Grasping the sword of Damocles.
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ABSTRACT:
SUBMITTER: Davies SM
PROVIDER: S-EPMC9642793 | biostudies-literature | 2021 Nov
REPOSITORIES: biostudies-literature
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Project description:The overwhelming post splenectomy infection (OPSI) in splenectomised patients is a rare but severe infection mostly caused by encapsulated bacteria. We analyse the case of a 65-year-old female patient who was presented with clinical and laboratory findings indicating gastroenteritis. Two years years before admission, the patient underwent a splenectomy for a two stage splenic rupture following resuscitation for pulmonary embolism. Immunisation of the patient was complete and timely. As a result of the unspecific clinical presentation, there was a delay in administration of antibiotics. However, administration of antibiotics induced a fulminant shock. The patient died 4 hours after attending the hospital due to a pneumococcal sepsis. The discussion highlights epidemiological and pathophysiological aspects and potential prevention strategies in the international context. Vaccination failed in our patient as the isolated pneumococcal strain (serogroup: 12F) is usually covered by the 23-valent pneumococcal polysaccharide vaccination (Pneumovax(®)). The case reported here indicates that there may be a potential benefit of prophylactic antibiotic treatment within the first 3 years after splenectomy for patients above the age of 65 years. Awareness of OPSI (prevention strategies, symptoms and treatment) among patients and their treating physicians is crucial for the improvement of prognosis. We partly address these issues in a standard operating procedure for the assessment of splenectomised patients in our departments of emergency medicine.
| S-EPMC5004600 | biostudies-literature
Project description:Background: The possible influence of different antithrombotic drugs on outcome after neurosurgical treatment of chronic subdural hematoma (CSDH) is still unclear. Nowadays, no randomized clinical trials are available. A metanalysis including 24 studies for a total of 1,812 pooled patients concluded that antiplatelets and anticoagulations present higher risk of recurrences. On the other hand, several studies highlighted that antithrombotic suspension, timing of surgery, and resumption of these drugs are still debated, and patients taking these present higher risk of thromboembolic events with no excess risk of bleed recurrences or worse functional outcome. Our assumption is that the real hemorrhagic risk related to antithrombotic drug continuation in CSDH may be overrated and the thromboembolic risk for discontinuation underestimated, especially in patients with high cardiovascular risk. Methods: A comprehensive literature review with the search terms "acetylsalicylic acid" and "chronic subdural x" was performed. Clinical status, treatment, time of drug discontinuation, complications (in particular, rebleeding or thromboembolic events), and clinical and radiological outcome at follow-up were evaluated. Results: Five retrospective studies were selected for the review, three of them reporting specifically low-dose acetylsalicylic intake and two of them general antithrombotic drugs for a total of 1,226 patients. Only two papers reported the thromboembolic rate after surgery; in one paper, it is not even divided from other cardiac complications. Conclusion: The literature review does not clarify the best management of low-dose acetylsalicylic in CSDH patients, in particular, concerning the balance between thromboembolic event rates and rebleeding risks. We do believe that CSDH precipitates the worsening of comorbidities with a resulting increased mortality. Further studies clearly evaluating the thromboembolic events are strongly needed to clarify this topic. In this perspective paper, we discuss the difficult choice of low-dose acetylsalicylic acid (LDAA) management in patients suffering from chronic subdural hematoma (CSDH). The balance between hemorrhagic and thromboembolic risks often represents a sword of Damocles for neurosurgeons, especially when dealing with patients with high cardiovascular risk. No guidelines are currently available, and a survey by Kamenova et al. showed that most neurosurgeons discontinue LDAA treatment for at least 7 days in the perioperative period of surgical evacuation of CSDH, even though recent studies show that early LDAA resumption might be safe. Thrombosis prophylaxis is administered by only 60%, even though patients with CSDH are at high risk of developing thromboembolic complications. We would like to bring attention to this controversial issue.
| S-EPMC7550681 | biostudies-literature
Project description:IntroductionThe management of a rare case of calcified cerebral emboli associated with a mobile carotid plaque (MCP) is reported and discussed.ReportA 76 year old patient presented with sudden weakness of the left lower limb one month ago, which resolved spontaneously. A cerebral magnetic resonance imaging showed recent multiple infarcts in the right middle cerebral artery (MCA) territory. Computed tomography cerebral angiogram (CTA) revealed calcified cerebral emboli (CCE) in the right MCA territory and an isolated calcified embolus in the M3 segment of the right MCA. No calcification was observed in the aorta. The echocardiogram findings were normal. Trans-oesophageal echocardiography did not show aortic or mitral valve calcifications. A cervical duplex ultrasound (DUS) was performed and demonstrated a highly mobile carotid plaque located in the right carotid bifurcation, contrasting with static CTA imaging showing a common calcified plaque, probably because the plaque appeared against the carotid wall during image acquisition. Antiplatelet and anticoagulation therapy were initiated, and carotid endarterectomy was performed on day two to prevent further embolisation. One month follow up including carotid DUS was satisfactory.DiscussionA case of mobile carotid plaque responsible for CCE which was diagnosed with DUS dynamic imaging is described, emphasizing the importance of multimodal imaging in such settings. Though the treatment of MCP remains controversial because of the paucity of published cases, carotid endarterectomy was considered to be the safest option to prevent recurrent stroke. Additional clinical data including large series and controlled trials are required to determine the best management of mobile carotid plaques with less than 50% diameter carotid stenosis.
| S-EPMC8077171 | biostudies-literature
Project description:Background and objectivesPresymptomatic testing is available for early diagnosis of hereditary autosomal dominant polycystic kidney disease (ADPKD). However, the complex ethical and psychosocial implications can make decision-making challenging and require an understanding of patients' values, goals and priorities. This study aims to describe patient and caregiver beliefs and expectations regarding presymptomatic testing for ADPKD.Design, setting and participants154 participants (120 patients and 34 caregivers) aged 18 years and over from eight centres in Australia, France and Korea participated in 17 focus groups. Transcripts were analysed thematically.ResultsWe identified five themes: avoiding financial disadvantage (insecurity in the inability to obtain life insurance, limited work opportunities, financial burden); futility in uncertainty (erratic and diverse manifestations of disease limiting utility, taking preventive actions in vain, daunted by perplexity of results, unaware of risk of inheriting ADPKD); lacking autonomy and support in decisions (overwhelmed by ambiguous information, medicalising family planning, family pressures); seizing control of well-being (gaining confidence in early detection, allowing preparation for the future, reassurance in family resilience); and anticipating impact on quality of life (reassured by lack of symptoms, judging value of life with ADPKD).ConclusionsFor patients with ADPKD, presymptomatic testing provides an opportunity to take ownership of their health through family planning and preventive measures. However, these decisions can be wrought with tensions and uncertainty about prognostic implications, and the psychosocial and financial burden of testing. Healthcare professionals should focus on genetic counselling, mental health and providing education to patients' families to support informed decision-making. Policymakers should consider the cost burden and risk of discrimination when informing government policies. Finally, patients are recommended to focus on self-care from an early age.
| S-EPMC7549480 | biostudies-literature
Project description:When grasping rectangular or circular objects with a precision grip the digits close in on the object in opposite directions. In doing so the digits move perpendicular to the local surface orientation as they approach opposite sides of the object. This perpendicular approach is advantageous for accurately placing the digits. Trapezoidal objects have non-parallel surfaces so that moving the digits in opposite directions would make the digits approach the contact surfaces at an angle that is not 90 degrees . In this study we examined whether this happens, or whether subjects tend to approach trapezoidal objects' surfaces perpendicularly. We used objects of different sizes and with different surface slants. Subjects tended to approach the object's surfaces orthogonally, suggesting that they aim for an optimal precision of digit placement rather than simply closing their hand as it reaches the object.
| S-EPMC1914251 | biostudies-other
Project description:We used a virtual reality setup to let participants grasp discs, which differed in luminance, chromaticity and size. Current theories on perception and action propose a division of labor in the brain into a color proficient perception pathway and a less color-capable action pathway. In this study, we addressed the question whether isoluminant stimuli, which provide only a chromatic but no luminance contrast for action planning, are harder to grasp than stimuli providing luminance contrast or both kinds of contrast. Although we found that grasps of isoluminant stimuli had a slightly steeper slope relating the maximum grip aperture to disc size, all other measures of grip quality were unaffected. Overall, our results do not support the view that isoluminance of stimulus and background impedes the planning of a grasping movement.
| S-EPMC2755776 | biostudies-other
Project description:The ability to recognize others' actions is an important aspect of social behavior. While neurophysiological and behavioral research in monkeys has offered a better understanding of how the primate brain processes this type of information, further insight with respect to the neural correlates of action recognition requires tasks that allow recording of brain activity or perturbing brain regions while monkeys simultaneously make behavioral judgements about certain aspects of observed actions. Here we investigated whether rhesus monkeys could actively discriminate videos showing grasping or non-grasping manual motor acts in a two-alternative categorization task. After monkeys became proficient in this task, we tested their ability to generalize to a number of untrained, novel videos depicting grasps or other manual motor acts. Monkeys generalized to a wide range of novel human or conspecific grasping and non-grasping motor acts. They failed, however, for videos showing unfamiliar actions such as a non-biological effector performing a grasp, or a human hand touching an object with the back of the hand. This study shows the feasibility of training monkeys to perform active judgements about certain aspects of observed actions, instrumental for causal investigations into the neural correlates of action recognition.
| S-EPMC5678109 | biostudies-literature
Project description:Grasping relies on a network of parieto-frontal areas lying on the dorsolateral and dorsomedial parts of the hemispheres. However, the initiation and sequencing of voluntary actions also requires the contribution of mesial premotor regions, particularly the pre-supplementary motor area F6. We recorded 233 F6 neurons from 2 monkeys with chronic linear multishank neural probes during reaching-grasping visuomotor tasks. We showed that F6 neurons play a role in the control of forelimb movements and some of them (26%) exhibit visual and/or motor specificity for the target object. Interestingly, area F6 neurons form 2 functionally distinct populations, showing either visually-triggered or movement-related bursts of activity, in contrast to the sustained visual-to-motor activity displayed by ventral premotor area F5 neurons recorded in the same animals and with the same task during previous studies. These findings suggest that F6 plays a role in object grasping and extend existing models of the cortical grasping network.
| S-EPMC5193144 | biostudies-literature
Project description: Not available
| S-EPMC9335499 | biostudies-literature
Project description:Weber's law states that our ability to detect changes in stimulus attributes decreases linearly with their magnitude. This principle holds true for many attributes across sensory modalities but appears to be violated in grasping. One explanation for the failure to observe Weber's law in grasping is that its effect is masked by biomechanical constraints of the hand. We tested this hypothesis using a bimanual task that eliminates biomechanical constraints. Participants either grasped differently sized boxes that were comfortably within their arm span (action task) or estimated their width (perceptual task). Within each task, there were two conditions: One where the hands' start positions remained fixed for all object sizes (meaning the distance between the initial and final hand-positions varied with object size), and one in which the hands' start positions adapted with object size (such that the distance between the initial and final hand-position remained constant). We observed adherence to Weber's law in bimanual estimation and grasping across both conditions. Our results conflict with a previous study that reported the absence of Weber's law in bimanual grasping. We discuss potential explanations for these divergent findings and encourage further research on whether Weber's law persists when biomechanical constraints are reduced.
| S-EPMC8641124 | biostudies-literature