Low Prevalence Of Complications Research Articles

A study on functional outcome of distal end femur fracture in adults managed with locking compression plate

Background: We have evaluated the clinical outcome of surgery using locking compression plate in patients with fracture of distal end of femur in terms of union time, weight bearing and complications. Methods: The present study was conducted in the department of orthopaedics, Bombay hospital, Indore (M. P.). With a prevalence of 3% of adult distal femoral fracture, the sample obtained was 30 with distal end femur fractures in the study. Protocol of surgery was followed in each patient. Postoperative rehabilitation was also adhered to in all patients. Results: The mean age of 37.87±11.76 years with a male (25) predominance and more right-side involvement. RTA constituted 90% of the patients. According to AO/ASIF classification, type C1 (23.3%) and type A2 (20%) were the common fracture types seen. The radiological union was achieved in majority by 19-20 weeks. Full weight bearing was started by 15-16 weeks with mean of 18.93±2.02 weeks. In 43.3% patients knee flexion of more than 110 degree was achieved. Infection was seen in 10% patients and limb shortening (<10 mm) was seen in 6.7% patients. According to Neer’s scoring system, 56.7% patients had excellent, 33.3% patients had good, 3.3% patients had fair and 6.7% patients had poor functional outcome. Conclusions: The treatment of fracture distal end of femur using locking compression plate was found to provide good to excellent functional outcome in majority of the patients, with low prevalence of complications.

S1010 Obesity Is Associated With Lower Prevalence of Complications in Crohn’s Disease: A Global Healthcare Database Study

S1010 Obesity Is Associated With Lower Prevalence of Complications in Crohn’s Disease: A Global Healthcare Database Study

Effect of Targeted Embolization on Seizure Outcomes in Patients with Brain Arteriovenous Malformations.

Seizures are one of the most debilitating manifestations of brain arteriovenous malformations (AVMs). This study aimed to evaluate the effect of curative embolization on brain AVM patients presenting with seizures. The records of patients who underwent embolization for brain AVM from January 2012 to December 2020 were evaluated and patients presenting with seizures were interviewed. Patient responses were evaluated according to the International League Against Epilepsy (ILAE) and Engel classifications. Statistical analyses of factors associated with seizure outcomes and complications were performed using ANOVA and Fischer's exact tests. The mean age of the participants was 35.2 ± 10.7 years. More than 80% of the patients received no or suboptimal dosages of antiepileptic drugs (AEDs) prior to embolization. Positive seizure dynamics were observed in 50% of the patients post-procedure. A correlation was found between length of seizures in anamnesis and outcomes of both Engel and ILAE score, where shorter length was associated with better outcomes. Post-embolization hemorrhage was associated with initial presentation with hemorrhage. The embolization of brain AVMs had a positive effect on seizure presentation and a relatively low prevalence of complications. However, the results of the study are obscured by inadequate AED treatment received by the patients, which prompts prospective studies on the topic with careful patient selection.

Transcranial electric stimulation motor evoked potentials for cervical spine intraoperative monitoring complications: systematic review and illustrative case of cardiac arrest

We show a systematic review of known complications during intraoperative neuromonitoring(IONM) using transcranial electric stimulation motor evoked potentials (TES-MEP) on cervical spine surgery, which provides a summary of the main findings. A rare complication during this procedure, cardiac arrest by cardioinhibitory reflex, is also described. Findings of 523 scientific papers published from 1995 onwards were reviewed in the following databases: CENTRAL, Cochrane Library, Embase, Google Scholar, Ovid, LILACS, PubMed, and Web of Science. This study evaluated only complications on cervical spine surgery undergoing TES-MEP IONM. The review of the literature yielded 13 studies on the complications of TES-MEP IONM, from which three were excluded. Five studies are case series; the rest are case reports. Overall, 169 complications on 167 patients were reported in a total of 38,915 patients, a global prevalence of 0.43%. The most common complication was tongue-bite in 129 cases, (76.3% of all complication events). Tongue-bite had a prevalence of 0.33% (CI 95%, 0.28-0.39%) in all patients on TES-MEP IONM. A relatively low prevalence of severe complications was found: cardiac-arrhythmia, bradycardia and seizure, the prevalence of this complications represents only one case in all the sample. Alongside, we report the occurrence of cardiac arrest attributable to TES-MEP IONM. This systematic review shows that TES-MEP is a safe procedure with a very low prevalence of complications. To our best knowledge, asystole is reported for the first time as a complication during TES-MEP IONM.

#29 Skin and Soft Tissue Infections and Associated Complications in Children Aged 0-3 Years in Two Urban Multiethnic Community Hospitals

Abstract Background Skin and soft tissue infections (SSTI) include cellulitis and abscess. Cellulitis is an infection of the deep dermis and an abscess is a collection of pus within the dermis and subcutaneous space. Complications of SSTI include bacteremia, lymphadenitis, endocarditis, septic arthritis or osteomyelitis, metastatic infection, sepsis, and toxic shock syndrome. There are no studies evaluating SSTI and complications and outcomes in children aged 0-3 years. Method This is a retrospective chart review of SSTI in children aged 0-3 years in Flushing Hospital Medical Center and Jamaica Hospital Medical Center between Jan 2015 and Oct 2021. Data extracted from EHR include demographics (age, gender, ethnicity), clinical presentation, laboratory studies, imaging studies, antibiotic used, treatment course, complications and length of stay (LOS). Data were analyzed using percentages. Results Of 206 patients admitted for SSTI, about a half (48%) were abscesses, less than half (44%) cellulitis, few impetigo (6%) and staphylococcal scalded skin syndrome (2%). Most were male (52%), Hispanic (70%) and Asian (26%). A fifth (18%) had previous SSTI and a tenth (8%) had a positive family history. Of a third (36%) who had imaging studies, three quarters (76%) had an ultrasound, less than a half (44%) confirmed an abscess and less than a third (29%) soft tissue infection. Almost all (94%) had a blood culture and most a wound culture (59%). Of the positive blood cultures (4%), majority (78%) were contaminants or normal skin flora and remainder (22%) Staphylococcus aureus. Of the positive wound cultures, most (86%) were Staphylococcus aureus. Methicillin-sensitive S. aureus (MSSA) was equal to methicillin-resistant S. aureus (MRSA) (44% vs 43%). Of the 11% having complications, the most common was lymphadenitis (6%). Clindamycin was the antibiotic of choice in most (70%) and 14% required a change in antibiotic due to susceptibility pattern. The median LOS was 3 days. Conclusion The most common SSTI in children aged 0-3 years is abscess and cellulitis. The yield of blood cultures is low. The prevalence of MRSA was equal to MSSA. Knowing the low prevalence of complications in children with SSTI, healthcare providers can provide appropriate antibiotic coverage and disposition for SSTI in our community.

High results and lower cost in four-bone arthrodesis with retrograde screws.

Aim To describe the technique of the four-corner fusion with two retrograde crossed headless screws in cases of carpal collapse. Methods This technique is a consolidated procedure performed in cases of scaphoid non- union advanced collapse (SNAC) type II and III, scapholunate advanced collapse (SLAC) type II and III and in other cases of carpal collapse. Between 2017 and 2019 we treated six male patients (a mean age of 55.0 years) with radiocarpal osteoarthritis. Our technique involves the use of two retrograde crossed headless screws; the first screw was placed distally proximally from the uncinate to the lunate and the second screw from the pyramidal to the capitate, crossed at approximately 90 degrees. Clinical and radiographic two-year follow-up was performed. Before the treatment and during the follow-ups VAS, PRWE and DASH Quick score scales, measured wrist range of motion (WROM) were administered and evaluated. Results In all cases the X-ray consolidation of arthrodesis within five months was noticed; in 50% patients already under 3-month control. No observed signs of mobilization of screws and inflammatory or infectious processes were found. All patients were satisfied (reduction/disappearance of pain). All surgically treated patients resumed normal daily activities. These improvements were confirmed by the results of the evaluation scale and clinical examination. Conclusion This technique, in our opinion, represents a gold standard. Its low costs of the material used (especially comparing to other technique), a low prevalence of complications of materials and fusion in 100% of cases should be also considered.

Surgical Aspects of Corpus Callosotomy.

Corpus callosotomy (CC) is one of the options in epilepsy surgeries to palliate patient seizures, and is typically applied for drop attacks. The mechanisms of seizure palliation involve disrupting the propagation of epileptic activity to the contralateral side of the brain. This review article focuses on the surgical aspects of CC. As a variations of CC, anterior two-thirds, posterior one-third, and total callosotomy are described with intraoperative photographs. As less-invasive surgical variations, recent progress in endoscopic CC, and CC without craniotomy, is described. CC remains acceptable under the low prevalence of complications, and surgeons should make the maximum effort to minimize the complication rate.

Clinical and functional outcome of metal backed versus all polyethylene post operated total knee replacement patients: a prospective study

<p class="abstract"><strong>Background:</strong> Osteoarthritis (OA) is most common chronic degenerative disease in orthopaedic practice. The literature pertaining to comparison of the clinical outcome and functional outcome between the metal backed and all polyethylene prosthesis for the total knee replacement are scant. </p><p class="abstract"><strong>Methods:</strong> A prospective study was undertaken in a tertiary hospital April 2018 to June 2019. The final sample size was 32 cases (40 knees) of newly diagnosed of primary OA knee cases treated with cemented TKR with Metal backed prosthesis and 29 cases (40 knees) with all polyethylene prosthesis. The patients were followed up at 1st, 3rd and 6th post-operative months.<strong></strong></p><p class="abstract"><strong>Results:</strong> Knee clinical score pre-op was not statistically significant. But after 1 month, after 3 months after 6 months, knee clinical score was statistically significant. Knee functional score pre-op, after 1 month, after 3 months, after 6 months was not statistically significant. 87% patients of metal back total knee replacement and 85% of all poly total knee replacement had no pain or just mild pain.</p><p class="abstract"><strong>Conclusions:</strong> Total knee arthroplasty resulted in excellent relief of pain, range of motion, restoration of function, and low prevalence of complications and continues to function well during the follow-up period. Improvement in clinical score in MB group is correlated significantly than all polyethylene group. Knee society scoring system is an effective in evaluating clinical, functional outcomes.</p>

Assessment of complications following use of pneumatic tourniquet for elective orthopedic procedures at National Orthopedic Hospital, Enugu

<p class="abstract"><strong>Background:</strong> A pneumatic tourniquet is a constricting or compressing device with an inflatable cuff used to control venous or arterial circulation to an extremity for a period of time. Tourniquet safety is related to the cuff pressure and duration of application. The objective of this study was to determine the common complications that follow the use of pneumatic tourniquet in elective orthopaedic surgical procedures at National Orthopaedic Hospital Enugu.</p><p class="abstract"><strong>Methods:</strong> This was a prospective study over 18 month period (June 2014 – November 2015) at National Orthopaedic Hospital, Enugu. Following ethical approval and written informed consent, patients who met the inclusion criteria were consecutively recruited. The study was conducted using the ‘intelligent pneumatic tourniquet’<strong><em> </em></strong>with single bladder reusable cylindrical cuff. The cuff pressure was determined in each case by addition of 100mmHg to the baseline systolic BP for the upper limbs and 150 mmHg to the baseline systolic BP for the lower limbs. The data collected included patients’ demographics, cuff pressure, cuff location, tourniquet duration and complication encountered among other parameters.</p><p class="abstract"><strong>Results: </strong>A total of 160 procedures in 152 patients were included and analyzed using SPSS version 20.0. The prevalence rate of 1.9% for nerve palsy, 1.3% for tourniquet pain, 1.9% for surgical site infection and 5.6% for pressure sore were found in the study. No other complication was encountered.</p><p class="abstract"><strong>Conclusions:</strong> From the results of this study, it is concluded that the use of pneumatic tourniquet under the prescribed conditions is associated with low prevalence of complications.</p>

Efficacy and the safety of percutaneous closure of persistent ductus arteriosus in low-weight infants

The persistent ductus arteriosus remains a common congenital pathology. Although percutaneous closure is an attractive alternative to the surgical treatment for infants weighing less than 6 kg. The objective was to evaluate the efficacy and safety of percutaneous closure in low-weight children. Children weighing less than 6 kg who underwent percutaneous closure of patent ductus arteriosus in Cardiology department of Sahloul University Hospital during 13 years between September 2003 and June 2016 were retrospectively included. Eighteen children (mean weight: 5.49 kg [range: 4.2–6]; mean age: 10.9 months [range: 3–85]) were included. The main circumstance for discovery was difficulty in breathing (100%). The average angiographic persistent ductus arteriosus diameter was 3.08 mm [range: 1.12–5.68 mm]. Fifteen children (83.35%) had pulmonary hypertension of cases. Eleven patients (61.2%) had a channel A-type, 5 patients (27.8%) had C type, un patient (5.5%) had D type and un patient (5.5%) had E type on the Krichenko classification. A device was implanted in all cases. The prosthesis was implanted successfully in 94.44 of cases. The only failure was explained by immediate embolization of the device. The average duration of the procedure was 50 ± 10 min. After a device was installed, complete occlusion was obtained in 90% at day 1, 92% at a month and 100% at 12 months. Two complications occurred: pulmonary protrusion in one case and aortic protrusion in another case. No late embolization occurred after 37.5 months of median follow-up [range: 3–138]. During this monitoring, we noted a marked clinical improvement with normalization of pulmonary pressure. The study shows the feasibility and the efficacy of percutaneous closure in persistent ductus arteriosus in infants weighing less than 6 kg. It confirms the effectiveness of the procedure with a relatively low prevalence of complications.

Minimally invasive spine surgery for degenerative spine disease and deformity correction: a literature review.

During the last two decades, minimally invasive techniques and instruments in spine surgery have undergone serious development in all fields. Specific advantages of these minimally invasive methods have put them forward in spine surgery in recent times. Preservation of important anatomical structures of the spine is a major factor for the evolution of these procedures. The lower prevalence of complications and faster rehabilitation of patients are some of the advantages of minimally invasive spine surgery (MISS). Due to the increasing use of minimally invasive methods in the clinical practice worldwide, there is a strong need for clarification of basic principles, tips and tricks, complications, and clinical outcomes. This review is an effort to provide a better understanding of some of these procedures.

Percutaneous closure of persistent ductus arteriosus in small weight infants

The persistent ductus arteriosus remains a common congenital pathology. If percutaneous closure of wide channels by Amplatzer duct occluder is an attractive alternative to the surgical treatment, this prosthesis is however not recommended for infants less than 6 kg. Our objective was to evaluate the efficacy and the safety of use of this prosthesis in low-weight children. The records of children less than 6 kg who underwent closure by the Amplatzer Duct Occluder prosthesis between January 2010 and December 2015 were retrospectively analyzed. Fourteen patients [mean weight 5.7 kg (4.8 to 6); mean age 6.5 months (3–12)] have been included. The average diameter angiographic persistent ductus arteriosus was 3.5 mm (3–6 mm) with a good correlation with that found on ultrasound ( r = 0.68). The prosthesis was implanted successfully in 92.8% of cases. The immediate angiographic occlusion rate was 71.4%. The average duration of the procedure was 46 ± 12 min. Three children had a type of channel C of the classification Krichenko. Two complications occurred in two of our patients. Persistent ductus arteriosus C-type (tubular) and a diameter ratio of the persistent ductus arteriosus/weight of higher child 0.95 were significantly associated with a failure of intervention and/or major complications throughout the percutaneous closure of register having included 67 patients, while a weight of less than 6 kg was not retained as a predictor of failure of the procedure. No late embolisation occurred after 11 months of median follow up. During this monitoring, we noted a marked clinical improvement with normalization of pulmonary pressure. Our study includes the few records reported in the literature assessing the feasibility of percutaneous closure in persistent ductus arteriosus in infants less or equal to 6 kg. It confirms the effectiveness of the procedure with a relatively low prevalence of complications.

Benefits and Risks of Non-Approved Injection Regimens for Botulinum Toxins in Spasticity.

Spasticity with muscle paresis and loss of dexterity is a common feature of upper motor neuron syndrome due to injuries or the pyramidal tract in several neurological conditions. Botulinum toxin type A has been considered the gold standard treatment for spasticity and movement disorders, with efficacy, reversibility, and low prevalence of complications. During the last 30years, thousands of studies of its use have been performed, but few guidelines are available. Therefore, there is great variability in both the doses and intervals of administration and the approaches taken by clinicians with considerable experience in spasticity and movement disorder treatment. In the present review article, we provide a short overview of the benefits and risks of non-approved injection regimens and doses for botulinum toxins, focusing on the treatment of post-stroke spasticity, where there is great interest in the potential for increasing the number of treatment/years and the dose of botulinum toxin treatment for subjects with upper and lower limb spasticity. However, many doubts exist regarding antibody development and possible adverse effects.

Long-term safety of repeated high doses of incobotulinumtoxinA injections for the treatment of upper and lower limb spasticity after stroke

Current guidelines suggested a dosage up to 600units (U) of botulinum toxin type A (BoNT-A) (onabotulinumtoxinA or incobotulinumtoxinA) in reducing spastic hypertonia with low prevalence of complications, although a growing body of evidence showed efficacy with the use of high doses (>800U). The available evidence mainly referred to a single set of injections evaluating the efficacy and safety of the neurotoxin 30days after the treatment. In a prospective, non-randomized, open-label study, we studied the safety of repeated higher doses of incobotulinumtoxinA in post-stroke upper and lower limb spasticity.Two years after the first set of injections, we evaluated in 20 stroke survivors with upper and lower limb spasticity the long-term safety of repeated high doses of incobotulinumtoxinA (up to 840U) for a total of eight sets of injections.Patients reported an improvement of their clinical picture concerning a reduction of spasticity measured with the Asworth Scale (AS) for elbow, wrist, fingers and ankle flexor muscles and disability measured with the Disability Assessment Scale (DAS) 30days after the last set of injections (eighth set) compared to the baseline (p<0.0001). No difference in AS and DAS scores has been found between t1 (30days after the first injection set) and t2 (30days after the eighth set of injections), with also similar safety.In a two-year follow-up, repeated high doses of incobotulinumtoxinA, administered for eight sets of injections, appeared to be safe in patients with upper and lower limb spasticity after stroke without general adverse effects.

La fermeture percutanée du canal artériel persistant chez les enfants de faible poids

The persistent ductus arteriosus remains a common congenital pathology. Although percutaneous closure of wide channels using an Amplatzer Duct Occluder is an attractive alternative to the surgical treatment, this prosthesis is not recommended for infants weighing less than 6kg. The objective was to evaluate the efficacy and safety of this prosthesis in low-weight children. The records of children weighing less than 6kg who underwent closure with the Amplatzer Duct Occluder prosthesis between January 2010and December 2014were retrospectively analyzed. Fourteen patients (mean weight: 5.7kg [range: 4.8-6]; mean age: 6.5months [range: 3-12]) were included. The main circumstance for discovery was difficulty in breathing (93% of children). The average angiographic persistent ductus arteriosus diameter was 3.5mm (range: 3-6mm), correlating well with that found on ultrasound (r=0.68). The prosthesis was implanted successfully in 93% of cases. The only failure was explained by the increased risk of aortic subocclusion. The immediate angiographic occlusion rate was 71%. The average duration of the procedure was 46±12min. Three children had a channel C-type on the Krichenko classification. Two complications occurred in two patients: a case of cardiac tamponade drained during the procedure without incident and one case of partial protrusion of the Amplatzer disk into the aortic lumen. C-type (tubular) persistent ductus arteriosus and a ratio of the diameter of the persistent ductus arteriosus/weight greater than 0.95were significantly associated with intervention failure and/or major complications during the percutaneous closure, while weight of less than 6kg was not retained as a predictor of procedure failure. No late embolization occurred after 11months of median follow-up. During this monitoring, we noted a marked clinical improvement with normalization of pulmonary pressure. This study includes the few records reported in the literature assessing the feasibility of percutaneous closure in persistent ductus arteriosus in infants weighing up to 6kg. It confirms the effectiveness of the procedure with a relatively low prevalence of complications.

Single-center experience with extracranial carotid aneurysm open repair.

Our aim is to report our single center experience with extracranial carotid artery aneurysms (ECAA) open repair. A retrospective review was performed including the perioperative and postoperative data of all patients who underwent ECAA repair between 2008 and 2015. The operative technique was based on aneurysm size, anatomical features and operative risk. Fourteen patients (6 men and 8 women, mean age 60.5 years) were admitted for ECAA. Thirteen patients (92.8%) were submitted to ECCA open repair while in one patient (7.2%) conservative treatment was realized. Bilateral lesions and concomitant internal carotid artery (ICA) kinking was observed in 2 cases (14.2%). Seven patients (50%) were asymptomatic at diagnosis and ECCA localization involved ICA in 9 cases (64.2-69.2%). Aneurysmectomy with end-to-end anastomosis was performed in 3 cases (23.07-23.1%), patch arterioplasty in 2 cases (15.38-15.4%), prosthetic graft interposition in 4 cases (30.76-30.7%), autologous vein graft bypass in 3 cases (23.07-23.1%) and artery ligation with distal ICA anastomosis in one case (7.6-7.6%). No perioperative deaths, major neurological complications and surgical reinterventions were recorded. Overall survival at a mean follow-up of 19.6 months (range 0-52 months) was 100%. ECAA open repair represents a safe surgical option, with lower prevalence of complications and no need for reintervention in high volume centers.

Safety and efficacy of incobotulinumtoxinA as a potential treatment for poststroke spasticity.

Spasticity is a common disabling symptom for several neurological conditions. Botulinum toxin type A injection represents the gold standard treatment for focal spasticity after stroke showing efficacy, reversibility, and low prevalence of complications. In recent years, incobotulinumtoxinA, a new Botulinum toxin type A free of complexing proteins, has been used for treating several movement disorders with safety and efficacy. IncobotulinumtoxinA is currently approved for treating spasticity of the upper limb in stroke survivors, even if several studies described the use also in lower limb muscles. In the present review article, we examine the safety and effectiveness of incobotulinumtoxinA for the treatment of spasticity after stroke.

The current status of intraoperative iPTH assay in surgery for primary hyperparathyroidism.

Intraoperative intact parathyroid hormone (iPTH) monitoring has been accepted by many centers specializing in parathyroid surgery as a useful adjunct during surgery for primary hyperparathyroidism. This method can be utilized in three discreet modes of application: (I) to guide surgical decisions during parathyroidectomy in one of the following clinical contexts: (i) to confirm complete removal of all hyperfunctioning parathyroid tissue, which allows for termination of surgery with confidence that the hyperparathyroid state has been successfully corrected; (ii) to identify patients with additional hyperfunctioning parathyroid tissue following the incomplete removal of diseased parathyroid/s, which necessitates extended neck exploration in order to minimize the risk of operative failure; (II) to differentiate parathyroid from non-parathyroid tissue by iPTH measurement in the fine-needle aspiration washout; (III) to lateralize the side of the neck harboring hyperfunctioning parathyroid tissue by determination of jugular venous gradient in patients with negative or discordant preoperative imaging studies, in order to increase the number of patients eligible for unilateral neck exploration. There are many advantages of minimally invasive parathyroidectomy guided by intraoperative iPTH monitoring, including focused dissection in order to remove the image-indexed parathyroid adenoma with a similar or even higher operative success rate, lower prevalence of complications and shorter operative time when compared to conventional bilateral neck exploration. However, to achieve such excellent results, the surgeon needs to be aware of hormone dynamics during parathyroidectomy and carefully choose the protocol and interpretation criteria that best fit the individual practice. Understanding the nuances of intraoperative iPTH monitoring allows the surgeon for achieving intraoperative confidence in predicting operative success and preventing failure in cases of unsuspected multiglandular disease, while safely limiting neck exploration in the majority of patients with sporadic primary hyperparathyroidism. Thus, parathyroidectomy guided by intraoperative iPTH monitoring for the management of sporadic primary hyperparathyroidism is an ideal option for the treatment of this disease entity. However, the cost-benefit aspects of the standard application of this method still remain a matter of controversy.

Percutaneous Coronary Intervention to Treat Chronic Total Occlusion: Predictors of Technical Success and One-Year Clinical Outcome

We investigated the overall success rate of percutaneous coronary intervention (PCI) as a treatment for coronary chronic total occlusion and sought to determine the predictive factors of technical success and of one-year major adverse cardiac events (MACE). These factors have not been conclusively defined. Using data from our single-center PCI registry, we enrolled 269 consecutive patients (mean age, 56.13 ± 10.72 yr; 66.2% men) who underwent first-time PCI for chronic total occlusion (duration, ≥3 mo) from March 2006 through September 2010. We divided them into 2 groups: procedural success and procedural failure. We compared occurrences of in-hospital sequelae and one-year MACE between the groups, using multivariate models to determine predictors of technical failure and one-year clinical outcome. Successful revascularization was achieved in 221 patients (82.2%). One-year MACE occurred in 13 patients (4.8%), with a predominance of target-vessel revascularization (3.7%). The prevalence of MACE was significantly lower in the procedural-success group (1.8% vs 18.8%; P <0.001). In the multivariate model, technical failure was the only predictor of one-year MACE. The predictors of failed procedures were lesion location, multivessel disease, the occurrence of dissection, a Thrombolysis In Myocardial Infarction flow grade of 0 before PCI, the absence of tapered-stump arterial structure, and an increase in serum creatinine level or lesion length. In our retrospective, observational study, PCI was successful in a high percentage of chronic total occlusion patients and had a low prevalence of complications. This suggests its safety and effectiveness as a therapeutic option.

Efficacy and safety of higher doses of botulinum toxin type A NT 201 free from complexing proteins in the upper and lower limb spasticity after stroke

Botulinum toxin type A (BTX-A) represents the gold standard therapy for focal spasticity after stroke, with low prevalence of complications, reversibility, and efficacy in reducing spastic hypertonia. Current guidelines suggest the employment of a dosage up to 600units (U) of BTX-A to treat spasticity after stroke, to avoid important adverse effects and the development of antibodies against the neurotoxin. In recent years, NT 201, a new BTX-A free of complexing proteins, has been used for treating several movement disorders, showing safety and efficacy in upper limb spasticity. In a prospective, non-randomized, open-label study, we studied the efficacy and safety of higher doses of BTX-A NT 201 (up to 840U) in 25 consecutive patients with upper and lower limb spasticity after stroke, evaluated at 30 and 90days after injections. Before and after the treatment, the grade of spasticity, the disability, and spasticity-related pain were extensively measured. After 30days of follow-up, a great reduction of spasticity and pain with improvement of disability was observed. The effects were still present at 90days of follow-up. No major adverse events were observed. Higher doses of BTX-A NT 201 appeared to be safe and efficacious in patients with upper and lower limb spasticity after stroke. However, further investigations are needed to determine its reproducibility in larger case series or randomized clinical trials and to observe the absence of antibodies against the neurotoxin also after repeated injections.