Abstract T P150: NIHSS Zero Strokes: Immeasurable but Not Innocent

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Elissavet Eskioglou ◽  
Michael Amiguet ◽  
Patrik Michel
Keyword(s):  
Laboratory Finding ◽  
Recurrence Rates ◽  
Laboratory Findings ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Stroke Registry ◽  
Stroke Disability ◽  
Current Deficit ◽  
Unadjusted Analysis

Aims: Patients with acute ischemic stroke (AIS) lasting >24 hours may have an immeasurable deficit on the admission NIHSS score. We sought to better characterize factors that are associated with NIHSS zero strokes and evaluate their long term outcome. Methods: We used all AIS patients with a measurable admission NIHSS in the Acute STroke Registry and Analysis and of Lausanne (ASTRAL) from 2003 - 2012. We then retrospectively analyzed and compared patients with an admission NIHSS of zero with all other patients regarding demographics, clinical characteristics, radiological and laboratory findings in uni- and multivariate analyses. Patients with a pre-stroke NIHSS>0 were also considered “NIHSS zero strokes” if a clearly described preexisting deficit accounted for the current deficit and no new NIHSS points were found. Outcome was assessed at 3 months using the modified Rankins score corrected for pre-stroke disability (corrected mRS) and considered favorable if it was ≤ 1. Combined stroke & TIA recurrences and rehospitalisation rates over 12 months were compared. Results: Comparing 109 NIHSS zero with 2’189 other strokes in multivariate analysis, patients with NIHSS zero stroke had lower pre-stroke disability levels, longer onset-to-hospital delays, and more lacunar and infratentorial strokes. When comparing radiological and laboratory finding in the two groups, NIHSS zero patients were less likely to have acute ischemic changes on acute NCCT, less arterial pathology on acute cervical and intracranial imaging and lower creatinine levels. In unadjusted analysis, NIHSS zero patients were more likely to have favorable corrected mRS (zero vs. others: 83.2% vs. 44.6%) and less likely to die (3.9% vs. 13.3%) at 12 months. Recurrence rates were similar (9.2% vs. 12.9%). Conclusion: Patients with NIHSS zero strokes as compared with all other patients have more frequently lacunar and infrantentorial strokes, normal acute CT, and less arterial pathology. However a significant minority faces persisting handicap at 12 months and recurrent ischemic events. These findings suggest that NIHSS zero stroke patients have better outcomes but still require support and aggressive secondary prevention.

Long-term outcome of modified radical mastoidectomy

2004 ◽  
Vol 118 (8) ◽  
pp. 612-616 ◽  
Author(s):  
Payal Mukherjee ◽  
Nicholas Saunders ◽  
Richard Liu ◽  
Paul Fagan
Keyword(s):  
Bone Conduction ◽  
Radical Mastoidectomy ◽  
Recurrence Rates ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Surgical Access ◽  
Modified Radical Mastoidectomy ◽  
Hearing Result

The primary aim of treatment of cholesteatoma is to attain a dry, safe, stable ear, free of disease. Maintaining or improving hearing is important but the pursuit of a hearing result should not compromise this primary aim. This study reviews the long-term outcome of 133 patients, suffering from advanced disease, who underwent modified radical mastoidectomy between 1995 and 2000. Of these, 49 per cent had had previous mastoid surgery elsewhere. A dry, waterproof ear was attained in 95 per cent of patients. In 77 per cent of patients, hearing was unchanged or improved. In this period, there were two cases of significant post-operative loss in bone conduction, including one dead ear secondary to suppurative labyrinthitis. There were epithelial pearls on follow up in two per cent. These results indicate that when properly performed, modified radical mastoidectomy provides safe surgical access and clears disease with low recurrence rates while mostly maintaining or improving hearing.

Remission and recurrence of depression in the maintenance era: long-term outcome in a Cambridge cohort

2003 ◽  
Vol 33 (5) ◽  
pp. 827-838 ◽  
Author(s):  
N. KENNEDY ◽  
R. ABBOTT ◽  
E. S. PAYKEL
Keyword(s):  
Psychological Treatment ◽  
Severe Depression ◽  
Severity Of Illness ◽  
Recurrence Rates ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Recent Cohort ◽  
Course Of Depression

Background. Long-term studies of severe depression have described high rates of non-recovery, recurrence, chronic incapacity and mortality. A more recent cohort was followed-up to ascertain whether the course had improved given developments in pharmacological and psychological treatments in the last 15 years.Method. Subjects from a cohort of 70 mainly severe recurrent depressives originally recruited to a shorter follow-up study from 1990–1992 were followed-up after 8–11 years. Data included longitudinal information on course of depression and other psychiatric disorders, pharmacological and psychological treatment and social functioning during follow-up.Results. Sixty-nine (99%) subjects were successfully followed-up, with 61 of 66 living subjects interviewed and detailed follow-up data obtained in total on 65. Sixty (92%) of 65 subjects recovered during follow-up, with two-thirds subsequently suffering a recurrence. Eleven (17%) suffered from an episode of chronic depression of at least 2 years duration during follow-up. Social function at follow-up was good and there were high levels of pharmacological and psychological treatment. Greater severity of illness was the most consistent predictor of poor outcome. Times to recovery and recurrence and recovery and recurrence rates were very similar to older studies.Conclusions. The long-term outcome of depression still shows high recurrence rates and does not appear to have changed in the last 20 years.

Serum calcium and long-term outcome after ischemic stroke: Results from the China National stroke registry III

2021 ◽  
Vol 325 ◽  
pp. 24-29
Author(s):  
Jun-Fang Zhang ◽  
Xia Meng ◽  
Jing Jing ◽  
Yuesong Pan ◽  
Yi-Long Wang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Serum Calcium ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Stroke Registry

Is perianal sepsis adequately managed? The results of a five year audit at Royal Naval Hospital Haslar

1994 ◽  
Vol 80 (3) ◽  
pp. 148-151
Author(s):  
S J Parker ◽  
R F Dale
Keyword(s):  
Statistical Difference ◽  
Perianal Fistula ◽  
Postal Questionnaire ◽  
Recurrence Rates ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Retrospective Audit ◽  
Perianal Sepsis ◽  
Naval Hospital

AbstractA retrospective audit and postal questionnaire of 148 patients presenting with perianal sepsis confirms that the isolation of gut-related organisms remains a sensitive indicator of a perianal fistula. It did not confirm that the use of microbiological results affects the long term outcome for these patients. It suggests that early examination under anaesthetic and laying open of a fistula may not be necessary in all patients in which gut-related organisms are identified. There was no statistical difference in recurrence rates of perianal sepsis between those operated on by senior or junior surgeons, though there may have been selection bias in these patients.

scholarly journals Initial GCS and laboratory findings of patients with TBI are associated with the GOSE and mortality rate at one year

2017 ◽  
Vol 6 (1) ◽  
pp. 14 ◽  
Author(s):  
Shahram Paydar ◽  
Elahe Bordbar ◽  
Mehdi Taghipour ◽  
Hosseinali Khalili ◽  
Mehran Jafari
Keyword(s):  
Mortality Rate ◽  
Laboratory Data ◽  
Base Deficit ◽  
Final Outcome ◽  
Laboratory Findings ◽  
Term Outcome ◽  
Long Term Outcome ◽  
One Year ◽  
The Relationship

Background: To evaluate the relationship between presenting Glasgow Coma Scale (GCS) or laboratory data of patients with TBI and Extended Glasgow Outcome Scale (GOSE) and final outcome (deceased, survived) at one year.Methods: 74 patients (59 males and 15 females; mean age ±SD of 40±19years) who presented with TBI were entered into the study, and their GCS and laboratory data were recorded. After one year, GOSE level and final outcome were evaluated with 11 yes/no questions obtained from the patients or their first-degree relatives.Results: The patients with lower GCS on admission or day six, significantly had lower GOSE. Moreover, the lower the GCS in the first week of admission, the poorer the final outcome. Among laboratory data, the base deficit (BD) level of -6 or worse on admission was an indicator of mortality at one year. Hypernatremia was the only laboratory factor which predicted poor GOSE after a year. Furthermore, patients with serum hypernatremia, hyperkalemia, or high PTT levels on the first week of admission had poor final outcome.Conclusions: Presenting GCS and metabolic derangements are reliable indicators of long-term outcome and GOSE at one year. 

scholarly journals Long-term outcome of surgery for perianal Crohn’s fistula

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
M Schaad ◽  
D Hahnloser ◽  
A Schoepfer ◽  
J -B Rossel ◽  
G Rogler
Keyword(s):  
Activity Index ◽  
Perianal Fistula ◽  
Fistula Closure ◽  
Recurrence Rates ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Additional Surgery ◽  
Seton Drainage

Abstract Objective Perianal fistulizing disease is a problem in patients with Crohn’s disease (CD) because they often need repetitive surgeries. Among the various available procedures, none of them proves to be superior. In addition, the long-term outcome of fistula Seton drainage is not well described. The aims of this study were to analyze the long-term healing and recurrence rates of perianal fistulas in CD patients, stratified according to the first procedure performed. Methods Database analysis of a prospective Swiss cohort of patients with perianal CD. Results 365 patients with 576 interventions and a median follow-up of 7.5 years (0 - 12.6) were analyzed. 39.7% of patients required more than one surgery. The first surgical interventions were fistulectomies (58.4%), Seton drainage (26.9%), fistula plugs (2.2%) and combined procedures (9.9%). Fistulectomy patients required no more surgery in 67.6%, one additional surgery in 25.4% and more than one additional surgery in 7.7%. In these 3 groups of patients, after a median follow-up of 12.1 years, perianal fistula closure was achieved in 77.1%, 74.1% and 66.7%, respectively. In patients with Seton drainage as index surgery, 50.3% required no more surgery and over 75% achieved fistula closure after 10 years. 49.7% of patients with Seton required one or more surgeries. At median follow up of 7.5 years, closure rates were 64.2% and 60.5% in patients with one and more than one surgeries, respectively. There was no difference in demographics in Seton patients with closed or not closed fistulas. Non-closure patients had a higher Crohn Disease Activity Index (33 vs. 6) and more frequent anti-TNF medication (57.4% vs. 48.1%). Conclusion First line fistulectomies achieved the highest healing rates in perianal CD but 1/3 of patients require additional surgeries and 1/4 patients will remain with a fistula at 10 years. Initial seton drainage and concurrent medical therapy can achieve fistula closure in 75%. However, in 50% of patients more surgeries are performed with a seton staying in place up to 5 years and fistula closure in only 2/3 patients.

The impact of predisposing factors on long-term outcome after stroke in diabetic patients: the Fukuoka Stroke Registry

2013 ◽  
Vol 20 (6) ◽  
pp. 921-927 ◽  
Author(s):  
T. Kuwashiro ◽  
H. Sugimori ◽  
T. Ago ◽  
J. Kuroda ◽  
M. Kamouchi ◽  
...  
Keyword(s):  
Predisposing Factors ◽  
Diabetic Patients ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Stroke Registry ◽  
The Impact

Palmar Wrist Ganglion: Does Intervention Improve Outcome A Prospective Study of the Natural History and Patient-Reported Treatment Outcomes

2003 ◽  
Vol 28 (2) ◽  
pp. 172-176 ◽  
Author(s):  
J. DIAS ◽  
K. BUCH
Keyword(s):  
Surgical Excision ◽  
Patient Evaluation ◽  
Recurrence Rates ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Patient Reported ◽  
Evaluation Measure ◽  
A Prospective Study

A prospective cohort study was undertaken to observe the long-term outcome of different treatments for palmar wrist ganglia. One hundred and eighty-two patients agreed to participate in the study. One hundred and fifty-five patients (88%) responded at 2 or 5 years. Seventy-nine had been treated by surgical excision, 39 by aspiration and 38 by reassurance alone. At 5 years no significant differences were observed in the recurrence rates which were 42% after excision of a palmar wrist ganglion and 47% (19 of 39) after aspiration. Twenty of the 39 untreated ganglia had disappeared spontaneously. Eighty-five per cent of the patients were satisfied irrespective of treatment. Patients having surgery had a complication rate of 20% and took more time off work (14 days). Significantly more patients in the untreated group felt the persistent ganglion was unsightly. The patient evaluation measure scores were similar. At 2 and 5 year follow-up, regardless of treatment, no difference in symptoms was found, regardless of whether the palmar wrist ganglion was excised, aspirated or left alone. One in four wrists remained weak regardless of treatment or disappearance of the ganglion.

scholarly journals P0311INFECTION-RELATED GLOMERULONEPHRITIS IN ADULTS: TIME FOR A DEFINITIVE PARADIGM SHIFT?

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Chiara Salviani ◽  
Mattia Zappa ◽  
Guido Jeannin ◽  
Mario Gaggiotti ◽  
Regina Tardanico ◽  
...  
Keyword(s):  
Risk Factors ◽  
Interstitial Fibrosis ◽  
Severe Disease ◽  
Significant Proportion ◽  
Laboratory Findings ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background and Aims The recent decades have witnessed significant changes in the epidemiology and clinical course of infection-related glomerulonephritis (IRGN). We analyzed the clinicopathological features and long-term outcome of adult patients with biopsy-proven IRGN followed in a large Italian referral centre. Method We included patients with biopsy-proven IRGN diagnosed from 2000 to 2018. Clinical and laboratory findings, histological features, possible risk factors and therapy were assessed for both renal and patient outcome. Results Forty-one patients met the inclusion criteria (male:female ratio 3:1, mean age 61±16 years). Smoke habit (47.2%), alcoholism (30.6%), and diabetes (27.5%) were the most common risk factors. The most frequently identified sites of infection were skin, lung and heart (Table 1). Staphylococci spp. accounted for 76.5% of positive cultures (Figure 1). Hypocomplementaemia emerged in 48.5% of cases. The most frequent histologic patterns were diffuse proliferative (56.0%) and membranoproliferative (29.3%) glomerulonephritis. Haemodialysis was required by 22.5% of patients at inception. Two thirds of patients developed chronic kidney disease; half of them reached end-stage renal disease (ESRD). By multivariate analysis ESRD was associated with diabetes (HR 13.7; 95% CI, 1.6-121.0; p=0.018), crescents (HR 25.2; 95% CI, 2.7-235.7; p=0.005), and interstitial fibrosis (HR 31.0; 95% CI, 3.3-287.3; p=0.003). Male gender (HR 12.7; 95% CI, 10.8-14.6; p=0.008) hypertension (HR 40.8; 95% CI, 38.6-43.1; p=0.001), gross haematuria (HR 11.8; 95% CI, 9.4-14.2; p=0.047), need for haemodialysis at onset (HR 16.3; 95% CI, 14.7-17.8; p<0.0001), and interstitial infiltrate (HR 13.3; 95% CI, 11.6-15.0; p=0.003) significantly affected survival. Corticosteroids did not affect prognosis. Conclusion While traditionally considered a “benign” disease with a favorable course in children, IRGN is a potentially severe disease in adults, particularly when a background of major comorbidities and older age are present. A significant proportion of patients does not recover renal function, with a remarkable risk of ESRD.

scholarly journals Comparison of Clinical, Laboratory and Immune Characteristics of the Monophasic and Biphasic Course of Tick-Borne Encephalitis

2021 ◽  
Vol 9 (4) ◽  
pp. 796
Author(s):  
Petra Bogovič ◽  
Stanka Lotrič-Furlan ◽  
Tatjana Avšič-Županc ◽  
Miša Korva ◽  
Andrej Kastrin ◽  
...  
Keyword(s):  
Immune Responses ◽  
Clinical Laboratory ◽  
Strong Association ◽  
Laboratory Findings ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Tick Borne Encephalitis ◽  
Underlying Illness ◽  
Csf Levels

The biphasic course of tick-borne encephalitis (TBE) is well described, but information on the monophasic course is limited. We assessed and compared the clinical presentation, laboratory findings, and immune responses in 705 adult TBE patients: 283 with monophasic and 422 with biphasic course. Patients with the monophasic course were significantly (p ≤ 0.002) older (57 vs. 50 years), more often vaccinated against TBE (7.4% vs. 0.9%), more often had comorbidities (52% vs. 37%), and were more often treated in the intensive care unit (12.4% vs. 5.2%). Multivariate logistic regression found strong association between the monophasic TBE course and previous TBE vaccination (OR = 18.45), presence of underlying illness (OR = 1.85), duration of neurologic involvement before cerebrospinal fluid (CSF) examination (OR = 1.39), and patients’ age (OR = 1.02). Furthermore, patients with monophasic TBE had higher CSF levels of immune mediators associated with innate and adaptive (Th1 and B-cell) immune responses, and they had more pronounced disruption of the blood–brain barrier. However, the long-term outcome 2–7 years after TBE was comparable. In summary, the monophasic course is a frequent and distinct presentation of TBE that is associated with more difficult disease course and higher levels of inflammatory mediators in CSF than the biphasic course; however, the long-term outcome is similar.

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