scholarly journals Mortality and morbidity in patients with spontaneous intracerebral hemorrhage: A single-center experience

2021 ◽  
Author(s):  
Morteza Faghih-Jouybari ◽  
Mohammad Taghi Raof ◽  
Sina Abdollahzade ◽  
Sanaz Jamshidi ◽  
Tahereh Padegane ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Functional Status ◽  
Surgical Intervention ◽  
High Rate ◽  
Term Outcome ◽  
Mortality And Morbidity ◽  
Single Center Experience ◽  
Poor Functional Status ◽  
Ich Score

Background: Intracerebral hemorrhage (ICH) is the most common cause of non-ischemic strokes. Considering high mortality and poor functional status following ICH, we investigated factors that can predict short-term outcome and affect recovery of these patients. Methods: In this prospective descriptive study, 100 patients with non-traumatic ICH were included. Clinical and radiographic data were collected and extent of disability was measured by modified Rankin Scale (mRS) at discharge, 1 week, 1 month, and 3 months after discharge. Results: 32 of 100 cases died at hospital and 6 more expired during 3-month follow-up. Risk factors of in-hospital mortality were warfarin use, surgical intervention, and high ICH score. Functional status of patients significantly improved 3 months after discharge. Factors associated with poor recovery were age older than 70, history of coronary artery disease (CAD), low Glasgow Coma Scale (GCS) at admission, elevated mean arterial pressure (MAP), longer hospitalization, and high ICH score. Conclusion: ICH was associated with high rate of mortality (36%). Warfarin use, surgical intervention, and high ICH score were predictive of mortality during hospitalization and 3-month follow-up. Improvement of functional status began after 1 month and significantly improved 3 months after discharge.

Clinical Outcome and Technical Considerations of Late Removal of Abdominal Aortic Endografts: 8-Year Single-Center Experience

Vascular ◽  
2005 ◽  
Vol 13 (3) ◽  
pp. 135-140 ◽  
Author(s):  
Jean-Paul P. M. de Vries ◽  
Joost A. van Herwaarden ◽  
Tim Th. Overtoom ◽  
Jan Albert Vos ◽  
Frans L. Moll ◽  
...  
Keyword(s):  
Open Repair ◽  
Surgical Intervention ◽  
Type I ◽  
Midline Incision ◽  
Mortality And Morbidity ◽  
Single Center Experience ◽  
Proximal Migration ◽  
Abdominal Aortic ◽  
Type I Endoleak

During an 8-year period, 355 patients underwent endovascular repair of mainly true (97%) infrarenal aneurysms. After a mean follow-up of 48 months, 11 (3.1%) patients required conversion to open repair and 10 were eligible for open surgical intervention. Via a midline incision, explantation of the endograft was performed by using an infrarenal aortotomy. Explantation was done for rupture in four patients (40%), with a marked difference in mortality rates between acute (50%) and elective (0%) explantations. The main reason for explantation was proximal type I endoleak caused by (1) malposition of the device, (2) proximal migration of the endograft, and (3) dislodgment of a tube endograft that followed former central reconstruction. Proximal migration is most worrisome and demands preventive endovascular reintervention. The mortality and morbidity rates of elective explantation are acceptable. When delayed conversion is indicated, priority has to be given to operate on these patients.

Aortic Remodeling After Custom-Made Candy-Plug for Distal False Lumen Occlusion in Aortic Dissection

2021 ◽  
pp. 152660282199672
Author(s):  
Ahmed Eleshra ◽  
Fiona Rohlffs ◽  
Konstantinos Spanos ◽  
Giuseppe Panuccio ◽  
Franziska Heidemann ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Clinical Success ◽  
False Lumen ◽  
High Rate ◽  
Single Center ◽  
Original Design ◽  
Mortality And Morbidity ◽  
Custom Made ◽  
Aortic Remodeling

Purpose: To report a single-center experience with the use of a custom-made Candy-Plug (CP) for distal false-lumen (FL) occlusion in subacute and chronic aortic dissection (AD). Materials and Methods: A retrospective single-center analysis was conducted on consecutive patients with subacute and chronic AD who were treated with a custom-made CP for distal FL occlusion using 3 design generations (CP I to CP III) from October 2013 to September 2019. Results: A custom-made CP was used in 57 patients. Of these, 34 patients (29 males, mean age 62±10 years) were treated with a CP I vs 23 patients (16 males, mean age 59±17 years) with CP II/III. Technical success was achieved in 57 (100%) patients. Clinical success was achieved in 54 (95%) patients; 33 (97%) in CP I group vs 21 (91%) patients in CP II/III group, p=0.116. The mean hospital stay was 10±8 days (9±5 days in CP I group vs 13±9 days in CP II/III, p=0.102). The 30-day computed tomography angiography (CTA) confirmed successful CP placement at the intended level in all patients within both groups. Early complete FL occlusion was achieved in 50 (88%) patients; 30 (88%) patients in CP I group vs 20 (87%) in CP II/III group, p=0.894. Follow up CTA was available in 44 (77%) patients. Of these; 30/34 (88%) patients in CP I group with mean follow-up 29±17 months) vs. 14/23 (61%) patients with mean follow-up 14±5 months in CP II/III group. Thoracic aortic remodeling was achieved in 34/44 (77%) patients; 25/30 (83%) patients in CP I group vs 9/14 (64%) patients in CP II/III group, p=0.197. The aneurysm size remained stable in 9/44 (20%) patients; 5/30 (17%) patients in CP I group vs 4/14 (29%) patients in CP II/III group, p=0.741. The thoracic aneurysm increased size was seen in 1/44 (2%) patient. This patient was in CPII/III group. Conclusion: CP technique using custom-made devices is technically feasible with a low mortality and morbidity, and a high rate of aortic remodeling. Both, the original design (CP I) and newer designs with a self-closing central sleeve (CP II and CP III) showed similar excellent outcomes.

SHORT TO MEDIUM RESULTS USING THE REMOTION TOTAL WRIST REPLACEMENT FOR RHEUMATOID ARTHRITIS

Hand Surgery ◽  
2013 ◽  
Vol 18 (02) ◽  
pp. 175-178 ◽  
Author(s):  
A. S. C. Bidwai ◽  
F. Cashin ◽  
A. Richards ◽  
D. J. Brown
Keyword(s):  
Rheumatoid Arthritis ◽  
Pain Relief ◽  
Surgical Intervention ◽  
Case Series ◽  
High Rate ◽  
Wound Breakdown ◽  
Radial Forearm ◽  
Skin Coverage

We present the clinical outcome of patients who underwent RE-MOTION Total Wrist Replacement (TWR) for the treatment of Rheumatoid arthritis involving the wrist. Ten patients were available for follow-up, ranging from one to five years after index surgery. Two patients required surgical intervention for wound breakdown, including one patient who required a radial forearm flap for skin coverage. No patients required revision surgery or conversion to fusion. Patients who did not have complications gained statistically significant pain relief and improvement in mean overall flexion. In this small case series with short to medium results patients reported an improvement in terms of flexion and pain. Despite this, the question of efficacy of TWR compared to fusion in the long term remains unanswered due to the high rate of complications.

Presurgical fMRI Affecting the Extent of Resection and Outcome of the Supratentorial Gliomas; a Single-center Experience From a Developing Country

2021 ◽  
Author(s):  
Abolghasem Mortazavi ◽  
Mohammad Ali Suraki Azad ◽  
Abbas Amirjamshidi ◽  
Mohammad Shirani ◽  
Seyed Ebrahim Ketabchi ◽  
...  
Keyword(s):  
Tumor Grade ◽  
Extent Of Resection ◽  
Positive Outcome ◽  
Short Term ◽  
Glioma Surgery ◽  
Term Outcome ◽  
Eloquent Areas ◽  
Single Center Experience ◽  
Supratentorial Gliomas

Abstract BackgroundFunctional magnetic resonance imaging (fMRI) is one of the available non-invasive imaging to map the different brain areas, which has been used during the current years. In this study, we aimed to evaluate the effect of fMRI on decision-making, the extent of resection, and the outcome of the patients with supratentorial gliomas.MethodsThis prospective study conducted from 2014 through 2017 to investigate how presurgical fMRI can help the neurosurgeon during glioma surgery. Baseline demographic and clinical data were collected, and standard fMRI protocol was used for each patient.Results Forty-one patients with supratentorial gliomas met inclusion criteria, including 29 males and 12 females ranging in age from 21 to 72. Our results showed a significant association between eloquent areas tumor and the EOR. Eight out of 41 (19.5%) experienced higher EOR than what the neurosurgeon expected after adjusting the fMRI findings with the intraoperative situation. Among these patients, postoperative KPS and motor indices reflected dropped levels accompanied by an instant language index level in the short-term period, whereas all indices improved after long-term follow-up. There was a significant association between increasing EOR and all indices in the 1-year follow-up.ConclusionsIn conclusion, we postulate that preoperative fMRI should be considered preoperatively, especially in the eloquent areas gliomas disregarding tumor grade. Moreover, it can lead to a positive outcome in supratentorial gliomas via giving useful data about the relation of the tumor and vital centers of the brain, although it may result in an unfavorable short-term outcome.

Abstract TP366: National Institutes of Health Stroke Scale (NIHSS) is a Potent Predictor of Outcome in Acute Intracerebral Hemorrhage

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Suzie Kazaryan ◽  
Nerses Sanossian ◽  
David S Liebeskind ◽  
Sidney Starkman ◽  
Marc Eckstein ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Strong Predictor ◽  
Final Diagnosis ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Acute Cerebral Ischemia ◽  
History Of ◽  
Acute Intracerebral Hemorrhage ◽  
Ich Score

Background: Although the NIHSS is a well-validated tool in assessing neurological deficit and predicting long-term outcome in acute cerebral ischemia, its utility in ICH has not been extensively studied. As NIHSS is routinely obtained in cases of stroke prior to imaging, it is often available in ICH patients to potentially assist physicians in triage, prognostication, and risk-adjustment. Methods: We analyzed consecutive patients enrolled in the NIH Field Administration of Stroke Therapy-Magnesium (FAST-MAG) phase 3 trial whose final diagnosis was ICH. Trained study nurses performed the NIHSS in the Emergency Department (ED) shortly after arrival and the modified Rankin Scale (mRS) at 90 days. Primary outcomes were disability or death (mRS 3-6) and mortality. Candidate potential predictor variables, including NIHSS, ICH Score, and GCS, those with threshold of p<0.10 were candidate parameters for backward selection logistic regression to determine independent predictors of disability or death and of mortality. Results: Among the 384 ICH patients, age was mean 65 (±13); female 34%; race white 78%, black 10%, Asian 10%; Hispanic ethnicity 33%; and history of hypertension 78%. The ED NIHSS and GCS was performed a median 148 minutes (IQR 121-180) after last known well. Initial NIHSS was median 16 (IQR 9-16), GCS 15 (IQR 10-15), and ICH Score 1(IQR 0-2). NIHSS correlated with ICH Score (r=0.780) and GCS (r=0.860). At 90 days, median mRS was 4 (IQR 2-6), disability or death (mRS 3-6) was present in 70%, and mortality occurred in 26%. In predicting disability or death at 90 days, c statistics were: NIHSS 0.81, ICH Score 0.81, and GCS 0.72. NIHSS≥14 showed 72% sensitivity and 75% specificity. For mortality by 90 days, c statistics were: NIHSS 0.78, ICH Score 0.80, and GCS 0.73. NIHSS≥19 had 80% sensitivity and 70% specificity. On multivariate analysis age (OR 1.07, 95%CI 1.04-2.0) and NIHSS (OR 1.18, 95%CI 1.13-1.23) were independent predictors of disability and death. Conclusions: The initial NIHSS is a strong predictor of disability and death and good predictor of mortality after intracerebral hemorrhage, performing as well as the ICH Score and better than the GCS. Consideration should be given to routine performance and documentation of the NIHSS in ICH patients.

Community prevalence, mechanisms and outcome of mitral or tricuspid regurgitation

Heart ◽  
2021 ◽  
pp. heartjnl-2020-318482
Author(s):  
Thomas J Cahill ◽  
Anthony Prothero ◽  
Jo Wilson ◽  
Andrew Kennedy ◽  
Jacob Brubert ◽  
...  
Keyword(s):  
Heart Disease ◽  
Tricuspid Regurgitation ◽  
Valvular Heart Disease ◽  
Surgical Intervention ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Age Dependent ◽  
Study Population

ObjectiveThe study aims were (1) to identify the community prevalence of moderate or greater mitral or tricuspid regurgitation (MR/TR), (2) to compare subjects identified by population screening with those with known valvular heart disease (VHD), (3) to understand the mechanisms of MR/TR and (4) to assess the rate of valve intervention and long-term outcome.MethodsAdults aged ≥65 years registered at seven family medicine practices in Oxfordshire, UK were screened for inclusion (n=9504). Subjects with known VHD were identified from hospital records and those without VHD invited to undergo transthoracic echocardiography (TTE) within the Oxford Valvular Heart Disease Population Study (OxVALVE). The study population ultimately comprised 4755 subjects. The severity and aetiology of MR and TR were assessed by integrated comprehensive TTE assessment.ResultsThe prevalence of moderate or greater MR and TR was 3.5% (95% CI 3.1 to 3.8) and 2.6% (95% CI 2.3 to 2.9), respectively. Primary MR was the most common aetiology (124/203, 61.1%). Almost half of cases were newly diagnosed by screening: MR 98/203 (48.3%), TR 69/155 (44.5%). Subjects diagnosed by screening were less symptomatic, more likely to have primary MR and had a lower incidence of aortic valve disease. Surgical intervention was undertaken in six subjects (2.4%) over a median follow-up of 64 months. Five-year survival was 79.8% in subjects with isolated MR, 84.8% in those with isolated TR, and 59.4% in those with combined MR and TR (p=0.0005).ConclusionsModerate or greater MR/TR is common, age-dependent and is underdiagnosed. Current rates of valve intervention are extremely low.

scholarly journals Periprosthetic Ankle Fractures

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0007
Author(s):  
Alexander Lazarides ◽  
Tyler Vovos ◽  
James DeOrio ◽  
Mark Easley ◽  
James Nunley ◽  
...  
Keyword(s):  
Periprosthetic Fracture ◽  
Surgical Intervention ◽  
Nonoperative Management ◽  
High Rate ◽  
Periprosthetic Fractures ◽  
Medial Malleolus ◽  
Operative Fixation ◽  
Time To Fracture ◽  
Univariate Analyses

Category: Ankle Introduction/Purpose: Total ankle replacements (TAR) are an increasingly popular option for the management of tibiotalar arthritis. Periprosthetic fracture is an uncommon but challenging complication of patients undergoing arthroplasty. Evidence on the management of and outcomes from periprosthetic fractures about a TAR are limited. The purpose of this study was to evaluate patients with postoperative periprosthetic fractures about a TAR and determine clinical outcomes of these patients following operative fixation. Additionally, we propose an algorithm for the management of these patients. Methods: We retrospectively analyzed 400 patients who underwent TAR from 2007 through 2017. Charts were reviewed and patients with postoperative fractures were selected for inclusion. Patients with a fracture >4 weeks from index surgery were considered candidates for inclusion. Patients with intraoperative fractures were excluded. Univariate analyses were used to identify differences in outcomes. Results: 32 patients were identified with a postoperative periprosthetic fracture about a TAR. Average age was 65.3 years. Average time to fracture was 39.5 months while average follow up from fracture was 26 months. Fractures were primarily located about the medial malleolus (60.6%). 76.8% of fractures were deemed to be stable (Table 1); 75% of these fractures were managed with ORIF or IMN, while 21% of these fractures were treated with immobilization. 80% of patients with stable fractures treated with immobilization ultimately required surgical intervention. 24.2% of fractures were deemed to be unstable. Fractures about the talus were always unstable and always required revision TAR surgery (100%, p= 0.0002). Conclusion: This retrospective review demonstrates that the majority of periprosthetic fractures about a TAR involve the medial malleolus. Additionally, the majority of stable fractures about a TAR required operative fixation. Despite attempts at nonoperative management, management with immobilization is fraught with a high rate of subsequent surgical intervention. Fractures about the talus should be treated with revision TAR surgery or arthrodesis. Based on these findings, we propose an algorithm for the management of patients with a periprosthetic fracture about a TAR.

scholarly journals P14.86 Bevacizumab-associated intracerebral hemorrhage in patients with CNS malignancy: A single-center retrospective cohort study

2019 ◽  
Vol 21 (Supplement_3) ◽  
pp. iii88-iii88
Author(s):  
N Clarke ◽  
M Ruff
Keyword(s):  
Intracerebral Hemorrhage ◽  
Functional Status ◽  
Retrospective Chart Review ◽  
Primary Diagnosis ◽  
Recurrent Glioblastoma ◽  
Adult Patients ◽  
Single Center ◽  
Cns Neoplasms ◽  
Ich Score ◽  
Cns Malignancy

Abstract BACKGROUND Gliomas are a known risk factor for the development of spontaneous intracranial hemorrhage (ICH) independent of therapies directed against them, with studies reporting an incidence of 1.9–3.8%. Bevacizumab (BEV) is a humanized monoclonal antibody targeting vascular endothelial growth factor (VEGF) FDA approved for recurrent glioblastoma. ICH is commonly considered to be a potential adverse effect of BEV use in patients with glioma, with previous retrospective studies describing incidence of intracerebral hemorrhage ranging from 1.9–3.3%. Material and METHODS We performed a single center (Mayo Clinic, Rochester, MN) retrospective chart review of all patients who received BEV therapy at our institution for a diagnosis of primary CNS malignancy. We used ICD-9 and ICD-10 codes to identify adult patients with primary CNS neoplasms that subsequently developed ICH. RESULTS We screened 10,507 adult patients with a diagnosis of primary CNS neoplasm treated at our center from 01/31/2008 to 12/31/2018 and found 644 patients treated with bevacizumab. Of these, 23 (3.6%) suffered an ICH within 12 weeks of a BEV infusion (median 9 days post infusion, 1–24 IQR). The dose of BEV in all hemorrhages was either 10 mg/kg every two weeks (n = 21) or 15 mg/kg every three weeks (n = 2). No patients treated with infusions at 7.5 mg/kg every three weeks (n = 79) or 5 mg/kg every two weeks (n = 17) suffered ICH events, however this did not meet significance (P = 0.06) when compared to patients on 10 mg/kg or above. The median ICH score was 1 (0–2 IQR). There was an increase in ECOG scores documented at clinical follow up following the hemorrhage compared to the pre-hemorrhage functional status (ECOG 3.28 versus 1.2, p = < 0.0001), with 13 patients (56%) having developed severe debility or death (ECOG 4 n = 3, ECOG 5 n = 10). CONCLUSION In our single-center cohort of patients with a primary diagnosis of CNS neoplasms treated with BEV, ICH occurred in 3.6% of patients. Those who experienced an ICH in proximity to BEV infusion had significant morbidity and mortality with a clear decline in functional status. There was a signal of dose response as far as ICH incidence in our cohort with dosages 10 mg/kg per infusion or above.

scholarly journals Safety and efficacy of stereoelectroencephalography in pediatric focal epilepsy: a single-center experience

2018 ◽  
Vol 22 (4) ◽  
pp. 444-452 ◽  
Author(s):  
Hannah E. Goldstein ◽  
Brett E. Youngerman ◽  
Belinda Shao ◽  
Cigdem I. Akman ◽  
Arthur M. Mandel ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Surgical Intervention ◽  
Focal Epilepsy ◽  
Wound Care ◽  
Pediatric Population ◽  
Attractive Alternative ◽  
Safety And Efficacy ◽  
Single Center Experience ◽  
A Minor

OBJECTIVEPatients with medically refractory localization-related epilepsy (LRE) may be candidates for surgical intervention if the seizure onset zone (SOZ) can be well localized. Stereoelectroencephalography (SEEG) offers an attractive alternative to subdural grid and strip electrode implantation for seizure lateralization and localization; yet there are few series reporting the safety and efficacy of SEEG in pediatric patients.METHODSThe authors review their initial 3-year consecutive experience with SEEG in pediatric patients with LRE. SEEG coverage, SOZ localization, complications, and preliminary seizure outcomes following subsequent surgical treatments are assessed.RESULTSTwenty-five pediatric patients underwent 30 SEEG implantations, with a total of 342 electrodes placed. Ten had prior resections or ablations. Seven had no MRI abnormalities, and 8 had multiple lesions on MRI. Based on preimplantation hypotheses, 7 investigations were extratemporal (ET), 1 was only temporal-limbic (TL), and 22 were combined ET/TL investigations. Fourteen patients underwent bilateral investigations. On average, patients were monitored for 8 days postimplant (range 3–19 days). Nearly all patients were discharged home on the day following electrode explantation.There were no major complications. Minor complications included 1 electrode deflection into the subdural space, resulting in a minor asymptomatic extraaxial hemorrhage; and 1 in-house and 1 delayed electrode superficial scalp infection, both treated with local wound care and oral antibiotics.SEEG localized the hypothetical SOZ in 23 of 25 patients (92%). To date, 18 patients have undergone definitive surgical intervention. In 2 patients, SEEG localized the SOZ near eloquent cortex and subdural grids were used to further delineate the seizure focus relative to mapped motor function just prior to resection. At last follow-up (average 21 months), 8 of 15 patients with at least 6 months of follow-up (53%) were Engel class I, and an additional 6 patients (40%) were Engel class II or III. Only 1 patient was Engel class IV.CONCLUSIONSSEEG is a safe and effective technique for invasive SOZ localization in medically refractory LRE in the pediatric population. SEEG permits bilateral and multilobar investigations while avoiding large craniotomies. It is conducive to deep, 3D, and perilesional investigations, particularly in cases of prior resections. Patients who are not found to have focally localizable seizures are spared craniotomies.

scholarly journals Surgical management of superior petrosal sinus dural arteriovenous fistulae with dominant internal carotid artery supply

2018 ◽  
Vol 24 (3) ◽  
pp. 331-338 ◽  
Author(s):  
Christopher J Stapleton ◽  
Anoop P Patel ◽  
Brian P Walcott ◽  
Collin M Torok ◽  
Matthew J Koch ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Surgical Intervention ◽  
High Rate ◽  
External Carotid ◽  
Arteriovenous Fistulae ◽  
Surgical Closure ◽  
Superior Petrosal Sinus

Background While technological advances have improved the efficacy of endovascular techniques for tentorial dural arteriovenous fistulae (DAVF), superior petrosal sinus (SPS) DAVF with dominant internal carotid artery (ICA) supply frequently require surgical intervention to achieve a definitive cure. Methods To compare the angiographic and clinical outcomes of endovascular and surgical interventions in patients with SPS DAVF, the records of all patients with tentorial DAVF from August 2010 to November 2015 were reviewed. Results Within this cohort, eight patients with nine SPS DAVF were eligible for evaluation. Five DAVF were initially treated with endovascular embolization, while four underwent surgical occlusion without embolization. Of the SPS DAVF treated with embolization, two (40%) remained occluded on follow-up, while the remaining three (60%) persisted/recurred and required surgical intervention for definitive closure. Of the four SPS DAVF treated with primary surgical occlusion, all four (100%) remained closed on follow-up. In addition, of the three SPS DAVF that persisted/recurred following embolization and required subsequent surgical closure, all three (100%) remained occluded on follow-up. Two (100%) SPS DAVF that were successfully treated with embolization had major or minor external carotid artery supply, while the three (100%) persistent lesions had major ICA supply via the meningohypophyseal trunk (MHT). Three (75%) of the four SPS DAVF treated with primary surgical occlusion had dominant MHT supply. Conclusion Complete endovascular closure of SPS DAVF with dominant ICA supply via the MHT may be difficult to achieve, while upfront surgical intervention is associated with a high rate of complete occlusion.

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