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Obstet Gynecol. 2001 Feb;97(2):316-7.
Repeated courses of antenatal corticosteroids.
Goldenberg RL, Wright LL.
Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, Alabama, USA. rlab.edu
A single course of corticosteroids given to women before an anticipated preterm birth reduces the incidence of respiratory distress syndrome, intraventricular hemorrhage, and neonatal death. For women who do not deliver within 1 week, repeated courses of corticosteroids have become common obstetric practice, despite little evidence of efficacy. Emerging data suggest little benefit and potential harm from that practice, so corticosteroids to improve perinatal outcomes should be restricted to a single course unless future randomized trial data prove additional courses to be beneficial.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11165602&dopt=Abstract hemorrhage
Surg Neurol. 2000 Nov;54(5):352-60.
Surgery following endovascular coiling of intracranial aneurysms.
Thornton J, Dovey Z, Alazzaz A, Misra M, Aletich VA, Debrun GM, Ausman JI, Charbel FT.
Department of Radiology and Neurosurgery, University of Illinois at Chicago, Chicago, Illinois 60612, USA.
BACKGROUND: Surgery for intracranial aneurysms that have been treated by endovascular coiling is a new challenge for neurosurgeons and the need for it will undoubtedly continue to increase. The indications for, timing, and technique of surgery in our experience are described. METHODS: We have reviewed our experience with 11 patients who underwent surgery following endovascular coiling with Guglielmi detachable coils (GDCs) of an aneurysm. We analyzed the indications for surgery, surgical techniques used, and patient outcome. RESULTS: There were nine female and two male patients. The mean age was 49 years (range 13 to 67 years). The intervals between coiling and surgery were 1, 2, 3, 4, 7, 7, 10, and 14 days, 6 weeks, 2, 18, and 25 months. The indications for surgery were partial treatment (3), growth of residual neck (2), persistent mass effect of a giant aneurysm (1), mass effect from the coil ball (2), coil migration (2), and coil protrusion with embolic event (1). The coils were removed at the time of surgery from 9 of 11 aneurysms before clipping. In two cases it was possible to place a clip across the neck of the aneurysm without removing the coils, as the coils no longer occupied the neck.There were two permanent deficits directly related to the endovascular procedures. Two other patients who presented with subarachnoid hemorrhage had residual neurological deficits post surgery and one patient with a giant aneurysm had persistent visual loss. CONCLUSION: Surgery remains a viable option at any time for treating aneurysms that have been previously treated by GDC placement. The operative approach is determined by the need for coil removal and the duration since coiling.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11165609&dopt=Abstract hemorrhage
Surg Neurol. 2000 Nov;54(5):361-5.
Multiple "mirror" aneurysms involving intracavernous carotid arteries and vertebral arteries: case report.
Yamada K, Nakahara T, Kishida K, Yano T, Yamamoto K, Ushio Y.
Department of Neurosurgery, Miyazaki Prefectural Nobeoka Hospital, Shinkoji, Nobeoka, Japan.
BACKGROUND: Bilateral intracavernous carotid artery aneurysms are rare. Moreover, the proportion of vertebrobasilar aneurysms in association with multiple aneurysms is extremely low. We describe a rare case of "mirror" aneurysms on the bilateral intracavernous carotid and bilateral vertebral arteries. CASE DESCRIPTION: A 54-year-old male suffered from ophthalmic pain and oculomotor palsy on the left side. Cerebral angiography disclosed a giant left cavernous aneurysm and large asymptomatic aneurysms on the right intracavernous carotid artery and bilateral vertebral arteries. The cavernous sinus syndrome on the left side was successfully treated by left carotid artery ligation. However, 2 years later, severe subarachnoid hemorrhage (SAH) occurred. Computed tomography revealed thick clots densely distributed in the basal cisterns and third and fourth ventricles, indicating that the SAH originated from one of the vertebral artery aneurysms. Consciousness disturbance progressed rapidly, leading to cardiopulmonary arrest. CONCLUSION: The literature contains no case of mirror intracranial aneurysms involving both intracavernous carotid and vertebral arteries. Multi-staged surgical techniques with optimal combinations of direct clipping, ligation or trapping, and endovascular embolization may be essential for patients with multiple aneurysms to avoid SAH.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11165612&dopt=Abstract hemorrhage
Harefuah. 2003 Jan;142(1):2-4, 80.
[The clinical significance of postictal electrocardiographic changes mimicking acute myocardial infarction]
[Article in Hebrew]
Yahalom M, Gellerman M, Wishniak A, Brezins M, Roguin N.
Cardiology Department and Heart Institute, Western Galilee Hospital, Nahariya, Israel.
The electrocardiogram (ECG) is of critical importance in the diagnosis of acute myocardial infarction. Clinical conditions such as acute pericarditis, esophageal rupture, pancreatitis, subarachnoid hemorrhage, perforated duodenal ulcer, pneumothorax and status following elective DC cardioversion result in ECG changes that include ST elevation and T wave inversion. This report aims to increase the awareness of non-cardiac syndromes, with ECG abnormalities mimicking acute myocardial infarction, and thus to avoid unjustified thrombolytic therapy. We describe the case of a patient after epileptic seizures and pathological EEG pattern. The ECG showed repolarization abnormalities suggestive of evolving acute myocardial infarction. The cardiac enzymes (except normal Troponin I) were severely elevated and coronary angiography was normal.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12647480&dopt=Abstract hemorrhage
Eur J Obstet Gynecol Reprod Biol. 2001 Feb;94(2):211-5.
Neonatal outcome of temporizing treatment in early-onset preeclampsia.
Withagen MI, Visser W, Wallenburg HC.
Erasmus University School of Medicine and Health Sciences, Institute of Obstetrics and Gynecology, Rotterdam, The Netherlands.
OBJECTIVE: To assess the effect of prolongation of pregnancy on neonatal outcome by means of hemodynamic treatment in patients with early-onset preeclampsia. STUDY DESIGN: A retrospective case-controlled study of 222 liveborn infants of patients with early-onset (24--31 weeks) preeclampsia, who underwent temporizing hemodynamic treatment. Of the two control groups of liveborn preterm infants of non-preeclamptic mothers one group was matched with the study group for gestational age on admission (group I), one for gestational age at birth (group II). Primary outcome measures were neonatal and infant mortality and variables of neonatal morbidity. RESULTS: Median gestation in the study group of preeclamptic patients was prolonged from 29.3 to 31.3 weeks. No difference in neonatal or infant mortality was observed between infants from preeclamptic mothers and in the control groups. The study population showed better results than control group I with regard to admission to NICU (P<0.01), mechanical ventilation (P<0.001) and intracranial hemorrhage (P<0.01). Control group II had better results than the study group with respect to birthweight (P<0.001), bronchopulmonary dysplasia (P<0.01), patent ductus arteriosus (P<0.01), and retinopathy (P<0.01). CONCLUSION: Prolongation of gestation in patients with early-onset preeclampsia may reduce neonatal morbidity, but neonates of the same gestational age without a preeclamptic mother still have a better prognosis.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11165727&dopt=Abstract hemorrhage
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