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Article
Subdural Hematoma and Effusion in Children

Author: Ahmed Aman Al-Khalili*, Haider Faris Alwash**
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2017 Volume: 16 Issue: 2 Pages: 117-121
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: Blood gathers between the inner layer of the dura mater and the arachnoid mater. Usually resulting from tears in bridging veins which cross the subdural space, subdural hemorrhages may cause an increase in intracranial pressure (ICP), which can cause compression of and damage to delicate brain tissue. A subdural effusion is a collection of cerebrospinal fluid OBJECTIVE: To gate an opinion about the types of surgical procedures which had been done for the collected cases into 2 centers in BaghdadMETHODS: This is a prospective study conducted at 2 Neurosurgical Hospitals in Baghdad, between September 2012 to December 2013, on 21 children and infants of subdural collection of fluid excluding abscess ages ranging from 40 days to 13 years . Clinical data was collected including symptoms and signs, in addition to assessment of radiological picture and subdural tab and diagnostic burr hole proved the diagnosis .treatment ranged from conservative to surgical interference included burr hole ,subdural peritoneal shunt and craniotomy. condition of the patients during discharge from the hospital was evaluatedRESULTS:In this study , the higher percentage of patient were under the age of one year. no great difference in the sex of patients , disturbance of consciousness was the more type of presentation , unilateral subdural collections were more than bilateral collections. only 12 patients had surgical interference , of these 12 the majority had subdural peritoneal shunt , which seemed to be the most convenient procedure in chronic cases but in acute cases burr holes were the most convenient procedure. craniotomy was also used in treating chronic cases.CONCLUSION : Most of the patient were under one year old , brain ct scan was the diagnostic procedure , brain ultrasound was also useful in diagnosis of subdural collection. the most convenient surgical treatment in acute cases was the burr holes and in chronic cases was the subdural -peritoneal shunt , and to arrange for surgical interference when decided as early as possible to gate better outcome


Article
Chronic Subdural Hematoma A Prospective Study
ورم دموي تحت الجافية المزمن دراسة مستقبلية

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Abstract

Background: Chronic subdural hematoma is a blood collection in the subdural space for more than 3 weeks from the onset of the bleeding. It is more likely to develop in infancy and after the age of 60 years. The incidence of subdural hematoma is 1- 2 per 100,000 people per year.Objective: To delineate the most common feature aspects of SDH like: age, predisposing factors, symptoms and signs and different types of management of the disease.Patients and Methods: A prospective study of 40 patients from the period January 2012 - January 2014, and conducted in Gazi Al-Hariri Hospital of Surgical Specialties, disregarding the age, complaining of chronic subdural hematoma as proved by CT scan. It includes the predisposing factors, the symptoms and signs, the location of hematoma, mode of treatment, complications and the outcome.Results: In this study the highest incidence of CSDH was above 50 year and the second age group was below 1 year. It was more common in males than females and they were unilateral more than bilateral, as shown by C.T scan which was the most reliable method for diagnosis and assessment.Conclusions: The most suitable treatment was burr hole in the older age group but craniotomy with membranectomy were still performed. In patients below 1 year, subdural peritoneal shunt found to be the method of choice. This study shows that the most common complications are the recurrence and infection. Outcome depends mainly on the early recognition and treatment.

المقدمة: النزف الدموي تحت الام الجافية المزمن هو تجمع الدم في المجال تحت الام الجافية لأكثر من 3 أسابيع من بداية النزف. من المرجح أن تحصل في مرحلة الطفولة وبعد سن 60 عاما. حدوث الورم الدموي تحت الام الجافية هو 1-2 لكل 100,000 شخص سنويا.الهدف من الدراسة: لتعيين المميزات الأكثر شيوعا في النزف الدموي تحت الام القاسية مثل: العمر، والعوامل المؤهلة والأعراض والعلامات وطرق العلاج.مرضى وطرق: دراسة مستقبلية من 40 مريضا من الفترة يناير 2012 - يناير 2014، وأجريت في مستشفى غازي الحريري للتخصصات الجراحية، بغض النظر عن العمر، والذين يشكون من ورم دموي تحت الام الجافية المزمن مشخص بالاشعة المقطعية. وتشمل العوامل المؤهلة، والأعراض والعلامات، وموقع الورم الدموي، وطريقة العلاج، والمضاعفات والنتيجة.النتائج: في هذه الدراسة كانت أعلى نسبة للمرضى الذين تتجاوز اعمارهم أكثر من 50 سنة، وكانت الفئة العمرية الثانية الاكثر شيوعا هي الأقل من 1 سنة. وكان الذكور أكثر شيوعا من الإناث وكانت في جهة واحدة أكثر من الثنائية، كما هو مبين من قبل الاشعة المقطعية التي كان الأسلوب الأكثر موثوقية للتشخيص والتقييم.الاستنتاجات: وكان العلاج الأنسب تثقيب الجمجمة في الفئة العمرية الأكبر سنا ولكن فتح الجمجمة مع استئصال الغشاء لا تزال تنفذ. في المرضى الذين تقل أعمارهم عن 1 سنة، وجدت تحويلة تحت الجافية بريتونية لتكون الطريقة المفضلة. وتبين هذه الدراسة أن المضاعفات الأكثر شيوعا هي التكرار والعدوى. النتيجة تعتمد أساسا على التشخيص المبكر والعلاج.التوصيات: تثقيب الجمجمة يجب ان تكون النهج الجراحي الرئيسي في العلاج للمرضى مع اعطاء علاج الستيرويد لتقليل إمكانية التكرار.

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