scholarly journals Mortality in Patients with Brainstem Cavernous Malformations

2021 ◽  
pp. 1-7
Author(s):  
Julia Velz ◽  
Marian Christoph Neidert ◽  
Yang Yang ◽  
Kevin Akeret ◽  
Peter Nakaji ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Literature Review ◽  
Systematic Literature Review ◽  
Postoperative Mortality ◽  
Mortality Rates ◽  
Cavernous Malformations ◽  
Patient Cohort ◽  
Actual Risk ◽  
Single Center Study

<b><i>Objective:</i></b> Brainstem cavernous malformations (BSCM)-associated mortality has been reported up to 20% in patients managed conservatively, whereas postoperative mortality rates range from 0 to 1.9%. Our aim was to analyze the actual risk and causes of BSCM-associated mortality in patients managed conservatively and surgically based on our own patient cohort and a systematic literature review. <b><i>Methods:</i></b> Observational, retrospective single-center study encompassing all patients with BSCM that presented to our institution between 2006 and 2018. In addition, a systematic review was performed on all studies encompassing patients with BSCM managed conservatively and surgically. <b><i>Results:</i></b> Of 118 patients, 54 were treated conservatively (961.0 person years follow-up in total). No BSCM-associated mortality was observed in our conservatively as well as surgically managed patient cohort. Our systematic literature review and analysis revealed an overall BSCM-associated mortality rate of 2.3% (95% CI: 1.6–3.3) in 22 studies comprising 1,251 patients managed conservatively and of 1.3% (95% CI: 0.9–1.7) in 99 studies comprising 3,275 patients with BSCM treated surgically. <b><i>Conclusion:</i></b> The BSCM-associated mortality rate in patients managed conservatively is almost as low as in patients treated surgically and much lower than in frequently cited reports, most probably due to the good selection nowadays in regard to surgery.

The role of the GP in follow-up cancer care: a systematic literature review

2016 ◽  
Vol 10 (6) ◽  
pp. 990-1011 ◽  
Author(s):  
Judith A. Meiklejohn ◽  
Alexander Mimery ◽  
Jennifer H. Martin ◽  
Ross Bailie ◽  
Gail Garvey ◽  
...  
Keyword(s):  
Literature Review ◽  
Systematic Literature Review ◽  
Cancer Care

scholarly journals Risk factors for mortality and mortality rates in interstitial lung disease patients in the intensive care unit

2018 ◽  
Vol 27 (150) ◽  
pp. 180061 ◽  
Author(s):  
Julio A. Huapaya ◽  
Erin M. Wilfong ◽  
Christopher T. Harden ◽  
Roy G. Brower ◽  
Sonye K. Danoff
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Interstitial Lung Disease ◽  
Mortality Rate ◽  
Lung Disease ◽  
Mortality Rates ◽  
Population Heterogeneity

Data on interstitial lung disease (ILD) outcomes in the intensive care unit (ICU) is of limited value due to population heterogeneity. The aim of this study was to examine risk factors for mortality and ILD mortality rates in the ICU.We performed a systematic review using five databases. 50 studies were identified and 34 were included: 17 studies on various aetiologies of ILD (mixed-ILD) and 17 on idiopathic pulmonary fibrosis (IPF). In mixed-ILD, elevated APACHE score, hypoxaemia and mechanical ventilation are risk factors for mortality. No increased mortality was found with steroid use. Evidence is inconclusive on advanced age. In IPF, evidence is inconclusive for all factors except mechanical ventilation and hypoxaemia. The overall in-hospital mortality was available in 15 studies on mixed-ILD (62% in 2001–2009 and 48% in 2010–2017) and 15 studies on IPF (79% in 1993–2004 and 65% in 2005–2017). Follow-up mortality rate at 1 year ranged between 53% and 100%.Irrespective of ILD aetiology, mechanical ventilation is associated with increased mortality. For mixed-ILD, hypoxaemia and APACHE scores are also associated with increased mortality. IPF has the highest mortality rate among ILDs, but since 1993 the rate appears to be declining. Despite improving in-hospital survival, overall mortality remains high.

Management of postoperative internal carotid artery intimal flap after carotid endarterectomy: a cohort study and systematic review

2021 ◽  
pp. 1-8
Author(s):  
Jonathan Rychen ◽  
Adrian Madarasz ◽  
Michael Murek ◽  
Philippe Schucht ◽  
Mirjam R. Heldner ◽  
...  
Keyword(s):  
Systematic Review ◽  
Carotid Artery ◽  
Literature Review ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Systematic Literature Review ◽  
Internal Carotid ◽  
Management Strategies ◽  
Intimal Flap

OBJECTIVE Postoperative internal carotid artery (ICA) intimal flap (IF) is a potential complication after carotid endarterectomy (CEA) for carotid artery stenosis. There are no clear recommendations in the current literature on the management of this condition due to sparse evidence. Some authors advocate carotid stent placement or reoperation, while others suggest watchful waiting. The aim of this study was to analyze incidence and management strategies of postoperative ICA-IF, and moreover, to put these findings into context with a systematic literature review. METHODS The authors retrospectively reviewed all consecutive CEA cases performed at the University Hospital of Bern over a decade (January 2008 to December 2018). The incidence of postoperative ICA-IF, risk factors, management strategies, and outcomes were analyzed. These results were put into context with a systematic review following the PRISMA guidelines. RESULTS A total of 725 CEAs were performed between January 2008 and December 2018. Postoperative ICA-IF was detected by routine duplex neurovascular ultrasound (NVUS) in 13 patients, corresponding to an incidence rate of 1.8% (95% CI 1.0%–3.1%). There were no associated intraluminal thrombi on the detected IF. Intraoperative shunt placement was used in 5.6% and one or more intima tack sutures were performed in 42.5% of the 725 cases. There was no significant association between intraoperative shunt placement and the occurrence of an IF (p > 0.99). Two patients (15.4%) with IF experienced a transient postoperative neurological deficit (transient ischemic attack). In these cases, the symptoms resolved spontaneously without any interventions or change in the antiplatelet regimen. All other cases (84.6%) with IF were asymptomatic. In 1 patient (7.7%) with IF, the antiplatelet treatment was switched from a mono- to a dual-antiaggregating regimen because the IF led to a stenosis > 70%; this patient remained asymptomatic. All cases of IFs were managed conservatively with close radiological follow-up evaluations, without reoperation or stenting of the ICA. All 13 IFs vanished spontaneously after a mean duration of 6.9 months (median 1.5 months, range 0.5–48 months). A systematic literature review revealed a postoperative ICA-IF incidence of 3.0% (95% CI 2.1%–4.1%) with relatively heterogenous management strategies. CONCLUSIONS Postoperative ICA-IF is a rare finding after CEA. Conservative therapy with close NVUS follow-up evaluations appears to be an acceptable and safe management strategy for asymptomatic IFs without associated intraluminal thrombi.

2208The interaction effect between myocardial infarction and comorbidity: nationwide cohort study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Schmidt ◽  
E Horvath-Puho ◽  
A G Ording ◽  
T L Lash ◽  
H E Botker ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cohort Study ◽  
Mortality Rate ◽  
Index Date ◽  
Mortality Rates ◽  
Rate Difference ◽  
Mortality Effect ◽  
Comparison Cohort ◽  
Comorbid Diseases

Abstract Background Comorbid diseases may influence the prognosis of acute myocardial infarction (MI) directly by increasing the mortality hazard and indirectly by modifying treatment intensity. Purpose To examine whether comorbid diseases and MI interact to increase mortality beyond the sum of their independent effects. Methods Using Danish medical databases, we conducted a nationwide cohort study of patients diagnosed with MI between 1995 and 2016 (n=179,515) and a comparison cohort of persons without MI (n=880,347)matched on age, sex, and comorbidities in the Charlson Comorbidity Index. The study outcome was time-to-death and the cohorts were followed from the MI/index date until death, emigration, five years of follow-up, or 31 December 2016, whichever came first. Standardized mortality rates with 95% confidence intervals (CIs) were computed using age and sex weights based on the inception MI cohort. The interaction was examined on the additive scale by calculating the interaction contrasts (the difference in rate differences), which measure the combined mortality effect of MI and comorbidity that cannot be explained by summing their individual effects. The follow-up period was stratified by the first 30 days, 31-days to one year, and >1–5 year after the index date. Analyses were repeated within strata of comorbidity levels (1, 2–3, 4+). Results 62% of patients were male. The median age was 70 (interquartile range: 60, 80) years. Among individuals without comorbidity, the mortality rate per 1000 person-years during 30-day follow-up was 1,851 (95% confidence interval: 1,818 to 1,884) for myocardial infarction patients and 22 (21 to 24) for comparison cohort members, yielding a rate difference of 1,829. For individuals with low comorbidity, corresponding baseline mortality rates per 1,000 person-years were 2,498 (2,436 to 2,560) in the myocardial infarction and 54 (50 to 57) in the comparison cohort (rate difference=2,444). The interaction contrast was 616, indicating that the interaction accounted for 25% (616/2,498) of the total mortality rate in MI patients with low comorbidity. The percentage of the 30-day mortality rate explained by interaction increased further for moderate (35%) and severe (45%) comorbidity levels. Absolute and relative interaction effects were largest within the first 30 days, but similar dose-response patterns were observed during 31–365 days and 1–5 years of follow-up (all p-values for trends<0.002). Conclusions Comorbidities interact with myocardial infarction to increase short- and long-term mortality beyond that explained by the additive effect of myocardial infarction and comorbid diseases acting alone Acknowledgement/Funding Department of Clinical Epidemiology's Research Foundation; Program for Clinical Research Infrastructure (PROCRIN)

Functional Outcome After Poor-Grade Subarachnoid Hemorrhage: A Single-Center Study and Systematic Literature Review

2016 ◽  
Vol 25 (3) ◽  
pp. 338-350 ◽  
Author(s):  
Airton Leonardo de Oliveira Manoel ◽  
Ann Mansur ◽  
Gisele Sampaio Silva ◽  
Menno R. Germans ◽  
Blessing N. R. Jaja ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Literature Review ◽  
Functional Outcome ◽  
Systematic Literature Review ◽  
Single Center ◽  
Poor Grade ◽  
Single Center Study ◽  
Center Study

scholarly journals The effect of tumour necrosis factor inhibitors on radiographic progression in axial spondyloarthritis: a systematic literature review

Rheumatology ◽  
2019 ◽  
Vol 58 (11) ◽  
pp. 1907-1922 ◽  
Author(s):  
Nadine Boers ◽  
Celia A J Michielsens ◽  
Désirée van der Heijde ◽  
Alfons A den Broeder ◽  
Paco M J Welsing
Keyword(s):  
Literature Review ◽  
Systematic Literature Review ◽  
Radiographic Progression ◽  
Axial Spondyloarthritis ◽  
Standard Dose ◽  
Tnf Α ◽  
Significant Difference ◽  
Synthetic Dmards ◽  
Necrosis Factor

Abstract The effect of TNF-α inhibitors (TNFi), with or without concomitant NSAIDs, on radiographic progression in axial SpA remains unclear. Therefore, we performed a systematic literature review up to January 2019 to determine whether longer use of standard dose TNFi is superior vs lower duration or lower dose TNFi therapy, conventional synthetic DMARDs alone, or no therapy in inhibiting radiographic progression in patients with axial SpA. Our search yielded 373 titles of which 14 full text articles and five abstracts were eligible for quantitative analysis. Studies had an overall moderate to critical risk of bias. Data could not be pooled due to clinical and methodological heterogeneity. Individual studies showed conflicting results with mainly no significant difference in radiographic progression when comparing effect of TNFi therapy to no TNFi therapy or when comparing to less TNFi therapy until 2 years of follow-up. Results that are more significant are shown after 2 years’ follow-up, mainly in subgroups with baseline syndesmophytes. Data on the additional or synergistic effect of concomitant NSAID use were inconclusive.

scholarly journals Polypharmacy in Middle-European Rheumatoid Arthritis-Patients: A Retrospective Longitudinal Cohort Analysis With Systematic Literature Review

2020 ◽  
Vol 7 ◽  
Author(s):  
Jacqueline Désirée Jack ◽  
Rick McCutchan ◽  
Sarah Maier ◽  
Michael Schirmer
Keyword(s):  
Rheumatoid Arthritis ◽  
Literature Review ◽  
Systematic Literature Review ◽  
Anatomical Therapeutic Chemical ◽  
Cohort Analysis ◽  
World Health ◽  
Management Guidelines ◽  
The Mean ◽  
Health Organization

Objective: To assess polypharmacy and related medication aspects in Middle-European rheumatoid arthritis (RA) patients, and to discuss the results in view of a systematic literature review.Methods: In this retrospective cohort study, charts were reviewed from RA-patients consecutively recruited between September 27, 2017 and April 29, 2019. Drugs were assigned to the Anatomical Therapeutic Chemical (ATC) groups as proposed by the World Health Organization (WHO). Results were compared to those of a systematic literature review.Results: One hundred seventy-five consecutive RA-patients were included. The mean number of drugs was 6.6 ± 3.5, with 2.4 ± 1.2 drugs taken specifically for RA—compared to 2.6 in the literature. 33.7% of patients experienced polypharmacy defined by ≥5 drugs, compared to 61.6% in the literature–with women affected more frequently than men. After 7 years of follow-up, the number of drugs increased in all ATC-groups by an average of 12.7 %, correlating with age (Corrcoeff = 0.46) and comorbidities (Corrcoeff = 0.599). In the literature, polypharmacy is not always defined precisely, and has not been considered in management guidelines so far.Conclusion: Polypharmacy is a frequent issue in RA-management. With an increasing number of comorbidities during the course of the disease, polypharmacy becomes even more relevant.

scholarly journals Bleeding Pseudocyst of the Pancreatic Head. The role of Omentoplasty and Local Hemostasis

HPB Surgery ◽  
1994 ◽  
Vol 8 (2) ◽  
pp. 123-128 ◽  
Author(s):  
Francesco Stipa ◽  
Adolfo Gavelli ◽  
Claude Huguet
Keyword(s):  
Surgical Treatment ◽  
Mortality Rate ◽  
Pancreatic Resection ◽  
Pancreatic Head ◽  
Postoperative Mortality ◽  
Arterial Embolization ◽  
Arterial Ligation ◽  
Post Traumatic

Treatment of bleeding psedoaneurysms and pseudocysts of the pancreas is controversial. Surgical treatment with pancreatic resection or trancystic arterial ligation is not always satisfactory since postoperative mortality rate is high, especially for lesions located in the pancreatic head and rebleeding is not unusual. Two patients with bleeding pseudoaneurysms (one post traumatic, one spontaneous) and one with a hemorrhagic pseudocyst of the pancreatic head were treated surgically with arterial suture and omentoplasty. Bleeding was controlled in all, without any postoperative mortality or morbidity. No rebleeding occurred with a follow up of 33, 26 and 12 months. Trancystic ligation of bleeding vessels with omentoplasty may be a useful approach, which should be compared to arterial embolization in the future.

scholarly journals Total knee arthroplasty reduces the risk of mortality in osteoarthritis patients up to 12 years: A Korean national cohort longitudinal follow-up study

2020 ◽  
Vol 28 (1) ◽  
pp. 230949902090258
Author(s):  
Hyo Geun Choi ◽  
Bong Cheol Kwon ◽  
Joong Il Kim ◽  
Joon Kyu Lee
Keyword(s):  
Total Knee Arthroplasty ◽  
Mortality Rate ◽  
Knee Arthroplasty ◽  
Causes Of Death ◽  
Age Groups ◽  
Mortality Rates ◽  
Control Group ◽  
Circulatory Disease ◽  
Total Knee

Introduction: Mortality rates and causes of death after total knee arthroplasty (TKA) are of great interest to surgeons. However, there is a shortage of studies regarding those of the Asian population. The aim of this study was to compare the mortality rate and causes of death in patients after TKA to the general population. Methods: National sample cohort data from the Korean Health Insurance Review and Assessment Service were used. In this study, 1:4 matched patients after TKA (TKA group: 5072) and general participants (control group: 20,288) were selected as subjects. Their average follow-up duration was 57.2 months ranging from a year up to 12 years. The matches were processed for age, gender, income, region of residence, and past medical history. Mortality rates and causes of death were compared between groups. Regarding the mortality rates, we also performed subgroup analyses according to age. Results: Adjusted hazard ratio (HR) of the TKA group for mortality rate was less than 1 with significance (adjusted HR = 0.61 (95% confidence interval = 0.54–0.70, p < 0.001)). The ratios were less than 1 for both age groups (<70 and ≥70 years), respectively; however, for patients under 70, they were insignificant. Among the 11 major causes of death, the circulatory disease showed the most significantly reduced mortality rate for the TKA group compared to the control group. The neoplasm was the only other cause with a significantly reduced mortality rate for the TKA group. Conclusion: The mortality rate in the TKA group was significantly lower than in the control group up to 12 years after the surgery in Korea. Among the major causes of death, circulatory disease and neoplasm showed a significant reduction in the mortality rate of the TKA group compared with the control group.

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