Factors Predicting the Outcomes of Incomplete Triple Pelvic Osteotomy

2017 ◽  
Vol 27 (6) ◽  
pp. 608-614 ◽  
Author(s):  
Engin Eceviz ◽  
Esat Uygur ◽  
Mehmet S. Söylemez ◽  
Abdullah Eren
Keyword(s):  
Clinical Outcomes ◽  
Acetabular Dysplasia ◽  
Pelvic Osteotomy ◽  
Crossover Sign ◽  
Patient Age ◽  
Edge Angle ◽  
Centre Edge Angle ◽  
Patient Âgé ◽  
Osteoarthritis Progression

Introduction In the present study, we identified factors affecting the outcomes of patients who underwent incomplete triple pelvic osteotomies due to acetabular dysplasia. Methods Data on a total of 58 hips in 50 patients for whom adequate data were available and who had undergone appropriate follow-up were retrospectively evaluated. We used Ömeroğlu scores for radiological evaluation, Harris Hip Scores for clinical evaluation, Tönnis scores to evaluate osteoarthritis progression and a modified Clavien-Dindo classification to evaluate complications. Results The average patient age was 23.26 (14-47) years, and the average follow-up duration 105.59 (18-191) months. The complication rate was 10.3%, and complications negatively influenced clinical outcomes. Patients with radiologically poorer outcomes had more advanced osteoarthritis. We found minimal improvements in lateral centre edge angle (LCEA), refined centre-edge angle (RCEA), and lateral acetabulum head index (LAHI) were associated with osteoarthritis progression and that good improvements in LCEA, RCEA, acetabular angle (AA), and LAHI were associated with radiological outcomes. Neither patient age at the time of operation nor development of a postoperative relative crossover sign affected osteoarthritis progression or clinical or radiological outcomes. Conclusions The most important factors influencing clinical outcomes were complications. However, neither postoperative acetabular retroversion nor a positive supra-equatorial crossover sign (often viewed as prognostically negative) directly affected clinical outcomes. When treating patients with acetabular dysplasia, either inadequate correction or overcorrection may negatively affect outcomes. In such patients, an incomplete triple pelvic osteotomy (allowing controlled correction) is both safe and effective.

Transpositional Periacetabular Osteotomy with Allografting in Patients with Severe Dysplasia: Mid-Term Results

2016 ◽  
Vol 27 (1) ◽  
pp. 35-41 ◽  
Author(s):  
Motoki Sonohata ◽  
Yutaka Yonekura ◽  
Masaru Kitajima ◽  
Syunsuke Kawano ◽  
Masaaki Mawatari
Keyword(s):  
Acetabular Dysplasia ◽  
Periacetabular Osteotomy ◽  
Clinical Results ◽  
Harris Hip Score ◽  
Acetabular Roof ◽  
Allogenic Bone ◽  
Edge Angle ◽  
Centre Edge Angle ◽  
Acetabular Head Index

Aim The purpose of this study was to analyse the extent of surgical correction and the early clinical results obtained using periacetabular osteotomy with allogenic bone grafting in patients with severe acetabular dysplasia. Methods 44 hips in 38 patients were confirmed to have severe acetabular dysplasia and underwent this procedure. The mean follow-up period was 4.2 (range 1.5-8.2) years. Severe acetabular dysplasia was defined as a centre-edge angle less than 0°, an acetabular-head index less than 50% and an acetabular roof obliquity greater than 30°. Periacetabular osteotomy was performed with transpositional osteotomy of the acetabulum. The patients were divided into 2 groups according to the radiographic appearance: 34 hips in the early stage group and 10 hips in the advanced stage group. Postoperatively, the hips were radiographically assessed for dysplasia correction. The clinical results and hip function were measured using the Harris Hip Score. Results The average pre-operative Harris Hip Score improved from 70 to 91 points at the latest follow-up. The average centre-edge angle, acetabular-head index and acetabular roof obliquity improved from −9° to 36°, 41% to 91% and 31° to 2°, respectively. Continuity of the Shenton line improved from 15 to 35 hips. No instances of nonunion or of transported segment collapse were encountered in this series; however, a grafted allogenic bone was absorbed in 1 case. Conclusions The usage of allogenic bone grafting combined with periacetabular osteotomy is an effective technique for treating severe acetabular dysplasia. In this series, the early clinical and radiographic results were excellent.

Risk of hemorrhage from de novo cerebral aneurysms

2013 ◽  
Vol 118 (1) ◽  
pp. 58-62 ◽  
Author(s):  
William J. Kemp ◽  
Daniel H. Fulkerson ◽  
Troy D. Payner ◽  
Thomas J. Leipzig ◽  
Terry G. Horner ◽  
...  
Keyword(s):  
Risk Factors ◽  
De Novo ◽  
Patient Age ◽  
Patient Âgé ◽  
Long Term Follow Up ◽  
De Novo Aneurysm ◽  
The Mean ◽  
Risk Of Hemorrhage

Object A small percentage of patients will develop a completely new or de novo aneurysm after discovery of an initial aneurysm. The natural history of these lesions is unknown. The authors undertook this statistical evaluation a large cohort of patients with both ruptured and unruptured de novo aneurysms with the aim of analyzing risk factors for rupture and estimating a risk of subarachnoid hemorrhage (SAH). Methods A review of a prospectively maintained database of all aneurysm patients treated by the vascular neurosurgery service of Goodman Campbell Brain and Spine from 1976–2010 was performed. Of the 4718 patients, 611 (13%) had long-term follow-up imaging. The authors identified 27 patients (4.4%) with a total of 32 unruptured de novo aneurysms from routine surveillance imaging. They identified another 10 patients who presented with a new SAH from a de novo aneurysm after treatment of their original aneurysm. The total study group was thus 37 patients with a total of 42 de novo aneurysms. The authors then compared the 27 patients with incidentally discovered aneurysms with the 10 patients with SAH. A statistical analysis was performed, comparing the 2 groups with respect to patient and aneurysm characteristics and risk factors. Results Thirty-seven patients were identified as having true de novo aneurysms. This group had a female predominance and a high percentage of smokers. These 37 patients had a total of 42 de novo aneurysms. Ten of these 42 aneurysms hemorrhaged. De novo aneurysms in both the SAH and non-SAH group were anatomically small (< 10 mm). The estimated risk of hemorrhage over 5 years was 14.5%, higher than the expected SAH risk of small, unruptured aneurysms reported in the ISUIA (International Study of Unruptured Intracranial Aneurysms) trial. There was no statistically significant correlation between hemorrhage and any of the following risk factors: hypertension, diabetes, tobacco and alcohol use, polycystic kidney disease, or previous SAH. There was a statistically significant between-groups difference with respect to patient age, with the mean patient age being significantly older in the SAH aneurysm group than in the non-SAH group (p = 0.047). This is likely reflective of longer follow-up and discovery time, as the mean length of time between initial treatment and discovery of the de novo aneurysm was longer in the SAH group (p = 0.011). Conclusions While rare, de novo aneurysms may have a risk for SAH that is comparatively higher than the risk associated with similarly sized, small, initially discovered unruptured saccular aneurysms. The authors therefore recommend long-term follow-up for all patients with aneurysms, and they consider a more aggressive treatment strategy for de novo aneurysms than for incidentally discovered initial aneurysms.

Abstract 47: Using Ultrasound and Inflammation to Improve Prediction of Ischemic Stroke: A Secondary Analysis of MESA

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Adam H de Havenon ◽  
Ka-Ho Wong ◽  
J Scott McNally ◽  
Jennifer Majersik
Keyword(s):  
Ischemic Stroke ◽  
Total Cholesterol ◽  
Primary Outcome ◽  
Epidemiologic Study ◽  
Secondary Analysis ◽  
Serum Marker ◽  
Patient Age ◽  
Cox Models ◽  
Patient Âgé

Background: The Multi-Ethnic Study of Atherosclerosis (MESA) is a large prospective epidemiologic study of the clinical factors that can predict transition from asymptomatic to symptomatic cardiovascular disease. Although prior studies have looked at ischemic stroke, they have not systematically examined the relationship between baseline ultrasound and inflammation measurements and subsequent primary stroke risk. Methods: The primary outcome is incident ischemic stroke during follow-up. The predictors are 9 ultrasound-derived measurements and 5 serum measurements related to inflammation. We fit Cox models to ischemic stroke and adjusted for patient age, hypertension, diabetes, total cholesterol, and smoking. Using DeLong’s method, we compared the AUC of the baseline adjusted model to the AUC of the model with predictor variables that were significant in the Cox models, to determine if they improved stroke prediction. Results: We included 6,095 patients with an average age of 61.9 years. The primary outcome of ischemic stroke was seen in 107 patients (1.8%) and the mean follow-up time was 7.7 years. In the Cox models, we found that small artery elasticity (SAE), carotid distensibility (CD), carotid stenosis (CS), and interleukin-6 (IL6) were associated with incident stroke. The AUC of the baseline model to predict stroke, which included patient age, hypertension, diabetes, total cholesterol, and smoking, was 0.745. When we added tertiles of SAE, CD, IL6 and categories of CS, the AUC improved to 0.765 (p=0.021 for difference). Conclusions: In a multiethnic cohort of patients without CVD at baseline, we found several ultrasound measurements and a serum marker of inflammation which predicted the occurrence of a primary ischemic stroke. Adding these basic ultrasound and serum measurements significantly improved the prediction of stroke, which could have implications for primary prevention efforts.

Abstract 126: Comparison of Flow Diversion and Coiling in Large Unruptured Intracranial Saccular Aneurysms

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Nohra Chalouhi ◽  
Stavropoula Tjoumakaris ◽  
Robert M Starke ◽  
L Fernando Gonzalez ◽  
Ciro Randazzo ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Multivariable Analysis ◽  
Flow Diversion ◽  
Similar Proportion ◽  
Anterior Communicating Artery ◽  
Patient Age ◽  
Aneurysm Size ◽  
Patient Âgé ◽  
Complete Obliteration ◽  
Saccular Aneurysms

Background and purpose: Flow diversion has emerged as an important tool for management of intracranial aneurysms. The purpose of this study was to compare flow diversion and traditional embolization strategies in terms of safety, efficacy, and clinical outcomes in patients with unruptured, large saccular aneurysms (≥ 10 mm). Methods: Forty patients treated with the Pipeline Embolization Device (PED) were matched in a 1:3 fashion with 120 patients treated with coiling based on patient age and aneurysm size. Fusiform and anterior communicating artery aneurysms were eliminated from the analysis. Procedural complications, angiographic results, and clinical outcomes were analyzed and compared. Results: There were no differences between the 2 groups in terms of patient age, gender, aneurysm size, and aneurysm location. The rate of procedure-related complications did not differ between the PED (7.5%) and the coil group (7.5% p=1). At the latest follow-up, a significantly higher proportion of aneurysms treated with PED (86%) achieved complete obliteration compared to coiled aneurysms (41%, p<0.001). In multivariable analysis, coiling was an independent predictor of nonocclusion. Retreatment was necessary in fewer patients in the PED group (2.8%) than the coil group (37%, p<0.001). A similar proportion of patients attained a favorable outcome (mRS 0-2) in the PED group (92%) and the coil group (94%, p=0.8). Conclusion: The PED provides higher aneurysm occlusion rates than coiling, with no additional morbidity and similar clinical outcomes. These findings suggest that the PED is a preferred treatment option for large unruptured saccular aneurysms.

scholarly journals Impact of mass effect, tumor location, age, and surgery on the cognitive outcome of patients with high-grade gliomas: a longitudinal study

2017 ◽  
Vol 4 (4) ◽  
pp. 229-240 ◽  
Author(s):  
Monica Dallabona ◽  
Silvio Sarubbo ◽  
Stefano Merler ◽  
Francesco Corsini ◽  
Giuseppe Pulcrano ◽  
...  
Keyword(s):  
Tumor Volume ◽  
High Grade Glioma ◽  
Joint Effect ◽  
Cognitive Outcome ◽  
Tumor Localization ◽  
High Grade ◽  
Patient Age ◽  
Patient Âgé ◽  
High Grade Gliomas

Abstract Background High-grade gliomas are the most frequently occurring brain tumors and carry unfavorable prognosis. Literature is controversial regarding the effects of surgery on cognitive functions. Methods We analyzed a homogenous population of 30 patients with high-grade glioma who underwent complete resection. Patients underwent extensive neuropsychological analysis before surgery, 7 days after surgery, and approximately 40 days after surgery, before adjuvant treatments. Thirty-four neuropsychological tests were administered in the language, memory, attention, executive functions, and praxis domains. Results The preoperative percentage of patients with impairment in the considered tests ranged from 0% to 53.3% (mean 20.9%). Despite a general worsening at early follow-up, a significant recovery was observed at late follow-up. Preoperative performances in language and verbal memory tasks depended on the joint effect of tumor volume, volume of surrounding edema, and tumor localization, with major deficits in patients with left lateralized tumor, especially insular and temporal. Preoperative performances in attention and constructive abilities tasks depended on the joint effect of tumor volume, volume of surrounding edema, and patient age, with major deficits in patients ≥ 65 years old. Recovery at late follow-up depended on the volume of resected tumor, edema resorption, and patient age. Conclusions Longitudinal neuropsychological performance of patients affected by high-grade glioma depends, among other factors, on the complex interplay of tumor volume, volume of surrounding edema, tumor localization, and patient age. Reported results support the definition of criteria for surgical indication based on the above factors. They may be used to propose more customized surgical, oncological, and rehabilitative strategies.

scholarly journals Atrial High-Rate Event Incidence and Predictors in Patients With Permanent Pacemaker Implantation

2021 ◽  
Vol 8 ◽  
Author(s):  
Jian Hua Chen ◽  
Guo Yao Chen ◽  
Hong Zheng ◽  
Quan He Chen ◽  
Fa Yuan Fu ◽  
...  
Keyword(s):  
Cox Regression ◽  
Previous History ◽  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
High Rate ◽  
Atrial Pacing ◽  
Patient Age ◽  
Cox Regression Analysis ◽  
Patient Âgé

Objective: The present study aims to investigate the incidence and predictors of atrial high-rate events (AHREs) in patients with permanent pacemaker implants.Methods: A total of 289 patients who were implanted with a dual-chamber pacemaker due to complete atrioventricular block or symptomatic sick sinus syndrome (SSS) and had no previous history of atrial fibrillation were included in the present study. AHREs are defined as events with an atrial frequency of ≥175 bpm and a duration of ≥5 min. The patients were divided into two groups according to whether or not AHREs were detected during the follow-up: group A (AHRE+, n = 91) and group N (AHRE–, n = 198).Results: During the 12-month follow-up period, AHREs were detected in 91 patients (31.5%). The multivariate Cox regression analysis revealed that patient age [odds ratio [OR] = 1.041; 95% confidence interval [CI], 1.018–1.064; and P &lt; 0.001], pacemaker implantation due to symptomatic SSS (OR = 2.225; 95% CI, 1.227–4.036; and P = 0.008), and the percentage of atrial pacing after pacemaker implantation (OR = 1.010; 95% CI, 1.002–1.017; and P = 0.016) were independent AHRE predictors.Conclusion: The AHRE detection rate in patients with pacemaker implants was 31.5%. Patient age, pacemaker implantation due to symptomatic SSS, and the percentage of atrial pacing after pacemaker implantation were independent AHRE predictors.

The Use oF Flexible Cystoscope in Posterior Urethroplasty

2009 ◽  
Vol 76 (2) ◽  
pp. 144-149
Author(s):  
E. Palminteri ◽  
E. Berdondini ◽  
S. Maruccia ◽  
M. Poluzzi ◽  
D. Vecchio ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Pelvic Trauma ◽  
Patient Age ◽  
Membranous Urethra ◽  
Urethral Strictures ◽  
Patient Âgé ◽  
Flexible Cystoscope ◽  
Age At Surgery

We present our experience with a simplified anastomotic posterior urethroplasty to highlight the necessity and usefulness of ancillary reconstructive maneuvers. We reviewed the records of 46 patients who had undergone anastomotic repair of posterior urethral strictures due to pelvic trauma between 2000 and 2007. Mean patient age at surgery was 43 years. Average stricture length was 2.3 cm. Repair was performed with a progressive perineal anastomotic procedure using flexible cystoscope by means of transcystostomic approach: after mobilization of the bulbo-membranous urethra and the corporal splitting, the prostatic apex is well visualized and the membranous urethra is sectioned proximally; the flexible cystoscope by means of transcystostomic approach facilitates to find the proximal urethral lumen and to perform the bulbo-prostatic anastomosis. Mean follow-up was 32 months. Of 46 cases, 40 (87 %) were successful and 6 (13 %) failed with recurrence of the stricture. Urinary incontinence did not develop in any patients. The operative details and maneuvers facilitate the preparation of the bulbo-membranous urethral tract and prostatic apex, and simplify the performance of the anastomotic repair.

Comparison Between Immediate and Delayed Laser-Treated Implants Surface With Switching Platform: A Clinical Retrospective Study

2013 ◽  
Vol 39 (3) ◽  
pp. 333-338 ◽  
Author(s):  
Eduardo José de Moraes ◽  
Francesco Rao Genovese
Keyword(s):  
Retrospective Study ◽  
Bone Graft ◽  
Survival Rates ◽  
Laser Surface ◽  
Patient Age ◽  
Patient Âgé ◽  
And Performance ◽  
Implant Length ◽  
Mature Bone

The aim of the present study was to compare immediate (Im) versus delayed (De) placement of laser-treated implants surface with switching platform to confirm the predictability and performance of this type of implant. The implants were placed in pos exodontia and healed sites at the incisor, canine, premolar, and molar regions of the maxilla or the mandible. A protocol was prepared in which patient age, sex, implant length, diameter, and use of bone graft were recorded. The study included 44 GEASS Srl (Udine, Italy) implants with laser surface and morse taper connection, placed in 27 patients (mean age: 56 years; range: 25–80 years).The survival rates were 100% in the Im group and in the De group. The patients were followed for a minimum of 12 months. Implants with laser surface and morse connection presented when placed in fresh sockets showed similar results to implants placed in mature bone after 12 months of follow-up.

Retrospective Comparison of Using or Not Using Donor Lymphocyte Transfusion in the Treatment of Hematological Relapse after Allogeneic Stem Cell Transplantation in 489 Adults with Acute Myeloid Leukemia.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 298-298
Author(s):  
Christoph Schmid ◽  
Myriam Labopin ◽  
Juergen Finke ◽  
Gerhard Ehninger ◽  
Olle Ringden ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
De Novo ◽  
Patient Age ◽  
Entire Cohort ◽  
Post Transplant ◽  
Patient Âgé ◽  
Retrospective Comparison ◽  
De Novo Aml

Abstract Relapsed AML after allogeneic SCT has a poor prognosis. So far, no standard therapy could be defined. Donor lymphocyte transfusion (DLT) has been effective in a minority, however, no data is available to identify patients who will benefit from the procedure. Neither, the outcome of patients treated with or without DLT have been compared. We retrospectively evaluated overall survival (OS) of 489 adults with de novo AML in hematological relapse after SCT, receiving DLT (n=190) or not (n=299). DLT and noDLTgroups were well balanced in terms of patient age (median:37y in both groups), donor age, cytogenetics (good:5vs7%, intermediate:83vs79%, poor:12%vs14%), WBC at diagnosis, donor type (geno-id:71vs72%, MUD:18% both, mismatched:11vs10%), status at transplantation (CR1:38vs41%, CR2:13vs15%, advanced:49vs44%), conditioning, source of stem cells, and time from transplant to relapse (5vs4.5 months). However, DLT patients had a median of 39% BM blasts, as compared to 54% for the noDLT group (p=0.03). Follow-up was 32 and 30 months. Within the DLT group, chemotherapy was additionally given in 130 cases. Nevertheless, only 33% of patients received DLT in CR or aplasia, 67% had measurable disease. AGvHD developed in 41% of patients following DLT. CR and PR were achieved in 31.1% and 4.8% of DLT patients. In a multivariate analysis, younger patient age (&lt;36 years) (HR=1.53,p=0.02) and a longer interval (&gt; 5 months) from transplant to relapse (HR=7.74,p=0.002) were associated with better OS after DLT. When comparing the outcome of patients receiving or not DLT, OS at 2 years was 10±1% for the entire cohort, 18±3% for DLT and 6±1% for noDLT (p&lt;.0001). In a multivariate analysis, use of DLT (HR=2.11,p&lt;0.0001); recipient’s age&lt;36 y (HR=1.69, p&lt;0.001); longer interval (&gt;5 months) from transplant to relapse (HR=2.40, p&lt;0.0001) and number of BM blasts (&lt;48%) at relapse (HR=1.56,p=0.002) were favorable for OS. In this retrospective analysis the results suggest that DLT may be of advantage in the treatment of AML relapse post transplant, at least in younger patients with a longer post transplant remission and relapsing with smaller amounts of blasts in BM. However, patients receiving DLT might represent a positive selection among all relapsed cases, since a considerable number from the noDLT cohort had died too early to proceed to DLT. An intetion-to-treat analysis and further prospective studies should investigate the role of DLT and other approaches, such as second reduced intensity SCT.

The Effect of Patient Age on Recovery Kinetics in 149 Adult Spinal Deformity Patients with Two-Year Follow-Up: A Novel Area under the Curve Analysis

2014 ◽  
Vol 14 (11) ◽  
pp. S57-S58 ◽  
Author(s):  
Christopher P. Ames ◽  
Justin K. Scheer ◽  
Gregory M. Mundis ◽  
Eric O. Klineberg ◽  
Robert A. Hart ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Area Under The Curve ◽  
Curve Analysis ◽  
Patient Age ◽  
Patient Âgé
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