Severe hydrocephalus is an independent predictor of 30-day mortality in SICH with ventricular extension. The IVH score is a simple and reliable tool for predicting 30-day mortality.
In 12 operatively (stereotactic aspiration and recombinant tissue-type plasminogen activator, rTPA) and 5 conservatively treated patients with spontaneous intracerebral hemorrhage the amounts of cysteinyl-leukotriene (cys-LT) released by blood-brain cell contact were measured by the urinary excretion of their metabolites during treatment. The mean cys-LT release before treatment was 14.51 ± 1.13 pg/mg creatinine/ml hematoma volume. The urinary cys-LT excretion at the end of the measurements was significantly lower in the operatively treated group than in the patients with conservative therapy (p < 0.05). We also found a significant correlation between the perifocal edema volume and the amount of cys-LT measured in patients’ urine (p < 0.01). In an additional animal experiment using dissociated rat brain cells plasmin was excluded as an activator for cerebral cys-LT formation, which emphasizes that rTPA did not influence cys-LT formation.
Our data show significant growth inhibition as well as antiangiogenic effects in intracerebral as well as patient-derived GBM xenografts. This encourages to investigate in detail the multifactorial effects of 5-azacitidine on glioblastomas.
External drainage of CSF in children is indicated in acute hydrocephalus e.g. after intraventricular bleeding or infection. In these cases the drainage has to remain in place until physiological CSF circulation is restored or an internal shunt can be inserted. External drainage is mostly performed using a silicon catheter connected to a plastic bag. An external CSF drainage left for several days in situ bears an increasing risk of bacterial infection. In these cases a metal needle minimizes the risk of ventriculitis. For prevention of accompanying infection we implanted a Cytocan port needle with a 20 G diameter in 7 infants. The needle is easily inserted with low risk of complications. By its plastic top angulated at 90 degrees to the needle the system can be fixed to the skin very safely by suture or tape. With this system neither an implantation related intracerebral haemorrhage nor an accompanying ventriculitis was encountered. In two cases a pre-existing ventriculitis was cured by this needle drainage and antibiotic treatment. In five cases an acute hydrocephalus after intraventricular haemorrhage was drained by the port needle system.
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