Ajutati-ma cu o traducere, va rooog!
Ajutati-ma cu o traducere, va rooog! | Autor: adrianangi
La "anunt umanitar" n-am avut nici un succes, asa ca bat si la usa "discutiilor generale". Sunt, spre rusinea mea, profana intr-ale limbii engleze, asa ca rog din suflet sa ma ajutati, traducindu-mi cele ce urmeaza (cit mai fidel cu putinta, ca eu sa ma prind daca e vorba de un refuz politicos sau o acceptare a cazului). Va multumesc din suflet!
1.Dear Adriana,
I've read through the papers you sent me. The child seems to have had appropriate treatment locally and has had chemo therapy. It's not unusual to have to insert a ventriculoperitoneal shunt after this typ of operations or in this condition. VP-shunts unfortunately can block and must be replaced when that happens. That is common to all shunts, whichever country they're inserted. I try to avoid putting in shunts from the start by doing keyhole surgery to the brain. In this case I'm not sure this keyhole surgery would be effective because of the previous operation and treatment. Anyhow I would only consider doing this if the shunt blocked, this because of the risk involved. At this point in time, the situation seems under control and no action needs to be taken.
If your local team would be interested in having some teaching on the subject, I'd be happy to come over to run a workshop. I don't ask for a fee, just my travel and local expenses. I have quite some teaching experience in this field and have run workshops with live operating in several countries. I joined my CV for reference.
Michael Vloeberghs, MD, PhD
Senior Lecturer in Paediatric Neurosurgery
Consultant Paediatric Neurosurgeon
University of Nottingham
Queens Medical Centre
Special Scientific Advisor to the Rutherford Appleton Laboratories, Oxford.
2.Dear mrs Popescu,
it certainly would be helpful to get access to the radiological examinations of the boy. According to the written information he had a carcinoma of the choroid plexus of the IVth ventricle with hydrocephalus. I would assume that he would have an obstructibe (= non-communicating) hydrocephalus but later it is mentioned that he has a communicating form of hydrocephalus.
If it is an obstructive type of hydrocephalus the preferred treatment would be removal of the shunt and endoscopic thrid ventriculostomy which would restore the normal cerebrospinal fluid pathway. But if it is a communicating form the only possible treatment is a shunt insertion (which indeed has the high chance of dysfunction in longterm).
The endoscopic thrid ventriculostomy is not a very complicated procedure but the surgeon needs to have experience with it (at least he/she should have a proper traing in it) and of course the surgeon would need the specific instruments for it. I don't know if that is available in Romania. The procedure is done very frequently here in now over 500 cases. So we could do the procedure here or one of us could travel to Romania and help the local neurosurgeon to perform the procedure there.
Best regards,
prof.dr.J.A.Grotenhuis
chairman, dep. of neurosurgery
university medical center st radboud
nijmegen, the netherlands
3.Dear Adriana,
Many children function well with ventriculo-peritoneal shunts. If he is doing fine, then I would not consider removing the shunt nor do a third ventriculostomy.
Dr. Stephen Huhn is our full-time pediatric neurosurgeon and I would direct further questions to him.
I hope this is helpful.
James R. Doty, M.D.
Neurosurgeon
Stanford University
4.I am not convinced that the shunt should be removed. As a rule we leave them in. If it bstops working and he has no symptoms then it can be removed. If he becomes symptomatic he obviously needs it. There is really no reason for him to come to the U.SA.
Sincerely Yours
Fred Epstein
5.There is an operation which might be appropriate. It is called a third ventriculostomy. It is another form of treatment for hydrocephalus but it is not a cure for the condition. Long term there is at least a 5% failure rate. That is better though than a shunt. We do the procedure here. It is also widely done in Europe and there are several centers with specialty interest there.
Rick Abbott, MD
INN, Beth Israel Medical Center
170 East End Ave.
New York, NY 10128
USA
(212) 870-9600
Salvati un inger:
www.casa-romanilor.ch/teodora.htm
Raspunsuri
oanaruth spune:
1.Draga Adriana,
Am citit actele pe care mi le-ai trimis. Copilul pare sa fi beneficiat de tratament local adecvat si a facut chemoterapie. Nu e ceva neobisnuit sa trebuiasca sa se introduca (implanteze) un shunt ventriculoperitoneal dupa acest tip de operatii sau in aceasta stare. Sunturile VP, din pacate, se pot bloca si trebuie inlocuite daca se intampla aceasta. Acest lucru e valabil pentru toate sunturile, indiferent de tara in care au fost implantate. Eu incerc sa evit implantarea de sunturi de la inceput, practicand o interventie chirurgicala laparoscopica (? - keyhole = gaura cheii) pe creier. In acest caz, nu sunt sigur ca acest tip de interventie ar fi eficienta, datorita operatiilor anterioare si tratamentului. In orice caz, as lua in considerare aceasta posibilitate doar daca suntul e blocat, datorita riscului pe care il implica. In acest moment, situatia pare sa fie stabila si nu trebuie intreprinsa nici o actiune.
Daca echipa voastra locala ar fi interesata sa invete cate ceva despre subiectul acesta, as fi dispus, cu placere, sa vin acolo, sa organizez un seminar. Nu solicit nici o taxa, in afara cheltuielilor locale si de transport. Am o bogata experienta de predare in acest domeniu si am condur seminarii cu operatii in direct in mai multe tari. Atasez si CV-ul meu, pentru referinte.
Michael Vloeberghs, MD, PhD
Lector Senior in Neurochirurgie Pediatrica
Neurochirurg Pediatric Consultant
Universitatea Nottingham
Queens Medical Centre
Consilier Stiintific Specialla Rutherford Appleton Laboratories, Oxford.
2.Stimata doamna Popescu,
Ar fi de un real folos sa am acces la examinarile radiologice ale baiatului. In conformitate cu informatiile scrise, a avut un carcinom al plexului choroid al ventriculului al IV-lea cu hidrocefalie. As fi banuit ca a avut o hidrocefalie obstructiva (= non-comunicanta), dar mai departe se mentioneaza ca a avut o forma comunicanta de hidrocefalie.
Daca e vorba de o forma obstructiva, tratamentul de preferat ar fi indepartarea suntului si ventriculostomie endoscopica, care ar restabili calea normala a lichidului cerebrospinal. Dar daca e vorba de o forma comunicanta, singurul tratament posibil ar fi introducerea unui sunt (care, intr-adevar, implica un risc crescut de disfunctie pe termen lung).
Ventriculostomia endoscopica nu este o procedura foarte complicata, dar chirurgul trebuie sa aiba experienta in acest tip de interventie (cel putin pregatire/perfectionare adecvata) si, desigur, are nevoie de instrumentele specifice pentru aceasta. Nu stiu daca acestea sunt disponibile in Romania. Procedura e aplicata foarte frecvent aici, in peste 500 de cazuri. Astfel, am putea-o aplica aici, sau unul din noi ar putea veni in Romania pentru a-l asista pe neurochirurgul local sa efectueze operatia acolo.
Cu stima,
prof.dr.J.A.Grotenhuis
presedintele departamentului de neurichirurgie
university medical center st radboud
nijmegen, the netherlands
3.Draga Adriana,
Multi copii "functioneaza" bine (iertare pentru traducerea lipsita de inspiratie!) cu sunturi ventriculo-peritoneale. Daca copilul e bine, nu i-as recomanda indepartarea suntului, nici o ventriculostomie.
Dr. Stephen Huhn este neurochirgul nostru pediatric permanent si , pentru intrebari suplimentare, v-as indruma catre domnia sa.
Sper ca v-am fost de folos.
James R. Doty, M.D.
Neurosurgeon
Stanford University
4. Nu sunt convins ca suntul trebuie indepartat. Ca regula generala, noi le lasam la locul lor. Daca se blocheaza si pacientul nu are simptome, atunci poate fi indepartat. Daca pacientul devine simptomatic, e evident ca are nevoie de sunt. Nu este chiar deloc nevoie ca pacientul sa vine in SUA.
Sincerely Yours
Fred Epstein
5. Exista o operatie care ar putea fi adecvata. Se numeste ventriculostomie tertiara. Este o alta forma de tratament pentru hidrocefalie, dar nu o vindecare pentru boala. Pe termen lung, exista o rata de esec de cel putin 5%. Totusi, aceasta e de preferat introducerii unui sunt. Noi efectuam procedura aici. Aceasta e efectuata, de asemenea, la scara larga, in Europa si exista cateva centre cu interese speciale acolo.
Rick Abbott, MD
INN, Beth Israel Medical Center
170 East End Ave.
New York, NY 10128
USA
(212) 870-9600
Dana si Iubirea ei, 
Oana-Ruth
