Microsurgical Management of Midbrain Cavernous Malformations: Predictors of Outcome and Lesion Classification in 72 Patients

2019 ◽  
Vol 17 (6) ◽  
pp. 562-572 ◽  
Author(s):  
Yoshihito Tsuji ◽  
Souvik Kar ◽  
Helmut Bertalanffy
Keyword(s):  
Clinical Results ◽  
Surgical Approaches ◽  
Time Interval ◽  
Term Outcome ◽  
Cavernous Malformations ◽  
Long Term Outcome ◽  
Before And After ◽  
Oculomotor Disturbances ◽  
Eye Movement Disorders

Abstract BACKGROUND Due to the complex segmental organization of the brainstem, it is preferable to study midbrain cavernous malformations (MCMs) separately from pontine and medullary lesions. OBJECTIVE To evaluate clinical results after microsurgical removal of MCMs, assess predictors for outcome and introduce a topographical classification of MCMs. METHODS A retrospective study was conducted on consecutive patients who underwent MCM resection. Clinical parameters before and after surgery, morphological CM features, surgical approaches and outcomes were analyzed. MCMs were classified according to their exact location within the midbrain and their axial and sagittal extension. RESULTS The authors reviewed 72 patients (35 male). Lesions varied in size between 4 and 55 mm. The vast majority of patients benefited from surgery. The mean modified Rankin Scale (mRS) decreased significantly from 1.6 at admission to 1.3 at discharge and to 0.7 at follow-up (6-247 mo postoperatively). Five patients (6.9%) suffered from delayed hypertrophic olivary degeneration as visualized on magnetic resonance imaging. One male suffered from early postoperative re-bleeding that required surgical hematoma evacuation. There were no severe long tract impairment or other disabling complications, no delayed re-bleedings, and no surgical mortality. CONCLUSION We present a new topographic classification of MCMs that may be useful for predicting the occurrence of postoperative eye movement disorders. Other predictors of persistent oculomotor disturbances are time interval between onset of symptoms and surgery, and patient's age over 40 yr. Early surgery is recommendable in patients with oculomotor disturbances. MCM size over 18 mm, patient age over 40 yr, and poor mRS at admission are important predictors for the long-term outcome.

Klinische Langzeitergebnisse der perkutanen transluminalen Angioplastie bei Patienten mit peripherer arterieller Verschlusskrankheit

VASA ◽  
2002 ◽  
Vol 31 (1) ◽  
pp. 36-42 ◽  
Author(s):  
. Bucek ◽  
Hudak ◽  
Schnürer ◽  
Ahmadi ◽  
Wolfram ◽  
...  
Keyword(s):  
Success Rate ◽  
Clinical Stage ◽  
Ankle Brachial Index ◽  
Clinical Situation ◽  
Clinical Results ◽  
Transluminal Angioplasty ◽  
Term Outcome ◽  
Long Term Outcome

Background: We investigated the long-term clinical results of percutaneous transluminal angioplasty (PTA) in patients with peripheral arterial occlusive disease (PAOD) and the influence of different parameters on the primary success rate, the rate of complications and the long-term outcome. Patients and methods: We reviewed clinical and hemodynamic follow-up data of 166 consecutive patients treated with PTA in 1987 in our department. Results: PTA improved the clinical situation in 79.4% of patients with iliac lesions and in 88.3% of patients with femoro-popliteal lesions. The clinical stage and ankle brachial index (ABI) post-interventional could be improved significantly (each P < 0,001), the same results were observed at the end of follow-up (each P < 0,001). Major complications occurred in 11 patients (6.6%). The rate of primary clinical long-term success for suprainguinal lesions was 55% and 38% after 5 and 10 years (femoro-popliteal 44% and 33%), respectively, the corresponding data for secondary clinical long-term success were 63% and 56% (60% and 55%). Older age (P = 0,017) and lower ABI pre-interventional (P = 0,019) significantly deteriorated primary clinical long-term success for suprainguinal lesions, while no factor could be identified influencing the outcome of femoro-popliteal lesions significantly. Conclusion: Besides an acceptable success rate with a low rate of severe complications, our results demonstrate favourable long-term clinical results of PTA in patients with PAOD.

scholarly journals Study of hypoglycemia in neonates with low birth weight

2020 ◽  
Vol 7 (8) ◽  
pp. 409-413
Author(s):  
Dr. Ekta Acharya ◽  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Clinical Signs ◽  
Time Interval ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Low Birth Weight Babies ◽  
Short And Long Term ◽  
Heel Prick ◽  
Glycogen Stores

Background and Aim: The maintenance of normoglycemia in newborns depends upon theadequacy of glycogen stores, maturation of glycogenolytic and gluconeogenic pathways, andintegrated endocrine response. The current study, therefore, proposes to observe the clinical profileof low-birth-weight babies concerning the occurrence of hypoglycemia. Materials and Methods:The neonates with a weight of fewer than 2500 grams were included in the study. A total of 100infants were included in the study. They were divided into two groups with infants withhypoglycemia in one group and infants with normoglycemic in another group. The aseptic conditionwas maintained and with the help of heel prick, the capillary blood was collected. The capillary bloodwas screened with the help of reagent strips. Results: Out of the total 100 neonates, a total of 76neonates were normoglycemic and 24 neonates had hypoglycaemic episodes. Overall 22 episodes ofhypoglycemia were recorded. There was no significant association between birth weight andepisodes of hypoglycemia. The majority of hypoglycaemic infants were male. Conclusion:Hypoglycemia associated with abnormal clinical signs (symptomatic hypoglycemia) has a poor short-and long-term outcome but evidence of risk in the absence of clinical signs (asymptomatichypoglycemia) is inconclusive. Small for gestational age is a significant determinant forhypoglycemia. Hypoglycaemic episodes were significantly noticed in the first 24 hours as comparedto another time interval.

Cervicogenic dizziness – musculoskeletal findings before and after treatment and long-term outcome

2007 ◽  
Vol 29 (15) ◽  
pp. 1193-1205 ◽  
Author(s):  
Eva-Maj Malmström ◽  
Mikael Karlberg ◽  
Agneta Melander ◽  
Måns Magnusson ◽  
Ulrich Moritz
Keyword(s):  
Term Outcome ◽  
Long Term Outcome ◽  
Before And After ◽  
Cervicogenic Dizziness

scholarly journals Treatment of unstable hips with the Tübingen splint in early postnatal period: radiological mid-term results of 75 hips with mean follow-up of 5.5 years

2020 ◽  
Vol 14 (4) ◽  
pp. 252-258
Author(s):  
Hannes Kubo ◽  
David Latz ◽  
Martin Hufeland ◽  
Erik Schiffner ◽  
Ruediger Krauspe
Keyword(s):  
Postnatal Period ◽  
Level Of Evidence ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Type D ◽  
Further Development ◽  
Mid Term Results

Purpose For treatment of unstable hips, the Tübingen splint is a treatment option. After the initial treatment, regular radiological follow-up examinations are recommended but there is a lack of long-term outcome studies. Therefore, the further development of unstable hips treated with the Tübingen splint were evaluated. Methods From 2004 to 2015 116 patients with 161 unstable hips treated with the Tübingen splint were evaluated. Inclusion criteria were: 1) successfully treated unstable hip (type D, III and IV); 2) pelvic radiographs at the age of one to ≤ two, two to ≤ four and four to ≤ eight years. The acetabular index (ACI) of all and the centre-edge angle (CEA) of the third radiograph were measured and classified according to the Tönnis classification. Results A total of 53 patients with 75 unstable hips (type D 34 (45.3%), III 33 (44.0%), IV 8 (10.7%)) were included. In comparison of the first, second and third radiograph, an increase of normal findings was seen in 31 (41.3%) to 53 (70.7%) and 60 (80.0%) hips, respectively. However, a decrease of slightly dysplastic hips from 31 (41.3%) to 19 (25.3%) and 14 (18.7%) respectively and severely dysplastic hips from 13 (17.3%) to three (4.0%) and one (1.3%) hip respectively was detected. In comparison of first to second radiograph, 32 hips improved and five hips deteriorated and of second to third radiograph 16 hips improved and six hips deteriorated. The Tönnis classification of ACI compared with CEA showed no significant differences (p = 0.442). Conclusion This study shows a good development of unstable hips treated with the Tübingen splint with mean follow-up 5.5 years. Nevertheless, unexpected deteriorations could be identified. The CEA is an alternative to the ACI. Level of evidence IV

RENAL FUNCTION IN HYPERPARATHYROIDISM

1970 ◽  
Vol 63 (1) ◽  
pp. 161-174 ◽  
Author(s):  
Lave Ohlsson
Keyword(s):  
Renal Function ◽  
Kidney Stones ◽  
Inulin Clearance ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Follow Up Studies ◽  
Before And After ◽  
Spontaneous Disappearance ◽  
Pah Clearance

ABSTRACT Clearances of inulin and para-aminohippurate (PAH) were studied before as well as three to nine years (average 5½) after surgery in 35 cases of primary hyperparathyroidism. The preoperative inulin clearance ranged from 18 to 105 (average 67) and the PAH clearance from 61 to 666 (349) ml/min/1.73 m2 BSA. In the follow-up studies clearances of inulin and PAH were, on the whole, well maintained both in subjects with normal as well as in cases showing depressed clearance values before surgery. In fact, a slight but statistically significant increase of inulin clearance was demonstrated in the material as a whole, whereas no significant change occurred in PAH clearance. The renal concentrating capacity was estimated before and after operation in 22 of the patients. An increase was almost regularly observed postoperatively but the concentrating capacity remained subnormal in almost half of the subjects studied. The changes in the concentrating capacity and clearances of inulin and PAH did not always run parallel. The renal clearance of phosphate was studied simultaneously with inulin and PAH clearances. Phosphate clearance decreased after surgery concomitantly with an elevation of serum phosphorus. However, restoration to the normal was not always obtained. Arterial hypertension was present in 40 per cent of the patients before and/or after surgery. Only grade I-II eye ground changes were found. Blood pressure was easily controlled by hypotensive drugs. A spontaneous disappearance or a decrease in the number of kidney stones was demonstrated radiologically at the follow-up studies in almost half of the patients. In only two subjects were additional kidney stones found. It is concluded that, following surgical treatment of hyperparathyroidism, the long-term outcome regarding renal function may be more favourable than has hitherto been thought.

Microsurgical infrapedicular paramedian approach for retrovertebral lumbar disc herniations

2005 ◽  
Vol 2 (1) ◽  
pp. 88-91 ◽  
Author(s):  
Nedal Hejazi
Keyword(s):  
Facet Joint ◽  
Lumbar Disc ◽  
Clinical Results ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Content Type ◽  
Clinical Benefits ◽  
Disc Herniations ◽  
Fine Print

✓ The author performed a microsurgical infrapedicular paramedian approach in 35 patients (23 men and 12 women) to remove herniated lumbar retrovertebral discs that did not have an apparent origin at either the superior or inferior disc level. The goal of this surgery was to minimize the bone resection, preserve the facet joint, and avoid the risk of secondary vertebral instability. The Macnab outcome classification was used to assess all patients who attended follow-up examination for at least 15 months. The clinical results were excellent or good in 34 (97%) of 35 cases. This minimally invasive lumbar spine technique resulted in minimal morbidity, excellent clinical benefits, and a long-term outcome without evidence of secondary segmental instability.

Altered serum levels of thyroxine, triiodothyronines and diiodothyronines in endogenous depression

1981 ◽  
Vol 96 (2) ◽  
pp. 199-207 ◽  
Author(s):  
C. Kirkegaard ◽  
J. Faber
Keyword(s):  
Similar Pattern ◽  
Serum Levels ◽  
Endogenous Depression ◽  
Serum Concentrations ◽  
Electroconvulsive Treatment ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Before And After ◽  
Altered Serum

Abstract. Serum levels of thyroxine (T4), 3,3',5-triiodothyronine (T3), 3,3',5'-triiodothyronine (rT3), 3,5-diiodothyronine (3,5-T2), 3,3'-diiodothyronine (3,3'-T2) and 3',5'-diiodothyronine (3',5'-T2) were studied in 80 patients with endogenous depression before and after electroconvulsive treatment (ECT). Compared to the values found after recovery, the patients when depressed had significant increased serum levels of T4, rT3, 3,3'-T2 and 3',5'-T2. Serum concentrations of T3 and 3,5-T2 were not significantly altered. Similarly the free T4 index (FT4I) was increased, while the free T3 index (FT3I) was unaffected. Previous studies have shown a reduced TSH response to TRH in patients with endogenous depression and that the long-term outcome after ECT is strongly related to changes in the TSH response. However, patients with increased TSH response to TRH (n = 23) had a pattern of serum iodothyronine concentrations similar to those (n = 57) with an unchanged TSH response. A similar pattern was also found in 7 patients with non-endogenous psychosis, in whom the TSH response to TRH was unchanged after recovery. It is concluded that the alterations of the TSH response to TRH found in endogenous depression cannot be explained by changes of FT4I or FT3I.

Does a fabella-tibial suture alter the outcome for dogs with cranial cruciate ligament insufficiency undergoing arthrotomy and caudal pole medial meniscectomy?

2009 ◽  
Vol 22 (04) ◽  
pp. 283-288 ◽  
Author(s):  
E.J. Comerford ◽  
M.R. Owen ◽  
M.S. Tivers
Keyword(s):  
Cruciate Ligament ◽  
Meniscal Tear ◽  
Control Group ◽  
Term Outcome ◽  
Cranial Cruciate Ligament ◽  
Long Term Outcome ◽  
Stifle Joint ◽  
Medial Meniscectomy ◽  
Before And After ◽  
Clinical Records

Summary Objectives: The objective of this study was to evaluate the effects of fabella-tibial suture (FTS) on long-term outcome in dogs with cranial cruciate ligament (CCL) insufficiency and concurrent medial meniscal tear (MMT) that were managed by an open, caudal pole medial meniscectomy (CPMM). Methods: A retrospective review was performed of the clinical records of dogs treated for CCL insufficiency with concurrent MMT by open CPMM, with or without the non-random addition of a nylon FTS according to surgeon preference, during the period of 2001 to 2004. The Bristol Osteoarthritis in Dogs questionnaire was modified for owner assessment of outcome using a visual analogue scale based on several criteria: level of activity, disability, severity of lameness and frequency of lameness before and after surgery. Results: Completed questionnaires from 31 dog owners were received. A FTS was used after CPMM in 22 dogs (FTS group), but in nine dogs (control group) only a CPMM was performed. The median time to follow up was longer in the FTS group (25 months) than the control group (16 months) (P=0.03). There were not any significant differences between the two groups before and after surgery for the following: disability, activity, frequency of lameness, severity of lameness, ability to climb stairs and ability to sit down. Clinical Significance: The placement of a FTS following stifle joint arthrotomy and CPMM in dogs with CCL deficiency and concurrent MMT may not be a significant factor affecting the ultimate surgical outcome, although our study is limited by the non-randomised study design.

Long-term results of the lateral resurfacing elbow arthroplasty

2018 ◽  
Vol 100-B (3) ◽  
pp. 338-345 ◽  
Author(s):  
C. E. L. Watkins ◽  
D. W. Elson ◽  
J. W. K. Harrison ◽  
J. Pooley
Keyword(s):  
Long Term Results ◽  
Time Interval ◽  
Consecutive Series ◽  
Range Of Movement ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Elbow Arthroplasty ◽  
Kaplan Meier ◽  
The Mean

Aim The aim of this study was to report the long-term outcome and implant survival of the lateral resurfacing elbow (LRE) arthroplasty in the treatment of elbow arthritis. Patients and Methods We reviewed a consecutive series of 27 patients (30 elbows) who underwent LRE arthroplasty between December 2005 and January 2008. There were 15 women and 12 men, with a mean age of 61 years (25 to 82). The diagnosis was primary hypotrophic osteoarthritis (OA) in 12 patients (14 elbows), post-traumatic osteoarthritis (PTOA) in five (five elbows) and rheumatoid arthritis (RA) in ten patients (11 elbows). The mean clinical outcome scores including the Mayo Elbow Performance Score (MEPS), the American Shoulder and Elbow Surgeons elbow score (ASES-e), the mean range of movement and the radiological outcome were recorded at three, six and 12 months and at a mean final follow-up of 8.3 years (7.3 to 9.4). A one sample t-test comparing pre and postoperative values, and survival analysis using the Kaplan–Meier method were undertaken. Results A statistically significantly increased outcome score was noted for the whole group at each time interval. This was also significantly increased at each time in each of the subgroups (OA, RA, and PTOA). Implant survivorship was 100%. Conclusion We found that the LRE arthroplasty, which was initially developed for younger patients with osteoarthritis, is an effective form of surgical treatment for a wider range of patients with more severe degenerative changes, irrespective of their cause. It is therefore a satisfactory alternative to total elbow arthroplasty (TEA) and has lower rates of complications in the subgroups of patients we have studied. It does not require activities to be restricted to the same extent as following TEA. Based on this experience, we now recommend LRE arthroplasty rather than TEA as the primary form of implant for the treatment of patients with OA of the elbow. Cite this article: Bone Joint J 2018;100-B:338–45.

Sign in / Sign up

Export Citation Format

Share Document