Borderline basal ganglia hemorrhage volume: patient selection for good clinical outcome after stereotactic catheter drainage

2016 ◽  
Vol 125 (5) ◽  
pp. 1242-1248 ◽  
Author(s):  
Yeon Soo Choo ◽  
Joonho Chung ◽  
Jin-Yang Joo ◽  
Yong Bae Kim ◽  
Chang-Ki Hong
Keyword(s):  
Basal Ganglia ◽  
Clinical Outcome ◽  
Internal Capsule ◽  
Hematoma Volume ◽  
Good Clinical Outcome ◽  
Catheter Drainage ◽  
Motor Weakness ◽  
Group A ◽  
Basal Ganglia Hemorrhage ◽  
Group B

OBJECTIVE The purpose of this study was to determine predisposing factors for good clinical outcome in patients with spontaneous basal ganglia hemorrhage with borderline volumes (defined as a hematoma volume between 20 and 50 cm3) who had undergone treatment by stereotactic catheter drainage. METHODS From the 298 patients whose information had been prospectively collected in the institutional database between January 2010 and December 2013, 93 patients were included in this retrospective study and divided into 2 groups: best medical treatment alone (Group A, n = 44) and best medical treatment plus catheterization (Group B, n = 49). All patients met the following criteria: 1) a diagnosis of spontaneous basal ganglia hemorrhage, and 2) a borderline hematoma volume (20 to 50 cm3). Postoperative modified Rankin Scale (mRS) scores and recovery of motor weakness were compared between the 2 groups, and predisposing factors for good clinical outcome were evaluated. RESULTS Patients in Group B showed earlier recovery of motor weakness and improved mRS scores than patients in Group A. The final mRS score at 12 months was better in Group B than in Group A (p = 0.006). Predisposing factors for a good clinical outcome were a hematoma volume < 30 cm3 (OR 6.158, 95% CI 1.221–31.053, p = 0.028), an initial Glasgow Coma Scale (GCS) score ≥ 13 (OR 6.331, 95% CI 1.129–35.507, p = 0.036), the absence of internal capsule involvement (OR 4.680, 95% CI 1.152–19.010, p = 0.031), and catheterization (OR 13.376, 95% CI 2.423–73.842, p = 0.003) based on logistic regression analysis. CONCLUSIONS Good clinical outcome can be expected after stereotactic catheter drainage in patients with a hematoma volume between 20 and 30 cm3, an initial GCS score ≥ 13, and the absence of internal capsule involvement. Among these patients, stereotactic catheter drainage may have a beneficial effect on early recovery of motor weakness and functional outcome, indicating that lateral-type basal ganglia hematoma compression not involving the internal capsule may be better treated using stereotactic catheter drainage than treated medically.

scholarly journals Evaluation of Volumetric Change of Intracerebral Hemorrhage in Patients Treated with Thrombolysis for Intraventricular Hemorrhage

2020 ◽  
Author(s):  
Franziska Staub-Bartelt ◽  
Jasper Hans van Lieshout ◽  
Thomas Beez ◽  
Rainer Kram ◽  
Daniel Hänggi ◽  
...  
Keyword(s):  
Basal Ganglia ◽  
Intracerebral Hemorrhage ◽  
Ct Scan ◽  
Intraventricular Hemorrhage ◽  
Volume Reduction ◽  
Percentage Reduction ◽  
Hematoma Volume ◽  
Group A ◽  
Group B ◽  
Lysis Therapy

Abstract Background Intraventricular hemorrhage (IVH) is often caused by irruption of intracerebral hemorrhage (ICH) of basal ganglia or thalamus into the ventricular system. Instillation of recombinant tissue plasminogen activator (rtPA) via an external ventricular drainage (EVD) has been shown to effectively decrease IVH volumes while the impact of rtPA instillation on ICH volumes remains unclear. In this series, we analyzed volumetric changes of ICH in patients with and without intrathecal lysis therapy. Methods Between 01/2013 and 01/2019, 36 patients with IVH caused by hemorrhage of basal ganglia, thalamus or brain stem were treated with rtPA via an EVD (Group A). Initial volumes were determined in the first available computed tomography (CT) scan, final volumes in the last CT scan before discharge. During the same period, 41 patients with ICH without relevant IVH were treated without intrathecal lysis therapy at our neurocritical care unit (Group B). Serial CT scans were evaluated separately for changes in ICH volumes for both cohorts using OsiriX DICOM viewer. The Wilcoxon signed-rank test was performed for statistical analysis in not normally distributed variables. Results Median initial volume of ICH for treatment Group A was 6.5 ml and was reduced to 5.0 ml after first instillation of rtPA (p < 0.01). Twenty-six patients received a second treatment with rtPA (ICH volume reduction 4.5 to 3.3 ml, p < 0.01) and of this cohort further 16 patients underwent a third treatment (ICH volume reduction 3.0 ml to 1.5 ml, p < 0.01). Comparison of first and last CT scan in Group A confirmed an overall median percentage reduction of 91.7% (n = 36, p < 0.01) of ICH volumes and hematoma resolution in Group A was significantly more effective compared to non-rtPA group, Group B (percentage reduction = 68%) independent of initial hematoma volume in the regression analysis (p = 0.07, mean 11.1, 95%CI 7.7–14.5). There were no adverse events in Group A related to rtPA instillation. Conclusion Intrathecal lysis therapy leads to a significant reduction in the intraparenchymal hematoma volume with faster clot resolution compared to the spontaneous hematoma resorption. Furthermore, intrathecal rtPA application had no adverse effect on ICH volume.

scholarly journals Comparison of endoscopic evacuation, stereotactic aspiration, and craniotomy for treatment of basal ganglia hemorrhage

2019 ◽  
Vol 12 (1) ◽  
pp. 55-61 ◽  
Author(s):  
Wei Guo ◽  
Haixiao Liu ◽  
Zhijun Tan ◽  
Xiaoyang Zhang ◽  
Junmei Gao ◽  
...  
Keyword(s):  
Basal Ganglia ◽  
Surgical Techniques ◽  
Multivariate Logistic Regression Model ◽  
Hematoma Volume ◽  
Entire Cohort ◽  
Stereotactic Aspiration ◽  
Group A ◽  
Basal Ganglia Hemorrhage ◽  
The Difference ◽  
Large Hematoma

BackgroundThe main surgical techniques for spontaneous basal ganglia hemorrhage include stereotactic aspiration, endoscopic aspiration, and craniotomy. However, credible evidence is still needed to validate the effect of these techniques.ObjectiveTo explore the long-term outcomes of the three surgical techniques in the treatment of spontaneous basal ganglia hemorrhage.MethodsFive hundred and sixteen patients with spontaneous basal ganglia hemorrhage who received stereotactic aspiration, endoscopic aspiration, or craniotomy were reviewed retrospectively. Six-month mortality and the modified Rankin Scale score were the primary and secondary outcomes, respectively. A multivariate logistic regression model was used to assess the effects of different surgical techniques on patient outcomes.ResultsFor the entire cohort, the 6-month mortality in the endoscopic aspiration group was significantly lower than that in the stereotactic aspiration group (odds ratio (OR) 4.280, 95% CI 2.186 to 8.380); the 6-month mortality in the endoscopic aspiration group was lower than that in the craniotomy group, but the difference was not significant (OR=1.930, 95% CI 0.835 to 4.465). A further subgroup analysis was stratified by hematoma volume. The mortality in the endoscopic aspiration group was significantly lower than in the stereotactic aspiration group in the medium (≥40–<80 mL) (OR=2.438, 95% CI 1.101 to 5.402) and large hematoma subgroup (≥80 mL) (OR=66.532, 95% CI 6.345 to 697.675). Compared with the endoscopic aspiration group, a trend towards increased mortality was observed in the large hematoma subgroup of the craniotomy group (OR=8.721, 95% CI 0.933 to 81.551).ConclusionEndoscopic aspiration can decrease the 6-month mortality of spontaneous basal ganglia hemorrhage, especially in patients with a hematoma volume ≥40 mL.

scholarly journals A positron emission tomography study of cerebrovascular reserve before and after shunt surgery in patients with idiopathic chronic hydrocephalus

2000 ◽  
Vol 8 (2) ◽  
pp. 1-5 ◽  
Author(s):  
Petra M. Klinge ◽  
Georg Berding ◽  
Thomas Brinker ◽  
Wolfram H. Knapp ◽  
Madjid Samii
Keyword(s):  
Positron Emission Tomography ◽  
Clinical Outcome ◽  
Emission Tomography ◽  
Control Group ◽  
Chronic Hydrocephalus ◽  
Cerebrovascular Reserve ◽  
Shunt Placement ◽  
Positron Emission ◽  
Group A ◽  
Group B

Object In this study the authors use positron emission tomography (PET) to investigate cerebral blood flow (CBF) and cerebrovascular reserve (CVR) in chronic hydrocephalus. Methods Ten patients whose mean age was 67 ± 10 years (mean ± standard deviation [SD]) were compared with 10 healthy volunteers who were 25 ±3 years of age. Global CBF and CVR were determined using 15O–H2O and PET prior to shunt placement and 7 days and 7 months thereafter. The CVR was measured using 1 g acetazolamide. Neurological status was assessed based on a score assigned according to the methods of Stein and Langfitt. Seven months after shunt placement, five patients showed clinical improvement (Group A) and five did not (Group B). The average global CBF before shunt deployment was significantly reduced in comparison with the control group (40 ± 8 compared with 61 ± 7 ml/100 ml/minute; mean ± SD, p < 0.01). In Group A the CBF values were significantly lower than in Group B (36 ± 7 compared with 44 ± 8 ml/100 ml/minute; p < 0.05). The CVR before surgery, however, was not significantly different between groups (Group A = 43 ± 21%, Group B = 37 ± 29%). After shunt placement, there was an increase in the CVR in Group A to 52 ± 37% after 7 days and to 68 ± 47% after 7 months (p < 0.05), whereas in Group B the CVR decreased to 14 ± 18% (p < 0.05) after 7 days and returned to the preoperative level (39 ± 6%) 7 months after shunt placement. Conclusions The preliminary results indicate that a reduced baseline CBF before surgery does not indicate a poor prognosis. Baseline CBF before shunt placement and preoperative CVR are not predictive of clinical outcome. A decrease in the CVR early after shunt placement, however, is related to poor late clinical outcome, whereas early improvement in the CVR after shunt placement indicates a good prognosis.

MR Imaging and Proton MR Spectroscopy of the Brain in Behçet's Disease

2003 ◽  
Vol 16 (2) ◽  
pp. 267-273 ◽  
Author(s):  
M. Cellerini ◽  
M. Bartolucci ◽  
M. Mortilla ◽  
M. Mascalchi ◽  
F. Li Gobbi ◽  
...  
Keyword(s):  
White Matter ◽  
Basal Ganglia ◽  
Mr Imaging ◽  
Mr Spectroscopy ◽  
Subcortical White Matter ◽  
Neurological Involvement ◽  
Medium Size ◽  
Proton Mr Spectroscopy ◽  
Group A ◽  
Group B

Cerebral MR imaging (MR) and proton-MR spectroscopy (H-MRS) data are lacking in neurologically asymptomatic patients with Behçet's disease (BD). Aim of the following work was to assess MR and H-MRS characteristics of brain involvement over time in patients with BD without clinical neurological involvement. Forty cerebral MR and 12 H-MRS examinations obtained over a one to nine year follow-up in 17 patients with (group A n=9) or without (group B n=8) neurological involvement were retrospectively reviewed. Four group-B patients had a normal first MR examination whereas all group-A and four group-B patients showed single (n?3) or multiple (n=10) subcortical white matter foci of signal change. Large midbrain, basal ganglia or subcortical white matter lesions were depicted in six group-A patients. Comparison between initial and last MR examinations revealed 28 new small-to-medium size lesions. Over the course of the study, lesion enhancement was seen in five patients all belonging to group A. NAA/Cr and Cho/Cr ratios of supraventricular white matter did not show significant differences between patients and healthy controls or between group-A and group-B patients. Clinically silent cerebral involvement in the form of small-to-medium size subcortical lesions may be present at MR examination in BD patients. Large brainstem and basal ganglia lesions associated with overt neurological symptoms are characteristic of the disease. H-MRS of cerebral normal-appearing white matter does not show any significant metabolic change in BD.

Microrna Expression Profile Identifies Distinct Clinically Relevant Sub-Groups in Multiple Myeloma: Novel Prognostic Markers and Potential Targets for Therapy

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 96-96 ◽  
Author(s):  
Sophia Adamia ◽  
Herve AvetLoiseau ◽  
Samirkumar B Amin ◽  
Yu-Tzu Tai ◽  
Steven P. Treon ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Cell Differentiation ◽  
Clinical Outcome ◽  
Signaling Pathways ◽  
Cell Lines ◽  
Plasma Cells ◽  
Normal Plasma ◽  
Group A ◽  
Group B

Abstract MicroRNA, an abundant class of small endogenous RNAs, regulate target genes through inducing translational inhibition and cleavage of targeted transcripts. To date, microRNAs have been implicated in normal biological processes, including development, cell differentiation, apoptosis and proliferation as well as in malignant transformation. However, their role in multiple myeloma (MM) remains unknown. Here we investigated role of microRNAs in myelomagenesis, and their influence on prognosis and clinical outcome. We evaluated profiles of 384 microRNAs in bone marrow derived CD138+ plasma cells (PC) from 79 uniformly treated MM patients, 11 MM cell lines and 9 healthy donors using qRT-PCR based microRNA array. The relative expression was calculated using comparative Ct method, and data was normalized using endogenous controls and analyzed using SDS, RQ manager, R and dChip softwares. MicroRNA expression profiles detected in MM patients were correlated with clinical outcome measures. We observed significant modulate expression of 61 microRNAs in myeloma cells compared to normal plasma cells. When more stringent criteria were used, we identified 24 differentially expressed microRNAs in patient samples. Further, unsupervised hierarchical clustering of filtered microRNAs, based on their DCt values, identified two major groups within the MM population (groups A and group B). Samples of Group A clusters with MM cell lines, indicating more proliferative nature of MM patient cells. Within B group, a second degree node group B2, clusters with normal plasma cells indicating more indolent course, while patients in an additional node B1 represented an assorted pattern. The unsupervised clustering of all MM samples showed consistent changes in miR-30b, -30c, -30d, -142-5p, -24, -191, -181d, -374, -146b, -140, -145, -125a, -151, -223, -155, let7b, indicative of a role of these microRNA in myelomagenesis; while supervised analysis of samples within groups A and B identified modulated expression of different sets of miRNAs. In group A miR-585 and let-7f were upregulated 8–12 fold, while miRs -125a, -126, -155, -223, -146a, -374 -19a, -20a, -26a, -30a -5p, -30b, and -30d were significantly downregulated; in group B, all differentially expressed microRNAs were downregulated (p<0.001) compared to normal plasma cells. These modulated miRNAs target critical signaling pathways including apoptosis, hematopoietic cell differentiation and proliferation, survival and angiogenesis by upregulating function of HOX9, c-myc, VCAM-1, Bcl-2, E2F1, SHP1, SHP2, VEGF, and DUSp6 molecules. We further analyzed the effect of microRNA on clinical outcome. We have observed significantly superior event free and overall survival of patients in group B2 compared to patients in group A (2 yr estimated EFS 79% versus 54% respectively; p=0.05; and 2 yr estimated OS 94% versus 70% respectively; p =0.017). Taken together this data identifies critical microRNAs as modulators of gene expression and signaling pathways and provides potential novel microRNA and gene targets in MM to both understand biological behavior and for therapeutic application.

Radiosurgery for Basal Ganglia, Internal Capsule, and Thalamus Arteriovenous Malformation: Clinical Outcome

Neurosurgery ◽  
2005 ◽  
Vol 56 (1) ◽  
pp. 56-64 ◽  
Author(s):  
Yuri M. Andrade-Souza ◽  
Gelareh Zadeh ◽  
Daryl Scora ◽  
May N. Tsao ◽  
Michael L. Schwartz ◽  
...  
Keyword(s):  
Basal Ganglia ◽  
Clinical Outcome ◽  
Internal Capsule ◽  
Patient Characteristics ◽  
Treatment Modalities ◽  
Study Patient ◽  
Excellent Outcome ◽  
Risk Of Hemorrhage ◽  
Brain Avms ◽  
Median Maximum

Abstract OBJECTIVE: Radiosurgery is accepted as the first option for treating deep arteriovenous malformations (AVMs), although the clinical outcome in this subgroup of brain AVMs is not well studied. The objective of this study is to review our experience with radiosurgical treatment for these AVMs. METHODS: Between October 1989 and December 2000, 45 patients with deep AVMs (including basal ganglia, internal capsule, and thalamus) underwent stereotactic radiosurgery. Three patients were lost to follow-up and therefore were excluded from this study. Patient characteristics and outcomes were collected and analyzed. The obliteration prediction index and the radiosurgery-based AVM score were calculated and tested. RESULTS: Forty-two patients were followed up for a median of 39 months (range, 25–90 mo; mean, 45.8 mo). The median maximum AVM diameter during the radiosurgery was 1.8 cm (range, 0.9–4.0 cm; mean, 2.07 cm), and the median AVM volume was 2.8 cm3 (range, 0.2–18.3 cm3; mean, 4.74 cm3). The mean marginal dose was 16.2 Gy (median, 15 Gy), and the median maximum dose was 22.4 Gy (range, 16.6–30 Gy). The AVM cure rate after the first radiosurgical treatment, using angiography- and magnetic resonance imaging-confirmed obliteration, was 61.9%. The predicted obliteration using the obliteration prediction index was 60%. Eight patients developed radiation-induced complications (19%). The deficit was transient in three patients (7.1%) and permanent in five patients (11.9%). The risk of postradiosurgical hemorrhage in this cohort was 9.5% for the first year, 4.7% for the second year, and 0% thereafter. Excellent outcome (obliteration plus no new deficit) was achieved in 70% of the patients in the group with radiosurgery-based AVM score less than 1.5 compared with 40.9% in the group with radiosurgery-based AVM score greater than 1.5% (P = 0.059). CONCLUSION: Radiosurgery for deep AVMs has a satisfactory obliteration rate and acceptable morbidity, considering the risk of hemorrhage without treatment and the risk of morbidity associated with other treatment modalities.

scholarly journals Transcranial versus Endoscopic Transsphenoidal Approaches in Management of Recurrent Giant Pituitary Adenomas

2020 ◽  
Vol 8 (B) ◽  
pp. 273-280
Author(s):  
Mohamed Ismail ◽  
Omar Abdel Aleem Abdel Moneim Ragab ◽  
Mohamed M. Salama ◽  
Basim M. Ayoub ◽  
Wael Elmahdy
Keyword(s):  
Clinical Outcome ◽  
Pituitary Adenomas ◽  
Tumor Resection ◽  
Transsphenoidal Approach ◽  
Subtotal Resection ◽  
Visual Improvement ◽  
Group A ◽  
Transcranial Approach ◽  
Giant Pituitary Adenomas ◽  
Group B

AIM: The aim of this study was to compare the transcranial and the endoscopic transsphenoidal approaches for patients with recurrent giant pituitary adenomas as regards the extent of tumor resection and the clinical outcome. METHODS: The study included 21 patients with recurrent giant pituitary adenomas divided into two groups; Group A included nine patients operated on by transcranial approaches and Group B included 12 patients operated on by the endoscopic transsphenoidal approach. Both groups were compared as regards the extent of tumor resection and the post-operative clinical outcome, particularly the visual and endocrinological outcomes, in addition to morbidity and mortality. RESULTS: There was a higher incidence of total and near-total resection in Group B (41.7%) and a higher incidence of subtotal resection in Group A (55.6%). The incidence of visual improvement was higher in Group B (55.6%) than in Group A (28.6%). Post-operative biochemical remission was achieved in 100% of Group B patients and in 50% of Group A patients with functioning adenomas. The incidence of post-operative complications was higher in Group A (77.8%) than in Group B (50%). CONCLUSION: The endoscopic transsphenoidal approach for recurrent giant pituitary adenomas is associated with a higher extent of tumor resection, better rates of visual improvement and endocrinological remission, and lower incidence of complications. The transcranial approach should be reserved for some adenomas with marked lateral or anterior extensions, fibrous tumors, and after the failure of the endoscopic transsphenoidal approach.

scholarly journals Traumatic Basal Ganglia Hematoma

2014 ◽  
Vol 48 (3) ◽  
pp. 154-156
Keyword(s):  
Basal Ganglia ◽  
Head Injury ◽  
Severe Head Injury ◽  
Motor Response ◽  
Brain Injuries ◽  
Internal Capsule ◽  
Coagulation Disorders ◽  
Basal Ganglia Hemorrhage ◽  
Hemorrhagic Lesion ◽  
Abnormal Motor

ABSTRACT Traumatic basal ganglia hemorrhage (TBGH) is characterized as a hemorrhagic lesion located in the basal ganglia or in internal capsule or thalamus. Outcome of TBGH is mainly determined by the extent of associated brain injuries particularly the larger the size, presence of coagulation disorders, diffuse, presence of intraventricular or brain stem hemorrhage, age ≥60, pupillary asymmetry, abnormal motor response, and severe head injury all are associated with poorer outcome. In present case, we discuss a case of adult male traumatic basal ganglia hemorrhage with good outcome. How to cite this article Agrawal A. Traumatic Basal Ganglia Hematoma. J Postgrad Med Edu Res 2014;48(3):154-156.

LDH serum levels as a predictive factor for global outcome in pretreated colorectal cancer patients receiving regorafenib: Implications for clinical management.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 497-497 ◽  
Author(s):  
Michela Del Prete ◽  
Mario Scartozzi ◽  
Tiziana Prochilo ◽  
Luca Faloppi ◽  
Riccardo Giampieri ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Clinical Outcome ◽  
Cancer Patients ◽  
Progression Free Survival ◽  
Serum Levels ◽  
Roc Curve Analysis ◽  
Group A ◽  
Group B ◽  
Colorectal Cancer Patients

497 Background: Although a demonstrated clinical efficacy, a non negligible proportion of colorectal cancer patients does not seem to benefit from regorafenib and are consequently exposed to unnecessary toxicity. LDH serum levels represent an indirect marker of tumour hypoxia, neo-angiogenesis and worse prognosis in many tumour types. In colorectal cancer LDH showed a correlation with treatment outcome for patients receiving antiangiogenetic treatment, thus suggesting a possible interaction with the activity profile of these drugs. We analyzed the role of LDH serum levels in predicting clinical outcome for pre-treated metastatic colorectal cancer patients receiving regorafenib. The final aim was to individuate a potentially reliable and easy to use marker for patients stratification. Methods: 118 colorectal cancer patients treated with regorafenib were available for our analysis. For all patients, LDH values were collected within one month before the procedure and after treatment end. LDH cutoff value was determined by ROC curve analysis, patients were then divided into two groups (A and B, below and above cut-off level respectively). Patients were also classified according to the variation in LDH serum levels pre- and post-treatment (increased patients vs. decreased patients). Results: Patients in group A and B proved homogeneous for all clinical characteristics analyzed. In group A patients median progression free survival (PFS) was 3.18 months, whereas it was 1.87 months in group B patients (p = 0.0018). Median overall survival (OS) was 6.23 months and 3.28 months in group A and B respectively (p = 0.048). Significant differences were not noted among the 2 groups for response rate. All the other clinical variables analyzed failed to show any correlation with patients outcome. Conclusions: Our observations seem to suggest a role of LDH as a marker of clinical outcome in colorectal cancer patients receiving regorafenib. We can then speculate that high LDH patients may not be optimal candidates for regorafenib. After further confirmation in larger trial, these findings may be relevant for a better patients stratification and selection.

Newborn Screening for Sickle Cell Disease in Brussels, a Program with an Ongoing Clinical Outcome Improvement

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4757-4757
Author(s):  
Phu-Quoc Le ◽  
Beatrice Gulbis ◽  
Laurence Dedeken ◽  
Anna Vanderfaeillie ◽  
Catherine Heijmans ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Newborn Screening ◽  
Comprehensive Care ◽  
Acute Chest Syndrome ◽  
Cell Disease ◽  
Number Of Patients ◽  
Group A ◽  
Neurological Event ◽  
Group B

Abstract Abstract 4757 Early identification of sickle cell disease (SCD) by newborn screening (NS) is well established to be an efficient and practical tool in enhancing the health care of affected patients with SCD. The aim of our study, conducted in Brussels Region, was to assess whether there is an ongoing improvement of clinical outcome of children with SCD detected by the NS program. Universal NS was progressively implemented in Brussels starting within a few maternity wards in 1994 and extending to all maternity wards in 2000. Children identified with SCD progressively benefited from comprehensive expert medical care in three dedicated reference centers. Care included education, prevention, emergency and specific out-patient and in-patient treatments. To evaluate the improvement in comprehensive care, we reviewed data of children born from January 1st 2000 to December 31st 2003 (group A) and from January 1st 2005 to December 31st 2008 (group B). All data were recorded from January 1st 2000 to December 31st 2005 for group A and from January 1st 2005 to December 31st2010 for group B. Both groups had the same follow-up period accounting for 118 patient-years in group A and 259 patient-years in group B. Median follow-up was 3.5 yrs (range 2.06–5.83 yrs) and 4.1 yrs (range 2.08–5.96 yrs) in group A and B respectively. The major events such as septicemia, anemia, dactylitis, vaso-occlusive event (VOC), acute chest syndrome (ACS), symptomatic neurological events and hospital days were reviewed and compared during the study follow-up between the two groups. The reasons for hospitalization that were selected were: septicemia, pneumonia, urinary tract infection, osteomyelitis, gastroenteritis, VOC crisis, dactylitis, ACS, acute splenic sequestration, aplastic episodes and neurologic events. Several biological parameters were also reviewed. Among the 98 patients identified with SCD at birth, 33 (16 girls and 17 boys) and 65 (37 girls and 28 boys) belonged to group A and B, respectively. In group A, 25 children were HbSS, 2 HbSβ+ and 6 HbSC. In group B, 53 were HbSS, 5 HbSβ°, 5 HbSβ+ and 2 had an other genotype. Most of the patients developed at least one major adverse event during the study period. The proportion of patients having presented severe anemia and acute chest syndrome was significantly lower in group B than in group A (table 1). The higher rate of septicemia in group A could be due to the delayed implementation of national vaccination for Streptococcus pneumonia or to the poor prophylactic penicillin compliance. No difference was observed between both groups for dactylitis, VOC and clinical neurological event. No patient died during the study period. Hematological parameters at one year of age were not different between both groups. In conclusion, newborn screening is obviously recognized as a precious tool to identify patients with SCD. However, it must be part of a comprehensive care program. Our results demonstrated that its sustained effectiveness is really and clearly proven when it is coupled with a comprehensive and dedicated treatment program including close and regular parent education. This ongoing assessment should be performed to monitor and improve the screening program. Thereby the progressively implementation of comprehensive care has improved over time the quality of SCD management and then the outcome of patients in Brussels Region. Table 1. Patients identified by neonatal screening in Brussels with SCD related events SCD related events Group A (N=33) Follow-up from 2000–2005 Number of patients (%) Group B (N=65) Follow up from 2005–2010 Number of patients (%) P value Dactylitis 9 (27.3) 19 (29.2) 1.0 Acute Chest Syndrome 14 (42.4) 10 (15.4) 0.005 Vaso-Occlusive Crisis 21 (63.6) 29 (44.6) 0.09 Anemia ≤ 6 g/dl 22 (66.7) 26 (40.00) 0.02 Septicemia 3 (9.1) 1 (1.5) 0.10 Neurological Event 0 (0.0) 2 (3.1) 0.55 Disclosures: No relevant conflicts of interest to declare.

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