scholarly journals Case Series about the Changed Antiplatelet Protocol for Carotid Endarterectomy in a Teaching Hospital: More Patients with Complications?

2018 ◽  
Vol 04 (04) ◽  
pp. e220-e225
Author(s):  
Martijn Marsman ◽  
Denise Özdemir- van Brunschot ◽  
Abdelkarime Jahrome ◽  
Nic Veeger ◽  
Wouter Schuiling ◽  
...  
Keyword(s):  
Acetylsalicylic Acid ◽  
Carotid Endarterectomy ◽  
Extended Release ◽  
Case Series ◽  
Daily Practice ◽  
Postoperative Hemorrhage ◽  
Consecutive Series ◽  
Cerebrovascular Event ◽  
First Choice ◽  
Ischemic Complications

Introduction In the Netherlands, clopidogrel monotherapy increasingly replaces acetylsalicylic acid and extended release dipyridamole as the first-choice antiplatelet therapy after ischemic stroke. It is unknown whether the risk of peri- and postoperative hemorrhage in carotid artery surgery is higher in patients using clopidogrel monotherapy compared with acetylsalicylic acid and extended release dipyridamole. We therefore retrospectively compared occurrence of perioperative major and (clinical relevant) minor bleedings during and after carotid endarterectomy of two groups using different types of platelet aggregation inhibition after changing our daily practice protocol in our center. Material and Methods A consecutive series of the most recent 80 carotid endarterectomy patients (November 2015–August 2017) treated with the new regime (clopidogrel monotherapy) were compared with the last 80 (January 2012–November 2015) consecutive patients treated according to the old protocol (acetylsalicylic acid and dipyridamole). The primary endpoint was any major bleeding during surgery or in the first 24 to 72 hours postoperatively. Secondary outcomes within 30 days after surgery included minor (re)bleeding postoperative stroke with persistent or transient neurological deficit, persisting or transient neuropraxia, asymptomatic restenosis or occlusion, (transient) headache. Reporting of this study is in line with the ‘Strengthening the Reporting of Observational Studies in Epidemiology’ statement. Results Although statistical differences were observed, from a clinical perspective both patients groups were comparable. Postoperative hemorrhage requiring reexploration for hemostasis occurred in none of the 80 patients in the group of the clopidogrel monotherapy (new protocol) and it occurred in one of the 80 patients (1%) who was using acetylsalicylic acid and dipyridamole (old protocol). In three patients (4%) in the clopidogrel monotherapy and one patient (1%) in the acetylsalicylic acid and extended release dipyridamole protocol an ipsilateral stroke was diagnosed. Conclusion In this retrospective consecutive series the incidence of postoperative ischemic complications and perioperative hemorrhage after carotid endarterectomy (CEA) seemed to be comparable in patients using clopidogrel monotherapy versus acetylsalicylic acid and extended release dipyridamole for secondary prevention after a cerebrovascular event. This study fuels the hypothesis that short- and midterm complications of clopidogrel and the combination acetylsalicylic acid and extended release dipyridamole are comparable.

scholarly journals 63 Chronic Femoral Osteomyelitis Case Series: Outcomes and Economic Impact at A United Kingdom Based Tertiary Centre

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
E Lau ◽  
Z Arshad ◽  
A Aslam ◽  
A Thahir ◽  
M Krkovic
Keyword(s):  
Economic Impact ◽  
Treatment Protocol ◽  
Case Series ◽  
Consecutive Series ◽  
Financial Loss ◽  
Patient Demographics ◽  
Tertiary Centre ◽  
The Mean ◽  
Eq Vas

Abstract Introduction Osteomyelitis refers to an inflammatory process affecting bone and bone marrow. This study reviews chronic femoral osteomyelitis treatment and outcomes, including economic impact. Method We retrospectively collected data from a consecutive series of 14 chronic femoral osteomyelitis patients treated between January 2013 and January 2020. Data collected include patient demographics, comorbidities, pathogens, complications, treatment protocol and costs. Functional outcome was assessed using EuroQOL five-dimensional interview administration questionnaire (EQ-5D-5L™) and EuroQOL Visual Analogue Scale (EQ-VAS™). Results Of these, 92.9% had one or more osteomyelitis risk factor, including smoking and diabetes. Samples from 78.6% grew at least one pathogen. Only 42.9% achieved remission after initial treatment, but 85.7% were in remission at final follow-up, with no signs of recurrence throughout the follow-up period (mean: 21.4 months). The average treatment cost was £39,249.50 with a net mean loss of £19,080.10 when funding was considered. The mean-derived EQ-5D score was 0.360 and the mean EQ-VAS score was 61.7, lower than their values for United Kingdom’s general population, p = 0.0018 and p = 0.013 respectively. Conclusions Chronic femoral osteomyelitis treatment is difficult, resulting in significant economic burden. With previous studies showing cheaper osteomyelitis treatment at specialist centres, our net financial loss incurred suggests the need for management at specialised centres.

Results of Embolization Used as the First Treatment Choice in a Consecutive Nonselected Population of Ruptured Aneurysms: Clinical Results of the Clarity GDC Study

Neurosurgery ◽  
2011 ◽  
Vol 69 (4) ◽  
pp. 837-842 ◽  
Author(s):  
◽  
Christophe Cognard ◽  
Laurent Pierot ◽  
René Anxionnat ◽  
Frédéric Ricolfi
Keyword(s):  
Clinical Results ◽  
Morbidity And Mortality ◽  
World Federation ◽  
Consecutive Series ◽  
Ruptured Aneurysms ◽  
First Choice ◽  
International Subarachnoid Aneurysm Trial ◽  
Treatment Morbidity ◽  
Intraoperative Rupture ◽  
The Impact

Abstract BACKGROUND: The International Subarachnoid Aneurysm Trial (ISAT) showed that for ruptured aneurysms suitable for both techniques, coiling should be the first-choice treatment. Only a small proportion of patients (22%) with ruptured aneurysms were included in that trial. Operators were selected on their experience. One could then criticize the impact of the ISAT on clinical practice as a result of recruitment biases and operators' selection. OBJECTIVE: To evaluate the morbidity and mortality of coiling when used as first-choice treatment in a consecutive population of patients with ruptured aneurysms treated by nonselected operators. METHODS: Thirty-four operators from 19 French centers treated 405 patients with GDC coils from November 2006 to July 2007. The method of treatment was not prespecified. RESULTS: World Federation of Neurological Societies grade at admission was I/II in 65.7% and IV/V in 30.6% of patients. At the 3- to 6-month follow-up, 23.3% of patients were dependent or dead. Thromboembolic events and intraoperative rupture resulted in permanent deficit in 13 (3.2%) and 2 (0.5%), respectively, and death in 4 (1.0%) and 0. Early rebleeding occurred in 2 patients (0.5%) with 2 subsequent deaths. Permanent treatment morbidity and mortality were 3.7 % and 1.5 %, respectively. CONCLUSION: Clinical results of the multicenter prospective Clarity registry show that when coiling is performed as first-intention treatment in a consecutive series of nonselected ruptured aneurysms by nonselected operators, clinical results are similar to those of the ISAT.

Effect of acetylsalicylic acid usage and platelet transfusion on postoperative hemorrhage and activities of daily living in patients with acute intracerebral hemorrhage

2013 ◽  
Vol 118 (1) ◽  
pp. 94-103 ◽  
Author(s):  
Xiaowei Li ◽  
Zhaosheng Sun ◽  
Wangmiao Zhao ◽  
Jinrong Zhang ◽  
Jianchao Chen ◽  
...  
Keyword(s):  
Basal Ganglia ◽  
Mortality Rate ◽  
Activities Of Daily Living ◽  
Acetylsalicylic Acid ◽  
Daily Living ◽  
Controlled Trial ◽  
Postoperative Hemorrhage ◽  
Basal Ganglia Hemorrhage ◽  
Hemorrhage Volume ◽  
Apheresis Platelets

Object The authors evaluated the effects of acetylsalicylic acid (ASA) usage and transfusion of previously frozen apheresis platelets on postoperative hemorrhage, activities of daily living (ADL) score, and mortality rate in patients with acute hypertensive basal ganglia hemorrhage undergoing craniotomy. Methods This was a prospective, double-blind, parallel, randomized controlled trial in patients with acute hypertensive basal ganglia hemorrhage, who had either not received ASA therapy (control) or received ASA therapy. The patients who received ASA therapy were divided according to the results of a platelet aggregation test into ASA-resistant, ASA-semiresponsive, and ASA-sensitive groups. All patients required an emergency craniotomy for hematoma removal after hospitalization. The patients who were sensitive to ASA were randomized to receive one of the following transfusion regimens of previously frozen apheresis platelets: no transfusion, 1 therapeutic dose before surgery, or 2 therapeutic doses (1 before surgery and 1 after 24 hours of hospitalization). The postoperative hemorrhage rate and the average postoperative hemorrhage volume were recorded and the ADL scores and mortality rate were measured during a 6-month follow-up period. Results The rate of postoperative hemorrhage, average postoperative hemorrhage volume, and mortality rate were significantly higher in the ASA-sensitive patients who received ASA therapy compared with patients who did not receive ASA therapy (all p < 0.005). The ADL scores were grouped into different grades and the number of cases in the lower grades was higher and the overall scores were poorer in patients who received ASA therapy compared with those who did not (all p < 0.005). After transfusion of previously frozen apheresis platelets, the postoperative hemorrhage rate, average postoperative hemorrhage volume, and mortality rate of the ASA-sensitive patients were significantly lowered (all p < 0.005), and the ADL scores and their classification level were better than those of patients who did not undergo transfusion (all p < 0.005). Conclusions Transfusion of previously frozen apheresis platelets reduces the rate of postoperative hemorrhage, average postoperative hemorrhage volume, disability rate, and mortality rate in ASA-sensitive patients with acute hypertensive basal ganglia hemorrhage undergoing craniotomy.

scholarly journals Multicentre Evaluation of Adherence to Extended-Release Metformin in Daily Practice in Russia

2017 ◽  
Vol 4 (2) ◽  
Author(s):  
U Hostalek ◽  
A Ametov ◽  
I Barykina ◽  
I Bondar ◽  
A Vaysberg ◽  
...  
Keyword(s):  
Extended Release ◽  
Daily Practice

scholarly journals Clinicopathological profile of patients with brain secondaries from Ca cervix: a case series of five patients from tertiary cancer centre in North India

2021 ◽  
Vol 10 (8) ◽  
pp. 3208
Author(s):  
Jyoti Sharma ◽  
Mrinalini Upadhyay ◽  
Manish Gupta ◽  
Vikas Fotedar
Keyword(s):  
Radiation Therapy ◽  
Case Series ◽  
Daily Practice ◽  
Best Supportive Care ◽  
North India ◽  
Rare Occurrence ◽  
Cancer Cervix ◽  
Whole Brain Radiation ◽  
Clinicopathological Profile ◽  
Brain Radiation

Ca cervix is a common gynaecological cancer in daily practice but secondaries in brain after ca cervix as primary is a rare occurrence. As the survival of ca cervix patients has improved, we are able to encounter secondaries in unusual sites like brain. Prognosis is usually dismal due to presence of extra cranial mets along with brain secondaries which limits the use of new radiotherapy techniques like Stereotactic radiosurgery. We present a case series of five patients who presented to us post radical treatment of cancer cervix and treated with whole brain radiation therapy and best supportive care.

scholarly journals Cerebrovascular fibromuscular dysplasia

2017 ◽  
Vol 7 (3) ◽  
pp. 225-236 ◽  
Author(s):  
Andrea M. Harriott ◽  
Eli Zimmerman ◽  
Aneesh B. Singhal ◽  
Michael R. Jaff ◽  
Mark E. Lindsay ◽  
...  
Keyword(s):  
Disease Progression ◽  
Fibromuscular Dysplasia ◽  
Massachusetts General Hospital ◽  
Case Series ◽  
Antiplatelet Agents ◽  
Cerebrovascular Event ◽  
Symptomatic Disease ◽  
Surveillance Imaging ◽  
History Of

AbstractBackground:Fibromuscular dysplasia (FMD) is a rare noninflammatory, nonatherosclerotic arteriopathy of medium-sized arteries affecting up to 7% of the population. The disease can affect any artery but commonly affects renal, extracranial carotid, and vertebral arteries. The epidemiology and natural course of cerebrovascular FMD is unknown and requires further investigation.Methods:We present demographic and outcomes data on a case series of 81 patients with cerebrovascular FMD from Massachusetts General Hospital presenting between 2011 and 2015 followed by a review of the peer-reviewed literature.Results:Patients were a median age of 53 years (±12 SD) and the majority were women. Approximately 50% had a history of tobacco use and more than two-thirds had hypertension. Most patients were on monoplatelet therapy with aspirin; during follow-up, 7 of 67 had progressive disease or additional symptoms. One of 67 patients had a cerebrovascular event: TIA. There were 5 of 67 who had noncerebrovascular events or disease progression and 1 death of unclear cause.Conclusions:Cerebrovascular FMD may present with myriad symptoms. Our data support that patients with FMD with symptomatic disease have a low rate of recurrent symptoms or disease progression and can be managed conservatively with stroke risk modification, antiplatelet agents, surveillance imaging, and counseling.

scholarly journals Clinical trial of carotid artery stenting using dual-layer CASPER stent for carotid endarterectomy in patients at high and normal risk in the Japanese population

2020 ◽  
pp. neurintsurg-2020-016250
Author(s):  
Hirotoshi Imamura ◽  
Nobuyuki Sakai ◽  
Yasushi Matsumoto ◽  
Hiroshi Yamagami ◽  
Tomoaki Terada ◽  
...  
Keyword(s):  
Clinical Trial ◽  
High Risk ◽  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Artery Stenting ◽  
Peak Systolic Velocity ◽  
Cerebrovascular Event ◽  
Performance Goal ◽  
Significant Difference ◽  
Event Rates

BackgroundThe dual-layer nitinol CASPER stent was designed to prevent plaque prolapse into its strut and periprocedural stroke.ObjectiveTo conduct a clinical trial for government approval of the device in patients at either high or normal risk for carotid endarterectomy (CEA).MethodsEligible patients had ≥50% symptomatic stenosis or ≥80% asymptomatic stenosis according to the North American Symptomatic Carotid Endarterectomy Trial methods (peak systolic velocity 130 and 230 cm/s on ultrasonography, respectively). The primary endpoint was the lack of major adverse events (MAEs), defined as death, stroke, and myocardial infarction within 30 days, and ipsilateral stroke within 1 year. The performance goal was set at 90.5%. MAE rates were also compared between the CEA high- and normal-risk groups.Results140 carotid artery stenting procedures, including 40% of patients at high risk and 60% at normal risk for CEA, were performed in 13 institutes. MAEs occurred in two cases (one intraprocedural and one postprocedural stroke), and the MAE rate was 1.4%. The non-MAE rate was 98.6% according to Kaplan-Meier analysis, which was superior to the previously set performance goal. The deployment success, target lesion revascularization (TLR), in-stent restenosis, and cerebrovascular event rates were 99.3%, 2.4%, 8.5%, and 7.2%, respectively. The MAE rate in patients with normal CEA risk was 1.2%, which was similar to the high-risk CEA group, with no significant difference due to the small number of MAEs.ConclusionsThe MAE rate following use of the CASPER stent was low (1.4%). The MAE, deployment success, TLR, in-stenosis, and cerebrovascular event rates were similar to those of previous reports.

scholarly journals Pulmonary benign metastasizing leiomyomas: a case series of 23 patients at a single facility

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Rong Fan ◽  
Fengzhi Feng ◽  
Hua Yang ◽  
Kaifeng Xu ◽  
Shanqing Li ◽  
...  
Keyword(s):  
Rare Disease ◽  
Single Case ◽  
Case Series ◽  
Progesterone Receptors ◽  
Complete Response ◽  
Gynecologic Surgery ◽  
Curative Surgery ◽  
College Hospital ◽  
First Choice ◽  
S 100

Abstract Background Pulmonary benign metastasizing leiomyoma (PBML) is a rare disease characterized by leiomyoma of benign histopathology existing in the lungs. Because of its rarity, limited literature with a single case or small number of cases has been regarding to the clinical course, pathology or management of PBML. Methods A retrospective study was performed of all PBML cases diagnosed and managed at Peking Union Medical College Hospital (PUMCH) from 2001 to 2019. The clinical characteristics, pathology, treatment and outcomes of each case were studied. Results There were 25 PBML patients identified in the 19-year period in PUMCH, and 23 patients’ data was analyzed. The median age at diagnosis was 46 years. There were 7 patients (30.4%) diagnosed with postmenopausal status. Two patients (8.7%) had no uterine leiomyoma, and 3 patients (13.0%) had no gynecologic surgery history. Immunohistochemistry of most lesions demonstrated positive for desmin, SMA and Estrogen/Progesterone Receptors; and negative for S-100 were shown in 7 cases. After curative or diagnostic surgeries for the PBML, several treatments from observation to medical or surgical castration were performed. Nine premenopausal patients preserved their ovaries at first. At a median follow-up of 8 years, 3 patients finally had oophorectomy. Conclusions PBML is a rare disease and should be treated by individualization according to the patients’ age, symptoms and extent of lesion. Curative surgery for patients with limited lesions can achieve the complete response. For patients that are young and asymptomatic, close observation is recommended as the first choice. All patients should undergo long-term surveillance.

A Modified Capsular Shift for Atraumatic Anterior-Inferior Shoulder Instability

2005 ◽  
Vol 33 (7) ◽  
pp. 1011-1015 ◽  
Author(s):  
Björn Marquardt ◽  
Wolfgang Pötzl ◽  
Kai-Axel Witt ◽  
Jörn Steinbeck
Keyword(s):  
Shoulder Instability ◽  
Case Series ◽  
Consecutive Series ◽  
Study Group ◽  
Level Of Evidence ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Capsular Shift ◽  
Redislocation Rate

Purpose To evaluate the long-term outcome of a modified inferior capsular shift procedure in patients with atraumatic anterior-inferior shoulder instability by analyzing a consecutive series of patients who had undergone a modified inferior capsular shift for this specific type of shoulder instability. Study Design Case series; Level of evidence, 4. Methods Between 1992 and 1997, 38 shoulders of 35 patients with atraumatic anterior-inferior shoulder instability that were unresponsive to nonoperative management were operated on using a modified capsular shift procedure with longitudinal incision of the capsule medially and a bony fixation of the inferior flap to the glenoid and labrum in the 1 o'clock to 3 o'clock position. The patient study group consisted of 9 men and 26 women with a mean age of 25.4 years (range, 15-55 years) at the time of surgery. The mean follow-up was 7.4 years (range, 4.0-11.4 years); 1 patient was lost to follow-up directly after surgery. The study group was evaluated according to the Rowe score. Results After 7.4 years, 2 patients experienced a single redislocation or resubluxation, 1 patient had recurrent dislocations, and 1 patient had a positive apprehension sign, which is an overall redislocation rate of 10.5%. The average Rowe score increased to 90.6 (SD = 19.7) points from 36.2 (SD = 13.5) points before surgery. Seventy-two percent of the patients participating in sports returned to their preoperative level of competition. Conclusions Results in this series demonstrate the efficacy and durability of a modified capsular shift procedure for the treatment of atraumatic anterior-inferior shoulder instability.

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