bluuebunny/crossref_metadata_2025 huggingface dataset:
Standardization of cerebrospinal fluid shunt valves in pediatric hydrocephalus: an analysis of cost, operative time, length of stay, and shunt failure
Authors: Berns Jessica , Priddy Blake , Belal Ahmed , Seibold R. Dianne , Zieles Kristin , Jea Andrew
Published: January 2021

OBJECTIVE

CSF shunts are the most common procedures performed in the pediatric neurosurgical population. Despite attempts in multiple studies, a superior shunt valve has never been shown. Because of this, the authors aim was to examine the impact of shunt valve standardization at their institution to determine if there is a difference in surgical cost, operative time, or short-term postoperative shunt failure.

METHODS

A retrospective analysis at the authors’ institution was performed for all new CSF diversion shunts, as well as shunt revisions requiring a new valve, or a new valve and at least a new proximal or distal catheter over a 1-year period (January 1, 2016, to December 31, 2016). After a period of transition, neurosurgeons were encouraged to use only one type of fixed-differential-pressure valve and one type of programmable valve when performing shunt surgeries. These patients who underwent “standardized” shunt surgery over a 1-year period (January 1, 2018, to December 31, 2018) were then compared to patients in the prestandardization epoch. All patients were followed for a 12-month period after surgery. Demographic information, surgical cost, operative time, and postoperative shunt failure data were collected in all patients in the study.

RESULTS

The authors analyzed 87 shunt surgeries in patients prior to standardization and 94 shunt surgeries in patients after standardization. The rate of violation of the standardized shunt valve policy after implementation was 5.3% (5 of 94 procedures). When comparing the prestandardization group to those who received the standardized valve, operative costs were less ($1821.04 vs $1333.75, p = 0.0034). There was no difference in operative times between groups (78 minutes vs 81 minutes, p = 0.5501). There was no difference in total number of shunt failures between the two groups at 12 months after surgery (p = 0.0859). The rate of postoperative infection was consistent with the literature at 8%.

CONCLUSIONS

In accordance with quality improvement principles, the reduction of unexplained clinical variance invariably leads to a decrease in cost and, more importantly, increased value. In this study, the implementation of a standardized shunt valve decreased operative cost. There were no differences in postoperative shunt failures at 12 months after surgery and no differences in length of surgery. Standardizing shunt valves in the treatment of pediatric hydrocephalus seems to be cost-effective and safe.
Survival, fusion, and hardware failure after surgery for spinal metastatic disease
Authors: Yee Timothy J. , Saadeh Yamaan S. , Strong Michael J. , Ward Ayobami L. , Elswick Clay M. , Srinivasan Sudharsan , Park Paul , Oppenlander Mark E. , Spratt Daniel E. , Jackson William C. , Szerlip Nicholas J.
Published: January 2021

OBJECTIVE

Decompression with instrumented fusion is commonly employed for spinal metastatic disease. Arthrodesis is typically sought despite limited knowledge of fusion outcomes, high procedural morbidity, and poor prognosis. This study aimed to describe survival, fusion, and hardware failure after decompression and fusion for spinal metastatic disease.

METHODS

The authors retrospectively examined a prospectively collected, single-institution database of adult patients undergoing decompression and instrumented fusion for spinal metastases. Patients were followed clinically until death or loss to follow-up. Fusion was assessed using CT when performed for oncological surveillance at 6-month intervals through 24 months postoperatively. Estimated cumulative incidences for fusion and hardware failure accounted for the competing risk of death. Potential risk factors were analyzed with univariate Fine and Gray proportional subdistribution hazard models.

RESULTS

One hundred sixty-four patients were identified. The mean age ± SD was 62.2 ± 10.8 years, 61.6% of patients were male, 98.8% received allograft and/or autograft, and 89.6% received postoperative radiotherapy. The Kaplan-Meier estimate of median survival was 11.0 months (IQR 3.5–37.8 months). The estimated cumulative incidences of any fusion and of complete fusion were 28.8% (95% CI 21.3%–36.7%) and 8.2% (95% CI 4.1%–13.9%). Of patients surviving 6 and 12 months, complete fusion was observed in 12.5% and 16.1%, respectively. The estimated cumulative incidence of hardware failure was 4.2% (95% CI 1.5–9.3%). Increasing age predicted hardware failure (HR 1.2, p = 0.003).

CONCLUSIONS

Low rates of complete fusion and hardware failure were observed due to the high competing risk of death. Further prospective, case-control studies incorporating nonfusion instrumentation techniques may be warranted.
Patient-specific prediction model for clinical and quality-of-life outcomes after lumbar spine surgery
Authors: Lubelski Daniel , Feghali James , Nowacki Amy S. , Alentado Vincent J. , Planchard Ryan , Abdullah Kalil G. , Sciubba Daniel M. , Steinmetz Michael P. , Benzel Edward C. , Mroz Thomas E.
Published: January 2021

OBJECTIVE

Patient demographics, comorbidities, and baseline quality of life (QOL) are major contributors to postoperative outcomes. The frequency and cost of lumbar spine surgery has been increasing, with controversy revolving around optimal management strategies and outcome predictors. The goal of this study was to generate predictive nomograms and a clinical calculator for postoperative clinical and QOL outcomes following lumbar spine surgery for degenerative disease.

METHODS

Patients undergoing lumbar spine surgery for degenerative disease at a single tertiary care institution between June 2009 and December 2012 were retrospectively reviewed. Nomograms and an online calculator were modeled based on patient demographics, comorbidities, presenting symptoms and duration of symptoms, indication for surgery, type and levels of surgery, and baseline preoperative QOL scores. Outcomes included postoperative emergency department (ED) visit or readmission within 30 days, reoperation within 90 days, and 1-year changes in the EuroQOL-5D (EQ-5D) score. Bootstrapping was used for internal validation.

RESULTS

A total of 2996 lumbar surgeries were identified. Thirty-day ED visits were seen in 7%, 30-day readmission in 12%, 90-day reoperation in 3%, and improvement in EQ-5D at 1 year that exceeded the minimum clinically important difference in 56%. Concordance indices for the models predicting ED visits, readmission, reoperation, and dichotomous 1-year improvement in EQ-5D were 0.63, 0.66, 0.73, and 0.84, respectively. Important predictors of clinical outcomes included age, body mass index, Charlson Comorbidity Index, indication for surgery, preoperative duration of symptoms, and the type (and number of levels) of surgery. A web-based calculator was created, which can be accessed here: https://riskcalc.org/PatientsEligibleForLumbarSpineSurgery/.

CONCLUSIONS

The prediction tools derived from this study constitute important adjuncts to clinical decision-making that can offer patients undergoing lumbar spine surgery realistic and personalized expectations of postoperative outcome. They may also aid physicians in surgical planning, referrals, and counseling to ultimately lead to improved patient experience and outcomes.
Cerebrospinal fluid biomarkers of glial and axonal injury in cervical spondylotic myelopathy
Authors: Tsitsopoulos Parmenion P. , Holmström Ulrika , Blennow Kaj , Zetterberg Henrik , Marklund Niklas
Published: January 2021

OBJECTIVE

Degenerative cervical spondylotic myelopathy (CSM) is a major cause of spinal cord dysfunction with an unpredictable prognosis. Βiomarkers reflecting pathophysiological processes in CSM have been insufficiently investigated. It was hypothesized that preoperative cerebrospinal fluid (CSF) biomarker levels are altered in patients with CSM and correlate with neurological status and outcome.

METHODS

CSF biomarkers from patients with CSM and controls were analyzed with immunoassays. Spinal cord changes were evaluated with MRI. The American Spinal Cord Injury Association Impairment Scale, the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), and the EQ-5D questionnaire were applied prior to and 3 months after surgery. A p value < 0.05 was considered statistically significant.

RESULTS

Twenty consecutive CSM patients with a mean age of 67.7 ± 13 years and 63 controls with a mean age of 65.2 ± 14.5 years (p > 0.05) were included in the study. In the CSM subjects, CSF neurofilament light subunit (NF-L) and glial fibrillary acidic protein (GFAP) concentrations were higher (p < 0.05), whereas fatty acid–binding protein 3 (FABP3), soluble amyloid precursor proteins (sAPPα and sAPPβ), and amyloid β (Aβ) peptide (Aβ38, Aβ40, and Aβ42) concentrations were lower than in controls (p < 0.05). Aβ peptide levels correlated positively with symptom duration. Preoperative JOACMEQ lower extremity function and CSF NF-L levels correlated positively, and the JOACMEQ bladder function correlated negatively with sAPPα and sAPPβ (p < 0.05). CSF NF-L and FABP3 levels were higher in patients with improved outcome (EQ-5D visual analog scale difference > 20).

CONCLUSIONS

CSF biomarkers of glial and axonal damage, inflammation, and synaptic changes are altered in symptomatic CSM patients, indicating that axonal injury, astroglial activation, and Aβ dysmetabolism may be present in these individuals. These findings reflect CSM pathophysiology and may aid in prognostication. However, future studies including larger patient cohorts, postoperative biomarker data and imaging, and longer follow-up times are required to validate the present findings.
Intrathecal baclofen therapy for Lesch-Nyhan disease: illustrative case
Authors: Satow Takeshi , Ogawa Masafumi , Komuro Taro
Published: January 2021

BACKGROUND

Lesch-Nyhan disease (LND) is a very rare metabolic disorder involving the purine salvage pathway. LND manifests hyperuricemia, self-mutilation, cognitive impairment, and movement disorders such as spasticity and dystonia, whose control is difficult pharmaceutically.

OBSERVATIONS

Intrathecal baclofen (ITB) therapy was received by a 22-year-old male for generalized dystonia. His paroxysmal abnormal dystonic posturing reduced after surgery, making the task of caregivers easier despite the unchanged assignment on the dystonia scale during a follow-up period of 4 years.

LESSONS

ITB may be a safe and feasible option for dystonic symptoms and difficulty with nursing care in patients with LND.
The recurrent plexiform neurofibroma of the scalp in neurofibromatosis type 1: illustrative case
Authors: Permana Galih Indra , Parenrengi M. Arifin , Suryaningtyas Wihasto , Fauziah Dyah , Azzam Muhammad
Published: January 2021

BACKGROUND

Plexiform neurofibroma is a benign tumor of the peripheral nerves. It is an unusual variant of neurofibroma originating from all parts of the nerve. Plexiform neurofibroma is primarily pathognomonic and exhibits an unusual variant from neurofibromatosis type 1 (NF1). The possibility of malignancy and recurrence are the main reasons for long-term, close follow-up.

OBSERVATIONS

The authors report a case of a 14-year-old girl with a recurrent plexiform neurofibroma derived from the peripheral nerves, which also presented with a typical sign of NF1 disease. The aim of the tumor resection is symptomatic relief.

LESSONS

Accomplishing a good outcome can be related to good perioperative planning and a precise operative procedure. The result of anatomical pathology determines the prognosis of the patient. Clinical examination and radiological studies are needed to evaluate the recurrence of complications after surgical procedures.
Diplopia associated with loop routing in deep brain stimulation: illustrative case
Authors: Miyagi Yasushi , Urasaki Eiichirou
Published: January 2021

BACKGROUND

Deep brain stimulation (DBS) is a powerful surgical option for drug-resistant movement disorders; however, electromagnetic interference (EMI) from external sources poses a potential risk for implanted electronics.

OBSERVATIONS

A 61-year-old woman with Parkinson’s disease originally had two implantable pulse generators (IPGs) for bilateral subthalamic DBS, which were then replaced with one dual-channel IPG routed in a loop. After the replacement surgery, with the same DBS programming as before the IPG replacement (bipolar setting for right, unipolar setting for left), the patient began to complain of transient paroxysmal diplopia. After multiple attempts to adjust the stimulation parameters, the diplopia was resolved by changing the left unipolar setting to a bipolar setting. At the authors’ institution, before the present case, four other patients had undergone IPG replacement with loop routing. None of these previous patients complained of diplopia; however, two of the four presented with diplopia in an experimental unipolar setting.

LESSONS

Clinicians should be aware that loop-routed circuits may generate distortion of the stimulus field in DBS, even in the absence of external EMI sources.
Cryptogenic cervical intramedullary abscess with rapidly progressive myelopathy: illustrative case
Authors: Warsi Nebras M. , Wilson Ann , Malhotra Armaan K. , Ku Jerry C. , Najjar Ahmed A. , Bui Esther , Baker Michael , Bartlett Eric , Hodaie Mojgan
Published: January 2021

BACKGROUND

The purpose of the present case report is to highlight the presentation, workup, clinical decision making, and operative intervention for a 68-year-old woman who developed rapidly progressive myelopathy secondary to idiopathic cervical intramedullary abscess.

OBSERVATIONS

The patient underwent laminectomy and aspiration/biopsy of the lesion. Intraoperatively, division of the posterior median sulcus released a large volume of purulent material growing the oral pathogens Eikenella corrodens and Gemella morbillorum. Broad-spectrum antibiotics were initiated postoperatively. At the 6-month follow-up, the patient had almost completely recovered with some persistent hand dysesthesia. Complete infectious workup, including full dental assessment and an echocardiogram, failed to reveal the source of her infection.

LESSONS

The authors report the first case of cryptogenic spinal intramedullary abscess secondary to Eikenella spp. and Gemella spp. coinfection. Intramedullary abscesses are exceptionally rare and most commonly develop in children with dermal sinus malformations or in the context of immunosuppression. In adults without risk factors, they can readily be mistaken for more common pathologies in this age group, such as intramedullary neoplasms or demyelinating disease. Prompt diagnosis and management based on rapidly progressive myelopathy, assessment of infectious risk factors and/or symptoms, and targeted imaging are critical to avoid potentially devastating neurological sequelae.
Decompression surgery for pure arterial malformations in a 15 year old with acute, progressive visual impairment: illustrative case
Authors: Iwaki Katsuma , Arimura Koichi , Nishimura Ataru , Iihara Koji
Published: January 2021

BACKGROUND

The authors document the first case of pure arterial malformations (PAMs) of the posterior communicating artery (PCoA), which were successfully treated with microsurgical clipping of the main body of the PAMs. PAMs are defined as dilated, overlapping, and tortuous arteries with a coil-like appearance and/or a mass of arterial loops without any associated venous component. Although PAMs usually have a benign history and are often incidental findings, this case presented with acute progression of visual field impairment.

OBSERVATIONS

Because the patient’s right optic tract was affected by the loop of PAMs of the PCoA, the authors performed microsurgical clipping of the main body of the PAMs using endoscopy, which ceased the progression of symptoms without any complications.

LESSONS

There have been several reports of PAMs receiving surgical treatment for accompanying lesions. However, in this case, the lesion to the main body of PAMs was the cause of visual field impairment and was successfully treated with microsurgical clipping.
Validation of the newly conceived Surgical Swedish ICH grading scale for surgically treated patients with intracerebral hemorrhage: patient series
Authors: Haga Johan A. , Poulsen Frantz R. , Forsse Axel
Published: January 2021

BACKGROUND

The authors sought to externally validate a newly developed clinical grading scale, the Surgical Swedish ICH (SwICH) score. Patients surgically treated for spontaneous supratentorial intracerebral hemorrhage (ICH) from 2009 to 2019 in a single center in Denmark were identified. Data were retrospectively collected from patient records and neuroimaging. Surgical SwICH and ICH scores were calculated for each patient, and the validity of the Surgical SwICH was assessed and compared.

OBSERVATIONS

The 126 patients included had an overall 30-day mortality rate of 23%. All patients with a Surgical SwICH score of 0 survived past one year. No patient scored the maximum Surgical SwICH score of 6. The 30-day mortality rates for Surgical SwICH scores 1, 2, 3, and 4 were 0%, 20%, 53%, and 25%, respectively (p <0.0001 for trend). Mortality rates for ICH scores 1, 2, 3, and 4 were 0%, 11%, 33%, and 76%, respectively (p <0.001 for trend). Receiver operator characteristics showed an area under curve of 0.78 for the Surgical SwICH score and 0.80 for the ICH score (p = 0.21 difference).

LESSONS

The Surgical SwICH score was a good predictor of 30-day mortality in patients surgically treated for spontaneous supratentorial ICH. However, the Surgical SwICH score did not outperform the previously established ICH score in predicting 30-day mortality.
Secondary Chiari malformation due to enlarged spinal arachnoid villi–like structure: illustrative case
Authors: Koyanagi Izumi , Chiba Yasuhiro , Imamura Hiroyuki , Yoshino Masami , Aida Toshimitsu
Published: January 2021

BACKGROUND

Secondary Chiari malformation can be caused by various disorders associated with cerebrospinal fluid (CSF) leakage at the spinal level. In this report, the authors describe a rare case of secondary Chiari malformation caused by excessive CSF absorption through the enlarged spinal arachnoid villi–like structure.

OBSERVATIONS

A 20-year-old woman presented with progressive severe headache and posterior neck pain. Magnetic resonance imaging showed tonsillar herniation and decreased subarachnoid space around the spinal cord. A hypointense signal area was observed in the ventral spinal canal on a T2-weighted image. An axial image revealed multiple small, arachnoid cyst–like structures at the right T1 nerve root sleeve. Direct surgery revealed that the cyst-like structures were continuous with the arachnoid membrane and protruded into the abnormally large epidural venous sinus. The cyst-like structures were resected, and the dural sleeve was repaired using fascia. The patient showed good improvement of symptoms after surgery.

LESSONS

Excessive CSF absorption through the enlarged spinal arachnoid villi–like structure can cause secondary Chiari malformation. Neurosurgeons should be aware of this unusual mechanism of CSF leakage. Simple posterior fossa decompression will be ineffective or even harmful.
Rapid contrast-induced encephalopathy after a small dose of contrast agent: illustrative case
Authors: Zhao Zhouyang , Huang Lijin , Chen Jinhua , Zhu Hongshen
Published: January 2021

BACKGROUND

Contrast-induced encephalopathy is a rare complication of cerebral angiography with only few cases reported to date. This paper reports on contrast-induced encephalopathy mimicking meningoencephalitis following cerebral angiography with iopromide, a subhypertonic nonionic contrast agent.

OBSERVATIONS

A 50-year-old woman underwent cerebral angiography for assessment of recurrent nasopharyngeal carcinoma with invasion of internal carotid artery. The patient experienced symptoms including a disturbance of consciousness, seizures, frequent blinking, and stiffness in the extremities immediately after angiography of the left common carotid artery using iopromide (4 ml/s, total 6 ml). Computed tomography scans of the brain showed no obvious abnormalities, whereas brain magnetic resonance imaging showed swelling of the left cerebral cortex without signs of ischemia or hemorrhage. The patient was treated with intravenous rehydration, mannitol dehydration, and other supportive treatment. With this treatment, neurological status progressively improved, with complete resolution of symptoms at day 10.

LESSONS

This observation highlights that even a small dose of subhypertonic nonionic contrast agent can rapidly induce contrast encephalopathy.
Endoscopic third ventriculostomy for VP shunt malfunction during the third trimester of pregnancy: illustrative case
Authors: Alhaj Ahmad K. , Al-Saadi Tariq , Hébert-Blouin Marie-Noëlle , Petrecca Kevin , Dudley Roy W. R.
Published: January 2021

BACKGROUND

Endoscopic third ventriculostomy (ETV) is a successful procedure for treating noncommunicating hydrocephalus as an alternative to initial ventriculoperitoneal (VP) shunt placement and as a salvage procedure when a VP shunt fails. Physiological changes of pregnancy can lead to VP shunt failure and complicate the management of shunt malfunction, particularly in the third trimester.

OBSERVATIONS

The authors present a case in which an ETV was successfully used in the third trimester (31 weeks of gestation) of pregnancy for acute hydrocephalus due to VP shunt malfunction, and the patient went on to deliver a healthy baby at term; the patient remained well in the long-term follow-up. An English-language PubMed literature review revealed four cases of VP shunt failure successfully treated with an ETV in the first or second trimester but no such reports in the third trimester of pregnancy.

LESSONS

ETV appears to be a safe and effective alternative to VP shunt replacement in the late prenatal period of pregnancy.
Spinal intramedullary hemangioblastoma and schwannoma collision tumor: illustrative case
Authors: Neal Matthew T. , Richards Alexandra E. , Curley Kara L. , Donev Kliment , Lyons Mark K. , Kalani Maziyar A.
Published: January 2021

BACKGROUND

Intramedullary spinal cord tumors represent a minority of intradural tumors. Among intramedullary spinal cord tumors, hemangioblastomas are uncommon, and schwannomas are extremely rare. Collision tumors are histologically distinct tumors that are intermingled and growing together.

OBSERVATIONS

In this report, the authors describe a patient with a cervical intramedullary collision tumor involving a hemangioblastoma and schwannoma. To the authors’ knowledge, no prior spinal intramedullary collision tumor involving multiple neoplasms has been described. The patient’s presentation and management are described.

LESSONS

Clinicians should consider the possibility of collision tumors when evaluating intramedullary spinal cord tumors, especially when patient presentation and radiographic findings are atypical. When tumors with similar radiographic characteristics form collision tumors, distinction using preoperative imaging can be extremely challenging. In addition, surgical management of intramedullary collision tumors, like that for all intramedullary spinal cord tumors, should involve meticulous perioperative care and a methodical surgical technique. Maximal safe resection will depend upon histopathological diagnosis, anatomical location of the tumor, presence of distinct dissection planes, and stability of neuromonitoring. Finally, ongoing research on the genetics of intramedullary spinal cord tumors may identify underlying genetic links for intramedullary hemangioblastomas and schwannomas.
Negative-pressure hydrocephalus in the course of a complex postoperative intracranial pressure disturbance: illustrative case
Authors: Suzuki Tomoya , Kaku Shogo , Karagiozov Kostadin , Murayama Yuichi
Published: January 2021

BACKGROUND

Negative-pressure hydrocephalus (NePH) is a rare clinical entity that presents on the background of ventriculomegaly with atypical symptoms. Its diagnosis is difficult, and some patients experience several shunt revisions until the proper solution is found.

OBSERVATIONS

The authors present a patient who developed acute deterioration due to iatrogenic NePH after surgery for a vertebral artery thrombosed giant aneurysm. The deterioration occurred after the insertion of a lumbar drain by which the authors intended to reduce a postoperative subcutaneous cerebrospinal fluid (CSF) collection. The drainage created an unexpected negative-pressure gradient in the CSF spaces, which resulted in NePH. Interventions, such as extraventricular drainage and blood patch, corrected the negative transmantle pressure and stabilized the patient’s condition.

LESSONS

Because the pathophysiology of NePH is theoretically considered to be caused by negative transmantle pressure, the intervention should be performed in order to deal with the coexistence of obstruction in the CSF pathways and a CSF leak. A blood patch would be an effective option in treating the CSF leak when the site of leakage is certain. This is the first case in which a blood patch was effectively applied in the treatment for NePH with a favorable outcome without any permanent CSF diversion.
Utility of Pipeline embolization device for emergency recanalization of a dissecting carotid tonsillar loop: illustrative cases
Authors: Akamatsu Yosuke , Gomez-Paz Santiago , Moore Justin M. , Ogilvy Christopher S. , Thomas Ajith J.
Published: January 2021

BACKGROUND

Cervical arterial tortuosity is not uncommon in patients with spontaneous carotid artery dissections (CADs), but the tortuosity often precludes endovascular stent reconstruction. The authors report 2 cases of emergency recanalization of a carotid tonsillar loop dissection using a Pipeline embolization device (PED).

OBSERVATIONS

Two patients presented with symptomatic CAD involving tonsillar looping of the cervical internal carotid artery (ICA). Although the tonsillar loop prevented navigation of the carotid and peripheral stent delivery system, a PED was easily navigated and successfully deployed, resulting in successful recanalization of a looped ICA.

LESSONS

Emergency recanalization of a cervical CAD using a PED is a feasible alternative for treating a cervical CAD associated with tonsillar loops.
Simultaneous intracranial and testicular germ cell tumors: illustrative case
Authors: Han Lei , Lu Jie , Fang Luxiong , Qi Songtao , Song Ye
Published: January 2021

BACKGROUND

Simultaneous intracranial and testicular germ cell tumors (GCTs) are extremely rare, leading to a lack of adequate experience in their treatment. Therefore, the authors report a case of this kind of GCT.

OBSERVATIONS

A 5-year-old boy was admitted to the hospital with headache and vomiting. Computed tomography and magnetic resonance imaging suggested the possibility of a GCT in the pineal region. The value of the serum tumor marker alpha-fetoprotein (AFP) was 5,396.1 μg/L, and β-human chorionic gonadotropin levels were within the normal range. Subsequently, the tumor was removed, and the final pathological result was a mixed GCT. Therefore, chemotherapy and radiation were added. However, the authors found a testicular tumor on ultrasound at the same time, and pathology after surgery suggested a mature cystic teratoma. Following treatment, the patient recovered well, and AFP levels dropped to normal values.

LESSONS

To the authors’ knowledge, this report is the fourth case of simultaneous intracranial and testicular GCTs and the first case of a simultaneous mixed GCT in the pineal region and mature teratoma of the testis. A combination of surgery, chemotherapy, and radiation therapy for mixed GCTs in the pineal region and surgical excision for testicular reproductive cell tumors are effective in these patients, but long-term monitoring is required.
Functional neurological disorders in patients undergoing spinal surgery: illustrative case
Authors: Yerneni Ketan , Wadhwa Harsh , Fatemi Parastou , Zygourakis Corinna C.
Published: January 2021

BACKGROUND

“Conversion disorder” refers to bodily dysfunction characterized by either sensory or motor neurological symptoms that are unexplainable by a medical condition. Given their somatosensory context, such disorders often require extensive medical evaluation, and the diagnosis can only be made after structural disease is excluded or fails to account for the severity and/or spectrum of the patient’s deficits.

OBSERVATIONS

The authors briefly review functional psychiatric disorders and discuss the comprehensive workup of a patient with a functional postoperative neurological deficit, drawing from their recent experience with a patient who presented with conversion disorder immediately after undergoing anterior cervical discectomy and fusion.

LESSONS

Conversion disorder has been found to be associated with bodily stress, requiring surgeons to be aware of this condition in the postoperative setting. This is especially true in neurosurgery, given the overlap of true neurological pathology, postoperative complications, and manifestations of conversion disorder. Although accurately diagnosing and managing patients with conversion disorder remains challenging, an understanding of the multifactorial nature of its etiology can help clinicians develop a methodical approach to this condition.
Acute pulmonary edema due to occult air embolism detected on an automated anesthesia record: illustrative case
Authors: Wood Samuel , Fuzaylov Gennadiy
Published: January 2021

BACKGROUND

The authors report a case of venous air embolism (VAE) during a pediatric posterior fossa craniotomy with resulting pulmonary edema requiring postoperative ventilation. Pulmonary edema is a known but rare complication of VAE, and diagnosis and treatment are discussed.

OBSERVATIONS

The embolism was undetected during the surgical procedure, and the first clinical sign of respiratory decompensation appeared an hour after the initial insult, with imaging suggesting acute pulmonary edema. A transient but significant end-tidal carbon dioxide decrease was detected on postoperative review of the anesthesiology record.

LESSONS

This report highlights an uncommon sequela of VAE and the importance of post hoc automated record review for intraoperative event analysis.
Asymptomatic rotational vertebral artery compression in a child due to head positioning for cranial surgery: illustrative case
Authors: Caton M. Travis , Narsinh Kazim , Baker Amanda , Abla Adib A. , Roland Jarod L. , Halbach Van V. , Fox Christine K. , Fullerton Heather J. , Hetts Steven W.
Published: January 2021

BACKGROUND

The authors recently reported a series of children with vertebral artery (VA) compression during head turning who presented with recurrent posterior circulation stroke. Whether VA compression occurs during head positioning for cranial surgery is unknown.

OBSERVATIONS

The authors report a case of a child with incidental rotational occlusion of the VA observed during surgical head positioning for treatment of an intracranial arteriovenous fistula. Intraoperative angiography showed dynamic V3 occlusion at the level of C2 with distal reconstitution via a muscular branch “jump” collateral, supplying reduced flow to the V4 segment. She had no clinical history or imaging suggesting acute or prior stroke. Sequential postoperative magnetic resonance imaging scans demonstrated signal abnormality of the left rectus capitus muscle, suggesting ischemic edema.

LESSONS

This report demonstrates that rotational VA compression during neurosurgical head positioning can occur in children but may be asymptomatic due to the presence of muscular VA–VA “jump” collaterals and contralateral VA flow. Although unilateral VA compression may be tolerated by children with codominant VAs, diligence when rotating the head away from a dominant VA is prudent during patient positioning to avoid posterior circulation ischemia or thromboembolism.
A case of brain metastasis with pathological transformation of long-surviving malignant pleural mesothelioma: illustrative case
Authors: Noda Ryuichi , Yanagisawa Shunsuke , Inoue Masato , Hara Tetsuo
Published: January 2021

BACKGROUND

Malignant pleural mesothelioma (MPM) is a rare cancer, and in 80% of cases the cause is asbestos exposure. In 1972, the World Health Organization (WHO) declared asbestos is a carcinogenic substance. Since then, every developed country has restricted and banned the product. Because of its high heat resistance, asbestos had been widely used as building material for decades. The WHO estimated that approximately 125 million people are exposed to asbestos, and more than 107,000 die from asbestos-related diseases annually. Because of its long incubation period, the number of patients is estimated to keep increasing in the near future.

OBSERVATIONS

The authors report a case of long-surviving MPM with a rushed clinical course after brain metastasis. A 69-year-old woman diagnosed with MPM (epithelial type) 6 years earlier presented with a brain metastasis. The pathological result of the brain metastasis was the sarcomatoid type. This case showed the possibility of subtype transition after long survival.

LESSONS

This article aids in understanding the long-term natural history of MPM and the possibility of epithelial-mesenchymal transition. Neurosurgeons have to be aware of its the natural history and the possibility of brain metastasis.
Pengaruh Polivinilpirolidon sebagai Polimer Mukoadhesif terhadap Sifat Fisik Patch Ekstrak Kulit Buah Delima (Punica granatum L.)
Authors: Wahid Rahmat A Hi
Published: January 2021

ABSTRAKBuah delima (Punica granatum L.) secara empiris digunakan untuk mengobati masalah gigi dan mulut seperti sariawan. Pengembangan obat sariawan berbasis herbal dengan bentuk sediaan patch dilakukan untuk mempertahankan waktu kontak antara zat aktif dengan bagian sariawan. Polivinilpirolidon (PVP) digunakan sebagai polimer karena sifatnya mukoadhesif sehingga mampu berikatan pada mukosa mulut. Penelitian ini bertujuan untuk mengetahui pengaruh penggunaan PVP sebagai polimer mukoadhesif terhadap karakteristik fisik sediaan patch yang mengandung ekstrak kulit buah delima (EKBD). EKBD diperoleh dengan metode maserasi. Konsentrasi EKBD yang digunakan adalah 5% dan 10%. Sedangkan konsentrasi polimer PVP yang digunakan yaitu 30,29%, 33,04, 48,75%, dan 65,5%. Patch selanjutnya akan di evaluasi fisik yang meliputi keseragaman bobot dan dimensi ketebalan, pH permukaan, swelling, daya lekat, dan waktu lekat. Hasil menunjukkan bahwa patch yang mengandung ekstrak 10% dengan tambahan polimer konsentrasi 30,29% memiliki sifat yang cukup elastis disbanding dengan konsentrasi 48,75% dan 65,5%. Sedangkan uji evaluasi fisik menghasilkan keseragaman bobot dan dimensi yang seragam, pH 6,63, rata-rata indeks swelling 40,69% ± 16, dan rata-rata daya dan waktu lekat 13,50 ± 11,6. Dengan demikian dapat disimpulkan bahwa konsentrasi PVP terbukti berpengaruh pada sifat fisik patch yang dihasilkan. Kata kunci : Polivinilpirolidon; Ekstrak Kulit Buah Delima; Patch.ABSTRACTPomegranate (Punica granatum L.) is empirically used to treat dental and mouth problems such as reccurent aphthous stomatitis (RAS). The development of RAS  therapy based on herbal with patches dosage forms is carried out to maintain the contact time between the active substance and the RAS. Polyvinylpyrrolidone (PVP) is used as a polymer because it is mucoadhesive, so it can bind to the oral mucosa. Aimed to determine the effect of the use of PVP as a mucoadhesive polymer on the physical characteristics of patches preparations containing pomegranate peel extract (PPE). PPE was obtained by maceration method. The PPE concentration used were 5% and 10%. PVP concentration used were 30.29%, 33.04%, 48.75%, and 65.5%. The patches properties such as uniformity of thickness, pH, swelling index, tensile and mucoadhesive strength. The results showed that patches containing 10% extract and PVP concentration of 30.29% had sufficient elastic properties compared to both concentration. While the physical evaluation test obtained uniform weights and dimensions that are uniform, pH 6.63, the average swelling index is 40.69% ± 16, and the tensile and mucoadhesive strength is 13.50 ± 11.6. Altogether, the concentration of PVP is proven to affect the physical properties of the resulting patch.Key word : Polyvinylpyrrolidone; Pomegranate Peel Extract; Patch.
Evaluasi Penerapan Standar Pelayanan Kefarmasian di Puskesmas Tanjung Karang
Authors: Oktaviani Nur
Published: January 2021

ABSTRAKPelayanan kefarmasian di puskesmas merupakan satu kesatuan yang tidak terpisahkan dari pelaksanaan upaya kesehatan yang berperan penting dalam meningkatkan mutu pelayanan kesehatan bagi masyarakat, khususnya di bidang kefarmasian Penelitian ini bertujuan untuk mengetahui evaluasi penerapan standar pelayanan kefarmasian di Puskesmas Tanjung Karang. Penelitian ini termasuk penelitian deskriptif, pengambilan data dengan menggunakan pendekatan cross sectional, instrumen dalam penelitian ini adalah kuesioner yang bersumber dari Peraturan Menteri Kesehatan No 74 Tahun 2016 tentang standar pelayanan kefarmasian di Puskesmas. Responden dalam penelitian ini adalah petugas farmasi dan pasien rawat jalan di puskesmas Tanjung Karang.  Hasil penelitian yaitu kegiatan pengelolaan obat dan bahan medis habis pakai sebesar 90%, Peralatan dan fasilitas pendukung sebesar 87,5%, pelayanan informasi obat sebesar 100%, dan sumber daya manusia sebesar 100%.Yang menunjukkan bahwa evaluasi penerapan standar pelayanan kefarmasian di Puskesmas Tanjung Karang berdasarkan Indikator-Indikator pelayanan farmasi sudah di laksanakan dengan baik dengan nilai rata-rata sebesar 94,37%.Kata kunci : Evaluasi; Pelayanan Kefarmasian; Puskesmas Tanjung Karang.ABTRACT :Pharmaceutical services in health centers are an integral part of the implementation of health efforts that play an important role in improving the quality of health services for the community, especially in the field of pharmacy. This study aims to determine the evaluation of the implementation of pharmaceutical service standards at the Tanjung Karang Puskesmas. This research is a descriptive study, data collection using a cross-sectional approach, the instrument in this study is a questionnaire which is sourced from the Minister of Health Regulation No. 74 of 2016 concerning the standard of pharmaceutical services at Puskesmas. Respondents in this study were pharmacy officers and outpatients at Tanjung Karang Public Health Center. The results of the study were the management of drugs and consumable medical materials by 90%, equipment and supporting facilities at 87.5%, drug information services at 100%, and human resources at 100%, which showed that the evaluation of the implementation of pharmaceutical service standards at the Puskesmas Tanjung Karang based on indicators of pharmaceutical services has been implemented well with an average value of 94.37%.Keywords : Evaluation; Pharmaceutical Services; Puskesmas Tanjung Karang.
Penetapan Kadar Fenolik Total Ekstrak Kacang Panjang (Vigna unguiculata) dengan Metode Spektrofotometri UV-Visible
Authors: Dewantara Lalu Aang Robby , Ananto Agus Dwi , Andayani Yayuk
Published: January 2021

ABSTRAKKacang panjang (Vigna unguiculata) merupakan salah satu tanaman yang berpotensi sebagai antioksidan karena mengandung metabolit sekunder hampir di seluruh bagian tanamannya, seperti pada daging buahnya. Penelitian ini bertujuan untuk menentukan kadar fenolik total ekstrak etanol dan ekstrak air daging buah kacang panjang dengan metode spektrofotometri UV-Visible. Sampel daging buah kacang panjang dimaserasi menggunakan dua pelarut berbeda, yaitu pelarut etanol 96% dan pelarut air. Analisis kadar fenolik total dilakukan dengan metode spektrofotometri UV-Visible. Kadar fenolik total dinyatakan dalam gallic acid equivalent (GAE). Hasil analisis menunjukkan bahwa kadar fenolik total ekstrak etanol kacang panjang sebesar 40,4173 ± 4.2303 mg GAE/g dan kadar fenolik total ekstrak air kacang panjang sebesar 60.6062 ± 2,8533 mg GAE/g. Ekstrak etanol dan ekstrak air dari daging buah kacang panjang berpotensi sebagai antioksidan dilihat dari parameter kadar fenolik totalnya. Berdasarkan hasil penelitian, diperoleh bahwa kadar fenolik total ekstrak air lebih tinggi dibandingkan ekstrak etanol daging buah kacang panjang. Kata kunci : Kacang panjang (Vigna unguiculata); Spektrofotometri UV-Visible; Kadar fenolik total.ABSTRACTCowpea (Vigna unguiculata) is one of the vegetables that have antioxidant potential due to it contains some secondary metabolites that scattered on every part of the Cowpea, such as the pod coat. The aimed of this study was to determine total phenolic content of Cowpea pod coat ethanolic extract and aqueous extract using UV-Vis spectrophotometry method. Cowpea pod coats were macerated using two different solvents, ethanol 96%, and aqueous.  Total phenolic content was showed as gallic acid equivalent (GAE). The analysis results showed that total phenolic content of ethanol extract of cowpea was 40,41732 ± 4.2303 mg GAE/g and total phenolic content of aqueous extract of cowpea was 60.6062 ± 2,8533 mg GAE/g. The ethanolic extract and aqueous extract of cowpea pod coat have antioxidant potential in terms of total phenolic content parameter. Based on the research, the total phenolic content of cowpea pod aqueous extract higher than cowpea pod coat ethanolic extract.Keywords : Cowpea (Vigna unguiculata); Spectrophotometric UV-Visible; Total phenolic content.
PERSEPSI MASYARAKAT TERHADAP KEBUTUHAN PELAYANAN RUMAH SAKIT SYARIAH DI KOTA YOGYAKARTA
Authors: Rochana Ruliyandari
Published: January 2021

Rumah sakit syariah merupakan rumah sakit yang dalam aktifitasnya atau pengoperasionalannya berdasarkan pada maqashid syariah. Rumah sakit syariah dibuat dengan standart, sistem dan mutu yang sesuai dengan syariat islam. Penelitian ini dilakukan pada masyarakat kota Yogyakarta. Dengan tujuan untuk melihat kebutuhan masyarakat terhadap rumah sakit syariah. Penelitian ini menggunakan metode deskriptif analitik, dengan teknik pengambilan sampel menggunakan random sampling dengan jumlah sampel sebanyak 43 orang. Data penelitian ini diambil menggunakan kuesioner elektronik. Analisis data dilakukan menggunakan analisis deskriptif. masyarakat sebagian besar setuju bahwa rumah sakit telah melaksanakan prinsip-prinsip syariat islam dalam melakukan pelayanan kesehatan pada pasien.  Melakukan pelayanan sesuai gender pasien, berinteraksi dan memiliki prinsip sosial, memiliki lingkungan yang nyaman sesuai syariat islam. Sebagian besar perlu terus menyesuaikan update pelayanan kesehatan yang berbasis syariah, sehingga meningkatkan kepuasan pasien.

Kata Kunci: Pelayanan Kesehatan, Rumah Sakit Syariah, Standar Rumah Sakit Syariah
Authors: Fathony Doohan Ryan , Ramadhani Sulthan Alif Secca , Poetra Vincentian Michael Anton , Rakhmawati Nur Aini
Published: January 2021

Pada zaman yang serba digital ini, hampir semua orang mempunyai akses internet untuk mememenuhi masing-masing kebutuhannya. Dengan adanya internet segala sesuatu hal informasi dapat diakses dengan mudah dan cepat. Penelitian ini dilakukan dengan tujuan  untuk melihat adanya hubungan dari sekolah daring yang memberikan kebebasan dan kemudahan akses internet di rumah dengan meningkatnya pemain game online. Peneltitan dilakukan dengan menyebar kuisioner kepada siswa-siswi SMA di Indonesia, lalu data diolah sedemikian mungkin untuk diidentifikasi perilaku siswa-siswi SMA. Hasilnya didapat terdapat beberapa tanda di mana adanya pengaruh dari sekolah daring dari rumah dengan meningkatnya pemain game online.
Authors: Mayseleste Jordy , Andry Johanes Fernandes
Published: January 2021

In the current era the need for information technology or information systems becomes an important thing in all aspects of life. The need for fast, relevant and reliable information is first and foremost for users of information technology, including for companies. Therefore, supporting information technology or information systems that are needed in the era of automation is now needed in developing information systems and the development of world technology that requires everything fast and precise. Information system support to the company's needs can only be answered by taking into account supporting factors in its development. Freight Forwarding Service Company is a business enterprise engaged in land transportation services. To improve the quality and service, therefore we need an information system that can help in the business process of the JPB. One of the factors driving the need for information systems is because of the increasingly needed needs and business activities carried out. Enterprise Architecture is used to determine the architecture in support of business processes and plans in a company to achieve business goals. This study uses the TOGAF method that starts from the Preliminary, Requirement Management, Architecture Vision, Business Architecture, Information Systems Architecture, Technology Architecture, Opportunities and Solutions and Migration Planning. The expectation of this research is about a discussion of the TOGAF model that is saved by the business processes and needs of the JPB in meeting the Enterprise Architecture.
PEMBANGUNAN APLIKASI GO-PAJAK BERBASIS MOBILE
Authors: Pamungkas Wicaksono Dwi , Setiyawati Nina
Published: January 2021

Public services are services, both in the form of public goods and public services which are the responsibility and are carried out by the government in an effort to meet the needs of the community and in accordance with statutory provisions. One of the public services provided by the government is the One-Stop Administration System (SAMSAT). According to SAMSAT data in the city of Magelang, data on motorized vehicle ownership has increased and there has been an increase in the number of taxpayers. However, the tax payment service is considered to be less than optimal because there are still long queues when paying taxes.This also causes many people to make payments past the due date or entrust queues to brokerage services. Therefore, to overcome the problem, a mobile-based application (GO-PAJAK) was built which can be used to make tax payments by means of a vehicle document pick-up to pay motor vehicle taxes connected between drivers (SAMSAT employees) and customers (taxpayers). With this application, it is expected to improve service standards at the SAMSAT office and reduce taxpayer queues also reduce the use of brokers in administering public service administration that can increase public trust.
PERBANDINGAN METODE NAÏVE BAYES DAN EQUIVALENCE CLASSES DALAM MENENTUKAN STRUKTUR BAYESIAN NETWORK
Authors: Rochmana Yussyafrida Choiriizzati , Hakimah Maftahatul , Farida Farida
Published: January 2021

Bayesian Network merupakan model yang termasuk dalam klasifikasi bayes, dimana metode ini mengasumsikan bahwa nilai variabel independen memiliki ketergantungan dengan nilai variabel lain. Bayesian Network memiliki keunggulan yaitu dapat memodelkan hubungan antar variabel dengan menggunakan graf atau semacam penggambaran alur hubungan antar variabel. Terdapat beberapa metode yang digunakan untuk menentukan struktur bayesian network. Metode pembentukan struktur jaringan Bayesian network pada penelitian ini adalah metode naïve bayes dan equivalence classes. Kedua metode pembentukan struktur ini diterapkan untuk klasifikasi kelayakan peminjaman dana Usaha Kecil Mikro Menengah (UMKM). Pada struktur metode naïve bayes variabel dependen menjadi pusat dari variabel independen sedangkan pada struktur metode equivalence classes setiap variabel memiliki hubungan antar variabel lain. Hasil pengujian dari metode naïve bayes dan equivalence classes dalam pembentukan struktur Bayesian network secara rata-rata adalah metode equivalence classes 79,53% dan naïve bayes 80,93%.