scholarly journals Comparative analysis of outcomes following craniotomy and expanded endoscopic endonasal transsphenoidal resection of craniopharyngioma and related tumors: a single-institution study

2016 ◽  
Vol 124 (3) ◽  
pp. 627-638 ◽  
Author(s):  
Sunil Jeswani ◽  
Miriam Nuño ◽  
Arthur Wu ◽  
Vivien Bonert ◽  
John D. Carmichael ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Surgical Outcomes ◽  
Demographic Data ◽  
Extent Of Resection ◽  
The Other ◽  
Tumor Characteristics ◽  
Endoscopic Endonasal ◽  
Patient Demographic ◽  
Concordance Analysis ◽  
Patient Demographic Data

OBJECT Craniopharyngiomas and similar midline suprasellar tumors have traditionally been resected via transcranial approaches. More recently, expanded endoscopic endonasal transsphenoidal approaches have gained interest. Surgeons have advocated for both approaches, and at present there is no consensus whether one approach is superior to the other. The authors therefore compared surgical outcomes between craniotomy and endoscopic endonasal transsphenoidal surgery (EETS) for suprasellar tumors treated at their institution. METHODS A retrospective review of patients undergoing resection of suprasellar lesions at Cedars-Sinai Medical Center between 2000 and 2013 was performed. Patients harboring suspected craniopharyngioma were selected for extensive review. Other pathologies or predominantly intrasellar masses were excluded. Cases were separated into 2 groups, based on the surgical approach taken. One group underwent EETS and the other cohort underwent craniotomy. Patient demographic data, presenting symptoms, and previous therapies were tabulated. Preoperative and postoperative tumor volume was calculated for each case based on MRI. Student t-test and the chi-square test were used to evaluate differences in patient demographics, tumor characteristics, and outcomes between the 2 cohorts. To assess for selection bias, 3 neurosurgeons who did not perform the surgeries reviewed the preoperative imaging studies and clinical data for each patient in blinded fashion and indicated his/her preferred approach. These data were subject to concordance analysis using Cohen’s kappa test to determine if factors other than surgeon preference influenced the choice of surgical approach. RESULTS Complete data were available for 53 surgeries; 19 cases were treated via EETS, and 34 were treated via craniotomy. Patient demographic data, preoperative symptoms, and tumor characteristics were similar between the 2 cohorts, except that fewer operations for recurrent tumor were observed in the craniotomy cohort compared with EETS (17.6% vs 42.1%, p = 0.05). The extent of resection was similar between the 2 groups (85.6% EETS vs 90.7% craniotomy, p = 0.77). An increased rate of cranial nerve injury was noted in the craniotomy group (0% EETS vs 23.5% craniotomy, p = 0.04). Postoperative CSF leak rate was higher in the EETS group (26.3% EETS vs 0% craniotomy, p = 0.004). The progression-free survival curves (log-rank p = 0.99) and recurrence rates (21.1% EETS vs 23.5% craniotomy, p = 1.00) were similar between the 2 groups. Concordance analysis of cases reviewed by 3 neurosurgeons indicated that individual surgeon preference was the only factor that determined surgical approach (kappa coefficient −0.039, p = 0.762) CONCLUSIONS Surgical outcomes were similar for tumors resected via craniotomy or EETS, except that more CSF leaks occurred in the EETS cohort, whereas more neurological injuries occurred in the craniotomy cohort. Surgical approach appears to mostly reflect surgeon preference rather than specific tumor characteristics. These data support the view that EETS is a viable alternative to craniotomy, providing a similar extent of resection with less neurological injury.

Accuracy of EMS-Recorded Patient Demographic Data

2008 ◽  
Vol 12 (2) ◽  
pp. 187-191 ◽  
Author(s):  
Jane H. Brice ◽  
Kevin D. Friend ◽  
Theodore R. Delbridge
Keyword(s):  
Demographic Data ◽  
Patient Demographic ◽  
Patient Demographic Data

scholarly journals Medial Displacement Osteotomy Performed Concurrently with Triple Arthrodesis Improves Pain and Mobility in Patients with Rigid Flatfoot Deformity and Hindfoot Valgus

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Mitchell Fourman ◽  
Patrick Ward ◽  
Dane Wukich
Keyword(s):  
Demographic Data ◽  
Categorical Variables ◽  
Wound Complications ◽  
Deltoid Ligament ◽  
Posterior Tibial Tendon ◽  
Triple Arthrodesis ◽  
Patient Demographic ◽  
Displacement Osteotomy ◽  
Patient Demographic Data

Category: Hindfoot, Midfoot/Forefoot, Flatfoot Introduction/Purpose: Progression of flatfoot deformity and arthritis affects 6-38% of patients with posterior tibial tendon dysfunction treated with a triple arthrodesis. Current theory suggests that undercorrection of hindfoot valgus places abnormal stresses on the deltoid ligament and tibiotalar joint, contributing to the development of increased valgus tilt of the ankle joint or collapse of the medial arch. No large series to our knowledge has attempted to assess the potential benefit of the prospective correction of hindfoot valgus at the time of the triple fusion. Here we analyze the outcomes of 31 unilateral Stage III or IV rigid flatfoot corrections performed with concurrent medial displacement osteotomies. Methods: In an institutional review board approved retrospective study, a total of 31 feet in 31 patients were operated upon from 1/1/2009 to 1/1/2016 by a single surgeon at a large academic medical center. American Orthopaedic Foot & Ankle Society hindfoot scores and visual analog pain scores (VAS) were obtained prior to surgery and at the final post-operative follow-up where available). Foot and Ankle Ability Measure (FAAM) scores were available for 17 (54.8%) of patients. Patient demographic data, including age, body mass index (BMI), charlson comorbidity score, smoking status, and HbA1c where available were recorded. Additional surgical outcomes of interest included a return to unassisted mobility in a shoe or boot, infection and wound complication rate, 90 day re-admissions and revision/subsequent procedures. Pre-and post-operative data were analyzed using Student’s t-test for continuous variables, and Fisher’s exact test for categorical variables using Graphpad Prism (LaJolla, CA). Results: Patient demographic data is demonstrated in figure 1. Average follow-up was 1.3 ± 1.1 years (range .5 to 6.0 years). Average Pre-operative AOFAS scores available from 23/31 (74.2% of patients) averaged 33.5, with 1-year post-operative scores (8/31, 25.8%) of 76.8 ± 4.6 (p < .0001). VAS scores decreased from 6 ± 2.9 to 2 ± 2.7 (p < .0001). Superficial infections were treated in 3/31 (9.7%) of patients, while wounds developed in 6.5%. Mobility without assistive modality in a shoe or boot was reported by 30/31 (96.8%) patients, with one patient requiring a walker. No 90-day readmissions occurred, no amputations occurred, and a single patient returned to the OR 393 days after admission for symptomatic hardware removal. Conclusion: Here we demonstrate in a large retrospective analysis that performing a medial displacement osteotomy in patients with hindfoot valgus in the setting of rigid flatfoot deformity results in nearly universal remobilization, substantially improved functional outcomes, and significantly decreased pain. Few patients had wound complications or infections, and no revision reconstructions were required. Limitations to this study include inconsistent post-operative reporting, and a lack of long term post-operative outcomes. Further work includes a re-surveying of this patient base for updated patient outcomes, as well as quantitative radiographic analysis.

Surgical outcomes of endoscopic transsphenoidal pituitary adenoma resection in elderly versus younger patients

2021 ◽  
Author(s):  
Tyler D Alexander ◽  
Chandala Chitguppi ◽  
Sarah Collopy ◽  
Kira Murphy ◽  
Pascal Lavergne ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Surgical Outcomes ◽  
Extent Of Resection ◽  
Common Type ◽  
Tumor Characteristics ◽  
Endoscopic Transsphenoidal Surgery ◽  
Younger Patients ◽  
Patient Variables ◽  
Intracranial Neoplasm ◽  
Csf Leaks

Introduction Pituitary adenomas (PAs) are one of the most common type of intracranial neoplasm with increased incidence in elderly patients. The outcomes of endoscopic transsphenoidal surgery (ETS) specifically on elderly patients remains unclear. Methods We performed a retrospective cohort study to compare elderly patients (age 65 years) with non-elderly patients (age <65 years) who underwent ETS for PA from January 2005 to December 2021. Surgical outcomes, including extent of resection, complication profile, length of stay, and endocrinopathy rates, were compared between elderly and non-elderly patients. Results A total of 690 patients were included with 197 (29%) being elderly. Elderly patients showed higher rates of hypertension (p<0.05), myocardial infarction (p<0.01), and atrial fibrillation (p=0.01) but not other comorbidities. Elderly patients also had more frequent optic nerve involvement (72% of cases vs. 61%, p=0.01). Tumor characteristics and other patient variables were otherwise similar between younger and elderly patients. Postoperative CSF leaks (2% vs. 2%, p=0.8), 30-day readmission, reoperation, postoperative complications, and postoperative endocrinopathies were similar between younger and older patients. Subdividing patients into age <65, 65-79, and >80 also did not demonstrate a worsening of surgical outcomes with age. Conclusion For well selected elderly patients in experienced endoscopic skull base centers, good surgical outcomes similarly to younger patients may be achieved.

scholarly journals Neurocysticercosis in Pregnancy

2018 ◽  
Vol 08 (02) ◽  
pp. e51-e56 ◽  
Author(s):  
Camille Webb ◽  
Mauricio Rosa ◽  
Gayle Olson ◽  
Miguel Cabada
Keyword(s):  
Differential Diagnosis ◽  
Postpartum Period ◽  
Demographic Data ◽  
Clinical Manifestations ◽  
Clinical Findings ◽  
Patient Demographic ◽  
Patient Demographic Data ◽  
Exposure History ◽  
In Pregnancy ◽  
New Onset

AbstractThe normal physiologic changes during pregnancy contribute to nutritional, metabolic, and immunologic adjustments, which can have an impact on the presentation of several diseases. New onset seizures during pregnancy and the postpartum can be attributed to several etiologies. Patient demographic data as well as personal and social histories are key in determining the etiology of new onset seizures. Neurocysticercosis (NCC), a commonly overlooked etiology, must be included in the differential diagnosis of patients with new onset seizures coming from NCC endemic areas. The diagnosis is based on a combination of clinical findings, exposure history, imaging, and serology. We present two cases of patients with NCC that became symptomatic during pregnancy or postpartum period. We will review the epidemiology, clinical manifestations, and management of NCC in pregnancy.

scholarly journals Oris dejavnikov, povezanih z zaupanjem bolnikov v izbranega osebnega zdravnika v Splošni ambulanti Pernica

2017 ◽  
Vol 86 (9-10) ◽  
Author(s):  
Nataša Maguša Lorber ◽  
Polona Selič
Keyword(s):  
Linear Regression ◽  
Physician Behavior ◽  
Demographic Data ◽  
Best Interest ◽  
Patient Trust ◽  
Patient Demographic ◽  
Patient Health Status ◽  
Patient Health ◽  
Patient Demographic Data ◽  
Deviation Factor

Introduction: Trust is crucial in forming a good relationship between a patient and a doctor, where both persons believe that they are benevolent, competent and willing to act in their best interest. This research examines factors associated with patient trust in their general practitioner (GP).Method: Every third patient at the General Practice in Pernica was asked to participate in a voluntary, anonymous survey. 464 questionnaires (92.8 % response rate) were filled in. The questionnaire consisted of patient demographic data, the Trust in Physician Scale (Cronbach α = 0.795), and the Humanistic Behaviours Questionnaire (Cronbach α = 0.965). The research sample was described with frequency and percentage distribution, average values and standard deviation. Factor analysis was implemented. Using linear regression modelling, the connection between patient demographic data, patient health status and patient’s cooperation with the GP, along with factors describing trust in physician, was analyzed. Factors of physician behaviour were included in the linear regression as independent variables.Results: Positive past experience with the GP (β = 0.20, p < 0.001), greater care and involvement in treatment (β = 0.28, p < 0.001), and greater benevolence (β = 0.32, p < 0.001) were positively correlated with the competence of the GP. A lower degree of benevolence (β = -0.28, p < 0.001) was associated with greater distrust.Discussion: Physician behavior was statistically associated with patient trust. With appropriate interventions we could improve patients’ trust in their physician and thus influence a better treatment outcome, continuity of care, better cooperation and most importantly, patient satisfaction.

Endoscopic approach for giant pituitary adenoma: clinical outcomes of 205 patients and comparison of two proposed classification systems for preoperative prediction of extent of resection

2021 ◽  
pp. 1-15
Author(s):  
Savas Ceylan ◽  
Harun Emre Sen ◽  
Bedrettin Ozsoy ◽  
Ecem Cemre Ceylan ◽  
Anil Ergen ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Clinical Outcomes ◽  
Classification System ◽  
Extent Of Resection ◽  
Classification Systems ◽  
Tumor Characteristics ◽  
Total Resection ◽  
Endoscopic Endonasal ◽  
Giant Pituitary Adenoma ◽  
Grade 3

OBJECTIVE Giant pituitary adenoma is considered a challenging pathology for surgery owing to its complications and low resection rate. In this study, the authors present their experience of using the endoscopic endonasal approach to treat patients with giant pituitary adenoma, and they aimed to develop a classification system for prediction of extent of resection. METHODS The institutional medical records of patients diagnosed with giant pituitary adenoma who underwent endoscopic endonasal transsphenoidal surgery between August 1997 and December 2019 were retrospectively reviewed. Surgical and clinical outcomes were evaluated in detail. The effects of tumor characteristics on extent of resection were analyzed. The findings were used to develop two classification systems that could preoperatively predict extent of resection. Morphological score was based on tumor characteristics, and landmark-based classification was defined according to surgical zones based on neurovascular landmarks. The effects of change in surgical strategy, which aimed to maximize tumor resection and capsule dissection, on rates of resection and complications were evaluated before and after 2017. RESULTS This study included 205 patients, with a mean patient age of 46.95 years and mean preoperative tumor diameter of 46.56 mm. Gross-total resection (GTR) was achieved in 35.12% of patients, near-total resection (NTR) in 39.51%, and subtotal resection (STR) in 25.36%. Extent of resection differed significantly between the grades and zones of the classification systems (p < 0.001 for both). Among patients with grade 3 tumor, 75.75% of patients achieved STR, 21.21% achieved NTR, and 3.03% achieved GTR. Among patients with zone 3 tumor, 65.75% achieved STR, 32.87% achieved NTR, and 1.36% achieved GTR. Both grade 3 and zone 3 indicated limited extent of resection. The mean (range) follow-up duration was 50.16 (9–247) months. Postoperative recovery of at least one hormone axis was seen in 15.24% of patients with pituitary deficiency, and development of new hormonal deficiency was observed in 22.43% of patients. Complications included permanent diabetes insipidus (7.80%), cerebrospinal fluid leakage (3.90%), postoperative apoplexy (3.90%), meningitis (3.41%), and epistaxis (3.41%). The surgical mortality rate was 1.46%. Among 85 patients treated before 2017, 27.05% of patients achieved GTR, 37.64% achieved NTR, and 35.29% achieved STR; among 120 patients treated after 2017, 40.83% achieved GTR, 40.83% achieved NTR, and 18.33% achieved STR. Seven patients in the pre-2017 cohort had postoperative apoplexy versus only 1 patient in the post-2017 cohort. There were no statistically significant differences between the two periods in terms of the incidence rates of other complications. CONCLUSIONS Capsule dissection and GTR are valuable for preventing serious complications and reducing recurrence of giant adenoma. Treatment of giant pituitary adenoma may be better managed with the help of a classification system that provides information about extent of resection that can be achieved with an endoscopic approach.

Venous stent versus conventional stent for the treatment of central vein obstruction in hemodialysis patients: a retrospective study

2021 ◽  
pp. 028418512110051
Author(s):  
Surasit Akkakrisee ◽  
Keerati Hongsakul
Keyword(s):  
Endovascular Treatment ◽  
Patency Rate ◽  
Demographic Data ◽  
Hemodialysis Patients ◽  
Primary Patency ◽  
Central Vein ◽  
Primary Patency Rate ◽  
Patient Demographic Data ◽  
Upper Thoracic ◽  
Vein Stenosis

Background Endovascular treatment is a first-line treatment for upper thoracic central vein obstruction (CVO). Few studies using bare venous stents (BVS) in CVO have been conducted. Purpose To evaluate the treatment performance of upper thoracic central vein stenosis between BVS and conventional bare stent (CBS) in hemodialysis patients. Methods Hemodialysis patients with upper thoracic central vein obstruction who underwent endovascular treatment at the interventional unit of our institution from 1 January 2008 to 31 December 2018 were enrolled in the present study. CBS was used to treat central vein obstruction in 43 patients and BVS in 34 patients. We compared the primary patency rates and complications between the two stent types. P values < 0.05 were considered statistically significant. Results The patient demographic data between the CBS and BVS groups were similar. The characteristics of the lesions, procedures, and complications were not significantly different between the two groups ( P > 0.05). There were no statistically significant differences of primary patency rates at three and six months between the BVS and CBS groups (94.1% vs. 86.0% and 73.5% vs. 58.1%, respectively; P > 0.05). The primary patency rate at 12 months in the BVS group was significantly higher than that in the CBS group (61.8% vs. 32.6%; P = 0.008). Conclusion Endovascular treatment of central vein obstruction with BVS provided a higher primary patency rate at 12 months than CBS.

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