Causalgic pain relieved by prolonged procaine amide sympathetic blockade

1984 ◽  
Vol 60 (5) ◽  
pp. 1095-1096 ◽  
Author(s):  
Thomas J. Leipzig ◽  
Sean F. Mullan
Keyword(s):  
High Risk ◽  
Local Anesthetic ◽  
Stellate Ganglion ◽  
Sympathetic Blockade ◽  
Content Type ◽  
Left Hand ◽  
Risk Patients ◽  
Procaine Amide ◽  
Sympathetic Blocks ◽  
Fine Print

✓ Reversible sympathetic blocks diagnostically relieve causalgic pain. At times, repeated blocks may be therapeutic. Causalgic pain of the left hand was successfully treated in a nonsurgical candidate by a continuous infusion of local anesthetic (procaine) into the region of the stellate ganglion. This technique was performed without significant complication and gave relief from the causalgia for extended periods of time. It may provide an effective alternative to surgical sympathectomy in high-risk patients.

Phenytoin and postoperative epilepsy

1983 ◽  
Vol 58 (5) ◽  
pp. 672-677 ◽  
Author(s):  
J. Brian North ◽  
Robert K. Penhall ◽  
Ahmad Hanieh ◽  
Derek B. Frewin ◽  
William B. Taylor
Keyword(s):  
Head Injury ◽  
High Risk ◽  
Seizure Control ◽  
Active Drug ◽  
Double Blind Trial ◽  
Double Blind ◽  
Content Type ◽  
Routine Prophylaxis ◽  
Risk Patients ◽  
Fine Print

✓ A double-blind trial of phenytoin therapy following craniotomy was performed to test the hypothesis that phenytoin is effective in reducing postoperative epilepsy. A significant reduction in the frequency of epilepsy was observed in the group receiving the active drug up to the 10th postoperative week. Half of the seizures occurred in the first 2 weeks and two-thirds within 1 month of cranial surgery. High rates of epilepsy were observed after surgery in patients with meningioma, metastasis, aneurysm, and head injury. Routine prophylaxis with phenytoin (in a dosage of 5 to 6 mg/kg/day) would seem to be indicated, particularly in high-risk patients and, where possible, this treatment should be started 1 week preoperatively. Seizure control is best when therapeutic levels of phenytoin are maintained.

Identification and management of high-risk patients with Klippel-Feil syndrome

1984 ◽  
Vol 61 (3) ◽  
pp. 523-530 ◽  
Author(s):  
Mahmoud G. Nagib ◽  
Robert E. Maxwell ◽  
Shelley N. Chou
Keyword(s):  
Spinal Cord ◽  
High Risk ◽  
Cervical Spinal Cord ◽  
Neurological Injury ◽  
Content Type ◽  
High Risk Patients ◽  
Cervicomedullary Junction ◽  
Risk Patients ◽  
Salient Features ◽  
Fine Print

✓ Patients with Klippel-Feil syndrome are often at high risk for neurological injury. The cervicomedullary junction and cervical spinal cord are especially vulnerable. Twenty-one patients examined and treated over a 20-year period are reviewed. The salient features of the syndrome are identified, and an approach to management is proposed.

Hemangiopericytoma of the spinal canal

1978 ◽  
Vol 49 (6) ◽  
pp. 914-920 ◽  
Author(s):  
Darrell J. Harris ◽  
Victor L. Fornasier ◽  
Kenneth E. Livingston
Keyword(s):  
Endothelial Cells ◽  
Differential Diagnosis ◽  
High Risk ◽  
Spinal Canal ◽  
Vertebral Column ◽  
Soft Tissues ◽  
Surgical Removal ◽  
Vascular Neoplasm ◽  
Content Type ◽  
Fine Print

✓ Hemangiopericytoma is a vascular neoplasm consisting of capillaries outlined by an intact basement membrane that separates the endothelial cells of the capillaries from the spindle-shaped tumor cells in the extravascular area. These neoplasms are found in soft tissues but have rarely been shown to involve the spinal canal. This is a report of three such cases. Surgical removal of the tumor from the spinal canal was technically difficult. A high risk of recurrence has been reported but in these three cases adjunctive radiotherapy appeared to be of benefit in controlling the progression of the disease. These cases, added to the six cases in the literature, confirm the existence of hemangiopericytoma involving the vertebral column with extension into the spinal canal. This entity should be included in the differential diagnosis of lesions of the spinal canal. The risk of intraoperative hemorrhage should be anticipated.

Direct percutaneous cerebral angiography in neurosurgical practice

1980 ◽  
Vol 52 (4) ◽  
pp. 525-528 ◽  
Author(s):  
Jerry Bauer ◽  
Jose Luis Salazar ◽  
Oscar Sugar ◽  
Ronald P. Pawl
Keyword(s):  
High Risk ◽  
Cerebrovascular Disease ◽  
Cerebral Angiography ◽  
Complication Rate ◽  
High Risk Population ◽  
Content Type ◽  
Pros And Cons ◽  
Sixth Decade ◽  
Symptoms And Signs ◽  
Fine Print

✓ A retrospective analysis of 1171 consecutive percutaneous retrograde brachial and carotid cerebral angiograms was performed on 635 patients, 50.7% of whom were in the sixth decade or older. Symptoms and signs of cerebrovascular disease were the most frequently investigated and diagnosed, accounting for 46.7% of all the angiograms. Despite this relatively high-risk population, we have found direct percutaneous cerebral angiography to have a very low risk. The pros and cons of direct percutaneous versus transfemoral cerebral angiography are discussed. The literature of the previous 10 years is reviewed, and the complication rate of these two techniques is compared.

Aneurysms of the intracavernous carotid artery: a multidisciplinary approach to treatment

1991 ◽  
Vol 75 (4) ◽  
pp. 525-534 ◽  
Author(s):  
Mark E. Linskey ◽  
Laligam N. Sekhar ◽  
Joseph A. Horton ◽  
William L. Hirsch ◽  
Howard Yonas
Keyword(s):  
Carotid Artery ◽  
Low Risk ◽  
Ct Scans ◽  
Xenon Ct ◽  
Content Type ◽  
Giant Aneurysms ◽  
Aneurysm Embolization ◽  
Risk Patients ◽  
Fine Print

✓ Of 43 cavernous sinus aneurysms diagnosed over 6½ years, 23 fulfilled indications for treatment; of these 19 were treated, eight surgically and 11 with interventional radiological techniques. Six small and two giant aneurysms were treated surgically: four were clipped, two were repaired primarily, and two were trapped with placement of a saphenous-vein bypass graft. Seven large and four giant aneurysms were treated with interventional radiological techniques: in five cases the proximal internal carotid artery (ICA) was sacrificed; one aneurysm was trapped with detachable balloons; and five were embolized with preservation of the ICA lumen. The mean follow-up period was 25 months. At follow-up examination, three patients in the surgical group were asymptomatic, two had improved, and three had worsened. Three of these patients had asymptomatic infarctions apparent on computerized tomography (CT) scans. At follow-up examination, four radiologically treated patients were asymptomatic, five had improved, two were unchanged, and none had worsened. One patient had asymptomatic and one minimally symptomatic infarction apparent on CT scans; both lesions were embolic foci after aneurysm embolization with preservation of the ICA. It is concluded that treatment risk depends more on the adequacy of collateral circulation than on the size of the aneurysm. A multidisciplinary treatment protocol for these aneurysms is described, dividing patients into high-, moderate-, and low-risk groups based on pretreatment evaluation of the risk of temporary or permanent ICA occlusion using a clinical balloon test occlusion coupled with an ICA-occluded stable xenon/CT cerebral blood flow study. Radiological techniques are suggested for most low-risk patients, while direct surgical techniques are proposed for most moderate- and high-risk patients.

High-risk mild head injury

1997 ◽  
Vol 87 (2) ◽  
pp. 234-238 ◽  
Author(s):  
John N. K. Hsiang ◽  
Theresa Yeung ◽  
Ashley L. M. Yu ◽  
Wai S. Poon
Keyword(s):  
Head Injury ◽  
High Risk ◽  
Mild Head Injury ◽  
Radiographic Findings ◽  
Content Type ◽  
Head Injured ◽  
Definition Of ◽  
Gcs Score ◽  
Injured Patients ◽  
Fine Print

✓ The generally accepted definition of mild head injury includes Glasgow Coma Scale (GCS) scores of 13 to 15. However, many studies have shown that there is a heterogeneous pathophysiology among patients with GCS scores in this range. The current definition of mild head injury is misleading because patients classified in this category can have severe sequelae. Therefore, a prospective study of 1360 head-injured patients with GCS scores ranging from 13 to 15 who were admitted to the neurosurgery service during 1994 and 1995 was undertaken to modify the current definition of mild head injury. Data regarding patients' age, sex, GCS score, radiographic findings, neurosurgical intervention, and 6-month outcome were collected and analyzed. The results of this study showed that patients with lower GCS scores tended to have suffered more serious injury. There was a statistically significant trend across GCS scores for percentage of patients with positive acute radiographic findings, percentage receiving neurosurgical interventions, and percentage with poor outcome. The presence of postinjury vomiting did not correlate with findings of acute radiographic abnormalities. Based on the results of this study, the authors divided all head-injured patients with GCS scores ranging from 13 to 15 into mild head injury and high-risk mild head injury groups. Mild head injury is defined as a GCS score of 15 without acute radiographic abnormalities, whereas high-risk mild head injury is defined as GCS scores of 13 or 14, or a GCS score of 15 with acute radiographic abnormalities. This more precise definition of mild head injury is simple to use and may help avoid the confusion caused by the current classification.

Frequency and management of recurrent stenosis after carotid artery stent implantation

2005 ◽  
Vol 102 (1) ◽  
pp. 29-37 ◽  
Author(s):  
Elad I. Levy ◽  
Ricardo A. Hanel ◽  
Tsz Lau ◽  
Christopher J. Koebbe ◽  
Naveh Levy ◽  
...  
Keyword(s):  
High Risk ◽  
Carotid Artery ◽  
Doppler Ultrasonography ◽  
Velocity Ratio ◽  
Content Type ◽  
Recurrent Stenosis ◽  
Diastolic Velocity ◽  
Lost To Follow Up ◽  
Fine Print

Object. To determine the rate of hemodynamically significant recurrent carotid artery (CA) stenosis after stent-assisted angioplasty for CA occlusive disease, the authors analyzed Doppler ultrasonography data that had been prospectively collected between October 1998 and September 2002 for CA stent trials. Methods. Patients included in the study participated in at least 6 months of follow-up review with serial Doppler studies or were found to have elevated in-stent velocities (> 300 cm/second) on postprocedure Doppler ultrasonograms. Hemodynamically significant (≥ 80%) recurrent stenosis was identified using the following Doppler criteria: peak in-stent systolic velocity at least 330 cm/second, peak in-stent diastolic velocity at least 130 cm/second, and peak internal carotid artery/common carotid artery velocity ratio at least 3.8. Follow-up studies were obtained at approximate fixed intervals of 1 day, 1 month, 6 months, and yearly. Angiography was performed in the event of recurrent symptoms, evidence of hemodynamically significant stenosis on Doppler ultrasonography, or both. Treatment was repeated because of symptoms, angiographic evidence of severe (≥ 80%) recurrent stenosis, or both of these. Stents were implanted in 142 vessels in 138 patients (all but five patients were considered high-risk surgical candidates and 25 patients were lost to follow-up review). For the remaining 112 patients (117 vessels), the mean duration of Doppler ultrasonography follow up was 16.42 ± 10.58 months (range 4–54 months). Using one or more Doppler criteria, severe (≥ 80%) in-stent stenosis was detected in six patients (5%). Eight patients underwent repeated angiography. Six patients (three with symptoms) required repeated intervention (in four patients angioplasty alone; in one patient conventional angioplasty plus Cutting Balloon angioplasty; and in one patient stent-assisted angioplasty). Conclusions. In a subset of primarily high-risk surgical candidates treated with stent-assisted angioplasty, the rates of hemodynamically significant restenosis were comparable to surgical restenosis rates cited in previously published works. Treatment for recurrent stenosis incurred no instance of periprocedure neurological morbidity.

scholarly journals Kidney Failure Risk Equation and Cost of Care in Patients with Chronic Kidney Disease

2021 ◽  
pp. CJN.06770521 ◽  
Author(s):  
Bhanu Prasad ◽  
Meric Osman ◽  
Maryam Jafari ◽  
Lexis Gordon ◽  
Navdeep Tangri ◽  
...  
Keyword(s):  
High Risk ◽  
Prescription Drugs ◽  
Kidney Failure ◽  
Hospital Admissions ◽  
Low Risk ◽  
Content Type ◽  
Physician Visits ◽  
Risk Equation ◽  
Risk Of Progression ◽  
Risk Patients

Background and objectivesPatients with CKD exhibit heterogeneity in their rates of progression to kidney failure. The kidney failure risk equation (KFRE) has been shown to accurately estimate progression to kidney failure in adults with CKD. Our objective was to determine health care utilization patterns of patients on the basis of their risk of progression.Design, setting, participants, & measurementsWe conducted a retrospective cohort study of adults with CKD and eGFR of 15–59 ml/min per 1.73 m2 enrolled in multidisciplinary CKD clinics in the province of Saskatchewan, Canada. Data were collected from January 1, 2004 to December 31, 2012 and followed for 5 years (December 31, 2017). We stratified patients by eGFR and risk of progression and compared the number and cost of hospital admissions, physician visits, and prescription drugs.ResultsIn total, 1003 adults were included in the study. Within the eGFR of 15–29 ml/min per 1.73 m2 group, the costs of hospital admissions, physician visits, and drug dispensations over the 5-year study period comparing high-risk patients with low-risk patients were (Canadian dollars) $89,265 versus $48,374 (P=0.008), $23,423 versus $11,231 (P<0.001), and $21,853 versus $16,757 (P=0.01), respectively. Within the eGFR of 30–59 ml/min per 1.73 m2 group, the costs of hospital admissions, physician visits, and prescription drugs were $55,944 versus $36,740 (P=0.10), $13,414 versus $10,370 (P=0.08), and $20,394 versus $14,902 (P=0.02) in high-risk patients in comparison with low-risk patients, respectively, for progression to kidney failure.ConclusionsIn patients with CKD and eGFR of 15–59 ml/min per 1.73 m2 followed in multidisciplinary clinics, the costs of hospital admissions, physician visits, and drugs were higher for patients at higher risk of progression to kidney failure by the KFRE compared with patients in the low-risk category. The high-risk group of patients with CKD and eGFR of 15–29 ml/min per 1.73 m2 had stronger association with hospitalizations costs, physician visits, and drug utilizations.

Radiosurgery as palliation for brain metastases: a retrospective review of 72 patients harboring multiple lesions at presentation

2002 ◽  
Vol 97 ◽  
pp. 511-514 ◽  
Author(s):  
Beatriz E. Amendola ◽  
Aizik Wolf ◽  
Sammie R. Coy ◽  
Marco A. Amendola
Keyword(s):  
Brain Metastases ◽  
Tumor Volume ◽  
Gamma Knife Radiosurgery ◽  
Karnofsky Performance Scale ◽  
Primary Tumors ◽  
Content Type ◽  
Fractionated Radiotherapy ◽  
Multiple Brain Metastases ◽  
Risk Patients ◽  
Fine Print

Object. The purpose of this study was to determine the outcome of palliative gamma knife radiosurgery (GKS) in a group of poor-risk patients with multiple brain metastases. Methods. The medical records of 72 patients with multiple brain metastases treated with GKS between October 1993 and November 9, 2001, were reviewed retrospectively. All patients presented with more than 10 lesions. There were 26 men and 46 women. The median age was 60 years (range 24–84 years). There were 39 patients with lung cancer, 18 with breast cancer, nine with metastatic melanomas, two with metastatic renal cell carcinomas, and four with other primary tumors. A total of 147 treatment sessions were required to treat 1304 sites in 72 patients. A mean of 10.4 isocenters per treatment was used. The mean tumor volume was 1.7 cm3. All patients had extracranial disease. The variables included in this study were the patient's Karnofsky Performance Scale score, age, sex, the radiation dose, initial number of lesions, and tumor volume and histopathology. Conclusions. Radiosurgery can be a powerful tool in the palliative management of advanced metastatic disease even in patients presenting with multiple brain metastases. A median of two outpatient treatments was required, allowing the advanced cancer patient to avoid protracted fractionated radiotherapy and to undergo other therapeutic treatment with an acceptable quality of life.

Improving screening for diabetes in cystic fibrosis

2015 ◽  
Vol 28 (5) ◽  
pp. 441-451 ◽  
Author(s):  
Ibrahim Abdulhamid ◽  
Lokesh Guglani ◽  
Jennifer Bouren ◽  
Kathleen C Moltz
Keyword(s):  
Cystic Fibrosis ◽  
High Risk ◽  
Standard Operating Procedure ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Screening Process ◽  
Content Type ◽  
Annual Screening ◽  
Risk Patients ◽  
Reminder Letters

Purpose – Annual screening for cystic fibrosis-related-diabetes (CFRD) using oral glucose tolerance test (OGTT) is recommended, but national testing rates are low. The purpose of this paper is to implement the quality improvement (QI) initiative to improve cystic fibrosis (CF) annual screening rates among patients at one CF center. Design/methodology/approach – To improve screening for CFRD at the CF Center, the authors used the Dartmouth Microsystem Improvement Ramp method and formed a collaborative working group. A process map was created to outline the steps and a fishbone analysis was performed to identify barriers and to utilize resources for implementing new interventions. Findings – Prior to these interventions, 21 percent of eligible patients had completed annual screening and after the intervention, it rose to 72 percent. The initial completion rate with the first prescription was only 50 percent, but it improved steadily to 54/75 (72 percent) in response to reminder letters sent six weeks after the initial script was given. Practical implications – Close tracking and reminder letters can improve adherence with annual OGTT screening for CFRD among CF patients, with special emphasis on high-risk patients. Originality/value – There should be a special emphasis on screening for CFRD in high-risk CF patients (those with low BMI or higher age). This QI initiative brought about several operational changes in the annual OGTT screening process that have now become the standard operating procedure at the center.

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