scholarly journals Ultraearly Hematoma Growth in Acute Spontaneous Intracerebral Hemorrhage Predicts Early and Long-Term Poor Clinical Outcomes: A Prospective, Observational Cohort Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Wen-Juan Wang ◽  
Jing-Jing Lu ◽  
Li-Ping Liu ◽  
Jiao-Kun Jia ◽  
Xing-Quan Zhao
Keyword(s):  
Intracerebral Hemorrhage ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Poor Outcome ◽  
Observational Cohort ◽  
Hematoma Growth ◽  
Prognostic Importance ◽  
Selection Of Patients ◽  
Selection Of

Aims: Although prognostic importance of ultraearly hematoma growth (uHG) in acute, non-traumatic intracerebral hemorrhage (ICH) has been established for early outcomes, longer-term clinical outcomes are lacking. We aimed to determine the association of uHG with early and 1-year clinical outcomes after acute ICH in a larger and broader range of patients.Methods: We studied 589 patients with acute (<6 h) spontaneous ICH. uHG was defined as baseline ICH volume/onset-to-imaging time (OIT) (ml/h). Multivariable logistic regression analyses were performed to determine the association of uHG with in-hospital mortality, 90-day, and 1-year poor outcome [3 ≤ modified Rankin Scale (mRS)] after ICH.Results: The median speed of uHG was 4.8 ml/h. uHG > 9.3 ml/h was independently related to in-hospital mortality [odds ratio (OR) 2.81, 95% CI 1.52–5.23], 90-day poor outcome (OR 3.34, 95% CI 1.87–5.95), and 1-year poor outcome (OR 3.59, 95% CI 2.01–6.40) after ICH. The sensitivity of uHG > 9.3 ml/h in the prediction of in-hospital mortality, 90-day poor outcome, and 1-year poor outcome was 68.8, 48.0, and 51.1%, respectively.Conclusions: Ultraearly hematoma growth was a useful predictor of in-hospital mortality, 90-day, and 1-year poor outcome after acute ICH. The combination of both uHG and baseline ICH volume could allow better selection of patients with ICH at high risk of poorest clinical outcomes for future clinical trials to improve early- and long-term clinical outcomes.

scholarly journals Active surveillance in patients with a PSA >10 ng/mL

2014 ◽  
Vol 8 (9-10) ◽  
pp. 702 ◽  
Author(s):  
Paul Toren ◽  
Lih-Ming Wong ◽  
Narhari Timilshina ◽  
Shabbir Alibhai ◽  
John Trachtenberg ◽  
...  
Keyword(s):  
Active Surveillance ◽  
Specific Antigen ◽  
Sufficient Evidence ◽  
Hazard Ratios ◽  
Diagnostic Biopsy ◽  
Selection Of Patients ◽  
Baseline Psa ◽  
Selection Of

Introduction: The use of prostate-specific antigen (PSA) in active surveillance (AS) for prostate cancer is controversial. Some consider it an unreliable marker and others as sufficient evidence to exclude patients from AS. We analyzed our cohort of AS patients with a PSA over 10 ng/mL.Methods: We included patients who had clinical T1c–T2a Gleason ≤6 disease, and ≤3 positive cores with ≤50% core involvement at diagnostic biopsy and ≥2 total biopsies. Patients were divided into 3 groups: (1) those with baseline PSA >10 ng/mL, (2) those with a PSA rise >10 ng/mL during follow-up; and (3) those with a PSA <10 ng/mL throughout AS. Adverse histology was defined as biopsy parameters exceeding the entry criteria limits. We further compared this cohort to a concurrent institutional cohort with equal biopsy parameters treated with immediate radical prostatectomy.Results: Our cohort included 698 patients with a median follow-up of 46.2 months. In total, 82 patients had a baseline PSA >10 ng/mL and 157 had a PSA rise >10 ng/mL during surveillance. No difference in adverse histology incidence was detected between groups (p = 0.3). Patients with a PSA greater than 10 were older and had higher prostate volumes. Hazard ratios for groups with a PSA >10 were protective against adverse histology. Larger prostate volume and minimal core involvement appear as factors related to this successful selection of patients to be treated with AS.Conclusion: These results suggest that a strict cut-off PSA value for all AS patients is unwarranted and may result in overtreatment. Though lacking long-term data and validation, AS appears safe in select patients with a PSA >10 ng/mL and low volume Gleason 6 disease.

scholarly journals Changing trends in the management of corpus luteum haemorrhage

2021 ◽  
Vol 10 (8) ◽  
pp. 3261
Author(s):  
Avantika Gupta ◽  
Deepthi Nayak ◽  
Purnima Tiwari
Keyword(s):  
Corpus Luteum ◽  
Conservative Management ◽  
Risk Group ◽  
Massive Bleeding ◽  
High Risk Group ◽  
Changing Trends ◽  
Oxygen Carrying Capacity ◽  
Selection Of Patients ◽  
Selection Of

Corpus luteal haemorrhage usually causes only mild symptoms and resolve spontaneously, however, it can cause massive bleeding in certain patients with coagulation or bleeding disorders. Over a decade, the management of corpus luteum haemorrhage has shifted from surgical to conservative management. This article focuses on selection of patients for conservative management so that the morbidities associated with the surgery can be avoided. Conservative management includes optimization of oxygen carrying capacity of blood, correction of coagulopathy and appropriate analgesia. It can be recurrent in certain high-risk group of patients who will need long term suppression of ovulation.

Needle aspiration techniques in preoperative selection of patients with thyroid nodules: a long-term study.

1996 ◽  
Vol 14 (5) ◽  
pp. 1704-1712 ◽  
Author(s):  
A Carpi ◽  
E Ferrari ◽  
M G Toni ◽  
A Sagripanti ◽  
A Nicolini ◽  
...  
Keyword(s):  
Thyroid Nodules ◽  
False Negative ◽  
Needle Aspiration ◽  
Long Term Study ◽  
Preoperative Selection ◽  
Pathologic Features ◽  
Term Evaluation ◽  
Selection Of Patients ◽  
Selection Of

PURPOSE Long-term evaluation of the combination of two needle aspiration techniques (NAT) (fine-needle aspiration [FNA] and aspiration needle biopsy [ANB]) in performing an efficient preoperative selection of palpable thyroid nodules. PATIENTS AND METHODS Eight years of extensive use of surgery for the detection of thyroid cancer was compared with 12 years of preoperative selection of by NAT. RESULTS A total of 1,140 operations were performed from 1972 to 1979, and 35 malignant nodules were discovered (3.1%). Five thousand four hundred three patients were examined by NAT from 1980 to 1992; 483 (9%) underwent surgery and 158 malignant nodules were excised. The number of malignant nodules identified by NAT was 166 (eight were not excised) (3.1% of the total population examined). The principal clinical and pathologic features were similar in both groups. ANB yielded a definite benign diagnosis in 88 patients with inadequate FNA findings, it correctly identified four malignant nodules diagnosed as benign by FNA, it showed a macrofollicular component in 115 nodules diagnosed by FNA as microfollicular nodules, and it significantly changed the predictive value of 79 suspicions FNA diagnoses. CONCLUSION Introduction of NAT reduced the number of operations for palpable thyroid nodules from 143 to 40 per year and increased from four to 13 the number of malignant nodules excised without any change in the overall incidence of malignant nodules. The combination of ANB to FNA significantly contributed to the high and efficient preoperative patient selection, principally by reducing the number of indeterminate or suspicious, as well as false-negative, preoperative FNA diagnoses.

scholarly journals Decreased Time to Evacuation Improves Long Term Functional Outcome in Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Christopher P Kellner ◽  
Rui Song ◽  
Dominic A Nistal ◽  
Ian T McNeill ◽  
Hasitha M Samarage ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
National Institutes Of Health ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Clinical Criteria ◽  
Poor Outcome ◽  
Deep Location

Abstract INTRODUCTION Preclinical and preliminary clinical data suggests that early minimally invasive intracerebral hemorrhage evacuation may convey a functional outcome benefit. Ongoing clinical trials permit an operative window extending out to 72 h. Here we present long term functional outcome after MIS endoscopic ICH evacuation with a focus on time to evacuation. METHODS Minimally invasive endoscopic ICH evacuation was performed on patients with supratentorial ICH who fit previously published clinical criteria including age = 18, National Institutes of Health Stroke Scale (NIHSS) = 6, hematoma volume = 15, and baseline modified Rankin Score (mRS) = 3 with a CTA negative for vascular malformation. Retrospective review was performed on patients who were treated in a single health system from December 2015 to August 2018. Demographic, clinical and radiographic previously demonstrated to impact ICH outcome were included in a multivariate logistic regression to identify factors predicting poor outcome (modified Rankin scale (mRS) 4-6) at 6 mo. RESULTS A total of 97 patients underwent minimally invasive endoscopic ICH evacuation. In a multivariate analysis, factors that predicted poor outcome included age (OR 1.81 (CI 1.15-3.08) P = .016), deep location (OR 11.1 (2.41-67.8) P = .004), presence of intraventricular hemorrhage (OR 5.81 (1.765-22.39) P = .006) and increased time to evacuation measured in hours (OR 1.048 (CI 1.017-1.084) P = .004). CONCLUSION Time to evacuation significantly impacts long term outcome in minimally invasive endoscopic ICH evacuation. Every minute counts.

Island Sign Predicts Long-Term Poor Outcome and Mortality in Patients with Intracerebral Hemorrhage

2018 ◽  
Vol 120 ◽  
pp. e304-e312 ◽  
Author(s):  
Fan Zhang ◽  
Hao Li ◽  
Juan Qian ◽  
Si Zhang ◽  
Chuanyan Tao ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Poor Outcome

scholarly journals Case selection in dental bleaching

2021 ◽  
Vol 67 (3) ◽  
pp. 183-185
Author(s):  
Irina-Maria Gheorghiu ◽  
◽  
Paula Perlea ◽  
Sanziana Scarlatescu ◽  
George Nicola ◽  
...  
Keyword(s):  
Hydrogen Peroxide ◽  
Treatment Plan ◽  
Dental Bleaching ◽  
Etiological Diagnosis ◽  
Aesthetic Result ◽  
Tooth Discoloration ◽  
Case Selection ◽  
Selection Of Patients ◽  
Selection Of

Dental bleaching is a method of treatment for tooth discoloration that uses hydrogen peroxide in various concentrations. For this dental maneuver to be successful, the etiological diagnosis of dental dyschromia and the treatment plan must be rigorously established. In this article we present the criteria underlying the selection of patients who can benefit from dental bleaching, grouped in a questionnaire. Adequate case selection suitable for teeth whitening, as well as the appropriate choice of the specific bleaching method are essential in obtaining satisfactory aesthetic result for the patient, immediately after completing the treatment, but also in the long term.

scholarly journals Posterior Maxillary Prosthetic Treatment with Molar Hemisection – A case report

2018 ◽  
Vol 1 (1) ◽  
pp. 22
Author(s):  
Abil Kurdi ◽  
Hanoem Eka Hidayati
Keyword(s):  
Case Report ◽  
Healing Process ◽  
Multiple Root ◽  
Bridge Abutment ◽  
Infected Root ◽  
Alternative Treatment Option ◽  
Molar Teeth ◽  
Selection Of Patients ◽  
Selection Of

Background: Hemisection is an alternative treatment option for maintaining tooth with multiple root that indicated for extraction. Purpose: To reported tooth with multiple root indicated by extraction to be used as a fixed-fixed bridge abutment by extracting the infected root and maintain the healthy one. Case: A 53-year-old woman with caries in upper 1st molar teeth in mesiobuccally root that can’t be maintained. Patients refuse the teeth to be extracted. Case Management: Hemisection treatment was performed on 26 mesiobuccal root, with the addition of bone graft. After the healing process, fixed-fixed bridges were made on 25, 26, 27, 28, with PFM on 25, 26, 27 and full cast crowns on 28 as the material. Discussion: Hemisection as a conservative treatment, can be an option for multiple  root teeth that has been indicated for extraction but still have root that can be maintained. Conclusion: Teeth performed by hemisection treatments can be used as abutments with attention to the selection of patients to achieve long-term success.

scholarly journals Biomarkers in functional movement disorders: a systematic review

2020 ◽  
Vol 91 (12) ◽  
pp. 1261-1269
Author(s):  
Birgitte Liang Chen Thomsen ◽  
Tiago Teodoro ◽  
Mark J Edwards
Keyword(s):  
Systematic Review ◽  
Treatment Response ◽  
Movement Disorders ◽  
Functional Movement ◽  
Diagnostic Biomarkers ◽  
Long Term Prognosis ◽  
Functional Movement Disorders ◽  
Selection Of Patients ◽  
Selection Of

Functional movement disorders (FMD) are proposed to reflect a specific problem with voluntary control of movement, despite normal intent to move and an intact neural capacity for movement. In many cases, a positive diagnosis of FMD can be established on clinical grounds. However, the diagnosis remains challenging in certain scenarios, and there is a need for predictors of treatment response and long-term prognosis.In this context, we performed a systematic review of biomarkers in FMD. Eighty-six studies met our predefined criteria and were included.We found fairly reliable electroencephalography and electromyography-based diagnostic biomarkers for functional myoclonus and tremor. Promising biomarkers have also been described for functional paresis, gait and balance disorders. In contrast, there is still a lack of diagnostic biomarkers of functional dystonia and tics, where clinical diagnosis is often also more challenging. Importantly, many promising findings focus on pathophysiology and reflect group-level comparisons, but cannot differentiate on an individual basis. Some biomarkers also require access to time-consuming and resource-consuming techniques such as functional MRI.In conclusion, there are important gaps in diagnostic biomarkers in FMD in the areas of most clinical uncertainty. There is also is a lack of treatment response and prognostic biomarkers to aid in the selection of patients who would benefit from rehabilitation and other forms of treatment.

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