Long-term outcome and prognostic factors of posterior circulation ischemia patients: Results from a single center retrospective study

Vascular ◽  
2019 ◽  
Vol 28 (1) ◽  
pp. 25-30
Author(s):  
Yanfei Han ◽  
Man Xu ◽  
Yuan Zhao ◽  
Yongbo Zhang

Objective This study was to assess the clinical features and prognostic factors of posterior circulation cerebral infarction (PCCI) patients. Methods A total of 165 PCCI patients who were admitted to the Department of Neurology, Beijing Friendship hospital, Capital Medical University between January 2016 and December 2016 were included. Patients had complete medical record and received 12-month follow-up. The demographics, risk factors, clinical manifestations, National Institutes of Health Stroke Scale (NIHSS) score and imaging findings were collected and factors affecting their prognosis were further analyzed. Results The mean age was 59.5 ± 10.8 years and the mean National Institutes of Health Stroke Scale (NIHSS) score on admission was 6.6 ± 2.8. The one-year recurrence rate of stroke was 6.7%; 84.8% of patients had good prognosis (modified Rankin Scale [mRS] score 0–3) and 15.2% had poor prognosis (mRS score >3). The one-year mortality was 3.0%. Patients with ≥50% stenosis in the basilar artery and higher NIHSS score were more likely to have poor outcome. Conclusion The majority of PCCI patients have a good prognosis and a low mortality. The prognosis is poor in patients with ≥50% stenosis in the basilar artery and higher NIHSS score on admission.

2017 ◽  
Vol 7 (1-2) ◽  
pp. 6-11
Author(s):  
Miguel S. Litao ◽  
Erez Nossek ◽  
Keith DeSousa ◽  
Albert Favate ◽  
Eytan Raz ◽  
...  

Background: Scarce reports exist of permanent deployment of Solitaire FR™ devices for arterial steno-occlusive disease as it is primarily indicated for temporary deployment for thrombectomy in large-vessel, anterior-circulation ischemic strokes. Even more scarce are reports describing permanent deployment of the Solitaire device for posterior circulation strokes. Summary: We present 2 cases where the Solitaire device was electrolytically detached to re-establish flow in an occluded or stenotic basilar artery in acutely symptomatic patients. In both cases, a 4 × 15 mm Solitaire device was positioned across the stenotic or occluded portion of the basilar artery and electrolytically detached to maintain vessel patency. Both cases had good clinical outcomes with a National Institutes of Health Stroke Scale (NIHSS) score of 1 (from 24) on 90-day follow-up and an NIHSS score of 2 (from 7) on 30-day follow-up. Key Messages: Permanent deployment of the Solitaire device may potentially be a safe and effective means of maintaining vessel patency in an occluded or stenotic basilar artery.


2012 ◽  
Vol 2012 ◽  
pp. 1-2
Author(s):  
N. Kozeis ◽  
K. T. Tsaousis ◽  
D. Gidaris

We present the management and postoperative course of a persistent fetal vasculature (PFV) case. A four-year-old girl visited the Eye Department of Hippokration, General Hospital of Thessaloniki due to reduced visual acuity of her left eye. She was diagnosed with PFV and underwent surgery (lensectomy, capsulorhexis of the posterior capsule, insertion of an intraocular lens in the posterior chamber, and posterior vitrectomy) in order to dissect the PFV. Along with the postoperative medical care, she underwent intensive treatment for amblyopia. The postoperative course was uncomplicated, and the visual acuity of her left eye improved from hand movement to 20/25 with proper correction. Patients with unilateral PFV and gradually deteriorating visual acuity could be good candidates for a combined surgical procedure, as the one described above, with a good prognosis.


2021 ◽  
Vol 28 ◽  
pp. 221049172110569
Author(s):  
Pui M Chung ◽  
Bolton KH Chau ◽  
Esther C-S Chow ◽  
Kwok H Lam ◽  
Nang MR Wong

Introduction Lower limb amputation has significant morbidity and mortality. This study reviews the potential factors affecting the one-year mortality rate after lower limb amputation in the Hong Kong Chinese population. Methods Cases with lower limb amputations (toe, ray, below-knee, and above-knee amputations) from a regional hospital from January 2016 to December 2017 were recruited. Amputations due to trauma were excluded. The one-year mortality rate and the potential risk factors (age, sex, length-of-stay, multiple operations, extent of surgery (minor vs. major), medical comorbidities including (1) end-stage renal failure (ESRF), (2) cardiac diseases, (3) ischemic heart disease, (4) peripheral vascular disease and (5) diabetes mellitus) were analyzed by multiple logistic regression using Matlab 2018a. Results A total of 132 patients were recruited (173 operations). The one-year mortality rate was 36.3%. The mean age at death was 72.2 years. The results of the regression analysis showed patients having ESRF (β = 2.195, t 120 = 3.008, p = 0.003) or a major amputation (including above- or below-knee amputation) (β = 1.079, t 120 = 2.120, p = 0.034), had a significantly higher one-year mortality. The remaining factors showed no significant effect. The one-year mortality rate in ESRF patients was 77.8%; while the one-year mortality rate without ESRF was 29.8%. The mean age at death in the ESRF group was 62.9 years; while that without ESRF was 76.1 years. The one-year mortality for patients with major amputation was 45.8% while that for minor amputation was 20.4%. Conclusion ESRF and major amputation are factors that increase the one-year mortality rate after lower limb amputation.


2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
O Hanon ◽  
J Vidal ◽  
E Chaussade ◽  
J P David ◽  
N Boulloche ◽  
...  

Abstract Background/Introduction Age is one of the strongest predictors/risk factors for ischemic stroke in subjects with atrial fibrillation (AF). Direct oral anticoagulants (DOACs) have been shown to be effective in the prevention of this condition; however, clinical evidence on bleeding risk with this therapeutic strategy in very old and frail geriatric patients is poor. Purpose To assess bleeding risk in French geriatric patients aged ≥80 years and diagnosed with AF newly treated with rivaroxaban. Methods Subjects, presenting to one of 33 geriatric centers, with non-valvular AF and recent initiation of a treatment with rivaroxaban were enrolled in the study and followed-up every 3 months for 12 months. Clinical and routine laboratory data and evaluation scores, such as HAS-BLED, HEMORR2HAGES, ATRIA, and CHA2DS2-VASc, as well as comprehensive geriatric evaluation were reported. Major bleeding, as defined in ROCKET AF study, was reported at each visit, and this primary outcome was adjudicated by an independent committee. Results of this cohort were compared with findings from a similar cohort treated with vitamin K antagonists (VKAs) from the same centers (n=924). Results A total of 1045 subjects were enrolled in the study of whom 995 (95%) had a one-year follow-up (analyzed population). The mean (standard deviation (SD)) age was 86.0 (4.3) years, with the majority of patients being female (61%), 23% aged 90 years or older, and 48% having an estimated glomerular filtration rate (eGFR) <50 mL/min. The main comorbidities were hypertension in 77% of subjects, malnutrition 49%, anemia 43%, dementia 39%, heart failure 36%, and falls 27%. The mean (SD) score for CHA2DS2-VASc was 4.8 (1.4), HAS-BLED 2.4 (0.9), Mini-Mental State Examination (MMSE) 21.5 (6.9), Activities of Daily Living (ADL) 4.4 (1.9), and Charlson Comorbidity Index 6.7 (2.0). The one-year rate of major bleeding events was 6.4% of which 0.8% were fatal and 1.1% intracranial hemorrhages (ICH), whereas the one-year rate of ischemic stroke was 1.4% and all-cause mortality 17.9%. Computed with VKA cohort findings and adjusted for age, gender, eGFR and Charlson score, this would result in a hazard ratio of 0.54 (95% confidence interval [CI], 0.38 to 0.78) for major bleeding, 0.36 (0.17 to 0.76) for ICH, 0.62 (0.29 to 1.33) for ischemic stroke, and 0.82 (0.65 to 1.02) for all-cause mortality, in favor of rivaroxaban. Conclusions This is the first large-scale prospective study in geriatric population in AF subjects treated with DOAC (rivaroxaban) Major bleeding risk appeared higher in very old than younger population, however major bleeding and ICH rates were significantly lower with rivaroxaban than with VKAs when used in the same geriatric population. This study indicates that Rivaroxaban can be used in very old and frail patients for the treatment of non-valvular AF. Acknowledgement/Funding Unrestricted grant from Bayer


2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0028 ◽  
Author(s):  
Patrick Allan Massey ◽  
Andrew Zhang ◽  
Christine Bayt Stairs ◽  
Stephen Hoge ◽  
Trevor Carroll ◽  
...  

Objectives: The purpose of the current study is to review the results of meniscus repairs with and without bone marrow aspiration concentrate (BMAC). It is hypothesized that with BMAC, meniscus repair outcomes will be improved when compared to without BMAC at 1 year after surgery. Methods: This is a prospective case control study performed from August 2014 until August 2017. Patients were included if they had a meniscus repair performed with no history of prior meniscus surgery to the operative knee. Patients were excluded if there was a full thickness cartilage tear or International Cartilage Repair Society (ICRS) Grade IV cartilage tear not treated in a single staged surgery. Patients were also excluded if they did not reach the one year follow-up, had a multi-ligamentous knee injury requiring multiple staged procedures. From August 2014 until November 2015, patients had meniscus repair without BMA. Menisci were all repaired arthroscopically using inside-out, outside-in and all-inside techniques. After November 2015, all meniscus repairs were augmented with BMAC. In the BMAC group, all bone marrow was obtained from the ipsilateral femur during the time of surgery. The Biocue BMAC system (Zimmer Biomet, Warsaw Indiana) was used for bone marrow aspiration and BMAC was injected directly into the tear site after repair. Numerical data such as VAS, lysholm and IKDC was analyzed using a 2 sample T-test. Categorical data such as sex, tear location, type of tear and zone of tear were analyzed using a chi-square. Results: A total of 150 patients were initially included in the study. The average age in the control group was 26.3 versus 29.4 in the BMAC group (P=0.27). Thirty seven percent of the control group had an ACL reconstruction versus 40% in the BMAC group (P= .77). The control group improved from an average pain level of 6.1 to 1.2 and the BMAC group improved from an average pain level of 5.9 to 0.7 at the 1 year end point. Both the control group and BMAC group improved with respect to pain with no difference at the 1 year end point (P=.19). There was, however a significantly larger reduction in pain at the 6 week and 3 month time point with BMAC compared to the control group (P=.02 and P=.02 respectively). At the 1-year follow-up, the mean lysholm score improved from 43 to 92 in the control group and 43 to 90 in the BMAC group. The mean IKDC score improved from 37 to 87 in the control group and 36 to 83 in the BMAC group at the one year follow-up. Conclusion: Meniscus repair outcomes were improved at 6 weeks and 3 months post-operatively, when BMAC is used to augment meniscus repair compared to repair without BMAC. Both groups, control group and BMAC meniscus repair group had improved outcomes at 1 year post-operatively with respect to VAS, lysholm and IKDC, with no difference in complication rate.


2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 10582-10582
Author(s):  
S. J. Crabb ◽  
C. D. Bajdik ◽  
C. H. Speers ◽  
D. G. Huntsman ◽  
K. A. Gelmon

10582 Background: Although breast cancer with 4+ axillary lymph nodes generally carries a poor prognosis, we hypothesized that a good prognostic subgroup of such patients would be identifiable by immunohistochemical (IHC) biomarkers. Methods: Patients with primary breast cancer with 4+ axillary nodes and no metastatic disease at diagnosis were identified from a large clinically annotated TMA of formalin-fixed paraffin-embedded archival breast cancers and analyzed for eight IHC based biomarkers: estrogen receptor, HER2, carbonic anhydrase IX, EGFR, CK 5/6, progesterone receptor, p53 and Ki67. Expression of each biomarker was scored 0 or 1 to indicate good or bad prognosis based on univariate analysis of relapse free survival (RFS). Patients were banded as having a total score of 0 (i.e. each biomarker predicted a good outcome), 1–4 or 5–8. Kaplan Meier and Cox regression analysis of RFS outcomes was performed. 10 year RFS for each band was compared to the mean of predicted outcomes based on the prognostic tool Adjuvant! ( www.adjuvantonline.com ). Results: 313 eligible patients were identified and complete data were available for 228. The subset of 228 was similar to the larger group of 313 with respect to RFS and conventional prognostic factors. 10 year RFS for the 228 patients was 39.5% (standard error, SE 3.4%). The subgroup of 37 (16%) scoring zero for all 8 biomarkers had a mean 10 year RFS of 77.6% (SE 7.0). Mean 10 year RFS for the bands scoring 1–4 (154 patients, 68%) and 5–8 (37 patients, 16%) were 34.9% (SE 4.1) and 19.0% (SE 6.9) respectively. Mean 10 year RFS predictions by Adjuvant! were 35.9% (SE 2.6), 34.5% (SE 1.2) and 34.3% (SE 2.3) respectively. In multivariate analysis with conventional prognostic factors, the banded biomarker score retained statistical significance for predicting RFS (p=0.0007) along with estrogen receptor status (p=0.03) and tumour size (p=0.01). Conclusions: This TMA biomarker panel identified a breast cancer subgroup with good prognosis despite extensive axillary node involvement. Long term outcome was markedly better than that predicted by conventional prognostic factors. If validated, treatment decisions and clinical trial stratification might be modified using this new score. No significant financial relationships to disclose.


1987 ◽  
Vol 101 (5) ◽  
pp. 467-470 ◽  
Author(s):  
G. T. A. Ijaduola ◽  
O. O. Akinyanju

AbstractA study of the effect of tonsillectomy on the frequency of sickle cell pain crises was carried out on 15 patients with sickle cell disease (Hb SS) who presented with complaints of frequent pain crises and were found to have chronic tonsillitis. They comprised 9 females and 6 males and ranged in age from 6 to 35 years, with a mean of 15 years. Tonsillectomy was performed under general anaesthesia. The mean number of pain crises in the one-year period after tonsillectomy was 1.5 and was significantly less than the mean number 4.7 in the one year preceding the operation (p<0.001). Four patients failed to show a reduced number of crises and these were those whose tonsils at operation showed no pus in their tonsillar crypts. It is thus observed that chronic tonsillitis, symptoms of which may not be volunteered at examination, is a potent inductor of sickle cell pain crisis and that tonsillectomy is an effective mode of treatment, especially when the tonsillar crypts contain pus.


PeerJ ◽  
2016 ◽  
Vol 4 ◽  
pp. e2788 ◽  
Author(s):  
Evgeni Mekov ◽  
Yanina Slavova ◽  
Adelina Tsakova ◽  
Marianka P. Genova ◽  
Dimitar T. Kostadinov ◽  
...  

Introduction One-year mortality in COPD patients is reported to be between 4% and 43%, depending on the group examined. Aim To examine the one-year mortality in COPD patients after severe exacerbation and the correlation between mortality and patients’ characteristics and comorbidities. Methods A total of 152 COPD patients hospitalized for severe exacerbation were assessed for vitamin D status, diabetes mellitus (DM), arterial hypertension (AH), and metabolic syndrome (MS). Data were gathered about smoking status and number of exacerbations in previous year. CAT and mMRC questionnaires were completed by all patients. Pre- and post-bronchodilatory spirometry was performed. One-year mortality was established from national death register. Results One-year mortality is 7.2%. DM, MS, and VD are not predictors for one-year mortality. However there is a trend for increased mortality in patients with AH (9.5% vs. 2.1%, p = 0.107). There is increased mortality in patients with mMRC > 2 (11.1 vs. 0%, p = 0.013). The presence of severe exacerbation in the previous year is a risk factor for mortality (12.5% vs. 1.4%, p = 0.009). There is a trend for increased mortality in the group with FEV1 < 50% (11.5 vs. 4.4%, p = 0.094). Cox regression shows 3.7% increase in mortality rate for 1% decrease in FEV1, 5.2% for 1% decrease in PEF, 7.8% for one year age increase and 8.1% for 1 CAT point increase (all p < 0.05). Conclusions This study finds relatively low one-year mortality in COPD patients after surviving severe exacerbation. Grade C and FEV1 > 80% may be factors for good prognosis. Risk factors for increased mortality are age, FEV1 value, severe exacerbation in previous year and reduced quality of life.


Irriga ◽  
2018 ◽  
Vol 22 (1) ◽  
pp. 177-193 ◽  
Author(s):  
Iug Lopes ◽  
Juliana Maria M De Melo ◽  
Brauliro Gonçalves Leal

ESPACIALIZAÇÃO DA TEMPERATURA DO AR PARA A REGIÃO DO SUBMÉDIO SÃO FRANCISCO  IUG LOPES¹; JULIANA MARIA MEDRADO DE MELO² E BRAULIRO GONÇALVES LEAL³ ¹ Departamento de Engenharia Agrícola, Universidade Federal Rural de Pernambuco, Rua Dom Manoel de Medeiros, Dois Irmão, CEP: 52171-900 – Recife, PE. [email protected]² Departamento de Agronomia, Universidade do Estado da Bahia, Rua Edgar Chastinet, s/n - São Geraldo, BA, 48905-680 – Juazeiro, BA. [email protected]³ Colegiado de Engenharia da Computação, Universidade Federal do Vale do São Francisco – Campus Juazeiro, Av. Antonio Carlos Magalhães, 510 Country Club, CEP: 48.902-300 – Juazeiro, BA. [email protected]  1 RESUMO  Dentre as variáveis meteorológicas requeridas para o cálculo do balanço hídrico destacam-se as temperaturas mínimas, médias e máximas do ar, que apresentam uma continuidade no quantitativo de distância e assim permitem de uma maneira mais simples a criação de campos contínuos utilizando métodos de interpolação espacial. O objetivo deste trabalho foi avaliar potências para o método de interpolação do Inverso da Potência da Distância (IPD) na espacialização de valores diários da temperatura no Submédio São Francisco, para os períodos de um ano, das estações do ano (inverno, primavera, verão e outono). Foram obtidos os parâmetros de potência do interpolador Inverso da Potência da Distância das temperaturas mínimas, médias e máximas a partir dos dados medidos em 14 estações meteorológicas automáticas do INMET em operação no Pólo de Desenvolvimento Petrolina-Juazeiro. Foram realizadas interpolações para as épocas: anual, inverno, primavera, verão e outono. A variação diária do erro relativo médio obtida, para a época ano, calculado utilizando os dados de temperatura mínima, média e máxima utilizando o valor da potência do interpolador foram iguais a 3,3; 3,4; e 3,4, respectivamente. Os valores de erro médio foram pequenos quando comparados com o erro instrumental. Palavras-chave: interpolação, validação cruzada, estação meteorológica  LOPES, I; MELO, J. M. M.; LEAL, B. G. SPATIALIZATION OF AIR TEMPERATURE TO THE REGION OF SUBMEDIO SÃO FRANCISCO  2 ABSTRACT Among the meteorological variables required for the calculation of the water balance are the temperatures, which present a continuity in the quantitative distance and thus allow in a simpler way the creation of continuous fields using spatial interpolation methods. The objective of this work was to evaluate the power of the Inverse Distance Power (IPD) in the spatialization of daily values of temperature in the Submedia of São Francisco, for the one-year periods of the seasons (winter, spring, summer it's fall). The power parameters of the Inverse Distance Power Interpolator were obtained from the minimum, average and maximum temperatures from the data measured in 14 INMET automatic meteorological stations operating at the Petrolina-Juazeiro Development Pole. Interpolations were performed for annual, winter, spring, summer and fall seasons. The daily variation of the average relative error obtained for the year time, calculated using the data of minimum, average and maximum temperature using the value of the power of the interpolator were equal to 3.3; 3.4; and 3.4, respectively. The mean error values were small when compared to instrumental error. Keywords: interpolation, validation cross, meteorological station


Author(s):  
Gesa von Olshausen ◽  
Ott Saluveer ◽  
Jonas Schwieler ◽  
Nikola Drca ◽  
Hamid Bastani ◽  
...  

Abstract Purpose Cather ablation is known to influence the autonomic nervous system. This study sought to investigate the association of sinus heart rate pre-/post-ablation and recurrences in patients with atrial fibrillation undergoing pulmonary vein isolation (PVI). Methods Between January 2012 and December 2017, data of 482 patients undergoing their first PVI were included. Sinus heart rate was recorded before (PRE), directly post-ablation (POST) and 3 months post-ablation (3 M). All patients were screened for atrial tachyarrhythmia recurrences during the one-year follow-up. Results In the total study cohort, the mean resting sinus heart rate at PRE [mean 57.9 bpm (95% CI 57.1–58.7 bpm)] increased by over 10 bpm to POST [mean 69.4 bpm (95% CI 68.5–70.3 bpm); p < 0.001] followed by a slight decrease at 3 M [mean 67.3 bpm (95% CI 66.4–68.2 bpm)] but still remaining higher compared to PRE (p < 0.001). This pattern was observed in patients with and without recurrences at POST and 3 M (both p < 0.001 compared to PRE). However, at 3 M the mean sinus heart rate was significantly lower in patients with compared to patients without recurrences (p = 0.031). In this regard, patients with a heart rate change < 11 bpm (PRE to 3 M) or, as an alternative parameter, patients with a heart rate < 60 bpm at 3 M had a significantly higher risk of recurrences compared to the remaining patients (Hazard ratio (HR) 1.82 (95% CI 1.32–2.49), p < 0.001 and HR 1.64 (95% CI 1.20–2.25), p = 0.002, respectively). Conclusion Our study confirms the impact of PVI on cardiac autonomic function with a significant sinus heart rate increase post-ablation. Patients with a sinus heart rate change < 11 bpm (PRE to 3 M) are at higher risk for recurrences during one-year post-PVI.


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