Causes of cardioembolic stroke

ESC CardioMed ◽  
2018 ◽  
pp. 957-959
Author(s):  
Stefan Hohnloser
Keyword(s):  
Primary Prevention ◽  
Recurrence Rate ◽  
Preventive Measures ◽  
Preventive Therapy ◽  
Sudden Onset ◽  
Cardioembolic Stroke ◽  
High Recurrence Rate ◽  
Recurrence Rates ◽  
Term Basis

Cardiogenic embolism is estimated to account for at least 20% of ischaemic strokes occurring each year worldwide. Strokes due to cardiac embolism are generally combined with greater severity, less favourable prognosis, and a particularly high recurrence rate, both on a short-term and on a long-term basis. In individual patients presenting with stroke, decreased consciousness at onset, sudden onset to maximal deficit, and simultaneous or sequential strokes in different arterial territories all increase the likelihood of a cardioembolic stroke. Cardioembolic stroke is largely preventable, emphasizing the need for primary prevention for major risk cardioembolic sources. Given the high recurrence rates of stroke in afflicted patients, secondary preventive measures are equally important. Details on the most effective primary and secondary preventive therapy are provided later in this chapter.

LONG-TERM RECURRENCE RATES OF ATYPICAL MENINGIOMAS AFTER GROSS TOTAL RESECTION WITH OR WITHOUT POSTOPERATIVE ADJUVANT RADIATION

Neurosurgery ◽  
2009 ◽  
Vol 64 (1) ◽  
pp. 56-60 ◽  
Author(s):  
Manish K. Aghi ◽  
Bob S. Carter ◽  
Garth R. Cosgrove ◽  
Robert G. Ojemann ◽  
Sepideh Amin-Hanjani ◽  
...  
Keyword(s):  
Recurrence Rate ◽  
Cox Regression ◽  
Hazard Ratio ◽  
Gross Total Resection ◽  
High Recurrence Rate ◽  
Adjuvant Radiation ◽  
Postoperative Radiation ◽  
Recurrence Rates ◽  
Total Resection

Abstract OBJECTIVE Atypical meningioma (AM) patients often undergo gross total resection (GTR) at the time of presentation, but subsequent prognosis and optimal management remain unclear. We sought to define the long-term recurrence rate of AMs after GTR, along with factors predicting recurrence, including postoperative radiation. METHODS We performed a retrospective review of 108 AMs after GTR at our institution from 1993 to 2004. Recurrence risk factors were analyzed using multivariate Cox regression. RESULTS There were 600 patient-years of imaging follow-up on 48 men and 60 women. Of 108 tumors, 30 (28%) recurred 3 to 144 months after GTR (mean, 36 months). Actuarial tumor recurrence rates were 7% (1 year), 41% (5 years), and 48% (10 years). Of 108 patients, 8 received postoperative radiation without recurrence (P = 0.1). Multivariate analysis including age, sex, postoperative radiation, tumor location, MIB-1 labeling index, and 6 atypical-defining histological features identified recurrence-predicting factors: older age (hazard ratio, 1.6/decade; P = 0.01), sheeting (hazard ratio, 2.2; P = 0.025), and prominent nucleoli (hazard ratio, 2.1; P = 0.034). Recursive partitioning identified a subset, men with mitoses and prominent nucleoli, with 70% recurrence (n = 14). All patients with recurrences received radiation, and 22 of 30 patients underwent craniotomies (average, 2.7 craniotomies per patient with recurrence; range, 1–7 craniotomies). Only 1 of 22 re-resected meningiomas underwent malignant transformation. Of 30 patients with recurrence, 10 experienced tumor-induced mortality an average of 7 years after recurrence (range, 1–14 years). CONCLUSION After GTR without postoperative radiation, AMs have a high recurrence rate. Most recurrences occurred within 5 years after resection. Recurrences caused numerous reoperations per patient and shortened survival. Our finding suggesting lower recurrence rates in patients undergoing immediate postoperative radiation should be investigated in larger, prospective series.

Abstract 2068: Systematic Undersized Rigid Ring Decreases Recurrence Rate Following Repair of Ischemic Mitral Valve

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Raphaël Fontaine ◽  
Denis Bouchard ◽  
Philippe Demers ◽  
Raymond Cartier ◽  
Michel Carrier ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Recurrence Rate ◽  
Nyha Class ◽  
High Recurrence Rate ◽  
Class Iii ◽  
Term Survival ◽  
Rigid Ring

Introduction: Chronic ischemic mitral regurgitation (MR) has been associated with poor long-term survival. Suboptimal midterm results have been a growing concern in the surgical community. In recent years, our approach to repair those valves has evolved to a standardized technique using complete, rigid and small annuloplasty rings. This study aims to compare this systematic approach with our prior experience from 1996 –2001 where recurrent MR rate was high. Methods: 129 patients underwent repair for pure ischemic mitral valve regurgitation between 2002 and 2005 at our institution. Of these patients, 99 had clinical and echographic follow-up. These patients were compared to the 1996 –2001 cohort of 73 patients. Results: Preoperatively, 84% of patients were in NYHA class III or IV, 17% had moderate MR, 83% had moderate-severe to severe MR. Sixteen were redo operations, mostly of previous CABG. All patients except one were treated with a complete rigid ring (Annuloflo 46.5%, Physioring 34.9%, Etlogix 13.9%, others 3.8%). Ring size was: 24 (0.8%); 26 (55.8%); 28 (38%); or 30 (4.5%). Mortality was 8.5% at 30 days, 14.7% at 1 year and 17.8% at 2 years. Immediate postoperative regurgitation was absent or trace in all patients. Freedom from reoperation was 97%. Mean postoperative NYHA class was 1.15 at a mean follow-up of 28 months. Recurrent moderate mitral regurgitation (2+) was 15.34%, severe mitral regurgitation (3+ to 4+) was 13.4% at a mean follow-up of 16 months. In the 73 patients from the period 1996 –2001 at the same echo follow-up time, the moderate and severe recurrence were: 37% and 21%. The decrease in the recurrence rate was highly significant (p=0.001). Conclusion: A more standardized approach to ischemic mitral valve repair has improved the high recurrence rate previously reported by our group. Long-term follow-up is necessary to confirm these findings.

scholarly journals Ultrasound-Guided Aspiration Does Not Reduce the Recurrence Rate of Ganglion Cysts of the Wrist

2018 ◽  
Vol 08 (02) ◽  
pp. 100-103 ◽  
Author(s):  
Gregory Kurkis ◽  
Albert Anastasio ◽  
Marijke DeVos ◽  
Michael Gottschalk
Keyword(s):  
Recurrence Rate ◽  
Ultrasound Guidance ◽  
Ganglion Cyst ◽  
High Recurrence Rate ◽  
P Value ◽  
Ultrasound Guided ◽  
Recurrence Rates ◽  
Level Of Evidence ◽  
Ganglion Cysts ◽  
Significant Difference

Background Ganglion cysts are the most frequent soft tissue tumor encountered in the upper extremity and are commonly treated by aspiration or by surgical excision. Ultrasound is a promising addition to traditional aspiration, as it allows for visualization of the needle within the ganglion before aspiration. Questions Are ganglion cysts of the wrist less likely to reoccur if they are aspirated under ultrasound guidance versus “blind” aspiration without the use of ultrasound guidance? Does patient functionality change based on whether or not the cyst recurred? Patients and Methods In total, 52 patients were successfully contacted and recurrence rates were compared between those whose cyst was treated with ultrasound-guided (13 patients) with those whose cyst was treated with blind aspiration (39 patients). Mean follow-up time was 2.9 years. Results Recurrence rates were 69% (9 patients) and 74% (29 patients) for the ultrasound-guided and blind aspiration groups, respectively (p-value: 0.73), showing no significant difference in recurrences of wrist ganglion between the two groups. A metric of functionality (Quick–DASH [Disabilities of the Arm, Shoulder, and Hand]) revealed worse outcomes in patients who experienced return of ganglion cyst after aspiration versus those who did not. Conclusion Additional studies with improved sample sizes are needed to demonstrate the superiority of ultrasound-guided aspiration versus blind aspiration. Due to a high recurrence rate following aspiration (both ultrasound-guided and blinded), a lower threshold for surgical intervention is likely reasonable. Level of Evidence This is a Level IIIb study.

Lithium and SSRIs in long-term treatment of unipolar subjects with high recurrence rate

1997 ◽  
Vol 42 (1) ◽  
pp. 258S
Author(s):  
L. Franchini ◽  
M. Gasperini ◽  
J. Perez ◽  
E. Smeraldi ◽  
R. Zanardi
Keyword(s):  
Recurrence Rate ◽  
Term Treatment ◽  
High Recurrence Rate ◽  
Long Term Treatment

scholarly journals Endoscopic Bulking Materials for the Treatment of Vesicoureteral Reflux: A Review of Our 20 Years of Experience and Review of the Literature

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Boris Chertin ◽  
Stanislav Kocherov ◽  
Leonid Chertin ◽  
Alaeddin Natsheh ◽  
Amicur Farkas ◽  
...  
Keyword(s):  
Recurrence Rate ◽  
Current Literature ◽  
Endoscopic Treatment ◽  
Long Term Results ◽  
High Recurrence Rate ◽  
Years Of Experience ◽  
Long Term Outcome ◽  
Term Efficacy ◽  
Endoscopic Correction

Purpose. We reviewed our 20 years of experience and the current literature regarding the long-term outcome of endoscopic treatment of vesicoureteric reflux (VUR) using the different tissue bulking substances with a special emphasis on the long-term efficacy.Material and Methods. Our own experience and the current literature on the long-term results after endoscopic treatment using various bulking agents were reviewed.Results. Short-term data following endoscopic treatment of VUR is similar to the various substances and comparable in the majority of the series to the success rate following open surgery. Recently, a relatively high recurrence rate was noticed especially with the use of dextranomer hyaluronic acid (Dx/HA) as a tissue augmenting material which raises the need for further search for alternative substances.Conclusions. Unfortunately, there is a significant shortage of evidence-based literature on the long-term followup after endoscopic correction of reflux with various substances. No doubt, there is a high recurrence rate during long-term followup after Dx/HA injection, and there is probably lack of proper evaluation regarding the long-term efficacy of other bulking materials. These facts demand long-term close observation and long-term studies beyond the routine protocols following endoscopic treatment of VUR and the correct parental counseling upon the endoscopic correction.

scholarly journals Recurrence Rates After Microvascular Decompression in Patients With Primary Trigeminal Neuralgia and Its Influencing Factors: A Systematic Review and Meta-Analysis Based on 8,172 Surgery Patients

2021 ◽  
Vol 12 ◽  
Author(s):  
Fangyu Chen ◽  
Yuming Niu ◽  
Fan Meng ◽  
Pan Xu ◽  
Chao Zhang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Trigeminal Neuralgia ◽  
Recurrence Rate ◽  
Influencing Factors ◽  
Microvascular Decompression ◽  
Meta Analysis ◽  
Postoperative Recurrence ◽  
Recurrence Rates ◽  
Primary Trigeminal Neuralgia

Background: Primary trigeminal neuralgia (PTN) is known to reoccur following microvascular decompression (MVD) surgery. However, the rates and contributing factors related to PTN recurrence remain controversial. The purpose of this study was to explore the postoperative recurrence rates and related influencing factors of patients with PTN after MVD. Additionally, recurrence rates after different treatments were compared to provide guidelines for clinicians.Methods: We conducted systematic reviews and meta-analyses in accordance with the preferred reporting items of the PRISMA guidelines. We searched nine databases, namely, the PubMed, EMBASE, Cochrane Library, Web of Science, CINAHL, CBM, CNKI, VIP, and Wanfang databases, from establishment to July 13, 2020, selecting for studies about the long-term postoperative efficacy of MVD in the treatment of PTN. Factors associated with higher recurrence rates after MVD and long-term postoperative results of other treatments underwent formal meta-analysis, where odds ratios (ORs) with the corresponding 95% confidence intervals (CIs) were calculated. The dose-response model was used to inspect the associations between several factors and higher recurrence rates.Results: Seventy-four studies (8,172 patients, 32 case series studies, and 42 non-randomized controlled trials) were analyzed in our research. Overall, 956 out of 8,172 patients relapsed, and the pooled recurrence rate was 0.096 (0.080–0.113). Influencing factors of relatively higher recurrence rates included atypical trigeminal neuralgia symptoms, lack of nerve groove, non-arterial compression, patients who were 50–60 years old, and longer disease duration. Dose–response analysis showed that the recurrence rate had a significant trend with the published year and the follow-up time. Simultaneously, the recurrence rate of MVD treatment was much lower than that of conventional drug treatment, gamma knife surgery, percutaneous balloon compression, and radiofrequency thermocoagulation. When the surgical technique was improved or combined with partial sensory rhizotomy (PSR), the postoperative recurrence rates were significantly reduced.Conclusions: Even for PTN patients who have a successful operation, ~10% of them will still relapse. This research identifies several factors that can affect the recurrence rate. Compared with other operations, MVD has a relatively lower recurrence rate. Our analysis suggests that improved surgical techniques and combining PSR and MVD will yield better results.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42020159276.

scholarly journals Surgery for wrist ganglia: one-hundred and twenty-two patients reviewed 8 years after operation

2014 ◽  
Vol 6 (1) ◽  
Author(s):  
Vilhjalmur Finsen ◽  
Øyvind Håberg ◽  
Grethe Elisabeth Borchgrevink
Keyword(s):  
Recurrence Rate ◽  
Radical Surgery ◽  
Common Reason ◽  
High Recurrence Rate ◽  
Hand Surgeon ◽  
Results Of Surgery

Wrist ganglia give few symptoms, but are a common reason for referral to a hand surgeon. We studied patient long-term satisfaction after operation. We reviewed 122 patients, who were operated for dorsal (n=82) and volar (n=40) wrist ganglia 8 years before (range 3-11). Three radial arteries were injured during surgery for volar a ganglion. By the time of review 33 patients (27%) had a recurrence or had been re-operated. Radical surgery did not reduce the recurrence rate significantly. Reported general complaints from the wrist improved from a mean visual analogue scores (VAS, 0=best; 100= worst) of 56 before surgery to VAS 14 at review and unsightliness from VAS 50 to VAS 14. Patients were equally happy with transverse and longitudinal scars. Ten patients (8%) stated that they would not have consented to surgery if they had known the outcome in advance. We conclude that, in spite of a high recurrence rate, most patients are happy with the results of surgery.

Outcomes of surgery for giant cell tumors of the tendon sheath within the hand.

2020 ◽  
Vol 92 (5) ◽  
pp. 1-5
Author(s):  
Andrzej Żyluk ◽  
Ada Owczarska
Keyword(s):  
Giant Cell ◽  
Recurrence Rate ◽  
Surgical Margin ◽  
Tendon Sheath ◽  
High Rate ◽  
High Recurrence Rate ◽  
Giant Cell Tumors ◽  
Proliferative Lesion

Giant cell tumor of the tendon sheath is the most common benign proliferative lesion involving the upper limb, characterised by relatively high recurrence rate after surgery. The objective of the study was a retrospective analysis of outcomes of the operative treatment of these tumours, in a long-term (a mean of 4,2 year) follow-up. Patients and methods. Preoperative examination was performed in 58 patients, 36 females (62%) and 22 males (38%), in a mean age of 41 years, and treatment outcomes were assessed in 47 persons (81% of the operated on), at a mean of 4,2 year follow-up. The final assessment was performed in a form of phone interview. Results. The tumours most frequently were located in fingers - 42 cases (72%). In 31 patients (53%) the lesion had well-defined capsule, and in 11 (19%) a satellite nodules were found around the main tumour. A total of 9 relapses (21%) occurred, all within first 2 years following surgery. Two patients had a next episode of recurrence after the second operation. In 8 out of the 9 patients with the recurrence, the primary lesion had not well-defined capsule. In 38 patients who had no relapse, 31 were completely symptom-free, whereas 7 complained from mild pain of the scar and/or numbness of the part of the involved finger. Conclusions. The main factor influencing the high rate of recurrence was incomplete tumour excision, what resulted from inadequately accurate surgery and the tumour morphology (having no well-defend capsule). The role of operating with the use of magnifying devices and keeping greater surgical margin at resection of the non-capsulated lesions was emphasised, what may translate into reducing of the recurrence rate.

scholarly journals The Durability of Pain Relief Following Endoscope-Assisted Microvascular Decompression for Trigeminal Neuralgia

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Alexandra D Baker ◽  
Melvin Field
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Recurrence Rate ◽  
Microvascular Decompression ◽  
Retrospective Chart Review ◽  
Postoperative Recurrence ◽  
Pain Scale ◽  
Neurovascular Compression ◽  
Recurrence Rates

Abstract INTRODUCTION Trigeminal neuralgia (TGN) is a facial pain disorder that is paroxysmal, stabbing, and produces a shooting pain that affects the face due to the compression of the trigeminal nerve. Literature has suggested that the use of an endoscope for microvascular decompression (eMVD), as opposed to a microscope alone, is more likely to identify the source of neurovascular compression and ensure that the nerve is adequately decompressed. However, the recurrence of TGN pain continues to be an issue for patients. This project will assess the long-term success of eMVD using the reduction in Barrow Pain Scale score and recurrence rate at 1 yr. METHODS This retrospective chart review aims at exploring the efficacy of eMVD for TGN by studying rates of recurrence in a cohort of 300 patients and comparing them to the literature using descriptive statistics. This is the largest study to date evaluating postoperative recurrence for eMVD for TGN. RESULTS In this cohort, on average, patients reduced their pain scale by 2.99 units on the Barrow Pain Scale. Additionally, 95.5% of patients experienced an immediate pain relief after eMVD surgery, while only 4.3% had no improvement in TGN pain after the procedure. In this eMVD patient cohort, 22% of patients had partial recurrence of TGN pain. CONCLUSION The endoscope seems to provide long-term success for eliminating TGN pain and is at least as successful as traditional MVD. Over 95% of patients with follow-up data experienced an immediate pain relief, indicating that the efficacy of this procedure is excellent. Recurrence rates of TGN pain seem to be comparable to the existing literature on traditional MVD approaches. This cohort had a partial recurrence rate of 22%, while previous MVD studies have shown significant recurrence rates between 3% and 32%. This indicates that significant recurrence rates of TGN need to be further investigated.

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