Idiopathic intracranial hypertension (IIH) is a disorder characterized by increased intracranial pressure without any identifiable etiology with normal brain imaging and normal cerebrospinal fluid (CSF) content. CSF d...Idiopathic intracranial hypertension (IIH) is a disorder characterized by increased intracranial pressure without any identifiable etiology with normal brain imaging and normal cerebrospinal fluid (CSF) content. CSF diversion procedures are commonly used for treatment if medical treatment failed. The aim of this study is to report our experience in treatment of IIH with lumboperitoneal (LP) and stereotactic guided ventriculoperitoneal (VP) shunts. The clinical data of 43 consecutive patients with IIH refractory to medical treatment and underwent CSF diversion procedures between 2009 and 2014 were analyzed. 29 patients underwent LP shunts and the remaining 14 patients underwent stereotactic guided Ventricular shunts. All patients underwent clinical, imaging and CSF manometry evaluation. 38 (88.4%) patients were female and the remaining 5 (11.6%) patients were male. The mean age was 27.2 years. The opening pressure was above 300 mm H2O in 26 (69.8%) patients. Headache (100%) and blurring and/or diminution of vision (81.4%) were the commonest clinical presentation. 36 (83.7%) patients reported recovery of their headache and 30 (69.7%) patients showed complete resolution of papilledema. The clinical outcome between both procedures was not significant. The incidence of perioperative complications (20.7% vs. 0%) and shunt revisions (27.6% vs. 7.1%) were higher in patients with LP shunt than patients with stereotactic Ventricular shunts. The results of this study demonstrate that both LP and Ventricular shunts are valid diversion procedures for treatment of IIH. Stereotactic guided Ventricular shunt has lower incidence of complications and revisions and seems to be safe, effective and feasible alternative procedure for treatment of IIH.展开更多
Background: Lumbar disc degeneration [LDD] is the main cause of low back pain, and is a medical circumstance that poses a great load on the global health care system with serious socioeconomic consequences. The aim of...Background: Lumbar disc degeneration [LDD] is the main cause of low back pain, and is a medical circumstance that poses a great load on the global health care system with serious socioeconomic consequences. The aim of this study was to determine the association of vitamin D receptors (VDR) gene Fok1 polymorphism, VDR expression and vitamin D level with LDD susceptibility and severity in Egyptians. Materials and methods: A total of unrelated 169 female patients with low back pain diagnosed as having lumbar disc degeneration and 169 controls were enrolled in the study. VDR Fok1 polymorphism was determined using restriction fragment length polymorphism-polymerase chain reaction [PCR-RFLP]. VDR expression was measured by reverse transcriptase PCR, while, serum levels of vitamin D were measured by high performance liquid chromatography [HPLC]. Results: Subjects with VDR Fok1 ff genotype were significantly more likely to develop LDD in Egyptians and associated with multilevel disc degeneration and disc herniation (adjusted OR = 7.9, 95% CI = 2.3-26.6 and P = 0.01) and (adjusted OR = 2.2, 95% CI = 1.6-3.7 and P = 0.031) respectively. VDR expression and vitamin D levels were significantly decreased in LDD patients and with multilevel disc degeneration and herniation, (adjusted P = 0.042 and adjusted P = 0.028) respectively. Conclusion: VDR Fok1 mutant alleles and genotypes are associated with the development and severity of LDD in Egyptians. Also, VDR expression and vitamin D level could be the marker for monitoring LDD.展开更多
Post-traumatic meningioma is a matter of controversy with many reported cases of cranial post-traumatic meningioma and rare cases for such pathology in human spine. The author reports a 61-year-old woman who had post-...Post-traumatic meningioma is a matter of controversy with many reported cases of cranial post-traumatic meningioma and rare cases for such pathology in human spine. The author reports a 61-year-old woman who had post-traumatic spinal meningioma at the site of old traumatic fracture for 26 year after her initial trauma. The patient treated successfully with microsurgical resection and posterior fusion with improvement of here recent weakness. The author reviews the literatures for similar cases as well as reviews the controversies regarding the development of post-traumatic meningiomas.展开更多
文摘Idiopathic intracranial hypertension (IIH) is a disorder characterized by increased intracranial pressure without any identifiable etiology with normal brain imaging and normal cerebrospinal fluid (CSF) content. CSF diversion procedures are commonly used for treatment if medical treatment failed. The aim of this study is to report our experience in treatment of IIH with lumboperitoneal (LP) and stereotactic guided ventriculoperitoneal (VP) shunts. The clinical data of 43 consecutive patients with IIH refractory to medical treatment and underwent CSF diversion procedures between 2009 and 2014 were analyzed. 29 patients underwent LP shunts and the remaining 14 patients underwent stereotactic guided Ventricular shunts. All patients underwent clinical, imaging and CSF manometry evaluation. 38 (88.4%) patients were female and the remaining 5 (11.6%) patients were male. The mean age was 27.2 years. The opening pressure was above 300 mm H2O in 26 (69.8%) patients. Headache (100%) and blurring and/or diminution of vision (81.4%) were the commonest clinical presentation. 36 (83.7%) patients reported recovery of their headache and 30 (69.7%) patients showed complete resolution of papilledema. The clinical outcome between both procedures was not significant. The incidence of perioperative complications (20.7% vs. 0%) and shunt revisions (27.6% vs. 7.1%) were higher in patients with LP shunt than patients with stereotactic Ventricular shunts. The results of this study demonstrate that both LP and Ventricular shunts are valid diversion procedures for treatment of IIH. Stereotactic guided Ventricular shunt has lower incidence of complications and revisions and seems to be safe, effective and feasible alternative procedure for treatment of IIH.
文摘Background: Lumbar disc degeneration [LDD] is the main cause of low back pain, and is a medical circumstance that poses a great load on the global health care system with serious socioeconomic consequences. The aim of this study was to determine the association of vitamin D receptors (VDR) gene Fok1 polymorphism, VDR expression and vitamin D level with LDD susceptibility and severity in Egyptians. Materials and methods: A total of unrelated 169 female patients with low back pain diagnosed as having lumbar disc degeneration and 169 controls were enrolled in the study. VDR Fok1 polymorphism was determined using restriction fragment length polymorphism-polymerase chain reaction [PCR-RFLP]. VDR expression was measured by reverse transcriptase PCR, while, serum levels of vitamin D were measured by high performance liquid chromatography [HPLC]. Results: Subjects with VDR Fok1 ff genotype were significantly more likely to develop LDD in Egyptians and associated with multilevel disc degeneration and disc herniation (adjusted OR = 7.9, 95% CI = 2.3-26.6 and P = 0.01) and (adjusted OR = 2.2, 95% CI = 1.6-3.7 and P = 0.031) respectively. VDR expression and vitamin D levels were significantly decreased in LDD patients and with multilevel disc degeneration and herniation, (adjusted P = 0.042 and adjusted P = 0.028) respectively. Conclusion: VDR Fok1 mutant alleles and genotypes are associated with the development and severity of LDD in Egyptians. Also, VDR expression and vitamin D level could be the marker for monitoring LDD.
文摘Post-traumatic meningioma is a matter of controversy with many reported cases of cranial post-traumatic meningioma and rare cases for such pathology in human spine. The author reports a 61-year-old woman who had post-traumatic spinal meningioma at the site of old traumatic fracture for 26 year after her initial trauma. The patient treated successfully with microsurgical resection and posterior fusion with improvement of here recent weakness. The author reviews the literatures for similar cases as well as reviews the controversies regarding the development of post-traumatic meningiomas.
