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1.
Hieronymus D. Boogaarts Mariana P. Duarte Conde Edith Janssen Willemijn F. M. van Nuenen Joost de Vries Rogier Donders Gert P. Westert J. André Grotenhuis Ronald H. M. A. Bartels 《Acta neurochirurgica》2014,156(9):1663-1667
Background
Several studies have included different co-morbid conditions in prediction models for stroke patients. For subarachnoid haemorrhage (SAH), it is not known whether the Charlson Co-morbidity Index (CCI) is associated with outcome. We evaluated if this index was associated with outcome in patients with ruptured intracerebral aneurysms.Methods
The data of all consecutive aneurysmal SAH (aSAH) patients treated at the Radboudumc, Nijmegen, The Netherlands and entered in the database were retrospectively analysed. Clinical condition at admission was recorded using the WFNS (World Federation of Neurological Surgeons Grading System) grade was collected, as were the age and treatment modality. The burden of co-morbidity was retrospectively registered using the CCI. Outcome was dichotomised on the modified Rankin Scale (mRS; 0–2, favourable outcome; 3–6, unfavourable outcome). A binary logistic regression analysis was performed.Results
Between 6th May 2008 and 31st July 2013, 457 patients were admitted because of non-traumatic SAH (aSAH). Seventy-seven (16.8 %) patients had no aneurysm. Of the 380 patients with aSAH, information on co-morbid conditions was available for 371 patients. Thirty-six of those 371 had no treatment because of: bad clinical condition in 34 (9.2 %), a non-treatable dissecting aneurysm in 1 (0.3 %) and the explicit wishes of another. Co-morbidity was present in 113 (31.5 %) patients. Binary logistic regression analysis revealed no added value of using the CCI in predicting the outcome (p?=?0.91).Conclusions
This study reports that the CCI is not associated with the outcome classified on the mRS at 6 months in patients after aSAH. The CCI has no added value in case-mix correction. 相似文献2.
Bawarjan Schatlo Christian Fung Ali-Reza Fathi Martin Sailer Kerstin Winkler Roy Thomas Daniel Philippe Bijlenga Peter Ahlborn Martin Seule Daniel Zumofen Michael Reinert Christoph Woernle Martin Stienen Marc Levivier Gerhard Hildebrandt Luigi Mariani René Bernays Javier Fandino Andreas Raabe Emanuela Keller Karl Schaller 《Acta neurochirurgica》2012,154(12):2173-2178
Background
Aneurysmal subarachnoid haemorrhage (aSAH) is a haemorrhagic form of stroke and occurs in a younger population compared with ischaemic stroke or intracerebral haemorrhage. It accounts for a large proportion of productive life-years lost to stroke. Its surgical and medical treatment represents a multidisciplinary effort. Due to the complexity of the disease, the management remains difficult to standardise and quality of care is accordingly difficult to assess.Objective
To create a registry to assess management parameters of patients treated for aSAH in Switzerland.Methods
A cohort study was initiated with the aim to record characteristics of patients admitted with aSAH, starting January 1st 2009. Ethical committee approval was obtained or is pending from the institutional review boards of all centres. In the study period, seven Swiss hospitals (five university [U], two non-university medical centres) harbouring a neurosurgery department, an intensive care unit and an interventional neuroradiology team so far agreed to participate in the registry (Aarau, Basel [U], Bern [U], Geneva [U], Lausanne [U], St. Gallen, Zürich [U]). Demographic and clinical parameters are entered into a common database.Discussion
This database will soon provide (1) a nationwide assessment of the current standard of care and (2) the outcomes for patients suffering from aSAH in Switzerland. Based on data from this registry, we can conduct cohort comparisons or design diagnostic or therapeutic studies on a national level. Moreover, a standardised registration system will allow healthcare providers to assess the quality of care. 相似文献3.
Weimin Zhu Daping Wang Yun Han Na Zhang Yanjun Zeng 《European journal of orthopaedic surgery & traumatology : orthopedie traumatologie》2013,23(8):939-943
Objective
To compare the effects of the three rehabilitation procedures following anterior cruciate ligament (ACL) autograft reconstruction with hamstring tendons.Design
An observational and retrospective case-controlled series.Setting
The Department of Sports Medicine, Shenzhen Second People Hospital, Shenzhen, PR China.Patients or participants
Forty-five patients who were made to undergo ACL reconstructions by using quadrupled semitendinosus and gracilis tendons were divided into three groups: accelerated rehabilitation procedures group, aggressive rehabilitation procedures group, and self-made rehabilitation procedures group.Main outcome measures
The knee range of motion, thigh perimeter, IKDC score, and bone tunnel diameter in 3D-CT films were evaluated 3 and 6 months and 1 year later.Results
The knee range of motion and thigh perimeter of group A were higher than those of group B and group C at 3, 6, and 12 months. IKDC scores of group C were better than those of groups A and B. The bone tunnel widening with group B was larger than that with groups A and C, and the differences were statistically significant (P < 0.05).Conclusion
Early rehabilitation is beneficial for restoration of knee function after ACL reconstruction. Moderate procedure is better than accelerated procedure. 相似文献4.
Martin N. Stienen Rahel Weisshaupt Javier Fandino Christian Fung Emanuela Keller Gerhard Hildebrandt Aline Studerus-Germann Rene Müri Klemens Gutbrod Stefan Bläsi Andreas U. Monsch Peter Brugger Christian Mondadori Martin Sailer Philippe Bijlenga Karl Schaller Bawarjan Schatlo 《Acta neurochirurgica》2013,155(11):2045-2051
Background
Neuropsychological deficits (NPD) are common in patients with aneurysmal subarachnoid haemorrhage (aSAH). NPD are one of the major limiting factors for patients with an otherwise acceptable prognosis for sustained quality of life. There are only a few studies reporting outcome after aSAH, which used a standardized neuropsychological test battery as a primary or secondary outcome measure. Aim of this study was to determine the current practice of reporting NPD following aSAH in clinical studies.Methods
A MEDLINE analysis was performed using the search term “subarachnoid haemorrhage outcome”. The latest 1,000 articles were screened. We recorded study design, number of patients, and the presence of neuropsychological outcome report. Additionally, the time of testing after aSAH, the neuropsychological tests administered, as well as the percentage of patients with NPD were analyzed.Results
A total of 324 publications between 2009 and 2012 were selected for further review. Of those, 21 studies (6.5%) reported neuropsychological outcome, in 2,001 of 346,666 patients (0.6%). The assessment of NPD differed broadly using both subjective and objective cognitive evaluation, and a large variety of tests were used.Conclusion
Neuropsychological outcome is underreported, and there is great variety in assessment in currently published clinical articles on aSAH. Prospective randomized trials treating aSAH may benefit from implementing more comprehensive and standardized neuropsychological outcome measures. This approach might identify otherwise unnoticed treatment effects in future interventional studies of aSAH patients. 相似文献5.
Suguru Ohira Kiyoshi Doi Hidetake Kawajiri Masahiro Dohi Tsunehisa Yamamoto Taiji Watanabe Kazunari Okawa Hitoshi Yaku 《General thoracic and cardiovascular surgery》2014,62(10):608-613
Objective
To evaluate the relationship between preoperative magnetic resonance imaging (MRI) findings and the occurrence of postoperative intracranial hemorrhage (ICH) in infective endocarditis (IE) patients.Methods
Between 2002 and 2012, 30 IE patients required surgical intervention. Four patients developed and 26 patients did not develop postoperative ICH. All patients underwent preoperative brain MRI. The presence of acute brain infarction was detected by diffusion-weighted imaging (DWI), and cerebral microbleeds were detected by T2*-weighted imaging.Results
Two ICH(+) patients died of stroke. Preoperative patient characteristics and operative results were not significantly different. Regarding MRI findings, the presence of cerebral microbleeds or acute brain infarction alone was not significantly different between the two groups (100 vs. 29.6 %, p = 0.07; 75.0 vs. 38.5 %, p = 0.37, respectively). The concurrent presence of cerebral microbleeds and acute brain infarction was significantly correlated with the development of major ICH (75 vs. 14.8 %, p = 0.04). In multiple logistic regression analyses, the concurrent presence of cerebral microbleeds and acute brain infarction on MRI was an independent predictor of major postoperative ICH (p = 0.03, odds ratio 16.5, 95 % confidence interval 1.35–201.3).Conclusion
The combination of T2*-weighted MRI and DWI may be useful to evaluate the risk of IE patients developing major postoperative cerebral bleeding. 相似文献6.
Jin-Ning Song Ming Zhang Dan-Dong Li Min Li Ji-Yang An Mao-Feng Cheng Xiao-Ye Guo 《Acta neurochirurgica》2014,156(5):941-949
Background
There are complex interactions between acetylcholine (ACh), the suppressor of cytokine signaling-3 (SOCS-3), and cytokines, however, little is known about their dynamic expression or their effects on cerebral vasospasm (CVS) after subarachnoid hemorrhage (SAH). Therefore, we aimed to describe and clarify the dynamic expression of SOCS-3 and cytokines after SAH, as well as the relationships between the levels of SOCS-3, cytokines, and ACh.Methods
The rat model of single cisterna magna injection was used to mimic acute SAH. The degree of CVS was indicated by lumen diameter and artery wall thickness under H&E staining. A semi-quantitative immunohistochemical analysis method was used to clarify the role of SOCS-3 in the CVS after SAH. We also measured the content of IL-6 and IL-10 in cerebrospinal fluid.Results
We found that SOCS-3 expression levels increased rapidly within 12 h after SAH, more slowly after 12 h, and did not reach a peak within 48 h. Interleukin 6 (IL-6) levels rapidly increased within 24 h after SAH, reached a peak 24 h after SAH, and decreased slightly at 48 h. IL-10 levels increased during the first 6 h after SAH, after which this increase tapered off. ACh treatment reduced IL-6 levels and resulted in elevated levels of SOCS-3, but had no effect on IL-10 expression. Furthermore, ACh treatment relieved basilar arterial vasospasm, whereas mecamylamine pretreatment counteracted the activity of ACh.Conclusions
Taken together, these data indicate that SOCS-3 was involved in vasospasm via an IL-6- and IL-10-related mechanism, and that CVS following SAH could be reversed by the intraventricular injection of ACh. 相似文献7.
Hampus Olof Erixon Angelika Sorteberg Wilhelm Sorteberg Per Kristian Eide 《Acta neurochirurgica》2014,156(11):2059-2069
Background
Hydrocephalus (HC) after aneurysmal subarachnoid hemorrhage (aSAH) is a common sequel. Proper selection of patients in need of permanent cerebrospinal fluid (CSF) diversion is, however, not straightforward. The aim of this study was to identify predictors of CSF shunt dependency following aSAH.Methods
We re-analyzed data acquired from aSAH patients previously enrolled in a prospective, controlled single-center clinical trial in which shunt dependency was not one of the end points. In the present study patients were allocated into two groups: those receiving a shunt (here denoted as shunt dependent) and those not receiving a shunt, based on a clinical decision process. Predictors of shunt dependency were identified by applying uni- and multivariable analysis. We tested a set of predefined possible risk factors based on the results of the clinical trial, including the impact of CSF drainage volume exceeding 1,500 ml during the 1st week after ictus.Results
Ninety patients were included in the study. Significant predictors of shunt dependency were poor clinical grade at admission [odds ratio (OR) 4.7, 95 % confidence interval (CI) 1.2–18.4], large amounts of subarachnoid blood (OR 3.8, 95 % CI 1.0–14.0), large ventricular size on preoperative cerebral computer tomographic (CT) scans (OR 1.0, 95 % CI 1.0–1.1), and CSF volume drainage exceeding 1,500 ml during the 1st week after the ictus (OR 16.3, 95 % CI 4.0–67.1). Age ≥70 years, larger amounts of intraventricular blood, vertebrobasilar aneurysm, and endovascular treatment tended to increase the likelihood of receiving a shunt. Outcome was not significantly different between shunted and non-shunted patients.Conclusions
In this cohort of patients with clinical grade aSAH at admission, larger amounts of subarachnoid blood and large ventricular size on preoperative cerebral CT, and CSF drainage in excess of 1,500 ml during the 1st week after the ictus were significant predictors of shunt dependency. Shunt dependency did not hamper outcome. 相似文献8.
Haitao Zhu Fei Li Mingming Zou Xingsen Xue Jichao Yuan Hua Feng Jiangkai Lin 《Acta neurochirurgica》2013,155(4):655-661
Background
Specific pathophysiological mechanism in intracerebral hemorrhage (ICH) at high altitude is unclear, and at present, there is no relevant and suitable animal model.Methods
A hypobaric chamber was used to simulate an altitude of 4,000 m. Autologous arterial blood (3 ml) was slowly infused into the right basal ganglia of minipigs by a double-injection method for producing ICH.Results
The intracranial pressure and neurological score of the high-altitude group were significantly higher than those of the low-altitude (plain) group. The brain water contents and pathological lesions of perihematoma tissue were more severe in the high-altitude group.Conclusions
The injury resulting from ICH at high altitude was more severe than that in the plain group. This model was able to produce controllable and reproducible hematomas and visible neurological deficits, which may be useful for future studies of the pathophysiology and functional rehabilitation of high-altitude ICH disease. 相似文献9.
Kosuke Endo Taku Iida Shintaro Yagi Atsushi Yoshizawa Yasuhiro Fujimoto Kohei Ogawa Yasuhiro Ogura Akira Mori Toshimi Kaido Shinji Uemoto 《Surgery today》2014,44(12):2293-2299
Purpose
Uncontrollable hepatic hydrothorax and massive ascites (H&MA) requiring preoperative drainage are sometimes encountered in liver transplantation (LT). We retrospectively analyzed the characteristics of such patients and the impact of H&MA on the postoperative course.Methods
We evaluated 237 adult patients who underwent LT in our institute between April 2006 and October 2010.Results
Recipients with uncontrollable H&MA (group HA: n = 36) had more intraoperative bleeding, higher Child–Pugh scores, lower serum albumin concentrations and higher blood urea nitrogen concentrations than those without uncontrollable H&MA (group C: n = 201). They were also more likely to have preoperative hepatorenal syndrome and infections. The incidence of postoperative bacteremia was higher (55.6 vs. 46.7 %, P = 0.008) and the 1- and 3-year survival rates were lower (1 year: 58.9 vs. 82.9 %; 3 years: 58.9 vs. 77.7 %; P = 0.003) in group HA than in group C. The multivariate proportional regression analyses revealed that uncontrollable H&MA and the Child–Pugh score were independent risk factors for the postoperative prognosis.Conclusions
Postoperative infection control may be an important means of improving the outcome for patients with uncontrollable H&MA undergoing LT, and clinicians should strive to perform surgery before H&MA becomes uncontrollable. 相似文献10.
B. Walter T. Weiss F. Hofstädter A. Gaumann A. Hartmann S. Rogenhofer R. Ganzer S. Wach D. Engehausen W. F. Wieland A. Blana 《World journal of urology》2013,31(5):1129-1133
Purpose
To overcome the difficulties in the interpretation of postoperative tumor obtaining biopsy cores for patients who treated their prostate cancer with high-intensity focussed ultrasound (HIFU) therapy.Methods
The H&E slides of 58 patients with residual prostate cancer after HIFU treatment were systematically reviewed. Correlation between the pathologist’s findings and immunohistochemical expression of MIB-1, alpha-Methyl-Co-Racemase and 34βE-12 staining was analyzed.Results
Mean time from treatment to biopsy was 40.2 (8–208) weeks. The expert review of the H&E slides identified 40 patients with viable carcinoma in the post-HIFU biopsy cores. 18 patients were revised to necrosis-only-tumors. These biopsies were performed not later than 16 weeks after HIFU treatment (median 10.9 weeks, range 8–14). Both MIB-1 and AMACR staining displayed significant differential expression in viable carcinoma (p < 0.001) compared to necrosis tumors. Referring to viable carcinoma tissue, AMACR staining index was significantly rising, the longer treatment dated back from biopsy (p < 0.002). In this context, 34-β-E12 stained negative through all tumor areas and positive in the majority (85%) of the surrounding non-neoplastic epithelium.Conclusions
AMACR and MIB-1 reliably differentiate viable carcinoma from a process of ongoing irreversible necrosis in early post-HIFU prostate biopsy cores and therefore proposed—in addition with 34 beta-E12—as useful markers exposing suspicious tumor foci in difficult cases. 相似文献11.
Background
A measurement of quality of life (QoL) should cover the important aspects of daily life and be easy to perform. Ease of performance is especially important for patients with spontaneous subarachnoid haemorrhage (SAH), since fatigue and cognitive disabilities are known sequeles. EuroQoL (EQ-5D) is a preference-based instrument measuring QoL, based on self-reported health status in five dimensions: Mobility, Self-Care, Usual Activities, Pain/Discomfort and Anxiety/Depression. In the present study EuroQoL was used in patients with aneurysmal SAH (aSAH) in comparison with a Swedish reference population. We also determined the extent to which demographic characteristics and clinical parameters predicted outcome.Methods
Seven hundred fifty-five patients with aSAH were studied after a median 12 months. The proportion of patients in the best QoL category for each dimension was compared with the corresponding proportion in an age matched reference population. Disease severity was measured using the World Federation of Neurosurgical Societies’ SAH grading system and the Fisher scale. The extent to which demographic and clinical factors predicted outcome was evaluated using linear regression.Results
Aneurysmal SAH patients generally had a worse QoL compared with the reference population, in all five dimensions of EQ-5D. In the patient population, disease severity predicted worse outcome in all five dimensions. Female gender and surgery as treatment method (in the case of anterior aneurysms) predicted worse outcome in Usual Activities and Anxiety/Depression.Conclusion
The nature of the sequeles after SAH depends on severity of disease, gender and treatment method. These factors should be more emphasised in planning rehabilitation. 相似文献12.
Homajoun Maslehaty Hannah Ngando Dan Meila Friedhelm Brassel Martin Scholz Athanasios K. Petridis 《Acta neurochirurgica》2013,155(6):1095-1100
Objective
International guidelines for the management of unruptured intracranial aneurysms (UIAs) recommend observation in aneurysms <10 mm due to the estimated low risk of rupture. The aim of our study was analyse the data of recently treated patients with ruptured cerebral aneurysms with the special focus on size and configuration in view of the frequency scale in a daily routine setting.Methods
We reviewed the data of all patients with aneurysmal subarachnoid haemorrhage (SAH) during the last 24 months at our institution. Configuration and size of the aneurysms were measured. Clinical data were collected using the following classifications for analysis: Hunt and Hess (H&H), modified Rankin Scale (mRS) and Fisher classification.Results
Data of 135 patients with aneurysmal SAH (98 women, 37 men; ratio 2.6:1) were analysed. Analysis showed that 19 aneurysms (14 %) were >10 mm (mean size, 19.2 mm) and 116 aneurysms (85.9 %) <10 mm (mean size, 6.2 mm). In total, 112 were categorised as berry-like configured aneurysms (n?=?113 <10 mm, n?=?3 >10 mm), 18 as multi-lobar (n?=?16 <10 mm, n?=?2 >10 mm) and 5 as fusiform (n?=?4 <10 mm, n?=?1, >10 mm).Conclusion
Since the results of our study showed that the majority of the aneurysms are <10 mm (mean, 6.2 mm), it is justified to challenge the recommendations of the international guidelines in a daily routine setting. We believe that the published data are not convincing enough to play a guidance role in daily routine. Due to improving surgical and endovascular techniques with satisfying results and the high number of ruptured small aneurysms, we believe a change in attitude in management of small-sized aneurysms is needed. Further diagnostic models are needed to determine the risk of rupture of intracranial aneurysms properly to obtain adequate treatment for UIAs. 相似文献13.
Masoud Hashemi Morteza Hashemian Seyed Amir Mohajerani Giv Sharifi 《European spine journal》2014,23(9):1927-1932
Background
Degenerative spondylolisthesis is a well-recognized source of low back pain mainly induced by facet joint pain. Pulsed radiofrequency (PRF) allows heat dissipation, thus producing a temporary injury that affects only type C fibers responsible for pain conduction.Objectives
We attempted to test whether PRF is a better choice for facet pain due to spondylolisthesis compared to routine steroid injection.Methods
Patients were randomly assigned to one of two groups: group one received pulsed RF, and group 2 received injection by steroids (triamcinolone) and bupivacaine.Outcomes assessment
Multiple outcome measures were utilized which included the numeric rating scale (NRS), the Oswestry Disability Index (ODI), satisfaction status, and analgesic intake with assessment at 3, 6, and 12 months post-treatment. Significant pain relief was defined as 50 % or more, whereas significant improvement in disability score was defined as reduction of 40 % or more.Results
Eighty patients were enrolled in the study and were divided into the two groups of study. PRF significantly reduced NRS at 6-month follow-up compared to steroid + bupivacaine. 75.6 ± 14.3 % at pre-treatment and 19.3 ± 9.5 % at 6 months (p = 0.001) in PRF group. The mean ODI is depicted in two groups of study (Fig. 1). Interestingly, ODI% was significantly lower in PRF group at 12 weeks and 6 months compare to steroid + bupivacaine group (p = 0.022 and 0.03, respectively), but it was not significantly different at 6 weeks (p = 0.31). Proportion of patients who did not require analgesics were significantly higher in PRF group compared to other group (p = 0.001) in Log-rank (Mantel–Cox) test.Conclusion
Our results demonstrated that the application of PRF might be more effective than steroid and bupivacaine injection in decreasing back pain due to degenerative facet pain and improvement in function of patients. 相似文献14.
Anna Paschali Constantinos Constantoyannis Fevronia Angelatou Pavlos Vassilakos 《Acta neurochirurgica》2013,155(3):497-505
Background
High-frequency deep brain stimulation (DBS) of the subthalamic nucleus (STN) has become an established therapeutic approach for the management of patients with late-stage idiopathic Parkinson’s disease (PD). The aim of the present study was to assess regional cerebral blood flow (rCBF) changes related to motor improvement.Methods
Twenty-one PD patients underwent two rCBF SPECT studies at rest, once preoperatively in the off-meds state and the other postoperatively (at 6?±?2 months) in the off medication/on stimulation state. Patients were classified according to the UPDRS and H&Y scale. NeuroGam software was used to register, quantify, and compare two sequential brain SPECT studies of the same patient in order to investigate rCBF changes during STN stimulation in comparison with preoperative rCBF. The relationship between rCBF and UPDRS scores was used as a covariate of interest.Results
Twenty patients showed clinical improvement during the first months after surgery, resulting in a 44 % reduction of the UPDRS motor score. The administered mean daily levodopa dose significantly decreased from 850?±?108 mg before surgery to 446?±?188 mg during the off-meds state (p?<?0.001, paired t test). At the 6-month postoperative assessment, we noticed rCBF increases in the pre-supplementary motor area (pre-SMA) and the premotor cortex (PMC) (mean rCBF increase = 10.2 %, p?<?0.05), the dorsolateral prefrontal cortex and in associative and limbic territories of the frontal cortex (mean rCBF increase = 8.2 %, p?>?0.05). A correlation was detected between the improvement in motor scores and the rCBF increase in the pre-SMA and PMC (r?=?0.89, p?<?0.001).Conclusions
Our study suggests that STN stimulation leads to improvement in neural activity and rCBF increase in higher-order motor cortical areas. 相似文献15.
Cynthia E. Weber Eileen A. Bock Michael G. Hurtuk Gerard J. Abood Jack Pickleman Margo Shoup Gerard V. Aranha 《Journal of gastrointestinal surgery》2014,18(2):340-347
Objective
The aim of the study was to determine the clinicopathological features that influence survival in patients with resected pancreatic ductal adenocarcinoma (PDA).Methods
The study used a single institution retrospective review of patients undergoing pancreaticoduodenectomy (PD) for PDA from 1993 to 2010.Results
Two hundred forty-six consecutive cases of resected PDA were identified: 128 males (52 %), median age 68 years. Median hospital length of stay was 8 days and 30-day mortality rate was 2.4 %. There were 101 (41.1 %) postoperative complications, 77 % of which were Dindo–Clavien Grade 3 or less. Overall survival was 85, 63, 25, and 15 % at 6 months, 1 year, 3 years, and 5 years, respectively, with a median survival of 17 months. Multivariate Cox proportional hazard modeling demonstrated lymph node ratio was negatively correlated with survival at all time points. Preoperative hypertension was a poor prognostic factor at 6 months, 3 years, and 5 years. The absence of postoperative complications was protective at 6 months whereas pancreatic leaks were associated with worse survival at 6 months. Abdominal pain on presentation, operative time, and estimated blood loss were also associated with decreased survival at various time points.Conclusion
The strongest prognostic variable for short- and long-term survival after PD for PDA is lymph node ratio. Short-term survival is influenced by the postoperative course. 相似文献16.
Claudia M. G. Keyzer-Dekker Jolanda de Vries Marlies C. Mertens Jan A. Roukema Alida F. W. van der Steeg 《World journal of surgery》2013,37(9):2140-2147
Background
High trait anxiety (HTA) causes an impaired quality of life (QOL) and fatigue in women with breast cancer (BC) and benign breast disease (BBD). We examined whether the lowered QOL was determined solely by the personality characteristic HTA or by the combination of personality and diagnosis.Methods
In a prospective longitudinal study, women with BC (n = 152), BBD (n = 205), or gallstone disease (GD) before laparoscopic cholecystectomy (n = 128) were included. Questionnaires concerning trait anxiety (baseline), fatigue, and QOL were completed at baseline and at 6 months. Multivariate linear regression analysis was performed to analyze the predictors for QOL at 6 months.Results
At 6 months QOL scores were increased in the GD group, especially in women without HTA. For women without HTA, in the BBD group the scores for fatigue and physical QOL had improved at 6 months, whereas in the BC group physical QOL and fatigue was impaired. Women with HTA scored unfavorably on fatigue and QOL. HTA was the most important factor influencing QOL.Conclusions
The course of QOL and fatigue during follow-up were significantly different for each diagnosis. Particularly HTA had a negative impact on QOL and fatigue. Especially the combination HTA and BC caused impaired QOL and fatigue. We recommend identifying women with BC and HTA and offer them a tailor-made follow-up protocol. 相似文献17.
Kazuko Hotta Takatoshi Sorimachi Takahiro Osada Tanefumi Baba Go Inoue Hideki Atsumi Hideo Ishizaka Minako Matsuda Naokazu Hayashi Mitsunori Matsumae 《Acta neurochirurgica》2014,156(5):911-917
Background
Few studies have examined the risk of computed tomography angiography (CTA) during the acute phase of spontaneous intracerebral hemorrhage (ICH), while the benefits of CTA in ICH have been well-documented. The present study investigated both the benefits of identifying spot signs, which are supposed to indicate hematoma enlargement after admission, and risks of CTA performed during the acute phase of ICH.Methods
We retrospectively assessed 323 consecutive patients with spontaneous ICHs admitted to our hospital between April 2009 and March 2012 and who underwent CTA on admission.Results
In 80 patients (24.7 %), spot signs were demonstrated on CTA source images. Multivariate analysis revealed two independent factors correlated with presence of the spot sign: age and hematoma volume (p?<?0.05 each). The presence of spot sign was associated with unfavorable outcomes at discharge and hematoma growth after admission (p?<?0.05 each). Adverse events related to CTA occurred in 17 patients (5.2 %), including transient renal dysfunction in 16 patients and allergy to contrast medium in one patient. All adverse events completely resolved within 1 week.Conclusions
Presence of the spot sign indicated the possibility of hematoma growth and unfavorable outcomes. A small number of adverse events occurred in association with CTA, but without any permanent deficits. Given the potential benefits and risks, we believe that CTA performed at admission in all patients with ICH is beneficial to improve the outcomes. 相似文献18.
19.
F. Muysoms G. Vander Mijnsbrugge P. Pletinckx E. Boldo I. Jacobs M. Michiels R. Ceulemans 《Hernia》2013,17(5):603-612
Background
Although laparoscopic intra-peritoneal mesh repair (LVHR) is a well-established treatment option to repair ventral and incisional hernias, no consensus in the literature can be found on the best method of fixation of the mesh to the abdominal wall.Methods
Between December 2004 and July 2008, 76 patients undergoing a LVHR were randomized between mesh fixation using a double row of spiral tackers (DC) (n = 33) and mesh fixation with transfascial sutures combined with one row of spiral tackers (S&T) (n = 43), in the WoW trial (with or without sutures). Patients were clinically examined and evaluated using a visual analog scale for pain (VAS) in rest and after coughing 4 h post-operatively, after 4 weeks and 3 months after surgery. Primary endpoint of the study was abdominal wall pain, defined as a VAS score of at least 1.0 cm, at 3 months post-operative. Quality of life was quantified with the SF-36 questionnaire preoperatively and after 3 months. Secondary endpoint was the recurrence rate at 24-month follow-up.Results
The DC and S&T group were comparable in age, gender, ASA score, BMI, indication, hernia, and mesh variables. The DC group had a significant shorter operating time compared with the S&T group (74 vs 96 min; p = 0.014) and a significant lower mean VAS score 4 h post-operatively (in rest; p = 0.028/coughing; p = 0.013). At 3 months, there were significant more patients in the S&T group with VAS score ≥1.0 cm (31.4 vs 8.3 %; p = 0.036). Clinical follow-up at 24 months was obtained in 63 patients (82.9 %). The recurrence rate at 24 months was 7.9 % overall (5/63). There were more recurrences in the S&T group (4/36) than in the DC group (1/27), but this difference was not significant (11.1 vs 3.7 %; p = 0.381).Conclusion
We found that double-crown fixation of intra-peritoneal mesh during laparoscopic ventral hernia repair was quicker, was less painful immediately post-operative and after 3 months, and did not increase the recurrence rate at 24 months. In hernias at a distance from the bony borders of the abdomen, transfascial sutures can be omitted if a double crown of tackers is placed. 相似文献20.