The International journal of neuroscience
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Observational Study
Do fluctuations in endogenous melatonin levels predict the occurrence of postoperative cognitive dysfunction (POCD)?
Delirium is a complex neuropsychiatric disorder that has an adverse impact on CNS function. Abnormal fluctuation of melatonin secretion occurs in the postoperative delirium (POD) in elderly patients. POD is strongly associated with early postoperative cognitive dysfunction (POCD). ⋯ The incidence of POCD in patients with 6-SMT fluctuation was significantly higher (p < 0.01). The results indicate that in the first week after major noncardiac surgery, POCD occurs in a significant proportion of people, and is linked to fluctuations in endogenous melatonin levels. Measurement of urinary 6-SMT during the perioperative period may assist the diagnosis of POCD.
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Cerebral white matter hyperdensities (WMH) are frequently reported on brain magnetic resonance images (MRI) of elderly people; its significance is still under debate. ⋯ From this first ever retrospective Lebanese study, WMH was reported increasingly with aging in accordance with data from the literature; PVWMH was found significantly more correlated with aging and HTN than was DWMH alone.
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In the current study, we reviewed and re-evaluated the experiences of microsurgical management for pineal region meningiomas via the unilateral occipital transtentorial approach (Poppen's approach). Clinical data were obtained on 15 meningiomas of the pineal region, which underwent microsurgery via unilateral Poppen's approach from March 2009 to June 2012. These patients were hospitalized in our department; their data were collected and analyzed retrospectively. ⋯ However, gross total resection might be difficult via the unilateral Poppen's approach for large-sized meningiomas with much contralateral infratentorial extension due to limited exposure. For these cases, combined supra-infratentorial or bilateral Poppen's approaches are recommended. Preoperative or intraoperative external ventricular drainage can increase tumor exposure and improve microsurgical effects.
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This detailed medical charts' data collection study conducted at a multiple sclerosis (MS) clinic in Germany evaluated the effectiveness of tetrahydrocannabinol (THC)/cannabidiol (CBD) oromucosal spray in patients with resistant MS spasticity. Over a 15-month timeframe, THC:CBD spray was initiated in 166 patients. Mean follow-up was 9 months. ⋯ Main reasons for treatment discontinuation were: adverse drug reactions, mainly dizziness, fatigue and oral discomfort (23 patients; 13.9%); lack of efficacy (14 patients; 8.4%); or need for a baclofen pump (9 patients; 5.4%). No new safety signals were noted with THC:CBD spray during the evaluation period. In this routine clinical practice setting at an MS clinic in Germany, THC:CBD spray was effective and well tolerated as add-on therapy or as monotherapy in a relevant proportion of patients with resistant MS spasticity.
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This study was undertaken to investigate the preventive or therapeutic effect of hyperbaric oxygen therapy (HBOT) on cerebral vasospasm following experimental subarachnoid hemorrhage (SAH). Twenty rabbits were assigned randomly to one of four groups. Animals in Group I were not subjected to SAH or sham operation (control group, n = 5). ⋯ Our results demonstrated that repeated application of HBOT at 2.4 ATA for 2 h attenuated vasospastic changes such as increased vasospasm index and arterial wall thickness. HBOT is thus a promising candidate for SAH-induced vasospasm. Further studies are needed to evaluate maximal effect and optimal application regimen.