Objective To set up a new grading system of intraventricular hemorrhage (IVH) and determine the value of predicting the probability of post-hemorrhagic hydrocephalus (PHH) in IVH. Methods We first modified the Graeb c...Objective To set up a new grading system of intraventricular hemorrhage (IVH) and determine the value of predicting the probability of post-hemorrhagic hydrocephalus (PHH) in IVH. Methods We first modified the Graeb criteria, then compared the value of prediction for PHH assessed by the Graeb criteria with the modified Graeb criteria. One hundred and thirty one IVH patients were divided into two groups: the upper group (n=67) and the lower group (n=64). Gold standard of PHH was assessed by CT scan or by out-drainage. The diagno-stic parameters such as sensitivity (SE), specificity (SP) were analyzed. In the cutoff point of SE and SP curves, diagnostic efficiency (DE), and Kappa value (K) were analyzed. The probability of PHH was estimated by binary logistic regressions. Results In all ventricular group, to Graeb criteria in the cutoff point, SE, SP, and K was 0.78, 0.84, and 0.60; and to modified Graeb criteria SE, SP, and K was 0.90, 0.84, and 0.74 respectively. The probability of PHH from point of 3-12 was 0.011, 0.032, 0.085, 0.212, 0.435, 0.689, 0.865, 0.949, 0.981, and 0.994 respectively according to modified Graeb criteria. Conclusion The modified Graeb criteria combined with logistic regression were useful methods to assess the severity of IVH and to predict the probability of PHH in IVH.展开更多
Objective To probe the mechanism of pathological changes of intraventricular hemorrhage(IVH). Methods The evaluation of neurological status,serial CT scans and pathological examination were applied on the canine model...Objective To probe the mechanism of pathological changes of intraventricular hemorrhage(IVH). Methods The evaluation of neurological status,serial CT scans and pathological examination were applied on the canine model of IVH. The ventricular volume and blood clot volume were measured based on the CT images. Results The normal adult canine ventricle tend to be slitlike. After injection, the ventricle was obviously dilated by the blood clot. The linear regression of ventricular volume against blood clot volume was significant in the first week. From then on, however, while the clots continued to shrink, the ventricular volume showed progressive enlargement. The clots were lysed completely within 3 to 4 weeks. The linear regression of the degree of ventricular dilatation against the first clot volume was also significant. In the pathological examination, we found the ependymal lining of ventricular system was destroyed and neurons in the subependymal areas developed acidophil necrosis, which was prominent around Sylvian aqueduct. Conclusion Hemorrhagic ventricular dilatation(HVD) is a prominent feature of IVH and also is a strong indicator for poor prognosis. Ischemic changes of periventricular neurons in some important structures may be the most direct cause for poor outcome of IVH. It may be induced by periventricular vascular structures compressed by HVD, increased intracranial pressure, cerebral vasospasm and others.展开更多
Objective: This study was undertaken to compare the effect of antenatal corticosteroid therapy on the risk for severe intraventricular hemorrhage (IVH grade III- IV) in pretermsingleton and multiple very low birth wei...Objective: This study was undertaken to compare the effect of antenatal corticosteroid therapy on the risk for severe intraventricular hemorrhage (IVH grade III- IV) in pretermsingleton and multiple very low birth weight (VLBW) infants. Study design:The occurrence of severe IVH was recorded in 5022 singleton,2032 twin, and 582 triplet infants, delivered at 24 to 32 weeks gestation, registered in the Israeli National VLBW infant database. Antenatal corticosteroid therapy was defined as complete,partial, or none. Results: The incidence of IVH grade Ⅲ - IV ranged from 6.8% among singletons receiving complete course to 29.3% in triplets without antenatal corticosteroid treatment.Complete treatment significantly reduced the incidence of IVH in all plurality groups. The adjusted risk for IVH among multiple infants who received a complete course compared with singletons was not significantly different, odds ratio (OR) 1.3,95% CI 1.0- 1.7 for twins and OR 1.5, 95% CI 0.9- 2.3 for triplets.Conclusion: Complete course of antenatal corticosteroid therapy was independently associated with decreased risk for severe IVH in singleton and in multiple preterm VLBW infants.展开更多
文摘Objective To set up a new grading system of intraventricular hemorrhage (IVH) and determine the value of predicting the probability of post-hemorrhagic hydrocephalus (PHH) in IVH. Methods We first modified the Graeb criteria, then compared the value of prediction for PHH assessed by the Graeb criteria with the modified Graeb criteria. One hundred and thirty one IVH patients were divided into two groups: the upper group (n=67) and the lower group (n=64). Gold standard of PHH was assessed by CT scan or by out-drainage. The diagno-stic parameters such as sensitivity (SE), specificity (SP) were analyzed. In the cutoff point of SE and SP curves, diagnostic efficiency (DE), and Kappa value (K) were analyzed. The probability of PHH was estimated by binary logistic regressions. Results In all ventricular group, to Graeb criteria in the cutoff point, SE, SP, and K was 0.78, 0.84, and 0.60; and to modified Graeb criteria SE, SP, and K was 0.90, 0.84, and 0.74 respectively. The probability of PHH from point of 3-12 was 0.011, 0.032, 0.085, 0.212, 0.435, 0.689, 0.865, 0.949, 0.981, and 0.994 respectively according to modified Graeb criteria. Conclusion The modified Graeb criteria combined with logistic regression were useful methods to assess the severity of IVH and to predict the probability of PHH in IVH.
文摘Objective To probe the mechanism of pathological changes of intraventricular hemorrhage(IVH). Methods The evaluation of neurological status,serial CT scans and pathological examination were applied on the canine model of IVH. The ventricular volume and blood clot volume were measured based on the CT images. Results The normal adult canine ventricle tend to be slitlike. After injection, the ventricle was obviously dilated by the blood clot. The linear regression of ventricular volume against blood clot volume was significant in the first week. From then on, however, while the clots continued to shrink, the ventricular volume showed progressive enlargement. The clots were lysed completely within 3 to 4 weeks. The linear regression of the degree of ventricular dilatation against the first clot volume was also significant. In the pathological examination, we found the ependymal lining of ventricular system was destroyed and neurons in the subependymal areas developed acidophil necrosis, which was prominent around Sylvian aqueduct. Conclusion Hemorrhagic ventricular dilatation(HVD) is a prominent feature of IVH and also is a strong indicator for poor prognosis. Ischemic changes of periventricular neurons in some important structures may be the most direct cause for poor outcome of IVH. It may be induced by periventricular vascular structures compressed by HVD, increased intracranial pressure, cerebral vasospasm and others.
文摘Objective: This study was undertaken to compare the effect of antenatal corticosteroid therapy on the risk for severe intraventricular hemorrhage (IVH grade III- IV) in pretermsingleton and multiple very low birth weight (VLBW) infants. Study design:The occurrence of severe IVH was recorded in 5022 singleton,2032 twin, and 582 triplet infants, delivered at 24 to 32 weeks gestation, registered in the Israeli National VLBW infant database. Antenatal corticosteroid therapy was defined as complete,partial, or none. Results: The incidence of IVH grade Ⅲ - IV ranged from 6.8% among singletons receiving complete course to 29.3% in triplets without antenatal corticosteroid treatment.Complete treatment significantly reduced the incidence of IVH in all plurality groups. The adjusted risk for IVH among multiple infants who received a complete course compared with singletons was not significantly different, odds ratio (OR) 1.3,95% CI 1.0- 1.7 for twins and OR 1.5, 95% CI 0.9- 2.3 for triplets.Conclusion: Complete course of antenatal corticosteroid therapy was independently associated with decreased risk for severe IVH in singleton and in multiple preterm VLBW infants.
