Consideration Of Clinical Characteristics Research Articles

Epidemiological Characteristics and Surgical Outcomes of Unruptured Intracranial Aneurysms: A Real-world Study

BACKGROUND: This study was aimed at epidemiological analysis of unruptured intracranial aneurysms (IAs) regarding their location, size, multiplicity, type of intervention provided, and associated complications in the Kazakhstani population. METHODS: We performed a retrospective analysis of a cohort of 400 patients diagnosed with IA admitted to the Central Clinical Hospital of Almaty, Republic of Kazakhstan, a referral hospital for the treatment of cerebrovascular disease. Patients admitted between January 1, 2019 and December 31, 2019 with radiologically confirmed diagnosis of unruptured IA were included in the study. RESULTS: Overall, there were 400 patients with a 2.8 female/male ratio. The bulk of aneurisms – 96.0% – were of size <25 mm in diameter and single. Median age of patients was 55 years and the youngest patient was 22-years-old, while the oldest patient aged 83 years. The left internal carotid artery (ICA) was the most common site if IA localization followed by the right ICA. The left and right middle cerebral arteries were the second most common localization sites. More than a half of patients presented with aneurysm-related complications before the intervention, of which subarachnoid hemorrhage was the most common type. Embolization with or without stenting was performed in more than 50% of patients and 96.5% of all surgeries were not associated with complications. CONCLUSION: There is a need for careful consideration of clinical characteristics and surgical outcomes of patients with unruptured IA in a real-world practice as these data are needed for the development of management strategies.

ためこみ傾向を有する日本の青年の臨床的特徴

ためこみ傾向を有する日本の青年の臨床的特徴

Angiogenic squamous dysplasia: Characteristics and implications

Objectives: Keith et al described angiogenic squamous dysplasia (ASD) in the lung epithelium of patients at high risk for the development of lung carcinoma. We have recently observed similar changes in the nasal epithelium of occasional patients undergoing routine sinus surgery. This retrospective study evalautes the demographic characteristics of this small group of patients and compares them to a control series of patients undergoing similar surgery to evaluate whether this lesion is premalignant. Methods: Consecutive sinus and nasal surgical pathological specimens were reviewed for the presence of ASD. Twelve patients with ASD were identified and studied in detail. Their demographic characteristics were compared to a control group found not to have ASD but undergoing similar sinus surgery for similar conditions, using a grid approach to allow consideration of clinical characteristics without violating patient confidentiality. Results: Clear demographic differences between the study and control groups were not identified, and no progression to carcinoma was observed in any patient with ASD. In 1 patient that was re-biopsied in view of other risk factors, the mucosa reverted to normal (absence of ASD). Conclusions: ASD is an identifiable histopathological change that occurs in the sinus epithelium. The presence of this lesion with chronic sinusitis suggests that these aberrent patterns of microvasculature may represent an inflammatory response in the sinus mucosa, rather than true neoplasia at risk to proceed to carcinoma, as occurs in the lung. Additional observations are indicated to evaluate this possibility in a larger group of patients.

Pharmacoeconomics of propofol in anesthesia.

Pharmacoeconomic data on the use of propofol in anesthesia are reviewed, with consideration of clinical characteristics that affect overall costs. Propofol is more expensive than many other anesthetics but its use can affect the costs of perioperative care as well as costs not directly related to the health care system, such as those associated with time off work. Using propofol can result in earlier discharge from the postanesthesia care unit (PACU), which can result in lower PACU costs. Anesthesia induction and maintenance with propofol versus barbiturates for induction and volatile anesthetics for maintenance have been associated with a lower frequency of postoperative nausea and vomiting (PONV) in the immediate postoperative period. A reduced frequency of PONV may improve the ability to increase patient flow through the PACU, which may reduce PACU costs. The cost of treating PONV in the PACU might not be high enough to justify the use of more expensive agents such as propofol solely for their reduced propensity to cause PONV. Propofol use has been associated with significantly shorter times to extubation of cardiac-surgery patients compared with the use of other agents. Early extubation has, in turn, been associated with shorter hospital stays, shorter stays in the cardiac intensive care unit, and lower hospital charges. Policy changes regarding criteria for discharge from the PACU may need to be implemented if the economic advantages of propofol are to be realized. Anesthesia with propofol, compared with other agents, has been associated with shorter stays in the PACU. Whether using propofol decreases the costs of care is unclear.