Interval between endoscopic surgery and decreased intracranial pressure related to putaminal hemorrhage prognosis

Background: Endoscopic evacuation of a putaminal hemorrhage is effective and minimally invasive; however, it may not result in sufficient brain decompression. While monitoring postoperative intracranial pressure (ICP) is likely useful, specific ICP data in patients with a putaminal hemorrhage are limited. The aim of this study was to determine the association between postoperative ICP and the prognosis of patients with putaminal hemorrhage after endoscopic surgery. Methods: We retrospectively analyzed 24 consecutive patients with a putaminal hemorrhage in whom ICP monitoring after endoscopic surgery was performed. Clinical data regarding hematoma volume, evacuation rate, onset-to-treatment time, operation time, ICP max, ICP peak out time (T peak out), and neurological outcomes on discharge were investigated. Results: From August 2011 to October 2015, 24 patients with a putaminal hemorrhage were analyzed. Consciousness on admission and hemorrhage volume were associated with poor outcomes after endoscopic surgery for putaminal hemorrhage. The hematoma volume, operation time, and evacuation rate of hemorrhage were correlated to early peak out of ICP. Furthermore, a T peak out ≤24 h was significantly associated with good neurological outcomes on discharge. Conclusions: Our data suggest that early peak out (≤24 h) of ICP after endoscopic surgery is predictive of a good prognosis following putaminal hemorrhage. Operation time and evacuation rate of hemorrhage could hasten peak out of ICP and improve outcomes in patients with a putaminal hemorrhage after endoscopic surgery.

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Significance of endoscopic hematoma evacuation in elderly patients with spontaneous putaminal hemorrhage

Surgical Neurology International ◽

10.25259/sni_872_2020 ◽

2021 ◽

Vol 12 ◽

pp. 121

Author(s):

Naohide Fujita ◽

Hideaki Ueno ◽

Mitsuya Watanabe ◽

Yasuaki Nakao ◽

Takuji Yamamoto

Keyword(s):

Endoscopic Surgery ◽

Functional Outcomes ◽

Mortality Rates ◽

National Institutes Of Health ◽

Modified Rankin Scale ◽

Hematoma Volume ◽

Treatment Groups ◽

Putaminal Hemorrhage ◽

Intracerebral Hemorrhages ◽

Intracranial Hematomas

Background: The efficacy of endoscopic surgery for spontaneous intracerebral hemorrhages (ICH) has been previously reported, but differences in the effect between early and late elderlies remain unclear. Methods: Ninety-seven patients diagnosed with putaminal hemorrhage (age, ≥65 years; hematoma volume, ≥30 mL) were included in this retrospective analysis and separated into three treatment groups: craniotomy surgery (CR), endoscopic surgery (EN), and non-surgical (NS) groups. The patients were additionally subdivided into two groups according to age: patients aged 65–74 years (“early elderlies”) and patients aged ≥75 years (“late elderlies”). Their clinical data and outcomes at discharge were compared using statistical analyses. Results: The CR and the EN groups were associated with lower mortality rates (P < 0.001), lower modified Rankin Scale (mRS; P = 0.007), and lower National Institutes of Health Stroke Scale (NIHSS; P = 0.029) compared to the NS group. Early elderlies in the CR and EN groups with ICH scores of 3 also had significantly better outcomes (P = 0.001). The proportion of patients with mRS ≤ 4 was highest in the early elderlies of the EN group (P = 0.553). Although significant differences in the change of NIHSS scores between the early and late elderlies was not observed, significantly improved NIHSS scores were observed in the EN group compared to the NS group, even in the late elderlies (P = 0.037). Conclusion: The evacuation of deep-seated intracranial hematomas using the endoscope might improve functional outcomes and mortality, regardless of age.

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Application of Three-dimensional Visualization assisted Ultrasound for Percutaneous Renal Puncture

10.21203/rs.3.rs-113148/v1 ◽

2020 ◽

Author(s):

Zhibin Xu ◽

Zhenchi Li ◽

Maomao Guo ◽

Hao Bian ◽

Tianli Niu ◽

...

Keyword(s):

Clearance Rate ◽

3D Visualization ◽

Three Dimensional ◽

Operation Time ◽

Control Group ◽

Transfusion Rate ◽

Stone Clearance ◽

Time Operation ◽

Postoperative Blood Transfusion ◽

Experimental Group

Abstract We present here the three-dimensional (3D) visualization fused with ultrasound and to evaluate its clinical application effect preliminarily. One hundred and eighteen patients with renal calculi in our hospital from September 2017 to December 2019 were prospectively randomized into two groups. The experimental group was treated with percutaneous renal puncture guided by the 3D visualization fused with ultrasound. The control group was treated with percutaneous renal puncture guided by B-ultrasonography (B-US). The puncture time, operation time, and the loss of hemoglobin in the experimental group were lower than those in the control group, and the success rate of establishing the channel at one time, and the coincidence rate between the channel and the longitudinal axis of the target renal calyx were higher. The stone clearance rate in the experimental group was higher, while the postoperative blood transfusion rate and interventional embolization rate in the experimental group were significantly lower. The difference was statistically significant (P < 0.05). 3D visualization assisted ultrasound could preliminarily guide precise navigation to puncture tissues, reduced operation time and bleeding, improved stone clearance rate and operation safety.

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Predictive Value of Charlson Comorbidity Index and Cofactors on 2-Year Mortality in Older Patients With Intertrochanteric Fractures: A Retrospective Analysis

10.21203/rs.3.rs-136253/v1 ◽

2021 ◽

Author(s):

Jianda Xu ◽

Homma Yasuhiro ◽

Yuta Jinnai ◽

Tomonori Baba ◽

Zhuang Xu ◽

...

Keyword(s):

Blood Loss ◽

Older Patients ◽

Demographic Data ◽

Survival Rates ◽

Operation Time ◽

Intertrochanteric Fractures ◽

Time Out ◽

Time Operation ◽

Significant Difference ◽

First Time

Abstract The aim of this study was to evaluate the role of Charlson comorbidities index (CCI) and cofactors on 2-year mortality in older patients with intertrochanteric fractures. 60 cases with unilateral intertrochanteric fracture were retrospectively analyzed and divided into Low-CCI group (CCI: 1-4) or high-CCI groups (CCI: 5-6). All the patients’ electronic hospital records were reviewed. The preoperative situations (demographic data, comorbidities and fracture conditions), perioperative situations (wait time, operation time, implant choice, blood loss, transfusion or not) and postoperative situations (complications, first time out of bed, function about 1-/2- week and 2-year mortality) were recorded. 51.67% were in low-CCI group and 48.33% in high-CCI group. The survival rates in low- and high-CCI group were 93.5% and 86.2 % respectively. According to the functional results of 1- or 2- week after operation, no significant difference was found (P=0.955, 0.140). Log-rank analysis showed that the main prognostic factors were blood loss, first time out of bed and complication (P<0.05). Multivariate analysis confirmed that complication and first time out of bed were significant factor on survival rate (P=0.029, 0.010). Charlson comorbidities index maybe not the indicator of 2-year mortality in older patients with intertrochanteric fractures. In order to improve the prognosis, more attentions should be paid to reduce the complications and encourage postoperative earlier excise out of bed.

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N-Terminal Pro-Brain Natriuretic Peptide Concentrations After Hypertensive Intracerebral Hemorrhage: Relationship With Hematoma Size, Hyponatremia, and Intracranial Pressure

Journal of Intensive Care Medicine ◽

10.1177/0885066616683677 ◽

2017 ◽

Vol 33 (12) ◽

pp. 663-670 ◽

Cited By ~ 3

Author(s):

Fei Li ◽

Qian-Xue Chen ◽

Shou-Gui Xiang ◽

Shi-Zhun Yuan ◽

Xi-Zhen Xu

Keyword(s):

Intracranial Pressure ◽

Intracerebral Hemorrhage ◽

Brain Natriuretic Peptide ◽

Natriuretic Peptide ◽

Linear Regression Analysis ◽

Peak Level ◽

Hematoma Volume ◽

The Mean ◽

Hypertensive Intracerebral Hemorrhage ◽

Mean Concentration

Introduction: The role of N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with hypertensive intracerebral hemorrhage (HICH) is poorly understood. This study aimed to investigate the secretion pattern of NT-proBNP in patients with HICH and to assess its relationship with hematoma size, hyponatremia, and intracranial pressure (ICP). Methods: This prospective study enrolled 147 isolated patients with HICH. Blood samples were obtained from each patient, and values of serum NT-proBNP, hematoma size, blood sodium, and ICP were collected for each patient. Results: The peak-to-mean concentration of NT-proBNP was 666.8 ± 355.1 pg/mL observed on day 4. The NT-proBNP levels in patients with hematoma volume >30 mL were significantly higher than those in patients with hematoma volume <30 mL ( P < .05). In patients with severe HICH, the mean concentration of NT-proBNP was statistically higher than that in patients with mild–moderate HICH ( P < .05), and the mean level of NT-proBNP in hyponatremia group was significantly higher than that in normonatremic group ( P < .05). In addition, the linear regression analysis indicated that serum NT-proBNP concentrations were positively correlated with ICP ( r = .703, P < .05) but negatively with blood sodium levels only in patients with severe HICH ( r = −.704, P < .05). The serum NT-proBNP levels on day 4 after admission were positively correlated with hematoma size ( r = .702, P < .05). Conclusion: The NT-proBNP concentrations were elevated progressively and markedly at least in the first 4 days after HICH and reached a peak level on the fourth day. The NT-proBNP levels on day 4 were positively correlated with hematoma size. There was a notable positive correlation between plasma NT-proBNP levels and ICP in patients with severe HICH. Furthermore, only in patients with severe HICH, the plasma NT-proBNP levels presented a significant correlation with hyponatremia, which did not occur in patients with mild–moderate HICH.

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Efficiency of an up-flow Anaerobic Sludge Blanket reactor coupled with an electrochemical system to remove chloramphenicol in swine wastewater

Water Science & Technology ◽

10.2166/wst.2021.632 ◽

2021 ◽

Author(s):

Itzel Romero-Soto ◽

Celestino Garcia-Gomez ◽

Luis Leyva-Soto ◽

Juan Napoles-Armenta ◽

María Concha-Guzman ◽

...

Keyword(s):

Oxygen Demand ◽

Operation Time ◽

Coupled System ◽

Swine Wastewater ◽

Uasb Reactor ◽

Organic Load ◽

Anaerobic Sludge ◽

Electrochemical System ◽

Time Operation ◽

Anaerobic Sludge Blanket

Abstract The application and design of treatment systems in wastewater are necessary due to antibiotics' potential toxicity and resistant genes on residual effluent. This work evaluated a coupled bio-electrochemical system to reduce chloramphenicol (CAP) and chemical oxygen demand (COD) on swine wastewater (SWW). SWW characterization found CAP of <10 μg/L and 17,434 mg/L of COD. The coupled system consisted of preliminary use of an Up-flow Anaerobic Sludge Blanket Reactor (UASB) followed by electrooxidation (EO). UASB reactor (primary stage) was operated for three months at an organic load of 8.76 kg of COD/m3d and 50 mg CAP/L as initial concentration. In EO, we carried out a 22 (time operation and intensity) factorial design with a central composite design; we tried two Ti cathodes and one anode of Ti/PbO2. Optimal conditions obtained in the EO process were 240 min of operation time and 1.51 A of current intensity. It was possible to eliminate 44% of COD and 64.2% of CAP in the preliminary stage. On bio-electrochemical, a total COD and CAP removal were 82.35% and >99.99%, respectively. This coupled system can be applied to eliminate antibiotics and other organic pollutants in agricultural, industrial, municipal, and other wastewaters.

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Application of Grid Complexity-Based Magnetic Resonance Imaging in Monitoring Electroencephalogram Signals of Anesthetized Patients

Journal of Medical Imaging and Health Informatics ◽

10.1166/jmihi.2021.3427 ◽

2021 ◽

Vol 11 (1) ◽

pp. 282-287

Author(s):

Yunlong Lei ◽

Zhenzhen Ma ◽

Huiqing Li

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Body Temperature ◽

Operation Time ◽

Transfusion Rate ◽

Intraoperative Blood Loss ◽

Resonance Imaging ◽

Time Operation ◽

Volume Blood ◽

Anesthesia Time

Objective: In this paper, a lattice algorithm is used to explore the effect of MRI on anesthesia when used in neurosurgery. Methods: Sixty patients with glioma were randomly divided into two groups. Thirty patients underwent intracranial glioma resection (iMRI group) under the guidance of intraoperative magnetic resonance imaging (iMRI) and functional neuronavigational, and 30 patients underwent functional neuronavigational. Guide the traditional resection of traditional craniotomy gliomas (group N), and record the general situation, anesthesia time, operation preparation time, operation time, intraoperative blood loss, infusion volume, blood transfusion rate, preoperative and postoperative hemoglobin concentrations, Postoperative body temperature, dosage of muscle relaxant, perioperative accidents related to iMRI and anesthesia. Results: Compared with the N group, the general conditions, anesthesia time, intraoperative blood loss, infusion volume, blood transfusion rate, hemoglobin concentration, and postoperative body temperature of the patients in the iMRI group were not significantly different (P > 0.05), but the time for preparation and operation. It was significantly prolonged, and the amount of muscle relaxant was significantly increased (P < 0.05). There were no accidents related to iMRI and anesthesia in both groups. Conclusion: The use of iMRI in neurosurgical surgery improves the accuracy of surgery and makes tumor resection more complete, but the operation time is significantly longer, and other perioperative characteristics are not different from traditional neurosurgery. iMRI is used for anesthesia in neurosurgery. In addition to following the general principles of neurosurgery anesthesia, attention should also be paid to the regulation of anesthesia for long-term surgery.

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Relationship between Hematoma Volume and Motor Impairment in Putaminal Hemorrhage

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2020.104812 ◽

2020 ◽

Vol 29 (6) ◽

pp. 104812

Author(s):

Hitoshi Ohnishi ◽

Kotaro Takeda ◽

Makoto Watanabe ◽

Shinichiro Maeshima ◽

Shigeru Sonoda

Keyword(s):

Motor Impairment ◽

Hematoma Volume ◽

Putaminal Hemorrhage

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Comparison of Clinical Outcomes With Proximal Femoral Nail Anti-rotation Versus Bipolar Hemiarthroplasty for the Treatment of Elderly Intertrochanteric Fractures

10.21203/rs.3.rs-527679/v1 ◽

2021 ◽

Author(s):

Wen-Bo Wei ◽

Sha-Jie Dang ◽

Ling Wei ◽

MengXi Xin

Keyword(s):

Postoperative Complications ◽

Operation Time ◽

The Elderly ◽

Proximal Femoral Nail ◽

Bipolar Hemiarthroplasty ◽

Intertrochanteric Fractures ◽

Hospitalization Time ◽

Femoral Nail ◽

Time Operation ◽

Significant Difference

Abstract Background: Although proximal femoral nail anti-rotation (PFNA) and bipolar hemiarthroplasty (BHA) are selected by most of the orthopaedic surgeons for elderly intertrochanteric fractures (ITFs) patients, there is still no consensus on the superiority of PFNA and BPH for ITFs in the elderly. The study aims to compare the curative effects of proximal femoral nail anti-rotation (PFNA) and cementless bipolar hemiarthroplasty (BHA) on ITFs in the elderly. Methods: From January 2012 to December 2016, a total of 62 patients participated in the study: BHA (Group B, n=30), PFNA (Group P, n=32). The fractures were classified according to Evans-Jensen. Hospitalization time, operation time, bleeding loss, Harris scores and postoperative complications were compared between the two groups. Results: The operation time was (125.76 ± 33.49) min and (94.38 ± 20.94) min in PFNA group and BHA group (P < 0.05); bleeding loss was (153.33 ± 59.96) mL and (335.31 ± 90.87) mL(P < 0.05); hospitalization time was (17.13 ± 2.92) days and (16.63 ± 3.64) days (P > 0.05); and the Harris scores were (73.20 ± 6.56) points and (68.91 ± 8.15) points (P < 0.05). There was no significant difference in postoperative complications between the two groups (P > 0.05). Conclusion: Both PFNA and BHA are safe and effective treatments for femoral intertrochanteric fractures in elderly patients. Nonetheless, BHA can be considered for those with the poor bone condition and short life expectancy.

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Application of Percutaneous Endoscopic Interlaminar Discectomy (PEID) with Modified Sensation-Motion Separation Anesthesia in the Treatment of L5-S1 Disc Herniation

10.21203/rs.3.rs-54655/v1 ◽

2020 ◽

Author(s):

Meng Kong ◽

Changtong Gao ◽

Chao Wang ◽

Derong Xu ◽

Shuo Han ◽

...

Keyword(s):

Disc Herniation ◽

Short Form ◽

Lumbar Disc ◽

Length Of Hospital Stay ◽

Operation Time ◽

Reoperation Rate ◽

Clinical Effects ◽

Time In Bed ◽

Time Operation ◽

Sf 36

Abstract Study Design: A retrospective cohort study.Purpose: To compare the clinical effects of local anesthesia (LA), general anesthesia (GA) and modified sensation-motion separation anesthesia (MA) in percutaneous endoscopic interlaminar discectomy (PEID) for treating L5/S1 lumbar disc herniation (LDH) and guide the junior surgeons.Patients and methods: Eighty-four patients with L5/S1 LDH underwent PEID using three anesthesia methods. Patients in groups LA (26), GA (29) and MA (29) were given a follow-up examination retrospectively. General parameters, preparation and anesthesia time, operation time, recovery time, incidence rate of complications, ambulation time, length of hospital stay, severe complications, and reoperation rate were compared, and clinical outcomes were analyzed using a visual analog scale (VAS), the Oswestry Disability Index (ODI), and the Short-Form Health Survey 36 (SF-36).Results: MA demonstrated obvious advantages over the other two methods in operation time and led a better intraoperative experience than LA. Group MA and LA required less time in bed postoperatively and shorter hospital stays than group GA. The mean postoperative VAS score, ODI score and SF-36 score were significantly better than the preoperative values in all groups (P<0.05), but no significant differences were found among the three groups (P>0.05). Three cases (3/29) of nervous disorder occurred in the GA group. Two cases in the GA (1/29) and LA (1/26) groups were revised among all three groups, with a total recurrence rate of 2.4% (2/84). Conclusions: Modified anesthesia with sensation-motion separation was a suitable method for spinal surgeons who were inexperienced with PEID in the treatment of L5/S1 disc herniation due to its high safety and good patient tolerance.

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Comparative analysis of three types of minimally invasive decompressive surgery for lumbar central stenosis: biportal endoscopy, uniportal endoscopy, and microsurgery

Neurosurgical FOCUS ◽

10.3171/2019.2.focus197 ◽

2019 ◽

Vol 46 (5) ◽

pp. E9 ◽

Cited By ~ 17

Author(s):

Dong Hwa Heo ◽

Dong Chan Lee ◽

Choon Keun Park

Keyword(s):

Back Pain ◽

Minimally Invasive ◽

Endoscopic Surgery ◽

Operation Time ◽

Endoscopic Approach ◽

Decompressive Surgery ◽

Leg Pain ◽

Vas Score ◽

Canal Stenosis ◽

Endoscopic Group

OBJECTIVERecently, minimally invasive unilateral laminotomy with bilateral decompression (ULBD) has been performed for lumbar stenosis using endoscopic approaches. The object of this retrospective study was to compare the clinical and radiological outcomes of three types of minimally invasive decompressive surgery: microsurgery, percutaneous uniportal endoscopic surgery, and percutaneous biportal endoscopic surgery.METHODSIn the period from March 2016 to December 2017, minimally invasive ULBD was performed using microscopy, a uniportal endoscopic approach, or a biportal endoscopic approach to treat lumbar canal stenosis. Patients were classified into three groups based on the surgery they had undergone. The angle of medial facetectomy area and postoperative dural expansion were measured using MR images. The visual analog scale (VAS) score for leg and back pain, Oswestry Disability Index (ODI), operation time, and complications were assessed. Clinical and radiological parameters were compared among the three groups.RESULTSThere were 33 patients in the microscopy group, 37 in the biportal endoscopy group, and 27 in the uniportal endoscopy group. Preoperatively stenotic dural areas were significantly expanded in each of the three groups after surgery (p < 0.05). Mean dural expansion in the uniportal endoscopy group was significantly lower than that in the microscopy or biportal endoscopy group (p < 0.05). The mean angle of the facetectomy in the biportal endoscopic group was significantly lower than that in the microscopic group or uniportal endoscopic group (p < 0.05). On the 1st day after surgery, the VAS score for back pain was significantly higher in the microscopic group than in the uniportal or biportal endoscopic group (p < 0.05). However, there were no significant differences in the VAS score for back pain, VAS score for leg pain, or ODI at the final follow-up among the three groups (p > 0.05).CONCLUSIONSAlthough radiological results were different among the three groups of patients, postoperative clinical outcomes were significantly improved after each type of surgery. The percutaneous biportal or uniportal endoscopic approach offers the advantage of reduced immediate postoperative pain. A percutaneous uniportal or biportal endoscopic lumbar approach may be effective for the treatment of lumbar central stenosis and an alternative to conventional microsurgical decompression.

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