Background
Stereotactic radiosurgery (SRS) has become a primary option for management for both newly diagnosed vestibular schwannomas (VS), as well as VS that enlarge after initial observation.
...Methods
A retrospective review of our prospectively maintained data base found 871 patients who underwent Gamma knife® SRS as their initial (primary) management between 1987 and 2008. Follow-up ranged from 1–25 years (median = 5.2 years) Median tumor volume was 0.9 cc (0.02–36) and median margin dose was 13 Gy (12–25).
Results
Progression free survival (PFS) after SRS was 97% at 3 years, 95% at 5 years, and 94% at 10 years. Freedom from delayed surgical resection was found in 98.7% of patients. Smaller tumor volume was significantly associated with improved PFS. There were 326 patients with serviceable hearing (Gardner–Robertson 1 or 2) at the time of SRS with audiological follow-up of ≥ 1 year. Serviceable hearing preservation rates after SRS were 89.8% at 1 year, 76.9% at 3 years, 68.4% at 5 years, 62.5% at 7 years, and 51.4% at 10 years. Factors associated with improved serviceable hearing preservation included younger age, Gardner-Robertson grade 1 at SRS, and absence of subjective complaints of dysequilibrium or vertigo (vestibulopathy). Fifty-one patients (5.8%) developed trigeminal neuropathy. Fourteen (1.6%) developed a transient House-Brackmann grade 2 or 3 facial neuropathy.
Conclusions
In this report with extended follow-up, primary SRS achieved tumor growth control in 94% of patients. Optimization of long- term cranial nerve outcomes remains an important achievement of this management strategy for VS.
Objective
To evaluate cranial nerve (CN) outcomes after primary stereotactic radiosurgery (SRS) for petroclival, cavernous sinus, and cerebellopontine angle meningiomas.
Methods
From our ...prospectively maintained database of 2022 meningioma patients who underwent Leksell stereotactic radiosurgery (SRS) during a 30-year interval, we found 98 patients with petroclival, 242 with cavernous sinus, and 55 patients with cerebellopontine angle meningiomas. Primary radiosurgery was performed in 245 patients. Patients included in this report had at least one CN deficit at the time of initial presentation and a minimum of 12 month follow up. Median age at the time of SRS was 58 years. Median follow up was 58 months (range 12–300 months), Median tumor volume treated with SRS was 5.9 cm
3
(range 0.5–37.5 cm
3
), and median margin dose was 13 Gy (range 9–20Gy).
Results
Tumor control was achieved in 229 patients (93.5%) at a median follow up of 58 months. Progression free survival rate (PFS) after SRS was 98.7% at 1 year, 96.4% at 3 years, 93.7% at 5 years, and 86.4% at 10 years Overall, 114 of the 245 patients (46.5%) reported improvement of CN function. Patients with CP angle meningiomas demonstrated lower rates of CN improvement compared to petroclival and cavernous sinus meningioma patients. Deterioration of CN function after SRS developed in 24 patients (10%). The rate of deterioration was 2.8% at 1 year, 5.2% at 3 years, and 8% at 10 years.
Conclusion
Primary SRS provides effective tumor control and favorable rate of improvement of preexisting CN deficit.
Dysmenorrhea is a common problem experienced by many women on a regular basis. It is characterized by recurrent bouts of crampy abdominal pain that is associated with the menstrual cycle. These ...episodes can vary in severity and frequency and may require treatment. The objective of this study is to shed light on a case of severe dysmenorrhea that occurred simultaneously with acute appendicitis. The patient underwent appendectomy, but despite this continued to have abdominal pain in the postoperative period. This led to many investigations for possible post-surgical complications that had no yield. The diagnosis of dysmenorrhea was made with help from family members who disclosed that the patient had heavy bleeding and severe crampy menstrual pain associated with nausea and vomiting. This information was unknown to the medical team as this patient did not disclose this information. The coincidence of dysmenorrhea and concurrent acute appendicitis led to difficulty in diagnosing the etiology of the lingering postoperative abdominal pain.
Atrial fibrillation (AF) is the most common cardiac arrhythmia. Dronedarone is a new antiarrhythmic used for rhythm and rate control in AF and is associated with reduced mortality in non-permanent ...AF. It has also been associated with increased mortality in those with heart failure and/or permanent AF. This case report presents the case of hypotensive shock after initiating treatment with dronedarone in a 73-year-old female patient. Shortly after her first dose of dronedarone, she developed hypotension that did not respond to intravenous fluids and was admitted to the intensive care unit for vasopressor administration. Dronedarone was the most likely cause of the hypotension as the patient's blood pressure normalized in 24 hours, which concurs with the half-life of dronedarone. Amiodarone and dronedarone are similar in composition; however, the absence of iodine moieties in dronedarone contributes to its improved side-effect profile. Furthermore, amiodarone has been linked to hypotensive shock likely due to a co-solvent used in some intravenous preparations; however, dronedarone-induced hypotension is less common.
Loperamide (Imodium) is an opioid receptor agonist available over-the-counter and can be used for the treatment of diarrhea. When ingested in excessive doses, loperamide can penetrate the blood-brain ...barrier and is reported to produce euphoria, depression of the central nervous system, and cardiotoxicity. It may also be used for its euphoric effects and potentially to alleviate opioid withdrawal. Loperamide has a US boxed warning for torsades de pointes and sudden death. Loperamide has been reported to cause torsades de pointes, cardiac arrest, and death when higher than the recommended dosage is consumed. We report a rare case of ventricular arrhythmia provoked by accidental ingestion of loperamide to treat simple diarrhea.
Heart failure with preserved ejection fraction (HFpEF) accounts for 50% of patients with heart failure. HFpEF carries almost similar morbidity and mortality outcomes to heart failure with reduced ...ejection fraction (HFrEF). Despite many trials, no management has been shown to improve mortality outcomes in HFpEF. An elevated heart rate in patients with HFpEF has been associated with worse outcomes. Previous trials on the use of beta-blockers in reducing the heart rate in patients with HFpEF have shown worse outcomes, possibly due to the negative inotropic effects. The funny current inhibitor, ivabradine, results in a reduced heart rate without affecting inotropy. Two randomized controlled trials and one cross-over study have evaluated the use of ivabradine in HFpEF patients. The outcomes of the trials have been heterogeneous; ivabradine showed improved exercise tolerance, no change in primary endpoints was seen l, and there was a worsening in the outcomes. Our review underscores the requirement of a large randomized clinical trial in the appropriate patient population.
Abstract only
Introduction:
Postoperative atrial fibrillation (POAF) is seen in around 30% of patients after coronary artery bypass grafting (CABG). It is associated with increased risk for stroke, ...heart failure, in-hospital mortality and hospital readmission. Prediction of POAF could help institute preventive and early treatment strategies.
Methods:
We queried PubMed, Ovid Medline, and Cochrane databases for key words ‘atrial speckle tracking” and/or “reservoir strain” and/or “post-operative atrial fibrillation”. We included studies that included patients in normal sinus rhythm before CABG and compared reservoir strain and/or peak atrial longitudinal strain (PALS) between patients who developed POAF and those who did not. Continuous data (LA strain) was pooled as a mean difference comparing patients who developed POAF versus patients who did not. We used the inverse variance method with the Restricted Maximum likelihood estimator of Tau2, for random effect analysis. We used Q and I2 statistics to calculate the heterogeneity.
Results:
Six observational studies met our inclusion criteria with a total of 338 patients, of which 91 patients developed POAF. Left atrial reservoir strain was significantly reduced in patients who developed POAF as compared with those who did not develop POAF, mean difference(MD), 95% confidence interval(CI): -13.97(-15.00-12.93), I2= 53%, , P <0.00001, Figure 1.
Conclusions:
Atrial reservoir strain was significantly reduced in patients who developed POAF as compared to those who remained in sinus rhythm. Atrial reservoir strain can be potentially used to identify patients at risk of POAF. More data is needed for further validation of this finding.
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