Sex and race: correlation with aneurysmal subarachnoid hemorrhage at the University of Mississippi Medical Center

✓ To determine what factors predict outcome, the authors retrospectively reviewed the management of all 159 poor-grade patients admitted to Harborview Medical Center at the University of Washington who suffered aneurysmal subarachnoid hemorrhage between 1983 and 1993. Favorable outcome (assessed by the Glasgow Outcome Scale) occurred in 53.9% of Hunt and Hess Grade IV, and 24.1% of Grade V patients. Outcome was largely determined by the initial hemorrhage and subsequent development of intractable intracranial hypertension or cerebral infarction. Using multivariate analysis, the authors developed three models to predict outcome. It was found that predicting outcome based only on clinical and diagnostic criteria present at admission may have resulted in withholding treatment from 30% of the patients who subsequently experienced favorable outcomes. It is concluded that aggressive management including surgical aneurysm obliteration can benefit patients with poor neurological grades and should not be denied solely on the basis of the neurological condition on admission.

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Continuing the Vision at the University of Mississippi Medical Center

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2019-0506-ed ◽

2020 ◽

Vol 144 (1) ◽

pp. 11-12

Author(s):

Timothy Craig Allen

Keyword(s):

Medical Center ◽

University Of Mississippi ◽

Mississippi Medical ◽

The University

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Detection of delayed cerebral ischemia using objective pupillometry in patients with aneurysmal subarachnoid hemorrhage

Journal of Neurosurgery ◽

10.3171/2018.9.jns181928 ◽

2020 ◽

Vol 132 (1) ◽

pp. 27-32 ◽

Cited By ~ 2

Author(s):

Salah G. Aoun ◽

Sonja E. Stutzman ◽

Phuong-Uyen N. Vo ◽

Tarek Y. El Ahmadieh ◽

Mohamed Osman ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Cerebral Ischemia ◽

Transcranial Doppler ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Medical Center ◽

Delayed Cerebral Ischemia ◽

Final Analysis ◽

Neurological Injury ◽

University Of Texas ◽

The University

OBJECTIVECerebral vasospasm causing delayed cerebral ischemia (DCI) is a source of significant morbidity after subarachnoid hemorrhage (SAH). Transcranial Doppler is used at most institutions to detect sonographic vasospasm but has poor positive predictive value for DCI. Automated assessment of the pupillary light reflex has been increasingly used as a reliable way of assessing pupillary reactivity, and the Neurological Pupil Index (NPi) has been shown to decrease hours prior to the clinical manifestation of ischemic injury or herniation syndromes. The aim of this study was to investigate the role of automated pupillometry in the setting of SAH, as a potential adjunct to TCD.METHODSOur analysis included patients that had been diagnosed with aneurysmal SAH and admitted to the neuro–intensive care unit of the University of Texas Southwestern Medical Center between November 2015 and June 2017. A dynamic infrared pupillometer was used for all pupillary measurements. An NPi value ranging from 3 to 5 was considered normal, and from 0 to 2.9 abnormal. Sonographic vasospasm was defined as middle cerebral artery velocities greater than 100 cm/sec with a Lindegaard ratio greater than 3 on either side on transcranial Doppler. Most patients had multiple NPi readings daily and we retained the lowest value for our analysis. We aimed to study the association between DCI and sonographic vasospasm, and DCI and NPi readings.RESULTSA total of 56 patients were included in the final analysis with 635 paired observations of daily TCD and NPi data. There was no statistically significant association between the NPi value and the presence of sonographic vasospasm. There was a significant association between DCI and sonographic vasospasm, χ2(1) = 6.4112, p = 0.0113, OR 1.6419 (95% CI 1.1163–2.4150), and between DCI and an abnormal decrease in NPi, χ2(1) = 38.4456, p < 0.001, OR 3.3930 (95% CI 2.2789–5.0517). Twelve patients experienced DCI, with 7 showing a decrease of their NPi to an abnormal range. This change occurred > 8 hours prior to the clinical decline 71.4% of the time. The NPi normalized in all patients after treatment of their vasospasm.CONCLUSIONSIsolated sonographic vasospasm does not seem to correlate with NPi changes, as the latter likely reflects an ischemic neurological injury. NPi changes are strongly associated with the advent of DCI and could be an early herald of clinical deterioration.

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One Hundred Fifty Liver Transplants at a New Program in the Modern Era: The University of Mississippi Experience

The American Surgeon ◽

10.1177/000313481908500947 ◽

2019 ◽

Vol 85 (9) ◽

pp. 1025-1027

Author(s):

Kyle Curtis ◽

Christopher Anderson ◽

Ashley Seawright ◽

Felicitas Koller ◽

James Wynn ◽

...

Keyword(s):

Confidence Interval ◽

Liver Transplant ◽

Medical Center ◽

Alcoholic Cirrhosis ◽

High Volume ◽

University Of Mississippi ◽

Liver Transplants ◽

Underserved Area ◽

Mississippi Medical ◽

The University

From 1991 to 2013, Mississippi was without liver transplant services. In 2013, a new liver transplant program was established at the University of Mississippi Medical Center. Here, we describe our experience with the first 150 transplants over a 4.5-year period. This study is a review of 147 patients who underwent the first 150 liver transplants at the University of Mississippi Medical Center between March 5, 2013, and January 4, 2018. There were no exclusion criteria for this study. Donor, recipient, and outcome variables were analyzed. Recipients were 46% female and 74% white. Age at the time of transplant was 57 [IQR 49–63]. BMI at transplant was 30 [IQR 25–35]. Thirty per cent of transplants were for alcoholic cirrhosis, 25% non-alcoholic steatohepatitis, 24% hepatitis C, and 12% cholestatic. Mean model for end-stage liver disease (MELD) at the time of transplant was 20 [95% confidence interval 19–21] and MELD-Na was 22 [95% confidence interval 20–23]. One-year patient- and graft survival were 89% and 87%, respectively, which were as expected based on Scientific Registry of Transplant Recipient reports after risk adjustment. The data published here verifies it is possible to establish a new liver transplant center in an underserved area previously lacking comprehensive liver care and to achieve results similar to other high-volume centers across the country.

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