scholarly journals Fronto-orbitozygomatic approach: functional and cosmetic outcomes in a series of 169 patients

2018 ◽  
Vol 128 (2) ◽  
pp. 466-474 ◽  
Author(s):  
Nicola Boari ◽  
Alfio Spina ◽  
Lodoviga Giudice ◽  
Francesca Gorgoni ◽  
Michele Bailo ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Clinical Outcomes ◽  
Additional Time ◽  
Orbital Reconstruction ◽  
Comprehensive Knowledge ◽  
Great Utility ◽  
Orbitozygomatic Approach ◽  
Cosmetic Outcomes

OBJECTIVEAdvantages of the fronto-orbitozygomatic (FOZ) approach have been reported extensively in the literature; nevertheless, restoration of normal anatomy and the esthetic impact of surgery are increasingly important issues for patients and neurosurgeons. The aim of this study was to analyze functional and cosmetic outcomes in a series of 169 patients with different pathologies who underwent surgery in which the FOZ approach was used.METHODSBetween January 2000 and December 2014, 250 consecutive patients underwent surgery with an FOZ approach as the primary surgical treatment. Follow-up data were available for only 169 patients; 103 (60.9%) of these patients were female and 66 (39.1%) were male, and their ages ranged from 6 to 77 years (mean 46.9 years; SD 15.6 years). Mean follow-up time was 66 months (range 6–179 months; SD 49.5 months). Evaluation of clinical outcomes was performed with a focus on 4 main issues: surgical complications, functional outcome, cosmetic outcome, and patient satisfaction. The additional time needed to perform orbitotomy and orbital reconstruction was also evaluated.RESULTSThe permanent postoperative complications included forehead hypesthesia (41.4%) and dysesthesia (15.3%), frontal muscle weakness (10.3%), exophthalmos (1.4%), enophthalmos (4.1%), diplopia (6.6%; 2% were related to surgical approach), and persistent periorbital and eyelid swelling (3%). Approximately 90% of the patients reported subjectively that surgery did not affect their quality of life or complained of only minor problems that did not influence their quality of life significantly. The mean time needed for orbitotomy and orbital reconstruction was approximately half an hour.CONCLUSIONSComprehensive knowledge of the potential complications and overall clinical outcomes of the FOZ approach can be of great utility to neurosurgeons in balancing the well-known benefits of the approach with potential additional morbidities.

scholarly journals Systemic Changes in Patients with Chronic Obstructive Pulmonary Disease (COPD): Two Years of Follow-up

2007 ◽  
Vol 30 (3) ◽  
pp. 38
Author(s):  
Roxana G. Galesanu ◽  
Sarah Bernard ◽  
Jean Bourbeau ◽  
Annie Michaud ◽  
François Maltais
Keyword(s):  
Quality Of Life ◽  
Clinical Outcomes ◽  
Lean Body Mass ◽  
Body Mass ◽  
Walking Distance ◽  
Inflammatory Status ◽  
Arterial Blood ◽  
Systemic Manifestations

Background: There is a lack of information concerning the natural evolution of the systemic manifestations related to COPD. The aim of this study was to observe the evolution of the systemic manifestations (muscle wasting, inflammation) related to COPD over a two-year period and to assess their relationships with clinical outcomes (exacerbations and worsening in quality of life) in a longitudinal prospective cohort. Methods: Forty-eight patients with COPD (FEV1: 42 ± 14 % predicted, lean mass: 49 ± 10 kg, 6-min walking distance: 422 ± 112 m, total SGRQ score: 45 ± 17) were included. Baseline and annual follow-up for body composition by DEXA scan, blood cytokines (CRP, IL-6), arterial blood gases, pulmonary function tests and quality of life were obtained. The number of acute exacerbations was recorded. Results: Overall, FEV1, lean body mass, 6-min walking distance and blood inflammatory markers did not change over the two years. During this time, the SGRQ scores decreased by 4 ± 11 points (P=0.021) and 2.7 ± 2.4 exacerbations per patient were observed. There was no relationship between the changes in physiological measures and the fall in SGRQ or the exacerbation rate. A loss in lean body mass > 3% was observed in 11 (23%) patients but this was not associated with any adverse clinical outcomes nor with further loss in FEV1, walking distance and inflammatory status. Conclusion: This cohort of patients remained remarkably stable over a 2-year follow-up period. A small loss in lean body mass was observed in some patients but this could not be associated with adverse clinical outcomes during this period.

scholarly journals Bevacizumab Combined with Corticosteroids Does Not Improve the Clinical Outcome of Nasopharyngeal Carcinoma Patients With Radiation-Induced Brain Necrosis

2021 ◽  
Vol 11 ◽  
Author(s):  
Honghong Li ◽  
Xiaoming Rong ◽  
Weihan Hu ◽  
Yuhua Yang ◽  
Ming Lei ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Nasopharyngeal Carcinoma ◽  
Adverse Events ◽  
Clinical Outcomes ◽  
World Health ◽  
World Health Organization Quality ◽  
Brain Necrosis ◽  
Radiation Induced

ObjectiveOur aim was to compare the clinical outcomes of patients treated with bevacizumab combined with corticosteroids and those with bevacizumab monotherapy from a radiation-induced brain necrosis (RN) registry cohort (NCT03908502).MethodsWe utilized clinical data from a prospective RN registry cohort (NCT03908502) from July 2017 to June 2020. Patients were considered eligible if they had symptomatic RN after radiotherapy for nasopharyngeal carcinoma (NPC) and received bevacizumab (5 mg/kg, two to four cycles) with a minimum follow-up time of 3 months. The primary outcome was a 2-month response rate determined by MRI and clinical symptoms. Secondary outcomes included quality of life [evaluated by the abbreviated World Health Organization Quality of Life (WHOQOL-BREF) questionnaire] and cognitive function (evaluated by the Montreal Cognitive Assessment scale) at 2 months, RN recurrence during follow-up, and adverse events.ResultsA total of 123 patients (34 in the combined therapy group and 89 in the monotherapy group) were enrolled in our study with a median follow-up time of 0.97 year [interquartile range (IQR) = 0.35–2.60 years]. The clinical efficacy of RN did not differ significantly between patients in these two groups [odds ratio (OR) = 1.642, 95%CI = 0.584–4.614, p = 0.347]. Furthermore, bevacizumab combined with corticosteroids did not reduce recurrence compared with bevacizumab monotherapy [hazard ratio (HR) = 1.329, 95%CI = 0.849–2.079, p = 0.213]. The most common adverse events of bevacizumab were hypertension (17.89%), followed by nosebleed (8.13%) and fatigue (8.13%). There was no difference in grade 2 or more severe adverse events between the two groups (p = 0.811).InterpretationOur results showed that the treatment strategy of combining bevacizumab with corticosteroids did not lead to better clinical outcomes for RN patients with a background of radiotherapy for nasopharyngeal carcinoma.

scholarly journals Toward a comprehensive assessment of functional outcomes in pediatric patients with brain arteriovenous malformations: the Pediatric Quality of Life Inventory

2016 ◽  
Vol 18 (5) ◽  
pp. 611-622 ◽  
Author(s):  
Isaac Josh Abecassis ◽  
John D. Nerva ◽  
Jason Barber ◽  
Jason Rockhill ◽  
Richard G. Ellenbogen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Clinical Outcomes ◽  
Pediatric Patients ◽  
Performance Category ◽  
Quality Of Life Inventory ◽  
Related Quality ◽  
Health Related ◽  
Life Inventory

OBJECTIVE Brain arteriovenous malformations (bAVMs) are rare in pediatric patients but represent the most common cause of hemorrhagic stroke in this population. Pediatric patients demonstrate superior outcomes in comparison with adult patients with similar lesions and presentations. Most studies of clinical outcomes of pediatric bAVMs use the modified Rankin Scale (mRS), despite a lack of validation in pediatric patients. METHODS The authors interviewed the parents of 26 pediatric patients who underwent multimodality bAVM treatment and administered the Pediatric Quality of Life Inventory (PedsQL)—a well-validated tool for pediatric outcomes that quantifies performance in a physical, emotional, social, and school domains. They also reviewed clinical information from the patients' medical charts. Statistical analysis was performed using a log-transformed t-test, the Mann-Whitney exact test, the Kruskal-Wallis test, and Spearman correlation. In addition, the literature was reviewed for prior reports of clinical outcome of pediatric cases of bAVM. RESULTS The average PedsQL health-related quality of life score was 71 ± 24, with an average age at diagnosis of 12.5 years and an average follow-up period of 6.8 years. Seventeen patients (65%) presented with hemorrhage and 4 (15%) with seizures. PedsQL scores correlated strongly and at a statistically significant level (p < 0.001) with mRS, Pediatric Overall Performance Category (POPC), Pediatric Cerebral Performance Category (PCPC), and Glasgow Outcome Scale scores. Multivariate modeling validated special education, corrective devices, and cure status as significant predictors of PedsQL scores. Statistically significant risk factors for undergoing placement of a ventriculoperitoneal shunt included lower Glasgow Coma Scale motor scores on admission (p = 0.042), cerebellar location (p = 0.046), and nidus volume (p = 0.017). Neither treatment modality nor location statistically affected clinical outcomes at follow-up. CONCLUSIONS There have been few studies of long-term clinical outcomes of bAVM in pediatric patients, and previously published studies have used conventional metrics that have been validated in the adult population, such as the mRS. Although these metrics can serve as reasonable surrogates, an accurate understanding of overall health-related quality of life is contingent on utilizing validated toolsets, such as the PedsQL.

scholarly journals Clinical outcomes and quality of life of COVID-19 survivors: a follow-up of 3 months post hospital discharge

2021 ◽  
pp. 106453
Author(s):  
Beatriz Costa Todt ◽  
Claudia Szlejf ◽  
Etienne Duim ◽  
Alana.O.M. Linhares ◽  
Diogo Kogiso ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Clinical Outcomes ◽  
Hospital Discharge

Early clinical outcomes for treatment of post-thrombotic syndrome and common iliac vein compression with a hybrid Oblique self-expanding nitinol stent – the TOPOS study

VASA ◽  
2020 ◽  
Vol 49 (4) ◽  
pp. 301-308 ◽  
Author(s):  
Tim Sebastian ◽  
Michael Lichtenberg ◽  
Oliver Schlager ◽  
Houman Jalaie ◽  
Rick de Graaf ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pain Intensity ◽  
Clinical Outcomes ◽  
Iliac Vein ◽  
Common Iliac Vein ◽  
Pain Intensity Score ◽  
Intensity Score ◽  
Iliac Vein Compression

Summary: Background: Physical attributes of conventional stents used in the ilio-caval territory are often unfavorable in the presence of external compression close to the bifurcation. A hybrid oblique stent was developed for the treatment of common iliac vein compression without compromising the contralateral iliac vein inflow. Patients and methods: The ongoing international monitored TOPOS study enrolled 60 patients with post-thrombotic syndrome (PTS) treated with the sinus-Obliquus stent (optimed) and provisional distal stent extension. At 3-month follow-up, patency rates were obtained from duplex ultrasound, and clinical outcomes were assessed by the Villalta score, revised venous severity score (rVCSS), pain intensity score and chronic venous disease quality of life questionnaire (CIVIQ-20). Results: Mean age was 46.6 ± 14.9 years (68.3 % women). Mean number of implanted stents was 1.9 ± 0.6; 12 (20 %) patients received the hybrid oblique stent only. Forty-eight (80 %) patients had distal stent extension, and 42 (70 %) had stents below the inguinal ligament. Four (7 %) patients (all with stent extension) developed stent thrombosis. Primary and secondary patency rates at 3 months were 93.1 % (95 %CI 83.3–98.1 %), and 100 % (95 %CI 93.8–100 %), respectively. Improvement in Villalta, rVCSS, CIVIQ-20, and pain intensity score from baseline to 3-month follow-up was 6.9 ± 1.4 points (95 %CI 4.1–9.8; p < 0.0001), 3.4 ± 1.0 points (95 %CI 1.3–5.4 points; p < 0.01), 13.6 ± 2.7 points (95 %CI 8.2–19.0 points; p < 0.0001), and 2.4 ± 0.5 (95 %CI 1.4–3.3; p < 0.0001), respectively. At follow-up, 38 (63 %) patients were free from the PTS and none developed contralateral deep vein thrombosis. Conclusions: In patients with PTS and common iliac vein compression, treatment with the hybrid oblique stent with provisional stent extension resulted in high patency rates and improvement in PTS severity and quality of life at 3-month. Two-year results of TOPOS will assess the durability of this treatment.

Abstract TP378: Long Term Follow Up Telephone Evaluation of Post Stroke Quality of Life is Feasible and Effective

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Renata Miranda ◽  
Carla Ledo ◽  
Daisa Escobosa ◽  
Caren Cristina Giannotti Bizutti ◽  
Amanda Ruiz ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Data Collection ◽  
Clinical Outcomes ◽  
Stroke Recurrence ◽  
Post Discharge ◽  
Phone Calls ◽  
Long Term Follow Up

Background: The long-term follow-up of clinical outcomes in patients admitted with acute stroke can identify relevant clinical data in the prevention of stroke recurrence as well as measure the quality of life of such patients. Follow-up after discharge in hospitals without stroke clinics can be a challenge. Therefore we created in our hospital an outcomes measurement nuclei characterized as a data collection center, with the main objective of periodically measuring clinical outcomes and quality of life of patients after hospital discharge.This sector works together with the different clinical specialties in providing information with a focus on outcome indicators, using questionnaires to estimate the parameters of evaluation of health states.Our objective was to describe data obtained from this data collection center evaluating post-discharge quality of life of patients treated in our stroke center 30, 90, 180 days and 01 years after the diagnosis. Methods: The study was conducted from January 2012 to March 2016, at a tertiary, general, private hospital in São Paulo, Brazil. Phone calls using the EuroQol instrument (EQ-5D) to measure quality of life were performed. The modified Rankin scale and a structured questionnaire to identify stroke recurrence, readmissions and medication failures were also applied. Results: We conducted 2184 telephone calls and obtained 1727 (79%) successful contacts. The mean EQ-5D at 30 days was: 0.732 +/-0.558; at 90 days: 0.722 +/- 0.358; at 180 Days: 0.781 +/- 0.326; and at 12 months 0.766 +/-0.349. During the follow-up, 31 patients (2%) died. The main reasons for censuring patients were unsuccessful contact after 3 attempts (51%); outdated registration data (3%) and refusals (9%). Conclusion: In conclusion, monitoring of standardized clinical outcomes after stroke is possible even in private non academic hospitals, allowing the acquisition of quality of care indicators and patient centered outcomes.

Results of Treatment of Type 3 Acromioclavicular Joint Dislocation with Three Methods

2019 ◽  
Vol 21 (3) ◽  
pp. 167-176
Author(s):  
Adam Łazarski ◽  
Sylwia Sarzyńska ◽  
Sławomir Struzik ◽  
Tomasz Jędral ◽  
Paweł Łęgosz ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Clinical Outcomes ◽  
Acromioclavicular Joint ◽  
Hook Plate ◽  
Fixation Method ◽  
Wire Cerclage ◽  
Rockwood Type Iii

Background. Rockwood Type III acromioclavicular joint injuries are treated both conservatively and surgically. There is still no consensus on an optimal fixation method. The aim of this study was to evaluate which of the surgical methods used in our Department produces the best outcomes in long-term follow-up. Material and methods. The study involved 27 patients. Wire cerclage was used in 12 patients, 11 patients were operated on by the Ladermann method, and a hook plate was used in 4 patients. The patients were assessed at a late follow-up visit after a mean of 22 months post-operatively. The Constant Shoulder Scale (CSS), Oxford Shoulder Scale (OSS), and PROMIS v1.2 for the upper limb were used to assess the long-term effects of the treatment. Results. There were no statistically significant differences between the Ladermann method and wire cerclage for the scales applied (p=0.98 at α=0.05). The functional CSS showed a significant advantage of the outcomes of the Lader­mann method and wire cerclage in comparison to the hook plate (p=0.014 and p=0.004, respectively, at α=0.05). The quality of life scales OSS and PROMIS showed no significant difference between the methods. Conclusions. 1. The outcomes of treatment with the Ladermann method and wire cerclage are excellent and com­parable with regard to both clinical outcomes and the quality of life. 2. The use of a hook plate may substantially contribute to worse clinical outcomes. 3. No considerable difference was found in the quality of life between the different groups, but a study involving a larger number of patients would be necessary for a complete evaluation.

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