Neurosurgery
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Paradoxical transtentorial herniation is a rare but well-documented complication of cerebrospinal fluid (CSF) drainage in patients with large decompressive craniectomies. However, brain sagging in the absence of CSF hypovolemia has not been previously reported. ⋯ Although rare, paradoxical herniation in the setting of a large craniectomy defect may occur in the absence of CSF drainage. This entity should be suspected whenever transtentorial herniation occurs in conjunction with direct or indirect signs of intracranial hypotension. Placing the patient in the Trendelenburg position should be attempted, because this simple maneuver may turn out to be life-saving.
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A precise definition of ventricular enlargement is important in the diagnosis of hydrocephalus as well as in assessing central atrophy. The Evans index (EI), a linear ratio between the maximal frontal horn width and the cranium diameter, has been extensively used as an indirect marker of ventricular volume (VV). With modern imaging techniques, brain volume can be directly measured. ⋯ VV (or RVV) and the EI reflect different properties. The exclusive use of EI in clinical studies as a marker of enlarged ventricles should be questioned. We suggest that the definition of dilated ventricles in white elderly individuals be defined as VV>77 mL or RVV>4.96 %. Future studies should compare intracranial volumes with clinical characteristics and prognosis.
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Comparative Study
Thermal comparison of novel bipolar forceps in bovine liver.
The goal of this work was to determine whether bipolar forceps using a novel heat pipe thermal regulation technology result in decreased thermal damage of untargeted collateral tissue compared with traditional bipolar forceps. ⋯ In an ex vivo study of bovine liver bipolar coagulation, forceps that incorporated heat pipe technology limited thermal spread and reduced the extent of unintended injury to untargeted collateral tissue.
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We examined reactive oxygen species (ROS) generation on cerebral ischemia/reperfusion by intravital fluorescence imaging. ⋯ ROS production increased in the early period of reperfusion but not during ischemia, which was location selective, being significant in the areas adjacent to the arteries. Our method was useful for investigating intracellular in situ ROS production.
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The restoration of sensory and motor function in brachial plexus root avulsion patients is a difficult challenge. The central nervous system plays an important role in sensory recovery after peripheral nerve injury and repair. ⋯ The cortical reorganization occurred only in the ipsilateral hemisphere, which is different from the motor cortex reorganization using the same model as that described in a previous study. This reorganization pattern offers an interpretation of the unique sensory recovery process after the transfer of the C7 nerve to the contralateral median nerve, but also provides the basis for further sensory restoration in clinical practice.