Background and Purpose
In the past years, technical developments have raised recanalization rates of endovascular treatments of intracerebral artery occlusions in acute ischemic stroke. By using ...stent retrievers, several prospective trials have reported recanalization rates up to 79 % as well as good neurological outcome in up to 58 % of the cases. The degree of the recanalization and the length of the procedure are factors known to influence the clinical outcome of patients treated endovascularly. Yet, still little is known about factors influencing the angiographic results of thrombectomy procedures. The purpose of this study was to investigate whether the use of intermediate catheters affects the angiographic results of thrombectomy procedures in basilar artery occlusions.
Materials and Methods
A total of 47 consecutive patients with acute basilar artery occlusions who underwent endovascular treatment with stent retrievers in our department were retrospectively identified. We analyzed the angiographic data regarding the use of intermediate catheters, the lengths of the procedures, the number of passes of the stent retrievers, the angiographic results, and the site of access to the basilar artery.
Results
Recanalization with modified thrombolysis in cerebral infarction (mTICI) ≥ 2b was achieved in 74.5 %. Intermediate catheters were used in 13 cases. The mean length of the procedures was significantly shorter when intermediate catheters were used (44.8 ± 27.6 vs. 70.7 ± 41.4 min,
P
= .043). There were no significant differences in the number of passes or in the final mTICI scores.
Conclusions
The use of intermediate catheters significantly reduces the length of mechanical thrombectomy procedures in acute basilar artery occlusions.
This prospective study was performed to investigate epidemiological characteristics in terms of the age‐ and sex‐specific incidence in patients with perforated and nonperforated appendicitis. The ...study population comprised 1486 consecutive patients who underwent appendectomy for suspected acute appendicitis between 1989 and 1993. Two patient cohorts n= 544 (37%) were analyzed with regard to prehospitalization duration of symptoms and in‐hospital observation time. The crude incidence of acute appendicitis was 86 per 100,000 per year. Although the incidence of nonperforated appendicitis was highest among adolescents and young adults (13–40 years of age), perforated appendicitis occurred at almost the same incidence in all sex and age groups. The diagnostic accuracy was 76%. Perforated appendicitis occurred in 19%, with higher rates in small children and the elderly, irrespective of gender. A high diagnostic accuracy was not associated with an increased rate of perforation. In small children and the elderly, the diagnostic accuracy was low and the perforation rate high. Patients with perforation had a significantly longer duration of symptoms as well as in‐hospital observation time than did patients with nonperforated appendicitis. Perforated appendicitis showed a different incidence pattern than nonperforated appendicitis and was associated with a significantly longer duration of symptoms and in‐hospital observation time, probably due to patient‐related factors. We suggest this observation deserves attention regarding clinical diagnosis and treatment decision‐making for patients with suspected acute appendicitis.
Background
Mechanical thrombectomy with stent retrievers in acute stroke has emerged as a promising new technique with the highest recanalization rate of the therapeutic procedures available so far. ...However, endovascular treatment is also associated with the risk of specific complications. One of those is the occurrence of peri-interventional subarachnoid hemorrhage (SAH), which has been reported in 5–16 % of the cases. Interestingly, this rate is higher than that of angiographically detectable perforations (0–3 %), leaving the majority of peri-interventional SAH to be due to angiographically occult perforations. Little is known about the influence of this finding on clinical outcome. The purpose of this study was to investigate the clinical relevance of SAH due to occult perforations during thrombectomy with stent retrievers.
Methods
Postinterventional computed tomography (CT) scans of 217 consecutive patients with acute occlusions of intracerebral arteries who were treated with stent retrievers in our department between October 2009 and October 2012 were retrospectively analyzed.
Results
SAH was found on postinterventional CT scans in 5.5 % of the cases. Seven cases were included for further analysis and matched to controls by the following characteristics: (1) site of occlusion, (2) result of the recanalization procedure according to the modified thrombolysis in cerebral infarction score, (3) administration of intravenous recombinant tissue plasminogen activator, (4) presence of proximal extracranial occlusion, (5) age, and (6) sex. Comparison of the angiographic data of the two cohorts showed no significant difference in the length of the procedures or the number of maneuvers needed for recanalization, nor were there significant differences in clinical outcomes as measured by NIHSS and mRS scores. Secondary symptomatic ICH occurred in one case in either cohort and led to death in both cases. The rate of asymptomatic ICH within the first 24 h after recanalization was significantly higher in the group with peri-interventional SAH (57 vs. 0 %,
P
= 0.018).
Conclusions
This small retrospective case-control study did not reveal a significant influence of peri-interventional SAH due to angiographically occult perforations on neurologic outcome of patients treated with stent retrievers.
Perforated colonic diverticulitis usually requires surgical resection, which is associated with significant morbidity. Cohort studies have suggested that laparoscopic lavage may treat perforated ...diverticulitis with less morbidity than resection procedures.
To compare the outcomes from laparoscopic lavage with those for colon resection for perforated diverticulitis.
Multicenter, randomized clinical superiority trial recruiting participants from 21 centers in Sweden and Norway from February 2010 to June 2014. The last patient follow-up was in December 2014 and final review and verification of the medical records was assessed in March 2015. Patients with suspected perforated diverticulitis, a clinical indication for emergency surgery, and free air on an abdominal computed tomography scan were eligible. Of 509 patients screened, 415 were eligible and 199 were enrolled.
Patients were assigned to undergo laparoscopic peritoneal lavage (n = 101) or colon resection (n = 98) based on a computer-generated, center-stratified block randomization. All patients with fecal peritonitis (15 patients in the laparoscopic peritoneal lavage group vs 13 in the colon resection group) underwent colon resection. Patients with a pathology requiring treatment beyond that necessary for perforated diverticulitis (12 in the laparoscopic lavage group vs 13 in the colon resection group) were also excluded from the protocol operations and treated as required for the pathology encountered.
The primary outcome was severe postoperative complications (Clavien-Dindo score >IIIa) within 90 days. Secondary outcomes included other postoperative complications, reoperations, length of operating time, length of postoperative hospital stay, and quality of life.
The primary outcome was observed in 31 of 101 patients (30.7%) in the laparoscopic lavage group and 25 of 96 patients (26.0%) in the colon resection group (difference, 4.7% 95% CI, -7.9% to 17.0%; P = .53). Mortality at 90 days did not significantly differ between the laparoscopic lavage group (14 patients 13.9%) and the colon resection group (11 patients 11.5%; difference, 2.4% 95% CI, -7.2% to 11.9%; P = .67). The reoperation rate was significantly higher in the laparoscopic lavage group (15 of 74 patients 20.3%) than in the colon resection group (4 of 70 patients 5.7%; difference, 14.6% 95% CI, 3.5% to 25.6%; P = .01) for patients who did not have fecal peritonitis. The length of operating time was significantly shorter in the laparoscopic lavage group; whereas, length of postoperative hospital stay and quality of life did not differ significantly between groups. Four sigmoid carcinomas were missed with laparoscopic lavage.
Among patients with likely perforated diverticulitis and undergoing emergency surgery, the use of laparoscopic lavage vs primary resection did not reduce severe postoperative complications and led to worse outcomes in secondary end points. These findings do not support laparoscopic lavage for treatment of perforated diverticulitis.
clinicaltrials.gov Identifier: NCT01047462.
Specialized roles for the pro-inflammatory cytokines tumor necrosis factor (TNF) and lymphotoxin (LT) were characterized in TNF/LT alpha -/- and TNF -/- mice established by direct gene targeting of ...C57BL/6 ES cells. The requirement for LT early in lymphoid tissue organogenesis is shown to be distinct from the more subtle and varied role of TNF in promoting correct microarchitectural organization of leukocytes in LN and spleen. Development of normal Peyer's patch (PP) structure, in contrast, is substantially dependent on TNF. Only mice lacking LT exhibit retarded B cell maturation in vivo and serum immunoglobulin deficiencies. A temporal hierarchy in lymphoid tissue development can now be defined, with LT being an essential participant in general lymphoid tissue organogenesis, developmentally preceeding TNF that has a more varied and subtle role in promotion of correct spatial organization of leukocytes in LN and spleen PP development in TNF -/- mice is unusual, indicating that TNF is a more critical participant for this structure than it is for other lymphoid tissues.
In Scandinavia, there is a strong tradition for research and quality monitoring based on registry data. In Denmark, Norway and Sweden, 63 clinical registries collect data on disease characteristics, ...treatment and outcome of various cancer diagnoses and groups based on process-related and outcome-related variables.
We describe the cancer-related clinical registries, compare organizational structures and quality indicators and provide examples of how these registries have been used to monitor clinical performance, develop prediction models, assess outcome and provide quality benchmarks. Further, we define unmet needs such as inclusion of patient-reported outcome variables, harmonization of variables and barriers for data sharing.
The clinical registry framework provides an empirical basis for evidence-based development of high-quality and equitable cancer care. The registries can be used to follow implementation of new treatment principles and monitor patterns of care across geographical areas and patient groups. At the same time, the lessons learnt suggest that further developments and coordination are needed to utilize the full potential of the registry initiative in cancer care.
Lymphotoxin (LT) is widely regarded as a proinflammatory cytokine with activities equivalent to tumor necrosis factor (TNF). The contribution of LT to experimental autoimmune encephalomyelitis (EAE) ...was examined using TNF/LTalpha-/- mice, TNF-/- mice, and a new LTalpha-/- line described here. All mice were generated directly in the C57BL/6 strain and used for the preparation of radiation bone marrow chimeras to reconstitute peripheral lymphoid organs and restore immunocompetence. This approach overcame the problems related to the lack of lymph nodes that results from LTalpha gene targeting. We show here that when LT is absent but TNF is present, EAE progresses normally. In contrast, when TNF is absent but LT is present, EAE is delayed in onset and inflammatory leukocytes fail to move normally into the central nervous system parenchyma, even at the peak of disease. In the absence of both cytokines, the clinical and histological picture is identical to that seen when TNF alone is deficient, including demyelination. Furthermore, the therapeutic inhibition of TNF and LTalpha with soluble TNF receptor in unmanipulated wild-type or TNF-/- mice exactly reproduces these outcomes. We conclude from these studies that TNF and LT are functionally distinct cytokines in vivo, and despite sharing common receptors, show no redundancy of function nor mutual compensation.
The very good thermal stability of polymer thermosets has produced the need for materials with reworkable behavior, that is, materials whose mechanical properties can be degraded under controlled ...circumstances. Rework enables the straightforward repair, replacement, recycling, or short-term use of structures assembled with such materials. It is well-known that lower modulus thermoplastic polymers can be easily removed by an appropriate choice of solvent or heat. However, in many applications thermosets are the materials of choice for long-term use because they are insoluble, infusible high-density networks. Conventional thermosets are difficult or impossible to thoroughly remove without damaging underlying structures. Recycling is thus also difficult. In this paper, we report the synthesis and characterization of a series of new epoxy compounds that incorporate thermally cleavable groups.
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