Emerging Medical and Surgical Management Strategies in the Evaluation and Treatment of Intracerebral Hemorrhage

2005 ◽  
Vol 80 (3) ◽  
pp. 420-433 ◽  
Author(s):  
Edward M. Manno ◽  
John L.D. Atkinson ◽  
Jimmy R. Fulgham ◽  
Eelco F.M. Wijdicks
Keyword(s):  
Intracerebral Hemorrhage ◽  
Surgical Management ◽  
Management Strategies

scholarly journals Coronary artery aneurysms: outcomes following medical, percutaneous interventional and surgical management

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001440
Author(s):  
Shameer Khubber ◽  
Rajdeep Chana ◽  
Chandramohan Meenakshisundaram ◽  
Kamal Dhaliwal ◽  
Mohomed Gad ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Surgical Management ◽  
Medical Management ◽  
Cox Regression ◽  
Artery Bypass ◽  
Management Strategies ◽  
Coronary Artery Aneurysms ◽  
Kaplan Meier

BackgroundCoronary artery aneurysms (CAAs) are increasingly diagnosed on coronary angiography; however, controversies persist regarding their optimal management. In the present study, we analysed the long-term outcomes of patients with CAAs following three different management strategies.MethodsWe performed a retrospective review of patient records with documented CAA diagnosis between 2000 and 2005. Patients were divided into three groups: medical management versus percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG). We analysed the rate of major cardiovascular and cerebrovascular events (MACCEs) over a period of 10 years.ResultsWe identified 458 patients with CAAs (mean age 78±10.5 years, 74.5% men) who received medical therapy (N=230) or underwent PCI (N=52) or CABG (N=176). The incidence of CAAs was 0.7% of the total catheterisation reports. The left anterior descending was the most common coronary artery involved (38%). The median follow-up time was 62 months. The total number of MACCE during follow-up was 155 (33.8%); 91 (39.6%) in the medical management group vs 46 (26.1%) in the CABG group vs 18 (34.6%) in the PCI group (p=0.02). Kaplan-Meier survival analysis showed that CABG was associated with better MACCE-free survival (p log-rank=0.03) than medical management. These results were confirmed on univariate Cox regression, but not multivariate regression (OR 0.773 (0.526 to 1.136); p=0.19). Both Kaplan-Meier survival and regression analyses showed that dual antiplatelet therapy (DAPT) and anticoagulation were not associated with significant improvement in MACCE rates.ConclusionOur analysis showed similar long-term MACCE risks in patients with CAA undergoing medical, percutaneous and surgical management. Further, DAPT and anticoagulation were not associated with significant benefits in terms of MACCE rates. These results should be interpreted with caution considering the small size and potential for selection bias and should be confirmed in large, randomised trials.

Surgical Management of Spontaneous Intracerebral Hemorrhage

2021 ◽  
Vol 23 (8) ◽  
Author(s):  
Sandeep Walia ◽  
Kirsten Fisher ◽  
Robert L. Dodd ◽  
Chitra Venkatasubramanian
Keyword(s):  
Intracerebral Hemorrhage ◽  
Surgical Management ◽  
Spontaneous Intracerebral Hemorrhage

scholarly journals Precision Surgery and Kidney Cancer: Knowledge of Genetic Alterations Influences Surgical Management

Genes ◽  
2021 ◽  
Vol 12 (2) ◽  
pp. 261 ◽  
Author(s):  
Patrick T. Gomella ◽  
W. Linehan ◽  
Mark W. Ball
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Surgical Management ◽  
Kidney Cancer ◽  
Renal Cell ◽  
Management Strategies ◽  
Genetic Alterations ◽  
Cancer Knowledge ◽  
Biological Potential

Renal cell carcinoma is a term that represents multiple different disease processes, each driven by different genetic alterations, with distinct histology, and biological potential which necessitates divergent management strategies. This review discusses the genetic alterations seen in several forms of hereditary kidney cancer and how that knowledge can dictate when and how to intervene with a focus on the surgical management of these tumors.

Caustic and Toxic Ingestions

2017 ◽  
Author(s):  
CDR Thomas Q Gallagher ◽  
CDR Robert L Ricca
Keyword(s):  
Surgical Management ◽  
Management Strategies ◽  
Treatment Strategies ◽  
Tracheobronchial Tree ◽  
High Rate ◽  
Health Concern ◽  
Endoscopic Management ◽  
Caustic Ingestion ◽  
Stricture Formation ◽  
Accidental Ingestion

Ingestion of caustic substances remains a potentially fatal public health concern with extensive morbidity and the possibility of long-term sequelae. The management strategies of these complex injuries continue to be extensively studied in the literature. Areas of interest include the most efficacious treatment of caustic esophageal stricture to preserve the native esophagus, use of steroids, and use of esophageal stents. Prevention of accidental ingestion through strategies to limit the availability of caustic substances is a key factor in reducing the incidence of injury, but there continues to be a high rate of accidental ingestion in developing countries with less rigorous manufacturing standards. Initial evaluation includes endoscopic evaluation of the esophagus and tracheobronchial tree. Optimal treatment strategies, including the use of proton pump inhibitors to reduce gastroesophageal reflux, steroid use to prevent stricture formation, and use of stents for management of strictures, continue to be debated. Initial surgical management includes esophagectomy for full-thickness injury with abdominal exploration. Multiple surgical options exist for both restoration of gastrointestinal continuity after esophagectomy and the management of strictures refractory to medical management, including reverse gastric tube, colonic interposition, and gastric advancement. Numerous small studies have evaluated the efficacy of these interventions, but there continues to be a need for larger prospective studies to develop a worldwide consensus opinion on best practices. We provide a review of the recent literature and practice recommendations for the management of injuries due to caustic ingestion. Key words: caustic ingestion, endoscopic management, stricture, surgical management 

Trends in Surgical Management and Mortality of Intracerebral Hemorrhage in the United States Before and After the STICH Trial

2010 ◽  
Vol 13 (1) ◽  
pp. 82-86 ◽  
Author(s):  
Opeolu Adeoye ◽  
Andrew Ringer ◽  
Richard Hornung ◽  
Pooja Khatri ◽  
Mario Zuccarello ◽  
...  
Keyword(s):  
United States ◽  
Intracerebral Hemorrhage ◽  
Surgical Management ◽  
The United States ◽  
Before And After ◽  
Stich Trial

scholarly journals Intracerebral Hemorrhage: A Brief Evidence-Based Review of Common Etiologies, Mechanisms of Secondary Injury, and Medical and Surgical Management

2019 ◽  
Vol 06 (02) ◽  
pp. 119-130
Author(s):  
Anand K. Sarma ◽  
Shivani Ghoshal ◽  
Spencer J. Craven ◽  
Aarti Sarwal
Keyword(s):  
Intracerebral Hemorrhage ◽  
Surgical Management ◽  
Surgical Care ◽  
Pressure Control ◽  
Treatment Modalities ◽  
Initial Contact ◽  
Secondary Injury ◽  
Golden Hour ◽  
Blood Aspiration ◽  
Perihematomal Edema

AbstractIntracerebral hemorrhage (ICH) accounts for only 10 to 15% of all strokes but remains a significant cause of morbidity and mortality. Despite lengthy stays in critical care units, only one-half of those experiencing an ICH survive after 30 days, and those who do are often left with considerable disability. Treatment has traditionally focused on minimizing the hemorrhage expansion and reducing clot volume through both medical and surgical means. Management of ICH is a complex and multidisciplinary process. This review will discuss a few common etiologies, explore the pathophysiology of secondary neuronal injury after ICH, review the basics of ICH imaging with computed tomography and magnetic resonance imaging, and highlight latest practices in medical and surgical management. Secondary injury mechanisms such as perihematomal edema and disordered cerebral autoregulation are discussed as potential targets for new treatment modalities. Emergent treatment in the “golden hour” after ictus provides a template of measures to adopt from initial contact with emergency medical services, to the emergency department, and thereafter, triage to the intensive care unit. Medical management including blood pressure control, hemostasis, and coagulopathy reversal are discussed and evidence from trials such as INTERACT 2, ATACH 2, and ANNEXA-4 are given a clinical context. Surgical management including intracranial pressure monitoring, surgical evacuation with open craniotomy, and minimally invasive approaches such as stereotactic-guided aspiration and thrombolysis, ultrasound-induced thrombolysis, image-guided stereotactic endoscopic aspiration, and stereotactic ICH underwater blood aspiration are enumerated. The outcomes and relevance of STICH, MISTIE, and CLEAR trials to present surgical care are elaborated. The review summarizes the current guidelines for the treatment of ICH and the latest literature in the field they are based upon. It aims to provide a concise article beneficial to the emergency physicians and neurointensivists/neuroanesthesiologists.

Medical and Surgical Management of Intracerebral Hemorrhage

1998 ◽  
Vol 18 (04) ◽  
pp. 513-519 ◽  
Author(s):  
Mitesh Shah ◽  
José Biller
Keyword(s):  
Intracerebral Hemorrhage ◽  
Surgical Management
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