scholarly journals 5-Year Angiographic and Clinical Follow-up of Coil-Embolised Intradural Saccular Aneurysms

2002 ◽  
Vol 8 (4) ◽  
pp. 349-366 ◽  
Author(s):  
LL Batista ◽  
J. Mahadevan ◽  
M. Sachet ◽  
H. Alvarez ◽  
G. Rodesch ◽  
...  
Keyword(s):  
First Year ◽  
Coil Embolisation ◽  
Short Term ◽  
Detachable Coil ◽  
Complete Occlusion ◽  
Guglielmi Detachable Coil ◽  
Short And Long Term ◽  
Arterial Aneurysms

The purpose of the paper is the follow-up of embolised intradural saccular Arterial Aneurysms (AA), excluding giant, dissecting, inflammatory, fusiform or AA associated to BVAM. Since its introduction in 1991, the Guglielmi Detachable Coil has offered protection against aneurysmal rebleeding in the critical few days and months after SAH regardless of the grade. A number of questions remain: is complete angiographic obliteration necessary at first embolisation? What duration of clinical / angiographic follow-up (FU) is required to ensure the risk of haemorrhage has been eliminated? What is the long-term protection against rebleeding? One hundred and two patients with 160 intradural saccular AA embolised before april 1997 were selected for this study. They had at least 5-yrs clinical FU, of which 22 patients had a mid-term (3 years) and 45 patients had a 5-year or more angiographic FU (mean 67,7 months per patient). Twenty-eight embolised AAs with 100% occlusion at 1 year, remained unchanged on the 5-year angiograms. A further 14 patients with complete occlusion at 1 year showed persisting complete occlusion on angiogram at 3-years FU, which in our series means that complete occlusion after the first year post-embolisation implies that the aneurysm will remain completely occluded. All secondary spontaneous thromboses (27.6% of cases), occurred during the first year pos-embolisation. In six patients with subtotal or partial occlusion no change was seen for three consecutive years of FU; none showed later change at 5-year angiography. Below 80% occlusion our series does not provide enough information but we consider the situation instable. No mortality related to the procedure was observed in the unruptured AA group. No bleeding or re-bleeding has occurred since the beginning of our experience (1993) in saccular AA treated by GDC-Coil. Coil-embolisation of properly selected patients is effective in protecting against bleeding or re-bleeding at short and long-term with stable morphological results provided a strict follow-up control is established at short term.

scholarly journals Angiographical Follow-up Results of Cerebral Aneurysms Treated by Guglielmi Detachable Coil System

2001 ◽  
Vol 7 (1_suppl) ◽  
pp. 137-142 ◽  
Author(s):  
T. Hyogo ◽  
T. Kataoka ◽  
K. Hayase ◽  
H. Nakamura
Keyword(s):  
Cerebral Aneurysms ◽  
Side Wall ◽  
Long Term Results ◽  
Partial Occlusion ◽  
Detachable Coil ◽  
Complete Occlusion ◽  
Guglielmi Detachable Coil ◽  
Wide Neck

To examine the long term results of endovascular treatment of cerebral aneurysms with the Guglielmi detachable coil (GDC) system, follow-up (F/U) angiography was performed at 6, 12 and 24 months after the procedure. We analyzed 45 cases, 49 procedures of GDC treated cerebral aneurysms from 1997.6. to 2000.5. Follow-up angiography was achieved at 6M 43/45 (96%), 12M 29/33 (87%) and 24M 22/25 (88%). Angiographical changes were found 23/43 (53%) of the cases at 6M F/U. There were angiographical improvements in 12 cases (CP: complete occlusion, NR: neck remnant, PA: partial occlusion, PA-CP; 8, NR-CP; 1, PA-NR; 3) and angiographical worsening in 11 cases (CP-NR; 5, CP-PA; 3, PA-PA; 3) at 6M F/U. Two cases had been demonstrating progressive angiographical worsening at 6M and 12MF/U (CP-NR-PA). No angiographical change was found at 24MF/U. There was no case of hemorrhage or re-hemorrhage after GDC treatment. In cases of side-wall aneurysm, tight packing of the inflow side of the aneurysm and small neck aneurysm were thought to be causes of the angiographical improvements. In patients with wide neck aneurysms with partial occlusion result were angiographic worsening at the F/U. Other factors of angiographical worsening were improper working angle at the procedure and improper follow-up angle at the angiography and the intraluminal clot in the case of ruptured aneurysm.

Impact of Cerebrovascular Disease on the Surgical Treatment of Idiopathic Normal Pressure Hydrocephalus

Neurosurgery ◽  
2006 ◽  
Vol 59 (3) ◽  
pp. 545-552 ◽  
Author(s):  
Diego Spagnoli ◽  
Lucia Innocenti ◽  
Lorenzo Bello ◽  
Mauro Pluderi ◽  
Susanna Bacigaluppi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cerebrovascular Disease ◽  
Vascular Disease ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Short Term ◽  
Long Term Follow Up ◽  
Short And Long Term

Abstract OBJECTIVE: The influence of cerebrovascular disease (CVD) on the short- and long-term results of surgery was evaluated in a series of consecutive patients with idiopathic normal-pressure hydrocephalus (iNPH). METHODS: Patients with suspected iNPH admitted to our department between June 1996 and June 2003 were evaluated with four clinical and handicap scales. CVD and risk factors for vascular disease were rated. All patients underwent intracranial pressure monitoring via a spinal catheter. Sixty-six patients received a ventriculoperitoneal shunt with a programmable valve. Prospective assessments were programmed at 2 weeks and 3 months after surgery (short-term follow-up). Long-term follow-up evaluations were arranged in June 2004 with patients and/or relatives and health/home care assistants. RESULTS: At the short-term follow-up examination, a significant clinical improvement was globally present in 89% of the patients (P < 0.05). CVD, such as leucoaraiosis or previous strokes, were present in 71% of the patients. Patients both with and without CVD and/or risk factors for vascular disease presented a significant improvement (P < 0.05) after shunting; 85 and 100% of the patients with and without CVD, respectively. At the long-term follow-up examination (mean, 52 ± 24.8 mo), 24% of the patients were dead and 8% had experienced stroke. Globally, 60% of the patients were still improved (P < 0.05); 52 and 79% of the patients with and without CVD, respectively. CONCLUSION: A high success rate in treatment of iNPH is possible in patients with and without CVD. Despite poorer short- and long-term treatment outcome of iNPH patients with CVD, a long-lasting improvement in their quality of life favors surgery.

The remodeling technique of balloon-assisted Guglielmi detachable coil placement in wide-necked aneurysms: experience at the University of Illinois at Chicago

2000 ◽  
Vol 93 (3) ◽  
pp. 388-396 ◽  
Author(s):  
Victor A. Aletich ◽  
Gerard M. Debrun ◽  
Mukesh Misra ◽  
Fady Charbel ◽  
James I. Ausman
Keyword(s):  
Cerebral Aneurysms ◽  
Detachable Coil ◽  
Content Type ◽  
Guglielmi Detachable Coil ◽  
Alternative Approach ◽  
Long Term Follow Up ◽  
The University ◽  
Fine Print

Object. Reports in the literature have offered discussions of the feasibility, efficacy, and safety of balloon-assisted Guglielmi detachable coil (GDC) placement in wide-necked intracranial aneurysms, which was first described by Jacques Moret as the “remodeling technique.” In this article the authors summarize their results in a subset of aneurysms treated with GDCs using the remodeling technique.Methods. This report contains a retrospective analysis of 72 patients with 75 aneurysms who underwent 79 endovascular procedures performed using the remodeling technique. Morphological outcome was determined at the end of each procedure and by reviewing available follow-up angiograms. Clinical assessments and outcomes are reported using a modified Glasgow Outcome Scale.Coils were placed in 66 (88%) of 75 aneurysms selected for treatment. In eight aneurysms (11%) treatment failures occurred due to the tortuosity of the vessel used to reach the aneurysms or because of balloon inadequacies.Incorporating all available follow-up data the authors found that 50 (78%) of 64 aneurysms were completely or subtotally (> 95%) occluded and eight (12%) of 64 were incompletely (< 95%) occluded. Since the time of coil placement, eight aneurysms have progressed to complete occlusion and another five have exhibited progressive thrombosis on follow-up angiograms. In three aneurysms there has been neck remnant growth. Surgical clipping was performed to treat six aneurysms after an initial coil placement procedure. Permanent incidences of morbidity were limited to four patients and there were three deaths directly related to the procedure.Conclusions. The remodeling technique shows promise in increasing the number of cerebral aneurysms amenable to treatment by endovascular coil placement, and offers an alternative approach to aneurysms that have met with failed surgical treatment or are surgically inaccessible. Long-term follow-up review is needed to determine the final outcome of aneurysms treated by this technique.

AB0641 MANAGING ANKYLOSING SPONDYLITIS (AS) WITH SHORT TERM BIOSIMILAR ADALIMUMAB REGIMEN IN A RESOURCE STRAPPED SETTING: A PROTOCOL DRIVEN COMMUNITY CLINIC ORIENTED STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1615.1-1615
Author(s):  
A. Chopra ◽  
N. Khadke ◽  
M. Saluja ◽  
T. Kianifard ◽  
A. Venugopalan
Keyword(s):  
Stress Reduction ◽  
Symptomatic Relief ◽  
Real Life ◽  
Substantial Improvement ◽  
First Year ◽  
Short Term ◽  
Mean Values ◽  
One Year

Background:We were handicapped by the exorbitant cost of innovator anti-Tumour Necrosis Factor (TNF) drugs. Despite limited use, we sometimes observed long-term benefits following short term induction like use. Emboldened by advent of biosimilars, we carried out an investigational study.Objectives:To evaluate the effectiveness of a short regimen of biosimilar (Bs) Adalimumab in ASMethods:50 consenting patients (86% B27+) naïve for biologics and negative for latent TB screen were enrolled into an observational design study of one year; Baseline mean values for age, duration, ASDAS and CRP was 31 years, 98.8 months, 4.6 and 64 mg per dl respectively. During the first year, patients were begun with 40 mg Bs Adalimumab (Bs-ADL) (Exemptia™), injected fortnight, for 12-16 weeks. No patient received DMARD or steroid in the first year of study. Patients continued standard of care follow up program in the clinic. The ASAS (Assessment Spondyloarthritis International Society) improvement indices were used. Standard intention-to-treat analysis was performed; significant p <0.05.Results:Optimum ASAS 40 improvement was observed at week 12 (68%); substantial improvement lasted till week 36. At one year, the ASAS 40 was 38%; ASAS partial remission 22% patients. Pro-inflammatory cytokines (IL-6, TNF α and IL-17) showed conspicuous reduction; maximum drop in IL-6 at week 24 (See Figure). 11 patients withdrew in the first year. 30 patients completed two years and 22 patients completed 3 year follow up. Over time, there was substantial loss in the ASAS 20 and 40 responses but patients seemed satisfied with the on-going symptomatic relief and improved function. Admittedly, patients showed more adherences to advice on physical exercise and stress reduction. Flares were more frequent after 1 year requiring short term round the clock NSAID; only 5 patients could afford to repeat a short term Bs-ADL regimen and one patient underwent hip arthroplasty. None received steroids and 5 patients were begun on Sulfasalazine in the second year and monitored. We could not evaluate structural modification (AS). Selected outcomes over 2 and 3 years from the current study will be compared to matched control (derived from the clinic database). None developed TB or any serious drug related toxicity. 2 patients developed recurrent uveitis.Conclusion:This real life documented experience unravelled impressive long term benefits following a kick start short term induction regimen of Biosimilar Adalimumab in AS. Though contrary to standard practice, this seemed a practical solution in our setting. We speculate a psychological and motivational boost rather than a prolonged real time biological effect (Bs-ADL) for this phenomenon. Our study has important socioeconomic bearing and merits validation.Acknowledgement:This was essentially a non-commercial investigator-initiated study. Zydus Cedilla India provided a generous research grant with free of cost Bs_ADL to several patients and a large concession in the cost to the rest.Disclosure of Interests:Arvind Chopra Grant/research support from: Zydus Pharamceutical Ltd India, Nagnath Khadke: None declared, Manjit Saluja: None declared, Toktam Kianifard: None declared, Anuradha Venugopalan: None declared

Models of internalizing outcomes of early rejection

1995 ◽  
Vol 7 (4) ◽  
pp. 683-695 ◽  
Author(s):  
Virginia Salzer Burks ◽  
Kenneth A. Dodge ◽  
Joseph M. Price
Keyword(s):  
Internalizing Problems ◽  
Longitudinal Design ◽  
Threshold Model ◽  
First Year ◽  
Short Term ◽  
Cross Sectional ◽  
The Third ◽  
School Year

AbstractViewing social rejection from same-age peers as a source of stress for children, the current study sought to determine the most appropriate model of the effects of temporary versus consistent experiences with rejection for both short-term and long-term internalizing problems. Adopting a cross-sectional longitudinal design, the sociometric status of children in the first year of the study (when the children were in the first, second, or third grades), and then again in the next school year (when children were in the second, third, or fourth grades) was assessed to determine which children were rejected by their peers. Internalizing outcome measures were administered in the third and sixth years of follow-up. Results indicated that, for boys, the Threshold Model best represented the stressful effects of rejection. That is, only boys who were exposed to rejection for 2 consecutive years demonstrated both short-term and long-term internalizing problems in subsequent years. For girls, however, there appeared to be few significant differences among those who never experienced rejection, who had only temporary experiences with rejection, and girls who were consistently exposed to rejection. Results are discussed in terms of the significance of a Threshold Model as well as possible explanations for these gender differences.

Endovascular Treatment of Basilar Tip Aneurysms Using Guglielmi Detachable Coils: Anatomic and Clinical Outcomes in 73 Patients from a Single Institution

Neurosurgery ◽  
2000 ◽  
Vol 47 (6) ◽  
pp. 1332-1342 ◽  
Author(s):  
Satoshi Tateshima ◽  
Yuichi Murayama ◽  
Y. Pierre Gobin ◽  
Gary R. Duckwiler ◽  
Guido Guglielmi ◽  
...  
Keyword(s):  
Los Angeles ◽  
Clinical Outcomes ◽  
Medical Center ◽  
Clinical Status ◽  
Giant Aneurysm ◽  
Detachable Coil ◽  
Complete Occlusion ◽  
Unruptured Aneurysms ◽  
Guglielmi Detachable Coil

ABSTRACT OBJECTIVE Seventy-three consecutive patients with 75 basilar tip aneurysms were treated with Guglielmi detachable coil (GDC) technology. Their anatomic and clinical outcomes are discussed. METHODS Seventy-five basilar tip aneurysms were treated with the GDC system at the University of California, Los Angeles Medical Center from 1990 to 1999. The average age of the population was 48.3 years (range, 28–82 yr). Forty-two patients (57.5%) presented with acute subarachnoid hemorrhage, 8 patients (10.9%) had unruptured aneurysms with mass effect, and 23 patients (31.5%) had incidental aneurysms. Thirty-one aneurysms (41.3%) were small with a small neck, 18 (24%) were small with a wide neck, 16 (21.3%) were large, and 10 (13.3%) were giant aneurysms. RESULTS Immediate anatomic outcomes demonstrated complete or near-complete occlusion in 64 aneurysms (85.3%) and incomplete occlusion in 7 aneurysms (9.3%). Four aneurysms (5.3%) could not be embolized because of anatomic difficulties. Of the 69 patients treated with GDCs, 63 patients (91.3%) remained neurologically intact or unchanged from their initial clinical status. Procedure-related morbidity and mortality were 4.1% and 1.4%, respectively. Long-term follow-up angiograms were obtained in 41 patients with 42 aneurysms. Thirty aneurysms (71.4%) demonstrated complete or near-complete occlusion. One incompletely embolized giant aneurysm ruptured during the follow-up period. CONCLUSION In contrast to surgical clipping of basilar tip aneurysms, the main technical challenge of the Guglielmi detachable coiling procedure depends on the shape of the aneurysm, not its location. The results of this study indicate that endovascular GDC technology is an appropriate therapeutic alternative in ruptured or unruptured basilar tip aneurysms regardless of patient age, clinical presentation, clinical status, or timing of treatment.

Crescentic Proximal Metatarsal Osteotomy for Moderate to Severe Hallux Valgus: A Mean 12.2 Year Follow-Up Study

2001 ◽  
Vol 22 (10) ◽  
pp. 817-822 ◽  
Author(s):  
J.P. Veri ◽  
S.P. Pirani ◽  
R. Claridge
Keyword(s):  
Hallux Valgus ◽  
Long Term Results ◽  
Soft Tissue Reconstruction ◽  
Short Term ◽  
Long Term Follow Up ◽  
Short And Long Term ◽  
The Mean ◽  
Severe Hallux Valgus

The senior author's (R.C.) first 25 patients (37 feet) treated with a combination proximal crescentic osteotomy and distal soft-tissue reconstruction made up the patient cohort. All 25 patients were reviewed at a minimum of one year post-op (short-term follow-up) and 20/25 (31/37 feet) were reviewed again at a mean 12.2 years (range 11.4 to 13.0 yrs) post-op (long-term follow-up). This allowed for a comparison of short- and long-term results and led to a long-term follow-up rate of 84% (31/37 feet, mean 12.2 yrs). Clinical, radiographic and patient outcome measures were obtained and compared pre-op and at short- and long-term follow-up. The mean preoperative hallux valgus (HVA) and intermetatarsal angles (IMA) were 37° and 16° respectively. The mean HVA correction was 24° and IMA correction 10° at long-term follow-up with no tendency toward recurrence. Sesamoid position and first MTP subluxation was markedly improved postoperatively and the correction was maintained at long-term follow-up. Patients were asked about their satisfaction in terms of pain, appearance and motion. At long-term follow-up, more than 90% of patients were completely satisfied with pain and motion and greater than 80% with their appearance. Ninety-four percent of patients said they would have the operation again. The AOFAS clinical rating scale for the hallux was calculated retrospectively for pre-op and short-term follow-up and prospectively for long-term follow-up. The mean pre-op score was 37/100 (16 to 60) which significantly improved to 92/100 (67 to 100) at both follow-up periods, suggesting no evidence of decrease in outcome over time. Complications included two patients (5%) that were over-corrected into varus (one symptomatic, one asymptomatic), and four patients (11%) that were undercorrected, developing asymptomatic recurrences (>10° increase HVA) at long-term follow-up. In addition, two patients (5%) developed new transfer lesions postoperatively, likely related to technical error (one varus overcorrection, one dorsiflexion malunion). In conclusion, the long-term results, with a mean follow-up of 12.2 years, of the resection realignment procedure for moderate to severe hallux valgus are generally excellent and the complication rate is low and acceptable. Attention to detail, avoiding both undercorrection, which can lead to recurrence, and overcorrection, which can cause symptomatic varus, is essential.

scholarly journals Må sykefravær legitimeres med legemelding?

2012 ◽  
Vol 9 (16) ◽  
Author(s):  
Torunn S. Olsen ◽  
Nils Fleten
Keyword(s):  
Sick Leave ◽  
First Year ◽  
Questionnaire Data ◽  
Short Term ◽  
Extended Self ◽  
Medical Certificate ◽  
Sickness Benefits ◽  
Short And Long Term ◽  
Prolonged Absence

Most Western countries require a medical certificate for payment of sickness benefits in prolonged absence spells. Based on an intervention enabling self-certified sick leave up to 365 days in the municipality of Mandal, this article discusses whether a medical certificate is necessary to legitimate sick leave. The municipality’s absence registry and questionnaire data form the basis of this article. In Mandal self-certification has become the rule, both for short- and long-term sick leave. For short-term absence, the transition to self-certification has reduced absence length and return to work has become more evenly distributed throughout the week. For sick leave in excess of 16 days, absence length has increased, but not significantly. The proportion of graded long-term sick leave significantly increased in self-certified episodes, from 23 percent the first year to 43 percent the third year. A large and increasing majority of the employees are satisfied with extended self-certification. Those whom still prefer a doctor’s sick note, are either critical to how they are followed-up at the workplace or feel that self-certification is a burden. The transition to self-certification as main documentation for sickness absence has not increased absence levels. During long-term absence spells employees consult their doctors. This indicates that the employees behave responsibly when they self-certify and retain contact with their doctor for medical purposes. The intervention suggests that mandatory certification by a doctor is not necessary for legitimising sick leave, even long-term absence.

Natural history of the neck remnant of a cerebral aneurysm treated with the Guglielmi detachable coil system

2000 ◽  
Vol 93 (4) ◽  
pp. 561-568 ◽  
Author(s):  
Motoharu Hayakawa ◽  
Yuichi Murayama ◽  
Gary R. Duckwiler ◽  
Y. Pierre Gobin ◽  
Guido Guglielmi ◽  
...  
Keyword(s):  
Los Angeles ◽  
Medical Center ◽  
Detachable Coil ◽  
Content Type ◽  
Giant Aneurysms ◽  
Guglielmi Detachable Coil ◽  
Small Aneurysms ◽  
Fine Print

Object. The long-term durability of Guglielmi detachable coil (GDC) embolization of cerebral aneurysms is still unknown. The purpose of this study was to evaluate the anatomical evolution of neck remnants in aneurysms treated with GDCs.Methods. Of 455 aneurysms treated with GDCs from 1990 to 1998 at the University of California at Los Angeles Medical Center, 178 aneurysms (39%) had residual necks postembolization. Long-term follow-up angiograms were obtained in 73 of these aneurysms in 71 patients. The mean duration of angiographic follow up was 17.3 months. Twenty-four of the aneurysms were small with small necks, 24 were small with wide necks, 15 were large, and 10 were giant aneurysms.In small aneurysms with small necks, postembolization angiography revealed 12 aneurysms (50%) with progressive thrombosis, eight (33%) unchanged, and four (17%) with recanalization. In small aneurysms with wide necks, six (25%) had progressive thrombosis, eight (33%) remained unchanged, and 10 (42%) had recanalization. In large aneurysms, two (13%) were unchanged and 13 (87%) had recanalization. Of the giant aneurysms only one (10%) remained unchanged and nine (90%) had recanalization. Overall, 18 aneurysms (25%) exhibited progressive thrombosis, 19 (26%) remained unchanged, and 36 (49%) displayed recanalization on follow-up angiography. During the last 2 years of the study, the recanalization rate decreased and a higher rate of progressive thrombosis was noted in aneurysms with small necks. These positive changes are related to important new technical developments.Conclusions. Treatment with GDCs appears to be effective and the results permanent in most small aneurysms with small necks. However, there are important technical limitations in the current GDC technology that prevent recanalization in wide-necked or large or giant aneurysms.

Bilateral Ventriculocordectomy via Ventral Laryngotomy for Idiopathic Laryngeal Paralysis in 88 Dogs

2012 ◽  
Vol 48 (4) ◽  
pp. 234-244 ◽  
Author(s):  
Cynthia Zikes ◽  
Timothy McCarthy
Keyword(s):  
Postoperative Complications ◽  
Surgical Trauma ◽  
Short Term ◽  
Laryngeal Paralysis ◽  
Long Term Follow Up ◽  
Short And Long Term ◽  
Low Incidence ◽  
Results Of Surgery

Bilateral ventriculocordectomy through a ventral median laryngotomy was performed for the treatment of idiopathic laryngeal paralysis in 88 dogs. The purpose of this retrospective analysis was to provide long-term follow-up for a large number of dogs surgically managed with this technique. A combination of medical record and completed client questionnaire information provided short-term (14 days) follow-up for 88 dogs and long-term (&gt;6 mo) follow-up for 42 dogs. Major short-term postoperative complications were identified in 3 of 88 (3.4%) patients. Major long-term complications were identified in 3 of 42 (7.1%) patients. The results of surgery were considered to be very satisfactory in 93% and unsatisfactory in 7%. Three dogs in this series developed aspiration pneumonia. Bilateral ventriculocordectomy through a ventral median laryngotomy is associated with a low incidence of both short- and long-term complications. Due to the ease of this procedure, the minimal surgical trauma to the patient, and the satisfactory results, this surgery should be considered an option for the treatment of idiopathic laryngeal paralysis in the dog.

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