Acute ischemia in the complete territory of the carotid artery may lead to massive cerebral edema with raised intracranial pressure and progression to coma and death due to uncal, cingulate, or tonsillar herniation. Although clinical data suggest that patients benefit from undergoing decompressive surgery for acute ischemia, little data about the effect of this procedure on experimental ischemia are available. this article the authors present results of an experimental study on the effects of decompressive craniectomy performed at various time points after endovascular middle cerebral artery (MCA) occlusion in rats.Focal cerebral ischemia was induced in 68 rats using an endovascular occlusion technique focused on the MCA. Decompressive cranioectomy was performed in 48 animals (in groups of 12 rats each) 4, 12, 24, or 36 hours after vessel occlusion. Twenty animals (control group) were not treated by decompression craniectomy. The authors used the infarct volume and neurological performance at Day 7 as study endpoints.Although the mortality rate in the untreated group was 35%, none of the animals treated by decompressive craniectomy died (mortality 0%). Neurological behavior was significantly better in all animals treated by decompressive craniectomy, regardless of whether they were treated early or late. Neurological behavior and infarction size were significantly better in animals treated very early by decompressive craniectomy (4 hours) after endovascular MCA occlusion (p less than 0.01); surgery performed at later time points did not significantly reduce infarction size.The results suggest that use of decompressive craniectomy in treating cerebral ischemia reduces mortality and significantly improves outcome. If performed early after vessel occlusion, it also significantly reduces infarction size. By performing decompressive craniectomy neurosurgeons will play a major role in the management of stroke patients.
This case has been presented as a poster presentation at the annual congress of the AGKi (Arbeitsgemeinschaft für Kieferchirurgie), Bad Homburg, on 10th May 2013. The authors disclose any commercial associations, current and within the past 5 years, that might pose a potential, perceived or real conflict of interest.
AbstractTwenty to thirty per cent of wisdom teeth are partially or completely retained. A displacement of such teeth into the ascending ramus of the mandible is far less frequent with few reported cases in the literature. The case of a young lady and a review of the literature are presented. A 27-year-old woman was referred to the specialist department by her dentist. At the age of 22, a panoramic radiograph had been taken for an agenesis of the patient's lower left second molar. At this time, the lower left third molar was situated slightly submucosally at the angle of the mandible. In the present radiograph, the tooth had migrated into the ascending ramus of the mandible. Clinically, there was no pain, sensation disorder, disturbed occlusion, limited mouth opening or any other complaint. Due to significant tooth migration within the last 6 years, operative removal of the displaced tooth was recommended. Computed tomography showed that the distal root was in direct relation with the inferior alveolar nerve. Treatment was performed via a transoral approach. Post-operative follow-up was uneventful. This case stresses the importance of long-time follow-up of retained teeth and their immense potential for migration.
In cases of numerous confluent and surgically not removable BCC, PDT represents an effective therapy. Frequent monitoring is necessary to maintain the clinical outcome.
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