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ons to improve access to care and reduce the burden of comorbidities in these populations will confer limb salvage benefits.
Compared with White patients, Black and Hispanic patients had higher 3-year major amputation and reintervention rates. However, mortality was lower for Black patients than for the White patients and similar between Hispanic and White patients. Disparities in amputation and reintervention were partly attributable to differences in demographic characteristics and the higher prevalence of comorbidities in Black and Hispanic patients with CLTI. Future work is necessary to determine whether interventions to improve access to care and reduce the burden of comorbidities in these populations will confer limb salvage benefits.
To explore work-arounds at faith-based obstetrics and gynecology residency programs to accomplish family planning training.
We invited educational stakeholders to participate in telephone interviews that elicited strategies for overcoming barriers to family planning training in religious settings.
Eighteen out of 30 invited programs leaders participated. Work-arounds included reliance on non-contraceptive indications for contraception and permanent contraception provision, obtaining ethics committee approvals for service provision, and developing partnerships with offsite centers for training.
Ob-gyn residency programs affiliated with religious hospitals utilize various work-arounds for family planning training and patient care. These findings may inform other programs that face similar barriers, secondary to institutional or governmental restrictions.
Ob-gyn residency programs affiliated with religious hospitals utilize various work-arounds for family planning training and patient care. These findings may inform other programs that face similar barriers, secondary to institutional or governmental restrictions.
Cerebral hyperperfusion syndrome (CHS) is a rare but serious complication following carotid endarterectomy (CEA). The aim of this study was to identify intraoperative transcranial Doppler (TCD) hemodynamic predictors of CHS after CEA.
Between January 2013 and December 2018, intraoperative TCD monitoring was performed for 969 patients who underwent CEA. The percentage increase in the mean velocity of the middle cerebral artery (MCAV%) at 3 postdeclamping time points (immediately after declamping, 5minutes after declamping, and after suturing the skin) over baseline was compared between CHS and non-CHS patients.
CHS was diagnosed in 31 patients (3.2%), including 11 with intracranial hemorrhage. The MCAV% values at the 3 postdeclamping time points over baseline were 177% (81%-275%), 90% (41%-175%), and 107% (55%-191%) in the CHS group, significantly higher than those in the non-CHS group (40% [14%-75%], 15% [1%-36%], and 18% [3%-41%], respectively, all P<0.001). Receiver operating characteristic curve analysis showed that the 3 intraoperative MCAV% parameters all had excellent accuracy in identifying CHS (areas under the curve 0.854, 0.839, and 0.858, respectively, all P<0.001). The predictive value of the model consisting only of preoperative parameters was significantly increased by adding the intraoperative TCD hemodynamic parameters (area under the curve 0.747 vs. 0.858, P=0.006). Multivariate analyses identified the intraoperative MCAV% immediately after declamping (odds ratio 9.840, 95% confidence interval 2.638-36.696, P<0.001) as an independent predictor of CHS.
Our results indicate that intraoperative TCD monitoring helps predict CHS after CEA at an early stage.
Our results indicate that intraoperative TCD monitoring helps predict CHS after CEA at an early stage.
Middle meningeal artery embolization (MMAE) is a novel approach for treatment of chronic subdural hematoma (cSDH). Studies comparing different procedural techniques for MMAE are lacking. It is unclear whether isolated use of coils results in suboptimal outcomes compared to when particle embolization is also performed. The objectives of this study are to describe the outcomes of coil-only MMAE and comparethem with those of combined use of coils and particles.
A single-institution retrospective study of cSDH cases treated by MMAE was performed. Clinical outcomes, need for rescue surgery, and changes in hematoma's size were compared between the coil-only and coil+particle groups.
Ninety-four hematomas in 78 patients were included. Twelve cases were treated by a coil-only MMAE procedure, often due to presence of dangerous ophthalmic collaterals. No treatment-related complications were observed in the coil-only group. There was no significant difference between the coil-only and coil+particle groups in baseles the technical complexity of the procedure.
This study assesses cervical alignments after 2-level cervical disc arthroplasty (CDA) versus anterior cervical discectomy and fusion (ACDF) with anterior plate fixation.
Eighty-two patients who underwent 2-level CDA or ACDF in 2014-2019 were identified. Cervical alignment parameters were compared between the 2 cohorts. Subgroup analyses were performed to determine factors that differentiate alignment outcomes between the 2 procedures.
Although both cohorts achieved significant focal lordosis (FL) and overall cervical lordotic (CL) gains, CDA cohorts achieved significantly greater 12-month FL gain (P= 0.022). However, in a multivariate analysis controlling for preoperative variables, FL gain was no longer significant. Although the CDA cervical sagittal vertical axis (cSVA) significantly improved at 3 (P= 0.030) and 12 (P= 0.007) months, these improvements were not superior to the ACDF cSVA. Male patients undergoing CDA achieved greater 12-month CL gain. Patients undergoing CDA with body mass index >2 changes in a 2-level operation.
Giant thoracic disk herniations are calcified hernias that fill >40% of the spinal canal and result in myelopathy with associated neurologic symptoms. This is a fairly rare abnormality that requires surgical treatment. Currently, there is no unambiguous opinion about the surgical approach to the treatment for this pathology. It is believed that the most effective method is the anterior approach (minithoracotomy or thoracoscopic approach), which reduces the risks of spinal cord injury but is associated with the risks of damage to the lungs, pleura, and major vessels. A giant thoracic disk herniation is also quite large.
We describe the case of a 60-year-old female patient with a giant thoracic disk herniation. Complete removal of the hernia through a minimally invasive dorsal approach was performed, followed by stabilization. In this case, we used 3-dimensional planning with the help of Surgical Theater, as well as intraoperative neuromonitoring. We also used the ZEISS QEVO, a microinspection tool to aid in resection.
No complications have been registered after the surgery. In this case, surgery resulted in a curative treatment outcome for the patient.
The minimally invasive dorsal approach in the surgery of giant thoracic herniated disks can be successfully used in neurosurgical practice. With this approach, it may be possible to avoid dorsal stabilization, but this requires additional research.
The minimally invasive dorsal approach in the surgery of giant thoracic herniated disks can be successfully used in neurosurgical practice. With this approach, it may be possible to avoid dorsal stabilization, but this requires additional research.
The pathophysiology underlying vertebrobasilar dolichoectasia (VBD) is largely unknown. However, a few reports have demonstrated that acute intramural hematoma (IMH) in VBD is associated with stroke. We aimed to investigate the clinical and radiological features of IMH in VBD and the role of IMH in predicting rupture and patient outcomes.
We retrospectively reviewed the medical records of patients treated in 2 stroke centers between January 2012 and December 2021. Patients presenting with VBD and stroke were eligible for study inclusion. We excluded patients with stroke caused by arterial dissection or artery-to-artery embolism. IMH was defined as a crescent-shaped area of high signal density in the vessel wall on axial computed tomography in the absence of an intimal flap, double lumen, and pearl-and-string sign.
Six patients were analyzed. selleck kinase inhibitor All presented with symptoms of brainstem/cerebellar infarction without headache. Interobserver agreement for the presence or absence of IMH was excellent (100%). IMH was detected in 5 patients. The positive predictive value of IMH for rupture was 80% (95% confidence interval, 28%-99.5%). The median time from symptom onset to rupture was 2.5days (range, 1.5-4). Median computed tomography values were significantly higher within the IMH than those in the lumen of the basilar artery (70 vs. 44.5 Hounsfield units; P=0.008). The modified Rankin scale score on day 30 after onset was 5 in 1 patient and 6 in the remaining5.
IMH in patients with VBD presenting with brainstem/cerebellar infarction should be regarded as a sign associated with a high risk of rupture.
IMH in patients with VBD presenting with brainstem/cerebellar infarction should be regarded as a sign associated with a high risk of rupture.
To describe the characteristics of neurotrophic keratopathy (NK) in the United States.
Retrospective database study.
Thirty-one thousand nine hundred fifteen eyes of 27 483 patients with a diagnosis of NK.
Retrospective analysis of visits associated with a diagnosis of NK between 2013 and 2018 using the American Academy of Ophthalmology Intelligent Research in Sight (IRIS®) Registry.
Demographic information, prevalence, visual acuity (VA), concomitant diagnosis and procedure codes, and risk factors impacting VA most closely after NK onset date.
Mean ± standard deviation (SD) age at initial diagnosis of NK was 68.0 ± 16.0 years, and 58.91% of patients were women (P < 0.0001). Presentation was unilateral in 58.14%, bilateral in 16.13%, and unspecified in 25.73%. Average 6-year prevalence of NK in the IRIS Registry was 21.34 cases per 100 000 patients. Mean ± SD VA was 0.60 ± 0.79 logMAR before diagnosis and 0.88 ± 0.94 logMAR after diagnosis (P < 0.0001). Most common concomitant diagno with other time points. Neurotrophic keratopathy was associated most commonly with herpetic keratitis and diabetes. Worse VA in patients with NK was associated with several demographic characteristics, history of diabetes, corneal transplantation, and herpetic keratitis.
To identify initial, preintervention magnetic resonance imaging (MRI) findings that are predictive of visual and mortality outcomes in acute invasive fungal rhinosinusitis (AIFRS).
Retrospective cohort study.
Patients with histopathologically or microbiologically confirmed AIFRS cared for at a single, tertiary academic institution between January 2000 and February2020.
A retrospective review of MRI scans and clinical records of patients with confirmed diagnosis of AIFRS was performed. For each radiologic characteristic, a modified Poisson regression with robust standard errors was used to estimate the risk ratio for blindness. A multivariate Cox proportional hazards model was used to study AIFRS-specific risk factors associated with mortality.
Identification of initial, preintervention MRI findings associated with visual and mortality outcomes.
The study comprised 78 patients (93 orbits, 63 with unilateral disease and 15 with bilateral disease) with AIFRS. The leading causes of immunosuppression were hematologic malignancy (38%) and diabetes mellitus (36%).
