Gender effect on the Relation between Diabetes and Hospitalization for Heart Failure

Aims: Cardiovascular risk among diabetic patients is at least twice as much the one for nondiabetic individuals and even greater when diabetic women are considered. Heart failure (HF) is a common unfavorable outcome of cardiovascular disease in diabetes. However, since the comparison among sexes of heart failure prevalence in diabetic patients remains limited, this study is aimed at expanding the information about this point. Methods: We have evaluated the association between diabetes and HF by reviewing the medical records of all subjects discharged from the Internal Medicine and Cardiology Units of all hospitals in the Tuscany region, Italy, during the period January 2002 through December 2008. In particular we sought concomitance of ICD-9-CM codes for diabetes and HF. Results: Patients discharged by Internal Medicine were on average older, more represented by women, and had a lesser number of individuals coded as diabetic (p < 0.05 for all). Relative risk for HF (95 % CI) was signifi cantly higher in patients with diabetes, irrespective of gender 1.39 (1.36– 1.41) in males; 1.40 (1.37–1.42) in females. When the diabetes-HF association was analyzed according to decades of age, a “horse-shoe” pattern was apparent with an increased risk in 40–59 years old in female patients discharged by Internal Medicine. Conclusions: Although there is not a diff erence in the overall HF risk between hospitalized male and female diabetic patients, women have an excess risk at perimenopausal ag

A large dumbbell glossopharyngeal schwannoma involving the vagus nerve: a case report and review of the literature

<p>Abstract</p> <p>Introduction</p> <p>Schwannoma arising from the glossopharyngeal nerve is a rare intracranial tumor. Fewer than 40 cases have been reported. Accurate pre-operative diagnosis and optimal treatment are still difficult.</p> <p>Case presentation</p> <p>We present one case of schwannoma originating from the ninth cranial nerve with palsies of the trigeminal nerve, facial-acoustic nerve complex, and vagus nerve in addition to ninth nerve dysfunction. Magnetic resonance imaging showed tumors located in the cerebellopontine angle with extracranial extension via the jugular foramen, with evident enhancement on post-contrast scan. Surgical management single-staged with the help of gamma knife radiosurgery achieved total removal.</p> <p>Conclusion</p> <p>Glossopharyngeal schwannoma is devoid of clinical symptoms and neurological signs. High resolution magnetic resonance imaging may play a key role as an accurate diagnostic tool. A favorable option of approach and appropriate planning of surgical strategy should be the goal of operation for this benign tumor.</p

Intracranial pressure monitoring after endoscopic third ventriculostomy: an effective method to manage the 'adaptation period'

Endoscopic third ventriculostomy (ETV) has become the treatment of choice for non-communicating hydrocephalus. Nevertheless, which technique should be considered of choice to identify features correlating with the failure of an endoscopic procedure and which is the optimal postoperative period care standard are still a matter of debate. Traditional neuroimaging techniques have several limitations in assessing the success of the procedure mostly in the early postoperative period. Indeed, a decrease in the ventricular size is often minimal and not visible before 3–4 weeks. MRI, able to detect the presence of a flow void signal through the third ventricle floor, has been reported to have a significantly high incidence of false positives. In our experience, the continuous measuring of intracranial pressure (ICP) by means of a ventricular catheter has been of great help in verifying the correct functioning of the communication between the ventricle and the subarachnoidal spaces during the first postoperative days. Furthermore, ICP monitoring allowed us to safely deal with the intracranial hypertension that may occur shortly after ETV

In-vivo biodegradation of alumino-silicates in Dentistry

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Expansion diverticulum of the suprapineal recess causing cerebellar ataxia. A case report.

As a result of long-standing cerebrospinal fluid (CSF) pulsation against the thinnest segments of the ventricular walls, focal enlargement of the ventricular system (diverticulum) may occur, mainly at the medial wall of the trigone of the lateral ventricles (atrial diverticula) or at the posterior wall of the third ventricle (expansion of the suprapineal recess). In the latter case, ocular signs are the most common symptoms, due to the severe deformation of the periaqueductal region. We describe a case of non-communicating hydrocephalus in a 36-year-old woman who presented a three-year history of cerebellar ataxia. Preoperative brain magnetic resonance (MR) scan showed marked supratentorial hydrocephalus with an apparently patent aqueduct of Sylvius, and an enlarged suprapineal recess causing cerebellar and tentorial dislocation. The patient was successfully treated by endoscopic third ventriculostomy and monitored by MR scans with phase-contrast sequences for assessment of CSF flow. Cerebellar ataxia is a very rare symptomatic onset for a suprapineal recess expansion diverticulum, which may cause obstructive hydrocephalus that can be effectively treated by endoscopic third ventriculostom

Expansion diverticulum of the suprapineal recess causing cerebellar ataxia. A case report

As a result of long-standing cerebrospinal fluid (CSF) pulsation against the thinnest segments of the ventricular walls, focal enlargement of the ventricular system (diverticulum) may occur, mainly at the medial wall of the trigone of the lateral ventricles (atrial diverticula) or at the posterior wall of the third ventricle (expansion of the suprapineal recess). In the latter case, ocular signs are the most common symptoms, due to the severe deformation of the periaqueductal region. We describe a case of non-communicating hydrocephalus in a 36-year-old woman who presented a three-year history of cerebellar ataxia. Preoperative brain magnetic resonance (MR) scan showed marked supratentorial hydrocephalus with an apparently patent aqueduct of Sylvius, and an enlarged suprapineal recess causing cerebellar and tentorial dislocation. The patient was successfully treated by endoscopic third ventriculostomy and monitored by MR scans with phase-contrast sequences for assessment of CSF flow. Cerebellar ataxia is a very rare symptomatic onset for a suprapineal recess expansion diverticulum, which may cause obstructive hydrocephalus that can be effectively treated by endoscopic third ventriculostom

Is the distance between mammillary bodies predictive of a thickened third ventricle floor?

Advances in the ETV technique have been based on a detailed understanding of third ventricular anatomy, surgical trajectories, and improved instrumentation.Knowledge of third ventricle anatomy is essential for the safety and reliability of intraventricular endoscopic procedures. Many anatomical variants or anomalies can complicate the ETV procedure and compromise the surgical results for example, thickening of the TVF, which disturbs the usual anatomical orientation and can render perforation of the floor technically difficult; a narrow foramen of Monro; or the so-called upward ballooning phenomenon, in which, after perforation of the TVF and withdrawal of a Fogarty catheter, the floor herniates into the third ventricle, hindering the endoscopic view. The operative results mainly depend on the selection of suitable hydrocephalic patients; therefore, specific MR imaging findings in the evaluation of the pathophysiological and anatomical prerequisites are a fundamental part of preoperative planning. Unfortunately, the consistency of the TVF cannot be adequately determined preopera-tively based on MR images, even with an advanced MR imaging protocol and 3D reconstruction. However, the distance between MBs, the fundamental anatomical landmarks for ETV, is a linear measure readily assessable on axial MR images and can provide indirect information about the conformation of the TVF. A thorough search of the medical literature failed to reveal any systematic MR imaging evaluation of this particular measure in healthy persons or in an ETV study. Because in neuroendoscopic studies variable IMDs and a thickened TVF have been commonly observed, we retrospectively evaluated the IMDs on routine MR images both in 23 patients with hydrocephalus who had undergone ETV and in 120 healthy persons to define normal values of the IMD, which to our knowledge has never been reported, and to assess the possible correlation between such preoperative measures and the thickness of the TVF in patients with hydrocephalus

Retropharyngeal cerebrospinal fluid collection as a cause of postoperative dysphagia after anterior cervical discectomy

Background: Transient dysphagia after anterior cervical discectomy is not uncommon. It is usually related to esophageal edema secondary to retraction, mechanical adhesions of the esophagus to the anterior spine, and stretch injuries to nerves involved in the swallowing mechanism. Structurally induced dysphagia, secondary to laceration of the neck viscera or to the presence of retropharyngeal masses, is by far less frequent, and it does not usually improve over time. Case Description: The authors present the case of a 36-year-old woman who complained of severe dysphagia both for solids and liquids after C4 through C5 anterior discectomy and fusion,complicated by a millimetric dural tear of the anterior thecal sac. Postoperative neuroimaging revealed retropharyngeal fluid collection, extending in front of the vertebral bodies of C3, C4, and C5, exerting a mass effect on the posterior wall of the pharynx. Taking into account both the MRI aspect of the collection and the dramatic improvement of symptoms after lumbar punctures, we conducted a diagnosis of CSF collection in continuity with the subarachnoid space. The dysphagia and the CSF collection resolved with conservative therapy (bed rest and 3 lumbar punctures). Conclusion: To the best of our knowledge, such a complication has never been described before in the literature. It should be included in the differential diagnosis of patients with postoperative dysphagia lasting more than 48 hours

Retropharyngeal cerebrospinal fluid collection as a cause of postoperative dysphagia after anterior cervical discectomy.

Background: Transient dysphagia after anterior cervical discectomy is not uncommon. It is usually related to esophageal edema secondary to retraction, mechanical adhesions of the esophagus to the anterior spine, and stretch injuries to nerves involved in the swallowing mechanism. Structurally induced dysphagia, secondary to laceration of the neck viscera or to the presence of retropharyngeal masses, is by far less frequent, and it does not usually improve over time. Case Description: The authors present the case of a 36-year-old woman who complained of severe dysphagia both for solids and liquids after C4 through C5 anterior discectomy and fusion, complicated by a millimetric dural tear of the anterior thecal sac. Postoperative neuroimaging revealed retropharyngeal fluid collection, extending in front of the vertebral bodies of C3, C4, and C5, exerting a mass effect on the posterior wall of the pharynx. Taking into account both the MRI aspect of the collection and the dramatic improvement of symptoms after lumbar punctures, we conducted a diagnosis of CSF collection in continuity with the subarachnoid space. The dysphagia and the CSF collection resolved with conservative therapy (bed rest and 3 lumbar punctures). Conclusion: To the best of our knowledge, such a complication has never been described before in the literature. It should be included in the differential diagnosis of patients with postoperative dysphagia lasting more than 48 hours