Comparison of endovascular and microsurgical management of 208 basilar apex aneurysms

2017 ◽  
Vol 127 (6) ◽  
pp. 1342-1352 ◽  
Author(s):  
Bradley N. Bohnstedt ◽  
Mary Ziemba-Davis ◽  
Rishabh Sethia ◽  
Troy D. Payner ◽  
Andrew DeNardo ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Endovascular Management ◽  
Long Term Outcomes ◽  
Chi Square ◽  
Treatment Groups ◽  
Microsurgical Treatment ◽  
Select Group ◽  
Discharge Status ◽  
Perforating Arteries

OBJECTIVEThe deep and difficult-to-reach location of basilar apex aneurysms, along with their location near critical adjacent perforating arteries, has rendered the perception that microsurgical treatment of these aneurysms is risky. As a result, these aneurysms are considered more suitable for treatment by endovascular intervention. The authors attempt to compare the immediate and long-term outcomes of microsurgery versus endovascular therapy for this aneurysm subtype.METHODSA prospectively maintained database of 208 consecutive patients treated for basilar apex aneurysms between 2000 and 2012 was reviewed. In this group, 161 patients underwent endovascular treatment and 47 were managed microsurgically. The corresponding records were analyzed for presenting characteristics, postoperative complications, discharge status, and Glasgow Outcome Scale (GOS) scores up to 1 year after treatment and compared using chi-square and Student t-tests.RESULTSAmong these 208 aneurysms, 116 (56%) were ruptured, including 92 (57%) and 24 (51%) of the endovascularly and microsurgically managed aneurysms, respectively. The average Hunt and Hess grade was 2.4 (2.4 in the endovascular group and 2.2 in the microsurgical group; p = 0.472). Postoperative complications of cranial nerve deficits and hemiparesis were more common in patients treated microsurgically than endovascularly (55.3% vs 16.2%, p < 0.05; and 27.7% vs 10.6%, p < 0.05, respectively). However, aneurysm remnants and need for retreatment were more common in the endovascular than the microsurgical group (41.3% vs 2.3%, p < 0.05; and 10.6% vs 0.0%, p < 0.05, respectively). Stent placement significantly reduced the need for retreatment. Rehemorrhage rates and average GOS score at discharge and 1 year after treatment were not statistically different between the two treatment groups.CONCLUSIONSPatients with basilar apex aneurysms were significantly more likely to be treated via endovascular management, but compared with those treated microsurgically, they had higher rates of recurrence and need for retreatment. The current study did not detect an overall difference in outcomes at discharge and 1 year after either treatment modality. Therefore, in a select group of patients, microsurgical treatment continues to play an important role.

scholarly journals Efficacy and Tolerability of Methotrexate and Methylprednisolone in a Comparative Assessment of the Primary and Long-Term Outcomes in Patients with Pulmonary Sarcoidosis

Diagnostics ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 1289
Author(s):  
Volodymyr Gavrysyuk ◽  
Ievgenia Merenkova ◽  
Yaroslav Dziublyk ◽  
Nataliia Morska ◽  
Nataliia Pendalchuk ◽  
...  
Keyword(s):  
Side Effects ◽  
Relapse Rate ◽  
Total Duration ◽  
Treatment Resistance ◽  
Pulmonary Sarcoidosis ◽  
Long Term Outcomes ◽  
High Resolution Computed Tomography ◽  
Chi Square ◽  
Ct Data

Background: There is insufficient information in the literature on the comparative efficacy and tolerability of methotrexate (MTX) and methylprednisolone (MP) in patients with pulmonary sarcoidosis in assessing primary outcomes and the relapse rate. Purpose: The aim of our study was to evaluate primary and long-term outcomes of using MTX and MP in patients with pulmonary sarcoidosis. Methods: A total of 143 patients with newly diagnosed pulmonary sarcoidosis, verified by high-resolution computed tomography (CT) data, were examined. Corticosteroid (CS) therapy was used in 97 patients using MP at a dose of 0.4 mg/kg body weight for 4 weeks, followed by a dose reduction to 0.1 mg/kg by the end of the sixth month. The total duration of CS therapy was 12 months on average. Forty-six patients were treated with MTX at a dose of 10 mg/week (28) and 15 mg/week (18) per os for 6 to 12 months. The study of the relapse rate was conducted within 12 months after the CT data normalization in 60 patients after CS therapy and in 24 after MTX treatment. Results: MP treatment was successfully completed in 68 (70.1%), and MTX in 29 (60.4%) patients. In five MP patients (5.2%) and in five (10.9%) MTX, treatment was discontinued due to serious side effects. In seven (7.2%) MP patients and ten (21.7%) MTX patients, treatment required additional therapy due to the lack of efficacy. Progression with MP treatment (17–17.5%) was more common than with MTX (2–4.3%; Chi square = 4.703, p = 0.031). Relapses after MP therapy were observed in 26 (43.3%) patients, and after MTX therapy in 2 (8.3%; Chi square = 9.450, p = 0.003). Conclusion: In patients with pulmonary sarcoidosis, MTX monotherapy does not differ significantly from MP monotherapy in terms of the level of efficacy and the rate of serious side effects. Increasing the MTX dose from 10 to 15 mg/week accelerates the rate of regression of sarcoidosis, improves treatment efficacy, and does not affect the rate of serious side effects. When using MTX, there is a significant decrease in the incidence of treatment resistance and the relapse rate.

Pneumonectomy for Treatment of Destroyed Lung: A Retrospective Study of 137 Patients

2016 ◽  
Vol 65 (07) ◽  
pp. 528-534 ◽  
Author(s):  
Yuping Li ◽  
Gening Jiang ◽  
Chang Chen ◽  
Xuefei Hu
Keyword(s):  
Risk Factor ◽  
Postoperative Complications ◽  
Operative Technique ◽  
Independent Risk Factor ◽  
Multivariate Analyses ◽  
Bronchopleural Fistula ◽  
Long Term Outcomes ◽  
Term Survival ◽  
Destroyed Lung

Objectives Whether pneumonectomy is needed for the treatment of destroyed lungs is still controversial and unresolved in the clinic. Pneumonectomy is destructive and is associated with a significant incidence of postoperative complications. The purpose of this study is to analyze the operative techniques, postoperative morbidity, mortality, and long-term outcomes of patients with destroyed lungs who underwent pneumonectomy. Patients and Methods We retrospectively analyzed 137 patients with destroyed lungs who underwent pneumonectomy. The data were queried for the details of operative technique, development of perioperative complications, mortality, and long-term survival. Univariate and multivariate analyses were performed to investigate the risk factors of pneumonectomy among the patients. Results A total of 77 male and 60 female patients were reviewed. The youngest patient was 18 years, and the oldest was 75 years, with a mean age of 40.1 years. Postoperative complications were observed in 25 patients (18.2%). The rate of bronchopleural fistula (BPF) was 5.1% (7/137). Two perioperative deaths (1.5%) were noted. Univariate and multivariate analyses indicated the blood loss (hazard ratio [HR], 5.32; 95% confidence interval [CI], 1.27–18.50; p = 0.021) was the independent risk factor of postoperative complications, and the type of the disease (HR, 4.50; 95% CI, 1.19–9.69; p = 0.034) was the independent risk factor of the BPF, for the patients with destroyed lung after pneumonectomy. Conclusion Pneumonectomy for destroyed lung is a high risk for postoperative complications. Our findings suggested that pneumonectomy in destroyed lung was satisfactory with strict surgical indications, adequate preoperative preparation, and careful operative technique, and the long-term outcomes can be especially satisfactory. Pneumonectomy for destroyed lung is still a treatment option.

scholarly journals The impact of major postoperative complications on long-term outcomes following curative resection of colon cancer

2018 ◽  
Vol 52 ◽  
pp. 303-308 ◽  
Author(s):  
Javier A. Cienfuegos ◽  
Jorge Baixauli ◽  
Carmen Beorlegui ◽  
Patricia Martínez Ortega ◽  
Lucía Granero ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Postoperative Complications ◽  
Curative Resection ◽  
Long Term Outcomes ◽  
The Impact

Abstract P101: Short and Long-Term Outcomes in Aspirin Treated PCI Patients Using NSAIDs

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Rizwan Alimohammad ◽  
Sayed Tariq ◽  
Ali Elkharbotly ◽  
Ed Timm ◽  
Mikhail Torosoff
Keyword(s):  
Myocardial Infarction ◽  
Rank Test ◽  
Long Term Outcomes ◽  
Chi Square ◽  
Low Dose Aspirin ◽  
History Of ◽  
Short And Long Term ◽  
Mortality Table ◽  
Prolonged Hospital

Background: NSAIDs may exert direct deleterious effects on CV system, while non-selective (NS) -NSAIDs may also diminish cardio-protective effect of low-dose aspirin. On another hand, NSAIDs may decrease CRP levels and ameliorate systemic inflammation. We have investigated short and long-term outcomes associated with NSAIDs use in post-PCI patients. Methods and Material: NSAID utilization, hospital and long-term outcomes of 2933 percutaneous coronary revascularizations (PCI) were collected and analyzed. Patients not on aspirin, or treated with rofecoxib and valdecoxib were excluded. ANOVA, Chi-square, Kaplan-Meyer analysis with log-rank test, and logistic regression were utilized. The study was approved by the Institutional IRB. Results: Patients treated with NS-NSAIDs, but not celecoxib, experienced longer length of stay, higher incidence of peri-procedural myocardial infarction, and mildly increased post-PCI mortality (Table). These effects were unchanged after adjustment for age (p=0.001), ejection fraction (p<0.001), and history of previous MI (p<0.001). There was a trend towards lower long-term (50+/-15 months) mortality in NS-NSAIDs (9%) and celecoxib (6.7%) treated patients, when compared to the rest of the cohort (11.3%, Table). Conclusion: Non-selective NSAIDs, but not Celecoxib, are associated with prolonged hospital stay and increased peri-procedural myocardial infarction in PCI patients. Long-term mortality does not appear to be affected by the NSAIDs use at the time of PCI. Randomized studies of this important clinical question are needed.

scholarly journals Geriatric nutritional risk index as a predictor of complications and long-term outcomes in patients with gastrointestinal malignancy: a systematic review and meta-analysis

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Hailun Xie ◽  
Shuangyi Tang ◽  
Lishuang Wei ◽  
Jialiang Gan
Keyword(s):  
Postoperative Complications ◽  
Meta Analysis ◽  
Risk Index ◽  
Nutritional Risk ◽  
Long Term Outcomes ◽  
Gastrointestinal Malignancy ◽  
Free Survival ◽  
Nutritional Risk Index ◽  
The Impact

Abstract Background The effect of the geriatric nutritional risk index (GNRI) on the prognosis of patients with gastrointestinal malignancy remains unclear. The aim of our study was to systematically explore the value of the GNRI in evaluating postoperative complications and long-term outcomes in gastrointestinal malignancy. Methods A systematic literature search was conducted using electronic databases to report the impact of the GNRI on postoperative complications and long-term outcomes of patients with gastrointestinal malignancies as of August 2020. The hazard ratio (HR) with a 95% confidence interval (CI) was used to evaluate the impact of the GNRI on long-term outcomes. The risk ratio (RR) with 95% CI was used to assess the impact of the GNRI on postoperative complications. Result A total of nine studies with 2,153 patients were enrolled in our meta-analysis. The results suggested that a low GNRI was correlated with poor overall survival of patients with gastrointestinal malignancy (HR = 1.94, 95% CI 1.65–2.28, p < 0.001). Patients with a low GNRI had a higher risk of complications than patients with a high GNRI (OR = 2.19, 95% CI 1.57–3.05, p < 0.001). In addition, patients with a low GNRI had shorter relapse-free survival (HR = 2.45, 95% CI 1.50–4.00, p < 0.001) and disease-free survival (HR = 1.84, 95% CI 1.23–2.76, p = 0.003) than those with a high GNRI. However, the GNRI was not an independent factor affecting cancer-specific survival (HR = 1.60, 95% CI 0.91–2.82, p = 0.101). Conclusion Based on existing evidence, the GNRI was a valuable predictor of complications and long-term outcomes in patients with gastrointestinal malignancy.

scholarly journals Endovascular Management of Popliteal Artery Occlusive Disease: Long-term Outcomes of Angioplasty, Stenting and Atherectomy

2020 ◽  
Vol 72 (1) ◽  
pp. e226-e227
Author(s):  
Michael Pezold ◽  
Neal Cayne ◽  
Caron Rockman ◽  
Glenn Jacobowitz ◽  
Virendra I. Patel ◽  
...  
Keyword(s):  
Popliteal Artery ◽  
Occlusive Disease ◽  
Endovascular Management ◽  
Long Term Outcomes

scholarly journals Prognostic Factors of Long-Term Outcomes in Endodontic Microsurgery: A Retrospective Cohort Study over Five Years

2020 ◽  
Vol 9 (7) ◽  
pp. 2210
Author(s):  
Yeon-Jee Yoo ◽  
Dong-Won Kim ◽  
Hiran Perinpanayagam ◽  
Seung-Ho Baek ◽  
Qiang Zhu ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Prognostic Factors ◽  
Periodontal Disease ◽  
Maxillary Sinus ◽  
Long Term Outcomes ◽  
Chi Square ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Endodontic Microsurgery

The aim of this study was to analyze the long-term outcomes of endodontic microsurgeries in a cohort and identify their association with prognostic factors. A cohort of endodontic microsurgeries followed up periodically with complete clinical and radiographic records for at least 5 years were reviewed retrospectively. Their survival and healing status and profile characteristics were analyzed by Pearson chi-square test and logistic regression (α = 0.05) to identify prognostic factors that influenced outcomes. Of 652 cases in the cohort, 225 (34.5%) were included. The mean follow-up period was 90.4 months (range, 60–168 months). The long-term success rate was 80.5%, and the 5-year survival rate was 83.5%. Logistic regression showed higher success in anteriors compared to molars (OR = 5.405, (95% CI, 1.663–17.571; p = 0.005)) and in teeth with crown restorations (OR = 10.232, (95% CI, 3.374–31.024; p < 0.001)). Conversely, lower success was found in teeth with periodontal disease (OR = 0.170, (95% CI, 0.032–0.900; p = 0.037)) and maxillary sinus involvement (OR = 0.187, (95% CI, 0.035–0.994; p = 0.049)). Endodontic microsurgery has a highly favorable long-term outcome. Tooth position, crown restoration, periodontal disease, and maxillary sinus involvement were identified as main prognostic factors.

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