Early Neurological Complications Research Articles

Neurological Sequelae and Clinical Outcomes After Lung Transplantation.

BackgroundNeurological complications are common after lung transplantation. However, no large cohort studies have examined the incidence, predictors, and clinical significance of neurological events sustained by lung transplant recipients.MethodsWe conducted a retrospective cohort analysis of a consecutive series of lung transplant recipients, transplanted at Duke University Medical Center between May 2014 and February 2017 (n = 276). Early neurological complications (ie, occurring during the first week after transplant) were documented by transplant mental health specialists and included delirium, ischemic injury, and posterior reversible encephalopathy syndrome. Analyses accounted for age, native disease, sex, type of transplant, lung allocation score, and primary graft dysfunction. The objectives of the study were to characterize the prevalence and predictors of early neurological sequelae (NSE), occurring during the first week posttransplant, and the association between NSE and subsequent clinical outcomes, including length of stay and mortality.ResultsNeurological sequelae were common, occurring in 123 (45%) patients. Fifty-seven patients died over a follow-up interval of 2.1 years. The most common NSE were postoperative delirium (n = 110 [40%]) and posterior reversible encephalopathy syndrome (n = 12 [4%]), followed by stroke/transient ischemic attack and neurotoxicity. Higher lung allocation score was the strongest predictor of delirium. The presence of a NSE was associated with longer length of hospital stay (32 days vs 17 days, P < 0.001) and greater mortality (hazard ratio, 1.90; 95% confidence interval, 1.09-3.32], P = 0.024), with the greatest mortality risk occurring approximately 2 years after transplantation.ConclusionsNeurological events are relatively common after lung transplantation and associated with adverse clinical outcomes.

Abstract 20970: Atrial Fibrillation and Intra-Arterial Treatment of Acute Ischemic Stroke: Is the Romance Deeper Than Embolism?

Introduction: Recent evidence remains inconclusive about the impact of atrial fibrillation (AF) on prognosis after intravenous thrombolysis and/or intra-arterial (IA) acute stroke treatment (AIS). Hypothesis: AF (either first episode or chronic) adversely affects stroke outcomes in patients undergoing IA treatment for AIS. Methods: We analyzed data from the 434 subjects in the IA treatment arm of Interventional Management of Stroke (IMS) III trial. The trial included AIS patients who were eligible for IV rtPA infusion within three hours after stroke onset. The subjects that were randomized to the IA treatment arm later received a protocol approved endovascular treatment. Demographics, vascular risk factors, and outcome measures were compared between patients with and without atrial fibrillation. The main outcomes considered were early neurological deterioration and hemorrhagic complications, excellent (mRS: scores of 0-2) functional outcome at 3 months, and good quality of life (EQ-5D index 0.5-1.0) at one year from randomization. Adjusted logistic regression analysis was performed to compare these outcomes. Results: Of the 434 patients who were studied (mean ± SD age, 66.3 ± 12.3 years, with 50.2% of patients being men), 153 had AF either chronic or diagnosed at baseline EKG and 281 had no AF. The patients with AF were significantly older (age 71.2±8.2 vs. 63.6±13.3 years), had more severe strokes (NIHSS&gt;=20) at baseline assessment (40.5% vs. 24.9%). The subjects with AF had higher adjusted odds of early neurological deterioration (OR 1.3, 95%CI 0.6-1.9, p=0.81), symptomatic intracranial hemorrhage (OR 1.7; 95% CI 0.7-3.8; p=0.27), and subarachnoid hemorrhage (OR 1.4; 95% CI 0.7-2.7; p=0.31). The subjects with AF had lower odds of having good functional outcome 3 months after randomization (OR 0.8; 95% CI 0.4-1.1; p=0.06). The two groups did not differ in their adjusted odds of symptomatic ICH, parenchymal hematomas, 90 days mortality, and quality of life after one year. Conclusions: In the patients undergoing IA treatment for AIS, AF may adversely impact early recovery in neurological function and long-term functional outcomes but not the rates of hemorrhagic complications, mortality, or good quality of life.

Serum S100B: A possible biomarker for severity of obstructive sleep apnea

IntroductionObstructive sleep apnea (OSA) is characterized by upper airway collapsibility and intermittent hypoxia (IH) during sleep. It has neurological complications and it has been associated with morbidity and mortality. Increased serum levels of S100B protein indicates brain injury. Early detection of possible complications of OSA patients could improve management of the disease. Study objectiveMeasurement of serum S100B protein in OSA patients with correlation to the severity of the disease. Patients and methodsFifty five OSA patients (24 females; 43.6% and 31 males; 56.4%) and 34 control individuals (17 females; 50% and 17 males; 50%) had a sleep apnea monitoring using the SAM equipment, Inter care technologies, model 100, USA, and S100B serum levels were measured after the sleep study at 6.30–7.30 am. ResultsS100B serum levels were higher in patients than controls (P<0.001) and the levels correlated with the apnea/hypopnea index (AHI) (P<0.001), lowest oxygen saturation (LOS) (P<0.001), and oxygen desaturation index (ODI) (P<0.001). ConclusionSerum S100B protein was significantly elevated in OSA patients and its serum levels correlated with the severity of the disease. Increased serum S100B could indicat brain injury and could be a potential serum biomarker for detection of early neurological complications in OSA patients that could improve the management and care of these patients.

Influence of early neurological complications on clinical outcome following lung transplant.

BackgroundNeurological complications after lung transplantation are common. The full spectrum of neurological complications and their impact on clinical outcomes has not been extensively studied.MethodsWe investigated the neurological incidence of complications, categorized according to whether they affected the central, peripheral or autonomic nervous systems, in a series of 109 patients undergoing lung transplantation at our center between January 1 2013 and December 31 2014.ResultsFifty-one patients (46.8%) presented at least one neurological complication. Critical illness polyneuropathy-myopathy (31 cases) and phrenic nerve injury (26 cases) were the two most prevalent complications. These two neuromuscular complications lengthened hospital stays by a median period of 35.5 and 32.5 days respectively. However, neurological complications did not affect patients’ survival.ConclusionsThe real incidence of neurological complications among lung transplant recipients is probably underestimated. They usually appear in the first two months after surgery. Despite not affecting mortality, they do affect the mean length of hospital stay, and especially the time spent in the Intensive Care Unit. We found no risk factor for neurological complications except for long operating times, ischemic time and need for transfusion. It is necessary to develop programs for the prevention and early recognition of these complications, and the prevention of their precipitant and risk factors.

Early and late neurological complications of liver transplantation in pediatric patients.

NCs occur commonly after solid organ transplantation and affect 15%-30% of liver transplant recipients. The aim of this retrospective study was to evaluate the type and incidence of neurologic events in pediatric patients following LT. Between May 2006 and June 2015, 242 patients (118 females, 124 males) requiring LT for different etiologies at the İnönü University Liver Transplantation Institute were included. The incidence, types, and risk factors of NCs that occurred following LT were evaluated retrospectively. Neurologic events occurred in 57 (23.5%) of the patients. Early NCs were encephalopathy (12.4%), seizures (11.5%), and PRES (7%). Of 57 patients, five (8.7%) experienced NCs at least 1month after LT; these late NCs included tremor, headaches, encephalopathy, ataxia, and neuropathy. The psychiatric symptoms after LT were noted in 42 patients (17.4%). The mortality rate after LT in those with or without neurological events was not significantly different (P=.73). There was a high incidence of serious neurologic events after LT. The major neurologic manifestation in our patients was encephalopathy followed by seizures.

Multidetector computed tomography in the assessment of neurologic complications after carotid endarterectomy

Rationale : Carotid endarterectomy is a surgical procedure to prevent acute ischemic cerebrovascular accidents. Neurologic complications can occur after surgery. Multidetector computed tomography (MDCT) is used for their diagnosis in severely ill patients. Aim : To evaluate the potential of MDCT in the diagnosis of neurologic complications after carotid endarterectomy. Materials and methods : We analyzed the results of radiologic assessments in 15 patients with early postoperative neurologic complications which occurred after surgery for internal carotid artery occlusion (595 patients underwent surgery). In stable patients, brain magnetic resonance imaging (MRI) was performed (T1, T2, FLAIR, DWI modes) with non-contrast MR angiography. In critically ill patients, brain computed tomography, computed tomographic angiography and perfusion computed tomography were performed. Results: Ischemic neurologic complications were found in 11 patients. One patient had no clinical manifestation of an ischemic stroke, and acute stage signs were found in his routine brain MDCT. In 9 patients with acute brain ischemia, MDCT (n = 6) and MRI (n = 3) results were specific for this diagnosis, with no diagnostic problems. There were problems with the diagnosis of the hyperacute ischemia in 1 patient. In this patient, the complication occurred against a background of abnormal carotid blood flow before surgery, therefore, differential diagnosis between the hyperperfusion syndrome on the intervention side and the hyperacute phase of ischemic insult on the opposite side was performed. Hyperperfusion syndrome and hemorrhagic strokes were observed in 4 patients. Conclusion : The most difficult for diagnosis by MDCT is the hyperacute phase of brain ischemia. Further studies are necessary in the area of diagnosis of postoperative complications, with the search for potential specific diagnostic criteria.

Incidence of early neurological complications in post allogeneic stem cell transplant patients

Incidence of early neurological complications in post allogeneic stem cell transplant patients

Analysis of early Versus Delayed Carotid Surgery after Acute Ischemic Stroke

Objective: Evaluate the 30-day outcomes of patients with an internal carotid artery (ICA) stenosis responsible for an acute brain infarct who underwent early (≤ 14 days) carotid endarterectomy (CEA) or delayed (15 days to 3 months) CEA. Methods: From July 2010 to June 2014, patients with a recent cerebral infarct who underwent CEA within 3 months after symptom onset were collected. This was a continuous, monocentric, and retrospective series. Two groups were identified : Group A with patients who underwent CEA in the first fourteen days after symptom onset and Group B with patients who underwent CEA from the fifteenth day to the third month after symptom onset. Death, stroke and major cardiac events were analyzed. Results: Seventy-one patients with ICA stenosis responsible for an acute brain infarct underwent CEA (73.2% men, with a median age of 71). Nineteen patients underwent early CEA and 52 underwent delayed CEA. The mean interval from initial examination to surgery was 9.5 days (range, 3-14 days) in Group A and was 42 days (range, 15-92 days) in Group B. After one month, and with a 98.6% follow-up, no postoperative complication occurred in Group A and 2 patients had post-operative stroke (3.8%) in Group B. Conclusion: This retrospective study confirms the satisfactory outcomes of early CEA after acute brain infarct. A strict clinical and radiological selection of patients allows to prevent early neurological complications. Keywords : carotid stenosis, early surgery, results, brain infarct.

Brain Oxygen Supply Parameters in the Risk Assessment of Cerebral Complications During Carotid Endarterectomy

To determine whether preoperative regional cerebral oxygen saturation (rSO2) and the decrease in rSO2 during carotid clamping were predictive of the risk for neurologic complications in carotid endarterectomy and to determine the cutoff values of the studied parameters. Cohort, prospective, nonrandomized trial. Research Institute of Circulation Pathology, Novosibirsk, Russia. The study comprised 466 adults who underwent carotid endarterectomy since 2012. None. Patient characteristics, postoperative complications, and brain oxygen supply during carotid endarterectomy were analyzed. The primary endpoints were the perioperative and early postoperative neurologic complications. Ischemic stroke was diagnosed in 1.5% of patients, and cognitive disorders were reported in 2.6% of patients. Preoperative rSO2 of 50% was the cutoff value for the prediction of stroke outcome after carotid endarterectomy, with a sensitivity of 90.7% and specificity of 66.7%. A 20% decrease in rSO2 during temporary carotid clamping was the cutoff value for the prediction of stroke, with a sensitivity of 86.0% and specificity of 57.1%, and for the prediction of cognitive disorders, with a sensitivity of 88.1% and specificity of 58.3%. Preoperative rSO2 less than 50% and a decrease in rSO2 of at least 20% during temporary carotid artery clamping caused a significant increase in the hospitalization period. A 20% or more decrease in rSO2 during temporary internal carotid artery clamping during carotid endarterectomy caused a 10-fold increased risk of ischemic stroke and an 8-fold increased risk of cognitive disorders, whereas preoperative rSO2 less than 50% resulted in a 6-fold increased risk of ischemic stroke in the perioperative and early postoperative periods of carotid endarterectomy.

Neurovascular complications following carotid body paraganglioma resection

ObjectiveThe present consecutive case series reports our experience in the management of carotid body paraganglioma and aims to assess whether the Shamblin classification or tumor size are predictive of early and late postoperative neurovascular complications. Material and methodsA retrospective study included 54 carotid body tumor resections in 49 patients, between 1980 and 2011. Data comprised early (<1month) and late (18 months) postoperative neurovascular complications. ResultsEarly postoperative complications occurred in 31 cases, including 30 cases of cranial nerve deficit (56%). Cranial nerve deficit occurred in 83% of Shamblin III carotid body paragangliomas and was associated with significantly larger mean tumor size (4±1.4cm versus 2.9±1.3cm; P<0.01). Shamblin III tumor and tumor size>3.2cm emerged as predictive factors for early postoperative peripheral neurological complications. Eight patients (17%) showed no cranial nerve deficit recovery, even after 18 months’ follow-up; no predictive factors could be identified for this. ConclusionSurgical resection remains the only curative treatment in carotid body paraganglioma, with low vascular morbidity. However, early postoperative nerve deficit remains frequent (56%), although mostly temporary, with 17% definitive sequelae at 18 months. Tumor size and Shamblin classification are predictive of early neurovascular complications.

Treatment strategies for early neurological deficits related to malpositioned pedicle screws in the lumbosacral canal: A pilot study.

ObjectivesTo employ a simple and fast method to evaluate those patients with neurological deficits and misplaced screws in relatively safe lumbosacral spine, and to determine if it is necessary to undertake revision surgery.MethodsA total of 316 patients were treated by fixation of lumbar and lumbosacral transpedicle screws at our institution from January 2011 to December 2012. We designed the criteria for post-operative revision scores of pedicle screw malpositioning (PRSPSM) in the lumbosacral canal. We recommend the revision of the misplaced pedicle screw in patients with PRSPSM = 5′ as early as possible. However, patients with PRSPSM < 5′ need to follow the next consecutive assessment procedures. A total of 15 patients were included according to at least three-stage follow-up.ResultsFive patients with neurological complications (PRSPSM = 5′) underwent revision surgery at an early stage. The other ten patients with PRSPSM < 5′ were treated by conservative methods for seven days. At three-month follow-up, only one patient showed delayed onset of neurological complications (PRSPSM 7′) while refusing revision. Seven months later, PRSPSM decreased to 3′ with complete rehabilitation.ConclusionsThis study highlights the significance of consecutively dynamic assessments of PRSPSMs, which are unlike previous implementations based on purely anatomical assessment or early onset of neurological deficits.and also confirms our hypothesis that patients with early neurological complications may not need revision procedures in the relatively broad margin of the lumbosacral canal.Cite this article: X-J. Lin. Treatment strategies for early neurological deficits related to malpositioned pedicle screws in the lumbosacral canal: A pilot study. Bone Joint Res 2016;5:46–51. DOI: 10.1302/2046-3758.52.2000477.

Clinical Outcomes after Carotid Endarterectomy in Patients with Contralateral Carotid Occlusion

Severe carotid stenosis is typically treated with carotid endarterectomy (CEA), but there is debate about the safety of this procedure in patients with contralateral carotid occlusion (CCO). To compare 30-day outcomes after CEA in patients with severe carotid stenosis or without CCO. This retrospective, single-institution analysis included 434 patients who underwent CEA. All CEAs were performed under general anesthesia, and carotid shunts were used in 32 patients. Patients were categorized into 2 groups according to patency of the contralateral carotid artery: groups I (no CCO, n = 394) and II (with CCO, n = 40). Demographics, preoperative symptomatic status, and frequency of early (<30 days) symptomatic neurologic complications and death were compared. Total mortality after CEA was 1.6% (n = 7), 7 and 0 in groups I and II, respectively (P = 0.39). Overall stroke rate was 3.5% (n = 15), 15 and 0 in groups I and II, respectively (P = 0.20). Rate of transient ischemic attacks was 1.4% (n = 6), 5 and 1 in groups I and II, respectively (P = 0.37). Symptomatic group I patients had a higher rate of stroke and/or death (6.7% vs. 0%) (P = 0.85). In asymptomatic patients, the stroke and/or death rate was higher in group II (3.4% vs. 8.3%, P < 0.05). In group II, the frequency of shunt placement was higher (3% vs. 53%, P = 0.001). At mean follow-ups of 75.4 ± 47.5 months (group I) and 72.7 ± 49.9 months (group II), 157 and 13 additional deaths had occurred in groups I and II, respectively (P = 0.21). Patients with CCO who undergo CEA do not appear to be at increased risk for perioperative incidence of stroke and/or death, or any neurologic event.

Axillary Cannulation for Surgical Repair for Acute Stanford A Aortic Dissection: Long-term Survival and Freedom from Major Cerebrovascular Events with up to 10-year Follow-up

Objectives: Previous research suggests that axillary cannulation for aortic repair of Stanford A acute aortic dissection (AAD) may reduce early mortality and neurological complications. However, there is a lack of long-term results in terms of survival and stroke in this patient cohort. The aim of this study was to evaluate safety and efficacy of axillary cannulation in terms of long-term outcomes after surgical repair for AAD Stanford A.

Comprehensive risk assessment for early neurologic complications after liver transplantation.

To determine risk factors for early neurologic complications (NCs) after liver transplantation from perspective of recipient, donor, and surgeon. In all, 295 adult recipients were enrolled consecutively between August 2001 and February 2014 from a single medical center in Taiwan. Any NC in the first 30 d post-liver transplantation, and perioperative variables from multiple perspectives were collected and analyzed. The main outcome was a 30-d NC. Generalized additive models were used to detect the non-linear effect of continuous variables on outcome, and to determine cut-off values for categorizing risk. Risk factors were identified using multiple logistic regression analysis. In all, 288 recipients were included, of whom 142 (49.3%) experienced at least one NC, with encephalopathy being the most common 106 (73%). NCs prolonged hospital stay (35.15 ± 43.80 d vs 20.88 ± 13.58 d, P < 0.001). Liver recipients' age < 29 or ≥ 60 years, body mass index < 21.6 or > 27.6 kg/m(2), Child-Pugh class C, history of preoperative hepatoencephalopathy or mental disorders, day 7 tacrolimus level > 8.9 ng/mL, and postoperative intra-abdominal infection were more likely associated with NCs. Novel risk factors for NCs were donor age < 22 or ≥ 40 years, male-to-male gender matching, graft-recipient weight ratio 0.9%-1.9%, and sequence of transplantation between 31 and 174. NCs post- liver transplantation occurs because of factors related to recipient, donor, and surgeon. Our results provide a basis of risk stratification for surgeon to minimize neurotoxic factors during transplantation.

Combined in utero hypoxia-ischemia and lipopolysaccharide administration in rats induces chorioamnionitis and a fetal inflammatory response syndrome

IntroductionPreterm birth is a major cause of infant morbidity and long-term disability, and is associated with numerous central nervous system (CNS) deficits. Infants exposed to intrauterine inflammation, specifically chorioamnionitis, are at risk for very early preterm birth and neurological complications including cerebral palsy, epilepsy, and behavioral and cognitive deficits. However, placenta-brain axis abnormalities and their relationship to subsequent permanent CNS injury remain poorly defined. MethodsIntrauterine injury was induced in rats on embryonic day 18 (E18) by transient systemic hypoxia-ischemia (TSHI) and intra-amniotic lipopolysaccharide (LPS) injection. Placenta, brain and serum were collected from E19 to postnatal day 0 (P0). Histology, TUNEL staining, western blot and multiplex immunoassays were used to quantify placental and brain abnormalities, and fetal serum cytokine levels. ResultsPrenatal TSHI + LPS caused acute and subacute placental injury hallmarked by inflammatory infiltrate, edema, hemorrhage and cell death along with placental increases in IL-1β and TNFα. TSHI + LPS increased a diverse array of circulating inflammatory proteins including IL-1β, TNFα, IL-6, IL-10, IL-4, IFNγ and CXCL1, both immediately after TSHI + LPS and in live born pups. CNS inflammation was characterized by increased CXCL1. DiscussionPrenatal TSHI + LPS in rats induces placental injury and inflammation histologically consistent with chorioamnionitis, concomitant with elevated serum and CNS pro-inflammatory cytokines. This model accurately recapitulates key pathophysiological processes observed in extremely preterm infants including placental, fetal, and CNS inflammation. Further investigation into the mechanism of CNS injury following chorioamnionitis and the placental-brain axis will guide the use of future interventions.

Evaluation of Early Postoperative Neurological Complications Following Living Donor Liver Transplantation.

Liver transplantation is one of the best treatment options for end-stage liver disease. In Turkey, living donor liver transplantation (LDLT) is performed more frequently than cadaveric transplantation, because organ donation is unpopular in our country. Neurological complications contribute to poor postoperative outcomes after liver transplantation. In the present study, we aimed to evaluate the outcomes of LDLT patients in whom such complications developed early during postoperative follow-up in the intensive care unit. Of 217 LDLTs performed between August 2011 and August 2012, neurology consultations were arranged for 29 patients (13.36%) because of development of new-onset neurological symptoms and/or findings in patients with neurologically uneventful preoperative histories. We retrospectively collected data on age, gender, primary disease, Model for End-Stage Liver Disease (MELD) score, and postoperative hospitalization duration of those who survived. The indications for neurological consultation and diagnoses were categorized into acute confusion/encephalopathy, epileptic seizures, leukoencephalopathy, and focal neurological deficits. The immunosuppressive treatment regimens prescribed were also considered. The outcomes of the 2 groups (with and without neurological complications) were compared. The mean patient age was 44.52±16.24 years, and males predominated (65.5%, n=19). Acute confusion/encephalopathy was the most frequent complication (62.1%, n=18), followed by epileptic seizures (27.6%, n=8), cerebrovascular disease (6.9%, n=2), and leukoencephalopathy (3.4%, n=1). Statistically significant between-group differences in age (44.5±16.2 vs. 34.33±20.98 years; p<0.001), and proportions of patients with a disease of viral etiology (55.17% vs. 35.63%, p<0.05), were evident. Mortality was significantly higher in the group with neurological complications (65.5% vs. 37.32%, p<0.05). The duration of postoperative hospitalization was also significantly longer in this group (29.80±15.04 vs. 10.00±5.47 days; p<0.05). Mortality was significantly higher and the duration of postoperative hospitalization significantly longer in LDLT patients with new-onset neurological complications than in those without such complications.

High Incidence of Neurological Complications in Patients with Sickle Anemia Disease Undergoing Related Myeloablative Allogeneic Hematopoietic Stem Cell Transplantation: Early Diagnosis and Treatment Can Chance the Prognosis

Introduction: Hematopoietic stem cell transplantation (HSCT) was offered primarily as a therapeutic option for severe sickle cell disease in the context of myeloablative matched sibling donor transplants over the last two decades and helped to establish the benefits of transplantation for this disorder. In recent years, the transplant community has set out to explore ways to make stem-cell transplantation more available to patients with the disease, define indications and better timing, and offset toxicities with novel approaches to conditioning and better supportive care. In this context, neurological complication such as stroke disease and blood flow alteration in medial cerebral artery constitute the main indications of HSCT but neurological complications are the main causes of TRM in D+100 and is important to find ways to prevent this problem.Objective: Describe early neurological complications in sickle patients undergoing related HSCT on single specialized center and its following after the early diagnosis.Material and Methods: Seven patient were undergone related HSCT for sickle disease from 2011 to 2013. All patients filled inclusion criteria in the study and signed agreement term.Results: Seven HSCT were developed in the period, being four males. The average age was 13 years old (7-24). The HSCT indications were previous stroke, cerebral flow alteration on Doppler, acute chest syndrome and alloimunization. All patient were on blood transfusion therapy. The conditioning regimen was BuCy + ATG and the GVHD prophylaxis was MTX and CSA. Related donors were chosen with 10/10 HLA match and graft source marrow. The median of the neutrophil engraftment was D+ 25 and the platelets engraftment was in D+60. Two patient died, one by intestinal and liver GVHD on D+120, and another with sagittal sinus thrombosis and hemorrhagic stroke on D+3. Other two patients showed PRES syndrome related to cyclosporine use. The patients showed generalized seizures with tomographic neurological alteration. After the imunossupressor change to tacrolimus and the change of Phenytoin to Lamotrigine, the patient had total resolution of neurological complications without development of neurological sequelae. Patients who used Lamotrigine since the beginning of the conditioning have not shown neurological alterations.Conclusion: The PRES Syndrome and Stroke are two of the main causes of mortality related to the use of calcineurin inhibitors. Patients with sickle disease have shown endothelial and cerebral microcirculation changes, which made them highly susceptible to neurological complication. The control of blood pressure, maintenance of 50.000 platelets level and the use of Lamotrigine as prophylaxis of seizures seems to decrease the risk of neurological complications. Prospective studies with lamotrigine as primary prevention of PRES Syndrome must be performed. Patients with severe neurological alteration as vessels stenosis more than 90% and Moya-Moya Syndrome must be better evaluated before the conditioning because of high TRM risk. DisclosuresNo relevant conflicts of interest to declare.

Phenotypic and genotypic characteristics of cryopyrin-associated periodic syndrome: a series of 136 patients from the Eurofever Registry

ObjectiveTo evaluate genetic, demographic and clinical features in patients with cryopyrin-associated periodic syndrome (CAPS) from the Eurofever Registry, with a focus on genotype-phenotype correlations and predictive disease severity markers.MethodsA web-based...

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Aims: To describe our experience using ECPR on children with cardiac arrest refractory to conventional CPR; and explore predictors of mortality and survival rates for ECPR. Methods: We retrospectively reviewed all medical records of paediatric patients who received ECMO after ECPR in our hospital from 2004 to 2011. We analysed: cause of cardiac arrest, CPR to ECMO times, complications and survival to discharge rates. Results: 31 cases of ECPR were identified. 23 cases were cardiac including 10 patients that were post cardiac surgery (RACHS 6/5 = 7); and the remaining 8 cases were respiratory. Survival to discharge was 55%, with deaths recorded from 9 cardiac (RACHS 6/5 = 3) and 5 non-cardiac cases. Hypotension was the main cause of cardiac arrest (18). The median time from CPR to ECMO was 32 minutes (5–278 mins). The median time for CPR to ECMO was less in cases from 2006–2008 compared to 2009–2011 (50 vs. 32 minutes p=0.189). The only identified predictors of mortality from the study were pre ECMO ph of <6.9 (p=0.007) and neonatal age group (p=0.003). Renal dysfunction and mechanical problems such as cannulation and circuit issues accounted for the commonest complications, 70% and 61% respectively; while early neurological complications were experienced in 22% of cases. Conclusions: The ECPR experience of the unit reflects a similar or slightly better survival outcome (>50%) than that reported in other units, albeit on a smaller number of patients. The study identified neonatal age group and pre ECMO ph of <6.9 to be poor predictors of mortality.

Endovascular management of acute complicated type B aortic dissection: adjunct procedures

Background: This study aims to evaluate the results of endovascular treatment (TEVAR) and the contribution of adjunct procedures in acute complicated type B aortic dissections. Methods: Thirty patients (26 males, 4 females; mean age 55.2±14.7 years, range 24 to 86 years) with acute complicated type B dissection underwent endovascular treatment. The dissection was complicated by malperfusion in eight patients (26.7%), impending rupture in four (13.3%), uncontrollable hypertension in 12 (40%), and severe treatmentresistant pain in six (20%). Self-expanding stent-grafts (Talent® and Valiant®, Medtronic Inc.) were used. Ostium of the left subclavian artery was covered intentionally in 19 patients (63.3%). Additional stenting was necessary in eight patients (26.7%). Of a total of 12 bare metal stents used in these patients, stents were inserted in the renal arteries in six (20%), iliac arteries in three (10%), and celiac arteries in two (6.7%) patients. Median follow-up was 55 months (range, 25 to 99 months). Results: The mean number of stent-grafts implanted was 1.42 (range, 1 to 3). One patient had inadvertent partial closure of the left common carotid artery ostium due to proximal migration of the stent-graft which caused no early neurological complications. Right hemiplegia occurred 15 months later due to his discontinuation of the anticoagulant therapy in the same patient. In another patient with visceral malperfusion, early laparoscopic exploration following the stenting of the celiac and the left renal arteries revealed no ischemia of the bowels. One patient with postoperative angina pectoris required stenting of the right coronary artery. There was no stroke in any patients, while reversal of paraplegia was observed in one patient early after the procedure. The mean lengths of intensive care unit and hospital stays were 3.2±3.4 and 9.8±7.1 days, respectively. There was no 30-day mortality. The one-year survival rate was 96.7%. Conclusion: Although endovascular treatment of complicated type B aortic dissections has a high success rate, TEVAR may not be the sole solution. Findings of malperfusion should be carefully sought in the early postoperative period. The adjunct procedures such as stenting of the visceral arteries or open surgical revascularization should always be considered particularly in young patients.