scholarly journals Recurrent or New Symptomatic Cerebral Aneurysm after Previous Treatment

2005 ◽  
Vol 11 (4) ◽  
pp. 341-348 ◽  
Author(s):  
S. Rothemeyer ◽  
D. Lefeuvre ◽  
A. Taylor
Keyword(s):  
Treatment Failure ◽  
Cerebral Aneurysm ◽  
Nerve Palsy ◽  
Cerebral Aneurysms ◽  
Previous Treatment ◽  
Primary Treatment ◽  
The Other ◽  
Endovascular Coiling ◽  
Previously Treated ◽  
Third Cranial Nerve Palsy

With the establishment of endovascular coiling as a successful treatment for symptomatic cerebral aneurysms, attention is now being directed at the durability of this treatment. If this is to be accurately done it will be important to understand the causes of symptomatic aneurysm presentation after previous treatment. In order to assess this we undertook a retrospective review, covering the four year period from 2000 to 2004, of all patients re-presenting with a symptomatic saccular aneurysm after previous treatment. Seven patients were identified, six presenting with subarachnoid haemorrhage (SAH) and one with a third cranial nerve palsy. Three patients had incomplete clipping of their aneurysms and all presented within months of their initial treatment. The other four patients presented between five and 20 years after primary treatment and all were felt to have new cerebral aneurysms. Two of these patients had aneurysms develop at the same location as their previously treated lesions, however these were still felt to be new aneurysms rather than re-growth or recurrence because of their morphology. Based on our findings it would appear that development of a new cerebral aneurysm after clipping is more of a risk than aneurysm recurrence from treatment failure. This will need to be considered when evaluating re-presentation after treatment by either coiling or clipping and more importantly, perhaps we should be directing more attention to preventing disease progression rather than treatment failure.

scholarly journals The impact of hybrid neurosurgeons on the outcomes of endovascular coiling for unruptured cerebral aneurysms

2017 ◽  
Vol 126 (1) ◽  
pp. 29-35 ◽  
Author(s):  
Kimon Bekelis ◽  
Dan Gottlieb ◽  
Nicos Labropoulos ◽  
Yin Su ◽  
Stavropoula Tjoumakaris ◽  
...  
Keyword(s):  
Propensity Score ◽  
Cerebral Aneurysm ◽  
Readmission Rate ◽  
Cerebral Aneurysms ◽  
Endovascular Coiling ◽  
Unruptured Cerebral Aneurysm ◽  
Hospital Referral ◽  
Unruptured Cerebral Aneurysms ◽  
The Impact ◽  
Aneurysm Coiling

OBJECTIVE The impact of combined practices on the outcomes of unruptured cerebral aneurysm coiling remains an issue of debate. The authors investigated the association of combined open and endovascular expertise with the outcomes of unruptured cerebral aneurysm coiling. METHODS The authors performed a cohort study of 100% of Medicare fee-for-service claims data for elderly patients who underwent endovascular coiling for unruptured cerebral aneurysms between 2007 and 2012. To control for confounding, the authors used propensity score conditioning, with mixed effects to account for clustering at the hospital referral region level. RESULTS During the study period, there were 11,716 patients who underwent endovascular coiling for unruptured cerebral aneurysms and met the inclusion criteria. Of these, 1186 (10.1%) underwent treatment performed by hybrid neurosurgeons, and 10,530 (89.9%) by proceduralists who performed only endovascular coiling. Multivariable regression analysis with propensity score adjustment demonstrated a lack of association of combined practice with 1-year postoperative mortality (OR 0.84; 95% CI 0.58–1.23), discharge to rehabilitation (OR 1.0; 95% CI 0.66–1.51), 30-day readmission rate (OR 1.07; 95% CI 0.83–1.38), and length of stay (adjusted difference, 0.41; 95% CI −0.26 to 1.09). Higher procedural volume was independently associated with improved outcomes. CONCLUSIONS In a cohort of Medicare patients, the authors did not demonstrate a difference in mortality, discharge to rehabilitation, readmission rate, and LOS between hybrid neurosurgeons and proceduralists performing only endovascular coiling.

scholarly journals Comparison of first-line tuberculosis treatment outcomes between previously treated and new patients: a retrospective study in Machakos subcounty, Kenya

2020 ◽  
Author(s):  
Johannes Ndambuki ◽  
Joseph Nzomo ◽  
Lucy Muregi ◽  
Chris Mutuku ◽  
Francis Makokha ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Treatment Outcomes ◽  
Adverse Outcome ◽  
Previous Treatment ◽  
First Line ◽  
Adherence Support ◽  
Previously Treated Patients ◽  
Previously Treated ◽  
Lost To Follow Up

Abstract Background Since 2016, patients with rifampicin-susceptible tuberculosis (TB) have been treated with the 6-month first-line regimen, regardless of treatment history. We assessed treatment outcomes of previously treated and new patients in Machakos subcounty, Kenya. Methods We performed a retrospective cohort study in patients started on first-line treatment between 2016 and 2017. Firth's logistic regression was used to estimate the effect of previous treatment on having a programmatic adverse outcome (either lost to follow-up, death, failure) and treatment failure vs treatment success (either cure or completion). Results Of 1024 new and 79 previously treated patients, 88.1% and 74.7% were treated successfully, 6.5% and 7.6% died, 4.2% and 10.1% were lost to follow-up and 1.2% and 7.6% had treatment failure, respectively. Previous treatment predicted having a programmatic adverse outcome (adjusted odds ratio [aOR] 2.4 [95% confidence interval {CI} 1.4 to 4.2]) and treatment failure (aOR 7.3 [95% CI 2.6 to 20.4]) but not mortality. Similar correlations were found in 334 new and previously treated patients with confirmed baseline rifampicin susceptibility. Conclusion Previously treated patients were more at risk of experiencing a poor treatment outcome, mainly lost to follow-up and treatment failure. Adherence support may reduce lost to follow-up. Rifampicin drug susceptibility testing coverage should increase. More robust retreatment regimens may reduce treatment failure.

Coil migration during or after endovascular coiling of cerebral aneurysms

2019 ◽  
Vol 12 (5) ◽  
pp. 505-511 ◽  
Author(s):  
Mohamad Abdalkader ◽  
Michel Piotin ◽  
Michael Chen ◽  
Santiago Ortega-Gutierrez ◽  
Edgar Samaniego ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cerebral Aneurysm ◽  
Significant Risk ◽  
Cerebral Aneurysms ◽  
The United States ◽  
Endovascular Coiling ◽  
Maximal Diameter ◽  
Distal Migration ◽  
Coil Migration ◽  
Aneurysm Coiling

BackgroundCoil migration is a complication of endovascular coiling of cerebral aneurysms that has not been well studied.ObjectiveTo report the frequency, risk factors, management strategies, and outcomes of coil migration.MethodsThis was a retrospective analysis of the clinical and radiological data of patients who underwent cerebral aneurysm coiling complicated by coil migration at five neuroendovascular centers in the United States, Canada, and France between 2008 and 2018.ResultsEighteen cases of coil migration met our study criteria with an occurrence of 0.3% (18/6071 cases) (procedural migration: 55%, delayed migration: 45%). The mean aneurysm maximal diameter, neck, and height to neck ratio in migration cases were 3.4±1.4 mm (range 2–7.6 mm), 2.4±0.9 mm (range 1.2–4.4 mm), and 1.4±0.4 (range 1–2.15), respectively. The 2 mm diameter coil was the most common (39%, range 1–2.5 mm) migrated coil. The length of the migrated coil was ≤4 cm in 95% of cases.Patients managed conservatively (5/18, 28%) did well. Thromboembolic and/or hemorrhagic complications were noted in 6/10 migration patients treated by endovascular modalities and in all migration patients who underwent surgical treatment (4/4). Three deaths occurred (3/18, 17%) related to high Hunt and Hess grade subarachnoid hemorrhage.ConclusionCoil migration is an uncommon but important complication of cerebral aneurysm coiling. Small aneurysms, aspect ratio <1.6, and small coils are significant risk factors. Endovascular treatment, such as using a stent retriever, can be considered for procedural, proximal migration, and/or in cases of vessel occlusion. Delayed or distal migration should be managed conservatively.

scholarly journals Outcomes of Elective Cerebral Aneurysm Treatment Performed by Attending Neurosurgeons after Night Work

Neurosurgery ◽  
2017 ◽  
Vol 82 (3) ◽  
pp. 329-334 ◽  
Author(s):  
Kimon Bekelis ◽  
Symeon Missios ◽  
Todd A MacKenzie
Keyword(s):  
Length Of Stay ◽  
Cerebral Aneurysm ◽  
New York State ◽  
Cerebral Aneurysms ◽  
Work Hours ◽  
Endovascular Coiling ◽  
Emergency Procedures ◽  
Aneurysm Treatment ◽  
Unruptured Cerebral Aneurysm ◽  
Unruptured Cerebral Aneurysms

Abstract BACKGROUND The association between long work hours and outcomes among attending surgeons remains an issue of debate. OBJECTIVE To investigate whether operating emergently the night before an elective case was associated with inferior outcomes among attending neurosurgeons. METHODS We executed a cohort study with unruptured cerebral aneurysm patients, who underwent endovascular coiling or surgical clipping from 2009 to 2013 and were registered in the Statewide Planning and Research Cooperative System database. We investigated the association of treatment by surgeons performing emergency procedures the night before with outcomes of elective cerebral aneurysm treatment using an instrumental variable analysis. RESULTS Overall, 4700 patients underwent treatment for unruptured cerebral aneurysms. There was no difference in inpatient mortality (adjusted difference, –0.7%; 95% confidence interval [CI], –1.4% to 0.02%), discharge to a facility (adjusted difference, –0.1%; 95% CI, –1.2% to 1.2%), or length of stay (adjusted difference, –0.58; 95% CI, –1.66 to 0.50) between patients undergoing elective cerebral aneurysm treatment by surgeons who performed emergency procedures the night before, and those who did not. CONCLUSION Using a comprehensive patient cohort in New York State for elective treatment of unruptured cerebral aneurysms, we did not identify an association of treatment by surgeons performing emergency procedures the night before, with mortality, discharge to a facility, or length of stay. Our study had 80% power to detect differences in mortality (our primary outcome), as small as 4.1%. The results of the present study do not support the argument for regulation of attending work hours.

scholarly journals Time-to-Treatment in Oral Cancer: Causes and Implications for Survival

Cancers ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1321
Author(s):  
Constanza Saka-Herrán ◽  
Enric Jané-Salas ◽  
Antoni Mari-Roig ◽  
Albert Estrugo-Devesa ◽  
José López-López
Keyword(s):  
Oral Cancer ◽  
Previous Treatment ◽  
Diagnostic Procedures ◽  
Original Data ◽  
Primary Treatment ◽  
Medical Attention ◽  
Time Interval ◽  
Pre Treatment ◽  
The Impact ◽  
Lack Of Knowledge

The purpose of this review was to identify and describe the causes that influence the time-intervals in the pathway of diagnosis and treatment of oral cancer and to assess its impact on prognosis and survival. The review was structured according to the recommendations of the Aarhus statement, considering original data from individual studies and systematic reviews that reported outcomes related to the patient, diagnostic and pre-treatment intervals. The patient interval is the major contributor to the total time-interval. Unawareness of signs and/or symptoms, denial and lack of knowledge about oral cancer are the major contributors to the process of seeking medical attention. The diagnostic interval is influenced by tumor factors, delays in referral due to higher number of consultations and previous treatment with different medicines or dental procedures and by professional factors such as experience and lack of knowledge related to the disease and diagnostic procedures. Patients with advanced stage disease, primary treatment with radiotherapy, treatment at an academic facility and transitions in care are associated with prolonged pre-treatment intervals. An emerging body of evidence supports the impact of prolonged pre-treatment and treatment intervals with poorer survival from oral cancer.

scholarly journals P120 The burden of the management of cerebral aneurysms in Africa: a scoping review

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Francklin Tetinou ◽  
Ulrick Sidney Kanmounye ◽  
Igor Nitcheu ◽  
Aliyu Baba Ndajiwo ◽  
Nourou Dine A Bankole ◽  
...  
Keyword(s):  
Cerebral Aneurysm ◽  
Full Text ◽  
Cerebral Aneurysms ◽  
Clinical Findings ◽  
African Countries ◽  
Female Predominance ◽  
Full Text Retrieval ◽  
Intracerebral Aneurysm ◽  
Study Participants ◽  
Mean Time

Abstract Introduction In Africa, the epidemiology, management, and prognosis of cerebral aneurysms remain poorly understood. Cerebral aneurysms are still highly underdiagnosed and inadequately treated in Africa due to a lack of vascular neurosurgeons and infrastructure. In this review we mapped the burden and management of intracerebral aneurysm in Africa. Methods A full systematic search on articles published in Africa on brain aneurysms was performed in PubMed, African Journals Online, Google Scholar, WHO Global Health Library and LILACS with no language restrictions. The search results were merged, uploaded into Rayyan software, (FDT, USK, IN, NDAB) independently based on the pre-defined inclusion and exclusion criteria. The full text of the remaining articles were then retrieved and screened by three reviewers independently (FDT, USK, NDAB). Conflicts were resolved by mutual agreement. From all included documents, we extracted information regarding study design, socio-demographic characteristics, clinical findings, type of treatment and outcome results. Results We included 28 articles in our full text retrieval. These studies totaled 1181 patients managed for cerebral aneurysm in Africa. Half (50.0%; n = 14) of all studies had been published in the past 5 years and nearly half (46.4%; n = 13) of these studies were conducted in two countries: eight in Morocco and five in South Africa, we didn’t found any publication on cerebral aneurysm for nearly 80% of African countries. Also, there was a female predominance among cerebral aneurysm study participants (62.5%), and the mean time from diagnosis to surgery was 12.1 days. Cerebral aneurysms were most often located in the internal carotid artery (29.6%) and anterior cerebral artery (23.2%). Microneurosurgery (67%) was the most widely used option in these studies ahead of coiling (7.9%). Patient outcomes were judged favorable in 64.2% of cases, and the mortality rate following surgical (open vascular and endovascular) intervention was 19.4%. Conclusion The management of intracerebral aneurysms remains suboptimal in Africa. There are few peer-reviewed reports of aneurysm practice.

scholarly journals CT-based radiomics model with machine learning for predicting primary treatment failure in diffuse large B-cell Lymphoma

2021 ◽  
Vol 14 (10) ◽  
pp. 101188
Author(s):  
Raoul Santiago ◽  
Johanna Ortiz Jimenez ◽  
Reza Forghani ◽  
Nikesh Muthukrishnan ◽  
Olivier Del Corpo ◽  
...  
Keyword(s):  
Machine Learning ◽  
Treatment Failure ◽  
B Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Primary Treatment ◽  
Large B Cell Lymphoma ◽  
Large B Cell

S114 Predictors of primary treatment failure in children with empyema

Thorax ◽  
2016 ◽  
Vol 71 (Suppl 3) ◽  
pp. A68.1-A68
Author(s):  
ES Ward-Booth ◽  
DA Spencer ◽  
JY Paton ◽  
SP Rushton ◽  
M Brodlie ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Primary Treatment

scholarly journals Endovascular management of intracranial aneurysms during pregnancy in three cases and review of the literature

2015 ◽  
Vol 21 (6) ◽  
pp. 654-658 ◽  
Author(s):  
Peng Liu ◽  
Xianli Lv ◽  
Youxiang Li ◽  
Ming Lv
Keyword(s):  
Cesarean Section ◽  
Cerebral Aneurysms ◽  
Endovascular Coiling ◽  
Review Of The Literature ◽  
Endovascular Techniques ◽  
Healthy Baby ◽  
Unruptured Aneurysms ◽  
Gestational Week ◽  
Basilar Tip Aneurysm ◽  
Case Basis

We present three cases of cerebral aneurysms (1 unruptured; 2 ruptured) treated with endovascular techniques in pregnancies. The first ruptured case is a 28-year-old female on 20th gestational week. After the endovascular coiling, the patient suffered persistent hemiparesis and delivered a healthy baby by cesarean section. The second ruptured case is a 25-year-old female on 36th week of pregnancy. She died of aneurysm re-rupture after delivery of a healthy baby by cesarean section. The third unruptured case is a 31-year-old woman on the 26th gestational week of pregnancy who died of a giant basilar tip aneurysm after stent-assisted coiling. Ruptured aneurysm obliteration should be prioritized followed by vaginal delivery or cesarean section. The decision regarding the treatment of unruptured aneurysms should be carefully considered on a case-by-case basis. Stent-assisted coiling may be applicable to aneurysm during pregnancy.

Sign in / Sign up

Export Citation Format

Share Document