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Biomedical subjects

J F Martínez-Lage

Publications and source records attributed to J F Martínez-Lage.

At least 19 recordsLinked to original sources
PubMed2006

Retrograde migration of ventriculoperitoneal shunt to the neck. Case report.

We report a patient, given a ventriculoperitoneal shunt at the neonatal period, who presented with a painless subcutaneous mass on his neck. Plain radiographs of the cervical region showed that the swelling was made up by a migrated and coiled peritoneal catheter. We briefly discuss the proposed mechanism for this complication and suggest that this occurrence must be taken into account at the time of evaluating a patient with shunt malfunction.

Adult↗
PubMed2006

[Postoperative delirium in patient neurosurgical: evaluation by means of the Abbreviated Mental Test].

OBJECTIVES: To assess the incidence and characteristics of postoperative changes in the higher cerebral functions after elective intracranial surgery under general anesthesia. PATIENTS AND METHODS: This is a prospective study of 60 patients, aged 18-81 years, submitted to neurosurgical operations, allocated into two groups of 30 patients each: intracranial surgery group, patients submitted to craniotomy, and extracranial surgery group or control group, patients submitted to spinal procedures. All patients were given the Abbreviated Mental Test (AMT) on the day before to the operation, and then 2 and 24 hours after the end of the procedure. All individuals were managed with the same anesthetic technique. RESULTS: No differences in regard to demographics, duration of the operation, ASA physical state, and habits were found between the two groups. No differences in the pre-surgical and post-surgical AMT mean score were encountered between patients submitted to intracranial 9.87 +/- 0.35 or to spinal surgeries 9.80 +/- 0.41. Similarly, there were no significant differences between the two groups in the results of the AMT performed at 2 and 24 hours after the end of the surgeries. Only two subjects undergoing spinal procedures had a score of < or = 8 in the AMT performed 2-hours after the operation, while none showed a decrease in the 24-hour test score. CONCLUSIONS: Patients submitted to intracranial surgery did not show any changes in cognitive or attention functions during the first postoperative 24 hours as assessed by the AMT.

Adolescent↗
PubMed2006

"Benign" shaken baby syndrome. Case report.

The authors report an infant with clinical and neuroimaging findings of shaken baby syndrome. The pitfalls encountered in the assessment on the cause of the bilateral frontal and interhemispheric subdural hematomas in this child are also briefly discussed. We have called this condition "benign" shaken baby syndrome and emphasize that not always acute subdural hematomas are of non-accidental nature.

Airway Obstruction↗
PubMed2005

[Syndromes of overdrainage of ventricular shunting in childhood hydrocephalus].

Overdrainage in ventricular shunting constitutes a difficult to prevent and to treat complication. The authors reviewed a retrospective series of 512 children submitted to a ventricular shunting procedure aimed at analysing factors influencing this type of complication. The causes for the hydrocephalus were congenital (n=172), post-myelomeningocele (n=123), posthemorrhagic (n=103), tumoral (n=64), postmeningitis (n=40) and posttraumatic (n=10). Eighty-eight children (17.8%) evolved with a complication related to the excessive function of the valve. The authors investigated the relationship between hydrocephalus' etiology and type of overdrainage syndromes. The most frequent complication was ventricular catheter block (n=50), followed by symptomatic slit ventricle syndrome (SVS) (n=19), subdural hematoma (n=10) and trapped fourth ventricle (n=9). There were no statistical differences regarding complications for each etiologic subset of hydrocephalus. SVS occurred in 19 children (3.71%), a low rate according to the current literature. Posthemorrhagic and postinfectious hydrocephalus grouped together showed a higher rate of SVS (p=0.005), a feature that we attributed to the cerebral destruction caused by these two conditions. Treatment of SVS was complex and required diverse procedures, applied in an escalated way, which included five decompressive craniectomies. The authors suggest avoiding, as much as possible, the use of ventricular shunts, and recommend the alternative use of new technology valves and neuroendoscopic procedures.

Cerebrospinal Fluid Shunts↗
PubMed2004

[Tension pneumocephalus after intracranial surgery in the supine position].

Tension pneumocephalus is a rare and severe complication appearing after posterior fossa procedures in the sitting position. This complication may endanger the patient's life and require immediate treatment. However, tension pneumocephalus after neurosurgical procedure in the supine position have been scarcely reported. We report such a complication occurring in a 14-year-old girl submitted to a frontotemporal craniotomy for removal of an astrocytome performed with the patient supine. We discuss ethiopathogenesis and management of this complication.

Adolescent↗
PubMed2004

Cystic mature teratoma of the filum terminale in an adult. Case report and review of the literature.

Intradural spinal teratoma is a very rare entity, more prevalent in childhood, that may associate with dysraphic defects. The authors report a 46 years old man with a cauda equina syndrome and an L1-2 tumor. An L1-2 laminectomy was performed and a mass was resected at the base of the filum terminale, which was in contact with the conus medullaris. Histopathological diagnosis was of cystic mature teratoma. Spinal teratomas may be found anywhere along the spine, but are more frequent in the cauda equina. We discuss the origin of these tumors and review the literature concerning these lesions.

Cauda Equina↗
PubMed2004

[Activity of copper-zinc superoxide dismutase in a global ischemic brain lesion model without arterial hypotension].

OBJECTIVE: To determine the behavior of the copper-zinc superoxide dismutase enzyme (SOD/Cu/Zn) in tissue homogenates of rat brains with ischemic lesions produced following the model of global cerebral ischemia without arterial hypotension. MATERIAL AND METHODS: Thirty rats were randomly assigned to five groups of six animals each. Bilateral carotid occlusion was temporarily produced in 24 rats (4 groups) during periods of 5, 15, 30 and 60 minutes, respectively. All the animals were then submitted to reperfusion for 30 minutes and after that, they were sacrificed. A control group of 6 rats was not exposed to arterial occlusion. Cerebral homogenates of the rats' brain were obtained and submitted to spectrophotometer analysis. RESULT: The control group showed the lowest mean values in SOD/Cu/Zn activity (40.60+/-11.42 U/mg of protein), while the highest mean values (60.34+/- 13.52 U/mg of protein) corresponded to the rats submitted to ischemia for 60 minutes, what indicates a statistically significant difference (p = 0.016) between the two groups. CONCLUSIONS: SOD/Cu/Zn activity in rats increases during the production of ischemic cerebral lesions. The analysis of SOD/Cu/Zn activity showed an important tendency to rise from the 30 minutes period of ischemic lesion and reached statistically significant values at 60 minutes from the beginning of the ischemic injury. The experimental model of global brain ischemia without arterial hypotension used in this study constitutes a reliable method for researching cerebral ischemia.

Animals↗
PubMed2003

Anesthetic technique and development of pneumocephalus after posterior fossa surgery in the sitting position.

OBJECTIVE: Pneumocephalus is a well-known complication of surgical procedures performed with the patients placed in the sitting position. Its incidence and intensity were prospectively studied in 90 consecutive patients undergoing a posterior fossa procedure in this position. Various anesthetic agents, with different effects on cerebral hemodynamics, were used. MATERIAL AND METHODS: Patients were randomly assigned to one of three groups. In group 1 (n=30), anesthesia was induced and maintained with propofol. In group 2 (n=30), anesthesia was induced with thiopental and maintained with isoflurane. In group 3 (n=30), anesthesia was induced with thiopental and maintained with nitrous oxide and low-dose isoflurane. All patients received a load dose and an infusion of fentanyl. A cerebral computed tomography scan was performed to all patients 8 hours after surgery for detecting the presence and location of intracranial air. The size of pneumocephalus was ascertained using the formula for calculating the volume of a spheroid: v = PI / 6. x. y. z. Preoperative diagnosis, existence of shunted or non-shunted hydrocephalus, type and duration of the surgical procedure, detection of intraoperative venous air embolism, and appearance of new neurological symptoms in the postoperative period, were recorded. RESULTS: All patients included in the study developed postoperative pneumocephalus. There were no significant differences (P = 0.133) in the estimated volume of intracranial air between the groups (group 1, volume = 38.3 -/+ 35.4 ml; group 2, volume = 48.9 -/+ 36.3 ml; group 3, volume = 31.5 -/+ 28.4 ml). Only two patients in the group 2 manifested symptoms of neurological involvement due to the pressure exerted by the intracranial air. CONCLUSIONS: Despite the hypothetical diverse effects of the three anesthetic techniques used in this series on cerebral hemodynamics, our results suggest that none of them has a substantial effect on the amount of intracranial air detected after posterior fossa procedures performed in seated individuals. To the best of our knowledge this is the first report that addresses in a prospective manner the effects of several habitual anesthetic techniques on the development of pneumocephalus in patients submitted to posterior fossa procedures performed in the sitting position.

Adolescent↗
PubMed2003

Inflammatory C2-3 subluxation: a Grisel's syndrome variant.

The concurrence of non-traumatic atlanto-axial subluxation with inflammation of the adjacent neck tissues is known as Grisel's syndrome. We report a 5 year old boy with recurring episodes of head tilt and painful and restricted neck movements that developed after repeated bouts of sinusitis. Radiographs showed a subluxation of the C2-3 joint. Medical treatment, with cervical collar, physiotherapy, and non-steroid anti-inflammatory agents, led to complete cure of the disease. We suggest that Grisel's syndrome can occur in a location different from the classic atlanto-axial joint. To the best of our knowledge, this is the first report of a symptomatic case of Grisel's syndrome occurring at the C2-3 segment.

Atlanto-Axial Joint↗
PubMed2002

Nasal cerebral heterotopia: nasal atretic cephalocele.

We report the case of a 4-year-old boy who presented with a congenital mass on the bridge of his nose. A magnetic resonance study failed to rule out a communication of the tumor with the cranial cavity. The lesion was totally removed. Histopathological study of the excised mass showed a peripheral zone of fibrous-connective tissue with a core of glial and neuronal elements. We discuss the origin of these masses and their relation to nasal cephaloceles. We suggest that this type of lesions should be included within the broader spectrum of atretic cephaloceles.

Child, Preschool↗
PubMed2002

Medulloblastomas in neurofibromatosis type 1. Case report and literature review.

A 6-year-old girl, previously diagnosed with neurofibromatosis type 1 (NF-1) presented with ataxia and symptoms of raised intracranial pressure. Diagnostic work up disclosed a posterior fossa tumor. Histopathological study of the excised neoplasm showed a cerebellar medulloblastoma. We review the current literature and suggest that the association of medulloblastoma with NF-1 is not a chance occurrence, and that it might be pathogenically related. We propose that medulloblastoma should be added to the list of malignancies that are apt to occur in NF-1.

Ataxia↗
PubMed2001

Air-gun pellet injuries to the head and neck in children.

Air-gun pellet injuries to the head and neck are seldom reported in pediatric practice, although they typically occur in children. The adult skeleton stops these projectiles, but they can easily transverse the thin bones of children. If unnoticed, these apparently trivial injuries may have catastrophic consequences. We report three children who sustained a central nervous system injury resulting from a shot by a compressed-air gun. The true nature and extent of the lesion in two infants was established only by neuroradiological investigations. We also briefly review the management and prevention of this type of injury.

Adolescent↗
PubMed2001

[Latex allergy in patients with spina bifida: prevention and treatment].

Latex allergy has become a health problem of growing interest due to the severe clinical manifestations it may produce. Previous reports indicate a prevalence of latex allergy in patients with spina bifida (SB) ranging between 10% and 73%. From the initial surgical repair of the myelomeningocele, children with SB are submitted to multiple surgeries due to the neurologic, orthopedic and urologic problems they may present. Consequently, these children are exposed to several latex-containing products during their multiple interventions. Several reports indicate that latex allergy in SB children is related to age, and especially to the number of operations that they are given, and perhaps to an unknown genetic predisposition. Accordingly, latex allergy manifestations can be prevented. In this connection, we have elaborated at our hospital protocols for the management of the three clinical situations in which these patients can present. These measures include: (1) To avoid using latex-containing products since the birth of children with SB. (2) In children already operated of myelomeningocele but without evidence of latex allergy, to prevent the use of latex materials during their successive admissions to hospital and during further surgeries. And (3) In children known to have developed latex allergy, to dispose of especial nursing measures and of a latex-free operating room. The preventive measures that have been started at our Hospital are easy to carry out, do not suppose a high economic cost, and are not uncomfortable for the hospital's staff.

Child↗
PubMed2001

Intravenous administration of propacetamol reduces morphine consumption after spinal fusion surgery.

We sought to determine the analgesic efficacy, opioid-sparing effects, and tolerability of propacetamol, an injectable prodrug of acetaminophen, in combination with morphine administered by patient-controlled analgesia (PCA) after spinal fusion surgery. Forty-two patients undergoing spinal stabilization surgery were randomized into two groups, which were given either an IV placebo or an IV injection of 2 g propacetamol every 6 h for 3 days after surgery. The postoperative opioid analgesic requirement was assessed with a PCA device used to self-administer morphine. Pain relief was evaluated by a visual analog pain scale and by verbal rating scores of pain relief at 8-h intervals for up to 72 h after surgery. The cumulative dose of morphine at 72 h was smaller in the Propacetamol group than in the Placebo group (60.3 +/- 20.5 vs 112.2 +/- 39.1 mg; P < 0.001). The pain scores were significantly lower in the Propacetamol group measured at two intervals of the study, although visual analog scale pain intensity scores were smaller than 3 in both groups. Most patients in the Placebo group obtained a greater degree of sedation on postoperative Day 3 (P < 0.05). This study demonstrates the usefulness of propacetamol as an adjunct to PCA morphine in the treatment of postoperative pain after spinal fusion.

Acetaminophen↗
PubMed2001

Rocuronium-induced neuromuscular blockade is affected by chronic phenytoin therapy.

Patients receiving chronic anticonvulsant therapy have been reported to show resistance to certain nondepolarizing neuromuscular blockers. In this study, the effects of chronic phenytoin therapy on the onset, duration, and recovery of rocuronium action was assessed. Thirty-six patients scheduled for various neurosurgical procedures were studied: 18 receiving chronic phenytoin therapy (Group I) and 18 controls (Group II). Rocuronium 0.6 mg/kg (2 x DE95) was administered after induction of general anesthesia with 4-6 mg/kg thiopental sodium and 3-5 microg/kg intravenous (IV) fentanyl. Maintenance anesthesia consisted of N2O in O2, 0.5% end-tidal isoflurane, and a fentanyl infusion. Neuromuscular block was monitored with acceleromyography of the adductor pollicis-brevis muscle by using a TOF-GUARD Biometer monitor (Biometer International A/S, Odense, Denmark). According to the amplitude of the first response of train-of-four, neither the lag time nor the onset time differed between the two groups. However, the recovery index was significantly shorter in patients chronically treated with phenytoin (mean recovery index: control group, 8.3 +/- 1.7 minutes; phenytoin group, 6.7 +/- 2.3 minutes; P < .05). In addition, the times of recovery to 10%, 25%, 75%, and 90% of the baseline response were also significantly shorter in the phenytoin group than in the control group. We conclude that the duration of action of rocuronium and the recovery index were affected by chronic phenytoin therapy.

Adult↗
PubMed2000

Ventriculopleural shunting with new technology valves.

Ventriculoperitoneal shunting constitutes the standard procedure for draining cerebrospinal fluid (CSF) in children with hydrocephalus. Ventriculoatrial and ventriculopleural shunting are alternative methods of CSF drainage, which have gained less acceptance. Ventriculopleural shunts are seldom used owing to justified fears of pneumothorax and symptomatic effusions of CSF. The addition of an antisiphon device to standard shunt systems seems to have prevented CSF pleural effusion. From 1988 to 1998, we treated each of six hydrocephalic children with a ventriculopleural shunt. In five cases we used new-technology valves designed to prevent the effects of siphoning with current differential pressure valves. Peritoneal adhesions, recent peritonitis, ascites, and obstruction of a previous ventriculoatrial shunt were the indications for pleural shunting. After a mean follow-up period of 2.5 years all shunts were functioning adequately. Only one patient showed transient symptoms of CSF overdrainage, which were corrected by up-grading the valve setting with the magnet. A late death was unrelated to the pleural shunting procedure. The use of valves of a new design designed to prevent overdrainage seems to account for the satisfactory outcomes observed in this series. We suggest that ventriculopleural shunting should be considered as the preferred alternative to peritoneal drainage in children with intra-abdominal adhesions or with a history of recent peritoneal infection.

Child↗