Predictors of patency of excimer laser–assisted nonocclusive extracranial-to-intracranial bypasses

2009 ◽  
Vol 110 (5) ◽  
pp. 887-895 ◽  
Author(s):  
Jochem P. Bremmer ◽  
Bon H. Verweij ◽  
Catharina J. M. Klijn ◽  
Albert van der Zwan ◽  
L. Jaap Kappelle ◽  
...  
Keyword(s):  
Excimer Laser ◽  
Important Determinant ◽  
Patient Characteristics ◽  
Bypass Flow ◽  
Flow Measurements ◽  
Bypass Patency ◽  
Temporary Occlusion ◽  
Male Sex ◽  
Surgical Aspects ◽  
Prospective Database

Object Excimer laser–assisted nonocclusive anastomosis (ELANA) is a technique that can be used for extracranial-to-intracranial (EC-IC) bypasses, without the necessity of temporary occlusion of the donor or recipient artery. Information on predictors of patency of EC-IC bypasses in general and the ELANA bypass in particular is sparse. The authors studied 159 ELANA EC-IC bypasses to find predictors of patency. Methods From a prospective database of patients who underwent EC-IC bypass surgery, 143 consecutive patients who underwent a total of 159 ELANA bypasses were studied. The associations of patient characteristics, surgical aspects, and technical aspects specific to the ELANA technique with intraoperative and postoperative bypass patency were studied using logistic regression analysis. Results At the end of the operation, 146 (92%) of the 159 bypasses were patent. A first attempt to create a bypass was almost 8 times more likely (OR 7.6, 95% CI 2.1–27.5; p = 0.02) to result in a patent bypass than a second attempt. Administration of a small amount of heparin during the operation was also associated with bypass patency (OR 5.2, 95% CI 1.1–24.9; p = 0.04). One hundred twenty-three (77%) of the 159 bypasses were functional at patency assessments during the 1st month after the operation. Older age (OR 1.043 for every year of increase in age, 95% CI 1.010–1.076; p = 0.01), male sex (OR 2.9, 95% CI 1.3–6.5; p = 0.01), and high intraoperative bypass flow (OR 1.017 for every milliliter per minute increase in flow, 95% CI 1.004–1.030; p = 0.01) were associated with postoperative bypass patency. Conclusions Attempts to create a second EC-IC ELANA bypass after the first one are more likely to fail, whereas administration of heparin to the patient during the procedure increases the intraoperative bypass patency rate. Postoperative patency results are better in male and in older patients. Intraoperative bypass flow measurements are essential because high bypass flow is an important determinant of postoperative patency.

The Cut Flow Index: An Intraoperative Predictor of the Success of Extracranial-Intracranial Bypass for Occlusive Cerebrovascular Disease

2005 ◽  
Vol 56 (suppl_1) ◽  
pp. ONS-75-ONS-85 ◽  
Author(s):  
Sepideh Amin-Hanjani ◽  
Xinjian Du ◽  
Nada Mlinarevich ◽  
Guido Meglio ◽  
Meide Zhao ◽  
...  
Keyword(s):  
Occlusive Disease ◽  
Flow Index ◽  
Bypass Flow ◽  
Flow Measurements ◽  
Cerebrovascular Reserve ◽  
Recipient Vessel ◽  
Bypass Patency ◽  
Graft Success ◽  
Blood Flow Measurements ◽  
Cerebrovascular Occlusive Disease

Abstract OBJECTIVE: There has been a resurgence of interest in selective extracranial-intracranial bypass for revascularization of cerebrovascular occlusive disease. We evaluated the usefulness of intraoperative blood flow measurements in predicting graft success after extracranial-intracranial bypass. METHODS: A retrospective review of 51 cases of extracranial-intracranial bypass for purposes of flow augmentation in the setting of cerebrovascular occlusive disease was performed. In all cases, free flow from the cut end of the donor vessel, termed cut flow, was measured. The cut flow index (CFI) (bypass flow [ml/min] / cut flow [ml/min]) was derived and correlated with bypass patency, postoperative bypass flow, cerebrovascular reserve testing, and clinical outcome. RESULTS: The CFI was a significant predictor of bypass patency (P = 0.002). Using a CFI of 0.5 as a threshold, the bypass patency rate was 92% in cases with a CFI greater than 0.5 compared with 50% in cases with a CFI less than 0.5. Intraoperative bypass flow correlated well with postoperative measurements obtained from quantitative phase-contrast magnetic resonance imaging. An analysis of cases with a poor CFI indicated that a logical interpretation of bypass function can be performed during surgery. CONCLUSION: A poor CFI can alert surgeons to potential difficulties with the donor vessel, anastomosis, or recipient vessel during surgery. Furthermore, a CFI closely approximating 1.0 provides physiological confirmation of impaired cerebrovascular reserve in the recipient bed.

Patency, flow, and endothelialization of the sutureless Excimer Laser Assisted Non-occlusive Anastomosis (ELANA) technique in a pig model

2011 ◽  
Vol 115 (6) ◽  
pp. 1221-1230 ◽  
Author(s):  
Tristan P. C. van Doormaal ◽  
Albert van der Zwan ◽  
Saskia Redegeld ◽  
Bon H. Verweij ◽  
Cornelis A. F. Tulleken ◽  
...  
Keyword(s):  
Excimer Laser ◽  
Pig Model ◽  
Mean Flow ◽  
Bypass Flow ◽  
Histological Studies ◽  
Bypass Patency ◽  
The Mean ◽  
The Right ◽  
Control Angiography

Object The purpose of this study was to assess flow, patency, and endothelialization of bypasses created with the sutureless Excimer Laser Assisted Non-occlusive Anastomosis (SELANA) technique in a pig model. Methods In 38 pigs, a bypass was made on the left common carotid artery (CCA), using the right CCA as a graft, with 2 SELANAs. Bypass flow was measured using single-vessel flowmetry. The pigs were randomly assigned to 1 of 12 survival groups (1, 2, 3, 4, 5, 6, 7, and 10 days; 2 and 3 weeks; and 3 and 6 months). One extra animal underwent the procedure and then was killed after 1 hour of bypass patency to serve as a control. Angiography was performed just before the animals were killed, to assess bypass patency. Scanning electron microscopy and histological studies were used to evaluate the anastomoses after planned death. Results The mean SELANA bypass flow was not significantly different from the mean flow in the earlier ELANA (Excimer Laser Assisted Non-occlusive Anastomosis) pig study at opening and follow-up. Overall SELANA bypass patency (87%) was not significantly different from the ELANA patency of 86% in the earlier study. Complete SELANA endothelialization was observed after 2–3 weeks, compared with 2 weeks in the earlier ELANA study. Conclusions The SELANA technique is not inferior to the current ELANA technique regarding flow, patency, and endothelialization. A pilot study in patients is a logical next step.

scholarly journals 365. Characteristics and outcomes of COVID-19 patients admitted to a regional health system in the southeast

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S251-S253
Author(s):  
Charles Teixeira ◽  
Henry Shiflett ◽  
Deeksha Jandhyala ◽  
Jessica Lewis ◽  
Scott R Curry ◽  
...  
Keyword(s):  
Renal Failure ◽  
Health System ◽  
Patient Characteristics ◽  
Supplemental Oxygen ◽  
Regional Health ◽  
Cancer Symptoms ◽  
Presenting Symptoms ◽  
Global Pandemic ◽  
Male Sex ◽  
Previous Admission

Abstract Background COVID-19, first described in Wuhan, China, is now a global pandemic. We describe a cohort of patients (pts) admitted to our academic health system (HS) in the southeast, where demographics and comorbidities differ significantly from other regions in the U.S. Methods This was a retrospective review of 161 consecutive pts admitted with COVID-19 from 3/12/20 to 6/1/20. We assessed demographics, comorbidities, presenting symptoms, treatments and outcomes and compared pts who died during hospitalization to those who survived to discharge (EpiInfo 7.2, Atlanta, GA). Results Mean age was 60.5 years, 51.6% were female, 72% African American (AA) and 69.6% admitted from home. 54.5% had a BMI >30, 72% had HTN, 47.2% diabetes, and 33.6% COPD or asthma. The majority (68.8%) presented with fever (>38.0) and required supplemental oxygen within 8 hours of admission (63.4%). Cough (65.6%), dyspnea (57.5%), myalgias (30.6%) and diarrhea (23.8%) were also common. 40.4% received hydroxychloroquine, 23.6% steroids and 19.9% convalescent plasma. 42.9% required ICU care, 27.3% were intubated, and 19.3% died. Characteristics associated with death included older age, male sex, HTN, ESRD on HD, and cancer. Symptoms associated with death included absence of cough, absence of myalgias, previous admission for COVID-19, tachypnea, need for supplemental oxygen, elevated BUN and creatinine, and elevated ferritin. Interventions associated with death included use of steroids, receipt of ICU care, intubation, delay to intubation, and use of vasopressors or inotropes. Complications associated with death included development of a new arrhythmia, bacteremia, pneumonia, ARDS, thrombosis, and new renal failure requiring HD (Table). Table 1. Patient Characteristics by Death Table 2. Patient Characteristics by Death Table 3. Patient Characteristics by Death Conclusion COVID-19 pts admitted to our southeast U.S. HS had significant comorbidities, most commonly obesity, HTN, and diabetes. Additionally, AA comprised a disproportionate share (72%) of our cohort compared to the general population of our state (30%), those tested in our region (32.9%), and those found to be positive for COVID-19 (35.8%). In-hospital mortality was 19.3% and intubation, particularly if delayed, was associated with death as were several complications, most notably arrhythmia, ARDS, and renal failure with HD. Disclosures All Authors: No reported disclosures

Higher-Than-Expected Rates of Distal Radioulnar Joint Fixation in Radial Shaft Fractures: Location of Fracture Matters

Hand ◽  
2021 ◽  
pp. 155894472110068
Author(s):  
Joanne Y. Zhang ◽  
Aneesh V. Samineni ◽  
David C. Sing ◽  
Alyssa Rothman ◽  
Andrew B. Stein
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Patient Characteristics ◽  
Distal Radioulnar Joint ◽  
Older Age ◽  
Radioulnar Joint ◽  
Factors Associated ◽  
Shaft Fractures ◽  
Male Sex ◽  
Preoperative Patient

Background: The purpose of this study was to evaluate rates of distal radioulnar joint (DRUJ) fixation based on location of the radial shaft fracture and risk factors associated with postoperative complications following radial shaft open reduction internal fixation (ORIF). Methods: Adult patients who underwent isolated radial shaft ORIF from 2014 to 2018 were identified from American College of Surgeons National Surgical Quality Improvement Program database and stratified by fracture location and by the presence or absence of DRUJ fixation. Preoperative patient characteristics and postoperative complications were compared to determine risk factors associated with DRUJ fixation. Results: We identified 1517 patients who underwent isolated radial shaft ORIF, of which 396 (26.1%) underwent DRUJ fixation. Preoperative patient characteristics and postoperative complications were similar between cohorts. Distal radioulnar joint fixation was performed in 50 (30.7%) of 163 distal radial shaft fractures, 191 (21.8%) of 875 midshaft fractures, and 3 (13.0%) of 23 proximal shaft fractures ( P = .025). Risk factors for patients readmitted include male sex (odds ratio [OR] = 12.76, P = .009) and older age (OR = 4.99, P = .035). Risk factors for patients with any postoperative complication include dependent functional status (OR = 6.78, P = .02), older age (50-69 vs <50) (OR = 2.73, P = .05), and American Society of Anesthesiologists (ASA) ≥3 (OR = 2.45, P = .047). Conclusions: The rate of DRUJ fixation in radial shaft ORIF exceeded previously reported rates of concomitant DRUJ injury, especially among distal radial shaft fractures. More distally located radial shaft fractures are significantly associated with higher rates of DRUJ fixation. Male sex is a risk factor for readmission, whereas dependent functional status, older age, and ASA ≥3 are risk factors for postoperative complications.

Acetabular Chondral Lesions in Hip Arthroscopy: Relationships Between Grade, Topography, and Demographics

2017 ◽  
Vol 45 (11) ◽  
pp. 2501-2506 ◽  
Author(s):  
Carlos Suarez-Ahedo ◽  
Chengcheng Gui ◽  
Stephanie M. Rabe ◽  
Sivashankar Chandrasekaran ◽  
Parth Lodhia ◽  
...  
Keyword(s):  
Traumatic Injury ◽  
Demographic Factors ◽  
Patient Characteristics ◽  
Cross Sectional Study ◽  
Chondral Lesion ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Chondral Lesions ◽  
Chondral Damage ◽  
Male Sex

Background: Hip pain remains a challenge given the multiple factors that can cause damage to the articular cartilage, such as traumatic injury, metabolic damage, and morphologic variations such as femoroacetabular impingement (FAI) and that can contribute to progression of osteoarthritis. However, a direct relationship between patient characteristics, the extent of acetabular chondral damage, and topologic characteristics of chondral lesions has not been established. Purpose: To compare the grade of acetabular chondral damage, measured in terms of acetabular labrum articular disruption (ALAD) classification, to the size and position of the chondral lesions, matching patients’ demographic factors such as age and body mass index (BMI). Study Design: Cross-sectional study; Level of evidence, 3. Methods: This study included all hip arthroscopies performed by the corresponding author from August 7, 2008, to November 19, 2014, in which acetabular chondral lesions were intraoperatively identified and measured in terms of ALAD grade, clockface location, and size. Bivariate analyses and multiple logistic regression were used to identify the demographic factors, characteristics of the acetabular chondral lesion, and other anatomic characteristics that were related to the ALAD grade of the acetabular chondral lesion. Results: Acetabular chondral lesions were measured in 1502 patients during the study period. Multivariate analysis showed that higher ALAD grade of acetabular chondral damage was significantly related to male sex, more advanced age, the area of the acetabular chondral lesion, anterior extension of the acetabular chondral lesion within the anterosuperior quadrant, labral detachment from the acetabular cartilage, and posterior extension of the labral tear. Conclusion: Higher grades of acetabular chondral damage were related to male sex, increased age, height, weight, BMI, and the size of the lesion. Chondral lesions were generally found in the anterosuperior region of the acetabulum, consistent with labral lesions and the weightbearing area of the acetabulum.

Patient Characteristics and Perioperative Outcomes of Female Urethral Diverticulectomy: Analysis of a Multi-Institutional Prospective Database

Urology ◽  
2015 ◽  
Vol 86 (4) ◽  
pp. 712-715 ◽  
Author(s):  
Valary T. Raup ◽  
Deborah S. Hess ◽  
Julian Hanske ◽  
Marianne Schmid ◽  
Briony Varda ◽  
...  
Keyword(s):  
Patient Characteristics ◽  
Perioperative Outcomes ◽  
Prospective Database

scholarly journals A 9-Year Teledermoscopy Service: Retrospective Service Review

Iproceedings ◽  
10.2196/35401 ◽  
2021 ◽  
Vol 6 (1) ◽  
pp. e35401
Author(s):  
Novell Shu Chyng Teoh ◽  
Amanda Oakley
Keyword(s):  
Waiting Time ◽  
Conflicts Of Interest ◽  
Significant Risk ◽  
Patient Characteristics ◽  
Skin Lesions ◽  
Number Needed To Treat ◽  
Melanoma In Situ ◽  
Male Sex

Background A teledermoscopy service was established in January 2010, where patients attended nurse-led clinics for imaging of lesions of concern and remote diagnosis by a dermatologist. Objective The study aimed to review the number of visits, patient characteristics, the efficiency of the service, and the diagnoses made. Methods We evaluated the waiting time and diagnosis of skin lesions for all patient visits from January 1, 2010, to May 31, 2019. The relationships between patient characteristics and the diagnosis of melanoma were specifically analyzed. Results The teledermoscopy clinic was attended by 6479 patients for 11,005 skin lesions on 8805 occasions. Statistically significant risk factors for the diagnosis of melanoma/melanoma in situ were male sex, European ethnicity, and Fitzpatrick skin type 2. Attendance was maximal during 2015 and 2016. The seasonal variation in visits 2011-2018 revealed a consistent peak at the end of summer and a dip at the end of winter. In the year 2010, 306 patients attended; 76% (233/306) of these were discharged to primary care and 24% (73/306) were referred to hospital for specialist assessment. For patients diagnosed by the dermatologist with suspected melanoma from January 1, 2010, to May 31, 2019, the median waiting time for an imaging appointment was 44.5 days (average 57.9 days, range 8-218 days). The most common lesions diagnosed were benign naevus (2933/11,005, 27%), benign keratosis (2576/11,005, 23%), and keratinocytic cancer (1707/11,005, 15%); melanoma was suspected in 5% (507/11,005) of referred lesions (Multimedia Appendix 1). The positive predictive value of melanoma/melanoma in situ was 61.1% (320 true positives and 203 false positives). The number needed to treat (ie, the ratio of the total number of excisions to the number with a histological diagnosis of melanoma/melanoma in situ) was 2.02. Conclusions Diagnoses were comparable to the experience of other teledermoscopy services. Teledermoscopy using a nurse-led imaging clinic can provide efficient and convenient access to dermatology by streamlining referrals to secondary care and prioritizing patients with skin cancer for treatment. Conflicts of Interest None declared.

scholarly journals Pre-existing interstitial lung disease is associated with onset of nivolumab-induced pneumonitis in patients with solid tumors: A retrospective analysis

2019 ◽  
Author(s):  
Teppei Yamaguchi ◽  
Junichi Shimizu ◽  
Takaaki Hasegawa ◽  
Yoshitsugu Horio ◽  
Yoshitaka Inaba ◽  
...  
Keyword(s):  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Solid Tumors ◽  
Odds Ratio ◽  
Malignant Tumors ◽  
Checkpoint Inhibitors ◽  
Patient Characteristics ◽  
Chest Ct ◽  
Life Threatening ◽  
Male Sex

Abstract BackgroundNivolumab, an anti-programmed death 1 (PD-1) monoclonal antibody, has shown survival benefit in clinical trials of various malignant tumors. Nivolumab-induced pneumonitis is major immune-related adverse event (irAE) that is occasionally serious and life-threatening. The aim of this study was to examine the association between pre-existing interstitial lung disease (ILD) on chest computed tomography (CT) and nivolumab-induced pneumonitis among different types of solid tumors.MethodsWe retrospectively collected the clinical data of 311 patients who were diagnosed with non-small cell lung cancer (NSCLC), head and neck cancer (HNC), or gastric cancer (GC), and treated with nivolumab monotherapy. Patients who underwent chest CT immediately before starting nivolumab without previous thoracic radiotherapy or other immune checkpoint inhibitors were eligible. We collected baseline patient characteristics and assessed pre-existing ILD on baseline chest CT.ResultsFinally, 188 patients were included in the analysis: 96 patients with NSCLC, 43 patients with HNC, and 49 patients with GC. NSCLC patients had a significantly higher rate of pre-existing ILD compared with HNC/GC patients (P=0.047). Nivolumab-induced pneumonitis occurred in 11.7% (22 of 188), including 14.6% (14 of 96) of NSCLC, and 8.7% (8 of 92) of HNC/GC. Univariate and multivariate logistic regression analyses revealed that pre-existing ILD (odds ratio, 5.92; 95% confidence interval (CI), 2.07–18.54, P=0.0008) and male sex (odds ratio, 5.58; 95% CI, 1.01–104.40, P=0.049) significantly increased the risk of nivolumab-induced pneumonitis.ConclusionOur results indicated that pre-existing ILD and male sex are risk factors for nivolumab-induced pneumonitis in solid tumors.

scholarly journals 396. Relationship Between Patient Characteristics and Critical Illness in Patients Admitted for CoVID-19

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S266-S267
Author(s):  
Samuel L Windham ◽  
Melissa P Wilson ◽  
Connor Fling ◽  
David W Sheneman ◽  
Taylor Wand ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Patient Characteristics ◽  
Minority Status ◽  
University Of Colorado ◽  
Early Intubation ◽  
Chart Abstraction ◽  
Male Sex ◽  
Poor Outcomes ◽  
Novel Coronavirus ◽  
Hospital Acquired

Abstract Background While several studies have explored hospitalization risk factors with the novel coronavirus (COVID-19) infection, the risk of poor outcomes during hospitalization has primarily relied upon laboratory or hospital-acquired data. Our goal was to identify clinical characteristics associated with intubation or death within 7 days of admission. Methods The first 436 patients admitted to the University of Colorado Hospital (Denver metropolitan area) with confirmed CoVID-19 were included. Demographics, comorbidities, and select medications were collected by chart abstraction. Missing height for calculating body mass index (BMI) was imputed using the median height for patients’ sex and race/ethnicity. Adjusted odds ratios (aOR) were estimated using multivariable logistic regression and a minimax concave penalty (MCP) regularized logistic regression explored prediction. Results Participants had a mean(SD) age 55(17), BMI 30.9(8.2), 55% were male and 80% were ethnic/racial minorities. Unadjusted comparisons by outcome are shown (Table 1). Male sex (aOR: 1.60, 95% CI (1.02, 2.54)), increasing age (aOR: 1.25(1.08, 1.47); per 10 years), higher BMI (aOR 1.03(1.00, 1.06) and poorly controlled diabetes (hemoglobin A1C ≥8) (aOR 2.33(1.27, 4.27) were significantly (p&lt; 0.05) associated with greater odds of intubation or death. Minority status tended to be associated with higher odds (aOR:1.8(1.01,3.36); p=0.052). Surprisingly, need for hospital interpreter was associated with decreased odds (OR: 0.58(0.35, 0.95)) of intubation/death. Our final MCP model included indicators of A1C≥8, age &gt;65, sex and minority status, but predicted intubation/death only slightly better than random chance (AUC= 0.61(0.56, 0.67)). Table 1. Patient Characteristics Stratified by Intubation and/or Death Within One Week of Admission (n=436) Conclusion In a hospitalized patient cohort with COVID-19, male sex, poorly controlled diabetes, increasing age and BMI were significantly associated with early intubation or death. These results complement larger cohort studies, and highlight risk differences across metropolitan areas with varying COVID-19 prevalence, demographics, and comorbid disease burden. Notably, our predictive model had limited success, which may suggest unmeasured factors also contribute to disease severity differences. Disclosures All Authors: No reported disclosures

Pulmonary embolism rule out: positivity and factors affecting the yield of CT angiography

2020 ◽  
Vol 96 (1140) ◽  
pp. 594-599 ◽  
Author(s):  
Tanya Aggarwal ◽  
Ali Eskandari ◽  
Sarv Priya ◽  
Aidan Mullan ◽  
Ishan Garg ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Patient Characteristics ◽  
Pulmonary Angiography ◽  
Test Results ◽  
Factors Affecting ◽  
Significant Difference ◽  
The Usa ◽  
Male Sex ◽  
The Difference ◽  
Rule Out

ObjectiveCT pulmonary angiography (CTPA) is one of the most commonly ordered CT imaging tests. It is often believed to be overutilised with few recent studies showing a yield of less than 2%. This study aimed to determine the overall positivity rate of CTPA examinations and understand the factors that affect the yield of the CTPA examination.MethodsWe retrospectively analysed 2713 patients who received the CTPA exam between 2016 and 2018. Type of study ordered (CTPA chest or CTPA chest with abdomen and pelvis CT), patient location (emergency department (ED), outpatient, inpatient, intensive care unit (ICU)) and patient characteristics—age, sex and body mass index (BMI) were recorded. A logistic regression analysis was performed to determine what factors affect the positivity rate of CT scans for pulmonary embolism (PE).ResultsWith 296 positive test results, the overall CTPA positivity was 10.9%. Male sex was associated with higher CTPA positivity, gender difference was maximum in 18-year to 35-year age group. Overweight and obese patients had significantly higher positivity as compared with BMI<25 (p<0.05). Higher positivity rate was seen in the BMI 25–40 group (11.9%) as compared with BMI>40 (10.1%) (p<0.05). Significant difference (p<0.001) was also found in CTPA examination yield from ICU (15.3%) versus inpatients (other than ICU) (12.4%) versus ED (9.6%), and outpatients (8.5%). The difference in CTPA yield based on the type of CT order (CTPA chest vs CTPA chest with CT abdomen and pelvis), patient’s age and sex was not significant.ConclusionCTPA yield of 10.9% in this study is comparable to acceptable positivity rate for the USA and is higher than recent studies showing positivity of <2%. Patient characteristics like obesity and ICU or inpatient location are associated with higher rate of CT positivity.

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