Rates of local procedural-related structural injury following clipping or coiling of anterior communicating artery aneurysms

2015 ◽  
Vol 8 (3) ◽  
pp. 256-264 ◽  
Author(s):  
Alex M Mortimer ◽  
Brendan Steinfort ◽  
Ken Faulder ◽  
Tian Erho ◽  
Daniel B Scherman ◽  
...  
Keyword(s):  
Univariate Analysis ◽  
Binary Logistic Regression ◽  
Cognitive Outcomes ◽  
Endovascular Coiling ◽  
Anterior Communicating Artery ◽  
Consecutive Series ◽  
Radiological Investigation ◽  
Adjacent Structures ◽  
Primary Hemorrhage ◽  
Structural Injury

BackgroundSurgical clipping and endovascular coiling yield similar functional outcomes for the treatment of saccular aneurysms of the anterior communicating (ACOM) artery. However, surgical treatment may be associated with greater rates of cognitive impairment due to injury of adjacent structures. We aimed to quantify the rates of injury (infarction/hemorrhage) for both clipping and coiling of ACOM aneurysms.MethodsThis was a retrospective dual-center radiological investigation of a consecutive series of patients with ruptured and unruptured ACOM aneurysms treated between January 2011 and October 2014. Post-treatment CT or MRI was assessed for new ischemic or hemorrhagic injury. Injury relating to the primary hemorrhage or vasospasm was differentiated. Univariate analysis using χ2 tests and multivariate analysis using binary logistic regression was used.Results66 patients treated with clipping were compared with 93 patients treated with coiling. 32/66 (48.5%) patients in the clipping group suffered treatment-related injury (31 ischemic, 1 hemorrhagic) compared with 4/93 (4.4%) patients in the coiling group (3 ischemic, 1 hemorrhagic) (p<0.0001). For patients with subarachnoid hemorrhage, the multivariate OR for infarction for clipping over coiling was 24.42 (95% CI 5.84 to 102.14), p<0.0001. The most common site of infarction was the basal forebrain (28/66 patients, 42.4%), with bilateral infarction in 4. There was injury of the septal/subcallosal region in 12/66 patients (18%).ConclusionsClipping of ACOM aneurysms is associated with significantly higher rates of structural injury than coiling, and this may be a reason for superior cognitive outcomes in patients treated with coiling in previously published studies.

scholarly journals Sacral Agenesis: A Neglected Deformity That Increases the Incidence of Postoperative Coronal Imbalance in Congenital Lumbosacral Deformities

2020 ◽  
pp. 219256822097050
Author(s):  
Tianyuan Zhang ◽  
Shibin Shu ◽  
Wenting Jing ◽  
Qi Gu ◽  
Zhen Liu ◽  
...  
Keyword(s):  
Risk Factor ◽  
Independent Risk Factor ◽  
Univariate Analysis ◽  
Binary Logistic Regression ◽  
Binary Logistic Regression Analysis ◽  
Consecutive Series ◽  
Coronal Balance ◽  
Sacral Agenesis ◽  
Coronal Imbalance

Study Design: A retrospective study. Objectives: To identify if there is a link between sacral agenesis (SA) and post-operative coronal imbalance in patients with congenital lumbosacral deformities. Methods: This study reviewed a consecutive series of patients with congenital lumbosacral deformities. They had a minimum follow-up of 2 years. According to different diagnosis, they were divided into SA and non-SA group. Comparison analysis was performed between patients with and without post-operative coronal imbalance and risk factors were identified. Results: A total of 45 patients (18 in SA group and 27 in non-SA group) were recruited into this study, among whom 33 patients maintained coronal balance while 12 demonstrated postoperative coronal imbalance at last follow-up (14.32 ± 7.67 mm vs 35.53 ± 3.91 mm, P < 0.001). Univariate analysis showed that preoperative lumbar Cobb angle, immediate postoperative coronal balance distance and diagnosis of SA were significantly different between patients with and without post-operative coronal imbalance (P < 0.05). Binary logistic regression analysis showed that SA was an independent risk factor for postoperative coronal imbalance. Conclusions: As an independent risk factor for postoperative coronal imbalance, high level of suspicion of SA should be aware in children with congenital lumbosacral deformities. Sufficient bone grafts at sacroiliac joint are recommended for SA patients to prevent postoperative coronal imbalance.

Chemoradiotherapy is an Alternative Choice for Patients with Primary Mediastinal Seminoma

2021 ◽  
Author(s):  
Yirui Zhai ◽  
Bo Chen ◽  
Xiaoli Feng ◽  
Kan Liu ◽  
Shulian Wang ◽  
...  
Keyword(s):  
Univariate Analysis ◽  
Progression Free Survival ◽  
Poor Performance ◽  
Rank Test ◽  
Clinicopathologic Characteristics ◽  
Cancer Specific Survival ◽  
Adjacent Structures ◽  
Significant Difference ◽  
Mediastinal Seminoma ◽  
Alternative Choice

Abstract Background: The low incidence of primary mediastinal seminomas has precluded the development of clinical trials on mediastinal seminomas. We investigated the clinicopathologic characteristics, prognosis of patients with primary mediastinal seminomas as well as the efficiency of nonsurgical treatments compared with treatments containing surgery.Methods: We retrospectively collected data on the clinicopathologic characteristics, treatments, toxicities, and survival of 27 patients from a single center between 2000 and 2018. Patients were divided into two groups according to whether they received operation. Survivals were assessed using the Kaplan-Meier method. Univariate analysis was performed using the log-rank test.Results: The median age was 28 (13-63) years. The most common symptoms were chest pain (29.6%), cough (25.9%), and dyspnea (22.2%). There were 13 and 14 patients in surgery and non-surgery group. Patients in the non-surgical group were more likely to be with poor performance scores (100% vs.76.9%) and disease invaded to adjacent structures(100% vs.76.9%) especially great vessels(100% vs.46.2%).The median follow-up period was 32.23 (2.7-198.2) months. There was no significant difference of overall survival (5-year 100% vs 100%), cancer-specific survival (5-year 100% vs.100%), local regional survival (5-year 91.7% vs.90.0%, p=0.948) , distant metastasis survival (5-year 100.0% vs. 90.9%, p=0.340) and progression-free survival (82.5% vs.90.0%, p=0.245) between patients with and without surgery. Conclusions: Primary mediastinal seminoma was with favorable prognosis, even though frequently invasion into adjacent structures brings difficulties to surgery administration. Chemoradiotherapy is an alternative treatment with both efficacy and safety.

Prognostic CT Features and Prediction Model of Patients With Primary Hepatocellular Carcinomas Undergoing Partial Hepatectomy

2021 ◽  
Author(s):  
Cuiping Zhou ◽  
Xiaohua Ban ◽  
Huijun Hu ◽  
Qiuxia Yang ◽  
Rong Zhang ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Model ◽  
Clinical Outcomes ◽  
Partial Hepatectomy ◽  
Logistic Regression Model ◽  
Univariate Analysis ◽  
Binary Logistic Regression ◽  
Roc Curve Analysis ◽  
Hepatocellular Carcinomas ◽  
Ct Features

Abstract Background: Hepatocellular carcinoma (HCC) is the most common primary malignant tumor in the liver. Partial hepatectomy is one of the most effective therapies for HCC but suffer from the high recurrence rate. At present, the studies of association between clinical outcomes and CT features of patients with HCCs undergoing partial hepatectomy are still limited. The purpose of this study is to determine the predictive CT features and establish a model for predicting relapse or metastasis in patients with primary hepatocellular carcinomas (HCCs) undergoing partial hepatectomy.Methods: The clinical data and CT features of 112 patients with histopathologically confirmed primary HCCs were retrospectively reviewed. The clinical outcomes were categorized into two groups according to whether relapse or metastasis occurred within 2 years after partial hepatectomy. The association between clinical outcomes and CT features including tumour size, margin, shape, vascular invasion (VI), arterial phase hyperenhancement, washout appearance, capsule appearance, satellite lesion, involvement segment, cirrhosis, peritumoral enhancement and necrosis was analyzed using univariate analysis and binary logistic regression. Then establish logistic regression model, followed by receiver operating characteristic (ROC) curve analysis.Results: CT features including tumor size, margin, shape, VI, washout appearance, satellite lesion, involvement segment, peritumoral enhancement and necrosis were associated with clinical outcomes, as determined by univariate analysis (P<0.05). Only tumor margin and VI remained independent risk factors in binary logistic regression analysis (OR=6.41 and 10.92 respectively). The logistic regression model was logit(p)=-1.55+1.86 margin +2.39 VI. ROC curve analysis showed that the area under curve of the obtained logistic regression model was 0.887(95% CI：0.827-0.947).Conclusion: Patients with ill-defined margin or VI of HCCs were independent risk predictors of poor clinical outcome after partial hepatectomy. The model as logit(p)= -1.55+1.86 margin +2.39 VI was a good predictor of the clinical outcomes.

Cognitive Impairments and Associated Factors After Ruptured Anterior Communicating Artery Aneurysm Treatment in Low-Grade Patients <60 Years: A Multicenter Retrospective Study

2020 ◽  
Author(s):  
Ning Ma ◽  
Xin Feng ◽  
Zhongxue Wu ◽  
Daming Wang ◽  
Aihua Liu
Keyword(s):  
Regression Analysis ◽  
Cognitive Impairment ◽  
Cox Regression ◽  
Cognitive Impairments ◽  
Young Patients ◽  
Endovascular Coiling ◽  
Anterior Communicating Artery ◽  
Cox Regression Analysis ◽  
Microsurgical Clipping

Abstract Background Aneurysmal subarachnoid hemorrhage (SAH) is a kind of destructive cerebrovascular disease which could affect people's cognition, even the life expectancy. People with SAH are considered in a fatal situation, especially in the young population. This study aimed to investigate cognitive impairment and related factors in young patients with ruptured anterior communicating artery (ACoA) aneurysms.Methods We conducted a multicentre retrospective follow-up study at three hospitals in China. The young patients (18-50 years) who underwent ruptured ACoA aneurysm treatment by microsurgical clipping or endovascular coiling at three academic institutions in China from January 2015 to November 2017 were recruited. Patient cognition and life quality were assessed by using modified Telephone Interview for Cognitive Status (TICS-m), the modified Rankin Scale (mRS), and the instrumental activities of daily living (IADL) scale 2. Multiple cox-regression analysis was used to identify variables independently associated with cognitive impairment.Results Of the total of 59 patients, 54 (91.5%) achieved good clinical outcomes (mRS score 0-2) and 51 (86.4%) had excellent quality of life (IADL score 8). Ten (16.9%) patients showed cognitive impairments (TICS-m<27). The multivariate COX regression analysis showed that mRS scores of 3-5 at discharge, female sex, and aneurysm size <5 mm was independently associated with cognitive impairment. TICS-m scores at the latest follow-up were similar after open surgery and coiling. Conclusion In this relatively young sample that excluded patients with very poor-grade SAH or serious complications, microsurgical clipping led to better clinical outcomes than endovascular coiling, while cognitive outcomes were similar across treatment modalities. These results are not completely consistent with previous studies, and should therefore be considered in the clinical practice as well as further investigated in larger patient samples.

Clinical Factors Associated with the Diagnosis of Granulomatosis with Polyangiitis

2017 ◽  
Vol 156 (3) ◽  
pp. 484-488 ◽  
Author(s):  
Erdem Eren ◽  
Toygar Kalkan ◽  
Seçil Arslanoğlu ◽  
Mustafa Özmen ◽  
Kazım Önal ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Nasal Mucosa ◽  
Odds Ratio ◽  
Granulomatosis With Polyangiitis ◽  
Univariate Analysis ◽  
Binary Logistic Regression ◽  
Binary Logistic Regression Analysis ◽  
Significant Difference ◽  
History Of

Objective To determine the predictive value of nasal endoscopic findings and symptoms in the diagnosis of granulomatosis with polyangiitis (GPA). Study Design A cross-sectional study. Setting A tertiary university hospital. Subjects and Methods A total of 116 adults were enrolled in the study: 19 patients with GPA, 29 patients with other rheumatic diseases, and 68 healthy volunteers. All patients were examined with a flexible endoscope, and nasal endoscopic images were recorded and evaluated blindly. The medical history of each patient was taken by a physician blinded to the patient’s diagnosis. Results Univariate analysis indicated a statistically significant difference in rhinorrhea ( P = .002), postnasal drip ( P = .015), epistaxis ( P < .001), and saddle nose ( P = .017). However, binary logistic regression analysis demonstrated that only history of epistaxis ( P = .012; odds ratio, 5.6) was statistically significant in predicting GPA. Univariate analysis showed a statistically significant difference in nasal secretion ( P = .028), nasal septal perforation ( P < .017), nasal crusting ( P < .001), nasal adhesion ( P < .001), nasal granuloma ( P = .017), and hemorrhagic fragile nasal mucosa ( P < .001). A binary logistic regression analysis demonstrated that only hemorrhagic fragile nasal mucosa ( P < .001; odds ratio, 52.9) was a statistically significant predictor of GPA. Conclusions Given the results of this study, we believe that hemorrhagic fragile nasal mucosa and history of recurrent epistaxis may put patients at risk for GPA and should be investigated accordingly.

scholarly journals Frequency and predictors of complications in neurological surgery: national trends from 2006 to 2011

2014 ◽  
Vol 120 (3) ◽  
pp. 736-745 ◽  
Author(s):  
John D. Rolston ◽  
Seunggu J. Han ◽  
Catherine Y. Lau ◽  
Mitchel S. Berger ◽  
Andrew T. Parsa
Keyword(s):  
Univariate Analysis ◽  
Binary Logistic Regression ◽  
National Database ◽  
Improvement Program ◽  
Chi Square ◽  
Surgical Specialty ◽  
Starting Point ◽  
Neurosurgical Patients ◽  
Us Government ◽  
Neurological Surgery

Object Surgical complications increase the cost of health care worldwide and directly contribute to patient morbidity and mortality. In an effort to mitigate morbidity and incentivize best practices, stakeholders such as health insurers and the US government are linking reimbursement to patient outcomes. In this study the authors analyzed a national database to determine basic metrics of how comorbidities specifically affect the subspecialty of neurosurgery. Methods Data on 1,777,035 patients for the years 2006–2011 were acquired from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database. Neurosurgical cases were extracted by querying the data for which the surgical specialty was listed as “neurological surgery.” Univariate statistics were calculated using the chi-square test, and 95% confidence intervals were determined for the resultant risk ratios. A multivariate model was constructed using significant variables from the univariate analysis (p < 0.05) with binary logistic regression. Results Over 38,000 neurosurgical cases were analyzed, with complications occurring in 14.3%. Cranial cases were 2.6 times more likely to have complications than spine cases, and African Americans and Asians/Pacific Islanders were also at higher risk. The most frequent complications were bleeding requiring transfusion (4.5% of patients) and reoperation within 30 days of the initial operation (4.3% of patients), followed by failure to wean from mechanical ventilation postoperatively (2.5%). Significant predictors of complications included preoperative stroke, sepsis, blood transfusion, and chronic steroid use. Conclusions Understanding the landscape of neurosurgical complications will allow better targeting of the most costly and harmful complications of preventive measures. Data from the ACS NSQIP database provide a starting point for developing paradigms of improved care of neurosurgical patients.

scholarly journals Thrombo-inflammatory features predicting mortality in patients with COVID-19: The FAD-85 score

2020 ◽  
Vol 48 (9) ◽  
pp. 030006052095503
Author(s):  
Junhong Wang ◽  
Hua Zhang ◽  
Rui Qiao ◽  
Qinggang Ge ◽  
Shuisheng Zhang ◽  
...  
Keyword(s):  
Univariate Analysis ◽  
Binary Logistic Regression ◽  
Albumin Concentration ◽  
Inflammatory Parameters ◽  
Coagulation Abnormalities ◽  
Risk Of Mortality ◽  
Factor Α ◽  
Sensitivity Specificity ◽  
Necrosis Factor ◽  
D Dimer

Background The roles of inflammation and hypercoagulation in predicting outcomes of coronavirus disease 2019 (COVID-19) are unclear. Methods Adult patients diagnosed with COVID-19 from 28 January 2020 to 4 March 2020 in Tongji Hospital, Wuhan were recruited. Data on related parameters were collected. Univariate analysis and multivariable binary logistic regression were used to explore predictors of critical illness and mortality. Results In total, 199 and 44 patients were enrolled in the training and testing sets, respectively. Elevated ferritin, tumor necrosis factor-α and D-dimer and decreased albumin concentration were associated with disease severity. Older age, elevated ferritin and elevated interleukin-6 were associated with 28-day mortality. The FAD-85 score, defined as age + 0.01 * ferritin +D-dimer, was used to predict risk of mortality. The sensitivity, specificity and accuracy of FAD-85 were 86.4%, 81.8% and 86.4%, respectively. A nomogram was established using age, ferritin and D-dimer to predict the risk of 28-day mortality. Conclusions Thrombo-inflammatory parameters provide key information on the severity and prognosis of COVID-19 and can be used as references for clinical treatment to correct inflammatory and coagulation abnormalities.

scholarly journals Evaluation of medication adherence and predictors of sub-optimal adherence among pre-dialysis patients with chronic kidney disease

2020 ◽  
Vol 4 ◽  
pp. 239920262095408
Author(s):  
Roland Nnaemeka Okoro ◽  
Ibrahim Ummate ◽  
John David Ohieku ◽  
Sani Ibn Yakubu ◽  
Maxwell Ogochukwu Adibe ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Logistic Regression ◽  
Medication Adherence ◽  
Kidney Disease ◽  
Univariate Analysis ◽  
Binary Logistic Regression ◽  
Regression Analyses ◽  
Dialysis Patients ◽  
Improve Medication Adherence ◽  
Significant Independent Predictor

Background: Multiple medications are required to effectively manage chronic kidney disease (CKD) and associated complications, posing the risk of poor medication adherence. Objectives: To measure medication adherence levels and to investigate the potential predictors of sub-optimal medication adherence in pre-dialysis patients with CKD. Methods: A prospective study was conducted in the medical and nephrology outpatients’ clinics in Maiduguri. Non-dialysis patients with CKD stages 1–4 aged 18 years and above were recruited through their physicians. The level of medication adherence was determined using Morisky Medication Adherence Scale. Descriptive statistics were used to summarize patients’ background characteristics. Multivariate binary logistic regression analyses were performed to investigate the significantly potential predictors of sub-optimal medication adherence at a p < 0.05. Results: There were 107 participants (48.6%) who had high medication adherence, while 97 (44.1%), and 16 (7.3%) of them had moderate adherence, and low adherence, respectively. The univariate analysis revealed that medication adherence level differed significantly with the number of medications taken daily by patients ( p < 0.05). Multivariate logistic regression analyses did not reveal a significant independent predictor of sub-optimal medication adherence. Conclusion: A majority of the participants reported sub-optimal medication adherence. The independent variables considered did not significantly predict sub-optimal medication adherence in the study population. Nevertheless, the study findings highlight the importance of clinical pharmacists’ CKD management supportive care to help improve medication adherence.

Quality of life and brain damage after microsurgical clip occlusion or endovascular coil embolization for ruptured anterior communicating artery aneurysms: neuropsychological assessment

2009 ◽  
Vol 110 (1) ◽  
pp. 19-29 ◽  
Author(s):  
François Proust ◽  
Olivier Martinaud ◽  
Emmanuel Gérardin ◽  
Stéphane Derrey ◽  
Sophie Levèque ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Executive Functions ◽  
Verbal Memory ◽  
Coil Embolization ◽  
Endovascular Coiling ◽  
Anterior Communicating Artery ◽  
Microsurgical Clipping ◽  
Endovascular Coil Embolization ◽  
Clip Occlusion

Object For anterior communicating artery (ACoA) aneurysms, endovascular coil embolization constitutes a safe alternative therapeutic procedure to microsurgical clip occlusion. The authors' aim in this study was to evaluate the quality of life (QOL), cognitive function, and brain structure damage after the treatment of ruptured ACoA aneurysms in a group of patients who underwent microsurgical clipping (36 patients) compared with a reference group who underwent endovascular coiling (14 patients). Methods At 14 months posttreatment all patients underwent evaluations by independent observers. These observers evaluated global efficacy, executive functions using a frontal assessment battery of tests (Trail making test, Stroop tasks, dual task of Baddeley, verbal fluency, and Wisconsin Card Sorting test), behavior dysexecutive syndrome (the Inventaire du Syndrome Dysexécutif Comportemental questionnaire [ISDC]), and QOL by using the Reintegration To Normal Living Index. Brain damage was analyzed using MR imaging. Results In the microsurgical clipping and endovascular coiling groups, the distribution on the modified Rankin Scale (p = 0.19) and mean QOL score (85.4 vs 83.4, respectively) were similar. Moreover, the proportion of executive dysfunctions (19.4 vs 28.6%, respectively) and the mean score on the ISDC questionnaire (8.9 vs 8.5, respectively) were not significant, but verbal memory was more altered in the microsurgical clipping group (p = 0.055). Magnetic resonance imaging revealed that the incidence of local encephalomalacia and the median number of lesions per patient increased significantly in the microsurgical clipping group (p = 0.003). Conclusions In the 2 groups, no significant difference was observed regarding QOL, executive functions, and behavior. Despite the significant decrease in verbal memory after microsurgical clipping, the interdisciplinary approach remains a safe and useful strategy.

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