scholarly journals Subarachnoid hemorrhage after surgical treatment of unruptured intracranial aneurysms

2018 ◽  
Vol 129 (2) ◽  
pp. 490-497
Author(s):  
Hidetoshi Matsukawa ◽  
Hiroyasu Kamiyama ◽  
Toshiyuki Tsuboi ◽  
Kosumo Noda ◽  
Nakao Ota ◽  
...  
Keyword(s):  
Risk Factors ◽  
Subarachnoid Hemorrhage ◽  
Surgical Treatment ◽  
Incidence Rate ◽  
Intracranial Aneurysms ◽  
Annual Incidence ◽  
Annual Incidence Rate ◽  
Excellent Outcome ◽  
Unruptured Intracranial Aneurysms ◽  
Average Annual Incidence

OBJECTIVEOnly a few previous studies have investigated subarachnoid hemorrhage (SAH) after surgical treatment in patients with unruptured intracranial aneurysms (UIAs). Given the improvement in long-term outcomes of embolization, more extensive data are needed concerning the true rupture rates after microsurgery in order to provide reliable information for treatment decisions. The purpose of this study was to investigate the incidence of and risk factors for postoperative SAH in patients with surgically treated UIAs.METHODSData from 702 consecutive patients harboring 852 surgically treated UIAs were evaluated. Surgical treatments included neck clipping (complete or incomplete), coating/wrapping, trapping, proximal occlusion, and bypass surgery. Clippable UIAs were defined as UIAs treated by complete neck clipping. The annual incidence of postoperative SAH and risk factors for SAH were studied using Kaplan-Meier survival analysis and Cox proportional hazards regression models.RESULTSThe patients’ median age was 64 years (interquartile range [IQR] 56–71 years). Of 852 UIAs, 767 were clippable and 85 were not. The mean duration of follow-up was 731 days (SD 380 days). During 1708 aneurysm years, there were 4 episodes of SAH, giving an overall average annual incidence rate of 0.23% (95% CI 0.12%–0.59%) and an average annual incidence rate of 0.065% (95% CI 0.0017%–0.37%) for clippable UIAs (1 episode of SAH, 1552 aneurysm-years). Basilar artery location (adjusted hazard ratio [HR] 23, 95% CI 2.0–255, p = 0.0012) and unclippable UIA status (adjusted HR 15, 95% CI 1.1–215, p = 0.046) were significantly related to postoperative SAH. An excellent outcome (modified Rankin Scale score of 0 or 1) was achieved in 816 (95.7%) of 852 cases overall and in 748 (98%) of 767 clippable UIAs at 12 months.CONCLUSIONSIn this large case series, microsurgical treatment of UIAs was found to be safe and effective. Aneurysm location and unclippable morphologies were related to postoperative SAH in patients with surgically treated UIAs.

Small (< 10-mm) incidentally found intracranial aneurysms, Part 1: reasons for detection, demographics, location, and risk factors in 212 consecutive patients

2011 ◽  
Vol 31 (6) ◽  
pp. E3 ◽  
Author(s):  
Ioannis Loumiotis ◽  
Anne Wagenbach ◽  
Robert D. Brown ◽  
Giuseppe Lanzino
Keyword(s):  
Risk Factors ◽  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysms ◽  
Imaging Techniques ◽  
Imaging Study ◽  
Consecutive Series ◽  
Common Location ◽  
Unruptured Intracranial Aneurysms ◽  
Paraclinoid Aneurysms ◽  
History Of

Object The widespread use of imaging techniques for evaluating nonspecific symptoms (vertigo, dizziness, memory concerns, unsteadiness, and the like) and focal neurological symptoms related to cerebrovascular disease has led to increased identification of asymptomatic incidentally discovered unruptured intracranial aneurysms (UIAs). The management of these incidental aneurysms is controversial and many factors need to be considered. The authors describe reasons leading to diagnosis, demographics, and risk factors in a large consecutive series of patients with small incidentally found UIAs. Methods The authors prospectively evaluated 335 patients harboring 478 small (< 10-mm) UIAs between January 2008 and May 2011. Patients with known aneurysms, possibly symptomatic aneurysms, arteriovenous malformation–related aneurysms, patients with a history of subarachnoid hemorrhage from another aneurysm, and patients harboring extradural aneurysms were excluded from the analysis. Only truly incidental small aneurysms (272 aneurysms in 212 patients) were considered for the present analysis. Data regarding the reason for detection, demographics, location, and presence of potential risk factors for aneurysm formation were prospectively collected. Results There were 158 female (74.5%) and 54 male (25.5%) patients whose mean age was 60.6 years (median 62 years). The most common reason for undergoing the imaging study that led to a diagnosis of the aneurysms was evaluation for nonspecific spells and symptoms related to focal cerebrovascular ischemia (43.4%), known/possible intracranial or neck pathology (24%), and headache (16%). The most common location (27%) of the aneurysm was the middle cerebral artery; the second most common (22%) was the paraclinoid internal carotid artery (excluding cavernous sinus aneurysms). Sixty-nine percent of patients were current or prior smokers, 60% had a diagnosis of hypertension, and 23% had one or more relatives with a history of intracranial aneurysms with or without subarachnoid hemorrhage. Conclusions Small incidental UIAs are more commonly diagnosed in elderly individuals during imaging performed to investigate ill-defined spells or focal cerebrovascular ischemic symptoms, or during the evaluation of known or probable unrelated intracranial/neck pathology. Hypertension, smoking, and family history of aneurysms are common in this patient population, and the presence of these risk factors has important implications for treatment recommendations. Although paraclinoid aneurysms (excluding intracavernous aneurysms) are uncommon in patients with ruptured intracranial aneurysms, this location is very common in patients with small incidental UIAs.

scholarly journals MO374DISCLOSURE OF THE RESULTS OF A 40-YEARS RESEARCH OF UPPER TRACT UROTHELILAL CANCER AND BALKAN ENDEMIC NEPHROPATHY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Stevan Glogovac ◽  
Zorica Dimitrijevic ◽  
Miomir Stojanovic ◽  
Danijela Tasic ◽  
Karolina Paunovic ◽  
...  
Keyword(s):  
Incidence Rate ◽  
Linear Trend ◽  
Annual Incidence ◽  
Balkan Endemic Nephropathy ◽  
Annual Incidence Rate ◽  
Upper Tract ◽  
Clinical Center ◽  
Average Annual Incidence ◽  
Endemic Nephropathy ◽  
Observation Period

Abstract Background and Aims The general significance of Balkan endemic nephropathy (BEN) is the association with upper tract urtohelial cancer (UTUC). In published papers studying these two entities, there is large difference between the obtained results. By UTUC research, obtained results are the most diverse in relation to the period and region of research. The aim of the research is to show the discrepancy between the results of the research of UTUC of Jablanica district in relation to the observation period and the type of settlement. Method The research period lasted from 1978-2017. During the analysis of the frequency of UTUC, we used the operative material of Urology Department, Health Care Center, Leskovac , and Urology Clinic, Clinical Center, Nis, Clinical Center, Nis. For practical reasons, this period was devided into two periods, the first (1978-1997) and the second (1998-2017). In order to make classification of settlements we used the data of the Institute of Nephrology and Hemodialysis in Nis (A-endemic regions, B-hypo-endemic, C-non-endemic urban, D-non-endemic rural regions). Data on the total number of Jablanica region population were obtained on the basis of the censuses from 1991 and 2011. The average annual incidence rate (AAIR) was calculated per 100 000 people. Finally, we jointly observed groups A and B (endemic areas) C and D (non-endemic areas) for UTUC. Results The average annual incidence rate (AAIR) in the period of 1978-2017 in endemic settlements of Jablanica region was (11.82), while in hypo-endemic was (4.49) and non-endemic (0.83). The data demonstrated that inhabitants of endemic settlements has 14.24 times higher UTUC frequency in comparison to non-endemic settlements in time span of research. Our research in Jablanica region also demonstrated unexpectedly high frequency of on UTUC not only in endemic settlements with BEN (Kutles village- 1 tumor per 99.63 and AAIR 40.15), but also in some of the non-endemic area (Brejanovac village-1 tumour per 98.75 people and AAIR of 40.50; Rudare village-1 tumour per 139.50 people and AAIR of 28.67; Bogojevce village-1 tumour per 187.63 people and AAIR 21.32). This occurrence of UTUC frequency in some non-endemic settlements refers to the first observed period until no occurrence was recorded in the second observed period. There is a higher UTUC frequency in endemic settlements of 11.37 in the first period (A- AAIR 21.95), while in hypo-endemic (B-AAIR 11.82) is 3.64 higher incedence. In non-endemic settlements (C,D-AAIR 1.09) there is 1.63 higher incidence in comparison to the second period. Observing the periods, there is a higher UTUC frequency of five times in endemic settlements (A, B) of Jablanica region in the first period comparing to the second. The linear trend of UTUC in the 40-year period demonstrates a slow decrease (y= -0.0797x + 4.2846; r2 = 0.2028) in Jablanica region. In the same observed period, linear trend of BEN is in corelation of decreased linear trend of UTUC (y= -0.164x+6.0669; r2 =0.748). Conclusion A forty-year study of UTUC in the Jablanica region showed a discrepancy between the results in relation to the observation period and the type of settlement, which coincides with the generally accepted view that epidemiology is the most fascinating part of BEN. In endemic settlements, in the second observed period, the frequency of UTUC was registered five times lower than in the first, which coincides with the decrease in the frequency of BEN in these settlements.

scholarly journals Descriptive epidemiology of measles cases in Bauchi State, 2013–2018

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Polycarp Uchechukwu Ori ◽  
Ayo Adebowale ◽  
Chukwuma David Umeokonkwo ◽  
Ugochukwu Osigwe ◽  
Muhammad Shakir Balogun
Keyword(s):  
Incidence Rate ◽  
Case Fatality ◽  
Secondary Data ◽  
Outcome Data ◽  
Annual Incidence ◽  
High Morbidity ◽  
Annual Incidence Rate ◽  
Average Annual Incidence ◽  
History Of ◽  
Variation Index

Abstract Background Measles accounts for high morbidity and mortality in children, especially in developing countries. In 2017, about 11,190 measles cases were recorded in Nigeria, including Bauchi State. The aim of this study was to describe the trend and burden of measles in Bauchi State, Nigeria. Method We analyzed secondary data of measles cases extracted from the Measles Surveillance data system in Bauchi State from January 2013 to June 2018. The variables extracted included age, sex, doses of vaccination, case location and outcome. Data were analyzed using descriptive statistics, logistic regression, and multiplicative time series model (α = 0.05). Results A total of 4935 suspected measles cases with an average annual incidence rate of 15.3 per 100,000 population and 57 deaths (Case Fatality Rate, CFR: 1.15%) were reported. Among the reported cases, 294 (6%;) were laboratory-confirmed, while clinically compatible and epi-linked cases were 402 (8%) and 3879 (70%), respectively. Of the 4935 measles cases, 2576 (52%) were males, 440 (9%) were under 1 year of age, and 3289 (67%) were between 1 and 4 years. The average annual incidence rate among the 1–4 year age-group was 70.3 per 100,000 population. The incidence rate was lowest in 2018 with 2.1 per 100,000 and highest in 2015 with 26.2 per 100,000 population. The measles cases variation index per quarter was highest in quarter 1 (198.86), followed by quarter 2 (62.21) and least in quarter 4 (10.37) of every year. Only 889 (18%) of the measles cases received at least one dose of measles vaccine, 2701 (54.7%) had no history of measles vaccination while 1346 (27.3%) had unknown vaccination status. The fatality of measles in Bauchi State were significantly associated with being under 5 years (AOR = 5.58; 95%CI: 2.19–14.22) and not having at least a dose of MCV (OR = 7.14; 95%CI: 3.70–14.29). Conclusion Measles burden remains high in Bauchi State despite a decrease in its incidence over the study years. Most of the cases occurred in the first quarter of every year. Improved routine measles surveillance for prompt case management could reduce the burden of the disease in Bauchi State.

Predicting outcome following surgical treatment of unruptured intracranial aneurysms: a proposed grading system

1996 ◽  
Vol 84 (1) ◽  
pp. 49-54 ◽  
Author(s):  
Rohit K. Khanna ◽  
Ghaus M. Malik ◽  
Nuzhat Qureshi
Keyword(s):  
Risk Factors ◽  
Surgical Treatment ◽  
Intracranial Aneurysms ◽  
Posterior Circulation ◽  
Content Type ◽  
Unruptured Aneurysms ◽  
Poor Outcome ◽  
Unruptured Intracranial Aneurysms ◽  
Predicting Outcome ◽  
Fine Print

✓ Surgical treatment of unruptured aneurysms is gaining increased support owing to the recently defined poor long-term natural history of these aneurysms. The benefit of treatment ultimately depends on the relative risk of subsequent aneurysm rupture in untreated patients versus the risk of surgery. To identify those patients at a higher risk from surgery, the authors reviewed the management of 172 patients with unruptured intracranial aneurysms treated at their institution. The size of the aneurysms ranged from 3 to 45 mm (mean 13.7 mm). Twenty-two patients (12.8%) had aneurysms in the posterior circulation, and 32 (18.6%) of these were giant aneurysms. Major morbidity occurred in 12 patients (6.9%) and five patients (2.9%) died. Multivariate logistic analysis of several risk factors revealed that aneurysm size and location had an independent correlation with surgical outcome and that patient age approached statistical significance. Patients presenting with ischemic cerebrovascular disease, in particular, did not have a higher risk of a poor outcome. A simple classification for predicting patients at high risk from surgical morbidity and mortality is proposed. Preoperative grading is based on the size and location of the aneurysm and patient's age. The lowest grade is given to young patients with small anterior circulation aneurysms, and the highest grade includes elderly patients with complex giant posterior circulation aneurysms. A retrospective analysis of this classification demonstrated a strong correlation with postoperative outcome. The incidence of poor outcome progressively increased with a higher grade, ranging from 0% in Grade 0 to 66.6% in Grade VI. An analysis of this classification on 50 consecutive surgically treated patients with unruptured aneurysms not included in the analysis also validated the predictive value of this system. Along with predicting outcome, this classification should provide a standardized format for comparison of results from different clinical centers as well as different therapeutic techniques (surgical vs. endovascular) without omission of significant risk factors found to influence outcome.

Acute myocardial infarction incidence and mortality rates in the population of the city of Nis in the period 1974-2000

2007 ◽  
Vol 60 (9-10) ◽  
pp. 479-483
Author(s):  
Marko Lazovic ◽  
Milica Lazovic ◽  
Gordana Devecerski ◽  
Vladmila Bojanic ◽  
Nebojsa Krstic ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Incidence Rate ◽  
Mortality Rates ◽  
Progressive Increase ◽  
Annual Incidence ◽  
Annual Incidence Rate ◽  
Female Ratio ◽  
Average Annual Incidence ◽  
The City

Introduction. The aim of this study was to investigate the annual incidence of hospital morbidity and mortality rates of acute myocardial infarction (AMI) in the population of Nis who were treated at the Cardiology Clinic in Nis during the period 1974-2000. Material and Methods. A retrospective clinical-epidemiological study was carried out in the population of the city of Nis aged 30 years and over. The number of citizens of Nis, aged 30 years and over, was 71.500 in 1974, and 100.000 in 2000, while the male to female ratio was 48 %:52%. Results. During the period from 1974 to 2000, 4319 patients of both sexes with AMI received hospital treatment. The average annual incidence rate was 159.92 per 100.000 inhabitants aged 30 years and over. The average annual incidence of AMI showed a trend of progressive increase, and in 2000 it was 274.87 (2.7 times higher than in 1974 - 102.19). The average annual mortality for both sexes was 11.57% (9.82% for males and 15.89% for females). The female mortality rate was significantly higher (p< 0.001). Conclusion. Trends in annual incidence rate of AMI in the population of the city of Nis aged 30 years and over are characterized by progressive increase during the period from 1974 to 2000. The trend line: yt = 159.92+6.2432x shows that without primary prevention further increase in the incidence of AMI can be expected. .

scholarly journals Epidemiology of Stroke in Iran

2016 ◽  
Vol 5 ◽  
pp. 3-9
Author(s):  
Kavian Ghandehari
Keyword(s):  
Ischemic Stroke ◽  
Subarachnoid Hemorrhage ◽  
Intracerebral Hemorrhage ◽  
Incidence Rate ◽  
Epidemiologic Study ◽  
Incidence Rates ◽  
Annual Incidence ◽  
Annual Incidence Rate ◽  
Stroke Registry ◽  
Stroke In Young Adults

Numerous hospital-based stroke registries have been developed in Iran during last decade. Khorasan Stroke Registry, Khorasan Posterior Circulation Stroke Registry, Khorasan Pediatric Stroke Registry and Khorasan Stroke in Young Adults Registry are among these published registries. Meanwhile, There is only one epidemiologic deigned study of stroke in Iran and Middle East. Based on this standard epidemiologic study; The crude annual incidence rate of First Ever Stroke (FES) is 139 (95% CI, 128 to 149) per 100 000; for men, 144 (95% CI, 128 to 159), and for women, 133 (95% CI, 118 to 148). The incidence rates increases significantly with each decade of life and is similar in men and women. Subtypes of FES in 81.9%  of patients is ischemic stroke,12.7% is intracerebral hemorrhage, and 2.4% have subarachnoid hemorrhage. The crude annual incidence rate per 100 000 inhabitants is 113 (95% CI, 104 to 123) for ischemic stroke, 18 (95% CI, 14 to 21) for intracerebral hemorrhage and 3 (95% CI, 2 to 5) for subarachnoid hemorrhage. Ischemic strokes are occurring approximately 1 decade earlier in Iran than in other countries.

SAT0524 THE INCIDENCE RATE OF ADULT ONSET STILL’S DISEASE IN SLOVENIA

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1218-1219
Author(s):  
A. Hocevar ◽  
Z. Rotar ◽  
M. Krosel ◽  
M. Plešivčnik Novljan ◽  
S. Praprotnik ◽  
...  
Keyword(s):  
Incidence Rate ◽  
Clinical Characteristics ◽  
Annual Incidence ◽  
Adult Onset Still’S Disease ◽  
Adult Onset ◽  
Still’S Disease ◽  
Annual Incidence Rate ◽  
Still's Disease ◽  
Average Annual Incidence ◽  
Adult Onset Still's Disease

Background:Adult Onset Still’s disease (AOSD) is an uncommon systemic inflammatory disease.Objectives:To determine for the first time the incidence rate of AOSD in our population.Methods:We retrospectively collected AOSD cases diagnosed between 1 January 2010 and 31 December 2019 at our secondary/tertiary rheumatology centre, which is the only referral centre for an average population of 704,000 adults. AOSD cases were identified by searching the electronic medical database both for ICD-10 code M06.1 and a full text search for »AOSD«. Patients’ records were analyzed and descriptive statistics was used to describe our study group. The adult population was obtained from the national statistics institute database. The annual incidence rate for AOSD was calculated.Results:During the 10-year observation period we identified 22 incipient AOSD cases. All 22 cases fulfilled Yamaguchi classification criteria for AOSD1. Five cases were excluded from analyses since they were referred to our department from regions served by other secondary/tertiary centres. Hence, we finally analyzed 17 AOSD cases (11 females; median (IQR) age 38.9 (29.9; 56.5) years, range 20-71 years), resulting in the average annual incidence rate of 2.4 (95%CI 1.5-3.8) cases per 106adults. Age specific incidence rate of AOSD is presented in Figure 1. Clinical characteristics of AOSD cases at presentation are shown in Table 1. AOSD was complicated with macrophage activating syndrome in 4/17 (23.5%) cases, and with pulmonary hypertension in one case. Patients were followed for a median (IQR) 31 (20; 58) months. Twelve (70.5%), 2 (11.8%), and 3 (17.6) patients had monophasic, relapsing, and chronic disease course, respectively.Table 1.Clinical characteristics of AOSD at presentationCharacteristicAOSD (%)CharacteristicAOSD (%)Female gender64.7Lung infiltrates23.5Age*38.9 (29.9;56.5)Pericardial effusion23.5Fever94.1Abdominal pain17.6Weight loss64.7Lymphadenopathy52.9Skin rash76.5Splenomegaly41.2Throat pain88.2Hepatomegaly17.6Arthralgia/Arthritis88.2/47.1Leukocytosis88.2Myalgia29.4Elevated AST/ALT88.2Pleural effusion23.5Ferritin >1000ng/ml94.1Legend: *median (IQR);Figure 1.Age specific incidence rate of AOSDConclusion:AOSD is rare in our population, with an average annual incidence rate of 2.4 cases per 106adults.References:[1]Yamaguchi M, Ohta A, Tsunematsu T, Kasukawa R, Mizushima Y, Kashiwagi H, et al. Preliminary criteria for classification of adult Still’s disease. J Rheumatol. 1992;19(3):424-30.Acknowledgments -Disclosure of Interests:ALOJZIJA HOCEVAR: None declared, Ziga Rotar Consultant of: Speaker and consulting fees from Abbvie, Amgen, Biogen, Eli Lilly, Medis, MSD, Novartis, Pfizer, Roche, Sanofi., Speakers bureau: Speaker and consulting fees from Abbvie, Amgen, Biogen, Eli Lilly, Medis, MSD, Novartis, Pfizer, Roche, Sanofi., Monika Krosel: None declared, Martina Plešivčnik Novljan: None declared, Sonja Praprotnik: None declared, Matija Tomsic: None declared

scholarly journals Evaluation of the Accero Stent for Stent-Assisted Coiling of Unruptured Wide-Necked Intracranial Aneurysm Treatment with Short-Term Follow-Up

2020 ◽  
Vol 9 (9) ◽  
pp. 2808
Author(s):  
Wojciech Poncyljusz ◽  
Kinga Kubiak ◽  
Leszek Sagan ◽  
Bartosz Limanówka ◽  
Katarzyna Kołaczyk
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysms ◽  
Clinical Results ◽  
Class I ◽  
Unruptured Aneurysms ◽  
Patient Demographics ◽  
Stent Deformation ◽  
Unruptured Intracranial Aneurysms ◽  
Occlusion Rate

Background: Stent-assisted coiling is an effective method of treating intracranial aneurysms. The aim of the study was to assess the safety and efficacy of the new Accero stent for the treatment of intracranial aneurysms. Materials and Methods: It was a retrospective, single-center study. Eighteen unruptured intracranial aneurysms were treated using the stent-assisted coiling method with the Accero stent. Patient demographics, aneurysm characteristics, procedural parameters, grade of occlusion, complications, and clinical results were analyzed. Follow-up magnetic resonance (MR) was performed 6 months after intervention. Results: Seventeen patients with 18 incidental unruptured aneurysms were electively treated with coiling and the Accero stent. The aneurysms were located on internal carotid artery (ICA), middle cerebral artery (MCA) and basilar artery (BA). All stents were deployed successfully. Immediate complete occlusion rate Raymond-Roy occlusion classification (RROC) class I was achieved in 13 cases and class II in 4 cases. Complications occurred in 2/17 treatments and included guidewire stent perforation with subarachnoid hemorrhage (SAH) and stent deformation. Vascular spasm in the subarachnoid hemorrhage (SAH) patient subsided before discharge. Ninety days after intervention, the modified Rankin Scale (mRS) value was 0. RROC class I was observed in 88.23% of cases in follow-up. Conclusion: The Accero stent provides excellent support for coil mass. It constitutes an efficacious device with good initial occlusion rate for treating wide-necked unruptured intracranial aneurysms.

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