PAW15 Screening patients with a family history of subarachnoid haemorrhage for intracranial aneurysms: screening uptake, patient characteristics and outcome

✓ Although the technology exists for accurate noninvasive screening for intracranial aneurysms, the efficacy of screening depends on several key parameters of the natural history of aneurysms. Recent studies suggest that the prevalence of intracranial aneurysms may reach 20% in the subpopulation of patients with a family history of these lesions; other key parameters are less certain. The authors investigated factors that impact the efficacy of screening to establish interim guidelines. Three plausible models for the natural history of aneurysms were constructed. For each model the monetary cost of screening and the average gain in life expectancy were computed for a range of screening ages and prevalence rates. It is shown that the efficacy of screening depends on the pattern of aneurysm rupture. If aneurysms develop and rupture rapidly, then screening has no benefit. On the other hand, if aneurysms remain at risk for some time after formation, then screening may improve average life expectancy depending on when it occurs. The authors recommend that patients with a positive family history of aneurysms who are 30 years of age or younger be screened. This recommendation is based on the belief that the gains attributable to screening, assuming a constant rupture rate, outweigh the losses attributable to screening using a decreasing rupture rate model.

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Migraine Angiitis Precipitated by Sex Headache and Leading to Watershed Infarction

Cephalalgia ◽

10.1046/j.1468-2982.1993.1306427.x ◽

1993 ◽

Vol 13 (6) ◽

pp. 427-430 ◽

Cited By ~ 37

Author(s):

Matthew Jackson ◽

Graham Lennox ◽

Timothy Jaspan ◽

David Jefferson

Keyword(s):

Family History ◽

Subarachnoid Haemorrhage ◽

Cerebrovascular Disease ◽

Past History ◽

Loss Of Consciousness ◽

Transient Loss Of Consciousness ◽

Border Zones ◽

History Of ◽

Transient Loss ◽

Watershed Infarction

Vasospasm is a rare cause of cerebrovascular disease except following subarachnoid haemorrhage. We describe a woman who developed an explosive-type sex headache, followed by a series of severe migrainous headaches associated with fully reversible segmental cerebral arterial narrowing and dilatation, resulting in widespread infarction in cerebral arterial border zones. This led to transient loss of consciousness and multiple focal cortical deficits including blindness. She had a past history of migraine and a family history of both migraine and sex headaches. Similar cases have been reported in the literature under a variety of rubrics. We suggest that this newly recognized clinico-radiological syndrome is a migraine variant.

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Association of MRI and locoregional recurrence (LRR) rates in ductal carcinoma in situ (DCIS) patients treated with or without radiation therapy (RT).

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.26_suppl.57 ◽

2013 ◽

Vol 31 (26_suppl) ◽

pp. 57-57

Author(s):

Melissa Louise Pilewskie ◽

Cristina Olcese ◽

Anne Eaton ◽

Sujata Patil ◽

Elizabeth Ann Morris ◽

...

Keyword(s):

Breast Cancer ◽

Family History ◽

Ductal Carcinoma ◽

Menopausal Status ◽

Patient Characteristics ◽

Breast Conserving Surgery ◽

Entire Cohort ◽

History Of ◽

History Presentation

57 Background: Perioperative MRI is frequently obtained in women with breast cancer; however, studies have not shown decreased rates of re-excision, and some report unnecessary increases in mastectomy rates. We examined LRR rates among women with DCIS who underwent perioperative MRI as compared to those who did not. Methods: All women who underwent breast-conserving surgery for DCIS in 1997-2010 were included from a prospectively maintained database. Patient characteristics and rates of LRR were compared in women with and without an MRI. Univariate and multivariate analyses were performed. Analysis was repeated in the subset of women who did not receive RT. Results: 2,321 cases were identified; 596 had MRI and 1,725 did not. Women who had MRI were younger, more likely to be premenopausal, have a family history of breast cancer, have a clinical presentation, receive RT and endocrine therapy, be treated in later years, and had fewer close/positive margins. At median follow-up of 57 months there were 184 IBTRs; 5-year LRR rates were 8.5% (MRI) and 7.2% (no MRI) (p = 0.52), and 8-year rates were 14.6% and 10.2%, respectively. MRI was not associated with lower LRR rates after adjustment for age, menopausal status, family history, presentation, adjuvant therapy, margin status, number of excisions, and year of surgery in both the entire cohort and in the subgroup who did not receive RT. Select factors from multivariate analysis for patients with all covariates available are shown in the Table. Conclusions: We observed no association between perioperative MRI and LRR rates for patients with DCIS, even when RT was not given. The benefit of perioperative MRI for DCIS remains uncertain. [Table: see text]

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Abstract WMP27: PAT Model Accurately Predicts Aneurysm Enlargement in 16 Growing Aneurysm Cases

Stroke ◽

10.1161/str.51.suppl_1.wmp27 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Aichi Chien ◽

Michelle Hildebrandt ◽

Geoffrey Colby ◽

Victor Chang ◽

Gary Duckwiler ◽

...

Keyword(s):

Medical Records ◽

Intracranial Aneurysms ◽

Medical Center ◽

Patient Characteristics ◽

Percentage Error ◽

Limited Information ◽

Unruptured Intracranial Aneurysms ◽

History Of ◽

And Behavior

Objective: Imaging technology for unruptured intracranial aneurysms (UIA) has improved detection of such aneurysms. However, there is limited information on UIA change over time, and how to predict the rate of enlargement. The objective of this study was to quantify the accuracy of the Predicted Aneurysm Trajectory (PAT) model recently developed by Chien et al. (J Neurosurgery. 2019; Mar 1:1-11). Methods: Patients diagnosed with UIA were prospectively enrolled at the UCLA Medical Center, and followed through serial imaging. 16 UIA cases exhibiting growth across multiple follow-ups were included in this study. Prior images and medical records were collected. Characteristics relevant to the PAT model (mean ± stdev), including initial UIA size (7.26 ± 6.38), patient age (67.4 ± 9.48 yrs.), sex (4 male), history of smoking (n=5), hypothyroidism (n=4), and follow-up duration (36.5 ± 50.0 mos.) were used to predict UIA size at each follow-up. Predicted and actual UIA sizes at follow-up were compared using symmetric mean absolute percentage error (SMAPE) with percentage error ranging from 0-100%. Results: The 16 UIA cases were split by initial UIA size. For UIA smaller than 7 mm (10 cases, 23 follow-up), SMAPE = 11.13%. For UIA greater than 7 mm (6 cases, 15 follow-up), SMAPE = 8.07%. For all UIA cases (16 cases, 38 follow-up), SMAPE = 9.92%. Conclusions: The PAT model predicts the rate of enlargement for UIA, as opposed to whether or not UIA will grow. With this new sample of data, we found the predicted UIA size at follow-up to be quite accurate, deviating in the range of 10% from the actual, measured size. Patient characteristics such as the demographics and behavior included in the model influence the growth of UIA, which allows prediction of growth to optimize treatment and management in future cases.

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Transition readiness in adolescents with juvenile idiopathic arthritis and their parents: Our single-center experience

Archives of Rheumatology ◽

10.46497/archrheumatol.2022.9219 ◽

2021 ◽

Author(s):

Dragana Lazarević ◽

Stefan Đorđević ◽

Dušica Novaković ◽

Maja Zečević ◽

Gordana Sušić

Keyword(s):

Juvenile Idiopathic Arthritis ◽

Family History ◽

Autoimmune Diseases ◽

Patient Characteristics ◽

Concomitant Disease ◽

Readiness Assessment ◽

Transition Readiness ◽

Single Center Experience ◽

Significant Difference ◽

History Of

Objectives: We aimed to identify characteristics of juvenile idiopathic arthritis (JIA) patients associated with good self-management skills in the transition readiness process and to investigate the readiness of JIA patients and their families for the transition into the adult healthcare system. Patients and methods: Between March 2021 and June 2021, a total of 44 JIA patients (9 males, 35 females; median age: 15.1 years; range, 12.3 to 19.3 years) admitted to the pediatric rheumatology outpatient and inpatient clinics and their parents were included. Transition Readiness Assessment Questionnaire (TRAQ) was cross-culturally adapted. The TRAQ was administered to all JIA patients and their parents at one point. Demographic and clinical data were collected. Results: Fourteen (31.8%) of 44 JIA patients had a concomitant disease, while 10 (22.7%) of them had uveitis. Eleven (25%) of them had a family history of autoimmune diseases. In total, 21 (47.7%) of JIA patients were receiving biologics. There was a strong correlation between older age and total TRAQ scores among patients (ρ=0.799, p<0.001) and a moderate correlation between older patient age and total TRAQ scores among parents (ρ=0.522, p<0.001). Patient and parent total TRAQ scores were strongly correlated (ρ=0.653, p<0.001). There was no significant association of JIA patient characteristics (JIA disease subtypes, disease duration, gender, concomitant diseases, uveitis, family history of autoimmune diseases, number of hospitalizations, and treatment with biologics) with TRAQ scores and JIA patients' and parents' readiness for transition. Conclusion: Transition readiness of JIA patients increases with advancing age. There is no significant difference between transition readiness for JIA patients and their parents.

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Eosinophilic Esophagitis: Clinical Features, Endoscopic Findings and Response to Treatment

Canadian Journal of Gastroenterology ◽

10.1155/2010/341925 ◽

2010 ◽

Vol 24 (9) ◽

pp. 547-551 ◽

Cited By ~ 16

Author(s):

Robert Enns ◽

Pooya Kazemi ◽

Wiley Chung ◽

Mitchell Lee

Keyword(s):

Family History ◽

Eosinophilic Esophagitis ◽

Patient Characteristics ◽

Response To Treatment ◽

Treatment Modalities ◽

Telephone Interviews ◽

Endoscopic Findings ◽

History Of ◽

One Year ◽

Seasonal Allergies

Eosinophilic esophagitis (EE) is a motility disorder of the esophagus that typically presents with dysphagia. The objective of the present study was to explore patient characteristics, clinical and endoscopic features, and response to treatment of patients with EE. Patients were selected retrospectively based on a review of biopsy results from previous endoscopies performed between 2004 and 2008. A total of 54 patients (41 men and 13 women) with biopsy-proven EE were included in the study. Further information regarding the patients’ clinical and endoscopic features, and response to treatment were obtained through chart reviews and patient telephone interviews. The mean age of the patients at symptom onset was 30 years. All patients complained of dysphagia, 81% had a history of bolus obstruction, 43% had a history of asthma and 70% had a history of environmental allergies. Thirty-three per cent had a family history of asthma, while 52% had a family history of food or seasonal allergies. The most common endoscopic findings were rings and/or corrugations, which were found in 63% of patients. Swallowed fluticasone therapy resulted in symptom resolution in 74% of patients; however, 79% of these patients relapsed after discontinuing fluticasone therapy and required repeat treatments. Esophageal dilation was complication free and resulted in improvement in 80% of patients. However, 83% of those reporting improvement relapsed within one year. The clinical and endoscopic findings were similar to those found in the literature, with most patients requiring ongoing, repeated therapies. Further studies are needed to assess the safety and efficacy of treatment modalities ideally suited to patients with EE.

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Individual and familial characteristics of patients with podoconiosis attending a clinic in Musanze District, Rwanda: A retrospective study

Transactions of the Royal Society of Tropical Medicine and Hygiene ◽

10.1093/trstmh/traa068 ◽

2020 ◽

Vol 114 (12) ◽

pp. 947-953

Author(s):

Jean Paul Bikorimana ◽

Ursin Bayisenge ◽

Tonya Huston ◽

Eugene Ruberanziza ◽

Jean Bosco Mbonigaba ◽

...

Keyword(s):

Retrospective Study ◽

Family History ◽

Age Of Onset ◽

Age At Onset ◽

Disease Onset ◽

Patient Characteristics ◽

Health Concern ◽

Red Clay ◽

Younger Age ◽

History Of

Abstract Background Podoconiosis is a progressive swelling of the legs affecting genetically susceptible people who live in areas with irritant red clay soils and walk barefoot. The disease is a public health concern in many countries, including Rwanda. Methods This retrospective study described individual and familial characteristics of patients with podoconiosis attending the Heart and Sole Africa (HASA) clinics in Rwanda. Data on patient characteristics and family history were retrieved from electronic medical records (January 2013 – August 2019). A multiple regression analysis was used to explore factors influencing age of onset of podoconiosis. Results Among 467 patients with podoconiosis, the mean (standard deviation) age of onset was 34.4 (19.6) years, 139 (29.8%) patients developed podoconiosis at <20 years of age, 417 (89%) came from Musanze or neighboring Burera Districts, and 238 (51.0%) had a family history of podoconiosis. Increasing patient age was associated with older age at onset of disease (p<0.001), while an increased number of relatives with podoconiosis (p<0.002) was significantly associated with earlier disease onset. Conclusion Most patients with podoconiosis were women, and more than half had a family history of podoconiosis. An increased number of relatives with podoconiosis was associated with a significantly younger age at disease onset.

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