Shunt surgery for hydrocephalus in tuberculous meningitis: a long-term follow-up study

1991 ◽  
Vol 74 (1) ◽  
pp. 64-69 ◽  
Author(s):  
Ravi Palur ◽  
Vedantam Rajshekhar ◽  
Mathew J. Chandy ◽  
Thomas Joseph ◽  
Jacob Abraham
Keyword(s):  
Tuberculous Meningitis ◽  
External Ventricular Drainage ◽  
Shunt Surgery ◽  
Ventricular Drainage ◽  
Initial Examination ◽  
Long Term Outcome ◽  
Long Term Follow Up ◽  
Grade Iii

✓ Hydrocephalus is a common complication of tuberculous meningitis. Case studies of 114 patients with tuberculous meningitis and hydrocephalus, who underwent shunt surgery between July, 1975, and June, 1986, were reviewed to evaluate the long-term outcome and to outline a management protocol for these patients based on the results. Seven factors were studied in each case: 1) age at admission; 2) grade on admission (I to IV, classified by the authors: Grade I being the best and Grade IV being the worst); 3) duration of alteration of sensorium; 4) cerebrospinal fluid (CSF) cell content at initial examination; 5) CSF protein levels at initial examination; 6) number of shunt revisions required; and 7) the necessity for bilateral shunts. During a long-term follow-up period ranging from 6 months to 13 years (mean 45.6 months), the mortality rate was 20% for patients in Grade I; 34.7% for patients in Grade II; 51.9% for patients in Grade III; and 100% for patients in Grade IV. Only the grade at the time of admission was found to be statistically significant in determining final outcome (p < 0.001). Based on these results, the authors advocate early shunt surgery for Grade I and II patients. For patients in Grade III, surgery may be performed either if external ventricular drainage causes an improvement in sensorium or without selection. All patients in Grade IV should undergo external ventricular drainage and only those who show a significant change in their neurological status within 24 to 48 hours of drainage, should have shunt surgery.

Catheter fixation and ligation: a simple technique for ventriculostomy management following endovascular stenting

2013 ◽  
Vol 118 (5) ◽  
pp. 1009-1013 ◽  
Author(s):  
Justin M. Sweeney ◽  
Rohit Vasan ◽  
Harry R. van Loveren ◽  
A. Samy Youssef ◽  
Siviero Agazzi
Keyword(s):  
Antithrombotic Therapy ◽  
External Ventricular Drainage ◽  
Ventricular Drainage ◽  
Management Options ◽  
Shunt System ◽  
Long Term Follow Up ◽  
Unique Method ◽  
Risk Of Hemorrhage

The object of this study was to describe a unique method of managing ventriculostomy catheters in patients on antithrombotic therapy following endovascular treatment of ruptured intracranial aneurysms. The authors retrospectively reviewed 3 cases in which a unique method of ventriculostomy management was used to successfully avoid catheter-related hemorrhage while the patient was on dual antiplatelet therapy. In this setting, ventriculostomy catheters are left in place and fixed to the calvarium with titanium straps effectively ligating them. The catheter is divided and the distal end is removed. The proximal end can be directly connected to a distal shunt system during this stage or at a later date if necessary. The method described in this report provided a variety of management options for patients requiring external ventricular drainage for subarachnoid hemorrhage. No patient suffered catheter-related hemorrhage. This preliminary report demonstrates a safe and effective method for discontinuing external ventricular drainage and/or placing a ventriculoperitoneal shunt in the setting of active coagulopathy or antithrombotic therapy. The technique avoids both the risk of hemorrhage related to catheter removal and reinsertion and the thromboembolic risks associated with the reversal of antithrombotic therapy. Some aneurysm centers have avoided the use of stent-assisted coiling in cases of ruptured aneurysms to circumvent ventriculostomy-related complications; however, the method described herein should allow continued use of this important treatment option in ruptured aneurysm cases. Further investigation in a larger cohort with long-term follow-up is necessary to define the associated risks of infection using this method.

Psychopathology 8½ Years Post Parasuicide

Crisis ◽  
1999 ◽  
Vol 20 (3) ◽  
pp. 115-120 ◽  
Author(s):  
Stephen Curran ◽  
Michael Fitzgerald ◽  
Vincent T Greene
Keyword(s):  
Rating Scales ◽  
Psychiatric Morbidity ◽  
Parental Bonding ◽  
Social Maladjustment ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Face To Face ◽  
Long Term Follow Up

There are few long-term follow-up studies of parasuicides incorporating face-to-face interviews. To date no study has evaluated the prevalence of psychiatric morbidity at long-term follow-up of parasuicides using diagnostic rating scales, nor has any study examined parental bonding issues in this population. We attempted a prospective follow-up of 85 parasuicide cases an average of 8½ years later. Psychiatric morbidity, social functioning, and recollections of the parenting style of their parents were assessed using the Clinical Interview Schedule, the Social Maladjustment Scale, and the Parental Bonding Instrument, respectively. Thirty-nine persons in total were interviewed, 19 of whom were well and 20 of whom had psychiatric morbidity. Five had died during the follow-up period, 3 by suicide. Migration, refusals, and untraceability were common. Parasuicide was associated with parental overprotection during childhood. Long-term outcome is poor, especially among those who engaged in repeated parasuicides.

OPEN HAEMORRHOIDS SURGERY IN SPINAL CORD INJURY PATIENTS

2020 ◽  
Vol 4 (11) ◽  
Author(s):  
Khaled Hassan
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Anal Fissure ◽  
Open Surgery ◽  
Anal Fissures ◽  
Cord Injury ◽  
Long Term Follow Up ◽  
Grade Iii

This Pilot retrospective research conducted on the results of open surgery in patients with Grade III and IV haemorrhoids With SCI. No major complications had arisen at 6 weeks post-operative and all wounds had healed, but 1 patient Anal fissure recurrence. 75% of patients reported a substantial increase in anorectal anorexia during long-term follow-up. With symptoms. Five patients reported recurrences: three haemorrhoids (18 percent) and two anal fissures (25 percent).   Keywords: Haemorrhoids, Pilot retrospective research, Anorectal Anorexia.

Abstract TP127: Mortality and Recurrence in Atherosclerotic Ischemic Stroke: Long-term Follow-up

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Miguel A Barboza ◽  
Rodrigo Uribe ◽  
Fabiola Serrano ◽  
Luis C Becerra-Pedraza ◽  
D. K Mantilla-Barbosa ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Functional Outcome ◽  
Median Time ◽  
Smoking History ◽  
Stroke Recurrence ◽  
Active Smoking ◽  
Long Term Outcome ◽  
Long Term Follow Up

Background and purpose: Atherosclerotic ischemic stroke is the second most frequent etiology of stroke in the adult population. Functional outcome, mortality and recurrence of stroke rates on the long-term follow-up are poorly studied. This study investigates long-term outcome among patients with ischemic stroke secondary to atherosclerotic causality, and identifies the main factors associated with poor outcome, recurrence, and death. Methods: We analyzed data from our consecutive acute ischemic stroke database, over a period of 25 years (1990-2015). The endpoints were: bad outcome (Modified Rankin Score ≥3), recurrence and mortality at discharge, and final follow-up. Multivariate Cox and Kaplan-Meier analysis were used to estimate the probability of death and recurrence. Results: A total of 946 consecutive atherosclerotic stroke patients were included (571 [60.4%] males, median age 65 years [interquartile range 57-73 years] for the entire population); dyslipidemia (64.2%), hypertension (63.3%), diabetes (35.0%), and active smoking history (31.8%) were the most prevalent risk factors.After a median follow-up of 38 months (IQR 12-75 months), 59.3% patients had a bad outcome at discharge. A result of 26.1% had stroke recurrence (median time until recurrence: 9 months [IQR 12-84 months], with 12.9% cases presenting ≥2 recurrences), and 24.1% were dead (median time to death: 18.5 months [IQR 11-74 months]) at the final follow-up period. After multivariate adjustment, hypertension (HR 4.2, CI 95% 2.8-6.1; p<0.001) was the strongest predictor of recurrence. Additionally, diabetes (HR 2.6, CI 95% 2.0-3.5; p<0.001), bad functional outcome after recurrence (HR 2.3, CI 95% 1.9-2.9; p<0.001), age ≥65 years (HR 2.2, CI 95% 1.7-2.9; p<0.001), and active smoking (HR 1.8, CI 95% 1.3-2.3; p<0.001) were the strongest predictors of mortality. Conclusions: Atherosclerotic ischemic stroke has a high rate of recurrence, associated mainly with hypertension. Mortality is predicted by diabetes, bad functional outcome at recurrence, and older age.

Abstract 18649: Long-term Outcome and the Mechanisms of Pulmonary Antrum Radial-linear Ablation in Patients With Paroxysmal Atrial Fibrillation

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Xue Zhao ◽  
Jianqiang Hu ◽  
Yan Huang ◽  
Yawei Xu ◽  
Yanzhou Zhang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Paroxysmal Atrial Fibrillation ◽  
Holter Monitoring ◽  
Pericardial Tamponade ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Long Term Follow Up ◽  
One Year

Objectives: The aim of this study was to determine the mechanisms and effectiveness of pulmonary antrum radial-linear (PAR) ablation in comparison with pulmonary vein isolation (PVI) in patients with paroxysmal atrial fibrillation (AF) after a long-term follow-up. Background: The one-year follow up data suggested that PAR ablation appeared to have a better outcome over the conventional PVI for paroxysmal AF. Methods: The enrollment occurred between March, 2011, and August, 2011, with the last follow-up in May, 2014. A total of 133 patients with documented paroxysmal AF were enrolled from 5 centers and randomized to PAR group or PVI group. Event ECG recorder and Holter monitoring were conductedduring the follow-up for all patients. Results: The average procedure time was 151±23 min in PAR group and 178±43 min in PVI group ( P <0.001). The average fluoroscopy time was 21±7 min in PAR group and 27±11 min in PVI group ( P= 0.002). AF triggering foci were eliminated in 59 patients (89.4%) in PAR group, whereas, only 4 patients (6.0%) in PVI group (P<0.001).At median 36 (37-35) months of follow-up after single ablation procedure, 43 of 66 patients in PAR group (65%) and 28 of 67 patients in PVI group (42%) had no recurrence of AF off antiarrhythmic drug (AAD) (P=0.007); and 47 of 66 patients in PAR group (71%) and 32 of 67 patients in PVI group (48%) had no recurrence of AF with AAD (P=0.006). At the last follow-up, the burden of AF was significantly lower in PAR group than in PVI group (0.9% ± 2.3% vs 4.9% ± 9.9%;90th percentile, 5.5% vs 19.6%; P=0.008). No major adverse event (death, stroke, PV stenosis) was observed in all the patients except one case of pericardial tamponade. Conclusions: PAR ablation is a simple, safe, and effective strategy for the treatment of paroxysmal AF with better long-term outcome than PVI. PAR ablation might exhibit the beneficial effect on AF management through multiple mechanisms. Registration: ChiCTR-TRC-11001191

Abstract 16668: Long-term Outcomes After Endo-epicardial Catheter Ablation of Ventricular Tachycardia in Nonischemic Cardiomyopathy

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Erica S Zado ◽  
Pasquale Santangeli ◽  
Francis E Marchlinski
Keyword(s):  
Ventricular Tachycardia ◽  
Catheter Ablation ◽  
Substantial Improvement ◽  
Nonischemic Cardiomyopathy ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Linear Ablation ◽  
Long Term Follow Up

Introduction: Endo-epicardial catheter ablation of ventricular tachycardia (VT) in patients (pts) with nonischemic cardiomyopathy (NICM) has been reported to have satisfactory results at the short- and mid-term follow-up. We sought to determine the outcomes at the long-term follow-up of endo-epicardial ablation of VT in NICM. Hypothesis: Catheter ablation provides satisfactory long term outcome Methods: We prospectively enrolled 128 pts (age 59±13 years, 116 [91%] males) with NICM who underwent endo-epicardial radiofrequency catheter ablation at our Institution. After substrate mapping, all critical sites for the clinical or induced VT(s), identified with activation, entrainment or pace-mapping, together with late, split and fractionated potentials were targeted with focal and/or linear ablation. The procedural endpoint was noninducibility of sustained monomorphic VT. Pts were followed with ICD interrogation. Results: A total of 108 (73%) pts had idiopathic dilated NICM. The remaining 20 (14%) pts had hypertrophic CM (n=11), suspected inflammatory CM (n=6), or valvular CM (n=3). The mean LV ejection fraction was 33±15%. After a mean follow-up of 19 months (max 97 months), a total of 36 (28%) pts died and 17 (13%) underwent heart transplant. Cumulative survival free from any recurrent VT was 53% (68/128 patients) (Figure A). In the remaining 60 (47%) patients with VT recurrences, catheter ablation still resulted in a significant beneficial clinical impact on VT burden, with 25/60 (42%) having only isolated (1-2) VT episodes over follow-up, and a striking reduction of VT storm in the remaining pts (Figure B). Conclusions: In patients with NICM and VT, endo-epicardial substrate-based ablation is effective in achieving long-term freedom from any VT in 53% of patients, with a substantial improvement in VT burden in many of the remaining patients.

scholarly journals LGG-40. NATURAL COURSE AND MANAGEMENT OF SMALL ASYMPTOMATIC LESION SUSPECTED OF LOW-GRADE GLIOMA IN CHILDREN

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii374-iii374
Author(s):  
Ai Muroi ◽  
Takao Tsurubuchi ◽  
Hidehiro Kohzuki ◽  
Ryoko Suzuki ◽  
Hiroko Fukushima ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Natural Course ◽  
Low Grade ◽  
Diffuse Astrocytoma ◽  
Mr Images ◽  
Initial Examination ◽  
Long Term Follow Up ◽  
Intracranial Lesions

Abstract OBJECTIVE The natural course of incidentally discovered small intracranial lesions has not been well discussed. Surgical intervention, including resection and biopsy, could be achieved if the lesion is growing. We present 13 cases with incidentally found, small non-enhancing lesions without related symptoms. METHODS We retrospectively reviewed a series of 13 children with T1 hypointense and T2 hyperintense intracranial lesions less than 20 mm in diameter without enhancement. We excluded the patients with NF-1 or Tuberous sclerosis. RESULTS Most patients underwent MRI for headache unrelated to the lesions. All cases were located supratentorially. The median age of the patients at the initial examination was 8.9 years (range, 2.2–14.6). Of these children, 2 patients (15.3%) underwent surgery because of progression on follow-up MR images. The pathological diagnosis was compatible with diffuse astrocytoma. Patients were followed for a median of 55 months (range, 11–87) and the overall survival rate was 100%. No patient experienced increase in size after 3 years of follow-up. CONCLUSIONS In most patients with small intracranial lesions, the lesions remained stable and conservative management was appropriate. However, in a few cases, the lesions changed in size or quality and surgical intervention was necessary. Long-term follow-up at least 3 years is mandatory.

scholarly journals Localized and indolent myeloma

Blood ◽  
1980 ◽  
Vol 56 (3) ◽  
pp. 521-525 ◽  
Author(s):  
R Alexanian
Keyword(s):  
Multiple Myeloma ◽  
Bone Lesions ◽  
Term Outcome ◽  
Myeloma Protein ◽  
Long Term Outcome ◽  
Long Term Follow Up ◽  
Tumor Load ◽  
Localized Disease

Abstract Criteria were defined for recognizing 29 patients with a localized plasmacytoma of bone and 20 patients with an indolent variety of multiple myeloma in order to justify long-term follow-up without chemotherapy. All patients with indolent myeloma were asymptomatic from their low tumor mass disease, had a hemoglobin greater than 10 g/dl, and showed no more than 3 lytic bone lesions. The presence of more than 200 mg/day of Bence Jones protein was usually followed by disease progression within 2 yr. Serial assessments of myeloma protein level provided a useful index of changing tumor load and the need for chemotherapy. In patients with localized disease, radiotherapy usually reduced myeloma proteins markedly with subsequent disease control for many years, even though small serum peaks persisted. Chemotherapy for multiple myeloma was not required for a median of 8 yr in patients presenting with localized disease and of 3 yr in those with indolent myeloma. The additional survival from the start of drug treatment was similar to that of comparable patients treated promptly for overt multiple myeloma. The delay of chemotherapy until evidence of tumor progression did not affect the long-term outcome of patients with localized or indolent myeloma.

Long-term outcome of social phobia treated by exposure

2001 ◽  
Vol 31 (5) ◽  
pp. 899-905 ◽  
Author(s):  
G. A. FAVA ◽  
S. GRANDI ◽  
C. RAFANELLI ◽  
C. RUINI ◽  
S. CONTI ◽  
...  
Keyword(s):  
Social Phobia ◽  
Consecutive Series ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Concurrent Use ◽  
Complete Treatment ◽  
Long Term Follow Up ◽  
Dsm Iv

Background. There is very little information on long-term follow-up of social phobia.Methods. A consecutive series of 70 patients satisfying the DSM-IV criteria for social phobia was treated in an out-patient clinic with behavioural methods based on exposure homework. Forty-five patients were judged to be remitted after eight individual sessions of psychotherapy. A 2 to 12 year (median = 6 years) follow-up was performed. Survival analysis was selected to characterize the clinical course of patients. Assessments were performed before treatment, at the end of therapy, after 1 year, and subsequently on a yearly basis, and utilized selected items of Paykel's Clinical Interview for Depression.Results. Six of the 45 patients (13%) had a relapse of social phobia at some time during follow-up. The estimated cumulative percentage of patients remaining in remission was 98 after 2 years, 85 after 5 years and 85 after 10 years. Such probabilities increased in the absence of a personality disorder, of residual social phobic avoidance after exposure, and of concurrent use of benzodiazepines.Conclusions. The findings suggest that, even though one patient out of three is unable to complete treatment or does not benefit sufficiently from it, exposure treatment can provide lasting effects to the majority of patients with social phobia. Disappearance of residual, subclinical social phobic avoidance appears to be the target of treatment.

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