P.008 Surgical Procedures are Common in Patients with Prion
                        Disease

Background: Surgical instruments used in patients with prion disease must be decontaminated or decommissioned to prevent iatrogenic transmission. This is only done when the diagnosis of prion disease is known. To assess the potential for iatrogenic transmission, we determined the prevalence of surgeries and use of precautions in patients with prion disease at two academic medical centers. Methods: Clinical details, results of investigations, and surgical interventions (performed within one-year of symptom onset) were extracted for patients with probable/definite prion disease at Mayo Clinic (n=107; 1-2014 to 12-2020) and Washington University School of Medicine (n=14; 2-2015 to 12-2019). Results: Twenty-six patients (21.5%) underwent 32 procedures, including 2 high-risk procedures involving the brain. Most procedures (17/32, 53%) occurred in the 1-year period preceding the onset of symptoms attributed to CJD. History of arthritis (OR: 7.4, 95%CI: 1.05-51.8), lack of behavioral symptoms (OR: 3.0, 95%CI 0.97-9.1), and greater time (months) from symptom onset to first MRI (OR: 1.1, 95%CI 1.03-1.2) were independently associated with odds of undergoing an invasive procedure. Prion disease precautions were observed in one case (diagnostic brain biopsy). Conclusions: Procedures were common in patients with diagnosis of prion disease; precautions were not. Coordinated approaches to screening and reporting are needed to prevent iatrogenic transmission.

Download Full-text

Management of Phantom Limb Pain through Thalamotomy of the Centro-Median Nucleus

Neurology International ◽

10.3390/neurolint13040058 ◽

2021 ◽

Vol 13 (4) ◽

pp. 587-593

Author(s):

Ramiro A. Pérez de la Torre ◽

Job J. Rodríguez Hernández ◽

Ali Al-Ramadan ◽

Abeer Gharaibeh

Keyword(s):

Phantom Limb Pain ◽

Phantom Limb ◽

Limb Pain ◽

Surgical Interventions ◽

Burning Pain ◽

A Value ◽

Thoracic Limb ◽

History Of ◽

One Year ◽

The Right

Background: Phantom limb syndrome is defined as the perception of intense pain or other sensations that are secondary to a neural lesion in a limb that does not exist. It can be treated using pharmacological and surgical interventions. Most medications are prescribed to improve patients’ lives; however, the response rate is low. In this case report, we present a case of phantom limb syndrome in a 42-year-old female with a history of transradial amputation of the left thoracic limb due to an accidental compression one year before. The patient underwent placement of a deep brain stimulator at the ventral posteromedial nucleus (VPM) on the right side and removal secondary to loss of battery. The patient continued to have a burning pain throughout the limb with a sensation of still having the limb, which was subsequently diagnosed as phantom limb syndrome. After a thorough discussion with the patient, a right stereotactic centro-median thalamotomy was offered. An immediate response was reported with a reduction in pain severity on the visual analogue scale (VAS) from a value of 9–10 preoperative to a value of 2 postoperative, with no postoperative complications. Although phantom limb pain is one of the most difficult to treat conditions, centro-median thalamotomy may provide an effective stereotactic treatment procedure with adequate outcomes.

Download Full-text

Clinical and prognostic differences between methicillin-resistant and methicillin-susceptible Staphylococcus aureus infective endocarditis

10.21203/rs.2.15316/v2 ◽

2020 ◽

Author(s):

Carmen Hidalgo Tenorio ◽

Juan Gálvez ◽

Francisco Javier Martínez-Marcos ◽

Antonio Plata-Ciezar ◽

Javier De La Torre-Lima ◽

...

Keyword(s):

Infective Endocarditis ◽

Methicillin Resistance ◽

Diagnostic Delay ◽

Invasive Procedure ◽

Study Objective ◽

Infection Focus ◽

History Of ◽

One Year ◽

The One ◽

Related Mortality

Abstract Background: S. aureus(SA) infective endocarditis (IE)has a very high mortality, attributed to the age and comorbidities of patients, inadequate or delayed antibiotic treatment, and methicillin resistance, among other causes. The main study objective was to analyze epidemiological and clinical differences between IE by methicillin-resistantversusmethicillin-susceptible SA (MRSA vs. MSSA) and to examine prognostic factors for SA endocarditis, including methicillin resistance and vancomycin minimum inhibitory concentration (MIC) values >1 ug/mL to MRSA. Methods: Patients with SA endocarditis were consecutively and prospectively recruited from the Andalusia endocarditis cohort between 1984 and January 2017. Results: We studied 437 patients with SA endocarditis, which was MRSA in 13.5% of cases. A greater likelihood of history of COPD (OR 3.19; 95% CI 1.41-7.23), invasive procedures, or recognized infection focus in the three months before IE onset (OR 2.9; 95% CI 1.14-7.65) and of diagnostic delay (OR 3.94; 95% CI 1.64-9.5) was observed in patients with MRSA versusMSSA endocarditis. The one-year mortality rate due to SA endocarditis was 44.3% and associated with decade of endocarditis onset (1985-1999) (OR 8.391; 95% CI (2.82-24.9); 2000-2009 (OR 6.4; 95% CI 2.92-14.06); active neoplasm (OR 6.63; 95% CI 1.7-25.5) and sepsis (OR 2.28; 95% CI 1.053-4.9). Methicillin resistance was not associated with higher IE-related mortality (49.7 vs. 43.1%; p= 0.32). Conclusion:MRSA IE is associated with COPD, previous invasive procedure or recognized infection focus, and nosocomial or healthcare-related origin.Methicillin resistance does not appear to be a decisive prognostic factor for SA IE.

Download Full-text

Double-Barreled (Diversionary)Tracheostomy in the Management of Juvenile Laryngeal Papillomatosis

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348948008900603 ◽

1980 ◽

Vol 89 (6) ◽

pp. 504-507 ◽

Cited By ~ 9

Author(s):

Harvey M. Tucker

Keyword(s):

Bronchial Tree ◽

Laryngeal Papillomatosis ◽

Active Growth ◽

Surgical Interventions ◽

Initial Procedure ◽

Life Threatening ◽

History Of ◽

Total Reconstruction ◽

One Year ◽

Multiple Recurrences

A two-year-old female presented to the author with a 1½ year history of multiple recurrences of juvenile laryngeal papillomatosis which when first seen had progressed to and below the tracheotomy site. The entire supraglottic larynx, glottis, and subglottic area were completely filled with exuberant papillomata. There was active growth of papilloma at and below the tracheotomy site and the tube had to be inserted through papilloma in order to reach a clear area in the trachea. In hopes of preventing further spread of papilloma below the area already involved and in order to control the airway and provide access to the subglottic area for laser removal, a double-barreled tracheostomy was performed. Laser treatment and/or spontaneous resolution ultimately resulted in complete clearing of all papillomata from the upper and lower tracheal segments. Four years and nine months after the initial procedure it was felt safe to attempt reconstruction. Her postoperative course was uneventful and she was successfully extubated three months later. Both vocal cords are normally mobile and her voice is quite clear although slightly hoarse as a result probably of slight changes in the edges of the cords because of the repeated surgical interventions. There has been no recurrence of papilloma now, over one year since reconstruction of the trachea. This somewhat radical approach to a life-threatening growth of endotracheal papilloma was successful in preventing further spread below the level of tracheostomy and ultimately permitted total reconstruction of an intact tracheal bronchial tree in the case reported.

Download Full-text

Fatal insomnia: the elusive prion disease

BMJ Case Reports ◽

10.1136/bcr-2020-241289 ◽

2021 ◽

Vol 14 (6) ◽

pp. e241289

Author(s):

Dharmini Patel ◽

Hagar Ibrahim ◽

Julia Rankin ◽

David Hilton ◽

Marcelo A Barria ◽

...

Keyword(s):

Prion Protein ◽

Prion Disease ◽

Short Term Memory ◽

Brain Biopsy ◽

Best Supportive Care ◽

Protein Markers ◽

Short History ◽

Short Term ◽

History Of ◽

Ocular Convergence

A previously well 54- year-old woman presented with a short history of diplopia, cognitive decline, hallucinations and hypersomnolence. The patient had progressive deterioration in short-term memory, ocular convergence spasm, tremor, myoclonus, gait apraxia, central fever, dream enactment and seizures. Results of investigations were normal including MRI brain, electroencephalogram, cerebrospinal fluid (CSF, including CSF prion protein markers) and brain biopsy. The patient died from pneumonia and pulmonary embolus. Brain postmortem analysis revealed neuropathological changes in keeping with Fatal familial insomnia (FFI); the diagnosis was confirmed on genetic testing. FFI is caused by an autosomal dominant and highly penetrant pathogenic Prion Protein gene PRNP. Although usually familial, fatal insomnia (FI) also occurs in a rare sporadic form. FI is a rare human prion disease with prominent sleep disturbance, autonomic, motor, cognitive and behavioural involvement. Patient management is with best supportive care and early suspected diagnosis allows for timely palliation.

Download Full-text

Progressive Multifocal Leukoencephalopathy with Negative JC Virus PCR following Treatment of Follicular Lymphoma: Implications for Biologics in the Era of Targeted Cancer Therapy

Case Reports in Oncological Medicine ◽

10.1155/2015/534529 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Kimberly A. Silverio ◽

Shyam A. Patel

Keyword(s):

Progressive Multifocal Leukoencephalopathy ◽

Follicular Lymphoma ◽

Jc Virus ◽

Brain Biopsy ◽

Csf Analysis ◽

Personalized Cancer Medicine ◽

First Case ◽

History Of ◽

One Year ◽

Personalized Cancer

Anticancer therapy predisposes patients to infections by the immunosuppression that results from treatment. Although 85% of patients with progressive multifocal leukoencephalopathy (PML) have concurrent HIV/AIDS, PML can also develop in patients after they receive chemotherapy for cancer. The case herein describes a 69-year-old man with history of follicular lymphoma who presented with progressive dysarthria and right-sided paralysis. He received rituximab one year prior to presentation. PET scan suggested no recurrence of lymphoma. Cerebrospinal fluid (CSF) analysis was negative and showed fewer than 500 copies/mL of JC virus. However, brain biopsy showed chromatin margination and viropathic change within oligodendrocytes, confirming PML. He was started on mirtazapine and mefloquine with some clinical improvement. To our knowledge, this is the first case of rituximab-associated PML in a patient with negative JC virus PCR from the CSF. Recognition of PML in the differential of oncology patients with CNS symptoms is an important consideration as we enter the era of targeted therapy and personalized cancer medicine involving biologics. Furthermore, screening of patients for presence of subclinical JC viremia prior to the use of biologics may be an important component of assessing patient candidacy for these agents.

Download Full-text

Clinical and prognostic differences between methicillin-resistant and methicillin-susceptible Staphylococcus aureus infective endocarditis

10.21203/rs.2.15316/v1 ◽

2019 ◽

Author(s):

Carmen Hidalgo Tenorio ◽

Juan Gálvez ◽

Francisco Javier Martínez-Marcos ◽

Antonio Plata-Ciezar ◽

Javier De La Torre-Lima ◽

...

Keyword(s):

Infective Endocarditis ◽

Methicillin Resistance ◽

Diagnostic Delay ◽

Invasive Procedure ◽

Study Objective ◽

Infection Focus ◽

History Of ◽

One Year ◽

The One ◽

Related Mortality

Abstract Background: S. aureus(SA) infective endocarditis (IE)has a very high mortality, attributed to the age and comorbidities of patients, inadequate or delayed antibiotic treatment, and methicillin resistance, among other causes. The main study objective was to analyze epidemiological and clinical differences between IE by methicillin-resistantversusmethicillin-susceptible SA (MRSA vs. MSSA)and to examine prognostic factors for SA endocarditis, including methicillin resistance and vancomycin minimum inhibitory concentration (MIC) values >1 ug/mL to MRSA. Methods: Patientswith SA endocarditis were consecutively and prospectively recruited from the Andalusia endocarditis cohort between 1984 and January 2017. Results: We studied 437 patients with SA endocarditis, which was MRSA in 13.5% of cases. A greater likelihood of history of COPD (OR 3.19; 95% CI 1.41-7.23), invasive procedures, or recognized infection focus in the three months before IE onset (OR 2.9; 95% CI 1.14-7.65) and of diagnostic delay (OR 3.94; 95% CI 1.64-9.5) was observed in patients with MRSA versusMSSA endocarditis. The one-year mortality rate due to SA endocarditis was 44.3% and associated with decade of endocarditis onset (1985-1999) (OR 8.391; 95% CI (2.82-24.9); 2000-2009 (OR 6.4; 95% CI 2.92-14.06); active neoplasm (OR 6.63; 95% CI 1.7-25.5) and sepsis (OR 2.28; 95% CI 1.053-4.9). Methicillin resistance was not associated with higher IE-related mortality (49.7 vs. 43.1%; p= 0.32). Conclusion: MRSA IE is associated with COPD, previous invasive procedure or recognized infection focus, and nosocomial or healthcare-related origin.Methicillin resistance does not appear to be a decisive prognostic factor for SA IE.

Download Full-text

Treatment of varicose tributaries with sclerotherapy with polidocanol 0.5 % foam

VASA ◽

10.1024/0301-1526/a000023 ◽

2010 ◽

Vol 39 (2) ◽

pp. 169-174 ◽

Cited By ~ 7

Author(s):

Reich-Schupke ◽

Weyer ◽

Altmeyer ◽

Stücker

Keyword(s):

Scientific Evidence ◽

Daily Practice ◽

Severe Adverse Effect ◽

Safe Procedure ◽

Efficacy And Safety ◽

Foam Sclerotherapy ◽

History Of ◽

One Year ◽

Additional Therapy

Background: Although foam sclerotherapy of varicose tributaries is common in daily practice, scientific evidence for the optimal sclerosant-concentration and session-frequency is still low. This study aimed to increase the knowledge on foam sclerotherapy of varicose tributaries and to evaluate the efficacy and safety of foam sclerotherapy with 0.5 % polidocanol in tributaries with 3-6 mm in diameter. Patients and methods: Analysis of 110 legs in 76 patients. Injections were given every second or third day. A maximum of 1 injection / leg and a volume of 2ml / injection were administered per session. Controls were performed approximately 6 months and 12 months after the start of therapy. Results: 110 legs (CEAP C2-C4) were followed up for a period of 14.2 ± 4.2 months. Reflux was eliminated after 3.4 ± 2.7 injections per leg. Insufficient tributaries were detected in 23.2 % after 6.2 ± 0.9 months and in 48.2 % after 14.2 ± 4.2 months, respectively. Only 30.9 % (34 / 110) of the legs required additional therapy. In 6.4 % vein surgery was performed, in 24.5 % similar sclerotherapy was repeated. Significantly fewer sclerotherapy-sessions were required compared to the initial treatment (mean: 2.3 ± 1.4, p = 0.0054). During the whole study period thrombophlebitis (8.2 %), hyperpigmentation (14.5 %), induration in the treated region (9.1 %), pain in the treated leg (7.3 %) and migraine (0.9 %) occurred. One patient with a history of thrombosis developed thrombosis of a muscle vein (0.9 %). After one year there were just hyperpigmentation (8.2 %) and induration (1.8 %) left. No severe adverse effect occurred. Conclusions: Foam sclerotherapy with injections of 0.5 % polidocanol every 2nd or 3rd day, is a safe procedure for varicose tributaries. The evaluation of efficacy is difficult, as it can hardly be said whether the detected tributaries in the controls are recurrent veins or have recently developed in the follow-up period. The low number of retreated legs indicates a high efficacy and satisfaction of the patients.

Download Full-text

The Diagnostic Value of Pericardial Fluid and Pericardial Biopsy: Single Center Experiences

The Heart Surgery Forum ◽

10.1532/hsf.1328 ◽

2016 ◽

Vol 19 (1) ◽

pp. 023 ◽

Cited By ~ 2

Author(s):

Mehmet Yildirim ◽

Recep Ustaalioglu ◽

Murat Erkan ◽

Bala Basak Oven Ustaalioglu ◽

Hatice Demirbag ◽

...

Keyword(s):

Pericardial Effusion ◽

Thoracoscopic Surgery ◽

Pericardial Tamponade ◽

Pericardial Fluid ◽

Pathological Examination ◽

Common Disease ◽

Pericardial Window ◽

Surgical Interventions ◽

History Of ◽

Recurrent Pericardial Effusion

Background: Patients with recurrent pericardial effusion and pericardial tamponade are usually treated in thoracic surgery clinics by VATS (video-assisted thoracoscopic surgery) or open pericardial window operation. The diagnostic importance of pathological evaluation of the pericardial fluid and tissue in the same patients has been reported in few studies. We reviewed pathological examination of the pericardial tissue and fluid specimens and the effect on the clinical treatment in our clinic, and compared the results with the literature. Methods: We retrospectively analyzed 174 patients who underwent pericardial window operation due to pericardial tamponade or recurrent pericardial effusion. For all patients both the results of the pericardial fluid and pericardial biopsy specimen were evaluated. Clinicopathological factors were analyzed by using descriptive analysis. Results: Median age was 61 (range, 20-94 years). The most common benign diagnosis was chronic inflammation (94 patients) by pericardial biopsy. History of malignancy was present in 28 patients (16.1%) and the most common disease was lung cancer (14 patients). A total of 24 patients (13.8%) could be diagnosed as having malignancy by pericardial fluid or pericardial biopsy examination. The malignancy was recognized for 12 patients who had a history of cancer; 9 of 12 with pericardial biopsy, 7 diagnosed by pericardial fluid. Twelve of 156 patients were recognized as having underlying malignancy by pericardial biopsy (n = 9) or fluid examination (n = 10), without known malignancy previously. Conclusion: Recurrent pericardial effusion/pericardial tamponade are entities frequently diagnosed, and surgical interventions may be needed either for diagnosis and/or treatment, but specific etiology can rarely be obtained in spite of pathological examination of either pericardial tissue or fluid. For increasing the probability of a specific diagnosis both the pericardial fluid and the pericardial tissues have to be sent for pathologic examination.

Download Full-text

Newton and the Origin of Civilization

10.23943/princeton/9780691154787.001.0001 ◽

2012 ◽

Cited By ~ 1

Author(s):

Jed Z. Buchwald ◽

Mordechai Feingold

Keyword(s):

Good Reason ◽

History Of Mathematics ◽

Primary Sources ◽

Ancient History ◽

Isaac Newton ◽

History Of ◽

Ancient Civilizations ◽

And Mathematics ◽

One Year ◽

Radical Ideas

Isaac Newton’s Chronology of Ancient Kingdoms Amended, published in 1728, one year after the great man’s death, unleashed a storm of controversy. And for good reason. The book presents a drastically revised timeline for ancient civilizations, contracting Greek history by five hundred years and Egypt’s by a millennium. This book tells the story of how one of the most celebrated figures in the history of mathematics, optics, and mechanics came to apply his unique ways of thinking to problems of history, theology, and mythology, and of how his radical ideas produced an uproar that reverberated in Europe’s learned circles throughout the eighteenth century and beyond. The book reveals the manner in which Newton strove for nearly half a century to rectify universal history by reading ancient texts through the lens of astronomy, and to create a tight theoretical system for interpreting the evolution of civilization on the basis of population dynamics. It was during Newton’s earliest years at Cambridge that he developed the core of his singular method for generating and working with trustworthy knowledge, which he applied to his study of the past with the same rigor he brought to his work in physics and mathematics. Drawing extensively on Newton’s unpublished papers and a host of other primary sources, the book reconciles Isaac Newton the rational scientist with Newton the natural philosopher, alchemist, theologian, and chronologist of ancient history.

Download Full-text

High Risk of One-year Stroke Recurrence in Patients with Younger Age and Prior History of Ischemic Stroke

Current Neurovascular Research ◽

10.2174/1567202616666190618164528 ◽

2019 ◽

Vol 16 (3) ◽

pp. 250-257 ◽

Cited By ~ 1

Author(s):

Jiann-Der Lee ◽

Ya-Han Hu ◽

Meng Lee ◽

Yen-Chu Huang ◽

Ya-Wen Kuo ◽

...

Keyword(s):

Logistic Regression ◽

Ischemic Stroke ◽

Multivariate Logistic Regression Analysis ◽

Stroke Recurrence ◽

Prior History ◽

Multivariate Logistic Regression ◽

Cart Analysis ◽

Younger Age ◽

History Of ◽

One Year

Background and Purpose: Recurrent ischemic strokes increase the risk of disability and mortality. The role of conventional risk factors in recurrent strokes may change due to increased awareness of prevention strategies. The aim of this study was to explore the potential risk factors besides conventional ones which may help to affect the advances in future preventive concepts associated with one-year stroke recurrence (OSR). Methods: We analyzed 6,632 adult patients with ischemic stroke. Differences in clinical characteristics between patients with and without OSR were analyzed using multivariate logistic regression and classification and regression tree (CART) analyses. Results: Among the study population, 525 patients (7.9%) had OSR. Multivariate logistic regression analysis revealed that male sex (OR 1.243, 95% CI 1.025 – 1.506), age (OR 1.015, 95% CI 1.007 - 1.023), and a prior history of ischemic stroke (OR 1.331, 95% CI 1.096 – 1.615) were major factors associated with OSR. CART analysis further identified age and a prior history of ischemic stroke were important factors for OSR when classified the patients into three subgroups (with risks of OSR of 8.8%, 3.8%, and 12.5% for patients aged > 57.5 years, ≤ 57.5 years/with no prior history of ischemic stroke, and ≤ 57.5 years/with a prior history of ischemic stroke, respectively). Conclusions: Male sex, age, and a prior history of ischemic stroke could increase the risk of OSR by multivariate logistic regression analysis, and CART analysis further demonstrated that patients with a younger age (≤ 57.5 years) and a prior history of ischemic stroke had the highest risk of OSR.

Download Full-text