Medical Treatment Group Research Articles

Is primary hyperparathyroidism a cause of endothelial dysfunction?

Symptomatic primary hyperparathyroidism (PHPT) is thought to be related to increased cardiovascular morbidity and mortality. In our study, we aimed to investigate endothelial dysfunction and markers of subclinical atherosclerosis in patients with PHPT. Also we aimed to demonstrate the effect of vitamin D supplementation on these parameters. Twenty-nine patients followed by medical treatment (A), 25 preoperative (B) and 23 postoperative patients with PHPT (C), and 26 normocalcaemic subjects (D) were included. Groups were assessed by measurements of flow-mediated dilation (FMD), carotid intima-media thickness (CIMT), serum levels of sCD40L, high-sensitivity CRP (hs-CRP) and interleukin-8 (IL-8). Thirteen patients with low levels of 25-hydroxy-vitamin D (25OHD) in the medical treatment group were assessed before and 3months after vitamin D replacement. The median FMD was 5% in group A, 5.1% in group B, 7.6% in group C and 7.7% in group D. The FMD measurement in group A was significantly lower than groups C and D (P=.02) and was similar to the FMD measurement in group B. FMD measurements of group B were not significantly lower than groups C and D. In 13 patients with low 25OHD in group A, the median FMD increased to 7.07% from 4.71% after vitamin D replacement (P=.02). Flow-mediated dilation was impaired in patients with PHPT, particularly in the medically observed group. Vitamin D supplementation seems to provide improvements in FMD in medically observed PHPT patients with low 25OHD levels, and this was the novel observation of our study.

Decompressive Craniectomy in Spontaneous Intracerebral Hemorrhage: ACase-Control Study.

Decompressive craniectomy is performed to relieve intracranial pressure as an emergency procedure. There is no large study to systematically evaluate the benefit of decompressive craniectomy versus best medical therapy. This study evaluates the survival and long-term functional outcomes of decompressive craniectomy for spontaneous intracranial hemorrhage. A total of 54 eligible patients with spontaneous supratentorial hemorrhage (median age, 55 years; interquartile range, 47-64 years) who underwent decompressive craniectomy were retrospectively matched to 72patients managed with best medical treatment (median age, 58 years; interquartile range, 32-74 years). Glasgow Outcome Scale (GOS) scores were dichotomized into favorable and unfavorable outcomes. Survival and functional outcomes were analyzed at discharge, 3, 6, and 12months. Survival in the craniectomy group was significantly higher compared with the medical treatment group at 30 days, 6, and 12 months (76%, 70%, and 70% vs. 60%, 57%, and 52% respectively; all P ≤ 0.05). There was no difference in functional outcomes at discharge, 3, 6, or 12 months after hemorrhage (all P > 0.05). Decompressive craniectomy was associated with longer hospital stay (median of 30 days vs. 7 days in the control group; P<0.001). Hospital adverse events were more frequent in the craniectomy group than in the control group (76% vs. 33%; P < 0.001), the commonest adverse events being pneumonia and urinary tract infections. We showed that decompressive craniectomy significantly improved survival compared with medical treatment with lasting benefits. This improvement came at a cost of increased length of hospital stay and related adverse events. There was no improvement in functional outcome.

Comparison of Metatarsal Head Resection Versus Conservative Care in Treatment of Neuropathic Diabetic Foot Ulcers

Complications from diabetic foot ulcers often lead to increased patient morbidity. Much debate still ensues concerning surgical versus conservative management of neuropathic diabetic foot ulcerations. The present study assessed and compared the efficacy of metatarsal head resection and medical approach in the treatment of neuropathic diabetic foot ulcers located at the plantar surface of metatarsal heads. In a retrospective cohort study, 24 consecutive neuropathic diabetic foot ulcers in the lower area of the metatarsal heads that had undergone metatarsal head resection were included as the operative group. For the control group, we included 25 similar ulcers that were scheduled for medical therapy. With respect to postoperative complications, wound healing occurred earlier in the operative group, and the recurrence rate was inversely greater in the medical treatment group. Also, the hospitalization rate was significantly greater in the medical treatment group. Overall, the long-term complication rate was lower in the operative than in the medical treatment group. Also, the infection rate was greater in the medical treatment group than in the operative group. Comparing early and late clinical outcomes of metatarsal head resection surgery and medical treatment showed complete superiority for the surgical approach, and metatarsal head resection is more completely cost beneficial than the medical approach.

Acute type A dissection in octogenarians: does emergency surgery impact in-hospital outcome or long-term survival?†

Surgical therapy for acute aortic dissection type A (AADA) in octogenarians carries high morbidity and mortality. The role of isolated medical treatment in this setting is controversial. The aim of this study is to determine whether risk of surgery for AADA outweighs risk of death from medical treatment only. From 2002 to 2015, 90 consecutive octogenarians (mean age, 83.5 ± 3 years) were treated for AADA at three institutions: 67 patients underwent surgery, 23 patients received medical treatment. Analysis of early and late outcome was performed. Patients in the medical treatment group were significantly older than in the surgical group (84.9 ± 3.7 vs 83 ± 2.5 years, P = 0.008) and in a more critical state. In patients undergoing surgical repair, perioperative mortality was 14.9% ( n = 10). Rate of prolonged ventilation (63.2% vs 5.9%; P < 0.001) and renal failure (35.1% vs 5.9%, P = 0.029) was significantly higher in the surgical group. Thirty-day survival was impaired in the medical treatment group (34.8% vs 61.2% in the surgical group; P = 0.032). Coronary artery disease (OR 3.95, 95% CI 1.16-13.49; P = 0.029) and complicated dissections (OR 5.28, 95% CI 1.48-18.88; P = 0.010)-composite variable of preoperative resuscitation, neurological injury and malperfusion-emerged as independent risk factors for 30-day mortality in the surgical group. There was no difference in long-term survival. Emergency surgery for AADA in octogenarians is associated with relatively high intraoperative mortality and may reasonably be avoided in patient with complicated presentation. Despite better immediate survival after surgery, long-term survival does not differ between medical and surgical patients, reflecting the extremely advanced point in life cycle octogenarians.

Outcomes analysis of surgical and medical treatments for patients with primary aldosteronism

Patients with aldosterone-producing adenomas are treated using surgery, and patients with idiopathic hyperaldosteronism receive medical treatment using mineralocorticoid receptor antagonists (MRAs). However, the outcomes of surgical and medical treatment for primary aldosteronism (PA) remain unclear. Therefore, we compared the outcomes of surgical and medical treatment for PA and aimed to identify a specific subgroup that might benefit from medical treatment. We identified 269 patients who were treated for PA (unilateral excess: 221 cases; bilateral excess: 48 cases) during 2000-2015 at the Seoul National University Hospital and two other tertiary centers. The main outcomes were the amelioration of hypertension and hypokalemia. Treatment improved hypertension in the surgical treatment group (78.2%) and the medical treatment group (55.6%) (p = 0.001). At the last follow-up, hypokalemia was normalized in the surgical treatment group (97.1%) and the medical treatment group (93.7%, p = 0.046). Among patients with unilateral aldosterone excess, surgery provided advantages in resolving hypertension without worsening renal function. Among patients who were >60 years old or had impaired renal function, surgical and medical treatment provided similar amelioration of hypokalemia and hypertension. Three patients developed hyperkalemia after surgery, and no patients developed hyperkalemia after initiating medical treatment. The surgical treatment group exhibited a lower postoperative estimated glomerular filtration rate (eGFR) and higher serum potassium levels, compared to the medical treatment group. Surgical treatment provided better hypertension and hypokalemia outcomes among patients with PA, compared to medical treatment. However, MRAs may be appropriate for elderly patients with impaired renal function.

Role of Liver Biopsy in Patients With Chronic Hepatitis B Who did not Fulfill the Criteria for Immediate Treatment

AIM: Lebanon is considered recently as a low endemic country for chronic Hepatitis B. The Aim of our study was to know the METAVIR score in patient with chronic hepatitis B and e negative Ag, who didn’t fulfill the local and international treatment criteria, who have HBVDNA > 2000 IU/mL, with normal or slightly elevated ALT level. METHODS: We review all hepatic biopsies done during the last 4 years in patient with chronic Hepatitis B, HBeAg negative, HBV DNA> 2000IU/ml and ALT within normal range. Collected data were classified and distributed according to METAVIR scoring system for fibrosis and activity, then subdivided according to age, sex and all possible associations between inflammation and fibrosis. RESULTS: A total of 248 liver biopsies were seen during this period, only 45 biopsies responded to inclusion criteria. The distribution of liver biopsies related to age show that 64% of patients were between 21 and 40 years old, there is a male predominance. The distribution of liver biopsies related to chronic hepatitis B according to the METAVIR score show that 28.86% had advanced fibrosis (stage F2 or more and/or activity A2 or more). CONCLUSION: This study demonstrate the importance of liver biopsy in patients with chronic hepatitis B, HBeAg negative and show that 29% of this group of population need medical treatment for advanced liver disease.

THE EFFECT OF TOPICAL APPLICATION OF TWO RE-MINERALIZNIG PASTES ON DENTAL ENAMEL EXPOSED TO FARCOLIN, FARCOSOLVIN AND HAEMOJET ORAL

Objectives: The aim of the present in vitro study was to evaluate the effect of “Casein phosphopeptide amorphous calcium phosphate” (MI) and “Casein phosphopeptide amorphous calcium phosphate with fluoride” (MI plus) pastes on dental enamel exposed to three different oral pediatric medications using Vickers microhardness test and scanning electron microscope (SEM).Methods: One hundred extracted caries free human permanent teeth were selected and divided into three groups: group I “control group” untreated teeth; group II “medication group” subjected to oral pediatric medications Farcolin, Farcosolvin and Heamojet ; group III “treatment group” was treated with remineralizing pastes MI and MI plus after exposure to the different medications. Microhardness values were registered and selected specimens were imaged by SEM.Results: There was a statistically significant difference (P<0.01) in microhardness values registered between control group (group I) and medication group (group II) and also between medication group (group II) and treatment group (group III). Images of SEM showed demineralization after usage of pediatric medications and remineralization after usage of remineralizing pastes.Conclusions: The used oral pediatric medications had an erosive effect on the enamel surface, also in an in vitro model the use of a CPP-ACP and CPP-APF pastes had a protective effect on the demineralization of enamel.

Treatment of intracerebellar haemorrhage: Poor outcome and high long-term mortality.

Background:Intracerebellar haemorrhage constitutes around 10% of all spontaneous, non-aneurysmal intracerebral haemorrhages (ICHs) and often carries a grim prognosis. In symptomatic patients, surgical evacuation is usually regarded the standard treatment. Our objective was to compare the in-hospital mortality and functional outcome at hospital discharge in either medically or surgically treated patients, and the impact of either treatment on long-term mortality after a cerebellar ICH.Methods:An observational, retrospective, single-centre consecutive series of 114 patients with cerebellar ICH. We assessed the effect of different demographic factors on functional outcome and in-hospital mortality using logistic regression. We also divided the patients in medical and surgical treatment groups based on how they had been treated and compared the clinical and radiological parameters, in-hospital, and long-term mortality in the different groups.Results:In our series, 38 patients (33.3%) underwent haematoma evacuation and 76 (66.7%) received medical treatment. Glasgow coma scale <8, blocked quadrigeminal cistern, and severe hydrocephalus were associated with in-hospital death or poor functional outcome at discharge (modified Rankin scale 4-6). Surgically treated patients were younger, had larger haematomas both in volume and diameter, were in a worse clinical condition, and suffered more from hydrocephalus and brainstem compression. There were no statistically significant differences in in-hospital or long-term mortality. However, the surgically treated patients remained in a poor clinical condition.Conclusions:Surgical treatment of cerebellar ICH can be life-saving but often leads to a poor functional outcome. New studies are needed on long-term functional outcome after a cerebellar ICH.

Outcomes of Descemet Membrane Endothelial Keratoplasty in Patients With Previous Glaucoma Surgery.

To evaluate outcomes of Descemet membrane endothelial keratoplasty (DMEK) in eyes with previous trabeculectomy or a drainage device. This is a retrospective study of 108 consecutive DMEK performed between October 2013 and December 2015. All eyes were divided into 3 groups: surgical treatment (ST) group, medical treatment (MT) group, and control group. Visual improvement, endothelial cell loss, and postoperative complications, including rejection, graft failure, and intraocular pressure elevation (≥25 mm Hg) were evaluated. The length of follow-up was 9.7 ± 7.3 months. Best-corrected visual acuity (BCVA) improved postoperatively in 85.3% of the ST group, 100% of the MT group, and 93% of the control (P = 0.24). Significantly more lines of BCVA were gained in the ST and MT groups (8.1 ± 8.1 and 9.2 ± 6.3 lines, respectively) than in the control (4.8 ± 5.6 lines, P < 0.05). The mean time to BCVA was 2.9 ± 2.8 months for the ST group, 4.7 ± 5.3 months for the MT group, and 3.0 ± 3.3 months for the control (P = 0.75). Endothelial cell loss was greater in the ST group (44.6 ± 17.8%) than in the MT group (29.9 ± 12.0%) and the control group (32.7 ± 11.3%, P = 0.001). There was one primary failure and no secondary graft failures. The overall rejection rate was 0.9%. Postoperative intraocular pressure elevation was less common in the ST group (14.7%) and control (23.3%) than in the MT group (50.0%, P = 0.04). There was no difference in the air injection rate among all groups (P = 1.0). DMEK in eyes with previous trabeculectomy and drainage device can result in very good short-term outcomes.

The age-related recurrence of endometrioma after conservative surgery

ObjectiveAs endometrioma frequently recurs after conservative surgery, long-term postoperative medical treatment for the prevention of recurrence is necessary. However, it has not been elucidated whether long-term postoperative medical treatment is crucial to all patients until menopause. Thereupon, this study was conducted to evaluate the age-related recurrence patterns after conservative surgery for endometrioma. Study designA retrospective cohort study was performed on a total of 420 reproductive-aged women who underwent conservative surgery for endometrioma between January 2000 and December 2010. Ultrasonography was used during the follow-up period to detect endometrioma recurrence. Patients were classified into two groups according to the use of postoperative medications. The first group was observation only, while the second received gonadotropin releasing hormone agonists followed by cyclic oral contraceptives. The cumulative recurrence rate of endometrioma was compared according to the age at surgery (20–29 years, 30–39 years, 40–45 years) within each group. Subgroup analysis was performed according to the age between the two groups. ResultsThe median follow-up duration after surgery was 29.0 months (range 6–159 months) for all patients. After adjusting for parity, size and bilaterality of cyst, and stage with American Society for Reproductive Medicine classification of endometriosis which was statistically different, within the group of no treatment, the cumulative recurrence rate in 40–45 years (10.2%) was significantly lower compared with those in 20–29 years (43.3%; hazard ratio (HR)=0.04; 95% confidence interval (CI)=0.01–0.52) and 30–39 years (22.5%; HR=0.19; 95% CI=0.04–0.92). However, there were no differences within the group of postoperative medical treatment. When we compared between the two groups, the cumulative recurrence rate was significantly different in 20–29 years (8.1 vs 43.3%; p<0.001) and 30–39 years (5.4 vs 22.5%; p=0.007), but there was no difference in 40–45 years (4.5 vs 10.2%; p=0.901). ConclusionsOur preliminary results demonstrate that the risk of endometrioma recurrence decreases with age. After the age of forty, the recurrence rate does not differ according to the use of postoperative medication. Based on our results, postoperative medical treatment may be individualized according to the patient’s age at the time of surgery. Further studies are needed to identify patients who may benefit from postoperative medication.

Study on Risk Factors, Clinical Presentation &amp; Operative Management of Ectopic Pregnancy

Introduction: Ectopic pregnancy is a major clinical problem in gynaecology because it is often difficult to diagnose as the patient present in different ways. An accurate history taking and physical examination is considered to be most important in the diagnosis of ectopic pregnancy. There are two treatment options, medical or surgical. Surgical treatment is the fastest treatment for ectopic pregnancy though surgical management decreased from approximately 90% to 65%1. Surgery may be the only treatment option if there is internal bleeding. In the medical treatment group, 15% of cases were categorized as failures and required surgery1.Objectives: This study was conducted in the department of obst and Gynae of Dhaka Medical College Hospital from January 2005 to June 2005 in an attempt to find out the risk factors of ectopic pregnancy, the way of presentation and to analyze the operative treatment of ectopic pregnancy.Materials and Methods: A total 50 consecutive patients who were clinically suspicious of ectopic pregnancy were included in this study between January 2005 to June 2005. Patients who were clinically suspicious of EP and also supported by positive urinary pregnancy tests, beta hCG and no intrauterine gestational sac in ultrasonography were included in this study. Detailed discussion about the study was done with the patient and then informed verbal consent was taken from them. Detailed history about patient profile, presenting symptoms, any risk factors and clinical examination done and the findings were recorded in the predesigned data collection sheet. Data was expressed in terms of frequencies and percentagesResults: Most of the patients were in the age group of 20-30 years and 38% of low parity (para- 1).Previous miscarriage, infertility,IUCD users and PID identified as the risk factors of ectopic pregnancy— 42% patients had history of previous abortion or MR, period of infertility 22%, pelvic infection 12%, IUCD users 16%. In this study acute abdominal pain after a short period of amenorrhoea was found to be the main symptoms in ectopic pregnancy—100% patients were presented with lower abdominal pain, 70% with period of amenorrhea and 50% patients with per vaginal bleeding. All the patients were presented with acute condition and were surgically managed fastest treatment. At the time of operation 84% of ectopic tubal pregnancy were found ruptured, 10% were tubal abortion and 4% unruptured. Sites of ectopic pregnancy were ampullary 50%, isthmic 20%, fimbrial 10%.Conclusion: Most of the patient presented in acute condition with the classical features of ruptured ectopic pregnancy. Near half of the patient were in younger age group (26 – 30 years) having risk factors like history of previous abortion/MR 42%, infertility 22% use of IUCD 16%, PID 12%. More then three forth( 84%) of cases were diagnosed as ruptured ectopic during operation. Operative management was done on the basis of site of ectopic and parity of the womanBangladesh J Obstet Gynaecol, 2013; Vol. 28(1) : 9-14

Risk-adjusted treatment selection and outcome of patients with acute cholecystitis.

Age and comorbidities increase the surgical risk for patients with acute cholecystitis and impact on the initial treatment selection. The aim of this article is the implementation of objective risk criteria that may be used to select the most appropriate treatment. We carried out a prospective cohort study of all patients who were admitted to the hospital with a diagnosis of acute cholecystitis during 2014. They were initially allocated to three different treatment groups according to cholecystitis grade, number of days from clinical onset, and surgical risk scores as follows: immediate surgery by sepsis (EmergS), early surgery (EarlyS), or medical treatment group (MedT). Differences in the outcomes between the treatment groups were evaluated using bivariate and logistic regression analyses. A total of 149 patients were admitted; 44% were >80years old and 40% were American Society of Anesthesiologists (ASA)>II. The mortality rate of the series was 0% in EarlyS, 17% in MedT, and 19% in EmergS. The mortality rate was significantly associated with a higher degree of cholecystitis, age, and worse score values in risk scales and Charlson index. Logistic regression identified that the only independent predictors of death at the time of admission were the degree of cholecystitis (OR 2.87, p=0.018) and the Portsmouth Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (P-POSSUM) score (OR 1.14, p=0.001). The evaluation for the initial treatment in acute cholecystitis should include a systematic determination of the degree of cholecystitis and a surgical risk assessment. Tokyo guideline recommendations should be reviewed.

Depression screening and referral in cardiac wards: A 12-month patient trajectory.

Depression is common among patients with coronary heart disease (CHD) and has a major impact on their quality of life, morbidity and mortality. The aim of this study was to map the 12-month psychosocial outcomes of patients with CHD who were screened positive for depression in an acute cardiac ward. A prospective cohort study was conducted of the psychosocial trajectory (depression, anxiety, wellbeing, social support, mental health service access) of 212 patients with CHD who were screened for depression after being admitted to acute cardiac wards of a major metropolitan hospital. Outcomes were assessed before hospital discharge and at one, three, six and 12 months post-discharge. Linear mixed models identified that those patients screened at 'moderate to high' risk of depression at baseline had higher levels of depression ( F(1,173)=53.93, p<0.0001) and anxiety ( F(1,180)=67.01, p<0.001), and lower levels of wellbeing ( F(1,186)=42.47, p<0.001) and social support ( F(1,177)=25.40, p<0.0001), compared to those at 'no to low' risk of depression. Levels of depression and wellbeing remained fairly constant over the 12-month trajectory. Surgical and medical treatment groups were of similar psychological composition over the 12-month period. These findings attest to the effectiveness and predictive validity of a simple nurse-administered screening tool designed to identify depression in hospital patients with CHD and also indicate that a screening and referral tool alone is not sufficient to achieve optimal disease management. A collaborative care model involving family members and integrated pathways to primary care is recommended.

Acupuncture Treatment of Depression in Epilepsy Children and Adolescent’s Parents

Objectives : To assess and compare the effectiveness of acupuncture treatment of depression in epilepsy children and adolescent`s parents. Methods : 20 cases of depression in epilepsy children and adolescent`s parents were investigated in Southern TCM Centre, Southern University College, Malaysia. Subjects were randomly divided into two groups; Acupuncture treatment group and Herbal medication treatment group. Family relationships questionnaires and Hamilton Depression Rating Scale were used before, after 4 weeks and 8 weeks treatments in order to investigate the effectiveness of treatment. Results : After 4 weeks Acupuncture treatment group showed significant reduction in the Hamilton Depression Rating Scale. On the other hand, after 8 weeks both groups showed significant reduction in Hamilton Depression Rating Scale. Conclusions : The result suggests that the effectiveness of Acupuncture treatment is comparable with treat of Herbal medication treatment to reduce parent`s Hamilton Depression Rating Scale.

Role of noninvasive ventilation in decreasing the length of postextubation ICU stay

Respiratory failure after a planned extubation is reported to be a common event, leading to reintubation. These reintubated patients have higher morbidity, mortality, hospitalization charges, and an increased length of hospital stay. The aim of this study was to assess the role of noninvasive ventilation (NIV) in decreasing the length of postextubation ICU stay. Fifty-six patients with respiratory failure type II were included in our study after exclusion of four patients who had self-extubation. Twenty-six patients were allocated to the NIV group and 26 to the control group. Physiological variables of the patients 1 h after the trial were mainly significantly better in the NIV group than in the standard medical treatment (SMT) group. Trial duration was significantly shorter in the NIV group than in the SMT group. This supports the use of NIV early after extubation in all patients regardless of risk for respiratory failure.

Hiperaldosteronismo primário: resultados do primeiro estudo multicêntrico português realizado pelo Grupo de Estudos de Tumores da Supra‐Renal

IntroductionPrimary Aldosteronism (PA) is the most prevalent cause of secondary hypertension. Nevertheless, there is no portuguese multicenter study characterizing PA patients. AimsTo characterize the clinical presentation, diagnostic workup, treatment and follow‐up of patients with confirmed PA. MethodsRetrospective multicenter study of PA patients followed in 9 portuguese hospitals. ResultsSixty‐three cases were selected with a mean age of diagnosis of 52.1±13.1 years, 9.9 years after the diagnosis of hypertension. At presentation, 37 cases (60.7%) had hypertension, 11 (22.9%) had resistant hypertension and 20 (32.8%) of patients had hipokalemia (mean 3.2 mmol/L). Baseline laboratory showed a mean serum aldosterone of 33.4ng/dL, plasmatic renin activity (PRA) of 0.2ng/mL/h with an aldosterone/PRA ratio of 97.1. Confirmatory testing was performed with saline infusion in 55 patients (positive in 84.4%) and captopril test in 14 (positive in 85.7%). Imaging showed adenomas in 55 cases, hyperplasia in 2 and bilateral cases in 8. Arterial venous sampling (AVS) was performed in 9 patients (14,5%) and was conclusive in 1. Iodocholesterol scintigraphy was done in 14 cases (22%) with unilateral fixation in 9 and no fixation in 4. Patients were treated with laparoscopic adrenalectomy in 28 cases (58.3%) and mineralocorticoid receptor antagonists in 20 cases (41.7%). The surgical treated group had less duration of hypertension (8 versus 14 years, p=0.002), higher prevalence of anti‐hypertensive drugs at presentation (100 versus 75% p=0.009) and bigger tumour size (1.8 versus 1.5cm, p=0.022). During follow‐up there was a trend towards a greater proportion of patients with no hypertension improvement in the medical treatment group (29.4% versus 7.4%, p=0.089). ConclusionThis is the first Portuguese PA multicenter study. It suggests that PA remains an under‐diagnosed condition with a significant delay in diagnosis. Surgical treated patients had a more aggressive disease and showed a trend towards better hypertension control.

Subacute Percutaneous Cerebral Balloon Angioplasty for Middle Cerebral Artery Occlusion in Patients with Internal Border Zone Infarcts.

Background We report our initial experiences of subacute percutaneous cerebral balloon angioplasty (PTCBA) for atherothrombotic middle cerebral artery (MCA) occlusion in patients with internal border zone (IBZ) infarcts more than 1 week after stroke onset. Methods Included in the retrospective analysis were patients (1) who were admitted to our institution between 3 and 72 hours after an atherothrombotic stroke onset, (2) whose diffusion-weighted image at admission showed small high-intensity lesions in the IBZ area, (3) whose magnetic resonance angiography at admission displayed the MCA occlusion, (4) whose computed tomography scans on day 7 showed the IBZ infarcts, (5) whose National Institutes of Health Stroke Scale (NIHSS) score was ≥ 10 on day 7, and (6) whose neurologic symptoms deteriorated day by day within 7 days of onset (a > 4-point increase on the NIHSS) despite medical therapy. Results Ten patients met our criteria and were informed of their treatment options including angioplasty and/or stenting for atherothrombotic MCA occlusion in a subacute stroke stage. Four patients gave written informed consent and underwent subacute PTCBA; six did not. Although there were no significant differences in the prestroke modified Rankin Scale (mRS), NIHSS on admission and NIHSS on day 7 after onset between the two groups, 3-month mRS score (median) was 3 in the PTCBA group and 5 in the medical treatment group (p < 0.05). Conclusion Subacute PTCBA for atherothrombotic MCA occlusion may be effective in improving long-term clinical outcome in patients with IBZ infarcts.

Comparison of long-term clinical outcomes of percutaneous coronary intervention in vasospastic angina patients associated with significant coronary artery stenosis

BackgroundCoronary spasm is the major pathophysiology of vasospastic angina (VA). Medical treatment is usually effective in VA patients without significant stenosis. However, there is little information about the percutaneous coronary intervention (PCI) in VA patients with significant coronary artery stenosis (CAS). MethodsAfter retrospective screening of all consecutive VA patients from January 2010 to April 2015, we selected significant CAS (>50% of diameter stenosis) after nitrate injection and divided them into two groups according to the presence of PCI. ResultsA total of 220 VA patients (41 females, mean age: 58±10years old) were screened, and 85 were included in this study. Males were predominant in the VA with significant CAS group (89 vs 76%, p=0.020). PCI was done in 43 patients (51%). The most common culprit coronary artery was the left anterior descending coronary artery (18, 42%), diameter stenosis was significantly higher (66±9 vs 61±10%, p<0.01), and total number of antianginal medication was significantly lower in the PCI group than in the medical group (1.7±0.9 vs 2.1±0.8, p=0.039). Moreover, 4 patients underwent PCI to control symptoms in the medical treatment group during the follow-up period (26±13months). However, additional antiplatelet therapy was necessary in patients with coronary angioplasty, and there were 2 cases with complication associated with angioplasty (1 restenosis and 1 bleeding complication). ConclusionIn VA patients with significant CAS, both treatment modalities showed similar clinical outcomes. Although the PCI can afford symptomatic improvement, it needed additional antiplatelet medications and can be associated with procedural complications.

29 Outcomes of PCI versus medical therapy in a surgically ineligible cohort from a single centre

Introduction There are limited data describing outcomes in patients who have been turned down for surgical revascularisation (CABG) on the basis of prohibitive risk. Methods We analysed cardiovascular outcomes (composite major adverse clinical event rate, MACE: all cause mortality; cardiac death, myocardial infarction, MI; repeat revascularisation; and stroke) in a retrospective cohort of patients turned down for elective CABG who were treated with PCI or medical therapy in a single centre over a 4 year period. Results Higher rates of cognitive impairment, chronic total occlusion, peripheral vascular disease (PVD) and atrial fibrillation were seen in the medical treatment group (n = 117). There was no difference between MACE rates in the PCI (n = 131) and medical groups at 30d however a significant difference emerged in MACE at 1 year, 2 year and 3 years due to a reduction in all cause death, cardiac death and MI in the PCI group. There was no difference between MACE rates in the high SYNTAX tertile, unless cases where residual SYNTAX was greater than 22 were excluded from the analysis. Independent predictors of MACE within the PCI group were SYNTAX score and diabetes, whereas peripheral vascular disease, haemodialysis and left main involvement were all associated with negative outcomes in the medical group. Conclusion Our data suggests a benefit from PCI revascularisation in patients ineligible for surgery at 1 year and a MACE-free survival benefit from PCI up to 3 years in patients within low and intermediate SYNTAX tertiles compared to medical therapy.

Overcoming Disembodiment: The Effect of Movement Therapy on Negative Symptoms in Schizophrenia-A Multicenter Randomized Controlled Trial.

Objective: Negative symptoms of patients with Schizophrenia are resistant to medical treatment or conventional group therapy. Understanding schizophrenia as a form of disembodiment of the self, a number of scientists have argued that the approach of embodiment and associated embodied therapies, such as Dance and Movement Therapy (DMT) or Body Psychotherapy (BPT), may be more suitable to explain the psychopathology underlying the mental illness and to address its symptoms. Hence the present randomized controlled trial (DRKS00009828, http://apps.who.int/trialsearch/) aimed to examine the effectiveness of manualized movement therapy (BPT/DMT) on the negative symptoms of patients with schizophrenia.Method:A total of 68 out-patients with a diagnosis of a schizophrenia spectrum disorder were randomly allocated to either the treatment (n = 44, 20 sessions of BPT/DMT) or the control condition [n = 24, treatment as usual (TAU)]. Changes in negative symptom scores on the Scale for the Assessment of Negative Symptoms (SANS) were analyzed using Analysis of Covariance (ANCOVA) with Simpson-Angus Scale (SAS) scores as covariates in order to control for side effects of antipsychotic medication.Results:After 20 sessions of treatment (BPT/DMT or TAU), patients receiving movement therapy had significantly lower negative symptom scores (SANS total score, blunted affect, attention). Effect sizes were moderate and mean symptom reduction in the treatment group was 20.65%.Conclusion:The study demonstrates that embodied therapies, such as BPT/DMT, are highly effective in the treatment of patients with schizophrenia. Results strongly suggest that BPT/DMT should be embedded in the daily clinical routine.