scholarly journals Dexamethasone prevents relapse after emergency department treatment of acute migraine: a randomized clinical trial

CJEM ◽  
1999 ◽  
Vol 1 (01) ◽  
pp. 26-33 ◽  
Author(s):  
Grant D. Innes ◽  
Iain Macphail ◽  
Edward C. Dillon ◽  
Cathy Metcalfe ◽  
Min Gao
Keyword(s):  
Emergency Department ◽  
Initial Treatment ◽  
Physician Visit ◽  
Recurrent Headache ◽  
Class A ◽  
Headache Severity ◽  
Class D ◽  
Class B ◽  
Class C

ABSTRACT:Objective:To determine whether the addition of intravenous dexamethasone to standard emergency department (ED) migraine therapy would decrease the incidence of severe recurrent headache 24 to 48 hours after initial treatment.Methods:Patients aged 19 to 65 years whose headache was severe enough to require parenteral therapy and who met International Headache Society migraine criteria were eligible for this randomized, double-blind trial. The study was conducted in the ED of 2 community hospitals, 1 of which was a tertiary referral centre. Exclusion criteria included pregnancy, focal findings, fever, meningismus, allergy to the study drug, active peptic ulcer disease and diabetes mellitus. Demographic and clinical data, including headache severity, were recorded. After abortive therapy (antiemetics, intravenous nonsteroidal agents, dihydroergotamine or opioids), blinded nurses administered dexamethasone (24 mg intravenously) or placebo. Patients recorded headache severity on a Visual Analogue Scale (VAS) at time T = 0, T = 30 minutes and T = 60 minutes and at discharge. They were contacted 48 to 72 hours later and asked whether they had suffered a recurrence of their headache, categorized as class A (severe, provoking another physician visit), class B (severe, interfering with daily activity but not provoking a physician visit), class C (mild, requiring self-medication but not limiting activity) or class D (mild, requiring no treatment). Results: Two of 100 patients were lost to follow-up, leaving 98 in the study sample. Placebo recipients were more likely to be female; other baseline characteristics were similar between groups. Median VAS pain score was 83 mm on ED arrival, 35 mm after initial treatment and 12 mm on discharge. At follow-up, 65 of 98 patients had suffered headache recurrence. In the placebo versus dexamethasone groups, respectively, the results were 11 versus 0 in class A, 11 versus 9 in class B, 7 versus 11 in class C and 4 versus 12 in class D. Regarding the primary outcome, 9 of 49 dexamethasone patients (18%) and 22 of 49 placebo patients (45%) had severe (classes A and B) recurrent headache (odds ratio 0.28; 95% CI, 0.11 to 0.69;p= 0 .005).Conclusions:Migraine recurrence is common after “successful” ED treatment. Inflammation may be a critical factor in migraine genesis. Intravenous dexamethasone decreases the incidence of severe recurrent headache after ED treatment and should be offered to patients thought to be at risk of recurrent headache.

Durability of hearing preservation after microsurgical treatment of vestibular schwannoma using the middle cranial fossa approach

2013 ◽  
Vol 119 (1) ◽  
pp. 131-138 ◽  
Author(s):  
Anthony C. Wang ◽  
Steven B. Chinn ◽  
Khoi D. Than ◽  
H. Alexander Arts ◽  
Steven A. Telian ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Hearing Preservation ◽  
Middle Cranial Fossa ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Class A ◽  
Class D ◽  
Class B ◽  
Class C

Object The middle cranial fossa (MCF) approach is a microsurgical technique described as a primary option in the treatment of small, intracanalicular schwannomas involving the eighth cranial nerve. Excellent rates of complete tumor resection, hearing preservation, preservation of facial nerve function, and low complication rates have been reproduced using this technique. However, the durability of hearing preservation attained using the various treatment options has not been adequately assessed. The purpose of this study was to evaluate the durability of long-term hearing preservation in patients with vestibular schwannoma (VS) treated via the MCF approach. The authors hypothesize that hearing preservation in these patients will prove to be durable years after treatment in a high percentage of cases. Methods Retrospective medical chart review was performed in 103 consecutive patients undergoing resection of VS via a modified MCF approach between 1999 and 2008. Patients in whom surgical goals were gross-total resection and hearing preservation were included. Preoperative and postoperative hearing assessment was performed using standard audiometric testing, and classified according to American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) guidelines as a primary outcome measure. Outcomes and neurological complications initially, and at 1, 3, and 5 years following operation were analyzed. Results Initial hearing preservation rates were in keeping with the best previously published results. At initial postoperative audiometric follow-up, of the patients presenting with Class A hearing, 67% remained Class A, 17% were Class B, 1% were Class C, and 15% were Class D. Of patients presenting with Class B hearing, 24% were Class A, 53% remained Class B, 6% were Class C, and 18% were Class D. Of patients presenting with Class C hearing, 100% remained Class C. To assess the durability of hearing preservation in our patients, the authors evaluated hearing function at regular intervals after the initial postoperative audiometric follow-up. Audiometric data were available for 56 patients at 5-year follow-up. Of the 20 patients with Class A hearing at initial postoperative follow-up with 5-year follow-up, 13 (65%) remained Class A, 6 (30%) were Class B, and 1 (5%) was Class C. Of the 12 patients with Class B hearing at initial postoperative follow-up with 5-year follow-up, 4 (33%) were Class A, 4 (33%) remained Class B, and 4 (33%) were Class C. Of the 3 patients with Class C hearing at initial postoperative follow-up with 5-year follow-up, all 3 (100%) remained Class C. Conclusions A majority of patients with preserved hearing following the MCF approach for treatment of VS experience durability of their preserved hearing at 5-year follow-up. The initial AAO-HNS classification was preserved in 13 (65%) of the 20 patients who had Class A hearing at 5 years, and in 8 (67%) of the 12 who had Class B hearing at 5 years. Overall, a decline in AAO-HNS classification was noted in 15% of patients with preserved Class A hearing, and in 33% of those with preserved Class B hearing. Facial nerve function was preserved in 91% of cases. Superior hearing preservation as well as good outcomes in facial nerve function and few serious complications can be accomplished using the MCF approach for resection of small VSs.

Endolymphatic SAC Surgery for Menière's Disease

1983 ◽  
Vol 92 (2) ◽  
pp. 113-118 ◽  
Author(s):  
Gershon J. Spector ◽  
Peter G. Smith
Keyword(s):  
Meniere’S Disease ◽  
Menière’S Disease ◽  
Meniere's Disease ◽  
Ménière’S Disease ◽  
Menière's Disease ◽  
Class A ◽  
Class D ◽  
Class B ◽  
Ménière's Disease

An endolymphatic-mastoid Silastic shunt procedure was performed in 122 cases of Menière's disease having a mean follow-up period of three years. In accordance with American Academy of Ophthalmology and Otolaryngology 1972 criteria, there were 43 % class A, 20% class B, 21% class C, and 17% class D results. Analysis of 35 recent cases having a mean follow-up period of nine months revealed 57% class A, 25% class B, 9% class C, and 9% class D results. Sixteen percent of the patients who experienced classes A, B or C results complained of other fluctuating symptoms which were not relieved by surgery. Moreover, three new eases of otolithic crisis were found in the postoperative group. Seven of ten patients who experienced a class A or B result had either a recrudescence of their vertigo or a significant decrement in hearing in response to a postoperative salt-loading test. It is concluded that the surgical success rate decreases with time and that the procedure appears to alter the symptom complex but does not cure Menière's disease.

Distribution of cortical granules in bovine oocytes classified by cumulus complex

Zygote ◽  
1997 ◽  
Vol 5 (4) ◽  
pp. 371-376 ◽  
Author(s):  
M. Hosoe ◽  
Y. shioya
Keyword(s):  
Type I ◽  
Cortical Granules ◽  
Type Iii ◽  
Class A ◽  
Class D ◽  
Class B ◽  
Cytoplasmic Maturation ◽  
Class C ◽  
Bovine Oocytes

SummaryThe present study was conducted to examine distributional changes of cortical granules(CGs)during meitotic maturation and fetilisation in vitro and the developmental ability in bovine oocytes classified by cumulus cells. The oocytes were classified by the morphology if their cumulus cell layers as follows: class A, compact and thick; class B, compact but thin; class C, naked; and class D, expanded. some of the oocytes were stained with Lens curinalis agglutinin(LCA) before and after maturation in vitro and after insemination, and then stained with orcein to observe their nuclear stages. The others were left in culture. Distributional patterns of the CGs were classified into four types: type I, CGs distributed in clusters; type II, CGs dispersed and partly clustered; type III, all CGs dispersed; and type IV, no CGs Most of the oocytes before culture showed a type I pattern, but this decreased after maturation culture, whereas type III increased in class A. The oocytes of class B showed similar changes while the oocytes of class C did not. In class C, many oocytes showed type I after culture indicating that cytoplasmic maturation was not completed. IN class D, 80.4% of the oocytes exhibited types III before maturation culture, indicating that their cytoplasmic maturation was different from classes A–C. and about 70% of the class D oocytes were at the unclear stage of germinal vesicle breakdown(GVBD) before culture. The developmental rates to blastocysts in classes A–D were 28.7%, 23.1%, 0.5% and 3.4% respectively.

scholarly journals Kinetics of Sulbactam Hydrolysis by β-Lactamases, and Kinetics of β-Lactamase Inhibition by Sulbactam

2017 ◽  
Vol 61 (12) ◽  
Author(s):  
Adam B. Shapiro
Keyword(s):  
Molar Ratio ◽  
Inactivation Kinetics ◽  
High Turnover ◽  
Content Type ◽  
Class A ◽  
Class D ◽  
Class B ◽  
Class C ◽  
Kinetics Of ◽  
Enzyme Class

ABSTRACT Sulbactam is one of four β-lactamase inhibitors in current clinical use to counteract drug resistance caused by degradation of β-lactam antibiotics by these bacterial enzymes. As a β-lactam itself, sulbactam is susceptible to degradation by β-lactamases. I investigated the Michaelis-Menten kinetics of sulbactam hydrolysis by 14 β-lactamases, representing clinically widespread groups within all four Ambler classes, i.e., CTX-M-15, KPC-2, SHV-5, and TEM-1 for class A; IMP-1, NDM-1, and VIM-1 for class B; Acinetobacter baumannii ADC-7, Pseudomonas aeruginosa AmpC, and Enterobacter cloacae P99 for class C; and OXA-10, OXA-23, OXA-24, and OXA-48 for class D. All of the β-lactamases were able to hydrolyze sulbactam, although they varied widely in their kinetic constants for the reaction, even within each class. I also investigated the inactivation kinetics of the inhibition of these enzymes by sulbactam. The class A β-lactamases varied widely in their susceptibility to inhibition, the class C and D enzymes were very weakly inhibited, and the class B enzymes were essentially or completely unaffected. In addition, we measured the sulbactam turnover number, the sulbactam/enzyme molar ratio required for complete inhibition of each enzyme. Class C enzymes had the lowest turnover numbers, class A enzymes varied widely, and class D enzymes had very high turnover numbers. These results are valuable for understanding which β-lactamases ought to be well inhibited by sulbactam. Moreover, since sulbactam has intrinsic antibacterial activity against Acinetobacter species pathogens, these results contribute to understanding β-lactamase-mediated sulbactam resistance in Acinetobacter, especially due to the action of the widespread class D enzymes.

Long-Term Results of Endolymphatic Mastoid Shunt Surgery in Patients with Intractable Ménière's Disease

2009 ◽  
Vol 141 (2) ◽  
pp. 237-242 ◽  
Author(s):  
Myeong Sang Yu ◽  
Kwang-Sun Lee ◽  
Jong Woo Chung
Keyword(s):  
Meniere’S Disease ◽  
Ménière’S Disease ◽  
Hearing Level ◽  
Menière's Disease ◽  
Class A ◽  
Class B ◽  
Ménière's Disease ◽  
Class C ◽  
Class F

OBJECTIVE: To evaluate changes in vertigo and hearing from patients with Ménière's disease managed by endolymphatic mastoid shunt (EMS). STUDY DESIGN: Case series with chart review. SETTING: Tertiary referral center. SUBJECTS AND METHODS: Data from 16 patients were analyzed using 1995 AAO–HNS criteria. RESULTS: Among 16 patients, six had class A vertigo control two years after treatment, five had class B, one class C, three class D, and one class F. At four years after surgery, seven patients had class A, four class B, three class C, and two class F. The mean functional level before surgery was 4.8 and improved to 2.9 and 2.6 at two years and four years after surgery, respectively. The bone conduction pure-tone averages (four frequencies) were 43.3 before surgery and improved to 33.5 dB HL and 35.5 dB HL at three and six months after surgery, respectively. At two years of follow-up, the hearing level was 38.6 dB HL and was not different from the preoperative hearing level. Two years after surgery, the hearing level gradually decreased and was 42.0 dB HL at five years of follow-up. CONCLUSION: EMS appears to be beneficial in the short term for the symptomatic patients.

scholarly journals Effect of an Er,Cr:YSGG Laser on the Surface of Implants: A Descriptive Comparative Study of 3 Different Tips and Pulse Energies

2020 ◽  
Vol 8 (4) ◽  
pp. 109
Author(s):  
Ehsan Chegeni ◽  
Antonio España-Tost ◽  
Rui Figueiredo ◽  
Eduard Valmaseda-Castellón ◽  
Josep Arnabat-Domínguez
Keyword(s):  
Dental Implants ◽  
In Vitro Study ◽  
Surface Damage ◽  
Sem Analysis ◽  
Implant Surface ◽  
Class A ◽  
Class D ◽  
Class B ◽  
Class C

Peri-implant diseases are one of the main complications of dental implants. There are no well-established guidelines regarding laser parameters for implant decontamination. The aim was to compare two different settings of irradiation of the Er,Cr:YSGG laser on dental implants regarding surface alterations and determine the best settings for less damage on the surface. An in vitro study was performed and 30 areas of dental implants were irradiated with two different regimes of energy per pulse 50 and 84 mJ (1.5 W/30 Hz and 2.5 W/30 Hz). A total of 30 sites of implants were irradiated with three different tips (10 surfaces per tip): conical (RTF3-17 mm), side firing (SFT8-18 mm) and cylindrical (MGG6-6 mm). The following descriptive classification on surface damage was employed: no damage (class A), minimal effects (class B), metal fall with melting (class C), and destruction with carbonization (class D). The assessment was made through a descriptive scanning electron microscope (SEM) analysis. Side firing and conical tips at 50 mJ were classified as class A. Side firing at 84 mJ and cylindrical tips 50 mJ and 84 mJ were classified as class B. Finally, class C defects were found in the areas where the conical tip was used at 84 mJ. Side firing and conical tips at 50 mJ do not seem to damage the implant surface.

Retrosigmoid removal of small acoustic neuroma: curative tumor removal with preservation of function

2014 ◽  
Vol 121 (3) ◽  
pp. 554-563 ◽  
Author(s):  
Iwao Yamakami ◽  
Seiro Ito ◽  
Yoshinori Higuchi
Keyword(s):  
Internal Auditory Canal ◽  
Tumor Removal ◽  
Class A ◽  
Class B ◽  
Sharp Dissection ◽  
Class C ◽  
Auditory Monitoring ◽  
Facial Function

Object Management of small acoustic neuromas (ANs) consists of 3 options: observation with imaging follow-up, radiosurgery, and/or tumor removal. The authors report the long-term outcomes and preservation of function after retrosigmoid tumor removal in 44 patients and clarify the management paradigm for small ANs. Methods A total of 44 consecutively enrolled patients with small ANs and preserved hearing underwent retrosigmoid tumor removal in an attempt to preserve hearing and facial function by use of intraoperative auditory monitoring of auditory brainstem responses (ABRs) and cochlear nerve compound action potentials (CNAPs). All patients were younger than 70 years of age, had a small AN (purely intracanalicular/cerebellopontine angle tumor ≤ 15 mm), and had serviceable hearing preoperatively. According to the guidelines of the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology–Head and Neck Surgery Foundation, preoperative hearing levels of the 44 patients were as follows: Class A, 19 patients; Class B, 17; and Class C, 8. The surgical technique for curative tumor removal with preservation of hearing and facial function included sharp dissection and debulking of the tumor, reconstruction of the internal auditory canal, and wide removal of internal auditory canal dura. Results For all patients, tumors were totally removed without incidence of facial palsy, death, or other complications. Total tumor removal was confirmed by the first postoperative Gd-enhanced MRI performed 12 months after surgery. Postoperative hearing levels were Class A, 5 patients; Class B, 21; Class C, 11; and Class D, 7. Postoperatively, serviceable (Class A, B, or C) and useful (Class A or B) levels of hearing were preserved for 84% and 72% of patients, respectively. Better preoperative hearing resulted in higher rates of postoperative hearing preservation (p = 0.01); preservation rates were 95% among patients with preoperative Class A hearing, 88% among Class B, and 50% among Class C. Reliable monitoring was more frequently provided by CNAPs than by ABRs (66% vs 32%, p < 0.01), and consistently reliable auditory monitoring was significantly associated with better rates of preservation of useful hearing. Long-term follow-up by MRI with Gd administration (81 ± 43 months [range 5–181 months]; median 7 years) showed no tumor recurrence, and although the preserved hearing declined minimally over the long-term postoperative follow-up period (from 39 ± 15 dB to 45 ± 11 dB in 5.1 ± 3.1 years), 80% of useful hearing and 100% of serviceable hearing remained at the same level. Conclusions As a result of a surgical technique that involved sharp dissection and internal auditory canal reconstruction with intraoperative auditory monitoring, retrosigmoid removal of small ANs can lead to successful curative tumor removal without long-term recurrence and with excellent functional outcome. Thus, the authors suggest that tumor removal should be the first-line management strategy for younger patients with small ANs and preserved hearing.

scholarly journals Prevalence and classification of anatomical variations of mandibular canal in panoramic radiographies

2020 ◽  
Author(s):  
George Borja de Freitas ◽  
Pierre Gomes de Morais Silva ◽  
Jalber Almeida dos Santos ◽  
Luiz Roberto Coutinho Manhães Júnior ◽  
Paula Bernardon
Keyword(s):  
Anatomical Variations ◽  
Mandibular Canal ◽  
Anatomical Structure ◽  
Panoramic Radiographs ◽  
Class A ◽  
Class D ◽  
Class B ◽  
Class C ◽  
The Right

Introduction: Dental surgeries involving structures adjacent to the mandibular canal require greater knowledge of the intraosseous path, anatomical structure, and its variables, reducing the risk of injuries to this region. This research aimed to verify on the panoramic radiographs the anatomical characteristics of the mandibular canal, as well as to analyze and classify its pathways.Methods: The classification of anatomical variations of the mandibular canal was divided into four types: Class A (inferior direction); Class B (mesial direction); Class C (alveolar direction); and Class D (retromolar direction). The sample consisted of 500 exams, 207 (41.4%) males and 293 (58.6%) females, with a mean age of 29.51 years.Results: A prevalence of 30 anatomical variations of the mandibular canal was observed. The most prevalent classifications were Class B (43.6%) followed by Class C (23.1%) and D (33.3%). In no case was the presence of bifid canals classified as Class A. The anatomical variations of the mandibular canal appeared both unilaterally and bilaterally, in which unilaterally the prevalence was on the left side (50%), on the right side (20%), and bilaterally (30%).Conclusions: According to the results obtained in this study, a prevalence of 6% of bifid mandibular canals was found. The most prevalent types of the bifid canal were Class B and Class D, and the highest occurrence of bifid mandibular canals was left unilateral. It is concluded that the appearance of mandibular canal anatomical variations in panoramic radiographs is frequent and that additional care must be taken to approach the region.

Treatment patterns and outcomes of hepatocellular carcinoma (HCC) patients (pts) in the CancerLinQ Research Database (CLQ).

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 283-283
Author(s):  
Shaum Kabadi ◽  
Linlin Luo ◽  
Andrew (Scott) Moren ◽  
Katherine Baria
Keyword(s):  
Clinical Trials ◽  
Kinase Inhibitor ◽  
Performance Status ◽  
Research Database ◽  
Duration Of Therapy ◽  
Class A ◽  
Class B ◽  
Pugh Class ◽  
Class C

283 Background: Treatment and management of pts with HCC is complicated by the presence of underlying chronic liver disease. Clinical trials with unresectable HCC pts are generally limited to Child-Pugh A or pts with good performance status. Therefore there is limited data for less fit HCC pts, particularly those treated in the community practice setting. Methods: The study design was a retrospective cohort study using the US-based CancerLinQ Discovery Database (CLQ). CLQ was launched by the American Society of Clinical Oncology in 2016 and consists of longitudinal, demographically, and geographically diverse data aggregated from oncology practice Electronic Health Record databases. Eligible pts were ≥18 years at time of HCC diagnosis, had a diagnosis of stage IV HCC within the record, and had ≥2 clinical encounters on separate dates during follow-up after the date of diagnosis. The study period and patient identification period was Jan 1997–Aug 2019; follow up continued through May 2020. Patient demographics, clinical characteristics, and general treatment characteristics were summarized using descriptive statistics. Results: 460 pts were eligible for analysis. Of these, 141 pts (31%) had a Child-Pugh score as reported in medical charts or imputed based on structured and curated data. 76 (54%) pts were Child-Pugh class A, 59 (42%) Child-Pugh class B, and 6 (4%) Child-Pugh class C. The proportion of pts with chronic hepatitis C infection and liver cirrhosis was higher in pts with Child-Pugh classes B and C compared to A. Time from diagnosis to first systemic therapy decreased from a median of 126 days for pts with Child-Pugh class A, to 47 and 16 days for class B and C, respectively. Sorafenib was the most common regimen regardless of line of therapy, followed by PD-1 pathway inhibitors and chemotherapy. Median duration of sorafenib therapy decreased from Child-Pugh class A to C (table). There was a similar decrease in duration of therapy for pts receiving PD-1 pathway inhibitors and chemotherapy when moving from class A to class C. Conclusions: This is the first published retrospective study in HCC using the CLQ. Pts with Child-Pugh class B or C, who are typically excluded from clinical trials, represented 48% of the pts with a Child-Pugh score included in this analysis. Duration of therapy was numerically lower for pts with Child-Pugh class B or C compared to Child-Pugh class A. Further research is needed to describe real-world evidence outside the context of a clinical trial for HCC pts. Funding: AstraZeneca. [Table: see text] Avg, average; obs, observed; TKI, tyrosine kinase inhibitor

scholarly journals Kinetic Study of Two Novel Enantiomeric Tricyclic β-Lactams Which Efficiently Inactivate Class C β-Lactamases

2001 ◽  
Vol 45 (8) ◽  
pp. 2215-2223 ◽  
Author(s):  
Mateja Vilar ◽  
Moreno Galleni ◽  
Tom Solmajer ◽  
Boris Turk ◽  
Jean-Marie Frère ◽  
...  
Keyword(s):  
Kinetic Study ◽  
Order Rate Constant ◽  
Class A ◽  
Complete Inactivation ◽  
Class D ◽  
Wide Range ◽  
Class B ◽  
Class C ◽  
Covalent Adducts ◽  
Derivatives Of

ABSTRACT A detailed kinetic study of the interaction between two ethylidene derivatives of tricyclic carbapenems, Lek 156 and Lek 157, and representative β-lactamases andd-alanyl–d-alanine peptidases (dd-peptidases) is presented. Both compounds are very efficient inactivators of the Enterobacter cloacae 908R β-lactamase, which is usually resistant to inhibition. Preliminary experiments indicate that various extended-spectrum class C β-lactamases (ACT-1, CMY-1, and MIR-1) are also inactivated. With the E. cloacae 908R enzyme, complete inactivation occurs with a second-order rate constant,k 2/K′, of 2 × 104to 4 × 104 M−1 s−1, and reactivation is very slow, with a half-life of >1 h. Accordingly, Lek 157 significantly decreases the MIC of ampicillin for E. cloacae P99, a constitutive class C β-lactamase overproducer. With the other serine β-lactamases tested, the covalent adducts exhibit a wide range of stabilities, with half-lives ranging from long (>4 h with the TEM-1 class A enzyme), to medium (10 to 20 min with the OXA-10 class D enzyme), to short (0.2 to 0.4 s with the NmcA class A β-lactamase). By contrast, both carbapenems behave as good substrates of the Bacillus cereus metallo-β-lactamase (class B). TheStreptomyces sp. strain R61 and K15 extracellulardd-peptidases exhibit low levels of sensitivity to both compounds.

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