scholarly journals Spontaneous Intracerebral Haematoma-II:Post-Operative Changes and Outcome of Burrhole Aspiration after Urokinase Mediated Clot Lysis

2017 ◽  
Vol 34 (2) ◽  
pp. 64-75
Author(s):  
Mohammad Nazrul Hossain ◽  
Shahryar Nabi ◽  
Sk Sader Hossain
Keyword(s):  
Diabetes Mellitus ◽  
Blood Clot ◽  
Clot Lysis ◽  
Intracerebral Hematoma ◽  
Invasive Technique ◽  
Intracerebral Haematoma ◽  
College Hospital ◽  
Clot Removal ◽  
Haematoma Volume ◽  
Number Of Patients

Background: Treatments of intracerebral hematoma (ICH) are controversial and surgical interventions in spontaneous ICH are required and more accepted. Although advantage of neurosurgical intervention conservative treatment of ICH has not been established, recent reports have suggested favourable effects of blood clot removal after liquefaction by means of urokinase.Objectives: To study the intervention by and out come in without or with complications of Burrhole aspiration treatment after urokinase mediated clot lysis; Study Design : Prospective interventional study. Place and Duration of Study: Departments of Neurosurgery and Radiology & Imaging ,Dhaka Medical College Hospital, Dhaka, Bangladesh from July 2010 to December 2010;Materials &Methods: A total of 30 Bangladeshi patients with spontaneous ICH (Age range: 40-75yrs,Mean age ±SD:59.1±11.52 years, Gender : 22 males, 8 females) full filling the criteria for spontaneous ICH were included in the study. The desired information relevant to the objectives were obtained and recorded carefully using a structured questionnaire; The Patients were treated with Burrhole aspiration after urokinase mediated lysis , evaluated for out come , complications and death and statistically analyzed ;Results: The results on delays of intervention ,types of intervention, doses of urokinase, post-operative changes in haematoma volume, outcome with Glasgow outcome scale(GOS) and GOS at follow–up, complications and death were presented with statistical analyses and significance .The outcome and death were compared with various variables such as hypertension (p <0.05), diabetes mellitus (p< 0.05) primary GOS (P<0.05),site of hematoma (p<0.05),volume of haematoma (p<0.05),ventricular extension of hematoma (p<0.05) and delay from ictus to intervention (p<0.05).Conclusion : It was observed that early treatment (within 24 hours of occurance) by using minimally invasive technique and clot removal by urokinase mediated lysis can improve the consequences especially those with haematoma volume < 40 ml, lobar haematoma and without ventricular extension. Bad prognostic factors were increase of blood pressure, diabetes mellitus, GOS level <8, haematoma in the basal ganglia , ventricular extension of the haematoma volume> 40 ml and delay in intervention. However, the present was conducted with 30 patients only and therefore, studies with larger number of patients are required to draw more meticulous and more definitive conclusions.J Bangladesh Coll Phys Surg 2016; 34(2): 64-75

Dependence of Blood Clot Lysis on the Mode of Transport of Urokinase into the Clot - A Magnetic Resonance Imaging Study in Vitro

1991 ◽  
Vol 65 (05) ◽  
pp. 549-552 ◽  
Author(s):  
A Blinc ◽  
G Planinšič ◽  
D Keber ◽  
O Jarh ◽  
G Lahajnar ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Pressure Difference ◽  
Volume Flow Rate ◽  
Blood Clot ◽  
Linear Regression Analysis ◽  
Imaging Study ◽  
Clot Lysis ◽  
Resonance Imaging

SummaryMagnetic resonance imaging was employed to study the dependence of clot lysing patterns on two different modes of transport of urokinase into whole blood clots. In one group of clots (nonperfused clots, n1 = 10), access of urokinase to the fibrin network was possible by diffusion only, whereas in the other group (perfused clots, n2 = 10) bulk flow of plasma containing urokinase was instituted through occlusive clots by a pressure difference of 3 .7 kPa (37 cm H2O) across 3 cm long clots with a diameter of 4 mm. It was determined separately that this pressure difference resulted in a volume flow rate of 5.05 ± 2.4 × 10−2 ml/min through occlusive clots. Perfused clots diminished in size significantly in comparison to nonperfused ones already after 20 min (p <0.005). Linear regression analysis of two-dimensional clot sizes measured by MRI showed that the rate of lysis was more than 50-times faster in the perfused group in comparison to the nonperfused group. It was concluded that penetration of the thrombolytic agent into clots by perfusion is much more effective than by diffusion. Our results might have some implications for understanding the differences in lysis of arterial and venous thrombi.

STUDY ON THE CHARACTERISTICS OF DOPPLER ULTRASOUND OF LOWER EXTREMITY ARTERIES IN PATIENTS WITH DIABETES MELLITUS TYPE 2

2011 ◽  
pp. 25-30
Author(s):  
Keyword(s):  
Diabetes Mellitus ◽  
Doppler Ultrasound ◽  
Lower Extremities ◽  
Arterial Stenosis ◽  
Invasive Technique ◽  
Atherosclerotic Plaques ◽  
Type 2 Dm ◽  
Arterial Lesions ◽  
Patients With Diabetes

Objectives: Vascular Doppler ultrasound is a non-invasive technique to rapidly detect lesions of the vessels in the lower extremities with high accuracy. The use of this technique for detecting early vascular damages in patients with diabetes mellitus (DM) type 2 could help preventing major vascular complications caused by this disease. Materials and Method: This descriptive, cross-sectional study included 31 patients with type 2 DM who were treated in Endocrinology - Neurology - Respiratory Department, Hue Central Hospital between March and August 2011. All patients were undergone clinical and biochemical examinations, and Doppler ultrasound for detection of arterial lesions in their lower extremities. Results: Most patients had high intima media thickness (IMT) (77.42%), and all of them suffered from hypertension concomitant, with the rate of atherosclerotic plaque accounted for 35.48%. No one experienced arterial stenosis >50% and arterial occlusions, but the peak systolic velocities were significantly higher in patients with atherosclerotic plaques than those without atherosclerotic plaques. Conclusion: Vascular Doppler ultrasound should be used as routine test for early detection of arterial lesions in patients with type 2 DM.

scholarly journals Diabetes mellitus was not associated with lower amputation-free survival after open revascularization for chronic limb-threatening ischemia – A nationwide propensity score adjusted analysis

2021 ◽  
pp. 1358863X2110082
Author(s):  
Erika Lilja ◽  
Anders Gottsäter ◽  
Mervete Miftaraj ◽  
Jan Ekelund ◽  
Björn Eliasson ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Propensity Score ◽  
Vascular Surgery ◽  
Incidence Rate ◽  
Cox Regression ◽  
Major Amputation ◽  
Incidence Rates ◽  
Major Adverse Cardiovascular Events ◽  
Cox Regression Analysis ◽  
Number Of Patients

The risk of major amputation is higher after urgently planned endovascular therapy for chronic limb-threatening ischemia (CLTI) in patients with diabetes mellitus (DM). The aim of this nationwide cohort study was to compare outcomes between patients with and without DM following urgently planned open revascularization for CLTI from 2010 to 2014. Out of 1537 individuals registered in the Swedish Vascular Registry, 569 were registered in the National Diabetes Register. A propensity score adjusted Cox regression analysis was conducted to compare outcome between the groups with and without DM. Median follow-up was 4.3 years and 4.5 years for patients with and without DM, respectively. Patients with DM more often had foot ulcers ( p = 0.034) and had undergone more previous amputations ( p = 0.001) at baseline. No differences in mortality, cardiovascular death, major adverse cardiovascular events (MACE), or major amputation were observed between groups. The incidence rate of stroke was 70% higher (95% CI: 1.11–2.59; p = 0.0137) and the incidence rate of acute myocardial infarction (AMI) 39% higher (95% CI: 1.00–1.92; p = 0.0472) among patients with DM in comparison to those without. Open vascular surgery remains a first-line option for a substantial number of patients with CLTI, especially for limb salvage in patients with DM. The higher incidence rates of stroke and AMI among patients with DM following open vascular surgery for infrainguinal CLTI require specific consideration preoperatively with the aim of optimizing medical treatment to improve cardiovascular outcome postoperatively.

scholarly journals Clinical condition of 120 patients alive at 3 years after poor-grade aneurysmal subarachnoid hemorrhage

2021 ◽  
Author(s):  
Anniina H. Autio ◽  
Juho Paavola ◽  
Joona Tervonen ◽  
Maarit Lång ◽  
Terhi J. Huuskonen ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Clinical Condition ◽  
Hospice Care ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Blood Clot ◽  
Neurointensive Care ◽  
Intracerebral Hematoma ◽  
Poor Grade ◽  
Final Study ◽  
Study Population

Abstract Background To study the clinical condition of poor-grade aneurysmal subarachnoid hemorrhage (aSAH) patients alive at 3 years after neurointensive care. Methods Of the 769 consecutive aSAH patients from a defined population (2005–2015), 269 (35%) were in poor condition on admission: 145 (54%) with H&H 4 and 124 (46%) with H&H 5. Their clinical lifelines were re-constructed from the Kuopio Intracranial Aneurysm Database and Finnish nationwide registries. Of the 269 patients, 155 (58%) were alive at 14 days, 125 (46%) at 12 months, and 120 (45%) at 3 years. Results The 120 H&H 4–5 patients alive at 3 years form the final study population. On admission, 73% had H&H 4 but only 27% H&H 5, 59% intracerebral hematoma (ICH; median 22 cm3), and 26% intraventricular blood clot (IVH). The outcome was favorable (mRS 0–1) in 45% (54 patients: ICH 44%; IVH clot 31%; shunt 46%), moderate (mRS 2–3) in 30% (36 patients: ICH 64%; IVH clot 19%; shunt 42%), and unfavorable (mRS 4–5) in 25% (30 patients: ICH 80%; IVH clot 23%; shunt 50%). A total of 46% carried a ventriculoperitoneal shunt. ICH volume was a significant predictor of mRS at 3 years. Conclusions Of poor-grade aSAH patients, 45% were alive at 3 years, even 27% of those extending to pain (H&H 5). Of the survivors, 75% were at least in moderate condition, while only 2.6% ended in hospice care. Consequently, we propose non-selected admission to neurointensive care (1) for a possibility of moderate outcome, and (2), in case of brain death, possibly improved organ donation rates.

scholarly journals Reported Diabetes Mellitus Prevalence Rates in the Colombia Healthcare System from 2009 to 2012: Analysis by Regions Using Data of the Official Information Sources

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Noël C. Barengo ◽  
Diana Carolina Tamayo
Keyword(s):  
Diabetes Mellitus ◽  
Healthcare System ◽  
Social Protection ◽  
Prevalence Rates ◽  
Annual Increase ◽  
Number Of Patients ◽  
High Expenditure ◽  
System Information ◽  
Using Data ◽  
Official Information

The objective of this study was to describe the reported diabetes mellitus (DM) prevalence rates of the 20–79-year-old population in Colombia from 2009 to 2012 reported by the healthcare system. Information on number of patients treated for DM was obtained by the Integral Information System of Social Protection (SISPRO), the registry of the Ministry of Health and Social Protection, and the High Cost Account (CAC), an organization to trace high expenditure diseases. From both sources age-standardized reported DM prevalence rates per 100.000 inhabitants from 2009 to 2012 were calculated. Whereas the reported DM prevalence rates of SISPRO revealed an increase from 964/100.000 inhabitants (2009) to 1398/100.000 inhabitants in 2012 (mean annual increase 141/100.000;pvalue: 0.001), the respective rates in the CAC register were 1082/100.000 (2009) and 1593/100.000 in 2012 (mean annual increase 165/100.000;pvalue: 0.026). The number of provinces reporting not less than 19% of the highest national reported DM prevalence rates (1593/100.000) increased from two in 2009 to ten in 2012. Apparently, the registries and the information retrieving system have been improved during 2009 and 2012, resulting in a greater capacity to identify and report DM cases by the healthcare system.

Effect of Heparin on TAFI-Dependent Inhibition of Fibrinolysis: Relative Importance of TAFIa Generated by Clot-Bound and Fluid Phase Thrombin

2002 ◽  
Vol 88 (08) ◽  
pp. 282-287 ◽  
Author(s):  
Anna Pentimone ◽  
Bianca Binetti ◽  
Marialisa Cramarossa ◽  
Donatella Piro ◽  
Nicola Semeraro ◽  
...  
Keyword(s):  
Thrombin Generation ◽  
Blood Clot ◽  
Fluid Phase ◽  
Clot Lysis ◽  
Relative Importance ◽  
Thrombin Activatable Fibrinolysis Inhibitor ◽  
Dependent Inhibition ◽  
Fibrinolysis Inhibitor ◽  
Dependent Mechanism

SummaryHeparin has been proposed to enhance thrombolysis by inhibiting thrombin-dependent generation of activated TAFI (thrombin activatable fibrinolysis inhibitor), a carboxypeptidase that inhibits fibrinolysis. We evaluated the effect of heparin in an in vitro thrombolysis model consisting of a radiolabelled blood clot submerged in defibrinated plasma. Fibrinolysis was induced by adding t-PA (250 ng/ml) and calcium to the plasma bath. Control experiments indicated that thrombin generation induced by recalcification caused significant TAFI activation and inhibited clot lysis. Heparin (up to 1 U/ml), added to the plasma bath, failed to enhance clot lysis. Thrombin generation in the fluid phase was totally inhibited by heparin at concentrations > 0.5 U/ml. In contrast, thrombin generation on the clot surface was not inhibited by heparin (1 U/ml). TAFIa generation did occur in heparin-containing samples (1 U/ml) and amounted to about 10% of TAFIa formed in control samples. This low amount of TAFIa did exert antifibrinolytic activity as indicated by the observation that the addition of a specific TAFIa inhibitor (PTI) along with heparin enhanced clot lysis. Hirudin (10 µg/ml), at variance with heparin, inhibited clot-bound thrombin and enhanced clot lysis. These data show that heparin is unable to stimulate fibrinolysis through a TAFI-dependent mechanism, most likely because of its inefficiency in inhibiting thrombin generation on the clot surface. Moreover, they suggest that clot-bound thrombin plays a major role in TAFI-mediated inhibition of fibrinolysis through “localized” TAFIa generation.

A Reconstituted Dilute Blood Clot Lysis Assay for the Medium Throughput Screening of Thrombolytic Compounds

1999 ◽  
Vol 270 (1) ◽  
pp. 24-32 ◽  
Author(s):  
Albert P. Gadbut ◽  
John R. Schullek ◽  
Arthur M. Hanel ◽  
David R.E. MacAllan
Keyword(s):  
Blood Clot ◽  
Clot Lysis ◽  
Dilute Blood

scholarly journals Prevalence of Depression Symptoms in Diabetes Mellitus

2018 ◽  
Vol 6 (2) ◽  
pp. 340-343 ◽  
Author(s):  
Salih Eker
Keyword(s):  
Diabetes Mellitus ◽  
Depressive Disorder ◽  
Depression Symptoms ◽  
Strong Indicator ◽  
Number Of Patients ◽  
High Prevalence ◽  
Prevalence Of Depression ◽  
The World

BACKGROUND: Diabetes mellitus (DM) is one of the most prevalent diseases all over the world. Prevalence of DM in Turkey is 13.7%. Depression is another condition which has a high prevalence. All over the world, an estimated 300 million people of all ages suffer from depression. The relevance between depression and DM is a well - known condition.AIM: We aimed in this study to find out the prevalence of depression symptoms for DM in an attempt to better manage the disease.METHODS: We preferred the Beck Depression Index (BDI) to evaluate the depression symptoms.RESULTS: The number of patients introduced the study were 171 (101 (59.1%) female). As a results of BDI 67 (39.2%) patients evaluated as normal [29 (28.7%) female], 54 (31.6%) had poor symptoms [35 (34.7%) female], 46 (26.9%) had moderate symptoms [34 (33.7%) female] and lastly only 4(2.3%) had strong symptoms 3 (3.0%) female]. So 50 (29.2%) of patients had median plus strong symptoms. There were statistically significant association between HbA1c stages and depression (P = 0.018).CONCLUSION: Being a patient with DM is a strong indicator that the patient may have a depressive disorder. So the physician who takes care patients with DM should be alert about depression, and the simplest way to accomplish is BDI.

scholarly journals A STUDY ON PATTERN OF PRESCRIBING MEDICATIONS USED IN SECONDARY PREVENTION OF STROKE

2016 ◽  
Vol 9 (9) ◽  
pp. 328
Author(s):  
Lakshmi R ◽  
Jithin Kc ◽  
Arya G ◽  
Lekshmi P Nair
Keyword(s):  
Diabetes Mellitus ◽  
Secondary Prevention ◽  
Tertiary Care ◽  
Age Group ◽  
Data Collection Form ◽  
Comorbid Conditions ◽  
Exclusion Criteria ◽  
Prescribing Pattern ◽  
Number Of Patients ◽  
Collection Form

ABSTRACTObjectives: The main objectives of this study were to estimate the demographic details of patients with the first incidence of stroke and to study thevarious risk factors for ischemic stroke.Methods: It was a retrospective, observational study carried out for 1 year at the Department of Stroke Medicine of a tertiary care teaching hospitalin Kerala, India. A total of 636 patients were admitted under stroke medicine during the period from July 1, 2014, to July 1, 2015, and who satisfiedthe inclusion and exclusion criteria were included in the study. A standardized data collection form was prepared and necessary data were collectedfrom patient’s medical records.Results: The maximum number of patients was in the age group of 60-69 years. 65.1% patients were residing in the rural area. 60.7% patients weremale. Most of them had hypertension as common comorbidity (21.35%) and the highest number of patients had diabetes mellitus and hypertension(21.7%). Majority of the patients were prescribed with antiplatelets (94.91%), followed by statins (93.8%).Conclusion: A strict control on the comorbid conditions and sticking on to the medications can prevent the occurrence of future stroke.Keywords: Stroke, Secondary prevention, Drugs, Prescribing pattern.

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