scholarly journals Biologic therapy in supra-aortic Takayasu arteritis can improve symptoms of cerebral ischaemia without surgical intervention

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_3) ◽  
pp. iii28-iii32
Author(s):  
Andrew Porter ◽  
Taryn Youngstein ◽  
Enrico Tombetti ◽  
Justin C Mason
Keyword(s):  
Takayasu Arteritis ◽  
Cerebral Ischaemia ◽  
Surgical Intervention ◽  
Biologic Therapy ◽  
Premature Mortality ◽  
Arterial Disease ◽  
Aortic Disease ◽  
Response To Therapy ◽  
High Rate ◽  
Organ Blood Flow

Abstract Objectives Takayasu arteritis commonly results in severe arterial injury with stenoses, occlusions and occasionally aneurysms. Arterial disease may compromise organ blood flow and result in significant cardiovascular morbidity and premature mortality. Involvement of the supra-aortic arteries is common, and in its most severe form may compromise cerebral blood supply, resulting in signs of cerebral ischaemia including visual impairment, dysphasia, transient hemiparesis, loss of consciousness and stroke. In addition to combination immunosuppression, the management paradigm for symptomatic cerebral ischaemia includes revascularization. The invasive nature of this surgery, the risk of complications and the relatively high rate of re-stenosis is of concern to patients and their physicians alike. The aim of this study was to determine whether combined immunosuppression with early escalation to biologic therapy improved outcomes and reduced the need for high risk surgical intervention. Methods A retrospective review of 145 Takayasu arteritis patients attending Imperial College Healthcare between 2010–2018 was conducted to identify those with cerebral ischaemia secondary to supra-aortic disease and to analyse their treatment and outcomes. Results Eight patients (5.5%) were identified. Seven patients received long-term combined immunosuppressive therapy and six were prescribed biologics. The data revealed a higher than expected comprehensive response to therapy, with significant falls in disease activity, the cerebral ischaemia score and the prednisolone dose required, over a median follow-up of 37 months. Serial imaging analysis detected no arterial disease progression after the initiation of optimal therapy. Only one patient required surgical intervention for persistent neurological symptoms. Conclusion Early use of biologic therapy in those with supra-aortic Takayasu arteritis presenting with cerebral ischaemia may reduce the numbers of patients requiring surgical intervention and improve outcomes.

scholarly journals Symptomatic intracranial arterial disease: incidence, natural history, diagnosis, and management

2011 ◽  
Vol 30 (6) ◽  
pp. E14 ◽  
Author(s):  
Ananth K. Vellimana ◽  
Andria L. Ford ◽  
Jin-Moo Lee ◽  
Colin P. Derdeyn ◽  
Gregory J. Zipfel
Keyword(s):  
Natural History ◽  
Medical Therapy ◽  
Endovascular Therapy ◽  
Medical Management ◽  
Surgical Intervention ◽  
Disease Incidence ◽  
Arterial Disease ◽  
High Rate ◽  
Diagnosis And Management ◽  
Ischemic Events

Symptomatic intracranial arterial disease is associated with a high rate of recurrent ischemic events. The management of this condition is controversial, with some advocating medical therapy as a sole means of treatment and others recommending endovascular therapy in addition to best medical management. In rare cases, surgical intervention is considered. A thorough review of the available literature was performed, and treatment recommendations based on these data are provided.

Outcomes after Emergency Admission with a Diabetic Foot Attack Indicate a High Rate of Healing and Limb Salvage But Increased Mortality: 18-Month Follow-up Study

2020 ◽  
Author(s):  
Erika Vainieri ◽  
Raju Ahluwalia ◽  
Hani Slim ◽  
Daina Walton ◽  
Chris Manu ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Diabetic Foot ◽  
Emergency Admission ◽  
Arterial Disease ◽  
Major Amputation ◽  
Outcome Data ◽  
High Rate ◽  
Free Survival ◽  
Peripheral Arterial

Abstract Aim The diabetic foot attack (DFA) is perhaps the most devastating form of diabetic foot infection, presenting with rapidly progressive skin and tissue necrosis, threatening both limb and life. However, clinical outcome data in this specific group of patients are not available. Methods Analysis of 106 consecutive patients who underwent emergency hospitalisation for DFA (TEXAS Grade 3B or 3D and Infectious Diseases Society of America (IDSA) Class 4 criteria). Outcomes evaluated were: 1) Healing 2) major amputation 3) death 4) not healed. The first outcome reached in one of these four categories over the follow-up period (18.4±3.6 months) was considered. We also estimated amputation free survival. Results Overall, 57.5% (n=61) healed, 5.6% (n=6) underwent major amputation, 23.5% (n=25) died without healing and 13.2% (n=14) were alive without healing. Predictive factors associated with outcomes were: Healing (age<60, p=0.0017; no Peripheral arterial disease (PAD) p= 0.002; not on dialysis p=0.006); major amputation (CRP>100 mg/L, p=0.001; gram+ve organisms, p=0.0013; dialysis, p= 0.001), and for death (age>60, p= 0.0001; gram+ve organisms p=0.004; presence of PAD, p=0.0032; CRP, p=0.034). The major amputation free survival was 71% during the first 12 months from admission, however it had reduced to 55.4% by the end of the follow-up period. Conclusions In a unique population of hospitalised individuals with DFA, we report excellent healing and limb salvage rates using a dedicated protocol in a multidisciplinary setting. An additional novel finding was the concerning observation that such an admission was associated with high 18-month mortality, almost all of which was after discharge from hospital.

SHORT TO MEDIUM RESULTS USING THE REMOTION TOTAL WRIST REPLACEMENT FOR RHEUMATOID ARTHRITIS

Hand Surgery ◽  
2013 ◽  
Vol 18 (02) ◽  
pp. 175-178 ◽  
Author(s):  
A. S. C. Bidwai ◽  
F. Cashin ◽  
A. Richards ◽  
D. J. Brown
Keyword(s):  
Rheumatoid Arthritis ◽  
Pain Relief ◽  
Surgical Intervention ◽  
Case Series ◽  
High Rate ◽  
Wound Breakdown ◽  
Radial Forearm ◽  
Skin Coverage

We present the clinical outcome of patients who underwent RE-MOTION Total Wrist Replacement (TWR) for the treatment of Rheumatoid arthritis involving the wrist. Ten patients were available for follow-up, ranging from one to five years after index surgery. Two patients required surgical intervention for wound breakdown, including one patient who required a radial forearm flap for skin coverage. No patients required revision surgery or conversion to fusion. Patients who did not have complications gained statistically significant pain relief and improvement in mean overall flexion. In this small case series with short to medium results patients reported an improvement in terms of flexion and pain. Despite this, the question of efficacy of TWR compared to fusion in the long term remains unanswered due to the high rate of complications.

scholarly journals Prophylaxis of infection in region of the surgical intervention performance in laparoscopic cholecystectomy

2020 ◽  
Vol 87 (3-4) ◽  
pp. 22-25
Author(s):  
V. V. Kryzhevskii ◽  
N. A. Mendel ◽  
A. P. Brodskaya ◽  
Yu. V. Pavlovych
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Infection Rate ◽  
Microbial Contamination ◽  
Surgical Intervention ◽  
High Rate ◽  
Simultaneous Application ◽  
Surgical Interventions ◽  
The Third ◽  
Wound Protector ◽  
Combined Application

Objective. To estimate the efficacy of prophylactic method for regional infection while performance of laparoscopic cholecystectomy, using simultaneous application of container for removal of the specimen and a two-ring wound protector of the wound. In accordance to the literature data, the infection rate in laparoscopic cholecystectomy conduction constitutes 2.4 - 9.6%. Materials and methods. The work was based on experience of performance of 759 laparoscopic cholecystectomies during the period of 2015 - 2018 yrs. There were performed 679 operations with the second class of microbial contamination, 17 - with the third one and 6 - with the fourth. In 21 patients the conversion into laparotomy was applied. The patients with third and fourth classes of microbial contamination of wounds were divided into two groups: the first - 61 patients, in whom a container was used for the specimen removal, and the second - 19 patients, in whom the method of combined application of container and the wound protector was applied for removal of the specimen. Results. Infection of region of the surgical intervention performance in laparoscopic cholecystectomy was revealed in 41 (5.40%) of 759 patients.In surgical interventions In surgical interventions, referring to second class of microbial contamination , the infection rate in the surgical intervention region have constituted 2,5%, while referring to the third class - 11.76%, and the fourth class - 34.92%. Conversion in laparoscopic cholecystectomy is accompanied with high rate of the wound infection - 38.09%. Conclusion. Application of the method of combined usage of container for removal of preparation and a two-ring protector of the wound in the third and the fourth classes of the wounds while performance of laparoscopic cholecystectomy have permitted to lower the infection rate in region of the surgical intervention performance from 37.70 to 5.26%.

Abstract 486: The Effects of Weekend Admission on the Outcomes and Management of Ruptured Aortic Aneurysms

2014 ◽  
Vol 34 (suppl_1) ◽  
Author(s):  
Elliott M Groves ◽  
Mahdi Khoshchehreh ◽  
Christine Le ◽  
Shaista Malik
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Surgical Intervention ◽  
Surgical Care ◽  
Aortic Aneurysms ◽  
High Rate ◽  
Ruptured Aortic Aneurysm ◽  
Primary Endpoints ◽  
Abdominal Aortic ◽  
Thoracic And Abdominal

The Effects of Weekend Admission on the Outcomes and Management of Ruptured Aortic Aneurysms Objective: Ruptured aortic aneurysm is a condition with a high rate of mortality that requires prompt surgical intervention. It has been noted that in some conditions requiting such prompt intervention, in-hospital mortality is increased in patients admitted on the weekends as compared to patients admitted on weekdays. We sought to determine if this was indeed the case for both ruptured thoracic and abdominal aortic aneurysm and elucidate the possible reasons. Methods: Using the Nationwide Inpatient Sample (NIS), a publicly available database of inpatient care, we analyzed the incidence of mortality among patients admitted on the weekends compared to weekdays for ruptured aortic aneurysm. Ultimately the care of over 7,000 patients was analyzed for the primary endpoints. We adjusted for demographics, comorbid conditions, hospital characteristics, rates of surgical intervention, timing of surgical intervention and use of additional therapeutic measures. Results: Patients admitted on the weekend for both ruptured thoracic and abdominal aortic aneurysm had a statistically significant increase in mortality as compared to those admitted on the weekdays (OR 2.55 for Thoracic and 1.32 for Abdominal). By our analysis this is likely due to a delay in surgical care on the weekends. Conclusions: Weekend admission for ruptured aortic aneurysm is associated with an increased mortality when compared to those admitted on the weekend and this is likely due to several factors with the most predominant being a delay in surgical intervention.

scholarly journals Periprosthetic Ankle Fractures

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0007
Author(s):  
Alexander Lazarides ◽  
Tyler Vovos ◽  
James DeOrio ◽  
Mark Easley ◽  
James Nunley ◽  
...  
Keyword(s):  
Periprosthetic Fracture ◽  
Surgical Intervention ◽  
Nonoperative Management ◽  
High Rate ◽  
Periprosthetic Fractures ◽  
Medial Malleolus ◽  
Operative Fixation ◽  
Time To Fracture ◽  
Univariate Analyses

Category: Ankle Introduction/Purpose: Total ankle replacements (TAR) are an increasingly popular option for the management of tibiotalar arthritis. Periprosthetic fracture is an uncommon but challenging complication of patients undergoing arthroplasty. Evidence on the management of and outcomes from periprosthetic fractures about a TAR are limited. The purpose of this study was to evaluate patients with postoperative periprosthetic fractures about a TAR and determine clinical outcomes of these patients following operative fixation. Additionally, we propose an algorithm for the management of these patients. Methods: We retrospectively analyzed 400 patients who underwent TAR from 2007 through 2017. Charts were reviewed and patients with postoperative fractures were selected for inclusion. Patients with a fracture >4 weeks from index surgery were considered candidates for inclusion. Patients with intraoperative fractures were excluded. Univariate analyses were used to identify differences in outcomes. Results: 32 patients were identified with a postoperative periprosthetic fracture about a TAR. Average age was 65.3 years. Average time to fracture was 39.5 months while average follow up from fracture was 26 months. Fractures were primarily located about the medial malleolus (60.6%). 76.8% of fractures were deemed to be stable (Table 1); 75% of these fractures were managed with ORIF or IMN, while 21% of these fractures were treated with immobilization. 80% of patients with stable fractures treated with immobilization ultimately required surgical intervention. 24.2% of fractures were deemed to be unstable. Fractures about the talus were always unstable and always required revision TAR surgery (100%, p= 0.0002). Conclusion: This retrospective review demonstrates that the majority of periprosthetic fractures about a TAR involve the medial malleolus. Additionally, the majority of stable fractures about a TAR required operative fixation. Despite attempts at nonoperative management, management with immobilization is fraught with a high rate of subsequent surgical intervention. Fractures about the talus should be treated with revision TAR surgery or arthrodesis. Based on these findings, we propose an algorithm for the management of patients with a periprosthetic fracture about a TAR.

scholarly journals Patterns of Arterial Disease in Takayasu Arteritis and Giant Cell Arteritis

2020 ◽  
Vol 72 (11) ◽  
pp. 1615-1624 ◽  
Author(s):  
K. Bates Gribbons ◽  
Cristina Ponte ◽  
Simon Carette ◽  
Anthea Craven ◽  
David Cuthbertson ◽  
...  
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Takayasu Arteritis ◽  
Arterial Disease

scholarly journals Surgical management of superior petrosal sinus dural arteriovenous fistulae with dominant internal carotid artery supply

2018 ◽  
Vol 24 (3) ◽  
pp. 331-338 ◽  
Author(s):  
Christopher J Stapleton ◽  
Anoop P Patel ◽  
Brian P Walcott ◽  
Collin M Torok ◽  
Matthew J Koch ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Surgical Intervention ◽  
High Rate ◽  
External Carotid ◽  
Arteriovenous Fistulae ◽  
Surgical Closure ◽  
Superior Petrosal Sinus

Background While technological advances have improved the efficacy of endovascular techniques for tentorial dural arteriovenous fistulae (DAVF), superior petrosal sinus (SPS) DAVF with dominant internal carotid artery (ICA) supply frequently require surgical intervention to achieve a definitive cure. Methods To compare the angiographic and clinical outcomes of endovascular and surgical interventions in patients with SPS DAVF, the records of all patients with tentorial DAVF from August 2010 to November 2015 were reviewed. Results Within this cohort, eight patients with nine SPS DAVF were eligible for evaluation. Five DAVF were initially treated with endovascular embolization, while four underwent surgical occlusion without embolization. Of the SPS DAVF treated with embolization, two (40%) remained occluded on follow-up, while the remaining three (60%) persisted/recurred and required surgical intervention for definitive closure. Of the four SPS DAVF treated with primary surgical occlusion, all four (100%) remained closed on follow-up. In addition, of the three SPS DAVF that persisted/recurred following embolization and required subsequent surgical closure, all three (100%) remained occluded on follow-up. Two (100%) SPS DAVF that were successfully treated with embolization had major or minor external carotid artery supply, while the three (100%) persistent lesions had major ICA supply via the meningohypophyseal trunk (MHT). Three (75%) of the four SPS DAVF treated with primary surgical occlusion had dominant MHT supply. Conclusion Complete endovascular closure of SPS DAVF with dominant ICA supply via the MHT may be difficult to achieve, while upfront surgical intervention is associated with a high rate of complete occlusion.

Use of an optimized primary ovarian cancer xenograft model to mimic patient tumor biology and heterogeneity.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 5036-5036
Author(s):  
Zachary C. Dobbin ◽  
Ashwini A. Katre ◽  
Angela Ziebarth ◽  
Monjri Shah ◽  
Adam D. Steg ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Tumor Biology ◽  
Xenograft Model ◽  
Complete Response ◽  
Response To Therapy ◽  
High Rate ◽  
Chemotherapy Response ◽  
Primary Ovarian Cancer ◽  
Subrenal Capsule

5036 Background: Current xenograft and transgenic models of ovarian cancer are mainly homogeneous and poorly predict response to therapy. Use of patient tumors may represent a better model for tumor biology and offer potential to test personalized medicine approaches, but poor take rates and questions of recapitulation of patient tumors have limited this approach. We have developed a protocol for improved feasibility of such a model and examined its similarity to the patient tumor. Methods: Under IRB and IACUC approval, 23 metastatic ovarian cancer samples were collected at the time of tumor reductive surgery. Samples were implanted either subcutaneously (SQ), intraperitoneally (IP), in the mammary fat pad (MFP), or in the subrenal capsule (SRC) and monitored for tumor growth. Cohorts from 8 xenolines were treated with combined carboplatin and paclitaxel or vehicle, and response to therapy compared between xenografts and patients. Expression of tumor-initiating cell (TIC) markers ALDH1, CD133, and CD44 was assessed by immunohistochemistry in tumors from patients and treated and untreated xenografts. Results: At least one SQ implanted tumor developed in 91.3% of xenografts, significantly higher than in the MFP (63.6%), IP (23.5%), or SRC (8%). Xenografts were similar in expression of putative TIC’s compared to patient tumors. The patients and the xenografts also have similar responses to chemotherapy in that xenografts from patients with a partial response responded more slowly than those from patients achieving a complete response (45 vs 21 days, p=.004). Treated xenografts were more densely composed of TICs. ALDH1 increased to 36.1% from 16.2% (p=0.002) and CD133 increased to 33.8% from 16.2% (p=0.026). Conclusions: Xenoline development can be achieved at a high rate when tumors collected from metastatic sites are implanted SQ. These xenografts are similar to patient tumors with regard to chemotherapy response and TIC expression.. This model may be a more accurate model for in vivo pre-clinical studies as compared to current models. Also, as treated xenografts become chemoresistant, this model is well positioned to evaluate targeted therapies aimed at the most aggressive populations in a heterogeneous tumor.

scholarly journals Water Resource Management, Quality and Climate Change in Nigeria

2020 ◽  
Vol 5 (6) ◽  
pp. 1166-1176
Author(s):  
Fatemeh Nouban ◽  
Serah Onuh John ◽  
Nura Yunusa ◽  
Alkasim Aminu ◽  
Zachariah Madaki
Keyword(s):  
Water Resources ◽  
Low Income ◽  
Water Resource Management ◽  
Premature Mortality ◽  
High Rate ◽  
Policy Framework ◽  
Annual Rainfall ◽  
Mortality And Morbidity ◽  
Surface Water Resources ◽  
Groundwater Source

Nigeria is endowed with natural water resources abundantly, the country has substantial annual rainfall, large water bodies such as rivers, streams, lakes etc. and abundant groundwater reservoirs which are least developed and utilized which resulted in economic, social, environmental and health costs, such as a high rate of premature mortality and morbidity resulting from contamination of consumption, pollution of environmental and environmental resources, pollution and overexploitation of ground and surface water resources and low income and productivity. Therefore, enabling citizens with access to potable water is paramount. Although conjugate or integral water management or monitoring inhabited with limited studies even in Nigeria where over 57% of the population rely on groundwater source the management approaches is practically scanty while integral water use studied extensively, the study recognized the integrated water resources managements (IWRM), internationally recognized principles to support the effort of ensuring robust policy framework and appropriate investments in Nigeria’s fresh water resources to enable the citizens with unlimited access to portable water.

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