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Background: Diffusion tensor imaging (DTI) tractography facilitates maximal safe resection and optimizes planning to avoid injury during subcortical dissection along descending motor pathways (DMPs). We provide an affordable, safe, and timely algorithm for preoperative DTI motor reconstruction for gliomas adjacent to DMPs. Methods: Preoperative DTI reconstructions were extracted from a prospectively acquired registry of glioma resections adjacent to DMPs. The surgeries were performed over a 7-year period. Demographic, clinical, and radiographic data were extracted from patients' electronic medical records. Results: Nineteen patients (12 male) underwent preoperative tractography between January 1, 2013, and May 31, 2020. The average age was 44.5 years (range, 19-81 years). A complete radiological resection was achieved in nine patients, a subtotal resection in five, a partial resection in three, and a biopsy in two. Histopathological diagnoses included 10 patients with high-grade glioma and nine with low-grade glioma. A total of 16 perirolandic locations (10 frontal and six frontoparietal) were recorded, as well as two in the insula and one in the basal ganglia. In 9 patients (47.3%), the lesion was in the dominant hemisphere. The median preoperative and postoperative Karnofsky Performance Scores were 78 and 80, respectively. Motor function was unchanged or improved over time in 15 cases (78.9%). Conclusion: This protocol of DTI reconstruction for glioma removal near the DMP shows good results in low-term neurological functional outcomes.
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OBJECTIVE: Open spina bifida or myelomeningocele (MMC) is a congenital defect that results from failure of caudal neurulation. We present a case series of patients who were treated with postnatal surgical correction for MMC, evaluating the possible preoperative and intraoperative risk factors associated with neurologic outcomes. METHODS: A retrospective chart review of patients who underwent postnatal surgical correction for MMCs over 11 years at our institution was performed. MMCs were classified based on their morphologic configuration into 3 types. Type I includes defects without a sac and there is cerebrospinal fluid (CSF) leak. Type II includes where there is a sac ≤4 cm, with or without CSF leak. Type III includes defects with a sac that are greater than 4 cm. RESULTS: Fifty patients were included. The median age of gestation at surgery was 37.4 weeks. There were 30 females (60%). All mothers received adequate folate supplementation. All patients underwent surgical correction in the first 48 hours. Lower extremity motor function at the last clinical follow-up was normal in 34 patients (68%). CSF leak, infection, and mortality were 8%, 2%, and 0%, respectively. Twenty-one patients (42%) underwent ventriculoperitoneal shunt for hydrocephalus. CONCLUSIONS: Despite there being no statistically significant associations with a timely closure, all cases were treated within the first 48 hours and this could influence the low complication rate. Individuals of Hispanic background who received appropriate folate supplementation still had high rates of MMC and we posit that this may be caused in part by a genetic/molecular predisposition.
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Hidrocefalia , Meningomielocele , Feminino , Humanos , Lactente , Meningomielocele/cirurgia , Meningomielocele/complicações , Estudos Retrospectivos , Hidrocefalia/cirurgia , Hidrocefalia/complicações , Fatores de Risco , Mitomicina , Ácido FólicoRESUMO
To determine the prevalence of antibodies to Brucella melitensis, Brucella abortus and Coxiella burnetii in animals on Caribbean islands we obtained sera from convenience samples of cattle (C), sheep (S), goats (G) and cats (F) from Dominica (C, S, G), Grenada (C, S, G), Montserrat (C, S, G), Puerto Rico (C), Nevis (C, S, G), St Kitts (C, S, G, F) and St Lucia (C, G). The sera were tested for antibodies against the Brucella spp. using commercial ELISA kits. Some sera were also tested at 1/80 for antibodies to C. burnetii using an indirect fluorescent antibody test. Positive sera were also tested at 1/640. None of 599 cattle, 462 sheep or 434 goats were positive in the Brucella ELISAs. None of 230 cattle had antibodies against C. burnetii, but one of 299 sheep was positive at 1/80 (Dominica - 1/54, 2%, 95% CI (0%-5.6%)), as were two of 314 goats, at 1/80 (Grenada - 1/53, 2%, 95% CI (0%-7.5%)) and 1/640 (St Kitts - 1/18, 5.6%, 95% CI (0%-16.7%)), and one of 34 cats, at 1/80 (St Kitts - 1/34; 3%, 95% CI (0%-8.8%)). Our data suggests that there is a very low prevalence or absence of B. melitensis and B. abortus on Caribbean islands. Coxiella burnetii, however, is present but it appears to be present on only some islands and then only at low levels. Overall, there appears to be a low threat to human and animal health from these organisms in the Caribbean.
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Brucelose/veterinária , Doenças do Gato/epidemiologia , Doenças dos Bovinos/epidemiologia , Doenças das Cabras/epidemiologia , Febre Q/veterinária , Doenças dos Ovinos/epidemiologia , Animais , Brucella abortus , Brucella melitensis , Brucelose/epidemiologia , Brucelose/microbiologia , Brucelose Bovina/epidemiologia , Brucelose Bovina/microbiologia , Doenças do Gato/microbiologia , Gatos , Bovinos , Doenças dos Bovinos/microbiologia , Coxiella burnetii , Doenças das Cabras/microbiologia , Cabras , Prevalência , Febre Q/epidemiologia , Febre Q/microbiologia , Estudos Soroepidemiológicos , Ovinos , Doenças dos Ovinos/microbiologia , Carneiro Doméstico , Índias Ocidentais/epidemiologiaRESUMO
STUDY DESIGN: A case series of dual time-point F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (F-FDG PET/CT) for the diagnosis of spinal cord sarcoidosis. OBJECTIVE: The aim of this study was to illustrate three cases of spinal sarcoidosis with occult presentation and subsequent identification with the use of dual time-point F-FDG PET/CT. SUMMARY OF BACKGROUND DATA: Sarcoidosis of the spinal cord is very rare and when it occurs without systemic manifestations of disease can be a challenging diagnostic dilemma frequently resulting in the need for spinal cord biopsy in order to establish a diagnosis. METHODS: Case series presentation and report. RESULTS: This manuscript presents a case series experience of dual time-point F-FDG PET/CT for the diagnosis of spinal cord sarcoidosis. We review the cases of three patients who presented with myelopathy and underwent F-FDG DTPI as part of the evaluation for enhancing spinal cord lesions of unknown etiology for 2 years at a university-based cancer hospital. F-FDG DTPI was vital in making the diagnosis of sarcoidosis, and in two of the cases, the patients were able to avoid biopsy, thereby avoiding potential morbidity from an invasive procedure. CONCLUSION: F-FDG PET/CT imaging is a noninvasive imaging technique that can be crucial in the diagnosis of sarcoidosis of the spinal cord and help avoid unnecessary procedures. LEVEL OF EVIDENCE: 4.
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Fluordesoxiglucose F18 , Compostos Radiofarmacêuticos , Sarcoidose/diagnóstico por imagem , Doenças da Coluna Vertebral/diagnóstico por imagem , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Sarcoidose/patologia , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/patologia , Doenças da Coluna Vertebral/patologiaRESUMO
INTRODUCTION: Pain management can be challenging following bariatric surgery, and patients with obesity tend to increase opioid use after undergoing surgery. This report quantifies marijuana (MJ) use and its relationship to pain and other surgery-related outcomes in a population from a state that has legalized MJ. METHODS: Data were collected for consecutive patients undergoing weight reduction surgeries between May 1, 2014 and July 31, 2015. Demographics, preoperative comorbidities, medications, and perioperative opioid use were analyzed. The primary outcome evaluated was inpatient opioid pain medication use quantified using natural log morphine equivalents. Secondary outcomes included percentage of total body weight loss after three months, postoperative complications, and changes in medical comorbidities. RESULTS: A total of 434 patients, among whom 36 (8.3%) reported MJ use, comprised the study population. Perioperative opioid requirements were significantly higher in the MJ-user group (natural log morphine equivalents of 3.92 vs 3.52, p = 0.0015) despite lower subjective pain scores (3.70 vs 4.24, p = 0.07). MJ use did not affect percentage of 90-day total body weight loss, development of postoperative complications, or improvement in medical comorbidities. CONCLUSION: Perioperative opioid use was significantly higher in the MJ-user group despite lower subjective pain scores. The difference in opioid requirements suggests an interaction between MJ use and opioid tolerance or pain threshold. The percentage of total body weight loss, improvement in medical comorbidity, and incidence of postoperative complications at 90-day follow-up were not affected by MJ use in this cohort analysis.
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Cirurgia Bariátrica/estatística & dados numéricos , Cannabis/efeitos adversos , Dor Pós-Operatória , Redução de Peso/efeitos dos fármacos , Adulto , Analgésicos Opioides/uso terapêutico , Feminino , Humanos , Incidência , Laparoscopia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Medição da Dor , Dor Pós-Operatória/tratamento farmacológico , Complicações Pós-OperatóriasRESUMO
Sub-disciplines of psychology have historically focused on the development and evaluation of interventions addressing social issues. However, little has been published regarding the development and evaluation of organizational structures that successfully support such interventions. By bridging the gap between the fields of community psychology and organization development, organizational structures and processes can be designed to enhance the effectiveness of social change programs. This article describes the interface between these two areas of psychology by presenting an integrative model that combines community psychology principles and values with organization development methodologies. This framework has been used to evaluate the organizational structure of a multi-site community-based research project entitled Connect to Protect (C2P) aimed at reducing HIV incidence among youth.(AU)
Varias sub-disciplinas de la psicología se han enfocado en el desarrollo de intervenciones para subsanar los problemas sociales. Sin embargo, se ha publicado poco sobre el desarrollo y evaluación de infraestructuras organizacionales que presten apoyo a dichas intervenciones para que sean exitosas. A través de un vínculo entre la psicología comunitaria y psicología organizacional podemos desarrollar estructuras organizacionales y procesos que incrementen la eficacia de programas de cambio social. Este articulo presenta la conexión entre estas dos áreas de la psicología a través de un modelo integrado que combina los supuestos y valores de la psicología comunitaria con la metodología de la psicología organizacional. Dicho modelo se utilizó para evaluar la estructura organizacional que provee apoyo a Conectar Para Proteger (C2P); una iniciativa investigativa a nivel comunitaria implantada en múltiples ciudad en los Estados Unidos y Puerto Rico. Cuyo propósito es reducir la incidencia de VIH entre jóvenes.(AU)