A Tertiary Cardiology Unit Perspective for Carotid Lesions: Which Lesion and When Intervention

INTRODUCTION: Stroke is one of the most common cause of mortality and morbidity all over the world, while atherosclerosis is the most common cause of its etiology. For this patients carotid endarterectomy (CEA) and carotid stenting (CAS) are two treatment modalities. In our study, carotid angiography in a tertiary center screened and treatment experiences, methods will present. METHODS: Carotid angiography performed in our hospital between June 2006 and 2018 in a single tertiary cardiology clinic was retrospectively screened and patients were included in the study including CAS, CAE and medical follow-up. The patient's clinical features and procedure-related data were obtained by scanning the patient files. RESULTS: A total of 905 carotid angiography were screened. Critical carotid artery lesions were detected in 476 patients. 49 patients were classified as CAS, 192 patients as CEA, and 235 as medical group. The mean age of the included patients was 66.08±10.53 and the patient population was 74.2% male. The most common comorbidity was coronary artery disease (81.6%) and arterial hypertension (63.3%). The most common symptom was stroke (73.3%). In the CAS group, the rate of stroke was 6.1% in the follow-up period, the rate of stroke in the medical follow-up group was 5.5%, and in the CEA group, the stroke rate was 3.6%. There was a 3.1% mortality in the CEA group. The procedure was completed without any complication in all CAS patients. The mean follow-up period was 1034 days. DISCUSSION AND CONCLUSION: Although CEA is still a class 1 indication despite the improvements in stent and protection devices, CAS can successfully perform in our center as well as in experienced centers.

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Hybrid Endovascular Repair of Thoracoabdominal Aorta: Early Results

The Heart Surgery Forum ◽

10.1532/hsf98.2014315 ◽

2014 ◽

Vol 17 (3) ◽

pp. 146

Author(s):

Osman Tansel Darcin ◽

Mehmet Kalender ◽

Ayse Gul Kunt ◽

Okay Guven Karaca ◽

Ata Niyazi Ecevit ◽

...

Keyword(s):

Endovascular Repair ◽

Therapeutic Option ◽

Complete Recovery ◽

Aortic Aneurysms ◽

Thoracoabdominal Aorta ◽

Mortality And Morbidity ◽

Early Results ◽

The Mean ◽

Procedural Success

Background: Thoracoabdominal aortic aneurysms (TAAA) present a significant clinical challenge, as they are complex and require invasive surgery. In an attempt to prevent considerably high mortality and morbidity in open repair, hybrid endovascular repair has been developed by many authors. In this study, we evaluated the early-term results obtained from this procedure.Methods: From November 2010 to February 2013, we performed thoracoabdominal hybrid aortic repair in 18 patients. The mean age was 68 years (12 men, 6 women). All of the patients had significant comorbidities. Follow-up computed tomography (CT) scans were performed at 1 week, 3 months, 6 months, and annually thereafter.Results: All patients were operated on in a staged procedure and stent graft deployment was achieved. Procedural success was achieved in all cases. All patients were discharged with complete recovery. No endoleaks weres detected in further CT examination.Conclusion: Our results suggests that hybrid debranching and endovascular repair of extensive thoracoabdominal aneurysms represents a suitable therapeutic option to reduce the morbidity and mortality of TAAA repair, particularly in those typically considered at high risk for standard repair.

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Radiosurgery for dural carotid-cavernous sinus fistulas: Gamma Knife compared with XKnife radiosurgery

Journal of Neurosurgery ◽

10.3171/2010.8.gks10689 ◽

2010 ◽

Vol 113 (Special_Supplement) ◽

pp. 9-20 ◽

Cited By ~ 4

Author(s):

Hung-Chuan Pan ◽

Ming-Hsi Sun ◽

Jason Sheehan ◽

Meei-Ling Sheu ◽

Clayton Chi-Chang Chen ◽

...

Keyword(s):

Clinical Improvement ◽

Gamma Knife ◽

Temporal Lobe ◽

Treatment Modalities ◽

Conformity Index ◽

Index Number ◽

The Mean ◽

Instrument Accuracy ◽

Group 1

Object In the modern era, stereotactic radiosurgery is an important part of the multidisciplinary and multimodality approach used to treat dural carotid-cavernous fistulas (DCCFs). Based on the ease of performance of techniques to fuse cerebral angiography studies with MR images or CT scans during the radiosurgical procedure, the Gamma Knife and XKnife are 2 of the most popular radiosurgical instruments for patients with DCCF. In this study, the authors compared the efficacy, neurological results, and complications associated with these 2 radiosurgical devices when used for DCCF. Methods Records for 41 patients with DCCF (15 treated using the XKnife and 26 with Gamma Knife surgery [GKS]) were retrieved from a radiosurgical database encompassing the period of September 2000 to August 2008. Among these patients, at least 2 consecutive MR imaging or MR angiography studies obtained after radiosurgery were available for determining radiological outcome of the fistula. All patients received regular follow-up to evaluate the neurological and ophthalmological function at an interval of 1–3 months. The symptomatology, obliteration rate, radiation dose, instrument accuracy, and adverse effects were determined for each group and compared between 2 groups. The data were analyzed using the Student t-test. Results The mean age of the patients was 63 ± 2.6 years, and the mean follow-up period was 63.1 ± 4.4 months (mean ± SD). Thirty-seven patients (90%) achieved an obliteration of the DCCF (93% in the XKnife cohort and 88% for the GKS cohort). In 34 of 40 patients (85%) with chemosis and proptosis of the eyes, these symptoms were resolved after treatment (4 had residual fistula and 2 had arterializations of sclera). All 5 patients with high intraocular pressure demonstrated clinical improvement. Ten (71%) of 14 patients with cranial nerve palsy demonstrated improvement following radiosurgery. Significant discrepancies of treatment modalities existed between the XKnife and GKS groups, such as radiation volume, conformity index, number of isocenters, instrument accuracy, peripheral isodose line, and maximum dosage. The XKnife delivered significantly higher radiation dosage to the lens, optic nerve, optic chiasm, bilateral temporal lobe, and brainstem. Few adverse events occurred, but included 1 patient with optic neuritis (GKS group), 1 intracranial hemorrhage (XKnife group), 1 brainstem edema (XKnife), and 3 temporal lobe radiation edemas (XKnife). Conclusions Radiosurgery affords a substantial chance of radiological and clinical improvement in patients with DCCFs. The Gamma Knife and XKnife demonstrated similar efficacy in the obliteration of DCCFs. However, a slightly higher incidence of complications occurred in the XKnife group.

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Bifurcated bypass in severe chronic limb threatening ischaemia

Vascular ◽

10.1177/1708538121999856 ◽

2021 ◽

pp. 170853812199985

Author(s):

Daniele Adami ◽

Michele Marconi ◽

Alberto Piaggesi ◽

Davide M Mocellin ◽

Raffaella N Berchiolli ◽

...

Keyword(s):

Survival Rates ◽

Primary Patency ◽

Free Survival ◽

Mortality And Morbidity ◽

Bypass Patency ◽

Stage 4 ◽

Endovascular Approach ◽

The Mean ◽

Clinical Records

Objectives Revascularization according to the angiosome concept is of proven importance for limb salvage in chronic limb threatening ischaemia but it is not always practicable. Bifurcated bypasses could be considered as an option when an endovascular approach is not feasible or has already failed and a single bypass would not allow direct revascularization of the ischaemic area. Bifurcated bypasses are characterized by landing on two different arteries, the main artery (in direct continuity with the foot vessels) and the secondary one (perfusing the angiosome district). The aim of this study is to evaluate the safety and effectiveness of bifurcated bypass in chronic limb threatening ischaemia. Methods Thirty-five patients were consecutively treated with a bifurcated bypass for chronic limb threatening ischaemia from January 2014 to December 2019 in a single vascular surgery centre. Data from clinical records and operative registers were collected prospectively in an electronic database and retrospectively analysed. Primary and primary assisted bypass patency, amputation-free survival, morbidity and mortality rates at 12 and 24 months were analysed. Results Mean follow-up period was 25.1 months (range 2–72 months). Thirty-six bifurcated bypasses were performed on 35 patients (age 75.3 ± 7.2 years; 69.4% were male). According to Wound, Ischemia, foot Infection classification 22.2% belonged to stage 3 and 77.8% to stage 4 and the mean Rutherford’s class was 5.1 ± 0.7. Immediate technical success was 100%. Early mortality and morbidity rates were respectively 5.5%, and 33.3%; foot surgery was performed in 50% of cases with wound healing in all patients. Primary patency and primary assisted bypass patency were 96.7% and 100% at 6 months; 85.2% and 92% at 12 months, 59.9% and 73.4% at 24 months, respectively. Amputation-free survival at 12 and 24 months was, respectively, 95.6% and 78.8%. Overall survival rates at 12 and 24 months were respectively 94.4% and 91.6%. Conclusions Bifurcates bypass can provide good results in patients with chronic limb threatening ischaemia without endovascular option, especially in diabetic ones. Bifurcated bypass is a complex surgical solution, both to be planned and performed, and it is quite invasive for frail patients that should be accurately selected.

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Fitting Tips and Visual Rehabilitation of Irregular Cornea with a New Design of Corneoscleral Contact Lens: Objective and Subjective Evaluation

Journal of Ophthalmology ◽

10.1155/2018/3923170 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Waleed Ali Abou Samra ◽

Amani E. Badawi ◽

Hanem Kishk ◽

Ayman Abd El ghafar ◽

Mohamed M. Elwan ◽

...

Keyword(s):

Contact Lens ◽

Subjective Evaluation ◽

Patient Comfort ◽

Visual Rehabilitation ◽

Common Cause ◽

The Mean ◽

High Degree ◽

Lens Wear ◽

Objective And Subjective Evaluation

Objectives. To study the fitting and the visual rehabilitation obtained with a corneoscleral contact lens, namely, Rose K2 XL in patients with irregular cornea.Methods. This prospective study included 36 eyes of 36 patients with irregular cornea fitted with Rose K2 XL. Refractive and visual outcomes and mesopic and aberrometric parameters of fitted eyes were assessed at 2 weeks, 3 months, and 6 months after the initial lens use. Objective and subjective parameters of patient satisfaction and lens comfort were noted. Causes of lens discontinuation and complications were also recorded.Results. Average logMAR VA improved significantly from 0.95 ± 0.09 without correction to 0.04 ± 0.05 six months after lens wear. Similarly, mesopic and aberrometric measures were significantly improved. Statistical analysis of the subjective patients’ responses showed a significant acceptance of the lens by most of them. At the end of follow-up, the mean wearing time was 9.9 ± 2.9 hours per day. The most common cause of wearing discontinuation was persistent discomfort (16.7%) and high lens expenses(16.7%). Self-assessed questionnaire showed statistically significant improvement in nearly all measured subjective parameters.Conclusion. Rose K2 XL lenses provide patients with irregular cornea with both quantitative and qualitative optimal visual function with high degree of patient comfort and satisfaction.

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Fracture of the Second Metatarsal Base

Journal of the American Podiatric Medical Association ◽

10.7547/87507315-93-1-6 ◽

2003 ◽

Vol 93 (1) ◽

pp. 6-10 ◽

Cited By ~ 7

Author(s):

Gregory Morris ◽

Kelly Nix ◽

Flair D. Goldman

Keyword(s):

Differential Diagnosis ◽

Clinical Presentation ◽

Recovery Period ◽

Treatment Modalities ◽

Transverse Fracture ◽

Imaging Studies ◽

Improve Treatment ◽

Second Metatarsal ◽

The Mean

Fracture of the second metatarsal is a cause of chronic midfoot pain that has not been thoroughly examined in the literature. A retrospective review of medical charts and imaging studies was undertaken to investigate this phenomenon. The clinical presentation, differential diagnosis, results of imaging studies, and treatment modalities are described for eight patients with midfoot pain who were treated for a mean of 3.7 months (range, 0 to 12 months) before imaging studies showed a nondisplaced transverse fracture of the second metatarsal base. Initial radiographs indicated fracture in only one patient. Two patients later had surgical bone grafting, two patients had asymptomatic nonunion, and three patients eventually healed. At the last follow-up examination, one patient was continuing treatment with immobilization and electrical bone stimulation. For the seven patients in whom symptoms resolved, the mean recovery period was 14 months (range, 5 to 23 months). Further research is needed to improve treatment and outcomes for this condition. (J Am Podiatr Med Assoc 93(1): 6-10, 2003)

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Long-term Results of Low Grade Appendiceal Mucinous Neoplasm (LAMN): A Retrospective Analysis of 24 Patients

Archives of Iranian Medicine ◽

10.34172/aim.2021.87 ◽

2021 ◽

Vol 24 (8) ◽

pp. 615-621

Author(s):

Mustafa Gok ◽

Ugur Topal ◽

Muhammet Akyüz ◽

Abdullah Bahadır Öz ◽

Erdogan Sozuer ◽

...

Keyword(s):

Age Distribution ◽

Long Term Results ◽

Pathological Examination ◽

Resection Margins ◽

Low Grade ◽

Common Symptom ◽

Mucinous Neoplasm ◽

The Mean

Background: Appendix tumors are rare tumors found in the gastrointestinal tract, observed at a rate of about 0.2%–0.3%. Our aim in this study was to present the clinicopathological classification, treatment and long-term prognosis of patients with low grade appendiceal mucinous neoplasm (LAMN). Methods: Patients who underwent surgery in the Erciyes University Department of (Kayseri, Turkey), Department of General Surgery between December 2010 and December 2018, and who had LAMN as a result of pathology were included in our study. Demographic data, clinical and pathological features of the disease, their treatment and follow-up results after treatment were reviewed retrospectively. Results: We included 24 patients in the study. Of these patients, 10 (41.6%) were male. The mean age distribution was 56.4 ± 20.3 (21–91) years. Appendectomy was performed in 14 patients, and additional organ resections were performed in 8 patients. The most common symptom at the time of presentation was abdominal pain (79.1%; 95% CI, 58.3–91.7). The most common preliminary diagnosis in the preoperative period was acute appendicitis (50%; 95% CI, 29.2–70.8). Mean postoperative hospitalization time was 7.4 ± 7.96 (2–31) days. On pathological examination, appendectomy resection margins were positive in two patients. The mean (median) postoperative follow-up was 31.25 ± 23.9 (27) (1–90) months. One-year survival was 91.6%, and 5-year survival was 83.3%. Recurrence was detected in three patients during the follow-up period. Conclusion: If appendix mucinous neoplasia (AMN) is suspected in patients undergoing surgery with an initial diagnosis of acute or plastron appendicitis, care should be taken to remove the lesion without perforation. Pseudomyxoma peritonei, which may develop as a result of perforation, is associated with recurrence and decreased survival.

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Malignant sinonasal tumors in Stockholm, 2000-2005.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e17001 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e17001-e17001

Author(s):

Mattias Jangard

Keyword(s):

Malignant Melanoma ◽

Squamous Cell ◽

Cell Cancer ◽

Undifferentiated Carcinoma ◽

Treatment Modalities ◽

Upper Respiratory Tract ◽

Malignant Tumours ◽

The Mean ◽

Upper Respiratory

e17001 Background: Between2000-2005 58 patients developed malignant sinonasal tumours in the region of Stockholm that consist of 2.5 million people. Sinonasal malignant tumours are uncommon and account for approximately 3% to 5% of all upper respiratory tract malignancies and 0.2% of all malignancies. Because these tumours are rare and the treatment varies internationally and also in different parts of Sweden; our aim was to follow up these patients to get a better picture of this group and also find out which treatment modalities that had the best outcome. Methods: All the patients have been identified through a database that register all new malignant head and neck tumours in Stockholm. We identified the patients from 2000-2005 and studied all the medical charts for the patients. Results: 10-15 patients develop malignant sinonasal tumour per year in the region of Stockholm. The mean age at diagnosis was 67 year (21-95 year). The distribution between men and women where equal. We found that 50 % was squamous cell carcinoma, 20% was malignant melanoma, 10 % adenocarcinoma, 10 % SNUC (Sino Nasal Undifferentiated Carcinoma) and 10 % other tumours. The 3-year survival was 50 % between 2000-2005. The prognosis varies between differnet tumour types. Squamous cell cancer and adenocarcinoma has a better prognosis than malignant melanoma and SNUC. Conclusions: This study brings light to the distribution of the different tumour types and also we found that malignant melanoma has a tendency to increase if you compare to a study from Sweden 2003. We were not able to analyse which treatment modality to prefer in this study due to short follow up and a small material.

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Evaluation of the Clinical Profile and Treatment Outcomes of Ocular and Adnexal Rhinosporidiosis in a Tertiary Eye Care Centre

Asian Journal of Ophthalmology ◽

10.35119/asjoo.v12i3.303 ◽

1970 ◽

Vol 12 (3) ◽

pp. 149-151

Author(s):

Prateek Agarwal ◽

Usha Kim ◽

Vipul Arora

Keyword(s):

Histopathological Examination ◽

Treatment Modalities ◽

Excision Biopsy ◽

Care Centre ◽

Lacrimal Sac ◽

Eye Care ◽

Recurrence Rates ◽

The Mean ◽

Conclusive Diagnosis

Aim: To describe the demographics, histopathology, treatment modalities, outcomes, and recurrence rates for patients diagnosed with ocular and adnexal rhinosporidiosis.Methods: This prospective descriptive study was conducted at the Department of Orbit, Oculoplasty, and Oncology at a tertiary eye care centre in South India. Fifty patients with a clinical diagnosis of ocular and adnexal rhinosporidiosis who presented from March 2005 to October 2007 were included. All patients underwent complete conjunctival and lid mass excision with cautery, and all patients with rhinosporidiosis of the lacrimal system underwent dacryocystectomy.Results: The mean age at presentation was 30.42 years (SD, 16.89 years; range, 1-70 years). The mean follow-up was 14.2 months (range, 12-18 months). The most common site was the conjunctiva (n = 26; 52%), followed by the lacrimal sac (n = 13; 26%) and the eyelids (n = 11; 22%). There was a single recurrence (2%) involving the lacrimal sac. Endonasal polypectomy and exploration of the sac region was done. There were no further recurrences during subsequent follow-up. The diagnosis was confirmed histopathologically for all patients.Conclusions: Rhinosporidiosis is an ocular disorder with high recurrence rates. Histopathological examination following excision biopsy is recommended for all patients for a conclusive diagnosis. Recurrence rates can be low if complete meticulous excision is performed coupled with cauterization of the lesion.

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Intracranial cavernous malformation in children: a single-centered experience with 30 consecutive cases

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20130006 ◽

2013 ◽

Vol 71 (4) ◽

pp. 220-228 ◽

Cited By ~ 14

Author(s):

Marcelo Campos Moraes Amato ◽

João Flávio Gurjão Madureira ◽

Ricardo Santos de Oliveira

Keyword(s):

Clinical Presentation ◽

Cavernous Malformation ◽

Neurological Deficits ◽

Treatment Modalities ◽

Study Group ◽

Functional Evaluation ◽

Cavernous Malformations ◽

Asymptomatic Patients ◽

The Mean

Objectives: To determine the clinical presentation and treatment outcome of pediatric intracranial cavernous malformation (CM) in a single-centered institution. Methods: Clinical data review of 30 patients under 18 years-old who had undergone surgery for cavernous malformation from January 1993 to December 2011. Results: The Study Group included 18 males and 12 females (mean age: 8.7 years-old). Symptoms at presentation were seizures (16/30, 53.3%), headache (15/30, 50.0%), and focal neurological deficits (11/30, 36.6%). Multiple cavernous malformations were found in 5/30 (16.6%). According to location, patients were classified in groups: (G1) brain-steam in 5/30 (16.6%), (G2) cerebellum in 2/30 (6.6%), (G3) supratentorial associated with seizures in 16/30 (53.3%), and (G4) supratentorial without seizures in 7/30 (23.3%). Surgical resection was performed in 26 out of 30 (86.6%) patients. The mean follow-up period was 4.1 years. Of 15 children followed-up with preoperative seizures, all were rendered seizure-free after surgery. Conclusions: For symptomatic solitary cavernous malformation, the treatment of choice is complete microsurgical excision preceded by careful anatomical and functional evaluation. For multiple cavernous malformation or asymptomatic patients, the treatment modalities must be cautiously considered.

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One-Step Autologous Minced Cartilage Procedure for the Treatment of Knee Joint Chondral and Osteochondral Lesions: A Series of 27 Patients With 2-Year Follow-up

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119853773 ◽

2019 ◽

Vol 7 (6) ◽

pp. 232596711985377 ◽

Cited By ~ 7

Author(s):

Felix Kurt Massen ◽

Cyril Raphael Inauen ◽

Laurent Pascale Harder ◽

Armin Runer ◽

Stefan Preiss ◽

...

Keyword(s):

Magnetic Resonance ◽

Knee Joint ◽

Large Diameter ◽

Single Step ◽

Knee Function ◽

Area Measurement ◽

Treatment Modalities ◽

Osteochondral Lesions ◽

The Mean

Background:Chondral and osteochondral lesions are being detected with increasing frequency. For large-diameter lesions, cell-based treatment modalities are speculated to result in the best possible outcome.Purpose:To prospectively evaluate the 2-year clinical and radiological results after the treatment of chondral and osteochondral knee joint lesions by a single-step autologous minced cartilage procedure.Study Design:Case series; Level of evidence, 4.Methods:From February 2015 to June 2016, a total of 27 consecutive patients suffering from chondral or osteochondral lesions of the knee joint were treated using a single-step autologous minced cartilage procedure. All patients underwent preoperative and postoperative magnetic resonance imaging for the collection of AMADEUS (Area Measurement and Depth and Underlying Structures) and MOCART (magnetic resonance observation of cartilage repair tissue) scores. Clinical analysis was conducted by a numeric analog scale (NAS) for pain and knee function before the intervention and at 12 and 24 months postoperatively.Results:A total of 12 female and 15 male patients (mean age, 28.7 years) were evaluated for a mean of 28.2 ± 3.8 months. The mean cartilage defect size encountered intraoperatively was 3.1 ± 1.6 cm2. There was a significant decrease in pain from 7.2 ± 1.9 preoperatively to 1.8 ± 1.6 ( P < .001) at 2-year follow-up. Knee function improved from a mean of 7.2 ± 2.0 preoperatively to 2.1 ± 2.3 ( P < .001) at 2 years after surgery. The mean preoperative AMADEUS score was 57.4 ± 21.4. Postoperatively, the mean MOCART score was 40.6 ± 21.1 at 6-month follow-up. No correlation was observed between the clinical data and the MOCART or AMADEUS scores.Conclusion:Overall, the findings of this study demonstrated that patients undergoing a single-step autologous minced cartilage procedure had a satisfactory outcome at 2-year follow-up. As a result, the single-step autologous minced cartilage procedure does represent a possible alternative to standard autologous chondrocyte implantation. Longer follow-up and larger cohorts are required to define the benefits of this procedure.

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