with graft versus host disease (GVHD), an often life-threatening complication of bone marrow and stem cell transplants, according to research from the University of Michigan. published in Lancet Haematology last January.
Patients with fatal blood cancers like leukaemia often need bone marrow or stem cell transplants to survive. But one of the most common and serious side effects that patients face is graft vs. host disease: when a patient

Examining post-mortem tissue from the brains of people with Alzheimer

When retrievable inferior vena cava (IVC) filters were approved for use in the United States in 2003 to prevent pulmonary embolism among patients unable to receive the standard blood thinner treatment, many experts anticipated most of them would be removed when no longer needed and IVC filter complications would decrease. Instead, the number of IVC filters placed has more than doubled in the last 10 years, and by some estimates, less than half of these retrievable devices are actually removed each year. Leaving the devices in place risks filter fracture or symptoms from penetration of filter components outside of the vein into adjacent structures, increased risk of new blood clots in the legs, and other complications.
Now, a Penn Medicine study confirms that an endobronchial forceps technique the research group developed is a safe and highly effective option for many patients seeking IVC filter removal.
The Penn Medicine team studied 114 adult patients, 77 women and 37 men, who visited the Hospital of the University of Pennsylvania for removal of a tip-embedded retrievable inferior vena cava (IVC) filter between January 2005 and April 2014. All patients who underwent retrieval of an IVC filter were evaluated by an interventional radiology attending physician and underwent computed tomographic venography of the abdomen and pelvis.
The researchers say the endobronchial forceps technique helps fill a void where standard procedures fail. The most common reason for a failed IVC filter retrieval is tilting of the filter, with the tip of the filter becoming embedded in the wall of the IVC. When this occurs, a snare or cone device cannot be placed over the tip of the IVC filter, and standard techniques for IVC filter removal fail. The newer technique allows these filters to be removed.

A technique called auditory brainstem implantation can restore hearing for patients who can’t benefit from cochlear implants. A team of US and Japanese experts has mapped out the surgical anatomy and approaches for auditory brainstem implantation.

Dr. Albert L. Rhoton, Jr., and colleagues of University of Florida, Gainesville, and Fukuoka University, Japan, performed a series of meticulous dissections to demonstrate and illustrate surgical approaches to auditory brainstem implant placement. Their article shares exquisitely detailed anatomic colour photographs, along with step-by-step descriptions of two alternative routes for neurosurgeons performing these demanding implant procedures.

Auditory brainstem implants can restore varying degrees of hearing to patients with ‘retrocochlear’ hearing loss. These patients have deafness caused by damage to the cochlear nerves — sometimes called the acoustic or auditory nerves — which transmit sound information from the inner ear to the brain. The cochlear nerve damage most commonly results from brain tumours associated with a genetic condition called neurofibromatosis type 2 (NF2).
Auditory brainstem implants are similar in principle to the more commonly placed cochlear implant, used in patients with damage to the cochlea — part of the inner ear. Because of the need to place the implant and electrodes in the brainstem, rather than the inner ear, the surgery required for auditory brainstem implantation is much more complex.

In a series of ten cadaver brainstem dissections, the researchers explored the anatomy of the region that the neurosurgeon must navigate to perform auditory brainstem implantation. They also mapped out the best neurosurgical approaches, both for surgery to remove the tumours and for auditory brainstem implant placement.

Based on their findings, Dr. Rhoton and colleagues detail two surgical approaches: a ‘translabyrinthine’ and a ‘retrosigmoid’ approach. They outline a step-by-step route for both approaches, designed to provide safe access to the area while minimizing trauma to the brainstem and surrounding structures. The authors highlight the value of using endoscopes to help in visualizing and accessing the target area for implant placement.

More than 1,000 auditory brainstem implant procedures have been performed worldwide so far. The procedure was previously approved only for patients with NF2 aged 12 years or older. Recently, clinical trials were approved for children with congenital malformations or other causes of retrocochlear deafness.

Minimizing damage to the brainstem and associated blood vessels appears to be a critical factor in achieving good speech recognition after auditory brainstem implantation. The hearing results are also better in patients with a shorter duration of deafness.

Dr. Rhoton and colleagues hope that their descriptions and illustrations will help to increase understanding of the anatomy and surgical approaches to auditory brainstem implantation, contributing useful hearing to adults and children with NF2 and other causes of retrocochlear deafness. EurekAlert