scholarly journals Neurosurgical Shunt Treatment of Paediatric Hydrocephalus: Epidemiology and Influencing Factors on Revision Surgeries – a Single-centre Retrospective Analysis of 131 Patients

2021 ◽  
Author(s):  
Jasmin Nagl ◽  
Frank Patrick Schwarm ◽  
Michael Bender ◽  
Aylin Gencer ◽  
Harald Ehrhardt ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Influence Factors ◽  
Differential Pressure ◽  
Time Interval ◽  
Therapeutic Approaches ◽  
New Therapeutic Approaches ◽  
Shunt Dysfunction ◽  
One Year ◽  
Gravitational Unit

Abstract Paediatric hydrocephalus is a result of cerebrospinal fluid circulatory dysfunction and has diverse pathogeneses. This study investigates the epidemiology of paediatric hydrocephalus and influences of primary aetiology, type of implants, and of complications to develope new therapeutic approaches and strategies. Between 2013-2018 a retrospective analysis of 131 children, suffering from hydrocephalus, was conducted. Medical charts, operative reports and clinical follow-up visits were reviewed. Statistical analysis was performed using t-test/ANOVA and Kruksal-Wallis-test/ Mann-Whitney-U test. Most common pathogeneses of hydrocephalus among our patients were meningomyelocele associated and posthaemorrhagic. The majority received a programmable differential pressure valve (PP valve, 77.8%) or a fixed differential pressure valve with gravitational unit (FPG valve, 14.8%). Among 333 shunt associated surgeries 66% were performed because of mechanical shunt dysfunction (61%), infection (12%), or due to other reasons (27%). The median rate of revisions for each patient within one year was 0.15 (IQR25-75:0.00-0.68) and was influenced by aetiology (p=0.045) and used valves (p=0.029). The highest rates were seen in patients with posthaemorrhagic hydrocephalus and in those with FPG valve, the lowest in meningomyelocele associated hydrocephalus and PP valve. The occurrence of mechanical dysfunctions showed a relation to FPG valve (p=0.014). Furthermore, the median time interval between initial shunt surgery and infections was shorter than in mechanical dysfunctions (p=0.033). Conclusion: We could state several influence factors on revision surgeries in paediatric shunt patients. With the assessment of patients’ risk profiles, we can classify paediatric shunt patients and could avoid unnecessary examinations or invasive procedures. Furthermore, we could prevent revisions surgeries, if we choose shunt material in accordance with the patients’ associated shunt complications.

Different Therapeutic Approaches and Outcome in the Treatment of Pterygium

1998 ◽  
Vol 8 (3) ◽  
pp. 148-152 ◽  
Author(s):  
C. H. Karabatsas ◽  
G. W. Marsh ◽  
A. M. Cook ◽  
S. D. Cook
Keyword(s):  
Surgical Treatment ◽  
Surgical Techniques ◽  
Surgical Excision ◽  
Lamellar Keratoplasty ◽  
Therapeutic Approaches ◽  
Therapeutic Modalities ◽  
Results Of Treatment ◽  
One Year

Purpose This study was initiated to investigate the role of different therapeutic modalities in the outcome of the surgical treatment of pterygium. Methods The results of treatment of pterygia with a variety of surgical techniques were studied in 56 eyes (49 patients) operated on at Bristol Eye Hospital during a period of five years. The surgical techniques included simple excision; bare sclera; conjunctival autograft; sliding conjunctival flap; lamellar keratoplasty and penetrating keratoplasty. Twelve eyes received additional beta irradiation in a fractionated total dose of 40 Gys. Results The incidence of recurrence was 23.2% for the 43 treated primary pterygia, and 23% for the 13 recurrent pterygia. All recurrences occurred between 2.5 and 11 months postoperatively. None of the 11 cases where additional beta irradiation was used showed any recurrence or other complication within the study period. In the recurrent pterygia group, the cases treated with a combination of surgical excision and beta irradiation, showed significantly lower recurrence rate (p<0.001) compared to those cases treated with surgical excision alone. Conclusions Beta irradiation as a complement to surgical treatment of pterygium, is successful in treating high risk cases such as reoperations, whereas for the majority of primary pterygia surgical excision alone is adequate. Additionally, follow up of one year will reveal any recurrences.

Diagnostic Applications and Therapeutic Approaches with Different Preparations of Anti-CEA Antibodies

1992 ◽  
Vol 7 (3) ◽  
pp. 193-197 ◽  
Author(s):  
A. BISCHOF Delaloye ◽  
B. Delaloye
Keyword(s):  
Colorectal Carcinoma ◽  
Therapeutic Approaches ◽  
New Therapeutic Approaches ◽  
Diagnostic Applications

Various preparations of anti-CEA antibodies have shown to detect very sensitively CEA producing tumors. The development of human anti-mouse antibodies (HAMA) prevents from the widespread use of immunoscintigraphy (IS) in the follow-up of patients with colorectal carcinoma. It is, however, not yet clear if genetically reshaped antibodies will solve this problem and it is even less clear if this will change prognosis of these patients. There is certainly room for new therapeutic approaches in colorectal carcinoma. Radioimmunotherapy in combination with other techniques might advantageously complete surgery, chemotherapy and radiotherapy, but needs to be further developed.

Fifty Years of Experience with Chordomas in Southeast Scotland

Neurosurgery ◽  
1985 ◽  
Vol 16 (2) ◽  
pp. 166-170 ◽  
Author(s):  
P. O'Neill ◽  
B.A. Bell ◽  
J.D. Miller ◽  
I. Jacobson ◽  
W. Guthrie
Keyword(s):  
Clinical Presentation ◽  
Surgical Intervention ◽  
Slow Growth ◽  
Multicenter Trial ◽  
Treatment Modalities ◽  
Therapeutic Approaches ◽  
Slow Growth Rate ◽  
The Past ◽  
New Therapeutic Approaches

Abstract We report the clinical presentation and management of 34 patients with a histologically proven chordoma, treated in the neurosurgical departments in Edinburgh and Dundee, over the past 50 years. Although these tumors are commonly regarded as being locally invasive with a variable, but generally slow growth rate, they can metastasize, and this may precede surgical intervention, as in one of our patients. Our cases are compared to those in previously published series, and a comprehensive review of the treatment modalities for tumors at various sites is presented. The optimal treatment to be recommended from our own experience, and that of others, is aggressive operation and radiotherapy. A combination of hyperthermia and chemotherapy has shown some promise, but remains untested, and highlights the need for a multicenter trial with long follow-up to allow the evaluation of new therapeutic approaches.

scholarly journals Εlectrocardiographic and electrophysiological characteristics of idiopathic ventricular arrhythmias with acute successful ablation at the anterior portion of the mitral annulus

2021 ◽  
Author(s):  
Chengye Di ◽  
Konstantinos Letsas ◽  
Peng Gao ◽  
Qun Wang ◽  
Yanxi Wu ◽  
...  
Keyword(s):  
Ventricular Arrhythmias ◽  
Mitral Annulus ◽  
Time Interval ◽  
Recurrence Rates ◽  
Anterior Portion ◽  
Premature Ventricular Contractions ◽  
Distinct Subgroup ◽  
One Year ◽  
The One

Abstract Background: We sought to clarify the electrocardiographic and electrophysiological characteristics of ventricular arrhythmias (VAs), including idiopathic ventricular tachycardia (VT) and premature ventricular contractions (PVCs), with acute successful radiofrequency catheter ablation (RFCA) at the anterior portion of the mitral annulus (AP-MA).Methods and Results: Among 437 consecutive patients who presented with VAs for RFCA, twenty-six patients with acute successful RFCA at the AP-MA were included in this study. The ratio of the amplitude of the first positive peak (if present) vs. the nadir in the unipolar electrogram (EGM) was 0.00 – 0.03 (0.00) at the acute successful RFCA site. The time interval between the QRS onset to the maximum descending slope (D-Max) in the unipolar EGM (QRS - Uni) were 18.8 ± 13.6 ms. With bipolar mapping, the V-QRS interval was 3.75 – 17.3 (11) ms, 6 (23.1%) patients showed earliest V-QRS interval of 0 ms, and the other 20 patients (76.9%) showed V-QRS interval of 10-54 ms. The RFCA start-to-effect time was 14.1 ± 7.2 seconds in 23 patients (88.5%). In the remaining 3 patients (11.5%), the mean duration of successful RFCA were not well determined due to infrequent nature of clinical VAs during RFCA. Early (within 3 days) and late (one-year) recurrence rates were 23.1% (6 patients) and 26.9% (7 patients), respectively. The VAs disappeared 3 days later due to delayed RFCA efficacy in 2 patients (7.7%). No complications occurred during RFCA or the one-year follow up.Conclusions: AP-MA VAs are a rare but distinct subgroup of VAs. Bipolar and unipolar EGM features can help to detect the optimal RFCA site, and the QRS - Uni interval may work as a marker for guiding RFCA.

Has the Incidence of Extramedullary Disease Changed with the New Therapeutic Approaches? Analysis of a Cohort of 965 Multiple Myeloma (MM) Patients (pts).

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4749-4749
Author(s):  
Marzia Varettoni ◽  
Alessandro Corso ◽  
Gianmatteo Pica ◽  
Patrizia Zappasodi ◽  
Silvia Mangiacavalli ◽  
...  
Keyword(s):  
Overall Survival ◽  
Median Time ◽  
Response To Therapy ◽  
Response To Treatment ◽  
High Dose ◽  
Solitary Plasmacytoma ◽  
Therapeutic Approaches ◽  
New Therapeutic Approaches ◽  
Over Time

Abstract Extramedullary myeloma (EMM) at diagnosis or during the course of the disease is rare and often anecdotal. We reviewed the records of 965 consecutive MM pts diagnosed and followed from 1969 to July 2007 in order to evaluate: the overall incidence of EMMs and the changes over time clinical presentation, response to treatment and outcome of EMM pts divided into two subgroups according to the time of appearance, at diagnosis or during the course of the disease. We considered three periods: 1969–1989 (conventional chemotherapy, CCT); 1990–1999 (introduction of high-dose therapy, HDT); 2000–2007, (era of novel agents). The overall incidence of EMM was of 13% (129/965 pts), 87/42 M/F, median age 58 (31–80) years. A prior MGUS was present in 24 pts and a solitary plasmacytoma in 10 (8%). Characteristics at the time of EMM were: 77 pts IgG (60%), 23 IgA (18%), 2 IgM (2%), 16 light chain (12%), 11 not secretory (8%); 29 pts were in stage I, 14 in stage II, 86 in stage III; 30/129 pts (23%) were asymptomatic. More frequently involved sites were: paravertebral (40%), rib cage (32%), pelvis (10%). Multiple localizations were present in 27 pts (21%). A plasmacytic leukemia was observed during the follow-up in 9 pts (7%). The overall median follow-up was 24.4 (2.5–148) months. Seventy-three pts presented EMM at the time of diagnosis with different incidences in the 3 periods: 1969–1989 4.5%, 1990–99 4.3%, 2000–07 12.7%. These pts were treated with HDT in 43 cases (59%) and CCT in 30 (41%). Radiotherapy (RT) was associated in 38 pts (52%). A partial response (PR) was achieved in 49 pts (67%). Progression or relapse were observed in 46 pts (63%) and the median time to progression (TTP) and overall survival (OS) in this subgroup of pts were 17.3 and 21.5 months respectively. The other 56 pts showed an EMM during the course of the disease after a median time of 20 (2–144) months from diagnosis. EMM incidence varied as follows: 1969–1989 2.7%, 1990–99 7.2%, 2000–07 7.4%. Median number of previous lines of therapy was 1 (range: 1–7), including HDT in 22 pts (39%), thalidomide or lenalidomide in 18 (32%), bortezomib in 5 (9%). The median time from HDT to EMM was 17 (2–125) months. Treatment of these pts consisted of CCT in 36 cases (64%), thalidomide in 3 (5%) and bortezomib in 8 (14%). RT was given in 29 cases (52%). Response rate in this subgroup was low, only 30% of pts obtained a PR. The median TTP and OS from the time of appearance of EMM were 4.7 and 6.5 months respectively and the overall survival from the diagnosis was 29.9 months. The two groups of EMM pts were also compared for all the clinical characteristics, response to therapy and outcome. EMM pts at diagnosis showed higher levels of monoclonal component and haemoglobin, and lower bone marrow plasmacytosis with respect to the others. OS from diagnosis was similar in the two groups. In conclusion, our study shows an increased incidence of EMM over time. The more recent increase of EMM at diagnosis might be due to the wider use of more sensitive imaging techniques as CT scan and magnetic resonance, while during the course of the disease after 1990 could be related to the longer survival of pts thanks to the new therapeutic approaches. Anyway, the presence of EMM whether at diagnosis or at progression seems to negatively affect the outcome of pts since the OS is shorter than MM pts without EMM.

scholarly journals Single-cell multimodal analysis in a case with reduced penetrance of Progranulin-Frontotemporal Dementia

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Karthick Natarajan ◽  
Jesper Eisfeldt ◽  
Maria Hammond ◽  
José Miguel Laffita-Mesa ◽  
Kalicharan Patra ◽  
...  
Keyword(s):  
Frontal Cortex ◽  
Mutation Carrier ◽  
Autosomal Dominant ◽  
Therapeutic Approaches ◽  
Protein Levels ◽  
Multimodal Analysis ◽  
New Therapeutic Approaches ◽  
Repressive Chromatin ◽  
Reduced Penetrance

AbstractWe identified an autosomal dominant progranulin mutation carrier without symptoms of dementia in her lifetime (Reduced Penetrance Mutation Carrier, RedPenMC). This resistance to develop expected pathology presents a unique opportunity to interrogate neurodegenerative mechanisms. We performed multimodal single-nuclei analyses of post-mortem frontal cortex from RedPenMC, including transcriptomics and global levels of chromatin marks. RedPenMC had an increased ratio of GRN-expressing microglia, higher levels of activating histone mark H3k4me3 in microglia and lower levels of the repressive chromatin marks H3k9me1 and H3k9me3 in the frontal cortex than her affected mutation carrier son and evidence of higher protein levels of progranulin in both plasma and brain homogenates. Although the study is limited to one case, the results support that restoring brain progranulin levels may be sufficient to escape neurodegeneration and FTD. In addition to previously identified modifier genes, it is possible that epigenetic marks may contribute to the increased progranulin expression in cases of reduced penetrance. These findings may stimulate similar follow-up studies and new therapeutic approaches.

scholarly journals Transjugular Portosystemic Shunting in Refractory Cirrhotic Ascites

2021 ◽  
Vol 31 (1) ◽  
pp. 39-46
Author(s):  
Yu. V. Khoronko ◽  
M. A. Kozyrevskiy ◽  
A. V. Dmitriev ◽  
A. A. Volokhova ◽  
G. Yu. Spiridenko ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Variceal Bleeding ◽  
Refractory Ascites ◽  
Esophagogastric Varices ◽  
Portosystemic Shunting ◽  
Shunt Dysfunction ◽  
Grade 3 ◽  
One Year ◽  
Medical University

Aim. Improvement of refractory ascites (RA) outcomes in underlying cirrhotic portal hypertension (PH) through optimising the transjugular intrahepatic portosystemic shunting (TIPS) procedure among therapy measures.Materials and methods. The survey included 107 patients with RA admitted to portal hypertension units of the Rostov State Medical University Surgical Clinic during 2007—2020. The patients were randomly assigned to two cohorts similar by gender, age, cirrhosis aetiology and condition severity. The control cohort had conventional paracentesis and albumin infusion. In cohort 2, 57 patients had minimally invasive endovascular TIPS surgery in a recommended setting.Results. TIPS eliminated PH in all 57 patients of cohort 2. Cohort 1 was reported with progressive esophagogastric varices (EGV), their enlargement in 37 and rupture in 11 patients during the first 12 months. Cohort 2 revealed the grade 3—2 and 2—1 EGV reduction in 24 (41.1%) patients with shunt surgery and in 39 (68.4%) patients in one year. Esophagogastric variceal bleeding (EGVB) developed in 9 patients in cohort 1, with 7 lethal outcomes. No variceal bleeding was observed in cohort 2, with 7 patients having the portosystemic shunt dysfunction.Conclusion. The TIPS procedure is justified in cirrhotic PH patients with RA for reducing the mortality rate in a one year follow-up.

Abstract P222: Percutaneous Coronary Intervention in Hospitals Without Surgery on Site: One Year Follow-Up From a Longitudinal Registry

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Jorge Gonzalez ◽  
Ankur Gupta ◽  
Mohamad Alkhouli ◽  
Abdul Kashem ◽  
Kristy Scheiring ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Carotid Artery Disease ◽  
Bare Metal Stents ◽  
Coronary Intervention ◽  
Metal Stents ◽  
Time Interval ◽  
Elective Percutaneous Coronary Intervention ◽  
Percutaneous Coronary ◽  
One Year

Background: The safety of performing elective percutaneous coronary intervention (PCI) in hospitals without surgery on site (SOS) has been questioned. We assessed the safety of this practice in a one year follow up study. Methods: 485 patients underwent elective (PCI) in two network hospitals without (SOS) were followed for one-year in a longitudinal registry. Baseline demographics, hemodynamics, and renal function were recorded for each patient before and after PCI. Clinical data were obtained at 6 weeks, 3, 6, 9, and 12 months. Results: Baseline demographics: Mean age was 68±12 years, 67% were male, BMI: 28.9±5.3. Comorbidities included heart failure-8.4%, carotid artery disease-7%, hypertension-80%, IDDM-9%, NIDDM-20%, PAD-6%, smoking-22%, prior PCI-31%. Systolic BP: 146±24 mmHg, diastolic BP: 79±15 mmHg, creatinine: 1.1±0.7mg/dl, Total Cholesterol: 157±40 mg/dl, EF: 52±14%. Total number of stents used was 558 (28% Bare-metal stents and 72% Drug eluted stents). Death, all cause readmissions, repeat PCI, CABG, and angina symptoms were recorded at each time interval (See table1 ). At one year 95% were taking aspirin and 89% were taking clopidogrel. No correlation was noted between clopidrogel use and repeat PCI. Conclusions: One year follow up after PCI in hospitals without SOS demonstrates acceptable rates of immediate complications and long term outcomes. The data suggest that elective PCI can be performed safely in hospitals without surgery on site. Time Interval Death Readmit Repeat PCI CABG Angina Symptoms 6 weeks 1% 7% 1.2% 1% 6.4% 3 months 0.4% 5% 0.6% 1% 6.9% 6 months 0.8% 7% 1.1% 0% 9.4% 9 months 0.4% 4% 9.3% 1% 10.4% 12 months 0.4% 3% 6.8% 0% 7.4%

scholarly journals Long-term survival rates of gravity-assisted, adjustable differential pressure valves in infants with hydrocephalus

2016 ◽  
Vol 17 (5) ◽  
pp. 544-551 ◽  
Author(s):  
Anna-Felicitas Gebert ◽  
Matthias Schulz ◽  
Karin Schwarz ◽  
Ulrich-Wilhelm Thomale
Keyword(s):  
Survival Rates ◽  
Differential Pressure ◽  
Older Children ◽  
Term Survival ◽  
Kaplan Meier ◽  
Single Center Study ◽  
Gravitational Unit ◽  
Shunt Survival ◽  
Flexible Application

OBJECTIVE The use of adjustable differential pressure valves with gravity-assisted units in shunt therapy of children with hydrocephalus was reported to be feasible and promising as a way to avoid chronic overdrainage. In this single-center study, the authors' experiences in infants, who have higher rates of shunt complications, are presented. METHODS All data were collected from a cohort of infants (93 patients [37 girls and 56 boys], less than 1 year of age [mean age 4.1 ± 3.1 months]) who received their first adjustable pressure hydrocephalus shunt as either a primary or secondary implant between May 2007 and April 2012. Rates of valve and shunt failure were recorded for a total of 85 months until the end of the observation period in May 2014. RESULTS During a follow-up of 54.2 ± 15.9 months (range 26–85 months), the Kaplan-Meier rate of shunt survival was 69.2% at 1 year and 34.1% at 85 months; the Kaplan-Meier rate of valve survival was 77.8% at 1 year and 56% at 85 months. Survival rates of the shunt were significantly inferior if the patients had previous shunt surgery. During follow-up, 44 valves were exchanged in cases of infection (n = 19), occlusion (n = 14), dysfunction of the adjustment unit (n = 10), or to change the gravitational unit (n = 1). CONCLUSIONS Although a higher shunt complication rate is observed in infant populations compared with older children, reasonable survival rates demonstrate the feasibility of using this sophisticated valve technology. The gravitational unit of this valve is well tolerated and its adjustability offers the flexible application of opening pressure in an unpredictable cohort of patients. This may adequately address overdrainage-related complications from early in treatment.

Sign in / Sign up

Export Citation Format

Share Document