Trans-Sulcal Endoport-Assisted Evacuation of Supratentorial Intracerebral Hemorrhage: Initial Single-Institution Experience Compared to Matched Medically Managed Patients and Effect on 30-Day Mortality

2017 ◽  
Vol 14 (5) ◽  
pp. 524-531 ◽  
Author(s):  
Nanthiya Sujijantarat ◽  
Najib El Tecle ◽  
Matthew Pierson ◽  
Jorge F Urquiaga ◽  
Nabiha F Quadri ◽  
...  
Keyword(s):  
Retrospective Data ◽  
Minimally Invasive Techniques ◽  
Single Institution ◽  
Significant Difference ◽  
Intracerebral Hemorrhages ◽  
Hemorrhage Volume ◽  
The Mean ◽  
Gcs Score ◽  
Invasive Techniques ◽  
Clot Evacuation

AbstractBACKGROUNDThe surgical management of supratentorial intracerebral hemorrhages (ICH) remains controversial due to large trials failing to show clear benefits. Several minimally invasive techniques have emerged as an alternative to a conventional craniotomy with promising results.OBJECTIVETo report our experience with endoport-assisted surgery in the evacuation of supratentorial ICH and its effects on outcome compared to matched medical controls.METHODSRetrospective data were gathered of patients who underwent endoport-assisted evacuation between January 2014 and October 2016 by a single surgeon. Patients who were managed medically during the same period were matched to the surgical cohort. Previously published cohorts investigating the same technique were analyzed against the present cohort.RESULTSSixteen patients were identified and matched to 16 patients treated medically. Location, hemorrhage volume, and initial Glasgow Coma Scale (GCS) score did not differ significantly between the 2 cohorts. The mean volume reduction in the surgical cohort was 92.05% ± 7.05%. The improvement in GCS in the surgical cohort was statistically significant (7-13, P = .006). Compared to the medical cohort, endoport-assisted surgery resulted in a statistically significant difference in in-hospital mortality (6.25% vs 75.0%, P < .001) and 30-d mortality (6.25% vs 81.25%, P < .001). Compared to previously published cohorts, the present cohort had lower median preoperative GCS (7 vs 10, P = .02), but postoperative GCS did not differ significantly (13 vs 14, P = .28).CONCLUSIONEndoport-assisted surgery is associated with high clot evacuation and decreases 30-d mortality compared to a similar medical group.

Intravenous Tranexamic Acid for Brain Contusion with Intraparenchymal Hemorrhage: Randomized, Double‐Blind, Placebo-Controlled Trial

2020 ◽  
Vol 15 (1) ◽  
pp. 70-75 ◽  
Author(s):  
Maryam Mousavinejad ◽  
Javad Mozafari ◽  
Reza Bahrami Ilkhchi ◽  
Mohammad Ghasem Hanafi ◽  
Pouya Ebrahimi
Keyword(s):  
Tranexamic Acid ◽  
Brain Injuries ◽  
Controlled Trial ◽  
Intraparenchymal Hemorrhage ◽  
Double Blind ◽  
Brain Contusion ◽  
Significant Difference ◽  
Brain Ct Scan ◽  
Hemorrhage Volume ◽  
The Mean

Introduction: Controlling of secondary traumatic brain injuries (TBI) is necessary due to its salient effect on the improvement of patients with TBI and the final outcomes within early hours of trauma onset. This study aims to investigate the effect of intravenous tranexamic acid (TAX) administration on decreased hemorrhage during surgery. Methods: This double-blind, randomized, and placebo-controlled trial was conducted on patients referring to the emergency department (ED) with IPH due to brain contusion within 8 h of injury onset. The patients were evaluated by receiving TXA and 0.9% normal saline as a placebo. The following evaluation and estimations were performed: intracranial hemorrhage volume after surgery using brain CT-scan; hemoglobin (Hb) volume before, immediately after, and six hours after surgery; and the severity of TBI based on Glasgow Coma Score (GCS). Results: 40 patients with 55.02 ± 18.64 years old diagnosed with a contusion and intraparenchymal hemorrhage. Although the (Mean ± SD) hemorrhage during surgery in patients receiving TXA (784.21 ± 304.162) was lower than the placebo group (805.26 ± 300.876), no significant difference was observed between two groups (P=0.83). The (Mean ± SD) Hb volume reduction immediately during surgery (0.07 ± 0.001 and 0.23 ± 0.02) and six hours after surgery (0.04 ± 0.008 and 0.12 ± 0.006) was also lower in TXA group but had no significant difference (P = 0.89 and P = 0.97, respectively). Conclusion: Using TXA may reduce the hemorrhage in patients with TBI, but this effect, as in this study, was not statistically significant and it is suggested that a clinical trial with a larger population is employed for further investigation.

scholarly journals Intestinal helminths of spiny mice (Acomys cahirinus dimidiatus) from St Katherine's Protectorate in the Sinai, Egypt

2000 ◽  
Vol 74 (1) ◽  
pp. 31-43 ◽  
Author(s):  
J.M. Behnke ◽  
C.J. Barnard ◽  
N. Mason ◽  
P.D. Harris ◽  
N.E. Sherif ◽  
...  
Keyword(s):  
Helminth Parasites ◽  
Acomys Cahirinus ◽  
Non Invasive ◽  
Spiny Mice ◽  
Host Sex ◽  
Significant Difference ◽  
Weight Analysis ◽  
The Mean ◽  
Invasive Techniques ◽  
Larger Sample

AbstractSpiny mice,Acomys cahirinus dimidiatus, inhabiting the wadis close to St Katherine in the mountains of the Sinai peninsula, were trapped and their helminth parasites were studied. Sixty one mice provided faeces for analysis and 27 were killed and autopsied. Six species of helminths were recorded (the spirurid nematodes,Protospirura muricola(74.1%) andMastophorus muris(11.1%), the oxyuroid nematodes,Dentostomella kuntzi(59.3%),Aspiculuris africana(3.7%), andSyphacia minuta(3.7%) and the hymenolepidid cestodeRodentolepis negevi(18.5%)). The spirurids were the dominant species present, accounting for up to 0.87% of total host body weight. Analysis of worm weights and lengths suggested that transmission had been taking place in the months preceding our study. No sex difference in the prevalence or abundance of spirurids was detected. Significant differences were identified in the abundance of total nematode burdens and the mean helminth species richness between the three wadis which provided multiple captures of mice. There was also a marked effect of host age on both parameters. A highly significant positive correlation between spirurid egg counts and total worm biomass indicated that non-invasive techniques based on egg counts could be used to quantify worm burdens and when this technique was applied to a larger sample size (n= 61), a significant difference between sites but no host sex or age effects were detected for spirurid faecal egg counts. The data suggest that there are differences between helminth component communities infecting spiny mice in different neighbouring wadis, a hypothesis which will be explored further through our continuing studies in the Sinai.

Surgery and endovenous techniques for the treatment of small saphenous varicose veins: a review of the literature

2011 ◽  
Vol 26 (5) ◽  
pp. 179-184 ◽  
Author(s):  
S S Tellings ◽  
R P M Ceulen ◽  
A Sommer
Keyword(s):  
Minimally Invasive ◽  
Saphenous Vein ◽  
Minimally Invasive Techniques ◽  
Success Rates ◽  
Review Of The Literature ◽  
Treatment Techniques ◽  
Significant Difference ◽  
Invasive Techniques ◽  
All Treatment

In 15% of all patients, varicosis is caused by insufficiency of the small saphenous vein (SSV). In the past it was common to entirely remove the SSV by surgical procedure; however, recently minimally invasive techniques have taken over a significant number of varicose vein treatments. The aim of this paper is a review of the literature of all treatment modalities of the insufficient SSV. The search aimed to identify all papers published describing one or more treatments for SSV insufficiency. International literature databases were searched through for articles eligible for this review. Articles describing one or more treatment techniques for SSV insufficiency were eligible for this review. Also studies describing SSV as well as greater saphenous vein were included as long as they made a clear distinction in their results between the two groups. Studies were excluded if they did not use ultrasound examination to qualify outcome, as this is the golden standard to evaluate venous insufficiency. Seventeen articles were included in this review. Five articles on surgical treatment showed success rates varying from 24% to 100% (follow-up 1.5–60 months). Ten articles on endovenous laser ablation (EVLA) showed success rates varying from 91% to 100% (follow-up 1.5–36 months). Two articles on ultrasound-guided foam sclerotherapy (UGFS) showed success rates varying from 82% to 100% (follow-up 1.5–11 months). Statistical analysis showed a significant difference ( P < 0.05) in success rate of 47.8% versus 94.9% for surgery and EVLA/UGFS, respectively. Most complications for all treatment techniques were mild and self-limiting. Rates of deep venous thrombosis were not described often and in the articles that mentioned it, varied from 1.8% to 3.5% (surgery) and 2.5–5.7% for EVLA. In the absence of large, comparative randomized clinical trials, minimally invasive techniques appear to have a tendency towards better results than surgery, in the treatment of the insufficient SSV.

scholarly journals Lesion distribution characteristics of deep infiltrating endometriosis with ovarian endometrioma: An observational clinical study

2020 ◽  
Author(s):  
Hungling Kwok ◽  
Hongye Jiang ◽  
Tian Li ◽  
Huan Yang ◽  
Hui Fei ◽  
...  
Keyword(s):  
Complete Removal ◽  
Deep Infiltrating Endometriosis ◽  
Retrospective Data ◽  
Distribution Characteristics ◽  
Experienced Surgeon ◽  
Ovarian Endometrioma ◽  
Significant Difference ◽  
The Mean ◽  
Histological Confirmation ◽  
Infiltrating Endometriosis

Abstract Background: To investigate the characteristics of deep infiltrating endometriosis (DIE) lesion distribution when associated with ovarian endometrioma (OEM). Methods: The present study analyzed retrospective data obtained by the First Affiliated Hospital of Sun Yat-sen University, between June 2008 to June 2016. A total of 304 patients underwent laparoscopic surgery for complete removal of endometriosis by one experienced surgeon, and histological confirmation of OEM associated with DIE was conducted for each patient. Clinical data were recorded for each patient from medical, operative and pathological reports. Patients were then divided into two groups according to unilateral or bilateral OEM. Patients with unilateral OEM were subsequently divided into two subgroups according to OEM location (left- or right-hand side) and the diameter of the OEM (≤50 and >50 mm). The distribution characteristics of DIE lesions were then compared between the groups. Results: DIE lesions were widely distributed, 30 anatomical sites were involved. Patients with associated unilateral OEM (n=184 patients) had a significantly increased number of DIE lesions when compared with patients with bilateral OEM (n=120 patients; 2.76±1.52 vs. 2.33±1.34; P=0.006). Compared with bilateral OEM with DIE, there was a higher rate of intestinal (39.1% vs. 18.3%; P<0.01) and vaginal (17.4% vs. 6.7%; P<0.01) infiltration by DIE lesions in unilateral OEM with DIE. The mean number of DIE lesions was not significantly correlated with the location or size of the OEM (2.83±1.56 vs. 2.74±1.53; P=0.678; and 2.65±1.42 vs. 2.80±1.43; P=0.518, respectively). There was no significant difference between the groups with OEM ≤50 mm and >50 mm. Conclusion: Lesion distribution characteristics in women diagnosed with histologically proven OEM associated with DIE were frequently multifocal and severe. Key Words: ovarian endometrioma, deep infiltrating endometriosis, lesion distribution characteristics

Discrete cerebral hypothermia in the management of traumatic brain injury: a randomized controlled trial

2009 ◽  
Vol 110 (6) ◽  
pp. 1256-1264 ◽  
Author(s):  
Odette A. Harris ◽  
Carrie R. Muh ◽  
Monique C. Surles ◽  
Yi Pan ◽  
Grace Rozycki ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Treatment Group ◽  
Temperature Gradient ◽  
Control Group ◽  
Systemic Effects ◽  
Randomized Controlled ◽  
Bladder Temperature ◽  
Significant Difference ◽  
The Mean ◽  
Gcs Score

Object Hypothermia has been extensively evaluated in the management of traumatic brain injury (TBI), but no consensus as to its effectiveness has yet been reached. Explanatory hypotheses include a possible confounding effect of the neuroprotective benefits by adverse systemic effects. To minimize the systemic effects, the authors evaluated a selective cerebral cooling system, the CoolSystem Discrete Cerebral Hypothermia System (a “cooling cap”), in the management of TBI. Methods A prospective randomized controlled clinical trial was conducted at Grady Memorial Hospital, a Level I trauma center. Adults admitted with severe TBI (Glasgow Coma Scale [GCS] score ≤ 8) were eligible. Patients assigned to the treatment group received the cooling cap, while those in the control group did not. Patients in the treatment group were treated with selective cerebral hypothermia for 24 hours, then rewarmed over 24 hours. Their intracranial and bladder temperatures, cranial-bladder temperature gradient, Glasgow Outcome Scale (GOS) and Functional Independence Measure (FIM) scores, and mortality rates were evaluated. The primary outcome was to establish a cranial-bladder temperature gradient in those patients with the cooling cap. The secondary outcomes were mortality and morbidity per GOS and FIM scores. Results The cohort comprised 25 patients (12 in the treatment group, 13 controls). There was no significant intergroup difference in demographic data or median GCS score at enrollment (treatment group 3.0, controls 3.0; p = 0.7). After the third hour of the study, the mean intracranial temperature of the treatment group was significantly lower than that of the controls at all time points except Hours 4 (p = 0.08) and 6 (p = 0.08). However, the target intracranial temperature of 33°C was achieved in only 2 patients in the treatment group. The mean intracranial-bladder temperature gradient was not significant for the treatment group (p = 0.07) or the controls (p = 0.67). Six (50.0%) of 12 patients in the treatment group and 4 (30.8%) of 13 in the control group died (p = 0.43). The medians of the maximum change in GOS and FIM scores during the study period (28 days) for both groups were 0. There was no significant difference in complications between the groups (p value range 0.20–1.0). Conclusions The cooling cap was not effective in establishing a statistically significant cranial-bladder temperature gradient or in reaching the target intracranial temperature in the majority of patients. No significant difference was achieved in mortality or morbidity between the 2 groups. As the technology currently stands, the Discrete Cerebral Hypothermia System cooling cap is not beneficial for the management of TBI. Further refinement of the equipment available for the delivery of selective cranial cooling will be needed before any definite conclusions regarding the efficacy of discrete cerebral hypothermia can be reached.

Minimally Invasive Technique for Closure of Atrial Septal Defect

1998 ◽  
Vol 6 (2) ◽  
pp. 88-90 ◽  
Author(s):  
Jacques AM van Son ◽  
Anno Diegeler ◽  
Eugene KW Sim ◽  
Rüdiger Autschbach ◽  
Friedrich W Mohr
Keyword(s):  
Minimally Invasive ◽  
Atrial Septal Defect ◽  
Iliac Artery ◽  
Septal Defect ◽  
External Iliac Artery ◽  
Invasive Technique ◽  
Minimally Invasive Techniques ◽  
The Mean ◽  
The Right ◽  
Invasive Techniques

Minimally invasive techniques for repair of extracardiac anomalies in congenital heart disease have evolved over the last 5 years and laid the foundation for the next phase: the repair of intracardiac defects. Fifteen patients (9 females and 6 males) with a median age of 9.8 years (range, 5.2 to 54 years) underwent closure of a secundum atrial septal defect through a small right anterior thoracotomy. The right external iliac artery was cannulated through a small groin incision and the atrial septal defect was repaired during hypothermic fibrillatory arrest for a mean period of 14 ± 5 minutes. The mean length of the thoracotomy was 4.9 ± 0.8 cm (range, 4.5 to 8.8 cm) while the mean length of the groin incision was 3.9 ± 0.5 cm (range, 2.9 to 5.3 cm). In the 3 youngest patients, the external iliac artery was cannulated with an 8F arterial cannula. Direct closure of the atrial septal defect was possible in all patients. The mean operative time was 109 ± 39 minutes. There was no perioperative or late mortality and no morbidity except for a tear in the right femoral artery of a 19-year-old girl. No residual atrial septal defect was observed in any of the patients. Although minimally invasive techniques for repair of intracardiac defects are not fully developed with regard to indications, the procedure described here provided secure closure of the defects with excellent cosmetic results.

scholarly journals Decompressive Hemicraniectomy in Hypertensive Basal Ganglia Hemorrhages

Pulse ◽  
2016 ◽  
Vol 8 (1) ◽  
pp. 38-42
Author(s):  
Md Aliuzzaman Joarder ◽  
AKM Bazlul Karim ◽  
Shariful Islam Sujon ◽  
Nahid Akhter ◽  
Md Waheeduzzaman ◽  
...  
Keyword(s):  
Basal Ganglia ◽  
Surgical Techniques ◽  
Time Interval ◽  
Modified Rankin Scale ◽  
Stereotactic Aspiration ◽  
Decompressive Hemicraniectomy ◽  
The Mean ◽  
Poor Outcomes ◽  
Gcs Score ◽  
Invasive Techniques

Objectives: The aim of this study was to analyze efficacy and safety of decompressive hemicraniectomy (DHC) in hypertensive basal ganglia hemorrhage (HBGH). Neurosurgical management of HBGH is still a controversial issue. Surgical techniques are diverse, from the open large craniotomy, to the minimally invasive techniques like stereotactic aspiration of the HBGH, endoscopic evacuation and stereotactic catheter drainage after instillation of thrombolytic agents. Decompressive hemicraniectomy lowers intracranial pressure and improves outcome in patients with HBGH.Methods: 8 patients with HBGH who underwent decompressive craniectomy in the last 2 years were analyzed. Parameters investigated included clinical presentations, radiologic profile, time interval from ictus to surgery, and modified Rankin Scale score at 6 months.Results: The patients mean age 55 years, the mean Glasgow Coma Scale (GCS) score was 7 (range 5–13), the mean ICH volume was 58 ml (range 40–70 ml), and the mean midline shift was 10.62 mm (range 6-16 mm). The outcome after 6 months was appreciated as good (modified Rankin Scale 0–4) or poor (modified Rankin Scale 5-6). Five patients had good and three had poor outcomes (including two deaths).Conclusion: We conclude, based on this small cohort, that DC can reduce mortality in some cases. Larger prospective studies are needed to assess safety and efficacy of this method.Pulse Vol.8 January-December 2015 p.38-42

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