Intraoperative Seizures During Awake Craniotomy

Neurosurgery ◽  
2013 ◽  
Vol 73 (1) ◽  
pp. 135-140 ◽  
Author(s):  
Erez Nossek ◽  
Idit Matot ◽  
Tal Shahar ◽  
Ori Barzilai ◽  
Yoni Rapoport ◽  
...  
Keyword(s):  
Frontal Lobe ◽  
Medical Center ◽  
Length Of Hospital Stay ◽  
Postoperative Outcome ◽  
Awake Craniotomy ◽  
Short Term ◽  
Intractable Seizures ◽  
Hospitalization Period ◽  
Incidence Risk ◽  
History Of

Abstract BACKGROUND: Awake craniotomy (AC) for removal of intra-axial brain tumors is a well-established procedure. However, the occurrence and consequences of intraoperative seizures during AC have not been well characterized. OBJECTIVE: To analyze the incidence, risk factors, and consequences of seizures during AC. METHODS: The database of AC at Tel Aviv Medical Center between 2003 to 2011 was reviewed. Occurrences of intraoperative seizures were analyzed with respect to medical history, medications, tumor characteristics, and postoperative outcome. RESULTS: Of the 549 ACs performed during the index period, 477 with complete records were identified. Sixty patients (12.6%) experienced intraoperative seizures. The AC procedure failed in 11 patients (2.3%) due to seizures. Patients with intraoperative seizures were significantly younger than nonseizing patients (45 ± 14 years vs 52 ± 16 years, P = .003), had a higher incidence of frontal lobe involvement (86% vs % 57%, P < .0001), and had higher prevalence of a history of seizures (P = .008). Short-term motor deterioration developed postoperatively in a higher percentage of patients with intraoperative seizures (20% vs 10.1%, P = .02) with a longer hospitalization period (4.0 ± 3.0 days vs 3.0 ± 3.0 days, P = .045). CONCLUSION: Although in most cases intraoperative seizures will not result in AC failure, the surgical team should be prepared to treat them promptly to avoid intractable seizures. Intraoperative seizures are more common in younger patients with a tumor in the frontal lobe and those with a history of seizures. Moreover, they are associated with a higher incidence of transient postoperative motor deterioration and protracted length of hospital stay.

Failed awake craniotomy: a retrospective analysis in 424 patients undergoing craniotomy for brain tumor

2013 ◽  
Vol 118 (2) ◽  
pp. 243-249 ◽  
Author(s):  
Erez Nossek ◽  
Idit Matot ◽  
Tal Shahar ◽  
Ori Barzilai ◽  
Yoni Rapoport ◽  
...  
Keyword(s):  
Medical Center ◽  
Brain Regions ◽  
Awake Craniotomy ◽  
Gross Total Resection ◽  
Total Resection ◽  
Failure Group ◽  
Communication History ◽  
Hospitalization Period ◽  
Successful Group ◽  
History Of

Object Awake craniotomy for removal of intraaxial tumors within or adjacent to eloquent brain regions is a well-established procedure. However, awake craniotomy failures have not been well characterized. In the present study, the authors aimed to analyze and assess the incidence and causes for failed awake craniotomy. Methods The database of awake craniotomies performed at Tel Aviv Medical Center between 2003 and 2010 was reviewed. Awake craniotomy was considered a failure if conversion to general anesthesia was required, or if adequate mapping or monitoring could not have been achieved. Results Of 488 patients undergoing awake craniotomy, 424 were identified as having complete medical, operative, and anesthesiology records. The awake craniotomies performed in 27 (6.4%) of these 424 patients were considered failures. The main causes of failure were lack of intraoperative communication with the patient (n = 18 [4.2%]) and/or intraoperative seizures (n = 9 [2.1%]). Preoperative mixed dysphasia (p < 0.001) and treatment with phenytoin (p = 0.0019) were related to failure due to lack of communication. History of seizures (p = 0.03) and treatment with multiple antiepileptic drugs (p = 0.0012) were found to be related to failure due to intraoperative seizures. Compared with the successful awake craniotomy group, a significantly lower rate of gross-total resection was achieved (83% vs 54%, p = 0.008), there was a higher incidence of short-term speech deterioration postoperatively (6.1% vs 23.5%, p = 0.0017) as well as at 3 months postoperatively (2.3% vs 15.4%, p = 0.0002), and the hospitalization period was longer (4.9 ± 6.2 days vs 8.0 ± 10.1 days, p < 0.001). Significantly more major complications occurred in the failure group (4 [14.8%] of 27) than in the successful group (16 [4%] of 397) (p = 0.037). Conclusions Failures of awake craniotomy were associated with a lower incidence of gross-total resection and increased postoperative morbidity. The majority of awake craniotomy failures were preventable by adequate patient selection and avoiding side effects of drugs administered during surgery.

Abstract NS12: Nursing-led Intervention to Improve Use of Prolonged Arrhythmia and Polysomnography in Veterans with Ischemic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Sharon Bottomley ◽  
Lisa Keefner ◽  
Jason J Sico
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Medical Center ◽  
Length Of Hospital Stay ◽  
Lean Six Sigma ◽  
Coordinated Care ◽  
Loop Recorder ◽  
Obstructive Sleep ◽  
Hospitalization Period ◽  
Potential Benefits

Background: Current AHA/ASA ischemic stroke prevention guidelines provide updated recommendations regarding prolonged arrhythmia monitoring to detect occult atrial fibrillation and polysomnography referral (PSG) for obstructive sleep apnea (OSA) assessment. While these assessments are traditionally considered “outpatient” testing, we sought to determine the feasibility of starting these referrals during the hospitalization period. Methods: We used Lean Six Sigma process improvement methods to process map the current and future states of obtaining prolonged arrhythmia monitoring and PSG at a single VA Medical Center. Working with stakeholders in neurology, cardiology, and sleep medicine we devised standard operating procedures for obtaining referrals for these respective testing during hospitalization. A stroke nurse coordinated all referrals. Results: Our single site intervention period was from 10/1/2015 to 2/29/2016, during which 21 patients were admitted to the neurology service with an ischemic stroke. At baseline, no patients received orders by hospital discharge for prolonged arrhythmia monitoring or PSG. Potential benefits and adverse effects of testing were discussed with Veterans. Of the twelve patients (57.1%) eligible for prolonged arrhythmia monitoring, half the patients agreed to the testing and were discharged with either a Holter monitor/implantable loop recorder. Of the 18 patients (85.7%) eligible for PSG, six agreed to the testing, with one patient receiving testing during hospitalization and the remaining patients received PSG after discharge. One Veteran was diagnosed with atrial fibrillation, whereas all Veterans receiving PSG were diagnosed with varying degrees of OSA. Positive test results initiated referrals to appropriate specialists for additional management. Length of hospital stay was not increased in order to receive the additional coordinated care. Conclusions: Implementation of a nursing coordinated program designed to improve delivery of guideline concordant post stroke arrhythmia monitoring and OSA assessment could be feasibly implemented using existing infrastructure without prolonging length of stay.

scholarly journals Prevalence of Bed sores among Patients Referring to a Medical Center in Iran

2021 ◽  
pp. 17-25
Keyword(s):  
Significant Relationship ◽  
Pressure Ulcers ◽  
Medical Center ◽  
Length Of Hospital Stay ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
The North ◽  
History Of ◽  
Low Bmi ◽  
High Bmi

Introduction: Despite the advances in medical technology and preventive programs, the incidence of pressure ulcers during hospitalization is increasing. This study aimed at evaluating the prevalence of bedsores among hospitalized patients in a hospital in the north of Iran. Methods: This analytical cross-sectional study was conducted on all patients (n=244) with pressure ulcers admitted to Poursina Hospital, Rasht, Iran, within more than 48 h. The information of patients, such as age, gender, history of hypertension, history of diabetes, length of hospital stay, and body mass index were gathered from the patient's hospital records. Ulcer evaluation was performed using the Braden Scale. The collected data were analyzed in Stata software version 14.1 using mean and standard deviation to describe the quantitative variables and numbers and percentages for qualitative variables. Results: Based on the findings, among all patients, 1.2%of the cases had pressure ulcers. The mean age of patients was obtained at 61.7±18.6 years. It was revealed that the frequency of pressure ulcers was higher in elderly patients. The history of diabetes had a significant positive relationship with pressure ulcers and Braden score. However, no significant relationship was observed between the history of smoking and ulcers. There was a significant inverse relationship between hypertension history and pressure ulcers and Braden score, meaning that the score was lower in patients with hypertension history. It was also found that patients with high BMI had a lower and significant score than patients with low BMI. A significant relationship was present between the length of hospitalization and the degree of bedsores. In the ulcers of the scapula, the Braden score was significantly higher. Conclusion: Pressure ulcer was more common in patients aged over 60 years. The subjects with diabetes had a 5 times higher degree of pressure ulcers, and the prolonged hospitalization increased the degree of ulcer. Patients with high BMI had less, while significant pressure ulcers, compared to patients with low BMI.

scholarly journals Short-Term Postoperative Outcome of Laparoscopic Total Mesorectal Excision in Rectal Carcinoma

2017 ◽  
Vol 28 (2) ◽  
pp. 75-78
Author(s):  
Sharmistha Roy ◽  
Samiron Kumar Mondal
Keyword(s):  
Total Mesorectal Excision ◽  
Anterior Resection ◽  
Operating Time ◽  
Length Of Hospital Stay ◽  
Postoperative Outcome ◽  
Laparoscopic Total Mesorectal Excision ◽  
Mesorectal Excision ◽  
Short Term ◽  
Central Vascular Ligation ◽  
Mean Time

Despite the proven benefits, laparoscopic colorectal surgery is still under utilized among surgeons. Aim of this study is to determine the feasibility and morbidity after laparoscopic Total Mesorectal Excision(TME), implementing a standardized operative technique and recovery protocol. The first 30 patients treated laparoscopically were included. Standardized oncological clearance ensured by early central vascular ligation, medial to lateral approach, and complete mesorectalexcision. Recovery parameters, short-term outcomes, morbidity and mortality have been assessed.Total number of patient was 30. In 26 patients anterior resection was done, in 4 patients Abdominoperineal resection was done.Overall mean operating time was 224( 242-137) minutes. In anterior resection Mean operating time was 187( 236-137) minutes, whereas in lap APR operating time was 210(242-178) minutes. In total 4 patients(13%) were converted to open procedure. Average bleeding in anterior resection group was 120 ml( 50-200ml), in Lap APR 210 ml(115-350ml). Mean number of lymphnodes removed in AR 16. In APR1, Mean time to flatus was 1.5 days. Mean time to stool 4.2 days, mean length of hospital stay in AR 8.6 days, in APR 11.5 days. Overall morbidity 23%(7), major morbidity 10%(3). There is no mortality, no anastomotic leak, and no 30 days readmission.laparoscopic Total Mesorectal Excision is safe and leads to excellent results in terms of recovery and short term outcomes. Key factors for better outcomes is adoption of a standardized technique and training model.Medicine Today 2016 Vol.28(2): 75-78

A Clinical Study and Management of Inguino-scrotal Swellings In Children

2018 ◽  
Vol 2 (S1) ◽  
pp. e000125
Author(s):  
Khyati Vaja ◽  
Mukesh Suvera
Keyword(s):  
Inguinal Hernia ◽  
Pediatric Surgery ◽  
Pediatric Patients ◽  
Undescended Testis ◽  
Length Of Hospital Stay ◽  
Indirect Inguinal Hernia ◽  
Short Term ◽  
One Year ◽  
Groin Hernias ◽  
Inguinal Hernia In Children

Aims and Objectives: To know the most common surgical problems in pediatric patients presented with inguino-scrotal swellings and management done routinely. Methodology: This study was carried out in the department of general surgery, Sharadaben hospital and pediatric surgery of VS hospital, Ahmedabad. The cases were studied for a period of about one year (January, 2017 to Dec, 2017) and all children below 12 years of age, presenting to us with inguinoscrotal swellings were included in this study. The information was analysed in terms of age, diagnosis, procedure carried out and outcome. Results: Amongst the 150 children under the age of 12 years, 143 patients were males and 7 were females. Among these 150, 52 cases were of hydrocoele, 70 cases of hernia (of which 63 were males and 7 were females), 25 cases of undescended testis and 3 cases of epididymo orchitis were documented. All cases underwent simple herniotomy for hernia and hydrocoele, orchidopexy for undescended testis. The length of hospital stay ranged from 2-4 days with mean of 2.46 days. 11 children in the study were documented to have short term complications, all of which were recognised in the hospital and managed with good results. Conclusion: Hernia and Hydrocoele in children are often congenital and diagnosed clinically (history and examination). Indirect inguinal hernia are more common than other groin hernias. Open herniotomy is the operation of choice for inguinal hernia in children.

scholarly journals Increased stress, weight gain and less exercise in relation to glycemic control in people with type 1 and type 2 diabetes during the COVID-19 pandemic

2021 ◽  
Vol 9 (1) ◽  
pp. e002035
Author(s):  
Merel M Ruissen ◽  
Hannah Regeer ◽  
Cyril P Landstra ◽  
Marielle Schroijen ◽  
Ingrid Jazet ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Weight Gain ◽  
Glycemic Control ◽  
Perceived Stress ◽  
Medical Center ◽  
Short Term ◽  
Design And Methods

IntroductionLockdown measures have a profound effect on many aspects of daily life relevant for diabetes self-management. We assessed whether lockdown measures, in the context of the COVID-19 pandemic, differentially affect perceived stress, body weight, exercise and related this to glycemic control in people with type 1 and type 2 diabetes.Research design and methodsWe performed a short-term observational cohort study at the Leiden University Medical Center. People with type 1 and type 2 diabetes ≥18 years were eligible to participate. Participants filled out online questionnaires, sent in blood for hemoglobin A1c (HbA1c) analysis and shared data of their flash or continuous glucose sensors. HbA1c during the lockdown was compared with the last known HbA1c before the lockdown.ResultsIn total, 435 people were included (type 1 diabetes n=280, type 2 diabetes n=155). An increase in perceived stress and anxiety, weight gain and less exercise was observed in both groups. There was improvement in glycemic control in the group with the highest HbA1c tertile (type 1 diabetes: −0.39% (−4.3 mmol/mol) (p<0.0001 and type 2 diabetes: −0.62% (−6.8 mmol/mol) (p=0.0036). Perceived stress was associated with difficulty with glycemic control (p<0.0001).ConclusionsAn increase in perceived stress and anxiety, weight gain and less exercise but no deterioration of glycemic control occurs in both people with relatively well-controlled type 1 and type 2 diabetes during short-term lockdown measures. As perceived stress showed to be associated with glycemic control, this provides opportunities for healthcare professionals to put more emphasis on psychological aspects during diabetes care consultations.

scholarly journals Nanomedicine Reformulation of Chloroquine and Hydroxychloroquine

Molecules ◽  
2020 ◽  
Vol 26 (1) ◽  
pp. 175
Author(s):  
David M. Stevens ◽  
Rachael M. Crist ◽  
Stephan T. Stern
Keyword(s):  
Safety Evaluation ◽  
Therapeutic Index ◽  
Short Term ◽  
Tissue Concentrations ◽  
History Of ◽  
History Of Use ◽  
Novel Applications ◽  
Therapeutic Doses ◽  
Extensive Clinical Experience ◽  
Higher Doses

The chloroquine family of antimalarials has a long history of use, spanning many decades. Despite this extensive clinical experience, novel applications, including use in autoimmune disorders, infectious disease, and cancer, have only recently been identified. While short term use of chloroquine or hydroxychloroquine is safe at traditional therapeutic doses in patients without predisposing conditions, administration of higher doses and for longer durations are associated with toxicity, including retinotoxicity. Additional liabilities of these medications include pharmacokinetic profiles that require extended dosing to achieve therapeutic tissue concentrations. To improve chloroquine therapy, researchers have turned toward nanomedicine reformulation of chloroquine and hydroxychloroquine to increase exposure of target tissues relative to off-target tissues, thereby improving the therapeutic index. This review highlights these reformulation efforts to date, identifying issues in experimental designs leading to ambiguity regarding the nanoformulation improvements and lack of thorough pharmacokinetics and safety evaluation. Gaps in our current understanding of these formulations, as well as recommendations for future formulation efforts, are presented.

scholarly journals Predictors for clinical effectiveness of baricitinib in rheumatoid arthritis patients in routine clinical practice: data from a Japanese multicenter registry

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Nobunori Takahashi ◽  
Shuji Asai ◽  
Tomonori Kobayakawa ◽  
Atsushi Kaneko ◽  
Tatsuo Watanabe ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Practice ◽  
Disease Activity ◽  
Retention Rate ◽  
Oral Prednisone ◽  
Multivariate Logistic Regression Analysis ◽  
Jak Inhibitors ◽  
Short Term ◽  
History Of ◽  
Multicenter Registry

AbstractThis study aimed to evaluate the short-term effectiveness and safety profiles of baricitinib and explore factors associated with improved short-term effectiveness in patients with rheumatoid arthritis (RA) in clinical settings. A total of 113 consecutive RA patients who had been treated with baricitinib were registered in a Japanese multicenter registry and followed for at least 24 weeks. Mean age was 66.1 years, mean RA disease duration was 14.0 years, 71.1% had a history of use of biologics or JAK inhibitors (targeted DMARDs), and 48.3% and 40.0% were receiving concomitant methotrexate and oral prednisone, respectively. Mean DAS28-CRP significantly decreased from 3.55 at baseline to 2.32 at 24 weeks. At 24 weeks, 68.2% and 64.1% of patients achieved low disease activity (LDA) and moderate or good response, respectively. Multivariate logistic regression analysis revealed that no previous targeted DMARD use and lower DAS28-CRP score at baseline were independently associated with achievement of LDA at 24 weeks. While the effectiveness of baricitinib was similar regardless of whether patients had a history of only one or multiple targeted DMARDs use, patients with previous use of non-TNF inhibitors or JAK inhibitors showed lower rates of improvement in DAS28-CRP. The overall retention rate for baricitinib was 86.5% at 24 weeks, as estimated by Kaplan–Meier analysis. The discontinuation rate due to adverse events was 6.5% at 24 weeks. Baricitinib significantly improved RA disease activity in clinical practice. Baricitinib was significantly more effective when used as a first-line targeted DMARDs.

Sign in / Sign up

Export Citation Format

Share Document