Abstract 165: Pial Synangiosis in Patients with Moyamoya less than 2 Years of Age

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Eric M Jackson ◽  
Ning Lin ◽  
Lissa Baird ◽  
R. Michael Scott ◽  
Edward R Smith
Keyword(s):  
Late Complications ◽  
High Risk Population ◽  
Consecutive Series ◽  
Ischemic Change ◽  
Initial Surgery ◽  
Long Term Follow Up ◽  
Progression Of Disease ◽  
Long Term Prognosis

Introduction: Moyamoya patients under two years of age represent a therapeutic challenge because of their frequent neurologic instability and concomitant anesthetic risks. We report our experience with pial synangiosis revascularization in this population. Methods: We reviewed the clinical and radiographic records of all patients with moyamoya syndrome in a consecutive series of patients under 2 years of age, who underwent cerebral revascularization surgery using pial synangiosis at a single institution. Results: During a 12-year period (1994-2005), thirty-four procedures (15 bilateral, 4 unilateral) were performed in 19 patients under two years of age (out of a total of 456 procedures in 240 patients). Eighteen of these patients presented with either stroke or TIA. Average age at first surgery was 1.4 years (range 6 months to 1.9 years). Unanticipated staged operations occurred in three patients, two due to persistent EEG changes during the initial surgery and one due to brain swelling during the procedure requiring ventriculostomy. There were two perioperative strokes; both patients had post-operative seizures but made clinical recoveries. The average follow-up was 7 years (range 1-14). In long term follow-up, 13 patients (68%) were clinically independent for their age, with 8 (42%) having no significant deficit. Late complications included subdural hygroma evacuation (1), additional revascularization procedures years later for frontal lobe ischemia (2), late infarction (1) and asymptomatic ischemic change on routine follow-up MRI studies (1). All patients who had both pre and post-operative angiography demonstrated progression of disease. Conclusions: Despite the challenges inherent to this population, the majority of children with moyamoya under 2 years of age have a good long-term prognosis. Our data support the use of pial synangiosis as a safe, effective and durable method for treatment of moyamoya for most children in this potentially high-risk population.

Pial synangiosis in patients with moyamoya younger than 2 years of age

2014 ◽  
Vol 13 (4) ◽  
pp. 420-425 ◽  
Author(s):  
Eric M. Jackson ◽  
Ning Lin ◽  
Sunil Manjila ◽  
R. Michael Scott ◽  
Edward R. Smith
Keyword(s):  
Late Complications ◽  
High Risk Population ◽  
Consecutive Series ◽  
Ischemic Change ◽  
Initial Surgery ◽  
Progression Of Disease ◽  
Long Term Prognosis ◽  
Ischemic Attack

Object Patients with moyamoya who are younger than 2 years of age represent a therapeutic challenge because of their frequent neurological instability and concomitant anesthetic risks. The authors report their experience with pial synangiosis revascularization in this population. Methods The authors reviewed the clinical and radiographic records of all patients with moyamoya in a consecutive series of patients under 2 years of age, who underwent cerebral revascularization surgery using pial synangiosis at a single institution. Results During a 12-year period (1994–2005), 34 procedures (bilateral in 15 patients, unilateral in 4) were performed in 19 patients younger than 2 years (out of a total of 456 procedures in 240 patients). Eighteen of these patients presented with either stroke or transient ischemic attack. The average age of the 19 patients at first surgery was 1.4 years (range 6 months–1.9 years). Unanticipated staged operations occurred in 3 patients, due to persistent electroencephalographic changes during the initial surgery in 2 cases and due to brain swelling during the procedure requiring ventriculostomy in the other. There were 2 perioperative strokes; both patients had postoperative seizures but made clinical recoveries. The average follow-up was 7 years (range 1–14 years). Long term, at follow-up, 13 patients (68%) were clinically independent for their age, with 8 (42%) having no significant deficit. Late complications included subdural hygroma evacuation (1), additional revascularization procedures performed years later for frontal lobe ischemia (2), late infarction (1), and asymptomatic ischemic change on routine follow-up MRI studies (1). All patients who had both pre- and postoperative angiography demonstrated progression of disease. Conclusions Despite the challenges inherent to this population, the majority of children with moyamoya under the age of 2 years have a good long-term prognosis. The data from this study support the use of pial synangiosis as a safe, effective, and durable method for treatment of moyamoya for most children in this potentially high-risk population.

Abstract 13882: Impact of Ischemic Mitral Regurgitation on Long-Term Prognosis in Patients With Acute Myocardial Infarction After Primary Percutaneous Coronary Intervention

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Kitae Kim ◽  
Shuichiro Kaji ◽  
Takeshi Kitai ◽  
Atsushi Kobori ◽  
Natsuhiko Ehara ◽  
...  
Keyword(s):  
Cardiac Death ◽  
Poor Prognosis ◽  
Coronary Intervention ◽  
Killip Class ◽  
Percutaneous Coronary ◽  
Long Term Follow Up ◽  
The Mean ◽  
Long Term Prognosis

Introduction: Ischemic mitral regurgitation (IMR) portends a poor prognosis during long-term follow-up and has been identified as an independent predictor of heart failure (HF) and reduced long-term survival. Despite the poor prognosis with chronic IMR, few studies report the impact of IMR on long-term prognosis in patients with acute myocardial infarction (AMI) who underwent primary percutaneous coronary intervention (PCI). Methods: We studied 674 consecutive patients with AMI from 2000 to 2006 who underwent emergent coronary angiography and primary PCI, and who were assessed by transthoracic echocardiography during index hospitalization. Primary outcomes were cardiac death and the development of HF during follow-up. Results: The mean age of the study patients was 65±12 years and 534 patients (79%) were men. Sixty patients (9%) had moderate or severe MR before hospital discharge. Patients with moderate or severe MR were older, more frequently non-smoker, and more likely to have Killip class ≥2, lower ejection fraction, larger left ventricular end-diastolic volume, compared with patients with no or mild MR. During the mean follow-up period of 5.7±3.6 years, 35 cardiac deaths and 53 episodes of HF occurred. Kaplan-Meier analysis revealed that patients with moderate or severe MR had significantly increased risk for cardiac death (P<0.001), and HF (P<0.001), compared with patients with no or mild MR. Multivariate analysis revealed that moderate or severe MR was the significant predictor of the development of cardiac death (P<0.001), and the development of HF (P=0.006), independently of age, gender, history of MI, Killip class ≥2, initial TIMI flow≤1, peak CPK level, ejection fraction. Conclusions: Moderate or severe IMR detected early after AMI was independently associated with adverse cardiac events during long-term follow-up in patients with AMI after primary PCI.

Long-term outcome of social phobia treated by exposure

2001 ◽  
Vol 31 (5) ◽  
pp. 899-905 ◽  
Author(s):  
G. A. FAVA ◽  
S. GRANDI ◽  
C. RAFANELLI ◽  
C. RUINI ◽  
S. CONTI ◽  
...  
Keyword(s):  
Social Phobia ◽  
Consecutive Series ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Concurrent Use ◽  
Complete Treatment ◽  
Long Term Follow Up ◽  
Dsm Iv

Background. There is very little information on long-term follow-up of social phobia.Methods. A consecutive series of 70 patients satisfying the DSM-IV criteria for social phobia was treated in an out-patient clinic with behavioural methods based on exposure homework. Forty-five patients were judged to be remitted after eight individual sessions of psychotherapy. A 2 to 12 year (median = 6 years) follow-up was performed. Survival analysis was selected to characterize the clinical course of patients. Assessments were performed before treatment, at the end of therapy, after 1 year, and subsequently on a yearly basis, and utilized selected items of Paykel's Clinical Interview for Depression.Results. Six of the 45 patients (13%) had a relapse of social phobia at some time during follow-up. The estimated cumulative percentage of patients remaining in remission was 98 after 2 years, 85 after 5 years and 85 after 10 years. Such probabilities increased in the absence of a personality disorder, of residual social phobic avoidance after exposure, and of concurrent use of benzodiazepines.Conclusions. The findings suggest that, even though one patient out of three is unable to complete treatment or does not benefit sufficiently from it, exposure treatment can provide lasting effects to the majority of patients with social phobia. Disappearance of residual, subclinical social phobic avoidance appears to be the target of treatment.

scholarly journals Supratentorial Brain AVM Embolization with Onyx-18 and Post-Embolization Management

2009 ◽  
Vol 15 (3) ◽  
pp. 275-282 ◽  
Author(s):  
J. W. Pan ◽  
H.J. Zhou ◽  
R.Y. Zhan ◽  
S. Wan ◽  
M. Yan ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Subsequent Treatment ◽  
Additional Surgery ◽  
Brain Avm ◽  
Initial Symptoms ◽  
Complete Obliteration ◽  
Long Term Follow Up ◽  
Long Term Prognosis

Onyx is increasingly used in endovascular therapy of intracranial arteriovenous malformations (AVMs). However, the embolic effect and post-embolization management are still under discussion. We report our experience in the treatment of supratentorial brain arteriovenous malformations (SBAVMs) with Onyx and discuss post-embolic management. From June 2006 to July 2008, 20 patients with SBAVM were embolized with Onyx. There were 14 men and six women ranging from 14 to 64 years of age (mean 38.3 years). Initial symptoms included spontaneous hemorrhage (n=12), headaches (n=4), seizure (n=3) and incidentally disclosed after head trauma (n=1). After the endovascular procedure, all had subsequent treatment (follow-up angiogram, stereotactic radiosurgery or microsurgery) according to the obliteration degree. At angiography, seven patients (35%, 7/20) were completely obliterated (over 95% closure) after embolization while one suffered a small subarachnoid hemorrhage without permanent clinical sequelae. Four patients (20%, 4/20) were subtotally obliterated (over 80% closure), one patient who suffered severe cerebral edema after embolization underwent decompressive craniectomy, two patients had additional radiosurgery and one patient had follow-up angiogram. Nine patients (45%, 9/20) were partially obliterated (20–80% closure), five patients had additional surgery, two patients had additional radiosurgery and two patients had follow-up angiogram (one patient had intraventricular hemorrhage three months after embolization). Of all 20 AVMs, an average of 2.2 ml Onyx was used per patient and average volume reduction was 80% (range, 30%–99%). Onyx is suitable for embolization of SBAVMs because of its diffuse controllable properties. We suggest clinical follow-up after complete obliteration, additional radiosurgery or angiographic follow-up after subtotal obliteration and additional surgery after partially obliteration. More cases with long-term follow-up are needed to evaluate the long-term prognosis of our post-embolization management.

Impact of new onset atrial fibrillation on long-term prognosis in patients with acute ST-segment elevation myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M.A Baturova ◽  
M.M Demidova ◽  
J Carlson ◽  
D Erlinge ◽  
P.G Platonov
Keyword(s):  
Clinical Characteristics ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
All Cause Mortality ◽  
Long Term Follow Up ◽  
Long Term Prognosis ◽  
New Onset

Abstract Introduction New onset AF is a known complication in patients with acute ST-segment elevation myocardial infarction (STEMI). However, whether new-onset AF affects the long-term prognosis to the same extent as pre-existing AF is not fully clarified and prescription of oral anticoagulants (OAC) in patients with new-onset AF remains a matter of debates. Purpose We aimed to assess the impact of new-onset AF in STEMI patients undergoing primary percutaneous intervention (PCI) on outcome during long-term follow-up in comparison with pre-existing AF and to evaluate effect of OAC therapy in patients with new-onset AF on survival. Methods Study sample comprised of 2277 consecutive patients with STEMI admitted to a tertiary care hospital for primary PCI from 2007 to 2010 (age 66±12 years, 70% male). AF prior to STEMI was documented by record linkage with the Swedish National Patient Register and review of ECGs obtained from the digital archive containing ECGs recorded in the hospital catchment area since 1988. SWEDEHEART registry was used as the source of information regarding clinical characteristics and events during index admission, including new-onset AF and OAC at discharge. All-cause mortality was assessed using the Swedish Cause-of-Death Register 8 years after discharge. Results AF prior to STEMI was documented in 177 patients (8%). Among patients without pre-existing AF (n=2100), new-onset AF was identified in 151 patients (7%). Patients with new-onset AF were older than those without AF history (74±9 vs 65±12 years, p&lt;0.001), but did not differ in regard to other clinical characteristics. Among 2149 STEMI survivors discharged alive, 523 (24%) died during 8 years of follow-up. OAC was prescribed at discharge in 45 (32%) patients with new onset AF and in 49 (31%) patients with pre-existing AF, p=0.901. In a univariate analysis, both new-onset AF (HR 2.18, 95% CI 1.70–2.81, p&lt;0.001) and pre-existing AF (HR 2.80, 95% CI 2.25–3.48, p&lt;0.001) were associated with all-cause mortality, Figure 1. After adjustment for age, gender, cardiac failure, diabetes, BMI and smoking history, new-onset AF remained an independent predictor of all-cause mortality (HR 1.40, 95% CI 1.02–1.92, p=0.037). OAC prescribed at discharge in patients with new-onset AF was not significantly associated with survival (univariate HR 0.86, 95% CI 0.50–1.50, p=0.599). Conclusion New-onset AF developed during hospital admission with STEMI is common and independently predicts all-cause mortality during long-term follow-up after STEMI with risk estimates similar to pre-existing AF. The effect of OAC on survival in patients with new-onset AF is inconclusive as only one third of them received OAC therapy at discharge. Kaplan-Meier survival curve Funding Acknowledgement Type of funding source: None

Symptomatic Retethering of the Spinal Cord After Section of a Tight Filum Terminale

Neurosurgery ◽  
2011 ◽  
Vol 68 (6) ◽  
pp. 1594-1602 ◽  
Author(s):  
Raymund L. Yong ◽  
Tracey Habrock-Bach ◽  
Mariko Vaughan ◽  
John R. Kestle ◽  
Paul Steinbok
Keyword(s):  
Tethered Cord ◽  
Invasive Procedure ◽  
Pediatric Neurosurgery ◽  
Filum Terminale ◽  
Initial Surgery ◽  
Long Term Follow Up ◽  
Initial Procedure ◽  
Tight Filum Terminale

Abstract BACKGROUND: Section of a tight filum terminale is a minimally invasive procedure compared with cord untethering procedures used for more complex spinal abnormalities. Anecdotal evidence suggests, however, that the risk of symptomatic retethering resulting from scarring might be higher than previously thought. OBJECTIVE: To determine the frequency of symptomatic retethering after section of a tight filum terminale and to explore possible risk factors. METHODS: We reviewed databases at 2 pediatric neurosurgery centers for all patients who had surgery for a suspected tight filum terminale between January 1982 and June 2009. RESULTS: We identified 152 patients. The median length of follow-up was 78 months. Thirteen patients (8.6%) went on to retether symptomatically at a median time of 23.4 months after the initial procedure. Eight had early retethering (within 2 years) and 5 had late retethering (after 7 years). Compared with late retetherers, early retetherers were older at initial surgery (median, 9.4 vs 0.9 years of age), had a higher level of the conus (median, L1/L2 vs L3/L4), had more arachnoiditis after initial surgery, and required more repeat untethering procedures. Late retetherers were younger at initial surgery than those who did not retether (median, 0.9 vs 4.5 years of age). CONCLUSION: Symptomatic retethering is not uncommon after a simple filum snip, and long-term follow-up is warranted. Two distinct patterns of retethering were observed. Arachnoiditis caused by infection or a cerebrospinal fluid fistula may predispose to early retethering, whereas early surgery for prevention of tethered cord symptoms may predispose to late retethering.

Long-term follow-up results of selective VIM-thalamotomy

1986 ◽  
Vol 65 (3) ◽  
pp. 296-302 ◽  
Author(s):  
Yoshishige Nagaseki ◽  
Tohru Shibazaki ◽  
Tatsuo Hirai ◽  
Yasuhiro Kawashima ◽  
Masafumi Hirato ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Essential Tremor ◽  
The Other ◽  
Content Type ◽  
Early Results ◽  
Initial Surgery ◽  
Long Term Follow Up

✓ The authors report the results of a long-term follow-up study of the effects of the physiologically defined selective VIM (nucleus ventralis intermedius)-thalamotomy on tremor of Parkinson's disease in 27 patients and essential tremor in 16 patients. The follow-up period ranged from 3.25 to 10 years (mean 6.58 years). In 43 patients a total of 50 operations (including four bilateral operations and three reoperations) were carried out. The early (2 to 4 weeks after surgery) and late effects on the tremors were determined clinically and electromyographically. Fourteen parkinsonian cases were treated with minimal lesions (about 40 cu mm). Their late results were very similar to the early results: in 10, the tremors were completely abolished, three had a slight residual tremor, and one underwent reoperation 3 months after the first surgery. Eleven essential tremor cases were treated with minimal lesions. Six of these tremors were completely abolished, four patients had slight residual tremors, and one patient with a recurrence underwent reoperation 2 years after the initial surgery. In these 23 successful operations with minimal lesions (excluding two cases with reoperation), the tremor was abolished without discernible long-lasting side effects. The other 23 operations on 16 patients with Parkinson's disease (including one reoperation) and on seven with essential tremor (one of whom also had a minimal lesion on the other side) involved relatively large lesions. In this group, the surgery was successful in almost every case. It was concluded that radiographically and physiologically monitored selective VIM-thalamotomy for parkinsonian and essential tremor is effective even when lesioning is minimal. Moreover, the beneficial effect is maintained over a long period of time.

Long-term follow up of surgical outcomes in patients with cervical disorders undergoing hemodialysis

2006 ◽  
Vol 5 (4) ◽  
pp. 313-319 ◽  
Author(s):  
Hideki Sudo ◽  
Manabu Ito ◽  
Kuniyoshi Abumi ◽  
Yoshihisa Kotani ◽  
Tatsuto Takeuchi ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Spinal Fusion ◽  
Posterior Instrumentation ◽  
Survival Rates ◽  
Spinal Instability ◽  
Initial Surgery ◽  
Long Term Follow Up ◽  
Spine Disorders

Object As increasing numbers of patients receive long-term hemodialysis, the number of reports regarding hemodialysis-related cervical spine disorders has also increased. However, there have been few reports summarizing the surgical results in patients with these disorders. The objective of this study was to evaluate the long-term follow up and clinical results after surgical treatment of cervical disorders in patients undergoing hemodialysis. Methods Seventeen patients in whom surgery was performed for cervical spine disorders while they received long-term hemodialysis therapy were enrolled in this study. Of these, 15 underwent follow-up review for more than 3 years after surgery, and these represent the study population. The remaining two patients died of postoperative sepsis. The average follow-up period was 120 months. Five patients without spinal instability underwent spinal cord decompression in which bilateral open-door laminoplasty was performed. Ten patients with destructive spondyloarthropathy (DSA) underwent reconstructive surgery involving pedicle screw (PS) fixation. In eight patients in whom posterior instrumentation was placed, anterior strut bone grafting was performed with autologous iliac bone to treat anterior-column destruction. Marked neurological recovery was obtained in all patients after the initial surgery. In the mobile segments adjacent to the site of previous spinal fusion, the authors observed progressive destructive changes with significant instability in four patients (40%) who underwent circumferential spinal fusion. No patients required a second surgery after laminoplasty for spinal canal stenosis without DSA changes. Conclusions Cervical PS-assisted reconstruction provided an excellent fusion rate and good spinal alignment. During the long-term follow-up period, however, some cases required extension of the spinal fusion due to the destructive changes in the adjacent vertebral levels. Guidelines or recommendations to overcome these problems should be produced to further increase the survival rates of patients undergoing hemodialysis.

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