Suzuki et al.119 reported on the post-surgical overall clinical outcome in 603 patients with an ACoA aneurysm. Of these patients, 367 (61%) had an excellent outcome, 107 (18%) had a good outcome, 99 (16%) had a fair/poor outcome, and 30 (5%) died. Of the 264 patients who presented in Hunt and Hess Grades 0–III, 86% had an excellent or good outcome.
Fukushima et al.37 reported on the overall clinical outcome post-surgery in 138 patients with an ACoA aneurysm. In 119 cases (86%) the outcome was excellent or good, and 8 (6%) died. Of the 83 patients presenting in Hunt and Hess Grades I–III, 92% had an excellent or good outcome.
In our study, 15 cases underwent microsurgical clipping with Hunt and Hess grade I- III , 40% grade III, 40% grade II
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and 20% grade I, the outcome measured on GOS was 5 in 8 cases (53.3%), 4 in 1 case (6.7%), 3 in 2 cases (13.3%) and 1 in 4 cases (26.7%). Endovascular Series In 2002 Kazekawa et al.54 presented the overall clinical and angiographic evaluation in 19 consecutive patients with ACoA aneurysms who were treated with GDCs. Complete obliteration was obtained in 68% of cases, whereas a neck remnant was observed in 32%. Regarding the overall clinical outcome, 3 patients (15%) who were originally categorized in Grades IV and V died, 1 (5%) was moderately disabled, and 15 (80%) had a good recovery. The authors pointed out that the patients who had a good recovery did not demonstrate significant personality or behavioral changes. In 1996, Moret et al.76 published the results of endovascular treatment in 36 ACoA aneurysms.
In 7 of these cases (20%) the treatment failed. This high rate of failure can be explained because the technical armamentarium in the mid-1990s was not as advanced and sophisticated as it is today. Of the 29 treated aneurysms, it was possible to achieve a complete occlusion in 23 (79%), whereas the occlusion was only partial (neck remnant) in the remaining 6 cases (21%). These investigators observed a post- procedural temporary neurological deficit in 2 cases, and the procedure-related permanent morbidity was 3.5% (1 case). No procedure-related death was reported.
Tsutsumi et al.128 reported on the overall results in 19 ruptured tiny (diameter ≤ 3 mm) ACoA aneurysms. Six- teen patients presented in Grades I–III, and 3 cases were categorized in Grade IV. Complete aneurysm occlusion was obtained in 84% of cases, whereas near-complete occlusion was obtained in 16% of cases. In 15 patients (79%) the outcome was good, whereas in 3 cases (16%) the clinical follow-up showed severe disability, and 1 patient (5%) died of severe vasospasm. None of the 18 patients who were followed clinically for a median period of 39.5 months showed
rebleeding. Proust et al.87 conducted a study in which the ACoA aneurysms were divided into 3 groups. In Group A, clip application was performed regardless of whether the aneurysm fundus was directed anteriorly or posteriorly. In Group B, clip application was performed only in aneurysms that were anteriorly directed. In Group C (37 cases), the aneurysms were treated endovascularly with coil occlusion. In this later group the investigators observed identical morbidity and mortality rates (8%). Proust et al.87 concluded that anteriorly directed ACoA aneurysms should be surgically clipped, whereas posteriorly directed ACoA aneurysms should be treated with coils. This was recommended because all the ACoA branches and perforating vessels arise from the posterior aspect of the artery. Guglielmi et al.41 in their endovascular series in 2009 said that the treatment was attempted and failed in 12 cases (4% failure rate). With recent technical advancements, such as rotational angiography, new microcatheters and microguidewires, small and supersoft coils, and compliant balloons for the balloon- assisted technique, the failure rate is diminishing. This is demonstrated in our series: 10 of the 12 failures occurred early in our experience, while only 2 failures (1.5%) occurred in the last 130 cases. Regarding the occlusion rates of the aneurysms, Guglielmi et al.41 reported a complete occlusion achieved in 139 cases (45.5%). A neck remnant was detected in 145 aneurysms (47.5%), and in 22 cases (7%) a residual filling of the aneurysm was observed. A detailed analysis of the significance of a residual aneurysm neck was reported by Hayakawa et al.45 Regarding the clinical neurological outcome, 280 patients (91.5%) remained neurologically intact, improved, or unchanged from their initial clinical status. Two large, wide-necked, subtotally occluded aneurysms ruptured 3–7 months after the procedure, with subsequent death of the patients. The procedure-related morbidity and mortality rates were 3.5% (11 cases) and 1% (3 cases), respectively.41 In our study, 15 cases underwent endovascular coiling with Hunt and Hess grade I- III , 40% grade III, 33.3% grade II and 26.7% grade I, the outcome measured on GOS was 5 in 9 cases (60%), 4 in 3 case (20%), 3 in 2 cases (13.3%) and 1 in one case (6.7%).
In November of 2010, I was playing basketball in the fifth game of my senior season. It was just like any other game. However, I would soon find out otherwise. It was late in the game; I drove into the lane and got fouled hard. I was knocked so off-balance that I speared the floor with my knee. As soon as my knee hit the floor I heard a “snap” that I will never forget for the rest of my life. Little did I know at the time, that would be the last shot of my high school basketball career. Not long after my injury, I consulted a doctor. After getting an x-ray and an MRI, the doctor informed me that I had completely torn my ACL and would need to have surgery. An ACL tear can be a very devastating injury. The anterior cruciate ligament (ACL) is one of the four major ligaments within the knee. The ACL is one of the most commonly injured ligaments, injured by an estimated 200,000 patients each year. Of the 200,000 annual ACL injuries, surgery is performed in approximately 100,000 cases. There are many types of reconstructive surgery on the ACL. However, there is an alternative to surgery in the form of physical therapy.
The Burden of the disease is high with a prevalence of 3.4% 2. With the progressive nature of the disease and the increased severity of the symptoms made the surgery the gold standard for symptomatic AS patients ,however up to 30% of cases are considered too high risk for classical valve replacement surgery and remain untreated and experiencing poor prognosis . Fortunately , with the introduction of TAVR its offer a valuable option for the inoperable or at high risk of surgery patients3..the annual eligible candidate for this procedure expected to be 27,000 in 19 European countries and North America according to recent meta-analysis an...
...sures (Milewicz, 2005). Acute dissection may be accompanied by all of the classic signs and symptoms similar to that of a heart attack, or it may be clinically silent. In an effort to decrease the mortality rate of patients suffering from Marfans and have a potentially high risk of aortic dissection, current studies are investigating the safety and practicality of endovascular stent graft repair.
A total of 90 patients (test [MEBO Scar ointment], n=40; control, n=50) were recruited in the study. All patients underwent elective surgery between February 01, 2013 and December 30, 2013.The majority of patients in the test group were female (n=30, 75%) with female to male ratio of 3:1; however, all participants in the control group were female. The mean age of the patients was 30 years (range: 10–60 years)(Table 1). There were no statistically significant differences between the test and control group with respect to type of surgery (Table 2)and type of incision (Table 3). Thyroidectomy was the most frequently performed surgery in the test group (30%), while breast mass excision biopsy was the most common in the control group. Revisional
There are several different causes of an aortic dissection. Trauma is a major cause of an aortic dissection, specifically blunt trauma, such as a chest hitting a steering ...
1. What is the difference between a. and a. Introduction The main aim of this report is to present and analyse the disease called Cerebrovascular Accident, popularly known as stroke. This disease affects the cerebrovascular system, which is a part of the cardiovascular system.
The secret to the successful management of these cases is preparation. Early involvement in anesthesia management and a thorough understanding of the pathophysiology of AAAs (including rupture and dissection), and the surgical and anesthetic implications for treatment will improve morbidity and mortality outcomes in this patient population.
The first patient I saw was a 14 month old boy who sustained a non-accidental head injury. He underwent surgery in July that relieved the excess pressure and fluid around his brain, resulting in him becoming a left hemiplegic.
Poor surgical technique was defined as the lack of fixation of one or more wires either in the distal or in the proximal fragment, convergence of the pin...
There has yet to be a cure for Hydrocephalus, but there are indeed treatments. Although, not many advances have been made in preventing, healing, or moderating Hydrocephalus. In fact, the device currently used as the dominant treatment was pronounced fifty years ago and has had the highest failure rates in comparison to any surgical remedy. Introducing said regimen, The National Institute of Neurological Disorders and Stroke (2013) explains, “Hydrocephalus is most often treated by surgically inserting a shunt system.” This operation revolves around the embedding of two catheters along with a valve. The valve influences the flow of CSF to generate an increasingly normal rate and direction. As an alternative, there is a procedure labeled as a ventriculostomy in which a hole is made in the underlying area of a ventricle or in between the ventricles. This functions as a funnel for the CSF to exit the cranial area. These methods are customarily permanent and must be monitored
This assignment will endeavour to demonstrate the map of medicine as followed within the National Health Service for the diagnosis, treatment and follow-up of abdominal aortic aneurysms (AAA). It shall discuss the current AAA screening programme being implemented across the United Kingdom to include the use of Ultrasound and Computed Tomography (CT) as imaging modalities in the demonstration of AAAs. Both the advantages and disadvantages of the modalities used during the diagnosis and treatment of AAA will be shown.
The other type of stroke is a hemorrhagic stroke. This occurs when a blood vessel ruptures and blood is spilled into the brain tissue. High blood pressure is the most common cause for this type of blood vessel rupture although aneurysms and arteriovenous malformations are other causes as well. According to Webmed.com, “Uncontrolled high blood pressure increases a person’s stroke risk by four to six times.” Having a stroke is more common in adults, although it can happen to anyone at anytime, including children. Strokes are the leading cause of adult disability and the 5th leading cause of death in the U.S. (Stroke.org). Up to 80% of strokes can be prevented by lowering blood pressure, losing weight, exercise, and not smoking. Some non-modifiable risk factors include advanced age (older than 55 years), gender (male), and race (African American). Treatment differs depending on the type of stroke. A person is affected differently depending on the location of the stroke and how much damage has occurred. People with minor strokes mainly have minor problems such as temporary weakness in the arm or
Neil. (2003, October 1). Triple-H therapy in the management of aneurysmal subarachnoid haemorrhage. The Lancet Neurology, 2(10), 614-620. doi: 10.1016/S1474-4422(03)00531-3
The average age of the patients was 68,89 (58-86). Preoperative knee flexion measurements of the patients treated with TKA after HTO was significantly lower compared to the group treated with primary TKA (p =0,01). There was no statistically significant difference between the two groups when postoperative knee flexion measurements were compared. (p = 0,21). Measurements of preoperative HSS scores of the patients treated with primary TKA was significantly higher than the patients treated with TKA after HTO. In the group of patients who were applied primary TKA, postoperative HSS scores were higher; however the difference was not statistically significant (p = 0,175). Satisfaction scores, based on the results of postoperative satisfaction surveys, was higher in primary TKA group compared to the scores of patients who had previously undergone HTO surgery. Cost values obtained according to the applied prostheses was lower in primary TKA group, but this difference was not statistically significant (p=
The most common procedures for age 18-and-under were chemical peel, laser hair removal, micro-dermabrasion, rhinoplasty, and otoplasty (ear reshaping).