The Experts below are selected from a list of 3216 Experts worldwide ranked by ideXlab platform
Matthew Ortman - One of the best experts on this subject based on the ideXlab platform.
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tuberculous brain abscess in an adolescent with complex congenital Cyanotic Heart Disease
Heart, 2013Co-Authors: Nayan Desai, Brian Gable, Matthew OrtmanAbstract:A 15-year-old boy presented with low-grade fever, frontal headache and projectile vomiting. Physical examination revealed clubbing, central cyanosis and systolic murmur at the base of the Heart. Twelve-lead electrocardiography revealed rightward P wave axis, prominent anterior precordial forces with an R/S ratio in V1 approaching 1, and reverse precordial progression, suggestive of dextrocardia (figure 1), and confirmed by chest roentgenogram (figure …
Nayan Desai - One of the best experts on this subject based on the ideXlab platform.
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tuberculous brain abscess in an adolescent with complex congenital Cyanotic Heart Disease
Heart, 2013Co-Authors: Nayan Desai, Brian Gable, Matthew OrtmanAbstract:A 15-year-old boy presented with low-grade fever, frontal headache and projectile vomiting. Physical examination revealed clubbing, central cyanosis and systolic murmur at the base of the Heart. Twelve-lead electrocardiography revealed rightward P wave axis, prominent anterior precordial forces with an R/S ratio in V1 approaching 1, and reverse precordial progression, suggestive of dextrocardia (figure 1), and confirmed by chest roentgenogram (figure …
Kazuo Momma - One of the best experts on this subject based on the ideXlab platform.
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current treatment of brain abscess in patients with congenital Cyanotic Heart Disease
Neurosurgery, 1997Co-Authors: Mikihiko Takeshita, Mizuo Kagawa, Masahiro Izawa, Seiji Yato, Hideaki Onda, Kintomo Takakura, Kazuo MommaAbstract:OBJECTIVE: The goal of this study was to define clearly the role of management in patients with Cyanotic Heart Disease and brain abscesses by evaluating retrospectively the factors influencing poor outcome in these patients. METHODS: This study included 62 patients with Cyanotic Heart Disease and brain abscesses diagnosed in the computed tomography era. Basic characteristic parameters (number, size, location, computed tomographic classification and organism type of abscess, convulsion, type of Cyanotic Heart Disease, age distribution, immunocompromised status, pretreatment neurological state, and intraventricular rupture of brain abscess [IVROBA]) and therapeutic parameters (type of antibiotics and duration of administration, steroid medication and therapeutic modalities, aspiration with or without cerebrospinal fluid drainage, total extirpation after aspiration, or primary extirpation and medical treatment) were evaluated as independent predictors of poor outcome (totally disabled state or death) by using univariate and multivariate logistic regression analysis. We also statistically estimated the possible causes of IVROBA and the multiplicity of brain abscess. RESULTS: Although there were no statistically significant correlations between patients with good and poor outcomes in regard to other basic characteristic and therapeutic parameters, patients with poor outcomes were older (P < 0.02), more frequently had IVROBA (P < 0.005), and had a higher frequency of neurological deterioration (P < 0.01 ) than those with good outcomes. Multiple logistic regression analysis predicted that poor outcome increased the relative risk of IVROBA by a factor of 18.9 (odds rate, 18.9; 95% confidence interval, 1.7-211.6; P < 0.02). More patients with multiple abscesses had positive immunocompromised states than those with single abscesses (P < 0.01). Deep-located abscesses also more frequently had IVROBA (P < 0.005) and abscesses located in the parieto-occipital region ruptured into the occipital horn of the lateral ventricle in a short period (P < 0.02). CONCLUSIONS: Our findings suggest that IVROBA strongly influences poor outcome in patients with Cyanotic Heart Disease. The key to decreasing poor outcomes may be the prevention and management of IVROBA. To reduce operative and anesthetic risk in these patients, abscesses should be managed by less invasive aspiration methods guided by computed tomography. Abscesses larger than 2 cm in diameter, in deep-located or parieto-occipital regions, should be aspirated immediately and repeatedly, mainly using computed tomography-guided methods to decrease intracranial pressure and avoid IVROBA. IVROBA should be aggressively treated by aspiration methods for the abscess coupled with the appropriate intravenous and intrathecal administration of antibiotics while evaluating intracranial pressure pathophysiology.
Mikihiko Takeshita - One of the best experts on this subject based on the ideXlab platform.
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current treatment of brain abscess in patients with congenital Cyanotic Heart Disease
Neurosurgery, 1997Co-Authors: Mikihiko Takeshita, Mizuo Kagawa, Masahiro Izawa, Seiji Yato, Hideaki Onda, Kintomo Takakura, Kazuo MommaAbstract:OBJECTIVE: The goal of this study was to define clearly the role of management in patients with Cyanotic Heart Disease and brain abscesses by evaluating retrospectively the factors influencing poor outcome in these patients. METHODS: This study included 62 patients with Cyanotic Heart Disease and brain abscesses diagnosed in the computed tomography era. Basic characteristic parameters (number, size, location, computed tomographic classification and organism type of abscess, convulsion, type of Cyanotic Heart Disease, age distribution, immunocompromised status, pretreatment neurological state, and intraventricular rupture of brain abscess [IVROBA]) and therapeutic parameters (type of antibiotics and duration of administration, steroid medication and therapeutic modalities, aspiration with or without cerebrospinal fluid drainage, total extirpation after aspiration, or primary extirpation and medical treatment) were evaluated as independent predictors of poor outcome (totally disabled state or death) by using univariate and multivariate logistic regression analysis. We also statistically estimated the possible causes of IVROBA and the multiplicity of brain abscess. RESULTS: Although there were no statistically significant correlations between patients with good and poor outcomes in regard to other basic characteristic and therapeutic parameters, patients with poor outcomes were older (P < 0.02), more frequently had IVROBA (P < 0.005), and had a higher frequency of neurological deterioration (P < 0.01 ) than those with good outcomes. Multiple logistic regression analysis predicted that poor outcome increased the relative risk of IVROBA by a factor of 18.9 (odds rate, 18.9; 95% confidence interval, 1.7-211.6; P < 0.02). More patients with multiple abscesses had positive immunocompromised states than those with single abscesses (P < 0.01). Deep-located abscesses also more frequently had IVROBA (P < 0.005) and abscesses located in the parieto-occipital region ruptured into the occipital horn of the lateral ventricle in a short period (P < 0.02). CONCLUSIONS: Our findings suggest that IVROBA strongly influences poor outcome in patients with Cyanotic Heart Disease. The key to decreasing poor outcomes may be the prevention and management of IVROBA. To reduce operative and anesthetic risk in these patients, abscesses should be managed by less invasive aspiration methods guided by computed tomography. Abscesses larger than 2 cm in diameter, in deep-located or parieto-occipital regions, should be aspirated immediately and repeatedly, mainly using computed tomography-guided methods to decrease intracranial pressure and avoid IVROBA. IVROBA should be aggressively treated by aspiration methods for the abscess coupled with the appropriate intravenous and intrathecal administration of antibiotics while evaluating intracranial pressure pathophysiology.
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risk factors for brain abscess in patients with congenital Cyanotic Heart Disease
Neurologia Medico-chirurgica, 1992Co-Authors: Mikihiko Takeshita, Mizuo Kagawa, Hiroshi Yonetani, Masahiro Izawa, Seiji Yato, Toshio Nakanishi, Kazuo MonmaAbstract:Brain abscess is a serious complication of congenital Cyanotic Heart Disease. We retrospectively evaluated the risk factors for brain abscess in 21 such patients treated between 1975 and 1990 in comparison with a control group. The mean arterial oxygen saturation, arterial partial pressure of O2, arterial blood oxygen content, and base excess in patients with brain abscess were significantly lower than in the control patients. The mean arterial partial pressure of CO2, pH, hematocrit, hemoglobin, and red blood cell content in patients with brain abscess were not significantly different. Patients with congenital Cyanotic Heart Disease may develop minute encephalomalacia due to severe hypoxemia and increased blood viscosity resulting from compensatory polycythemia. The increased blood viscosity and reduced blood flow in the microcirculation may induce cerebral thrombosis or exaggerate minute encephalomalacia during dehydration or cardiac dysfunction, and shunted blood containing infectious organisms at such sites may be followed by focal cerebritis.
Yinglong Liu - One of the best experts on this subject based on the ideXlab platform.
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a novel hybrid method for creating a porcine model of Cyanotic congenital Heart defect with decreased pulmonary blood flow
Journal of Surgical Research, 2009Co-Authors: Yinglong LiuAbstract:Objective To create an experimental model of Cyanotic congenital Heart defect with decreased pulmonary blood flow using a novel hybrid method. Methods A model of congenital Heart defect with decreased pulmonary blood flow and chronic cyanosis was produced surgically in eight piglets (mean, 2 mo old). An artificial atrial septal defect was created followed by pulmonary artery banding to generate a systolic pressure gradient at 2 mo of ≥50 mm Hg (Cyanotic group). Another eight piglets underwent a sham operation (control group). Results There were six long-term survivors in the Cyanotic group. At a mean duration of 2 mo following the hybrid procedure, the resting gradient across the pulmonary artery band was 53.7 mm Hg. The Qp/Qs reached 0.54:1. The arterial oxygen tension, arterial oxygen saturation, hematocrit, and hemoglobin concentration were 52.9 mm Hg, 85.6%, 49.8%, and 16.6 g/dL in the Cyanotic group versus 118.0 mm Hg, 98.0%, 37.9%, and 12.2 g/dL in the control group, respectively (all P Conclusions A porcine model of Cyanotic congenital Heart defect with decreased pulmonary blood flow was established by a hybrid method. Application of this experimental design may enhance our understanding and possibly influence the treatment of patients who have Cyanotic Heart Disease with decreased pulmonary blood flow.
