scholarly journals Anticoagulation in Cerebral Embolism

1983 ◽  
Vol 10 (1) ◽  
pp. 32-36 ◽  
Author(s):  
Edward Bass
Keyword(s):  
Experimental Data ◽  
Retrospective Study ◽  
Prospective Studies ◽  
Early Treatment ◽  
Treatment Plan ◽  
Experimental Models ◽  
Cerebral Embolism ◽  
Insufficient Information ◽  
Hematoma Formation ◽  
Risk Of Hemorrhage

SUMMARY:A case of presumed anticoagulant induced hemorrhage into infarction is presented along with a retrospective study of 110 cases of cerebral embolus.An accurate recommendation for the timing of anticoagulation following cerebral embolism hinges on balancing the risk of hemorrhage into infarction against the benefits of early treatment attributed to preventing recurrent embolism. It is felt that the present literature, concepts of pathogenesis and experimental data provide insufficient information to make absolute clinical decisions. The available evidence implies that the risk of further embolic events is three to four times that of hemorrhage into infarction, yet additional randomized prospective studies and better experimental models are needed to establish a valid treatment plan. It may be possible to distinguish separate mechanisms underlying early diffuse hemorrhage into infarction from sudden delayed massive hematoma formation.

scholarly journals The effects of a preoperative multidisciplinary conference on outcomes for high-risk patients with challenging surgical treatment options: a retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Masayoshi Koike ◽  
Mie Yoshimura ◽  
Yasushi Mio ◽  
Shoichi Uezono
Keyword(s):  
Patient Safety ◽  
Retrospective Study ◽  
High Risk ◽  
Treatment Plan ◽  
Treatment Options ◽  
High Risk Patients ◽  
Appropriate Treatment ◽  
Risk Patients ◽  
Treatment Plans ◽  
Multidisciplinary Conference

Abstract Background Surgical options for patients vary with age and comorbidities, advances in medical technology and patients’ wishes. This complexity can make it difficult for surgeons to determine appropriate treatment plans independently. At our institution, final decisions regarding treatment for patients are made at multidisciplinary meetings, termed High-Risk Conferences, led by the Patient Safety Committee. Methods In this retrospective study, we assessed the reasons for convening High-Risk Conferences, the final decisions made and treatment outcomes using conference records and patient medical records for conferences conducted at our institution from April 2010 to March 2018. Results A total of 410 High-Risk Conferences were conducted for 406 patients during the study period. The department with the most conferences was cardiovascular surgery (24%), and the reasons for convening conferences included the presence of severe comorbidities (51%), highly difficult surgeries (41%) and nonmedical/personal issues (8%). Treatment changes were made for 49 patients (12%), including surgical modifications for 20 patients and surgery cancellation for 29. The most common surgical modification was procedure reduction (16 patients); 4 deaths were reported. Follow-up was available for 21 patients for whom surgery was cancelled, with 11 deaths reported. Conclusions Given that some change to the treatment plan was made for 12% of the patients discussed at the High-Risk Conferences, we conclude that participants of these conferences did not always agree with the original surgical plan and that the multidisciplinary decision-making process of the conferences served to allow for modifications. Many of the modifications involved reductions in procedures to reflect a more conservative approach, which might have decreased perioperative mortality and the incidence of complications as well as unnecessary surgeries. High-risk patients have complex issues, and it is difficult to verify statistically whether outcomes are associated with changes in course of treatment. Nevertheless, these conferences might be useful from a patient safety perspective and minimize the potential for legal disputes.

Salzburg Criteria, A Useful Tool in Non-Convulsive Status Epilepticus Diagnosis: A Retrospective Study

2021 ◽  
pp. 155005942199171
Author(s):  
Adriana Gómez Domínguez ◽  
Raidili C. Mateo Montero ◽  
Alba Díaz Cid ◽  
Antonio J. P. Mazarro ◽  
Ignacio R. Bailly-Bailliere ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Status Epilepticus ◽  
Prospective Studies ◽  
Correct Diagnosis ◽  
Original Description ◽  
Neurological Deficits ◽  
Convulsive Status Epilepticus ◽  
Poor Outcome

Introduction. Non-convulsive status epilepticus (NCSE) has been traditionally a challenging electroencephalographic (EEG) diagnosis. For this reason, Salzburg consensus criteria (SCC) have been proposed to facilitate correct diagnosis. Methods. We retrospectively reanalyzed 41 cases referred to our department (from 2016 to 2018) under the suspicion of NCSE. In this study, we compared the original description (standard criteria) versus the updated description (SCC) of the same EEG. Results. Originally, 15 patients were diagnosed as NCSE (37%) and 26 patients as no NCSE (63%), using the standard criteria. Then, we analyzed EEGs according to the SCC, which led to the following results: 9 patients fulfilled the criteria for definite NCSE (22%), 20 patients were diagnosed as possible NCSE (49%) and 12 patients were diagnosed as no NCSE (29%). Subsequently, when we analyze the outcome of possible NCSE cases, we note that 50% of these patients presented mild-poor outcome (neurological deficits, deceased). Indeed, we observed worse outcomes in patients previously diagnosed as no NCSE and untreated, specifically post-anoxic cases. Conclusions. Salzburg criteria seem to be a useful tool to support NCSE diagnosis, introducing the category of possible NCSE. In our study, we observed that it contributes to improving the prognosis and management of the patients. However, more prospective studies are needed to demonstrate the accuracy of SCC.

Cetirizine versus diphenhydramine in the prevention of chemotherapy-related hypersensitivity reactions

2018 ◽  
Vol 25 (6) ◽  
pp. 1396-1401 ◽  
Author(s):  
Charis G Durham ◽  
Deepthi Thotakura ◽  
Lauren Sager ◽  
Jennifer Foster ◽  
Jon D Herrington
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Retrospective Study ◽  
Prospective Studies ◽  
Clinical Setting ◽  
Hypersensitivity Reactions ◽  
Efficacy And Safety ◽  
Infusion Reactions

Objective This study evaluated the role of cetirizine compared to diphenhydramine as premedications for patients receiving paclitaxel, cetuximab, and rituximab infusions. Historically, diphenhydramine has been linked with more sedation in comparison to cetirizine; however, it is unknown if cetirizine can replace diphenhydramine in the prevention of hypersensitivity reactions in patients receiving chemotherapy. Methods This is a retrospective study designed to assess infusion reactions occurring in patients receiving diphenhydramine or cetirizine premedication for rituximab, paclitaxel, or cetuximab therapies. Infusion reactions were defined as various symptoms such as flushing, itching, alterations in heart rate and blood pressure, and dyspnea plus the clinical setting of a concurrent or very recent infusion. Results A total of 207 patients were evaluated in this study with 83 patients receiving cetirizine and 124 diphenhydramine patients. Overall, the percentage of patients with at least one chemotherapy-related infusion event in the cetirizine group was 19.3% (95% CI 11.4–29.4) compared to diphenhydramine group 24.2% (95% CI 17.0–32.7), P = 0.40. Of the patients who received cetirizine and then experienced an event in the first cycle, 41.7% (95% CI 13.7–74.3) of the events were due to paclitaxel, 50.0% (95% CI 19.4–80.6) were due to rituximab, and 8.3% (95% CI 0.1–43.6) were due to cetuximab. Of the patients who received diphenhydramine and then experienced an event in the first cycle, 26.1% (95% CI 5.7–51.4) were due to paclitaxel, 73.9% (95% CI 48.6–94.3) were due to rituximab and none due to cetuximab. Conclusion Cetirizine appears to be a viable substitute for diphenhydramine for the prevention of infusions reactions with cetuximab, paclitaxel, and rituximab infusions in adults. Prospective studies are needed to determine the efficacy and safety of cetirizine compared with diphenhydramine in the prevention of chemotherapy-related infusion reactions.

scholarly journals Use of systemic thrombolytic therapy in patients with non-traumatic cardiac arrest: A systematic review and meta-analysis

2019 ◽  
Vol 7 (28) ◽  
pp. 7-17
Author(s):  
Daniel Cordoba ◽  
Eneko Larumbe ◽  
Brittany Rosales ◽  
Kenneth Nugent
Keyword(s):  
Cardiac Arrest ◽  
Retrospective Study ◽  
Thrombolytic Therapy ◽  
Major Bleeding ◽  
Prospective Studies ◽  
Meta Analysis ◽  
Spontaneous Circulation ◽  
Study Analysis ◽  
Bleeding Events ◽  
Systemic Thrombolytic Therapy

Objective: To better delineate the benefits and risks of systemic thrombolytic therapy inpatients with cardiac arrest from non-traumatic etiologies.Data sources: MEDLINE, EMBASE, and SCOPUS were systematically searched up toNovember of 2017.Study Selection: All retrospective and prospective studies in which systemic thrombolytictherapy was used during the sequence of cardiopulmonary resuscitation (CPR) or shortly afterachieving return of spontaneous circulation (ROSC) were included.Data extraction: The following variable results were extracted from intervention and controlgroups if available: rate of ROSC, survival after 24 hours, survival at discharge, neurologicalperformance at 6 months based on a favorable Cerebral Performance Categories Scale (1 or 2)and major bleeding events.Data Synthesis: Eight retrospective studies and 6 prospective studies were included in thequalitative analysis. Research synthesis was conducted when at least 4 studies were availablefor an outcome, which limited the analysis of major bleeding events and neurologic outcomes.Benefit of thrombolytic therapy in survival to discharge showed a moderate beneficial effect(OR = 2.79, 2.11–3.69) in the retrospective study analysis while in the prospective study analysisno statistically significant benefit was found (OR = 1.27, 0.77–2.10). Benefit of thrombolysis inthe rate of ROSC was not statistically significant in the prospective analysis (OR = 1.59, 0.92–2.76, p = 0.138) as well as survival at 24 hours (OR = 1.17, 0.72–1.71).Conclusions: The widespread use of thrombolytics in patients with non-traumatic cardiacarrest does not seem to improve major outcomes, including survival to discharge. However,the modest benefit found in the retrospective study analysis suggests a subgroup of patientsthat may benefit from this therapy.

Early Treatment Initiation Improves Outcomes in Nevus of Ota: A 10-Year Retrospective Study

2020 ◽  
Author(s):  
Petchlada Achavanuntakul ◽  
Woraphong Manuskiatti ◽  
Rungsima Wanitphakdeedecha ◽  
Tatre Jantarakolica
Keyword(s):  
Retrospective Study ◽  
Early Treatment ◽  
Treatment Initiation ◽  
Nevus Of Ota

Dizygotic to monozygotic twinning ratio at The Royal Women's Hospital, Melbourn 1947–1997, compared with Australian national twinning incidence

Twin Research ◽  
2000 ◽  
Vol 3 (1) ◽  
pp. 12-16
Author(s):  
Stephen Tong
Keyword(s):  
Retrospective Study ◽  
Prospective Studies ◽  
Maternal Age ◽  
Close Agreement ◽  
Significant Decline ◽  
Asian Countries ◽  
Twin Research ◽  
National Statistics ◽  
Monozygotic Twinning ◽  
Human Fertility

AbstractThe incidence of dizygotic (Dz) twinning can be used as an index of natural human fertility. A retrospective study was done at The Royal Women's Hospital, Australia, to see whether the dizygotic to monozygotic (Mz) twinning ratio from one hospital can accurately reflect the national incidence of Dz twinning. The yearly twinning incidence from 1947–1997 was expressed as a Dz:Mz ratio, standardised for maternal age and plotted against previously published national statistics. The proportion of mothers born in Asia (of both singleton and multiples) between 1983–1997 was analysed to see whether different racial mixes might influence twinning trends. There were 5275 twins born of known sex and maternal age between 1947–1997. The agestandardised Dz:Mz ratio increased non-significantly from 1.39 in 1947 to 2.29 in 1953 (P = 0.08), underwent a significant decline to 0.73 in 1977, then remained stable until 1997 (P > 0.05). The same trends were also apparent when the data was pooled into 2-year groups with the increase from 1947/48–1953/54 becoming highly significant (P < 0.009). These trends observed in the hospital-based data were in close agreement with those found in the national statistics, with the exception of a rise in 1977–1982 only reflected in the Australia-wide data. In 1993, 2.6% of mothers were born in Asian countries; by 1997, this had risen to 10.6%. We found that the Dz:Mz ratio from one hospital closely reflects national twinning trends. Prospective studies must account for race, and would need around 200–300 twin pairs per year to minimise fluctuations of the ratio. Twin Research (2000) 3, 12–16.

A retrospective study of cardiac rhythm disorders

1998 ◽  
Vol 87 (02) ◽  
pp. 77-85 ◽  
Author(s):  
Michel Van Wassenhoven
Keyword(s):  
Retrospective Study ◽  
Supraventricular Tachycardia ◽  
Prospective Studies ◽  
Treatment Strategy ◽  
Cardiac Rhythm ◽  
Retrospective Studies ◽  
Heart Rhythm ◽  
Paroxysmal Supraventricular Tachycardia

AbstractRetrospective studies can be considered as the first step towards an evaluation and improvement of homoeopathic practice. Through these preliminary studies, criteria for future prospective studies can be chosen as well as suitable homoeopathic practitioners to conduct them. From this study, we can conclude that disorders of heart rhythm seem to be an excellent subject for research into the efficacy of homoeopathy. Especially for paroxysmal supraventricular tachycardia, all patients were cured and able to discontinue their allopathic medication. In view of the fact that 50% of the patients included in this study stopped the use of allopathic drugs, one can conclude that homoeopathy certainly has a place in the treatment strategy of these diseases.

scholarly journals Retrospective analysis underestimates neurological deficits in complex spinal deformity surgery: a Scoli-RISK-1 Study

2017 ◽  
Vol 27 (1) ◽  
pp. 68-73 ◽  
Author(s):  
Michael P. Kelly ◽  
Lawrence G. Lenke ◽  
Jakub Godzik ◽  
Ferran Pellise ◽  
Christopher I. Shaffrey ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Cohort Studies ◽  
Prospective Study ◽  
Spinal Deformity ◽  
Neurological Deficit ◽  
Prospective Studies ◽  
Adult Spinal Deformity ◽  
Statistical Significance ◽  
Neurological Deficits ◽  
Inclusion Criteria

OBJECTIVEThe authors conducted a study to compare neurological deficit rates associated with complex adult spinal deformity (ASD) surgery when recorded in retrospective and prospective studies. Retrospective studies may underreport neurological deficits due to selection, detection, and recall biases. Prospective studies are expensive and more difficult to perform, but they likely provide more accurate estimates of new neurological deficit rates.METHODSNew neurological deficits were recorded in a prospective study of complex ASD surgeries (pSR1) with a defined outcomes measure (decrement in American Spinal Injury Association lower-extremity motor score) for neurological deficits. Using identical inclusion criteria and a subset of participating surgeons, a retrospective study was created (rSR1) and neurological deficit rates were collected. Continuous variables were compared with the Student t-test, with correction for multiple comparisons. Neurological deficit rates were compared using the Mantel-Haenszel method for standardized risks. Statistical significance for the primary outcome measure was p < 0.05.RESULTSOverall, 272 patients were enrolled in pSR1 and 207 patients were enrolled in rSR1. Inclusion criteria, defining complex spinal deformities, and exclusion criteria were identical. Sagittal Cobb measurements were higher in pSR1, although sagittal alignment was similar. Preoperative neurological deficit rates were similar in the groups. Three-column osteotomies were more common in pSR1, particularly vertebral column resection. New neurological deficits were more common in pSR1 (pSR1 17.3% [95% CI 12.6–22.2] and rSR1 9.0% [95% CI 5.0–13.0]; p = 0.01). The majority of deficits in both studies were at the nerve root level, and the distribution of level of injury was similar.CONCLUSIONSNew neurological deficit rates were nearly twice as high in the prospective study than the retrospective study with identical inclusion criteria. These findings validate concerns regarding retrospective cohort studies and confirm the need for and value of carefully designed prospective, observational cohort studies in ASD.

Sign in / Sign up

Export Citation Format

Share Document