Embolic stroke of undetermined source: a retrospective analysis from an Italian Stroke Unit

Marco Masina; Annalena Cicognani; Carla Lofiego; Simona Malservisi; Riccardo Parlangeli; Alessandro Lombardi

doi:10.4081/itjm.2016.690

Embolic stroke of undetermined source: a retrospective analysis from an Italian Stroke Unit

Italian Journal of Medicine ◽

10.4081/itjm.2016.690 ◽

2016 ◽

Vol 10 (3) ◽

pp. 202 ◽

Cited By ~ 1

Author(s):

Marco Masina ◽

Annalena Cicognani ◽

Carla Lofiego ◽

Simona Malservisi ◽

Riccardo Parlangeli ◽

...

Keyword(s):

Stroke Unit ◽

Cerebral Arteries ◽

Real Life ◽

Antiplatelet Agents ◽

Embolic Stroke ◽

Recurrence Rates ◽

Stroke Type ◽

Mean Time ◽

Real Life Condition

The new clinical construct of embolic stroke of undetermined source (ESUS) suggests that many cryptogenic strokes are related to minor-risk covert embolic cardiac sources or to embolus from non-occlusive plaques in the aortic arch or in the cerebral arteries. The authors analyzed the prevalence of ESUS in a real-life condition in Italy and compared the recurrence rates in cryptogenic strokes, cardioembolic strokes, and ESUS. The authors retrospectively reassessed according to ESUS criteria 391 consecutive admissions in a stroke unit where extensive diagnostic search was routinely performed. Recurrences in each stroke type within a 3-year follow-up period (mean time: 25.44 months - standard deviation: 9.42) were also compared. The prevalence of ESUS in the aforementioned cohort was 10.5%. All ESUS patients received antiplatelet agents. Warfarin was prescribed in 56.9% of cardioembolic strokes. The recurrence rate in ESUS patients was 4.4% per year, slightly higher than in cardioembolic strokes (3.5%) and significantly higher than in cryptogenic non-ESUS (1.2%) (P<0.0001). This is the first description of a cohort of ESUS patients in an Italian stroke unit. Patients with ESUS have a significantly higher risk of recurrence than in those with non-ESUS cryptogenic strokes, and slightly higher than in those with cardioembolic strokes. Results support the hypothesis of a more extensive diagnostic evaluation in cryptogenic strokes and the feasibility of such approach.

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Adjuvant Radiotherapy in Grade II, Atypical Meningioma of the Skull Base

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0041-1735879 ◽

2021 ◽

Author(s):

David P. Bray ◽

Bryan E. Buster ◽

Joseph W. Quillin ◽

Robert H. Press ◽

Bree R. Eaton ◽

...

Keyword(s):

Skull Base ◽

Adjuvant Radiotherapy ◽

Recurrence Rates ◽

Time To Recurrence ◽

Grade Ii ◽

Atypical Meningiomas ◽

Mean Time ◽

Two Populations ◽

Initial Resection

Abstract Introduction Atypical meningiomas (AM) are meningiomas that are more aggressive than their grade-I counterparts and have a higher rate of recurrence. The effect of adjuvant radiotherapy (ART) on AM of the skull base is not defined. Methods A retrospective review of all AM's of the skull base primarily resected at our institution from 1996 to 2018 was completed. ART was defined as radiotherapy (RT) that occurred within 6 months of initial resection, regardless of Simpson's grade. Minimum time length of follow-up after resection was 2 years. Statistical analysis was performed using SAS. Results There were a total of 59 skull base–located (SBL) AMs resected at our institution from 1996 to 2018. The average age of our cohort was 53.2 years. Gross total resection, defined as Simpson's grades I to III resection, was achieved in 36 (61%) of cases. Thirty-five of 59 (59%) patients received ART. Recurrence was observed in 14 patients (24%), and mean time to recurrence was 63.8 months. Patients who received ART had a lower observed rate of recurrence (8 vs. 46%); however, time to recurrence was not significantly different between the two populations. Conclusion We observe that AM in the skull base location have higher recurrence rates than we would expect from grade-I meningioma. These data suggest that ART may offer benefit to the overall observed frequency of recurrence of SBL AM; however, the time to recurrence between patients who received ART and those who did not was not statistically significant in survival analysis.

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Real-life experience with 4 years of golimumab persistence in ulcerative colitis patients

Scientific Reports ◽

10.1038/s41598-020-73577-0 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Marisa Iborra ◽

Natalia García-Morales ◽

Saoia Rubio ◽

Federico Bertoletti ◽

Marta Calvo ◽

...

Keyword(s):

Ulcerative Colitis ◽

Disease Duration ◽

Life Experience ◽

Real Life ◽

Efficacy And Safety ◽

Dose Intensification ◽

Factors Associated ◽

Mean Time

Abstract Golimumab has demonstrated its long-term efficacy and safety in ulcerative colitis in clinical trials, but no data of long-term persistence has been published from real world. To estimate long-term persistence of golimumab, as well as factors associated with longer persistence, in patients with ulcerative colitis in real life. Observational multicentre study including adult patients with ulcerative colitis treated with golimumab and with at least twelve months of follow-up. We included 190 patients, 105 (55.26%) naive to anti-TNF, with mean disease duration of 9.32 ± 8.09 years. Probability of persistence was 63%, 46%, 39% and 27% at 1, 2, 3 and 4 years, respectively. Persistence was lower in patients with primary failure to previous anti-TNF. Eighty-two (43.16%) patients needed dose intensification during follow-up, with a mean time until intensification of 8.03 ± 8.64 months. Dose intensification and lower disease duration predicted higher persistence with golimumab (p = 0.037 and p = 0.008, respectively). During a follow-up of 17.25 ± 15.83 months, 32 (16.5%) patients needed hospitalisation and 11 (6%) underwent colectomy. No unexpected adverse events were reported. Golimumab has demonstrated good persistence and safety profile for long treatment in ulcerative colitis patients.

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P4139Prediction of atrial fibrillation in embolic stroke of unknown source

European Heart Journal ◽

10.1093/eurheartj/ehz745.0711 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

F T Range ◽

D P Peters ◽

T Zeus ◽

S Jander ◽

P Mueller ◽

...

Keyword(s):

Atrial Fibrillation ◽

Real Life ◽

Patient Characteristics ◽

Embolic Stroke ◽

Baseline Heart Rate ◽

Loop Recorder ◽

Chads2 Score ◽

Unknown Source ◽

Significant Difference

Abstract Background Atrial fibrillation (AF) is one of the leading cardiogenic causes for embolic stroke of unknown source (ESUS). Its incidence is growing with patients' age. Detection and rule out of AF is complex and cumbersome. The best method is an implantable loop recorder (ILR). In patients elder than 60 years, incidence of AF is reported incongruently and reliable patient characteristics that can predict a low or high risk for AF are scarce. Purpose This study reports real life incidences of AF in a group of patients undergoing ILR after ESUS. It aims to depict age dependency of AF and to identify potential confounding factors. Methods In a single center study, we analysed 111 patients (age=62±13 years, nmale=65) who received an ILR in our centre following ESUS. Patient characteristics, brain imaging, hemodynamic monitoring, blood pressure, electrocardiography, holter ecg and echocardiography data from the initial hospital stay and ILR follow-up over a mean of 460 days were analysed. Primary endpoint was the recording of AF during follow-up. Results AF was detected in 23% of all patients. Patients with AF were significantly elder than those without AF (p=0.01). Incidence of AF was in Patients <60y: 14%, 60–69y: 13%, 70–79y: 45%, >80y: 67%. We observed a significant difference in AF incidence comparing patients younger and elder than 70 years (p=0.034). Both, CHADS-Vasc (p=0.036) and HATCH-scores (p=0.018) were higher in the AF group while the simple CHADS2 Score missed significance (p=0.068). PQ duration was longer in AF patients (p=0.022) and baseline heart rate at admission was lower (p=0.027). NIHSS scores were lower in the AF group at admission (2.97 vs. 4.10; p=0.049) but due to less neurological improvement in the AF group, this difference faded until dismission (1.09 vs 1.79 p=ns). Conclusions In our real life ILR group following ESUS, strongest predictor of AF was age. Pivot point rather was at 70 than at 60 years of age.

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Clinical course of IPF in Italian patients during 12 months of observation: results from the FIBRONET observational study

Respiratory Research ◽

10.1186/s12931-021-01643-w ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

V. Poletti ◽

◽

C. Vancheri ◽

C. Albera ◽

S. Harari ◽

...

Keyword(s):

Lung Function ◽

Observational Study ◽

Clinical Course ◽

Real Life ◽

Primary Objective ◽

Course Of Disease ◽

Antifibrotic Therapy ◽

Short Time ◽

Mean Time

Abstract Background FIBRONET was an observational, multicentre, prospective cohort study investigating the baseline characteristics, clinical course of disease and use of antifibrotic treatment in Italian patients with idiopathic pulmonary fibrosis (IPF). Methods Patients aged ≥ 40 years diagnosed with IPF within the previous 3 months at 20 Italian centres were consecutively enrolled and followed up for 12 months, with evaluations at 3, 6, 9 and 12 months. The primary objective was to describe the clinical course of IPF over 12 months of follow-up, including changes in lung function measured by % predicted forced vital capacity (FVC% predicted). Results 209 patients (82.3% male, mean age 69.54 ± 7.43 years) were enrolled. Mean FVC% predicted was relatively preserved at baseline (80.01%). The mean time between IPF diagnosis and initiation of antifibrotic therapy was 6.38 weeks; 72.3% of patients received antifibrotic therapy within the first 3 months of follow-up, and 83.9% within 12 months of follow-up. Mean FVC% predicted was 80.0% at baseline and 82.2% at 12 months, and 47.4% of patients remained stable (i.e. had no disease progression) in terms of FVC% predicted during the study. Conclusions FIBRONET is the first prospective, real-life, observational study of patients with IPF in Italy. The short time between diagnosis and initiation of antifibrotic therapy, and the stable lung function between baseline and 12 months, suggest that early diagnosis and prompt initiation of antifibrotic therapy may preserve lung function in patients with IPF. Trial registration: NCT02803580

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Italian real-life experience on the use of ocriplasmin

BMJ Open Ophthalmology ◽

10.1136/bmjophth-2017-000110 ◽

2018 ◽

Vol 3 (1) ◽

pp. e000110 ◽

Cited By ~ 4

Author(s):

Francesco Barca ◽

Dario Pasquale Mucciolo ◽

Tomaso Caporossi ◽

Gianni Virgili ◽

Ruggero Tartaro ◽

...

Keyword(s):

Adverse Events ◽

Macular Hole ◽

Life Experience ◽

Real Life ◽

Full Thickness Macular Hole ◽

Potential Alternative ◽

Mean Time ◽

Selection Of Patients ◽

Selection Of

ObjectiveTo evaluate the success of an intravitreal injection of ocriplasmin to release symptomatic vitreomacular traction (VMT) and close a full-thickness macular hole.Methods and analysisAn observational retrospective multicentre study conducted in Italy. Patients with symptomatic distortion and loss of vision secondary to VMT were included in the study. The patients received a single injection of ocriplasmin and were followed up for 1, 3 and 6 months. Best-corrected visual acuity (BCVA) and spectral domani OCT (SD-OCT) were performed for patient assessment, and adverse events were recorded and analysed.Results74 patients (74 eyes) were included in the study. 44 of 74 eyes (59.5%) experienced complete release of the VMT. Macular hole closure was obtained in eight eyes (40%). BCVA improved about three lines after 3 months of follow-up in the patients with VMT resolution in comparison with the patients who did not have VMT resolution (p<0.0001). In 55/74 eyes of 55 patients (74.3%), no adverse events were reported, and most of them were transitory (17/19; 89.5%). The mean time to resolve VMT was 27.4±21.9 days. No cases of retinal tear, retinal detachment or lens destabilisation were observed.ConclusionOcriplasmin is a potential alternative treatment for patients with symptomatic VMT and has a good safety profile. A more careful selection of patients, in clinical practice, may increase the success rate.

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AB0318 CHARACTERISTICS OF PATIENTS WITH RHEUMATOID ARTHRITIS WHO HAVE WITHDRAWN THE LAST BIOLOGICAL DRUG: REAL-LIFE RESULTS FROM A LOCAL REGISTRY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.4824 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1458.1-1458

Author(s):

J. Rosas ◽

A. Pons ◽

J. M. Senabre Gallego ◽

G. Santos Soler ◽

J. A. Bernal ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Real Life ◽

Cross Sectional Study ◽

Cross Sectional ◽

Biological Drug ◽

Time In Treatment ◽

General Data ◽

Group 3 ◽

Mean Time

Objectives:To assess the characteristics of patients with rheumatoid arthritis (RA), who have withdrawn the last biological drug (bDMARD), and to know the reasons for withdrawal of treatment.Methods:Retrospective and cross-sectional study on December 31, 2019, of patients with RA, treated with any of the bDMARDs, including JAK (JAKi) inhibitor drugs, commonly used, from 1/1/2000 to 12/31/2019. General data were collected from patients, and RA: time of evolution, presence of rheumatoid factor (RF) and anti-citrullinated peptide antibodies (ACPA), type of bDMARD, time in bDMARD, and cause of withdrawal.Results:Of 252 patients, who have received some bDMARD, 81 (32%) patients had withdrawn on 12/31/2019. 62 (77%) patients were women, with a mean age at diagnosis of RA of 48 years (SD: 16.5 years) and 59.5 (15) years at the beginning of the first bDMARD (F1), with an average evolution of RA 10.2 (2.5) years. 68% and 74% of patients were positive for RF and ACPA, respectively.In 64 (79%) patients, bDMARD was withdrawn as second to fifth bDMARD received (F2 to F5): as F2: 37/81 (46%) patients, F3: 14 (18%), F4: 8 (10%) and as F5: (6%) patients.When comparing the last bDMARD received, before the suspension as F1 vs F2-F5, 95% vs. 61% of patients (p <0.0001), the drug was an anti-TNF (TNFi); Abatacept: 1 (1%) vs 9 (14%); Tocilizumab: 0% vs 8 (12%); Rituximab: 1 (1%) vs 5 (8%) and JAKi: 4 (5%) vs 3 (5%). The mean time in treatment with some bDMARD was 2.6 (SD: 3) years in the F1 group vs 1.7 (2) years in the F2-F5 group (p = 0.034). Among the F3-F5 patients, 9 (14%) patients had failed at 2 different previous therapeutic targets and 6 (9%) at 3 targets.No differences were detected between the F1 group vs F2-F5, regarding the causes of withdrawal of bDMARD: whether it had occurred due to 1) loss of efficacy (25/31% patients vs 19/30%); 2) adverse events (31/38% vs. 29/45%): infection: 18/81 (22%) patients, malignancy: 5 (6%), malaise/pain: 11 (14%), laboratory parameters alteration: 7 (9%), death: 5 (6%), others: 14 (17%); 3) change of address/loss of follow-up (20/25% vs. 7/11%) or by 4) voluntary abandonment of treatment by the patient (5/6% vs. 9/14%).Conclusion:1. 32% of patients with RA withdraw the bDMARD. 2. The group treated with TNFi withdraws it significantly higher among the F1 group. 3. Survival of bDMARD is significantly higher in group F1 compared to F2-F5. 4. No differences were detected between the groups regarding the cause of withdrawal of bDMARD. 25% -30% of patients withdraw it due to loss of follow-up or voluntary abandonment of bDMARD.Acknowledgments:The study was supported by a research grant from the Association for Research in Rheumatology of the Marina Baixa (AIRE-MB).Disclosure of Interests:None declared

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Long-term remission and recurrence rates after first and second transsphenoidal surgery for Cushing's disease: care reality in the Munich Metropolitan Region

Acta Endocrinologica ◽

10.1530/eje-13-0634 ◽

2014 ◽

Vol 170 (2) ◽

pp. 283-292 ◽

Cited By ~ 57

Author(s):

C Dimopoulou ◽

J Schopohl ◽

W Rachinger ◽

M Buchfelder ◽

J Honegger ◽

...

Keyword(s):

Transsphenoidal Surgery ◽

Disease Recurrence ◽

Metropolitan Region ◽

Recurrence Rates ◽

Time To Recurrence ◽

Remission Status ◽

Mean Time ◽

Disease Persistence

ObjectiveTranssphenoidal surgery (TSS) presents the treatment of choice for Cushing's disease (CD). Remission and recurrence rates vary dependent on tumor size, extension, adenoma visibility on magnetic resonance imaging, and neurosurgical expertise. Other than published from single-surgeon neurosurgical series so far, we have aimed to describe long-term remission and recurrence rates of CD in a series incorporating different neurosurgeons, trying to reflect care reality in the Munich Metropolitan Region, which is accommodated by three tertiary university and multiple, smaller neurosurgical centers.DesignWe conducted a retrospective analysis of 120 patients who underwent first and 36 patients who underwent second TSS as treatment for CD between 1990 and 2012.MethodsPatients were divided into three groups according to remission status. Potential risk factors for recurrence, pituitary function, and strategy in persistent disease were assessed.ResultsThree outcome groups were identified according to remission status after first TSS (mean follow-up 79 months): remission, 71% (85/120), disease persistence, 29% (35/120), and disease recurrence, 34% (29/85) (mean time to recurrence 54 months). After second TSS (n=36, mean follow-up 62 months), we documented remission in 42% (15/36), disease persistence in 58% (21/36), and disease recurrence in 40% (6/15) (mean time to recurrence 42 months). Postoperative hypocortisolism after first, though not after second, TSS was associated with a lower risk of suffering disease recurrence (risk=0.72; 95% CI 0.60–0.88; exact significance (two-sided) P=0.035).ConclusionsOur study shows higher recurrence rates of CD after first TSS than previously reported. Second TSS leads an additional 8% of the patients to long-term CD remission.

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Recurrence following Varicose Vein Surgery

Phlebology The Journal of Venous Disease ◽

10.1177/026835550201600304 ◽

2002 ◽

Vol 16 (3) ◽

pp. 101-105 ◽

Cited By ~ 1

Author(s):

D. D. I. Wright ◽

K. G. Rose ◽

E. Young ◽

C. N. McCollum

Keyword(s):

Varicose Vein ◽

Continuous Wave ◽

Varicose Veins ◽

Postal Questionnaire ◽

Consecutive Series ◽

Varicose Vein Surgery ◽

Recurrence Rates ◽

Primary Surgery ◽

Mean Time

Objective: To determine the site-specific rates of recurrence following varicose vein surgery. Design: Postal questionnaire followed up by telephone enquiries. Full clinical review, including continuous wave and duplex Doppler investigations were carried out for all patients with responses suggesting recurrence. Setting: Surgicare Manchester, an independent provider of specialist varicose vein treatments. All procedures were guided by Doppler ultrasound and performed by surgeons working to the same protocol. Subjects: A consecutive series of 250 operations on 246 Patients. Of these, 208 (85%) could be contacted for follow-up. Mean time to re-examination was 27 months. Results: Twelve patients returned spontaneously and 51 were recalled for examination based on questionnaire responses. Recurrences were divided into ‘site’, ‘perforator’ or ‘new site’ recurrence. Primary surgery to the sapheno-femoral junction (SFJ) had the lowest ‘site’ recurrence rate of 2.3% compared with 9.5% for SFJ re-operation. Primary surgery and re-operation of the sapheno-popliteal junction (SPJ) had higher recurrence rates of 8.3% and 7.8% respectively. New incompetence was detected in 5% and 2% of previously competent SFJ and SPJ respectively. Minor perforator incompetence was found in a further 14%. Conclusions: Varicose veins were progressive in some individuals, with new sites of incompetence appearing over time. However, ‘cure’ remains possible for most Patients and major recurrence can be reduced by Doppler diagnosis and precise surgery.

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