Surgical complications of decompressive craniectomy in patients with head injury

2020 ◽  
Vol 99 (7) ◽  
Keyword(s):  
Risk Factors ◽  
Head Injury ◽  
Ct Scan ◽  
Decompressive Craniectomy ◽  
Soft Tissues ◽  
Simple Procedure ◽  
Massive Bleeding ◽  
Temporal Muscle ◽  
Potential Risk Factors ◽  
The Impact

Introduction: Decompressive craniectomy is an important method for managing refractory intracranial hypertension. Although decompressive craniectomy is a relatively simple procedure, various complications may arise. The aim of our paper was to determine the incidence of complications of decompressive craniectomy in patients with head injury and to analyse their risk factors. Methods: We retrospectively analysed a group of 94 patients after decompressive craniectomy for head injury between 01 Jan 2014 and 31 Dec 2018. Postoperative complications were evaluated based on clinical examination and postoperative CT scan. The impact of potential risk factors on the occurrence of complications was assessed (age, worse initial clinical condition, any haemocoagulation disorder). Results: Twenty patients died within the first month after surgery. Control CT scan showed one complication in 78 patients (83%), while 46 patients (49%) had more than one complication. We had to reoperate 22 patients (23.4%) due to a complication. The following complications were found: postoperative acute subgaleal/subdural haematoma (30× – 32%), subgaleal/subdural cerebrospinal fluid effusion (29× – 31%), soft tissues oedema (29× – 31%), haemorrhagic progression of brain contusion (17× – 18%), malignant brain oedema (8× – 8.5%), hydrocephalus (8× – 8.5%), temporal muscle atrophy (7× – 7.5%), peroperative massive bleeding ( 6× – 6.4%), epilepsy (4× – 4.3%), syndrome of the trephined (2× – 2.1%), skin necrosis (2× – 2.1%). Patients with a haemocoagulation disorder had a significantly higher incidence of complications (p=0.01). Conclusion: Complications of decompressive craniectomy after head injury are frequent. The potential benefit of decompressive craniectomy can be adversely affected by the occurrence of many complications.

Complications Following Decompressive Craniectomy

2021 ◽  
Author(s):  
Jan Mraček ◽  
Jan Mork ◽  
Jiri Dostal ◽  
Radek Tupy ◽  
Jolana Mrackova ◽  
...  
Keyword(s):  
Risk Factors ◽  
Decompressive Craniectomy ◽  
Clinical Status ◽  
Fluid Collection ◽  
Epileptic Seizures ◽  
Middle Cerebral Artery Infarction ◽  
Temporal Muscle ◽  
Life Saving ◽  
Potential Risk Factors ◽  
The Impact

Abstract Background Decompressive craniectomy (DC) has become the definitive surgical procedure to manage a medically intractable rise in intracranial pressure. DC is a life-saving procedure resulting in lower mortality but also higher rates of severe disability. Although technically straightforward, DC is accompanied by many complications. It has been reported that complications are associated with worse outcome. We reviewed a series of patients who underwent DC at our department to establish the incidence and types of complications. Methods We retrospectively evaluated the incidence of complications after DC performed in 135 patients during the time period from January 2013 to December 2018. Postoperative complications were evaluated using clinical status and CT during 6 months of follow-up. In addition, the impact of potential risk factors on the incidence of complications and the impact of complications on outcome were assessed. Results DC was performed in 135 patients, 93 of these for trauma, 22 for subarachnoid hemorrhage, 13 for malignant middle cerebral artery infarction, and 7 for intracerebral hemorrhage. Primary DC was performed in 120 patients and secondary DC in 15 patients. At least 1 complication occurred in each of 100 patients (74%), of which 22 patients (22%) were treated surgically. The following complications were found: edema or hematoma of the temporal muscle (34 times), extracerebral hematoma (33 times), extra-axial fluid collection (31 times), hemorrhagic progression of contusions (19 times), hydrocephalus (12 times), intraoperative malignant brain edema (10 times), temporal muscle atrophy (7 times), significant intraoperative blood loss (6 times), epileptic seizures (5 times), and skin necrosis (4 times). Trauma (p = 0.0006), coagulopathy (p = 0.0099), and primary DC (p = 0.0252) were identified as risk factors for complications. There was no significant impact of complications on outcome. Conclusions The incidence of complications following DC is high. However, we did not confirm a significant impact of complications on outcome. We emphasize that some phenomena are so frequent that they can be considered a consequence of primary injury or natural sequelae of the DC rather than its direct complication.

scholarly journals Birth desires and intentions of women diagnosed with a meningioma

2015 ◽  
Vol 122 (5) ◽  
pp. 1151-1156 ◽  
Author(s):  
Michelle A. Owens ◽  
Benjamin M. Craig ◽  
Kathleen M. Egan ◽  
Damon R. Reed
Keyword(s):  
Risk Factors ◽  
General Population ◽  
Potential Risk ◽  
Online Survey ◽  
Common Factor ◽  
Reproductive Decisions ◽  
Childbearing Age ◽  
Potential Risk Factors ◽  
Risk Factors For Recurrence ◽  
The Impact

OBJECT To the authors' knowledge, no previous study has examined the impact of meningioma diagnosis on women's birth desires and intentions. In an exploratory study, the authors surveyed women affected by meningioma to determine their attitudes toward childbearing and the influences, including physician recommendations, on this major life decision and compared their responses to those of women in the general population. METHODS Meningioma survivors from the Meningioma Mommas online support group participated in an online survey that included questions on their birth desires and intentions, whether the risk of disease recurrence influenced their reproductive decisions, and risks communicated to them by their physicians. Using chi-square and rank-sum tests, the authors compared the survey participants' responses with those of the general population as assessed by the 2006–2010 National Survey of Family Growth. Logistic regression was used to adjust for differences in age, race, ethnicity, education, parity, pregnancy status, and infertility status in these populations. RESULTS Respondents with meningioma were more likely than those in the general population to report wanting a baby (70% vs 54%, respectively), intending to have a baby (27% vs 12%, respectively), and being very sure about this intention (10% vs 2%, respectively). More than half (32 of 61) of the women of childbearing age reported being advised by a physician about potential risk factors for recurrence of the meningioma, and pregnancy was the most commonly cited risk factor (26 of 61). The most common factor influencing birth desires and intentions was risk of the meningioma returning and requiring more treatment, which was reported by nearly two-thirds of the women in their childbearing years. CONCLUSIONS A majority of the meningioma survivors of childbearing age who completed the survey reported a desire for children, although concern about the risk of meningioma recurrence was an important factor for these women when making reproductive decisions. Physicians are in a position to educate their patients on potential risk factors for recurrence and to provide contact information for services such as counseling and family planning.

Onset, timing and risk for depression and anxiety in family caregivers to heart transplant recipients

2004 ◽  
Vol 34 (6) ◽  
pp. 1065-1082 ◽  
Author(s):  
MARY AMANDA DEW ◽  
LARISSA MYASKOVSKY ◽  
ANDREA F. DIMARTINI ◽  
GALEN E. SWITZER ◽  
HERBERT C. SCHULBERG ◽  
...  
Keyword(s):  
Risk Factors ◽  
Psychiatric Disorder ◽  
Family Caregivers ◽  
Heart Transplant ◽  
Transplant Recipients ◽  
Post Traumatic Stress ◽  
Entire Study ◽  
Post Transplant ◽  
Potential Risk Factors ◽  
The Impact

Background. Family members adopt key caregiving roles in the maintenance of transplant recipients' health. While the bulk of the caregiving literature suggests that rates of psychiatric disorder should be high in these caregivers, the potential benefits of transplantation may instead lead to less distress than in other caregiving situations. We examined prevalence and risk factors for depressive and anxiety-related disorders in caregivers throughout 3 years after their family member's heart transplant.Method. A total of 190 caregivers (97% of eligible respondents) were enrolled. They received psychiatric and psychosocial evaluations at 2, 7, 12 and 36 months post-transplant. Survival analysis determined cumulative rates of psychiatric disorders and the impact of potential risk factors.Results. Rates of depressive and anxiety-related disorders met or exceeded other caregiver populations' rates. By 3 years post-transplant, cumulative onset rates were: Major Depressive Disorder (MDD), 31·6%, Adjustment disorders, 35·4% (29·4% with anxious mood); Post-Traumatic Stress Disorder related to the transplant (PTSD-T), 22·5%, Generalized Anxiety Disorder, 7·3%, and any assessed disorder, 56·3%. PTSD-T occurred primarily during the first year post-transplant. Other disorders' rates increased over the entire study period. Risk for disorder was elevated by positive lifetime history of psychiatric disorder, greater post-transplant caregiving responsibilities, and a poorer relationship with the patient. Risk for MDD was further increased by caregiver unemployment, and risk for anxiety disorders was further increased by younger age, low sense of personal mastery, and high use of avoidance coping strategies.Conclusions. Transplantation is associated with costs and benefits for not only patients but family caregivers. Caregivers' risk for psychiatric illness should be considered when developing interventions to promote families' long-term adjustment to the transplant process.

Assessment of The Influence of Non-Genetic Risk Factors on The Disease Onset and Progression of Androgenetic Alopecia in Egyptian Males

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Naziha Hafez Khafagy ◽  
Marwa Yassin Soltan ◽  
Ahmed Adel Ali Ali
Keyword(s):  
Risk Factors ◽  
Hair Loss ◽  
Genetic Risk ◽  
Disease Onset ◽  
Genetic Risk Factors ◽  
Androgenetic Alopecia ◽  
Major Type ◽  
Young Males ◽  
Potential Risk Factors ◽  
The Impact

Abstract Background Androgenetic alopecia (AGA) is a patterned hair loss with multifactorial background including genetic, hormonal as well as environmental and lifestyle-related risk factors. The impact of non-genetic risk factors on the onset and disease progression of androgenetic alopecia in Egyptian males. Objective To explore the potential role of non-genetic risk factors on the disease development and progression of androgenetic alopecia in Egyptian males. Patients and Methods The study included 2000 subjects with and without AGA, during the period from February 2019 to September 2019. The study protocol was approved by faculty of medicine, Ain Sham University, Research ethics committee (FWA 000017585). An informed written consent for participation in this study was obtained from patients and controls before enrollment. One thousand male patients with AGA were recruited in the study. The diagnosis was made via clinical diagnosis, dermatological findings, trichoscopic assessment. Results Our study showed that after skin examination 416 patients had acne and 344 patients had seborrhea, with statistically significant association to AGA cases. Conclusion From our study, it can be concluded that AGA became a major type of hair loss complaint among Egyptian males especially young males. Many potential risk factors were found to be associated with the disease as smoking, stress, obesity, family history, exercise, HTN and unbalanced diet. Avoidance of such risk factors may help improve the disease.

Child Sexual Abuse: An Overview

2000 ◽  
Vol 17 (1) ◽  
pp. 2-14 ◽  
Author(s):  
Paul E. Mullen ◽  
Neville J. King ◽  
Bruce J. Tonge
Keyword(s):  
Risk Factors ◽  
Sexual Abuse ◽  
Child Sexual Abuse ◽  
Potential Risk ◽  
Developmental Model ◽  
Potential Risk Factors ◽  
The Impact

AbstractThis overview examines the nature, prevalence, and impact of child sexual abuse. Associations and potential risk factors are identified, thus showing that child sexual abuse is not randomly distributed through the population. Finally, we discuss the ways in which clinicians and researchers have conceptualised the impact of child sexual abuse. A social and developmental model is outlined.

Patient risk factors and pegfilgrastim use in cabazitaxel-treated prostate cancer pateints in an academic setting.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 224-224
Author(s):  
Marina Dusevic Kaymakcalan ◽  
Sherri Stuver ◽  
Christopher Sweeney ◽  
Toni K. Choueiri ◽  
Aymen Elfiky
Keyword(s):  
Prostate Cancer ◽  
Risk Factors ◽  
Performance Status ◽  
Poor Performance ◽  
Prior History ◽  
Poor Performance Status ◽  
Castration Resistant Prostate Cancer ◽  
Exact Test ◽  
Potential Risk Factors ◽  
The Impact

224 Background: Cabazitaxel can offer a survival advantage in patients (pts) with metastatic castration resistant prostate cancer (mCRPC). Febrile neutropenia (FN) has emerged as a serious complication, with a rate of 8% in the TROPIC trial (de Bono, Lancet 2010). Prophylaxis with pegfilgrastim (P) can decrease the risk of FN, although predictors of FN continue to evolve. We performed an analysis on the effect of prophylactic P use on FN and the impact of certain risk factors on FN rates. Methods: We conducted a retrospective analysis of mCRPC patients treated with cabazitaxel from June 2010 to August 2013 at Dana-Farber Cancer Institute. Patient clinical and treatment variables were extracted. Fisher’s exact test was used to evaluate the association between potential risk factors and FN. Results: A total of 89 patients were treated at our institution and included in this analysis. All patients received at least one dose of cabazitaxel and received a mean of four cycles. Five pts (5.6%) developed FN; 3 out of 70 (4.3%) receiving P and 2 out of 19 (10.5%) not receiving P (p=0.3). Of the 24 patients that started cabazitaxel at a reduced dose, none developed FN. No toxic death was reported. Among several risk factors including P use, age older than 65, pre-existing neutropenia, prior chemotherapy, pre-existing infection, poor performance status, liver and renal dysfunction, and recent surgery, only a prior history of palliative radiation had a significant association with FN (p=.002). Conclusions: The rate of FN in a large academic practice is similar to what was reported in the TROPIC trial. Prior radiation may be a risk factor for FN in cabazitaxel-treated mCRPC patients. Other factors that may help better predict the risk of FN in different groups of patients receiving cabazitaxel must be identified.

scholarly journals School Performance and Disease Interference in Adolescents with Sickle Cell Disease

2015 ◽  
Vol 34 (1) ◽  
pp. 14-30 ◽  
Author(s):  
Lori E Crosby ◽  
Naomi E Joffe ◽  
Mary Kay Irwin ◽  
Heather Strong ◽  
James Peugh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Sickle Cell Disease ◽  
School Performance ◽  
Sickle Cell ◽  
Educational Achievement ◽  
Educational Interventions ◽  
Cell Disease ◽  
Potential Risk Factors ◽  
Demographic Risk ◽  
The Impact

 Sickle cell disease (SCD) results in neuropsychological complications that place adolescents at higher risk for limited educational achievement. A first step to developing effective educational interventions is to understand the impact of SCD on school performance. The current study assessed perceptions of school performance, SCD interference and acceptability of educational support strategies in adolescents with SCD. To identify potential risk factors, the relationships between school performance, SCD interference and demographics were also examined. Thirty adolescents aged 12 to 20 years completed demographics and SCD school performance questionnaires. Approximately 37% of participants reported receiving special education services, but more than 60% reported that SCD interfered with their school performance. Females reported that SCD impacted their schooling more than males (X2 (1, n = 30) = 5.00, p < .05). Study findings provide important insights into demographic risk factors and support the need for individualized health and educational plans for adolescents with SCD.

scholarly journals Intracranial haemorrhage detected by cerebral computed tomography after falls in hospital acute medical wards

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Shiny Stephen ◽  
Elena W. W. Wong ◽  
Adam M. Idris ◽  
Andy K. H. Lim
Keyword(s):  
Risk Factors ◽  
Computed Tomography ◽  
Head Injury ◽  
Brain Imaging ◽  
Potential Risk ◽  
Intracranial Haemorrhage ◽  
Brain Ct ◽  
Potential Risk Factors ◽  
Inpatient Falls ◽  
Medical Wards

Abstract Background There is little published data on brain imaging and intracranial haemorrhage after hospital inpatient falls. Imaging protocols for inpatient falls have been adopted from head injury guidelines developed from data in patients presenting to the Emergency Department. We sought to describe the use of brain computed tomography (CT) following inpatient falls, and determine the incidence and potential risk factors for intracranial haemorrhage. Methods We identified inpatient falls in acute medical wards at Monash Health, a large hospital network in the southeast region of Melbourne in Australia, from the incident reporting system during a 32 month period. We examined the post-fall medical assessment form, neurological observation chart and the diagnostic imaging system for details of the fall and brain CT findings. We used survival analysis to evaluate the timeliness of brain imaging and determined potential risk factors for intracranial haemorrhage by logistic regression. Results From 934 falls in 789 medical inpatients, 191 brain CT scans were performed. The median age of patients was 77 years. Only 55% of falls were from standing height and 24% experienced a head strike. Less than 10% of patients received an urgent scan within one hour, and timeliness of imaging was influenced by anticoagulation status rather than guideline determination of urgency. The overall incidence of intracranial haemorrhage was 0.9%. The factors associated with intracranial haemorrhage were head strike, anticoagulation, loss of consciousness or amnesia, drop in Glasgow Coma Scale and advanced chronic kidney disease. Conclusions The incidence of intracranial haemorrhage was low as most inpatient falls were at low risk for head injury. Research is needed to determine if guidelines specific for hospital inpatients may reduce unnecessary scans without compromising case detection, and improve timeliness of urgent scans.

scholarly journals Risk Factors for In-Hospital Complications of Fall-Related Fractures among Older Chinese: A Retrospective Study

2016 ◽  
Vol 2016 ◽  
pp. 1-11 ◽  
Author(s):  
Hong-Ying Pi ◽  
Yuan Gao ◽  
Jing Wang ◽  
Meng-Meng Hu ◽  
Dan Nie ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Potential Risk ◽  
Preventive Measures ◽  
Chinese Patients ◽  
Potential Risk Factors ◽  
Older Chinese ◽  
Individual Complication ◽  
The Impact ◽  
Univariate Analyses

Purpose. The aim of this study was to investigate the risk factors and the efficacy of the preventive measurements for the in-hospital complications of fall-related fractures. Methods. The data on older Chinese patients with fall-related fractures were collected, including information on the patients, diseases, and preventive measurements. The potential risk factors for the in-hospital complications included health status on admission, comorbidity, fractures, preventive measures of the complications, and drugs use for the comorbidity. After univariate analyses, multivariate logistic regression analyses were applied to investigate the impact of the potential risk factors on the number of the complications and each individual complication, respectively, and the efficacy of the preventive measurements. Results. A total of 525 male and 1367 female were included in this study. After univariate analyses, multiple logistic regression showed that dementia, pneumonia, antidepressant, postural hypotension, and cerebral infarction could increase the incidence and number of comorbidities. Meanwhile, dementia has shown the strongest association with each individual complication. Conclusions. Different combinations of comorbidity, medication use, and preventive measurements were related to the in-hospital complications of fall-related fractures. Dementia emerged as the most important risk factor for these complications, while most of the preventive measurements could not reduce their incidences.

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