Support the Haiti Disaster Relief Effort

Tuesday, October 10, 2006

Endoscopic Neurological Surgery

Overview
Endoscopic neurosurgery has greatly simplified the management of many intracranial ailments in adults and children. Similar in concept to other endoscopic surgery, intracranial neuroendoscopy reduces the surgical morbidity, shortens the hospital stay, and minimizes the cosmetic concerns associated with many major neurosurgical conditions. In general, neuroendoscopy does not require large incisions on the scalp, removal of skull flaps, or extensive dissection through brain tissue. In the past several years the technological advancements in endoscope design have been substantial. A reduced size, improved resolution, and brighter illumination of the endoscope has allowed the benefits of endoscopic surgery to be applied in neurosurgery.

Neuroendoscopy has dramatically altered the management of several diseases affecting the central nervous system of children and adults. At the Minimal Access Surgery Center, endoscopic neurosurgical procedures have been used in the treatment of hydrocephalus, intracranial cysts, and intraventricular brain tumors.

http://www.nyp.org/masc/neurosurgery.htm

Tuesday, October 03, 2006

Epidemic vs. endemic, R0 & S

epidemic--> the rate of a disease spreading throu a population is larger than expected. eg, epidemic outspread of plaque in europe, epidemic AIDS in Africa.

Endemic--> the rate of a disease remains the same; no increase nor decrease.
To be endemic, R0 x S=1 (an infected individual can spread to 1 person only on average. R0=1).

R0 is the basic reproductive number, meaning the susciple number of seondary infections an infected individual can spread. If R0>1, the disease will spread in the population and become epidemic. If R0<1, disease will fade out.


S stands for suspecible population, meaning w/o any vaccine.

Streptomycin

http://en.wikipedia.org/wiki/Streptomycin

antiobiotic drug--> comes from a gram-positive bacterium (Actinobacterium).

Streptomycin is an antibiotic drug, the first of a class of drugs called aminoglycosides to be discovered, and was the first antibiotic remedy for tuberculosis. It is derived from the actinobacterium Streptomyces griseus. Streptomycin stops bacterial growth by damaging cell membranes and inhibiting protein synthesis. Specifically, it binds to the 23S rRNA molecule of the bacterial ribosome, which prevents the release of the growing protein (polypeptide chain). Humans have structurally different ribosomes than bacteria, thereby allowing the selectivity of this antibiotic for bacteria. Streptomycin cannot be given orally, but must be administered by regular intramuscular injection.
[edit]

History

It was first isolated on October 19, 1943 in the laboratory of Selman Abraham Waksman at Rutgers University by Albert Schatz, a graduate student in his laboratory. Waksman and his laboratory discovered several antibiotics, including actinomycin, clavacin, streptothricin, streptomycin, grisein, neomycin, fradicin, candicidin, candidin, and others. Two of these, streptomycin and neomycin, found extensive application in the treatment of numerous infectious diseases. Streptomycin was the first antibiotic that could be used to cure the disease tuberculosis. Waksman is credited with having coined the term antibiotics.

The details and credit for the discovery of streptomycin were strongly contested by Albert Schatz and resulted in litigation. The contention arose because Schatz was the graduate student in charge of performing the lab work on streptomycin; however, it was argued that he was using techniques, equipment and lab space of Waksman's while under Waksman's direction. There is contention as to whether or not Schatz should have been included in the Nobel Prize awarded in 1952. However, the committee stated that the Nobel Prize was awarded not only for the discovery of streptomycin but also for the development of the methods and techniques that led up to its discovery and the discovery of many other antibiotics.

The litigation ended with a settlement for Schatz and the official decision that Waksman and Schatz would be considered co-discoverers of streptomycin. Schatz was awarded the Rutgers medal in 1994, at the age of 74. The controversy ultimately had a negative impact on the careers of both Waksman and Schatz and the controversy continues today.

Mycobacterium & Actinobacteria

http://en.wikipedia.org/wiki/Mycobacterium

Mycobacterium is a genus of Actinobacteria, given its own family, the Mycobacteriaceae. It includes many pathogens known to cause serious diseases in mammals, including tuberculosis and leprosy.

The Actinobacteria or Actinomycetes are a group of Gram-positive bacteria. Most are found in the soil, and they include some of the most common soil life, playing an important role in decomposition of organic materials, such as cellulose and chitin.

Gamma Knife® Surgery, Khyphoplasty, Carpel Tunnel Syndrome, Hyperhidrosis

http://www.temple.edu/medicine/departments_centers/clinical_departments/neurosurgery_clinical_progs.htm

Gamma Knife® Surgery


Developed over 30 years ago in Sweden, Gamma Knife® surgery is a unique, non-invasive method of operating on certain types of brain tumors. Because the procedure is non-invasive, Gamma Knife® patients face little risk of infection or excessive inflammation, the two most significant issues with traditional surgery. Often patients do not require general anesthesia, leading to shorter recovery periods. Most surgeries can be performed in one day, with many patients returning to their homes the same evening. The Gamma Knife® itself consists of a spherical housing in which 201 beams of cobalt radiation are arranged. Alone, each of these beams is relatively weak, but when all 201 beams intersect at the same time at a single point, the energy in that center point is very high. During surgery, the patient's head is restrained in a special frame and positioned so that the tumor is centered in the spot where all of the beams intersect. This way, the tumor receives a strong dose of radiation while the surrounding brain tissue receives very little radiation. The shape and dose of the radiation is optimized to hit only the target, without damaging surrounding healthy tissue.



When treatment is complete, the head frame is removed. If the patient has been given an angiogram, which involves an IV, they might be required to remain in a reclining position for several more hours so that the doctors can continue to monitor their recovery. Some patients experience a mild headache or minor swelling where the head frame was attached, but most report no discomfort following surgery. Most patients are able to return to their normal routine within another day or two.



The effects of Gamma Knife® treatment will occur over time. Radiation treatments are designed to stop the growth of tumors or lesions, which means that the effect will be seen over a period of weeks or months. The patient's physician will monitor and assess their progress, which may include follow-up MRI, CTs or angiography images.



Return to top




Kyphoplasty



The Condition: Spinal Fractures



Osteoporosis causes more than 700,000 spinal fractures each year in the U.S. According to the National Osteoporosis Foundation, this is more than twice the annual number of hip fractures.



Spinal fractures can also be caused by cancer, the most common being multiple myeloma. According to the Multiple Myeloma Research Foundation, in the majority of patients with multiple myeloma, osteolytic lesions develop which weaken the bone, causing pain and increasing the risk of fractures.



Some spinal fractures may collapse acutely while others collapse more slowly. Left untreated, one fracture can lead to subsequent fractures, often resulting in a condition called kyphosis, or rounded back. Kyphosis, signified by the dowager’s hump, can compress the chest and abdominal cavity, which may result in negative health consequences.



Balloon Kyphoplasty is a minimally invasive, orthopaedic treatment that stabilizes the fracture, thereby reducing pain and providing for correction of the deformity.



Studies also report the following benefits:



* Correction of vertebral body deformity
* Significant reduction in back pain
* Significant improvement in quality of life
* Significant improvement in mobility, including the ability to perform daily activities such as walking, hobbies and work
* Significant reduction in the number of days per month that a patient remains in bed
* Low complication rate

About the Balloon Kyphoplasty Procedure

* The spine specialist creates a small pathway into the fractured bone. A small, orthopaedic balloon is guided through the instrument into the vertebra. The incision site is approximately 1 cm in length.
* The balloon is carefully inflated in an attempt to raise the collapsed vertebra and return it to its normal position. Inflation of the balloon creates a void (cavity) in the vertebral body.
* Once the vertebra is in the correct position, the balloon is deflated and removed.
* The cavity is filled with bone cement forming an “internal cast” to support the surrounding bone and prevent further collapse.
* Generally, the procedure is done on both sides of the vertebral body.

The Balloon Kyphoplasty procedure typically takes about one hour per fracture and may require an overnight hospital stay. The procedure can be done using either local or general anesthesia; the surgeon will determine the most appropriate method, based on the patient’s overall condition.



Return to top




Brain Topics


We offer an extensive program for treatment of conditions of the brain including:

Arteriovenous malformations
Bell's palsy
Brain tumors
Cancer
Carotid disease
Epilepsy
Essential tremor
Head injury
Headaches
Hydrocephalus
Meniere's disease
Multiple sclerosis
Parkinson's disease
Pituitary tumor
Spasticity
Stroke
Trigeminal neuralgia

Return to top




Spine Topics


We offer an extensive spinal surgery program treating a variety of conditions including:

Lumbar disk herniations
Lumbar spinal stenosis
Spasticity
Spinal tumor

Return to top




Peripheral Nerve Topics



What is carpal tunnel syndrome?



Carpal tunnel syndrome is a common, painful disorder of the wrist and hand.



How does it occur?



Carpal tunnel syndrome is caused by pressure on the median nerve in your wrist. People who use their hands and wrists repeatedly in the same way (for example, illustrators, carpenters, and assembly-line workers) tend to develop carpal tunnel syndrome.


Pressure on the nerve may also be caused by a fracture or other injury, which may cause inflammation and swelling. In addition, pressure may be caused by inflammation and swelling associated with arthritis, diabetes, and hypothyroidism. Carpal tunnel syndrome can also occur during pregnancy.



What are the symptoms?



The symptoms include:

* Pain, numbness, or tingling in your hand and wrist, especially in the thumb and index and middle fingers; pain may radiate up into the forearm
Increased pain with increased use of your hand, such as when you are driving or reading the newspaper
* Increased pain at night
* Weak grip and tendency to drop objects held in the hand
Sensitivity to cold
* Muscle deterioration especially in the thumb (in later stages).

How is it treated?



If you have a disease that is causing carpal tunnel syndrome (such as rheumatoid arthritis), treatment of the disease may relieve your symptoms. Other treatment focuses on relieving irritation and pressure on the nerve in your wrist.



To relieve pressure your doctor may suggest:

* Restricting use of your hand or changing the way you use it
* Wearing a wrist splint during sleep and physical activity involving the wrist
* Exercises.

Your doctor may prescribe a cortisonelike medicine or a nonsteroidal anti-inflammatory medicine, such as ibuprofen. Your doctor may recommend an injection of a cortisonelike medicine into the carpal tunnel area. In some cases surgery may be necessary.


Return to top




Testing



What is CT scanning?




Computed tomography or CT scanning is a radiographic procedure used for diagnosis. X-rays are taken from a series of different angles and assembled to show a cross-sectional view of internal organs. In this procedure your body is exposed to a very small amount of radiation.



When is it used?



CT scanning is used when your doctor needs more detailed information than regular x-rays provide, particularly to look for head injuries, brain disease, and tumors.



How do I prepare for CT scanning?



No preparation is necessary unless your doctor gives you special instructions.



What happens during the procedure?



CT scanning can be done in a hospital. You are put in a reclining position on a moving table that can change your position inside the scanner. The scanner itself can move around you to change the angles of the x-rays. Contrast media may be injected into your blood vessels or you may be asked to swallow the contrast media, which will show any abnormalities as it passes through the body. This process is called enhancement.



Inside the scanning machine, multiple x-ray beams are passed very quickly through your body at different angles. The images are projected onto a TV screen and prepared for the doctor to examine.



What happens after the procedure?



Generally, there are no special measures to take after the procedure.



What are the benefits of this procedure?



A CT scan may help the doctor diagnose your problem.



What are the risks associated with this procedure?



Exposure to radiation is considered unhealthy if you are exposed to it frequently or in large amounts. However, the amount of radiation you receive in a CT scan is not considered threatening.

Pregnant women should not have a CT scan without first discussing the possible risks with their doctor.

There is a small risk that you will have an allergic reaction to the contrast media. Be sure to tell your doctor if you know you are allergic to any medications.
When should I call the doctor?

Call the doctor immediately if you have any change or worsening of pain or symptoms.

Call the doctor during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.


Return to top




Hyperhidrosis (treatment for excessive sweating)


Up to one percent of the population suffers from hyperhidrosis, a neurological condition caused by an overactive sympathetic nervous system. The condition causes excessive sweating, usually of the hands, armpits and feet, making it very difficult to perform even simple acts such as shaking hands or writing on paper or on a keyboard. This problem is much more than cosmetic; the embarrassment associated with it often leads to social avoidance and can greatly impact on one's career and personal life. In severe cases, medical therapies for this condition are not very effective, or have unacceptable side-effects.



Temple neurosurgeons treat hyperhidrosis with an elegant surgical procedure called endoscopic transthoracic sympathectomy (ETS). This minimally-invasive procedure is done through two very small incisions on the side of the chest. Using an endoscope, tiny silver clips are placed across the upper thoracic sympathetic chain inside the chest. Sweating in the hands is usually immediately and permanently eliminated.



"People who have hyperhidrosis have often given up on leading a normal life," says Jack Jallo, M.D. "After the surgery, patients find their hands warm and dry for the first time in many years. To people who have never experienced the problem it might seem trivial, but to those who suffer from hyperhidrosis, it is an intensely emotional issue-one that they cannot easily discuss, often even with their close friends or family.



According to Dr. Jallo, patients are usually sent home the day after surgery, normal activities can be resumed within a couple of days and the quarter inch incisions on both sides of the chest are barely noticeable within a few weeks.

Angiogram

Angiogram
From Wikipedia, the free encyclopedia
Jump to: navigation, search
Patient about to undergo an angiogram, image courtesy of WHO.
Enlarge
Patient about to undergo an angiogram, image courtesy of WHO.

Angiography or arteriography is a medical imaging technique in which an X-ray picture is taken to visualize the inner opening of blood filled structures, including arteries, veins and the heart chambers. Its name comes from the Greek words angeion, "vessel", and graphien, "to write or record". The X-ray film or image of the blood vessels is called an angiograph, or more commonly, an angiogram.

The Portuguese physician and neurologist Egas Moniz, Nobel Prize winner in 1949, developed in 1927 the technique of contrasted x-ray cerebral angiography to diagnose several kinds of nervous diseases, such as tumors and arteriovenous malformations. He is usually recognised as one of the pioneers in this field. With the introduction of the Seldinger technique in 1953, the procedure became markedly safer as no sharp introductory devices needed to remain inside the vascular lumen.

Angiograms require the insertion of a catheter into a peripheral artery, e.g. the femoral artery.

As blood has the same radiodensity as the surrounding tissues, a radiocontrast agent (which absorbs X-rays) is added to the blood to make angiography visualization possible. The angiographic X-Ray image is actually a shadow picture of the openings within the cardiovascular structures carrying blood (actually the radiocontrast agent within). The blood vessels or heart chambers themselves remain largely to totally invisible on the X-Ray image.

The X-ray images may be taken as either still images, displayed on a fluoroscope or film, useful for mapping an area. Alternatively, they may be motion images, usually taken at 30 frames per second, which also show the speed of blood (actually the speed of radiocontrast within the blood) traveling within the blood vessel.

The most common angiogram performed is to visualize the blood in the coronary arteries. A long, thin, flexible tube called a catheter is used so as to administer the radiocontrast agent at the desired area to be visualized. The catheter is threaded into an artery in the groin or forearm, and the tip is advanced through the arterial system into one of the two major coronary arteries. X-ray images of the transient radiocontrast distribution within the blood flowing within the coronary arteries allows visualization of the size of the artery openings. Presence or absence of atherosclerosis or atheroma within the walls of the arteries cannot be clearly determined. See coronary catheterization for more detail.

Angiography is also commonly performed to identify vessel narrowing in patients with retinal vascular disorders, such as diabetic retinopathy and macular degeneration.

Terms

Rheumatism pain caused by inflammation in joints

Coronary heart disease-associated with obesity

Angina-chest pain due to decrease in oxygen

Spasm- involuntary muscle contractions

Vasospasm- narrowing of coronary arteries due to contractions of smooth muscle

Prinzmetal's angina- chest pain in young women. Reason--> narrowing of coronary arteries due to contractions of smooth muscle, not due to atherosclerosis.

ausculation-listening to sounds of the heart using a stethoscope

stereotic- In Greek, stereo=3-dimensional and tactic= touched . Stereotactic surgery--> using 3 dimensional precise location by MRI or CT to go deep into the brain while the patient's head is clamped.