Eimir Perez-Arjona

Brain retraction injury.

Abstract This paper reviews the literature of the brain retraction injury during the last century. The review focused on the instrument characteristic as well as the physiopathological and histopathological damage of the brain induced by brain retraction. It was found that lesions were induced by cerebral ischemia. We conclude that a better monitoring system needs to be developed to avoid brain injury.

Direct percutaneous carotid artery stenting with distal protection: technical case report

Abstract We describe the technique of percutaneous carotid artery stent placement with distal protection in a patient in whom marked innominate artery ectasia prevented transfemoral access to the right common carotid artery. After induction of general anesthesia, ultrasound was used to guide direct puncture of the common carotid artery followed by the introduction of a 5 French sheath. A GuardWire distal protection balloon (Medtronic, Santa Rosa, CA) was placed distal to the lesion and deployed at nominal diameter. A balloon-expandable stent was deployed without difficulty. Following stent placement, angiography demonstrated improved flow in the entire right carotid artery territory. There were no complications related to cervical soft tissue damage or clinical embolism. The patient tolerated the procedure well and was discharged in 24 hours. Direct carotid access is acceptable in select patients in whom a transfemoral, brachial, or transradial approach is technically difficult. The use of distal cerebral protection devices may reduce cerebral embolism associated with these procedures.

Stereolithography: Neurosurgical and medical implications

Abstract We present material to define and understand the concept of Stereolithography (STL) and its potential benefits to the field of neurosurgery and other medical specialties. A historical and scientific review of the literature on stereolithography, its evolution and uses in neurosurgery, forensic medicine, and other medical specialties are described. Considerations regarding different techniques used to obtain STL are discussed. The reproduction of cranial and vascular structures using this technique is evaluated. Data acquisition and model fabrication are the two basic steps required for stereolithography to create custom models for multiple applications in cranio-facial surgery, vascular studies, orthopedic surgery, urology and forensic medicine, among others. Stereolithography is a relatively new technique which continues to grow in many medical fields. Pre-operative education of patients, better understanding of patient anatomy, and the creation of custom-made prostheses are proven benefits of this technique.

New techniques in cerebral imaging.

Abstract This article presents a review of the current techniques in Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) that enhance the usefulness of these tests for the diagnosis of cerebral disease. We were able to analyze concepts and definitions and give a comparative description for each test studied including Multidetector/Perfusion CT, Xenon CT, CT-Angiogram, MRI-Perfusion, MRI-Diffusion, MRIS-pectroscopy, MRI CSF Flow, Functional MRI studies and Cerebral Angiography. [Neurol Res 2002; 24: S17-S26]

Late outcome following central nervous system injury in child abuse

Abstract Objective. The object of this study was to increase our understanding of the social, clinical, radiographic and psychological consequences of child abuse after the initial insult and to describe the role of neurosurgery and other specialties in this context. Methods. A review of the literature on child abuse (using scientific journals, textbooks, and internet reports) was conducted, with special attention given to child abuse in infants. The biomechanical patterns of injury, the long-term neurological, psychological, and social outcomes and methods of rehabilitation are reviewed. Conclusions. Head injury associated with physical abuse carries a significantly worse clinical outcome than accidental trauma. Late findings in CT scans and MRI show evidence of cerebral atrophy in 100% and cerebral ischemia in 50% of physical abuse cases. Abuse and neglect have a strong impact in developing children, producing emotional, cognitive, and social problems that may persist throughout the rest of their lives. Outcome cannot be improved without an integrated rehabilitation strategy encompassing early field management, hospital therapy, precise targeting of educational and cognitive needs, and finally return to the community. New ancillary tests have emerged that are aimed at improving rehabilitation and illuminating the long-term physiological and functional impact of abuse.

Current concepts on the expression of neurotrophins in the greater omentum.

Abstract The omentum has been utilized in Neurosurgery since the late 1960s. Its overwhelming effects on fibroblast and peripheral nerve growths were soon noticed. However, there was no direct evidence of production of any of the growth factors by the omentum, although substances were shown to be present in the omentum. Three animals were used in the study.After removal of the omentum in one, the8 tissue was submitted to PCR for BDNF, NT3/4 and NT5. Water was the negative control utilized. There was marked expression of all neurotrophins in the omentum, indicating local production of all those substances. The omentum has, for the first time, demonstrated to produce and not only accumulate neurotrophins. Utilization of this concept may permit transplant or transposition of parts of the omentum into the central nervous system for the management of multiple diseases, including vascular dementia, strokes, Alzheimers disease or Moya-Moya disease.

CNS child abuse: Epidemiology and prevention

Abstract The problem of child abuse and the central nervous system implications are reviewed from a multidimensional approach. Statistics regarding prevalence, risk factors, epidemiological considerations, and physiological aspects are studied. The incidence is reviewed in the United States and in other countries where incidence and social services are also described. Implications for prevention efforts are considered. [Neurol Res 2002; 24: 29-40]

Secuelas neurológicas del maltrato infantil: Revisión bibliográfica

Summary Child abuse is both socially and medically troublesome and many times produces permanent consequences. A review of the literature is done from a neurosurgical standpoint, and the lesions produced at the Central Nervous System are evaluated in detail, including their physiopathology, neurological sequels and implications for rehabilitation treatment and the childs future life.

Baseball bats: a silent weapon

Abstract Objective: The objective of this work was to understand how the baseball bat is a silent weapon. The baseball bat has been utilized illegally in different areas of the world. In the past, several case reports are known for their lethal effect. In this paper, we analyse the outcome of the utilization of baseball bat for illegal purposes as well as review the principal injury and the utilization of baseball bat as explained by an engineer. Material and Method: The medical and radiographic records of patients admitted to Sinai-Grace and Detroit Receiving Hospitals in Detroit, MI, USA, from June 1997 to June 2000, were reviewed. Ninety patients presented with documented baseball bat injury by history. Clinical data were obtained from the patients charts. Detailed descriptions of those body parts affected by baseball bat injury were registered and classified by anatomical regions. Results: A total of 39 cranial fractures were observed, mainly on the skull base and orbital wall. Discussion: Baseball bat-related injury is an endemic problem in Detroit. This urban use of the baseball bat as a weapon is getting severe. A team approach to this type of injury is recommended.