scholarly journals The impact and causes of negative cortical mapping in primary motor area tumours

2021 ◽  
pp. 29-35
Author(s):  
Mihaela Coșman ◽  
Bogdan Florin Iliescu ◽  
Anca Sava ◽  
Gabriela Florența Dumitrecu ◽  
Ion Poeata
Keyword(s):  
Motor Response ◽  
False Negative ◽  
The Other ◽  
Motor Area ◽  
Primary Motor Area ◽  
Operative Field ◽  
The Real ◽  
Direct Cortical Stimulation ◽  
One Year

Introduction: Intraoperative neurophysiological monitoring is the golden standard for lesions located in eloquent areas of the brain. On the one hand, positive mapping offers a view of the relationship between the anatomo-functional cortical organisation of the patient and the lesion, facilitating the choice of the cerebrotomy entry point and the resection until the functional borders are found. On the other hand, negative mapping does not offer certainty that the absence of the motor response, from the operative field, is the real feedback or is the result of the false-negative response. In such a situation, a differentiation between those two must be done. Materials and methods: We evaluated the results of direct cortical stimulation of lesion located in or near the primary motor area, which were diagnosticated with contrast-enhancement head MRI and admitted to the Third Department of Neurosurgery, "Prof. Dr N. Oblu” Emergency Clinical Hospital, Iasi, Romania, between January 2014 and July 2018. Special attention was given especially to the negative mapping cases, regarding the histological type, imagistic localisation, symptoms and neurological outcome immediate postoperative, at 6 months and one-year follow-up. Results: From all 66 patients meeting the inclusion and exclusion criteria in 9,09% (6 cases) we did not obtain any motor response after direct cortical stimulation. The imagistic localisations of those cases were: 3 – Rolandic, 2 – pre-Rolandic and one retro-Rolandic. Tumors histological types were: glioblastoma, anaplastic astrocytoma, oligoastrocytoma and oligodendroglioma each one case and two cases of fibrillary astrocytoma. The intensity range was between 6 – 18mA, the mode – 12mA and the median – 10mA. Postoperatively the neurological condition of 3 patients worsened (4,54% from all the cases), while 3 had a favourable evolution with symptom remission. At 6monts and one-year follow-up in one case (1,51%), we observed no improvement in contrast with the other two, where dysfunction remission was highlighted. Conclusion: The possible technical, surgical and anesthesiologic causes of false-negative motor response must be eliminated to be able to differentiate from the real absence of the functional area from the operative field. In the first scenario, the resection may be associated with permanent postoperative neurologic deficit and major life quality alteration while in the second one the patient presents no motor dysfunction after surgery and the resection may be extensive with multiple oncological benefits.

scholarly journals Surgical management of Rolandic area meningioma in the era of intraoperative neurophysiological monitoring

2020 ◽  
pp. 488-494
Author(s):  
Mihaela Coșman ◽  
Ionuț Mihail Panțiru ◽  
Andrei Ionuț Cucu ◽  
Andreea Lenuța Atomei ◽  
Gabriela Florența Dumitrecu ◽  
...  
Keyword(s):  
Cortical Stimulation ◽  
Motor Area ◽  
Intraoperative Neurophysiological Monitoring ◽  
Motor Deficit ◽  
Cortical Mapping ◽  
Neurophysiological Monitoring ◽  
Direct Cortical Stimulation ◽  
One Year ◽  
The Impact

Introduction: The advantages and the necessity of intraoperative neurophysiological monitoring (IOM) in the surgery of motor area infiltrative tumours is well known. The use of this technique for Rolandic meningioma is still debatable. The absence or the loss of the cleavage plan and an infiltrative border make the dissection exceedingly difficult and increase the risk of new postoperative motor disfunction. Materials and methods: We evaluated the impact of IOM, especially direct cortical stimulation on the degree of resection, new postoperative deficits, symptom remission and clinical-imagistic aspects at one-year follow up of 19 cases of Rolandic meningioma admitted in Third Department of Neurosurgery,” Prof. Dr N. Oblu” Emergency Clinical Hospital, Yassi, Romania, between January 2014 and July 2018. Results: More than half of the cases (57,88%) had epileptic manifestations as the main clinical symptom with the Jacksonian seizures being on the first place (31,57%), followed by progressive paresis (26,31%) and other nonspecific symptoms. Intraparenchymal preoperative oedema was observed in 36,84% of patients. The intensity of direct cortical stimulation was between 6-13 mA (median = 9mA; mode = 12mA). Simpson degree of resection was dominated by S3– 47,36% and S4 was obtained in 15,78% of cases. Postoperative the outcome was favourable for 73,68% patients with 5,26% motor aggravation and 10,52% new deficits. At one-year follow up no imagistic recurrence was observed and the permanent motor deficit was maintained in one of the three cases (5,26%). Conclusion: Even though meningiomas are extranevraxial lesions and those located on the convexity have a low risk of complication, the absence of a clear dissection plan between the tumour and the adjacent motor cortex is associated with a high risk for new postoperative neurological deficits. Therefore, it is important to perform cortical mapping for Rolandic meningioma, to determine the location of the primary motor area and to protect it from mechanical and vascular trauma, during tumour resection.

scholarly journals A Conservative Approach to a Peripheral Ameloblastoma

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Rocco Borrello ◽  
Elia Bettio ◽  
Christian Bacci ◽  
Marialuisa Valente ◽  
Stefano Sivolella ◽  
...  
Keyword(s):  
Oral Cavity ◽  
Soft Tissues ◽  
Complete Removal ◽  
The Other ◽  
Conservative Approach ◽  
Choice Of Treatment ◽  
Long Term Follow Up ◽  
One Year

Peripheral Ameloblastoma (PA) is the rarest variant of ameloblastoma. It differs from the other subtypes of ameloblastoma in its localization: it arises in the soft tissues of the oral cavity coating the tooth bearing bones. Generally, it manifests nonaggressive behavior and it can be treated with complete removal by local conservative excision. In this study we report a case of PA of the maxilla in a 78-year-old female patient and we describe the four different histopathological patterns revealed by histological examination. After local excision and diagnosis, we planned a long term follow-up: in one year no recurrence had been reported. The choice of treatment is illustrated in Discussion.

scholarly journals S123. EARLY DETECTION OF PSYCHOSIS: DIAGNOSTIC TRAJECTORIES

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S82-S82
Author(s):  
Line Lindhardt ◽  
Morten Lindhardt ◽  
Ulrik Haahr ◽  
Lene Halling Hastrup ◽  
Erik Simonsen ◽  
...  
Keyword(s):  
Early Detection ◽  
Clinical Evaluation ◽  
Help Seeking ◽  
False Negative ◽  
Mental Healthcare ◽  
Healthcare Services ◽  
Psychiatric Research ◽  
One Year ◽  
Detection Unit

Abstract Background Psychosis and signs of severe mental disorders such as schizophrenia often emerge in adolescence. Much attention has been devoted to identifying the individuals experiencing psychosis at an early stage. Implementation of early detection services is widely acknowledged as effective in reducing treatment delays. However, little is known about the diagnostic patterns of individuals entering an early detection service regardless of the initial psychopathological evaluation. The aim of the study is to investigate the diagnostic trajectories of individuals evaluated by an early detection of psychosis unit. Methods A real-life cross-sectional study coupling register data with information of diagnoses allocated by clinical evaluation in an early detection unit. All individuals clinically evaluated in the early detection unit from 2012 to 2015 were included. A Central Psychiatric Research Register was searched for lifetime allocated diagnoses. Register search allowed a minimum of one-year follow-up after evaluation. To determine the predictive ability of the early detection unit, diagnoses allocated by the initial clinical evaluation were compared to later diagnoses in psychiatric services. Results In total 450 individuals were clinically evaluated in the early detection unit during a period of 3 years. Previously 174 (39 %) patients had been in contact with mental healthcare services, and 28 (6.2%) had previously been diagnosed with psychosis. During follow-up, a diagnosis of psychosis was allocated in 146 (32.4%) of all evaluated individuals. In the clinical assessment by the early detection unit 107 (73.3 %) were diagnosed with psychosis. In total 39 (14.7%) were assessed false negative for psychosis by the early detection unit, they were later diagnosed with psychosis in mental healthcare services. The majority of psychosis diagnoses was allocated within one year after assessment in the early detection unit and half of individuals who were diagnosed with psychosis was re-diagnosed with schizophrenia (n=73). The hazard ratio of receiving a diagnosis of psychosis subsequently in mental healthcare services in individuals diagnosed with psychosis by the early detection unit was 4.73 (95 % CI: 3.01 – 7.44, p < 0.0001) compared to individuals not found psychotic by the early detection unit. Discussion That more than a third of the clinical evaluated has previously been help-seeking in mental healthcare system demonstrates a source of delay in treatment, suggesting that contact to other parts of mental healthcare services can delay detection of psychosis. Of the individuals not evaluated cases of psychosis 15 % later received a diagnose of psychosis. This suggests that an important subgroup of the help-seeking individuals undergoes transition to psychosis after contact or that detection of psychosis has not been possible by evaluation in the early detection unit. In conclusion, attention should be made to all individuals self-referred to an early detection unit, as diagnoses of psychosis is seen in the majority within the first year after contact. Also in individuals not initially suspected of psychosis.

A European multicentric experience using the CardioSEAL® and Starflex double umbrella devices to close interatrial communications holes within the oval fossa

2000 ◽  
Vol 10 (5) ◽  
pp. 519-526 ◽  
Author(s):  
M. Carminati ◽  
S. Giusti ◽  
G. Hausdorf ◽  
S. Qureshi ◽  
M. Tynan ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Surgical Repair ◽  
Clinical Success ◽  
The Other ◽  
Thromboembolic Events ◽  
Clinical Complications ◽  
The Mean ◽  
One Year ◽  
Flap Valve

AbstractIn this review, we describe the experience from 13 European centres using the CardioSEAL and Starflex double umbrella devices to close interatrial communications within the oval fossa (so-called ‘stcundum’ defects). Between October 1996 and April 1999, the procedure was attempted in 334 patients with a mean age of 12 years and a mean weight of 44kg. The mean measured stretched diameter of the defect was 15 mm. In the overall group, the defect was solitary in 245 patients (73%), multiple in 21 (6%), associated with an aneurysm of the flap valve in 15 (5%), was represented by patency of the oval foramen in 44 (13%), and was a fenestration in a Fontan repair in 9 (3%). In all patients, the devices were inserted under general anesthesia, using fluoroscopic and transesophageal echocardiographic control. Implantation was achieved in 325 (97,3%). The device embolized within either a few minutes or a few hours in 13 patients (4%). Of these, uncomplicated surgical repair was undertaken in 10, while the device was retrieved in 3 using catheters and a second device was successfully implanted. Residual shunting was detected immediately after the procedure in 41% of the patients, with the incidence decreasing to 31% at discharge, 24% at 1 month, 21% at 6 months, and 20.5% at one year. During the period of follow-up, elective surgical repair became necessary in two patients, due to malposition of the device in one, and late embolization in the other. Fractures of arms were seen in 6.1%, most commonly with the largest devices. All those with fractured arms of the device were asymptomatic, and no clinical complications related to the fractures were observed. There were no arrythmias, endocarditis, valvar distortion, thromboembolic events, or other complications. After one year of follow-up, clinical success, defined as complete closure of the defect or presence of only a trivial leak, had been obtained in 92.5% of the patients. We conclude, therefore, that these devices produce excellent results when used to close defects of small to moderate size. Results are less than optimal, or else complications ensure, when attempts are made to close very large defects.

scholarly journals Rivastigmine as a Symptomatic Treatment for Apathy in Parkinson’s Dementia Complex: New Aspects for This Riddle

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
Rita Moretti ◽  
Paola Caruso ◽  
Matteo Dal Ben
Keyword(s):  
Symptomatic Treatment ◽  
Neuropsychiatric Symptom ◽  
The Other ◽  
Nigrostriatal Pathway ◽  
One Year

Over 90% of PDD patients show at least one neuropsychiatric symptom (NPS); in the 60–70% two or more NPS are present. Their incidence is important in terms of prognosis and severity of pathology. However, among all NPS, apathy is often the most disturbing, associated with greater caregiver’s burden. Similar to other NPS, apathy may be due to a dysfunction of the nigrostriatal pathway, even though, not all the PD patients become apathetic, indicating that apathy should not entirely be considered a dopamine-dependent syndrome, and in fact it might also be related to acetylcholine defects. Apathy has been treated in many ways, without sure benefits; among these, Rivastigmine may present benefic properties. We present a series of 48 patients, suffering from PDD, treated with Rivastigmine, and followed-up for one year; they have been devotedly studied for apathy, even though all the other NPS disorders have been registered. Rivastigmine did not have a prolonged benefic effect on apathy, in our work, on the contrary of what had been observed in the literature, probably due to the longer follow-up of our patients.

Prognosis of new-onset of atrial fibrillation in acute coronary syndrome: Portuguese experience

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
H Santos ◽  
M Santos ◽  
I Almeida ◽  
H Miranda ◽  
C Sa ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Mortality Rates ◽  
The Other ◽  
Coronary Syndrome ◽  
Group A ◽  
One Year ◽  
Group B ◽  
New Onset

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf Portuguese Registry of Acute Coronary Syndromes Background Acute coronary syndrome (ACS) and atrial fibrillation (AF) are common diseases in developed countries and in some cases, the first episode of AF can occur during the ACS. A stressful event like an ACS can be a trigger for AF, being important to realize its impact and prognosis in the short and long term. Objective Evaluate the impact and prognosis of new-onset AF in ACS. Methods Multicenter retrospective study, based on the Portuguese Registry of ACS between 1/10/2010-4/09/2019. Patients were divided into two groups: A – patients without new-onset AF, and B – patients that presented new onset of AF. Were excluded patients without a previous cardiovascular history or clinical data during the admission and the follow-up period. Logistic regression was performed to assess if new-onset AF in ACS was a predictor of major adverse cardiac events and mortality. Kaplan-Meier test was performed to establish the survival rates and re-admission for one year of follow up. Results 9687 patients suffered ACS and had follow-up at 1 year, 9264 in group A (95.6%) and 423 in group B (4.4%). Both groups were similar regarding dyslipidemia, diabetes mellitus, previous coronary artery disease, multivessel disease after the cardiac catheterization. Group A had more smokers (28.2 vs 17.8%, p < 0.001) and left ventricular ejection fraction (LVEF) >50% (69.2 vs 45.1%, p < 0.001). On the other hand, group B was elderly (67 ± 14 vs 75 ± 12, p < 0.001), female (26.9 vs 34.0%, p < 0.001), arterial hypertension (70.5 vs 77.5%, p = 0.005), was more admitted directly to the cat lab (12.5 vs 17.7%, p = 0.002), ST-segment elevation myocardial infarction (40.2 vs 49.9%, p < 0.001), Killip-Kimball classification > I (12.8 vs 34.8%, p < 0.001) and hybrid revascularization (0.7 vs 2.4%, p = 0.002). Logistic regression revealed that new-onset of AF in ACS patients was a predictor of congestive heart failure (odds ratio (OR) 1.75, p < 0.001, confidence interval (CI) 1.47-2.09), cardiogenic shock (OR 3.08, p < 0.001, CI 2.37-4.01), sustained ventricular tachycardia (OR 2.29, p < 0.001, CI 1.61-3.25) and intrahospital mortality (OR 1.99, p < 0.001, CI 1.51-2.63). Nevertheless, new-onset of AF was not associated with re-infarction (p = 0.361), mechanical complications (p = 0.319), atrioventricular block (p = 0.574), stroke (p = 0.131) and cardiac arrest (p = 0.060) during the hospitalization for ACS. Mortality rates at one year of follow-up showed significant differences, p < 0.001, between the two groups (Figure 1). Similar results were found concerning re-admission for all causes, p = 0.021 (Figure 2), on the other causes, re-admission for cardiovascular causes do not reveal to be significant, p = 0.515. Conclusions New-onset of AF in ACS was a predictor of congestive heart failure, cardiogenic shock, sustained ventricular tachycardia and intrahospital mortality. AF was associated with higher mortality rates and re-admission for all causes at one year follow up.

Atypical Carcinoid Tumors of Lung: Clinicopathologic Study of Six Cases

2000 ◽  
Vol 8 (1) ◽  
pp. 41-45 ◽  
Author(s):  
Girish Moghe ◽  
Nirmala A Jambhekar ◽  
Ramakant K Deshpande ◽  
Rahul Hejmadi ◽  
Jitendra Vyas
Keyword(s):  
Local Recurrence ◽  
Neuron Specific Enolase ◽  
Surgical Excision ◽  
The Other ◽  
Atypical Carcinoid ◽  
Typical Carcinoid ◽  
Clinicopathologic Study ◽  
One Year ◽  
And Behavior

This retrospective study of 6 cases of atypical carcinoid tumor was carried out to highlight their clinicopathological features and behavior. All patients were over 40 years of age and were treated by surgical excision of the tumor. Four tumors were central and 2 were peripherally located in the lung. Grossly, the tumors were large with spotted areas of necrosis. Microscopically, all tumors had a typical carcinoid pattern with spotted areas of necrosis and mitotic activity in the range of 2 to 5 per 10 high-power fields. On immunohistochemistry, the tumors were positive for neuron-specific enolase and cytokeratin. Follow-up ranging from 1 to 5 years was available in 4 patients; 2 are currently alive, 1 with local recurrence and distant metastasis one year postoperatively, the other with no disease after 5 years. Two patients died; one had a local recurrence at 2 years and the other had liver metastasis at 3 years.

scholarly journals The Impact of Coexistence of Smoking and Diabetes on the Coronary Artery Severity and Outcomes following Percutaneous Coronary Intervention: Results from the 1ST Jordanian PCI Registry

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Mohamad I. Jarrah ◽  
Said Al-Khatib ◽  
Yousef Khader ◽  
Hanin N. AlKharabsheh ◽  
Ayman Hammoudeh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Percutaneous Coronary Intervention ◽  
Middle Eastern ◽  
Coronary Intervention ◽  
The Other ◽  
Percutaneous Coronary ◽  
One Year ◽  
The Impact ◽  
Nonsmoker Group

Introduction. Diabetes mellitus (DM) and smoking are highly prevalent among Middle Eastern patients admitted with acute coronary syndrome (ACS) or who undergo percutaneous coronary intervention (PCI). Methods. This study used the analysis of the data from the first Jordanian PCI registry (JoPCR1) to determine the impact of coexistence of smoking and diabetes mellitus on the coronary artery severity and outcome following percutaneous coronary intervention in Middle Eastern patients. Results. Of 2426 patients enrolled, 1300 (53.6%) and 1055 (43.5%) were diabetics and smokers, respectively. The patients’ age was 59.0±10.1 and ranged between 24 and 95 years. Males comprised 79.4% of all patients. The patients were divided into four groups: nondiabetic-nonsmokers (22.2%), diabetic-nonsmokers (34.3%), nondiabetic-smokers (24.2%), and diabetic-smokers (19.2%). Compared with the other three groups, patients in the diabetic-nonsmoker group were older, more likely to be females, and having a higher prevalence of hypertension, dyslipidemia, chronic renal disease, and history of CVD and revascularization. Consequently, the diabetic-nonsmoker patients (but not the diabetic-smokers) had a higher prevalence of multivessel CAD and PCI than the other three groups, highlighting the importance of other risk factors (age, gender, metabolic syndrome, and comorbidities) and not only smoking in predisposing for CAD. Furthermore, those patients had a higher incidence of ACS as an indication for PCI than the stable coronary disease (73% vs 27%) and the highest CRUSADE bleeding risk score (63.9%) among other groups. The in-hospital events including in-stent thrombosis and emergency CABG events did not significantly differ among groups (p=0.5 and 0.22). Heart failure and major bleeding events occurred significantly higher among diabetic-nonsmokers compared to other groups. In-hospital deaths occurred significantly more among diabetic-nonsmokers. Moreover, the one-month and one-year follow-up outcome events (the mortality rate, in-stent thrombosis, readmission for ACS, coronary revascularization, and major bleedings) occurred more frequently in the diabetic-nonsmoker group. However, the difference was statistically significant only for major bleeding incidences. Conclusions. In this analysis of a completed prospective Middle Eastern PCI registry, the majority of the diabetic-nonsmoker (and not the diabetic-smokers) patients (73%) presented with ACS. This group was the highest at risk for in-hospital PCI complications as well as the worst in outcomes after one year of follow-up. Those patients were more likely to be older, female, and have the worst cardiovascular baseline features, highlighting the importance of other risk factors (age, gender, metabolic syndrome, and comorbidities) and not only smoking in predisposing for CAD. Thus, more sufficient education about controlling CVD risk factors should be implemented in the Middle Eastern region.

scholarly journals A large-scale experiment on New Year’s resolutions: Approach-oriented goals are more successful than avoidance-oriented goals

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0234097
Author(s):  
Martin Oscarsson ◽  
Per Carlbring ◽  
Gerhard Andersson ◽  
Alexander Rozental
Keyword(s):  
Weight Loss ◽  
Goal Setting ◽  
Large Scale ◽  
Eating Habits ◽  
Current Knowledge ◽  
The Other ◽  
Success Rates ◽  
Scale Experiment ◽  
One Year

Despite the popularity of New Year’s resolutions, current knowledge about them is limited. We investigated what resolutions people make when they are free to formulate them, whether different resolutions reach differing success rates, and whether it is possible to increase the likelihood of a resolution’s success by administering information and exercises on effective goal setting. Participants (N = 1066) from the general public were randomized into three groups: active control, some support, and extended support. The most popular resolutions regarded physical health, weight loss, and eating habits. At a one-year follow-up, 55% of responders considered themselves successful in sustaining their resolutions. Participants with approach-oriented goals were significantly more successful than those with avoidance-oriented goals (58.9% vs. 47.1%). The group that received some support was exclusively and significantly more successful compared to the other two. This study reveals that New Year’s resolutions can have lasting effects, even at a one-year follow-up.

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