验、1项随机对照临床试验、1项裂口自对照临床试验和1项裂口随机对照临床研究。所确定的研究中有90%是在埃及进行的,而10%是在尼日利亚进行的。结论非洲国家对氟化二胺银的研究较少,且仅限于少数国家。氟化二胺银可用于干预儿童乳牙活动性和进展性未经治疗的龋齿,但使用后会污染牙齿。更多来自非洲不同种族人口的研究将有助于现有文献。
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引用次数: 0
Study of Percutaneous transvenous mitral commissurotomy outcomes in valves with different Echocardiographic features 不同超声心动图特征瓣膜经皮经静脉二尖瓣合拢切开术的疗效研究
Pub Date : 2023-07-30 DOI: 10.3126/nmmj.v4i1.57111
R. Rajbhandari, R. Tamrakar, J. Shah, Arya Pradhan, Sarbagya Manandhar, Utsav Dangol, Rebika Dangol
BACKGROUND Percutaneous transvenous mitral commissurotomy (PTMC) is now a standard treatment for suitable mitral stenosis. However all procedures are not always successful or optimal. Despite having so much experience on the procedure the prediction as which types of valves give good results after PTMC is not very much defined.METHODS Initial sixty patients of PTMC of Shahid Gangalal hospital (18 male, 42 female), age ranging from 13 to 65 years, mean age 29.9±11.5 years, were studied retrospectively. Their echocardiography data before and after balloon dilatation of mitral valve were collected. The appearance of mitral valve on echocardiogram before PTMC was scored for leaflet thickening, leaflet mobility, subvalvular thickening and calcification. They were categorized into low scoring group A if they scored 8 or low, and high scoring group B if they scored above 8 according to Wilkins score.RESULTS Results were classified as successful and optimal (if valve area > 1.5cm2) or suboptimal (if valve area ≤1.5 cm2). High scoring leaflet deformity with more than 8 was associated with suboptimal results while low score group had successful outcomes and their difference was significant statistically.CONCLUSION Patients with high severity scoring of mitral valve disease had poor outcome in comparison to those with low score.
背景:经皮经静脉二尖瓣合并术(PTMC)是目前治疗二尖瓣狭窄的标准方法。然而,并非所有的手术都是成功的或最佳的。尽管在这个过程中有这么多的经验,但预测哪种类型的阀门在PTMC后会产生良好的效果并不是很明确。方法回顾性分析沙希德医院收治的60例PTMC患者,其中男18例,女42例,年龄13 ~ 65岁,平均29.9±11.5岁。收集二尖瓣球囊扩张术前后的超声心动图资料。对PTMC前二尖瓣超声心动图表现进行小叶增厚、小叶活动性、瓣下增厚和钙化评分。根据威尔金斯分数,如果得分为8分或更低,就分为A组低分,如果得分在8分以上,就分为B组高分。结果将结果分为成功和最优(瓣膜面积> 1.5cm2)和次优(瓣膜面积≤1.5 cm2)。评分高于8分的小叶畸形评分高组预后不佳,评分低组预后良好,差异有统计学意义。结论二尖瓣疾病严重程度评分高的患者预后较低。
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引用次数: 0
Pattern of Patients in Intensive Care Unit in a Tertiary Care Hospital in Lumbini Province Nepal 尼泊尔蓝毗尼省某三级医院重症监护室患者模式
Pub Date : 2023-07-30 DOI: 10.3126/nmmj.v4i1.57137
R. Mandal, N. Bhandari, U. Gupta, Sailes Paudel, K. Yadav, Nirmal Shakya
BACKGROUND Intensive care is a crucial component of hospital care, reserved for patients with potentially recoverable conditions who can benefit from invasive treatment. However, in developing countries like Nepal, resources and availability of intensive care become hurdles in delivering healthcare. This study presents the pattern of admission and outcome of patients' management in a general intensive care unit (ICU) of this tertiary care center in Lumbini Province, Nepal. METHODS A cross sectional study conducted in the Department of Internal Medicine, Bheri Hospital between July 2021 to June 2022. A total of 792 patient’s details were obtained from the record section. Demographic data, diagnosis, duration of stay in ICU, managing units, and outcome were collected and analyzed with Statistical Package for the Social Sciences 20. RESULTS A total of 729 patients were admitted in the study period; 57.82% were male and 42.18% were female. Majority 60% of admissions were from Department of Medicine followed by Cardiology 24% and Surgery 10%. Pneumonia and Chronic Obstructive Pulmonary Disease 18.30% followed by Myocardial Infraction 14.52%, Acute abdomen 10.22% and sepsis 9.84% were the most common morbidity. Mean duration of ICU stay was 3.5. days. Discharge rate was 69.82% and the mortality rate was 17.80 %. CONCLUSION The most common patients admitted in the ICU of Bheri hospital were mostly Medical cases. Surgical and obstetric cases were lesser in number. The outcomes were comparable with other multidisciplinary ICU of similar settings.
背景:重症监护是医院护理的一个重要组成部分,专为有可能康复的患者保留,这些患者可以从侵入性治疗中获益。然而,在尼泊尔等发展中国家,资源和重症监护的可用性成为提供医疗保健的障碍。本研究介绍了在兰毗尼省,尼泊尔三级护理中心的一般重症监护病房(ICU)的入院模式和患者管理的结果。方法:横断面研究于2021年7月至2022年6月在Bheri医院内科进行。从记录部分共获得792例患者的详细信息。统计数据、诊断、在ICU的住院时间、管理单位和结果被收集并使用《社会科学统计软件包》20进行分析。结果研究期间共收治729例患者;男性占57.82%,女性占42.18%。60%的住院患者来自内科,其次是心脏病24%和外科10%。肺炎和慢性阻塞性肺疾病占18.30%,其次是心肌梗死占14.52%,急腹症占10.22%,败血症占9.84%。ICU的平均住院时间为3.5。天。出院率为69.82%,死亡率为17.80%。结论Bheri医院重症监护室最常见的患者以内科病例为主。外科和产科病例较少。结果与其他类似情况的多学科ICU具有可比性。
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引用次数: 0
A retrospective study on bacteriological profile and antibiotics prescription practice in a tertiary level intensive care unit 回顾性研究细菌学概况和抗生素处方实践在三级重症监护病房
Pub Date : 2023-07-30 DOI: 10.3126/nmmj.v4i1.57136
K. Khanal, S. Poudel, Bikash Khadka, A. Ghimire, Ashim Regmi, Manoj Bist, S. Shrestha
BACKGROUND Antibiotics are the most commonly prescribed medicines in intensive care units (ICU). The irrational use of antibiotics leads to the development of multidrug-resistant organisms (MDR). The aim of the study is to determine the bacteriological profile of infections in our ICU and antibiotic prescription practice, before and after the culture results.METHODOLOGY This is a retrospective study conducted in a tertiary-level, 33-bedded ICU in Nepal to evaluate the bacteriological profile and antibiotic prescription practice. The patients who were admitted between a period of 3 months (January 2023 to March 2023) were enrolled. The data variables collected were; patients' details, culture samples sent (blood, urine, endotracheal (ET) aspirate, sputum, cerebrospinal fluid (CSF), wound swab, pleural fluid, ascitic fluid, tissue culture, and peritoneal fluid), gram stain results, culture sensitivity results, empirical antibiotics used, and change in antibiotics following culture results.RESULTS A total of 378 culture samples were obtained from 230 patients. A positive culture report was obtained for 165 (43.65%) of the 378 samples sent. Urine was the most common sample sent for microbiology (28%), followed by blood (25.3%) and sputum (22.75%). The percentage occurrence of gram-negative bacteria was 84%, while that of gram-positive bacteria was 16%. Methicillin- resistant coagulase-negative staphylococcus (MRCONS) was the most common gram-positive organism isolated (46.15%), and Klebsiella pneumoniae was the most common gram-negative organism (38.84%). Cephalosporin was the commonest group of empirical antibiotics used in our ICU, followed by carbapenem. Empirical antibiotic treatment was continued in 108 patients (47%), changed following the culture results in 92 patients (40%), and discontinued in 30 patients (13%). Escalation of antibiotics was done in 78 patients (85%) and de-escalation in 14 patients (15%). CONCLUSION Antimicrobial resistance and the irrational prescription of antibiotics can lead to a global economic burden. Hence, antibiotic stewardship programs are required to reduce the irrational prescribing patterns of antibiotics.
背景:抗生素是重症监护病房(ICU)最常用的处方药。抗生素的不合理使用导致了多重耐药菌(MDR)的产生。本研究的目的是确定我们ICU和抗生素处方实践中感染的细菌学概况,培养结果前后。这是一项回顾性研究,在尼泊尔的三级,33个床位的ICU进行,以评估细菌学概况和抗生素处方实践。入选时间为3个月(2023年1月至2023年3月)的患者。收集的数据变量为;患者的详细资料,送出的培养样本(血液、尿液、气管内(ET)抽液、痰液、脑脊液(CSF)、伤口拭子、胸膜液、腹水、组织培养和腹膜液)、革兰氏染色结果、培养敏感性结果、使用的经验性抗生素以及培养结果后抗生素的变化。结果230例患者共获得培养标本378份。378份送检样本中,培养阳性165份(43.65%)。尿液是最常见的微生物样本(28%),其次是血液(25.3%)和痰(22.75%)。革兰氏阴性菌检出率为84%,革兰氏阳性菌检出率为16%。革兰氏阳性菌以耐甲氧西林凝固酶阴性葡萄球菌(MRCONS)最常见(46.15%),革兰氏阴性菌以肺炎克雷伯菌最常见(38.84%)。头孢菌素是我院ICU最常用的经验性抗生素,其次是碳青霉烯类。108例患者(47%)继续经验性抗生素治疗,92例患者(40%)根据培养结果改变治疗,30例患者(13%)停止治疗。78例患者(85%)增加了抗生素用量,14例患者(15%)减少了抗生素用量。结论抗菌药物耐药和不合理处方可导致全球性经济负担。因此,需要抗生素管理计划来减少抗生素的不合理处方模式。
{"title":"A retrospective study on bacteriological profile and antibiotics prescription practice in a tertiary level intensive care unit","authors":"K. Khanal, S. Poudel, Bikash Khadka, A. Ghimire, Ashim Regmi, Manoj Bist, S. Shrestha","doi":"10.3126/nmmj.v4i1.57136","DOIUrl":"https://doi.org/10.3126/nmmj.v4i1.57136","url":null,"abstract":"BACKGROUND Antibiotics are the most commonly prescribed medicines in intensive care units (ICU). The irrational use of antibiotics leads to the development of multidrug-resistant organisms (MDR). The aim of the study is to determine the bacteriological profile of infections in our ICU and antibiotic prescription practice, before and after the culture results.\u0000METHODOLOGY This is a retrospective study conducted in a tertiary-level, 33-bedded ICU in Nepal to evaluate the bacteriological profile and antibiotic prescription practice. The patients who were admitted between a period of 3 months (January 2023 to March 2023) were enrolled. The data variables collected were; patients' details, culture samples sent (blood, urine, endotracheal (ET) aspirate, sputum, cerebrospinal fluid (CSF), wound swab, pleural fluid, ascitic fluid, tissue culture, and peritoneal fluid), gram stain results, culture sensitivity results, empirical antibiotics used, and change in antibiotics following culture results.\u0000RESULTS A total of 378 culture samples were obtained from 230 patients. A positive culture report was obtained for 165 (43.65%) of the 378 samples sent. Urine was the most common sample sent for microbiology (28%), followed by blood (25.3%) and sputum (22.75%). The percentage occurrence of gram-negative bacteria was 84%, while that of gram-positive bacteria was 16%. Methicillin- resistant coagulase-negative staphylococcus (MRCONS) was the most common gram-positive organism isolated (46.15%), and Klebsiella pneumoniae was the most common gram-negative organism (38.84%). Cephalosporin was the commonest group of empirical antibiotics used in our ICU, followed by carbapenem. Empirical antibiotic treatment was continued in 108 patients (47%), changed following the culture results in 92 patients (40%), and discontinued in 30 patients (13%). Escalation of antibiotics was done in 78 patients (85%) and de-escalation in 14 patients (15%). \u0000CONCLUSION Antimicrobial resistance and the irrational prescription of antibiotics can lead to a global economic burden. Hence, antibiotic stewardship programs are required to reduce the irrational prescribing patterns of antibiotics.","PeriodicalId":131440,"journal":{"name":"Nepal Mediciti Medical Journal","volume":"44 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124902919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Ultrasound guided suprascapular and supraclavicular nerve block in combination with continuous perineural brachial plexus block for operative management of upper limb multiple fractures: a case report 超声引导肩胛上、锁骨上神经阻滞联合连续神经周围臂丛神经阻滞治疗上肢多发骨折1例
Pub Date : 2023-07-30 DOI: 10.3126/nmmj.v4i1.57143
P. Bhattarai, Hemant Adhikari
We report a case of multiple upper limb fractures resulting from a road traffic accident, wherein the patient declined general anesthesia. Instead, we successfully administered anesthesia using ultrasound-guided supraclavicular and suprascapular nerve blocks, combined with continuous perineural brachial plexus block. The surgical procedure was successfully completed within six hours, and no complications were encountered.
我们报告一例多上肢骨折导致的道路交通事故,其中病人拒绝全身麻醉。相反,我们成功地使用超声引导的锁骨上和肩胛上神经阻滞,结合连续的神经周围臂丛阻滞进行麻醉。手术在6小时内顺利完成,无并发症发生。
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引用次数: 0
Ocular Manifestations of Coronavirus Disease 2019 (COVID-19): Its Remedy and Prevention 冠状病毒病2019 (COVID-19)眼部表现:治疗与预防
Pub Date : 2022-12-31 DOI: 10.3980/j.issn.1672-5123.2022.12.34
S. Bhattarai
SARS-CoV-2 is a Coronavirus that causes COVID-19 with mild to severe respiratory illness. It is highly contagious disease transmitted through direct or indirect contact with infected people or contaminated surfaces mainly through respiratory droplets. Several research articles are published which evaluated the ocular findings in patients with Coronavirus disease 2019. Commonly patients are suffering from initial ocular symptoms followed by systemic symptoms of the disease. Transmission even from the ocular surface could be possible via tears and other secretions through eyes. The most frequently noted initial symptom of COVID-19 is follicular conjunctivitis with acute and diffuse bilateral red eye. Similarly other ocular manifestations include eye Corneal sub epithelial infiltrates with epithelial defects,episclerits,acute anterior Uveitis, Retinitis, Optic neuritis, Cataract, Vitreous hemorrhages and cranial nerve palsies. As a remedy for ocular manifestation, orally administered Ribavirin has been used in vision threatening cases. For mild to moderate ocular symptoms ,antihistaminic eye drops with ocular lubricating drops and cool compress are till now applied. To be in safe side and to prevent the transmission from the ocular surfaces, all eye care practitioners are advised to wear personal protective equipment including gowns, gloves, masks and face shields during the ophthalmic procedures.
SARS-CoV-2是一种冠状病毒,可导致COVID-19并伴有轻度至重度呼吸道疾病。它是一种高度传染性疾病,主要通过呼吸道飞沫直接或间接接触受感染者或受污染的表面传播。发表了几篇研究文章,评估了2019冠状病毒病患者的眼部表现。通常,患者首先出现眼部症状,然后出现全身症状。甚至从眼表也有可能通过眼睛的眼泪和其他分泌物传播。COVID-19最常见的初始症状是滤泡性结膜炎伴急性和弥漫性双侧红眼。类似的其他眼部表现包括角膜上皮下浸润伴上皮缺损、表皮炎、急性葡萄膜前炎、视网膜炎、视神经炎、白内障、玻璃体出血和脑神经麻痹。作为眼部表现的补救措施,口服利巴韦林已用于视力威胁的情况下。对于轻度至中度眼部症状,目前使用抗组胺滴眼液加眼润滑液和冷敷。为安全起见,并防止从眼表传播,所有眼科医生在眼科手术期间应穿戴个人防护装备,包括防护服、手套、口罩和面罩。
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引用次数: 0
Intramedullary Spinal Cord Tumors (IMSCTs): Outcome after surgical resection in 35 cases and review of literature 脊髓髓内肿瘤(IMSCTs): 35例手术切除后的结果及文献复习
Pub Date : 2022-12-31 DOI: 10.3126/nmmj.v3i2.52345
G. Sharma, Sumit Joshi, P. Poudel, Prassana Karki, D. B. Shah, Baburam Pokharel
BACKGROUND Intramedullary Spinal Cord Tumors (IMSCTs) are rare and they represent only 5% of all spinal tumors. Ependymoma and astrocytoma are two most common IMSCTs. Due to recent advances in micro instruments, imaging and technology, aggressive surgical excision has become a safer possibility with better outcome. Aim of this study is to analyze functional outcome of patients after surgical resection of IMSCTs and review of literature. METHODOLOGY Over a period of 4 years, between May 2017 and January 2021, 35 patients were operated for IMSCTs under general anesthesia. Neurophysiological monitoring (NPM) was recently available and used only in last few cases. CUSA was used whenever required in these microsurgical procedures. This retrospective study was carried out after retrieving data from OT registers, inpatient files, OPD records, and statistical analysis was executed using SPSS software (version 18). Functional outcome was assessed by McCormick grading scale and mean follow up period was 2.5 years. RESULTS Out of 35 patients, 17 were male and 18 female. Mean age distribution was 27.57(+/-17.68). On admission, 30 patients had motor deficits, 18 had neck or back pain, 10 had sphincter dysfunction, 7 had kyphoscoliosis and 2 patients had normal neurology. MRI with IV contrast of these 35 patients revealed intramedullary lesions at cervical (11), cervicomedullary (4), thoracic (8), cervicothoracic (2), thoracolumbar (3), conus (6) and lumbar (1) regions. 22 patients had gross total and 13 had subtotal resection. Histological examination confirmed 30 glial tumors (ependymoma & astrocytoma), 2 dermoid/epidermoid, 2 neurenteric cysts and 1 secondary. Postoperative complication was 17% and there was no surgery related 30 days’ mortality. Functional outcome was measured by McCormick grade before and after microsurgical resection. Preoperatively 3(8.5%) patients had low grade or independent and 32 (91.4%) had high grade or dependent. Postoperatively and at the time of discharge 14 (40%) of patients had low grade or independent and 21 (60%) were dependent or high grade. On last followed up (4 years) 15 (48.3%) had low grade and 16 (51.6%) had high grade or dependent. In our series, on followed up of 4 years, recurrence rate was 5(14.2%), They were 2 astrocytoma, 1 secondary, and 2 myxopapillary ependymomas. Two patients with myxopapillary ependymoma were operated twice and no radiotherapy was advocated. 8 (22.6%) patients received local radiation and recurrence rate was 17.2%. CONCLUSION  Safe resection of intramedullary lesion is possible with the aid of modern neurosurgical tools, however, functional outcome relies on preoperative neurological status of the patients, extent of excision and histology of tumor. Risk factors for recurrence of IMSCTS are extent of resection and histological behavior of tumor.
脊髓髓内肿瘤(IMSCTs)是罕见的,仅占所有脊髓肿瘤的5%。室管膜瘤和星形细胞瘤是两种最常见的imsct。由于近年来显微仪器、影像和技术的进步,积极的手术切除已经成为一种更安全、效果更好的可能性。本研究的目的是分析imsct手术切除后患者的功能结局并复习文献。在2017年5月至2021年1月的4年时间里,35例患者在全身麻醉下接受了imsct手术。神经生理监测(NPM)是最近才出现的,仅在少数病例中使用。在这些显微外科手术中,只要需要,就使用CUSA。本回顾性研究从门诊挂号、住院档案、门诊记录中检索数据,并使用SPSS软件(版本18)进行统计分析。功能结局采用McCormick评分法评定,平均随访时间2.5年。结果35例患者中,男性17例,女性18例。平均年龄分布为27.57岁(±17.68岁)。入院时,30例患者有运动障碍,18例有颈部或背部疼痛,10例有括约肌功能障碍,7例有脊柱后凸,2例神经正常。这35例患者的MRI与IV对比显示髓内病变位于颈椎(11)、颈髓(4)、胸(8)、颈胸(2)、胸腰椎(3)、圆锥(6)和腰椎(1)区域。22例全部切除,13例次全切除。组织学检查证实神经胶质瘤(室管膜瘤和星形细胞瘤)30例,皮样/表皮样2例,神经肠囊肿2例,继发性1例。术后并发症为17%,无手术相关30天死亡率。显微手术切除前后以McCormick评分法测定功能结局。术前3例(8.5%)患者分级低或独立,32例(91.4%)患者分级高或依赖。术后和出院时14例(40%)患者为低分级或独立级,21例(60%)患者为依赖级或高分级。末次随访(4年)低分级15例(48.3%),高分级或依赖16例(51.6%)。在我们的研究中,随访4年,复发率为5例(14.2%),其中2例为星形细胞瘤,1例为继发性,2例为黏液乳头状室管膜瘤。2例黏液乳头状室管膜瘤手术两次,不主张放疗。局部放疗8例(22.6%),复发率17.2%。结论在现代神经外科工具的帮助下,髓内病变的安全切除是可能的,但功能预后取决于患者术前神经系统状况、切除程度和肿瘤组织学。IMSCTS复发的危险因素是肿瘤的切除程度和组织学行为。
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引用次数: 0
Low-volume Plasma Exchange In Immune-mediated Neurological Diseases : A tertiary care center study 免疫介导的神经系统疾病的低容量血浆交换:一项三级保健中心研究
Pub Date : 2022-12-31 DOI: 10.3126/nmmj.v3i2.52363
Aashish Shrestha, B. Gajurel, R. Karn, R. Ojha, R. Rajbhandari, N. Gautam, Sumit Shahi, P. Ghimire, Pradeep Panthee, S. Bijukchhe
BACKGROUND The optimal cost benefit of standard plasma exchange (SPE) has not been met where most of the patients do not afford the treatment. As an alternative, low volume plasma exchange (LVPE) is cost-effective than SPE where albumin replacement is eliminated. The aim of this study was to analyse the efficacy and safety of LVPE in various Immune mediated neurological diseases (IMND). METHODS A hospital-based retrospective study was conducted in patients with IMND who were admitted in TUTH between October 15, 2020, and October 14, 2022. Hemodynamically stable patients over the age of 18 who met the plasma exchange criteria were eligible. Outcomes and treatment-related complications were studied separately for the different diseases. RESULTS Of the 29 patients enrolled, 3 had Myasthenia gravis (MG), 6 had Neuromyelitis optica spectrum disorder (NMOSD), 11 had Gullian Barre syndrome (GBS), 6 had Chronic inflammatory demyelinating polyneuropathy (CIDP), and 3 had Autoimmune encephalitis (AE). Patients with MG, GBS, and CIDP all showed statistically significant improvement in mRS scores from 2.3±0.6 to 0 (p value = 0.0198), 3.03±1.8 to 2.2±1.4 (p value=0.0046) and 2.5±1.4 to 1.8±1(p value=0.025) respectively by the time they were discharged following treatment. Two patients developed Deep vein thrombosis (DVT), and two developed anaphylaxis during the course of their treatment, although none deteriorated further while in the hospital. CONCLUSION LVPE was effective in MG, GBS and CIDP. Myasthenia crisis patients who re-quired mechanical ventilation demonstrated complete resolution with LVPE making it a potential life-saving alternative for those who cannot afford standard therapy.
背景:标准血浆置换(SPE)的最佳成本效益尚未得到满足,因为大多数患者负担不起治疗费用。作为替代方案,低容量血浆交换(LVPE)比SPE更具成本效益,无需白蛋白替代。本研究的目的是分析LVPE在各种免疫介导的神经系统疾病(IMND)中的疗效和安全性。方法:对2020年10月15日至2022年10月14日期间在TUTH住院的IMND患者进行基于医院的回顾性研究。符合血浆交换标准的18岁以上血流动力学稳定的患者符合条件。分别对不同疾病的治疗结果和治疗相关并发症进行研究。结果入选的29例患者中,3例为重症肌无力(MG), 6例为视神经脊髓炎谱系障碍(NMOSD), 11例为Gullian Barre综合征(GBS), 6例为慢性炎症性脱髓鞘性多神经病变(CIDP), 3例为自身免疫性脑炎(AE)。MG、GBS、CIDP患者治疗出院时mRS评分分别由2.3±0.6分改善至0分(p值= 0.0198)、3.03±1.8分改善至2.2±1.4分(p值=0.0046)、2.5±1.4分改善至1.8±1分(p值=0.025),均有统计学意义。两名患者出现深静脉血栓形成(DVT),两名患者在治疗过程中出现过敏反应,尽管在医院期间没有进一步恶化。结论LVPE治疗MG、GBS、CIDP均有效。需要机械通气的重症肌无力危重患者显示出LVPE的完全解决方案,使其成为无法负担标准治疗费用的患者的潜在救生选择。
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Nepal Mediciti Medical Journal
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