Patterns of Drug Use and Serum Sodium Concentrations in Older Hospitalized Patients : A Latent Class Analysis Approach

Peer reviewedPublisher PD

Relationship between body temperature and neurological outcome in patients with acute brain injury: systematic review of clinical evidence (06AP03-11)

Background and Goal of Study: Temperature alterations in neurocritical care setting are common and have striking effect on brain metabolism leading or exacerbating neuronal injury. Fever (T >38,3°C) also negatively impact on acute brain injury (ABI) patients outcome. Conclusive evidence linking temperature control to improved outcome is still lacking. Aim of this review article is to evaluate the relationship between changes in body temperature in ABI and outcome. Materials and Methods: A literature search of 2 medical database was accomplished: PubMed Medline. Only complete studies (no abstracts), published in English in peer-reviewed journals were included. Two authors (M.P and P.S) independently screened and assessed titles, abstracts, and the full-text papers, using inclusion and exclusion criteria. A total of 32401 papers were screened and 32354 were excluded. We present 47 articles into 5 subchapters: mixed acute brain injury (7), brain trauma (6), intracranial hemorrhage (5), subarachnoid hemorrhage (12); ischemic stroke (17). Results and Discussion: ABI: fever correlates with increased inhospital mortality and functional outcome increasing brain metabolism and reducing blood flow. Brain trauma: fever in the first 48 hours after trauma did not predict mortality. Both the degree and duration of early post-trauma hyperthermia were strongly related with outcome.Intracranial hemorrhage: fever determines prognosis. Also subacute fever in large volume hematoma is a driver of neurological deterioration. Subarachnoid hemorrhage: the impact of fever on poor outcome is related to cerebral inflammatory response initiated at the time of aneurysm rupture, increased rate of vasospasm and delayed ischemic neurological deficits (DIND), increased ICP related to metabolic distress. Ischemic stroke: delayed hyperthermia is adverse associated with long-term outcomes and mortality compared with early period after an ischemic stroke. In patients treated with recanalization the role of hyperthermia on outcome is still controversial. Conclusion(s): Fever, infectious or central, is strongly correlated with poor neurological and functional outcome. Optimal patient temperature management and optimal method to recognise and treat infections in absence of fever remain still to define. References: Greer DM, Funk SE, Reaven NL, Ouzunelli M, Uman GC, Impact of Fever on Outcome in Patients With Stroke and Neurologic Injury A Comprehensive Meta-Analysis, Stroke. 2008;39: 3029-303

Optic nerve sheath diameter (ONSD) in sovratentorial brain tumor surgery: an option for non invasive raised ICP detection and management. Preliminary results and feasibility assessment (06AP04-9)

Background and Goal of Study: Increase in optic nerve sheath diameter (ONSD) in transorbital sonography has been proven to be able to non-invasively detect elevated intracranial pressure in different clinical scenarios. The aim of this study is to assess the feasibility of ONSD sonography method detecting changes in intracranial pressure in patients with sovratentorial brain tumors. Materials and Methods: After a learning curve of 25 cases, for two intensivists, high-frequency linear probes 7 Mhz are used to measure ONSD (ophthalmic artery - optic nerve cross point) in a patients population with sovratentorial brain solid tumors scheduled to elective neurosurgery. A convenience small sample of patients’ cohort with sovratentorial brain tumors scheduled to elective neurosurgery was analyzed. ONSD was measured, also, in preoperative RMN and/or CT scan and compared with postoperative CT scan in another small cohort of patients. Results and Discussion: A total of 25 encounters were completed. ONSD was enlarged in 94.3% of patients bilaterally (cut off > 5.5 mm). The mean ultrasound ONSD before surgery was 6,64 +/- 0,33 mm preoperatively and 5,31 +/- 0,10 mm postoperatively. Mean ONSD on CT/MRI scan was respectively 5,62 +/- 0,51 mm preoperatively and 5,42 +/- 0,46 mm postoperatively. We also found a good correlation between the side of lesion and rasied ONSD. Conclusion(s): ONSD ultrasound measurement in sovratentorial tumors patient population could be an optional non invasive method, beside CT or MRI to detect changes in intracranial pressure even if the paucity of the sample can’t allow us to make a precise assessment. References: Moretti R, Pizzi B Ultrasonography of the optic nerve in neurocritically ill patients, Acta Anaesthesiol Scand 2011; 55: 644-652. Bekerman I, Sigal T, Kimiagar I, Almer ZE, Vaiman M., Diagnostic value of the optic nerve sheath diameter in pseudotumor cerebri. J Clin Neurosci. 2016 Aug;30:106-9. Frederick A. Zeiler, Markus T.Ziesmann, Patrick Goeres, Bertram Unger, Jason Park1, Dimitrios Karakitsos, Michael Blaivas, Ashley Vergis and Lawrence M. Gillman - A unique method for estimating the reliability learning curve of optic nerve sheath diameter ultrasound measurement - Crit Ultrasound J (2016) 8:

The surgical treatment of the first carpometacarpal joint arthritis: evaluation of 400 consecutive patients treated by suspension arthroplasty

Arthritis of the first carpometacarpal joint is a widespread disease in Western countries. It affects predominantly women with marked impairment in daily life activities. Its aetiopathogenesis is well described, while its treatment still controversial. The authors report their experience with 400 consecutive patients with established clinical and radiological findings of carpometacarpal joint arthritis treated by suspension arthroplasty with Ceruso's modified Weilby's technique. At 12 months follow-up, we were able to assess 315 patients using MAYO's score pre- and post-operatively, obtaining 86 excellent results, 134 good, 62 fair and 33 poor. As for complications, there were seven infections, 32 persistent pain and 42 limited range of motion. According to our experience the treatment modality of suspension arthroplasty with Ceruso's modified Weilby's technique represents the procedure of choice in indicated cases of first carpometacarpal joint arthritis in advanced stages according to Eaton-Littler classification