scholarly journals Comparison of endoscopic evacuation, stereotactic aspiration, and craniotomy for treatment of basal ganglia hemorrhage

2019 ◽  
Vol 12 (1) ◽  
pp. 55-61 ◽  
Author(s):  
Wei Guo ◽  
Haixiao Liu ◽  
Zhijun Tan ◽  
Xiaoyang Zhang ◽  
Junmei Gao ◽  
...  
Keyword(s):  
Basal Ganglia ◽  
Surgical Techniques ◽  
Multivariate Logistic Regression Model ◽  
Hematoma Volume ◽  
Entire Cohort ◽  
Stereotactic Aspiration ◽  
Group A ◽  
Basal Ganglia Hemorrhage ◽  
The Difference ◽  
Large Hematoma

BackgroundThe main surgical techniques for spontaneous basal ganglia hemorrhage include stereotactic aspiration, endoscopic aspiration, and craniotomy. However, credible evidence is still needed to validate the effect of these techniques.ObjectiveTo explore the long-term outcomes of the three surgical techniques in the treatment of spontaneous basal ganglia hemorrhage.MethodsFive hundred and sixteen patients with spontaneous basal ganglia hemorrhage who received stereotactic aspiration, endoscopic aspiration, or craniotomy were reviewed retrospectively. Six-month mortality and the modified Rankin Scale score were the primary and secondary outcomes, respectively. A multivariate logistic regression model was used to assess the effects of different surgical techniques on patient outcomes.ResultsFor the entire cohort, the 6-month mortality in the endoscopic aspiration group was significantly lower than that in the stereotactic aspiration group (odds ratio (OR) 4.280, 95% CI 2.186 to 8.380); the 6-month mortality in the endoscopic aspiration group was lower than that in the craniotomy group, but the difference was not significant (OR=1.930, 95% CI 0.835 to 4.465). A further subgroup analysis was stratified by hematoma volume. The mortality in the endoscopic aspiration group was significantly lower than in the stereotactic aspiration group in the medium (≥40–<80 mL) (OR=2.438, 95% CI 1.101 to 5.402) and large hematoma subgroup (≥80 mL) (OR=66.532, 95% CI 6.345 to 697.675). Compared with the endoscopic aspiration group, a trend towards increased mortality was observed in the large hematoma subgroup of the craniotomy group (OR=8.721, 95% CI 0.933 to 81.551).ConclusionEndoscopic aspiration can decrease the 6-month mortality of spontaneous basal ganglia hemorrhage, especially in patients with a hematoma volume ≥40 mL.

Borderline basal ganglia hemorrhage volume: patient selection for good clinical outcome after stereotactic catheter drainage

2016 ◽  
Vol 125 (5) ◽  
pp. 1242-1248 ◽  
Author(s):  
Yeon Soo Choo ◽  
Joonho Chung ◽  
Jin-Yang Joo ◽  
Yong Bae Kim ◽  
Chang-Ki Hong
Keyword(s):  
Basal Ganglia ◽  
Clinical Outcome ◽  
Internal Capsule ◽  
Hematoma Volume ◽  
Good Clinical Outcome ◽  
Catheter Drainage ◽  
Motor Weakness ◽  
Group A ◽  
Basal Ganglia Hemorrhage ◽  
Group B

OBJECTIVE The purpose of this study was to determine predisposing factors for good clinical outcome in patients with spontaneous basal ganglia hemorrhage with borderline volumes (defined as a hematoma volume between 20 and 50 cm3) who had undergone treatment by stereotactic catheter drainage. METHODS From the 298 patients whose information had been prospectively collected in the institutional database between January 2010 and December 2013, 93 patients were included in this retrospective study and divided into 2 groups: best medical treatment alone (Group A, n = 44) and best medical treatment plus catheterization (Group B, n = 49). All patients met the following criteria: 1) a diagnosis of spontaneous basal ganglia hemorrhage, and 2) a borderline hematoma volume (20 to 50 cm3). Postoperative modified Rankin Scale (mRS) scores and recovery of motor weakness were compared between the 2 groups, and predisposing factors for good clinical outcome were evaluated. RESULTS Patients in Group B showed earlier recovery of motor weakness and improved mRS scores than patients in Group A. The final mRS score at 12 months was better in Group B than in Group A (p = 0.006). Predisposing factors for a good clinical outcome were a hematoma volume < 30 cm3 (OR 6.158, 95% CI 1.221–31.053, p = 0.028), an initial Glasgow Coma Scale (GCS) score ≥ 13 (OR 6.331, 95% CI 1.129–35.507, p = 0.036), the absence of internal capsule involvement (OR 4.680, 95% CI 1.152–19.010, p = 0.031), and catheterization (OR 13.376, 95% CI 2.423–73.842, p = 0.003) based on logistic regression analysis. CONCLUSIONS Good clinical outcome can be expected after stereotactic catheter drainage in patients with a hematoma volume between 20 and 30 cm3, an initial GCS score ≥ 13, and the absence of internal capsule involvement. Among these patients, stereotactic catheter drainage may have a beneficial effect on early recovery of motor weakness and functional outcome, indicating that lateral-type basal ganglia hematoma compression not involving the internal capsule may be better treated using stereotactic catheter drainage than treated medically.

Does body position, age, and heart rate induce IOP’s changes?

2021 ◽  
pp. 112067212110233
Author(s):  
Marcelina Sobczak ◽  
Magdalena Asejczyk ◽  
Malwina Geniusz
Keyword(s):  
Heart Rate ◽  
Body Position ◽  
Age Groups ◽  
Cardiovascular Parameters ◽  
Entire Cohort ◽  
Significant Difference ◽  
Group A ◽  
The Difference ◽  
Group B ◽  
Effect Of Age

Objectives: The main goal of this research was to determine the differences between the values of intraocular pressure (IOP) in the supine and sitting positions, and to assess the effect of age and cardiovascular parameters. Methods: Seventy-two healthy adults were enrolled and classified into age groups: 20–30 years (group A), 31–40 years (group B), and 41–71 years (group C). Corneal biometry and cardiovascular parameters, such as heart rate (HR), were measured. IOP measurements were taken in the sitting position (IOPS) and in the supine position (IOPL) using the iCare® Pro tonometer. Results: A significant difference between the IOPS and IOPL in the entire cohort was found ( p < 0.001). Regarding the age subgroups, a significant difference ( p < 0.001) between the IOPS and IOPL was obtained in group A (2.6 ± 1.6 mmHg) and group C (1.5 ± 1.3 mmHg). There were no significant differences in the IOPS between groups. The highest IOP values were obtained for group A. The correlations between HR and IOPS are statistically significant for group A and group B, and for HR and IOPL-S for group B only. Multivariate analysis showed that HR has a significant influence on the difference in IOP in the two body positions. Conclusion: A statistically significant difference between the effect of age and the values of IOPS and IOPL was shown. Cardiovascular parameters showed some relevant statistical dependencies, but with a rather marginal significance in young people. The influence of body position for the measurement of IOP for healthy subjects does not seem to matter, despite the fact that there are some dependencies that are statistically significant.

scholarly journals Evaluation of Volumetric Change of Intracerebral Hemorrhage in Patients Treated with Thrombolysis for Intraventricular Hemorrhage

2020 ◽  
Author(s):  
Franziska Staub-Bartelt ◽  
Jasper Hans van Lieshout ◽  
Thomas Beez ◽  
Rainer Kram ◽  
Daniel Hänggi ◽  
...  
Keyword(s):  
Basal Ganglia ◽  
Intracerebral Hemorrhage ◽  
Ct Scan ◽  
Intraventricular Hemorrhage ◽  
Volume Reduction ◽  
Percentage Reduction ◽  
Hematoma Volume ◽  
Group A ◽  
Group B ◽  
Lysis Therapy

Abstract Background Intraventricular hemorrhage (IVH) is often caused by irruption of intracerebral hemorrhage (ICH) of basal ganglia or thalamus into the ventricular system. Instillation of recombinant tissue plasminogen activator (rtPA) via an external ventricular drainage (EVD) has been shown to effectively decrease IVH volumes while the impact of rtPA instillation on ICH volumes remains unclear. In this series, we analyzed volumetric changes of ICH in patients with and without intrathecal lysis therapy. Methods Between 01/2013 and 01/2019, 36 patients with IVH caused by hemorrhage of basal ganglia, thalamus or brain stem were treated with rtPA via an EVD (Group A). Initial volumes were determined in the first available computed tomography (CT) scan, final volumes in the last CT scan before discharge. During the same period, 41 patients with ICH without relevant IVH were treated without intrathecal lysis therapy at our neurocritical care unit (Group B). Serial CT scans were evaluated separately for changes in ICH volumes for both cohorts using OsiriX DICOM viewer. The Wilcoxon signed-rank test was performed for statistical analysis in not normally distributed variables. Results Median initial volume of ICH for treatment Group A was 6.5 ml and was reduced to 5.0 ml after first instillation of rtPA (p < 0.01). Twenty-six patients received a second treatment with rtPA (ICH volume reduction 4.5 to 3.3 ml, p < 0.01) and of this cohort further 16 patients underwent a third treatment (ICH volume reduction 3.0 ml to 1.5 ml, p < 0.01). Comparison of first and last CT scan in Group A confirmed an overall median percentage reduction of 91.7% (n = 36, p < 0.01) of ICH volumes and hematoma resolution in Group A was significantly more effective compared to non-rtPA group, Group B (percentage reduction = 68%) independent of initial hematoma volume in the regression analysis (p = 0.07, mean 11.1, 95%CI 7.7–14.5). There were no adverse events in Group A related to rtPA instillation. Conclusion Intrathecal lysis therapy leads to a significant reduction in the intraparenchymal hematoma volume with faster clot resolution compared to the spontaneous hematoma resorption. Furthermore, intrathecal rtPA application had no adverse effect on ICH volume.

scholarly journals Early versus delayed appendectomy for uncomplicated acute appendicitis.

2020 ◽  
Vol 27 (04) ◽  
pp. 842-848
Author(s):  
Farhan Javed ◽  
Saira Saleem ◽  
Ayesha Rehman ◽  
Nazim Hayat ◽  
Zakariya Rashid ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Surgical Techniques ◽  
Related Distribution ◽  
Perforated Appendix ◽  
Group A ◽  
Study Population ◽  
The Difference ◽  
And Gender ◽  
Group B ◽  
Uncomplicated Acute Appendicitis

Study Design: Sectional study. Setting: Madina Teaching Hospital Faisalabad. Period: July 2018 to June 2019. Material & Methods: A sample of 107 patients was selected using non-probability purposive sampling out of all the patients presenting with acute appendicitis. Study population was divided into Groups A and B, former undergoing appendectomy within 8 hours of admission and later undergoing surgery more than 8 hours after admission. Spinal and general anesthesia was used and both Laparoscopic and open surgical techniques were employed. Results: Out of total 107 patients, 62 (57.94%)were placed in group A and 45 (42.06%) in group B. Age and gender related distribution in both groups were similar. 5 patients in group A had perforated appendix and 3 patients in Group B were found to have perforated appendix. The difference between incidence of perforation between the two groups was not statistically significant. Conclusion: in-hospital delay before appendectomy does not significantly increase the risk of perforation in uncomplicated acute appendicitis.

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

scholarly journals A study on-effect of hematoma and perihematomal edema volume on GCS at the time of admission in patients with spontaneous lobar and basal ganglia hemorrhage

Pulse ◽  
2015 ◽  
Vol 7 (1) ◽  
pp. 22-28
Author(s):  
MA Joarder ◽  
AKMB Karim ◽  
KK Barua ◽  
MA Hossain
Keyword(s):  
Basal Ganglia ◽  
Cross Sectional Study ◽  
Hematoma Volume ◽  
Cross Sectional ◽  
Edema Volume ◽  
Key Factor ◽  
Basal Ganglia Hemorrhage ◽  
Gcs Score ◽  
Perihematomal Edema ◽  
Time Of Admission

Objective: To know effect of hematoma and perihematomal edema volume on Glasgow Coma Scale (GCS) at the time of admission in patients with spontaneous lobar and basal ganglia hemorrhage.Methods: this cross sectional study was conducted in Neurosurgery department, BSMMU to observe effect of hematoma and perihematomal edema volume on GCS at the time of admission in patients with spontaneous lobar and basal ganglia hemorrhage. The duration of study period was from November 2005 to April 2007.Results: a total 48 patients were included in the study and the variables that were analyzed included site of hematoma, volume of hematoma, perihematomal edema and the initial GCS score. Associations between the hematoma and perihematomal edema, site of hemorrhage and perihematomal edema, hematoma volume and GCS at the time of admission, perihematomal edema volume and GCS at the time of admission were evaluated. Level of consciousness (GCS) at the time of admission is the key factor in predicting outcome and neurological deterioration. In our study we found significant association between- hematoma and perihematomal edema volume, hematoma volume and GCS at the time of admission, perihematomal edema volume and GCS at the time of admission. But there was no significant association found between hemorrhage site and perihematomal edema.Conclusion: more the volume of hematoma more was the volume of perihematomal edema. More the volume of hematoma less was the GCS. More the volume of perihematomal edema less was the GCS. But we found no significant association between site of hemorrhage and perihematomal edema volume. GCS is an established predictor of outcome in patients with SICH (spontaneous intracerebral hemorrhage). Accurate prediction of the outcome in ICH patients is important for several reasons: a reliable prognosis must be given to patient and relatives as soon as possible, realistic rehabilitation goals should be set and resources should be allocated in the most efficient way.Pulse Vol.7 January-December 2014 p.22-28

I Like Her, Because I Like Myself: Self-Evaluation as a Source of Interpersonal Attitudes

2003 ◽  
Vol 50 (4) ◽  
pp. 239-246 ◽  
Author(s):  
Eva Walther ◽  
Claudia Trasselli
Keyword(s):  
Opposite Effect ◽  
Learning Phase ◽  
The Self ◽  
Attitude Formation ◽  
Formation Processes ◽  
False Feedback ◽  
Self Evaluation ◽  
Evaluation Group ◽  
Group A ◽  
The Difference

Abstract. Two experiments tested the hypothesis that self-evaluation can serve as a source of interpersonal attitudes. In the first study, self-evaluation was manipulated by means of false feedback. A subsequent learning phase demonstrated that the co-occurrence of the self with another individual influenced the evaluation of this previously neutral target. Whereas evaluative self-target similarity increased under conditions of negative self-evaluation, an opposite effect emerged in the positive self-evaluation group. A second study replicated these findings and showed that the difference between positive and negative self-evaluation conditions disappeared when a load manipulation was applied. The implications of self-evaluation for attitude formation processes are discussed.

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