Long-term outcomes after surgery for catastrophic epilepsy in infants: institutional experience and review of the literature

OBJECTIVEUncontrolled epilepsy is associated with serious deleterious effects on the neurological development of infants and has been described as “catastrophic epilepsy.” Recently, there has been increased emphasis on early surgical interventions to preserve or rescue neurodevelopmental outcomes in infants with early intractable epilepsy. The enthusiasm for early treatments is often tempered by concerns regarding the morbidity of neurosurgical procedures in very young patients. Here, the authors report outcomes following the surgical management of infants (younger than 1 year).METHODSThe authors performed a retrospective review of patients younger than 1 year of age who underwent surgery for epilepsy at Miami (Nicklaus) Children’s Hospital and Jackson Memorial Hospital between 1994 and 2018. Patient demographics, including the type of interventions, were recorded. Seizure outcomes (at last follow-up and at 1 year postoperatively) as well as complications are reported.RESULTSThirty-eight infants (median age 5.9 months) underwent a spectrum of surgical interventions, including hemispherectomy (n = 17), focal resection (n = 13), and multilobe resections (n = 8), with a mean follow-up duration of 9.1 years. Hemimegalencephaly and cortical dysplasia were the most commonly encountered pathologies. Surgery for catastrophic epilepsy resulted in complete resolution of seizures in 68% (n = 26) of patients, and 76% (n = 29) had a greater than 90% reduction in seizure frequency. Overall mortality and morbidity were 0% and 10%, respectively. The latter included infections (n = 2), infarct (n = 1), and immediate reoperation for seizures (n = 1).CONCLUSIONSSurgical intervention for catastrophic epilepsy in infants remains safe, efficacious, and durable. The authors’ work provides the longest follow-up of such a series on infants to date and compares favorably with previously published series.

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Hemispherectomy for the Control of Intractable Epilepsy in Childhood: Comparison of 2 Surgical Techniques in a Single Institution

Operative Neurosurgery ◽

10.1227/neu.0b013e3181f743dc ◽

2010 ◽

Vol 67 (suppl_2) ◽

pp. ons429-ons436 ◽

Cited By ~ 8

Author(s):

Allison Kwan ◽

Wai Hoe Ng ◽

Hiroshi Otsubo ◽

Ayako Ochi ◽

O. Carter Snead ◽

...

Keyword(s):

Surgical Techniques ◽

Intractable Epilepsy ◽

Class I ◽

Clinical Criteria ◽

Patient Demographics ◽

Initial Surgery ◽

Age At Surgery ◽

Second Procedure ◽

Catastrophic Epilepsy

ABSTRACT BACKGROUND: Hemispherectomy is an established neurosurgical procedure for catastrophic epilepsy in childhood. However, the technique used to achieve an optimum outcome remains to be determined. OBJECTIVE: We examined the influence of hemidecortication (HD) vs peri-insular hemispherotomy (PIH) on patient outcome. METHODS: The medical records of 41 children undergoing hemispherectomy were reviewed for patient demographics, clinical criteria, and surgical outcomes. RESULTS: HD and PIH were performed in 21 and 20 children, respectively. The mean age at surgery for HD was 54 months and 61 months for PIH. The median durations of surgery for HD and PIH were 5 hours and 7 hours, respectively (P < .001). For HD, 6 patients required a second surgery and 3 required a third. One PIH patient required a second procedure. Postoperative shunting was required in 5 HD patients, but only 1 PIH patient. All patients had increased hemiparesis after surgery. The overall mean follow-up time was 72 months. Engel class I or II outcomes after initial surgery were better after PIH (85%) compared with HD (48%) (P < .02). After subsequent surgeries for seizure control, 4 HD patients and 1 PIH patient improved to Engel class I or II. CONCLUSION: Hemispherectomy is an effective surgical procedure for childhood intractable catastrophic epilepsy. In patients with diffuse hemispheric disorder, PIH tends to have fewer major complications, more favorable seizure outcomes, and a decreased need for subsequent surgical procedures, including shunting for hydrocephalus, compared with HD.

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Delayed Aortic Stent Collapse in Blunt Traumatic Aortic Injury Repair

Aorta ◽

10.1055/s-0039-3401022 ◽

2019 ◽

Vol 07 (05) ◽

pp. 129-136

Author(s):

Abdullah Alhaizaey ◽

Badr Aljabri ◽

Musaad Alghamdi ◽

Ali AlAhmari ◽

Ahmed Abulyazied ◽

...

Keyword(s):

Aortic Arch ◽

Age Groups ◽

Young Patients ◽

Aortic Injury ◽

Stent Grafts ◽

Mortality And Morbidity ◽

Technical Success Rate ◽

Stent Grafting ◽

Blunt Traumatic Aortic Injury

Abstract Background Endovascular stent grafting has emerged as an option to treat traumatic aorta injuries with reported significantly low mortality and morbidity. Stent collapse is one of the complications that can occur in this type of treatment. The aim of this article is to analyze the expected cause of stent collapse and to draw attention to the importance of the surveillance follow-up, as this phenomenon may occur late postdeployment. Methods A retrospectively collected dataset from the two highest volume trauma centers in Saudi Arabia was analyzed between April 2007 and October 2012. A total of 66 patients received stent grafts for traumatic aortic injury and were included in the study. We apply Ishimaru's anatomical aortic arch zones and Benjamin's aortic injury grading systems. There were 35 patients with aortic injury at zone 2, 26 patients in zone 3, and 5 patients in zone 4. About 96% (63) of the injuries were grades 2 and 3, including large intimal flap or aortic wall pseudoaneurysm with change in wall contour. The technical success rate, as defined by complete exclusion of lesions without leaks, stroke, arm ischemia or stent-related complications, was 90%. Results Proximal stent collapse occurred in 4.5% of patients (3 of 66 inserted stents) during follow-up of 4 to 8 years (mean, 6 years). Patients with stent collapse tended to have an acute aortic arch angle with long-intraluminal stent lip, when compared with patients with noncollapsed stents. Intraluminal lip protrusion more than 10-mm increased collapse (p < 0.001). Stent-grafts sizes larger than 28 mm also demonstrated a higher collapse rate (p < 0.001). Conclusions The risk of stent collapse appears related to poor apposition of the stent due to severe aortic arch angulation in young patients and to large stent sizes (>28 mm). Such age groups may have more anatomical and aortic size changes during the growth. Clinical and radiological surveillance is essential in follow-up after stent-graft treatment for traumatic aortic injury.

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Wide-neck bifurcation aneurysms of the middle cerebral artery and basilar apex treated by endovascular techniques: a multicentre, core lab adjudicated study evaluating safety and durability of occlusion (BRANCH)

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-013771 ◽

2018 ◽

Vol 11 (1) ◽

pp. 31-36 ◽

Cited By ~ 25

Author(s):

Reade A De Leacy ◽

Kyle M Fargen ◽

Justin R Mascitelli ◽

Johanna Fifi ◽

Lena Turkheimer ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Endovascular Techniques ◽

Mortality And Morbidity ◽

Patient Demographics ◽

Procedural Information ◽

Morbidity Data ◽

Aneurysm Morphology ◽

Wide Neck

Background and purposeBRANCH (wide-neck bifurcation aneurysms of the middle cerebral artery and basilar apex treated by endovascular techniques) is a multicentre, retrospective study comparing core lab evaluation of angiographic outcomes with self-reported outcomes.Materials and methodsConsecutive patients were enrolled from 10 US centres, aged between 18 and 85 with unruptured wide-neck middle cerebral artery (MCA) or basilar apex aneurysms treated endovascularly. Patient demographics, aneurysm morphology, procedural information, mortality and morbidity data and core lab and self-reported modified Raymond Roy (RR) outcomes were obtained.Results115 patients met inclusion criteria. Intervention-related mortality and significant morbidity rates were 1.7% (2/115) and 5.8% (6/103) respectively. Core lab adjudicated RR1 and 2 occlusion rates at follow-up were 30.6% and 32.4% respectively. The retreatment rate within the follow-up window was 10/115 (8.7%) and in stent stenosis at follow-up was 5/63 (7.9%). Self-reporting shows a statistically significant direction to angiographic RR one outcomes at follow-up compared with core lab evaluation, with OR 1.75 (95% CI 1.08 to 2.83).ConclusionEndovascular treatment of wide-neck MCA and basilar apex aneurysms resulted in a core lab adjudicated RR1 occlusion rate of 30.6%. Self-reported results at follow-up favour better angiographic outcomes, with OR 1.75 (95% CI 1.08 to 2.83). These data demonstrate the need for novel endovascular devices specifically designed to treat complex intracranial aneurysms, as well as the importance of core lab adjudication in assessing outcomes in such a trial.

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Treatment of sepsis secondary to blast injuries

Journal of Surgical Arts ◽

10.14717/jsurgarts-210106 ◽

2021 ◽

pp. 31-40

Keyword(s):

Intensive Care ◽

Soft Tissue ◽

Care Service ◽

Young Patients ◽

Infectious Agent ◽

Blast Injuries ◽

Soft Tissue Infections ◽

Mortality And Morbidity ◽

One Year

Blast injuries are an important cause of morbidity and mortality due to ongoing conflicts, especially among young patients. Due to the adversities of warfare, the first interventions for these patients are performed in unsuitable environments. Patients generally do not receive further treatment in their own country, but in other countries as wounded war refugees. Local and systemic infections in patients with associated polytrauma, soft tissue damage, and blast effects cause mortality and morbidity. All of the patients were injured during the Libyan civil war and the first intervention was performed in hospitals in their own country or in Tunisia. The patients were transferred to our clinic by ambulance plane. All patients presented bone-soft tissue infection and sepsis. Bone-soft tissue and blood cultures were obtained from the patients. The first interventions for the patients were performed multidisciplinarily in orthopedics, general surgery, infection, and intensive care clinics. The patients were followed in our clinic for one year including inten-sive care, service, and outpatient monitoring. Sixteen patients with a mean age of 28.8 years were included in the study. All patients were wounded by explosives or missiles. The patients were admitted to our clinic at a mean of approximately 24.4 days after these events. The patients were followed in the intensive care unit for an average of 7.9 days. The mean follow-up was 4 months. After the service follow-up, each patient continued outpatient follow-up for a total of 12 months. Antibiotics were given according to the causative infectious agent during the intensive care and service follow-up. Three patients had lung infections. Colistin-induced renal failure or hepatotoxicity developed due to resistant infections in 4 patients. After colistin was ceased, this situation resolved. Two of the 16 patients died. The sepsis and bone-soft tissue infections were controlled in all other patients. Four patients had femoral nonu-nion and one patient had short femoral healing. While 2 patients were able to walk without support and 11 patients could walk using support and one patient who was Quadriplegic was unable to walk. The treatment of bone-soft tissue infections accompanied by sepsis should be multidisciplinary. This should be kept in mind for patients with systemic injuries due to explosion effects. The infectious agents in these patients are often drug-resistant and there may be complications secondary to the antibiotics used during treatment.

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1477 Epistaxis Management During The COVID-19 Pandemic First Wave- Do We Need to Admit Patients with Rapid Rhinos? A Complete Loop Audit

British Journal of Surgery ◽

10.1093/bjs/znab259.572 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

S McCrossan ◽

K O'Doherty ◽

R Adair

Keyword(s):

Traditional Approach ◽

Management Plan ◽

Nasal Packing ◽

Mortality And Morbidity ◽

Patient Demographics ◽

Bed Days ◽

Group 5 ◽

Time Of Admission

Abstract Introduction Epistaxis is a common ENT emergency, which if management requires nasal-packing, usually results in an inpatient admission. We audited our management of nasal-packing practices in the pre- and intra-pandemic era. Method Review of medical notes including patient demographics, reason for admission, time of admission, bed-day numbers, management plan and 30-day mortality and morbidity (M&M). 1st-cycle- January 2020, 2nd-cycle during the 1st-wave of the COVID-19 pandemic April-June 2020. Change implemented- patients were sent home with their nasal-pack in-situ. Results Pre-pandemic we admitted 100% (n = 15) of patients requiring rapid-rhino (RR) insertion compared to 7% (n = 1) of patients during the 1st-wave with an average age of 69 and 74-years respectively. 67% of patients in each group were on an antiplatelet or anticoagulant. Most common co-morbidities were hypertension (67%v40%), atrial-fibrillation (27%v53%) and cognitive impairment (13%v20%). 60% of patients attended in the out-of-hours period (5pm-8am). There was no difference in M&M. Bed-day average was 3.9-days and 2-days in the first and second groups. In the first group 5 patients (33%) needed arterial ligation with only one (7%) patient in the second group requiring ligation. Conclusions RR insertion and discharge with outpatient follow up is safe with no difference in M&M. Total bed-days were 57v4 bed-days in group one compared to group two, with £222/bed-day (NICE costings statement) the total-price was £12654v£888. We hope that the traditional approach of admitting every patient with RR may be reconsidered as the standard and only required when necessary.

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The Avocado Hand – the UK Experience of the Management of Avocado Hand Injuries

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s2424835520500423 ◽

2020 ◽

Vol 25 (04) ◽

pp. 402-406

Author(s):

Soha Sajid ◽

James Gill ◽

Adrian Chojnowski ◽

Rohit Singh

Keyword(s):

Surgical Management ◽

Young Patients ◽

Hand Injuries ◽

Dominant Hand ◽

Patient Demographics ◽

Outpatient Visits ◽

The Uk ◽

Nutritional Benefits ◽

Serious Injuries

Background: Avocados are increasingly being consumed due to the nutritional benefits they provide. Avocado related hand injuries reflect their increasing popularity. Most injuries occur in attempting to de-stone the fruit. This is a prospective cohort study reviewing hand injuries sustained from preparing the fruit. Methods: Data was prospectively collected from three centres across United Kingdom (UK) over a 4-year period. The data was analysed for patient demographics, nature and zone of injury and management required. Results: A total of 35 patients and 42 injuries were included in the study. The median age of patients presenting with these injuries was 33 years, with majority of injuries occurring in the 21–30 age group. Most (88%, n = 31) of patients were male. Majority (85%, n = 36) of injuries happened during the de-stoning of the fruit. All injuries occurred in the non-dominant hand, with 70%, (n = 30) of wounds being sustained in zone 3. All injuries required surgical management and needed between 1 to 6 follow up outpatient visits. Vital structures such as tendons, digital nerves, pulleys and joint capsule were frequently implicated and required exploration or repair. Conclusions: Avocado related hand wounds are serious injuries with an associated morbidity. They frequently sustained by young patients. They usually require surgical management and may need numerous outpatient attendances. Caution and public education should be advocated on the preparation of avocados. This is the largest study to date that has reviewed the surgical management of avocado hand injuries.

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Plasma Ablation–Assisted Endoscopic Management of Postintubation Laryngotracheal Stenosis: An Alternate Tool for Management

Otolaryngology ◽

10.1177/0194599819881439 ◽

2019 ◽

Vol 161 (6) ◽

pp. 993-995

Author(s):

Ramandeep Singh Virk ◽

Sandeep Bansal ◽

Gyanaranjan Nayak ◽

Lokesh P

Keyword(s):

Endoscopic Management ◽

Lower Grade ◽

Laryngotracheal Stenosis ◽

Effective Treatment Option ◽

Surgical Interventions ◽

Plasma Ablation ◽

Number Of Patients ◽

Institutional Experience ◽

The Mean

The current study was conducted to highlight the use of plasma ablation as a promising method in management of adult laryngotracheal stenosis. We present our institutional experience with a minimum follow-up of 6 months. Seventy adult patients with acquired postintubation laryngotracheal stenosis were included. Efficacy and clinical outcomes of plasma ablation in endoscopic management and eventual decannulation rate were studied. Number of patients with Myer-Cotton stenosis grades 1, 2, 3, and 4 were 20, 25, 18, and 7, respectively. The mean number of surgical interventions required in each grade of stenosis were 1, 2, 3.8, and 4, respectively. Overall, 47 patients (67%) were without tracheotomy by the end of 6 months. Plasma ablation is an effective treatment option for adult laryngotracheal stenosis, with a better success rate for lower-grade stenosis. It has lesser complications and requires fewer surgical interventions.

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Frequency and clinical impact of different definitions of moderate aortic stenosis

European Heart Journal ◽

10.1093/ehjci/ehaa946.1991 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

Y.U Du ◽

G.O Hashimoto ◽

J Cavalcante ◽

M Goessl ◽

S Garcia ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Stroke Volume Index ◽

High Rate ◽

Volume Index ◽

Funding Source ◽

Aortic Valve Area ◽

Mortality And Morbidity ◽

Patient Demographics

Abstract Background Current echocardiographic guidelines recommend five parameters to define severity of aortic stenosis (AS): peak velocity (PV), mean gradient (MG), aortic valve area (AVA), index AVA (AVAi), and dimensionless index (DI). However, the clinical utility of these parameters for patients with moderate AS largely remain unknown. Objective To investigate the clinical profiles and outcomes of patients with moderate AS according to five different definitions for severity. Methods Using standard echocardiographic definitions, we identified patients with moderate AS who were evaluated in our health care system from 2011 to 2012. Patient demographics, morbidities, and adverse events were reviewed, including death, heart failure (HF) admission, and aortic valve replacement (AVR). Results We enrolled 1,042 patients (age, 75±12 yrs; 40% women). Very few patients (4%) met all five criteria for moderate AS, while 49% had only one or two criteria met. DI was the most common parameter for defining moderate AS, employed in 93% of patients. Patients with area-based indices (i.e., AVA, AVAi, DI) had lower stroke volume index, lower mean gradients, lower peak velocities, and more morbidities in comparison to those flow-based definitions of severity (i.e., PV, MG). During a median follow-up of 5.7 years, overall survival was poor with all-cause mortality of 62.8%. Notably, there was no difference in the rates of mortality (range, 56.4 to 63.3%) or HF hospitalization (range, 28.9 to 32.2%) for groups defined by the five parameters, though patients with flow-based definitions more likely had AVR in follow-up. Conclusions Most patients with moderate AS meet the definition for severity with one or few criteria. Regardless of the method of definition for severity, a high rate of mortality and morbidity can occur in patients with moderate AS. Further study to optimize the clinical outcomes of patients with moderate AS is warranted. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Minneapolis Heart Institute Foundation

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Rezidivrisiko nach thyreostatischer Behandlung immunogener und nicht-immunogener Hyperthyreosen

Nuklearmedizin ◽

10.1055/s-0038-1629504 ◽

1990 ◽

Vol 29 (01) ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

E. Voth ◽

N. Dickmann ◽

H. Schicha ◽

D. Emrich

Keyword(s):

Relapse Rate ◽

Urinary Iodine ◽

Young Patients ◽

Antithyroid Drugs ◽

Urinary Iodine Excretion ◽

Old Patients ◽

Primary Disease ◽

Iodine Excretion ◽

Immunogenic Hyperthyroidism

Data of 196 patients treated for hyperthyroidism exclusively with antithyroid drugs were analyzed retrospectively concerning the relapse rate within a follow-up period of four years. Patients were subdivided for primary or recurrent disease, and for immunogenic or non-immunogenic hyperthyroidism, respectively. In immunogenic as well as in non-immunogeriic hyperthyroidism, the relapse rate was significantly lower for patients with primary disease (35% and 52%, respectively) compared to those with recurrent hyperthyroidism (82%, p <0.001 and 83%, p <0.001, respectively). In patients with primary disease, clinical, biochemical and scintigraphic parameters were tested with respect to their capability of predicting a relapse. For immunogenic hyperthyroidism the highest relapse rates were observed in young patients and in those with large goitres, whereas for non-immunogenic hyperthyroidism they were highest in old patients, in those with nodular goitres and in those without an increased urinary iodine excretion at the time of diagnosing hyperthyroidism.

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Hybrid Endovascular Repair of Thoracoabdominal Aorta: Early Results

The Heart Surgery Forum ◽

10.1532/hsf98.2014315 ◽

2014 ◽

Vol 17 (3) ◽

pp. 146

Author(s):

Osman Tansel Darcin ◽

Mehmet Kalender ◽

Ayse Gul Kunt ◽

Okay Guven Karaca ◽

Ata Niyazi Ecevit ◽

...

Keyword(s):

Endovascular Repair ◽

Therapeutic Option ◽

Complete Recovery ◽

Aortic Aneurysms ◽

Thoracoabdominal Aorta ◽

Mortality And Morbidity ◽

Early Results ◽

The Mean ◽

Procedural Success

Background: Thoracoabdominal aortic aneurysms (TAAA) present a significant clinical challenge, as they are complex and require invasive surgery. In an attempt to prevent considerably high mortality and morbidity in open repair, hybrid endovascular repair has been developed by many authors. In this study, we evaluated the early-term results obtained from this procedure.Methods: From November 2010 to February 2013, we performed thoracoabdominal hybrid aortic repair in 18 patients. The mean age was 68 years (12 men, 6 women). All of the patients had significant comorbidities. Follow-up computed tomography (CT) scans were performed at 1 week, 3 months, 6 months, and annually thereafter.Results: All patients were operated on in a staged procedure and stent graft deployment was achieved. Procedural success was achieved in all cases. All patients were discharged with complete recovery. No endoleaks weres detected in further CT examination.Conclusion: Our results suggests that hybrid debranching and endovascular repair of extensive thoracoabdominal aneurysms represents a suitable therapeutic option to reduce the morbidity and mortality of TAAA repair, particularly in those typically considered at high risk for standard repair.

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