bluuebunny/crossref_metadata_2025_split huggingface dataset:
Retrospective Study of Conservative Management of Appendicular Lump
Authors: Adhikari Bimarsh 
Published: April 2019

Introduction: Appendicitis is very common surgical emergency and incidence of appendicular lump is about 2-6%. There are different approaches for management of appendicular lump among which most common and widely accepted approach is managing lump conservatively with interval appendicectomy 6 weeks after resolution of inflammation. The aim of the study is to evaluate the efficacy of the conservative management in appendicular lump.
Materials and methods: Retrospective study of the 43 patients admitted with a diagnosis of appendicular lump from March 2015 to February 2016 at Nepalgunj medical college, Nepalgunj were carried out.
Result: Out of 204 patients of appendicitis 43(21.07%) patients were found to have appendicular lump. Age ranged from 6 to 81yrs old. Appendicitis was found to be common at the age range of 21 to 30 years (44.18%).patient reported after 3 to 8 days of Onset of symptoms but most of the patients reported at 5 to 6 days of onset of symptoms. Among 43 patients, 40 patients (93.01%) managed successfully with conservative management. Only three patients (6.97%) developed complications. Out of these conservatively managed, 18(41.86%) underwent interval appendicectomy, 19(44.18%) patients lost to follow up,3(6.97%) had recurrent appendicitis.
Conclusion: Our study concluded that most of the appendicular lumps can be managed conservatively with few complications, which can be managed with immediate intervention.
Doxorubicin Deteriorates the Histomorphology of the Kidneys of Albino Rats
Authors: Pandeya Anup , Jha Chandra Bhushan , Karki Smriti , Rauniar Gajendra Prashad 
Published: April 2019

Background and Objectives: Nephrotoxicity is one of the limiting factors for using doxorubicin as an anticancer chemotherapeutic. Reactive oxygen species and cytokines have been implicated in the nephrotoxicity induced by doxorubicin. The main objective of the present study is to identify and compare the histomorphological features in kidneys of albino rats and gross morphological features such as weight of rats and weight of the kidneys due to administration of doxorubicin.
Materials and Methods: In the study, albino rats were taken as the animal model. Sixty animals were taken as the sample size. They were divided into two equal groups: experimental (n=30) and control (n=30). Rats of experimental group were treated with anticancer drug doxorubicin at a single intraperitoneal dose of 10 mg/kg body weight while the Control group of rats received a similar volume of 0.9% normal saline. The ethical clearance was taken prior to the research from IERB committee BPKIHS Dharan.
Results: Our results showed that there was high effect of drug in experimental groups of rats. It was seen that there was significant decrease in the body weight and weight of kidneys. The final body weight and kidney weight between experimental and control group showed the significant difference. Similarly there were no significant differences in the normal architecture between the male and female rats. The normal renal histological features were seen on the kidneys in the control group whereas the rats intervened with the drug had some disrupted histological features which reveal the toxicity of the drugs in the kidneys. Conclusion: The study showed toxicity of the drug in the kidneys of experimental groups of rats irrespective of gender and suggest that doxorubicin causes significant loss of the body weight and weight of kidneys and causes the disruption in the normal histological features.
Nerve Conduction Study in Bell's Palsy
Authors: Shah Sanjib Kumar , Kothari R. P. , Bassi S. D. 
Published: April 2019

Background: Nerve conduction study (NCS) is an important electrophysiological tool that can be used for the measurement of the latency and amplitude of the facial nerve. The NCS helps in predicting the prognosis of patients with Bell's palsy. Evaluation of NCS of patients with Bell's palsy may have contribution in counselling and management of the patient.
Objective: The study was aimed to study the state of nerve damage in patients with Bell's palsy. Methods: The latency and amplitude of facial nerve stimulating bilateral Orbicularis Oculi and Orbicularis Oris muscles were assessed and noted in 24 patients of Bell's palsy.
Results: 15(62.5%) of the patients had significant axonal injury affecting one side and only 1(4.16%) patient had demyelinating injury. The total of 8(33.33%) patients had insignificant axonal injury of the facial nerve in comparision with the normal side.
Conclusions: Nerve conduction study shows predominant axonal type of facial nerve injury in patients with Bell's palsy and hence provides valuable information regarding the prognosis and the state of nerve damage in patients with Bell's palsy.
Alteration of metabolic connectivity in a rat model of deafferentation pain: a 18F-FDG PET/CT study
Authors: Huo Bei-Bei , Shen Jun , Hua Xu-Yun , Zheng Mou-Xiong , Lu Ye-Chen , Wu Jia-Jia , Shan Chun-Lei , Xu Jian-Guang 
Published: April 2019

OBJECTIVERefractory deafferentation pain has been evidenced to be related to central nervous system neuroplasticity. In this study, the authors sought to explore the underlying glucose metabolic changes in the brain after brachial plexus avulsion, particularly metabolic connectivity.METHODSRats with unilateral deafferentation following brachial plexus avulsion, a pain model of deafferentation pain, were scanned by small-animal 2-deoxy-[18F]fluoro-d-glucose (18F-FDG) PET/CT to explore the changes of metabolic connectivity among different brain regions. Thermal withdrawal latency (TWL) and mechanical withdrawal threshold (MWT) of the intact forepaw were also measured for evaluating pain sensitization. Brain metabolic connectivity and TWL were compared from baseline to 1 week after brachial plexus avulsion.RESULTSAlterations of metabolic connectivity occurred not only within the unilateral hemisphere contralateral to the injured forelimb, but also in the other hemisphere and even in the connections between bilateral hemispheres. Metabolic connectivity significantly decreased between sensorimotor-related areas within the left hemisphere (contralateral to the injured forelimb) (p < 0.05), as well as between areas across bilateral hemispheres (p < 0.05). Connectivity between areas within the right hemisphere (ipsilateral to the injured forelimb) significantly increased (p = 0.034). TWL and MWT of the left (intact) forepaw after surgery were significantly lower than those at baseline (p < 0.001).CONCLUSIONSThis study revealed that unilateral brachial plexus avulsion facilitates pain sensitization in the opposite limb. A specific pattern of brain metabolic changes occurred in this procedure. Metabolic connectivity reorganized not only in the sensorimotor area corresponding to the affected forelimb, but also in extensive areas involving the bilateral hemispheres. These findings may broaden our understanding of central nervous system changes, as well as provide new information and a potential intervention target for nosogenesis of deafferentation pain.
Safety and efficacy of anterior communicating artery compromise during endovascular coil embolization of adjoining aneurysms
Authors: Choi Hyun Ho , Cho Young Dae , Yoo Dong Hyun , Lee Su Hwan , Yeon Eung Koo , Kang Hyun-Seung , Cho Won-Sang , Kim Jeong Eun , Han Moon Hee 
Published: April 2019

OBJECTIVEIn the presence of symmetric A1 flow, the safety and efficacy of compromising the anterior communicating artery (ACoA) during coil embolization of ACoA aneurysms has yet to be evaluated. Herein, the authors describe their experience, focusing on procedural safety.METHODSBetween October 2012 and July 2017, 285 ACoA aneurysms with symmetric A1 flows were treated at the authors’ institution by endovascular coil embolization. Clinical and angiographic outcome data were subjected to binary logistic regression analysis.RESULTSACoA compromise was chosen in the treatment of 71 aneurysms (24.9%), which were completely (n = 15) or incompletely (n = 56) compromised. In the remaining 214 lesions, the ACoA was preserved. Although 9 patients (3.2%) experienced procedure-related thromboembolisms (compromised, 4; preserved, 5), all but 1 patient (with ACoA compromise) were asymptomatic. In multivariate analysis, subarachnoid hemorrhage at presentation was the sole independent risk factor for thromboembolism (OR 15.98, p < 0.01), with ACoA compromise being statistically unrelated. In 276 aneurysms (96.8%) with follow-up of > 6 months (mean 20.9 ± 13.1 months, range 6–54 months), recanalization was confirmed in 21 (minor, 15; major, 6). A narrow (≤ 4 mm) saccular neck (p < 0.01) and ACoA compromise (p = 0.04) were independently linked to prevention of recanalization.CONCLUSIONSDuring coil embolization of ACoA aneurysms, the ACoA may be compromised without serious complications if A1 flows are symmetric. This approach may also confer some long-term protection from recanalization, serving as a valid treatment option for such lesions.
Clinical characteristics of and treatment protocol for trapped temporal horn following resection of lateral ventricular trigone meningioma: a single-center experience
Authors: Lin Zhiqin , Wang Chengjun , Gao Zhenwen , Li Xiangrong , Lan Folin , Liu Tianqing , Wang Yongzhi , Jiang Zhongli 
Published: April 2019

OBJECTIVETrapped temporal horn (TTH) is a rare subtype of loculated hydrocephalus that is often managed surgically. The natural history of TTH is not well understood, and there are few data on the outcomes of conservative management of this condition. The aim of this study was to analyze the clinical features and outcomes of conservatively and surgically managed cases of TTH.METHODSThe authors retrospectively reviewed the clinical data for 19 consecutive cases of TTH that developed after microsurgical resection of lateral ventricular trigone meningioma between 2011 and 2015.RESULTSThe 19 cases involved 6 male and 13 female patients (mean age [± SD] 39.9 ± 13.8 years). The mean time interval from tumor resection to onset of TTH was 3.2 ± 3.0 months (range 3 days–10 months). Symptoms of intracranial hypertension were the most common complaints at presentation. The mean Karnofsky Performance Scale (KPS) score at onset was 52.1 ± 33.3 (range 10–90). Midline shift was observed in 15 cases (78.9%), and the mean amount of midline shift was 6.0 ± 4.8 mm (range 0–15 mm). Eleven cases (57.9%) were managed with surgical intervention, while 8 cases (42.1%) were managed conservatively. All patients (100%) showed improved clinical status over the course of 4.8 ± 1.0 years (range 2.8–6.3 years) of follow-up. The mean KPS score at last follow-up was 87.9 ± 11.3 (range 60–100). Eighteen patients (94.7%) showed signs of radiographic improvement, and 1 patient (5.3%) exhibited stable size of the temporal horn. Significant differences were observed between the surgical and nonsurgical cohorts for the following variables: KPS score at onset, presence of intracranial hypertension, and midline shift. The mean KPS score at onset was greater (better) in the nonsurgical group than in the surgical group (82.5 ± 8.9 vs 30 ± 25.7, p = 0.001). A greater proportion of patients in the surgical group presented with symptoms of intracranial hypertension (81.8% vs 0%, p = 0.001). The extent of midline shift was greater in the surgical group than in the nonsurgical group (9.0 ± 3.8 mm vs 2.0 ± 2.4 mm, p = 0.001).CONCLUSIONSThe majority of patients with TTH presented in a delayed fashion. TTH is not always a surgical entity. Spontaneous resolution of TTH may be under-reported. Conservative management with clinical and radiological follow-up is effective in selected patients.
The influence of nimodipine and vasopressors on outcome in patients with delayed cerebral ischemia after spontaneous subarachnoid hemorrhage
Authors: Paľa Andrej , Schick Julia , Klein Moritz , Mayer Benjamin , Schmitz Bernd , Wirtz Christian Rainer , König Ralph , Kapapa Thomas 
Published: April 2019

OBJECTIVEDelayed cerebral ischemia (DCI) is a major factor contributing to the inferior outcome of patients with spontaneous subarachnoid hemorrhage (SAH). Nimodipine and induced hypertension using vasopressors are an integral part of standard therapy. Consequences of the opposite effect of nimodipine and vasopressors on blood pressure on patient outcome remain unclear. The authors report the detailed general characteristics and influence of nimodipine and vasopressors on outcome in patients with SAH.METHODSThe authors performed a 2-center, retrospective, clinical database analysis of 732 SAH patients treated between 2008 and 2016. Demographic and clinical data such as age, sex, World Federation of Neurosurgical Societies (WFNS) grade, BMI, Fisher grade, history of arterial hypertension and smoking, aneurysm location, C-reactive protein (CRP) level, and detailed dosage of vasopressors and nimodipine during the treatment period were evaluated. Clinical outcome was analyzed using the modified Rankin Scale (mRS) 6 months after treatment. Univariate and multivariate regression analyses were performed. Additionally, mean arterial pressure (MAP), age, nimodipine, and vasopressor dose cutoff were evaluated with regard to outcome. The level of significance was set at ≤ 0.05.RESULTSFollow-up was assessed for 397 patients, 260 (65.5%) of whom achieved a good outcome (defined as an mRS score of 0–3). Univariate and multivariate analyses confirmed that nimodipine (p = 0.049), age (p = 0.049), and CRP level (p = 0.002) are independent predictors of good outcome. WFNS grade, Fisher score, hypertension, initial hydrocephalus, and total vasopressor dose showed significant influence on outcome in univariate analysis, and patient sex, smoking status, BMI, and MAP showed no significant association with outcome. A subgroup analysis of patients with milder initial SAH (WFNS grades I–III) revealed that initial hydrocephalus (p = 0.003) and CRP levels (p = 0.001) had significant influence on further outcome. When evaluating only patients with WFNS grade IV or V, age, CRP level (p = 0.011), vasopressor dose (p = 0.030), and nimodipine dose (p = 0.049) were independent predictors of patient outcome. Patients with an MAP < 93 mm Hg, a nimodipine cutoff dose of 241.8 mg, and cutoff total vasopressor dose of 523 mg had better outcomes.CONCLUSIONSAccording to the authors’ results, higher doses of vasopressors can safely provide a situation in which the maximum dose of nimodipine could be administered. Cutoff values of the total vasopressor dose were more than 3 times higher in patients with severe SAH (WFNS grade IV or V), while the nimodipine cutoff remained similar in patients with mild and severe SAH. Hence, it seems encouraging that a maximum nimodipine dosage can be achieved despite the need for a higher vasopressor dose in patients with SAH.
Dorsal component of the superior longitudinal fasciculus revisited: novel insights from a focused fiber dissection study
Authors: Komaitis Spyridon , Skandalakis Georgios P. , Kalyvas Aristotelis V. , Drosos Evangelos , Lani Evgenia , Emelifeonwu John , Liakos Faidon , Piagkou Maria , Kalamatianos Theodosis , Stranjalis George , Koutsarnakis Christos 
Published: April 2019

OBJECTIVEThe aim of this study was to investigate the anatomical consistency, morphology, axonal connectivity, and correlative topography of the dorsal component of the superior longitudinal fasciculus (SLF-I) since the current literature is limited and ambiguous.METHODSFifteen normal, adult, formalin-fixed cerebral hemispheres were studied through a medial to lateral fiber microdissection technique. In 5 specimens, the authors performed stepwise focused dissections of the lateral cerebral aspect to delineate the correlative anatomy between the SLF-I and the other two SLF subcomponents, namely the SLF-II and SLF-III.RESULTSThe SLF-I was readily identified as a distinct fiber tract running within the cingulate or paracingulate gyrus and connecting the anterior cingulate cortex, the medial aspect of the superior frontal gyrus, the pre–supplementary motor area (pre-SMA), the SMA proper, the paracentral lobule, and the precuneus. With regard to the morphology of the SLF-I, two discrete segments were consistently recorded: an anterior and a posterior segment. A clear cleavage plane could be developed between the SLF-I and the cingulum, thus proving their structural integrity. Interestingly, no anatomical connection was revealed between the SLF-I and the SLF-II/SLF-III complex.CONCLUSIONSStudy results provide novel and robust anatomical evidence on the topography, morphology, and subcortical architecture of the SLF-I. This fiber tract was consistently recorded as a distinct anatomical entity of the medial cerebral aspect, participating in the axonal connectivity of high-order paralimbic areas.
Preoperative MRI findings and prediction of diagnostic utility of foramen ovale electrodes
Authors: Bick Sarah K. , Dolatshahi Marjan S. , Grannan Benjamin L. , Cole Andrew J. , Hoch Daniel B. , Eskandar Emad N. 
Published: April 2019

OBJECTIVEForamen ovale electrodes (FOEs) are a minimally invasive method to localize mesial temporal seizures in cases in which noninvasive methods are inconclusive. The objective of this study was to identify factors predicting the ability of FOEs to yield a diagnosis in order to determine optimal candidates for this procedure.METHODSAll cases of diagnostic investigations performed with FOEs at the authors’ institution between 2005 and 2017 were reviewed. FOE investigation was defined as diagnostic if it led to a treatment decision. Demographic and clinical variables for diagnostic and nondiagnostic investigations were compared using a Wilcoxon rank-sum test for continuous variables and Fisher’s exact test for categorical variables.RESULTSNinety-three patients underwent investigations performed with FOEs during the study period and were included in the study. FOE investigation was diagnostic in 75.3% of cases. Of patients who underwent anterior temporal lobectomy following diagnostic FOE evaluation, 75.9% were Engel class I at last follow-up (average 40.1 months). When the diagnostic and nondiagnostic FOE groups were compared, patients who had diagnostic investigations were more likely to be male (57.1% male vs 26.1% in the nondiagnostic group, p = 0.015). They were also more likely to have temporal lesions on preoperative MRI (p = 0.018).CONCLUSIONSFOEs are a useful, minimally invasive diagnostic modality resulting in a treatment decision in 75% of cases. Male patients and patients with temporal lesions on MRI may be most likely to benefit from FOE investigation.
Survival benefit of lobectomy over gross-total resection without lobectomy in cases of glioblastoma in the noneloquent area: a retrospective study
Authors: Roh Tae Hoon , Kang Seok-Gu , Moon Ju Hyung , Sung Kyoung Su , Park Hun Ho , Kim Se Hoon , Kim Eui Hyun , Hong Chang-Ki , Suh Chang-Ok , Chang Jong Hee 
Published: April 2019

OBJECTIVEFollowing resection of glioblastoma (GBM), microscopic remnants of the GBM tumor remaining in nearby tissue cause tumor recurrence more often than for other types of tumors, even after gross-total resection (GTR). Although surgical oncologists traditionally resect some of the surrounding normal tissue, whether further removal of nearby tissue may improve survival in GBM patients is unknown. In this single-center retrospective study, the authors assessed whether lobectomy confers a survival benefit over GTR without lobectomy when treating GBMs in the noneloquent area.METHODSThe authors selected 40 patients who had undergone GTR of a histopathologically diagnosed isocitrate dehydrogenase (IDH)–wild type GBM in the right frontal or temporal lobe and divided the patients into 2 groups according to whether GTR of the tumor involved lobectomy, defined as a supratotal resection (SupTR group, n = 20) or did not (GTR group, n = 20). Progression-free survival (PFS), overall survival (OS), and Karnofsky Performance Status (KPS) scores were compared between groups (p ≤ 0.05 for statistically significant differences).RESULTSThe median postoperative PFS times for each group were as follows: GTR group, 11.5 months (95% CI 8.8–14.2) and SupTR group, 30.7 months (95% CI 4.3–57.1; p = 0.007). The median postoperative OS times for each group were as follows: GTR group, 18.7 months (95% CI 14.3–23.1) and SupTR group, 44.1 months (95% CI 25.1–63.1; p = 0.040). The mean postoperative KPS scores (GTR, 76.5; SupTR, 77.5; p = 0.904) were not significantly different. In multivariate analysis, survival for the SupTR group was significantly longer than that for the GTR group in terms of both PFS (HR 0.230; 95% CI 0.090–0.583; p = 0.002) and OS (HR 0.247; 95% CI 0.086–0.704; p = 0.009).CONCLUSIONSIn cases of completely resectable, noneloquent-area GBMs, SupTR provides superior PFS and OS without negatively impacting patient performance.
Positive and negative work events attributed to the spine 2 years after lumbar surgery among patients working preoperatively
Authors: Mancuso Carol A. , Duculan Roland , Cammisa Frank P. , Sama Andrew A. , Hughes Alexander P. , Girardi Federico P. 
Published: April 2019

OBJECTIVEReturn to work after lumbar surgery is not synonymous with effective job performance, and it is likely that patients who undergo spine surgery experience both positive and negative events attributable to their spine after returning to work. The authors’ objectives were to measure work events attributable to the spine during the 2 years after lumbar surgery and to assess associated demographic and clinical characteristics.METHODSEmployed patients scheduled for lumbar surgery were interviewed preoperatively and reported work characteristics, including amount of improvement in job performance that they expected from surgery. Clinical variables, such as comorbidities and surgical complexity, were collected using standard scales. Two years postoperatively patients completed the 22-item work domain of the Psychiatric Epidemiological Research Interview Life Events Scale (PERI) asking about major positive and negative events attributable to the spine that occurred since surgery. Event rates were assessed with logistic regression. Patients also reported the amount of improvement obtained in job performance, which was compared to the amount of improvement expected in bivariate analyses.RESULTSTwo hundred seven working patients (mean age 53 years, 62% men) were interviewed preoperatively. At 2 years after surgery, 86% were working and 12% reported negative events attributable to the spine (e.g., reduced workload, retirement). In multivariable analysis, high school education or less (OR 4.6, CI 1.7–12.3, p = 0.003), another spine surgery (OR 3.4, CI 1.2–10.1, p = 0.03), and new/worse comorbidity (OR 3.3, CI 1.2–8.8, p = 0.02) remained associated. Seven percent reported positive events attributable to the spine; not having postoperative complications was associated (OR 24, CI 4–156, p = 0.001). Of 162 patients queried preoperatively about expectations, 120 expected improvement in work; postoperatively, 82% reported some improvement (42% reported less improvement than expected and 40% as much as or more improvement than expected), 18% reported no improvement. No improvement was associated with less education (OR 1.5, CI 1.0–2.1, p = 0.04), older age (OR 1.1, CI 1.0–1.1, p = 0.005), more complex surgery (OR 1.1, CI 1.0–1.1, p = 0.07), and another spine surgery (OR 6.1, CI 1.9–19.8, p = 0.003). In descriptive analyses for another sample of preoperatively work-disabled patients, most had physically demanding jobs and only 33% returned to work postoperatively.CONCLUSIONSMost preoperatively working patients were working postoperatively, reported spine-related improvement in job performance, and reported the occurrence of both positive and negative work events attributable to the spine. This study proposes novel work outcomes (i.e., positive and negative work events) and potential methods to measure them.